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CORNELL  UNIVERSITY. 


THE 
THE  GIFT  OF 

ROSWELL  P.  FLOWER 

FOR  THE  USE  OF 

THE  N.   Y.    STATE   VETERINARY  COLLEGE. 

1897 


COHNELL  UNIVERSITY  LIBRARY 


924   104  226  216 


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/cletails/cu31924104226216 


A  TEXT-BOOK 


MATERIA  MEDICA, 


THERAPEUTICS,  AND  PHARMACOLOGY. 


GEORGE  FRANK  BUTLER,  Ph.G,  M.D., 

Professor  of  Materia  Medica  and  Clinical   Medicine   in   the   College   of  Physicians   and  Surgeons, 

Chicago;  Professor  of  Materia  Medica  and  Therapeutics,  Northwestern  University,  Woman's 

Medical  School ;  Attending  Physician   to   Cook   County  Hospital ;    Member  of  the 

American    Medical    Association,    Illinois    State    Medical    Society,    Chicago 

Medical    Society,   Chicago    Pathological    Society,   and    Fellow   of 

the  Chicago  Academy  of  Medicine,  etc.,  etc. 


liEPARTMENT  OF  PHARMACOLOGY. 


Miseris  succurrere  disco. 


PHILADELPHIA  ; 

W.    B.    SAUNDERS, 

925   Walnut   Street. 

1897. 

k 


•>u.  yai5 

Copyright,  1896, 
By  W.    B.    SAUNDERS, 


ELECTBOTYPED    BY  PRESS    OF 

WESTCOTT    &   THOMSON.   PHILADA.  W.    o.    SAUNDERS,  PHILADA. 


TO 


THE  MEDICAL  STUDENTS  OF  THE  UNITED  STATES, 

IN  THE  HOPE  THAT  IT  MAY  AID  THEM  IN  ATTAINING  A  CORRECT 

KNOWLEDGE  OF  THE  NATURE  AND  ACTION   OF  DRUGS 

AND  THE  RATIONAL  TREATMENT  OF  DISEASE, 

^  THIS  WORK    IS   CORDIALLY   INSCRIBED    BY 

THE    AUTHOR. 


■TJk 


PREFACE. 


The  present  work  has  been  undertaken  with  the  immediate 
object  of  supplying  the  student  of  medicine  with  a  clear,  concise, 
and  practical  text-book,  adapted  for  permanent  reference  no  less 
than  for  the  requirements  of  the  class-room. 

The  arrangement — embodying  the  synthetic  classification  of 
•drugs  based  upon  therapeutic  affinities — the  author  believes  to  be 
at  once  the  most  philosophical  and  rational,  as  well  as  that  best 
calculated  to  engage  the  interest  of  those  to  whom  the  academic 
study  of  the  subject  is  wont  to  offer  no  little  perplexity. 

Should  an  intelligent  and  comprehensive  understanding  of 
Materia  Medica  and  Therapeutics  be  facilitated  by  the  author's* 
treatment  of  the  theme,  the  deductions  derived  from  his  experience 
as  a  practitioner  and  instructor  will  not  have  been  committed  to 
print  in  vain. 

Special  attention  has  been  given  to  the  Pharmaceutical  section, 
which  there  is  reason  to  hope  will  be  found  .exceptionally  lucid 
and  complete.  It  has  been  deemed  advisable,  however,  in  the 
general  work  to  include  in  the  descriptive  enumeration  only  such 
drugs  as  experience  has  proved  to  be  of  unquestionable  value 
and  are  of  standard  and  authoritative  acceptance  in  general  prac- 
tice. In  accordance  with  this  plan,  many  new  and  comparatively 
untried  remedies  have  been  omitted,  since,  while  of  established 
efficacy  in  certain  conditions,  they  are  as  yet  too  imperfectly  known 
to  warrant  association  with  remedial  agents  bearing  the  sanction 
of  exhaustive  scrutiny.  So,  too,  a  few  official  drugs  have  been 
excluded  because  they  are  practically  never  used  or  are  employed 
only  in  isolated  instances. 

It  will  be  observed  that  "Untoward  Action"  and  "Poisoning" 

n 


12  PREFACE. 

are  treated  under  separate  heads.  By  the  former  it  is  intended  to 
record  the  effects  of  medicinal  doses  in  developing  certain  symp- 
toms dependent  more  or  less  upon  individual  susceptibility,  not 
necessarily  assuming  the  aggravated  form  incident  to  toxic  doses, 
which  exert  a  definite  influence  regardless  of  idiosyncrasy. 

In  giving  the  careful  Latin  accent  and  quantity  of  medicinal 
nomenclature  (Foster),  so  far  as  practicable  with  the  prosodial 
signs  employed,  the  design  has  been  to  correct  a  prevalent  dis- 
regard of  proper  pronunciation  reflecting  little  credit  upon  those 
to  whom  a  knowledge  of  the  subject  should  be  as  exact  as  it  is 
familiar.  To  the  prescription-writer  the  appropriate  Latin  genitive, 
and  in  a  few  cases  the  accusative,  will  doubtless  afford  valuable 
assistance. 

During  the  preparation  of  the  work  many  important  text- 
books, periodicals,  etc.  have  been  freely  consulted,  and  from  the 
U.  S.  Pharmacopoeia  chiefly,  and  from  the  National  Dispensatory, 
have  been  adopted  almost  verbatim  the  "Origin"  and  "Description 
and  Properties  "  of  the  Various  drugs  under  consideration. 

In  reviewing  the  progress  of  the  present  volume  the  author 
desires  to  express  his  cordial  acknowledgments  to  Prof  Carl  S.  N. 
Hallberg,  Ph.  G.,  whose  exhaustive  contribution  of  "  Weights  and 
Measures"  and  "Pharmaceutical  Preparations"  cannot  fail  to 
lend  permanent  interest  to  the  work ;  to  Dr.  Alfred  C.  Cotton,  Dr. 
Wm.  E.  Quine,  and  Dr.  James  B.  Herrick,  for  friendlj^  suggestions  ; 
to  Dr.  D.  Lee  Shaw,  Dr.  Fred  C.  Zapffe,  and  Dr.  Thomas  J.  Jack- 
son, for  assistance  in  compilation.  To  Mr.  Storrow  Higginson  the 
author's  personal  thanks  are  due  for  his  scholarly  assistance  in 
the  revision  of  the  text. 

G.  F.  B. 
Chicago,  III.,  794  West  Adams  St., 
September,  1896. 


CONTENTS. 


PAGE 

INTRODUCTION 17 

PHARMACOLOGY  AND  GENERAL  THERAPEUTICS 21 

Classification  of  Medicines 24 

Administration  of  Medicines 29 

Definitions 34 

Weights  and  Measures 40 

PHARMACEUTICAL  PREPARATIONS 49 

Solutions    .           51 

Aquse  Medicatse — Medicated  Waters 51 

Liquores — Solutions S  ' 

Spiritus — Spirits 57 

Syrupi — Syrups 58 

Elixiria — Elixirs 64 

Glycerita — Glycerites            71 

Liquid  Mixtures — Internal 72 

Misturse — Mixtures           72 

Emulsa— Emulsions 76 

Extractive  Preparations 79 

Infusa — Infusions 81 

Decocta — Decoctions 82 

Aceta — ^Vinegars 82 

Vina — Wines             82 

Tincturae — Tinctures , 84 

Extracta  Fluida — Fluid  Extracts 90 

Extracta — Extracts 95 

Abstracta — Abstracts 96 

Oleoresin^ — Oleoresins 97 

Resinse — Resins    .    .                98 

Solid  Mixtures  for  Internal  Use 99 

Pulveres — Powders 100 

Sales  Effervescentes — Effervescent  Salts 103 

Confectiones — Confections 104 

Trochisci — Troches  ....            105 

Massae — Masses 106 

Pilulse— Pills 107 

Unofficial  Forms  of  Mixtures  of  Solids  for  Internal  Use 112 

Preparations  for  External  Use 113 

Linimenta — Liniments 114 

Lotiones — Washes 115 

Oleata— Oleates 116 

13 


14  CONTENTS. 

PAGE 

Olea  Infusa— Infused  Oils       .        .  ;. Ii7 

Collodia— Collodions    .    .                    II7 

Unguenta — Ointments nS 

Cerata — Cerates        120 

Suppositoria — Suppositories                     I2t 

Emplastra— Plasters     .    .                            122 

Chartae — Papers , 124 

Poultice  or  Cataplasm  .        .            .  125 

Fomentations     ....            .  125 

Plaster  Mull  .    ,            ....                125 

Bandages,  Antiseptic  Dressings  .    .        .            125 

Medicated  Dressings    ...            126 

Medicated  Cottons        ....                    126 

Medicated  Gauzes — Carbasa                ....  126 

Plaster-of-Paris  Bandages                               .  127 

CLASS  I.— DISEASE  MEDICINES 129 

Division  I. — Restoratives 129 

Group  I. — Digestants      ...              129 

Group  II. — Fats  and  Oils .       .       .  132 

Group  III. — Mineral  Acids                      137 

Group  IV. — Vegetable  Acids           .           146 

Group  V. — Alkalies    .     ,         ....           149 

Group  VI. — Mineral  Waters   ....           .                         .    .  165 

Group  VII. — Bitters    .           .           ...           .                         ...  170 

Simple  Bitters 170 

Aromatic  Bitters 172 

Group  VIII. — Hematics 179 

Animal  Extracts  (Organo-therapy)        217 

Division  II. — Specifics 221 

Serum-therapy  .           .          269 

CLASS  XL— ANTISEPTICS 302 


Aromatics 


Group  I. — Antispasmodics 


Group  III. — Anesthetics 
Group  IV. — Hypnotics 

Group  V. — Narcotics  

Group  VI. — Motor  Excitants  . 
Group  VII. — Motor  Depressants    . 
Bromides  .        .    , 

Group  VIII. — Cardiac  Stimulants  , 
Group  IX. — Cardiac  Sedatives    .   , 

Group  X.' — Diaphoretics 

Group  XI. — Emetics  .   .  . 

Group  XII. — Expectorants    . 
Group  XIII. — Diuretics  . 


357 


CLASS  III.— SYMPTOM  MEDICINES 379 


379 


Group  II. — Antipyretics   ...      388 


396 
410 
427 
464 
498 
527 
534 
576 
592 

599 
614 
628 


CONTENTS.  15 

PAGE 

Group  XIV. — Cathartics .   .  656 

Laxatives 664 

Simple  Purgatives  .  672 

Hydragogue  Purgatives  682 

Salines .  686 

Drastic  Purgatives 689 

Group  XV. — Anthelmintics .  gg^ 

Group  XVI. — Emmenagogues  and  Ecbolics .  702 

Group  XVII. — Astringents 708 

Vegetable  Astringents 710 

Mineral  Astringents 724 

TOPICAL  REMEDIES. 

Group  XVIII. — Caustics  or  Escharotics 754 

Group  XIX. — Vesicants  and  Epispastics  .  761 

Group  XX. — Rubefacients 769 

Group  XXI. — Emollients,  Demulcents,  and  Protective  Agents   .   .    .  771 

PRESCRIPTIONS 782 

INDEX 8ii 


A  TEXT-BOOK 

OF 

MATERIA   MEDICA, 

THERAPEUTICS,  AND  PHARMACOLOGY. 


INTRODUCTION. 


The  history  of  medicine  since  the  time  of  Hippocrates  is  the 
record  of  a  more  or  less  continuous  series  of  experimental  re- 
searches, having  for  their  paramount  object  a  precise  and  compre- 
hensive knowledge  of  the  nature  of  disease  and  the  practical 
application  of  remedial  science.  Regarded  sensu  latiori,  the 
various  "  schools "  which  have  arisen  from  time  to  time  are 
philosophically  co-ordinate,  their  fundamental  principles  being  ref- 
erable to  one  dominating  thought — the  art  of  healing. 

It  is  scarcely  practicable  here,  even  were  it  necessary,  to  review 
in  detail  the  separate  doctrines  which  have  obtained  during  the 
evolution  of  sectarian  therapy.  From  the  earliest  ideas  promul- 
gated by  the  ancient  priests  of  .^sculapius,  through  the  subse- 
quent era  of  Hippocrates,  Theophrastus,  and  the  Alexandrian 
school,  influenced  by  the  crude,  misguided  notions  prevailing  ere 
science  emerged  from  its  infancy ;  discernible  in  the  Galenic  and 
other  tentative  yet  memorable  systems,  in  the  epoch  of  Paracelsus 
and  the  Monastic  Medicine  of  the  Mediaeval  period,  and  in  the 
radical  theories  of  Rasori  and  Roeschlaub  which  attended  the 
development  of  the  last,  and  have  left  a  passing  impress  upon  the 
present,  century, — ^through  all,  the  gradual  acceptamce  of  empiri- 
cism as  a  legitimate  guide  to  therapeutic  truth  is  manifest.  Yet 
viewed  with  reference  to  their  underlying  animus,  these  varied 
expressions  of  scientific  endeavor  distinguishing  the  past  are  per- 
ceptibly linked  with  the  ampler  system  which  has  emanated  from 
the  more  rational  methods  of  modern  research. 

2  17 


l8  A    TEXT-BOOK  OF  MATERIA    MEDICA. 

The  light  of  inductive  reasoning  and  the  marvellous  progress  in 
scientific  knowledge  which  characterize  the  nineteenth  century  are 
a  living  appeal  from  the  idealism  of  a  less  enlightened  age.  The 
release  from  tradition — anticipated  in  the  labors  of  Bichat  and 
others — to  which  later  investigation  owes  so  many  signal  triumphs 
has  doubtless  been  profoundly  affected  by  the  realistic  tendency  of 
modern  thought.  It  is  to  the  startling  advancement  attained  in  the 
natural  sciences,  however,  resulting  in  a  chemical  skill  and  in  me- 
chanical appliances  of  incomparable  value,  that  we  must  look  for 
the  originating  impulse  which  has  inspired  the  therapeutic  know- 
ledge of  the  present  day.  It  needs  but  little  reflection  to  perceive 
the  immeasurable  superiority  of  actual  acquirements  over  the  vague, 
hesitating — though  ardent  and  laborious — methods  to  which  the 
theory  and  practice  of  medicine  were  so  long  subservient. 

We  have  said  that,  considered  in  the  larger  sense,  the  history  of 
medicine  has  been  a  harmonious  rather  than  an  intermittent  devel- 
opment. It  is  not  to  be  supposed  that,  in  the  evolution  of  so 
momentous  a  scheme  as  the  formulation  of  a  remedial  system 
applicable  to  the  extensive  catalogue  of  human  ailments,  there 
should  not  have  occurred  spasmodic  and  ill-adjusted  theories, 
crystallizing  in  many  a  strange  cultus,  which,  if  ineffectual  in 
retarding  the  onward  sweep  of  rational  progress,  has,  it  may  be 
safely  averred,  worked  incalculable  injuiy  to  the  cause  of  medical 
truth.  Mesmerism,  astrology,  spiritualism,  even  theosophy,  how- 
ever incongruously  conjoined,  and  similar  vagaries  have  not  failed 
to  enlist  among  their  votaries  many  enraptured,  even  noted,  be- 
lievers ;  nor  is  the  mental  strabismus  with  which  they  are  afflicted 
amenable  to  any  resource  of  rational  treatment.  We  need,  more- 
over, but  contemplate  the  pitiable  hallucinations  which  urge  the 
pious  pilgrimages  to  Marpingen,  Lourdes,  and  Treves,  and  the 
criminal  negligence  and  incredible  offence  to  reason  which  stultify 
the  so-called  "  Christian  Scientists  "  (as  ironical  a  misnomer  as  lan- 
guage permits),  to  realize  that  miraculous  cures  still  hold  bhghting 
yet  potent  sway  over  the  minds  of  the  ignorant  and  credulous. 
May  not  even  the  assumption  of  thaumaturgical  powers  be  one 
day  possible  with  those  who  arrogate  to  themselves  a  knowledge 
little  short  of  omniscience,  and  to  whose  rudimentary  intelligence 
the  laws  of  nature  convey  no  perceptible  lesson  ?  As  from  the 
sublime  to  the  ridiculous,  so  from  faith  to  fanaticism,  it  is  but  a 
step,  after  all. 

It  is  appropriate   here  to    emphasize  the    unfailing — nay,  ever- 


INTRODUCTION.  19 

increasing — importance  of  therapeutics  in  its  relation  to  the  wel- 
fare of  mankind.  Especially  imperative  is  this  obligation  in  an 
epoch  of  unprecedented  achievement  in  every  department  of  science 
which  contributes  to  the  perfection  of  the  heaUng  art,  in  which 
general  advancement  medicine  has  borne  no  inconspicuous  a  role. 

The  rapid  advance  of  experimental  philosophy,  however,  applied 
to  medical  treatment,  culminating  in  bacteriological  discoveries  of 
signal  value  to  mankind,  and  the  remarkable  triumphs  attending 
the  development  of  operative  surgery,  have  inevitably  tended  to 
disparage  the  equally  noble  and  far  more  widely  cultivated  field  of 
therapeutic  science.  This  result  is  the  more  deplorable  since  it 
creates  in  the  minds  of  the  young  and  inexperienced  an  impression 
of  contrast  and  divergence  in  departments  of  study  naturally  and 
indissolubly  correlated.  It  is  scarcely  surprising  that  the  marvels 
of  the  laboratory  and  the  splendid  achievements  of  the  arena  should 
possess  for  the  tyro  an  entrancing  interest.  Yet  it  is  to  be  borne  in 
mind  that  the  most  brilliant  triumphs  of  diagnostic  and  surgical 
skill  might  prove  futile  as  the  means  of  arresting  disease  were  they 
not  supplemented  by  the  course  of  treatment  which  constitutes 
therapy. 

It  must  be  confessed  that  medical  art  has  too  often  been  dis- 
credited by  professional  incompetence,  and  consequent  failure  to 
effect  the  cure  that  with  the  laity  is  wont  to  form,  however  ignor- 
antly,  the  only  criterion  of  ability.  In  America  especially — where 
from  defective  laws  the  widest  latitude  is  given  to  incapacity  and 
imposture — the  lack  of  proper  academical  training  is  frequently 
the  cause  of  serious  consequences  in  practice,  little  calculated  to 
enhance  the  popular  confidence  and  esteem.  It  therefore  behooves 
the  student  of  medicine  to  master  thoroughly  the  details  of  the 
remedial  art,  become  practically  conversant  with  physiological 
conditions  and  the  manifold  phenomena  of  morbid  anatomy,  and 
so  familiarize  himself  with  the  varying  indications  of  disease  that 
in  the  presence  of  whatever  malady,  his  diagnosis  and  treatrnent 
may  command  respect — not  only  from  the  laity,  but,  what  is  of  far 
more  consequence  to  him,  from  the  profession. 

It  is  almost  superfluous  to  lay  stress  upon  pharmaceutical  know- 
ledge as  a  powerful  weapon  in  the  armament  of  the  medical  prac- 
titioner. Yet  no  branch  of  therapeutic  science  has,  perhaps,  been 
more  neglected  than  a  practical  acquaintance  with  the  nature  and 
uses  of  Materia  Medica,  their  origin,  potency,  and  characteristic 
value,  as  well  as  their  physiological  action,  and  the  incompatible 


20  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

and  synergistic  agents  upon  which  their  efficacy  often  largely 
depends. 

Thanks  to  careful  and  competent  training  among  pharmacists, 
the  skilful  preparation  and  dispensing  of  drugs  relieve  the  physi- 
cian of  much  responsibility ;  yet  he  should  be  keenly  sensible  of 
the  fact  that  the  larger  share  of  public  confidence  is  reposed  in 
him,  and  by  diligent  study  of  the  subject  endeavor  to  command 
the  minutiae  of  pharmacology,  holding  himself  morally  accountable 
for  errors  quite  possible  in  the  druggist's  dispensary.  It  may  not 
be  irrelevant  to  add  that  in  all  medical  procedure  a  sympathetic 
yet  perfectly  controlled  nature,  ready  tact,  and  sterling  common 
sense  are  cardinal  requisites  to  professional  triumph,  it  being  gene- 
rally true,  as  was  long  since  observed  by  Hufeland,  that  "  success- 
ful treatment  requires  only  one-third  science  and  two-thirds  savoir 
faire." 

Finally,  the  author  would  counsel  the  utmost  seriousness  in 
the  pursuit  of  a  calling  which  might  aptly  be  termed  "  Christian 
Science  " — ^the  power  to  alleviate  human  suffering  by  means  of 
curative  agents  with  which  the  laboratory  of  nature  has  been 
mercifully  stored.  There  can  be  no  loftier,  more  practical  mani- 
festation of  love  to  men  than  is  exemplified  in  the  benignant  eiTort 
to  assuage  the  ills  to  which  mortality  is  heir ;  nor  can  any  devotion 
be  more  privileged  and  inspiring  than  that  which  softens  the  shock 
of  disease,  illumines  the  darkness  of  mental  and  physical  distress, 
and  from  the  debris  of  misfortune,  vice,  and  heredity  creates  anew 
the  image  of  divine  perfection.  It  is  this  uplifting,  "consecrated 
zeal,  akin  to  veneration  for  medical  science,  which  has  endeared  to 
the  world  the  masters  of  the  profession — of  which  the  same  wise 
Hufeland  said :  "  To  him  who  fails  to  make  a  religion  of  the  heal- 
ing art  it  is  the  most  cheerless,  wearisome,  and  thankless  labor 
upon  earth ;  indeed,  in  him  it  must  become  the  greatest  frivolity 
and  a  sin."  And  for  those — and  they  are  many — to  whom  the 
material,  possibly  mercenary,  aspect  of  their  task  appeals  unduly 
it  is  enough  to  cite  in  rebuke  the  elevated  maxim  of  Stigelius  : 

Non  omnia  quae  suscipiraus  lucrum  spectant. 


PHARMACOLOGY  AND  GENERAL  THERAPEUTICS. 


Eemedies. — In  a  comprehensive  sense  every  means  of  counter- 
acting, curing,  or  mitigating  disease  or  bodily  disorder  may  be 
termed  a  remedy  or  remedial  agent.  The  mode  of  treatment  may 
be  preventive,  reparative,  or  restorative ;  but  the  agents  employed 
by  the  physician  are  properly  called  remedies.  Although  their 
number  is  wellnigh  as  great  as  the  multifarious  causes  of  disease, 
the  chief  classes  of  remedies  are  comparatively  few,  and  may  be 
grouped  mainly  under  the  following  heads : 

Prophylactic,  whereby  attention  is  directed  to  the  immediate 
environment  of  the  patient,  with  a  view  to  secure  proper  sanita- 
tion and  outward  conditions  more  favorable  to  recovery  sug- 
gested by  hygienic  laws. 

Sanitary,  when  hygienic  treatment  is  combined,  as  it  now 
usually  is,  with  medical  remedies,  constituting  what  is  known  as 
regimen,  including  proper  ventilation,  temperature,  diet,  bathing, 
and  exercise. 

Imponderable,  as  when  the  forces  of  light,  heat,  cold,  and  elec- 
tricity or  magnetism  are  brought  into  requisition  by  the  aid  of 
science. 

Mechanical,  pertaining  to  certain  surgical  methods  and  remedial 
applications,  or  a  course  of  physical  training,  including  the  peculiar 
yet  often  efficacious  treatment  known  as  massage. 

Pharmaceutical,  including  a  very  large  and  varied  class  of 
remedies  which,  from  their  established  curative  properties  and 
their  signal  importance  to  the  physician  (medicus),  are  technically 
termed  medicines.  They  are  designed  to  preserve  or  restore  the 
health  of  the  animal  organism,  promote  recovery  in  cases  of  injury 
or  disease,  and,  in  short,  perform  every  office  proper  to  a  palliative 
or  remedial  agent.  > 

Pharmacology  is,  strictly  speaking,  the  science  which  treats  of 
the  origin,  nature,  chemical  affinities,  and  physiological  action  of 
drugs.     For  the  sake  of  a  clearer  knowledge  of  its  relations  to 

21 


22  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

remedial  treatment,  and  to  facilitate  a  practical  understanding  of  so 
comprehensive  a  subject,  pharmacology  may  be  regarded  as  a 
union  of  two  correlated  themes  of  research : 

Materia  Medica,  which  deals  especially  with  the  sources  from 
which  drugs  are  derived,  their  chemical  and  physical  properties, 
their  constituent  elements,  and  their  general  function  as  substances 
or  agencies  in  the  practice  of  medicine. 

Pltarmacy,  restricted  to  the  analysis  and  determination  of  drugs, 
and  the  science  of  preparing  and  dispensing  medicines  in  the  forms 
in  which  they  are  best  administered. 

Therapeutics  (from  the  Greek  word  meaning  to  attend,  to  serve) 
is  the  science  and  practice  of  selecting  and  applying  remedies  for 
sickness  and  disease,  and  necessarily  includes  the  proper  care  and 
treatment  of  invalids.  "  The  ultimate  aim  of  all  medical  research," 
it  has  been  truly  said,  "  is  the  treatment  and  prevention  of  disease." 
This  constitutes  the  primary  object  of  the  therapeutist. 

In  its  amplest  signification  therapeutics  embraces  all  that  relates 
to  the  science  and  art  of  healing,  and  the  application  not  only  of 
medicines,  but  of  every  remedial  agent  likely  to  accomplish  this 
paramount  motive  of  the  physician's  labor.  Under  the  general 
term  of  therapeutics,  therefore,  are  included  the  action  of  natural 
forces,  the  varied  resources  of  Materia  Medica,  and  the  contingent 
considerations  of  climate,  food,  clothing,  etc.,  grouped  under  two 
principal  divisions : 

Natural  Therapeutics,  being,  as  the  term  implies,  a  curative 
method  dependent  upon  the  laws  of  nature  rather  than  the  sub- 
sidiary arts  of  man. 

Applied  Therapeutics,  including  the  scientific  application  of 
palliative  or  remedial  agents  having  no  counterpart  in  the  living 
organism,  designed,  through  the  art  of  medicinal  administration,  to 
assist  nature  in  the  process  of  restoring  health.  This  division  con- 
stitutes more  properly  the  study  of  therapeutics  and  the  domain  of 
professional  practice. 

Empirical  Therapeutics  implies  the  application  of  remedies  to 
which  experience  has  ascribed  certain  specific  properties  irre- 
spective of  systematic  value.  It  is  not  based  upon  scientific 
research,  but  rather  upon  formulae  established  by  the  accumula- 
tion of  isolated  facts — empiricism — and  practical  observation,  apart 
from  theoretical  reasoning  and  the  relations  of  physiological 
phenomena  as  revealed  by  modern  methods  of  investigation. 
Were  it  possible  to  extend  indefinitely  the  list  of  remedial  agents 


PHARMACOLOGY  AND  GENERAL   THERAPEUTICS.     23 

so  as  to  embrace  the  entire  field  of  therapeutic  knowledge,  the 
empirical  method  might  attain  the  dignity  of  an  exact  science. 
Such,  however,  is  the  complexity  arising  from  the  manifold,  often 
contradictory,  impressions  drawn  from  human  experience  that  for 
the  evolution  of  a  systematic  scheme  of  therapeutics  the  empirical 
system  must  of  necessity  prove  inadequate. 

Rational  Therapeutics  is  based  upon  the  use  of  medicines  in 
accordance  with  a  scientific  knowledge  of  pathology  and  the  physi- 
ological effects  of  remedial  agents.  Here  nothing  is  left  to  chance, 
and  the  nostrums  of  the  older  system  have  but  little  weight  com- 
pared with  the  methods  of  careful  and  intelligent  diagnosis  and  a 
skilful  administration  of  remedies  suggested  by  well-known  and 
accepted  indications  of  disease.  Every  department  of  medical  sci- 
ence has  been  illumined  by  the  light  of  modern  research,  and  the 
chemical  and  physical  properties  of  Materia  Medica  submitted  to 
severe  and  competent  analysis,  that  Rational  Therapeutics  may 
establish  a  system  through  which  the  errors  and  uncertainty  of 
empiricism  may  be  supplanted  by  a  more  stable  and  philosophical 
method,  and  the  chances  of  inaccuracy  minimized.  Through  the 
college  curriculum  and  the  medium  of  professional  intercourse, 
afforded  by  personal  comparison  of  opinions  and  by  innumerable 
publications  throughout  the  world,  the  results  of  scientific  experi- 
mentation are  becoming  widely  diffused  and  the  scope  of  serious 
investigation  constantly  enlarged. 

In  connection  with  this  subject  it  may  be  well  to  call  the  atten- 
tion of  the  student  to  the  technical  signification  of  the  following 
terms : 

Pharmacopoeia  is  the  descriptive  list  of  drugs  and  their  prepara- 
tions recognized  by  the  medical  profession  of  any  locality  or  coun- 
try as  official.  In  foreign  countries  pharmacopoeias  are  issued 
under  government  sanction  and  are  strengthened  by  legal  accept- 
ance. In  the  United  States  the  work  is  published  under  the 
auspices  of  the  medical  and  pharmaceutical  professions,  being 
revised  every  ten  years  by  a  convention  called  for  that  purpose. 
It  may  be  added  that  the  British  Pharmacopoeia  is  in  the  main  in 
conformity  with  that  of  our  own  country.  In  all,  twenty-four 
countries  issue  pharmacopoeias,  while  thirteen  have  none. 

Official — Officinal. — Unnecessary  confusion  appears  to  prevail 
concerning  the  precise  import  of  these  terms.  They  are  readily 
understood  by  reference  to  the  Latin  originals  from  which  they  are 
derived. 


24  A    TEXT-BOOK  OF  MA  TEH  I  A   MEDIC  A. 

Official  drugs  are  those  which  bear  the  stamp  of  professional 
i.e.   official^sanction  (Lat.   officiiim,  authority).     They    are    prac- 
tically ordered  by  the  Pharmacopoeia  to  be  kept  in  all  druggists' 
shops,  the  formuljE  being  supplied  by  the  work  revised  in  decennial 
conventions. 

Officinal  drugs  are  those  prepared  or  kept  by  the  druggist  upon 
his  own  responsibility,  bearing  only  the  authority  of  the  shop  (Lat. 
officina,  a  shop).  Such  preparations  are  often  included  in  works  on 
Materia  Medica,  and,  together  with  those  emanating  from  other 
individual  formula,  are  marked  "  unofficial." 

The  term  "  unofficinal,"  it  will  be  seen,  is  a  solecism ;  and  it  fol- 
lows, moreover,  that  there  are  many  preparations  which  are  in 
pharmacy  officinal,  but  not  official,  and  that  a  pharmacopceial 
formula  cannot  possibly  be  officinal,  although,  speaking  generally, 
all  official  drugs  are  officinal  in  that  they  are  kept  or  prepared  in 
the  druggist's  shop. 

Dispensatory. — This  is  a  compilation  of  and  commentary  on 
one  or  more  pharmacopoeias,  enlarging  the  authoritative  but  re- 
stricted pharmacopceial  formulae  by  including  the  medical  and 
physical  history  of  the  various  substances,  with  directions  regard- 
ing dosage,  together  with  observations  on  their  physiological  action 
and  therapeutics.  It  also  contains  information  concerning  drugs 
not  accepted  by  pharmacopceial  authority,  yet  which  are  of  occa- 
sional use  or  interest.  The  Dispensatory  is  in  effect  a  private  pub- 
lication and  unofficial,  in  this  respect  differing  essentially  from 
a  pharmacopcfiia.  There  are  in  the  United  States  various  works 
of  this  character,  the  United  States  and  National  Dispensatories 
being  commonly  in  use. 


CLASSIFICATION  OF  MEDICINES. 

The  classification  of  drugs  and  remedial  agents  is  a  theme 
regarding  which  the  many  writers  upon  and  teachers  of  medicine 
have  shown  a  wider  diversity  of  opinion,  perhaps,  than  upon  the 
physiological  action  and  medical  uses  of  individual  remedies.  The 
fact  that  therapeutics  is  far  from  being  an  exact  science,  and  the 
rapid  advance  in  our  knowledge  of  normal  physiological  processes, 
of  pathological  conditions,  and  the  systematic  action  of  drugs,  are 
sufficient  explanation  of  the  ever-changing  judgments  of  our 
best  observers  concerning  the  action  of  certain  medicinal  agents 
under  given  conditions. 


CLASSIFICATION  OF  MEDICINES.  25 

It-  follows  that  from  time  to  time,  as  appears  in  reviewing  the 
literature  of  the  subject,  different  writers,  in  their  attempt  to  keep 
pace  with  the  advancement  of  knowledge,  have  devised  various 
systems  of  classification. 

In  earlier  days,  when  the  therapeutist  culled  from  the  fields  his 
simples  for  the  cure  of  disease,  there  was  naturally  created  a  strong 
tendency  toward  a  botanical  classification.  So  far  was  the  system 
pushed  that  in  certain  so-called  schools  of  medicine  the  authority 
of  Scripture  was  invoked,  it  being  proclaimed  as  an  axiom  that 
■"  the  leaves  of  the  tree  were  for  the  healing  of  the  nations  "  (Rev. 
xxii.  2).  The  outgrowth  of  this  eclecticism,  strange  as  it  may 
seem  to-day,  was  the  Thompsonian  or  Botanical  system  of  thera- 
peutics. On  the  other  hand,  as  an  evolution  of  the  old  alchemic 
school,  an  attempt  was  made  to  found  a  classification  by  explaining 
the  remedial  action  of  all  medicines  upon  a  purely  chemical  basis. 

With  the  advent  of  more  modern  methods  of  study,  applied  to 
the  physiological  action  of  drugs  upon  the  animal  economy,  came 
the  physiological  classification,  in  which  the  effects  of  remedial 
agents  were  explained  upon  rational  grounds. 

It  is  hardly  necessary  to  state  that  coexistent  with  these  various 
endeavors  to  attain  a  philosophical  method  of  classification,  com- 
plicating them  and  perplexing  their  votaries,  the  dominating  prin- 
ciple of  empiricism  held  universal  sway,  setting  at  defiance  in  many 
instances  the  cardinal  maxims  of  rational  therapeutics,  the  rational 
therapeutist  even  to-day  welcoming  as  a  last  resort  the  cruder, 
though  often  efficient,  empirical  method. 

Some  authors,  perceiving  the  inutility  of  the  older  systems, 
have  contented  themselves  with  a  mere  alphabetical  arrangement 
of  medicinal  agents,  regardless  of  their  origin,  mode  of  preparation, 
or  physiological  affinities. 

With  due  respect  for  the  many  able  and  worthy  efforts  at 
classification  recorded  in  the  history  of  modern  therapeutics,  the 
author  believes  that  the  main  object  of  classifying  medicinal  reme- 
dies— viz.  to  facilitate  the  retention  of  a  vast  number  of  valuable  yet 
isolated  facts — is  best  accomplished  by  grouping  them  along  the 
lines  of  greatest  practical  utility. 

Remembering  that  the  medical  student  of  to-day  is  animated  by 
an  earnest  effort  to  fit  himself  for  the  noblest  sphere  of  usefulness 
— knowledge  applied  to  the  relief  of  human  suffering — the  author 
holds  that  the  most  philosophical,  as  well  as  practical,  synthesis 
and  comparison  of  remedial  agents,  based  upon  manifest  physical 


26  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

and  physiological  relationships,  will  afford  to  the  pupil  the  widest 
grasp,  from  a  therapeutical  standpoint. 

With  the  object  of  aiding  the  student,  in  accordance  with  this  con- 
viction the  author  has  endeavored  in  this  work  to  give  emphasis  ta 
a  therapeutical  classification,  claiming  for  it  no  especial  originality,' 
but  assured  that  the  method  he  has  selected  is  alike  the  most  judi- 
cious and  the  one  best  calculated  to  respond  to  the  demands  of 
daily,  practical  utility. 

The  thoughtful  and  logical  student  of  medicine  must  realize  that 
there  are  two  great  classes  of  remedial  agents : 

1.  Those  used  in  cases  which  cannot  be  relieved  by  a  single 
dose  of  any  remedy,  but  require  repeated  and  prolonged  admin- 
istration. 

2.  Those  employed  in  cases  which  are  susceptible  of  immediate 
relief  by  the  exhibition  of  a  single  dose. 

The  remedies  employed  for  the  cure  of  the  first  class  of  cases; 
have  been  appropriately  styled  Disease-Medicines — an  unscientific 
term,  perhaps,  yet  useful  to  convey  the  intended  idea,  since  they 
remove  the  cause  of  the  departure  from  normal  physiological  action 
in  the  living  organism — i.  e.  perversion  of  functional  integrity,  or 
disease. 

Upon  reflection  it  will  be  seen  that  remedial  agents  in  the  second 
class  are,  by  the  nature  of  the  case,  designed  for  the  relief  of  some 
manifestation  or  change  in  the  system  or  in  its  functions  indicating 
the  character,  locality,  severity,  etc.  of  a  morbid  process — a  symp- 
tom of  disease.  The  remedies  in  this  class,  therefore,  are  termed 
Symptom-Medicines ,  partly  because  of  their  specific  virtue  in  reliev- 
ing symptoms,  partly  from  the  fact  that  they  produce  certain  mani- 
festations characteristic  of  themselves. 

The  classes  named  might  be  subdivided  ad  infinitum,  yet  it  has 
seemed  advisable  to  the  author,  for  the  sake  of  simplicity,  to  divide 
only  the  first  class,  Disease-Medicines,  including  the  remedial  agents 
employed  therein  under  three  general  heads.  Restoratives,  Specifics, 
and  Antiseptics. 

It  is  obvious  to  every  reflecting  physician  that  a  class  of  reme- 
dies act  as  such  by  supplying  some  deficiency  in  the  animal  organ- 
ism, the  agent  in  such  cases  being  either  itself  the  substance 
lacking,  or  its  analogue,  or  by  its  presence  restoring  the  deficient 
element  or  secretion.     Iron  or  fats,  for  instance,  act  in  certain  forms 

'  This  classification  is  adapted  from  one  formerly  used  by  Prof.  William  N.  Thompson 
of  New  York. 


CLASSIFICA  TION  OF  MEDICINES.  2/ 

of  anemia  in  which  these  ingredients  are  wanting  in  the  red  blood- 
corpuscles;  phosphorus  or  the  earthy  salts  behave  similarly  in 
conditions  where  the  tissues  are  deficient  in  these  necessary  constit- 
uents; and  bitters,  though  not  natural  ingredients  of  the  system, 
act  upon  the  gastro-intestinal  mucous  membrane,  stimulating  the 
glands  to  secrete  a  larger  quantity  of  normal  digestive  fluid. 

In  view  of  the  physiological  action  of  the  remedies  pertaining  to 
this  division,  the- term  Restoratives  so  aptly  expresses  their  general 
character  that  no  apology  is  needed  for  its  adoption. 

The  second  division.  Specifics,  can  be  administered  without 
injurious  results  only  in  diseased  conditions,  in  which  the  particular 
remedy  combats  in  a  specific  and  occult  manner  the  prime  etiologi- 
cal factor  of  the  pathological  derangement. 

These  medicines  act  properly  only  upon  diseased  organisms, 
their  peculiar  effect  never  being  obtained  by  the  exhibition  of  a  sin- 
gle dose,  but  only  after  prolonged  administration.  They  normally 
produce  no  symptoms,  the  patient  being  unaware  of  their  action 
save  by  a  recognition  of  his  gradually  improved  condition. 
Should,  in  fact,  symptoms  occur,  they  should  serve  as  a  warning 
that  the  remedy  is  not  indicated  or  that  the  dose  is  unsuitable  to 
the  condition. 

To  elucidate  this  principle,  the  use  of  morphine  to  allay  the  pain 
of  gout  may  be  cited.  A  single  dose  is  usually  sufficient,  yet  it  is 
not  curative;  while  lithia  acts  as  a  restorative  through  its  well- 
known  solvent  and  eliminative  properties,  reinvigorating  the  circu- 
lation and  by  continued  treatment  curing  the  disease. 

Again,  caffeine  may  be  employed  to  relieve  anemic  neuralgia, 
yet  it  requires  hemic  restoratives  to  alleviate  the  condition  produ- 
cing the  symptoms. 

A  genuine  specific  is  tolerated  only  by  the  system  in  which  it 
antagonizes  some  disease.  For  instance,  A  and  B  are  put  under  a 
prolonged  course  of  mercury :  A  is  salivated  beyond  recognition, 
while  B's  health  improves — simply  for  the  reason  that  B  had 
syphilis,  which  A  had  not. 

At  the  present  day  the  number  of  remedies  which  we  are 
compelled  to  relegate  to  this  class,  Specifics,  for  want  of  accu- 
rate knowledge  regarding  their  modus  operandi,  is  quite  limited. 
Quinine  was  formerly  considered  a  specific  in  malaria,  until  the  fact 
was  recognized  that  the  drug  is  analogous  to  a  normal  constituent 
of  healthy  bile  in  its  action  upon  plasmodia  malariae. 

The  second  great  class  of  agents  to  which  the  name  Symptom- 


28  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Medicines  is  applied  embraces  all  medicinal  substances  which, 
being  introduced  into  the  system,  may  produce  by  a  single  dose 
abrupt  or  serious  disturbances  of  function.  From  the  earliest  his- 
tory of  medicine  they  have  offered  a  tempting  field  to  the  thera- 
peutist, because  of  the  absolute  certainty  of  their  action  in  allaying 
symptoms  or  producing  manifestations  pecuHar  to  themselves.  It 
is  perhaps  superfluous  to  add  that,  owing  to  their  extreme  activity, 
the  greater  number  of  therapeutic  errors  may  be  ascribed  to  their 
use. 

To  the  young  practitioner  the  charm  of  therapeutics  lies  in  that 
•class  of  agents  which  produce  immediate  and  tangible  results. 
These  are  obtained  most  readily  by  the  remedies  affording  instant 
relief  of  prominent  symptoms  of  disease,  such  as  pain,  pyrexia, 
insomnia,  etc.  Yet  the  author  is  here  constrained  to  add  a  word 
of  caution  to  the  amateur  therapeutist,  reminding  him  that,  in  the 
maturer  knowledge  derived  from  subsequent  experience,  he  will 
have  less  to  regret  should  he  confine  his  study  and  practice  to 
physiological  medication — that  is,  to  the  examination  and  adminis- 
tration of  legitimate  restoratives  and  specifics — rather  than  yield  to 
the  allurements  presented  by  the  energetic  action  of  a  large  number 
of  agents  classed  among  Symptom-Medicines. 

The  members  of  this  class  of  remedies  have  been  variously 
divided  and  subdivided  by  different  writers  on  therapeutics. 

Antiseptics  are  classed  among  Disease-Medicines  on  account  of 
their  property  of  restoring  to  their  normal  condition  the  tissues, 
fluids,  and  secretions  of  the  body  by  destroying  the  germs  or 
micro-organisms  which  by  their  presence  excite  pathological 
processes. 

This  great  class.  Antiseptics,  embraces  some  of  our  most  important 
neurotics.  Most  of  them  are  antipyretic,  and  many  of  them  possess 
analgesic  and  hypnotic  properties.  Instance,  chloral,  a  powerful 
antiseptic,  hypnotic,  antipyretic,  and  circulatory  depressant.  Con- 
sidered only  as  an  antiseptic,  it  would  be  classed  as  a  Disease- 
Medicine  ;  clinically,  however,  it  is  used  more  as  a  hypnotic,  and 
therefore  in  this  work  it  is  ranked  as  a  Symptom-Medicine — a 
neurotic  in  the  subdivision  of  Hypnotics. 

Drugs,  in  fact,  exhibit  so  many  different  actions  that  an  arbitrary 
line  of  demarcation  between  them  is  practically  impossible,  the 
author  merely  desiring  to  assign  a  given  remedy  to  the  class  to 
which  its  chief  therapeutic  uses  would  naturally  attribute  it. 

The  principal  use  of  opium,  as  we  know,  is  to  relieve  pain.     It 


ADMINISTRATION  OF  MEDICINES.  29 

is  the  typical  narcotic,  yet  it  possesses  astringent  and  hypnotic 
properties,  and  could  therefore  not  inaptly  be  classed  as  an  astrin- 
gent or  hypnotic. 

It  is  already  a  question  whether  antipyrine  should  not  be  ranked 
in  the  division  of  Analgesics  rather  than  Antipyretics,  since,  while 
formerly  it  was  used  almost  exclusively  for  the  reduction  of  tem- 
perature, we  now  know  it  to  possess  marked  anodyne  properties  - 
so  that  it  is  actually  doubtful  which  is  its  more  important  use — to 
lower  temperature  or  to  relieve  pain. 

These  few  illustrations  serve  to  show  how  varied  are  the  actions 
of  drugs,  and  how  their  several  divisions  overlap  one  another. 
Thus,  the  last  division  of  Disease-Medicines,  Antiseptics,  imme- 
diately precedes  the  first  group  of  Symptom-Medicines,  Antispas- 
modics, so  closely  are  they  allied,  the  last-named  class  possessing 
properties  similar  to  those  of  that  interesting  division  of  Antisep- 
tics—the Aromatics. 

The  next  group,  Antipyretics,  is  logically  followed  by  Anes- 
thetics, and  this  in  turn  by  Hypnotics,  Narcotics,  etc.,  each  group 
being  succeeded  by  the  one  most  closely  resembling  it  in  physio- 
logical and  therapeutic  action.  The  last  group  comprises  the 
Astringents,  classed  under  Symptom-Medicines,  these  agents  occu- 
pying the  borderland  between  external  and  internal  medicines. 

Caustics,  the  first  group  under  topical  remedies,  naturally  follow 
Astringents,  since  they  differ  from  the  latter  drugs  only  in  degree 
perhaps,  as  is  well  shown  in  sulphuric  acid,  which  when  diluted  is 
an  asti-ingent,  but  undiluted  an  active  caustic. 

A  thoughtful  study  of  drugs  as  classified  in  this  work  will,  it  is 
hoped,  enable  the  student  to  become  more  familiar  with  the  com- 
parative value  of  the  various  remedial  agents  than  were  possible 
had  the  author  chosen  an  alphabetical  arrangement,  associating 
remedies  having  no  possible  relationship  either  in  their  actions  or 
their  medical  uses. 


ADMINISTRATION   OF   MEDICINES. 

External  Method  of  Application. — In  order  to  utilize  the 
absorptive  power  of  the  cutaneous  surface  for  therapeutic  pur- 
poses various  methods  have  been  adopted.  The  simplest  of  these, 
though  by  no  means  the  most  successful,  is  by 

Inunction,  which   consists   in   an   outward  application   of  the 


30  A    TEXT-BOOK  OF  MA  TERIA  MEDJCA. 

medicinal  agent,  without  abrasion  of  the  cutis,  and  compulsory 
absorption  through  the  process  of  "  rubbing  in."  The  horny 
epidermis,  however,  presents  an  effectual  barrier  to  the  absorption 
of  many  drugs,  and  the 

Endermic  Method  has  been  found  more  serviceable.  This  plan 
consists-  in  producing,  by  means  of  a  blister,  a  raw  surface,  which 
readily  absorbs  the  medicinal  agent — morphine,  strychnine,  atro- 
pine, quinine,  etc. — with  highly  marked  effect.  The  process  is 
somewhat  painful  and  necessarily  slow  in  action,  being  now  almost 
wholly  superseded  by  the 

Hypodermic  Method. — This  consists  in  injecting  the  drug  into 
the  subcutaneous  tissues  by  means  of  the  hypodermic  needle  and 
syringe.  Since  absorption  bythe  tissues  takes  place  readily,  it  will 
be  seen  that  this  method  of  application  is  far  more  efficacious  than 
those  previously  mentioned.  Not  all  drugs,  it  is  to  be  observed, 
are  available  for  administration  by  the  hypodermic  process  of 
injection.  The  eminent  success  attending  the  operation,  however, 
renders  it  of  signal  value  to  the  physician. 

Parenchymatous  Method. — This  is  a  more  heroic  means  of 
injection,  by  which  the  drug  is  deposited  in  the  corporeal  tissues. 
It  is  said  to  afford  temporary  relief  in  sciatica,  but  for  various 
reasons  is  highly  objectionable,  chiefly  because  of  the  excruciating 
pain  consequent  to  the  operation. 

Intravenous  Injection  may  be  resorted  to  in  desperate  cases  :  its 
dangers  are  obvious,  however,  and,  save  for  the  purpose  of  trans- 
fusion after  severe  hemorrhage,  it  can  seldom  be  attempted  with 
impunity. 

Internal  Administration. — The  most  obvious,  and  by  far  the 
most  useful^  method  of  internal  administration  is  hy  th.Q_inouth  ; 
yet  care  and  discretion  are  to  be  used  even  in  so  ordinaiy  a  process, 
and  the  physician  should  consider  thoughtfully  the  time,  consequent 
effects,  and  chemical  changes,  that  the  drug  may  produce  the  most 
beneficial  results. 

Inhalation  is  in  many  respects  of  the  first  importance  as  a 
method  of  internal  administration.  Its  great  facility  in  practice 
and  its  unquestionable  efficiency — as  in  the  case  of  anesthetics — 
render  it  readily  available  and  highly  beneficial,  although  the 
method  has  attained  as  yet  only  a  limited  use  in  therapeutics- 
beyond  a  resort  to  it  in  pulmonary  diseases. 

Enemata. — A  different  class  of  administrative  operations  consists 
in  injections  into  the  rectum,  which  injections  may  be  purgative. 


ADMINISTRA  TION  OF  MEDICINES.  31 

anodyne,  nutrient,  emollient,  astringent,  anthelmintic,  etc.  For 
speedy  and  efficient  cleansing  of  the  large  intestine  the  purgative 
enema  is  of  incomparable  value,  care  being  taken  that  the  quantity 
of  the  injection  be  sufficient,  that  it  be  passed  up  as  far  as  possible, 
and  that  it  remain  as  long  as  the  patient  is  able  to  retain  it. 

Absorbable  enemata  are  usually  small  in  quantity ;  they  have 
proved  useful  in  certain  cases  of  diarrhea  and  dysentery,  and  are 
serviceable  when  the  act  of  swallowing  is  precluded  by  affections 
of  the  esophagus  or  in  cases  where  the  stomach  requires  complete 
rest.  The  rectum,  however,  possessing  no  digestive  capacity,  the 
injection  should  consist  of  the  simplest  materials  and  contain  pepsin 
and  acid  or  pancreatic  fluid. 

Another  mode  of  securing  beneficial  results  from  internal  admin- 
istration through  the  absorptive  properties  of  the  intestine  is  by 
means  of  suppositories,  readily  introduced  within  the  sphincter  ani 
and  dissolving  at  the  temperature  of  the  body. 

Dosage. — The  term  dose  implies  the  quantity  of  a  medicinal 
agent  which  under  certain  conditions  it  is  advisable  to  administer, 
many  considerations  entering  into  the  question,  to  be  weighed  by 
the  features  of  the  individual  case.  Dosage  may  be  regarded  as 
perhaps  the  most  vulnerable  point  in  therapeutic  science,  yet  one 
upon  which  the  art  of  healing  almost  wholly  depends. 

Since  Heller  in  1755  enunciated  his  philosophical  maxims 
touching  the  rational  method  of  testing  the  therapeutic  effects  of 
drugs,  eminent  clinicians  have  sought  to  solve  the  mysteries  attend- 
ing the  action  of  various  remedies  whose  modus  operandi  remains 
to  this  day  obscure.  Indeed,  so  great  is  the  diversity  of  operation 
pertaining  to  the  commonest  remedies,  conditioned  by  the  character 
and  circumstances  of  the  case,  as  well  as  the  amount  and  quality 
of  the  drug,  that  it  is  next  to  impossible  to  predicate  the  precise 
effects  of  agents  whose  physiological  properties  are  theoretically 
and  even  practically  established. 

The  dose  may  often  determine  the  specific  action  of  a  remedy, 
yet  medicinal  doses  are  specific  as  regards  each  other,  their  true 
action  being  discoverable  only  by  experience.  The  doses  given  in 
many  text-books  differ  materially  from  those  prescribed  in  actual 
practice,  being  intended  to  express  only  the  average  quantities  to 
be  administered,  the  exact  amounts  varying  with  the  conditions  of 
the  particular  case.  These  conditions  may  be  classed  under  the 
heads  of  age,  sex,  temperament,  idiosyncrasy,  habit,  state  of  the 
system,  temperature  of  the  body,  time  of  administration,  intervals 


32  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

between  doses,  cumulative  action  of  the  drug,  and  the  contingent 
considerations  of  diet,  climate,  race,  etc. — oftentimes  a  complicated 
problem  even  to  the  most  skilful  therapeutist.  A  few  suggestions 
regarding  the  leading  characteristics  of  dosage,  as  limited  by  these 
various  circumstances,  may  be  of  value  to  the  student. 

The  influence  exercised  by  Age  is  indubitable,  as  a  rule  the 
young  requiring  smaller  doses  than  adults,  the  aged  being  least 
susceptible  to  therapeutic  impressions.  With  regard  to  children 
several  mathematical  formulae  have  been  devised,  none  being 
infallible,  and  the  best  of  them  based  upon  conditions  of  weight 
and  preconceived  estimates  of  physiological  effects  to  the  detri- 
ment of  other  factors  than  age,  upon  which  infant  development 
largely  depends.  Nor  can  deductions  as  to  the  efficacy  of  a  given 
dose  be  drawn  from  the  action  of  drugs  with  which  the  agent  is 
naturally  associated.  A  single  drop  of  laudanum  has  been  knowrt 
to  produce  the  death  of  a  child,  whereas  large  doses  of  belladonna, 
conium,  arsenic,  and  mercury  have  been  taken  with  impunity. 

The  most  convenient  rule  (Young's)  adds  12  to  the  child's 
age  and  divides  by  the  age  to  get  a  denominator  of  a  fraction 
whose  numerator  is  i,  this  fraction  representing  the  proportion 
between  adult  and  infant  doses.     Thus,  for  a  child  three  years  old 

3  +  12 

— - —  =  5,  or  \,  the  dose  being  one-fifth  of  that  given  to  an  adult. 

Temperament  acts  as  an  important  agent  in  modifying  the  effect 
of  medicinal  remedies,  phlegmatic  subjects  readily  tolerating  cer- 
tain medicines,  such  as  opium,  which  those  of  nervous  temperament 
are  unable  to  bear.  Stimuli  act  upon  sanguineous  patients  forcibly, 
yet  upon  others  their  influence  may  be  either  tardy  or  ineffectual. 
The  condition  is  one  which  discloses  a  wide  field  of  inquiry,  the 
mental,  moral,  and  physical  tendencies  of  the  individual  being 
involved  in  the  practical  administration  of  medicines. 

Closely  allied  to  the  foregoing  is  the  question  of  Idiosyncrasy ,  the 
constitutional  peculiarity  which  exerts  a  subtle  influence,  scarcely 
understood,  as  potent  as  it  is  obscure.  Its  characteristics  cannot 
be  formulated,  but  must  be  studied  with  the  aid  of  experience — an 
odor,  a  taste,  a  casual  or  fixed  impression,  or  hereditary  instinct 
often  determining  their  existence  and  manifestation.  In  tempera- 
ment and  idiosyncrasy,  indeed,  the  psychological  rather  than  the 
physiological  side  of  therapeutics  is  developed,  requiring  for  its 
treatment  a  professional  acumen  not  always  at  command. 

The  influence  of  Habit  is  to  diminish  the  susceptibility  of  the 


ADMINTSTRA  TION  OF  MEDICINES.  33 

organism  to  impressions  which  under  normal  conditions  would  be 
speedy  and  effectual.  Only  by  gradually  increasing  the  quantity 
of  the  dose  can  results  be  obtained  which  in  ordinary  circumstances 
require  few  exhibitions.  Thus,  patients  accustomed  to  the  use  of 
alcoholic  stimulants  accept  heroic  doses  of  alcohol  with  little  or  no 
indication  of  effects  quickly  perceptible  in  temperate  subjects. 

Bodily  condition  obviously  affects  the  action  of  remedial  agents. 
It  is  well  established  that  in  severe  pain  opium  may  be  adminis- 
tered in  quantities  which  in  a  healthy  organism  would  produce 
untoward,  perhaps  fatal,  results.  The  salivation  occasionally  caused 
by  mercury  is  seldom  apparent  in  febrile  conditions.  Yet  in  cases 
where  sensibility  is  diminished  great  care  is  necessary  to  avoid  the 
deleterious  effects  of  over-stimulation  or  excessive  dosage. 

Respecting  Sex,  although  it  is  generally  admitted  that  females 
require  smaller  doses  than  males,  the  exceptions  to  the  rule  are  so 
numerous  as  almost  to  vitiate  the  accepted  theory. 

The  Time  of  Administration  is  closely  connected  with  the  Form 
of  the  Remedy  given,  as  a  rule  remedies  being  withheld  immedi- 
ately before  and  after  meals.  The  practice,  however,  is  subject 
to  modifications,  certain  drugs  acting  best  on  an  empty  stomach, 
and  others,  such  as  local  irritants,  being  more  safely  diffused  when 
the  stomach  is  full,  in  which  case  by  mingling  with  the  food  they 
are  not  brought  into  irritating  contact  with  the  intestinal  mucous 
membranes. 

With  regard  to  Intervals  between  Doses  it  may  be  said,  in  brief, 
that  they  are  to  be  determined  by  the  special  features  of  the  case, 
the  character  and  potency  of  the  drug,  and  the  degree  of  tolerance 
and  assimilation  evidenced  by  the  patient.  Every  remedial  agent, 
under  normal  conditions,  produces  a  specific  and  definite  action, 
the  system  by  absorption  and  elimination  limiting  the  period  of  its 
efficacy  in  cases  of  prolonged  treatment,  so  that  the  drug  is  evi- 
dently to  be  renewed  in  order  to  secure  perfect  results.  Failure  to 
continue  treatment  has  frequently  proved  disastrous,  even  fatal,  to 
the  patient,  and  it  should  be  borne  in  mind  that,  in  the  absence  of 
contraindications  or  untoward  effects,  a  primary  object  of  dosage  is 
to  create  and  maintain  an  impression  upon  the  morbid  system. 
Knowledge  of  therapeutic  action  and  a  thorough  understanding  of 
pathological  conditions  can  best  determine  the  interval  requisite  to 
attain  the  most  beneficial  effect  of  successive  dosage. 

Other  considerations — by  some  therapeutists '  held  to  be  of , 
minor,  by  others  of  paramount,  importance — affect  the  vital  question 

3 


34  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

of  dosage.  The  emotions,  for  example,  play  an  interesting  part  in 
the  toleration  or  rejection  of  remedial  agents.  Strangely  enough, 
too,  the  imaginative  faculty  is  often  a  cause  of  idiosyncrasy,  numer- 
ous instances  being  adduced  by  reputable  authorities  wherein 
either  positive  or  fancied  ills  were  affected  through  the  agency  of 
spurious  remedies — bread-pills,  deceptive  concoctions,  and  the  like 
— the  ethical  aspect  of  therapeutics  being  here  left  to  the  conscience 
of  the  physician. 


DEFINITIONS. 

There  are  certain  general  terms  employed  to  signify  specific 
actions  of  drugs  which  may  properly  be  here  defined. 

Acids. — Salts  of  hydrogen,  of  great  value  in  medicine  and  sur- 
gery. They  are  marked  by  a  high  diffusive  power  when  used 
externally,  and  act  as  depressants  upon  those  glands  whose  normal 
secretion  is  acid,  while  stimulating  those  whose  normal  secretion 
is  alkaline. 

Mineral  acids  act  as  astringents,  and  possess  the  power  of 
arresting  fermentation,  some  of  them  being  characterized  by 
strongly  antiseptic  properties. 

Alteratives. — Medicines  having  the  power  to  produce  favorable 
changes  in  the  system  or  alter  some  abnormal  condition.  They 
are  especially  useful  in  specific  or  chronic  diseases.  Their  modus 
operandi  is  unknown,  and  they  require  time  to  produce  favorable 
results. 

Anesthetics. — Certain  substances  having  the  property  of  de- 
stroying sensation  or  producing  anesthesia,  either  general  or  local. 
Various  alcohols  and  ethers  are  used  for  this  purpose,  the  degree 
of  unconsciousness  being  regulated  by  the  nature  of  the  anesthetic 
and  the  method  of  administration.  The  invaluable  properties  of 
ether  and  chloroform  are  well  known  in  connection  with  operative 
surgery. 

Analgesics  or  Anodynes. — Agents  used  to  reduce  or  efface  the 
sensation  of  pain,  without  necessarily  inducing  stupor,  the  sense  of 
touch  being  usually  unaffected.  In  this  respect  they  offer  a  marked 
difference  from  anesthetics,  which  destroy  all  sensation. 

Anaphrodisiacs. — Agents  whose  action  tends  to  reduce  venereal 
desire  and  sexual  power.  They  act  by  depressing  the  brain-centers 
or  the  spino-genital  center,  or  by  lessening  the  blood-supply  to  the 
genital  organs. 


DEFINITIONS.  35 

Anhydrotics. — Medicinal  agents  employed  to  check  perspira- 
tion, acting  either  upon  the  sweat-glands  and  centers  or  upon  the 
cutaneous  circulation. 

Antacids  or  Alkalies. — Agents  used  to  counteract  acidity, 
neutralizing  the  strongest  acids,  and  with  weak  acids  forming  salts 
'having  alkaline  properties.  When  applied  to  the  ducts  of  glands 
whose  normal  secretion  is  acid,  they  increase  it,  lessening  the 
secretion  from  alkaline  glands.  They  dissolve  albumin,  rendering 
the  blood  more  alkaline,  and  consequently  neutralize  the  acidity 
of  the  urine. 

Antidotes. — Remedies  which  either  counteract  the  effect  of 
poisons  or  by  their  action  serve  to  eliminate  or  destroy  the  poison 
itself. 

Anti-emetics. — Medicines  effecting  a  diminution  of  nausea  and 
vomiting,  either  by  reducing  the  irritability  of  stimulated  centers  or 
by  sedative  action  upon  the  gastric  nerves. 

Antigalactagogues. — Remedies  which  prevent,  reduce,  or  arrest 
the  secretion  of  milk. 

Antilithics  or  Lithontriptios. — ^Agents  found  to  be  efficacious 
in  checking  the  formation  of  urinary  and  biliary  calculi,  or  of  dis- 
solving them  when  formed. 

Antiperiodios. — Medicines  employed  to  prevent  the  periodical 
recurrence  of  paroxysmal  symptoms,  especially  the  attacks  incident 
to  febrile  disorders. 

Antiphlogistics. — Agents  used  to  reduce  inflammation.  The 
term  is  related  to  ancient  practice — the  methods  of  bloodletting, 
depressing  regimen,  etc. — the  remedies  holding  but  a  subordinate 
place  in  modern  therapeutics. 

Antipyretics. — Remedies  designed  for  the  reduction  of  an 
abnormally  high  temperature  of  the  body,  acting  in  various  ways, 
some  of  which  are  still  imperfectly  understood,  the  principal  modes 
of  action  being  (i)  by  limiting  the  production  of  heat,  and  (2)  by 
favoring  the  loss  of  heat. 

Antiseptics. — These  prevent  or  check  putrefaction  and  septic 
infection,  destroying  the  germs  which  produce  them  or  neutralizing 
the  toxic  products  of  these  germs. 

Antisialics. — Medicines  having  the  effect  of  reducing  the  secre- 
tions of  the  salivary  glands  or  checking  salivation.  Certain  drugs 
lessen  reflex  excitability,  while  others  act  through  paralysis  of  the 
nerve-terminals  or  a  reduction  of  the  blood-supply  to  the  salivary 
glands. 


36  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Antispasmodics. — Remedies  used  to  allay  spasms,  whether  the 
muscular  action  be  voluntary  or  involuntary.  They  may  act  as 
stimulants  to  certain  nerve-centers  or  as  depressants  upon  others, 
according  to  the  agent  employed  and  the  nature  of  the  spasmodic 
disorders. 

Antizymotics. — Agents  used  as  preventives  in  zymotic  dis- 
eases, by  arresting  fermentative  development. 

Aphrodisiacs. — Medicines  whose  effect  is  to  stimulate  sexual 
desire  and  power,  acting  either  upon  the  cerebral  or  the  spino- 
genital  center. 

Astringents. — Agents  which  cause  the  contraction  of  living 
tissues,  diminishing  the  amount  of  blood  or  other  fluid  in  them, 
reducing  hemorrhage,  or,  through  constipating  action,  limiting  the 
intestinal  secretions,  as  well  as  those  from  mucous  membranes 
generally. 

Cardiac  Sedatives. — Agents  designed  especially  to  control 
palpitation  or  to  reduce  the  action  of  the  pulse  in  certain  febrile 
conditions.  They  are  employed  to  allay  over-energetic  action  of 
the  heart,  a  hypersystolic  condition. 

Cardiac  Stimulants. — Remedies  acting  upon  the  cardiac  appa- 
ratus in  depressed  conditions,  having  the  specific  effect  of  length- 
ening and  invigorating  the  contraction  of  the  cardiac  muscle, 
increasing  the  force  and  frequency  of  the  heart's  action. 

Cardiac  Tonics. — Properly,  these  agents  act  directly  upon  the 
muscles  of  the  heart,  increasing  its  nutrition  and  giving  tone  both 
to  the  cardiac  muscle  and  to  the  nervous  mechanism  of  the  heart, 
thereby  increasing  its  capacity  for  work. 

Carminatives. — Chiefly  aromatic  agents,  used  for  the  purpose 
of  expelling  gas  from  the  stomach  and  intestines,  correcting 
flatulency. 

Cathartics. — Agents  employed  to  promote  intestinal  evacuations. 
They  are  numerous,  being  divided  into  several  groups  according  to 
their  physiological  effect :  Purgatives,  Laxatives,  etc. 

Cerebral  Depressants. — The  effect  of  these  remedies  is  to 
produce  primarily  cerebral  stimulation,  followed  by  functional  de- 
pression. Among  them  are  included  Narcotics,  Anesthetics,  etc., 
some  of  which,  such  as  chloroform  and  the  like,  should  be  admin- 
istered with  great  care,  lest  their  powerful  action  induce  dangerous 
conditions. 

Cerebral  Excitants. — Medicines  used  to  augment  brain-activity 
without  necessarily  impairing  the  normal  exercise  of  the  cerebral 


DEFINITIONS.  37 

functions.  Their  modtis  operandi  is  through  the  heart — and,  con- 
sequently, the  circulatory  system — or  by  direct  action  upon  the 
brain. 

Ciliary  Excitants. — By  acting  on  the  tracheal  and  bronchial 
cilia  these  agents  assist  the  expectoration  of  bronchial  secretions, 
the  mucus  being  expelled  by  reflex  stimulation  of  the  upper 
respiratory  tract. 

Demulcents. — Drugs  possessing  soothing  properties,  the  local 
action  of  which,  owing  to  their  oily  or  mucilaginous  nature,  is  that 
of  a  sedative  and  protective  to.  the  parts  under  treatment.  Many 
demulcents  appear  to  affect  favorably  remote  portions  of  the  organ- 
ism, since  they  are  frequently  given  internally  to  allay  irritation  of 
the  respiratory,  gastro-intestinal,  and  genito-urinary  tracts. 

Dentifrices. — Various  medicated  powders  or  liquids  used  for 
cleansing  the  teeth  and  gums,  an  excellent  basis  for  the  powders 
being  chalk.  Antiseptics,  as  well  as  stimulants  and  disinfectants, 
are  desirable,  the  lodgement  of  food  frequently  resulting  in  fer- 
mentation and  the  production  of  organic  acids,  with  consequent 
injury  to  the  dentine  (caries). 

Deodorants. — Agents  employed  for  the  destriiction  of  noxious 
gases  and  foul  odors. 

Diaphoretics. — Medicines  intended  to  produce  perspiration, 
affecting  the  sweat-glands  of  the  skin  either  through  local  or  cen- 
tral action  or  by  relaxing  the  cutaneous  blood-vessels.  The  name 
"  sudorifics "  has  been  applied  to  those  agents  causing  profuse 
sweating. 

Diluents. — Agents  which,  being  absorbed,  perform  the  office  of 
diluting  the  excretory  fluids.     Pure  water  is  the  simplest  and  best. 

Disinfectants. — Agents  that  prevent  infection  by  destroying 
the  specific  germs  of  disease  or  rendering  them  innocuous. 

Diuretics. — A  class  of  remedies  tending  to  increase  the  secre- 
tion of  the  kidneys,  thereby  augmenting  the  urinary  flow. 

Emetics. — Agents  which  produce  vomiting,  acting  either  by 
reflex  or  direct  stimulation. 

Emollients. — These  are  medicinal  substances  which  soften  and 
relax  the  tissues  in  topical  applications.  By  relieving  tension  they 
modify  the  pressure  and  guard  the  affected  parts  from  irritation.. 
They  usually,  act  upon  the  skin,  whereas  Demulcents  are  designed 
to  act  upon  the  mucous  membrane. 

Emmenagogues. — Agents  intended  to  restore  or  increase  the 
menstrual  function. 


38  A    TEXT-BOOK  OF  MA  TERIA  MEDIC  A. 

Brrhines  or  Sternutatories. — Remedies  used  to  promote  nasal 
irritation  and  produce  sneezing,  causing  the  discharge  of  mucus. 

Bscharotics  or  Caustics. — Medicinal  agents  possessing  caustic 
properties,  destroying  the  tissue  to  which  they  are  applied  and  pro- 
ducing a  slough. 

Expectorants. — Designed  to  promote  expectoration,  modifying 
and  facilitating  the  expulsion  of  the  bronchial  secretions. 

Galactagogues. — Agents  used  to  increase  the  secretion  of 
milk.  Some  of  them  are  of  doubtful  efficacy,  while  others,  such 
as  the  leaves  of  the  castor-oil  plant,  have  produced  excellent 
results. 

Gastric  Tonics  or  Stomachics. — These  remecijes  are  service- 
able in  aiding  digestion  and  promoting  appetite  and  the  secretion 
of  gastric  juice. 

Hepatic  Depressants. — Intended  to  reduce  the  secretion  of  bile 
in  the  liver  by  lowering  hepatic  activity,  and  thereby  lessening  the 
formation  of  urea  and  glycogen. 

Hepatic  Stimulants. — Agents  employed  to  increase  the  func- 
tional activity  of  the  liver  and  the  formation  of  bile,  urea,  and  gly- 
cogen. Cholagogues  are  generally  regarded  as  synonymous  with 
Hepatic  Stimulants,  but  their  special  office  is  to  remove  the  accu- 
mulated bile  from  the  duodenum,  thus  preventing  its  reabsorption, 
rather  than  for  the  purpose  of  increasing  its  secretion. 

Hypnotics. — Medicines  designed  to  produce  sleep,  in  a  general 
sense  embracing  Anesthetics  and  Narcotics,  yet  lacking  their 
specific  or  analgesic  properties.  Many  agents  are  employed  to 
cause  artificial  sleep  besides  those  classed  under  simple  hypnotics, 
their  efficacy  varying  with  the  mental  and  physiological  condition 
of  the  patient. 

Intestinal  Astringents. — Remedies  used  to  act  upon  the  walls 
of  the  intestines,  reducing  exudation  and  rendering  the  feces  less 
fluid,  or  acting  by  constriction  of  the  intestinal  mucous  membrane. 

Irritants. — Applied  to  the  cutaneous  surface,  these  remedies 
produce  vascular  excitation.  When  the  irritation  occurs  remote 
from  the  seat  of  application  they  are  termed  counter-irritants. 

Ischemics  or  Hemostatics. — Agents  capable  of  arresting  hem- 
orrhage. 

Local  Stimulants. — Agents  which  increase  nervous  sensibility, 
acting  upon  the  nerves  or  stimulating  blood-circulation. 

Local  Sedatives. — Remedies  intended  to  produce  effects  the 
reverse  of  the  foregoing. 


DEFINITIONS.  39 

Local  Anesthetics  or  Anodynes. — Medicines  which  so  lower 
the  susceptibility  of  the  sensory  nerves  that  they  become  incapable 
of  transmitting  impressions.  The  peculiar  property  of  Anesthetics 
is  to  destroy  or  paralyze ;  that  of  Anodynes,  to  temper. 

Motor  Depressants. — Agents  which  reduce  the  activity  of  the 
motor  apparatus  and  spinal  cord. 

Motor  Excitants. — Employed  to  stimulate  the  activity  of  the 
motor  nerves. 

Mydriatics. — Agents  used  to  produce  mydriasis,  or  persistent 
dilatation  of  the  pupil. 

Myotics. — Agents  which  contract  the  pupil. 

Narcotics. — Powerful  agents  which,  acting  on  the  brain,  may 
produce  sleep,  stupor,  coma,  and  death,  the  nerve-centers  being  at 
first  stimulated  and  afterward  paralyzed. 

Oxytocics  or  Bcbolios. — Medicinal  agents  employed  to  con- 
tract the  muscular  fibers  of  the  womb  during  pregnancy. 

Pancreatic  Stimulants. — Remedies  used  to  increase  the  func- 
tional activity  of  the  pancreas. 

Parasiticides. — Lotions  and  ointments  of  drugs  employed  to 
destroy  animal  and  vegetable  parasites  infesting  the  human  body. 

Protectives. — These  are  various  substances,  including  medicinal 
agents,  used  to  protect  injured  surfaces  by  excluding  air,  water,  etc. 

Pulmonary  Sedatives. — Agents  used  to  lessen  irritation  of  the 
respiratory  tract,  reducing  cough  and  dyspnea. 

Refrigerants. — Medicines  employed  to  quench  thirst  and  cool 
the  overheated  system. 

Respiratory  Depressants. — Agents  which  depress  the  action 
of  the  respiratory  center,  resulting  in  slow  and  shallow  respi- 
rations. 

Respiratory  Stimulants. — Agents  which  stimulate  the  respi- 
ratory apparatus,  deepening  and  quickening  the  respirations. 

Restoratives. — Agents  which  act  upon  the  tissues  to  restore 
exhausted  or  impaired  activity,  by  supplying  the  deficiency  through 
dietetic  treatment  or  by  means  of  various  medicinal  resources.  They 
are  natural  ingredients  of  the  system,  or  analogous  to  them,  acting 
directly  or  indirectly  to  restore  or  renew  some  tissue  or  structure 
or  to  sustain  or  increase  some  vital  action. 

Sedatives. — These  remedies  are  of  several  classes,  all  tending 
to  soothe  the  system  by  tempering  functional  activity. 

Sialagogues. — Agents  used  to  promote  secretion  in  the  salivary 
glands,  either  topical  or  general  in  their  action. 


40  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Styptics  and  Hemostatics.— Remedies  designed  to  arrest 
hemorrhage,  Styptics  being  those  applied  externally,  and  Hemo- 
statics those  used  for  internal  administration. 

Uterine  Depressants.— Agents  employed  to  restrain  the  con- 
tractions of  the  gravid  uterus,  thereby  controlling  its  action. 

Uterine  Tonics  and  Alteratives.— Remedies  having,  or  sup- 
posed to  have,  a  specific  influence  upon  the  uterus. 

Vascular  Sedatives.— These  have  the  effect  of  contracting  the 
vessels  and  diminishing  the  circulation.  They  are  useful  in  check- 
ing heniorrhage  and  allaying  local  inflammation. 

Vascular  Stimulants. — Medicines  which  increase  and  equalize 
circulation,  acting  through  dilatation  of  the  cutaneous  vessels  and 
heart-stimulation. 

Vascular  Tonics.— These  tend  to  increase  blood-pressure,  acting 
upon  the  mechanism  of  the  vessels  through  the  vaso-motor  nerves, 
lessening  the  caliber  of  the  arterioles. 

Vesical  Sedatives. — Agents  employed  in  allaying  irritation  of 
the  bladder  and  relieving  pain. 

Vesical  Tonics. — These  increase  the  contractile  force  of  the 
vesical  muscles. 

Urinary  Sedatives  and  Astringents. — Agents  which,  being 
administered  internally,  become  incorporated  with  the  urine,  and 
thus  act  upon  the  entire  urinary  tract.  They  relieve  irritation 
(sedative)  or  diminish  or  check  abnormal  secretion  (astringent), 
the  latter  agents  being  usually  applied  locally  in  the  form  of  an 
injection. 


WEIGHTS  AND   MEASURES. 

The  history  of  Weights  and  Measures  affords  a  striking  example 
of  the  incongruity  resulting  from  the  absence  of  a  uniform  standard 
of  stable  value  to  science,  and  must  be  regarded  as  the  strongest 
argument  in  favor  of  the  Metric,  or  Decimal,  System. 

An  idea  of  the  confusion  prevailing  under  the  old  methods  may 
be  gained  from  an  examination  of  their  comparative  units,  by  which 
we  find  that  a  pint  is  not  a  pound,  an  ounce  not  equal  to  a  fluid- 
ounce,  a  drachm  not  equivalent  to  a  fluidrachm,  and  a  minim  not 
commensurate  with  a  grain.  It  was  not  until  1836  that  the  Secre- 
tary of  the  U.  S.  Treasury  was  directed  by  Congress  to  furnish  each 
State  in  the  Union  with  a  complete  set  of  revised  standards,  includ- 


WEIGHTS  AND  MEASURES.  41 

ing  the  troypound  of  5760  grains,  from  which  the  Apothecaries', 
or  Troy,  weight  is  derived,  the  latter  term  at  present  being  applied 
only  to  the  system  used  in  weighing  precious  metals. 

For  commercial  purposes  the  following  Weights  and  Measures 
are  employed : 

Avoirdupois  Weights:  the  Pound  divided  into  16  Ounces. 

Liquid  Measures :  the  "Wine  Measure,"  of  which  the  U.  S. 
Gallon  represents  a  volume  of  231  cubic  inches;  each  cubic  inch 
of  water  at  the  maximum  density  (4°  C.)  being  equivalent  to 
252.892  grains,  the  weight  of  a  Gallon  being  therefore  58,418 
grains.  The  Gallon  is  divided  into  8  Pints  (octarius),  and  the  Pint 
is  divided  into  16  Fluidounces,  each  containing  8  Fluidrachms, 
or  480  Minims,  the  Fluidrachm  containing  60  Minims.  The  signs 
used  to  designate  these  units  are — TH,,  denoting  minim  or  minims ; 
fS,  fluidrachm  or  fluidrachms ;  and  f S,  fluidounce  or  fluidounces. 

Apothecaries'  (Wine)  Measure. 

20  grains  (gr.  granuni)    =  1  scruple  9  (scrupulum). 
60  grains,  or  3  scruples  =  i  drachm  3  {drachma). 
480  grains,  or  8  drachms  =  i  ounce  3  {uncia). 
5,760  grains,  or  12  ounces  =  i  pound  ft  {libra). 

Apothecaries'  (Troy)  Weight. 

60  minims  (TTl)  =  i  fluidrachm  f  3. 

480  minims,  or  8  fluidrachms   =  i  fluidounce  fg. 
7,680  minims,  or  16  fluidounces  =  I  pint  O  {octarius). 
61,440  minims,  or  8  pints  =  i  gallon  C  {congius). 

This  lack  of  uniformity  in  the  units  and  the  denominations  of 
the  three  systems  of  weights  and  measures  is  exemplified  in  the 
subjoined  table.  While  the  two  weight  systems  have  a  unit  in 
common,  the  grain,  there  is  no  correlation  in  the  higher  denomina- 
tions, ounces  and  pounds.  The  desirability  of  adopting  a  fixed 
standard,  applicable  in  all  cases  where  great  accuracy  in  weights 
and  measures  is  requisite,  has  been  frequently  emphasized  by 
writers  on  therapeutics.  As  we  have  premised,  the  present  diffi- 
culty forms  a  cogent  argument  in  favor  of  the  metric  system,  as 
wisely  adopted  in  the  U.  S.  Pharmacopoeia.  A  remarkable  dis- 
parity is  shown  in  the  liquid  measures,  in  which  there  is  no  unit 
in  common :  a  minim  is  not  a  grain,  nor  "  a  pint  a  pound  the  world 
around." 


42 


A    TEXT-BOOK  OF  MA  TERIA  MEDIC  A. 


Table  of  Apothecaries'  Weight  and  U.  S.  Liquid  Measure,  showing  the 
equivalents  of  the  various  denominations  (by  reading  from  the  left-hand  column 
and  referring  to  headings),  the  weight  equivalent  of  liquid  measures  being  for  water 
at  15°  C. ; 


Symbol. 

Minim. 

Granum. 

Scru- 
pulus. 

Drach- 
ma. 

Fluid- 
drachma. 

Av. 
ounce. 

Fluid- 
uncia. 

Uncia. 

Libra. 

Av. 
pound. 

Octa- 
rius. 

Con- 
gius. 

gr. 
3 
3 
f3 
av.  oz. 
fl.  S 

1 

lb. 

lb.  av. 

0. 
Cong. 

I 
0.95 

60 
480 

7,680, 
61,440 

0.95 
1 

20 
60 
57 
437.5 
456 
4S0 
5,760 
7,000 
7,292 

20 

1 
3 

24 
238 
350 

57 
60 
3 

i 

'% 
96 
1168 

60 
57 

I 

^28 

1,024 

437-5 
I 
16 

480 
4S6 

'% 

■A 

I 

16 
128 

24 
8 

84 

0.9115 

1 
14-58 

288 
96 

ICX) 

I3i 

12 

I 
0.823 

7,000 
350 
Z16 
iioi 
16 

14.58 
1-215 

I 

7,680 
7>3O0 

I 

8 

61,440 
58,400 

1024 
^28. 

3 

I 

Minim. 

Grain. 

Scru- 
ple. 

Drachm. 

Fluid- 
drachm. 

Av. 

oz. 

Fluid- 
ounce. 

Apoth. 

or  Tr. 

oz. 

Apoth. 
orTr. 
pound. 

Av. 

pound. 

Pint. 

Gal- 
lon. 

THE   METRIC   SYSTEM. 

The  Metric  System  of  Weights  and  Measures,  destined  to  sup- 
plant all  others,  originated  with  Prince  de  Talleyrand,  bishop  of 
Autun,  in  1 790.  Its  almost  universal  adoption  by  civilized  nations, 
its  legality,  though  not  compulsion,  in  England  and  the  United 
States,  and  its  adoption  by  the  U.  S.  Pharmacopoeia  of  1890, 
require  that  it  should  be  understood  alike  by  the  physician  and 
the  druggist.  Save  in  the  English-speaking  world  it  is  the  only 
system  used  for  governmental,  statistical,  and  scientific  purposes, 
and  in  the  arts  and  manufactures  its  value  has  long  since  been 
recognized.  Its  extreme  simplicity,  its  uniformity,  and  its  facility  of 
computation  render  it  far  superior  to  any  other  system  of  Weights 
and  Measures,  and  it  is  highly  probable  that  in  the  near  future  it 
will  prevail  in  the  transactions  of  every-day  life,  as  it  has  already 
acquired  international  importance,  and  is  in  fact  referred  to  as  the 
International  System. 

The  starting-point  is  the  unit  of  length,  the  meter  {metre),  which 
'^  the  4uooVQTrTi-  part  of  the  earth's  circumference  around  the  poles.^ 
From   this  apparently  irrelevant  measure  of  length  the  unit  of 

'  In  1806,  Francois  Arago  and  Blot  were  commissioned  by  the  French  government 
to  complete  the  meridional  measurements  interrupted  in  1804.  The  object  of  their 
survey  was  to  determine,  with  as  great  nicety  as  possible,  the  ten-millionth  part  of  a 
quadrant  of  the  meridian  passing  "through  Paris,  which  had  been  chosen  by  the  National 
Convention  as  the  standard  unit  of  length,  and  named  the  niHre.  It  being  impossible  to 
measure  from  the  poles,  an  arc  of  the  meridian,  equalling  a  quadrant,  from  Dunkirk  to 
Barcelona  was  selected,  and  from  their  known  difference  of  latitude  the  entire  length  of 
the  arc  was  deducted. 


WEIGHTS  AND  MEASURES.  43 

capacity,  or  volume,  the  liter,  was  established,  it  being  the  cube  of 
^  of  a  meter.  With  equal  simplicity  and  clearness,  from  the  meter 
was  derived  the  unit  of  weight,  the  gramme,  which  is  the  weight 
of  that  quantity  of  pure  water  at  the  maximum  density,  4°  C. 
(39.2°  F.),  which  will  fill  the  cube  of  ^-^  part  of  a  meter  ^  (cubic 
centimeter). 

The  Metric  is  also  known  as  the  Decimal  System,  because  its 
multiples  and  subdivisions  are  obtained  by  ten  (Lat.  decern).  The 
prefixes  denoting  multiplication  are  of  Greek  derivation,  and  are 
usually  spelled  with  a  capital  letter:  Deka  10,  Hecto  100,  Kilo 
1000,  Myria  10,000.  Division  of  the  units  is  indicated  by  Latin  pre- 
fixes, not  capitalized :  deci  -^,  centi  ■^-^,  milli  y^^.  To  distinguish 
readily  one  process  from  the  other  the  word  GILD  has  been  aptly 
suggested  as  a  mnemonic : 

GILD. 

Greek  increases,  Latin  decreases. 

It  may  be  observed  that,  strangely  enough,  while  we  still  oppose 
the  general  adoption  of  the  Metric  System,  our  enumeration  is 
decimal.  We  count  from  one  to  ten,  and  begin  a  new,  yet  similar, 
series  of  another  ten  units,  and  so  on  indefinitely,.  We  compute 
money  in  dollars,  dimes,  cents,  and  mills,  decimally,  and  our  record 
of  time — years,  decades,  centuries— is  in  harmony  with  decimal 
arithmetic. 

Even  the  provision  of  the  Federal  Constitution  declaring  that  a 
national  census  be  taken  every  ten  years  is  pertinent  as  a  sugges- 
tion of  decimal  convenience ;  and  in  the  period  prescribed  for  the 
State  censuses,  every  five  years,  one-half  of  ten,  there  is  no  great 
deviation  from  the  same  principle  of  utility. 

Contrary  to  a  prevalent  opinion,  the  Metric  System  is  easily 
mastered.  A  perfect  acquaintance  with  the  metric  tables  is,  nat- 
urally, indispensable,  and  the  abbreviations  for  the  different  weights 
and  measures  should  be  thoroughly  at  command.  For  the  rest, 
the  system  is  simply  that  of  arithmetical  decimals,  requiring  chiefly 
a  correct  use  of  the  decimal  point.  Only  a  tyro  would  read  .065 
six  and  five-tenths  hundredths  instead  of  sixty-five  thousandths  ;  so 
Gm.  .065  would  never  be  read  by  one  acquainted  with  decimals 

1  The  unit  of  surface  measure,  the  are,  the  square  of  ten  meters,  and  the  unit  of  the 
solid  measure,  the  stere,  having  the  c'apacity  of  a  cubic  meter,  need  not  claim  the  atten- 
tion of  the  physician  or  the  practical  pharmacist. 


44 


A    TEXT-BOOK  OF  MATERIA  MEDICA. 


six  centigrammes    and  five    milligrammes,   but    sixtyfive 

grammes. 

Metric  Table  of  Lengths. 

lo  millimeters  make  i  centimeter. 


milli- 


lo  centimeters 
lo  decimeters 
lO  Meters 
lo  Dekameters 
lo  Hectometers 
lo  Kilometers 


I  decimeter. 
I  Meter. 
I  Dekameter. 
I  Hectometer. 
I  Kilometer. 
I  Myriameter. 


Abbreviations  for  the  different  divisions  and  multiples  of  the 
Meter  are  herewith  given,  together  with  their  equivalents  in  inches, 
showing  that  the  written  system  depends  wholly  upon  the  place 
of  the  decimal  point,  the  figures  remaining  unchanged.  It  may  be 
noted  that  the  first  abbreviations  cited  are  those  commonly  in  use, 
although  in  certain  cases  the  second  are  preferable : 

Metric  Table  of  Linear  Measure. 
I  millimeter  is  written  I  mm.,  or  M  .001,  equal  in  inches  to        .039370432,  approx.    i. 


I  centimeter         ' 

'       I  cm., 

"  M  .01, 

.39370432, 

0.4. 

I  decimeter           • 

'       I  dm.. 

"  M.I, 

3.9370432, 

"        4- 

I  Meter 

'       iM., 

"  M  I., 

39.370432, 

"      40. 

I  Dekameter         ' 

I  Dm., 

"  M  10., 

393.70432 

X  Hectometer 

I  Hm. 

"  M  100., 

3937.0432 

I  Kilometer           ' 

I  Km., 

"  M  1000., 

"       39370432 

I  Myriameter        ' 

'       I  Mm. 

"  M  1 0000., 

"     393704-32 

The  term  micromillimeter,  one-thousandth  of  a  millimeter 
{0.00000 1 ),  is  used,  especially  in  microscopy,  the  abbreviations 
being  mmm.,  mic,  mkm.,  or  the  Greek  letter  //. 

Metric  Table  of  Capacities. 
10  milliliters  make  i  centiliter. 


10  centiliters 
10  deciliters 
10  Liters 
10  Dekahters 
10  Hectoliters 
10  Kiloliters 


I  deciliter. 
I  Liter. 
I  Dekaliter. 
I  Hectoliter. 
I  Kiloliter. 
I  Myrialiter. 


Abbreviations  for  the  different  divisions  and  multiples  of  the 
Liter,  with  their  corresponding  equivalents  in  minims  or  ounces 
are  as  follows : 


WEIGHTS  AND  MEASURES.  45 

1  milliliter  is  written  I  Cc. '  or  L  .001,  equal  in  minims  to  16.23 


I  centiliter 

" 

I  d. 

"  L  .01, 

(              (( 

162.3 

I  deciliter 

« 

idl. 

"  L.I, 

< 

1623. 

I  Liter 

C( 

I  L. 

"  L  I., 

'        fl.  ounces 

33-814 

I  Decaliter 

" 

I  Dl. 

"  L  10., 

(              (1 

338-14 

I  Hectoliter 

(C 

I  HI. 

"  L  IOC, 

i              it 

3381-4 

I  Kiloliter 

" 

iKl. 

"  L  1000., 

. 

33814- 

I  Myrialiter 

(( 

I  Ml. 

"  L  10000., 

f              « 

338140. 

Metric  Table  of  Weights. 

10  milligrammes  make  i  centigramme. 

10  centigrammes  "  i  decigramme. 

10  decigrammes  "  i  Gramme. 

10  Grammes  "  i  Dekagramme. 

20  Dekagrammes  "  i  Hectogramme. 

10  Hectogrammes  "  i  Kilogramme. 

10  Kilogrammes  "  i  Myriagramme. 

Abbreviations  for  the  different  divisions  and  multiples  of  the 
Gramme,  with  their  corresponding  equivalents  in  grains,  are  as 
follows : 

I  milligramme  is  written  i  ing.,  or  Gm.  .001,  equal  in  grains  to  (^y  .015432 

I  centigramme  "  i  eg.,  "  Gm.  .01,       "  "  (^)             -15432 

I  decigramme  "  1  dg.,  "  Gm.  .1,         "  "  I-S432 

I  Gramme  "  I  Gm.,  "  Gm.  I.,          "  "  15-432 

I  Dekagramme  "  i  Dg.,  "  Gm.  10.,       "  "  154-32 

I  Hectogramme  "  i  Hg.,  "  Gm.  100.,      "  "  '543-2 

I  Kilogramme  "  i  Kg.,  "  Gm.  1000.,    "  "  15432.3 

I  Myri^rarame  "  i  Mg.,  "  Gm.  loooo.,  "  "  154323.4 

METHOD    OF   CONVERTING    METRIC    WEIGHTS,   MEASURES,   AND 
LENGTHS   INTO   THOSE   IN   COMMON   USE,  AND  VICE  VERSA. 
Approximate  Table  of  Weights. 
I    grain  =      ,,0165  Gm.  (65  milligrammes). 

15  J  grains  =        i.      Gm. 

I    drachm  =        3.9    Gm. 

I    troy  ounce      =      31.1    Gm. 

Approximate  Table  of  Capacities. 

I  minim  =  .06  Cc. 

16  minims  =  i.      Cc. 

I  fluidrachm  =  3.75  Cc. 

I  fluidounce  =  30.      Cc. 

1  This  is  designated  by  Cc.  instead  of  Ml,  and  in  practice  only  cubic  centimeters  and 
Liters  are  employed. 


46  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Approximate  Table  of  Lengths. 

I  inch     =    .025  M.  (25  millimeters). 
40  inches  =  i.        M. 

Weights. 

To  Convert  Grains  into  the  Corresponding  Metric  Equivalents. — 
It  has  been  seen  that  i  grain  is  equal  to  Gm.  .065.  In  order,  then, 
to  convert  grains  or  fractions  of  a  grain  into  the  corresponding 
metric  quantity,  we  have  simply  to  multiply  the  number  of  grains 
by  .065. 


2  grains     =         2 

X 

.065, 

or    .130       Gm. 

)0  grains     =      60 

X 

.065, 

"  3.9           Gm. 

\  grain.     =        \ 

of 

.065, 

"     .0325,    Gm. 

T  grain      =    r^ 

of 

.065, 

"     .00065    Gm., 

etc. 

To  Convert  Metric  Quantities  into  their  Equivalent  in  Grains. — 
Instead  of  multiplying  as  above,  divide,  using  the  same  number, 
.065,  as  a  divisor. 

Gm.    .130  =  .130  -^  .065,  or     2    grains. 

Gm.  3.9  =  3.9  -;-  .065,   "  60    grains. 

Gm.    .0325  =  .0325  -i-  .065,   "  .5     grain. 

Gm.    .00065  =  .00065  "^  -065,  "  .01  grain. 

It  follows  that  to  convert  Apothecaries'  drachms  into  Grammes 
we  multiply  the  number  of  drachms  by  3.9,  the  number  of  Grammes 
in  I  drachm  ;  and  to  convert  Grammes  into  Apothecaries'  drachms 
we  divide  the  number  of  Grammes  by  3.9.    . 

The  same  rule  applies  to  the  conversion  of  Apothecaries'  ounces 
into  Grammes  and  Grammes  into  ounces,  the  multiplier  and  divisor 
being  31.1,  the  number  of  Grammes  in  i  ounce. 


Volumes. 


To  convert  minims  into  the  corresponding  metric  equivalents, 
multiply  the  number  or  fractions  of  minims  by  .06,  this  being  the 
equivalent  in  Cc.  of  i  minim ;  and  to  convert  the  metric  quantities 
into  the  corresponding  equivalents  in  minims,  divide  the  metric 
quantity  by  .06.  To  convert  fluidrachms  into  Cc,  multiply  the 
number  of  drachms  by  3.75,  the  number  of  Cc.  in  i  fluidrachm; 
and  to  convert  Cc.  into  fluidrachms,  divide  the  number  of  Cc.  by 
3.75.  To  convert  fluidounces  into  Cc,  multiply  the  number  of 
ounces  by  30.  Cc,  the  equivalent  of  i  fluidounce;  and  to  convert 
^.Cc.  into  fluidounces,  divide  the  number  of  Cc.  by  30. 


WEIGHTS  AND  MEASURES. 


47 


For  convenience  of  i-eady  reference  and  to  facilitate  computa- 
tion the  following  tables  are  subjoined : 


Table  of  Metric  Equivalents 

of  Grains,  Drachms,  Minims,  and  Fluidrachms, 


3 

Grains. 

Milligrams, 
mg. 

Centigrams, 
eg- 

Decigrams, 

dcg. 

Grammes, 
Gm. 

Minims. 

Cubic  centi- 
meters, Cc  . 

I 

Tffir 

0.65 

0.065 

0.0065 

0.00065 

■l\ 

0.8s 

0.085 

0.0085 

0.00085 

iz 

I. 

O.I 

O.OI 

O.OOI 

I 

1-3 

0.13 

0.013 

0.0013 

2-S 

0.25 

0.025 

0.0025 

A 

6.5 

0.65 

0.065 

0.0065 

\ 

13- 

1-3 

0.13 

0.013 

J 

16. 

1.6 

0.16 

0.016 

^ 

32. 

3-2 

0.32 

0.032 

I 

65. 

6.5 

0.65 

0.065 

I 

0.06 

2 

«3- 

1-3 

0.13 

2 

0.12 

3 

20. 

2. 

0.2 

3 

0.18 

4 

25- 

2-S 

0.25 

4 

0.24 

S 

30- 

3- 

0.3 

5 

0-3 

7i 

so. 

S- 

o-S 

8 

o.s 

lO 

65. 

6.S 

0.65 

10 

0.6 

15 

100. 

10. 

I. 

16 

I. 

20 

13- 

1-3 

20 

1.25 

3° 

20. 

2. 

32 

2. 

■.5J 

6o 

40. 

4- 

60 

3-75 

f3J 

lOO 

65. 

6.5 

100 

6. 

3y 

120 

80. 

8. 

120 

7-S 

fgy 

150 

100. 

10. 

150 

9- 

S'ij 

180 
200 

12. 
13- 

180 
200 

11.25 

12. 

fSiiJ 

-3'v 

240 

16. 

240 

IS- 

feiv 

3^ 

300 

20. 

300 

18. 

fgv 

3vj 

360 
400 

24. 
26. 

360 
400 

22.5 
24- 

fsri 

3vy 

420 

45° 

28. 
30- 

420 
450 

26.25 
27- 

f^vij 

gj 

480 

32. 

480 

3°- 

f|j 

Equivalents. 
Various  methods  have  been  proposed  for  adapting  the  metric 
weights  to  our  apothecaries'  weights  used  in  prescription  writing 
without  entailing  calculations  in  fractions.  The  method  of  taking 
32  Grammes  as  equivalent  to  one  troy  ounce,  and  30  Cc,  or  fluid 
Grammes,  as  equal  to  one  fluidounce,  seems  to  be  the  least  objec- 
tionable.    These  equivalents  are  shown  in  the  following : 


32  Gm.  =  I  ounce ;  32  -h 

30  Cc.    =  I  fluidounce ;  30  ^ 


i  =  4.      Gm.  =  I  drachm. 
—  375  Cc.    =  I  fluidrachm. 


The  exact  metric  equivalent  of  i  grain  is  obtained  by  dividing 
the  unit  by  the  Gramme  equivalent  in  grains;  thus,  i.  -^  15-432  = 
•0.0648  Gramme  (or  6|-  centigrammes). 


48 


A    TEXT-BOOK  OF  MATERIA    MEDIC  A. 


The  metric  equivalents  of  all  the  other  denominations  may  be 
obtained  by  multiplying  the  grain  equivalent  by  the  number  of 
grains  in  one  drachm  ;  the  number  of  drachms  in  a  troy  ounce,  etc. 
The  following  exact  Gramme  equivalents  are  thus  obtained : 

I  grain.        i  drachm,     i  ounce  av.     i  ounce  troy.       i  H)  troy.  i  R)  av. 

0.0648  3.888  28.349  3>io3  373-250  453-592 

To  convert  avoirdupois  or  troy  into  metric  weights,  the  equiva- 
lent of  the  Gramme  in  grains — 1 5 .432 — should  be  remembered,  as  it 
serves  the  purpose  of  a  basis  for  obtaining  the  equivalent  of  all  the 
higher  denominations. 


Table  of  Metric  Equivalents 

of  Ounces  (Apoth.,  Av.^and  Fluid)  in  Grammes  and  Cubic  Centimeters. 

Ounces, 

I 

Grammes, 

Fluidounces. 

Cubic  centimeters. 

Exact 

Apoth., 

Grs. 

Gm.  or  G. 

f3 

Cm.  or  Cc. 

equivalents. 

I 

31 

I 

30 

29-57 

2 

62 

2 

60 

59-15 

3 

93 

3  „ 

90 

88.72 

3 

103 

100 

3-38 

100 

4 

124 

4 

120 

"8.3 

5 

155 

5 

150 

147-87 

6 

186 

6 

180 

177-44 

7 

• 

217 

7 

210 

207.01 

8 

248 

8 

240 

236-59 

8 

18 

250 

8-45 

250 

9 

' 

280 

9 

270 

266.16 

10 

311 

10 

300 

295-73 

II 

342 

II 

33° 

325-31 

I  R> 

12 

373 

12 

360 

354-88 

453-6 

I  pt.    16 

'7A 

.480 
"500 

493-18 

Av. 

Ounces. 

Grs. 

lib 

16 

17 

278 

500. 

20 

.600 

591-47 

20 

566.8 

24 

■720 

709.77 

24 

680. 

2pt.     32 

960 

946-35 

28 

793-2 

34  A 

1000 

2  R) 

32 

'   907-25 

3pt.    48 

1440 

1419. 

35  • 

120 

1000. 

4pt.    64 

1920 

1892.71 

3ft 

48 

1360. 

68  A 

2000 

4  ib 

64 

1814.S 

5  pt.    80 

2400 

2365.9 

70 

240 

2000. 

100 

3000 

2957-37 

5ft 

80 
100 

2268 
2835 

I  gal.  128 

3840 

3785.43 

10  lb 

160 

4536 

It  will  be  noted  that  in  the  Pharmacopoeia  of  1 890  the  Gramme 
(Gm.)  and  the  Cubic  Centimeter  (Cc.)  are  the  only  metrical  terms 
used.  The  reason  of  this  is  simply  that  these  two  terms  express 
sufficiently  the  quantities  ordinarily  handled,  the  remaining  ones 
being  excluded  to  avoid  confusion,  Grammes  and  Cubic  Centi- 
meters standing  as  perfect  equivalents  of  ordinary  weights  and 
measures,  as  the  foregoing  tables  indicate. 


PHARMACEUTICAL  PREPARATIONS.  49 


PHARMACEUTICAL  PREPARATIONS. 

Preparations  made  by  the  pharmacist  are  called  pharmaceutical 
preparations.  Nearly  one-half  of  the  articles  of  the  United  States 
Pharmacopoeia  are  pharmaceutical ;  formulas  being  given  for  their 
preparation,  they  are  intended  to  be  made  in  the  pharmacy.  A 
still  greater  number  are  unofficial,  being  chiefly  such  as  are  made 
according  to  the  formulas  or  prescriptions  of  eminent  medical 
practitioners  and  teachers.  Such  of  the  latter  as  have  attained 
general  use  and  proved  of  value  have  been  incorporated  in  the 
National  Formulary,  a  work  pubhshed  under  the  direction  of  the 
American  Pharmaceutical  Association. 

The  importance  of  having  a  uniform  standard  for  the  prepara- 
tion and  strength  of  this  class  of  medicines  has  long  been  recog- 
nized, instead  of  the  variation  in  strength  and  product  inseparable 
from  a  number  of  manufactures  with  the  consequent  multiplicity  in 
processes  and  formulas.  These  preparations  of  the  National  For- 
mulary, designated  N.  F.,  are  included  in  this  work,  following  the 
official  preparations  (U.  S.  P.)  of  the  classes  to  which  they  belong. 

The  pharmaceutical  preparations  may  be  divided  as  follows  : 

I.  Solutions. 

II.  Liquid  Mixtui'es — Internal. 

III.  Extractive  Preparations — Liquid  and  Solid. 

IV.  Mixtures  of  Solids — Internal. 

V.  Mixtures  for  External  Use^ — Liquids  and  Solids. 

These  groups  are  each  divided  into  a  number  of  Classes,  each 
class  having  a  distinct  Latin  title  by  which  its  members,  or  indi- 
vidual preparations,  are  officially  designated  and  alphabetically 
arranged  in  the  U.  S.  P.  In  addition  to  the  Latin  and  English 
titles,  each  class  is  also  known  by  an  English  name,  besides  various 
synonyms.     There   are   altogether   34   of   these   Classes   official, 

besides  a  number  unofficial.  official 

number. 
I.  The  Solutions  are  divided,  according  to  the  charac- 
ter of  the  solvent,  into — 

Aqueous:  Aquae — Waters 19 

Liquores — Liquors  (solutions  proper) 24 

Alcoholic:  Spiritus — Spirits 25 

Elixiria — Elixirs 2 

Vina — Wines  (by  solution) 3 

4 


50  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Official  number. 

Saccharine:  Syrupi — Syrups 32 

Mellita — Honeys 2 

Glycerin :  Glycerita — Glycerites 6 

II.  The  Liquid  Mixtures — Internal : 

Misturae — Mixtures  (proper) 4 

Emulsa — Emulsions 4 

III.  Extractive  Preparations : 

Liquid  : 

Aqueous  :  Mucilagines — Mucilages 4 

Infusa — Infusions 4 

Decocta — Decoctions 2 

Acetous :  Aceta — Vinegars 2 

Vinous:  Vina — Wines       5 

Alcoholic:  Tincturae — Tinctures 71 

Extracta  Fluida — Fluid  Extracts 89 

Solid: 

Alcoholic:  Extracta — Extracts 33 

Abstracts  (unofficial). 

Resinae — Resins 3 

Semi-liquid : 

Ethereal:  Oleoresinse — Oleoresins 6 

IV.  Mixtures  of  Solids — Internal : 

Pulveres — Powders 9 

Trituratio — Trituration i 

Sales  effervescentes — Salts,  effervescent  ....  4 

Confectiones — Confections 2 

Trochisci — Troches 15 

Massse — Masses 3 

Pilulse— Pills IS 

V.  Mixtures  of  Solids — External : 

Liquid:  Linimenta — Liniments 9 

Oleata — Oleates 3 

Collodia — Collodions 4 

Solid:  U-nguenta — Ointments 23 

Cerata — Cerates 6 

Suppositoria — Suppositories i 

Emplastra — Plasters 13 

Chartae — Papers 2 

Total ^ 


PHARMACEUTICAL  PREPARATIONS.  51 

AQU^  MEDICATE— MEDICATED  WATERS. 

The  Medicated  Waters  are  solutions  of  volatile  substances  in 
Water.  They  comprise  (i)  the  Aromatic  Waters  and  (2)  the 
Chemical  Waters. 

The  Aromatic  Waters  are  made  by  dissolving  the  volatile  oils 
of  their  respective  drugs,  or  distilling  the  latter  with  Water ;  two 
Waters  are  saturated  solutions  of  other  liquids  than  volatile  oils — 
viz.  Aqua  Chloroformi  and  Aqua  Creosoti. 

The  following  are  official : 

Contains  Cc.  in  /oo  Cc, 
Aqua —  or  percentage  by  volume. 

Amygdalae  Amarae bitter  almond  oil  o.l 

Anisi , anise  oil  0.2 

Aurantii  Florum  Fortior saturated 

Aurantii  Florum of  the  above  50. 

Camphorae camphor  0.8 

Chloroformi^ chloroform  0.5 

Cinnamomi cinnamon  oil  0.2 

Creosoti creosote  i. 

Fceniculi fennel  oil  0.2 

Menthae  Piperitae peppermint  oil  0.2 

Menthae  Viridis spearmint  oil  0.2 

Rosae  Fortior saturated 

Rosse of  the  above  50. 

The  Chemical  Waters  are  solutions  of  gases  in  Water.  The  fol- 
lowing are  official : 

Contains  gas,  percent- 
Aqua —  age  by  weight. 

Ammoniac NH3  10 

Ammoniae  Fortior NH3  28 

Chlori CI       0.4 

Hydrogenii  Dioxidi  (Hydrogen  Peroxide)  .    .    .   HjOj       3. 

LIQUORES— SOLUTIONS. 

The  Solutions  (also  termed  Solutio,  -nes,  Lat.)  are  solutions  of 
non-volatile  substances  in  Water. 

The  official  Solutions  are  all  solutions  of  inorganic  salts.  They 
are  made  either  by  simple  solution  (dissolving  the  particular  salt  in 

'  Chloroform  Water,  aside  from  its  medicinal  properties,  is  an  efficient  preservative 
agent,  and  forms  a  good  solvent  in  place  of  water  for  preparing  solutions  intended  to  be 
kept  free  from  micro-organisms,  as,  for  example,  those  for  hypodermic  use. 


52  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Water)  or  by  chemical  solution  (reacting  upon  different  substances, 
and  obtaining  the  newly-formed  salt  in  solution  in  the  Water).  The 
following  24  are  official : 

The  Arsenic  Solutions :  these  are  all  of  the  same  strength — 
viz.  I  per  cent. ;  10  minims  (0.6  Cc.)  represent  ^^5-  grain  (0.006  Gm.) 
of  arsenic,  the  usual  dose : 

Percentage 
Liquor^  or  Gm.  in  100  Cc. 

Acidi  Arsenosi acid,  arsenous  i. 

Arseni  et  Hydrargyri  lodidi arsenic  iodide  i. 

(Donovan's  Solution).  mercuric  iodide  i. 

Potassii  Arsenitis  .    .    .  potas.  bicarb.  2 ;  acid,  arsenous  i. 

(Fowler's  Solution)  tinct.  lavender  comp.  3. 

Sodii  Arsenatis sodium  arsenate  i. 

The  Alkaline  Salt  Solutions,  prepared  by  saturating  an  organic 
acid  with  an  alkaline  carbonate  or  bicarbonate,  furnishing  an  agree- 
able and  refreshing  potion  (also  designated  Saturatio,  Potio,  Lat.) 
charged  with  Carbonic  Acid  Gas.  The  dose  is  from  2  to  4  fluid- 
drachms  (8-15   Cc),  except  Liq.  Magnesiae  Citratis : 

Liquor —  Gm.  in  100  Cc. 

Ammonii  Acetatis  (Spiritus  Mindererus)  ammon.  carb.       5. 

acid,  acetic,  dil.  100. 

Ferri  et  Ammonii  Acetatis   .    .    .   liquor  ammon.  acet.     20. 

(Basham's  Mixture),  acid,  acetic,  dil.  3.;  tr.  ferri  chlor.       2. 

elix.  arom.  12;  glycerin  10;  aqua  ad  100. 

Magnesii  Citratis   .    .    .  magnes.  carb.  15.;  acid,  citric.     30. 

potas,  bicarb.  25.;   syrup, 
acid,  citric.  60  Cc. ;  aqua  ad  350. 
Potassii  Citratis  (Neutral  Mixture)   .    .  potass,  bicarb.       8. 

acid,  citric.  6.;  aqua  ad  100. 

The  Iron  Solutions,  containing  ferric  salts  in  the  following  pro- 
portions by  weight : 

Gm.  in  100,  or 
Liquor —  percentage  by  weight. 

Ferri  Acetatis ferric  acetate  31. 

Ferri  Chloridi ferric  chloride  37.8 

Ferri  Citratis ferric  citrate  42.5 

Ferri  Nitratis ferric  nitrate  6.2 

Ferri  Subsulphatis  (Monsel's)    .    .     ferric  subsulphate  43.7 

Ferri  Tersulphatis ferric  sulphate  28.7 


PHARMACEUTICAL  PREPARATIONS.  53 

These  are  mostly  used  in  producing  other  Iron  preparations  and 
compounds,  particularly  the  Tincture  of  Ferric  Chloride,  the  Ferric 
Hydrate  (arsenical  antidote),  and  the  scaled  salts  of  iron. 

The  Alkali  Solutions  : 

Percentage  by  vol. 
Liquor —  or  ■weight. 

Calcis  (Lime  Water) calcium  hydrate       0.17 

Potassae potassium  hydrate       5. 

Sodae sodium  hydrate       5. 

Sodse  Chloratse  (Labarraque's) chlorine       2.6 

Lime  Water  is  given  as  an  antacid  (10-30  Cc);  Labarraque's 

Solution  is  used  as  a  powerful  disinfectant. 

The  Solutions  of  Metallic  Compounds ;   all  but  that  of  Iodine 

are  used  only  externally : 

Percentage  by  vol. 
Liquor —  or  weight. 

lodi  Compositus  (Lugol's  Solution)  .    .  potass,  iodid.     10. 

iodine       5. 

Hydrargyri  Nitratis mercuric  nitrate     60. 

Plumbi  Subacetatis lead  subacetate     25. 

Plumbi  Subacetatis  Dilutus  ....   of  above  solution       3. 

(Lead  Water) distilled  water  to  100. 

Sodii  Silicatis sodium  silicate     50. 

Zinci  Chloridi zinc  chloride     50. 

The  dose  of  Liq.  lodi  Comp.  is  3-10  minims  (0.2-0.6  Cc), 
preferably  given  in  a  little  milk. 

Unofficial  Liquors  of  the  National  Formulary. 
Liquor —  , 

AciDi  Phosphorici  Compositus  (Acid  Phosphates). 
Alumini  Acetatis  (Alumini  Acetici,  Ph.  Ger.). — Contains  8 

per  cent,  of  basic  Aluminum  Acetate. 
Alumini  Acetico-tartratis. — Contains  about  50  per  cent. 

of  dry,  so-called  Aluminum  Acetico-tartrate,  which  may 

be  obtained  by  evaporating  the  solution. 
AuRi   ET  Arseni   Bromidi. — Ten  minims  contain  -^  grain 

(0.002  Gm.)  of  Tribromide  of  Gold  and  ^  grain  (0.004  Gm). 

of  Tribromide  of  Arsenic. 
BiSMUTHi. — Each  fluidrachm  (4  Cc.)  represents  i  grain  (0.06 

Gm.)  Bismuth  and  Ammonium  Citrate. 
Bromi  (Smith's  Solution  of  Bromine). — Bromine,  20  per  cent. ; 

Potassium  Bromide,  10  per  cent. ;  Water. 


54  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Liquor — 

Calcis  Sulphurate  (Solution  of  Oxysulphuret  of  Calcium; 

Vleminck's  Solution  or  Lotion). 
CuPRi  Alkalinus  (Fehling's  Solution). 

I.    The  Copper  Solution, 

Copper  Sulphate,  pure grains         505  .  .  34,6390111. 

Distilled  Water      .  enough  to  make  fluidounces  16  .  .  500  Cc. 
II.    The  Alkaline  Solution. 

Potassium  and  Sodium  Tartrate  .  grains         252  .  .  173  Gm. 

Soda  (U.  S.  P.) troy  ounces    2  .  .  60  Gm. 

Distilled  Water  .    .  enough  to  make  fluidounces  16  .  .  500  Cc. 

Keep  both  solutions,  separately,  in  small  well-stoppered  vials,  in  a  cool  and 
dark  place.  For  use,  mix  exactly  equal  volumes  of  both  solutions  by  pouring 
the  copper  solution  into  the  alkaline  solution.  Ten  Cc.  of  the  mixture  prepared 
by  metric  weight  and  measure  correspond  to  0.05  Gm.  of  glucose.  Of  the  mix- 
ture prepared  by  apothecaries'  weight  and  measure,  210  minims  correspond  to 
I  grain  of  glucose. 

I  Electropoeicus  (Battery-fluid). 

A.  For  the  Ca7-bon  and  Zinc  Battery. — I.  (For  ordinary  use). — Potassium  Bi- 
chromate, in  powder,  6  troy  ounces  (180  Gm.) ;  Sulphuric  Acid,  commercial, 
6  fluidounces  (180  Cc.) ;  Water,  cold,  48  fluidounces  (1400  Cc). — II.  (For  use 
with  the  galvano-cautery). — Sodium  Bichromate,  in  powder,  6^  troy  ounces 
(185  Gm.) ;  Sulphuric  Acid,  commercial,  14  fluidounces  (420  Cc);  Water, 
cold,  48  fluidounces  (1400  Cc). 

Pour  the  Sulphuric  Acid  upon  the  powdered  Bichromate  and  stir  the  mix- 
ture occasionally  during  one  hour.  Then  slowly  add  the  Water.  Sodium  Bi- 
chromate is  more  soluble  than  the  Potassium  Salt,  and  also  much  cheaper. 
When  it  cannot  be  obtained,  the  Potassium  Salt  may  be  substituted  for  it, 
weight  for  weight. 

B.  For  the  Leclanchi  Battery. — Ammonium  Chloride,  6  troy  ounces  (180 
Gm.) ;  Water,  enough  to  make  20  fluidounces  (600  Cc.) ;  dissolve  tlie  Salt  in 
the  Water. 

Ferri  Oxysulphatis  (Oxysulphate  of  Iron). 

Ferri  Protochloridi  (Solution  of  Ferrous  Chloride). — Each 
fluidrachm  (4  Cc.)  represents  about  20  grains  (1.3  Gm.)  of 
Protochloride  of  Iron  (ferrous  chloride). 

Hydrargyri  et  Potassii  Iodidi  (Solution  of  Iodide  of  Mer- 
cury and  Potassium ;  Channing's  Solution). — Red  Mercuric 
Iodide,  72  grains  (5.0  Gm.) ;  Potassium  Iodide,  56  grains 
(3.8  Gm.) ;  in  Di.stilled  Water,  16  fluidounces  (450  Cc). 

Hypophosphitum. — Each  fluidrachm  (4  Cc.)  contains  2  grains 
(0.12  Gm.)  of  Calcium  Hypophosphite,  \\  grains  (0.75  Gm.) 
of  Sodium  Hypophosphite,  and  i  grain  (0.06  Gm.)  of  Po- 
tassium Hypophosphite. 

loDi  Carbolatus  (Boulton's  Solution  ;  "  French  Mixture  "). — 


PHARMACEUTICAL  PREPARATIONS.  55 

Liquor — 

Comp.  Tincture  of  Iodine,  no  minims  (7  Cc);  Carbolic 
Acid,  40  grains  (3.0  Gm.) ;  Glycerin,  2\  fluidounces  (loo.o 
Cc.) ;  in  16  fluidounces  (450  Cc). 

loDi  Causticus  (Iodine  Caustic ;  Churchill's  Iodine  Caustic). 
— Iodine,  i  troy  ounce  (3 1  Gm  ) ;  Potassium  Iodide,  2  troy 
ounces  (63  Gm.) ;  in  Water,  4  fluidounces  (120  Cc). 

Magnesii  Bromidi. — Each  fluidounce  (30  Cc.)  contains  about 
7  grains  (0.5  Gm.)  of  Magnesium  Bromide. 

Morphine  Citratis. — Each  fluidrachm  (4  Cc.)  contains  2 
grains  (0.12  Gm.)  of  Morphine  in  the  form  of  citrate. 

Morphine  Hypodermicus  (Magendie's  Solution  of  Morphine).' 
— i6grains(i  Gm.)  Morphine  Sulphate  to  i  fluidounce  (30  Cc). 

Pancreaticus  (Pancreatic-  Solution). — Each  fluidrachm  (4  Cc.) 
represents  i  grain  (0.06  Gm.)  of  Pancreatin,  effectually  pre- 
served in  Glycerin  and  a  little  Alcohol. 

Pepsini  Aromaticum. — Each  fluidrachm  (4  Cc.)  represents 
I   grain  (0.06  Gm.)  of  Pepsin. 

Phosphori  (Thompson's  Solution  of  Phosphorus). — Each  fluid- 
drachm  (4  Cc.)  contains  about  ^  grain  (0.0025  Gm.)  of 
Phosphorus,  preserved  in  Absolute  Alcohol  and  Glycerin. 

Picis  Alkalinus  (Tar,  Alkaline). 

Potass^  Chlorate  (Solution  of  Chlorinated  Potassa ;  Javelle 
Water). — An  effective  and  popular  disinfectant. 

PoTASSii  Arsenatis  et  Bromidi  (Liquor  Arsenii  Bromidi; 
Clemens'  Solution). — This  solution  contains  an  amount  of 
Arsenic  in  combination  corresponding  to  about  i  per  cent, 
of  Arsenous  Acid. 

The  title  "  Solution  of  Bromide  of  Arsenic  "  (Liquor  Arsenii  Bromidi),  which 
is  often  applied  to  Clemens'  Solution  or  similar  preparation,  is  a  misnomer, 
sinc^e  bromide  of  arsenic  cannot  exist,  as  such,  in  presence  of  water,  but  is 
split  up  into  hydrobromic  and  arsenous  acids.  The  proportions  of  the  ingre- 
dients, in  the  formula  above  given,  have  been  adjusted  as  closely  as  practicable, 
so  as  to  yield  definite  compounds — viz.  arsenate  and  bromide  of  potassium. 

Saccharini  (Solution  of  Saccharin). — Each  fluidrachm  repre- 
sents 4  grains  of  Saccharin. 

Intended  to  be  used  for  sweetening  liquids  and  solids  when  the  use 
of  sugar  is  objectionable,  or  when  a  sweet  taste  is  to  be  imparted  to  a  liquid 
without  increasing  its  density. 

'  Particular  care  should  be  taken  in  prescribing  and  dispensing  this  solution,  so  that 
it  may  not  be  mistaken  for  the  so-called  United  States  Solution  of  Morphine  (Liquor 
Morphiae  Sulphatis,  U.  S.  P.  1870).  containing  only  i  grain  of  Sulphate  of  Morphine 
in  each  fluidounce,  which  is  still  occasionally  used. 


56  A   TEXT-BOOK  OF  MATERIA  MEDICA. 

Liquor — 

Seriparus  (Liquid  Rennet). 

If  this  liquid  is  to  be  used  merely  for  curdling  milk,  without  separating  the 
whey  as  a  distinct  layer,  it  should  be  added  to  the  milk,  previously  warmed 
to  a  temperature  of  about  35°  C.  (95°  F.),  and  the  mixture  should  then  be  set 
aside  undisturbed  until  it  coagulates.  If  the  whey  is  to  be  separated,  the 
Liquid  Rennet  should  be  added  to  the  milk  while  cold,  and  the  mixture 
heated  to  about  35°  C.  (95°  F.),  but  not  exceeding  40°  C.  (104°  F.).  One  part 
of  the  liquid  should  coagulate  between  200  and  300  parts  of  cows'  milk. 

Liquor  Sodii  Arsenatis,  Pearson. — This  Solution  contains 
about  ^  per  cent,  of  anhydrous  Sodium  Arsenate. 

This  preparation  should  not  be  confounded  with  the  Liquor  Sodii  Arsenatis 
of  the  U.  S.  P.,  which  is  ten  times  stronger  than  the  above.  Pearson's  Solu- 
tion is  official  in  the  French  Pharmacopoeia,  under  the  title  Solute  d'Arse- 
niate  de  Sonde   (or  Solution  Arsenicale  de  Pearson). 

Sodii  Boratis  Compositus  (Dobell's  Solution). — Sodium 
Borate  and  Sodium  Bicarbonate,  each  1 20  grains  (8.0  Gm.) ; 
Carbolic  Acid,  24  grains  (1.5  Gm.);  Glycerin,^  fluidounce 
(15    Cc);  in  Water,  16  fluidounces  (450  Cc). 

Sodii  Carbolatis  (Phenol  Sodique). — Carbolic  Acid,  50  per 
cent. ;  Soda,  3  per  cent. ;  in  Water. 

Sodii  Citratis. — Saturatio  (Potio  Riveri,  Ph.  Ger.). — Citric 
Acid,  150  grains  (lo.o  Gm.);  Sodium  Bicarbonate,  190 
grains  (12.5   Gm.) ;  in  Water,   16  fluidounces  (450  Cc). 

Sodii  Citro^tartratis  (Effervescing  Saline  Water). — Sodium 
Bicarbonate,  Tartaric  Acid,  Citric  Acid,  Syrup,  and  Water, 
in  about  the  same  proportions  as  in  Solution  of  Magnesium 
Citrate,  for  which  it  is  a  cheaper  substitute. 

Sodii  Oleatis  (Oleate  of  Sodium). — Intended  to  be  used  in 
the  preparation  of  oleates. 

Strychnine  Acetatis  (Hall's  Solution  of  Strychnine). — Each 
fluidrachm  (4  Cc.)  contains  \  grain  (0.008  Gm.)  Strychnine 
Acetate. 

The  Ph.  Br.  directs  a  Liquor  Strychninae  Hydrochloratis  (with  synonym, 
Liquor  Strychnise)  which  is  much  stronger,  and  should  not  be  confounded 
with  the  above  preparation.  It  should  never  be  dispensed  unless  expressly 
designated. 

ZiNci  et  Ferri  Compositus  (Deodorant  Solution). — A  com- 
bination of  Sulphates  of  Zinc  and  Iron,  Naphthol,  Oil  of 
Thyme,  and  Hypophosphorous  Acid,  in  Water. 

Used  as  a  simple  deodorant  and  antiseptic  for  common  domestic  use  when 
it  is  unnecessary  or  impracticable  to  employ  more  powerful  agents. 


PHARMACEUTICAL  PREPARATIONS.  57 

When  a  deodorant  solution  is  required  for  purposes  where  iron  is  objection- 
able— as,  for  instance,  when  woven  fabrics  are  to  be  steeped  in  it — the  follow- 
ing preparation  may  be  employed  : 

Liquor  Zinci  et  Alumini  Compositus,  in  which  the  Iron  Sulphate  is  replaced 
by  Aluminum  Sulphate. 

Liquor — 

ZiNGiBERis  (Essence  of  Ginger). — A  25  per  cent,  preparation 
of  Ginger  for  flavoring  aqueous  mixtures. 

SPIRITUS— SPIRITS. 

The  Spirits  are  solutions  of  volatile  substances  in  Alcohol. 
They  comprise  (i)  the  Natural  Spirits;  (2)  the  Aromatic  Spirits, 
or  so-called  "  Essences ; "  and  (3)  the  Medicinal  Spirits. 

The  Natural  Spirits  are  produced  by  distillation,  and  include : 

Spiritus  Frumenti  (Whiskey),  containing  Alcohol  50-58  per 

cent,  by  volume. 
Spiritus  Vini  Gallici, (Brandy),  containing  Alcohol  46-55  per 

cent,  by  volume. 
Spiritus  Juniperi  Comp.  (Gin),  containing  Alcohol  60-70  per 

cent,  by  volume. 

The  Aromatic  Spirits  are  made  by  dissolving  the  respective  oils 
or  aromatic  principles  in  (deodorized)  Alcohol: 

Cc.  in  100  Cc, 
Spiritus —  or  percentage  by  vol. 

Amygdalae  Amarae  (water  20)   .    .  bitter  almond  oil  i . 

Anisi  (alcohol  deod.) anise  oil  10. 

Aurantii     "         "  orange  oil  5. 

Aurantii  Comp.  (alcohol  deod.)    ....  orange  oil  20. 

oils,  anise  o.  5 ,  coriander  2 ;  lemon  oil  5 . 

Camphorae camphor  10. 

Cinnamomi cinnamon  oil  10. 

Gaultheriae wintergreen  oil  5. 

Juniperi ....  juniper  oil  5- 

Lavandulae  (alcoholdeod.) lavender  oil  5. 

Limonis lemon  peel  5;  oil  5. 

Menthae  Piperitse peppermint  herb  i ;  oil  10. 

Mentha  Viridis  .    .    .  •     .    .     spearmint  herb  i ;  oil  10. 

Myrciae  (Bay  Rum) water  38;  oil  of  bay  0.8 

oils,  orange,  pimenta,  each  0.05 

Myristicae nutmeg  (vol.)  oil  5. 

These  are  chiefly  used  for  flavoring  purposes ;  some  are  used 


58  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

medicinally  as  aromatic  stimulants  and  carminatives  in  doses  of 
from  15-30  minims  (1-2  Cc);  Spiritus  Amygdalae  Amarae  con- 
tains Hydrocyanic  Acid,  and  is  never  used  internally  except  in 
very  small  quantities  as  a  flavor. 

The  Medicinal  Spirits  are  made  by  solutions  of  the  medicinal 
substance  in  Alcohol. 

The  following  are  official :  cc.  in  100  Cc, 

Spiritus—  or  percentage  by  voL 

Athens ether  (QHj)^     32.5 

^theris  Comp.  (Hoffmann's  Anodyne)  .  ethereal  oil       2.5 

ether     32.5 

By  weight. 

Athens  Nitrosi  (Sweet  Spirit  of  Nitre)  .    ethyl  nitrite  4. 

Ammonise ammonia  gas  10. 

Ammonia  Aromaticus  .    .  water  14;  ammonia  water  9. 

ammonia  carb.  3.4 

oils,  lavender,  nutmeg,  each  0.1  ;  lemon  oil  i. 

Chloroformi chloroform  6. 

Glonoini  ...  nitroglycerin  i. 

Phosphori absolute  alcohol,  phosphorus  0.12 

The  dose  of  these  Spirits  is  from  30  to  60  minims  (2  to  4  Cc. ; 
about  75  to  150  "  drops"),  except  the  Ammonia  Spirit,  used  only  in 
the  preparation  of  Liniments  (externally),  and  that  of  Phosphorus,, 
which  is  for  the  preparation  of  the  Elixir. 

Unofficial  Spirits  of  the  Natio?ial  Formulary. 
Spiritus — 

AciDi  FoRMici  (Spirit  of  Ants,  Ph.  Ger.). — A  solution  of 
3  per  cent,  of  Formic  Acid  in  Water  and  Alcohol. 

Ophthalmicus  (Alcoholic  Eye-wash). — A  solution  of  10  min- 
ims (0.6  Cc.)  Oil  of  Lavender  and  30  minims  (2  Cc.)  Oil 
of  Rosemary,  in  Alcohol   i   fluidounce  (30  Cc). 

Saponatus  (Spirit  of  Soap). 

SiNAPis  (Spirit  of  Mustard,  Ph.  Ger.). — A  solution  of  2|  per 
cent,  of  Volatile  Oil  of  Mustard  in  Alcohol. 

SYRUPI— SYRUPS. 

Syrups  are  nearly  saturated  Solutions  of  Sugar  in  Water,  in 
which  aromatic  or  medicinal  substances  are  dissolved. 

The  official  Syrup,  Syrupns,  contains  65  per  cent,  by  weight, 
85  per  cent,  by  volume,  of  Sugar  (about  7  pounds,  average,  in 


PHARMACEUTICAL  PREPARATIONS.  59 

I  gallon)  :  with  a  smaller  proportion  of  Sugar  the  syrup  undergoes 
fermentation  (spoils). 

The  "  Medicated  Syrups  "  contain  less  sugar,  owing  to  the  solu- 
tion of  the  medicinal  substances,  which  usually  reduce  the  solubility 
of  the  sugar  in  the  liquid  from  which  the  syrup  is  prepared. 
Syrups  should  be  kept  in  a  cool  plac.e,  in  cork-stoppered  bottles,  in 
order  to  preserve  them. 

The  thirty-two  official  Syrups  are  made  by  different  methods  : 
by  solution,  or  mixing  the  medicinal  substance  with  the  syrup; 
by  dissolving  the  Sugar  in  the  medicinal  solution ;  by  extraction 
from  the  drug ;  and  by  chemical  reaction  and  solution. 

They  may  be  divided  into  (i)  the  aromatic  or  adjuvant  syrups, 
and  (2)  the  medicinal  syrups,  comprising  {a)  those  made  from 
extractive  drugs,  including  alteratives,  astringents,  cathartics,  and 
expectorants,  and  {S)  those  made  from  chemicals,  either  by  simple 
solution  or  by  chemical  reaction  and  solution,  including  the  hypo- 
phosphites,  iron,  and  other  tonics. 

The  Aromatic  or  Adjuvant  Syrups  are  mostly  used  as  additions 
to,  or  vehicles  of,  liquid  mixtures  containing  Bromides,  Iodides, 
Phosphates,  or  similar  salts  of  disagreeable  saline  taste,  desirable 
to  disguise. 

The  following  are  official :  „    .  „ 

°  Cc.  tn  100  Cc, 

Syrupus —  or  percentage  by  vol. 

Acacise mucilage  acacia  25. 

Acidi  Citrici spin  lemon,  i  ;  acid,  citric  i. 

Althaeas marshmallow  5. 

Amygdalae     .    .  (bitter  almond  4,  sweet  almond  14)  18. 

orange  flower  water  10. 

Aurantii orange,  fresh  exterior  rind  5. 

Aurantii  Florum orange  flower  water  50. 

Rubi  Idaei raspberry  juice  (fresh)  40. 

Tolutanus tolu  balsam  i. 

Zingiberis fluid  extract  of  ginger  3. 

The  Extractive  Syrups  are  often  made  by  mixing  the  Fluid 
Extract  of  the  respective  drugs  with  Syrup. 

Tinctures  and  Fluid  Extracts  of  resinous  drugs  often  precipitate 
when  mixed  with  Syrups  and  aqueous  solutions.  In  order  to  fur- 
nish clear  mixtures  it  is  therefore  sometimes  necessary  to  mix  the 
extractive  preparation  with  Water,  clarify  the  mixture  by  filtration, 
and  dissolve  the  sugar  in  the  filtered  hquid. 


6o  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

The  following  are  official :  ^^  ^^  ^^^^ 

Syrupus —  2»  ^oo  Cc. 

Allii vinegar  of  garlic  20. 

Ipecacuanhse fl.  ext.  ipecac       7. 

Krameriae fl.  ext.  rhatany  45. 

Lactucarii tinct.  lactucarium  10. 

Picis  Liquidse glycerite,  tar       7.5 

Pruni  Virginianse wild  cherry  15. 

Rhei fl.  ext.  rhubarb  10. 

Rhei  Aromaticus     ....  tinct.  rhubarb, arom.  15. 

Rosse fl.  ext.  red  rose  12.5 

Rubi      fl.  ext.  blackberry  bark  25. 

Sarsaparillse  Comp fl.  ext.  sarsaparilla  20. 

fl.  ext.  glycyrrh.,  senna,  each       1.5 
oils,  sassafras,  anise,  gaultheria,  each       o.oi 

Scillse vinegar  of  squill  45. 

Scillse  Comp fl.  exts.  squill,  senega,  each       8. 

(Coxe's  Hive  Syrup)  .    .  antimony  and  potass,  tart.       0.2 

Senegse fl.  ext.  senega  20. 

Sennse oil  coriander  0.5  ;  senna  25. 

The  dose  of  the  Syrups  of  Ipecac,  Squill,  Squill  Comp.,  and 
Senega  as  an  expectorant  is  from  5-30  minims  (0.5-2  Cc);  as 
emetic,  from   1-2  fluidrachms  (4-8  Cc). 

The  Chemical  Syrups  are  an  elegant  class  of  preparations  in 
which  the  taste  of  the  medicinal  agents  is  greatly  modified.  They 
do  not  keep  well  unless  put  up  in  small  bottles  completely  filled, 
ready  for  dispensing.  Except  the  Syrup  of  Iodide  of  Iron,  which 
is  best  preserved  in  bottles  exposed  to  light,  they  should  be  kept 
in  a  cool  and  dark  place. 

The  dose  is  from  i  to  2  teaspoonfuls  (4  to  8  Cc),  except  of  the 
Syrup  of  Iodide  of  Iron,  the  ordinary  dose  of  which  is  10  drops, 
nearly  equivalent  to  10  minims  (0.6  Cc). 

The  Syrup  of  Iron,  Quinine,  and  Strychnine  Phosphates  (Easton's 
Syrup,  Ph.  Br.)  is  almost  identical  with  the  well-known  unofficial 
Elixir  of  that  name.  It  contains  -^  grain  of  Strychnine  in  80  min- 
ims (i  mg.  in  5  Cc);  the  formula  of  the  U.  S.  P.  1880  yielding  a 
Syrup  nearly  three  times  as  strong,  care  should  be  observed  that 
the  preparations  of  the  two  formulas  be  not  accidentally  confused 
with  each  other.  A  somewhat  similar  preparation  is  the  Syrupus 
Hypophosphitum  Compositus  of  the  N.  F. 


PHARMACEUTICAL  PREPARATIONS.  6i 

The  following  are  official :  Percentage. 

Gm.  or  Cc. 
Syiupus —  in  loo. 

Acidi  Hydriodici acid,  hydriodic,  by  weight  i . 

Calcii  Lactophosphatis     .    .    .  calcium  lactophosphate  i. 

Calcis lime  (calcium  saccharate)  i. 

Ferri  lodidi ferrous  iodide,  by  weight  lo. 

Grains        Percent- 
in  I  fluid-       age  by 
drachm  [4  Cc.) .     vol. 

Ferri,  Quininae  et  Strychninse  Phosphatum: 

ferric  phosphate,  soluble  i\       2. 

quinine  sulphate  2  3. 

strychnine  -^      0.02 

acid,  phosphoric  3  4.8 

Hypophosphitum   .    .    .   calcium  hypophosphite  3  4.5 

potassium  and  sodium  hypophosphites,  each  I  1.5 

spirit  lemon  0.5  ;  acid  hypophos.  dil.  0.2 

Hypophosphitum  cum  Ferro   .    .   ferrous  lactate  I. 

with  potass,  citrate  i,  in  syrup  hypophosph. 

Unofficial  Syrups  of  the  National  Formulary. 

Unless  otherwise  stated,  the  dose  is  I  to  2  fluidrachms  or  tea- 
spoonfuls  (4-8  Cc). 

Syrupus — 

KciRB.  CoMPOSiTus  (Cimicifuga  or  Black  Cohosh). — Contain- 
ing 2^  grains  (0.15)  each  of  Cimicifuga  and  Wild  Cherry, 
\\  grains  (0.07)  Glycyrrhiza  and  Senega,  and  \  grain  (0.04) 
Ipecac  in  each  fluidrachm  (4  Cc). 

AsARi  CoMPOSiTUS  (Canada  Snake  Root). — Each  fluidrachm 
(4  Cc.)  represents  3^  grains  (0.2)  of  Asarum. 

Calcii  Chlorhydrophosphatis  (Chlorhydrophosphate  of 
Lime). — Each  fluidrachm  (4  Cc.)  contains  i  grain  (0.06)  of 
Calcium  Phosphate. 

Calcii  et  Sodii  Hypophosphitum  (Hypophosphite  of  Lime 
and  Soda). — Each  fluidrachm  (4  Cc.)  contains  2  grains  (o.  1 3), 
each,  of  Hypophosphites  of  Calcium  and  Sodium. 

Calcii  Hypophosphitis  (Hypophosphite  of  Lime). — Each 
fluidrachm  (4  Cc.)  contains  2  grains  (0.13)  of  Calcium  Hypo- 
phosphite. 

Calcii  Iodidi  (Iodide  of  Calcium). — Each  fluidrachm  (4  Cc.) 
contains  about  5  grains  (0.3)  of  Calcium  Iodide. 


62  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Syrupus — 

CalcIi  Lactophosphatis  cum  Ferro  (Lactophosphate  of 
Lime  with  Iron).— Each  fluidrachm  (4  Cc.)  contains  \  grain 
(0.03)  of  Lactate  of  Iron  and  about  \  grain  (0.015)  of 
Calcium  Lactate  (or  about  f  grain  (0.02)  of  so-called  Lacto- 
phosphate of  Calcium). 

Chondri  Compositus  (Irish  Moss). — Containing  i  grain  (0.06) 
each  of  Squill  and  Senega,  -^  grain  (0.004)  each  of  Ipecac 
and  Irish  Moss,  and  if  minims  (o.i)  Tincture  Opium  Camph. 
to  each  fluidrachm  (4  Cc). 

CiNNAMOMi  (Cinnamon,  Ph.  Ger.). — Chiefly  used  for  flavoring. 

Codeine. — Containing  \  grain  (0.3)  Codeine  Sulphate  in  each 
fluidrachm  (4  Cc).  The  Syrup  of  the  French  Codex  is  about 
one-fourth  this  strength. 

Coffee  (Coffee). — Containing  15  grains  (i.)  of  the  choicest 
Coffee  (Java  and  Mocha)  in  fluidrachm  (4  Cc.) ;  an  elegant 
vehicle  for  Quinine  and  addition  to  nauseous  mixtures. 

Eriodictyi  Aromaticus  (Yerba  Santa;  Syrupus  Corrigens). 
— Chiefly  intended  as  a  vehicle  for  disguising  the  taste  of 
Quinine  and  other  bitter  substances. 

Ferri  Arsenatis. — Each  fluidrachm  (4  Cc)  contains  about 
•^  grain   (0.00 1)  of  Arsenate  of  Iron  (ferric). 

Ferri  Bromidi  (U.  S.  P.,  '80). — Containing  10  per  cent,  of 
Ferrous  Bromide. 

Ferri  Citro-iodidi  (Tasteless  Syrup  of  Iodide  of  Iron). — 
Each  fluidrachm  (4  Cc.)  contains  an  amount  of  Iron  corre- 
sponding to  about  3.6  grains  (0.25)  of  Ferric  Iodide.  The 
official  Syrupus  Ferri  lodidi  contains  about  8  grains  (0.5) 
of  P'errous  Iodide  (Protiodide  of  Iron)  in  each  fluidrachm 
(4  Cc). 

Ferri  et  Mangani  Iodidi  (Iodide  of  Iron  and  Manganese). — 
Each  fluidrachm  (4  Cc.)  contains  6  grains  (0.4)  of  Iodide 
of  Iron  (ferrous)  and  3  grains  (0.2)  of  Iodide  of  Manganese. 

Ferri  Hypophosphitis  (Hypophosphite  of  Iron). — Each  fluid- 
drachm  (4  Cc.)  contains  i  grain  (0.06)  of  Hypophosphite  of 
Iron  (ferric). 

Ferri  Lactophosphatis  (Lactophosphate  of  Iron). — Each 
fluidrachm  (4  Cc.)  contains  i  grain  (0.06)  of  Lactate  of 
Iron,  or  about  i^  grains  (o.i)  of  so-called  Lactophosphate 
of  Iron. 

Ferri  Protochloridi  (Ferrous  Chloride). — Each  fluidrachm 


PHARMACEUTICAL  PREPARATIONS.  63 

Syrupus — 

(4  Cc.)  contains  about  i  grain  (0.06)  of  Protochloride  of 
Iron. 

Ferri  Saccharati  Solubilis  (Soluble  Saccharated  Iron; 
Saccharated  Oxide  of  Iron,  Ph.  Ger.). — Each  75  minims  (5 
Cc.)  represents  approximately  i  grain  (0.06)  of  Metallic 
Iron,  or  3  grains  (0.2)  of  Oxide  of  Iron. 

Glycyrrhiz^  (Liquorice). — Each  fluidrachm  (4  Cc.)  repre- 
sents 30  grains  (2.)  of  Glycyrrhiza. 

Hypophosphitum  Compositus. — Each  fluidrachrn  (4  Cc.)  con- 
tains 2  grains  (0.12)  of  Calcium  Hypophosphite,  i  grain 
(0.06),  each,  of  the  HypOphosphites  of  Potassium  and 
Sodium,  \  grain  (0.008),  each,  of  the  Hypophosphites  of 
Iron  and  Manganese,  -^  grain  (0.004)  of  Quinine  Hydro- 
chlorate,  and  i^  minims  (0.0 1)  of  Tincture  of  Nux  Vomica. 

This  Syrup  should  not  be  confounded  with  the  official  Syrupus  Hypo- 
phosphitum (Syrup  of  the  Hypophosphites:  Calcium,  Sodium, and  Potassium). 
It  is  intended  to  replace  a  well-known  proprietary  article,  for  which  it  has  been 
found  by  many  physicians  to  be  a  satisfactory  substitute.  It  is  uniform  in  com- 
position and  more  stable  and  elegant  than  the  patent  article. 

Ipecacuanha  et  Opii  (Syrup  of  Dover's  Powder). — ^Each 
fluidrachm  (4  Cc.)  represents  5  grains  (0.3)  of  Dover's  Pow- 
der, or  \  grain  (0.03),  each,  of  Ipecac  and  Opium. 

Manna  (Syrup  of  Manna,  Ph.  Ger.). 

MoRPHiNA  Compositus. — A  preparation  sometimes  dispensed 
as  Jackson's  Pectoral  Syrup,  but,  as  it  differs  in  essential 
particulars,  the  N.  F.  recommends  that  this  preparation  be 
dispensed  only  when  expressly  designated  under  this  title. 
Each  fluidrachm  (4  Cc.)  contains  \  grain  (0.008)  Ipecac, 
5  grains  (0.3)  Senega,  i  grain  (0.06)  Rhubarb,  and  -^ 
grain  (0.002)  Morphine,  with  Oil  of  Sassafras. 

MoRPHiNA  SuLPHATis  (Syrup  of  Morphine). — Each  fluid- 
drachm  (4  Cc.)  contains  \  grain  (0.008)  of  Sulphate  of 
Morphine. 

Papaveris  (Poppy,  Ph.  Br. ;  Diacodii,  Ph.  Ger.). — Similar  to  the 
preceding,  but  considerably  weaker. 

Pectoralis  (Jackson's  Pectoral  Syrup). — Each  fluidrachm 
(4  Cc.)  contains  -^  grain  (0.002),  each,  of  Morphine  and  Oil 
of  Sassafras. 

Phosphatum  Compositus  (Chemical  Food). — Each  fluidrachm 
(4  Cc.)  contains    about   2    grains  (0.12)  of  Phosphate  of 


64  A    TEXT- BOOK  OF  MATERIA  MEDIC  A. 

Syrupus — 

Calcium,  i  grain  (0.06),  each,  of  the  Phosphates  of  Iron 
and  Ammonium,  and  smaller  quantities  of  the  Phosphates 
of  Potassium  and  Sodium. 

PiNi  Strobi  Compositus  (White  Pine  Compound). — A  com- 
bination of  White  Pine,  Wild  Cherry,  Spikenard,  San- 
guinaria,  Chloroform,  and  Morphine,  -^  grain  (0.002)  in  a 
fluidrachm. 

Rhamni  Cathartics  (Buckthorn  Berries;  Syrupus  Spinae 
Cervinae,  Ph.  Ger.). 

RuBi  Aromaticus  (Blackberry,  Aromatic). — A  combination 
of  Rubus,  Cinnamon,  Nutmeg,  Cloves,  and  Allspice. 

SanguinarijE  (Bloodroot). — Each  fluidrachm  (4  Cc.)  repre- 
sents  13   grains  (0.8)  of  Sanguinaria. 

Senns  Aromaticus  (Senna,  Aromatic). — Each  fluidrachm 
(4  Cc.)  represents  'j\  grains  (0.5)  of  Senna,  3  grains  (0.2) 
of  Jalap,  and  i   grain  (0.06)  of  Rhubarb,  with  aromatics. 

Senns  Compositus  (Senna,  Compound). — Each  fluidrachm 
(4  Cc.)  represents  8  grains  (0.5)  of  Senna,  2  grains  (0.12), 
each,  of  Rhubarb  and  Frangula. 

SoDii  Hypophosphitis. — Each  fluidrachm  (4  Cc.)  contains 
2  grains  (o.  12)   of  Sodium  Hypophosphite. 

StillingIjE  Compositus. — Each  fluidrachm  (4  Cc.)  represents 
1 5  minims  ( i  Cc.)  of  Compound  Fluid  Extract  of  Stillingia. 

OxYMEL  SciLLiE  (Oxymel  of  Squill,  Ph.  Br.). — ^A  preparation 
of  Honey  containing  about  5  grains  (.32  Gm.)  of  Squill  in 
each  fluidrachm  (4  Cc). 

ELIXIRIA— ELIXI RS. 
Elixirs  are  a  class  of  elegant  preparations  similar  to  wines  or 
cordials,  composed  of  Water,  Sugar,  Alcohol,  and  Aromatics. 

The  medicinal  substances  are  usually  in  such  proportion  that  an 
ordinary  dose  may  be  contained  in  one  or  two  teaspoonfuls  (4  to  8 
Cc.)  of  the  elixir. 

There  are  but  two  Elixirs  official :  Aromatic  Elixir,  which 
serves  as  a  vehicle,  and  one  medicinal,  Elixir  of  Phosphorus. 

Elixir  Aromaticum spirit  of  orange,  comp.       12  Cc. 

mix  with alcohol,  deodorized,  to  make     250  Cc. 

to  this  solution  add  in  several  portions,  agitating 

after  each  addition syrup     375  Cc. 

and  in  the  same  manner water     375  Cc. 


PHARMACEUTICAL  PREPARATIONS.  65 

mix  the  liquid  with  precipitated  calcium  phosphate       15  Gm. 
and  filter,  adding  .    .    water  3  ;  alcohol  i  ;  to  make     1 000  Cc. 

This  illustrates  the  method  by  which  Elixirs  are  made.  The 
medicinal  ingredients  are  dissolved  in  the  Water,  or  Alcohol,  as 
indicated  by  their  solubilities,  before  mixing  the  Alcoholic  Solution 
of  Oils  with  the  Saccharine  Solution. 

Elixir  Phosphori :  glyc.  55 ;  anise  oil  0.2;  sp.  phosph.       21.Cc. 
mix  by  agitation ;  then  add    .   aromatic  elixir,  to     100  Cc. 

This  Elixir  contains  of  phosphorus  25  mg.  in  1 00  Cc,  or  ^ 
grain  (i  mg.)  in  i  fluidrachm  (4  Cc),  the  ordinary  dose. 

Some  Salts  and  Fluid  Extracts  may  be  dissolved  in  or  mixed 
with  the  Elixir  itself     For  example : 

Potassii  Bromidi 10. 

Elixir  Aromatici q.  s.  ad     100.' Cc. 

This  contains  15  grains  (i  Gm.)  in  2\  fluidrachms  (10  Cc),  6 
grains  in   i  fluidrachm  or  teaspoonful. 

Elixirs  of  the  National  Formulary. 
The  value  of  pleasant  vehicles  to  mask  or  modify  the  taste  of 
bitter  and  nauseous  drugs  is  recognized  by  every  prescriber.  The 
following  Elixirs  of  the  National  Formulary  have  been  carefully- 
selected,  and  embrace  the  most  effective  combinations  of  adjuvants 
and  aromatics  for  disguising  the  different  drugs  for  which  they  are 
recommended : 
Elixir — 

Anisi  ;  a  combination  of  Anethol,  Fennel,  and  Bitter  Almond. 
CuRASSAO  (Curagao  Cordial) ;  a  combination  of  Curasao,  Orris, 
and  a  little  Citric  Acid. 
Adjuvant  Elixirs. — The  following  are  intended  as  vehicles  for 
Quinine  and  similar  bitter  substances,  and  as  adjuvants  for  Tinctures 
and  Fluid  Extracts  of  bitter  and  resinous  drugs,  such  as  Cinchona, 
Cascara  Sagrada,  etc.     They  all  contain  Glycyrrhiza,  which,  in  the 
form  directed  in  the  N.  F.  (Russian  Licorice  Root,  peeled),  is  most 
effective  in  masking  the  bitter  taste  of  Quinine,  when  it  is  directed  to 
be  simply  suspended  in  the  mixture  without  the  use  of  acid  for 
effecting  solution.     Acids  precipitate  the  glycyrrhizin  and  -destroy 
its  power  of  masking  the  bitter  taste : 
Elixir— 

Adjuvans  ;  a  combination  of  Orange,  Wild  Cherry,  Glycyr- 
rhiza, Coriander,  and  Caraway. 

Except  for  the  exhibition  of  Quinine  this  is  the  most  effective  of  the  adju- 
vant Elixirs.  ' 
5 


66  A    TEXT- BOOK  OF  MA  TERIA   MEDIC  A. 

Elixir— 

Eriodictyi  Aromaticum  (Arom.  Elixir  Yerba  Santa;  Elixir 
Corrigens). — A  solution  of  Yerba  Santa  in  Comp.  Elixir  of 
Taraxacum,  intended  as  a  vehicle  for  Quinine  and  other 
bitter  remedies. 

GlycyrrhiZjE  (Elixir  of  Licorice) ;  a  solution  of  Licorice  in 
Aromatic  Elixir,  the  most  effective  vehicle  for  Quinine. 

Glycyrrhiz^  Aromaticum  ;  Elixir  of  Licorice,  with  the  addi- 
tion of  strong  aromatics. 

Taraxaci  Compositum  ;  an  improved  form  of  this  well-known 
compound,  useful  as  a  mild  adjuvant. 

Medicinal  Elixirs. — These  comprise  the  Elixirs  mostly  in  use ; 
also,  a  number  of  preparations  in  which  the  prescriber  will  find 
satisfactory  substitutes,  designated  by  scientific  titles  and  of 
definite  strength  and  uniform  composition,  intended  to  replace 
various  nostrums. 

Active  Drug  in 

I  Fluidrachm,  4.  Cc. 
Elixir —  grains.       Gm. 

AciDi  Salicylici 5        0.3 

Ammonii  Bromidi 5        0.3 

Ammonii  Valerian atis 2        0.12 

The  odor  and   taste  of  the  salt  being  well 
covered  by  the  addition  of  vanilla  and  a 
little  chloroform. 
Ammonii    Valerianatis    et    Quinine. — The 

above,  with  Quinine  Hydrochlorate   ....         \       0.015 
Apii  Graveolentis  (Celery  Compound). — Con- 
taining Celery,  Coca,  Kola,  and  Viburnum, 

each 4         0.25 

BisMUTHi. — Bismuth  and  Ammonium  Citrate    .      2         0.12 

BucHu 'j\      0.5 

BucHu  Compositum. — Buchu,  Cubeb,  Juniper, 

and  Uva  Ursi,  combined 15  i. 

Buchu  et  Potassii  Acetatis. — Elixir  Buchu, 

with  Potassium  Acetate 5         0.3 

Caffeine. — Caffeine  (in  solution    in    Hydro- 

bromic  Acid) I  0.06 

Calcii  Bromidi c         0.3 


Calcii  Hypophosphitis 2 


.12 


PHARMACEUTICAL  PREPARATIONS.  67 

Active  Drug  in 

I  Fluidrachm.  4  Cc. 
Elixir Grains.       Gm. 

Calcii  Lactophosphatis. — Calcium  Lactate  (in 

Phosphoric  Acid) i         0.06 

Catharticum  Compositum. — Each  fluidrachm 
(4  Cc.)  contains  Senna  j\  grains  (0.5) ;  Podo- 
phyllum 4  grains  (0.25);  Leptandra  and 
Jalap,  each  3  grains  (0.2) ;  Rochelle  Salts 
7\  grains  (0.5) ;  and  Sodium  Bicarbonate  i 
grain  (0.06).     The  mixture  should  be  shaken. 

Chloroformi  Compositum. — A  mixture  of 
equal  parts  of  Chloroform,  Tincture  of 
Opium,  Spirit  of  Camphor,  Aromatic  Spirit 
of  Ammonia,  and  Alcohol,  flavored  with  Cin- 
namon. The  old  title,  "  Chloroform  Pare- 
goric," is  recommended  to  be  abandoned  for 
the  above.  Each  fluidrachm  (4  Cc.)  contains 
I  grain  (0.06)  of  Opium  and  1 1  minims  (0.7) 
of  Chloroform. 

Cinchona  (Elixir  Cahsaya). — This  preparation 
is  from  the  best  Calisaya  Bark,  representing 
about  2  grains  (0.12)  in  each  fluidrachm  (4 
Cc).  It  is  preferable  to  preparations  made 
from  Quinine  and  the  cheaper  alkaloids  in 
being  a  more  agreeable  and  effective  anti- 
periodic  tonic. 

Cinchona  et  Ferri  (Calisaya  and  Iron ;  Fer- 

rated  Elixir  of  Calisaya). — Phosphate  of  Iron  .      2       0.12 

Cinchona  et  Hypophosphitum. — Calcium  and 

Sodium  Hypophosphites,  each i       0.06 

Cinchona,  Ferri,  Bismuthi  et  STRYCHNra^. 

— Phosphate  of  Iron 2       0.12 

Bismuth  and  Ammonium  Citrate i       0.06 

Strychnine  Sulphate y^    0.0007 

C1NCH0N.E,  Ferri  et  Bismuthi. — Phosphate  of 

Iron 2       0.12 

Bismuth  and  Ammonium  Citrate i       0.06 

Cinchona,  Ferri  et  Calcii  Lactophosphatis. 

— Phosphate  of  Iron ij     o.i 

Calcium  Lactophosphate about      i       0.06 


68  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Active  Drug  in 

I  Fluidrachm.  4  Cc. 
Elixir —  Grains.        Gvf.  "■. 

CinchonjE,  Ferri  et  Pepsini. — Phosphate  of 

Iron ij    0.1 

Pepsin -    .    .    .    .       I       0.06 

Cinchona,  Ferri  et  StrychninjE. — Phosphate 

of  Iron 2       0.12 

Sulphate  of  Strychnine Y^^     0.0007 

CiNCHONiE,  Pepsini  et  Strychnin^e. — Contain- 
ing smaller  quantities  of  the  Cinchona  Alka- 
loids, Pepsin    I    grain  (0.06),  and  Sulphate 

of  Strychnine Y^     0.0007 

CoCiE  (Coca). — Leaves,  Erythroxylon  Coca  .    .      7J     0.5 
CoCjE  et  Guaran^. — Coca  and  Guarana,  of  each      7^     0.5 
CoRYDALis  CoMPOSiTUM. — Containing  of  Cory- 
dalis,    Stillingia,    Iris,    and    Xanthoxylum, 

combined IS       i- 

Potassium  Iodide 3       0.2 

DiGESTivuM  CoMPOsiTUM. — Containing  about  5 
grains  (0.3)  of  Pulvis  Digestivus  in  each 
fluidrachm  (4  Cc). 

Eucalypti. — Eucalyptus  Globulus 7i     0.5 

EuoNYMi  (Wahoo). — Euonymus  Atropurpureus    10      0.6 
Ferri    Hypophosphitis.  —  Hypophosphite    of 

Iron  (ferric) I       00.6 

Ferri  Lactatis i       0.06 

Ferri  Phosphatis. — Phosphate  of  Iron  (U.  S.  P.)      2       o.  1 2 
Ferri  Phosphatis,  Cinchonidin^  et  Strych- 
nine.— Phosphate  of  Iron 2       O.I 2 

.  Cinchonidine \      0.03 

Sulphate  of  Strychnine Ysir     0.0007 

Ferri  Phosphatis,  Quinine  et  Strychnin^e. 
— Phosphate  of  Iron,  i  grain  (0.06) ;  Qui- 
nine  ._      \      0.03 

Sulphate  of  Strychnine -^      O.OOI 

Ferri  Pyrophosphatis 2      0.12 

Ferri,  QumiNiE  et  Strychnine. — Ferric  Chlo- 
ride, I  grain  (0.06) ;  Quinine  Hydrochlorate     \       O.03 

Sulphate  of  Strychnine j^     0.0007 

Frangule  (Buckthorn). — Rhamnus  Frangula  .     15        i. 


PHARMACEUTICAL  PREPARATIONS.  69 

Active  Drug  in 

I  Fluidrachm.  4  Cc. 
Elixir —  Grains.         Gm. 

Gentians 2  0.12 

Gentians  cum  Tincture  Ferri  Chloridi. — 

Tincture  Citro-chloride  of  Iron 5  0.3 

Gentian^e   et   Ferri   Phosphatis  (ferrophos- 

phated). — Phosphate  of  Iron i  0.06 

GRiNDELi-ffi. — Grindeha  Robusta 4  0.25 

GuARAN^. — Paullinia  Cupana 12  0.75 

HUMULI 72  O-S 

Hypophosphitum. — Calcium  Hypophosphite     .  3  0.2 

Sodium  and  Potassium  Hypophosphites,  each  i  0.06 
Hypophosphitum    cum   Ferro. — Calcium    and 

Sodium  Hypophosphite,  each i  0.06 

Potassium  and  Iron  Hypophosphites,  each     .  \  0,03 

LiTHii  Bromidi 5  0.3 

LiTHii  Citratis 5  0.3 

LiTHii  Salicylatis 4  5  0.3 

Malti  et  Ferri. — Phosphate  of  Iron    ....  i  0.06 

Mah  Extract 15  i. 

Paraldehydi. — Paraldehyde 15  i. 

Pepsini. — Pepsin ■  .    .    .  i  0.06 

Pepsini,  Bismuthi  et  Strychnine. — Elixir  Pep- 
sin and  Bismuth,  and  Strychnine     ....  y^  0.0007 

Pepsini  et  Bismuthi. — Pepsin i  0.06 

Bismuth  and  Ammonium  Citrate 2  o.  1 2 

Pepsini  et  Ferri. — Elixir  of  Pepsin  and  Tinc- 
ture Citro-chloride  of  Iron 5.  0.3 

Phosphori  et   Nucis  Vomica. — Elixir   Phos- 
phorus, with  Tincture  Nux  Vomica     ....  2  0.12 
Picis  CoMPOSiTUM. — A  combination  of  Prunus 
Virginiana,  Tolu,  Methylic  Alcohol,  and  Sul- 
phate of  Morphine ^  0.0015 

Pilocarpi  (Jaborandi). — Pilocarpus  Selloanus   .  4  o!2S 

Potassii  Acetatis 5  0.3 

PoTAssii  Acetatis  et  Juniperi. — Elixir  Potass. 

Acet.  with  Juniper 73  0.5 

Potassii  Bromidi. — Potassium  Bromide,  effect- 
ually masked  in  Adjuvant  Elixir    ....  10  0.6 
An  Elixir  half  this  strength  has  also  been  used. 


70  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Active  Drug  in 

I  Fluidrachm.  4  Cc. 
Elixir —  Grains.        Gm. 

Quinine  Compositum  (Red). — Sulphates  of 
Quinine,  \  grain    (0.008),   Cinchonidine  and 

Cinchonine,  each YB"       0-004 

Chiefly  intended  as  a  substitue  for  EUxir 
Cinchona  when  the  administration  of  other 
constituents  of  the  bark  may  be  deemed  ob- 
jectionable. 
•    Quinine  et  Phosphatum  Compositum. — Qui- 
nine Sulphate .        .    .    .      \       0.015 

Phosphate  of  Iron i       0.06 

Calcium  Lactophosphate f       0.05 

Quinine  Valerianatis  et  Strychnine. — Va- 
lerianate of  Quinine i       0.06 

Sulphate  of  Strychnine Y^     0.0007 

Rhamni  Purshiane  (Cascara  Sagrada). — Rham- 
nus  Purshiana,  its  bitterness  effectually  masked 
with  Elixirs  of  Glycyrrhiza  and  Taraxacum 
Compound      IS        i. 

Rhamni    Purshiane     Compositum    (Laxative 

EHxir;  Elixir  Purgans). — Cascara  Sagrada  .       7  J     0.5 

Senna  and  Juglans,  each 5       0.3 

Associated  with  aromatics  and  correctives  ; 
a  most  effective  laxative  in  doses  of  from  i  to  2 
fluidrachms  (4-8  Cc). 

Rhei. — Sweet  Tincture  of  Rhubarb,  represent- 
ing Rhubarb 2j     0.15 

Rhei    et    Magnesia   Acetatis. — Magnesium 

Acetate,  4  grains  (0.25) ;  Rhubarb 7i     0-5 

Rubi   Compositum  (Blackberry  Compound). — 
Blackberry  Root,  Galls,  and  Cinnamon  (Sai- 
gon), in  equal  proportions,  combined  ....     10       0.6 
with  smaller  quantities  of  Cloves,  Mace,  and 
Ginger,  in  Blackberry  Juice  and  Syrup. 

SoDii  Bromidi. — Sodium  Bromide,  in  Adjuvant 

Elixir 10       0.6 

SoDii  Hypophosphitum 2       0.12 

SoDii  Salicylatis  (to  be  freshly  prepared  when 

required  for  use) 5       0.3 


PHARMACEUTICAL   PREPARATIONS.  Jl 

Active  Drug  in 

J  Fluidrachm.  4  Cc. 
Elixir—  Grains.      Gm. 

Stillingi^    Compositum.  —  Compound    Fluid 

Extract  of  Stillingia,  N.  F 15  i . 

Strychnine  Valerianatis -^  0.0007 

Turners  (Damiana). — Turnera  Aphrodisiaca   .10  0.6 

ViBURNi  Opuli  Compositum. — Viburnum  Opu- 

lus,  Aletris  Farinosa,  each 5  0.3 

Trillium  (Beth  Root) 10  0.6 

ViBURNi  Prunifolii  (Bkck  Haw) 7i  0.5  . 

ZiNCi  Valerianatis. — Zinc  Valerianate         .    .  i  0.06 


CoRDiALE  RuBi  Fructus  (Blackberry  Cordial). — An  aromatic 
Syrup  of  Blackberry  Juice,  used  as  a  mild  astringent  in  bowel 
complaints. 

Succus  Limonis  cum  Pepsino  (Lime  Juice  and  Pepsin). — Each 
fluidrachm  (4  Cc.)  represents  2  grains  (0.12)  of  Pepsin. 

GLYCERITA— GLYCERITES. 

The  Glycerites,  or  "  Glyceroles,"  are  solutions  of  substances  in 
Glycerin. 

They  are  made  either  by  direct  solution,  by  heat,  or  by  extrac- 
tion of  a  drug,  as  in  Hydrastis  ;  one  is  made  by  chemical  reaction 
— i.  e.  Boroglycerin. 

There  are  six  official,  comprising  those  used  externally  either 
alone  or  as  additions  to  washes,  gargles,  injections,  etc. : 

Percentage 
Qlyceritum —  by  weight. 

Acidi  Carbolici acid,  carbolic  20. 

Acidi  Tannici acid,  tannic  20. 

Boroglycerini boroglyceride  50. 

Hydrastis representing  hydrastis  100. 

The  following  are  used  chiefly  as  pharmacal  agents ;    the  Gly- 
cerite  of  Starch  as  an  excipient  for  Pill-masses ;  and  the  Glycerite 
of  Egg-yolk  as  an  emulsifying  agent : 
Glyceritum — 

Amyli ....  water  10,  starch     10. 

Vitelli fresh  egg-yolk     45. 

The  Glycerite  of  Starch  is  sometimes  used  externally,  and  is 


72  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

known  as  Glycerin  Ointment,  also  as  "  plasma."  The  Glycerite  of 
Egg-yolk,  also  known  as  "  glyconin,"  has  been  used  as  an  applica- 
tion to  sore  nipples. 

Unofficial  Glycerites  of  the  National  Formulary. 

Glyceritum — 

Pepsini  (Glycerole  of  Pepsin).— Each  4  Cc.  (fluidrachm)  repre- 
sents 0.3  (5  grains)  of  Pepsin. 
Picis  Liquids  (Tar). — Containing  about  0.3  (5  grains)  of  Tar. 
Tragacanth^. — Containing  about  1 2  per  cent,  of  tragacanth. 

MUCILAGINES— MUCILAGES. 

The  Mucilages  are  prepared  by  extracting  a  mucilaginous  drug 
with  Water  or  dissolving  a  Gum  in  Water. 
The  following  four  are  official : 

Gm.  in  lOo  Cc.^ 
Mucilago —  or  percentage. 

Acaciae gum  arable  34. 

Sassafras  MeduUae sassafras  pith  2. 

Tragacanthse glycerin  1 8 ;  tragacanth  6. 

Ulmi slippery-elm  bark  6. 

The  Mucilages  are  chiefly  employed  as  vehicles  in  Mixtures  to 
aid  in  suspending  insoluble  substances  ;  as  excipients  in  Pills  and 
Troches ;  and  as  emulsifying  agents.  They  are  sometimes  used 
for  their  denlulcent  effect. 


THE   LIQUID   MIXTURES— INTERNAL. 

MISTUR^— MIXTURES. 

The  official  Mixtures  are  liquid  preparations,  for  internal  use, 
pf  medicinal  substances  dissolved  or  suspended  in  Water  containing 
sugar,  gum,  or  glycerin.  They  should  be  prepared  extemporane- 
ously. The  term  Mixture  is  also  applied  to  any  combination  of 
substances  that  cannot  be  otherwise  classified. 

There  are  four  official  mixtures  : 

Mistura —  Gms.  in  100  Cc. 

Cretse  (Chalk  Mixture)    ....    comp.  chalk  powder  20. 

cinnamon  water  40  ;  water,  to  100. 

Ferri  Comp.  (Griffith's  Mixt.)  .    .    .  myrrh,  sugar,  each  1.8 

potass,  carb.  0.8 

triturate  with  gradual  addition  of  rose  water  70. 

ferrous  sulphate,  0.6 ;  spin  lavend.,  6 ;  rose  water,  to  100. 


.THE  LIQUID  MIXTURES— INTERNAL.  73 

Mistura —  Gms.  in  100  Cc. 

Glycyrrhizse  Comp pure  extract  glycyrrhiza  3.0 

(Brown  Mixture)                            Spirit  ether  nitrous  3 

wine  antimony  6, 

tinct.  opium,  camph.  12 

syrup  5  ;  mucilage  acacia  10;  water,  to  100. 

Rhei  et  Sodae sodium  bicarbonate  3.5 

fl.  exts.  ipecac  0.3,  rhubarb  1.5 

spirit  peppermint  3.5  ;  glycerin  35. ;  water,  to  100, 


Unofficial  Mixtures  of  the  National  Formulary. 
Mistura — 

AcacIjE — (Mistura  Gummosa,  Ph.  Ger.). — Acacia,  pulv.,  Sugar, 
in  Water. 

Should  be  freshly  made  when  wanted  for  use. 

Adstringens  et  Escharotica  (Villate's  Solution). — Solu- 
tion of  Lead  Subacet.  i^  fluidounces  (45.) ;  Sulphates  of 
Copper,  Zinc,  each,  i  troy  ounce  (30.) ;  Acetic  Acid  1 3  fluid- 
ounces  (360  Cc). 

Ammonii  Chloridi  (Mistura  Solvens  Simplex). — Ammonium 
Chloride,  Purif.  Ext.  Glycyrrhiza,  each  180  grains  (12.),  in 
Water  16  fluidounces  (450  Cc). 

Mistura  (or  Mixturd)  Solvens  Stibiata  is  prepared  by  dis- 
solving 0.3  Antimony  and  Potassium  Tartrate  in  1000  Cc. 
of  Mistura  Ammonii  Chloridi. 

Camphors  Acida  (Mistura  Antidysenterica ;  Hope's  Mix- 
ture).— Nitric  Acid  120  mins.  (8  Cc);  Tinct.  Opium  80 
mins.  (5  Cc.) ;  in  Camphor  Water  16  fluidounces  (450  Cc). 

Camphors  Aromatica  (Parrish's  Camphor  Mixture). — Tinct. 
Lavender  Comp.  4  fluidounces  (120  Cc);  Sugar  240  grains 
(15.);  in  Camphor  Water  16  fluidounces  (450  Cc). 

Carminativa  (Dalby's  Carminative). — Magnes.  Carb.  i  troy 
ounce  (30.);  Potass.  Carb.  20  grains  (1.3);  Tinct.  Opium 
180  mins.  (12  Cc);  Oils  of  Caraway,  Fennel,  Peppermint, 
each,  4  drops  (o.i);  Syrup  2\  fluidounces  (75  Cc);  in  16 
fluidounces  (450  Cc).  Each  fluidounce  (30  Cc.)  represents 
about  I  grain  of  Opium  (0.06). 

Chloral  et  Potassii  Brqmidi  Composita  (Mixture  of 
Chloral  and  Bromide). — Each  fluidrachm  (4  Cc.)  contains 
15   grains  (i.),  each,  of  Chloral   and  Potassium    Bromide, 


74  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Mistura — 

and  \  grain  (0.008),  each,  of  Exts.   Indian  Cannabis  and 
Hyoscyamus. 
Chloroformi  et  Cannabis  Indice    Composita  (Chloroform 
'Anodyne). — Each  fluidrachm  (4  Cc.)  represents  7 J  minims 
(0.5  Cc),  each,  of  Chloroform  and  Tinct.  Indian  Cannabis; 
3f  minims  (0.25  Cc.)  Tinct.  Capsicum;  and  about  \  grain 
(0.0 1 )  of  Morphine  Sulph. 
Contra  Diarrhceam  (Cholera Mixture). — Tinctures  of  Opium, 
Capsicum,  Rhubarb,  and  Spirits  of  Camphor  and  Pepper- 
mint, each,  equal  volumes. 

The  above  formula  appears  to  be  that  in  most  general 
use,  also  known  under  the  name  of  "  Sun  Mixture." 

Of  other  similar  preparations  in  more  or  less  general  use, 
the  following  may  be  mentioned  here : 

2.  Loomis'  Diarrhea  Mixture. — Tincture  Opium,  \  fluid- 
ounce  (15  Cc.) ;  Tincture  Rhubarb,  5  fluidounce  (15  Cc); 
Tincture  Catechu  Comp.,  i  fluidounce  (30  Cc.) ;  Oil  of  Sas- 
safras, 20  minims  (1.3  Cc.) ;  Tincture  Lavender  Comp.,  to 
make  4  fluidounces  (120  Cc). 

3.  Squibb's  Diarrhea  Mixture: — Tincture  Opium,  i  fluid- 
ounce  (30  Cc) ;  Tincture  Capsicum,  i  fluidounce  (30  Cc.) ; 
Spirit  of  Camphor,  i  fluidounce  (30  Cc.)  ;  Purif.  Chloroform, 
180  minims  (12  Cc.) ;  Alcohol,  enough  to  make  5  fluidounces 
(150  Cc). 

4.  Thielemann' s  Mixture  (Mixt.  Thielemanni,  Ph.  Suec). — 
Wine  Opium,  i  fluidounce  (30  Cc.) ;  Tinct.  Valerian,  \\ 
fluidounces  (45  Cc);  Ether,  \  fluidounce  (15  Cc.) ;  Oil 
Peppermint,  60  minims  (4  Cc.) ;  Fl.  Ex.  Ipecac,  1 5  minims 
(i   Cc);  Alcohol,  to  make  4  fluidounces  (120  Cc). 

5.  Velpeau's  Diarrhea  Mixture. — Tincture  Opium,  Tinc- 
ture Catechu  Comp.,  Spirit  Camphor,  of  each,  equal  volumes. 

Copaiba  Composita — 

1.  Lafayette  Mixture. — Copaiba,  2  fluidounces  (60  Cc); 
Tinct.  Lavender  Comp.,  2  fluidounces  (60  Cc.) ;  Solution 
Potassa,  \  fluidounce  (15  Cc.) ;  Spirit  Nitr.  Ether,  2  fluid- 
ounces  (60  Cc.) ;  Syrup,  5  fluidounces  (150  Cc);  Mucilage 
Dextrin,  to  make  16  fluidounces  (450  Cc).  This  mixture 
should  be  well  agitated  when  used.  Each  fluidrachm  con- 
tains 'j\  minims  of  Copaiba. 

2.  Chapman's  Mixture. — Copaiba,  4  fluidounces  (125  Cc.) ; 


THE  LIQUID  MIXTURES— INTERNAL.  75 

Mistura — 

Tinct.  Lav.  Comp.,  240  minims  (15.5  Cc);  Tincture  Opium, 
240  minims  (15.5  Cc);  Spirit  Nitro.  Ether,  4  fluidounces 
(125  Cc);  Mucilage  Acacia,  i  J  fluidounces  (45  Cc);  Water, 
to  make  16  fluidounces  (450  Cc). 

ExPECTORANs,  Stokes  (Stokes'  Expectorant). — Ammonium 
Carb.,  120  grains  (8.);  Fl.  Ext.  Senega,  \  fluidounce  (15 
Cc);  Fl.  Ext.  Squill,  \  fluidounce  (15  Cc.) ;  Tinct.  Opium, 
Camph.,  2.\  fluidounces  (80  Cc);  Water,  \\  fluidounces  (45 
Cc.) ;  Syrup  Tolu,  to  make  16  fluidounces  (450  Cc). 

GuAiACi  (Guaiac  Mixture,  Ph.  Br.). — Resin  Guaiac,  ^ugar,  each, 
190  grains  (12.5);  Acacia  Powder,  100  grains  (7.);  Cinna- 
mon Water,  16  fluidounces  (450  Cc).  To  be  well  agitated 
when  used. 

Magnesia  et  Asafcetid^e  (U.  S.  P.  1880.). — Dewees'  Carmina- 
tive.— Magnesium  Carbonate,  90  grains  (6.0) ;  Tinct.  Asa- 
fcetida,  2  fluidrachms  (8  Cc.) ;  Tinct.  Opium,  20  minims  (1.2 
Cc);  Sugar,  180  grains  (12.0);  Water,  to  make  4  fluid- 
ounces  (120  Cc). 

Olei  Balsamica  (Balsamum  Vitae  Hoffmanni,  Ph.  Ger.). — 
A  solution  of  Oils  of  Lavender,  Thyme,  Lemon,  Mace, 
Orange-flowers,  Cloves,  Cinnamon,  and  Balsam  Peru  in 
Alcohol. 

Olei  Picis  (Tar  Mixture). — A  mixture  of  Oil  of  Tar,  \  fluid- 
ounce  (15  Cc.)  ;  Chloroform,  75  minims  (5  Cc.) ;  Oil  of  Pep- 
permint, 20  minims  (1.3  Cc),  in  Elixir,  to  make  16  fluid- 
ounces  (450  Cc). 

Rhei  Composita  (Squibb's  Rhubarb  Mixture). — Fl.  Ext. 
Rhubarb,  120  minims  (6.  Cc);  Fl.  Ext.  Ipecac,  16  minims 
(i.  Cc.) ;  Sodium  Bicarb.,  330  grains  (11.) ;  Glycerin,  6  fluid- 
ounces  (240.),  in  Peppermint  Water,  16  fluidounces  (450  Cc). 

Sassafras  et  Opii  (Mist.  Opii  Alkalina ;  Godfrey's  Cordial). — 
A  mixture  of  Oil  of  Sassafras,  Tincture  of  Opium,  and  Potass. 
Carb.  in  Molasses,  Alcohol,  and  Water.  Each  fluidrachm 
(4  Cc.)  contains  2  minims  (0.12)  Tinct.  Opium,  correspond- 
ing to  \  grain  (o.oi)  Opium. 

SoDjE  et  MentHjE  (Soda  Mint). — Sodium  Bicarb.,  320  grains 
(20.) ;  Spirit  Amrnonia  Arom.,  4  Cc.  (60  minims) ;  Spear- 
mint Water,  16  fluidounces  (450  Cc). 

Sflenetica  (Spleen  Mixture;  Gadberry's  Mixture). — Iron 
Sulphate,  Quinine  Sulphate,  Nitric  Acid,  each,  100  grains 


76  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Mistura — 

(7.);  Potassium  Nitrate,  300  grains  (20.),  in  Water,  16  fluid- 
ounces  (450  Cc). 
SuLPHURiCA   AciDA   (Haller's    Acid    Elixir,   Ph.  Ger.). — Sul- 
phuric Acid,  I  part ;  Alcohol,  to  make  4  parts,  by  weight. 

EMULSA— EMULSIONS. 

Emulsions  are  liquid  preparations  consisting  of  oily,  fatty,  resin- 
ous, or  otherwise  insoluble  substances  suspended  in  watery  liquids 
by  the  intervention  of  gum,  mucilage,  or  other  viscid  matter. 

For  the  internal  administration  of  Oils  it  is  often  necessary  to 
exhibit  them  in  a  palatable  form,  so  that  they  may  be  borne  by  the 
stomach  and  their  assimilation  favored.  This  is  usually  effected  by 
suspending  the  oil  in  a  watery  liquid  or  mixture  by  means  of  an 
emulsifying  agent,  such  as  acacia,  etc. 

Many  natural  substances  are  intimate  mixtures  of  oils  or  fats 
with  water,  in  the  form  of  an  emulsion.  Of  animal  products.  Milk 
is  a  most  perfect  emulsion  ;  so  is  Egg-yolk.  From  the  Milk-juice 
of  some  plants  the  water  evaporates  and  the  dried  milk-juice  col- 
lects in  the  seeds,  as  in  almonds  and  other  nuts,  or  exudes  from 
other  portions  of  the  plant  when  the  parts  are  wounded ;  in  this 
way  the  gum-resins  of  asafoetida,  etc.  are  produced.  From  these 
substances  Emulsions  may  be  obtained  by  restoring  the  water  lost 
by  evaporation — that  is,  by  rubbing  them  with  water  in  a  mortar. 
In  this  way  the  so-called  natural  Emulsions  are  made. 

Artificial  Emulsions. 

These  are  made  by  mixing  the  Oil  with  a  certain  proportion  of 
the  emulsifying  agent,  adding  Water,  and  triturating  the  mixture  in 
a  mortar  or  agitating  it  in  a  flask. 

There  are  various  methods,  but  these  are  general  rules : 

The  emulsification  of  the  oil  should  be  complete  before  the  mixture  is  made  up  to  the 
required  measure. 

When  alcoholic  liquids  are  to  be  added,  they  should  first  be  diluted  as  much  as 
possible. 

Salts  should  be  dissolved  before  being  added. 

No  heat  should  be  employed,  as  the  oil  separates  when  an  emulsion  is  heated. 

Emulsions  should  he  freshly  prepared  and  be  preserved  in  a  co/a' place. 

The  most  common  emulsifying  agent  is  Powdered  Gum  Acacia 
(Acacia  pulv.).  The  Oil  is  thoroughly  mixed  by  trituration  in  a 
mortar  with  one-fourth  its  weight  of  powdered  Acacia.  To  this 
one  and  a  half  times  as  much  water  as  of  gum  is  added  at  once,  and 
the  mixture  is  rapidly  triturated  with  a  rotary  motion  of  the  pestle 


THE  LIQUID  MIXTURES— INTERNAL.  77 

until  it  becomes  stiff  and  assumes  a  milk-white  color.  This  so- 
called  "  mother-emulsion "  may  now  be  diluted  to  the  required 
measure,  and  other  substances,  flavors,  etc.  be  added. 

Powdered  Tragacanth  may  be  used  in  the  same  way  or  in  the 
form  of  mucilage,  but  it  does  not  produce  so  permanent  emulsions 
as  does  gum  acacia. 

Mucilage  of  Acacia  or  of  Irish  Moss  is  not  so  satisfactory  as 
powdered  gum :  while  it  produces  a  good  emulsion,  the  division  of 
the  oil-globules  is  not  so  thorough  as  in  the  preceding :  emulsifica- 
tion  being  incomplete,  the  mixture  more  rapidly  separates  into  a 
heavier,  watery  liquid  and  a  lighter,  thick,  gelatinous  emulsion, 
which  requires  thorough  mixing  before  use. 

Extract  of  malt  is  an  excellent  emulsifying  agent  when  its  use  is  admissible.  The 
Oil  should  be  added  to  the  Malt  Extract  contained  in  a  capacious  mortar,  and  incorporated 
in  small  quantities  at  a  time.  A  good  article  will  emulsify  an  equal  volume  of  cod- 
liver  oil. 

Condensed  Milk  and  Egg-yolk  produce  the  most  perfect  emulsions,  and  also  the 
most  palatable,  but  they  rapidly  ferment  and  spoil. 

Glycerin  and  sugar  added  to  emulsions  for  the  purpose  of  preservation  and  palata- 
bility  induce  separation,  and  their  use  is  not  advisable. 

Emulsification  "  by  intervention  "  is  the  best  and  only  reliable 
method  to  be  employed  with  Ethereal  Oils  and  all  substances  of 
themselves  not  emulsifiable.  The  process  is  illustrated  in  the 
official  Chloroform  Emulsion. 

Oil  of  Turpentine,  for  example,  is  emulsified  by  dissolving  the  Turpentine  Oil  in 
twice  its  volume  of  a  bland  fixed  oil  (Almond  Oil),  incorporating  an  equal  weight  of 
powdered  Acacia,  adding  Water,  and  proceeding  as  with  an  ordinary  emulsion. 

Pancreatin  emulsionizes  fats  in  preparing  them  for  digestion,  but  it  does  not  produce 
a  permanent  emulsion  when  used  artificially.  While,  therefore,  not  a  reliable  emulsifying 
agent,  it  aids  the  assimilation  of  oils,  and  its  addition  to  emulsions  is  sometimes  therapeu- 
tically desirable.  As  it  is  only  active  in  alkaline  media,  the  Emulsion  should  be  prepared 
with  a  little  Sodium  Bicarbonate. 

The  addition  of  Alkalies  to  emulsions  should  be  avoided.  Soaps  are  not  Emulsions, 
nor  is  the  use  of  Soap-bark  to  be  recommended. 

Of  the  four  official  Emulsions  three  are  natural  emulsions ;  one 
is  artificial : 

Gm.  in  loo  Cc, 
Emulsum —  or  percentage  by  vol. 

Ammoniaci ammoniac  4 

Amygdalae sweet  almond  6. 

sugar  3 ;  acacia  i 

Asafoetida asafoetida,  in  select  tears  6, 

Chloroformi  ....  tragacanth  powd.  1.5  ;  chloroform  4, 

expressed  oil  almond  6 ;  water,  to  100. 


78  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Shake  the  Chloroform  and  Tragacanth  together  in  a  dry  bottle, 
incorporate  25  Cc.  Water,  then  the  Almond  Oil  in  small  quantities, 
and  finally  in  the  same  way  add  the  remainder  of  the  Water. 

Unofficial  Emulsions  of  the  National  Formulary. 

Emulsions  should,  of  all  pharmaceuticals,  be  prepared  within  a 
reasonable  period  previous  to  the  time  of  dispensing.  A  true 
emulsion  should  contain  the  oil  simply  suspended  in  the  form  of  a 
mechanical  mixture,  which,  from  its  very  character,  cannot  with- 
stand the  effects  of  variation  in  temperature  any  better  than  a 
natural  emulsion,  such  as  milk  or  emulsions  of  almonds,  gum- 
resins,  etc.,  and  consequently  quickly  degenerates  or  spoils. 

An  emulsion  may  be  perfect — that  is,  the  oil-globules  entirely 
extinguished — yet  a  separation  similar  to  that  occurring  in  milk 
will  take  place,  which,  though  in  its  first  stage  not  so  objection- 
able, will  eventually  impair  the  medicinal  value  of  the  preparation. 
These  reasons  are,  it  is  believed,  sufficient  to  condemn  the  various 
"  ready-made  "  or  patent  emulsions,  and  to  justify  the  physician  in 
prescribing  such  as  are  kept  on  hand  by  the  pharmacist,  in  smaller 
quantities,  prepared  according  to  these  formulas. 

A  typical  formula  for  emulsions,  with  Acacia,  is — 

'&!„  Olei  Morrhuse 120  Cc,    siv; 

Acaciae  pulv 30  Gm.,  |j ; 

Aquae q.  s.  ad  240  Cc,   Iviij. 

Emulsify  by  trituration  in  a  mortar,  and  add  the  flavoring. 

The  following  are  flavors  employed:  (i)  Gaultheria,  (2)  gaul- 
theria  and  sassafras,  (3)  aromatic  spirit,  (4)  gaultheria,  bitter  almond, 
and  coriander,  (5)  gaultheria,  sassafras,  and  bitter  almond,  (6)  gaul- 
theria and  bitter  almond,  (7)  oil  of  neroli,  bitter  almond,  and  cloves. 
Unless  otherwise  specified,  that  designated  as  No.  5  may  be  em- 
ployed in  these  Emulsions. 

The  following  formulas  may  be  useful  as  indicating  the  form  of 
prescription  for  any  combination  desired.  Hypophosphite  Salts  or 
any  medication  desired  may  usually  be  dissolved  in  the  water 
directed  in  the  formula,  should  a  preparation  be  indicated  different 
from  any  of  the  following  emulsions  of  the  N.  F. : 

Emulsio — 

Olei  Morrhu^  cum  Calcii  et  Sodii  Phosphatibus. — Cal- 
cium Phosphate,  Sodium  Phosphate,  of  each,  i  grain  in  i 
fluidrachm  (0.06  in  4  Cc). 


EXTRACTIVE  PREPARATIONS.  79 

Olei  MoRRHUiE  CUM  Calcii  Lactophosphate.  —  Calcium 
Lactophosphate,  3  grains  in  i  fluidrachm  (0.2  in  4  Cc). 

Olei  Morrhu^  cum  Calcii  Phosphate. — Calcium  Phos- 
phate, 2  grains  in  i.  fluidrachm  (0.12  in  4  Cc). 

Olei  Morrhu^  cum  Extracto  Malti. — Contains  40  per 
cent.  Extract  of  Malt. 

Olei  Morrhu^  cum  HypophosphitE. — The  Hypophosphite 
Salt  or  any  combination  of  the  following :  Calcium,  Po- 
tassium, Sodium,  or  Iron,  to  be  directed  by  the  prescriber, 
8  grains  to  the  fluidounce  (0.5  in  30  Cc). 

Olei  Morrhu^  cum  Pruno  Virginiana. — Wild  Cherry 
(Fluid  Ext),  \  fluidrachm  to  i  fluidounce  (2  Cc.  in  30  Cc). 

Olei  Ricini. — i  fluidounce  (30  Cc.)  contains  2\  fluidrachms 
(10  Cc.)  Castor  Oil,  disguised  by  the  addition  of  Vanilla. 

Olei  TEREBiNTHiNiE. — Contains  i  fluidrachm  (4  Cc.)  Oil  of 
Turpentine  i  fluidounce  (in  30  Cc),  prepared  according  to 
the  following  formula: 

I|i.  Olei  Terebinthinse 3iv,     12.5  Cc; 

Acacise  pulv gr.  xxx,       2.0 

Vitelli  Ovi  (Egg-yolk) ; 

Elixir  Aromaticae    ....  ana  giv,     i  S      Cc. ; 
Aquae  Cinnamomi   .    .    q.  s.  ad  Siv,   100     Cc. 
.  Make  an  emulsion  by  trituration  in  a  mortar. 

Phosphatica  (Phosphatic  Emulsion). — Prepared  with  Glycerite 
of  Egg-yolk,  and  contains  in  i  fluidounce  (30  Cc.)  Cod 
Liver  Oil,  2  fluidrachms  (8  Cc.) ;  Dilute  Phosphoric  Acid, 
22^  minims  (1.5  Cc);  Jamaica  Rum,  flavored  with  Bitter 
Almond  and  Orange  Flower  Water. 


EXTRACTIVE   PREPARATIONS. 

The  active  medicinal  constituents,  or  principles,  of  crude  drugs 
are  obtained  by  extraction.  Extraction  is  effected  either  by  macera- 
tion, expression,  and  filtration  or  straining,  or  by  maceration  with 
heat,  when  it  is  called  digestion,  or  by  percolation.  The  liquid 
employed,  termed  menstruum  (pi.  menstrua),  may  be  Water  or  Al- 
cohol, or  Alcohol  and  Water  in  various  proportions,  sometimes 
with  Glycerin.  A  few  drugs  require  alkaline  menstrua,  some 
acid  menstrua,  while  the  oleoresins  are  made  with  Ether. 


8o  A    TEXT-BOOK  OF  MA  TERIA   MEDIC  A. 

The  Infusions  and  Decoctions  are  the  simplest  preparations  made 
by  extraction,  and  represent  most  nearly  all  the  soluble  constitu- 
ents of  the  drugs.  But  not  all  drugs  are  adapted  to  this  method 
of  extraction  nor  to  this  exceedingly  effective,  though  not  espe- 
cially elegant,  form  of  exhibition. 

The  most  generally  convenient  and  effective  class  of  extractive 
preparations  are  the  Tinctures.  They  are  the  simplest  form  of  alco- 
holic preparations,  and  the  other  more  concentrated  preparations 
are  usually  first  obtained  as  tinctures  and  then  concentrated  by 
evaporation,  so  as  to  yield  the  fluid  extract,  extract,  or  resin 
respectively. 

The  only  accurate  method  for  determining  the  doses  of  extrac- 
tive preparations  is  to  compare  their  drug-strength. 

Thus,  the  doses  of  the  respective  preparations  of  Nux  Vomica, 
based  upon  their  relative  drug-strength,  would  be  as  follows : 

Average  Dose 
of  Drug.  of  Preparation. 


Tincture  .  .  .20%,  i  in  5,  3  grains  (0.2)=  15  minims  (i.  Cc). 
Fluid  Extract  100^,  i  in  i,  3  grains  (0.2)=  3  minims  (0.2  Cc). 
Extract  .    .    .  1000%,  10  in  i,  3  grains  (0.2)=^  grain  (0.02  Gm.). 

In  the  same  way  the  doses  of  the  preparations  of  Opium  may 
be  presented : 

Average  Dose 
of  Drug.  of  Preparation. 


Tincture  of  Opium    .     10%,  i  grain  (0.06)  =  10  minims  (0.6  Cc). 
"  "     deod.  10%,  I  grain  (0.06)  =  10  minims  (0.6  Cc). 

Vinegar  of  Opium  .  10%,  i  grain  (0.06)  =  10  minims  (0.6  Cc). 
Wine  of  Opium  .  .  10%,  I  grain  (0.06) -- 10  minims  (0.6  Cc). 
Extract  of  Opium     .  150%,  i  grain  (0.06)  =  f  grain       (0.04). 

While  the  preparations  of  these  two  drugs  are  standardized 
according  to  their  alkaloid  percentage  strength  in  the  U.  S.  P., 
such  strength  is  not  as  available  for  computing  or  estimating  doses 
as  is  the  drug-strength.  The  determination  of  alkaloidal  percentage 
in  preparations  is  a  check  upon  their  preparation,  but  is  not  of  so 
much  importance  to  the  physician  as  it  is  that  the  preparations  be 
made  by  a  skilful  and  conscientious  pharmacist,  from  the  very  best 
quality  of  material,  in  a  thorough  manner. 


EXTRACTIVE  PREPARATIONS.  8 1 

INFUSA— INFUSIONS. 
Unless  otherwise  directed,  Infusions  are  prepared  by  the  general 
official  process  : 

Of  the  Drug,  coarsely  comminuted 5  Gm. 

Boiling  Water 100  Cc. 

Pour  the  boiling  Water  on  the  Drug  in  a  suitable  vessel,  provided  with  a  cover,  and 
let  it  stand  for  half  an  hour ;  strain,  and  add  enough  Water  through  the  strainer  to  make 
100  Cc. 

Caution. — The  strength  of  Infusions  of  powerful  drugs — e.  g. 

Ipecac — should  be  especially  prescribed.     The  following  Infusions 

are  official,  being   prepared  of  different  strengths  and  by  other 

processes  than  directed  in  the  general  formula: 

Gm,  in  100  Cc. 

Infusum  Digitalis  .  alcohol,  10;  cinnamon  water,  15;  digitalis    1.5 
Infusum  Sennae  Comp.  (Black  Draught)  .    .  fennel  2 ;  senna    6. 
manna,  magnesium  sulph.,  of  each  12. 
Drugs  whose  active  principles  are  volatile  or  changed  by  heat 
are  prepared  by  percolation  without  heat,  or  cold  Infusion : 

Gm.  in  100  Cc. 

Infusum  Cinchonae  ....  acid  arom.  sulph.  i ;  cinchona    6. 
Infusum  Pruni  Virginianse wild  cherry    4. 

Unofficial  Infusions  of  the  National  Formulary. 
Infusum — 

Bravery  (U.  S.  P.  1880). — Brayera  (Cusso),  6 ;  Boiling  Water, 

100  Cc.     To  be  dispensed  without  straining  the  mixture. 
Gentians    Compositum    Fortius. — For   preparing   Infusum 

Gentianae  Compositum  by  mixing  i  volume  with  3  volumes 

of  water. 
Ros^  Compositum  (Compound  Infusion  of  Rose,  Ph.  Br.). — 

An  infusion  of  Red  Rose  in  diluted  Sulphuric  Acid,  Sugar, 

and  Water. 

The  Species  (Teas)  are  mixtures  of  drugs  contused  or  bruised 
for  the  preparation  of  Cataplasms;  or  Infusions  and  Decoctions, 
sometimes  designated  as  Haustus  (Draught).     The  following  are 
in  the  National  Formulary : 
Species — 

Emollientes  (Emollient  Cataplasm,  Ph.  Ger.). — A  mixture  of 
Althaea  Leaves,  Mallow  Leaves,  Melilot  Tops,  Matricaria, 
and  Flaxseed,  equal  parts  of  each. 


82  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Species — 

Laxantes  (St.  Germain  Tea,  Ph.  Ger.). — A  mixture  of  Senna, 

Elder-flowers,  Fennel,  Anise,  and  Potassium  Bitartrate. 
Pectorales  (Breast  Tea,  Ph.  Ger.). — A  mixture  of  Althaea, 
Coltsfoot,  Glycyrrhiza,  Anise,  Mullein  Flowers,  and  Orris 
Root. 

Infusum  Pectorale  (Pectoral  Infusion,  or  Infusion  of  Pec- 
toral Species)  is  made  by  infusing  i  troy  ounce  (30  Gm.) 
of  the  above  in  the  usual  manner,  so  as  to  obtain  10  fluid- 
ounces  (300  Cc.)  of  strained  product. 

DECOCTA— DECOCTIONS. 

Unless  otherwise  directed.  Decoctions  are  prepared  according 
to  the  following  general  process : 

Of  the  Drug,  coarsely  comminuted 5  Gm. 

Boiling  water,  to  make 100  Cc. 

Pour  the  boiling  Water  on  the  Drug,  contained  in  a  suitable  vessel  provided  with  a 
cover,  bring  it  to  a  boil,  and  let  it  boil  for  fifteen  minutes;  let  it  cool  to  40°  C.  (104°  F.), 
express,  strain,  and  add  cold  Water  through  the  strainer  to  make  ICK)  Cc. 

Caution  as  with  Infusions. 

The  following  Decoctions  are  official,  as  being  made  of  strengths 
and  methods  other  than  those  directed  in  the  general  process : 

Gm.  in  too  Cc. 

Decoctum  Centrariae Iceland  moss         5. 

Decoctum  Sarsaparillae  Comp.  mezereum  i  ;  sarsaparilla       10. 
glycyrrhiza,  sassafras,  guaiac  wood,  of  each         2. 

Decoctum  Aloes  Compositum,  N.  F.,  is  a  mixture  of  Ext.  Aloes, 
Myrrh,  Saffron,  Potass.  Carb.,  Ext.  Glycyrrh,  Tinct.  Cardamom 
Comp.,  and  Water. — Extempore. 

ACETA— VINEGARS. 

The  Vinegars  are  made  by  extraction  with  Dilute  Acetic  Acid. 
By  maceration : 

Gm.  in  100  Cc. 

Acetum  Opii  (Black  Drop)  .  sugar  20;  nutmeg  3 ;  opium       10. 
Scillse squill       10. 

The  Vinegars  of  Lobelia  and  Sanguinaria  (U.  S.  P.  1880)  were  of  the  same  strength. 
VINA— WINES. 

The  Wines  are  made  by  solution,  by  maceration,  or  by  macera- 
tion and  percolation.    The  Menstruum  is  White  Wine,  to  which  from 


EXTRACTIVE  PREPARATIONS.  83 

10  to  15  per  cent,  of  Alcohol  is  added  to  aid  in  the  extraction  and 
the  preservation.     There  are  ten  Wines  official. 

The  Natural  Wines :  Vinum  Album  and  Vinum  Rubrum  are 
treated  under  Alcohol. 

Vinum —  Gm.  in  100  Cc. 

Antimonii  .    .    .    antimony,  potass,  tart.  (sol.  water)  0.4 

Colchici  Radicis colchicum  root  40. 

Colchici  Seminis colchicum  seed  15. 

Ergotse ergot  15. 

Ferri  Amarum  .    .   soluble  iron  and  quinine  citrate         5. 

(Bitter  Wine  of  Iron)  tinct.  orange  peel  1 5  ;  syrup  30. 

Ferri  Citratis     ....  iron  and  ammonium  citrate  4. 

syrup  10;  tinct.  orange  peel  15. 

Ipecacuanhae alcohol  10 ;  fl.  ext.  ipecac  10. 

Opii cinnamon,  cloves,  each,  I ;  opium  10. 

The  Dose  of  the  Vinegar  and  Wine  of  Opium  is  the  same,  10 
minims  (0.6)  representing  i  grain  (0.06)  opii  pulvis.  The  dose  of 
the  Wine  of  Colchicum  Root  is  10  minims  (0.6),  it  being  nearly 
three  times  the  strength  of  the  Wine  of  Colchicum  Seed,  of  which 
the  dose  is  30  minims  (2  Cc). 

Unofficial  Wines  of  the  National  Formulary. 
The  Wines,  with  a  few  exceptions,  are  prepared  with  White 
Wine  (Vinum  album.,  U.  S.),  usually  with  the  addition  of  10  per 
cent,  of  Alcohol,  in  order  better  to  preserve  the  preparation. 
Vinum — 

Aloes  (U.  S.  P.  1880). — Representing  6  per  cent,  of  Aloes 

with  Aromatics. 
AuRANTii. — Sherry  Wine  flavored  with  Orange. 
AuRANTii  CoMPOSiTUM  (EHxir  Aurantiorum  Compositum). — A 
combination  of  Bitter  Orange  Peel,  Absinthium,  Menyanthes, 
Cascarilla,  Cinnamon,  and  Gentian,  in  Sherry  Wine.     Useful 
as  a  stomachic  tonic  in  doses  of  i  fluidrachm  (4  Cc). 
Carnis  (Beef  and  Wine). — Each  fluidrachm  (4  Cc.)  represents 
2  grains  (0.12)  of  Extract  of  Beef. 

The  Extract  of  Beef  in  this  and  similar  preparations  is  that  which  is  pre- 
pared by  Liebig's  method. 
Carnis  et  Ferri  (Beef,  Wine,  and  Iron). — Each  fluidrachm 
(4  Cc.)  represents  2  grains  (0.12)  of  Extract  of  Beef  and 
2  minims  (0.12)  Tincture  of  Citro-chloride  ("Tasteless" 
Tincture)  of  Iron. 


84  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Vinum — 

Carnis,  Ferri  et  Cinchona  (Beef,  Wine,  Iron,  and  Cinchona). 

—Each  fluidrachm(4  Cc.)  represents  2  grains  (0.12)  Extract 

of  Beef,  2  minims  (0.2)  Tincture  Citro-chloride  of  Iron,  and 

small  quantities  of  Cinchona  alkaloids,  in  Angelica  Wine. 
Coc^  (Erythroxyli).— Each  fluidounce  (30  Cc.)  represents 

30  grains  (2  Gm.)  of  Coca  in  Claret  Wine. 
Coc^  Aromaticum. — Each  fluidounce  (30  Cc.)  represents  30 

grains  (2  Gm.)  of  Coca  with  Aromatics. 
Fraxini  Americans  (White  Ash). — Each  fluidrachm  (4  Cc.) 

represents  30  grains  (2  Gm.)  of  Fraxinus  (bark). 
Pepsini  (Pepsin). — Each  fluidrachm  (4  Cc.)  represents  i  grain 

(0.06)  of  Pepsin. 
Picis  (Tar). — A  saturated  solution  of  Tar,  in  Sherry  Wine. 
Pruni  Virginians  (Wild  Cherry). — Each  fluidrachm  (4  Cc.) 

represents  15  grains  (i  Gm.)  of  Wild  Cherry,  in  Angelica 

Wine. 
Pruni  Virginians  Ferratum  (Wild  Cherry,  Ferrated). — Each 

fluidrachm  (4  Cc.)  represents  5  minims  (0.3  Cc.)  of  Tincture 

of  Citro-chloride  of  Iron  and  13!  grains  (0.9  Gm.)  of  Wild 

Cherry,  in  Angelica  Wine. 
Rhei  (U.  S.  p.  1880). — Representing  10  per  cent,  of  Rhubarb 

and  I  per  cent,  of  Calamus. 

TINCTUR.(E— TINCTURES. 

Tinctures  are  liquid  preparations  made  by  the  extraction  of 
Drugs  with  menstrua  of  Alcohol  and  Water  in  various  propor- 
tions. They  are  prepared  by  maceration  and  filtration ;  also  by 
percolation : 

By  maceration  and  filtration,  those  containing  resins  and  oleo- 
resins.  Musk,  and  tinctures  of  fresh  herbs ;  in  a  few  instances  with 
heat,  the  Tincture  of  Quillaja  and  Tincture  of  Strophanthus. 

'Qy  percolation,  when  prepared  from  dried  vegetable  drugs — i.  e. 
barks,  leaves,  roots,  etc.,  usually  after  brief  maceration. 

By  solution,  mixing  a  solution  (chloride  of  iron)  or  dissolving 
a  solid  in  Alcohol  (Iodine,  Ext.  Nux  Vomica). 

Assayed  Tinctures. — Two  of  the  most  important  Tinctures  are 
required  to  be  of  certain  specified  alkaloidal  strengths,  and  their 
classification  according  to  their  respective  drug-strengths  is  there- 
fore only  approximately  correct. 

Tinctura  Opii  is  made  so  as  to  represent  from   1.3  to  1.5  per 


EXTRACTIVE  PREPARATIONS. 


85 


cent,  of  crystallized  morphine,  the  proportion  obtained  from  10  per 
cent,  of  Opii  Pulvis,  U.  S. 

Tinctura  Nucis  Vomicce  is  made  by  solution  of  2  per  cent,  of  the 
official  Extract,  representing  about  ten  times  its  weight  of  the  drug ; 
the  Tincture  therefore  represents  20  per  cent,  of  the  drug,  and  con- 
tains 0.3  per  cent,  total  alkaloids. 

TincturaB  Herbarum  Recentium, — Tinctures  of  Fresh  Herbs, 
or  "  Green  Tinctures,"  similar  to  the  Homoeopathic  or  so-called 
"  German  Tinctures,"  also  to  the  specific  tinctures  of  the  Eclectics, 
when  not  otherwise  directed  are  to  be  prepared  by  the  following 
general  formula: 

Take  of  the  fresh  herb,  bruised  or  crushed,  50  Gin. ;  macerate  for  fourteen  days  in 
Alcohol  100  Cc. ;  express  the  liquid  and  filter. 


Tinctures  of  the  U.  S.  P. 


Name. 


Tinctura — 
Aconiti 

Aloes     . 


Aloes  et  Myrrhse . 

Arnicas  Florum 
Arnicae  Radicis     .    . 
Asafoetidae     .... 
Aurantii  Amarse  .   . 
Aurantii  Dulcis     . 
Belladonnae  Foliorum 
Benzoini    .... 

Benzoini  Composita 
(Turlington's  Bal- 
sam). 


Bryoniae     ... 
Calendulas     .    . 
Calumbae  .    .    .    , 
Cannabis  Indicse  . 
Canlharidis   .    .    . 

Capsici 

Cardamomi    .    .    , 


Cardamom! 
Composita 


} 


Gm. 

Drug.  in 
100  Cc. 

■  Root 35 

f  Aloes     ....  lo  ■ 

I  Licorice     ....  10 

/■Aloes 10  ■ 

]  Myrrh lo 

I  Licorice 10  . 

.  Flowers 20 

.  Root 10 

.  Gum  resin      ...  20 

.  Bitter  Orange  peel  20 

.  Sweet 20 

.  Leaves  .....  15 

.  Balsam 20 

'Benzoin      ....  12 

Storax 8 

Tolu 4 

-  Aloes 2 . 

Root 10 

Florets 20 

Root  .••...  10 

Flower  tops  ...  15 

Insect     5 

Fruit S 

Fruit 10 

Cardamom  ....  2' 

Cassia  Cinnam.  .    .  2 

Caraway      ....  I 

Cochineal   ....  0.5 

Glycerin 50 


Menstrua. 
Alcoholf         Drug, 
per  cent.  Grains.  Gm. 

0.06 


Average  Dose. 


70 

SO 

75 

5° 
65 

100 
60 

100 

50 
100 


100 

100 

60 

100 

100 

95 

50 


50 


3 
3 
6 
6 
6 

6 


Rep. 
Cc. 


0.4 

0.8 

0.2 
0.2 
0.4 
0.4 
0.4 
O.I 

0.4 

o-S 

0.2 

0.4 
0.4 

°-3 
0.015 
0.1 
0.4 


I. 

2. 

2. 

2. 

2. 

0.6 

2. 


2. 

2. 

4- 
2. 

0-3 
2. 

4- 


Ttnci. 
Min. 

3 
60 

60 

'5 
30 
30 
30 
30 

ID 
30 

30 

30 
30 
60 

30 

5 
30 
60 


60 


86 


A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 


Average  Dose, 


Gm. 


Name. 


Drug, 


Menstrua, 
Alcohol, 


Tinctura — 

Catechu  Composita 


Drug. 
100  Cc,    percent.  Grains,  Gm, 


Rep.  Tinct, 
Cc.       Mia. 


Chiratse 

CimicifugEe  .    . 

Cinchonce  .    .        .    . 

Cinchonte  Composita 
(Huxham's   Tinc- 
ture). 

Cinnamomi 
Colchici  Seminis 
Croci      .        .    . 
CubebK 
Digitalis    .    . 
Ferri  Chloridi  . 
Gallse    .        .    . 
Gelsemii    .    .    . 


Catechu    .    . 

Cinnamon     . 

Herb         .    . 

Rhizome    .    . 

Bark.    .    .    . 
'  Red  Cinchona 

Bitter  Orange  peel 

Serpentaria 
.  Glycerin 

Ceylon 

Seed 

Saffron  . 

Fruit     . 

Leaves  . 

.Solution 

Nutgall 

Root     . 
r  Gentian 
Gentianae  Composita  J  Bitter  Orangi 
I  Cardamom 

Guaiaci Resin    . 

Guaiaci  Ammoniata  .    .  Resin 

Humuli Hops    . 

Hydrastis Rhizome 

Hyoscyami    ...        .  Herb 

lodi Iodine  . 

I  Ipecac  . 
Ipecacuanhas  et  Opii    (  Qpium  deod 

Kino Insp.  juice 

Kramerise Rhatany  . 

Lactucarii Insp.  juice 

-Oil  Lavender 

Oil  Rosemary 

Cinnamon    . 

Cloves  .    .    . 

Nutmeg   .    . 

Red  Saunders 

Lobelia Herb     .    .    . 

Matico Leaves  . 

Moschi Musk    .    .    . 

Myrrhse         Gum  resin    . 

Nucis  Vomicae  ....  Extract     .    . 
Opii Pulv.  Opium 

Opium  pulv. 


Opii  Camphorata  , 
(Paregoric.) 


Lavandulae  Composita 
(For  flavoring.) 


Acid  Benzoic 
Camphor  .    . 
Oil  Anise 
.  Glycerin   ,    . 


10  I 

lO    ) 
lO 
20 
20 

8 

2 

7-SJ 

lO 

IS 

lO 
20 
IS 

2SCc. 

20 

IS 
lO 

4 
I 

20 
20 
20 
20 
IS 

7 
10  I 

10] 

10 

20 

SO 
0.8 

0.2 
2. 

0-5 

I. 

I. 

20 
lO 

s 

20 

2 

10 

0.4 
0.4 
0.4 
0.4 

4- 


SO 
65 

ICO 

67 
85 

7S 
60 

SO 

100 

SO 

75 
90 

6S 
60 


SO 

50 

SO 

100 

20 

65 
50 
SO 


7S 


50 
SO 
SO 

I  GO 

75 
SO 


6 
12 
12 


4 
12 

2i 


12 

6 
12 
12 

5 


0.8 

0.4 
0.8 
0.8 

0.8 


0.4 

0.3 

0.4 

0.8 

CIS 

0.25 

0.8 

0.15 

0.8 

0.8 
0.4 
0.8 
0.8 
03 


4- 
4- 

4- 


Only  externally, 
I         0.06 
6 


0.4 
12        0.8 
For  syrup. 


6 

3 

ij 

6 


0.4 

0.2 

0.1 

0.4 

0.02 

0.06 


2. 
2. 
2. 

2. 
1. 

0.6 


50 


Opium 
1 


0.015    4- 


60 

60 
60 
60 

60 

60 

30 
60 
60 
15 
IS 
60 

15 
60 

60 

3° 
60 
60 
30 


60 
60 


30 


30 
30 
30 
30 
IS 
10 


60 


EXTRACTIVE  PREPARATIONS. 


87 


Drug. 

Cm. 

in 

Menstrua 
Alcokoi, 

Average  Dose. 

Name. 

Drug. 

Rep. 

Tinct. 

Tinctura — 

100  Cc 

.    per  cent. 

Grains 

.  Gm. 

Cc. 

Min. 

Opii  Deodorata    .    . 

Opium  .    . 

.     .        10 

20 

I 

0.06 

0.6 

10 

Physostigmatis  .    .    . 

Calabar  Bea 

n  .    .       15 

too 

I 

0.06 

0.4 

7 

Pyrethri         .... 

Pellitory   . 

.    .       20 

100 

Externally. 

Quassise 

Wood    .    . 

.    .       10 

3S 

3 

0.2 

2. 

30 

Quillajse    .... 

Soap  Bark 

.    .       20 

3S 

6 

0.4 

2. 

30 

Rhei [Rhubarb. 

(.  Cardamom 

:.  'D  ^ 

8 

o-S 

4- 

60 

r  Rhubarb  . 
Cinnamon 

20- 

•    •        4 

Rhei  Aromatica    .    . 

Cloves  .    . 

■    •        4 

SO 

IS 

I. 

4- 

60 

(For  syrup.) 

Nutmeg 
.  Glycerin   . 

.    .        2 

.    .      10. 

'  Rhubarb  .    . 

10 

Rhei  Dulcis  (Sweet  | 
Tincture  of  Rhu-   '  " 

Glycyrrhiza 
Anise    .    . 

•    ■        4 
■    .        4 

50 

,   . 

a. 

120 

barb.)                   ■' 

Cardamom 

'-  Glycerin 

.    .        I 

.    .      10-' 

Sanguinarise  .... 

Blood-root 

IS 

60 

5 

0.3 

2. 

30 

SciUae 

Squill    .    , 

•   ■      IS 

7S 

2J 

0.15 

I. 

IS 

Serpentarise  .    . 

Rhizome 

.   .      10 

65 

6 

0.4 

4- 

60 

Stramonii  Seminis    . 

Seed     .    . 

•   •      IS 

50 

H 

oiS 

I. 

15 

Strophanthi       .    .    . 

Seed     .    . 

•     s 

65 

i 

0.015 

°-3 

s 

Sumbul 

Musk-root 

.     .        lO 

6S 

3 

0.2 

2. 

30 

Tolutana  .        ... 

Tolu     . 

.    .      10 

100 

3 

0.2 

2. 

30 

ValerianEe      .... 

Root     .    . 

20 

7S 

12 

0.8 

4- 

60 

Valerianae  Ammoniatse 

Root 

20 

6 

0.4 

2. 

30 

Vanillse         .    .    . 

Fruit     .    . 

.   .      10 

6S 

3 

0.2 

2. 

30 

Veratri  Viridi    .    .    . 

Rhizome  . 

40 

ICO 

2 

0.12 

0.3 

s 

Zingiberis  .           .    . 

Ginger  .    . 

20 

100 

6 

0.4 

2. 

30 

Unofficial  Tinctures  of  the  National  Formulary. 
Tinctura — 

Amara  (Bitter  Tincture,  Ph.  Ger.). — Containing  Gentian,  Cen- 
taury, Bitter  Orange  Peel,  Orange  Berries,  and  Zedoary. 

Antacrida  (Dysmenorrhcea  Mixture ;  Fenner's  Guaiac  Mix- 
ture).— A  mixture  of  Guaiac,  Canada  Turpentine,  Oil  of  Sas- 
safras, and -^  grain  (0.02)  Corrosive  Mercuric  Chloride  in  each 
fluidrachm  (4  Cc).  Dose,  from  10  to  20  minims  (0.6  to 
1.3  Cc). 

Antiperiodica  (Warburg's  Tincture). —  With  Aloes:  Rhubarb, 
Angelica  Seed,  of  each,  grains  $6  (4.) ;  Elecampane,  Saf- 
fron, Fennel,  of  each,  grains  28  (2.) ;  Aloes  (aq.  ext.),  Gen- 
tian, Zedoary,  Cubeb,  Myrrh,  White  Agaric,  Camphor,  of 
each,  grains  14  (i.);  Quinine  Sulphate,  grains  160  (10.); 
Diluted  Alcohol,  enough  to  make  fluidounces  16  (473  Cc). 


88  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Tinctura — 

Antiperiodica  (Warburg's). — The  preceding  without  Aloes. 
Each  fluidounce  (30  Cc.)  of  either .  tincture  contains  10 
grains  (0.6)  of  Quinine  Sulphate. 

Aromatica  (Stomachic,  Ph.  Ger.). — A  combination  of  Cinna- 
mon, Ginger,  Galangal,  Cloves,  and  Cardamom. 

Capsici  et  MyrrHjE  (Hot  Drops). — The  preparation  popularly 
known  as  "  Number  Six." 

Cinchona  Detannat^. — For  admixture  with  preparations 
containing   Iron. 

CoNii  (U.  S.  P.  1880). — Representing  15  per  cent,  of  Conium. 

CoTO. — This  preparation  contains  'j\  grains  (0.5)  true  Bolivian 
Bark  in  each  fluidrachm  (4  Cc).  The  Para  Coto,  frequently- 
employed,  differs  considerably  from  the  above. 

Ferri  Chloridi  .(Etherea  (Bestucheff's  Tincture ;  Lamott's 
Drops,  Ph.  Ger.). — Each  fluidrachm  (4  Cc.)  represents  about 
\  grain  (0.3)  Metallic  Iron. 

Ferhi  Citro-chloridi  (Tasteless  Tincture  of  Iron). — Practi- 
cally identical  in  the  strength  of  Iron,  but  not  in  Alcohol, 
with  the  officinal  Tincture  of  Chloride  of  Iron,  containing  an 
amount  of  Iron  equivalent  to  7J  grains  (0.5)  of  Dry  Chloride 
of  Iron  in  each  fluidrachm  (4  Cc). 

A  convenient  form  of  Iron  for  admixture  with  Tinctures 
of  vegetable  astringent  drugs,  such  as  Gentian  and  Cinchona, 
preparations  of  which  it  does  not,  unlike  other  iron  com- 
pounds, discolor. 

Ferri  Pomata  (Ferrated  Extract  of  Apples ;  Malate  of  Iron, 
Ph.  Ger.). — Each  fluidrachm  (4  Cc.)  represents  about  | 
grain  (0.025)  of  Metallic  Iron. 

GuAiAci  CoMPOSiTA  (Dewccs'  Tincture  of  Guaiac). — Each 
fluidrachm  (4  Cc.)  represents  7 J  grains  (0.5)  Guaiac. 

Ignati^  (U.  S.  p.  1880). — Representing  10  per  cent,  of 
Ignatia. 

loDi  (Churchill's). — A  solution  of  10  grains  (0.6)  Iodine  in 
each  fluidrachm  (4  Cc),  with  Potassium  Iodide  in  Alcohol. 
Not  to  be  confounded  with  Churchill's  Iodine  Caustic 
(Liquor  lodi  Causticus). 

loDi  Decolorata  (Colorless  Tincture  of  Iodine). — Contain- 
ing about  I  per  cent,  of  Ammonium  Iodide,  with  some 
other  Iodine  compounds,  in  alcoholic  solution ;  for  external 
use. 


EXTRACTIVE  PREPARATIONS.  89 

Tinctura — 

jALAPiE  (U.  S.  P.  1870). — Each  fluidrachm  (4  Cc.)  represents 
about  10  grains  (0.6)  Jalap. 

jALAPiE  CoMPOSiTA. — Each  fluidrachm  (4  Cc.)  represents  7J 
grains  (0.5)  Jalap  and  about  2  grains  (0.12)  Scammony. 

Kino  Composita — 

Tinctures  of  Kino,  Opium,  each  .    .    minims  180      12.      Cc. 
Spirit  of  Camphor    ........         "         130        8.5 

Oil  of  Cloves "  2\     0.15 

Aromatic  Spirit  of  Ammonia     .    .        "  15        i. 

Cochineal grains      16        i. 

Diluted  Alcohol  to  make  fluidounces  4  .    .    .    .120. 

Each  fluidrachm  (4  Cc.)  represents  \  grain  (0.03),  each, 
of  Kino  and  Opium. 

Papaveris  (Poppy). — Each  fluidrachm  (4  Cc.)  represents  30 
grains  (2.)  of  Poppy  (Capsule). 

Pectoralis  (Bateman's  Pectoral  Drops). — A  popular  mixture 
of  Opium,  Catechu,  Camphor,  and  Oil  of  Anise,  containing 
2\  minims  (0.15)  Tincture  of  Opium  {^  grain  Pulv.  Opium) 
in  each  fluidrachm  (4  Cc). 

Persionis  (Cudbear). — Intended  as  a  coloring  agent  when  a 
bright-red  tint  or  color  is  to  be  produced,  particularly  in 
acid  liquids. 

Persionis  Composita. — A  mixture  of  Cudbear  and  Caramel, 
intended  as  a  coloring  agent  when  a  brownish-red  tint  or 
color  is  to  be  reproduced. 

Pimpinell^  (Pimpinella,  Ph.  Ger.). — Each  fluidrachm  (4  Cc). 
represents  about  10  grains  (0.6)  Pimpinella  Root. 

Rhei  Aquosa  (Rhubarb,  Aqueous,  Ph.  Ger.). — Each  fluid- 
drachm  (4  Cc.)  represents  about  5f  grains  (0.4)  of  Rhu- 
barb, with  alkalies,  flavored  with  Cinnamon. 

Rhei  et  Gentian^e. — Each  fluidrachm  (4  Cc.)  represents  5 
grains  (0.3)  of  Rhubarb  and  I  grain  (0.06)  of  Gentian. 

Rhei  Vinosa  (Rhubarb,  Vinous,  Ph.  Ger.). — Each  fluidrachm 
(4  Cc.)  represents  about  5  grains  (0.3)  Rhubarb,  with  Bitter 
Orange  and  Cardamom,  in  Sweet  Sherry  Wine. 

Saponis  Viridis  Composita. — A  solution  of  about  15  per 
cent,  of  Green  Soap  and  2  per  cent,  of  Oil  of  Cade. 

Tincture  .^there^  (Ethereal  Tinctures). — The  drug,  prop-  • 
erly  comminuted,  troy  ounces  2  (60  Gm.) ;  Stronger  Ether, 
I   volume ;  Alcohol,  2  volumes ;  enough  to  make   fluid- 


go  A    TEXT-BOOK  OF  MA  TREIA    MEDICA. 

Tinctura — 

ounces  i6  (473  Cc).  A  general  formula  for  the  prepara- 
tion of  Ethereal  Tinctures  of  Belladonna,  Castor,  Digitalis, 
Lobelia,  Valerian,  and  other  drugs.  Official  in  several 
European  pharmacopoeias,  and  sometimes  prescribed  by- 
foreign  physicians. 

ToLUTANA  SoLUBiLis  (Tolu,  Soluble). — A  so-called  soluble 
essence   of   Tolu,  for  flavoring. 

Vanillini  Composita. — A  solution  of  Vanillin  and  Coumarin,, 
intended  for  flavoring. 

Zedoari^  Amara  (Zedoary  Comp.). — Similar  to,  but  not 
identical  with,  the  Tinctura  Carminativa,  Wedelii,  etc.,  for- 
merly official  in  some  Continental  pharmacopoeias. 

Each  fluidrachm  (4  Cc.)  represents  15  grains  (i  Gm.)  of 
Zedoary,  7^  grains  (0.5)  of  Aloes,  and  3f  grains  (0.25),  each, 
of  Rhubarb,  Gentian,  White  Agaric,  and  Saffron. 

EXTRACTA  FLUIDA— FLUID  EXTRACTS. 

Fluid  Extracts  may  be  defined  as  a  class  of  concentrated 
tinctures  of  such  strength  as  to  represent  the  drug,  volume  for 
weight. 

The  fluid  extracts  of  the  U.  S.  P.  previous  to  1880  represented 
I  grain  of  drug  in  i  minim,  or  i  troy  ounce  in  i  fluidounce.  In 
the  U.  S.  P.  of  1880  the  standard  adopted  was  i  Gm.  in  i  Cc,  and 
this  strength  has  been  retained  as  the  standard  of  the  U.  S.  P.  1890. 

Fluid  extracts  are  made  by  percolation,  maceration,  or  digestion. 
Except  on  a  large  scale  or  by  fractional  percolation,  they  cannot 
be  prepared  by  simple  percolation  without  evaporation  to  concen- 
trate the  percolate  to  the  required  measure. 

Fractional  percolation  or  repercolation,  or  simultaneous  frac- 
tional percolation,  by  employment  of  which  the  use  of  heat  for 
concentrating  the  percolate  is  avoided,  may  be  used  to  advantage 
when  the  quantity  operated  upon  is  sufficiently  large  to  warrant 
the  greater  time  and  attention  required. 

The  following  is  the  process  chiefly  employed : 

In  proceeding  to  percolate  100  Gm.  of  the  drug,  according  to 
directions,  the  first  80  to  90  Cc.  are  reserved,  and  percolation  con- 
tinued until  the  exhaustion  is  completed.  The  weak  percolate  is 
evaporated  to  a  soft  extract  (the  alcohol  being  recovered)  and  dis- 
solved in  the  reserved  percolate.  Sufficient  menstruum  is  then 
added  to  make  the  product  measure   100  Cc. 


EXTRACTIVE  PREPARATIONS. 


Official  Name 
Extractutn  Fluidum — 


of  Drug, 


91 

Average  Dose. 
Cc.  Minints. 


Aconiti  . 
Apocyni    .    .    . 
Arnicse  Radicis     . 
Aromaticum  .    ,    . 
Asclepiadis    .    .    . 
Aspidospermatis 
Aurantii  Amari 
Belladonnse  Radicis 
Buchu    .        ... 

Calami 

Calumbse  .... 
Cannabis  Indicee  . 
Capsici  ... 
Castaneae  .    .    . 
Cliimaphilae  .    .    . 

Cliiiatse 

Cimicifugae  .  .  . 
Cinchonse  .... 
Cocse.  .    .    . 

Colchici  Radicis  . 
Colchici  Seminis  . 

Conii 

Convallkriae  .  .  . 
Cubebse  .  .  . 
Ciisso  .... 
Cypripedii  .  .  . 
Digitalis  .... 
Dulcamaise  .  .  . 
Ergotse  ... 
Eriodictyi  .... 
Eucalypti  .... 


Eupatorii  .    . 
Frangulse  .    .    .    . 
Gelsemii    .    .    .    . 
Gentianae  .    .    .    . 

Geranii 

Glycyrrhizae  .  .  . 
Gossypii  Radicis  , 
Grindeliae .  .  .  . 
Guaranse  ,    , 

Hamamelidis  .  . 
Hydrastis  .  .  .  , 
Hyoscyami  .  .  . 
Ipecacuanhse  .  , 
Iridis  .    . 

Krameriae  .   .    .    - 

Lappse 

Leptandrse    .   .    . 


Aconitum  Napellus Tuber    . 

Apocynum  Cannabinum  .    .        .    ,  Root  . 

Arnica  montana Root  ... 

Pulvis  Aromaticus 

Asclepias  tuberosa Root  .    . 

Aspidosperma  Quebracho-bianco   .  Bark      .   , 

Citrus  vulgaris  Rind  .    . 

Atropa  Belladonna Root  .    .    , 

Barosma  betulina Leaves  . 

Acorus  Calamus Rhizome   , 

Jateorrhiza  palmata Root  .    .    , 

Cannabis  sativa Fl.  Tops 

Capsicum  fastigiatum       Fruit  .    . 

Castanea  dentata Leaves  .    , 

Chimaphila  umbellata Leaves  .    , 

Swertia  Chirata  Plant .    .    , 

Cimicifuga  racemosa   ...  .  Rhizome    , 

Cinchona  Calisaya Bark  . 

Erythroxylon  Coca Leaves  .    , 

Colchicum  autumnale       Corm 

Colchicum  autumnale Seed  . 

Conium  maculatum Fruit .    .    . 

Convallaria  majalis Rhizome 

Piper  Cubeba Fruit .    . 

Hagenia  Abyssinica Inflor.    .    . 

Cypripedium  pubescens Rhizome    , 

Digitalis  purpurea Leaves  .    , 

,  Solanum  Dulcamara        Branches  . 

.  Claviceps  Purpurea Sclerotium 

,  Eriodictyon  glutinosum Leaves  . 

Eucalyptus  globulus Leaves  . 

Eupalorium  perfoliatum       ....  Herb .    . 

Rhamnus  Frangula Bark  .    . 

Gelsemium  sempervirens    ....  Rhizome 
Gentiana  lutea  .    .  ....  Root  . 

,  Geranium  maculatum Rhizome 

Glycyrrhiza  glabra Root  . 

Gossypium  herbaceum Root  Bark 

Grindelia  robusta Leaves  . 

FauUinia  Cupana Seeds 

Hamamelis  Virginiana Leaves  . 

Hydrastis  Canadensis Rhizome 

Hyoscyamus  niger Herb 

Cephaelis  Ipecacuanha Root  . 

Iris  versicolor  Rhizome 

,  Krameria  triandra Root  .    . 

Arctium   Lappa Root  .    . 

Veronica  Virginica Rhizome 


.  0.06 
.  I. 
,0.5 
.0.5 
.  2. 
,  2. 
,  I. 
,  0.2 
.  2. 


,  2. 
,0.6 
,  0.2 

.  4- 

2. 

2. 

2. 
,  2. 

2. 
.0.3 

0-3 

0.25 

0.6 

2. 

4- 

,  0.12 

2. 

2. 
.  2. 

I. 

2. 

•  4- 

.  0.2 

1-3 
2. 

4- 

2. 

.  2. 

•  4- 
.  2. 
.  2. 

0-3 
.  0.06-2. 

.  I. 
.  2. 
.  2. 
.  2. 


I 
15 


30 
30 
15 
3 
30 
30 
30 
10 

3 
60 

30 
30 
■30 
30 
30 

5 

5 

4 
10 

30 
60 

'5 
2 

3° 
30 
30 
IS 
30 
60 

3 
20 

30 
60 

3° 
3° 
60 

30 
3° 
S 
1-30 

IS 
30 
30 
3° 


92 


A    TEXT- BOOK  OF  MA  TERIA  MEDIC  A. 


Average  Dose. 


Ojffkial  Name 
Extractum  Fluidum 
Lobelise     .... 
LupuUns  .    .    . 

Matico  .... 
Menispermi  .    .    .    . 

Mezerii 

Nucis  VomicEe  .    .    . 

Pareirae 

Phytolacca  Radicis   . 
Pilocarpi    ... 
Podophylli     .    .    .    . 
Pruni   Virginianae    . 

Quassise 

Rhamni  Purshianse   . 

Rhei 

Rhois  Glabra  .   .    . 

Rosse 

Rubi 

Rumicis 

Sabinse 

Sanguinarias  .   .    .    . 
Sarsaparillae  .... 

Sarsaparillae  Com- 
positum 


Drug. 


Part. 


Cc. 


Scilte 

Scoparii     .    .    . 
Scutellariae    .    .    . 

SenegEe 

Senn^  .... 
SerpentariiE  .  .  . 
Spigelise  .  .  . 
StillingiEE  . 
Stramonii  Seminis 
Taraxaci    .... 

Tritici 

Uvae  Ursi  .... 
Valerianae  .  . 
Veratri  Viridis  .  . 
Viburni  Opuli 
Viburni  Prunifolii 
Xanthoxyli  .  .  . 
Zingiberis  .... 


Lobelia  inflata Herb  ....  0.6 

Humuliis  Lupulus Powder .    .    .0.6 

Piper  Angustifolium Leaves  ...  4. 

Menispermum  Canadense    ....  Rhizome    .    .  2. 

Daphne  Mezereum Bark  .    .        .  0.3 

Strychnos  Nux-vomica Seed  ....  0.2 

Chondodendrum  tomentosum  .    ,    .  Root  ....  2. 

Phytolacca  decandra  ....  Root' ....  0.5 

Pilocarpus  Selloanus  (Jaborandi)   .  Leaves  ...  2. 

Podophyllum  peltatum     .        ...  Rhizome    .    .  0.6 

Prunus  serotina Bark  .        .    .  2. 

Picr^na  excelsa Wood    .    .    .0.5 

(Cascara  sagrada) Bark  ....  2. 

Rheum  officinale Root  .    .    .    .1. 

Rhus  glabra Leaves  ...  2. 

Rosa  Gallica Petals    ...  2. 

,  Rubus   villosus         Root  Bark     .  2. 

Rumex  crispus Root  ....  4. 

.  Juniperus  Sabina Tops  ....  0.5 

,  Sanguinaria  Canadensis Rhizome    .    .  0.3 

Smilax   officinalis,  etc Root  ....  4. 

Sarsaparilla,  75 

Glycyrrhiza,  12 

Sassafras,        10 

Mezereum,       3 

Urginea  maritima Bulb  ....  0.3 

Cytisus    Scoparius Tops  ....  I. 

Scutellaria  lateriflora Herb      ...  2. 

Polygala  Senega Root  ....  0.3 

.  Cassia  acutifoha  and  Angust.      .    .  Leaves  ...  4. 

Aristolochia  Serpentaria Rhizome  .    .1. 

Spigelia  Marilandica Rhizome    .    .  2. 

Stillingia  sylvatica Root  ....  2. 

Datura  Stramonium Seed  ....  0.2 

Taraxacum  officinale Root  ....  4. 

Agropyrum  repens Rhizome    .    .  4. 

Arctostaphylos  Uva  Ursi     ....  I^eaves  . 

Valeriana  officinalis Rhizome 

Veratrum  viride Rhizome 

(Cramp  bark) Bark  .    . 

(Black  haw) Bark  .    . 

Xanthoxylum  Americanum 

Zingiber  officinale     .... 


2. 

2. 

0.12 

2. 

2. 

.  Bark  .    .    .    .  i. 
.  Rhizome    ,    .  0.6 


Minims. 
10 

lo 

60 
30 

5 

3 

30 

g 

30 
10 

30 

8 

30 
IS 
30 
30 
30 
60 
8 

S 
60 


30 

5 
"5 

3° 

5 

60 

15 
30 
30 

3 

60 
60 
30 
30 

2 

30 
30 
»S 
lo 


Unofficial  Fluid  Extracts  of  the  National  Formulary. 

Unless  otherwise  indicated,  the  dose  of  the  following  Fluid  Ex- 
tracts is  from  ^  to  i  fluidrachm  (2  to  4  Cc.) : 


EXTRACTIVE  PREPARATIONS.  93 

Extractum  Fluidum — 

Adonidis. — Root  of  Adonis  vernalis  L.  (Bird's  Eye). 
Aletridis. — Rhizome  of  Aletris  farinosa  L.  (Stargrass). 
Angelica  Radicis. — Root  of  Archangelica  L.  (Angelica). 
Apii  Graveolentis. — Seed  of  Apium  graveolens  L.  (Celery). 
AralIjE  RACEMOS.E. — Root  of  Aralia  racemosa  L.  (American 

Spikenard). 
ARNiCiE  Florum. — Flower  heads  of  Arnica  montana  L.  (Ar- 
nica). 
Berberidis  Vulgaris. — Bark  of  the  root  of  Berberis  vulgaris 

L.  (Barberry). 
BoLDi. — Leaves  of  Peumus  Boldus  Molina  (Boldo). 
BucHU  CoMPOSiTUM. — A  Combination  of  Buchu,  10;  Cubeb, 

2  ;  Juniper,  2  ;  Uva  Ursi,  2  parts. 
Calendula. — Flowering    herb   of    Calendula    ofificinahs    L. 

(Marigold). 
Camellia. — Leaves  of  Camellia  Thea  Link  (Tea).     The  best 

quality  of  commercial  black  tea,  "  Formosa  Oolong,"  to  be 

employed  for  this  preparation. 
Caulophylli. — Rhizome  and  rootlets  of  Caulophyllum  thalic- 

troides  Mich.  (Blue  Cohosh). 
Coffee  Viridis. — Unroasted  seeds  of  Coffea  Arabica  L. 
Coffee  Tost^. — Roasted  seeds  of  Coffea  Arabica  L. 

The  N.  F.  recommends  equal  portions  of  Java  and  Mocha 

to  be  employed  in  preparing  the  Fluid  Extracts  of  Coffee. 
Convallari^  Florum. — Flowers  of  Convallaria  majalis   L. 

(Lily  of  the  Valley). 
CoPTis. — Rhizome  of  Coptis  trifolia  Salisb.  (Goldthread). 
CoRNUS  CircinaTjE. — Bark  of  Cornus  circinata  L'Her.  (Green 

Osier.) 
Cornus  Florida  (U.  S.  P.  1880). — Dogwood  Bark. 
CoRYDALis. — Tubers  of  Dicentra  Canadensis    De  C.  (Turkey 

Corn). 
CoTO. — Coto  bark,  undetermined  tree.     Dose,  from  5  to  15 

minims  (0.3  to  i   Cc). 
FucL — Thalus  of  Fucus  vesiculosus  L.  (Bladder-wrack). 
Heliantheml — Herb   of    Helianthemum    Canadense    Mich. 

(Frost-wort). 
HuMULi. — Strobiles  of  Humulus  lupulus  L.  (Hops). 
Hydrangea. — Root   of   Hydrangea    arborescens    L-   (Seven 

Barks). 


94  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Extractum  Fluidum — 

Jalaps. — Tuber  of  Exogonium  purga  Benth.  (Jalap).  Dose, 
from  15  to  20  minims  (i  to  1.3  Cc). 

JuGLANDis. — Bark  of  the  root  of  Juglans  cinerea  L.  (Butternut). 

JuNiPERi. — Fruit  of  Juniperus  communis  L. 

Kava. — Root  of  Piper  methysticum  Forster  (Kava;  Kava- 
Kava). 

Lactucarii  (U.  S.  p.  1880). — Insp.  juice  of  Lactuca  virosa  L. 

Malti.— (Fluid  Extract  of  Malt). 

Menyanthis. — Leaves  of  Menyanthes  trifoliata  L.  (Buckbean  ; 
Trifolium  fibrinum,  Ph.  G.). 

Mezerei  (U.  S.  p.  1880). — Bark  of  Daphne  mezereum  L. 
Dose,  from  5  to  10  minims  (0.3-0.6  Cc). 

Petroselini  Radicis. — Root  of  PetroseHnum  sativum  Hoff- 
man (Parsley). 

QuiLLAjA. — Bark  of  Quillaja  Saponaria  Molina  (Soap  Bark). 

Rhamni  Purshian^  Aromaticum. — Cascara  Sagrada  de- 
prived of  its  bitter  taste. 

Rhei  Aromaticum. — A  combination  of  Rhubarb,  Cinnamon, 
Cloves,  and  Nutmeg. 

SenNjE  Deodoratum  (Aqueous  Fluid  Extract  of  Senna). — 
This  preparation  is  free  from  the  objectionable  "  griping " 
qualities  of  the  ordinary  fluid  extract. 

Sterculi^. — Seeds  of  Sterculia  acuminata  R.  Brown  (Cola 
or  Kola). 

StilllingIjE  Compositum  (Stillingia  Comp.). — Stillingia,  Cory- 
dalis,  each,  4  parts ;  Iris,  Sambucus,  Chimaphila,  each,  2 
parts ;  Coriander,  Xanthoxylum  Berries,  each,  i  part. 

Trillii. — Rhizome  of  Trillium  erectum  L.  (Bethroot). 

TuRNERyE. — Leaves  of  Turnera  microphylla  De  C.  (Damiana). 

Urtice. — Root  of  Urtica  dioica  L.  (Nettle). 

Verbasci. — Leaves  (and  flowers)  of  Verbascum  Thapsus  L. 

Verbena. — Root  of  Verbena  hastata  L.  (Vervain). 

Ze^. — Stigmatum  Maydis  ;  Corn  Silk  ;  Stigmata  of  Zea  Mays 
L.  (Indian  Corn). 
As  a  rule,  a  Fluid  Extract  is  made  of  every  vegetable  drug 
which  is  a  part  of  a  plant.  There  are  altogether  about  500  Fluid 
Extracts.  Relatively,  the  Fluid  Extracts  are  not  as  strong  as  the 
Tinctures,  but  they  have  the  great  advantage  over  the  latter  in  that 
they  are  more  concentrated  and  of  uniform  drug-strength — the 
strength  of  the  drug. 


EXTRACTIVE  PREPARATIONS.  95 

EXTRACTA— EXTRACTS. 
Extracts — or  "  solid  "  extracts  as  they  are  termed,  to  distinguish 
them  from  fluid  extracts — are  the  soluble  active  principles  of  vege- 
table drugs,  concentrated  by  evaporation  to  a  soft  solid  or  a  plastic 
mass  of  pilular  consistence. 

The  strength  of  an  extract  depends  upon  the  amount  of  the 
crude  drug  it  represents.  Hence,  the  smaller  the  percentage  of 
extract  obtained  from  a  drug,  the  greater  the  relative  strength 
of  the  extract,  provided  that  the  drug  be  exhausted  with  menstrua 
adapted  to  secure  all  the  active  principles  in  this  form. 

The  yield  of  extract  is  influenced  by  the  character  of  the  men- 
struum employed  :  with  a  few  drugs  like  Rhubarb  the  quality  of  the 
drug  sometimes  governs  the  yield,  the  least  percentage  being 
obtained  from  the  poorest  quality. 

As  a  general  rule,  the  more  aqueous  the  menstrua,  the  greater 
the  yield  of  extract ;  conversely,  the  more  alcoholic  the  menstrua, 
the  smaller  the  yield  of  extract.  To  obtain  the  extracts,  therefore, 
of  official  strength  it  is  necessary  to  use  official  menstrua  in  the 
extraction. 

Thus  the  extracts  of  different  drugs  are  as  many  times  stronger 
than  the  drug  as  the  quotient  obtained  by  dividing  the  drug  at 
100  by  the  percentage  yield.  For  example  :  Podophyllum  yields 
10  per  cent,  of  extract ;  then  100-5-10=10;  that  is,  the  extract  is 
ten  times  as  strong  as  the  drug  and  the  fluid  extract,  or  o.i  of  the 
extract  represents  i  Gm.  of  the  drug  or  i  Cc.  of  the  fluid  extract. 
The  drug-strengths  of  the  official  Extracts,  calculated  by  this 
method,  as  well  as  their  relative  doses  based  upon  the  amounts  of 
drug  they  represent,  are  exhibited  in  the  table  given  on  page  96. 

The  33  official  Extracts  are  made  by  extraction  with  alcoholic 
menstrua  or  with  water,  sometimes  by  the  additiorf  of  acid  or 
alkali. 

There  are  four  extracts  made  by  the  addition  of  powders  to 
the  extracts,  including  the  Extract  of  Colocynth,  the  Compound 
Extract  of  Colocynth,  and  the  assayed  extracts,  made  by  the  addi- 
tion of  Sugar  of  Milk  to  represent  a  certain  alkaloidal  strength  in 
the  powdered  extract. 

Extractum  Nucis  Vomicae  contains  1 5  per  cent,  of  total  alka- 
loids ;  I  Gm.  represents  about  10  Gm.  of  drug. 

Extractum  Opii  contains  18  per  cent,  of  crystallized  morphine; 
I  Gm.  represents  2  Gm.  of  normal  moist  opium,  about  1.4  Opii 
pulvis  (14  per  cent,  morphine). 


q6 


A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 


Table  showing  the  Drug-strength  and  the  Average  Doses  of  the 

Official  Extracts. 


Extractum. 


Parts 
of  Drug 

in 
I  part  of 
Extract. 


Dose  of  Drug. 


Grains.      Gm 


Dose  of  Extract. 


Grains.       Gm, 


Aconiti Root  .    . 

Aloes   (aqueous)  ....  .... 

Arnicse  .    .    .    .- Root  .    . 

Belladonnse  Fol.  Alcoholic.     .  Leaves   . 
Cannabis  Indicas  .    .        .        .  Herb  .    . 

Cimicifugae Rhizome 

Cinchonse  (Calisaya)        .    .    .  Bark  .    . 

Colchici  (acetic) Corm  .    . 

Colocynthidis  (powder)  .    .    .  Fruit  .    . 

[Ext.   Colocynth,    i6; 

Colocynthidis  Com-      Cardamom,  6 ;  Aloes, 

positum  (powder)       50;  Soap,Scammony, 

L  each,  14. 

Conii  (acetic) Fruit  . 

Digitalis Leaves 

Ergqtas Sclerot. 

Euonymi Bark   . 

Gentianae  (aqueous)     ....  Root  . 

Glycyrrhizse  (stick) Root  . 

Glycyrrhizse  Purum  (ammon.)  Root  . 
Hsematoxyli  (aqueous)    .        .  Logwood 

Hyoscyami Herb  . 

Iridis Rhizome 

Jalapas Tuber 

Juglandis Bark  . 

Kramerise  (aqueous)    .        .    .  Root  . 
Leptandrse  .        ...  Root  . 

Nucis  Vomicae  (powder)     .      Seed   . 

Opii  (powder) 

Physostigmatis Calabar  bean 

Podophylli Rhizome    . 

Quassiae  (aqueous) Wood 

Rhei Root  . 

Stramonii Seed  . 

Taraxaci  (aqueous) Root  . 

Uvae  Ursi Leaves 


5 
2 

5 
5 

10 

10 

6 

3 
6 


4 
4 
5 
5 
4 
3 
3 
4 
6 

7 
6 
6 
5 

5i 
10 

20 
10 
25 
3 
10 

3 
3 


I 

10 
10 

3 

10 

10 

3° 

5 

3 


4 

2 

30 
30 
20 

30 

60 

10 

6 

7 

IS 

IS 

IS 

IS 

3 

I 

I 

10 

s 
30 

3 

30 
30 


.06 
.65 

.6S 
.2 
.65 
.6s 
2. 

•3 
.2 


.25 

.12 
2. 
2. 

1-3 
2. 

4. 
.6s 

■4 

■5 
I. 
I. 
I. 
I. 

.2 

.06 

.06 

•6S 

•3 
2. 

.2 


5 
6 
6 

S 

10 
20 

2' 

^2 

I 
I 

3 
3 
3 

3 

1 

y 
3 

I 
1 

I 
I 

10 

1 

¥ 
10 
10 


.012 

•32 
.12 

•03 
.06 
.06 

■3 

.12 
•03 


.06 

■03 

•4 
■4 
■3 
.65 

1-3 
■IS 
.06 
.06 
.2 
.2 
.2 
.2 
.02 
.04 
.01 
.06 
.06 
.65 
•IS 
■6S 
.65 


ABSTRACTA— ABSTRACTS. 

A  class  of  powdered  extracts,  prepared  from  the  extracts  by  the 
addition  of  sufficient  Milk  Sugar  to  make  the  product  represent 
one-half  its  weight  of  the  crude  drug,  was  official  in  the  U.  S.  P. 
VI.  (1880)  under  the  title  of  Abstracts. 

The  Abstracts  have  a  uniform  relation  to  the  drug viz.  /  grain 

represents  2  grains  of  the  drug,  just  as  the  fluid  extracts  have  the 
uniform  relation  of  representing  the  drug  measure  for  weight. 

In  preparing  an  abstract  the  drug  is  exhausted,  the  extract 
obtained  incorporated  with  its  weight  of  Milk  Sugar,  the  mixture 


EXTRACTIVE  PREPARATIONS.  97 

powdered,  and  enough  Milk  Sugar  added  to  bring  the  product  to 
one-half  the  weight  of  the  drug  employed.  Abstracts  must  be  pre- 
served in  small,  perfectly  dry,  and  well-corked  vials  in  a  dry  and 
cool  place. 

Their  uniformity  alone  should  have  favored  the  employment  of 
Abstracts  in  preference  to  the  Extracts,  since  they  do  not  share  the 
variability  in  strength  of  the  extracts,  the  dose  of  the  Abstract  being 
exactly  one-half  that  of  the  crude  drug  or  Fluid  Extract.  This 
advantage  was  offset  by  the  disadvantage  that  Abstracts  are  more 
bulky,  and  caused  their  deletion  in  the  U.  S.  P.  1890.  The  Ab- 
stracts are  therefore  unofficial. 

The  official  Extracts  of  Jalap  and  of  Nux  Vomica  have  su- 
perceded the  abstracts  of  these  respective  drugs  in  a  more  con- 
centrated and  equally  convenient  form.  Of  the  remaining  nine 
Abstracts  formerly  official,  Aconite,  Belladonna,  Conium,  Digitalis, 
Hyoscyamus  (Ignatia,  superceded  by  Nux  Vomica),  Podophyllum, 
Senega,  and  Valerian,  the  five  first  mentioned,  commonly  but 
erroneously  called  the  "narcotic  extracts,"  may  be  prepared,  in 
the  powdered  form,  of  such  strength  as  to  represent  the  same 
drug-strength  as  their  respective  official  "  solid  extracts." 

ExTRACTUM  Ferri  Pomatum,  N.  F. — Ferri  Malas  Crudus  (Fer- 

rated  Extract  of  Apples,  Ph.  Ger.). 
ExTRACTUM  Glycyrrhiz^  Depuratum,  N.  F. — Succus  Liqui- 

ritiffi,  Ph.  Ger.  (Purified  Extract  of  Liquorice). 

OLEORESIN.^— OLEORESINS. 

To  natural  Oleoresins,  derived  as  plant-exudations,  belong  the 
Turpentines  and  the  Pitches.  From  similar  exudations  are  ob- 
tained the  Gum  Resins,  mixtures  of  Gum  and  Resins  and  sometimes 
Volatile  Oils ;  also  the  Balsams,  which  are  Resins  or  Oleoresins 
associated  with  Benzoic  or  Cinnamic  Acid.  These  are  treated 
under  their  respective  Drugs. 

The  pharmaceutical  Oleoresins  are  semi-liquid  extracts,  obtained 
by  exhausting  oleoresinous  drugs  with  Ether. 

Ether  extracts  fixed  and  volatile  oils  from  drugs,  as  well  as^resin; 
these  principles  constitute  therefore  the  oleoresins,  which  some- 
times also  contain  other  active  matter  in  solution  or  suspension. 

The  menstruum  (Ether),  being  easily  volatilized,  is  recovered  by 
distillation  ;  it  is  sometimes  superseded  by  Alcohol,  which  yields  an 
extract  very  similar  to  that  obtained  with  ether. 
7 


98  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

The  six  following  are  official : 

Dose. 
Oleoresina —  , ^ ■ » 

Aspidii;   separates  in  two  layers, 

to  be  mixed  when  used    .    .    .  i-2  drachms.  4.-8. 
Capsici ;  separates  fat,  used  only  as 

corrective T5~i  grain.  0.01-0.005 

Cubebse;  separates  wax     ....  1-2  grains.  0.06-0.  i 

Lupulinae 2-3  grains.  0.1-0.2 

Piperis ;  separates  piperine,  to  be 

rejected 1-2  grains.  0.08-0.1 

Zingiberis ^— J  grain.  0.02-0.01 

RESIN.E— RESINS. 

The  official  Resins  may  be  divided  into  the  (i)  Natural  Resins, 
(2)  Resins  obtained  from  Oleoresins  by  separating  the  Volatile  Oil 
by  distillation,  and  (3)  the  Pharmaceutical  Resins,  prepared  by  pre- 
cipitation. 

When  a  concentrated  tincture  of  a  resinous  drug  is  poured  into  a 
large  quantity  of  cold  water,  the  resinous  matter  becomes  insoluble 
and  is  precipitated ;  this,  after  being  washed,  dried,  and  sometimes 
powdered,  is  termed  a  resin. 

Resins  are  usually  soluble  in  alkalies  and  insoluble  in  acids 
(dilute) ;  for  this  reason  the  water  used  for  precipitation  is  some- 
times rendered  slightly  acid  to  favor  the  separation. 

The  three  following  are  official : 

Per  cent,  yield 

from  Drug.          Dose.                       Rep.  Drug. 
Resina —  , • ,      , ■ , 

Jalapse 15       3  grains     0.2     20  grains     1.3. 

Podophylli 5       \  grain       0.03    10  grains     0.6. 

Scammonii 65       3  grains     0.2       5  grains     0.3. 

Resina  and  Resina  Copaiba  are  obtained  as  residue  in  the  dis- 
tillation of  the  respective  Oleoresins,  Turpentine  and  Copaiba. 
The  natural  Resins  are  obtained  as  exudates — e.  g.  R.  Guaiac. 

The  terms  resin,  resinoid,  and  concentration  are  also  applied  to  a 
class  of  preparations  used  by  eclectic  physicians,  prepared  by  this 
general  process  with  some  modifications.    (See  U.  S.  and  Am.  Disp.) 

They  are  named  after  their  respective  Drugs  with  the  ending  in, 
as  in  Glucosides,  and  must  not  be  confused  with  the  latter.  While 
the  Glucosides  are  usually  the  active  medicinal  constituents  repre- 
senting the  drug,  the  resinoids,  with  the  exception  of  those  made 


SOLID  MIXTURES  FOR  INTERNAL   USE.  99 

from  drugs  whose  active  principles  are  resins,  such  as  Cimicifuga 
and  Podophyllum,  are  more  or  less  inert,  unreliable  mixtures,  too 
indefinite  in  their  composition  and  strength  for  medicinal  use. 


SOLID   MIXTURES   FOR   INTERNAL  USE. 

Mixtures  of  Solids  for  internal  use  embrace  the  following 
classes  of  preparations :  Powders,  Effervescent  Salts,  Confections, 
Troches,  Masses,  and  Pills. 

Powders  are  substances  reduced  to  a  fine  pulverulent  condition 
to  favor  their  administration  and  solution  or  absorption.  A  powder 
may  be  simple,  such  as  a  powdered  drug,  Pulvis  opii,  or  a  pow- 
dered salt — i.  e.  Quinines  sulphas ;  or  it  may  be  compound,  a  mix- 
ture of  several  substances. 

Sparingly  soluble  substances,  when  finely  powdered  (impalpable) 
and  thoroughly  mixed  by  trituration  in  a  mortar  with  some  inert 
powder  (diluent)  such  as  Milk  Sugar,  are  rendered  more  soluble, 
since  a  greater  surface  is  exposed  to  the  solvent  action  of  the 
liquids  of  the  body,  and  prompter  and  fuller  effects  are  obtained. 
The  potency  of  calomel,  of  the  resins,  and  of  alkaloids  is  in  this 
way  considerably  increased  within  certain  limits,  but  not  to  the 
unreasonable  extent  advocated  by  Homoeopathic  pharmacy,  in 
which  this  process  is  carried  to  a  reductio  ad  absurdum.  It  is  an 
excellent  and  convenient  method  for  dispensing  and  administering 
the  more  potent  agents,  such  as  arsenous  acid,  mercury  com- 
pounds, and  the  alkaloids.  Substances  triturated  in  this  way  have 
been  called  Triturations,  for  whose  preparation  the  U.  S.  P.  gives  a 
general  formula : 

Take  of  the  substance,  for  example,  Elaterin  .    .    .  i  Gm. 
Milk  Sugar,  in  fine  powder 9  Gm. 

First  thoroughly  triturate  the  medicinal  substance  (Elaterin) 
with  an  equal  weight  of  Milk  Sugar,  then  add  the  remainder  of  the 
Milk  Sugar,  and  mix  thoroughly  by  trituration  (for  about  ten 
minutes). 

Unless  otherwise  specified,  triturations  should  be  of  the  official 
strength — i.  e.  \o  per  cent,  of  the  drug. 

By  the  addition  of  about  an  equal  weight  of  Alcohol  to  the 
triturate  it  becomes  a  soft  mass,  which,  after  being  moulded  into 


imUKi'  jj)  DEPARTMENT  OF  Pl-lABMACOU>G¥* 

lOO  ^'^^TEJ^S^OOJi'  OF  MA  TERIA  MEDIC  A. 

disks  of  about  i  grain  (0.06)  each,  after  the  evaporation  of  the 
Alcohol,  furnishes  the  so-called  Tablet  Triturates.  These  afford 
a  convenient  method  of  medication  for  such  substances  as  are 
adapted  to  trituration,  which  is,  however,  confined,  as  indicated, 
to  a  comparatively  limited  number  of  agents.  To  represent  in  the 
form  of  these  tablets  every  kind  of  medicinal  agent  of  volatile  cha- 
racter, or  drugs  otherwise  susceptible  to  change  through  the  inevi- 
table exposure  to  the  atmosphere  to  which  every  such  mixture  is 
liable,  is  simply  to  invite  error  in  practice.  These  tablets,  more- 
over, with  certain  chemical  substances,  undergo  chemical  changes 
which  render  them  entirely  insoluble,  and  thus  practically  inert. 
In  order  to  be  effective  and  otherwise  reliable,  they  should  be  pre- 
pared extemporaneously  by  the  pharmacist,  in  order  to  ensure 
their  solubility. 

They  should  always  be  dissolved  in  a  little  water  before  they 
are  administered. 

When  it  is  desired  to  obtain  a  mild  and  prolonged  local  effect 
of  a  medicinal  agent  in  the  mouth  or  throat,  the  substance  is  made 
into  a  soft  mass  (confection)  with  a  diluent  and  excipient.  Sugar  and 
Mucilage,  and  flavor,  and  formed  into  round  or  oval-shaped  disks, 
weighing  from  8  to  30  grains  (-^  to  2  Gm.),  called  variously  Lozenges, 
Troches,  Tablets,  and  Pastils. 

Troches. — When  these  are  allowed  to  dissolve  slowly  in  the 
mouth  the  diluent  serves  as  a  vehicle  for  the  medicinal  agent,  and 
a  gradual  prolonged  effect  is  obtained  upon  the  mucous  surfaces. 
This  form  of  medication  is  adapted  only  to  astringents,  antacids, 
expectorants,  and  stomachics  consisting  of  substances  not  especi- 
ally disagreeable  to  the  palate. 

Tablets,  or  Lozenges,  are  not  intended  to  be  swallowed,  nor 
adapted  to  exceedingly  volatile,  caustic,  irritant,  or  otherwise  un- 
palatable substances.  For  ingestion,  medicinal  agents  should  be 
made  into  a  Mass  [massd)  with  an  excipient,  and  formed  into  small 
spheres,  or  balls,  as  a  rule  not  over  5  grains  (0.3)  in  weight, 
to  be  swallowed  and  slowly  dissolved  in  the  stomach  or  intestines. 
Such  preparations  are  the  so-called  Pills  {Pilules,  from  pila,  ball). 

PULVERES— POWDERS. 

The  nine  official  Powders  are  impalpable  mixtures  of  one  or 
more  active  drugs,  usually  with  some  nearly  inert  substance,  such 
as  Sugar,  as  a  diluent,  and  Aromatics. 

They  are  made  by  trituration. 


SOLID  MIXTURES  FOR  INTERNAL   USE.  lOi 

Pulvis —  Gm.  in  loo. 

Antimonialis  (James')  .  calc.  phos.  67;  antimon.  oxide  33 

Aromaticus    ....  cinnamon  (Ceylon),  ginger,  each  35 

cardamom  (seed),  nutmeg,  each  15 

Cretae  Gompositus  .  acacia  p.  20;  sugar  50;  prep,  chalk  30. 

Glycyrrhizse  Gompositus     .    .    .  senna  18;  glycyrrhiza  24. 

fennel  oil  0.4 ;  sulphur,  washed,  8 ;  sugar  50, 

Ipecacuanhae  et  Opii    .    .    .    ipecac,  opium  pulv.,  each  10. 

(Dover's  Powder)  sugar  of  milk  80. 

Jalapse  Gompositus  .    .    .    .  potass,  bitartrate  65  ;  jalap  35 

Rhei  Gompositus  .  magnesia  65  ;  ginger  10;  rhubarb  25 

In  60  grains. 

Pulv.  Morphinse  Gompositus  .    .  camphor  10;  morphine 

(Tulley's  Powder)  sulph.         i. 

calcium  carb.,  precip. ;  glycyrrhiza  p.,  each       20. 

I<'or  13  fow . ;  in  each,  grains. 

Effervescens  Gompositus  .  (Seidlitz  Powder) 

potassium  and  sodium  tartrate    93  Gm.     120 
sodium  bicarbonate     31  Gm.       40 

acid  tartaric.     27  Gm.       35 

Many  methods  are  in  use  for  the  purpose  of  disguising  the  taste 
of  disagreeable  remedies  in  the  powder  form.  Of  these  the  most 
elegant  and  effective  method  is  that  of  enclosing  the  powder  in  a 
cachet  or  wafer.  Originally  wafers  were  made  of  starch-paste  in 
thin  sheets ;  a  piece  about  0.5  dcm.  (2  inches)  square,  immersed 
in  water  for  a  minute,  being  placed  in  a  spoon,  the  powder  poured 
into  it,  and  then  enwrapped  by  folding  up  the  edges  and  swallowed 
with  a  little  water.  The  cachets  or  "  konseals  "  are  wafer-disks 
consisting  of  two  concentric  halves,  one  of  .which  is  filled  with  the 
powder,  and  the  other  half  attached  by  moistening  the  edge  and 
pressing  the  edges  together  by  means  of  various  devices.  These 
cachets  are  of  three  sizes,  the  largest  holding  5  grains  (0.3)  Quinine 
Sulphate.  After  one  minute's  immersion  in  water  they  can  be 
swallowed  without  any  effort. 

Unofficial  Powders  of  the  N.  F. 
Pulvis — 

Acacia  Gompositus  (Pulvis  Gummosus,  Ph.  Ger.). 
AcETANiLiDi   Gompositus. — Containing  50  per  cent.  Acetan- 


I02  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Pulvis — 

ilid,  2  per  cent.  Caffeine,  with  Tartaric  Acid  and   Sodium 
Bicarbonate. 

Aloes  et  Canell^  (Hiera  Picra). 

Amygdala  Compositus  (Almonds  Cpmp.) — A  mixture  of 
Sweet  Almond,  Sugar,  and  Acacia,  in  fine  powder;  i8o 
grains  (lo  Gm.),  triturated  with  Water,  yield  about  4  fluid- 
ounces  (119  Cc.)  of  Emulsum  Amygdalae. 

Anticatarrhalis  (Catarrh  Snuff.) — Hydrochlorate  of  Mor- 
phine, I  part;  Acacia,  60  parts;  Subnitrate  of  Bismuth,  180 
parts,  in  fine  powder. 

Catechu  Compositus  (Compound  Powder  of  Catechu,  Ph.  Br.). 
— Catechu,  4  parts  ;  Kino,  2  parts ;  Krameria,  2  parts ; 
Cinnamon,  i  part;  Nutmeg,  i  part. 

CretjE  Aromaticus. — A  mixture  of  Cinnamon,  Saffron,  Nut- 
meg, Cloves,  Cardamon,  prepared  Chalk,  and  Sugar. 

Cret^  Aromaticus  cum  Opio. — Aromatic  Powder  of  Chalk, 
with  I  grain  (0.06)  of  powdered  Opium,  in  40  grains  (1.5)  of 
the  mixture.     Official  in  the  Ph.  Br. 

Hydrargyri  Chloridi  Mitis  et  Jalaps  (Calomel  and 
Jalap). — A  mixture  of  Mild  Chloride  of  Mercury,  10  grains 
(0.6),  and  Jalap,  20  grains  (1.3). 

When  "  Calomel  and  Jalap  "  is  prescribed  for  an  adult,  without  any  specifi- 
cation of  quantities,  the  N.  F.  recommends  that  the  above  mixture  be  dispensed 
as  one  dose. 

loDOFORMi  Compositus  (Iodoform  and  Naphthalin). — A  mixture 
of  Iodoform,  2  parts ;  Boric  Acid,  3  parts ;  Naphthalin,  5 
parts ;  with  Oil  of  Bergamot,  in  fine  powder. 

This  powder  is  used  in  many  cases  where  a  diluted  preparation  of  Iodo- 
form, for  external  purposes,  is  desired.  The  odor  is  masked  both  by  the  Oil 
of  Bergamot  and  by  the  Naphthalin. 

Kino  Compositus. — A  mixture  of  Kino  and  Cinnamon,  with  i 
grain  (0.06)  of  Powdered  Opium  in  each  20  grains  (1.3). 

Myric^  Compositus  (Composition  Powder). — A  mixture  of 
Bayberry,  Ginger,  Capsicum,  and  Cloves. 

Pancreaticus  Compositus  (Peptonizing  Powder). — ^A  mixture 
of  20  parts  Pancreatin  and  80  parts  Sodium  Bicarbonate; 
25  grains  will  peptonize  i  pint  of  milk. 

Pepsini  Compositus  (Pulvis  Digestivus). — A  mixture  of  Pep- 
sin, Pancreatin,  Diastase,  Lactic  and  Hydrochloric  Acids, 
with  Milk  Sugar  to  represent  the  gastric  juice. 


SOLID  MIXTURES  FOR  INTERNAL   USE.  103 

Pulvis — 

Rhei  et  Magnesi^e  Anisatus  (Compound  Anise  Powder.) — 
A  mixture  of  Rhubarb,  Heavy  Magnesia,  and  Oil  of  Anise. 

Talci  Salicylicus  (Salicylated  Powder  of  Talcum). — A  mix- 
ture of  Talcum  with  3  per  cent.  Salicylic  Acid  and  10  per 
cent.  Boric  Acid,  in  fine  powder. 

Powders  are  usually  directed  to  be  divided  into  papers  {char- 
tulce) ;  thus,  for  example,  a  formula  for  a  prescription  would  be — 

]^,  Hydrargyri  Chloridi  Mitis  .    .1. 

Sacchari  Lactis 9. 

Misce  cum  trituratio  et  in  chartulae  No.  x.  divide. 

Encapsuling  powders  by  filling  them  in  gelatin  capsules  is  a 
very  convenient  and  elegant  form  of  administration.  No  mixture 
which  is  desired  to  be  given  in  the  form  oi  powder,  however,  should 
be  made  into  a  mass  for  facilitating  the  encapsuling  process — 
a  custom  too  frequently  adopted.  Many  substances,  especially 
Bismuth  Subnitrate  and  Calomel,  become  exceedingly  hard  and 
quite  insoluble  when  made  into  a  mass.  No  dispenser  should 
assume  the  prerogative  of  changing  the  form  of  medication  pre- 
scribed. 

sales    EFFERVESCENTES EFFERVESCENT    SALTS. 

These  are  granulated  mixtures  of  Salts  with  Sugar  and  Sodium 
Bicarbonate  and  Tartaric  Acid,  which  decompose  when  the  Salt  is 
dissolved  in  Water  and  furnish  agreeable  aerated  draughts. 

The  following  are  official,  the  strength  indicated  being  that  con- 
tained in  90  grains  (6  Gm.),  a  heaped  teaspoonful  being  the  ordinary 
dose,  dissolved  in  about  6  fluidounces  (180  Cc.)  of  water: 

Caffeina  Citrata  Effervescens caffeine  0.06 

Lithii  Citras  Effervescens     ....  lithium  citrate  0.06 

Magnesii  Citras  Effervescens    .    magnesium  citrate  i.o 

Potassii  Citras  Effervescens  .    .    .  potassium  citrate  3.0 

Effervescent  Salts  (Granular^,  N.  F. 

The  strength  given  for  these  is  the  quantity  contained  in  90 
grains  (6  Gm.),  which  represents  about  the  quantity  of  these  Salts 
contained  in  a  heaped  teaspoonful  of  ordinary  size,  the  average 
dose. 


I04  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Ferri  et  Quinine  Citras  Effervescens,  i  grain  (0.06)  Citrate 
of  Iron  and  Quinine. 

Ferri  Phosphas  Effervescens,  2  grains  (0.12)  Phosphate  of  Iron, 

PoTASSii  Bromidum  Effervescens,  20  grains  (1.3)  Potassium  Bro- 
mide. 

PoTAssii  Bromidum  cum  Caffein^e,  10  grains  (0.6)  Potassium  Bro- 
mide and  I  grain  (0.06)  Caffeine. 

Sal  Carolinum  Factitium  Effervescens  (Effervescent  Carlsbad 
Salt,  artificial). — A  solution  of  about  87  grains  (5.5)  in  6  fluid- 
ounces  (178  Cc.)  of  Water  represents  an  equal  volume  of 
Carlsbad  Water  (Sprudel). 

Sal  Kissingense  Factitium  Effervescens  (Effervescent  Kissingen 
Salt,  artificial). — A  solution  of  about  80  grains  (g  Gm.)  in  6  fluid- 
ounces  (178  Cc.)  represents  an  equal  volume  of  Kissingen 
Water  (Rakoczy). 

Sal  Vichyanum  Factitium  Effervescens  (Effervescent  Vichy 
Salt,  artificial). — A  solution  of  about  57  grains  (4  Gm.)  in  6 
fiuidounces  (178  Cc.)  of  Water  represents  an  equal  volume  of 
Vichy  Water  (Grand  Grille). 

Salts  {Non- effervescent). 

Sal  Carolinum  Factitium. — In  two  forms,  Dry  (Ph.  Ger.)  and 
Crystalline.  A  solution  of  about  16  grains'(i  Gm.)  of  the  Dry 
(27  grains  (1.8)  of  the  Crystalline)  in  6  fiuidounces  (178  Cc) 
of  Water  represents  an  equal  volume  of  Carlsbad  Water 
(Sprudel). 

Sal  Kissingense  Factitium. — A  solution  of  about  24  grains  (1.5) 
in  6  fiuidounces  (178  Cc.)  of  Water  represents  an  equal  volume 
of  Kissingen  Water  (Rakoczy). 

Sal  Vichyanum  Factitium. — A  solution  of  about  14  grains  (i  Gm.) 
in  7  fiuidounces  (207  Cc.)  of  Water  represents  an  equal  volume 
of  Vichy  Water  (Grand  Grille). 

CONFECTIONES— CONFECTIONS. 

Confections  may  be  defined  as  flavored  masses  wherein  the 
adhesive  substance  is  Sugar  in  large  proportions,  serving  as  a 
vehicle  for  masking  the  taste  of  fhe  drug. 

Confections,  when  made  by  beating  a  fresh  drug,  first  reduced 
to  pulp  with  sugar  until  of  the  proper  consistence,  are  termed 
conserves.  When  made  from  powders  or  extracts  they  are  called 
electuaries. 


SOLID  MIXTURES  FOR  INTERNAL   USE. 


105 


Only  one  representative  of  each  class  is  official : 

Gm.  in  100  Cc. 

Confectio  Rosse rose  water  16,  red  rose        8 

(Conserve  of  Rose)  sugar  64,  honey      12 

!oil  coriander  0.5,  senna      10 
cassia  fistula  16,  fig  1 2,  tamarind      lO 
prune  7,  sugar  55,  water  to    100 
The  Confection  of  Senna  is  a  very  agreeable  laxative,  especially 
adapted  for  constipation  in  women  and  children.    It  is  exceedingly 
.agreeable  to  the  taste. 

TROCHISCI— TROCHES. 

Troches,  or  lozenges,  are  confections  made  into  various  forms 
and  then  dried. 

The  vehicle  or  excipient  consists  of  Powdered  Gum  Tragacanth 
or  -Sugar  with  flavoring — in  some  cases  orange  flower  water,  in 
others  tolu,  nutmeg,  vanilla,  etc. 

The  active  ingredients  are  mixed  with  the  diluent  or  vehicle  and 
made  into  a  plastic  mass  with  the  particular  excipient.  Water  or 
Syrup.  The  mass  is  rolled  out  to  the  requisite  thickness,  and  the 
disks  formed  by  cutting  through  it  with  a  punch  or  troche-cutter. 
The  troches  are  then  dried  by  exposure. 

The  size  and  weight  of  the  troche  are  regulated  by  the  thickness 
■of  the  mass  and  the  diameter  of  the  cutter. 

The  15  official  Troches  vary  in  weight  from  Gm.  0.5  to  1.5. 


Trochisci — 

Acidi  Tannici 

Ammonii  Chloridi   .    .    .    . 
extract  glycyrrhiza 

Catechu 

Cretae 

Cubebae    ....  oleoresin 

extract  glycyrrhiza 

sassafras  oil 

Ferri     .    .    .  ferric  hydrate 

Glycyrrhizae  et  Opii 

ext.  glycyrrhiza 
powd.  opium 


Act 

ivE  Drug. 

Gm.  in 

Gvt.  in 

Grains 

in 

100 

each 

each 

Troches. 

Troche. 

Troche 

6. 

0.06 

I 

Orange  flor. 

10. 

O.I 

4 

Tolu. 

25. 

0.25 

4 

6. 

0.06 

I 

Orange  flor. 

25. 

0.25 

4 

Nutmeg. 

4- 

0.04' 

1 

25. 

0.25 

4 

I. 

0.0 1 

i 

30. 

0.3 

s 

Vanilla. 

IS- 

0.15 

2i 

Anise. 

0.5 

mg.5. 

h 

lo6  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Active  Drug. 


Gm.  in     Gm.  in    Grains  in 
loo  each  each 

Trochisci —  Troches.    Troche.      Troche. 

Ipecacuanhse 2.         0.02         \  Orange. 

Krameriae     ....  extract      6,         0.06  i  "        flor. 

Menthse  Piperitse    ...  oil      i.         o.oi         \  Peppermint. 

Morphinse.  morphine sulph.  0.16  mg.  16  -^  Gaultheria. 

et  Ipecac,      powd.  ipecac  0.50  "5.  -^ 

Potassii  Chloratis     ....  30.         0.3  5  Lemon. 

Santonini 3.         0.3  \  Orange  flor. 

Sodii  Bicarbonatis    ....  20.         0.2  \  Nutmeg. 

Zingiberis    .    .  tinct.  ginger  20.         0.2  \  Ginger. 

Lozenges  of  Peppermint,  Lemon,  Musk,  Vanilla,  and  Gaultheria 
may  readily  be  prepared  by  saturating  sugar  lozenges  with  the 
respective  essences  or  tinctures  and  permitting  the  alcohol  to 
volatilize. 

MASS^E— MASSES. 

Masses  are  plastic  mixtures  of  pilular  consistence.  They  are 
made  by  incorporating  the  drug  with  adhesive  substances,  by  chem- 
ical reaction,  and  sometimes  by  both  processes. 

The  Masses  are  intended  to  be  formed  into  pills  whenever  they 
are  to  be  dispensed.  They  are  therefore  often  called  Pil.,  Pilules, 
instead  of  Massa.     There  are  only  three  official : 

Massa  Copaibae  ....  water  i,  magnesia  6,  copaiba    94. 

The  Copaivic  Acid  combines  with  the  magnesia,  forming  mag- 
nesium copaivate  of  pilular  consistence.  This  is  also  known  as 
"solidified  copaiba." 

Massa  Ferri  Carbonatis  f  sodium  carb.,  ferrous  sulph., each  icx). 
(Vallet's  Mass)  I     honey  38,  sugar  25,  syrup  to  100. 

By  double  decomposition  between  the  Ferrous  Sulphate  and 
Sodium  Carbonate  ferrous  carbonate  is  formed,  which  is  incorpo- 
rated with  Honey  and  Sugar  to  prevent  oxidation  and  to  render 
the  mixture  a  plastic  mass.  The  Pill  of  Ferrous  Carbonate  (Pil 
Blaudii)  is  preferable  to  this  mass,  as  in  the  pill  the  ferrous  car- 
bonate is  better  protected  against  oxidation. 

Massa  Hydrargyri  .  glycyrrhiza  5,  althaea  25,  mercury    33. 
(Blue  Mass)  glycerin  3,  honey  of  rose    34. 


SOLID  MIXTURES  FOR  INTERNAL    USE.  107 

The  mercury  is  extinguished  by  trituration  with  the  rose  honey 
and  glycerin  and  the  powdered  glycyrrhiza ;  the  other  ingredients 
are  then  incorporated.  The  usual  dose  is  from  5  to  10  grains 
(0.3-0.6). 

PILUL.E— PILLS. 

Pills  are  spherical,  more  or  less  soluble  masses  of  medicinal 
substances  rendered  cohesive,  plastic,  and  firm  in  consistence  by  the 
addition  of  some  substance  (usually  inert)  termed  an  excipient. 

The  kind  of  excipient  employed  varies  with  the  nature  of  the 
medicinal  substance.  As  a  general  rule,  such  substances  are  chosen 
as  give  to  the  mass,  with  the  smallest  proportion,  the  greatest  plas- 
ticity, and  also  best  preserve  the  spherical  shape  of  the  pills.  The 
excipient  must  also,  unless  the  contrary  be  directed  for  especial 
purposes,  be  indifferent  in  character,  to  avoid  change  in  the  medic- 
inal agents. 

Soluble  substances  are  rendered  adhesive  by  the  action  of  sol- 
vents, and  require,  according  to  their  solubilities,  the  addition  of 
some  liquid  such  as  Water,  Alcohol,  Glycerin,  etc.  Others  require 
the  addition  of  adhesive  substances,  such  as  Syrup,  Mucilage,  Glu- 
cose, Glycerite  of  Starch  or  Tragacanth,  etc. 

Drugs  adapted  for  dispensing  in  the  form  of  pills  may  be  divided 
as  follows : 

(i)  The  official  Masses,  Extracts,  and  Scaled  Salts. 

Masses  and  extracts,  being  of  pilular  consistence,  require  no 
addition  except  when  hard  or  dry ;  Water  should  then  be  incor- 
porated to  restore  them  to  their  original  form.  Abstracts  and 
powdered  extracts  are  best  made  into  a  mass  with  Water. 

(2)  Vegetable  Powders  in  which  the  dose  does  not  exceed  five 
grains. 

With  these  adhesive  excipients  are  indicated,  such  as  Syrup,  Mu- 
cilage, Glycerite  of  Tragacanth,  and  Glucose.  The  last  mentioned 
answers  the  requirements  better  than  most  other  substances.  Con- 
fection of  Rose  and  Extracts  of  Gentian,  Glycyrrhiza,  and  Taraxa- 
cum are  also  used  when  their  color  is  not  objectionable. 

(3)  Salts  not  too  deliquescent,  and  Alkaloids. 

Excipients  for  these  must  combine  adhesive  and  absorbent  quali- 
ties. They  are  first  triturated  with  a  dry  powder — e.  g.  Althaea, 
Glycyrrhiza,  or  Milk  Sugar — and  then  mixed  with  the  adhesive 
substance — viz.  Glucose  or  Glycerite  of  Starch  or  Tragacanth. 

No  excipient  must  be  used  that  will  give  to  the  mass  a  color 
different  from  that  of  the  medicinal  ingredients  (the  base). 


lo8  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

(4)  Volatile  Oils  and  Oleoresins. 

The  quantity  of  these  when  dispensed  in  pills  being  compara- 
tively large,  it  is  necessary  to  add  some  light  absorbent  substance, 
such  as  Magnesia  or  Starch,  to  which  is  added  the  adhesive 
material.  The  practice  of  adding  wax  or  resin  to  oils  is  not  to  be 
recommended  except  as  a  last  resort,  since  they  tend  to  render  the 
pill  insoluble. 

(5)  Resins  and  Gum  Resins. 

These  form  an  adhesive  mass  by  the  addition  of  a  little  Alcohol, 
with  which  more  bulky  excipients,  such  as  Soap,  may  be  incorpo- 
rated to  preserve  the  shape  of  the  pill. 

(6)  Salts  of  the  Cinchona  Alkaloids,  Quinine  and  Cinchonidine 
Sulphates,  etc. 

These  are  often  prescribed  in  pill  form  in  large  doses,  and  it  is 
therefore  desirable  to  reduce  their  bulk.  For  this  purpose  dilute 
Sulphuric  Acid  or  Tartaric  Acid  is  added  in  small  quantity,  which 
acts  as  a  solvent  upon  the  salt,  thereby  converting  it  into  a  mass. 
This  mass  is  incorporated  with  a  little  Glycerite  of  Starch,  other- 
wise it  soon  loses  its  plasticity;  it  must  therefore  be  rolled  into 
pills  as  soon  as  formed. 

(7)  Substances  easily  decomposed  by  organic  matter. 
Potassium   Permanganate  and  Silver  Nitrate  are  quickly  "  re- 
duced "  when  incorporated  with  the  excipients  usually  employed. 

These  should  be  mixed  with  an  inorganic  diluent  not  affected 
by  them,  such  as  Kaolin,  Pipe  Clay,  or  Fuller's  Earth,  and  made 
into  a  mass  with  Water,  Petrolatum,  Resin  Cerate,  etc. 

In  order  to  disguise  the  bitter  or  otherwise  disagreeable  taste 
of  pills,  th.ey  are  usually  coated  with  sugar  or  gelatin.  These 
coated  pills  are  often  objectionable  on  account  of  the  coating,  or 
the  pill  itself,  becoming  quite  insoluble.  When  a  coated  pill  is 
desired,  it  should  be  freshly  made  and  enclosed  in  a  gelatin  capsule 
of  the  smallest  size.  Pills  may  also  be  coated  extemporaneously 
by  rolling  them  on  a  piece  of  filter-paper  saturated  with  Mucilage 
of  Acacia,  and  then  in  powdered  Milk  Sugar. 

Keratin-cozied  pills  are  designed  for  solution  in  the  duodenum, 
the  pills  being  dipped  in  a  solution  of  Keratin  prepared  from  horn 
shavings  treated  with  pepsin  and  hydrochloric  acid. 

Concentric  pills  are  made  up  of  concentric  layers  of  different 
ingredients,  intended  to  dissolve  and  become  active  at  various 
stages  in  their  passage  through  the  intestinal  tract. 

The  following  1 5  Pills  are  official : 


SOLID  MIXTURES  FOR  INTERNAL   USE. 


109 


Pilule. 


Aloes aloes  purif.,  soap,  each 

Aloes  et  Asafoetidse  .  aloes,  asafoetida,  soap,  each 
Aloes  et  Feiri  .  .  aloes,  iron  sulph.,  arom.  powder 
Aloes  et  Mastiches  (Dinner  Pill)   .....  aloes 

mastic 

red  rose 

Aloes  et  Myrrhge       .  ...  aloes 

myrrh 
arom.  powder 

Antimonii  Comp antimony,  sulphurated 

(Plummer's  Pills)  mild  mercurous  chlor. 

guaiac 

Asafoetidse asafoetida 

Catharticse  Comp ext.  colocynth  comp. 

mild  mercurous  chloride 

extract  of  jalap 

gamboge 

Catharticse  Vegetabilis   .    ,    .  ext.  colocynth  comp. 

exts.  hyoscyam.,  jalap,  each 

ext.  leptandra,  res.  podophyll 

oil  peppermint 

Ferri  Carbonatis ferrous  sulphate 

(Ferruginous,  Chalybeate,  Blaud's)  potass,  carb. 
sugar  4;  tragac,  althsEa,  each 

Ferri  lodidi  ^ reduced  iron 

iodine 

glycyrrh.,  sugar,  each 

ext.  glycyrrh.,  acacia,  each 

Opii soap  2 ;  opium  pulv. 

Phosphori » phosphorus 

althzea,  acacia,  each 

Rhei soap  6;  rhubarb 

Rhei  Comp rhubarb 

aloes 

myrrh 

oil  peppermint 


IN  EACH. 

Gm. 
for  100. 

eg. 

grams. 

13 

13 

2 

9 

9 

•i 

7 

7 

I 

13 

"3 

2 

4 

4 

1 

3 

3 

\ 

13 

13 

2 

6 

6 

I 

4 

4 

1 

4 

4 

1 

4 

4 

1 

8 

8 

't 

20 

20 

3 

8 

8 

^ 

6 

6 

I 

3 

3 

\ 

•S 

i-S 

\ 

6 

6 

I 

3 

3 

\ 

'■S 

i-S 

i 

0.8 

0.8 

\ 

16 

6 

I 

8 

I 

4 

6 

I 

5 

4 

I 

6.^ 

6.S 

I 

0.06 

0.06 

Tfftr 

6 

,   . 

20 

20 

3 

13 

13 

2 

10 

10 

«i 

6 

6 

I 

0-5 

Excipient. 


Glyc.  water. 
Conf.  rose. 

Water. 

Syrup. 

Castor  oil. 
Soap. 

Water. 

Water. 
Glyc.  water. 

Water. 


Glyc.  water. 
Water. 


Unofficial  Pills  of  the  National  Formulary. 
When  a  large  number  of  pills  are  to  be  prepared  in  accordance 
with  the  given  proportions,  and  the  quantities  of  the  ingredients 
are  to  be  determined  by  multiplying  with  the  number  of  pills  re- 
quired, it  is  recommended  that  the  nearest  whole  number,  or  near- 
est convenient  fraction,  in  each  case,  be  chosen. 

Pilulse— 

Ad  Prandium  (Dinner  Pills).— When  "  Dinner  Pills,"  under 
this  or  some  other  equivalent"  name,  are  prescribed  without 
further  specification,  the  National  Formulary  recommends 
that  the  Pilulse  Aloes  et  Mastiches  of  the  U.  S.  P.,  also 
called  "  Lady  Webster's  Dinner  Pills,"  be  dispensed. 
1  Coated  with  ethereal  solution  of  Balsam  Tolu.     ^  Phosphorus  dissolved  in  Chloroform. 


no  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Pilulse— 

Of  other  combinations  bearing  similar  names  or  used  for 
similar  purposes,  the  following  appear  to  be  those  most 
commonly  in  use : 

Chapman's  Dinner  Pill.^Kloes,  Mastic,  each,  grains  ij 

(o.i);  Ipecac,  grain  i  (0.06);  Oil  of  Fennel,  grain  \  (0.015). 

Cole's  Dinner  Pill. — Aloes,  Mass  of  Mercury,  and  Jalap, 

each,  grains  i^  (0.075) ;  Ant.  and  Potas.  Tartrate,  grain  ^^5- 

(0.0013). 

Hall's  Dinner  Pill. — Aloes,  Ext.  of  Glycyrrhiza,  Soap, 
and  Molasses,  each,  grain  i  (0.06). 

Aloes  et  Podophylli  ComposiTjE  (Janeway's  Pills). — Aloes, 
grain  i  (0.06) ;  Resin  Podophyllum,  grain  \  (0.03) ;  Ext. 
Bellad.  Ale,  Ext.  Nux  Vomica,  each,  grain  \  (0.015). 

Aloini  Composite. — Aloin,  grain  \  (0.03) ;  Resin  Podophyl- 
lum, grain  \  (o.oi);  Ext.  Belladonna,  grain  \  (0.015). 

Aloini,  SxRYCHNiNiE  et  Belladonna. — Aloin,  grain  \  (o.oi 
Gm.) ;  Strychnine,  alkaloid,  grain  j|^  (0.0005  Gm.) ;  Alco- 
holic Extract  of  Belladonna,  grain  J  (0.008  Gm.). 

Aloini,  Strychnine  et  Belladonna  Composite. — Aloin, 
grain  \  (0.012);  Ext.  Bellad.  Ale,  grain  \  (0.008  Gm.); 
Strychnine,  alkaloid,  grain  y^-jj-  (0.0005) ;  Ext.  Rham.  Pursh., 
grain  \  (0.03). 

Antidyspeptica. — Strychnine,  alkaloid,  grain  -^  (0.0014) ; 
Ipecac,  Ext.  Bellad.  Ale,  each,  grain  ^  (0.006) ;  Mass  of 
Mercury,  Ext.  Colocynth.  Comp.,  each,  grains  2  (0.13). 

Antineuralgica. — I.  Gross'  Antineuralgic  Pills:  Quinine 
Sulphate,  grains  2  (o.  1 3) ;  Morphine  Sulphate,  grain  -^ 
(0.003) ;  Strychnine,  alkaloid,  grain  -^  (0.002) ;  Arsenous 
Acid,  grain  ^  (0.003) ;  Ex.  Aconite  Leaves  (U.  S.  P.  1870), 
grain  \  (0.03). 

When  "  Antineuralgic  Pills,"  or  "  Neuralgia  Pills,"  with- 
out other  specifications,  are  prescribed,  it  is  recommended 
that  the  above  preparation  be  dispensed.  Sometimes  the 
Morphine  is  directed  to  be  omitted. 

2.  Brown- Se quard' s  Antineuralgic  (or  Neuralgia)  Pills: 
Extracts  of  Hyoscyamus  and  Conium,  each,  grain  f  (0.04) ; 
Extracts  of  Ignatia  and  Opium,  each,  grain  \  (0.03) ;  Ext. 
Aconite  Leaves,  grain  \  (0.02) ;  Ext.  Stramonium,  grain  \ 
(o.oi);  Ext.  Indian  Cannabis,  grain  \  (0.015);  Ext.  Bellad. 
Ale,  grain  \  (o.oi). 


SOLID  MIXTURES  FOR  INTERNAL   USE.  ill 

Pilulse— 

Antiperiodic^  (Warburg's  Pills). — i.  With  Aloes :  Aqueous 
Extract  of  Aloes,  grain  i  (0.06) ;  Rhubarb,  grain  \  (0.03) ; 
Elecampane,  Saffron,  Fennel,  each,  grain  \  (0.015);  Zedo- 
ary,  Cubebs,  Myrrh,  White  Agaric,  Camphor,  each,  grain  \ 
(0.008);  Quinine  Sulphate,  grains  if  (0.085);  Extract  of 
Gentian,  a  sufficient  quantity. 

2.  Without  Aloes :  The  same  formula  as  above,  with  omis- 
sion of  the  Aqueous  Extract  of  Aloes.  These  pills  have 
been  introduced  for  the  purpose  of  facilitating  the  adminis- 
tration of  Warburg's  Tincture  in  a  solid  form.  When 
"  Warburg's  Pills  "  or  "  Pills  of  Warburg's  Tincture  "  are 
prescribed,  without  further  specification,  those  containing 
Aloes  are  recommended  to  be  dispensed — those  without 
Aloes  only  when  they  are  expressly  demanded. 

Each  Warburg's   Pill  represents  about  i  fluidrachm  (4 
Cc.)  of  Warburg's  Tincture.     (See  Tinctura  Antiperiodica) 
CoLOCYNTHiDis  ComposiTjE  (Pilulse  Cochia). — Extract  of  Colo- 
cynth,  grain  \  (ooi) ;  Aloes,  Resin  of  Scammony,  of  each, 
grains  2  (0.13);  Oil  of  Cloves,  min.  \  (0.015). 
CoLOCYNTHiDis  ET  Hygscyami. — Extract  of  Colocynth,  grain 
Yj-  (0.006) ;  Aloes,  Resin  of  Scammony,  Ext.  Hyoscyamus, 
each,  grains  i\  (o.i);  Oil  of  Cloves,  min.  \  (0.0 1). 
COLOCYNTHIDIS  ET  PoDOPHYLLi. — Compound  Extract  of  Colo- 
cynth, grains    i^  (0.16);   Resin  of  Podophyllum,  grain  J 
(0.015). 
Ferri  Composite  (U.  S.  P.  1880). — Myrrh,  i^  grains  (o.i); 
Ferrous  Sulphate,  Sodium  Carbonate,  each,  f  grains  (0.048). 
Galbani    ComposiTvE   (U.  S.  P.    1880). — Galbanum,    Myrrh, 

each,  i^  grains  (0.1);  Asafoetida,  \  grain  (0.03). 
Glonoini  (Nitroglycerin). — Spirit  of  Glonoin   (i   per   cent.), 
Athsea,  each,  grains  200  (13.0);  Confection  of  Rose,  a  suf- 
ficient quantity.     Make  a  mass  and  divide  it  into  two  hun- 
dred (200)  pills.     Each  pill  contains  -j-^  grain  (0.0007)  of 
Glonoin  (Nitro-glycerin). 
Laxative  Post-partum  (Barker's). — Ext.  Colocynth.  Comp., 
.grains  if  (0.1) ;  Aloes,  grain  f  (0.05) ;  Res.  Podoph.,  Ipecac, 
each,  ^  grain  (0.005) !  Ext.  Nux  Vomica,  -f^  grain  (0.03) ; 
Ext.  Hyoscyamus,  i^  grains  (0.8). 

This  is  the  formula  generally  employed  by  Dr.  Fordyce 
Barker,  except  where  special  circumstances  render  modi- 


112  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Pilulse — 

fications  necessary.     The  formula  usually  quoted  in  manu- 
facturers' lists  and  some  formularies  is  not  correct. 

Metallorum  (Metallorum  Amarse).  —  Reduced  Iron  and 
Quinine  Sulphate,  each,  grain  i  (0.06) ;  Strychnine  and  Ar- 
senous  Acid,  of  each,  grain  -^-^  (0.003). 

Aitken's  Tonic  Pill  is  a  similar  combination : 

Reduced  Iron,  grain  f  (0.04);  Quinine  Sulphate,  grain  i 
(0.06);  Strychnine,  Arsenous  Acid,  each,  grain  -^  (0.0012). 

Opii  et  CAMPHORiE. — Powdered  Opium,  i  grain  (0.06) ;  Cam- 
phor, grains  2  (0.13). 

Opii  et  Plumbi. — Powdered  Opium  and  Acetate  of  Lead, 
each,  grain   i  (0.06). 

PoDOPHYLLi,  Belladonna,  et  Capsici  (Squibb's  Podophyllum 
Pills). — Resin  Podophyllum,  grain  \  (o.oij);  Capsicum, 
grain  \  (0.03) ;  Ext.  Bellad.  Ale,  grain  \  (0.008) ;  Sugar  of 
Milk,  grain  i  (0.06);  Acacia,  Glycerin,  and  Syrup,  each, 
a  sufficient  quantity. 

Quadruplices  (Ferri  et  Quininae  Compositae). — Ferrous  Sul- 
phate, Quinine  Sulphate,  Aloes,  each,  grain  i  (0.06);  Ext. 
Nux  Vomica,  grain  \  (0.015);  Ext.  Gentian,  sufficient. 

Triplices  (Triplex). — Aloes,  grains  2  (0.13);  Resin  Podo- 
phyllum, grain  \  (0.015);  Mass  of  Mercury,  grain  i  (0.06). 
When  Pilula  Triplex,  under  this  name  or  some  equiva- 
lent, is  prescribed  without  further  specification,  the  N.  F. 
recommends  that  the  above  preparation  be  dispensed.  A 
formula  devised  by  John  W.  Francis  is  also  in  use : 

2.  Francis's  Triplex  Pill. — Aloes,  Scammony,  Mass  of 
Mercury,  of  each,  grain  \  (0.05) ;  Croton  Oil,  -^  min.  (0.003); 
Oil  of  Caraway,  grain  \  (0.015);  Tincture  of  Aloes  and 
Myrrh,  a  sufficient  quantity. 

UNOFFICIAL  FORMS  OF  MIXTURES  OF  SOLIDS  FOR  INTERNAL 

USE. 

Granules  are  small  pills,  less  than  i  grain  (0.06)  in  weight, 
usually  sugar-coated  and  containing  alkaloids  and  other  active 
drugs. 

Parvules  are  identical  with  granules.  They  are  usually  colored 
red  or  pink. 

Globules  {Orbiculce)  are  sugar  pellets  to  be  saturated  with  alco- 
holic solutions  of  medicinal  agents,  chiefly  in  Homoeopathy. 


PREPARATIONS  FOR  EXTERNAL   USE.  1 13 

Compressed  Pills  are  made  by  compressing  powders  into  disks 
not  exceeding  5  grains  (0.3)  in  weight,  without  any  excipient. 

Friable  Pills  are  made  by  aggregation,  spreading  the  powdered 
mixture  upon  nuclei  or  sugar  granules  in  a  revolving  pan  until  the 
pills  are  formed. 

Bolus  is  the  name  given  to  pills  exceeding  5-10  grains  (0.3-0.6) 
in  weight,  used  in  veterinary  practice.  A  sugar-coated  bolus  is 
called  a  Dragee. 

RotulcB  are  disk-shaped  forms  of  sugar  about  i^  grains  (o.i)  in 
weight,  which  may  be  flavored  with  alcoholic  solution  (spirits). 

Bacilli  are  cylindrical  sticks,  a  form  of  lozenge  (Licorice). 

Laniellce,  thin  squares  of  gelatin  in  which  the  active  agent  has 
been  incorporated,  intended  for  solution  in  the  eye. 


PREPARATIONS  FOR  EXTERNAL  USE. 

To  this  group  belong  the  liquid  preparations :  Liniments, 
Oleates  and  Collodions,  and  the  mixtures  of  solids:  Ointments, 
Cerates,  Suppositories,  Plasters,  and  Papers.  The  Vehicle,  some- 
times incorrectly  called  the  "  base,"  consists  chiefly  of  fatty  sub- 
stances which  serve  as  protectives  or  facilitate  absorption.  The 
Collodions  are,  however,  an  exception. 

The  solid  mixtures  may  be  classified  according  to  their  fusi- 
bility, or  melting-points,  because  their  therapeutic  uses,  as  well  as 
their  pharmaceutical  forms,  are  through  this  quality  respectively 
determined. 

Ointments  fuse  at  the  body-temperature,  and  therefore  produce 
an  emollient  effect,  or  induce  absorption  of  the  medicinal  substance 
by  the  system.     They  are  applied  by  rubbing  or  inunction. 

Cerates  have  a  higher  fusing-point,  due  to  Wax  they  contain ; 
the  medicinal  agent  is  not  so  readily  absorbed,  and  they  are  there- 
fore used  to  produce  local  effects,  being  spread  on  cloth  and  applied 
as  dressings. 

Suppositories  have  the  same  fusibility  as  cerates,  and  may  be  said 
to  be  cerates  intended  for  application  to  the  orifices  of  the  body,  both 
for  absorption  and  local  effect. 

Plasters  have  a  still  higher  fusibility ;  they  do  not  melt,  but 
become  adhesive  by  the  body-temperature,  and  are  intended  to 
produce  local  effects  and  afford  mechanical  support  to  the  parts 
affected. 


114  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

The  fusibilities  of  these  various  preparations  are  likewise  gov- 
erned by  the  respective  vehicles  employed. 

LINIMENTA— LINIMENTS. 

The  Liniments  are  liquid  preparations  for  external  use,  consistr 
ing  of  solutions  of  oily  or  resinous  constituents  in  Alcohol  or  Oils, 
or  mixtures  of  liquid  Soaps.  The  nine  official  Liniments  are 
prepared  by  simple  admixture  or  solution. 

Linimentum — 

Ammonia  .    .    cotton  seed  oil  60  Cc. ;  ammonia  water  35  Cc. ; 

alcohol  5  Cc. 
Belladonnae  .  .  .  fl.  ext.  belladonna  95  Cc. ;  camphor  5  Gm. 
Calcis  (Carron  Oil)  .  .  linseed  oil  50  Cc. ;  lime  solution  50  Cc. 
Camphorae  ....  cotton  seed  oil  80  Gm.;  camphor  20  Gm. 
Chloroformi  ....  soap  liniment  70  Cc. ;  chloroform  30  Cc. 
Saponis camphor  4.5,  soap  7, 

rosemary  oil  i  ;  alcohol  75  ;  water,  to  100  Cc. 
Saponis  Mollis,  alcohol  35  Cc;  lavender  oil  2;  soft  soap  65  Gm. 
Sinapis  Comp.    .    .    .  fl.  ext.  mezereum  20;  mustard  oil,  vol.  3, 

camphor  6 ;  castor  oil  15;  alcohol,  to  100  Cc. 
Terebinthinse  .    .     resin  cerate  65  Gm.;  turpentine  oil  35  Gm. 

Unofficial  Liniments  of  the  National  Formulary. 
Linimentum — 

AcoNiTi  ET  Chloroformi. — Tincture  of  Aconite,  Chloroform, 

each,  2  fluidounces  (60  Cc.) ;  Soap  Liniment,  12  fluidounces 

(355  Cc). 
Ammonii   Iodidi. — Iodine,  30  grains  (2.) ;  Oil  of  Rosemary, 

Oil  of  Lavender,  each,  no  minims  (7  Cc);  Camphor,  220 

grains  (15.);  Water  of  Ammonia,  if  fluidounces  (50  Cc); 

Alcohol,  enough  to  make  16  fluidounces  (473.17  Cc).    On 

standing,  it  becomes  colorless. 
Cantharidis  (U.  S.  p.  1880). — Oil  of  Turpentine  containing 

15  per  cent,  of  Cantharides. 

loDi  (similar  to  Ph.  Br.). — Iodine,  900  grains  (60.) ;  Potassium 
Iodide,  360  grains  (24.);  Glycerin,  \  fluidounce  (15  Cc); 
Water,  i   fluidounce  (30  Cc.) ;    Alcohol,  enough  to  make 

16  fluidounces  (473.17  Cc). 

Opii  Compositum  (Canada  Liniment). — Tincture  of  Opium,  i^ 
fluidounces  (45  Cc.) ;  Camphor,  1 20  grains  (8.) ;  Alcohol,  4 
fluidounces   (118    Cc.) ;    Oil   of  Peppermint,    180   minims 


PREPARATIONS  FQR  EXTERNAL  USE.  1 15 

Linimentum— 

(12  Cc);  Water  of  Ammonia,  6  fluidounces  (180  Cc); 
Oil  of  Turpentine,  enough  to  make  16  fluidpunces 
(473.17  Cc). 

Plumbi  Subacetatis  (U.S.  p.  1880). — Solution  of  Lead  Sub- 
acetate,  35  parts ;  Cotton  Seed  Oil,  65  parts. 

Saponato-camphoratum  (Opodeldoc;  Solid  Opodeldoc). — 
White  Castile  Soap,  i^  ounces  (45.);  Camphor,  J  ounce 
(15.);  Alcohol,  20  fluidounces  (592  Cc);  Oil  of  Thyme,  30 
minims  (2  Cc.) ;  Oil  of  Rosemary,  60  minims  (4  Cc.) ;  Water 
of  Ammonia,  Fort.,  i  fluidounce  (30  Cc). 

TerebinthinjE  Aceticum  (Linimentum  Album.,  Stokes'  Lini- 
ment ;  St.  John  Long's  Liniment). — Oil  of  Turpentine,  3 
fluidounces  (89  Cc.) ;  Fresh  Egg,  i ;  Oil  of  Lemon,  60 
minims  (4  Cc.) ;  Acetic  Acid,  300  minims  (20  Cc.) ;  Rose 
Water,  2^  fluidounces  (75  Cc). 

TiGLii  (Linimentum  Crotonis,  Ph.  Br.). — Croton  Oil,  2  fluid- 
drachms  (8  Cc);  Oil  of  Cajuput,  7  fluidrachms  (27.5 
Cc). 

TiGLii  CoMPOSiTUM. — Croton  Oil,  i  fluidounce  (30  Cc);  Oil 
of  Sassafras,  i  fluidounce  (30  Cc);  Oil  of  Turpentine,  i 
fluidounce  (30  Cc);  Oil  of  Olive,  2  fluidounces  (60  Cc). 

LOTIONES— WASHES. 
Lotio — 

Adstringens   (Warren's   Styptic). — A  mixture  of  Sulphuric 

Acid,  Oil  of  Turpentine,  and  Alcohol. 
Flava  (Yellow  Wash,  Aqua  Phagedsenica  Flava,  Ph.  Ger.). 
— Corrosive   Mercuric  Chloride,   24  grains  (i-S),  in  Lime 
Water,  16  fluidounces  (473  Cc). 
Nigra  (Black  Wash;  Aqua  Phagedaenica  Nigra,  Ph.  Ger.). 
— Mild  Mercurous  Chloride,  64  grains  (4.),  in  Lime  Water, 
16  fluidounces  (473  Cc). 
Plumbi   et  Opii   (Lead-and-Opium   Wash). — Lead  Acetate, 
120  grains  (8.);  Tincture  of  Opium,  J  fluidounce  (15  Cc); 
in  Water,  16  fluidounces  (473  Cc).     To  be  shaken  when 
dispensed. 
The  following  are  unofficial  solutions  and  mixtures  for  external 
use: 

Injectio,  -ones. — Aqueous  solutions  for  introduction  by  means 
of  a  syringe  in  the  orifices  of  the  body. 


Il6  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

InjecUo  Hypodermica. — Solution  for  hypodermic  or  subcu- 
taneous injection. 

Enema,  -atis ;  Clyster. — A  warm  solution  of  Soap  or  a  muci- 
laginous mixture  for  injection  in  the  rectum  to  produce 
evacuation,  or  for  nutrition. 

Gargarisma,  -atis  ;  Gargle. — A  wash  or  lotion  for  the  throat. 

Collyrium,  -i ;  "Eye-wash." — A  weak  solution  for  instillation 
in  the  eyes. 

Nebula,  -cb  ;  Spray. — A  liquid  intended  for  application  by 
means  of  an  atomizer. 

Vapor,  -oris;  Inhalation. — Volatile  agents  to  be  added  to 
boiling  water  and  inhaled,  to  affect  the  air-passages. 

Balneum,  -ei  ;  Bath. — Mixture  to  be  added  to  water  for  bath- 
ing purposes. 

OLEATA— OLEATES. 

The  official  Oleates  are  solutions  of  oleates  in  Oleic  Acid. 
They  are  distinct  from  the  solid  oleates,  which  are  made  by  double 
decomposition  of  salts  of  the  metals  and  alkaline  earths  and 
sodium  oleate,  or  Soap.     (See  Soap}) 

The  liquid  Oleates  are  intended  for  endermic  medication.  They 
are  applied  by  inunction,  when  the  Oleic  Acid  favors  the  absorp- 
tion of  the  medicinal  agent,  the  oleate  in  solution.  When  it  is  not 
desirable  to  administer  remedies  by  the  mouth,  the  Oleates  afford 
an  effective  form  of  medication. 

The  solid  Oleates  are  either  dry  powders,  well  adapted  for  pro- 
tectives  as  dusting  powders,  or  soft,  pliable  masses  to  be  applied  in 
the  form  of  ointments  or  plasters. 

Three  are  official — two  liquid,  and  one.  Zinc  Oleate,  semi-solid. 
They  are  made  by  incorporating  the  sohd  with  the  Oleic  Acid, 
contained  in  a  warm  mortar,  and  effecting  solution  with  a  gentle 
heat: 

Percentage 
by  weight. 

Oleatum  Hydrargyri   ....  yellow  mercuric  oxide      20. 

Oleatum  Veratrinae veratrine        2. 

Oleatum  Zinci  Oxidi zinc  oxide        5. 

Unofficial  Oleates  of  the  National  Formulary. 

The  following  are  simply  solutions  of  the  alkaloids  in  Oleic 
Acid: 


PREPARATIONS  FOR  EXTERNAL   USE.  117 

Oleatum — 

AcONiTiN^. — Contains  2  per  cent,  of  crystallized  Aconitine 

(Duquesnel's). 
QuiNiNiE. — Contains  25  per  cent,  of  Quinine  (Alkaloid). 

Of  the  solid  Oleates  introduced  by  Dr.  J.  V.  Shoemaker,  the 
following  have  been  recognized,  but  others  may  also  be  prepared 
as  desired: 

Oleatum  Plumbi. — Contains  about  28  per  cent,  of  Lead  Oxide. 

It  is  of  the  consistence  and  general  character  of  Lead  Plaster, 

and  suggests  similar  use. 
Oleatum  Zinci. — In  the  form  of  a  soft  white  powder,  useful  as 

a  "  dusting  powder,''  or  converted  into  a  plaster  or  ointment 

by  mixing  it  with  such  proportion  of  Oleic  Acid  as  may  be 

required. 

OLEA  IN  FUSA— INFUSED  OILS. 

These  preparations  are  obtained  by  infusing  a  dry  herb,  usually 
from  the  so-called  narcotic  plants,  in  five  times  its  weight  of  a 
mixture  of  equal  parts  of  Cotton  Seed  Oil  and  Lard  Oil.  Oleum 
Hyoscyami  Infusum  is  the  most  familiar  example. 

Oleum — 

Carbolatum. — A  mixture  of  Cotton  Seed  Oil  with  S  per  cent, 
of  Carbolic  Acid. 

Hyoscyami  Compositum  (Balsamum  Tranquillans). — Infused 
Oil  of  Hyoscyamus,  with  a  small  proportion  of  each  of  the 
Ethereal  Oils  of  Absinth,  Lavender,  Rose,  Sage,  and  Thyme. 

COLLODIA— COLLODIONS. 

The  Collodions  are  solutions  in  Ether-Alcohol  of  Pyroxylin  or 
Soluble  Gun  Cotton.  Upon  evaporation  of  the  solvent  the  remain- 
ing film  excludes  the  air,  thus  protecting  abraded  surfaces.  Col- 
lodion is  also  used  as  a  vehicle  when  a  prolonged  local  effect  is 
desired. 

The  following  forms  are  official : 

Collodium   .    .  solution  in  ether  75  ;  alco.  25  ;  pyroxylin  3 

Collodium  Flexile  .    .    .  castor  oil  3  ;  Canada  turpentine  5 

Collodium  Acidi  Tannic!    .    .  alco.  5  ;  ether  25  ;  acid  tan.  20 
Collodium  Cantharidatum  (Blistering  Collodion)   .    (flex. 

collo.)  cantharides  60 


Il8  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Unofficial  Collodions. 
Collodium — 

loDATUM  (Iodized  Collodion). — Contains  5  per  cent.  Iodine  in 

Flexible  Collodion. 
loDOFORMATUM  (Iodoform  Collodion). — Contains  5  per  cent. 

Iodoform  in  Flexible  Collodion. 
Salicylatum  Compositum  (Corn  Collodion). — Contains  1 1  per 

cent.  Salicylic  Acid  and  2  per  cent.  Ext.  Cannabis  Indica  in 

Flexible  Collodion. 
TiGLii  (Croton  Oil  Collodion). — Contains  10  per  cent.  Croton 

Oil  in  Flexible  Collodion. 

UNGUENTA— OINTMENTS. 

Ointments  are  mixtures  of  a  fatty  vehicle  with  which  medicinal 
agents  are  incorporated,  readily  fusing  at  the  body-temperature, 
35°  to  40°  C.  (95°  to  104°  F.). 

The  vehicles  used  are :  Benzoated  Lard,  Ointment  (simple),  Lard, 
and  Wax  or  Spermaceti  in  different  proportions,  Lard  Oil,  Olive 
Oil,  and  Suet.  Petrolatum  and  Wool-fat  (Adeps  Lance  Hydrosus, 
U.  S.  P.)  are  employed  in  unofficial  ointments. 

The  medicinal  ingredients  must  be  minutely  distributed  through 
the  vehicle  in  order  that  the  ointment  may  not  prove  irritating,  and 
that  the  greatest  possible  surface  be  presented  to  the  epidermis 
with  a  view  to  quick  and  uniform  absorption.  For  this  reason  the 
highest  quality  of  an  ointment  (next  to  its  proper  melting-point)  is 
smoothness.  In  the  preparation  of  ointments  care  must  therefore 
be  taken  that  the  method  employed  be  such  as  to  yield  smooth 
products. 

The  melting-point  is  governed  by  the  fusibility  of  the  vehicle 
used,  which  is  either  officially  directed,  as  in  official  preparations, 
or  in  extemporaneous  preparations  prescribed  by  the  physician. 

The  twenty-three  official  Ointments  are  prepared  (i)  by  me- 
chanical admixture,  (2)  by  fusion,  or  (3)  by  chemical  reaction. 

Mixing  the  medicinal  substances  with  the  fatty  body  in  a  mor- 
tar or  on  a  slab  is  the  process  usually  employed  for  solid  sub- 
stances, especially  when  insoluble  in  the  fat.  Powdered  drugs, 
acids,  alkaloids,  extracts,  and  salts  (not  attended  by  chemical 
union)  are  examples  adapted  to  this  process. 

The  following  points  must  be  observed : 

Solids  must  be  in  a  fine  powder  before  being  incorporated  with 
the  vehicle ;  sometimes  it  is  an  advantage  to  triturate  the  solid  with 


PREPARATIONS  FOR  EXTERNAL   USE.  119 

a  small  quantity  of  a  bland  fixed  oil,  as  Almond  Oil  or  Olive  Oil, 
into  a  smooth  cream  before  it  is  mixed  with  the  vehicle  proper — 
Lard,  etc. 

Extracts  should  be  reduced  to  a  semi-hquid  condition  by  tritura- 
tion with  a  little  dilute  Alcohol  or  Water.  Substances  soluble  in 
fats,  such  as  Carbolic  Acid,  Iodine,  and  Camphor,  may  be  dis- 
solved directly  in  the  fat  by  the  aid  of  a  gentle  heat. 

The  following  are  the  official  Ointments,  with  their  drug- 
strengths,  their  respective  vehicles  being  given  in  parentheses : 

Percentage 
Unguentum —  of  Drugs. 

Acidi  Carbolici (ointment)  5 

Acidi  Tannici (benz.  lard)  20 

Aquae  Rosae  (Cold  Cream)  .    .  spermaceti  12.5  ;  white 

wax,  12;  expressed  oil  of  almond  60 

then  incorporate  borax  0.5  ;  rose  water  19 

Belladonnae  (dil.  alcohol  5)  extract     .    .    .    (benz.  lard)  10 

Chrysarobini  (chrysophanic  acid) "  5 

Diachylon  (Hebra's) lead  plaster  50 

oil  lavender  i ;  olive  oil  49 

Gallae (benz.  lard)  20 

Hydrargyri  (Blue  Ointment) mercury  50 

mercuric  oleate  2  ;  suet  23  ;  lard  25 

Hydrargyri  Ammoniati (benz.  lard)  10 

Hydrargyri  Oxidi  Flavi (ointment)  10 

Hydrargyri  Oxidi  Rubri  (castor  oil  5)     .    .    .        "  10 

lodi  (potass,  iod.  i,  water  2  parts)  ....  (benz.  lard)  4 

lodoformi "  10 

Picis  Liquidae    .    .    .   yellow  wax  12.5  ;  lard  37.5  ;  tar  50 

Plumbi  Carbonatis (benz.  lard)  10 

Plumbi  lodidi "  10 

Potassii  lodidi  (sod.  hypo,  sulph.  i ;  water  10)  "  12 

Stramonii  (dil.  ale.  5)  Extract "  10 

Sulphuris  (washed) "  30 

Veratrinae  (olive  oil  6) "  4 

Zinci  Oxidi "  20 


Unofficial  Ointments  of  the  National  Formulary. 

Unguentum  Acidi  Gallici  (U.  S.  P.  1880). — Contains  10  per 
cent.  Gallic  Acid. 


I20  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Unguentum  Calamine  (Unguentum  Zinci  Carbonatis  Im- 
puri;  Turner's  Cerate).— Contains  17  per  cent.  Zinc  Car- 
bonate (Imp.). 

Unguentum  Camphors  (Unguentum  Camphoratum). — Con- 
tains 20  per  cent.  Camphor. 

Unguentum  Fuscum  (Unguentum  Matris;  Mother's  Salve). 
— Contains  50  per  cent,  of  Camphorated  Brown  Plaster 
(N.  F.). 

Unguentum  Mezerii  (U.  S.  P.  1880).— Represents  25  per 
cent.  Mezereum. 

Unguentum  Picis  Compositum  (Tar,  Comp.). — Contains  Oil 
of  Tar,  4  per  cent. ;  Tincture  of  Benzoin,  2  per  cent. ;  and 
Oxide  of  Zinc,  3  per  cent. 

Unguentum  Sulphuris  Alkinum  (U.  S.  P.  1880). — Contains 
20  per  cent.  Sulphur  and  10  per  cent.  Potassium  Carbonate. 

Unguentum  Sulphuris  Compositum  (Wilkinson's  Ointment; 
Hebra's  Itch  Ointment). — Precipitated  Calcium  Carbonate, 
10;  Sublimed  Sulphur,  Oil  of  Cade,  of  each,  15;  Soft 
Soap  and  Lard,  of  each,  30  parts.  The  Lard  is  mixed 
with  the  Soft  Soap  and  Oil  of  Cade;  the  Sublimated 
Sulphur  and  Precipitated  Calcium  Carbonate  are  then  grad- 
ually incorporated. 

CERATA— CERATES. 

Cerates  are  mixtures  of  fats  similar  to  the  ointments,  but  of 
firmer  consistence,  because  they  contain  Wax  or  Resin  (having  a 
higher  melting-point  than  Lard)  in  greater  proportion  than  do  oint- 
ments. In  the  preparation  of  Cerates  the  same  rules  are  to  be 
observed  as  noted  under  Ointments. 

The  six  official  Cerates  are  prepared  by  fusion  or  simple  admix- 
ture, and  one  by  extraction  and  digestion  (Ceratum  Cantharidis) : 

Percentage 
of  Drugs. 

Ceratum  (Simple) lard  70 ;  white  wax  30 

Camphorae  .  camphor  liniment  10;  lard  60;  white  wax  30 

Cantharidis  (Blistering  Cerate)    .    .    .oil  of  turpentine  15 

lard,  22  ;  cantharides  32 

yellow  wax,  resin,  each  18 

previously  fused,  and  evaporate  to  100 

Cetacei    .    .    .   olive  oil  55  ;  white  wax  35  ;  spermaceti  10 


PREPARATIONS  FOR  EXTERNAL   USE.  I3I 

Percentage 
of  Drugs, 
Plumbi  Subacetatis  (Goulard's  Cerate),  camphor  cerate     80 

solution  lead  subacetate     20 
Resinae  (Basilicon)    .    .  yellow  wax  15     lard  50;  resin     35 
in  cold  weather  yellow  wax  12; 

lard  53  ;  resin     35 

In  the  "  Blistering  Cerate "  the  maceration  in  Turpentine  Oil 
and  subsequent  digestion  dissolve  the  vesicating  principle  of  the 
Cantharides,  and  the  preparation  is  therefore  more  active. 

Ceratum  CAMPHORiE  CoMPOsiTUM,  N.  F.  (Camphor  Ice). — 
Moulded  into  small  cakes  suitable  for  popular  use  as  an  appHca- 
tion  to  excoriated  surfaces.  It  contains  very  small  quantities  of 
Benzoic  and  Carbolic  Acids. 

Ceratum   Extracti   Cantharidis  (U.  S.  P.  1880). — Repre- 
sents 30  per  cent.  Cantharides. 
Ceratum  SabinjE  (U.  S.  P.  1880). — Represents  25  per  cent 
Sabine. 

SUPPOSITORIA— SUPPOSITORIES. 

Suppositories  may  be  defined  as  variously  shaped  masses  of 
medicated  fat,  possessing  a  consistence  ensuring  their  quick  fusion 
when  introduced  in  the  orifices  of  the  body. 

The  U.  S,  P.  defines  Suppositories  with  reference  to  their 
weights  and  shapes,  corresponding  to  their  several  uses — i.  e.  for 
introduction  in  the  respective  orifices  of  the  body — as  follows : 

Rectal,  cone-shaped,  should  weigh  15  grains  (i  Gm.). 

Urethral,  pencil-shaped,  should  weigh  15  grains  (i  Gm.). 

Vaginal,  globular,  should  weigh  about  45  grains  (3  Gm.). 

The  vehicle  is  Cacao  Butter  {Oleum  Theobromatis),  which  pos- 
sesses the  property  of  melting  at  the  temperature  of  the  human 
body,  35"  C.  (95°  F.),  and  yet  remaining  firm  at  ordinary  tempera- 
tures. An  addition  of  10  per  cent,  of  spermaceti  has  been  recom- 
mended to  raise  the  melting-point  and  thus  give  more  stability  to 
suppositories  during  the  heated  seasons  of  the  year. 

The  U.  S.  P.  gives  a  general  formula  for  preparing  supposi- 
tories ;  only  one  Suppository  is  official,  and  this  is  not  made  from 
Cacao  Butter. 

The  methods  of  preparing  suppositories  are  quite  numerous : 
any  process  may  be  employed  by  which  the  product  is  obtained 
uniform  in  size  and  shape  and  with  the  medicinal  ingredients  thor- 


122  A   TEXT-BOOK  OF  MATERIA  MEDJCA. 

oughly  incorporated.  Moulds  are  usually  employed ;  the  medici- 
nal ingredients,  if  solid,  are  first  reduced  to  powder  in  a  mortar, 
and  mixed  with  a  small  quantity  of  the  grated  Fat ;  the  remainder 
of  the  Fat,  previously  melted  and  cooled  to  35  °  C,  is  then  gradually 
incorporated  with  this  mixture,  thoroughly  mixed,  and,  if  possible, 
without  further  heating,  poured  into  the  moulds,  previously  chilled. 

Another  process  consists  in  rolling  the  mass  on  a  slab,  cutting 
it  as  in  making  pills,  and  forming  the  cones  with  the  fingers.  By 
cold  compression  in  a  screw-press  "  machine,"  suppositories  may 
be  formed  from  the  prepared  mass. 

Urethral  Suppositories  are  commonly  called  Bougies,  or,  more 
properly,  Medicated  Bougies.  They  are  usually  made  with  the 
addition  of  Wax,  or  from  Glyco-gelatin  mass. 

Suppositoria  Glycerini. — Made  by  reaction  of  Sodium  Carbonate 
5  grains  (0.3),  in  Glycerin  i^  grains  (6  Gm.),  with  Stearic  Acid 
8  grains  (0.5),  and  heating  until  a  solution  of  sodium  stearate  or 
soap  is  formed,  which  is  poured  into  a  mould.  Upon  cooling,  the 
mixture  gelatinizes  and  the  suppository  is  wrapped  in  tin-foil. 

Uses. — Upon  introduction  into  the  rectum  the  mass  melts,  and 
the  Glycerin,  acting  upon  the  feces,  produces  evacuation. 

Rectal  suppositories  are  usually  made  twice  the  official  size,  or 
30  grains  (2  Gm.).  1 

A  formula  for  suppositories  would  be : 

Extracti  Belladonnse  FoL,  ale,        o.i ; 
Acidi  Tannici,  i  .0 ; 

Olei  Theobromatis,  q.  s.  (20  Gm.). 
Ut  fiat  suppositoriae  No.  x.  (2  Gm.). 

Each  suppository  would  contain  \  grain  (o.oi)  Ext.  Belladonna 
and  \\  grains  (o.i)  Tannic  Acid. 

EMPLASTRA— PLASTERS. 

Plasters  are  mixtures  of  various  fatty  or  resinous  solids  of  such 
high  melting-point  as  to  be  friable  when  cold,  but  rendered  adhesive 
by  the  warmth  of  the  body. 

The  vehicles  of  plasters  are :  Lead  plaster ;  resinous  substances, 
made  adhesive  by  admixture  with  the  medicinal  ingredients ;  and 
simple  plasters,  such  as  isinglass. 

The  making  of  plasters  does  not  differ  materially  from  the  pro- 
cess employed  for  ointments  and  cerates,  since  they  are  all  prepared 
by  melting  the  various  substances  and  incorporating  the  inedicinal 


PREPARATIONS  FOR  EXTERNAL   USE.  123 

substances  last.  The  spreading  of  plasters,  though  usually  done 
on  a  large  scale,  may  be  easily  effected  by  the  pharmacist  with 
the  use  of  a  plaster  iron. 

The  thirteen  official  Plasters  may  be  divided  into — (i)  Lead 
Plasters ;  (2)  Pitch  and  Gum-Resin  Plasters,  and  (3)  Isinglass 
Plaster. 

(i)  The  most  important  plasters  are  made  from  Lead  Plaster, 
or  Lead  Plaster  mixed  with  Resin,  the  official  Resin  Plaster. 

Percentage  or 
Emplastrum—  P""-''  '"  '°°- 

Plumbi  (Diachylon)  ....  olive  oil  60;  lead  oxide     32 

mix,  and  add  to  water     10 
Boil  the  mixture  until  the  reaction  has  ceased  and 
the  plaster  is  of  the   right   consistence,  replacing 
water  lost  by  evaporation  from  time  to  time. 

Resinae  (Adhesive) yellow  wax  6 ;  resin     14 

lead  plaster     80 
Saponis lead  plaster  90 ;  soap     10 

From  these  the  following  are  prepared : 

Emplastrum — 

Arnicae resin  plaster  67 ;  extract  arnica  root  33 

Belladonnse ext.  belladonna  leaves  20 

resin  plaster,  soap  plaster,  each  40 
Capsici     .    .    .     resin  plaster,  oleoresin  capsicum  q.  s. 

Hydrargyri,  lead  plaster  70 ;  mercury  oleate  1.2;  mercury  30 

Containing  lead  plaster  and  pitch : 
Emplastrum — 

Ferri  (Strengthening)  .    .    .  olive  oil,  5  ;  ferric  hydrate  9 

Burgundy  pitch  14;  lead  plaster  72 

Opii  .  Burgundy  pitch  18 ;  lead  plaster  yS;  ext.  opium  6 

Picis  Cantharidatum  (Warming)  .    .    .  Burgundy  pitch  92 

cerate  cantharides  8 
(2)  Pitch  and  Gum  Resin  Plasters : 
Emplastrum — 

Ammoniaci  cum  Hydrargyro  ....     oleate  mercury  0.8 

mercury  18 

ammoniac  72;  dil.  acetic  acid,  lead  plaster,  to  100 

Picis  Burgundicae olive  oil  5  ;  yellow  wax  1 5 

Burgundy  pitch  80 


124  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

(3)  Isinglass  plaster  (Emplastrum  Ichthyocollae ;  Court-plaster). 
— A  solution  of  10  Gm.  Isinglass  is  dissolved  in  hot  Water  120 
Gm. ;  one-half  of  the  solution  is  spread  upon  silk  (taffeta)  in  suc- 
cessive layers,  and  when  dry  the  other  half  of  the  solution  is  spread 
on  in  a  similar  manner,  after  first  having  been  mixed  with  Alcohol 
40  Gm.,  Glycerin  i  Gm.  The  taffeta  is  then  coated  on  the  reversed 
side  with  Tincture  of  Benzoin  to  make  it  waterproof  and  antiseptic. 

Unofficial  Plasters  of  the  National  Formulary. 
£mplastrum — 

Ammoniaci  (U.  S.  p.  1880). — Gum- resin  Ammoniac  with 
Acetic  Acid. 

Aromaticum  (Spice  Plaster). — Consisting  of  Cloves,  Cinna- 
mon, and  Ginger,  each,  10  per  cent.;  Capsicum  and  Cam- 
phor, each,  5  per  cent. 

AsAFCETiDiE  (U.  S.  P.  1880). — Asafoetida  35  p.;  Galbanum  15 
p. ;  with  Lead  Plaster. 

FuscuM  Camphoratum  (Matris  Camphoratum,  Ph.  Ger.). — 
Camphorated  Mother's  Plaster.  A  plaster  similar  to  lead 
plaster,  and  containing  camphor,   i   per  cent. 

Galbani  (U.  S.  P.  1880). — Galbanum  Plaster. 

Picis  Canadensis  (U.  S.  P.  1880). — Canada  Pitch  Plaster. 

Picis  Liquids  Comp. — A  mixture  of  Resin  and  Tar,  with  Podo- 
phyllum, Phytolacca,  and  Sanguinaria,  of  each,  10  per  cent. 

CHARTjE— PAPERS. 

There  are  two  Papers  official.  One  is  made  by  saturating  strips 
of  white  unsized  paper  in  a  20  per  cent,  solution  of  Potassium 
Nitrate  and  diying;  the  other  is  paper  coated  with  Mustard,  used 
similarly  to  the  Plasters  : 

Charta  Potassii  Nitratis  ....  potass,  nitrate  20 ;  water  80. 

Vapors  from  incineration  as  inhalant. 
Charta  Sinapis   .    .  oil-free  black  mustard,  4  Gm.  in  60  sq.  cm. 
The  Mustard  is  freed  from  the  fixed  oil  by  extraction  with  Ben- 
zin,  and  mixed  with  a  solution  of  India  Rubber  in  equal  volumes 
of  Benzin  and  Carbon  Bisulphide,  and  spread  upon  Paper.     This 
is   the   well-known    Mustard   Plaster  or  Mustard  Paper.    When 
applied,  the  paper  should  be  immersed  in  lukewarm  water  for  a 
few  minutes,  in  order  to  render  the  vesicating  principle  active. 
Charta  Cantharidis,  U.S.  P.  1880. — Cantharidis  Paper  (Blis- 
tering Paper). 


PREPARATIONS  FOR  EXTERNAL   USE.  125 

Poultice  or  Cataplasm  (Lat.  Cataplasm,  -atis). — A  coarsely 
ground  substance  or  mixture  of  substances,  such  as  flaxseed  or 
elm-bark,  made  into  a  mass  with  hot  water  or  some  other  liquid, 
spread  upon  cloth  or  filled  into  porous  bags,  and  applied  to  the 
body  while  hot. 

Fomentations  (Lat.  Fometitum,  -i). — Porous  woollen  cloths  sat- 
urated with  hot  infusion  or  decoction  of  herbs,  or  other  hot  liquids 
or  lotions,  and  apphed  hot. 

Spongiopiline. — A  thick  cloth  covered  with  layers  of  sponge 
for  the  saturation  and  retention  of  medicinal  agents  intended  for 
absorption,  the  exterior  being  composed  of  waterproof  material, 
such  as  rubber. 

Plaster-Mull. — A  thin  cloth  made  impervious  with  rubber  or 
gutta-percha  tissue,  upon  which  is  spread  or  painted  medicinal 
agents  in  the  liquid  form,  intended  for  local  application. 

Caustics  or  Escharotics  (Lat.  Escharotica,  -cb). — Substances, 
used  to  destroy  tissue  by  chemical  action  or  by  heat,  either  semi- 
solid mixtures  made  into  a  paste  with  starch  or  other  diluent,  or 
chemicals  fused  and  moulded  into  sticks  called  pencils  or  "  crayons  " 
(Lat.  stilus,  -i),  to  be  apphed  directly  to  the  skin.  Moxa  is  the 
name  given  to  small  cones  of  combustible  substances  which  upon 
incineration  do  not  inflame,  but  give  off  an  intense  heat,  used  for 
cauterization  when  heat  is  desired. 

Bandages;  Antiseptic  Dressings. — The  material  used  for 
bandages  is  cellulose  in  various  modifications,  such  as  cotton, 
linen,  jute,  and  other  fibrous  substances.  Aside  from  the  me- 
chanical support  afforded,  bandages  also  serve  to  keep  wounds 
clean  by  absorbing  and  withdrawing  secretions  (pus)  which  would 
otherwise  prove  irritating,  and  by  protecting  them  against  extrane- 
ous matter  serve  to  promote  the  healing  process. 

These  various  substances  may  be  used  either  plain  or  medi- 
cated, when  they  are  called  antiseptic. 

Gossypiuin  Purificatum,  U.  S.  P.;  Absorbent  Cotton. — The  hairs 
of  Gossypium  herbaceum  L.,  freed  from  oil  and  resinous  substances 
by  treatment  with  alkalies  and  bleaching  agents.  These  hairs  rep- 
resent microscopic  ducts  in  which  liquids  are  absorbed  through 
capillarity.  The  freer  from  oily  constituents,  the  more  readily  will 
watery  liquids  be  taken  up  and  retained ;  hence  the  absorbability  of 
cotton  depends  upon  its  purity.  This  is  equally  true  with  all  other 
bandage  material. 

Linen  in  the  form  of  thin  sheets,  known  as  Muslin  or  Muslin- 


J26  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

gauze,  or  purified  similarly  to  cotton,  when  it  is  called  Lint,  is 
made  from  the  bast-fibres  of  the  Linum  usitatissimum  L.,  Flax. 
Hemp  and  Jute  are  the  bast-fibres  of  their  respective  plants. 

Medicated  Dressings. — These  are  made  by  saturating  the  ma- 
terial or  vehicle  in  a  solution  of  certain  strength  of  the  medicinal 
agent,  or  incorporating  the  latter  in  powdered  form.  In  the  appli- 
cation of  a  dressing  which  has  been  rendered  aseptic  or  antiseptic 
by  impregnating  it  with  Phenol  (Carbolic  Acid),  Salicylic  Acid, 
Mercuric  Chloride,  or  similar  agent,  it  is  desired  to  bring  in  con- 
tact with  the  wound  a  solution  of  certain  strength — for  example, 
a  5  or  lo  per  cent,  solution  of  Phenol,  a  ^^g-  or  ^  of  i  per  cent, 
solution  of  Mercuric  Chloride,  etc.  The  quantity  of  material  which 
conveys  the  agent  is  of  no  consequence,  as  the  fabric  simply  serves 
as  a  vehicle  for  the  medicinal  or  antiseptic  agent.  The  strengths 
of  such  dressings  should  therefore  be  designated  by  the  percentage^ 
strength  of  the  solutions  by  which  they  are  saturated,  rather  than  by 
the  percentage  by  weight  of  the  medicinal  agent  the  finished  dress- 
ing may  contain. 

In  dressings  of  antiseptic  agents  that  are  usually  applied  in  sub- 
stance, such  as  Boric  Acid  and  Iodoform,  the  percentage-amount 
actually  contained  by  weight  in  the  finished  dressing  should  be 
stated.  Here  the  use  of  a  vehicle  is  only  a  matter  of  convenience, 
and  it  is  desirable  to  know  just  how  much  of  the  medicinal  agent 
is  contained  in  a  certain  quantity  by  weight  or  by  area  of  the 
dressing. 

Medicated  Cottons. — Purified  cotton  is  saturated  in  a  solution 

in  Water,  or  Glycerin  and  Water,  of  the  strength  desired  of  the 

medicinal  agent,  and  thoroughly  expressed. 

The  following  are  the  usual  strengths  : 

Percentage. 

Gossypium  Boratum acid  boric  S  or  10 

Carbolatum phenol  5  or  10 

lodoformatum iodoform  10  to  20 

Salicylatum acid  salicylic  10  to  20 

Stypticum Monsel's  solution 

Sublimatum mercuric  chloride  ^  to  -^ . 

Iodoform,  being  insoluble  in  Water,  should  be  dissolved  in  Ether 
or,  preferably,  in  a  mixture  of  Alcohol  and  Glycerin. 

Medicated  Gauzes  ;  Carbasa. — The  material  used  for  making 
Medicated  Gauzes  is  a  muslin  gauze  free  from  sizing  or  other  ex- 
traneous matter.     The  gauze  is  thoroughly  impregnated  with  the 


PREPARATIONS  FOR  EXTERNAL   USE.  127 

solution  of  the  particular  strength  required,  then  forcibly  expressed, 
after  which  it  is  ready  for  use ;  or,  if  desired  for  future  use,  it  should 
be  tightly  rolled,  wrapped  in  parchment  paper,  and  kept  in  closely 
covered  boxes  in  a  cool,  dry  place. 

The  following  are  the  most  commonly  used  Gauzes  and  their 

strengths : 

Percentage. 

Carbasus  Boratum acid  boric  5-10 

Carbolatum phenol  5-10 

lodoformatum iodoform  10-20 

Salicylatum acid  salicylic  10-20 

Sublimatum mercuric  chloride  ^(^   ^^ 

The  Iodoform  Gauze  is  made  in  the  same  way  as  the  Cotton, 
by  saturation  with  a  solution  of  Iodoform  in  Alcohol  and  Glycerin. 
All  the  others,  except  the  Mercurial  Gauze,  contain  Glycerin. 
Mercuric  Chloride  is  dissolved  in  Water  with  a  little  Acid  Tartaric 
(5  parts  for  i  of  Mercuric  Chloride),  the  presence  of  which  in  the 
Gauze  prevents  the  formation  of  insoluble  albuminate  of  mercury 
when  it  is  brought  in  contact  with  the  albuminous  discharges  from 
wounds. 

Plaster-of-Paris  bandages  are  made  by  thoroughly  incorpo- 
rating Calcium  Sulphate  (gypsum)  into  linen  bandages.  When 
applied,  the  bandage,  after  being  dipped  in  water,  sets  hard  and 
firm  in  a  few  minutes. 


CLASS  I.-DISEASE  MEDICINES. 


DIVISION  I.— RESTORATIVES. 


GROUP   I.— DIGESTANTS. 

[In  the  present  work  care  has  been  taken  to  designate  the  proper  pronunciation 
(Foster)  of  the  names  of  drugs  and  their  preparations  common  to  Materia  Medica  and 
Therapeutics.  The  simplest  and  most  efficient  method  appears  to  be  that  herein  fol- 
lowed— namely,  to  indicate  accent  and  quantity  by  a  single  sign ;  for  example,  Pep- 
slnum  (nom.) — Pepsini  (gen.),  in  which  the  i  is  long  and  the  accent  upon  the  second 
syllable;  Cflcculus — C6cculi,  in  which  the  o  is  short  and  the  accent  upon  the  first 
syllable. 

In  nearly  all  cases  the  genitive,  as  used  in  prescription-writing,  and  the  English 
equivalent,  are  given.  When  the  accusative,  not  genitive,  is  adopted,  tlje  usage  is 
marked  by  "(ace.)";  as  Pilulse,  Pilulas  (ace),  etc.] 

Pepsinum—PepsTni— Pepsin.     U.  S.  P. 

Origin. — A  proteolytic  ferment  or  enzyme  obtained  from  the 
glandular  layer  of  fresh  stomachs  from  healthy  pigs,  and  capable 
of  digesting  not  less  than  3000  times  its  own  weight  of  freshly 
coagulated  and  disintegrated  egg  albumen  when  tested  by  the 
process  given  in  the  United  States  Pharmacopoeia. 

Description  and  Properties. — A  fine  white,  or  yellowish-white, 
amorphous  powder,  or  thin,  pale  yellow,  or  yellowish,  transparent 
or  translucent  grains  or  scales,  free  from  offensive  odor,  and  having 
a  mildly  acidulous  or  slightly  saline  taste,  usually  followed  by  a 
suggestion  of  bitterness.  It  slowly  attracts  moisture  when  exposed 
to  the  air.  Soluble,  or  for  the  most  part  soluble,  in  about  100  parts 
of  water,  with  more  or  less  opalescence ;  more  soluble  in  water  acid- 
ulated with  hydrochloric  acid  ;  insoluble  in  alcohol,  ether,  or  chlo- 
roform. Pepsin  usually  has  a  slightly  acid  reaction.  It  may  be 
neutral,  but  should  never  be  alkaline. 

Dose. — 5~6o  gr.  (0.3-4.0  Gm.). 

9  129 


130  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Official  Preparations. 
Pepsinum  Saccharatum — Pepsini  Saccbarati — Saccharated  Pepsin. 
Formula :  Pepsin  10,  Sugar  of  Milk  90  parts.     Dose,  30  gr.-4  dr.  (2.0-16.0  Gm.). 

Antagonists  and  Incompatibles. — Tannic  and  gallic  acids  are 
incompatibles.  Mineral  salts,  alcohol,  and  alkalies  precipitate  pep- 
sin from  solution,  the  two  latter  impairing  its  digestive  property. 
The  "  Wine  of  Pepsin  "  is  therefore  unreliable. 

Synergists. — Diluted  hydrochloric,  lactic,  acetic,  and  citric  acids 
increase  its  digestive  action. 

Physiological  Action. — Its  only  influence  seems  to  be  upon  the 
digestive  system.  Pepsin  is  a  typical  restorative,  being  a  normal 
constituent  of  the  gastric  juice,  and  in  the  presence  of  hydrochloric 
acid  digesting  the  nitrogenous  elements  of  the  food,  converting 
them  into  peptones  or  albumoses. 

Therapeutics. — Externally  and  Locally. — Its  digestive  action  is 
utilized  to  dissolve  or  digest  the  false  membrane  in  diphtheria  and 
croup.  A  solution  of  pepsin  has  also  been  injected  into  the  blad- 
der to  digest  blood-clots.  It  has  been  further  recommended  as 
an  application  to  cancer  of  the  cervix  uteri. 

Internally. — As  a  restorative,  where  there  is  a  lessened  secre- 
tion of  gastric  juice,  atonic  dyspepsia,  apepsia  of  infants,  cancer  of 
the  stomach,  and  gastric  ulcer,  pepsin  has  proved  serviceable.  It  is 
also  employed  to  favor  digestion  in  convalescence  from  acute  and 
long  illness.  It  is  frequently  necessary  to  give  pepsin,  or  "  pepton- 
ized milk,"  in  acute  dyspeptic  diarrhea  of  infants. 

Administration. — Pepsin  should  be  given  in  powder  or  dis- 
solved in  glycerin  (Glycerol  of  Pepsin),  or  in  water  acidulated  with 
hydrochloric  acid,  directly  after  meals. 

The  drug  should  not  be  given  continuously  for  too  long  a 
period,  lest  the  function  of  the  stomach  become  impaired  from 
disuse,  the  artificial  digestion  having  replaced  the  natural,  normal 
process. 

Unless  there  be  some  direct  indication  for  its  use,  rather  than 
give  pepsin  it  is  better  to  stimulate  the  gastric  glands  to  secrete  a 
larger  amount  of  their  normal  juice,  that  they  may  not  lie  idle, 
and  their  function  be  consequently  impaired  by  disuse.  Hydro- 
chloric acid  administered  with  pepsin  probably  slightly  promotes 
glandular  activity.  Often,  however,  pepsin  must  be  given,  and  in 
certain  cases  the  stomach  is  in  such  a  condition  that  nutrient  en- 
emata  must  be  administered.     Yet,  since  the  rectum  possesses  very 


DIGESTANTS.  131 

feeble  powers  of  digestion,  the  food  should  always  be  predigested. 
Suppositories  of  peptonized  meat  are  frequently  used  for  this 
purpose. 

Pancreatlnum— Pancreatlni— Pancreatin.    V.  S.  I*. 

Origin. — A  mixture  of  the  enzymes  naturally  existing  in  the 
pancreas  of  warm-blooded  animals,  usually  obtained  from  the  fresh 
pancreas  of  the  hog. 

Description  and  Properties. — A  yellowish,  yellowish-white,  or 
grayish  amorphous  powder,  odorless,  or  havipg  a  faint,  peculiar, 
not  unpleasant  odor,  and  a  somewhat  meat-like  taste.  Slowly  and 
almost  completely  soluble  in  water,  insoluble  in  alcohol. 

Pancreatin  digests  albuminoids  and  converts  starch  into  sugar. 
Prolonged  contact  with  mineral  acids  renders  it  inert. 

Dose. — 10-20  gr.  (0.6-1.2  Gm.). 

Antagonists  and  Incompatibles. — Mineral  acids. 

Synergists. — Alkalies  and  the  digestive  ferments. 

Physiological  Action. — The  four  ferments  which  it  contains 
render  it  capable,  in  alkaline  media,  of  digesting  albuminoids  ; 
emulsifying  fats  and  oils,  and  resolving  them  into  fatty  acids  and 
glycerin ;  converting  starch  into  sugar ;  and  curdling  milk. 

Therapeutics. — Like  pepsin,  it  is  used  as  an  artificial  agent  in 
certain  disorders  of  digestion. 

Administration. — It  may  be  given  dry,  in  powder,  capsules,  or 
compressed  pills,  or  in  solution.  It  should  be  administered  in 
combination  with  an  alkali,  as  the  activity  of  pancreatin  is  de- 
stroyed by  acids,  and  should  be  given  ordinarily  from  two  to  four 
hours  after  meals,  when  the  chyme  has  entered  the  intestine.  It 
•may  also  be  administered  immediately  after  eating  or  with  the  food, 
since  there  is  an  interval  of  from  fifteen  minutes  to  half  an  hour 
after  the  ingestion  of  food  before  the  stomach-contents  are  ren- 
dered sufficiently  acid  by  the  gastric  juice  to  interfere  with  the 
activity  of  the  pancreatin. 

For  rectal  nourishment  pancreatin  is  preferable  to  pepsin,  be- 
cause of  its  superior  action  in  predigesting  food. 

Papain,  Papoid,  or  Papayotin. 

Origin. — The  inspissated  juice  of  the  unripe  fruit  of  Carica 
Papaya. 

Description  and  Properties. — A  whitish,  slightly  astringent 
powder,  soluble  in  water. 


132  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Dose. — 1-8  gr.  (0.06-0.5  Gm.). 

Antagonists  and  Incompatibles. — Tannic  and  gallic  acids. 
Lead  salts  and  alcohol  are  incompatible  with  papain. 

Synergists. — The  digestive  ferments. 

Physiological  Action. — In  this  it  resembles  pepsin,  though  dif- 
fering from  the  latter,  as  well  as  from  paricreatin,  in  that  it  is 
equally  active  in  neutral,  alkaline,  or  acid  media.  It  converts  pro- 
teids  into  soluble  peptones,  and  acts  as  a  stimulant  to  the  gastric 
glands.  It  converts  starch  into  maltose,  and  upon  false  membranes 
acts  more  energetically  than  pepsin.     It  dissolves  intestinal  worms. 

Therapeutics. — Externally. — The  uses  of  papain  are  more  mani- 
fold than  those  of  the  digestive  ferments  previously  mentioned. 
Like  pepsin,  it  has  been  successfully  employed  to  dissolve  false 
membrane  in  diphtheria  and  croup.  The  juice  of  pineapple,  which 
possesses  a  ferment  (bromelin)  similar  to  that  of  papain,  is  a  val- 
uable domestic  remedy  in  these  diseases.  Papain  has  been  used 
with  some  benefit  in  indurated  eczema  and  in  syphilitic  ulcerations 
of  the  tongue.  It  has  been  highly  recommended  by  Johnston  as  a 
solvent  oi  cerumen:  15  drops  (i.o  Cc.)  of  a  solution  of  20  grains 
to  I  oz.  (1.2  Gm-30  Cc.)  of  distilled  water  are  dropped  into  the 
outer  meatus,  and  the  parts  syringed  an  hour  afterward  with  a 
solution  of  boric  acid. 

Internally,  papain  may  be  used  for  the  same  purposes  as  pepsin 
and  pancreatin ;  yet,  while  theoretically  superior,  it  is  practically 
inferior  to  them,  fortunately  not  having  supplanted  them  in  actual 
practice. 

Administration. — When  used  to  aid  digestion,  papain  should  be 
given  after  meals,  either  in  powders,  capsules,  compressed  tablets, 
or  aqueous  solution  freshly  prepared. 


GROUP  II.— FATS  AND  OILS. 

Oleum   Morrhuae— Olei    Morrhuae— Cod    Liver  Oil. 

V.  s.  p. 

Origin. — A  fixed  oil  obtained  from  the  fresh  livers  of  Gadus 
Morrhua  L.  and  other  species  of  Gadus. 

Description  and  Properties. — A  pale-yellow,  thin,  oily  liquid, 
having  a  peculiar,  slightly  fishy,  but  not  rancid  odor,  and  a  bland, 
slightly  fishy  taste.  Specific  gravity  0.920  to  0.925  at  15°  C. 
(59°  F.).     Scarcely  soluble  in  alcohol,  but  readily  soluble  in  ether, 


FATS  AND  OILS.  133 

chloroform,  or  carbon  disulphide,  also  in  2.5  parts  of  acetic  ether. 
It  contains  several  glycerides,  the  principal  one  being  olein,  traces 
of  iodine,  bromine,  chlorine,  biliary  salts,  phosphoric  and  sulphuric 
acids,  a  peculiar  principle  (gaduin),  and  several  alkaloids. 

MoRRHUOL,  a  name  given  by  Chapoteaut  to  a  mixture  of  the 
various  alkaloids  and  important  principlies  of  cod  liver  oil,  occurs 
as  an  amber-brown,  bitter,  aromatic  liquid. 

Dose. — 1-4  fluidrachms  (3.8-15  Cc). 

Physiological  Action. — Externally  and  Locally. — It  possesses 
emollient  properties,  and  may  be  applied  to  the  skin  and  mucous 
membranes  without  causing  irritation.  It  slightly  reduces  tempera- 
ture in  fever  when  applied  to  the  body. 

Internally. — Fat  is  a  normal  and  necessaiy  constituent  of  the 
body.  It  is  the  fuel  used  to  supply  force,  and  those  tissues  and 
organs  which  are  the  most  energetic  require  the  most  fat.  Conse- 
quently, nerves,  muscles,  and  glands  are  more  abundantly  fur- 
nished with  fat  than  cartilage,  and  in  cases  of  starvation  those 
structures  demanding  the  greater  supply  must  have  it,  at  the  ex- 
pense of  the  less  highly  organized  and  active  tissues — as  is  seen  in 
the  great  emaciation  preceding  the  decline  of  mental  powers.  The 
blood  contains  about  one-half  of  i  per  cent,  of  fat ;  the  muscles,  3 
per  cent. ;  the  brain,  8  per  cent. ;  and  the  nerves  22  per  cent.  In 
order,  therefore,  that  the  various  cells  of  the  body  may  possess 
sufficient  vitality  to  withstand  by  physiological  resistance  the  en- 
croachments of  disease  and  the  invasion  of  pathogenic  micro-or- 
ganisms, this  equilibrium  must  be  maintained.  Yet  this  necessary 
food,  fat,  is  more  frequently  deficient  than  any  other,  from  the 
difficulty  either  of  obtaining  a  supply  or  of  digesting  and  assimi- 
lating it. 

Dr.  Hughes  Bennett  was  near  the  truth  in  observing  that  "  the 
main  causes  of  tuberculosis  are  the  dearness  of  butter  and  the 
abundance  of  pastry-cooks,"  intimating  that  the  poor  and  underfed 
are  unable  to  obtain  sufficient  fat,  while  the  digestion  of  the 
wealthy  class  is  deranged  by  pastries,  so  that  they  are  unable  to 
assimilate  a  proper  amount  of  fat. 

Dr.  Brunton  cites  the  case  of  a  barrister  who  before  pleading  a 
case  invariably  took  a  full  dose  of  cod  liver  oil,  believing  that  it 
rendered  his  mind  more  active. 

Before  oils  or  fats  can  enter  the  various  cells  and  act  as  food, 
and  consequently  a  source  of  power,  they  must  be  digested  and 
assimilated  by  the  system.     The  value  of  an  oil  is  based  upon — (i) 


134  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Its  rate  of  absorption ;  (2)  its  rate  of  oxidation ;  (3)  its  agreeable 
taste. 

Cod  liver  oil,  while  to  many  persons  repugnant  in  taste,  is  more 
readily  absorbed  and  oxidized  than  any  other  fat.  It  has  already 
been  prepared  by  the  liver,  and  therefore  partly  elaborated,  and, 
owing  to  the  biliary  salts  which  it  contains,  it  passes  more  readily 
through  animal  membranes.  Moreover,  Naumann  has  shown  that 
cod  liver  oil  is  more  easily  oxidized  than  any  other  oil,  rendering 
.  this  substance  almost  an  ideal  ready-made  food.  Its  actions  upon 
the  several  systems  are  here  considered. 

Digestive  System. — Large  doses  disturb  the  stomach  and  may 
even  occasion  vomiting,  but  in  medicinal  doses  alone,  or  in  the 
form  of  an  emulsion,  it  may  be  taken  usually. without  discomfort, 
in  some  cases  even  increasing  the  appetite.  In  the  stomach  cod- 
liver  oil  is  unaffected,  but  in  the  intestines  it  meets  the  pancreatic 
juice,  which  resolves  a  portion  of  it  into  glycerin  and  fatty  acids, 
the  latter  combining  with  the  alkalies  of  the  bile  and  the  intes- 
tinal juice  to  form  soaps,  while  the  remaining,  and  larger,  por- 
tion is  emulsionized  by  the  alkaline  secretions  of  the  intestines. 

Circulatory  System. — The  number  of  red  corpuscles  is  increased 
and  the  quality  of  the  blood  is  greatly  improved. 

Nervous  System. — This  shares  with  the  other  tissues  of  the  body 
the  general  amelioration,  the  drug  being  a  food  and  tonic  to  the 
brain  and  nerves. 

Respiratory  System. — No  special  action  is  noticeable  other  than 
the  natural  improvement  in  the  respiratory  power  incidental  to 
better  blood  and  an  increased  functional  activity  of  the  nerves  and 
muscles. 

Absorption  and  Elimination. — Cod  liver  oil  can  be  absorbed  only 
after  it  enters  the  intestines.  The  glycerin  and  fatty  acids  formed 
by  the  pancreatic  juice,  having  a  great  affinity  for  water,  readily 
diffuse  through  the  mucous  membrane;  the  soaps  produced  by 
the  action  of  the  bile  and  the  intestinal  juice  are  also  readily  ab- 
sorbed by  osmosis. 

The  oil  remaining,  as  has  been  stated,  is  emulsionized — that  is, 
it  is  subdivided  into  minute  globules  each  enclosed  in  an  envelope 
composed  of  alkaline  albuminate  and  soap,  which  has  a  great 
affinity  for  the  mucous  membrane  and  carries  the  oil  through  the 
columnar  epithelium  of  the  intestinal  villi  into  the  lymph-spaces. 
The  osmosis  inward  of  the  oil-emulsion  is  rendered  still  easier  by 
the  action  of  the  bile  with  which  the  mucous  membrane  is  bathed. 


FATS  AND  OILS.  135 

Oils  and  fats  which  are  absorbed  and  not  needed  for  cell-food 
are  deposited  beneath  the  skin  as  subcutaneous  fat.serving  as  a 
protection  against  external  cold  as  well  as  a  reserve  supply  in  case 
the  economy  needs  more  fat  than  can  be  taken  into  the  system 
and  assimilated.  The  weight,  therefore,  is  usually  greatly  increased 
under  the  administration  of  cod  liver  oil. 

It  will  be  seen  that  much  of  the  oil  taken  into  the  system  is 
oxidized,  being  subsequently  excreted  as  carbonic  acid  and  water. 

Temperature. — When  taken  internally  the  temperature  is  unaf- 
fected, but,  as  has  been  observed,  when  applied  to  the  epidermis 
the  bodily  heat  is  reduced. 

Untoward  Action. — In  addition  to  disturbances  of  digestion 
sometimes  occasioned  by  moderate  doses,  cod  liver  oil  at  times 
produces  a  vesicular  eczema  which  may  spread  over  the  entire 
body.  This  eruption  is  probably  caused  by  the  volatile  fatty  acids 
which  the  oil  contains. 

Poisoning. — Cod  liver  oil  possesses  no  poisonous  action. 

Therapeutics. — Externally  and  Locally. — Cod  liver  oil  is  much 
used  by  dermatologists  in  diseases  of  the  skin,  being  especially  ser- 
viceable in  softening  the  crusts  of  eczema.  It  has  been  applied  to 
the  skin  to  allay  irritation  and  for  the  reduction  of  temperature  in 
the  exanthemata.  In  cases  of  marasmus  and  rachitis,  and  in  wasting 
diseases  generally,  it  is  a  valuable  remedy  to  sustain  the  vital 
energy  and  improve  nutrition,  the  oil  being  given  in  the  form  of 
baths. 

Daily  inunctions  are  beneficial  in  chronic  scaly  skin  diseases, 
while  a  local  application  to  the  chest  has  seemed  at  times  to  influ- 
ence favorably  the  course  of  pertussis.  Local  applications  have 
also  been  adopted  empirically,  and  with  satisfactory  results,  in 
chronic  rheumatism  and  rheumatoid  arthritis. 

Internally. — For  two  or  three  centuries  cod  liver  oil  has  been 
used  both  externally  and  internally  for  chronic  rheumatism,  but  it 
is  only  since  184 1  that  it  has  been  employed  in  the  treatment  of 
tuberculosis.  While  to-day  it  does  not  receive  the  enthusiastic 
support  which  attended  its  introduction  in  the  latter  disease,  it  is 
nevertheless  a  standard  and  highly  efficacious  remedy  in  the  various 
forms  of  the  disorder.  It  is  equally  valuable  in  scrofulous  affections, 
and  even  more  potent  in  rachitis.  Chronic  bronchitis  is  perhaps 
more  frequently  relieved  by  its  use  than  by  any  other  internal 
remedy.  Diseases  resulting  in  anemia  are  usually  more  benefited 
by  cod  liver  oil  than,  by  other  remedial  agents.     Chronic  arthritis. 


136  A    TEXT-BOOK  OF  MATERIA   MEDTCA. 

fistula,  and  abscess  in  the  neighborhood  of  the  joints  have  been 
greatly  improved  by  its  use.  Atheroma  of  the  arteries  and  many 
cutaneous  diseases,  particularly  the  strumous  variety,  and  syphilo- 
dermata  yield  to  its  alterative  and  nutrient  properties. 

Probably  no  single  drug  is  employed  in  nervous  diseases  with 
effects  so  markedly  beneficial  as  those  of  cod  liver  oil.  While 
possessing  no  specific  action,  it  increases  the  strength  and  vitality 
of  the  patient,  enabling  him  to  resist  morbid  tendencies  more  suc- 
cessfully, and,  by  augmenting  the  force-producing  material  and 
improving  the  condition  of  the  nerves,  lessens  the  liability  to 
nervous  derangement. 

Diabetes  mellitus  and  Bright' s  disease,  with  anemia  yet  unat- 
tended by  marked  digestive  disturbance,  are  decidedly  improved 
by  the  administration  of  cod  liver  oil. 

Should  no  gastric  disorder  supervene,  this  remedy  should  invari- 
ably be  given  in  the  last-named  diseases.  It  certainly  ^erves  to 
maintain  the  general  health,  and  is  singularly  efficacious  in  pro- 
longing the  lives  of  the  afflicted  patients,  enabling  them  to  profit 
by  hygienic  measures,  upon  which  great  reliance  should  be  placed. 
The  tonic  and  nutritive  properties  of  the  drug  have  been  strikingly 
shown  in  the  rapid  improvement  of  patients  convalescing  from 
acute  diseases.  In  catarrhal  conditions,  especially  in  ozena  and  otitis 
following  measles  and  scarlet  fever,  it  is  of  marked  benefit. 

Without  entering  upon  specific  considerations  other  than  the 
above,  it  will  be  seen  that  cod  liver  oil  is  indicated  whenever  there 
is  defective  activity,  whether  inherited  or  acquired. 

Contraindications. — It  is  to  be  remembered  that  cod  liver  oil 
is  a  food  and  not  a  medicine :  it  is  therefore  contraindicated  in  all 
diseases  where  it  proves  detrimental  to  the  appetite,  causing  eruc- 
tation, heartburn,  diarrhea,  etc.  It  is  usually  contraindicated  in 
fevers,  owing  to  the  suspension  of  the  secretions  and  impairment 
of  digestion  characteristic  of  acute  febrile  disorders. 

Administration. — In  the  early  use  of  cod  liver  oil  it  is  advis- 
able to  prescribe  small  doses,  that  its  toleration  by  the  stomach 
may  be  gradually  acquired.  To  many  patients,  however,  it  is  ex- 
tremely distasteful,  and  the  repugnance  is  increased  rather  than 
lessened  by  continued  use.  In  such  cases  it  is  better,  if  possible, 
to  disguise  the  taste  and  smell  in  some  manner  rather  than  to 
abandon  so  valuable  a  remedy  when  clearly  indicated.  Various 
means  have  been  employed  for  this  purpose.  An  emulsion  may 
be  made  which  obviates  its  disagreeable  qualities.     There  are  in 


MINERAL  ACIDS.  137 

the  market  soft  capsules  containing  this  oil,  that  serve  an  excellent 
purpose,  being  easily  swallowed  and  disguising  completely  the 
taste  and  odor  of  the  drug.  Administration  should  occur  ordi- 
narily some  time  after  meals,  that  the  oil  may  reach  the  intestines 
as  soon  as  possible. 


GROUP  III.— MINERAL  ACIDS. 

Mineral  Acids  are  classed  here  as  Restorative  Medicines,  be- 
cause three  secretions  of  the  body — the  perspiration,  urine,  and  gas- 
tric juice — are  normally  of  acid  reaction,  the  last-named  on  account 
of  its  acidity  to  hydrochloric  acid.  Sulphuric  and  nitric  acids  are 
not  normal  constituents  of  the  body,  and  are  by  some  authors 
classed  as  astringents,  although  the  action  and  medical  uses  of 
these  inorganic  acids  will  here  be  considered.  There  are,  however, 
certain  characteristics  common  to  all  mineral  acids  which  claim  pri- 
mary attention : 

1.  Concentrated  mineral  acids  are  caustic  to  a  greater  or  less 
degree. 

2.  They  combine  with  alkalies  and  alkaline  earths  to  form  salts, 
and  unite  with  vegetable  acids,  setting  them  free  from  their  com- 
bination with  bases. 

3.  When  in  contact  with  the  tissues  of  the  body  they  combine 
with  the  protoplasm,  neutralizing  the  alkalies  which  the  latter  con- 
tains and  forming  mineral  salts.  They  also  combine  with  the  albu- 
min, forming  acid  albumin. 

4.  Upon  the  blood  they  precipitate  the  albuminous  constituents 
and  decompose  the  hemoglobin. 

5.  Acids  stimulate  the  secretion  of  alkaline  glands — salivary, 
duodenal,  pancreatic,  and  hepatic.  On  the  other  hand,  they 
depress  the  secretion  from  acid  glands — gastric,  sudoriparous,  etc. 

6.  Mineral  acids  reduce  the  formation  of  urea,  preventing  the 
conversion  of  retrograde  products  into  this  substance. 

7.  They  diminish  the  functional  activity  of  the  muscular  and 
nervous  systems.  Applied  locally  in  a  concentrated  form,  or  taken 
internally  in  poisonous  doses,  they  tend  to  produce  rigidity  of  the 
muscles  by  coagulating  the  myosin. 

8.  The  alkalinity  of  the  blood  is  lessened  and  the  activity  of  the 
urine  increased  by  the  internal  administration  of  all  mineral  acids 
save  nitric,  the  great  amount  of  nitrogen  which  the  latter  contains 
being  converted  into  ammonia,  an  alkali. 


138  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Acidum  Hydrochloricum— Acidi  Hydrochlorici— 
Hydrochloric  Acid.    V.  S.  P. 

(Muriatic  Acid.) 

Origin. — A  liquid  composed  of  3 1 .9  per  cent,  by  weight  of  Abso- 
lute Hydrochloric  Acid  (HCL=  36.37)  and  68.1  per  cent,  of  Water. 

Description  and  Properties. — A  colorless,  fuming  liquid,  of  a 
pungent  odor  and  an  intensely  acid  taste.  Fumes  and  odor  disap- 
pear on  diluting  the  acid  with  2  volumes  of  water.  Specific  grav- 
ity about  1. 163  at  15"  C.  (59°  F.).  Miscible  in  all  proportions  with 
water  and  alcohol.  Hydrochloric  acid  should  be  kept  in  dark, 
amber-colored,  glass-stoppered  bottles. 

Dose. — 25  minims  (0.12-0.3  Cc),  well  diluted. 

Official  Preparations. 

Acidum  Hydrochloricum  Dilutum — Acidi  Hydrochlorici  Diluti — Diluted 
Hydrochloric  Acid  (Diluted  Muriatic  Acid). — Dose,  10-20  minins  (0.6-1.2  Cc). 
Formula:  Hydrochloric  Acid,  100;  Distilled  Water,  219.     Sp.  gr.  about  1.050. 

Acidum  Nitrohydrochloricum— Acidi  Nitrohydrochlorici — Nitrohydro- 
chloric  Acid. — Dose,  2-5  minims  (0.12-0.3  Co.),  well  diluted.  (Described  under 
, Nitric  Acid.) 

Acidum  Nitrohydrochloricum  Dilutum — Acidi  Nitrohydrochlorici  Diluti 
— Diluted  Nitrohydrochloric  Acid. — Dose,  5-20  minims  (0.3-1.2  Cc).  (Described 
under  Nitric  Acid.) 

Acidum  Pliosplioricum— Acidi  Piiosphorici— 
Pliosphoric  Acid.    JJ.  S.  P. 

Origin. — A  liquid  composed  of  not  less  than  85  per  cent,  by 
weight  of  Absolute  Orthophosphoric  Acid  (H3P04  =  97.8)  and  not 
more  than   15  per  cent,  of  Water. 

Description  and  Properties.^-A  colorless  liquid,  without  odor, 
but  having  a  strongly  acid  taste.  Specific  gravity  not  below  I.710 
at  15°  C.  (S9°  F.).  Miscible  in  all  proportions  with  water  or  alco- 
hol.    Phosphoric  acid  should  be  kept  in  glass-stoppered  bottles. 

Dose. — The  diluted  acid  only  is  given  internally. 

Official  Preparation. 

Acidum  PhosphSricum  Dilutum— Acidi  PhosphSrici  Diluti  (Diluted  Phos- 
phoric Acid).— Z><j«,  5-25  minims  (0.3-1.5  Co.).  Diluted  phosphoric  acid  contains 
10  per  cent,  by  weight  of  absolute  orthophosphoric  acid. 

Acidum  Sulphuricum— Acidi  Sulphurlci— Sulphuric 
Acid.    JJ.  S.  P. 

Origin. — A  liquid  composed  of  not  less  than  92.5  per  cent,  by 


MINERAL  ACIDS.  139 

weight  of  Absolute  Sulphuric  Acid  (H2SO4  =  97-82)  and  not  more 
than  7.5  per  cent,  of  Water. 

Description  and  Properties. — A  colorless  liquid  of  oily  con- 
sistence, inodorous,  and  very  caustic  and  corrosive.  Specific  gravity 
not  below  1.835  ^t  15°  C.  (59°  F.).  Miscible  in  all  proportions 
with  water  and  alcohol,  with  evolution  of  so  much  heat  that  the 
mixing  requires  great  caution.  Sulphuric  acid  should  be  kept  in 
glass-stoppered  bottles. 

Dose. — 2-5  minims  (o.i  2-0.3  Cc),  well  diluted. 

Official  Preparations. 

Acidum  Sulphuricum  AromSticum — Acidi  Sulphuric!  AromStici — Aro- 
matic Sulphuric  Acid. — Dose,  5-20  minims  (0.3-1.2  Cc).  Formula:  Sulphuric 
Acid,  100;  Tincture  of  Ginger,  50;  Oil  of  Cinnamon,  i ;  Alcohol,  to  make  1000  parts. 

Acidum  Sulphiiricum  Diliitum — Acidi  Sulphurici  Diliiti — Diluted  Sul- 
phuric Acid. — Dose,  5-20  minims  (0.3-1.2  Cc).  Diluted  sulphuric  acid  contains 
10  per  cent,  by  weight  of  absolute  sulphuric  acid. 

Acidum  NItricum— Acidi  NTtrici— Nitric  Acid. 

17.  H.  P. 

Origin. — A  liquid  composed  of  68  per  cent,  by  weight  of  Abso- 
lute Nitric  Acid  (HNO3  =  62.89)  and  32  per  cent,  of  Water. 

Description  and  Properties. — A  colorless,  fuming  liquid,  very 
caustic  and  corrosive,  and  having  a  peculiar,  somewhat  suffocating 
odor.  Specific  gravity  about  1.414  at  15°  C.  (59°  F.).  Nitric  acid 
should  be  kept  in  dark,  amber-colored,  glass-stoppered  bottles. 

Dose. — 2-5  minims  (0.12-0.3  Cc),  well  diluted. 

Official  Preparations. 

Acidum  Nitricum  Dilutum— Acidi  Nitrici  Diluti— Diluted  Nitric  Acid.— 
Dose,  5-20  minims  (0.3-1.2  Cc).  Diluted  nitric  acid  contains  10  per  cent,  by  weight 
of  absolute  nitric  acid. 

Acidum  Nitrohydrochloricum  —  Acidi  Nitrohydrochlorici  —  Nitrohydro- 
chloric  Acid Formula:   Nitric  Acid,  180;    Hydrochloric  Acid,  820  parts. 

Description  and  Properties.— Pi.  golden  yellow,  fuming,  and  very  corrosive  liquid, 
having  a  strong  odor  of  chlorine.  Completely  volatilized  by  heat.  It  readily  dissolves 
gold-leaf,  and  a  drop  of  it  added  to  potassium  iodide  T.  S.  liberates  iodine. 

Dose.—x-'i  minims  (0.06-0.18  Cc). 

Acidum  Nitrohydrochloricum  Dilutum — Acidi  Nitrohydrochlorici  Diluti — 
Diluted  Nitrohydrochloric  P^Q.\i..—Dose,  5-20  minims  (0.3-1.2  Cc).  Formula: 
Nitric  Acid,  40;  Hydrodiloric  Acid,  180;  Distilled  Water,  780  parts. 


Antagonists  and  Incompatibles. — Hydrochloric  acid  and  its 
preparations  are  incompatible  (forming  explosive  compounds)  with 


I40  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

oxidizable  substances — phosphorus,  sulphur  and  the  sulphides, 
alcohols,  ethers,  carbohydrates,  etc.  All  the  mineral  acids  are  in- 
compatible with  the  alkalies  and  their  carbonates,  salts  of  lime, 
lead,  and  silver,  and  decompose  glucosides. 

Synergists. — The  action  of  hydrochloric  acid  upon  the  digestive 
system  is  aided  by  the  digestive  ferments  and  the  vegetable  bitters. 

Physiologioal  Action. — The  general  action  of  mineral  acids 
upon  the  various  systems  is  herewith  given  in  detail : 

Externally  and  Locally. — ^Applied  in  a  concentrated  form  to  the 
skin  or  to  any  tissue  of  the  body,  acids  abstract  the  water  from 
the  tissues  and  destroy  the  protoplasm,  acting  as  escharotics. 
Weaker  solutions  vesicate,  merely  inflaming  the  parts  to  which  they 
are  applied,  without  destroying  the  tissue,  while  extremely  diluted  , 
or  weak  solutions  are  irritant  and  astringent. 

Internally. — Digestive  System. — Diluted  acids  only  should  be 
administered  internally.  Save  with  reference  to  the  poisonous 
effects  of  concentrated  acids,  therefore,  the  physiological  action  of 
diluted  acids  only  will  be  here  considered. 

The  salivary  glands  are  stimulated,  resulting  in  an  increased  flow 
of  saliva,  moistening  the  mouth  and  allaying  thirst.  The  appetite 
and  digestion  are  improved,  and  the  secretions  from  the  liver  and 
the  duodenal  glanda  are  increased.  Long-continued  use  of  the 
mineral  acids  impairs  digestion  by  lessening  the  normal  secretion 
of  the  gastric  glands,  while  protracted  use  may  produce  salivation. 
Mineral  acids  tend  to  constipate  the  bowels. 

Circulatory  System. — Diluted  acids  act  as  general  astringents, 
narrowing  the  caliber  of  the  blood-vessels,  increasing  the  heart's 
action,  and  raising  arterial  tension.  Concentrated  acids  relax  the 
muscular  tissue  of  both  the  heart  and  blood-vessels.  Mineral  acids 
combine  with  the  albumin  or  the  alkaline  bases  of  the  blood,  less- 
ening the  alkalinity  of  that  fluid. 

Nervous  System. — Medicinal  doses,  so  far  as  observed,  produce 
no  special  action  upon  the  nervous  system  other  than  to  occasion 
a  slight  stimulation  of  the  brain,  due  probably  to  a  gentle  arterial 
excitement. 

Respiratory  System. — No  important  action  under  medicinal  doses 
has  been  observed. 

Absorption  and  Elimination. — Mineral  acids,  above  all  hydro- 
chloric acid,  possess  high  diffusive  power.  They  are  quickly  con- 
verted into  neutral  salts  in  the  intestines,  and  are  absorbed  as  such. 
That  portion  of  the  acid  which  does  not  enter  into  combination  in 


MINERAL  ACIDS.  141 

the  stomach  and  intestines  rapidly  diffuses  into  the  blood,  combin- 
ing with  either  its  alkaline  bases  or  its  albumin.  When,  however, 
the  acid  is  eliminated  by  the  excretory  glands,  the  albumin  remains 
in  the  blood,  while  the  acid  is  expelled  in  union  with  other  bases, 
acting  as  an  astringent  at  the  points  of  elimination. 

Temperature. — Medicinal  doses  have  no  influence  upon  temper- 
ature. 

Untoward  Action. — Mineral  acids  under  too  prolonged  admin- 
istration impair  the  appetite  and  disturb  digestion,  occasioning 
toothache  and  gastric  oppression,  and  at  times  salivation  and  diar- 
rhea. The  prolonged  use  of  nitric  acid  may  produce  erosion  of 
the  gums  and  tongue,  with  loosening  of  the  teeth. 

Poisoning. — The  mineral  acids  when  taken  in  a  concentrated 
form  and  in  toxic  doses  act  like  corrosive  poisons,  causing  intense 
burning  in  the  stomach  and  intestines  and  active  gastric  inflamma- 
tion. Violent  vomiting  occurs,  the  ejected  matter  containing  blood, 
and,  in  the  case  of  hydrochloric  acid,  a  white  cloud  of  ammonium 
chloride  is  discerned  if  the  ejecta  be  placed  near  the  vapor  of 
ammonia. 

The  respiration  is  greatly  depressed,  and  there  is  a  strong, 
persistent  acid  taste  in  the  mouth,  the  mucous  membrane  of 
which  is  discolored,  while  the  tongue  is  swollen  and  inflamed. 
There  is  great  thirst,  and  the  pulse  becomes  rapid  and  tense. 
The  temperature,  at  first  elevated,  soon  falls  below  normal,  pro- 
found prostration  supervening,  and  death  resulting  either  from 
shock  or  from  secondary  inflammation. 

A  post-mortem  examination  shows  the  results  of  corrosive  poi- 
soning: ulceration  or  evidences  of  intense  inflammation  of  the 
mucous  membrane  of  the  mouth,  esophagus,  stomach,  and  intes- 
tines. Occasionally  the  walls  of  the  latter  are  perforated.  Should 
death  be  delayed  for  some  time,  there  is  found  fatty  degeneration 
of  the  kidneys  and  other  internal  organs. 

Treatment  of  Poisoning. — This  should  be  prompt.  The  cautious 
administration  of  alkalies  is  indicated  to  neutralize  the  acid,  though 
the  evolution  of  carbonic-acid  gas  resulting  therefrom  may  rupture 
the  stomach.  The  stomach  should  be  washed  out,  and  this  treat- 
ment followed  by  demulcent  drinks  and  oil,  milk,  and  eggs. 
Opium  may  be  necessary  for  the  relief  of  pain,  and  brandy  or 
v^hiskey  subcutaneously  in  case  of  collapse. 

Therapeutics. — Externally  and  Locally. — Hydrochloric  acid 
is  employed  as  a  caustic  in  noma  and  putrid  sore  throat.     Mixed 


142  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

with  two  or  three  parts  of  honey,  it  is  an  efficient  application  to 
the  throat  in  diphtheria.  Andrews  and  Morris  have  recommended 
diluted  hydrochloric  acid  for  the  removal  of  sequestra,  and  Chas- 
saignac  has  utilized  the  acid  in  removing  necrosed  bone  in  osteitis 
and  caries. 

Nitric  acid  is  a  much  more  powerful  caustic,  and  as  such  is 
used  more  extensively  than  any  other  mineral  acid,  because  of  its 
limited  action  and  the  ease  with  which  it  is  controlled.  It  is  an 
excellent  caustic  in  cases  of  cancer  of  the  cervix,  venereal  warts, 
hospital  gangrene,  phagedenic  ulceration,  hemorrhoids,  and  prolapse 
of  the  rectum.,  especially  in  the  case  of  children.  In  cases  also 
of  fungoid  granulation  and  excessive  hemorrhage  from  the  uterus 
it  has  been  highly  recommended.  In  certain  diseases  of  the 
throat,  nose,  and  ear  this  acid  has  been  used  for  the  destruction 
of  growths,  as  well  as  for  its  escharotic  action  in  ulcerated 
conditions. 

Dermatologists  find  nitric  acid  to  be  an  efficient  application  for 
the  removal  and  destruction  of  epithelioma,  moles,  nevi,  chloasma, 
etc.,  caution  being  exercised  in  the  latter  case  merely  to  produce 
an  exfoliation  of  the  skin,  not  sufficient  destruction  of  tissue  to 
result  in  a  cicatrix. 

Liveing  recommends  a  veiy  weak  solution  of  nitric  acid  with 
tincture  of  opium  in  pruritus. 

Phosphoric  acid,  in  the  strength  of  50  grains  (3.2)  to  the  ounce 
(30.0  Cc.)  of  distilled  water,  has  been  suggested  by  Grossich  in  the 
treatment  of  scrofulous  ulcers,  and  an  injection  of  this  solution  into 
tuberculous  glands  of  the  neck  is  highly  recommended  by  the  same 
authority. 

Sulphuric  acid  is  perhaps  the  most  persistent,  irritating,  and 
destructive  caustic  known.  Its  affinity  for  water,  and  its  consequent 
extensive  action,  render  it  when  used  alone  unfit  for  caustic  pur- 
poses. Mixed  with  powdered  charcoal,  however,  it  forms  a  paste 
which  is  an  efficient  caustic  application  to  chancres,  cancers,  etc. 
Frazer  considers  the  strong  sulphuric  acid  the  best  caustic  in 
the  bites  of  rabid  animals.  Diluted  solution,  in  the  proportion  of 
6  parts  of  the  strong  acid  to  4  parts  of  diluted  alcohol,  has  been 
recommended  'io'i'^^idstaxh. 

Internally. — Hydro^^ric  acid,  being  a  normal  constituent  of 
the  stomach,  is  indicated  in  certain  forms  of  gastric  dyspepsia,  par- 
ticularly in  the  atonic  variety.  In  these  latter  cases  there  is  usually 
decomposition  and  fermentation  of  food,  which  condition  is  greatly 


MINERAL  ACIDS.  143 

relieved  by  the  administration  of  pepsin  or  hydrochloric  acid  after 
meals,  or  the  same  with  bitters  before  meals. 

In  intestinal  indigestion  hydrochloric  acid  is  an  admirable  rem- 
edy, given  one  or  two  hours  after  meals. 

The  diluted  hydrochloric  acid  is  a  valuable  internal  remedy  in 
the  treatment  of  diphtheria,  and  during  the  course  oi  fevers,  par- 
ticularly typhoid.  As  a  routine  treatment  in  the  latter  disease  the 
author  almost  invariably  gives  hydrochloric  acid  in  connection  with 
pepsin,  finding  that  it  not  only  allays  thirst  and  moistens  the  tongue, 
but  exerts  an  antiseptic  influence  in  the  bowels,  thereby  lessening 
the  danger  of  auto-infection  and  relapse.  Alkiewicz  recommends 
weak  solutions  of  hydrochloric  acid  as  efficacious  in  nausea  and 
vomiting  accompanying  certain  infectious  diseases. 

In  certain  affections  of  the  skin  dependent  upon  deranged  diges- 
tion hydrochloric  acid  often  proves  a  potent  remedy. 

Nitric  acid  has  been  used  for  the  same  purposes  as  hydro- 
chloric acid,  although  for  digestive  disorders  it  is  inferior  to  the 
latter  drug. 

In  intermittent  and  periodical  fevers,  however,  nitric  acid  is  an 
efficient  remedy.  In  hepatic  disorders  the  diluted  nitrohydrochloric 
acid  deservedly  holds  a  high  place  as  a  remedial  agent,  and  the  same 
remedy  is  frequently  employed  with  success  in  chronic  syphilis. 

In  the  conditions  known  as  oxaluria  and  lithemia  nitric  and 
nitrohydrochloric  acids  serve  an  excellent  purpose. 

The  invaluable  preparation  introduced  by  Dr.  Hope  in  1826, 
known  as  "  Hope's  camphor  mixture  " — a  combination  of  nitrous 
acid,  camphor-water,  and  tincture  of  opium — has  never  been  sur- 
passed as  a  remedy  in  serous  diarrhea. 

The  aphonia  of  singers  and  public  speakers  is  often  relieved  by 
the  diluted  nitric  acid,  certain  cases  of  bronchitis  being  also  bene- 
fited by  the  same  remedy. 

Melancholia  and  the  hypochondriasis  of  dipsomaniacs  are  some- 
times relieved  by  dilut-ed  nitrohydrochloric  acid. 

Phosphoric  acid  has  acquired  some  reputation  as  a  remedy 
in  anemia  and  as  a  tonic  in  wasting  diseases  and  neurasthenia.  Its 
value,  however,  is  based  ftiore  upon  theory  than  upon  the  results 
of  clinical  observation.  Tlie  experience  of  fhe  author  warrants 
the  assumption  that  phospnaric  is  infe^W  to  hydrochloric  aoid  in 
these  conditions,  its  action  bibg  entirely  due  to  increasing  diges- 
tion and  thereby  improving  niwition. 

Probably  phosphoric  acid  isl^jperior  to  the  other  mineral  acids 


144  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

only  in  its  action  in  diabetes,  in  which  disease  it  certainly  possesses 
a  remarkable  influence  in  diminishing  thirst  and  lessening  the 
secretion  of  urine. 

Sulphuric  acid,  in  the  author's  opinion,  is  inferior  to  nitric  or 
nitrous  acid  in  serous  diarrhea.  It  is  nevertheless  an  invaluable,  as 
well  as  an  old  and  tried,  remedy  in  cholera,  the  statistics  furnished 
by  the  Insane  Department  of  the  Philadelphia  Almshouse  during 
an  epidemic  of  this  disease  appearing  to  prove  its  efficacy. 

This  remedy  also  deserves  favorable  consideration  in  the  treat- 
ment of  acute  lead-poisoning.  Moreover,  in  chronic  lead-poisoning 
water  acidulated  with  sulphuric  acid  makes  an  efficient  prophylactic, 
and  the  remedy  has  also  been  suggested  as  a  preventive  oi  Asiatic 
cholera. 

Owing  to  its  astringent  and  antiseptic  properties  this  acid,  par- 
ticularly the  aromatic  sulphuric  acid,  proves  a  good  remedy  in  cer- 
tain cases  of  diarrhea.  It  is  especially  valuable  in  checking  the 
sweating  in  phthisis.  The  same  preparation  has  been  found  bene- 
ficial in  hematemesis,  as  well  as  in  intestinal  and  uterine  hemorrhage: 

Where  there  is  a  tendency  to  dissolution  of  the  blood,  as  in 
scurvy  and  purpura,  sulphuric  acid  has  proved  valuable,  and  it  has 
been  recommended  as  an  internal  remedy  in  lichen,  prurigo,  and 
many  itching  diseases  of  the  skin. 

Contraindications. — Acute  inflammation  of  the  stomach,  rheu- 
matism, gout,  and  where  the  urine  is  excessively  acid  and  of  high 
specific  gravity. 

Administration. — Only  the  diluted  acids  should  be  given  in- 
ternally, and  even  these  should  be  further  diluted,  and  taken,  if 
possible,  through  a  glass  tube,  to  prevent  injury  to  the  enamel  of 
the  teeth.  They  should  not  be  administered  for  too  long  a  period, 
and  the  first  indication  of  untoward  action,  such  as  griping,  diar- 
rhea, etc.,  is  to  be  taken  as  a  warning  that  the  drug  must  be  with- 
drawn. 

Acidum    Lacticum— Acidi    Lactlci— Lactic  Acid. 

Z7.  S.  P. 

Origin. — An  organic  acid  usually  obtained  by  subjecting  milk 
sugar  or  grape  sugar  to  lactic  fermentation.  It  is  composed  of  75 
per  cent,  by  weight  of  Absolute  Lactic  Acid  (CHC3H503  =  89.79) 
and  25  per  cent,  of  Water. 

Description  and  Properties. — A  colorless,  syrupy  liquid, 
odorless,  of  a  purely  acid  taste,  and  absorbing  moisture  on  ex- 


MINERAL  ACIDS.  1 45 

posure  to  damp  air.  Specific  gravity  about  1.2 13  at  15°  C.  (59° 
F.).  Freely  miscible  with  water,  alcohol,  or  ether;  insoluble  in 
chloroform,  benzin,  or  carbon  disulphide. 

Dose. — 20-30  minims  (1.2-1.8  Cc),  diluted  and  sweetened. 

Official  Preparation. 

Syrupus  Cdlcii  Lactophosphatis — SJ^rupi  CSlcii  Lactophosphatis — Syrup 
of  Calcium  Lactophosphate. — Dose,  1-2  fluidrachms  (3.7-7.3  C).  Formula: 
Precipitated  Calcium  Carbonate,  25 ;  Lactic  Acid,  60 ;  Phosphoric  Acid,  36 ;  Orange 
Flower  Water,  25;  Sugar,  700;  Water,  q.  s.  ad  1000. 

Antagonists  and  Incompatibles. — Alkalies  and  the  salts  of 
the  mineral  acids  are  incompatible  with  lactic  acid. 

Synergists. — Pepsin,  vegetable  acids,  hydrochloric  acid,  and 
sodium  chloride. 

Physiological  Action. — Externally  and  Locally. — Lactic  Acid  is 
a  caustic  to  highly  organized  tissues,  resembling  the  mineral  acids 
in  its  local  action.  It  dissolves  false  membrane  to  which  it  is 
applied. 

Internally. — Digestive  System. — It  is  normally  present  in  the 
stomach,  especially  during  the  digestion  of  carbohydrates.  Its 
action  on  the  digestive  system  does  not  differ  materially  from  that 
of  hydrochloric  acid. 

Circulatory  System. — Being  absorbed  from  the  stomach,  it  com- 
bines with  bases  in  the  blood,  forming  lactates  which  are  rapidly 
converted  into  carbonates.  In  certain  morbid  conditions  of  the 
system,  such  as  acute  rheumatism,  it  is  found  free  in  the  blood. 

Richardson  has  produced  endocarditis  in  dogs  by  injecting 
lactic  acid  into  the  peritoneal  cavity.  Large  doses  decrease  the 
normal  alkalinity  of  the  blood. 

Nervous  System. — Large  doses  greatly  depress  the  nervous  sys- 
tem, frequently  producing  neuralgia  and  myalgia. 

Absorption  and  Elimination. — It  is  absorbed  from  the  stomach, 
undergoes  a  change  in  the  blood,  and  is  eliminated  by  the  kidneys, 
although,  according  to  Lehmann,  when  large  doses  have  been 
taken  it  is  found  in  the  urine  unchanged ;  and  we  have  Benzelius 
and  Scherer  as  authorities  that  lactic  acid  can  be  detected  in  the 
spleen  and  the  muscular  fluid  and  has  been  found  in  the  exudates 
of  puerperal  fever. 

Untoward  Action,  Poisoning,  and  Treatment  of  Poisoning  are 
similar  to  those  of  the  mineral  acids. 

Therapeutics. — Externally  and  Locally. — It  has  been  used 
10 


146  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

locally  for  the  same  purposes  as  the  mineral  acids,  but  it  is 
thought  by  many  clinicans  to  be  superior  to  the  latter  in  tubercu- 
lous ulceration.  In  the  Hamburg  General  Hospital,  Dr.  Zippel 
has  employed  it  with  excellent  success  in  the  treatment  of  tubercu- 
lous fistulae.  He  inserted  into  the  fistula  rods  made  of  lactic  acid, 
gelatin,  and  menthol,  enveloped  with  a  thin  layer  of  collodion. 

As  a  solvent  of  false  membranes  lactic  acid  is  unquestionably 
superior  to  the  mineral  acids,  being  highly  recommended  for  this 
purpose  in  diphtheria  and  croup  by  such  authorities  as  Morell 
Mackenzie,  Lennox  Browne,  Weber,  Bureau,  etc. 

Internally. — Digestive  System. — It  is  used  in  the  digestive  dis- 
orders, such  as  atonic  and  irritative  dyspepsia,  and  in  all  those 
derangements  of  digestion  which  are  benefited  by  hydrochloric 
acid.  In  oxaluria,  litkemia,  chronic  cystitis  with  ammoniacal  urine, 
chronic  dysentery,  and  dyspeptic  and  tuberculous  diarrhea  it  has 
proved  an  efficient  remedy.  It  has  been  recommended  by  Dr. 
Foucaut  as  a  prophylactic  in  gout. 

Since  this  drug  was  suggested  by  Cantani  as  a  remedy  in  dior 
betes  mellitus  it  has  been  used  with  varying  success.  Balfour  and 
Foster,  as  well  as  Cantani  himself,  have  reported  many  cases 
which  have  greatly  improved  under  the  administraton  of  lactic  acid 
accompanied  by  an  appropriate  dietetic  regimen.  In  the  continued 
use  of  this  drug  for  diabetes,  however,  it  is  well  to  remember  that 
acute  rheumatism  and  rheumatic  endocarditis  may  be  induced, 
endangering  the  life  of  the  patient  even  more  than  the  disease  for 
which  the  drug  was  prescribed. 

Lactic  acid  has  been  recommended  by  Preyer,  Mendel,  and 
Maragliano  as  a  hypnotic.  Yet  the  authority  appears  to  rest 
rather  upon  theoretical  deduction  than  the  result  of  clinical 
observation. 

Contraindications. — The  same  as  for  mineral  acids. 

Administration. — Lactic  acid  should  be  given  well  diluted. 


GROUP  IV.— VEGETABLE  ACIDS. 


Acidum  Aceticum— Acidi  Acetici— Acetic  Acid. 

77.  S.  P. 

Origin. — A  liquid  composed  of  36  per  cent,  by  weight  of  Ab- 
solute Acetic  Acid  (HC2H302=  59.86)  and  64  per  cent,  of  Water. 
Description  and  Properties. — A  clear,  colorless  liquid,  having 


VEGETABLE  ACIDS.  147 

a  strong,  vinegar-like  odor,  a  purely  acid  taste,  and  a  strongly  acid 
reaction.     Miscible  with  water  or  alcohol  in  all  proportions. 
Dose. — The  diluted  acid  only  is  given  internally. 

Official  Preparation. 

Acidum  Aceticum  Dilutum— Acidi  Acetici  Diluti— Diluted  Acetic  Acid.— 

Dose,  1-2  fluidrachms  (3.7-7.4  Cc). 

Acidum  Cltricum— Acidi  Citrici— Citric  Acid. 
V.  S.  I*. 

Origin. — An  organic  acid  usually  prepared  from  lemon-juice. 

Description  and  Properties. — Colorless,  translucent,  right- 
rhombic  prisms ;  odorless,  having  an  agreeable,  purely  acid  taste ; 
efflorescent  in  warm  air  and  deliquescent  when  exposed  to  moist 
air.  Soluble  in  0.63  part  Water,  in  1.61  parts  of  alcohol,  in  about 
0.4  part  of  boiling  water,  and  in  1.43  parts  of  boiling  alcohol. 

Dose. — 5-20  grains  (0.3-1.25  Gm.). 

Official  Preparation. 

Sjhrupus  Acidi  Citrici — Sj^rupi  Acidi  Citrici — Syrup  of  Citric  Acid. — Dose, 
2-8  fluidrachms  (7.4-30.  Cc.)  (10  per  cent.). 

Acidum  Tart§.ricum— Acidi  Tartarici— Tartaric 
Acid.    TJ.  S.  P. 

Origin. — An  organic  acid  usually  prepared  from  argols. 

Description  and  Properties. — Colorless,  translucent,  mono- 
clinic  prisms,  or  crystalline  crusts,  or  a  white  powder;  odorless, 
having  a  purely  acid  taste,  and  permanent  in  air.  Soluble  in  about 
0.8  part  of  water  and  in  2.5  parts  of  alcohol;  also  in  about  0.5  part 
of  boiling  water  and  in  0.2  part  of  boiling  alcohol. 

Dose. — 10-30  grains  (0.6—2.0  Gm.). 


Antagonists  and  tncompatibles. — Alkalies  are  chemically  in- 
compatible with  the  vegetable  acids.  With  the  alkaline,  earthy, 
and  metallic  bases  vegetable  acids  unite  to  form  salts,  the  acetates 
of  which  are  all  soluble. 

Synergists. — Alkalies,  and,  under  certain  circumstances,  mineral 
acids  and  the  digestive  ferments. 

Physiological  Action. — Externally  and  Locally. — The  vege- 
table acids  have  about  the  same  action  externally  and  locally  as  the 
diluted  mineral  acids,  not  caustic  but  irritant,  acetic  acid  being  the 
most  powerful  and  citric  acid  the  weakest. 


148  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Internally. — Digestive  System. — Their  action  on  the  salivary  and 
gastric  glands  is  similar  to  that  of  the  mineral  acids.  Their  influ- 
ence upon  the  stomach  is  not  so  marked  as  that  of  hydrochloric 
acid,  though  the  secretions  from  the  intestinal  glands  are  more 
augmented  by  vegetable  than  by  mineral  acids.  Too  large  or 
prolonged  doses  of  the  vegetable  acids  produce  flatulence  and 
abdominal  pain,  and  may  even  occasion  diarrhea  or  enteritis. 

Circulatory  System. — Large  doses  retard  and  weaken  the  pulse. 
As  with  mineral  acids,  their  tendency  is  to  lessen  the  alkalinity  of 
the  blood.  They  unite  with  alkalies  in  the  stomach  to  form  salts, 
and  as  such  enter  the  blood,  where  they  are  oxidized,  the  product 
being  carbonic  acid,  which  lessens  the  alkalinity  of  the  blood  and 
increases  the  acidity  of  the  urine. 

Absorption  and  Elimination. — As  stated,  vegetable  acids  unite 
with  the  alkalies  to  form  salts,  as  such  entering  the  circulation. 
They  are  eliminated  chiefly  by  the  kidneys,  increasing  the  excre- 
tion of  both  water  and  solids.  Eliinination  also  takes  place  to  a 
considerable  extent  by  the  intestinal  canal. 

Untoward  Action. — Under  prolonged  dosage  there  is  great  ema- 
ciation, deterioration  of  the  blood,  and  a  scorbutic  condition. 

Poisoning. — Their  toxic  effects  are  almost  identical  with  those 
of  the  mineral  acids,  the  Treatment  of  Poisoning  being  the  same 
as  with  the  latter. 

Therapeutics. — Externally  and  Locally. — All  the  above-named 
vegetable  acids  are  irritant,  more  or  less  antiseptic,  and  hemo- 
static, ACETIC  ACID  being  the  most  powerful  antiseptic  of  the  three. 
Englemann  regards  acetic  acid  as  superior  to  mercuric  chloride  as 
a  disinfectant  in  obstetrical  practice,  employing  a  solution  of  from 
3  to  S  per  cent,  for  this  purpose.  A  diluted  solution  is  a  valuable 
injection  in  gonorrhea  of  the  female.  The  glacial  acetic  acid  is  a 
powerful  caustic,  and  is  much  used  to  dissolve  horny  growths,  warts, 
corns,  etc. 

The  most  important  use  of  acetic  acid  is  in  the  treatment  of 
certain  parasitic  skin  diseases,  probably  no  remedy  excelling  it  in 
cases  of  ringworm  and  pityriasis.  Diluted  acetic  acid,  or  vinegar, 
is  an  efficient  gargle  in  simple  sore  throat  and  the  last  stage  of 
angina  of  exanthemata,  as  well  as  a  valuable  hemostatic,  espe- 
cially in  epistaxis. 

Citric  acid  is  but  little  used,  locally,  although  solutions  have 
been  employed  with  some  success  to  relieve  the  itching  and  sting- 
ing of  "  prickly  heat "  and  urticaria.    A  sponge-bath  of  vinegar 


ALKALIES.  149 

and  water  is  a  grateful  and  efficient  means  of  reducing  temperature 
and  checking  excessive  sweating  in  disease. 

Tartaric  acid  has  been  used  by  Potter  as  an  application  to 
the  throat  in  diphtheria,  the  effect  being  to  convert  the  membrane 
into  a  gelatinous  mass  which  is  more  easily  expelled. 

Internally. — Acetic  acid  is  little  used  internally.  Citric  acid, 
however,  in  the  form  of  a  lemonade,  is  a  refreshing  refrigerant 
drink  la  fevers,  while  a  similar  hot  lemonade  taken  at  bedtime  is  a 
valuable  and  agreeable  means  of  aborting  a  "  cold."  Lemon-  or 
lime-juice  is  an  infallible  prophylactic  against  scurvy,  being  unques- 
tionably the  most  efficient  remedy  for  the  disease. 

It  is  well  known  by  the  laity  that  eating  lemons  increases  the 
functional  activity  of  the  liver.  Lemons  and  citric  acid,  there- 
fore, are  efficient  remedies  in  relieving  attacks  of  biliousness  and 
catarrhal  jaundice,  and  they  even  appear  to  counteract  the  effects 
of  malaria.  Lemon-juice  is  an  old  and  esteemed  remedy  in  acute 
rheumatism. 

Vegetable  acids  are  used  for  the  same  disorders  of  the  digestive 
tract  as  mineral  acids,  although  not  so  efficient  as  the  latter,  espe- 
cially the  hydrochloric.  Much  of  the  benefit  derived  from  sour 
table-wines  is  due  to  the  fruit-acids  they  contain. 

Contraindications. — Ordinarily  the  same  as  for  mineral  acids. 
It  is  a  matter  of  observation  that  nursing  mothers  may  produce  a 
troublesome  diarrhea  in  the  infant  by  partaking  too  freely  of  vine- 
gar or  acid  fruits. 

Administration. — A  solution  of  citric  acid  may  be  made  of 
about  the  acidity  of  lemon-juice  by  dissolving  570  grains  (36.93 
Gm.)  in  i  pint  (473.17  Cc.)  of  distilled  water.  Vegetable  acids 
when  taken  internally  should  be  mixed  with,  or  dissolved  in,  water 
and  diluted  and  sweetened,  that  they  may  be  pleasant  to  the  taste 
and  acceptable  to  the  stomach. 


GROUP  v.— ALKALIES. 


Alkahes  are  classed  as  Restoratives  because  the  blood  and  many 
secretions  of  the  body  are  normally  alkaline  in  reaction.  The  fol- 
lowing drugs  are  numbered  apiong  alkalies  or  antacids :  Liquor 
potassse,  potassii  acetas,  potassii  bicarbonas,  potassii  bitartras, 
potassii  carbonas,  potassii  citras,  potassii  tartras,  liquor  sodze,  sodii 


150  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

acetas,  sodii  bicarbonas,  sodii  carbonas,  sodii  carbonas  exsiccatus, 
calcii  carbonas  praecipitatus,  creta  preparata,  liquor  calcis,  mistura 
cretse,  syrupus  calcis,  lithii  benzoas,  lithii  carbonas,  lithii  citras, 
lithii  citras  effervescens,  lithii  salicylas,  magnesii  carbonas,  ammonii 
carbonas,  spiritus  ammonise  aromaticus. 

Liquor   Potassae— Liquoris   Potassae— Solution    of 
Potash.    TJ.  S.  I*. 

Origin. — An  aqueous  solution  of  Potassium  Hydrate  containing 
about  5  per  cent,  of  the  Hydrate. 

Description  and  Properties. — A  clear,  colorless  liquid,  odor- 
less, having  a  very  acrid  and  caustic  taste  and  a  strongly  alkaline 
reaction.  It  should  conform  to  the  same  reaction  and  tests  as  an 
aqueous  solution  of  potassa.     (See  Poiassa.) 

Dose. — 5-20  minims  (0.3-1.2  Cc),  well  diluted. 

Potassii  Acetas— Potassii  Acetatis— Potassium 
Acetate.    U.  8.  P. 

Origin. — Prepared  by  the  action  of  Acetic  Acid  upon  Potassium 
Carbonate. 

Description  and  Properties. — A  white  powder  or  crystalline 
masses,  of  a  satiny  lustre,  odorless,  and  having  a  warm,  saline 
taste ;  very  deliquescent  on  exposure  to  the  air.  Soluble  in  0.36 
part  of  water  and  in  1.9  parts  of  alcohol;  with  increasing  tempera- 
ture it  becomes  much  more  soluble  in  both  hquids.  Potassium 
acetate  should  be  kept  in  well-stoppered  bottles. 

Dose. — 15-60  grains  (1.0-4.0  Gm.). 

Potassii    Bicarbonas— Potassii    Bicarbonatis— Po- 
tassium Bicarbonate.    U.  S.  I*. 

Origin. — Prepared  by  the  action  of  Carbon  Dioxide  upon  a 
solution  of  the  Carbonate. 

Description  and  Properties. — Colorless,  transparent,  mono- 
clinic  prisms,  odorless,  and  having  a  saline  and  slightly  alkaline 
taste.  Permanent  in  the  air,  soluble  in  3.2  parts  of  water  at  15°  C. 
(S9°  F-)  and  in  1.9  parts  at  50°  C.  (122°  F.).  At  a  higher  temper- 
ature the  solution  rapidly  loses  carbon  dioxide,  and,  after  boiling, 
contains  only  potassium  carbonate.  It  is  almost  insoluble  in 
alcohol.     The  drug  should  be  kept  in  well-stoppered  bottles. 

Dose. — 10-40  grains  (0.6-2.5  Gm.). 


ALKALIES.  151 

Potassii  Bitartras— Potassii  Bitartratis— Potassium 
Bitartrate.    V.  S.  P. 

(Cream  of  Tartar.) 

Origin. — Prepared  by  purifying  and  crystallizing  Argol  or  Crude 
Tartar,  a  residuum  of  grape-juice  after  fermentation. 

Description  and  Properties. — Colorless  or  slightly  opaque, 
rhombic  crystals,  or  a  white,  somewhat  gritty  powder,  odorless, 
and  having  a  pleasant,  acidulous  taste ;  permanent  in  the  air.  Sol- 
uble in  about  200  parts  of  water  and  in  about  16.7  parts  of  boiling 
water ;  very  slightly  soluble  in  alcohol. 

Dose. — 10  grains— |-  ounce  (0.6-16.0  Gm.). 

Official  Preparation. 

Piilvis  Jalapse  Compdsitus — Ptilveris  Jalapae  CompSsiti — Compound  Pow- 
der of  Jalap. — Dose,  10-30  grains  (0.6-2.0  Gm.) ;  used  as  a  hydragogue  cathartic. 

Potassii    Carbonas— Potassii    Carbonatis— Potas- 
sium Carbonate.    JJ.  S.  I*. 

Origin. — Prepared  from  the  ash  obtained  from  the  residue  of  the 
beet-sugar  manufacture.    It  may  also  be  obtained  from  wood-ashes. 

Description  and  Properties. — A  white,  granular  powder,  odor- 
less, and  having  a  strongly  alkaline  taste ;  very  deliquescent ;  solu- 
ble in  I.I  parts  of  water  at  15°  C.  (59°  F.)  and  in  about  0.65  part 
of  boiling  water ;  insoluble  in  alcohol.  Its  aqueous  solution  (i  in 
20)  has  a  strongly  alkaline  reaction  upon  litmus-paper,  and  effer- 
vesces with  acids.  Potassium  carbonate  should  be  kept  in  well- 
stoppered  bottles. 

Dose. — 5-30  grains  (0.3-2.01  Gm.). 

Potassii  Citras— Potassii  Citratis— Potassium 
Citrate.    U.  S.  P. 

Origin. — Prepared  by  the  action  of  Citric  Acid  upon  a  solution 
of  Potassium  Carbonate. 

Description  and  Properties. — Transparent,  prismatic  crystals, 
or  a  white,  granular  powder,  odorless,  and  having  a  cooling,  saline 
taste ;  deliquescent  on  exposure  to  the  air.  Soluble  in  0.6  part  of 
water  at  15°  C.  (59°  F.),  and  very  soluble  in  boiling  water;  feebly 
soluble  in  alcohol.  Potassium  citrate  should  be  kept  in  well-stop- 
pered bottles. 

Dose. — 15-60  grains  (1.0-4.0  Gm.). 


152         .      A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Potassii  Tartras— Potassii  Tartratis— Potassium 

Tartrate.    (Unofficial.) 
Origin. — Prepared  by  the  action  of  Acid  Potassium  Tartrate 
upon  Potassium  Carbonate. 

Description,  and  Properties. — It  occurs  usually  in  the  form  of 
a  granular  or  fine  white  powder,  inodorous,  and  of  a  saline,  bitter- 
ish taste.  Soluble  in  0.75  part  of  water  at  2""  C.  (35.6°  F.),  and  in 
0.47  part  of  water  at  64°  C.  (147.2°  F.). 

Dose. — 30  grains-^  ounce  (2.0-16.0  Gm.). 

PREPARATIONS  OF  SODIUM. 

Liquor  Sodae— Liquoris  Sodae— Solution  of  Soda. 

V.  S.  JP. 

(Solution  of  Sodium  Hydrate.) 

Origin. — An  aqueous,  solution  of  Sodium  Hydrate  (NAOH  = 
39.96),  containing  about  5   per  cent,  of  the   Hydrate. 

Description  and  Properties. — A  clear,  colorless  liquid,  odor- 
less, having  a  very  acrid  and  caustic  taste  and  a  strongly  alkaline 
reaction. 

Dose. — 5-20  minims  (0.3-1.8  Cc). 

Sodii  Acetas— Sodii  Acetat is— Sodium  Acetate. 

Z7.  S.  P. 

Origin. — It  may  be  obtained  by  neutralizing  Acetic  Acid  with 
Sodium  Carbonate.  The  usual  article,  however,  is  manufactured  on 
a  large  scale  in  the  United  States  in  the  process  of  purifying  acetic 
acid  from  wood  vinegar. 

Description  and  Properties. — Colorless,  transparent,  mono- 
clinic  prisms,  or  a  granular,  crystalline  powder,  odorless,  and  having 
a  cooling,  saline  taste ;  efflorescent  in  warm,  dry  air.  Soluble  in 
1.4  parts  of  water  and  in  30  parts  of  alcohol ;  also  in  0.5  part  of 
boiling  water  and  in  2  parts  of  boiling  alcohol.  Sodium  acetate 
should  be  kept  in  well-stoppered  bottles. 

Dose. — 15-60  grains  (1.0-4.0  Gm.). 

Sodii  Bicarbonas— Sodii   Bicarbonatis— Sodium  * 
Bicarbonate.    TJ.  8.  P. 

Origin. — ^Prepared  by  saturating  a  mixture  of  2  parts  of  Crys- 
tallized and  3  parts  of  Dried  Sodium  Carbonate  with  Carbon  Diox- 


ALKALIES.  153 

ide,  generated  by  the  action  of  hydrochloric  acid  upon  marble. 
The  damp  Salt  formed  is  shaken  with  half  its  weight  of  Distilled 
Water,  the  undissolved  portion  being  dried  by  exposure  to  the  air. 

Description  and  Properties. — A  white,  opaque  powder,  odor- 
less, and  having  a  cooling,  mildly  alkaline  taste ;  permanent  in  dry, 
but  slowly  decomposed  in  moist,  air.  Soluble  in  11.3  parts  of 
water  at  15"  C.  (59°  F.) ;  above  that  temperature  the  solution  loses 
carbon  dioxide,  and  at  a.  boiling  heat  the  salt  is  entirely  converted 
into  normal  carbonate.  Insoluble  in  alcohol  and  ether.  The  drug 
should  be  kept  in  well-closed  vessels,  in  a  cool  place. 

Dose. — 10-30  grains  (0.6-2.0  Gm.). 

Official  Preparations. 

Mistura  Rhei  et  Sodae — Misturse  Rhei  et  Sodse — Mixture  of  Rhubarb  and 
Soda. — Dose,  J-2  fluidounces  (7.4-59  Cc). 

Trochlsci  Sodii  Bicarbonatis — TrocMscos  (ace.)  Sodii  Bicarbonatis — 
Troches  of  Sodium  Bicarbonate. — Dose,  i  to  6  troches. 

Sodii  Carbonas— Sodii  Carbonatis— Sodium 
Carbonate.    V.  S.  J*. 

Origin. — Obtained  from  Sodium  Sulphate  and  Sodium  Chloride, 
but  chiefly  by  a  compUcated  process,  known  as  Leblanc's,  from 
Sodium  Sulphate,  which  is  mixed  with  Chalk  and  Coal,  the  mixture 
ignited,  and  the  resultant  mass  exhausted  with  Water  and  concen- 
trated, the  carbonate  separating  from  the  hot  liquid  being  purified. 

Description  and  Properties. — Colorless,  monoclinic  crystals, 
having  a  strongly  alkaline  taste.  In  dry  air  the  salt  effloresces, 
and  if  left  exposed  soon  loses  about  half  its  water  of  crystallization 
(31.46  per  cent,  of  its  weight),  becoming  a  white  powder.  Soluble 
in  1.6  parts  of  water  at  15°  C.  (59°  F.),  in  0.09  part  at  38°  C. 
(100.4°  F.),  in  0.2  part  of  boiling  water,  and  in  1.02  parts  of  glycerin; 
insoluble  in  alcohol  and  ether.  The  aqueous  solution  gives  an 
alkaline  reaction  with  litmus-paper,  and  effervesces  strongly  with 
acids.     The  drug  should  be  kept  in  well-closed  vessels. 

Dose. — 10-30  grains  (.06-2.0  Gm.). 

Official  Preparation. 

Sodii  carbonas  Exsiccatus — Sodii  Carbonatis  Exsiccati — Dried  Sodium 
Carbonate. — Description  and  Properties. — A  loose  white  powder,  conforming  to  the 
reactions  and  tests  for  sodii  carbonas. 

Dose. — 3-10  grains  (0.2-0.6  Gm.). 


154  A    TEXT-BOOK  OF  MATERIA  MEDICA. 


PREPARATIONS  OF  CALCIUM. 

Calcii  Carbonas  Praecipitatus— Calcii  Carbonatis 
Praecipitati— Precipitated  Calcium  Carbonate. 
V.  s.  p. 

Origin. — Prepared  by  mixing  aqueous  solutions  of  Calcium 
Chloride  and  Sodium  Carbonate,  the  resulting  precipitate  of  Cal- 
cium, Carbonate  being  purified. 

Desoription  and  Properties. — A  fine  white  powder,  without 
odor  or  taste,  permanent  in  the  air.  Nearly  insoluble  in  water,  its 
solubility  being  increased  by  the  presence  of  ammonium  salts,  and 
especially  by  carbonic  acid,  and  diminished  by  alkali  hydrates. 
Insoluble  in  alcohol,  but  in  diluted  acetic,  hydrochloric,  or  nitric 
acid  completely  soluble,  with  effervescence. 

Dose. — 15-30  grains  (i. 0-2.0  Gm.). 

Creta  Praeparata— Cretae  Praeparatae— Prepared 
Chalk.    U.  S.  J*. 

Origin. — Native,  friable  Calcium  Carbonate  freed  from  most  im- 
purities by  elutriation. 

Description  and  Properties. — A  white,  amorphous  powder, 
often  moulded  into  conical  drops,  odorless  and  tasteless,  permanent 
in  the  air.  Almost  insoluble  in  water ;  insoluble  in  alcohol ;  soluble 
in  diluted  acetic,  hydrochloric,  or  nitric  acid,  with  copious  efferves- 
cence, but  without  leaving  more  than  a  trifling  residue. 

Dose. — 5-60  grains  (0.3-4.0  Gm.). 

Official  Preparations. 

Hydrargyrum  cum  Greta— HydrSrgyri  cum  Greta— Mercury  with  Ghalk.— 
Dose,  2-10  grains  (0.12-0.6  Gm.).     (Described  under  Hydrargyrum.) 

Ptilvis  Gretse  Compasitus— Pttlveris  Gretse  GompSsiti  -Compound  Chalk 
Powder. — Dose,  20-60  grains  (1.30-4.0  Gm.). 

Trochlsci  Cretae- Trochfecos  (ace.)  Cretae- Troches  of  Chalk.— Zlo«,  ad 
libitum. 

Unofficial  Preparations. 

Paivis  Cretse  AromSticus — Piilveris  Cretae  AromStici— Aromatic  Powder 
of  Cha.\k.—Dose,  30-60  grains  (2.0-4.0  Gm.).  A  mixture  of  Aromatics  with 
Chalk. 

Ptilvis  Cretae  AromSticus  cum  Opio— Piilveris  Cretae  AromStici  cum  Opio 
—Aromatic  Powder  of  Ghalk  and  Opium.— Z)o«,  10-20  grains  (0.6-1.30  Gm.). 
I  grain  (.06  Gm.)  of  Opium  in  every  40  grains  (2.5  Gm.)  of  the  previous  mixture. 


ALKALIES.  155 

Liquor  Calcis— Liquoris  Calcis— Solution  of  Lime. 

V.  8.  P. 

(Solution  of  Calcium  Hydrate;  Lime  Water.) 

Origin. — A  saturated,  aqueous  solution  of  Calcium  Hydrate. 

Description  and  Properties. — A  clear,  colorless  liquid,  without 
odor,  and  having  a  saline  and  feebly  caustic  taste.  It  absorbs 
carbon  dioxide  from  the  air,  so  that  a  pellicle  of  calcium  carbonate 
forms  on  the  surface  of  the  liquid.  On  being  heated  it  becomes 
turbid  through  separation  of  calcium  hydrate,  which  redissolves 
when  the  liquid  is  cooled.  It  gives  a  strong  alkaline  reaction  with 
litmus  paper. 

Dose. — 1-4  ounces  (15.0- 11 8. 3  Cc). 

Official  Preparations. 

Linimfintum  C31cis — LinimSnti  CSlcis — Lime  Liniment  (Carron  Oil). — 
For  external  use. 

Mistiira  Cretse— MistiiraE  Cretae — Chalk  Mixture. — Dose,  1-4  fluidrachms 
(4.0-15.  Cc).     Compound  Chalk  Powder,  Cinnamon  Water,  and  Water. 

Sj^rupus  calcis — Syrupi  CSlcis — Syrup  of  Lime. — Dose,  \-z  fluidrachms 
(1.8-7.4  Cc). 

PREPARATIONS  OF  LITHIUM. 

Llttiii  Carbonas— Lithii  Carbonatis— Lithium 
Carbonate.    Xf.  S.  JP. 

Origin. — Lithium  is  found  in  many  mineral  waters,  the  carbon- 
ate being  prepared  from  lepidolite. 

Description  and  Properties. — A  light  white  powder,  odorless, 
and  having  an  alkaline  taste ;  permanent  in  the  air.  Soluble  in  80 
parts  of  water  and  140  parts  of  boiling  water ;  much  more  soluble 
in  water  saturated  with  carbon  dioxide ;  insoluble  in  alcohol,  but 
soluble  in  diluted  acids,  with  active  effervescence. 

Dose. — 2-10  grains  (0.12-0.6  Gm.). 

LTtiiii  CTtras— LTthii  Citratis— Litinium  Citrate. 

U.  S.  I*. 

Origin. — Prepared  by  adding  Lithium  Carbonate  to  a  solution 
of  Citric  Acid. 

Description  and  Properties. — A  white  powder,  odorless,  and 
having  a  cooling,  faintly  alkaline  taste ;  deliquescent  on  exposure 
to  the  air.     Soluble  in  2  parts  of  water  and  in  0.5  part  of  boiling 


156  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

water ;  almost  insoluble  in  alcohol  or  ether.    Lithium  citrate  should 
be  kept  in  well-stoppered  bottles. 
Dose. — 2-10  grains  (0.12-0.6  Gm.). 

Official  Preparation. 
Lfthii  Cftras   EffervSscens — Othii   Citratis    EffervescSntis — Effervescent 
Lithium  Citrate. — Dose,  1-2  drachms  (4.0-8.0  Gm.). 

PREPARATIONS  OF  MAGNESIUM. 

Mag-nesia— Magnesias— Magnesia.    JJ.  S.  P, 

(Light  Magnesia;  Calcined  Magnesia.) 

Orisin. — Prepared  by  subjecting  Magnesium  Carbonate  to  a  low 
red  heat  in  a  Cornish  or  Hessian  crucible  closed  loosely  by  a  lid. 

Description  and  Properties. — A  white,  very  light,  and  very 
fine  powder,  without  odor,  and  having  an  earthy,  but  not  a  saline, 
taste.  On  exposure  to  the  air  it  slowly  absorbs  moisture  and  car- 
bon dioxide.  Almost  insoluble  in  water  and  insoluble  in  alcohol, 
but  soluble  in  diluted  acids.  Magnesia  should  be  kept  in  well- 
closed  vessels. 

Dose. — As  an  antacid,  10-15  grains  (0.6-1.0  Gm.). 

Official  Preparation. 

Piilvis  Rhei  Compttsitus — Ptilveris  Rhei  Comp6siti — Compound  Powder 

of  Rhubarb Dose,  as  a  laxative,  20-60  grains  (1.30-4.0  Gm.).     Formula:  Rhubarb, 

25 ;  Magnesia,  65 ;  Ginger,  10  parts. 

Magnesii  Carbonas— Magnesii  Carbonatis— 
Magnesium  Carbonate.    V.  S.  J*. 

Origin. — Prepared  by  evaporating  to  dryness  the  mixed  solu- 
tions of  Magnesium  Sulphate  and  Sodium  Carbonate,  and  purifying 
and  drying  the  residue. 

Description  and  Properties. — Light,  white,  friable  masses,  or 
a  light,  white  powder,  without  odor,  and  having  a  slightly  earthy 
taste;  permanent  in  the  air.  Almost  insoluble  in  water,  to  which, 
however,  it  imparts  a  slightly  alkaline  reaction ;  insoluble  in  alco- 
hol, but  soluble  in  diluted  acids,  with  active  effervescence. 

Dose. — As  an  antacid,  5-20  grains  (0.3-1.3  Gm.). 

PREPARATIONS   OF  AMMONIUM. 

Ammonil  Carbonas— Ammonii  Carbonatis— 
Ammonium  Carbonate,    f:  S.  J*. 

Origin. — Prepared  by  a  complicated  process  by  heating  in  an 
iron  or  earthen  retort  a  mixture  of  Sal  Ammoniac  and  Chalk. 


ALKALIES.  157 

Description  and  Properties. — White,  hard,  translucent,  striated 
masses,  having  a  strongly  ammoniacal  odor  without  empyreuma, 
and  a  sharp,  saline  taste.  On  exposure  to  the  air  the  salt  loses 
both  ammonia  and  carbonic  acid,  becoming  opaque,  and  is  irnally 
converted  into  friable  porous  lumps  or  a  white  povifder.  Slowly 
but  completely  soluble  in  about  5  parts  of  water  at  15°  C.  (59°  F.)^ 
and  decomposed  by  hot  water,  with  the  evolution  of  carbonic  acid 
and  ammonia.  By  prolonged  boiling  with  water  the  salt  is  com- 
pletely dissipated.  The  aqueous  solution  possesses  a  strongly 
alkaline  reaction  and  effervesces  with  acids. 

Dose. — 3-10  grains  (0.18-0.6  Gm.). 

Official  Preparation. 

Spbitus  Amm5niae  AromSticus — Splritus  Ammoniae  AromStici — Aromatic 
Spirit  of  Ammonia. — Composition:  Ammonium  Carbonate,  Ammonia  Water,  Aro- 
matic Oils,  Alcohol,  and  Water. 

Description  and  Properties. — A  nearly  colorless  liquid  when  freshly  prepared, 
but  gradually  acquiring  a  somewhat  darker  tint.  It  has  a  pungent,  ammoniacal  odor 
and  taste. 

Dose. — ^i  fluidrachm  (1.8-3.7  Cc). 


Antagonists  and  Incompatibles. — The  alkalies  and  their  car- 
bonates are  incompatible  with  acids  and  with  metallic  salts.  The 
ammonium  carbonate  is  incompatible  with  the  acidulous  salts  and 
with  lime  water. 

Synergists. — Agents  promoting  waste,  such  as  vegetable  acids, 
mercury,  iodine,  etc.,  increase  the  therapeutic  activity  of  the 
alkalies. 

Physiological  Action. — The  alkalies  mentioned  in  this  group 
may  be  divided  into  direct  antacids,  or  those  which  neutralize  or 
lessen  the  acidity  of  the  stomach,  and  indirect  antacids,  or  those 
which,  being  oxidized  in  the  blood,  are  excreted  as  carbonates, 
diminishing  the  acidity  of  the  urine  and  increasing  the  alkalinity  of 
the  blood,  although  not  influencing  the  acidity  in  the  stomach. 

The  direct  antacids  are  lime  water,  prepared  chalk,  and  magnesia. 

The  indirect  antacids  are  potassium  acetate,  bitartrate,  citrate, 
and  tartrate,  sodium  acetate,  and  lithium  citrate. 

The  following  alkalies  are  both  direct  and  indirect  antacids: 
solution  of  potassa,  solution  of  soda,  carbonates  and  bicarbonates 
of  potassium,  sodium,  lithium,  magnesium,  and  ammonium. 

The  physiological  action  of  the  various  alkalies  will  now  be 
considered  in  detail. 


158  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Externally  and  Locally. — The  hydrates  of  potassium  and  sodium 
are  caustic  and  rubefacient.  The  solutions  of  soda  and  potassa, 
when  apphed  undiluted,  irritate  the  surface  of  the  skin  and  soften 
and  dissolve  the  epidermis  and  horny  tissues,  uniting  with  the 
albumin  of  the  various  structures  to  form  a  soluble  alkali-albu- 
minate.  The  carbonates  and  bicarbonates  exert  a  similar,  though 
much  weaker,  action,  while  the  acetates,  bitartrates,  citrates,  and 
tartrates  have  no  local  influence. 

The  ammonium  salts  do  not  affect  the  epidermis  in  the  manner 
of  those  previously  mentioned,  penetrating  without  dissolving  it, 
irritating  the  underlying  structures,  and  inducing  an  effusion  of 
lymph,  thus  acting  as  vesicants.  Should  a  strong  solution  of 
ammonia  be  applied  to  the  skin  and  evaporation  be  prevented, 
suppuration  and  sloughing  may  ensue. 

Internally. — Digestive  System. — Potassium  salts  in  small  doses 
promote  the  secretion  of  gastric  juice,  thus  obeying  the  law  by 
which  alkalies  augment  acid  secretions.  Large  doses  neutralize 
free  acid  in  the  stomach,  and,  by  rendering  the  chyme  neutral  or 
alkaline,  interfere  with  the  secretion  from  the  pancreas,  liver,  and 
intestines,  thereby  deranging  digestion. 

Circulatory  System. — The  salts  of  potassium,  by  lessening  the 
acidity  of  the  gastric  juice  and  entering  the  circulation,  increase 
the  alkalinity  of  the  blood.  The  bicarbonates,  however,  taken  in 
large  doses  upon  an  empty  stomach,  enter  the  circulation  unchanged, 
where,  by  decomposing  the  neutral  phosphate  of  sodium  present, 
they  form  the  acid  phosphate  of  sodium,  reducing  the  alkalinity 
of  the  blood  and  increasing  the  acidity  of  the  urine. 

Far  different  are  the  effects  of  these  alkalies  when  taken  after 
meals,  the  salts  being  then  decomposed  in  the  stomach  by  the 
acid  gastric  juice,  the  alkaline  base  increasing  the  alkalinity  of  the 
blood. 

The  acetates,  citrates,  and  bitartrates  enter  the  blood  unchanged. 
The  acid  radical  being  destroyed,  and  the  base  combining  with  the 
carbon  dioxide  formed,  the  salts  are  converted  into  the  alkaline  car- 
bonates, increasing  the  alkalinity  of  the  blood  and  urine.  It  is 
believed  that  the  amount  of  hemoglobin  is  increased  by  the  potas- 
sium salts  when  the  blood  is  deficient  in  this  substance,  though 
large  doses  interfere  with  the  ozonizing  function  of  the  red  blood- 
corpuscles. 

Should  the  caustic  alkalies  be  injected  directly  into  the  blood, 
death  quickly  ensues  from  coagulation  of  that  fluid,  arising  from 


ALKALIES.  159 

excessive  formation  of  alkali-albuminate.  Under  very  large  or 
poisonous  doses  the  heart-muscle  is  weakened,  decreasing  the  force 
of  its  contractions,  arrest  taking  place  in  diastole.  Even  medicinal 
doses,  if  long  continued,  may  occasion  cardiac  depression,  diminish- 
ing the  force  of  the  circulation.  Small  doses  may  increase  blood- 
pressure,  though  the  pulse-rate  be  diminished.  Brunton  and  Cash 
have  demonstrated  that  minute  amounts  of  potassium  salts  applied 
to  muscle  increase  its  contractile  power,  while  large  doses  diminish 
or  paralyze  this  force. 

Nervous  System. — When  potassium  salts  are  administered  in 
medicinal  doses  and  for  a  reasonable  length  of  time,  no  important 
action  upon  the  nervous  system  is  produced ;  but  if  excessive  doses 
be  taken,  the  nerve-centers  and  motor  nerves  are  paralyzed,  after  a 
period  of  temporary  excitement.  Owing,  however,  to  the  fact  that 
potassium  is  a  protoplasmic  poison,  affecting  alike  the  muscles  and 
nerve-tissues,  its  salts  should  not  be  given  in  full  doses  for  too  long 
a  period  without  counteracting  their  depressing  influence  by  the  use 
of  muscle-  and  nerve-tonics. 

Respiratory  System. — The  only  action  of  importance  upon  the 
respiratory  system  is  the  increased  amount  and  diminished  viscidity 
of  the  secretion  from  the  bronchial  tubes. 

Absorption  and  Elimination. — The  potassium  salts  possess  very 
high  diffusive  power.  They  are  easily  and  quickly  absorbed  and 
rapidly  excreted,  the  salts  with  vegetable  acids  being  eliminated 
as  alkaline  carbonates,  rendering  the  urine  alkaline.  Salts  of  potas- 
sium are  chiefly  eliminated  by  the  kidneys,  though  the  process 
takes  place  to  some  extent  through  the  bronchial  mucous  mem- 
brane and  other  secretions.  They  are  active  diuretics,  increasing 
the  amount  of  water  and,  by  stimulating  the  renal  epithelium, 
augmenting  the  excretion  of  solids.  The  uric  acid  is  greatly  dimin- 
ished, being,  converted  into  urea,  and  as  such  eliminated,  showing 
that  the  alkalies  increase  oxidation  and  promote  waste. 

Tejnperature. — Medicinal  doses  have  no  effect  upon  temperature. 

Untoward  Action. — Under  prolonged  dosage  the  digestion  be- 
comes impaired.  There  is  present  paralysis  of  the  muscular  fibers 
of  the  intestines,  accompanied  by  diarrhea  or  constipation  and  tym- 
panites. There  may  be  also  present  emaciation,  muscular  weakness, 
nervous  prostration,  and  anemia. 

Poisoning. — The  caustic  preparations  of  potassium  produce  all 
the  symptoms  of  a  corrosive  mineral  poison,  somewhat  resembling 
the  poisonous  action  of  the  mineral  acids  already  described.    Death 


i6o  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

is  occasionally  preceded  by  convulsions,  the  heart's  action  being- 
arrested  before  respiratory  failure.  The  carbonates  and  bicarbonates 
and  the  salts  of  vegetable  acids  are  not  considered  poisonous,  nor 
do  they  produce  the  corrosive  effects  of  caustic  potash  or  its  solution. 

Treatment  of  Poisoning. — Vegetable  acids  are  chemically  incom- 
patible, and  should  be  given  freely,  together  with  oils  and  demul- 
cent drinks  as  protectives,  and  opium,  if  necessary,  to  relieve  pain. 
Cardiac  stimulants — digitalis,  brandy,  caffeine,  etc. — may  be  required 
to  sustain  the  heart,  to  be  given  hypodermically. 

The  Comparative  Action  of  the  Alkalies. — Sodium  salts  in 
their  action  are  analogous  to  potassium,  although  less  irritating 
to  the  gastro-intestinal  tract.  They  are  also  less  depressing  to 
the  circulatory,  muscular,  and  nervous  systems.  They  differ  from 
the  potassium  salts  in  that  they  lengthen,  ihstead  of  shortening, 
the  muscular  curve.  They  are  neither  absorbed  nor  eliminated 
so  rapidly,  and  are  consequently  less  active  as  diuretics.  They 
are  not  nearly  so  powerful  solvents  of  uric  acid,  and  are  therefore 
inferior  to  the  potassium  salts  in  gout.  Indeed,  the  nodules,  known 
as  "  chalk-stones,''  frequently  found  upon  the  joints  of  gouty  pa- 
tients are  composed  of  urate  of  sodium. 

Lithium  salts  closely  resemble  in  their  effects  those  of  potas- 
sium, their  action  upon  the  nerves  and  muscles,  however,  being 
less  powerful.  The  contractile  force  of  muscle  is  invariably  di- 
minished by  lithium  and  increased  by  potassium.  As  a  solvent 
of  uric  acid,  lithium  is  the  most  powerful  of  all  the  alkalies,  the 
urates,  formed  under  the  administration  of  the  carbonate  or  citrate, 
being  extremely  soluble,  rendering  the  alkaline  salts  of  lithium 
superior  to  the  other  alkalies  in  gout  and  in  the  uric-acid  diathesis. 

Calcium  salts  are  more  sedative  and  astringent  in  their  action 
upon  the  gastro-intestinal  tract  than  the  other  alkalies,  and  are 
direct  antacids.  They  tend  to  produce  constipation.  The  nervous 
and  muscular  systems  are  less  affected  by  these  salts  than  by  the 
remaining  alkalies,  the  contractile  muscular  force,  however,  being 
increased  by  calcium.  They  are  less  readily  absorbed  and  excreted 
than  the  foregoing  alkalies,  and  less  active  in  increasing  the  alka- 
linity of  the  urine. 

Magnesium  Salts. — Magnesia  and  the  magnesium  carbonates 
are  direct  antacids  and  sedative  to  the  stomach,  acting  upon  the 
intestinal  canal  as  saline  cathartics.  In  their  influence  upon  the 
circulatory  system  they  are  feebler  than,  but  similar  to,  the  potas- 
sium salts,  slightly  increasing  the  alkalinity  of  the  blood.    They 


ALKALIES.  l6l 

are  not  so  readily  absorbed,  nor  so  rapidly  excreted,  as  the  salts 
of  potassium  and  sodium,  while  increasing  the  amount  of  water 
and  solids  excreted  and  acting  as  solvents  of  uric  acid. 

Ammonium  Salts. — ^These  preparations  are  used  rather  as  car- 
diac stimulants,  their  physiological  action  being  more  extensively 
considered  under  that  group.  As  antacids  their  action  may  be 
briefly  compared  with  that  of  the  other  alkaUes.  Their  effect  upon 
the  gastric  juice  and  its  secretion  is  similar  to  that  of  the  car- 
bonates and  bicarbonates  above  mentioned.  They  dilate  the  blood- 
vessels of  the  stomach,  augmenting  the  blood-supply  and  pro- 
ducing a  sensation  of  warmth  in  the  epigastrium.  Lethal  doses  act 
as  emetics.  They  increase  the  glycogenic  function  of  the  liver  and 
stimulate  the  circulatory  system,  elevating  the  pulse-rate  and  rais- 
ing arterial  tension.  In  medicinal  doses  they  stimulate  the  spinal 
cord,  motor  nerves,  and  muscles,  while  toxic  doses  paralyze  these 
structures.  They  prevent  the  coagulation  of  the  blood  and  lessen 
the  oxygen-carrying  power  of  the  red  corpuscles.  By  them  also 
the  respirations  are  increased  in  frequency. 

The  salts  of  ammonium  are  quickly  absorbed  and  undergo  oxi- 
dation in  the  body,  augmenting  the  amount  of  uric  acid  and  urea  in 
the  urine,  thereby  increasing  its  acidity  to  some  extent. 

As  regards  the  poisonous  activity  of  the  alkalies  mentioned, 
ammonium  ranks  next  to  potassium,  the  most  toxic  of  all. 

Therapeutics. — Externally  and  Locally. — Norton  has  recom- 
mended LIQUOR  POTASSiE  in  ingrowing  toe-nail,  the  solution  being 
applied  to  the  nail,  which  is  soon  rendered  so  soft  that  it  can  be  easily 
scraped  without  causing  pain.  The  same  remedy  is  used  in  many 
diseases  of  the  skin  to  allay  itching  and  soften  the  horny  epithelium. 
It  is  also  employed  extensively  in  diseases  of  the  ear  and  throat,  and 
in  the  proportion  of  i  part  to  ID  of  water  it  is  very  effective  in 
softening  impacted  cerumen. 

The  POTASSIUM  CARBONATE  in  solution  is  frequently  used  in  various 
pruriginous  diseases  of  the  skin,  being  a  highly  efficient  antipruritic. 

The  detergent  and  sialagogue  properties  of  potassium  citrate 
and  TARTRATE  are  rendered  serviceable  in  cextaJindiseases  of  the  mouth. 

Sodium  bicarbonate  is  a  deservedly  popular  dressing  for  burns, 
and  pain  and  swelling  of  the  joints  in  acute  articular  rheumatism  are 
sometimes  greatly  relieved  by  enveloping  the  articulations  in  a  hot 
solution  rendered  alkaline  with  this  salt.  T.  Michailoff  highly 
recommends  sodium  bicarbonate  in  granular  tonsillitis  and  pharyn- 
gitis, the  powdered  salt  being  applied  every  two  or  three  hours. 
11 


l63  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

In  diseases  of  the  ear  it  is  used  for  the  same  purposes  as  the  potas- 
sium preparations  above  mentioned.  It  is  one  of  the  ingredients 
of  "  Dobell's  Solution,"  which  is  an  effective  antiseptic  wash  in 
nasal  catarrh,  and  the  solution  of  sodium  bicarbonate  has  been  sug- 
gested by  Forchheimer  as  a  valuable  remedy  in  thrush  or  aphthm. 

Sodium  carbonate  may  be  used  for  the  same  purposes  as  the 
bicarbonate,  though  probably  inferior  to  it  in  all  cases  save  infantile 
eczema  capitis,  in  which  condition  it  is  a  most  valuable  remedy  for 
softening  the  eczematous  crusts. 

Prepared  chalk  is  an  ingredient  of  many  ointments  used  in  the 
treatment  of  erysipelas  and  subacute  eczema.  Lime  water,  mixed 
with  equal  parts  of  linseed  or  olive  oil,  is  highly  prized  as  a  dress- 
ing for  burns,  and  the  efficiency  of  the  "black"  and  "yellow" 
washes  in  the  treatment  of  venereal  sores  is  too  well  known  to 
require  further  testimony  in  their  favor.  These  latter  preparations 
also  make  excellent  applications  in  acute  eczema.  Lime  water  may 
sometimes  be  used  with  advantage  in  leucorrhea  and  vaginitis. 

LiTHii  carbonas,  in  the  proportion  of  5  grains  (0.3  Gm.)  to 
I  ounce  (30.0  Cc.)  of  water,  is  highly  recommended  by  Garrod 
for  the  removal  •  of  gouty  deposits,  the  solution  being  kept"  con- 
stantly applied  to  the  parts  by  means  of  lint  or  absorbent  cotton. 

Magnesium  carbonate  makes  an  efficient  dusting  powder  in  der- 
matitis and  irritable  conditions  of  the  skin.  Ammonium  carbonate 
mixed  with  lanolin  readily  dissolves  the  epidermic  scales  of  psori- 
asis, and  the  aromatic  spirit  of  ammonia  is  a  grateful  application 
to  the  scalp  in  pityriasis. 

Internally. — Digestive  System. — The  carbonates  and  bicarbon- 
ates,  when  given  before  meals,  serve  to  increase  the  flow  of  gastric 
juice.  They  act  as  sedatives  to  the  stomach,  particularly  in  painful 
conditions  arising  from  a  deficient  secretion  of  gastric  juice.  As 
antacids,  when  given  after  meals,  they  are  very  useful  in  counter- 
acting excessive  acidity  of  the  stomach.  The  acidity  due  to  the 
formation  of  fatty  acids,  the  result  of  defective  digestion,  is  not 
relieved  by  the  administration  of  these  salts  after  meals,  but  if 
taken  before  meals  they  are  valuable  in  correcting  the  deficiency 
of  gastric  secretion  to  which  the  disordered  digestion  is  due.  In 
atonic  dyspepsia  these  preparations  administered  with  vegetable 
bitters  serve  a  useful  purpose. 

The  bicarbonates  and  the  salts  of  the  vegetable  acids,  by  increas- 
ing the  alkalinity  of  the  blood,  are  of  great  value  in  gout,  the  lithia 
salts  being  the  most  efficient  in  this  condition.     They  are  also  of 


ALKALIES.  163 

great  benefit  in  the  treatment  of  acute  rheumatism.     The  extensive 
experience  of  the  author  in  connection  with  the  latter  disease  justifies 
the  statement  that  in  the  treatment  of  them  alkahes  are  far  superior 
to  any  other  drugs,  sahcyHc  acid  not  excepted.     It  is  necessary  to 
saturate  the  system  with  some  bland  alkali,  preferably  a  sodium 
salt,  that  the  pernicious  effects  of  the  increased  amount  of  uric  acid 
formed  may  be  rendered  nugatory  until  convalescence  shall  have 
become  assured.     Thorough  alkalinization  should  be  produced  and 
maintained,  so  that  the  sweat,  saliva,  and  urine,  which  are  acid  in 
acute  rheumatism,  shall  give  no  acid  reaction  to  blue  litmus-paper. 
While  it  is  admitted  that  the  treatment  of  acute  rheumatism  by 
alkalies  alone  will  not  shorten  the  course  of  the  disease  so  readily 
as  the  employment  of  salicylates,  there  is  certainly  less  danger  of 
heart-complications,  the  period  of  convalescence  is  reduced,  and 
the  tendency  to  relapse  lessened  by  the  use  of  alkaline  remedies. 
Even  in  chronic  rheumatism  where  no  serious  renal  derange- 
ments exist  the  mild  alkalies,  which  are  well  borne  by  the  stomach, 
are  undoubtedly  indicated,  since  it  is  well  known  that  in  chronically 
rheumatic  subjects  there  is  a  decidedly  lessened  alkalinity  of  the 
blood.     It  is,  perhaps,  unnecessary  to  add  that  in  the  treatment  of 
these  cases  proper  hygiene,  food,  and  cholagogues  are  important 
adjuncts  to  successful  management.     The  autho'r  is  disposed  to  go 
still  further  and  urgently  recommend  complete  alkalinization  of  the 
system,  in  connection  with  other  therapeutic  measures,  in  dealing 
with  rheumatoid  arthritis. 

The  acetates,  bitartrates,  and  citrates  are  efficient  diuretics, 
cathartics,  and  diaphoretics,  the  first-named  salts  being  superior 
diuretics,  the  potassium  bitartrate  a  reliable  cathartic,  and  the 
citrates  active  diaphoretics. 

In  lithemia  these  salts  serve  a  valuable  purpose  by  rendering 
the  urine  persistently  alkaline,  retarding  the  formation  of  uric-acid 
calculi,  and  even  dissolving  small  calculi  of  this  variety. 

In  chronic  Bright' s  disease  the  acetates  and  citrates  are  fre- 
quently indicated  for  their  diuretic  action,  while  potassium  bi- 
tartrate is  one  of  the  most  effective  cathartics  and  diuretics  in 
acute  nephritis  and  cardiac  dropsy. 

Lime  water  is  a  useful  remedy  for  vomiting — whether  due  to 
irritability,  gastric  ulcer,  or  cancer — and  is  also  valuable  in  check- 
ing this  symptom  in  pulmonary  tuberculosis.  It  is  an  important 
adjunct  to  milk,  in  preventing  the  formation  of  curds  and  relieving 
infantile  vomiting. 


l64  A  ■  TEXT-BOOK  OF  MATERIA    MEDICA. 

I  In  the  acuie  mycotic  diarrhea  of  children,  characterized  by  acid 
gastro-intestinal  fermentation,  the  above  combination  is  extremely 
useful.  ;  The  symptoms  also  of  chronic  diarrhea  and  dysentery  are 
often  mitigated  by  this^simple  remedy.  -In  rachitis  and  osteomalacia 
it  has  in  certain  cases?  appeared  to  be  beneficial. 

'  Lime  water  is  without  doubt  a  very  efficient  remedy  in  diabetes 
insipidus,  and  may  also  exert  a  favorable  influence  in  chronic  bron- 
chitis by  checking  and  otherwise  modifying  the  mucous  secretion. 
It  should  be  remembered  that,  this  preparation,  is  a  valuable  anti- 
I  dote  in  arsenical  poisoning.  The  syrup  of  Hme  is  a  very  inferior 
I  remedy,  the  sugar  which  it  contains  neutralizing  the  beneficial 
action  which  the  lime  alone  might  exert. 

-  Prepared  chalk,  or  CHAiK  .mixture,  is  useful  in  relieving  the 
premonitory  diarrhea  of  cholera,  and  simple  diarrheas  of  children, 
with  greenish  acid  stools  and  flatulent  distention  of  the  abdo- 
men, are  greatly  benefited  by  this  preparation.  It  is  very  neces- 
sary, however,  that  the  chalk  mixture  be  freshly  prepared,  the 
cinnamon,  water  it  contains  being  liable  with  age  to  fungoid  con- 
tamination, and  the  propagation  of  microorganisms,  which  would 
seriously  aggravate  the  condition  for -which  the  remedy  is  given, 
occasioning  vomiting,  etc. 

^  Magnesia  is  an  invaluable  antacid  in  gastric  disorders,  and 
especially  in  aphthcB  attending  infantile  diarrhea. 

f.  As  above  stated,  the  lithium  preparations  are  unquestionably 
superior  to  the  other  alkalies  in  the  gouty  and  uric-acid  diatheses. 
The  AMMONIUM  PREPARATIONS  are  useful  antacids,  being  particu- 
larly efficacious  in  the  dyspepsia  oi  drunkards  to  allay  nausea  and 
vomiting,  render  the  mucus  less  viscid,  and  act  as  stimulants  to 
the  circulation.  Their  excitant  qualities,  together  with  their  prop- 
erty of  modifying  the  mucous  secretion,  render  them  also  of  value 
in  appropriate  cases  of  subacute  and  chronic  bronchitis.  The  re- 
maining important  uses  of  the  ammonium  preparations  will  be 
considered  under  "Cardiac  Stimulants." 

In  conclusion,  it  may  be  well  to  mention  the  value  of  alkalies 
in  aiding  the  digestion  of  fats,  and  as  efficient  remedies  in  the  dys- 
pepsia and  indigestion  from  which  obese,  gouty,  and  rheumatic 
subjects  frequently  suffer. 

The  virtue  and  uses  of  mineral  waters  will  be  fully  discussed  in 
the  following  group  devoted  to  the  subject. 

Contraindications. — Alkalies  are  contraindicated  in  the  phos- 
phatic  diathesis,  since  there  is  danger  of  the  formation  of  phosphatic 


MINERAL    WATERS.'-  165' 

leuli.     Thecalcium  preparations  should  not  be  given  to  patients: 
ffering'  from  oxaluria. 

Administration. — The -alkalies  should  invariably  be  adminis-, 
ed  largely  diluted,  thus  favoring  absorption  and  preventing  their 
itant  action  upon  the  gastro-intestinal  mucous  membrane.  The 
le  of  administration — ^whether  before  or  after  meals — will  depend 
tirely  upon  the  effect  desired,  a  thorough  .knowledge  of  their; 
:ion  as  above  given  being  necessary  to  an  intelligent  and  proper 
e  of  the  various  preparations. 


GROUP  VI.— MINERAL  WATERS. 

The  line  of  demarcation  between  mineral  and  ordinary  waters 
nnot  be  definitely  drawn.  Although  in  the  former  there  is  usu- 
y  present  an  excess  of  mineral  constituents  or  of  temperature, 
me  drinking  waters  contain  more  mineral  ingredients  than  others; 
lile  many  very  pure  waters,  both-  cold  and  warm,  have  been  're- 
rded  for  ages  as  mineral  springs.  As  Pliny  observed,  waters  are 
ch  as  the  soil  through  which  they  flow,  it  being  a  matter  of 
servatibn  that  chalk  or  limestone  formaticMis,-for  instance,  natu- 
lly  impregnate  with  thdr  normal  constituents  the  springs  originat- 

1  in  them.  Still,  it  is  impossible-to  determine  with  certainty  the 
pth  from  which  these  watere  flow,  or  to  ascertain  the  various  dis- 
ices  from  the  surface  at  which  they  assimilate  foreign  ingredients. 

Nor  are  the  geographical  distribution  and  altitude  of  mineral 
rings  less  remarkable  than  the  diversity  of  their  constituents, 
[though  especially  abundant  in  volcanic  regions,  mineral  springs 

2  by  no  means  confined  to  them.  They  have  been  found  on 
sine  heights — even  at  the  snow-line  in  the  Himalayas — and  they 
e  from  the  bottom  of  the  sea,  as  at  Baiae  and  Ischia. 

The  foreign  ingredients  of  mineral  waters,  as  shown  by  analysis, 
2  very  numerous,  some  of  them  occurring  in  exceedingly  minute", 
tiers  in  large,  quantities.  Among  them  are  soda,  magnesium, 
Icium,  potash j  alumina,  iron,  boron,  iodine,"  bromine,  arsenic, 
bium,  cesium,  rubidium,  fluorine,  barium,  copper,  zinc,  manga- 
se,  strontium,  silica,  phosphbrus,  besides  •  extractive  substances 
d'  various  organic  deposits  known  under  various  names.  The 
nstituent' gases  include  carbonic  and  hydrosulphuric  acids,  nitro- 
n,  oxygen.  Hydrogen-,  and'ammonJai     Of  all  these,  -by  far  the: 


l66  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

most  important  from  a  therapeutic  point  of  view  are  sodium,  mag- 
nesium, iron,  carbonic  acid,  sulphur,  and  perhaps  hydrosulphuric 
acid.  The  various  substances  detected  separately  by  chemists  are 
in  their  analyses  combined  by  them  into  various  salts — if  not  with 
absolute  certainty,  undoubtedly  with  a  close  approximation  to  it. 

These  combinations  are  very  numerous,  some  waters  containing 
from  lo  to  20  per  cent,  of  them;  yet  there  are  always  certain  pre- 
dominating constituents  which  mark  the  character  of  the  spring, 
while  many  substances,  such  as  cesium,  rubidium,  or  fluorine,  occur 
in  mere  traces  and  must  be  regarded  as  unimportant. 

Mineral  waters  may  be  considered,  therefore,  as  weaker  or 
stronger  solutions  of  salts  and  gases  of  higher  or  lower  tempera- 
ture, although  the  quantity  of  saline  ingredients  commonly  bears 
but  a  very  small  proportion  to  that  of  the  fluids  containing  them. 
For  purposes  of  therapy  they  are  used  either  externally  in  the  form 
of  baths  or  internally  as  beverages.  With  regard  to  the  former 
use — or,  to  speak  technically,  balneotherapy — the  scope  of  the 
present  work  precludes  treatment  in  extenso.  Enough  to  say  that 
in  certain  conditions  the  system  is  undoubtedly  benefited  by  resort 
to  baths  of  various  characters,  especially  when  accompanied  by  the 
accessory  aid  of  well-considered  diet  and  regimen. 

The  literature  connected  with  the  subject  of  potable  waters  is 
voluminous,  yet  the  deductions  drawn  by  various  observers  touch- 
ing their  efficacy  and  in  relation  to  the  comparative  value  of  natural 
springs  are  too  frequently  colored  by  individual  bias,  or  based  upon 
too  hasty  analysis  to  furnish  infallible  data  or  warrant  the  definite 
statement  possible  in  ordinary  therapeutics.  That  certain  waters 
charged  with  foreign  ingredients  when  ingested  react  upon  the 
system  favorably  in  the  case  of  certain  disorders  it  were  futile  to 
deny.  Yet  even  here  there  are  subsidiary  considerations  not  to  be 
ignored ;  and  it  is  an  open  question  how  far  the  patient  may  be 
relieved  by  the  potency  of  the  remedy  per  se,  or  whether  the  col- 
lateral aids  of  environment,  climate,  altitude,  temperature,  etc.  may 
not  have  an  important  bearing  upon  beneficial  results. 

It  has  been  well  observed  that  in  the  case  of  water  taken  in  situ 
the  curative  atmosphere  of  the  surroundings,  the  favorable  season 
of  the  year,  the  reflex  influence  of  social  amenities,  and  freedom 
from  customary  car.es,  aided  by  studied  regimen  under  constant 
medical  supervision,  play  no  unimportant  part  in  the  alleviation  of 
positive  or  imaginary  disorders.  The  maxim,  "Amuse  the  patient 
and  let  nature  work  the  cure,"  seems  not  wholly  inapplicable  to 


MINERAL    WATERS.  167 

iny  fashionable  resorts  where  a  constant  round  of  gayety  acts  as 
practical,  though  imperceptible,  tonic  or  stimulant  upon  subjects 

certain  nervous  susceptibilities.  These  considerations  are  no 
is  forcible  in  the  case  of  American  "  watering-places  "  than  in 
ose  of  the  more  famous  resorts  of  Europe. 

Various  attempts  have  been  made  to  range  mineral  waters 
cording  to  their  therapeutic  action,  their  external  and  internal 
'ects  physiologically,  and,  most  frequently,  according  to  their 
lemical  composition.  Yet  their  influence  is  so  dependent  upon 
iosyncrasy  and  their  constituents  so  varied  that  it  is  wellnigh 
[possible  to  select  a  definite  system  free  from  objections,  although 
scientific  classification,  uniformly  adopted,  would  undoubtedly 
omote  their  rational  employment.  Many  sulphur  waters  are 
actically  earthy  or  saline  ones,  yet  the  presence  of  minute  quan- 
ies  of  hydrosulphuric  acid,  an  ingredient  so  palpable  as  always 

attract  attention,  has  determined  a  classification  obviously  at 
.riance  with  natural  fact:  The  general  rule  has  been  to  class 
Iters  under  the  head  of  their  predominating  elements,  the  desid- 
atum  being  comparative  simplicity  untrammelled  by  theoretical 
insiderations.  In  this  view  perhaps  the  most  convenient  arrange- 
ent  of  native  mineral  springs  is  that  subjoined,  adopted  by  Dr. 
.  N.  Bell  and  widely  accepted  by  writers  on  therapeutics : 

Alkaline. — These  waters  owe  their  chief  therapeutic  value  to 
e  alkaline  salts  they  contain.  They  are  rich  in  alkaline  car- 
)nates,  especially  the  sodium  carbonate.  Other  substances  are 
eluded  among  their  ingredients,  many  of  them  strongly  charged 
ith  carbonic-acid  gas,  which  may  possibly  contribute  to  their 
lysiological  activity. 

Saline. — These  either  contain  (1)  chloride  of  sodium  as  the 
incipal  ingredient,  or  (2)  are  largely  impregnated  with  the  sul- 
lates  of  sodium  and  magnesium.  Several  other  ingredients  enter 
to  their  composition,  yet  their  efficacy  chiefly  depends  upon  their 
edominating  elements :  the  second  class  includes  the  bitter  or 
irgative  waters  highly  prized  both  in  this  country  and  abroad. 

Sulphuretted. — The  sulphuretted  hydrogen  present  in  these 
iters  lends  to  them  their  chief  therapeutic  value.  They  contain 
30  various  sulphides — of  potassium,  sodium,  calcium,  and  mag- 
:sium — together  with  earthy  and  other  sulphates,  which  doubtless 
ntribute  in  a  measure  to  their  potency  as  physiological  agents, 
:hough  their  action  upon  the  system  is  still  a  matter  of  con- 
cture. 


i68 


A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 


Chalybeate.  —  Many  mineral  springs  contain  iron,  yet  in 
amounts  so  insignificant  as  to  be  of  little  value  to  therapy.  There 
are,  however,  chalybeate  waters  highly  charged  with  iron  salts  in 
the  form  of  the  carbonate  or  sulphate  which  have  acquired  a  repu- 
tation for  efficacy  in  the  treatment  of  certain  diseases. 

Acidulous. — The  valuable  property  of  these  springs  lies  in  the 
superabundance  of  carbonic-acid  gas  they  contain,  to  which  the 
solid  constituents  are  subordinate,  the  carbon  dioxide  being  the 
important  therapeutic  ingredient. 

Calcareous. — Calcium,  in  the  form  of  the  carbonate,  is  the 
valuable  constituent  of  calcareous  waters.  Besides  this  substance 
they  contain  magnesium  carbonate  in  varying  quantities.  Their 
utility  as  mineral  waters  has  been  questioned,  many  authorities 
refusing  them  recognition  as  therapeutic  agents. 


The  following  enumeration 
able  list  compiled  by  Dr.  A.  N. 

Alkaline  : 

Adams,  California. 
Albury,  Vermont. 
Alum,  Virginia. 
Borax,  California. 
Blount,  Alabama. 
Berkshire,  Vermont. 
Canon  City,  Colorado. 
Carlisle,  Colorado. 
Congress,  California. 
Elgin,  Vermont. 
Fry's  Soda,  California. 
Highland,  California. 
Highgate,  Vermont. 
Lower  Soda,  California. 
Milford,  New  Hampshire. 
Manitou,  Colorado. 
Middletown,  Vermont. 
Napa  Soda,  California. 
Newbury,  Vermont. 
Perry,  Illinois. 
Rocky  Mountain,  Colorado. 
Ravenden,  Arkansas. 
South  Park,  Colorado. 


of  native  springs  is  from  the  admir- 
Bell: 

Summit  Soda,  California. 
Seltzer,  California. 
Sheldon,  Vermont. 
Vichy,  California. 
Wilholt  Soda,  California. 

Calcic  : 

Bethesda,  Wisconsin. 
Butterworth,  Michigan. 
Birch-Dale,  Vermont. 
Clarendon,  Vermont. 
Eaton  Rapid,  Michigan. 
Gettysburg,  Pennsylvania. 
Hubbardstown,  Michigan. 
Silurian,  Wisconsin. 

Chalybeate  : 
Abbeville,  South  Carolina. 
Bedford,  Pennsylvania. 
Blossburg,  Pennsylvania. 
Cooper's  Well,  Mississippi. 
Esbitt,  Kentucky. 
Fayette,  Pennsylvania. 
Gordon's,  Georgia. 


MINERAL    WATERS. 


169 


Greencastle,  Indiana. 
Kittrell's,  North  Carolina. 
Madison,  Georgia. 
Manley,  North  Carolina. 
Milford,  New  Hampshire. 
Montvale,  Tennessee. 
Owasso,  Michigan. 
Rowland's,  Georgia. 
Schooley's  Mountain,  New 

Jersey. 
Schuyler  County,  Illinois. 
Sparta,  Wisconsin. 
Versailles,  Indiana. 

'urgative  Saline  : 
Blue  Lick,  Kentucky. 
Crab  Orchard,  Kentucky. 
Elgin,  Vermont. 
Esculapian,  Kentucky. 
Harrodsburg,  Kentucky. 
Midland,  Michigan. 
Pagosa,  Colorado. 

aline  : 

Fruit-Port  Well,  Michigan. 
Grand  Haven,  Michigan. 
Louisville  Artesian,  Kentucky. 
Michigan  Congress,  Michigan. 
Mt.  Clemens,  Michigan. 
Ocean,  Alabama. 
Salt,  Virginia. 

Spring  Lake  Well,  Michigan. 
St.  Louis,  Missouri. 

ulphurous : 
Alpena,  Michigan. 
Balston,  New  York. 
Bladon,  Florida. 
Blue  Lick,  Kentucky. 
Carlisle,  Pennsylvania. 
De  Soto,  Louisiana. 


Dremion,  Kentucky. 
French  Lick,  Indiana. 
Glenn's,  South  Carolina. 
Highgate,  Vermont. 
Indian,  Georgia. 
Indian,  Indiana. 
Lodi  Artesian,  Indiana. 
Manley,  North  Carolina. 
Minnequa,  Pennsylvania. 
Montesano,  Missouri. 
Olympian,  Kentucky. 
Portea  Springs,  Colorado. 
Salt  Sulphur,  Virginia. 
Saratoga,  New  York. 
Sharon,  New  York. 
Sheldon,  Vermont. 
Shocco,  North  Carolina. 
St.  Helena   White   Sulphur, 

California. 
St.  Louis,  Michigan. 
Sweet,  Missouri. 
Valhemosa,  Alabama. 
West  Baden,  Indiana. 
White  Sulphur,  Louisiana. 
White  Sulphur,  Montana. 
White  Sulphur,  Virginia. 

Unclassified  : 
Alum,  Virginia. 
Birch-Dale,  New  Hampshire. 
Borax,  California. 
Chmax,  Missouri. 
Eureka,  Arkansas. 
Fairview,  Texas. 
Greeneleone,  Florida. 
Geysers,  the  American,  Wyo- 
ming. 
Geyser  Spa,  California. 
Iodide  and  Bromide,  Missouri. 
Piedmont,  Texas. 
Stafford,  Connecticut. 


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A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 


Summit,  Maine. 
Sheldon,  Vermont. 

Thermal  Springs: 
Agua  Caliente,  New  Mexico. 
Arrow-Head,  California. 
Buncombe    County,    North 

Carolina. 
Calistoga,  California. 
Chalk  Creek  Hot,  Colorado. 
Charleston  Artesian,  South 

Carolina. 
Des  Cahutes  Hot,  Oregon. 


Harbines,  California. 
Hot  Springs,  Arkansas. 
Idaho  Hot,  Colorado. 
Merriweather,  Georgia. 
Middle  Park  Hot,  Colorado. 
Ojo  Caliente,  New  Mexico. 
Paraiso,  Cahfornia. 
Passo  Robles,  California. 
Salt  Lake,  Utah. 
Seigler,  California. 
Skaggs,  California. 
Volcano,  Nebraska. 
Warm  and  Hot,  West  Virginia. 


GROUP  VII.— BITTERS. 

SIMPLE   BITTERS. 

Quassia— Quassiae— Quassia.    V.  S.  I*. 

Origin. — The  wood  of  Picrcena  excelsa  Swz.,  a  tree  resembling 
the  common  ash,  attaining  a  height  of  from  60  to  80  feet  (18-24 
M.),  indigenous  in  Jamaica. 

Description  and  Properties. — In  the  shops  it  is  usually  met 
with  in  the  form  of  chips  or  raspings  of  a  yellowish-white  color. . 
Quassia  contains  two  bitter  principles — quassin  and  picrasmin.  It 
contains  no  tannin. 

Dose. — 20-30  grains  (1.30-2.0  Gm.). 

Official  Preparations. 

Extrdctum  QuKssise — ExtrScti  QuSssis — Extract  of  Quassia. — Dose,  1-3 
grains  (0.065-0.2  Gm.). 

Extr^ctum  QuSssise  Fluidum— ExtrScti  QuSssia  Fluidi — Fluid  Extract 
of  Quassia. — Dose,  10-60  minims  (0.6-0.4  Cc). 

Tinctiira  QuSssise — Tinctiirse  QuSssise — Tincture  of  Quassia. — Dose,  ^-2 
fluidrachms  (2.0-7.3  Cc). 

Gentianae— Gentianae- Gentian.    77.  8.  P. 

Origin. — The  root  of  Gentiana  lutea  L.,  a  plant  from  2  to  3  feet 
high,  indigenous  in  the  mountainous  portions  of  Central  Europe. 

Description  and  Properties. — It  appears  in  nearly  cylindrical 
pieces  or  longitudinal  slices  about  i  inch  (25  Mm.)  thick,  the  upper 
portion  closely  annulate,  the  lower  longitudinally  wrinkled ;  exter- 
nally deep  yellowish-brown ;  internally  lighter ;  somewhat  flexible 


BITTERS.  171 

id  rather  thick,  separated  from  the  subspongiose  meditullium  by- 
black  cambium  Hne.  Odor  peculiar,  faint,  stronger  when  moist- 
led;  taste  sweetish  and  persistently  bitter.  Gentian  contains  a 
tter  principle,  gentiopicrin,  and  also  gentisic  acid,  to  which  its 
:llow  color  is  due.  It  contains  about  1 5  per  cent,  of  glucose,  but 
1  starch  or  tannin. 
Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Official  Preparations. 

Extractum  Gentianae — ExtrScti  Gentianae — Extract  of  Gentian. — Dose,  2- 

grains  (0.12-0.6  Gm.). 

Extractum  Gentians  Pluidum — ExtrScti  Gentianse  Fluidi — Fluid  Extract 

Gentian. — Dose,  10-60  minims  (0.6-4.0  Cc). 

TinctiiTa  Gentianae  Compdsita — TinctiiTse  Gentianse  Comp6sit8e — Com- 
lund  Tincture  of  Gentian. — Dose,  1-2  fluidrachms  (4.0-8.0  Cc).  10  per  cent, 
th  Orange  Peel  and  Cardamom. 

Calumba— Calumbae— Calumba.    Tf.  S.  P. 

(COLUMBO.) 

Origin. — The  root  of  Jateorhiza  palmata.  Lam.,  a  plant  native 
I  the  forests  of  Eastern  Africa  and  Madagascar,  and  cultivated 

the  East  Indies. 

Description  and  Properties. — Nearly  circular  disks  i  to  2 
ches  (25-50  Mm.)  in  diameter  and  |  to  ^  inch  (6-12  Mm.)  thick, 
xternally  greenish-brown  and  wrinkled ;  internally  yellowish  or 
-ayish-yellow ;  depressed  in  the  center,  with  a  few  interrupted  cir- 
es  of  projecting  wood-bundles ;  distinctly  radiate  in  the  outer  por- 
sn;  fracture  short,  mealy;  odor  slight;  taste  mucilaginous,  slightly 
•omatic,  very  bitter.  It  contains  a  bitter  crystalline  principle,  ca- 
mbin,  calumbic  acid,  berberine,  and  starch.     No  tannin  is  present. 

Dose. — 10-30  grains  (0.6—2.0  Gm.). 

Official  Preparations. 
Extractum  Calfimbae  Fluidum— ExtrScti  Calilmbse  Fliiidi— Fluid  Extract 
Calumba. — Dose,  15-60  minims  ( 1. 0-4.0  Cc). 

Tinctiira  CaltimbEe— Tincturse  Caltlmbae— Tincture  of  Calumba.— ZJoj^,  i- 
kidrachms  (4.0-15.  Co.). 

Calendula— Calendulse— Calendula.    TI.  S.  P. 

(Marigold.) 
Origin. — The  florets  of  Calendula  officinalis  L.,  an  annual  plant, 
native  of  the  Levant  and  Europe,  frequently  cultivated  as  a 
irden  ornament. 


172  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Description  and  Properties. — Florets  about  \  inch  (12  Mm.) 
long,  linear  and  strap-shaped,  delicately  veined  longitudinally, 
yellow  or  orange-colored,  three-toothed  at  the  apex,  the  short, 
hairy  tube  enclosing  the  remnants  of  a  filiform  style  elongately 
cleft.  Odor  slight  and  somewhat  heavy ;  taste  rather  bitter  and 
faintly  saline.  It  contains  a  peculiar  gummy  principle,  calendulin, 
a  bitter  constituent,  and  a  trace  of  volatile  oil. 

Dose. — 5-50  grains  (0.3-2.0  Gm.). 

Official  Preparation. 
Tinctura  Caiendul8e — Tincturse  CalSndulse— Tincture  of  Calendula. — Dose, 
15-60  minims  (1.0-4.0  Cc). 

Unofficial  Preparation. 

ExtrSctum  CalSndulse  Fluidum — ExtrScti  CalSndulae  Fluidi — Fluid  Ex- 
tract of  Calendula. — Dose,  10-30  minims  (0.65-2.0  Co.). 

Chirata— Chiratae— Chirata.     U.S.JP. 

Origin. — The  entire  plant,  Swertia  chirata  Hamilton,  an  annual, 
native  to  Northern  India. 

Description  and  Properties. — Chirata  as  found  in  the  shops 
consists  of  short  sections  of  the  stem  and  branches  pressed  and 
split,  brown  or  dark-purple  in  color,  and  mixed  with  a  few  leaves 
and  flowers.  It  contains  a  very  bitter  yellow  principle,  a  hygro- 
scopic powder,  chiratin,  a  bitter  syrupy  liquid,  ophelic  add,  a  resin, 
coloring  matter,  etc. 

Dose. — 5-15  grains  (0.3-1.0  Gm.). 

Offiicial  Preparations. 

ExtrSctum  Chiratae  Fluidum— ExtrScti  Chiratae  Fluidi — Fluid  Extract  of 
Chirata.— ZJoj^,  15-60  minims  (1.0-4.0  Cc). 

Tinctiira  Chiratae — Tincturae  Chiratae — Tincture  of  Chirata.— Z>oj^,  yi-i 
fluidiachm  (2.0-4.0  Co.). 

AROMATIC  BITTERS. 

Anthemis— Anthemidis— Anthemis.    V.  S.  JP. 

(Chamomile.) 

Origin. — The  flower-heads  of  Anthemis  nobilis  L.,  a  low  peren- 
nial plant  indigenous  in  Southern  and  Western  Europe. 

Description  and  Properties. — Heads  subglobular,  about  |  inch 
(2  Cm.)  broad,  consisting  of  an  imbricated  involucre  and  numerous 
white,  strap-shaped,  three-toothed  florets,  and  a  few,  if  any,  yellow 


BITTERS.  173 

tubular  disk-florets,  inserted  upon  a  chaffy,  conical,  solid  receptacle ; 
of  a  strong,  agreeable  odor  and  an  aromatic,  bitter  taste.  Anthemis 
contains  a  bitter  principle,  a  pale-blue  or  yellowish-brown  volatile 
oil,  and  a  trace  of  tannin,  together  with  other  unimportant  con- 
stituents. 

Dose. — 15-60  grains  (1.0-4.0  Gm.),  in  infusion  or  fluid  extract. 

Cascarilla— Cascarillae— Cascarilla.    TJ.  S.  JP. 

Origin. — The  bark  of  Croton  eluteria,  Bennett,  a  small  shrub 
indigenous  in  the  Bahama  Islands. 

Description  and  Properties. — Quills  or  curved  pieces  about  -j^ 
inch  (2  Mm.)  thick,  having  a  grayish,  somewhat  fissured,  easily 
detached,  corky  layer,  more  or  less  coated  with  a  white  lichen,  the 
uncoated  surface  being  dull  brown,  the  inner  surface  being  smooth. 
The  bark  breaks  with  a  short  fracture,  having  a  resinous  and 
radially  striate  appearance.  When  burned  it  emits  a  strong,  aro- 
matic, somewhat  musk-like  odor ;  taste  warm  and  very  bitter.  It 
contains  a  volatile  oil,  a  bitter,  crystalline  principle,  cascarillin,  tannin, 
resin,  etc. 

Dose. — 20-30  grains  (1.2-2.0  Gm.),  or  \-2  fluidrachms  (2.0-8.0 
Cc.)  of  the  fluid  extract. 

Prunus  Virginiana— Pruni  Virginianse— Wild 
Cherry.    V.  S.  JP. 

Origin. — The  bark,  collected  in  autumn,  of  Prunus  serotina 
Ehr,  a  large  forest  tree  indigenous .  in  North  America. 

Description  and  Properties. — It  is  met  with  in  curved  pieces 
or  irregular  fragments  -^  inch  (2  Mm.)  or  more  thick;  outer 
surface  greenish-brown  or  yellowish-brown,  smooth  and  somewhat 
glossy,  marked  with  transverse  scars.  If  the  bark  is  collected  from 
the  old  wood  and  deprived  of  the  corky  layer,  the  outer  surface  is 
nut-brown  and  uneven ;  inner  surface  somewhat  striate  or  fissured. 
Upon  maceration  in  water  it  develops  a  distinct  bitter-almond  odor. 
Taste  astringent,  aromatic,  and  bitter.  It  contains  a  volatile  oil, 
hydrocyanic  acid,  tannin,  a  bitter  glucoside,  resin,  etc. 

Dose. — ^i  drachm  (2.0-4.0  Gm.). 

Official  Preparations. 

ExtrSctum  Pruni  Virginianae  Fluidum— ExtrScti  Pruni  Virginianae  Fliiidi 
—Fluid  Extract  of  Wild  Cherry.— Z»tfji?,  30-60  minims  (z.0-4.0  Cc). 


174  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Infusum  Pruni  Virginianse — Infusi  Pruni  Virginianse — Infusion  of  Wild 
Cherry. — Dose,  1—2  fluidounces  (30.0-60.0  Cc). 

Syrupus  Pruni  Virginianse — Syrupi  Priini  Virginianse — Syrup  of  Wild 
Cherry. — Dose,  2-4  fluidrachms  (8.0-15.  Cc). 

Serpentaria— Serpentariae— Serpentaria.    JJ.  S.  I*. 

(Virginia  Snake-root.) 

Origin. — The  rhizome  and  roots  of  Aristolochia  serpentaria  L., 
and  of  Aristolochia  reticulata  Nutt.,  perennial  herbs  indigenous  in 
the  United  States. 

Description  and  Properties. — The  rhizome  is  about  i  inch  (25 
Mm.)  long,  thin,  curved;  on  the  upper  side  with  approximate, 
short  stem-bases  ;  on  the  lower  side  with  numerous  thin,  branching 
roots  about  4  inches  (10  Cm.)  long;  dull  yellowish-brown,  inter- 
nally whitish ;  the  wood-rays  of  the  rhizome  are  longest  on  the 
lower  side ;  odor  aromatic,  camphoraceous ;  taste  warm,  bitterish, 
and  camphoraceous.  It  contains  \  per  cent,  of  volatile  oil,  a  bitterish 
principle,  aristolqchine,  tannin,  resin,  starch,  etc.  The  roots  of 
Aristolochia  reticulata  are  coarser,  longer,  and  less  interlaced  than 
those  of  Aristolochia  serpentaria. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Official  Preparations. 

Extractum  Serpentariae  Fluidum— ExtrScti  Serpentariae  Fliiidi— Fluid 
Extract  of  Serpentaria. — Dose,  30  minims-l   fluidrachm  (2.0-4.0  Cc). 

Tinctura  Cinchonae  CompSsita — TinctQrae  Cinchonse  CompSsitae— Com- 
pound Tincture  of  Cinchona. — Dose,  1-4  fluidrachms  (4.0-15.  Cc)  (2  per  cent, 
of  serpentaria.) 

Tinctura  Serpentariae — Tinctiirae  Serpentariae — Tincture  of  Serpentaria. — 
Dose,  \-2  fluidrachms  (2.0-8.0  Cc). 


Antagonists  and  Incompatibles. — The  salts  of  iron,  lead,  and 
silver  are  incompatible  with  gentian  and  the  aromatic  bitters,  though 
preparations  of  iron  can  be  given  with  quassia  and  calumba.  Boil- 
ing water  impairs  the  virtues  of  wild  cherry. 

Synergists. — The  digestants,  mineral  acids,  and,  under  certain 
conditions,  alkalies,  and  the  restorative  agents  generally,  aid  the 
action  of  vegetable  bitters. 

Physiological  Action. — Because  of  their  action  in  augmenting 
the  secretions  from  the  salivary  and  gastric  glands,  aiding  diges- 
tion and  improving  nutrition.  Vegetable  Bitters  are  classed  among 
Restoratives.     By  increasing  the  activity  of  the  various  glands  they 


BITTERS. 


175 


aid  digestion,  and  by  their  effect  upon  the  nerves  they  stimulate  the 
appetite. 

Pure  bitters  act  immediately  upon  contact;  that  is,  their 
efficiency  is  due  to  their  local  action  upon  the  mucous  membrane 
of  the  gastro-intestinal  tract,  with  which  they  are  brought  into 
direct  contact.  There  are  certain  drugs,  however — such  as  cin- 
chona, nux  vomica,  etc. — which  act  also  upon  the  blood  or  remote 
parts  of  the  system.  When  used  as  bitters  we  are  concerned  only 
with  the  local  action  of  these  agents. 

I.  Bitters  increase  the  secretion  from  the  salivary  glands.  This 
effect  is  produced  by  stimulating  the  ends  of  the  nerves  of  taste 
distributed  in  the  mucous  membrane  of 

the  mouth,  from  which  nerves  the  im- 
pression is  conveyed  to  the  center  in  the 
medulla,  and  from  there  transmitted  to 
the  vaso-motor  and  secretory  nerves  sup- 
plying the  salivary  glands,  increasing  their 
blood-supply  and  activity,  and  at  once 
promoting  the  secretion  of  saliva.  Were 
salivary  secretion  stimulated  by  the  drug 
•entering  the  circulation,  and  through  the 
blood  exciting  the  medulla  and  the  glands, 
a  much  longer  time  would  elapse  before 
an  increased  flow  of  saliva  would  be  pro- 
duced. It  is  therefore  certain  that  the 
•rapid  reflex  excitation  of  the  glands,  and 
consequent  immediate  increase  in  the  sal- 
ivary secretion,  are  due  to  direct  contact 
with  the  nerve-endings  in  the  mucous 
membrane  of  the  mouth.  The  accompanying  diagram  (Fig.  i) 
will  serve  to  elucidate  the  .action  named. 

II.  Bitters  increase  the  secretion  from  the  gastric  glands.  The 
primary  action  is  an  augmented  flow  of  gastric  juice,  caused  by 
reflex  stimulation  from  the  mouth.  It  is  well  known  that  there 
is  an  intimate  relationship  between  the  stomach  and  the  senses  of 
taste  and  smell — the  taste  of  victuals  or  the  odor  of  a  tempting 
dinner,  or  the  familiar  instance  of  a  dog  looking  wistfully  at  a  meat- 
stand,  exciting  the  appetite  and,  reflexly,  the  flow  of  gastric  juice. 
Bitters  act  in  a  similar  manner.  The  nerves  of  taste  are  stimu- 
lated ;  the  impression  is  conveyed  to  the  medulla,  and  from  it  trans- 
mitted not  only  to  the  salivary  glands,  but  through  the  fibers  of 


Fig.  I. — Diagram  illustrating  the 
action  of  bittets  on  the  salivary 
glands :  i,  nerve  conveying  the 
impression  from  the  mucous  mem* 
brane  of  the  mouth  (C)  to  the  me- 
dulla (A) ;  2,  secretory  nerve  trans- 
mitting the  impression  from  the 
medulla  [A)  to  the  salivary  gland 
t^B) ;  3,  duct  of  the  salivary  gland. 


176 


A    TEXT-BOOK  OF  MATERIA  MEDICA. 


the  vagus,  increasing  the  blood-supply  to  the  gastric  glands  and 
thereby  promoting  their  functional  activity. 

When  the  bitters  have  been  swallowed,  an  increased  secretion 
ensues,  occasioned  by  direct  stimulation  of  the  mucous  mem- 
brane of  the  stomach.  Through  the  sen- 
sory fibers  of  the  vagus  the  impression  is 
conveyed  to  the  center  in  the  medulla, 
returning  by  the  vaso-motor  and  secretory 
fibers,  and  increasing  the  functional  activity 
of  the  glands.  This  action  is  well  shown 
in  the  diagram  (Fig.  2). 

When  too  large  a  dose  of  bitters  has 
been  taken,  or  under  prolonged  medicinal 
dosage — when  contraindicated  by  an  irri- 
table stomach — the  effects  are  )a  diminished 
secretion  of  gastric  juice  and  a  corre- 
sponding increase  in  the  secretion  of  mucus. 
This  effect  of  over-stimulation  or  irritation 
is  well  illustrated  in  persons  addicted  to  the 
excessive  use  of  alcohol,  a  moderate  amount 
promoting  the  secretion  of  gastric  juice  and 
improving  the  appetite,  while  excess  occa- 
sions nausea  and  the  vomiting  of  glairy 
mucus. 

The  theory  governing  the  above  action 
is  that  a  medicinal  dose  of  bitters  is  just 
sufficient  to  stimulate  the  functional  activity 
of  the  gastric  glands,  but  that  immoderate 
or  continuous  dosage  tends  to  convey  the  impression  farther  up  in 
the  medulla,  causing  stimulation  of  the  vaso-constrictor  fibers,  con- 
tracting the  blood-vessels,  and  lessening  the  blood-supply  and  the 
secretion  from  the  glands.  At  the  same  time  the  secretory  fibers 
supplying  the  mucous  cells  are  stimulated,  causing  an  increased 
secretion  of  mucus.  Should  the  dose  be  sufficiently  large  to  pro- 
duce vomiting,  the  action  is  due  to  the  fact  that  the  impression  is 
conveyed  still  higher  in  the  medulla,  and  from  there  transmitted 
to  the  nerves  supplying  the  abdominal  walls  and  diaphragm,  the 
effect  being  to  produce  emesis.  The  diagram  (Fig.  3)  graphically 
illustrates  this  action. 

III.  Bitters  stimulate  the  peristaltic  movements  of  the  stomach 
by  reflex  action.    The  sensory  nerves  in  the  mucous  membrane  are 


Fig.  2. — Diagram  illustrating 
the  action  of  bitters  on  the  gas- 
tric secretion :  A^  medulla  ;  B, 
stomach ;  C,  gland ;  D,D,  blood- 
vessels supplying  the  gland;  E^ 
nerves  of  taste ;  t,  vaso-motor 
fibers ;  2,  secretory  fibers  ;  3,  sen- 
sory fibers. 


BITTERS. 


177 


irritated,  and  an  impression  is  conveyed  by  them  to  Auerbach's 
plexus  between  the  muscles  in  the  walls  of  the  stomach,  from 
which  plexus,  or  ganglion,  the  influence  is  transmitted  to  the  mus- 
cles themselves,  causing  increased  activity  or  peristalsis. 

Another  method  by  which  peristalsis  is  stimulated  occurs  when 
the  impression  is  conveyed  by  the  sensory  nerves  directly  to  the 
center  in  the  medulla,  and  from  there  through  the  motor  fibers  of 
the  vagus  to  Auerbach's  plexus,  affecting  the  muscles  in  the  man- 
ner above  described.  The  cut  (Fig.  4)  will  serve  to  illustrate  the 
modus  oi 


Fig  3. — Diagram  illustrating  the  supposed  nervous  connections  of  the  stomach.  A  gentle  stimulus 
applied  to  the  walls  of  the  stomach  is  transmitted  by  the  afferent  nerves  (^)  to  a  nerve-center  (5), 
and  thence  along  the  vaso-dilating  nerves  ( C)  and  the  secreting  nerves  (/?)  to  the  vessels  of  the  mucous 
membrane  and  the  cells  of  the  gastric  follicles.  A  stronger  stimulus  is  transmitted  up  to  the  nerve- 
center  {£),  and  thence  along  the  vaso-constricting  fibers  (^)  and  the  secreting  fibers  (£?)  of  the  mu- 
cous follicles.  A  still  stronger  stimulus  is  transmitted  to  H,  and  thence  along  the  motor  nerves  to  the 
abdominal  walls  (A*.  K)^  causing  them  to  contract  and  produce  retching  or  vomiting. 


IV.  Bitters  augment  absorption  by  increasing  the  blood-supply 
to  the  mucous  membrane  of  the  stomach.  It  is  a  physjifelogical 
fact  that  the  larger  the  blood-supply  passing  through  tlje  blood- 
vessels, and  the  greater  the  amount  of  lymph  conveyed  through 
the  lymph-channels,  the  more  rapid  the  absorption. 

V.  Bitters  are  more  or  less  antiseptic  and  arrest  fermentation, 
both  physiological  and  pathological     The  peptonization  of  food  is 

12 


178 


A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 


a  physiological  fermentative  process,  forming  a  contraindication  to 
the  administration  of  bitters  during  active  digestion. 

Therapeutics. — Externally  and  Locally. — Calendula,  in  the 
form  of  a  poultice,  is  an  efficient  and  grateful  application  as  a  dress- 
ing to  cancer  of  the  breast.  The  tincture 
of  calendula  is  recommended  by  many  phy- 
sicians as  an  external  application  for  contu- 
sions, sprains,  etc.,  although  not  so  efficient 
as  tincture  oC  arnica.  The  drug  has  been 
used  topicallpl  in  chronic  pharyngitis  and 
suppurative  vMammation  of  the  ear. 

Internally. i— The  simple  bitters  are  pecu- 
liarly useful  in  atonic  and  fermentative  dys- 
pepsia, chronic  gastric  catarrh,  and  as  a  tonic 
in  convalescence  fro^n  acute  disease,  in  mala- 
rial fever,  and  in  the  anorexia  following  it. 
Infusion  of  quassia  is  a  most  efficacious 
injection  to  destroy  seat-worms  {Oxyuris  ver- 
micularis),  the  infusion  being  injected  into 
the  rectum,  which  has  been  previously 
washed  out  with  soap  and  water. 

The  aromatic  bitters  are  used  to  stimu- 
late the  appetite  and  improve  the  condition 
of  the  digestive  apparatus.  The  simple  bit- 
ters are  similarly  used,  but  the  former  pos- 
sess more  stimulating  and  tonic  properties, 
owing  to  their  volatile  and  astringent  con- 
stituents. Chamomile,  in  addition  to  its 
action  as  a  stimulant  to  the  digestion,  has  been  employed  with 
benefit  in  delirium  tremens  and  as  an  emmcnagogue,  while  in  the 
form  of  hot  poultices  chamomile  flowers  serve  as  an  efficient  appli- 
cation for  local  pains  of  almost  any  description. 

Wild  cherry  might  not  inaptly  be  called  a  sedative  tonic,  its 
peculiarly  bitter  yet  not  unpleasant  taste  causing  it  to  be  well  toler- 
ated by  the  stomach,  and  rendering  it  one  of  the  best  stomachic 
tonics,  especially  during  convalescence,  when  its  sedative  action 
upon  the  heart  allays  febrile  and  cardiac  excitement.  The  syrup 
of  wild  cherry  is  a  common  ingredient  of  "  cough  syrups."  It  is 
thought  to  quiet  the  cough  and  allay  the  irritability  of  the  nervous 
system  in  bronchitis  and  phthisis. 

Serpentaria  is  considered  an  efficient  expectorant  in  pneumonia 


Fig.  4. — Diagram  illustrating 
the  action  of  bitters  upon  peri- 
stalsis:  A,  medulla;  B^  stom- 
ach; C,  Auerbach's  plexus;  D, 
mucous  membrane ;  E,  muscles  ; 
I,  motor  fibers  ;  2,  sensory  fibers. 


HEMATICS.  179 

and  capillary  bronchitis.  Next  to  its  use  as  a  stomachic  its  chief 
value  seems  to  be  as  a  stimulant  in  typhus  and  typhoid  fevers,  the 
compound  tincture  of  cinchona  being  a  most  excellent  remedy  in 
the  low  forms  of  typhoid.  The  fluid  extract  of  serpentaria  is  con- 
sidered somewhat  of  a  sexual  stimulant.  It  is  a  valuable  apphca- 
tion  for  poisoning  by  Rhus  toxicodendron. 

Oontraindications. — i.  Bitters  should  not  be  given  when  the 
secretion  of  gastric  juice  is  diminished  as  the  result  of  organic 
disease.  2.  They  are  contraindicated  as  stomachics  during  the 
course  of  acute  disease,  as  in  fevers.  3.  When,  after  a  reasonable 
time,  they  fail  to  improve  the  appetite,  they  should  be  discontinued. 
4.  In  convalescence  from  acute  disease,  when  the  appetite  is  vora- 
cious, they  are  contraindicated.  5.  In  catarrhal  conditions  of  the  mu- 
cous membrane  of  the  stomach — as  in  chronic  gastritis  and  "  drunk- 
ards' catarrh  of  the  stomach  " — alcoholic  preparations  of  bitters, 
tinctures,  etc.  should  not  be  administered,  aqueous  preparations 
only,  like  infusions,  being  permissible.  6.  Should  the  digestion  be 
impaired  and  the  appetite  good,  it  is  an  indication  that  the  indiges- 
tion is  intestinal,  and  therefore  beyond  the  influence  of  bitters. 

Administration. — To  improve  the  appetite  bitters  should  be 
given  from  one-half  to  one  hour  before  meals.  When  necessary  to 
use  them  for  a  long  time,  one  bitter  should  be  substituted  for 
another  in  the  course  of  every  week  or  two ;  otherwise  the  stomach 
may  rebel  at  the  monotony.  Bitters  may  be  given  in  the  form  of 
a  powder  or  a  solid  extract.  Ordinarily,  however,  it  is  preferable  to 
administer  a  liquid  preparation — fluid  extract,  tincture,  or  infusion. 
A  pleasant  method  of  giving  the  latter  preparation  in  the  case  of 
quassia  is  to  allow  water  to  stand  over-night  or  for  a  few  hours  in 
a  quassia-cup — purchasable  at  almost  any  drug-store — when  the 
water  will  become  impregnated  with  the  bitter  principle  of  the 
quassia. 

GROUP  VIII.— HEMATICS. 

PREPARATIONS  OF  IRON. 

Ferrum  Reductum— Ferri  Reducti— Reduced  Iron. 

V.  s.  p. 

(Iron  by  Hydrogen;  Quevenne's  Iron.) 

Origin. — Obtained  by  passing  Hydrogen  through  a'  hot  closed 
tube  containing  freshly  prepared  and  thoroughly  washed  Ferric 
Oxide. 


l8o  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Description  and  Properties. — A  very  fine,  grayish-black,  lustre- 
less powder,  odorless  and  tasteless ;  permanent  in  dry  air ;  insolu- 
ble in  water  or  alcohol. 

Dose. — 1-5  grains  (0.5-0.3  Gm.). 

Ferri  Carbonas  Saccharatus  —  Ferri  Carbonatis 
Saccharati  — Saccharated  Ferrous  Carbonate. 
TJ.  S.  jP. 

Origin. — Prepared  from  Ferrous  Sulphate,  Sodium  Bicarbonate, 
Sugar,  and  Distilled  Water,  by  solution  and  filtration. 

Description  and  Properties. — A  greenish-brown  powder  grad- 
ually becoming  oxidized  by  contact  with  air ;  without  odor,  and 
having  at  first  a  sweetish,  afterward  a  slightly  ferruginous,  taste. 
Only  partly  soluble  in  water,  but  completely  soluble  in  hydro- 
chloric acid,  with  copious  evolution  of  carbonic-acid  gas,  forming  a 
clear,  greenish-yellow  liquid.  The  product  should  be  kept  in  small, 
well-stoppered  bottles. 

Dose. — 2-10  grains  (0.12-0.6  Gm.). 

Massa  Ferri  Carbonatis— Massse  Ferri  Carbonatis 
—Mass  of  Ferrous  Carbonate.    U.S. I*. 

(Vallet's  Mass.) 

Origin. — Prepared  by  solution,  filtration,  and  evaporation  from 
Ferrous  Sulphate,  Sodium  Carbonate,  Clarified  Honey,  Sugar, 
Syrup,  and  Distilled  Water. 

Description  and  Properties. — When  recently  prepared  the 
mass  is  of  a  greenish-gray  color,  but  on  exposure  it  becomes 
greenish-black. 

Dose. — 3-5  grains  (0.15-0.3  Gm.). 

Mistura   Ferri    Composita  — Misturae    Ferri    Com- 
positae— Compound  Iron  IVIixture.     U.S.I*. 

(Griffith's  Mixture.) 

Origin.— Prepared  by  mixing  Ferrous  Sulphate,  Myrrh,  Sugar, 
Potassium  Carbonate,  Spirit  of  Lavender,  and  Rose  Water. 

Description  and  Properties. — When  newly  prepared  it  is  of 
a  dirty  greenish  color,  but  slowly  oxidizes  on  exposure  to  the  air, 
and  should  therefore  be  freshly  prepared  when  needed. 

Dos,e. — |-i^  ounces  (i 5.-45  Cc). 


HEMATICS.  i8i 

Ferri  lodidum  SaccharatuTn— Ferri  lodidi  Saccha- 
rati— Saccharated  Ferrous  Iodide.    JJ.  8.  P. 

Origin.— Prepared  by  solution,  filtration,  evaporation,  and  tritu- 
ration from  Iron  Wire,  Reduced  Iron,  Iodine,  Distilled  Water,  and 
Sugar  of  Milk. 

Description  and  Properties. — A  yellowisli-white  or  grayish, 
hygroscopic,  odorless  powder,  having  a  sweetish,  ferruginous  taste. 
Soluble  in  7  parts  of  water,  but  only  partially  soluble  in  alcohol. 
It  should  be  kept  in  a  cool,  dark  place,  in  small,  perfectly  dry, 
securely-stoppered  bottles. 

Dose. — 5-10  grains  (0.3-0.6  Gm.). 

PTlulae  Ferri  lodidi— PTIulas  (ace.)  Ferri  lodidi— Pills 
of  Ferrous  Iodide.    U.S.I*. 

Origin. — Pills  made  of  Reduced  Iron,  Iodine,  Glycyrrhiza,  Sugar, 
Extract  of  Glycyrrhiza,  Acacia,  Balsam  of  Tolu,  Water,  and  Ether, 
evaporated  to  pilular  consistence. 

Description  and  Properties. — These  preparations  are  very  un- 
stable, and  should  be  kept  from  the  light  as  much  as  possible. 

Dose. — One  to  two  pills,  each  pill  containing  nearly  i  grain 
(0.061  Gm.)  of  ferrous  iodide. 

Syrupus  Ferri  lodidi— S^rupi  Ferri  lodidi— Syrup  of 
Ferrous  Iodide.    JJ.  S.  I*. 

Origin. — A  syrup  containing  10  per  cent,  of  Ferrous  Iodide. 
Description  and  Properties. — A  transparent,  pale-green  liquid, 
having  a  sweet,  strongly  ferruginous  taste  and  a  neutral  reaction. 
Dose. — 5-30  minims  (0.3-2.0  Cc). 

Ferri   Chloridum— Ferri   Chloridi— Ferric  Chloride. 

Origin. — Prepared  by  the  action  of  Hydrochloric  Acid  and 
Distilled  Water  upon  Iron  Wire,  subsequent  filtration,  addition  of 
Nitric  Acid,  and  crystallization. 

Description  and  Properties. — Orange-yellow,  crystalline  pieces, 
odorless  or  having  a  faint  odor  of  hydrochloric  acid,  and  a  strongly 
styptic  taste  ;  very  deliquescent  in  moist  air ;  freely  and  completely 
soluble  in  water  or  alcohol,  also  in  a  mixture  of  i  part  of  ether 
and  3  parts  of  alcohol.  Ferric  chloride  should  be  kept  in  glass- 
stoppered  bottles  protected  from  light. 

Dose. — It  is  chiefly  used  topically,  as  an  astringent  and  hemo- 
static. 


l82  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Liquor  Ferri  Chloridi— Liquoris  Ferri  Chloridi— 
Solution  of  Ferric  Cinloride.    TJ-  S.  P. 

Origin. — An  aqueous  solution  of  Ferric  Chloride  (Fe2Cle  = 
323.98),  containing  about  37.8  per  cent,  of  the  anhydrous  salt, 
corresponding  to  62.9  per  cent,  of  the  crystallized  salt,  or  about 
13  per  cent,  of  metallic  iron. 

Description  and  Properties. — A  reddish-brown  liquid,  having 
a  faint  odor  of  hydrochloric  acid,  an  acid,  strongly  styptic  taste, 
and  an  acid  reaction. 

Dose. — 2-10  minims  (o.  1 2-0.6  Cc),  largely  diluted. 

Tinctura  Ferri  ChI5ridi— Tincturae  Ferri  CFiloridi— 
Tincture  of  Ferric  Ciiloride.    U.  S.  P. 

Origin. — A  hydro-alcoholic  solution  of  Ferric  Chloride,  con- 
taining about  13.6  per  cent,  of  the  anhydrous  salt,  corresponding 
to  about  4.7  per  cent,  of  metallic  iron. 

Description  and  Properties. — A  bright,  brownish  liquid  having 
a  slightly  ethereal  odor,  a  very  astringent,  styptic  taste,  and  an  acid 
reaction. 

Dose. — 5-30  minims  (0.3-2.0  Cc). 

Liquor  Ferri  Acetatis— Liquoris  Ferri  Acetatis— 

Solution  of  Ferric  Acetate.    77.  S.  P. 
Origin. — An   aqueous   solution  of  Ferric  Acetate,  containing 
about  31  per  cent,  of  the  anhydrous  salt,  corresponding  to  about 
7.5  per  cent,  of  metallic  iron. 

Description   and  Properties. — A  dark,  reddish-brown,  clear 
liquid,  of  an  acetous  odor,  a  sweetish,  acidulous,  somewhat  styptic 
taste,  ^nd  a  slightly  acid  reaction. 
Dose. — 1-8  minims  (0.06-0.5  Cc). 

Liquor  Ferri  et  Ammonii  Acetatis— Liquoris  Ferri 
et  Ammonii  Acetatis— Solution  of  Iron  and 
Ammonium  Acetate.    U.  S.  P. 

(Basham's  Mixture.) 

Formula. — Prepared  with  Tincture  of  Ferric  Chloride,  20  parts ; 
Diluted  Acetic  Acid,  30 ;  Solution  of  Ammonium  Acetate,  200 ; 
Aromatic  Elixir,  100;  Glycerin,  120;  Water,  to  1000. 

Dose. — 1-4  fluidrachms  (4.0-15.0  Cc). 

Ferri  CTtras— Ferri  Citratis— Ferric  Citrate.   TI.  8.  P. 

Origin. — Prepared  by  evaporating  solution  of  Ferric  Citrate  on 
a  water-bath  at  a  temperature  not  exceeding  60°  C.  (140*^  F.). 


HEM  A  TICS.  183 

Description  and  Properties. — Thin,  transparent,  garnet-red 
scales,  without  odor  and  having  a  slightly  ferruginous  taste. 
Slowly  but  completely  soluble  in  cold  water,  and  readily  soluble 
in  hot  water,  but  diminishing  in  solubility  with  age.  Insoluble  in 
alcohol.  Ferric  citrate  should  be  kept  in  well-stoppered  bottles, 
protected  from  light. 

Dose. — 5-20  grains  (0.3-1.20  Gm.),  in  solution. 

Liquor  Ferri  Citratis— Liquoris  Ferri  Citratis— 
Solution  of  Ferric  Citrate.    JJ.  S.  I*. 

Origin. — Prepared  byi  precipitating  a  solution  of  Ferric  Sulphate 
in  Water  with  Ammonia  Water,  adding  Citric  Acid,  filtering,  and 
evaporating  the  filtrate  to  the  proper  amount. 

Description  and  Properties. — A  dark-brown  liquid,  odorless, 
of  an  acid  reaction,  and  possessing  a  slightly  ferruginous  taste. 

Dose. — 5-15  minims  (0.3-I.O  Cc). 

VTnum  Ferri  Citratis— Vini  Ferri  Citratis— Wine  of 
Ferric  Citrate.     U.  S.  I*. 

Composition. — Iron  and  Ammonium  Citrate,  Tincture  of  Sweet 
Orange  Peel,  Syrup,  and  Water. 

Dose. — J-i  fluidrachm  (2.0-4.0  Cc). 

Ferri  et  Ammonii  Citras— Ferri  et  Ammonii  Citratis 
—Iron  and  Ammonium  Citrate.    TJ.  S.  JP. 

Origin. — Prepared  by  evaporating  a  solution  of  Ferric  Citrate 
and  Ammonia  Water. 

Description  and  Properties. — Thin,  transparent,  garnet-red 
scales,  odorless,  and  having  a  saline,  mildly  ferruginous  taste; 
deliquescent  in  moist  air.  Completely  soluble  in  water,  but 
insoluble  in  alcohol. 

Dose. — 5-10  grains  (0.3-0.6  Gm.). 

Ferri  et  Quinlnse  CTtras— Ferri  et  Quinlnae  Citratis 
—Iron  and  Quinine  Citrate.     U.  S.  P. 

Origin. — Solution  of  Ferric  Citrate  in  Distilled  Water  and 
solution  of  Quinine  and  Citric  Acid  in  Distilled  Water  are  mixed, 
evaporated  on  a  water-bath  to  the  consistence  of  syrup,  and  dried 
on  plates  of  glass. 

Description   and  Properties. — Thin,  transparent  scales,  of  a 


i84  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

reddish-brown  color,  without  odor,  and  having  a  bitter,  mildly- 
ferruginous  taste  ;  slowly  deliquescent  in  damp  air.  Gradually  but 
completely  soluble  in  cold  water,  more  readily  soluble  in  hot  water, 
and  but  partially  soluble  in  alcohol,  its  solubility  diminishing  with 
age.  It  should  be  kept  in  well-stoppered  bottles,  protected  from 
light. 

Dose. — 2-IO  grains  (0.12-O.6  Gm.). 

Ferri  et  Quinlnae  CTtras  Solubilis— Ferri  et  Quinlnae 
Citratis  Solubilis— Soluble  Iron  and  Quinine 
Citrate.    V.  S.  JP. 

Origin. — Prepared  in  the  same  manner  as  the  above  salt,  but 
with  the  addition  of  Ammonia  Water. 

Description  and  Properties. — Thin,  transparent  scales,  of  a 
greenish,  golden-yellow  color,  odorless,  and  having  a  bitter,  mildly 
ferruginous  taste;  deliquescent  in  damp  air.  Rapidly  and  com- 
pletely soluble  in  cold  water,  but  only  partially  soluble  in  alcohol. 
It  should  be  kept  in  well-stoppered  bottles,  protected  from  hght. 
Dose. — 2-10  grains  (0.12-0.6  Gm.). 

Ferri  et  Strychnlnae  Citras— Ferri   et  Strychnlnae 
Citratis— Iron  and  Strychnine  Citrate.    U.S.JP. 

Origin. — Solution  of  Iron  and  Ammonium  Citrate  in  Distilled 
Water  and  solution  of  Strychnine  and  Citric  Acid  in  Distilled 
Water  are  mixed,  evaporated  to  the  consistence  of  syrup  by  means 
of  a  water-bath,  and  dried  on  plates  of  glass. 

Description  and  Properties. — Thin,  transparent  scales,  varying 
in  color  from  garnet-red  to  yellowish-brown,  without  odor,  and 
having  a  bitter,  slightly  ferruginous  taste ;  deliquescent  in  damp 
air.  Readily  and  completely  soluble  in  water,  but  only  partly  sol- 
uble in  alcohol.  It  should  be  kept  in  well-stoppered  bottles,  pro- 
tected from  light. 

Dose. — 1-3  grains  (0.06-0.18  Gm.). 

VInum  Ferri  Amarum— VTni  Ferri  Amari— Bitter 
Wine  of  Iron.     U.S.I*. 

Composition. — Soluble  Iron  and  Quinine  Citrate,  Tincture  of 
Sweet  Orange  Peel,  Syrup,  White  Wine. 
Dose. — 1-2  fluidrachms  (4.0-8.0  Cc). 


HEMATICS.  185 

Syrupus  Ferri,  QuinTnae,  et  Strychnlnae  Phospha- 
tum— Syrupi  Ferri,  QuinTnae,  et  Strychnlnae 
Piiospiiatum— Syrup  of  tiie  Piiosphates  of  Iron, 
Quinine,  and  Stryclinine.    JJ.  S.  J*. 

Dose. — 1-2  fluidrachms  (4.0-8.0  Cc). 


Ferri  Lactas— Ferri  Lactatis— Ferrous  Lactate. 

U.  8.  I*. 

Description  and  Properties.— Pale,  greenish-white  crusts,  con- 
sisting of  small,  needle-shaped  crystals,  having  a  slight,  peculiar 
odor,  and  a  mild,  sweetish,  ferruginous  taste.  Slowly  but  com- 
pletely soluble  in  40  parts  of  water  and  in  12  parts  of  boiling 
-water;  almost  insoluble  in  alcohol.  Ferrous  lactate  should  be 
kept  in  well-stoppered  bottles. 

Dose. — 1-3  grains  (0.06-0.2  Gm.). 

syrupus  HypophosphTtum  cum  Ferro— SS^rupi  Hy- 
pophospiiTtum  cum  Ferro— Syrup  of  Hypopiios- 
phites  witii  Iron.    U.  S.  JP. 

Ferrous  Lactate  and  Potassium  Citrate  dissolved  in  Syrup  of 
Hypophosphites. 

Dose. — |— I  fluidrachm  (2.0-4.0  Cc). 

Ferri    Oxidum    Hydratum— Ferri    Oxidi    Hydrati— 
Ferric  Hydrate.    U.S.JP. 

(Ferric  Hydroxide — Hydrated  Oxide  of  Iron.) 

Origin. — To  a  solution  of  Ammonia  Water  in  Water  is  added  a 
solution  of  Ferric  Sulphate  in  Water,  and  the  precipitate  collected. 

Description  and  Properties. — A  brownish-red  magma,  wholly 
soluble  in  hydrochloric  acid,  without  effervescence. 

Dose. — ^4  drachms  (16  Gm.),  or  ad  libitum  in  case  of  arsenical 
poisoning. 

Ferri  Oxidum  Hydratum  cum  Magnesia— Ferri 
Oxidi  Hydrati  cum  Magnesid— Ferric  Hydrate 
with  Magnesia.     TJ.  S.  JP. 

Solution  of  Ferric  Sulphate,  Magnesia,  and  Water. 
Dose. — Amounts  as  necessary  ad  libitum. 


1 86  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Ferri  et  Ammonii  Sulphas— Ferri  et  Ammonii  Sul- 
phatis— Ferric  Ammonium  Sulphiate.     V.  S.  F. 

(Ammonio-ferric  Sulphate— Ammonio-ferric  Alum.) 
Origin. — The  crystals  formed  by  adding  Ammonium  Sulphate 
to  a  boiling-hot  solution  of  Ferric  Sulphate. 

Description  and  Properties. — Pale  violet,  octahedral  crystals, 
odorless,  and  having  an  acid,  styptic  taste ;  efflorescent  on  exposure 
to  the  air.  Soluble  in  3  parts  of  water  and  in  0.8  part  of  boiling 
water ;  insoluble  in  alcohol.  The  product  should  be  kept  in  well- 
stoppered  bottles. 

Dose. — 5-15  grains  (0.5-1.0  Gm.). 

Ferri  et  Ammonii  Tartras — Ferri  et  Ammonii  Tar- 
tratis— Iron  and  Ammonium  Tartrate.    17.  S.  JP. 

(Ammonio-ferric  Tartrate.) 

Description  and  Properties. — Thin,  transparent  scales,  varying 
in  color  from  garnet-red  to  reddish-brown,  without  odor,  and 
having  a  sweetish,  slightly  ferruginous  taste ;  slightly  deliquescent 
in  the  air.  Very  soluble  in  water ;  insoluble  in  alcohol.  Iron  and 
ammonium  tartrate  should  be  kept  in  well-stoppered  bottles,  pro- 
tected from  light. 

Dose. — 10-30  grains  (0.6-2.0  Gm.). 

Ferri   et  Potassii  Tartras— Ferri  et  Potassii  Tar- 
tratis— Iron  and  Potassium  Tartrate.    TJ.  8.  P. 

(POTASSIO-FERRIC  TARTRATE.) 

Description' and  Properties. — Thin,  transparent  scales,  vary- 
ing in  color  from  garnet-red  to  reddish-brown,  without  odor,  and 
having  a  sweetish,  slightly  ferruginous  taste ;  slightly  deliquescent 
in  the  air.  Very  soluble  in  water ;  insoluble  in  alcohol.  It  should 
be  kept  in  well-stoppered  bottles,  protected  from  light. 

Dose. — 5-20  grains  (0.3-1.2  Gm.). 

Ferri  Piiosphas  Solubilis— Ferri   Phosphatis  Solu- 
bilis— Soluble  Ferric  Phosphate.    TI.  S.  P. 

Description  and  Properties. — Thin,  bright-green,  transparent 
scales,  odorless,  and  having  an  acidulous,  slightly  saline  taste.  The 
salt  is  permanent  in  dry  air  when  excluded  from  light,  becoming 
dark  and  discolored  when  exposed  to  it.     Freely  and  completely 


HEMATICS.  187 

soluble  in  water,  but  insoluble  in  alcohol     It  should  be  kept  in 
dark  amber-colored,  well-stoppered  bottles. 
Dose. — 5-10  grains  (0.3-0.6  Gm.). 


Ferri  Pyrophosphas  Solubilis— Ferri  Pyrophospha- 
tis  Solubilis— Soluble  Ferric  Pyrophosphate, 
JJ.  S.  I*. 

Description  and  Properties. — Thin  apple-green,  transparent 
scales,  without  odor,  and  having  an  acidulous,  slightly  saline  taste ; 
permanent  in  dry  air  if  protected  from  light,  and  if  exposed  to  it 
becoming  dark  and  discolored.  Freely  and  completely  soluble  in 
water,  but-  insoluble  in  alcohol.  It  should  be  kept  in  dark  amber- 
colored,  well-stoppered  bottles. 

Dose. — 2-5  grains  (0.1-0.3  Gm.). 

Ferri  Hypophosphis— Ferri  Hypophosphitis— Ferric 
Hypophosphite.     U.  S.  -P. 

Origin. — The  precipitate  formed  by  mixing  solutions  of  Sodium 
Hypophosphites  and  Ferric  Chloride  or  Ferric  Sulphate. 

Description  and  Properties. — A  white  or  grayish-white  pow- 
der, odorless  and  nearly  tasteless,  permanent  in  the  air.  Only 
slightly  soluble  in  water.  It  should  be  kept  in  well-stoppered 
bottles. 

Dose. — 5-10  grains  (0.3-0.6  Gm.). 


Ferri  Valerianas— Ferri  Valerianatis— Ferric 
Valerianate.    TJ.  S.  T. 

Origin. — The  precipitate  obtained  by  adding  to  a  cold  solution 
of  Ferric  Sulphate  or  Ferric  Chloride  a  cold  solution  of  Sodium 
Valerianate. 

Description  and  Properties. — A  dark,  brick-red,  amorphous 
powder,  of  somewhat  varying  chemical  composition,  having  the 
odor  of  valerianic  acid  and  a  mildly  styptic  taste ;  permanent  in 
dry  air.  Insoluble  in  cold  water,  but  readily  soluble  in  alcohol. 
Boiling  water  decomposes  it,  setting  free  the  valerianic  acid  and 
leaving  ferric  hydrate.  It  should  be  kept  in  small,  well-stoppered 
bottles,  in  a  cool,  dark  place. 

Dose. — 1-3  grains  (0.06-0.18  Gm.). 


i88  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Ferri  Sulphas— Ferri  Sulphatis— Ferrous  Sulphate. 

JJ.  8.  JP. 

Origin. — Obtained  by  the  action  of  Sulphuric  Acid  and  Water 
upon  Iron  Wire. 

Description  and  Properties. — Large,  pale  bluish-green  mono- 
clinic  prisms,  without  odor,  and  having  a  saline,  styptic  taste; 
efflorescent  in  dry  air ;  on  exposure  to  moist  air  the  crystals  rap- 
idly absorb  oxygen,  becoming  coated  with  a  brownish-yellow, 
basic  ferric  sulphate.  Soluble  in  1.8  parts  of  water  and  in  0.3  part 
of  boiling  water ;  insoluble  in  alcohol. 

Dose. — 1-3  grains  (0.06-0.18  Gm.). 


Ferri   Sulphas   Exsiccatus— Ferri  Sulphatis  Exsic- 
cati— Dried  Ferrous  Sulphate.    U.  S.  P. 

Description  and  Properties. — A  grayish-white  powder,  slowly 
but  completely  soluble  in  water. 

Dose. — |— 2  grains  (0.03-0. 12  Gm.). 


Ferri  Sulphas  Gran ulatus— Ferri  Sulphatis  Granu- 
lati— Granulated  Ferrous  Sulphate.     U.  S.  P. 

Description  and  Properties. — A  pale  bluish-green,  crystallized 
powder,  which  should  conform  in  every  respect  to  the  reactions 
and  tests  given  under  Ferri  Sulphas  in  the  U.  S.  P. 

Dose. — ^3  grains  (0.03-0.18  Gm.). 


Liquor  Ferri  Subsulphatis— Liquoris  Ferri  Subsul- 
phatis— Solution  of  Ferric  Subsulphate.    U.  S.  P. 

(Solution  of  Basic  Ferric  Sulphate — Monsel's  Solution.) 

Origin. — An  aqueous  solution  of  basic  Ferric  Sulphate — of 
varying  chemical  composition — corresponding  to  about  13.6  per 
cent,  of  metallic  iron. 

Description  and  Properties. — A  dark,  reddish-brown  liquid, 
odorless  or  nearly  so,  of  an  acid,  strongly  styptic  taste,  and  an 
acid  reaction.  Miscible  with  water  and  alcohol  in  all  proportions, 
without  decomposition. 

Dose. — i-io  minims  (0.06-0.6  Cc),  largely  diluted — chiefly 
used,  however,  as  a  local  styptic. 


HEMATICS.  189 

Liquor  Ferri  Tersulphatis— Liquoris   Ferri  Tersul- 
phatis— Solution  of  Ferric  Sulphate.    TJ.  S.  I*. 

Origin. — An  aqueous  solution  of  normal  Ferric  Sulphate,  con- 
taining about  28.7  per  cent,  of  the  salt,  and  corresponding  to  about 
8  per  cent,  of  metallic  iron. 

Description  and  Properties. — A  dark,  reddish-brown  liquid, 
almost  odorless,  having  an  acid,  strongly  styptic  taste,  and  an  acid 
reaction.  Miscible  with  water  and  alcohdl  in  all  proportions,  with- 
out decomposition. 

Dose. — i-io  minims  (0.06-0.6  Cc),  given  in  the  same  manner 
and  for  the  same  purposes  as  the  preceding  preparation. 

Pilulae  Aloes  et  Ferri— Pilulas  (ace.)  Aloes  et  Ferri— 
Pills  of  Aloes  and  Iron.    U.  8.  JP. 

Described  under  Aloes. 

Dose. — 5-10  grains  (0.3-0.6  Gm.),  or  two  or  three  pills. 

Emplastrum  Ferri— Emplastri  Ferri— Iron  Plaster. 

U.  S.  P. 

(Strengthening  Plaster.) 

Formula :  Ferric  Hydrate,  90 ;  Olive  Oil,  50 ;  Burgundy  Pitch, 
140;  Lead  Plaster,  720.     For  external  use. 

Trochisci  Ferri— TrochTscos  (ace.)  Ferri— Troches  of 
Iron.    U.  S.  P. 

Composition. — Ferric  Hydrate ;  Vanilla ;  Sugar ;  Mucilage  of 
Tragacanth. 

Dose. — One  to  two  troches,  each  troche  containing  5  grains 
(0.3  Gm.)  of  ferric  hydroxide. 

Liquor  Ferri  Nitratis— Liquoris  Ferri  Nitratis— 
Solution  of  Ferric  Nitrate.     U.  S.  JP. 

Origin. — An  aqueous  solution  of  Ferric  Nitrate,  containing 
about  6.2  per  cent,  of  the  anhydrous  salt,  corresponding  to  about 
1.4  per  cent,  of  metallic  iron. 

Description  and  Properties. — A  clear,  amber-colored  or  red- 
dish liquid,  odorless,  having  an  acid,  styptic  taste,  and  an  acid  reaction. 

Dose. — 5-10  minims  (0.3-0.6  Cc). 


I  go  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Pilulse   Ferri   Carbonatis— Pilulas    (ace.)    Ferri    Car- 
bonatis— Pills   of    Ferrous   Carbonate.     V.  S.  P. 

(Ferruginous  Pills — Chalybeate  Pills — Blaud's  Pills.) 
Dose. — 2  to   S   pills,  each  pill  containing   i   grain  (0.064  Gm.) 
of  ferrous  carbonate. 

Unofficial  Preparations. 

Tinctura  Fferri  Acetatis — Tincturse  FSrri  Acetatis — Tincture  of  Ferric  Ace- 
tate, U.  S.  P. — Composition:  Solution  of  Ferric  Acetate;  Alcohol;  Acetic  Ether. 

Description  and  Properties. — A  clear,  dark,  reddish-brown  liquid,  transparent  in 
thin  layers,  having  the  odor  of  acetic  ether,  an  acidulous  and  astringent  taste,  and  a 
slightly  acid  reaction.  Miscible  in  all  proportions  with  water,  without  becoming  turbid. 
The  tincture  should  be  kept  in  the  dark  and  in  a  cool  place. 

Dose. — S-30  minims  (0.2-2.0  Cc). 

FSrri  Arsenas — F6rri  Arsenatis — Iron  Arsenate. — Description  and  Proper- 
ties.— A  green  or  blue-green,  amorphous  powder,  insoluble  in  water  and  in  alcohol. 

Dose. — jij-^  grain  (0.003-0.03  Gm.). 

FSrri  Albutninas — FSrri  Albuminatis — Albuminate  of  Iron. — Description 
and  Properties. — Golden  yellow,  transparent  scales,  containing  3.34  per  cent,  of  iron. 

Dose. — 5-30  grains  (0.3-2.0  Gm.).  A  liquor  and  a  syrup  of  albuminate  of  iron 
are  used. 

FSrrum  Dialysatum — FSrri  Dialysati — Dialyzed  Iron  (Liquor  Ferri  Dia- 
LYSATUS — Liquor  Ferri  Oxychlorati). — Description  and  Properties. — Perfectly 
transparent,  thin  layers,  of  a  deep  brown-red  color,  inodorous,  and  almost  destitute  of 
styptic  taste.  Miscible  with  alcohol,  glycerin,  syrup,  and  distilled  water,  but  not  with 
spring-water  or  other,  even  dilute,  saline  solutions. 

Dose. — 10-30  minims  (0.6-2.0  Cc). 

Liquor  FSrri  Peptonati — Liquoris  FSrri  Peptonati — Solution  of  Peptonate 
of  Iron. — Dose,  \-2  fluidrachms  (2.0-8.0  Cc). 

Liquor  Mangano-FSrri  Peptonatus — Liquoris  MSngano-FBrri  Peptonati 
(Gude) — Solution  of  Peptonate  of  Iron  and  Manganese. — A  proprietary  prepa- 
ration from  the  formula  of  Dr.  Gude. 

Dose. — 2-4  fluidrachms  (8.0-15.0  Cc). 

Allied  Compounds. 

Hsetnogallol. — Origin. — Prepared  by  the  action  of  Pyrogallol  on  the  coloring 
matter  of  the  blood. 

Description  and  Properties. — A  reddish-brown,  tasteless  powder. 
Dose. — 1-8  grains  (0.06-0.5  Gm.). 

Hsmol. — Origin. — Prepared  by  the  action  of  Zinc  Dust  on  the  coloring  matter 
of  the  blood. 

Description  and  Properties. — A  blackish-brown  powder  having  a  slight  taste. 

Dose. — 1-8  grains  (0.06-0.5  Gm.). 

Ferratin. — Origin. — A  compound  of  Iron  first  obtained  by  Professor  Schmiedeberg 
from  hog's  liver. 

Description  and  Properties. — A  fine,  reddish-brown  powder  containing  about  7  per 
cent,  of  iron.  One  variety  is  insoluble,  though  the  sodium  ferratin  is  freely  soluble  in 
water. 


HEM  A  TICS.  191 

Dose. — 10-20  grains  (0.16-1.2  Gm.). 

Hsemalbumin. — A  preparation  said  to  contain  two  albuminoids  and  salts  of  the 
blood. 

Description  and  Properties. — A  permanent  powder,  soluble  in  water  and  in  alcohol. 

Dose. — S-15  grains  (0.3-1.0  Gm.). 

liaemoglobin. — Said  to  be  the  coloring  principle  of  the  solid  elements  of  the  blood. 

Dose. — 1-3  grains  (0.06-0.18  Gm.). 

HsemofeTTum, — Claimed  to  be  a  natural  proteid  compound  of  Iron  obtained  from 
hullock's  blood. 

Dose. — 1-3  grains  (0.06-0.18  Gm.). 

Iron  Quinine  Chloride. — A  yellowish-red  powder,  soluble  in  water,  alcohol,  and 
glycerin. 

Dose. — 1-3  grains  (0.06-0.18  Gm.).     Used  externally  as  a  hemostatic. 


Antagonists  and  Incompatibles. — The  ferric  salts  are  incom- 
patible with  tannic  and  gallic  acids  and  vegetable  astringents,  and 
gelatinize  mucilage  of  acacia.  The  carbonates  are  also  incompatible 
■with  tannic  and  mineral  acids  and  acidulous  salts. 

The  salts  of  the  vegetable  acids  and  the  iodides  are  incompatible 
with  mineral  acids,  tannic  acid,  and  with  alkalies  and  their  carbon- 
ates. The  tincture  of  the  chloride  of  iron  is  also  incompatible 
with  tannic  acid,  vegetable  astringents,  alkalies  and  their  carbon- 
ates, lime  water,  and  the  carbonates  of  calcium  and  magnesium. 

Synergists. — All  the  restorative  medicines  are  synergistic. 

Physiological  Action. — Iron  is  a  typical  restorative,  being  an 
essential  element  of  the  blood,  there  being  i  part  of  iron  to  230 
of  red  globules.  It  has  also  been  found  in  the  gastric  juice,  bile, 
lymph,  chyle,  milk,  urine,  pigment  of  the  eye,  etc.  This  omni- 
presence is  readily  accounted  for  when  it  is  remembered  that  the 
food  of  man  contains  iron  in  variable  quantities.  Indeed,  this  use- 
ful metal  may  well  be  called  a  respiratory  nutrient  because  of  its 
property  of  increasing  the  oxygen-carrying  power  of  the  red  blood- 
corpuscles — muscular  force  and  functional  activity  generally  being 
dependent  upon  the  supply  of  oxygen,  or  proper  respiration,  as 
the  motive  power. 

When  the  system  is  in  a  normal,  healthy  condition,  sufficient 
iron  is  furnished  by  the  mixed  diet  to  answer  all  physiological 
requirements.  In  many  diseased  conditions,  however,  there  is  a 
deficiency  of  iron,  and  it  is  necessary  to  restore  this  element  in 
one  way  or  another. 

The  chief  actions  of  iron  are — I.  To  increase  the  oxygen- 
carrying  powers  of  the  blood ;  2.  To  convert  the  oxygen  present 
in  the  tissues  into  ozone ;  3.  To  serve  both  as  a  local  and  general 
astringent. 


192  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

The  physiological  effects  upon  the  various  systems,  locally  ana 
internally,  now  to  be  considered,  are  due  directly  or  indirectly  to- 
the  principal  actions  above  mentioned. 

Externally  and  Locally. — Neither  the  ferric  nor  the  ferrous  salts 
exert  any  action  upon  the  unbroken  skin.  When  applied,  however, 
to  mucous  membranes  or  denuded  surfaces,  they  are  astringent  and 
hemostatic,  the  ferric  salts  being  the  more  powerful,  coagulating 
albuminous  fluids.  When  applied  to  bleeding  surfaces  the  hemo- 
static action  is  due  rather  to  the  coagulation  of  the  blood,  forming 
a  natural  barrier  to  its  escape,  than  to  any  direct  action  upon  the 
walls  of  the^  vessels.  The  vegetable  salts — scale  preparations — 
possess  so  feeble  astringent  properties  that  they  are  rarely,  if  ever, 
used  as  local  applications. 

The  acid  and  astringent  preparations  of  iron  act  upon  the  teeth. 
The  ferric  oxides  are  disinfectant,  owing  to  their  property  of  con- 
verting oxygen  into  ozone. 

Internally. — Digestive  System. — The  teeth  and  tongue  are  black- 
ened by  the  preparations  of  iron.  In  the  stomach,  when  not  con- 
traindicated  and  in  small  doses,  its  slightly  irritant  and  astringent 
properties  render  iron  quite  a  valuable  stomachic  tonic.  Under 
excessive  doses  or  prolonged  administration  the  acid  preparations 
especially  are  apt  to  cause  gastric  derangement — anorexia,  nausea, 
and  serious  indigestion.  The  ferric  chloride  is  particularly  valu- 
able in  that  its  ingestion  does  not,  like  that  of  other  preparations 
of  iron,  diminish  the  supply  of  hydrochloric  acid  in  the  gastric  juice. 

The  scale  salts,  though  disturbing  the  digestion  less  than  the 
acid  preparations,  are  ordinarily  inferior  to  the  latter. 

All  the  preparations  of  iron  are  probably  converted  into  the 
chloride  in  the  stomach.  When  entering  the  intestines  they  are 
converted  into  the  ferric  oxide,  ferrous  chloride,  the  alkaline  albu- 
minate, and  the  insoluble  sulphide  and  tannate.  Most  of  the  iron 
preparations  are  constipating,  the  phosphate  and  pyrophosphate 
being  exceptions.  They  tend  to  diminish  the  bile  and  the  secre- 
tions from  the  gastro-intestinal  tract. 

Circulatory  System. — The  action  of  iron  upon  the  blood  is  of 
great  importance,  since,  the  metal  being  a  normal  constituent 
of  that  fluid,  its  administration  has  a  nutrient  as  well  as  a  medicinal 
influence.  A  primary  effect  is  to  supply  a  deficiency  of  red  cor- 
puscles and  bring  the  hemoglobin  up  to  the  normal  standard. 
Iron  enables  the  red  corpuscles  to  convey  more  oxygen  to  the 
tissues,  converting  that  element  into  ozone  and  thereby  rendering  it 


HEM  A  TICS.  193 

more  active  in  promoting  oxidation.  The  muscular  power  of  the 
heart  is  increased,  the  arterioles  slightly  contracted,  and  arterial 
tension  somewhat  raised. 

Nervous  System. — The  general  effect  is  tonic,  the  influence  of 
iron  and  its  salts  being  highly  beneficial  in  strengthening  the  action 
of  the  nerves  in  cases  of  physical  debility.  With  subjects  inclined 
to  plethora,  however,  certain  untoward  symptoms  may  result  from 
administration  of  the  stronger  preparations,  including  a  feeling  of 
congestion  in  the  cerebrum. 

Respiratory  System. — No  immediate  action  is  perceptible  under 
normal  conditions,  but  in  anemic  states,  by  supplying  the  nerve- 
centers,  muscles,  and  lungs  with  better  blood,  the  respiratory  power 
is  increased. 

Absorption  and  Elimination. — Opinions  differ  regarding  the  form 
in  which  iron  is  absorbed.  Probably  much  of  it  is  converted  into 
the  soluble  chloride  and  absorbed  as  such,  while  a  portion,  passing 
into  the  intestines,  may  there  be  converted  into  the  insoluble  alka- 
line albuminate  capable  of  absorption.  The  larger  portion  of  iron 
taken  into  the  system-,  however,  is  changed  into  the  insoluble  sul- 
phide and  tannate,  and  excreted  as  such,  giving  to  the  feces  a 
black  color.  Such  part  of  the  iron  as  enters  the  circulation  com- 
bines with  the  red  corpuscles.  The  salts  of  the  organic  acids 
are  absorbed  directly  into  the  blood. 

Such  careful  pharmacologists  as  Bunge,  Schmiedeberg,  and 
Hamburger  claim  that  inorganic  preparations  of  iron  are  neither 
absorbed  nor  assimilated,  maintaining  that  the  blood  and  hemo- 
globin are  influenced  only  by  the  organic  compounds.  Yet,  not- 
withstanding these  statements,  clinical  experience  has  fully  demon- 
strated the  value  of  such  preparations  as  reduced  iron,  tincture  of 
the  chloride,  carbonate,  etc. ;  and  it  is  still  perhaps  a  mooted  ques- 
tion whether  appreciable  amounts  of  them  are  actually  absorbed, 
or  whether,  according  to  Bunge,  the  inorganic  prevent  the  decom- 
position of  the  organic  salts  of  iron  in  the  food  by  fixing  the 
decomposing  agents  in  the  intestines.  At  all  events,  the  beneficial 
results  in  anemia  and  chlorosis  of  large  doses  of  the  inorganic 
preparations  are  too  manifest  to  justify  abandonment  of  these 
agents  because  of  our  ignorance  touching  their  modus  operandi. 

Bunge's  hypothesis  would  at  least  seem  plausible  when  it  is 
remembered  that  only  traces  of  iron  can  be  found  in  the  urine 
when  the  drug  is  given  by  the  stomach,  while  if  injected  into  the 
circulation  large  quantities  are  eliminated  by  the  kidneys.     It  is 

13 


194  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

quite  possible  that  the  improvement  in  the  red  corpuscles,  and  the 
promotion  of  oxidation  independent  of  them,  take  place  in  the 
portal  circulation,  and  that  when  the  iron  reaches  the  Hver  it  is 
there  intercepted  and,  together  with  the  bile,  turned  back  into  the 
intestines. 

The  amount  of  urea  is  increased  and  micturition  rendered  more 
frequent  by  preparations  of  this  metal. 

Elimination  takes  place  chiefly  by  the  feces,  to  which  a  blackish 
color  is  imparted  by  the  formation  of  ferrous  sulphide.  The  bile, 
urine,  and  even  the  skin,  as  well  as  the  mucous  and  serous  mem- 
branes, share  in  the  excretory  process. 

Temperature. — The  administration  of  iron  tends  to  raise  bodily 
heat.  This,  however,  may  be  due  only  to  the  normal  influence 
of  the  metal,  the  ozonizing  power  of  which,  affecting  the  promo- 
tion of  tissue-waste,  naturally  causes  an  elevation  of  temperature. 

Untoward  Action. — The  continued  use  of  ferruginous  prepara- 
tions has  a  tendency  to  impair  the  normal  digestive  powers,  occa- 
sioning even  gastric  oppression,  nausea,  and  vomiting.  Reduced 
iron,  the  phosphate,  and  the  pyrophosphate  produce  less  untoward 
action  than  other  preparations,  and  the  ferrous  are  better  tolerated 
than  the  ferric  salts.  Not  infrequently  acne  of  the  face,  breast, 
and  back  is  occasioned,  while  the  prolonged  administration  of  the 
drug  may  in  rare  cases  be  accompanied  by  hemorrhages  from 
the  mucous  membranes  and  symptoms  of  plethora  and  vascular 
excitement.  Large  doses  of  the  ferrous  sulphate  may  occasion 
obstruction  of  the  bowels. 

Poisoning. — The  ferric  preparations  in  a  concentrated  form  pro- 
duce all  the  symptoms  of  an  irritant  poison — gastric  pain,  vomit- 
ing, etc. 

Treatment  of  Poi'soning. — The  stomach  should  be  emptied  by 
an  emetic  or  carefully  cleansed,  the  treatment  being  followed  by 
the  administration  of  alkali  solutions,  tannic  acid,  and  demulcent 
drinks,  the  procedure  being  similar  to  thafemployed  in  poisoning 
from  niineral  acids. 

Therapeutics. — Externally  and  Locally. — The  astringent  and 
styptic  properties  of  chlorides  and  sulphates  of  iron  have  rendered 
them  serviceable  in  controlling  hemorrhage  and  as  local  astrin- 
gents in  relaxed  conditions  oi  \S\&  pharynx  and  larynx  and  mucous 
membranes  generally.  The  tincture  of  the  chloride  has  been 
highly  recommended  as  a  local  application  to  the  throat  in  diph- 
theria, and  chronic  and  indolent  ulcers  may  often  be  benefited  by 


HEMATICS.  195 

a  wash  containing  from  2  to  5  grains  (0.12-0.3  Gm.)  of  the  sulphate 
to  I  ounce  (30.0  Cc.)  of  water. 

Internally. — The  most  important  use  of  iron  is  to  restore  the 
number  of  red  corpuscles.  In  nearly  every  form  of  anemia,  there- 
fore, iron  is  indicated.  In  chlorosis,  especially,  it  is  of  great  value  ; 
but  in  order  that  its  effects  may  be  most  beneficial,  cathartics,  such 
as  rhubarb  and  aloes,  which  do  not  weaken  the  intestines  should 
accompany  its  use.  Even  the  anemia  due  to  hemorrhage  calls  for 
iron ;  yet  if  the  assimilative  functions  are  not  impaired,  the  drug 
should  be  reinforced  by  plenty  of  nutritious  food,  from  which  the 
constituents  of  the  blood  are  normally  elaborated. 

The  anemia  of  scrofula  and  syphilis  is  benefited  by  some  form 
of  iron,  care  being  taken  in  these  cases  to  select  the  proper  salts. 
In  glandular  scrofula,  for  instance,  the  iodide  is  to  be  preferred, 
and,  theoretically,  this  salt  is  preferable  also  in  syphilis,  yet  in  the 
latter  disease  the  efficacy  of  the  salt  depends  less  upon  its  particular 
radical  than  upon  its  restorative  properties  and  its  power  of  counter- 
acting the  depressing  and  mischievous  effects  so  often  produced  by 
excessive  use  of  the  specific. 

In  the  desquamative  forms  of  Bright' s  disease  iron  is  of  signal 
benefit.  In  this  condition  the  blood-disks  are  rapidly  destroyed 
by  the  urea ;  moreover,  certain  preparations  of  iron  possess  quite 
a  local  action  upon  the  kidney.  Iron  is  also  useful  m  jaundice 
where  there  is  more  or  less  cholemia,  with  destruction  of  the  red 
corpuscles. 

Many  nervous  disorders  dependent  upon  anemia  are  relieved  by 
iron.  Even  in  chorea  and  various  neuralgias — especially  those  of 
an  intermittent  nature  arising  from  an  impoverished  state  of  the 
blood — iron  is  of  decided  value.  In  many  chronic  nervous  diseases, 
however,  good  judgment  in  the  use  of  the  drug  is  necessary,  lest 
it  prove  more  prejudicial  than  advantageous. 

In  anemia  of  certain  cardiac  diseases  iron  is  of  unquestioned 
value,  though  the  fact  is  well  known  to  observant  practitioners  that 
in  these  cases  iron  alone  is  but  a  single  element  in  the  successful 
treatment  of  them. 

While  iron  is  of  great  service  in  lessening  the  muco-purulent 
expectoration  of  chronic  bronchitis,  its  influence  in  pulmonary  tuber- 
culosis is  less  favorable.  At  times,  it  is  true,  the  drug  appears  to 
improve  the  condition  of  phthisical  patients,  yet  more  frequently 
it  induces  hemoptysis  and  hastens  the  progress  of  the  disease.  In 
certain  disorders  of  the  genito-urinary  tract — prolapsus  uteri,  incon- 


196  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

tinence  of  urine,  seminal  emissions,  prostatorrhea,  etc. — iron  is  an 
appropriate  remedy.  It  is  an  important  agent  in  the  treatment 
of  diabetes,  though  care  should  be  taken  to  guard  against  its 
tendency  to  constipate  the  bowels. 

As  observed  later  on,  iron  is  contraindicated  in  febrile  diseases, 
yet  it  is  a  matter  of  clinical  experience  that  the  drug  acts  favorably 
in  modifying  the  course  of  idiopathic  erysipelas,  pyemia,  septicemia^ 
and  diphtheria. 

The  astringent  action  of  iron  is  available  in  the  treatment  of 
vaginal  leucorrhea,  hematemesis,  and  passive  hemorrhages  from  the 
uterus,  bladder,  kidneys,  etc.  It  has  also  proved  highly  beneficial 
in  certain  forms  of  chronic  diarrhea  and  dysentery.  In  amenorrhea 
and  menorrhagia,  when  due  to  a  deficiency  of  normal  blood,  iron 
is  an  extremely  valuable  remedy. 

Contraindications. — Iron  is  usually  contraindicated  in  fever 
and  acute  inflammatory  conditions,  in  anemia  of  mahgnant  disease, 
such  as  cancer,  in  Addison's,  disease,  and  in  the  hemorrhagic  diath- 
esis. Should  the  use  of  iron  derange  digestion  or  aggravate 
hemorrhoidal  conditions,  the  drug  should  be  discontinued  or  care- 
fully administered,  being  associated  with  stomachics  or  laxatives 
to  mitigate  its  untoward  effects. 

Administration. — If  the  appetite  be  poor,  iron  should  be  ad- 
ministered in  small  doses  (invariably  after  meals)  or  preceded  by 
vegetable  bitters.  The  tincture  of  the  chloride  and  the  stronger 
preparations  should  be  freely  diluted  with  water.  The  citrate  of 
iron  is  a  mild  preparation  well  adapted  for  children  and  persons  of 
delicate  stomach. 

Probably  the  salt  richest  in  iron,  yet  of  all  the  ferruginous 
preparations  the  most  agreeable  and  least  irritating,  is  the  iron  and 
potassium  tartrate.  The  soluble  ferric  pyrophosphate  is  also  a 
mild  and  pleasant  preparation.  The  compound  iron  mixture  pos- 
sesses special  advantages  in  the  treatment  of  chlorosis  and  chronic 
diseases  of  the  skin,  while  the  solution  of  iron  and  ammonium 
acetate  (Basham's  mixture)  is  the  best  preparation  in  albuminuria — 
particularly  that  accompanying  tubular  nephritis — it  being  agree- 
able and  well  tolerated. 

The  best  styptic  is  the  ferric  subsulphate  or  its  solution. 

Dialyzed  iron,  being  agreeable  to  the  taste,  was  formerly  a  pop- 
ular remedy. 

Some  of  the  allied  compounds  above  mentioned  are  very  useful. 
The  ferratin  especially  is  a  most  valuable  compound  of  iron,  while 


HEMATICS. 


197 


the  liquor  mangano-ferri  peptonatus  is  an  agreeable  and  efficient 
remedy,  having  no  deleterious  effect  upon  digestion,  but,  on  the 
contrary,  actually  improving  the  appetite. 

Manganum-Mangani— Manganese. 

This  metal  is  a  normal  constituent  of  the  body,  existing  in  ap- 
preciable though  minute  quantities  in  the  blood,  bile,  etc.  From 
the  fact  of  its  presence  in  the  blood,  and  because  of  the  similarity 
of  its  chemical  affinities  to  those  of  iron,  theorists,  rather  than 
careful  and  practical  observers,  have  advocated  its  use  as  a  worthy 
and  efficient  substitute  for  the  latter  agent. 

Its  therapeutic  uses  as  a  restorative,  or  as  an  alternative  or 
synergist  to  iron,  are  based  more  upon  abstract  deductions  than 
upon  clinical  observation.  Still,  as  its  chemical  character  resem- 
bles that  of  iron — though  the  metal  in  its  operation  is  often 
antagonistic  to  the  latter — its  salts  are  of  sufficient  therapeutic 
importance  to  merit  brief  mention  here. 

Mangani  Dioxidum— Mangani  Dioxidi— Manganese 
Dioxide.    TJ.  S.  JP. 

(Black  Oxide  of  Manganese.) 

Origin. — Native,  crude  manganese  dioxide,  containing  at  least 
66  per  cent,  of  the  pure  dioxide. 

Description  and  Properties. — A  heavy,  grayish-black,  more  or 
less  gritty  powder,  without  odor  or  taste ;  permanent  in  the  air ; 
insoluble  in  water  or  alcohol. 

Dose. — 5-40  grains  (0.3-3.0  Gm.). 

MS-ngani  Sulphas— Mangani  Sulpinatis— Manganese 
Sulphate.    U.  S.  JP. 

Origin. — Obtained  by  heating  Manganese  Dioxide  with  suf- 
ficiently strong  Sulphuric  Acid,  evaporation,  and  crystallization. 

Description  and  Properties. — Colorless  or  pale  rose-colored, 
transparent,  tetragonal  prisms,  odorless,  and  having  a  slightly  bitter 
and  astringent  taste ;  slightly  efflorescent  in  dry  air.  Soluble  in 
0.8  part  of  water  and  in  i  part  of  boiling  water ;  insoluble  in  alco- 
hol.   Manganese  sulphate  should  be  kept  in  well-stoppered  bottles. 

Dose. — 2-5  grains  (0.1-0.3  Gm.). 

(For  Potassium  Permanganate  see  section  on  Antiseptics^ 

Antagonists  and  Incompatibles. — The  salts  of  lead,  silver,  and 
mercury  are  incompatible  with  manganese. 


198  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Synergists. — Iron  is  theoretically  synergistic,  and  the  salts  of 
zinc,  copper,  and  silver  are  similar  in  their  action  on  the  nervous 
system. 

Physiological  Action. — Externally  and  Locally. — The  two  salts 
above  mentioned  have  no  important  local  action. 

Internally. — In  large  doses  these  salts,  especially  the  sulphate, 
irritate  the  gastro-intestinal  tract,  while  excessive  doses  may  even 
occasion  gastro-enteritis.  The  sulphate  acts  as  an  emeto-cathartic 
and  possesses  cholagogue  properties. 

As  is  the  case  with  many  other  drugs  of  this  character,  small 
doses  may  even  promote  the  appetite  and  improve  the  digestive 
function.  Large  doses,  or  the  continued  administration  of  these 
preparations,  affects  the  system  more  like  zinc  than  iron,  pro- 
ducing great  depression,  muscular  weakness  and  waste,  diminishing 
the  pulse-beat,  weakening  the  heart,  and  lowering  arterial  tension. 
There  is,  moreover,  a  tendency  to  fatty  degeneration  of  the  muscles 
and  liver. 

Therapeutics. — The  manganese  dioxide  has  been  used  in  the 
treatment  of  gastralgia,  pyrosis,  and  simple  ulcer  of  the  stomach. 
Its  action  probably  resembles  that  of  bismuth,  though  it  is  a  much 
less  efficient  remedy  than  the  latter  drug. 

The  sulphate  is  used  occasionally  as  a  cholagogue  purgative  in 
malarial  jaundice,  although  why  it  should  be  preferred  to  many 
other  and  superior  cholagogues  it  is  difficult  to  understand.  Gouty 
dyspepsia  appears  to  have  been  much  improved  by  the  use  of 
manganese.  The  association  of  iron  and  manganese  makes  a 
valuable  combination  in  the  treatment  of  chlorosis  and  many 
variations  of  anemia. 

Phosphorus— Phosphor!— Phosphorus.  TJ.  8.  P. 

Origin. — It  exists,  chiefly  as  phosphates,  in  many  minerals  and 
in  all  plants  and  animals.  It  is  prepared  by  treating  Calcined 
Bones  with  Sulphuric  Acid,  evaporation,  and  distillation. 

Description  and  Properties. — A  translucent,  nearly  colorless 
solid,  of  a  waxy  luster,  having  at  ordinary  temperatures  about  the 
consistence  of  beeswax.  When  kept  for  some  time  the  surface 
becomes  red  and  occasionally  black.  Phosphorus  has  a  distinctive 
and  disagreeable  odor  and  taste  (tasting  being  allowable  only  in  the 
form  of  extreme  dilution).  When  exposed  to  the  air  it  emits  white 
fumes,  visible  in  the  dark,  and  having  an  odor  somewhat  resembling 


HEMATICS.  ^  199 

that  of  garlic.     Upon  prolonged  exposure  to  air  it  takes  fire  spon- 
taneously. 

Phosphorus  is  insoluble,  or  nearly  so,  in  water,  to  which,  how- 
ever, it  imparts  its  characteristic  disagreeable  odor  and  taste.  It  is 
soluble  in  350  parts  of  absolute  alcohol,  in  80  parts  of  absolute 
ether,  and  in  about  50  parts  of  any  fatty  oil.  It  is  very  soluble  in 
chloroform  or  in  carbon  disulphide,  the  latter  yielding  a  solution  to 
be  handled  with  the  greatest  care  to  prevent  accident  from  combus- 
tion. The  drug  should  be  carefully  kept  under  water,  in  strong, 
well-closed  vessels,  in  a  secure  and  moderately  cool  place  protected 
from  light. 
.  Dose. — ^\f^   gifl  grain  (0.0006-0.002  Gm.). 

Official  Preparations. 

Oleum  Phosphoratum— Olei  Phosphorati— Phosphorated  0\\.—Dose,  1-5 
minims  (0.06-0.3  Cc).  A  clear,  yellowish  liquid,  having  the  odor  of  phosphorus  and 
of  ether,  but  not  phosphorescent  in  the  dark.  It  should  be  perfectly  free  from  particles 
of  undissolved  phosphorus. 

Pllulse  Ph6sphori— PJlulas  (ace.)  Ph6sphori — Pills  of  Phosphorus.— iJow, 
one  to  two  pills.     Each  pill  contains  ^-^  grain  (0.0006  Gm.)  of  phosphorus. 

Splritus  PhSsphori — SpKritus  PhSsphori— Spirit  of  Phosphorus  (Tincture 
OF  Phosphorus). — Dose,  5-30  minims  (0.3-2.0  Cc). 

Elixir  PhSsphori — Elixir  PhCsphori — Elixir  of  Phosphorus. — Dose,  ^2  fluid- 
drachms  (2.0-8.0  Cc). 

Antagonists  and  Incompatibles. — The  principal  chemical  anti- 
dotes are  hydrated  magnesia,  lime  water,  powdered  charcoal,  cop- 
per sulphate,  and  old  acid  turpentine. 

Sjrnergists. — Cod  liver  oil  and  the  Restoratives  generally  aid 
the  action  of  phosphorus.  It  is  claimed  that  arsenic  and  sulphur 
are  also  synergistic. 

Physiological  Action. — Externally  and  Locally. — Applied  to 
the  skin,  phosphorus  causes  local  inflammation,  ulceration,  and 
possibly  gangrene.  The  fumes  may  produce  the  most  serious 
results — even  maxillary  necrosis  where  dental  caries  is  present,  as 
well  as  great  irritation  of  the  conjunctivae  and  the  respiratory 
mucous  membrane.  The  graver  systemic  symptoms  are  confined 
to  the  conditions  induced  by  toxic  doses  of  the  drug. 

Internally. — Digestive  System. — Taken  into  the  stomach,  no 
special  effect  is  apparent  as  a  result  of  small  doses,  save  that  the 
drug  acts  as  a  functional  stimulant.  Larger  amounts  have  been 
held  to  impede  digestion  by  impairing  the  action  of  the  gastric 
juice   upon   albuminoid   materials.     Immoderate    dos^s   occasion 


200  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

great  irritation  of  the  stomach  and  intestines,  accompanied  by 
abdominal  distress,  vomiting,  and  purging.  Jaundice  is  a  not 
infrequent  result  of  ingestion,  due  to  obstruction  of  the  biliary 
ducts.  Minute  quantities  stimulate  the  nutrition  of  the  tissues, 
especially  that  of  the  osseous  system. 

Circulatory  System. — The  primaiy  action  is  stimulating,  the 
pulse  rising  and  acquiring  additional  force,  though  not  firmness. 
The  facial  capillaries  are  expanded,  often  congested ;  the  cutaneous 
circulation  becomes  more  rapid;  and  diaphoresis  is  produced. 
Under  toxic  doses  the  action  of  the  heart  is  strongly  depressed. 
Nervous  System. — In  repairing  the  waste  of  tissue  phosphorus 
acts  upon  the  nervous  system  as  a  tonic,  improving  the  nutrition 
of  debilitated  parts  and  restoring  to  normal  conditions  the  func- 
tional activity  of  organs  and  tissues.  Small  or  moderate  doses  act 
as  stimulants  to  the  entire  nervous  system,  intellectual  activity 
being  promoted  and  the  sexual  appetite  increased.  Toxic  effects 
include  coma,  and  occasionally  vertigo,  with  delirium,  convulsions, 
insensibility,  and  collapse. 

Respiratory  System. — The  deleterious  action  of  the  fumes  of 
phosphorus  is  exemplified  in  their  irritating  effect  upon  the  broncho- 
pulmonary mucous  membrane.  Toxic  symptoms  are  often  accom- 
panied by  serious  disturbances,  respiratory  failui^e  being  among  the 
immediate  causes  of  death. 

Absorption  and  Elimination. — The  modus  operandi  of  absorption 
is  a  matter  of  some  dispute.  Probably  a  portion  of  the  drug 
undergoes  oxidation  in  the  stomach,  and  the  phosphoric  acid 
formed,  combining  with  the  alkalies,  enters  the  blood  as  phos- 
phates. A  part  of  the  phosphorus  is  dissolved  in  the  fats  and  oils 
present  in  the  stomach,  probably  entering  the  circulation  as  ele- 
mentary phosphorus. 

The  drug,  having  undergone  oxidation  in  the  system,  is  elim- 
inated as  phosphoric  acid,  chiefly  by  the  urine,  increasing  the 
excretion  of  urinary  phosphates.  The  liver  shares  in  the  excretoiy 
process. 

Temperature. — Owing  to  capillary  expansion,  the  superficial 
temperature  is  at  first  slightly  raised,  being  subsequently  dimin- 
ished. Evaporation  and  radiation,  arising  from  profuse  diaphoresis, 
contribute  to  thermal  reduction. 

Eye. — In  chronic  poisoning  from  phosphorus  hemorrhages  and 
patches  of  degeneration  in  the  retina  are  sometimes  visible,  the 
ophthalmoscopic  picture  resembling  the  retinitis  of  albuminuria. 


HEMATICS.  20I 

Under  medicinal  doses  no  special  effects  upon  the  eye  are  reported, 
although,  as  has  been  stated,  the  vapor  of  phosphorus  is  highly 
irritant  to  the  conjunctivae. 

Uterus. — The  action  of  phosphorus  tends  to  increase  the  men- 
strual flow. 

Untoward  Action. — Small  doses  produce  in  some  individuals 
severe  gastric  disturbance,  and  in  rare  cases  diarrhea,  tenesmus, 
and  jaundice.  The  fatty  degeneration  of  the  retinal  capillaries 
mentioned  above — such  as  results  from  chronic  intoxication  affect- 
ing workers  in  match-factories — is  an  untoward  manifestation  to 
be  guarded  against  by  every  available  means. 

Poisoning. — The  effects  of  a  fatal  dose  of  phosphorus  are  not 
immediate.  After  a  lapse  of  several  hours  great  weakness  occurs, 
accompanied  in  a  large  majority  of  cases  by  vomiting.  Abdominal 
pains  follow,  the  symptoms  becoming  more  acute,  mucus  and  bile 
being  present  in  the  ejecta,  which  for  a  while  retain  the  odor  and 
luminosity  of  phosphorus.  With  the  cessation  of  vomiting  pain 
is  abated,  although  it  may  extend  over  the  entire  abdominal  region 
and  even  be  attended  with  paroxysms. 

The  foregoing  symptoms  are  accompanied  by  pronounced 
anorexia,  thirst  and  fever,  a  thickly-coated  or  whitish  tongue, 
burning  in  the  throat,  and  often  signs  of  collapse.  The  temper- 
ature at  first  reaches  nearly  the  maximum  possible  without  proving 
fatal,  subsequently  sinking  below  the  normal.  After  a  few  days 
jaundice  sets  in.  The  urine  is  diminished,  becoming  charged  with 
albumin  and  urates,  and  even  bloody,  containing  among  other 
ingredients  biliary  acids  and  coloring  matter.  In  fatal  cases  urea 
is  almost  wholly  wanting.  The  stools  may  be  normal,  but  the 
general  condition  is  usually  marked  by  diarrhea  or  constipation 
and  flatulence;  Hemorrhage  often  occurs,  wounds  bleeding  pro- 
fusely, and  as  the  severity  of  the  symptoms  increases  delirium 
ensues,  or  coma  terminating  in  convulsions. 

Serious  nervous  manifestations  are  frequently  preceded  by 
restlessness,  insomnia,  headache,  and  vertigo.  In  some  delirious 
conditions  wild,  erotic  states  of  the  mind  are  the  precursors  of 
convulsive  or  comatose  symptoms.  Somnolence  is  not  uncommon, 
with  partial  spasms  and  contraction  or  paresis  of  the  voluntary 
muscles.  Post-mortem  examinations  show  that  the  liver,  heart, 
kidneys,  muscles,  capillaries,  and  arterioles  are  implicated  in  the 
general  effects  of  the  poisoning,  undergoing  fatty  degeneration. 

Sometimes  the  preponderating  influence  of  the  poison  affects 


202  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

the  bronchial  and  gastro-intestinal  mucous  membranes,  or  it  rtiay 
visit  the  nervous  system  or  be  manifested  in  the  circulatory  sys- 
tem. In  cases  of  acute  poisoning  the  duration  of  the  malady 
varies  greatly,  death  occurring  at  times  within  a  few  days,  or,  again, 
being  deferred  for  a  few  weeks.  As  a  rule,  recovery  is  retarded, 
the  elimination  of  the  drug  requiring  time. 

The  symptoms  of  dironic  poisoning  are  in  some  respects  espe- 
cially marked,  inhalation  of  phosphorus-fumes  frequently  resulting 
in  pronounced  conditions  of  necrosis,  particularly  of  the  lower  max- 
illary, although  it  has  been  maintained  that  this  feature  of  the  poi- 
soning is  contingent  upon  denuded  surfaces  of  bone,  disintegration 
or  softening  of  tissues,  caries  of  the  teeth,  or  communicating  wounds. 
Very  rarely  the  palate  and  frontal  bones  are  similarly  attacked. 

Treatment  of  Poisoning. — Emetics  and  purgatives  are  of  the 
first  necessity.  Copper  sulphate  is  the  most  efficient  emetic  as  well 
as  the  best  chemical  antidote.  Hydrated  magnesia,  charcoal,  and 
lime  water  have  been  suggested,  yet  their  action  is  tardy,  and  a 
more  efficient  antidote  is  desirable.  Several  chemical  and  physio- 
logical agents  have  been  employed  to  counteract  the  effects  of  the 
drug,  among  them  old  acid  (oxygenated)  oil  of  turpentine  and 
potassium  permanganate  in  a  ^  per  cent,  solution,  opium  being 
used  as  a  stimulant  to  the  heart  and  the  circulatory  system. 

As  prophylactic  measures  for  the  protection  of  workmen  against 
phosphor-necrosis  masks  covering  mouth  and  nose  have  been 
found  serviceable,  as  well  as  inhalation  of  the  vapor  of  turpentine 
obtained  by  suspending  a  small  bottle  of  the  fluid  about  the  neck. 
The  teeth  should  be  kept  constantly  in  good  condition,  since  caries 
favors  the  tendency  to  necrosis. 

Therapeutics. — Phosphorus  is  not  used  externally,  but  inter- 
nally it  is  a  food,  especially  of  the  nervous  and  osseous  systems, 
stimulating  protoplasmic  activity,  although,  according  to  Gubler, 
"  phosphorus  is  a  rapid  stimulant,  but  it  acts  by  causing  waste,  and 
not  by  increasing  power ;  it  impoverishes,  and  does  not  enrich ; 
it  momentarily  galvanizes,  as  it  were,  the  torpid  functions,  but  is 
incapable  of  renewing  a  dilapidated  constitution  or  even  a  nervous 
system  exhausted  by  chronic  disease." 

Clinical  experience  has  certainly  demonstrated  its  utility  as  a 
nutrient  tonic  to  the  nervous  and  osseous  tissues.  In  neurasthenia 
and  chronic  nervous  exhaustion  it  is  highly  efficacious.  Paraplegia, 
particularly  when  resulting  from  excessive  venery,  is  usually  bene- 
fited by  this  drug,  while  the  cases  of  locomotor  ataxia  improved  by 


HEMATICS.  303 

phosphorus  are  numerous  enough  to  deserve  special  consideration. 
Neuralgia,  particularly  of  the  fifth  nerve  and  accompanied  by  great 
debility,  is  relieved  by  full  doses  administered  every  four  hours. 

It  is  claimed  by  competent  observers  that  certain  cases  of  angina 
pectoris  have  been  completely  relieved  by  phosphorus.' 

It  has  even  been  recommended  in  epilepsy,  but  its  value  here 
becomes  more  than  doubtful  when  no  mention  of  it  is  made  by  the 
best  authorities  on  this  disease. 

In  paralysis  resulting  from  cerebral  hemorrhage  it  has  been 
found  beneficial. 

It  has  proved  of  great  value  in  osteomalacia  and  rachitis,  and 
the  drug  is  credited  with  the  cure  of  pernicious  anemia,  though  it 
is  singular,  if  the  drug  possesses  any  real  value  in  this  disease,  that 
the  fact  has  been  recognized  by  so  few  observers.  Such  able  men 
as  Fox  and  Broadbent  praise  its  efficacy  in  lymphadenoma.  The 
insomnia  of  the  aged  and  the  wakefulness  of  cerebral  anemia  and 
exhaustion  usually  yield  to  this  remedy. 

As  to  its  aphrodisiac  effects  there  is  great  difference  of  opinion, 
some  physicians  believing  it  to  be  a  most  powerful  agent  in  reliev- 
ing functional  impotence,  while  others — among  them  so  enthusiastic 
an  advocate  of  phosphorus  as  Thompson — conclude  that  the  drug 
is  inefficient  for  this  purpose  unless  given  in  larger  doses  than 
safety  prescribes.  The  enthusiastic  praise  of  its  eulogists,  however, 
as  a  remedy  in  impotence  of  a  functional  character  is  of  so  con- 
vincing a  nature  as  to  certainly  justify  an  extended  trial  in  this 
condition.  Scarcely  less  is  the  testimony  regarding  its  efficacy  in 
chronic  psoriasis,  lepra,  lupus,  and  acne  indurata. 

Administration. — Since  many  persons  have  a  peculiar  suscepti- 
bility to  phosphorus,  its  administration  should  begin  with  small 
doses,  and,  should  it  be  thought  necessary  to  prolong  the  adminis- 
tration for  an  indefinite  period,  the  tendency  of  the  drug  to  produce 
general  steatosis  should  not  be  forgotten. 

The  phosphorus  pill  is  undoubtedly  the  best  form  in  which  to 
administer  the  drug,  though  it  possesses  the  disadvantages  of  being 
insoluble  in  the  intestinal  fluids  and  of  producing  more  or  less 
irritation  of  the  gastro-intestinal  mucous  membrane,  though  the 
latter  effect  is  usually  unnoticed  under  ordinary  medicinal  dosage 
on  a  full  stomach.  The  liquid  preparations  of  phosphorus  are 
more  unstable,  tending  to  become  rapidly  inert  by  oxidation. 

The  spirit  of  phosphorus  is  sometimes  given  in  cod  liver  oil  or 
the  elixir  of  calisaya. 


204  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Calcii   Hypophosphis— Calcii  Hypophosphltis— Cal- 
cium Hypophosphite.     JJ.  S.  F. 

Origin. — Obtained  by  heating  Phosphorus  with  Milk  of  Lime 
and  exposing  the  mixture  to  the  air. 

Description  and  Properties. — Colorless,  transparent,  mono- 
clinic  prisms,  or  small,  lustrous  scales,  or  a  white,  crystalline 
powder;  odorless,  having  a  nauseous,  bitter  taste,  and  permanent 
in  the  air.  Soluble  in  6.8  parts  of  water  and  in  6  parts  of  boiling 
water;  insoluble  in  alcohol. 

Dose. — 5-6  grains  (0.3-0.4  Gm.). 

Calcii  Phosphas  Praecipitatus— Calcii  Phosphatis 
Praecipitati— Precipitated  Calcium  Phosphate. 
V.  8.  P. 

Origin. — Prepared  by  the  action  of  Hydrochloric  Acid  and 
Water  upon  Bone-ash,  the  addition  of  Solution  of  Ammonia  to 
render  the  mixture  of  an  alkaline  reaction,  and  washing  and  drying 
the  precipitate. 

Description  and  Properties. — A  light,  white,  amorphous  pow- 
der, odorless  and  tasteless,  permanent  in  the  air.  Almost  insoluble 
in  cold  water ;  partly  decomposed  by  boiling  water,  which  dissolves 
out  an  acid  salt;  almost  insoluble  in  acetic  acid,  except  when 
freshly  precipitated ;  easily  soluble  in  hydrochloric  or  nitric  acid ; 
insoluble  in  alcohol. 

Dose. — 10-30  grains  (0.6-2.0  Gm.). 

Sodii  Hypophosphis— Sodii  HypophosphTtis— 
Sodium  Hypophosphite.    U.  S.  I*. 

Origin. — Prepared  by  adding  Sodium  Carbonate  to  a  solution 
of  Calcium  Hypophosphite  and  evaporating  the  filtrate. 

Description  and  Properties. — Small,  colorless,  transparent,  rec- 
tangular plates  of  a  pearly  lustre,  or  a  white,  granular  powder, 
odorless,  and  having  a  bitterish-sweet,  saline  taste.  Very  deliques- 
cent on  exposure  to  moist  air.  Soluble  in  i  part  of  water  and  in 
30  parts  of  alcohol,  also  in  0.12  part  of  boiling  water  and  in  i  part 
of  boiling  alcohol ;  slightly  soluble  in  absolute  alcohol ;  insoluble 
in  ether.  Sodium  hypophosphite  should  be  kept  in  well-stoppered 
bottles. 

Dose. — 5-10  grains  (0.3-0.6  Gm.). 


HEM  A  TICS.  205 

Potassii  Hypophosphis— Potassii  Hypophosphitis— 
Potassium  Hypophosphite.    U.S.  P. 

Origin. — Prepared  in  a  similar  manner  to  Calcium  Hypophos- 
phite, or  by  double  decomposition  of  Calcium  Hypophosphite  and 
Potassium  Carbonate. 

Description  and  Properties. — White,  opaque,  hexagonal  plates, 
or  crystalline  masses,  or  a  granular  powder,  odorless,  and  having  a 
pungent,  saline  taste;  very  deliquescent.  Soluble  in  0.6  part  of 
water  and  in  7.3  parts  of  alcohol.  Potassium  hypophosphite 
should  be  kept  in  well-stoppered  bottles. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Acidum  Hypophosphorosum  Dilutum— Acidi  Hypo- 
phosphorosi  Diluti— Diluted  Hypophosphorous 
Acid.    U.S. P. 

Origin. — Prepared  by  decomposing  Potassium  Hypophosphite 
by  Sulphuric  Acid,  filtering,  and  evaporating  to  a  syrupy  consist- 
ence. It  contains  10  per  cent,  by  weight  of  absolute  hypophos- 
phorous acid. 

Description  and  Properties. — A  colorless  liquid,  without  odor, 
and  having  an  acid  taste.  Specific  gravity  about  1.046.  Miscible 
in  all  proportions  with  water. 

Dose. — It  is  never  used  as  a  therapeutic  agent  by  itself,  but  in 
the  syrup  of  the  hypophosphites. 

Syrupus   HypopiiosphTtum— Syrupi    HypophospFiI- 
tum— Syrup  of  Hypopinosphites. 

Formula :  Calcium  Hypophosphite,  45  ;  Sodium  Hypophos- 
phite, 1 5  ;  Potassium  Hypophosphite,  1 5  ;  Diluted  Hypophos- 
phorous Acid,  2 ;  Spirit  of  Lemon,  5 ;  Sugar,  500 ;  sufficient 
Water  to  make   1000. 

Dose. — 1-2  fluidrachms  (4.0-8.0  Cc). 

SS^rupus  Hypophosphltum  cum  Ferro— S^rupi  Hy- 
pophosphltum  cum  Ferro— Syrup  of  Hypophos- 
phites with  Iron. 

Formula:  Ferrous  Lactate,  10;  Potassium  Citrate,  10;  Syrup 
of  the  Hypophosphites,  to  1000. 

Dose. — 1-2  fluidrachms  (4.0-8.0  Cc). 


2o6  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

ZTnci  Phosphidum— ZTnci  Phosphidi— Zinc 
Phosphide.     TJ.  S.  JP. 

Origin. — Prepared  from  Vapor  of  Phosphorus  in  a  current  of 
Dry  Hydrogen  over  heated  Zinc,  after  all  atmospheric  air  has  been 
expelled. 

Description  and  Properties. — A  gritty  powder  of  a  dark-gray 
color,  or  crystalline  fragments  of  a  dark,  metallic  luster,  and  having 
a  faint  odor  and  taste  of  phosphorus.  In  contact  with  air  it  slowly 
emits  phosphorous  vapor.  Insoluble  in  water  or  alcohol.  Zinc 
phosphide  should  be  kept  in  small  glass-stoppered  bottles. 

Dose. — j3g_i  grain  (0.004-0.02  Gm.). 

Antagonists  and  Incompatibles. — The  sodium  and  potassium 
hypophosphites  are  incompatible  with  the  soluble  salts  of  mercury 
and  silver,  and  the  soluble  phosphates  and  carbonates  are  incom- 
patible with  calcium  hypophosphite.  Zinc  phosphide  is  decom- 
posed by  mineral  acids. 

Synergists. — Phosphorus,  cod  liver  oil,  and  the  Restoratives 
generally. 

Physiological  Action. — Although  not  possessing  the  active 
and  poisonous  properties  of  phosphorus,  the  hypophosphites  are 
similar  in  their  effect  to  small  doses  of  phosphorus — i  e.  in  stimu- 
lating and  regenerating  the  nervous  system  and  those  tissues 
which  contain  phosphorus  and  lime. 

The  CALCIUM  PHOSPHATE  possesses  no  action  superior  to  that  of 
the  hypophosphite,  and  its  virtues  are  chiefly  those  of  the  hypo- 
phosphite. 

The  phosphate  is  soluble  to  a  slight  extent  in  lactic  and  hydro- 
chloric acids,  so  that  when  taken  by  the  stomach  a  portion  diffuses 
into  the  blood. 

The  ZINC  PHOSPHIDE  is  more  active,  and  resembles  more  closely 
the  action  of  phosphorus,  and  in  too  large  doses  it  irritates  the 
stomach  in  the  same  manner  as  uncombined  phosphorus. 

Therapeutics. — Externally  and  Locally. — The  calcium  phos- 
phate, combined  with  a  little  free  phosphoric  acid,  has  been 
recommended  by  Doubenski  in  the  treatment  of  tuberculous  ulcera- 
tions. "  Cold  abscesses  and  fistulous  tracts  were  treated  by  packing 
with  gauze  soaked  with  a  solution  of  5  parts  to  100." 

Internally. — The  hypophosphites  may  be  employed  for  the  same 
conditions  as  those  in  which  phosphorus  is  used.  In  chlorosis, 
anemia,  scrofula,  and  tuberculosis  they  have  been  highly  recom- 
mended.    In  the  author's  opinion,  in  the  cachexiae  mentioned  the 


HEMA  TICS.  207 

benefit  derived  from  their  use  is  slight  compared  with  that  of  cod 
hver  oil  and  the  hygienic  influences  rendered  serviceable  in  these 
conditions. 

The  praise  bestowed  upon  calcium  phosphate  consists  largely 
of  assertions  rather  than  evidence :  if  it  possesses  any  therapeutic 
value,  it  is  chiefly  that  of  the  hypophosphite. 

The  ZINC  PHOSPHIDE  has  medicinal  virtues  greatly  superior  to 
those  of  the  preparations  above  mentioned.  In  nervous  disorders 
dependent  upon  defective  nutrition  it  is  equal,  if  not  superior,  to 
phosphorus,  and  it  may  be  employed  for  any  condition  in  which 
the  latter  drug  is  useful. 

Administration. — The  zinc  phosphide  is  best  given  in  pill  form. 
The  hypophosphites  and  calcium  phosphate  may  be  given  in  cap- 
sules, though  the  syrup  of  the  hypophosphites  is  usually  preferred. 
It  is  a  question  whether  the  sugar  which  the  syrup  contains  may 
not  tend  to  induce  or  aggravate  the  gastric  fermentation  so  often 
present  in  cases  requiring  the  use  of  a  reconstituent. 

Cinchona— Cinchonas— Cinchona.    V.  S.  J?. 

Origin. — The  bark  of  Cinchona  Calisaya  Weddell,  Cinchona 
officinalis  L.,  and  of  their  hybrids  and  those  of  other  species 
of  Cinchona,  yielding,  when  assayed  by  the  process  given  in  the 
U.  S.  Pharmacopoeia,  "  not  less  than  5  per  cent,  of  total  alkaloids 
and  at  least  2.5  per  cent,  of  quinine."  The  genus  Cinchona 
as  at  present  constituted  consists  of  from  thirty-one  to  thirty-six 
species,  all  of  which  are  native  to  South  America.  The  habitat 
of  the  tree  follows  the  eastern  slope  of  the  Andes,  beginning  in 
Bolivia  and  extending  through  Peru.  From  about  2"  south  lati- 
tude in  Ecuador  it  occupies  also  the  eastern  slope  of  the  Western 
Cordilleras,  until  by  two  narrow  belts  it  enters  the  highlands  of 
New  Granada,  whence  it  spreads  northeast  and  northward  into 
Venezuela,  reaching  the  vicinity  of  Caracas  and  the  Caribbean 
Sea. 

The  climate  in  which  the  most  valuable  species  are  found  is, 
according  to  Karster  (1858),  characterized  by  a  rainy  season  lasting 
for  nine  months,  heavy  rains  falling  principally  during  the  night, 
alternating  with  sunshine  and  fog  during  the  day.  During  the 
remaining  three  months  of  the  year  the  nightly  temperature  fre- 
quently sinks  below  freezing-point,  in  the  day-time,  however, 
reaching  25°  C.  {77°  F.),  producing  dense  fogs. 

The  Cinchonas  are  evergreen  trees  or  shrubs,  the  most  valuable 


2o8  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

species  attaining  a  height  of  from  40  to  80  feet  (12  to  24  M.). 
They  are  not  met  with  in  the  valleys,  but  are  found  at  altitudes 
varying  from  330  feet  (100  M.)  to  11,500  feet  (3500  M.).  Accord- 
ing to  Weddell,  the  most  valuable  species  grow  at  an  altitude  of 
5300  to  7900  feet  (1600  to  2400  M.).  All  the  species  are  found 
in  the  primeval  forests,  either  singly  or  in  collections  of  a  few 
specimens.  The  tree  is  cultivated  in  British  Sikkin,  Ceylon,  Java, 
and  Jamaica. 

Description  and  Properties. — In  quills  or  in  curved  pieces, 
varying  in  length,  and  usually  ^  ox  \  inch  (2  or  3  Mm.),  or  some- 
times \  inch  (5  Mm.),  thick ;  the  outer  surface  covered  with  a  gray 
or  brownish-gray  cork,  usually  slightly  wrinkled,  marked  with 
transverse  and  also  intersecting  longitudinal  fissures  {C.  Calisayd), 
and  sometimes  with  scattered  warts  and  slight  longitudinal  ridges ; 
inner  surface  light  cinnamon-brown,  very  highly  striate;  fracture 
of  the  outer  layer  short  and  granular,  finely  fibrous  in  the  inner 
layer ;  powder  light-  or  yellowish-brown ;  odor  slight,  somewhat 
aromatic;  taste  bitter  and  somewhat  astringent. 

Cinchona  Rubra— Cinchonae  Rubra— Red  Cin- 
chona.    U.  S.  JP. 

Origin. — The  bark  of  Cinchona  succirubra  Pavor,  containing  not 
less  than  5  per  cent,  of  its  peculiar  alkaloids. 

Description  and  Properties. — In  quills  or  in  curved  pieces, 
varying  in  length,  and  from  ^I^.  to  |  or  |  inch  (2  to  4  or  5  Mm.) 
thick ;  the  outer  surface  covered  with  a  grayish-brown  cork,  more 
or  less  rough  from  warts  and  longitudinal  warty  ridges,  and  few, 
mostly  short,  transverse  fissures;  inner  surface  rpore  or  less  deep 
reddish-brown  and  distinctly  striate ;  fracture  short-fibrous  in  the 
inner  layer ;  powder  reddish  brown  ;  odor  slight ;  taste  bitter  and 
astringent. 

Among  the  various  alkaloids  found  in  cinchona  the  following 
are  the  most  important:  Quinine,  quinidine,  cinchonine,  and  cin- 
chonidine,  the  medicinal  value  of  the  bark  depending  almost  exclu- 
sively upon  the  alkaloid  quinine. 

Other  less  important  ingredients  are  kinic  and  kinovic  acids, 
kinovin,  cinchotannic  acid,  cinchona-red,  and  a  minute  quantity  of 
a  butyraceous,  volatile  oil.  The  ash  amounts  to  between  i  and  2 
per  cent,  consisting  chiefly  of  the  carbonates  of  calcium  and  potas- 


sium. 


Dose  of  powdered  cinchona,  15-60  grains  (1.0-4.0  Gm.). 


HEM  A  TICS.  209 

Official  Preparations  of  Cinchona. 

ExtrSctum  Cinchonae — ExtrScti  Cinchonae — Extract  of  Cinchona. — Dose,  5- 
30  grains  (0.3-2.0  Gm.). 

Extractum  Cinchonae  Fluidum — ExtrScti  Cinchonae  Fliiidi — Fluid  Extract 
of  Cinchona. — Dose,  10-60  minims  (0.6-4.0  Cc). 

Infusum  Cinchonae — Infusi  Cinchonae — Infusion  of  Cinchona  (6  per  cent.). — 
Dose,  1-4  fluidrachms  (4.0-15.0  Cc). 

Tinctiira  Cinchonae — Tinctjirae  Cinchonae — Tincture  of  Cinchona  (20  per 
cent.). — Dose,  1-2  fluidrachms  (4.0-8.0  Cc). 

Official  Preparation  of  Cinchona  Rubra. 

Tinctiira  Cinchonae  Comp6sita — Tinctiirae  Cinchonae  Compfisitae — Com- 
pound Tincture  of  Cinchona  (10  per  cent.,  with  Bitter  Orange  Peel  8  per  cent.,  and 
Serpentaria  2  per  cent.). — Dose,  1-4  fluidrachms  (4.0-15.0  Cc). 

Official  Alkaloids  and  Salts. 

Cinchonidinae  Stilphas — Cinchonidinae  Sulphatis— Cinchonidine  Sulphate. 

— Description  and  Properties. — White,  silky,  acicular  crystals,  without  odor  and  having 
a  very  bitter  taste ;  slightly  efflorescent  on  exposure  to  air.  Soluble  in  70  parts  of  water 
and  in  66  parts  of  alcohol. 

Dose. — 10-30  grains  (0.6—2.0  Gm.). 

Cinchonina — Cinchonlnae — Cinchonine . — Description  and  Properties. — White 
lustrous  prisms  or  needles,  without  odor,  at  first  almost  tasteless,  but  soon  developing 
a  bitter  after-taste;  permanent  in  the  air;  soluble  in  3760  parts  of  water  and  in  116 
parts  of  alcohol. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Cinchoninae  Stilphas — Cinchonlnae  Sulphatis — Cinchonine  Sulphate. — 
Description  and  Properties. — Hard,  white,  lustrous,  prismatic  crystals,  without  odor 
and  of  a  very  bitter  taste ;  permanent  in  the  air ;  soluble  in  66  parts  of  water  and  in 
10  parts  of  alcohol. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Quinidinae  Stilphas — Quinidinae  Sulphatis — Quinidine  Sulphate. — Descrip- 
tion and  Properties. — White  silky  needles,  odorless,  and  of  a  very  bitter  taste;  per- 
manent in  the  air;  soluble  in  100  parts  of  water  and  in  8  parts  of  alcohol.  It  should 
be  kept  in  well-stoppered  bottles,  in  a  dark  place. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Quinina — Quininae — Quinine. — Description  and  Properties. — A  white^  flaky, 
amorphous  or  crystalline  powder,  odorless,  and  having  a  very  bitter  taste ;  permanent  in 
the  air;  soluble  in  1670  parts  of  water  and  in  6  parts  of  alcohol.  Quinine  should  be 
kept  in  well-stoppered  bottles,  in  a  dark  place. 

Dose. — 1-60  grains  (0.06-4.0  Gm.). 

Quininae  Bistilphas — Quininae  Bisulphatis — Quinine  Bisulphate. — Descrip- 
tion and  Properties. — Colorless,  transparent,  or  whitish  orthorhombic  crystals  or  small 
needles ;  odorless  and  having  a  very  bitter  taste ;  efflorescent  on  exposure  to  the  air. 
Soluble  in  10  parts  of  water  and  in  32  parts  of  alcohol.  It  should'te  Kept  in  well- 
stoppered  bottles,  in  a  dark  place. 

Dose.— t-lS  grains  (0.06-1.0  Gm.). 

Quininae  Hydrobromas— Quininae  Hydrobromatis — Quinine  Hydrobro- 
msite.— Description  and  Properties.— ^hite,  light,  silky  needles ;  odorless  and  of  a  very 
14 


J 


3IO  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

bitter  taste.  The  salt  is  liable  to  lose  water  on  exposure  to  warm  or  dry  air.  Soluble 
in  54  parts  of  water  and  in  0.6  part  of  alcohol.  It  should  be  kept  in  well-stoppered 
bottles,  in  a  dark  place. 

Dose. — 1-20  grains  (0.06-1.3  Gm.). 

Quininae  Hydrochloras — Quinlnae  Hydrochloratis— Quinine  Hydrochlorate. 
— Description  and  Properties. — White,  silky,  light,  and  fine  needle-shaped  crystals, 
odorless,  and  having  a  very  bitter  taste.  The  salt  is  liable  to  lose  water  on  exposure  to 
warm  air.  Soluble  in  34  parts  of  water  and  in  3  parts  of  alcohol.  Quinine  hydro- 
chlorate  should  be  kept  in  well-stoppered  bottles,  in  a  dark  place. 

Dose. — 1-15  grains  (0.06-1.0  Gm.). 

Quininae  SOlphas — Quinmae  Sulphatis — Quinine  Sulphate, — Description  and 
Properties. — White,  silky,  light,  and  fine  needle-shaped  crystals,  fragile  and  somewhat 
flexible,  making  a  very  light  and  easily  compressible  mass,  lusterless  from  superficial 
efflorescence  after  being  for  some  time  exposed  to  the  air;  odorless  and  having  a  per- 
sistent, very  bitter  taste.  The  salt  is  liable  to  lose  water  on  exposure  to  warm  air,  to 
absorb  moisture  in  damp  air,  and  to  become  colored  by  exposure  to  light.  Soluble  in 
740  parts  of  water  and  in  65  parts  of  alcohol,  also  in  40  parts  of  glycerin  and  in  about 
680  parts  of  chloroform,  nnd  freely  soluble  in  dilute  acids.  It  should  be  kept  in  well- 
stoppered  bottles,  in  a  dark  place. 

Dose. — 1-60  grains  (0.06-4.0  Gm.). 

Quininae  Valerianas  —  Quininae  Valerianatis  —  Quinine  Valerianate. — 
Description  and  Properties. — White  or  nearly  white,  pearly,  lustrous,  triclinic  crystals, 
having  a  slight  odor  of  valerianic  acid,  and  a  bitter  taste ;  permanent  in  the  air ;  soluble 
in  100  parts  of  water  and  in  5  parts  of  alcohol.'  It  should  be  kept  in  well-stoppered 
bottles,  in  a  cool  place. 

Dose. — 1-20  grains  (0.06-1.3  Gm.). 

Unofficial  Alkaloids  and  Salts. 

Chinoidinum— Chinoidini — Chinoidine. —  Origin. — Obtained  from  the  mother- 
liquor  in  the  preparation  of  quinine  sulphate,  cinchonine,  and  the  other  alkaloids  of 
cinchona. 

Description  and  Properties. — Cylindrical  rolls  or  masses,  of  a  more  or  less  deep- 
brown  or  black  color  and  a  resin-like  appearance.  It  has  but  a  slight  taste,  being  faintly 
bitter  on  mastication.     Almost  insoluble  in  water;  freely  soluble  in  alcohol. 

Dose. — 3-30  grains  (0.2-2.0  Gm.). 

Cinchonidinae  SalKcylas — Cinchonidinae  Salicylatis — Cinchonidine  Salicy- 
late.— Dose,  2-10  grains  (0.12-0,6  Gm.). 

Cinchonina  lodosfilphas— Cinchoninae  lodosulphatis— Cinchonine  lodosul- 
phate  (Antiseptol)  (50  per  cent,  of  wSmt).— Description  and  Properties.— K  light 
powder  of  a  reddish-brown  color;  insoluble  in  water,  but  soluble  in  alcohol.  Used 
principally  as  a  substitute  for  iodoform. 

Chlnolin— Chinolin— Chinolin  (Quinolin).—  0?-;;^««.— Prepared  from  Cincho- 
nine or  Quinine  by  distillation,  or  obtained  synthetically. 

Description  and  Properties.— K  colorless  liquid,  with  an  aromatic,  pungent  odor; 
sligh^  soj^^jein  water,  freely  soluble  in  alcohol. 

Dos'e. — 3-ilLminims  (0.18-0.6  Cc). 

CM^ollfli^'rartras— Chlnolin  Tartratis— Chinolin  Tartrate.— Soluble  in  70  or 
80  parts  of  water.     Dose,  5-15  grains  (0.3-1.0  Gm.). 

Quinetum— Quineti— Quinetum.— A  mixture  of  the  alkaloids  precipitated  by  an 


f        alkali.     Dose,  l-6o  grains  (0,06-4,0  Gm.). 


HEMATICS.  2X1 

Quininae  Hydrochloras  Carbamidata — Quininae  Hydrochloratis  Carbami- 
dStae. — Double  salt  of  Quinine  and  Urea.  Soluble  in  water.  Dose,  I-IO  grains  (0.06- 
0.6  Gm.).     Usually  employed  hypodermically. 


Antagonists  and  Inoompatibles. — Agents  promoting  waste — 
such  as  the  salts  of  mercury,  iodine,  copper,  zinc,  and  lead — are 
therapeutically  antagonistic  to  cinchona.  The  cerebral  effects  of 
quinine  are  antagonized  by  morphine,  while  atropine  opposes  its 
action  upon  the  nervous  and  circulatory  systems,  as  well  as  its 
antipyretic  powers. 

The  incompatibles  are  free  tannic  acid,  alkalies  and  alkaline 
earths,  and  iodine.  Fowler's  solution  is  incompatible  with  infusion 
and  decoction  of  cinchona. 

Synergists. — The  Restoratives  and  all  agents  promoting  con- 
structive metamorphosis.  The  antipyretic  action  of  quinine  is 
enhanced  by  the  antipyretics,  salicyhc  acid,  and  sortie  of  the  anti- 
septics. Its  antiperiodic  action  is  aided  by  arsenic,  eucalyptus, 
carbolic  acid,  and  creasote. 

Quinine  fully  represents  the  crude  drug.  It  is  classed  as^  a 
Restorative  because  it  is  analogous  to  taurocholate  of  sodium, 
taurin  being  a  natural  antiseptic  and  germicide,  destroying  or  pre- 
venting the  propagation  of  many  pathogenic  organisms  entering 
the  system. 

The  name  Cinchona  given  to  Peruvian  bark  was  accorded  in 
honor  of  the  countess  of  Chinchon,  cured  of  tertian  fever  by  the 
use  of  the  drug,  as  early  as  the  seventeenth  century,  the  Spanish 
conquerors  of  the  country  having  discerned  the  curative  properties 
of  the  plant  which  scientific  investigation  has  rendered  invaluable 
as  a  therapeutic  agent.  The  native  Indians  had  long  been  ac- 
quainted with  its  medicinal  virtue,  and  but  for  the  inquisitorial 
bigotry  of  the  age  the  beneficiary  of  its  potency,  upon  her 
return  to  Spain,  would  have  introduced  it  into  Europe.  Such, 
however,  was  the  antagonism  aroused  among  an  over-zealous 
clergy,  and  so  great  the  force  of  professional  rivalry,  that  every- 
where the  new  discovery  encountered  opposition,  one  religious 
body  formally  spurning  it  as  the  invention  of  unenlightened  sav- 
ages, although  the  countess  was  not  deterred  from  employing  it 
among  the  peasantry  dwelling  upon  her  estates  (Markham). 

About  the  middle  of  the  seventeenth  century  a  large  quantity 
of  the  bark  received  from  America  reawakened  discussion,  and 
finally  a  council  of  Jesuits  held  at  Rome  approved  a  distribution 
of  the  drug — called  therefrom  "  Jesuits'  bark."     It  quickly  found 


213  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

its  way  to  other  parts  of  the  Continent  and  to  England ;  yet  still 
the  opposition  to  its  use  was  pronounced,  and  it  was  only  when  an 
English  quack  doctor  succeeded  in  effecting  cures  among  persons 
of  rank  by  an  employment  of  the  drug  that  its  services  became 
general  in  malarial  and  typhoid  fevers,  as  well  as  in  various  other 
diseases. 

The  discovery  of  the  active  principles  of  cinchona,  crudely  es- 
tablished by  Duncan  in  1803,  was  perfected  by  Pelletier  and  Cav- 
entou  in  1820  by  the  preparations  of  quinine  and  cinchonine.  In 
1833  quinidine  became  partially  known,  being  completely  isolated 
as  an  active  principle  in  1852,  quinine  a,nd  cinchonine  having  been 
employed  since  18 20-2 1. 

Until  the  researches  of  Marchiafava,  Celli,  Laveran,  Golgi,  and 
others  had  disclosed  the  true  etiology  of  malaria,  quinine  was  used 
empirically  in  malarial  diseases,  its  precise  action  being  unknown. 
Its  efficacy  is  now  ascertained  to  be  due  to  its  power  of  destroying 
the  Plasmodia  of  malaria.  In  addition  to  this  action,  which  renders 
the  drug  of  the  greatest  value  in  malarial  diseases,  quinine  pos- 
sesses many  other  important  properties,  which  are  here  considered.  . 

Physiological  Action. — Externally  and  Locally. — The  drug  is  a 
potent  antiseptic,  preventing  putrefaction  and  fermentation  by  its 
destructive  influence  upon  fungi  and  infusoria,  a  solution  of  i :  250 
being  sufficient  for  this  purpose,  while  i  :  500  is  fatal  to  certain 
micro-organisms,  and  even  so  weak  a  solution  as  i  :  1000  suffices 
to  destroy  some  infusoria. 

Upon  the  unbroken  skin  it  has  little  effect,  other  than  to  pro- 
duce occasionally  a  slight  roughening  of  the  surface.  To  raw 
surfaces,  however,  and  to  mucous  membranes  it  is  irritant. 

Internally. — Digestive  System. — Its  action  resembles  that  of 
vegetable  bitters,  augmenting  the  secretions  from  the  salivary  and 
gastro-intestinal  glands,  stimulating  peristalsis,  and  increasing  the 
blood-supply  to  the  stomach.  Under  moderate  doses,  therefore, 
the  appetite  and  digestion  are  improved.  Large  dosage  disturbs 
digestion,  occasioning  nausea,  with,  possibly,  vomiting  and  diarrhea. 
The  acidity  of  the  stomach  is  said  to  be  increased  by  quinine  sul- 
phate. 

Circulatory  System. — Small  doses  increase  the  force  and  fre- 
quency of  the  heart's  action,  excessive  doses  slowing  and  weaken- 
ing it,  and,  frequently  in  children,  causing  an  intermittent  pulse. 
Toxic  doses  paralyze  the  heart,  arresting  it  in  diastole.  It  is  not 
certain  whether  these  effects  are  due  to  an  action  on  the  cardiac 


HEMATICS.  313 

muscle  or  on  the  ganglia.  It  is  evident,  though,  that  small  doses 
elevate  and  large  doses  depress  arterial  tension. 

Quinine  in  a  remarkable  manner  affects  the  constituents  of  the 
blood.  The  ameboid  movements  of  the  white  blood-corpuscles 
are  arrested;  preventing  their  migration  through  the  capillary  walls 
in  inflammation,  while  their  number  is  diminished  by  full  doses  of 
the  drug  both  in  health  and  in  inflammatory  conditions.  The  red 
corpuscles  are  materially  increased  in  number,  at  least  in  propor- 
tion to  the  white  corpuscles,  the  size  of  the  former  being  dimin- 
ished in  febrile  conditions. 

Quinine  retards  or  impairs  the  ozonizing  power  of  the  blood, 
and  lessens  the  oxygen-carrying  capacity  of  the  red  corpuscles. 

Nervous  System. — Small  doses  stimulate  the  cerebrum.  Large 
doses  occasion  cerebral  congestion,  with  a  sensation  of  dizziness, 
fulness  in  the  head,  and  other  symptoms  described  at  length  under 
"  Cinchonism." 

The  reflex  function  of  the  spinal  cord  is  reduced,  and  under 
toxic  doses  ultimately  abolished,  owing  to  stimulation  of  Setsche- 
now's  inhibitory  center,  and  later  to  direct  depression  of  the  spinal 
cord  and  nerves.  In  frogs  the  sensory  nerves  are  first  excited  and 
subsequently  paralyzed,  through  the  influence  of  the  drug  upon 
the  peripheral  endings.  The  muscles  are  uninfluenced,  though 
when  appUed  directly  to  muscular  fiber  the  drug  acts  as  an  irritant, 
producing  muscular  contractions. 

Respiratory  System. — Quinine  exerts  but  little  influence  upon 
the  respiration,  small  doses  shghtly  increasing  and  large  doses 
depressing  the  respiratory  movements. 

Absorption  and  Elimination. — The  drug  is  quite  rapidly  absorbed 
from  the  stomach,  but  not  from  the  intestines.  While  its  presence 
may  be  detected  in  the  urine  within  fifteen  minutes  afl:er  the  inges- 
tion of  a  full  dose,  many  hours,  or  even  days,  may  elapse  before 
the  drug  is  finally  excreted. 

Much  of  the  drug  undergoes  a  change  in  the  system,  being 
oxidized  in  the  Uver,  yet  it  may  be  detected  in  the  urine  as  quinine 
and  various  isomeric  modifications  of  it.  While  chiefly  eliminated 
by  the  kidneys,  it  may  escape  from  the  system  by  other  channels, 
having  been  found  in  the  milk,  sweat,  saliva,  tears,  bile,  and  in 
dropsical  effusions. 

The  excretion  of  uric  acid,  urea,  and  other  nitrogenous  material 
is  considerably  diminished  under  the  use  of  quinine. 

Temperature. — In  health  the  temperature  is  unaffected  by  qui- 


214  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

nine,  but  in  febrile  conditions,  particularly  in  malarial  fever,  the 
drug  acts  as  a  powerful  antipyretic.  Yet  it  is  doubtful  whether  the 
drug  is  a  true  antipyretic — i.  e.  through  its  action  upon  the  thermo- 
genetic  tissues  or  centers.  It  is  a  matter  of  clinical  observation 
that  intermittent,  typhoid,  and  one  form  of  puerperal  fever  are  the 
only  diseases  which  readily  yield  to  the  antipyretic  influence  of 
quinine,  the  temperature  in  such  maladies  as  erysipelas,  pneu- 
monia, pleurisy,  etc.  being  comparatively  unaffected  even  by  large 
dosage,  seeming  to  prove  that  the  drug  is  an  antipyretic  only  when 
it  destroys  or  renders  inert  the  infective  agent  producing  the  fever. 

Eye. — There  have  been  recorded  several  cases  of  quinine  amau- 
rosis, with  transitory  blindness,  color-blindness,  wide  dilatation  of 
pupils — irresponsive  to  light,  but  responding  to  accommodation 
effort — pallor  of  the  optic  disks,  with  extreme  diminution  of  both 
retinal  veins  and  arteries  and  contraction  of  the  visual  field. 

Quinine  amaurosis,  however,  is  probably  very  rare,  but  a  lim- 
ited number  of  cases  being  recorded,  although  Rogers  believes 
that  "  incomplete  ocular  cinchonism  "  is  of  quite  frequent  occur- 
rence. 

Uterus. — After  the  inception  of  labor  quinine  seems  frequently 
to  stimulate  the  uterine  contractions.  It  also  increases  a  scanty 
menstrual  flow.  There  appears  to  be  no  authoritative  evidence 
that  quinine  is  an  abortifacient. 

Untoward  Action. — Besides  the  symptoms  of  cinchonism  from 
which  some  persons  suffer  after  the  ingestion  of  a  small  dose,  there 
are  often  occasioned  various  eruptions  of  the  skin,  often  accom- 
panied by  marked  pruritus,  the  eruption  produced  by  the  drug  at 
times  strongly  resembling  scarlatina. 

Peculiar  disturbances  of  vision  and  impaired  hearing  not  infre- 
quently attend  the  administration  of  quinine.  There  have  been 
recorded  cases  of  renal  and  vesical  irritation,  varying  in  intensity, 
following  the  use  of  the  drug.  The  administration  of  the  salts  of 
quinine  in  pill  form  is  often  followed  by  gastro-intestinal  catarrh. 
The  drug  has  also  been  known  to  occasion  epistaxis  and  hem- 
optysis. 

Poisoning. — Excessive  doses  of  quinine  produce  a  series  of 
symptoms  collectively  termed  cinchonism.  They  are — a  feeling  of 
fulness  in  the  head,  ringing  or  buzzing  in  the  ears,  varying  degrees 
of  deafness,  headache,  with  possibly  delirium,  disturbances  of 
vision,  vertigo,  and  muscular  weakness.  Should  the  dose  be  lethal, 
there  may  be  marked  cardiac  and  respiratory  failure,  and  collapse. 


HEMATICS. 


215 


Treatment  of  Poisoning. — Potassium  bromide  and  hydrobromic 
acid  are  the'  best  agents  to  relieve  the  symptoms  of  cinchonism, 
full  doses  of  the  latter  given  with  quinine  being  said  to  prevent 
untoward  results. 

Should  the  dose  be  sufficient  to  depress  the  heart  and  respira- 
tion in  a  marked  degree,  cardiac  and  respiratory  stimulants  would 
be  indicated. 

Therapeutics. — Externally  and  Locally. — Powdered  cinchona 
bark  is  an  ingredient  of  many  tooth-powders.  Quinine  also  enters 
into  the  composition  of  many  "  hair  tonics,"  and  is  highly  recom- 
mended by  some  physicians  in  the  treatment  of  alopecia. 

The  drug  has  been  employed  with  varying  success  in  many 
diseases  of  the  nose  and  throat,  such  as  hay  fever,  whooping  cough, 
ozena,  tonsillitis,  etc. 

Ledetsch  has  highly  recommended  quinine  bisulphate,  i  part  to 
100  parts  of  water  and  glycerin,  as  an  injection  in  gonorrhea.  The 
drug  has  been  used  with  tincture  of  ferric  chloride  as  a  paint  to 
prevent  the  spread  of  erysipelas.  A  2  per  cent,  solution  has  proved 
an  efficient  remedy  in  cystitis,  effectually  preventing  the  decomposi- 
tion of  the  urine. 

Internally. — Undoubtedly  the  principal  use  of  quinine  is  in  the 
treatment  of  malarial  diseases.  When  we  realize  that  quinine  in 
I  part  to  20,000  is  destructive  of  the  plasmodium  malarise,  it  is 
readily  understood  why  the  drug  should  be  so  efficient  as  an 
antimalarial  remedy. 

Quinine  is  one  of  the  most  powerful  antiperiodics,  being  of 
more  or  less  value  in  many  diseased  conditions  characterized  by 
periodical  exacerbations.  All  forms  of  malarial  fever  usually  yield 
to  the  proper  use  of  quinine.  It  seems  to  be  equally  efficient  as  a 
prophylactic. 

The  pq|ibdical  affections  due  to  paludal  miasm  are  peculiarly 
amenable  to  this  drug,  among  these  disorders  being  the  various 
neuralgias,  headache,  asthma,  hay  fever,  chorea,  jaundice,  diarrhea, 
dysentery,  etc. 

Quinine  is  a  potent  antiphlogistic,  being  very  efficient  in  check- 
ing inflammation  and  suppuration. -  It  is  particularly  beneficial  in 
cases  of  prolonged  suppuration,  such  as  pulmonary  phthisis,  fistu- 
lous discharges,  septicemia,  pyemia,  puerperal  fever,  etc.  It  favor- 
ably influences  the  formative  stages  of  acute  inflammations,  as  in 
the  beginning  of  endocarditis,  pneumonia,  pleurisy,  etc. 

As  a  tonic  or  restorative  during  the  course  of  febrile  diseases. 


2i6  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

as  well  as  in  convalescence,  quinine  is  highly  efficient.  Its  action 
upon  the  gastro-intestinal  tract  renders  it  valuable  in  many  forms 
of  dyspepsia,  especially  the  atonic  variety.  In  these  cases,  where 
anemia  is  present,  the  drug  may  be  advantageously  combmed  with 
iron  and  nux  vomica. 

Quinine  is  but  little  used  now  as  a  pure  antipyretic,  being  of 
value  in  this  respect,  as  previously  stated,  only  when  it  destroys 
the  infective  cause  of  the  fever.  Its  antipyretic  influence  is  conse- 
quently more  marked  in  intermittent  fever.  It  is  of  value  also  in 
typhoid,  although  now  seldom  employed  in  this  disease. 

The  remedy  has  proved  efficient  in  some  cases  of  chorea  and 
whooping  cough.  It  is  of  decided  value  in  the  yeasty  vomiting  pro- 
duced by  the  sarcina  ventriculi,  and  equally  beneficial  in  impetigo ; 
while  acne  and  ecthyma,  when  occasioned  by  reduced  vitality  and 
impaired  nutrition,  are  greatly  benefited  by  its  internal  use. 

Quinine  is  serviceable  in  stimulating  the  uterine  contractions 
during  labor  and  increasing  the  menstrual  discharge  in  amenorrhea. 

Contraindications. — The  drug  is  contraindicated  in  acute  in- 
flammations of  the  genito-urinary  and  gastro-intestinal  tracts,  in 
acute  or  subacute  inflammations  of  the  middle  ear,  and  in  menin- 
gitis and  cerebritis.  It  should  not  be  given  to  infants  suffering 
from  eczema,  nor  to  persons  having  a  marked  idiosyncrasy  against 
the  drug. 

Administration. — Because  of  its  intensely  bitter  and  disagree- 
able taste  quinine  should  not  be  given  in  solution.  It  may  be  sus- 
pended in  syrup  of  yerba  santa  or  in  the  aromatic  elixir  of  liquorice, 
which  disguises  the  taste  quite  effectually,  and  for  children  is  pref- 
erable, as  a  method  of  administration,  to  capsules  or  pills.  In  the 
case  of  adults  the  drug  should  be  given  in  gelatin  capsules  or  in 
the  form  of  gelatin-  or  sugar-coated  pills. 

The  tannate  of  quinine  is  comparatively  tasteless,  and  may  be 
incorporated  with  chocolate  in  the  form  of  lozenges,  thus  being 
readily  taken  by  children. 

The  drug  may  be  also  administered  in  a  suppository  by  the 
rectum  or  incorporated  in  lard  and  rubbed  into  the  skin,  preferably 
in  the  axillae  and  the  inner  side  of  the  thighs  or  over  the  abdomen. 
It  has  been  employed  to  some  extent  hypodermically,  the  quinine 
hydrobromate  and  hydrochlorate  being  the  salts  preferred  for  this 
purpose.  Injections  should  be  made  in  the  buttocks,  and  very 
slowly  administered,  since  this  method  of  administration  depresses 
the  heart  to  a  considerable  degree. 


ANIMAL  EXTRACTS.  217 

Occasionally  in  the  treatment  of  malaria  Warburg's  tincture, 
containing  numerous  aromatics,  is  more  efficient  than  quinine. 

In  obstinate  malarial  affections  aromatics  and  spices  greatly 
enhance  the  effect  of  quinine,  capsicum  making  one  of  the  best 
adjuvants.  The  portal  circulation  is  stimulated,  rendering  the 
absorption  of  the  drug  more  rapid  and  its  effects  more  lasting. 

As  to  the  time  and  method  of  administration  in  malarial  dis- 
eases, the  student  is  referred  to  any  standard  work  on  the  Practice 
of  Medicine. 

The  various  tinctures  and  elikirs  of  cinchona  are  used  exten- 
sively ;  when  employed  as  stomachics  they  should  be  given  before 
meals. 

Quinine  is  best  given  on  an  empty  stomach  or  after  the  active 
process  of  digestion  is  completed. 


ANIMAL   EXTRACTS    (ORGANOTHERAPY). 

The  striking  fact  that  various  excretions  and  tissues  of  the 
living  organism,  when  administered  under  certain  conditions,  possess 
a  peculiar  therapeutic  value  is  now  well  established.  The  theory 
has  long  been  the  subject  of  studious  attention,  yet  the  practical 
application  of  organotherapy  has  in  recent  years  acquired  unprece- 
dented importance.  Extracts  derived  from  almost  every  portion  of 
the  human  system,  together  with  many  animal  secretions,  have  been 
prepared,  one  of  the  most  original  being  the  hypodermic  injection 
of  an  extract  from  the  recent  testicles  of  mammals  adopted  by 
Brown-Sequard  in  1889  in  the  treatment  of  senile  debility.  As  a 
nutrient  restorative  spermini  hydrochloras  was  found  to  be  an 
efficacious  remedy,  abundant  evidence  showing  that  the  functional 
activity  of  deteriorating  organs  of  the  animal  economy  was  per- 
ceptibly improved,  the  nervous  system  responding  favorably  to  the 
influence  of  the  new  agent.  Cancer  and  chorea  are  said  to  have 
also  been  benefited  by  spermine. 

Subsequently  neurasthenia,  locomotor  ataxia,  and  declining 
nervous  force  due  to  old  age  were  successfully  treated  with  a 
glycerin  extract  from  the  gray  matter  of  a  sheep's  brain,  the  pro- 
cedure, as  suggested  by  Paul,  consisting  of  a  nervous  transfusion 
by  hypodermic  injection. 

The  most  rational  and  successful  application  of  organotherapy, 
however,  was  that  of  Murray  in  1891,  who  proposed  the  subcu- 


2i8  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

taneous  injection  of  a  thyroid  extract  in  the  treatment  oi myxedema, 
many  cases  of  which  have  ameliorated,  while  others  have  been 
definitely  cured,  by  the  adoption  of  the  remedy.  The  preparations 
in  this  case  have  included  the  ingestion  of  the  dry  powder,  the 
injection  of  a  glycerin  extract,  and  the  raw  or  partially  cooked 
gland  administered  as  food.  The  general  testimony  of  writers 
amply  attests  the  efficacy  of  the  remedy,  which  now  receives 
almost  universal  acceptance. 

Baumann  has  recently  isolated  from  the  thyroid  glands  of  sheep 
an  organic  compound  which  he  believes  to  be  the  essential  prin- 
ciple of  the  gland  and  the  efficient  agent  in  the  treatment  of 
various  forms  of  myxedema.  Clinical  observations  by  Ewald,  Ross, 
and  Treufel  seem  to  prove  the  correctness  of  Baumann's  opinion. 

In  exophthalmic  goiter  the  employment  of  thyroid  gland  has 
been  held  to  be  favorable,  although  authorities  are  not  wanting 
who  claim  that  its  use  tends  to  aggravate  the  symptoms. 

Especially  interesting  are  the  results  of  thyroid  treatment  in 
cretinism  of  infants — infantile  myxedema — authentic  reports  offer- 
ing highly  encouraging  details  of  its  successful  application  in  this 
disease,  eliciting  from  Sinkler  the  declaration :  "  It  is  too  short  a 
time  since  the  introduction  of  the  thyroid-feeding  in  cretinism  to 
form  any  opinion  as  to  the  final  results ;  but  since  in  all  the  cases 
reported  remarkable  changes  have  taken  place,  we  have  reason  to 
rejoice  in  possessing  a  remedy  which  can  accomplish  so  much  as 
has  already  been  done  in  these  once  worse  than  hopeless  cases." 

It  is  to  be  observed  that  both  the  endemic  and  sporadic  forms 
of  the  above  malady  have  proved  amenable  to  the  thyroid  treat- 
ment. 

Jackson  concludes  that  "  in  myxedema  and  cretinism  it  is  worth 
while  to  run  a  risk  as  to  life  in  the  hope  of  removing  symptoms 
that  make  life,  hardly  worth  living.  In  dermatoses,  on  the  con- 
trary, life  is  generally  little  endangered,  and  we  are  not  justified  in 
resorting  to  too  heroic  measures." 

The  remedy  has  been  applied  in  insanity,  with  the  effect  of  im- 
proving depressed,  but  intensifying  maniacal,  conditions,  care  being 
requisite  in  the  presence  of  certain  contraindications,  such  as 
tuberculosis,  valvular  disease  of  the  heart,  etc. 

Bramwell  reports  a  case  of  tetamis  resulting  from  thyroid  extir- 
pation cured  by  doses  of  the  gland ;  another  of  idiopathic  tetany 
yielding  to  the  same  treatment. 

With  regard  to  thyroid  treatment  in  skin  diseases,  Abraham 


ANIMAL  EXTRACTS.  319 

asserts  that  there  is  no  constant  effect  in  psoriasis  and  many  other 
cutaneous  affections,  and  that  in  a  large  number  of  cases  the  results 
are  negative,  and  that  untoward  effects  are  alarmingly  frequent. 

Improvement  has  been  noted  in  several  cases  of  malignant 
syphilis,  Menzies  considering  that  thyroid  acts  as  a  powerful  skin- 
tonic  and  a  useful  adjuvant  to  mercury  and  potassium  iodide  in  the 
treatment  of  this  disease. 

With  regard  to  thyroid,  however,  it  must  be  admitted  that,  save 
in  myxedema,  simple  goiter,  and  obesity,  the  remedy  is  of  com- 
paratively slight  value,  and  even  in  these  affections  only  by  con- 
tinued treatment  have  favorable  results  been  obtained. 

The  favorable  results  often  attending  the  partial  employment  of 
animal  agents  in  diseases  of  corresponding  organs,  and  especially 
the  noteworthy  benefits  derived  from  the  application  of  the  thyroid 
treatment  in  myxedema,  have  suggested  the  preparation  of  many 
extracts  of  varying  efficacy.     Among  these  are — 

Nucleins,  compounds  of  proteid  substances  with  nucleic  acid, 
obtained  by  artificial  digestion,  among  their  sources  being  pus-cor- 
puscles, the  spermatozoa  of  various  animals,  testicles,  thyroid 
gland,  yolk  of  hens'  eggs,  liver,  brain,  cows'  milk,  etc.  A  marked 
property  of  the  blood,  as  has  long  been  kn.own,  is  its  germicidal 
power,  and  it  has  furthermore  been  satisfactorily  determined  that 
the  basic  force  resides  in  a  nuclein.  The  agent  has  consequently 
been  essayed  in  the  hope  of  establishing  a  bactericidal  influence. 
Vaiighan  reports  that  in  tuberculosis  the  effect  of  moderate  injec- 
tions has  been  to  lower  the  temperature,  without  untoward  mani- 
festations. Indolent  ulcer,  too,  according  to  the  same  authority, 
has  yielded  completely  to  a  similar  treatment,  the  nuclein  being 
derived  from  yeast. 

It  is  also  stated  upon  high  authority  that  the  remedy  is  useful 
in  "  all  forms  of  anemia,  in  chronic  and  recurrent  malaria,  in  diges- 
tive disorders,  and  in  acute  and  chronic  pulmonary  affections" 
(Aulde),  the  nuclein  adopted  being  obtained  from  the  thyroid  and 
thymus  glands.  The  latter  author  suggests  the  use  of  nuclein  in 
the  treatment  of  typhoid,  in  which  disease  the  activity  of  leucdcy- 
tosis  is  defective. 

Bone-marrow  has  proved  efficacious  in  anemia  (Dickson, 
Frazer),  and  has  also  been  employed  by  Filleau  in  tuberculosis. 

Brain-extract,  besides  its  utility  in  locomotor  ataxia  and  senile 
debility,  has  been  reported  as  beneficial  in  certain  organic  and  func- 
tional diseases  of  the  nervous  system — in  epilepsy,  hysteria,  mi- 


220  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

graine,  hebephrenia,  etc.,  as  well  as  in  bulbar  palsy  and  general 
paralysis  of  the  insane. 

Heart-extract  has  been  recommended  in  cases  of  nervous 
prostration,  it  being  claimed  that  its  action  tends  to  raise  the 
blood-pressure  and  increase  the  number  of  red  corpuscles; 
muscle-extract  has  served  a  useful  purpose  in  affections  of  the 
corresponding  tissues ;  extract  of  pancreas,  though  with  small 
success,  has  been  employed  in  diabetes  mellitus ;  and  among  other 
preparations  used  with  doubtful  or  auspicious  results  are  medullin, 
from  the  cord ;  renin,  from  the  kidneys ;  gastrin,  from  the  stom- 
ach; and  ovarin,  from  the  ovaries. 

The  subject  is  fraught  with  interest  to  the  clinician,  and,  as  in 
serum-therapy,  the  rapid  progress  of  therapeutic  knowledge  bids 
fair  to  extend  its  value  in  the  rational  treatment  of  human  disease. 


DIVISION   II.— SPECIFICS. 


These  drugs  are  unnatural  to  the  system,  though  acting  spe- 
cifically, and  in  some  unknown  way,  against  certain  diseases  or 
morbid  conditions.  They  are  given  with  a  view  to  influencing  the 
course  of  the  disease  itself,  not  for  their  effect  upon  the  symptoms 
alone.  If  administered  for  any  length  of  time,  there  is  danger  of 
causing  an  artificial  disease,  because  of  the  characteristic  action  of 
these  medicines,  which  differs  essentially  from  their  remedial  influence. 

When  used  as  specifics  they  do  not  produce  or  relieve  symp- 
toms, except  by  renewal  of  health  or  by  removing  either  the 
pathological  condition  or  the  disease.  Whenever,  therefore,  these 
drugs  produce  symptoms  when  used  specifically,  it  is  a  sign  that 
they  are  contraindicated,  or  have  been  given  for  too  long  a  time, 
or  in  too  large  doses.  As  they  are  unnatural,  and  consequently 
more  or  less  poisonous  to  the  system,  their  administration  should 
be  accompanied  by  restoratives  to  lessen  their  tendency  to  unto- 
ward manifestations  and  systemic  depression. 

Mercury,  being  perhaps  the  most  typical  specific,  will  be  first 
considered. 

Hydrargyrum— Hydrargyri— Mercury.     U.  S.  P. 

(Quicksilver.) 

Origin. — The  knowledge  of  this  drug  antedates  the  Christian 
era.  It  is  found  in  Spain,  Austria,  Peru,  and  China,  but  is  obtained 
principally  from  New  Almaden,  California.  It  occurs  to  some  ex- 
tent in  the  metallic  state  in  the  form  of  minute  or  large  globules ; 
also  in  combination  with  oxygen,  chlorine,  selenium,  etc. ;  but  the 
principal  ore  from  which  it  is  extracted  is  cinnabar. 

Description  and  Properties. — A  shining,  silver-white  metal, 
without  odor  or  taste.  It  is  liquid  at  the  ordinary  temperature, 
and  easily  divisible  into  spherical  globules;  but  when  cooled  to 
— 39.38°  C.  ( — 38.88°  F.),  it  forms  a  ductile,  malleable  mass. 
Specific  gravity,  13.5584  at  15°  C.  (59°  R). 

Insoluble  in  the  ordinary  solvents,  also  in  concentrated  hydro- 
chloric acid,  and,  at  common  temperatures,  in  sulphuric  acid,  but 
dissolving  in  the  latter  when  boiled  with  it,  and  readily  and  com- 
pletely soluble  in  nitric  acid.  Mercury  should  be  kept  in  strong, 
well-stoppered  bottles. 

221 


223  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Dose.— Mercury  is  seldom  given  internally  except  in  the  modi- 
fied form  of  blue  pill. 

Hydrargyrum  Ammoniatum— Hydrargyri  Ammo- 
niati—Ammoniated  Mercury.     TJ.S.F. 

Origin. — Prepared  by  mixing  solutions  of  Ammonia  and  Cor- 
rosive Mercuric  Chloride.  Filter  and  wash  the  precipitated  am- 
moniated  mercury. 

Description  and  Properties. — White,  pulverulent  pieces,  or 
white,  amorphous  powder,  without  odor,  and  having  an  earthy, 
and  afterward  styptic  and  metallic  taste.  Permanent  in  the  air. 
Almost  insoluble  in  water  or  in  alcohol.  It  should  be  kept  in  well- 
stoppered  bottles,  protected  from  the  light.     Used  externally. 

Official  Preparation. 

Ungu6ntum  HydrSrgyri  Ammoniati — UnguSnti  Hydrargyri  Ammoniati — 
Ointment  of  Ammoniated  Mercury. — Formula:  Ammoniated  Mercury,  lo;  Ben- 
zoinated  Lard,  90  parts.     For  external  use. 

Hydrargyrum  cum  Creta— HydrS.rgyri  cum  Greta- 
Mercury  with  Chalk.    JJ.  S.  P. 

Origin. — Obtained  by  trituration  of  Mercury,  Prepared  Chalk, 
Clarified  Honey,  and  Water. 

Description  and  Properties. — A  light  gray,  rather  damp  pow- 
der, free  from  grittiness,  without  odor,  and  having  a  slightly  sweet- 
ish taste.  It  contains  38  per  cent,  of  mercury.  This  preparation 
should  be  kept  in  well-stoppered  bottles,  protected  from  light. 

Dose. — 3-10  grains  (0.18-0.6  Gm.). 

Massa   Hydrargyri— MSssae    Hydrargyri— Mass  of 
Mercury.     JJ.  S.  P. 

(PiLULA  Hydrargyri— Blue  Mass — Blue  Pill.) 
Composed   of  Mercury,   Glycyrrhiza,   Althaea,    Glycerin,    and 
Honey  of  Rose. 

Dose. — |-io  grains  (0.03-0.6  Gm.). 

Unguentum    Hydrargyri  — Unguenti    Hydrargyri  — 
Mercurial  Ointment.    JJ.  S.  JP. 

(Blue  Ointment.) 
Composition:    Mercury,  Lard,  Suet,  and  Oleate  of  Mercuiy. 
Used  externally. 


SPECIFICS.  223 

Emplastrum  Ammoniaci  cum  Hydrargyro  — Em- 
plastrum  (ace.)  Ammoniaci  cum  Hydrargryro— 
Ammoniac  Plaster  witii  Mercury.    V,  S.  -P. 

Composition :  Ammoniac,  Mercury,  Oleate  of  Mercury,  Diluted 
Acetic  Acid,  and  Lead  Plaster.     Used  externally. 

Emplastrum    Hydrargryri— Emplastri   Hydrargyri— 
Mercurial  Plaster.     U.  S.  P. 

Composition :  Mercury,  Oleate  of  Mercury,  and  Lead  Plaster. 
Used  externally.  O 

Hydr§.rgyri  Chloridum  Corro^wTn  —  Hydrargyri 
Chloridi  CorrosTvi— Corrosive  Mercuric  Chloride. 
U.  S.  JP. 

(Corrosive  Chloride  of  Mercury — Corrosive  Sublimate.) 

Origin. — Prepared  by  heating  a  mixture  of  Mercuric  Stilphate, 
Sodium  Chlorate,  and  Manganese  Dioxide.  The  corrosive  chloride 
sublimes  and  is  condensed. 

Description  and  Properties. — Heavy,  colorless,  rhombic  crys- 
tals or  crystalline  masses ;  odorless  and  having  an  acrid  and  per- 
sistent metallic  taste.  Permanent  in  the  air.  Soluble  in  16  parts 
of  water,  in  3  parts  of  alcohol,  in  2  parts  of  boiling  water,  in  1.2 
parts  of  boiling  alcohol,  in  4  parts  of  e.ther,  and  in  about  14  parts 
of  glycerin.     It  should  be  kept  in  well-stoppered  bottles. 

Dose. — ^^^  grain  (0.001-0.008  Gm.). 

Hydrargyri  Chloridum  Mite  —  Hydrargyri  Chloridi 
MTtis— Mild  Mercurous  Chloride.     U.  S.  JP. 

(Calomel — Mild  Chloride  of  Mercury.) 

Origin. — Obtained  by  triturating  Mercuric  Sulphate,  Mercury, 
Sodium  Chloride,  and  boiling  Distilled  Water.  Sublime,  and  wash 
the  sublimed  calomel  with  boiling  distilled  water. 

Description  and  Properties. — A  white,  impalpable  powder,  be- 
coming yellowish-white  on  being  triturated  with  strong  pressure. 
It  is  odorless  and  tasteless,  and  permanent  in  the  air.  Insoluble  in 
water,  alcohol,  or  ether,  and  also  in  cold,  diluted  acids.  When 
strongly  heated  it  is  wholly  volatilized,  without  melting.  Calomel 
should  be  kept  in  dark,  amber-colored  bottles. 

Dose. — ^^10  grains  (0.002-0.6  Gm.). 

Calomel  enters  into  the  following 


234  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Official  Preparations. 

PJlulae  Antimonii  Comp6sitK— Pllulas  (ace.)  AntimSnii  CompSsitas-Com- 
pound  Pills  of  Antimony.— -Dojf,  i  or  2  pills. 

Pllute  Catharticee  Comp6sitae— PJlulas  (ace.)  CathSrticas  Conip6sitas— 
Compound  Cathartic  V\\\s.—Dose,  i  to  3  pills. 

Hydrarg^yri  Cyanidum— Hydrargyri  Cyanidi— Mer- 
curic Cyanide.    TJ.  8.  P. 

Origin. — It  may  be  obtained  by  boiling  pure  Ferrocyanide  of 
Iron  with  Mercuric  Oxide;  the  mercuric  cyanide,  entering  into 
solution,  is  separated  by  filtration,  evaporization,  and  crystallization 
from  diluted  alcohol. 

Description  and  Properties. — Colorless  or  white  prismatic 
crystals ;  odorless,  and  having  a  bitter,  metallic  taste  (fhe  salt  is 
exceedingly  poisonous),  becoming  dark-colored  on  exposure  to 
light.     Soluble  in  12.8  parts  of  water  and  in  15  parts  of  alcohol. 

Dose. — j-^o'  ^^  grain  (o.ooo6hd.oo4  Gm.). 

Hydr^rg-yri    lodidum    Fiavum— Hydrargyri    lodidi 
Fiavi— Yellow  Mercurous  Iodide.    TJ.  S.  JP. 

(Hydrargyri  Iodidum  Viride — Protiodide  of  Mercury — Yellow  (or  Green) 
Iodide  of  Mercury.) 

Origin. — Prepared  by  mixing  solutions  of  Potassium  Iodide 
and  Mercurous  Nitrate  with  Nitric  Acid  and  Distilled  Water. 
The  precipitate  is  washed  and  dried. 

Description  and  Properties. — A  bright  yellow  amorphous 
powder,  odorless  and  tasteless.  By  exposure  to  light  it  becomes 
darker  in  proportion  as  it  undergoes  decomposition  into  metallic 
mercury  and  mercuric  iodide.  Almost  insoluble  in  water,  and 
wholly  insoluble  in  alcohol  or  ether.  It  should  be  kept  in  dark, 
amber-colored  vials,  with  the  least  possible  exposure  to  light. 

Dose. — \-\  grain  (0.01-0.03  Gm.). 

Hydrargyri    lodidum    Rubrum -Hydrargyri    lodidi 
Rubri— Red  Mercuric  Iodide.     U.  S.  P. 

(BiNiODiDE  OF  Mercury — Red  Iodide  of  Mercury.) 

Origin. — Prepared  by  mixing  solutions  of  Corrosive  "TVTercuric 
Chloride  and  Potassium  Iodide ;  filter,  and  dry  the  precipitated  red 
iodide. 

Description  and  Properties. — A  scarlet-red,  amorphous  pow- 
der, odorless  and  tasteless ;  permanent  in  the  air.     Almost  insoluble 


SPECIFICS.  235 

in  water,  but  soluble  in  1 30  parts  of  alcohol.     It  should  be  kept  in 
well-stoppered  bottles,  protected  from  light. 

Dose. — g\   j^ig  grain  (0.002-0.004  Gm.). 

This  drug  enters  into  the 

Official  Preparation. 

Liquor  Arseni  et  Hydrargyri  lodidi — Liquoris  Arseni  et  Hydrar'gyri  I5didi 
— Solution  of  Arsenic  and  Mercuric  Iodide. — (Described  under  Arsenic.') — Dose, 
5  minims  (0.3  Cc),  gradually  increased. 

Hydrargryri  Oxidum  Flavum— Hydrargyri  Oxidi 
Flavi— Yellow  Mercuric  Oxide.    JJ.  S.  I*. 

Origin. — Prepared  by  precipitating  a  solution  of  Corrosive 
Mercuric  Chloride  with  Soda. 

Description  and  Properties. — A  light  orange-yellow,  amor- 
phous, heavy,  impalpable  powder ;  odorless,  and  having  a  some- 
what metallic  taste.  Permanent  in  the  air,  but  turning  darker  on 
exposure  to  light.  Almost  insoluble  in  water  or  in  alcohol.  It 
should  be  kept  in  well-stoppered  bottles,  protected  from  light. 
Not  used  internally. 

Official  Preparation. 

UnguSntum  HydrSrgyri  Oxidi  Flavi — UnguSnti  HydrSrgyri  Oxidi  Flavi — 
Ointment  of  Yellow  Mercuric  Oxide. — Formula:  Yellow  Mercuric  Oxide,  10 ; 
Ointment,  90  parts.     Used  externally. 

Hydrargryri    Oxidum    Rubrum— Hydrargyri    Oxidi 
RQbri— Red  iVIercuric  Oxide.    TJ.  S.  I*. 

(Red  Precipitate.) 

Origin. — Prepared  by  dissolving  Mercury  in  Diluted  Nitric 
Acid.  Evaporate  to  dryness.  Triturate  the  mercuric  nitrate  thus 
formed  with  mercury  and  heat. 

Description  and  Properties. — Heavy,  orange-red  crystalline 
scales,  or  a  crystalline  powder,  becoming  yellower  the  finer  it  is 
divided ;  odorless,  and  having  a  somewhat  metallic  taste ;  perma- 
nent in  the  air.  Almost  insoluble  in  water  and  in  alcohol.  It 
should  be  kept  in  well-stoppered  bottles,  protected  from  light. 

Dose. — ^ij-^J^' grain  (0.001-0.006  Gm.). 

Official  Preparation. 

UnguSntum  HydrSrgyri  Oxidi  Riibri — UnguSnti  HydrSrgyri  Oxidi  Rubri 
— Ointment  of  Red  Mercuric  Oxide. — Formula:  Red  Mercuric  Oxide,  lo;  Castor 
Oil,  5;  Ointment,  85  parts.     Used  externally. 
15 


326  A    TEXT-BOOK  OF  MATERIA     MEDIC  A. 

Hydrargyri  Subsulphas  Flavus— Hydrargyri  Sub- 
sulphatis  Flavi— Yellow  Mercuric  Subsulphate. 
JJ.  S.  I*. 

(Basic  Mercuric  Sulphate — Turpeth  Mineral.) 

Origin. — Obtained  by  dissolving  Mercury  in  Sulphuric  and 
Nitric  Acids.  Add  a  sufficient  quantity  of  Water.  Decant  and 
dry  the  residue. 

Description  and  Properties. — A  heavy,  lemon-yellow  powder, 
odorless  and  almost  tasteless ;  permanent  in  the  air.  Soluble  in 
about  2000  parts  of  water.  Insoluble  in  alcohol.  It  should  be 
kept  in  well-stoppered  bottles,  protected  from  the  light. 

Dose. — 1-3  grains  (0.015-0.18  Gm.). 

Liquor  Hydrargyri  Nitratis— Liquoris  Hydrargyri 
Nitratis— Solution  of  Mercuric  Nitrate.    TT.  S.  P. 

A  liquid  containing  about  60  per  cent,  of  Mercuric  Nitrate, 
together  with  about   1 1   per  cent,  of  free  Nitric  Acid. 

Description  and  Properties. — A  clear,  nearly  colorless,  heavy 
liquid,  having  a  faint  odor  of  nitric  acid  and  a  strongly  acid  reac- 
tion.    The  product  should  be  kept  in  glass-stoppered  bottles. 

Used  externally  as  a  caustic. 


Unguentum  Hydrargyri  Nitratis  — Unguenti  Hy- 
drargyri Nitratis— Ointment  of  Mercuric  Nitrate. 
U.  S.  I*. 

(Citrine  Ointment.) 

Formula:  Mercury,  70;  Nitric  Acid,  157;  Lard  Oil,  760  parts. 
Used  externally. 

Unofficial  Preparations. 

Hydrargyri  SaHcylas— Hydrargyri  Salicylatis— Mercurous  Salicylate.— 
Dose  of  Mercurous  Salicylate,  \-\  grain  (0.008-0.015  Gm.).—Dose  of  Mercuric  Salicy- 
late, t'j-J^  grain  (0.004-0.008  Gm.). 

Hydrargyri  Formamidatum— HydrSrgyri  Formamidati— Formamidate  of 
Mercury. — Dose  for  hypodermic  use,  ■^■^-\  grain  (0.005-0.01  Gm.). 

Hydrargyri  Tannas— HydrSrgyri  Tannatis— Mercurous  Tannate.— £»«?, 
^I  grain  (0.03-0.06  Gm.). 

Lotio  Flava— Lotionis  Flavae— Yellow  Wash.— Coirosive  Sublimate,  25  grains 
(1.5  Gm.),  in  Lime  Water,  16  ounces  (473.17  Cc).     For  external  use. 

Lotio  Nigra— Lotionis  Nigrae— Black  Wash.— Calomel,  64  grains  (4.15  Gm.), 
in  Lime  Water,  16  ounces  (473.17  Co.).     For  external  use. 

Asparagin  Hydrargyrate.- iPoj^,  \  grain  (o.oi  Gm.),  hypodermically. 


SPECIFICS.  227 

Antagonists  and  Incompatibles. — Mercury  with  chalk  is  in- 
compatible with  acids  and  acidulous  salts.  Calomel  is  incompatible 
with  alkalies,  alkaline  earths,  alkaline  carbonates,  iron,  lead,  copper, 
iodine,  bromides,  soaps,  sulphydrates,  and  nitrohydrochloric  acid, 
as  well  as  hydrochloric  acid,  potassium,  ammonium,  and  sodium 
chloride. 

Corrosive  subhmate  is  incompatible  with  alkalies  and  their  car- 
bonates, soap,  lime  water,  tartar  emetic,  the  iodides  of  potassium 
and  sodium,  acetate  of  lead,  silver  nitrate,  the  sulphides,  albuminous 
liquids  (as  milk,  etc.),  many  vegetable  infusions,  and  compound 
syrup  of  sarsaparilla. 

In  general,  metallic  preparations  of  mercury  are  incompatible 
with  iodine  and  the  chlorides. 

Synergists. — Potassium  iodide  enhances  the  antisyphilitic  action 
of  mercury.  Depressants — such  as  antimony  and  alkalies — increase 
the  physiological  activity  of  mercury  and  its  preparations. 

Tonic  and  resin-bearing  purgatives — such  as  aloes,  rhubarb, 
and  podophyllum — aid  the  cathartic  action  of  some  of  the  mercurial 
preparations. 

Physiological  Action. — Externally  and  Locally. — Liquid  metal- 
lic mercury  is  inert.  Most  of  the  preparations  applied  to  the  skin 
are  antiparasitic  and  antiseptic,  corrosive  mercuric  chloride  being 
one  of  the  most  important  antiseptics  and  universal  germicides 
known. 

Some  of  the  mercurials  are  powerful  irritants,  the  nitrate  being 
an  active  caustic.  The  mercurous  salts,  even,  possess  slightly 
stimulating  properties. 

Metallic  mercury  and  its  salts  are  readily  absorbed  with  the  aid 
of  friction,  at  times  producing  a  slight  irritation  resulting  from  their 
stimulating  properties.  Absorption  may  also  take  place  from  local 
application  in  the  form  of  a  fine  vapor. 

The  introduction  of  the  drug  into  the  system  through  the 
medium  of  the  skin  is  attended  with  all  the  symptoms  of  mercurial 
poisoning.  The  local  actions  of  the  various  preparations  differ 
somewhat,  yet  they  agree  in  certain  physiological  effects  produced 
after  absorption  of  the  drug. 

A  common  feature  of  mercurial  application  is  a  slight,  peculiar 
fetor  in  the  mouth,  accompanied  by  soreness  of  the  teeth,  swelling 
of  the  gums,  and  an  increase  of  saliva,  ptyalism  being  a  marked 
symptom  of  mercurial  disturbance.  A  disagreeable  metallic  taste 
is  seldom  absent.  ^  These  symptoms  assume  a  serious  phase  if  the 


228  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

application  be  continued,   stomatitis   and  other  graver  conditions 


ensuing-. 


Ijiternally.— Digestive  System.— SmzW  doses  have  httle  untoward 
effect;  they  may  even  prove  tonic.  Large  doses  act  unfavorably 
upon  the  gastro-intestinal  mucous  membrane,  causing  diarrhea  and 
possibly  rnore  serious  derangement.  As  purgatives  the  mercurial 
preparations  act  by  augmenting  the  secretions  of  the  intestinal 
glands ;  at  the  same  time  the  pancreatic  secretions  are  increased 
and  there  is  marked  activity  of  the  absorbent  system.  The  prin- 
cipal action  is  on  the  duodenum,  hastening  evacuation  of  the  bile 
and  preventing  its  reabsorption.  While  promoting  excretion  of 
bile,  they  act  the  reverse  as  to  its  secretion.  This  is  particularly 
true  of  calomel,  which  actually  diminishes  that  secretion,  though 
it  is  alleged  that  the  corrosive  mercuric  chloride  is  a  direct  chola- 
gogue,  stimulating  to  some  extent  the  hepatic  secretory  apparatus. 
Circulatory  System. — Corrosive  sublimate  exerts  a  decided  in- 
fluence upon  the  heart,  its  toxic  effect  tending  to  diminish  cardiac 
action.  The  remaining  preparations  of  mercury  appear  to  be  less 
active  in  this  respect.  The  physical  action  of  the  drug  upon  the 
corpuscular  constituents  of  the  blood  has  been  well  ascertained, 
anemia,  reduced  cohesion,  and  final  dissolution  having  been  ob- 
served. It  is  to  be  noted  that  under  prolonged  or  over-dosage 
the  blood  becomes  impoverished,  its  ozonizing  function  is  impaired, 
and  the  fibrin  loses  its  coagulability.  But  when  administered  in 
minute  doses  the  mercuric  corrosive  chloride  acts  as  a  tonic  to  the 
blood,  increasing  the  number  of  red  corpuscles  and  the  body- 
weight.  ^, 

Should  "  tonic  doses  "  be  continued  for  too  long  a  period,  there 
would  be  increased  weight,  owing  to  too  great  stimulation  of  the 
lymphatic  system. 

Nervous  System. — The  full  effects  of  mercury  and  its  prepara- 
tions upon  the  nervous  system  are  best  seen  when  toxic  doses 
are  given.  The  effects  are  considered  in  extenso  under  the  head 
of  "  Poisoning." 

Respiratory  System. — The  general  tendency  of  mercury,  in  those 
who  have  been  subject  to  prolonged  dosage,  is  to  depress  the- cir- 
culation, rendering  the  breathing  labored  and  debilitated,  a  sense 
of  respiratory  constriction  being  present. 

Absorption  and  Elimination. — When  a '  preparation  of  mercury 
is  taken  internally  it  is  converted  in  the  stomach  into  a  double 
chloride  of  sodium  and  mercury.     This  substance,  uniting  with  the 


SPECIFICS.  229 

albuminous  juices,  is  soluble  in  an  excess  of  albumin  and  sodium 
chloride,  and,  readily  diffusing  into  the  blood,  is  converted  into, 
and  exists  in  that  fluid  as,  the  oxyalbuminate  of  mercury. 

The  absorption  of  this  drug  is  gradual,  yet,  notwithstanding 
every  secretion  of  the  body  contributes  to  its  general  expulsion 
from  the  system,  its  cumulative  action  is  a  well-established  fact. 
Elimination  occurs  chiefly  by  the  urine,  the  saliva,  bile,  sweat,  milk, 
and  feces.  Even  the  semen  shares  in  the  process.  Single  doses 
may  be  eliminated  in  twenty-four  hours,  but  the  drug  has  been 
detected  in  the  liver  a  year  after  the  discontinuance  of  prolonged 
treatment. 

Mercury  has  been  found  in  serum  and  in  pus  from  ulcers. 

Calomel  possesses  marked  diuretic  action,  greatly  increasing  the 
amount  of  urine. 

Temperature. — Save  in  a  secondary  manner,  temperature  is  sel- 
dom affected.  From  over-stimulation  or  irritation  the  drug  may 
produce  local  inflammatory  conditions  or  even  febrile  symptoms. 

Eye. — Himly  mentions  that  amaurosis  mercurialis  occurs  in 
workers  in  mercury,  while  Galezowski  reports  an  example  of  optic 
atrophy,  and  Square  cites  a  case  of  optic  neuritis,  due  to  the  toxic 
action  of  mercurial  salts. 

Untoward  Action. — Many  affections  of  the  skin  manifest  them- 
selves after  the  exhibition  of  mercury,  erythema  and  eczema  (eczema 
mercuriale)  frequently  occurring  after  either  the  ingestion  or  the 
external  application  of  mercurial  preparations. 

The  author  recalls  one  patient  in  whom  \  grain  (0.016  Gm.)  of 
calomel  excited  an  exanthematous  eruption  over  the  entire  body, 
some  edema  of  the  face,  together  with  fever  and  angina  of  the 
fauces.  At  another  time  similar  symptoms  were  produced  in  this 
patient  by  immersing  the  hands  in  a  i  :  2000  solution  of  corrosive 
sublimate. 

In  certain  persons  having  an  idiosyncrasy  regarding  this  drug 
extreme  salivation  and  stomatitis  may  be  induced  by  the  internal 
use  or  the  external  application  of  mercurial  preparations  in  medici^ 
nal  quantities. 

Medicinal  doses  may  produce,  in  susceptible  persons,  marked 
disturbances  of  nutrition,  sensation,  and  motion  to  such  a  degree 
as  to  suggest  poisoning. 

Poisoning. — Although  mercury  in  a  metallic  state  is  compara- 
tively innocuous,  its  vapor  is  capable  of  producing  violent  and 
dangerous  symptoms.     All  the  salts  are  active  poisons,  especially 


230  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

that  known  as  corrosive  sublimate.  The  symptoms  following  toxic 
doses  of  this  preparation  resemble  those  occasioned  by  arsenic. 
The  salt,  however,  being  more  readily  soluble,  produces  propor- 
tionately more  speedy  and  pronounced  effects.  They  are,  briefly, 
a  strong,  metallic  taste  in  the  mouth,  frequent  and  bloody  evacua- 
tions, tenesmus,  severe  abdominal  pains,  vomiting,  and  labored  res- 
piration. There  may  be  suppression  of  urine,  syncope,  and  perhaps 
insensibility  and  convulsions. 

One  of  the  most  obstinate  features  of  mercurial  poisoning  is 
ptyalism  or  salivation.  This  condition  is  first  manifested  by  tender- 
ness of  the  gums  and  teeth.  The  gums  are  inflamed  and  covered 
by  a  white,  sticky  substance,  and  bleed  at  the  slightest  provocation. 
The  breath  is  very  offensive.  The  teeth  become  loose,  and  may 
drop  out.  Necrosis  of  the  maxillary  bones  may  appear,  and  ex- 
tensive ulcerations  of  the  gums  and  cheeks  frequently  occur. 
Accompanying  these  manifestations  is  an  enormous  increase  in  the 
amount  of  saliva  secreted,  which  in  some  instances  literally  runs 
from  the  mouth  night  and  day,  often  depriving  the  patient  of  sleep. 
Not  infrequently  a  swelling  of  the  lymphatic  glands  is  also  ob- 
served. Articulation  and  deglutition  are  interfered  with  from  swell- 
ing of  the  tongue  and  ulceration  of  the  gums,  cheeks,  palate,  and 
tonsils.  These  symptoms,  together  with  the  fever,  anorexia,  mus- 
cular weakness,  and  headache  which  are  constant  accompaniments 
of  ptyalism,  render  the  condition  of  the  patient  very  serious  and 
tormenting. 

Chronic  mercurial  poisoning ,  or  mercurial  cachexia,  is  the  effect 
produced  by  prolonged  exposure  to  the  fumes  of  mercury.  The 
blood  becomes  thin  and  poor,  with  degeneration  of  the  corpuscles. 
The  person  becomes  emaciated,  the  heart  is  weak,  and  the  whole 
muscular  system  impaired.  Respiration  is  rapid  and  shallow,  and 
the  mental  faculties  are  affected.  Loss  of  memory,  irritability  of 
temper,  melancholia,  and,  in  rare  cases,  mania,  may  ensue.  All  the 
special  senses  are  affected.  Deafness,  dimness  of  vision,  impaired 
taste  and  sensation,  as  well  as  intestinal  derangement,  edema, 
articular  pains,  and  generally  disordered  secretions,  manifest  them- 
'  selves. 

Mercurial  cachexia  frequently  produces  muscular  tremors,  usu- 
ally beginning  in  the  upper  extremities  with  gradual  extension. 
Even  paralysis  of  groups  of  muscles  is  often  the  result  of  chronic 
mercurial  poisoning. 

Treatment  of  Poisoning. — In  acute  poisoning  from  corrosive  sub- 


SPECIFICS.  231 

limate  or  other  active  salt  of  mercury  it  is  necessary  to  evacuate 
the  stomach  as  quickly  as  possible,  and  give  white  of  eggs  freely. 
The  after-treatment  is  similar  to  that  of  other  corrosive  poisons — 
the  use  of  demulcents  and  opiates. 

For  salivation,  potassium  chlorate  probably  occupies  the  first 
place  as  a  prophylactic  and  curative  agent.  It  is  employed  as  a 
gargle  and  mouth-wash  in  a  2  to  3  per  cent,  solution.  An  astrin- 
gent wash  is  frequently  necessary.  Such  drugs  as  tannin,  myrrh, 
krameria,  etc.  may  be  used  for  this  purpose.  Where  there  is  ex- 
tensive ulceration  of  the  mouth  disinfectant  and  antiseptic  solutions 
will  be  found  desirable. 

In  cases  of  chronic  mercurial  poisoning  it  is  of  primary  import- 
ance to  remove  all  traces  of  the  drug  from  the  system  by  means 
of  iodides,  the  dosage  being  limited  in  quantity,  but  continued  for 
some  time. 

Elimination  of  the  poison  from  the  tissues  may  be  accomplished 
in  various  ways — the  potassium  iodide  administered  alternately  with 
magnesium  sulphate,  laxatives,  sulphur  baths,  and  sulphur  given 
internally.  A  change  of  air,  liberal  and  nutritious  diet,  and  tonics 
are  also  necessary. 

Therapeutics. — Externally  and  Locally. — As  a  germicide,  anti- 
septic, and  antiparasitic  the  preparations  of  mercury  are  extremely 
valuable,  the  corrosive  chloride  of  mercury  being  extensively  em- 
ployed as  an  antiseptic  in  general  surgery  in  strengths  of  from 
1 :  1000  to  I  :  10,000. 

In  diseases  of  the  skin  due  to  animal  or  vegetable  parasites  there 
are  no  drugs  so  valuable  as  certain  preparations  of  mercury,  the 
ointment  of  ammoniated  mercury  being  highly  prized. 

Calomel  in  the  form  of  an  ointment,  5  to  20  grains  (0.3-1.25 
Gm.)  to   I    ounce  (32.0  Gm.)  is  an  efficient  remedy  in  eczema. 

Indolent  venereal  ulcers  are  much  iniproved  by  dusting  them 
with  calomel,  while  the  early  inflammatory  conditions  of  these  sores 
may  be  greatly  benefited  by  the  use  of  black  wash. 

Many  diseases  of  the  eye,  ear,  nose,  and  throat  yield  to  various 
preparations  of  mercury.  The  ointment  of  the  yellow  oxide  of 
MERCURY  is  particularly  adapted  to  phlyctenular  ophthalmia,  pannus, 
keratitis,  chronic  blepharitis  marginalis,  etc. 

Inunction  with  mercurial  ointment  or  with  oleate  of  mer- 
cury is  excellent  for  the  constitutional  treatment  of  syphilis.  These 
two  preparations  are  of  great  value  in  subacute  synovitis,  pelvic 
cellulitis,  and  syphilitic  orchitis  and  epididymitis. 


332  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

The  OINTMENT  OF  THE  RED  IODIDE  OF  MERCURY  has  a  reputation 
as  an  efficient  remedy  in  goiter  and  enlargement  of  the  spleen,  as 
well  as  in  pachymeningitis. 

The  SOLUTION  OF  NITRATE  OF  MERCURY  is  an  active  and  reli- 
able caustic  in  the  treatment  of  phagedenic  ulcerations  and  venereal 
ulcerations  of  the  os  uteri. 

The  use  of  mercurials  is  usually  attended  with  excellent  results 
in  promoting  resolution  of  fibrous  induration  resulting  from  chronic 
inflammation. 

Internally. — The  principal  use  of  mercury  is  undoubtedly  as 
an  antisyphilitic.  Mercury  is  an  antidote  against  constitutional 
syphilis,  being  particularly  efficient  in  the  secondary  stage.  Many 
methods  of  mercurializing  a  patient  have  been  adopted,  mention  of 
which  will  be  made  under  "  Administration."  It  is  perhaps  un- 
necessary to  caution  the  therapeutist  to  make  an  accurate  and 
positive  diagnosis  of  syphilis  before  instituting  the  mercurial  treat- 
ment, as  otherwise  the  consequences  may  be  disastrous. 

Mercury  has  been  used  in  all  stages  of  the  disease,  though, 
possibly  from  ignorance  of  its  proper  use,  its  employment  has  met 
with  less  favorable  results  in  the  primary  than  in  the  secondary 
form,  while  a  careful  study  of  syphilology  leads  one  to  believe  that 
in  tertiary  syphilis  it  is  inferior  to  the  iodides,  if  not,  indeed,  actually 
contraindicated. 

The  medical  uses  of  mercurial  preparations  in  disorders  of  the 
alimentary  tract  are  very  numerous. 

Chronic   dysentery   will   frequently   yield   to   -^   to  -^  grain 

(0.0006-0.0001     Gm.)    of    CORROSIVE    CHLORIDE    OF    MERCURY    and 

diarrheas  of  children — particularly  those  characterized  by  pale, 
offensive  stools— together  with  ileo-colitis  of  infants,  are  greatly 
benefited  by  small  doses  of  calomel  or  gray  powder,  which  will 
also  allay  obstinate  vomiting. 

As  a  purgative  in  bilious  attacks,  hepatic  congestion,  and  cirrhosis 
CALOMEL  is  an  extremely  valuable  drug.  Its  action  as  a  purgative 
will  be  more  fully  described  under  "Cathartics." 

This  drug  is  also  a  remarkably  efficient  diuretic. 

The  internal  use  of  mercury  is  of  great  value  in  all  nonsuppu- 
rative inflammations,  as  cirrhotic  conditions  in  the  glandular  struc- 
tures, or  in  scleroses  in  the  nervous  system,  such  as  hepatic  cirrhosis, 
chronic  interstitial  nephritis,  locomotor  ataxia,  chronic  endarteritis, 
chronic  affections  of  the  lungs  and  pleura,  etc. 

Many  acute  febrile  and  inflammatory  conditions,  such  as  menin- 


SPECIFICS.  233 

gitis,  pericarditis,  and  hepatitis,  are  sometimes  benefited  by  the  in- 
ternal administration  of  calomel,  though  in  acute  inflammations  the 
chief  value  of  the  drug,  whether  specific  or  non-specific,  is  manifest 
in  iritis  and  in  acute  bronchitis  which  shows  a  tendency  to  persist. 

Calomel  given  in  frohi  10-  to  20-grain  (0.6-1.  Gm.)  doses  in 
cases  of  pneumonia  is  esteemed  very  highly  by  some  authorities. 

Calomel  and  opium  have  been  used  and  recommended  by  some 
physicians  in  the  treatment  of  Asiatic  cholera. 

The  internal  use  of  bichloride  of  mercury  is  unquestionably 
of  much  value  in  the  treatment  of  diphtheria,  and  the  subsulphate 
of  mercury  is  an  old  and  veiy  effective  emetic  in  membranous 
laryngitis. 

The  author  has  often  successfully  treated  marasmus  of  infants 
with  bichloride  of  mercury  administered  three  times  a  day  in  doses 
of  from  ^-|-g-  to  3-^  grain  (0.0005-0.0006  Gm.). 

Contraindications. — Mercury  is  usually  contraindicated  in 
tuberculosis  and  in  persons  of  strumous  diathesis ;  and,  while  it  is 
of  value  when  judiciously  employed  in  chronic  interstitial  nephritis, 
it  must  nevertheless  be  given  cautiously,  and  if  the  excretion  of 
urine  is  diminished  by  its  use,  the  drug  should  be  immediately 
discontinued. 

Children,  though  not  easily  salivated,  are  very  susceptible  to 
other  poisonous  actions  of  calomel. 

Ordinarily,  acute  asthenic  diarrhea  and  dysentery  in  adults  would 
contraindicate  the  use  of  mercurials. 

Administration. — Mercuiy  is  introduced  into  the  system  by — 

1 .  Inunction. — ^The  portion  of  the  body  upon  which  the  prepa- 
ration is  to  be  applied  should  first  be  thoroughly  washed  with  soap 
and  warm  water,  and  the  ointment  well  rubbed  in  with  the  palm  of 
the  hand.  The  best  localities  for  application  are  the  inner  sides  of 
the  thighs,  the  sides  of  the  chest,  the  axillae,  abdomen,  and  back. 
An  excellent  way  to  mercurialize  a  child  is  to  put  the  ointment  on 
the  abdomen  beneath  a  flannel  binder.  An  efficient  means  also  of 
favoring  absorption  is  to  apply  the  ointment  to  the  soles  of  the 
feet,  when  it  will  be  rubbed  in  by  walking.  Mercurial  ointment 
is  ordinarily  used  for  this  purpose,  15  to  30  grains  (1.0-2.0  Gm.) 
being  required  for  each  inunction.  Oleate  of  mercury  when  applied 
externally  should  not  be  rubbed  in,  the  simple  application  to  the 
skin  being  sufficient. 

2.  Fumigation. — The  iodide,  mercuric  sulphide,  and  calomel  are 
used  in  this  manner.    The  latter  preparation,  being  preferable,  is  the 


234  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

one  ordinarily  used.  From  5  to  20  grains  (0.3-1.2  Gm.)  of  calomel 
are  put  in  a  plate  or  a  porcelain  dish  over  a  lighted  spirit-lamp. 
These  are  placed  under  a  cane-bottomed  chair,  in  which  the  patient 
sits,  nude,  enveloped  in  a  blanket  reaching  to  the  floor  and  fastened 
loosely  about  the  neck.  The  calomel  is  volatilized  by  the  heat,, 
deposited  in  minute  particles  over  the  surface  of  the  body,  and  read- 
ily absorbed.    The  fumigation  should  last  fifteen  to  twenty  minutes. 

3.  Endermically. — Mercurials  may  be  absorbed  by  dusting  calo- 
mel and  certain  other  preparations  on  ulcers,  open  wounds,  etc. 

4.  By  the  Rectum. — Mercury  may  be  administered  in  .the  form 
of  a  suppository  containing  5  to  10  grains  (0.3-O.6  Gm.)  of  mer- 
curial ointment. 

5.  Hypodermically. — From  xS"  to  |-  grain  (0.005-0.01  Gm.)  of 
the  bichloride  of  mercury,  dissolved  in  5  to  10  minims  (0.3-0.6- 
Cc.)  of  distilled  water,  is  injected  deeply  into  the  muscles  of  the 
gluteal  region  or  in  the  subcutaneous  areolar  tissue  of  the  back. 
The  solution  of  peptonate  of  mercury  has  been  used  for  this  pur- 
pose, though  the  preparation  which  is  the  least  objectionable  is  the 
solution  of  the  formamidate  of  mercury,  16  minims  (i.o  Cc),  cor- 
responding to  \  grain  (o.i   Gm.)  of  mercuric  chloride. 

A  I  per  cent,  solution  of  asparagin  hydrargyrate  has  been 
highly  recommended  by  Neumann  for  hypodermic  use,  the  dose 
being  about  15  minims  (i.o  Cc),  equivalentto  \  grain  (o.oi    Gm.). 

Numerous  other  preparations  have  been  recommended,  but 
probably  possess  no  advantage  over  those  mentioned. 

6.  Internally. — In  the  treatment  of  syphilis  nearly  every  prepara- 
tion of  mercury  has  been  employed,  authorities  differing  in  their 
choice.  Bumstead  prefers  the  bichloride,  the  mercurous  iodide,, 
and  the  mercurial  pill;  Berkeley  Hill,  the  red  mercuric  iodide; 
Fox,  the  cyanide ;  Hutchinson,  the  gray  powder,  etc.  It  matters 
little  which  of  these  preparations  is  used.  That  which  agrees  best 
with  the  patient  is  advisable.  Calomel,  gray  powder,  blue  pill,  and 
corrosive  subUmate  are  ordinarily  used  in  disorders  of  the  ali- 
mentary tract.     As  a  rule,  the  first  two  are  preferable. 

ARSENIC. 

Acidum    Arsenosum  —  Acidi    Arsenosi  —  Arsenous 
Acid.     V.S.P. 

(Arsenic  Trioxide — White  Arsenic.) 
Origin.— Arsenic  has  been  found  in  minute  proportions  in  many 
mineral   waters."    It   is    obtained   in   large  quantities  by  roasting 


SPECIFICS.  235 

arsenical  ores— cobalt,  nickel,  tin,  and  particularly  arsenical  iron 
pyrites — and  purifying  by  resublimation. 

Description  and  Properties.— It  is  a  heavy  solid,  occurring- 
either  as  an  opaque  white  powder  or  in  irregular  masses,  of  two- 
varieties — the  one,  amorphous,  transparent,  and  colorless,  like 
glass ;  the  other,  crystalline,  opaque,  or  white,  resembling  porce- 
lain. Frequently  the  glassy  variety  is  found  enclosed  in  an  opaque, 
white  crust.  Contact  with  moist  air  changes  the  glassy  into  the 
white,  opaque  variety.     Both  are  odorless  and  tasteless. 

Both  varieties  dissolve  very  slowly  in  cold  water,  the.  glassy 
variety  requiring  about  30,  the  porcelain-like  about  80,  parts  of 
water  at  15°  C.  (59°  F.).  Both  are  slowly  but  completely  soluble 
in  1 5  parts  of  boiling  water.  Arsenous  acid  is  but  slightly  soluble 
in  alcohol,  but  is  soluble  in  about  5  parts  of  glycerin.  Oil  of  tur- 
pentine dissolves  the  glassy  variety  only.  Both  varieties  are  freely 
soluble  in  hydrochloric  acid  and  in  solutions  of  alkali  hydrates  and 
carbonates. 

Dose. — -^jp-j^  grain  (0.001-0.003  Gm.). 

Official  Preparations. 

Liquor  Acidi  Arsenosi — Liquoris  Acidi  Arsenosi — Solution  of  Arsenous- 
Acid. — Strength,  i  per  cent,  of  arsenous  acid. 

Description  and  Properties. — A  clear,  colorless  liquid,  odorless,  having  an  -acidu- 
lous taste  and  an  acid  reaction. 

Dose. — 2-10  minims  (0.12-0.6  Cc). 

Liquor  PotSssii  Arsenitis — LiqUoris  PotSssii  Arsenitis — Solution  of  potas- 
sium Arsenite  (Fowler's  Solution). — Strength,  i  per  cent,  of  arsenous  acid. 

Dose, — 2-10  minims  (0.12-0.6  Cc). 

Arseni  lodidum— Arseni  lodidi— Arsenic  Iodide. 

V.  8.  P. 

Origin. — Prepared  by  triturating  in  a  mortar  finely-powd,fred 
metalhc  Arsenic  and  Iodine  until  they  are  thoroughly  mixed ;  or  by 
mixing  solutions  of  Arsenous  and  Hydriodic  Acids,  and  evapo- 
rating. . ; 

Description  and  Properties. — Glossy,  orange-red,  crystalline 
masses,  or  shining,  orange-red,  crystalline  scales,  having  an  iodine- 
like odor  and  taste ;  gradually  losing  iodine  on  exposure  to  air  and 
light.  Soluble  in  7  parts  of  water  and  in  about  30  parts  of  alcohol. 
Arsenic  iodide  should  be  kept  in  glass-stoppered  vials,  in  a  cool 
place,  protected  from  light. 

Dpse. — jl^-|  grain  (0.002-0.008  Gm.). 


236  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Official  Preparation. 

Liquor  Arseni  et  Hydrargyri  lodidi— Liquoris  Arseni  et  Hydrargyri  lodidi 
— Solution  of  Arsenic  and  Mercuric  Iodide — (Donovan's  Solution). — Strength: 
I  per  cent.,  each,  arsenic  iodide  and  mercuric  iodide. 

Description  and  Properties. — A  clear,  pale-yellowish  liquid,  without  odor,  and  having 
a  disagreeable  metallic  taste. 

Dose. — i-io  minims  (0.06-0.6  Cc). 


Sodii  Arsenas— Sodii  Arsenatis— Sodium  Arsenate. 

Z7.  S.  P. 

Origin.^Prepared  by  heating  to  redness  Arsenous  Acid,  Sodium 
Nitrate,  and  Sodium  Carbonate.  Dissolve  the  fused  mass  in  water, 
and  crystallize.     Dissolve  crystals  in  water,  and  recrystallize. 

Description  and  Properties. — Colorless,  transparent,  mono- 
clinic  prisms,  odorless,  and  having  a  mild,  alkaline  taste  (the  salt  is 
very  poisonous).  Efflorescent  in  dry  air,  and  somewhat  deliques- 
cent in  moist  air.  Soluble  in  4  parts  of  water,  very  soluble  in 
boiling  water,  and  slightly  soluble  in  cold  water.  Soluble  in  60 
parts  of  boiling  alcohol.  Sodium  arsenate  should  be  kept  in  well- 
stoppered  bottles. 

Dose. — ^Vtt  grain  (0.001-0.006  Gm.). 

Official  Preparation. 

Liquor  Sodii  Arsenatis — Liquoris   Sodii  Arsenatis — Solution  of  Sodium 
Arsenate— (Pearson's  Solution). — Strength:  i  per  cent,  of  sodium  arsenate. 
Dose. — i-io  minims  (0.06-0.6  Cc). 

Unoffiicial  Preparations. 

Ciipri  Arsenis— Ciipri  Arsenitis— Cupric  Arsenite— (Scheele's  Green,  Min- 
eral Green,  Paris  Green,  eic.).—Dose,  ^-^^  grain  (0.0006  Gm.),  daily,  in  divided 
doses. 

Liquor  Arseni  Bromidi — Liquoris  Arseni  Bromidi— Solution  of  Arsenic 
Bromide— (Clemens'  Solution).— Strength :  the  equivalent  of  i  per  cent,  of  arsenous 
acid. 

Dose. — I-S  minims  (0.06-0.3  Cc). 

Liquor  Arseni  et  Aiiri  Bromidi— Liquoris  Arseni  et  Attri  Bromidi— Solu- 
tion of  Arsenic  and  Gold  Bromide.— Originated  with,  and  recommended  by,  Dr. 
Barclay,  and  sold  under  the  trade  name  "  Arsenauro."  Strength :  10  minims  (0.6  Cc.) 
contain  ^^  grain  (0.002  Gm.)  of  each  salt. 

Dose. — S~'5  minims  (0.3-1.0  Cc). 

Antagonists  and  Incompatibles. — Arsenic  is  incompatible  with 
the  salts  of  iron,  silver,  magnesia,  lime,  copper,  ammonium,  and 
with  vegetable  astringents. 


SPECIFICS.  237 

Synergists. — The  Restoratives  and  nux  vomica  are  synergistic 
to  arsenic. 

Physiological  Action. — Externally  and  Zoca//)/.— ^Applied  to 
the  skin,  arsenic  acts  as  a  caustic,  exciting  violent  inflammation. 
Its  escharotic  influence  results  in  destruction  of  vitality  in  the 
aiifected  parts,  accompanied  with  sloughing. 

Internally. — Digestive  System. — Except  in  very  small  doses 
arsenic  acts  as  a  severe  gastro-intestinal  irritant.  Minute  and 
medicinal  doses  stimulate  the  flow  of  gastric  and  intestinal  juices, 
and  augment  peristalsis,  improving  the  digestive  and  nutritive  func- 
tions. When  too  long  continued,  the  drug  produces  nausea,  diar- 
rhea, and  increased  micturition,  with  a  sensation  of  heat  and  dry- 
ness of  the  throat  and  stomach.  Toxic  doses  are  followed  by 
violent  gastro-enteritis.  Indeed,  in  whatever  manner  introduced 
into  the  system,  arsenic  appears  to  have  a  marked  selective  action 
upon  the  gastro-intestinal  tract. 

Circulatory  System. — Cardiac  action  may  be  slightly  stimulated 
by  small  doses,  the  experience  of  arsenic-eaters  proving  that  the 
drug,  so  far  from  being  necessarily  deleterious,  actually  tends  to 
invigorate  the  system.  Large  doses  render  the  heart  irritable  and 
feeble  and  decrease  the  number  of  red  corpuscles,  rendering  the 
blood  less  coagulable.  Medicinal  doses,  while  not  increasing  the 
number  of  red  corpuscles,  prevent  their  destruction  in  such  dis- 
eases as  pernicious  anemia.  Toxic  doses  induce,  among  other 
severe  results,  the  characteristic  arsenical  symptom — fatty  degen- 
eration of  the  cardiac  muscle. 

Nervous  System,. — The  general  effect  of  arsenic  upon  the  brain 
and  nervous  system  is  that  of  a  tonic — a  property  which  is  sup- 
posed to  explain  its  antiperiodic  nature,  in  which  respect  quinine 
alone  is  its  superior.  The  cerebral  functions  are  stimulated,  even 
to  the  point  of  exhilaration.  Experiments  have  shown  that  the 
sensory  nervous  apparatus  is  strongly  and  untowardly  affected. 
The  action  finally  involves  the  motor  system,  complete  paralysis 
supervening.  Medicinal  amounts  act  as  a  nervous  excitant,  stimu- 
lating the  trophic  apparatus  (Hare).  Large  doses  produce  dis- 
orders of  motility  and  sensibility,  tremors,  and  other  serious 
symptoms.  It  has  been  noted  that  the  continued  use  of  arsenic 
produces  tingling  and  a  sensation  of  numbness  in  the  tips  of  the 
fingers. 

Under  prolonged  use  arsenic  tends  to  accumulate  to  a  greater 
extent  in   nervous   than   in   other  tissues.     Thus,   according    to 


238  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Scolosuboff,  if  I   part  is  found  in  fresh  muscle,  the  proportion  in 
the  liver  is   10.8 ;  in  the  brain,   36.5  ;  in  the  spinal  cord,  37.3. 

Respiratory  System.— Ox^mzxy  amounts  effect  no  special  change 
in  respiration  other  than  increased  power  and  stimulation  of  the 
respiratory  center.  It  has  been  held,  with  authority,  that  small 
doses  stimulate  the  peripheral  endings  of  the  pulmonary  vagi.  In 
toxic  doses  arsenic  acts  as  a  powerful  respiratory  depressant. 

Absorption  and  Elimination.— Arsenic  is  readily  absorbed  by 
the  blood.  Its  presence  has  also  been  detected  in  the  viscera,  bile, 
urine,  sweat,  the  bronchial  and  intestinal  mucous  membranes,  and 
even  in  the  parenchymatous  tissues.  It  is  eliminated  slowly  from 
the  system  by  the  intestines,  and  rapidly  by  the  urine ;  possibly, 
also,  by  the  bile  and  the  skin.  The  saliva,  milk,  and  even  the 
tears,  are  said  to  share  in  the  process  of  elimination. 

Medicinal  doses  prevent  tissue-change,  while  large  doses  in- 
crease nitrogenous  metamorphosis.  The  therapeutic  action  is  cer- 
tainly to  modify  and  improve  nutrition. 

Temperature. — The  temperature  is  unaffected  by  medicinal  doses. 
Toxic  doses  are  accompanied  by  a  considerable  rise  in  bodily  heat, 
though  the  extremities  are  often  cold. 

Eye. — Large  doses  of  arsenic  are  followed  by  injection  of  the 
conjunctivae,  eczema,  inflammation,  and  edema  of  the  lids.  Zehn- 
der  asserts  that  the  prolonged  administration  of  arsenic  has  caused 
retrobulbar  neuritis,  and  Hutchinson  believes  vitreous  opacities 
may  result  from  such  a  course. 

Untoward  Action. — Differing  from  the  characteristic  symptoms 
of  poisoning  occasionally  produced  by  medicinal  doses  in  very 
susceptible  persons,  there  are  induced,  not  infrequently,  restless- 
ness, headache,  alopecia  areata,  bronchitis,  hoarseness,  disturbances 
of  digestion,  thirst,  coryza,  and,  in  rare  cases,  epistaxis,  anaphro- 
disia,  icterus,  lacrymation,  photophobia,  amblyopia,  dermatitis, 
•and  various  cutaneous  eruptions,  frequently  followed  by  desqua- 
mation. 

An  eruption  resembling  that  of  measles,  produced  by  3  drops 
(0.18  Cc.)  of  Fowler's  solution,  is  reported  by  Macnal  {Medical 
Times  and  Gazette,  1868).  Falck  reports  a  case  in  which  arsenic 
produced  a  discolored  sanguinolent  eruption  with  erysipelatous 
swelling.  Papules  and  erythematous  pustules  have  also  been 
observed. 

The  variety  of  these  eruptions  is  well,  yet  somewhat  homeo- 
pathically,  described  by  Imbert-Gourbeyre  (quoted  from  Lewin) : 


SPECIFICS.  239 

"  Eruptions  petechiales  ou  ecchymoses,  eruptions  papuleuses, 
ortiees,  vesiculeuses,  erysipelateuses,  pustuleuses,  .  .  .  telles  sont 
les  formes  principales  de  I'arsenic,  exanthematogene  dans  ses  mani- 
festations.a  la  peau." 

Poisoning. — Large  doses  of  arsenic  produce  symptoms  of  acute 
poisoning,  the  drug  almost  immediately  manifesting  its  character- 
istic effects  upon  the  gastro-intestinal  canal  (to  which  it  is  a  marked 
irritant),  exciting  active  inflammation  in  its  delicate  membrane. 
Other  symptoms  are  colicky  pains  in  the  stomach,  looseness  of 
the  bowels,  great  pain  in  the  esophagus,  and  edema  of  the  face 
indicated  by  puffiness  under  the  eyelids.  The  passages  are  at 
length  similar  to  the  "  rice-water  "  discharges  of  cholera,  although 
different  from  the  latter  in  the  presence  of  blood  or  serum.  The 
purging  becomes  obstinate  and  exhausting.  In  certain  cases  other 
choleraic  symptoms  are  especially  manifested,  as  increasing  cold- 
ness of  the  body  and  cramps.  Among  the  more  prominent  symp- 
toms is  violent  vomiting,  which,  however,  aids  in  eliminating  the 
poison  from  the  stomach. 

The  effects  of  arsenic  are  somewhat  variable,  intestinal  inflam- 
mation, as  autopsies  show,  not  always  being  present.  The  quan- 
tity requisite  to  produce  poisoning  is  often  dependent  upon  idio- 
syncrasy, minute  doses  having  proved  fatal,  and  large  amounts 
followed  by  surprising  recoveries.  Frequently,  in  place  of  the 
usual  symptoms,  profound  coma  occurs  from  which  the  patient  is, 
perhaps,  never  roused.  Convulsions  and  localized  paralysis  have 
also  been  observed.  It  is  well  established,  too,  that  absorption  of 
arsenic  from  a  wound  or  from  injection  into  the  blood  causes 
stomachic  and  intestinal  effects  often  as  severe  as  those  attend- 
ing its  ingestion. 

Various  cutaneous  symptoms  are  recorded,  and  in  some  cases 
the  effects  of  arsenical  poisoning  strongly  resemble  those  of  acute 
yellow  atrophy  of  the  liver. 

Chronic  Poisoning. — This  malady  is  frequently  due  to  the  fumes 
or  powder  of  arsenic  inhaled  in  certain  processes  connected  with 
the  arts  and  manufactures  or  from  manufactured  products,  such  as 
wall-paper,  certain  dyes,  textile  fabrics,  etc.  The  symptoms  are 
similar  to  those  accompanying  full  doses  of  the  drug,  save  that 
they  appear  occasionally  in  a  more  aggravated  form.  Ordinarily, 
loss  of  appetite  occurs,  with  nausea,  abdominal  pains,  vomiting, 
mild  diarrhea,  and  headache.  The  conjunctivae  are  injected,  the 
eyes  and  nose  watery.     In  severer  cases  peripheral  neuritis  may  be 


240  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

induced,  as  well  as  herpes  zoster  and  paralysis  of  the  muscles  of 
the  limbs,  particularly  the  extensors  of  the  hands  and  feet.  Ataxic 
gait  and  darting  pains,  with  rapid  loss  of  muscular  "power,  are  not 
infrequent.  Death  from  arsenical  poisoning,  however,  is  commonly 
the  result  of  gastro-enteritis  or  collapse. 

The  post-mortem  changes  are  usually  characteristic  of  corrosive 
poisoning — ecchymoses,  erosions,  and  softening  of  the  mucous 
membrane.  The  lungs  and  bronchial  membrane  are  frequently 
congested.  There  is  also  present  marked  fatty  degeneration  of  the 
heart,  kidneys,  liver,  and  spleen. 

Treatment  of  Poisoning. — It  is  necessary  that  treatment  be  ex- 
peditious, and  the  agents  and  methods  adopted  carefully  chosen. 
Vomiting  often  renders  the  use  of  the  stomach-pump  unnecessary, 
yet  emetics  are  frequently  serviceable,  the  cleansing  of  the  stomach 
being  of  primary  importance.  Various  antidotes  have  been  suc- 
cessfully used,  the  best,  chemically,  being  freshly  prepared  hydrated 
sesquioxide  of  iron,  administered  in  water,  2  or  3  tablespoonfuls 
every  fifteen  or  twenty  minutes.  Magnesia,  chalk,  and  lime-water 
also  serve  as  efficient  antidotes.  The  temperature  of  the  patient 
should  be  maintained,  and  demulcents  (oil,  milk,  etc.)  freely  given. 
The  after-treatment  should  include  mucilaginous  drinks,  opiates  if 
indicated,  cathartics,  and,  in  case  of  necessity,  stimulants. 

Therapeutics.— £r/^r«a//K  and  Loca/fy.— The  chief  use  of 
arsenic  locally  is  as  an  escharotic.  For  this  purpose  it  is  employed 
to  destroy  malignant  growths,  such  as  cancer,  sarcoma  of  the  skin, 
and  multiple  sarcomatous  degeneration  of  the  lymphatic  glands.  In 
the  latter  affection  the  parenchymatous  injection  of  5  minims 
(0.3  Cc.)  of  Fowler's  solution,  diluted  with  fwice  the  amount  of 
distilled  water,  is  used.  ' 

Many  of  the  pastes  and  "  quack  "  cancer  remedies  owe  what- 
ever efficiency  they  possess  to  arsenic.  Manec's  paste  contains 
arsenous  acid,  15  grains  (i.o  Gm.);  black  sulphide  of  mercury,  75 
grains  (5.0  Gm.);  burnt  sponge,  35  grains  (2.3  Gm.). 

The  r\ote6.  poudre  caustique  de  Frere  Cosme  ou  du  Rousselot  is  a 
similar  preparation,  containing  about  the  same  quantity  of  arsenic. 

The  solution  of  arsenous  acid  is  an  excellent  local  application 
to  warts  and  corns.  If  these  growths  are  very  firm  and  horny, 
their  removal  may  be  facilitated  by  the  previous  application  of 
solution  of  potassa.  When  used- over  large  surfaces  arsenic  should 
be  applied  in  good  strength  and  heroically,  so  that  active  inflam- 
mation may  be  excited  and  the  danger  of  absorption   lessened. 


SPECIFICS.  241 

Internally. — Arsenic  is  a  peculiarly  efficient  remedy  in  chronic 
scaly  skin  diseases. 

Like  all  other  specifics,  it  influences  diseases  of  a  chronic  nature 
more  favorably  than  acute  disorders,  invariably  aggravating  acute 
skin  diseases.  This  drug,  therefore,  is  one  of  the  most  valued 
remedies  in  psoriasis,  lepra,  and  chronic  squamous  eczema. 

While  arsenic  cannot,  perhaps^  be  classed  as  a  specific  in  the 
above-mentioned  diseases,  it  undoubtedly  yields  uniformly  better 
results  than  any  other  single  drug. 

The  solution  of  potassa  is  a  valuable  synergist  to  arsenic  in 
these  conditions,  especially  in  eczematous  cases. 

Pemphigus,  prurigo,  acne,  and  lichen  ruber  have  also  been  fa- 
vorably influenced  by  the  continued  administration  of  Fowler's 
solution. 

In  the  successful  management  of  these  chronic  skin  diseases  it 
is  necessary  that  the  preparation  of  arsenic  employed  be  given  in 
as  large  doses  as  can  be  tolerated  by  the  patient,  and  the  treatment 
continued  unremittingly  for  a  long  period. 

Lymphoma,  whether  superficial  or  occupying  the  great  cavities, 
is  frequently  benefited  greatly  by  similar  treatment. 

Asthma  and  bronchitis,  whether  acute  or  chronic,  accompanying 
or  succeeding  scaly  skin  diseases,  are  singularly  amenable  to  this 
medicine  when  the  dose  is  carried  to  the  full  physiological  limit. 
Another  condition,  dysmenorrhea,  frequently  noticed  in  women 
with  a  tendency  to  asthma  or  subject  to  chronic  diseases  of  the 
skin,  is  often  cured  or  greatly  benefited  by  arsenic. 

The  obstinate  and  often  incurable  disease  known  as  pernicious 
anemia  yields  better  to  arsenic  than  to  any  other  known  remedy. 
The  effect  of  the  drug  in  this  disease  is  not  due  to  its  increasing 
the  number  and  quality  of  the  red  blood-corpuscles,  but  rather  to 
its  preventing  or  delaying  their  destruction  in  the  portal  circulation. 
It  should  be  given  continuously  and  in  gradually  increasing  doses 
until  symptoms  of  arsenical  poisoning  appear,  when  the  increase 
should  cease  and  the  same  dose  be  maintained  for  some  time.  By 
carefully  watching  the  indications  and  by  the  timely  use  of  lax- 
atives the  dosage  may  be  easily  adjusted  so  that  the  full  benefit 
may  be  derived  from  this  invaluable  drug. 

The  statements  in  the  preceding  paragraph  are  applicable  also 
to  leukemia,  whether  splenic,  myelogenic,  or  lymphatic,  and  to  Hodg- 

kin's  disease. 

Arsenic   ranks  next  to  quinine  in  the  treatment  of  malaria. 

16 


243  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Chronic  cases  in  which  quinine  has  lost  its  power  are  generally- 
benefited  in  a  marked  manner  by  arsenic.  It  is  a  peculiar  fact  that 
relapses  are  fewer  after  the  arsenic  treatment  than  after  the  use  of 
quinine.  Moreover,  arsenic  can  be  administered  in  intermittent 
fever',  frequently  with  as  favorable  results  as  quinine  would  give. 

Arsenic  can  be  employed  in  cases  of  malaria  at  all  times  with- 
out regard  to  the  presence  or  absence  of  fever  or  chills. 

The  neuralgias,  anemia,  and  headache  of  malarial  origin  are 
singularly  amenable  to  this  medicine. 

In  the  treatment  of  malaria  with  arsenic  it  must  be  remembered 
that  the  paroxysms  of  ague  are  not  relieved  at  once,  as  is  the  case 
when  quinine  is  the  medicament  used ;  but  they  recur  with  less 
severity,  and  are  of  shorter  duration,  gradually  declining  until  they 
disappear  altogether. 

Fowler  first  reported  the  remarkable  efficacy  of  arsenic  in 
neuralgia  of  the  intercostal  and  fifth  pair  of  nerves.  It  is  equally 
valuable  in  these  cases  whether  the  disease  be  due  to  malaria  or 
to  general  debility. 

The  author  wishes  to  recommend  urgently  the  use  of  arsenic  in 
pulmonary  phthisis.  In  certain  forms  of  this  disease  he  regards  it 
equal,  if  not  superior,  to  any  other  remedy.  It  is  useful,  however, 
only  in  those  conditions  which  are  characterized  by  excessive 
expectoration  and  a  slow  degenerative  process.  The  good  results 
of  the  arsenic  treatment  in  thgse  cases  is  shown  in  a  conspicuous 
manner  by  a  marked  improvement  in  the  general  condition  of  the 
patient,  there  being  a  lessened  pulmonary  secretion,  a  reduction  in 
temperature,  improvement  of  the  appetite,  and  consequent  increase 
of  the  body-weight.  Arsenic  is  contraindicated  in  phthisis  when 
the  cough  is  harsh  and  paroxysmal,  with  but  scanty  expectoration 
and  a  tendency  to  pulmonary  hemorrhage. 

If  this  drug  is  specific  in  any  one  disease,  it  is  so  in  chorea, 
very  rarely  failing  to  effect  a  cure  when  judiciously  administered. 
It  should  be  given  in  full  doses,  and  increased  as  tolerance  is 
established. 

This  medicine  seems  to  act  equally  well  in  gastralgia.  It  is  also 
an  efficient  remedy  in  gastritis  or  the  vomiting  of  gastritis,  espe- 
cially in  that  occasioned  by  the  excessive  use  of  alcohol.  Many 
irritative  conditions  of  the  stomach  are  relieved  by  minute  doses  of 
Fowler's  solution.  Excessive  peristalsis,  resulting  in  diarrhea, 
coming  on  immediately  after  taking  food,  is  usually  cured  com- 
pletely by  very  small  doses  of  Fowler's  solution,  alone  or  com- 


SPECIFICS.  243 

bined  with  an  equal  quantity  of  tincture  of  opium.     Arsenic  has 
also  been  recommended  in  gastric  ulcer  and  cancer. 

It  has  proved  of  great  service  in  hay  fever,  spasmodic  asthma, 
and  acute  coryza.  It  is  often  very  serviceable  in  catarrhal  pneu- 
monia and  in  chronic  bronchitis.  Bromide  of  arsenic  is  highly 
recommended  in  diabetes  m,ellitus.  Rheumatoid  arthritis  is  more 
favorably  influenced  by  the  use  of  arsenic  than  by  any  other  medi- 
cine. It  should  be  employed  in  the  treatment  of  chronic  rheuma- 
tism. Even  in  secondary  syphilis  a  combination  of  mercury  and 
arsenic  has  produced  better  results,  in  some  cases,  than  mercury 
alone.  Anstie  has  recommended  arsenic  in  angina  pectoris,  alleging 
that  it  mitigates  the  severity  of  the  attacks.  Chronic  diarrhea, 
when  induced  by  intestinal  ferrrientation  or  chronic  malarial  infec- 
tion, is  sometimes  greatly  benefited  by  this  drug.  Constipation, 
also,  if  due  to  deficient  intestinal  secretion,  may  frequently  be 
relieved  by  the  administration  of  small  doses  of  arsenic. 

Albuminuria  dependent  upon  imperfect  digestion  of  albuminous 
substances  is  almost  invariably  relieved  by  Fowler's  solution  taken 
with  meals. 

Certain  nervous  diseases  of  the  aged,  not  due  to  malaria,  such 
as  melancholia  and  hypochondria,  are  often  relieved  by  small  doses 
of  this  drug. 

Finally,  arsenic  is  a  valuable  adjunct  to  iron  in  the  treatment  of 
simple  anemia  and  chlorosis.  It  is  thought  by  some  clinicians  to 
retard  the  progress  of  epithelioma,  and  particularly  gastric  and 
uterine  cancer. 

Contraindications. — In  acute  skin  diseases  and  pulmonary 
tuberculosis  with  a  tendency  to  hemoptysis. 

Administration. — Arsenic  should  be  given  ordinarily  after 
meals.  There  are  certain  conditions,  however,  requiring  its  admin- 
istration in  small  doses  before  meals.  When  it  is  desired  to  give 
arsenic  in  pill  form,  the  arsenous  acid  should  be  used ;  and  for 
solutions  the  liquor  potassii  arsenitis  is  usually  preferred. 

In  syphilitic  disorders  Donovan's  solution  is  an  excellent  prepa- 
ration to  use. 

Children  are  much  less  susceptible  to  the  drug  than  adults, 
often  being  able  to  take  adult  doses  with  impunity. 

During  a  course  of  arsenic  the  patient  should  be  instructed  to 
watch  carefully  for  the  first  untoward  manifestations,  such  as  puf- 
finess  about  the  eyes,  itching  of  the  conjunctivae,  nausea,  diarrhea, 
or  numbness  of  the  fingers.     Any  one  of  these  symptoms  is  an 


244  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

indication  that  the  dose  should  not  be  increased ;  and  it  may  be 
necessary  to  lessen  the-  dose,  or  even  to  discontinue  the  remedy 
altogether,  for  a  while. 

There  are  two  methods  of  getting  a  patient  thoroughly  under 
the  influence  of  the  drug: 

1.  Begin  with  a  full  dose  of  Fowler's  solution,  and  decrease  i 
minim  (0.06  Cc.)  a  day  until  a  minim  (0.06  Cc.)  dose  is  reached ; 
then  repeat  the  method. 

2.  Begin  with  a  small  dose  of  Fowler's  solution,  and  increase  i 
minim  (0.06  Cc.)  a  day  until  untoward  symptoms  appear  or  the 
dose  has  reached  10  or  15  minims  (0.6-1.0  Cc);  then  either  re- 
peat the  method  or  decrease  the  amount  i  minim  (0.06  Cc.)  a 
day. 

Enormous  doses  of  arsenic  can  be  given  hypodermically,  and  it 
is  then  much  less  toxic  than  when  given  by  the  mouth.  Equiva- 
lents of  20  (1.2  Cc),  SO  (3.2  Cc),  and  indeed  100,  minims  (6.5 
Cc.)  of  Fowler's  solution  have  been  given  in  this  manner  at  a 
single  dose  without  toxic  symptoms.  Arsenic  often  acts  more 
efficiently  when  given  in  this  manner  than  when  given  by  the 
mouth.  The  liver  has  a  strong  elective  affinity  for  arsenic,  but  it 
is  absorbed  through  the  alimentary  canal  with  considerable  diffi- 
culty. The  toxic  action  expends  itself  almost  wholly  upon  the 
stomach  and  upper  portion  of  the  intestine.  The  hypodermic  use 
of  arsenic  distributes  the  drug  through  the  system  just  as  mercury 
is  distributed  by  inunction,  carrying  it  immediately  to  all  parts  of 
the  system  by  the  circulation.  The  arsenite  of  sodium  is  free  from 
any  objection  for  hypodermic  use  :  it  never  causes  the  least  sign  of 
irritation.  Fowler's  solution  is  objectionable  :  it  invariably  causes 
much  irritation,  and  frequently  forms  an  abscess. 

Careful  study  of  the  effects  of  the  drug  in  each  case  will  make 
it  possible  to  guard  its  administration  so  that  tolerance  can  be 
established — a  result  much  to  be  desired  in  order  to  secure  the 
maximum  benefit. 

Considering  the  enormous  doses  to  which  the  arsenocophagi 
become  habituated,  failure  in  the  medicinal  administration  of  arsenic 
argues  the  want  of  ability  to  employ  it  scientifically. 

I6dum—I6di— Iodine.     TJ.  S.  I*. 

Origin. — It  is  found  in  the  ashes  of  sea-weeds  and  is  prepared 
from  the  mother-liquor  obtained  in  the  purification  of  Chili  salt- 
petre. 


SPECIFICS.  245 

Description  and  Properties. — Heavy,  bluish-black,  dry  and 
friable  rhombic  plates,  having  a  metallic  luster,  a  distinctive  odor, 
and  a  sharp  and  acrid  taste.  It  imparts  a  deep-brown,  slowly 
evanescing  stain  to  the  skin,  and  gradually  destroys  vegetable 
colors.  Iodine  is  soluble  in  about  5000  parts  of  water  and  in  10 
parts  of  alcohol,  with  a  brown  color ;  also  freely  soluble  in  ether 
and  in  a  solution  of  potassium  iodide,  with  a  brown  color,  and  in 
chloroform  or  carbon  disulphide,  with  a  violet  color.  It  should  be 
kept  in  glass-stoppered  bottles,  in  a  cool  place. 

Dose. — About  \  grain  (0.016  Gm.),  although  seldom  given  in 
substance. 

Official  Preparations. 

Liquor  lodi  CompOsitus — Liquoris  lodi  Comp6siti — Compound  Solution 
of  Iodine  (Lugol's  Solution). — Iodine,  S;  Potassium  Iodide,  10;  Distilled  Water,  to 
make  100  parts.     Strength,  5  per  cent.     Dose,  l-io  minims  (0.06-0.6  Cc). 

Tincttira  lodi — Tinctiirse  lodi — Tincture  of  Iodine. — Iodine,  70;  Alcohol,  to 
1000.     Strength,  7  per  cent.     Dose,  1—5  minims  (0.06-0.3  Cc). 

Ungufentum  lodi — UnguSnti  lodi — Iodine  Ointment. — Iodine,  4;  Potassium 
Iodide,  l;  Water,  2;  Benzoinated  Lard,  93.     Strength,  4  per  cent.     For  external  use. 

S^rupus  Acidi  Hydriodidi— Sj^rupi  Acidi  Hydriodidi 
—Syrup  of  Hydriodic  Acid.     TI.  S.  P. 

A  syrupy  liquid  containing  about  I  per  cent,  by  weight  of 
hydriodic  acid. 

Description  and  Properties. — A  transparent,  colorless,  or  only 
pale  straw-colored  liquid,  odorless,  and  having  a  sweet  and  acidu- 
lous taste. 

Dose. — J-2  fluidrachms  (2.0-8.0  Cc). 

Ammonii  lodidum— Ammonii  lodidi— Ammonium 
Iodide.     U.S.  P. 

Origin. It  is  prepared  by  dissolving   Potassium   Iodide   and 

Ammonium  Sulphate  in  boiling  Water,  adding  Alcohol,  filtering, 
washing  the  filtrate,  and  evaporating  it  to  dryness. 

Description  and  Properties. — Minute,  colorless,  cubical  crys- 
tals or  a  white,  granular  powder,  without  odor  when  colorless,  but 
emitting  a  slight  odor  when  colored,  and  having  a  sharp,  saline 
taste.  The  salt  is  hygroscopic,  and  soon  becomes  yellow,  or 
yellowish-brown,  on  exposure  to  the  air  and  light,  owing  to  the 
loss  of  ammonia  and  the  elimination  of  iodine.     Soluble  in  x  part 


246  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

of  water  and  in  9  parts  of  alcohol.     Ammonium  iodide  should  be 
kept  in  small,  well-stoppered  vials,  protected  from  light. 
Dose. — 3-20  grains  (o.  1 8-1.2  Gm.). 

Potassii  lodidum— Potassii  lodidi— Potassium 
Iodide.     TJ.  S.  P. 

Origin. — Iodine  is  dissolved  in  a  solution  of  Potassa  in  hot  dis- 
tilled Water.  The  solution  is  evaporated,  and  the  residue  heated 
with  charcoal.  Dissolve  in  boiling  Water,  filter,  wash  the  filtrate, 
and  crystallize. 

Description  and  Properties. — Colorless,  transparent  or  trans- 
lucent, cubical  crystals,  or  a  white,  granular  powder,  having  a  pecu- 
liar, faint,  iodine-like  odor,  and  a  pungent,  saline,  and  afterward 
bitter  taste.  Permanent  in  dry  air  and  but  slightly  deliquescent  in 
moist  air.  Soluble  in  0.75  part  of  water  and  in  18  parts  of  alcohol; 
also  soluble  in  2.5  parts  of  glycerin.  Potassium  iodide  should  be 
kept  in  well-stoppered  bottles. 

Dose. — 2-30  grains  (0.12-2.0  Gm.). 

Official  Preparation. 

UnguSntum  PotSssii  lodidi — UnguSnti  PotSssii  lodidi — Ointment  of  Po- 
tassium Iodide. — Potassium  Iodide,  12;  Sodium  Hyposulphite,  I;  Water,  10;  Ben- 

zoinated  Lard,  77.     For  external  use. 

Sodii  I5didum— Sodii  I5didi— Sodium  Iodide.  TJ.  S.  P. 

Origin. — Prepared  from  a  solution  of  Soda  in  a  manner  similar 
to  the  preparation  of  potassium  iodide. 

Description  and  Properties. — Colorless,  cubical  crystals,  or  a 
white,  crystalline  powder,  odorless,  and  having  a  saline  and  slightly 
bitter  taste.  In  moist  air  it  deliquesces  and  becomes  partially  de- 
composed into  sodium  carbonate  and  free  iodine,  assuming  thereby 
a  reddish  color.  Soluble  in  0.6  part  of  water  and  in  about  3  parts 
of  alcohol.     It  should  be  kept  in  well-stoppered  bottles. 

Dose. — 2-30  grains  (o.i  2-2.0  Gm.). 

Strontii  lodidum— Strontii  lodidi— Strontium  Iodide. 

V.  s.  p. 

Origin.— Prepared  by  neutralizing  freshly  prepared  solution  of 
Hydriodic  Acid  with  Strontium  Carbonate,  concentrating  the  filtrate, 
and  crystallizing. 

Description    and    Properties.— Colorless,    transparent,    hex- 


SPECIFICS.  247 

agonal  plates,  odorless,  and  having  a  bitterish,  saline  taste ;  deli- 
quescent and  colored  yellow  by  exposure  to  air  and  light. 
Soluble  in  0.6  part  of  water,  also  soluble  in  alcohol,  and  slightly 
in  ether.  It  should  be  kept  in  dark,  amber-colored,  glass-stop- 
pered vials. 

Dose. — 2-30  grains  (0.12-2.0  Gm.). 

Zinci  lodidum— ZTnci  lodidi— Zinc  Iodide.     U.S.I*. 

Origin. — Obtained  by  dissolving  Zinc  Oxide  or  Carbonate  in 
Hydriodic  Acid,  or  digesting  Granulated  Zinc  in  10  parts  of  Iodine 
and  20  parts  of  Water,  and  evaporating  to  dryness. 

Description  and  Properties. — A  white,  granular  powder,  odor- 
less, and  having  a  sharp,  saline,  and  metallic  taste.  Very  deliques- 
cent, and  liable  to  absorb  oxygen  from  the  air  and  to  become 
brown  from  liberated  iodine.  Readily  soluble  in  water,  alcohol,  or 
ether.  Zinc  iodide  should  be  kept  in  small,  glass-stoppered  bot- 
tles. 

Dose. — 1-3  grains  (0.06-0.18  Gm.). 

Sulphuris  lodidum— Sulplnuris  lodidi— Sulphur 
Iodide.    U.  S.  P. 

Origin. — Prepared  by  heating  Washed  Sulphur  and  Iodine  in  a 
flask  until  the  ingredients  combine. 

Description  and  Properties. — Brittle  masses,  of  a  crystalline 
fracture  and  a  grayish-black,  metallic  luster,  having  the  odor  of 
ipdine  and  a  somewhat  acrid  taste.  Almost  insoluble  in  water; 
soluble  in  about  60  parts  of  glycerin ;  very  soluble  in  carbon  di- 
sulphide.  Alcohol  and  ether  dissolve  out  the  iodine,  leaving  the 
sulphur.  Sulphur  iodide  should  be  kept  in  glass-stoppered  bottles, 
in  a  cool  place. 

Dose. — 1-5  grains  (0.06-0.3  Gm.). 

Unofficial  Preparation. 

UnguSntum  Stilphuris  lodidi — Ungu&nti  Stilphuris  lodidi — Ointment  of 
Sulphur  Iodide. — Sulphur  Iodide,  30  grains  (2.0  Gm.);  Lard,  i  ounce  (30.0  Gm.). 
For  external  use. 

Plumbi  lodidum— Plumbi  lodidi— Lead  Iodide. 

U.  S.  F. 

Origin. — Mix  solutions  of  Lead  Nitrate  and  Potassium  Iodide, 
filter,  wash  the  precipitate  with  Distilled  Water,  and  dry  it  at  a 
gentle  heat. 


248  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Description  and  Properties. — A  heavy,  bright-yellow  powder, 
without  odor  or  taste.  Permanent  in  the  air.  Soluble  in  2000 
parts  of  water ;  very  slightly  soluble  in  alcohol,  but  soluble,  with- 
out color,  in  solutions  of  the  fixed  alkalies,  in  concentrated  solu- 
tions of  the  acetates  of  the  alkalies,  of  potassium  iodide,  and  of 
sodium  hyposulphites,  and  in  a  hot  solution  of  ammonium  chloride. 
Lead  iodide  should  be  kept  in  well-stoppered  bottles,  protected 
from  light. 

Dose. — \  grain  (0.013  Gm.),  although,  as  a  rule,  this  drug  is 
employed  externally. 

Arg-enti  lodidum— Arg-enti  lodidi— Silver  Iodide. 

TJ.  8.  P. 

Origin. — Aqueous  solutions  of  Silver  Nitrate  and  of  Potassium 
Iodide  are  poured  together ;  the  precipitate  is  then  collected  upon 
a  filter  and  washed  with  Distilled  Water  and  dried  upon  bibulous 
paper. 

Description  and  Properties. — A  heavy,  amorphous,  light-yel- 
lowish powder,  unaffected  by  light  if  pure,  but  generally  becom- 
ing somewhat  greenish-yellow,  and  having  neither  odor  nor  taste. 
Insoluble  in  water  and  alcohol. 

Dose. — \-2  grains  (0.008-0. 13  Gm.). 

Allied  Compounds. 

lodi  Bromidum— lodi  Bromidi— Bromide  of  Iodine.— Orz^w.— Obtained  by 
heating  together  Iodine  and  Bromine. 

Description  and  Properties. — A  dark,  reddish-brown  liquid,  resembling  bromine  in 
appearance  and  sensible  properties,  but  yielding  a  perfectly  transparent,  brown-red  solu- 
tion with  less  than  6  parts  of  water.     For  external  use. 

lodi  Chloridum— lodi  Chloridi— Iodine  Chloride  (Iodine  Trichloride).— 
On^'w.- Prepared  by  passing  dry  Chlorine  Gas  over  dry  Iodine. 

Description  and  /'«/,?>-/««.— Orange-yellow  needles,  gradually  changing  to  large, 
transparent,  rhombic  plates.  It  has  a  penetrating,  pungent  odor,  resembling  bromine. 
Soluble  in  5  parts  of  water,  and  also  in  alcohol  and  ether. 

Dose.—\  grain  (o.oi  Gm.),  and  externally  in  ^1  per  cent,  aqueous  solution. 


Antagonists  and  Incompatibles. — Iodine  and  the  iodides  are 
antagonized  by  most  of  the  Restoratives.  Iodine  is  incompatible 
with  the  alkaloids  and  most  of  the  mineral  salts  and  acids,  and 
with  ammonia.  The  iodides  are  incompatible  with  mineral  acids 
and  acid  salts,  bismuth  subnitrate,  alkaloids,  silver  nitrate,  soluble 
lead  salts,  spirit  of  nitrous  ether,  potassium  chlorate,  liquorice,  and 


SPECIFICS.  249 

preparations  containing  starch.  The  tincture  of  iodine  is  incom- 
patible with  water  and  aqueous  preparations. 

Synergists. — The  specifics,  alkalies,  and  remedies  increasing 
waste. 

Physiological  Action. — Externally  and  Locally. — Iodine  is  a 
powerful  disinfectant  and  rubefacient,  as  well  as  vesicant,  caustic, 
parasiticide,  and  antiseptic.  When  applied  to  the  skin  or  mucous 
membrane  it  produces  a  yellow,  brown,  or  black  stain,  and  is  irri- 
tant, or  caustic  according  to  the  strength  and  frequency  of  the 
application.  The  discoloration,  however,  can  be  easily  removed 
by  sodium  hyposulphite  or  ammonia. 

It  combines  with  the  albumin  of  the  tissues  and  prevents  putre- 
factive changes.  When  tincture  of  iodine  is  frequently  applied  or 
large  amounts  are  used,  desquamation  of  the  skin  is  produced,  and 
sometimes  rapid  vesication,  or  perhaps  sloughing.  The  blood- 
vessels of  the  organs  subjacent  to  the  area  to  which  it  is  applied 
are  reflexly  dilated,  rendering  this  drug  an  efficient  counter-irritant. 

The  vapor  of  iodine  when  inhaled  produces  considerable  irrita- 
tion of  the  respiratory  passages,  exciting  cough,  sneezing,  increased 
secretion  of  mucus,  dyspnea,  and  more  or  less  pain  in  the  chest, 
although  when  inhaled  in  moderate  amounts  its  antiseptic  proper- 
ties exert  a  beneficial  influence  upon  the  bronchial  tissues,  prevent- 
ing decomposition  of  the  secretions. 

The  iodides  have  no  local  action. 

Internally. — Digestive  System. — Taken  internally  in  small  doses, 
IODINE  acts  as  a  gastric  tonic,  minute  doses  acting  as  a  sedative, 
allaying  nausea.  In  other  cases  a  single  moderate  dose  may  occa- 
sion gastric  uneasiness,  larger  amounts  intensifying  the  discomfort 
and  causing  violent  vomiting,  increased  salivary  flow,  abdominal 
pains,  and  purging. 

The  IODIDES  in  moderate  doses  produce  a  sense  of  warmth  in 
the  stomach,  larger  amounts  acting  like  iodine,  though  less  irri- 
tating to  the  gastro-intestinal  tract  than  the  latter  drug. 

Owing  to  their  rapid  diffusibility,  the  iodides  can  be  tasted  in  a 
few  minutes  after  their  ingestion,  considerably  increasing  the  flow 
of  saliva. 

Circulatory  System. — The  effects  of  iodine  and  its  salts  have 
beerj  variously  reported,  it  being  claimed  that  their  tendency  is  to 
contract  the  vessels  and  cause  increased  cardiac  action.  Intro- 
duced into  the  veins,  a  slight  increase,  followed  by  decrease  of 
pressure,  has  been  observed.     The  rapidity  of  elimination  from  the 


250  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

blood  is  doubtless  an  impediment  to  any  marked  action  on  the 
circulation.  Trasbot  claims  that  potassium  iodide  dilates  the 
blood-vessels,  thereby  increasing  glandular  secretion. 

The  iodides  are  all  supposed  to  be  converted  into  the  sodium 
iodide  in  the  blood,  without  modifying  the  composition  of  that 
fluid. 

Nervous  System. — No  special  action  is  recorded,  although  the 
potassium  iodide  is  known  to  occasion  unpleasant  symptoms,  in- 
cluding distress  of  mind  and  depression  of  spirits,  accompanied 
now  and  then  by  lassitude  and  muscular  debility — symptoms  due 
rather  to  the  influence  of  potassium  upon  the  spinal  cord. 

Respiratory  System. — Little  or  no  effect  from  medicinal  doses 
has  been  noted. 

Absorption  and  Elimination. — Iodine  and  the  iodides  are  rapidly 
absorbed  by  the  mucous  membranes  generally,  being  found  in  the 
blood,  mainly  in  combination  with  sodium. 

Elimination  takes  place  by  various  channels — ^the  urine,  saliva, 
milk,  intestinal  and  nasal  mucous  membranes.  Salivary  elimina- 
tion appears  to  be  even  more  active  than  the  urinary  process, 
although  the  drug  escapes  largely  through  the  kidneys,  increasing 
the  amount  of  water,  urea,  uric  acid,  and  phosphoric  and  sulphuric 
acids  excreted.  At  the  points  of  elimination  the  iodine  escapes  in 
its  nascent  state,  setting  free  ozone,  which  occasions  more  or  less 
irritation. 

Temperature. — No  effects  have  been  noted,  the  temperature 
appearing  to  remain  stationary  even  in  the  presence  of  decidedly 
untoward  symptoms. 

Eye. — Beyond  a  local  congestion  of  the  minute  vessels  of  the 
sclerotic  coat  under  certain  conditions  little  effect  has  been  ob- 
served. The  symptoms  of  ocular  iodism  at  times  present  are 
described  under  "  Poisoning." 

Uterus. — Small  doses  may  increase  or  hasten  the  menstrual 
flow  and  act  as  aphrodisiacs ;  larger  doses  have  a  marked  anaphro- 
disiac  effect ;  while  prolonged  administration  may  result  in  atrophy 
of  the  ovaries.  It  has  been  maintained  with  authority  that  the 
catamenia  are  liable  to  increase,  and  that  during  pregnancy  the 
drug  may  cause  abortion. 

Untoward  Action. — The  untoward  manifestations,  in  susceptible 
patients,  are  identical  with  those  of  iodism. 

Poisoning.— T?i\ie.r\.  in  excessive  doses,  iodine  acts  as  a  poison, 
and  has  even  produced  death,  though  rarely.     The  symptoms  of 


SPECIFICS.  251 

acute  poisoning  are  those  of  severe  gastro-enteritis,  characterized 
by  distressing  stomachic  and  abdominal  pains,  accompanied  by 
painful  irritation  of  the  esophagus,  followed  by  violent  purging  and 
vomiting. 

An  early  symptom  is  a  strong  metallic  taste  in  the  mouth,  to- 
gether with  increased  salivation.  Suppression  of  urine,  hiccough, 
and  dysenteric  pain  have  been  reported  in  a  fatal  case  resulting 
from  external  application  (Biddle,  p.  460).  Very  immoderate  doses 
are  attended  with  rapid  and  feeble  pulse,  deathly  pallor,  severe 
renal  irritation  affecting  urinary  secretion,  and  final  loss  of  vitaL 
power  followed  by  respiratory  failure. 

The  condition  induced  by  prolonged  or  excessive  use  of  iodine 
or  its  salts  is  known  as  lodism.  Together  with  a  metallic  taste 
there  are  present  tenderness  of  the  teeth  and  gums,  nausea  and 
coryza  or  symptoms  of  gastric  irritation,  acneiform  eruptions — 
even  a  vesicular  and  purpuric  variety  not  infrequently  occurs — 
while  under  continued  dosage  the  coryza  becomes  more  pro- 
nounced, accompanied  by  edema  of  the  eyelids,  lacrymation,  and 
ocular  pains.  Moreover,  muscular  twitchings,  edema  of  the  glottis,, 
neuralgic  pains,  and  atrophy  of  mammae,  testicles,  and  other  tis- 
sues occasionally  supervene.  Anemia  and  even  cachexia  are  often 
manifest. 

Treatment  of  Poisoning. — The  use  of  large  amounts  of  starch,, 
in  the  form  of  arrowroot  or  starch-water,  has  been  successfully- 
adopted  as  an  antidote.  Hypodermic  injections  of  ammonia, 
strychnine,  digitalis,  alcohol,  and  atropine  have  been  employed 
with  excellent  results,  as  tending  to  restore  the  circulation  and 
assist  respiratory  movements.  More  recently  bicarbonate  of  so- 
dium has  proved  an  efficient  antidote. 

The  use  of  the  stomach-pump  and  the  application  of  heit  to 
the  body  and  extremities  are  naturally  of  the  first  importance. 

Therapeutics. — Externally  and  Locally. — The  tincture,  com- 
pound SOLUTION,  and  ointment  are  extensively  employed  as  coun- 
ter-irritants and  as  aids  to  the  absorption  of  fluid!  The  tincture  is 
an  efficient  application  to  joints  in  chronic  rheumatism,  gout,  and 
synovitis,  and  in  pleurisy,  both  for  the  purpose  of  aborting  an 
attack  and  to  aid  the  absorption  of  fluid  when  effusion  has  taken 
place.  In  neuritis,  onychia,  periostitis,  venereal  bubo,  glandular 
swellings,  etc.  the  tincture,  applied  externally,  will  ofl;en  be  of 
service. 

This  same  preparation  is  of  marked  benefit  when  hypodermi- 


.^52  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

tally  injected  in  goiter,  particularly  of  the  soft  or  cystic  variety, 
hydrocele,  empyema,  extensive  serous  arthritic  effusion  unaccompanied 
by  inflammation,  spinal  meningocele,  and  anal  fistula. 

The  tincture  is  also  a  very  efficient  application  in  chronic  metritis 
and  chronic  endometritis. 

In  many  diseases  of  the  skin  iodine  serves  a  useful  purpose  as 
a  discutient  and  parasiticide,  lentigo,  lupus,  chloasma,  tinea  tonsurans, 
etc.  especially  indicating  its  use. 

Many  chronic  splenic  and  hepatic  disorders  are  favorably  influ- 
enced by  an  external  application  of  the  iodine  ointment. 

The  TINCTURE  OF  IODINE  has  been  recommended  as  an  efficient 
application  in  recession  of  the  gums  attendant  upon  pyorrhoea 
ulveolaris. 

The  vapor  of  iodine  is  frequently  employed  in  subacute  ca- 
tarrhal deafness  'and  in  acute  coryza. 

A  mixture  of  tincture  of  iodine  |  fluidrachm  (2.0  Co.),  carbolic 
acid  ID  minims  (0.6  Cc),  glycerin  and  water,  each,  ij  ounces 
(45.0  Cc),  has  been  highly  recommended  by  Samuel  Johnston  in 
the  treatment  of  chronic  pharyngitis. 

As  an  inhalant  in  chronic  laryngitis  and  phthisis  iodine  in  some 
form  is  highly  esteemed  by  rnany  physicians. 

Internally. — One  of  the  principal  and  most  important  uses  of 
iodine  and  the  iodides  is  in  the  treatment  of  secondary  and  tertiary 
syphilis.  All  the  manifestations  of  this  disease,  such  as  syphilitic 
periostitis,  meningitis,  endarteritis,  gumjnata,  paralysis,  etc.,  are  re- 
lieved by  large  doses  of  the  iodides  to  saturation  of  the  system. 
The  more  chronic  the  disease,  the  larger  the  dose  required ;  and 
the  more  acute  the  attack,  the  smaller  the  dose. 

Iodine  is  peculiarly  useful  in  combining  with  and  eliminating 
mercury  from  the  system  of  patients  suffering  from  mercurial 
cachexia,  paralysis,  etc.  Other  metals,  lead,  etc.,  are  readily  elim- 
inated by  a  course  of  potassium  iodide. 

Potassium  iodide  is  of  marked  utility  in  arresting  the  various 
manifestations  of  scrofula,  such  as  inflammation  and  ulceration  of 
cartilaginous  structures  and  mucous  catarrhs,  and  hastening  the  reso- 
lution of  adenitis  and  enlargement  of  lymphatics. 

With  regard  to  the  use  of  iodine  in  the  treatment  of  aneurysm 
of  the  aorta  Walshe  says  :  "  Not  only  has  relief  of  neuralgic  pains 
and  of  the  general  distress  followed  its  administration,  but  the  local 
pressure-symptoms  have  been  mitigated,  and  firm  thrombosis  has 
taken  place  within  the  sac,  while  the  area  of  pulsation  and  of  per- 


SPECIFICS.  255 

cussion-dulness  has  exhibited  sensible  reduction."  Other  authori- 
ties have  reported  favorably  of  its  use  in  this  condition. 

As  a  cardiac  tonic  iodine  is  of  undoubted  value,  being  especially- 
serviceable  in  fatty  degeneration  of  the  heart,  and  in  usually  miti- 
gating the  symptoms  of  chronic  valvular  diseases  of  the  heart, 
especially  those  of  the  aortic  orifice.  It  is  a  particularly  useful 
remedy  in  chronic  asthma  and  bronchitis,  and  to  hasten  the  removal 
of  inflammatory  products  of  pneumonia,  pleurisy,  and  pericarditis. 

The  spasmodic  asthma  of  adults  and  the  bronchitis  of  children, 
both  of  which  alternate  with  eczematous  attacks,  are  greatly 
relieved  by  the  potassium  iodide. 

Even  hereditary  asthma  occurs  at  less  frequent  intervals  and  in 
a  milder  form  when  the  patient  is  kept  constantly  under  the  influ- 
ence of  moderate  doses  of  this  drug.  And  if  there  is  any  remedy 
which  has  a  beneficial  influence  in  acute  tubercular  meningitis,  it  is 
potassium  iodide. 

In  the  early  stages  of  cirrhosis,  whether  of  the  liver  or  kidneys,, 
as  well  as  in  sclerosis  of  the  cord,  it  is  an  efficient  remedy.  The 
dropsy  of  splenic  or  hepatic  induration  is  relieved  by  iodine,  while 
in  the  various  forms  of  muscular  rheumatism  it  is  one  of  the  most 
potent  medicaments.  It  has  been  advocated  as  a  successful  remedy 
in  sciatica  and  chronic  gout. 

It  unquestionably  retards  the  changes  in  chronic  interstitial 
nephritis,  though  the  tincture  of  iodine  in  these  cases  is  considered 
superior  to  the  potassium  iodide. 

Ammonium  iodide  is  highly  recommended  as  an  efficient  rem- 
edy in  acute  catarrhal  pneumonia  and  capillary  bronchitis.  It  is 
especially  useful  in  catarrhal  jaundice,  and  has,  moreover,  been 
suggested  as  a  good  remedy  in  hay  fever  and  in  malarial  fevers. 

The  SYRUP  OF  HYDRiODic  ACID  has  been  commended  by  Craig 
as  a  valuable  agent  in  acute  rheumatism. 

Contraindications. — The  drug  should  be  discontinued  at  once 
when  symptoms  of  iodism  appear.  It  is  contraindicated  also  in 
pulmonary  tuberculosis  when  there  is  rapid  change  taking  place 
in  the  lung.  The  iodides  should  not  be  given  immediately  before 
or  after  the  administration  of  quinine. 

Administration. — The  sodium  iodide  is  less  active  and  toxic 
than  the  potassium  salt.  The  strontium  iodide  may  be  used  for 
the  same  purposes  as  the  other  iodides,  and  possesses  the  advantage 
of  disturbing  the  stomach  less,  besides  being  less  likely  to  produce 
iodism. 


254  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

The  iodides  should  be  given  in  a  large  quantity  of  liquid.  Their 
unpleasant  taste  may  be  concealed  to  a  considerable  extent  by 
dissolving  them  in  carbonic-acid  water  or  Vichy  water.  Milk,  com- 
pound syrup  of  sarsaparilla,  and  currant  and  raspberry  syrups  have 
all  been  used  for  this  purpose. 

It  is  said  that  tincture  of  belladonna  or  sodium  bicarbonate 
prevents  the  coryza  caused  by  the  iodides. 

The  syrup  of  hydriodic  acid  is  quite  pleasant  to  the  taste,  and 
has  but  little  tendency  to  produce  iodism  or  untoward  effects. 
This  preparation  should  always  be  administered  upon  an  empty 
stomach. 


Colchicum— Colchici— Colchicum.    JJ.  S.  J*. 

(Meadow  Saffron.) 

Origin. — A  plant  indigenous  in  Europe,  in  the  southern  and 
central  portions  of  which  it  is  frequently  found  in  pastures  and 
meadows,  flowering  in  September  or  October,  and  ripening  its 
seeds  in  June  following.     The  root  and  seeds  are  ofScial. 

Description  and  Properties. — TAe  root  is  about  i  inch  (25 
Mm.)  long,  ovoid,  flattish,  with  a  groove  on  one  side ;  externally 
brownish  and  wrinkled,  internally  white  and  solid  ;  often  in  trans- 
verse slices  reniform  in  shape,  and  breaking  with  a  short,  mealy 
fracture ;  inodorous ;  taste  sweetish,  bitter,  and  somewhat  acrid. 

Dose. — 2-8  grains  (0.12-0.5  Gm.)  in  powder. 

Official  Preparations  of  the  Root. 

Extractum  C61chici  RSdicis — Extracti  CSlchici  RSdicis — Extract  of  Col- 
chicum Root. — Dose,  \-2  grains  (0.03-0.12  Gm.). 

Extractum  Cdlchici  Radicis  Fluidum— Extracti  Cdlchici  Radicis  Fliiidi — 
Fluid  Extract  of  Colchicum  Root. — Dose,  2-8  minims  (0.12-0.5  Cc). 

Vinum  COlchici  Radicis — Vini  CSlchici  Radicis — Wine  of  Colchicum 
Root. — Dose,  5-20  minims  (0.3-1.2  Cc). 

Colchicum  seeds  are  subglobular,  about  -^  inch  (2  Mm.)  thick, 
very  slightly  pointed  at  the  hilum ;  reddish-brown,  finely  pitted, 
internally  whitish ;  very  hard  and  tough ;  inodorous ;  taste  bitter 
and  somewhat  acrid. 

Both  the  root  and  seeds  contain  an  active  principle,  colchicine, 
which  is  present  in  greater  proportion  in  the  root. 

Dose  of  the  Powdered  Seeds. — 1-5  grains  (0.06^.3  Gm.). 

Dose  of  Colchicine. — ^^^   g^  grain  (0.0012-0.001  Gm.). 


SPECIFICS. 


255 


Official  Preparations  of  the  Seed. 

Extractum  Cttlchici  SSminis  Fluidum— ExtrScti  Caichici  Sgminis  Fluidi— 
Fluid  Extract  of  Colchicum  Seed. — Dose,  1-5  minims  (0.06-0.3  Cc). 

Tinctura  COlchici  S6minis— Tincture  C61chici  S6minis— Tincture  of  Col- 
chicum  Seed. — Dose,  10-30  minims  (0.6-2.0  Cc). 

Vinum  CSlchici  SSminis— Vini  C61chici  Sgminis— Wine  of  Colchicum 
Seed. — Dose,  10-30  minims  (0.6-2.0  Cc.). 

Antagonists  and  Incompatibles. — Alcohol  and  opium  antago- 
nize the  cardiac  depression  produced  by  colchicum.  Tannic  acid 
and  vegetable  infusions  containing  it  are  incompatible,  forming  an 
insoluble  tannate  with  the  alkaloid. 

Sjmergists. — Diuretics,  purgatives,  emetics,  and  alkalies  pro- , 
mote  the  therapeutic  activity  of  colchicum. 

Physiological  Action. — Externally  and  Locally. — Colchicum  is 
a  decided  local  irritant,  and  when  appUed  to  the  skin  acts  as  a 
rubefacient.     The  dust  when  inhaled  excites  sneezing. 

Internally. — Digestive  System. — In  small  medicinal  doses  colchi- 
cum slightly  stimulates  the  salivary,  gastric,  biliary,  and  intestinal 
secretions.  If  these  doses  are  repeated  for  several  days,  a  sensa- 
tion of  heat  is  experienced  in  the  epigastrium,  accompanied  by  loss 
of  appetite  and  frequently  by  nausea.  Full  medicinal  doses  may 
produce  purging  and  colic.  Larger  doses  occasion  profuse  watery 
and  choleriform  or  bloody  evacuations  from  the  bowels,  severe 
abdominal  pain  and  tenderness,  excessive  vomiting — in  fact,  all  the 
symptoms  produced  by  a  violent  gastro-intestinal  irritant. 

Circulatory  System. — Full  medicinal  or  larger  doses  produce 
great  depression  of  the  circulation,  with  a  small,  rapid,  and  thready 
pulse.  The  marked  cardiac  depression  and  collapse  which  occur 
when  poisonous  doses  of  colchicum  have  been  taken  are  more  the 
result  of  the  severe  gastro-enteritis  than  of  any  direct  action  upon 
the  heart. 

Nervous  System. — The  nervous  system  is  unaffected  by  medici- 
nal doses.  Even  when  poisonous  doses  have  been  taken  the 
intellect  usually  remains  unimpaired,  though  Toulrriouche  has  seen 
the  drug  induce  marked  cerebral  excitement.  Discordant  state- 
ments have  been  made  regarding  the  action  of  colchicum  upon  the 
nervous  system.  The  drug  evidently  affects  different  persons  dif- 
ferently. Thus  numbness  or  prickling,  muscular  pains  or  spasms, 
and  occasionally  convulsions,  have  been  noticed ;  yet  the  recent 
investigations  of  Laborde  and  Houde  upon  the  action  of  colchicine 
show  that  it  has  no  influence  upon  the  centers  of  intelligence  and 


256  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

volition,  and   does  not  induce  paralysis   of  central  origin,  either 
motor  or  sensory,  though  the  sensory  nerves  are  considerably 

depressed. 

Respiratory  System— \jax%&  or  poisonous  doses  of  colchicum 
render  the  respiratory  movements  slow  and  shallow.  This  action 
is  not  due  to  any  direct  effect  upon  the  respiratory  center,  but 
reflexly  to  the  depression  occasioned  by  the  violent  action  of  the 
drug  upon  the  gastro-intestinal  tract. 

Absorption  and  Elimination.— Colchicum  is  quite  rapidly  ab- 
sorbed, and  is  eliminated  chiefly  by  the  bowels  and  kidneys,  the 
skin  sharing  to  some  extent  in  the  excretory  process.  Some  ob- 
servers allege  that  colchicum  does  not  increase  the  amount  of 
urine  or  the  excretion  of  urea  and  uric  acid,  while  others  claim 
that  these  substances  are  increased.  The  author's  experiments 
are  sufficient  to  satisfy  him  that  the  excretion  of  all  these  sub- 
stances is  considerably  heightened  under  medicinal  doses  of  col- 
chicum. 

Temperature. — Under  moderate  medicinal  doses  the  temperature 
is  unaffected,  though  doses  large  enough  to  produce  emeto-cathar- 
sis  are  followed  by  a  reduction  of  temperature. 

Untoward  Action. — Many  symptoms  described  under  "  Poison- 
ing" have  been  produced  by  very  small  doses.  It  is  a  matter  of 
speculation  whether  these  untoward  manifestations  were  due  to  a 
decided  idiosyncrasy  on  the  part  of  the  patient,  or  to  the  fact  that- 
the  preparation  employed  might  have  contained  an  unusually  large 
percentage  of  the  alkaloid. 

Poisoning. — The  symptoms  of  poisoning  by  colchicum  are  vio- 
lent vomiting  and  purging,  griping  and  intense  pain  in  the  abdomen, 
and  at  times  excessive  salivation  or  possibly  convulsions.  While 
death  is  for  a  time  delayed  under  a  poisonous  dose,  a  fatal  termina- 
tion is  almost  inevitable.  Meanwhile  the  patient  suffers  excruci- 
atingly, being  little  relieved  by  treatment. 

Treatment  of  Poisoning. — All  that  can  be  done  is  to  combat 
symptoms,  giving  opium  for  pain,  oil  and  demulcent  drinks  for  the 
irritation,  and  stimulants  to  counteract  respiratoiy  and  cardiac 
depression.  Washing  out  the  stomach  or  the  use  of  emetics  may 
be  required.  Tannic  acid  serves  as  a  partial  antidote,  precipitating 
the  colchicine. 

Therapeutics. — Externally    and    Locally. — Colchicum    has    no 
local  therapeutic  action. 
I      Internally. — Colchicum  is  the  typical  vegetable   specific.     Its 


SPECIFICS.  257, 

effects  are  in  many  ways  analogous  to  those  of  mercury  and  iodine, 
even  resulting  in  fatty  degeneration  of  the  liver,  loss  of  hair,  nails, 
teeth,  etc. 

The  drug  is  as  valuable  and  certain  a  specific  for  gout  as  is  mer- 
cury for  syphilis.  Gout  in  all  its  varied  manifestations  is  relieved 
by  this  invaluable  remedy.  Diarrhea,  dysentery,  dyspepsia,  bron- 
chitis, asthma,  neuralgia,  and  eczema  dependent  upon  a  gouty  condi- 
tion are  singularly  benefited  by  colchicum. 

This  medicine,  while  quite  efficacious  in  chronic  rheumatism,  and 
occasionally  of  some  benefit  in  rheumatoid  arthritis,  is  of  no  value 
in  acute  articular  rheumatism. 

Its  value  is  more  apparent  in  acute  than  in  chronic  gout,  and  in 
the  first  attacks  than  in  succeeding  ones.  Chronic  gout,  as  well  as 
chronic  rheumatism,  yields  better  to  a  combination  of  colchicum 
and  potassium  iodide  than  to  colchicum  alone. 

Some  physicians  recommend  hypodermic  injections  of  colchi- 
cine into  the  sheath  of  the  nerve  in  sciatica.  The  author's  quite 
limited  use  of  this  method  has  resulted  in  so  much  local  irritation 
that  he  is  prompted  to  caution  the  reader  against  the  hypodermic 
employment  of  this  drug. 

In  combination  with  certain  other  agents  colchicum  serves  an 
excellent  purpose  as  a  cholagogue,  full  doses  being  frequently  very 
effective  in  relieving  ascites  due  to  obstructive  diseases  of  the  liver. 
■  Colchicum  is  sometimes  employed  as  a  drastic  purgative  in 
cerebral  and  portal  congestion,  although  when  given  in  doses  suf- 
ficient for  this  purpose  it  occasions  considerable  nausea  and  abdom- 
inal distress. 

Colchicum  has  also  been  recommended  in  the  treatment  of 
gonorrhea  and  chordee. 

In  doses  of  -^  grain  (o.OOi  Gm.)  colchicine  has  been  suggested 
by  Darier  in  certain  inflammatory  diseases  of  the  eye.  Hypochon- 
driasis resulting  from  renal  insufficiency  is  frequently  benefited  by 
colchicum. 

Contraindications. — The  drug  would  be  contraindicated  in 
acute  inflammatory  conditions  of  the  gastro-intestinal  tract.  It 
should  be  cautiously  administered  to  old  people. 

Administration. — The  liquid  preparations  are  to  be  preferred, 
and,  in  order  to  secure  the  full  curative  effects  of  the  drug,  it  is 
unnecessary  to  give  it  in  doses  sufficiently  large  to  excite  vomiting 
or  purging.  The  initial  dose,  therefore,  should  be  small,  that  it 
may  occasion  no  gastric  disturbance. 

17 


258  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

The  beneficial  effects  of  colchicum  may  be  enhanced  by  first 
emptying  the  intestinal  canal  by  means  of  a  saline  cathartic. 

The  preparations  of  colchicum  vary  greatly  in  strength.  The 
crude  drug  contains  different  percentages  of  the  alkaloid,  accord- 
ing to  the  season  of  the  year  in  which  the  plant  is  gathered,  the 
colchicum  root  collected  in  July  and  August  containing  the  largest 
percentage  of  colchicine.  Owing  to  this  variation  in  strength  the 
assayed  tincture  or  the  alkaloid  is  recommended  as  the  best  prepa- 
ration to  use,  though,  because  of  its  activity  and  poisonous  prop- 
erties, the  alkaloid  should  be  given  in  very  small  doses  at  first — 
not  to  exceed  -j^  of  a  grain  (0.0005  Gm.)  two  or  three  times 
a  day. 

Gualaci  LTgrnum— Guaiaci  LTgrni— Gualacum  Wood. 

V.  s.  p. 

(Lignum  Vit^.) 

Origin. — The  heart-wood  of  Guaiacum  officinale  L.  and  of  Guai- 
acum  sanctum  L.,  trees  indigenous  in  the  West  Indies  and  on  the 
northern  coast  of  South  America.  The  former  is  about  40  feet 
(12  M.)  high,  having  evergreen  pinnate  leaves. 

Description  and  Properties. — The  wood  is  heavier  than  water, 
hard,  brown  or  greenish-brown,  resinous,  marked  with  irregular 
concentric  circles  surrounded  by  a  yellowish  alburnum ;  splitting 
unevenly,  when  heated  emitting  a  balsamic  odor ;  taste  slightly 
acrid.  It  contains  from  20  to  25  per  cent,  of  resin,  its  most 
important  constituent. 

Dose. — ^i  drachm  (i. 0-4.0  Gm.). 

Official  Preparation. 

Guaiacum  wood  is  contained  in  Decoctum  Sarsaparillse  Compositum,  for  which  see 
Sarsaparilla. 

Guaiaci  ResTna— Guaiaci  Resinae— Guaiac.    TJ.  S.  P. 

Origin. — The  resin  of  the  wood  of  Guaiacum  officinale. 

Description  and  Properties. — Irregular  masses  or  subglobular 
pieces,  externally  greenish-brown,  internally  of  a  glassy  luster,  and 
in  recent  guaiac  usually  reddish-brown,  transparent  in  thin  splinters, 
fusible,  feebly  aromatic,  the  odor  becoming  stronger  upon  heating ; 
taste  somewhat  acrid ;  powder  grayish,  turning  green  on  exposure 
to  air.     Soluble  in  potassium  or  sodium  hydrate  T.  S.  and  in  alco- 


SPECIFICS.  259 

hoi,  the  alcoholic  solution  being  colored  blue  by  the  addition  of 
tincture  of  ferric  chloride. 

The  principal  constituents  of  guaiac  are — guaiaconic  acid,  guai- 
acic  acid,  guaiaretic  acid,  and  a  small  amount  of  gum.  These 
substances  are  insoluble  in  water,  but  soluble  in  alkalies. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Official  Preparations. 

PUulae  Antimonii  Compdsitse — Ptlulas  (ace.)  Antimonii  Compdsitas — Com- 
pound Pills  of  Antimony  (Plummer's  Pills). — Dose,  i  or  2  pills. 

TinctOra  Guaiaci — Tincturae  Guaiaci — Tincture  of  Guaiac. — Dose,  30-60 
minims  (2.0-4.0  Cc). 

Tinctiira  Guaiaci  Ammoniata — Tinctiirse  Guaiaci  Ammoniatse — Ammoni- 
ated  Tincture  of  Guaiac. — Dose,  30-60  minims  (2.0-4.0  Co.). 

Unofficial  Preparation. 

Gmillsum  Guaiaci — Emtilsi  Guaiaci — Guaiac  Emulsion. — Dose,  \-2  fluid- 
drachms  (2.0-8.0  Cc). 

Antagonists  and  Inoompatibles. — Spirit  of  nitrous  ether  and 
the  mineral  acids  are  incompatible  with  guaiac.  Water  is  pharma- 
ceutically  incompatible  with  the  tinctures,  precipitating  the  resin. 

Synergists. — Many  of  the  diaphoretics  and  diuretics  aid  the 
action  of  guaiac.  Colchicum,  sarsaparilla,  mezereum,  stillingia, 
sassafras,  sanguinaria,  and  xanthoxylum  are  also  synergistic. 

Physiological  .^ction. — Externally  and  Locally. — Guaiac  is 
antiseptic,  and  possesses  mildly  astringent  properties,  being  used 
locally  as  a  gargle. 

Internally.' — Digestive  System. — It  increases  the  flow  of  saliva 
and  gastric  juice,  producing  a  sensation  of  warmth  in  the  epigas- 
trium. It  also  augments  the  secretions  from  the  intestinal  canal, 
excessive  doses  even  causing  vomiting  and  purging. 

Circulatory  System. — Guaiac  increases  the  force  and  rapidity  of 
the  heart's  action  and  dilates  the  cutaneous  blood-vessels. 

Nervous  System. — No  special  action  has  been  observed. 

Respiratory  System. — The  drug  is  an  expectorant,  increasing  the 
production  and  excretion  of  bronchial  mucus. 

Absorption  and  Elimination. — Though  a  colloidal  substance,  it 
is  absorbed  into  the  blood  with  considerable  facility,  being  excreted 
chiefly  by  the  skin,  exciting  free  diaphoresis.  The  bowels,  kidneys, 
and  bronchial  mucous  membrane  assist  in  the  excretory  process. 

Temperature. — Under  doses  sufficient  to  cause  free  diaphoresis 


26o  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

the  temperature  may  be  reduced.  Guaiac  has,  however,  no  direct 
influence  upon  the  heat-center. 

Uterus. Large  doses  of  guaiac  induce  contraction  of  the  womb, 

the  drug  thus  acting  as  an  ecbolic. 

Untoward  Action.— ^o  special  symptoms  are  manifest  other 
than  the  gastro-intestinal  disturbance  mentioned,  and  occasionally 
headache  and  giddiness. 

Poisoning.— QiMzxa.c  cannot  be  classed  as  a  poisonous  substance. 
Excessive  doses  act  as  a  gastro-intestinal  irritant,  although  no  case 
of  death  is  recorded  resulting  directly  from  this  drug. 

Treatment  of  Poisoning.— This  should  be  symptomatic,  and 
similar  to  the  treatment  of  poisoning  from  colchicum. 

Therapeutics. — Externally  and  Locally. — Guaiac  in  some  form 
is  an  excellent  application  m  follicular  tonsillitis,  rheumatic  pharyn- 
gitis, and  quinsy.  For  these  cases  the  emulsion  of  guaiac  serves 
as  an  efficient  gargle,   or  the  troches  of  guaiac  may  be  used. 

Internally.— Yxom  the  sixteenth  to  the  eighteenth  century 
guaiac  was  renowned  as  a  cure  for  syphilis,  having  been  introduced 
into  Europe  from  San  Domingo.  The  heroic  manner,  however,  in 
which  the  drug  was  employed  rendered  the  results  more  injurious 
than  beneficial,  so  that  the  guaiac  treatment  was  condemned,  one 
of  its  most  vigorous  opponents  being  Paracelsus,  to  whom  the 
reintroduction  of  mercury  for  the  treatment  of  syphilis  is  largely 
due.  Since  we  have  learned  to  use  mercury  and  iodine  and  its 
preparations  intelligently  the  guaiac  treatment  of  this  disease  pos- 
sesses only  a  historic  interest.  Nevertheless,  the  drug  possesses 
properties  which  render  it  exceedingly  valuable  in  chronic  muscular 
rheumatism,  neuralgic  dysmenorrhea,  and  atonic  amenorrhea. 

Guaiac  is  considered  to  be  an  efficient  remedy  in  lumbago  and 
chronic  gout.  Its  most  important  service,  however,  in  therapeutics 
is  in  the  treatment  of  quinsy.  It  is  doubtful  whether  there  is  any 
drug  which  will  modify  the  course  of  this  disease  or  abort  an 
attack  of  tonsillitis  so  readily  as  this  medicine.  The  tincture  of 
guaiac  is  the  preparation  usually  employed  for  this  purpose,  \ 
fluidrachm  (2.0  Cc.)  being  given  in  the  form  of  an  emulsion  every 
three  or  four  hours. 

Contraindications. — There  are  no  marked  contraindications  to 
its  use. 

Administration. — The  tinctures  are  very  acrid  and  disagreeable 
to  the  taste,  and  should  be  given  in  the  form  of  an  emulsion.  The 
emulsion  of  guaiac,  a  formula  for  which  is  given  in  the  Dispensa- 


SPECIFICS.  261 

tories,  is  not  unpleasant,  and  is  altogether  the  best  liquid  prepara- 
tion to  give. 

The  lozenges  of  guaiac,  allo/wed  to  dissolve  slowly  in  the 
mouth,  serve  as  an  agreeable  and  efficient  method  of  medicating  the 
throat  with  this  drug. 

Sarsaparilla— Sarsaparillae— Sarsaparilla.    TJ.  8.  P. 

Origin. — The  root  of  Smilax  officinalis  Kunth  and  other  species 
of  Smilax  growing  in  swampy  forests  in  Mexico  and  as  far  south 
as  the  northern  portion  of  Brazil.  They  are  woody  climbers,  often 
attaining  a  great  height. 

Description  and  Properties. — About  -g-  to  J  inch  (3.17-6.35 
Mm.)  thick,  very  long,  cylindrical,  longitudinally  wrinkled,  exter- 
nally grayish-  or  orange-brown ;  internally  showing  a  whitish  and 
mealy  or  somewhat  horny  cortical  layer  surrounding  a  circular 
wood-zone  enclosing  a  broad  pith ;  nearly  inodorous ;  taste  muci- 
laginous, bitterish,  and  acrid.  The  thick,  woody,  knotty  rhizome, 
if  present,  should  be  removed. 

Sarsaparilla  contains  an  active  principle,  parillin,  an  acrid  gluco- 
side  which  froths  with  water  and  otherwise  closely  resembles  sapo- 
nin in  its  action. 

Dose. — 30-60  grains  (2.0-4.0  Gm.). 

Official  Preparations. 

DecOctuni  Sarsaparillse  CompSsitum — DecScti  Sarsaparillae  Compftsiti — 
Compound  Decoction  of  Sarsaparilla. — Dose,  4-6  fluidounces  (118.-178.  Cc). 
10  per  cent.,  with  Sassafras,  Guaiac-wood,  GlycyiThiza,  and  Mezereura. 

ExtrSctum  Sarsaparillse  Fluidum — ExtrScti  SarsaparlUae  Fliiidi— Fluid 
Extract  of  Sarsaparilla. — Dose,  J-2  fluidrachms  {2.0-8.0  Co.). 

Extractum  SarsaparlUae  Fluidum  Comp6situm — ExtrScti  Sarsaparillse 
Fluidi  Comp6siti — Compound  Fluid  Extract  of  Sarsaparilla. — Dose,  ^-2  fluid- 
drachms  (2.0-8.0  Cc). 

Syrupus  Sarsaparillse  Comp6situs — SJhrupi  Sarsaparillae  CompSsiti — Com- 
pound Syrup  of  Sarsaparilla. — Dose,  2-4  fluidrachms  (8.0-16.0  Cc).  A  Fluid 
Extract,  20  per  cent.,  with  the  J'luid  Extracts  of  Glycyrrhiza  and  Senna,  and  the  Oils 
of  Sassafras,  Anise,  and  Gaultheria. 

Antagonists  and  Incompatibles. — Alkalies  and  free  iodine  are 
incompatible  with  the  official  preparations  of  sarsaparilla.  Corro- 
sive subHmate  is  said  to  be  changed  into  calomel  by  the  compound 
syrup  of  sarsaparilla. 

Synergists. — The  specifics,  diaphoretics,  and  diuretics. 

Physiological   Action. — Sarsaparilla   has   no   local    influence. 


263  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Internally  its  action  is  similar  to  that  of  guaiac,  though  not  so 
energetic  and  irritant  in  large  doses. 

Therapeutics. — As  with  guaiac,  the  history  of  sarsaparilla  is 
full  of  interest.  Introduced  into  Europe  in  the  sixteenth  century 
by  the  Spaniards,  who  had  learned  of  its  alleged  virtues  in  consti- 
tutional syphilis  in  Peru,  San  Domingo,  and  Brazil,  it  retained  its 
reputation  as  a  specific  in  this  disease  for  a  century  or  more,  when 
it  was  abandoned,  only  to  be  revived  at  the  close  of  the  eighteenth 
century.  Since  that  time  it  has  retained  its  place  in  medicine  more 
through  the  wonderful  virtues  ascribed  to  it  by  nostrum-venders 
than  to  any  real  medicinal  properties  which  it  possesses. 

The  consensus  of  competent  opinion  seems  to  be  that  sarsa- 
parilla can  claim  no  special  medicinal  virtues  other  than  its  diuretic 
and  diaphoretic  properties. 

The  compound  decoction  of  sarsaparilla  is  probably  the  most 
useful  official  preparation,  and  appears  to  have  been  of  some  bene- 
fit in  scrofula  and  strumous  cutaneous  affections.  Indeed,  some 
cases  of  constitutional  syphilis  have  improved  more  rapidly  under 
the  administration  of  this  preparation  than  when  mercury  or  potas- 
sium iodide  has  been  given  alone. 

Contraindications. — There  are  none. 

Administration. — No  special  directions  can  be  given  for  the 
administration  of  the  various  preparations.  The  compound  syrup 
of  sarsaparilla  is  quite  pleasant  to  the  taste,  and  is  used  extensively 
as  a  vehicle,  particularly  for  potassium  iodide. 

StillTng-ia— Stilllngfise— Stillingria.    TJ.  S.  P. 

(QuEEN'.s  Root.) 

Origin. — The  root  of  Stillingia  sylvatica  L.,  a  perennial  herb 
growing  in  dry  and  sandy  soil  in  the  Southern  United  States  as 
far  north  as  Eastern  Virginia. 

Description  and  Properties. — About  i  foot  (30  Cm.)  long  and 
nearly  2  inches  (5  Cm.)  thick,  subcylindrical,  slightly  branched, 
compact,  wrinkled,  tough,  grayish-brown,  breaking  with  a  fibrous 
fracture,  showing  a  thick  bark  and  porous  wood,  inner  bark  and 
medullary  rays  having  numerous  yellowish-brown  resin-cells. 
The  odor  is  peculiar  and  unpleasant;  the  taste  bitter,  acrid,  and 
pungent. 

The  fresh  root  probably  contains  an  active  principle  not  yet 
determined.     (Old  roots  are  nearly  inert.)     It  contains  an  acrid 


SPECIFICS.  263 

resin,  sylvacrol,  a  volatile  and  a  fixed  oil,  resin,  starch,  gum,  and 
tannin. 

Dose. — 15-30  grains  (1.0-2.0  Gm.). 

Official  Preparation. 

ExtrSctum  StilHngiae  Fluidum— ExtrScti  StilHngise  Flfiidi— Fluid  Extract 
of  Stillingia. — Dose,  \-i  fluidrachm  (1.0-4.0  Cc). 

Unofficial  Preparations. 

Decactum  StilHngiae— DecScti  StilHngiae— Decoction  of  Stillingia.— Z)»j,f, 
1-2  fluidounces  (30-60  Co.). 

Extractum  StiU&igiae  Fluidum  Conip6situm -ExtrScti  StilHngise  Fluidi 
Comp6siti— Compound  Fluid  Extract  of  Stillingia.— Z)<;jf,  1-2  fluidrachms  (4.0- 
8.0  Co.).  Stillingia,  130;  Corydalis,  130;  Chimaphila,  60;  Iris,  60;  Sambucus,  60; 
Xanthoxylum  Berries,  30;  and  Coriander,  30;  to  make  500  parts  Fluid  Extract  with 
Dilute  Alcohol. 

Syrupus  StilHngiae  Comp6situs— SJ^rupi  Stillingia  CompSsiti— Compound 
Syrup  of  Stillingia. — Dose,  i  fluidrachm  to  i  ounce  (4.0-30  Cc).  Compound  Fluid 
Extract,  I,  to  Simple  Syrup,  3  parts. 

Tinctiira  StilHngis— Tincturse  StilHngia;— Tincture  of  Stillingia.— Z)ojf, 
^i  fluidrachm  (2.0-4.0  Cc). 

Antagonists  and  Incompatibles. — There  are  none  affecting 
Stillingia. 

Synergists. — The  same  as  for  sarsaparilla. 

Physiological  Action. — The  action  of  stillingia  resembles  that 
of  sarsaparilla,  the  drug  increasing  the  various  secretions  and  stim- 
ulating the  heart  and  circulation. 

Therapeutics. — The  medical  uses  are  the  same  as  those  of 
sarsaparilla. 

Sanguinaria— Sanguinariae— Sangruinaria.    TJ.  S.  I*. 

(  Blood-root.) 

Origin. — The  rhizome  of  Sanguinaria  Canadensis  L.,  a  low 
perennial,  a  native  of  Canada  and  the  United  States,  where  it  grows 
in  open  woods  in  a  rich  soil.  The  rhizome  should  be  collected  in 
autumn. 

Description  and  Properties. —  Of  horizontal  growth,  about  2 
inches  (5  Cm.)  long  and  |-  inch  (i  Cm.)  thick,  cylindrical,  some- 
what branched,  slightly  annulate,  wrinkled,  reddish-brown;  frac- 
ture short,  somewhat  waxy,  whitish,  with  numerous  small  red 
resin-cells,  or  of  a  nearly  uniform,  brownish-red  color ;  bark  thin ; 
odor  slight ;  taste  persistently  bitter  and  acrid.     It  contains  a  color- 


264  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

less  alkaloid,  sanguinarine ,  yielding  red  salts  ;  chelerythine,  yield- 
ing lemon-yellow  salts  ;  homochelidonine  ;  and  protopine. 
Dose. — 2-20  grains  (0.12- 1. 2  Gm.). 

Official  Preparations. 

Extractum  Sanguinariae  Fluidum — Extracti  Sanguinarise  Fluidi— Fluid 
Extract  of  Sanguinaria. — Dose,  5-15  minims  (0.3-1.0  Cc). 

Tinctiira  Sanguinarise  (15  per  cent.) — Tinctiirse  Sanguinariae — Tincture  of 
Sanguinaria. — Dose,  10-60  minims  (0.6-4.0  Co.). 

Unofficial  Preparations. 

Acetum  Sanguinariae — -Aceti  Sanguinariae — Vinegar  of  Sanguinaria. — Dose, 
15-40  minims  (1.0-2.5  Cc.) ;  as  an  emetic,  1-4  fluidrachms  (4.0-16.0  Cc). 
Sanguinarine  Nitrate. — Dose,  xV" i  grain  (0.005-0.008  Gm.). 

Antagonists  and  Incompatibles. — The  irritation  and  circu- 
latoiy  depression  occasioned  by  blood-root  are  antagonized  by 
opium,  atropine,  etc.,  while  the  incompatibles  are  tannic  and  gallic 
acids,  alkalies,  and  metallic  salts. 

Synergists. — The  Specifics  and  the  mineral  and  vegetable 
emetics  aid  the  action  of  sanguinaria. 

Physiologioal  Action. — Externally  and  Locally. — Sanguinaria 
is  an  irritant  and  a  feeble  escharotic.  When  the  powder  of  blood- 
root  is  inhaled  it  produces  great  irritation  of  the  respiratory  pas- 
sages, with  excessive  secretion  and  violent  sneezing. 

Internally. — Digestive  System. — Medicinal  doses  occasion  a 
sense  of  constriction  in  the  throat  and  heat  in  the  epigastrium, 
increasing  the  secretions  from  the  stomach,  liver,  and  intestines. 
Excessive  doses  are  followed  by  marked  salivation,  nausea,  and 
vomiting,  the  drug  acting  as  a  systemic  emetic.  Very  large  doses 
cause  great  irritation  of  the  intestines,  producing  hypercatharsis. 

Circulatory  System. — At  first  the  heart's  action  is  increased  and 
arterial  tension  raised,  but  these  effects  are  followed  by  cardiac  and 
circulatory  depression.  Poisonous  doses  sometimes  result  in  car- 
diac paralysis. 

Nervous  System. — Large  doses  diminish  reflex  excitability  by 
paralysis  of  the  spinal  centers,  occasionally  producing  convulsions 
of  spinal  origin. 

Respiratory  System. — Medicinal  doses  of  sanguinaria  have  no 
apparent  effect  upon  the  respiration;  poisonous  doses,  however, 
render  the  breathing  slow  and  shallow,  death  resulting  from  as- 
phyxia due  to  paralysis  of  the  respiratory  center.-    The  final  col- 


SPECIFICS.  265 

lapse  is  often  preceded  by  convulsions  arising  from  the  accumulation 
of  carbon  dioxide  in  the  blood  from  failure  of  respiration. 

Blood-root  is  a  stimulant  expectorant,  increasing  the  secretion 
from  the  broncho-pulmonary  mucous  membrane. 

Absorption  and  Elimination. — The  drug  is  quite  rapidly  ab- 
sorbed, and  is  eliminated  by  the  intestines,  stomach,  skin,  kidneys, 
and  bronchial  mucous  membrane. 

Temperature. — Medicinal  doses  have  no  effect  upon,  but  exces- 
sive doses  lower,  the  temperature. 

Eye. — Poisonous  doses  produce  dilatation  of  the  pupils. 

Uterus. — Sanguinaria  possesses  emmenagogue  properties. 

Untoward  Action. — This  does  not  differ  from  the  poisonous 
action  which  follows. 

Poisoning. — Blood-root  is  an  acro-narcotic  poison,  exciting  sali- 
vation, violent  vomiting,  profuse  watery  evacuations  from  the 
bowels,  and  producing  a,ll  the  symptoms  of  gastro-enteritis.  The 
muscular  system  is  greatly  relaxed,  the  pulse  is  slow,  weak,  and 
irregular,  the  skin  covered  with  cold  sweat,  and  finally  collapse  of 
the  vital  powers  supervenes.  Convulsions  may  precede  a  fatal 
termination,  which  is  due  to  paralysis  of  the  respiratory  or  cardiac 
center. 

Treatment  of  Poisoning. — The  stomach  should  be  washed  out 
and  diffusible  stimulants  freely  given.  Strychnine  may  be  admin- 
istered hypodermically,  and  digitalis  and  amyl  nitrate  given  if 
necessary.  The  pain  and  nausea  may  be  relieved  by  morphine  and 
atropine.  The  normal  temperature  of  the  body  should  be  main- 
tained by  external  warmth. 

Therapeutics. — Externally  and  Locally. — The  nitrate  of  san- 
guinarine — \  grain  (o.oi  5  Gm.)  to  i  ounce  (30  Cc.)  of  glycerin — 
has  been  recommended  by  Keyser  in  conjunctivitis  granulosa.  The 
powdered  blood-root  has  been  employed  as  a  sternutatory,  and 
when  mixed  with  two  or  three  times  the  amount  of  powdered 
acacia  or  starch  it  has  proved  beneficial,  in  the  hands  of  some 
physicians,  in  the  dry  form  of  atrophic  rhinitis.  The  pure  powder 
is  said  to  be  an  efficient  escharotic  to  nasal  polypi  2Lnd  fungoid  con- 
ditions of  the  mucous  membrane.  Some  authorities  claim  it  to  be 
an  effective  remedy  for  cancer,  and  consider  it  a  valuable  stimulant 
for  indolent  ulcers. 

The  decoction  of  sanguinaria  has  been  employed  as  a  gargle  in 
scarlatinal  angina. 

This  drug  is  now  seldom  used  locally,  the  irritation  caused  by 


266  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

it  being  so  great  that  patients  can  only  with  great  difficulty  be  per-.- 
suaded  to  submit  to  the  treatment. 

Internally. — While  possessing  alterative  properties  and  classed 
among  the  Specifics,  one  of  the  principal  uses  of  sanguinaria  is  in 
acute  bronchitis,  when  the  spasmodic  element  predominates  and 
after  the  subsidence  of  the  more  acute  symptoms. 

In  atonic  conditions  of  the  stomach  and  bowels,  with  increased 
secretion  of  mucus,  small  doses  of  tincture  of  sanguinaria  prove 
beneficial.  The  tincture  is  of  equal  value  in  duodenal  catarrh  with 
jaundice. 

As  an  emmenagogue  and  aphrodisiac  blood-root  has  been  suc- 
cessfully employed  in  functional  amenorrhea  and  dysmenorrhea,  as 
well  as  in  functional  impotence  with  relaxation  of  the  genital  organs 
and  daily  seminal  losses. 

Sanguinarine  has  been  recommended  in  hysteria,  either  alone  or 
associated  with  podophyllum. 

Protracted  muscular  rheumatism  has  apparently  been  benefited 
by  this  drug. 

Tincture  of  sanguinaria  has  served  as  an  emetic  in  spasmodic 
laryngitis,  though  its  depressing  and  irritating  action  renders  san- 
guinaria much  less  desirable  than  certain  other  emetics. 

The  drug  is  considered  to  possess  marked  alterative  proper- 
ties, and  is  still  frequently  employed  in  the  treatment  of  syphilitic 
and  strumous  affections  of  a  chronic  nature. 

It  certainly  appears  to  be  a  mild  stimulant  to  the  vegetative  sys- 
tem of  nerves,  improving  the  circulation,  nutrition,  and  secretion. 

Contraindications. — No  special  contraindication  exists,  unless 
it  be  an  acute  inflammatory  condition  of  the  stomach  and  bowels. 

Administration. — The  nitrate  of  sanguinarine  is  the  best  prepa- 
ration to  use  in  diseases  of  the  respiratory  tract.  As  a  gargle  the 
vinegar  of  sanguinaria  is  to  be  preferred,  while,  if  the  drug  is  to  be 
employed  as  an  emetic,  the  infusion,  given  in  tablespoonful  doses 
at  short  intervals,  serves  the  best  purpose.  For  other  purposes 
the  tincture  is  the  most  desirable  preparation. 

The  sanguinarine  nitrate  is  best  administered  in  pill  form ;  the 
liquid  preparations  should  be  given  well  diluted  with  water. 


Mezereum— Mezerei— Mezereon.— C/;  s.  p. 

Origin. — The  bark  of  Daphne  Mezereum  L.  and  other  species 
of  Daphne,  small  shrubs  about  2-4  feet  (0.6-1.2  .M.)  high,  indige- 


SPECIFICS.  267 

nous  in  hilly  and  mountainous  regions  of  Europe,  extending  to 
the  Arctic  Circle  and  eastward  to  Siberia. 

Description  and  Properties.— Long,  thin  bands,  usually  folded 
or  rolled  into  disks,  the  outer  surface  yellowish  or  brownish-yellow, 
with  transverse  scars  and  minute  blackish  dots,  underneath  of  a 
light  greenish  color ;  inner  surface  whitish,  silky.  Bast  in  trans- 
verse layers,  very  tough;  inodorous;  taste  very  acrid.  The  im- 
portant constituent  is  an  acrid  resin,  mezerin ;  it  also  contains  a 
crystalline  glucoside,  daphnin. 

Dose. — 1-5  grains  (0.06-0.3  Gm.). 

Official  Preparation. 

Extractum  Mezerei  Fluidum— ExtrScti  Mezerei  Fluidi— Fluid  Extract  of 
Mezereon. — Dose,  1-5  minims  (0.06-0.3  Cc).  Mezereon  is  also  one  of  the  ingredi- 
ents in  Decoctum  Sarsaparill^  Compositum,  Extractum  Sarsaparillae  Fluidum  Composi- 
tum,  and  Linimentum  Sinapis  Compositum. 

Antagonists  and  Incompatibles. — The  glucoside  is  precipi- 
tated by  tannic  and  free  acids,  and  the  resin  by  water,  in  which  it 
is  insoluble. 

Synergists. — All  the  vegetable  specifics,  with  the  exception  of 
colchicum. 

Physiological  Action. — Its  action,  both  locally  and  internally, 
is  quite  similar  to  that  of  sanguinaria,  but  when  applied  to  the 
skin  it  is  more  of  a  vesicant  than  an  escharotic,  and  taken  inter- 
nally it  is  more  of  a  diuretic  than  sanguinaria,  in  poisonous  doses 
causing  severe  urinary  irritation  and  other  symptoms  produced  by 
a  violent  gastro-intestinal  irritant.  The  treatment  of  poisoning 
would  be  the  same  as  that  prescribed  under  poisoning  by  sanguin- 
aria. 

Therapeutics. — It  is  employed  as  a  masticatory  in  paralysis  of 
the  tongue  and  the  muscles  of  deglutition,  and  as  a  counter-irritant 
in  the  form  of  an  ointment.  Internally  it  is  now  seldom  if  ever  used 
alone,  but  in  combination  with  other  vegetable  specifics  it  is  pre- 
scibed  in  chronic  rheumatism  and  in  chronic  syphilitic  and  non- 
syphilitic  cutaneous  diseases. 

Contraindications. — Acute  inflammation  of  the  stomach,  bow- 
els, and  kidneys. 

Administration. — As  it  is  never  given  internally  alone,  no  spe- 
cial instructions  for  its  administration  are  necessary.  The  fluid 
extract  freely  diluted  with  water  would,  however,  be  the  only 
preparation  to  use. 


268  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

X?Lnth6xylum— Xanthoxyli— Xanthoxylum .    U.  S.  P. 

(Prickly  Ash.) 

Origin. — The  bark  of  Xanthoxylum  Americanum  Miller  and  of 
Xanthoxylum  Clava-Herculis  L.  Both  species  are  native  to  North 
America,  the  first  being  shrubby  and  attaining  a  height  of  lo  or 
12  feet  (3-3.6  M.),  while  the  second  species  is  a  small  tree  some- 
times 30  or  40  feet  (9-12  M.)  high. 

Description  and  Properties.  —  Xanthoxylum  Americanum 
(Northern  Prickly  Ash)  occurs  in  curved  or  quilled  fragments 
about  2^5-  inch  (i  Mm.)  thick ;  outer  surface  brownish-gray,  with 
whitish  patches  and  minute  black  dots,  slightly  furrowed,  with 
some  brown,  glossy,  straight,  two-edged  spines,  linear  at  the  base 
and  about  \  inch  (6  Mm.)  long;  inner  surface  whitish,  smooth; 
fracture  short,  non-fibrous,  green  in  the  outer  and  yellowish  in  the 
inner  layer ;  inodorous ;  taste  bitterish,  very  pungent.  Xanthoxy- 
lum Clava-Herculis  (Southern  Prickly  Ash)  resembles  the  preced- 
ing, but  is  about  -^-^  inch  (2  Mm.)  thick,  and  is  marked  by  many 
conical,  corky  projections,  sometimes  ^  inch  (2  Cm.)  high,  and  by 
stout  brown  spines  rising  from  a  corky  base. 

Xanthoxylum  should  not  be  confounded  with  the  bark  of 
Aralia  spinosa  L.,  which  is  nearly  smooth  externally,  and  beset 
with  slender  prickles  in  transverse  rows. 

Prickly  ash  contains  an  acrid  green  oil,  a  colorless,  crystalline 
resin,  a  bitter  principle,  sugar,  ash,  and  tannic  acid. 

Dose. — 10-30  grains  (0.6-2.0  Gm.). 

Official  Preparation. 

ExtrSctum  XanthSxyli  Fluidum— ExtrScti  Xanth6xyli  Fluidi — Fluid  Ex- 
tract of  Xanthoxylum. — Dose,  10-30  minims  (0.6-2.0  Cc). 

Physiological  Action. — The  action  of  xanthoxylum  is  quite 
similar  to  that  of  sanguinaria,  though  it  is  more  of  a  stomachic 
tonic,  sialagogue,  diuretic,  and  diaphoretic,  and  not  so  much  of  a 
local  irritant.  It  increases  the  heart's  action  and  raises  arterial 
tension. 

Therapeutics. — It  is  used  locally  as  a  masticatory  for  the  same 
purposes  as  mezereon,  and  the  decoction  has  been  highly  recom- 
mended as  a  gargle  in  chronic  pharyngitis. 

Internally  its  medical  uses  are  the  same  as  those  of  stillingia, 
mezereon,  etc.,  although  of  more  value  in  atonic  dyspepsia. 


SPECIFICS.  269 

Contraindications  and  Administration  are  the  same  as  for 
sanguinaria. 

Serum-therapy. 

Among  the  marvels  of  scientifie  research  which  have  distin- 
guished our  century  no  achievements  are  more  remarkable,  nor 
of  greater  moment  to  the  welfare  of  mankind,  than  those  pertain- 
ing to  the  field  of  biological,  pathological,  and  therapeutic  inves- 
tigation. Yet,  brilliant  as  have  hitherto  been  the  triumphs  of 
speculative  thought  and  the  deductions  drawn  from  tireless  ex- 
perimentation and  practically  applied  to  the  curative  art,  the  highest 
generahzations  and  most  signal  exhibitions  of  genius  are  perhaps 
related  to  the  special  phenomena  revealed  by  the  study  of  zymotic 
diseases.  The  limits  of  the  present  work  preclude  a  detailed  treat- 
ment of  so  extensive  and  complicated  a  subject ;  yet  a  brief  sum- 
mary, elucidating  the  theory  and  development  of  serum-therapy  as 
exemplified  in  contemporaneous  research,  should  be  of  interest 
as  well  as  benefit  to  the  student  of  modern  therapeutics. 

A  glance  at  the  history  of  therapeutic  procedure  in  the  prophy- 
lactic treatment  of  infectious  diseases  shows  that  the  general  prin- 
ciple underlying  all  later  discoveries  was,  however  crudely,  divined 
at  a  much  earlier  period  than  we  are  wont  to  suppose.  In  view 
of  actual  attainment  it  is  natural  that  the  mind  should  revert  to 
the  transcendent  services  rendered  to  mankind  by  Jenner ;  yet  it  is 
known  that  the  ancient  Hindus  and  Persians,  as  well  as  the  nomad 
tribes  and  caravans  of  Farther  Asia,  practised  inoculation  of  equine 
virus,  or  horse-pox — the  mammary  pustule  developed  during  early 
lactation  in  the  horse,  camel,  and  cow,  and  even  in  woman. 

The  inoculation  of  human  virus  is  of  immemorial  origin,  proba- 
bly coeval  with  the  importation  of  variola  from  Asia  into  Africa  by 
the  Saracens.  Certain  it  is  that  as  early  as  the  tenth  century  the 
Arabs  and  Chinese  adopted  the  custom  of  variolization,  the  inoc- 
ulation of  small-pox,  although  the  skeptical  physicians  of  the  age 
consigned  the  practice  as  a  monopoly  to  women. 

In  17 17,  Lady  Montague,  wife  of  the  British  ambassador  at 
Constantinople,  saw  an  old  Thessalian  woman  whose  immunity  so 
impressed  her  that  she  practised  the  operation  upon  her  own  child. 
Writing  from  Adrianople,  she  says:  "They  take  the  small-pox 
here  for  diversion;  I  have  tried  it  on  my  dear  little  son;  I  am 
going  to  bring  this  useful  invention  into  fashion  in  England."     In 


270  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

1 7 18  her  desire  was  realized,  King  George  adopting  the  practice  in 
the  royal  family.  Three  years  later  the  custom  was  introduced  in 
France,  being  accepted  by  Chirac  and  Helvetius,  although  the 
decrees  of  the  Sorbonne  and  the  Faculty  of  Medicine  condemned 
the  innovation  as  "  illicite  et  contraire  a  la  loi  de  Dieu  ;"  notwith- 
standing which  official  malediction  the  practice  of  inoculation  con- 
tinued to  spread  until  supplanted  by  vaccination  proper  in  1800. 
The  French  peasants  knew  in  the  last  century  that  the  act  of  milk- 
ing cows  infected  with  mammary  pustule,  where  there  was  any 
lesion  of  the  epidermis  on  the  hands,  conferred  immunity  against 
small-pox ;  and  the  mountaineers  have  long  been  accustomed  to 
collect  the  crusts  resulting  from  vaccine  disease,  macerating  them 
in  water,  and  inoculating  their  children  with  the  solution. 

The  success  attending  these  rude  experiments  in  France  was 
communicated  by  a  Frenchman,  Rabault,  in  1768,  to  Dr.  Pew,  an 
English  physician,  who  reported  the  matter  to  his  friend  Jenner, 
who  at  once  perceived  the  momentous  import  of  the  discovery. 
Meanwhile,  in  1771,  a  Holstein  schoolmaster  vaccinated  three 
pupils ;  and  in  1 774  an  English  farmer,  having  observed  the  pro- 
tection existing  among  his  dairymaids,  and  having  implicit  con- 
fidence in  the  efficacy  derived  from  inoculation  of  bovine  virus, 
vaccinated  his  wife. 

It  was  reserved  for  Jenner,  however,  in  1 776,  to  commence  the 
systematic  and  exhaustive  study  of  the  subject  destined  to  prove 
inestimably  beneficial  to  mankind.  It  was,  in  truth,  the  year 
celebrated  for  his  declaration  of  scientific  independence,  which, 
after  long  contumely  and  scurrilous  ridicule,  was  to  wrest  from  his 
humiliated  adversaries  every  weapon  of  derision  and  reproach. 

His  early  experiments  were  but  a  repetition  of  the  empirical  yet 
prophetic  test  of  the  English  farmer ;  yet  with  his  gifted  insight 
and  indomitable  courage  the  field  of  discovery  was  greatly  ampli- 
fied, the  results  being  in  accordance  with  scientific  methods  inspired 
by  Jenner's  originality  and  force. 

He  found  in  the  northern  counties  of  England  a  certain  form  of 
ulcer  upon  the  hands  of  those  employed  in  dairies  and  immune 
against  small-pox ;  observed  that  the  malady  resembled  the  pus- 
tules affecting  the  udder  of  the  cow,  having  apparently  been  occa- 
sioned by  contact;  vaccinated  an  individual  supposed  to  be  un- 
protected against  the  disease,  and  subsequently  exposed  him  to 
infection  with  triumphant  impunity,  i^'long  interval  of  laborious 
investigation  had  led  to  this  final  test,  and  it  was  not  until   1798 


SPECIFICS. 


271 


that  Jenner  published  his  first  paper  upon  the  subject,  vaccination 
being  transported  to  America  in  the  following  year. 

Such  is  the  brief  yet  eloquent  record  of  an  achievement  which 
experience  has  proved  to  be  of  incalculable  benefit  to  man.  To- 
day there  is  no  question  among  the  more  enlightened  members  of 
the  profession  that  the  operation,  properly  performed,  is  an  absolute 
safeguard  against  the  infection  of  small-pox. 

Strange  indeed  is  it  that  a  century  of  comparative  quiescence 
should  have  elapsed  since  Jenner  pointed  the  way  to  the  startling 
accomplishment  of  the  present  epoch.  Yet  not  until  Pasteur,  in 
1880,  announced  to  the  world  the  issue  of  his  labors  touching  the 
protective  inoculation  of  animals  was  the  broken  thread  of  patho- 
genic research  taken  up  anew,  and  the  task  of  solving  its  mysteries 
resumed — be  it  said  with  profounder  acumen  and  far  more  com- 
plete appliances  than  ever  before. 

It  is  a  matter  of  record  how  the  French  savant  demonstrated 
that  cultures  of  the  bacilli  of  chicken-cholera,  when  thoroughly 
dried  and  long  exposed  to  the  air,  lost  their  virulence,  and  that 
fowls  inoculated  with  the  attenuated  virus  were  rendered  insensible 
to  the  attacks  of  more  energetic  micro-organisms.  It  was,  mutatis 
mutandis,  a  modification  or  development  of  the  Jennerian  principle  : 
"  L'histoire  de  la  vaccine  constitue  la  premiere  etape  d'une  longue 
serie  de  travaux,  qu'ont  inspires  les  admirable  decouvertes  revelees 
par  le  genie  de  Pasteur.  Le  principe  en  est  toujours  le  meme: 
attenuer  un  virus,  et  I'injecter  a  I'animal  qu'on  veut  immuniser " 
(Bernheim).  Yet  in  the  far-reaching  possibilities  suggested  by 
Pasteur's  experiments  the  present  was  immeasurably  in  advance  of 
previous  attainment. 

The  further  application  of  this  discovery  to  other  animal  infec- 
tions confirmed  by  indisputable  evidence  the  validity  of  the  savant's 
theories  and  the  efficacy  of  their  practical  illustration.  A  new 
light  was  shed  upon  pathogenic  study ;  all  Europe  felt  the  impulse 
given  to  scientific  thought  in  its  relation  to  therapeutic  progress, 
and  in  the  sanctum  of  the  laboratory  many  a  fervent  recluse  sought 
to  amplify  the  knowledge  already  attained. 

A  striking  departure  from  Pasteur's  method  by  Salmon  and 
Smith,  in  1886-87,  led  indirectly  to  the  latest  evolution  of  inocula- 
tive therapy.  They  showed  conclusively  that  animals  may  be  ren- 
dered immune  against  certain  infectious  diseases  by  inoculating 
them  with  filtered  cultures  containing  the  toxic  products  of  patho- 
genic micro-organisms  entirely  free  from  the  living  bacteria  to 


272  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

which  they  owe  their  origin.  By  this  process  immunity  against 
the  bacillus  of  hog-cholera  was  attained  in  pigeons,  the  disease 
being  almost  invariably  fatal  to  these  birds.  A  little  later  (1888) 
Roux,  employing  similar  sterilized  cultures,  succeeded  in  protect- 
ing susceptible  animals  against  the  anthrax  bacillus ;  and  more 
recently  (1890)  Behring  and  Kitasato  have  proved  that  immunity 
against  the  action  of  the  tetanus  bacillus  may  be  conferred  by  the 
use  of  toxic  products  in  solution  freed  from  the  presence  of  active 
germs — in  a  word,  that  purely  chemical  agents  sufficed  to  attain  the 
object  hitherto  deemed  wholly  dependent  upon  the  influence  of 
living  bacteria.  The  significance  of  this  discovery  could  hardly  be 
over-estimated.  By  it  the  entire  theory  of  causal  phenomena — the 
protective  force  in  which  the  immunizing  property  was  supposed 
to  reside — became  modified.  If  not  a  living  organism,  but  a  chemi- 
cal substance,  proved  to  be  the  immunizing  agent,  then  resistance 
to  toxic  influences  must  proceed  from  some  source  other  than  bac- 
terial metabolism,  some  organic  force  inherent  in  the  inoculated 
system.  To  ascertain  the  nature  and  operation  of  this  bactericidal 
power  and  determine  the  rationale  of  acquired  immunity  now 
engaged  the  earnest  attention  of  savants   throughout   the  world. 

It  was  soon  found  that  the  lymph  and  blood  of  a  normally 
healthy  organism  possessed  in  a  degree  this  mysterious  property 
of  neutralizing  the  toxic  effects  of  bacterial  action,  and  gradually 
the  truth  which  had  thus  far  eluded  the  most  searching  investiga- 
tion was  revealed.  Finally,  by  a  series  of  experiments  involving 
the  rarest  skill  and  discrimination,  the  resistant  energy  developed 
by  the  infected  organism  was  traced  to  certain  albuminoids  pertain- 
ing to  or  dissolved  in  the  blood-serum,  the  acute  and  comprehen- 
sive insight  of  Behring,  especially,  sustaining  the  new  hypothesis, 
which  speedily  passed  from  the  realm  of  conjecture  to  the  assurance 
of  experimental  proof,  culminating  in  the  establishment  of  serum- 
therapy  as  a  legitimate  and  auspicious  field  of  therapeutic  science. 
It  should  be  observed  that  the  remarkable  discoveries  of  Koch  in 
his  chosen  domain  of  bacteriology  had  exercised  no  little  influence 
in  guiding  and  confirming  the  wider  researches  of  his  successors. 

Before  entering  upon  a  consideration  of  practical  details  it 
should  be  stated  that  the  theory  and  practice  of  serum-therapy 
are  based  upon  the  condition  of  the  system,  whether  in  man  or  the 
lower  animals,  which  renders  it  inhibitive  of  bacterial  development 
by  opposing  an  effective  barrier  to  the  propagation  of  pathogenic 
germs.     This   self-protective  antagonism   pertaining  to  the  indi- 


SPECIFICS.  273 

vidual  organism  is  termed  immunity,  and  may  be  either  natural  or 
acquired. 

By  natural  immunity  is  understood  the  absence  of  all  personal 
predisposition  toward  certain  infections  or  diseases,  even  under  the 
most  favorable  exposure.  A  familiar  example  of  this  inherent, 
congenital  unsusceptibility  is  found  in  poisoning  by  Rhus  {R.  toxico- 
dendron, R.  venenata!),  some  persons  handling  the  plants  and  even 
chewing  the  leaves  with  impunity,  while  upon  others  the  mere 
proximity  of  the  poison  has  a  toxic  effect. 

Acquired  immunity  may  be  either  accidental  or  artificial.  In 
the  former  case  protection  is  secured  by  a  previous  access  of  the 
disease — as,  for  instance,  a  child  recovered  from  scarlet  fever,  who 
is  rarely  prone  to  a  second  attack.  In  the  latter  case  the  suscept- 
ibility is  obviated  by  protective  inoculation,  it  being  known,  to  illus- 
trate, that  an  animal  inoculated  by  injections  of  anthrax-poison  is, 
after  recovery  from  transient  symptoms  of  disease,  rendered  arti- 
ficially immune — a  fact  demonstrated  by  the  thoroughly  scientific 
experiments  of  Pasteur. 

An  eminent  authority,  Schleich,  has  declared  that  natural  or 
spontaneous  immunity  does  not  exist,  but  that  the  protective  qual- 
ity is  created  by  the  animal  kingdom — either  through  a  previous 
malady  or,  as  more  frequently  happens,  through  transmission  from 
progenitors  to  offspring.  Syphilis  or  tuberculosis  in  parents,  he 
maintains,  confers  upon  children  immunity  from  these  diseases; 
and  the  author  cites  in  support  of  his  theory  that  certain  infections, 
such  as  plague  and  leprosy,  have  wholly  disappeared  from  various 
countries  because  of  the  inoculation  of  succeeding  generations  and 
the  consequent  attenuation  of  the  virus — exhaustion  of  the  soil,  as 
it  were.  Bernheim  asserts  that  no  animal  is  endowed  with  absolute 
immunity,  but  that,  however  strong  may  be  the  resistance  of  the 
particular  organism,  it  must  succumb  to  an  excessive  invasion  of 
microbes  or  of  toxic  products. 

The  doctrine  of  immunity  has,  not  inaptly,  been  styled  the 
theorem  of  which  serum-therapy  is  the  logical  corollary ;  yet  it  is 
only  within  a  few  years  that  the  mystery  which  shrouded  the  entire 
subject  has  been  dispelled.  To-day,  thanks  to  untiring  researches 
in  the  fields  of  physiology,  biology,  and  chemistry,  we  are  ac- 
quainted, if  not  with  its  precise  nature  and  origin,  at  least  with 
many  details  intimately  associated  with  its  causation.  Formerly 
supposed  to  be  absolute  in  its  relation  to  species  and  individuals, 
we  now  recognize  that  immunity  is  but  relative,  considerations  of 

IS 


274  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

climate,  race,  receptivity,  character  of  pathogenic  germs,  and  con- 
ditions of  infection  all  entering  as  modifying  factors  into  the  devel- 
opment and  exercise  of  this  potent  yet  complex  force. 

Chauveau  has  shown  that  Algerian  sheep,  relatively  immune 
against  anthrax,  contract  the  disease  under  enormous  hypodermic 
injections  of  culture ;  on  the  other  hand,  a  slight  puncture  of  the 
aural  epidermis  is  fatal  to  sheep  in  France,  which,  transported  to 
Algeria,  succumb  to  natural  infection.  Watson-Cheyne  states  that 
a  single  virulent  bacillus  may  cause  the  death  of  a  guinea-pig  or 
induce  septicemia  in  the  mouse,  provided  these  animals  be  pecu- 
liarly susceptible.  Yet  the  guinea-pig  is  not  affected  by  the  injec- 
tion of  a  few  bacilli  from  a  septicemic  mouse,  while  several  thou- 
sands occasion  only  an  abscess,  although  death  ensues  with  higher 
dosage.  Again,  young  white  mice  are  quickly  killed  by  the  anthrax 
bacillus,  while  the  same  injection  produces  in  the  old  only  a  local 
lesion.  Cattle,  though  more  amenable  to  infectious  disease  than 
sheep,  are  but  slightly  affected  by  hypodermic  injections.  Hogs 
are  but  slightly  sensitive  to  anthrax,  while  the  immunity  of  car- 
nivora  is  proverbial.  Meat  infected  with  anthrax  is  innocuous  to 
the  dog,  the  cat,  and  the  fox. 

Again,  anthrax  has  but  little  influence  upon  birds  or  fowls, 
especially  chickens,  yet  it  has  proved  fatal  to  sparrows  and  pigeons ; 
and  Pasteur  overcame  the  immunity  of  chickens  by  plunging  their 
feet  in  water,  heat  and  cold,  according  to  M.  Roger,  predisposing 
animals  to  infection,  less  by  moderating  bodily  temperature  than 
by  disturbing  the  general  economy  and  diminishing  the  power  of 
resistance. 

As  with  anthrax,  so  in  the  case  of  glanders,  peculiar  to  horses 
— the  varying  susceptibility  to  infectious  diseases  is  apparent,  bo- 
vine animals  being  wholly  immune,  and  the  hog,  dog,  singing- 
birds,  and  pigeons  but  slightly  affected. 

In  tuberculosis  experimental  injection  of  the  same  culture  is 
followed  by  results  widely  diverse,  certain  animals  being  seized 
with  acute  phthisis,  while  others  show  marked  resistance  to  the 
poison,  although  under  excessive  doses  none  is  completely  immune. 
In  this  connection  it  may  be  noted  that  clinical  experience  demon- 
strates the  same  pathological  diversity  in  human  beings.  The 
goat,  dog,  ass,  and  sheep  are  rarely  affected  by  tuberculous  disease, 
yet  all  are  susceptible  to  pathogenic  inoculation.  The  monkey, 
seldom  contracting  the  disease  in  his  native  haunts,  becomes  upon 
transportation  remarkably  prone  to  phthisical  affections.     With  the 


SPECIFICS.  275 

exception  of  the  dog,  most  of  the  carnivora  are  easily  influenced 
by  tuberculous  contagion.  On  the  other  hand,  cold-blooded  ani- 
mals are  singularly  immune,  inoculation  of  toxic  germs  producing 
no  development  of  the  disease,  though  fatal  results  may  occur 
from  systemic  intoxication. 

These  examples,  which  might  be  multiplied  indefinitely,  suffice 
to  show  the  relative  character  of  natural  immunity.  It  may  be 
added  that  the  caprice  of  toxic  infection  becomes  even  more  appa- 
rent in  studying  the  physiological  and  pathological  conditions  of 
the  same  organism  when  subject  to  the  modifying  influences  of 
climate,  altitude,  seasons,  heat,  cold,  traumatism,  diet,  ventilation, 
etc.,  and  the  subjective  considerations  of  age,  sex,  race,  fatigue, 
splenetic  influence,  nervous  lesions,  alcoholism,  auto-intoxication, 
and  acquired  or  hereditary  diathesis.  Indeed,  the  pathological 
records  of  disease  abound  in  curious,  often  inexplicable,  data 
touching  individual  and  racial  immunity.  The  subject  is  important 
in  its  bearing  upon  serum-therapy,  and  furnishes  a' theme  of  profit- 
able study  in  its  relation  to  the  practical  treatment  of  infectious 
disease. 

With  regard  to  the  rationale  of  immunity,  the  theories  advanced 
in  explanation  of  this  occult  yet  indubitable  force  are  many,  and 
often  greatly  at  variance.  Eliminating  those  which  may  be  re- 
garded as  too  fantastic  for  serious  consideration,  the  more  plausible 
conjectures  refer  the  phenomena  in  question  to  cellular,  humoral, 
humor o-cellular,  and  vaso-motor  agencies. 

Prominent  among  competent  opinions  is  the  doctrine  of  phago- 
cytosis proposed  by  Metchnikoff 

In  1883  Metchnikoff"  established  the  existence  of  an  intracellular 
digestion,  showing  that  nomad  cells  were  capable  of  absorbing  vege- 
table filaments ;  that  mesodermic  protoplasm  possessed  the  same 
power  over  bacteria ;  and  that  in  the  higher  animals  this  phagocytic 
function  had  its  analogue  in  the  digestive  property  of  leucocytes, 
or  white  blood-corpuscles.  Gluge  observed  that  in  hemorrhage 
of  the  nervous  centers  these  corpuscles  digest  the  disintegrated 
myelin,  and  in  a  fresh-water  crustacean,  daphne,  they  have  been 
seen  to  gather  about  the  spores  of  algae,  penetrating  the  meso- 
derm. 

Metchnikoff"  multiplied  these  examples  of  cellular  defence 
among  invertebrates,  distinguishing  two  sorts  of  leucocytes :  the 
stationary  (macrophages)  and  the  mobile  (microphages),  the  latter 
including  the  white  globules  of  lymph,  and  especially  of  blood,  of 


276  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

which,  together,  they  constitute  about  20  per  cent.  It  may  be 
said  that  all  organs  contain  elements  of  defence— macrophages. 
The  experiments  of  Gabritschevsky,  who  has  studied  phagocy- 
tosis in  diphtheria,  are  highly  instructive.  Injecting  a  pure  culture 
of  Loeffler's  bacillus  into  the  anterior  chamber  of  a  rabbit's  eye,  he 
saw  the  devastation  wrought  among  the  leucocytes,  which  appeared 
powerless  to  contend  against  the  deadly  germs.  But  after  immu- 
nizing the  rabbit  with  attenuated  cultures  previous  to  the  injection 
of  toxic  bacilli,  a  battle-royal  ensued,  the  phagocytic  action  of  the 
leucocytes  resulting  in  the  signal  triumph  of  the  latter,  so  that  at 
the  end  of  eight  hours  not  a  single  free  bacillus  was  found  in  the 
chamber,  all  having  been  absorbed  within  the  opposing  globules. 
Yet,  notwithstanding  the  plausibility  of  Metchnikoff's  hypothe- 
sis and  the  striking  significance  of  his  experiments — embracing  in 
epitome  the  whole  theory  of  preventive  inoculation — certain  argu- 
ments of  Behring  and  Kitasato,  based  upon  experimental  research, 
go  far  to  disprove  the  validity  of  the  doctrine  he  so  zealously 
maintained.  Still,  although  the  substances  which  form  the  defen- 
sive property  of  phagocytes,  and  are  so  fatal  to  the  pathogenic 
action  of  microbes,  remain  unknown  to  us,  the  fact  of  phagocyto- 
sis cannot  be  denied. 

It  was  natural  in  the  light  of  new  developments  that  investiga- 
tion should  inquire  whether  the  leucocytes  constituted  the  only 
protective  force  within  the  organism.  Then  followed  the  theory 
that  the  humors  in  general  possess  microbicidal  power — either 
through  the  presence  of  destructive  elements  and  the  secretion  of 
soluble  toxins  or  through  the  humoral  capacity  of  withdrawing 
oxygen  from  the  invading  micro-organisms.  To  Buchner  is  chiefly 
due  the  early  elucidation  of  the  humoral  theory,  and  of  first  recog- 
nizing in  serum  bactericidal  properties,  he  being  followed  by  Behring, 
to  whom  is  to  be  credited  the  more  important  labor  of  extending 
experimentation  and  proving  that  animals  naturally  immune  against 
a  certain  disease  may  furnish  serum  endued  with  neutralizing  power. 
Behring  found  that  the  blood  and  blood-serum  of  the  rat,  which 
is  naturally  immune  against  anthrax,  possesses  strong  bactericidal 
properties,  while  those  of  mice,  cattle,  etc.,  very  susceptible  to  anthrax 
infection,  have  none. 

Further  research  resulted  in  Behring's  all-important  law,  es- 
tablished by  searching  experiment,  that  "the  blood  and  blood- 
serum  of  an  individual  which  has  been  rendered  artificially  \xsvsxmri& 
against  a  certain  infectious  disease  may  be  transferred  into  another 


SPECIFICS. 


277^ 


individual,  with  the  effect  of  rendering  the  latter  also  immune,  no 
matter  how  susceptible  this  animal  is  to  the  disease  in  question." 
This  formulated  doctrine  became  the  fundamental  motive  in  all 
future  investigations,  the  culminating  achievement  of  inoculative 
therapy  being  the  announcement  of  Behring  and  Kitasato  in  1890 
concerning  the  artificial  immunity  against  tetanus  and  diphtheria 
conferred  by  blood-serum,  including  the  first  emphatic  declaration 
that  the  power  of  rabbits  and  mice  when  rendered  immune  to  re- 
sist tetanus-poisoning  "  is  based  upon  the  ability  of  blood-serum  to 
neutralize  the  toxins  produced  by  the  tetanus  bacilli."  As  Krieger 
well  observes :  "  These  toxins  are  the  poisonous  products  of  bac- 
terial metaboUsm,  and  are  the  causes  of  acute  disease  when  circu- 
lating in  the  organism.  Their  effect  is  an  intoxication  of  the  system, 
while  after  the  introduction  of  virulent  germs  the  cause  of  the  dis- 
ease is  an  infection." 

The  moment  had  now  arrived  for  applying  the  therapeutic  test 
of  serum  to  man.  In  every  instance  the  validity  of  Behring's  law 
was  sustained,  and,  moreover,  the  invaluable  discovery  was  made 
that  the  serum  of  individuals  naturally  immune  against  a  certain 
disease  possesses  no  immunizing  properties  for  other  individuals. 
This  militated  partly  against  previous  theories,  and  proved  conclu- 
sively that  the  protective  agent  is  not  a  substance  produced  by 
nature  in  naturally  immune  animals,  but  the  result  of  "  an  organic 
chemism  "  called  into  activity  only  by  introduction  of  the  corre- 
sponding poison  or  toxin. 

In  diphtheria  and  similar  infectious  diseases,  as  in  tetanus,  the 
bacillus  produces  toxins,  the  effects  of  which  can  be  neutralized 
only  by  the  properly  prepared  antitoxin.  It  was  even  shown  by 
Ehrlich  that  the  law  applied  to  intoxication  by  certain  purely 
chemical  poisons,  such  as  ricin  and  abrin,  injections  of  gradually 
increased  doses  of  serum  affording  complete  immunity. 

A  third  theory  in  regard  to  the  causes  of  immunity^  the  humoro- 
cellular,  seeks  to  combine  phagocytic  and  humoral  agencies,  on  the 
ground  that  neither  separately  suffices  to  account  for  the  phenom- 
ena observed.  Such  is  the  theory  of  alexins  of  Buchner — certain 
albuminoid  substances  in  the  blood  which  release  the  leucocytes 
at  the  point  of  infection,  the  bactericidal  property  being  active 
rather  than  passive,  as  previously  supposed.  Although  defended 
by  able  advocates,  Hankin  and  others,  the  fallacy  of  certain  prem- 
ises, as  shown  by  Metchnikoff,  served  to  invalidate  the  doctrine, 
while  several  eminent  authorities  have  disproved  the  facts  upon 


278  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

which   the    original   hypothesis    was    founded.     Nevertheless,    so 
high  an  authority  as  Bernheim  may  be  cited  in  its  favor. 

Lastly,  the  vaso-motor  theory  of  Bouchard  and  others  asserts 
the  claims  of  physiology  in  determining  the  causes  of  immunity. 
Admitting  the  fact  of  phagocytosis,  they  contend  that  the  emigration 
of  leucocytes  from  the  vessels  occurs  only  through  the  action  of 
the  vaso-motor  centers,  whether  by  exciting  the  dilator  or  paralyz- 
ing the  constrictor  muscles. 

From  these  varying  opinions  it  is  as  yet  difficult  to  form  a 
rational  conclusion  entirely  in  accord  with  physiological  phenom- 
ena. In  this  connection  the  remarks  of  Bernheim  may  be  cited 
as  those  of  a  highly  competent  authority.  He  says,  while  inclining 
to  the  humoro-cellular  hypothesis,  "  Be  it  as  it  may,  we  can  safely 
aver  that  relative  immunity  exists  among  the  majority  of  animals. 
Against  certain  diseases  this  immunity  may  even  be  absolute. 
Thus  rats,  mice,  and  dogs  are  naturally  immune  against  the  mini- 
mum mortal  dose  of  the  Loeffler  bacillus ;  yet  the  serum  from 
these  animals  when  injected  into  other  individuals  is  powerless 
to  prevent  infection — a  point  having  an  important  bearing  upon 
serum-therapy.  Moreover,  we  know  that  man  is  frequently  ex- 
posed to  contagion  without  contracting  a  taint,  of  infectious  dis- 
ease. I  myself,  under  the  most  unfavorable  conditions  occasioned 
by  fatigue,  have  passed  through  epidemics  of  typhoid  fever, 
cholera,  and  malignant  influenza  {la  grippe)  without  the  slightest 
contamination,  and  other  practitioners  have  had  a  similar  ex- 
perience. Meanwhile,  it  were  folly  to  imitate  those  courageous 
experimenters  who,  wishing  to  prove  their  immunity  against  cer- 
tain diseases,  have  absorbed  their  pathogenic  germs,  not  infre- 
quently with   fatal   results As   many   conditions  tend  to 

diminish  the  power  of  resistance  in  the  human  organism,  so  others 
fortify  the  system  against  the  inroads  of  infection.  Obedience  to 
sound  hygienic  principles,  a  regulated  and  nutritious  diet,  and  a 
healthy  parentage  render  the  individual  capable  of  withstanding 
microbic  influences  which  constantly  assail  him,  his  natural  immu- 
nity being  greatly  reinforced  by  these  favorable  circumstances." 

Obscure  as  is  the  precise  nature  of  the  immunizing  property 
possessed  by  serum,  there  is  no  question  as  to  its  marvellous 
potency.  Behring  and  Kitasato  showed  that  it  was  sufficient  to 
mingle  very  small  quantities  of  serum  from  an  immunized  subject 
with  virulent  toxins  to  inoculate  with  impunity  animals  sensible  to 
infinitesimal  amounts  of  pure  toxins.     In  experiments   made  by 


SPECIFICS.  279 

MM.  Roux  and  Vaillard  the  resistant  force  of  antitoxin  passes 
imagination.  During  their  researches  concerning  tetanus  bacilli 
they  employed  cultures  which,  when  filtered,  killed  guinea-pigs  in 
doses  of  0.005  c.cm. ;  yet  one  cubic  centimeter  of  equine  serum 
served  to  neutralize  thirty  times  its  volume  of  toxin,  so  that  by 
the  addition  of  0.000 1  c.cm.  of  serum  it  was  possible  to  neutralize 
completely  the  action  of  a  mortal  dose.  In  order  to  render  a 
mouse  immune  the  requisite  quantity  of  antitoxin  is  so  infinitesimal 
as  scarely  to  be  computed.  In  fact,  serum  is  obtainable  possessing 
an  activity  of  one-millionth,  the  immunizing  unit  being  the  quan- 
tity necessary  to  protect  one  gram  of  a  mouse's  weight ;  that  is, 
one  cubic  centimeter  of  serum  suffices  to  confer  immunity  against 
fatal  dosage  in  1000  kilograms  of  mice,  or  70,000  of  these  ani- 
mals, each  weighing  about  15  grams. 

It  will  readily  be  understood  that  the  discovery  of  so  protective 
a  force  soon  awakened  therapeutic  hopes  which,  if  not  completely 
realized  in  tetanus — largely  by  reason  of  the  difficulties  attending 
any  treatment  of  so  fatal  a  disease — have,  on  the  other  hand,  in 
the  case  of  diphtheria,  been  even  more  happily  fulfilled  than  was 
anticipated. 

It  is  to  be  regretted,  en  passant,  that  in  the  use  of  the  term 
antitoxin  needless  ambiguity  should  have  arisen  in  the  public  mind, 
a  fancied  identity  between  the  antitoxic  and  prophylactic  power  of 
serum  being  widely  diffused.  The  association  of  the  term  with 
the  preventive  property  of  the  immunizing  agent — antitetanic, 
antidiphtheritic — has  contributed  not  a  little  to  this  confusion  of 
characteristic  properties.  In  reality,  nothing  could  be  more  erro- 
neous, than  to  suppose  coequal  activities  in  the  two  forces,  the  pre- 
ventive property  of  serum  being  far  more  general  than  its  antitoxin 
influence — as  yet  scarcely  proven  save  in  tetanus  and  diphtheria. 
In  hog-cholera,  typhoid  fever,  pneumonia,  aviary  septicemia,  and 
cholera  careful  researches  abundantly  demonstrate  that  the  serum 
of  animals  rendered  immune  against  these  diseases,  while  protect- 
ing the  alien  organism  from  microbic  infection,  has  no  power  over 
bacterial  products,  or  toxins.  That  the  immunity  is  conferred  apart 
from  this  latter  agency  is  evidence  that  the  protection  is  due  to 
causes  other  than  direct  bactericidal  action. 

It  is  because  the  present  terminology  is  defective — antitoxin 
failing  to  denote  the  salient  property  of  serum — that  the  more 
descriptive  expression  stimuline  has  been  suggested  on  high  author- 
ity as  a  substitute.     It  may  be  observed,  moreover,  that  a  still  fur- 


28o  A    TEXT-BOOK  OF  MATERIA    MEDIC  A. 

ther  confusion  prevails  in  giving  the  name  antitoxin  to  the  substance 
injected  as  well  as  to  the  defensive  proteids  formed  by  its  action 
upon  the  organism — an  ambiguity  which  the  use  of  the  term 
"  stimuline  "  would  obviate. 

In  considering  the  prophylactic  effect  of  antitoxin,  so  intimately 
allied  to  serum-therapy,  it  may  be  well  to  emphasize  the  distinction 
between  vaccination  as  founded  by  Jenner  and  the  new  method. 

It  was  formerly  sought  to  create  immunity  by  inoculating  the 
individual  with  the  pathogenic  micro-organism  itself — the  virulent 
germs  of  disease.  To-day  protection  is  found  in  the  injection  of 
soluble  products  secreted  by  the  micro-organism,  administered  in 
progressive  doses,  or,  as  by  the  latest  process,  in  the  inoculation 
of  serum  taken  from  an  animal  previously  rendered  immune. 
Herein  lies  the  essential  difference  between  vaccination  and  immu- 
nization— a  distinction  too  often  ignored.  Vaccination  can  at  most 
but  prevent  infection  ;  immunization  is  curative.  The  vaccinal  sub- 
stance possesses  no  power  over  the  actual  microbes  and  their 
products :  the  immunizing  agent  is  endowed  with  the  remarkable 
property  of  neutralizing  the  influence  of  pathogenic  germs  or  of 
determining  their  destruction.  Vaccination  produces  in  the  indi- 
vidual inoculated  deterrent  forces  which  serve  to  arrest  bacterial 
development :  in  immunization  the  obstructive  agents  injected  are 
prepared,  as  in  the  laboratory,  by  a  separate  organism.  In  this 
latter  medium  we  have  a  true  therapeutic  remedy. 

If  we  seek  to  draw  the  line  of  demarcation  between  the  two 
methods  more  closely,  we  recognize  that  the  modern  doctrine 
of  immunity  rests  upon  wholly  new  and  original  researches  quite 
distinct  from  those  formerly  pursued.  Doubtless  the  immunizing 
property  of  serum  was  divined  by  those  who  adopted  free  vene- 
section in  cachectic  patients,  abstracting  the  vitiated  blood  and 
replacing  it  with  venous  injection  of  that  supplied  by  a  healthy 
organism.  A  certain  antagonism  had  also  been  observed  between 
infectious  maladies  mutually  opposed  in  their  development,  one 
of  which  was  prone  to  exert  a  curative  action  upon  the  other. 
Fehleisen  in  1 880  cited  the  phenomenal  case  of  a  woman  afflicted 
with  cancer  of  the  breast,  which  after  three  successive  operations 
still  redeveloped  rapidly.  Finally  erysipelas  affected  the  cicatricial 
wound  of  the  amputated  breast,  the  new  malady  proving  beneficial 
to  the  patient,  since  carcinoma  was  not  renewed.  From  this  and 
similar  data  Emmerich  inferred  that  it  sufficed  to  inject  the  serum 
of  animals  immunized  with  the  streptococcus  of  Fehleisen  to  treat 


SPECIFICS.  281 

and  cure  (?)  cancerous  subjects,  the  toxins  of  streptococcus  erysipe- 
latis  preventing  carcinomatous  development. 

Having  purposely  dwelt  at  some  length  upon  the  evolution 
and  general  properties  of  serum-therapy,  let  us  turn  to  the  actual 
achievement  of  the  method  in  its  therapeutic  relations  to  infectious 
disease.  In  view  of  well-authenticated  and  obvious  records  attest- 
ing the  efficacy  of  the  new  treatment,  the  charge  "not  proven" 
cannot  properly  be  sustained.  Yet  the  observation  of  Achalme, 
that  it  is  well  to  accept  new  theories  salts  cum  grano,  is  not  inap- 
plicable; and  the  wise  admonition  of  Bacon  in  regard  to  books, 
that  we  should  read  "  not  to  accept  nor  refute,  but  to  weigh  and 
consider,"  is  equally  apposite  in  estimating  the  value  of  scientific 
discoveries,  however  distinguished  may  be  their  claim  to  recog- 
nition. 

Tetanus. — The  first  proof  that  tetanus  is  an  infectious  disease, 
of  bacillary  origin,  was  furnished  by  Carle  and  Rattone,  who  in 
1884  reproduced  the  symptoms  in  a  rabbit  by  inoculation  of  pus 
taken  from  a  human  tetanus  wound.  The  bacilli  were  found  in  the 
adjacent  soil,  but  it  was  not  until  1889  that  Kitasato  succeeded  in 
isolating  pure  cultures,  proving  conclusively  the  microbic  nature 
of  the  disease. 

The  earliest  case  treated  with  antitoxin  was  reported  in  1891 
by  a  Bolognese  physician.  Dr.  Gagliardi,  the  result  being  highly 
satisfactory.  In  the  light  of  subsequent  experiments  it  is  of  ab- 
sorbing interest.  The  patient,  a  man  forty-five  years  of  age, 
accidentally  received  a  wound  of  the  left  foot  while  crossing  a 
rice-field.  Next  day  (May  12,  1891),  the  foot  having  swollen 
considerably,  he  consulted  Dr.  Gagliardi,  who  made  an  incision 
and  applied  antiseptics.  May  19th  the  wound  was  healed,  but 
four  days  later  symptoms  of  trismus  appeared,  becoming  acute 
May  24th.  Injections  of  5  per  cent,  carbolic  acid  in  the  vicinity 
of  the  wound  produced  no  effect,  and  on  June  3d  opisthotonos 
and  aggravated  symptoms  were  manifested.  The  doctor  now 
injected  0.25  c.cm.  of  Tizzoni's  antitoxin,  obtained  from  a  strongly 
immunized  dog,  the  treatment  being  followed  by  some  im- 
provement. June  7th,  relapse  and  tetanic  spasms  having  super- 
vened, two  more  injections  were  administered,  and  the  following 
day  the  patient  gradually  convalesced,  being  discharged  as  cured 
July  5th.  The  quantity  of  antitoxin  sufficient  to  neutralize  the 
tetanus-poison  was  less  than  i  c.cm.  In  1891-92  four  other  cases 
were  treated  with  like  favorable  results,  injections  of  0.25  c.cm. 


282  A    TEXT-BOOK  OF  MA  TERIA  MEDIC  A. 

twice  a  day,  from  two  to  six  doses  in  all,  being  attended  with  com- 
plete recovery.  When  it  is  taken  into  consideration  that  the  most 
authentic  statistics  of  tetanus  show  a  mortality  of  about  88  per 
cent,  and  that  by  the  above  procedure  it  was  reduced  to  20  per 
cent,  it  is  small  wonder  that  the  issue  in  these  cases  should  be 
regarded  as  simply  marvellous.  And  yet  we  have,  after  devious- 
wanderings,  reached  but  the  threshold  of  the  new  science. 

In  December,  1890,  Behring  and  Kitasato  demonstrated  that 
the  serum  of  animals  rendered  immune  against  tetanus  by  the 
injection  of  iodine  trichloride  in  the  blood  was  capable  of  neutral- 
izing tetanic  poison,  whether  in  the  laboratory  or  in  other  animals,, 
the  property  not  being  possessed  by  organisms  not  inoculated- 
Not  only  did  they  succeed  in  preventing  infection,  but  they  recog- 
nized in  the  serum  a  curative  power,  as  shown  in  the  inoculation 
and  cure  of  mice.  At  the  same  time  it  was  observed  by  Vaillard 
that  the  immunity  conferred  by  the  serum  was  of  short  duration,, 
lasting  only  fifteen  days. 

Kitasato's  preventive  injection — a  mixture  of  living  culture  and 
gradually  decreasing  doses  of  iodine  trichloride — was  perfected  by 
Behring,  who  successfully  applied  it  to  the  mouse,  rabbit,  sheep,, 
and  horse.  Various  results  of  experimental  research  ensued,  elicit- 
ing among  other  interesting  phenomena  the  fact  that  removal  of 
the  spleen  renders  immunization  impossible.  In  1891,  Vaillard 
showed  that  the  serum  of  animals  naturally  immune  is  not  anti- 
toxic, becoming  so  only  after  a  powerful  dose  of  tetanic  poison,, 
and  that  the  spleen  and  the  fluids  of  immunized  subjects  are  devoid 
of  antitoxic  properties. 

One  point  in  the  doctrine  advanced  by  Behring  and  KitasatO' 
awakened  the  liveliest  discussion  :  whether  it  was  possible  to  cure 
disease  by  the  serum  of  inoculated  individuals.  Tizzoni  and  Cat- 
tani  had  failed  to  attain  this  result,  and  had,  moreover,  recognized 
that  the  condition  of  immunity  was  transient  On  the  other  hand, 
Behring  had  claimed  the  cure  of  tetanus  in  the  sheep  and  horse, 
and  Kitasato  had  obtained  results  equally  positive  in  the  case  of 
mice. 

All  doubt  on  this  head  was  dissipated  by  Ehrlich  in  1891,  who 
proved  by  experiments  with  ricin  and  abrin  that  the  antitoxic  and 
immunizing  property  of  serum  varies  greatly  with  the  degree  of 
immunity  conferred.  In  seeking  a  favorable  issue  it  was  evident 
that  in  cases  of  failure  the  inoculation  had  fallen  short  of  the 
degree  requisite  to  render  the  serum  curative. 


SPECIFICS.  285 

It  should  be  added  that  in  subsequent  treatment  Tizzoni,  Cat- 
tani,  and  Vaillard  met  with  perfect  success  in  effecting  cures. 

Thus  far,  the  employment  of  serum  as  a  curative  agent  had 
been  confined  to  experiments  upon  animals.  The  results  obtained 
urged  its  application  to  human  tetanus.  The  first  attempt  was 
made  by  Kitasato  in  1891,  the  serum  being  taken  from  a  rabbit. 
It  was  unsuccessful,  the  dose  of  serum  employed  being  too  feeble 
to  cope  with  the  gravity  of  the  conditions  presented.  In  1892, 
Tizzoni  and  Cattani  and  others  reported  8  cures  with  serum  from 
immunized  dogs.  It  was  contended,  however,  that  a  comparatively- 
mild  form  of  the  disease  was  treated.  In  France  the  results  of 
similar  treatment  in  1892  were  wholly  unfavorable,  but  in  1893  the 
cure  of  a  peculiarly  aggravated  case  was  authentically  announced, 
amelioration  of  symptoms  having  occurred  in  three,  and  complete 
restoration  in  twenty,  days.  The  injection  was  subcutaneous  in 
the  abdominal  region,  300  c.cm.  of  equine  serum  from  an  immun- 
ized animal  being  given.  The  injections  are  said  to  be  in  them- 
selves harmless. 

Finally,  MM.  Roux  and  Vaillard  formulated  the  mode  of  prep- 
aration of  antitetanic  serum,  together  with  an  analysis  of  its  prop- 
erties and  its  curative  application  in  man  and  the  lower  animals.. 

It  may  reasonably  be  expected  that  future  experiments  with 
the  antitoxin  of  tetanus,  made  with  greater  precision  and  untiring 
patience,  will  produce  more  favorable  results. 

It  is  of  primary  importance  to  consider,  first,  whether  sufficient 
amounts  of  immunizing  serum  are  injected  to  combat  the  condi- 
tions of  this  most  difficult  disease,  and,  second,  whether  the  doses 
are  renewed  often  enough  to  arrest  its  progress  or  ensure  immunity. 
These  desiderata  are  sufficiently  obvious,  especially  in  view  of  the 
certainty  that  the  antitoxin  is  wholly  innocuous. 

Diphtheria. — It  is  in  the  treatment  of  this  universal  and  terrible 
disease  that  serum-therapy  has  achieved  its  most  signal  triumphs, 
the  marvels  wrought  by  its  influence  attracting  more  and  more  the 
attention  both  of  the  medical  profession  and  of  the  laity. 

The  micro-organism  of  the  malady  was  described  by  Klebs  in 
1883,  his  investigations  being  quickly  followed  by  those  of  Loeffler, 
who  confirmed  Klebs'  discovery  and  announced  that  it  was  possible 
not  only  to  isolate,  but  also  to  produce,  cultures  of  the  microbe. 
Roux  and  Yersin,  as  well  as  other  savants,  have  established  the 
fact  that  the  germ  is  found  only  in  the  false  membrane— especially 
its  surface — and  in  the  saliva  or  contiguous  mucous  membrane. 


284  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

never  developing  in  the  circulating  fluid  either  of  the  lymph  or  any- 
other  portion  of  the  organism. 

The  bacillus  frequenting  the  false  membrane  is  rarely  unaccom- 
panied, but  is  found  associated  with  other  micro-organisms  which 
■exert  great  influence  upon  the  progress  of  the  disease.  It  propa- 
gates rapidly  upon  solidified  serum,  bouillon,  and  gelatin,  though 
not  on  potato,  preserving  its  virulence  for  several  months.  In 
direct  contact  with  light  and  air  it  perishes  within  a  few  weeks. 

The  false  membrane  is  artificially  formed  by  painting  with  pure 
■culture  the  buccal  ulcers  of  the  mucous  membrane  in  rabbits,  dogs, 
guinea-pigs,  and  chickens,  the  symptoms  produced  being  those  of 
human  diphtheria,  and  frequently  fatal.  The  researches  of  Loeffler 
indicate  that  no  direct  action  is  attributable  to  the  bacillus,  the  sys- 
temic effects  of  the  poison  being  rather  those  of  a  general  intoxi- 
cation of  unknown  nature — an  opinion  sustained  by  the  researches 
of  Roux  and  Yersin.  The  microbe  may  be  ejected  by  the  mouth 
together  with  the  false  membrane,  but  oftener  it  remains  in  an  iso- 
lated state  ensconced  in  buccal  and  nasal  cavities,  perhaps  for  sev- 
■eral  days  or  even  weeks. 

Although  the  discovery  of  the  pathogenic  micro-organism  of 
diphtheria  is  of  quite  recent  date,  no  time  has  been  lost  in  seeking 
to  determine  the  means  of  conferring  immunity  against  the  disease. 
To  Behring  (1889)  is  due  the  credit  of  having  first  indicated  the 
method  of  immunization  in  the  disease,  as  well  as  in  tetanus,  his 
investigations  leading  him  to  affirm  that  the  process  of  conferring 
immunity  by-  the  soluble  products  of  Loeffler's  bacillus  derived 
from  immunized  animals,  combined  with  a  solution  of  iodine  tri- 
chloride, is  positively  innocuous  and  curative  in  diphtheria. 

Little  progress  was  made  by  the  experiments  of  earlier  investi- 
gators, but,  in  1 89 1,  Aronson  succeeded  in  immunizing  rabbits 
against  diphtheria  by  inoculation  with  cultures  attenuated  by  the 
vapor  of  formaldehyde.  The  serum  obtained  possessed  great  im- 
munizing power,  a  single  cubic  centimeter  sufficing  to  inoculate  4 
kilograms  of  animal  weight  against  the  minimum  mortal  dose  of 
virulent  cultures. 

Subsequently,  Aronson  applied  this  therapeutic  method  to 
numerous  children  affected  with  diphtheri'a,  and  affirmed  with  Behr- 
ing that  serum-therapy  was  inoffensive  and  a  sovereign  remedy  in 
a  large  number  of  cases.  He  obtained  the  serum  from  dogs  and 
sheep,  but  declared  that  large  animals  were  preferable,  especially 
the  horse. 


SPECIFICS.  285 

In  order  to  formulate  the  dosage,  Behring  established  a  techni- 
cal scale  in  which  one  cubic  centimeter  of  prepared  serum  is  consid- 
ered a  unit,  the  antitoxin  supplied  being  of  the  strength  of  60,  1 50, 
or  500  units  according  to  the  degree  of  immunity  of  the  animal 
from  which  it  is  derived.  The  value  of  serum  depends,  he  affirms, 
upon  the  difference  between  the  original  condition  of,  and  the  re- 
fractory state  attained  by,  the  animal  under  immunization. 

Notwithstanding  the  significance  attaching  to  experiments  hith- 
erto recorded,  the  thereapeutic  apphcation  of  serum-therapy  to 
diphtheria  may  be  said  to  date  from  the  communication  of  Roux 
to  the  Congress  of  Buda-Pesth  (September,  1894).  From  this 
moment  clinical  observations  multiplied  and  statistics  were  reported 
from  all  parts  of  the  world. 

In  this  memorable  address  the  author  ably  reviewed  the  entire 
subject  of  serum-therapy,  stating  the  relations  of  serum  to  the 
general  economy  and  offering  advanced  and  cogent  suggestions 
concerning  the  employment  of  antitoxins  to  arrest  the  ravages  of 
infectious  disease.  The  early  failures  to  cure  tetanus  were  explained 
by  the  fact  that  the  symptoms  of  the  disease  are  frequently  not 
manifested  until  it  is  too  late  to  stay  its  progress.  On  the  other 
hand,  in  diphtheria  the  evident  appearance  of  the  characteristic 
false  membrane  rendered  it  possible  to  treat  the  malady  from  its 
inception.  The  most  approved,  though  complicated,  methods  of 
preparing  the  toxin  were  minutely  described — either  through  the 
medium  of  bouillon  as  a  host  in  contact  with  dry  air,  or  a  similar 
process  in  a  current  of  moist  air — and  explicit  instructions  given 
regarding  the  attenuation  of  the  poison  by  means  of  iodine,  and  the 
modus  operandi  of  administration  in  gradually  intensified  doses. 

"  With  regard  to  diphtheria  associated  with  certain  microbes," 
said  M.  Roux,  "especially  streptococcus,  the  results  of  sero- 
therapy have  been  far  from  satisfactory.  I  have  often  saved  rab- 
bits treated  six  or  eight  hours  after  tracheal  infection,  although 
repeated  injections  of  therapeutic  serum  were  necessary :  when 
treatment  has  been  deferred  twelve  hours,  the  animals  have  inva- 
riably succumbed. 

"  The  efficacy  of  antidiphtheritic  serum  having  been  estabHshed 
experimentally,  its  application  to  the  human  malady  was  a  natural 
consequence.  All  my  experience  occurred  at  the  Hospital  for  Sick 
Children  in  conjunction  with  MM.  Martin  and  Chaillou.  From  the 
1st  of  February  to  the  24th  of  July,  1894,  448  children  were  ad- 
mitted to  the  diphtheritic  ward,  of  whom  109  died — a  mortality  of 


286  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

24.33  psr  cent.  Now,  the  average  mortality  from  189O  to  1895 
was  51.71  per  cent,  in  a  tdtal  of  3971  children.  The  advantage  of 
serum-therapy,  all  conditions  being  equal,  is  27.28  per  cent,  greater 
than  under  the  former  treatment. 

"  Such  are  the  gross  statistics.  It  is  necessary,  however,  to 
deduct  from  the  foregoing  448  patients  treated  with  serum  128  who, 
as  the  bacterial  examination  showed,  were  not  affected  with  true 
diphtheria  of  the  Klebs-Loeffler  bacillus  type,  besides  20  desperate 
cases  amenable  to  no  possible  treatment.  The  net  statement, 
therefore,  is  300  cases  with  78  deaths — a  mortality  of  26  per  cent., 
whereas  a  previous  report,  similarly  computed,  recorded  a  mortality 
of  50  per  cent." 

M.  Roux  is  quoted  at  length  because  his  views  are  authoritative, 
embodying  the  most  careful  researches  connected  with  serum- 
therapy  in  its  application  to  diphtheria.  With  regard  to  the  relative 
proportion  of  deaths,  it  is  instructive  to  compare  with  his  figures 
those  of  more  recent  investigators  and  medical  practitioners. 

At  an  international  Congress  held  in  Munich  in  April,  1895, 
the  merits  of  serum-therapy  in  diphtheria  formed  the  subject  of 
an  interesting  debate,  eliciting  reports  from  the  most  competent 
Continental  authorities  in  which  the  efficacy  of  the  new  treatment 
was  strikingly  demonstrated. 

Dr.  O.  Heubner  of  the  University  of  Berlin,  comparing  the 
statistics  of  the  Berlin  hospitals  during  1894,  stated  that  the  mor- 
tality since  the  introduction  of  serum-therapy  had  been  reduced  to 
one-half  of  that  recorded  prior  to  that  date,  about  1500  cases  being 
included  in  each  period.  Allowing  for  the  condition  of  medium 
virulence  which  marked  the  disease.  Prof  Heubner  believed  that 
this  factor  alone  could  not  account  for  the  great  difference  in  the 
mortality.  Up  to  the  present  time,  he  said,  reliable  information  of 
over  3000  cases  had  been  obtained  from  all  parts  of  the  world  in 
which  the  disease  was  treated  with  antitoxin  serum.  The  average 
of  cures  was  80  per  cent.  Referring  to  clinical  analysis  of  300 
cases  of  diphtheria  coming  under  his  own  supervision,  he  declared 
that  the  disease  could  be  diagnosed  only  by  identification  of  the 
diphtheria  bacilli.  Of  207  cases  so  diagnosed  and  treated  in  the 
Berlin  Charite,  the  mortality  in  simple  attacks  was  10  per  cent., 
and  in  more  complicated  ones  1 3  per  cent.  From  personal  expe- 
rience the  speaker  regarded,  as  the  specific  results  of  serum-treat- 
ment, the  improvement  in  the  febrile  symptoms  and  the  quickened 
cleansing  of  the  air-passages — facts  first  noted  since  the  introduc- 


SPECIFICS.  287 

tion  of  serum-therapy,  and  confirmed  wherever  the  method  was 
adopted. 

Prof.  A.  Baginsky  of  Berlin  said  that  prior  to  the  introduction 
■of  the  treatment  with  serum  the  more  difficult  and  sorrowful  por- 
tion of  his  life  had  been  spent  in  combating  the  disease,  against 
which  he  felt  absolutely  helpless,  the  mortality  for  the  past  four 
years,  in  spite  of  every  effort,  having  been  50,  33,  36,  and  42  per 
cent,  respectively.  The  deaths  occurring  under  treatment  of  525 
cases  with  Dr.  Aronson's  preparation  had  been  1 5  per  cent. 

Prof  von  Widerhofer  of  Vienna  stated  that  in  300  cases  of 
diphtheria  coming  under  his  cognizance  the  average  mortality  was 
23.7  per  cent.  Excluding  those  that  died  within  twenty-four  hours, 
the  disease  having  reached  a  ■  very  advanced  stage  previous  to 
treatment,  the  mortality  falls  to  14.3  per  cent. 

Prof  von  Ranke  of  Munich  reported  that  of  124  cases  treated 
in  the  six  months  previous,  26  children,  or  22.4  per  cent,  died,  102 
cases  presenting  features  of  uncomplicated  diphtheria.  Compared 
with  the  mortality  during  the  preceding  eight  years,  the  reduction 
was  enormous,  being  less  than  half  the  minimum  record  for  any 
year  during  that  period. 

Prof  von  Mehring  reported  on  74  cases,  all  treated  with  serum 
on  the  first  or  second  day,  of  which  only  4  died,  giving  a  mortality 
of  5  per  cent.  During  the  preceding  five  years  30  per  cent,  of  his 
diphtheria  patients  had  died. 

Prof  von  Noorden  gave  the  results  of  his  experience  in  8 1  cases 
treated  at  the  Frankfort  Hospital.  Most  of  them,  unfortunately, 
were  admitted  at  a  late  stage  of  the  disease,  generally  on  the  third 
or  fourth  day,  the  severest  symptoms  being  developed.  Notwith- 
standing this  obstacle,  in  place  of  the  previous  mortality  of  45  per " 
cent.,  only  23  per  cent,  was  recorded. 

Dr.  G.  Seiz  of  Constance  stated  that  of  27  cases  treated  with 
serum  he  lost  only  i,  or  3.3  per  cent. 

Prof  Sigel,  in  charge  of  the  Olga  Hospital  at  Stuttgart,  reported 
that  the  general  mortality  for  the  five  years  previous  to  1894  was 
40.1  per  cent,  and  60  per  cent,  among  those  upon  whom  trache- 
otomy was  performed  in  the  first  nine  months  of  1894 — in  fact,  up 
to  the  day  on  which  the  antitoxin  treatment  was  commenced — the 
mortality  rising  to  50.3  and  70  per  cent,  respectively.  During  the 
three  months  of  serum  treatment  in  1894  there  was  an  astonishing 
decrease  in  the  number  of  deaths,  the  mortality  falling  to  12  per 
■cent,  in  general  and  20.3  per  cent,  in  tracheotomy  cases. 


28b 


A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 


The  reports,  emanating  from  authorities  of  the  highest  standing; 
were  of  themselves  conclusive  testimony  in  favor  of  serum-therapy 
in  diphtheria  as  immensely  superior  to  former  methods  of  treatment. 

An  interesting  resume  of  statistics,  compiled  from  the  library 
of  the  Royal  College  of  Surgeons,  England,  by  Dr.  G.  C.  CrandalL 
of  St.  Louis,  Mo.,  emphasizes  in  comprehensive  figures  the  explicit 
advance  made  within  a  few  years  in  the  scientific  control  of  the  dis- 
ease. The  following  table  embodies  the  results  of  Dr.  Crandall's 
timely  study  of  the  subject : 


Authorities. 


Locality. 


Cases 

treated  with 

serum. 


Mortality 
in  percent. 


Previous 

mortality 

in  per  cent. 


Vierordt   ...  ... 

Ganghofner      ....  ... 

Viederhofer 

Kossel 

Baginsky  (quoted  by  Virchow) 

Sonnenburg         

Aroiison  ....  

Ranke 

Soltmann 

Risel 

Roux,  Martin,  and  Chaillou  .    .    . 

Lebreton 

Moizard 

Washbourn,   Goodall,    Card,    and 

others 

White 

Withington 

Total  number  of  cases 

Average  mortality,  per  cent 

Previous  average  mortality,  per  cent. 

Collective  report  of  other  observers  in  different 

countries 


Heidelberg 
Prague 
Vienna 
Berlin  . 
Berlin  . 
Berlin  . 
Berlin  . 
Munich 
Leipsic 
Halle  . 
Paris  . 
Paris  . 
Paris 


London 
New  York 
Boston 


55 
no 

100 

35° 
303 
107 
190 

85 
122 
114 
300 
258 
231 

195 
32 
80 


2632 


14.6 
12.7 

25-3 
16.7 
13.Z 
20.6 
14.0 
18.8 
18.0 
8.0 
26.0 
1 2.0 
147 

18.6 
25.0 
16.0 


4022 


16.8 


17.1 


58.0 
50.0 
42.8 
34-7 
47-8 
27.6 
37-0 
48.S 


517 
50.0 

311 
42.7 

45-0 


42.0 


The  official  report  from  the  Imperial  German  Health  Depart- 
ment up  to  June  20,  1895,  records  2228  cases,  with  a  percentage 
of  mortality  of  17.3;  and  further  German  statistics  (August  10, 
189s)  include  10,240  cases  in  hospitals  and  private  practice,  5790 
of  which  were  treated  with  antitoxin  serum,  the  number  of  deaths 
being  552 — a  mortality  of  9.5  per  cent. 

Prof  Eulenburg,  the  author  of  this  report,  reiterated  the  import- 
ance of  early  recourse  to  antitoxin,  stating  that  when  used  within 
the  first  forty-eight  hours  the  mortality  was  only  4.2  per  cent. : 
delayed  beyond  this  period,  the  percentage  was  increased  to  16.8. 

In  America  the  merits  of  serum-therapy  have  been  amply 
attested  by  reports  from  various  sections  of  the  country,  one  of 


SPECIFICS.  289 

the  most  recent  and  instructive  being  that  of  the  resident  physi- 
cian of  the  South  Department  of  the  Boston  City  Hospital,  as 
follows : 

"In  the  Boston  City  Hospital,  from  Feb.  i,  1894,  to  Jan.  31, 
1895,  before  antitoxin  was  used,  698  cases  of  diphtheria  were 
treated,  with  266  deaths — a  mortality  of  38.1  per  cent.  Since  the 
opening  of  the  South  Department,  from  Sept.  i  to  Nov.  30,  1895, 
inclusive,  when  antitoxin  was  used  in  every  case,  332  cases  were 
treated,  with  41  deaths — a  percentage  of  12.3.  Of  these  41  deaths, 
23  occurred  within  twenty-four  hours  of  entrance.  Eliminating 
these,  there  were  309  cases  with  18  deaths — a  mortality  of  5.8  per 
cent." 

Finally,  the  statement  of  Prof  Welch  of  Johns  Hopkins  Uni- 
versity, published  in  July  and  August,  1895,  contains  statistics  of 
7166  cases  of  diphtheria  treated  with  antitoxin,  in  which  the  mor- 
tality was  17.0  per  cent.,  and  2276  cases  treated  otherwise  with  a 
death-rate  of  42  per  cent. 

The  foregoing  figures,  selected  from  a  mass  of  corroborative 
testimony,  must  certainly  be  regarded  as  an  eloquent  tribute  to  the 
virtues  of  serum-therapy.  They  are  at  least  a  striking  illustration 
of  what  Virchow  has  called  the  "  brute  force  "  of  the  numerical 
argument. 

Touching  the  method  of  administration  and  collateral  manifes- 
tations, Roux,  in  the  communication  previously  cited,  says : 

"  The  serum  I  have  employed,  derived  from  immunized  horses, 
had  an  active  strength  of  50,000  to  100,000.  To  all  diphtheritic 
patients  entering  the  hospital  20  cubic  centimeters  of  this  serum, 
in  a  single  dose,  are  systematically  administered,  the  injection  being 
in  the  subcutaneous  tissue,  and  not  renewed  should  bacteriological 
examination  prove  that  the  disease  was  other  than  diphtheria. 
Should  the  existence  of  the  disease  be  fully  established,  I  have 
never  observed  the  slightest  discomfort  resulting  from  the  dose. 

"  The  injection  is  painless,  and  if  made  antiseptically  should  be 
attended  with  no  accident.  Twenty-four  hours  after  the  first  injec- 
tion a  second  is  made  of  10  or  20  cubic  centimeters,  these  two 
inoculations  sufficing,  as  a  rule,  to  ensure  recovery. 

"  Should  the  temperature  continue  high,  a  third  injection  of 
10  or  20  cubic  centimeters  is  given.  The  average  weight  of  chil- 
dren being  14  kilograms,  the  total  dose  constitutes  one-thou- 
sandth, or  in  exceptional  cases  one-hundredth,  part  of  their  weight. 
Untoward   sequelae  are   less   frequent   under  the   use  of  serum, 

19 


290  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

although  I  have  observed  symptoms  of  paralysis.  Eruptions,  also, 
allied  to  urticaria  may  be  occasioned  by  the  antitoxin. 

"  The  physiological  effect  of  the  serum  is  apparent  in  its  action 
upon  the  false  membrane,  which  ceases  to  develop  within  twenty- 
four  hours  after  the  first  injection,  being  detached  after  twenty-six, 
forty-eight,  or,  at  most,  sixty  hours.  In  7  cases  only  have  I  known 
it  to  persist  longer.  Let  me  add,  in  conclusion,  that  in  treatment 
with  serum  I  have  studiously  avoided  the  use  of  local  applications, 
simply  irrigating  the  throat  with  boiled  water,  to  which  was  added 
perhaps  50  grams  (per  liter)  of  Labarraque's  solution." 

In  commenting  upon  the  address  of  M.  Roux,  Dr.  Behring 
added  that  "the  specific  action  of  antidiphtheritic  serum  is  the 
surer  and  more  rapid  in  proportion  to  the  heroic  nature  of  the  dose. 
Since  the  injection  is  positively  harmless,  it  may  be  adopted  with 
impunity  even  in  simply  suspected  cases  of  the  disease." 

The  prophylactic  property  of  equine  serum  is  well  attested  by 
Aronson,  who  employed  antidiphtheritic  injections  to  immunize 
children  in  families  where  the  disease  was  established.  One  cubic 
centimeter  of  prepared  serum  sufficed  for  his  purpose,  of  130  chil- 
dren thus  treated  preventively  only  2  being  affected  with  a  very 
mild  form  of  the  disease. 

It  is  impossible,  says  Bernheim,  to  assign  a  definite  duration 
to  the  antitoxic  property  of  serum.  It  may  last  several  weeks,  or 
even  months,  according  to  the  strength  of  the  injection  and  the 
species  of  animal  under  treatment.  But,  he  adds,  when  definite 
immunity  has  been  attained  the  protective  power  of  serum  may  be 
prolonged  by  the  injection  of  a  small  quantity  of  toxin  every 
fourteen  days. 

Concerning  the  various  untoward  complications  arising  from  the 
use  of  serum  and  authentically  reported,  it  is  fair  to  say  that  the 
same  phenomena  are  observed  in  diphtheritic  patients  treated  by 
other  methods  than  serum-therapy. 

Notwithstanding  the  eminent  success  of  the  method  herein  con- 
sidered, it  should  be  said,  in  conclusion,  that  several  important 
features  are  as  yet  but  imperfectly  formulated  or  even  understood.' 

'  In  a  paper  upon  the  subject  "Antitoxin,"  Prof.  A.  C.  Cotton,  M.  D.,  of  Rush  Medical 
College,  Chicago,  puts  the  case  thus  strongly : 

"  "What  we  do  not  know  is  how  much  antitoxin  exactly  is  necessary  to  neutrahre 
u  given  quantity  of  toxin  at  somewhat  lengthened  periods  precedent.  What  we  do  not 
know,  and  what  we  most  particularly  desire  to  know,  inasmuch  as  it  is  about  the  only 
phase  of  the  entire  subject  that  has  any  practical  beai-ing  upon  our  profession  as  life- 
savers,  is  what  number  of  antitoxin  units  is  neeessary  to  neutralize  an  indefinite  amount 


SPECIFICS.  291 

It  is  of  paramount  interest  to  ascertain,  for  example,  the  precise 
prophylactic  power  of  the  immunizing  serum.  Behring  has  already 
directed  his  attention  to  this  problem,  advising  the  injection  of  5 
cubic  centimeters  of  serum  in  children  under  ten  years  of  age,  and 
10  cubic  centimeters  in  older  patients.  Crouzon,  who  has  prac- 
tised these  preventive  injections  in  230  cases,  reports  but  two  light 
attacks  of  the  disease.  A  similar  experience  is  that  of  Baginsky 
in  Berlin.  Bernheim  asserts  that  he  has  personally  injected  serum 
in  28  subjects  exposed  to  diphtheritic  infection  without  noting  a 
single  case  of  the  malady.  The  dose  employed  was  somewhat  in 
excess  of  that  proposed  by  Behring,  being  from  10  to  20  cubic 
centimeters,  as  recommended  by  Hilbert,  the  injection  being  twice 
repeated  at  intervals  of  twenty  days. 

From  a  careful  consideration  of  the  subject  in  its  relations  to 
diphtheria,  we  may  safely  conclude — 

1st.  That  immunized  serum  forms  a  remedy  which  experience 
proves  to  be  wholly  innocuous  and  eminently  adapted  for  use  in 
human  infection. 

2d.  That  antidiphtheritic  serum  has  in  every  respect  corre- 
sponded with  the  most  sanguine  hopes  of  its  advocates,  its  employ- 
ment being  attended  with  astonishing  success  wherever  properly 
used  and  in  sufficient  quantities. 

3d.  Finally,  that  it  is  incontrovertibly  established  that  by  means 
of  injecting  serum  temporary  immunity  from  infection  may  be 
readily  conferred,  permanent  protection  being  contingent  merely 
upon  a  renewal  of  treatment.  ^ 

In  view  of  the  extraordinary  rapidity  with  which  recent  discov- 
eries have  been  made,  it  is  unwise  to  presume  that  we  have  by  any 
means  exhausted  the  possibilities  of  serum  in  its  dominion  over 
this  dread  disease.  Resources  of  science  undreamed  of  in  the  past 
are  now  concentrated  upon  the  momentous  problem  of  infection. 
What  new  light  future  investigation  may  shed  can  be  regarded  only 
as  a  theme  for  hopeful  conjecture. 

Tuberculosis. — It  may  be  stated,  in  general  terms,  that  the 
microbic  nature  of  tuberculosis  was  admitted  by  nearly  all  writers 
upon  the  subject  before  the  discovery  of  the  pathogenic  micro- 
organism.    Villemin  in   1866  had  established  by  experiment  the 

of  diphtheria  toxin  of  unknown  virulence  that  has  invaded  at  a  prior  indefinite  time, 
and  is  presumably  houriy  continuing  to  invade,  in  unknown  strength  and  quantity,  from 
a  patch  of  recurrent  and  extending  culture  of  Klebs-Loeffler  bacillus  on  an  unknown 
extent  of  mucous  surface  of  a  human  being  of  unknown  susceptibility ."— W^  Corpuscle, 
Dec,  1895. 


292  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

infectious  character  of  the  malady ;  but  in  France  the  idea  seemed 
almost  revolutionary,  creating  no  enthusiasm,  it  being  reserved  for 
Germany,  through  the  indefatigable  labors  of  Robert  Koch,  to 
develop  and  elucidate  the  theory  conceived  by  Villemin.  Koch 
discovered  the  bacillus  of  tuberculosis,  and  even  succeeded  in  iso- 
lating and  cultivating  it,  the  pure  cultures  obtained  by  him  always 
producing  tuberculosis  in  every  form.  His  original  communication, 
addressed  to  the  Physiological  Society  of  Berlin,  bore  date  of 
April  10,  1882,  and  at  once  stimulated  experimental  research  in 
others,  who  fully  confirmed  his  discovery. 

The  tubercle  bacillus  is  aerobic,  its  existence  depending  wholly 
upon  the  supply  of  oxygen — a  fact  readily  explaining  its  predilec- 
tion for  the  pulmonary  tissue.  The  bacillus  may  affect  all  warm- 
blooded animals,  although  in  different  degrees,  the  microbe  being 
somewhat  differentiated  in  the  lesions  of  birds  and  those  of  man 
and  the  mammalia  in  general. 

Spontaneous  tuberculosis  is  extremely  frequent  in  man,  it  being 
estimated  that  one-fifth  of  all  fatalities  are  due  to  phthisis  in  its 
various  forms.  It  is  equally  common  among  cattle,  in  which  the 
progress  of  the  disease  and  its  lesions  are  precisely  similar  to  those 
observed  in  human  beings — a  fact  demonstrated  by  the  admirable 
studies  of  Koch  respecting  pulmonary  lesions  and  their  character- 
istic pathogenic  micro-organisms. 

Like  other  microbes,  the  bacillus  tuberculosis  secretes  a  large 
amount  of  soluble  products.  These  toxins,  which  of  late  years 
have  been  subjected  to  careful  experiment,  are  derived  from  cul- 
tures of  human  bacilli,  modified  or  not  by  aviary  germs  and  the 
tuberculous  products  produced  in  the  organism  itself  Koch's 
tuberculin,  now  known  throughout  the  world,  is  simply  a  soluble 
product,  prepared  by  a  special  process,  consisting  of  a  glycerized 
extract  drawn  from  pure  cultures  of  tubercle  bacillus,  its  activity 
depending,  upon  the  virulence  of  the  germs,  those  derived  from 
man  being  more  dangerous  than  aviary  cultures. 

Various  methods  of  inoculation  have  been  adopted  in  tubercu- 
losis :  I ,  inoculating  the  patient  with  another  disease  ;  2,  inocula- 
tion with  attenuated  tuberculosis  or  that  proceeding  from  a  different 
species,  as  from  birds  ;  3,  inoculation  of  the  soluble  bacillar  prod- 
ucts— tuberculin;  4,  injection  of  bloOd  taken  from  animals  often 
immune  against  tuberculosis;  5,  injection  of  serum  drawn  from 
inoculated  animals ;  6,  finally,  injection  of  serum  taken  from 
immunized  animals.     With  the  last  two  of  these  methods  we  are 


SPECIFICS.  293 

properly  concerned.  The  fifth  has  been  scientifically  adopted  by" 
Babes,  Richard,  and  Hericourt,  who  have  treated  a  large  number 
of  cases  in  which  various  cures  have  been  effected.  The  main 
obstacle  of  the  procedure  lies  in  the  difficulty  of  successful  inocu- 
lation, the  greater  part  of  the  animals  employed  dying  of  infectious 
nephritis. 

By  the  sixth  method,  as  employed  by  Bernheim,  this  fatality  is 
largely  obviated,  a  careful  procedure  with  the  serum  of  immunized 
animals  proving  the  most  efficacious  hitherto  devised.  The  pro- 
cess of  immunizing  consists  in  injecting  the  toxic  products  nor- 
mally secreted  by  Koch's  bacillus,  and  is,  in  effect,  that  adopted  by 
Behring  in  preparing  the  antitoxin  of  diphtheria.  In  experiment- 
ing upbn  a  large  number  of  animals,  suffice  it  to  say  that  the 
results  obtained  by  Bernheim  were  eminently  satisfactory,  every 
case  indicating  improvement  and  the  actual  cures  being  about  40 
per  cent.  So  convinced  was  he  of  the  sovereign  value  of  his 
method  that  he  emphatically  declared  it  to  be  the  only  rational 
procedure  possible  in  tuberculosis:  "Je  puis  meme  affirmer  que 
I'avenir  de  la  therapeutique  antituberculeuse  reside  tout  entier  dans 
cette  maniere  d'immuniser  les  animaux  et  d'utiliser  leur  serum." 

Applied  to  tuberculosis  in  man,  there  are  as  yet  few  signs  of 
encouragement  in  the  inoculation  with  the  product  of  specific  germs. 
The  tuberculin  of  Koch  has  not  responded  to  the  hopes  of  its  ad- 
vocates, the  danger  from  untoward  symptoms  and  relapse  attending 
its  use  offsetting  effectually  any  temporary  benefit.  Yet  it  is  quite 
possible  that  the  discovery  of  so  powerful  an  agent  may  lead  to 
others  of  more  established  efficacy. 

Pneumonia. — All  the  pulmonary  symptoms  which  characterize 
this  disease  are  produced  by  a  single  microbe,  suspected  by  Klebs, 
described  by  Koch  and  others,  and  discovered  by  Pasteur  in  the 
bucco-pharyngeal  cavity,  its  habitual  haunt,  whence  it  carries  in- 
fection to  the  lungs.  The  pneumococcus  does  not  confine  its 
attacks  to  man,  the  rabbit  and  guinea-pig  being  especially  sensitive 
to  its  influence.  It  has  been  observed  that  the  microbe  is  a  fre- 
quent prey  to  leucocytosis.  It  thrives  in  a  total  absence  of  oxygen, 
its  vitality  and  virulence,  so  far  from  diminishing,  being  sensibly 
increased  by  anaerobic  conditions.  Pure  cultures  are  easily  obtain- 
able. 

Repeated  inoculations  of  attenuated  virus  readily  confer  immunity, 
reduction  of  virulent  germs  being  attained  by  the  use  of  desiccated 
pneumonic  viscera.     The  saliva  of  a  patient,  collected  after  defer- 


294  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

vescence,  ensures  protection  to  the  mouse,  the  same  being  true  of 
blood-serum.  Immunization  of  animals  was  inaugurated  by  Em- 
merich and  Fovitsky  in  1 89 1,  subsequent  investigators  confirming 
their  experiments  under  varying  conditions,  Foa  and  Scabia  finally 
employing  human  serum  in  the  inoculation  of  rabbits  with  marked 
success. 

It  had  been  supposed  that  the  spleen  was  the  seat  of  an  im- 
munizing product  possessing  greater  activity,  but  a  glycerized 
extract  of  human  spleen  injected  into  the  veins  of  refractory  rabbits 
failed  to  arrest  death.  The  general  deduction  drawn  from  a  care- 
ful scrutiny  of  the  subject  tends  to  prove  that  the  production  of 
the  neutralizing  force  in  the  system — the  antipneumotoxin — is 
shared  by  all  the  elements  of  the  organism,  including  the  spleen. 

The  therapeutic  interest  of  the  subject  centers  in  the  application 
of  inoculation  to  man.  The  early  experiments  of  Foa  and  Scabia 
were  without  result,  neither  reaction  nor  ameHoration  attending 
their  treatment;  but  in  1892,  Klemperer  reported  favorably  con- 
cerning immunization  in  40  cases  of  human  pneumonia. 

In  January,  1893,  Lava  communicated  to  the  Academy  of  Med- 
icine in  Turin  the  application  of  serum-therapy  with  auspicious 
results.  He  inoculated  10  subjects — 5  with  from  4  to  9  cubic  cen- 
timeters of  rabbit's  blood-serum ;  4  with  a  like  dose  of  glycerized 
extract  of  the  viscera  of  immunized  rabbits ;  and  i  with  from  4  to 
5  cubic  centimeters  of  canine  seruni.  There  is  no  reaction  at  the 
point  of  inoculation,  no  general  disturbance  of  the  system,  nor 
any  influence  upon  temperature  or  respiration.  On  the  contrary, 
the  pulse  is  favorably  influenced,  as  is  also  the  general  progress,  as 
shown  by  Lava's  experiments.  Moreover,  the  injection  hastens 
the  crisis  of  the  disease,  conducing  rapidly  to  complete  restoration. 

Rozzolo  also  reported  5  cases  treated  with  serum,  4  of  which 
were  cured.  No  influence  upon  the  pulse,  heart,  or  kidneys  was 
noted. 

The  effect  of  animal  serum  is  fugacious ;  that  of  the  human 
product  lasts  several  days.  In  all  cases  the  serum  of  immunized 
subjects  possesses  a  therapeutic  but  not  an  antitoxic  power.  It 
does  not  diminish  the  virulence  of  pneumococci,  which,  injected  in 
an  inoculated  organism,  retain  their  pathogenic  activity  about 
eighteen  hours,  after  which,  indeed,  their  vitality  is  manifested  by 
the  production  of  toxins  producing  positive  chemotaxis  in  the 
phagocytes. 

Among  other  curative  methods  in  pneumonia  may  be  cited  the 


SPECIFICS.  295 

hypodermic  injection  of  blood  taken  from  convalescents  and  the 
infusion  of  blood  from  similar  patients.  The  former  resulted  fav- 
orably (Audeoud),  and  the  latter  (Hughes  of  Philadelphia),  an 
intravenous  operation,  was  no  less  successful. 

Audeoud  explains  the  natural  crisis  in  pneumonia  by  the  theory 
of  Klemperer — that  the  antipneumotoxin  formed  in  the  blood  of 
an  inoculated  subject  by  neutralizing  the  pneumotoxin  cures  the 
infection. 

Cholera. — The  microbe  of  this  terrible  disease  had  been  sought 
since  1848,  yet  the  subject  had  never  been  profoundly  studied  until 
Koch  succeeded  in  isolating  the  germ.  Being  associated  with 
other  micro-organisms,  the  bacillus  had  remained  undetected,  being 
distinguishable,  in  fact,  only  in  fulminant  attacks  of  the  disease,  as 
was  noted  by  Strauss  and  Roux. 

Stagnant  water  is  particularly  favorable  to  the  propagation  of 
germs.  In  distilled  water  the  bacillus  survives  but  twelve  hours  ; 
in  drinking-water,  seven  days  (Babes) ;  while  in  river  or  well-water 
it  may  live  for  seven  months  (Wolfhiigel).  As  a  rule,  the  acids  are 
injurious  to  the  bacilli,  bichloride  of  mercury,  sulphate  of  copper, 
and  quinine  being  very  powerful  antiseptics  in  presence  of  the 
germs. 

Cholera  has  been  observed  in  man  alone,  although  Koch  easily 
imparted  the  disease  to  guinea-pigs,  to  which  it  was  fatal.  Inocu- 
lation of  choleraic  virus  has  never  produced  the  malady  in  man. 
The  pathogenic  power  of  the  bacillus  is  well  demonstrated  by  the 
fact  that  in  one  of  the  Berlin  hospitals,  of  207  patients  attacked 
by  cholera  nostras  (cholerine)  in  which  no  germ  was  manifest, 
but  one  case  proved  fatal;  and,  notwithstanding  vigorous  oppo- 
sition, Koch's  original  thesis  appears  to  be  sustained  by  observation. 

A  singular  fact  in  connection  with  cholera  germs  is  that  they 
may  be  ingested  at  times,  if  not  with  impunity,  at  least  without  in- 
ducing the  disease.  Pettenkofer,  having  taken  large  doses  of  alkali, 
absorbed  a  considerable  quantity  of  the  poison  with  only  the  effect 
of  a  diarrhea  during  five  days,  there  being  no  disturbance  of  the 
general  system  or  of  the  kidneys.  Emmerich,  ingesting  the  tenth 
part  of  Pettenkofer's  dose,  was  seized  with  diarrhea  twenty-four 
hours  afterward,  and  became  seriously  ill.  Purging  lasted  four 
days,  and  on  the  eleventh  day  the  bacilli  disappeared  from  the 
stools. 

It  were  beside  the  purpose  of  the  present  work  to  relate  in 
detail  the  many  interesting  experiments  upon  animals  undertaken 


296         •     A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

with  a  view  to  the  application  of  serum-therapy  in  the  treatment  of 
human  cholera.  Although  the  experimental  investigations  of 
recent  years  foreshadow  the  possibility  of  immunization  in  man,  it 
must  be  confessed  that,  as  in  the  case  of  tuberculosis,  they  have 
been  thus  far  barren  of  definite  results.  It  is  announced  that  Behr- 
ing  has  discovered  a  practical  method  of  combating  the  disease : 
until  the  results  of  his  later  researches  are  known  the  therapeutic 
problem  must  apparently  remain  unsolved.  The  result  of  Haff- 
kin's  investigation  in  India  will  be  awaited  with  interest. 

Septicemia. — The  streptococcus  of  Fehleisen  (erysipelatis), 
which  causes  erysipelas,  was  discovered  by  Nepveu  in  France  and 
Hiiter  in  Germany  (1868-80),  and  has  been  the  subject  of  careful 
study  by  Klemperer  and  others  in  the  hope  of  determining  its 
availability  as  an  immunizing  agent.  Employing  the  serum  of 
immunized  rabbits,  it  has  been  found  possible  by  intravenous  injec- 
tion to  cure  the  disease  in  mice,  the  serum  proving  efficacious  only 
against  the  disease  with  which  the  animal  supplying  it  was  inocu- 
lated. Subsequent  experiments  have  been  attended  with  varying 
results,  Marmoret  in  February,  189S,  having  succeeded  in  obtain- 
ing a  germ  of  streptococcus  so  virulent  that  the  hypodermic  injec- 
tion of  ^  Q  d^^  D  (,  of  a  cubic  centimeter  was  fatal  to  the  rabbit  in  thirty 
hours.  Inoculation  with  this  microbe  or  its  toxins  conferred  im- 
munity upon  rabbits,  which  furnished  a  preventive  and  curative 
serum. 

Encouraged  by  previous  experimentation,  Charrin  and  Roget 
now  sought  to  apply  the  method  of  serum-therapy  in  the  treat- 
ment of  puerperal  fever.  Having  satisfied  themselves  of  the  cura- 
tive property  of  the  serum  of  a  mule  inoculated  with  the  microbe 
of  erysipelas,  collected  fifteen  days  after  the  eighth  inoculation, 
they  injected  subcutaneously  8  cubic  centimeters  of  serum  in  a 
woman  affected  with  the  fever.  The  report  is  as  follows :  "  The 
next  day  no  improvement.  A  second  injection  of  8  cubic  centi- 
meters. Next  day  condition  slightly  improved,  but  still  serious. 
Third  injection  of  25  cubic  centimeters.  Result  on  the  following 
day  rapid  improvement;  decline  of  fever;  general  good  health; 
and  early  establishment  of  convalescence." 

Syphilis. — The  pathogenic  source  of  syphilis  is  still  unknown. 
The  disease  being  contagious,  attempts  have  long  been  made  to 
discover  its  specific  microbe,  yet  the  highest  authorities  agree  that  as 
yet  all  researches  have  proved  abortive.  No  lower  animal  is  known 
to  be  susceptible  to  the  malady,  and,  although  various  experiments 


SPECIFICS.  297 

have  seemed  to  prove  the  contrary,  it  is  now  determined  that  the 
lesions  primarily  indicating  contraction  of  syphilis  were  the  result 
■of  septicemia  induced  by  some  agent  infected  with  the  syphilitic 
virus. 

The  sero-therapeutic  methods  employed  in  the  treatment  'of  the 
disease  consist  of  inoculation  with  the  blood  of  naturally  immune 
or  of  syphilitic  subjects.  Of  all  animals,  the  horse  is  perhaps  the 
only  one  capable  of  syphilization. 

Tommasoli  in  1892-93  essayed  inoculation  of  public  women, 
.affected  with  acute  secondary  syphiHs,  with  lamb's  serum,  the 
results  being,  according  to  his  report,  highly  favorable — even  to 
the  cure  of  syphilitic  infection.  Many  untoward  symptoms,  how- 
ever, have  attended  the  inoculations  thus  made.  Mozza  (1893) 
instituted  a  series  of  experiments,  employing  blood  from  the  carotid 
artery  of  a  lamb  or  dog,  and  another  series  in  which  injections  were 
made  of  serum  drawn  from  sheep  inoculated  with  serum  from 
syphilitic  subjects  in  whom  the  disease  was  latent.  His  records 
indicate  no  very  satisfactory  results,  yet  he  demonstrated  that 
aseptic  precautions  allow  the  application  of  serum-therapy  without 
local  or  general  reaction. 

Finally,  Hericourt  and  Richet  attempted,  with  dubious  success, 
the  experimental  injection  of  syphilitic  serum,  the  results,  in  their 
therapeutic-  importance,  being  inconsequential. 

Typhoid  Fever. — The  bacillus  of  this  disease  was  first  detected 
in  the  kidneys  by  Bouchard  in  1879.  The  name  was  given  by 
Eberth,  who  studied  the  germ  in  1880-81.  Old  cultures  contain 
an  exceedingly  toxic  ptomaine,  besides  a  soluble  substance  capable 
of  inoculating  animals.  The  vigor  of  the  bacillus  of  Eberth  is  re- 
markable, Grancher  and  Deschamps  having  shown  that  it  sur- 
vives five  and  a  half  months  at  a  depth  of  50  centimeters  in  damp 
soil.  Infection  may  occur  through  the  medium  of  the  pulmonary 
tract,  and  the  microbe  is  transmissible  from  the  mother  to  the 
fetus. 

All  animals  yet  submitted  to  experiment  are  naturally  immune, 
the  first  effort  to  inoculate  them  dating  from  1862  (Murchison); 
the  attempt  proved  futile.  Other  experiments  in  this  direction 
were  attended  with  like  failure  until  Vidal  and  Chantemesse  suc- 
ceeded in  inoculating  with  very  virulent  cultures  30  white  mice,  17 
of  which  succumbed  within  twenty-four  hours. 

Later  experiments  have  proved  the  extreme  virulence  of  serum 
derived  from  a  typhoid  human  subject,  fatality  speedily  resulting 


298  A    TEXT-BOOK  OF  MA  TERIA  ' MEDICA. 

from  its  injection,  caused  not  by  the  microbe  itself,  since  none  are 
found  after  death,  but  by  its  toxic  products. 

Among  the  phenomena  observed  in  varied  experimentation  the 
inexplicable  fact  was  revealed  that  the  serum  of  certain  persons 
never  having  contracted  typhoid  fever  conferred  immunity  upon 
guinea-pigs. 

Casual  experiments  followed  without  favorable  progress,  other 
than  the  reduction  of  temperature.  In  January,  1895,  however, 
M.  Legrain,  turning  his  attention  to  typhus — so  closely  allied  to 
true  typhoid  fever — met  with  encouraging  success.  Injecting  suc- 
cessively increased  doses  of  serum  from  typhus  convalescents, 
besides  the  reduction  of  temperature  within  three  hours  after  the 
operation  it  was  noted  that  stupor,  coma,  and  even  hemiplegia  of 
a  toxic  nature,  disappeared  after  an  injection  of  10  cubic  centimeters. 
In  a  case  of  grave  typhus  the  injection  of  14  cubic  centimeters  on 
the  fourth  day  of  the  infection  resulted  in  lowering  the  temperature 
and  inaugurating  recovery  within  two  days.  In  other  serious  cases, 
where  the  injection  was  delayed  until  the  sixth  or  eighth  day  of 
the  infection's  course,  the  disease,  though  not  arrested,  was  marked 
by  mitigated  symptoms.  The  serum  of  convalescents  was  taken 
after  one  week's  remission  of  febrile  manifestations. 

Relying  upon  the  fact  that  an  attack  of  typhus  confers  immunity 
against  a  second  access  of  the  disease,  Stern  sought  to  ascertain 
whether  the  serum  of  individuals  cured  was  endowed  with  immu- 
nizing properties.  The  results  were  partially  successful,  eliciting 
the  curious  fact  that  the  protective  power  of  the  serum  appeared 
most  active  in  those  who  finally  succumbed  to  the  disease.  It  also 
seemed  problematical,  to  judge  from  these  and  other  instantes, 
whether  immunized  serum  employed  in  this  disease  possesses  either 
bactericidal  or  antitoxic  properties. 

Influenza. — Although  the  disease  has  occurred  at  intervals  since 
the  serious  epidemic  of  1830-33,  the  earliest  microbiological  studies 
of  influenza  date  from  the  epidemic  of  1889-90.  Investigation  at 
that  time  revealed  no  microbes  in  the  sputum  and  viscera,  save 
those  which  habitually  frequent  the  bucco-pharyngeal  cavity — 
streptococcus,  pneumococcus,  pneumo-bacillus,  and  staphylococcus 
— which  diversity  of  germs  might  induce  the  behef  that  "la  grippe" 
is  not  due  to  any  single  micro-organism,  but  to  several. 

Notwithstanding  this  and  similar  suppositions,  the  majority  of 
microbiologists  maintain  that  these  bacteria  are  but  the  result  of  a 
secondary  infection,  and  that  the  true  germ  of  influenza  is  still 


SPECIFICS.  299 

unknown,  although  many  investigators  have  thought  they  had  iso- 
lated the  specific  microbe. 

One  deduction  is  constant  as  the  result  of  their  studies :  the 
great  importance  of  secondary  infections  in  the  course  of  the 
disease. 

Failure  to  discover  the  germ  was  in  reality  due  to  a  deficiency 
of  technique — inadequate  methods  of  staining.  Pfeiffer  devised  a 
new  method,  by  which  he  detected  it,  and  Kitasato  (1892)  suc- 
ceeded in  isolating  and  cultivating  the  identical  microbe. 

Animals  do  not  contract  the  disease  spontaneously,  although 
the  saliva  of  cats  and  dogs  contains  a  bacillus  having  a  pathogenic 
influence  upon  rabbits,  the  character  of  which  closely  resembles 
that  of  the  Pfeiffer  bacillus.  Monkeys  and  rabbits  contract  the 
malady  when  inoculated  with  the  pure  culture  of  this  germ. 

In  man  the  port  of  entry,  so  to  speak,  of  this  microbe  is  the 
pulmonary  tract,  where  it  often  produces  lesions  of  suppurating 
broncho-pneumonia.  The  general  phenomena  observed  in  the 
disease  are  held  by  Pfeiffer  to  be  the  result  of  intoxication,  the 
microbes  being  localized ;  Cauch,  on  the  contrary,  considers  them 
due  to  the  presence  of  the  microbe  in  all  the  organs,  even  the 
blood.     The  latest  investigations  confirm  the  opinion  of  Pfeiffer. 

Brischettini  has  demonstrated  that  the  propagation  of  the  Pfeiffer 
bacillus  is  not  checked  by  the  action  of  serum  from  immunized 
animals,  being  limited  to  diminishing  the  toxicity  of  its  soluble 
products.  The  immunity  caused  by  the  injection  of  these  products 
is  augmented  by  the  injection  of  the  culture. 

The  injection  of  serum  of  an  immunized  animal  neutralizes 
in  vitro  the  toxins  secreted  by  the  bacillus,  and  in  a  healthy  organ- 
ism establishes  immunity,  whether  against  infection  or  intoxication. 
It  is  therefore  assured  that  in  future  use  the  serum  may  be  em- 
ployed at  once  as  an  inoculative  and  curative  agent. 

Reptile  Poisons. — It  has  long  been  known  that  certain  animals 
(reptiles)  possess  natural  immunity  against  their  own  venom.  The 
poison  of  the  toad  having  been  detected  in  his  blood,  the  reptile's 
immunity  was  at  .first  thought  to  be  due  to  tolerance,  the  same 
condition  existing  in  the  salamander  and  viper. 

The  relation  between  the  blood  and  the  venomous  glands  demon- 
strates the  internal  secretion  of  these  glands.  The  idea  of  an  anal- 
ogy between  microbic  virus  and  reptilian  venom  was  deduced  from 
the  existence  of  soluble  microbic  toxins,  as  elucidated  by  Chauveau. 
The  attenuating  power  of  heat  upon  the  venom  of  serpents  has 


300  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

also  its  analogue  in  the  similar  susceptibility  of  micro-organisms. 
A  mortal  dose  of  venom  subjected  for  five  minutes  to  a  heat  of 
100°  C.  may  be  injected  with  impunity  into  a  guinea-pig  weighing 
500  grammes. 

The  reaction  of  the  organism  engenders  an  antitoxin  which,  in- 
jected into  a  healthy  animal,  is  preventive  of  fatal  inoculation.  The 
precise  nature  of  this  antitoxin  is  undetermined,  yet  its  protective 
power  is  evident.  Certain  it  is  that  the  serum  of  a  rabbit  inocu- 
lated against  viperous  venom,  when  injected  an  hour  and  a  half 
before  the  poison,  completely  neutralizes  the  latter.  Curiously 
•enough,  this  preventive  serum  of  rabbits  inoculated  against  the 
poison  of  vipers  also  confers  immunity  against  cobra-venom. 

So  far  as  affects  man,  Calmetti  announces  that  he  has  employed 
serum  with  success  in  the  treatment  of  snake-bites,  even  to  the 
■extent  of  curing  them. 

Carbuncle  (Anthrax). — The  bacterium  of  anthrax,  of  the  genus 
bacillus,  has  proved  a  subject  of  elaborate  and  interesting  experi- 
ment, many  features  of  which  are  of  absorbing  interest  alike  to  the 
bacteriologist  and  the  clinician.  The  animals  subjected  to  inocula- 
tion have  been  chosen  with  great  care,  and  those  supplying  the 
immunizing  serum  include  many  species.  The  general  results  of 
protective  inoculation  have  been  treated  briefly  early  in  the  discus- 
sion of  serum-therapy. 

Rabies. — In  January,  1881,  Galtier  announced  that  intravenous 
inoculation  of  rabid  saliva  confers  immunity  upon  sheep,  confirm- 
ing his  experiments  later  in  the  year  by  injecting  the  fluid  into  nine 
sheep  and  one  goat.  Pasteur,  Chamberland,  Roux,  and  Thuiller 
pursued  experiments  in  a  similar  line,  with  somewhat  negative 
results. 

By  passing  the  virus  successively  from  dogs  to  monkeys  Pasteur 
was  able  to  attenuate  its  virulence,  and  finally,  by  transferring  the 
poison  from  monkeys  to  rabbits,  a  serviceable  immunizing  agent 
was  obtained,  still  further  experiments  perfecting  the  method  in 
view. 

Satisfied  with  his  success,  Pasteur  now  turned  his  attention  to 
the  inoculation  of  man  against  hydrophobia.  The  first  operation 
(in  1885)  was  attended  with  auspicious  results,  and  from  that 
moment  the  savant's  laboratory  was  invaded  by  affected  individuals 
demanding  cure.  Institutes  were  founded  in  various  parts  of  the 
world,  that  in  Paris  being  the  center  of  bacteriological  study  in 
France.     In  America  the  subject  has  received  wide  attention,  but 


SPECIFICS.  3or 

in  many  instances  the  benefits  derived  from  Pasteur's  inoculative 
procedure  have  been  of  doubtful  importance  among  intelligent 
observers. 

It  has  been  impossible  to  present  within  a  necessarily  limited 
space  the  entire  field  covered  by  this  profoundly  interesting  subject. 
For  a  multitude  of  details,  embodying  a  wide  range  of  experimen- 
tation, and  for  many  expressions  of  individual  opinion  awakened 
by  a  consideration  of  so  absorbing  a  theme,  the  student  is  referred 
to  the  extensive  bibliography  relating  to  every  phase  of  serum- 
therapy. 

It  may  be  readily  imagined  what  would  have  been  the  discus- 
sion of  Jenner's  vaccination  had  our  bacteriological  and  chemical 
knowledge  and  delicate  appliances  for  investigation  existed  in  his 
day.  It  is  scarcely  surprising,  therefore,  that  the  renewal  of  similar 
studies,  after  an  interval  of  unprecedented  scientific  progress,  should 
elicit  from  all  parts  of  the  world  a  zeal  and  enthusiasm  impossible 
in  any  previous  epoch,  together  with  a  mass  of  concurrent  or  dis- 
senting testimony  touching  new  discoveries  proportionate  to  the 
greatly  increased  number  of  competent  investigators.  Whatever  be 
the  limitations  of  serum-therapy,  the  consensus  of  opinion  among 
thoughtful  observers  is  that  its  rationale  and  purpose  are  deeply 
rooted  in  the  eternal  laws  of  matter  and  the  methods  of  great 
Nature.  "  Vestigium  nullum  retrorsumi"  it  cries  to  us,  and  we 
must  be  guided  by  its  light  or  still  remain  in  darkness. 


CLASS  II.-ANTISEPTICS. 


Acidum  Carbolicum— Acidi  Carbolici— Carbolic 
Acid.    U.S.  P. 

Origin. — A  constituent  of  Coal-tar,  obtained  by  fractional  distil- 
lation and  subsequently  purified. 

Description  and  Properties. — Colorless,  interlaced,  or  sepa- 
rate, needle-shaped  crystals,  or  a  white,  crystalline  mass,  some- 
times acquiring  a  reddish  tint,  having  a  characteristic,  somewhat 
aromatic  odor,  and,  when  copiously  diluted  with  water,  a  sweetish 
taste,  with  a  slightly  burning  after-taste.  Deliquescent  on  exposure 
to  damp  air. 

Soluble  in  about  1 5  parts  of  water,  the  solubility  varying  accord- 
ing to  the  degree  of  hydration  of  the  acid ;  very  soluble  in  alcohol, 
ether,  chloroform,  benzol,  carbon  disulphide,  glycerin,  and  fixed  and 
I  volatile  oils.  It  is  liquefied  by  the  addition  of  about  8  per  cent. 
[  of  water.  The  vapor  of  the  acid  is^  highly  inflammable.  Carbolic 
acid  is  faintly  acid  to  litmus-paper.  Jt  should  be  kept  in  dark 
amber-colored,  well-stoppered  bottles. 

Dose. — \-2  grains  (0.03-0. 12  Gm.).  If  Hquefied,  1-2  minims 
(0.03-0.12  Cc). 

Official  Preparations. 

Glycerltum  Acidi  Carb61ici— Glyceriti  Acidi  CarbSlici — Glycerite  of  Car- 
bolic Acid  (25  per  cent.). — For  external  use. 

UnguSntum  Acidi  Carbaiici — UnguSnti  Acidi  CarbSlici— Ointment  of  Car- 
bolic Acid  (10  per  cent.). — For  external  use. 

Unofficial  Preparations. 

Aqua  Acidi  CarbOlici — Aquae  Acidi  Carb61ici — Carbolic  Acid  Water. — 
Strength,  2  drachms  in  I  pint  (8.0-473.17  Cc).     Dose,  1-2  fluidrachms  (4.0-8.0  Cc). 

Oleum  Acidi  CarbSlici— Olei  Acidi  Carb61ici — Carbolated  Oil. — i  in  20  of 
Olive  or  Cotton  Seed  Oil.     For  external  use. 

CSrbasus  Acidi  Carb51ici — CSrbasi  Acidi  Carb&lici — Carbolic  Acid  Gauze. 
— Gauze  containing  Carbolic  Acid,  i ;  Resin,  5 ;  Paraffin,  7  parts.  Used  as  a  surgical 
dressing. 

302 


ANTISEPTICS.  303 

Empiastrum  Acidi  Carb61ici — Emplastrum  (ace.)  Acidi  CarbSlici — Car- 
"bolic  Acid  Plaster. — Composed  of  Carbolic  Acid,  25;  Shellac,  75  ;  coated  with  Gutta- 
percha dissolved  in  Carbon  Bisulphide.     For  external  use. 

Camphora  Carbolisata — Camphorse  Carbolisatse — Camphorated  Carbolic 
Acid  (Phenol-camphor). — Camphor,  2;  Carbolic  Acid,  i ;  allow  to  liquefy.  A  color- 
less, oily  liquid,  having  the  odor  of  camphor,  soluble  in  fixed  oils,  alcohol,  and  ether, 
nearly  insoluble  in  water  and  glycerin.    Used  as  a  local  anesthetic,  chiefly  for  toothache. 

Liquor   Sodii   Carbolatus — Liquoris   Sodii   Carbolati — Phenol-Sodique. — 
Composed  of  Carbolic  Acid,  188  grains  (12.5  Gm.) ;  Caustic  Soda,  31  grains  (2.06  Gm.) 
Distilled  Water,  4  ounces  (118.29  Cc).     For  external  use. 

Liquor  Sodii  Boratis  CompSsitus — Liquoris  Sodii  Boratis  Comp6siti — 
Cobell's  Solution. — Composed  of  Borax  and  Sodium  Bicarbonate,  of  each,  2  drachms 
(15.0  Gm.) ;  Carbolic  Acid,  24  grains  (1.8  Gm.) ;  in  Water,  I  pint  (473.17  Cc).  Used 
externally  in  spray. 

Acidum  Carb61icum  lodatum  (N.  F.) — Acidi  Carb61ici  lodati — Iodized 
Carbolic  Acid  (Phenol  Iodatum). — Composed  of  Iodine,  20  parts;  Carbolic  Acid, 
76  parts ;  Glycerin,  4  parts.  The  iodine,  the  acid  which  has  been  previously  melted, 
and  the  glycerin  are  put  in  a  flask,  digested  at  a  gentle  heat,  and  frequently  agitated 
until  the  iodine  is  dissolved.  It  should  be  kept  in  glass-stoppered  bottles  in  a  dark 
place.     Used  locally,  especially  in  gynecological  practice. 

Allied  Compounds. 

Creasols. — Obtained  by  distilling  Coal-tar  between  200°  and  210°  C. ;  also  obtained 
by  fusing  Toluene  Sulphonic  Acid  with  Potash.  The  familiar  compounds  of  creasols 
are  Crealin,  Lysol,  Solutol,  Saprol,  etc.  They  are  powerful  disinfectants  and  germi- 
cides, and  less  poisonous  than  carbolic  acid.  Aseptol,  or  orthophenol-sulphonic  acid,  is 
a  commercial  article,  a  straw-colored,  slightly  caustic  liquid.     It  is  a  powerful  antiseptic. 


Antagonists  and  Incompatibles. — Bromine,  metallic  salts, 
antipyrine,  collodion,  alkalies,  saccharate  of  lime  or  lime,  and 
soluble  sulphates  like  Epsom  or  Glauber  salts,  are  incompatibles. 
Atropine  is  a  phystologisal  antagonist. 

Synergists. — All  members  of  the  carbolic-acid  group,  antisep- 
tics, and  motor  depressants. 

Physiological  Action. — Externally. — Carbolic  acid  is  a  local 
anesthetic,  and,  applied  in  full  strength  to  animal  tissues,  acts  as  a 
caustic,  but  does  not  produce  vesication.  In  weaker  solutions  it 
produces  a  burning  and  reddening  of  the  skin.  It  acts  more 
severely  upon  mucous  membranes.  It  coagulates  albumin,  and 
therefore  its  caustic  action  is  limited. 

The  eschar  is  first  whitish,  subsequently  becoming  brownish.    It 
is  readily  absorbed  through  the  skin  or  through  raw  surfaces,  and 
toxic  effects  have  been  thus  produced.     Weak  solutions  are  anti-/ 
pruritic  and  gratefully  cooling  and  anodyne.     It  is  a  disinfectant,  a 
■deodorant,  and  a  parasiticide. 


304  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Internally. — Digestive  System. — In  small  doses  it  is  cooling  and 
sedative  to  the  stomach.  In  large  or  poisonous  doses  it  is  a  pow- 
erful gastro-intestinal,  irritant.  Ordinary  medicinal  doses  are  con- 
verted by  the  gastric  contents  into  the  sulphocarbolates. 

Circulatory  System. — Medicinal  doses  have  no  apparent  effect 
on  the  circulation.  Large  doses  first  depress  and  later  accelerate 
the  heart.  Poisonous  doses  powerfully  depress  the  heart,  stopping 
it  in  diastole.  The  arterial  tension  is  lowered  by  lethal  doses,  from 
paralysis  of  the  vaso-motor  center  in  the  medulla. 

Nervous  System. — Medicinal  doses  have  no  special  effect  upon 
the  nervous  system.  Large  or  poisonous  doses  depress  the  cere- 
brum. Vertigo  may  first  be  noticed,  which  is  soon  followed  by 
stupor.  Owing  to  stimulation  of  the  anterior  cornua  of  the  spinal 
cord,  there  may  be  muscular  trembling  or  convulsions.  The 
cornua  are  ultimately  depressed,  causing  abolition  of  reflexes  and 
paralysis. 

Respiratory  System. — Small  doses  do  not  affect  the  respiration. 
Large  doses  first  accelerate  the  respiratory  movements,  rendering 
them  full,  but  shallow  respirations  soon  follow.  This  action  is  due 
to  stimulation  of  the  vagi,  both  at  the  periphery  and  at  the  center. 
If  the  dose  has  been  a  poisonous  one,  there  is  great  depression, 
and  ultimately  paralysis  of  respiration,  due  to  depression  of  the 
centers. 

Absorption  and  Elimination. — It  is  absorbed  from  the  stomach, 
and  diffuses  into  the  blood  with  great  facility,  circulating  in  that 
tissue  probably  as  an  alkaline  carbolate. 

It  is  eliminated  by  all  the  secretions — chiefly  by  the  kidneys 
and  lungs — and  appears  in  the  urine  as  salts  of  sulphocarbolic  and 
i  glycuronic  acids,  and  the  oxidated  products  hydrochinon  and 
pyrocatechin.  To  the  last  substance  is  mainly  due  the  peculiar 
smoky  or  olive-green  color  imparted  to  the  urine  after  large  or 
continued  doses  have  been  taken.  (There  is  also,  probably,  some 
other  factor  causing  this  change,  for  pyrocatechin  can  exist  only  in 
alkaline  urine.) 

When  a  very  large  amount  of  carbolic  acid  has  been  taken, 
some  of  it  can  be  found  in  the  urine  unchanged. 

Temperature. — It  is  not  specially  affected  by  small  doses.  Full 
medicinal  doses  tend  to  lower  bodily  temperature  in  fever,  while 
poisonous  doses  lower  the  temperature  several  degrees.  The  re- 
duction of  temperature  is  due  to  its  diminishing  heat-production 
and  increasing  heat-dissipation. 


ANTISEPTICS.  305 

Eye. — Poisonous  doses  almost  invariably  cause  the  pupil  to  be 
minutely  contracted,  due,  probably  to  paralysis  of  the  radiating 
fibers,  the  circular  fibers  being  unaffected. 

Untoward  Action. — Headache,  either  in  the  frontal  or  the  occip- 
ital region,  heaviness  and  a  sensation  of  fulness  in  the  head,  dizzi- 
ness, and  the  appearance  of  rings  before  the  eyes,  muscular  weak- 
ness, especially  of  the  legs,  profuse  sweating,  formication. 

Where  there  is  an  idiosyncrasy  on  the  part  of  the  individual 
against  this  drug,  small  doges  even  may  produce  the  symptoms  of 
poisoning. 

Poisoning. — Carbolic  acid  is  one  of  the  most  deadly  poisons, 
often  equalling  hydrocyanic  acid  in  its  rapidity  of  action. 

The  patient  is  rendered  rapidly  unconscious  or  may  drop  dead 
within  a  very  few  moments  from  paralysis  of  respiration.  Should 
the  dose  be  insufficient  to  produce  so  sudden  a  death,  the  patient 
suffers  from  all  the  symptoms  of  gastro-enteritis — intense  pain,  with  ' 
violent  vomiting  and  purging.  Fibrillary  trembling  maybe  present. 
Stertorous  breathing  appears,  with  cold,  clammy  skin,  pinched  face, 
anxious  expression,  abolition  of  reflexes,  weak,  thready,  and  often 
imperceptible  pulse,  feeble  respiration,  and  frequently  dyspnea,  and 
death  finally  occurs  from  failure  of  respiration. 

As  toxic  symptoms  may  be  produced  by  the  external  applica-  1 
tion  of  solutions  of  carbolic  acid,  as  in  surgical  dressings  or  vaginal  ' 
or  intra-uterine  douches,  the  toxicity  of  this  drug  should  be  appre- 
ciated, and  patients  carefully  watched  for  the  first  untoward  mani- 
festations, such  as  pain  in  the  lumbar  region,  smoky  urine,  nervous- 
ness, and  cerebral  disturbance,  when  the  drug  should  be  immedi- ' 
ately  withdrawn. 

Treatment  of  Poisoning. — The  immediate  administration  of  mag- 
nesium sulphate  (Epsom  salts)  and  warm  demulcent  drinks  should 
be  resorted  to.  The  application  of  external  heat.  Atropine  and  ( 
strychnine  hypodermically.  Digitalis  and  coffee  may  also  be  re- 
quired. Opium,  or  some  preparation  of  it,  for  the  relief  of  pain. 
If  the  patient  is  seen  soon  after  the  drug  has  been  taken,  the  stom- 
ach should  be  washed  out,  after  which  the  above  treatment  should 
be  followed. 

Therapeutics. — Externally  and  Locally. — For  some  time  after 
it  was  so  prominently  brought  forward  by  Lister  carbolic  acid  was 
thought  to  be  indispensable  in  antiseptic  surgery.  It  is  now 
known  that  the  solutions  which  are  safe  to  use  are  inefficient, 
ordinarily,  beyond  the  mere  mechanical  effect  of  washing. 
20 


3o6  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

The  benumbing  influence  produced  on  the  hands  of  the  sur- 
geon, and  the  discoloration  of  bright  instruments  and  rapid  impair- 
ment of  their  cutting  surfaces,  render  strong  solutions  for  disinfect- 
ing instruments  impracticable,  and  indeed  of  less  value  for  this 
purpose  than  the  prolonged  boiling  in  distilled  water  rendered 
slightly  alkaline  with  sodium  bicarbonate. 

The  pain  of  superficial  burns  is  relieved  by  applying  strong 
solutions  of  carbolic  acid,  care  being  taken  to  prevent  absorption. 

It  is  an  extremely  valuable  drug  as  an  antipruritic,  and  is  hence 
of  great  utility  in  the  treatment  of  certain  diseases  of  the  skin — 
pruritus,  chronic  eczema.  In  •  chilblains,  tinea  tonsurans,  t.  capitis, 
t.  circinata,  favus,  etc.  it  is  of  great  value.  Chronic  laryngitis,  cha- 
racterized by  diminished  secretion,  is  greatly  benefited  by  the  direct 
application  to  the  parts  of  a  solution  of  \  drachm  to  i  ounce  of 
glycerin  (2.0-30.0  Cc).  A  spray  containing  from  2  to  5  grains 
(0.12-0.36  Gm.)  to  I  ounce  (30.0  Cc.)  of  water  is  an  efficient  appli- 
cation in  the  treatment  of  acute  and  chronic  inflammation  of  the 
throat  and  nose. 

Camphorated  carbolic  acid  (campho-phenique)  is  a  useful  appli- 
cation in  toothache  due  to  an  exposed  and  inflamed  pulp. 

As  a  deodorant  it  is  valuable  to  correct  the  fetor  arising  from 
syphilitic  ulcerations,  carcinoma,  gangrene  of  the  lungs,  bronchorrhea, 
pneumothorax,  etc. 

It  reduces  the  discharge  and  relieves  the  pain  in  acute  otitis 
media:  a  10  per  cent,  solution  in  glycerin  should  be  used.  It  is 
also  of  value  in  the  treatment  of  otorrhea  and  in  acute  perforations 
of  the  tympanic  membrane,  but  should  be  used  in  much  weaker 
solutions — I  or  2  per  cent. 

A  lotion,  8  to  15  grains  (0.5-1.0  Gm.)  to  i  ounce  (30.0  Cc), 
is  an  efficient  antiseptic  in  foul  and  indolent  ulcers. 

The  pure  acid  is  used  as  a  cauterant  in  chancroids,  lupus,  gan- 
grene, bites  of  rabid  animals,  etc. 

The  iodized  carbolic  acid  is  a  valued  local  remedy  in  endometri- 
tis, chronic  endocervicitis,  and  tdcers  of  the  cervix. 

Huter  in  1878  advocated  the  use  of  hypodermic  injections  of 
a  3  per  cent,  solution  of  carbolic  acid  for  erysipelas,  the  punctures 
to  be  made  at  intervals  upon  the  edge  of  the  inflammation. 

Great  improvement  has  taken  place  in  goitre  after  the  treatment 
by  hypodermic  injections  into  the  tumor  of  a  5  per  cent,  solution 
of  carbolic  acid. 

Internally. — While  inferior  to  salicylic  acid  to  check  fermentation, 


ANTISEPTICS.  307 

it  is  nevertheless  used  for  that  purpose  in  dilatation  of  the  stomach 
and  so-called  fermentative  or  flatulent  dyspepsia. 

In  nervous  and  irritative  vomiting  it  may  be  given  in  doses  of 
from  I  to  2  minims  (0.06-0.12  Cc),  well  diluted  and  repeated  at 
intervals  of  from  one  to  four  hours  according  to  the  symptoms 
of  the  case. 

It  has  been  used  in  acute  and  chronic  dysentery,  and  as  an  anthel- 
mintic against  ascarides  and  tcenia  solium,. 

It  has  also  been  advocated  as  a  remedy  for  typhoid  fever  and  in 
malarial  cachexia,  but  purely  upon  theoretical  grounds,  no  clinical 
results  having  thus  far  justified  its  use  in  these  disorders. 

Administration. — It  may  be  given  internally  in  pills  or  capsules, 
mixed  with  powdered  liquorice-root  as  an  excipient,  or  dissolved  in 
glycerin  and  well  diluted  with  sweetened  water. 

For  external  use  various  strengths  are  used  (from  1:10  to 
1 :  500),  and  the  various  preparations  mentioned  may  be  used 
according  to  the  case  and  indications. 

Sodii  Sulphocarbolas— Sodii  Sulphocarbolatis— 
Sodium  Sulphocarbolate.    TJ.  S.  J*. 

Description  and  Properties. — Colorless,  transparent,  rhombic 
prisms,  odorless,  having  a  cooling,  saline,  slightly  bitter  taste. 
Somewhat  effervescent  in  dry  air.  Soluble  in  4.8  parts  of  water, 
132  parts  of  alcohol,  0.7  part  of  boiling  water,  and  in  lO  parts  of 
boiling  alcohol.     The  aqueous  solution  is  neutral  to  litmus-paper. 

Dose. — 10-30  grains  (0.60-2  Gm.). 

Allied  Compounds. 

PotSssii  Sulphocarbolas— PotSssii  Sulphocarbolatis— Potassium  Sulpho- 
carbolate. 

Caicii  Sulphocarbolas— Caicii  Sulphocarbolatis— Calcium  Sulphocarbolate. 

Magnesii  Sulphocarbolas— Magnesii  Sulphocarbolatis— Magnesium  Sul- 
phocarbolate. 

Zlnci  Sulphocarbolas— Zlncii  Sulphocarbolatis— Zinc  Sulphocarbolate. 

All  of  the  above  have  been  employed,  but  the  zinc  sulphocarbolate  is  believed  to  be 
preferable  to  check  diarrhea  and  render  the  stools  less  foul.  It  is  best  given  in  pills,  in 
doses  of  2-3  grains  (0.1-0.15  Gm.). 

Physiological  Action. — In  medicinal  doses  sodium  sulphocar- 
bolate occasions  no  special  symptoms,  and  in  three  or  four  times 
the  medicinal  dose  it  causes  only  slight  lightness  of  the  head. 

It  is  changed  in  the  system  into  carbolic  acid  and  sodium  sul- 


3o8  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

phate,  the  latter  being  eliminated  with  the  urine.  The  carbolic 
acid  set  free  exerts  its  characteristic  action  and  influence. 

Therapeutics. — Externally  and  Locally. — In  the  strength  of 
J  drachm  (2.0  Gm.)  to  8  ounces  (237.0  Cc.)  of  water  it  forms  a 
valuable  gargle  in  relaxed  conditions  of  the  throat. 

Solutions  of  different  strengths  have  been  used  in  diphtheria, 
acute  tonsillitis,  aphthcz  of  children,  and  nasal  catarrh. 

30  grains  (2.0  Gm.)  in  2  ounces  (60.0  Cc.)  each,  of  water,  and 
hydrogen  peroxide  make  an  efficient  injection  in  gonorrhea. 

Internally. — It  is  a  mild  intestinal  antiseptic,  and  may  be  used 
internally  for  the  same  purposes  as  carbolic  acid  in  such  disorders 
as  diarrhea,  fermentative  dyspepsia,  etc.  It  arrests  the  growth  of 
thrush,  and  is  considered  by  some  physicians  to  exert  a  favorable 
action  in  anginose  scarlatina,  diphtheria,  and  typhoid  fever.  The 
ZINC  SULPHOCARBOLATE  is  One  of  the  best  intestinal  antiseptics  to 
use  in  cases  of  dyspeptic  diarrhea  of  children. 

Administration. — Sodium  sulphocarbolate  is  best  given  in 
solution. 

Creasotum— Creasoti— Creasote.    TJ.  8.  P. 

Origin. — ^A  mixture  of  phenols,  chiefly  Guaiacol  and  Creasol, 
obtained  during  the  distillation  of  wood-tar,  preferably  that  of  beech. 

Description  and  Properties. — An  almost  colorless,  yellowish 
or  pinkish,  highly  refractive,  oily  hquid,  having  a  penetrating 
smoky  odor,  and  a  burning,  caustic  taste ;  usually  becoming  darker 
in  tint  on  exposure  to  light.  Soluble  in  about  150  parts  of  water, 
but  without  forming  a  perfectly  clear  solution.  With  120  parts  of 
hot  water  it  forms  a  clear  liquid  which  on  cooling  becomes  turbid, 
from  the  separation  of  minute  oily  drops.  Soluble  in  all  propor- 
tions in  absolute  alcohol,  in  ether,  chloroform,  benzin,  carbon  disul- 
phide,  acetic  acid,  and  in  fixed  and  volatile  oils.  Creosote  is  in- 
flammable, burning  with  a  luminous,  smoky  flame.  It  is  neutral, 
or  only  faintly  acid,  to  litmus-paper. 

Tests. — Carbolic  acid  is  often  substituted  for  creosote,  and  the 
following  tests. for  the  detection  of  carbolic  acid  are  important: 

1.  If  the  suspended  liquid  is  mixed  with  collodion,  a  coagulum 
will  form  if  carbolic  acid  be  present. 

2.  Carbolic  acid  produces  a  violet  color  with  ferric  chloride  and 
ammonium  hydrate,  creosote  producing  a  green  color  passing  to 
brown. 

Dose. — 1-5  minims  (0.06-0.3  Cc). 


ANTISEPTICS.  309 

Official  Preparation. 

Aqua  Creosoti — Aquae  Creosoti — Creosote  Water. — Dose,  1-4  fluidrachms 
(4.0-15.0  Cc). 

Incompatibles. — Strong  sulphuric  and  nitric  acid.     It  reduces , 
silver  salts,  and  explodes  when  combined  with  oxide  of  silver. 

Synergists. — The  same  as  for  carbolic  acid. 

Physiological  Action. — Externally. — It  has  the  same  action  as 
carbolic  acid. 

Internally. — Its  action  upon  the  digestive,  circulatory,  nervous, 
and  respiratory  systems  is  practically  the  same  as  that  of  carbolic 
acid. 

It  does  not  stimulate  the  spinal  cord  so  much  as  carbolic  acid, 
and  differs  also  from  the  latter  drug  in  increasing  the  coagulability 
of  the  blood.  Poisonous  doses  act  like  those  of  carbolic  acid,  but 
with  more  marked  nervous  symptoms. 

Absorption  and  Elimination. — It  is  eliminated  by  the  bronchial  , 
mucous  membrane,  but  the  process  takes  place  by  the  kidneys  as 
guaiacol  sulphate  and  creosol  sulphate  of  potassium. 

It  is  a  stimulant  expectorant. 

It  has  the  peculiar  property  when  applied  to  meat  of  preserving  : 
it,  whence  its  name  {creas,  flesh,  sohzote,  preserve). 

Poisoning. — The  symptoms  and  treatment  of  poisoning  from 
creosote  are  the  same  as  described  under  Carbolic  Acid. 

Therapeutics. — Externally  and  Locally. — Creosote  is  superior  , 
to  carbolic  acid  as  an  antipruritic,  although  not  so  generally  used 
as  the  latter,  on  account  of  its  acrid  and  penetrating  odor.  It  can 
be  used  externally  for  the  same  purposes  as  carbolic  acid.  It  is  a 
valuable  hemostatic,  and  the  creosote  water  may  be  used  for  this 
purpose. 

Inhalations   of  creosote  are   recommended  in  phthisis,  chronic 
bronchitis,,  and  chronic  congestion  of  the  larynx  and  trachea.     It  is  a  ' 
powerful  local  anesthetic,  and  is  largely  used  by  dentists  and  the  ' 
laity  for  aching  teeth.     It  is  used  to  preserve  dead  animal  matter 

for  dissection,  etc. 

Internally.— Creosote  can  be  used  internally  for  the  same  pur- 
poses as  carbolic  acid,  having  the  advantage  over  the  latter  drug  in  , 
being  one  of  the  most  efficient  remedies  in  pulmonary  tuberculosis.  \ 
Probably  no  one  remedy  exerts  so  favorable  an  action  upon  the  , 
night-sweatsi  cough,  and  expectoration  as  creosote,  or  guaiacol,  | 
which  is  preferred  by  many  physicians.     It  is  of  less  value  in  cases 


3IO  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

accompanied  by  high  temperature  and  hemoptysis,  and  often 
aggravates  these  symptoms. 

It  must  be  remembered  that  many  of  the  cases  alleged  to  have 
been  cured  by  creosote  have  been  treated  with  cod  liver  oil,  tonics, 
and  hygienic  methods  as  well. 

Contraindications. — The  same  as  for  carbolic  acid. 

Administration. — Pure  beech-wood  creosote  alone  should  be 
used.  It  may  be  given  in  the  form  of  creosote  water,  emulsion,  or 
pills,  or  in  capsules  mixed  with  cod  liver  oil.  Capsules  are  the 
least  offensive  way  of  administration.  Some  persons  prefer  to  take 
the  drug  in  milk. 

In  the  treatment  of  phthisis  large  doses  are  necessary.  A  tol- 
erance can  usually  be  established  by  gradually  increasing  doses. 
If  the  patient  manifest  any  untoward  symptoms,  the  drug  must  be 
reduced  in  quantity  or  discontinued  altogether. 

Guaiacolum— Guaiacoli— Guaiacol. 

Origin. — As  before  stated,  creosote  consists  chiefly  of  Guaiacol, 
Creosols,  and  Cresols,  and  of  these  guaiacol  is  present  to  the  extent 
of  from  60  to  90  per  cent. 

Guaiacol  is  obtained  by  fractional  distillation  of  beechwood-tar 
Creosote,  treated  with  Ammonia  to  remove  acid  compounds,  and 
again  fractionated. 

Guaiacol  is  rarely  met  with  absolutely  pure. 

Description  and  Properties. — A  colorless,  slightly  refractive 
liquid,  of  strongly  aromatic  odor.  Specific  gravity  at  15"  C. 
(59°  F.)  is  I.I  17.  Sparingly  soluble  in  water,  but  readily  soluble 
in  alcohol  and  ether.  It  is  soluble  in  solutions  of  sodium  and 
potassium  hydroxides,  forming  unstable  compounds  known  as 
sodium-  and  potassium-guaiacol. 

Tests. — Pure  guaiacol  will  separate  rapidly  if  shaken  with  twice 
its  weight  of  benzene,  whereas  the  impure  article  forms  a  clear 
solution. 

"  If  a  trace  of  ferric  chloride  is  added  to  an  alcoholic  solution 
of  guaiacol,  a  blue  color  is  developed,  which  changes  to  emerald- 
green  upon  the  adclition  of  more  ferric  chloride."  ' 

Dose. — 2-10  minims  (0.12-0.6  Cc). 

The  following  derivatives  have  been  introduced : 

Guaiacoli  B6nzoas — Guaiacoli  Benzoatis — Guaiacol  Benzoate  (Benzosol). 
—  Origin,  by  heating  on  a  watev-bath  Potassium  Guaiacol  with  Benzosol-chloride :  the 
impure  benzosol-guaiacol  formed  is  purified  by  recrystallization  from  Alcohol. 


ANTISEPTICS. 


3" 


Description  and  Properties.— Co\ox\ess,,  tasteless,  and  odorless  crystalline  powder, 
almost  insoluble  in  water,  but  readily  soluble  in  ether,  chloroform,  and  hot  alcohol. 

Dose. — 10-150  grains  (0.60-10  Gm.)  daily. 

Guaidcoli  Carbonas — Guaiacoli  Carbonatis— Guaiacol  Carbonate. — Origin, 
this  substance  is  prepared  by  passing  Phosgene  Gas  (carbonyl  chloride)  into  Guaiacol 
previously  dissolved  in  soda  solution.  The  guaiacol  carbonate  is  formed  and  is  purified 
and  crystallized  from  Alcohol. 

Description  and  Properties. — White,  neutral,  crystalline  powder,  nearly  void  of  odor 
and  taste,  insoluble  in  water,  slightly  soluble  in  cold  and  readily  soluble  in  hot  alcohol, 
also  in  ether,  chloroform,  and  benzene,  and  sparingly '  soluble  in  glycerin  and  fixed 
oils. 

Dose. — 3-60  grains  (0.2-4  Gm.)  daily,  gradually  increased. 

GuaiScoli  Di-iodidum — GuaiScoli  Dl-iodidi — Guaiacol  Diodide. —  Origin, 
by  adding  a  solution  of  Iodine  in  potassium  iodide  to  an  aqueous  solution  of  Sodium- 
guaiacol  as  long  as  precipitation  continues. 

Description  and  Properties. — Reddish-brown  salt,  having  the  odor  of  iodine,  soluble 
in  alcohol  and  fixed  oils,  and  readily  decomposed. 

Dose. — i!-I5  grains  (o.io-l  Gm.). 

GuaiScoli  SaHcylas— Guaiacoli  Salicylatis— Guaiacol  Salicylate  (Guaiacol- 
SALOL). — Origin,  by  the  action  of  Phosphorous  Oxychloride  on  a  mixture  of  Sodium- 
guaiacol  and  Salicylate.     It  is  analogous  to  salol. 

Description  and  Properties. — White,  crystalline,  odorless,  and  tasteless  powder,  in- 
soluble in  water,  but  soluble  in  alcohol,  ether,  and  chloroform. 

Dose. — 10-150  grains  (0.60-10  Gm.)  daily.  • 

Physiological  Action  of  Guaiacol  and  its  Derivatives. — 
Guaiacol  produces  an  action  very  similar  to  that  of  creosote.  It  is 
not  caustic  when  applied  in  full  strength.  It  possesses  marked 
antipyretic  properties.  It  is  readily  absorbed  through  the  unbroken 
skin,  and  rapidly  reduces  febrile  temperature  when  applied  in  this 
manner.  The  reduction  of  temperature  lasts  from  four  to  six 
hours. 

It  is  a  diaphoretic  and  diuretic.  It  is  excreted  by  the  sweat, 
saliva,  and  urine,  but  is  only  sHghtly  thrown  out  by  the  expired 
air,  though  small  amounts  of  the  drug  have  been  found  in  the 
lung-tissue.  As  it  is  eliminated  as  a  salt  of  ethyl-sulphuric  acid,  it 
must  combine  with  albuminous  bodies  in  the  blood,  and  chiefly 
through  the  sulphur  present  in  the  albumin  molecules.  It  can  be 
found  in  the  urine  within  fifteen  minutes  after  administration  or 
external  application  in  the  form  of  a  substance  giving  the  reaction 
of  phenol. 

It  is  more  agreeable  to  the  stomach  than  creosote,  and  fre- 
quently improves  the  appetite,  though  to  some  patients  it  is  very 
disagreeable  and  acts  as  an  irritant. 

'  The  GUAIACOL  CARBONATE  is  usually  much  better  borne  by  the 
stomach,  and  is  therefore  a  useful  and  efficient  substitute. 


312  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Benzosol,  guaiacol  benzoate,  contains  54  per  cent,  of  guaia- 
col.  It  is  usually  well  borne  by  the  patient,  and  seldom  occasions 
any  digestive  disturbance.  In  the  intestinal  canal  it  resolves  into 
guaiacol  and  benzoic  acid,  and  is  excreted  by  the  urine  as  combi- 
nations of  these  substances. 

Therapeutics. — Guaiacol  is  used  for  the  same  purposes  as 
creosote — less   likely  to  irritate  the  intestinal  canal  and  kidneys. 

Guaiacol  causes  a  marked  reduction  of  the  temperature  in  cases 
of  tubercular  disease  when  applied  locally,  nor  is  the  antipyretic 
action  when  thus  employed  confined  to  tuberculous  cases.  It  has 
given  satisfactory  results  in  other  pyrexias.  It  is  a  very  active 
antipyretic  in  erysipelas.  The  temperature  begins  to  fall  within 
fifteen  or  twenty  minutes  after  the  application  of  the  drug.  As 
with  all  antipyretics,  the  depressing  action  of  guaiacol  must  be 
borne  in  mind. 

Raymond  first  suggested  the  local  application  of  guaiacol 
in  tonsillitis.  It  undoubtedly  exerts  a  favorable  action  on  the 
disease. 

Guaiacol,  or  some  one  of  its  derivatives,  has  been  substituted 
for  creosote  in  "the  tr&dX'm&vA  o{  phthisis  and  other  wasting  forms 
of  tuberculosis.  Guaiacol  itself  has  no  advantage  over  creosote. 
The  BENZOSOL  and  guaiacol  carbonate  possess  the  only  advan- 
tage of  being  tasteless. 

Piatkowski  of  Vienna  recommends  benzosol  in  diabetes  mellitus. 
There  have  been  conflicting  reports  regarding  its  efficacy,  yet  suf- 
ficient is  known  in  its  favor  to  justify  a  further  trial  of  this  drug  in 
diabetes. 

Contraindications. — The  same  as  for  creosote. 

Administration. — The  application  of  guaiacol  for  the  reduction 
of  temperature  may  be  made  upon  any  portion  of  the  skin — the 
back,  breast,  arms,  thighs,  or  abdomen — without  causing  any  appre- 
ciable difference.  From  \  to  i  drachm  (2.0-4.0  Cc.)  is  applied 
with  a  brush,  and  the  part  covered  with  cotton  or  gutta-percha 
tissue.  The  application  may  be  repeated  as  often  as  necessary  for 
the  reduction  of  the  fever. 

Other  than  a  decided  taste  of  guaiacol  and  free  diaphoresis,  the 
patient  usually  complains  of  no  untoward  symptoms,  although  in 
some  cases  quite  marked  nervous  disturbances  and  other  unfavor- 
able manifestations  have  been  observed. 

It  may  be  inhaled  from  hot  water  for  certain  conditions  in  doses 
of  from  5-10  minims  (0.3-0.6  Cc). 


ANTISEPTICS.  313 

The  solid  derivatives  of  guaiacol  may  be  given  in  powders  or 
capsules.  Guaiacol  itself  may  be  given  in  the  same  manner  as 
creosote — preferably,  mixed  with  cod  liver  oil  or  enclosed  in  cap- 
sules. 

Acidum  Salicyiicum— Acidi  Salicylici— Salicylic 
Acid.    jj.s.:p. 

Origin. — An  organic  acid,  existing  naturally  in  combination  in 
various  plants  like  Spircea  ulmaria  (meadow-sweet),  Gaultheria 
procumbens  (wintergreen),  etc.,  but  chiefly  prepared  synthetically 
by  combining  the  elements  of  pure  Carbolic  Acid  with  dry  Car- 
bonic Acid  and  purifying. 

Description  and  Properties. — Light,  fine,  white  prismatic 
needles,  or  a  light  white  crystalline  powder,  odorless,  having  a 
sweetish,  afterward  acrid  taste ;  permanent  in  the  air.  It  is  soluble 
in  about  450  parts  of  water,  in  2.4  parts  of  alcohol,  and  in  14  parts 
of  boiling  water.  The  addition  of  2  parts  of  sodium  sulphite  or 
I  part  of  ammonium  phosphate  renders  it  much  more  soluble  in 
water. 

Test. — The  addition  of  ferric  chloride  to  a  saturated  solution 
produces  a  fine  bluish-violet  color. 

Dose. — 3-60  grains  (0.25-4.0  Gm.). 

Lithii  Salicylas— LTthii  Salicylatis— Litinium  Salicy- 
late.    V.  S.  J». 

Origin. — Obtained  by  heating  Salicylic  Acid,  Lithium  Carbonate, 
and  Water  until  effervescence  ceases,  filtering,  and  evaporating. 

Description  and  Properties. — A  white  or  grayish-white  pow- 
der, odorless,  having  a  sweetish  taste,  deliquescent  on  exposure  to 
air,  very  soluble  in  water  and  alcohol. 

Dose, — 5-60  grains  (0.3-4.0  Gm.). 

S5dii   Salicylas— Sod ii   Salicylatis— Sodium  Salicy- 
late.    U.  S.  -P. 

Origin. — Prepared  by  acting  on  Sodium  Carbonate  with  Salicylic 
Acid,  straining,  and  heating  the  solution. 

Description  and  Properties. — A  white  amorphous  powder,  odor- 
less, sweetish,  saline  taste,  permanent  in  air,  soluble  in  0.9  part  of 
water,  in  6  parts  of  alcohol,  and  in  glycerin. 

Dose. — S-60  grains  (0.3-4.0  Gm.). 


314  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Antagonists  and  Inoompatibles.— The  arterial  and  cerebral 
stimulants  are  antagonistic  to  salicylic  acid  and  the  salicylates. 
The  incompatibles  are  the  mineral  acids,  alkalies,  metallic  salts, 
particularly  the  ferric  salts. 

Synergists. — The  carbolic-acid  derivatives,  anesthetics,  cardiac 
depressants,  and  cerebral  sedatives. 

Physiological  Action. — Externally  and  Locally. — Salicylic  acid 
is  antiseptic,  parasiticide,  irritant  to  mucous  membranes  ;  possesses 
the  power  to  soften  the  epidermis ;  checks  perspiration  when  locally 
applied  (anhydrotic). 

Internally. — Digestive  System. — Small  doses  stimulate  the  stom- 
ach ;  larger  doses  act  as  an  irritant.     It  is  an  antiferment. 

Circulatory  System. — Small  doses  of  salicylic  acid  have  no  very 
appreciable  effect  upon  the  circulation.  Full  medicinal  doses  first 
cause  the  heart  to  beat  faster  and  stronger,  increasing  arterial 
tension ;  later  the  arterial  pressure  is  lowered,  and  excessive  or 
toxic  doses  cause  the  pulse  to  become  slow  and  labored.  Its  tend- 
ency ultimately,  even  in  medicinal  doses,  is  to  depress  rather  than 
stimulate  the  heart.  Its  effect  upon  the  blood  is  to  restrain  the 
migration  of  the  white  corpuscles. 

Nervous  System. — In  toxic  doses,  and  in  some  susceptible  per- 
sons in  full  medicinal  doses,  salicylic  acid  causes  cerebral  conges- 
tion, indicated  by  a  feeling  of  tension  in  the  cerebrum,  headache, 
confusion  of  thought,  tinnitus  aurium,  vertigo,  and  sometimes 
delirium.  Toxic  doses  may  occasionally  produce  cerebral  con- 
vulsions. It  lessens  the  reflexes,  but  does  not  affect  the  peripheral 
nerves,  either  motor  or  sensory. 

Respiratory  System. — Small  doses  stimulate  the  respiratory  cen- 
ter and  the  pulmonary  vagi,  making  the  respiration  quicker  and 
deeper.  Toxic  doses  paralyze  the  center  and  vagi,  causing  slow 
and  labored  respiration   and  death  from  asphyxia. 

Absorption  and  Elimination. — Salicylic  acid  is  converted  by  the 
gastro-intestinal  secretions  into  the  sodium  salicylate,  in  which  form 
it  enters  into  the  circulation. 

It  increases  the  urinary  flow,  and  the  proportion  of  urea, 
uric  acid,  and  phosphoric  acid.  It  appears  in  the  urine  as  sali- 
cyluric acid.  The  color  of  the  urine  is  changed  to  a  dark  olive- 
green  after  large  doses  have  been  taken.  This  change  is  due 
to  the  presence  of  indican  and  pyrocatechin,  produced  by  the 
action  of  the  pancreatic  juice  upon  the  salicylic  acid  in  the 
intestine. 


ANTISEPTICS.  315 

It  is  a  powerful  diaphoretic,  large  doses  often  causing  exhaust- 
ing sweating.  It  also  increases  the  secretion  of  milk  and  the 
amount  of  sugar  in  that  secretion. 

Elimination  takes  place  slowly  by  all  the  emunctories,  but 
chiefly  through  the  kidneys  and  skin. 

Temperature. — Febrile  temperature  is  markedly  reduced  by  large 
doses  of  sahcylic  acid.  The  reduction  takes  place  usually  within 
half  an  hour  after  a  dose  has  been  taken,  and  lasts  several  hours. 
The  antipyretic  action  varies  in  degree  according  to  the  cause  of 
the  pyrexia  and  the  individual  susceptibility  of  the  patient.  The 
reduction  of  temperature  is  produced  by  lessening  heat-production 
and  increasing  heat-dissipation. 

Untoward  Action. — Erythema,  urticaria,  or  petechise,  accom- 
panied by  intense  itching,  occasionally  edema  of  the  eyelids  and 
lower  extremities,  mental  depression,  muscular  weakness,  motor 
disturbances,  sweating,  and  buzzing  in  the  ears,  as  mentioned  under 
Poisoning,  but  to  a  less  degree. 

Poisoning. — There  are  roaring  in  the  ears,  deafness,  intense 
headache,  vertigo,  and  possibly  delirium,  profuse  and  exhausting 
sweating,  subnormal  temperature,  very  weak,  compressible  pulse, 
feeble  and  shallow  respirations,  dimness  of  vision,  ptosis,  and  often 
strabismus.  The  blood  is  disorganized,  and  the  corpuscles  rapidly 
break  down.  The  urine  and  feces  pass  involuntarily.  Death 
usually  results  from  respiratory  failure. 

Treatment  of  Poisoning. — Diffusible  stimulants,  atropine,  strych- 
nine— the  same  treatment  as  in  poisoning  by  acetanilid. 

Therapeutics. — Externally  and  Locally. — Salicylic  acid  has 
been  satisfactorily  employed,  in  the  strength  of  J  to  i  drachm  in  i 
ounce  (2.0  to  4.0  in  32.0  Gm.)  of  cosmoline,  in  the  treatment  of 
erysipelas. 

In  the  treatment  of  chancroid  salicylic  acid  has  been  extensively 
employed.  The  powdered  acid  should  be  thoroughly  dusted  over 
the  surface. 

The-  peculiar  action  of  salicylic  acid  in  softening  and  loosening 
thickened  masses  of  epidermis  and  favoring  the  normal  prolifera- 
tion of  epithelium  renders  the  drug  especially  useful  in  the  treat- 
ment of  indurated  eczema,  particularly  of  the  palm  and  sole,  ver- 
ruca, tylosis,  callositas,  corns,  warts,  etc. 

It  is  one  of  the  most  useful  drugs  in  the  different  varieties  of 
eczema,  impetigo  contagiosa,  psoriasis,  lupus,  parasitic  affections,  and 
in  non-parasitic  sycosis  it  has  been  employed  by  Heitzmann  with 


3i6  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

marked  success.  It  has  been  used  successfully  in  the  treatment 
of  acne,  comedones,  and  pruritus.  A  3  per  cent,  solution  has  been 
recommended  in  aspergillus  of  the  outer  auditory  meatus.  A 
wash,  3  grains  to  i  ounce  (0.2  to  30.0  Cc.)  is  efficient  in  otorrhea. 
Solutions  of  various  .strengths  are  frequently  useful  in  acute  coryza, 
diphtheria,  inflammation  of  fauces,  catarrhal  stomatitis,  and  to  cor- 
rect offensive  expectoration,  especially  in  phthisis  and  gangrene  of  the 
lung. 

Internally.— Thtre  is  no  better  example  of  empiricism  in  thera- 
peutics than  the  employment  of  salicylic  acid  in  acute  articular 
rheumatism.  Used  at  first  in  this  disease  to  reduce  temperature, 
it  was  found  that  while  it  exerted  marked  antipyretic  action,  it  also 
lessened  the  pain  and  swelling,  and  in  the  majority  of  cases  short- 
ened the  duration  of  the  disease.  It  cannot  be  classed  as  a 
"  specific "  in  any  sense  of  the  word,  but  merely  reUeves  certain 
symptoms — fever,  pain,  and  swelling.  Other  symptoms — or  com- 
plications, according  to  some  authors — such  as  heart  affections,  are 
uninfluenced  by  this  medicine.  Indeed,  when  so-called  cardiac 
complications  exist  salicylic  acid  is  certainly  contraindicated.  It 
has  no  power  to  prevent  either  affections  of  the  heart  or  relapses. 
In  the  author's  opinion,  it  is  doubtful  if  saHcylic  acid  alone  is  equal 
to  the  alkaline  treatment  or  greatly  superior  to  acetanilid  or  anti- 
pyrine. 

Rheumatic  tetanus,  irido-choroiditis ,  and  sclerotitis  are  alleged  to 
have  been  cured  by  this  drug.  It  is  useless  in  gotit,  according 
to  the  best  English  authorities,  and  is  of  no  value  in  chronic  or 
gonorrheal  rheumatism,  rheumatic  arthritis,  or  rheumatic  hyper- 
pyrexia. 

It  is  credited  with  being  quite  efficient  in  chorea  of  rheumatic 
origin,  and  in  relieving  the  pains  of  herpes  zoster  and  neuralgic 
headache. 

It  is  a  drug  to  be  tried  in  many  diseases  of  rheumatic  origin, 
unless  some  distinct  contraindication  to  its  use  exists.  It  surpasses 
any  drug,  with  the  possible  exception  of  guaiac,  in  the  treatment 
of  quinsy,  and  particularly  rheumatic  tonsillitis.  The  medicine  is 
highly  regarded  by  competent  advocates  as  a  remedy  in  diphtheria. 
Lumbago  often  yields  to  its  influence,  and  it  has  also  been  recom- 
mended in  sciatica,  although  in  Cook  County  Hospital  the  author 
has  seen  a  great  number  of  cases  of  the  latter  treated  with  salicylic 
acid  without  any  apparent  improvement.  He  also  regards  it  as 
valueless  in  typhoid  and  intermittent  fevers. 


ANTISEPTICS.  317 

It  is  a  useful  antizymotic  to  prevent  putrefactive  fermentation 
and  flatulence,  and  lessen  thereby  the  tendency  to  crapulous  diar- 
rhea. 

Owing  to  the  similarity  of  its  action  to  that  of  quinine,  it  has 
been  used,  and  with  some  success,  in  periodical  neuralgias  which 
have  not  responded  to  the  latter  drug. 

It  has  been  found  of  use  in  influenza,  and  is  an  efficient  anti- 
septic remedy  in  chronic  gastric  catarrh,  diarrhea,  cholera,  and 
entero-colitis.  By  some  eminent  clinicians  it  is  considered  to  be 
one  of  the  most  effectual  remedies  in  pleurisy  with  effusion. 

It  has  been  recommended  as  an  effectual  anthelmintic,  both  for 
tape-  and  round-worms. 

Contraindications. — Salicylic  acid  should  not  be  given  in  large 
doses  to  persons  who  have  a  weak  heart  or  are  otherwise  greatly 
debilitated,  at  least  not  without  counteracting  its  toxical  tendencies 
with  nutrients  and  diffusible  stimulants. 

Administration. — Owing  to  its  irritant  action  upon  the  mucous 
membranes,  it  is  best  given  in  a  solution  of  glycerin  and  some  aro- 
matic water,  after  meals.  So  concentrated  a  form  as  a  pill  or  cap- 
sule is  not  recommended. 

Many  of  the  untoward  cerebral  effects  may  be  relieved  by  giving 
20  grains  (1.3  Gm.)  of  sodium  or  potassium  bromide. 

Many  of  the  toxical  effects  have  been  attributed  to  an  impurity 
in  the  manufactured  acid. 

If  any  benefit  is  to  be  derived  from  salicylic  acid  in  acute  artic- 
ular rheumatism,  it  must  be  used  early  in  the  disease  and  in  heroic 
doses  at  comparatively  frequent  intervals — not  less  than  20  grains 
(1.3  Gm.)  every  two,  three,  or  four  hours  for  an  adult.  If  too 
serious  gastric  and  cerebral  symptoms  manifest  themselves,  the 
drug  may  be  decreased  in  amount  or  discontinued  until  the 
unpleasant  action  subsides. 

It  is  better,  except  in  acute  articular  rheumatism,  to  give  a 
small  dose,  repeated  frequently,  than  to  administer  a  full  dose  at 
once. 

The  physiological  action  and  therapeutics  of  lithium  salic- 
ylate are  practically  the  samfe  as  those  of  salicylic  acid  or  sodium 
salicylate.  It  is,  however,  richer  in  salicylic  acid  than  the  sodium 
salt,  and  in  gout  and  chronic  rheumatism  has  been  found  to  be  of 
more  value  than  salicylic  acid. 

It  should  be  given  in  solution. 

Sodium   salicylate  'is  identical  in  physiological  action  and 


3l8  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

uses  with  salicylic  acid,  with  the  exception  that  it  is  less  irritating 
to  the  stomach,  and  is  therefore  ordinarily  to  be  preferred  to  the 

acid. 

It  may  be  prescribed  in  aromatic  water,  in  syrup,  or  in  powder, 

pills,  or  capsules. 

Salol— Salol— Salol.     V.  S.  -P. 

(Phenyl  Salicylate.) 

Origin. — The  Salicylic  Ether  of  Phenol,  prepared  by  heating 
Salicylic  Acid  with  Phenol  in  the  presence  of  Phosphorus  Penta- 
chloride. 

Description  and  Properties. — A  white,  crystalline  powder, 
odorless,  or  having  a  faintly  aromatic  odor,  and  almost  tasteless. 
Permanent  in  the  air.  Almost  insoluble  in  water ;  soluble  in  lo 
parts  of  alcohol ;  also  in  0.3  part  of  ether,  and  readily  in  chloro- 
form and  in  fixed  or  volatile  oils. 

Dose. — 3-15  grains  (0.19-1.0  Gm.). 

Physiological  Action. — Externally  and  Locally. — It  is  a  more 
powerful  antiseptic  than  either  of  its  constituents.  Nencki  claims 
that  it  is  not  a  germicide,  as  it  will  not  destroy  bacteria  when 
present,  although  it  prevents  their  formation.  It  is  not,  like  sali- 
cylic acid,, irritating  to  the  mucous  membranes. 

Internally. — The  action  of  salol  is  essentially  like  that  of  salicylic 
acid,  but  it  is  a  more  powerful  antipyretic,  analgesic,  and  cerebro- 
spinal sedative.  It  reduces  temperature  much  more  promptly,  the 
antipyretic  action  occurring  within  fifteen  minutes  after  a  full  medi- 
cinal dose  has  been  taken.  The  effect,  however,  is  not  prolonged, 
repeated  doses  being  required  to  maintain  the  reduction  of  tem- 
perature. 

The  circulation  is,  perhaps,  not  so  much  depressed  as  by  sali- 
cylic acid.  The  respirations  are  at  first  quite  rapidly  increased,  and 
are  rendered  very  shallow,  requiring  some  time  to  resume  their 
normal  condition. 

It  is  converted  by  the  pancreatic  and  intestinal  juices  into  its 
original  constituents — salicylic  acid  and  carboHc  acid.  It  is  usu- 
ally absorbed  and  eliminated  very  rapidly,  having  been  detected 
in  the  urine  in  the  form  of  salicyluric  acid  and  phenol-ether-sul- 
phuric acid  within  thirty  minutes  after  its  ingestion  by  the  stomach. 
To  the  latter  acid  is  due  the  dark,  smoky  color  of  the  urine  which 
sometimes  exists  under  large  or  continued  doses  of  salol. 

Therapeutics. — Externally   and   Locally. — Salol    is   especially 


ANTISEPTICS.  319 

recommended  as  an  antiseptic  dressing  for  wounds,  burns,  venereal 
ulcers,  and  buboes.  Powdered  salol  or  an  ointment — i  part  to  150 
parts  of  petrolatum — has  been  used  in  cases  of  tubercular  laryngitis 
and  ozena.  Like  salicylic  acid,  it  is  also  of  value  in  eczema  and 
sycosis  simplex. 

Internally. — It  is  an  efficient  remedy  in  all  diseases  benefited  by 
the  internal  administration  of  salicylic  acid.  In  addition  to  these 
services  it  is  a  valuable  remedy  in  acute  and  chronic  cystitis,  gonor- 
rhea, intestinal  catarrh,  especially  duodenal  catarrh  and  catarrhal 
jaundice,  and  to  relieve  the  pains  of  neuritis  and  myalgia. 

Salol  is  much  more  useful  than  salicylic  acid  in  diarrhea,  cholera 
morbus,  and  cholera,  the  latter  disease  yielding  better,  perhaps,  to 
this  remedy  than  to  any  other. 

Administration. — It  may  be  given  in  pills,  capsules,  powders, 
emulsion,  or  suspended  in  milk.  The  compressed  tablets  of  this 
drug  so  extensively  used  at  present  are  not  recommended,  owing 
to  their  slow  and  difficult  solution. 

SalicTnum— SalicTni— Salicin.    TJ.  8.  P. 

Origin. — A  neutral  principle  obtained  from  several  species  of 
Salix  (willow)  and  Populus  (poplar). 

Description  and  Properties. — Colorless  or  white,  silky,  shining, 
crystalline  needles,  or  a  crystalline  powder,  odorless  and  having  a 
very  bitter  taste.  Permanent  in  the  air.  Soluble  in  28  parts  of 
water,  30  parts  of  alcohol,  0.7  part  of  boiling  water,  and  in  2  parts 
of  boiling  alcohol. 

Dose. — 10  grains-2  drachms  (0.6-8.0  Gm.). 

Physiological  Action. — Its  physiological  effect  is  analogous  to 
that  of  salicylic  acid,  but  is  much  less  active  than  the  latter.  It 
does  not  disturb  digestion,  but  in  moderate  doses  promotes  appe- 
tite and  acts  Hke  other  bitters.  It  is  rrtore  rapidly  absorbed  than 
salicylic  acid,  is  partly  decomposed,  and  is  found  in  the  urine,  as 
salicin  and  salicylic  acid,  in  from  fifteen  to  thirty  minutes  after  the 
ingestion  of  a  single  dose. 

Therapeutics. — While  inferior  to  salicylic  acid  in  most  respects, 
salicin  is  frequently  used  for  the  same  purposes.  It  is  superior  to, 
and  safer  than,  salicylic  acid  in  acute  rheumatism  characterized  by 
a  weak  heart  and  depressed  vaso-motor  system. 

It  is  an  excellent  stomachic  tonic,  and  may  be  used  like  other 
bitters  in  the  treatment  of  atonic  dyspepsia  and  other  conditions 
benefited  by  this  class  of  drugs. 


320  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Contraindications. — In  acute  inflammatory  affections    of  the 

brain  and  ear. 

Administration. — Salicin  may  be  administered  in  powders,  cap- 
sules, or  solution.  Owing,  however,  to  its  bulk  and  intensely  bitter 
taste,  it  is  perhaps  best  given  in  suspension  in  the  aromatic  elixir 
of  liquorice  or  in  syrup  of  yerba  santa. 

Naphtallnum— Naphtallni— Naphtalin.    TJ.  8.  P. 

Origin. — A  hydrocarbon  obtained  from  coal-tar. 

Description  and  Properties. — Colorless,  shining,  transparent 
laminae,  having  a  strong,  characteristic  odor  resembling  that  of 
coal-tar,  and  a  burning,  aromatic  taste ;  slowly  volatilized  on  expo- 
sure to  air.  Insoluble  in  water,  but  when  boiled  in  it  imparting  a 
faint  odor  and  taste.  Soluble  in  15  parts  of  alcohol,  and  very 
soluble  in  boiling  alcohol ;  also  very  soluble  in  ether,  chloroform, 
carbon  disulphide,  and  in  fixed  or  volatile  oils.  Naphtalin  vola- 
tilizes slowly  at  ordinary  temperatures,  but  rapidly  when  heated. 
Its  vapor  is  inflammable,  burning  with  a  luminous  and  smoky 
flame.     It  should  be  kept  in  well-stoppered  bottles. 

Dose. — 2-10  grains  (o.i  2-0.6  Gm.). 

Naphtol— Naphtol— Naphtol.    V.  S.  P. 

(Beta-naphtol.) 

Origin. — A  phenol  occurring  in  coal-tar,  but  usually  prepared 
artificially  from  naphtalin. 

Description  and  Properties. — Colorless  or  pale  buff-colored, 
shining,  crystalline  laminae,  or  a  white  or  yellowish-white  crystal- 
line powder,  having  a  faint,  phenol-like  odor,  and  a  sharp,  pungent, 
but  not  persistent  taste.  Permanent  in  the  air.  Soluble  in  about 
1000  parts  of  water,  in  0.75  part  of  alcohol,  in  about  75  parts  of 
boiling  water,  and  very  soluble  in  boiling  alcohol,  ether,  chloro- 
form, and  solutions  of  caustic  alkalies.  It  should  be  kept  in  dark 
amber-colored,  well-stoppered  bottles. 

Dose. — 2-10  grains  (0.12-0.6  Gm.). 

Allied  Compounds. 

Altimnol. — An  almost  colorless,  non-hygroscopic  powder;  readily  soluble  in  cold 
water  or  glycerin,  less  soluble  in  alcohol,  and  insoluble  in  ether.  It  is  employed  as  a 
local  remedy  in  solutions  varying  in  strength  from  I  to  50  per  cent.     Used  externally. 

Asaprol. — A  colorless,  neutral  crystalline  powder,  soluble  in  i^  parts  of  water  and 
in  3  parts  of  alcohol. — Dose,  15-60  grains  (1.0-4.0  Gm.). 

BenzonSphtol. — Obtained  by  the  action  of  Benzoic  Chloride  on  Beta-naphtol  in  a 


ANTISEPTICS.  321 

sand-bath.  It  is  an  odorless,  tasteless,  white,  crystalline  powder,  or  occurs  in  the  form 
of  long  needles.     Insoluble  in  cold  water.     Dose,  4-8  grains  (0.18-0.5  Gm.). 

Betol  (Napht'Osaiol — Salinaphtol) . — A  substance  analogous  to  salol,  and  pre- 
pared in  the  same  manner,  except  that  sodium-naphtol  is  used  instead  of  sodium-phenol. 
It  occurs  as  a  colorless,  odorless,  tasteless,  lustrous  crystalline  powder.  Insoluble  in 
water  or  glycerin,  and  with  difficulty  soluble  in  cold  alcohol.  Dose,  2-5  grains  (o.i2- 
0.3  Gm.). 

Camphorated  Naphtol. — Obtained  by  mixing  I  part  of  Beta-naphtol  with  2  parts 
of  Camphor.     It  is  a  brownish,  transparent,  syrupy  liquid. 

Hydronaphtol. — A  derivative  of  beta-naphtol,  obtained  by  the  action  of  reducing 
agents.  It  occurs  in  scale-like  crystals,  of  a  silvery  white  or  grayish  hue,  of  slightly 
aromatic  odor  and  taste.  Soluble  in  1 100  parts  of  water,  and  freely  soluble  in  alcohol, 
ether,  glycerin,  benzene,  chloroform,  and  fixed  oils.     Dose,  2-3  grains  (0.12-0.18  Gm.). 


Antagonists  and  Inoompatibles. — Physiological  antagonists 
of  NAPHTALiN  are  the  same  as  for  other  members  of  this  group. 
Naphtol  is  incompatible  with  subacetate  of  lead. 

Ssniergists. — Carbolic  acid  and  its  derivatives. 

Physiological  Action. — Naphtalin  is  antiseptic,  antifermenta- 
tive,  disinfectant,  and  deodorant.  Its  action  is  quite  similar  to 
salol,  it  being  insoluble  in  the  gastric  juices,  but  soluble  in  the  in- 
testines, where  it  acts  as  an  antiseptic,  deodorizing  the  stools  and 
often  imparting  to  them  its  own  odor.  It  is  absorbed  to  some 
extent,  and  is  eliminated  by  the  lungs  and  kidneys,  but  escapes 
principally  in  the  feces.  It  is  broken  up  into  naphtol  or  phenol, 
and  acts  as  a  local  antiseptic  and  disinfectant  at  points  of  elimina- 
tion, but  does  not  occasion  any  local  irritation  unless  quite  large 
doses  have  been  taken :  "  15  grains  (i.o  Gm.)  daily  have  occasioned 
frequent  micturition,  with  burning  pain,  vesical  tenesmus,  and  red- 
ness of  the  urethral  orifice."  Purdy  states  that  in  certain  cases 
of  genito-urinary  disease  he  has  known  a  dose  of  5  grains  (0.32 
Gm.)  to  cause  severe  suffering  along  the  whole  urinary  tract.  It  is 
a  stimulant  expectorant,  and  differs  from  other  members  of  the 
group  in  that  it  possesses  no  antipyretic  action. 

Naphtol  is  quickly  absorbed  when  apphed  locally.  It  produces 
considerable  irritation  when  used  in  solution,  but  has  no  irritating 
effect  when  applied  in  the  form  of  ointment.  Toxic  effects  may 
result  from  its  absorption  by  the  skin,  their  character  resembling 
the  action  of  carbolic  acid. 

Aliimnol. — An  astringent  antiseptic. 

Asaprol. An  antipyretic,  analgesic,  and  antiseptic.     It  is  considered  superior  to 

the  salicylates  in  these  respects,  having  the  advantage  of  neither  exciting  vomiting  nor 
disturbing  the  brain  or  the  auditory  apparatus. 

Benzonaphtol. — Antiseptic,  diuretic,  and  but  slightly  poisonous. 

21 


322  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Betol. — Action  almost  identical  with  that  of  salol. 

Hydronaphtol. — A  powerful  non-irritating,  non-corrosive,  and  non-poisonous  anti- 
septic, said  by  Dr.  Fowler  to  possess  "  antiseptic  properties  fifteen  times  greater  than 
carbolic  acid."  '  Dr.  Levis  claims  that  it  is  thirty  times  as  antiseptic  as  salicylic  acid, 
and  that  this  property  exceeds  that  of  boric  acid  sixty  times,  of  alcohol  six  hundred 
times,  and  that  in  this  respect  it  ranks  next  to  mercuric  chloride. 

Therapeutics. — Externally  and  Locally. — Naphtalin  in  alcoholic 
solution  is  advised  by  Henri  Laserre  in  the  treatment  of  chronic 
abscesses  and  adenitis.  It  is  also  recommended  in  the  treatment  of 
scabies  and  other  parasitic  skin  diseases. 

Internally. — It  is  used  in  typhoid  fever  and  in  the  gastro-intestinal 
and  genito-urinary  disorders  for  which  salol  and  carbolic  acid  are 
administered,  such  as  chronic  diarrhea  and  dysentery,  acute  or 
chronic  cystitis,   etc. 

The  internal  uses  of  naphtol  are  the  same  as  those  of  naphtalin, 
while  externally  it  may  be  employed,  like  carbolic  acid  or  creasote, 
as  a  general  antiseptic  in  cutaneous  disorders,  whether  organic  or 
parasitic, 

Aliimnol. — An  efficient  remedy  in  many  acute  and  chronic  inflammatory  diseases 
of  the  skin,  and  in  gonorrhea,  chancres,  syphilitic  ulcers,  balanitis,  etc.  A  I  per  cent, 
solution  may  be  injected  in  gonorrhea,  while  stronger  solutions  (10-50  per  cent.),  or 
alumnol  plaster,  are  recommended  in  chronic  diseases  of  the  skin. 

Asaprol. — Given  for  the  same  purposes  as  salicylic  acid  and  the  salicylates,  although 
it  is  not  so  uniformly  successful  in  acute  articular  rheumatism,  while  having  the  advan- 
tage of  causing  less  heart-depression. 

Betol. — Used  chiefly  in  the  bowel  complaints  of  children.  It  may  be  administered 
either  by  the  mouth  or  through  the  rectum,  associated  with  bismuth  or  antacids.  It  has 
been  used  also  in  acute  articular  rheumatism  and  bladder  affections. 

Camphorated  naphtol  is  considered  by  some  practitioners  to  be  superior  to  all 
other  remedies  to  prevent  suppuration  in  acute  tonsillitis. 

Fernet  has  employed  it  successfully  in  tubercular  ulcerations  of  the  tongue,  while 
Reboul  of  Marseilles  and  others  have  adopted  it  with  good  effect  hypodermically  in 
tuberculous  adenitis  and  tuberculosis  of  the  testis.  It  has  also  been  used  in  tuberculosis 
of  the  bladder,  joints,  etc. 

Ruault  claims  it  to  be  an  efficient  local  application  to  the  turbinated  bones  in 
ozena. 

Hydronaphtol. — Considered  by  many  physicians  to  be  superior  to  carbolic  acid, 
since  it  is  without  disagreeable  odor  and  can  be  used  without  exciting  irritation  or 
danger  of  toxic  impression. 

Dockrell  employs  it  in  the  form  of  a  plaster  for  destroying  the  trichophyton  fungus 
of  tinea  tonsurans,  and  believes  it  to  be  superior  to  mercuric  chloride  as  a  germicide. 

It  has  been  used  as  a  preventive  of  dental  caries,  and  in  the  treatment  of  gingivitis, 
pyorrhoea  alveolaris,  diphtJieria,  etc. 

Internally  it  has  been  recommended  in  dysentery,  diarrhea,  pulmonary  tuberculosis, 
and  typhoid  fever. 

'  New  York  Med.  Journ.,  Oct.  3,  1885. 


ANTISEPTICS.  323 

Contraindications. — These  preparations  should  not  be  given 
internally  when  the  functional  activity  of  the  kidneys  is  defective. 

Administration. — Naphtalin  is  best  given  internally  in  the 
form  of  pills  or  in  capsules.  When  it  is  necessary  to  use  it  topi- 
cally, the  offensive  odor  of  the  drug  may  be  disguised,  it  is  said,  by 
triturating,  it  with  a  small  quantity  of  the  oil  of  bergamot.  Naphtol 
should  be  given  in  capsules,  in  the  dose  recommended,  three  times 
a  day  or  oftener  if  necessary. 

Asaprol,  betol,  and  hydronaphtol  are  best  given  in  capsules, 
although  betol,  which  is  tasteless  and  insoluble  in  water,  may  be 
administered  in  the  form  of  powders. 

ResorcTnunn— ResorcTni— Resorcin.    JJ.  S.  P. 

Origin. — Prepared  by  melting  Galbanum,  Ammoniac,  or  Guai- 
acum  Resin  with  Potassa.  It  is  also  prepared  in  a  similar  manner 
from  Asafetida,  Sagapenum,  Ascaroid  Resin,  and  from  Phenol- 
sulphonic  Acid  and  other  derivatives  of  Phenol. 

Description  and  Properties. — Colorless  or  faintly  reddish,  needle- 
shaped  crystals,  or  rhombic  plates,  having  a  faint,  peculiar  odor, 
and  a  disagreeable  sweetish  and  afterward  pungent  taste.  Resorcin 
acquires  a  reddish  or  brownish  tint  by  exposure  to  light  and  air, 
and  should  be  kept  in  dark  amber-colored  vials.  It  is  soluble  in 
0.6  part  of  water,  0.5  part  of  alcohol,  very  soluble  in  boiling  water 
and  in  boiling  alcohol,  readily  soluble  in  ether  and  in  glycerin,  and 
very  slightly  soluble  in  chloroform.  The  aqueous  solution  is  neutral 
or  only  faintly  acid  to  litmus-paper. 

Dose. — 3-8  grains  (0.2-0.5  Gm.). 

Allied  and  Derivative  Compounds. 

Hydroquinol — Hydroquinone — Hydrochinone — Paradioxybeftzene. — Color- 
less, odorless,  dimorphous  crystals,  having  a  sweetish  taste.  Soluble  in  17  parts  of  water, 
and  very  soluble  in  hot  water,  alcohol,  and  ether.     Dose,  1^5  grains  (0.03-0.30  Gm,). 

Catechol — Pyrocatechin — Orthodioxybenzene. — Acicular  crystals,  readily  solu- 
ble in  water,  alcohol,  and  ether. 

Other  allied  compounds  are — Thioresorcin,  Resopyrine,  and  Fluorescein. 

Antagonists. — Cerebral  excitants,  cardiac  and  respiratory  stim- 
ulants. 

Ssmergists. — Salicylic  acid,  quinine,  carbolic  acid. 

Physiological  Action. — Externally  and  Locally. — Resorcin  is  an 
antiferment,  antiseptic,  deodorant,  a  feeble  analgesic,  and  a  parasiti- 
cide.    Applied  to  the  unbroken  skin,  it  is  non-irritating,  is  not  ab- 


324  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

sorbed  by  it,  and  when  injected  into  the  subcutaneous  tissues 
produces  but  little  irritation,  with  no  suppuration.  Applied  to  the 
moistened  mucous  membrane,  its  action  is  similar  to  that  of  car- 
bolic acid,  producing  vesication,  etc.- 

Internally. — The  physiological  properties  of  resorcin.are  allied 
to  those  of  carbolic  acid.  It  possesses  more  marked  antipyretic 
and  diaphoretic  actions  than  carbolic  acid,  but  when  used  to  pro- 
duce these  effects  it  greatly  depresses  the  heart. 

Its  chief  action  is  on  the  nervous  system,  which  it  first  power- 
fully stimulates  and  then  depresses. 

It  is  niainly  and  rapidly  ehminated  by  the  urine,  which  it  colors 
an  olive-green  or  bluish-violet  hue. 

Poisoning. — Poisonous  doses  produce  vertigo,  ringing  in  the 
ears,  deafness,  disturbance  of  vision,  weak,  rapid,  and  irregular  pulse, 
respiration  at  first  convulsive  and  jerking,  afterward  accelerated, 
shallow,  and  weak,  death  resulting  finally  from  respiratory  failure. 
There  are  great  mental  anxiety,  epileptiform  convulsions,  collapse, 
and  unconsciousness.  Just  before  death  there  is  a  rise  in  temper- 
ature, doubtless  due  to  excessive  muscular  action,  although  the 
temperature  may  fall  below  normal  if  there  is  quiet  narcosis,  as 
there  may  be  in  some  instances. 

Treatment  of  Poisoning. — Hypodermic  injections  of  atropine. 
The  administration  of  diffusible  stimulants.     Artificial  respiration. 

Therapeutics. — Externally  and  Locally. — Resorcin  is  especially 
useful  in  certain  subacute  or  chronic  skin  affections,  and  may  be 
used  like  salicylic  acid  in  indurated  eczema.  It  is  of  great  value  in 
psoriasis,  seborrhoea  sicca,  pityriasis  capitis,  sycosis,  acne  rosacea,  etc. 

A  5  to  I  o  per  cent,  solution  is  an  efficient  application  in  pharyn- 
gitis, diphtheria,  and  ulcerative  laryngitis.  An  ointment  of  resorcin 
is  an  excellent  application  to  foul  ulcers,  sloughing  wounds,  and 
syphilitic  ulcers. 

Condylomata  have  been  cured  by  dusting  upon  them  powdered 
resorcin. 

A  mixture  of  powdered  resorcin  and  boric  acid  (i  :  20  or  i  :  lo) 
has  been  used  with  brilliant  results  in  suppuration  of  the  middle  ear. 

A  2  per  cent,  solution  has  been  found  useful  in  the  form  of  a 
spray  in  whooping  cough,  while  stronger  solutions  of  10  or  20  per 
cent,  have  been  used  with  some  success  in  hay  fever. 

Solutions  of  resorcin  have  been  used  in  gonorrhea  and  cystitis. 

Internally. — Resorcin  is  preferable  to  carbolic  acid  for  internal 
administration,  especially  in  digestive  disorders  such  as  gastralgia. 


ANTISEPTICS.  325 

chronic  gastritis,  ulcer  of  the  stomach,  znd  fermentative  dyspepsia,  so 
called.  Owing  to  its  sedative  and  antifermentative  properties,  it  is 
of  value  in  acute  diarrhea  of  children. 

It  has  been  used  with  some  success  in  intermittent  fever,  but 
not  with  .good  results  sufficiently  uniform  to  justify  the  exclusion 
of  quinine.  As  an  antipyretic  it  may  be  used  when  a  drug  of  that 
character  is  indicated,  but  it  is  not  equal  to  antipyrine  or  acetanilid, 
and  in  doses  sufficient  to  produce  the  desired  reduction  of  temper- 
ature it  is  too  depressant  to  the  heart.  Its  chief  therapeutic  value 
is  for  external  or  local  use,  and  internally  for  the  digestive  disorders 
above  mentioned. 

Administration. — It  should  be  given  in  pills  or  capsules. 

Ichthyolum— Ichthyoli— Ichthyol.     (Unofficial.) 

Origin. — It  is  obtained  by  the  destructive  distillation  of  bitumin- 
ous rock  found  near  Seefeld  in  the  Tyrolese  Alps,  which  contains 
enormous  quantities  of  semi-fossilized  fishes  and  marine  animals. 

Description  and  Properties. — It  occurs  in  the  form  of  a  brown- 
ish-yellow, transparent,  oily  liquid,  containing  about  10  per  cent,  of 
sulphur. 

Upon  being  treated  with  concentrated  sulphuric  acid  ichthyol 
is  converted  into  ichthyol-sulphonic  acid,  which  readily  combines 
with  ammonia  and  other  alkalies,  as  well  as  with  lithium,  zinc, 
mercury,  etc.,  forming  the  ammonium  ichthyol,  sodium  ichthyol, 
zinc  ichthyol,  etc. 

Ammonium  ichthyol  occurs  as  a  clear  reddish-brown,  syrupy 
liquid  with  a  bituminous  odor  and  taste.  Soluble  in  water  and  in 
a  mixture  of  equal  volumes  of  ether  and  alcohol. 

Dose. — 2-10  minims  (0.12-0.6  Cc). 

The  other  salts  of  ichthyol-sulphonic  acid  occur  as  brownish  or 
black  tar-like  masses,  the  sodium  salt  being  the  most  important, 
as  it  is  the  one  most  employed  when  ichthyol  is  desirable  in  pill 
form. 

Dose. — Sodium  ichthyol,  2-4  grains  (0.1-0.25  Gm.). 

Allied  Drugs. 

Thiolum—Thioli— Thiol.— Or^fw.— This  substance  is  prepared  by  heating 
brown-colored  paraffin  or  gas  oils  with  Sulphur,  and  extracting  the  sulphurated,  unsatu- 
rated hydrocarbons  with  Alcohol. 

Description  and  Properties .—Vi  occurs  as  a  neutral,  solid  body,  non-hygroscopic 
and  soluble  in  water,  and  of  a  dark-brown  color,  or  in  the  form  of  a  dark  reddish- 
brown,  syrupy  liquid,  containing  about  40  per  cent,  of  thiol. 


336  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Dose. — \-\  grain  (0.03-0.06  Gm.). 

Tumenolum — Tumenoli — Tumenol. —  Origin. — It  is  obtained  from  purified 
mineral  oils  by  the  direct  action  of  concentrated  sulphuric  acid,  without  previous  sul- 
phuration,  being  a  mixture  of  sulphones  and  sulphonic  acids. 

Description  and  Properties. — A  dark-brown  or  blackish-brown  liquid  of  a  syrupy 
consistency. 

Dose. — It  is  used  only  externally,  in  strengths  of  from  5  to  10  per  cent. 

Antagonists  and  Inoompatibles. — Ichthyol  possesses  marked 
reducing  properties,  and  should  not  therefore  be  combined  with 
substances,  like  potassium  permanganate,  which  part  readily  with 
oxygen. 

Synergists. — Most  members  of  this  group,  particularly  the  tars, 
carbolic  acid,  creasote,  etc.,  aid  its  action. 

Physiological  Action. — Externally  and  Locally. — Ichthyol  is 
ischemic,  sedative;  parasiticide,  and  possesses  antiseptic  and  prob- 
ably disinfectant  properties. 

When  applied  to  the  skin  in  full  strength  it  produces  some  irri- 
tation. It  is  readily  absorbed,  having  the  power  to  penetrate  the 
skin,  affecting  the  deeper  tissues  beneath. 

Internally. — Digestive  System. — Very  large  doses  produce  con- 
siderable gastro-intestinal  irritation. 

Circulatory  System. — It  has  the  power  in  medicinal  doses  of 
contracting  the  caliber  of  the  arteries,  and  in  large  doses  it  increases 
the  migration  of  the  white  blood-corpuscles. 

The  physiological  action  has  not  been  fully  studied,  and  it  is 
not  yet  positively  known  what  action  it  has  upon  the  nervous  and 
respiratory  systems  and  upon  temperature. 

Therapeutics. — Externally  and  Locally. — Ichthyol  was  intro- 
duced by  Unna  as  a  valuable  remedy  in  certain  diseases  of  the 
skin.  It  is  particularly  useful  in  erythematous  eczema,  erysipelas, 
lupus  erythematosus,  irritable  acne,  and  certain  forms  of  acne  rosacea. 

Agnew  has  employed  it  with  advantage  in  lymphatic  enlarge- 
ments. It  has  also  been  found  useful  in  synovial  inflammations,  in- 
flammatory conditions  of  the  female  genital  organs,  and  in  certain 
diseases  of  the  ear  and  nose. 

Thiol,  although  inferior,  is  similar  to  ichthyol  in  its  therapeutic 
action.  It  has  been  found  to  be  valuable  in  the  treatment  of  herpes 
zoster,  dermatitis  herpetiformis,  and  erythema  multiforme. 

Administration. — Ichthyol,  when  given  internally,  should  be 
dispensed  in  capsules,  while  thiol  may  be  given  in  capsules,  pills, 
or  wine. 

Externally,  ichthyol  may  be  employed  in  solution,  dissolved  in 


ANTISEPTICS.  337 

chloroform  or  in  a  mixture  of  alcohol  and  ether,  and  applied  with 
a  brush ;  or  in  the  form  of  an  ointment  mixed  with  soft  petrolatum 
or  lanolin  in  from  1-4  to  8  drachms  (4.0-15.0  Cc.  to  32.0  Gm.).  It 
is  used  also  in  the  form  of  a  soap  in  from  5  to  20  per  cent,  strength. 
Thiol  is  used  locally  in  powder  form,  or  as  an  ointment  of  5  to 
10  per  cent,  of  the  liquid,  or  in  collodion  containing  5  per  cent,  of 
the  powder,  or  in  solutions  of  glycerin  and  aqueous  solutions  con- 
taining from  5  to  50  per  cent,  of  the  powder. 

lodoformum—Iodoformi— Iodoform.    TJ.  S.  -P. 

Origin. — It  is  obtained  by  the  action  of  Iodine,  in  the  presence 
of  fixed  alkalies  or  alkali  carbonates,  upon  Alcohol  or  Acetic  and 
other  easily-saponifiable  Ethers. 

Description  and  Properties. — Small,  lemon-yellow,  lustrous 
crystals,  of  the  hexagonal  system,  having  a  peculiar,  very  pene- 
trating, and  persistent  odor,  somewhat  resembling  that  of  saffron 
and  iodine,  and  an  unpleasant,  slightly  sweetish,  and  iodine-like 
taste.  It  is  very  slightly  soluble  in  water,  to  which,  however,  it 
imparts  its  odor  and  taste;  soluble  in  about  52  parts  of  alcohol,  in 
about  12  parts  of  boiling  alcohol,  or  in  5.2  parts  of  ether,  and  very 
soluble  in  chloroform,  benzin,  and  iixed  and  volatile  oils. 

Iodoform  is  sUghtly  volatile,  even  at  ordinary  temperatures,  and 
in  boiling  water  distils  slowly  over  with  its  vapor.  It  should  be 
kept  in  well-stoppered  bottles,  in  a  cool  and  dark  place. 

Iodoform  contains  96.69  per  cent,  of  its  weight  as  iodine. 

Dose. — 1-3  grains  (0.06-0.2  Gm.). 

Official  Preparation. 

UnguSntum  lodoffirmi — UnguSnti  lodofSrmi — Ointment  of  Iodoform. — 16 
per  cent.     Used  externally. 

Allied  Compounds. 

AntisSptol — Cinchonine  lodosulphate. — Origin. — It  is  prepared  by  mixing  an 
aqueous  solution  of  Cinchonine  Sulphate  with  an  aqueous  solution  of  Iodine  and  Potas- 
sium Iodide,  and  washing  and  drying  the  resulting  precipitate. 

Description  and  Properties. — It  occurs  as  a  light  reddish-brown  powder,  insoluble  in 
water,  but  soluble  in  alcohol  and  chloroform.     It  contains  about  50  per  cent,  of  iodine. 

Dose. — 1-3  grains  (0.06-0.2  Gm.). 

Arfatol^^Dithymol  Di-iodide. — Origin. — It  is  obtained  by  adding  a  solution  of 
iodated  Iodide  of  Potassium  to  an  aqueous  solution  of  Hydrate  of  Sodium  containing 
thymol.  The  resulting  precipitate  is  washed  and  subsequently  dried  at  ordinary  tem- 
perature. 

Description  and  Properties. — A  dark,  brownish-red,  amorphous,  almost  tasteless 
powder,  of  a  slight,  pecuhar,  iodine-like  odor,  insoluble  in  water  and  glycerin,  sparingly 


328  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

soluble  in  alcohol,  but  readily  soluble  in  ether,  collodion,  and  chloroform.     It  is  also 
taken  up  by  fixed  oils,  petrolatum,  etc. 

Aristol  is  decomposed  by  heat  and  light,  and  it  should  be  kept  in  dark  amber- 
colored,  well-stoppered  bottles.     It  contains  45.8  per  cent,  of  iodine. 

Dose. — It  is  not  given  internally. 

Eiirophen. — Prepared  in  a  manner  analogous  to  that  of  preparing  aristol,  except 
that  isobutylorthocresol  is  used  in  place  of  thymol. 

Description  and  Properties. — An  amorphous,  yellow  powder,  having  an  odor  resem- 
bling safifron ;  soluble  in  ether,  chloroform,  and  fixed  oils ;  insoluble  in  water  and 
glycerin. 

It  is  permanent  in  dry  air,  but  when  moistened  with  water  resolves  into  iodine,  form- 
ing a  new  soluble  iodine  compound.  When  heated  to  110°  C.  (230°  F.)  it  melts, 
forming  a  clear  brown  liquid.     It  contains  27.6  per  cent,  of  iodine. 

Dose. — j-ij  grains  (0.016-0.09  G™-)-  ■"■'  '^  "^^<i  hypodermically  in  olive  oil,- and 
externally  in  the  form  of  an  ointment,  in  strengths  varying  from  3  to  10  per  cent. 

Antagonists  and  Incompatibles. — It  is  incompatible  with  the  preparations  of  mercury 
and  zinc,  with  metallic  oxides,  and  with  starch. 

lodol. —  Origin. — Obtained  by  the  interaction  of  Iodine  and  Pyrrol  (a  constituent  of 
mineral  oil)  in  Alcoholic  Solution  for  twenty-four  hours,  the  iodol  being  precipitated  upon 
the  addition  of  Water;  or  it  may  be  prepared  after  the  manner  of  preparing  aristol, 
except  that  Pyrrol  is  used  instead  of  Thymol.  j. 

Description  and  Properties. — It  is  a  pale-yellow  or  grayish-brown,  more  or  less 
crystalline,  bulky,  tasteless,  and  odorless  powder.  It  is  insoluble  in  water,  and  but 
slightly  soluble  in  diluted  alcohol.  It  is  soluble  in  alcohol  and  ether.  The  alcoholic 
solution  is  miscible  with  glycerin,  but  when  mixed  with  water  a  milky  precipitate  is 
formed. 

Iodol  contains  88.97  P^"^  cent,  of  iodine. 

Dose. — 1|— 2  grains  (0.03-0.12  Gm.). 

Losophene . —  Origin. — Prepared  by  slowly  adding  an  aqueous  solution  of  Iodine  and 
Iodide  of  Potassium  to  an  aqueous  solution  of  Ortho-oxyparatoluic  Acid  and  Sodium  Bicar- 
bonate.    The  precipitate  formed  is  washed  with  Water  and  recrystallized  from  Alcohol. 

Description  and  Properties. — It  occurs  as  colorless,  odorless,  needle-shaped  crystals. 
Insoluble  in  water  and  alcohol,  but  readily  soluble  in  ether,  benzene,  chloroform,  and 
fixed  oils. 

It  contains  78.39  per  cent,  of  iodine. 

Dose. — It  is  used  externally. 

Sozoiodol.— 0?7;g-OT.— A  combination  of  Iodine  54  per  cent..  Carbolic  Acid  20  per 
cent.,  and  Sulphur  7  per  cent. 

Description  and  Properties.— 'Dx^  sodium,  potassium,  ammonium,  mercury,  lead,  and 
zinc  salts  of  this  acid  ai-e  the  preparations  used,  the  sodium  salt  being  the  one  most 
commonly  employed.  The  sodium  sozoiodolate  occurs  in  bright, .prismatic,  needle-shaped 
crystals.     Soluble  in  water,  alcohol,  and  glycerin. 

Dose. — For  external  use,  in  strengths  varying  from  3  to  20  per  cent. 

Sulphaminol.— Orz;fz«.— It  is  formed  by  the  action  of  Sulphur  on  the  salts  of  Meta- 
oxydiphenylamine. 

Description  and  Properties. — It  is  a  yellow  powder,  insoluble  in  water,  readily  solu- 
ble in  alkalies,  alcohol,  and  glacial  acetic  acid. 

Dose. — 1-4  grains  (0.006-0.25  Gm.). 

Antagonists  and  Incompatibles. — Iodoform  is  incompatible 
with  mercuric  chloride. 


ANTISEPTICS.  329 

Physiological  Action. — Externally  and  Locally. — Iodoform  or- 
dinarily possesses  no  irritating  action  when  applied  to  the  skin  or 
mucous  membranes,  or  to  ulcers  and  wounds.  On  the  contrary, 
it  possesses  analgesic  properties.  It  Has  a  tendency  to  check  serous 
oozing  when  applied  to  wounds. 

Internally. — Digestive  System. — Small  doses,  if  they  have  any 
effect,  slightly  increase  the  appetite,  and  tend  to  increase  the  sali- 
vary, biliary,  and  intestinal  secretions.  Large  doses  disturb  the 
stomach,  and  may  occasion  nausea,  vomiting,  and  diarrhea. 

Circulatory  System. — Small  doses  retard  and  strengthen  the 
pulse,  and,  for  a  brief  period  only,  increase  arterial  tension.  Full 
medicinal  doses  lessen  arterial  tension  and  render  the  pulse  slower 
and  weaker.  Lethal  doses  rapidly  accelerate  the  pulse,  causing  it 
to  become  irregular ;  later,  the  action  of  the  heart  is  slowed,  and 
finally  arrested  in  diastole,  from  paralysis  of  the  cardiac  muscle. 

Nervous  System. — Large  doses  are  apt  to  produce  headache, 
restlessness,  delirium,  or  stupor.  The  reflexes  may  be  depressed, 
or  in  some  cases  choreic  movements  may  appear.  Muscular  con- 
tractility and  the  excitability  of  the  nerve-trunks  to  external  stimu- 
lation are  lessened. 

Respiratory  System. — Very  large  doses  produce  convulsive  res- 
piratory movements. 

Absorption  and  Elimination. — Iodoform  is  absorbed  from  the  stom- 
ach, or  from  mucous  membranes  or  wounds  to  which  it  is  applied. 
It  is  slowly  absorbed  from  the  alimentary  canal,  but  readily  absorbed 
from  wounds.  It  is  ehminated  in  all  the  secretions,  and  has  been 
detected  in  the  urine  and  saliva  within  one  hour  after  its  administra- 
tion, traces  of  it  being  perceptible  in  the  secretions  for  three  days. 
'  Iodine  is  liberated  at  the  points  of  elimination,  either  as  an  iodate  or  as 
some  organic  compound  of  iodine,  or  both.  The  drug  is  also  detected 
in  the  breath,  though  it  is  chiefly  eliminated  in  the  urine  as  alkaline 
sodium  iodate,  coloring  the  urine  yellow.  It  should  be  remembered 
that  iodoform  is  absorbed  much  more  rapidly  than  it  is  eliminated. 

Temperature. — Large  doses  cause  a  rise  of  temperature,  while 
poisonous  doses  may,  at  the  last,  produce  a  decided  reduction  of 
animal  heat. 

Untoward  Action. — Sometimes  iodoform  excites  an  eczematous 
eruption,  which  may  be  papular  or  erythematous,  and  symptoms  of 
vertigo.  Muscular  weakness  and  double  vision  have  also  been 
observed ;  sleepiness,  alternating  with  excitement ;  incoherence  of 
speech;  headache;  mental  confusion;  and  amblyopia. 


330  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Poisoning. — Three  forms  of  poisoning  by  iodoform  are  described 
by  Duret — the  eruptive,  the  cerebral,  and  the  syncopal. 

In  the  first  of  these  there  may  be  a  severe  and  extensive  ery- 
thema or  eczematous  eruption.  The  cerebral  variety  is  character- 
ized by  rapid  increase  of  temperature  and  accelerated  pulse — as 
high  as  150  or  175  per  minute;  great  irritation  of  the  gastro-intes- 
tinal  tract ;  widely  dilated,  or  motionless  and  contracted,  pupils ; 
intense  headache  over  the  entire  circumference  of  the  head ;  mel- 
ancholia; great  depression  of  spirits;  hallucinations  and  active 
delirium  or  suicidal  mania. 

In  the  syncopal  variety  the  patient  complains  of  dizziness  and 
mental  confusion ;  is  languid  and  weak ;  the  heart's  action  becomes 
very  rapid  and  feeble,  the  patient  passing  at  length  into  a  lethargic 
or  comatose  condition,  with  paralysis  of  the  sphincters,  and  finally 
dying,  perhaps  quite  suddenly. 

The  symptoms  of  poisoning  may  appear  soon  after  the  applica- 
tion of  the  drug,  or  they  may  be  deferred  for  days  and  even  weeks. 
In  the  latter  case,  which  may  properly  be  termed  chronic  poison- 
ing, the  patient  is  more  apt  to  be  melancholy,  weak,  and  apathetic, 
with  slight  fever  and  accelerated  pulse.  Old  people  are  the  more 
susceptible  to  its  toxic  influence. 

Treatment  of  Poisoning. — Every  particle  of  the  drug  should  be 
immediately  removed  from  the  body  or  its  internal  administration 
be  discontinued  at  once.  Stimulants,  diaphoretics,  and  diuretics 
should  be  given,  with  frequent  bathing  of  the  body  in  warm  water, 
to  hasten  elimination.  Opium  and  large  doses  of  potassium  bicar- 
bonate have  been  recommended. 

Therapeutics. — Externally  and  Locally. — Iodoform  acts  as  an 
alterative,  analgesic,  protectant,  antiseptic,  and  germicide  to  at  least 
some  forms  of  bacilli.  It  is  therefore  one  of  the  best  applications 
to  wounds,  ulcers,  etc.  It  is  especially  valuable  in  the  treatment  of 
tubercular  affections,  such  as  tubercular  joints,  when  it  is  used  in 
the  form  of  an  injection — 10  to  20  per  cent. — in  sterilized  olive  oil. 
In  tubercular  parenchymatous  synovitis  the  mixture  is  injected  di- 
rectly into  the  joint-cavity.  RinonapoH  recommends  a  10  per 
cent,  ethereal  solution  in  malignant  pustule,  injected  hypodermically 
into  the  base  of  the  tumor ;  while  Terrier  and  Mosetig  von  Moorhof 
have  both  used  it  successfully  in  parenchymatous  goiter. 

Iodoform  is  an  exceedingly  valuable  application  to  syphilitic 
ulcers,  chancres,  chancroids,  suppurating  buboes,  ulcerations  of  the 
uterus,  uterine  cancer,  and  indolent  and  irritable  ulcerations  of  the  leg. 


ANTISEPTICS.  331 

Incorporated  in  a  suppository,  it  is  very  efficacious  in  painful 
hemorrhoids,  fistula,  and  fissure  of  the  anus. 

It  is  a  valuable  application  in  many  diseases  of  the  ear,  nose, 
throat,  eye,  and  skin  where  a  drug  of  this  character  is  indicated. 

Internally. — Iodoform  is  used  but  very  little  internally,  although 
it  has  been  employed  in  phthisis,  hemoptysis,  syphilis,  catarrhal 
jaundice,  hepatic  cirrhosis,  gastric  catarrh,  diabetes,  and  as  an  intes- 
tinal antiseptic. 

The  allied  compounds  mentioned  above  are  used  locally  as  sub- 
stitutes for  iodoform.  Most  of  them  possess  the  great  advantage 
of  being  odorless,  and  some  of  them  seem  to  be  in  all  respects 
quite  as  eiificient  as  iodoform.  Aristol  is  undoubtedly  superior  to 
it  in  the  treatment  of  indolent  ulcers  and  in  many  diseases  of  the 
skin,  ear,  nose,  and  throat.  Europhen  and  iodol  should  certainly- 
replace  iodoform  in  many  cases. 

Administration. — Internally,  iodoform  should  be  given  in  pills 
or  capsules.  Externally,  it  may  be  used  in  the  form  of  a  powder,, 
alone  or  mixed  with  powdered  borax  or  boric  acid.  It  is  also  used 
in  the  form  of  an  ointment  or  collodion.  It  is  given  hypodermi- 
cally,  mixed  with  olive  oil  and  glycerin,  or  dissolved  in  ether,  in 
strengths  varying  from  10  to  30  per  cent. 

Its  disagreeable  odor  may  be  modified  or  disguised  by  mixing 
it  with  tar,  liquid  styrax,  balsam  of  Peru,  thymol,  coumarin,. 
menthol,  ground  coffee,  oil  of  lavender,  bergamot,  bitter  almond, 
coriander,  musk,  vanilla,  or  some  similar  aromatic  and  pleasantly 
odorous  substance. 

BenzoTnum—BenzoTni— Benzoin.    JJ.  S.  JP. 

Origin. — A  balsamic  resin  obtained  from  Styrax  Benzoin  Dry- 
ander,  a  large  tree  indigenous  in  Sumatra  and  Java,  and  probably 
also  in  Cochin  China  and  Siam. 

Description  and  Properties. — Benzoin  exudes  from  incisions  in 
the  bark,  and  upon  exposure  to  the  air  hardens  into  lumps  con- 
sisting of  agglutinated,  yellowish-brown  tears,  which  are  internally 
milk-white,  or  in  the  form  of  a  reddish-brown  mass,  more  or  less 
mottled  from  whitish  tears  imbedded  in  it.  It  is  almost  wholly 
soluble  in  5  parts  of  moderately  warm  alcohol  and  in  solutions  of 
the  fixed  alkalies.  When  heated  it  gives  off  fumes  of  benzoic  acid. 
It  has  an  agreeable  balsamic  odor  and  a  slight  aromatic  taste. 

Benzoin  is  of  the  nature  of  a  balsam,  containing  from  20  to  24. 
per  cent,  of  benzoic  acid,  resin,  and  volatile  oil.     Some  varieties- 


332  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

contain  cinnamic  acid,  which  is  undesirable,  while  the  benzoin  from 
Siam  contains  vanillin  and  possesses  the  odor  of  vanilla. 
Dose. — Benzoin  is  never  administered  in  substance. 

Official  Preparations. 

Adeps  Benzoinatus — Adipis  Benzoinati — Benzoinated  Lard  (2  per  cent.). — 
For  external  use. 

Tinctura  Benzoin! — Tincturse  Benzoini — Tincture  of  Benzoin. — Dose,  30 
minims  to  I  fluidrachm  (2.0-4.0  Cc). 

Tinctiira  Benzoini  CompBsita — Tinctiirae  Benzoini  CompSsitse — Com- 
pound Tincture  of  Benzoin. — Benzoin,  2;  Aloes,  2;  Storax,  8;  Tolu,  4;  Alcohol, 
74  parts.     Dose,  \-2  fluidrachms  (2.0-8.0  Cc). 

Antagonists  and  Incompatibles. — The  tincture  and  compound 
tincture  are  incompatible  with  aqueous  preparations,  the  benzoins 
and  other  resins  and  balsams  being  precipitated  from  their  alcoholic 
solutions  by  water. 

Physiological  Action. — The  action  of  benzoin  is  due  to  the 
benzoic  acid  which  it  contains,  and  will  therefore  be  considered 
under  Benzoic  Acid. 

Acidum  Benzoicum— Acidi  Benzoici— Benzoic  Acid. 

V.  8.  I*. 

Origin. — An  organic  acid  usually  obtained  from  Benzoin  by 
sublimation,  or  prepared  artificially,  chiefly  from  Toluol. 

Description  and  Properties. — White  or  yellowish-white  lus- 
trous scales  or  friable  scales,  having  a  slight  characteristic  odor 
resembling  that  of  benzoin,  and  of  a  warm,  acid  taste ;  somewhat 
volatile  at  a  moderately  warm  temperature,  and  rendered  darker 
by  exposure  to  light.  Soluble  when  pure  in  about  500  parts  of 
water,  in  2  parts  of  alcohol  at  about  15°  C.  (59°  R),  in  15  parts 
of  boiling  water,  and  in  i  part  of  boiling  alcohol.  It  is  also  soluble 
in  3  parts  of  ether,  7  parts  of  chloroform,  and  readily  soluble  in 
carbon  disulphide,  in  benzol,  and  in  fixed  and  volatile  oils.  Sparingly 
soluble  in  benzin. 

Benzoic  acid  has  an  acid  reaction  and  is  inflammable.  It  should 
be  kept  in  dark  amber-colored,  well-stoppered  bottles  and  in  a  cool 
place. 

Dose. — 5-15  grains  (0.3-1.0  Gm.). 

Ammonli    Benzoas— Ammonii    Benzoatis— Ammo- 
nium Benzoate.    U.S.  P. 

Origin. — Dissolve  Benzoic  Acid  in  Water  of  Ammonia  and  Dis- 
tilled Water,  evaporate,  and  crystallize. 


ANTISEPTICS.  333 

Description  and  Properties. — Thin,  white,  four-sided  laminar 
crystals ;  odorless,  or  having  a  slight  odor  of  benzoic  acid ;  a  sa- 
line, bitter,  afterward  slightly  acrid  taste,  and  gradually  losing  am- 
monia on  exposure  to  air.  Soluble,  at  15°  C.  (59°  F.),  in  5  parts 
of  water,  in  28  parts  of  alcohol,  in  1.2  parts  of  boiling  water,  and 
in  7.6  parts  of  boiling  alcohol.  The  salt  is  neutral  or  has  a  very 
slight  reaction  upon  litmus-paper.  It  should  be  kept  in  well- 
stoppered  bottles. 

Dose. — 10-20  grains  (0.6-1.2  Gm.). 

Lithii  Benzoas— Lithii  Benzoatis— Lithium 
Benzoate.    JJ.  S.  P. 

Origin. — Prepared  by  decomposing  Lithium  Carbonate  with 
Benzoic  Acid. 

Description  and  Properties. — A  light  white  powder,  or  small, 
shining,  crystalline  scales ;  odorless  or  of  u  faint,  benzoin-like  odor, 
and  of  a  cooling,  sweetish  taste ;  permanent  in  the  air.  Soluble  in 
4  parts  of  water,  in  12  parts  of  alcohol,  in  2.5  parts  of  boiling  water, 
and  in  10  parts  of  boiling  alcohol.  The  presence  of  sodium  ben- 
zoate increases  the  solubility  in  water  and  lessens  it  in  alcohol. 
The  aqueous  solution  (i  in  20)  of  lithium  benzoate  has  a  faintly 
acid  reaction  upon  litmus. 

Dose. — 5-20  grains  (0.3-1.2  Gm.). 

Sodil   Benzoas— Sodii   Benzoatis— Sodium 
Benzoate.     U.  S.  JP. 

Origin. — Prepared  by  decomposing  Sodium  Carbonate  with 
Benzoic  Acid. 

Description  and  Properties. — A  white  amorphous  powder, 
odorless  or  having  a  faint  odor  of  benzoin  and  a  sweetish,  astrin- 
gent taste.  Soluble  in  1.8  parts  of  water,  in  45  parts  of  alcohol, 
in  1.3  parts  of  boiling  water,  and  in  20  parts  of  boiling  alcohol. 
The  aqueous  solution  is  neutral  to  litmus-paper.  It  is  efflorescent, 
and  should  be  kept  in  well-stoppered  bottles. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Allied  and  Unofficial  Preparations. 

Bismuthi  Bfinzoas — Bismuthi  Benzoatis — Benzoate  of  Bismuth. 
Menthol  Bgnzoas— MSnthol  Benzoatis— Benzoate  of  Menthol.— For  exter- 
nal use. .  

Antagonists  and  Incompatibles. — Benzoic  acid  is  incompatible 


334  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

with  the  alkaline  salts,  as  those  of  sodium,  etc.,  and  ammonium 
BENZOATE  is  incompatible  with  the  ferric  salts. 

Physiological  Action. — Externally. — When  applied  in  a  con- 
centrated form  to  the  skin  or  mucous  membrane  benzoic  acid  is  an 
irritant,  and  produces  a  catarrhal  condition  of  the  bronchial  mucous 
membrane  when  its  vapors  are  inhaled,  It  is  a  powerful  antiseptic 
and  germicide,  preventing  the  growth  of  putrefactive  bacteria  in 
a  solution  of  i  :  looo. 

Internally. — Digestive  System. — In  full  medicinal  doses  benzoic 
ACID  irritates  the  throat  and  produces  a  sense  of  heat  in  the  epi- 
gastrium. Very  large  doses  may  occasion  gastric  inflammation, 
with  nausea  and  vomiting.  The  functional  activity  of  the  liver  is 
stimulated  by  sodium  benzoate. 

Circulatory  System. — In  large  doses  benzoic  acid,  increases  the 
pulse-rate  to  a  marked  extent,  and  is  a  stimulant  to  the  entire 
circulatory  apparatus. 

Respiratory  System. — It  is  a  powerful  stimulant  in  moderate 
medicinal  doses,  increasing  the  respiratory  movements  and  promot- 
ing the  bronchial  secretion. 

Absorption  and  Elimination. — It  is  eliminated  chiefly  by  the 
kidneys,  but  also  by  the  skin,  salivary  glands,  and  broncho-pul- 
monary mucous  membrane. 

The  important  action  of  benzoic  acid  is  the  change  it  undergoes 
in  the  kidneys,  being  converted  into  hippuric  acid,  in  combination 
with  glycocoll,  at  the  expense  of  the  urea.  This  change  takes 
place  only  in  the  kidneys,  and  the  hippuric  acid  formed  renders 
alkaline  urine  acid,  besides  increasing  the  urinary  flow  and  disin- 
fecting and  stimulating  the  genito-urinary  tract. 

Temperature. — Like  other  members  of  this  group,  the  acid,  as 
well  as  its  salts,  possesses  antipyretic  properties,  many  observers 
holding  it  to  be  equal,  if  not  superior,  to  salicylic  acid  in  this 
respect.  It  is  not  yet  known  in  what  manner  it  reduces  temper- 
ature. 

Untoward  Actio7i. — Benzoic  acid  sometimes  produces  urticaria 
or  an  erythematous  condition  of  the  skin. 

Therapeutics. — Externally  and  Locally. — The  compound  tinc- 
ture OF  benzoin  is  an  admirable  preparation  for  many  conditions 
requiring  antiseptic,  astringent,  and  stimulating  dressing.  It  is  fre- 
quently applied  to  cutaneous  wounds,  the  alcohol  evaporating  and 
leaving  upon  the  injured  parts  a  protective  film  of  balsams.  A 
piece  of  lint  or  absorbent  cotton  saturated  with  the  compound 


ANTISEPTICS.  335 

tincture  has  been  used  to  close  the  punctures  in  the  skin  after 
tenotomy. 

Stille  recommends  a  combination  of  the  compound  tincture  of 
benzoin  and  glycerin  for  the  treatment  of  chapped  hands  and  lips, 
frost-bite,  znd  fissured  and  chapped  nipples. 

R.  W.  Taylor  treats  "  ringworm  of  the  thighs  "  by  painting  the 
affected  part  with  a  mixture  of  bichloride  of  mercury  and  com- 
pound tincture  of  benzoin,  2-5  grains  to  i  ounce  (0.12-03  to  30.0 
Cc). 

The  compound  tincture,  diluted  with  water  in  various  propor- 
tions, makes  an  efficient  application  in  catarrhal  affections  of  the 
pharynx  and  larynx,  either  in  the  beginning  of  an  inflammation  or 
during  the  relaxed  condition  which  so  often  accompanies  the  ter- 
mination of  an  acute  attack.  The  hoarseness  of  vocalists  and  public 
speakers,  the  result  of  excessive  strain  upon  the  vocal  cords,  is 
frequently  relieved  by  this  remedy. 

Inhalations  of  benzoin  are  a  popular  and  frequently  effective 
method  of  treating  acute  catarrhal  inflammation  of  the  upper 
respiratory  passages. 

The  cough  and  expectoration  of  chronic  bronchitis  and  chronic 
phthisis  are  eased  and  lessened  by  inhaling  night  and  morning  a 
drachm  (4  Gm.)  of  benzoic  acid,  added  to  boiling  water. 

A  preparation  like  the  following  is  an  efficient  and  agreeable 
lotion  for  irritative  forms  of  chronic  nasal  catarrh  : 

R.  Sodii  boratis,  aa.  gij  (60.0  Gm.) ; 

Acidi  benzoici,  gr.  x    (0.6  Gm.). — M. 

Fiat  pulvis  No.  I. 

Sig.  To  half  a  tumblerful  of  water  add  hall  --^  teaspoonful  each  of  the  powder  and 
glycerin.     Use  freely  as  a  lotion. 

The  simple  tincture  of  benzoin  is  an  excellent  application  to 
spongy  gums.  There  is  much  evidence  of  the  efficiency  of  bismuth 
benzoate  as  a  dressing  for  chronic  or  sloughing  ulcers.  Specific 
sores,  chancroids  and  chancres  especially,  are  well  treated  by  dust- 
ing the  parts  with  the  benzoate  after  thoroughly  bathing  the  surface 
with  a  weak  solution  of  bichloride  of  mercury. 

Probably  the  most  important  therapeutic  action  of  benzoic  acid 
is  shown  in  the  treatment  of  cystitis  and  pyelitis  accompanied  by 
decomposing  and  alkaline  urine. 

The  uric-acid  diathesis  is  modified  by  this  drug  and  its  prepara- 
tions, particularly  by  the  lithium  benzoate.     Phosphatic  calculi 


33^  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

may  be  dissolved  by  the  prolonged  administration  of  ammonium: 
BENZOATE,  which  is  preferable  to  benzoic  acid  for  this  purpose.  In- 
continence of  urine,  if  due  simply  to  the  alkahnity  of  the  urine,  is 
relieved  by  the  same  remedy. 

Liegeois  has  employed  sodium  benzoate  as  a  cholagogue  with 
excellent  results.  He  associates  it  with  rhubarb.  He  also  states 
that  benzoate  of  sodium  favorably  modifies  the  pain  of  pharyngitis. 
Sodium  benzoate  is  an  excellent  substitute  for  sodium  saUcylate, 
being  especially  useful  in  the  septic  diseases.  It  is  equally  power- 
ful as  an  antiseptic  and  antipyretic,  though  slower  in  its  action  than 
sodium  salicylate.  Its  effects,  however,  are  more  permanent,  and 
innocuous. 

Administration. — Benzoic  acid  is  best  administered  in  pill  form 
or  in  capsules,  with  balsam  of  fir  or  Castile  soap  as  an  excipient. 
The  soluble  benzoates  may  be  given  in  solution  in  some  aromatic 
water  or  in  compressed  pills.  The  solution,  however,  is  preferable,, 
and  the  unpleasant  taste  may  be  well  disguised  by  a  little  spirit  of 
chloroform.  When  any  of  these  preparations  are  given  for  their 
action  upon  the  urinary  tract,  it  may  sometimes  be  advantageous . 
to  combine  them  with  a  urinary  sedative,  such  as  tincture  of  bella- 
donna or  hyoscyamus. 

MS^rrha—MS^rrhae— Myrrh.    TJ.  S.  JP. 

Origin. — A  gum-resin  obtained  from  Commiphora  Myrrha 
(Nees)  Engler,  a  shrub  or  small  tree  "  forming  the  chief  underwood 
of  the  Arabian  and  African  forests  along  the  shores  of  the  Red 
Sea." 

Description  and  Properties. — Roundish,  irregular  tears  or 
masses,  dusty  brownish-yellow  or  reddish-brown ;  fracture  waxy, 
somewhat  splintery,  translucent  on  the  edges,  sometimes  marked 
with  whitish  veins ;  odor  balsamic ;  taste  aromatic,  bitter,  and  acrid. 
It  contains  60  per  cent,  of  gum,  35  per  cent,  of  resin,  and  3  or  4 
per  cent,  of  a  volatile  oil  (myrrhol). 

Dose.— s-30  grains  (0.3-2.0  Gm.),  in  pills  or  emulsion. 

Official  Preparations. 

Mistura  Fgrri  Comp6sita— Misturae  F6rri  Compasitffi— Compound  Iroa 
Mixture.— .Dot^,  1-2  fluidounces  (15-60  Cc). 

Pllulse  Aloes  et  Myrrhae— Pllulas  (ace.)  Aloes  et  Myrrhae— Pills  of  Aloes 
and  Myrrh. — Dose,  2  to  s  pills. 

Tinctura  Aloes  et  Myrrhae— Tincture  Aloes  et  Myrrhae— Tincture  of  Aloes 
and  Myrrh  (lo  per  cent.).— Z)m^,  \-2.  fluidrachms  (2-8  Cc). 


ANTISEPTICS.  337 

Tinctura  Mjrrrhae — Tincturse  Myrrhse — Tincture  of  Myrrh  (20  per  cent.). — 
Dose,  15-60  minims  (1-4  Cc). 

Physiological  Action. — Myrrh  is  astringent,  disinfectant,  slightly 
antiseptic,  and  stimulant.  Its  action  resembles  that  of  the  aro- 
matics,  stimulating  the  appetite  and  acting  as  a  carminative,  exces- 
sive doses  causing  nausea  and  vomiting.  It  increases  the  number 
of  white  blood-corpuscles,  and  is  a  stimulant  to  the  circulation. 

The  drug  is  eliminated  by  the  mucous  membranes  generally,  aug- 
menting and  disinfecting  their  secretions.  It  possesses  emmena- 
gogue  properties. 

Therapeutics. — As  a  stimulant  and  astringent  myrrh  is  service- 
able as  a  mouth-wash  in  ptyalism  and  spongy  gums  and  in  ozena. 
It  is  useful  as  a  gargle  in  pharyngitis,  relaxed  throat,  etc.,  and  as  an 
injection  in  leucorrhea,  the  latter  disease,  as  well  as  cystitis,  being 
favorably  influenced  by  the  internal  administration  of  the  drug.  It 
has  been  used  internally,  with  considerable  success,  as  a  stimulant 
expectorant  in  bronchorrhea  and  chronic  bronchitis,  and  as  a  stom- 
achic in  atonic  dyspepsia. 

Administration. — Myrrh  may  be  given  internally  in  the  form 
of  an  emulsion  or  pills.  The  tincture,  either  in  full  strength  or 
diluted,  is  chiefly  employed  externally. 

Baisamum  Peruvianum— Balsami  Peruvian!— Bal- 
sam of  Peru.    TJ.  S.  JP. 

Origin. — A  balsam  obtained  from  Toluifera  Pareirce  (Royle) 
Baillon,  a  tree  growing  in  Brazil  and  near  the  west  coast  of  South' 
America. 

Description  and  Properties. — A  liquid  having  a  syrupy  con- 
sistence, free  from  stringency  or  stickiness,  of  a  brownish-black 
color  in  bulk,  reddish-brown  and  transparent  in  thin  layers,  of  an 
agreeable,  vanilla-like,  somewhat  smoky  odor,  and  a  bitter  taste, 
leaving  a  persistent  after-taste.  On  exposure  to  air  it  does  not 
become  hard.     It  is  completely  soluble  in  5  parts  of  alcohol. 

The  drug  contains,  among  other  substances,  benzoic  and  cin- 
namic  acids,  cinnamein  about  60  per  cent,  and  resin  32  per  cent. 

Dose. — 8-30  minims  (0.5-1.84  Cc). 

Physiological  Action. — Its  properties  are  similar  to  those  of 
myrrh,  its  action  being  almost  analogous. 

Therapeutics. — In  various  cutaneous  disorders  balsam  of  Peru 
is  very  efficient,  being  employed  in  pruritus  vulvce,  eczema,  scabies, 
ringworm,  etc.     It  is  remarkably  efficacious  as  an  application  to 

23 


338  A  TEXT-BOOK  OF  MATERIA   MEDICA. 

cracked  nipples,  cracked  lips,  indolent  sores,  bed-sores,  etc.,  and  is 
also  serviceable  in  certain  diseased  conditions  of  the  nose  and 
throat,  such  as   atrophic  rhinitis  and  tonsillar  diphtheria. 

As  a  stimulant  expectorant  the  drug  is  efficient  in  chronic  bron- 
chitis, being  regarded  by  some  physicians  as  of  great  service  in 
phthisis  pulmonalis.  Like  myrrh,  balsam  of  Peru  has  been  used 
to  some  extent  as  a  stomachic  carminative  and  tonic. 

Administration. — It  is  best  given  in  an  emulsion  or  in  glycerin. 

Eucalyptus— Eucalypti— Eucalyptus.    U.  S.  I*. 

Origin. — The  leaves  of  Eucalyptus  globulus  Labillardiere,  col- 
lected from  the  older  part  of  the  tree.  The  blue-gum  tree  is  a  rapid 
grower,  attaining  a  height  of  200  to  300  feet  (60-90  M.).  It  is 
native  to  Australia,  but  is  cultivated  in  various  portions  of  Europe, 
Africa,  and  the  United  States  with  the  view  of  rendering  malarial 
districts  habitable  by  its  antiseptic  exhalations. 

Description  and  Properties. — Petiolate,  lanceolate,  scythe- 
shaped,  from  6  to  12  inches  (15-30  Cm.)  long,  rounded  below, 
tapering  above,  entire,  leathery,  grayish-green,  glandular,  feather- 
veined  between  the  midrib  and  marginal  veins ;  odor  strongly  cam- 
phoraceous  ;  taste  pungently  aromatic  and  somewhat  cooling,  bitter, 
and  astringent. 

The  most  important  constituent  is  a  volatile  oil,  of  which  the 
leaves  yield  about  6  per  cent. 

Dose. — J-2  drachms  (2.0-8.0  Gm.). 

Official  Preparation. 

Extractum  Eucalypti  Fluidum — ExtrScti  Eucalypti  Fluidi— Fluid  Extract 
of  Eucalyptus. — Dose,  5-60  minims  (0.3-4.0  Co.). 

Oleum  Eucalypti— Olei  Eucalypti— Oil  of  Eucalyp- 
tus.    V.  S.  JP. 

Origin.— A  volatile  oil  distilled  from  the  fresh  leaves  of  Euca- 
lyptus globulus  Labillardiere,  E.  oleosa  F.  v.  Miiller,  and  some 
other  species  of  the  genus. 

Description  and  Properties. — A  colorless  or  faintly  yellowish 
liquid,  having  a  characteristic,  aromatic,  somewhat  camphoraceous 
odor,  and  a  pungent,  spicy,  and  cooling  taste.  Soluble  in  all 
proportions  in  alcohol.  This  oil  consists  of  two  hydrocarbons 
(cymene  and  eucalyptene),  terpene,  and  a  substance  upon  which  its 
medicinal  value  depends — eucalyptol.     Oil  of  eucalyptus  should  be 


ANTISEPTICS.  339 

kept  in  well-stoppered  bottles,  in  a  cool  place,  protected  from 
light. 

Dose. — 5-15  minims  (0.3-1.0  Cc). 

EucalS^ptoI— Eucalyptol— Eucalyptol.     TJ.  S.  P. 

Origin. — A  neutral  body  obtained  from  the  volatile  oil  of 
Eucalyptus  globulus. 

Description  and  Properties. — ^A  colorless  liquid,  having  a  cha- 
racteristic, aromatic,  and  distinctly  camphoraceous  odor,  and  a  pun- 
gent, spicy,  and  cooling  taste.    Soluble  in  all  proportions  in  alcohol. 

Dose. — 5-10  minims  (0.3-0.6  Cc). 

Unofficial  Preparations. 

5qua  Eucalj^pti — Aqus  Eucalypti — Eucalyptus  Water. — Dose,  2-4  fluid- 
drachms  (7.39-15.0  Co.). 

Tinctura  Eucalj^pti — Tincturae  Eucalypti— Tincture  of  Eucalyptus. — Dose, 
1-4  fluidrachms  (3.7-15.0  Co.). 

Antagonists  and  Incompatibles. — Agents  promoting  waste  an- 
tagonize the  therapeutic  action  of  eucalyptus.  The  chemical  incom- 
patibles are  the  mineral  acids,  mineral  salts,  and  alkalies. 

Synergists. — The  vegetable  bitters,  aromatics,  antispasmodics, 
turpentine,  cubebs,  and  copaiba. 

Physiological  Action. — Externally  and  Locally. — Locally  ap- 
plied, the  oil  of  eucalyptus  and  eucalyptol  are  more  or  less  irritant, 
though  perhaps  less  active  than  many  volatile  oils.  In  contact  with 
mucous  membranes  or  injected  hypodermically,  they  cause  pain, 
and,  when  swallowed,  produce  a  burning  sensation  in  the  throat, 
stomach,  and  intestines. 

If  the  vapor  of  eucalyptus  be  confined  by  preventing  evapora- 
tion, vesication  and  pustulation  result,  the  drug  also  acting  as  a 
rubefacient.  Inhalation  affects  the  bronchial  mucous  membrane 
unfavorably,  the  beneficial  effects  of  the  remedy  residing  in  its 
properties  as  a  powerful  antiseptic  and  disinfectant.  It  is  also 
slightly  detergent  and  astringent. 

Internally. — Digestive  System. — Small  doses,  by  stimulating  the 
salivary  and  peptic  glands,  improve  the  appetite  and  digestion, 
while  peristalsis  is  increased,  the  drug  acting  as  a  mild  laxative. 
The  ingestion  of  large  amounts  may  occasion  anorexia,  nausea, 
vomiting,  and  perhaps  diarrhea,  although  the  driig  cannot  be  con- 
sidered an  active  emetic  nor  does  it  possess  marked  purgative 
properties. 


340  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Circulatory  System. — Like  quinine,  eucalyptus  arrests  the  ame- 
boid movements  of  the  white  blood-corpuscles.  It  resembles  that 
drug  also  in  its  reputed  property  of  contracting  the  enlarged  spleen. 
Medicinal  doses  of  eucalyptol  stimulate  the  heart,  increasing  the 
blood-pressure — probably  the  effect  of  reflex  action  from  the  stom- 
ach. The  arterial  tension,  however,  though  at  first  raised,  is  sub- 
sequently reduced,  the  pulse,  which  under  moderate  amounts  of 
the  drug  shows  an  increase  in  force  and  frequency,  being  lowered 
by  immoderate  dosage. 

Nervous  System. — Small  doses  stimulate  mental  activity.  Fre- 
quent accompaniments  of  large  doses  are  insomnia  in  the  healthy 
and  somnolence  in  debilitated  subjects,  and  under  certain  condi- 
tions cerebral  congestion,  owing  to  the  increased  quantity  of  blood 
sent  to  the  brain.  Large  or  toxic  doses  are  powerfully  depressant 
to  the  brain,  medulla,  and  spinal  cord,  abolishing  the  reflexes  and 
at  times  occasioning  loss  of  sensation  in  the  lower  hmbs.  "  In 
large  doses,  after  absorption,  it  seems  to  act  chiefly  on  the  nerve- 
centers,  producing  paralysis  and  death"  (Hare). 

Respiratory  System. — The  drug  tends  to  accelerate  the  respira- 
tory movements  under  small  or  moderate  dosage ;  poisonous  doses 
retard  the  breathing,  finally  arresting  it,  and  causing  death  by 
paralysis  of  respiration. 

Absorption  and  Elimination. — The  drug  acting  as  a  marked  diu- 
retic, it  is  natural  that  elimination  should  take  place  largely  by  the 
kidneys,  greatly  increasing  the  amount  of  urea.  The  skin,  bowels, 
and  bronchial  mucous  membrane  share  in  the  excretory  process, 
the  drug  acting  as  a  stimulant  to  the  structures  by  which  elimina- 
tion takes  place.  A  characteristic  odor — resembling  that  of  vio- 
lets—is imparted  to  the  urine,  breath,  and  discharges  from  the 
bowels.  Renal  congestion,  with  pain  in  the  region  of  the  kidneys,' 
is  occasionally  produced  by  very  large  doses  of  the  drug. 

Temperature. — Excessive  doses  result  in  a  fall  of  temperature. 
According  to  Schlager,  a  thermal  rise  succeeds  the  hypodermic 
injection  of  the  drug,  due  probably  to  local  irritation. 

Poisoning. — While  fatal  results  from  the  ingestion  of  large  doses 
are  recorded,  the  toxic  effects  of  eucalyptus  are  practically  confined 
to  the  lower  forms  of  animal  and  vegetable  life — infusoria,  crypto- 
gamia,  etc.  In  Gimbert's  experiments  upon  animals  it  was  noted 
that  the  heart  continued  to  beat  for  some  time  after  respiration  had 
ceased;  from  which  it  may  be  concluded  that,  since  the  motor 
nerves  and  muscles  retained  their  functional  activity  after  death. 


ANTISEPTICS.  341 

failure  of  mobility  and  reflex  power  is  due  to  central  action,  the 
drug  in  toxic  doses  being  a  paralyzant  to  the  spinal  cord  and  the 
medulla. 

Drowsiness,  shallow  breathing,  cardiac  weakness,  and  reduced 
arterial  pressure  are  common  results  of  poisonous  doses  of  euca- 
lyptus. 

Treatment  of  Poisoning. — The  stomach  should  be  emptied,  and 
the  treatment  should  include  the  administration  of  alkalies  or  some 
preparation  of  iron,  eliminants,  strychnine,  coffee,  and  diffusive 
stimulants. 

Therapeutics. — The  author  is  indebted  to  Prof  G.  Frank  Lys- 
ton,  M.  D.,  for  the  following  communication  in  regard  to  the  thera- 
peutics of  this  drug.  Dr.  Lyston's  experience  with  the  remedy, 
having  been  very  extensive,  lends  to  his  statements  authoritative 
weight;  he  is  therefore  quoted  verbatim-: 

"  Eucalyptus  is,  in  my  experience,  a  most  valuable  remedy  in 
chronic  inflammation  of  mucous  membranes.  In  nasopharyngeal 
catarrh  it  is  of  especial  value.  It  may  be  used  either  in  the  form 
of  spray  or  a  thin  ointment.  If  used  as  a  spray,  it  should  be  com- 
bined with  albolene  or  liquid  vaseline  in  the  proportion  of  15  to 
20  drops  (0.92-1.23  Cc.)  of  the  oil  of  eucalyptus  to  the  ounce 
(30  Cc.)  of  menstruum.  The  strength  may  be  considerably  in- 
creased as  tolerance  is  established.  The  most  eligible  preparation 
in  the  form  of  ointment  is  a  combination  of  oil  of  eucalyptus  with 
lanoline,  sufficient  albolene  being  added  to  liquefy  the  ointment. 
The  eucalyptus  may  be  used  in  this  manner  in  a  strength  of  30  to 
60  minims  (1.84-3.7  Cc.)  to  the  ounce  (32.0  Gm.).  The  action  of  the 
eucalyptus  is  mildly  stimulant  and  astringent  and  decidedly  anti- 
septic, 

"  Eucalyptus  has  proven  of  value  in  my  hands  as  a  local  applica- 
tion in  acute  and  chronic  skin  diseases.  In  simple  dermatitis  a  mild 
ointment  of  eucalyptus  is  quite  efficacious.  In  chronic  affections, 
such  as  some  forms  of  eczema  and  psoriasis,  a  strong  ointment  of 
eucalyptus,  or  even  the  pure  oil  itself,  may  in  some  cases  be 
applied  with  great  benefit. 

"  Eucalyptus  is  also  valuable  in  the  treatment  of  sluggishly 
granulating  wounds  and  ulcers.  In  gastro-intestinal  diseases  euca- 
lyptus is  of  great  value.  It  is  a  gastro-intestinal  antiseptic  of 
great  merit,  and  one  which  should  be  more  generally  used.  In 
certain  forms  of  diarrhea  due  to  the  development  of  toxines  in  the 
gastro-intestinal  tract  the  drug  is  a  most  valuable  remedy.     It  has 


342  A    TEXT-BOOK  OF  MA  TERIA  MEDIC  A. 

the  merit  of  marked  antiseptic  action  without  sufficient  astringent 
effect  to  interfere  with  the  normal  method  of  elimination  by  the 
bowel.  In  typhoid  fever  eucalyptus  is  in  my  opinion  more  strongly 
indicated  than  any  other  drug.  Inasmuch  as  salol  has  such  an 
enviable  reputation  as  an  intestinal  antiseptic,  it  might  be  well  to 
suggest  that  the  oil  of  eucalyptus  may  be  with  propriety  combined 
with  that  drug.  I  have  used  the  eucalyptus  alone  and  combined 
with  salol,  and  am  satisfied  that  either  way  is  better  than  the  use 
of  the  salol  alone. 

"  It  has  been  my  fortune  to  have  a  moderately  extensive  expe- 
.rience  in  the  use  of  eucalyptus  in  malarial  affections.  Diseases  of 
malarial  origin  are  infrequently  met  with  in  Chicago  and  its  im- 
mediate environs,  but  in  the  New  York  hospitals  at  the  time  I  was 
serving  as  interne  typical  malarial  affections  were  abundant.  I  ex- 
perimented at  that  time  quite  extensively  with  eucalyptus,  and 
found  that  the  drug  was  not  to  be  relied  upon  in  distinct  attacks 
of  acute  ague,  but  that  it  was  of  considerable  value  in  the  chronic 
forms  and  in  the  peculiar  lassitude  and  depression  with  which 
patients  who  were  not  affected  with  typical  malarial  exacerbations 
often  suffered. 

"  After  some  years'  experimentation  with  eucalyptus  I  have 
become  convinced  that  its  most  valuable  property  is  that  of  a 
urinary  antiseptic.  I  take  the  opportunity  of  repeating  here  what 
I  have  repeatedly  said  elsewhere,  that  eucalyptus  is  the  most 
reliable  urinary  antiseptic  at  our  command.  Careful  experimenta- 
tion and  clinical  observation  have  shown  me  that  in  eucalyptus  we 
have  a  remedy  which  greatly  lessens  the  dangers  of  genito-urinary 
surgery  by  lessening  or  entirely  removing  the  septic  propei-ty  of 
the  urine,  that  bete  noire  of  the  andrologist.  Boric  acid  and  salol 
have  in  my  experience  been  disappointing,  while  eucalyptus  has 
exceeded  my  anticipations.  My  method  of  administration  is  by 
capsule,  lo  minims  (0.6  Cc.)  of  the  oil  being  given  four  times  daily, 
beginning  several  days  before  the  operation.  The  only  disadvan- 
tage attending  the  use  of  eucalyptus  is  gastric  intolerance  on  the 
part  of  a  few  patients.  As  a  rule,  the  remedy  is  taken  without 
complaint,  but  occasionally  disagreeable  eructations  or  even  vomit- 
ing occurs.  By  preceding  the  remedy  with  a  large  draught  of  milk 
this  objection  may  usually  be  done  away  with.  In  some  cases  sus- 
pension of  the  remedy  for  a  few  hours  will  enable  the  stomach  to 
acquire  the  desired  toleration. 

"  In  the  administration  of  eucalyptus  much  depends  upon  the 


ANTISEPTICS.  343 

preparation  used.  Without  the  slightest  desire  to  advocate  unduly 
any  special  preparation,  but  simply  as  a  matter  of  information  to 
the  profession,  I  will  state  that  in  my  experience  the  preparations 
known  as  Tyndale's  are  the  most.,  reliable  and  elegant  upon  the 
market.  These  preparations  comprise  an  aqueous  solution,  an 
ointment,  and  an  oil,  the  latter  of  which  is  in  daily  use  in  my 
practice." 

The  foregoing  quotation  expresses  so  clearly  the  uses  of  euca- 
lyptus that  further  details  appear  unnecessary.  The  antiseptic 
properties  of  the  drug  are  not  sufficiently  realized  by  many  physi- 
cians. Schultz  claims  that  eucalyptus  as  an  antiseptic  is  three 
times  as  powerful  as  carbolic  acid,  and  that  as  an  agent  to  arrest 
suppuration  it  is  perhaps  fully  equal  to  quinine. 

As  a  stimulant  expectorant  eucalyptus  is  of  great  value,  equal- 
ling, if  not  being  superior  to,  any  other  remedy  in  bronchorrhea, 
pulmonary  gangrene,  and  fetid  bronchitis,  associated  or  not  with 
■phthisis.  Chronic  or  catarrhal  conditions  of  the  lungs  and  bronchi 
only  are  benefited  by  eucalyptus,  acute  affections  of  the  broncho- 
pulmonary mucous  membrane  contraindicating  its  use.  A  solution 
of  oil  of  eucalyptus  is  used  as  an  antiseptic  inhalation  in  diphtheria. 

Administration. — The  fresh  leaves  may  be  employed  as  poul- 
tices. Any  of  the  preparations  may  be  used,  but  for  internal  pur- 
poses the  oil,  or  eucalyptol,  is  preferable,  although  a  good  fluid 
extract  is  an  agreeable  form  of  the  medicine.  The  oil,  or  euca- 
lyptol, may  be  given  in  an  emulsion  or  in  capsules,  for  topical  use 
being  diluted  with  alcohol  or  oil  or  incorporated  in  suppositories  or 
ointments. 

Sodii  Boras— Sodii  Boratis— Sodium  Borate. 

V.  S.  I*. 

(Borax.) 

Origin. — Prepared  by  boiling  together  solutions  of  Boric  Acid 
and  Sodium  Carbonate,  the  borax  crystallizing  out.  It  is  also  found 
in  a  native  state  on  the  shores  of  certain  lakes  and  as  a  crystalline 
deposit  in  the  Borax  Lake  of  California. 

Desoription  and  Properties. — Colorless,  transparent,  mono- 
clinic  prisms,  or  a  white  powder,  inodorous,  and  of  a  sweetish, 
alkaline  taste;  slightly  efflorescent  in  warm,  dry  air;  soluble  in  i6 
parts  of  water  and  in  i  part  of  glycerin ;  insoluble  in  alcohol. 

Dose. — 5-30  grains  (0.32-2.0  Gm.). 


344  A.    TEXT- BOOK  OF  MATERIA  MEDIC  A. 

Acidum  Boricum— Acidi  Borici— Boric  Acid.  U.S.I*, 

(BoRACic  Acid.) 

Origin. — Found  native  in  Northern  Tuscany.  It  may  be  pre- 
pared by  the  action  of  Hydrochloric  Acid  on  Borax,  filtration,  and 
recrystallization. 

Description  and  Properties. — Transparent,  colorless  scales,  of 
a  somewhat  pearly  luster,  or,  when  in  perfect  crystals,  six-sided, 
triclinic  plates,  slightly  unctuous  to  the  touch,  odorless,  of  a  faintly 
bitterish  taste,  permanent  in  the  air.  Soluble  in  25.6  parts  of 
water,  15  parts  of  alcohol,  and  10  parts  of  glycerin.  The  addition 
of  hydrochloric  acid  increases  its  solubility  in  water. 

Dose. — 5-15  grains  (0.32-1.O  Gm.). 

Official  Preparation. 

Glycerltum  Boroglycerlni — Glycerlti  Boroglycerini-^-GIycerite  of  Boro- 
glycerin  (Glycerite  of  Glyceryl  Borate — Solution  of  Boroglyceride). — 
Boric  Acid,  310;  Glycerin,  to  1000.     For  external  use. 


Antagonists  and  Inoompatibles. — The  incompatibles  of  borax 
are  the  acids  and  metallic  salts.  Morphine  and  cocaine  are  pre- 
cipitated from  solution  by  borax.  Boric  acid  is  also  incompatible 
with  the  carbonates  and  bicarbonates,  and  with  the  alkaline,  earthy, 
and  metallic  bases. 

Synergists. — The  action  of  borax  is  enhanced  by  alkalies  and 
substances  promoting  waste ;  that  of  boric  acid,  by  the  .  anti- 
septics. 

Physiologioal  Action. — Externally  and  Locally. — Borax  is  ab- 
sorbent, protectant,  sedative,  and  antiseptic.  Applied  to  the  un- 
broken skin,  it  acts  upon  the  epidermis  as  a  soap.-  By  removing 
the  stimulus  to  secretion  and  lessening  irritation  borax  checks  the 
secretion  of  the  salivary  glands. 

Boric  acid  possesses  properties  similar  to  those  of  borax, 
although  more  of  an  antiseptic  and  antipruritic.  It  has  also  an 
exsiccant  and  detergent  influence.         v 

Internally. — In  a  general  way  the  action  of  borax  is  analogolis 
to  that  of  the  alkalies.  It  is  refrigerant  and  diuretic,  and  by  its 
immediate  action  upon  the  womb  serves  as  an  emmenagogue,  large 
doses  contracting  the  uterine  muscles  and  acting  as  an  ecbolic. 
Excessive  doses  of  either  of  these  drugs  act  as  gastro-intestinal 
irritants. 

Boric  acid,  though  stronger,  resembles  borax  in  its  action.   Both 


ANTISEPTICS.  345 

substances,  especially  boric  acid,  retard  the  action  of  saliva  upon 
starch,  increasing  that  of  the  pancreatic  juice  upon  albuminous 
substances,  and  increase  gastric  digestion.  Immoderate  doses  of 
BORIC  ACID  check  gastric  digestion. 

The  drug  is  a  moderate  antipyretic,  and  when  injected  in  large 
amounts  into  the  circulation  may  occasion  paralysis  of  the  motor 
nerves  and  muscles. 

Absorption  and  Elimination. — It  is  eliminated  by  the  saliva,  per- 
spiration, feces,  and  urine,  the  latter  being  increased  in  quantity. 
The  amount  of  nitrogen  and  solid  matter  excreted  with  the  feces 
is  also  increased,  as  well  as  the  elimination  of  urea  in  the  urine. 
Untoward  Action. — Boric  acid  has  occasioned  the  following 
untoward  symptoms :  frequent  desire  to  micturate ;  nausea,  vom- 
iting, and  other  gastric  disturbances ;  small,  weak  pulse ;  derange- 
ment of  the  nervous  system;  hiccough;  and  various  cutaneous 
eruptions. 

Poisoning. — The  symptoms  of  poisoning  are  analogus  to  those 
described  above. 

Treatment  of  Poisoning. — The  treatment  of  poisoning  should 
be  symptomatic,  stimulants,  morphine,  etc.  being  employed. 

Therapeutics. — Externally  and  Locally. — Both  of  the  above 
drugs  are  exceedingly  valuable  as  local  remedies  in  the  treatment 
of  many  disorders  of  the  ear,  nose,  and  throat,  such  as  acute  and 
chronic  nasal  catarrh,  pharyngitis,  gingivitis,  and  acute  hoarseness. 
An  efficient  domestic  remedy  in  aphthce  afifectiag  the  mouths  of 
nursing  children  is  a  mixture  of  borax  and  honey. 

An  invaluable  aseptic  application  in  acute  cotijunctivitis  is  a  sat- 
urated solution  of  boric  acid. 

Leucorrhea,  gonorrhea,  and  chronic  cystitis  are  greatly  benefited 
by  solutions,  in  various  strengths,  of  either  or  both  of  these  drugs. 
Sir  James  Simpson  recommends  a  solution  of  borax,  5-10  grains 
(0.32-0.6  Gm.)  to  I  ounce  (30.0  Cc.)  of  hot  water,  for  the  eruption 
occurring  on  the  mucous  membrane  of  the  vulva  in  young  girls. 

Since  the  introduction  of  boric  acid  as  an  antiseptic  by  Lister  in 
1872  it  has  steadily  grown  in  favor  in  this  respect,  being  univer- 
sally employed  to-day,  both  in  solution  and  in  the  powdered  form, 
for  the  numerous  conditions  requiring  an  agent  of  this  character. 
It  is  invaluable  as  a  bland,  unirritating  antiseptic  in  general  surgeiy, 
and  in  diseases  of  the  eye,  ear,  nose,  throat,  and  skin. 

It  is  perhaps  unnecessary  to  enumerate  the  multifarious  and 
efficient  uses  of  this  drug,  the  practising  physician  readily  recog- 


346  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

nizing  the  conditions  in  which  this  potent  remedy  may  be  advan- 
tageously employed. 

Internally. — Borax  is  used  internally  more  than  boric  acid. 
While  in  epilepsy  inferior  to  the  bromides,  there  are  cases  uninflu- 
enced by  the  latter  remedies  which  respond  favorably  to  borax. 

The  drug  has  been  employed  in  typhoid  fever,  though  with  little 
benefit.  Dr.  Sacaze  of  Montpelier  claims  to  have  greatly  improved 
a  case  of  paralysis  agitans  with  4-  to  8-grain  (0.25-0.5 1  Gm.) 
doses,  given  three  times  a  day. 

The  author  has  favorably  influenced  the  character  of  the  urine 
in  chronic  cystitis  by  5-grain  (0.3  Gm.)  doses  of  boric  acid  three 
times  a  day. 

These  drugs  have  been  used  internally  in  the  summer  diarrhea 
of  children. 

Administration. — The  remedies  may  be  given  in  capsules  or 
solution.  The  taste  of  borax  may  be  disguised  by  coffee,  syrup  of 
orange,  or  aromatic  elixir  of  liquorice,  the  drug  not  being  admin- 
istered with  glycerin,  lest  an  acid  reaction  occur. 

Potassii  Permanganas— Potassii  Permanganatis— 
Potassium  Permangranate.     V.  8.  JP. 

Origin. — Obtained  by  heating  together  Caustic  Potash,  Potas- 
sium Chlorate,  and  Manganese  Dioxide.  The  potassium  manga- 
nate  formed  is  converted  into  the  permanganate  by  boiling  it  in 
water. 

Description  and  Properties. — Slender,  monoclinic  prisms,  of 
a  dark-purple  color,  almost  opaque  by  transmitted  light,  and  of  a 
blue,  metallic  luster  by  reflected  light ;  odorless,  with  at  first  a  sweet 
and  afterward  a  disagreeable  and  astringent  taste ;  permanent  in  the 
air;  soluble  in  16  parts  of  water.  In  contact  with  alcohol  it  is 
decomposed. 

Potassium  permanganate  should  be  kept  in  glass-stoppered  bot- 
tles, protected  from  light,  and  should  not  be  brought  in  contact 
with  organic  or  readily  oxidizable  substances. 

Dose. — 1-2  grains  (0.03-0. 1 2  Gm.),  as  a  pill. 

Antagonists  and  Incompatibles. — Organic  matter  easily  deox- 
idizes it,  causing  an  explosion. 

Synergists. — Theoretically,  the  antiseptics  would  enhance  its 
antiseptic  action. 

Physiological  Action. — Potassium  permanganate  is  employed 
as  an  antiseptic  and  oxidizing  agent  in  certain  diseases,  both  the 


ANTISEPTICS.  347 

internal  and  external  use  of  the  drug  having  proved  beneficial. 
The  peculiar  property  of  the  remedy  is  its  readiness  to  part  with 
oxygen,  and  its  consequent  availability  as  an  agent  in  the  destruc- 
tion of  deleterious  organisms.  Brunton  asserts  that  "  when  mixed 
with  cobra-poison  it  completely  destroys  the  deadly  power  of  the 
latter,  and  the  mixture  may  be  injected  subcutaneously  without 
any  bad  effect,"  though  he  adds  that  as  an  antidote  it  is  unservice- 
able, since  it  does  not  come  in  contact  with  the  venom  in  the  tissues. 

In  rare  instances,  it  is  asserted,  potassium  permanganate  has 
occasioned  a  vesicular  eruption  not  unlike  eczema.  It  is  at  times 
decidedly  caustic. 

Therapeutics. — Externally  and  Locally. — In  concentrated  solu- 
tions or  in  substarice  it  is  a  mild  escharotic.  Its  readiness  to  part 
with  ogygen  renders  it  of  great  value  as  a  deodorant,  and  in  dilute 
solutions,  I  to  5  grains  (0.06  to  0.32  Gm.)  to  i  ounce  (30  Cc.)  of 
water,  it  is  a  useful  application  to  foul  ulcers,  cancer  of  the  uterus, 
vagina,  etc.  A  solution  of  this  drug  is  employed  for  various  pur- 
poses as  an  antiseptic,  germicide,  and  deodorant,  in  the  treatment 
of  gonorrhea,  leucorrhea,  diphtheria,  putrid  sore  throat,  ozena,  naso- 
pharyngeal catarrh,  cancer  of  the  tongue,  and  syphiltic  ulcers. 

A  weak  solution  of  potassium  permanganate  is  an  efficient  ap- 
plication in  bromidrosis,  and  a  i :  2000  or  i  :  5000  solution  is  recom- 
mended by  Dr.  Terson  in  purulent  ophthalmia.  Potassium  per- 
manganate should  not  be  used  as  an  antiseptic  in  the  peritoneal 
cavity,  on  account  of  its  irritating  properties. 

It  is  employed  extensively  in  surgical  practice  for  washing  the 
hands  and  utensils. 

Internally. — Like  iron,  potassium  permanganate  has  been  em- 
ployed in  anemia,  although  far  inferior  to  the  former  drug.  Favor- 
able reports  are  given  regarding  its  value  in  gastric  fermentation 
and  lithiasis. 

Dr.  Moor  of  New  York  recently  advocated  its  use  as  an  anti- 
dote to  morphine-poisoning.  Its  effect  here  is  the  same  as  in 
poisoning  from  the  bites  of  reptiles,  it  being  of  service  only  when 
the  drug  comes  in  contact  with  the  poison,  which  it  oxidizes  as  it 
does  any  other  organic  substance.  After  the  toxic  agent  has  en- 
tered the  circulation  the  remedy  is  of  no  value,  it  being  only  a 
chemical  antidote  for  morphine,  and  not  a  physiological  antagonist. 

Dr.  Moor  claims,  however,  that  potassium  permanganate  does 
not  possess  the  same  antidotal  power  over  certain  other  alkaloids, 
such  as  strychnine,  atropine,  cocaine,  aconitine,  etc.     Antal,  on  the 


348  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

other  hand,  maintains  that  the  drug  is  equally  serviceable  in  mor- 
phine- and  strychnine-,  as  well  as  muscarine-,  poisoning,  and  in  that 
resulting  from  toxic  doses  of  colchicum  and  oxalic  acid.  Dr.  Koosa 
believes  it  to  be  also  efficient  in  poisoning  from  hydrocyanic  acid, 
and  Dr.  Hognos  reports  very  favorably  as  to  its  antidotal  power  in 
poisoning  from  phosphorus,  having  treated  two  cases  successfully 
with  this  remedy. 

Recently,  Dr.  Fr.  Lanz  reports  interesting  statistics  of  Prof 
von  Jaksch's  clinic  in  which  phosphorus-poisoning  was  treated 
with  douches  of  potassium  permanganate,  the  death-rate,  however 
— 36.66  per  cent. — not  speaking  very  favorably  for  the  antidotal 
power  of  the  drug  in  connection  with  phosphorus. 

Administration. — For  internal  use  potassium  permanganate 
should  always  be  given  in  pill  form,  kaolin  being  used  as  an 
excipient,  lest  an  explosion  occur. 

Potassii  Bichromas— Potassii  Bichromatis— Potas- 
sium Bichromate.    V.  S.  I*. 

Origin. — Prepared  by  roasting  in  a  reverberatory  furnace  Potas- 
sium Carbonate  and  Chrome-iron  Ore,  with  the  addition  of  Lime 
or  Chalk  to  prevent  fusion.  The  potassium  bichromate  formed  is 
separated  by  crystallization  from  its  solution  in  water  acidulated 
with  sulphuric  acid. 

Description  and  Properties. — Large  orange-red,  transparent 
triclinic  prisms  or  four-sided  tables,  odorless,  and  having  a  bitter, 
metallic  taste.  Permanent  in  the  air;  soluble  in  10  parts  of  water; 
insoluble  in  alcohol. 

Dose. — ilo   I  grain  (0.0006-0.06  Gm.). 

Antagonists  and  Inoompatibles. — Potassium  bichromate  is  in- 
compatible with  soluble  salts  of  silver,  mercury,  and  lead,  and 
with  liquor  potassae,  liquor  sodae,  and  ammonia  water. 

Synergists. — ^Agents  promoting  waste,  antiseptics,  and  caustics. 

Physiological  Action. — Externally  and  Locally. — In  substance 
potassium  bichromate  is  an  irritant  caustic,  and,  according  to 
Miquel,  an  antiseptic  in  the  proportion  of  i   to  909. 

Internally. — Its  action  is  nearly  identical  with  that  of  potassium 
chlorate,  with  the  additional  properties  of  an  expectorant,  emetic, 
and  mild  alterative. 

Poisoning  and  treatment  of  poisoning  do  not  differ  essentially 
from  those  of  potassium  chlorate. 

Therapeutics. — Externally  and  Locally. — Potassium  bichromate 


ANTISEPTICS.  349 

is  used  as  a  caustic  for  warts,  corns,  chancres,  chancroids,  mucous 
patches,  etc.,  and  is  also  of  considerable  value  as  a  gargle  in 
pharyngnis. 

Internally. — Frazer  has  recently  recommended  this  drug  in  the 
treatment  Of  dyspepsia  and  gastric  ulcer,  claiming  that  the  pain, 
nausea,  vomiting,  and  tenderness  may  be  readily  allayed  by  doses, 
of  ^^g.  to  ^  grain  (0.005-0.01  Gm.),  taken  upon  an  empty  stomach 
fliree  fimes  a  day.  In  acute  gastric  ulcer  he  has  perceived  no 
benefit  so  far  as  its  effect  upon  the  hemorrhage  is  concerned,  the 
most  desirable  action  of  the  drug  in  the  latter  condition  being 
derived  from  its  antiseptic  and  analgesic  influence. 

The  author  desires  to  recommend  favorably  potassium  bi- 
chromate, in  doses  of  y^  grain  (0.0006  Gm.)  every  hour  or  two,  in 
aphonia  and  hoarseness  due  to  excessive  action  of  the  vocal  cords 
or  resulting  from  an  acute'^cold.  He  has  found  this  method  of 
treatment  peculiarly  and  spgKdily  efificacious. 


Pota.ssii  Chloras— Potassii  Chloratis— Potassium 
Chlorate.     JJ.  S.  P. 

Origin. — Prepared  by  passing  Chlorine  into  a  mixture  of  Potas- 
sium Carbonate  and  Slaked  Lime.  By  subsequent  boiling  in 
water  the  chlorate  separates  by  crystallization. 

Description  and  Properties. — Colorless,  lustrous,  monpclinic 
prisms  or  plates,  or  a  white  powder,  odorless,  and  having  a  cool- 
ing, saline  taste;  permanent  in  the  air;  soluble  in  16.7  parts  of 
water ;  insoluble  in  absolute  alcohol.  Potassium  chlorate  should  be 
kept  in  glass-stoopered  bottles.  Great  caution  should  be  observed 
in  handling  the  salt,  since  dangerous  explosions  are  liable  to  occur 
when  it  is  mixed  with  organic  matters — cork,  tannic  acid,  sugar, 
etc. — or  with  sulphur,  antimony  sulphide,  phosphorus,  or  other 
easily  oxidizable  substance,  or  upon  being  either  heated  directly  or 
subjected  to  tritui-ation  or  concussion. 

Dose. — 3-20  grains  (0.2-1.3  Gm.). 

Official  Preparation. 

Trochfeci  Potassii  Chloratis  —  Trochlscos  (ace.)  PotSssii  Chloratis  — 
Troches  of  Potassium  Chlorate.— Each  troche  contains  5  grains  (0.32  Gm). 
Dose,  I  to  4  troches. 

Antagonists  and  Incompatibles. — In  addition  to  those  sub- 
stances   mentioned   above  with  which  potassium  chlorate  forms 


35°  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

explosive  compounds,  mixture  with  glycerin  and  the  hypophos- 
phites  is  liable  to  produce  similar  dangerous  results. 

Synergists. — Agents  promoting  waste  increase  the  ^fctivity  of 
the  drug. 

Physiologioal  Action. — Externally  and  Locally. — It*  is  slightly 
detergent  and  stimulant,  antiseptic  and  astringent,  being  irritant 
when  applied  in  concentrated  solution  to  ulcerated  surfaces. 

Internally. — Digestive  System. — Medicinal  doses  have  no* effect ; 
poisonous  doses  excite  violent  gastro-intestinal  irritation,  nausea, 
bloody  vomiting,  diarrhea,  and  jaundice. 

Circulatory  System. — Small  doses  of  potassium  chlorate  tend 
to  depress  and  subsequently  raise  arterial  tension,  accelerating  the 
pulse ;  large  doses  lower  arterial  pressure  alarmingly ;  toxic  doses 
convert  the  hemoglobin  of  the  blood  into  methemoglobin,  the  dis- 
organized fluid  appearing  in  the  urine.  *Post-mortem  lesions  are — 
enlargement  of  the  liver,  spleen,  and.  kidneys,  with  evidences  of 
marked  inflammation  over  the  whole  intestinal  tract. 

Nervous  System. — Medicinal  doses  are  inert.  Toxic  doses  may 
produce  delirium  and  death,  preceded  by  coma  or  convulsions. 

Respiratory  System. — Large  doses  act  as  a  depressant  to  the 
respiratory  apparatus. 

Absorption  and  Elimination. — The  drug  is  absorbed  with  cc^- 
siderable  rapidity,  being  chiefly  eliminated  by  the  salivary  glands 
unchanged.  The  drug  does  not  increase  the  urinary  flow,  large 
doses,  on  the  contrary,  .tending  to  suppress  it. 

Temperature. — Unaffected  by  medicinal  doses,  but  lowered  by 
toxic  amounts. 

Untoward  Action. — Small  doses  of  potassiumgphlorate  seldom 
produce  untoward  symptoms,  although  in  rare  instances  eruptions 
of  an  erythematous,  papular,  or  vesicular  nature  have  followed  the 
use  of  the  drug.  Digestive  disturbances  occasionally  ensue,  with 
pain  in  the  region  of  the  kidneys  and  albuminuria. 

Poisoning. — In  the  few  recorded  cases  of  poisoning  there  were 
observed  a  continuous  sensation  of  choking,  excessive  thirst,  per- 
sistent vomiting,  pain  in  the  abdomen  and  renal  tract,  and  violent 
hiccough.  Accompanying  symptoms  were — a  small  and  rapid 
pulse  and  faintness,  while  the  urine  was  albuminous  and  diminished 
in  quantity;  epistaxis  was  present;  the  eyes  and  lips  were  cyanotic, 
and  the  skin  slightly  jaundiced  and  markedly  anemic;  the  liver  and 
spleen  were  slightly  enlarged  f  and  there  were  alternating  sensations 
of  cold  and  heat,  with^drowsiness  ending  in  coma  and  death. 


ANTISEPTICS.  3^1 

Treatment  of  Poisoning. — The  stomach  should  be  emptied  as 
quickly  as  possible  and  demulcents  administered.  The  patient 
should  be  treated  symptomatically,  and  it  may  be  advisable  to 
practice  venesection,  followed  by  transfusion  of  blood,  as  suggested 
by  Landerer. 

Therapeutics. — Externally  and  Locally. — A  solution  of  this 
drug  has  been  applied  with  some  success  in  foul  ulcers  and  moist 
eczemq.  Like  the  potassium  permanganate,  it  has  been  employed 
in  various  diseases  of  the  nose  and  throat,  and  is  especially  service- 
able in  ptyalism  and  aphthous  ulceration.  As  a  remedy  for  syphilitic 
mucous  patches  and  herpes  of  the  buccal  cavity  it  is  of  considerable 
value.     It  is  more  efficient  in  acute'than  in  chronic  pharyngitis. 

It  possesses  marked  cicatrizing  power,  advantage  of  which 
property  has  been  taken  in  the  treatment  of  phagedenic  sores,  the 
powdered  drug  being  used  for  this  purpose.  It  is  thought  that  ene- 
mas of  potassium  chlorate'sjlution  favor  the  healing  of  rMal  ulcers. 
*  Internally. — As  a  remedial  agent  this  drug  has  not  met  with  die 
success  prophesied  by  many  physicians.  Dr.  Coghill  of  England 
is  one  of  its  most  enthusiastic  champions,  the  drug  having  proved 
in  his  hands  highly  efficient  in  improving  the  quality  of  the  blood 
in  such  cases  as  simple  anemia,  chlorosis,  etc.,  as  well  as  in  "pul- 
monary insufficiency"  and  "deficient  oxygenation  of  the  blood." 
Other  physicians  have  recommended  it  as -a  valuable  galactagogue,  ' 
tonic,  and  alterative,  and  as  beneficial  in  certain  chronic  diseases  of 
the  skin,  scrofula,  etc.  It  has  found  some  advocates  as  a  genito- 
urinary antiseptic  and  as  a  remedy  in  typhoid  fever. 

Yet,  notwithstanding  the  extravagant,  though  isolated,  reports 
■concerning  theagreat  value  of  the  drug,  its  utility  has  not  be^n 
universally  recognized ;  indeed,  so  good  an  authority  as  Marchand 
declares  that  "  chlorate  of  potassium  shou^  be  entirely  rejected  in 
practice,  and  particularly  in  the  treatment  of  children." 

Administration. — It  may  be    given    in  the   form   of  troches, 
powder,  tablets,  or  a  solution,  an  agreeable  means  of  administra- 
tion being  in  aerated  water.     Owing  to  its  tendency  to  decomposi- 
tion when  combined  with  other  substances,  the  drug  should  be^' 
prescribed  alone. 
♦   _ 

Aqua  Hydrogenii  Dioxidi— Aquae  Hydrogenii  Diox- 
idi— Solution  of  Hydrogen  Dioxide.    TJ.  8.  P. 

Origin. — A  slightly  acid,  aqueous  solution  of  hydrogen  diox- 
ide, containing,  when  freshly  prepared,  ab^ut  3  per  cent,  by  weight 


3^2  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

of  the  pure  dioxide,  corresponding  to  about  lO  volumes  of  avail- 
able oxygen. 

Description  and  Properties. — A  colorless  liquid,  w^ithout  odor, 
slightly  acidulous  to  the  taste,  and  producing  a  peculiar  sensation 
and  a  soapy  froth  in  the  mouth ;  liable  to  deteriorate  with  age  or 
by -exposure  to  heat  or  protracted  agitation. 

Dose. — 1-4  fluidrachms  (3.7-15.0  Cc),  well  diluted  with^water. 

Physiological  Action. — Externally  aiid  Locally. — The  principal 
action  of  this  preparation  seems  to  be  its  property  of  imparting 
oxygen  to  all  oxidizable  substances,  it  being  one  of  the  most  pow- 
erful oxidizing  agents  in  Materia  Medica,  and  therefore  an  exceed- 
ingly active  non-toxic  antiseptic. 

When  applied  to  a  suppurating  surface,  or  when  mixed  with 
mucus,  cerumen,  or  blood,  active  effervescence  is  produced.  Hy- 
drogen dioxide  is  a  useful  detergent  and  bleaching  agent,  being 
employed*  largely  for  the  purpose  of  Bleaching  hair  and  delicate 
fabrics. 

Internally. — It  is  asserted  that  hydrogen  dioxide  yields  oxygen 
to  the  blood,  slightly  stimulates  the  nervous  system,  and  acts  as  a 
diuretic.  ^ 

Therapeutics. — Externally  and  Locally. — Hydrogen  dioxide  is 
extensively  employed  to  cleanse  diseased  surfaces,  such  as  ulcers, 
buboes,  fistulous  tracts,  etc.  It  has  been  highly  recommended  as  an 
antiseptic  in  abdominal  surgery.  As  an  antiseptic  wash  in  empyema, 
cystitis,  joint-cavities,  venereal  sores,  puerperal  septic  endometritis,  etc. 
hydrogen  dioxide  is  an  exceedingly  valuable  agent. 

Hydrogen  dioxide  appears  to  be  an  efficient  injection  in  gonor- 
rhea, and  is  much  used  as  an  antiseptic  in  mais^  diseases  of  the 
eye,  ear,  nose,  and  throat.  It  has  been  highly  recommended  as  a 
solvent  for  diphtheritic  Membrane,  although  when  frequently  applied 
to  the  throat  it  causes  an  unpleasant  sensation  of  dryness,  and  it 
seems  to  prevent  the  exfoliation  of  the  membrane  when  the  patient 
is  treated  with  antitoxine. 

Hydrogen  dioxide  serves  a  useful  purpose  in  disinfecting  drink- 
ing-water when  suspected  of  pollution,  i  part  sufficing  for  looo 
parts  of  water,  in  which  amount  the  taste  or  other  potable  quali- 
ties of  the  water  are  in  no  way  impaired.  ^ 

Internally. — While  hydrogen  dioxide  has  been  recommended 
in  epilepsy,  diabetes,  angina  pectoris,  pneumojiia,  asthma,  and  dyspnea 
due  to  deficient  circulation  of  blood  through  the  heart  and  lungs, 
the  results  following  the  internal  administration  in  these  diseases 


ANTISEPTICS.  353 

have  not  warranted  classing  the  drug  among  important  internal 
medicines. 

Administration. — For  external  and  local  use  the  drug  may  be 
gargled,  sprayed,  or  applied  with  a  syringe  or  a  swab,  either  in  full 
strength  or  diluted  with  water.  Whether  for  external  or  internal 
use,  the  solution  should  be  freshly  prepared ;  when  given  internally 
it  should  be  taken  from  a  porcelain  or  china,  not  a  metal,  cup  or 
spoon. 

Acidum  Sulphurosum— Acidi  Sulphurosi— Sulphur- 
ous Acid.    U.  S.  JP. 

Origin. — ^A  liquid  composed  of  not  less  than  6.4  per  cent,  by 
weight  of  Sulphurous  Acid  Gas  (Sulphur  Dioxide)  and  not  more 
than  93.6  per  cent,  of  Water. 

Description  and  Properties. — A  colorless  liquid,  of  the  cha- 
racteristic odor  of  burning  sulphur,  and  of  a  very  acrid,  sulphur- 
ous taste.  It  should  be  kept  in  dark-colored,  glass-stoppered 
bottles,  in  a  cool  place,   and  protected  from   light. 

Dose. — J-2  fluidrachms  (1.8-7.39  Cc). 

Physiological  Action. — Externally  and  Locally. — Sulphurous 
acid  is  a  powerful  deoxidizing  agent,  the  fumes  of  burning  sulphur 
having  been  employed  centuries  ago  to  disinfect  temples,  dwellings, 
etc.  It  easily  abstracts  oxygen  from  organic  bodies,  the  acid,  in 
short,  being  a  powerful  disinfectant,  antiseptic,  deodorant,  and 
parasiticide. 

Internally. — The  disinfecting  properties  of  sulphurous  acid  are 
less  apparent  when  the  drug  is  ingested  than  when  it  is  used 
externally. 

Therapeutics. — Externally  and  Locally. — As  an  antiseptic,  dis- 
infectant, and  deodorant  sulphurous  acid  may  be  employed  in  the 
treatment  of  various  parasitic  skin  diseases,  and  a  solution  of  sul- 
phurous acid  affords  an  efficient  application  to  the  throat  in  pharyn- 
gitis, particularly  the  gangrenous  form,  diphtheria,  etc. 

According  to  Dujardin-Beaumetz,  Sollaud,  and  Balbaud,  non- 
febrile  pulmonary  phthisis  is  often  favorably  influenced  by  the  daily 
inhalation  for  a  short  time  of  sulphurous-acid  vapor.  This  dis- 
agreeable, not  to  say  dangerous,  method  of  treatment  has  neither 
been  generally  adopted  nor  proved  to  be  of  established  efficacy. 

The  acid  is  a  useful  antiseptic  to  apply  to  recent  wounds,  and 
may  be  employed  to  disinfect  the  dejections  of  the  sick,  the  fumes 

23 


354  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

from  burning  sulphur  also  being  serviceable  to  disinfect  rooms  and 
bedding  tainted  with  infectious  disease. 

Internally. — Sulphurous  acid  is  seldom  used  internally,  though, 
owing  to  its  powerful  antifermentative  properties,  it  has  been  em- 
ployed in  so-called  fermentative  dyspepsia,  intestinal  fermentation, 
and  urticaria.  While  it  checks  fermentation  in  the  .  laboratory,  its 
effect  is  less  certain  in  the  body ;  nor  can  the  internal  administra- 
tion of  the  drug  be  regarded  as  satisfactory. 

Administration. — Sulphurous  acid  should  be  given  well  diluted 
with  water. 

Sodii  SCilphis— Sodii  Sulphltis— Sodium  Sulphite. 

U.  S.  JP. 

Origin. — Prepared  by  saturating  a  solution  of  Sodium  Carbon- 
ate or  Caustic  Soda  with  Sulphur-dioxide  Gas. 

Description  and  Properties. — Colorless,  transparent,  mono- 
clinic  prisms ;  odorless,  and  having  a  cooling,  saline,  sulphurous 
taste.  In  the  air  the  salt  effloresces  and  is  slowly  oxidized  to  sul- 
phate. Soluble  in  4  parts  of  water ;  sparingly  soluble  in  alcohol. 
It  should  be  kept  in  well-stoppered  bottles,  in  a  cool  place. 

Dose. — 5-60  grains  (0.3-4.0  Gm.). 

Sodii  Bisulphis— S5dii  Bisulphitis— Sodium  Bisul- 
phite.  U.  S.  JP. 

Origin. — Prepared  from  Sodium  Carbonate  or  Bicarbonate  and 
Sulphur  Dioxide. 

Description  and  Properties. — Opaque,  prismatic  crystals,  or  a 
granular  powder,  exhaling  an  odor  of  sulphur  dioxide,  and  having 
a  disagreeable,  sulphurous  taste.  Exposed  to  the  air,  the  salt  loses 
sulphur  dioxide  and  is  gradually  oxidized  to  sulphate.  Soluble  in 
4  parts  of  water  and  in  72  parts  of  alcohol.  The  drug  should  be 
kept  in  a  cool  place,  in  small,  well-stoppered  bottles  filled  as  full  as 
possible. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Sodii  Hyposulphis— Sodii  HyposulphTtis— Sodium 
Hyposulphite.    U.  S.  I*. 

Origin. — Prepared  by  passing  Sulphurous  Anhydride  into  a 
solution  of  Sodium  Carbonate  with  Salts. 

Description  and  Properties. — Colorless,  transparent,  mono- 
clinic  prisms ;  odorless,  and  of  a  cooling,  afterward  bitter,  taste. 


ANTISEPTICS.  355 

Soluble  in  0.65  part  of  water ;  insoluble  in  alcohol.  It  should  be 
kept  in  well-stoppered  bottles. 

Dose. — 5-20  grains  (0.3-1.3  Gm.). 

Physiological  Action  and  Therapeutics  of  Sodium  Sulphite, 
Bisulphite,  and  Hyposulphite. — These  substances  are  feeble  ger- 
micides and  antiseptics,  checking  putrefaction  and  other  forms  of 
fermentation.  It  is  supposed  that  they  are  decomposed  in  the 
stomach,  liberating  sulphurous  anhydride;  on  which  assumption 
they  have  been  given  to  arrest  gastric  fermentation  and  as  reme- 
dies in  typhoid  and  yellow  fevers,  diphtheria,  erysipelas,  etc.  The 
hypothesis,  however,  upon  which  they  have  been  thus  hopefully 
employed  has  not  been  confirmed  by  clinical  experience. 

These  drugs  have  nevertheless  proved  efficacious  in  the  treat- 
ment of  scabies,  sycosis,  impetigo,  favus,  etc.  Atomized  solutions 
of  sodium  hyposulphite  inhaled  are  beneficial  in  gangrene  of  the 
lungs,  fetid  bronchitis,  etc. 

Administration. — The  foregoing  preparations  of  sulphur  may 
be  given  in  solution  or  in  this  form  applied  topically.  The  sodium 
hyposulphite  may  also  be  applied  in  the  form  of  an  ointment. 

Aqua  Chlori— Aquae  Chlori— Chlorine  Water. 

V.  s.  p. 

Origin. — An  aqueous  solution  of  Chlorine,  containing  at  least 
0.4  per  cent,  of  the  gas. 

Description  and  Properties. — A  clear,  greenish-yellow  liquid, 
having  the  suffocating  odor  and  disagreeable  taste  of  chlorine,  and 
leaving  no  residue  on  evaporation.  Chlorine  water,  even  when 
kept  from  light  and  air,  is  apt  to  deteriorate ;  when  it  is  required 
of  full  strength,  .it  should  be  freshly  prepared. 

Dose. — 1-4  fluidrachms  (3.7-15.O  Cc). 

Antagonists  and  Incompatibles. — The  salts  of  lead  and  silver 
are  incompatible. 

Synergists.  —  The  antiseptics  are  theoretically  synergistic, 
though  practically  the  drug  is  almost  always  used  alone. 

Physiological  Action.  —  Externally  and  Locally.  —  Chlorine 
water  is  a  powerful  antiseptic,  germicide,  and  deodorant,  When 
applied  to  the  skin  it  acts  as  a  rubefacient  and  vesicant,  while  the 
yapor  is  quite  irritating  to  the  respiratory  passages. 

Internally. — Chlorine  water  is  more  or  less  irritating  to  the 
mucous  membrane  of  the  stornach,  and  possesses  an  astringent 
taste. 


356  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Therapeutics. — Externally  and  Locally. — Chlorine  water  is  still 
occasionally  used  as  an  antiseptic  and  deodorant  in  gangrenous  or 
sloughing  wounds  and  for  disinfecting /o?</  discharges,  etc.  It  has 
proved  beneficial  as  a  local  application  in  aphthous  stomatitis,  diph- 
theria, and  parasitic  skin  diseases. 

Internally. — Chlorine  water  is  so  seldom  employed  internally 
that  its  use  in  this  respect  scarcely  requires  comment. 

Administration. — When  given  internally  the  drug  should  be 
well  diluted.  Should  poisoning  ensue  from  the  ingestion  of  exces- 
sive amounts,  albumen  is  the  best  antidote ;  for  the  irritation  occa- 
sioned by  the  inhalation  of  chlorine  gas  steam-inhalations  are 
indicated. 

Calx  Chlorata—CalcisChloratae— Chlorinated  Lime. 

V.  s.  p. 

("Chloride  of  Lime.") 

Origin. — A  compound  resulting  from  the  action  of  Chlorine 
upon  Calcium  Hydrate,  and  containing  not  less  than  35  per  cent, 
of  available  Chlorine. 

Description  and  Properties. — A  white  or  grayish-white,  granu- 
lar powder,  exhaling  the  odor  of  hypochlorous  acid ;  of  a  repulsive 
saline  taste,  and  becoming  moist  and  gradually  decomposing  on 
exposure  to  air.  It  is  but  partially  soluble  in  water  or  alcohol. 
The  drug  should  be  kept  in  well-closed  vessels,  in  a  cool  and  dry 
place.     Used  externally. 

Physiological  Action  and  Therapeutics. — Chlorinated  lime  is. 
a  powerful  disinfectant,  yielding,  when  exposed  to  air,  hypochlorous 
acid,  which  is  resolved  into  chlorine  and  chloric  acid,  the  last  in 
turn  yielding  chlorine. 

The  effects  of  the  drug  are  therefore  analogous  to  those  of 
chlorine,  yet  almost  the  only  use  which  chlorinated  lime  serves  is 
in  disinfecting  cesspools  and  utensils  employed  for  the  dejections 
of  invalids. 

Liquor  Sodae  Chloratae— Liquorls  Sodae  Chloratae— 
Solution  of  Chlorinated  Lime.     U.S. P. 

(Labarraque's  Solution.) 

Origin. — An  aqueous  solution  of  several  chlorine  compounds 
of  Sodium,  containing  at  least  2.6  per  cent,  by  weight  of  available 
chlorine. 


AROMA  TICS.  357 

Description  and  Properties. — A  clear,  pale-greenish  liquid, 
having  a  faint  odor  of  chlorine  and  a  disagreeable  alkaline  taste. 
It  should  be  kept  in  well-stoppered  bottles,  protected  from  light. 
Used  externally. 

Physiological  Action. — The  action  of  the  drug  resembles  that 
of  aqua  chlori,  although  it  is  feebler  than  the  latter. 

Therapeutics. — Solution  of  chlorinated  soda  is  used  as  a  disin- 
fectant iox  fetid  ulcers,  gangrenous  sores,  and  ozena,  and  as  a  disin- 
fectant wash  in  diseases  of  the  uterus,  vagina,  and  auditory  canal. 

Administration. — There  are  no  special  directions  to  be  ob- 
served in  the  application  of  this  solution. 


AROMATICS. 

The  following-named  drugs,  classed  by  some  authors  as  aro- 
matics,  are  not  only  powerful  antiseptics  and  antispasmodics,  but 
possess  properties  very  similar  to  those  of  the  more  typical  anti- 
septics, antipyretics,  and  anesthetics.  These  antiseptic  properties 
of  aromatic  drugs  are  well  known  to  modern  science,  and,  what  is 
of  unique  interest  and  significance,  were  perfectly  familiar  to  the 
ancients,  who  could  not  possibly  divine  the  scientific  value  of  the 
virtues  familiarized  only  by  the  crudest  empiricism.  In  the  custom 
of  the  Egyptians  of  embalming  the  dead  we  have  a  remarkable 
example  of  their  divination  of  antisepsis  in  the  perfumes  and  spices 
in  which  their  dead  were  buried ;  and  in  the  Christian  Gospel  we 
read  of  Nicodemus  that  he  "brought  a  mixture  of  myrrh  and 
aloes,"  and  that  they  "  took  the  body  of  Jesus,  and  wound  it  in 
linen  cloths  with  the  spices,  as  the  manner  of  the  Jews  is  to  bury" 
(John  xix.  39, 40). 

Apart,  however,  from  the  remarkable  testimony  of  the  fore- 
going examples,  these  peculiar  properties  of  aromatic  herbs  appear 
to  have  been  established  in  all  succeeding  ages.  Especially  among 
the  Greeks  were  the  medicinal  virtues  of  certain  aromas  recognized, 
recipes  for  celebrated  healing  essences  being  inscribed  on  marble 
tablets  in  their  temples.  Among  the  Romans,  too,  the  custom  pre- 
vailed of  mingling  sacred  aromatic  ingredients  with  the  ashes  of 
the  departed — a  usage  not  wholly  to  be  regarded  as  a  religious 
ceremony,  but  rather  as  a  recognition  of  the  properties  ascribed  to 
these  agents  by  their  Athenian  neighbors.     ^ 

Indeed,  the  history  of  perfumes  teems  with  illustrations  of  the 


358  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

common  faith  in  their  healing  power,  though  from  the  derivation 
of  the  word — per,  through,  and  fumum,  smoke — the  offering  of 
incense,  by  burning  aromatic  woods,  spices,  and  gums,  seems  to 
have  been  the  original  use  suggested  by  them.  This  conception 
of  the  sacred  and  purifying  influence  of  aromas  is  seen  to-day  in 
the  censer  of  the  ritualistic  churches,  as  it  may  be  traced  from 
earliest  recorded  times  through  the  centuries  that  intervene. 

The  more  secular  regard  for  aromatic  herbs,  however,  rests 
rather  upon  a  rational,  though  unscientific,  observation  of  facts 
than  upon  hierarchical  assumption.  It  is  recorded,  for  instance, 
that  while  cholera  raged  in  Paris  and  London  the  gentle  office  in 
which  they  were  engaged  secured  to  the  perfumers  immunity  from 
the  plague,  and  that  when  the  Dutch  on  the  island  of  Ternate 
destroyed  the  clove  tree  the  colony  suffered  from  epidemics  and 
disorders  unknown  before. 

The  property  of  absorbing  malaria  generally  ascribed  to  the 
leaves  of  Eucalyptus  globulus  is  a  further  illustration  of  the 
medicinal  uses  of  aromatic  plants,  this  tree  being  considered  a 
potent  febrifuge.  Witness  also  the  beneficial  results  of  planting 
this  tree  in  the  Roman  Campagna. 

Even  the  refined  taste  and  delicacy  of  sense  which  have  per- 
petuated the  "perfumes  of  Araby"  to  "sweeten,"  not  the  murder- 
ous hand  of  a  Lady  Macbeth,  but  milady's  dainty  finger-tips,  have 
their  rationale  in  a  basis  of  sanitary  law.  A  writer  on  this  subject 
observes  that  "  the  toilet  vinegars  had  their  origin  in  the  presump- 
tion of  keeping  those  who  carried  them  from  the  effects  of  infec- 
tious disease,  doubtless  springing  out  of  the  story  of  the  four 
thieves'  vinegar — reputed  freebooters  supposed  to  have  plundered 
the  sick  and  dying,  protected  by  the  spell  of  an  enchanted  prophy- 
lactic composed  of  rosemary,  mint,  lavender,  calamus,  cinnamon, 
cloves,  nutmeg,  etc.  macerated  in  vinegar.'' 

Yet  the  vinaigrette  of  a  lady's  boudoir  of  to-day  has  its  ana- 
logue in  the  beautiful  scent-bottles  unearthed  among  the  ruins  of 
Pompeii;  for  the  cultivated  tastes  which  still  prompt  the  utility, 
as  well  as  beauty,  of  flowers  are  fortified  by  the  tradition  of  loyal 
centuries,  and  are,  after  all,  but  a  tacit  tribute  to  the  truth  not  in- 
aptly stated  that  "  poison  and  malaria  enter  the  system  by  neglect- 
ing the  warning  given  it  by  the  nose,  that  outpost  of  the  animal 
citadel." 

Aromatics  owe  their  virtues  chiefly  to  the  volatile  oils  they  con- 
tain, which  usually  possess  the  characteristic  odor  and  taste  of  the 


AROMA  TICS.  359 

plants  from  which  they  are  derived.  Locally,  they  are  stimulant 
and  irritant.  Internally,  they  stimulate,  when  taken  in  moderate 
quantities,  the  digestive  organs  in  the  same  manner  as  vegetable 
bitters,  and  increase  the  activity  of  the  circulation  reflexly  by  stim- 
ulating the  sensory  ends  of  the  vagus  distributed  to  the  mucous 
membrane  of  the  stomach.  The  impression  is  conveyed  to  the 
center  in  the  medulla,  and  from  there  transmitted  to  the  accelerator 
nerves  of  the  heart.  Very  large  doses  depress  the  heart's  action, 
arresting  it  in  diastole.  The  poisonous  action  of  aromatics  is  simi- 
lar to  that  of  irritant  narcotic  poisons.  Many  of  them  are  quite 
powerful  local  anesthetics.  They  first  stimulate  and  then  depress 
and  exhaust  the  nervous  system.  In  diseased  conditions  they  are 
used  to  increase  peristalsis,  to  impart  tone  to  the  stomach,  and 
to  act  as  antiseptics ;  to  arrest  gastric  and  intestinal  fermentation ; 
to  relieve  pain  wherever  they  are  applied ;  and,  by  increasing  the 
circulation  in  the  brain  and  improving  the  condition  of  the  gastro- 
intestinal tract,  to  relieve  many  of  the  phenomena  of  hysteria. 
The  chief  contraindication  for  the  internal  use  of  these  drugs  is  in 
inflammation  of  the  stomach  and  bowels. 

The  volatile  oils  and  the  various  preparations  of  the  aromatics 
should  be  given  diluted  in  some  proper  vehicle. 

Anlsum—Anisi— Anise.    TI.  S.  P. 

Origin. — The  fruit  of  Pimpinella  Anisum  L.,  a  plant  indigenous 
in  Western  Asia  and  Egypt,  and  extensively  cultivated  in  Europe. 

Description  and  Properties. — About  \-^  inch  (3-6  Mm.)  long, 
ovate  compressed  laterally,  grayish,  finely  pubescent,  consisting  of 
two  mericarps,  each  with  a  flat  face,  and  five  light-brownish  filiform 
ridges,  and  about  fifteen  thin  oil-tubes,  perceptible  in  transverse  sec- 
tion by  the  aid  of  the  microscope.  Anise  has  an  agreeable,  aro- 
matic odor,  and  a  sweet,  spicy  taste.  It  contains  from  i^  to  3  per 
cent,  of  a  volatile  oil.  It  resembles  the  fruit  of  the  Conium,  differ- 
ing from  it  usually  in  being  longer  and  more  ovate,  and  having 
another  odor  and  taste.  The  fruit  of  the  Conium  has,  moreover, 
but  a  single  smooth  mericarp  without  oil-tubes. 

Dose. — 8-30  grains  (0.5-2.0  Gm.). 

Oleum  Anisi— Olei  Anlsi— Oil  of  Anise.    TJ.  S.  P. 

Origin. — A  volatile  oil  distilled  from  Anise. 
Description  and  Properties. — A  colorless  or  pale-yellow,  thin 
and  strongly  refractive  liquid,  having  the   characteristic  odor  of 


360  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

anise,  and  a  sweetish,  mildly  aromatic  taste ;  neutral  in  reaction. 
It  contains  a  substance  known  as  anethol. 

Oil  of  anise  should  be  kept  in  well-stoppered  bottles,  protected 
from  light,  and  if  it  has  separated  into  a  liquid  and  a  solid  portion, 
it  should  be  completely  liquefied  by  warming  before  being  dis- 
pensed. 

Dose. — 1-5  minims  (0.06-0.3  Cc). 

Official  Preparations. 

S.qua  Anisi — Aquse  Anisi — Anise  Water. — Dose,  %-i  fluidounce  (8.0-30.0 
Cc). 

Spltritus  Anisi — Splritus  Anisi — Spirit  of  Anise. — Dose,  i-i:  fluidrachms 
(4.0-8.0  Cc). 

Oil  of  anise  is  contained  in  the  following  preparations : 

Spiritus  AurSntii  CompSsitus  ;  Sj^rupus  Sarsaparfllse  CompSsitus  ;  Tinc- 
tiira  Opii  Camphorata ;    Trochisci  Glycyrrhizae   et   Opii. 

Physiological  Action. — Anise  is  slightly  antiseptic,  stimulant, 
and  carminative ;  Oil  of  Anise  is  irritant  if  applied  in  full  strength  to 
mucous  membranes,  stimulating  both  the  digestive  and  circulatory 
apparatus,  improving  the  appetite,  and  slightly  strengthening  and 
accelerating  the  heart's  action.  In  very  large  doses  it  possesses 
mildly  narcotic  properties.  It  is  excreted  in  the  urine,  sweat,  and 
by  the  bronchial  mucous  membrane,  the  secretion  from  which  it 
liquefies. 

Therapeutics. — Anise  is  employed  to  relieve  flatulence  in 
children,  as  a  sedative  expectorant,  and  as  a  vehicle  to  flavor 
medicines. 

Cinnamomum—Cinnamomi— Cinnamon.  TJ.  S.I*. 

Origin. — There  are  three  official  varieties  of  cinnamon:  i,  the 
inner  bark  of  the  shoots  of  Cinnamomum  Zeylanicum  Breyne,  a 
tree  about  30  feet  high  (9  M.),  found  in  the  forests  of  Ceylon 
(Ceylon  Cinnamon) ;  2,  the  bark  of  the  shoots  of  one  or  more 
undetermined  species  of  Cinnamomum  grown  in  China  (Chinese 
Cinnamon,  Cassia  Cinnamon);  3,  the  bark  of  an  undetermined 
species  of  Cinnamomum  known  as  Cinnamomum  Saigonicum 
(Saigon  Cinnamon,  Saigon  Cassia),  from  Saigon,  the  capital  of 
French   Cochin-China,   where  it  is   collected  and   exported. 

Description  and  Properties.^— Most  of  the  article  brought  to 
the  United  States  is  the  Cassia  cinnamon.    The  varieties  differ  some- 


AROMA  TICS.  361 

what  in  appearance,  and  are  found  in  the  shops  as  quills  of  varying 
lengths,  about  -^  inch  (i  Mm.)  or  more  in  thickness,  yellowish- 
brown  in  color,  externally  rough  (Cassia),  of  fragrant  odor,  a 
sweet,  aromatic  taste,  but  less  delicate  than  that  of  Ceylon  cinna- 
mon, which  appears  in  large,  closely-rolled  quills,  composed  of 
eight  or  more  layers  of  bark  of  the  thickness  of  paper ;  pale, 
yellowish-brown,  the  outer  surface  smooth,  marked  with  wavy 
lines  of  bast-bundles ;  of  a  very  sweet,  fragrant  odor,  and  a  warm, . 
aromatic,  delicate  taste.  The  Saigon  cinnamon  is  found  in  the 
shops  as  large  quills  or  broken  pieces,  1^  to  -^  inch  (2  to  3  Mm.) 
thick ;  the  outer  surface  gray  or  light  grayish-brown,  with  whitish 
patches,  more  or  less  rough  and  warty,  transversely  ridged  and 
longitudinally  wrinkled ;  the  inner  surface  cinnamon  or  dark  brown, 
granular  and  slightly  striate,  with  short  and  granular  fracture.  It 
has  a  fragrant  odor,  and  a  sweet,  warmly  aromatic,  and  somewhat 
astringent  taste. 

Constituents. — All  the  varieties  contain  volatile  oil,  tannin, 
mucilage,  sugar,  starch,  a  coloring  principle,  and  a  peculiar  acid. 

The  official  Oil  of  Cinnamon  is  distilled  from  Cassia  Cinnamon. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Official  Preparations  {Cassia  Cinnamon). 

Tinctura  Cardamomi  Comp6sita — Tincturse  Cardamomi  Comp5sitse — 
Compound  Tincture  of  Cardamom. — Cardamom,  20;  Cassia  Cinnamon,  20 ;  Car- 
away, 10;  Cochineal,  5;  Glycerin,  50;  Diluted  Alcohol,  q.  s.  ad  1000  parts.  Dose, 
1-2  fluidrachms  (4.0-8.0  Cc). 

Tinctiira  Catechu  CompOsita — Tincturse  CStechu  CompSsitse — Compound 
Tincture  of  Catechu. — Catechu,  100;  Cassia  Cinnamon,  50;  Diluted  Alcohol,  q.  s. 
ad  1000  parts.     Dose,  \-2  fluidrachms  (2.0-8.0  Cc). 

Tinctiira  Lavandulae  Comp6sita — Tincturae  Lavandulse  Comp&sitse — Com- 
pound Tincture  of  Lavender.— i)M^,  }i-i  fluidrachm  (2.0-4.0  Cc).  (Formula 
given  under  Lavender.) 

Official  Preparations  {Ceylon  Cinnamon). 

Tinctiira  Cinnamomi  (10  per  cent.) — Tinctiirae  Cinnamomi — Tincture  of 
Cinnamon. — Dose,  ^-z  fluidrachms   (2.0-8.0  Cc). 

Ptilvis  AromSticus — Ptllveris  Aromatici — Aromatic  Powder. — Dose,  10-30 
grains  (0.6-2  Gm.).     (Formula  given  under  Cardamomum.) 

Oleum  Cinnamomi— Olei  Cinnamomi— Oil  of 
Cinnamon.    U.  S.  P. 

Origin. — A  volatile  oil  distilled  from  Cassia  Cinnamon. 
Description  and  Properties. — A  yellowish  or  brownish  liquid. 


362  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

becoming  darker  and  thicker  with  age  and  exposure  to  the  air, 
having  the  characteristic  odor  of  cinnamon,  and  a  sweetish,  spicy, 
burning  taste.  Specific  gravity,  1.055  to  1.065.  Soluble  in  an 
equal  volume  of  alcohol,  the  solution  being  sHghtly  acid  to  litmus- 
paper  ;  also  soluble  in  an  equal  volume  of  glacial  acetic  acid.  It 
should  be  kept  in  well-stoppered  bottles,  in  a  cool  place,  protected 

from  light. 

Constituents. — Oil  of  cinnamon  contains  variable  quantities  of 
hydrocarbon,  but  consists  chiefly  of  cinnamic  aldehyde,  and  when 
old  or  exposed  to  the  air  for  a  considerable  time  cinnamic  acid  and 
resin  are  formed.  Cinnamic  acid  crystallizes  in  shining,  colorless, 
odorless  prisms,  freely  soluble  in  alcohol,  ether,  and  boiUng  water. 
Chlorinated  lime  and  hot  dilute  nitric  acid  oxidize  it  into  oil  of 
bitter  almond  and  benzoic  acid. 

Dose. — 1-5  minims  (0.06-O.3  Cc). 

Official  Preparations. 

Aqua  Cinnamomi  (0.2  per  cent.) — Aquae  Cinnamomi — Cinnamon  Water. — 
Dose,  J-i  fluidounce  (15-30  Co.). 

Spfritus  Cinnamomi  (10  per  cent.) — Splritus  Cinnamomi— Spirit  of  Cinna- 
mon.— Dose,  5-20  minims  (0.3-1.2  Co.). 

Physiological  Action. — Cinnamon  is  an  agreeable  aromatic 
stimulant,  carminative,  stomachic,  astringent,  hemostatic,  and  anti- 
septic.    The  oil  possesses  germicidal  properties. 

Therapeutics. — The  same  as  for  other  aromatics.  It  is  much 
used  to  impart  an  agreeable  flavor  to  medicinal  compounds  and  as 
an  adjuvant  to  other  members  of  this  group.  Preparations  of  cin- 
namon are  supposed  to  stimulate  the  uterus  and  check  uterine  hem- 
orrhage, and  are  often  employed  alone  or  in  combinations  with 
more  powerful  medicines  for  this  purpose. 

Coriandrum—Coriandri— Coriander.    JJ.  S.  P. 

Origin. — The  fruit  of  Coriandrum  sativum  L.,  an  annual  herb 
about  2  feet  (60.0  Cm.)  high,  indigenous  in  China  and  on  the 
north-eastern  shore  of  the  Mediterranean.  Cultivated  in  Asia, 
Europe,  and  America. 

Description  and  Properties. — Globular,  about  \  inch  (3  Mm.) 
in  diameter,  slightly  pointed  at  the  apex  and  crowned  with  the 
calyx-teeth  at  the  base.  The  two  concave  mericarps  cohere,  en- 
closing a  lenticular  cavity,  each  furnished  on  the  face  with  two  oil- 
tubes  ;  odor  and  taste  agreeably  fragrant  and  aromatic. 


AROMA  TICS.  363 

Constituents. — Coriander  contains  nearly  ^  of  i  per  cent,  of 
volatile  oil,  13  per  cent,  of  fatty  matter,  mucilage,  and  traces  of 
tannin. 

Dose. — 8-30  grains  (0.5-2.0  Gm.). 

Oleum  Coriandri— Olei  Coriandri— Oil  of  Coriander. 

u.  s.  p. 

Origin. — A  volatile  oil  distilled  from  Coriander. 

Description  and  Properties. — A  colorless  or  slightly  yellow- 
ish liquid,  having  the  characteristic  aromatic  odor  of  coriander,  and 
a  warm,  spicy  taste.  It  is  one  of  the  most  stable  of  the  volatile 
oils. 

Dose. — 1-5  minims  (0.06-0.3  Cc). 

Official  Preparations. 

ConfSctio  SSnnse  (5  per  cent.) — Confectionis  SSnnse — Confection  of  Senna. 
— Dose,  1-2  drachms  (4.0-8.0  Gm.).     (Formula  given  under  Senna.') 

Spiritus  Juniperi  Compfisitus — Spfritus  Juniperi  Comp6siti — Compound 
Spirit  of  Juniper. — Dose,  2—4  fluidrachms  (8.0-15.0  Cc).  (Formula  given  under 
Carum.) 

Physiological  Action  and  Therapeutics. — The  same  as  those 
of  the  other  volatile  oils.  Frequently  used  as  a  corrective  to  pur- 
gative medicines. 

FoenTculum—Foeniculi— Fennel.    TJ.  8.1*. 

Origin. — The  fruit  of  Fmniculum  capillaceum  Gilibert,  an  herba- 
ceous annual  or  perennial  indigenous  in  Southern  Europe  and  cul- 
tivated in  Germany,  France,  and  the  United  States. 

Description  and  Properties. — Oblong,  nearly  cylindrical, 
slightly  curved,  from  |-  to  |  inch  (4-12  Mm.)  long,  brownish  or 
greenish-brown,  readily  separable  into  the  two  prominent  meri- 
carps,  each  with  five  light-brown,  obtuse  ribs,  with  four  oil-tubes  on 
the  back  and  two  or  four  upon  the  flat  face ;  odor  and  taste  aro- 
matic, anise-like. 

Constituents. — Fennel  contains  from  2  to  4  per  cent,  of  volatile 
oil,  which  is  almost  identical  chemically  with  that  of  anise,  12.5 
per  cent,  of  fixed  oil,  and  sugar. 

Dose. — 8-30  grains  (0.5-2.0  Gm.). 

Official  Preparation. 
Infusum  S6nnae  Compttsitum— Infusi  Sfenns  CompSsiti — Compound  In- 
fusion of  Senna.— i)oj<f,  1-2  fluidounces  (30.0-60.0  Cc).     (Formula  given  under 
Senna^ 


364  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Oleum  FcenTculi— Olei  Foeniculi— Oil  of  Fennel. 

V.  s.  p. 

Origin. — A  volatile  oil  distilled  from  Fennel. 

Description  and  Properties. — A  colorless  or  pale-yellowish 
liquid,  having  the  characteristic  aromatic  odor  of  fennel,  and  a 
sweetish,  mild,  and  spicy  taste.  Soluble  in  an  equal  volume  of 
alcohol.  It  should  be  kept  in  well-stoppered  bottles,  in  a  cool 
place,  and  if  it  has  partly  or  wholly  soHdified,  it  should  be  com- 
pletely liquefied  by  warming  before  being  dispensed. 

Constituents. — It  has  the  same  constituents  as  the  oil  of  anise. 

Dose. — 1-5  minims  (0.06-0.3  Cc). 

Official  Preparations. 

Aqua  Foeniculi  (2  per  cent.) — Aquae  Foeniculi — Fennel  Water. — Dose,  \-i 
fluidounce  (8.0-30.0  Cc). 

Ptilvis  Glycyrrhlzae  Comp5situs — Piilveris  Glycyrrhizae  Comp5siti — Com- 
pound Liquorice  Powder. — ZJej?,  ^-2  drachms  (2.0-8.0  Gm.).  (Formula  given  under 
Senna.) 

Splritus  Junlperi  CompSsitus  (0.5  per  cent.) — Spiritus  Juniperi  Comp6siti — 
Compound  Spirit  of  Juniper. — Dose,  2-4  fluidrachms  (8.0-15.0  Cc).  (Formula 
given  under  Carum.) 

Physiologicsal  Action  and  Therapeutics  are  the  same  as  those 
of  anise. 

Capsicum— Capsici— Capsicum.     Z7.  S.  P. 

(Cayenne  Pepper.) 
Origin. — The  fruit  of  Capsicum  fastigiatum  Blume,  a  small 
crooked-branched  shrub,  i  to  2  feet  (30-60  Cm.)  high,  indigenous 
in  tropicar  America  and  Asia,  and  cultivated  in  gardens.  The 
fruit  is  an  oblong-conical  pod  from  ^  to  |  inch  (8-19  Mm.)  long, 
of  a  crimson  or  yellow  color.  It  encloses  two  or  three  cells  con- 
taining flat,  reniform,  yellowish  seeds,  attached  to  a  thick,  central 
placenta.  These  pods  when  dried  and  ground  form  capsicum, 
which  has  a  peculiar  odor  and  an  intensely  hot,  aromatic  taste. 
This  ground  product  is  of  a  bright-red  color,  fading  upon  long 
exposure  to  the  light.  Capsicum  of  the  market  usually  consists 
of  several  species  ground  together,  and  is  often  adulterated  with 
sawdust  and  sometimes  with  red  lead. 

Constituents. — Capsicum  contains  capsaicin,  an  acrid  principle 
found  in  the  greatest  amount  in  the  African  product ;  also  a  vola- 
tile alkaloid,  fixed  and  volatile  oil,  and  fat  acids. 

Dose. — 3-5  grains  (0.2-0.3  Gm.). 


AROMA  TICS.  365 

Official  Preparations. 

KxtrSctum  CSpsici  Fluidum — ExtrScti  CSpsici  Pluidi — Fluid  Extract  of 
Capsicum. — Dose,  J-to  2  minims  (0.03-0.12  Co.). 

Empiastrum  CSpsici — Empiastrum  (ace.)  CSpsici — Capsicum  Plaster.  For 
external  use. 

Oleoresina  CSpsici — Oleoresinse  C3psici — Oleoresin  of  Capsicum. — Dose, 
J-I  minim  (0.015-0.06  Cc). 

Tinctiira  CSpsici — Tincturae  CSpsici — Tincture  of  Capsicum. — Dose,  5-20 
minims  (0.3-1.2  Cc). 

Physiological  Action. — Externally  and  Locally. — Capsicum  is 
an  irritant  and  rlibefacient,  producing  vesication  if  kept  in  contact 
with  the  skin  for  a  long  time.  It  so  irritates  the  mucous  membrane 
of  the  mouth  and  nose  as  to  induce  sneezing. 

Internally. — Digestive  System. — Capsicum  is  a  powerful  gastro- 
intestinal stimulant,  increasing  the  flow  from  the  salivary,  gastric, 
and  intestinal  glands.  It  increases  the  blood-supply  to,  and  stimu- 
lates the  walls  of,  the  stomach,  occasioning  a  sense  of  heat.  It  is 
a  powerful  carminative.  Large  doses  produce  great  irritation  in 
the  stomach  and  bowels. 

Circulatory  System. — It  is  a  powerful  stimulant  to  the  heart, 
greatly  increasing  the  strength  and  rapidity  of  its  action. 

Absorption  and  Elimination. — It  is  chiefly  eliminated  by  the  kid- 
neys, increasing  the  flow  of  urine.  Large  doses  may  produce 
vesical  tenesmus,  and  aphrodisiac  effects  have  sometimes  been  pro- 
duced. 

Therapeutics. — Externally  and  Locally. — Owing  to  its  counter- 
irritant  action,  capsicum  is  employed  to  relieve  lumbago,  torticollis, 
neuralgia,  rheumatic  pains,  and  acute  inflammations  of  the  skin  or 
mucous  membrane.  An  infusion  or  the  diluted  tincture  is  an 
excellent  gargle  in  relaxed  uvula,  pharyngitis,  and  the  angina  of 
scarlet  fever. 

The  tinctures  of  capsicum  and  cantharides  have  been  used  to 
stimulate  the  scalp  in  the  various  forms  of  alopecia.  The  tincture 
is  frequently  used  as  a  domestic  remedy  for  the  benefit  of  chilblains 
and  toothache. 

Internally. — Capsicum  is  a  most  valuable  stomachic  in  an  atonic 
condition  of  the  digestive  organs,  and  a  very  efficient  remedy  in 
the  irritable  and  catarrhal  conditions  of  the  stomach  due  to  the  ex- 
cessive use  of  alcohol. 

The  tincture  of  capsicum  or  the  powdered  drug,  added  to  hot 
water  or  to  hot  water  and  whiskey,  makes  a  valuable  and  rapid  car- 
diac and  vascular  stiniulant. 


366  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Contraindications. — Capsicum  and  its  preparations  should  not 
be  given  in  acute  inflammatory  affections  of  the  gastro-intestinal 
and  genito-urinary  tracts. 

Administration. — The  oleoresin  and  the  powder  should  be 
given  in  pills  or  capsules.  The  fluid  extract  and  the  tincture  should 
be  administered  well  diluted  with  water. 

Piper— Piperis— Pepper.     U.  8.  P. 

{Black  Pepper.) 

Origin. — The  unripe  fruit  of  Piper  nigrum  L.,  a  knotted,  pointed- 
branched,  aromatic,  climbing  shrub,  indigenous  in  India,  and  culti- 
vated in  many  of  the  East  Indian  and  Philippine  and  some  of  the 
West  Indian  islands. 

Constituents. — Its  important  constituents  are  a  volatile  oil  (i  to 
2  per  cent.) ;  a  neutral  principle,  piperin  (6  to  8  per  cent.) ;  and  a 
pungent,  soft,  dark-green  resin,  to  which  the  acrid  taste  and  medici- 
nal properties  of  pepper  are  due. 

Dose. — 5-20  grains  (0.3-1.2  Gm.) 

Official  Preparations. 

Oleoresina  Piperis — Oleoresinae  Piperis — Oleoresin  of  Pepper. — Dose,  \-i 
grain  (0.015-0.06  Gm.). 

Piperinum — Piperini — Piperin. — Origin. — A  neutral  principle  obtained  from 
Pepper,  as  well  as  from  other  plants  of  the  natural  order  Piferacets. 

Description  and  Properties. — Colorless,  or  pale-yellowish,  shining,  prismatic  crystals, 
odorless,  and  almost  tasteless  when  first  taken  into  the  mouth,  but  after  a  while  pro- 
ducing a  sharp,  biting  sensation.  Permanent  in  the  air ;  almost  insoluble  in  water,  but 
soluble  in  30  parts  of  alcohol  and  in  1  part  of  boiling  alcohol.  It  is  isomeric  with  mor- 
phine, and  can  be  decomposed  into  piperic  acid  and  a  liquid  alkaloid,  piperidine. 

Dose. — l-io  grains  (0.03-0.6  Gm.). 

Derivative  Compound. 

Piperonal — Heliotropin. — Obtained  from  Piperic  Acid  by  oxidation.  It  occurs  in 
small  white  crystals,  soluble  in  about  600  parts  of  cold  water,  and  very  readily  soluble  in 
alcohol  and  ether.  The  dose  is  10-15  grains  (0.6-1.0  Gm.).  It  has  been  used  as  an 
antiseptic  and  antipyretic. 

Physiological  Action  and  Therapeutics  of  pepper  and  its 
preparations  are  almost  identical  with  those  of  capsicum. 

Pepper,  particularly  piperin,  possesses  antiperiodic  and  anti- 
septic properties  to  a  greater  extent  than  capsicum. 


Myristica— My  risticae— Nutmeg.    TI.S.P.    Macis— 
Macidis— Mace.    TI.  S.  P. 

Origin. — The  seed  (Myristica)  and  the  membrane,  "  arillode," 


AROMA  TICS.  367 

investing  the  kernel  (Mace)  oi  Myristica  fragrans  Houttuyn,  a  tree 
about  30  feet  (9  M.)  high,  found  in  the  Molucca  Islands  and  cul- 
tivated in  the  East  Indies. 


Oleum  Myristicae— Olei  Myristicae— Oil  of  Nutmeg. 

JJ.  S.  P. 

Origin. — A  volatile  oil  distilled  from  Nutmeg. 

Description  and  Properties. — A  thin,  colorless  or  pale-yel- 
lowish liquid,  having  the  characteristic  odor  of  nutmeg  and  a 
warm,  spicy  taste.  It  becomes  darker  and  thicker  by  age  and  ex- 
posure to  the  air.  Soluble  in  an  equal  volume  of  alcohol.  It 
should  be  kept  in  well-stoppered  bottles,  in  a  cool  place,  protected 
from  light. 

Dose. — 1-3  minims  (0.06-0.18  Cc). 

Official  Preparation. 

SpKritus  Myrlsticse  (J  per  cent.) — SpKritus  Myristicae — Spirit,  or  Essence,  of 
Nutmeg. — Dose,  15-60  minims  (1.0-4.0  Co.). 

Physiological  Action  and  Therapeutics  are  the  same  as  those 
of  anise. 


Caryophyilus—CaryophS^lll— Cloves.     TJ.  8.  JP. 

Origin. — The  unexpanded  flowers^of  Eugenia  aromatica  (L.)  O. 
Kuntze,  a  hard-wood,  shrubby  evergreen.  It  was  originally  found 
in  the  Molucca  Islands,  whence  it  was  introduced  and  cultivated 
among  the  East  Indian  Islands. 

Description  and  Properties. — The  buds  are  about  f  inch  (15 
Mm.)  long,  dark-brown,  consisting  of  a  subcylindrical,  solid  and 
glandular  calyx-tube,  terminated  by  four  teeth  and  surmounted  by 
a  globular  head,  formed  by  four  petals  covering  numerous  curved 
stamens,  and  one  style.  A  clove  resembles  a  nail  (L,  clavus ;  Fr. 
-clou). 

Cloves  have  a  strong  aromatic  odor  and  a  pungent,  spicy  taste, 
and  when  pressed  or  scratched  emit  oil. 

Constituents. — Cloves  contain  about  18  per  cent,  of  a  highly 
pungent  volatile  oil,  17  per  cent,  of  tannin,  and  small  quantities  of 
iixed  oil,  gum,  resin,  etc.  Two  crystalline  principles  have  been 
separated :  caryophyllin,  a  white,  resinous  substance — a  stearopten 
— odorless  and  tasteless ;  and  eugenin,  a  substance  soluble  in  boil- 


368  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

ing  alcohol  and  isomeric  with  eugenol,  a  constituent  of  the  volatile 
oil. 

Dose. — 5-10  grains  (0.3-0.6  Gm.). 

Official  Preparation. 
Tinctura  Lavandulae  CompSsita — Tincturse  Lavandulae  CompSsitse — Tinc- 
ture  of   Lavender. — Dose,  ^i   fluidrachm  (2.0-4.0   Cc).     (T'ormula  given  under 
Lavender.') 

Oleum  CaryophSi^lli— Olei  Caryophylli— Oil  of  Cloves. 

V.  B.  jP. 

Origin. — A  volatile  oil  distilled  from  Cloves. 

Description  and  Properties. — A  pale-yellow,  thin  liquid,  be- 
coming darker  and  thicker  by  age  and  exposure  to  the  air,  having 
a  strongly  aromatic  odor  of  cloves  and  a  pungent,  spicy  taste.  Its 
specific  gravity  is  i. 060-1. 067.  Soluble  in  an  equal  volume  of 
alcohol,  the  solution  being  slightly  acid  to  litmus-paper. 

Constituents. — Oil  of  cloves  consists  of  a  light  and  a  heavy 
oil,  the  former  a  hydrocarbon,  supposed  to  be  inactive ;  the  latter 
a  phenol-like  liquid  termed  eugenol,  a  colorless  oil,  with  the  odor 
of  cloves,  a  specific  gravity  of  1.076  to  1.0785,  yielding  with  bases 
crystalline  salts.  Schenck  has  demonstrated  the  presence  of  sali- 
cylic acid  in  oil  of  cloves. 

Dose. — i-io  minims  (0.06-0.6  Cc). 

Allied  Compounds  and  Derivatives. 

Benzoyl-eugenol.' —  Origin. — From  Eugenol. 

Description  and  Properties.- — It  occurs  in  neutral,  odorless,  colorless,  acicular  crys- 
tals, having  a  feebly  bitter  taste ;  soluble  in  hot  alcohol,  ether,  and  chloroform,  and 
insoluble  in  water. 

Dose. — Not  yet  determined. 

Cinnamyl-eugenol. —  Origin. — A  derivative  of  Eugenol. 

Description  and  Properties. — Colorless,  odorless,  tasteless,  lustrous  needles,  soluble 
in  hot  alcohol,  ether,  and  chloroform,  and  insoluble  in  water. 

Eugenol-acetamide. —  Origin.  —  Obtained  from  Eugenol-acetic-ethyl-ether  by 
treating  with  solution  of  Ammonia.     It  occurs  as  a  crystalline  powder. 

Physiological  Action. — Externally  and  Locally. — Oil  of  cloves 
is  a  counter-irritant,  local  anesthetic,  and  germicide. 

Internally. — Its  action  is  essentially  the  same  as  that  of  anise,  it 
being  a  powerful  carminative  and  stimulant. 

Therapeutics. — Externally  and  Locally. — Oil  of  cloves  is  em- 
ployed as  a  local  anesthetic  in  toothache,  earache,  and  neuralgia, 
and  as  a  synergist  to  other  counter-irritants,  rubefacients,  and  anti- 


AROMA  TICS.  369 

septics.     The  eugenol-acetamide  is  a  powerful  local  anesthetic, 
being  analogous  to  cocaine  in  its  action. 

Internally. — The  therapeutics  are  similar  to  those  of  anise. 
The  BENZOYL-EUGENOL  has  been  highly  recommended  by  some  prac- 
titioners as  a  valuable  remedy  in  tuberculosis.  The  author  has  suc- 
cessfully employed  the  following  combination  as  an  antiseptic  and 
antifermentative  in  gastric  fermentation,  to  be  administered  either  in 
soft  capsules,  with  olive  oil  as  a  vehicle,  or  in  the  form  of  an  emul- 
sion: 

R.  Olei  Caryophylli, 
Olei  Cinnamomi, 
Olei  Menthae  Piperitae, 
Creasoti,  aa.  tr\j. 

M.  Sig. — Take  at  one  dose. 

The  better  way  to  administer  it  is  in  the  form  of  soft  capsules, 
each  capsule  containing  the  above  dose  in  about  6  minims  (0.37  Cc.) 
of  olive  oil.  One  or  two  capsules  should  be  given  three  times  a 
day,  after  meals. 

Pimenta— Pimentae— Pimenta.    TJ.  S.  P. 

(Allspice.) 

Origin. — The  nearly  ripe  fruit  of  Pimenta  officinalis  Lindley,  an 
evergreen  tree  about  30  feet  (9  M.)  high,  indigenous  in  the  West 
Indies,  Central  America,  and  the  northern  part  of  South  America. 

Constituents. — The  most  important  constituent  is  the  volatile 
oil,  of  which  the  fruit  yields  from  3  to  4  per  cent. 

Oleum  Pimentae— Olei  Pimentae— Oil  of  Allspice. 

V.  S.  B. 

Origin. — A  volatile  oil  distilled  from  Pimenta. 

Description  and  Properties. — A  colorless  or  pale-yellow  liquid, 
having  a  strong,  aromatic,  clove-like  odor,  and  a  pungent,  spicy 
taste.  It  becomes  darker  and  thicker  with  age  and  exposure. 
With  an  equal  volume  of  alcohol  it  forms  a  clear  solution. 

Dose. — 1-5  minims  (0.06-0.3  Cc). 

Physiological  Action  and  Therapeutics  are  similar  to  those  of 
cloves. 

Oleum  Cajuputi— Olei  Cajuputi— Oil  of  Cajuput. 

U.  S.  JP. 

Origin. — A  volatile  oil  distilled  from  the  leaves  of  Melaleuca 

24 


370  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

leucadendron  L.,  a  tree  with  crooked  stem  and  scattered  branches, 
resembling  the  weeping  willow,  indigenous  in  the  East  Indies. 

Description  and  Properties. — A  light,  thin,  bluish-green,  or, 
after  rectification,  colorless  liquid,  having  a  peculiar,  agreeable  and 
distinctly  camphoraceous  odor,  and  an  aromatic,  bitterish  taste. 
Specific  gravity,  0.9^2.  With  an  equal  volume  of  alcohol  it  affords 
a  clear  solution,  which  either  has  a  slightly  acid  reaction  or,  in  the 
case  of  the  rectified  oil,  is  neutral  to  litmus-paper. 

Constituents. — The  chief  constituent  is  cajuputol,  the  hydrate 
of  the  hydrocarbon  cajuputene.  Cajuputol  is  identical  with  euca- 
lyptol. 

Dose. — 1-5  minims  (0.06-0.3  Cc). 

Physiological  Action  and.  Therapeutics  are  identical  with  those 
of  the  oil  of  cloves. 

Cardamomum—Cardamomi— Cardamom.    TJ.  S.  P. 

Origin. — The  fruit  of  Elettaria  repens  (Sonnerat)  Baillon,  a  per- 
ennial plant  6  to  10  feet  (1.8-3  M-)  high. 

Cardamom  is  indigenous  in  Hindustan,  in  the  mountainous 
regions  of  Malabar. 

The  same  plant  furnishes  three  varieties  of  cardamoms,  known 
in  commerce  as  the  shorts,  short-longs,  and  long-longs. 

Description  and  Properties. — Ovoid  or  oblong,  from  f  to  f 
inch  (12  Mm.-2  Cm.)  long,  obtusely  triangular,  rounded  at  the 
base,  beaked,  longitudinally  striate;  of  a  pale-buff  color,  three- 
celled,  with  a  thin,  leathery,  nearly  tasteless  pericarp  and  a  central 
placenta.  The  seeds  are  about  \  inch  (5  Mm.)  long  and  \  inch  (3 
Mm.)  broad,  reddish-brown,  angular,  rugose,  depressed  at  the 
hilum,  surrounded  by  a  thin  membranous  arillus.  They  have  an  , 
agreeable  odor  and  a  pungent,  aromatic  taste. 

The  seeds  contain  10  per  cent,  of  fixed  oil  and  4.6  per  cent,  of  a 
volatile  oil,  besides  albuminous  matter,  gum,  starch,  etc.  The 
volatile  oil  possesses  the  odor  and  taste  of  the  seeds,  is  colorless 
or  yellowish,  dextrogyre,  contains  oxygen,  and  has  a  specific 
gravity  of  0.93  to  0.94. 

Dose. — 5-15  grains  (0.3-1  Gm.). 

Official  Preparations. 

Tinctura  Cardamomi  (10  per  cent.) — Tincturse  Cardamdmi — Tincture  of 
Cardamom. — Dose,  1-2  fluidrachms  {4.0-8.0  Cc). 

Tinctura    Cardamomi    Compdsita — Tincturse    Cardamomi    Comp&sitse — 


A  ROM  A  TICS.  371 

Compound  Tincture  of  Cardamom. — Cardamom,  20;  Cinnamon,  20;  Caraway,  10 ; 
Cochineal,  5;  Glycerin,  50;  Dilute  Alcohol,  q.  s.  ad  1000  parts.  Dose,  1-2  fluid- 
drachms  (4.0-8.0  Cc). 

Ptllvis  Aromaticus— Ptilveris  AromStici— Aromatic  Powder. — Ceylon  Cinna- 
mon, 35;  Ginger,  35;  Cardamon,  15;  Nutmeg,  15.  Dose,  10-30  grains  (0.6- 
2.0  Gm.). 

There  is  also  a  fluid  extract  made  from  this  powder.  Dose,  10-30  minims  (0.6- 
2.0  Cc). 

Antagonists  and  Incompatibles. — Free  acids  are  incompatible 
with  the  compound  tincture  of  cardamom,  separating  insoluble  car- 
minic  acid  in  it. 

Physiological  Action. — In  this  respect  Cardamom  conforms  to 
the  general  character  of  the  Aromatic  Group. 

Therapeutics. — Essentially  the  same  as  for  other  members  of 
this  group.  Cardamom  is  used  principally  as  an  adjuvant  to  other 
aromatics,  stimulants,  stomachics,  and  carminatives. 

Zingiber— Zingiberis— Ginger.    V.  S.  P. 

Origin. — The  rhizome  of  Zingiber  officinale  Roscoe,  a  perennial 
herb  indigenous  in  tropical  Asia  and  now  cultivated  in  most  tropi- 
cal countries. 

Description  and  Properties. — A  thick,  flattish  rhizome  from  i 
to  4  inches  (25  to  100  Mm.)  long,  with  club-shaped  lobes  on  one 
side;  deprived  of  the  corky  layer,  pale,  buff-colored,  striate, 
breaking  with  a  mealy,  rather  fibrous  fracture,  showing  numerous 
small,  scattered  resin-cells  and  fibro-vascular  bundles,  the  latter 
enclosed  by  a  nucleus  sheath.  Agreeably  aromatic,  and  of  a  warm, 
pungent  taste. 

Ginger  contains  from  f  to  2  per  cent,  of  a  pale-yellow,  volatile 
oil,  to  which  the  ginger  owes  its  aromatic  properties ;  also  a  soft 
resin,  giving  to  the  drug  its  hot,  pungent  taste.  The  proportion 
of  resin  present  varies  with  the  different  varieties  of  ginger,  that 
from  the  East  Indies  yielding  about  8  per  cent.,  while  the  Jamaica 
product  yields  only  about  5  per  cent. 

Dose. — 8-30  grains  (0.5-2.0  Gm.). 

Official  Preparations. 

ExtrSctum  Zinglberis  Fluidum— Extract!  Zingfteris  Fluidl — Fluid  Ex- 
tract of  Ginger. — Dose,  10-30  minims  (0.6-2.0  Cc). 

Oleoresina  Zinglberis — Oleoresinse  Zinglberis — Oleoresin  of  Ginger. — 
Dose,  1-3  grains  (0.06-0.18  Gm.). 

PiSlvis  Aromaticus — PiSlveris  Aromatici — Aromatic  Powder. — Dose,  10-30 
grains  (0.6-^2.0  Gm.).     (Formula  given  under  Cardamomum.) 


372  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Paivis  Rhei  CompSsitus— Ptllveris  Rhei  Comp6siti— Compound  Powder 
of  Rhubarb.— Rhubarb,  25 ;  Magnesia,  65 ;  Ginger,  10  parts.  Dose,  ^-I  drachm 
(2.0-4.0  Gm.). 

Syrupus  Zingiberis — Syrupi  Zingiberis — Syrup  of  Ginger. — Dose,  ^-2 
drachms  (2.0-8.0  Cc). 

Tinctura  Zingiberis — Tincturae  Zingiberis — Tincture  of  Ginger. — Dose,  1-2 
fluidrachms  (4.0-8.0  Cc). 

Trochisci  Zingiberis — Trochiscos  (ace.)  Zingiberis — Troches  of  Ginger. — 
Dose,  use  freely  as  required. 

Physiological  Action  and  Therapeutics  are  almost  identical 
with  those  of  other  aromatics.  Ginger  is  especially  valuable  as  a 
stomachic  and  carminative,  to  stimulate  the  stomach,  improve  the 
appetite,  and  relieve  flatulency  and  colic.  It  is  a  safe  and  efficient 
domestic  remedy  for  the  relief  of  simple  diarrhea.  It  is  also  much 
used  as  a  corrective  to  modify  the  taste  and  action  of  other 
medicines. 

Calamus— Calami— Calamus.    TJ.  S.  JP. 

(Sweet  Flag.) 

Origin. — The  rhizome  of  Acorus  Calamus  L.,  a  plant  indige- 
nous in  North  America,  Europe,  and  Western  Asia,  growing  in 
swamps  and  along  the  shores  of  streams  and  ponds. 

Description  and  Properties. — Calamus  is  found  in  subcylin- 
drical  sections  of  various  lengths,  about  i  inch  (2  Cm.)  broad, 
externally  reddish-brown,  internally  whitish,  of  a  spongy  texture, 
breaking  with  a  short,  corky  fracture,  showing  numerous  oil-cells 
and  scattered  wood-bundles.  It  has  a  strong  aromatic,  fragrant 
odor,  and  a  warm,  peculiar,  bitterish  taste.  Calamus  contains  from 
I  to  2  per  cent,  of  volatile  oil  possessing  the  odor  and  taste  of  cal- 
amus, a  glucosid  (acorin)  in  the  form  of  a  bitter,  yellow  syrupy 
hquid,  besides  calamine,  choline,  resin,  starch,  and  mucilage. 

Dose. — 15-60  grains  (1.0-4.0  Gm.). 

Official  Preparation. 

ExtrSctum  Calami  FlQidum— ExtrScti  Calami  Fluidi— Fluid  Extract  of 
Calamus. — Dose,  15-60  minims  (1.0-4.0  Co.). 

Physiological  Action  and  Therapeutics. — The  action  of  cala- 
mus is  similar  to  that  of  anise,  but  it  is  more  tonic  than  the  latter. 
Large  doses  of  the  volatile  oil  produce  tetanic  convulsions. 

It  is  used  for  the  same  purposes  as  anise,  but  probably  possesses 
more  stomachic  and  carminative  properties. 


AROMA  TICS.  373 

Oleum  Gaultheriae— Olei  Gaultherise— Oil  of  Winter- 
green,    u.  s.  p. 

Origin. — A  volatile  oil  distilled  from  the  leaves  of  Gaultheria 
procumbens  L.,  a  small  evergreen  plant  indigenous  in  the  northern 
hemisphere  and  bearing  a  scarlet,  fleshy,  berry-like  fruit. 

Description  and  Properties. — The  volatile  oil  is  a  colorless  or 
yellow,  or  occasionally  reddish,  liquid,  having  a  characteristic, 
strongly  aromatic  odor,  and  a  sweetish,  warm,  and  aromatic  taste. 
Specific  gravity,  1.175  to  1.185. 

It  consists  almost  entirely  of  methyl  salicylate.  It  should  be 
kept  in  well-stoppered  bottles,  protected  from  light. 

Dose.^ — 2-10  minims  (0.12-0.6  Cc). 

Official  Preparation. 

Splritus  Gaultheriae — Splritus  Gaultheriae — Spirit  of  Gaultheria  (Essence 
OF  Wintergreen). — Dose,  1-2  fluidrachms  (4.0-8.0  Cc). 

Physiological  Action. — Externally  and  Locally. — Oil  of  winter- 
green  is  a  stimulant  and  a  powerful  antiseptic. 

Internally. — Its  action  is  identical  with  that  of  salicylic  acid  and 
its  salts,  but  it  does  not  depress  the  heart  like  the  latter  drugs. 

Therapeutics. — Externally  and  Locally. — Used  for  the  same 
purposes  as  oil  of  cloves  and  other  aromatic  oils. 

Internally. — Used  for  the  same  purposes  as  salicylic  acid. 

Oleum  Lavandulae  Florum— Olei  Lavandulae  Florum 
—  Oil  of  Lavender  Flowers.    V.  S.  P. 

Origin.-^A  volatile  oil  distilled  from  fresh  flowers  of  Lavandula 
officinalis  Chaix.  Lavender  is  native  to  Southern  Europe  and 
cultivated  in  gardens. 

Description  and  Properties. — A  colorless  or  yellowish  liqiiid, 
having  the  fragrant  odor  of  lavender  flowers  and  a  pungent  and 
bitterish  taste.  Soluble  in  all  proportions  of  alcohol.  It  should 
be  kept  in  well-stoppered  bottles,  in  a  cool  place,  protected  from 
light. 

Dose. — 1-5  minims  (0.06-0.3  Cc). 

Official  Preparations. 
Splritus  Lavandulae  (S  per  cent.)-SpIritus  Lavandulae— Spirit  of  Lavender. 
—Dose,  %-\  fluidrachm  (2.0-4.0  Cc). 

Tinctura  Lavandulae  Compasita— Tincture  Lavan4ulae  CompSsitae-Com- 


374  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

pound  Tincture  of  Lavender —Oil  of  Lavender,  8;  Oil  of  Rosemary,  2;  Cassia 
Cinnamon,  20;  Cloves,  5;  Nutmeg,  10;  Red  Saunders,  10;  Alcohol,  0.7;  Water,  250; 
Diluted  Alcohol,  q.  ».  ad  1000  parts.  Dose,  %-l  fluidrachm  (2.0-4.0  Cc).  Com- 
pound Tincture  of  Lavender  is  an  ingredient  of  Liquor  Potassii  Arsenitis. 

Physiological  Action  and  Therapeutics  are  the  same  as  those 
of  other  volatile  oils  mentioned  in  this  group. 

Mentha  Piperita— Menthae  Plperitae— Peppermint. 

u.  s.  r. 

Origin. — The  leaves  and  tops  of  Mentha  piperita  Smith,  a 
perennial  plant  found  in  damp  places  in  England  and  other  Euro- 
pean countries  and  in  North  America. 

Peppermint  contains  about  i  per  cent,  of  a  volatile  oil— its  most 
important  constituent. 

Official  Preparation. 

Spfritus  Mgnthse  Piperitae  (loper  cent.)— Spiritus  Mgnthse  Piperitse— Spirit, 
or  Essence,  of  Peppermint. — Dose,  5-60  minims  (0.3-0.4  Cc). 
Spirit  of  Peppermint  is  an  ingredient  of  Mistura  Rhei  et  Sodse. 

Oleum  IVIentiiae  Piperitae— Olei  Menthae  Piperitae— 
Oil  of  Peppermint.    V.  S.  -P. 

Origin. — A  volatile  oil  distilled  from  Peppermint. 

Description  and  Properties. — A  colorless  or  yellowish  or 
greenish-yellow  liquid,  becoming  darker  and  thicker  by  age  and 
exposure  to  the  air,  having  the  characteristic  strong  odor  of  pep- 
permint, and  a  strongly  aromatic,  pungent  taste,  followed  by  a 
sensation  of  cold  upon  inhalation.  It  forms  a  clear  solution  with 
an  equal  volume  of  alcohol,  becoming  turbid  when  further  diluted, 
and  is  soluble  in  all  proportions  in  carbon  disulphide  and  in  glacial 
acetic  acid. 

When  exposed  to  a  freezing  temperature  the  oil  becomes  thick 
and  cloudy,  and  separates  crystals  of  menthol,  to  which  it  owes  its 
peculiar  odor. 

Dose. — 1-5  minims  (0.06-0.3  Cc). 

Official  Preparations. 

Aqua  Mfinthse  Piperitae  (0.2  per  cent.) — Aquae  MSnthae  Piperitae — Pepper- 
mint Water.— Z)Mf,  ^-i  fluidounce  (15.0-30.0  Cc). 

TrocWsci  Mfinthae  Piperitae  (.01  Cc.  in  each)— Trochlscos  (ace.)  MSnthae 
Piperitae — Troches  of  Peppermint. — Dose,  freely  as  desired. 


AROMA  TICS.  375 

Menthol— Menthol— Menthol.    TI.  S.  JP. 

Origin. — ^A  stearopten  obtained  from  the  official  Oil  of  Pepper- 
mint or  from  Japanese  or  Chinese  Oil  of  Peppermint. 

Description  and  Properties. — Colorless,  acicular  or  prismatic 
crystals,  having  a  strong  and  pure  odor  of  peppermint,  and  a 
warm,  aromatic  taste,  followed  by  a  sensation  of  cold  when  air  is 
inhaled.  Menthol  is  but  slightly  soluble  in  water,  but  imparts  to 
the  latter  its  odor  and  taste.  It  is  freely  soluble  in  alcohol,  ether, 
chloroform,  carbon  disulphide,  and  glacial  acetic  acid. 

Dose. — J-2  grains  (0.03-0.12  Gm.). 

Allied  Compounds. 

Benzoate  of  Menthol ;  Chloral  Menthol. — These  combinations  are  quite  active 
local  anesthetics  and  analgesics. 

Physiological  Action  and  Therapeutics. — Externally  and  Lo- 
cally.— Menthol  is  an  antiseptic,  antipruritic,  analgesic,  and  anes- 
thetic, as  well  as  a  germicide.  It  is  used  for  the  same  purposes  as 
oil  of  cloves.  It  is  used  extensively  in  headache,  being  rubbed 
on  the  forehead.  Owing  to  its  analgesic  properties,  it  is  used  in 
the  form  of  an  ointment  in  various  strengths  for  painful  hemor- 
rhoids, burns,  boils,  and  superficial  inflammations. 

The  OIL  OF  PEPPERMINT,  or  MENTHOL,  is  an  ingredient  of  many 
sprays  and  lotions  for  the  treatment  of  diseases  of  the  ear,  nose,  and 
throat. 

As  an  antipruritic  menthol  is  a  valuable  remedy  to  relieve  the 
itching  of  eczema,  pruritus,  urticaria,  etc.  It  should  be  dissolved 
in  oil  for  this  purpose — in  severe  cases  50  grains  to  i  ounce  (3.2 
Gm.  to  30.0  Cc). 

Internally. — The  uses  of  oil  of  peppermint  are  similar  to 
those  of  other  aromatic  oils,  it  being  a  valuable  carminative,  stimu- 
lant, antifermentative,  and  antispasmodic.  In  small  doses  menthol 
has  been  given  to  allay  nausea  and  vomiting  and  to  relieve  the 
pain  of  gastralgia. 

Mentha  Viridis— Menthae  Viridis— Spearmint. 

V.  s.  p. 

This  is  one  of  the  mints,  found  in  the  same  localities  as 
peppermint,  and  containing,  like  the  latter  drug,  a  volatile  oil 
forming  its  active  constituent.  It  possesses  milder  properties  than 
peppermint,  although  similar  to  it  in  its  action  and  uses.     To  some 


376  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

people  it  has  a  more   agreeable   taste   than   peppermint,  and   in 
infantile  cases  it  is   usually  preferred. 

Official  Preparations. 

Aqua  MSnthae  Vfridis— Aquae  MSnthae  Viridis— Spearmint  Water. 

Spiritus  Mgnthse  Viridis— Spfritus  Mgnthse  Vfridis— Spirit,  or  Essence,  of 
Spearmint. 

The  dose  of  the  oil  of  spearmint  and  of  the  above  preparations  is  the  same  as  for 
the  corresponding  oil  and  preparations  of  peppermint. 

Thymol— Thymol— Thymol.     U.  S.  P. 

Origin. — A  phenol  or  stearopten  occurring  in,  and  obtained  by, 
freezing  or  distilling  the  volatile  oils  of  Thymus  vulgaris.  Thymus 
monarda,  and  Carum  ajowan. 

Description  and  Properties. — Large,  colorless,  translucent 
crystals  of  the  hexagonal  system,  having  an  aromatic,  thyme-like 
odor,  and  a  pungent  aromatic  taste,  with  a  very  slight  caustic  effect 
upon  the  lips.  Its  specific  gravity  as  a  solid  is  1.069,  but  when 
liquefied  by  fusion  it  is  lighter  than  water.  It  is  soluble  in  about 
1200  parts  of  water  and  in  less  than  its  own  weight  of  alcohol, 
ether,  or  chloroform;  also  readily  soluble  in  carbon  disulphide, 
glacial  acetic  acid,  and  in  fixed  or  volatile  oils.  When  triturated 
with  about  equal  quantities  of  camphor,  menthol,  or  chloral,  it 
liquefies. 

Dose. — 1-5  grains  (0.06-0.3  Gm.). 

Allied  and  Derivative  Compound. 

ThymScetin,  a  derivative  of  thymol,  prepared  after  the  manner  of  phenacetin,  and 
holding  the  same  relation  to  thymol  as  phenacetin  does  to  phenol  (carbolic  acid).  It  is 
a  white,  ciystalline  powder,  sparingly  soluble  in  water.  Dose,  3-10  grains  (0.2-0.6 
Gm.). 

Physiological  Action  and  Therapeutics  are  similar  to  those  of  phenacetin,  thymace- 
tin  possessing  marked  analgesic  and  hypnotic  properties. 

Physiological  Action. — Thymol  is  a  powerful  antiseptic,  being 
ten  times  less  poisonous  than  carbolic  acid,  yet  as  an  antiseptic  far 
superior  to  it.  While  stimulant,  it  is  not  irritant  or  corrosive.  It 
is  also  a  deodorant,  disinfectant,  parasiticide,  and  local  anesthetic, 
as  well  as  an  antipruritic,  antipyretic,  and  antifermentative. 

Absorption  and  Elimination. — It  is  eliminated'  chiefly  by  the 
lungs  and  kidneys,  producing  some  irritation  at  the  points  of 
elimination.  The  urine  is  increased  in  quantity,  often  assuming  a 
dark  greenish  hue. 


AROMA  TICS.  377 

Untoward  Action. — The  following  symptoms  have  been  pro- 
duced by  the  administration  of  large  doses  :  burning  sensation  in 
the  mouth  and  stomach,  persisting  in  some  instances  for  days, 
accompanied  by  pain  and  tenderness  under  pressure.  According 
to  Balz,  "  perspiration  is  sometimes  observed,  and  occasionally  a 
transient  buzzing  in  the  ears  and  deafness." 

Poisoning. — In  addition  to  untoward  manifestations,  there  may 
be  nausea  and  vomiting,  profuse  sweating,  great  reduction  of  tem- 
perature, dizziness,  violent  deUrium,  and  collapse. 

Therapeutics. — Externally  and  Locally. — The  applications  of 
thymol  in  surgery  are  identical  with  those  of  carbolic  acid.  Among 
surgeons  who  recommend  and  use  it  is  Mr.  Spencer  Wells,  who 
employs  it  in  a  solution  of  i :  looo  for  spray,  irrigation,  sponges, 
instruments,  and  all  other  antiseptic  purposes. 

Crocker  in  1878  introduced  it  as  an  efficient  remedy  in  certain 
skin  diseases.  It  probably  owes  its  value  in  these  cases  to  its  anti- 
pruritic and  antiparasitic  properties. 

It  is  also  extensively  used  in  diseases  of  the  nose,  throat,  and 
ear,  and  in  certain  disorders  of  the  genito-urinary  tract.  Thymol 
is  also  administered  by  inhalation  in  certain  broncho-pulmonary 
disorders. 

Internally. — Thymol  is  used  for  the  same  purposes  as  other 
antiseptics,  such  as  carbolic  acid,  resorcin,  beta-naphtol,  etc. 

Martini  highly  recommends  it  as  an  intestinal  antiseptic  in  the 
treatment  of  diarrhea,  dysentery,  and  typhoid  fever. 

Bulfalini  has  employed  it  with  some  success  in  limiting  fermen- 
tation during  a  proteid  diet  in  the  treatment  of  diabetes.  It  has 
also  been  favorably  recommended  in  phthisis,  vesical  catarrh,  sto- 
matitis, and  diphtheria. 

Administration. — It  may  be  applied  externally  in  solution 
(i  :  1000),  as  an  ointment  (i-io  per  cent),  or  in  the  form  of  thymol 
gauze  as  a  surgical  dressing  (i  per  cent,  of  thymol). 

For  internal  use  it  should  be  given  in  pills  or  capsules. 

Carum—Cari— Caraway.    V.  8.  P. 

Origin. — The  fruit  of  Carum  Carvi  L.,  a  biennial  plant  native 
to  Central  and  Western  Asia.  It  is  cultivated  in  Europe  and  in  the 
United  States. 

Description  and  Properties. — Oblong,  laterally  compressed, 
about  ^  to  I  inch  (4-5  Mm.)  in  length,  tapering  somewhat  at  the 


378  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

ends,  brown,  with  five  yellowish,  filiform  ribs,  and  six  oil-tubes.. 
Caraway  has  an  agreeable  odor  and  a  sweetish,  spicy  taste. 

Constituents. — It  contains  fi-om  5  to  7  per  cent,  of  a  volatile 
oil. 

Dose. — 15-30  grains  (1.0-2.0  Gm.). 

Official  Preparation. 

Tinctura  Cardamomi  Compttsita  (10  per  cent.) — Tincturse  Cardamomi' 
Comp6sitae — Compound  Tincture  of  Cardamom. — Dose,  1-2  fluidrachms  (4.0- 
8.0  Cc).     (Formula  given  under  Cardamomum.) 

Oleum  Cari— Olei  Cari— Oil  of  Caraway.   JJ.  S.  I*. 

Origin. — A  volatile  oil  distilled  from  Caraway. 

Description  and  Properties. — A  colorless  or  pale-yellow,  thin 
liquid,  having  the  characteristic  aromatic  odor  of  daraway  and  a 
mild,  spicy  taste.  Soluble  in  an  equal  volume  of  alcohol,  this 
solution  being  neutral  to   litmus-paper. 

By  fractional  distillation  the  oil  may  be  separated  into  two- 
portions  :  a  light  hydrocarbon  with  but  little  odor  and  taste,. 
carvene,  a,nd  a  heavy  oil  having  an  agreeable  caraway  odor,  carvol^ 
and  isomeric  with  menthol,  myristicol,  and  thymol. 

Dose. — i-io  minims  (0.6-0.66  Cc). 

Official  Preparation. 

SpKritus  JunJperi  Comp6situs  (0.05  per  cent.) — Sp&itus  Junlperi  Comp6siti — 
Compound  Spirit  of  Juniper.— Oil  of  Juniper,  4 ;  Oil  of  Caraway,  \ ;  Oil  of  Fennel, 
yi. ;  Alcohol,  0.7 ;  Water,  q.  s.  ad  looo  parts.     Dose,  2-4  fluidrachms  (8.0-15.0  Cc). 

Physiological  Action  and  Therapeutics. — The  same  as  those 
of  the  other  aromatic  oils. 


CLASS  III.-SYMPTOM  MEDICINES. 


GROUP   I.— ANTISPASMODICS. 

Antispasmodics  are  remedies  used  to  allay  spasm  and  quiet 
nervous  excitement  or  improve  unfavorable  conditions  of  the 
mind,  as  in  cases  of  convulsions,  hysteria,  melancholia,  hypo- 
chondriasis, etc.  They  act  as  stimulants  to  the  brain  and  higher 
nervous  centers,  and  as  depressants  of  the  lower  centers,  diminish- 
ing muscular  activity  and,  partly  through  their  action  upon  the 
higher  nervous  centers,  increasing  the  co-ordinating  power.  They 
are  to  a  considerable  degree  cardiac  stimulants,  diaphoretics,  ex- 
pectorants, and  antiseptics. 

Asafoetida— Asafoetidae— Asafetida.   TJ.  8.  P. 

Origin. — A  gum  resin  obtained  from  the  root  of  Ferula  foetida 
(Bunge)  Regel,  a  large  perennial  herb  found  in  Turkestan,  Western 
Thibet,  and  Western  Afghanistan. 

Description  and  Properties. — Irregular  masses  composed  of 
whitish  tears  imbedded  in  a  yellowish-  or  brownish-gray,  sticky 
mass.  The  tears  when  hard  break  with  a  conchoidal  fracture, 
showing  a  milk-white  color,  which  changes,  on  exposure,  to  pink, 
and  finally  to  brown.  The  drug  has  a  persistent  alliaceous  odor 
and  a  bitter,  alliaceous,  acrid  taste.  When  triturated  with  water  it 
yields  a  milk-white  emulsion,  which  becomes  yellow  upon  the  addi- 
tion of  ammonia  water.  It  is  partly  soluble  in  ether,  and  at  least 
60  per  cent,  of  it  should  dissolve  in  alcohol. 

Dose. — 5-8  grains  (0.3-0.5  Gm.). 

Official  Preparations. 

Emtilsum  Asafcetids — Emtilsi  Asafoetids — Emulsion  of  Asafetida.  —Dose, 
2-4  flutdrachins  (7.39-15  Cc). 

Pllulae  Aloes  et  Asafcetidae — Pilulas  (ace.)  Aloes  et  Asafoetidse. — Pills  of 
Aloes  and  Asafetida. — Dose,  2  to  5  pills. 

PUulse  Asafcetidse — Pilulas  (ace.)  Asaffltidse — Pills  of  Asafetida. — Dose, 
2  to  5  pills. 

Tinctiira  Asafcetids — Tinctiirae  Asafoetidse — Tincture  of  Asafetida  (20 
per  cent.). — Dose,  10-40  minims  (0.6-2.5  Cc.). 

379 


380  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

AmmonTacum—Ammoniaci— Ammoniac.    TI.  S.  P. 

Origin. — A  gum  resin  obtained  from  Dorema  Ammoniacum 
Don,  a  plant  6  or  7  feet  (2  M.)  high,  found  in  the  deserts  and 
barren  regions  of  Persia  and  Tartary. 

Description  and  Properties. — Roundish  tears,  y^\  'ycic\\  (1.5- 
12  Mm.)  in  diameter;  externally  pale  yellowish-brown,  internally 
milk-white ;  brittle  when  cold,  and  breaking  with  a  flat,  conchoidal, 
and  waxy  fracture ;  or  the  tears  are  superficially  united  into  irreg- 
ular masses  without  any  intervening  dark-colored  substance.  It 
has  a  peculiar  odor  and  a  bitter,  acrid,  and  nauseous  taste.  When 
triturated  with  water  it  readily  yields  a  milk-white  emulsion.  It 
contains  from  i  .8  to  4  per  cent,  of  volatile  oil,  70  to  72  per  cent, 
of  resin,  and  18  to  22  per  cent,  of  gum. 

Dose. — 2-10  grains  (0.12-O.6  Gm.). 

Official  Preparations. 

EmpISstrum  Atnmoniaci  cum  Hydrargyro — EmpISstri  Ammoniaci  cum 
HydrSrgyro — Ammoniac  Plaster  with  Mercury. — For  external  use. 

Emtilsum    Ammoniaci— Emiilsi    Ammoniaci — Emulsion    of    Ammoniac 

{4  per  cent.). — Dose,  ^-l  fluidounce  (15  to  30  Co.). 

Camphora—Camphorae— Camphor.     TJ.  S.  P. 

Origin. — A  stearopten  (of  the  nature  of  a  ketone)  obtained 
from  Cinnamomum  camphora  L.,  and  purified  by  sublimation.  The 
camphor  laurel  is  a  handsome  tree  25  to  30  feet  (7.5-9  M.)  high, 
indigenous  in  Eastern  and  Southeastern  Asia,  and  cultivated  in 
Italy  as  an  ornamental  tree. 

Description  and  Properties. — White,  translucent  masses,  of  a 
tough  consistence  and  crystalline  structure,  readily  pulverizable  in 
the  presence  of  a  little  alcohol,  ether,  or  chloroform ;  having  a 
penetrating,  characteristic  odor  and  a  pungently  aromatic  taste. 
Very  sparingly  soluble  in  water,  but  readily  soluble  in  alcohol, 
ether,  chloroform,  carbon  disulphide,  benzin,  and  in  fixed  and  vola- 
tile oils. 

When  camphor  is  triturated  in  about  molecular  proportions 
with  menthol,  thymol,  phenol,  or  chloral  hydrate,  liquefaction 
ensues.  It  melts  at  175"  C.  (347°  F.),  boils  at  204°  C.  (399.2°  R), 
and  is  inflammable,  burning  with  a  luminous,  smoky  flame.  On 
exposure  to  the  air  it  evaporates  more  or  less  rapidly  at  ordinary 
temperatures,  and  when  moderately  heated  it  sublimes  without 
leaving  a  residue. 


ANTISPASMODICS.  381 

From  camphor  may  be  obtained  a  number  of  interesting  com- 
pounds, such  as  camphoric  acid,  cymol,  etc.  The  drug  should  be 
kept  in  well-closed  vessels,  in  a  cool  place. 

Dose. — 2-10  grains  (o.  12-0.6  Gm.). 

Official  Preparations. 

Aqua  Camphors — Aquae  Camphorse — Camphor  Water  (0.8  per  cent.). — 
Dose,  J-2  fluidounces  (15-30  Cc). 

LinimSntum  Camphorae — Linim&nti  Camphorse — Camphor  Liniment. — 
Camphor,  20 ;  Cotton  Seed  Oil,  80  parts.     For  external  use. 

LinimSntum  Saponis — Linimfinti  Saponis — Soap  Liniment  (4,5  per  cent.). — 
For  external  use. 

Splritus  Camphorae — Splritus  Camphorae^ — Spirit  of  Camphor  (10  per  cent.). 
— Dose,  5-40  minims  (0.3-2.6  Cc). 

Tinctiira  Opii  Camphorata — Tinctiirae  Opii  Camphoratae — Camphorated 
Tincture  of  Opium  (0.4  per  cent.). — Dose,  1-4  fluidiachms  (4-15  Cc). 

Camphora  Monobromata— Camphorae  Monobro- 
matae— Monobromated  Camphor.    V.  S.  I*. 

Origin. — Prepared  by  heating  Camphor  and  Bromine,  dissolving 
in  Benzin,  and  crystallizing  from  hot  Alcohol. 

Description  and  Properties. — Colorless,  prismatic  needles  or 
scales,  of  a  mild,  camphoraceous  odor  and  taste,  permanent  in  the 
air,  unaffected  by  light,  and  neutral  to  litmus-paper.  Almost  in- 
soluble in  water ;  freely  soluble  in  alcohol,  ether,  chloroform,  hot 
benzin,  and  fixed  and  volatile  oils;    slightly  soluble  in  glycerin. 

Dose. — 2-5  grains  (o.i  2-0.3  Cm.). 

Acidum  Camph6ricum— Acidi  CamphSrici — Camphoric  Acid. — Origin. — 
Obtained  by  the  oxidation  of  Camphor  through  the  action  of  Nitric  Acid. 

Description  and  Properties. — White,  acicular  crystals,  odorless,  and  of  a  weak,  acid, 
and  slightly  astringent  taste.  Soluble  in  hot  water,  alcohol,  ether,  and  fatty  oils;  almost 
insoluble  in  cold  water. 

Dose. — 10-30  grains  (0.6-2.0  Gm.). 

Valeriana— Valerianae— Valerian.    TJ.  S.  I*. 

Origin. — The  rhizome  and  roots  of  Valeriana  officinalis  L.,  an 
herbaceous  perennial  2  to  4  feet  (0.6-1.2  M.)  high,  a  native  of 
Europe,  and  cultivated  to  some  extent  in  New  England  and  New 
York. 

Description  and  Properties. — The  rhizome  varies  in  length  be- 
tween \  and  i\  inches  (1-3  Cm.),  and  has  nearly  an  equal  diameter, 
thick,  upright,  subglobular  or  obconical,  truncate  at  both  ends, 
brown  or  yellowish-brown,  internally  whitish  or  pale-brownish, 


382  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

with  a  narrow  circle  of  white  wood  under  the  thin  bark.  Roots 
numerous,  slender,  brittle,  brown,  with  a  thick  bark  and  slender, 
ligneous  cord.  Odor  peculiar,  becoming  stronger  and  unpleasant 
on  keeping;  taste  camphoraceous  and  somewhat  bitter. 

Valerian  contains  valerianic  and  other  acids  and  a  volatile  oil. 

Dose. — 15-60  grains  (i. 0-4.0  Gm.). 

Official  Preparations. 

ExtrSctum  Valerianae  Fluidum — ExtrScti  Valerianae  Flflidi — Fluid  Ex- 
tract of  Valerian. — Dose,  15-60  minims  (1.0-4.0  Cc). 

Tinctura  Valerianae — Tinctiirse  Valeriana — Tincture  of  Valerian  (20  per 
cent.). — Dose,  1-2  fluidrachms  (4-8  Cc). 

Tinctiira  Valeriana  Ammoniata — Tincturse  Valeriana^  Atntnoniatae — Am- 
moniated  Tincture  of  Valerian  (20  per  cent.). — Dose,  30-60  minims  (2.0-4.0  Cc,). 

Ammonii  Valerianas— Ammonii  Valerianatis— Am- 
monium Valerianate.    V.  S.  J*. 

Origin. — Obtained  by  saturating  Valerianic  Acid  with  Gaseous 
Ammonia  and  crystaUizing. 

Description  and  Properties. — Colorless  or  white  quadrangular 
plates,  emitting  the  odor  of  valerianic  acid ;  of  a  sharp  and  sweet- 
ish taste ;  deliquescent  in  moist  air.  Very  soluble  in  water  and  in 
alcohol.  Ammonium  valerianate  should  be  kept  in  well-stoppered 
bottles. 

Dose. — 2-10  grains  (0.12-0.6  Gm.). 

Ferri  Valerianas— Ferrl  Valerianatis— Ferric 
Valerianate.    U.  S.  -P. 

Origin.— Prepared  by  mixing  solutions  of  Ferric  Sulphate  and 
Sodium  Valerianate  and  washing  the  precipitate  formed. 

Description  and  Properties. — ^A  dark  brick-red  amorphous 
powder  of  somewhat  vaiying  chemical  composition,  having  the 
odor  of  valerianic  acid  and  a  mildly  styptic  taste ;  permanent  in 
dry  air.  Insoluble  in  cold  water,  but  readily  soluble  in  alcohol. 
Ferric  valerianate  should  be  kept  in  small,  well-stoppered  bottles, 
in  a  cool  and  dark  place. 

Dose. — 1-3  grains  (0.6-0.2  Gm.). 

Zinci  Valerianas— Zinci  Valerianatis— Zinc  Vale- 
rianate.    JJ.  S.  J*. 

Origin. — Obtained  by  evaporating  hot  solutions  of  Zinc  Sul- 


ANTISPASMODICS.  383 

phate  and  Sodium  Valerianate,  the  zinc  valerianate  crystallizing 
out. 

Description  and  Properties. — White,  pearly  scales,  having  the 
odor  of  valerianic  acid  and  a  sweetish,  astringent,  and  metallic 
taste.  On  exposure  to  air  it  slowly  loses  valerianic  acid.  Soluble  in 
about  100  parts  of  water  and  in  40  parts  of  alcohol.  It  should  be 
kept  in  small,  well-stoppered  bottles. 

Dose. — 1-3  grains  (0.03-0.2  Gm.). 


Antagonists  and  Incompatibles. — The  actions  of  asafetida, 
AMMONIAC,  and  CAMPHOR  are  opposed  by  arterial  sedatives,  acids, 
and  neutral  salts,  while  quinine,  digitalis,  and  ergot  antagonize  the 
action  of  valerian. 

Water  and  aqueous  solutions  precipitate  camphor  from  its  alco- 
holic solution. 

Synergists. — The  antispasmodics  are  synergistic  to  each  other. 
They  are  also  aided  in  their  action  by  the  aromatics  and  many  of 
the  gum  resins  and  balsams,  alcohol,  ether,  etc. 

These  remedies  are  so  nearly  alike  in  their  action  that  their 
physiological  effects  will  here  be  considered  as  a  whole,  mention 
being  made  of  any  marked  difference  in  their  individual  action 
should  it  exist. 

Physiological  Action. — Externally  and  Locally. — The  only 
member  of  this  group  having  any  special  local  action  is  camphor. 
This  drug  has  an  anesthetic  effect  upon  the  unbroken  skin,  but  in 
-a  concentrated  state  is  very  irritating  to  mucous  membranes,  and 
may  even  produce  inflammation  and  sloughing.  Camphor  is  also 
■a  powerful  parasiticide. 

Digestive  System. — In  medicinal  doses  antispasmodics  stimulate 
the  digestion  and  augment  the  secretions  from  the  gastro-intestinal 
tract.  They  also  stimulate  peristalsis,  and  are  active  carminatives 
and  calmatives  to  the  digestive  tract.  Asafetida  is  the  most  laxa- 
tive of  all. 

Large  doses  of  any  antispasmodic  cause  nausea,  vomiting,  and 
purging,  camphor  being  the  most  irritant,  and  in  toxic  doses  acting 
as  an  irritant  poison. 

Circulatory  System. — In  medicinal  doses  the  antispasmodics  in- 
crease the  force  of  the  heart  and  elevate  arterial  tension. 

Asafetida  exerts  the  greatest  influence  on  menstruation,  while 
■camphor  has  the  most  marked  effect  upon  the  general  circulation. 

Nervous  System. — It  is  probably  upon  the  nervous  system  that 


384  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

these  drugs  exert  their  most  potent  action.  They  are  all  stimu- 
lants to  some  portion  of  the  cerebrum.  Their  precise  influence 
upon  the  brain  is,  however,  unknown,  and  in  order  to  form  a  better 
conception  of  the  action  of  these  drugs  some  explanation  of  the 
function  of  the  brain  is  necessary. 

The  cerebrum  consists  of  a  complex  mechanism,  each  localized 
area  having  a  definite  physiological  function,  the  relations  of  the 
several  areas  differing  one  from  another,  some  being  equal  and 
others  subordinate.  These  areas  probably  are — i.  Perception  areas 
— five;  2.  Judgment  areas;  3.  Emotion  areas;  4.  Motor  areas; 
5.  Inhibitory  areas.  These  areas  are  all  connected  by  commissural 
fibers. 

The  emotion  and  motor  areas  are  controlled  by  the  functional 
influence  of  the  areas  of  inhibition.  Sometimes  disturbing  influ- 
ences modify  this  adjustment,  so  that  the  lower  areas  act  inde- 
pendently. The  perturbation  may  be  due  either  to  deficient  power 
of  inhibition,  to  unusual  activity  of  the  lower  areas,  or  to  lack  of 
co-ordination  in  the  connecting  fibers  by  which  the  unimpeded  areas 
are  held  in  subjection.  Even  a  slight  loss  of  command  occasions 
in  the  subject  an  irritability  readily  aroused,  together  with  annoy- 
ance from  trivial  causes  which  under  normal  conditions  would  be 
inconsequential.  The  mental  derangement  accompanying  these 
phenomena  we  call  nervousness,  and  when  the  symptoms  become 
still  further  aggravated  the  mental  disturbance  known  as  hysteria 
results. 

Again,  the  emotion  and  cerebral  motor  areas  may  become  so 
far  freed  from  restraint  that  even  violent  hysterical  symptoms  ensue, 
including  convulsions  or  coma.  Obviously,  therefore,  the  only 
remedy  for  the  malady  is  to  restore  the  equilibrium  between  the 
inhibitory  and  lower  areas. 

This  may  be  effected  either  by  stimulation  of  the  debilitated 
areas  of  inhibition,  by  depression  of  the  over-active  lower  areas,  or 
by  supplying  a  possible  deficiency  in  the  conductive  force  of  the 
fibers.  The  first  of  these  desiderata  may  be  attained  by  improving 
the  circulation  and  affording  stronger  nutriment.  By  dilating  the 
arterioles  small  doses  of  alcohol  and  ether  accomplish  this  object, 
and  may  act  favorably  in  an  attack  of  hysteria.  Alcohol,  however, 
in  large  doses  exerts  a  deleterious  influence  upon  the  commissural 
fibers,  resulting  in  incoherence.  Arsenic,  quinine,  cod  liver  oil,  and 
iron  by  their  tonic  effects  may,  under  continued  dosage,  abort  access 
of  hysteria. 


ANTISPASMODICS.  385 

Other  remedial  agents  which  tend  to  act  directly  upon  the  cell- 
ular structure  of  the  inhibitory  areas,  and  thereby  invigorate  them, 
are  the  drugs  under  consideration — the  antispasmodics.  By  stim- 
ulation of  the  inhibitory  centers  they  may  allay  the  spasms  of 
hysteria. 

The  morbid  activity  of  the  lower  areas  may  be  ameliorated  by 
depressant  remedies,  among  which  morphine  and  the  bromides  may 
prove  particularly  beneficial. 

The  antispasmodics,  it  will  be  seen,  appear  to  exert  a  calmative 
influence  upon  certain  nerve-centers,  allaying  nervous  excitement 
and  muscular  spasm.  They  produce  a  gentle,  exhilarating  effect 
upon  the  brain,  and  diffuse  a  feeling  of  warmth  in  the  system.  It 
is  claimed  that  they  also  possess  mildly  aphrodisiac  properties. 
Excessive  doses,  on  the  other  hand,  may  occasion  delirium,  even 
merging  in  maniacal  excitement,  this  being  particularly  true  of 
CAMPHOR,  toxic  doses  of  which  drug,  in  the  monobromated  form, 
cause  muscular  weakness,  passing  into  paralysis,  followed  by  stupor 
and  collapse.  Valerian  may  occasion  formication  of  the  hands 
and  feet  and  a  condition  of  melancholia. 

Respiratory  System. — The  antispasmodics  are  all  respiratory 
stimulants  and  stimulant  expectorants.  Large  doses  of  mono- 
bromated CAMPHOR  depress  respiration. 

Absorption  and  Elimination. — These  drugs  are  readily  absorbed 
from  the  stomach  or  rectum,  and  are  eliminated  by  the  intestinal 
tract,  kidneys,  lungs,  skin,  and  mucous  membranes  generally,  stim- 
ulating the  glands  in  these  structures,  and,  in  the  case  of  asafetida 
and  VALERIAN,  imparting  the  characteristic  odor  of  these  drugs  to 
the  excretions. 

Temperature. — Unaffected  except  by  monobromated  camphor,. 
which  in  large  doses  acts  as  a  depressant. 

Uterus. — ^The  menstrual  flow  and  sexual  appetite  are  increased 
at  first ;  continued  dosage,  however,  has  a  depressing  effect  upon 
the  generative  functions,  camphor  perhaps  being  the  most  active 
in  large  doses. 

It  is  said  that  the,  sexual  passion  of  cats  is  extraordinarily 
excited  by  valerian,  probably  because  of  its  odor. 

Untoward  Action. — Camphor  may  occasion  mental  confusion, 
headache,  vertigo,  dryness  of  the  mouth  and  thirst,  flushing  of  the 
face,  clammy  perspiration,  disturbances  of  digestion,  and  strangury. 
Musk  produces  similar  untoward  manifestations,  with  a  sense  of 
pressure  in  the  eye-sockets  and  marked  sexual  excitement.     The 

25 


386  A    TEXT-BOOK  OF  MA  TERIA    MEDICA. 

symptoms  caused  by  valerian  are  very  much  the  same,  although, 
as  in  the  untoward  action  of  asafetida,  there  is  more  disturbance 
of  the  gastro-intestinal  tract,  such  as  nausea,  borborygmi,  diarrhea, 
and  colicky  pains.  Barbier  noted  visual  hallucinations  in  a  person 
treated  with  valerian. 

Poisoning. — The  symptoms  of  poisoning  resemble  the  untoward 
action,  save  that  the  effects  may  be  more  marked,  with  greater 
irritation  of  the  intestinal  tract  and  more  pronounced  cerebral 
disturbance. 

Treatment  of  Poisoning. — Coffee  and  the  arterial  sedatives  an- 
tagonize the  action  of  camphor.  The  patient  should  be  treated 
symptomatically ;  emetics  or  the  stomach-pump  should  be  employed, 
and  measures  taken  to  favor  elimination.  Excessive  nervous  mani- 
festations may  be  controlled  by  opium  or  the  bromides. 

Therapeutics. — Externally  and  Locally. — The  only  member  of 
the  present  group  used  locally  is  camphor,  its  anesthetic  and  anti- 
pruritic properties  rendering  it  of  great  value  in  the  treatment  of 
diseases  of  the  skin.  "Anderson's  powder,'  composed  of  pulver- 
ized camphor,  starch,  and  zinc  oxide,  is  a  very  soothing  and 
efficient  dusting  powder  in  erythema,  erythematous  eczema,  and  urti- 
caria. "  Camphor-ice  "  and  ointments  of  camphor,  alone  or  com- 
bined with  salicylic  acid,  are  used  for  " chapped  hands"  ulcers,  etc. 

Various  inhalants  and  powders  containing  camphor  have  been 
successfully  employed  in  the  treatment  of  ozena,  acute  coryza,  and 
laryngitis.  Suppositories  of  camphor  afford  great  relief  in  cases 
ol  chordee,  while  the  camphor  liniment  is  a  household  remedy  for 
sprains,  bruises,  chilblains,  etc. 

Camphor  chloral  makes  an  efficient  local  application  in  neur- 
algia, and  the  campho-phenique  is  an  excellent  antiseptic,  when 
mixed  with  oil  being  an  efficient  dressing  for  wounds. 

Internally. — The  disagreeable  odor  and  taste  of  many  of  the 
antispasmodics — notably  asafetida,  valerian,  and  musk — greatly 
limit  their  use.  Asafetida  is  an  exceedingly  valuable  stomachic 
tonic,  and  singularly  beneficial  in  the  atonic  dyspepsia  and  constipa- 
tion of  nervous  and  anemic  women.  It  stimulates  the  appetite  and 
digestion,  acts  as  a  laxative,  and  allays  much  of  the  nervousness 
and  melancholia  from  which  these  patients  so  frequently  suffer. 

Asafetida  is  a  peculiarly  potent  remedy  in  relieving  parox- 
ysms of  hysteria,  and  there  is  probably  no  more  effective  agent 
for  the  alleviation  of  flatulent  colic  of  infants  and  various  infantile 
convulsions. 


ANTISPASMODICS.  387 

Chronic  bronchitis  and  bronchorrhea,  especially  when  attended 
with  spasmodic  dyspnea,  are  very  favorably  influenced  by  this  rem- 
edy. Its  antispasmodic  action  renders  asafetida  of  considerable 
value  in  whooping  cough  and  the  sympathetic  cough  of  mothers. 
The  drug  has  been  highly  recommended  in  chorea  occurring  in 
young  girls  about  the  age  of  puberty,  who  are  weak,  anemic,  and 
suffering  from  menstrual  irregularities.  The  emulsion  of  asafetida, 
used  as  an  enema,  often  affords  prompt  and  complete  relief  in  the 
tympanitis  of  typhoid  fever. 

Ammoniacum  is  chiefly  employed  as  a  stimulant  expectorant  in 
chronic  bronchitis.  Camphor  is  a  remarkably  efficient  anodyne,  an- 
tispasmodic, and  carminative  in  flatulent  colic,  diarrhea  of  infants, 
and  the  diarrhea  of  the  aged  produced  by  relaxation  of  the  bowels. 
For  many  years  camphor  has  been  considered  a  valuable  remedy 
in  the  diarrhea  ushering  in  an  attack  of  Asiatic  cholera. 

The  various  spasmodic  and  hysterical  disorders  for  which  asa- 
fetida is  recommended  are  also  greatly  benefited  by  camphor.  It 
is,  moreover,  a  serviceable  stimulant  expectorant  and  a  potent 
remedy,  especially  monobromated  camphor,  to  allay  sexual  excite- 
ment and  for  the  relief  of  chordee.  It  has  likewise  proved  effica- 
cious in  spermatorrhea. 

Mania,  especially  the  puerperal  form,  delirium  tremens,  and 
•melancholia  have  readily  yielded  to  full  doses  of  camphor.  The 
internal  use  of  the  drug  has  appeared  to  prove  beneficial  in  senile 
gangrene. 

Dysmenorrhea  and  the  after-pains  of  labor  are  greatly  relieved 
by  camphor,  either  alone  or  combined  with  morphine.  The  drug 
has  been  used  extensively  as  a  cardiac  stimulant  and  to  allay  the 
delirium  and  restlessness  o{ typhoid,  typhus,  and  exanthematous  fevers. 

Camphoric  acid  is  an  efficient  remedy  in  checking  the  night- 
sweats  oi  phthisis  and  excessive  perspiration  in  acute  rheumatism. 
It  is  recommended  by  Wood  in  enuresis  and  spermatorrhea.  While 
not  so  efficient  as  camphor  or  monobromated  camphor  in  spas- 
modic and  hysterical  disorders,  it  has  proved  of  some  benefit  in 
these  conditions. 

Camphoric  acid  in  from  i  to  2  per  cent,  solution  is  useful  in 
the  treatment  of  acute  pharyngitis  and  acute  coryza,  being  employed 
in  the  form  of  a  gargle  or  spray. 

Camphoric  acid  has  been  used  internally  to  acidify  ammoniacal 
urine  in  cystitis. 

Valerian  has  been  employed  for  the  same  class  of  disorders  as 


388  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

those  treated  with  asafetida,  but  seems  to  be  superior  to  the  latter 
in  mitigating  the  hysterical  manifestations  and  vaso-motor  disturb- 
ances occurring  at  the  menopause. 

The  hypochondriasis  of  feeble  and  morbidly  sensitive  girls  and 
women  is  usually  soon  relieved  by  this  remedy.  Nervous  headache 
and  vertigo  due  to  cerebral  anemia  and  the  irregular  distribution 
of  blood  are,  in  the  majority  of  cases,  promptly  relieved  by  valerian 
or  the  ammonium  valerianate. 

Valerian  has  been  favorably  recommended  in  both  diabetes 
insipidus  and  mellitus. 

Contraindications. — There  are  no  special  contraindications  to 
the  use  of  antispasmodics  other  than  in  acute  inflammations  of  the 
gastro-intestinal  tract,  when  camphor  should  not  be  employed. 

Administration. — Any  of  the  preparations  of  the  various  mem- 
bers of  this  group  may  be  used.  Asafetida  and  camphor  in  sub- 
stance should  always  be  given  in  the  form  of  pills  or  capsules. 
Camphoric  acid  is  best  administered  in  capsules. 


GROUP   II.— ANTIPYRETICS. 
Acetan  i  lid  u  m '— Acetan  i  lid  i— Acetan  i  1  i  d . 

Origin. — An  acetyl  derivation  of  Anihne. 

Description  and  Properties. — White,  shining,  micaceous,  crys- 
talline laminae,  or  a  crystalline  powder,  odorless,  faintly  burning 
taste,  permanent  in  air,  neutral  to  litmus-paper.  It  is  soluble,  at 
IS"  C.  (S9°  F.),  in  194  parts  of  water,  5  parts  of  alcohol,  i8  parts 
of  boiling  water,  and  in  0.4  part  of  boiling  alcohol;  also  in  18 
parts  of  ether,  and  easily  soluble  in  chloroform. 

Dose. — 2-10  grains  (0.1-0.65  Gm.). 

Physiological  Action. — Externally  and  Locally. — Antiseptic, 
slightly  sedative. 

1  Antifebrin  is  a  copyrighted  name  for  Acetanilid,  or  Phenyl-acetamide,  as  it  is 
sometimes  called.  The  copyrighted  word  Antifebrin  should  never  be  used.  The  pro- 
prietary preparations  like  Antikamnia,  Antinervin,  Pkenolyd,  Exodyne,  etc.  are  said, 
by  different  chemists  who  have  analyzed  them,  to  be  mechanical  mixtures  of  Acetanilid 
and  one  or  more  such  substances  as  Sodium  Bicarbonate,  Caffeine,  Ammonium  Bromide, 
Sahcylic  Acid,  Sodium  Salicylate,  etc.  Such  secret  preparations  should  not  be  counte- 
nanced by  medical  men.  Should  a  combination  containing  some  of  the  aforesaid  drugs 
be  desired,  a  prescription  for  the  same  should  be  written,  specifying  the  proportions 
■wanted  in  each  particular  case,  rather  than  prescribe  a  proprietary  article  costing  a 
dollar  or  more  an  ounce,  the  same  mixture  being  put  up '  by  any  pharmacist  for  ten 
cents  an  ounce. 


ANTIPYRETICS.  389 

Internally. — Digestive  System. — Non-irritating,  sedative ;  medi- 
cinal doses  sometimes  allay  nausea. 

Circulatory  System. — Acetanilid  decreases  the  ozonizing  func- 
tion and  the  oxygen-carrying  power  of  the  blood.  The  corpus- 
cles are  unaffected  under  the  influence  of  small  doses,  but  toxic 
doses  disorganize  the  corpuscles.  When  large  doses  are  taken, 
or  even  small  doses  by  one  who  has  an  idiosyncrasy  against  the 
drug,  the  arterial  blood  becomes  venous  in  character,  the  normal 
alkalinity  of  the  blood  is  decreased,  and  much  of  the  hemoglobin 
is  reduced  to  methemoglobin. 

Heart  and  Blood-vessels. — In  medicinal  doses  the  arterial  ten- 
sion is  slightly  raised,  while  the  heart  is  slowed.  Toxic  doses 
directly  depress  the  heart  and  vaso-motor  mechanism,  causing  an 
immediate  fall  of  arterial  pressure  and  great  cardiac  depression. 

Nervous  System. — In  medicinal  doses  acetanilid  is  a  sedative  to 
the  sensory  nerves  and  spinal  cord.  Small  doses  are  mildly  stim- 
ulant to  the  brain,  and  under  certain  conditions  the  drug  is  a 
hypnotic.  Toxic  doses  result  in  general  anesthesia  and  abolition 
of  reflexes,  with  paralysis  of  motor  and  sensory  nerves. 

Respiratory  System. — Medicinal  doses  produce  no  special  effect. 
When  toxic  doses  are  given  there  is  a  rapid  and  labored  respiration. 
Death  is  produced  by  respiratory  failure,  due  to  direct  action  of  the 
drug  upon  the  respiratory  center,  and  indirectly  by  greatly  de- 
creasing the  ozonizing  and  oxygen-carrying  power  of  the  blood 
and  by  paralyzing  the  peripheral  motor  nerves. 

Absorption  and  Elimination. — Acetanilid  is  quite  an  active 
diuretic,  especially  increasing  the  excretion  of  urea,  and  to  some 
extent  the  excretion  of  uric  acid. 

After  toxic  doses  have  been  taken  the  urine  becomes  dark  or 
brownish  in  color,  from  the  presence  of  disorganized  corpuscular 
elements  of  the  blood.     It  is  also  diaphoretic. 

Acetanilid  is  chiefly  eliminated  by  the  kidneys  in  the  form  of 
sulphate  of  para-amido-phenol. 

Temperature. — A  full  medicinal  dose  lowers  a  fevered  tempera- 
ture within  one  hour  after  its  administration,  and  the  effect  lasts 
about  six  hours.  The  drug  acts  both  by  increasing  heat-dissi- 
pation and  by  decreasing  heat-production,  mainly  by  the  latter 
method,  and  probably  through  the  nervous  system  acting  upon 
the  heat-centers,  and  by  contracting,  and  limiting  oxidation  in,  the 
individual  cells  of  the  body.  Toxic  doses  lower  the  temperature 
to  below  normal,  and  may  produce  collapse  and  rigors. 


39°  -A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Eye. — Medicinal  doses  have  no  apparent  influence  on  the  eye. 
Toxic  doses,  however,  have  produced  contracted  and  motionless 
pupils. 

Uftioward  Action. — Under  prolonged  use  of  acetanilid  conges- 
tion of  the  liver,  kidneys,  and  spleen  occurs.  Paroxysms  of 
sneezing  have  apparently  been  induced  by  a  medicinal  dose,  and, 
under  the  same,  redness  of  the  skin,  chilliness,  and  cyanosis  have 
sometimes  ensued. 

Poisoning. — The  skin  is  cyanosed,  the  face  is  livid  and  anxious, 
and  the  body  is  covered  with  cold  sweat.  There  may  be  vomiting  ; 
the  pulse  is  soft,  slow,  and  weak,  accompanied  by  profound  pros- 
tration. The  respirations  are  first  rapid  and  labored,  and  later  slow 
and  very  shallow,  death  resulting  usually  from  respiratory  paraly- 
sis. After  death  the  heart,  liver,  and  kidneys  are  found  in  a  state 
of  acute  fatty  degeneration. 

Treatment  of  Poisoning. — Diffusible  stimulants,  like  alcohol,  in 
small  doses,  ammonia,  and  sulphuric  ether.  Coffee,  atropine,  and 
strychnine  hypodermically  as  circulatory  and  respiratory  stimu- 
lants. External  heat  and,  if  necessary,  oxygen  inhalations  to  over- 
come cyanosis. 

Therapeutics. — Externally  and  Locally. — Acetanilid  has  been 
locally  applied  for  the  treatment  of  chancre  and  chancroid,  but  there 
are  other  antiseptics  which  are  generally  considered  to  be  more 
satisfactory.  It  is  quite  an  active  hemostatic,  and  may  be  used  in 
epistaxis  and  hemoptysis. 

Internally.— T\i&  use  of  acetanilid  in  fevers  has  been  practically 
abandoned  by  the  great  majority  of  clinicians.  If  an  antipyretic 
of  this  character  is  indicated  at  all,  it  is  in  sthenic  fevers,  and  then 
;  to  be  used  only  with  great  care.  Its  tendency  to  cause  cardiac 
depression,  profuse  sweating,  and  collapse  renders  its  use  harmful, 
if  not  unsafe,  in  low  conditions  like  typhoid  fever  and  advanced 
phthisis. 

It  may  often  be  administered  with  good  effect  in  the  first  stage 
of  pneumonia.  The  headache,  fever,  and  other  unpleasant  symp- 
toms in  the  exanthemata  are  greatly  modified  by  its  use,  although 
when  this  drug  is  given  to  children  they  must  be  very  carefully 
watched  to  avoid  untoward  effects. 

There  is  considerable  difference  of  opinion  in  regard  to  the  utility 
of  acetanilid  in  rheumatism.  Some  authorities  believe  that  it  exer- 
cises a  most  favorable  influence  in  the  acute  articular  variety,  being 
less  apt  to  disturb  the  brain  than  salicylic  acid  or  its  salts.     The 


ANTIPYRETICS.  391 

drug  certainly  mitigates,  and  often  entirely  relieves,  the  pain  and  j 
swelling,  while  it  reduces  the  fever.     Like  salicylic  acid,  it  has  no 
power  to   prevent   heart-complications,  but,   on  the   contrary,  it 
should  be  used  with  great  care,  if  at  all,  when  such  complications 
exist.     It  has  no  tendency  to  prevent  relapses. 

The  dose  of  acetanilid  in  acute  rheumatism  should  not  exceed  6  \ 
grains  (0.5  Gm.)  three  times  a  day. 

Acetanilid  is  a  very  efficient  analgesic,  and  the  introduction  of 
this   drug,  antipyrine,  and  other  remedies   of  this   character  has 
enabled  us  to  relieve  the  pains  of  certain  spinal  diseases  more , 
efficiently  than  was  possible  before. 

The  crises  of  locomotor  ataxia  are  quite  promptly  relieved  by 
acetanilid.  Neuralgias  of  every  kind  indicate  its  use.  ■  The  pains 
of  neuritis,  lumbago,  gastralgia,  dysm.enorrhea,  sciatica,  tabes  dor- 
salis,  and  nearly  every  kind  of  headache  usually  yield  to  its  anal- 
gesic influence. 

In  many  cases  of  chorea  and  epilepsy  (especially  the  diurnal 
variety),  and  in  those  cases  characterized  by  full  habit  and  high 
arterial  tension,  the  drug  has  often  been  employed  successfully. 

Pains  which  are  paroxysmal  in  character  yield  best  to  acetanilid. 
It  quiets  the  excitement  in  mama  a  potu,  and  in  exceptional  cases 
lessens  the  paroxysms  of  whooping  cough. 

In  doses  of  3-5  grains  (0.2-0.32  Cc),  thrice  daily,  acetanilid  has 
proved  efficient  as  a  relief  for  sea-sickness.  It  has  also  been  found 
serviceable  in  traumatic  tetanus. 

The  author  has  found  it  to  be  of  great  value  in  influenza,  or  "  la 
grippe"  combined  or  given  alternately  with  salol  or  sodium  salicy-/ 
late.     It  is  also  highly  praised  in  acute  bronchitis. 

Contraindications. — In  low  fevers,  at  any  rate  not  in  repeated 
doses ;  in  fatty  or  dilated  heart,  blood  disorders,  advanced  tuber- 
cular disease,  and  exhaustion  from  hemorrhages. 

Administration. — It  may  be  prescribed  in  powders,  pills,  com- 
pressed tablets,  capsules,  or  alcohohc  solution.  A  speedier  effect 
is  produced  if  it  is  taken  dissolved  in  a  small  quantity  of  alcohol  or 
wine  diluted  with  water. 

The  average  dose  as  an  antipyretic  usually  should  not  exceed  5 
grains  (0.3  Gm.);  as  an  anodyne,  2-5  grains  (0.1-0.3  Gm.).  It 
may  be  repeated  at  intervals  of  about  four  hours  or  less,  according 
to  its  effects. 

Its  action  in  neuralgias,  according  to  Hare,  may  be  assisted  by 
associating  it  with  small  doses  of  monobromated  camphor. 


392  A   TEXT-BOOK  OF  MATERIA   MEDICA. 

Anti  pyrina—Anti  pyrin  ae—Anti  pyri  ne . 

Origin. — A  Coal-tar  derivative. 

Description  and  Properties. — A  white,  crystalline  powder, 
odorless,  of  a  slightly  bitter  taste,  freely  soluble  in  water,  alcohol, 
and  chloroform. 

Dose. — 3-20  grains  (0.19-13  Gm.).' 

Antagonists  and  Incompatibles. — Antipyrine  is  incompatible 
with  spirit  of  nitrous  ether  and  nitrous  compounds,  the  chlorides 
of  mercury,  the  iodides  of  arsenic  and  mercury,  the  ferric  salts  in 
solution,  tincture  of  iodine,  most  of  the  vegetable  astringents,  car- 
bolic acid,  chloral,  beta-naphtol,  sodium  bicarbonate,  sodium  salicy- 
late, and  the  salts  of  quinine  and  caffeine. 

Synergists. — The  same  as  for  other  members  of  this  group. 

Physiological  Action. — Digestive  System. — Antipyrine  differs 
from  acetanilid  in  that  it  often  produces  vomiting. 

Respiratory  System. — In  medicinal  doses  it  increases  the  number 
of  respiratory  movements.  In  every  other  respect  it  has  the  same 
action  upon  the  respiration  as  acetanild. 

Absorption  and  Elimination. — Kidneys. — Antipyrine  lessens  the 
amount  of  urine,  urea,  and  uric  acid  excreted,  but  increases  the 
amount  of  sulphuric  acid  in  the  urine.  Like  acetanilid,  toxic  doses 
cause  the  urine  to  assume  a  dark  or  brownish  color.  It  is  more  rap- 
idly eliminated  than  acetanilid,  being  detected  in  the  urine  within 
three  hours  after  being  taken. 

Eye. — Toxic  doses  have  produced  amblyopia  and  hallucinations 
of  vision. 

Therapeutics.  ^The  remarks  on  the  therapeutics  of  acetanilid 
are  applicable  to  this  drug,  although  antipyrine  is  a  more  powerful 
antiseptic,  analgesic,  and  local  anesthetic.  As  an  analgesic  it  prob- 
ably ranks  next  to  opium.  The  anesthesia  produced  by  antipyrine 
often  lasts  for  several  hours  or  even  days.  In  acute  coryza  and 
inflammation  of  the  pharynx  great  relief  is  obtained  by  spraying 
the  parts  with  a  2  or  4  per  cent,  solution,  after  applying  a  solution 
of  cocaine  to  prevent  the  primary  smarting  and  irritation  which  the 
antipyrine  produces. 

A  20  per  cent,  solution  has  been  used  in  otitis,  and  a  4  per  cent, 
solution  has  been  found  very  efficient  in  cystitis. 

Antipyrine  has  been  used  with  some  success  in  diabetes  mellitus 
and  malarial  diseases,  particularly  in  intermittent  fever.  It  does  not, 
however,  possess  the  antiperiodic  and  specific  action  of  quinine  in 
malarial  poisoning. 


ANTIPYRETICS.  393 

Administration. — The  drug  is  best  given  in  water  or  some 
aromatic  water  or  syrup.  It  may  also  be  given  hypodermically. 
In  hemorrhage  the  powdered  drug  may  be  appHed  locally,  or  a 
40  per  cent,  solution,  which  causes  less  irritation.  From  \-2 
grains  (0.03-0.12  Gm.),  once  or  twice  a  day,  is  sufficient  for 
children.  Ordinarily  a  dose'  of  5  grains  (0.3  Gm.)  is  sufficient 
for  an  adult. 

Phenacetin. 

Origin. — A  Coal-tar  derivative. 

Description  and  Properties. — A  colorless,  odorless,  tasteless 
powder,  or  glistening,  scaly  crystals,  sparingly  soluble  in  cold 
water,  more  or  less  soluble  in  boiling  water,  and  freely  soluble  in 
16  parts  of  rectified  spirits.  '*^ 

Dose. — i-io  grains  (0.06-0.6  Gm.). 

Physiological  Action. — Phenacetin  differs  from  acetaniUd  only 
in  the  following  respects  : 

Circulatory  System. — Small  doses  increase  the  force  of  the  heart, 
accelerate  the  pulse,  and  raise  arterial  tension.  Large  doses  affect 
the  blood  and  the  circulatory  system  like  acetanilid. 

Kidneys. — It  is  a  diuretic,  but  not  so  active  as  acetanilid.  When 
large  doses  have  been  taken  the  urine  is  dark-yellow  in  color  and 
gives  the  reaction  for  sugar. 

As  an  antipyretic  phenacetin  is  said  to  be  slower  in  its  action 
than  acetanilid,  nor  is  it  so  powerful  as  an  analgesic  and  hypnotic. 

By  many  physicians  the  drug  is  considered  one  of  the  safest 
of  the  synthetical  antipyretics,  though  in  very  large  doses,  accord- 
ing to  Hare,  it  is  more  apt  to  disintegrate  the  blood  than  either 
antipyrine  or  acetanilid.  It  certainly  has  an  advantage  over  many 
other  antipyretics  in  being  tasteless,  seldom  exciting  nausea,  exces- 
sive diuresis,  diaphoresis,  or  diarrhea.  The  author's  experience 
leads  him  to  consider  it  as  possessing  a  briefer  antithermic  action 
and  a  greater  tendency  to  produce  cyanosis  and  rigors  than  ace- 
tanilid or  antipyrine. 

Therapeutics. — Phenacetin  is  given  in  the  same  class  of  diseases 
as  acetaniUd. 

Contraindications. — The  same  as  for  acetanilid. 

Administration. — The  drug  may  be  dispensed  in  powders,  pills, 
capsules,  tablets,  or  suspended  in  mucilaginous  drinks.* 

■  Phenacetin  may  be  adulterated  with  phenacetidin,  a  by-product  in  manufacture  and 
a  poisonous  substance,  which  in  small  doses  induces  kidney  trouble.     Many  of  the  toxic 


394  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Phenocoll. 

Origin. — A  combination  of  Para-amido  Phenocoll  and  GlycocolK 
The  phenocoll  hydrochloride  is  the  salt  used  in  medicine. 

Description  and  Properties. — A  white  crystalline  powder,  sol- 
uble in  1 6  parts  of  water,  and  freely  soluble  in  hot  alcohol,  forming 
a  neutral  solution. 

Dose. — 3-15  grains  (0.2-1.0  Gm.). 

Incompatibles. — All  the  alkalies. 

Physiological  Action. — Phenocoll  differs  from  acetanilid  in  no 
essential  particulars  other  than  the  following : 

Circulatory  System. — Its  effect  upon  the  heart  and  pulse  is  sim- 
ilar to  that  of  acetanihd,  but  it  has  no  influence  upon  the  blood 
itself. 

Kidneys. — The  excretion  of  nitrogen  in  the  urine  is  increased. 

Temperature. — In  febrile  conditions  it  produces  a  decided  fall 
of  temperature  within  one  hour  after  its  administration  by  the 
stomach,  caused  by  an  enormous  diminution  of  heat-production 
without  any  marked  alteration  of  heat-dissipation. 

Therapeutics — Experience  with  phenocoll  hydrochloride  is  yet 
too  limited  for  us  to  draw  any  trustworthy  conclusions  as  to  its 
safety  compared  with  the  antipyretics  previously  mentioned  or  re- 
garding its  real  place  in  medicine.  The  results,  thus  far,  have  shown 
it  to  be  comparatively  safe — probably  the  safest  of  all  antipyretics — 
and  of  value  internally  for  all  conditions  benefited  by  the  previously 
named  antipyretics.  It  is  not  so  valuable  an  antipyretic  and  anal- 
gesic in  rheumatism,  as  acetanilid  or  antipyrine,  nor  is  it  so  efficient 
an  analgesic  in  myelitis,  sciatica,  or  neuralgia ;  but,  on  the  other 
hand,  it  far  surpasses  these  drugs  in  the  treatment  of  intermittent 
fever,  ranking  next  to  quinine  in  malarial  disorders. 

Pelletini,  indeed,  regards  it  as  superior  to  all  antimalarial  reme- 
dies, and  Bonetti  considers  it  a  real  substitute  for  quinine. 

symptoms  of  acetani'id  so  closely  resemble  aniline-poisoning  as  to  suggest  the  production 
of  that  substance  in  the  blood.  There  is  a  close  relationship  between  the  two  bodies, 
and  there  is  some  ground  to  suspect  the  occasional  presence  of  aniline  in  samples.  The 
important  question  of  adulteration  and  impurity  should  not  be  lost  sight  of  in  consider- 
ing the  ill  effects  of  any  drug.  In  the  experience  of  the  author,  better  results,  in  every 
particular,  have  been  obtained  from  antipyrine  than  from  either  of  the  other  antipyretics 
mentioned,  so  that  he  almost  invariably  uses  it,  both  for  adults  and  children,  believing  it 
the  safest  drug  of  its  class,  as  well  as  the  most  certain  and  uniform  in  its  action. 

These  drugs  are  unquestionably  given  in  too  large  doses  by  the  majority  of  physi- 
cians, and  persons  suffering  from  high  temperature  are  more  susceptible  to  their  untoward 
influences — like  cyanosis,  collapse,  etc. — than  those  whose  temperature  is  normal. 


ANTIPYRETICS.  395 

Phenocoll  possesses  the  advantage  of  not  producing  the  un- 
pleasant effects  of  quinine.  It  is  a  powerful  antiseptic,  and  may 
be  applied  locally  where  a  drug  of  that  character  is  indicated. 

Contraindications. — Probably  the  same  as  for  acetanilid. 

Administration. — Locally,  the  drug  may  be  employed  in  solu- 
tion or  in  the  form  of  an  ointment  in  strengths  varying  from  5  to 
20  per  cent.  Internally  it  may  be  administered,  in  the  doses  recom- 
mended, from  three  to  five  times  a  day,  in  powders,  aqueous  solu- 
tion, or  in  capsules. 

Exalgine  (Methylacetanilide). 

Origin. — As  the  chemical  name  indicates,  this  substance  isi 
a  derivative  of  Acetanilid. 

Description  and  Properties. — Exalgine  occurs  in  colorless 
needles  or  prisms,  inodorous  and  tasteless.  It  is  neutral  to  test- 
paper,  and  is  freely  soluble  in  alcohol,  chloroform,  carbon  disul- 
phide,  and  boiling  water.  It  requires  about  60  parts  of  cold  water 
or  10  parts  of  ether  for  solution. 

Dose. — 2-4  grains  (0.1-0.2  Gm.). 

Antagonists  and  Incompatibles. — Exalgine  is  incompatible 
with  the  iodides,  salicylic  acid,  and  solution  of  potassa. 

Sjmergists. — All  members  of  this  group,  as  well  as  opium,, 
cocaine,  belladonna,  and  hyoscyamus. 

Physiological  Action. — Exalgine  is  almost  identical  in  its  action 
with  acetanilid,  with  the  exception  that  it  possesses  less  antipyretic 
po.wer.  In  medicinal  doses  the  drug  increases  arterial  tension,  and 
in  full  doses  profoundly  affects  the  cerebro-spinal  axis.  It  is  more 
uncertain  than,  and  not  so  safe  as,  either  of  the  drugs  previously 
mentioned. 

Therapeutics. — Exalgine  should  never  be  employed  as  an  anti- 
pyretic, but  as  an  analgesic  it  may  be  given  for  the  same  purposes 
as  acetanilid  and  antipyrine.  Good  results  have  been  reported  in 
the  treatment  of  chorea  by  this  drug. 

Contraindications. — The  same  as  for  other  agents  of  this  group,, 
and,  in  addition,  fever,  it  is  said,  contraindicates  its  use. 

Administration. — Exalgine  may  be  administered  either  in  pow- 
ders or  capsules,  but  the  doses  should  not  be  given  at  frequent 
intervals,  from  six  to  seven  hours  elapsing  between  them,  and  only 
in  exceptional  cases  should  more  than  10  grains  (0.16  Gm.)  be 
given  in  twenty-four  hours. 


396  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

GROUP   III.— ANESTHETICS. 

As  heretofore  defined,  ihese  are  substances  having  the  property 
of  destroying  sensation,  or  producing  anesthesia,  either  general  or 
local. 

To  Dr.  Oliver  Wendell  Holmes  is  due  the  credit  of  proposing 
the  term  "anesthetic."  This  group  naturally  occupies  the  place 
between  the  preceding  one  and  the  next — Hypnotics.  As  before 
stated,  there  exists  a  close  chemical  relationship  between  antiseptics, 
antipyretics,  anesthetics,  hypnotics,  and  analgesics.  The  first  two 
of  these  possess  marked  anesthetic  and  analgesic  properties.  The 
drugs  included  in  the  present  group  should  properly  be  classed  as 
general  anesthetics,  possessing  more  nearly  the  characteristics  of 
typical  anesthetics. 

An  ideal  agent  of  this  description  should  be  a  substance  capable 
of  rapidly  and  safely  producing  profound  anesthesia,  and  susceptible 
of  speedy  elimination,  so  that  consciousness  may  be  restored  soon 
after  the  withdrawal  of  the  anesthetic,  with  no  discomfort  to  the 
patient. 

The  typical  anesthetic  should  also  be  convenient  and  safe — 
a  stable,  non-irritating,  pleasantly  odorous,  homogeneous  liquid, 
with  a  boiling-point  neither  too  high  nor  too  low.  Unfortunately, 
there  is  no  substance  which  fully  meets  these  requirements,  ether 
and  chloroform  approaching  nearest  to  the  ideal  agent. 

The  general  anesthetics,  with  the  exception  of  nitrous  oxide, 
all  belong  to  the  class  of  alcohols  and  ethers.  Indeed,  alcohol, 
although  in  this  work  not  classed  among  anesthetics,  possesses 
marked  anesthetic  properties,  as  well  as  others — antiseptic,  anti- 
pyretic, etc. — characteristic  of  these  drugs. 

It  has  been  stated  by  Dr.  Richardson  that  the  first  recorded 
case  of  the  use  of  an  anesthetic  in  surgery  was  that  of  Dr.  Collier 
in  1 839,  who  anesthetized  his  patient  by  causing  him  to  inhale  the 
fumes  of  alcohol. 

It  has  been  well  known  for  centuries  that  alcohol,  when  taken 
in  large  quantities,  possesses  the  power  to  lessen  pain  and  sensa- 
tion. The  anesthesia  produced  by  this  drug,  however,  is  too  tardy 
and  prolonged  to  render  it  practically  serviceable. 

General  anesthetics  abolish  sensation  throughout  the  whole 
body  by  destroying  the  sensibility  of  the  nerve-centers — directly, 
by  affecting  the  nervous  tissue,  or  indirectly,  by  influencing  the  cir- 
culation, or  the  blood,  in  such  a  manner  as  to  interfere  with  the 
functional  activity  of  the  nerve-cells. 


ANESTHETICS.  397 

The  detailed  action  and  uses  of  anesthetics  are  fully  described 
under  "  ^ther  "  and  "  Chloroformum." 

Local  anesthetics  are  used  to  deaden  the  sensation  or  abolish 
the  sensibility  of  the  peripheral  nerves  of  a  localized,  particular 
area.  The  most  important  are — cocaine,  carbolic  acid,  iodoform 
eugenol-acetamide,  and  antipyrine.  Some  aromatics  are  also  quite 
powerful  anesthetics.  The  physiological  action  of  local  anesthetics 
is  given  under  the  respective  agents. 

y^ther—i^theris— Ether.    U.  S.  P. 

Origin. — A  liquid  composed  of  about  96  per  cent,  by  weight 
of  Ether  or  Ethyl  Oxide,  and  about  4  per  cent,  of  Alcohol  con- 
taining a  little  Water. 

Ether  is  known  as  sulphuric  ether,  and  was  called  ^ther  For- 
tior  by  the  Pharmacopoeia  of  1880. 

Description  and  Properties. — A  transparent,  colorless,  mobile 
liquid,  having  a  characteristic  odor  and  a  burning,  sweetish  taste. 
Specific  gravity,  0.725-0.728.  Soluble  in  about  ten  times  its  vol- 
ume of  water,  with  slight  contraction  of  bulk.  Miscible,  in  all  pro- 
portions, with  alcohol,  chloroform,  benzin,  benzol,  and  fixed  and 
volatile  oils. 

Ether  is  highly  volatile  and  inflammable,  its  vapor,  when  mixed 
with  air  and  ignited,  exploding  violently.  It  should  be  kept  in 
well-stoppered  containers,  preferably  in  tin  cans,  in  a  cool  place, 
rernote  from  lights  or  fire. 

Dose. — 15-40  minims  (i. 0-4.0  Cc). 

Official  Preparations. 

Splritus  Athens — Spiritus  .ffitheris — Spirit  of  Ether. — Dose,  \-\  fluidrachm 
(t.o-4.oCc.). 

Spiritus  ^theris  Comp6situs — Spiritus  ^theris  Comp6siti — Compound 
Spirit  of  Ether  (Hoffmann's  Anodyne). — Ether,  325;  Alcohol,  650;  Ethereal  Oil, 
25  parts.     Dose,  5-60  minims  (0.3-4.0  Cc). 

Antagonists  and  Incompatibles. — The  stimulant  and  anodyne 
action  of  ether  is  antagonized  by  the  arterial  sedatives,  the  tetaniz- 
ing  alkaloids,  strychnine,  picrotoxin,  etc. 

Synergists. — The  arterial  and  cerebral  stimulants,  chloroform 
and  other  anesthetics,  and  alcohol. 

Physiological  Action. — Externally  and  Locally. — Ether  when 
applied  to  the  skin  produces  intense  cold  by  its  rapid  evaporation. 
If  it  is  confined  and  its  evaporation  prevented,  great  irritation  is 


398  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

excited.  By  spraying  a  part  with  ether  it  becomes  quickly  frozen, 
marked  local  anesthesia  being  produced  thereby. 

Applied  to  mucous  membranes,  it  creates  considerable  irritation, 
especially  of  the  fauces  and  respiratory  tract  when  inhaled. 

Internally. — Digestive  System. — It  is  a  carminative,  increasing 
peristalsis  and  the  secretions  from  the  pancreas  and  the  salivary 
and  gastric  glands,  at  the  same  time  dilating  the  vessels  of  the 
stomach. 

Circulatory  System. — When  taken  into  the  stomach  ether  re- 
flexly  stimulates  the  heart  in  a  manner  similar  to  that  of  alcohol, 
raising  arterial  tension  by  increasing  the  force  and  frequency  of  the 
heart's  action. 

Ether  stimulates  the  heart  and  increases  the  blood-pressure  when 
inhaled.  It  is  a  diffusible,  rapid,  and  reliable  cardiac  stimulant.  In 
very  large  or  poisonous  amounts  it  exhausts  the  heart  by  over- 
stimulation, acting  as  a  cardiac  depressant. 

Nervous  System. — Ether  first  occasions  a  considerable  degree 
of  excitement,  due  to  the  direct  action  of  the  ethyl  upon  the  cere- 
bral cortex.  Its  action  in  this  respect  is  analogous  to  that  of 
alcohol,  and,  like  the  latter  drug,  it  affects  the  nervous  system  in  a 
certain  order,  primarily  stimulating  and  afterward  depressing,  first, 
the  cerebral  hemispheres ;  second,  the  sensory  areas  of  the  spinal 
cord ;  third,  the  motor  areas  of  the  spinal  cord ;  fourth,  the  sensory 
centers  of  the  medulla  oblongata ;  and,  finally,  the  motor  areas  of 
the  medulla.     The  motor  nerves  and  muscles  are  unaffected. 

Respiratory  System.. — Medicinal  doses  stimulate  and  poisonous 
doses  paralyze  the  respiratory  center. 

Respiration  is  frequently  arrested  at  the  beginning  of  ether- 
inhalation,  owing  to  reflex  spasm  arising  from  irritation  of  the 
peripheral  ends  of  the  vagi  and  trigemini.  As  the  inhalation  is 
continued  the  breathing  becomes  deeper  and  faster  from  stimula- 
tion of  the  respiratory  center.  This  part  of  the  nervous  system 
may,  in  fact,  become  exhausted  from  over-stimulation,  when  the 
respirations  are  slow  and  shallow. 

In  fatal  cases  of  ether-narcosis  the  respiration  is  usually  arrSted 
before  the  cessation  of  the  heart's  action. 

Absorption  and  Elimination. — Ether  is  rapidly  eliminated,  chiefly 
by  the  lungs,  but  also  by  the  kidneys,  which  are  often  considerably 
irritated  by  the  process. 

Temperature. — The  prolonged  administration  of  ether  produces 
a  great  reduction  of  temperature — doubtless  due  to  the  depression 


ANESTHETICS.  399 

of  the  circulation  and  respiration  and  the  rapid  evaporation  of  the 
drug  chilhng  the  body  and  lungs,  rather  than  to  any  direct  action 
upon  the  nervous  mechanism  presiding  over  the  heat-centers. 

In  brief,  the  action  of  ether  when  inhaled  is  as  follows :  At  first 
a  sensation  of  choking  and  irritability  of  the  respiratory  mucous 
membrane  is  experienced.  A  greatly  increased  activity  of  the  sali- 
vary glands  follows,  accompanied  by  a  sensation  of  pricking  or 
tingling  of  the  hands  and  feet.  The  conjunctiva  is  injected,  the 
face  is  flushed,  the  veins  of  the  neck  are  distended,  and  there  is 
experienced  a  peculiar  feeling  of  lightness,  together  with  a  perver- 
sion of  all  the  senses,  due  to  emotional  excitement.  The  patient 
may  yell,  laugh,  cry,  curse  or  pray,  struggle  or  become  pugilistic, 
while  the  breathing  may  be  spasmodic  or  stertorous,  the  pulse 
becoming  rapid  and  strong. 

As  the  inhalation  is  continued  the  respiration  is  quickened,  the 
skin  becomes  moist  and  warm,  and  relaxation  of  the  muscles  en- 
sues, with  abolition  of  reflexes,  contracted  pupils,  and  complete 
suspension  of  sensation.  Finally,  as  perfect  unconsciousness  super- 
venes, the  pupils  are  dilated ;  the  respiration  is  slow  and  deep,  and 
later  very  weak ;  and  the  skin  is  cool  and  moist. 

If  the  inhalation  be  discontinued  before  a  toxic  quantity  of  ether 
has  been  administered,  consciousness  gradually  returns — in  some 
cases  almost  at  once,  although  some  loss  of  sensation  and  muscular 
weakness  remain  for  a  while. 

The  return  of  consciousness  is  usually  accompanied  by  retching 
and  vomiting — often  by  severe  rigors,  unless  care  has  been  taken 
to  keep  the  patient  warm.  Great  excitement  not  infrequently 
attends  this  stage  of  etherization. 

Treatment  of  Untoward  Manifestations. — Withdraw  the  ether  if 
there  be  danger  of  respiratory  or  cardiac  failure,  lowering  the  head 
if  there  be  indications  of  the  latter,  and  if  respiratory  failure  be 
threatened,  as  indicated  by  cyanosis,  avoiding  a  prostrate  position. 
Meanwhile,  other  measures  for  the  relief  of  cardiac  or  respiratory 
failure  may  be  resorted  to :  artificial  respiration,  friction,  or  the 
electric  current  to  excite  respiratory  action,  one  electrode  being 
placed  upon  the  larynx  and  the  other  upon  the  epigastrium.  Hy- 
podermic injections  may  be  resorted  to — of  strychnine,  digitalis,  or 
atropine,  or,  in  desperate  cases,  of  ammonia. 

When  asphyxia  is  produced  by  the  lodgement  of  mucus  in  the 
respiratory  passages,  the  hypodermic  injection  of  ether  itself  is  per- 
missible, if  necessary,  to  excite  more  vigorous  respirations. 


400  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Should  nausea  become  too  persistent,  a  hypodermic  injection  of 
morphine  will  usually  suffice  to  quiet  it. 

Ice-water  or  a  little  ether  poured  over  the  epigastrium  will 
establish  regular  respirations  when  suspended,  as  is  often  the  case, 
during  the  first  stage  of  anesthesia. 

Therapeutics. — Externally  and  Locally. — The  hypodermic  in- 
jection of  15  minims  (i.o  Gm.)  of  ether  in  close  proximity  to  the 
affected  nerve  has  been  found  valuable  in  neuralgia  and  sciatica. 

The  hypodermic  method  of  administration  has  been  also  prac- 
tised in  the  treatment  of  shock  and  in  the  threatened  collapse  fol- 
lowing post-partum  hemorrhage,  as  well  as  for  the  cure  of  sebaceous 
cysts. 

The  local  anesthetic  properties  of  ether  render  it  valuable  in 
many  diseases  of  the  skin,  such  as  pruritus,  urticaria,  etc.  For 
treatment  of  these  disorders  it  is  usually  combined  with  some 
aromatic. 

A  wet  compress  saturated  with  ether  has  been  successfully 
applied  to  the  forehead  for  the  relief  of  epistaxis. 

Internally. — Ether  is  used  as  an  antispasmodic  in  order  to  facili- 
tate certain  examinations,  the  reduction  of  dislocations,  and  to 
relieve  pain  in  the  general  practice  of  surgery,  obstetrics,  and  den- 
tistry. 

It  has  been  used  as  an  anthelmintic  against  tape-worms. 

The  compound  spirit  of  ether  is  a  stimulant,  antispasmodic, 
and  anodyne.  It  is  an  efficient  remedy  for  gastralgia  and  flatulent 
colic,  and  is  used  to  allay  many  of  the  symptoms  of  hysteria,  as  well 
as  restlessness  and  insomnia  unaccompanied  by  fever.  Palpitation  of 
the  heart  and  nausea  due  to  the  excessive  use  of  tobacco  are  also 
greatly  benefited  by  this  preparation.  In  angina  pectoris  and  hic- 
cough it  is  an  efficient  remedy. 

Contraindications. — Acute  or  chronic  disease  of  the  kidneys. 
Dilatation  or  fatty  degeneration  of  the  heart.  Disease  of  the 
lungs.  Tumors  of  the  brain  or  about  the  neck.  Atheromatous 
condition  of  the  arteries.  Enlarged  tonsils,  chronic  alcoholism, 
or  aneurysm. 

It  is  necessary  at  times  to  give  an  anesthetic  in  the  foregoing 
cases,  and  the  surgeon  is  justified  in  the  use  of  ether,  but  the 
administration  should  be  extremely  careful  and  conducted  under 
skilful  supervision  whenever  the  above  contraindications  exist — 
particularly  in  conditions  of  dilated  or  fatty  heart  or  chronic 
alcoholism. 


ANESTHETICS.  401 

Administration. — In  administering  anesthetics  the  following 
precautions  should  be  taken : 

The  stomach  of  the  patient  should  contain  no  undigested  food. 

The  clothing  should  be  loose  about  the  neck,  thorax,  and  ab- 
domen, allowing  perfect  freedom  of  respiration. 

Artificial  teeth  should  be  removed. 

It  should  be  remembered  that  ether  is  inflammable,  and,  when 
its  vapor  is  mixed  with  air,  explosive :  it  should,  therefore,  not  be 
used  near  a  flame  or  an  actual  cautery,  from  which  it  .may  ignite. 

The  patient  should  be  kept  covered,  in  order  that  there  may  not 
be  too  great  a  reduction  in  temperature.  He  should,  moreover,  be 
watched  for  several  hours  after  the  administration,  since  there  is 
always  more  or  less  danger  until  the  effects  of  the  ether  have 
entirely  disappeared. 

Under  proper  methods  the  administration  of  ether  occasions 
little  inconvenience.  In  addition  to  the  recommendations  above 
given,  it  may  be  added  that  smearing  the  mouth  and  nose  with 
oil  prevents  the  excoriation  frequently  occasioned  by  contact  with 
the  anesthetic. 

There  are  various  means  of  administration,  the  simplest  and  in 
many  cases  the  most  efficient  being  a  towel  shaped  into  a  funnel  or 
hollow  cone,  with  a  piece  of  stiff  paper  laid  between  the  outer  folds 
to  preserve  the  shape.  Among  many  mechanical  contrivances  the 
inhaler  of  Dr.  O.  H.  Allis  of  Philadelphia  is  perhaps  the  best.  At 
the  Massachusetts  General  Hospital  a  cone-shaped  sponge  is 
employed. 

In  using  the  towel-cone  the  inner  surface  is  saturated  with 
about  half  an  ounce  of  ether,  the  inhaler  at  first  not  being  placed 
close  to  the  mouth  and  nose,  thus  allowing  the  vapor  to  be  suf- 
ficiently diluted  with  air.  The  effect  of  this  method  is  to  accustom 
the  air-passages  to  the  primary  irritation  of  the  anesthetic  and 
graduate  its  effects.  After  this  the  towel  may  be  pressed  close  to 
the  mouth  and  nose  and  the  concentrated  ether  freely  adminis- 
tered. In  this  manner  a  person  may  become  completely  etherized 
without  nausea  or  resistance.  The  insensibility  of  the  conjunctiva 
and  complete  relaxation  of  the  muscles,  accompanied  by  semi- 
stertorous  breathing,  indicate  that  the  stage  of  desirable  anesthesia 
is  attained.  The  quantity  of  ether  administered  should  now  be 
reduced,  further  supplies  being  limited  to  the  amount  requisite  to 
maintain  complete  anesthesia. 

The  symptoms  incident  to  the  primary  effects  of  etherization — 

26 


402  A    TEXT-BOOK  OF  MA  TERIA   MEDIC  A. 

cerebral  excitement,  muscular  activity,  etc. — should  not  induce 
withdrawal  of  the  anesthetic,  but  rather  its  continuance.  Should 
vomiting  occur  at  this  stage,  etherization  should  be  suspended 
and  the  mouth  thoroughly  cleansed  by  means  of  a  sponge  or  a 
towel. 

Complete  loss  of  consciousness  marks  the  following  stage  of 
anesthesia,  when  total  relaxation  supervenes,  accompanied  by 
gentle,  regular  breathing.  Should  stertorous  respiration  attend 
further  etherization,  it  is  a  warning  of  paresis,  and  the  drug  should 
be  withdrawn. 

Congestion  of  the  facial  muscles  during  anesthesia  is  quite 
normal,  pallor,  as  a  rule,  indicating  cardiac  or  respiratory  debility. 
The  practice  of  closely  covering  the  face  is  thus  to  be  discouraged, 
since  it  conceals  important  symptoms  of  the  patient's  physiological 
condition.  The  danger  from  asphyxia  in  complete  etherization  is 
shown  by  the  entire  muscular  relaxation  of  the  tongue,  which  is 
prone  to  drop  backward,  and  the  closing  of  the  glottis,  suspending 
respiration.  In  such  an  occurrence  the  jaw  should  be  pressed  for- 
ward, the  head  being  well  extended,  and,  if  necessary,  the  tongue 
brought  forward  with  the  forceps. 

Under  favorable  conditions  from  five  to  twelve  minutes  are  re- 
quired to  etherize  the  patient  completely.  The  effects  of  anesthesia 
upon  recovery  vary  with  the  temperament  and  character  of  the 
individual  and  the  conditions  under  which  the  drug  is  administered. 
Great  excitability  may  attend  awakening  from  etherization,  or  the 
patient  may  return  to  consciousness  as  from  a  tranquil  slumber. 
Nausea  and  vomiting  frequently  accompany  rallying  from  the 
narcosis — not,  however,  such  as  may  require  especial  treatment. 
Should  somnolence  be  manifested,  it  is  best  not  to  rouse  the 
patient,  that  the  awakening  may  be  easy  and  natural. 

In  etherizing  a  female  patient  the  presence  of  a  woman  is  always 
desirable,  in  order  that  her  testimony  may  assuage  certain  abnor- 
mal impressions  to  which  women  during  anesthesia  are  prone,  the 
hallucinations  being  more  readily  dispelled  by  one  of  their  own 
sex.  To  the  operator  and  attendants  her  presence  is'  also  of 
importance. 

Great  care  should  be  taken  to  see  that  the  patient  is  well  cov- 
ered and  not  exposed  to  drafts,  in  its  relaxed  condition  the  body 
being  peculiarly  susceptible  to  pneumonia  or  pleurisy.  The  anes- 
thetic should  be  carefully  examined  before  administration,  and  the 
character  of  the  drug  thoroughly  known. 


ANESTHETICS.  403 

Chloroformum—Chloroformi— Chloroform.   TJ.  S.  P. 

Origin. — A  liquid  consisting  of  from  99  to  99.4  per  cent.,  by 
weight,  of  Absolute  Chloroform,  and  from  i  to  0.6  per  cent,  of 
Alcohol. 

Description  and  Properties. — A  heavy,  clear,  colorless,  mobile, 
and  diffusible  liquid,  of  a  characteristic  ethereal  odor  and  a  burning 
taste.  Specific  gravity,  not  below  i  .490.  Soluble  in  about  200  times 
its  volume  of  cold  water,  and  in  all  proportions  in  alcohol,  ether, 
benzol,  benzin,  and  fixed  and  volatile  oils. 

Chloroform  is  volatile,  even  at  a  low  temperature,  and  boils  at 
60°  to  61°  C.  (i40°-i4i.8°  R).  It  is  not  inflammable,  but  its 
heated  vapor  burns,  emitting  a  green  flame.  It  should  be  kept  in 
dark,  amber-colored,  glass-stoppered  bottles,  in  a  cool  and  dark 
place. 

(See  tests  for  chloroform  in  U.  S.  Pharmacopoeia,  p.  88.) 

Dose. — 2-15  minims  (0.12-1.0  Cc). 

Official  Preparations. 

Aqua  ChlorofSrmi — Aquse  ChlorofOrmi — Chloroform  Water. — Dose,  1-4 
fluidrachms  (4.0-16.0  Cc.).- 

Emtilsum  ChlorofSrmi— Emiilsi  ChlorofSrmi — Chloroform  Emulsion. — 
Dose,  1-4  fluidrachms  (4.0-16.0  Cc). 

LinimSntum  Chlorof6rmi — LinimSnti  ChlorofSrmi — Chloroform  Liniment. 
— For  external  use.     Chloroform,  30 ;  Soap  Liniment,  70  parts. 

Spiritus  Chloroffirmi — Spiritus  Chlorof6rmi — Spirit  of  Chloroform. — Dose, 
10  minims-l  fluidrachm  (0.6-4.0  Cc). 

Unofficial  Preparations. 

Chlorodyne. — This  preparation  was  first  introduced  by  Dr.  Collis  Browne  of  Lon- 
don. Numerous  formulae  for  chlorodyne  have  been  published,  the  British  Pharmacopoeia 
containing  an  official  preparation,  Tinctura  Vhloroformi  et  Morphina,  intended  as  a 
substitute  for  chlorodyne,  and  composed  of  chloroform,  ether,  alcohol,  morphine 
hydrochlorate,  dilute  hydrocyanic  acid,  oil  of  peppermint,  fluid  extract  of  liquorice, 
treacle,  and  syrup.  Dose,  10  minims  (0.6  Cc).  Parke,  Davis  &  Co.  of  Detroit, 
Mich.,  prepare  a  similar  and  excellent  compound  known  as   Chlor-Anodyne. 

The  different  preparations  of  chlorodyne  and  its  substitutes  vary  greatly  in  the  dose, 
from  5  minims  to  I  fluidrachm  (0.3-4.0  Cc.) ;  in  prescribing,  therefore,  the  strength  of 
the  agent  should  be  ascertained.  Remedies  of  this  character  possess  powerful  narcotic, 
anodyne,  and  antispasmodic  properties,  and  should  be  administered  cautiously  and  only 
under  the  direction  of  a  physician. 

In  addition  to  the  above,  there  is  an  efficient  carminative  and  antispasmodic  known 
as  Tinctura  Chloroformi  Composiia  (B.  P.) — dose,  20  minims-l  fluidrachm  (1.2-4.0 
Cc.) — containing  chloroform  and  compound  tincture  of  cardamom  and  various  anesthetic 
mixtures;  and  chloroform  ointments  of  different  strengths. 


404  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Antagonists  and  Incompatibles. — Chloroform  will  not  mix 
with  weak  spirits  or  glycerin.  Circulatory  and  respiratory  stimu- 
lants and  galvanism  antagonize  to  some  extent  its  poisonous  action. 
There  is  no  chemical  antidote. 

Synergists. — Anesthetics,  alcohol,  morphine,  chloral,  and  many 
of  the  hypnotics. 

Physiological  Action. — Externally  and  Locally. — Its  action  is 
similar  to  that  of  ether,  though  when  confined  on  the  skin  it  pro- 
duces vesication.  It  is  more  of  an  irritant  to  mucous  membranes 
than  ether,  yet  when  inhaled  it  is  less  irritating  to  the  respiratory 
tract. 

Internally. — Digestive  System. — Its  action  upon  the  digestive 
tract  is  nearly  identical  with  that  of  ether,  except  that  when  taken 
in  a  concentrated  form  it  occasions  marked  irritation  of  the  stom- 
ach and  intestines,  often  resulting  in  violent  gastro-enteritis. 

Circulatory  System. — Chloroform  depresses  the  heart  and  cir- 
culation, the  former  by  weakening  the  cardiac  muscle,  and  the 
latter  by  lowering  arterial  pressure  by  depressing  the  vaso-motor 
center.  It  frequently  produces  an  intermittent  pulse  by  stimulating 
the  inhibitory  ganglia  of  the  heart. 

Nervous  System. — It  affects  the  brain  and  spinal  cord  in  the 
same  manner  and  order  as  ether,  like  it  producing  death,  usually 
by  respiratory  failure,  though  sometimes  the  heart  first  succumbs 
to  the  influence  of  the  drug. 

When  locally  applied  the  sensory  and  motor  nerves  are  affected 
in  the  same  manner  as  by  ether.  Small  amounts  of  chloroform 
stimulate,  and  large  quantities  depress,  the  nervous  system. 

Respiratory  System. — Its  action  closely  resembles  that  of  ether, 
though  its  operation  is  more  rapid  and  powerful. 

Absorption  and  Elimination. -^t  affects  the  kidneys  and  is  elim- 
inated in  the  same  manner  as  ether. 

Temperature. — It  depresses  the  temperature,  although  probably 
by  a  different  action  from  that  of  ether,  reducing  bodily  tempera- 
ture by  lessening  heat-production  and  increasing  heat-dissipation. 

Untoward  Action. — If  there  be  any  marked  idiosyncrasy  against 
chloroform,  death  usually  occurs  suddenly  after  a  few  inhalations 
of  the  drug. 

When  applied  externally  there  is  produced  not  infrequently  an 
urticaria-like  eruption  or  an  eczematous  condition  of  the  skin; 
vesicles  may  result.  If  applied  to  sensitive  portions  of  the  skin, 
such  as  the  scrotum,  severe  and  persistent  pain  is  sometimes  occa- 


ANESTHETICS.  405 

sioned.  Frequently,  when  applied  to  wounds  and  mucous  mem- 
branes, it  causes  intense  irritation,  so  much  so  that  the  mucous 
membrane  may  be  shed  in  pieces. 

The  symptomatic  manifestations  of  chloroform-anesthesia,  the 
methods  of  administration,  and  the  treatment  of  chloroform  acci- 
dents are  here  given  in  detail. 

The  phenomena  attending  the  administration  of  chloroform  in- 
dicate three  separate  stages  of  narcosis.  The  first  of  these  is  allied 
to  intoxication  induced  by  alcoholic  stimulants.  In  this  stage, 
although  sensation  is  dulled,  consciousness  is  retained,  and,  al- 
though the  period  is  brief  as  a  rule,  in  some  patients,  such  as  those 
of  intemperate  habits,  it  may  last  for  some  time  and  be  accom- 
panied by  violent  excitement.  In  such  cases  the  administration 
of  chloroform  is  attended  with  no  little  danger. 

The  second  stage,  available  for  surgical  operations,  is  one  of 
complete  anesthesia.  The  patient  is  perfectly  passive,  conscious- 
ness and  sensation  being  for  the  time  wholly  obliterated. 

The  third  stage  is  the  most  delicate  to  deal  with,  profound  un- 
consciousness, with  stertorous  breathing  and  total  muscular  relaxa- 
tion, as  well  as  temporary  annihilation  of  reflexes,  indicating  the 
danger-line  of  anesthesia.  Only  under  extreme  necessity  should 
the  administration  be  carried  thus  far. 

It  is  well  to  guard  against  taking  the  pulse  as  an  infallible  guide 
to  the  patient's  condition.  In  each  successive  stage  the  cardiac 
movements  are  variable,  although,  generally  speaking,  certain 
pulsations  accompany  the  above-named  degrees  of  narcosis. 

As  has  been  suggested  in  the  case  of  ether,  a  few  precautions  in 
the  administration  of  chloroform  are  obvious — that  there  be  no 
undigested  food  in  the  stomach ;  that  the  clothing  be  loose  about 
the  neck,  chest,  and  abdomen ;  and  that  artificial  teeth  be  removed. 

The  appliances  used  in  producing  anesthesia  by  the  aid  of 
chloroform  are  various,  the  simplest,  as  in  the  administration  of 
ether,  being  a  cone  formed  of  a  napkin  or  a  towel  enclosing  a  sponge 
or  not,  a  sponge  alone,  or  a  handkerchief,  upon  which  a  small 
quantity  of  chloroform — not  exceeding  from  a  half  to  one  fluid- 
drachm  (2.0-4.0  Cc.)  at  a  time — is  poured.  The  utmost  vigilance  is 
requisite  in  the  administration,  the  respiration,  pulse,  and  facial 
indications  being  constantly  observed;  a  supply  of  air  being 
allowed  to  mingle  with  the  anesthetic  to  obviate  the  dangerous 
effect  of  its  concentrated  vapor;  and  the  drug  being  instantly 
withdrawn  upon  the  slightest  indication  of  untoward  symptoms, 


4o6  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

such  as  lividity  of  the  face,  debility  of  heart-pulsations,  and  ster- 
torous or  spasmodic  respiration,  and  an  ominous  dilatation  of  the 

pupils. 

Should  respiration  cease,  the  tongue  should  immediately  be 
brought  forward  or  the  lower  maxillary  manipulated  as  in  the  case 
of  ether.  Should  these  resources  be  unavailing,  artificial  respira- 
tion or  the  galvanic  current  should  be  tried.  To  restore  cardiac 
action  nitrite  of  amyl  may  be  used;  or  hypodermic  injections  of 
ammonia  or  digitalis  as  a  cardiac  stimulant. 

A  mixture  of  ether  and  chloroform,  has  been  suggested  by  com- 
petent authorities  as  the  safest  and  most  efficient  anesthetic.  Yet 
its  utility  in  many  cases  has  proved  doubtful,  experience  in  opera- 
tive surgery  rather  inclining  to  the  use  of  a  single  agent. 

Although  the  symptomatic  features  of  chloroform-narcosis, 
especially  those  which  accompany  collapse  and  death,  have  been 
studiously  examined,  the  conditions  causing  disaster  are  still  but 
imperfectly  understood.  Nevertheless,  premonitory  indications  are 
seldom  wanting  which  mark  clearly  enough  the  limit  of  safety  in 
administration.  Of  these,  extreme  mydriasis  and  failure  to  pro- 
duce reflex  action  in  the  conjunctiva  are  alone  symptoms  to  be 
regarded  with  the  gravest  apprehension. 

The  statistics  of  deaths  from  chloroform  present  a  melancholy 
yet  instructive  spectacle  to  the  thoughtful  physician,  and  the  deduc- 
tions drawn  from  them  go  far  to  show  the  value  of  exceeding  cau- 
tion in  the  use  of  so  subtle  and  powerful  an  anesthetic.  The 
pathological  considerations  of  any  given  case  fail  to  throw  light 
upon  the  immediate  cause  of  the  patient's  collapse,  the  cessation 
of  respiration  or  stoppage  of  the  pulse  resulting  in  syncope  or 
asphyxia  varying  in  their  mutual  order  and  coincidences. 

It  is  not  to  be  inferred  that  chloroform  is  of  itself  necessarily 
dangerous,  its  noxious  effects  depending  upon  its  administration 
rather  than  upon  the  drug.  An  instance  of  its  harmless  use  is 
found  in  the  method  of  producing  partial  and  temporary  anesthesia 
adopted  by  some  physicians  in  cases  of  childbirth,  neuralgia,  etc., 
by  which  the  patient  is  permitted  to  administer  the  anesthetic. 
This  method  consists  in  saturating  with  chloroform  a  small  sponge 
placed  in  a  cup  or  tumbler,  and  allowing  the  patient  to  inhale  the 
fumes  at  will.  Before  the  system  can  absorb  a  lethal  quantity  of 
the  drug  muscular  relaxation  intervenes  and  the  hand  involuntarily 
drops,  the  semi-conscious  state  meanwhile  dulling  sensation  and 
causing  the  patient  to  forget  pain.     Upon  the  return  of  conscious- 


ANESTHETICS.  407 

ness  the  administration  may  be  repeated,  with  little  danger  of  un- 
toward results  from  the  small  amount  of  chloroform  inhaled.  The 
bottle,  it  is  hardly  necessary  to  say,  should  never  be  entrusted  to 
the  patient. 

Additional  Anesthetics,  and  their  Comparative  Value. 

Ethyl  Bromide. — A  colorless,  inflammable  liquid,  with  a  burn- 
ing taste  and  an  odor  like  that  of  chloroform.  It  is  readily  decom- 
posed, with  evolution  of  bromine.  Its  action  is  uncertain,  causing 
great  irritation  of  the  respiratory  passages,  and  usually  producing 
death  by  paralysis  of  respiration. 

Ethyl  Chloride. — A  volatile,  colorless,  and  inflammable  liquid 
having  a  pleasant  odor.  It  is  a  very  fugacious  anesthetic,  greatly 
depressing  the  heart  and  respiration,  and  is  mainly  used,  in  the 
form  of  a  spray,  to  produce  local  anesthesia. 

Ethyl  Iodide. — A  liquid  anesthetic,  similar  in  its  physiological 
action  to  chloroform.  Anesthesia  produced  by  it,  however,  is  more 
tardy,  although  more  permanent.  It  is  considered  a  comparatively 
safe  and  efficient  anesthetic  to  relieve  spasm  of  the  respiratory 
passages,  as  in  asthma  and  laryngitis. 

Ethylene  Bichloride. — More  rapid  and  powerful  in  its  action 
than  chloroform,  though  not  so  safe,  affecting  the  respiratory  center 
invariably  before  influencing  the  heart.  While  speedier  in  its  action 
than  ether,  it  is  probably  more  dangerous. 

Ethylene  Bromide. — A  weak  yet  dangerous  anesthetic,  greatly 
depressing  the  respiratory  center,  and  tending  to  cause  paralysis 
of  the  extremities  and  stoppage  of  the  heart. 

Bthylidene  Chloride. — A  non-inflammable  liquid  resembling 
chloroform  in  its  physical  appearance,  and  in  its  physiological 
action  as  well,  although  much  less  depressant  to  the  heart.  It 
causes  more  irritation  to  the  respiratory  passages,  with  vomiting 
and  great  languor  and  discomfort  as  its  sequelae. 

Ethylene  Iodide. — A  crystalline  substance,  its  fumes  when 
heated  producing  anesthesia,  with  great  irritation  of  the  respiratory 
passages,  and  death  by  asphyxia. 

Methyl  Chloride. — ^A  colorless,  inflammable  gas,  with  a  taste 
and  odor  resembling  those  of  ether  and  chloroform.  Cold  lique- 
fies it.  It  is  used  locally  to  produce  anesthesia  and  to  relieve  pain 
in  neuralgia. 

Methylene  Bichloride. — A  colorless  liquid,  its  odor  being  like 
that  of  chloroform.     Exposure  to  the  light  decomposes  it.     Anes- 


4o8  A    TEXT-BOOK  OF  MA  TERIA  MEDIC  A. 

thesia  produced  by  this  agent  is  accompanied  with  comparatively- 
little  irritation  of  the  respiratory  tract,  but  it  occasions  a  primary 
stage  of  excitement  like  that  induced  by  ether,  and,  as  in  the  case 
of  chloroform  administration,  vomiting  is  Hkely  to  ensue.  Death 
takes  place  from  paralysis  of  the  heart.  The  numerous  fatalities 
which  have  occurred  under  this  anesthetic  indicate  the  danger  of 
its  use,  and  its  volatility  renders  its  employment  difficult  in  a  hot 
atmosphere. 

Carbon  Tetrachloride — Tetrochlormethane. — A  transparent, 
colorless  liquid,  of  an  agreeable  aromatic  flavor,  analogous  in  its 
action  to  chloroform,  but  less  irritating,  although  far  more  danger- 
ous to  the  heart. 

Formic  Ether. — ^A  thin,  colorless,  inflammable  liquid,  of  strong, 
agreeable  odor  and  pungent  taste.  It  acts  like  chloroform,  though 
the  signs  of  asphyxia  are  less  marked.  Its  effects  last  for  several 
hours. 

Methylic  Ether. — A  colorless,  inflammable  gas,  heavier  than 
air,  of  an  ethereal  odor  and  aromatic  taste.  Richardson  considers 
it  a  safe  anesthetic,  though  objectionable  because  of  its  odor — less 
agreeable  than  those  of  ether  and  chloroform — and  the  rapidity 
with  which  it  volatilizes  from  its  solution. 

Methylal — Methylen — Dimethyl  Ether. — A  highly  volatile, 
colorless,  hmpid  liquid,  of  penetrating  ethereal  odor.  It  is  used 
chiefly  as  a  local  anesthetic  and  as  an  efficient  hypnotic  in  insanity 
and  delirium  tremens. 

Acetic  Ether  (U.  S.  P.). — A  colorless,  limpid,  volatile  liquid 
having  an  agreeable,  refreshing,  ethereal,  and  somewhat  acetous 
odor  and  taste.  It  has  the  advantage  over  sulphuric  ether  of  being 
less  inflammable  and  less  volatile.  Owing  to  its  pungent  and 
agreeable  odor,  too,  it  is  superior  to  the  latter  drug  in  stimulating 
the  nasal  passages  in  cases  of  syncope  and  nervous  agitation. 

Pental. — A  colorless,  volatile,  inflammable  liquid,  insoluble  in 
water,  but  miscible  in  all  proportions  with  alcohol,  ether,  and  chlo- 
roform. It  has  a  mustard-like  odor,  and  is  comparatively  free  from 
danger.  When  poisonous  amounts  are  administered  the  pulse  is 
quickened,  the  respiration  embarrassed,  and  death  ensues  from 
paralysis  of  the  heart.  It  resembles  chloroform  rather  than  ether, 
but  is  less  irritating  and  seldom  accompanied  by  unpleasant  after- 
effects. It  requires  but  about  S  drachms  (20.0  Cc.)  to  produce 
anesthesia,  which  occurs  in  from  two  to  three  minutes. 

There  is  a  difference  of  opinion  as  to  the  safety  of  pental,  some 


ANESTHETICS.  409 

physicians  considering  it  less  dangerous  than  chloroform,  and  others 
regarding  it  as  less  efificient  and  not  so  safe. 

Nitrous  Oxide  ("Laughing  Gas"). — A  colorless  gas,  of  a  very 
slight,  agreeable  odor  and  sweetish  taste.  It  is  not  inflammable, 
but  supports  combustion  of  ignited  bodies.  Pressure  and  cold 
condense  it  into  either  a  thin,  colorless,  very  mobile  liquid  or 
colorless  crystals.  It  is  a  rapid  anesthetic,  unconsciousness  being 
produced  in  from  one-half  a  minute  to  three  minutes.  The  pulse  is 
strong  and  quick,  the  respirations  frequent  and  shallow,  while,  as 
the  inhalation  continues,  the  breathing  becomes  stertorous  and  the 
face  is  cyanotic.  If  the  inhalation  be  interrupted  or  the  gas  mixed 
with  air,  symptoms  of  intoxication  are  manifested,  accompanied  by 
a  high  degree  of  mental  excitement.  It  is  a  very  safe  anesthetic, 
but  the  anesthesia  is  of  quite  short  duration,  rendering  it  valuable 
mainly  for  the  extraction  of  teeth  and  in  minor  surgery. 

.  The  comparative  value  of  ether  and  chloroform  may  be  sum- 
marized as  follows : 

1.  If  an  anesthetic  be  required,  ether  is  preferable  in  the  case 
of  a  patient  suffering  from  a  weak  cardiac  action  or  an  organic 
disease  of  the  heart. 

2.  For  operations  about  the  face  or  of  the  stomach,  as  there  is 
less  danger  of  reflex  inhibition  of  the  heart,  ether  is  preferable  to 
chloroform. 

3.  Ether  is  preferable  as  an  anesthetic  in  the  extraction  of  teeth, 
chloroform  being  more  apt  to  cause  cardiac  paralysis,  reflexly  by 
way  of  the  dental  nerve  to  the  root  of  the  vagus,  and  through  the 
vagus  to  the  inhibitory  ganglia  of  the  heart-muscle. 

4.  Ordinarily,  ether  is  superior  to,  and  safer  than,  chloroform  as 
an  anesthetic  for  adults,  unless  some  special  contraindication  exist, 
there  being  less  danger  in  ether  of  cardiac  failure,  to  which  adults 
are  more  liable. 

Chloroform  is  much  superior  to  ether  in — 

1.  Obstetrics,  since  the  use  of  it  is  attended  with  less  depression 
and  irritation  of  the  respiration  and  respiratory  tract.  Moreover, 
chloroform  produces  less  nausea  and  vomiting,  and  may  be  admin- 
istered by  the  patient  herself  under  proper  directions. 

2.  It  is  preferable  in  anesthetizing  children,  being  more  rapid  in 
its  action  and  less  potent  as  a  respiratory  depressant,  the  respiratory 
center  of  the  child  being  more  susceptible  than  that  of  the  adult, 
and  in  children  the  danger  of  cardiac  paralysis  being  slight. 


4IO  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

3.  Should  the  patient  be  suffering  from  nephritis,  chloroform  is 
preferable  as  an  anesthetic,  since  it  is  less  irritating  to  the  kidneys. 

4.  Should  an  anesthetic  be  required  for  patients  afflicted  with 
pulmonary  tuberculosis,  empyema,  or  other  disease  of  the  lungs, 
chloroform  should  be  used,  since  its  effect  upon  the  respiratory 
system  is  less  depressing. 


GROUP   IV.— HYPNOTICS. 
Chloral— Chloralis— Chloral.     TJ.  S.  JP. 

Origin. — A  crystalline  solid  composed  of  Trichloraldehyde  or 
Chloral  (an  unstable,  oily,  and  colorless  fluid),  with  i  molecule  of 
Water,  forming  the  Hydrate  of  Chloral,  the  official  preparation, 
and  the  only  one  used  in  medicine.  Chloral  itself  is  prepared  by 
the  action  of  Chlorine  upon  Alcohol,  whence  the  name  chlor-al. 

Description  and  Properties. — Chloral  hydrate  occurs  as  sepa- 
rate, rhomboidal,  colorless,  transparent  crystals,  having"  an  aromatic, 
penetrating,  and  slightly  acrid  odor,  and  a  bitterish,  caustic  taste. 
It  is  slightly  volatilized  when  exposed  to  the  air,  and  is  freely  solu- 
ble in  water,  alcohol,  and  ether,  being  also  soluble  in  chloroform, 
benzol,  benzin,  carbon,  disulphide,  and  fixed  and  volatile  oils.  It 
liquefies  when  triturated  with  an  equal  quantity  of  camphor, 
menthol,  thymol,   or   carbolic    acid. 

Dose. — 5-20  grains  (0.3-1.2  Gm.). 

Unofficial  Preparations. 

The  proprietary  preparation  known  as  Bromidia  contains  to  each  drachm  (4,0  Cc.) 
15  grains  (i.o  Gm.),  each,  of  Chloral  and  Potassium  Bromide,  together  with  a  small 
quantity  of  Extract  of  Hyoscyamus  and  Extract  of  Cannabis  Indica. 

Camphorated  Chloral. — Equal  parts  of  Chloral  and  Camphor.  A  colorless  liquid, 
of  syrupy  consistence,  soluble  in  alcohol,  ether,  chloroform,  glycerin,  and  fixed  oils,  and 
also  in  aqueous  solutions  of  chloral.  It  is  decomposed  by  water,  chloral  hydrate  being 
dissolved  and  camphor  precipitated. 

Chloral.glycerite  is  prepared  by  dissolving  I  drachm  (4.0  Gm.)  of  Chloral  in  4 
drachms  (IS-O  Cc.)  of  Glycerin,  being  used  as  a  solvent  for  powerful  alkaloids. 

Chloral-phenol. — Prepared  by  triturating  equal  parts  of  Chloral  and  Carbolic  Acid. 
It  occurs  as  a  colorless,  viscid  liquid,  with  a  sweet  caustic  taste.     Used  externally. 

Allied  Compounds. 

Amylene  Hydrate. — A  tertiary  alcohol,  the  chemical  name  being  dimethylethyl- 
carbinol. 

Description  and  Properties. — It  occurs  as  a  limpid,  colorless,  neutral  fluid,  of  a 


HYPNOTICS.  411 

peculiar  odor  and  burning  taste.     It  is  soluble  in  8  parts  of  water,  and  miscible  in  all 
proportions  with  alcohol,  chloroform,  benzin,  glycerin,  and  fixed  oils. 
Dose. — 1-2  fluidrachms  (4.0-8.0  Cc). 

Chloral-ammonium. — Obtained  by  passing  a,  rapid  current  of  dry  Ammonia 
through  a  solution  of  Anhydrous  Chloral  and  Chloroform  as  long  as  it  is  absorbed.  Its 
chemical  name  is  trichloramidethylic  alcohol.  It  occurs  as  small,  white  acicular  crys- 
tals, and  is  soluble  in  alcohol  and  slightly  soluble  in  water,  although  the  aqueous  solution 
is  unstable. 

Dose. — 15-30  grains  (1.0-2.0  Gm.). 

Chloralose. — Prepared  by  heating  equal  quantities  of  Anhydrous  Chloral  and  dry 
Glucose ;  hence  the  name,  chloi-al-ose. 

Description  and  Properties. — It  occurs  in  the  form  of  fine  needles,  completely  vola- 
tilizing without  decomposition.  It  has  an  acrid,  nauseous  taste,  and  is  soluble  in  hot 
water  and  in  alcohol. 

Dose. — 2-10  grains  (0.12-0.6  Gm.). 

Hypnal. — A  compound  of  Chloral  and  Antipyrine,  known  as  monochlorantipyrine. 
A  similar  preparation  containing  more  chloral  is  called  dichloralantipyrine. 

Description  and  Properties. — It  occurs  in  the  form  of  transparent,  rhombic  crystals, 
odorless  and  tasteless,  soluble  in  from  5  to  6  parts  of  water. 

Dose. — 5-20  grains  (0.35-1.3  Gm.). 

Hypnone. — A  term  given  by  Dujardin-Beaumetz  to  a  member  of  the  ketones, 
known  as   acetophenone  or  phenylmethyl-ketone,  phenomethyl-acetone. 

Description  and  Properties. — A  colorless,  mobile,  refrangent  liquid,  of  a  pungent 
taste  and  a  persistent  odor  resembling  that  of  bitter  almond  and  orange.  It  is  not 
inflammable,  though  mtensifying  the  combustion  of  substances  impregnated  with  it.  It 
is  freely  soluble  in  alcohol,  ether,  chloroform,  benzin,  and  fixed  oils,  sparingly  soluble 
in  glycerin,  and  insoluble  in  water. 

Dose. — 5-10  minims  (0.3-0.6  Cc). 

Unofficial  Preparations. — A  Syrup  and  an  Elixir  of  Hypnone  are  in  use. 

Ural— Chloral-urethane— Uralium.— A  compound  of  the  following  drug,  Ure- 
thane,  and  Chloral  Hydrate. 

Description  and  Properties.— K  crystalline  body,  soluble  in  alcohol  and  ether,  in- 
soluble in  cold  water,  and  decomposed  by  boiling  water. 

Dose. — 10-30  grains  (0.6-2.0  Gm.).  , 

Urethane— Ethyl  Carbamate— Kthyl  Urethane.— This  substance  is  obtainea 
by  the  action  of  Ammonia  on  Ethyl  Carbonate,  or  by  that  of  Urea  or  Carbamide  on 
Ethyl  Alcohol  at  a  high  temperature. 

Description  and  Properties.— Vi  occurs  as  colorless,  odorless,  columnar  or  tabular 
crystals,  having  a  pleasant,  cooling,  and  saline  taste,  somewhat  resembling  that  of  salt- 
petre. It  is  soluble  in  about  I  part  of  water,  and  in  like  proportion  in  ether  and  chlo- 
loform,  in  0.6  part  of  alcohol,  0.8  part  of  liquefied  carbohc  acid,  3  parts  of  glycerin,  15 
parts  of  castor  oil,  atid  20  parts  of  olive  oil. 

Dose. — IO-4S  grains  (0.6-3.0  Gm.). 

Cannabin  Tannate  and  Hyoscine  Hydrobromate  are  both  quite  powerful 
hypnotics,  to  be  described  under  Cannabis  Indica  and  Hyoscyamus,  respectively. 

The  action  and  therapeutics  of  the  above  allied  compounds  will  be  compared  with 
those  of  chloral  hereafter. 

Antagonists  and  Incompatibles. — Chloral  is  incompatible  with 
all  alkalies,  and  calcic  hydrate  converts  it  into  formate  of  calcium 
and  chloroform. 


412  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Liebreich  considers  strychnine  an  antagonist  to  chloral.  The 
action  of  strychnine,  however,  is  limited  to  the  spinal  cord,  and 
its  efficacy  in  opposing  chloral  is  certainly  inferior  to  that  of 
chloral  as  an  opponent  to  strychnine.  Atropine  is  undoubtedly 
a  stronger  antagonist  in  counteracting  the  depressing  influence  of 
chloral  upon  the  heart  and  respiration,  as  well  as  upon  the  spine. 
External  heat  is  also  an  opponent. 

Synergists. — All  the  hypnotics  favor  its  characteristic  property 
of  producing  sleep.  Conium  and  physostigma  assist  its  action 
upon  the  spinal  cord,  and  morphine  enhances  its  hypnotic  effects, 
while  lessening  its  depressing  influence  upon  the  heart. 

Physiological  Action. — Externally  and  Locally. — Chloral  is 
antiseptic,  anesthetic,  and  vesicant.  It  produces  redness  and  some- 
times vesication  when  applied  to  the  unbroken  skin,  and  when 
strong  solutions  are  brought  in  contact  with  the  derma  or  with 
wounds  they  may  even  occasion  sloughing,  and  in  healthy  mucous 
membranes  excite  much  pain.  When  introduced  into  the  system 
hypodermically  chloral  is  apt  to  occasion  gangrenous  inflammation. 

Internally. — Digestive  System. — Small  doses  are  slightly  seda- 
tive to  the  stomach,  though  causing  a  sense  of  burning  in  .the 
throat  and  exciting  more  or  less  salivation.  Large  doses  some- 
times produce  nausea,  vomiting,  and  purging. 

Circulatory  System. — Full  medicinal  doses  may  at  first  accel- 
erate the  pulse,  which  soon,  however,  becomes  slower,  weaker,  and 
softer.  Under  toxic  doses  the  heart's  action  may  be  weak,  rapid, 
and  irregular,  when  death  ensues,  the  heart  being  arrested  in 
diastole. 

A  primary  effect  of  chloral  is  to  lower  arterial  tension  by  its 
depressant  action  upon  the  heart  and  by  paralysis  of  the  cardiac 
ganglia.  It  acts  similarly  upon  the  vaso-motor  center  and  upon  the 
structures  in  the  arteriole  wall,  dilating  the  blood-vessels. 

The  fluidity  of  the  blood  is  increased  by  the  action  of  chloral, 
and  under  large  doses,  the  red  corpuscles  are  crenated  and  there  is 
a  tendency  to  destroy  the  white  corpuscles. 

Nervous  System. — Medicinal  doses  sometimes  occasion  a  pre- 
liminary stage  of  cerebral  excitement,  due  probably  to  a  combined 
temporary  stimulation  of  the  circulation  and  of  the  brain-tissue 
itself  This  is  soon  followed — usually  in  from  fifteen  to  thirty 
minutes — by  a  sound,  dreamless  slumber,  induced  by  a  direct 
depression  of  the  cortical  cells  of  the  psychic  areas  and  an  anemic 
condition  of  the  brain. 


HYPNOTICS.  413 

(' 
The  sleep  thus  produced  is  perhaps  nearer  that  of  physiological 

slumber  than  any  caused  by  other  agencies,  lasting  from  seven  to 
eight  hours,  when  the  patient  awakes  refreshed  and  without  malaise 
or  digestive  disturbance. 

As  upon  the  circulation  and  the  brain,  so  upon  the  nerve- 
centers,  there  is  usually  a  preliminary  stage  of  excitement,  with 
exaggerated  reflexes.  This  condition  is,  however,  of  short  dura- 
tion, and  is  succeeded  by  a  greatly  diminished  reflex  irritability  of 
the  spinal  cord  and  total  abolition  of  reflexes  if  toxic  doses  have 
been  taken.  This  action  upon  the  spinal  cord  is  due  to  the  depres- 
sion of  its  motor  areas,  the  depression  of  the  muscles  and  motor 
nerves  and  the  diminished  sensation  being  also  of  spinal  origin. 

Respiratory  System. — In  full  doses  chloral  is  a  respiratory 
depressant,  rendering  the  breathing  slower  and  weaker,  while 
under  toxic  doses  it  may  cease  altogether  from  paralysis  of  the 
respiratory  center.  Death  may  result  from  this  action  or  from 
paralysis  of  the  cardiac  motor  ganglia. 

Absorption  and  Elimination. — Chloral  is  quite  rapidly  absorbed, 
and  is  supposed  to  circulate  in  the  blood  in  its  original  state.  It  is 
eliminated  by  the  lungs  and  skin,  but  chiefly  by  the  kidneys  as 
urochloralic  acid,  although  when  an  excessive  amount  of  the  drug 
has  been  taken  it  may  be  found  in  the  urine  unchanged.  It  usually 
increases  the  flow  of  urine,  which  gives  a  reaction  for  sugar  with 
Fehling's  test. 

Temperature. — Chloral  is  a  decided  antipyretic  even  in  medicinal 
doses,  while  toxic  doses  produce  a  dangerous  reduction  of  tempera- 
ture. This  action  is  doubtless  owing  to  a  diminution  of  heat-pro- 
duction by  limiting  oxidation  in  the  cells  of  the  body  and  increasing 
heat-dissipation  by  cooling  the  blood  in  the  dilated  cutaneous 
vessels  and  by  surface  evaporation. 

Eye. — The  continued  use  of  chloral  almost  invariably  results  in 
a  contracted  pupil,  unless  psychic  alterations  supervene,  when  the 
pupillary  contraction  gives  place  to  dilatation.  This  action  of 
chloral  is  due  to  paresis  of  the  sympathetic  nerves  supplying  the 
iris. 

Berger  claims  that  when  mydriasis  is  present  there  is  usually  a 
congestion  of  the  papilla,  resulting  from  distention  of  the  retinal 
veins ;  while,  according  to  Ulrich,  intraocular  tension  is  lessened 
in  the  later  stages  of  chloralism. 

Untoward  Action. — There  may  occur  great  anxiety;  disturb- 
ances of  respiration,  such  as  spasmodic  breathing  and  even  as- 


414  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

phyxia,  together  with  disturbances  of  vision  and  swelhng  of  the 
conjunctivae.  There  may  also  be  present  edema  of  the  epiglottis, 
icterus,  and  various  cutaneous  eruptions  commonly  designated  as 
"chloral  rash." 

Poisoning.— K\Ca.oM^  one  of  the  most  powerful  hypnotics 
known,  extraordinary  doses  of  chloral  have  failed  to  prove  fatal, 
as  many  as  460  grains  (29.8  Gm.)  having  been  given  without  per- 
ceptible discomfort.  Nevertheless,  20  grains  (1.29  Gm.),  an  ordi- 
nary dose,  have  been  followed  by  toxic  effects,  while  30  grains 
(1.94  Gm.)  have  produced  death.  In  view  of  so  uncertain  a  power 
great  care  is  requisite  in  the  administration  of  this  drug.  In  many 
ways  its  action  is  occult,  nor  have  careful  autopsies  of  fatal  cases 
furnished  insight  into  the  precise  causes  of  collapse,  however  clearly 
certain  physiological  effects  may  be  defined. 

The  toxicology  of  chloral  may  be  classed  under  two  general 
heads— acute  and  chronic  poisoning.  In  each  of  these  the  symp- 
toms are  sufficiently  marked  to  indicate  a  corresponding  treatment, 
although  the  doubtful  action  of  chloral  hydrate  has  caused  it  to 
become  the  subject  of  special  study  and  a  more  careful  method  of 
administration  than  formerly. 

Acute  Poisoning. — Owing  to  the  peculiar  action  of  chloral,  the 
symptoms  of  poisoning  from  lethal  doses  are  those  characterizing 
profound  coma.  The  pulse  is  feeble,  thready,  and  irregular ;  the 
temperature  falls  rapidly ;  there  is  a  striking  diminution  in  the  fre- 
quency of  respiration,  with  accompanying  lividity ;  the  skin,  par- 
ticularly that  of  the  forehead  and  extremities,  is  covered  with  cold 
sweat ;  the  pupil  contracts  and  then  dilates  perceptibly,  and  great 
muscular  relaxation  occurs,  together  with  abolition  of  reflexes, 
until  finally  the  cerebral  functions  are  suspended  and  death  ensues, 
caused  by  paralysis  of  the  respiratory  center  and  of  the  cardiac 
motor  ganglia,  the  arrest  of  the  heart's  action  taking  place  in  dias- 
tole. Autopsies  have  revealed  cerebral  and  pulmonary  congestion, 
together  with  enlargement  of  the  right  cardiac  cavities.  Since 
chloral  but  slightly  affects  the  motor  nerves,  and  has  little  influence 
in  impairing  muscular  contractility,  it  appears  that  the  paralytic 
phenomena  attending  collapse  are  due  chiefly  to  the  direct  action 
of  the  drug  upon  the  nerve-centers. 

Treatment  of  Poisoning. — It  is  of  primary  importance  to  main- 
tain or  restore  the  temperature  by  means  of  artificial  heat — warm 
blankets,  hot  bottles,  friction,  massage,  or  other  resources  at  com- 
mand.    (It  has  been  found  that  animals  are  much  less  susceptible 


HYPNOTICS.  415 

to  chloral-poisoning  when  their  temperatures  are  sustained  by  out- 
ward appliances  than  when  exposed.) 

Somnolence  is  to  be  resisted  by  such  resources  as  flagellation, 
friction,  douches,  beating  with  wet  towels,  by  injection  of  strong 
hot  coffee  in  the  rectum,  or  any  other  means  readily  available.  It 
must  be  borne  in  mind,  however,  that  the  toxic  effects  of  chloral, 
unlike  those  of  opium,  tend  to  reduce  cardiac  activity,  the  patient 
often  dying  simply  from  exhaustion ;  so  that  violent  exercise,  such 
as  brisk  walking,  is  to  be  discouraged  as  a  restorative. 

In  order  to  arrest  respiratory  failure  and  stimulate  the  circula- 
tion, hypodermic  injections  of  strychnine  or  atropine,  inhalations 
of  amyl  nitrite,  or  the  administration  of  other  physiological  anti- 
dotes, the  inhalation  of  oxygen,  and  artificial  respiration,  may  prove 
advantageous.  Galvanism,  internal  stimulants,  digitalis,  and  car- 
bonate of  ammonium  have  also  been  tried,  with  beneficial  results. 

Chronic  Poisoning. — Chloral  toxemia,  or  chloralism,  is  a  well- 
recognized  development  of  simple  dosage,  in  which  the  habitual 
use  of  the  drug  becomes  as  baneful  and  tyrannical  in  its  operation 
as  the  opium-habit  or  confirmed  alcoholism.  Various  symptoms 
mark  the  degrees  of  excess,  in  which  the  respiratory  apparatus, 
the  skin,  and  the  entire  circulation  are  severally  affected.- 

Respiration  is  embarrassed  by  the  presence  of  dyspnea,  which, 
however  slight,  is  manifested  after  meals  or  is  stimulated  by  physi- 
cal exertion.  The  skin  may  be  subject  to  erythematous  eruption, 
either  persistent  or  temporarily  excited  by  trivial  causes.  Finally, 
the  gravest  complications  may  occur  in  the  circulatory  system, 
resulting  in  high  fever,  pyemia,  and  ultimate  collapse. 

The  line  of  demarkation  between  these  stages  of  toxemia  can- 
not be  infallibly  drawn,  the  general  effects  of  chloralism  being 
somewhat  dependent  upon  the  temperament  and  habits  of  the 
individual.  The  following  symptoms  are  more  or  less  apparent  in 
all  cases  of  chronic  poisoning : 

The  eyes  are  brilliant ;  the  speech  is  voluble,  often  uncontrolla- 
ble ;  and  the  manner  strangely  affected  by  nervous  excitement.  As 
the  craving  for  the  drug  assumes  the  phase  of  monomania  through 
habitual  indulgence,  its  votary  appears  to  border  upon  pronounced 
insanity.  The  eyes  become  irritable  and  injected,  the  manner  more 
restless,  and  the  subject  is  sensible  of  vacuity  in  the  brain  and 
liable  to  accesses  of  vertigo.  During  the  daytime  a  listless  stupor 
allied  to  melancholia  is  observable ;  the  appetite  is  uncertain,  often 
entirely  wanting,  and  digestion   difficult.     These   symptoms   are 


4i6  A    TEXT-BOOK  OF  MA  TERIA  MEDIC  A. 

accompanied  by  profound  lassitude  and  debility  of  heart-action, 
together  with  marked  anemia,  especially  of  the  lower  extremities. 
Meanwhile,  the  hepatic  functions  are  deranged,  the  secretion  of 
bile  is  deficient,  and  an  increasing  weakness  of  the  limbs  simulates 
paralysis.  The  stools  are  colorless  and  wanting  in  biliary  elements, 
and  the  urine  is  stained  with  bile  and  at  times  albuminous  and  sac- 
charine. 

At  this  stage  of  chloralism  the  necessity  of  the  drug  in  order 
to  overcoirie  insomnia  has  grown  to  be  imperative,  sleep  being  in- 
duced only  through  the  agency  of  the  accustomed  hypnotic.  An 
over-dose  may  now  at  any  moment  produce  death  in  the  manner 
above  indicated,  the  cumulative  effects  of  the  poison  with  which 
the  system  is  saturated  wholly  deranging  the  vital  functions  and 
rendering  elimination  impossible. 

The  simplest  treatment  in  these  extreme  cases  is  primarily  the 
gradual  withdrawal  of  the  toxic  agent,  although  delirium  tremens 
is  recorded  as  a  result  of  abstention.  The  diet  should  be  carefully 
regulated  with  a  view  to  restoring,  if  possible,  the  decreased  vitality. 
Change  of  scene,  abundant  air  and  exercise,  chalybeate  tonics, 
calmatives,  and  nerve-stimulants  undoubtedly  contribute  to  re- 
establish functional  activity  and  normal  circulation,  and  occasional 
purgatives  may  assist  in  eliminating  from  the  system  the  noxious 
elements  with  which  it  has  become  chronically  affected. 

The  following  prescription  has  been  suggested  as  efficacious  in 
cases  of  established  chloralism  : 

R.  Chloralis,  gijveliv; 

Morphinse  sulphatis,  gr-  ij ; 

Syr.  lactucarii  (Aubergier),  f§ij; 

Aquae,  q.  a.  ad  f  giij. 

Sig. — Dessertspoonful  in  water  at  lo  and  up.  M.,  if  necessary. 

Therapeutics. — Externally  and  Locally. — An  injection  into  the 
sac  of  a  lo  per  cent,  solution  of  chloral  has  been  highly  recom- 
mended by  Marc  See  in  the  treatment  of  hydrocele.  One  ounce  of 
this  solution  is  injected,  being  followed  in  two  or  three  days  by  a 
copious  effusion,  which  is  soon  absorbed. 

The  antiseptic  properties  of  chloral  are  utilized  as  a  wash  or 
dressing  in  cancer  of  the  uterus,  foul  ulcers,  etc.  For  these  purposes 
the  strength  should  be  from  5  to  10  grains  (0.3  to  0.6  Gm.)  to  i 
ounce  (30.0  Cc).  Gonorrhea  is  readily  cured  in  many  instances 
by  a  I  per  cent,  injection  of  this  drug. 

Spohn  recommends  the  continued  application  of  a  solution  of  I 


HYPNOTICS.  417 

drachm  (4.0  Gm.)  of  chloral  in  4  drachms  (16.0  Cc),  each,  of 
glycerin  and  water  in  cases  oi  furuncle. 

Bromidrosis  and  hyperidrosis  have  yielded  to  local  applications 
of  from  2  to  5  per  cent,  aqueous  solutions  of  chloral. 

Sir  Morrell  Mackenzie  successfully  employed  a  pigment  com- 
posed of  25  grains  (1.6  Gm.)  of  this  drug  to  i  drachm  (4.0  Cc.)  of 
syrup,  as  a  local  application  to  the  throat  in  diphtheria. 

Camphorated  chloral  is  often  an  efficient  remedy  for  toothache, 
and,  when  mixed  with  petrolatum  or  simple  ointment  in  the  pro- 
portion of  I  to  7,  makes  an  excellent  application  in  pruritus  and 
other  itching  diseases  where  the  skin  is  unbroken.  This  prepara- 
tion undiluted  has  been  used  in  neuralgia,  painted  over  the  affected 
nerves. 

Cregny  employs  a  20  per  cent,  solution  of  chloral  in  anal  fis- 
sure, and  a  i  per  cent,  solution  is  used  in  cracked  nipples. 

Chloral  is  frequently  used  to  preserve  urine  for  microscopic 
examination,  though  it  should  not  be  added  to  urine  reserved  for 
chemical  analysis  intended  to  detect  the  supposed  presence  of 
sugar. 

Solutions  of  chloral  are  used  for  embalming  purposes  and  the 
preservation  of  anatomical  specimens. 

Internally. — The  principal  use  of  chloral  internally  is. to  depress 
the  psychic  mechanism  and  produce  sleep.  It  is  also  employed  to 
depress  the  reflexes  and  motor  apparatus,  and  thereby  diminish 
convulsions,  and  is  sometimes  useful  in  lowering  the  action  of  the 
sensory  mechanism. 

As  a  hypnotic  it  is  especially  valuable  in  conditions  character- 
ized by  excessive  cerebral  activity,  such  as  insomnia  resulting  from 
overwork  or  worry,  and  in  the  wakefulness  of  many  acute  diseases 
— typhoid,  typhus,  and  o\}a&x  fevers,  delirium  tremens,  and  puerperal 
mania — it  is  a  remedy  of  well-known  efficacy.  Its  depressing 
effects  should  always  be  guarded  against  during  the  active  course 
of  disease,  as  well  as  in  delirium  tremens  where  great  cardiac 
weakness  already  exists.  The  insomnia  of  convalescence  would 
usually  indicate  its  use.  Indeed,  where  no  special  contraindication 
to  its  employment  exists  it  is  the  most  satisfactory  hypnotic  we 
possess. 

On  account  of  its  powerful  depression  upon  the  motor  mechan- 
ism it  is  a  valuable  drug  in  treating  the  various  convulsions  and 
spasmodic  disorders  of  childhood,  such  as  chorea,  whooping  cough, 
laryngistnus  stridulus,  and  all  infantile  convulsions  and  colic. 

27 


41 8  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Even  in  asthma,  tetanus,  uremic  convulsions,  hiccough,  and 
strychnine-poisoning  chloral  has  proved  an  important  remedy. 

Certain  forms  of  epilepsy,  particularly  the  nocturnal  variety,  are 
benefited  by  this  drug,  and  it  has  been  found  useful  in  angina  pec- 
toris, though  it  should  be  very  cautiously  administered  in  these 
cases  if  there  be  reason  to  suspect  valvular  disease  or  degeneration 
of  the  cardiac  muscle. 

The  reflex  vomiting  in  pregnancy  is  sometimes  relieved  by  either 
the  internal  administration  of  chloral  or  by  enemas.  It  has  also 
been  used  to  depress  the  reflexes  in  sea-sickness. 

Cholera  and  cholera  morbus  are  often  alleviated  by  the  hypo- 
dermic injection  of  this  drug,  in  lO-  or  15-grain  (0.6-1.0  Gm.) 
doses. 

Spasmodic  rigidity  of  the  os  uteri  is  greatly  reduced  by  a 
medicinal  dose  of  this  remedy,  and,  while  its  action  on  the  sensory 
mechanism  is  feeble,  it  is  nevertheless  frequently  efficient  in  modify- 
ing the  pains  of  labor  and  in  quieting  the  alarm  and  allaying  the 
nervous  excitement  of  the  mother. 

There  are  certain  other  pains  of  moderate  intensity,  especially 
those  of  neuralgia,  which  are  temporarily  more  or  less  relieved  by 
chloral.  Its  anodyne  effect,  however,  is  too  transient  to  render 
chloral  very  popular  as  an  analgesic. 

A  combination  of  morphine  and  chloral  is  a  very  efficient  ano- 
dyne and  hypnotic  in  sleeplessness  due  to  pain,  which  is  palliated 
by  this  combination  with  less  digestive  disturbance  than  if  the 
former  drug  had  been  used  alone,  and  less  cardiac  depression  than 
if  the  latter  had  been  the  sole  remedy,  the  medicines  thus  aiding 
each  other  and  serving  the  twofold  purpose  of  mitigating  pain  and 
inducing  sleep. 

The  author  desires  to  recommend  here  chloral  hydrate  as  an 
antipyretic.  As  has  been  previously  stated,  the  hypnotics  possess 
many  of  the  characteristics  of  antipyretics,  antiseptics,  and  anes- 
thetics. 

Chloral  possesses  to  a  considerable  degree  the  properties  of  a 
typical  antipyretic.  It  is  antiseptic,  somewhat  volatile,  and  readily 
eliminated,  and  thought  by  some  observers  to  be  changed  in  the 
system  into  chloroform  and  sodium  formate,  while,  if  not  pushed 
too  far,  it  is  not  toxic. 

We  know  that  one  of  the  principal  actions  of  chloral  is  to  re- 
duce temperature ;  indeed,  toxic  doses  exert  so  marked  an  effect 
as  to  produce  death  by  loss  of  heat  alone. 


HYPNOTICS.  419 

In  sthenic  fevers  chloral  is  an  admirable  remedy,  not  only  as  an 
antipyretic,  but  in  allaying  nervous  irritability,  restlessness,  and 
excessive  cardiac  action,  and,  in  the  opinion  of  the  author,  this 
remedy  claims  far  more  attention  in  these  cases  than  it  has  received. 

Contraindioations. — Fatty  heart ;  marked  respiratory  weakness, 
whether  due  to  acute  or  chronic  disease  of  the  lungs ;  atheromatous 
degeneration  of  the  blood-vessels.  Owing  to  the  lessened  alka- 
linity of  the  blood,  the  action  of  chloral  is  so  unfavorable  in  acute 
inflammatory  rheumatism  as  to  justify  classing  this  disease  under 
the  present  head. 

The  drug  should  be  administered  cautiously,  the  patient  being 
uninformed  as  to  its  nature  in  certain  nervous  diseases,  lest  he 
acquire  the  chloral  habit. 

Administration. — As  is  recommended  in  the  case  of  all  drugs, 
only  the  purest  article  should  be  prescribed.  Frequently  the  un- 
toward symptoms  of  chloral  are  due  more  to  the  impure  article 
than  to  any  idiosyncrasy  against  it.  The  recrystallized  form  alone 
should  be  used,  the  first  dose  administered  not  exceeding  from  1 5 
to  20  grains  (i.o  to  1.2  Gm.),  repeated  as  occasion  may  demand. 
Ordinarily,  a  maximum  dose  should  not  be  given  oftener  than  once 
in  forty-eight  hours. 

Children  bear  chloral  well,  and,  as  a  rule,  i  grain  (0.06  Gm.) 
may  be  prescribed  for  each  year  of  the  child's  age. 

Enemas  of  chloral  may  be  rendered  less  irritating  by  mixing 
the  drug  with  the  yolk  of  an  egg  and  milk.  Chloral  should  always 
be  well  diluted  when  given  internally,  especially  when  combined 
with  sodium  or  potassium  bromide.  Its  disagreeable  taste  may  be 
partially  disguised  by  mixing  the  solution  with  peppermint  water 
and  elixir  or  syrup  of  orange. 

The  following  differences  exist  between  the  action  and  thera- 
peutics of  chloral  and  those  of  the  various  allied  compounds  men- 
tioned above : 

Amylene  Hydrate  is  considered  by  many  observers  to  be  safer  than  chloral,  while 
its  soporific  effects  are  produced  sooner,  being  manifested  usually  in  from  five  to  thirty 
minutes,  the  awakening  being  ordinarily  prompt  and  complete.  In  toxic  doses  it  para- 
lyzes the  respiratory  and  cardiac  centers. 

Its  comparison  with  chloral  is  so  well  stated  by  Laves  that  his  remarks  are  here  quoted 
verbatim.  "  It  has,"  he  says,  "  neither  the  unpleasant  and  persistent  taste  and  smell  of 
the  latter  (chloral),  nor  the  same  uncertainty  of  action.  It  seems  to  have  about  half  the 
strength  of  chloral,  and,  although  its  hypnotic  action  is  perhaps  less  certain,  the  sleep  it 
causes  is  more  refreshing  and  the  mind  remains  clearer  after  its  use." 

Amylene  hydrate  is  best  given  in  n  mixture  of  wine  and  syrup  of  liquorice ;  if 
administered  by  the  rectum,  it  should  be  suspended  in  mucilage. 


420  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Chlor-ammonium  is  not  so  depressing  upon  the  heart  and  circulation,  yet  it  does 
not  offer  sufficient  advantages  over  chloral  to  justify  its  use  as  a  substitute. 

Chloralose. — Its  taste  is  to  many  persons  more  nauseating  than  that  of  chloral, 
while  its  action  is  practically  identical,  though  perhaps  not  so  depressing  upon  the  spinal 
cord,  its  influence  being  exerted  rather  upon  the  brain.  It  probably  also  possesses  more 
anodyne  properties,  and  vi'ould  therefore  be  superior  to  chloral  as  a  hypnotic  in  insomnia 
with  pain,  sleep  being  produced  in  about  half  an  hour. 

Chloralose  is  best  administered  in  capsules  followed  by  a  drink  of  water,  to  prevent 
too  great  irritation  of  the  mucous  membranes  of  the  stomach. 

Hypnal. — This  substance  possesses  more  antispasmodic  properties  than  chloral,  and 
theoretically  it  should  be  a  better  analgesic,  it  being  a  compound  of  chloral  and  anti- 
pyrine.  Yet  physicians  who  have  had  the  largest  experience  with  the  drug  claim  its 
effects  to  be  illusory,  and  that  it  has  no  special  value  as  an  anodyne.  Indeed,  Dujardin- 
Beaumetz,  who  introduced  the  drug,  regarded  it  more  of  a  soporific  than  anodyne. 

Hypnal  causes  greater  gastric  disturbance  than  chloral,  and,  withal,  cannot  be  recom- 
mended as  an  efificient  substitute  for  it. 

It  may  be  dissolved  in  almond  oil  and  given  in  capsules,  or  administered  in  a  mixture 
of  wine  and  cordial  or  some  aromatic  syrup. 

Hypnone. — As  a  hypnotic  a  much  weaker  substance  than  chloral,  although  it  has 
found  some  advocates  as  a  remedy  for  the  insomnia  of  alcoholism.  Toxic  doses  para- 
lyze the  heart  and  respiration.     It  should  be  given  in  capsules. 

Ural — Chloral-urethane. — A  good  hypnotic,  yet  possessing  no  special  advantages. 
It  is  not  so  depressing  upon  the  circulation,  but  is  a  more  feeble  antipyretic  than  chloral. 

Urethane. — Its  physiological  action  is  almost  identical  with  that  of  chloral.  It  is 
less  depressing  upon  the  circulation  and  respiration,  but  more  so  upon  the  peripheral  ends ' 
of  the  motor  nerves.  Acting  directly  upon  the  cerebrum,  it  produces  a  refreshing  and 
dreamless  sleep,  with  no  unpleasant  after-effects.  Nevertheless,  it  is  not  so  reliable  a 
hypnotic  as  chloral,  and  its  usefulness  as  a  therapeutic  agent  is  still  a  debatable  question, 
probably  no  hypnotic  having  been  introduced  concerning  the  effects  of  which  there  is 
such  diversity  of  opinion.  Until,  therefore,  its  use  shall  be  restricted  to  a  place  uni- 
versally assigned  to  it,  there  can  be  no  good  reason  why  urethane  should  supplant  chloral 
for  any  purpose. 

It  may  be  given  in  capsules  or  in  some  pleasant  water  or  syrup,  and  may  also  be 
conveniently  administered  as  an  injection  by  the  rectum. 


Chloral  Formamidatum— Chloralis  Formamidati— 
Chloral  Formamide. 

(Chloralamide.) 

Origin. — Obtained  as  the  result  of  the  interaction  between  An- 
hydrous Chloral  and  Formamide,  consisting  of  Chloral  Anhydride 
2  parts  and  Formamide  i  part. 

Description  and  Properties. — Chloralamide  occurs  as  white, 
shining,  odorless  crystals,  having  a  faintly  bitter  taste.  It  is  solu- 
ble in  9  parts  of  water  and  in  ij  parts  of  alcohol. 

Dose. — 10-30  grains  (0.65-2.0  Gm.). 

Antagonists  and  Incompatibles. — It  is  decomposed  into  chloral 
with  alkalies  and  with  water  at  above  140°  F. 


HYPNOTICS.  421 

Synergists. — The  bromides  of  sodium  and  potassium. 

Physiological  Action. — As  might  be  expected,  when  the  stim- 
ulating action  of  ammonia  is  combined  with  the  soporific  action  of 
chloral,  as  is  the  case  in  chloralamide,  we  have  a  substance  much 
less  depressant  upon  the  heart  and  respiration  than  chloral,  although 
probably  possessing  as  active  hypnotic  properties.  Its  action  upon 
different  systems  compared  with  that  of  chloral  is  as  follows : 

Externally  and  Locally. — It  is  not  so  irritating  to  mucous  mem- 
branes, as  chloral. 

Internally. — Digestive  System. — In  its  action  it  does  not  differ 
essentially  from  chloral. 

Circulatory  System. — Its  influence  is  very  feeble,  producing  no 
perceptible  effect  upon  the  pulse  in  medicinal  doses. 

Nervous  System. — It  probably  acts  as  powerfully  upon  the  cere- 
bral cortex  as  chloral,  but  in  medicinal  doses  does  not  depress  the 
spinal  cord  to  the  same  extent,  though  toxic  doses  may  abolish  the 
reflexes  and  the  conductivity  of  the  motor  nerves.  It  produces, 
usually  in  from  thirty  minutes  to  one  hour  after  its  ingestion,  a  sleep 
which  lasts  from  six  to  ten  hours,  with  no  bad  after-effects.  As  an 
analgesic  it  is  superior  to  chloral. 

Respiratory  System. — It  is  an  active  respiratory  stimulant  in 
medicinal  doses,  through  its  influence  upon  the  center.  Toxic 
doses,  on  the  other  hand,  paralyze  the   respiratory  center. 

Absorption  and  Elimination. — In  the  blood  it  is  converted  into 
chloral  and  formamide,  being  chiefly  eliminated  with  the  urine, 
which  it  tends  to  diminish — as  well  as  the  amount  of  phosphates 
excreted — though  it  is  said  that  the  urea  is  increased  by  small  and 
lessened  by  large  doses. 

Temperature. — In  medicinal  doses  the  temperature  is  uninflu- 
enced. 

Untoward  Action. — Restlessness,  mild  delirium,  rapid  and  feeble 
heart,  great  thirst,  nausea,  and  vomiting. 

Poisoning. — Its  toxic  effects  are  similar  to  those  of  acute  chloral- 
poisoning.  It  does  not  possess  the  cumulative  action  of  the  latter 
drug  nor  any  tendency  to  induce  chloralism. 

Treatm.ent  of  Poisoning. — The  same  as  for  acute  chloral-pois- 
oning. 

Therapeutics. — It  is  not  employed  externally  and  locally.  Its 
therapeutic  uses  are  similar  to  those  of  chloral.  As  a  hypnotic  it 
is  superior  when  there  is  cardiac  or  respiratory  weakness.  In  the 
insomnia  of  neurasthenia  it  is  especially  valuable, and, in  conjunction 


422  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

with  potassium  bromide,  is  preferable  to  a  like  combination  with 
chloral  in  cases  of  sea-sickness. 

By  many  physicians  it  is  thought  to  relieve  pain  better  than 
chloral,  which,  if  true,  would  render  it  superior  in  insomnia  com- 
plicated with  pain. 

Administration.— It  is  best  given  in  aromatic  elixir  or  some 
other  dilute  alcoholic  vehicle.  Simple  syrup  slightly  acidulated 
with  hydrochloric  acid,  beer,  and  sweet  wine  are  also  recommended 
as  pleasant  menstrua.  When  given  at  night  for  insomnia  the  medi- 
cine should  be  taken  upon  an  empty  stomach,  about  one  hour 
before  sleeping-time. 

Chloral  Butylicum— Chloralis  BuWllcl— Butyl- 
chloral  Hydrate. 

(Croton-chloral.) 

Origin. — Prepared  by  passing  dry  Chlorine  Gas  into  Acetic 
Aldehyde,  resulting  in  the  formation  of  butyl-chloral,  which  is 
separated  by  fractional   distillation,  and  Water  added. 

Description  and  Properties. — Butyl-chloral  occurs  as  a  heavy, 
colorless  oil,  having  an  odor  resembling  that  of  chloral.  The 
hydrate  (croton-chloral  hydrate)  used  in  medicine  is  in  the  form  of 
white  scales,  of  a  silky  luster,  nauseous  taste,  and  a  peculiar  fruit- 
like odor.  It  is  freely  soluble  in  alcohol,  ether,  glycerin,  and  hot 
water,  but  not  easily  soluble  in  cold  water.  Its  solutions  are  un- 
stable, and  are  decomposed  if  kept  on  hand  even  for  a  short  time. 

Dose. — 3-20  grains  (o.i  8-1.2  Gm.). 

Inoompatibles  and  Synergists  are  the  same  as  for  chloral. 

Its  Physiological  Action  and  Therapeutics  are  quite  similar  to 
those  of  chloral,  though  it  is  considered  less  depressing  to  the 
heart  and  circulation,  while  possessing  greater  anodyne  properties, 
having  a  selective  action  upon  the  fifth  nerve,  doses  even  of  2 
grains  (0.12  Gm.)  often  producing  anesthesia  of  the  trigeminal 
nerve  before  other  actions   of  the   drug  are   manifest. 

It  is  therefore  superior  to  chloral  as  an  anodyne  and  hypnotic 
in  headaches,  facial  neuralgia,  tic  douloureux,  migraine,  etc. 

As  a  simple  hypnotic  it  is  feebler  and  more  uncertain  in  its 
effects  than  chloral,  and,  even  with  its  alleged  advantages,  it  is 
doubtful  if  it  will  ever  supplant  that  drug  to  any  extent,  save  in 
cases  of  neuralgia  of  the  fifth  nerve  and  painful  spasm  of  the 
face. 


HYPNOTICS.  423 

In  facial  neuralgias  a  mixture  of  butyl-chloral  and  tincture  of 
camphor  may  be  applied  locally. 

Contraindications. — Hyperemia  of  the  brain,  gastro-intestinal 
irritation,  and  weak  heart. 

Administration. — It  should  be  given  in  pill  form  or  in  capsules. 
If  given  in  solution,  the  bitter  taste  may  be  disguised  by  dissolv- 
ing it  in  the  aromatic  elixir  or  syrup  of  liquorice.  A  mixture  of 
glycerin,  syrup,  and  peppermint  water  also  serves  as  a  good  vehicle. 

Sulphonal— Sulphonal— Sulphonal. 

The  chemical  name  of  this  drug  is  diethyl-sulphon-dimethyl- 
methane. 

Origrin. — It  is  prepared  by  combining  Ethyl  Hydrosulphide 
(Mercaptan)  with  Acetone,  forming  mercaptol,  which  is  oxidized  by 
potassium  permanganate  into  sulphonal. 

Description  and  Properties. — It  occurs  as  colorless,  odorless, 
nearly  tasteless  prismatic  crystals ;  soluble  in  450  parts  of  cold 
water,  in  15  parts  of  boiling  water,  and  in  65  parts  of  cold  or  2 
parts  of  boiling  alcohol.  It  is  a  very  stable  substance,  being  un- 
affected by  concentrated  acids ,  or  alkalies. 

Dose. — 15-30  grains  (1.0-2.0  Gm.). 

Allied  Compounds. 

Trional  (Diethyl-sulphon-methyl-ethyl-methane). — Origin. — Prepared  ex- 
actly like  sulphonal,  except  that  Methyl-ethyl-ketone  is  used  in  place  of  Acetone. 

Description  and  Properties. — Shining,  colorless,  odorless,  crystalline  plates ;  freely 
soluble  in  alcohol,  and  soluble  in  320  parts  of  water. 

Dose. — 10-40  grains  (0.6-2.5  Gm.). 

Tgtronal  (Diethyl-sulphon-diethyl-methane). —  Origin. — This  substance  is 
also  prepared  like  sulphonal,  differing  from  the  latter  in  that  it  contains  two  additional 
ethyl  groups. 

Description  and  Properties. — Colorless,  shining  plates  and  laminae,  of  bitter  taste 
and  slightly  camphoraceous  odor ;  soluble  in  450  parts  of  cold  and  in  5  parts  of  boiling 
alcohol ;  insoluble  in  water. 

Dose. — 10-40  grains  (0.6-2.5  Gm.). 

Antagonists  and  Incompatibles. — There  are  none  of  import- 
ance, and,  owing  to  its  insolubility,  sulphonal  is  usually  given  alone. 

Synergists. — Morphine  intensifies  its  hypnotic  action. 

Physiological  Action. — Externally  and  Locally,  sulphonal  has 
no  influence. 

Internally. — Digestive  System. — In  medicinal  doses  it  has  no 


424  A    TEXT- BOOK  OF  MA  TERIA  MEDIC  A. 

effect  on  the  digestive  tract.  Toxic  doses  may  result  in  nausea, 
vomiting,  and  gastric  pain. 

Circulatory  System. — It  has  no  depressing  action  on  the  heart ; 
on  the  contrary,  it  is  stated  by  Shick  to  accelerate  the  pulse  and 
slightly  raise  arterial  tension. 

Nervous  System. — Like  chloral,  it  depresses  the  cerebral  cortex, 
but  has  no  influence  upon  the  motor  or  sensory  nerves.  Shick 
believes  that  it  stimulates  Setschenow's  reflex  inhibitory  centers, 
and  to  this  influence  is  due  the  diminished  reflex  activity  occa- 
sioned by  the  drug. 

It  is  capable  of  producing  sleep,  but  its  action  is  very  much 
slower  than  that  of  chloral,  from  three  to  eight  hours  often  elapsing 
between  the  ingestion  of  a  medicinal  dose  and  its  soporific  effect, 
the  duration  of  which  averages  about  seven  hours.  The  mental 
disturbance  which  ensues  is  greater  than  in  the  case  of  chloral. 
Sulphonal  possesses  no  anodyne  properties. 

Respiratory  System. — In  medicinal  doses  it  is  much  less  depress- 
ing to  the  respiratory  center  than  chloral,  yet  when  death  from 
sulphonal  occurs  it  is  usually  the  result  of  respiratory  paralysis. 

Absorption  and  Elimination. — Kast  alleges  that  it  is  slowly  sol- 
uble in  the  gastric  juice  and  gradually  absorbed.  William  J.  Smith 
of  London,  who  has  experimented  extensively  with  this  drug, 
claims  that  it  is  eliminated  by  the  kidneys  as  ethyl-sulphonic  acid. 
It  has  also  been  shown  that  under  the  administration  of  large  doses 
or  prolonged  use  a  small  quantity  of  sulphonal  is  eliminated  as 
such  unchanged.  Furst  states  that  the  greater  portion  is  excreted 
in  the  form  of  soluble  sulphates,  and  that  the  urine  often  contains 
traces  of  albumin  and  renal  elements,  wisely  suggesting  that  the 
drug  be  at  once  discontinued  should  there  be  reason  to  suspect 
the  presence  of  hematoporphyrin,  as  indicated  by  the  discoloration 
of  the  urine. 

Temperature  is  unaffected  by  medicinal  doses. 

Eye. — Knaggs  and  Dillingham  report  cases  accompanied  by 
affection  of  the  eye,  loss  of  sensation  in  the  conjunctivae,  and  ptosis 
lasting  two  weeks.  The  cause  in  these  instances  was  sulphonal- 
poisoning.  Medicinal  doses  produce  no  notable  effect  upon  this 
organ. 

The  Untoward  Action  and  Poisoning  resulting  from  the  use  of 
sulphonal  present  symptoms  of  so  varied  a  character  that  the  drug 
seems  to  possess  no  properties  of  a  uniformly  toxic  nature.  More- 
over, in  the  cases  of  poisoning  recorded  the  condition  of  the  patient 


HYPNOTICS.  425 

and  the  quality  of  the  drug  have  been  such  as  to  require  consider- 
able variation  in  the  amount  given.  In  one  case  30  grains  (2.0  Gm.) 
produced  death  in  forty  hours  {Med.  News,  Iv.  p.  166),  while  in 
another  a  man  swallowed  3  ounces  (96.0  Gm.)  of  sulphonal,  which, 
although  resulting  in  a  condition  of  coma  lasting  six  dayg,  termi- 
nated in  recovery  {Journ.  Amer.  Med.  Assn.,  iv.  p.  21). 

Perhaps  the  most  prominent  symptoms  of  acute  sulphonal-poi- 
soning  are  painful  convulsions,  vomiting,  constipation  or  diarrhea, 
and  diminished  urine,  containing  bile,  blood,  and  epithelial  casts. 
"  Sulphonalism,"  or  chronic  poisoning,  produces  vertigo,  head- 
ache, somnolence,  mental  and  muscular  debility,  edema  of  the  eye- 
lids, cyanosis,  and  many  other  deranged  conditions  of  the  system. 

Treatment  of  Poisoning. — Discpntinuance  of  the  drug;  elimina- 
tive  and  symptomatic  treatment. 

Therapeutics. — Sulphonal  is  never  used  externally,  and  inter- 
nally it  is  valuable  only  as  a  hypnotic — in  insomnia  unaccompanied 
by  pain,  and  particularly  to  produce  sleep  and  quiet  the  intense  ex- 
citement of  the  insane.  In  the  author's  opinion,  its  many  disadvan- 
tages, together  with  its  unreliability  and  uncertainty  of  action, 
should  relegate  it  to  a  place  greatly  inferior  to  that  of  chloral  or 
any  other  hypnotic  mentioned  above.  No  skilled  and  conservative 
physician  can  peruse  the  literature  of  sulphonal  without  being 
startled  by  the  incongruous  statements  contained  therein,  being 
tempted  to  attribute  the  irrational  statements  concerning  not  only 
this  drug,  but  other  new  synthetical  remedies,  to  the  ill-advised 
efforts  of  some  sensational  physicians,  alike  inexact  and  illogical, 
to  advertise  themselves  rather  than  give  expression  to  established, 
incontrovertible  facts. 

Contraindications. — None  of  importance. 

Administration. — Sulphonal  should  be  given  in  powder  or  cap- 
sules or  in  hot  whiskey.  Owing  to  its  insolubility,  it  should  not 
be  administered  in  the  form  of  compressed  tablets. 

Paraldehydum—Paraldehydi— Paraldehyde. 

TJ.  S.  JP. 

Origin. — ^A  polymeric  form  of  Ethylic  Aldehyde. 

Description  and  Properties. — A  colorless,  transparent  liquid, 
having  a  strong,  characteristic,  but  not  unpleasant,  pungent  odor, 
somewhat  resembling  that  of  chloroform,  and  a  burning,  cooling 
taste.  Soluble  in  8.5  parts  of  water  and  in  16.5  parts  of  hot  water, 
being,  as  will  be  observed,  more  soluble  in  the  former  than  in  the 


426  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

latter.     Miscible  in  all  proportions  with  alcohol,  ether,  and  fixed 
and  volatile  oils. 

Dose. — J— I  fluidrachm  (1.0-4.0  Cc). 

Unofficial  Preparation. 

Elixir  Paraldehydi — Elixir  Paraldehydi — Elixir  of  Paraldehyde. — Dose,  r- 
2  fluidrachms  (4.0-8.0  Cc). 

Synergists. — Opium  and  the  hypnotics  aid  its  action. 

Physiological  Action. — Externally  and  Locally. — Antiseptic, 
antifermentative. 

Internally. — Digestive  System. — Paraldehyde  has  no  action  upon 
the  digestive  tract. 

Circulatory  System. — It  differs  from  chloral  in  affecting  the  cir- 
culatory system  favorably  in  medicinal  doses,  tending  rather  to 
slow  and  strengthen  the  pulse.  Toxic  doses  weaken  the  heart  and 
lower  arterial  pressure,  the  heart's  action  ceasing  in  diastole. 

Nervous  System. — Its  influence  upon  the  brain  and  spinal  cord 
is  similar  to  that  of  chloral.  The  sleep  it  induces,  however,  is  not 
so  prolonged  as  that  caused  by  the  latter  drug,  more  frequent  doses 
being  required  for  continued  soporific  effects.  The  sequelae  of 
paraldehyde  are  not  unpleasant. 

Respiratory  System. — Its  action  resembles  that  of  chloral,  al- 
though it  is  not  so  powerful  a  respiratory  depressant.  In  toxic 
doses  death  usually  ensues  from  paralysis  of  the  respiratory  center. 

Absorption  and  Elimination. — Paraldehyde  is  eliminated  by  the 
lungs  and  kidneys. 

Temperature. — Like  chloral,  it  lowers  the  temperature,  but  in 
less  degree. 

Untoward  Action. — It  occasionally  causes  irritation  of  the 
mucous  membranes  and  erythematous  eruption. 

Poisoning. — The  symptoms  of  poisoning  are  similar  to  those  of 
chloral.  Fatty  degeneration  of  the  heart  and  liver  have  been  found, 
together  with  disorganization  of  the  red  corpuscles. 

Treatment  of  Poisoning. — The  same  as  in  poisoning  from  chloral. 

Therapeutics. — Like  those  of  chloral.  Paraldehyde  is  more 
hypnotic  than  anodyne,  appearing  to  be  best  adapted  to  reUeve  so- 
called  idiopathic  insomnia.  It  is  a  better  diuretic  than  chloral,  and 
in  certain  degenerated  conditions  of  the  heart  and  arteries,  where  a 
diuretic  as  well  as  hypnotic  is  desirable,  paraldehyde  serves  as  a. 
valuable  remedy. 


NARCOTICS.  427 

Cervello  has  recommended  it  highly  in  strychnine-poisoning, 
and  several  cases  of  its  successful  use  in  tetanus  are  reported. 

Administration. — It  may  be  given  in  capsules,  or,  when  other- 
wise administered,  its  unpleasant  taste  may  be  disguised  by  giving 
it  in  an  emulsion  flavored  with  orange  or  bitter  almond.  Glycerin 
also  renders  it  quite  palatable,  yet  it  is  always  mpre  disagreeable  to 
the  taste  than  chloral,  besides  lending  to  the  breath  an  offensive 
and  persistent  odor. 


GROUP   v.— NARCOTICS. 
Opium— Opii— Opium.    U.S.  P. 

Origin. — The  concrete,  milky  exudation  obtained  by  incising 
the  unripe  capsules  of  Papaver  somniferum  (L.),  the  substance  in 
its  nprmal  moist  condition  yielding  not  less  than  9  per  cent,  of 
crystallized  morphine  when  assayed. 

The  poppy  from  which  opium  is  derived  is  indigenous  in  Westr 
em  Asia  and  cultivated  in  Egypt,  Persia,  Asia  Minor,  the  elevated 
plains  of  India,  and  in  some  parts  of  Europe. 

Description  and  Properties. — Opium  appears  in  irregular  or 
subglobular  cakes — with  the  remnants  of  poppy-leaves  and  the 
fruit  of  a  species  of  Rumex  adhering  to  their  surfaces — plastic  or 
of  a  harder  consistence,  chestnut-brown  or  darker,  and  somewhat 
shining  internally,  showing  tears,  and  fragments  of  vegetable  tissue. 
It  has  a  sharp,  narcotic  odor  and  a  peculiar,  bitter  taste.  This  de- 
scription applies  to  the  Smyrna,  Levant,  Turkey,  and  Constantinople 
opium.  There  are,  however,  five  other  varieties — viz.  i.  Egyptian, 
flattened,  roundish  cakes;  2.  Persian,  black,  cylindrical  sticks,  or 
small  cakes  or  balls,  wrapped  in  paper;  3.  Indian,  flat  squares 
covered  with  mica  and  wax  or  an  oiled  paper  wrapper ;  4.  Chinese, 
oblate-spheroidal  masses  wrapped  in  white  paper ;    5.  European. 

Opium  contains  about  twenty  different  alkaloids,  either  in  a 
free  state  or  in  combination  with  meconic  or  sulphuric  acid.  The 
principal  alkaloids,  in  the  order  of  their  medical  importance,  are 
morphine,  codeine,  narceine,  and  thebaine ;  others  are  narcotine, 
papaverine,  cryptopine,  pseudomorphine ,  protopine,  hydrocotarnine, 
laudanine,  cadamine,  rheadine,  meconidine ,  laudanosine,  lanthopine, 
gnoscopine,  and  oxynarcotine. 

The  following  constituents  of  opium  are  in  some  respects  im- 
portant :    Meconic  acid,  meconin,  meconoiosin,  and  porphyroxin. 


428  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

In  addition  to  the  above,  opium  contains  these  substances, 
making  it  one  of  the  most  complex  drugs  in  Materia  Medica: 
Mucilage,  resin,  fats,  essential  oil,  glucose,  caoutchouc,  ammonium, 
calcium,  and  magnesium  salts,  and  odorous  and  coloring  matters, 
besides  certain  impurities  and  adulterants,  such  as  stones,  fruits, 
leaves,  starch,  water,  lead,  etc. 

Dose. — \-2  grains  (0.015-0.12  Gm.). 

Official  Preparations. 

Opii  Ptilvis — Opii  Pillveris — Powdered  Opium. — Dose,  ^-z  grains  (0.015- 
0.12  Gm.). 

Powdered  opium  should  yield  not  less  than  1 3  nor  more  than  1 5  per  cent,  of  crys- 
tallized morphine. 

J  Acetum  Opii  (lo  per  cent.) — Aceti  Opii — Vinegar  of  Opium. — Dose,  3-15 
minims  (0.18-1.0  Cc). 

^  ExtrSctum  Opii  (18  per  cent,  of  morphine) — ExtrScti  Opii — Extract  of  Opium. 
— Dose,  \-\  grain  (0.01-0.06  Gm.). 

EmplSstrum  Opii  (6  per  cent,  of  extract  of  opium) — EmplSstrum  (ace.)  Opii — 
Opium  Plaster. — For  external  use. 

Formula:  Extract  of  Opium,  60;  Burgundy  Pitch,  180;  Lead  Plaster,  780; 
"Water,  80. 

V  Opium  Deodoratum  (13  to  15  per  cent,  of  morphine) — Opii  Deodorati — De- 
odorized Opium  (Denarcotized  Opium). — Dose,  J-2  grains  (0.015-0.12  Gm.). 

•^  PUulae  Opii  (i  grain,  or  0.06  Gm.,  in  each  pill) — Pflulas  (ace.)  Opii — Pills  of 
Opium. — Dose,  i  or  2  pills. 

v^'Ptilvis  IpecacuSnhse  et  Opii — Ptllveris  IpecacuSnhse  et  Spii — Powder  of 
Ipecac  and  Opium  (Dover's  Powder). — Dose,  5-10  grains  (0.3-0.6  Gm.). 

Formula:  I  grain  (0.06  Gm.)  Opium,  I  grain  (0.06  Gm.)  Ipecac,  8  grains  (0.5  Gm.) 
Sugar  of  Milk,  in  every  10  grains  (0.6  Gm.). 

•i^Tinctiira  Opii  (lopercent.)— Tincturae  Opii— Tincture  of  Opium  (Laudanum). 
—Dose,  5-15  rninims  (0.3-1.0  Cc). 

13  minims  (0.78  Cc.)  represent  about  i  grain  (0.06  Gm.)  of  Opium. 
^Tinctura  Opii  Camphorata — Tincturae    Opii   Camphoratae— Camphorated 
Tincture  of  Opium  (Paregoric). — Dose,  \-\  fluidrachms  (2.0-15.0  Cc). 

Formula:  Powdered  Opium,  4;  Benzoic  Acid,  4;  Camphor,  4;  Oil  of  Anise,  4; 
Glycerin,  ,40;  Diluted  Alcohol,  to  1000.  Prepared  by  maceration  and  percolation. 
4  fluidrachms   (15.0  Cc)   represent  about   i   grain   (0.06  Gm.).  of  Opium. 

V  Tinctiira  Opii  Deodorati  (10  percent.) — Tincturae  Opii  Deodorati— Tincture 
of  Deodorized  Opium. — Dose,  5-15  minims  (0.3-1.0  Cc). 

Tinctura  Ipecacu^nhse  et  Opii — Tincturae  IpecacuSnhae  et  Opii— Tincture 
of  Ipecac  and  Opium  (Tincture  of  Dover's  Powder). — Dose,  5-15  minims  (0.3- 
i.o  Cc). 

10  minims  (0.6  Cc.)  contain  i  grain  (0.06  Gm.)  each  of  Opium  and  Ipecac. 
•^TrochKsci  Glycyrrhizae  et  Opii— TrocWscos  (ace.)  Glycyrrhizae  et  Opii— 
Troches  of  Liquorice  and  Opium. — Dose,  i  to  3  troches. 
Each  troche  contains  about  ^^  grain  (0.005  Gm.)  of  Opium. 
^  Vinum  Opii  (10  per  cent.)— VIni  Dpii — Wine  of  Opium. — Dose,  5-15  minims 
(0.3-1.0  Cc). 


NARCOTICS.  429 

The  Description  and  Properties  of  the  official  allcaloids  of  opium  and  their  salts  are 
as  follows  : 

Morphina — Morphlnse — Morphine. — Colorless  or  white,  shining,  prismatic 
crystals,  or  fine  needles,  or  a  crystalline  powder,  odorless,  having  a  bitter  taste,  per- 
manent in  the  air.  Soluble  in  4350  parts  of  water,  in  300  parts  of  alcohol,  in  455  parts 
of  boiling  water,  and  in  36  parts  of  boiling  alcohol.  Dose,  |-J  grain  (o.ooS-o.oiJ 
Gm.). 

Morphinae  Acetas — Morphlnae  Acetatis — Morphine  Acetate. — A  white  or 
faindy  yellowish-white,  crystalline  or  amorphous  powder,  having  a  faint,  acetous  odor 
and  a  bitter  taste.  Soluble  in  2.5  parts  of  water  and  in  47.6  parts  of  alcohol.  On  pro- 
tracted exposure  to  the  air  the  salt  gradually  loses  some  acetic  acid,  becoming  less 
soluble.  It  should  be  kept  in  dark  amber-colored,  well-stoppered  bottles.  Dose,  \-\ 
grain  (0.008-0.015  Gm.). 

Morphlnse  Hydrochloras — Morphinse  HydTochloratis — Morphine  Hydro- 
chlorate. — White,  feathery  needles,  of  a  silky  luster,  or  minute,  colorless,  cubical 
crystals,  odorless,  having  a  bitter  taste,  permanent  in  the  air.  Soluble  in  24  parts  of 
water  and  in  62  parts  of  alcohol.     Dose,  \-\  grain  (0.008-0.015  Gm,). 

Morphinae  Stilphas — Morphinae  Sulphatis — Morphine  Sulphate. — White, 
feathery,  acif  ular  crystals,  of  a  silky  luster,  odorless,  of  a  bitter  taste,  permanent  in  air. 
Soluble  in  21  parts  of  water  and  in  702  parts  of  alcohol.  Dose,  \-\  grain  (0.008- 
0.015  Gm.). 

Codeina — Codeinae  — Codeine.  —  White  or  nearly  translucent,  orthorhombic 
prisms,  or  octahedral  crystals,  odorless,  having  a  faintly  bitter  taste,  and  slightly  efflores- 
cent in  warm  air.  Soluble  in  80  parts  of  water  and  in  3  parts  of  alcohol.  Dose,  \-2. 
grains  (0.03-0.12  Gm.). 

Various  salts  of  codeine  are  in  use,  the  sulphate  being  the  most  important. 

Official  Preparations  of  Morphine  Sulphate. 

Ptllvis  Morphinae  CompSsitus — Ptllveris  Morphinae  Comp6siti — Com- 
pound Powder  of  Morphine  (Tully's  Powder). — Dose,  5-15  grains  (0.3-1.0  Gm.). 

Formula:  Morphine  Sulphate,  I ;  Camphor,  19;  Glycyrrhiza,  20;  Precipitated  Cal- 
cium Carbonate,  20 ;  Alcohol,  q.  s.  to  60. 

Trochlsci  Morphinae  et  Ipecacuanhse — Trochiscos  (ace.)  Morphinae  et 
Ipecacu^nhae — Troches  of  Morphine  and  Ipecac. — Dose,  i  to  5  troches. 

Formula:  Morphine  Sulphate,  0.16;  Ipecac,  0.50;  Sugar,  65;  Oil  of  Gaultheria, 
0.2 ;  Mucilage  of  Tragacanfh,  a  sufficient  quantity  to  make  100  troches.  Each  troche 
contains  about  ^  grain  (0.0015  Gm.). 

Antagonists  and  Incompatibles  of  Opium  and  its  Alkaloids. 
— ^The  physiological  antagonists  are  atropine,  strychnine,  coffee  or 
caffeine.  Quinine  antagonizes  some  of  the  cerebral  effects  of  the 
drug,  while  tartrate  of  antimony  and  potassa  (tartar  emetic)  and 
digitalis  oppose  its  action  on  the  intracranial  circulation.  The 
incompatibles  are  alkalies,  tannic  acid  and  infusions  containing  it, 
and  salts  of  lead,  iron,  copper,  mercury,  and  zinc. 

The  following  are  incompatible  with  morphine  and  its  salts : 
iodine  and  iodides,  bromine  and  bromides,  Fowler's  solution, 
and  sodium  borate. 


43°  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Synergists. — The  hypnotic  action  of  opium  is  aided  by  the 
hypnotics ;  its  anodyne  influence  is  enhanced  by  belladonna  and 
cocaine,  and  its  sudoriferous  effects  by  ipecacuanha. 

The  Physiological  Action  of  opium  differs  in  some  respects 
from  that  of  morphine  or  codeine,  and  will  therefore  be  described 
first. 

Externally  and  Loca/fy.—r Applied  to  the  unbroken  skin,  opium 
possesses  feeble  analgesic  properties,  and  from  mucous  membranes 
or  raw  surfaces  it  is  readily  absorbed,  producing  marked  anodyne 
effects. 

Internally. — Digestive  System. — Its  prominent  action  is  upon  the 
secretions — checking  that  from  the  salivary  glands,  causing  great 
dryness  of  the  mouth  and  consequent  thirst — largely  diminishing 
those  from  the  stomach,  and  reducing  the  bile  and  pancreatic  juice 
secreted.  In  fact,  every  secretion  in  the  body  is  lessened  except 
the  perspiration,  the  cause  being  the  depressing  influence  of  the 
drug  upon  the  secretory  centers  in  the  medulla.  It  may  be  added 
that  the  peristaltic  movements  of  the  digestive  apparatus  are  re- 
duced, which,  together  with  diminished  secretions,  impairs  diges- 
tion and  produces  constipation. 

The  action  upon  the  intestines,  however,  varies  with  the  dose 
administered,  moderate  or  full  medicinal  doses  checking  peristalsis 
and  promoting  constipation.  On  the  other  hand,  very  large  or  very 
small  doses  increase  peristalsis,  the  former  augmenting  this  effect, 
and  producing  violent  movement  of  the  bowels  through  the  drug's 
paralyzing  action  upon  the  splanchnic  inhibitory  fibers  of  the  intes- 
tine, so  that  inhibition  is  removed  and  peristalsis  reinforced.  Very 
small  doses  act  as  purgatives  when  by  some  reflex  disturbance, 
such  as  a  tender  ovary,  the  peristalsis  is  inhibited.  Minute  quanti- 
ties, by  partially  benumbing  the  inhibitory  nerves  or  diverting 
the  stimulus  from  them  to  the  stimulating  fibers,  relieve  consti- 
pation. This  action  is  rendered  serviceable  in  the  similar  con- 
stipation accompanying  lead-poisoning,  the  metal  constipating  the 
patient  not  only  by  its  astringent  action,  but  also  by  the  tetanic 
spasm  of  the  intestines  caused  by  the  irritating  action  of  the  lead 
upon  their  mucous  membrane.  The  feces  are  held  by  spasmodic 
intestinal  contraction,  relief  of  which  by  a  small  dose  of  opium, 
sufficient  to  induce  peristalsis,  will  be  followed  by  evacuation. 

Circulatory  System.-— ^vaakX  doses  accelerate  the  pulse,  render- 
ing it  fuller  and  firmer,  and  dilate  the  arterioles,  though  increasing 
arterial  tension.     This  action  is  due  to  stimulation  of  the  motor 


NARCOTICS.  431 

ganglia  and  cardiac  muscle,  as  well  as  to  an  effect  upon  the  periph- 
eral vaso-motor  apparatus.  Large  doses,  while  primarily  quicken- 
ing, soon  retard  the  heart's  action,  rendering  the  pulse  full.  This 
influence  is  occasioned  by  stimulation  of  both  ends  of  the  vagus. 
Should  the  dose  be  lethal,  the  pulse  may  become  rapid  and  weak 
from  over-stimulation,  and  consequent  exhaustion,  of  the  vaso- 
motor center  and  pneumogastric  nerves. 

Nervous  System. — Opium  acts  differently  upon  the  brain  and  the 
spinal  cord.  Upon  the  former  it  produces  a  temporary  period  of 
excitement,  varying  in  duration  according  to  the  size  of  the  dose 
administered,  small  doses  greatly  stimulating  the  imaginative  fac- 
ulty. The  state  of  excitation  is  followed  by  drowsiness,  soon  yield- 
ing to  deep  sleep,  frequently  disturbed  by  dreams,  which  may  be 
of  a  pleasant,  voluptuous  character  or  disagreeable  and  hideous, 
the  condition  of  the  patient  at  this  time  varying  with  the  dose  he 
has  taken.  If  it  has  been  sufficient  to  produce  profound  stupor, 
the  patient  is  insensible  to  sound,  light,  or  external  irritation.  Pain 
is  abolished,  and  the  reflexes  transmit  no  impression.  On  waking 
the  patient  complains  of  headache,  a  feeling  of  languor,  vertigo, 
nausea,  and  constipation. 

Opium  first  stimulates  and  afterward  depresses  the  higher  cen- 
ters, the  same  action  being  subsequently  manifested  in  the  lower  | 
centers. 

The  cerebral  exhilaration  is  doubtless  the  result  of  an  increased 
hlood-supply  to  the  brain,  while  the  sleep  and  mental  depression 
are  due  to  the  direct  sedative  action  of  the  drug  upon  the  cortical 
cells  of  the  brain. 

Pain  is  relieved  by  opium  through  its  depressing  influence  upon 
the  entire  sensory  apparatus,  the  peripheral  ends  of  the  sensory 
nerves,  the  conducting  path  in  the  spinal  cord,  and  the  receiving 
cerebral  center  all  being  similarly  affected  by  opium,  rendering  the 
drug  one  of  the  most  powerful  analgesics  known. 

'  Respiratory  System. — In  very  small  doses  opium  slightly  stim- 
ulates respiration ;  in  full  or  large  doses  it  is  a  strong  respiratory 
depressant,  its  action  being  upon  the  center  in  the  medulla.  Death 
is  usually  caused  by  paralysis  of  respiration. 

Absorption  and  Elimination. — Opium  is  rapidly  absorbed,  and  is 
eliminated  chiefly  by  the  gastro-intestinal  mucous  membrane  and 
the  kidneys. 

Moderate  quantities  of  the  drug  are  oxidized  in  the  body, 
though  when  large  doses  are  administered  opium  may  be  found 


432  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

unchanged  in  the  urine.  It  is  also  excreted  in  the  bile,  in  the 
milk,  and  to  some  extent  in  the  sweat,  which  is  largely  increased 
by  opium,  particularly  when  the  drug  is  combined  with  ipecacu- 
anha, as  in  Dover's  powder.  The  sweat  is  the  only  secretion  aug- 
mented by  opium,  although  the  manner  in  which  the  sudoriparous 
glands  are  stimulated  is  not  positively  known — whether  centrally 
or  peripherally.  Probably  the  action  is  due  to  increasing  venosity 
of  the  blood  stimulating  the  sweat-centers  in  the  spinal  cord. 

The  reabsorption  of  opium  may  be  prevented  by  frequently 
washing  out  the  stomach,  from  which  viscus  the  drug  is  mainly 
eliminated.  Catheterization  is  also  indicated  from  time  to  time  to 
assist  elimination. 

Temperature  is  at  first  raised,  but  later  lowered  when  free 
diaphoresis  is  established. 

Eye. — The  pupils  are  minutely  contracted  by  large  doses,  the 
modus  operandi  not  being  fully  understood,  though  probably  the 
action  is  due  to  stimulation  of  the  oculo-motor  center.  The  pupil 
usually  dilates  just  before  death  from  opium-poisoning,  owing 
either  to.  paralysis  of  the  oculo-motor  center  or  depression  of  the 
sympathetic  fibers,  and,  perhaps,  excessive  venosity  of  the  blood. 

Untoward  Action. — Headache,  disturbances  of  hearing,  muscular 
tremor  or  temporary  paralysis,  itching  of  the  skin  with  or  without 
eruption.  In  case  the  latter  symptom  appears,  it  is  commonly  in 
the  form  of  small  red  spots  resembling  roseola.  An  erythematous 
inflammation  may  affect  the  mucous  membrane  of  the  mouth  and 
throat. 

Morphine  has  produced  paresthesia  of  the  sense  of  taste,  as 
well  as  spasm  of  accommodation  of  the  eye  and  edema  of  the 
eyelids.  Many  other  untoward  manifestations  occur,  even  under 
minute  doses,  in  persons  having  an  idiosyncrasy  against  the  drug. 

Poisoning. — Small  medicinal  doses  of  opium,  as  we  know,  tend 
to  produce  moderate  excitement,  a  pleasing  sense  of  freedom  from 
care,  and,  in  sleep,  tranquil,  even  happy,  dreams.  Far  otherwise  it 
is  with  toxic  doses.  Under  their  influence  the  entire  physiological 
conditions  of  the  system  are  perverted.  Here  the  drug  exerts  its 
baneful  effects,  and  the  mind  rapidly  succumbs  to  a  power  over 
which  it  has  no  control.  The  period  of  excitement  is  absent,  the 
predominating  desire  of  the  patient  being  to  sleep,  and  from  the  dull, 
lethargic  stupor  which  supervenes  he  is  roused  only  by  vigorous 
and  unremitting  treatment.  Giddiness  portends  this  mental  and 
physical  state.     The  pulse,  though    still   full,   diminishes  in   fre- 


NARCOTICS.  433 

quency;  the  breathing  becomes  heavy  and  labored,  and  finally 
stertorous;  the  heart  is  now  apparently  seized  with  indefinable 
loppression,  and  the  pupils  are  visibly  contracted ;  the  skin  is  dry 
and  warm,  and  the  face  suffused  or  at  length  of  a  marked  cyanotic 
hue,  cutaneous  eruptions  being  not  uncommon.  Should  relief  be 
not  forthcoming,  the  pulse  continues  to  sink ;  the  drowsiness  and 
subsequent  lethargy  are  followed  by  a  state  of  true  coma;  the 
muscular  system  is  wholly  relaxed;  the  reflexes  are  obliterated, 
and  death  ensues  from  respiratory  failure,  the  asphyxia  being 
closely  accompanied  by  cessation  of  the  heart's  action. 

':  Although  this  stage  of  toxemia  is  not  necessarily  fatal,  it  will  be 
readily  seen  that  its  alarming  manifestations  demand  the  utmost 
skill  and  vigilance  on  the  part  of  the  physician.  In  fact,  the  diag- 
nosis is  not  always  clear,  the  phenomena  so  nearly  resembling 
those  of  alcohoUsm,  especially  apoplexy,  uremia,  and  congestion 
of  the  brain,  that  it  is  at  times  next  to  impossible  to  predicate  from 
symptoms  alone  the  presence  of  opium-poisoning.  It  may  be  ob- 
served, however,  that,  save  in  certain  exceptional  cases,  contraction 
of  the  pupil  is  wanting  in  apoplexy,  while  there  is  present  partial 
distortion  of  the  face  or  paralysis  of  the  limbs.  From  uremia 
opium-poisoning  is  differentiated  by  the  presence  in  the  former  of 
edema  and  by  albumin  and  casts  in  the  urine, 

The  treatment  of  acute  opium-poisoning  covers  an  ample  field 
of  therapeutic  experience,  the  remedies  employed  being  numer- 
ous, and  in  their  physical  properties  often  widely  diverse. 
Three  objects  are  of  paramount  necessity :  to  evacuate  the 
stomach,  maintain  respiration,  and  prevent  failure  of  circulation. 
The  first  of  these  may  be  attained  by  the  use  of  the  stomach- 
pump  or  siphon-tube  (easily  improvised).  Active  stimulants  and 
irritating  emetics  are  of  great  service,  the  latter  being  assisted 
by  frequent  and  copious  draughts  of  warm  water  in  the  intervals 
of  vomiting,  and  the  doses  being  large  in  order  to  make  an  im- 
pression upon  the  insensibility  of  the  stomach.  Various  agents, 
including  chemical  antidotes,  may  aid  recovery — tannic  acid,  per- 
manganate of  potassium,  strychnine  especially,  atropine,  strong 
black  coffee,  hypodermic  injections  of  apomorphine,  etc. — and  other 
resources  have  been  tried  with  varying  success.  Warm  water  in- 
jected into  the  rectum  and  stomach  have  proved  efficacious.  Coun- 
ter-irritants, flagellation,  shouting  in  the  ear,  may  rouse  the  patient 
from  his  lethargy.  Should  artificial  respiration  become  necessary, 
either  Sylvester's  method  or  the  use  of  the  faradic  current  can  be 

28 


434  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

adopted.  It  is  here  of  great  importance  that  the  subject  should  be 
kept  awake,  that  he  may  voluntarily  assist  in  the  recuperative  pro- 
cess, which  while  the  will  is  quiescent  in  sleep  he  is  unable  to  do. 
The  full  force  of  the  faradic  battery  may  be  used,  but  it  should 
never  be  applied  to  the  phrenic  nerve  directly,  lest  paralysis  of  the 
cardiac  muscles  ensue.  Should  the  bodily  temperature  fail  to  be 
sustained,  external  heat  should  be  employed  to  supply  the  de- 
ficiency. 

In  maintaining  the  circulation  strychnine  and  atropine,  both 
powerful  antidotes  to  opium,  will  be  of  great  value.  Rubbing, 
massage,  flagellation — but  never  such  as  to  produce  exhaustion — 
and,  if  necessary,  moderate  venesection,  may  be  used  as  supple- 
mentary efforts  at  restoration.  Walking  the  patient  will  often  ward 
off  somnolence,  the  exercise  being  continued  until  thorough  wake- 
fulness results,  provided  there  be  no  untoward  muscular  debility. 
Inhalations  of  ammonia  have  proved  efficacious,  and  the  use  of  the 
catheter  has  been  found  to  stimulate  excretion  by  the  kidneys. 
Special  efforts  should  be  directed,  however,  toward  sustaining 
respiration,  since  failure  in  this  respect  is  most  to  be  feared. 
Should  the  breathing  be  normally  resumed,  or  even  partially  so, 
there  is  no  special  danger  to  be  apprehended  from  the  state  of 
coma.  Cerebral  effects  have  sometimes  been  relieved  by  quinine. 
The  use  of  atropine  is  not  to  be  encouraged,  save  in  exceptional 
cases — and  then  without  repetition — since  it  may  prove  irritating  to 
the  cardiac  ganglia,  while  continued  doses  are  liable  to  induce 
belladonna-poisoning,  as  dangerous  as  the  original  condition. 

In  the  choice  of  remedies  it  should  be  borne  in  mind  that  the 
influence  of  opium  is  limited  to  the  nervous  system,  and  that 
lethal  doses  tend  to  cause  paresis  of  the  arterioles  and  veins. 
Each  case,  moreover,  is  to  be  studied  individually,  scarcely  any 
drug  being  more  dependent  than  opium  upon  the  idiosyncrasies  of 
the  patient. 

Chronic  opium-poisoning,  resulting  from  the  habitual  use  of 
opium,  its  most  active  constituent  moiphia,  or  its  salts,  is  undoubt- 
edly one  of  the  most  pernicious  habits  to  which  the  human  system 
can  be  subjected,  its  mental,  moral,  and  physical  phenomena  being 
among  the  saddest  and  most  terrible  known  to  therapeutics. 

The  symptoms  of  this  disease  of  mind  and  body  are  in  some 
respects  similar  to  those  of  acute  opium-poisoning  in  their  physio- 
logical aspect,  but  the  psychological  features  of  the  malady  are 
more  abhorrent  and  less  amenable  to  treatment.     Extreme  nervous- 


NARCOTICS.  435 

ness  and  tremors ;  abnormal  exercise  of  cerebral  functions,  mani- 
fested in  extraordinary  hallucinations ;  hypochondria ;  anxiety ; 
insomnia;  spasms  and  painful  neuralgia;  and  not  infrequently 
suicidal  intent  or  mania, — these  are  among  the  prominent  charac- 
teristics which  mark  the  victim  of  the  opium  habit.  The  physio- 
logical symptoms  include  dryness  of  the  tongue ;  vesical  irritation, 
with  possibly  excessive  urinary  discharge;  constipation;  serious 
disturbances  of  the  sexual  function,  resulting  in  impotence  or  sus- 
pension of  catamenia ;  while,  caries  of  the  teeth  is  also  sometimes 
present, — the  derangement  of  the  system  being  wellnigh  com- 
plete, often  beyond  the  reach  of  therapeutic  aid.  In  the  words  of 
a  votary  to  the  habit,  "  My  head  throbs  like  a  trip-hammer ;  my 
teeth  are  set ;  a  metallic  taste  is  in  my  mouth ;  my  face,  neck,  and 
arms  are  red  as  fire,  and  all  the  veins  swollen.  Worst  is  the 
throbbing  in  my  head." 

The  conditions  inducing  the  opium-habit  are  frequently  caused, 
or  are  largely  influenced,  by  the  therapeutic  employment  of  the 
drug — as  was  the  case  with  De  Quincey,  whose  graphic  analysis 
of  the  Pleasures  and  Pains  of  opium,  if  possibly  to  be  taken  satis 
cum  grano,  is  at  once  the  most  powerful  and  the  most  eloquent 
ever  written.  The  patient  who  has  once  experienced  the  anodyne 
influence  of  the  drug — as  captivating  to  his  senses  as  though  it 
were  a  draught  of  fabled  Lethe — readily  yields  to  it  upon  the 
slightest  occasion,  as,  for  instance,  to  alleviate  trivial  indispositions 
for  which,  in  ordinary  circumstances,  he  would  ridicule  the  idea  of 
medical  treatment.  With  repeated  indulgence — often  promoted  by 
a  casuistic  reasoning  of  which  by  degrees  the  subject  is  scarcely 
conscious,  or  by  persistent  and  intentional  deception — comes  the 
craving  which  knows  no  restraint,  and  which  can  be  quieted  only 
by  complete  mental  and  physical  regeneration  or  the  merciful  re- 
lease of  death.  Dependent  for  fancied  happiness  upon  his  ex- 
traneous resource,  the  blind  idolater  of  personal  ease  pursues  his 
ignus  fatuus  heedless  of  consequences,  in  his  mental  and  moral 
degeneracy  apparently  lost  to  all  finer  feeling  or  to  manlier  resist- 
ance in  presence  of  his  insidious,  blighting  temptation.  Mean- 
while, physiological  torpor  demands  an  ever-increasing  amount  of 
the  drug  that  the  system  may  be  sufficiently  impressed.  Psychical 
emotions,  anxiety,  anger,  mental  anguish,  or,  indeed,  the  most 
puerile  pretexts,  continue  to  furnish  occasion  for  indulgence,  and 
the  facilities  of  administration  afforded  by  the  modern  method  of 
hypodermic  injection  unhappily  serve  to  stimulate  a  longing  for 


436  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

momentary  exhilaration  or  the  alluring  oblivion  which  may  oblit- 
erate the  past,  but  which  reason  cannot  suffer  to  ignore  the  future 
when  the  mind  recalls  the  overwhelming  testimony  of  experience. 

Should  amelioration  be  now  attempted  and  the  drug  withheld, 
more  distressing  symptoms  still  are  developed.  Depression  and 
exhaustion  are  manifested  at  once,  followed  by  increasing  melan- 
cholia, attended  by  horrible  visions  and  anxieties  no  mental  energy 
— such  as  remains  of  it — can  dispel.  The  pulse  is  scarcely  percepti- 
ble ;  the  patient  is  in  a  state  of  nervous  tension,  occasionally  evinced 
by  paroxysms  of  despair ;  and  in  the  deprivation  endured  the  poor 
wretch,  with  outstretched  hands  and  imploring  expression,  begs, 
screams,  for  morphine,  laudanum,  or  other  habitual  form  of  opium, 
at  last  breaking  down  utterly  in  a  fit  of  passionate  weeping  when 
denied  the  solace  craved.  It  is,  indeed,  an  appalling  spectacle  of 
human  misery  which,  could  it  be  witnessed  by  those  in  whose 
imaginations  the  first  subtle  effects  of  opium  awaken  dreams  of 
elysium,  might  well  persuade  the  victim  to  forswear  a  gratification 
for  which  so  tragic  a  fate  is  reserved. 

The  treatment  of  so  dire  a  malady — for  such  the  chronic  use 
of  opium  must  be  regarded — demands  the  utmost  forethought, 
patience,  and  tact.  The  method  of  sudden,  absolute  withdrawal 
of  the  drug  is  admitted  by  the  wisest  observers  to  be  fraught  with 
danger  commensurate  with  that  of  the  indulgence  to  be  overcome. 
Collapse,  insanity,  and  other  serious  results  have  attended  so  dras- 
tic a  measure,  the  general  opinion  obtaining  to-day  being  that  a 
gradually  reduced  dose  of  the  drug  is  the  safest  and  most  rational 
mode  of "  procedure.  The  conditions  are  extremely  difficult  to 
combat  successfully,  repeated  hypodermic  injections  being  eradi- 
cated from  the  system  far  less  readily  than  opium  from  the  stom- 
ach. The  moral  nature  of  the  patient,  too,  has  become  so  per- 
verted that  little  or  no  reliance  can  be  reposed  in  his  veracity,  the 
physician  being  thrown  upon  his  unaided  resources,  supplemented 
by  the  untiring  vigilance  and  fidelity  of  the  attendant. 

The  gravity  of  the  situation  should  from  the  first  be  fully  real- 
ized, since  it  is  too  often  simply  a  case  of  life  or  death,  the  patient 
being  not  infrequently  seized  with  the  desire  of  self-destruction  in 
the  extremity  of  mental  anguish  occasioned  by  the  ordeal  imposed 
by  unwonted  abstinence.  Could  he  be  put  upon  his  honor,  and 
that  honor  be  steadfast,  his  co-operation  would  be  invaluable.  But 
this  assistance  is  seldom  at  command,  the  patient's  loyalty  of  pur- 
pose and  unswerving  resolution,  as  professed,  being  wholly  sub- 


NARCOTICS.  437 

servient  to  a  volition  long  since  weakened,  if  not  annihilated,  by 
pitiful  sophistries  and  moral  degradation.  Nevertheless,  the  case 
must  be  approached  from  the  sympathetic  side,  and  every  means 
of  inspiring  confidence  employed,  remembering  that  a  human  will 
as  well  as  body  is  under  treatment,  and  that  mental  sanity  as  well 
as  physiological  health  is  to  be  restored. 

Of  the  many  agents  suggested  by  therapeutic  science,  valerian- 
ate of  ammonia,  fluid  extract  of  coca  or  camellia,  judicious  tonics, 
easily  digested  and  strengthening  food,  and,  if  necessary,  alcoholic 
stimulants,  have  been  especially  beneficial.  Other  remedies,  such 
as  dilute  phosphoric  acid,  tincture  of  lupulin,  codeine,  trional,  co- 
nium,  and  cannabis  Indica,  have  in  many  cases  proved  efficient. 

Change  of  scene,  a  healthful,  stimulating  diet,  and  abundant 
out-door  exercise — always  favorable  to  diversion  of  thoughts — 
seldom  fail  to  react  encouragingly  upon  the  mind  and  physique  of 
the  patient.  The  exhibition  of  symptomatic  remedies  not  indicated 
has  been  authoritatively  condemned,  the  primary  object  of  treat- 
ment being  not  so  much  to  afford  temporary  relief  of  pathological 
conditions  as  to  remove  the  dominating  cause.  Cocaine  has  also 
been  discouraged,  lest  its  use  generate  habitual  desire  for  the  drug. 
In  conclusion,  it  may  be  said  that  the  obstacles  attending  a  com- 
plete mastery  of  the  opium  habit  by  means  of  therapeutic  resources 
are  apparent  from  the  fact  that  but  a  small  proportion  of  patients 
addicted  to  thejiuse  of  morphine  are  permanently  cured.  Yet,  though 
the  admission  be  made  with  regret,  it  is  no  disparagement  to  pro- 
fessional science  nobly  directed,  and  assuredly  carries  with  it  a 
fearful  warning  to  those  who  are  tempted  to  seek  immunity 
from  mortal  ills  by  purblind  indulgence  in  so  fatal  a  medium  of 
relief. 

Therapeutics. — In  a  general  way,  the  medical  uses  of  opium  \ 
are — i,  to  reheve  pain ;  2,  to  produce  sleep ;  3,  to  lessen  reflex  irri-  1 
tation;  4,  to  diminish  secretion ;  5,  to  support  the  system;  6,  to  act  j 
as  a  sudorific. 

Opium  is  the  most  important  and  useful  drug  known  to  medi- 1 
cine,  as  well  as  the  most  remarkable  in  its  multifarious  applications.  ] 
It  would,  therefore,  be  idle — indeed,  wellnigh  impossible — to  enu- 
merate all  the  maladies  and  abnormal  conditions  for  which  this 
invaluable  remedy  has  been  employed.     It  perhaps  best  represents  \ 
the  typical  symptom  medicine,  being  used  almost  invariably  for  the 
relief  of  one  or  more  symptoms  of  disease,  rather  than  for  its  spe-  , 
cific  or  direct  curative  action  upon  the  disease  itself.     Unless  some/ 


438  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

special  contraindication  exists,  it  may  be  employed  when  any  of  the 
above  medical  uses  are  desired. 

Externally  and  Locally.— \\.  is  used  to  relieve  pain,  either  in  the 
form  of  an  ointment,  a  liniment,  or  a  suppository,  an  aqueous  solu- 
tion of  morphine  sulphate  as  a  collyrium  in  conjunctivitis,  in  the 
form  of  bougies,  injections,  snuff,  or  lozenges,  or  solution  in  diseases 
of  the  genito-urinary  tract,  the  ear,  nose,  and  throat. 

Tincture  of  opium  is  frequently  added  to  flaxseed  poultices  to 
allay  the  pain  of  superficial  inflammation. 

Internally. — Either  opium  or  morphine  may  be  used  for  the 
relief  of  pain,  regardless  of  the  seat  or  cause.  Pain  of  moderate 
intensity  may  often  be  allayed  by  other  anodynes,  such  as  anti- 
pyrine,  exalgin,  etc. ;  but  when  it  is  severe  or  excruciating,  it  is 
useless  to  experiment  with  other  drugs  when  so  potent  an  agent 
for  relief  as  opium  is  obtainable. 

It  is  not  recommended  for  ordihary  use  to  produce  sleep,  because 
of  its  seductive,  insidious  action  and  the  danger  of  creating  in  the 
patient  a  tendency  toward  the  opium  habit.  When,  however,  sleep- 
lessness is  occasioned  by  pain,  and  in  the  insomnia  of  delirium 
tremens  or  acute  mania,  opium  or  some  one  of  its  preparations  is 
often  an  indispensable  remedy. 

Spasmodic  conditions  of  involuntary  muscles,  as  in  cases  of 
asthma,  the  convulsions  of  tetanus,  uremia,  hydrophobia,  chorea,  etc., 
frequently  call  for  a  drug  as  powerful  as  opium. 

The  paroxysms  oi  periodical  fevers ,  and  especially  the  congestive 
chills  of  virulent  malaria,  often  yield  more  readily  to  this  medicine 
than  to  quinine. 

In  dysentery,  cholera  morbus,  and  cholera  it  has  been  used"  with 
excellent  results,  having  also  been  employed  in  many  cases  of 
excessive  secretion  in  other  portions  of  the  body. 

Opium  is  frequently  given  in  bronchitis  with  profuse  secre- 
tion and  irritable  cough,  in  which  condition  it  acts  favorably 
through  depression  of  the  reflexes  and  power  to  allay  irritation 
and  check  secretion.  In  these  cases,  however,  small  doses  only 
should  be  administered,  and  the  condition  of  the  patient  carefully 
watched,  especially  that  of  the  aged,  lest  the  respiratory  apparatus 
be  so  depressed  that  expulsion  of  the  accumulated  viscid  mucus  be 
impossible  and  danger  of  death  from  suffocation  ensue. 

As  a  supporter  of  the  system  when  the  vital  forces  are  weak- 
ened by  acute  or  chronic  disease  or  injury  there  are  but  few  drugs 
as  efficacious  as  opium.     It  calms  and  strengthens  the  debilitated 


NARCOTICS.  439 

heart,  and  secures  to  the  patient  refreshing  sleep,  soothing  and  in- 
vigorating his  system  by  means  of  the  much-needed  rest.  If  pain 
be  persistent,  wearing  seriously  upon  the  sufferer's  vitality,  opium 
by  its  anodyne  influence  enables  him  to  recuperate  during  the 
interval  of  relief. 

One  of  its  most  valuable  services  is  in  peritonitis,  although,  not- 
withstanding its  incomparable  value,  some  physicians,  more  scien- 
tific than  practical,  have  subordinated  it  to  the  treatment  by  free 
purgation  with  saline  cathartics  or  the  irrigation  of  the  peritoneal 
cavity  with  antiseptic  solutions  in  order  to  eradicate  from  the  sac 
the  pathogenic  bacteria. 

Despite  the  aggressiveness  and  dogmatism  of  abdominal  sur- 
geons, opium  still  remains,  and  justly  so,  the  abiding  resource  of 
the  great  mass  of  conscientious  physicians,  more  thoughtful  of  their 
patients'  welfare  than  of  enhancing  their  skill  and  technique  in 
abdominal  surgery. 

When  given  in  proper  doses  in  peritonitis,  opium  reduces  peri- 
stalsis and  removes  the  pain,  promoting  the  patient's  comfort  and 
supporting  his  vital  powers.  It  diverts  the  blood  from  the  con- 
gested peritoneum  by  dilating  the  cutaneous  blood-vessels.  Further- 
more, it  possesses  the  peculiar  property  of  causing  the  irritation  in 
the  inflamed  area  to  contract  reflexly  the  local  blood-vessels,  thus 
diminishing  the  blood-supply  to  the  diseased  part. 

In  shock  from  severe  injury,  opium,  by  benumbing  sensation 
and  depressing  the  reflex  mechanism,  lessens  the  danger  of  cardiac 
and  respiratory  failure. 

In  pleurisy  it  is  the  most  efficient  remedy,  relieving  congestion 
as  in  peritonitis,  besides  reducing  the  respirations,  and  consequently 
the  friction  of  the  inflamed  pleural  surfaces,  as  well  as  allaying  the 
pain  accompanying  each  respiration. 

Dover's  powder  is  a  common  and  valuable  agent  in  acute  coryza, 
it  also  being  one  of  the  most  efficient  diaphoretics. 

Opium  is  considered  the  best  remedy  in  puerperal  septicemia.! 
It  has  also  been  advocated  for  hemorrhage,  both  active  and  passive,! 
its  greatest  utility  being  manifested  in  the  latter  condition. 

Although  frequently  used  in  continued  fevers  of  various  kinds, 
it  is  indicated  as  a  rule  only  during  their  course — or,  rather,  after 
the  fever  is  well  established  or  during  its  decline — to  mitigate  its 
violence  or  conserve  the  strength  and  relieve  the  nervous  manifes- 
tations foreboding  exhaustion.  Clinical  experience  has  demon- 
strated its  inutility,  ordinarily,  at  the  onset  or  climax  of  such  fevers. 


440  A    TEXT- BOOK  OF  MA  TERIA   MEDIC  A. 

Even  in  exanthematous  fevers  opium  has  proved  valuable  when  the 
eruption  is  delayed. 

As  already  intimated,  the  space  allotted  to  this  drug  will  scarcely 
permit  an  enumeration  of  the  many  disorders  for  which  this  remedy 
has  been  successfully  administered.  The  independent  and  thought- 
ful physician,  knowing  the  chief  indications  for  its  use,  will  find  no 
difficulty  in  employing  opium  alike  to  the  relief  of  the  patient  and 
his  own  satisfaction. 

Contraindications. — If  avoidable,  opium  should  not  be  given 
to  children  under  five  years  of  age.  Should  the  necessity  of  ad- 
ministration under  that  age  be  deemed  advisable  in  the  judgment 
of  the  physician,  it  should  be  remembered  that  the  drug  acts  with 
greatly  disproportionate  power  upon  the  nervous  systems  of  the 
young,  I  minim  (0.06  Gm.)  of  tincture  of  opium  having  caused  the 
death  of  a  child  one  day  old,  and  a  few  drops  of  camphorated  tinc- 
ture of  opium  having  proved  fatal  to  an  infant  of  nine  months. 
The  death  is  even  recorded  of  a  nursing  babe,  from  the  mother 
having  taken  a  medicinal  dose  of  laudanum. 

Opium  is  contraindicated  in  excessive  bronchial  secretion  of  the 
aged  during  the  second  stage  of  pneumonia,  in  cerebral  conges- 
tion, and  in  alcoholism. 

Administration. — As  has  been  stated  undL&x Poisoning,  ^&r^  are 
many  circumstances  which  modify  the  action  of  opium,  the  young 
and  the  old  requiring  smaller  doses  and  great  care  in  administra- 
tion. For  children  the  best  preparation  is  paregoric.  Females, 
moreover,  need  smaller  doses  than  males,  since  they  are  more 
readily  affected  by  the  drug  and  more  subject  to  untoward  mani- 
festations, such  as  nausea,  headache,  etc. 

Caution  should  be  exercised  in  administering  opium  to  those 
who  have  an  idiosyncrasy  against  it.  On  the  other  hand,  persons 
addicted  to  the  opium  habit  require  enormous  doses  to  make  a 
medicinal  impression. 

Agonizing  pain  seems  to  antagonize  the  drug,  so  that  in  peri- 
tonitis or  during  the  passage  of  biliary  or  renal  calculi,  in  severe 
neuralgia,  tic  douloureux,  etc.,  opium  is  well  borne,  doses  which 
under  other  conditions  might  produce  dangerous  symptoms  having 
little  effect  save  to  deaden  the  pain,  frequently  not  even  inducing 
sleep. 

In  other  cases,  such  as  nephritis,  very  small  doses  may  be  fol- 
lowed by  serious  and  alarming  consequences,  continued  adminis- 
tration resulting  in  an  accumulation  of  the  drug  in  the  system, 


NARCOTICS.  441 

owing  to  defective  elimination.  Should  prolonged  administration 
be  desirable,  it  is  necessary  to  increase  the  dose  gradually  in  order 
to  produce  the  requisite  effect,  because  of  the  growing  insensibility 
to  the  drug. 

Certain  preparations  are  preferable  in  given  condition's.  Thus, 
if  it  be  necessary  to  produce  diaphoresis,  Dover's  powder  or  some 
other  combination  with  ipecac  is  advisable.  When,  relief  of  pain, 
unless  it  be  intense,  is  desired,  small  doses  of  morphine  or  tincture 
of  opium  will  usually  be  sufficient,  full  doses  being  required  to 
produce  sleep. 

The  deodorized  tincture  of  opium  causes  less  disagreeable 
symptoms  than  the  plain  preparation,  which  contains  narcotine. 
Potassium  bromide  is  said  to  prevent  untoward  after-effects. 

When  opium  is  demanded  for  its  astringent  action,  it  should  be 
given  in  small  or  stimulant  doses  or  combined  with  chalk  or  with 
some  of  the  astringents.  The  camphorated  tincture,  owing  to  the 
camphor  it  contains,  is  probably  the  most  astringent  liquid  prepa- 
ration of  opium,  and  is  therefore  preferable  in  cases  of  diarrhea,  as 
it  is  the  favorable  form  as  an  adjunct  to  cough-mixtures. 

When  the  prolonged  sedative  and  astringent  effect  of  opium  is 
desired,  as  in  intestinal  hemorrhage,  diarrhea,  nausea,  and  certain 
diseases  of  the  stomach,  an  old,  dry  opium  pill  or  pill  of  opium  and 
lead  is  better  than  any  liquid  preparation  or  morphine,  owing  to  its 
tardy  solution. 

In  diseases  of  the  rectum  requiring  opium  a  suppository  con- 
taining the  extracts  of  opium  and  belladonna  is  perhaps  the  best 
combination  to  use. 

Ovarian  and  pelvic  pain  more  readily  succumbs  to  the  anodyne 
action  of  codeine  than  distress  in  other  parts  of  the  body. 

When  opium  is  used  as  a  soporific,  it  is  best  to  combine  it  with 
chloral,  a  small  dose  only  of  each  being  necessary.     These  unite 
in  their  action  upon  the  brain,  depressing  the  heart  less  than  if, 
chloral  alone  had  been  given,  and  attended  by  less  serious  after- 
effects than  had  morphine  been  the  sole  agent  employed. 

Opium  prolongs  the  narcotic  effect  of  chloroform,  and  in  cer- 
tain operations  it  is  good  practice  to  administer  a  dose  of  the  drug, 
following  it  soon  with  a  few  inhalations  of  the  anesthetic. 

The  hypodermic  injection  of  morphine  is  usually  preferable  to 
the  internal  administration  of  opium  in  cases  of  severe  pain,  since 
a  smaller  dose  is  required  and  a  much  more  rapid  effect  produced, 
with  less  danger  of  affecting  the  appetite  and  bowels. 


442  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

The  many  circumstances  influencing  the  action  of  the  drug- 
appear  to  confirm  the  statement  that  "  there  is  no  dose  of  opium," 
its  conduct  being  wholly  dependent  upon  the  age,  sex,  idiosyn- 
crasies, and  condition  of  the  patient.  The  amounts  given  under 
the  different  preparations  are  such  as  experience  has  shown  to  be 
safe  ordinarily  as  the  initial  ones  for  adults,  succeeding  doses  being 
adjusted  according  to  the  indications  of  the  individual  case. 

Opium  compared  with  its  Alkaloids. 

Morphine  does  not  stimulate  the  nervous  and  circulatory  sys- 
tems so  much  as  opium,  nor  is  it  so  decided  a  narcotic  or  con- 
vulsant.  Morphine  is  more  apt  to  excite  nausea  and  vomiting,  and 
its  sequelae  iare  of  longer  duration. 

Opium  slightly  increases  the  temperature — morphine  lowers  it ; 
and,  while  the  former  accelerates,  the  latter  retards  the  pulse. 

The  continued  use  of  morphine  hypodermically  tends  to  con- 
stipate, while  its  prolonged  action  upon  the  stomach  is  apt  to 
occasion  diarrhea :  under  like  circumstances  opium  does  not  pro- 
duce diarrhea,  its  only  effect  being  a  cessation  of  confinement  in 
the  bowels.  Morphine,  therefore,  ingested,  fails  to  constipate,  while 
opium  is  the  better  drug  to  check  diarrhea. 

Morphine  is  excreted  more  readily  than  opium,  and  does  not 
affect  the  secretion  of  bile. 

Opium  possesses  greater  diaphoretic  properties  than  morphine. 

Morphine  produces  more  irritability  of  the  bladder,  frequently 
causing  ardor  urinse.  It  also  occasions  much  greater  itching  of 
the  skin,  which  usually  begins  and  is  intense  about  the  eyes  and 
nose.  In  its  action  as  an  anodyne  and  soporific  morphine  is  more 
rapid  and  certain  than  opium. 

Codeine  is  a  much  feebler  anodyne  and  hypnotic  than  morphine, 
4  grains  (0.25  Gm.)  being  about  equivalent  to  i  grain  (0.06  Gm.) 
of  the  latter  drug.  It  produces  sleep,  however,  freer  from  disturb- 
ance, with  a  less  disagreeable  sequel. 

Codeine  has  a  more  marked  and  selective  action  than  morphine 
upon  the  nerves  of  the  abdominal  viscera. 

It  possesses  an  advantage  over  both  opium  and  morphine  in  that 
it  can  be  given  in  increasing  doses  without  producing  narcosis. 

It  is  more  stimulating  to  the  spinal  cord  and  sedative  to  the 
pneumogastric  nerve  than  morphine. 

Codeine  is  superior  to  opium  or  morphine  as  a  stimulant  to  the 
glycogenic  function  of  the  hver.     In  the  treatment  of  diabetes  mel- 


NARCOTICS.  443 

litus  it  surpasses  all  other  drugs,  almost  invariably  lessening,  and 
often  entirely  removing,  the  sugar  from  the  urine.  In  justice,  how- 
ever, to  authorities  so  eminent  as  Bruce,  Frazer,  and  Osier  it  may 
be  said  that  they  consider  morphine  much  more  reliable  than  code- 
ine in  diabetes,  regarding  the  latter  as  nothing  save  a  weak  or 
diluted  morphine. 

Admitting  the  general  correctness  of  this  opinion,  codeine  is 
nevertheless  preferable  to  morphine  or  opium  in  prolonged  admin- 
istration, as  is  necessary  in  diabetes,  at  least  for  the  reasons  that  no 
untoward  manifestations  accompany  its  use,  and  that  it  does  not  j 
engender  an  habitual  proclivity  for  the  drug. 

Finally,  codeine  is  a  valuable  remedy  in  troublesome  or  nervous 
cough  or  to  quiet  the  cough  in  bronchitis  and  phthisis,  and  is  also 
efficient  in  gastrodynia.  Codeine  should  be  administered  in  water, 
syrup,  elixir  of  orange,  or  in  the  form  of  pills  or  capsules. 

The  true  action  of  the  following  alkaloids  is  so  questionable 
that  they  are  seldom,  if  ever,  prescribed : 

Narceine  is  alleged  by  equally  competent  observers  to  possess 
feeble  hypnotic  properties  and  to  be  practically  inert. 

.Narcotine  is  a  misnomer,  the  preparation  being  devoid  of  nar- 
cotic power,  although  it  is  said  to  possess  marked  stomachic  and 
antiperiodic  properties. 

Papaverine  is  a  mild  hypnotic  and  cardiac  sedative. 

Thebaine  is  a  powerful  tetanizing  poison,  its  action  upon  the 
spinal  cord  being  analogous  to  that  of  strychnine  and  brucine. 

Humulus— Humuli— Hops.    U.S.  P. 

Origin. — The  strobile-like  aments  of  Humulus  lupulus  L.,  a 
rough,  climbing  perennial,  native  and  cultivated  in  the  north  tem- 
perate zone. 

Desoription  and  Properties. — Ovate,  about  i^  inches  (3.17  Cm.) 
long,  consisting  of  a  thin,  hairy,  undulating  axis  and  many  obliquely 
ovate,  membranaceous  scales,  the  upper  portion  of  which  is  reticu- 
lately  veined  and  the  lower  parallel-veined,  glandular,  surrounding 
a  subglobular  akene ;  color  of  the  scales  greenish,  free  from  red- 
dish or  brownish  spots,  odor  aromatic,  and  taste  bitter,  aromatic, 
and  shghtly  astringent.     The  active  and  important  constituent  is — 

Lupullnum— Lupulini— Lupulin.    JJ.  S.  JP. 

Origin.^A  glandular  powder  separated  from  the  aments  of 
Humulus  lupulus. 


444  ^    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Description  and  Properties. — Bright,  brownish-yellow,  becom- 
ing yellowish-brown,  resinous,  consisting  of  minute  granules  which 
under  the  microscope  are  seen  to  be  subglobular,  or,  rather,  hood- 
shaped,  and  reticulate — aromatic  and  bitter. 

Dose  of  Lupulin. — 5-30  grains  (0.3-2.0  Gm.). 

Official  Preparations  of  Humulus. 
Tinctura  Humuli— Tincturse  Humuli— Tincture  of  Hops.— £>oj?,  1-2  fluid- 
drachms  (4.0-8.0  Cc). 

Official  Preparations  of  Lupulin. 

Extractum  Lupulini  Fmidum-Extracti  LupulJni  Fluidi— Fluid  Extract 
of  Lupulin. — Dose,  5-30  minims  {0.12-2.0  Co.). 

Oleoresina  Lupulini— Oleoresinse  Lupulini— Oleoresin  of  Lupulin.— ZJwf, 
1-5  grains  (0.06-0.3  Gm.). 

Unofficial  Preparations. 

Infusum  Hiimuli— Infusi  Humuli— Infusion  of  Hops.— Z)w«,  1-4  ounces 
(30-125  Cc). 

Tinctura  Lupulini— Tincturse  Lupulini— Tincture  of  Lupulin. — Dose,  )^-2 
fluidrachms  (2-8  Cc). 

Antagonists  and  Incompatibles. — Mineral  acids  and  metallic 
salts. 

Synergists. — Alcohol;  opium,  lactucarium,  and  many  other 
narcotics. 

Physiological  Action. — Externally  and  Locally. — Hops  are 
sedative  and  astringent. 

Internally. — Digestive  System. — The  action  of  hops  is  similar  to 
that  of  vegetable  bitters,  augmenting  the  secretions  from  the  sali- 
vary and  gastric  glands,  thereby  promoting  appetite  and  digestion. 

Circulatory  System. — The  heart's  action  is  slightly  increased,  the 
remedy  also  raising  arterial  tension  and  exciting  the  cutaneous  cir- 
culation. 

Nervous  System. — Like  opium,  hops  primarily  stimulate  the 
brain,  and  secondarily  act  as  a  mild  soporific.  These  effects  are 
increased  if  the  preparation  be  an  alcoholic  one,  such  as  beer. 
The  hypnotic  action  is  due  partly  to  the  volatile  oil  which  the  hops 
contain. 

Respiratory  System. — They  slightly  stimulate  the  respiration. 

Absorption  and  Elimination. — ^The  active  principles  of  hops  are 
chiefly  eliminated  by  the  skin  and  kidneys,  increasing  considerably 
the  sweat  and  urine. 


NARCOTICS.  445 

Temperature  is  unaffected. 

Untoward  Action. — None  is  noticeable,  although  the  drug  pos- 
sesses marked  aphrodisiac  properties. 

Therapeutics. — Externally  and  Locally. — The  sedative  action 
of  hops  is  utilized  in  what  are  known  as  hop  poultices  in  superficial 
and  abdominal  infiammations ,  in  orchitis,  and  as  a  preventive  of 
chordee. 

A  hop  pillow  is  frequently  employed  to  induce  sleep  and  allay 
the  pain  of  earache,  while,  if  the  pillow  be  moistened  with  weak 
vinegar  and  the  fumes  inhaled,  the  result  is  found  to  be  efficacious 
in  the  treatment  of  inflammatory  conditions  of  the  upper  respiratory 
passages. 

Internally. — Its  stomachic  and  carminative  properties  render  this 
remedy  valuable  in  atonic  dyspepsia,  so  called,  and  m  flatulent  colic. 
Preparations  of  hops  are  also  useful  in  febrile  restlessness. 

Priapism,  perverted  sexual  appetite,  spermatorrhea,  etc.  may  be 
relieved  by  lupulin. 

The  combined  tinctures  of  lupulin  and  capsicum  serve  as  ex- 
cellent substitutes  for  alcoholic  stimulants  during  the  treatment 
of  alcoholism,  as  well  as  being  useful  remedies  in  mild  attacks  of 
delirium  tremens. 

Administration. — Lupulin  and  oleoresin  of  lupulin  are  best 
given  in  pills  and  capsules  respectively.  The  tincture  and  fluid 
extract  should  be  administered  in  syrup. 

Lactucarium— Lactucarii— Lactucarium.    TJ.  S.JP. 

Origin. — The  concrete  milk-juice  of  Lactuca  virosa  L.,  a  bien- 
nial rank-smelling  herb  growing  in  Europe. 

Description  and  Properties. — It  occurs  in  sections  of  plano- 
convex, circular  cakes,  or  in  irregular,  angular  pieces,  externally 
grayish-brown  or  dull  reddish-brown,  internally  whitish  or  yellow- 
ish, of  a  waxy  lustre,  heavy,  narcotic  odor,  and  somewhat  bitter 
taste.  It  contains  lactucin,  lactucopicrin,  lactucic  acid,  lactucerin, 
and  wax. 

Dose. — 5-60  grains  (0.3-4.0  Gm.). 

Official  Preparations. 

Tinctura  Lactucarii — Tincturae  Lactucarii — Tincture  of  Lactucarium. — 
Dose,  J-2  fluidrachms  (1.0-8.0  Co.). 

SJrupus  Lactucarii — Syrupi  Lactucarii — Syrup  of  Lactucarium. — Dose,  i- 
4  fluidrachms  (4.0-15.0  Co.). 


446  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Synergists. — The  same  as  for  opium. 

Physiological  Action  and  Therapeutics. — Its  action  closely 
resembles  that  of  opium,  save  that  it  is  very  feeble,  in  adults  never 
producing  alarming  symptoms.  It  is  slightly  soporific  and  anodyne, 
and  also  diuretic,  which  properties,  especially  in  the  syrup  form, 
render  it  of  some  value  in  cases  of  irritating  cough,  as  well  as  in 
sleeplessness  and  nervousness  of  children. 

Lactucin  may  be  given  in  doses  of  from  i  to  5  grains  (0.06-0.3 
Gm.)  as  a  mild  sedative  and  hypnotic. 


Cannabis  Indica— Cannabis  Indicae— Indian  Can- 
nabis.    TJ.  S.  I*. 

(Indian  Hemp.) 

Origin. — The  flowering  tops  of  the  female  plant  of  Cannabis 
sativa  L.,  grown  in  the  East  Indies. 

Description  and  Properties. — The  article  of  commerce  con- 
sists of  bundles  of  a  few  flowers,  the  branches  and  bracts,  and 
nearly  ripe  fruit,  the  whole  more  or  less  agglutinated  by  a  resinous 
exudation.  Of  a  brownish-green  color,  peculiar,  narcotic  odor, 
and  slightly  acrid  taste.  The  drug  contains  a  resin,  cannabin,  a 
brown,  amorphous  powder  soluble  in  absolute  alcohol,  and  a  vola- 
tile oil. 

The  crude  drug  is  commonly  called  in  India  "  gunjah."  "  Bhang," 
"  siddhi,"  or  "  hashish,"  the  term  usually  employed — from  whose 
toxic  effects,  frequently  inciting  to  murder,  is  said  to  be  derived  our 
word  "  assassin  " — is  another  form  of  cannabis  appearing  as  the 
Arabian  confection  prepared  by  mixing  aromatics  with  fruits  and 
dried  leaves. 

Dose. — 2-5  "grains  (0.12-0.3  Gm:). 

Official  Preparations. 

Extractum  Cannabis  Indies — ExtrScti  Cannabis  Indicae— Extract  of  In- 
dian Cannabis. — Dose,  J-i  grain  (o.oi5-o'.o6  Gm.). 

Extractum  Cannabis  Indicae  Fliiidum — Extracti  Cannabis  Indicae  Fliiidi — 
Fluid  Extract  of  Indian  Cannabis. — Dose,  3-6  minims  (0.18-0.36  Co.). 

Tinctura  Cannabis  Indicse  (15  per  cent.)— Tincturae  Cannabis  fndicae— 
Tincture  of  Indian  Cannabis. — Dose,  5-20  minims  (0.3-1.2  Cc). 

Unofficial  Preparations.  ' 

Cannabine  Tannate. — Dose,  2-10  grains  (0.13-0.60  Gm.). 
Cannabinone. — Dose,  J-I  grain  (0.03-0.06  Gm.). 


NARCOTICS.  ^^y 

Antagonists  and  Incompatibles. — Strychnine,  caustic  alkalies, 
acids,  and  aqueous  preparations  are  pharmaceutical  incompatibles, 
precipitating  the  resin. 

Ssmergists. — ^Alcoholics,  ether,  bromides,  cocaine,  and  members 
of  the  present  group  enhance  its  cerebral  effects. 

Physiological  Action. — Externally  and  Locally. — Its  only  local  ' 
action  is  that  of  a  feeble  sedative. 

Internally. — Digestive   System. — It  is  slightly  sedative  to  the  \ 
stomach,  in  many  persons  appearing  to  promote  the  appetite  and  / 
aid  digestion.     Its  use  is  not  followed  by  constipation  or  other  i 
gastro-intestinal  disturbance. 

Circulatory  System. — A  slight  acceleration  of  the  pulse  is  notice-  ,1 
able,  probably  due  more  to  the  stimulation  of  the  nervous  system  ■j 
than  to  any  direct  action  upon  the  circulatory  apparatus. 

Nervous  System. — Like  opium,  it  primarily  stimulates  the  brain, 
large  doses  producing  a  peculiar  exhilaration  and  subsequent  reac- 
tion more  fully  described  under  Poisoning.  The  period  of  excita- 
tion is  more  prolonged  than  with  opium,  but  is  eventually  succeeded 
by  sleep — almost  always  disturbed  by  dreams  and  spectral  illusions. 
The  coma  resulting  from  cannabis  is  never  so  profound  as  in  the 
case  of  opium. 

It  is  like  the  latter  drug  as  an  analgesic,  but  feebler  in  its  action. 
It  is  unlike  opium  in  producing  a  sensation  of  tingling  and  numb- 
ness, through  its  effect  upon  the  sensory  nerves,  followed  by 
cutaneous  anesthesia,  accompanied  by  muscular  debility  and  fre- 
quently a  cataleptic  condition. 

Respiratory  System. — No  marked  or  uniform  action  upon  the 
respiration  has  been  observed,  it  being  at  times  quickened  and 
again  retarded,  though  the  effects  are  less  pronounced  than  with 
opium. 

Absorption  and  Elimination. — Cannabis  is  slowly  eliminated, 
though  in  what  manner  is  unknown,  the  effects  of  the  drug  some- 
times persisting  for  twenty-four  or  thirty-six  hours.  Of  all  the 
secretions,  the  urine  alone  is  affected,  the  amount  being  increased. 

Temperature. — Cannabis  has  no  direct  depressing  action  upon 
temperature,  which,  however,  may  rise  during  the  period  of  excita- 
tion and  be  diminished  somewhat  during  sleep. 

Eye. — The  drug  differs  from  opium  in  that  it  dilates  the  pupil 
and  produces  exaggerated  vision. 

Uterus. — It  is  considered  to  be  a  powerful  uterine  stimulant,  and 
like  properties  are  usually  ascribed  to  it  as  an  aphrodisiac,  though 


448  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

its  effect  upon  sexual  desire  is  not  always  manifest.  It  undoubtedly 
increases  the  energy  of  the  uterus,  though  possessing  no  power  to 
inaugurate  uterine  contractions  when  once  suspended. 

Untoward  Action. — The  uncertain  effects  of  different  prepara- 
tions, together  with  varying  susceptibilities  to  the  drug,  render  it 
almost  impossible  to  cite  any  characteristic  untoward  symptoms. 
Certain  of  the  effects  described  under  Poisoning  may  be  present 
even  under  small  doses  in  persons  having  an  idiosyncrasy  against 
the  remedy. 

Poisoning. — Large  doses  of  cannabis  Indica  are  wont  to  produce 
toxic  effects  which  in  their  manifestations  present  a  singular  study 
of  psychological  phenomena,  varying  with  the  temperament  and 
idiosyncrasies  of  the  subject,  yet  in  certain  characteristics  common 
to  all  who  experience  the  full  force  of  the  drug.  The  transition 
from  the  influence  of  medicinal  doses  to  that  exerted  by  poisonous 
absorption  is  often  gradual,  many  features  of  the  conditions  result- 
ing therefrom  being  strikingly  similar. 

Moderate  administration,  however,  is  seldom  attended  by  unto- 
ward effects,  whereas  toxic  doses,  in  place  of  emotional  delight — 
among  the  earlier  sensations — develop  an  intensity  of  mental 
anxiety  which  even  contemplates  death  as  the  inevitable  issue  of 
the  malady.  The  buoyancy  of  spirit,  the  soothing  calm  and 
insouciance,  the.  ecstasy  of  an  ethereal  mood  by  which  finer  natures 
are  swayed, — these  have  given  place  to  a  mental  and  physical 
oppression  best  described  as  "  a  sensation  as  of  the  brain  boiling 
over  and  lifting  the  cranial  arch  like  the  lid  of  a  tea-kettle."  Not 
infrequently  the  blissful  nirvana  induced  by  moderate  doses  is 
rudely  broken  by  an  intemperate  use  of  the  drug,  extreme  vio- 
lence and  even  murderous  thoughts  supplanting  calmer  reveries 
and  the  intellectual  solace  of  passive  emotions.  Especially  is  this 
true  among  Oriental  nations— the  Hindustanis,  for  example- 
addicted  to  excessive  indulgence  in  bhang  or  hashish,  the  form  of 
the  drug  generally  employed,  its  effects  upon  the  grosser  passions 
rivalling  those  of  opium  among  the  Malays. 

Among  the  .most  curious  and  striking  of  the  psychological 
phenomena  attending  immoderate  doses  of  hashish  is  the  abolition 
of  space  and  time.  So  manifold  are  the  images  which  throng  the 
imagination,  and  so  rapid  and  intense  the  impressions  made  upon 
the  mind,  that  the  sense  of  proportion  and  the  normal  relations  of 
material  objects  become  wholly  lost.  Thus,  the  furniture  in  the 
room  may  appear  infinitely  removed  to  the  distorted  vision,  while 


NARCOTICS.  449 

a  few  seconds  of  time  may  be  prolonged  by  the  disordered  fancy 
into  hours,  days,  weeks,  and  even  years.  These  hallucinations, 
strangest  of  all,  are  not  accompanied  by  corresponding  loss  of 
reasoning  power,  the  intellect  taking  cognizance  frequently  of  the 
true  relations  of  external  things,  as  if  aware  of  its  own  abnormal 
condition.  Nor  is  volition  seriously  affected,  the  mental  lesion,  so 
to  speak,  existing  rather  in  lack  of  coordination  between  con- 
sciousness and  the  imaginative  faculty. 

These  spasmodic  or  persistent  hallucinations  are  often  associated 
with  a  haunting  sense  of  dual  existence,  in  which  all  trace  of  per- 
sonal id,entity  is  for  the  time  either  obliterated  or  hopelessly  con- 
fused. During  a  certain  stage  of  poisoning,  moreover,  the  conviction 
of  impending  death  takes  possession  of  the  mind ;  fear  and  des- 
peration seize  upon  the  bewildered  faculties,  intensified  by  an  im- 
pression of  physical  dissolution  ;  and  the  subject  endures  unspeak- 
able anguish,  in  which  gloomy  forebodings  of  disaster  contrast 
terribly  with  the  buoyancy,  the  temporary  joy,  and  peals  of  laughter 
accompanying  the  earlier  effects  of  the  drug. 

Upon  regaining  his  normal  condition  the  hashish-eater  is  either 
wholly  oblivious  of  the  events  which  have  transpired  during  the 
interval  of  intoxication,  or  recalls  vividly  the  scenes  and  incidents 
through  which  he  has  passed.  As  in  the  case  of  opium,  the  pecu- 
liar influence  of  the  drug  is  largely  dependent  upon  temperament, 
sex,  age,  and  idiosyncrasy.  A  refined  and  noble  intellect,  like  De 
Quincey's,  might  readily  be  moved  to  gentler  emotions  and  sensi- 
bilities suffused  with  human  sympathy  and  love.  A  baser,  more 
unfeeling  nature  might  exhibit  latent  symptoms  of  ungovernable 
passion  manifested  in  sensual  or  criminal  conduct  scarcely  con- 
ceivable either  to  himself  or  to  others. 

The  physiological  symptoms  characteristic  of  cannabis-poisoning 
are  well  marked,  the  drug  acting  reflexly  yet  powerfully  upon  the 
mental  state.  Loss  of  consciousness,  followed  by  collapse  or  stupor, 
or  in  some  cases  resulting  in  catalepsy  and  convulsions,  in  all  cases 
complete  anesthesia,  and  in  very  many  a  depression  of  the  pre- 
cordium,  a  sensation  of  arterial  contraction,  and  cardiac  palpitation, 
are  among  the  prominent  features  of  the  malady.  The  sight  and 
hearing  are  perceptibly  rendered  more  acute;  the  pupils  are  dilated,, 
although  contracting  to  light ;  the  reflexes  are  lowered  by  stimu- 
lation of  inhibitory  centers ;  and  an  oppressive  sense  of  paralysis; 
in  the  extremities  induces  horror  and  despair.  The  urinary  se- 
cretions  are   augmented,   although   constipation    seldom    occuirs, 

29 


450  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

and  a  ravenous  appetite  almost  invariably  attends  the  toxic  phe- 
nomena. 

Occasionally  there  is  experienced  great  difficulty  in  breathing, 
as  if  the  lungs  were  on  the  point  of  bursting.  An  increase  of 
sexual  desire  is  common,  although  the  aphrodisiac  properties  of 
the  drug  are '  not  always  present. 

The  after-effects  of  hashish  indulgence  vary  with  the  physiolog- 
ical and  mental  peculiarities  of  the  individual.  As  a  rule,  they  are 
not  disagreeable,  though  it  requires  time  to  eradicate  the  effects  of 
the  poison.  Death  directly  attributable  to  the  drug  has  not  been 
recorded. 

Treatment  of  Poisoning. — Among  antidotes,  lemon-juice,  coffee, 
and  tobacco  have  been  favorably  mentioned.  The  best  treatment 
appears  to  be  similar  to  that  adopted  in  cases  of  chloral-  and 
opium-poisoning. 

Therapeutics.  —  Externally  and  Locally. — Cannabis  is  very 
seldom  used  locally,  although  it  is  an  ingredient  of  a  powder 
recommended  by  W.  H.  Beverly  for  insufflation  in  hay  fever. 

Internally. — Cannabis  has  been  discarded  as  a  remedy  in  many 
disorders  for  which  it  was  formerly  used.  It  is,  however,  still 
employed  to  a  considerable  extent  as  an  hypnotic  in  melancholia  and 
mania  and  for  its  anodyne  and  anesthetic  action  in  neuralgia  and 
pruritus. 

As  a  uterine  tonic  and  anodyne  it  has  been  found  efficient,  either 
alone  or  in  combination  with  other  medicines,  in  subinvolution, 
chronic  metritis,  dysmenorrhea,  menorrhagia,  etc. 

Probably  there  is  no  remedy  superior  to  cannabis  Indica  in 
functional  impotence,  its  action  in  this  disorder  being  aided  by  com- 
bining it  with  ergot  and  nux  vomica. 

It  is  a  valuable  adjuvant  to  cough-mixtures  intended  to  relieve 
tickling  or  irritation  of  the  throat,  as  well  as  to  quiet  the  excessive 
cough  of  bronchitis  or  phthisis,  being  superior  to  opium  in  this 
respect,  since  it  disturbs  the  stomach  less  and  does  not  produce 
constipation. 

It  has  been  used  in  spasm  of  the  bladder,  and  in  go7iorrhea  and 
chordee  it  has  been  found  to  be  a  most  valuable  remedy. 

In  considering  the  therapeutics  of  cannabis  Indica  reference 
should  be  made  to  its  efficacy  in  migraine  and  headaches,  particu- 
larly those  present  at  the  menopause.  Although  as  a  remedy  for 
the  former  disorder  cannabis  has  been  largely  superseded  by  the 
adoption  of  antipyrine  and  agents  of  its  class,  the  old  use  of  tine- 


NARCOTICS.  451 

ture  of  gelsemium,  combined  with  tincture  of  cannabis,  serves  an 
important  purpose  in  aborting  the  distressing  attacks  of  migraine. 

Administration. — The  extract  should  be  given  in  pill  form ;  the 
tincture  and  fluid  extract,  in  an  alcoholic  menstruum.  As  has  been 
already  intimated,  different  samples  vary  greatly  in  strength ;  it  is 
therefore  best  to  begin  with  the  minimum  dose  until  the  force  and 
quality  of  the  preparation  be  ascertained. 

It  is  advisable  to  prescribe  invariably  the  preparations  of  that 
particular  manufacture  which  experience  has  shown  to  produce 
samples  of  uniform  strength. 


The  following  drugs — Belladonna,  Stramonium,  Hyoscyamus, 
Duboisia,  and  Dulcamara — belong  to  the  Solanacese,  and  are  by 
some  authors  classed  as  Mydriatics,  on  account  of  their  character- 
istic action  on  the  pupil.  It  has  been  thought  best  in  the  present 
work  to  include  them  in  the  subdivision  of  Narcotics,  because  of 
their  narcotic  properties,  utilized  clinically  in  the  treatment  of  dis- 
eased conditions. 

Belladonna  is  considered  the  type  of  the  Mydriatic  Narcotics, 
and  claims  the  first  attention.  Two  portions  of  the  plant  are  used 
— ^the  leaves  and  the  root. 

Belladonnae  Folia— Belladonnae  Foliorum— Bella- 
donna Leaves.    ?7.  S.  JP. 

Origin. — ^The  leaves  of  Atropa  Belladonna  L.,  a  nearly  glabrous, 
herbaceous,  perennial  plant,  from  4  to  6  feet  (1.2-1.8  M.)  high, 
bearing  dark-purple,  bell-shaped  flowers  and  shining  purplish- 
black  berries  of  the  size  of  a  cherry.  It  is  found  in  the  woods, 
chiefly  in  the  mountainous  districts,  of  Central  and  Southern  Eu- 
rope, and  as  far  east  as  Asia  Minor,  Caucasia,  and  Central  Asia. 
It  is  cultivated  in  Europe  and  in  the  United  States  to  some  extent, 
being  known  by  the  common  name  of  "  deadly  nightshade." 

Description  and  Properties. — The  leaves  are  from  4  to  6 
inches  (10-15  Cm.)  long  and  about  one-half  as  broad,  broadly 
ovate,  equilaterally  narroWed  into  a  petiole,  tapering  at  the  apex, 
entire  on  the  margin,  smooth,  thin,  the  upper  surface  brownish- 
green,  the  lower  surface  grayish-green,  both  surfaces  whitish  punc- 
tate ;  odor  slight,  taste  bitterish  and  disagreeable. 

Belladonna  leaves  contain  from  0.2  to  0.6  per  cent,  of  atropine, 
the  most  important  alkaloid,  belladonnine  (probably  anhydro-atro- 


452  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

pine),  besides  an  alkaloid  identical  with  hyoscyamine,  duboisine, 
daturine,  atropamine — sometimes  present — and  chrysatropic  acid 
(scopaline). 

Dose. — 1-5  grains  (0.06-0.30  Gm.). 

Official  Preparations. 

Extractum  BelladSnn^  Foliorum  AlcohSlicum — ExtrScti  Bellad6nnse  Fo- 
liorum  AlcohSlici — Alcoholic  Extract  of  Belladonna  Leaves. — Dose,  J-|  grain 
(0.008-0.048  Gm.). 

EmplSstrum  BelladSnnaE  (20  per  cent.) — Empiastrum  (ace.)  BelladSnnae — 
Belladonna  Plaster. — For  external  use. 

Formula:  Alcoholic  Extract  of  Belladonna  Leaves,  200;  Resin  Plaster,  400;  Soap 
Plaster,  400. 

Tinctura  BelladSnnae  Foliorum  (15  percent.) — Tincturae  BelladOnnae  Folio- 
rum — Tincture  of  Belladonna  Leaves. — Dose,  5-20  minims  (0.3-1.2  Cc). 

Ungu6ntum  BelladOnnae  (10  per  cent.) — Ungufinti  Belladonnae — Belladonna 
Ointment. — For  external  use. 

Formula:  Alcoholic  Extract  of  Belladoipa  Leaves,  10;  Diluted  Alcohol,  5;  Ben- 
zoinated  Lard,  85. 

Belladonnae  Radix— Belladonnae  Radicis— Bella- 
donna Root.    TJ.  S.  J*. 

Description  and  Properties. — The  root  of  Atropa  Belladonna 
occurs  in  cylindrical,  somewhat  tapering,  longitudinally  wrinkled 
pieces,  ^  inch  to  i  inch  (12-25  Mm.)  thick;  externally  brownish- 
gray,  internally  whitish ;  fracture  nearly  smooth  and  mealy,  not 
radiating  or  showing  medullary  rays  in  the  thicker  roots,  except  in 
the  layer  near  the  bark ;  nearly  inodorous,  of  sweetish  taste,  after- 
ward bitterish  and  strongly  acrid. 

The  root  contains  the  same  constituents  as  the  leaves,  with -the 
exception  of  chrysatropic  acid — which  is  wanting — and  in  addition 
a  red  coloring  principle,  atrosin,  found  also  in  the  berries. 

Official  Preparations. 

Extractum  Bellad6nnse  RSdicis  Fluidum— Extract!  Belladannae  Radicis 
Fluidi— Fluid  Extract  of  Belladonna  V.ooX.—Dose,  1-3  minims  (0.06-0.18  Cc). 

LinimSntum  BelladSnnae  (95  per  cent.)— LinimSnti  BelladSnnae— Bella- 
donna Liniment. — For  external  use. 

Formula:  Camphor,  50;  Fluid  Extract  of  Belladonna  Root,  950. 

The  important  alkaloid  of  belladonna  is — 

AtropTna—AtropTnae— Atropine.    V.  S.  JP. 

Description  and  Properties. — White  acicular  crystals,  or  a 
more  or  less  amorphous  white  powder,  odorless,  having  a  bitter,. 


NARCOTICS.  453 

acrid  taste,  gradually  assuming  a  yellowish  tint  on  exposure  to  air. 
Soluble  in  130  parts  of  water,  3  parts  of  alcohol,  16  parts  of  ether, 
4  parts  of  chloroform,  and  about  50  parts  of  glycerin. 
^°s®- — 1^0' 4^0  ^rdin  (o.cx)os-o.ooi6  Gm.). 

Atroplnae  Sulphas— Atroplnae  Sulphatis— Atropine 
Sulphate.    JJ,  S.  JP. 

Description  and  Propertiee. — A  white,  indistinctly  crystalline 
powder,  odorless,  having  a  very  bitter,  nauseating  taste,  permanent 
in  air.  Soluble  in  0.4  part  of  water,  6.2  parts  of  alcohol,  3270 
parts  of  ether,  and  694  parts  of  chloroform. 

Dose. — ^2  0'  id  g""^'"  (0.0005-0.0016  Gm.). 

HOMATROPINA HOMATROPIN^ HOMATROPINE. 

An  unofficial  and  derivative  alkaloid,  obtained  by  the  action  of 
dilute  hydrochloric  acid  on  amygdalate  of  tropin.  The  hydrobro- 
mate  of  homatropine  is  used  only  as  a  mydriatic. 

Allied  Plants. 

AtTOpa  MandrSgoTa  L.,  Mandrake,  closely  resembles  Atropa  Belladonna.  It  pos- 
sesses marked  anesthetic  properties,  and  contains  a  mydriatic  alkaloid.  It  is  especially 
interesting  because  of  its  ancient  history,  its  action  having  been  fully  described  by 
Dioscorides  and  Pliny.  Historians  and  poets  have  alike  celebrated  its  peculiar  and 
wonderful  properties. 

SciSpola  CamiSlica  and  Scopola  Japonica  both  resemble  belladonna  physically, 
and  somewhat  In  their  physiological  action,  the  roots  and  leaves  of  these  plants  having 
been  found  mixed  with  those  of  belladonna. 


Antagonists  and  Incompatibles. — Muscarine  antagonizes  the 
action  of  belladonna  in  nearly  every  particular,  and  physostigmine, 
pilocarpus,  and  aconite  counteract  many  of  its  effects.  Opium  an- 
tagonizes its  action  on  the  cerebrum,  pupil,  heart,  respiration,  arterial 
tension,  and  kidneys. 

Atropine  is  incompatible  with  caustic  alkalies,  tannin,  and  vege- 
table infusions  containing  tannin,  an  insoluble  tannate  of  the  alka- 
loid being  formed. 

Ssmergists. — The  mydriatic  drugs  mentioned  above  aid  the 
action  of  belladonna. 

Physiological  Action. — The  action  of  belladonna  is  dependent 
upon  the  amount  of  atropine  it  contains. 

Externally  and  Locally. — When  locally  applied  atropine  is 
anodyne,   antispasmodic,  resolvent,   antisecretory,  and   mydriatic. 


454  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

When  thus  used,  in  combination  with  absorbable  substances — 
such  as  alcohol,  camphor,  animal  fats,  glycerin,  etc. — it  diminishes 
the  sensibility  of  the  sensory  nerves,  and  when  absorbed  from  raw 
surfaces  of  the  skin  or  from  the  subcutaneous  tissue  it  is  capable 
of  producing  systemic  effects. 

Internally. — Digestive  System. — Even  small  doses  produce  dry- 
ness of  the  mouth,  owing  to  the  greatly  diminished  secretion  of 
saliva  and  mucus.  The  salivary  secretion  is  lessened  through 
paralysis  of  the  peripheral  endings  of  the  chorda  tympani  nerve 
in  the  submaxillary  gland. 

The  drug  probably  diminishes  the  secretions  from  the  stomach, 
liver,  pancreas,  and  intestines  in  a  similar  manner.  It  is  reasonable 
to  suppose  that  it  produces  these  effects,  since  it  checks  all  other 
secretions,  with  the  possible  exception  of  the  urine.  The  sweat  is 
diminished  through  paralysis  of  the  peripheral  nerve-endings  in  the 
sudoriparous  glands.  The  secretion  of  milk  is  reduced  by  paral- 
ysis of  the  peripheral  terminations  of  the  secretory  nerves  in  the 
mammary  glands.  The  secretion  from  the  bronchial  mucous  mem- 
branes is  lessened  through  the  depressing  influence  of  the  drug 
upon  the  nerve-endings. 

The  peristaltic  movements  of  the  intestines  are  increased  by 
small  doses,  large  doses  checking  them. 

The  intestines  contain  a  complicated  nervous  mechanism : 

1.  Auerbach's  plexus,  located  between  the  muscular  walls  of 
the  intestine,  and  possessing  the  function  of  maintaining  rhythmical 
vermicular  movements  of  the  intestines. 

2.  Two  sets  of  nerves — the  accelerator  and  inhibitory,  situated 
outside  of  the  intestines,  but  connected  with  Auerbach's  plexus, 
their  function  being  to  coordinate  peristalsis. 

When  a  small  dose  of  belladonna  is  administered  it  paralyzes 
the  peripheral  terminations  of  the  inhibitory  nerves,  so  that,  the 
inhibition  being  interfered  with,  peristalsis  is  increased.  On  the 
other  hand,  a  large  dose  paralyzes  Auerbach's  plexus,  interfering 
with  the  transmission  of  impressions  from  the  accelerator  nerves  to 
the  intestinal  walls,  thereby  diminishing  peristalsis.  The  action  of 
belladonna,  therefore,  upon  the  intestines  may  at  first  sight  appear 
paradoxical,  its  tendency  being  to  remove  constipation  and  to  check 
diarrhea,  although  a  correct  understanding  of  the  matter  will  serve 
as  a  rational  explanation  of  these  apparently  contradictory  effects. 

Circulatory  System. — Medicinal  doses  of  atropine  or  belladonna  - 
at  first  retard  the  pulse,  but  it  is  quickly  accelerated  and  rendered 


NARCOTICS.  455 

firmer,  with  increased  arterial  pressure.  The  primary  transitory 
action  is  4ue  to  a  sHght  stimulation  of  the  vagi  roots,  the  subse- 
quent quickening  of  the  pulse  resulting  from  depression  of  the 
peripheral  ends  of  the  pneumogastric  nerve  distributed  in  the  car- 
diac muscle.  The  inhibition  being  thus  removed,  the  heart  re- 
sponds to  the  influence  of  the  accelerator  nerves.  The  center  for 
these  nerves  in  the  medulla  is  also  stimulated  by  the  drug,  increas- 
ing still  further  the  rapidity  of  the  heart's  action.  The  cardiac 
muscle  itself,  being  stimulated,  renders  the  contractions  of  the 
heart  more  forcible. 

Arterial  tension  is  increased  not  only  by  the  greater  rapidity 
and  force  of  the  heart,  but  also  by  the  contraction  of  the  arterioles 
arising  from  stimulation  of  the  vaso-motor  center.  Very  large  or 
poisonous  doses  lower  arterial  pressure.  This  effect  is  produced 
by  exhaustion  of  the  vaso-motor  center  from  over-stimulation, 
resulting  in  dilatation  of  the  cutaneous  arterioles,  which  lowers 
arterial  tension  and  flushes  the  skin.  Overwhelming  doses  may 
weaken  the  cardiac  muscle  itself  from  over-stimulation,  weakening 
the  heart's  contractions,  as  well  as  paralyzing  the  terminal  nerve- 
filaments  in  the  muscles  of  the  vessel-walls,  and  even  the  muscular 
fibers. 

Nervous  System. — A  full  medicinal  dose  of  belladonna  stimulates 
the  brain,  while  large  doses — and,  in  susceptible  persons,  medicinal 
ones — may  produce  hallucinations  and  delirium,  accompanied  by 
spectral  illusions.  The  delirium  may  be  mild,  joyful,  and  talkative, 
or  it  may  assume  a  violent  type.  It  may,  moreover,  persist  for  a 
long  time,  after  which  the  patient  sinks  to  sleep,  induced  either  by 
exhaustion  from  the  delirium  or  a  secondary  depressing  action  of 
the  drug.  True  coma,  like  that  produced  by  opium,  rarely  if  ever 
occurs. 

The  spinal  cord  shares  in  the  stimulation  caused  by  belladonna. 
The  reflexes  are  at  first  slightly  exaggerated,  being  afterward 
diminished.  Very  often  under  poisonous  doses  there  is  complete 
motor  paralysis,  the  loss  of  power  occurring  first  in  the  lower 
extremities. 

The  sensory  nerves  are  depressed,  especially  when  the  drug  is 
locally  applied,  the  influence  being  exerted  on  their  terminal  fila- 
ments. For  this  reason  belladonna  is  of  little  service  as  an  ano- 
dyne when  given  internally. 

Respiratory  System. — Medicinal  doses  quicken  and  deepen  the 
respirations,  owing  to  stimulation  of  the  respiratory  center.     The 


I   i 


456  A    TEXT- BOOK  OF  MATERIA  MEDIC  A. 

peripheral  nerve-filaments  of  the  pulmonary  vagi  are,  however, 
depressed ;  which,  were  it  not  for  the  increased  action  of  the  center, 
would  retard  respiration. 

Poisonous  doses  over-stimulate,  and  consequently  exhaust  or 
paralyze,  the  respiratory  center,  the  result  being  slow  and  shallow 
breathing  or  perhaps  death  from  asphyxia. 

Absorption  and  Elimination. — Atropine  is  rapidly  absorbed  and 
eliminated,  chiefly  by  the  kidneys,  but  also  to  some  extent  by  the 
bowels.     It  is  said  that  part  of  the  drug  is  destroyed  by  the  liver. 

Te^nperature . — Large  doses  increase  bodily  heat,  probably  by 
increasing  the  circulation  and  respiration,  consequently  augmenting 
combustion.  Some  authors  maintain  that  belladonna  stimulates 
the  heat-center.  In  cases  of  severe  poisoning  from  the  drug  the 
temperature  rapidly  falls. 

Eye. — Belladonna  dilates  the  pupil,  whether  locally  applied  or 
taken  internally,  its  effect  differing  from  that  of  cannabis  Indica  in 
that  the  pupil  cannot  be  made  to  contract  by  stimulation  of  the 
third  nerve,  although  excitement  of  the  muscle  itself  causes  pupil- 
lary contraction.  The  manner  in  which  atropine  dilates  the  pupil 
is  not  yet  satisfactorily  explained,  the  prevailing  opinion  being  in 
favor  of  Jessup's  theory  that  the  action  is  due  to  a  stimulation  of 
the  ends  of  the  sympathetic  nerve-filaments  distributed  to  the  iris, 
and  paralysis  of  the  peripheral  ends  of  the  oculo-motor  nerves. 

Atropine  increases  intraocular  tension,  rendering  it  a  dangerous 
drug  in  glaucomatous  conditions. 

Untoward  Action. — Very  frequently  there  appears,  especially  in 
children,  an  erythematous  or  scarlatinal  eruption,  oftener  noticeable 
on  the  face  and  neck,  but  sometimes  affecting  the  entire  surface  of 
the  body.  Redness  and  pain  in  the  throat  may  also  be  present,  but 
no  fever,  with  itching  of  the  skin  or  desquamation. 

Occasionally  instillation  of  atropine  into  the  eye  produces  pro- 
fuse lacrymation,  edema  of  the  eyelids,  and  blepharo-conjunctival 
irritation. 

When  taken  internally  in  medicinal  doses  it  sometimes  occasions 
in  certain  persons  vertigo,  turgescence  of  the  face,  hallucinations, 
erethistic  debility,  and  impaired  assimilation. 

Homatropine  has  caused  dizziness,  uncertainty  of  gait,  fatigue', 
difficulty  in  deglut4^ion,  and  loquacious  delirium. 

Poisoning. — The  poisonous  actions  of  belladonna  may  be  sum- 
marized as  follows : 

The  skin  is  dry  and  hot;  the  conjunctivae  are  congested,  with. 


NARCOTICS.  457 

possibly,  edema  of  "the  eyelids  and  pupils  widely  dilated;  the  face 
is  swollen,  while  the  whole  body  may  be  covered  with  an  erythem- 
atous rash,  and  there  is  a  sensation  of  heat  and  pain  in  the  throat 
and  difficulty  in  swallowing. 

Rapid  respirations,  muscular  weakness,  and  incoordination  of 
movements  appear ;  the  patient  becomes  dizzy  or  mildly  or  violently 
delirious,  continually  talking,  shouting,  or  laughing.  While  there 
is  a  constant  desire  to  micturate,  there  is  an  inability  to  pass 
any  urine.  At  this  stage  the  respirations  are  slow  and  shallow. 
Finally,  convulsions  may  occur,  and  the  patient  sink  into  a  coma- 
tose condition  and  die  from  asphyxia  and  cardiac  exhaustion. 

Treatment  of  Poisoning. — Wash  out  the  stomach  with  solutions 
of  tannic  acid,  pursuing  the  treatment  with  the  cautious  adminis- 
tration of  physostigmine,  opium,  or  the  hypodermic  injection  of 
pilocarpine.  Should  cardiac  failure  be  pronounced  or  the  patient 
lapse  into  a  state  of  stupor,  stimulants  and  the  subcutaneous  injec- 
tion of  caffeine  are  indicated,  the  patient  being  aroused  meanwhile 
and  kept  awake  if  possible,  respiration  being  maintained  by  the  use 
of  strychnine  and  by  artificial  means  when  necessary.  Should  the 
temperature  fall  below  normal,  external  heat  must  be  applied. 

Atropine  compared  with  Morphine. 

Atropine  stimulates  respiration ;  morphine  is  a  powerful  respi- 
ratorj"-  depressant.  Atropine  dilates  the  pupil ;  morphine  contracts 
it.  Atropine  increases  bodily  heat,  and  frequently  reddens  the 
surface  of  the  skin ;  morphine  produces  pallor  of  the  skin  and 
lowers  temperature. 

Atropine  augments  peristaltic  movements  of  the  bowels ;  mor- 
phine checks  them.  Atropine  reinforces  the  functional  activity  of 
the  kidneys ;  morphine  lessens  it.  On  the  other  hand,  atropine 
checks  the  secretion  from  the  skin,  while  morphine  increases  it. 

The  remaining  secretions  are  diminished  by  both  drugs,  but  in 
different  ways.  Atropine,  for  instance,  checks  secretion  by  depress- 
ing the  peripheral  terminations  of  the  secretory  nerves ;  morphine, 
by  depressing  the  secretory  center  in  the  medulla. 

Both  drugs  depress  the  sensory  mechanism,  yet  again  by  differ- 
ent actions,  atropine  depressing  the  function  of  the  sensory  nerve- 
terminations,  and  morphine  depressing  the  center  mainly,  although 
to  some  extent  influencing  the  entire  sensory  tract. 

Atropine  acts  rather  as  a  cerebral  excitant,  producing  delirium, 
hallucinations,  and  disturbed  sleep ;  morphine  is  more  of  a  cerebral 


458  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

depressant,  the  period  of  mental  excitation  being  comparatively- 
brief,  while  sleep  is  longer  and  more  profound. 

In  medicinal  doses  atropine  contracts  the  arterioles ;  morphine 
dilates  them.  Again,  while  morphine,  like  atropine,  causes  the 
heart  to  beat  faster  and  stronger,  it  is  by  no  means  so  powerful  a 
cardiac  stimulant  as  atropine. 

In  many  respects  these  drugs  are  mutually  synergistic.  Both 
relieve  pain,  though  morphine  is  much  the  more  powerful  anodyne. 
Both  cause  incoordination  of  muscular  movements  and  mental 
confusion. 

Although  in  many  respects  antagonistic,  they  are  frequently- 
combined  when  an  anodyne  action  is  desired.  As  has  been  forcibly 
suggested,  their  reciprocal  influence,  when  administered  together, 
modifies  in  a  remarkable  manner  their  physiological  effects. 

Therapeutics. — The  many  uses  for  which  belladonna  has 
been  employed  would  render  it  a  difficult,  perhaps  useless,  task 
to  enumerate  them.  As  in  the  case  of  opium,  there  are  cer- 
tain general  and  important  actions  in  disease  which  the  physician 
can  utilize  in  daily  practice,  a  succinct  mention  of  which  is  ap- 
pended : 

1.  Belladonna  is  serviceable  in  relaxing  spasms  of  invol- 
untary MUSCLES,  as  in  asthma,  spasmodic  colic,  lead  colic,  spasmodic 
dysmenorrhea,  laryngismus  stridulus,  etc. 

2.  In  DIMINISHING  SECRETION,  as  in  acute  coryza,  bronchitis,  night- 
sweats  of  phthisis,  and  to  check  the  secretion  of  milk,  mercurial 
ptyalism,  etc. 

3.  In  RELIEVING  PAIN,  either  combined  with  opium  or  morphine, 
or  alone,  particularly  where  it  can  be  applied  locally,  as  in  lumbago, 
neuralgia,  pleurodynia,  etc. 

4.  Belladonna  is  used  to  stimulate  the  circulatory  system 
in  cases  of  a  weak  heart  and  low  arterial  tension,  as  in  fevers,  etc. 

5.  For  its  peculiar  action  upon  the  eye  in  ophthalmo- 
LOGicAL  practice,  to  dilate  the  pupil,  prevent  adhesion,  remove 
congestion,  relieve  pain,  and  afford  rest. 

While,  as  has  been  said,  it  is  impossible  to  mention  in  detail  the 
manifold  uses  of  belladonna,  its  more  important  therapeutic  services 
may  be  here  mentioned  : 

Externally  and  Locally. — Belladonna  ointment  is  useful  in  the 
treatment  of  boils,  carbuncles,  chronic  inflammatory  conditions  about 
the  articulcflions,  chronic  synovitis  of  the  kneefoint,  its  efficiency  in 
the  latter  condition  being  enhanced  by  combining  it  with  mercurial 


NARCOTICS.  459 

ointment.  Orchitis  is  greatly  relieved  by  covering  the  testicle  with 
belladonna  ointment.  Suppositories  containing  extract  of  bella- 
donna are  beneficial  in  the  treatment  of  hemorrhoids  and  in  anal 
fissure.  A  rigid  os  may  be  made  to  dilate,  hastening  delivery,  by 
smearing  the  cervix  with  the  ointment  of  this  drug. 

Eczema  and  excessive  sweating  of  certain  areas  of  the  skin,  such 
as  the  palms  and  soles,  are  benefited  by  a  local  application  of  the 
tincture  or  the  dried  and  powdered  extract  mixed  with  some  inert 
desiccant  powder  like  powdered  talcum. 

Belladonna  plaster  is  one  of  the  most  useful  applications  in  cases 
of  acute  or  chronic  muscular  rheumatism,  and  in  certain  forms  of 
neuralgia.  In  its  power  to  arrest  the  secretion  of  milk  the  drug 
is  perhaps  without  an  equal.  Should  inflammation  have  already 
set  in  and  the  breasts  be  swollen  and  painful,  the  ointment  is  to  be 
applied  and  the  breasts  covered  with  hot  flaxseed  poultices,  the 
parts  being  entirely  supported  by  wide  bandages. 

Internally. — Belladonna  is  combined  with  opium  to  relieve  the 
pain  of  gastralgia  and  enteralgia,  while  its  combination  with  strych- 
nine and  iron  is  useful  in  anemic  neuralgia. 

Next  to  bromoform,  it  is  the  most  efficient  remedy  in  whooping 
cough;  the  spasmodic  manifestations  of  hysteria  are  also  favorably 
affected  by  full  doses  of  tincture  of  belladonna. 

Nocturnal  incontinence  of  urine  in  children,  when  resulting  from 
supersensitiveness  of  the  mucous  membrane  of  the  bladder,  derives 
signal  benefit  from  this  drug.  By  depressing  the  ends  of  the  sen- 
sory nerves  distributed  to  the  bladder  belladonna  prevents  the  irri- 
tation of  the  accumulated  urine  from  being  conveyed  to  the  center 
in  the  cord,  and  from  there  reflexly  exciting  the  detrusor  muscle 
of  the  sphincter  and  causing  micturition. 

Belladonna  combined  with  strychnine  stimulates  the  respiration 
and  checks  the  sweating  in  phthisis.  A  similar  union  with  some 
laxative  drug  makes  an  exceedingly  useful  pill  in  habitual  constipa- 
tion, while  the  obstinate  constipation  due  to  lead-poisoning  \?,  greatly 
relieved  by  belladonna. 

This  drug,  as  well  as  the  other  mydriatic  narcotics,  is  one  of  the 
most  reliable  remedies  we  possess  to  relieve  the  symptoms  of  spas- 
modic asthma.  It  is  highly  recommended  also  by  many  physicians 
in  typhoid  fever  to  support  the  circulation  and  relieve  many  dis- 
tressing symptoms  of  the  disease.  In  scarlatina,  too,  it  is  thought 
to  be  a  useful  remedy. 

Cardiac  pain  and  distress  due  to  over-action  of  the  heart  are 


460  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

alleviated  by  the  application  of  belladonna  plaster  over  the  cardiac 
region  or  by  the  internal  use  of  the  drug. 

Intestinal,  hepatic,  and  renal  colic,  cystitis,  prostatitis,  spermator- 
rhea, exophthalmic  goiter,  cerebral  and  spinal  hyperemia,  sea-sickness, 
facial  erysipelas,  and  menorrhagia  have  all  apparently  been  favor- 
ably influenced  by  belladonna. 

Atropine  subcutaneously  injected  is  a  powerful  antidote  to  clilo- 
roform-,  physostigma-,  aconite-,  and  jaborandi-poiso7ting,  as  well  as 
that  contracted  from  toadstools. 

Administration. — The  crude  drug,  leaves,  and  root  are  seldom 
if  ever  used.  Owing  to  its  action  in  diminishing  secretion,  it  is 
better  to  time  the  internal  administration  of  belladonna  so  as  to 
interfere  as  little  as  possible  with  the  process  of  digestion. 

Children  are  peculiarly  insusceptible  to  this  drug,  tolerating 
even  larger  doses  than  adults. 

When  atropine  is  used  hypodermically  in  cases  of  sciatica  or 
neuralgia,  the  injection  should  be  made  deeply  in 'close  proximity 
to  the  affected  nerve-trunk. 

The  part  of  the  body  to  which  a  belladonna  plaster  is  to  be 
applied  should  be  first  thoroughly  cleansed  and  dried,  the  exact 
area  to  be  covered  being  specifically  designated  by  the  physician. 
Caution  should  be  exercised  in  the  application,  lest  too  large  a 
space  be  covered  by  the  plaster  and  dangerous  symptoms  super- 
vene from  absorption  of  its  more  active  constituents,  a  result  which 
may  also  occur  from  too  prolonged  contact,  from  three  to  five  days 
being  usually  sufficient.  Should  it  be  desirable  to  continue  the 
influence  of  the  drug,  the  application  of  fresh  plaster  from  time  to 
time  will  produce  better  results  than  too  long  use  of  a  single  one. 

Stramonii  Folia— Stramonii  Foliorum— Stramonium 
Leaves.     TJ.  S.  I*. 

(Thorn-apple;  Jamestown  or  Jimson  Weed.) 
Origin. — The  leaves  of  Datwa  Stramonium  L.,  a  coarse-look- 
ing annual  weed,  believed  to  be  a  native  of  Asia,  but  found  grow- 
ing in  waste  places  and  along  roadsides  throughout  the  greater 
part  of  the  world. 

Description  and  Properties.— From  3  to  8  inches  (7-20  Cm.) 
long,  petiolate,  dark-green,  smooth,  ovate,  pointed,  unequal,  espe- 
cially at  the  base,  coarsely  and  sinuately  toothed  ;  thin,  brittle  and 
nearly  inodorous ;  taste  unpleasant,  bitter  and  nauseous.     Stramo- 


NARCOTICS.  461 

nium  leaves  contain  about  0.2  per  cent,  of  a  mixture  of  atropine 
and  hyoscamine  known  as  daturine. 
Dose. — 1-5  grains  (0.06-0.3  Gm.). 

Stramonii  Semen— Stramonii  Seminis— Stramo- 
nium Seed.     U.  S.  JP. 

Origin. — The  seed  oi  Datura  Stramonium  L. 

Description  and  Properties. — About  \  inch  (4  Mm.)  long, 
reniform,  flattened,  pitted  and  wrinkled,  testa  dull  brownish-black, 
hard,  enclosing  a  cyhndrical,  curved  embryo  imbedded  in  a  whitish, 
oily  perisperm ;  of  an  unpleasant  odor  when  bruised,  and  of  an 
oily  and  bitter  taste. 

The  seeds  contain  a  larger  proportion  of  daturine  than  the 
leaves,  besides  scopalimine,  resin,  fixed  oil,  etc.    . 

Dose. — 1-3  grains  (0.06-0.2  Gm.). 

Official  Preparations. 

ExtrSctum  Stramonii  S£tninis — ExtrScti  Stramonii  S&minis^ — Extract  of 
Stramonium  Seed. — Dose,  J-J  grain  (0.02-0.03  Gm.). 

ExtrSctum  Stramonii  S6minis  Fliiidum — ExtrScti  Stramonii  Sfeminis 
Fluidi — Fluid  Extract  of  Stramonium  Seed. — Dose,  1-3  minims  (0.06-0.2  Cc). 

Tinctiira  Stramonii  S6minis — Tinctjirse  Stramdnii  SSminis — Tincture  of 
Stramonium  Seed  (:5  per  cent.). — Dose,  5-10  minims  (0.3-0.6  Cc). 

UnguSntum  Stramonii — Ungu6nti  Stramonii — Stramonium  Ointment  (10 
per  cent,  of  extract). — For  external  use. 

Antagonists  and  Incompatibles  and  Synergists  are  the  same 
as  for  belladonna. 

Physiological  Action. — The  action  of  stramonium  is  almost 
identical  with  that  of  belladonna,  the  main  difference  being  the 
influence  of  stramonium  upon  the  sympathetic  system,  the  motor 
and  sensory  nerves  being  less  powerfully  affected  than  by  bella- 
donna. Stramonium  is  more  apt  to  occasion  irregular  action  of 
the  heart,  and  the  involuntary  muscle-fibers  of  the  bronchial  tubes 
are  relaxed  more  by  stramonium  than  by  belladonna.  It  usually 
occasions  more  delirium  and  is  more  of  an  aphrodisiac  than  bella- 
donna. 

Poisoning  and  Treatment  of  Poisoning  are  precisely  the  same  as 
described  under  Belladonna. 

Therapeutics. — The  medical  uses  of  belladonna  are  applicable 
to  this  drug,  although  stramonium  is  much  the  better  remedy  in 
spasmodic    asthma.     The    stramonium    ointment   appears    to    be 


462  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

superior  to  that  prepared  from  belladonna  as  an  application  to 
painful  hemorrhoids. 

Administration. — No  special  directions  are  necessary,  any  of 
the  preparations  being  serviceable.  For  asthma  the  leaves  may  be 
smoked  in  a  pipe  or  in  the  form  of  cigarettes,  this  method  of  em- 
ploying the  drug  to  relieve  bronchial  spasm  being  probably  superior 
to  internal  administration. 

Hyoscyamus— Hyoscyami— Hyoscyamus.    TJ.  S.  P. 

(Henbane.) 

Origin. — The  leaves  and  flowering  tops  of  Hyoscyamus  niger  L., 
collected  from  plants  of  the  second  year's  growth.  Henbane  is  a 
biennial  growing  in  sandy  soil  and  waste  places  throughout  the 
greater  portion  of  Europe  and  Asia,  and  naturalized  in  North 
America. 

Description  and  Properties. — Leaves  ovate  or  obovate-oblong, 
up  to  10  inches  (25  Cm.)  long  and  4  inches  (10  Cm.)  broad;  sinu- 
ate-toothed, the  teeth  large,  oblong,  or  triangular ;  grayish-green, 
and,  particularly  on  the  lower  surface,  glandular-hairy;  midrib 
prominent ;  flowers  nearly  sessile,  with  an  urn-shaped,  five-toothed 
calyx  and  a  light-yellow,  purple-veined  corolla ;  odor  heavy,  nar- 
cotic ;  taste  bitter  and  somewhat  acrid. 

The  active  constituents  are  hyoscyamine  and  hyoscine,  and  a  very 
poisonous  volatile  oil  is  obtained  by  distillation  of  the  leaves,  which 
contain  also  a  small  percentage  of  potassium  nitrate. 

Dose  of  the  Leaves. — 5-15  grains  (0.3-1.0  Gm.). 

Official  Preparations. 

Extractum  Hyoscyami — ExtrScti  Hyoscyami — Extract  of  Hyoscyamus. — 

Dose,  1-3  grains  {0.06-0.2  Gm.). 

Extractum  Hyoscyami  FlQidum — Extract!  Hyoscyami  Fluidi — Fluid  Ex- 
tract of  Hyoscyamus. — Dose,  5-15  minims  (0.3-1.0  Co.). 

Tinctiira   Hyoscyami — Tincturae    Hyoscyami — Tincture   of  Hyoscyamus 

(15  per  cent.). — Dose,  10-60  minims  (0.6-4.0  Cc). 

Hyoscinae  Hydrobromas— HyoscTnae  Hydrobro- 
matis— Hyoscine  Hydrobromate.     JJ.  S.  -P. 

Origin. — The  hydrobromate  of  an  alkaloid  obtained  from  Hy- 
oscyamus. 

Description  and  Properties. — Colorless,  transparent,  rhombic 
crystals,  odorless,  and  having  an  acrid,  slightly  bitter  taste ;  perma- 


NARCOTICS.  463 

nent  in  the  air.     Soluble  in  i  .9  parts  of  water  and  in   1 3  parts  of 
alcohol.     It  should  be  kept  in  small,  well-stoppered  vials. 
Dose. — r^^p-^  grain  (0.0006-0.001  Gm.). 

Hyoscyamlnae  Hydrobromas— Hyoscyamlnae  Hy- 
drobromatis  —  Hyoscyamine  Hydrobromate. 
V.  8.  P. 

Origin. — The  hydrobromate  of  an  alkaloid  obtained  from  Hy- 
oscyamus. 

Description  and  Properties. — A  yellowish-white,  amorphous, 
resin-like  mass  or  prismatic  crystals,  having,  particularly  when 
damp,  a  tobacco-like  odor  and  an  acrid,  nauseous,  and  bitter  taste. 
Deliquescent  on  exposure  to  the  air ;  soluble  in  about  0.3  part  of 
water  and  2  parts  of  alcohol.  It  should  be  kept  in  small,  well- 
stoppered  vials.  ' 

Dose. — r^^y— rir  grain  (0.0006-0.0015  Gm.). 

Hyoscyami  Sulphas— Hyoscyami  Sulphatis— Hyos- 
cyamine Sulphate.    ?7.  S.  F. 

Origin. — The  neutral  sulphate  of  an  alkaloid  obtained  from 
Hyoscyamus. 

Description  and  Properties. — White,  indistinct  crystals  or  a 
"white  powder,  without  odor,  and  of  a  bitter,  acrid  taste ;  deliques- 
cent in  damp  air.  Soluble  in  0.5  part  of  water  and  2.5  parts  of 
alcohol.     It  should  be  kept  in  small,  well-stoppered  bottles. 

Dose. — i^a-ib  grain  (0.0006-0.0015  Gm.). 


Antagonists,  Incompatibles,  and  Synergists  the  same  as  for 
belladonna. 

Physiological  Action. — The  action  of  hyoscyamus  is  analo- 
gous to  that  of  belladonna,  with  the  following  differences : 

1.  Hyoscyamus  increases  the  peristaltic  action  of  the  intestines 
more  than  belladonna,  while  at  the  same  time  it  is  more  efficient  in 
relieving  the  griping  and  pain  occasioned  by  the  rougher  cathartics. 

2.  It  is  less  powerful  than  belladonna  as  a  cardiac  stimulant, 
though  stronger  than  stramonium. 

3.  It  does  not  occasion  nearly  so  much  mental  excitement  as 
belladonna,  on  account  of  the  hyoscine  it  contains,  which  is  a 
powerful  hypnotic  and  cerebral  and  spinal  sedative. 


464  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

4.  As  a  urinary  sedative  hyoscyamus  is  greatly  superior  to 
belladonna. 

5.  It  differs  from  belladonna  in  affecting  the  respiration  less 
powerfully. 

Untoward  Action,  Poisoning,  and  Treatment  of  Poisoning  are  the 
same  as  for  belladonna. 

Therapeutics. — Hyoscyamus  may  be  used  for  the  same  pur- 
poses as  belladonna,  but  is  considered  superior  to  the  latter  drug 
as  a  urinary  sedative  in  the  treatment  of  incontinence  of  urine^ 
vesical  tenesmus,  cystitis,  prostatitis,  etc. 

For  the  relief  of  colic  of  various  forms,  and  to  allay  the  griping 
produced  by  certain  purgatives,  hyoscyamus  is  better  than  bella- 
donna. 

In  mental  and  convulsive  diseases,  such  as  delusional  insanity,, 
delirium  tremens,  acute  and  febrile  mania,  insomnia,  chronic  dementia^ 
hysterical  convulsions,  chorea,  paralysis  agitans,  etc.,  hyoscyamus,. 
particularly  hyoscine,  is  superior  to  belladonna. 

Hyoscyamus  and  its  alkaloids  are  fully  equah  to  belladonna  in 
the  treatment  of  asthma,  whooping  cough,  neuralgia,  enteralgia,  etc. 

As  an  anodyne  and  hypnotic  for  children  hyoscyamus  is  safer 
than,  and  frequently  as  efficient  as,  opium. 

Contraindications.— The  same  as  for  belladonna. 

Administration. — Like  belladonna,  this  drug  should  be  admin- 
istered tentatively.  Any  of  the  preparations  may  be  given.  The 
salts  of  the  alkaloids  may  be  administered  either  subcutaneously 
or  internally. 

The  hyoscine  is  tasteless,  and  may  be  easily  given  in  various, 
drinks.  When  used  internally  its  action  is  slower,  but  more  pro- 
longed, than  when  given  hypodermically,  though  the  dose  under 
the  former  method  should  be  twice  that  of  the  latter. 


GROUP  VI.— MOTOR   EXCITANTS. 

The  drugs  belonging  to  this  group  excite  the  functional  activity 
of  the  spinal  cord  and  the  sympathetic  nervous  system.  They 
serve  to  stimulate  muscular  contraction  and  the  functional  opera- 
tions of  the  heart,  lungs,  and  secretory  apparatus. 

It  is  difficult  to  separate  by  sharply-defined  limits  the  remedies 
having  these  actions,  and  group  them  according  to  their  analogous 
therapeutic  uses. 


MOTOR  EXCITANTS.  465 

In  the  present  group,  for  instance,  are  placed  ergot  and  gossyp- 
ium,  chiefly  used  for  their  action  upon  the  uterus,  while  those 
drugs  which,  although  excito-motors,  are  employed  principally  for 
their  action  upon  the  circulatory  system  are  placed  in  the  group. 
Cardiac  Stimulants. 

The  motor  excitants  are  exceedingly  valuable  remedies,  the 
typical  member  of  the  group  being  Nux  Vomica,  and  therefore 
first  considered. 

Nux  Vomica— Nucis  Vomicae— Nux  Vomica. 
JJ.  8.  P. 

Origin. — The  seeds  of  Strychnos  Nux  Vomica  L.,  a  small  tree 
common  in  many  parts  of  Hindustan,  Farther  India,  some  of  the 
East  Indies,  and  in  some  parts  of  Australia. 

Description  and  Properties. — Nux  vomica  is  about  i  inch 
(25  Mm.)  in  diameter,  orbicular,  grayish  or  greenish-gray;  soft- 
hairy,  of  a  silky  luster,  with  a  slight  ridge  extending  from  the 
center  of  one  side  to  the  edge ;  internally  horny,  somewhat  trans- 
lucent, very  tough,  with  a  large  circular  cavity,  into  which  the 
heart-shaped,  nerved  cotyledons  project.  It  is  inodorous  and  per- 
sistently bitter. 

Nux  vomica  contains  two  important  alkaloids — strychnine  and 
brucine,  the  former  being  in  excess.  The  seeds  also  contain  iga- 
suric  acid,  with  which  these  alkaloids  are  combined.  Of  total 
alkaloids  the  drug  should  contain  from  2.5   to   5  per  cent. 

Dose. — 1-5  grains  (0.06-0.3  Gm.). 

Official  Preparations. 

ExtrSctum  Nucis  Vttmicse — ExtrScti  Nucis  VSmicae — Extract  of  Nux 
Vomica. — Dose,  |-J  grain  (0.008-0.03  Gm.). 

ExtrSctum  Nucis  VOmicae  Fliiidum — ExtrScti  Nucis  VSmicae  Fliiidi — 
Fluid  Extract  of  Nux  Vomica. — Dose,  1-5  minims  (0.06-0.3  Cc). 

Tinctiira  Nucis  V&micavTincturse  Niicis  Vttmicae — Tincture  of  Nux 
Vomica. — Dose,  5-20  minims  (0.3-1.2  Cc). 

Strychnina—StrycFinlnse— Strychnine.    V.  8.  P. 

Origin. — An  alkaloid  obtained  from  Nux  Vomica,  and  also 
derived  from  other  plants  of  the  natural  order  Loganiacece. 

Description  and  Properties. — Colorless,  transparent,  octahedral 
or  prismatic  crystals,  or  a  white,  crystalline  powder,  odorless  and 
having  an  intensely  bitter  taste,  perceptible  even  in  highly  dilute 
(i  to  700,000)  solution.     Permanent  in  the  air.     Soluble  at  15°  C. 

30 


466  A    TEXT-BOOK  OF  MA  TERIA   MEDIC  A. 

(59°  F.)  in  67(X)  parts  of  water,  in  no  parts  of  alcohol,  in  2500 
parts  of  boiling  water,  and  in  12  parts  of  boiling  alcohol;  also 
soluble  in  7  parts  of  chloroform,  but  almost  insoluble  in  ether. 

Dose. — ^Vt^  grain  (0.001-0.004  Gm.). 

Strychnine  enters  into  the  following  preparations : 

FSrri  et  Strychninae  CJtras. 

Syrupus  F6rri,  Quinlnae  et  Strychninae  Phosphatum.  (See  Ferrum,  page 
185.) 

Strychninae   Sulphas— Strychninae   Sulphatis— 
Strychnine  Sulphate.    V.  8.  P. 

Description  and  Properties. — Colorless  or  white,  prismatic 
crystals,  odorless,  and  having  an  intensely  bitter  taste,  perceptible 
even  in  highly  dilute  (i  in  700,000)  solution.  Efflorescent  in  dry 
air.  Soluble  at  15"  C.  (59°  F.)  in  50  parts  of  water  and  in  109 
parts  of  alcohol ;  also  soluble  in  2  parts  of  boiling  water  and  8.5 
parts  of  boiling  alcohol.     Almost  insoluble  in  ether. 

Dose. — ii--i6  grain  (0.001-0.OO4  Gm.). 

Antagonists  and  Incompatibles. — Chloral,  tobacco,  potassium 
bromide,  chloroform,  and  ether  antagonize  the  toxic  action  of 
strychnine,  the  first-named  drug  being  the  best  antagonist.  Phy- 
sostigma,  curare,  conium,  opium,  hydrastine,  and  oil  of  chamomile 
are  also  antagonistic. 

The  incompatibles  are  tannic  acid,  bromides,  iodides,  and  chlo- 
rides. 

Synergists. — The  motor  excitants,  ergot,  ustilago,  electricity, 
and  cold. 

Physiological  Action. — Since  strychnine  fully  represents  the 
physiological  action  of  nux  vomica,  that  of  the  former  is  here  given. 

Externally  and  Z(?<r«//j/.— Strychnine  is  a  very  powerful  anti- 
septic, yet  on  account  of  its  poisonous  nature  it  is  too  dangerous 
to  be  serviceable.  Locally,  it  possesses  the  power  of  arresting  the 
movements  of  protoplasmic  life,  and  from  mucous  membranes  it  is 
readily  absorbed. 

Internally. — Digestive  System. — Strychnine  is  an  excellent  sto- 
machic tonic,  improving  the  appetite  greatly  and  aiding  digestion. 
By  its  favorable  action  upon  the  gastric  mucous  membrane  it  facili- 
tates the  secretion  of  gastric  juice,  and  by  imparting  tone  to  the 
muscular  walls  of  the  intestines  it  increases  peristalsis  and  allays 
constipation. 

Probably  the  favorable  action  which  strychnine  exerts  on  the 


MOTOR  EXCITANTS. 


467 


E 


Stomach  is  due  to  its  stimulation  of  the  nerve-centers  which  preside 
over  the  vascularity  and  the  secretory  cells,  thus  rendering  the 
digestive  process  more  perfect. 

Circulatory  System.— ^\xyc\mm.&  stimulates  the  heart  by  its 
action  on  the  cardiac  muscle  and  motor  ganglia.  The  pulse  at 
first  is  decreased  in  frequency,  due  to  stimulation  of  the  cardio- 
inhibitory  apparatus.  Soon,  however,  the  pulse  is  increased,  though 
under  paralytic  doses  it  is  lowered,  because  of  a  depression  of  the 
excito-motor  gangUon  in  the  heart. 

Medicinal  doses  increase  arterial  pressure  by  stimulation  of  the 
vasomotor  centers  in  the  medulla 
oblongata.    Poisonous  doses,  how- 
ever, lower  arterial  tension. 

It  is  to  be  observed  that,  al- 
though when  mixed  with  blood 
strychnine  exhibits  an  oxidizing 
power,  there  is  no  evidence  that 
the  process  occurs  in  the  living 
organism. 

Nervous  System. — Strychnine 
enormously  increases  the  excita- 
bility of  the  motor  nerve-cells  in 
the  spinal  cord.  That  its  action 
is  not  cerebral  is  proved  by  con- 
clusive experiments.  Moreover, 
in  cases  of  poisoning  the  brain 
retains  "its  activity  to  the  last,  the 
cerebral  functions  remaining  un- 
impaired. Violent  tetanic  spasms, 
on  the  contrary,  indicate  its  pow- 
erful action  upon  the  spinal  cord, 
especially  its  reflex  mechanism. 

Very  large  doses  paralyze  the 
motor  apparatus,  involving  dimi- 
nution or  loss  of  voluntary  rnove- 
ments.  The  large  multipolar  gan- 
glia, in  the  anterior  column  of  the 
cord  are  affected  by  selective  action  of  the  drug,  paralysis  from 
over-stimulation  following  the  first  excitatory  effects. 

Notwithstanding  authoritative  proof  of  the  action  of  strychnine 
upon  the  spinal  cord,  it  has  been  maintained  by  Falck  that  the 


Fig.  s. — Diagram  showing  how  strychnine 
affects  the  motor  and  reflex  mechanisms ;  A, 
motor  and  sensory  mechanisms ;  Bt  cerebral 
motor  areas ;  C,  sensory  center ;  D,  motor  tract ; 
Ej  sensory  tract ;  F.  spinal  motor  areas ;  G, 
switch  center t  or  mechanism  for  conveying  im- 
pressions from  sensory  to  motor  nerves ;  H^ 
sensory  nerve  ;  /,  motor  nerve ;  K^  muscle. 


468  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

primary  effects  of  the  drug  are  manifested  in  its  influence  upon 
the  brain  or  its  vasomotor  center ;  next  upon  the  inhibitory  center 
of  the  heart ;  then  upon  the  respiratory  apparatus ;  and  lastly  upon 
the  reflex  apparatus  of  the  cord,  the  spasms  being  the  combined 
result  of  these  actions. 

The  prolonged  administration  of  small  doses  has  a  marked  effect 
upon  the  sensory  nerves,  stimulating  the  senses  of  touch,  sight,  and 
hearing,  so  that  ordinary  impressions  are  rendered  more  acute. 

The  motor  mechanism  is  the  most  sensitive  to  the  action  of 
strychnine,  as  is  indicated  by  the  convulsions.  The  points  of  this 
mechanism  which  may  possibly  be  attacked  by  the  drug  are — (i) 
the  cerebral  motor  areas  ;  (2)  the  spinal  motor  areas ;  (3)  the  spinal 
motor  tracts;  (4)  the  ends  of  the  motor  nerves;  (5)  the  muscles. 
Careful  experiments,  however,  have  shown  that  the  only  points  in 
the  motor  apparatus  stimulated  by  strychnine  are  the  spinal  motor 
areas  (2).     See  Fig.  5. 

Strychnine  greatly  intensifies  reflex  excitability,  so  that  in 
strychnine-poisoning  a  bright  light,  a  sound,  a  jar  of  the  bed,  or 
touching  the  skin  may  reflexly  produce  a  convulsive  seizure. 

The  points  where  the  drug  may  act  to  increase  reflex  muscular 
action  are — (6)  the  ends  of  the  sensory  nerves ;  (7).  mechanism  in 
the  cord  for  switching  from  sensory  nerves ;  (8)  the  ends  of  the 
motor  nerves.  Experiment  has  proved  that  strychnine  stimulates 
only  the  reflex  mechanism  in  the  spinal  cord  (7)  (see  Fig.  5).  It 
will  be  seen,  therefore,  that  the  whole  action  of  strychnine  upon 
the  motor  mechanism  is  exerted  upon  the  spinal  cord  rather  than 
upon  the  nerves,  muscles,  or  cerebrum. 

Respiratory  System. — The  effect  of  strychnine  being  to  excite 
the  spinal  cord  and  respiratory  centers,  the  breathing  is  rendered 
quicker  and  deeper.  From  prolonged  contraction  of  the  respira- 
tory muscles  under  poisonous  doses,  and  consequent  exhaustion, 
the  patient  may  become  asphyxiated,  the  heart  having  been 
observed  to  beat  after  death,  showing  that  the  fatal  effects  of  the 
drug  are  due  to  failure  of  respiration. 

Contrary  to  the  opinion  of  other  able  observers,  Reichert  does 
not  consider  strychnine  in  medicinal  doses  a  direct  respiratory 
stimulant,  but  believes  that  its  beneficial  influence  on  the  respira- 
tion is  due  to  its  stimulation  of  the  nerve-centers  in  general. 

Regardless  of  the  exact  modus  operandi,  it  is  well  known  to 
every  observing  clinician  that  strychnine  not  only  increases  the 
frequency  of  the  breathing,  but  also  the  respiratory  capacity. 


PLATE   I. 


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Strychnine-poisoning. 


MOTOR  EXCITANTS.  469 

Absorption  and  Elimination. — Strychnine  is  rapidly  absorbed 
and  slowly  excreted,  and  consequently  accumulates  in  the  system. 
It  is  eliminated  mainly  by  the  kidneys,  appearing  in  the  urine  as 
strychnine  and  strychnic  acid,  a  product  of  oxidation.  The  sali- 
vary and  cutaneous  channels  share  in  the  excretory  process. 

Temperature. — Ordinary  doses  have  little  or  no  effect  upon  tem- 
perature, but  toxic  doses,  by  producing  spasms  and  tetanic  convul- 
sions, raise  arterial  pressure,  thereby  increasing  bodily  heat. 

Eye. — The  general  nervous  stimulation  produced  by  strychnine 
affects  the  mechanism  of  the  eye,  vision,  as  has  been  remarked, 
being  rendered  more  acute. 

Uterus. — Strychnine  exerts  some  influence  upon  the  muscular 
uterine  tissues  and  assists  the  catamenia. 

Untoward  Action. — Certain  peculiar  manifestations,  having  but 
slight  resemblance,  or  none  vi^hatever,  to  the  characteristic  symp- 
toms of  poisoning,  have  followed  the  ingestion  of  small  doses  of 
strychnine,  such  as  the  presence  of  a  scarlatiniform  eruption; 
cramps  followed  by  perspiration,  resembling  in  some  respects  the 
tertian  type  of  intermittent  fever ;  redness  of  the  eyes ;  formication ; 
a  peculiar  heaviness  and  stiffness  of  the  limbs ;  persistent  and  painful 
priapism ;  and  gastric  uneasiness. 

Children  are  exceedingly  susceptible  to  the  untoward  effects 
of  strychnine,  its  administration  requiring  extreme  caution.  The 
author,  however,  is  familiar  with  a  case  resulting  beneficially  in 
the  practice  of  Dr.  Alfred  C.  Cotton  of  Chicago,  when  -^  grain 
(0.036  Gm.)  of  strychnine  sulphate  was  given  hypodermically  every 
three  hours  to  a  child  three  years  of  age  seriously  ill  with  pneu- 
monia.    Such  heroic  dosage  is  nevertheless  seldom  advisable. 

Poisoning. — As  is  the  case  with  other  active  poisons,  strychnine 
in  lethal  doses  produces  varying  effects  dependent  upon  tempera- 
ment, idiosyncrasy,  and  physiological  conditions.  Generally  speak- 
ing, the  absorption  of  large  doses  is  followed  by  rigidity  of  the 
lower  maxillary,  dilatation  of  the  pupils,  increased  action  of  the 
reflexes,  and  spasmodic  and  distressing  muscular  contraction,  affect- 
ing the  extensors  particularly.  Finally,  the  respiratory  muscles 
are  affected  with  tetanic  rigidity,  death  resulting  from  asphyxia. 
In  many  cases  the  earliest  symptoms  of  poisoning  are  restlessness 
and  anxiety,  twitching  of  the  muscles,  and  stiffness  of  the  neck. 
Spinal  convulsions  are  manifested,  the  patient  assuming  the  position 
of  opisthotonos,  so  that  he  rests  upon  his  head  and  his  heels. 
The  slightest  external  irritation  at  this  stage,  even  a  movement 


470  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

of  the  bed-clothes,  is  sufficient  to  cause  a  recurrence  of  convulsions. 
Notwithstanding  these  grave  symptoms,  the  mind  remains  unaf- 
fected until  carbonic-acid  poisoning  sets  in,  and  the  stomach  is 
usually  retentive.  Accompanying  the  usual  symptoms  in  cases 
of  acute  poisoning  is  the  distortion  of  the  features,  which  assume 
a  ghastly  grin  {risus  sardonicus).  The  action  upon  the  genito- 
urinary tract  is  quite  marked,  involuntary  ejaculations  of  semen 
frequently  taking  place,  together  with  incontinence  of  urine. 

The  earlier  paroxysms  attendant  upon  the  effects  of  the  drug 
are  seldom  fatal,  but  in  the  intervals  of  repose  the  patient's  mind 
is  oppressed  with  a  sense  of  impending  dissolution,  intensified  by 
each  renewed  access  of  spasm  and  increasing  severity  of  pain. 

Treatment  of  Poisoning. — Emetics  and  cleansing  of  the  stomach 
are  naturally  of  the  first  importance.  Animal  charcoal  and  tannic 
acid  should  be  freely  administered,  while  copious  anal  injections 
containing  potassium  bromide  and  chloral  are  often  efficacious  in 
relieving  the  spasms. 

Amyl-nitrite  inhalations  may  prove  serviceable  as  an  aid  to 
restore  failing  respiration  when  artificial  means  are  required. 

The  chemical  antidote  to  strychnine  is  tannin,  which  should  be 
given  immediately,  perhaps  best  in  the  convenient  form  of  strong, 
unstrained  decoctions  of  tea  or  coffee,  the  stomach  being  subse- 
quently well  cleansed.  Catheterism  should  be  performed  frequently 
to  favor  elimination,  care  being  taken  not  to  create  a  recurrence  of 
spasm  and  consequent  convulsions,  which  may  often  be  obviated 
by  the  use  of  nitrite  of  amyl  or  chloroform.  The  bowels  should 
be  evacuated,  croton  oil  per  rectum,  being  an  efficient  agent. 

As  has  been  stated,  potassium  bromide,  chloral,  and  physostig- 
mine  are  serviceable  physiological  antidotes.  Opium  and  conium 
may  also  be  used  to  counteract  the  effects  of  the  drug.  Paralde- 
hyde has  been  preferred  to  chloral,  and  tobacco  and  alcohol  have 
been  suggested,  even  in  heroic  doses,  should  the  malady  refuse  to 
yield  to  other  remedial  agents. 

Therapeutics. — Externally  and  Locally. — M.  Mackenzie  has  rec- 
ommended strychnine  in  ^j^-  ^^  grain  (0.0027-0.004  Gm.)  doses  in 
some  harmless  and  inert  medium  as  an  insufflation  in  anosmia, 
and  lint  saturated  with  the  tincture  of  nux  vomica  and  applied  to 
the  perineum  has  been  advised  in  incontinence  of  urine. 

Internally. — There  is  no  more  efficient  remedy  in  atonic  dys- 
pepsia than  nux  vomica  or  strychnine.  Both  possess  all  the  prop- 
erties of  the  simple  bitters,  besides  stimulating  the  nerve-centers. 


MOTOR  EXCITANTS.  471 

rendering  the  co-ordination  of  the  digestive  process  more  perfect 
and  enabling  the  stomach  to  respond  more  readily  when  the  stim- 
ulus of  food  is  applied  to  it. 

The  gastric  catarrh  of  inebriates  is  especially  benefited  by  this 
drug,  which  also  serves  a  useful  purpose  in  the  vomiting  of  preg- 
nancy and  of  phthisis. 

Its  tonic  action  upon  the  intestinal  muscles  renders  it  an  invalu- 
able remedy  in  habitual  constipation,  atonic  diarrhea,  and  prolapsus 
of  the  rectum,  the  latter  condition  being  frequently  observed  in 
children  and  aged  persons,  especially  the  latter,  who  are  often  men- 
tally depressed  by  this  infirmity,  and  who  are  relieved  by  strych- 
nine, either  given  internally  or  injected  as  a  solution  into  the  sub- 
cutaneous tissue  of  the  rectum,  toning  up  the  muscles  and  at  the 
same  time  stimulating  the  cerebrum,  relieving  the  melancholia  and 
inspiring  the  patient  with  hope. 

Strychnine  is  a  most  valuable  cardiac  tonic,  having  a  marked 
action  on  the  cardiac  nervous  system.  In  pneumonia,  typhoid  fever, 
and  other  diseases  accompanied  by  dyspnea  and  feeble  heart-action 
no  more  valuable  drug  can  be  employed.  It  differs  from  alcohol 
and  other  cardiac  stimulants  in  that  its  use  is  not  followed  by 
depression.  The  hypodermic  injection  of  full  doses  of  strychnine 
ordinarily  renders  the  pulse  full  and  strong,  even  when  it  is  scarcely 
perceptible  and  death  appears  imminent.  Many  clinicians  have  un- 
doubtedly tided  pneumonic  patients  over  the  critical  period  by  the 
heroic  use  of  strychnine,  when,  but  for  the  drug,  they  would  have 
died.  The  functional  irregularity  of  the  heart's  action  accompany- 
ing hysteria,  hypochondriasis,  and  pregnancy  is  greatly  relieved  by 
moderate  doses  of  tincture  of  nux  vomica. 

As  a  tonic  in  chlorosis  and  anemia  strychnine  is  an  esteemed  rem- 
edy, being,  in  the  author's  opinion,  the  best  we  possess  in  general 
efficiency.  It  improves  the  appetite,  prevents  putrefactive  changes, 
and  aids  digestion,  thereby  enabling  the  patient  to  partake  of  and 
assimilate  more  nutriment.  It  also  increases  the  force  of  the  heart, 
quickens  the  circulation,  and  raises  arterial  tension,  nourishing  all 
parts  of  the  body  and  rendering  the  condition  more  favorable  for 
oxidation  in  the  tissues  and  for  the  removal  of  waste  products. 
The  amount  of  urine  is  increased,  constipation  is  relieved,  and  thus 
elimination  of  these  products  facilitated. 

Oxidation  is  further  enhanced  by  the  increased  respiratory 
movements,  rendering  the  blood  richer  in  oxygen  and  increasing 
the  number  of  the  red  corpuscles. 


473  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

The  potent  action  of  strychnine  upon  the  nervous  system  stimu- 
lates the  spinal  cord,  giving  the  patient  greater  strength,  and,  by 
invigorating  the  brain,  animating  him  with  cheerfulness  and  con- 
fidence and  a  disposal  to  exercise. 

Strychnine,  then,  is  at  once  a  gastric,  vascular,  nervous,  mus- 
cular, and  respiratory  tonic,  being  an  invaluable  remedy  in  debility 
from  any  cause. 

In  bronchial  and  neurotic  asthma,  as  well  as  in  many  forms  of 
neuralgia,  particularly  the  visceral  variety,  the  drug  is  an  efficient 
remedy.  In  bronchitis  also,  and  to  relieve  the  coughs  of  neurotic 
origin,  it  is  of  great  value. 

Paralysis  of  spinal  on^m— paraplegia,  etc. — and  hemiplegia  pre- 
vious to  degeneration,  with  complete  relaxation  of  the  muscles,  are 
benefited  by  strychnine,  although  in  the  latter  affection  it  is  of  little 
if  any  value  in  recent  cases  or  when  the  muscles  do  not  respond  to 
the  electric  current. 

The  sphincters  of  the  body,  although  belonging  to  the  unstriped 
muscles,  are  more  or  less  under  the  control  of  the  will ;  still,  when 
there  is  an  atonic  condition  of  these  structures,  as  in  incontinence 
of  urine,  due  to  weakness  of  the  sphincter,  strychnine  is  a  very 
powerful  remedy.  For  the  same  remedial  properties  it  is  equally 
valuable  in  retention  of  urine  when  the  detrusor  muscle  is  too  weak 
to  empty  the  bladder. 

Probably  no  other  drug  equals  strychnine  in  diphtheritic  paraly- 
sis, the  form  of  the  disease  most  benefited  by  the  remedy.  It  is  of 
use,  however,  in  all  varieties  oi  functional  paralysis,  such  as  those 
resulting  from  hysteria,  mental  emotion,  alcohohsm,  venereal  ex- 
cesses, the  abuse  of  opium,  lead-poisoning,  gout,  rheumatism, 
concussion  of  the  spinal  marrow,  etc. 

Jewell  claims  that  strychnine  has  caused  an  improvement  in 
myelitis  after  the  failure  of  other  remedies. 

The  weak  and  semi-paralyitic  condition  sometimes  induced  by 
bromides  is  improved  by  strychnine. 

The  drug  has  found  a  few  supporters  in  the  treatment  of  tetanus, 
epilepsy,  tic  douloureux,  and  chorea,  though  it  has  not  been  gener- 
ally adopted  as  a  remedy  in  these  diseases. 

Strychnine  is  exceedingly  efficacious  in  amaurosis  due  to  exces- 
sive use  of  alcohol  or  tobacco,  being  also  valuable  in  paresis  of  the 
ocular  muscles.  Night-blindness  is  also  greatly  benefited  by  this 
drug. 

It  is  of  undoubted  merit  in  delirium  tremens,  as  well  as  in  pre- 


MOTOR  EXCITANTS.  473 

venting  the  usual  effects  of  alcoholic  intoxication  ;  in  fact,  the  drug 
is  one  of  the  best  remedies  in  the  treatment  of  alcoholism,  the 
strychnine  nitrate  being  usually  employed,  hypodermically.  Ac- 
cording to  the  best  authorities  on  dipsomania,  strychnine  seems  to 
be  a  true  antagonist  to  the  untoward  action  of  alcohol,  and  it  is 
probably  the  important  constituent  of  the  numerous  "  cures  "  for 
the  alcohol  habit. 

No  less  valuable  is  strychnine  in  the  treatment  of  acute  poisoning 
by  chloral,  morphine,  and  physostigmine. 

As  an  aphrodisiac  it  is  of  unquestioned  value  in  functional  sper- 
matorrhea, and  it  is  thought  to  produce  contractions  of  the  gravid 
uterus  and  cause  abortioti  or  premature  delivery.  When  a  predis- 
position to  post-partum  hemorrhage  exists,  the  administration  of 
strychnine  may  prove  of  great  service. 

Finally,  strychnine  has  been  highly  recommended  in  the  night- 
sweats  of  phthisis  and  in  diabetes  m.ellitus. 

Contraindications. — Strychnine   is   contraindicated   or   of   no 
value  in  true  voluntary  muscular  paralysis,  where  the  region  is  : 
directly  under  the  control  of  the  cerebrum.     It  is  also  contraindi- 
cated in  acute  inflammatory  conditions   of  the  spinal  cord  and 
excessive  reflex  irritability. 

Administration. — The  extract  of  nux  vomica,  the  tincture,  the 
fluid  extract,  or  the  alkaloid  strychnine  may  be  given  and  gradually 
increased,  a  tolerance  by  the  system  being  rapidly  established.  The 
salts  of  strychnine  are  preferable  to  other  preparations,  the  crude 
drug  and  its  preparations  vaiying  greatly  in  strength,  10  minims 
(0.6  Cc.)  of  one  tincture  sometimes  containing  as  large  a  percent- 
age of  strychnine  as  20  minims  (1.2  Cc.)  of  another. 

The  drug  should  be  cautiously  administered  to  children,  the 
initial  dose  for  a  child  five  or  six  years  of  age  not  exceeding 
x^  grain  (0.0006  Gm.). 

In  using  strychnine  hypodermically  the  soluble  hypodermic 
tablets  should  be  freshly  dissolved  in  distilled  water. 

The  solutions  of  strychnine  and  of  the  other  alkaloids  should 
not  be  kept  in  stock,  as  they  become  contaminated  with  microscopic 
plants. 

Cocculus— Cocculi— Cocculus  Indicus. 

(Fish  Berry.) 
Origin. — The  dried   fruit  of  Anamirta    Cocculus  Wright  and 
Arnott,  a  climbing  shrub  in  Eastern  India,  native  to  the  Malabar 
coast. 


474  A    TEXT-BOOK  OF  MA  TERIA   MEDIC  A. 

Description  and  Properties. — A  globular,  kidney-shaped,  one- 
celled  berry,  about  \  inch  (6  Mm.)  in  diameter  and  f  inch  (lO  Mm.) 
in  length,  blackish-brown  and  wrinkled.  The  seed  is  very  bitter, 
but  the  pericarp  is  tasteless.  The  chief  constituent  is  picrotoxin, 
the  poisonous  principle  contained  in  the  kernel  and  first  isolated 
by  BouUay  in  1819. 

The  crude  drug  is  not  used  internally. 

Unofficial  Preparations. 

Tinctura  C6cculi— Tincturae  CScculi— Tincture  of  Cocculus.— Z)(;i^,  2-20' 
minims  (0.12-1.2  Cc). 

Extractum  C6cculi  Fluidutn— ExtrScti  CScculi  Fliiidi— Fluid  Extract  of 
Cocculus. — Dose,  1-3  minims  (0.06-0.2  Co.). 

Picrotoxinum—Picrotoxini— Picrotoxin.    TJ.  S.  P. 

Origin. — A  neutral  principle  obtained  fi-om  the  seed  of  Ana- 
mirta  paniculata  Colebrooke. 

Description  and  Properties. — Colorless,  flexible,  shining,  pris- 
matic crystals,  or  a  micro-crystalline  powder,  odorless  and  having 
a  very  bitter  taste ;  permanent  in  the  air.  Soluble  in  240  parts  of 
water  and  in  9  parts  of  alcohol. 

Dose. — ^^~%<i,  grain  (0.001-O.002  Gm.). 

Antagonists  and  Incompatibles. — Chloral,  the  motor  depres- 
sants, acetic  acid,  and  the  anesthetics  antagonize  the  effects  of 
picrotoxin. 

Synergists. — All  the  motor  excitants. 

Physiological  Action. — Externally  and  Locally. — It  is  a  power- 
ful parasiticide,  being  very  destructive  to  lower  forms  of  animal  life. 

Internally. — Digestive  System. — In  small  medicinal  doses  its 
action  is  similar  to  that  of  strychnine. 

Circulatory  System. — Its  general  effects  do  not  differ  essentially 
from  those  of  strychnine. 

Nervous  System. — Picrotoxin  differs  somewhat  from  strychnine 
in  its  action  upon  the  nervous  system,  poisonous  doses  producing 
epileptiform  convulsions  and  spasms  of  the  flexor  muscles,  alter- 
nating from  tonic  to  clonic,  whereas  the  spasms  induced  by 
strychnine  affect  principally  the  extensor  muscles  and  are  tetanic 
in  character.  The  brain  also  is  differently  affected — toxic  doses 
resulting  in  stupor,  delirium,  coma,  and  complete  insensibility. 

Respiratory  System. — Picrotoxin  tends  to  stimulate  the  respira- 
tory center,  its  general  influence  being  analogous  to  that  of  strych- 
nine. 


MOTOR  EXCITANTS.  475 

Absorption  and  Elimination. — The  drug  is  rapidly  absorbed,  and, 
as  in  the  case  of  strychnine,  is  eliminated  chiefly  by  the  kidneys, 
the  sweat  being  also  a  channel  of  excretion,  since  cocculus,  even 
more  than  strychnine,  acts  as  a  powerful  diaphoretic. 

Temperature. — No  special  action  has  been  noted,  though  the 
temperature  may  be  raised  slightly  during  the  convulsive  period. 

Eye. — The  pupils  are  dilated  during  the  tonic  and  contracted 
during  the  clonic  spasms.  An  ophthalmoscopic  examination  shows 
a  marked  hyperemia  of  the  ocular  fundus. 

Poisoning. — The  drug  produces  muscular  twitchings,  incoordi- 
nation, great  restlessness,  tonic  convulsions,  with  opisthotonos  or 
emprosthotonos,  alternating  with  clonic  spasms  and  succeeded  by 
paralysis,  delirium,  and  coma.  The  respiratory  apparatus  is  affected 
as  in  strychnine-poisoning. 

The  symptoms  are  very  similar  to  those  of  an  epileptic  seizure, 
and  the  post-mortem  lesions  are  analogous  to  those  of  epilepsy. 

Treatment  of  Poisoning. — This  is  identical  with  that  prescribed 
in  cases  of  poisoning  by  strychnine. 

Therapeutics. — Externally  and  Locally. — The  most  important 
use  of  COCCULUS  locally  is  in  the  treatment  o{ parasitic  and  skin  dis- 
eases, an  ointment  of  picrotoxin — 10  grains  to  i  ounce  (0.6-32.0 
Gm.) — being  employed  for  this  purpose.  Caution  should  be  used 
in  applying  it  to  abraded  surfaces  lest  poisoning  result. 

The  DECOCTION  or  tincture  of  cocculus  Indicus  is  very  effective 
in  destroying  parasitic  vermin  infesting  the  head  and  body. 

Internally. — Picrotoxin  has  been  used,  although  less  success- 
fully, for  many  diseases  treated  with  strychnine,  especially  paralysis 
of  the  extremities  and  of  the  sphincters. 

Planat  has  highly  recommended  the  use  of  cocculus  in  epilepsy  ; 
the  best  results  in  this  disease,  however,  are  obtained  in  the  treat- 
ment of  the  nocturnal  variety.  The  same  authority  advised  the 
employment  of  the  drug  iii  chorea,  infantile  eclampsia,  and  chronic 
spasm  of  the  limbs. 

Bartholow  suggested  that  the  drug,  like  strychnine,  would  prove 
valuable  in  intestinal  torpor. 

Bokai  has  advocated  its  use  in  opium-poisoning. 

Unquestionably,  its  most  valuable  action  is  in  controlling  the 
night-sweats  of  phthisis.  Mirrell,  who  first  used  it  for  this  purpose, 
reported  but  one  failure  in  twenty.  Gubler  has  succeeded  in 
greatly  benefiting  glosso-labio-laryngeal  paralysis  by  the  hypo- 
dermic injection  of  ^  grain  (o.coi  Gm.)  of  picrotoxin. 


476  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Dysmenorrhea  and  migraine  occurring  at  the  menstrual  period 
are  said  to  be  greatly  relieved  by  this  drug.  Even  sero-purulent 
Jeucorrkea,  it  is  claimed,  has  derived  benefit  from  the  administration 
of  some  preparation  of  cocculus. 

Contraindications. — Similar  to  those  for  strychnine. 

Administration. — The  picrotoxin  is  far  preferable  to  other 
preparations  of  cocculus,  both  for  external  and  internal  use.  It 
should  be  very  cautiously  administered,  however. 

Ergrota—Ergot.se— Ergot.    U.  S.  P. 

(Ergot  of  Rye.) 

Origin. — The  sclerotinum  of  Claviceps  purpurea  (Fries)  Tulasne 
{Fungi),  replacing  the  grain  of  rye,  Secale  cereale  L.  Most  of  the 
commercial  article  comes  from  Spain  and  Russia. 

Description  and  Properties. — Somewhat  fusiform,  obtusely 
triangular,  usually  curved,  about  f  to  i^  inches  (2-3  Cm.)  long  and 
-|^  inch  (3  Mm.)  thick ;  three-furrowed,  obtuse  at  both  ends,  purplish- 
black,  internally  whitish,  with  some  purplish  striae,  breaking  with  a 
short  fracture ;  odor  peculiar,  heavy,  increased  by  trituration  with 
potassium  or  sodium  hydrate  T.  S. ;  taste  oily  and  disagreeable. 
Old  ergot,  which  breaks  with  a  sharp  snap,  is  almost  or  entirely 
devoid  of  a  pinkish  tinge  in  the  fracture,  is  hard  and  brittle  between 
the  teeth,  and  comparatively  odorless  and  tasteless — should  be 
rejected. 

Ergot  should  be  but  moderately  dried  and  preserved  in  a  close 
vessel,  with  a  few  drops  of  chloroform  added  from  time  to  time  to 
prevent  the  development  of  insects.  When  more  than  one  year 
•old  it  is  unfit  for  use. 

The  active  constituents  of  ergot  are  not  definitely  ascertained. 
It  contains,  however,  an  acid  soluble  in  water  and  variously  termed 
sderotinic,  ergotinic,  and  ergotic  acid,  and  another,  soluble  in  alka- 
lies, known  as  sphacelic  acid.  Both  of  these  acids  possess  ecbolic 
properties.  Ergot  also  contains  a  principle  known  as  cornutin,  and 
30  per  cent,  of  a  yellow  non-drying  saponifiable  fixed  oil,  besides 
proteids,  sugar,  tannin,  and  ash.  The  commercial  ergotin  is  merely 
s.  purified  aqueous  extract  of  ergot. 

Dose.— 5-20  grains  (0.30-1.30  Gm.). 

Official  Preparations. 

Extractum  Ergotae— ExtrScti  Ergotae— Extract  of  Ergot.— Z>w*,  2-10  grains 
'(0.12-0.06  Gm.). 


MOTOR  EXCITANTS.  477 

Extractum  Brgotse  Fluidum — ExtrScti  Ergots  Fluidi— Fluid  Extract  of 
Ergot. — Dose,  15-60  minims  (:.o-4.o  Cc). 

Vinum  Ergotae— Vini  Ergotse— Wine  of  Ergot.— Z»oi?,  1-3  fluidrachms  (4.0- 
12.0  Cc). 

Unofficial  Preparations. 

Tinctiira  Ergotae— Tincturae  Ergotae— Tincture  of  Ergot. — Dose,  \-2  fluid- 
draclims  (2.0-8.0  Cc). 

Ergotin  (Bonjean's). — Dose,  2-8  grains  (0.012-0.5  Gm.). 

Antagonists  and  Incompatibles. — The  cardiac  and  motor 
depressants  antagonize  the  action  of  ergot.  Caustic  alkalies  and 
metallic  salts  are  chemically  incompatible. 

Synergists. — Its  action  upon  the  circulation  is  aided  by  digitalis 
and  belladonna;  upon  the  nervous  system  by  strychnine;  while 
ustilago,  hydrastine,  gossypium,  and  the  emmenagogues  enhance 
its  influence  upon  the  uterus. 

Physiological  AatioTn.^Externally  and  Locally. — Ergot  has  no 
distinctive  action  upon  the  skin,  but  upon  mucous  membranes  its 
influence  is  that  of  an  astringent,  possessing  hemostatic  properties. 

Internally. — Digestive  System. — In  large  doses  it  is  a  gastro- 
intestinal irritant,  occasioning  considerable  heat  and  dryness  of  the 
throat,  accompanied  by  thirst  and  succeeded  by  pain  in  the  stom- 
ach and  bowels,  vomiting,  and  occasionally  purging,  with  violent 
peristalsis,  although  constipation  is  the  commoner  sequence. 

Circulatory  System. — Repeated  medicinal  doses  increase  the 
blood-pressure,  although  rendering  the  pulse  slower  and  smaller, 
the  result  either  of  stimulation  of  the  peripheral  endings  of  the 
inhibitory  vagi  or  the  inhibitory  ganglia,  and  excitation  of  the  vaso- 
motor system,  contracting  the  arterioles. 

A  poisonous  dose  lowers  arterial  tension,  causing  the  pulse  to 
beat  faster  and  softer — an  effect  due  to  exhaustion  from  over- 
stimulation or  to  direct  depressant  action  upon  the  heart-muscle. 
It  is  claimed  by  competent  authority  that  there  is  no  active  and 
actual  contraction  of  the  arteries,  the  result  of  stimulation  of  the 
vaso-motor  system,  but  that  the  arteries  contract  because  of  the 
fulness  of  the  veins,  there  not  being  sufficient  blood  to  fill  both 
systems,  marked  arterial  anemia  consequently  resulting.  It  must 
be  admitted  that  the  true  physiological  action  upon  the  circulatory 
system  is  not  yet  generally  understood,  being  still  sub  judice,  since 
equally  competent  pharmacologists  maintain  that  the  arterial  pres- 
sure is  increased  as  explained  above. 

It  is  an  undisputed  fact,  however,  that  the  cardiac  muscle  is 


478  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

actually  contracted  by  ergot.  Indeed,  Willebrand  claims  that  "  the 
normal  or  hypertrophied  heart  so  contracts  under  the  action  of 
ergot  that  the  difference  in  size  is  appreciable  by  percussion" 
{Bartholow). 

If  any  changes  are  produced  by  this  drug  in  the  composition 
■of  the  blood,  they  have  not  been  ascertained. 

Nervous  System. — Medicinal  doses  have  no  especial  action, 
though  excessive  doses  sometimes  depress  the  sensory  mechanism, 
producing  general  cutaneous  anesthesia. 

The  action  of  toxic  doses  on  the  nervous  system  will  be 
described  under  "  Poisoning." 

Respiratory  System. — Medicinal  doses  produce  no  particular 
effect.  Large  doses  depress  the  respiratory  center,  rendering  the 
breathing  shallow.  This  action  is  manifest  from  the  first,  there 
being  no  primary  stimulation  of  the  respiration.  Death  from  an 
overdose  of  ergot  usually  results  from  paralysis  of  the  respiratory 
center. 

Absorption  and  Elimination. — The  active  constituents  of  ergot 
are  rapidly  absorbed  into  the  blood,  and  are  eliminated  principally 
by  the  kidneys,  increasing  the  urinary  flow. 

Temperature. — No  special  action  has  been  observed. 

Eye. — The  caliber  of  the  retinal  and  nutrient  opticus  blood- 
vessels is  reduced,  resulting  in  marked  pallor  of  the  disk,  transitory 
amblyopia,  and  pupillary  anemia. 

Uterus. — Probably  the  most  important  action  of  ergot  is  upon 
this  organ.  It  produces  in  full  doses  tetanic,  tonic  contraction  of 
the  uterine  muscle,  the  uterus  becoming  hard  and  pale,  and  forcing 
the  blood  out  of  the  uterine  arterioles.  The  organ  is  more  sensi- 
tive to  the  action  of  the  drug  during  pregnancy. 

The  precise  manner  in  which  ergot  affects  the  uterus  is  still 
a  matter  of  discussion,  although  Hemmeter's  experiments  would 
seem  to  prove  that  the  uterine  contractions  are  the  result  of  stimu- 
lation of  the  centers  in  the  lumbar  portion  of  the  spinal  cord. 
The  drug  causes  a  contraction  of  involuntary  muscles  throughout 
the  body. 

It  is  doubtful  if  any  drug  in  our  Materia  Medica  has  been  more 
carefully  studied  than  ergot,  and,  if  opinions  differ  widely  as  to  its 
modus  operandi,  it  is  because  we  have  to  deal  with  a  very  complex 
substance,  the  nature,  and  even  the  number,  of  whose  constituents 
are  as  yet  inadequately  known.  Many  principles  of  the  drug  are 
unstable  and  variable  in  their  action,  certain  preparations  differing 


MOTOR  EXCITANTS.  479 

■decidedly  from  others  in  their  influence,  as,  for  instance,  Tanret's 
ergotinine,  which  has  no  effect  upon  the  uterus.  Bonjean's  ergotin 
is  a  powerful  ecbohc,  and  has  a  marked  action,  moreover,  upon  the 
vascular  system,  whereas  Wigger's  ergotin  is  inert. 

Untomuard  Action. — In  addition  to  the  gastro-intestinal  disturb- 
ances already  described,  there  are  occasionally  produced  headache, 
mental  confusion,  dizziness,  a  feeling  of  chiUiness,  muscular  weak- 
ness, dilatation  of  pupils,  and  glimmering  before  the  eyes. 

Poisoning. — There  are  two  varieties  of  ergot-poisoning,  acute 
and  chronic.  Under  the  administration  of  immoderate  doses  pecu- 
liar symptoms  appear,  known  collectively  as  acute  ergotism.  Rest- 
lessness, mental  worry,  headache,  tinnitus  aurium,  dilatation  of  the 
pupils,  pallor  and  coldness  of  the  skin,  and  other  effects  are  present. 
At  times  cutaneous  anesthesia  is  manifest  or  general  formication. 
Epileptiform  spasms,  great  reduction  of  respiration  and  temperature, 
may  occur,  while  obstruction  of  cardiac  movements,  with  sudden 
nausea  and  violent  vomiting,  and  other  alarming  manifestations, 
attest  the  untoward  properties  of  the  drug. 

Chronic  ergotism  is  confined  chiefly  to  Europe,  where  ergotized 
rye  is  used  in  bread-making.  The  disease  is  marked  by  convulsive 
or  gangrenous  conditions. 

The  first  variety,  the  convulsive,  is  characterized  by  paroxysmal 
spasms  of  the  flexor  muscles,  which  later  become  continuous,  re- 
sulting in  opisthotonos  or  emprosthotonos.  There  is  dimness  of 
vision,  while  an  increasing  intensity  of  symptoms  develops  affection 
of  other  special  senses,  those  of  hearing  and  smell  being  either 
impaired  or  temporarily  lost.  Violent  abdominal  cramps  also  occur, 
together  with  painful  dyspnea,  death  resulting  from  asphyxia  or 
coma. 

The  second  (gangrenous)  form  is  signalized  by  severity  of  local 
phenomena,  profound  dyscrasia,  formication  or  cutaneous  anes- 
thesia, impairment  of  special  senses,  and  numbness  of  the  muscles 
or  extremities,  followed  by  sloughing  or  atrophy  of  the  diseased 
parts  and  mummification  or  dry  or  moist  gangrene. 

Fatal  results  of  chronic  ergotism  are  usually  traceable  to  the 
convulsions,  although  moist  or  dry  gangrene  may  in  certain  cases 
produce  death.  ' 

Treatment  of  Poisoning. — Symptoms  of  acute  poisoning  may  be 
alleviated  by  hot  baths  and  the  administration  of  tannic  acid  and 
cardiac  stimulants.  For  the  treatment  of  chronic  ergotism  hygienic 
measures  and  symptomatic  remedies  are  indicated. 


48o  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

* 

Therapeutics. — Externally  and  Locally. — Ergot,  in  an  impalpa- 
ble powder,  has  been  recommended  as  an  external  application  in 
the  treatment  of  carbuncle  and  epithelioma.  In  the  form  of  lozenges 
or  diluted  fluid  extract  the  drug  has  been  employed  in  acute 
pharyngitis.  The  hypodermic  injections  of  ergotin  are  valua- 
ble in  nasal  hypertrophies,  prolapsus  of  the  rectum,  hemorrhoids, 
enlargement  of  the  prostate  gland,  aneurysm,  varicocele,  and  vari- 
cose veins. 

Internally. — The  most  important  medical  use  of  ergot  is  to 
promote  uterine  contractions  in  labor.  The  preponderance  of 
testimony  among  the  most  experienced  obstetricians  is  in  favor  of 
its  use  only  after  the  expulsion  of  the  uterine  contents.  This  is  a 
rule,  however,  which  cannot  be  invariably  followed.  While  the 
employment  of  the  drug  is  contraindicated  in  the  first  stage  of 
labor,  it  may  be  safely  employed  during  the  second  stage,  when 
there  is  uterine  inertia,  provided  all  the  parts  be  in  a  normal 
condition  and  there  exists  no  mechanical  impediment  to  the  rapid 
delivery  of  the  child.  Ergot  is  of  service  also  when  the  placenta 
is  retained  owing  to  inefficient  and  feeble  uterine  contractions. 

With  these  exceptions  it  is  customary — and  the  author  concurs 
in  the  procedure — to  delay  the  administration  of  the  drug  until  the 
expulsion  of  the  placenta,  when  a  full  dose  of  the  fluid  extract  is 
given,  or  ergotin  hypodermically.  When  ergot  is  administered 
during  the  second  stage  of  labor,  it  should  be  given  in  small  doses, 
so  as  to  promote  intermittent  rather  than  continuous  contractions 
of  the  uterus.  No  drug  possesses  so  energetic  and  prompt  an 
action  as  ergot  in  post-partum  and  uterine  hemorrhage.  It  is  an 
exceedingly  efficacious  remedy  also  in  subinvolution  and  in  uterine 
fibroids  and  polypi. 

The  accompanying  diagrams  will  illustrate  the  control  of  hemor- 
rhage through  the  contraction  of  the  uterine  muscle  and  arterioles, 
and  the  influence  of  ergot  upon  submucous  fibroid  tumors  by 
mechanical  compression  and  consequent  diminution  of  their  blood- 
supply.  It  is  obvious  that  the  location  of  a  subperitoneal  tumor 
is  such  that  the  drug  cannot  influence  its  growth  as  it  can  a  sub- 
mucous fibroid. 

This  remedy  is  also  extremely  useful  in  the  treatment  of  ple- 
thoric amenorrhea,  congestive  dysmenorrhea,  menorrhagia,  chronic 
metritis,  etc. 

Dilatation  of  the  cardiac  cavities  without  valvular  lesion  is 
much  improved  by  the  administration  of  ergot ;  the  remedy  has 


MOTOR  EXCITANTS. 


481 


also  been  employed  with  considerable  success  in  chronic  diarrhea 
and  dysentery. 

Incontinence  of  urine — depending  either  upon  enlarged  prostate, 
irritability,  or  a  paretic  or  paralytic  condition  of  the  bladder- 


is 


Fig.  6. — Diagram  showing  how  ergot  reduces 
uterine  hemorrhage;  At  uterine  muscle;  B,  Bj 
arteries. 


Fig.  7. — Diagram  showing  how  ergot  reduces 
the  size  of  a  submucous  fibroid,  but  has  no  effect 
upon  a  subperitoneal  fibroid  ;  A,  uterine  muscle ; 
B,  subperitoneal  fibroid  ;  C,  submucous  fibroid ; 
D,  D,  arteries. 


greatly  relieved  by  this  remedy.  The  atonic  form  of  spermatorrhea 
is  palliated  or  cured  by  ergot. 

The  drug  is  of  value  also  in  cerebral  hyperernia  and  consequent 
mania,  as  well  as  in  cerebrospinal  meningitis,  congestion  of  the 
spine,  myelitis,  and  congestive  headaches. 

Ergot  has  been  highly  recommended,  notably  by  Dr.  J.  M.  Da 
Costa,  in  diabetes  insipidus,  and  by  such  authorities  as  Heltzmann 
and  D'Enslow  in  prurigo,  erythema,  urticaria,  and  acne  rosacea. 

Owing  to  the  peculiar  action  of  ergot  upon  unstriped  muscular 
fiber  it  is  a  valuable  drug  in  various  forms  of  hemorrhage. 

The  diseases  mentioned  as  being  favorably  influenced  by  the 
local  application  yield  as  readily  perhaps  to  the  internal  administra- 
tion of  ergot. 

Finally,  this  remedy  has  met  with  some  success  in  the  treatment 
of  leticorrhea,  galactorrhea,  hypostatic  congestion  of  the  lungs,  whoop- 
ing cough,  the  different  varieties  oi  purpura,  colliquative  sweats, 
splenic  enlargements,  and  exophthalmic  goiter. 

Contraindications. — During  the  first  stage  of  labor  and  in 
cerebral  or  spinal  anemia. 

Administration. — For  its  action  upon  the  uterus  a  valuable 

31 


482  A    TEXT-BOOK  OF  MATERIA    MEDICA. 

fluid  extract  is  the  best  preparation  as  an  internal  remedy;  for 
hypodermic  use  the  aqueous  extract  (ergotin)  or  some  of  the 
non-alcoholic  fluid  preparations  manufactured  by  certain  reliable 
pharmacists  for  this  particular  purpose,  should  be  employed. 
Ergotin  may  be  incorporated  in  suppositories  when  for  any  reason 
it  is  desirable  to  administer  the  drug  per  rectum. 

Gossypii  Radicis  Cortex— Gossypii  Radicis  Corticis— 
Cotton  Root  Bark.     TJ.  8.  P. 

Origin. — The  bark  of  the  root  of  Gossypium  herbaceum  L.  and 
of  other  species  of  the  genus,  indigenous  in  the  tropical  and  sub- 
tropical regions  of  Asia  and  Africa.  The  plant  has  been  cultivated 
in  the  United  States  and  other  countries  from  a  very  early  period, 
many  characteristic  varieties  having  been  produced. 

Description  and  Properties. — It  occurs  in  thin,  flexible  bands 
or  quilled  pieces,  the  outer  surface  brownish-yellow,  with  slight 
longitudinal  ridges  or  meshes,  small,  black  circular  dots,  or  short, 
transverse  lines,  and  dull,  brownish-orange  patches,  from  the  abra- 
sion of  the  thin  cork  ;  inner  surface  whitish,  of  a  silky  lustre,  finely 
striate ;  bast-fibers  long,  tough,  and  separable  into  papery  layers ; 
inodorous ;  taste  very  slightly  acrid  and  faintly  astringent. 

It  contains  a  fixed  oil,  a  small  quantity  of  tannin,  sugar,  and 
starch,  a  yellow  resin,  and,  in  the  fresh  bark,  a  pale-yellow  chromo- 
gene,  soluble  in  alcohol,  which  on  exposure  to  air  becomes  red 
and  resinous. 

Dose. — 15-60  grains  (1.04-4.0  Gm.). 

Official  Preparation. 
Extractum  Gossypii  Radicis  Flflidum— Extracti  Gossypii  Radicis  Fliiidi— 
Fluid  Extract  of  Cotton  Root  Bark.— Zloj?,  J-i  fluidrachm  (1.8-3.7  Cc). 

Antagonists  and  Inoompatibles. — The  same  as  for  ergot. 

Synergists. — Ergot  and  its  synergists. 

Physiological  Action. — Identical  with  that  of  ergot,  but  infe- 
rior in  certainty  of  action. 

Therapeutics. — Cotton  root  bark  is  employed  only  for  its  action 
upon  the  uterine  system,  in  which  respect  it  is  identical  with  ergot 
An  exception  may  possibly  be  in  its  use  in  the  treatment  of  subin- 
volution and  tumors  of  the  utems,  in  which  cases  it  is  less  efficient 
than  ergot. 

Contraindications. — The  same  as  for  ergot. 

Administration. — The  fluid  extract  only  should  be  employed. 


MOTOR  EXCITANTS.  483 

Hydrastis— Hydrastis— Hydrastis.    TJ.  S.  JP. 

(Golden  Seal.) 

Origin. — The  rhizome  and  roots  of  Hydrastis  Canadensis.  L.,  a 
perennial  native  to  Canada  and  the  United  States  east  of  the  Mis- 
sissippi, growing  in  rich  woodlands  and  in  the  Southern  States, 
confined  to  mountainous  districts. 

Description  and  Properties. — The  rhizome  is  from  i  to  2 
inches  (2-5  Cm.)  long  and  about  \  inch  (6  Mm.)  thick,  oblique, 
with  short  branches,  somewhat  annulate  and  longitudinally 
wrinkled;  externally  brownish-gray;  fracture  short,  waxy,  red- 
dish-yellow, with  a  thickish  bark,  about  ten  narrow  wood-wedges, 
broad  medullary  rays,  and  large  pith.  Roots  thin,  brittle,  with  a 
thick  yellow  bark  and  subquadrangular  woody  centre.  Odor 
slight,  taste  bitter. 

The  principal  constituents  are  hydrasiine  (colorless  and  slightly 
acrid)  and  berberine  (yellow  and  intensely  bitter),  the  latter  alkaloid 
being  also  found  in  berberis,  Colombo,  menispermum,  coptis,  etc. 
There  is  a  yellow  resinoid  (hydrastin)  on  the  market  which  should 
not  be  confounded  with  the  active  alkaloid  hydrastine. 

Dose. — The  crude  drug  is  not  given  internally. 

Official  Preparations. 

ExtrSctum  Hydrastis  Fluidum — Extract!  Hydrastis  Fluidi — Fluid  Extract 
of  Hydrastis. — Dose,  10-30  minims  (0.6-2.0  Co.). 

Glycerltum  Hydrastis — Glyceriti  Hydrastis — Glycerite  of  Hydrastis. — Used 
externally. 

Tinctura  Hydrastis — Tincturae  Hydrastis — Tincture  of  Hydrastis. — Dose, 
30-60  minims  (2.0-4.0  Co.). 

Hydrastina — Hydrastinae — Hydrastine  (unofficial). — An  alkaloid  obtained  from 
Hydrastis. 

Origin,  Description,  and  Properties. — Colorless,  very  brilliant,  glassy  crystals ;  taste 
slightly  acrid ;  fully  soluble  in  ether  and  chloroform,  but  freely  soluble  in  water. 

Dose. — yV"i  grail  (0.002-0.03  Gm.). 

Hydrastinae  Hydrochloras — Hydrastinae  Hydrochloratis — Hydrastine  Hy- 
drochlorate.  U.  S.  P. — Origin. — The  hydrochlorate  of  an  artificial  alkaloid  derived 
from  Hydrastine. 

Description  and  Properties. — Light-yellow,  amorphous  granules,  or  a  pale-yellow 
crystalline  powder,  odorless,  and  having  a  bitter,  saline  taste ;  deliquescent  on  exposure 
to  damp  air.  Soluble  in  0.3  part  of  water  and  in  3  parts  of  alcohol.  The  product 
should  be  kept  in  well-stoppered  vials. 

Dose. — j-\j-4  g^^"  (0.005-0.03  Gm.). 

Antagonists  and  Incompatibles. — The  alkalies,  mineral  acids, 
and  tannic  and  other  vegetable  acids  are  incompatible  with  prepara- 
tions of  hydrastis.  The  physiological  antagonists  are  chloral, 
potassium  bromide,  and  the  motor  depressants. 


484  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Synergists. — Quinine  and  the  vegetable  bitters  aid  its  action 
upon  the  digestive  tract,  ergot  upon  the  uterus,  and  strychnine 
upon  the  spinal  cord. 

Physiological  Action. — Externally  and  Locally. — Hydrastine 
possesses  considerable  anesthetic  action  when  applied  locally, 
and  upon  the  eye  its  effect  is  to  contract  and  afterward  dilate  the 
pupil. 

Internally. — Digestive  System. — Its  action  resembles  that  of 
strychnine,  though  excessive  doses  produce  greater  gastric  dis- 
turbance, almost  invariably  occasioning  vomiting. 

Circulatory  System. — Its  influence  is  similar  to  that  of  strych- 
nine, but  not  so  powerful.  In  its  effect  upon  the  white  blood-cor- 
puscles it  resembles  quinine,  arresting  their  movements. 

Nervous  System. — Here  also  the  action  of  hydrastis  is  analogous 
to  that  of  strychnine,  although  it  is  much  less  powerful,  while  more 
persistent.  It  differs  from  its  congener,  however,  in  its  effect  upon 
the  sensory  nerve-fibers,  very  large  doses  impairing  their  func- 
tional activity,  and,  when  locally'  applied,  producing  anesthesia. 

Respiratory  System. — In  its  action  upon  the  respiratory  system 
it  resembles  strychnine,  differing  in  no  essential  particular. 

Absorption  and  Elimination. — It  is  slowly  absorbed,  tending  to 
accumulate  in  the  system.  It  is  eliminated  chiefly  by  the  kidneys, 
increasing  slightly  the  urinary  flow. 

Temperature. — Medicinal  doses  have  no  effect ;  poisonous  doses 
decrease  bodily  heat. 

Eye. — It  has  no  particular  action  upon  the  eye,  other  than  to 
first  contract  and  then  dilate  the  pupil  when  directly  applied. 

Uterus. — Hydrastine  is  a  feeble  oxytocic,  affecting  the  womb  in 
a  manner  similar  to,  though  much  less  powerful  than,  ergot. 

Untoward  Action. — The  untoward  manifestations  are  essentially 
those  of  poisoning. 

Poisoning. — The  symptoms  are  almost  identical  with  those  of 
strychnine. 

Treatment  of  Poisoning. — The  same  as  that  of  poisoning  by 
strychnine. 

Therapeutics. — Externally  and  Locally. — Hydrastin  (the  yellow 
resinoid) — in  the  proportion  of  5  grains  (0.3  Gm.)  to  i  ounce  (30.0 
Cc.)  of  water,  or  the  fluid  extract  of  hydrastis,  15  to  20  minims 
(1.0-1.2  Cc.)  to4  ounces  (118  Cc.)  of  water — makes  an  efficient 
injection  in  gonorrhea. 

Hydrastine  (the  alkaloid),  or,  preferably,  hydrastine  hydro- 


MOTOR  EXCITANTS.  485 

CHLORATE — 3  grains  (1.2  Gm.)  to  i  ounce  (30.0  Cc.)  of  glycerin — 
affords  great  relief  in  certain  forms  of  chronic  conjunctivitis. 

Hydrastis  is  a  valuable  remedy  in  catarrh  of  the  upper  respira- 
tory tract. 

The  TINCTURE — I  fluidrachm  (3.7  Cc.)  to  i  ounce  (30.0  Cc.)  of 
water — is  a  valuable  mouth-wash  in  all  indolent  and  offensive  ulcera- 
tions of  the  mouth  and  throat,  such  as  syphilitic  and  mercurial  affec- 
tions, follicular  pharyngitis,  etc. 

The  FLUID  EXTRACT  serves  a  useful  purpose  in  the  local  treatment 
of  anal  fissure  and  of  rectal  ulcer,  vaginal  and  uterine  ulcerations, 
and  leucorrhea.  Indolent  ulcers  anywhere,  and  chancres  and  chan- 
croids, are  stimulated  to  a  healthier  condition  by  the  application  of 
this  preparation. 

An  ointment  of  hydrastine  hydrochlorate,  in  strength  vary- 
ing from  5-30  grains  (0.3-2.0  Gm.)  to  i  ounce  (32.0  Gm.)  of  simple 
ointment,  affords  an  efficient  local  application  in  acne  and  seborrhea 
sicca,  and  the  same  preparation  makes  a  serviceable  dressing  for 
ulcerated  carcinoma  and  bromidrosis. 

The  distilled  extract  of  witch-hazel  with  hydrastine  hydro- 
chlorate  is  recommended  in  hyperidrosis. 

Palmer  has  successfully  employed  inhalations  of  a  solution  of  i 
part  of  the  extract  to  3  parts  of  salt  water  in  tubercular  and  simple 
bronchitis.. 

The  topical  action  of  hydra^s  and  its  preparations  is  that  of  an 
antiseptic  and  tonic,  strengthening  the  circulation  and  nutrition, 
rendering  the  drug  peculiarly  valuable  in  diseases  of  mucous  sur- 
faces. 

Internally. — ^As  a  remedy  for  diseased  conditions  of  the  stomach 
and  bowels  it  is  of  much  the  same  value  as  the  vegetable  bitters, 
ai^d  may  be  used  for  the  same  purposes. 

Hydrastine  possesses  considerable  antiperiodic  power,  having 
been  employed  in  intermittent  fever  and  chronic  m.alaria,  though 
much  inferior  to  quinine,  and  probably  also  to  arsenic.  Its  bene- 
ficial action  in  these  conditions  is  undoubtedly  due  to  its  power  to 
iflicrease  the  functional  activity  of  the  liver,  this  influence  also  ren- 
dering it  valuable  in  chronic  constipation  induced  by  hepatic  inac- 
tivity— catarrhal  jaundice,  too,  being  frequently  relieved  by  the 
remedy. 

Hydrastine,  more  especially  hydrastine  hydrochlorate,  acts 
upon  the  uterus  very  much  like  ergot,  and  has  been  highly  recom- 
mended by  well-known  authorities  in  uterine  hemorrhage  and  other 


486  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

uterine  disorders  for  which  ergot  is  used.  By  careful  observers,  of 
experience  with  the  drug,  it  is  considered  superior  to  ergot  in  the 
hemorrhage  of  puberty  and  the  menopause,  as  well  as  in  congestive 
dysmenorrhea. 

Bossi,  who  has  employed  hydrastis  Canadensis  extensively  in 
obstetrical  practice,  regards  it  as  a  valuable  hemostatic,  believing 
it  to  be  much  safer  than  ergot  in  the  hands  of  ignorant  individuals 
and  midwives. 

Koniger  has  treated  hemoptysis  successfully  with  the  fluid 
EXTRACT  in  20-  or  30-minim  (1.2-2.0  Cc.)  doses,  repeated  several 
times  a  day.  The  drug  has  proved  equally  beneficial  in  arresting 
the  night-sweats  of  phthisis,  and  is  an  efficient  substitute  for  alco- 
holic stimulants  when  their  use  is  abandoned. 

Hydrastine  hydrochlorate  has  recently  been  favorably  men- 
tioned as  a  remedy  for  epilepsy,  strychnine-poisoning,  and  hydro- 
phobia. 

Contraindications. — The  same  as  for  vegetable  bitters,  strych- 
nine, and  ergot. 

Administration. — When  taken  for  its  action  upon  the  stomach 
and  bowels  it  should  be  given  before  meals ;  for  its  effect  on  the 
uterus  it  is  best  administered  in  divided  doses  or  the  hydrastine 
hydrochlorate  hypodermically. 

Rhus  Toxicodendron— Rhois  Toxicodendri— Rhus 
Toxicodendron.    JJ.  S.  JP. 

(Poison  Ivy.) 

Origin. — The  fresh  leaves  of  Rhus  radicans  L.,  a  climbing  shrub 
indigenous  in  Canada  and  the  greater  part  of  the  United  States 
westward  to  the  Rocky  Mountains. 

Description  and  Properties.— Long-petiolate,  trifoliate,  the  lat- 
eral leaflets  sessile  or  nearly  so,  about  4  inches  (10  Cm.)  long, 
obliquely  ovate,  pointed;  the  terminal  leaflets  stalked,  ovate  or 
oval,  pointed,  with  a  wedge-shaped  or  rounded  base ;  the  leaflets 
entire  and  glabrous  or  variously  notched,  coarsely  toothed,  or  lobed, 
more  or  less  downy  ;  when  dry  papery  and  brittle ;  inodorous  ;  taste 
somewhat  astringent  and  acrid.  The  fresh  leaves  abound  in  an 
acrid  juice  which  darkens  on  exposure  to  air,  and  when  applied  to 
the  skin  produces  inflammation  and  swelling.  The  leaves  should 
therefore  not  be  touched  with  the  bare  hands. 

The  fresh  leaves  contain  a  volatile  acid  (toxicodendric),  which 


MOTOR  EXCITANTS.  487 

is  almost  entirely  absent  in  the  dried  leaves.     In  addition  to  this 
active  constituent  the  leaves  contain  tannin. 
Dose. — 1-5  grains  (0.06-0.3  Gm.). 

Unofficial  Preparation. 

Tinctura  Rhtis  Toxicodfindri — Tincturae  Rhois  Toxicodgndri — Tincture  of 
Toxicodendron. — Dose,^^-2.xa\xi\Tas,  (0.006-0.12  Cc).  Prepared  from  fresh  plants 
— I  part  of  fresh  leaves  to  2  parts  of  alcohol. 

Physiological  Action. — Externally  and  Locally. — The  fresh 
leaves  of  this  common  plant  are  extremely  irritant  to  the  skin, 
generally  acting  as  a  marked  vesicant  and  establishing  severe  local 
inflammation,  manifested  by  acute  dermatitis,  excessive  edema,  and 
hyperemia.  In  many  cases  these  effects  are  much  less  pronounced, 
while  in  certain  individuals  they  are  never  occasioned  by  contact 
with  or  even  chewing  the  leaves.  As  with  poison  sumach — Rhus 
venenata — the  toxic  influence  of  the  plant  derived  from  local  appli- 
cation is  apparently  more  virulent  during  the  period  of  florescence. 

The  inflammation  somewhat  resembles  erysipelas,  being  rapidly 
diffused  and  accompanied  by  a  general  systemic  disturbance,  in- 
cluding abdominal  pains,  nausea,  and  vomiting,  with  perhaps  diar- 
rhea, diuresis,  and  serous  passages.  Profuse  diaphoresis  and  lum- 
bar and  articular  pains  may  also  result.  These  symptoms  cease 
after  about  ten  days  or  a  fortnight  without  other  sequel  than 
desquamation  of  the  affected  surface. 

Internally. — The  effects  of  the  drug  administered  internally  are 
to  cause  gastro-intestinal  inflammation,  with  drowsiness  and  stupor, 
and  occasionally  delirium  and  convulsions.  Vertigo,  nausea,  chilli- 
ness, thirst,  weak  and  irregular  cardiac  movements,  diaphoresis, 
muscular  debility,  and  diuresis  are  also  reported.  Dilatation  of  the 
pupils  is  also  a  result  of  ingestion  or  internal  absorption,  and  an 
illustration  of  the  virulence  of  the  drug  is  seen  in  the  fact  that  even 
air  impregnated  with  exhalations  from  the  leaves  may  cause  epi- 
dermic eruption,  while  the  berries  have  produced  serious  symptoms 
in  the  spinal  and  cerebral  systems,  and  in  an  authentic  case  the 
root  has  proved  notably  fatal.  1 

Treatment  of  Poisoning. — Many  remedies  have  been  used,  with 
varying  efficacy,  to  allay  the  toxic  effects  of  the  drug.  Dermal 
poisoning  has  been  relieved  by  glycerite  of  carbolic  acid  or  alkaline 
lotions.  In  the  earlier  stage  of  external  irritation  warm  soapsuds 
and  sodium  bicarbonate  have  been  successfully  applied.  Alum- 
curd,  ammonia  in  weak  solution,  solution  of  chlorinated  soda,  and 


488  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

many  other  agents  have  been  employed  to  meet  the  requirements 
of  certain  stages  of  the  affection.  A  solution  of  cocaine,  4  to  8 
per  cent.,  quickly  relieves  the  cutaneous  irritation ;  a  liquid  prepara- 
tion of  grindelia  robusta  makes  a  grateful  application ;  while  opium, 
coffee,  and  laxatives  would  be  indicated. 

Therapeutics. — Externally  and  Locally. — The  diluted  tincture — 
8  minims  (0.5  Cc.)  to  4  ounces  (118  Cc.)  of  water — has  met  with 
some  favor,  as  has  been  stated,  in  the  treatment  of  sprains,  burns, 
etc. 

In  weak  solution  with  alcohol  the  remedy  has  been  used  as 
a  stimulating  application  in  cases  of  sprains,  chilblains,  burns, 
insect-stings,  etc. 

Internally. — It  has  been  recommended  in  rheumatic  affections  of 
fibrous  tissues,  paralysis,  erysipelas,  herpes  zoster,  pemphigus,  eczema, 
and  erythema. 

Dr.  Rothrock  believes  it  to  be  a  valuable  cerebro-spinal  stimu- 
lant. 

It  has  been  supported  as  a  strong  palliative  or  cure  in  inconti- 
nence of  urine  depending  upon  atony  of  the  bladder. 

It  is  evident  that  the  drug  needs  to  be  much  more  thoroughly 
investigated,  there  being  widely  diverse  opinions  regarding  its  thera- 
peutic value.  There  is,  however,  sufficient  testimony  in  its  favor 
from  competent  authorities  to  justify  further  examination  and  use 
of  this  extremely  active  remedy. 

Contraindications. — The  meager  knowledge  we  possess  re- 
specting its  true  action  in  disease  renders  it  impossible  to  mention 
any  special  contraindication  to  its  employment. 

Administration. — The  tincture  is  the  only  preparation  used, 
and  should  be  cautiously  administered. 

Coca— Cocae— Coca.    TJ.  8.  -P. 

Origin. — The  leaves  of  Erythroxylon  Coca  Lam.,  a  shrub  about 
6  feet  (1.8  M.)  high,  with "  numerous  spreading  purplish-brown 
branches,  bearing  bright  green  leaves  varying  in  size  according  to 
the  nature  of  the  plant  or  of  the  soil  in  which  it  grows.  The 
flowers,  found  either  alone  or  in  clusters,  are  small,  regular,  her- 
maphrodite, white  or  greenish-yellow,  being  succeeded  by  small 
scarlet  berries. 

Coca  is  indigenous  in  the  mountains  of  Peru  and  Boliva,  and 
on  the  eastern  slopes  of  the  Andes  is  cultivated  in  damp,  warm 
valleys  from  3000  to  6000  feet  (914.5-1829  M.)  above  the  sea- 


MOTOR  EXCITANTS.  489 

level,  being  also  grown  in  some  parts  of  Colombia,  Brazil,  the 
Argentine  Republic,  and  the  island  of  Java.  The  province  of 
La  Paz  in  Bolivia  produces  the  largest  crops,  the  article  being 
more  highly  esteemed  than  the  Peruvian  variety.  Cocaine,  how- 
ever, is  obtained  from  leaves  of  the  Javanese  plant. 

Description  and  Properties. — In  size  and  shape  the  leaves 
resemble  those  of  tea,  ovate,  lanceolate,  or  obovate-oblong,  from 
f  to  2  or  2|  inches  (2-5  or  7  Cm.)  long  and  i  to  i  J  inches  (25- 
37  Mm.)  broad ;  short-petiolate,  entire,  rather  obtuse  or  emarginate 
at  the  apex,  slightly  reticulate  on  both  sides,  with  a  prominent 
midrib,  and  on  each  side  of  it  a  curved  line  running  from  base  to 
apex ;'  odor  slight  and  tea-like,  taste  somewhat  aromatic  and  bitter, 
when  chewed  temporarily  benumbing  the  lips  and  tongue. 

The  active  constituent  is  the  alkaloid  cocaine.  The  plant  also 
contains  two  other  alkaloids — ecgonine  and  hygrine,  and  a  peculiar 
tannin,  coca-tannic-acid,  having  a  green  reaction  upon  salts  of  iron. 

Dose. — J-4  drachms  (2.0-16.0  Gm.). 

Official  Preparation. 

Extrdctum  C5cx  Fluidum — ExtrScti  Cocse  Fluidi — Fluid  Extract  of  Coca. 

— Dose,  20  minins-l  fluidrachm  (1.2-4.0  Co.). 

Cocaina — Cocalnse — Cocaine  (unofficial). — Description  and  Properties. — Color- 
less, prismatic  crystals,  of  a  strongly  alkaline  reaction.  The  taste  is  bitterish  and  pro- 
duces a  transient  numbness  of  the  tongue.  Soluble  in  704  parts  of  water,  in  much  less 
alcohol  and  ether,  aMd  in  fixed  oil. 

Dose. — \-\  grain  (0.03-0.06  Gm.). 

Cocalnae  Hydrochloras— Cocainse  Hydrochloratis— 
Cocaine  Hydrochlorate.    V.  S.  JP. 

This  is  the  only  official  salt  of  cocaine,  and  the  one  almost 
invariably  used  in  medicine. 

Description  and  Properties. — Colorless,  transparent  crystals 
or  a  white,  crystalline  powder,  odorless,  of  a  saUne,  slightly  bitter 
taste,  and  producing  upon  the  tongue  a  tingling  sensation  followed 
by  numbness  of  some  minutes'  duration.  Permanent  in  air,  soluble 
in  0.48  part  of  water  and  3.5  parts  of  alcohol;  very  soluble  in 
boiling  water  and  in  boiling  alcohol. 

Dose. — -1—2  grains  (0.008-0.12  Gm.). 

Cocainx  Phenas — Cocainse  Phenatis — Cocaine  Phenate  (unofficial). — This 
salt  contains  about  75  per  cent,  of  the  alkaloid. 

Description  and  Properties. — It  occurs  as  a  yellow,  viscid  mass.  Soluble  in  alcohol, 
insoluble  in  water. 

Dose. — j'j-J  grain  (0.005-0.01  Gm.). 


490  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Antagonists  and  Incompatibles. — Morphine,  chloral,  amyl- 
nitrite,  alcohol,  chloroform,  and  ether  are  physiological  antagonists. 
The  most  direct  opponents  are  chloral  and  morphine. 

Cocaine  is  incompatible  with  caustic  alkalies  and  the  alkaline 
carbonates  and  bicarbonates,  as  well  as  with  bichloride  of  mercury, 
iodine  and  the  iodides,  ammonia,  zinc  chloride,  and  borax. 

Synergists. — Medicinally,  its  cerebral  effects  may  be  enhanced 
by  the  cerebral  stimulants,  such  as  alcohol,  cannabis  Indica,  and 
belladonna,  while  its  analgesic  and  anesthetic  action  may  be  aided 
by  carbolic  acid,  atropine,  opium,  and  conium.  When  used  as 
a  mydriatic  atropine  serves  as  a  valuable  synergist. 

Physiological  Action. — For  our  first  knowledge  of  the  physio- 
logical properties  of  coca  we  are  indebted  to  its  empirical  use 
among  the  natives  of  Peru.  The  history  of  the  drug  is  replete 
with  interest  and  romance.  It  was  regarded  as  the  living  repre- 
sentation of  the  Deity,  the  ground  whereon  it  grew  being  held , 
sacred.  During  the  reign  of  the  Incas  its  use  was  a  royal  privi- 
lege, the  people  being  compelled  to  obtain  permission  from  the 
governor  to  avail  themselves  of  its  benefits.  Later  it  was  adopted 
indiscriminately. 

The  native  coqueros  (coca-chewers)  have  learned  from  experi- 
ence that  they  can  climb  the  Andes,  work  laboriously  in  the  mines, 
and  endure  fatigue  and  hunger  more  hardily  when  chewing  the 
leaves  of  the  plant,  and  from  time  immemorial  the  drug  has  been 
recognized  by  observers  as  possessing  powerful  nutritive,  stimulant, 
and  restorative  properties. 

In  describing  the  action  of  the  crude  drug  the  author  can  add 
little  to  the  words  of  Linnffius,  who  long  ago  wrote  that  coca 
possessed  "the  penetrating  aroma  of  vegetable  stimulants,  the 
astricting  and  fortifying  virtues  of  an  astringent,  the  antispasmodic 
qualities  of  bitters,  and  the  mucilaginous,  nutritive  properties  of 
analeptics  or  of  alimentary  plants."  "  This  leaf,"  he  adds,  "  ex- 
hibits with  energy  its  action  on  all  parts  of  the  animal  economy. 
Ohdo  in  nervos,  sapidq  in  fibras,  utroque  in  fluido!' 

Since  the  isolation  of  the  alkaloid  cocaine,  to  which  the  drug 
owes  its  physiological  and  medical  properties,  by  Gaedeke  in  1855, 
and  the  subsequent  study  of  it  by  eminent  pharmacologists  and 
therapeutists,  we  have  learned  more  of  the  physiological  action  of 
coca.  Its  effect  upon  different  systems  are  here  described  in 
detail. 

Externally  and  Locally. — Cocaine  is  analgesic,  anesthetic,  and 


MOTOR  EXCITANTS.  .  491 

ischemic.  Upon  the  unbroken  skin  it  has  no  action,  but  upon 
mucous  membranes  or  the  subcutaneous  tissue  it  produces  com- 
plete local  anesthesia.  The  surface  to  which  it  is  applied  becomes 
paler  than  normal,  owing  to  contraction  of  the  blood-vessels,  but 
afterward  reddens  and  acgears  turgescent  through  secondary  dila- 
tation of  th^|gselSj^^Ii^^l^iDrndon  of  the  drug  by  mucous 
membranes  ^W^PHE^fc^cgS^^S^  which  it  is  applied — with 
difficulty  from  the  conjmctrva,^^feT^tj^^great  readiness  from  the 
Schneiderian  membrane,  producing  its  characteristic  constitutional 
effects. 

Applied  to  the  conjunctiva,  or  even  taken  internally,  cocaine 
causes  a  transitory  contraction  of  the  pupil,  soon  followed  by  dila- 
tation. The  accommodation  is  impaired,  but  not  completely  de- 
stroyed, the  ocular  tension  being  lowered. 

The  anesthetic  action  of  cocaine  applied  locally  is  due  to  the 
depression  of  the  ends  of  the  sensory  nerves.  It  dilates  the  pupil 
by  stimulating  the  ends  of  the  sympathetic  nerve,  which  innervates 
the  radiating  fibers  of  the  iris.  «,^ 

In  addition  to  its  local  analgesic  action  the  drug  possesses  the 
power  of  destroying  the  functions  of  the',  nerves  of  special  sense, 
so  that  taste  and  smell,  as  well  as  the  tactile  sense,  are  abolished. 
When  applied  locally  or  taken  internally  it  primarily  checks  many 
of  the  secretions,  though  those  from  the  pancreas  and  liver  seem 
to  be  uninfluenced  by  its  internal  use.  The  secondary  impression 
of  cocaine,  however,  when  the  blood-vessels  become  dilated,  is 
accompanied  by^SMflSfd  secretion. 

Frangois-Fra^pP^mo  has  made  an  exhaustive  study  of  the 
local  action  o^^^aine,  contends  that  it  is  "  a  powerful  paralyzfrig 
poison,  acting  alike,  on  saispry  and  motor  nerve-endings,  on  all 
kinds  of  peripheral  ne^^^Ji^erve-centers,  muscles, 
epithelium,  leucocytes,  vegetable  "protoplasm,  micro-organ^ 
etc." 

Internally. — Digestive  System. — On  account  of  its  stimulant 
action  upon  the  constrictor  fibers  of  the  great  sympathetic  nerve, 
under  the  influence  of  moderate  doses  peristalsis  is  largely  increased 
in  the  stomach  and  intestines,  very  large  or  poisonous  doses,  on 
the  contrary,  causing  great  sluggishness  of  the  bowels. 

Although  it  has  been  shown  by  experiments  upon  animals  that 
cocaine  is  incapable  of  sustaining  life,  it  diminishes  in  man  the  sen- 
sation of  hunger,  owing  to  its  local  anesthetic  action  upon  the 
mucous  membrane  of  the  stomach,  so  that  the  coqueros  are  able  to 


492  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

abstain  from  food  for  days,  thirst  also  being  allayed.  This  diminu- 
tion of  hunger  does  not  seem  to  impair  appetite  and  digestion, 
since  food  is  subsequently  relished  and  digested  as  well  as,  if  not 
better  than,  if  coca  had  not  been  used. 

Circulatory  System. — Medicinal  doses  of  cocaine  increase  the 
force  and  frequency  of  the  cardiac  contractions,  and  also  arterial 
pressure.  Large  or  poisonous  doses  render  the  pulse  slow,  soft, 
and  weak,  and  lower  arterial  tension.  The  exact  modus  operandi  is 
not  fully  determined,  such  eminent  authorities  as  Mosso,  Von 
Aurep,  Vulpian,  Ott,  Nikolsky,  and  others  differing  as  to  its  action 
upon  the  circulatory  apparatus.  It  is  quite  probable  that  its  action 
is  similar  to  that  of  atropine  in  this  respect. 

Nervous  System. — When  given  internally  its  first  action  is  upon 
the  brain,  moderate  doses  greatly  stimulating  the  intellectual  facul- 
ties and  producing  a  feeling  of  ecstasy  and  well-being,  in  many 
respects  akin  to  the  sensations  experienced  under  the  action  of 
cannabis  Indica.  In  the  course  of  a  few  hours  the  stage  of  cere- 
bral excitement  is  succeeded  by  mental,  moral,  and  muscular 
depression. 

Toxic  doses  result  in  incoherent  speech  and  wild  delirium, 
accompanied  by  swaying  of  the  head,  followed  by  epileptiform  con- 
vulsions and  narcosis.  The  convulsions  are  of  cerebral  origin,  the 
effect  of  cocaine  upon  the  spinal  cord  being  yet  but  imperfectly 
understood. 

The  sensory  nerves  are  depressed  by  small  and  paralyzed  by 
lethal  doses.  The  motor  nerves  are  also  depressed  by  large  doses, 
this  action,  however,  being  subordinate  to  that  exerted  upon  the 
sensory  nerves.  The  muscles  are  stimulated  by  medicinal  doses 
through  impression  upon  the  motor  tracts,  although  large  doses 
greatly  depress  muscular  activity.  The  chewing  of  coca,  as  prac- 
tised by  the  natives  of  Peru  and  Bolivia,  undoubtedly  appears  to 
augment  muscular  strength  and  powers  of  endurance. 

Mosso  claims  that  small  doses  of  cocaine  serve  as  a  power- 
ful muscular  stimulant  in  cases  of  exhaustion  from  hunger  or 
fatigue. 

Laffont  states  that  cocaine  possesses  an  "  excito-functional  action 
on  the  great  sympathetic  constrictor  nerve,  consequently  an  exalta- 
tion of  the  functional  action  of  all  the  non-striated  muscles  or 
muscles  of  organic  life  which  are  subordinated  to  it." 

Respiratory  System. — Medicinal  doses  powerfully  stimulate  the 
respiratory  center,  increasing  the  rapidity  and  depth  of  the  respira- 


MOTOR  EXCITANTS.  493 

tions.  Poisonous  doses  paralyze  the  center,  the  result  being  dys- 
pnea, feeble  breathing,  and  death  from  respiratory  failure. 

Absorption  and  Elimination. — Cocaine  is  quickly  absorbed,  being 
eliminated  principally  by  the  kidneys  in  a  form  differing  from  its 
original  nature.  Much  of  it  undergoes  oxidation  in  the  body. 
The  amount  of  urine  is  increased,  though  the  nitrogenous  ele- 
ments are  diminished.  The  habitual  use  of  the  drug  lessens  urinary 
secretion. 

Cocaine  possesses  no  cumulative  action,  although  its  effects 
become  more  marked  under  repeated  dosage,  due  probably  to 
some  special  dynamic  action  upon  the  nervous  system. 

Temperature. — Medicinal  doses  have  no  influence  on  bodily 
heat,  but  poisonous  doses  usually  raise  the  temperature,  owing, 
according  to  Reichert,  to  an  increase  of  heat-production. 

Eye. — Cocaine  produces  a  noticeable  dilatation  of  the  pupil,  as 
already  explained  under  "  Local  Action,"  the  maximum  change 
being  reached  in  about  an  hour,  and  the  normal  state  regained  in 
from  twelve  to  twenty-four  hours. 

Cocaine-poisoning. — Among  the  more  prominent  physiological 
symptoms  resulting  from  the  ingestion  of  excessive  doses  of  coca- 
ine or  repeated  and  continued  injections  are  a  tendency  to  coma 
or  collapse ;  a  feeble,  thready  pulse,  often  running  extremely  high ; 
great  emaciation ;  anorexia  and  impairment  of  the  digestive  powers ; 
and  increased  frequency,  and  again  alarming  depression,  of  respira- 
tion. There  are  other  symptoms,  scarcely  less  serious,  which,  as 
the  majority  of  observations  show,  render  cocaine  one  of  the  most 
generally  deleterious  of  drugs,  opium  not  excepted.  Dropsy,  ma- 
rasmus, numbness,  syncope,  profound  malaise,  muscular  twitchings 
with  mild  convulsions,  insomnia,  amblyopia,  mydriasis,  visual  hal- 
lucinations, headache,  vertigo,  dangerously  elevated  temperature, 
dental  decay,  and  fetid  breath, — even  this  admonitory  catalogue  of 
ills  fails  to  complete  the  recorded  phenomena  attending  poisoning 
from  cocaine. 

Yet,  grave  as  are  the  foregoing  physical  changes  incident  to  an 
immoderate  use  of  the  drug,  the  mental  and,  above  all,  the  moral 
effects  of  cocaine-poisoning  are  far  more  deplorable.  It  is  a  melan- 
choly but  indubitable  fact  that  to  one  fully  committed  to  the  so-called 
"  cocaine  habit "  there  appears  at  times  no  principle  of  honor  or  deco- 
rum to  which  the  vitiated  sensibilities  are  amenable.  The  enfeeble- 
ment  of  the  intellectual  faculties,  the  loss  of  memory,  inability  to 
coordinate  or  control  ideas,  a  consciousness  occasionally  merged 


494  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

in  pronounced  mania,  possibly  with  homicidal  inclination,  and  an 
intense  selfishness  of  thought  and  purpose,  in  which  apathy,  neg- 
lect of  domestic  obligations,  and  complete  debasement  of  nobler 
qualities  are  developed, — these  lamentable  accompaniments  mani- 
fest too  clearly  the  degenerating  influences  exerted  by  a  constant 
resort  to  the  use  of  this  ill-fated,  if  not  fatal,  drug. 

An  instance  coming  under  the  author's  personal  observation 
will  serve  to  illustrate  the  entire  lapse  of  the  subject's  morale. 
The  case  is  that  of  a  well-known,  successful,  and  highly  esteemed 
practitioner,  who,  becoming  addicted  to  the  employment  of  cocaine 
as  an  alleviation  for  bodily  and  mental  depression,  reiached  at  last 
a  stage  of  moral  degradation  in  which  he  neither  shrank  from 
lying  and  stealing  nor  considered  any  means  of  gratifying  his  dis- 
eased appetite  too  abject — the  persuasions  of  friends,  the  considera- 
tions of  professional  duty  and  social  position,  and  the  distracted 
appeals  of  his  own  family  being  alike  unavailing  to  arrest  the  passion 
to  which  he  had  succumbed.  It  is  grateful  to  record  that  from  his 
moral  turpitude  the  subject  at  length  emerged  triumphantly,  to-day 
occupying  a  proud  position  reflecting  honor  upon  himself  and  his 
profession. 

A  still  more  distressing  case,  in  that  it  was  attended  with  fatal 
results,  is  that  of  a  physician  personally  known  to  the  author 
who,  contracting  the  cocaine  habit,  in  blind  folly  administered 
the  drug  to '  his  wife  and  child,  all  dying  within  the  period  of  a 
few  months. 

The  desperation  to  which  the  cocaine  habitue  may  be  driven  in 
his  temporary  madness  is  shown  in  the  case  of  a  young  man  scarcely 
twenty  years  of  age,  son  of  an  eminent  surgeon,  who,  the  author 
is  authentically  informed,  during  a  journey  by  rail  in  which  he  was 
deprived  of  the  customary  facilities  for  hypodermic  injection,  ripped 
open  his  arm  with-  a  pocket-knife  and  poured  the  drug  into  the 
wound. 

In  such  cases  the  salient  features  of  the  malady  may  be  prop- 
erly regarded  as  allied  to  those  of  acute  mania,  the  treatment  being 
exceedingly  difficult — the  more  so  because  of  the  absence  of  deter- 
rent motives  prompted  by  conscience,  which  in  the  course  of  the 
indulgence  becomes  torpid  or  perverted.  There  is,  moreover,  with 
cocaine-poisoning  always  danger  of  deliberate  or  involuntary  relapse. 

It  frequently  happens  that  cocainism  arises  from  a  desire  to 
relieve  effects  produced  by  the  immoderate  use  of  opium.    Yet  the  ■ 
latter  drug,  being  taken  to  offset  the  influence  of  cocaine,  in  reality 


MOTOR  EXCITANTS.  495 

but  aggravates  the  evil,  the  two  agents  interacting  and  still  further 
lessening  the  chances  of  recovery. 

Treatment  of  Poisoning. — Several  antidotes  have  been  favorably 
adopted — amyl  nitrite,  caffeine,  atropine,  and  inhalations  of  ammonia. 
Chloroform,  ether,  subcutaneously  injected,  and  strychnine  have 
also  proved  more  or  less  efficient  remedies. 

With  regard  to  the  withdrawal  of  cocaine,  equally  competent 
authorities  appear  to  differ,  the  immediate  cessation  of  the  drug 
being  advocated,  and  again  this  course  condemned  as  liable  to 
produce  collapse.  The  author  is  of  the  opinion  that,  as  in  other 
respects,  the  procedure  followed  in  the  treatment  of  the  opium 
habit  is  the  wisest  and  safest. 

The  disease,  however,  at  least  during  its  more  serious  manifes- 
tations, is  essentially  allied  to  insanity,  and  permanent  cure  must 
look  to  the  rationale  of  the  conditions,  with  the  paramount  object 
of  restoring  to  its  normal  activity  the  moral  tone  of  the  patient's 
thought  and  desire.  That  complete  regeneration  of  mind  and  body 
may  be  reasonably  contemplated  is  amply  attested  by  the  case 
above  cited ;  nor  should  discouragement  deter  the  physician  from 
his  task,  nor  measures  of  untimely  severity  be  suffered  to  exas- 
perate and  confirm  an  untoward  mental  state  possibly  susceptible 
of  intelligent  control. 

Therapeutics. — Externally  and  Locally. — The  indications  for 
the  local  anesthetic  action  of  cocaine  are  very  numerous.  The 
general  surgeon  will  find  many  opportunities  to  employ  the  drug 
advantageously ;  indeed,  in  many  instances  it  has  replaced  all 
other  anesthetics.  In  many  operations  on  the  genito-urinary  tract, 
rectum,  nose,  throat,  ear,  and  eye  it  serves  a  most  valuable  pur- 
pose. The  urethra  can  be  rendered  perfectly  insensible  to  pain  by 
the  application  of  a  2  to  4  per  cent,  solution,  repeated  two  or  three 
times  at  intervals  of  fiye  or  ten  minutes.  Even  the  sensibihty  of 
the  bladder  itself  can  be  benumbed  to  a  great  extent  by  the  local 
application  of  a  cocaine  solution,  so  that  sounding  for  stone  may  be 
painlessly  accomplished.  A  case  of  lithotrity  is  reported  in  which, 
without  suffering,  an  operation  was  performed  in  fifteen  minutes, 
the  only  anesthetic  used  being  a  solution  of  cocaine  applied  to  the 
parts. 

Urethral  caruncles  may  be  removed  successfully  and  without 
inconvenience  to  the  patient  by  the  injection  of  a  4  per  cent,  solu- 
tion at  the  lines  of  attachment.  An  injection  of  a  small  amount 
-of  the  same  solution  into  the  cellular  tissue  of  the  prepuce  pre- 


496  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

vents  pain  in  circumcision  and  in  the  operation  for  phimosis.  In 
the  treatment  of  fistula  in  ano,  hemorrhoids,  both  internal  and 
external,  and  other  diseases  of  the  rectum,  cocaine  is  of  signal  value. 

An  OINTMENT  OF  COCAINE,  4  per  cent,  strength,  affords  a  grateful 
anodyne  dressing  for  burns,  it  being  borne  in  mind  that  in  all  cases 
where  ointments  of  this  drug  are  used  the  alkaloid  cocaine,  and 
not  its  salts,  is  to  be  employed. 

Cocaine  is  an  important  anesthetic  in  many  minor  operations, 
such  as  opening  of  felons,  abscesses,  etc. ;  it  is  also  highly  service- 
able in  dentistry  and  for  the  removal  of  small  neoplasms.  Prob- 
ably its  most  extensive  use  in  this  respect  is  in  operations  upon 
the  eye,  nose,  and  throat,  its  widest  field  of  usefulness  being  in 
operative  ophthalmic  surgery. 

The  following  prescription  makes  an  efficient  application  for 
the  relief  of  many  of  the  distressing  symptoms  of  acute  coryza 
and  hay  fever : 

R.  Cocainse  hydrochloratis,  gr.  x    (0.6    Gm.); 

Menthol,  gr.  xij  (0.72  Gm.) ; 

Pulveris  camphorae,  gr.  iij    (0.2    Gm.) ; 

Pulveris  magnesise, 

Sacchari  lactis,  aa.  gij         (8.0  Gm.). 

M. — Sig.  Use  a  small  portion  as  a  snuff  twice  a  day. 

A  small  quantity  of  morphine  sulphate  is  sometimes  an  excellent 
addition  to  the  above. 

The  peculiar  qualities  of  cocaine  render  it  one  of  the  safest,  as 
well  as  most  convenient  and  serviceable,  mydriatics.  It  quickly 
dilates  the  pupil,  which  regains  its  normal  condition  in  from  ten  to 
twenty  hours.  The  dilatation,  too,  is  easily  overcome  by  the 
application  of  eserine,  a  solution  of  \  grain  (0.03  Gm.)  to  i  ounce 
(30.0  Cc.)  of  the  latter  drug  being  strong  enough  to  neutralize  the 
effects  of  a  4  per  cent,  solution  of  cocaine. 

It  should  be  remembered  that  local  applications  to  the  conjunc- 
tivjE,  nares,  and  fauces  may  produce  in  susceptible  persons  systemic 
effects. 

Cocaine  combined  with  atropine  forms  a  mydriatic  which  for 
many  purposes  is  superior  to  either  drug  separately,  the  mydriasis 
being  of  longer  duration  than  that  produced  by  cocaine,  while  the 
paralysis  of  the  accommodative  apparatus  is  briefer  than  that 
occasioned  by  atropine. 

The  PHENATE  OF  COCAINE  is  less  toxic  than  the  hydrochlorate. 


MOTOR  EXCITANTS.  497 

owing  to  its  power  of  coagulating  albumin,  and  thereby  being  less 
readily  absorbed.  It  is  also  more  agreeable  to  the  taste.  While  it 
does  not  produce  anesthesia  so  readily  as  the  hydrochlorate,  its 
effect  is  more  permanent,  and,  in  addition,  it  possesses  powerful 
antiseptic  properties.  By  many  physicians  it  is  preferred  in  laryn- 
gological  work. 

Internally. — Coca  has  been  successfully  used  in  gastralgia  and 
to  improve  the  digestion.  Cocaine  is  frequently  an  efficient  remedy 
in  sea-sickness  and  to  allay  excessive  vomiting. 

Bartholow  has  highly  recommended  the  drug  in  chorea,  asthma, 
paralysis  agitans,  and  alcoholic  and  senile  tremor.  It  has  also  been 
suggested  as  a  cure  for  the  opium.,  alcohol,  and  tobacco  habits. 

The  WINE  OF  COCA  is  an  excellent  tonic  during  convalescence 
from  acute  disease  and  in  debilitated  conditions  generally.  It  has 
been  extensively  employed  in  melancholia. 

Cocaine  combined  with  atropine  is  said  to  make  an  efficient 
hypnotic. 

Contraindications. — No  special  or  distinct  contraindication  to 
its  use  exists.  In  diseases  of  the  kidneys  with  diminished  urinary 
flow  it  should  be  cautiously  administered,  lest  cumulative  effects 
ensue.  With  subjects  suffering  from  weak  or  diseased  heart  similar 
caution  is  to  be  used. 

Administration, — For  hypodermic  use  solutions  of  from  2  to 
5  per  cent,  are  generally  employed. 

It  should  be  noted  that  children  and  females  require  smaller 
doses  of  the  drug. 

It  is  altogether  probable  that  many  of  the  coca  wines  on  the 
market  contain  varying  quantities  of  cocaine.  The  reckless  and 
indiscriminate  prescription  of  these  preparations,  therefore,  is  liable 
to  induce  the  cocaine  habit.  It  is  questionable,  indeed,  whether 
the  admini-stration  of  cocaine  with  a  view  to  curing  the  intemperate 
use  of  opium,  alcohol,  or  tobacco  is  wise.  It  frequently  happens 
that  patients  thus  treated  lose  their  craving  for  the  latter  drugs 
only  to  acquire  an  inordinate  appetite  for  cocaine,  which,  as  has 
been  shown,  is  possibly  more  dangerous  than  either  of  them  in  its 
physical  and  moral  effects. 
32 


498  A    TEXT-BOOK  OF  MA  TERIA  MEDIC  A. 

GROUP  VII.— MOTOR   DEPRESSANTS. 
Conlum— Conli— Conium.    U.S.  I*. 

(Hemlock.) 

Origin. — The  full-grown  fruit  of  Conium  maculatum  L.,  gath- 
ered while  yet  green.  Spotted  hemlock  is  a  biennial  indigenous 
in  the  temperate  regions  of  Asia,  Europe,  and  Northern  Africa,  and 
naturalized  in  some  portions  of  New  England,  New  York,  and 
South  America.     It  grows  in  waste  places  and  along  streams. 

Description  and  Properties. — About  \  inch  (3  Mm.)  long, 
broadly  ovate,  laterally  compressed,  grayish-green,  often  divided 
into  two  mericarps,  each  with  five  crenate  ribs,  without  oil-tubes, 
and  containing  a  seed  grooved  on  the  face ;  odor  and  taste  slight 

When  triturated  with  solution  of  potassium  or  sodium  hydrate 
conium  gives  off  a  strong,  disagreeable,  mouse-hke  odor. 

The  most  important  constituent  is  a  volatile  liquid  alkaloid, 
coniine.  It  also  contains  methyl-coniine,  conhydrine,  and  its  isomer 
pseudo-conine. 

Dose. — 1-5  grains  (0.06-0.3  Gm.). 

Official  Preparations. 

Extractum  Conii — ExtrScti  Conii — Extract  of  Conium. — Dose,  \-i  grain 
(0.03-0.06  Gm.). 

ExtrSctum  Conii  Fliiidum — ExtrScti  Conii  Fliiidi — Fluid  Extract  of  Co- 
nium.— Dose,  1-5  minims  (0.06-0.3  Cc). 

Unofficial  Preparations. 

Tinctiira  Conii — Tincturae  Conii— Tincture  of  Conium  (15  per  cent.).— Z>ok, 
10-30  minims  (0.6-1.8  Co.). 

Sttccus  Conii — Silccus  Conii — Conium  Juice. — Dose,  \-2  fluidrachms  (1.8-7.4 
Co.).  The  juice  expressed  from  fresti  leaves,  and  \  volume  of  alcohol  added  to  pre- 
serve it. 

Coniina — Coniinae— Coniine. — Description  and  Properties. — A  colorless,  inflam- 
mable, oily  liquid,  having  a  strong  alkaline  reaction  and  a  penetrating,  suffocating  odor. 
It  is  soluble  in  all  proportions  in  alcohol,  ether,  chloroform,  benzene,  benzin,  and  fixed 
oils.  It  requires  100  parts  of  cold  water  for  solution,  the  liquid  becoming  turbid  on 
warming. 

Dose. — j'^j-l  minim  (0.006-0.06  Cc). 

Coniinse  Hydrobromas — Coniinae  Hydrobromatis — Coniine  Hydrobro- 
mate. — Description  and  Properties. — It  occurs  in  colorless,  transparent  prisms ;  soluble 
in  water  and  alcohol  in  the  proportion  of  I  to  2  parts ;  very  slightly  soluble  in  ether. 

Dose. — ylj-l  grain  (0.002-0.06  Gm.). 


Antagonists  and  Incompatibles. — Nux  vomica  and  its  alka- 


MOTOR  DEPRESSANTS.  499 

loids,  cocculus  and  picrotoxin,  are  antagonistic  to  conium.  Tannic 
acid  and  the  alkalies  are  chemically  incompatible. 

Synergists. — The  motor  depressants  and  morphine. 

Physiological  Action. — Externally  and  Locally. — Coniine,  the 
active  principle  of  conium,  has  no  effect  upon  the  unbroken  skin. 
Applied  to  bruised  surfaces,  it  has  been  thought  to  possess  anes- 
thetic or  analgesic  properties. 

The  specific  behavior  of  the  drug,  however,  renders  the  above 
action  problematical,  according  to  some  authorities. 

Internally. — Digestive  System. — Conium  increases  the  salivary- 
secretion,  and  when  taken  into  the  stomach  exerts  no  special  action 
upon  the  digestive  system,  other  than  an  occasional  disturbance  of 
the  gastro-intestinal  tract,  possibly  resulting  in  vomiting  and  diar- 
rhea under  full  dosage. 

Circulatory  System. — Although  when  ingested  coniine  is  rapidly 
absorbed  by  the  blood ;  circulating  in  the  system  unchanged,  its 
action  is  not  clearly  defined,  though  it  has  been  held  that  the  cir- 
culation is  first  accelerated  and  then  retarded,  with  a  lowering  of 
arterial  pressure  preceded  by  a  decided  increase. 

From  its  capacity  to  paralyze  the  terminal  vagi  it  is  natural  to 
suppose  that  it  increases  the  rapidity  of  the  cardiac  movements, 
yet  a  characteristic  feature  of  the  absorption  of  coniine  is  the  appar- 
ent absence  of  cardiac  derangement,  the  heart,  as  well  as  the  mind, 
remaining  unaffected  in  the  presence  of  alarming  symptoms. 

Nervous  System. — The  brain  is  unaffected,  consciousness  being 
preserved  to  the  last;  muscular  irritability  is  uninfluenced;  and 
even  under  large  doses  there  is  little  impression  made  upon  the 
nerves  beyond  a  slight  impairment  of  their  conductivity,  although 
the  motor  mechanism  is  peculiarly  susceptible  to  the  effects  of  the 
drug,  which  acts  as  a  powerful  depressant  upon  their  functional 
energy.  This  latter  influence  is  first  manifested  in  the  peripheries, 
gradually  ascending  until  the  spinal  cord  is  involved,  the  reverse 
process  marking  the  effects  of  methyl-coniine. 

Respiratory  System. — Large  or  poisonous  doses  act  as  depres- 
sants upon  the  respiratory  center  in  the  medulla,  and,  although  the 
breathing  may  at  first  be  normal,  paralysis  and  asphyxia  may  finally 
result  from  immoderate  ingestion. 

Absorption  and  Elimination. — The  drug  is  readily  absorbed, 
elimination  taking  place  by  various  channels,  but  chiefly  through 
the  kidneys  and  by  expiration.  Coniine  has  been  detected  in  con- 
siderable quantities  in  the  liver,  lungs,  and  spleen. 


500  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Temperature. — It  has  been  held  that  bodily  temperature  is  per- 
ceptibly lowered  by  conium,  proportionately  with  the  extent  of  the 
paralysis  occasioned.  High  authorities,  however,  assert  an  increase 
of  temperature  under  both  therapeutic  and  toxic  doses. 

Eye. — Heaviness  of  the  eyelids,  dilated  pupils,  accompanied  by 
double  or  confused  vision  and  occasionally  entire  loss  of  sight, 
have  been  noted  among  the  symptoms  incident  to  the  administra- 
tion of  active  dosage.  The  effects  thus  recorded  have  been  ascribed 
to  paralysis  of  the  third  nerve  rather  than  to  stimulation  of  the 
sympathetic. 

Poisoning. — A  frequent  symptom  of  conium-poisoning  is  ptosis, 
arising  from  paralysis  of  the  oculo-motor  nerves.  Staggering  gait, 
general  muscular  relaxation,  impairment  of  vision,  nausea,  and  ver- 
tigo are  also  not  infrequent.  The  severer  symptoms  are  marked 
by  muscular  paralysis  of  the  extremities,  derangement  of  vocal 
organs  resulting  in  difficulty  of  speech,  and  dilatation  of  the  pupils. 
The  brain  meanwhile  remains  unaffected  until  overcome  by  the 
accumulation  of  carbonic-acid  gas  in  the  blood,  when  delirium  and 
coma  may  ensue,  and  finally  cerebral  convulsions  and  fatal  collapse 
through  respiratory  failure. 

With  regard  to  the  effect  of  toxic  doses  upon  the  heart  conflict- 
ing statements  are  recorded,  experiment  having  proved  that  in 
warm-blooded  animals  the  cardiac  movements  speedily  cease,  it 
being  authoritatively  stated,  on  the  other  hand,  that  the  drug  exerts 
no  influence  upon  the  heart. 

Treatment  of  Poisoning. — The  stomach  should  be  evacuated  by 
means  of  emetics  or  lavage,  after  which  tannic  acid  and  the  phys- 
iological antidotes  may  be  administered — tetanizing  agents,  such 
as  strychnine  and  picrotoxin,  with  alcoholic  stimuli  if  necessary. 
Coffee  and  also  hypodermic  injections  of  atropine  have  been 
highly  recommended.  Muscular  exercise  has  been  known  to  delay 
the  action  of  the  poison,  and  free  counter-irritation  by  mustard 
may  be  serviceable. 

Therapeutics. — Externally  and  Locally. — In  many  respects 
the  medicinal  operation  of  conium  bears  no  relation  to  its  physio- 
logical action.  Experimentation  shows  that  it  exerts  but  a  feeble 
action  upon  the  sensory  nerves,  yet  clinical  experience  establishes 
its  value  in  mitigating  the  pain  of  cancer  when  locally  appUed.  In 
ulcerating  cancer  of  the  breast  especially,  poultices  composed  of 
conium  leaves  afford  wonderful  relief  from  pain  and  greatly 
improve  the  condition.     A  similar  application  has  proved  beneficial 


MOTOR  DEPRESSANTS.  501 

in  scrofulous  glandular  sores.  Dewees  has  recommended  an  injec- 
tion composed  of  the  extract  3  parts  to  water  16  parts  in  uterine 
cancer. 

Ovarian  menorrhagia  is  well  treated  by  inserting  in  the  vagina 
once  or  twice  daily  a  suppository  containing  i  or  2  grains  (0.06- 
0.12  Gm.)  of  CONIUM. 

Acute  laryngitis  may  be  greatly  relieved  by  the  inhalation  of  a 
solution  containing  2  fluidrachms  (7.4  Cc.)  of  succus  conii  to  16  or 
20  ounces  (473-591.5  Cc.)  of  water  and  20  grains  (1.2  Gm.)  of 
sodium  carbonate. 

The  vapor  of  coniine  inhaled  is  an  efficient  palliative  of  the 
cough  of  phthisis  and  acute  bronchitis. 

The  peculiar  mouse-like  odor  renders  the  use  of  conium  in  dis- 
eases of  the  respiratory  tract  objectionable  to  many  persons. 

Internally. — Its  action  upon  the  motor  mechanism  gives  value 
to  the  drug  in  diseases  characterized  by  excessive  motor  activity. 
Conium  is  therefore  an  efficient  remedy  in  allaying  the  motor 
excitement  of  acute  mania.  Advantage  has  been  taken  of  its 
action  in  the  treatment  of  asthma,  and  in  chorea  and  paralysis 
agitans  it  certainly  serves  a  useful  purpose. 

It  has  been  claimed  that  whooping  cough  yields  to  its  influence. 
It  has  proved  beneficial  in  other  spasmodic  affections,  such  as 
tetanus  and  blepharospasm  accompanying  many  acute  inflamma- 
tions of  the  eye.  Coniine  has  even  been  suggested  as  a  remedy  in 
hydrophobia  and  strychnine-poisoning. 

Coniine  hydrobromate  has  been  proposed  by  Wolfenden  as  an 
efficient  remedy  in  epilepsy. 

Conium  has  also  been  suggested  in  puerperal  convulsions,  while 
in  infantile  convulsions  the  drug  has  been  employed  with  great 
benefit,  being  well  tolerated  by  children. 

Coniine  has  been  used  hypodermically  and  with  marked  success 
to  relax  the  muscles  in  dislocations  of  the  joints,  as  well  as  in  pneu- 
monia and  pleurisy.  In  the  latter  diseases  the  drug  so  depresses 
the  ends  of  the  motor  nerves  that  the  impulse  exciting  the  respira- 
tory muscles  is  interfered  with  and  the  cough  greatly  relieved,  a 
reduction  of  the  pulse-rate  and  temperature  usually  accompanying 
the  cessation  of  coughing. 

Contraindioations. — Conium  should  not  be  given  to  persons 
suffering  from  great  exhaustion  and  debility  or  from  diseases  inter- 
fering with  the  rhythm  of  the  heart. 

Administration. — The  preparations  of  conium  are  very  unreli- 


502  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

able,  the  fluid  extract  being  perhaps  the  one  to  be  depended  upon 
most  uniformly.  Owing  to  the  uncertainty  of  their  strength,  the 
administration  should  begin  with  small  doses  gradually  augmented 
until  interference  with  involuntary  motion  is  observed,  when  further 
increase  should  be  stopped. 

The  effects  of  the  drug  are  weakened  by  repeated  doses, 
rendering  an  increase  in  the  dose  necessary  from  time  to  time. 
Coniine  and  morphine  greatly  aid  each  other,  and  this  combination 
is  a  particularly  efficient  one  in  the  treatment  of  painful  muscular 
spasms  and  acute  mania  with  excessive  motor  activity. 

Dr.  Squibbs  has  stated  that  there  is  danger  in  diluting  the  fluid 
extract,  a  precipitate  being  formed  containing  the  active  principle. 

Gelsemium— Gelsemii— Gelsemium.    TJ.  S.  J*. 

(Yellow  Jasmine.) 

Origin.— The  rhizome  and  roots  of  Gelsemium  sempervirens  (L.) 
Pers.,  a  pl^nt  indigenous  in  the  southern  United  States,  growing  in 
moist  woods. 

Description  and  Properties. — Cylindrical,  long  or  cut  in  sec- 
tions about  I  inch  (25  Mm.)  in  length,  externally  Ught  yellowish- 
brown,  with  purplish-brown  longitudinal  lines ;  tough,  fracture 
splintery ;  bark  thin,  with  silky  bast-fibers  closely  adhering  to  the 
pale-yellowish,  porous  wood,  which  has  five  medullary  rays,  and 
in  the  rhizome  a  thin  pith  ;  odor  aromatic,  heavy ;  taste  bitter. 

It  contains  an  alkaloid,  gelsemine,  which  forms  its  active  princi- 
ple, gelseminine,  gelseminic  acid,  volatile  oil,  resins,  gallic  acid,  etc. 

Dose. — 2-10  grains  (0.13-0.6  Gm.). 

Official  Preparations. 

Bxtractum  Gelsemii  Fluidum— ExtrScti  Gelsemii  Fluidi— Fluid  Extract 
of  Gelsemium. — Dose,  5-15  minims  {0.3-1.0  Cc). 

Gelsemina  (unofficial) — Gelseminae — Gelsemine. — Description  and  Proper- 
ties.— A  brittle  solid,  transparent,  crystallizable  mass,  converted  into  a  colorless  liquid  at 
45°  C.  (113°  F.).  Insoluble  in  cold  water,  but  soluble  to  a  slight  extent  in  hot  water, 
as  well  as  in  alcohol ;  taste  bitter. 

Dose. — i^^  grain  (0.0003-0.001  Gm.). 

Antagonists  and  Incompatibles. — The  cardiac  and  diffusible 
stimulants  are  antagonistic;  tannic  acid  and  caustic  alkalies  are 
incompatible,  precipitating  the  alkaloid. 

Synergists. — The  motor  depressants. 

Physiological  Action. — Externally  and  Locally. — It  is  a  mild 
sedative  and  astringent,  the  alkaloid  being  a  mydriatic. 


MOTOR  DEPRESSANTS. 


503 


Internally. — Digestive  System. — No  special  action  has  been 
noted,  though  when  excessive  doses  have  been  taken  nausea  and 
vomiting  may  ensue.' 

Circulatory  System. — Medicinal  doses  of  gelsemium  produce  no 
marked  effect,  but  toxic  doses  reduce  the  heart's  action,  rendering 
the  pulse  slower  and  weaker  and  lowering  arterial  tension. 

Nervous  System. — The  drug  has  no  effect  upon  higher  cerebral 
centers,  the  mind  remaining  clear  to  the  last.  In  large  doses  it 
paralyzes  the  roots  of  the  motor  cerebral  nerves  and  the  motor 
areas  of  the  spinal  cord,  with  consequent  paralysis  of  all  the  mus- 
cles of  the  body.  This  condition  is  succeeded  by  cutaneous  anes- 
thesia, due  to  depression  of  the  receiving  center  and  the  sensory 
tract  in  the  spinal  cord.  The  motor  nerves  and  muscles  are  unaf- 
fected. Convulsions  rarely  result  in  man  from  a  poisonous  dose, 
but  occur  in  animals,  with  backward  movements.  The  exact  cause 
of  this  action  is  undetermined. 

Respiratory  System. — The  breathing  is  rendered  slower  and 
shallower,  being  frequently  irregular.  Death  results  from  asphyxia, 
caused  by  depression  and  ultimate  paralysis  of  the  respiratory  center. 

Absorption  and  Elimination. — Gelsemium  is  speedily  absorbed 
and  readily  excreted,  chiefly  by  means  of  the  kidneys.  Untoward 
symptoms  produced  by  immoderate  amounts  of  the  drug  prac- 
tically subside  within  three  hours  after  ingestion. 


Fig.'  8.— Diagram  showing  how  gelsemium  produces  convergent  strabismus  '.  A,A,  superior  rectus  ; 
B  B,  external  rectus— too  weak;  C,C,  internal  rectus;  D,D,  third  nerve;  E,By  sixth  nerve;  F,F, 
optic  nerve;   G,G,  lesser  wing. 

Temperature. — Poisonous  doses  cause  a  reduction  in  temper- 
ature. 

Eye. — Under  full  dosage  the  pupil  is  widely  dilated  and  diplopia 
and  marked  ptosis  ensue.     The  mydriasis  and  ptosis  are  caused  by 


504  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

paralysis  of  the  third  nerve.  The  sixth,  which  innervates  the  ex- 
ternal rectus  muscle,  is  often  depressed  more  than  the  third  nerve, 
supplying  the  internal  rectus,  producing  convergent  strabismus,  as 
shown  in  Figure  8. 

The  diplopia  is  caused  by  the  squint  and  incoordination  of  the 
ocular  movements.  In  strabismus  the  eyes  are  not  directed  exactly 
to  the  object,  and  the  image  does  not  fall  on  corresponding  parts 
of  the  retinse ;  consequently,  two  perceptions  are  received  in  the 
visual  center  and  two  objects  apparently  seen. 

Uterus. — No  important  action  has  been  observed. 

Untoward  Action. — This  does  not  essentially  differ  from  that 
observed  in  poisoning,  though  the  symptoms  may  be  of  a  milder 
form. 

Poisoning. — In  toxic  doses  gelsemium  is  quickly  fatal.  The 
early  symptoms  include  drooping  of  the  eyelids,  wide  dilatation 
and  immobility  of  the  pupils,  extreme  muscular  weakness,  affecting 
first  the  muscles  of  the  upper  extremities,  and  incoordination  of 
movements.  Diplopia  and  dimness  of  vision  may  ensue,  accom- 
panied by  difficulty  of  speech,  coldness  of  the  body  surface,  and 
general  cutaneous  anesthesia,  with  decidedly  lower  temperature. 
Meanwhile,  there  is  marked  diminution  in  the  force  and  frequency 
of  the  pulse  and  respiration. 

While  the  patient  may  be  drowsy,  the  mind  is  unaffected  until 
carbonic-acid  necrosis  supervenes.  Death  is  usually  the  result  of 
respiratory  failure,  due  to  paralysis  of  the  muscles  of  respiration. 
(See  Plate  I.) 

Treatment  of  Poisoning. — The  evacuation  of  the  stomach  is  of 
the  first  importance,  either  by  the  stomach-pump  or  by  the  use  of 
emetics.  Washing  out  with  a  solution  of  tannic  acid  is  probably 
the  best  method  to  pursue.  External  heat  should  be  applied  and 
diffusible  stimulants  administered,  followed  by  digitalis  and  strych- 
nine. The  hypodermic  injection  of  morphine  and  atropine  is 
highly  recommended  in   gelsemium-poisoning. 

Therapeutics. — Externally  and  Locally. — The  drug  is  seldom 
used  externally,  although  it  has  been  employed  by  ophthalmolo- 
gists as  a  mydriatic. 

Internally. — Clinically,  gelsemium  is  now  considered  less  valu- 
able than  formerly.  It  has  been  favorably  mentioned  by  certain 
authors  in  the  treatment  of  tetanus,  mania  with  motor  excitement, 
and  paralysis  agitans.  Theoretically,  it  would  seem  to  be  of  value 
m  certain  convulsive^  disorders,  like  chorea,  pertussis,  etc.,  yet  its 


PLATE    II. 


Gelsemium-poisoniiig. 


MOTOR  DEPRESSANTS.  505 

use  has  not  met  with  the  success  which  its  action  upon  the  mus- 
cular system  would  indicate. 

The  drug  appears  to  be  more  serviceable  in  trifacial  neuralgia, 
and  it  seems  to  be  even  more  efficient  in  neuralgia  with  involve- 
ment of  the  inferior  dental  nerve.  In  these  disorders,  as  in  ovarian 
neuralgia,  dysmenorrhea,  etc.,  for  which  it  has  been  employed  with 
some  success,  the  drug  should  be  pushed  to  its  physiological  limit. 

Bartholow  praised  the  action  of  gelsemium  in  cerebrospinal 
meningitis  and  "  acute  inflammations  of  the  lungs  and  pleura!' 

Bulkley  is  responsible  for  its  use  in  pruritus  and  eczema,  the 
itching  of  which  it  certainly  appears  to  alleviate. 

The  therapeutics  of  gelsemium  would  perhaps  be  incomplete 
without  mentioning  hemoptysis,  remitte7it  fever,  acute  coryza,  mi- 
graine, Meniere's  disease,  and  spermatorrhea,  in  all  of  which  the 
drug  has  been  used  and  recommended. 

Contraindications. — Diseases  accompanied  by  exhaustion  and 
great  muscular  weakness. 

Administration. — Any  of  the  preparations  may  be  given,  the 
initial  dose  being  small,  and  the  amount  increased  gradually  until 
dilatation  of  the  pupil  or  drooping  of  the  eyelids  is  manifest. 

Grindelia— Grindeliae— Grindelia.    JJ.  S.  J*. 

Origin. — The  leaves  and  flowering  tops  of  Grindelia  robusta 
Nutt,  and  of  Grindelia  squarrosa  Dunal,  herbaceous  or  suffi-uticose 
perennials  indigenous  in  the  western  part  of  North  America  and 
Mexico. 

Description  and  Properties. — Leaves  about  2  inches  (5  Cm.) 
long,  varying  from  broadly  spatulate  or  oblong  to  lanceolate,  sessile 
or  clasping,  obtuse,  more  or  less  sharply  serrate,  often  spinous- 
toothed  or  even  laciniate-pinnatifid,  pale-green,  smooth,  finely 
dotted,  thickish,  brittle;  heads  many-flowered,  subglobular  or 
somewhat  conical,  the  involucre  hemispherical,  about  f  inch 
(10  Mm.)  broad,  composed  of  numerous  imbricated,  squarrose- 
tipped,  or  spreading  scales ;  ray-florets  yellow,  liqulate,  pistillate ; 
disk-florets  yellow,  tubular,  perfect ;  pappus  consisting  of  two  or 
three  awns  of  the  length  of  the  disk-florets ;  odor  balsamic ;  taste 
pungently  aromatic  and  bitter. 

The  principal  constituent  is  probably  a  resinous  substance.  It 
also  contains  an  alkaloid  principle,  grindeline,  and  a  volatile  and  a 
fixed  oil. 

Dose. — 10-60  grains  (0.6-4.0  Gm.). 


5o6  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Oficial  Preparation. 
Extractum  Grindeliae  Fluidum — Extracti  Grindelise  Fluidi — Fluid  Extract 
of  Grindelia. — Dose,  10-60  minims  (0.6-3.7  Cc). 

Antagonists  and  Incompatibles. — The  motor  excitants  and 
cerebral  stimulants  are  antagonistic.  Aqueous  preparations,  the 
caustic  alkalies,  and  mineral  salts  are  incompatible. 

Synergists. — The  motor  depressants. 

Physiological  Action. — Externally  and  Locally. — ^The  drug  is 
sedative  and  mildly  astringent. 

Internally. — Digestive  System. — When  ingested  it  excites  a  sense 
of  warmth  in  the  epigastrium,  and  in  moderate  doses  increases  the 
secretion  of  the  gastric  juice,  stimulating  the  appetite  and  improv- 
ing digestion. 

Circulatory  System. — It  differs  somewhat  from  conium  in  that 
the  heart  is  slowed  by  medicinal  doses  through  stimulation  of  the 
inhibitory  center.  The  blood-pressure,  however,  is  raised  and 
maintained  by  stimulation   of  the  vaso-motor  center. 

Nervous  System. — Grindelia  possesses  considerable  hypnotic 
power.  Its  effect  upon  the  motor  mechanism  is  similar  to  that  of 
conium,  the  muscular  weakness  affecting  first  the  lower  extremi- 
ties. The  sensory  nerves  are  first  depressed,  there  being  quite 
marked  cutaneous  anesthesia.  The  drug  depresses  the  reflex 
mechanism  in  the  spinal  cord,  so  that  the  reflex  movements  are 
greatly  lessened  :  it  is  said  that  it  also  depresses  the  phrenic  nerve. 

Respiratory  System. — Small  doses  have  little  effect  upon  the 
respiratory  movements  ;  large  doses  retard  the  breathing ;  while 
toxic  doses  may  produce  death  through  paralysis  of  the  respiratory- 
muscles. 

The  drug  slightly  increases  the  secretion  from  the  pulmonary 
mucous  membrane,  and  relaxes  the  circular  fibers  of  the  bronchial 
muscles  through  depression  of  the  ends  of  the  motor  fibers  of  the 
vagus  distributed  to  these  muscles  and  of  the  reflex  center  in  the 
medulla.  The  ends  of  the  sensory  nerves  distributed  to  the  pul- 
monary mucous  membrane  are  also  depressed. 

Absorption  and  Elimination. — Grindelia  is  readily  absorbed,  and 
is  eliminated  chiefly  by  the  kidneys,  increasing  the  urinary  flow, 
the  lungs  sharing  in  the  excretory  process. 

Temperature  is  unaffected. 

Eye. — Large  doses  cause  dilatation  of  the  pupil. 

Uterus. — No  effect  has  been  noticed. 

Untoward  Action. — Excepting  drowsiness,-  reduction  of  cutane- 


MOTOR  DEPRESSANTS. 


507 


ous  sensibility,  slight  gastric  disturbance,  and  a  feeling  of  weakness 
no  symptoms  have  been  recorded. 

Poisoning. — The  drug  is  feebly  toxic;  excessive  doses,  how- 
ever, act  as  a  gastro-intestinal  irritant.  The  patient  is  sleepy  and 
complains  of  muscular  weakness ;  there 
is  a  numb  or  anesthetic  condition  of  the 
skin,  while  the  pupils  are  dilated  and 
the  pulse  and  respiratory  movements 
slow  and  feeble.  Should  death  occur, 
it  will  be  from  paralysis  of  the  muscles 
of  respiration. 

Treatment  of  Poisoning. — The  same 
as  in  poisoning  from  conium — diffusible 
stimulants,  strychnine,  etc. 

Therapeutics. — Externally  and  Lo- 
cally.— Grindelia  is  a  very  efficient  ap- 
plication to  the  skin  in  rhus-poisoning. 
Indeed,  it  serves  as  a  soothing  lotion  in 
many  acute  inflammations  of  the  skin, 
such  as  eczema,  etc.  The  fluid  extract 
used  should  be  well  diluted  and  applied 
on  cloths. 

Indolent  ulcers  are  well  treated  by  a 
diluted  solution  of  the  drug.  It  also 
serves  as  an  efficient  injection  in  gonor- 
rhea, leucorrhea,  and  vaginitis. 

Internally. — Grindelia  has  acquired 
an  enviable  reputation  as  a  remedy  for 
spasmodic  asthma,  its  action  upon  the 
bronchial  muscles  rendering  it  singu- 
larly beneficial  in  this  disorder.     It  acts  upon  every  possible  point 
to  relax  the  spasm  of  the  bronchial  muscles,  as  is  shown  in  Fig- 
ure 9.    The  drug  has  no  influence,  however,  in  preventing  a  recur- 
rence of  the  paroxysms. 

The  drug  has  been  highly  recommended  in  acute  and  chronic 
bronchitis,  hay  fever,  whooping  cough,  and  in  spasmodic  cough  of 
whatever  nature.  It  has  even  been  suggested  as  a  palliative  remedy 
in  pneumonia  ^nd  cardiac  and  pulmonary  dyspnea. 

There  are  no  special  Contraindications  or  directions  for  Ad- 
ministration, save  that  the  fluid  extract  is  pharmaceutically  incom- 
patible with  aqueous  preparations. 


Fig.  9. — Diagram  showing  how  grin- 
delia relaxes  spasm  of  the  bronchial 
muscles  in  asthma.  The  sensory  nerves 
(5)  in  the  mucous  membrane  of  the 
bronchial  tubes  are  depressed,  so  that 
there  is  less  irritation  transmitted  to 
the  medulla,  to  be  returned  by  the 
motor  fibers  supplying  the  bronchial 
muscles,  thus  exciting  bronchial  spasm. 
The  respiratory  center  {A)  is  depressed, 
together  with  the  ends  of  the  motor 
nerves  ( C),  limiting  the  amount  of  irri- 
tation in  the  bronchial  muscles  {K). 
The  diaphragm  {F)  is  relaxed  through 
depression  of  the  phrenic  nerve  (Z7), 


5o8  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Physostigrma— Physostigmatis— Physostigrma. 

V.  s.  p. 

(Calabar  Bean.) 

Origin. — The  seed  of  Physostigma  venenosuin  Balfour,  a  lofty, 
half-shrubby,  climbing  plant  (somewhat  resembling  the  scarlet- 
runner  or  Spanish  bean  of  our  gardens)  growing  near  the  mouths 
of  the  Niger  and  Old  Calabar  River  in  Western  Africa,  and  attain- 
ing a  height  of  40  or  50  feet  (12-15  M.). 

Description  and  Properties. — The  seeds  are  about  i  to  i^ 
inches  (25-30  Mm.)  long,  f  to  |  inch  (15-20  Mm.)  broad,  and  f  to 
•finch  (10-15  Mm.)  thick;  oblong  and  somewhat  reniform;  testa 
granular,  chocolate-brown,  with  a  broad  black  groove  extending 
the  entire  length  of  the  convex  edge ;  embryo  with  a  short,  curved 
radicle  and  two  large,  white  concavo-convex  cotyledons ;  inodor- 
ous ;  taste  bean-like. 

The  drug  contains  an  alkaloid,  physostigmine  (also  known  as 
eserine),  which  is  the  principal  constituent ;  calabarine,  to  which  the 
drug  owes  its  tetanizing  properties  ;  and  eseridine  (a  laxative  and 
motor  excitant) ;  besides  a  neutral  principle,  physosterin,  related  to 
cholesterin. 

Dose. — 1-4  grains  (0.065-0.25  Gm.). 

Official  Preparations. 

Extractum  Physostigmatis— ExtrScti  Physostlgmatis — Extract  of  Physo- 
stigma.— Dose,  -jJj-J  grain  (0.004-0.01  Gm.). 

Tinctiira  PhysostJgmatis— Tincturse  Physostitgmatis— Tincture  of  Physo- 
stigma.— Dose,  5-10  minims  (0.3-0.6  Cc). 

The  allcaloid,  Physostigmine,  is  not  official.  It  occurs  in  colorless  or  slightly  pink- 
ish crystals;  sparingly  soluble  in  water;  readily  soluble  in  alcohol.— Z?o.jf,  ^^-^  grain 
(0.0006-0.003  Gm.).     The  salicylate  and  sulphate  of  physostigmine  are  official. 

Physostigminae  SaKcylas— Physostigmlns  Salicylatis— Physostigmine 
Salicylate  (Eserine  Salicylate).    U.  S.  P. 

Description  and  Properties. — Colorless  or  faintly  yellowish,  shining,  acicular,  or' 
short,  columnar  crystals,  odorless,  and  of  a  bitter  taste ;  acquiring  a  reddish  tint  when 
exposed  to  light  and  air;  soluble  in  150  parts  of  water  and  12  parts  of  alcohol.  The 
salicylate  should  be  kept  in  small,  dark  amber-colored,  and  well-stoppered  vials. 

Dose. — Y^j-Tf*^  grain  (0.0005-0.002  Gm.). 

Physostigminae  Siilphas— Physostigminae  Sulphatis— Physostigmine  Sul- 
phate (Eserine  Sulphate).     U.  S.  P. 

Description  and  Properties.— K  white,  or  yellowish-white,  micro-crystalline  pow- 
der, odorless,  and  of  a  bitter  taste.  It  is  very  deliquescent  when  exposed  to  moist  air, 
gradually  turning  reddish  in  air  and  light.  Very  soluble  in  water'and  alcohol;  still 
more  so  at  the  boiling-point  of  these  liquids.  It  should  be  kept  in  small,  dark  amber- 
colored,  and  well-stoppered  vials. 

Dose.—^\^^^  grain  (0.0005-0.002  Gm.). 


MOTOR  DEPRESSANTS. 
Unofficial  Preparation. 


509 


Physostigmlnse  Hydrobromas — Physostigminae  Hydrobromatis — Physo- 
stigmine  Hydrobromate. — Dose,  xirs-^V  gi^^i"  (0.0005-0.002  Gm.). 

Antagonists  and  Incompatibles. — The  action  of  physostigma 
upon  the  heart,  respiration,  and  pupils  is  antagonized  by  atropine ; 
that  on  the  spinal  cord  by  chloral ;  while,  in  a  general  way,  the 
motor  excitants,  particularly  the  tetanizing  agents,  are  therapeuti- 
cally antagonistic. 

The  caustic  alkalies  and  tannic  acid  are  chemically  incompatible. 

Synergists. — The  motor  depressants. 

Physiological  Action. — Externally  and  Locally. — No  external 


Fig.  zo. — Diagram  illustrating  the  mechanism  of  secretion.  An  impression  is  transmitted  over  the 
aflferent  nerve  (5)  to  the  medulla  (.(4),  and  thence  over  the  secretory  nerve  (C)  to  the  secretory  cells 
(iir,  K)  of  the  gland  {F).  At  the  same  time  the  vaso-motor  nerves  (.E)  are  stimulated,  causing  a  con- 
traction of  the  arterioles  (/)  supplying  the  gland ;  hence,  as  soon  as  the  lymph  in  the  lymph-spaces 
{H)  is  consumed,  the  secretion  from  the  gland  is  diminished  for  lack  of  material  necessary  to  the 
secretory  cells  in  elaborating  their  normal  secretions. 

-action  of  physostigma  and  its  preparations  is  noted,  unless  it  be  its 
effect  upon  the  pupil,  which  outward  application  contracts,  and  the 
slight  abolition  of  functional  activity  in  the  motor  and  sensory 


5IO  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

nerves,  occasioned,  it  is  said,  by  a  strong  solution  of  physostig- 
mine. 

Internally. — Digestive  System. — The  administration  of  the  drug 
tends  to  stimulate  the  saUvary,  gastric,  and  intestinal  secretions, 
followed  by  lessened  secretion  (see  Figure  lo),  and,  by  acting 
upon  the  muscular  coats  of  the  stomach  and  intestines,  to  increase 
peristalsis.  Nausea,  retching,  vomiting,  and  purging  may  result. 
The  rationale  of  its  action  is  doubtless  direct  stimulation  of  the 
unstriped  muscle-fibers. 

Circulatory  System. — No  influence  on  the  blood  has  been  de- 
tected. Small  doses  increase  arterial  tension,  the  heart's  action 
becoming  slower  and  stronger. 

Although  the  effect  upon  the  heart  is  somewhat  obscure,  it 
appears  that  under  poisonous  doses  the  'cardiac  pulsations  are 
greatly  reduced,  being  slow  and  feeble,  and  finally  ceasing  alto- 
gether. It  is  reasonably  supposed  that  this  action  is  due  to  pri- 
mary stimulation  of  the  peripheral  vagi,  influencing  the  cardiac 
ganglia,  and  also  to  the  effect  upon  the  vaso-motor  centers.  The 
subsequent  exhaustion  and  relaxation  of  the  arteries  are  doubtless 
the  result  of  a  similar  influence. 

There  is  marked  elevation  of  blood-pressure  under  moderate 
doses,  although  there  may  occur  a  brief  period  of  depression. 
Toxic  doses  are  accompanied  by  a  notable  decrease  of  arterial  ten- 
sion, the  cardiac  ganglia  being  seized  with  paralysis  and  the  heart 
finally  arrested  in  diastole. 

Nervous  System. — As  with  conium,  the  mind  is  comparatively 
unaffected  by  physostigma,  remaining  lucid  even  to  the  verge  of 
final  collapse.  The  spinal  cord,  however,  appears  to  bear  the  prin- 
cipal shock,  the  total  abolition  of  reflex  activity  indicating  a  selective 
action  of  the  drug. 

To  the  effect  on  the  motor  nerves,  occasioning  a  diminution  of 
power,  must  be  attributed  the  muscular  debility  and  paralytic 
symptoms  manifest  under  the  administration  of  toxic  doses. 

Respiratory  System. — No  interference  with  respiration  is  caused 
by  moderate  doses  of  the  drug.  Larger  amounts  primarily  de- 
press the  respiratory  centers,  stimulate  the  peripheries  of  the  pul- 
monary vagi,  and  contract  the  caliber  of  the  bronchial  tubes,  even 
to  the  extent  of  serious  constriction,  death  usually  resulting  from 
asphyxia. 

The  breathing  is  first  quickened  and  then  retarded,  the  effect  of 
the  drug  upon  the  respiration  being  more  powerful  than  its  circu- 


MOTOR  DEPRESSANTS.  511 

latory  influence,  the  heart  continuing  to  beat  for  some  time  after 
pulmonary  action  has  ceased. 

Absorption  and  Elimination. — The  active  principles  of  physo- 
stigma  and  its  alkaloids  are  rapidly  diffused  in  the  blood.  They  are 
largely  excreted  by  the  kidneys,  the  bile  and  saliva  contributing  to 
the  process  of  elimination,  and  have  been  detected  in  the  gastric 
juices  after  intravenous  injection. 

Temperature. — A  slight  depression  has  been  noted. 

Eye. — Applied  locally  to  the  conjunctiva  or  introduced  into  the 
circulation,  whether  by  ingestion  or  injection,  physostigmine  causes 
myosis  or  contraction  of  the  pupil  by  stimulating  the  peripheral 
endings  of  the  oculo-motor  nerves,  possibly  by  a  depression  of  the 
sympathetic  fibers. 

Other  prominent  symptoms  present  are  spasm  of  accommoda- 
tion and  decreased  intraocular  tension  and  myopia.  Irritation  of 
the  third  nerve  is  the  principal  cause  of  these  phenomena :  they 
have  also  been  attributed  to  the  stimulating  action  of  the  drug 
upon  the  muscular  fibers  of  the  iris  rather  than  to  any  paralyzing 
influence  upon  the  sympathetic,  pupillar  dilatation  being  manifest 
under  excitation  of  the  latter  nerve. 

The  intraocular  pressure  is  lowered  (i)  by  lessening  the  blood- 
supply  to  the  eye  through  contraction  of  the  blood-vessels ;  (2)  by 
diminishing  the  secretion  of  the  aqueous  humor  from  the  glands  on 
the  surface  of  the  ciliary  body ;  (3)  by  contracting  the  iris,  so  that 
the  aqueous  humor  can  more  readily  pass  through  the  canal  of 
Schlemm. 

Uterus. — The  full  influence  of  the  drug  tends  to  produce  uterine 
contraction. 

Untoward  Action. — When  eserine  is  applied  to  the  eye  it  occa- 
sionally produces  a  nervous  contractile  pain  in  the  entire  eyeball, 
which  extends  in  a  manner  similar  to  ciliary  neurosis  along  the 
course  of  the  supraorbital  -nerve,  resembling  migraine. 

Small  doses  have  in  some  individuals  produced  nausea  and 
general  uneasiness,  and  occasionally  intense  pain  in  the  epigas- 
trium. 

Poisoning. — Taken  in  poisonous  doses,  physostigma  causes 
nausea,  giddiness,  and  muscular  tremors  and  weakness,  followed 
by  complete  muscular  relaxation.  Cardiac  action  is  diminished ; 
the  reflexes  are  in  abeyance;  the  respiration  is  retarded;  and 
myosis  and  motor  paralysis  are  manifest.  The  pupils  visibly  con- 
tract, and  purging  and  vomiting  may  ensue.     Fatal  results  are 


512  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

possible  through  paralysis  of  the  respiratory  center  and  consequent 
asphyxia.  The  more  rapid  collapse  succeeding  the  administration 
of  lethal  doses  is  due  to  cardiac  syncope. 

Treatment  of  Poisoning. — The  stomach  should  be  evacuated,  the 
process  being  followed  by  the  hypodermic  injection  of  a  solution 
of  atropine,  which  may  prove  an  efficient  physiological  antidote. 
Tannic  acid  may  be  used  as  a  chemical  antagonist.  Diffusible 
stimulants,  such  as  ether  or  ammonia,  may  serve  to  arrest  cardiac 
and  respiratory  failure.  Digitalis  and  alcohol  have  also  been  suc- 
cessfully employed.  Temperature  should  be  maintained  by  the 
application  of  external  heat. 

Therapeutics. — Externally  and  Locally. — Physostigmine  and 
ESERiNE  SULPHATE  are  the  preparations  usually  employed,  their  only 
action  of  importance  being  in  diseases  of  the  eye.  They  are  of 
value  in  breaking  up  adhesions  of  the  iris  to  the  cornea  or  lens, 
strengthening  the  muscle  of  accommodation,  reducing  intraocular 
pressure,  and  removing  the  effects  of  atropine,  although  Jessup 
claims  that  complete  ciliary  paralysis  by  atropine  and  the  mydriasis 
induced  by  hyoscine  are  unaffected  by  eserine. 

In  certain  cases  of  ulcer  of  the  cornea  uncomplicated  with  iritis 
and  sloughing  keratitis,  where  there  is  little  inflammation  or  ciliary 
irritation,  eserine  sometimes  produces  prompt  improvement  when 
atropine  has  failed. 

Paralytic  mydriasis  and  paralysis  of  accommodation  are  tempo- 
rarily relieved  by  this  drug,  and  weak  solutions  have  been  employed 
with  varying  success  in  accommodative  asthenopia  without  refrac- 
tive errors. 

The  remedy  is  of  unquestioned  value  in  the  early  stages  of 
glaucoma,  but  only  at  the  commencement  of  an  acute  attack  and 
contraindicated  in  the  hemorrhagic  form.  Should  the  drug  fail  to 
contract  the  pupil  when  used  for  glaucoma,  it  may  induce  irritating 
spasm  of  the  ciliary  muscles  by  increasing  the  blood-supply  to  the 
iris. 

Physostigmine  is  sometimes  employed  to  prevent  prolapsus  of 
the  iris,  following  peripheral  perforation  of  the  cornea  or  cataract 
extraction,  particularly  without  iridectomy. 

The  remedy  serves  a  useful  purpose  also  in  coal-miners'  nys- 
tagmus, one  drop  of  a  collyrium  containing  \  grain  (0.096  Gm.)  of 
PHYSOSTIGMINE  SULPHATE  in  I  ounce  (30.0  Cc.)  of  distilled  water 
being  dropped  into  the  eye  three  times  a  day.  Eserine  is  also  em- 
ployed in  neuralgia  of  the  eyeball  and  photophobia. 


MOTOR  DEPRESSANTS.  513 

Internally. — Physostigma  has  proved  efficacious  in  constipation 
due  to  an  atonic  condition  of  the  intestines  with  deficient  secretion. 
The  state  of  the  muscular  intestinal  layer  frequently  allows  gas  to 
accumulate  in  the  bowels,  with  consequent  troublesome  flatulence. 
The  drug,  by  imparting  tone  to  the  muscles  and  increasing  peri- 
stalsis, greatly  relieves  this  unpleasant  condition. 

Gastric  and  intestinal  dilatation  have  been  successfully  treated 
by  Hare  with  this  remedy.  It  is  valuable  in  chronic  bronchitis  with 
dilatation  of  the  bronchial  tubes,  and  is  said  to  relieve  bronchial 
asthma  and  emphysema. 

Progressive  paralysis  of  the  insane  is  sometimes  relieved  by 
PHYSOSTIGMA,  while  its  good  reputation  in  tetanus  is  well  estab- 
lished. It  has  been  used,  but  with  less  favorable  results,  in  chorea, 
epilepsy,  infantile  convulsions,  and  other  spasms.  Some  authorities 
have  recommended  it  in  the  treatment  of  paraplegia  due  to  myeh- 
tis,  renal  hemorrhage,  night-sweats  of  phthisis,  and  locomotor  ataxia. 

Contraindications. — The  same  as  for  conium. 

Administration. — The  extract  or  the  tincture  is  usually  pre- 
ferred for  internal  administration,  although  the  alkaloid  fully  repre- 
sents the  drug  and  may  be  given  either  by  the  mouth  or  hypo- 
dermically.  For  application  to  the  eye  the  salts  of  the  alkaloid 
are  used.  A  convenient  form  of  eserine  in  ophthalmic  practice  is 
-the  medicated  gelatin  disks. 

Curare— Curare— Curare. 

(WOORARI.) 

Origin. — An  extract  of  uncertain  composition  prepared  by  the 
natives  of  South  America  as  an  arrow-poison.  Dr.  Jobert  reported 
to  the  French  Academy  in  1878  that  the  poison  was  prepared 
chiefly  from  Strychnos  Castelnceana  and  other  species  of  Strychnos, 
and  Cocculus  toxiferus,  containing  also  variable  quantities  of  other 
poisonous  plants,  such  as  Didelphys  cancrivora,  etc.  It  is  alto- 
gether probable  that  its  ingredients  include  the  poison  of  venomous 
reptiles. 

Description  and  Properties. — The  extract  is  a  blackish-brown, 
friable  solid,  brittle  or  hygroscopic,  of  a  very  bitter  taste ;  almost 
completely  soluble  in  dilute  alcohol.  Cold  water  dissolves  about 
75  per  cent.,  which  portion  contains  the  poisonous  alkaloids  and  is 
insoluble  in  ether  and  but  sparingly  soluble  in  absolute  alcohol. 

Two  alkaloids  have  been  obtained  from  this  substance — curarine 
and  curine. 


514  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Dose. — 2iy~i  grain  (0.003-0.03  Gm.),  hypodermically  given. 

Dose  of  Curarine. — g-B-j-yFC  grain  (0.0003-0.0006  Gm.),  hype 
dermically. 

Antagonists  and  Incompatibles. — The  excito-motors  are  ai 
tagonistic.  Tannic  acid  and  the  caustic  alkahes  are  chemical] 
incompatible. 

Synergists. — The  depresso-motors. 

Physiological  Action. — When  applied  to  the  denuded  skin  it : 
a  powerful  irritant ;  introduced  into  the  circulation  hypodermicallj 
it  exerts  a  very  decided  and  characteristic  action. 

Circulatory  System. — Medicinal  doses  render  the  pulse  fulle 
and  exceedingly  rapid ;  there  is  marked  dilatation  of  the  blooc 
vessels  of  the  skin  and  the  various  glands ;  while  the  blood-pres 
sure,  though  little  affected  by  small  doses,  is  decidedly  lowered  b 
large  ones.  The  action  on  the  circulation  is  due  to  diminishe 
inhibition  on  the  heart,  owing  to  paralysis  of  the  ends  of  the  vag 
while  the  accelerator  nerves  are  stimulated. 

Nervous  System. — Immoderate  doses  cause  great  muscula 
weakness  and  paralysis  of  all  the  voluntary  muscles.  The  end 
of  the  motor  and  sensory  nerves  are  paralyzed,  the  former  beini 
soonest  affected.  Beyond  a  slightly  diminished  contractility  th 
voluntary  muscles  are  but  little  influenced.  The  spinal  cord  ma; 
be  paralyzed  under  toxic  doses,  although  the  brain-centers  remai 
unaffected  until  carbonic-acid  narcosis  sets  in. 

Respiratory  System. — Curare  is  a  powerful  respiratory  depress 
ant,  paralyzing  the  ends  of  the  motor  nerves  distributed  to  th 
respiratory  muscles.  When  lethal  doses  have  been  given  th 
paralysis  becomes  central,  finally  producing  death  by  its  action  o 
the  respiratory  muscles. 

Absorption  and  Elimination. — When  ingested  the  process  0 
absorption  is  exceedingly  slow,  but  when  injected  into  the  circula 
tion  the  drug  is  rapidly  absorbed. 

It  is  quickly  eliminated  by  the  kidneys,  causing  sugar  to  appea 
in  the  urine.  A  portion  of  the  poison  is  also  excreted  with  th 
feces.  The  sweat,  saliva,  nasal  mucus,  and  tears,  although  thai 
secretion  is  greatly  increased  by  the  drug,  do  not  seem  to  share  i 
the  process  of  elimination. 

Temperature. — The  temperature  is  elevated. 

Eye. — Under  poisonous  doses  there  is  marked  ptosis,  disordere 
vision,  protrusion  of  the  eyeballs,  and,  as  a  late  ocular  sympton 
myosis. 


MOTOR  DEPRESSANTS.  515 

Poisoning. — Curare  is  a  rapid  and  active  poison.  The  move- 
ments of  the  heart  are  greatly  accelerated ;  the  pulse  is  weak  and 
dicrotic ;  the  temperature  is  elevated,  and  the  respiration  corre- 
spondingly depressed ;  extreme  muscular  weakness  ensues,  with 
incoordination  of  movements ;  the  urine  becomes  saccharine. 
Finally,  paralysis  of  the  extremities  and  the  respiratory  muscles 
supervenes,  death  occurring  from  respiratory  paralysis. 

Treatment  of  Poisoning. — The  same  as  in  the  treatment  of  poi- 
soning from  conium,  with  catheterization  of  the  bladder  to  favor 
elimination,  and  artificial  respiration. 

Therapeutics. — While  of  great  scientific  interest  and  of  value 
for  experimental  purposes  in  ascertaining  the  effect  of  certain  drugs 
upon  animals,  the  therapeutic  uses  of  curare  are  quite  limited,  being 
confined  to  certain  spasmodic  diseases,  particularly  hydrophobia.  The 
remedy  has  also  been  used  with  varying  success  in  chorea,  tetanus, 
and  epilepsy,  but  when  the  convulsions  are  due  to  excessive  activity 
of  the  cerebral  motor  areas  the  bromides  are  superior  to  curare. 

Contraindications. — The  same  as  for  conium. 

Administration. — The  crude  drug  or  the  alkaloid  curare  should 
be  given  hypodermically. 

Aspidosperma— Aspidospermatis— Aspidosperma; 

V.  S.  JP. 

Origin. — The  bark  oi  Aspidosperma  Quebracho-bianco  Schlech- 
tendal,  a  large  evergreen  tree,  of  exceedingly  hard  wood  (Sp. 
quebrar,  to  break,  and  hacha,  an  axe),  indigenous  in  the  Argentine 
Republic. 

Description  and  Properties. — Occurring  in  nearly  flat  pieces 
about  \  to  i^  inches  (12.0-30.0  Mm.)  thick;  the  outer  surface  yel- 
lowish-gray or  brownish,  deeply  fissured,  inner  surface  yellowish- 
brown  or  reddish-brown,  distinctly  striate ;  fracture  displaying  two 
sharply-defined  strata  of  about  equal  thickness,  both  marked  with 
numerous  whitish  dots  and  striae  arranged  in  tangential  lines ;  the 
fracture  of  the  outer  lighter-colored  layer  rather  coarsely  granu- 
lar, and  that  of  the  darker-colored  inner  layer  short-splintery; 
inodorous ;  taste  very  bitter  and  slightly  aromatic. 

Six  alkaloids  have  thus  far  been  isolated  from  aspidosperma,  the 
most  important  being  aspidosp ermine  and  quebrachine,  the  former 
occurring  in  colorless  prismatic  crystals  insoluble  in  water  and 
soluble  in  48  parts  of  alcohol. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 


5i6  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Official  Preparations. 

Extractum  AspidospSrmatis  Fluidum— Extract!  AspidospSrmatis  Fluidi— 
Fluid  Extract  of  Aspidosperma. — Dose,  5-30  minims  (0.3-1.8  Co.). 
Aspidospermine  (unofficial). — Dose,  J-J  grain  (0.016-0.03  Gm-)- 
Quebrachine  (unofficial). — Dose,  1-2  grains  (0.06-0.12  Gni.). 

Physiological  Action. — Externally  and  Locally. — No  important 
action  has  been  noted. 

Internally. — Digestive  System. — It  is  a  stomachic,  having  an 
action  analogous  to  the  vegetable  bitters. 

Circulatory  System. — Aspidosperma  depresses  the  heart,  render- 
ing its  action  slower,  with  reduction  of  arterial  tension. 

Nervous  System. — In  its  action  it  resembles  conium.  It  de- 
presses the  motor  mechanism  by  its  influence  on  the  motor  centers, 
and  lessens  the  reflexes  through  its  influence  on  the  spinal  cord. 
Excessive  doses  cause  vertigo  and  headache,  together  with  paraly- 
sis of  the  extremities,  the  lower  being  first  affected. 

Respiratory  System. — Medicinal  amounts  of  aspidosperma  retard 
the  breathing,  but  deepen  the  inspirations ;  aspidospermine,  on  the 
contrary,  increases  the  respiratory  movements.  Toxic  doses  para- 
lyze the  respiratory  center,  death  resulting  apparently  from  asphyxia 
and  convulsions. 

Absorption  and  Elimination. — It  readily  passes  into  the  blood, 
and  is  excreted  chiefly  by  the  urine,  the  saliva  and  sweat  sharing 
in  the  process  of  elimination. 

Temperature. — It  is  antipyretic,  febrile  temperature  being  re- 
duced by  full  doses  of  the  drug. 

Poisoning. — Aspidospermine  is  an  active  respiratory  poison,  the 
toxic  symptoms  being  vertigo,  headache,  free  diaphoresis  and  sali- 
vation, great  muscular  weakness,  with  paralysis  of  the  lower 
extremities,  slow  and  weak  heart,  reduction  of  temperature,  marked 
depression  of  the  respiration,  and  death  from  respiratory  failure. 

Treatment  of  Poisoning. — The  same  procedure  is  advisable  as  in 
cases  of  poisoning  from  the  other  motor  depressants. 

Therapeutics. — Aspidosperma  is  not  employed  locally,  its  chief 
value  being  in  the  treatment  of  dyspnea  of  whatever  variety,  though 
it  is  fair  to  state  that  Pluzoldt  considers  it  contraindicated  in  cardiac 
dyspnea. 

The  drug  is  equal,  if  not  superior,  to  grindelia  inthe  treatment 
of  spasmodic  disorders  of  the  respiratory  apparatus. 

By  some  clinicians  it  is  claimed  to  be  an  efficient  remedy  in 
pneumonia,  being  especially  useful  in  relieving  cyanosis. 


MOTOR  DEPRESSANTS.  .  517 

AspiDOSPERMiNE  has  been  highly  recommended  as  an  anti- 
periodic  in  malaria,  and  has  appeared  to  modify  the  symptoms  of 
acute  articular  rheumatism. 

Administration. — Both  the  fluid  extract  and  the  alkaloid  may 
be  given  internally,  although  a  favorite  and  efficient  method  of 
administering  the  alkaloids  is  by  hypodermic  injection. 

Sumbul— Stimbul— Sumbul.     TJ.  S.  P. 

Origin. — The  root  of  Ferula  sumbul  (Kauffmann)  Hooker  fil,  a 
perennial  about  8  feet  (2.4  M.)  high,  indigenous  in  regions  north 
and  east  of  British  India. 

Description  and  Properties. — It  occurs  in  transverse  segments, 
varying  in  diameter  from  i  to  3  inches  (2-7  Cm.),  and  in  length 
from  6  to  12  inches  (14-30  Cm.);  light  spongy,  annulate  or  longi- 
tudinally wrinkled ;  bark  thin,  brown,  more  or  less  bristly  fibrous  ; 
the  interior  whitish,  with  numerous  brownish-yellow  resin-dots  and 
irregular,  easily  separated  fibers;  odor  strong,  musk-hke;  taste 
bitter  and  balsamic.  It  contains  sumbulic  and  valerianic  acids,  a 
small  quantity  of  volatile  oil,  and  two  balsamic  resins  to  which  its 
odor  is  due. 

Dose. — 15-30  grains  (1.0-2.0  Gm.). 

Official  Preparation. 

Tinctura  Sflmbul — Tincturae  Stimbul — Tincture  of  Sumbul. — Dose,  15-60 
minims  (1.0-3.7  Cc). 

The  drug  has  not  yet  been  carefully  studied.  It  is  unknown 
just  what  substances  are  incompatible  with  it,  though  the  motor 
excitants  are  probably  antagonistic.  The  exact  physiological  action 
is  not  definitely  understood,  yet  so  far  as  it  has  been  investigated  it 
seems  to  possess  some  of  the  properties  of  both  the  motor  de- 
pressants and  antispasmodics,  having  a  sedative  action  upon  the 
brain  and  spinal  cord. 

■  Therapeutics. — The  drug  is  valuable  in  the  various  manifesta- 
tions of  hysteria,  and  has  been  employed  with  some  success  in 
ovarian  neuralgia  and  dysm.enorrhea. 

It  is  similar  to,  though  not  so  efficient  as,  grindelia  in  spasmodic 
coughs.  Indeed,  most  of  the  disorders  benefited  by  the  antispas- 
modics yield  to  the  influence  of  sumbul. 

In  neurasthenia  with  anemia  the  extract  of  sumbul,  combined 
with  iron  and  arsenic,  sei^ves  a  very  useful  purpose. 


5l8  ^    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Administration. — It  may  be  given  in  the  form  of  the  tincture, 
or  the  extract  may  be  administered  in  pill  form. 

Viburnum   Prunifolium— Viburni  'Prunifolii— Black 
Haw.     V.  S.  JP. 

Origin. — The  bark  of  Viburnum  prunifolium  L.,  a  tall  shrub  or 
small  tree  lO  to  20  feet  (3-6  M.)  high,  growing  in  thickets  through- 
out the  greater  portion  of  the  United  States  east  of  the  Mississippi. 

Description  and  Properties. — Thin  pieces  or  quills,  glassy 
purplish-brown,  with  scattered  warts  and  minute  black  dots ;  when 
collected  from  old  wood,  grayish-brown,  the  thin  corky  layer  easily 
removed  from  the  green  layer ;  inner  surface  whitish,  smooth ;  frac- 
ture short ;  inodorous  ;  somewhat  astringent  and  bitter. 

It  contains  a  bitter  principle  (viburnin),  a  bitter  resin,  valerianic 
acid,  besides  tannic,  oxalic,  citric,  and  malic  acids. 

Dose. — 30-60  grains  (2.0-4.0  Gm.). 

Official  Preparation. 
Extractum  Vibtirni  Prunifolii  Fluidum — Extracti  Vibiirni  Prunifolii  Fluidi 
—Fluid  Extract  of  Black  Haw.'— Z)o«,  %-\  fiuidrachm  (1.8-3.7  Cc). 

Antagonists  and  Incompatibles. — It  is  chemically  incompatible 
with  iron  and  other  substances  affected  by  tannic  acid. 

Ssmergists. — Antispasmodics  and  uterine  sedatives. 

Physiological  Action  and  Therapeutics. — The  action  of  black 
haw  is  not  thoroughly  understood.  It  appears  to  have  a  sedative 
action  upon  the  spinal  centers,  similar  in  many  respects  to  that  of 
conium.  It  acts  as  an  antispasmodic,  diuretic,  nervine,  and  tonic, 
being  especially  useful  in  various  uterine  disorders,  such  as  spas- 
fnodic  and  membranous  dysmenorrhea. 

The  various  vaso-motor  disturbances  and  the  menorrhagia  inci- 
dent to  the  menopause  are  frequently  relieved  by  this  remedy.  It 
is  also  of  some  value  in  the  prevention  of  abortion.  Its  sedative 
properties  render  it  serviceable  in  relieving  the  severity  of  after- 
pains. 

Liquor  Sedans  (P.,  D.  &  Co.)  is  superior  to  the  fluid  extract  of 
black  haw  for  the  disorders  mentioned. 

Contraindications  and  Administration  require  no  special  com- 
ment or  suggestion. 

1  Parke,  Davis  &  Co.  of  Detroit  manufacture  a  preparation  called  Liquor  Sedans, 
intended  as  a  substitute  for  certain  secret  preparations.  The  formula  is  given  on  the 
label  of  each  bottle,  and  the  remedy  is  composed  of  black  haw,  golden  seal,  and  Jamaica 
dogwood,  combined  with  aromatics,  in  the  form  of  an  elixir. 


MOTOR  DEPRESSANTS.  519 

Viburnum  Opulus— Viburni  Opuli— Cramp  Bark. 

V.  S.  JP. 

Origin. — The  bark  of  Viburnum  Opulus  L.,  a  small  tree  10  to 
15  feet  (3-4.5  M.)  high,  indigenous  in  Canada,  the  Northern  United 
States,  Europe,  and  Northern  Asia. 

Description  and  Properties. — Flattish  or  curved  bands,  or 
occasionally  quills,  sometimes  12  inches  (30  Cm.)  long  and  from 
^  to  yi^  inch  (1-1.5  Mm.)  thick;  outer  surface  ash-gray,  marked 
with  somewhat  transversely  scattered,  elongated  warts  of  a  brown- 
ish color,  due  to  abi;asion,  and  marked  more  or  less  with  blackish 
dots,  with  black,  irregular  lines  or  thin  ridges,  arranged  chiefly  in 
a  longitudinal  direction;  underneath  the  easily-removed  corky 
layer  of  a  pale-brownish  or  reddish-brown  color ;  the  inner  surface 
dingy  white  or  brownish ;  fracture  tough,  the  tissue  separating  in 
layers ;  inodorous ;  taste  somewhat  astringent  and  bitter. 

Dose. — 1-2  drachms  (4.0-8.0  Gm.). 

Official  Preparation. 
Extractum  Vibiirni  Opuli  Fluidum — ExtrScti  Vibfirni  Opuli  Fluidi — Fluid 
Extract  of  Cramp  Bark. — Dose,  1-2  fluidrachms  {3.7-7.3  Cc).  j,  ' 

The  general  observations  upon  Viburnum  prunifoliuni  are  appli- 
cable to  this  drug. 

Acidum  Hydrocyanicum  Dilutum— Acldi  Hydrocy- 
anic! Diluti— Diluted  Hydrocyanic  Acid.    U.S. P. 

(Prussic  Acid.) 

Origin. — A  liquid  composed  of  2  per  cent,  by  weight  of  abso- 
lute Hydrocyanic  Acid  and  98  per  cent,  of  Water,  prepared  by 
distilling  a  mixture  of  Potassium  Ferrocyanide,  Sulphuric  Acid, 
and  Water  into  Distilled  Water. 

Description  and  Properties. — A  colorless  liquid,  of  a  charac- 
teristic odor  and  taste,  resembling  those  of  bitter  almonds.  As  it 
is  very  poisonous,  great  care  should  be  taken  in  tasting  it.  It  should 
be  kept  in  small,  dark-amber  colored,  cork-stoppered  bottles,  in 
a  cool  place. 

Dose. — 1-5  minims  (0.06-0.3  Cc). 

Antagonists  and  Incompatibles. — Atropine  is  a  physiological 
antagonist,  the  diffusible  stimulants  also  couftteracting  the  effects 
of  the  drug.  The  metallic  salts,  particularly  cobalt  nitrate,  are 
chemically  incompatible. 


520  A    TEXT-BOOK  OF  MA  TERTA   MEDICA. 

Synergists. — The  cardiac  and  motor  depressants. 

Physiological  Action. — Externally  and  Locally. — Applied  lo- 
cally to  the  unbroken  skin,  its  first  effect  is  slightly  irritating,  but 
soon  after  sedative  and  anesthetic,  because  of  its  influence  in 
causing  paralysis  of  the  sensory  nerve-endings. 

It  is  very  rapidly  absorbed  from  raw  surfaces,  even  toxic  effects 
resulting  from  its  application. 

Internally. — Digestive  System. — Being  quickly  absorbed  by  the 
mucous  membranes,  hydrocyanic  acid  acts  as  an  anesthetic  and 
sedative  upon  the  stomach,  moderate  doses  having  little  influ- 
ence upon  a  healthy  organism.  Toxic  doses  may  be  followed  by 
vomiting  and  the  terribly  lethal  action  of  the  drug,  the  peculiarly 
sudden  and  violent  activity  of  which  renders  it  the  most  fatal 
poison  known. 

Circulatory  System. — Prussic  acid  passes  very  readily  into  the 
blood,  upon  which  it  acts  with  physical  effects  variously  reported, 
it  having  been  observed  that  the  blood  is  at  first  changed  to  a 
bright  red  or  arterial  tint,  soon  changing  to  a  dark  venous  color. 
Upon  the  heart  its  influence,  though  in  small  doses  sedative 
through  stimulation  of  the  vagus  center,  in  toxic  doses  is  particu- 
larly active,  suspending  its  movements  and  arresting  it  in  diastole. 

A  temporary,  yet  doubtful,  increase,  followed  by  a  decline,  of 
arterial  pressure  has  been  noted.  In  lethal  doses  the  decrease  of 
tension  is  unquestionable.  Observations  upon  the  physiological 
effects  of  prussic  acid  have  been  attended  with  considerable  dif- 
ficulty :  a  slow  and  frequently  irregular  pulse,  however,  is  among 
the  authenticated  phenomena.  By  its  action  on  the  respiratory 
functions  of  the  red  blood-corpuscles  the  supply  of  oxygen  to  the 
circulation  is  impeded. 

Nervous  System. — Medicinal  doses  have  no  appreciable  effect 
save  to  occasion  a  depression  of  the  sensory  fibers  of  the  vagus. 
The  cerebral  effects  of  large  doses  are  giddiness  and  stupor,  often 
accompanied  by  total  insensibility  or  coma.  Toxic  doses  produce 
marked  cutaneous  anesthesia,  beginning  in  the  lower  extremities, 
caused  by  paralysis  of  the  sensory  ends  and  sensory  tracts. 

The  motor  mechanism  shares  in  the  general  influence,  which 
causes  excessive  muscular  weakness,  resulting  from  depression  of 
the  spinal  motor  areas,  the  ends  of  the  motor  nerves,  and  the  mus- 
cles respectively. 

Respiratory  System. — Very  small  doses  of  hydrocyanic  acid  have 
no  effect  upon  respiration.     Full  or  large  doses  have  been  observed 


MOTOR  DEPRESSANTS.  521 

to  render  the  breathing  labored  and  irregular.  Under  toxic  doses 
the  respiration  becomes  enfeebled,  finally  ceasing  altogether,  death 
■ensuing  from  asphyxia  due  to  paralysis  of  the  respiratory  move- 
ments by  direct  action  upon  the  center.  It  has  been  noted  that 
lethal  doses  are  so  quickly  fatal  that  the  respirations  cannot  be 
counted. 

Absorption  and  Elimination. — As  has  been  remarked,  absorption 
takes  place  with  great  rapidity,  elimination  being  probably  through 
the  kidneys,  salivary  glands,  and  lungs,  the  process  being  accel- 
erated by  means  of  the  drug's  exceeding  volatility.  In  case  of 
poisoning,  should  death  be  averted  for  half  an  hour  there  is  chance 
of  recovery. 

Temperature. — No  special  influence  has  been  observed. 

Eye. — The  pupils  are,  as.  a  rule,  visibly  dilated  under  serious 
dosage,  a  temporary  hemianopia  having  been  also  observed  in  a 
case  of  poisoning  with  recovery. 

Untoward  Action. — There  are  no  untoward  manifestations  save 
those  described  under  "  Poisoning." 

Poisoning. — The  celerity  of  action  characteristic  of  prussic  acid 
is  evidenced  by  the  fact  that  death  may  be  instantaneous,  the  sub- 
ject falling  with  a  gasp  and  momentary  convulsion,  followed  by 
immediate  collapse.  In  such  cases  the  countenance  is  cyanotic,  the 
teeth  fiirmly  set,  the  eyes  wide  open,  and  the  lips  covered  with 
bloody  froth.  In  less  violent  cases  the  symptoms  may  take  the 
form  of  reduced  respiration,  impairment  of  cardiac  movements,  and 
cerebral  disturbance.  A  third  stage  is  marked  by  wide  dilatation 
of  the  pupils,  loss  of  consciousness,  delirious  cries,  accompanied 
by  strong  convulsions,  vomiting,  incontinence  of  urine,  involuntary 
defecation,  and  even  erections  of  the  penis  and  ejaculations  of 
semen  (Hare).  In  still  another  stage  asphyxia,  collapse,  and  death 
occur  in  rapid  succession. 

Treatment  of  Poisoning. — Owing  to  the  physical  action  of 
prussic  acid  upon  the  blood,  artificial  respiration  is  generally  pow- 
erless to  avert  fatal  results  (Ringer).  Efficient  antidotee  are 
ammonia  and  its  carbonate,  to  be  administered  whenever  prac- 
ticable. Alcoholic  stimuli  may  prove  of  service,  yet  the  fearful 
rapidity  of  the  drug's  action  renders  poisoning  by  prussic  acid 
rarely  amenable  to  systematic  treatment. 

A  vigorous  recourse  to  alternately  warm  and  cold  affusions, 
together  with  inhalations  of  ammonia,  has  been  recommended  as 
of  primary  importance.     Secondary  means  of  allaying-toxic  effects 


522  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

may  be  found  in  the  internal  administration  of  chlorine  water  or 
of  potassium  carbonate,  followed  by  the  sulphates  of  iron. 

More  recently  the  subcutaneous  injection  of  atropine  has  been 
suggested  as  the  true  physiological  antidote  (Farquharson),  while 
Dr.  Antal  considers  cobalt  nitrate  the  best  chemical  antagonist. 
So  long  as  the  faintest  pulsation  is  discernible  no  efforts  at  recovery 
should  be  remitted. 

Therapeutics. — Externally  and  Locally. — Hydrocyanic  acid  is 
a  valuable  antipruritic,  being  frequently  employed  to  relieve  the 
itching  of  various  diseases  of  the  skin,  such  as  eczema,  erythema, 
urticaria,  pruritus  vulvee,  etc.  It  is  commonly  applied  in  strengths 
of  ^  fluidrachm  (1.8  Cc.)  to  I  ounce  (30.0  Cc.)  of  water. 

Inhalations  of  a  solution  containing  3  minims  (0.18  Cc.)  of 
diluted  hydrocyanic  acid  to  8  ounces  (236.6  Cc.)  of  water  at  a 
temperature  of  120°  F.  have  been  recommended  by  Mackenzie 
and  others  in  asthma  and  the  irritative  cough  of  phthisis. 

Internally. — Its  sedative  properties  render  the  drug  an  efficient 
remedy  in  obstinate  vomiting  and  gastric  pain  from  whatever 
cause.  It  is  also  valuable  to  relieve  coughs  of  a  dry,  hacking 
nature,  whooping  cough,  and  various  neuroses  of  the  respiratory 
organs.  Macdonald  reports  a  case  of  night  cough  of  a  child  that 
yielded  promptly  to  hydrocyanic  acid  after  every  other  treatment 
had  been  tried  in  vain. 

The  drug  has  also  been  employed  in  neuralgia  and  acute  mania 
and  m.elancholia. 

In  irritable  conditions  of  the  heart  it  serves  as  a  useful  palliative, 
and  it  is  also  of  some  value  in  relieving  the  distress  of  irritative 
dyspepsia. 

Contraindications. — Extreme  muscular  weakness  and  the  last 
stages  of  valvular  heart  disease. 

Administration. — Owing  to  the  exceedingly  rapid  elimination 
of  prussic  acid  the  dose  should  be  frequently  repeated — every 
hour  or  two.  In  the  early  administration  the  minimum  dose 
should  be  first  prescribed,  the  amount  being  gradually  increased  to 
the  maximum  or  until  the  patient  complains  of  constriction  about 
the  throat  or  other  untoward  manifestation,  when  the  dosage  should 
be  discontinued.  Whenever  a  fresh  supply  is  prescribed  it  is  best 
to  begin  with  the  minimum  dose,  owing  to  the  variations  in  strength 
in  the  different  samples. 

Hydrocyanic  acid  may  be  given  in  syrup,  water,  or  glycerin,  or 
in  some  effAvescent  draught. 


MOTOR  DEPRESSANTS.  523 

Potassii  Cyanidum— Potassil  Cyanidi— Potassium 
Cyanide.    V.  S.  F. 

Origin. — Prepared  by  heating  in  an  iron  crucible  a  mixture  of 
exsiccated  Potassium  Ferrocyanide  8  parts  and  Potassium  Carbon- 
ate 3  parts  until  effervescence  ceases. 

Description  and  Properties. — White,  opaque,  amorphous  pieces, 
or  a  white,  granular  powder,  odorless  when  perfectly  dry,  but  in 
moist  air  exhaling  the  odor  of  hydrocyanic  acid.  The  taste  is 
sharp  and  somewhat  alkaline,  but  should  be  ascertained  with  great 
care,  as  ike  salt  is  very  poisonous.  In  moist  air  it  deliquesces  ; 
soluble  in  about  2  parts  of  water  and  sparingly  soluble  in  alcohol. 
Potassium  cyanide  should  be  kept  in  well-stoppered  bottles. 

Dose. — \^-\  grain  (0.004-0.008  Gm.). 

Cyanide  of  potassium  differs  from  hydrocyanic  acid,  with  which 
it  generally  assimilates,  in  being  less  rapid  in  its  action,  producing 
dermatitis  or  eczematous  eruption  by  local  application  to  the  epi- 
dermis, and  in  its  possibly  fatal  results  from  free  contact  with 
abraded  surfaces. 

The  therapeutic  uses  are  practically  those  of  hydrocyanic 
acid. 

Amyl  NTtris— Amyl  Nitrltis— Amy!  Nitrite.    TJ.S.F. 

Origin. — Obtained  by  the  action  of  Nitric  Acid  upon  Amylic 
Alcohol — a  liquid  containing  about  80  per  cent,  of  amyl  (princi- 
pally iso-amyl)  nitrite,  together  with  variable  quantities  of  unde- 
termined compounds. 

Description  and  Properties. — A  clear  yellow  or  pale-yellow 
liquid,  of  a  peculiar,  ethereal,  fruity  odor  and  a  pungent,  aromatic 
taste.  Almost  insoluble  in  water ;  miscible  in  all  proportions  with 
alcohol  or  ether.  In  alcoholic  solution  it  gradually  decomposes, 
with  formation  of  ethyl  nitrite  and  amylic  alcohol.  It  should  be 
kept  in  small,  dark-colored,  glass-stoppered  bottles,  in  a  cool  and 
dark  place,  remote  from  lights  and  fire. 

Dose. — J-I  minim  (0.03-0.06  Cc.)  internally ;  for  inhalation  I-5 
minims  (0.06-0.3  Cc). 

Antagonists  and  Incompatibles. — The  motor  excitants  antago- 
nize the  action  of  amyl  nitrite. 

Synergists. — The  motor  depressants. 

Physiological  Action. — Externally  and  Locally. — Its  action  is 
that  of  a  mild  irritant  when  applied  to  the  skin. 


524  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Internally. — The  following  actions  apply  to  ingestion  or  inhala- 
tion of  the  drug. 

Digestive  System. — No  important  action  has  been  observed. 

Circulatory  System. — Almost  immediately  after  inhalation  of 
amyl  nitrite  there  is  a  marked  increase  in  the  heart's  action  and 
great  dilatation  of  the  arteries,  with  lowering  of  arterial  pressure. 
The  rapidity  of  the  pulse  is  due  to  depression  of  the  vagus  and  the 
removal  of  inhibition  from  the  low  arterial  tension.  The  exact 
cause  of  dilatation  in  the  arterial  system  is  undetermined,  some 
experimenters  believing  it  to  be  due  to  depression  of  the  muscular 
coat  of  the  vessels  or  ganglia,  while  others  suppose  its  action  to  be 
on  the  vaso-motor  center. 

The  inhalation  of  large  amounts  renders  the  heart  very  weak, 
toxic  doses  arresting  that  organ  in  diastole.  The  functional  activ- 
ity of  the  hemoglobin  is  checked,  giving  to  the  arterial  and  venous 
blood  a  dark  chocolate  color. 

Nervous  System. — Among  the  effects  are  cerebral  oppression, 
flushing  of  the  head  and  face,  vertigo,  headache,  and  confusion  of 
ideas,  with  diminished  reflex  excitability,  muscular  weakness,  and 
unsteadiness  of  gait,  both  the  voluntary  and  involuntary  muscles 
being  relaxed.  These  actions  are  due  to  the  depressing  influence 
of  the  drug  upon  the  motor  areas  of  the  brain  and  spinal  cord. 

Respiratory  System. — Small  doses  quicken  the  respiration  by 
lowering  arterial  pressure  and  possibly  by  stimulation  of  the  cen- 
ter. Immoderate  or  toxic  amounts  render  the  breathing  slow  and 
labored  from  depression  of  the  respiratory  center  and  arrest  of  the 
corpuscular  action  of  the  blood. 

Absorption  and  Elimination. — Amyl  nitrite  is  rapidly  absorbed, 
being  eliminated  chiefly  by  the  kidneys,  increasing  the  amount  of 
urine,  uric  acid,  and  urea  excreted.  Sugar  may  frequently  be  de- 
tected in  the  urine,  probably  resulting  from  the  action  of  the  drug 
in  dilating  the  hepatic  vessels  and  increasing  the  circulation  in  the 
liver. 

Temperature.— '?,o^\\y  heat  is  reduced  both  in  health  and  in 
fever,  due  to  dilatation  of  the  peripheral  blood-vessels  and  a  reduc- 
tion of  the  oxygen-carrying  power  of  the  red  blood-corpuscles. 

^«'.— There  is  marked  dilatation  of  the  retinal  vessels  and 
hyperemia  of  the  papilla,  producing  chromatopsia  of  the  parti- 
colored variety  and  hallucinations  of  vision.  These  effects  are 
usually  transitory,  and  disappear  with  the  elimination  of  the  drug. 

Uterus. — The  uterine  muscle  is  relaxed. 


MOTOR  DEPRESSANTS.  525 

Untoward  Action. — In  addition  to  the  symptoms  described  under 
"  Poisoning,"  there  have  been  noted  gastric  disturbance,  nausea  and 
vomiting,  dryness  of  the  mouth  and  trembling  of  the  lips,  irritation 
of  the  throat,  defective  vision,  and  subjective  sensations  of  color, 
usually  yellow  vision. 

Poisoning. — The  toxic  effects  of  amyl  nitrite  include  an  exceed- 
ingly rapid  and  weak  heart,  final  retardation  of  the  pulse,  cyanosis 
of  the  face,  slow  and  shallow  respiration,  cold  extremities,  subnor- 
mal temperature,  great  muscular  weakness,  abolished  reflexes, 
vertigo,  intense  headache,  and  disordered  vision.  Death  results 
from  cardiac  or  respiratory  failure. 

Treatment  of  Poisoning. — Strychnine  and  digitalis  are  required 
to  sustain  the  heart ;  ergotin  or  atropine  may  be  administered  sub- 
cutaneously,  together  with  cold  applications  to  the  head,  diffusible 
stimulants,  and  artificial  respiration  if  necessary. 

Sodii  NItris— Sodii  Nitritis— Sodium  Nitrite.    TJ.  S.  P. 

Origin. — Obtained  by  heating  Sodium  Nitrate  with  Lead,  the 
oxygen  from  the  nitrate  being  abstracted  by  the  lead  oxide  formed. 

Description  and  Properties. — White,  opaque,  fused  masses, 
usually  in  the  form  of  pencils,  or  colorless,  transparent,  hexagonal 
crystals ;  odorless,  and  of  a  mild,  saline  taste.  When  exposed  to 
the  air  the  salt  deliquesces  and  is  gradually  oxidized  to  sodium 
nitrate.  Soluble  in  about  1.5  parts  of  water;  slightly  soluble  in 
alcohol.     It  should  be  kept  in  well-stoppered  bottles. 

Dose. — 2-5  grains  (o.  1 2-0.3  Gm.). 

Spiritus  GlonoTni— SpTritus  GlonoTni— Spirit  of  Gio- 
noin.     U.S.  P. 

(Spirit  of  Nitroglycerin.) 
An  alcoholic  solution  of  i  per  cent,  of  nitroglycerin. 
Origin. — Nitroglycerin  is  obtained  by  gradually  adding  Dehy- 
drated Glycerin  to  a  mixture  of  Nitric  and  strong  Sulphuric  Acid, 
the  nitroglycerin  formed  being  washed  with  water  and  dilute  soda 
solution  to  remove  all  acid. 

Description  and  Properties. — Nitroglycerin  occurs  as  a  clear, 
colorless  liquid  possessing  the  odor  and  taste  of  alcohol.  It 
should  be  tasted  and  handled  with  great  caution,  since  it  is  apt  to 
produce  violent  headache,  whether  ingested  or  applied  to  the  skin. 
It  explodes  with  great  force,  and  should  be  kept  in  a  cool  place, 
remote  from  lights  or  fire. 


526  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Dose. — 1-3  minims  (0.06-0.18  Cc.)  of  the  spirit. 

The  actions  of  sodium  nitrite  and  nitroglycerin  are  very  similar 
to  those  of  amyl  nitrite,  although  they  are  less  prompt,  while  more 
persistent.  Nitroglycerin  produces  a  frontal  headache  of  much 
greater  intensity  than  that  caused  by  amyl  nitrite.  This  is  also 
true  of  sodium  nitrite,  though  the  headache  it  occasions  is  less 
severe  than  that  resulting  from  nitroglycerin. 

Both  the  sodium  nitrite  and  nitroglycerin  are  preferable  to  the 
amyl  nitrite  for  internal  administration. 

Therapeutics. — Externally  and  Locally. — The  nitrites  are  not 
used  for  external  purposes. 

Internally. — The  property  of  amyl  nitrite  in  suddenly  lowering 
arterial  pressure  and  dilating  the  arterioles  renders  it  of  inestima- 
ble value  as  a  relief  for  the  terrible  precordial  pain  in  angina 
pectoris. 

Epileptic  seizures  may  often  be  aborted  by  the  instant  inhalation 
of  amyl  nitrite  upon  the  first  indication  of  the  aura  epileptica.  The 
drug  has  also  been  successfully  employed  for  the  relief  of  asthma, 
particularly  the  uremic  form,  as  well  as  for  cardiac  dyspnea  and 
puerperal  eclampsia.  , 

Like  many  other  motor  depressants,  it  has  been  used  in  the 
treatment  of  tetanus  and  strychnine-poisoning.  It  has  proved  an 
efficient  preventive  for  the  chill  occurring  in  virulent  malarial  fever, 
and  has  served  as  a  valuable  antidote  in  poisoning  from  chloroform. 

The  drug  is  indicated  in  all  conditions  of  high  arterial  tension, 
as  in  chronic  nephritis,  etc.  It  is  also  beneficial  in  congestive  dys- 
menorrhea. 

The  SODIUM  NITRITE  IS  used  for  the  same  purposes  as  the  amyl 
nitrite,  though  superior  to  it  for  internal  administration,  as  in  cases 
of  abnormally  high  arterial  tension. 

Nitroglycerin  is  specially  adapted  for  the  treatment  of  cardi- 
opathies occurring  after  middle  life.  The  tendency  to  increase  of 
peripheral  resistance  in  the  vessels  after  adult  life  is  attained  renders 
possible  the  favorable  administration  of  doses  of  nitroglycerin  intol- 
erable in  early  life. 

The  drug  is  often  of  marked  benefit  in  the  arrhythmia  of  slightly 
enlarged  atid  degenerated  hearts  with  arteriosclerosis.  It  is  also 
of  considerable  value  in  relieving  the  pseudo-anginas  which  are 
frequently  a  feature  of  vascular  disease.  It  should  be  given  in 
doses  of  -^-^  to  Y^ir  grain  (0.00032-0.0006  Gm.)  twice  or  four 
times  daily. 


MOTOR  DEPRESSANTS.  527 

Osier  recommends  the  prolonged  administration  of  nitroglycerin 
in  locomotor  ataxia,  affirming  that  it  lessens  the  frequency  of  the 
crises  and  relieves  the  neuralgic  pains. 

The  drug  is  of  use  in  sciatica,  and  frequently  relieves  obstinate 
hiccough.  It  has  been  recommended  for  the  same  diseases  for 
which  amyl  nitrite  is  used. 

BROMIDES. 

Potassii  Bromidum— Potassii  Bromidi— Potassium 
Bromide.    V.  S.  P. 

Origin. — Prepared  by  adding  Bromine  to  a  solution  of  Potassa, 
evaporating  to  dryness,  mixing  with  Charcoal,  heating  to  redness, 
dissolving  in  Water,  and  crystallizing. 

Description  and  Properties. — Colorless  or  white,  cubical  crys- 
tals or  granules,  odorless,  with  a  pungent,  saline  taste ;  permanent 
in  air;  soluble  in  about  1.6  parts  of  water  and  in  200  parts  of 
alcohol. 

Dose. — 5-60  grains  (0.3-4.0  Gm.). 

Sodii  Bromidum— Sodii  Bromidi— Sodium  Bromide. 

u.  s.  p. 

Origin. — Obtained  from  a  solution  of  Soda  in  the  same  manner 
as  Potassium  Bromide. 

Description  and  Properties. — Colorless  or  white,  cubical  crys- 
tals, or  a  white,  granular  powder,  odorless,  and  with  a  saline, 
slightly  bitter  taste.  From  air  the  salt  abstracts  moisture  without 
deliquescing.  Soluble  in  1.2  parts  of  water  and  in  13  parts  of 
alcohol.     It  should  be  kept  in  well-stoppered  bottles. 

Dose. — 10-60  grains  (0.6-4.0  Gm.). 

Ammonii  Bromidum— Ammonii   Bromidi— Ammo- 
nium Bromide.    U.  S.  JP. 

Origin. — Obtained  by  neutralizing  Hydrobromic  Acid  with 
Ammonia  or  Ammonium  Carbonate,  evaporating,  and  crystallizing. 

Description  and  Properties. — Colorless,  transparent,  prismatic 
crystals,  or  a  white,  crystalline  powder,  odorless,  and  of  a  pungent, 
saline  taste;  permanent  in  the  air.  Soluble  in  1.5  parts  of  water 
and  in  30  parts  of  alcohol. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 


528  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

LTthii  Bromidum— Lithii  Bromidi— Lithium  Bromide. 

JJ.  S.  JP. 

Origin. — Prepared  by  a  solution  of  Ferrous  Bromide  and  Lithium 
Carbonate,  the  cool  liquid  being  evaporated  and  crystallized. 

Description  and  Properties. — A  white,  granular  salt,  odorless, 
and  having  a  sharp,  slightly  bitter  taste ;  very  deliquescent.  Solu- 
ble in  0.6  part  of  water  and  very  soluble  in  alcohol.  It  should  be 
kept  in  well-stoppered  bottles. 

Dose. — 5-20  grains  (0.3-1.2  Gm.). 

Calcii    Bromidum— Calcii    Bromidi— Calcium    Bro- 
mide.    U.  S.  JP. 

Origin. — Prepared  by  dissolving  pure  Calcium  Carbonate  in 
Hydrobromic  Acid  and  evaporating. 

Description  and  Properties. — A  white,  granular  salt,  odorless, 
of  a  sharp,  saline  taste  and  very  deliquescent.  Soluble  in  0.7  part 
of  water  and  in  i,  part  of  alcohol.  It  should  be  kept  in  well- 
stoppered  bottles. 

Dose. — 10-30  grains  (0.6-2.0  Gm.). 

ZTnci    Bromidum— ZTnci    Bromidi— Zinc    Bromide. 

U.  S.  JP. 

Origin. — Prepared  by  digesting  Granulated  Zinc  in  Hydrobromic 
Acid,  concentrating  the  solution,  acidulating  with  Hydrobromic 
Acid,  and  drying  upon  a  water-bath. 

Description  and  Properties. — A  white,  granular  powder,  odor- 
less, and  having  a  sharp,  saline,  and  metaUic  taste.  Very  deliques- 
cent.    Readily  soluble  in  water  and  alcohol. 

Dose. — 1-5  grains  (0.06-0.3  Gm.). 

Strontii    Bfomidum— Strontii    Bromidi— Strontium 
Bromide.    U.  S.  J>. 

Origin. — Obtained  by  neutralizing  Hydrobromic  Acid  with 
Strontium  Carbonate,  filtration,  and  evaporation. 

Description  and  Properties. — Colorless,  transparent,  hexagonal 
crystals,  odorless,  and  having  a  bitter,  saline  taste.  Very  deUques- 
cent.  Soluble  in  1.05  parts  of  water  and  readily  soluble  in 
alcohol. 

Dose. —  5-30  grains  (0.3-2.0  Gm.). 


MOTOR  DEPRESSANTS.  529 

Acidum  Hydrobromicum  Dilutum— Acidi  Hydro- 
bromici  Diluti  —  Diluted  Hydrobromic  Acid. 
TT.  8.  JP. 

Origin. — A  liquid  composed  of  10  per  cent,  by  weight  of  Abso- 
lute Hydrobromic  Acid  and  90  per  cent,  of  Water. 

Description  and  Properties. — A  clear,  colorless  liquid,  odor- 
less, and  having  a  strongly  acid  taste.  Miscible  in  all  proportions 
with  water  and  alcohol.  It  should  be  kept  in  glass-stoppered 
bottles,  protected  from  light. 

Dose. — 20  minims-2  fluidrachms  (1.23-7.39  Co.). 

Bromoformum— Bromoformi—Bromoform 

(Unofficial). 

Origin. — Obtained  by  the  action  of  Bromine  upon  equal  parts 
of  Methylic  Alcohol  and  Caustic  Potash. 

Description  and  Properties. — A  colorless,  limpid  liquid  with 
an  agreeable  odor  and  sweet  taste.  Insoluble  in  water,  but  soluble 
in  alcohol  and  ether.  It  should  be  kept  in  well-stoppered,  dark, 
amber-colored  bottles. 

Dose. — 1-5  minims  (0.06-0.3  Cc). 


Antagonists  and  Incompatibles. — The  bromides  are  antago- 
nized by  the  motor  excitants  and  cardiac  stimulants.  The  incom- 
patibles are  acids,  acidulous  and  metallic  salts.  Spirit  of  nitrous 
ether  is  incompatible  with  the  ammonium  bromide. 

Synergists. — Their  action  upon  the  brain  is  enhanced  by  opium 
and  the  hypnotics,  while  the  cardiac  depressants  increase  their 
effect  upon  the  circulatory  system. 

Physiological  Action. — The  action  of  potassium  bromide  is 
here  given,  that  being  the  type  of  the  group :  later  the  comparative 
actions  of  the  various  members  will  be  considered. 

Externally  and  Locally. — Potassium  bromide  is  slightly  seda- 
tive to  mucous  membranes  when  applied  locally,  lessening  the 
reflex  irritability,  particularly  of  the  pharynx. 

Internally. — Digestive  System. — No  effect  is  produced  by  mod- 
erate amounts.  Excessive  doses  have  occasioned  a  sense  of  cold- 
ness in  the  epigastrium,  with  nausea  and  looseness  of  the  bowels. 

Circulatory  System. — The  bromides  depress  the  circulation, 
causing  the  pulse  to  become  slower,  softer,  and  weaker,  and  short- 
ening the  systole  while  prolonging  the  diastole  of  the  heart.  The 
caliber  of  the  vessels  is  diminished,  although  arterial  pressure  is 
34 


53°  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

lowered.  Arterial  anemia  of  the  brain  is  present,  owing  to  the 
contraction  of  the  blood-vessels  and  diminished  arterial  pressure. 
Toxic  doses  of  potassium  bromide  cause  dilatation  of  the  heart 
and  paralysis  in  diastole. 

The  exact  points  where  the  bromides  act  to  cause  this  circula- 
toiy  depression  are  undetermined. 

Nervous  System. — When  given  for  a  long  time  or  under  large 
dosage  the  bromides  depress  the  cerebral  cells,  producing  somno- 
lence, reducing  the  excitability  of  the  brain,  and,  if  long  continued, 
impairing  the  memory  and  intellect. 

Under  their  influence  there  is  marked  depression  of  the  motor 
mechanism,  resulting  in  muscular  weakness.  Every  possible  point 
of  the  apparatus  is  depressed — the  cerebral  and  spinal  motor  areas, 
the  spinal  motor  tracts,  the  ends  of  the  motor  nerves,  and  even 
the  muscles  themselves. 

Bromides  also  lessen  greatly  the  reflex  excitability  of  the  spinal 
cord.  As  in  their  action  upon  the  motor  mechanism,  they  depress 
every  part  of  the  reflex  apparatus — the  ends  of  the  afferent  and 
efferent  nerves  and  the  reflex  center  wherever  it  may  be. 

The  sensory  mechanism  is  therefore  impaired,  causing  dimin- 
ished sensibility  of  the  skin  and  mucous  membranes. 

The  functional  activity  of  the  sexual  organs  is  considerably  less- 
ened by  these  drugs. 

Respiratory  System. — Under  full  doses  the  respirations  are 
slower  and  shallower,  owing  to  depression  of  the  respiratory 
center,  paralysis  of  which  usually  causes  death,  although  fatal 
paralysis  may  affect  the  heart  because  of  the  poisonous  influence 
of  the  potassium  upon  the  cardiac  muscle. 

Absorption  and  Elimination. — The  bromides  are  very  rapidly 
absorbed,  having  been  found  in  the  urine  ten  minutes  after  their 
ingestion  (Dujardin-Beaumetz),  and  are  quickly  eliminated,  chiefly 
by  the  kidneys,  increasing  the  flow  of  urine,  and  also  by  the  skin, 
saliva,  intestinal  and  mammary  glands,  and  the  bronchial  mucous 
membrane.  The  sulphur  and  nitrogen  in  the  urine  are  increased 
and  the  amount  of  phosphorus  decreased. 

Notwithstanding  the  rapid  elimination  of  the  bromides,  under 
prolonged  administration  they  tend  to  accumulate  in  the  system, 
being  found  abundantly  in  the  nerve-centers. 

Temperature. — Immoderate  doses  cause  a  reduction  of  temper- 
ature, due  to  depression  of  the  circulation  and  lessening  of  tissue- 
change. 


MOTOR  DEPRESSANTS.  531 

Eye. — There  may  occur  dilatation  of  the  pupil,  conjunctival 
catarrh,  diplopia,  amblyopia,  dimness  of  vision,  and  dilatation  of 
the  retinal  blood-vessels. 

Uterus. — A  diminution  of  the  catamenia  may  sometimes  be 
present. 

Untoward  Action. — The  susceptibility  of  individuals  to  the  un- 
toward action  of  the  bromides  is  extremely  variable.  The  symp- 
toms observed  are — gastric  uneasiness  with  eructation,  nausea  and 
vomiting,  analgesia  of  the  epiglottis  and  pharynx,  bronchial  catarrh, 
hoarseness  and  cough,  acute  coryza  and  conjunctivitis,  offensive 
breath,  dysuria,  diminished  sensibility  of  the  genito-urinary  mucous 
membrane,  and  a  variety  of  cutaneous  eruptions. 

Poisoning. — Bromism,3.s  the  symptoms  of  poisoning  are  termed, 
may  be  divided  into  acute  and  chronic. 

Acute  bromism,  resulting  from  a  single  toxic  dose,  is  manifested 
by  violent  frontal  headache,  great  muscular  weakness,  incoordi- 
nation of  movements,  abolition  of  reflexes,  somnolence,  slow  and 
shallow  breathing,  subnormal  temperature,  lustreless  eyes,  and 
very  slow  and  weak  pulse,  death  resulting  from  either  respiratory 
or  cardiac  failure. 

Chronic  bromism,  caused  by  prolonged  use  of  the  bromides,  is 
characterized  by  mental  apathy,  constant  drowsiness,  hallucination 
or  melancholia,  considerable  cutaneous  anesthesia,  muscular  weak- 
ness, poor  circulation,  cold  extremities,  marked  anemia,  impairment 
of  the  sexual  function,  deranged  digestion,  and  cutaneous  eruptions 
of  various  forms  collectively  designated  as  "  bromine  acne.'' 

Treatment  of  Poisoning.  —  The  drug  should  be  immediately 
withdrawn  and  methods  adopted  to  hasten  elimination,  such  as  the 
administration  of  diuretics,  cathartics,  etc.  Tonics,  such  as  strych- 
nine, iron,  and  the  cardiac  stimulants,  should  be  given,  while  exer- 
cise and  change  of  scene  may  counteract  the  psychical  symptoms. 

It  is  claimed  that  the  daily  administration  of  Fowler's  solution 
causes  a  rapid  disappearance  of  the  bromine  eruption. 

Comparative  Action  of  the  Bromides. — Potassium  bromide 
contains  66  per  cent,  of  bromine.  It  is  the  least  hypnotic  and  most 
toxic  to  the  heart  and  muscular  system. 

Sodium  bromide,  78  per  cent,  of  bromine,  is  more  hypnotic,  but 
much  less  toxic,  than  the  potassium  salt.  Its  effect  upon  the  cir- 
culation is  the  most  pronounced  of  all  the  bromides. 

Ammonium  bromide  is  less  toxic  and  more  stimulating  than 
potassium  bromide,  though  resenibling  it  in  other  respects. 


532 


A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 


Lithium  bromide  is  the  richest  in  bromine,  containing  92  per 
cent.,  and  is  probably  the  most  hypnotic  of  all.  Its  action  more 
nearly  resembles  that  of  the  sodium  salt. 

Calcium  bromide,  while  resembling  them  in  its  action,  is  less 
energetic  than  the  other  bromides. 

Zinc  bromide  is  the  most  irritant,  and  is  supposed  to  possess 
both  tonic  and  sedative  properties. 

Strontium  bromide  is  the  mildest  of  all,  being  less  prone  to 

cause  bromism.  ' 

Diluted  hydrobromic  acid  in  its  action  resembles  the  bro- 
mides, though  much  less  depressant  than  the  potassium  salt,  and 
less  likely  to  occasion  symptoms  of  chronic  poisoning. 

Therapeutics. — Externally  and  Locally. — Pharyngitis  is  relieved 
by  a  gargle  containing  potassium  bromide  and  potassium  chlorate. 
A  solution  of  potassium  bromide  diminishes  the  sensibility  of  the 
throat,  so  that  examinations  are  more  easily  made.  A  solution  of 
4  parts  of  potassium  bromide  in  20  parts  of  glycerin  affords  a 
soothing  lotion  in  painful  hemorrhoids.  It 
is  asserted  that  the  powdered  salt  has  been 
dusted  over  indolent  ulcers  with  benefit. 

Internally. — The  bromides  are  especially 
useful  in  allaying  excessive  brain  activity,  the 
insomnia  (particularly  the  sleeplessness  de- 
pendent upon  nervous  excitement,  exhaus- 
tion, and  irritability)  and  headache  of  cerebral 
congestion  yielding  readily  to  these  remedies. 
They  are  undoubtedly  the  most  efficient 
medicinal  agents  for  the  relief  of  epilepsy, 
being  given  either  alone  or  in  combination 
with  some  vegetable  bitter.     Fere  combines 
with  them  an  intestinal  antiseptic,  asserting 
that  the  union  lessens  the  tendency  to  bro- 
mism. Bechterew  highly  recommen  ds  a  com- 
bination of  the  bromides  with  Adonis  vernalis. 
Being  such  marked  depressants  of  the 
reflex  centers,  they  are  of  decided  benefit  in 
nervous  spasmodic  disorders,  and  particu- 
larly valuable  in  infantile  convulsions. 
During  dentition  children  suffer  from  various  disturbances  due 
to  irritation  of  the   dental   nerve — convulsions,  cough,  indigestion, 
diarrhea,  strabismus,  etc.— in  all  of  which  the  bromides,  being 


Fig.  II.  —  Diagram,  showing 
how  irritation  of  the  dental  nerve 
in  teething,  by  stimulating  the 
sensitive  reflex  mechanism  of  the 
infant,  may  produce  strabismus 
(5),  cough  (2?,  K),  indigestion 
(Z.),  diarrhea  {M),  and  convul- 
sions {N). 


MOTOR  DEPRESSANTS.  533 

powerful  depressants  of  the  reflex  mechanism,  prove  of  great  value. 
(See  Diagram  1 1 .) 

Whenever  there  is  increased  reflex  excitability  the  bromides  are 
indicated.  They  are  therefore  valuable  in  the  reflex  disturbances  of 
the  menopause,  spasmodic  asthma,  laryngismus  stridulus,  whooping 
cough,  and  other  coughs  of  reflex  origin.  They  have  also  been  used 
in  tetanus  and  strychnine-poisoning. 

Excessive  nervous  irritability  is  quickly  relieved  by  these  reme- 
dies, either  singly  or  in  combination  with  some  of  the  antispas- 
modics, such  as  asafetida,  valerian,  etc. 

Because  they  depress  the  sexual  mechanism  they  are  of  decided 
benefit  in  spermatorrhea  of  the  plethoric  or  in  the  condition  arising 
from  irritation  of  the  deep  urethra.  Menorrhagia  resulting  from 
excessive  ovarian  excitement  is  frequently  relieved  by  these  agents, 
while  nymphomania  and  delirium  tremens  are  often  greatly  benefited 
by  full  doses  of  the  bromides. 

The  AMMONIUM  BROMIDE  has  been  employed  with  benefit,  it  is 
said,  in  diabetes  of  nervous  origin.  Cerebral  vomiting  and  the 
vomiting  of  pregnancy  are  sometimes  singularly  amenable  to  the 
influence  of  the  bromides. 

The  author  is  quite  partial  to  a  combination  of  sodium  bromide, 
spirit  of  nitrous  ether,  and  tincture  of  aconite,  in  anise  water,  as  a 
remedy  in  acute  febrile  attacks  of  children  with  delirium.  Small 
doses  are  given  at  frequent  intervals  until  there  is  a  decided  im- 
provement in  the  symptoms. 

The  bromides  are  claimed  to  be  of  value  in  acute  and  muscular 
rheumatism.  The  lithium  salt  is  undoubtedly  of  service  in  these 
cases  and  in  the  uric-acid  diathesis. 

The  sedative  action  upon  the  circulatory  apparatus  exerted  by 
the  bromides  renders  them  valuable  in  cardiac  irritability  when  not 
due  to  anemia.  They  are  particularly  useful  in  quieting  the  heart's 
action  in  exophthalmic  goiter. 

Augagneur  advises  the  use  of  the  bromides  together  with  the 
iodides  in  the  treatment  of  syphilis,  believing  that  their  administra- 
tion prevents  such  untoward  manifestations  as  dysphonia,  aphonia, 
or  dyspnea  in  laryngeal  syphilis. 

The  STRONTIUM  BROMIDE  is  highly  recommended  m fermentative 
dyspepsia  due  to  decomposition  of  food. 

Bromoform  ranks  to-day  superior  to  all  other  remedies  in  the 
treatment  of  whooping  cough,  an  overwhelming  amount  of  authori- 
tative evidence  tending  to  prove  that  the  drug  not  only  greatly 


534  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

curtails  the  duration  of  the  disease,  but  mitigates  the  severity  of 
the  paroxysms  and  renders  them  less  frequent. 

Bromoform  has  also  been  highly  recommended  in  acute  mania 
and  delirium  tremens. 

Diluted  hydrobromic  acid  is  used  for  the  same  purposes  as 
the  bromides,  some  clinicians  preferring  it  to  the  latter  to  quiet  the 
delirium,  of  simple  continued  fevers.  It  is  employed  extensively 
to  relieve  the  symptoms  of  cinchonism. 

Contraindications. — The  bromides  are  contraindicated  in  con- 
ditions of  great  debility,  anemia,  or  fatty  or  weak  heart  with  low 
arterial  pressure. 

Administration. — The  bromides  should  be  given  in  solution, 
and  when  long  continued,  as  in  the  treatment  of  epilepsy,  they 
should  be  accompanied  by  restorative  agents.  Carbonated  waters, 
milk,  and  aromatic  elixir  serve  as  efficient  vehicles  to  disguise  the 
taste  of  these  salts. 

Children  acquire  a  remarkable  tolerance  for  the  bromides,  so 
that  large  doses  may  be  given  them  with  but  little  danger. 

Bromoform  may  be  dropped  into  a  spoonful  of  water  and  ad- 
ministered in  this  simple  manner,  or  it  may  be  dissolved  in  gly- 
cerin. P.  W.  Bedford  has  originated  a  formula  which  makes  an 
exceedingly  palatable  and  perfect  solution : 

Bromoformi,  tlflxvj  (i.o  Cc); 

Alcohohs, 

Tincturse  Cardamom!  Compositse,       aa.  f  gij  (7.39  Cc.) ; 

Glycerini,  q.  s.  ad.  gij  (60.0  Cc). 

Each  fluidrachm  contains  i  minim  (0.06  Cc.)  of  bromoform. 

The  diluted  hydrobromic  acid  should  be  given  in  water  or 
syrup. 


GROUP  VIII.— CARDIAC   STIMULANTS.* 

Cardiac  remedies  may  be  divided  into  Cardiac  Tonics,  Cardiac 
Stimulants,  and  Cardiac  Sedatives  or  Depressants.  The  grouping 
is  a  rational  one,  both  from  a  clinical  and  a  physiological  point  of 
view,  although  the  Cardiac  Sedatives  are  at  present  much  more 

1  The  author  is  indebted  to  Joseph  M.  Patton,  M.  D.,  Professor  of  Medicine  in  the 
Chicago  Policlinic,  for  valuable  assistance  in  preparing  the  present  group,  his  obiierva- 
tions  on  therapeutics  being  occasionally  cited  verbatim. 


CARDIAC  STIMULANTS.  535 

limited  in  their  clinical  application  than  they  were  a  few  years 
ago,  being  used  principally  in  sthenic  fevers  with  excessive  cardiac 
action. 

Cardiac  Tonics. — By  these  are  implied  those  drugs  which  add 
tone  to  the  cardiac  muscle  and  the  nervous  mechanism  of  the  heart, 
increasing  the  nutrition  of  that  muscle,  and  consequently  augment- 
ing its  capacity  for  work. 

The  cardiac  tonics  have  little  or  no  effect  upon  the  dynamic 
force  exerted  through  the  contraction  of  the  heart-muscle,  herein 
lying  their  essential  distinction  from  cardiac  stimulants,  which  affect 
per  se  the  muscular  contractile  force. 

The  proper  period  for  the  employment  of  cardiac  tonics  antici- 
pates that  where  the  exhibition  of  cardiac  stimulants  becomes  neces- 
sary. They  are,  moreover,  prophylactic  against  the  latter  contin- 
gency, preventing  the  development  of  a  hyposystolic  condition  of 
the  heart.  They  are  also  indicated  subsequent  to  the  temporary 
use  of  cardiac  stimulants  to  improve  the  nutrition  of  the  heart  and 
maintain  the  beneficial  results  of  stimulation. 

Cardiac  tonics  should  be  given  in  small  doses  and  the  admini.s- 
tration  prolonged. 

The  principal  members  of  the  group  are — strychnine,  the 
IODIDES,  ARSENIC,  and  IRON,  to  which  should  be  added  mercury  in 
small  doses.  The  most  useful  are  strychnine  and  the  iodides,  and 
they  are  well  adapted  for  combined  administration. 

Since  most  cases  requiring  the  exhibition  of  this  class  of 
remedies  occur  after  middle  life,  they  are  especially  benefited  by 
the  action  of  strychnine  on  the  cardiac  nervous  system  and  the 
increased  nutrition  to  the  heart-muscle  through  the  effect  of  the 
iodides  on  the  smaller  vessels.  The  progressive  tendency  of  after- 
lifetime  toward  loss  of  elasticity  and  a  contraction  of  the  smaller 
arteries  is  opposed  by  the  action  of  the  iodides  in  dilating  these 
vessels. 

The  advantage  of  prolonged  administration  of  mercury  in 
small  doses  in  chronic  cardiopathies  during  or  after  middle  life 
is  probably  due  to  the  stimulating  effect  of  the  drug  on  the  func- 
tions of  ehmination. 

Mercury  is  adapted  to  nearly  all  senile  cardiopathies,  particu- 
larly in  conditions  of  general  vascular  sclerosis,  the  most  desirable 
form  being  the  bichloride  or  red  iodide  in  doses  of -^  grain  (o.ooi 
Gm.)  three  times  daily. 

Arsenic  may  be  used  in  the  form  of  the  arsenic  iodide  or  as 


536  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Fowler's  solution.     It  is  of  special  value  in  anemic  conditions 
associated  with  cardiopathies  in  young  persons. 

The  most  eligible  form  of  iron  for  cardiac  patients,  especially 
after  middle  life,  when  elimination  is  an  important  consideration,  is 
the  LiQ.  FERRi  ET  AMMONii  ACETATis  (Basham's  mixture),  or  tlie 
so-called  tasteless  tincture  of  iron,  with  which  the  tincture  of 
nux  vomica  may  be  well  combined. 

The  physiological  action  and  further  medical  uses  of  these 
cardiac  tonics  are  more  fully  described  under  their  respective 
heads. 

Cardiac  Stimulants. — As  cardiac  stimulants  are  designated 
those  drugs  endued  with  the  specific  property  of  lengthening  and 
invigorating  the  contraction  of  the  cardiac  muscle.  This  effect 
would  necessarily  be  more  or  less  temporary,  and,  while  some 
permanent  benefit  may  be  derived  from  improved  nutrition  result- 
ing from  a  better  blood-supply  afforded  by  these  agents,  they  are 
adapted  only  for  passing  administration  and  are  not  true  cardiac 
tonics. 

The  general  indication  for  the  employment  of  this  class  of 
remedies  rests  in  the  presence  of  dynamic  insufficiency  of  the 
muscle,  which  may  be  either  actual  or  relative,  as  is  the  case  of 
increased  peripheral  resistance  to  the  blood-current.  In  the  latter 
instance  it  is  evident  that  the  extracardiac  obstruction  must  be 
removed  before  the  salutary  effects  of  cardiac  stimulants  can  be 
obtained. 

It  is  in  actual  failure  of  the  contractile  force  of  the  cardiac 
muscle  that  these  stimulants  display  their  most  beneficial  influence. 
This  failure  is  due  to  a  greater  quantity  of  blood  in  the  cavity  than 
the  muscle  is  able  to  cope  with.  The  amount  of  dynamic  force 
required  at  each  contraction  to  expel  this  quantity  is  so  great  that  - 
the  muscle  is  unable  to  withstand  the  pressure  without  stretching, 
and  consequently  dilatation  is  developed.  Here  the  favorable 
action  of  cardiac  stimulants  is  manifest,  since  by  stimulating  the 
muscle  to  more  vigorous  contraction  the  equilibrium  of  the  circu- 
lation is  maintained  until  compensatory  increase  in  muscular 
power  has  had  time  to  develop. 

The  principal  cardiac  stimulants  are — Digitalis,  Strophan- 
THus,  Caffeine,  Alcohol,  Ammonia,  Spartein,  Cactus  grandi- 
FLORA,  Adonis  vernalis,  and  Convallaria,  all  fully  described 
under  their  respective  heads. 

In  addition  to  these,  strychnine,  opium,  and  nitroglycerin  are 


CARDIAC  STIMULANTS.  537 

sometimes  used  as  cardiac  stimulants.     They  are  fully  described 
under  their  respective  heads. 

Digitalis  is  the  typical  medicament  of  the  group,  after  many 
years  still  retaining  its  place  as  the  most  trustworthy  and  generally 
useful  cardiac  stimulant. 

Digitalis— Digitalis— Digitalis.    TJ.  S.  P. 

(Fox-glove.) 
Origin. — The  leaves  of  Digitalis  purpurea  L.,  collected  from 
plants  of  the  second  year's  growth.  The  plant  is  a  biennial,  2-5 
feet  (0.6-1.5  M.)  high,  indigenous  in  Southern  and  Central  Europe, 
and  growing  wild  as  far  north  as  Norway.  It  is  also  found  in 
Madeira  and  the  Azores,  and  is  well  known  everywhere  as  an 
•ornamental  garden  plant. 

Description  and  Properties. — From  4  to  12  inches  (10-30 
Cm.)  long,  ovate  or  ovate-oblong,  narrowed,  with  a  petiole,  crenate, 
dull  green,  densely  and  finely  pubescent,  wrinkled  above,  paler  and 
reticulate  beneath,  midrib  broad  near  the  base ;  odor  slight,  some- 
what tea-like ;  taste  bitter,  nauseous.  The  leaves  of  mullein.  Inula 
^oryza  and  Inula  helenium,  are  sometimes  mixed  with  those  of 
fox-glove. 

It  is  yet  undecided  what  the  chief  constituents  are.  Five  prin- 
ciples, however,  have  been  isolated,  neither  of  which  represents  the 
crude  drug.  They  are — digitalin  (soluble  in  alcohol,  insoluble  in 
water) ;  digitalein  (soluble  in  water  and  alcohol) ;  digitonin,  the 
most  active  diuretic  principle  (soluble  in  water,  insoluble  in  alcohol) ; 
digitin,  an  inert  substance;  and  digitoxin,  the  most  active  con- 
stituent (insoluble  in  water  and  sparingly  soluble  in  alcohol).  AH 
save  digitoxin  are  glucosids. 

Dose. — 1-2  grains  (0.03-O.12  Gm.). 

Official  Preparations. 

ExtrSctum  Digitalis — ExtrScti  Digitalis — Extract  of  Digitalis. — Dose,  \-\ 
grain  (0.01-0.03  Gm.). 

Extractum  Digitalis  Fluidum — Extract!  Digitalis  Fliiidi — Fluid  Extract 
of  Digitalis. — Dose,  ^-2  minims  (0.03-0.12  Cc). 

Infusum  Digitalis — Infusi  Digitalis — Infusion  of  Digitalis  (i^  per  cent.). — 
Dose,  1-4  fluidrachms  (3.7-lS  Cc). 

Tinctura  Digitalis — Tinctiirse  Digitalis — Tincture  of  Digitalis  (ij  per  cent.). 
— Dose,  5-20  minims  (0.3-1.2  Cc). 

Unofficial  Preparations. 

Digitalinutn — Digitalini — Digitalin. — Description  and  Properties. — An  amor- 
phous, yellowish-white,  crystalline  powder  or  scales,  or  light,  white  crystalUne  tufts  of 


538  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

needles,  odorless  and  of  an  intensely  bitter  taste.  Insoluble  in  water,  soluble  in 
alcohol. 

Dose.—^-^^-^  grain  (0.0006-0.002  Gm.). 

DigitSxin— DigitSxin — 'D\%\Xoyia.— •Description  and  Properties. — A  white,  crys- 
talline body,  of  a  bitter  taste  ;  insoluble  in  water,  soluble  in  chloroform. 

Dose.—^^-T^-^  grain  (0.0003-0.0006  Gm.). 

Antagonists  and  Inoompatibles. — The  most  complete  antag- 
onist is  saponine,  the  active  constituent  of  Saponaria  officinalis. 
The  cardiac  depressants  antagonize  the  action  of  digitalis  upon  the 
heart,  morphine  and  the  emetics  possessing  a  similar  property, 
though  in  less  degree. 

The  inoompatibles  are  the  ferric  chloride  and  sulphate,  prepara- 
tions of  cinchona,  tannic  acid  and  preparations  containing  it,  and 
the  subacetate  and  acetate  of  lead. 

Synergists. — The  cardiac  action  of  digitalis  is  aided  by  other 
members  of  the  group  (cardiac  stimulants),  and  also  by  belladonna 
and  ergot. 

Physiological  Action. — Externally  and  Locally. — Digitalis  pos- 
sesses mild  sedative  properties  when  locally  applied,  and  is  readily 
absorbed  by  the  skin. 

Internally. — Digestive  System. — Small  doses  ordinarily  produce 
no  effect  upon  the  stomach.  Large  doses  act  as  a  gastro-intestinal 
irritant,  exciting  nausea,  vomitifig,  and  diarrhea.  These  effects  may 
follow  the  prolonged  administration  even  of  small  doses. 

Circulatory  System. — The  principal  effects  of  digitalis  are  upon 
the  circulatory  apparatus,  the  action  of  the  drug  varying  according 
to  the  size  of  the  dose.  Medicinal  doses  cause  the  pulse  to  beat 
stronger,  firmer,  and  slower,  the  strength  of  the  beat  being  due  to 
stimulation  of  the  cardiac  ganglia  and  the  muscular  fibers  them- 
selves. Arterial  pressure  is  raised  through  stimulation  of  the  vaso- 
motor center  in  the  medulla  and  the  ganglia  situated  in  the  mus- 
cular coats  of  the  blood-vessels,  causing  a  contraction  both  of  the 
arteries  and  arterioles. 

This  increase  of  arterial  tension  gives  firmness  to  the  pulse-beat: 
its  slowness  is  due  to  lessened  frequency  in  the  heart-beat,  caused 
by  stimulation  of  both  the  roots  and  ends  of  the  cardiac  vagus, 
and  consequent  lengthening  of  the  diastolic  period. 

Large  doses  may  cause  the  pulse  to  beat  faster  and  still  increase 
arterial  pressure.  The  rapid  cardiac  action  is  due  to  over-stimula- 
tion of  the  pneumogastric  nerve  and  consequent  exhaustion.  The 
inhibition  being  removed  and  the  heart  acting  under  the  influence 
of  the  sympathetic  nerves,  its  beats  are  more  frequent.    The  arterial 


CARDIAC  STIMULANTS.  539 

tension  is  still  high,  because  the  mechanism  presiding  over  the 
caliber  of  the  arterioles  is  not  so  easily  over-stimulated  as  the 
vagus,  and  contracts  still  more,  which,  with  the  increased  action  of 
the  heart,  tends  to  increase  arterial  tension. 

Toxic  doses  render  the  pulse  very  rapid,  irregular,  soft,  and 
weak.  The  irregular  action  of  the  heart  is  due  to  exhaustion  of 
the  motor  ganglia  in  the  heart-muscle  from  over-stimulation,  one 
of  the  functions  of  these  ganglia  being  to  induce  regular  cardiac 
contraction. 

The  pulse  is  soft  because  of  lowered  arterial  pressure,  the 
arterioles  under  these  doses  being  dilated  from  exhaustion  of  the 
vaso-motor  mechanism.  The  weak  pulse  is  due  to  exhaustion  of 
the  muscular  power  of  the  heart  from  over-stimulation. 

Death  usually  occurs  with  stoppage  of  the  heart  in  diastole, 
though  under  a  lethal  dose  there  may  ensue  a  sudden  tetanic  car- 
diac contrfiction,  the  patient  dying  in  a  very  few  minutes  because 
the  heart,  being  rigidly  contracted,  cannot  be  relaxed. 

Nervous  System. — No  effect  is  produced  by  medicinal  doses. 
Immoderate  doses,  however,  occasion  headache  and  vertigo,  to- 
gether with  lessened  reflex  activity — ^by  stimulating  Setchenow's 
inhibitory  center  and  depressing  the  motor  nerves.  The  muscles 
themselves  may  be  paralyzed,  the  sensory  nerves  being  unaffected. 

Respiratory  System. — Medicinal  doses  have  no  effect  upon  the 
system;  toxic  doses  slow  the  respiration. 

Absorption  and  Elimination. — Digitalis  is  rapidly  absorbed  and 
slowly  eliminated,  probably  by  the  kidneys,  under  certain  conditions 
increasing  the  urinary  flow  and  the  amount  of  solids  excreted,  ex- 
cept urea  and  uric  acid,  which  are  diminished. 

Its  diuretic  action  is  due  to  the  increase  of  blood-pressure  in 
the  glomeruli  of  the  kidneys,  being  therefore  more  pronounced  in 
conditions  of  low  arterial  pressure.  Very  large  doses,  instead  of 
increasing  the  amount  of  urine,  may  diminish  or  even  wholly 
suppress  it. 

The  action  of  digitalis  upon  the  kidneys  is  elucidated  by  the 
diagram  (Fig.  12). 

It  is  claimed  that  two  constituents  of  digitalis,  digitoxin  and 
digitalein,  dilate  the  renal  arteries,  while  digitalin  has  no  effect 
upon  the  renal  blood-vessels,  but  contracts  those  of  the  general 
system. 

The  true  action  of  digitalis,  however,  is  as  yet  undetermined. 
It  is  an  extremely  complex  drug,  and  its  various  constituents  pos- 


540 


A    TEXT-BOOK  OF  MATERIA  MEDICA. 


sess  different  properties  when  therapeutically  employed.  It  is 
obvious,  therefore,  that  the  action  upon  the  heart  and  kidneys  will 
depend  largely  upon  the  particular  preparation  administered. 

Temperature. — Medicinal  amounts  have  no  appreciable  effect 


Fig.  x2, — Af  heart;  B,  veins;   C,  efferent  vessels;  D,  artery;  E^  capillary  system;  P,  afferent 
vessels  ;  G,  kidney  ;  Hj  glomemles  of  the  kidney. 

upon  the  temperature;  large  doses  cause  a  reduction  of  bodily 
heat  in  febrile  conditions,  while  toxic  doses  reduce  temperature 
even  in  health. 

The  action  of  digitalis  upon  the  circulatory  system  is  retarded 
by  high  temperature. 

Eye. — Medicinal  amounts  have  no  effect.  Large  or  poisonous 
doses  may  cause  dimness  of  vision,  amblyopia,  diplopia,  or  mydri- 
asis. In  a  case  of  poisoning  by  digitalis  recorded  by  Jeanton  there 
was  xanthopsia  for  two  days. 

Uterus. — Large  doses  stimulate  contraction  in  the  uterine 
muscles. 

Untoward  Action. — Erysipelatous  and  papular  eruptions  have 
been  produced  by  the  drug,  there  having  been  also  observed 
nausea  and  a  feeling  of  weakness  in  the  stomach,  dimness  of  vision, 
headache,  heaviness  of  the  head,  sleeplessness,  and  debility. 

Poisoning. — Toxic  symptoms  may  occur  either  from  the  inges- 
tion of  a  single  poisonous  dose  or  the  accumulation  of  the  drug 
under  prolonged  administration.  There  are  marked  disturbances 
of  the  gastro-intestinal  tract,  abdominal  pains,  vomiting  and 
purging,  a  rapid,  irregular,  and  compressible  pulse — often  imper- 
ceptible at  the  wrist — and  syncope,  more  frequently  occurring 
when  the  patient  is  raised  up. 

Other  symptoms  are — feeble  respiration,  dilated  pupils  and 
occasionally  double   vision,  headache,  delirium  and  stupor,  and 


CARDIAC  STIMULANTS.  541 

possibly  convulsions  just  before  death,  which  occurs  from  cardiac 
failure.  Digitalis  is  not  a  rapid  poison,  the  fatal  collapse  being 
usually  deferred  from  ten  to  forty-eight  hours. 

Treatment  of  Poisoning. — Lavage  of  the  stomach  should  be 
immediate,  emetics  being  too  depressing,  if  the  heart  is  already 
affected  by  the  poison.  A  solution  of  tannic  acid  should  be  intro- 
duced into  the  stomach  as  the  best  chemical  antidote.  Diffusible 
stimulants  may  be  required,  the  horizontal  position  should  be 
maintained,  and  external  heat  applied,  particularly  to  the  abdomen. 

Saponin,  aconite,  and  opium  are  physiological  antidotes,  and 
one  or  more  of  them  should  be  employed. 

Therapeutics. — Externally  and  Locally. — Poultices  made  of 
DIGITALIS  LEAVES  have  been  employed  with  some  success  in  acute 
inflammation  of  the  joints,  and  when  applied  over  the  loins  act  as 
an  efficient  sedative  and  diuretic  in  congestion  of  the  kidneys. 

Internally. — Digitalis  is  one  of  the  most  important  drugs  known 
to  medicine.  The  remedy  is  indicated  in  deranged  conditions  of 
the  circulatory  system  itself,  and,  moreover,  where,  although  the  cir- 
culatory mechanism  be  normal,  an  abnormal  state  of  other  organs 
.may  be  improved  by  changing  the  circulation  in  them.  Digitalis 
is  indicated  in  any  case  where  there  is  actual  failure  in  the  dynamic 
power  of  the  heart-muscle,  irrespective  of  the  nature  of  any 
primary  valvular  lesion  inducing  the  hyposystolic  condition. 

Of  course  the  rational  use  of  the  drug  presupposes  the  absence 
of  extensive  fatty  degeneration  or  interstitial  myocarditis,  since, 
should  these  conditions  be  advanced,  there  is  danger  of  producing 
permanent  asystole.  It  is  difficult  to  estimate  the  integrity  of  the 
heart-muscle,  and  many  cases  presumably  intolerant  of  the  drug 
bear  digitalis  well. 

There  has  been  considerable  objection  to  the  use  of  digitalis 
in  cardiac  ataxia  resulting  from  aortic  regurgitation,  on  the  ground 
that  the  latter  action  is  more  forcible  and  extensive  under  its 
influence. 

This  argument  is  generally  advanced  by  those  who  believe 
that  the  dilatation  of  the  left  ventricle  in  aortic  regurgitation  is 
due  mainly  to  the  effect  of  the  counter-current  upon  the  relaxed 
ventricle  while  in  diastole.  The  regurgitant  stream  has  probably 
little  or  no  influence  in  producing  the  dilatation,  since  the'  cubic 
area  of  the  ventricular  cavity  covered  by  the  stream  is  so  much  ' 
greater  than  that  of  its  inlet  that  it  is  difficult  to  see  how  great 
pressure  could  be  exerted  in  this  way.    The  phenomenon  is,  rather, 


543  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

mainly  due  to  the  greater  pressure  necessary  to  empty  the  ventricle 
of  its  superfluous  blood. 

That  there  is  any  marked  increase  in  the  amount  of  regurgi- 
tated blood  through  reduced  action  of  the  heart  is  not  sustained 
by  the  clinical  results  of  the  administration  of  digitalis  in  cases  of 
aortic  regurgitation.  Indeed,  they  respond  to  the  use  of  the  drug 
as  promptly  as  any  other  lesion,  save  that  it  is  at  times  necessary 
to  give  larger  doses,  often  twice  the  quantity  administered  in  other 
valvular  lesions. 

As  to  the  cumulative  effect  of  digitalis,  so  much  feared  by  the 
older  writers  on  its  action,  the  evil  may  be  ascribed  to  improperly 
selected  cases  or  faulty  administration.  Under  proper  conditions 
the  drug  may  be  given  for  months  without  ill  effect. 

It  is  asserted  that  the  action  of  digitalis  may  be  manifested  for 
some  time  upon  discontinuance  of  a  brief  dosage. 

With  regard  to  the  specific  effect  of  the  drug  upon  the  heart- 
muscle  this  is  not  true,  since  the  influence  of  the  drug  lasts  but 
a  few  days,  indirectly,  through  the  additional  muscle-power  devel- 
oped during  a  few  weeks'  administration.  During  or  after  middle 
life,  if  the  vascular  tension  be  increased,  and  especially  if  there  be 
any  sclerosis  of  the  vessels,  the  administration  of  digitalis  should 
be  combined  with  that  of  vaso-dilators,  to  prevent  contraction  of 
the  vessels  and  consequent  increase  of  peripheral  resistance.  Of 
these  adjuncts,  opium  is  generally  the  most  useful,  from  2  to  5 
drops  (0.1-0.3  Cc.)  of  the  deodorized  tincture  or  ^^g- to -3^  grain 
(0.003-0.005   Gm.)  of  morphine  sulphate  being  given  (Patton). 

In  mitral  regurgitation  digitalis  is  an  exceedingly  efficient  rem- 
edy. As  shown  in  the  diagram  (Fig.  13),  there  is  a  deficiency  of 
blood  in  the  systemic  arteries,  and  consequently  an  over-accumula- 
tion in  the  pulmonary  vessels  and  systemic  veins.  Owing  to  this 
venous  hyperemia,  there  is  congestion  of  the  lungs,  stomach,  liver, 
-and  the  entire  digestive  tract,  together  with  the  attendant  symp- 
toms— dyspnea,  bronchitis,  deranged  digestion,  constipation,  edema, 
etc. 

Digitalis  by  improving  the  pumping  power  of  the  heart  equalizes 
the  circulation,  fills  the  systemic  arteries,  and  relieves  the  venous 
congestion  with  its  accompanying  symptoms. 

Digitalis  is  valueless  in  the  presence  of  compensatory  hyper- 
trophy, but  after  dilatation  occurs  is  wonderfully  effective,  the  size 
of  the  heart  being  often  perceptibly  diminished  by  a  proper  admin- 
istration of  the  drug. 


CARDIAC  STIMULANTS. 


543 


Digitalis  may  act  indirectly  as  a  tonic  by  improving  the  nutri- 
tion of  the  heart  through  the  prolonged  diastole  and  contraction 
of  the  cardiac  muscle  it  occasions.  The  longer  the  period  of  dia- 
stole, the  more  time  is  allowed  for  the  coronary  arteries  to  fill  and 
nourish  the  heart  by  the  better  blood-supply.  The  increased  arte- 
rial tension  produced  by  the 
drug  causes  the  blood  to  be 
sent  into  the  coronary  arteries 
with  greater  force  during  the 
cardiac  diastole. 

The  forcible  contraction  of 
the  heart  occasioned  by  this 
drug  expels  the  blood  from 
the  veins  of  the  cardiac  mus- 
cle, improved  nutrition  of  the 
muscle  resulting  from  this  me- 
chanical action. 

The  prolonged  diastole  pro- 
duced by  digitalis  allows  the 
heart  to  rest,  conserving  its 
energy  and  rendering  the  drug 
of  great  value  in  many  acute 
diseases  accompanied  by  ex- 
cessive cardiac  action. 

In  many  valvular  diseases 
of  the  heart  there  is  marked 
irregularity,  an  irritability  in  its  action  being  often  more  serious 
than  the  mere  leakage  of  blood.  Digitalis  by  stimulating  the 
vagus  and  motor  ganglia  reduces  the  irritative  influence,  causing 
the  heart  to  beat  more  regularly.  The  drug  is  therefore  of  great 
service  in  exophthalmic  goiter. 

In  any  condition  of  low  arterial  tension,  whether  resulting  from 
hemorrhage,  general  debility,  or  whatever  cause,  digitalis  by  increas- 
ing the  force  of  the  heart  and  raising  arterial  pressure  serves  a 
useful  purpose. 

In  collapse  from  shock,  poisoning,  or  cholera,  where  the  great 
veins  are  dilated,  it  has  proved  an  efficient  agent. 

The  functional  activity  of  the  various  organs  in  anemia  and 
other  deranged  conditions  of  the  system  may  be  improved  by  the 
administration  of  this  remedy. 

The  circulation  being  improved,  there  is  increased  absorption 


Fig.  13. — Diagram  showing  how  digitalis  relieves 
the  symptoms  of  mitral  disease :  i,  right  heart ;  2 
left  heart ;  3,  lungs ;  4,  systemic  arteries  ;  5,  capil- 
laries :  6,  systemic  veins ;  7,  liver ;  8,  intestines ; 
9,  lymphatics. 


544  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

of  fluid  from  the  tissues,  as  well  as  greater  circulation  of  fresh 
intercellular  fluid,  favoring  combustion  and  functional  activity, 
while  the  waste  products  are  more  readily  removed.  This  action 
renders  digitalis  valuable  as  a  tonic. 

In  the  second  stage  of  pneumonia  it  is  of  the  greatest  importance, 
being  of  use  here  to  stimulate  the  contractile  force  of  the  cardiac 
muscle  when  the  intraventricular  pressure  becomes  stronger  than 
the  unaided  muscle  can  resist,  and  dilatation  is  imminent  if  not 
already  begun.  The  main  indication  for  the  drug  is  the  increase  in 
intensity  of  the  second  pulmonic  sound. 

In  congestion  of  the  lungs  during  the  course  of  exhausting  fevers,. 
such  as  typhoid,  and  in  the  first  stage  of  meningitis,  bronchitis,  cellu 
litis,  etc.  before  transudation  takes  place,  it  is  considered  by  many 
physicians  to  be  a  valuable  remedy  in  relieving  the  venous  stasis 

Digitalis  is  singularly  beneficial  in  scarlet  fever  to  slow .  the 
heart  and  by  its  action  upon  the  kidneys  prevent  renal  com- 
plications. 

Mr.  Jones  was  among  the  first  to  recommend  large  doses  of 
digitalis  in  delirium  tremens.  The  author  has  found  it  to  be  won- 
derfully effective  in  this  condition,  particularly  where  there  is  low 
arterial  pressure,  at  the  same  time  having  observed  that  smaller  or 
stimulant  doses  are  more  beneficial  than  the  larger  ones  suggested 
by  Jones.  The  drug  is  undoubtedly  less  serviceable  in  delirium 
tremens  characterized  by  high  arterial  tension. 

Digitalis  has  been  successfully  employed  in  acute  mania  and' 
epilepsy,  Gowers  recommending  it  in  the  latter  disease  as  an  adju- 
vant to  the  bromides,  associated  with  belladonna.  It  is  fair  to 
state  that  in  maniacal  conditions  the  preponderance  of  testimony  is 
in  favor  of  large  doses — \  to  4  fluidrachms  (1.8-15.  Cc.)  of  the 
tincture. 

Through  its  action  in  contracting  the  caliber  of  the  arterioles 
digitalis  serves  as  a  valuable  hemostatic  in  hemoptysis,  epistaxis,. 
menorrhagia,  etc. 

The  drug  is  thought  to  enhance  the  influence  of  ergot  in  post- 
partum hemorrhage,  and  when  associated  with  iron  it  is  of  value  in 
purpura  hemorrhagica. 

According  to  Harold  Henry,  digitalis  and  strychnine  have 
proved  beneficial  in  the  diarrhea  complicating  remittent  fever. 

The  drug,  combined  with  ergot  or  potassium  bromide  according- 
to  the  indications,  has  been  successfully  employed  in  spermatorrhea- 
and  nocturnal  emissions. 


CARDIAC  STIMULANTS.  ,      545 

It  is  said  that  absorption  of  pleuritic  effusion  is  hastened  by  the 
continued  administration  of  digitalis. 

Clifford  Allbutt  recommends  it  in  sufficient  doses  to  reduce  the 
pulse  to  45  or  50  in  aneurysm.  This  method  of  treatment,  how- 
ever, has  not  been  widely  adopted. 

Digitalis  is  one  of  the  best  antidotes  to  aconite-  and  muscarine- 
poisoning. 

The  remedy  is  invaluable  as  a  diuretic  to  relieve  cardiac  or  renal 
dropsy,  its  efficiency  being  more  apparent  in  the  former  variety, 
although  acute  renal  dropsy  usually  yields  to  its  influence.  Should 
the  renal  structure  be  impaired,  the  drug  is  less  serviceable,  al- 
though, when  combined  with  other  appropriate  remedies,  it  is 
decidedly  beneficial  in  chronic  Bright' s  disease  with  cardiac  dilata- 
tion. In  the  early  stages  of  the  malady,  accompanied  by  cardiac 
hypertrophy  and  high  arterial  tension,  it  is  doubtful  whether 
digitalis  is  indicated,  either  alone  or  in  combination. 

In  conclusion,  it  should  be  stated  that  digitalis  is  recommended 
by  all  authors  in  every  valvular  disease  of  the  heart,  with  the  pos- 
sible exception  of  aortic  regurgitation,  some  writers  supposing  it  to 
be  harmful  in  this  condition  because  of  the  prolonged  diastole  it 
occasions. 

The  author's  experience  leads  him  to  differ  with  those  who  con- 
sider aortic  insufficiency  a  contraindication  to  the  use  of  this 
important  drug.  The  excellent  and  logical  reasons  advanced  by 
Professor  Patton  for  the  use  of  the  remedy  in  aortic  regurgitation 
coincide  entirely  with  the  author's  views. 

Contraindications. — Digitalis  should  not  be  given  when  there 
is  marked  degeneration  of  the  heart-muscle  or  of  the  arterial 
walls.  In  simple  hypertrophy,  apoplexy,  high  arterial  pressure, 
or  vascular  excitement  the  use  of  the  drug  is  inadvisable.  Many 
physicians  regard  aneurysm  as  a  contraindication  to  the  use  of 
digitalis. 

Administration. — Any  of  the  official  preparations  may  be  given, 
or  the  powdered  leaves  in  pills  or  capsules — not  at  too  frequent 
intervals,  however,  from  four  to  eight  hours  elapsing  between  the 
doses,  lest  the  drug  accumulate  in  the  system,  producing  poisonous 
symptoms. 

When  digitalis  has  been  administered  for  some  time  to  a  patient 
suffering  from  ascites,  and  the  fluid  is  removed  by  paracentesis, 
poisoning  may   ensue.     It  is   well,  therefore,   to   discontinue  the 
remedy  for  two  or  three  days  before  tapping  the  patient. 
35 


546  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

It  is  wise  to  give  always  only  such  amounts  of  digitalis  as  may 
be  requisite  to  produce  the  desired  effect. 

The  rapidity  of  the  drug's  action  upon  the  heart  depends  upon 
the  presence  or  absence  of  a  febrile  state.  The  stimulant  action 
upon  the  heart  is  usually  observable  in  from  twenty-four  to  thirty- 
six  hours.  The  effects  of  the  drug  commonly  continue  from  three 
to  seven  days  after  its  discontinuance. 

The  powdered  digitalis,  though  the  most  irritant  to  the  stomach, 
fully  represents  the  drug,  which  is  true  of  none  of  the  preparations. 

Of  the  active  constituents,  digitalin  is  usually  preferred,  notwith- 
standing its  uncertain  action. 

The  infusion  of  digitalis,  being  an  aqueous  preparation  and  con- 
taining, therefore,  a  larger  proportion  of  digatonin,  is  superior  for 
diuretic  purposes ;  while  the  alcoholic  preparations,  like  the  fluid 
extract  and  tincture,  being  richer  in  digitalin  and  digitalein,  are 
preferable  when  an  action  upon  the  heart  is  desired. 

Ordinarily,  therefore,  digitalis  should  be  given  in  solution,  the 
tincture  and  infusion  being  the  most  reliable  preparations ;  care 
being  taken  in  the  selection  of  the  crude  drug  upon  the  character 
of  which  the  strength  of  the  preparation  depends. 

In  uncomplicated  cases  of  cardiac  failure,  the  result  of  valvular 
lesion,  the  tincture  is  most  ehgible.  In  cardiac  failure  associated 
with,  or  resulting  from,  kidney  lesions  the  infusion,  combined  with 
some  other  diuretic,  should  be  used. 

Strophanthus— Strophanthi— Strophanthus. 
TJ.  S.  jP. 

Origin. — The  seed  of  Strophanthus  hispidus  D.  C,  deprived  of 
its  long  awn.  The  plant  is  a  woody  climber,  ascending  to  the  tops 
of  high  trees,  from  which  it  hangs  in  festoons.  It  is  found  in 
tropical  Africa,  where  it  is  used  to  prepare  an  arrow-poison  termed 
kombi. 

Description  and  Properties. — The  seeds  are  about  |  inch 
(is  Mm.)  long  and  i  to  ^  inch  (4-5  Mm.)  broad,  oblong-lanceolate, 
flattened  and  obtusely-edged,  grayish-green,  covered  with  appressed 
silky  hairs,  one  side  extending  into  the  attenuated,  pointed  end; 
kernel  white  and  oily,  consisting  of  a  straight  embryo  having  two 
cotyledons,  and  surrounded  by  a  thin  layer  of  perisperm ;  nearly 
inodorous ;  taste  very  bitter. 

Strophanthus  contains  a  glucosid,  stropJianthin,  upon  which  its 
medicinal  properties  depend.    It  also  contains  kombic  acid.   Another 


CARDIAC  STIMULANTS.  547 

active   principle,  ouabain,  is  obtained  from  a  similar  species  of 
Strophanthus. 

Official  Preparations. 

Tinctura  Strophanthi— Tincturae  Strophanthi— Tincture  of  Strophanthus 

(S  per  cent.). — Dose,  2.-10  minims  (0.12-0.6  Cc.). 

Unofficial  Preparations. 

Strophanthin— Strophanthin— Strophanthin.  Origin. — A  glucosid  obtained 
from  the  seeds  of  several  species  of  Strophanthus,  chiefly  from  Strophanthus  hispidus. 

Description  and  Properties. — A  white,  amorphous  or  crystaUine  powder,  of  an  acid- 
ulous, intensely  bitter  taste ;  soluble  in  water  and  in  alcohol. 

Dose. — j-^^  to  ^\y  grain  (0.0006-0.001  Gm.). 

Ouabain — Ouabain — Ouabain. — Origin. — A  glucosid  obtained  from  Acocan- 
thera  ouabaio  and  Strophanthus  glabrus. 

Description  and  Properties. — A  white,  transparent,  crystalline  powder,  inodorous 
and  of  a  slightly  bitter  taste.  Soluble  in  hot  water,  sparingly  soluble  in  cold  water, 
insoluble  in  alcohol. 

Dose. — -^-^  to  3^^  grain  (0.000032-0.00012  Gm.). 


Antagonists  and  Incompatibles. — Probably  the  same  as  for 
digitalis. 

Synergists. — Digitalis,  spartein,  adonidin,  etc. 

Physiological  Action. — Externally  and  Locally. — The  tincture 
of  strophanthus  has  no  local  action  of  importance.  Strophanthin 
and  ouabain,  however,  possess  marked  sedative  properties,  the 
latter  being  much  the  stronger.  They  paralyze  the  ends  of  the 
sensory  nerves  and  are  powerful  local  anesthetics,  in  this  respect 
surpassing  even  cocaine  in  their  influence  upon  the  cornea,  the 
anesthesia  produced  by  the  glucosids  being  of  much  longer  dura- 
tion than  that  caused  by  cocaine. 

When  poisonous  amounts  of  ouabain  are  applied  locally  the  motor  nerves  are 
paralyzed. 

These  substances  apparently  have  no  action  upon  the  central 
nervous  system. 

Externally. — Digestive  System. — Strophanthus  is  similar  in  its 
action  to  digitalis,  though  less  apt  to  disturb  digestion  in  small 
doses ;  on  the  contrary,  its  bitter  taste  tends  to  improve  the 
appetite. 

Ouabain  increases  peristalsis  and  acts  as  an  emetic  by  centric  influence. 

Circulatory  System. — Upon  the  heart  its  action  is  identical  with 


548  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

that  of  digitalis,  though  differing  from  the  latter  drug  in  its  effect 
upon  arterial  tension  and  the  arterioles.  Strophanthus  does  not 
contract  the  arterioles  and  the  arterial  pressure  is  but  slightly 
raised,  the  elevation  being  due  to  the  increased  force  of  the  heart, 
toxic  doses  paralyzing  it  in  systole. 

The  glucosidal  principle,  ouabain,  on  the  other  hand,  increases  arterial  tension 
and  contracts  the  principal  vessels  in  the  same  manner  as  digitalis. 

Nervous  System. — Strophanthus  affects  the  nervous  system 
even  less  than  digitalis.  Poisonous  doses,  while  not  influencing 
the  motor  nerves  so  much  as  digitalis,  act  as  a  direct  muscle- 
poison. 

Ouabain  paralyzes  both  the  sensory  and  motor  nerves  and  abolishes  reflex  action,, 
being  a  direct  poison  to  the  striated  muscles. 

Respiratory  System. — It  has  no' important  action. 

Ouabain  primarily  increases  and  secondarily  diminishes  respiration  through  its  actioiv 
upon  the  center. 

Absorption  and  Elimination. — Strophanthus  is  rapidly  absorbed,, 
and  more  readily  eliminated  than  digitalis,  possessing  no  cumulative 
action.  It  is  principally  excreted  by  the  kidneys,  increasing  the 
amount  of  urine  by  the  strengthened  heart's  action.  Unlike  digi- 
talis, the  drug  has  no  influence  upon  the  caliber  of  the  renal 
vessels. 

Temperature. — Very  large  doses  of  strophanthus  cause  a  slight 
reduction  of  temperature,  not,  however,  to  the  extent  of  digitalis. 

Eye. — Excessive  doses  contract  the  pupil  and  increase  intra- 
ocular tension. 

Uterus. — It  resembles  digitalis,  though  more  feeble  in  its  action 
upon  the  uterus. 

The  symptoms  and  treatment  of  Poisoning  are  similar  to  those 
described  under  Digitalis,  although  strophanthus  is  more  apt  to 
occasion  diarrhea. 

Therapeutics. — Externally  and  Locally. — Strophanthin  has 
been  occasionally  employed  as  a  local  anesthetic,  but  the  testimony 
in  its  favor  is  hardly  sufficient  to  encourage  its  use. 

Internally. — Strophanthus  is  a  cardiac  remedy,  being  indicated 
in  the  same  varieties  of  heart  disease  as  digitalis.  It  is  of  particular 
value  in  stenosis  of  the  mitral  orifice,  having  a  happy  influence  in 
controlling  the  irregular  rhythm,  nervous  dyspnea,  and  intermittent 
pains  distinctive  of  this  lesion.     The  drug  is  also  well  adapted  in 


CARDIAC  STIMULANTS.  549 

subduing  functional  irregularities  of  rhythm  in  cases  of  imtable  or 
tobacco  heart. 

Theoretically,  strophanthus  is  superior  to  digitalis  in  certain 
stages  of  Bright s  disease  and'  heart  failure  of  elderly  people  with 
slightly  degenerated  arteries. 

Shoemaker  advocates  the  use  of  strophanthus  in  the  treatment 
of  psoriasis,  combining  it  with  the  fluid  extract  of  hoang-nan. 

While  in  the  majority  of  cardiac  diseases  digitalis  should  be 
first  tried,  where  it  fails  strophanthus  is  the  proper  recourse.  It  is 
a  peculiarly  efficient  drug  in  the  cardiac  diseases  of  children,  accord- 
ing to  the  majority  of  observers  being  safer  than  digitalis  for  young 
patients. 

Strophanthin  has  been  used  hypodermically  with  some  success 
for  the  relief  of  chills  due  to  malaria,  shock,  or  nervousness. 

Dr.  Gemmell  and  other  observers  claim  that  ouabain  in  doses  of  from  -^-^^  to  -^^ 
grain  (0.00006-0.00003  Gm.)  greatly  reduces  the  number  and  severity  of  the  paroxysms 
in  whooping  cough. 

Contraindications. — The  same  as  for  digitalis. 

Administration. — Of  the  preparations  of  strophanthus,  the 
tincture  is  preferable,  both  for  convenience  and  safety.  Should 
strophanthin  or  ouabain  be  desirable,  a  solution  is  to  be  pre- 
ferred. 

Scoparius— Scoparii— Scoparius.     TJ.  8.  I*. 

(Broom.) 

Origin. — The  tops  of  Cytisus  scoparius  L.,  a  shrub  3  to  6  fed; 
(.9-1.8  M.)  high,  found  in  Western  Siberia  and  the  greater  part  of 
Europe.  It  is  sometimes  cultivated,  and  is  occasionally  met  with 
wild  in  some  of  the  Middle  and  Southern  States. 

Description  and  Properties.  —  Occurring  in  thin,  flexible, 
branched  twigs,  pentangular,  winged,  dark  green,  nearly  smooth, 
tough,  usually  free  from  leaves ;  odor  peculiar  when  bruised ;  taste 
disagreeably  bitter. 

The  constituents  of  scoparius  are  an  oily,  bitter  substance,  spar- 
teine, a  cardiac  stimulant,  and  a  neutral,  crystalline  principle,  scopa- 
rin,  to  which  the  diuretic  action  of  the  drug  is  due. 

Dose. — \-\  drachm  (2.0-4.0  Cc),  in  infusion. 

Official  Preparations. 

Extractum  Scoparii  FlQidum — Extracti  Scoparii  Fliiidi— Fluid  Extract  of 
Scoparius. — Dose,  yi-i  fluidrachm  (2.0-4.0  Cc). 


55°  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Sparteinse  StSlphas — Sparteinae  Sulphatis— Sparteine  Sulphate. — The  neu- 
tral  sulphate  obtauied  from  the  alkaloid  sparteine. 

Description  and  Properties. — Colorless,  white,  prismatic  crystals,  or  a  granular 
powder,  odorless,  and  having  a  slightly  saline  and  somewhat  bitter  taste;  liable  to 
attract  moisture  when  exposed  to  damp  air;  very  soluble  in  water  and  alcohol. 

Dose. — 5J-2  grains  (0.003-0.1  Gm.). 

Unofficial  Preparation. 

Scoparine — Scoparine — Scoparine. — Description  and  Properties. — Amorphous 
or  in  small  crystals,  of  a  pale-yellow  color,  inodorous  and  tasteless. 
Dose. — 1-15  grains  (0.06-1.0  Gm.),  as  a  diuretic. 


Antagonists  and  Incompatibles. — The  antagonists  are  the 
same  as  for  digitalis,  and  tannic  acid  and  potassium  iodide  are 
incompatibles. 

Synergists. — Digitalis,  strophanthus,  adonidin,  etc. 

Physiological  Action. — Externally  and  Locally. — No  action 
observed. 

Internally. — Digestive  System. — Sparteine  sulphate  acts  like  bit- 
ters in  improving  the  appetite  and  digestion.  Large  doses,  as  with 
digitalis,  produce  vomiting  and  purging. 

Circulatory  System. — Its,  effect  upon  the  heart  and  blood-vessels 
is  similar  to  that  of  digitalis.  It  is  more  rapid,  however,  in  its 
action,  its  effect  upon  the  heart  being  manifested  within  half  an 
hour,  and  an  increase  of  arterial  pressure  within  one  hour,  after 
ingestion  of  the  drug,  though  the  arterioles  are  not  contracted,  as 
is  the  case  with  digitalis. 

An  abnormally  slow  pulse  is  quickened  under  the  influence  of 
sparteine,  it  being  claimed  that  even  very  small  doses  accelerate 
the  pulse,  while  full  doses  retard  the  cardiac  rate.  Toxic  doses 
affect  the  circulatory  system  like  digitalis. 

Nervous  System. — Sparteine  resembles  coniine  rather  than  digi- 
talis in  its  action  upon  the  nervous  system,  depressing  the  brain 
and  spinal  cord,  and  lowering  reflex  action  through  paralysis  of 
the  motor  tracts.  Under  toxic  doses  there  is  also  extreme  mus- 
cular weakness,  often  complete  paralysis. 

Respiratory  System. — Medicinal  doses  produce  no  effect.  Toxic 
doses  slow  and  weaken  the  respiration,  death  being  possible  from 
paralysis  of  the  respiratory  center. 

Absorption  and  Elimination. — It  is  rapidly  absorbed  and  as  read- 
ily eliminated,  and,  unlike  digitalis,  has  no  cumulative  action. 
In  disease  it  is  an  active  diuretic,  particularly  the  infusion  or  fluid 


CARDIAC  STIMULANTS.  551 

extract  or  the  alkaloid  scoparin.  Sparteine,  on  the  other  hand,  is 
not  an  active  diuretic. 

Scoparius  therefore  increases  the  flow  of  urine  and  the  excre- 
tion of  urea.  The  drug  has  no  direct  action  upon  the  renal  struc- 
ture, diuresis  being  produced  by  increased  blood-pressure.  It  also 
possesses  diaphoretic  properties. 

Poisoning. — The  following  symptoms  occur :  Small,  rapid,  and 
irregular  pulse,  dyspnea,  great  muscular  weakness,  incoordination 
of  movement,  and  muscular  tremors,  followed  possibly  by  clonic 
and  tonic  convulsions,  which  are  replaced  by  marked  depression 
of  the  nervous  and  muscular  systems,  and  collapse,  death  usually 
resulting  from  paralysis  of  the  respiratory  center. 

Treatment  of  Poisoning. — The  respiration  should  be  stimulated 
by  hypodermic  injections  of  strychnine  and  atropine.  It  may  even 
be  necessary  to  apply  electricity  over  the  vagi  or  practise  artificial 
respiration.  Potassium  iodide  or  solutions  of  tannic  acid  should 
be  given,  and  the  free  use  of  diuretics  or  diluents  to  favor  elim- 
ination. 

Therapeutics. — Externally  and  Locally. — No  influence  is  ex- 
erted. 

Internally. — Scoparius  is  used  for  the  same  purposes  as  digi- 
talis. It  is  particularly  serviceable  in  some  cases  of  nephritis  with 
weak,  irregular  heart-action,  and  in  chronic  Bright's  disease  with 
cardiac  hypertrophy  and  high  arterial  tension.  It  is  also  useful  in 
the  nervous,  irregular  heart  of  opium  habitues. 

Sparteine  sulphate  has  been  recommended  in  paralysis  agi- 
tans  and  asthma.  Like  strophanthus,  it  is  of  more  value  in  mitral 
than  in  other  valvular  diseases. 

For  some  reason  scoparius  is  generally  less  esteemed  than 
digitalis,  although,  while  competent  clinicians  consider  it  of  minor 
importance  as  a  cardiac  remedy,  the  drug  is  not  without  enthusi- 
astic advocates  among  those  of  authority. 

Oontraindications. — Practically  the  same  as  for  digitalis,  though 
less  definite. 

Administration. — The  fluid  extract  of  scoparius  may  be  given, 
or  the  decoction,  "  made  by  adding  \  an  ounce  (16.0  Gm.)  of  the 
broom-tops  to  i  pint  (J  liter)  of  water  and  boiling  them  down  to 
\  pint  (250  Cc).  Of  this  i  ounce  (32.0  Cc.)  should  be  taken 
every  three  hours.  This  decoction  is  one  of  the  most  efficient 
diuretics  in  cardiac  dropsy"  (Hare). 

The  sparteine  sulphate  is  usually  employed  when  an  action  on 


552  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

the  heart  is  desired  :  it  may  be  administered  either  hypodermically, 
in  pill,  capsule,  or  aqueous  solution. 

Cactus— Cacti— Cactus. 

(Night-blooming  Cereus.) 

Origin. — The  stems  and  flowers  of  Cactus  grandiflorus  L., 
a  plant  indigenous  in  tropical.  America  and  frequently  cultivated 
for  ornament. 

Preparations. 

Extractum  CScti  Fluidum — ExtrScti  Cacti  Fluidi— Fluid  Extract  of  Cac- 
tus.— Dose,  5-10  minims  (0.3-0,6  Co.). 

Tinctura  Cacti — Tincturae  Cacti — Tincture  of  Cactus. — Dose,  15-20  minims 
(I. -1. 2  Cc). 

Physiological  Action  and  Therapeutics. — Cactus  differs  from 
digitalis  in  its  less  disturbing  influence  upon  the  digestive  appa- 
ratus. 

Its  action  upon  the  circulation  is  to  elevate  arterial  pressure  and 
increase  the  strength  and  rapidity  of  the  heart's  action  when  given 
in  medicinal  doses.  Toxic  doses,  on  the  contrary,  diminish  both 
the  blood-pressure  and  the  pulse-rate,  rendering  the  heart  irregular 
in  its  action  and  arresting  it  in  systole.  Moreover,  the  reflexes  are 
increased  by  poisonous  doses,  death  being  preceded  by  clonic  and 
tetanic  convulsions  of  spinal  origin. 

Therapeutically,  cactus  probably  possesses  no  advantages  over 
digitalis.  It  has,  however,  been  highly  recommended  by  certain 
physicians  in  myocarditis,  aortic  regurgitation,  functional  disorders 
of  the  heart,  severe  arrhythmia,  angina  pectoris,  and  cardiac  weak- 
ness following  typhoid  fever. 

Dr.  Wilcox  considers  mitral  stenosis  a  contraindication  to  its 
use.  It  is  asserted  that  it  produces  no  cumulative  effects  or 
untoward  symptoms. 

Adonis  Vernalis— Adonidis  Vernalls— False   Helle- 
bore. 

(Pheasant's  Eye.) 

Origin. — A  perennial  herb  attaining  a  height  of  about  lo  inches 
(25  Cm.),  indigenous  in  Europe. 

Description  and  Properties. — It  has  but  httle  odor  and  a  some- 
what acrid  and  bitter  taste.     The  plant  contains  a  glucosid,  adoni- 


CARDIAC  STIMULANTS.  553 

din,  to  which  it  owes  its  medicinal  properties.  This  constituent  is 
a  light-colored,  crystalline  powder,  of  a  bitter  taste  and  soluble  in 
water  and  alcohol. 

Dose  of  Adonidin. — ^^-\  grain  (0.003-0.01  Gm.). 

Antagonists,  Inoompatibles,  and  Sjmergists. — The  same  as 
for  digitalis. 

Physiological  Action  and  Therapeutics. — The  action  of  adoni- 
din is  similar  to  that  of  digitalis,  although  more  nearly  resembling 
that  of  digitalin,  save  that  it  is  not  cumulative. 

It  is  used  for  the  same  purposes  as  digitalis,  being  peculiarly 
valuable  in  relieving  the  pains  of  heart  disease,  and  is  by  some 
physicians  preferred  to  digitalis  in  the  treatment  of  aortic  and  mitral 
insufficiency,  cardiac  asthma,  z.nd  functional  irregularity  of  the  heart. 

Convallaria— Convallariae— Convallaria.    JJ.  8.  F. 

(LlI.Y  OF  THE  VaLI.EY.) 

Origin. — The  rhizome  and  roots  of  Convallaria  majalis  L.,  a 
stemless  perennial  indigenous  in  Europe,  Northern  Asia,  and  North 
America. 

Description  and  Properties. — Of  horizontal  growth  and  some- 
what branched,  about  \  inch  (3  Mm.)  thick,  cylindrical,  wrinkled, 
whitish,  marked  with  a  few  circular  scars ;  at  the  annulate  joint 
with  about  eight  or  ten  thin  roots ;  fracture  somewhat  fibrous, 
white ;  odor  peculiar,  pleasant ;  taste  sweetish,  bitter,  and  somewhat 
acrid. 

Convallaria  contains  two  glucosids"  convallamarin,  the  cardiac- 
acting  principle ;  and  convallarin,  an  emeto-cathartic  principle. 

Offi,cial  Preparations. 

Extractum  Convallariae  Fluidum — Extract!  Convallariae  Fluidi — Fluid  Ex- 
tract of  Convallaria.— iJoji',  15-30  minims  (1-2  Co.). 

Unofficial  Preparations. 

ExtrSctum  Convallariae — Extracti  Convallariae— Extract  of  Convallaria. — 
Dose,  5-15  grains  (0.3-1.6  Co.). 

Infiisum  Convallariae — Infilsi  Convallariae — Infusion  of  Convallaria. — Dose, 
i-2  ounces  (15-60  Co.)  (25  parts  in  75  parts  of  water). 

Convallamarinum  —  Convallamarlni  —  Convallamarin.  —  Description  and 
Properties. — A  whitish-brown,  amorphous  powder,  soluble  in  water  and  alcohol. 

Dose. — J -2  grains  (0.016-0.12  Gm.). 

Convallarinum — Convallarini — Convallarin. — Description  and  Properties. — A 
■crystalline  body  insoluble  in  water,  soluble  in  alcohol. 

Dose. — 2-4  grains  (0.12-0.24  Gm.). 


554  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Antagonists  and  Incompatibles. — The  antagonists  are  the 
same  as  for  digitalis ;  tannic  acid  precipitates  the  convallamarin. 

Synergists. — The  cardiac  stimulants  enhance  its  cardiac  action  ; 
emetics  and  cathartics  aid  its  emeto-cathartic  effects. 

Physiological  Action. — Almost  identical  with  that  of  digitalis,, 
but  less  powerful  and  possessing  no  cumulative  action.  Prepara- 
tions free  from  convallarin  do  not  disturb  the  stomach  nor  affect 
the  cerebro-spinal  functions.  It  is  asserted  that  convallaria  has 
stronger  diuretic  properties  than  digitalis. 

Convallamarin  in  some  cases  has  produced,  among  other  un- 
toward symptoms,  hemoptysis  and  dyspnea. 

Convallarin  is  a  drastic  purgative,  and  in  full  doses  occasions 
nausea  and  gastric  pain. 

Therapeutics. — Convallaria  is  used  for  the  same  purposes  ex- 
actly as  digitalis.  The  only  advantage  it  possesses  over  the  latter 
drug  is  that  it  has  no  cumulative  action.  By  some  physicians  it  is 
considered  superior  to  digitalis  as  a  diuretic  and  cardiac  stimulant 
after  failure  of  compensation,  the  diuresis  it  occasions  persisting  for 
some  time  after  the  withdrawal  of  the  drug. 

It  has  been  employed  with  sortie  benefit  in  various  forms  of 
neuralgia,  and  has  even  been  recommended  to  calm  the  restlessness- 
and  relieve  the  insomnia  of  fever. 

Contraindications. — The  same  as  for  digitalis. 

Administration. — The  fluid  extract  is  the  best  preparation  to- 
use,  although  the  infusion  is  highly  recommended  by  many  physi- 
cians. 

Caffeina—Caffeinae— Caffeine.     U.  8.  P. 

Origin. — A  feebly  basic,  proximate  principle  obtained  from  the 
dried  leaves  of  Thea  Sinensis  (tea)  L.,  or  from  the  dried  seeds  of 
Coffea  Arabica  (coffee)  L.,  and  found  also  in  other  plants. 

It  may  also  be  prepared  synthetically  from  theobromine  by  the 
introduction  of  a  third  methyl  group. 

Description  and  Properties. — Fleecy  masses  of  long,  flexible, 
white  crystals,  having  a  silky  luster,  without  odor  and  of  a  bitter 
taste;  permanent  in  the  air;  soluble  in  8o  parts  of  water  and 
33  parts  of  alcohol. 

Dose. — 2-5  grains  (0.12-0.3  Gm.). 

Official  Preparations. 

Cafieina  Citrata  —  Caffeina  Citrats  —  Caffeine  Q.\\xa.\^.— Description  ani 
Properties. — A    white    powder,    odorless,   having   a    purely   acid   taste   and    an   acid. 


CARDIAC  STIMULANTS.  555 

reaction.  I  part  of  citrated  caffeine  forms  a  clear,  syrupy  solution  with  about  3  parts 
of  water. 

Dose. — 2-5  grains  (0.12-0.3  Gm.). 

Caffeina  Citrata  Effervgscens — Caffeina  Citrata  EffervescSntis— Efferves- 
cent Citrated  Caffeine. — Dose,  1-4  drachms  (4.0-16.0  Gm.). 

Allied  Compounds. 

Guaranine. — The  alkaloid  obtained  from  the  seeds  of  Paullinia  cupana. 

Theine. — An  alkaloid  obtained  from  tea. 

Theobromine. — An  alkaloid  obtained  from  cacao  seeds. 

Sodio-theobromine  Salicylate  (Diuretin). — An  active  diuretic  described  under 
the  group  "  Diuretics." 

Guaranine,  theine,  and  theobromine,  while  chemically  almost  identical  with  caffe- 
ine, differ  from  it  somewhat  in  their  physiological  action. 

Guaranine  depresses  first  the  sensory  and  afterward  the  motor  nerves,  affecting 
them  from  the  center  toward  the  periphery.  Its  primary  effect  in  toxic  doses  is  to  pro- 
duce general  hyperesthesia,  succeeded  by  convulsions  of  spinal  origin. 

Theine  in  its  action  very  closely  resembles  guaranine,  save  that  when  injected  it 
causes  local  anesthesia.  It  lowers  the  temperature,  while  caffeine  tends  to  raise  bodily 
heat. 

Theobromine  differs  in  no  essential  from  caffeine. 

Antagonists  and  Incompatibles. — Cerebral  and  cardiac  de- 
pressants antagonize  the  action  of  caffeine. 

Synergists. — Members  of  this  group  and  the  Cerebral  and 
Motor  Excitants.  The  action  of  caffeine  upon  the  digestive  tract 
may  be  enhanced  by  the  vegetable  bitters. 

Physiological  Action. — Externally  and  Locally. — Caffeine  pos- 
sesses no  very  important  local  action,  though  freshly  roasted  coffee 
is  slightly  analgesic  and  deodorant,  as  well  as  antiseptic — a  prop- 
erty due  to  the  empyreumatic  oils  developed  by  roasting  rather 
than  to  the  caffeine  which  it  contains. 

Internally. — Digestive  System. — In  moderate  amounts  caffeine, 
like  tea  and  coffee,  stimulates  the  appetite,  improving  the  digestion, 
and  relieving  the  sense  of  plenitude  in  the  stomach.  All  of  them 
increase  peristalsis  and  (particularly  coffee)  act  as  mild  laxatives 
and  stimulate  the  secretion  of  bile. 

Immoderate  and  continued  dosage  of  caffeine  or  the  excessive 
use  of  tea  and  coffee  profoundly  disturbs  the  digestive  function, 
resulting  in  gastric  catarrh,  indigestion,  hepatic  congestion,  consti- 
pation, and  hemorrhoids. 

Circulatory  System. — Medicinal  doses  of  caffeine  strengthen 
the  cardiac  contraction  and  lengthen  the  duration  of  the  systole. 
The  rapidity  of  the  heart's  action  is  increased,  shortening  the  dia- 
stolic period,  the  drug  in  this  respect  differing  from  digitalis ;  at 
the  same  time  the  arterial  pressure  is  elevated. 


556  A    TEXT-BOOK  OF  MATERIA    MEDIC  A. 

The  precise  modus  operandi  of  caffeine  in  its  action  upon  the 
circulatory  system  is  still  a  disputed  question,  some  investigators 
claiming  that  its  whole  and  only  influence  proceeds  from  a  direct 
stimulation  of  the  heart-muscle,  while  others  consider  its  action  to 
be  upon  the  nervous  system.  So  far  as  relates  to  arterial  pressure, 
the  preponderance  of  testimony  seems  to  prove  that  the  tension 
is  raised  independently  of  any  action  on  the  vaso-motor  centers. 
Excessive  doses  depress  the  heart,  causing  an  irregular,  slow,  and 
weak  pulse. 

Nervous  System. — The  drug  is  a  decided  cerebral  excitant,  stim- 
ulating the  mental  function,  occasioning  wakefulness,  and  under 
large  doses  producing  hallucinations  and  delirium. 

There  is  a  marked  difference  between  the  effects  upon  the  brain 
caused  by  caffeine  and  those  occasioned  by  opium.  The  former 
renders  the  reasoning  and  imaginative  powers  more  acute,  enabling 
the  person  to  perform  increased  and  prolonged  mental  work. 
Moreover,  the  cerebral  excitation  caused  by  caffeine  is  not  suc- 
ceeded by  mental  depression  and  sleep ;  while  opium  occasions 
an  incoordination  of  mental  activity,  the  brain  being  incapable  of 
performing  active  practical  and  physiological  work,  and  the  reason- 
ing powers  rendered  subservient  to  the  imaginative.  The  opium 
habitue  thus  becomes  a  visionary,  his  mental  powers  inclining  more 
to  revery  than  to  action.  The  primary  excitation  induced  by  the 
drug,  however,  is  soon  succeeded  by  lethargy  and  sleep. 

The  moderate  use  of  tea  or  coffee  increases  muscular  endu- 
rance; large  doses,  on  the  other  hand,  occasion  muscular  trem- 
bling and  marked  weakness.  Excessive  doses  lessen  the  activity 
of  the  spinal  reflex  centers.  In  moderate  amounts  coffee  possesses 
some  aphrodisiac  action. 

Respiratory  System. — Medicinal  doses  slightly  stimulate,  while 
toxic  doses  depress,  the  respiration. 

Absorption  and  Elimination. — Caffeine  is  freely  absorbed,  and  is 
chiefly  eliminated  by  the  kidneys,  although  the  greater  portion  is 
oxidized  in  the  body.  The  primary  effect  of  the  drug  upon  the 
kidneys  is  to  contract,  the  later  to  engorge,  these  organs.  The 
urine,  therefore,  is  at  first  diminished  in  quantity,  although  its 
amount  is  soon  greatly  augmented.  Caffeine  is  a  direct  stimulant 
to  the  secreting  structure  of  the  kidney,  the  diuresis  being  prin- 
cipally the  result  of  this  action,  though  partly  due  to  the  increased 
renal  blood-supply. 

Ordinarily,  caffeine  lessens  tissue-waste ;  the  elimination  of  urea. 


CARDIAC  STIMULANTS.  557 

however,  is  not  uniform,  being  in  some  cases  increased  and  in  others 
diminished. 

Temperature. — Under  large  doses  of  the  drug  the  temperature 
is  slightly  elevated,  the  result  of  combined  increase  of  heat-pro- 
duction and  heat-dissipation.  Toxic  doses  first  raise  and  then 
depress  temperature. 

Eye. — Strong  solutions  of  caffeine  applied  to  the  cornea  act  as 
a  mild  mydriatic  and  anesthetic.  Hutchinson  records  a  case  of 
amblyopia  produced  by  the  drug. 

Untoward  Action. — Caffeine  occasionally  causes  marked  cere- 
bral congestion,  insomnia,  and  embarrassment  of  respiration,  while 
the  untoward  effects  of  an  immoderate  use  of  coffee  are  described 
by  Guilliot  (Nat.  Disp.,  p.  363)  as  follows : 

"  The  skin  is  pale  or  dusky,  the  expression  is  dull,  and  the 
features  have  the  look  of  premature  old  age,  and  sometimes  are 
slightly  swollen.  The  flesh  wastes,  the  eyes  have  a  glassy  look, 
the  pupils  are  dilated,  the  lips  and  tongue  are  tremulous ;  the 
appetite  is  lost ;  there  is  insomnia  or  else  disturbed  sleep ;  dyspep- 
sia accompanies  constipation  or  diarrhea ;  neuralgia  affects  the 
stomach  and  other  parts ;  headache  and  vertigo  are  common,  and 
spasms  or  general  convulsions  may  occur."  According  to  the 
same  writer,  "  habitual  excess  of  coffee  induces  in  men  sexual 
apathy  and  impotence,  and  in  women  leucorrhea.  Sometimes  it 
produces  pruritus  ani  aut  vulvce." 

Poisoning. — A  case  has  been  reported  by  Liell  where  18  grains 
(1.16  Gm.)  of  citrated  caffeine  taken  by  a  woman  were  in  an  hour 
and  a  half  accompanied  by  the  following  symptoms : 

"  Delirium,  semi-consciousness,  absence  of  headache,  pulse  5  5 
and  irregular,  cold  extremities  and  general  clammy  perspiration, 
normal  temperature  (?),  anesthesia,  slight  paresis  of  hands,  feet, 
and  tongue,  and  a  reeling  gait.  Convulsions  followed  of  a  teta- 
noid character ;  the  pupils  were  normal,  the  vision  dim ;  some 
vomiting  took  place ;  there  was  abdominal  colic,  but  no  opening 
of  the  bowels ;  and  urination  was  frequent  and  copious." 

Treatment  of  Poisoning. — This  should  include  the  use  of  emetics 
and  eliminants,  together  with  diffusible  stimulants  and  the  applica- 
tion of  external  heat. 

Therapeutics. — Externally  and  Locally. — Burning  coffee  in  a 
room  deodorizes  the  air,  and  micro-organisms  can  be  destroyed  by 
allowing  a  bowl  of  coffee  to  stand  in  it.  Powdered  coffee  is  used 
to  disguise  the  offensive  odor  of  iodoform,  and  is  frequently  asso- 


558  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

dated  with  it  in  the  form  of  an  ointment  in  the  treatment  of  aural 
eczema.  Equal  portions  of  pulverized  coffee  and  boric  acid  have 
been  recommended  by  Guerder  as  an  insufflation  in  whooping 
cough. 

Internally. — The  chief  value  of  caffeine  is  as  a  diuretic  and 
cardiac  stimulant,  being  peculiarly  useful  in  cases  of  senile  cardi- 
opathies associated  with  nephritis,  in  which,  from  degeneration  of 
the  heart-muscle,  digitalis  is  not  well  tolerated. 

In  some  instances  the  primary  effect  of  caffeine  is  to  increase 
the  pulse-rate ;  usually,  however,  if  the  remedy  be  adapted  to  the 
case,  there  is  a  secondary  slowing  of  the  heart's  action.  The  drug 
is  considered  by  some  physicians  to  be  superior  to  digitalis  as  a 
cardiac  stimulant  in  valvular  disease  accompanied  by  fatty  heart. 
It  is  an  efficient  remedy  to  counteract  the  cardiac  depression  in  low 
fevers,  and  is  a  comparatively  safe  drug  in  myocarditis. 

It  is  a  remarkably  efficacious  remedy  in  cardiac  and  renal 
dropsy  and  to   remove  pleuritic  effusion,  etc. 

Its  action  upon  the  digestive  system  renders  caffeine  of  great 
value  as  a  stomachic  tonic.  Migraine,  due  either  to  gastric  catarrh 
or  nervousness,  frequently  yields  to  this  drug. 

Its  value  in  the  treatment  of  headaches  may  be  enhanced  by 
administering  it  together  with  antipyrine  or  sodium  bromide. 

Choleraic  diarrhea,  the  result  of  nervous  depression,  is  often 
markedly  benefited  by  citrated  caffeine.  It  has  also  been  used 
with  some  success  in  the  diarrhea  of  phthisis. 

The  pains  of  locomotor  ataxia  have  been  greatly  relieved  by 
the  hypodermic  injection  of  from  ^  to  ■!■  grain  (o.or-0.03   Gm.) 

of  THEINE. 

Sodio-benzoate  of  CAFFEINE  in  doses  of  5  to  10  grains  (0.32- 
0.64  Gm.)  is  considered  by  Misrachi  to  be  superior  to  ergot  in 
post-partum  hemorrhage.  Caffeine  possesses  a  considerable  repu- 
tation as  a  remedy  for  asthma. 

It  is  a  matter  of  frequent  observation  that  strong  coffee  cer- 
tainly modifies  the  effects  of  alcoholic  intoxication.  Hiccough  is 
often  relieved  by  coffee. 

Caffeine  or  strong  coffee  has  unquestionably  proved  valuable 
in  the  reduction  of  strangulated  hernias  after  taxis  has  failed. 

The  medical  uses  of  caffeine  would  be  incomplete  without 
mention  of  its  extreme  value  in  opium-poisoning.  Here  a  salt  of 
caffeine  may  be  used  hypodermically  or  a  strong  infusion  of  coffee 
given  by  the  mouth  or  rectum. 


CARDIAC  STIMULANTS.  559 

In  conclusion,  it  may  not  be  out  of  place,  in  comparing  this 
drug  with  digitalis,  to  quote  aigain  from  the  National  Dispensatory, 
5th  ed.,  p.  365  :  "  Unlike  digitalis,  whiqh  affects  only  certain  invol- 
untary muscles,  caffeine,  like  alcohol,  stimulates  the  entire  muscu- 
lar and  vascular  systems.  It  has  been  repeatedly  said  that  caffeine 
and  digitalis  cannot  be  therapeutically  substituted  for  one  another 
— that  the  former  acts  where  the  latter  ceases  to  act ;  and  the  ex- 
planation of  this  fact  resides  in  their  very  dissimilar  modes  of 
action.  When  digitalis  fails,  it  is  because  the  heart  is  either  posi- 
tively or  relatively  incompetent  to  propel  the  blood,  and  the  medi- 
cine has  no  power  of  strengthening  except  by  tonically  contracting 
it ;  but  coffee  or  caffeine  stimulates  the  nervous  centers  which  are 
the  source  of  the  heart's  power,  and  temporarily  restores  the  regu- 
larity and  efficiency  of  its  function,  and  so  permits  the  removal  of 
the  dropsies,  etc.  which  immediately  threaten  the  extinction  of  life." 

Contraindications. — Ordinarily,  caffeine  is  contraindicated  in 
acute  inflammations,  particularly  of  the  kidneys. 

Administration. — The  alkaloid  may  be  given  by  the  stomach, 
but  when  hypodermic  medication  is  desired  caffeine  is  unavailable, 
a  fresh  salt  for  hypodermic  use  being  properly  employed,  made  by 
combining  caffeine  with  salicylic  acid,  cinnamic  acid,  or  sodium 
benzoate.  The  latter  salt — sodio-benzoate  of  caffeine — is  probably 
the  most  eligible  and  contains  45  per  cent,  of  caffeine. 

The  citrated  caffeine  should  be  given  in  pills,  capsules,  or 
tablets ;  the  effervescent  citrate,  in  water. 

A  valerianate  of  caffeine  is  prepared  which  has  been  employed 
with  success,  it  is  asserted,  in  hysterical  vomiting  and  whooping 
£ough  in  doses  of  from  J  to  2  grains  (0.03-0.12  Gm.). 

Strong  coffee  serves  as  a  most  excellent  substitute  for  the  alka- 
loid, and  may  be  given  by  the  mouth  or  as  an  enema. 

Alcohol— Alcoholis— Alcohol.    V.  8.  P. 

Origin. — A  liquid  composed  of  about  91  per  cent,  by  weight  or 
94  per  cent,  by  volume  of  Ethyl  Alcohol,  and  about  9  per  cent,  by 
weight  of  Water. 

Description  and  Properties. — A  transparent,  colorless,  mobile, 
and  volatile  liquid,  of  a  characteristic,  rather  agreeable  odor,  and  a 
burning  taste.  Miscible  with  water,  ether,  or  chloroform  in  all  pro- 
portions. It  is  inflammable,  and  readily  volatilized  even  at  low 
temperatures.  Alcohol  should  be  kept  in  well-closed  vessels,  in  a 
cool  place,  remote  from  lights  or  fire.      ' 


560  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Official  Preparation. 

Alcohol  Dilutum — Alcoholis  Diluti — Diluted  Alcohol. — A  liquid  composed 
of  about  41  per  cent,  by  weight,  or  about  48.6  per  cent,  by  volume,  of  absolute  Ethyl 
AlcohoJ,  and  about  59  per  cent,  by  weight  of  Water.  It  should  be  kept  in  well-closed 
vessels,  in  a  cool  place,  remote  from  lights  or  fire. 

Alcohol    Absolutum— Alcoholis    Absolut!— Absolute 
Alcohol.    V.S.F. 

Origin. — Ethyl  Alcohol,  containing  not  more  than  i  per  cent, 
by  weight  of  Water. 

Description  and  Properties. — A  transparent,  colorless,  mobile, 
and  volatile  liquid,  of  a  characteristic,  rather  agreeable  odor,  and  a 
burning  taste.  Very  hygroscopic.  It  should  be  kept  in  well- 
stoppered  bottles  or  tin  cans,  in  a  cool  place,  remote  from  lights  or 
fire. 

Alcohol  Deodoratum— Alcoholis  Deodorati— De- 
odorized Alcohol.    TJ.  S.  JP. 

Origin. — A  liquid  composed  of  about  92.5  per  cent,  by  weight,, 
or  95.1  per  cent,  by  volume,  of  Ethyl  Alcohol,  and  about  7.5  per 
cent,  by  weight  of  Water. 

Description  and.  Properties. — As  given  and  described  under 
Absolute  Alcohol. 

SpTritus  VTni  Gallic!— SpTriti  VTn!  Gallic!- Brandy. 

U.  S.  P. 

Origin. — An  alcoholic  liquid  obtained  by  the  distillation  of  the 
fermented,  unmodified  juice  of  fresh  grapes,  and  at  least  foyr  years, 
old. 

Description  and  Properties. — A  pale  amber-colored  liquid,^ 
having  a  distinctive  odor  and  taste  and  a  slightly  acid  reaction.  Its 
specific  gravity  should  not  be  more  than  0.941,  nor  less  than  0925, 
corresponding,  approximately,  to  an  alcoholic  strength  of  39  to  47 
per  cent,  by  weight  or  46  to  55  per  cent,  by  volume. 

Spiritus  Frumenti— SpTritus  Frumenti— Whiskey. 

77.  S.  I*. 

Origin. — An  alcoholic  liquid  obtained  by  the  distillation  of  the 
mash  of  fermented  grain — usually  mixtures  of  Corn,  Wheat,  and 
Rye — and  at  least  two  years  old. 


CARDIAC  STIMULANTS.  561 

Description  and  Properties. — An  amber-colored  liquid,  having 
a  distinctive  odor  and  taste,  and  a  slightly  acid  reaction.  Its 
specific  gravity  should  not  be  more  than  0.930  nor  less  than  0.9 1 7, 
corresponding,  approximately,  to  an  alcoholic  strength  of  44  to  50 
per  cent,  by  weight  or  50  to  58  per  cent,  by  volume. 

Vinum  Album— VTni  AIbi— White  Wine.    TI.  S.  JP. 

Origin. — An  alcoholic  liquid  made  by  fermenting  the  juice  of 
fresh  grapes,  the  fruit  of  Vitis  vinifera  (nat.  ord.  Vitacece),  freed  from 
seeds,  stems,  and  skins. 

Description  and  Properties. — A  pale  amber-colored  or  straw- 
colored  liquid,  having  a  pleasant  odor,  free  from  yeastiness,  and  a 
fruity,  agreeable,  slightly  spirituous  taste,  without  excessive  sweet- 
ness or  acidity.  It  should  contain  not  less  than  10  nor  more  than 
14  per  cent,  by  weight — equivalent  to  12.4  to  17.3  per  cent,  by 
volume — of  absolute  alcohol. 

Vinum  Rubrum— VTni  Rijbri— Red  Wine.     U.S. p. 

Origin. — An  alcoholic  liquid  made  by  fermenting  the  juice  of 
fresh,  colored  grapes,  together  with  their  skins. 

Description  and  Properties. — A  deep  red  liquid,  having  a 
pleasant  odor,  free  from  yeastiness,  and  a  fruity,  moderately  astrin- 
gent, pleasant,  andslightly  acidulous  taste,  without  excessive  sweet- 
ness or  acidity.  It  should  contain  not  less  than  10  nor  more  than 
14  per  cent,  by  weight — equivalent  to  12.4  to  17.3  per  cent,  by 
volume — of  absolute  alcohol. 

Unofficial  Alcoholic  Preparations. 

Splritus  Rectificatus — SpJritus  Rectificati — Rectified  Spirit  contains  85  per 
cent,  by  weight  of  absolute  alcohol. 

Proof  Spirit  contains  49  per  cent,  by  weight  of  absolute  alcohol,  together  with  a 
peculiar  volatile  oil  and  other  foreign  material. 

Gin  is  usually  distilled  in  Holland  from  rye  or  barley,  and  flavored  with  juniper  ber- 
ries and  hops.  It  contains  about  42  per  cent,  by  weight  of  absolute  alcohol,  and  is 
probably  more  diuretic  than  other  liquors  because  of  the  oil  of  juniper  it  contains. 

Rum  is  obtained  by  distilling  feimented  molasses,  having  about  the  same  alcoholic 
strength  as  gin. 

Port  Wine  is  prepared  by  adding  spirit  during  the  process  of  manufacture,  bring- 
ing the  alcoholic  strength  up  to  30  or  40  per  cent. 

Sherry  Wine  is  a  dry  wine,  having  from  20  to  35  per  cent,  of  alcohol. 

Sparkling  Wines  contain  from  8  to  lo  per  cent,  of  alcohol.     They  are  more  or 
less  sweet  wines,  and  are  charged  with  carbonic  acid,  being  bottled  before  fermentation 
is  completed,  the  gi-ape-sugar,  in  consequence,  not  undergoing  conversion  into  alcohol, 
The  sparkling  wines  are  Champagne,  Hock,  and  Sparkling  Catawba. 
36 


562  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Sweet  Wines  are  those  in  which  the  sugar  has  not  all  been  converted  into  alcohol, 
the  alcoholic  strength  being  therefore  relatively  low — from  6  to  7  per  cent.  Among  the 
sweet  wines  may  be  classed  Angelica,  Madeira,  Malaga,  Muscatel,  Tokay,  etc. 

Dry  Acid  Wines  are  those  in  which  the  fermentation  is  complete,  the  alcoholic 
strength  varying  from  5  to  7  per  cent.  They  are  such  as  California  Hock,  Ohio  and 
Kelly  Island  Catawba,  Rhine  and  Moselle  wines,  Hochheimer,  Durkheimer,  Deides- 
heimer,  etc. 

Light  Red  Wines  contain  5  to  7  per  cent,  of  alcohol,  and  are  astringent,  contain- 
ing tannic  acid  and  the  coloring  matter  of  the  grape.  They  are  Claret,  Red  Rhine, 
Concord,  Hungarian,  etc. 

Beer,  Ale,  and  Porter  aie  prepared  by  fermenting  malted  grain  with  hops  and 
adding  other  bitters.  Beer  contains  from  2  to  3  per  cent,  of  alcohol ;  ale  and  porter, 
from  4  to  6  per  cent.,  besides  carbonic  and  lactic  acids,  malt  extract,  various  aromatics, 
and  potassium  and  sodium  salts. 


Antagonists  and  Incompatibles. — The  motor,  cerebral,  and 
cardiac  depressants  are  antagonistic  to  moderate  amounts  of  alcohol. 

Synergists. — The  motor  excitants,  atropine,  ether,  and  the  dif- 
fusible stimulants. 

Physiological  Action. — Few  drugs  have  occasioned  such  di- 
versity of  opinion  regarding  their  physiological  action  and  uses  as 
alcohol.  With  those  who — as  Nathaniel  asked,  "_Can  any  good 
thing  come  out  of  Nazareth  ?" — question  whether  any  benefit  can 
accrue  from  alcohol,  being  honestly  convinced  that  the  drug  pos- 
sesses no  value  in  medicine,  the  author  begs  leave  to  take  respect- 
ful yet  decided  issue.  Indeed,  extensive  reading,  experimentation, 
and  clinical  experience  have  alike  proved  to  him  conclusively  that 
we  have  in  alcohol  a  drug  endued  with  peculiar  and  invaluable 
properties,  rendering  its  efficacy  inferior  to  that  of  no  remedy  in  the 
range  of  materia  medica.  Like  opium  and  other  powerful  agents, 
the  drug  may  prove  noxious  or  beneficial  according  to  the  manner 
and  judgment  with  which  it  is  employed. 

The  physiological  action  as  here  given  agrees  with  the  best 
authorities  on  the  subject. 

Externally  and  Locally. — Alcohol  is  a  powerful  antiseptic  and 
disinfectant.  It  possesses  also  rubefacient,  astringent,  and  anhi- 
drotic  properties.  When  applied  in  full  strength  to  the  skin  it  pro- 
duces a  sensation  of  coldness,  due  to  rapid  evaporation.  Should 
the  drug  be  diluted,  the  sensation  of  cold  is  greatly  diminished. 
If  evaporation  be  prevented,  the  effect  is  that  of  heat  or  burning, 
owing  to  the  penetration  of  the  drug  through  the  epidermis  and  its 
chemical  influence  upon  the  tissues  beneath. 

Its  effect  upon  mucous  membranes  is  similar  to  that  upon  the 


CARDIAC  STIMULANTS.  563 

skin,  save  that  the  former  are  more  readily  affected.  The  mucous 
membrane  becomes  whitened  and  corrugated,  because  of  the  coagu- 
lation of  albumin  and  the  abstraction  of  water.  The  white  film, 
which  is  the  precipitated  albumin,  later  disappears  as  the  albu- 
min is  redissolved  in  liquids  present,  although  the  prolonged  action 
of  alcohol  upon  mucous  membranes  produces  a  permanent  co- 
agulation. 

When  the  drug  is  applied  to  the  skin  the  secretion  of  sweat  is 
lessened  and  the  cutaneous  blood-vessels  contracted. 

Internally. — Digestive  System. — The  local  action  upon  the  mu- 
cous membrane  of  the  mouth  is  as  above  described.  There  is  a 
burning  sensation,  and  marked  increase  of  saliva  due  entirely  to 
reflex  action.  When  ingested  a  sense  of  warmth  is  experienced  in 
the  stomach,  the  blood-vessels  of  which  are  dilated,  with  accom- 
panying increase  in  the  secretion  of  gastric  juice,  as  well  as  stimu- 
lation of  peristaltic  action.  As  a  consequence,  moderate  amounts 
of  the,  drug,  when  taken  before  meals,  improve  the  appetite  and 
favor  digestion :  if  taken  during  the  active  period  of  digestion,  the 
process  is  retarded. 

It  will  be  observed  that  the  action  of  alcohol  upon  the  digestive 
system  is  quite  similar  to  that  of  vegetable  bitters,  immoderate 
amounts  checking  the  flow  of  gastric  juice  and  increasing  the  secre- 
tion of  mucus,  producing  a  catarrhal  condition ;  while  excessive 
doses  or  the  daily  and  intemperate  use  of  the  drug  frequently 
occasions  nausea  and  vomiting. 

Upon  the  intestines  alcohol  acts  as  an  astringent,  brandy  being 
an  efficient  agent  in  checking  diarrhea.  Small  amounts  of  the 
drug  act  as  an  hepatic  stimulant,  while  large  quantities  change  the 
character  of  the  bile,  at  the  same  time  lessening  its  amount. 

Circulatory  System. — Taken  into  the  stomach,  alcohol  reflexly 
and  rapidly  stimulates  the  heart  before  absorption  can  take  place, 
the  effect  upon  the  circulation  persisting  after  the  drug  is  absorbed. 
Cardiac  action  is  rendered  more  rapid  and  forcible  by  stimulation 
of  the  heart-muscle  and  motor  ganglia,  as  well  as  of  the  accelerator 
center  in  the  medulla.  Arterial  tension  is  raised,  although  the 
blood-vessels  are  dilated,  especially  those  of  the  skin,  owing  to 
depression  of  the  vaso-motor  center  and  the  ganglia  located  in  the 
vessel-walls.  Toxic  doses  depress  the  heart  and  still  further  dilate 
the  arterioles,  greatly  lowering  the  blood-pressure.  This  action  of 
alcohol,  in  causing  the  heart  to  beat  stronger  and  faster,  at  the 
same  time  dilating  the  blood-vessels — particularly  those   of  the 


564  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

peripheries — renders  the  drug  one  of  the  most  valuable  diffusible 
stimulants. 

Excessive  doses  of  alcohol  greatly  depress  or  paralyze  the 
heart,  while  an  enormous  amount,  when  taken  upon  an'  empty 
stomach,  by  reflex  action  occasioning  cardiac  paralysis,  may  pro- 
duce instantaneous  collapse. 

The  ameboid  movements  of  the  white  blood-corpuscles  are  tem- 
porarily increased,  though  subsequently  diminished.  The  function 
of  the  red  corpuscles  is  impaired,  preventing  the  oxyhemoglobin 
from  parting  with  its  oxygen,  consequently  retarding  oxidation  in 
the  tissues.  It  is  a  matter  of  observation  that  persons  addicted  to 
the  habitual  use  of  alcohol  are  frequently  obese,  on  account  of  the 
imperfect  combustion  of  fat  and  its  consequent  accumulatiori  in  the 
tissues. 

Experiments  have  conclusively  shown  that  moderate  amounts 
of  alcohol  are  oxidized  during  their  circulation  in  the  body.  Alco- 
hol must,  then,  serve  as  a  food  to  a  certain  extent.  Indeed,  experi- 
ments have  irrefutably  proved  that  the  body-weight  of  an  animal 
may  be  maintained  for  a  considerable  period  upon  alcohol  alone. 
This  peculiar  and  apparently  paradoxical  property,  of  lessening 
and  at  the  same  time  undergoing  oxidation,  renders  the  drug  of 
eminent  value  in  certain  conditions. 

Nervous  System. — Moderate  amounts  of  alcohol  stimulate  the 
nervous  system,  particularly  the  brain,  chiefly  through  the  increased 
supply  of  blood  to  the  parts,  although  the  drug  probably  exerts 
some  influence  also  upon  the  nerve-cells.  The  highest  nerve- 
centers  are  first  affected,  so  that  a  person  who  has  taken  alcohol 
displays  a  keener  intelligence,  a  brighter  wit,  and  possesses  a  sense 
of  general  mental  and  physical  power.  Should  the  dose  have  been 
large,  depression  is  wont  to  succeed  the  feeling  of  exaltation,  the 
functions  in  general  sharing  in  the  change,  which  passes  from  the 
highest  to  the  lowest  centers  in  regular  succession,  the  order  of 
functional  disturbance  being  that  of  the  cerebrum,  cerebellum, 
spinal  cord,  and,  lastly,  the  medulla  oblongata. 

It  will  be  observed  that  in  this  descending  scale  of  functional 
derangement  the  mental  faculties,  being  the  highest,  are  earliest 
affected,  resulting  in  failure  of  coordination  in  reasoning  power 
and  loss  of  control  in  the  logical  sequence  of  ideas,  although  the 
imagination,  the  emotions,  and  the  faculty  of  speech  may  still  re- 
tain their  normal  energy  and  exercise.  Soon,  however,  the  will- 
power succumbs  ;  the  emotions,  while  yet  stimulated,  are  no  longer 


CARDIAC  STIMULANTS.  565 

subject  to  mental  command ;  the  imagination  becomes  disordered ; 
and  the  patient  laughs  and  weeps  hysterically,  and,  as  a  final  result 
accompanying  this  stage  of  intoxication,  the  power  of  speech  is 
merged  in  spasmodic,  incoherent,  or  almost  inaudible  utterances 
or  perhaps  total  dumbness. 

The  muscular  system,  being  less  highly  organized,  may  still 
retain  its  activity ;  yet  it  at  last  yields  to  the  influence  of  the  poi- 
son, the  movements  becoming  wholly  incoordinate,  until  the  patient 
sinks  into  a  condition  of  drowsy,  helpless  stupor,  in  which  he  is 
incapable  of  the  slightest  effort  dependent  upon  muscular  energy. 

Consequent  to  this  stage  is  the  influence  upon  the  spinal  cord, 
the  reflex  centers  in  which  are  abolished,  the  patient  micturating 
and  defecating  involuntarily.  Meanwhile  the  respiratory  center, 
hitherto  unaffected,  shares  the  general  influence  of  the  drug.  The 
breathing  is  difficult,  or  even  paralyzed,  and  the  face  livid.  At 
length  the  cardiac  movements  are  involved,  and,  the  paralysis 
affecting  its  functions — at  first  stimulated — fatal  collapse  ensues. 

A  frequent  phenomenon  incident  to  the  depression  of  the  reflex 
centers  is  found  in  the  fact  that  injuries  which  under  normal  condi- 
tions might  prove  fatal  to  the  subject  have  little  or  no  effect  upon 
the  system  saturated  with  alcohol,  the  heart  and  respiration  being 
for  the  time  immune  against  reflex  action. 

Respiratory  System. — Medicinal  amounts  deepen  and  accelerate 
respiration ;  large  doses  render  the  breathing  slow  and  shallow, — 
these  effects  being  due  to  stimulation  or  depression  of  the  respira- 
tory center.  Death  from  a  toxic  dose  of  alcohol  usually  results 
from  paralysis  of  respiration.  It  may  be  noted  that  under  toxic 
dosage  of  the  drug  the  amount  of  carbonic  acid  exhaled  is  dimin- 
ished. 

Absorption  and  Elimination. — Alcohol  is  very  rapidly  absorbed, 
and  ■'  eliminated  unchanged  in  small  proportion  to  the  quantity  in- 
gested," owing  to  the  fact  that  the  greater  proportion  of  it  is  oxi- 
dized in  the  body.  The  kidneys,  lungs,  skin,  and  liver  share  in 
the  excretory  process. 

The  quantity  of  urine  is  greatly  increased,  principally  on  account 
of  increased  arterial  pressure,  although  the  amount  of  urea,  sodium 
chloride,  and  uric,  phosphoric,  and  sulphuric  acids  in  the  urine  is 
diminished  by  alcohol. 

When  taken  internally  the  amount  of  sweat  is  slightly  increased, 
due  partly  to  a  direct  stimulation  of  the  sweat-glands,  and  partly 
to  the  dilatation  of  the  cutaneous  blood-vessels. 


566  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Temperature. — Alcohol  is  an  antipyretic  of  considerable  power. 
This  action  is  owing  (i)  to  lessening  of  tissue-oxidation ;  (2)  to  the 
cooling  of  the  blood  through  dilatation  of  the  cutaneous  blood- 
vessels, subjecting  the  warm  blood  from  the  interior  of  the  body 
to  the  cooling  influence  of  the  atmosphere ;  (3)  to  the  cooling  of 
the  surface  of  the  body  from  the  evaporation  of  sweat.  The  power 
to  resist  cold  is  diminished  by  the  habitual  use  of  alcohol.  The 
drug  would  be  useful  in  stimulating  warmth  in  a  person  who  had 
been  long  exposed  to  cold,  but  only  in  a  warm  room.  Then,  by 
rapidly  dilating  the  blood-vessels  of  the  skin  and  allowing  the 
blood  to  flow  to  the  surface,  the  subject  is  favorably  affected  by 
the  external  heat,  while  there  is  less  danger  of  congestion  in  some 
internal  organ. 

Eye. — The  excessive  use  of  alcohol  may  produce  amblyopia, 
watery  eyes,  and  congested  conjunctivae. 

Untoward  Action  is  fully  described  under  "  Poisoning." 

Poisoning. — The  untoward  or  poisonous  action  of  alcohol  may 
be  divided  into  what  are  known  as  Acute  and  Chronic  Alcoholism. 
The  former  has  been  described  in  detail  under  the  effect  of  alcohol 
upon  the  Nervous  System,  and  doubtless  most  readers  are  too 
familiar,  from  observation,  with  the  effects  of  alcoholic  intoxi- 
cation to  require  further  enlightenment  as  to  its  general  phe- 
nomena. 

A  serious  and  altogether  too  frequent  accompaniment  of  acute 
alcoholism  is  delirium  tremens,  the  symptoms  of  which  are  as  fol- 
lows :  The  malady  is  usually  announced  by  marked  anorexia, 
insomnia,  and  restlessness ;  tremor,  especially  of  the  tongue ;  dis- 
orders of  vision  and  hearing ;  great  mental  depression ;  a  soft 
and  weak  pulse ;  and  cold  extremities.  These  manifestations  are 
succeeded  in  a  day  or  two  by  active  delirium,  even  passing  into 
wild  mania  and  horrible  hallucinations,  in  which  the  distorted 
imagination  conjures  up  the  most  loathsome  images  of  reptiles, 
the  vivid  spectacle  of  which  preys  upon  the  mind  with  pitiable 
terror  and  dismay.  Even  the  tenderest  offices  in  behalf  of  the 
sufferer  are  perveiled  by  the  disordered  reason,  which  becomes 
possessed  only  with  the  sentiment  of  abject,  agonizing  fear. 

The  muscles  are  in  a  constant  tremor,  and  the  patient  talks  in- 
cessantly and  incoherently.  The  pulse  is  usually  rapid,  feeble,  and 
dicrotic,  and  insomnia  is  continuous.  The  patient  may  even  pass 
into  a  state  of  coma-vigil,  which  is  generally  the  precursor  of  death, 
or  fatal  collapse  may  occur  suddenly  and  unexpectedly.     In  other 


CARDIAC  STIMULANTS.  S^J 

cases  the  sufferer  may  relapse  into  a  sound  sleep,  when  the  delirium 
subsides  and  convalescence  is  established. 

It  should  be  observed  that  alcoholic  coma  may  be  confounded 
with  uremic  coma,  apoplexy,  opium-narcosis,  sunstroke,  epileptic 
coma,  or  asphyxia. 

Diabetic  or  hysterical  coma  may  also  be  confounded  with  alco- 
holic coma.  So  far  as  the  odor  of  the  breath  is  concerned,  it  is  not 
pathognomonic,  since  a  person  in  a  comatose  condition  from  other 
causes  may  have  previously  taken  sufficient  alcohol  to  impart  to 
the  breath  a  distinct  odor  of  the  drug. 

It  is  often,  in  fact,  extremely  difficult  to  make  a  positive  diagno- 
sis of  true  alcoholic  coma.  It  may  sometimes  happen  that  the 
patient  is  suffering  from  the  combined  action  of  alcohol  and  opium 
or  noxious  gases,  or  that  he  has  been  seized  with  cerebral  hemor- 
rhage or  sunstroke. 

Chronic  alcoholism  is  generall^r  the  result  of  the  continuous  and 
excessive  use  of  alcohol.  The  symptoms  vary  according  to  the 
individual  case.  There  maybe  (i)  the  moderate,  daily  drinker; 
(2)  the  periodical  inebriate,  usually  the  highly  gifted,  sensitive,  and 
sympathetic,  who  drinks  to  excess  at  certain  distinct  intervals  with 
a  deliberation  and  moral  perversity  expressed  by  the  declaration  of 
a  noted  British  general :  "  By  the  blessing  of  God,  I  intend  to  get 
gloriously  drunk  next  Saturday  night ;"  (3)  the  immoderate,  im- 
pulsive, maniacal  inebriate,  who,  during  his  usually  brief  existence 
after  the  establishment  of  the  disease,  is  subject  to  constant  and 
excessive  indulgence,  incapacitating  him  from  the  simplest  duties 
of  a  rational  life.  ■ 

The  habitual  drinker  sooner  or  later  suffers  from  disturbed 
digestion,  gastric  catarrh,  and  irregularity  of  the  bowels ;  his  face 
is  usually  puffed  and  bloated,  while  the  capillaries,  especially  of  the 
cheeks  and  nose,  become  permanently  dilated,  marked  acne  rosacea 
not  infrequently  developing  in  the  latter  organ. 

The  excessive  use  of  alcohol  predisposes  the  subject  to  cirrhosis 
of  the  liver,  other  conditions  being  arterio-sclerosis,  fatty  degenera- 
tion of  the  heart  and  liver,  paralysis,  peripheral  neuritis,  Bright's 
disease,  amaurosis,  ataxia,  epilepsy,  insanity,  etc. 

Treatment  of  Acute  Alcoholic  Poisoning. — The  stomach  should 
be  emptied  of  all  unabsorbed  alcohol ;  cautious  inhalations  of  am- 
monia should  be  given,  accompanied  by  the  internal  administration 
of  the  aromatic  spirit  of  ammonia  and  black  coffee.  Capsicum  and 
vinegar  also  have  the  power  to  stimulate  the  patient  and  counteract 


568  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

the  ill  effects  of  alcohol,  while  it  is  said  that  ammonium  chloride, 
in  a  dose  of  30  grains  (2.0  Gm.)  given  in  8  ounces  (236.59  Cc.)  of 
water,  is  an  exceedingly  efficient  antagonist. 

Should  there  be  great  depression  of  respiration,  faradism  of  the 
muscles  of  respiration  may  be  necessary,  with  warm  applications  to 
the  extremities  and  cold  to  the  head.  Hot  milk  and  other  forms 
of  nutritious  liquid  food  form  an  essential  element  in  the  restoration 
of  the  patient. 

Treatment  of  Delirium  Tremens. — The  management  of  this  phase 
of  alcoholism  requires  great  skill  and  judgment,  the  student  being 
referred  for  details  to  any  standard  work  on  the  Practice  of  Medi- 
cine. The  indications  are  to  quiet  the  patient  and  sustain  his 
physical  strength.  This  has  been  accomplished  by  the  adminis- 
tration of  chloral  and  potassium  bromide  or  opium,  these  drugs, 
together  with  digitalis,  strychnine,  and  other  cardiac  stimulants, 
having  proved  highly  efficient  remedies.  Gastric  sedatives  may  be 
required,  such  as  bismuth,  carbolic  acid,  hydrocyanic  acid,  etc. 

Nutritious  and  easily  digested  food  should  be  given,  and,  in  case 
of  gastric  intolerance,  enemata  should  be  adopted. 

Treat7nent  of  Chronic  Alcoholism. — A  thoughtful  and  extended 
experience  with  inebriates  has  convinced  the  author  that  the  great 
majority  of  dipsomaniacs  suffer  from  a  disease  possessing  usually 
a  distinct  and  traceable  etiology  and  resulting  from  either  inher- 
ited or  acquired  neurosis.  In  many  cases  the  malady  is  charac- 
terized by  uniform  development,  progress,  symptomatology,  and 
termination. 

The  author  makes  this  statement  with  the  full  knowledge  that 
he  will  be  regarded  as  a  "sentimentalist"  by  many  professedly 
"  practical "  men.  Yet  a  careful  scrutiny  of  numerous  cases  and  a 
consideration  of  the  means  adopted  in  the.  treatment  of  them  will, 
he  believes,  convince  the  thoughtful  physician  that  he  has  to  deal 
with  a  thoroughly  diseased  organism  rather  than  with  the  victim 
of  a  "  vicious  drug  habit "  readily  overcome  by  a  moderate  exercise 
of  the  will. 

The  medicinal  agents  most  serviceable  in  the  treatment  of 
chronic  alcoholism  are  stiychnine,  atropine,  small  doses  of  the 
alteratives,  arsenic,  potassium  iodide,  and  mercury,  while  phos- 
phorus and  other  restoratives  and  tonics  will  frequently  be  found 
useful. 

The  hygienic  surroundings  should  be  of  the  best,  and  the  treat- 
ment should  include  a  nutritious,  non-stimulating  diet  taken  with 


CARDIAC  STIMULANTS.  569 

regularity,  and  the  free  use  of  fruits  and  vegetables.  Close  atten- 
tion should  be  paid  to  the  condition  of  the  bowels  and  skin,  and, 
among  other  remedial  influences,  should  be  mentioned  laxatives 
when  necessary,  frequent  Turkish  baths,  and,  above  all,  change  of 
scene  and  engaging  mental  occupation. 

From  time  to  time  various  drugs  have  been  heralded  as  specifics 
in  the  treatment  of  alcoholism,  certain  "  cures  "  (sic)  acquiring  an 
influence  among  the  ignorant  and  unscientific  wholly  at  variance 
with  the  therapeutic  value  of  these  vaunted  remedies.  It  is  super- 
fluous to  say  that  to  a  skilled  and  enlightened  professional  judg- 
ment the  rationale  of  intemperance  and  the  agents  serving  to  miti- 
gate the  malady  present  a  problem  far  too  complicated  to  be 
grasped  by  the  empirical  understanding,  operating  even  under  the 
most  ingenuous  motives. 

Therapeutics. — Externally  and  Locally . — Alcohol  is  an  efficient 
application  for  contusions,  sprains,  and  indolent  ulcers,  and  is  also 
serviceable  in  hardening  the  skin  and  preventing  the  formation  of 
bed-sores.  It  is  a  useful  hemostatic  to  check  capillary  oozing,  and, 
being  a  powerful  antiseptic,  is  available  in  all  wounds.  Uterine 
hemorrhage  is  controlled  by  inserting  in  the  cavity  of  the  uterus  a 
tampon  saturated  with  the  drug. 

Its  local  anesthetic  properties  render  alcohol  valuable  in  relieving 
irritation  of  the  skin  in  urticaria,  frost-bite,  etc. ;  it  also  serves  as  an 
efficient  gargle  in  diphtheria  and  acute  pharyngitis. 

Alcohol,  or  brandy,  has  been  successfully  employed  to  harden 
nipples  and  prevent  their  cracking. 

A  very  efficient  means  of  reducing  temperature  in  fever  is  to 
bathe  the  skin  with  alcohol,  the  method  being  also  useful  to  check 
excessive  sweating. 

The  absorption  of  inflammatory  exudates  may  be  aided  and  the 
pain  of  muscular  rheumatism  relieved  by  rubbing  the  affected  area 
with  TINCTURE  of  CAMPHOR  or  SOAP  LINIMENT,  both  of  which  Con- 
tain alcohol. 

Internally. — Alcohol,  in  the  form  of  wine,  beer,  or  ale,  taken 
before  or  during  meals,  is  an  efficient  stomachic.  Atonic  dyspepsia 
and  the  weakened  digestion  attendant  upon  convalescence  from  acute 
diseases  are  greatly  benefited  by  some  form  of  alcohol.  When 
digestion  becomes  impaired  as  the  result  of  physical  or  mental 
exhaustion  the  drug  serves  a  useful  purpose  as  a  tonic. 

The  wisdom  of  using  the  drug,  however,  in  the  above  condi- 
tions may  be  questioned,  because  of  the  danger  of  establishing  the 


570  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

desire  or  habit,  particularly  in  the  case  of  neurotic  women  and 
those  whose  debilitated  energies  call  for  renewed  and  increasing 
quantities  of  the  drug. 

Frequently  the  physical  or  mental  depression,  the  peculiar,  irre- 
sistible craving  for  stimulants,  the  insomnia  and  fitful  appetite  and 
disposition  which  urge  recourse  to  alcoholic  indulgence,  are  but 
the  early  manifestations  of  a  brain-and-nerve  degeneration,  the 
impulse  to  drink  being  only  the  physical  demand  for  relief. 

There  is  less  danger  attending  the  administration  of  alcohol  in 
conditions  of  lowered  vitality  and  weakened  digestion  in  old  people 
than  in  the  young  and  middle-aged.  The  drug  is  decidedly  contra- 
indicated  in  persons  of  average  health  and  fair  digestion,  although 
beneficial  in  the  aged,  whose  powers  are  failing  from  natural 
decline. 

The  anesthetic  and  sedative  properties  of  alcohol,  especially  in 
the  form  of  champagne,  which  contains  carbon-dioxide  gas,  may 
frequently  control  obstinate  vomiting.  Gastralgia  and  the  pain 
arising  from,  flatulence  are  often  readily  relieved'  by  brandy,  and 
the  same  remedy  may  be  used  efficiently  in  checking  simple 
diarrhea. 

As  a  pure  cardiac  stimulant,  alcohol  is  remarkably  serviceable 
in  syncope,  asphyxia,  exhausting  hemorrhages,  diphtheria,  and  col- 
lapse where  death  seems  imminent.  In  counteracting  the  effects 
of  narcotic  poisons  it  is  almost  indispensable ;  it  is,  moreover,  un- 
doubtedly the  most  efficient  antidote  to  the  poison  of  venomous 
reptiles. 

It  is  a  common  practice  with  some  surgeons  to  precede  the 
inhalation  of  chloroform  with  the  administration  of  i  or  2  ounces 
(30.0-60.0  Cc.)  of  WHISKEY  or  BRANDY,  for  the  twofold  purpose  of 
sustaining  the  heart  and  prolonging  the  anesthesia. 

In  certain  stages  of  various  acute  diseases,  such  as  typhoid, 
typhus,  small-pox,  pneumonia,  cerebrospinal  meningitis,  capillary 
bronchitis,  etc.,  alcohol  is  one  of  the  most  potent  and  valuable  rem- 
edies. It  should  be  employed  in  these  cases  only  when  there  is 
marked  depression  of  the  circulatory  apparatus,  characterized  by 
a  weak,  rapid,  soft,  and  irregular  pulse,  with  a  feeble  sound  of  the 
heart  and  threatened  syncope  or  delirium. 

Alcohol  is  beneficial  in  such  cases  as  the  foregoing  when  by 
its  use  the  tongue  is  moistened,  the  pulse  and  respiration  is  slowed, 
the  restlessness  and  delirium  quieted,  and  the  skin  becqmes  less 
parched. 


CARDIAC  STIMULANTS.  5/1 

Should  the  drug  increase  the  pulse  and  intensify  the  nervous 
manifestations,  it  is  an  indication  that  the  dosage  is  excessive,  in 
which  event  it  may  be  well  to  discontinue  the  administration  alto- 
gether. Even  where  the  action  of  the  drug  is  favorable,  it  is 
doubtful  whether  it  should  ever  be  given  in  fevers  throughout  the 
twenty-four  hours,  administration  being  advisable  rather  when  the 
muffled  or  absent  first  sound  of  the  heart  indicates  impending  cardiac 
failure.  This  usually  occurs  during  the  interval  between  midnight 
and  7  a.m.  Stimulation  should  therefore  begin  before  midnight, 
and  full  doses — say  i  fluidounce  (30  Cc.) — be  given  every  three 
hours,  full  doses  being  of  more  service  than  repeated  smaller 
amounts. 

It  should  be  remembered  that  alcohol  generates  no  new  energy, 
but  simply  enables  a  person  to  utilize  in  a  short  period  all  his 
available  reserve  force.  The  utmost  discrimination  and  judgment 
are  requisite  to  the  proper  administration  of  the  drug. 

In  pyemia,  septicemia,  erysipelas,  and  diphtheria  alcohol  is  fre- 
quently one  of  our  most  efficient  remedies,  while  clinical  experi- 
ence has  fully  demonstrated  its  value  in  retarding  the  progress  of 
phthisis.  Tubercular  patients  acquire  a  marked  tolerance  for  the 
drug,  being  often  able  to  assimilate  enormous  quantities  without 
deleterious  results. 

Small  quantities  of  alcohol  appear  to  exert  a  favorable  action 
in  functional  impotence. 

Its  sedative  action,  or  possibly  its  property  of  increasing  intra- 
cranial blood-pressure,  renders  alcohol  valuable  as  a  hypnotic  in 
neurasthenia. 

A   very   common   remedy  for   anemia   and    chlorosis   is   red 

WINE. 

Acute  coryza  or  a  cold  may  often  be  wholly  aborted  by  taking 
a  good  quantity  of  hot  whiskey  or  hot  "gin  sling"  upon  retiring. 

The  statement  made  by  so  prominent  a  physician  as  Mr.  Law- 
son  Tait,  "  I  am  fully  persuaded,  after  thirty  years  of  life  as  hard 
in  work  and  as  full  of  responsibility  as  well  could  be,  that  the  mod- 
erate use  of  alcohol  is  a  necessity  in  our  modern  life,"  is,  in  the 
author's  opinion,  too  strong.  Physicians,  of  all  men,  should  realize 
the  ill  effects  of  over-work,  as  well  as  those  of  alcohol.  Is  it  not 
wiser  to  limit  the  amount  of  labor  than  to  attempt  undue  exertion 
under  the  stimulus  of  so  seductive  and  dangerous  a  drug  ?  Sta- 
tistics show  that  of  those  addicted  to  the  excessive  use  of  alcohol 
and  other  pernicious  drugs,  by  far  the  largest  percentage  is  among 


572  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

physicians — a  sad  commentary  on  their  wisdom  and  professional 
knowledge. 

Contraindications. — Alcohol  should  not  be  given  when  the 
urine  is  of  high  specific  gravity.  It  is  ordinarily  contraindicated 
in  nephritis  and  diseases  of  the  liver,  gout,  gleet,  gonorrhea,  and 
urethritis.  The  malt  liquors  and  sweet  wines  should  not  be  given 
in  diabetes  nor  to  persons  suffering  from  eczema.  Alcohol  is  also 
dangerous  in  hypertrophy  of  the  heart  and  excessive  cardiac 
action. 

Administration. — When  possible,  alcohol  should  always  be 
taken  with  food.  Brandy  is  the  best  astringent,  and  brandy  and 
champagne  are  the  best  preparations  to  allay  nausea.  Whiskey  is 
the  least  constipating,  and  gin  the  most  diuretic.  As  regards 
their  sedative  action,  there  is  no  preference,  whichever  is  most 
agreeable  to  the  patient  and  least  affects  the  head  being  advisable. 
As  stomachics  either  claret,  beer,  or  ale  is  most  efficacious  in  im- 
proving the  appetite.  In  cases  of  fermentative  dyspepsia  sweet 
wines  and  malted  liquors  are  more  injurious  than  beneficial,  whiskey 
or  brandy  being  preferable. 

When  desired  as  diffusible  stimulants  in  cases  of  cardiac  failure 
brandy  or  whiskey  only  should  be  employed,  which  preparations 
may  be  given  hypodermically. 

PREPARATIONS   OF   AMMONIUM. 

Aqua  Ammonii  Fortior— Aquae  Ammonii  Fortioris— 
Stronger  Ammonia  Water.     JJ.  S.  JP. 

Origin. — An  aqueous  solution  of  ammonia  (NH,  =  17.01),  con- 
taining 28  per  cent,  by  weight  of  the  gas. 

Description  and  Properties. — A  colorless,  transparent  liquid, 
having  an  excessively  pungent  odor  and  a  very  acrid  and  alkaline 
reaction.     It  should  be  kept  in  strong,  glass-stoppered  bottles. 

Dose. — 3-6  minims  (0.18-0.3  Cc). 


Official  Preparation. 

Spilritus  Ammdnise — Splritus  Ammoniae — -Spirit  of  Ammonia. — Origin. — 
An  alcoholic  solution  of  ammonia,  containing  10  per  cent,  by  weight  of  the  gas. 

Description  and  Properties. — A  colorless  liquid,  having  a  strong  odor  of  ammonia 
and  a  specific  gravity  of  about  0.810  at  15°  C.  (59°  F.).  It  should  be  kept  in  glass- 
stoppered  bottles,  in  a  cool  place. 

Dose. — 10-60  minims  (0.6-3.7  Cc). 


CARDIAC  STIMULANTS.  573 

Aqua  Am moniae— Aquae  Ammoniae— Ammonia 
Water.    TJ.  S.  P. 

Origin. — ^An  aqueous  solution  of  ammonia,  containing  lo  per 
cent,  by  weight  of  the  gas. 

Description  and  Properties. — A  colorless,  transparent  liquid, 
having  a  pungent  odor,  an  acrid,  alkaline  taste,  and  a  strongly 
alkaline  reaction.  It  should  be  kept  in  glass-stoppered  bottles,  in 
a  cool  place. 

Dose. — 10-20  minims  (0.6-1.2  Cc.)  well  diluted. 

Official  Preparations. 

Linim£ntum  Ammoniae — L.inim£nti  Ammoniae — Ammonia  Liniment  (Am- 
monia Water,  350;  Alcohol,  50;  Cotton-seed  Oil,  600). — For  external  use. 

SpKritus  Ammonise  AromSticus — Spiritus  Ammoniae  AromStici.  See  Am- 
monium Carbonate. 

Ammoniae  Carbonas— Ammoniae  Carbonatis— 
Ammonium  Carbonate.    TJ.  S.  P. 

Origin. — Prepared  by  subjecting  to  sublimation  and  resublima- 
tion  a  mixture  of  Ammonium  Sulphate  or  Chloride  and  Calcium 
Carbonate. 

Description  and  Properties. — White,  hard,  translucent,  striated 
masses,  having  a  strongly  ammoniacal  odor  without  empyreuma, 
and  a  sharp,  saline  taste.  On  exposure  to  air  the  salt  loses  both 
ammonia  and  carbonic  acid,  becoming  opaque,  and  is  finally  con- 
verted into  friable,  porous  lumps  or  a  white  powder.  Slowly  but 
completely  soluble  in  about  5  parts  of  water ;  decomposed  by  hot 
water,  with  the  elimination  of  carbonic  acid  and  ammonia. 

Ammonium  carbonate  should  be  kept  in  well-stoppered  bottles, 
in  a  cool  place. 

Dose. — 2-15  grains  (0.12-1.0  Gm.). 

Official  Preparation. 

Spiritus  Ammoniae  Aromaticus— Spiritus  Ammoniae  AromStici— Aromatic 
Spirit  of  Ammonia  (Ammonium  Carbonate,  34;  Ammonia  Water,  90;  Oil  of  Nut- 
meg, I ;  Oil  of  Lemon,  10 ;  Alcohol,  700 ;  Oil  of  Lavender  Flowers,  I ;  Water,  to 
make  \ooa).— Description  and  Properties.— P>.  nearly  colorless  liquid  when  freshly  pre- 
pared, but  gradually  acquiring  a  somewhat  darker  tint.  It  has  a  pungent,  ammoniacal 
odor  and  taste.     It  should  be  kept  in  glass-stoppered  bottles,  in  a  cool  place. 

Dose.—yi-T.  fluidrachms  (1.8-7.3  Cc). 


Antagonists  and   Incompatibles. — The  cardiac  sedatives  are 


574  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

antagonistic.  The  incompatibles  are  the  vegetable  and  mineral 
acids,  the  earthy  salts,  lime  water,  and  solutions  of  acidulous  salts. 

Synergists. — Cardiac  and  diffusible  stimulants,  antispasmodics, 
and  capsicum  internally.  The  local  action  of  ammonium  prepara- 
tions is  enhanced  by  cantharides  and  counter-irritants. 

Physiological  Action. — Externally  and  Locally. — When  solu- 
tions of  ammonia  are  applied  to  the  skin  or  mucous  membranes 
they  act  as  irritants,  rubefacients,  or  vesicants  according  to  the 
strength  of  the  solution  and  the  freedom  or  confinement  of  the 
vapor. 

When  inhaled  the  vapor  occasions  great  irritation  of  the  respi- 
ratory passages,  together  with  a  sense  of  suffocation  and  spasmodic 
closure  of  the  glottis.  There  are  also  produced  marked  irritation 
of  the  conjunctivje,  lacrymation,  and  a  watery  secretion  from  the 
nose. 

Internally. — Digestive  System. — Small  doses  act  like  alkalies 
upon  the  gastro-intestinal  tract,  augmenting  the  flow  of  gastric 
juice  when  given  before  meals  and  neutralizing  it  when  given  after 
meals. 

Excessive  doses  occasion  violent  and  destructive  inflammation 
of  the  mouth,  esophagus,  and  stomach,  possibly  resulting  in  stric- 
ture of  the  esophagus  and  stenosis  of  the  pyloric  orifice. 

Circulatory  System. — These  preparations,  whether  ingested  or 
injected  into  the  system,  cause  a  temporary  fall  of  arterial  pressure, 
quickly  followed  by  a  decided  increase  and  acceleration  of  the  pulse, 
owing  to  stimulation  of  the  accelerator  muscle  of  the  heart.  Their 
precise  action  upon  the  blood  is  not  known,  though  they  certainly 
lessen  the  oxygen-carrying  power  of  the  red  corpuscles  and  dimin- 
ish the  tendency  to  coagulation  of  the  blood. 

Nervous  System. — Other  than  their  action  upon  the  sensory 
nerves  when  locally  applied,  these  preparations  affect  the  nervous 
system  only  in  stimulating  the  motor  centers  of  the  spinal  cord, 
excessive  doses  causing  convulsions. 

Respiratory  System. — They  stimulate  the  respiratory  center, 
greatly  increasing  the  number  of  respirations. 

Absorption  and  Elimination. — ^The  preparations  of  ammonium 
are  rapidly  absorbed,  being  oxidized  in  the  system  and  eliminated 
chiefly  by  the  kidneys,  increasing  the  acidity  of  the  urine  and  aug- 
menting its  amount,  as  well  as  increasing  the  proportion  of  nitric 
acid,  uric  acid,  and  urea  excreted.  The  continued  use  of  ammo- 
nium preparations  therefore  promotes  tissue-waste. 


CARDIAC  STIMULANTS.  575 

Temperature  is  unaffected  by  medicinal  amounts. 

Poisoning. — In  toxic  doses  these  preparations  are  powerful  cor- 
rosive poisons,  exciting  violent  inflammation  of  the  gastro-intestinal 
tract,  labored  respiration,  great  cardiac  depression,  muscular  weak- 
ness, and  possibly  convulsions. 

Treatment  of  Poisoning. — Similar  to  that  of  poisoning  by  the 
corrosive  alkalies — evacuation  of  the  stomach,  the  internal  admin- 
istration of  vinegar  or  other  vegetable  acids,  followed  by  oil  and 
demulcent  drinks,  opium  being  indicated  for  the  relief  of  pain. 

Therapeutics. — Aqua  ammonite  is  a  valuable  ingredient  of 
"  hair  tonics  "  in  premature  alopecia.  The  ammonia  liniment  is  a 
favorite  remedy  for  chilblains. 

The  AROMATIC  SPIRIT  OF  AMMONIA  is  of  valuc  in  many  diseases 
of  the  scalp,  such  as  pityriasis,  etc.,  and,  when  well  diluted  with 
water,  has  been  recommended  in  acute  pharyngitis.  The  ammonium 
CARBONATE  posscsses  an  action  similar  to  that  of  salicylic  acid  in 
its  property  of  dissolving  epidermic  scales,  rendering  it  of  value  in 
preparing  the  skin  for  the  subsequent  local  treatment  of  psoriasis. 

As  a  counter-irritant  ammonia  water — or,  preferably,  the  am- 
monium liniment — is  efficient  in  chronic  rheumatism  and  joint 
affections. 

Ammonia  water  relieves  the  irritation  caused  by  bites  of  insects  ; 
its  vapor  inhaled  acts  as  a  rapid  restorative  in  cases  o{  fainting.  , 

Internally. — The  ammonium  preparations  here  mentioned  are 
serviceable  in  lessening  excessive  acidity  of  the  stomach.  The 
aromatic  spirit  of  ammonia  is  frequently  beneficial  in  allaying 
the  distress  of  nervous  headache,  and  is  also  an  efficient  remedy  to 
counteract  the  effects  of  an  immoderate  use  of  alcoholic  stimulants, 
having  proved  in  many  cases  valuable  in  the  treatment  of  delirium 
tremens. 

The  most  important  uses  of  these  preparations  are,  perhaps,  as 
powerful  diffusible  stimulants  to  the  circulatory,  respiratory,  and 
spinal  systems.  They  are  of  undoubted  value  in  sudden  cardiac 
failure  arising  from  any  cause,  such  as  poisoning  from  chloroform, 
noxious  gases,  hydrocyanic  acid,  etc.  Taken  internally  or  by  intra- 
venous injection,  they  counteract  the  poisonous  effects  resulting 
from  the  bites  of  venomous  reptiles. 

The  carbonate  is  an  excellent  stimulant  to  sustain  the  heart 
and  respiration  during  the  course  of  pneumonia,  eruptive  and  con- 
tinued fevers,  etc.  In  all  dynamic  conditions  of  the  heart  this 
preparation  should  be  given  in  small  doses,  frequently  repeated. 


576  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

The  carbpnate  is  also  a  valuable  stimulant  expectorant  in  chronic 
bronchitis  and  broncho-pneumonia. 

The  preparations  of  ammonia  have  been  recommended  in 
threatened  thrombosis.  The  condition  being  established,  however, 
the  only  effective  method  of  treatment  is  by  intravenous  injection, 
when  the  thrombi  may  be  redissolved  through  direct  contact  with 
the  remedy. 

Contraindioations. — Acute  gastritis  and  conditions  of  excessive 
acidity  of  the  urine.  Conditions  of  anemia  and  great  emaciation 
would  contraindicate  the  prolonged  use  of  these  preparations. 

Administration. — The  liquid  preparations  should  always  be 
well  diluted,  and  the  carbonate  should  invariably  be  given  in  solu- 
tion. The  fluid  extract  of  glycyrrhiza  disguises  the  taste  very 
well. 

Owing  to  the  rapid  elimination  of  these  drugs,  the  dosage 
should  be  frequently  repeated. 


GROUP  IX.— CARDIAC  SEDATIVES. 

Aconltum—Aconiti— Aconite.     TJ.  S.  JP. 

Origin. — The  tuber  of  Aconitum,  Napellus  L.,  a  plant  about 
40  inches  (i  M.)  high,  met  with  throughout  the  greater  portion 
of  Asia  and  Europe,  mostly  in  mountainous  regions. 

Description  and  Properties. — From  f  to  f  inch  (10-20  Mm.) 
thick  at  the  crown,  and  from  2  to  3  inches  (50-75  Mm.)  long,  with 
scars  or  fragments  of  radicles ;  dark  brown  externally,  whitish  in- 
ternally ;  with  a  rather  thick  bark,  the  central  axis  about  seven- 
rayed  ;  without  odor,  taste  at  first  sweetish,  soon  becoming  acrid, 
and  producing  a  sensation  of  tingling  and  numbness  lasting  for 
some  time.     It  contains  an  acrid  alkaloid,  aconitine. 

Dose. — 1—2  grains  (0.03-0. 12  Gm.). 

Official  Preparations. 

Extractum  Aconiti — ExtrScti  Aconiti— Extract  of  Aconite. — Dose,  -f^ 
grain  (0.006-0.01  Gm.). 

ExtrSctum  Aconiti  Fluidum — ExtrScti  Aconiti  Fliiidi — Fliiid  Extract  of 
Aconite. — Dose,  -y^-^  minims  (0.006-0.12  Cc. ). 

Tinctiira  Aconiti — Tinctiirae  Aconiti — Tincture  of  Aconite. — Dose,  \-$  min- 
ims (0.008-0.3  Cc). 


CARDIAC  SEDATIVES.  577 

'Unofficial  Preparation. 

Fleming's  Tincture  of  Aconite  is  nearly  twice  as  strong  as  the  official  tincture, 
the  dose  being  correspondingly  smaller. 

Aconitlna— Aconitlnae— Aconitine.    (Unofficial.) 

Origin. — An  alkaloid  principle  extracted  from  Aconite. 

Description  and  Properties. — The  alkaloid  exists  in  two  forms, 
crystalline  and  amorphous ;  white  or  yellowish-white,  odorless,  with 
a  strong  acrid  taste  characteristic  of  aconite.  The  crystalline  form 
is  soluble  in  alcohol,  ether,  and  chloroform,  and  partially  so  in 
water. 

The  alkaloid  is  one  of  the  most  powerful  of  poisons,  rivalling  in 
virulence  hydrocyanic  acid.  The  various  aconitines  are  of  different 
strengths,  so  that  only  the  minimum  dose  of  a  new  sample  should 
at  first  be  employed. 

Dose. — 1 0^0  0   2^0  grain  (o.oooo6-o.ooo?5  Gm.). 

Oleatum  Aconitmse — Oleati  Aconitinx — Oleate  of  Aconite. — A  2  per  cent, 
solution  of  Aconitine  in  Oleic  Acid.     For  external  use. 


Antagonists  and  Incompatibles. — The  cardiac  stimulants, 
atropine,  morphine,  and  ether,  antagonize  the  action  of  aconite. 

Synergists. — All  members  of  this  group  and  cold  enhance  the 
action  of  the  drug. 

Physiological  Action. — Externally  and  Locally. — Applied  to 
mucous  membranes  or  to  the  skin  for  any  length  of  time,  aconite 
first  stimulates  and  then  depresses  the  ends  of  the  sensory  nerves, 
producing  respectively  tingling,  numbness,  and  local  anesthesia. 

Internally. — Digestive  System. — Except  when  given  in  very  di- 
lute solutions,  aconite  produces  tingling  and  numbness  of  the  lips 
and  mouth,  with  increased  secretion  from  the  salivary  glands. 
Large  doses  cause  great  irritation,  together  with  a  sense  of  con- 
striction in  the  fauces. 

Under  normal  conditions  of  the  stomach  aconite  may  act  upon 
that  organ  as  a  sedative,  augmenting  its  secretions.  Large  doses 
occasion  pain,  nausea,  and  vomiting. 

Circulatory  System. — Upon  the  heart  aconite  acts  almost  imme- 
diately as  a  depressant,  although  it  is  thought  to  accelerate  cardiac 
action  within  a  very  brief  period.  It  slows  the  heart  by  stimulat- 
ing the  roots  of  the  vagus,  and  weakens  the  force  of  the  cardiac 
contractions  by  depressing  the  motor  ganglia.     The  arterioles  are 

37 


578  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

dilated  and  the  blood-pressure   lowered  through  the  depressing 
effects  of  the  drug  upon  the  vaso-motor  center. 

Toxic  doses  accelerate  the  pulse,  causing  it  to  become  irregular 
and  thready  through  over-stimulation  and  consequent  exhaustion 
of  the  inhibitory  nerve-roots,  so  that  the  motor  ganglia  are  too 
profoundly  depressed  to  maintain  the  regular  contractions.  The 
arterial  tension  is  consequently  greatly  lowered,  so  that  the  radial 
pulse  may  be  imperceptible.  Death  usually  occurs  from  cardiac 
paralysis,  the  heart  stopping  in  diastole. 

Nervous  System. — Moderate  doses  have  no  important  action 
upon  this  system ;  excessive  doses  depress  the  terminations  of  the 
sensory  nerves,  and,  possibly,  the  sensory  side  of  the  spinal  cord. 
This  action  is  followed  by  a  depression  of  the  motor  mechanism, 
affecting  first  the  peripheral  endings  of  the  motor  nerves,  giving 
rise  to  great  muscular  weakness. 

Respiratory  System. — The  respiration  is  slowed  by  moderate 
doses ;  under  large  doses  it  is  rendered  both  shallow  and  slow. 
The  breathing  is  retarded,  because  the  peripheral  endings  of  the 
vagi  distributed  to  the  lungs  are  depressed.  Under  large  doses 
there  is  depression  of  the  respiratory  center,  paralysis  of  which 
may  be  occasioned  by  lethal  amounts. 

Absorption  and  Elimination. — Aconite  is  rapidly  absorbed,  but 
its  channels  of  elimination  are  not  definitely  known,  although  it  is 
probably  excreted  by  the  kidneys,  and  to  some  extent  by  the  skin, 
the  drug  acting  as  a  mild  diaphoretic. 

Temperature. — Aconite  is  a  decided  antipyretic,  the  reduction 
of  temperature  being  probably  due  to  increased  heat-dissipation. 

Eye. — Toxic  amounts  of  the  drug  have  produced  mydriasis, 
misty  vision,  and  diplopia. 

Untoward  Action. — Besides  the  symptoms  described  under 
"  Poisoning,"  there  have  been  observed  pustular  and  erythematous 
eruptions,  vertigo,  and  dimness  of  vision. 

Poisoning. — The  first  effect  of  toxic  doses  is  to  cause  marked 
tingling  of  the  tongue  and  lips,  which  sensation  soon  extends  to 
the  fingers  and  may  even  affect  the  entire  cutaneous  surface.  There 
is  extreme  muscular  weakness,  particularly  noticeable  in  the  lower 
ejftremities.  The  pulse,  at  first  slow  and  weak,  soon  becomes  rapid 
and  almost  imperceptible.  The  respirations  are  quite  feeble  and 
shallow,  and  there  may  be  marked  dyspnea. 

,  The  countenance  is  anxious  and  the  skin  pallid,  cold,  and  cov- 
ered with   sweat,   with   great   reduction    of  temperature.     These 


CARDIAC  SEDATIVES.  579 

symptoms  are  accompanied  by  dimness  of  vision,  the  pupils  usually 
being  widely  dilated.  Rarely  there  are  present  epileptiform  con- 
vulsions. 

Death  may  be  postponed  for  some  time,  or  it  may  rapidly  follow 
a  Ifethal  dose. 

Treatment  of  Poisoning. — The  patient  should  be  placed  in  a 
horizontal  position,  better  with  the  feet  raised  slightly.  The 
stomach  should  be  thoroughly  evacuated ;  bodily  heat  should  be 
maintained  by  external  warmth ;  diffusible  stimulants,  such  as  ether 
and  alcohol,  should  be  given  hypodermically,  the  treatment  being 
followed  by  administration  of  digitalis.  Atropine  and  strychnine 
hypodermically  are  indicated  to  stimulate  the  respiration  and  assist 
in  stimulating  the  heart. 

Therapeutics. — Whether  locally  applied  or  given  internally 
ACONITE  is,  an  excellent  remedy  in  neuralgice,  particularly  in  tic 
douloureux.  The  tincture,  aconite  liniment,  or  an  ointment  of 
ACONITINE  may  be  applied  to  the  course  of  the  affected  nerve.  The 
TINCTURE  OF  ACONITE  frequently  proves  beneficial  in  herpes  zoster, 
■chilblain,  pruritus,  etc.,  and  its  extended  application  has  even  been 
recommended  to  allay  the  pain  of  chronic  rheumatism. 

Internally. — Aconite  is  an  exceedingly  efficacious  remedy  in 
many  febrile  diseases,  particularly  the  s the  f lie  fevers  of  children  and 
those  fevers  resulting  from  inflammation,  such  as  tonsillitis,  laryn- 
gitis, pharyngitis,  quinsy,  etc.  The  drug  seems  to  exert  a  pecu- 
harly  beneficial  influence  on  mucous  membranes,  all  acute  inflam- 
matory conditions  of  the  throat,  bronchial  tubes,  or  intestinal  canal 
— characterized  by  fever,  a  small,  wiry  pulse,  and  rapid  cardiac 
action — being  greatly  improved  by  the  remedy. 

As  previously  indicated,  aconite  is  one  of  the  most  efficient 
sedatives  in  the  irritative  fevers  of  children.  It  is  equally  valuable 
in  ^e:  first  stage  of  pneumonia  and  va  pleurisy,  and  is  an  invaluable 
adjunct  to  opium  in  the  treatment  oi  peritonitis. 

Pericarditis  is  often  favorably  influenced  by  this  drug,  while  it  is 
also  of  great  service  in  allaying  nervous  palpitation  of  the  heart  or 
that  due  to  excessive  cardiac  hypertrophy. 

The  injection  into  the  rectum  of  8  or  lo  minims  (0.5-0.6  Cc.)  of 
the  TINCTURE  OF  ACONITE,  while  perhaps  producing  a  slight  pro- 
lapsus of  the  rectum,  quickly  affects  an  irritable  stricture  of  the 
urethra,  so  that  a  catheter  may  be  passed  with  little  difficulty, 
although  the  operation  may  have  been  previously  found  impos- 
sible. 


580  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Probably  there  is  no  better  combinatipn  to  "break  up  a  cold" 
than  aconite  and  Dover's  powder,  the  tincture  of  aconite,  given  at 
frequent  intervals  for  a  few  hours,  being  followed,  preferably  at  bed- 
time, with  8  or  ID  grains  (0.5-0.6  Gm.)  of  Dover's  powder. 

Aconite  has  been  favorably  recommended  in  the  acute  stages  of 
cerebrospinal  meningitis  and  as  a  cardiac  sedative  in  aneurysm. 

Contraindications. — Aconite  is  always  contraindicated  in  sub- 
acute or  chronic  conditions  or  when  the  heart's  action  is  weak.  It 
is  also  intolerable  in  catarrhal  conditions  of  the  stomach.- 

Administration. — A  good,  reliable  tincture  is  the  best  prepara- 
tion for  internal  use.  Moreover,  better  results  are  obtained  by 
giving  the  drug  in  fraction  of  minim  doses — ^from  ^  to  \  minim 
(0.006-0.03  Cc.)  in  a  teaspoonful  of  water  every  fifteen  minutes — 
than  by  larger  dosage.  The  most  desirable  influence  of  the  drug 
appears  to  be  realized  by  this  method. 

Veratrum  Viride— Veratri  VTrldis— Veratrum  Viride. 

V.  s.  p. 

(American  Hellebore.) 

Origin. — The  rhizome  and  roots  of  Veratrum  viride  Solander,  a 
plant  growing  in  swampy  places  and  damp  thickets  in  Canada,  and 
in  the  United  States  as  far  south  as  Georgia.  The  plant  closely 
resembles  V.  album  of  Europe,  and  is  also  allied  to  a  species  found 
in  Eastern  Siberia. 

Description  and  Properties. — Rhizome  upright,  obconical,, 
simple  or  divided,  from  2  to  3  inches  (50  to  75  Mm.)  long;  exter- 
nally blackish-gray,  internally  grayish-white,  showing  numerous 
short,  irregular  wood-bundles.  Many  shrivelled,  light  yellowish- 
brown  roots  issue  from  all  parts  of  the  rhizome. 

The  drug  is  inodorous,  but  strongly  sternutatory  when  pow- 
dered, the  taste  being  bitterish  and  very  acrid. 

Veratrum  viride  contains  the  following  alkaloids  :  jervine,  pseu- 
dojervine,  rubijervine ,  and  cervadine.  The  first  named  is  the  cardiac 
depressant  principle  of  the  drug,  and  the  remaining  three  are  ster- 
nutatory'. 

Veratrina  (U.  S.  P.)  is  not  found  in  this  drug,  as  formerly  sup- 
posed, Sabadilla  being  its  principal  source.  Veratroidine,  once 
supposed  to  be  a  distinct  alkaloid,  is  probably  only  a  mixture  of 
rubijervine  and  a  toxic  resin. 

Dose. — ^5  grains  (0.01-0.3  Gm.). 


CARDIAC  SEDATIVES.  581 

Official  Preparations. 

ExtrSctum  Veratri  Vfridis  Fluidum— ExtrScti  Veratri  VKridis  Fluidi — 
Fluid  Extract  of  Veratrum  Viride. — Dose,  \-t,  minims  (0.01-0.3  Cc). 

Tinct&ra  Veratri  Viridis — Tinctiirse  Veratri  Vfridis — Tincture  of  Veratrum 
Viride  (40  per  cent.). — Dose,  J-5  minims  (0.01-0.3  Cc). 

Allied  Drugs. 

Veratrum  Album — Veratri  Albi — White  or  European  Hellebore. 

Sebadnia— Sebadnis— Cevadilla. 

The  seeds  of  this  plant  yield  the  following  official  alkaloid,  known  as  Veratrine : 

Veratrina— Veratrlnae— Veratrine.    TJ.  S.  P. 

Description  and  Properties. — A  white  or  grayish-white,  amor- 
phous or  semi-crystalline  powder ;  odorless,  but  causing  intense 
irritation  and  sneezing  whenever  even  a  minute  quantity  reaches 
the  mucous  membrane ;  of  an  acrid  taste,  and  leaving  a  sensation 
of  tingling  and  numbness  on  the  tongue ;  permanent  in  the  air ; 
very  slightly  soluble  in  hot  or  cold  water,  soluble  in  3  parts  of 
alcohol. 

Dose. — ^5— f  grain  (0.0016-0.016  Gm.). 

Official  Preparations. 

Oleatum  Veratrinae — Oleati  Veratrlnae — Oleate  of  Veratrine  (2  per  cent.). 
For  external  use. 

Ungugntum  Veratrinae — Ungufinti  Veratrlnae — Veratrine  Ointment  (4  per 

cent.).     For  external  use. 

Antagonists  and  Incompatibles  and  Synergists  are  the  same 
as  for  Aconite. 

Physiological  Action. — The  following  remarks  refer  only  to 
the  crude  drug,  the  actions  of  Jervine,  the  mixture  Veratroidine , 
and    Veratrine  being  given  separately. 

Externally  and  Locally. — Veratrum  is  more  of  an  irritant  than 
aconite,  exciting  some  inflammation  of  the  skin  when  applied  locally, 
and  when  in  contact  with  the  nasal  mucous  membrane  producing 
violent  sneezing. 

Internally. — Its  effects  are  in  every  respect  analogous  to  those 
of  aconite,  with  the  following  exceptions,  in  the  several  systems : 

Digestive  System. — Veratrum  is  more  apt  to  occasion  nausea 
and  vomiting. 

Circulatory  System. — The  drug  is  a  more  powerful  depressant 
to  the  circulation,  small  doses,  while  not  materially  affecting  the 


582  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

pulse-rate,  greatly  reducing  its  force,  large  doses  rendering  the 
pulse  very  weak,  almost  indistinguishable,  and  very  rapid. 

Nervous  System. — It  does  not,  as  does  aconite,  affect  the  sen- 
sory nerves,  but  in  large  doses  paralyzes  the  motor  system  cen- 
trally, impairing  the  reflexes.  Under  moderate  doses  there  is 
extreme  muscular  weakness. 

Respiratory  System. — Veratrum  depresses  the  respiration  less 
than  aconite. 

Absorption  and  Elimination. — The  drug  is  absorbed  with  great 
facility,  and  is  eliminated  chiefly  by  the  bowels.  It  possesses  much 
feebler  diuretic  and  diaphoretic  properties  than  aconite. 

Temperature. — In  medicinal  doses  it  is  not  so  powerful  an  anti- 
pyretic as  aconite. 

Untoward  Action. — Veratrum  occasionally  produces  an  erythem- 
atous or  pustular  eruption. 

Poisoning. — Except  that  the  drug  causes  no  cutaneous  anesthe- 
sia or  diminution  of  sensation,  the  symptoms  of  poisoning  are 
almost  identical  with  those  occasioned  by  aconite. 

Treatment  of  Poisoning. — The  same  as  prescribed  for  aconite. 

The  Physiological  Actions  of  jervine,  veratroidine,  and  vera- 
trine  are  as  follows  : 

Externally  and  Locally. — ^Jervine  is  a  mild  irritant  when  applied 
to  the  skin  or  mucous  membranes.  Veratroidine  is  less  irritating 
when  similarly  applied.  Veratrine  is  a  powerful  irritant  when 
applied  by  inunction,  producing  a  tinghng  or  prickling  sensation, 
followed  by  pain  and  finally  by  numbness. 

Internally. — Digestive  System. — Jervine  has  no  noticeable  effect 
upon  the  stomach  and  bowels,  but  produces  marked  salivation. 
Veratroidine  in  full  doses  occasions  vomiting  and  purging.  Vera- 
trine excites  great  irritation  of  the  gastro-intestinal  tract,  causing 
profuse  salivation,  with  vomiting  and  purging  and  severe  epigas- 
tric pain. 

Circulatory  System. — Jervine  renders  the  pulse  slower,  softer, 
and  fuller,  with  marked  reduction  of  arterial  pressure.  This  action 
is  due  to  direct  depression  of  the  cardiac  muscle  or  of  the  motor 
ganglia,  the  dilatation  of  the  arterioles  being  the  result  of  a  de- 
pressant effect  upon  the  vaso-motor  center. 

Veratroidine  retards  the  heart's  action  by  stimulating  the  pneu- 
mogastrics.  The  arterial  pressure  is  lowered  by  weakening  of  the 
heart.  The  vaso-motor  center  is  not  depressed,  nor  are  the  arte- 
rioles dilated. 


CARDIAC  SEDATIVES.  583 

Veratrine  markedly  retards  cardiac  action,  lengthening  the  sys- 
tolic period.  The  blood-pressure  is  increased  because  of  the  addi- 
tional force  of  the  heart's  contractions.  Under  poisonous  doses, 
however,  when  the  cardiac  movements  are  very  slow,  arterial  ten- 
sion is  diminished. 

Nervous  System. — Jervine  causes  great  muscular  weakness,  with 
abolition  of  reflexes,  owing  to  its  depressing  action  upon  the  motor 
areas  of  the  spinal  cord.  Upon  the  cerebral  motor  areas,  however, 
its  influence  is  that  of  a  stimulant,  so  that  poisonous  doses  of  this 
alkaloid  produce  convulsions  of  cerebral  origin.  The  muscles 
themselves  and  the  motor  nerves  are  unaffected,  though  in  the 
later  stage  of  poisoning  numbness  is  present,  showing  that  some 
portion  of  the  sensory  mechanism  is  depressed. 

Veratroidine  manifests  the  same  action  as  jervine. 

Veratrine. — This  alkaloid  affects  neither  the  brain  nor  the 
spinal  cord.  The  motor-  and  sensory  nerves,  on  the  other  hand, 
betray  its  influence,  being  first  stimulated  and  then  paralyzed. 

The  pain  primarily  produced  by  the  local  application  of  vera- 
trine is  due  to  excessive  stimulation  of  the  peripheral  endings  of 
the  sensory  nerves. 

Respiratory  System. — Jervine  is  a  powerful  depressant  to  the  res- 
piration, death  occurring  from  asphyxia  when  lethal  doses  are  taken. 

Veratroidine  affects  the  system  in  like  manner  with  jervine. 

Veratrine. — Small  doses  accelerate  the  respiratory  movements. 
Large  doses  retard  and  finally  arrest  respiration — the  former 
amounts  acting  as  stimulants,  and  the  latter  causing  paralysis  of 
the  peripheral  vagi  and  respiratory  center. 

Temperature. — Moderate  amounts  of  jervine  and  veratro- 
idine have  no  marked  effect  upon,  while  poisonous  doses  depress, 
temperature. 

Veratrine  in  large  doses  is  more  of  an  antipyretic  than  either 
jervine  or  veratroidine. 

Poisoning. — The  symptoms  of  poisoning  from  either  one  of  the 
above  alkaloids  would  be  a  combination  of  the  effects  produced 
by  lethal  amounts,  as  stated,  separately. 

Treatment  of  Poisoning. — The  same  as  prescribed  under  Vera- 
trum  Viride. 

Therapeutics. — Externally  and  Locally. — Veratrum  viride  is 
seldom,  if  ever,  used  locally.  Veratrine,  though  in  rare  cases 
given  internally,  is  wellnigh  restricted  to  external  or  local  appli- 
cation. 


584  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

The  OLEATE  or  ointment  of  veratrine  when  applied  over  the 
affected  nerve  is  exceedingly  efficacious  in  neuralgia,  particularly 
in  tic  douloureux  and  orbital  neuralgia.  In  the  latter  affection  great 
care  should  be  taken  in  administration,  lest  some  portion  of  the 
drug  enter  the  eye,  in  which  case  violent  and  persistent  conjuncti- 
vitis would  ensue. 

Internally. — Veratrum  viride  may  be  employed  for  the  same 
conditions  for  which  aconite  is  recommended,  although  it  is  doubt- 
ful whether  it  possesses  any  advantages  over  the  latter  drug ;  in- 
deed, by  many  competent  physicians  it  is  considered  inferior  to, 
and  more  dangerous  than,  aconite.  Moreover,  the  nausea  and 
vomiting  which  in  many  patients  are  likely  to  follow  the  ingestion 
of  this  drug  render  its  use  objectionable. 

Contraindications. — The  same  as  for  aconite. 

Administration. — The  tincture  of  veratrum  viride  only  should 
be  given,  beginning  with  small  doses,  as  recommended  for  aconite, 
and  cautiously  increasing  the  amount.  Veratrine  may  be  applied 
in  the  form  of  an  ointment,  oleate,  or  in  solution  together  with 
alcohol  and  glycerin. 

Phytolaccae  Fructus— Phytoiaccae  Fructus— Phyto- 
lacca Fruit.    TJ.  8.  J*. 

Origin. — The  fruit  of  Phytolacca  decandra  L.,  a  perennial  herb 
indigenous  in  North  America,  growing  in  waste  places. 

Description  and  Properties. — A  depressed-globular,  dark- 
purple  compound  berry,  about  \  inch  (8  Mm.)  in  diameter,  com- 
posed of  ten  carpels,  each  containing  one  lenticular  black  seed ; 
juice  purplish-red,  inodorous;  taste  sweet,  slightly  acrid.  The 
fruit  contains  phytolaccin,  phytolaccic  acid,  tannin,  gum,  sugar,  and 
a  coloring  matter. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Phytolaccae  Radix— Phytolaccae  Radicis— Phyto- 
lacca Root.    IT.  S.  P. 

(Poke-root.) 

Origin. — The  root  of  Phytolacca  decandra  L. 

Description  and  Properties. — Large,  conical,  branched,  and 
fleshy ;  mostly  in  transverse  or  longitudinal  slices,  wrinkled,  gray- 
ish, hard;  fracture  fibrous,  the  wood-bundles  in  several  distinct 
concentric  circles;  inodorous;  taste  sweetish  and  acrid.  It  con- 
tains resin,  gum,  fixed  oil,  tannin,  starch,  sugar,  and  a  glucosid. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 


CARDIAC  SEDATIVES.  585 

Official  Preparation. 

EztrSctum  PhytoUccs  Radicis  Fluidum— ExtrScti  Phytoiaccae  RSdicis 
■piuidi — Fluid  Extract  of  Phytolacca  Root. — Dose,  5-30  minims  (0.3-2.0  Cc). 

Antagonists  and  Incompatibles. — The  cardiac  stimulants, 
■opium,  and  ether  oppose  the  action  of  phytolacca. 

Synergists.— All  the  members  of  this  group;  the  motor- 
depressants  and  emetics  also  enhance  the  action  of  the  drug. 

Physiological  Action. — Externally  and  Locally. — The  pow- 
dered root  is  extremely  irritating  to  mucous  membranes,  in  certain 
•subjects  occasioning  an  erythematous  eruption  and  excoriations. 

Internally. — Digestive  System. — Phytolacca  possesses  emeto- 
■cathartic  properties.  It  occasions  much  nausea,  with  great  de- 
pression, persisting  for  some  time  before  vomiting  occurs.  The 
■drug  augments  the  secretion  of  bile  and  acts  as  a  laxative. 

Circulatory  System. — Like  aconite,  it  reduces  the  force  and  fre- 
■quency  of  the  heart's  action  and  lowers  arterial  tension. 

Nervous  System. — Poke-root  is  a  powerful  motor  depressant, 
acting  as  a  direct  paralyzant  to  the  spinal  cord  and  medulla, 
■although  the  muscles  and  motor  nerves  are  unaffected. 

Respiratory  System. — Phytolacca  is  a  respiratory  depressant. 
Tendering  the  breathing  slow  and  shallow.  Toxic  doses  produce 
death  by  paralysis  of  the  respiratory  center,  preceded  by  tetanic 
■convulsions. 

Absorption  and  Elimination. — The  drug  is  readily  absorbed,  and 
is  eliminated  chiefly  by  the  kidneys. 

Temperature. — Medicinal  doses  have  no  effect  on  temperature. 

Poisoning. — The  symptoms  of  poisoning  are  quite  similar  to 
those  produced  by  veratrum,  though  the  nausea  and  vomiting  are 
postponed  longer  after  the  ingestion  of  phytolacca. 

Treatment  of  ■  Poisoning. — The  same  as  recommended  under 
Aconite  and  Veratrum. 

Therapeutics. — Externally  and  Locally. — Preparations  of  phyto- 
lacca have  been  successfully  used  to  allay  inflammation,  as  in  cases  of 
follicular  pharyngitis ,  tonsillitis,  mastitis,  ulcers,  buboes,  burns,  abscesses. 
The  drug  is  also  useful  in  chronic  eczema,  sycosis,  favus,  etc.  The. 
FLUID  EXTRACT  may  be  applied,  or  the  powdered  root  incorporated 
in  ointment  either  singly  or  associated  with  other  medicinal  agents. 

Internally. — The  drug  has  proved  an  efficient  remedy  in  chronic 
rheumatism,  its  alterative  properties  rendering  it  also  of  some  service 
in  the  treatment  of  scrofula,  syphilis,  and  chronic  diseases  of  the  skin. 


586  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

In  mastitis,  follicular  pharyngitis,  tonsillitis,  etc.  the  internal  use 
of  the  drug  is  indicated,  mastitis  especially  often  yielding  readily 
to  the  internal  use  of  the  fluid  extract,  combined  with  the  local, 
application  of  an  ointment  containing  phytolacca. 

It  has  been  recommended  in  obesity,  possessing  undoubted 
efficacy  in  this  respect.  It  is  claimed  that  the  proprietary  prep- 
aration known  as  "Anti-fat"  is  a  resinoid  preparation  of  the  berries. 

Contraindications. — The  same  as  for  veratrum  viride. 

Administration. — No  special  directions  are  necessary.  The 
powder,  tincture,  or  fluid  extract  may  be  given  internally;  for 
topical  use  an  ointment  may  be  prepared. 

Pulsatilla— Pulsatillae— Pulsatilla.    V.  S.  I*. 

Origin. — The  herb  of  Anemone  Pulsatilla  and  Anemone  pra- 
tensis  L,,  collected  soon  after  flowering. 

Description  and  Properties. — Leaves  radical,  petiolate,  silky- 
villous,  twice  or  thrice  deeply  three-parted  or  pinnately  cleft,  with 
linear,  acute  lobes,  appearing  after  the  large  purple  flowers;  in- 
odorous, \'feVy  acrid.  It  contains  a  peculiar,  acrid,  crystallizable 
principle  known  as  anemonin. 

Dose. — 1-5  grains  (0.06-0.3  Gm.). 

Unofficial  Preparations. 

Extractum  Pulsatillae— ExtrScti  Pulsatillae — Extract  of  Pulsatilla.— Z>d«, 
J-3  grains  (0.03-0.2  Gm.). 

Tinctiira  Pulsatillae — Tincturae  Pulsatniae— Tincture  of  Pulsatilla. — Dose, 
10-20  minims  (0.6-1.2  Co.). 

Anemonin. — Occurring  in  crystalline,  colorless  needles,  soluble  in  warm  alcohol, 
insoluble  in  water. — Dose,  \-\  grain  (0.05-0.01  Gm.). 

Antagonists  and  Incompatibles  and  Synergists  the  same  as 
for  Aconite. 

Physiological  Action. — Externally  and  Locally. — Pulsatilla  is 
a  decided  irritant  to  the  skin,  the  bruised  plant  when  rubbed  upon 
it  even  producing  vesication.  In  the  mouth  it  produces  a  sensation 
of  burning,  succeeded  by  numbness. 

Internally. — The  action  of  the  drug  is  identical  with  that  of 
aconite,  though  Pulsatilla  possesses  greater  emetic  properties. 

Therapeutics. — The  drug  may  be  employed  for  the  same  pur- 
poses as  aconite,  though  as  a  cardiac  sedative  it  is  less  efficient.  It 
has  been  recommended  as  a  useful  emmenagogue. 


CARDIAC  SEDATIVES.  -587 

Arnicae  Flores— Arnicae  Florum— Arnica  Flowers. 

V.  S.  J*. 

Origin. — The  flower-heads  of  Arnica  montana  L.,  a  plant  in- 
digenous in  the  mountainous  regions  of  Europe  and  Northern 
Asia,  and  also  found  in  the  northwestern  part  of  America. 

Description  and  Properties. — Heads  about  i  to  2  inches  (25-50 
Mrn.)  in  diameter,  depressed-roundish,  consisting  of  a  scaly  in- 
volucre in  two  rows,  and  a  small,  nearly  flat,  hairy  receptacle, 
bearing  about  sixteen  yellow,  strap-shaped,  ten-nerved  ray-florets 
and  numerous  yellow,  five-toothed,  tubular  disk-florets,  with  slen- 
der, spindle-shaped  akenes  crowned  by  a  hairy  pappus.  Odor 
feeble  and  aromatic ;  taste  bitter  and  acrid. 

Arnica  flowers  contain  a  glucosid  (?),  arnicin,  a  volatile  oil, 
capronic  and  caprylic  acids,  resins,  tannin,  etc. 

Dose, — 5-30  grains  (0.3-2.0  Gm.). 

Official  Preparation. 

Tinctura  Arnicae  Florum — Tincturse  Amies  Florum — Tincture  of  Arnica 
Flowers  (20  per  cent.).— /?»«,  10-30  minims  (0.6-2.0  Cc).  Chiefly,  however,  used 
externally  as  a  vulnerary. 

Arnica  Radix— Arnicae  Radicis— Arnica  Root. 

JJ.  8.  JP. 

Origin. — The  rhizome  and  roots  of  Arnica  montana  L. 

Description  and  Properties. — The  rhizome  is  horizontal,  some- 
what contorted,  2  to  3  inches  (5-7  Cm.)  long,  and  ^  or  |-  (3  or  4 
Mm.)  or  less  in  diameter,  externally  brown,  rough  from  leaf-scars, 
internally  whitish,  with  a  rather  thick  bark  containing  a  circle  of 
resin-cells  surrounding  the  short,  yellowish  wood-wedges,  and  a 
large,  spongy  pith.  The  roots  are  numerous,  thin,  fragile,  grayish- 
brown,  with  a  thick  bark  containing  a  circle  of  resin-cells.  Odor 
somewhat  aromatic ;  taste  pungently  aromatic  and  bitter ;  the  con- 
stituents the  same  as  those  of  the  flowers. 

Dose. — 5-30  grains  (0.3-2  Gm.). 

Official  Preparations. 

BxtrSctum  Arnicae  R^dicis  Flufdum — ExtrScti  Arnicee  RSdicis  Fliiidi — 
Fluid  Extract  of  Arnica  Root. — Dose,  5-30  minims  (0.3-2.0  Cc). 

ExtrSctum  Arnicae  Radicis — Extrilcti  Arnicae  RSdicis — Extract  of  Arnica 
Root. — Dose,  2-S  grains  (0.13-0.3  Gm.).  ^ 

EmplSstrum  Arnicae — EmplSstri  Arnicae — Arnica  Plaster  (33  per  cent,  of 
extract).     For  external  use. 


588  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Tinctura  Arnicse  RSdicis — Tincturse  Arnicae  RSdicis — Tincture  of  Arnica 
Root  (lo  per  cent.). — Dose,  20-30  minims  (1.3-2.0  Cc). 

Antagonists  and  Incompatibles  and  Synergists  are  the  same 
as  for  Aconite. 

Physiological  Action. — Externally  and  Locally. — The  local 
action  of  both  the  root  and  flowers  is  irritant,  that  of  the  latter 
being  the  more  powerful.  Occasionally  tinfcture  of  arnica  flowers 
produces  marked  inflammation  of  the  skin,  resembling  erysipelas. 

Internally. — The  internal  effects  of  arnica  are  as  yet  imperfectly 
understood,  it  being  difficult  to  assign  the  drug  to  its  proper  group. 

Digestive  System. — Small  doses  slightly  stimulate  the  digestive 
apparatus.  Large  amounts  produce  nausea,  vomiting,  and  diarrhea 
of  a  choleraic  character. 

Circulatory  System. — Small  doses  stimulate  the  heart  and  in- 
crease arterial  pressure ;  full  or  large  doses  retard  the  pulse  and 
depress  the  circulation. 

Nervous  System. — Large  amounts  cause  headache,  with  great- 
depression  of  the  nerve-centers.  Toxic  amounts  occasion  motor 
and  sensory  paralysis,  coma,  at  times  convulsions,  collapse,  and 
death. 

Respiratory  System.- — The  respiration  is  slowed,  although  under 
small  doses  there  may  be  temporary  acceleration. 

Absorption  and  Elimination. — The  active  principle  of  arnica  dif- 
fuses readily  into  the  blood,  the  drug  being  eliminated  chiefly  by 
the  kidneys,  though  the  skin  shares  in  the  excretory  process. 

Tempera^ture. — Large  doses  cause  a  reduction  of  temperature. 

Untoward  Action. — The  topical  appUcation  of  arnica  may  cause 
in  susceptible  persons  violent  cutaneous  inflammation  and  the  pro- 
duction of  pustules,  or  even  distinct  bullae,  attended  with  marked 
constitutional  symptoms.  When  taken  internally  the  drug  occa- 
sions a  sensation  of  burning  in  the  mouth  and  throat,  violent  pain 
in  the  stomach,  tenesmus,  and  choleraic  diarrhea,  intense  headache, 
and  dizziness. 

Poiso7iing. — In  addition  to  the  above-named  symptoms  there  are 
great  cardiac  depression,  decided  muscular  weakness,  slow  and 
shallow  respiration,  paralysis  of  the  nervous  system,  and  death 
resulting  from  collapse. 

Treatment  of  Poisoning. — The  treatment  should  be  much  the 
same  as  that  prescribed  under  Aconite.  Atropine  is  probably  the 
best  physiological  antidote. 

Therapeutics. — Externally  and  Locally. — Arnica  enjoys  a  well- 


CARDIAC  SEDATIVES.  589 

deserved  reputation  as  an  efficient  remedy  for  the  relief  of  bruises, 
sprains,  and  external  inflammations  generally.  It  has  been  recom- 
mended also  as  a  topical  application  in  myalgic  rheumatism.  The 
local  application  of  the  tincture  causes  the  rapid  disappearance  of 
ecchymoses.  Equal  parts  of  the  tincture  of  arnica  and  glycerin, 
diluted  with  water,  have  been  recommended  as  a  stimulant  in 
inflammation  of  the  mucous  membrane  of  the  mouth. 

Internally. — Arnica  is  not  a  very  popular  remedy  for  internal 
administration.  It  has,  however,  been  used  with  varying  success 
in  idiopathic  mania,  delirium  tremens,  and  rheumatic  gout.  It  has 
also  been  beneficially  employed  in  exhausting  diarrhea,  chronic  dys- 
entery, epistaxis,  hemoptysis,  and  paralysis  of  the  bladder. 

Contraindications. — Externally  when  there  exists  any  acute 
skin  disease ;  internally  in  cases  of  inflammation  of  the  gastro-in- 
testinal  tract,  fatty  or  valvular  disease  of  the  heart,  and  in  all 
asthmatic  conditions. 

Administration. — The  tincture  of  arnica  is  the  form  generally 
preferred  for  external  and  internal  use.  In  applying  any  prepara- 
tion externally  the  susceptibility  to  the  irritating  properties  of  the 
drug  peculiar  to  certain  persons  should  be  remembered. 

Pota.ssii    Nltras— Potassii   Nitratis— Potassium 
Nitrate.    V.8.P. 

(Nitre;  Saltpetre.) 

Origin. — Purified  from  native  Saltpetre. 

Description  and  Properties. — Colorless,  six-sided,  rhombic 
prisms,  or  a  crystalline  powder;  odorless,  and  having  a  cooling, 
saline,  and  pungent  taste.  Permanent  in  the  air.  Soluble  in  3.8 
parts  of  water,  very  sparingly  soluble  in  alcohol. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Oflicial  Preparations. 

ArgSnti  Nitras  Dilutus^Arg6nti  Nitratis  Diliiti — Diluted  Silver  Nitrate. 
— Used  externally.  Jb  V 

ChSrta  PotSssii  Nitratis — Ch^Ss  (ace.)  PotSssii  Nitratis — Potassium 
Nitrate  Paper. — Intended  for  burning,  the  fumes  to  be  inhaled. 

Antagonists  and  Incompatibles. — Cardiac  and  diffusible  stim- 
ulants antagonize  tlje  action  of  potassium  nitrate  upon  the  heart. 
Mineral  acids  and  metallic  salts  are  incompatible. 

Synergists. — The  cardiac  depressants,  diuretics,  and  agents 
increasing  waste  aid  the  action  of  potassium  nitrate. 


59Q  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Physiological  Action. — Externally  and  Locally. — The  drug  has 
no  important  local  action. 

Internally. — Digestive  System. — Large  doses  occasion  nausea 
and  vomiting;  poisonous  doses  produce  violent  gastro-intestinal 
inflammation  and  diarrhea,  blood  sometimes  being  vomited  and 
passed  with  the  stools. 

Circulatory  System. — Small  doses  have  no  marked  influence  on 
the  circulatory  system  ;  full  doses  act  as  a  cardiac  depressant,  slow- 
ing and  weakening  the  pulse ;  poisonous  doses  produce  great  weak- 
ness, syncope,  and  death  from  cardiac  failure. 

Nervous  System. — No  special  action  is  noticeable,  although  poi- 
sonous doses  produce  tremulousness,  insensibility,  and  convulsions. 

Respiratory  System. — Large  doses  retard  respiration. 

Absorption  and  Elimination. — Potassium  nitrate  passes  rapidly, . 
into  the  blood  unchanged,  and  is  eliminated  by  the  kidneys  un'%| 
changed.     Small  doses  are  actively  diuretic,  stimulating  the  renal 
cells.     Large  amounts,  from  too  free  stimulation,  are  apt  to  irri-   ■ 
tate  and  inflame  the  kidneys,  even  so  far  as  to  produce  hematuria. 
The  drug  is  also  eliminated  to  some  extent  by  the  skin,  being 
therefore  a  rtiild  diaphoretic.  ^ 

Temperature. — Unaffected  by  medicinal  amounts,  but  lowered" 
by  poisonous  doses. 

Poisoning. — There  is  violent  gastro-intestinal  inflammation,  with 
vomiting  and  purging,  blood  being  present  in  the  ejecta  and  feces. 
Other  symptoms  are — subnormal  temperature,  coldness  of  the  ex- 
tremities, a  weak  and  thready  pulse,  slow  and  shallow  respiration, 
tremulousness  and  great  muscular  weakness,  dimness  of  vision  or 
totaj|:blindness,  deafness,  insensibility,  and  possibly  convulsions^ 
The  urine  is  diminished  or  suppressed. 

Should  the  patient  recover  from  an  immoderate  dose  of  the 
,drug,  he  suffers   for  some  time  from  dysuria,  irritability  of  the 
stomach,  colic,  muscular  weakness,  and  a  sensation   of  chilliness 
in  the  back  and  limbs. 

Treatment  of  Poisoning. — Therrf^s  no  special  antidote  for  nitre ; 
cases  of  poisoning,  therefore,  are  to  be  treated  symptomatically, 
measures  for  relief  including  evacuation  of  the  stomach,  de- 
mulcents, opiates  for  pain,  and  cardiac  and  respiratory  stim- 
ulants. 

Therapeutics. — Externally  and  Locally. — Solutions  of  this  drug 
have  been  found  serviceable  as  applications  to  bruises  and  abrasions. 
The  last  stage  of  pharyngitis  is  greatly  relieved  by  a  gargle  of  a 


CARDIAC  SEDATIVES.  59I 

SOLUTION  OF  POTASSIUM  NITRATE,  in  the  proportion  of  I  drachm 
(4.0  Gm.)  to   I  pint  (473  Cc.)  of  water. 

It  is  claimed  that  a  paste  of  powdered  nitre  and  water  appHed 
to  the  face  night  and  morning  is  an  effective  method  of  removing 
freckles. 

The  difficuhy  of  breathing  in  cases  of  spasmodic  asthma  may 
be  greatly  relieved  by  the  inhalation  of  the  fumes  of  burning 

NITRE- PAPER. 

Internally. — The  drug  was  formerly  much  used  in  acute  artic- 
ular rheumatism  and  as  a  refrigerant  and  sedative  in  inflammations, 
pneumonia,  and  various  fevers.  It  is  employed  to  a  considerable 
extent  as  a  diuretic  and  diaphoretic,  although  greatly  inferior  to  the 
acetates  and  citrates. 

Administration. — It  should  be  given  in  solution,  though  the 
powder  is  sometimes  used  in  combination  with  calomel,  tartar 
■emetic,  or  Dover's  powder. 

The  potassium-nitrate  paper,  as  has  been  stated,  should  be 
burned  and  the  fumes  arising  therefrom  inhaled. 

Sodii  NTtras— Sodii  Nitratis— Sodium  Nitrate. 

TJ.  S.  P. 

Origin. — It  is  found  in  great  quantities  imbedded  in  clay  and- 
sand  in  certain  districts  of  Chili  and  Peru. 

Description  and  Properties. — Colorless,  transparent,  rhombo- 
hedral  crystals,  odorless,  having  a  cooling,  saline,  and  slightly  bit- 
ter taste;  deliquescent  in  moist  air.  Soluble  in  1.3  parts  of  water 
and  in  about  100  parts  of  alcohol.  Sodium  nitrate  should  be  kept 
in  well-stoppered  bottles. 

Dose. — J-i  ounce (15.5-3 1. oGm.). 

Physiological  Action. — The  action  of  the  salt  resembles  closely 
-^at  of  potassium  nitrate,  though  it  is  much  feebler  than  the  latter 
difug,  while  possessing  greater  purgative  properties. 

Therapeutics. — Externally  and  Locally. — A  solution  of  the  salt 
possesses  some  power  as  a  solvent  of  false  membranes,  and  has 
been  used  in  the  form  of  a  spray  to  diminish  fibrinous  exudations 
in  the  pharynx  and  larynx. 

Internally. — It  may  be  employed  for  the  same  purposes  as  the 
potassium  nitrate,  and  has  been  advantageously  adopted  as  a  laxa- 
tive in,  diarrhea  and  dysentery. 

Administration. — Sodium  nitrate  is  best  given  dissolved  in  a 
large  quantity  of  water. 


592  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

GROUP   X.— DIAPHORETICS. 

Diaphoretics — or  sudorifics,  as  they  are  also  called — are  medi- 
cines which  promote  diaphoresis  or  sweating.  Their  action  in 
stimulating  transpiration  by  the  skin  may  be  enhanced  by  exer- 
cise, external  warmth,  nauseants,  and  drugs  which  dilate  the  vessels,, 
determining  more  blood  to  the  cutaneous  blood-vessels. 

Diaphoretics  are  employed  principally  for  their  evacuant,  revul- 
sive, and  alterative  effects,  and  to  promote  absorption. 

Pilocarpus— Pilocarpi— Pilocarpus.    JJ.  S.  P. 

(JABORANDI.) 

Origin. — The  leaflets  of  Pilocarpus  selloanus  Engler  (Rio  Janeiro- 
Jaborandi)  and  oi  Pilocarpus  Jaborandi  Holmes  (Pernambuco  Jabo- 
randi). 

Description  and  Properijies. — About  4  to  6  inches  (10-15  Cm.), 
long  and  \  to  2\  inches  (4-6  Cm.)  broad,  short-stalked,  oval  or 
ovate-oblong,  entire  and  slightly  revolute  at  the  margin,  obtuse 
and  slightly  emarginate,  unequal  at  the  base ;  dull-green,  coriace- 
ous, pellucid  punctate,  mostly  smooth;  when  bruised,  slightly 
aromatic;  taste  somewhat  bitter  and  pungent. 

Pilocarpus  contains  a  volatile  oil  and  two  alkaloids,  pilocarpine- 
and  jaborine,  the  latter  being  chemically  isomeric  with  the  former,, 
although  directly  antagonistic  in  physiological  action. 

Dose. — 5-60  grains  (0.3-4.0  Gm.). 

Official  Preparation. 

ExtrSctutn  Pilocarpi  Pluidum — ExtrScti  Pilocarpi  Fluidi — Fluid  Extract. 
of  Pilocarpus. — Dose,  5-60  minims  (0.3-4.0  Co.). 

Unofficial  Preparation. 

Infusum  Pilocarpi — Infusi  Pilocarpi— Infusion  of  Pilocarpus.— Z)oj^  2  fluid- 
drachms-4'fluidounces  (8.0-118.3  Cc). 

PIlocarpTnae  Hydrochloras— PilocarpTnae   Hydro- 
cFiloratis- Pilocarpine  Hydrochlorate.  U.S. P. 

Origin. — The  hydrochlorate  of  an  alkaloid  obtained  from  Pilo- 
carpus. 

Description  and  Properiiies. — Small,  white  crystals,  odorless- 
and  of  a  faintly  bitter  taste ;  deliquescent  on  exposure  to  damp  air.. 


DIAPHORETICS.  593 

Very  soluble  in  water  and  in  alcohol.     It  should  be  kept  in  small, 
well-stoppered  bottles. 

Dose. — -^x~k  grain  (0.001-0.03  Gm.). 

JABORINE  is  a  yellow,  amorphous  alkaloid,  isomeric  with  pilocarpine  and  closely 
resembling  atropine  in  its  physiological  action.  The  varying  effects  which  occasionally 
follow  the  use  of  the  commercial  pilocarpine  are  due  to  the  presence  of  jaborine,  which 
antagonizes  the  action  of  pilocarpine  in  almost  every  particular. 

It  is  highly  important,  therefore,  when  administering  pilocarpine  or  any  of  its  prep- 
arations to  obtain  the  drugs  free  from  jaborine,  which  is  not  used  medicinally. 

Antagonists  and  Incompatibles. — Atropine  is  a  perfect  physi- 
ological antagonist  to  pilocarpine,  being  directly  opposite  in  its 
action  throughout  its  entire  range,  -3-^  grain  (0.0006  Gm.)  being 
sufficient  to  counteract  \  grain  (0.0 1  Gm.)  of  pilocarpine.  Morphine 
relieves  the  nausea. 

The  incompatibles  are  tannic  acid,  caustic  alkalies,  and  the  ferric 
and  metallic  salts. 

Synergists. — The  cardiac  depressants,  particularly  aconite  and 
veratrum  viride,  gelsemium,  sarsaparilla,  spirit  of  nitrous  ether,  and 
drugs  which  paralyze  the  vaso-motor  system,  enhance  the  activity 
of  pilocarpus. 

Physiological  Action. — Externally  and  Locally. — There  is  no 
action  of  importance. 

Internally. — Digestive  System. — The  action  of  pilocarpine  is  here 
given,  since  the;  alkaloid  fully  represents  the  drug. 

When  pilocarpine  is  taken  into  the  mouth,  the  ends  of  the 
chorda  tympani  and  secretory  nerves  are  stimulated,  causing  an 
increased  secretion  of  saliva.  Should  large  doses  be  taken,  there 
is  a  feeling  of  tenderness  in  the  mouth  and  severe  salivation  is 
produced. 

The  gastric  glands  are  stimulated  by  the  drug,  their  normal 
secretion  being  augmented.  By  stimulating  the  unstriped  muscle- 
fibers  pilocarpine  increases  peristalsis,  both  of  the  stomach  and  the 
intestines,  in  large  doses  acting  as  a  cathartic.  Immoderate  amounts 
may  also  induce  vomiting.  The  bile  and  pancreatic  juice  are  not 
affected  by  moderate  amounts  of  the  drug. 

Circulatory  System. — At  first  the  vaso-motor  nervous  system  is 
depressed,  resulting  in  an  acceleration  of  the  cardiac  movements, 
with  dilatation  of  the  blood-vessels.  The  heart,  however,  is  soon 
slowed  and  the  arterial  pressure  lowered,  so  that  pilocarpine  is  in 
reality  a  cardiac  depressant  rather  than  a  cardiac  stimulant. 

Pilocarpine  acts  directly  upon  the  heart,  either  by  stimulating 

38 


594  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

the  terminations  of  the  vagus  or  by  depressing  the  motor  centers 
in  the  heart-muscle  or  the  muscle  itself. 

Nervous  System. — In  medicinal  amounts  pilocarpine  has  no  per- 
ceptible action  on  the  central  nervous  system,  although  stimulating 
the  nerve-terminations  of  involuntary  muscles — i.  e.  those  of  the 
stomach,  intestines,  heart,  spleen,  bladder,  uterus,  etc. 

Poisonous  doses  have  produced  (in  the  frog)  tetanic  convulsions, 
followed  by  paralysis,  the  result  of  depression  of  the  muscles  and 
spinal  centers,  the  nerves  apparently  being  unaffected. 

Respiratory  System. — ^The  respiratory  movements  are  unaffected 
by  medicinal  amounts,  but  the  bronchial  secretion  is  augmented. 

Absorption  and  Elimination. — Pilocarpine  is  rapidly  absorbed, 
and  is  eliminated  principally  by  the  skin,  occasioning  free,  and 
under  large  doses  excessive,  diaphoresis. 

The  sweat  is  at  first  alkaline,  then  neutral,  and  finally  alkaline  in 
reaction.  The  diaphoresis  produced  by  pilocarpine  is  due  to  stimu- 
lation of  the  secretory  nerves  supplying  the  glands. 

The  kidneys,  under  small  doses,  are  stimulated,  there  being  a 
slight  increase  in  the  urine,  while  in  disease  the  amount  of  urea  is 
considerably  augmented. 

The  drug  is  also  eliminated  by  the  salivary  glands,  there  being 
frequently  an  enormous  increase  in  the  salivary  secretion.  Under 
the  influence  of  pilocarpine  there  is  an  increase  in  the  gastric, 
bronchial,  and  lacrymal  secretions,  even  the  secretion  of  milk  being 
notably  augmented. 

Temperature. — Succeeding  a  very  brief  and  slight  elevation  of 
temperature  there  is  a  decided  diminution  of  bodily  heat,  resulting 
from  the  dilatation  of  cutaneous  blood-vessels  and  the  evaporation 
of  the  perspiration. 

Eye. — Whether  applied  locally  to  the  eye  or  taken  internally, 
pilocarpine  produces  marked  contraction  of  the  pupil  by  stimulating 
the  peripheral  endings  of  the  iridal  nerves.  The  drug  also  pro- 
duces an  increased  tension  of  the  eyeball. 

Uterus. — There  is  authority  for  the  statement  that  pilocarpine 
stimulates  the  gravid  uterus,  inducing  uterine  contractions  or  in- 
creasing the  energy  of  those  already  established. 

The  effect  of  the  drug  upon  the  uterus,  however,  is  more  pro- 
nounced and  apparent  in  cases  of  eclampsia,  seeming  to  prove  the 
fallacy  of  the  statement  that  pilocarpine  is  a  true  ecbolic. 

Untoward  Action. — Nausea  and  vomiting  are  of  quite  frequent 
occurrence,  the  vomiting  being  preceded  by  long  and  distressing 


DIAPHORETICS.  595 

nausea.  Occasionally  the  patient  complains  of  severe  pain  in  the 
urethra  and  in  the  lumbar  region,  with  frequent  desire  to  micturate. 

There  have  often  been  present  headache,  vertigo,  hiccough, 
dimness  of  vision,  gastric  and  abdominal  pains,  stupor,  and  chilli- 
ness.    There  may  occur  even  collapse. 

Poisoning. — The  symptoms  produced  by  poisonous  doses  of 
pilocarpine  are  exaggerations  of  those  described  above,  together 
with  diarrhea,  exhausting  and  excessive  sweating  and  salivation, 
marked  cardiac  and  respiratory  depression,  and  collapse. 

Treatment  of  Poisoning. — If  the  drug  has  been  ingested,  the  stom- 
ach should  be  immediately  cleansed  with  a  solution  of  tannic  acid. 

To  counteract  the  untoward  effects  of  pilocarpine,  whether  the 
drug  has  been  ingested  or  given  by  subcutaneous  injection,  atro- 
pine is  undoubtedly  the  most  complete  physiological  antagonist, 
and  should  be  given  hypodermically.  Morphine  is  indicated  to 
control  the  nausea^  and  vomiting,  while  some  of  the  cardiac  stimu- 
lants may  be  required  to  counteract  cardiac  depression. 

Therapeutics. — Externally  and  Locally. — Pilocarpine,  or  the 
FLUID  EXTRACT  OF  JABORANDI,  has  been  highly  recommended  for 
alopecia.  By  the  use  of  pilocarpine  the  hair  becomes  darker.  The 
FLUID  EXTRACT  OF  PILOCARPUS  has  been  employed  as  a  local  appli- 
cation in  erysipelas  and  eczema. 

Lozenges  containing  -^  grain  (o.ooi  Gm.)  of  pilocarpine  are 
efficient  in  relieving  dryness  of  the  throat.  As  a  myotic  pilocarpine 
is  used  in  many  diseases  of  the  eye. 

Internally. — The  principal  internal  use  of  pilocarpine  is  as  a 
diaphoretic  in  Brighfs  disease.  In  cardiac  dropsy  it  is  not  a  safe 
remedy,  because  of  its  depressing  influence  upon  the  heart. 

The  drug  is  very  efficient  in  removing  pleuritic  effusion,  while  in 
uremic  poisoning  it  is  unquestionably  the  most  valuable  remedy  we 
possess. 

The  hypodermic  injection  of  small  doses  of  pilocarpine  has 
been  highly  recommended  as  an  efficient  remedy  in  erysipelas, 
particularly  during  the  first  stages  of  the  disease. 

The  drug  has  been  successfully  used  to  abort  malarial  paroxysm, 
and  has  proved  beneficial  in  tobacco  and  alcoholic  amblyopia. 

Pilocarpine  has  been  found  useful  in  humid  asthma,  bronchor- 
rhea,  and  hiccough,  and,  in  small  doses,  in  arresting  the  sweating  of 
phthisis  and  for  the  relief  of  ptyalism.  The  drug  is  an  efficient 
galactogogue,  and  has  been  used  with  success  in  mumps,  chronic  en- 
largement of  the  cervical  glands,  and  adenitis  of  the  inguinal  glands. 


596  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Pilocarpine  materially  lessens  the  flow  of  urine  in  diabetes  in- 
sipidus, and  in  many  diseases  of  the  eye  and  ear  the  internal  use  of 
the  drug  serves  a  useful  purpose. 

The  property  possessed  by  pilocarpine  of  stimulating  the  glands 
of  the  skin  renders  this  remedy  of  great  service  in  many  chronic 
diseases  of  the  skin  characterized  by  a  dry,  scaly  condition.  It  is  a 
peculiarly  valuable  agent  in  phthiriasis,  psoriasis,  certain  forms  of 
eczema,  pruritus  senilis,  etc.  Pilocarpine  or  fluid  extract  of 
jABORANDi  may  be  useful  in  breaking  up  a  cold. 

Finally,  pilocarpine  has  been  highly  recommended  in  catarrhal 
jaundice,  and  is  one  of  the  most  efficient  antidotes  to  belladonna- 
poisoning. 

Contraindications. — The  drug  should  never  be  employed  when 
the  heart  is  weak  from  thinning  and  atrophy  of  its  walls  or  from  fatty 
degeneration,  nor  where  there  is  a  tendency  to  pulmonary  conges- 
tion and  edema.  The  drug  is  also  contraindicated  in  asthenic 
fevers,  such  as  typhoid  fever,  etc. 

Administration. — Pilocarpine  is  superior  to  the  crude  drug, 
being  far  more  reliable  in  its  action  and  less  liable  to  produce 
nausea  and  vomiting.  Pilocarpine  is  usually  given  hypodermically, 
although  it  is  frequently  administered  by  the  mouth,  in  solution,  or 
in  troches. 

Of  all  the  preparations  of  the  crude  drug,  the  fluid  extract  and 
infusion  are  commonly  employed,  the  latter  being  less  apt  to  cause 
profuse  salivation.  An  elixir  of  pilocarpus  is  prescribed  consider- 
ably. 

Should  preparations  of  jaborandi  be  given  upon  an  empty 
stomach,  they  are  less  apt  to  occasion  nausea.  This  inconvenience 
may  be  also  avoided  by  giving  an  infusion  by  enema. 

Liquor  Ammonii  Acetatis— Liquoris  Ammonii  Ace- 
tatis— Solution  of  Ammonium  Acetate.    V.  S.  P. 

(Spirit  of  Mindererus.) 

Origin. — An  aqueous  solution  of  Ammonium  Acetate,  contain- 
ing about  7  per  cent,  of  the  salt,  together  with  small  amounts  of 
Acetic  and  Carbonic  Acids. 

.Description  and  Properties. — A  clear,  colorless  liquid  free 
from  empyreuma,  of  a  mildly  saline,  acidulous  taste  and  an  acid 
reaction.     This  preparation  when  required  should  be  freshly  made. 

Dose. — |-i  fluidounce  (i 5.0-30.0  Cc),  in  sweetened  water. 


DIAPHORETICS.  597 

Official  Preparation. 

Liquor  F6rri  et  Amtnonii  Acetatis — Liquoris  FSrri  et  Ammonii  Acetatis — 
Solution  of  Iron  and  Ammonium  Acetate  (Basham's  Mixture). — Described 
under  "  Preparations  of  Iron." 

Antagonists  and  Incompatibles. — The  metallic  sulphates,  the 
salts  of  lead  and  silver,  lime  water,  the  carbonates  of  potassium 
and  sodium,  and  acids  are  incompatible. 

Synergists. — Spirit  of  nitrous  ether,  potassium  citrate,  and 
many  of  the  refrigerants  and  diaphoretics. 

Physiological  Action  and  Therapeutics. — Solution  of  am- 
monium acetate  is  both  a  mild  diaphoretic  and  diuretic,  according 
as  the  action  is  governed  by  other  more  powerful  agents.  For 
instance,  if  the  skin  is  warm  and  the  cutaneous  blood-vessels 
dilated,  the  preparation  acts  as  a  diaphoretic,  while  if  the  condition 
of  the  skin  is  the  reverse,  the  action  of  the  drug  is  directed  to  the 
kidneys.  Should  the  preparation  be  given  with  aconite  or  spirit 
of  nitrous  ether,  its  action  would  be  that  of  a  diaphoretic,  but  if 
the  drug  were  associated  with  digitalis  or  squill,  it  would  act  as  a 
diuretic.  In  any  case  the  action  of  the  drug  is  due  to  a  stimulation 
of  the  secretory  cells  or  nerves. 

The  principal  medical  use  of  solution  of  ammonium  acetate  is 
as  a  diaphoretic  in  febrile  conditions,  such  as  acute  coryza,  influenza, 
acute  pharyngitis,  etc.  It  is  a  very  efficient  remedy  in  muscular 
rheumatism,  and  in  the  eruptive  fevers  when  the  eruption  is  re- 
tarded. It  is  frequently  associated  with  other  remedies  in  the 
treatment  of  scarlatinous  dropsy. 

Owing  to  its  property  of  stimulating  the  heart  and  circulation,, 
the  remedy  has  been  recommended  in  low  forms  of  fever,  in  the 
belief  that  it  helps  to  sustain  the  powers  of  life,  in  lowering  the 
pulse  and  temperature,  moistening  the  tongue,  and  quieting  the 
deHrium. 

In  migraine  and  in  alcoholic  intoxication  few  remedies  are  so 
successful,  the  drug  frequently  dissipating  the  effects  of  acute 
alcoholism  at  once. 

The  remedy  has  been  found  efficacious  in  dysmenorrhea  and 
menorrhagia,  and  has  been  employed  externally  and  locally  as  a 
discutient  in  mammary  engorgements,  glandular  swellings,  contu- 
sions, incipient  abscesses,  etc. 

Administration. — The  preparation,  as  has  been  said,  should  be 
freshly  made  when  wanted,  and  should  be  administered  well  diluted 
with  sweetened  water. 


598  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

SpTritus  y^theris  Nitrosi— SpTritus  ,<^theris  Nitrosi 
—Spirit  of  Nitrous  Ether.     TJ.  S.  I*. 

(Sweet  Spirit  of  Nitre.) 

Origin. — An  alcoholic  solution  of  Ethyl  Nitrite,  yielding,  when 
freshly  prepared  and  tested  in  a  nitrometer,  not  less  than  eleven 
times  its  own  volume  of  nitrogen  dioxide. 

Description  and  Properties. — A  clear,  mobile,  volatile,  and 
inflammable  liquid,  of  a  pale-yellowish  or  faintly  greenish-yellow 
tint,  having  a  fragrant,  ethereal,  and  pungent  odor  free  from  acridity, 
and  a  sharp,  burning  taste.  It  should  be  kept  in  dark  amber-col- 
ored, well-stoppered  bottles,  remote  from  lights  and  fire. 

Dose. — 1-2  fluidrachms  (2.0-8.0  Cc). 

Antagonists  and  Incompatibles. — The  incompatibles  are  po- 
tassium iodide,  ferric  sulphate,  antipyrine,  mucilage  of  acacia,  tinc- 
ture of  guaiacum,  and  gallic  and  tannic  acids. 

Synergists. — Diaphoretics,  diuretics,  antispasmodics,  tincture 
of  aconite,  potassium  citrate,  etc. 

Physiological  Action  and  Therapeutics. — When  applied  to 
the  skin  and  allowed  to  evaporate  spirit  of  nitrous  ether  produces 
a  slight  anesthetic  effect.  Internally,  its  action  is  very  similar  to 
that  of  the  ammonium  acetate.  It  dilates  the  blood-vessels  more 
than  the  latter  preparation,  besides  being  more  of  a  diffusible  stim- 
ulant, stomachic,  and  carminative. 

Like  the  solution  of  ammonium  acetate,  spirit  of  nitrous  ether 
acts  either  as  a  diaphoretic  or  diuretic,  the  effect  depending  upon 
the  manner  in  which  it  is  administered.  For  its  diuretic  action  it 
should  be  given  in  ice-water  and  the  patient  kept  cool ;  to  produce 
diaphoresis  its  administration  should  be  accompanied  by  warm 
drinks  and  the  patient  be  well  covered. 

Spirit  of  nitrous  ether  is  used  for  about  the  same  purposes  as 
the  solution  of  ammonium  acetate,  being  particularly  serviceable  in 
febrile  affections  to  promote  critical  sweating,  employed  either  alone 
or  in  combination  with  tincture  of  aconite.  It  is  frequently  given 
as  a  diuretic  in  Brigkt's  disease,  congestion  of  the  kidneys,  and  pain- 
ful affections  of  the  urinary  apparatus. 

It  is  a  serviceable  remedy  to  relieve  flatulent  distention  of  the 
stomach,  to  allay  nausea,  and  to  quiet  nervous  agitation.  As  an 
antispasmodic  the  remedy  is  frequently  employed  to  relieve  the 
pain  of  dysmenorrhea,  and  it  may  be  inhaled  for  the  relief  of  cough- 
ing. It  enters  into  many  expectorant  mixtures,  and  is  a  soothing 
application  to  the  forehead  in  neuralgic  headache. 


EMETICS.  599 

Administration. — The  dose  and  manner  of  administering  spirit 
of  nitrous  ether  depend  upon  the  action  desired.  As  an  anti- 
pyretic in  febrile  affections  it  should  be  given  in  doses  of  20-30 
minims  (1.30—2.0  Cc),  in  sweetened  water,  every  half  hour.  To 
produce  diuresis  the  drug  should  be  associated  with  some  other 
diuretic  and  given  in  larger  doses,  J-i  fluidrachm  (2.0-4.0  Cc), 
every  three  or  four  hours.  If  the  remedy  is  desired  for  its  diapho- 
retic action,  it  should  be  given  in  hot  water,  in  doses  of  20  or  30 
minims  (i. 30-2.0  Cc),  repeated  every  half  hour,  the  patient  being 
well  covered. 

Should  the  drug  be  given  as  a  nervous  stimulant,  the  dose 
should  not  be  less  than  i  fluidrachm  (4.0  Cc). 

Care  should  be  exercised  in  the  selection  of  spirit  of  nitrous 
ether  that  it  be  reliable  and  of  full  strength.  If  the  preparation 
has  been  kept  in  large  bottles  exposed  to  light  and  air,  the  drug 
will  be  more  or  less  inert  and  should  not  be  prescribed. 


GROUP  XL— EMETICS. 

Emetics  are  agents  which  produce  vomiting  or  emesis. 

Vomiting  is  the  result  of  the  following  actions  :  i.  The  relaxa- 
tion of  the  cardia ;  2.  The  contraction  of  the  pylorus ;  3.  The  con- 
traction of  the  gastric  muscles ;  4.  The  contraction  of  the  dia- 
phragm; 5.  The  contraction  of  the  abdominal  muscles.  The  effect 
of  these  coordinate  acts  is  to  compress  the  stomach,  expelling  its 
contents  through  the  relaxed  cardia. 

The  nervous  mechanism  involved  in  the  act  of  vomiting  is 
under  the  control  of  the  medulla.  The  vomiting  center  may  be 
stimulated  in  various  ways — reflexly,  through  the  sense  of  sight 
or  taste,  the  stomach,  peritoneum,  biliary  passages,  kidneys,  heart, 
or  lungs,  or  by  irritation  of  the  pharynx  or  esophagus.  The  dia- 
gram (Fig.  14)  serves  to  explain  the  mechanism  of  emesis. 

This  is  the  nervous  mechanism  directly  involved  in  the  act  of 
vomiting,  regardless  of  the  cause  of  the  emesis.  The  vomiting 
center  and  a  portion  of  the  respiratory  center  intimately  connected 
with  it  act  simultaneously,  either  by  way  of  the  stomach  or  reflexly 
through  other  parts  of  the  body — as  is  illustrated  in  certain' injuries 
or  diseases — or  by  direct  stimulation  of  the  center  by  some  sub- 
stance carried  to  it  in  the  blood. 


6oo 


A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 


Fig.  14. — ^^,.(4,  abdominal  walls  ;  .5,  respiratory  muscle :  r,  respiratory  center;  2,  vomiting  center ; 
3,  stomach;  4,  afferent  nerve  passing  from  mucous  membrane  in  stomach  to  vomiting  center  in  me- 
dulla ;  5,  efferent  nerve  passing  from  vomiting  center  to  muscular  fiber  of  cardia,  relaxing  it ;  6,  efferent 
nerve  passing  from  medulla  to  pylorus,  contracting  it ;  7,  efferent  nerve,  influencing  gastric  muscles  to 
contract ;  8,  efferent  nerve,  causing  contraction  of  diaphragm ;  9,  efferent  nerve,  causing  abdominal 
muscles  to  contract. 

The  Local  or  Gastric  Emetics'  are — 

*  Alum ;  *  Yellow  Mercuric  Sulphate ; 

*  Copper  Sulphate ;  *  Sodium  Chloride ; 

*  Zinc  Sulphate ;  *  Ammonium  Carbonate  ; 

*  Mustard. 

(The  drugs  marked  with  an  asterisk  (*)  are  considered  elsewhere  in  the  present 
work.) 

The  Direct  or  Systemic  Emetics  are — 
Apomorphine  Hydrochlorate ; 
Antimony  and  Potassium  Tartrate ; 
Ipecacuanha ; 
Lobelia. 

Local  or  gastric  emetics  are  the  more  rapid  in  their  action, 
producing  emesis  in  from  two  to  five  minutes.  The  systemic 
emetics  must  be  absorbed  and  pass  to  the  medulla  before  they 
produce  vomiting,  consequently  requiring  more  time  to  exert  their 

'  Some  authors  reverse  the  nomenclature,  considering  those  drags  which  act  only 
on  the  stomach  "  direct,"  and  those  affecting  the  medulla  "  indirect." 


EMETICS.  6oi 

influence.  Moreover,  the  action  of  the  latter  class  of  emetics  is 
of  much  longer  duration  and  followed  by  greater  depression  of 
the  muscular  and  circulatory  systems,  together  with  greater  consti- 
tutional disturbance. 

Some  emetics  act  both  locally  and  centrally.  Tartar  emetic 
and  ipecacuanha  affect  the  stomach  locally,  but,  since  their  action 
is  chiefly  upon  the  vomiting  center  through  the  circulation,  they 
are  classed  as  systemic  emetics.  Zinc  sulphate  and  copper  sul- 
phate, on  the  other  hand,  while  to  a  slight  extent  acting  on  the 
medulla,  are  classed  as  local  emetics,  because  their  principal  action 
is  upon  the  mucous  membrane  of  the  stomach. 

Within  a  few  minutes  after  an  emetic  has  been  ingested  there  is 
a  feeling  of  nausea  and  distress,  with  decided  muscular  relaxation. 
The  circulatory  system  is  depressed ;  the  pulse  is  small  and  irregu- 
lar, and  a  sensation  of  faintness  ensues.  The  flow  of  saliva  is 
increased,  and  vomiting  soon  follows.  During  emesis  the  arterial 
tension  is  raised,  the  face  is  flushed,  and  there  is  an  increase  in 
bodily  heat.  When  vomiting  has  subsided  there  is  a  reduction  of 
temperature,  with  cardiac  and  muscular  weakness,  the  skin  being 
bathed  in  perspiration.  Occasionally  fatal  syncope  has  followed 
the  use  of  emetics. 


Antagonists. — Drugs  known  as  Anti-emetics  are  used  to  allay 
nausea  and  check  vomiting.  Like  emetics,  these  agents  are  divided 
into  Local  Anti-emetics  or  Gastric  Sedatives  and  Direct  or  Sys- 
temic Anti-emetics,  according  to  their  action. 

Among  the  most  important  Anti-emetics  are  the  following : 

Local  Anti-emetics  or  Gastric  Sedatives. 

(AH  save  Ice  are  treated  elsewhere  in  the  present  work.) 

Alcohol  (especially  champagne) ;  Ether ; 

Arsenic  (small  doses) ;  Ipecac  (small  doses) ; 

Belladonna;  Ice; 

Bismuth  subnitrate  and  subcar-  Opium ; 

bonate ;  Hydrocyanic  acid ; 

Carbolic  acid ;  Menthol ; 

Cerium  oxalate ;  Potassium  nitrate ; 

Chloroform ;  Silver  nitrate ; 

Cocaine ;  Sulphocarbolates ; 

Creasote ;  Tincture  of  iodine  (small  doses). 
Calomel  (small  doses) ; 


6o3  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Direct  or  Systemic  Anti-emetics  or  Gastric  Sedatives. 

Alcohol ;  Chloral ; 

Ammonium;  Hydrocyanic  acid; 

Amyl  nitrite ;  Nitroglycerin ; 

Bromides ;  Opium. 

It  will  be  observed  that  some  drugs  are  both  local  and  direct 
Anti-emetics. 

There  are  certain  measures  which  may  be  adopted  to  allay 
nausea  and  relieve  vomiting,  such  as  a  recumbent  posture  and 
injection  of  large  quantities  of  aerated  water  into  the  rectum. 

'Synergists. — The  emetics  are  of  course  mutually  synergistic. 
Emetics  are  adjuncts  to  antiperiodics  and  expectorants,  although 
the  latter  do  not  particularly  enhance  the  action  of  the  former. 

Emetics  are  used — 

1.  To  empty  the  stomach  in  cases  where  the  presence  of  undi- 
gested food  occasions  pain,  headache,  etc.,  or  to  expel  some  poi- 
sonous substance  from  the  stomach.  For  this  purpose  the  local 
emetics  are  preferable. 

In  cases  of  poisoning  the  local  emetics  are  the  more  reliable. 

2.  To  remove  foreign  bodies  from  the  esophagtis.  For  this  pur- 
pose the  direct  or  systemic  emetics  should  be  used. 

3.  To  remove  foreign  bodies  from  the  larynx,  as  in  cases  of 
membranous  croup,  laryngeal  diphtheria,  etc.,  the  'effort  of  vomit- 
ing being  sometimes  sufficient  to  dislodge  and  remove  the  mem- 
brane or  other  foreign  substance. 

4.  To  remove  the  bronchial  secretion  in  cases  of  bronchitis  and 
catarrhal  pneumonia.  In  these  cases  the  direct  emetics  should  be 
employed,  preferably  ipecacuanha  or  apomorphine,  because  they 
possess  more  expectorant  properties. 

5.  To  empty  the  gall-bladder  in  cases  of  biliousness  or  malaria, 
or  where  small  gall-stones  are  present  in  the  gall-duct,  the  com- 
pression of  the  liver  between  the  diaphragm  and  the  abdominal 
muscles  expelling  the  bile  from  the  liver  into  the  duodenum  and 
forcing  the  gall-stones  through  the  duct. 

6.  To  relax  spasm  of  the  pharyngeal  muscles  in  cases  of  spas- 
modic laryngitis.  For  this  purpose  the  systemic  emetics  are  pref- 
erable. 

Contraindications. — Emetics  should  not  be  given  to  persons 
suffering  from  aneurysm,  hernia,  peritonitis,  prolapse  of  the  uterus 
or  rectum,  atheroma,  or  where  there  is  very  high  arterial  tension,  a 


EMETICS.  603 

tendency  to  hemorrhage  from  the  lungs  or  uterus,  or  a  tendency 
to  abortion. 

The  emetic  drugs  which  have  not  been  elsewhere  discussed  in 
the  present  work  are  here  given  in  detail: 

Apomorphmse  Hydrochloras— Apomorphinae  Hy- 
drochloratis  —  Apomorphine  Hydrochlorate. 
V.  8.  J*. 

Origin. — The  hydrochlorate  of  an  artificial  alkaloid  prepared 
from  Morphine  or  Codeine. 

Description  and  Properties. — Minute,  grayish-white,  shining, 
acicular  crystals,  without  odor,  having  a  faintly  bitter  taste,  and 
acquiring  a  greenish  tint  upon  exposure  to  light  and  air.  Soluble 
in  about  45  parts  of  water  and  about  45  parts  of,  alcohol.  It 
should  be  kept  in  small,  dark,  amber-colored  vials.  If  the  prepa- 
ration imparts  to  100  parts  of  water  when  slightly  shaken  an 
emerald-green  color,  the  drug  should  be  rejected. 

Dose. — io-io  grain  (0.003-0.006  Gm.)  by  the  mouth ;  ■^■g-^ 
grain  (0.0025-0.01   Gm.)  hypodermically. 

Physiological  Action. — Externally  and  Locally. — None. 

Internally. — Digestive  System. — From  five  to  twenty  minutes 
after  ingestion — according  to  the  dose  and  the  manner  of  adminis- 
tration— vomiting  ensues,  being  repeated  three  or  four  times  at 
intervals  of  about  fifteen  minutes.  The  emesis  is  preceded  and 
attended  by  a  slight  nausea,  with  but  moderate  depression.  Apo- 
morphine is  a  typical  direct  or  systemic  emetic,  its  entire  action 
being  exerted  upon  the  vomiting  center  in  the  medulla.  It  is  per- 
haps the  most  powerful  and  certain  emetic  we  possess. 

Circulatory  System. — Small  doses  have  no  perceptible  effect  upon 
the  circulation.  Full  doses  increase  the  rapidity  and  force  of  the 
heart's  action  and  raise  arterial  pressure,  owing  to  stimulation  of  the 
accelerator  nerves  and  vaso-motor  center.  Large  or  toxic  arnounts 
depress  the  circulatory  system  or  paralyze  the  cardiac  muscle. 

Nervous  System. — Full  doses  stimulate  the  brain  and  may  even 
occasion  delirium.  Poisonous  amounts  produce  convulsions,  prob- 
ably of  spinal  origin,  succeeded  by  paralysis  of  the  motor  and  sen- 
sory nerves,  and  consequently  of  the  muscles. 

Respiratory  System. — Small  amounts  do  not  affect  the  respira- 
tory movements,  although  the  secretion  from  the  bronchial  mucous 
membrane  is  increased.  Full  doses  accelerate  and  deepen  respira- 
tion, while  toxic  amounts  cause  depression. 


6o4  A    TEXT-BOOK  OF  MA  TERIA  MEDIC  A. 

Absorption  and  Elimination. — Apomorphine  is  readily  absorbed, 
and  is  excreted  through  the  gastro-intestinal  tract,  as  well  as  by  the 
broncho-pulmonary  mucous  membrane,  the  kidneys,  and  the  skin. 

Temperature  is  unaffected  by  small  doses,  but  may  be  lowered 
by  large  amounts. 

Poisoning. — The  symptoms  would  be  violent  vomiting,  delirium 
or  convulsions,  and  marked  cardiac  and  respiratory  depression, 
death  resulting  from  asphyxia; 

Treatment  of  Poisoning. — The  systemic  gastric  sedatives  and 
cardiac  stimulants. 

Therapeutics. — Apomorphine  is  the  most  reliable  emetic  to  use 
when  prompt  emesis  is  necessary  or  in  cases  where  swallowing  is 
difficult  or  impossible. 

It  is  extremely  useful  as  an  emetic  in  cases  of  poisoning,  though 
it  frequently  happens  in  narcotic  poisoning  that  the  vagus  center  is 
so  blunted  by  the  poison  that  apomorphine  fails  to  act. 

Should  it  be  necessary  to  provoke  emesis  when  the  stomach  is 
in  a  state  of  acute  inflammation,  apomorphine  is  preferable  to  any 
other  emetic. 

Given  by  the  mouth  in  small  doses — from  ^  grain  (o.ooi  Gm.) 
to  ^  grain  (0.003  Gm.)  every  three  or  four  hours — this  drug  is  an 
exceedingly  efficient  remedy  in  acute  bronchitis.  It  is  equally 
beneficial  in  relieving  the  dry,  hacking  cough  of  chronic  bronchitis, 
chronic  catarrhal  pneuinonia,  and  tuberculosis. 

Contraindications. — The  same  as  for  emetics  generally. 

Administration. — Apomorphine  when  given  as  an  emetic 
should  invariably  be  administered  hypodermically,  and  the  solu- 
tion be  always  freshly  prepared.  When  the  drug  is  used  as  an 
expectorant  it  should  be  given  by  the  mouth.  Great  care  should 
be  taken  in  administering  the  drug  to  children,  as  they  bear  the 
remedy  very  badly. 

Antimonii  et  Potassii  Tartras— Antimonii  et  Potas- 
sii  Tartratis— Antimony  and  Potassium  Tartrate. 
V.  S.  JP. 

(Tartar  Emetic;  Tartrated  Antimony.) 
Origin. — Antimony  Trioxide  is    mixed  with  Acid    Potassium 
Tartrate  and  Water  to  the  consistence  of  a  paste,  allowed  to  stand 
for  twenty-four  hours,  boiled  in  water,  and  crystallized. 

Description  and  Properties. — Colorless,  transparent  crystals 
of  the  rhombic  system,  becoming  opaque  and  white  on  exposure 


EMETICS.  605 

to  air,  or  a  white,  granular  powder,  without  odor  and  having  a 
sweet,  afterward  disagreeable,  metallic  taste.  Soluble  in  17  parts 
of  water  and  in  3  parts  of  boiling  water,  but  insoluble  in  alcohol, 
which  precipitates  it  from  its  aqueous  solution  in  the  form  of  a 
crystalline  powder. 

Dose. — As  an  emetic,  1-2  grains  (0.06-0.12  Gm.) ;  as  a  cardiac 
depressant,  \-\  grain  (0.03-O.06  Gm.);  as  a  diaphoretic  and 
expectorant,  -gV^  grain  (0.003-0.01   Gm.). 

Official  Preparations. 

Syrupus  Scillae  CompSsitus — Syrupi  Scillse  Comp6siti — Compound  Syrup 
of  Squills  (Hive  Syrup). — Formula:  Fluid  Extract  of  Squill,  80;  Fluid  Extract  of 
Senega,  80;  Antimony  and  Potassium  Tartrate,  2;  Sugar,  750;  Precipitated  Calcium 
Phosphate,  10;  Water,  to  1000. 

Dose. — 5-60  minims  (0.3-4.0  Cc). 

Vinum  Antimonii — Vini  Antimonii — Wine  of  Antimony. — Formula :  Anti- 
mony and  Potassium  Tartrate,  4 ;  Boiling  Distilled  Water,  65;  Alcohol,  150;  White 
Wine,  to  1000. 

Dose. — 5-60  minims  (0.3-4.0  Cc). 

Antagonists  and  Incompatibles. — Opium,  alcohol,  and  the 
cardiac  stimulants  and  antispasmodics  generally  are  antagonistic. 
Tannic  and  gallic  acids  and  the  lead  salts  are  incompatible. 

Synergists. — Emetics,  cathartics,  and  cardiac  depressants  pro- 
mote the  action  of  tartar  emetic. 

Physiological  Action. — Externally  and  Locally. — Tartar  emetic 
is  a  powerful  irritant  when  applied  to  the  skin,  producing  a  fol- 
licular inflammation  followed  by  a  papular  eruption,  becoming 
vesicular,  and  later  forming  pustules  with  a  central  umbilication, 
desiccation  finally  occurring,  the  pustules  closely  resembling  those 
of  small-pox. 

Internally. — Digestive  System. — ^Upon  the  mucous  membrane  of 
the  gastro-intestinal  tract,  as  upon  the  skin,  antimony  and  potas- 
sium tartrate  acts  as  a  powerful  irritant.  Small  doses,  occasioning 
only  a  sensation  of  warmth  in  the  stomach,  soon  produce  an  in- 
creased secretion  of  saliva  and  gastric  juice,  as  well  as  of  secretions 
from  the  intestines,  liver,  and  pancreas,  more  or  less  nausea  fre- 
quently accompanying  these  symptoms. 

A  little  larger  dosage  excites  vomiting,  due  at  first  to  the  irri- 
tating action  of  the  drug  upon  the  mucous  membrane  and  nerves 
of  the  stomach,  and,  as  soon  as  the  drug  is  absorbed,  affecting 
directly  the  vomiting  center  in  the  medulla.  Full  or  large  doses 
irritate  the  intestines,  producing  diarrhea,  the  discharges,  if  the  dose 


6o6  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

has  been  excessive,  strikingly  resembling  those  of  cholera.  Ac- 
companying the  foregoing  symptoms  are  severe  cramps  and 
epigastric  pain. 

Circulatory  System. — Tartar  emetic  is  a  powerful  cardiac  de- 
pressant, even  in  small  doses  slowing  and  weakening  the  heart's 
action,  and  simultaneously  lowering  arterial  pressure  by  direct  de- 
pression of  the  heart-muscle  and  of  the  vaso-motor  mechanism  in 
the  walls  of  the  blood-vessels. 

Poisonous  doses  of  the  drug  profoundly  depress  the  heart, 
which  is  finally  arrested  in  diastole. 

Nervous  System. — Antimony  and  potassium  tartrate  in  small 
doses  and  under  certain  conditions  exerts  a  sedative  influence  upon 
the  brain.  Indeed,  its  action  is  that  of  a  depressant  to  the  entire 
nervous  system,  particularly  the  spinal  cord,  small  doses  depressing' 
the  sensory  side,  while  poisonous  doses  paralyze  both  the  motor 
and  sensory  centers  of  the  cord. 

Under  the  administration  of  antimony,  therefore,  reflex  excita- 
bility is  diminished  and  the  muscular  system  is  depressed,  the  drug 
acting  as  an  antispasmodic,  probably  by  its  influence  both  upon  the 
muscles  and  the  nervous  system. 

Respiratory  System. — Very  small  doses  have  no  effect  upon 
the  respiratory  movements,  but  increase  the  secretions  from  the 
bronchial  mucous  membrane.  Full  doses  depress  the  respiratory 
movements,  shortening  the  inspiration,  but  prolonging  expiration. 
Toxic  doses  render  the  breathing  extremely  irregular  and  greatly 
lengthen  the  pause  between  inspiration  and  expiration,  while  there 
is  an  enormous  increase  in  the  bronchial  secretion. 

The  action  of  tartar  emetic  upon  the  respiratory  system  is  very 
complex.  The  explanation  as  given  by  Hare  is :  "  Primarily  the 
respiratory  center  in  the  medulla  is  depressed,  and  the  governing 
nerves  of  breathing,  the  pneumogastrics,  are  also  rendered  inactive ; 
secondarily,  the  cardiac  failure  readily  causes  pulmonary  conges- 
tion ;  and,  thirdly,  the  drug  causes  such  an  outpouring  of  liquid 
and  mucus  into  the  bronchial  tubes  that  the  patient  is  drowned  in 
his  own  secretion,  which  he  is  too  weak  to  expel." 

Absorption  and  Elimination. — Tartar  emetic  rapidly  enters  the 
blood,  and  is  eliminated  by  many  channels,  principally  by  the 
bowels,  but  also  by  the  bile,  milk,  sweat,  and  urine.  The  drug  is 
an  active  diaphoretic,  expectorant,  and  cholagogue. 

Temperature. — Small  doses  do  not  affect  temperature  percep- 
tibly ;  large  doses   lower  bodily  heat,  chiefly  by  depressing  the 


EMETICS.  607 

circulation,  although  the  drug  may  possibly  influence  the  heat- 
center  to  some  extent,  lessening  heat-production. 

Untoward  Action. — The  untoward  manifestations  produced  by 
medicinal  amounts  of  tartar  emetic  in  individuals  having  a  marked 
susceptibility  to  the  drug  do  not  differ  essentially  from  the  symp- 
toms of  poisoning  next  described. 

Poisoning. — Tartar  emetic  produces  all  the  symptoms  of  an 
irritant  poison — severe  burning  sensation  in  the  esophagus  and 
stomach  and  violent  and  repeated  vomiting,  the  ejecta,  in  addition 
to  undigested  food,  containing  mucus,  bile,  and  frequently  blood. 

These  symptoms  are  attended  with  severe  colicky  pains  in  the 
abdomen  and  serous  purging,  the  discharges  resembling  those  of 
cholera,  the  analogy  with  the  latter  disease  being  rendered  the 
more  striking  by  the  presence  of  cramps  in  the  extremities — a  cha- 
racteristic feature  of  poisoning  by  tartar  emetic. 

Together  with  these  gastro-intestinal  symptoms  there  is  extreme 
prostration,  accompanied  by  an  irregular,  weak,  almost  impercep- 
tible pulse,  great  muscular  relaxation,  depressed  respiration,  pinched 
and  livid  countenance,  cold,  clammy  skin,  reduction  of  tempera- 
ture, and  scanty  and  bloody  urine.  Death  may  be  preceded  by 
stupor,  wild  delirium,  or  convulsions. 

Treatment  of  Poisoning. — If  the  poison  has  not  been  entirely 
ejected  in  the  act  of  vomiting,  the  stomach  should  be  immediately 
washed  out  with  a  solution  of  tannic  acid,  after  which  strong  coffee 
should  be  administered,  together  with  demulcent  drinks,  anodynes, 
and  respiratory  and  cardiac  stimulants  should  they  be  necessary.  ■ 

Therapeutics. — Externally  and  Locally. — Tartar  emetic  was 
formerly  used  as  a  rubefacient,  being  still  so  employed  to  some 
extent.  The  tendency  of  the  drug,  however,  to  produce  extensive 
papular  eruption  and  destruction  of  tissue  renders  its  external  use 
unsafe.  Hebra  considers  that  the  external  use  of  tartar  emetic  is 
a  "useless,  injurious  procedure,  and  occasionally  even  dangerous 
to  life." 

S.  Hartwell  Chapman  has  recommended  the  use  of  a  lozenge 
containing  2^5-  grain  (0.0003  Gm.)  of  tartar  emetic  and  ^-^  grain 
(0.00 1  Gm.)  of  codeine  in  acute  inflammation  of  the  throat  when 
accompanied  with  fever. 

Internally. — The  medical  uses  of  tartar  emetic  are  constantly 
becoming  more  restricted.  Because  of  its  slow  and  depressing 
action  the  employment  of  the  drug  as  an  emetic  has  been  prac- 
tically abandoned.     It  is  still  used  as  a  sedative  antiphlogistic  in 


6o8  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

various  acute  inflammations.  It  is  beneficial  in  the  early  stages  of 
acute  laryngitis  and  bronchitis,  but  its  administration  should  be  dis- 
continued after  a  free  secretion  of  bronchial  mucus  is  established. 

The  remedy  is  occasionally  given  for  its  diaphoretic  influence  in 
VA.x\o\!iS  fevers,  and  has  even  been  recommended  as  a  cholagogue. 

The  COMPOUND  SYRUP  OF  SQUILLS  is  a  useful  expectorant,  being 
a  popular  and  efficient  remedy  for  croup. 

Administration. — As  an  emetic  the  action  of  the  drug  is  facili- 
tated and  enhanced  by  associating  it  with  ipecacuanha,  the  reme- 
dies together  being  given  in  powdered  form. 

As  a  diaphoretic  and  expectorant  small  doses  of  the  wine  of 
antimony  are  preferable,  repeated  every  two  or  three  hours. 

Ipecacuanha— Ipecacuanhae— Ipecac.  TJ.  S.  I*. 

Origin. — The  root  of  Cephiielis  Ipecacuanha  (Brotero)  A.  Rich- 
ard, a  plant  indigenous  in  the  damp  forests  of  Brazil,  New  Granada, 
and  the  northeastern  portion  of  Bolivia.  It  is  cultivated  to  some 
extent  in  India  and  Sikkim. 

According  to  the  National  Dispensatory,  "  The  drug  first  be- 
came known  in  Europe  in  1672,  and  a  few  years  after  was  success- 
fully employed  by  Helvetius,  a  Dutch  physician  living  in  Paris, 
from  whom  (1688)  Louis  XIV.  purchased  the  secret  for  1000  louis. 
d'or  and  made  it  public." 

Description  and  Properties. — The  older  roots  are  in  pieces  of 
2  to  6  inches  (5-15  Cm.)  in  length  and  about  \  inch  (4  Mm.)  thick,, 
mostly  simple,  contorted,  dull  grayish-brown  or  blackish,  finely 
wrinkled,  closely  and  irregularly  annulated  and  often  transversely 
fissured ;  bark  thick,  brittle,  brownish,  easily  separated  from  the 
thin,  whitish,  tough,  Hgneous  portion ;  odor  slight,  peculiar,  nau- 
seous; taste  bitterish,  acrid,  nauseating.  When  ipecac  is  sound 
and  free  from  mouldiness  its  quality  is  proportionate  to  the  thick- 
ness of  the  bark  and  the  thinness  of  the  Hgneous  portion. 

The  active  principle  of  ipecac  is  emetine,  of  which  there  is  present 
I  to  2  per  cent.  The  drug  also  contains  ipecacuanhic  or  cephaelic 
acid,  starch,  resin,  etc. 

Dose. — As  an  emetic,  15-30  grains  (i. 0-2.0  Gm.);  as  an  expec- 
torant, \-2  grains  (0.03-0.12  Gm.). 

Official  Preparations. 
Bxtractum  Ipecacuanhae   Fluidum— ExtrScti  IpecacuSnhse  Fluidi — Fluid 
Extract  of  Ipecacuanha. — Dose,  as  an  emetic,  15-30  minims  (0.2-0.5  Cc);  as  an 
expectorant,  ^5  minims  (0.03-0.3  Cc). 


EMETICS.  609 

Pillvis  IpecacuSnhse  et  Opii — Ptilveris  IpecacuSnhx  et  Opii — Powder  of 
Ipecac  and  Opium.     (See  Opium,  p.  428.) 

Syrupus  IpecacuSnhse — Sj^rupi  IpecacuSnhse — Syrup  of  Ipecac. — Formula : 
Fluid  Extract  of  Ipecac,  75;  Acetic  Acid,  10;  Glycerin,  100 ;  Sugar,  700;  Water,  to 
1000. — Dose,  as  an  emetic,  2-6  fluidrachms  (7.39-22.50  Cc.) ;  as  an  expectorant,  5-30 
minims  (0.3-2.0  Cc). 

Tinctura  Ipecacuanhas  et  Opii — Tinctiirae  IpecacuSnhse  et  Opii — Tincture 
of  Ipecac  and  Opium.     (See  Opium,  p.  428.) 

Trochlsci  IpecacuSnhse — Trochiscos  (ace.)  IpecacuSnhae — Troches  of  Ipe- 
cac.— Composition  :  Each  troche  contains  about  \  grain  (0.02  Gm.)  of  Ipecac,  together 
with  Tragacanth,  Sugar,  and  Oil  of  Orange. 

Dose. — I  to  6  troches. 

Trochlsci  Morphinae  et  IpecacuSnhse — Trochiscos  (ace.)  Morphinae  et  Ipe- 
cacuSnhse.     (See  Morphine,  p.  429.) 

Vinum  IpecacuSnhse — Vini  IpecacuSnhse — Wine  of  Ipecac  (10  per  cent.). — 
Dose,  1-60  minims  (0.06-4.0  Cc). 

Antagronists  and  Incompatibles. — The  gastric  sedatives  and 
narcotics  generally  hinder  the  emetic  properties  of  ipecac.  The  in- 
compatibles are  tannic  acid  and  vegetable  infusions  containing  it, 
metallic  salts,  and  caustic  alkalies. 

Sjmergists. — The  emetics,  sedative  expectorants,  warm  drinks, 
are  synergistic,  and  opium  aids  the  diaphoretic  properties  of  the 
drug. 

Physiological  Action. — Externally  and  Locally. — Ipecac  is  a 
powerful  irritant  to  the  mucous  membranes  of  the  respiratory  tract 
when  the  powdered  drug  is  inhaled.  The  prolonged  application 
of  ipecac  to  the  skin  occasions  much  irritation,  even  producing 
vesication,  pustulation,  and  ulceration.  Ipecac  also  possesses  some 
antiseptic  properties. 

Internally. — Digestive  System. — In  small  doses  ipecac  acts  as  a 
stimulant  to  the  stomach.  The  salivary  and  gastric  glands  are 
stimulated,  the  action  of  very  small  doses  of  the  drug  resembling 
that  of  vegetable  bitters. 

Large  doses  are  powerfully  irritant  and  emetic,  the  emesis  being 
the  result  of  both  a  local  irritation  upon  the  stomach  and  a  direct 
action  upon  the  vomiting  center  in  the  medulla.  The  vomiting  is 
preceded  by  and  attended  with  but  little  if  any  nausea,  although 
there  is  usually  a  marked  increase  in  the  secretion  of  bile  and  intes- 
tinal mucus,  full  doses  of  the  drug  acting  not  only  as  an  emetic, 
but  as  a  purgative  and  cholagogue. 

Circulatory  System. — Except  in  occasioning  the  ordinary  depres- 
sion incident  to  the  act  of  vomiting,  ipecac  in  moderate  a:mounts , 
has  no  influence  upon  the  heart.     Enormous  doses,  however,  par- 
39 


6lO  A    TEXT-BOOK  OF  MATERIA    MEDICA. 

ticularly  if  injected  into  the  jugular  vein,  have  destroyed  the  ufe 
of  dogs  by  cardiac  paralysis. 

Nervous  System. — Save  in  stimulating  that  portion  of  the  me- 
dulla oblongata  which  presides  over  the  act  of  vomiting,  and  a 
slight  diminution  of  the  reflex  activity  of  the  spinal  cord,  ipecac 
has  no  important  action  upon  the  nervous  system. 

Respiratory  System. — So  far  as  the  respiratory  movements  are 
concerned,  they  are  unaffected  by  moderate  doses  of  ipecac.  The 
bronchial  mucous  membrane  is  stimulated,  augmenting  the  se- 
cretion of  bronchial  mucus,  and  therefore  reflexly  stimulating 
coughing. 

Absorption  and  Elimination. — The  active  principle  of  ipecac  is 
rapidly  absorbed,  being  eliminated  chiefly  by  the  gastro-intestinal 
mucous  membrane,  although  the  other  secretions  share  in  the 
excretory  process,  the  skin  being  especially  affected  by  this  drug, 
which  acts  as  a  mild  diaphoretic. 

Temperature . — Under  medicinal  doses  the  temperature  is  un- 
changed.    Poisonous  doses  reduce  temperature. 

Untoward  Action. — Rarely,  in  persons  peculiarly  susceptible  to 
the  drug,  intense  cutaneous  irritation  and  conjunctival  inflammation, 
accompanied  by  neuralgia  of  the  face  and  scalp,  have  been  produced. 
Even  soiling  the  hand  with  a  few  drops  of  the  tincture  of  ipecac  has 
occasioned  unfavorable  results.  The  general  untoward  symptoms 
are  those  of  poisoning. 

Poisoning. — There  is  violent  vomiting  and  purging,  the  ejecta 
containing  bile  and  frequently  blood.  Among  the  graver  symp- 
toms are  abdominal  pain,  marked  cardiac  depression,  muscular 
weakness,  and  greatly  diminished  reflex  irritability.  The  skin  is 
cold  and  bathed  in  perspiration. 

Treatment  of  Poisoning. — Tannic  acid  should  be  given  as  the 
chemical  antidote.  Opium,  belladonna,  and  cardiac  stimulants  may 
be  necessary. 

Therapeutics. — Externally  and  Locally. — Troches  of  ipecac 
and  spray  inhalations  of  wine  of  ipecac  are  used  to  allay  the  cough 
and  expectoration  in  acute  bronchitis  and  obstinate  "  winter  cough!' 

Powdered  ipecac  has  been  successfully  employed  as  a  dressing 
in  anthrax,  the  drug  being  capable  of  destroying  the  anthrax 
bacilli,  although  having  no  effect  on  the  spores. 

Internally. — Ipecac  in  proper  doses  is  a  very  efficient  emetic, 
and  is  frequently  employed  as  such,  particularly  when  it  is  desir- 
able through  the  act  of  vomiting  to  empty  the  air-passages,  as  in 


EMETICS.  6 11 

croup,  bronchitis,  tracheitis,  and  the  early  stages  of  diphtheria.  The 
action  of  the  drug  is  so  tardy,  however,  that  it  is  not  the  most  de- 
sirable emetic  to  use  when  it  is  necessary  to  empty  the  stomach 
quickly,  as  in  cases  of  poisoning. 

When  the  stomach  contains  a  quantity  of  undigested  food, 
causing  pain,  headache,  etc.,  ipecac  is  a  valuable  emetic  to  empty 
the  stomach,  since  the  drug  occasions  no  marked  nausea  or  de- 
pression. 

Paradoxical  as  it  may  seem,  minute  doses  of  ipecac,  such  as  i 
to  4  minims  (0.06-0.2  Cc.)  of  the  wine  or  -j^jj-  to  J  grain  (0.006-0.01 
Gm,)  of  the  powdered  drug,  act  as  an  efficient  gastric  sedative 
and  stomachic,  frequently  arresting  vomiting  when  other  drugs  have 
failed.  The  statement,  however,  that  minim  doses  of  the  wine  of 
ipecac  allay  the  nausea  and  vomiting  of  pregnancy  is  probably 
apocryphal. 

Ipecac  in  small  doses  is  an  excellent  adjuvant  to  other  chola- 
gogues  to  relieve  the  distress  of  hepatic  dyspepsia.  The  drug  is 
equally  advantageous  in  atonic  dyspepsia,  attended  with  flatulence, 
depression  of  spirits,  etc. 

The  notoriety  and  pecuniary  profit  which  Helvetius  secured  in 
connection  with  ipecac — or  Radix  antidysenterica,  as  it  was  origi- 
nally named  by  its  propagator — were  due  to  its  apparent  specific 
action  in  dysentery. 

The  drug  is  peculiarly  efficient  in  dysentery  of  a  bilious  type, 
acute  dysentery  other  than  bilious  yielding  less  readily  to  the  rem- 
edy. It  is  true  that  in  these  last-named  cases  ipecac  and  opium 
have  been  advantageously  employed,  though  it  is  probable  that  the 
opium  had  the  larger  influence  in  modifying  the  course  of  the  dis- 
ease. Whatever  the  form  of  dysenteric  attack  may  be,  ipecac  is 
the  more  efficient  the  earlier  it  is  administered. 

The  drug,  in  order  to  exert  any  beneficial  influence  in  bilious 
dysentery,  must  be  given  in  large  doses — 60  to  90  grains  (3.88- 
5.83  Gm.)in  a  single  dose  or  20  grains  (1.29  Gm.)  every  four  hours. 
These  doses  of  course  will  at  first  produce  emesis,  but  the  repeti- 
tion of  them  tends  to  establish  a  tolerance  of  the  remedy,  an  early 
attainment  of  which  is  most  desirable. 

Various  methods  have  been  employed  to  aid  the  stomach  in 
retaining  the  drug,  such  as  the  administration  of  opium  or  other 
gastric  sedative,  a  sinapism  placed  upon  the  epigastrium,  etc. 

Ipecac  has  been  highly  recommended  in  infantile  diarrhea.  It 
has  been  successfully  employed  in  hematemesis  and  uterine  hemor- 


6i2  A    TEXT-BOOK  OF  MATER/A   MEDICA. 

rhage,  it  being  customary  in  the  former  complaint  to  give  at  first, 
an  emetic  dose,  succeeded  by  smaller  and  nauseating   amounts. 

Like  other  emetics,  ipecac  has  proved  efficient  in  expediting 
labor  by  relieving  rigidity  of  the  os  uteri. 

The  drug  has  been  found  beneficial  in  relieving  hemoptysis,  and 
it  is  of  unquestioned  value  in  many  affections  of  the  lungs  and 
bronchial  tubes.  In  pneumonia,  particularly  in  the  congestive  and 
declining  stages  of  the  disease,  it'  has  proved  serviceable. 

In  bronchitis  and  phthisis,  especially  when  the  secretion  is  scanty, 
and  in  chronic  bronchitis  with  much  cough  and  but  a  moderate 
amount  of  expectoration,  ipecac  is  a  valuable  remedy.  It  has  been 
found  valuable  in  spasmodic  asthma. 

Ipecac  is  an  important  adjuvant  to  quinine  in  the  treatment  of 
remittent  and  intermittent  fevers,  the  latter  disease  having  been 
cured,  it  is  claimed,  by  ipecac  alone  in  doses  of  i  or  2  grains 
(o.o6k3.I2   Gm.),  given  every  three  or  four  hours. 

Contraindioations. — Ipecac  is  not  permissible  for  patients  suf- 
fering from  aneurysm,  hernia,  prolapse  of  uterus  or  rectum,  etc.. 

Administration. — The  drug  is  notoriously  uncertain  in  its 
action,  probably  because  of  the  variation  in  the  percentage  of  eme- 
tine, the  freshly  powdered  root  being  ordinarily  more  reliable. 

For  purposes  of  emesis  the  freshly  powdered  root  is  preferable,, 
to  be  taken  with  plenty  of  warm  water.  An  infusion  or  decoction 
is  frequently  employed  to  produce  emesis. 

As  a  diaphoretic  the  powder  is  also  preferable,  though  in  any; 
case  the  fluid  extract  may  be  substituted  for  the  powdered  form. 
As  an  expectorant  the  syrup  and  wine  are  the  preparations  usually 
employed. 

Children  are  very  tolerant  of  ipecac,  the  syrup  being  the  prepa- 
ration usually  given  to  them. 

Emetine,  though  not  official,  is  an  important  remedy,  and  may 
be  administered  as  an  emetic  in  doses  of  j^  to  :|^  grain  (0.005-0.01 
Gm.),  and  in  correspondingly  small  doses  when  a  diaphoretic  or 
expectorant  action  is  desired. 

Lobelia— Lobeliae— Lobelia.    TJ.  S.  P. 

(Indian  Tobacco.) 

Origin. — The  leaves  and  tops  of  Lobelia  inflata  L.,  collected 
after  a  portion  of  the  capsules  have  become  inflated.  The  plant 
is  indigenous  in  the  United  States. 

Description  and  Properties. — As    it   appears  in  the    market 


emetics:  613 

lobelia  consists  of  fragments  of  green  leaves,  stems,  rather  elon- 
:gated  dried  flowers,  and  portions  of  the  membranous  capsules. 
The  odor  is  very  irritating,  and  the  taste  pungent  and  persistently- 
acrid.  The  plant  contains  a  yellowish  acrid  liquid  alkaloid,  lobeline, 
besides  lobelic  acid,  lobelacrin,  resin,  fixed  oil,  gum,  etc. 
Dose. — i-io  grains  (0.065-0.6  Gm.). 

Official  Preparations. 

ExtrSctum  Lobelise  Fluidum — ExtrScti  Lobelise  Fluidi — Fluid  Extract  of 
Lobelia. — Dose,  1-5  minims  (0.06-0.3  Cc). 

Tinctiira  Lobelise — Tinctiirae  Lobelise — Tincture  of  Lobelia  (20  per  cent.). 
— Dose,  8-15  minims  (0.5-1.0  Cc). 

Antagonists  and  Incompatibles. — The  effects  of  lobelia  on  the 
circulatory  system  are  antagonized  by  the  cardiac  stimulants ;  its 
influence  on  the  nervous  system  is  counteracted  by  strychnine  and 
other  motor  excitants.    The  incompatibles  are  all  caustic  alkalies. 

Synergists. — The  motor  depressants  and  emetics  enhance  the 
effects  of  lobelia. 

Physiological  Action. — Externally  and  Locally. — Although  the 
drug  is  readily  absorbed  through  the  skin,  there  is  no  action  of 
importance. 

Internally. — Digestive  System. — Lobelia  produces  symptoms 
similar  to  those  of  ipecac,  save  that  lobelia  is  more  powerful,  occa- 
sioning more  distressing  nausea  and  intense  prostration. 

Circulatory  System. — Lobelia  is  a  powerful  cardiac  depressant, 
its  action  being  due  both  to  direct  depression  of  the  heart  and 
paralysis  of  the  vaso-motor  centers.  Under  poisonous  doses  the 
heart  stops  in  diastole. 

Nervous  System. — Full  doses  depress  the  motor  centers  of  the 
spinal  cord.  Poisonous  doses  are  necessary  to  afiect  the  higher 
cerebral  centers,  when  coma  and  convulsions  are  produced.  The 
muscles  and  nerves  themselves  are  unaffected  by  lobelia. 

Respiratory  System. — The  muscular  coats  of  the  bronchi  are 
relaxed  by  the  drug.  The  respiration  is  slowed  even  by  small 
■doses.  Large  or  toxic  doses  profoundly  depress  the  respiratory 
center,  death  resulting  from  respiratory  failure. 
.  Absorption  and  Elimination. — The  active  principle  of  lobelia  is 
readily  absorbed,  and  is  excreted  chiefly  by  the  kidneys  and 
skin,  the  drug  acting  as  a  diuretic  and  diaphoretic.  Under  emetic 
doses  much  of  the  drug  is  eliminated  by  way  of  the  stomach  and 
intestines. 


6i4  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Temperature. — Full  doses  lower  the  temperature. 
■     Untoward  Action. — Does  not  differ  essentially  from  the  effects 
of  poisoning. 

Poisoning. — The  symptoms  include — violent  vomiting  and 
purging,  a  very  weak  and  irregular  pulse,  an  anxious,  livid  coun- 
tenance, skin  cold  and  bathed  in  perspiration,  respiration  slow  and 
very  feeble,  contracted  pupils,  and  possibly  coma  or  convulsions 
preceding  death,  which  occurs  from  respiratory  failure. 

Treatment  of  Poisoning. — The  symptoms  should  be  counter- 
acted by  cardiac  and  respiratory  stimulants,  employing  such  drugs 
as  atropine,  strychnine,  alcohol,  ammonia,  etc.,  hypodermically. 

Therapeutics. — Externally  and  Locally. — None. 

Internally. — While  formerly  lobelia  was  used  extensively  as  an 
emetic,  at  the  present  day,  owing  to  the  intense  nausea  and  great 
depression  occasioned  by  the  drug,  it  has  been  practically  sup- 
planted by  other  less  dangerous  emetics. 

Its  principal  use  nowadays  is  as  a  remedy  in  spasmodic  asthma 
and  as  an  expectorant  in  certain  cases  of  bronchitis. 

Contraindications. — The  same  as  for  emetics  in  general. 

Administration. — The  powder,  fluid  extract,  or  tincture  may 
be  used.  The  taste  of  the  fluid  preparations  may  be  agreeably 
disguised  by  aromatic  elixir  or  aromatic  elixir  of  liquorice. 


GROUP  XII.— EXPECTORANTS. 

Expectorants  are  drugs  which  stimulate,  depress,  or  modify 
the  secretion  from  the  bronchial  or  laryngeal  membrane  and  pro- 
mote its  expulsion. 

There  are  many  drugs  not  classed  as  expectorants  which,  under 
certain  conditions,  may  be  used  to  serve  one  of  these  purposes. 
Thus,  opium  and  chloral,  by  the  depressing  influence  which  they 
exert  upon  the  respiratory  center  and  the  reflex  mechanism,  may 
relieve  reflex  and  purposeless  cough,  or,  as  is  the  case  with  the 
former  drug,  check  excessive  secretion  or  render  it  more  viscid. 

Demulcents,  such  as  gum  acacia,  flaxseed,  elm,  etc.,  and  other 
drugs  like  potassium  chlorate,  sodium  chloride,  etc.,  either  lessen 
or  excite  the  tracheal  and  bronchial  cilia,  retarding  or  promot- 
ing expectoration  of  bronchial  mucus.  The  classification  usually 
adopted  seems  to  be  the  most  reasonable — viz.  that  of  dividing 
expectorants  into  two  classes:  i.  Nauseant  or  Sedative.  2.  Stim- 
ulating. 


EXPECTORANTS.  615 

Among  the  more  important  Nauseant  or  Sedative  Expectorants 
are — 

Alkalies ;  Ipecacuanha ; 

Antimony  and  Potassium  Tar-      Lobelia; 

trate  (Tartar  Emetic) ;  Pilocarpus  ; 

Apomorphine ;  Potassium  Iodide ; 

Grindelia ;  Quebracho ; 

all  of  which  are  considered  in  detail  elsewhere. 
The  important  Stimulating  Expectorants  are — 

*  Acids ;  Oil  of  Scotch  Fir  (Oleum  Pini 

*  Ammonium  Carbonate;  Sylvestris); 
Ammonium  Chloride ;                    Oleum  Pini  Pumilionis ; 

*  Balsam  of  Peru ;  Onion ; 

Balsam  of  Tolu  ;  Saccharine  Substances ; 

*  Benzoin  and  Benzoic  Acid ;  Senega  (Saponin) ; 

*  Copaiba ;  *  Sulphur ; 

*  Cubeb ;  *  Squill ; 
Garlic ;  Tar ; 
Liquorice ;  Terebene ; 

*  Nux  Vomica  Terpin  Hydrate ; 

(Strychnine) ;  *  Turpentine. 

(Those  marked  with  an  asterisk  (*)  are  elsewhere  given  in  detail.) 

As  a  rule,  Sedative  Expectorants  are  permissible  only  in  acute 
stages  of  bronchitis,  when,  as  is  the  case  in  the  beginning  of  all  in- 
flammations, there  is  complete  or  partial  suspension  of  function, 
absence  of  secretion,  and  much  irritation  in  the  bronchi,  with  dis- 
tressing, harsh,  and  dry  cough. 

In  these  conditions  of  the  respiratory  passages  the  nauseating 
sedative  expectorants  serve  a  useful  purpose  in  lowering  arterial 
tension,  lessening  the  blood-supply  to  the  inflamed  parts,  and 
increasing  the  secretion  of  mucus. 

In  sufficiently  large  doses  to  produce  emesis  the  same  expecto- 
rants are  frequently  employed  to  expel  an  accumulation  of  mucus 
mechanically  by  the  act  of  vomiting. 

Stimulating  expectorants  are  more  serviceable  in  chronic  and 
relaxed  conditions  of  the  mucous  mernbrane.  They  are  usually 
employed  to  diminish  or  disinfect  an  abnormally  increased  secre- 
tion. These  remedies  generally  increase  blood-pressure  and  facili- 
tate expectoration,  being  eliminated  to  a  great  extent  by  the 
mucous  membranes  which  they  stimulate. 


6l6  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

The  alkalies  are  especially  useful  in  lessening  the  viscidity  of 
mucus,  rendering  it  more  fluid,  less  tenacious,  and  therefore  more 
easily  expelled. 

It  requires  considerable  skill  to  combine  expectorants  so  as  to 
best  suit  the  various  conditions  found  in  practice.  The  diseases  of 
the  respiratory  passages  gradually  merge,  so  that  in  the  treatment 
of  them  it  is  often  difficult  to  decide  which  remedy  will  be  of  more 
service,  a  sedative  or  a  stimulant  expectorant.  The  physician 
should  carefully  examine  each  individual  case  and  decide  whether 
he  wishes  to  diminish  or  increase  the  blood-supply  to  the  respira- 
tory tract ;  to  stimulate  or  depress  the  respirations ;  to  overcome 
spasm  of  the  bronchial  muscles ;  to  diminish,  increase,  or  disinfect 
the  bronchial  secretion. 

A  thorough  knowledge  of  the  patient's  condition  and  of  the 
physiological  action  of  the  various  remedies  at  command  will 
enable  the  observant  practitioner  to  combine  expectorants  in  such 
manner  as  to  yield  ordinarily  highly  satisfactory  results. 

Ammonii    Chloridum— Ammonii    Chloridi — Ammo- 
nium Chloride.    JJ.  S.  -P. 

Origin. — Ammonium  sulphate  is  first  formed  by  neutralizing 
Gas  Liquor  with  Sulphuric  Acid.  After  crystallization  sublime 
with  Sodium  Chloride. 

Description  and  Properties. — A  white,  crystalline  powder, 
without  odor,  having  a  cooling,  saline  taste,  and  permanent  in  the 
air.     Soluble  in  3  parts  of  water ;  almost  insoluble  in  alcohol. 

Dose. — 1-30  grains  (0.06-2.0  Gm.). 

Official  Preparation. 

Trochlsci  Ammonii  Chloridi — TrocWscos  (ace.)  Ammonii  Chloridi— 
Troches  of  Ammonium  Chloride. — Each  troche  contains  2  grains  (0.12  Gm.). — 
Dose,  I  to  6  troches. 

Antagonists  and  Inoompatibles. — Therapeutically,  ammonium 
chloride  is  antagonized  by  the  cardiac  depressants.  The  incom- 
patibles  are — alkalies,  alkaline  earths  and  their  carbonates,  tartaric 
acid,  mineral  acids,  and  the  soluble  lead  and  silver  salts. 

Synergists. — The  expectorants,  emetics,  and  diaphoretics  en- 
hance the  action  of  the  drug. 

Physiological  Action. — Externally  and  Locally. — Ammonium 
chloride  is  irritant  and  resolvent. 


EXPECTORANTS.  617 

Internally. — In  medicinal  doses  the  drug  increases  the  secretions 
from  the  gastro-intestinal  glands,  acting  as  a  cholagogue.  The 
■solid  constituents  of  the  blood  are  diminished.  The  drug  appears 
to  have  a  special  action  upon  the  mucous  membranes,  augmenting 
their  normal  secretions  and  promoting  nutritive  changes  and 
epithelial  exfoliation. 

Ammonium  chloride  is  readily  absorbed,  and  is  eliminated  by 
the  kidneys,  skin,  bronchi,  and  mucous  membranes  generally,  the 
drug  being  a  feeble  diuretic,  diaphoretic,  and  expectorant 

Save  uric  acid,  which  is  slightly  diminished,  all  the  solids  of  the 
urine  are  increased  under  the  use  of  ammonium  chloride.  The 
drug  is  not  considered  poisonous. 

Therapeutics. — Externally  and  Locally. — Ammonium  chloride 
possesses  a  wide  range  of  therapeutic  applications.  Solutions  of 
various  strengths  have  proved  markedly  efficient  as  local  applica- 
tions in  indolent  buboes,  epididymitis,  orchitis,  bruises,  inflammatory 
swellings,  suppurative  mastitis,  etc.  Senile  gangrene  is  much  bene- 
'fited  by  immersing  the  foot  in  a  bath  containing  8  ounces  (249.0 
Gm.)  of  the  drug. 

A  solution  of  3  drachms  (12.0  Gm.)  of  ammonium  chloride  to 
I  pint  (473.17  Cc.)  of  water  is  an  efficient  remedy  in  vaginitis. 
The  lotion  may  be  used  as  an  injection  or  a  tampon  saturated  with 
the  fluid  and  applied  to  the  parts. 

Lozenges,  solutions,  or  the  nascent  fumes  of  the  drug  have 
been  found  serviceable  in  many  diseases  of  the  nose,  throat,  and 
ear,  such  as  corysa,  chronic  laryngitis  and  pharyngitis,  chronic  aural 
catarrh,  etc. 

Internally. — Few  remedies  are  more  efficient  than  ammonium 
CHLORIDE  in  bronchitis  that  has  passed  its  inflammatory  stage.  In 
chronic  bronchitis,  particularly  that  form  occurring  in  old  people 
and  persons  of  a  feeble  habit  of  body,  the  drug  is  very  valuable, 
either  given  alone  or  associated  with  stimulant  expectorants.  The 
remedy  has  appeared  to  be  somewhat  beneficial  in  whooping  cough. 

Ammonium  chloride  has  been  employed  in  intermittent  fever  z.x\A 
■  to  promote  the  eruption  in  the  exanthematous  fevers.  It  is  certainly 
of  great  utility  in  goiter,  and  has  proved  beneficial  in  amenorrhea 
and  dysmenorrhea.  The  drug  is  considered  an  efficient  remedy  in 
glandular  enlargements,  as  in  those  of  the  prostate,  liver,  etc.  It 
assuredly  stimulates  the  functional  activity  of  the  liver  and  is  fre- 
quently given  as  a  cholagogue. 

Ammonium    chloride    usually  exerts    a  prompt  and    salutary 


6l8  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

action  in  neuralgias,  particularly  the  neuralgia  affecting  the  fifth 
pair,  the  intercostal  nerves,  and  the  sciatic  nerve.  The  remedy  has 
been  also  advantageously  employed  in  myalgia  and  chronic  mus- 
cular rheumatism. ' 

Contraindications. — Inflammation  of  the  stomach,  aggravated 
dyspepsia,  marked  emaciation,  and  anemia  contraindicate  the  drug. 

Administration. — Ammonium  chloride  is  best  given  in  solution, 
its  disagreeable  taste  being  wrell  disguised  by  the  addition  of  some 
preparation  of  liquorice,  such  as  the  syrup,  fluid  extract,  or  the 
aromatic  elixir  of  liquorice.  In  bronchial  diseases  the  virtues  of 
the  drug  are  enhanced  by  this  association. 

Balsamum  Tolutanum— Balsami  Tolutani— Balsam 
of  Tolu.    TJ.  S.  I*. 

Origin.^ — A  balsam  obtained  from  Toluifera  Balsamum  L.,  an 
evergreen  tree  from  60  to  80  feet  (18-24  M.)  high,  growing  in  the 
high,  rolling  country  of  Venezuela  and  New  Granada. 

Description  and  Properties. — A  yellowish-brown,  semi-fluid, 
or  nearly  solid  mass,  becoming  more  brittle  when  exposed  to  cold ; 
transparent  in  thin  layers,  having  an  agreeable  odor,  recalling  that 
of  vanilla,  but  distinct  from  it,  and  a  mild,  aromatic  taste ;  readily 
and  completely  soluble  in  alcohol,  chloroform,  and  solutions  of  the 
fixed  alkalies ;  almost  wholly  soluble  in  ether,  but  nearly  insoluble 
in  water  or  carbon  disulphide. 

The  drug  contains  a  volatile  oil  (chiefly  toluene),  cinnamic  and 
benzoic  acids,  and  a  resin. 

Dose. — 8-30  minims  (0.5-2.0  Cc). 

Official  Preparations. 

Syrupus  Tolutanus— Syrupi  Tolutani— Syrup  of  Tolu  (l  per  cent.).— Z»ow, 
2-6  fluidrachms  (8-24  Cc). 

Tinctura  Tolutana— Tincturae  Tolutanse— Tincture  of  Tolu  (10  per  cent.). 
— Dose,  Yi-z  fluidrachms  (2-8  Cc). 

Tinctura  Benzolni  Coinp6sita— Tincturae  Benzoini  CompSsitae— Compound 
Tincture  of  Benzoin  (4  per  cent.).— Described  under  Benzoin. 

Antagonists  and  Incompatibles. — Aqueous  preparations  are 
pharmaceutically  incompatible  with  the  tincture  of  tolu. 

Synergists. — The  balsams,  aromatic  drugs,  volatile  oils,  and 
stimulant  expectorants. 

Physiological  Action. — Balsam  of  tolu  is  antiseptic,  disinfec- 
tant, and  stimulant  when  applied  to  the  skin  and  to  raw  surfaces. 
It  is  a  pleasant  carminative  and  stomachic. 


EXPECTORANTS.  619 

The  drug  is  excreted  principally  by  the  mucous  membranes, 
the  secretions  from  which  it  stimulates  and  disinfects.  The  skin 
and  kidneys  also  share  in  the  excretory  process. 

Therapeutics. — Inhalations  of  the  vapor  of  tolu  have  been  suc- 
cessfully employed  in  the  treatment  of  chronic  pharyngitis,  and  a 
pigment  composed  of  i  part  of  tolu  to  5  parts  of  ether  or  alcohol 
has  been  beneficially  applied  to  diphtheritic  deposits  on  the  tonsils 
and  pharynx. 

Its  agreeable  flavor,  together  with  its  stimulating  and  expector- 
ant properties,  renders  tolu  an  efficient  and  eligible  ingredient  of 
cough  mixtures,  lozenges,  vapors,  etc.  employed  to  modify  the 
course  of  subacute  and  chronic  bronchitis. 

Administration. — Tolu  is  usually  administered  in  the  form  of 
syrup,  although  the  tincture  may  be  given  in  emulsion.  Inhala- 
tions of  tolu  vapor  are  employed  and  lozenges  containing  tolu  are 
frequently  used. 

Allium— Allii— Garlic.    V.  S.  JP. 

Origin, — The  bulb  of  Allium  sativum  L.,  a  bulbous  plant  indig- 
enous in  Central  Asia  and  the  basin  of  the  Mediterranean,  and 
cultivated  for  culinary  purposes  in   Europe  and  North  America. 

Description  and  Properties. — Bulb  subglobular,  compound, 
consisting  of  about  eight  compressed,  wedge-shaped  bulblets, 
arranged  in  a  circle  about  the  base  of  the  stem  and  covered  by 
several  dry,  membranaceous  scales.  Odor  pungent  and  disagree- 
able ;  taste  warm  and  acrid.  Garlic  should  be  used  without  having 
been  dried. 

The  drug  contains  about  \  per  cent,  of  a  volatile  oil,  to  which 
its  odor  and  taste  are  due. 

Dose,  of  bruised  or  chopped  garlic  or  of  the  expressed  juice, 
about  30  grains  (2.0  Gm.). 

Official  Preparation. 
Syrupus  Allii— Syrupi  Allii— Syrup  of  GaxWxi.—Dose,  1-2  fluidrachms  {4.0- 
8.0  Cc). 

Allied  species. 
Allium  Cepa  L.— Allii  Cepse— Onion. 

Physiological  Action. — Both  garlic  and  onion  are  stimulants 
to  the  part  to  which  they  are  directly  applied,  garlic  being  the 
stronger  of  the  two. 


620  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Internally  they  are  carminative  and  stomachic,  and  are  used  as 
condiments  and  as  foods.  Like  all  substances  which  stimulate  the 
digestive  apparatus,  in  excessive  amounts  they  may  occasion  nausea, 
-vomiting,  colic,  and  diarrhea. 

The  active  constituents  of  these  drugs  are  eliminated  by  the 
mucous  membranes,  skin,  kidneys,  and  respiratory  tract.  The 
taste  and  odor  of  the  drugs  are  imparted  to  the  milk  of  nursing 
women.  Both  garlic  and  onion  are  rapidly  absorbed  and  about  as 
quickly  eliminated. 

Therapeutics. — An  onion  poultice  is  a  valuable  domestic  rem- 
edy for  chronic  or  acute  bronchitis  in  children,  abscesses,  and  to 
relieve  strangury  when  applied  to  the  perineum,  in  which  case  it 
proves  to  be  singularly  efficient. 

The  core  of  a  roasted  onion  is  said  to  quickly  relieve  earache 
when  inserted  in  the  auditory  canal. 

Syrup  of  garlic  or  onion  is  an  invaluable  expectorant  in  chronic 
catarrhs  of  the  respiratory  passages  in  children  and  infants,  and  is 
quite  an  efficient  remedy  in  the  decline  of  whooping  cough. 

A  synthetical  substance  known  as  Allyl  Tribromide  (Tribrom- 
hydrin),  closely  allied  to  oil  of  garlic,  has  been  highly  recommended 
in  spasmodic  asthma,  infantile  convulsions,  hysteria,  angina  pectoris, 
and  other  spasmodic  disorders.  It  should  be  administered  in  cap- 
sules in  doses  of  from  i  to  5  minims  (0.06-0.3  Cc). 

Administration. — When  garlic  or  onion  is  used  for  poultices,  it 
should  be  boiled. 

Internally,  the  expressed  juice  made  into  a  syrup  with  sugar  or 
the  official  syrup  of  garlic  is  the  form  in  which  these  drugs  are 
usually  given. 

GlycyrrhTza— Glycyrrhlzae— Glycyrrhiza.    V.  S.  P. 

(Liquorice  Root.) 

Origin. — The  root  of  Glycyrrhiza  glabra  L.  and  of  the  variety 
glandulifera  (Waldstein  et  Killaibel)  Regel  et  Herder,  a  perennial 
plant  indigenous  in  the  countries  lying  on  the  northern  and  south- 
ern shores  of  the  Mediterranean  and  farther  east  through  the  Cau- 
casus, Northern  Persia,  Afghanistan,  and  Southern  Siberia  to  China, 
and  cultivated  to  some  extent  in  England,  France,  Germany,  and 
the  United  States. 

Description  and  Properties. — In  long,  cylindrical  pieces  from 
\  to  I  inch  (6-25  Mm.)  thick,  longitudinally  wrinkled,  externally 
grayish-brown,  warty ;    internally  tawny  yellow,  pliable,   tough ; 


EXPECTORANTS.  621 

fracture  coarsely  fibrous ;  bark  rather  thick ;  wood  porous,  but 
dense  in  the  narrow  wedges ;  medullary  rays  linear ;  taste  sweet, 
somewhat  acrid.  The  underground  stem,  which  is  often  present, 
has  the  same  appearance,  but  contains  a  thin  pith. 

The  drug  derived  from  the  variety  glandulifera  (so-called  Rus- 
sian liquorice)  consists  usually  of  roots  or  root-branches  i  to  4 
inches  (2-10  Cm.)  thick  and  8  to  12  inches  (15-30  Cm.)  long,  fre- 
quently deprived  of  the  corky  layer,  the  wood  rather  soft  and 
usually  more  or  less  cleft. 

Liquorice  contains  a  glucoside,  glycyrrhizin,  besides  asparagin, 
glycyramarin,  an  acrid  resin,  starch,  etc. 

Dose. — 15-60  grains  (1-4  Gm.). 

Official  Preparations. 

Extr^ctutn  Glycyrrhizae  Fluidum — ExtrScti  Glycyrrhizse  Fluidi — Fluid 
Extract  of  Glycyrrhiza. — Dose,  1 5-60  minims  (1.0-4.0  Cc). 

ExtrSctum  Glycyrrhizae — ExtrScti  Glycyrrhizae — Extract  of  Glycyrrhiza. — 
Dose,  freely.  (Extract  of  Glycyrrhiza  is  contained  in  Trochisci  Ammonii  Chloridi  and 
Trochisci  Glycyrrhizae  et  Opii.) 

ExtrSctum  Glycyrrhizae  Purum — ExtrScti  Glycyrrhizae  Pfiri — Pure  Extract 
of  Glycyrrhiza. — Dose,  freely. 

Glycyrrhizinum  Ammoniatum — Glycyrrhizini  Ammoniati — Ammoniated 
Glycyrrhizin. — Description  and  Properties. — Dark-brown  or  brownish-red  scales,  with- 
out odor  and  having  a  very  sweet  taste ;  readily  soluble  in  water  and  in  alcohol. 

Dose. — 5-15  grains  (0.3-1.0  Gm.). 

Mistura  Glycyrrhizae  Compdsita — Mistiirae  Glycyrrhizae  Compdsitae — Com- 
pound Mixture  of  Glycyrrhiza  (Brown  Mixture). — Formula:  Pure  Extract  of 
Glycyrrhiza,  30;  Sugar,  50;  Mucilage  of  Acacia,  100 ;  Camphorated  Tincture  of  Opium, 
120;  Wine  of  Antimony,  60;  Spirit  of  Nitrous  Ether,  30;  Water,  to  looo. 

Dose. — 1-4  fluidrachms  (4.0-15.0  Cc). 

Ptilvis  Glycyrrhizae  Compfisitus — Ptllveris  Glycyrrhizae  Compdsiti — Com- 
pound Povyder  of  Glycyrrhiza.     (See  Senna,  p.  681.) 

Besides  the  foregoing  compounds,  glycyrrhiza  forms  a  more  or 
less  important  ingredient  of  eleven  other  official  preparations. 

Physiological  Action  and  Therapeutics. — The  drug  when 
chewed  increases  the  flow  of  saliva.  It  is  demulcent  and  laxative, 
and  possesses  slight  stimulating  properties  when  locally  applied. 
It  favors  the  secretions  of  the  congested  mucous  membrane  of  the 
respiratory  passages. 

Liquorice  is  used  chiefly  for  its  demulcent  properties  in  sore 
throat,  hoarseness,  pharyngeal  cough,  acute  bronchitis,  etc.  An  in- 
fusion of  the  root  is  an  agreeable  and  useful  drink  in  febrile 
catarrhal  affections  and  in  irritative  disorders  of  the  bowels  and 
urinary  organs  attended  with  fever  and  great  thirst. 


622  A    TEXT-BOOK  OF  MA  TERIA  MEDIC  A. 

The  various  preparations  of  liquorice  are  serviceable  in  conceal- 
ing the  taste  of  nauseous  and  bitter  medicines  and  as  an  excipient 
for  pills. 

Administration. — There  are  no  special  directions  to  be  given — 
any  of  the  preparations  may  be  used. 

Oleum  Plni  Sylv6stris — Olei  Pini  SylvSstri — Oil  of  Scotch  Fir  (unofiScial).— 
Origin,  Description,  and  Properties. — A  volatile  oil  distilled  from  the  leaves  of  Pinus 
Sylvestris,  colorless,  fragrant.  Used  by  inhalation  or  locally.  The  drug  is  used  in 
various  sprays  and  inhalations  in  nasal  catarrh,  acute  coryza,  and  many  diseases  of  the 
respiratory  passages. 

Oleum  Templmum — OleiTemplIni — Oil  of  Pine  (unofficial). — Origin,  Descrip- 
tion, and  Properties, — A  volatile  oil  distilled  from  the  shoots  of  Pinus  Pumilio.  A  col- 
orless or  yellovifish-green  oil,  of  an  agreeable,  somevchat  terebinthinate  odor. 

Oleum  Templinum  is  used  in  the  same  manner  and  for  the  same  purposes  as  Oil  of 
Scotch  Fir. 

Pix  LTquida— PTcis  LTquidae— Tar.    U.  S.  I*. 

Origin. — An  empyreumatic  oleoresin  obtained  by  the  destructive 
distillation  of  the  wood  of  Pinus  palustris  Miller,  and  other  species 
of  Pinus. 

Description  and  Properties. — Thick,  viscid,  semi-fluid,  black- 
ish-brown, heavier  than  water,  transparent  in  thin  layers,  becoming 
granular  and  opaque  with  age ;  odor  empyreumatic,  terebinthinate ; 
taste  sharp,  empyreumatic.  Tar  is  slightly  soluble  in  water;  solu- 
ble in  alcohol,  fixed  and  volatile  oils,  and  solution  of  potassium  or 
sodium  hydrate. 

The  drug  contains  many  substances,  chief  among  which  are  an 
empyreumatic,  volatile  oil,  pyrocatechin,  acetone,  xylol,  toluol, 
cresols  (creasote),  guaiacol,  phenol,  etc. 

Dose. — 15-60  grains  (1-4  Gm.). 

Official  Preparations. 

Syrupus  PIcis  Liquids — Syrupi  PIcis  Liquidse — Syrup  of  Tar  (7.5  percent.). 
— Dose,  1-4  fluidrachms  (4.0-15.0  Cc). 

UnguSntum  PIcis  Liquids — Ungufinti  Picis  Liquids — Tar  Ointment  (50 
per  cent.). — Used  externally. 

Oleum  Picis  Liquids — Olei  Picis  Liquids — Oil  of  Tar.  U.  S.  P. — Origin. 
— A  volatile  oil  distilled  from  tar. 

Description  and  Properties. — An  almost  colorless  liquid  when  freshly  distilled,  but 
soon  acquiring  a  dark  reddish-brown  color  and  having  a  strong  tarry  odor  and  taste.  It 
is  readily  soluble  in  alcohol. — Dose,  1-5  minims  (0.065-0.3  Cc). 

Unofficial  Preparations. 

Squa  Picis  Liquids — Aqus  Picis  Liquids — Tar  Water. — Dose,  i  pint 
(473.17  Cc.)  in  the  course  of  a  day. 


EXPECTORANTS.  633 

Glyceritum  Picis  Liquids — Glyceriti  PIcis  Llquidse— Glycerite  of  Tar.— 

Dose,  J-2  fluidrachtns  (2.0-8.0  Cc). 

Vinurri  Picis  (N.  F.) — Vini  Picis— Wine  of  Tar  (a  saturated  solution  in  sherry 
wine). — Dose,  1-4  fluidrachms  (4.0-15.0  Cc). 

Derivatives  and  Allied  Drugs. 

Lysol. — Prepared  by  the  action  of  alkalies  on  tar-oils  and  fats.  A  brownish,  oily 
liquid  with  a  feeble,  aromatic  creasote-like  odor,  containing  50  per  cent,  of  cresols  and 
readily  niiscible  with  water.     Used  as  a  disinfectant  and  antiseptic. 

Pixol. — A  compound  of  tar  soap  and  caustic  potash  or  soda.  Used  as  a  disinfec- 
tant and  antiseptic. 

Pix  BStuls — Picis  BStulae — Birch  Tar  (Oleum  Rusci). —  Origin. — Prepared 
in  Russia  from  the  wood  and  bark  of  Betula  alba  L. 

Description  and  Properties. — Resembling  wood-tar  in  appearance,  but  remaining 
liquid,  and  having  the  peculiar,  penetrating  odor  of  Russia  leather,  in  the  manufacture 
of  which  it  is  used.     For  the  most  part  employed  externally. 

Oleum  Cadinum — Olei  Cadini — Oil  of  Cade.  U.  S.  P. —  Origin. — A  product 
of  the  dry  distillation  of  the  wood  of  Juniperus  oxycedrus  L. 

Description  and  Properties. — An  empyreumatic,  brownish  or  dark-brown,  clear, 
thick  liquid,  possessing  a  tarry  odor  and  an  empyreumatic,  burning,  somewhat  bitter 
taste.     Almost  insoluble  in  water;  partially  soluble  in  alcohol. 

Dose. — 2-6  minims  (0.12-0.3  Cc).     Chiefly  used  externally. 

Antagonists  and  Incompatibles. — There  are  none  of  special 
importance. 

Synergists. — The  aromatics,  carbolic  acid,  creasote,  and  many 
of  the  antiseptics,  turpentine,  and  the  stimulant  expectorants. 

Physiological  Action. — Externally  and  Locally. — Tar  is  a  stim- 
ulant, astringent,  antipruritic,  antiseptic,  and  parasiticide.  It  is  readily 
absorbed  from  the  skin,  and  when  applied  too  freely  may  produce 
a  papular  eruption. 

Internally. — The  action  of  tar  closely  resembles  that  of  turpen- 
tine, although  creasote  is  perhaps  a  more  perfect  analogue.  Small 
doses  stimulate  the  circulation  and  increase  secretions  generally. 
Immoderate  dosage  or  the  prolonged  administration  of  tar  impairs 
the  appetite,  deranges  digestion,  and  depresses  the  circulatory  and 
nervous  systems. 

While  the  drug  is  not  considered  poisonous,  the  ingestion  of 
excessive  quantities  of  oil  of  tar  has  been  attended  with  a  few  fatal 
results.  The  symptoms  following  imprudent  dosage  are  nausea, 
vomiting,  severe  abdominal  pain,  diarrhea,  headache,  and  dizziness. 
The  urine  is  colored  blackish-brown,  and  may  contain  blood  or 
albumin  and  emit  the  peculiar  odor  of  tar.  There  may  be  present 
erythema,  or  the  skin  may  be  covered  with  papules  or  vesicles 
attended  with  intense  itching. 

Therapeutics. — Externally   and  Locally. — With    the    possible 


624  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

exception  of  sulphur  and  mercury,  tar  is  the  most  universally 
employed  remedy  for  cutaneous  diseases,  the  drug  having  for  cen- 
turies held  an  important  place  among  the  efficient  topical  agents 
in  the  treatment  of  diseases  of  the  skin,  unhealthy  ulcers,  fissured 
nipples,  boils,  excoriations,  etc. 

In  chronic  eczema  the  drug  is  peculiarly  serviceable,  and  it  has 
proved  beneficial  in  chronic  psoriasis  and  scabies. 

The  OIL  OF  CADE  and  oil  of  birch  are  used  for  the  same  pur- 
poses as  tar,  being  usually  preferred  by  expert  dermatologists. 
The  tarry  preparations  are  valuable  antipruritics,  and  of  service  in 
pruritus  and  various  itching  diseases  of  the  skin,  although  their 
tendency  to  produce  irritative  and  inflammatory  effects  when  con- 
tinuously and  injudiciously  applied  should  not  be  overlooked. 

The  benign  and  emollient  effects  of  tar  are  best  obtained  when 
the  drug  is  mixed  with  some  soothing  or  astringent  powder,  such 
as  chalk. 

The  valuable  properties  of  tar  in  the  treatment  of  cutaneous 
diseases  are  often  nullified  by  the  ignorance  of  the  physician  and 
lack  of  proper  administration  of  the  drug.  Prof.  James  Nevins 
Hyde  has  truthfully  observed  that  "  the  skill  of  a  physician  en- 
trusted with  the  management  of  a  disease  of  the  skin  might  also 
be  measured  by  his  success  in  the  use  of  tar." 

Lozenges  containing  tar,  the  vapor  of  oil  of  tar,  and  sprays 
containing  tar  are  extensively  employed  in  the  treatment  of  various 
diseases  of  the  nose  and  throat. 

Internally. — Tar  has  long  possessed  an  enviable  reputation  as  a 
remedy  for  chronic  pulmonary  complaints,  being  very  efficient  in 
the  treatment  of  chronic  bronchitis  and  the  advanced  stages  of 
obstinate  acute  bronchitis,  lessening  the  expectoration,  allaying 
the  oppression  and  distress  in  the  chest,  and  soothing  the  cough. 
These  symptoms,  which  attend  many  cases  of  pulmonary  phthisis, 
are  frequently  relieved  by  some  preparation  of  tar. 

Not  only  is  this  remedy  of  value  in  catarrhal  conditions  of  the 
respiratory  passages  :  it  is  equally  efficient  in  similar  conditions  of 
mucous  membranes  elsewhere.  Thus  tar  water  has  been  employed 
with  great  benefit  in  gleet,  leucorrhea,  vesical  catarrh,  etc.,  being 
given  both  by  the  mouth  and  in  the  form  of  an  injection. 

Administration. — ^Tar  may  be  given  in  milk  or  beer  or  in  pill 
form,  although  the  most  palatable  forms  are  the  syrup,  glycerite, 
wine,  and  tar  water,  the  last  of  which  may  be  given  to  the  extent 
of  I   or.  2  pints  (473-17  or  946.35    Cc.)  daily. 


EXPECTORANTS.  625 

Senega— Senegae— Senega.  V.  8.  P. 

Origin. — The  root  of  Polygala  Senega  L.,  a  plant  indigenous  in 
North  America,  from  Canada  southward  to  South  Carolina  and 
westward  to  Wisconsin. 

Description  and.  Properties. — About  4  inches  (10  Cm.)  long, 
with  a  knotty  crown  and  spreading,  tortuous  branches,  keeled 
when  dry,  fleshy  and  round  after  having  been  soaked  in  water ; 
externally  yellowish-gray  or  brownish-yellow ;  bark  thick,  white 
within,  enclosing  an  irregular,  porous,  yellowish  wood ;  odor  slight, 
unpleasant ;  taste  sweetish,  afterward  acrid.  Senega  contains  sene- 
gin,  also  known  as  saponin,  and  polygalic  acid,  an  acrid  principle 
to  which  the  medicinal  property  of  the  drug  is  due,  besides  a  fixed 
and  a  volatile  oil. 

Dose. — 10-30  grains  (0.6-2.0  Gm.). 

Official  Preparations. 

ExtrSctum  SSnegse  Fluidum — ExtrScti  S£negae  Pluidi — Fluid  Extract  of 
Senega. — Dose,  10-30  minims  (0.6-2.0  Cc). 

Synipus  S&negse — Sjrrupi  SSnegse — Syrup  of  Senega  (20  per  cent,  of  fluid 
extract). — Dose,  30-60  minims  (2.0-4.0  Cc). 

Syrupus  Sclllse  Conip6situs — Syrupi  ScKUae  CompSsiti — Compound  Syrup 
of  Squill  (contains  8  per  cent,  of  Senega).     (Described  under  Scilla,  p.  635.) 

Physiological  Action. — Externally  and  Locally. — The  active 
principle  of  senega  is  a  decided  irritant  to  the  skin  and  mucous 
membranes,  causing  violent  sneezing  and  cough,  with  marked 
hydremia  and  increased  secretion  from  the  bronchial  and  nasal 
mucous  membranes  when  the  powder  is  inhaled. 

Internally. — Digestive  System. — Small  doses  stimulate  the  mu- 
cous membranes  of  the  mouth  and  stomach,  augmenting  the  sali- 
vary and  gastric  secretions,  although  frequently  occasioning  indi- 
gestion. Large  doses  irritate  the  alimentary  canal,  producing 
vomiting,  diarrhea,  and  abdominal  pain. 

Circulatory  System. — The  active  principle  of  senega  circulates  in 
the  blood  unchanged,  affecting  the  heart  and  blood-vessels  after 
the  manner  of  digitalis,  though  with  less  power  and  certainty. 

Nervous  System. — Under  medicinal  doses  no  important  action 
has  been  noted.     Very  large  doses  depress  the  nervous  system. 

Respiratory  System. — It  is  here  that  senega  appears  to  exert  its 
most  important  influence.  The  excretion  of  the  drug  through  the 
bronchial  mucous  membrane  irritates  the  respiratory  passages,  oc- 
casioning hyperemia,  increased  secretion,  and,  reflexly,  cough. 

Absorption  and  Elimination. — The  active  principle  of  senega  is 

40 


626  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

absorbed  with  difficulty,  being  excreted  through  the  bronchial 
mucous  membrane  and  the  kidneys,  irritating  these  structures 
during  the  process,  and  consequently  acting  as  a  stimulant,  expec- 
torant, and  diuretic.  The  drug  also  possesses  some  diaphoretic 
virtue,  being  partially  excreted  by  the  skin. 

Temperature. — The  body-heat  is  uninfluenced. 

Uterus. — It  is  believed  that  senega  possesses  emmenagogue 
properties. 

Untoward  Action. — Immoderate,  and  in  certain  susceptible  sub- 
jects small,  doses  of  senega  have  produced  irritation  and  burning 
in  the  throat,  salivation,  impaired  appetite,  a  sense  of  oppression  in 
the  stomach,  nausea,  vomiting,  colicky  pains,  and  profuse  diarrhea. 

Poisoning. — Senega  is  not  regarded  as  a  poisonous  drug,  exces- 
sive doses  producing  symptoms  analogous  to  those  of  "  Untoward 
Action,"  save  that  they  are  intensified. 

Treatment  of  Poisoning. — Elimination  is  to  be  favored,  and  the 
symptoms  treated  as  they  appear,  ga;stric  sedatives,  anodynes,  and 
cardiac  stimulants  being  employed. 

Therapeutics. — Externally  and  Locally. — No  action  has  been 
observed. 

Internally. — The  principal  use  of  senega  is  that  of  a  stimulating 
expectorant.  The  reputation  of  the  drug  originated  with  its 
efficacy  in  typhoid  pneumonia,  and  it  is  still  considered  a  valuable 
remedy  in  asthenic  pulmonary  diseases. 

It  is  highly  beneficial  in  subacute  bronchitis  when  the  power  to 
cough  is  feeble.  In  like  manner  senega  is  useful  in  bronchorrhea 
and  chronic  bronchitis  with  profuse  expectoration,  though  less  valu- 
able when  the  mucus  is  tough  and  scanty. 

The  simple  catarrhal  laryngitis  following  croup  is  greatly 
relieved  by  the  administration  of  senega. 

The  drug  is  an  appropriate  remedy  in  amenorrhea  the  result  of 
passive  uterine  congestion,  and  senegin  has  been  recommended  as 
a  remedy  for  uterine  hemorrhage. 

According  to  some  authorities,  the  drug  has  proved  beneficial 
in  chronic  rheumatism. 

Contraindications. — Senega  is  inadmissible  in  acute  bronchitis 
and  indigestion,  or  when  there  is  marked  irritation  and  inflamma- 
tion of  the  gastro-intestinal  tract. 

Administration. — The  syrup  of  senega  is  the  preparation 
usually  employed  as  an  expectorant.  Senegin  may  be  given  in 
doses  of  2  grains  (0.13  Gm.)  in  capsules. 


EXPECTORANTS.  627 

Terebenum— Terebeni— Terebene.    Xf.  S.  JP. 

Origin. — A  liquid  consisting  chiefly  of  Pinene,  and  containing 
only  very  small  proportions  of  Terpinene  and  Dipentene ;  obtained 
by  the  action  of  Sulphuric  Acid  upon  Turpentine,  and  distillation. 

Description  and  Properties. — A  colorless  or  slightly  yellow- 
ish, thin  liquid  having  rather  an  agreeable  thyme-like  odor  and  an 
aromatic,  somewhat  terebinthinate  taste.  Only  slightly  soluble  in 
water,  but  soluble  in  an  equal  volume  of  alcohol.  Terebene  should 
be  kept  in  well-stoppered  bottles,  in  a  cool  place  protected  from  light. 

Dose. — 5-15  minims  (0.3-1.0  Cc). 

Physiological  Action. — When  applied  externally  terebene  acts 
as  a  stimulant,  germicide,  antiseptic,  and  astringent.  Internally, 
small  doses  act  as  a  stimulant  to  the  gastro-intestinal  tract,  large 
amounts  being  irritant  and  producing  effects  similar  to  those  of 
turpentine. 

The  drug  is  eliminated  by  the  kidneys,  bronchial  mucous  mem- 
branes, skin,  bowels,  etc.,  acting  as  a  mild  astringent  and  antiseptic 
at  the  points  of  elimination. 

Therapeutics. — Externally  and  Locally. — The  inhalation  of 
terebene — 20  minims  (1.23  Cc.)  daily — allays  the  cough  oi laryngeal 
phthisis  and  has  proved  beneficial  in  irritative  bronchial  cough,  while 
a  spray  of  terebene  mixed  with  oil  of  eucalyptus  and  alcohol  has 
been  advised  in  whooping  cough. 

Equal  parts  of  terebene  and  olive  oil  have  been  recommended 
by  Vaucher  and  Bertin  in  the  treatment  of  uterine  cancer.  Tere- 
bene has  been  successfully  employed  as  a  general  antiseptic  dress- 
ing of  wounds,  ulcers,  burns,  etc. 

Internally. — Whether  inhaled  or  taken  into  the  stomach,  terebene 
is  a  powerful  stimulant,  antiseptic  expectorant  in  chronic  bronchitis. 

The  drug  is  of  service  in  affections  of  either  the  upper  or  lower 
respiratory  passages.  In  winter  cough,  bronchorrhea,  emphysema, 
and  even  in  phthisis,  it  is  an  efficient  remedy. 

Not  only  in  bronchial  affections  is  the  drug  valuable,  but  it  has 
been  used  with  striking  success  as  a  substitute  for  copaiba  and  oil 
of  sandalwood  in  genito-urinary  diseases.  It  has  even  been  claimed 
to  influence  favorably  the  course  oi  puerperal  fever  and  to  relieve 
the  symptoms  oi  flatulent  dyspepsia. 

Administration. — Terebene  may  be  given  in  emulsion  or  in 
mixtures  associated  with  other  expectorants  and  enclosed  in  cap- 
sules or  dropped  upon  sugar. ' 


628  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

TerpTni  Hydras— TerpTni  Hydratis— Terpin  Hydrate. 

77.  S.  F. 

Origin. — The  hydrate  of  the  diatomic  alcohol  Terpin,  prepared  by- 
mixing  rectified  Oil  of  Turpentine,  Alcohol,  and  Nitric  Acid,  allow- 
ing the  mixture  to  stand  for  three  or  four  days  in  shallow  porcelain 
dishes,  collecting  the  crystals  which  have  formed,  drying  on  ab- 
sorbent paper,  and  recrystallizing  in  a  cold  solution  of  alcohol. 

Description  and  Properties. — Colorless,  lustrous,  rhombic 
prisms,  nearly  odorless,  and  having  a  slightly  aromatic  and  some- 
what bitter  taste.  Permanent  in  the  air.  Soluble  in  about  250 
parts  of  water  and  in  10  parts  of  alcohol.  Terpin  hydrate  should 
be  kept  in  well-stoppered  bottles. 

Dose. — 2-30  grains  (0.12-2.O  Gm.). 

Physiological  Action. — Terpin  hydrate  is  a  powerful  antiseptic, 
its  action  resembling  that  of  turpentine,  though  inferior  in  strength. 

Therapeutics. — Externally  and  Locally. — The  drug  is  used  in 
the  form  of  lozenges  and  as  an  inhalant  in  chronic  tracheitis  and 
chronic  bronchitis. 

Internally. — Terpin  hydrate  may  be  used  for  the  same  purposes 
as  terebene,  being  considered  by  some  physicians  superior  to  the 
latter  drug  in  bronchial  affections.  It  has  been  recommended  as 
an  efficient  remedy  in  asthma,  hay  fever,  nephritis,  and  neuralgia. 

Administration. — Terpin  hydrate  may  be  given  in  lozenges, 
emulsion,  or  aromatic  elixir,  although  the  most  judicious  method 
of  administration  perhaps  is  in  capsules. 

Terpinol  is  obtained  by  boiling  terpin  hydrate  with  dilute  mineral  acids.  It  occurs 
as  an  oily  body  with  a  hyacinthine  odor.  Insoluble  in  water,  but  readily  soluble  in 
alcohol  and  in  ether. 

Terpinol  is  a  valuable  bronchial  stimulant,  and  may  be  used  for  the  same  diseases 
of  the  respiratory  passages  for  which  terpin  hydrate  is  recommended. 

It  is  best  given  in  capsules,  in  doses  of  about  2  grains  (0.12  Gm.)  each,  repeated 
from  four  to  six  times  a  day. 


GROUP   XIII.— DIURETICS 

AND   SUBSTANCES  ACTING  ON  THE  KIDNEVS  AND   THE  URINARY 

SYSTEM. 

Diuretics  are  drugs  which  increase  the  flow  of  urine.  Con- 
sidered in  a  broader  sense,  however,  these  agents  augment  the 
secretion  and  modify  the  character  of  the  urine — 

I.  By  increasing  the  amount. 


DIURETICS.  629 

2.  By  rendering  the  urine  acid. 

3.  By  rendering  the  urine  alkahne. 

4.  By  removing  waste  products  or  increasing  the  sohd  con- 
stituents of  the  urine. 

5.  By  preventing  the  decomposition  of  the  urine. 

The  last-named  action  is  pecuhar  to  benzoic  *  and  saHcylic  * 
acids,  cubeb,  copaiba,  uva-ursi,  oil  of  sandalwood,  volatile  oils,* 
saccharin,  and  saloL' 

The  following  medicines  affecting  the  urinary  system  are  called 
Lithontriptics,  because  of  their  power  to  prevent  the  formation  of 
concretions  in  the  urinary  passages  or  to  dissolve  them  when 
formed : 

Piperazin,  potassium  salts,*  lithium  salts,*  ammonium  benzoate,* 
benzoic  acid,*  dilute  nitric  acid.* 

Among  the  principal  drugs  which  render  the  urine  acid  are — 
benzoic  *  and  salicylic  *  acids  and  many  of  their  salts,  immoderate 
amounts  of  the  vegetable  acids,*  and  sour  wines.* 

The  alkahes,*  particularly  the  potassium  and  lithium  salts,  when 
taken  internally,  render  the  urine  alkaline  in  reaction. 

Diuretics  may  be  either  Direct  or  Indirect — i.  e.  they  may  act 
on  the  kidneys  themselves  or  upon  certain  structures  outside  the 
kidneys.  The  structures  in  the  kidneys  which  have  to  do  with 
the  elimination  of  water,  solids,  etc.  are — i.  The  Malpighian  cor- 
puscles, which  eliminate  principally  water,  but  also  mineral  salts 
and  certain  pathological  and  foreign  substances  which  may  be 
present.  2.  The  glandular  epithelium  lining  the  convoluted  tubules, 
which  excretes  waste  products,  such  as  urea,  etc.  3.  The  con- 
stricted portion  of  the  tubules,  seri-^ing  to  prevent  the  too  rapid 
escape  of  water,  thus  allowing  time  for  its  absorption  in  cases 
where  it  is  desirable  that  the  water  be   retained  in  the .  system. 

The  functional  activity  of  these  various  structures  is  regulated 
by  the  nervous  mechanism.  For  example,  the  supply  of  blood  to 
the  glomeruli  is  influenced  largely  by  the  size  of  the  blood-vessels, 
regulated  by  the  vaso-constrictor  and  vaso-dilator  nerves,  and  the 
activity  of  the  secreting  cells  is  increased  or  diminished  according 
as  they  are  controlled  by  the  secretory  or  inhibito-secretory 
nerve-fibers. 

Diuretics  act — 

1 .  By  increasing  the  general  blood-pressure. 

2.  By  causing  local  dilatation  of  the  renal  arterioles. 

'  The  drugs  marked  with  an  asterisk  are  described  elsewhere  in  the  present  work. 


630 


A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 


3.  By  stimulating  the  glandular  secreting  renal  structures. 

4.  By  simple  mechanical  force. 

The  following  table,  modified  from  Brunton's  work  on  Pharma- 
cology, Therapeutics,  and  Materia  Medica,  serves  to  elucidate  the 
methods  by  which  the  various  diuretic  agents  probably  exert  their 
influence : 

Increased     cardiac 
action. 


Raise  arterial 
pressure. 


Generally  . 


Locally  on  kidneys. 


Contract  effer- 
ent vessels. 


Dilate  efferent 
vessels. 


General     vascular 
contraction. 


Act  on   the  vaso- 
motor centers. 


Locally  on  kidney.  ■ 


Act  either  on  vaso- 
motor centers  or 
locally  on  renal 
vessels. 


Act  on  secreting 
nerves  and  renal 
cells. 


Increase  water  excreted 


Increase  water  and  solids  excreted  . 


By  simple  mechanical  action 


Digitalis,* 
Alcohol.* 
■  Digitahs,* 
Strophanthus,* 
Squill, 
Spartein,* 
Convallaria,* 
Strychnine,* 
Caffeine,* 
Erythrophleum 
(cold  to  the  skin). 

Same  as  above  ? 

Scoparius,* 

Buchu, 

Uva  Ursi, 

Juniper, 

Turpentine, 

Copaiba, 

Cantharides.* 

Nitrites,* 
Alcohol.* 

Urea, 
Caffeine,* 
Diuretin, 
Calomel.* 
Colchicum,* 
Liquor  Potassse,* 
Potassium  Acetate,* 
Potassium  Citrate,* 
Potassium  Nitrate,* 
Sodium  Citrate  * 

and  other  salines. 
Water,  local   bleeding, 

dry    cupping,    warm 

fomentations. 


The  secretion  of  urine  is  considerably  influenced  by  the  activity 
of  the  skin  and  bowels ;  for  instance,  when  the  cutaneous  glands 
are  stimulated  and  there  is  free  perspiration,  a  diminished  urinary 
secretion  ensues.     The  functional  activity  of  the  skin  and  sudo- 


DIURETICS. 


631 


riparous  glands  depends  greatly  upon  the  amount  of  blood  sup- 
plied to  them.  Whatever  augments  the  flow  of  blood  to  these 
structures  increases  the  secretion  of  the  sweat-glands.  Conse- 
quently, external  warmth  dilates  the  cutaneous  blood-vessels  and 
promotes  diaphoresis,  while  cold  contracts  the  cutaneous  vessels, 
diverting  the  flow  of  blood  to  the  internal  organs,  thereby  increas- 
ing the  secretion  from  the  kidneys  and  lessening  that  from  the 
skin. 

It  will  be  seen,  therefore,  that  the  functions  of  the  skin  and 
kidneys  are  compensatory,  the  compensation  being  also  partially 
observable  in  the  mutual  relations  between  the  bowels  and  kidneys. 
It  is  well  known  that  when  there  is  active  purgation,  with  frequent 
watery  movements  from  the  bowels,  the  amount  of  urine  secreted 
is  proportionally  diminished. 

Any  drug  which  increases  the  general  blood-pressure  and  forces 
a  larger  blood-supply  into  the  kidneys  augments  the  pressure  in 
the  glomeruli,  distending  the  capsule 
and  enlarging  the  area  of  the  osmotic 
membrane,  which  action,  combined 
with  an  increase  in  the  circulation, 
promotes  and  facilitates  osmosis, 
thereby  augmenting  the  amount  of 
urine. 

The  membrane  lining  the  inner 
capsule  of  the  glomerulus  is  covered 
with  a  single  layer  of  cubical  epithe- 
lium possessing  a  secretory  function, 
rendered  more  active  in  accordance 
with  the  physiological  fact  that  the 
greater  the  blood-supply  to  a  gland 
or  secreting  structure,  the  greater  its 
functional  activity. 

The  blood-pressure  in  the  glom- 
eruli, as  has  been  said,  may  be  in- 
creased by  additional  pressure  in 
the  general  circulation.  It  may  be 
raised  also  locally  through  dilatation 
of  the  afferent  blood-vessel  supply- 
ing the  Malpighian  corpuscle,  or  con- 
traction of  the  efferent  vessels,  allowing  a  smaller  quantity  of  blood 
to  escape  from  the  glomeiules. 


Fig.  15. — A,  glomerules  of  capillary 
blood-vessels ;  B^  cubical  or  secreting  cells 
covering  the  membrane  surrounding  the 
capillary  plexus ;  C,  space  between  the 
two  layers  opening  into  a  convoluted  tu- 
bule; D,  the  exte/nal  layer  covered  by 
flattened  epithelial  cells ;  E,  convoluted 
tubule  lined  with  a  single  layer  of  nucle- 
ated polyhedral  epithelium ;  F,  afferent  ar- 
tery entering  the  Malpighian  corpuscle, 
dividing  in  the  interior  into  a  dense,  con- 
voluted capillary  plexus,  which  finally  leads 
out  of  the  corpuscle  by  G,  a  small,  efferent 
vessel  comparable  to  a  vein,  at  a  point  op- 
posite to  that  where  the  afferent  vessel 
enters  the  Malpighian  corpuscle. 


632 


A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 


By  referring  to  the  foregoing  tabular  view  we  may  ascertain 
the  drugs  acting  upon  the  general  and  those  affecting  the  local 
circulation. 

The  preceding  diagram  (Fig.  15)  will  serve  to  elucidate  the 
action  taking  place  in  the  glomeruli. 

The  secreting  structures  of  the  convoluted  tubules  are  stimu- 
lated not  only  by  the  increased  blood-pressure,  but  also  by  the 
influence  of  certain  drugs  which  are  carried  in  the  blood,  acting  as 
excitants  upon  the  secreting  cells  or  the  secretory  nerves  supply- 
ing them.  By  reference  to  the  table  it  will  be  seen  what  diuretics 
act  upon  these  structures. 

The  subjoined  diagram  (Fig.  16)  shows  the  structures  concerned 
with  the  functional  activity  of  the  kidney. 


Fig.  16. — I,  Malpighian  corpuscle ;  2,  convoluted  tubule  with  capillary  plexus  from  efferent  vessel; 
3,  constricted  portion  of  the  tubule ;  4,  unstriped  muscle-fibers  surrounding  the  constricted  portion ; 
5,  afferent  blood-vessel  leading  into  the  Malpighian  body  ;  6,  efferent  vessel  leading  out  of  the  Mal- 
pighian corpuscle ;  7,  the  collecting  tube. 


The  imbibition  of  large  amounts  of  water,  while  increasing  the 
blood-pressure  to  some  extent,  has  mainly  a  mechanical  effect 
upon  the  kidneys,  simply  flushing  the  tubuli  uriniferi,  allowing 
secretion   to   be   re-established,    and   acting  as   a   diluent  to    the 


unne. 


In  congested  conditions  of  the  kidneys  certain  remedial  meas- 
ures— such  as  local  venesection,  dry  cupping,  warm  fomentations, 
etc. — promote  renal  secretion. 

Therapeutics. — i.  To  remove  excessive  accumulation  of  fluid  in 


DIURETICS.  633 

the  tissues  and  serous  cavities  of  the  body  when  the  blood-pressure  is 
low. 

For  this  purpose  the  most  efficient  service  is  derived  from  the 
use  of  drugs  which  act  by  increasing  the  systemic  blood-pressure, 
contracting  the  efferent  and  dilating  the  afferent  vessels,  and  stimu- 
lating the  convoluted  tubules. 

Ordinarily,  the  agents  most  beneficial  in  cardiac  dropsy  or  drop- 
sies due  to  venous  congestion  are  digitalis,  calomel,  scoparius, 
squill,  diuretin,  etc. 

2.  To  remove  excess  of  fluid  from  the  body  when  the  blood-pressure 
is  about  normal,  as  in  cases  of  hepatic  cirrhosis  with  dropsy. 

The  remedies  found  to  be  most  efficient  in  these  conditions  are 
diuretin,  copaiba,  and  calomel,  although  frequently  hydragogue 
cathartics,  by  ridding  the  peritoneal  cavity  of  excess  of  water  and 
preventing  the  accumulation  of  fluid  by  lowering  the  abnormally 
high  blood-pressure  in  the  portal  circulation,  prove  more  beneficial 
than  diuretics. 

3.  To  remove  water  from  the  blood  when  the  arterial  pressure  is 
abnormally  high. 

For  this  purpose  diuretics  are  indicated  in  the  early  stages  of 
many  acute  diseases,  such  as  the  eruptive  fevers,  tonsillitis,  bron- 
chitis, etc.  In  these  cases  agents  which  dilate  the  cutaneous  blood- 
vessels, such  as  spirit  of  nitrous  ether,  etc.,  should  be  employed. 
Diaphoretics  and  cathartics  are  likewise  beneficial. 

4.  To  remove  from  the  blood  injurious  waste  products  and  poi- 
sonous substances. 

For  this  purpose  drugs  which  stimulate  the  convoluted  tubules 
and  increase  oxidation  should  be  given,  such  as  potassium  nitrate 
and  bitartrate,  the  lithium  salts,  turpentine,  juniper,  caffeine,  and 
the  remedies  mentioned  under  "  Lithontriptics." 

The  foregoing  remedies  will  be  found  useful  in  diseases  asso- 
ciated with  rheumatic,  gouty,  and  uric-acid  diatheses,  as  well  as  in 
many  acute  diseases  where  there  is  rapid  accumulation  of  deleteri- 
ous, retrograde  material. 

5.  To  lessen  the  acidity  of  the  urine. 

The  alkalies  are  the  most  useful  agents  for  this  purpose,  being 
serviceable  in  such  conditions  as  gonorrhea  and  acute  inflammatory 
states  of  the  genito-urinary  tract.  In  debilitated  conditions  there 
is  quite  often  an  excessive  acidity  of  the  urine,  irritating  the  mucous 
membrane  and  causing  frequent  micturition.  In  such  cases  the 
alkaline  diuretics  or  alkaline  mineral  waters  are  of  service. 


634  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

6.  To  increase  the  acidity  of  the  urine. 

This  is  necessary  when,  from  any  cause,  there  is  ammoniacal 
decomposition  of  the  urine,  as  in  cystitis.  In  such  cases  benzoic 
acid  is  probably  the  most  beneficial  remedy,  though  the  salicylates^ 
salol,  and  the  volatile  oils,  etc.  may  also  prove  useful. 

7.  To  prevent  the  formation  of  urinary  concretions  or  to  dissolve 
them  when  formed,  as  in  cases  of  renal  calculi,  etc. 

For  these  purposes  the  drugs  included  under  "  Lithontriptics  " 
are  the  most  efficient. 

8.  To  dilute  the  urine. 

This  process  is  necessary  to  prevent  the  deposit  of  urinary  solids 
from  f  ~irming  calculi  in  the  kidneys  or  bladder.  For  this  purpose 
water  ur  the  alkaline  mineral  waters,  taken  in  large  quantities,  will 
prove  most  useful. 

Administration. — Diuretics  are  often  very  uncertain  in  their 
action,  in  health  many  of  them  apparently  exerting  no  influence 
upon  the  kidneys,  and  in  diseased  conditions  not  infrequently 
proving  inert.  They  are  more  certain  in  their  action  when  em- 
ployed in  combination — that  is,  a  union  of  drugs  which  act  both 
generally  upon  the  systemic  circulation  and  locally  upon  the 
various  secreting  structures  of  the  kidneys.  Diaphoretics,  being 
diverse  in  their  action,  should  not  be  given  with  diuretics. 

When  administered,  diuretics  should  be  freely  diluted  with 
water.  The'  patient's  skin  should  be  kept  cool  and  the  bowels 
prevented  from  acting  too  freely,  in  order  that  the  full  benefit  of 
this  class  of  remedies  may  be  obtained. 

The  diuretic  drugs  not  described  elsewhere  in  the  present  work 
are  herewith  considered  in  detail. 

ScTlla—ScilIae— Squill.    JJ.  S.  I*. 

Origin. — The  bulb  of  Urginea  maritima  (L.)  Baker,  a  plant  in- 
digenous in  the  basin  of  the  Mediterranean  from  Syria  westward  to 
the  coast  of  the  Atlantic.  The  bulb  is  deprived  of  its  dry,  mem- 
branaceous outer  scales  and  cut  into  thin  slices,  the  central  por- 
tions being  rejected. 

Description  and  Properties. — Occurring  in  narrow  segments 
about  2  inches  (5  Cm.)  long,  slightly  translucent,  yellowish-white 
or  reddish,  brittle  and  pulverizable  when  dry,  tough  and  flexible 
afl:er  exposure  to  damp  air ;  inodorous ;  taste  mucilaginous,  bitter, 
and  acrid.     The  drug  contains  three  active  principles — scillipicrin, 


DIURETICS.  635 

scillitoxin  (both  acting  upon  the  heart),  and  scillin  (an  emetic  prin- 
ciple)— together  with  various  unimportant  substances,  such  as  mu- 
cilage, sugar,  etc. 

Dose. — 1-2  grains  (0.06-0.13  Gm.). 

Official  Preparations. 

Acetum  Scllla — Aceti  Scnise— Vinegar  of  Squill  (10  per  cent.). — Dose,  10-30 
minims  (0.6-2.0  Cc). 

Extractum  SclUse  Flfiidum— ExtrScti  Scflte  Fliiidi— Fluid  Extract  of 
Squill. — Dose,  1-4  minims  (0.065-0.25  Cc). 

Syrupus  Sclillae — Syrupi  ScIUse — Syrup  of  Squill  (45  per  cent,  of  the  Acetum). 
— Dose,  30-60  minims  (2.0-4.0  Cc). 

Syrupus  Sclllse  CompSsitus— Syrupi  ScKUse  Compdsiti — Compound  Syrup 
of  Squill. — Dose,  15  minims-2  fluidraclims  (1.0-8.0  Cc).  Fluid  Extract  8  per  cent., 
with  Fluid  Extract  of  Senega  8  per  cent,  and  Tartar  Emetic  2  per  cent.,  or  \  grain  (.ooS 
Gm.)  to  I  fluidrachm  (4.0  Cc). 

Tinctura  SciUae — Tincturae  Scfllae — Tincture  of  Squill  (15  per  cent.). — Dose, 
5-20  minims  (0.3-1.3  Cc). 

Antagonists  and  Incompatibles. — The  action  of  squill  upon 
the  circulatory  system  is  antagonized  by  the  cardiac  depressants. 
Tannic  acid  is  incompatible. 

Synergists. — The  diuretic  action  of  squill  is  enhanced  by  the 
diuretics  and  many  of  the  cardiac  stimulants.  As  an  expectorant 
the  drug  is  aided  by  senega  and  tartar  emetic. 

Physiological  Action. — Externally  and  Locally. — There  is  no 
action  of  special  importance.  Applied  to  mucous "  membranes, 
however,  squill  acts  as  an  irritant. 

Internally. — Digestive  System. — Large  doses  of  the  drug  excite 
nausea,  vomiting,  and  purging.  Excessive  amounts  may  produce 
gastro-enteritis. 

Circulatory  System. — The  action  of  squill  upon  the  heart  and 
blood-vessels  resembles  that  of  digitaUs,  although  as  a  cardiac 
stimulant  digitalis  is  the  more  powerful. 

Nervous  System. — Poisonous  doses  produce  marked  cerebral 
symptoms,  and  in  warm-blooded  animals  may  occasion  paralysis 
and  convulsions. 

Respiratory  System. — The  bronchial  mucus  is  increased  and 
expectoration  facilitated  by  small  doses  of  squill.  Toxic  doses 
render  the  respiration  rapid  and  shallow. 

Absorption  and  Elimination. — The  active  principles  of  squill  are 
quickly  diffused  through  the  blood,  being  eliminated  chiefly  by  the 
kidneys  and  bronchial  mucous  membrane. 

In  the  passage  of  squill  through  the  kidneys  the  latter  are 


636  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

stimulated  by  the  drug,  which  influence,  together  with  the  drug's 
action  upon  the  systemic  circulation,  renders  squill  an  active  and 
valuable  diuretic,  increasing  not  only  the  amount  of  urine,  but  also 
the  quantity  of  inorganic  solids. 

Very  large  doses  irritate  and  inflame  the  kidneys,  resulting  in 
strangury  and  hematuria,  with  occasionally  entire  suppression  of 
urinary  flow. 

Untoward  Action. — This  does  not  differ  essentially  from  the 
symptoms  of  "  Poisoning." 

Poisoning. — In  toxic  doses  squill  acts  as  an  acro-narcotic  poison. 
The  symptoms  produced  by  excessive  doses  are — nausea,  violent 
vomiting,  serous  and  bloody  diarrhea,  severe  griping,  a  sensation 
of  burning  in  the  throat,  vesical  tenesmus  accompanied  by  pain, 
bloody  urine,  and  perhaps  entire  suppression  of  the  urinary  flow. 
The  pulse  is  feeble  and  slow  or  sometimes  rapid,  the  symptoms 
terminating  in  collapse  and  death,  occasionally  preceded  by  convul- 
sions. 

Treatment  of  Poisoning. — The  stomach  should  be  evacuated  and 
demulcent  drinks  freely  given.     Opium  may  be  necessary  to  relieve  ■ 
pain,  while  diffusible  stimulants  serve  to  counteract  cardiac  and 
respiratory  depression. 

Therapeutics. — Squill  is  not  used  externally  and  locally.  It 
has  been  employed  internally  as  a  diuretic  in  dropsy.  When  asso- 
ciated with  digitalis  and  calomel  it  is  an  exceedingly  active  diuretic 
in  cases  of  cardiac  dropsy,  chronic  pleurisy,  and  pericarditis  with 
effusion. 

Squill  is  an  efficient  expectorant,  the  vinegar,  syrup,  and  com- 
pound SYRUP  OF  SQUILL  being  useful  preparations  in  subacute  and 
chronic  forms  of  bronchitis,  particularly  when  the  sputum  is  tena- 
cious and  with  difficulty  expelled. 

Contraindications. — Squill  should  not  be  employed  in  cases  of 
acute  diseases  of  the  kidneys.  It  is  also  inadmissible  in  acute 
bronchitis  and  in  phthisis. 

Administration. — Any  of  the  preparations  of  the  drug  may  be 
given,  to  be  prescribed  well  diluted  with  syrup  or  glycerin. 

Inasmuch  as  the  diuretic  action  of  squill  ceases  afl:er  a  while, 
the  doses  should  be  repeated  and  gradually  enlarged  until  some 
untoward  action  supervenes,  when  further  increase  should  be  sus- 
pended. 

Because  of  its  too  irritating  properties  the  drug  is  seldom  given 
alone  when  desired  for  its  diuretic  action. 


DIURETICS.  637 

Owing  to  the  free  acetic  acid  which  it  contains,  syrup  of  squill 
is  incompatible  with  ammonium  carbonate  and  other  alkalies. 

Erythrophleum— Erythrophlei— Erythrophleum. 

(Casca  Bark.) 

Origin. — A  glucosid  obtained  from  the  bark  of  Erythrophlceum 
Guinense  Don,  known  under  the  names  of  Casca  bark.  Sassy  bark, 
and  Ordeal  bark.  The  tree  is  a  native  of  West  Africa,  the  plant 
being  used  by  the  natives  as  an  ordeal  in  witchcraft. 

Description  and  Properties. — Erythrophlein  hydrochloride, 
the  salt  usually  employed,  occurs  in  the  form  of  whitish  crystals, 
soluble  in  water. 

Dose. — i^-xi  grain  (.001-005  Gm.). 

Physiological  Action  and  Therapeutics. — The  powdered  bark 
when  inhaled  causes  violent  sneezing.  The  tincture  of  the  bark, 
or  the  glucosid,  when  taken  in  poisonous  doses  occasions  nausea, 
vomiting,  purging,  intense  headache,  intoxication,  convulsions,  and 
death. 

In  medicinal  doses  the  drug  affects  the  circulatory  system  after 
the  manner  of  digitalis,  and  acts  upon  the  kidneys  as  an  active 
diuretic.  It  was  at  one  time  supposed  to  be  a  powerful  local  anes- 
thetic ;  further  examination,  however,  has  proved  the  claim  to  be 
unfounded. 

Casca  bark  or  its  glucosid  has  been  employed  in  intermittent 
fever,  diarrhea,  dysentery,  and  dyspepsia.  Its  chief  medical  uses 
are  in  valvular  diseases  of  the  heart  and  as  a  diuretic  in  cardiac 
and  renal  dropsies. 

Administration. — A  tincture  of  the  bark  (10  per  cent,  strength) 
may  be  given  internally,  diluted  with  water,  in  doses  of  5-10  min- 
ims (0.3-0.6  Cc).  Erythrophlein  hydrochlorate  is  usually  given 
hypodermically. 

Buchu— Buchu— Buchu.    TJ.  8.  P. 

Origin. — The  leaves  of  Barosma  betulina  (Thunberg)  Bartling 
et  Wendland,  and  Barosma  crenulata  (L.)  Hooker,  plants  or  shrubs 
attaining  a  height  of  several  feet,  indigenous  in  the  southern  por- 
tion of  Africa,  particularly  in  various  parts  of  Cape  Colony. 

Description  and  Properties. — The  leaves  are  ^  to  f  inch  (12 
to  19  Mm.)  long,  roundish-obovate,  with  a  rather  wedge-shaped 
base,  or  varying  between  oval  and  obovate,  crenate  or  serrate,  with 
a  gland  at  the  base  of  each  tooth,  dull  yellowish-green,  thickish, 


638  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

pellucid-punctate ;  odor  and  taste  strongly  aromatic,  somewhat 
mint-like,  pungent,  and  bitterish.  Buchu  contains  from  i  to  1.56 
per  cent,  of  a  volatile  oil,  which,  on  exposure  to  a  low  temperature, 
releases  barosma  camphor  or  diosphenol,  a  stearopten.  The  bitter 
principle  of  buchu  is  rutin  ;  resin  is  also  present. 
Dose. — 15-30  grains  (1.-2.  Gm.). 

Official  Preparation. 
Extractum  Buchu  Fluidum— ExtrScti   Buchu  Fluidi — Fluid   Extract  of 
Buchu. — Dose,  15-60  minims  (1.-4.  Cc). 

Physiological  Action  and  Therapeutics. — Externally  and 
locally  buchu  has  no  action  of  importance.  When  ingested  it 
acts  as  a  carminative,  in  small  doses  occasioning  a  feeling  of 
warmth,  but  in  excessive  doses  acting  as  an  irritant. 

Upon  the  circulation  the  influence  of  the  drug  is  that  of  a  mild 
stimulant. 

Its  active  constituents  are  rapidly  diffused  through  the  blood, 
and  are  eliminated  principally  by  the  kidneys,  the  bronchial  mucous 
membrane  sharing  in  the  excretory  process. 

Buchu  increases  the  fluid  and  solid  constituents  of  the  urine, 
imparting  to  it  a  peculiar  aromatic  odor.  The  drug  acts  as  a  tonic 
astringent  and  disinfectant  to  the  mucous  membranes,  from  which 
it  is  eliminated,  diminishing  the  secretions. 

If  taken  for  too  long  a  period,  irritation  and  inflammation  of  the 
kidneys  are  apt  to  ensue  because  of  excessive  stimulation. 

The  drug  is  chiefly  employed  as  a  stimulant  diuretic  and  expecto- 
rant in  catarrhal  conditions  of  the  genito-urinary  organs  and  bron- 
chial tiibes.  Buchu  is  therefore  of  service  in  urethritis,  gonorrhea, 
gleet,  chronic  cystitis,  incontinence  of  urine  due  to  want  of  muscular 
tone,  pyelitis,  etc.  The  drug  has  also  proved  beneficial  in  certain 
cases  of  chronic  bronchitis,  and  has  even  been  recommended  in 
chronic  rheumatism  and  lithemia. 

Contraindications. — Buchu  is  contraindicated  in  acute  inflam- 
mation of  the  kidneys. 

Administration. — The  fluid  extract  and  the  infusion  are  the 
only  preparations  employed.  They  should  be  given  freely  diluted 
with  water. 

Uva  Orsi— Uvae  Orsi— Uva  Ursi.    ZJ.  S.  P. 

(Bearberry.) 
Origin. — The  leaves  of  Arctostaphylos  Uva  JJrsi  (L.)  Sprengel., 
a  trailing  evergreen  plant  distributed  throughout  the  northern  por- 


DIURETICS.  639 

tion  of  North  America,  extending  as  far  south  as  New  Jersey  and 
westward  to  Colorado.  The  plant  is  also  found  in  most  parts  of 
Europe  and  in  Northern  Asia. 

Description  and  Properties. — Leaves  very  short-stalked, 
obovate  or  oblong-spatulate,  coriaceous,  about  f  inch  (2  Cm.)  long 
and  \  \.o\  inch  (6  to  8  Mm.)  wide,  obtuse,  with  slightly  revolute 
edges,  upper  surface  with  depressed  veins,  lower  surface  distinctly 
reticulate ;  odor  faint,  hay-like ;  taste  strongly  astringent  and  some- 
what bitter. 

Uva  ursi  contains  two  bitter  glucosids,  arbutin  and  ericolin,  and 
a  tasteless  principle,  urzone,  besides  tannic  and  gallic  acids. 

Dose. — 15-60  grains  (1.-4.  Gm.). 

Official  Preparations. 

Extractum  Ovse  Ursi— Extract!  Uvae  Ursi — Extract  of  Uva  Ursi. — Dose, 
5-15  grains  (0.3-1.0  Gm.). 

ExtrSctum  Uvae  Ursi  Fluidum— ExtrScti  Uvae  Ursi  Fluidi— Fluid  Extract 
of  Uva  Ursi. — Dose,  15-60  minims  (J-4  Cc). 

The  Physiological  Action  and  Therapeutics  of  uva  ursi  are 
analogous  to  those  of  buchu. 

JunTperus— J  unTperi— Juniper. 

(Juniper  Berries.) 

Origin. — The  fruit  of  Juniperus  communis  (L.),  an  evergreen 
tree  indigenous  in  the  northern  hemisphere  and  found  in  the 
United  States  and  Canada  and  in  Europe. 

Description  and  Properties. — Berries  globular,  about  the  size 
of  a  large  pea,  externally  of  a  glossy,  purplish-black  color,  covered 
with  a  grayish  bloom.  They  have  an  aromatic,  balsamic  odor,  and 
a  sweet  terebinthinate,  bitterish,  and  slightly  acrid  taste.  Juniper 
contains  a  volatile  oil;  also  juniperin,  sugar,  wax,  fat,  etc. 

Dose. — 15-60  grains  (1.-4.  Gm.). 

Oleum  JunTperi— Olei  JunTperi— Oil  of  Juniper. 

V.  S.  JP. 

Origin. — A  volatile  oil  distilled  from  the  fruit  of  Juniperus 
communis. 

Description  and  Properties. — A  colorless  or  faintly  greenish- 
yellow  liquid,  becoming  darker  and  thicker  through  age  and 
exposure  to   air,  having  the   characteristic   odor  of  juniper  and 


640  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

a  warm,  aromatic,  somewhat  terebinthinate  and  bitterish  taste.    Sol- 
uble in  about  four  times  its  volume  of  alcohol,  forming  a  more  or 
less  turbid  liquid,  which  is  neutral  or  slightly  acid  to,  litmus-paper. 
Dose. — 5-15  minims  (0.3-1. 0  Cc). 

Official  Preparations. 

Spfritus  Juniperi— Spfritus  JunJperi— Spirit  of  Juniper.— Z>o.ff,  1-8  fluidrachms 
(4.0-30.0  Cc).     Formula:  Oil  of  Juniper,  5;  Alcohol,  95  parts. 

Spiritus  Juniperi  CompSsitus— Splritus  Juniperi  CompSsiti— Compound 
Spirit  of  Juniper.— Formula :  Oil  of  Juniper,  8 ;  Oil  of  Caraway,  I ;  Oil  of  Fennel, 
I;  Alcohol,  1400;  Water  sufficient  to  make  2000  parts.— Z»o«,  2-4  fluidrachms- 
(8.0-15.0  Cc). 

Unofficial  Preparations. 

Extractum  Juniperi  Frtlctus  Fluidum — ExtrScti  Juniperi  Frfictus  Fliiidi— 
Fluid  Extract  of  Juniper  Berries. — Dose,  ^-2  fluidrachms  (2.0-8.0  Cc). 

Infiisum  Juniperi— Infusi  Juniperi — Infusion  of  Juniper. — i  ounce  (31.  Gm.) 
of  Juniper  to  I  pint  (473.  Cc.)  of  Water. — Dose,  2-4  fluidounces  (60.-118.  Cc). 

Physiological  Action  and  Therapeutics. — Juniper  in  its  action 
resembles  buchu,  being  a  stimulant  diuretic.  Under  certain  condi- 
tions it  acts  as  a  diaphoretic.  It  is  a  tonic  to  the  stomach  and 
a  mild  aphrodisiac. 

The  volatile  oil,  which  is  the  active  constituent  of  juniper, 
diffuses  through  the  blood  with  great  facility,  stimulating  the  heart, 
and,  in  dropsical  conditions,  increasing  the  'flow  of  urine.  In 
health,  however,  the  amount  of  urine  is  diminished,  while  that 
of  urea  is  augmented. 

Juniper  is  used  for  the  same  purposes  as  buchu — being  superior 
to  the  latter  drug  perhaps — especially  in  various  dropsies  and 
passive  congestion  of  the  kidneys. 

Contraindications. — The  same  as  for  buchu. 

Administration. — Any  of  the  preparations  may  be  given,  gin 
being  a  popular  diuretic. 

Oleum  TerebinthTna— Olei  Terebinthlnae— Oil  of 
Turpentine.    V.  S.  -P. 

Origin. — A  volatile  oil  distilled  from  turpentine — a  concrete 
oleoresin  obtained  from  Pinus  palustris  Miller  and  other  species 
of  Pinus. 

Description  and  Properties. — A  thin,  colorless  liquid,  of  a 
characteristic  odor  and  taste,  both  of  which  become  stronger  and 
less  agreeable  with  age  and   exposure  to  air.     Soluble  in  three 


DIURETICS.  641 

times  its  volume  of  alcohol.     Oil  of  turpentine  should  be  kept 
in  well-stoppered  bottles,  protected  from  light. 
Dose. — S-15  minims  (0.3-1.0  Cc),  in  emulsion. 

Official  Preparations. 

LinimSntum  Terebinthinae — Linimfinti  Terebinthlnse — Turpentine  Lini- 
ment (35  per  cent,  with  resin  cerate).     For  external  use. 

Dleum  Terebinthinae  Rectificatum — Olei  Terebinthinae  Rectiiicati — Rec- 
tified Oil  of  Turpentine. — Dose,  5-15  minims  (0.3-1.0  Cc). 

Antagonists  and  Incompatibles. — The  motor  depressants  and 
agents  increasing  waste  therapeutically  antagonize  the  action  of 
turpentine.  Bromine,  iodine,  and  nitric  and  sulphuric  acids  are 
incompatible,  explosion  occurring  with  the  first  two,  and  combus- 
tion taking  place  by  mixture  with  the  acids  named. 

Ssrnergists. — The  therapeutic  actions  of  turpentine  are  enhanced 
by  buchu,  cubeb,  copaiba,  oil  of  sandalwood,  and  the  diffusible  and 
alcoholic  stimulants. 

Physiological  Action. — Externally  and  Locally. — Oil  of  turpen- 
tine is  antiseptic,  hemostatic,  irritant,  counter-irritant,  rubefacient, 
vesicant,  and  a  parasiticide.  Its  action  resembles  closely  that  of 
the  volatile  oils  as  described  under  "  Aromatics." 

When  applied  to  the  epidermis  the  drug  dilates  the  cutaneous 
blood-vessels,  occasioning  a  sensation  of  heat  and  producing  red- 
ness of  the  skin,  and,  if  the  oil  be  applied  with  inunction  for  any 
length  of  time,  vesication  ensues,  with,  occasionally,  intractable 
ulcerations.  The  fumes  of  oil  of  turpentine  when  inhaled  cause 
great  irritation  of  the  eyes  and  the  respiratory  passages. 

The  drug  is  readily  absorbed  from  the  unbroken  skin. 

Internally. — Digestive  System. — When  taken  into  the  mouth 
turpentine  produces  a  burning,  pungent  taste  and  an  immediate  and 
augmented  salivary  secretion.  Swallowed  in  immoderate  amounts, 
the  drug  occasions  a  sensation  of  heat  in  the  epigastrium,  with  in- 
creased peristaltic  action  and  secretion.  The  intestines  are  simi- 
larly affected,  the  intestinal  peristalsis  being  greatly  augmented,  the 
drug  acting  as  an  efficient  carminative. 

Large  doses  of  turpentine  produce  severe,  burning  pain  in  the 
stomach  and  bowels,  accompanied  by  nausea,  vomiting,  and  purg- 
ing, the  feces  often  containing  blood. 

The  drug  is  an  efficient  anthelmintic  for  tape-worm. 

Circulatory  System. — Turpentine  is  a  cardiac  stimulant,  increasing 
the  force  and  rapidity  of  the  heart's  action  and  raising  arterial  ten- 

41 


642  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

sion  by  direct  cardiac  influence.  The  blood-vessels  are  contracted 
by  the  drug,  which  may  account  for  its  hemostatic  properties. 
Very  large  doses  slow  the  heart  by  stimulating  the  vagus  inhibitory 
center. 

Nervous  System. — Small  doses  increase  and  large  doses  dimin- 
ish reflex  excitability.  Large  doses  produce  giddiness,  mental 
exhilaration,  and  incoherence  of  ideas,  followed  by  dulness  and 
occasionally  coma. 

There  is  incoordination  of  movements,  resulting  in  unsteady 
gait,  great  muscular  weakness,  and  diminished  sensation,  usually 
preceding  the  impairment  of  voluntary  motion. 

Respiratory  System. — The  effect  of  inhaled  oil  of  turpentine  on 
the  respiratory  passages  has  been  described.  When  ingested  the 
drug  increases  and  disinfects  the  bronchial  secretion.  Small  doses 
increase  and  large  doses  diminish  the  respiratory  movements. 

Absorption  and  Elimination. — Oil  of  turpentine  is  rapidly  diffused 
in  the  blood,  in  moderate  doses  stimulating  the  kidneys  and  in- 
creasing the  flow  of  urine,  to  which  it  imparts  the  odor  of  violets. 
Large  doses  irritate  the  kidneys,  lessening  the  amount  of  urine, 
rendering  it  highly  colored,  and  in  some  cases  producing  albu- 
minuria, hematuria,  and  even  total  suppression.  There  are  present 
priapism  and  a  frequent  desire  to  micturate. 

Turpentine  is  rapidly  eliminated  from  the  system,  not  only  by 
the  kidneys,  but  by  the  skin,  and  bronchial  and  intestinal  mucous 
membranes  as  well.  ' 

Temperature . — The  drug  is  a  mild  antipyretic. 

Untoward  Action. — Erythema  and  eczematous  eruptions  are 
produced  by  both  the  ingestion  and  the  local  application  of  turpen- 
tine. In  susceptible  individuals  small  doses  may  occasion  serious 
disturbances  of  the  genito-urinary  and  gastro-intestinal  tracts,  such 
as  strangury,  painful  erections,  salivation,  and  stomatitis. 

The  administration  of  repeated  doses  of  oil  of  turpentine  may 
produce  peculiar  nervous  manifestations,  such  as  headache,  drowsi- 
ness, dizziness,  and  a  sense  of  mental  vacuity. 

Poisoning. — Few  cases  are  recorded  of  death  resulting- from  the 
ingestion  of  excessive  amounts  of  turpentine,  owing  to  the  fact 
that  the  greater  amount  of  the  drug  passes  away  through  the 
bowels. 

The  symptoms  produced  by  very  large  doses  are — great  mus- 
cular weakness,  abolition  of  reflexes,  and  violent  vomiting  and 
purging,  with  bloody  evacuations  from  the  bowels.     There  is  great 


DIURETICS.  643 

irritation  of  the  genito-urinary  tract,  with  constant  efforts  to  mic- 
turate, hematuria  or  entire  suppression  of  urine,  painful  priapism, 
and  violent  strangury. 

The  skin  is  moist,  and  the  face  flushed  or  cyanosed,  while  dila- 
tation of  the  pupils,  slow,  labored,  and  stertorous  breathing,  and 
occasionally  paroxysms  of  convulsive  coughing,  may  be  attendant 
symptoms. 

Either  great  mental  excitement  or  profound  insensibility  may  be 
present.  The  heart  and  circulatory  system  are  greatly  depressed, 
death,  when  occurring,  being  usually  the  result  of  cardiac  failure. 

Treatment  of  Poisoning. — The  stomach  should  be  at  once  evacu- 
ated, and  elimination  favored  by  every  possible  means.  The  free 
administration  of  demulcent  drinks  is  advisable,  while  to  relieve 
pain  opium  may  be  given.  Other  symptoms  should  be  treated 
according  to  their  indications. 

Therapeutics. — Externally  and  Locally. — Oil  of  turpentine  is 
an  efficient  counter-irritant,  being  employed  as  such  in  lumbago,  my- 
algia, neuralgia,  rheumatic  pains,  bronchitis,  pleurisy,  and  various 
forms  of  chronic  inflammation.  A  turpentine  stupe  is  perhaps  the 
most  effective  method  in  the  local  application  of  the  drug.  It  is 
appUed  as  follows:  (i)  A  flannel  is  wrung  out  of  hot  water, 
sprinkled  well  with  the  oil  and  allowed  to  remain  in  contact  with 
the  affected  part  from  five  to  twenty  minutes,  as  indicated  by  the 
sensibility  of  the  skin.  Care  must  be  taken  in  the  preparation  of 
the  flannel  lest  the  patient  be  chilled  or  scalded.  (2)  A  vessel 
containing  the  oil  is  placed  in  hot  water  and  a  flannel  wrung  from 
the  oil  applied  as  desired. 

A  turpentine  stupe  is  perhaps  the  most  grateful  and  efficient 
local  application  in  peritonitis. 

Owing  to  its  antiseptic  and  hemostatic  properties  the  oil  of 
turpentine  is  frequently  and  beneficially  employed  as  a  dressing 
for  lacerated  wounds. 

The  drug  is  an  active  parasiticide,  and  has  been  used  success- 
fully in  the  treatment  of  tinea  tonsurans,  etc.  It  has  also  been 
favorably  recommended,  when  diluted  with  some  bland  oil,  as  a 
remedy  for  alopecia  areata  and  psoriasis. 

Turpentine  serves  a  useful  purpose  in  many  diseases  of  the  ear 
and  throat. 

Cecchini  uses  turpentine  in  the  treatment  of  caries  of  the  tem- 
poral bone. 

J.  Solis  Cohen  recommends  the  vapor  of  turpentine  as  an 


644  '4    TEXT-BOOK  OF  MATERIA  MEDICA. 

efficient  means  of  allaying  the  cough  and  irritation  occasioned  by 
acute  laryngeal  catarrh. 

Erichsen  employs  the  drug  as  a  hemostatic  to  check  bleeding 
after  excision  of  the  tonsils. 

The  inhalation  of  the  oil  of  turpentine  lessens  pulmonary 
hyperemia  and  excessive  bronchial  secretion. 

The  drug  has  been  recommended  as  a  local  application  in 
diphtheria  after  the  removal  of  the  membranes. 

Internally. — Turpentine  is  a  valuable  remedy  for  gastric  or 
intestinal  flatulence,  particularly  when  the  condition  arises  from 
an  atonic  state  of  the  muscles  of  the  stomach  or  intestines. 

The  drug  is  frequently  employed  in  typhoid  fever,  not  only  for 
the  relief  of  tympanitis,  but  also  to  check  intestinal  hemorrhage. 

In  chronic  intestinal  catarrh,  as  well  as  in  a  catarrhal  condi- 
tion of  any  mucous  membrane,  turpentine  is  a  valuable  remedial 
agent. 

The  drug  is  an  effectual  hemostatic  when  given  internally, 
having  been  successfully  employed  in  hemoptysis,  hematemesis, 
hematuria,  menorrhagia,  purpura  hemorrhagica,  etc. 

Turpentine  is  a  very  powerful  anthelmintic  against  tape-worm. 
When  given  for  this  purpose  it  should  be  administered  in  a  single 
large  dose,  from  4-8  fluidrachms  (i 5.-30.  Cc),  together  with  a 
large  dose  of  some  purgative  like  castor-oil  to  ensure  the  prompt 
elimination  of  the  turpentine  from  the  bowels. 

As  a  cardiac  stimulant  turpentine  is  often  employed  in  low  and 
depressed  conditions  of  the  circulatory  system,  such  as  typhoid, 
yellow,  and  puerperal  fevers,  pneumonia,  capillary  bronchitis,  trau- 
matic erysipelas,  etc. 

As  has  been  suggested,  the  drug  has  a  decided  and  beneficial 
influence  upon  relaxed  and  chronic  catarrhal  conditions  of  mucous 
membranes,  rendering  this  remedy  of  great  value  in  bronchorrhea, 
chronic  bronchitis,  emphysema  with  marked  bronchial  catarrh,  etc. 
This  action  upon  the  mucous  membranes,  together  with  the  diu- 
retic properties  of  the  drug,  renders  turpentine  an  exceedingly 
valuable  remedy  in  the  treatment  of  gleet,  subacute  gonorrhea, 
chronic  cystitis,  spermatorrhea,  prostatorrhea,  pyonephrosis,  etc. 

Old  ozonized  oil  of  turpentine  is  one  of  the  best  antidotes 
and  prophylactics  in  cases  of  phosphorus-poisoning. 

So-called  atonic  incontinence  of  urine  is  frequently  benefited  by 
the  drug ;  and  Durand  has  highly  recommended  oil  of  turpen- 
tine as  a  solvent  of  biliary  calculi. 


DIURETICS.  645 

Contraindications. — Oil  of  turpentine  should  never  be  given 
to  patients  suffering  from  Bright's  disease  or  acute  inflammation 
of  the  gastro-intestinal  and  genito-urinary  tracts. 

The  drug  should  be  withheld  in  cases  of  active  hemorrhage  in 
plethoric  subjects ;  and,  while  some  authorities  recommend  turpen- 
tine in  hematuria,  others  class  this  condition  as  a  contraindication. 
If  given  in  the  latter  condition,  the  dose  should  be  small  and 
cautiously  repeated. 

Administration. — Small  doses  of  turpentine  may  be  given  on 
lumps  of  cut  sugar,  but  usually  preference  is  given  to  administra- 
tion in  the  form  of  a  capsule  or  an  emulsion,  i  fluidrachm  (4.  Cc.) 
of  mucilage  of  acacia,  if  properly  manipulated,  emulsifying  \  fluid- 
drachm  (2.  Cc.)  of  oil  of  turpentine  with  i  fluidounce  (30.  Cc.)  of 
water.  Flavoring  substances  can  be  incorporated  in  the  emulsion, 
rendering  the  preparation  not  unpleasant  to  the  taste. 

In  giving  turpentine  its  tendency  to  produce  untoward  manifes- 
tations, particularly  of  the  genito-urinary  tract,  should  be  remem- 
bered, care  being  invariably  exercised  in  the  administration  of  the 
drug. 

For  external  use  the  drug  may  be  used  in  full  strength,  diluted 
with  some  bland  oil  or  ointment,  or  applied  in  the  form  of  stupes. 

Turpentine  is  sometimes  employed  as  an  enema,  in  which  case 
it  should,  of  course,  be  mixed  with  some  bland  oil  and  mucilage 
of  acacia  in  the  form  of  an  emulsion. 


Copaiba— Copaibae— Copaiba.    TJ.  S.  JP. 

(Balsam  of  Copaiba.) 

Origin. — The  oleoresin  of  Copaiba  Langsdorffii  (Desfontaines) 
O.  Kuntze,  and  other  species  of  Copaiba,  lofty  forest  trees,  natives 
of  Central  America. 

Description  and  Properties. — A  transparent  or  translucent, 
more  or  less  viscid  liquid  of  a  pale-yellow  to  brownish-yellow 
color,  having  a  peculiar  aromatic  odor  and  a  bitter  acrid  taste. 
Insoluble  in  water ;  readily  soluble  in  absolute  alcohol,  ether,  chlo- 
roform, carbon  disulphide,  benzin,  and  fixed  and  volatile  oils. 

Copaiba  contains  a  volatile  oil,  two  resins,  copaibic  acid  (soluble 
in  absolute  alcohol  and  in  ammonia),  and  a  bitter  principle.  The 
term  "  balsam "  is  a  misnomer,  since  the  drug  contains  neither 
benzoic  nor  cinnamic  acid. 

Dose. — 5-30  minims  (0.3-2.0  Cc),  in  emulsion  or  in  capsule. 


646  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

Official  Preparation. 

Massa  Copaibse — MSssse  Copaibs — Mass  of  Copaiba. — Formula:  Copaiba, 
94;  Magnesia,  6;  Water,  a  sufficient  quantity. — Dose,  5-30  grains  (0,3-2.0  Gm.). 

Oleum  Copaibse— Olei  Copalbae— Oil  of  Copaiba. 

Z7.  8.  P. 

Origin. — A  volatile  oil  distilled  from  Copaiba. 

Description  and  Properties. — A  colorless  or  pale-yellowish 
liquid,  having  the  characteristic  odor  of  copaiba  and  an  aromatic, 
bitterish,  and  pungent  taste.  Soluble  in  about  ten  times  its  volume 
of  alcohol,  forming  a  slightly  turbid  liquid,  which  is  neutral  to 
litmus-paper.  The  drug  should  be  kept  in  well-stoppered  bottles, 
in  a  cool  place. 

Dose. — 5-15  minims  (0.3-1  Cc). 

ResTna  Copalbae— ResTnae  Copalbae— Resin  of 
Copaiba.    U.  S.  JP. 

Origin. — The  residue  left  after  distilling  off  the  volatile  oil  from 
Copaiba. 

Description  and  Properties.' — A  yellowish  or  brownish-yellow, 
brittle  resin,  having  a  slight  odor  and  taste  of  copaiba.  Soluble  in 
alcohol,  ether,  chloroform,  carbon  disulphide,  benzol,  and  amylic 
alcohol. 

Dose. — 5-15  grains  (0.3-1.0  Gm.). 

Antagonists  and  Incompatibles. — Copaiba  is  antagonized  by 
the  same  drugs  which  antagonize  turpentine.  It  is  pharmaceuti- 
cally  incompatible  with  aqueous  preparations. 

Synergists. — The  same  as  for  turpentine. 

Physiological  Action. — Externally  and  Locally. — Copaiba  has 
no  influence  of  importance,  being  but  slightly  stimulant  to  the 
skin. 

Internally. — Digestive  System. — Its  action  is  analogous  to  that 
of  turpentine  and  the  volatile  oils.  The  ingestion  of  the  drug, 
even  in  small  doses,  is  almost  always  succeeded  by  eructations 
tasting  of  copaiba. 

Copaiba  exerts  no  special  influence  upon  the  circulatory,  ner- 
vous, and  respiratory  systems. 

Absorption  and  Elimination. — The  drug  enters  the  circulation 
with  facility,  and  is,  slowly  eliminated  by  the  skin  and  mucous 
membranes  generally,  although  chiefly  by  the  kidneys.  The  resin 
which  the  drug  contains   is  a  powerful  stimulant  of  the  genito- 


DIURETICS.  647 

urinary  structures,  increasing  the  quantity,  and  to  some  extent  the 
solid  constituents,  of  the  urine.  Large  doses  irritate  the  kidneys, 
occasionally  producing  strangury,  bloody  urine,  pain  in  the  blad- 
der, etc. 

Under  the  use  of  copaiba  albumin  is  sometimes  found  in  the 
urine.  Frequently  the  nitric-acid  test  with  urine  may  give  a  reac- 
tion as  if  for  albumin,  the  conclusions  being  then  erroneous,  since 
the  resin  of  copaiba  eliminated  in  the  urine  is  by  the  action  of 
nitric  acid  precipitated  as  a  milky  cloud,  readily  diiiferentiated  from 
albumin  by  heating  the  urine  or  mixing  it  with  alcohol,  by  both  of 
which  means  the  resinous  precipitate  is  dissolved. 

Copaiba  acts  as  a  stimulant  and  disinfectant  at  the  points  of 
elimination,  in  medicinal  amounts  increasing  secretion  and  impart- 
ing to  the  secretion  from  the  kidneys,  bronchial  mucous  membrane, 
and  skin  a  peculiar,  fragrant  odor. 

Untoward  Action. — It  often  happens  that  after  a  few  days'  ad- 
ministration of  copaiba  there  is  produced  in  certain  individuals  an 
eruption,  usually  resembling  roseola,  which  later  may  be  trans- 
formed into  true  papules.  Or  the  eruption  may  be  scarlatiniform 
in  character  or  a  true  eczema  ensue.  These  eruptions  are  first 
noticeable  on  the  upper  and  lower  extremities,  backs  of  the  hands 
and  knees,  malleoli,  etc.,  and  are  attended  with  intense  itching. 

Under  the  prolonged  use  of  the  drug  there  may  occur  serious 
disturbances  of  the  digestive  and  genito-urinary  tracts. 

Poisoning. — In  addition  to  the  untoward  manifestations  already 
mentioned,  very  large  doses  of  copaiba  produce  symptoms  similar 
to  those  described  under  Turpentine.  Cases  have  been  recorded 
in  which  excessive  amounts  occasioned  paralysis  and  tetanoid 
attacks. 

Treatment  of  Poisoning. — This  should  be  the  same  as  prescribed 
under  Turpentine. 

Therapeutics. — Externally  and  Locally. — The  use  of  copaiba 
has  recently  been  revived  by  Dr.  Beach  of  Boston  as  a  protectant 
antiseptic  and  antiphlogistic  dressing  for  the  treatment  of  chronic 
and  indolent  ulcers. 

It  has  been  advocated  as  an  excellent  application  in  many 
chronic  diseases  of  the  skin,  such  as  psoriasis,  lupus,  etc.  The 
drug  has  proved  valuable  in  frost-bites,  while  Shoemaker  mentions 
it  as  a  useful  remedy  to  apply  to  "  thickened  and  irritable  conditions 
of  the  tongue,  mouth,  rectum,  vagina,  uterus,  and  urethra"  The 
same  authority  affirms  that  the   drug  sometimes   completely  re- 


648  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

moves  the  discharge  of  gleet  when  applied  directly  to  the  ure- 
thra. 

Internally. — The  principal  use  of  copaiba  is  as  a  stimulant  and 
disinfectant  of  the  genito-urinary  tract  in  cases  of  gleet,  subacute 
gonorrhea,  vaginitis,  cystitis,  pyelitis,  etc. 

In  ascites  and  dropsical  conditions,  particularly  those  due  to 
hepatic  and  cardiac  disease,  the  resin  of  copaiba  proves  a  very 
efficient  and  reliable  diuretic.  Under  prolonged  use,  however,  a 
tolerance  appears  to  be  established. 

Copaiba  is  a  valuable  remedy  in  chronic  bronchitis  and  bronchor- 
rhea  with  offensive  expectoration. 

The  drug  has  been  at  times  given  internally  with  good  results 
in  psoriasis,  urticaria,  etc.,  although  the  internal  use  of  copaiba  in 
these  disorders  is  less  common  than  formerly. 

The  drug  has  found  enthusiastic  advocates  as  a  remedy  in 
chronic  diarrhea  and  dysentery,  and  has  also  been  recommended 
in  chronic  proctitis  and  chronic  intestinal  catarrh. 

Contraindications. — The  same  as  for  turpentine. 

Administration. — The  methods  of  administration  recommended 
for  turpentine  are  applicable  to  this  drug.  It  is  claimed  that  many 
of  the  untoward  manifestations  produced  by  copaiba  may  be  pre- 
vented by  giving  the  drug  with  an  alkali.  With  this  object  in 
view  copaiba  was  associated  with  magnesia  in  the  "  Massa  Copaibse." 
Yet,  while  this  preparation  is  perhaps  less  likely  to  produce  unto- 
ward results,  it  is  undoubtedly  less  active  therapeutically  than  the 
single  drug. 

Oleum  Santali— Olei  Santali— Oil  of  Santal. 
V.  8.  P. 

(Oil  of  Sandalwood.) 

Origin. — A  volatile  oil  distilled  from  the  wood  of  Santalum 
album  L.,  a  small  tree  indigenous  in  Southern  India  and  portions 
of  the  East  Indies. 

Description  and  Properties. — A  pale-yellowish  or  yellow, 
somewhat  thickish  liquid,  having  a  peculiar,  strongly  aromatic 
odor  and  a  pungent,  spicy  taste ;  readily  soluble  in  alcohol.  It  is 
frequently  adulterated  with  oil  of  cedar. 

Dose. — 5-20  minims  (0.3-1.2  Cc). 

Physiological  Action  and  Therapeutics. — The  action  of  oil  of 
sandalwood  resembles  closely  that  of  copaiba,  and  it  may  be  given 
for  the  same  purposes  as  the  latter  drug,  although  oil  of  sandal- 


DIURETICS.  649 

wood  is  more  popular,  and  ordinarily  a  more  efficient  remedy,  for 
gonorrhea,  particularly  in  the  early  stages. 

Administration. — The  same  as  in  the  case  of  copaiba. 

Cubeba— Cubebae— Cubeb.    V.  S.  F. 

Origin. — The  unripe  fruit  of  Piper  Cubeba  Linn,  fil.,  a  climbing 
diecious  shrub  about  20  feet  (6  M.)  high,  indigenous  in  Java. 

Description  and  Properties. — Globular,  about  ^  or  |-  inch 
(4  or  5  Mm.)  in  diameter,  contracted  at  the  base  into  a  rounded 
stipe  about  i  or  f  inch  (6  or  10  Mm.)  long,  reticulately  wrinkled, 
blackish-gray,  internally  whitish  and  hollow ;  odor  strong,  spicy ; 
taste  aromatic  and  pungent.  It  contains  from  5  to  15  per  cent, 
of  a  volatile  oil,  an  odorous  principle,  cubebin,  and  a  diuretic  prin- 
ciple, cubebic  acid,  besides  resin,  fat,  wax,  and  starch. 

Dose. — 5-60  grains  (0.32-4.0  Gm.). 

Official  Preparations. 

Extractum  Cubebae  Fluidum — ExtrScti  Cubebee  Fluidi — Fluid  Extract  of 
Cubeb. — Dose,  5-60  minims  (0.32-4.0  Cc). 

Oleoreslna  Cubebae — Oleoresinae  Cubebae — Oleoresin  of  Cubeb. — Dose,  15- 
30  minims  (0.32—2.0  Cc). 

Tinctura  Cubebae — Tincturae  Cubebae — Tincture  of  Cubeb  (20  per  cent). 
— Dose,  ^-2  fluidrachms  (2.0-8.0  Cc). 

Trochlsci  Cubebae — TrocMscos  (ace.)  Cubebae — Troches  of  Cubeb.  (Each 
troche  contains  %  minim  (.043  Cc.)  of  the  oleoresin.) — Dose,  I  to  6  troches. 

Oleum  Cubebae— Olei  Cubebae— Oil  of  Cubeb. 

TJ.  S.  P. 

Origin. — A  volatile  oil  distilled  from  Cubeb. 

Description  and  Properties. — A  colorless,  pale-greenish,  or 
yellowish  liquid,  having  the  characteristic  odor  of  cubeb  and 
a  warm,  camphoraceous,  aromatic  taste.  Soluble  in  an  equal 
volume  of  alcohol.  It  should  be  kept  in  well-stoppered  bottles, 
in  a  cool  place,  protected  from  light. 

Dose. — 5-15  minims  (0.3-1.0  Cc). 

Antagonists  and  Incompatibles. — The  motor  depressants  and 
cardiac  stimulants  antagonize  the  action  of  cubeb. 

Sjmergists. — Buchu,  copaiba,  oil  of  santal,  black  pepper,  and 
many  of  the  aromatics  and  volatile  oils. 

Physiological  Action. — Externally  and  Locally. — Like  the 
aromatics  and  drugs  containing  a  volatile  oil,  cubeb  is  irritant  and 
rubefacient  when  applied  by  inunction. 


650  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Internally. — Digestive  System. — In  medicinal  amounts  cubeb  is 
an  aromatic  stomachic,  increasing  the  appetite  and  improving 
digestion.  As  is  the  case  with  other  drugs  of  this  class,  large  dos- 
age or  the  too  prolonged  use  of  small  amounts  irritates  the  stomach 
and  deranges  digestion,  cubeb  acting  as  a  laxative  and  occasioning 
a  sensation  of  heat  and  discomfort  about  the  rectum. 

Circulatory  System. — Like  other  members  of  the  Pepper  family, 
cubeb  enters  the  blood  with  facility,  and  increases  the  force  and 
frequency  of  the  heart's  action. 

Nervous  System. — No  important  action  has  been  noted. 

Respiratory  System. — There  is  no  perceptible  effect  when  the 
drug  is  given  in  medicinal  doses. 

Absorption  and  Elimination. — Cubeb  is  absorbed  and  eliminated 
with  considerable  rapidity.  It  escapes  from  the  system  chiefly  by 
the  urine,  though  the  skin  and  bronchial  mucous  membrane  share 
in  the  excretory  process.  The  drug  acts  as  an  active  stimulant 
and  disinfectant  to  the  structures  by  which  it  is  excreted,  and  is 
consequently  a  diuretic  expectorant  and  mild  diaphoretic. 

The  urine  and  the  amount  of  uric  acid  are  increased  by  cubeb, 
the  drug  appearing  in  the  urine  as  a  salt  of  cubebic  acid,  which 
may  be  precipitated  by  nitric  acid,  the  precipitate  resembling  that 
of  albumin. 

Untoward  Action. — Cubeb  occasionally  produces  great  disturb-  . 
ance  in  the  gastro-intestinal  tract,  colicky  pains,  and  diarrhea. 
The  most  frequent  untoward  manifestations,  however,  are  various 
cutaneous  eruptions,  appearing  in  the  form  of  papules,  and  often-  | 
times  as  a  diffuse  erythema.  No  febrile  symptoms  attend  these 
eruptions,  which  usually  disappear  shortly  after  the  suspension  of 
the  drug. 

Poisoning. — Although  cubeb  is  not  regarded  as  a  poison,  very 
large  doses  may  be  followed  by  all  the  symptoms  of  severe  gastro- 
intestinal irritation. 

Treatment  of  Poisoning. — The  indications  are  to  empty  the 
stomach,  favor  elimination,  and  treat  the  patient  symptomatically 
by  the  use  of  demulcents,  anodynes,  stimulants,  etc.,  as  necessary. 

Therapeutics. — Externally  and  Locally. — The  drug  is  a  de- 
servedly popular  remedy  in  many  diseases  of  the  nose  and  throat. 
The  insufflation  of  an  impalpable  powder  of  cubeb  or  the  inhala- 
tion of  smoke  from  the  burning  drug  is  an  efificient  palliative  to  the 
sense  of  oppression  arising  from  turgescence  of  the  nasal  mucous 
membrane. 


DIURETICS.  651 

The  troches  of  cubeb  are  extensively  used  for  coughs,  hoarse- 
ness, etc.  The  oil  of  cubeb  is  used  as  an  inhalant  and  as  a  local 
application  in  many  diseases  of  the  throat  and  respiratory  passages. 

Intertially. — Cubeb  is  used  internally  for  about  the  same  pur- 
poses as  copaiba,  although  by  many  physicians  considered  to  be 
inferior  to  the  latter  drug  in  genito-urinary  disorders. 

The  drug  has  been  recommended  in  certain  nervous  disorders, 
such  as  headache,  impaired  memory,  vertigo,  and  fainting,  and  has 
even  been  thought  to  prove  beneficial  in  certain  cases  of  paralysis. 

Contraindications. — The  same  as  for  copaiba. 

Administration. — Any  of  the  preparations  may  be  given.  The 
oleoresin  is  best  administered  in  capsules  or  emulsion. 

Diuretin— Diuretin— Diuretin. 

(SODIO-SALICYLATE   OF  THEOBROMINE.) 

Origin. — The  name  indicates  the  origin,  the  drug  being  a  chemi- 
cal combination  of  Theobromine  (49.7  per  cent.)  and  Salicylic 
Acid  (38.1  per  cent.).  It  is,  in  reality,  a  deiinite  double  compound 
of  Sodium  Theobromine  and  Sodium  Salicylate. 

Description  and  Properties. — A  white  powder,  soluble  in  less 
than  half  its  weight  of  hot  water,  the  solution  remaining  perfect  on 
cooling.  Sparingly  soluble  in  cold  water ;  soluble  in  warm  alco- 
hol ;  insoluble  in  chloroform  or  ether.  The  drug  has  a  disagree- 
able, soap-like  taste,  and  undergoes  decomposition  when  exposed 
to  the  air. 

Dose. — 15  grains  (i.o  Gm.);  45  to  105  grains  (2.9-7.0  Gm.) 
may  be  given  in  divided  portions  in  twenty-four  hours. 

Antagonists  and  Inoompatibles. — The  properties  of  diuretin 
being  as  yet  imperfectly  known,  it  is  impossible  to  enumerate  all 
the  antagonists,  incompatibles,  and  synergists.  The  action  of  the 
drug  would  certainly  be  retarded  by  the  cardiac  and  motor  de- 
pressants.    Acids,  both  mineral  and  vegetable,  are  incompatible. 

Synergists. — The  therapeutic  influence  of  the  drug  would 
theoretically  be  enhanced  by  caffeine,  digitalis,  and  many  of  the 
cardiac  stimulants  and  diuretics. 

Physiological  Action. — Externally  and  Locally. — There  is  none. 

Internally. — Digestive  System. — Diuretin  has  no  important  ac- 
tion, though  in  many  cases  it  may  cause  disturbance  of  digestion, 
impair  the  appetite,  and  even  occasion  nausea,  vomiting,  and 
diarrhea. 

Circulatory  System. — There  is  some  difference  of  opinion  regard- 


652  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

ing  the  effect  of  diuretin  upon  the  heart  and  blood-vessels.  Pa- 
winski  concluded,  from  a  study  of  over  50  cases,  that  the  drug 
does  not  regulate  the  heart's  action  through  any  influence  on  the 
nerves  of  that  organ,  its  effect  upon  it  bteing  due  entirely  to  the 
action  of  diuretin  in  diminishing  the  edema  by  its  diuretic  property, 
thereby  removing  the  obstacles  to  be  overcome  by  the  heart. 

This  view  is  entertained  by  Cohnstein,  Gram,  and  Schroeder,  and, 
to  judge  from  a  few  careful  experiments,  the  author  is  of  the  same 
opinion.  On  the  other  hand,  authorities  so  eminent  as  Pfeffer, 
Kress,  Hoffman,  Geissler,  Babcock,  and  Herrick  believe  that  the 
drug  strengthens  the  heart's  action  after  the  manner  of  digitalis. 

Nervous  System. — Large  and  continued  doses  frequently  occa- 
sion headache,  somnolence  or  insomnia,  with  buzzing  in  the  ears, 
and  symptoms  resembling  those  produced  by  the  salicylates. 

Respiratory  System. — Diuretin  exerts  no  direct  influence  upon 
the  respiratory  system.  Yet  dyspnea,  bronchitis,  etc.,  the  result  of 
a  dropsical  condition,  are  relieved  by  the  administration  of  the 
drug. 

Absorption  and  Elimination. — Diuretin  is  somewhat  rapidly  ab- 
sorbed, being  eliminated  mainly  by  the  kidneys,  the  process  greatly  . 
stimulating  the  renal  epithelium.  It  is  proper  to  state,  however, 
that  some  authors  attribute  the  diuretic  power  of  the  drug  to  its 
action  upon  the  circulation,  rather  than  to  any  effect  upon  the 
secreting  structures  of  the  kidney.  The  author's  experience  leads 
him  to  incline  to  the  opinion  that  the  principal  action  of  the  drug 
is  upon  the  kidneys. 

In  cases  where  diuretin  is  indicated  the  amount  of  urine  is 
increased  from  three-  to  sixfold  in  twenty-four  hours,  under  its 
administration  the  diuretic  action  of  the  drug  gradually  reaching 
its  maximum  between  the  second  and  third  days.  In  the  case  of 
healthy  persons  diuretin  has  little  influence  upon  the  amount  of 
urine  excreted. 

Untoward  Action. — In  certain  individuals  the  drug  causes  great 
disturbance  of  the  gastro-intestinal  tract,  such  as  nausea,  vomiting, 
diarrhea,  palpitation  of  the,  heart,  headache,  and  slight  fever ;  occa- 
sionally cutaneous  eruptions  may  be  present. 

Poisoning. — No  cases  of  poisoning  are  recorded. 

Therapeutics. — The  drug  is  used  exclusively  as  a  diuretic  in 
cases  of  dropsy,  ascites,  pleuritic  effusion,  etc. 

Diuretin  is  worthy  of  a  thorough  trial  for  the  removal  of  drop- 
sical fluids,  irrespective  of  the  cause. 


DIURETICS.  653 

Dr.  Herrick  of  Chicago,  who  has  not  only  devoted  much  study 
to  the  literature  of  the  subject,  but  has  also  had  a  wide  experience 
with  the  remedy,  in  a  recent  paper  on  "  Diuretin  "  sums  up  the 
medical  uses  of  the  drug  as  follows : 

"  Diuretin  is  a  diuretic  acting  by  direct  stimulation  of  the  renal 
epithelium,  and  best  suited  to  cases  in  which  there  is  general  drop- 
sical effusion.  It  is  the  best  medicinal  remedy  for  removing  drop- 
sical fluid  due  to  valvular  disease  of  the  heart  after  digitalis  and 
pure  cardiac  tonics  have  failed.  Diuretin  has  oftentimes  a  bene- 
ficial effect  in  other  circulatory  diseases  with  dropsy,  as  myocarditis, 
pericarditis,  aneurysm,  arteriosclerosis.  Its  action  is  here  more 
uncertain  than  in  valvular  disease.  In  the  dropsy  of  nephritis  it 
can  be  used  without  danger  of  irritating  the  kidney,  the  effects  in 
acute  nephritis  being  more  certain  than  in  chronic  nephritis.  Where 
the  renal  epithelium  has  undergone  too  extensive  degeneration  the 
drug  may  fail  to  act.  In  the  dropsy  of  portal  obstruction,  arid 
especially  of  cirrhosis  of  the  liver,  it  usually  fails  to  give  good 
results." 

Contraindications. — There  are  no  special  contraindications  to 
the  use  of  diuretin,  unless  it  be  in  cases  of  marked  gastric  irritation, 
when  the  drug  would  undoubtedly  aggravate  the  symptoms. 

Administration. — Diuretin  may  be  given  in  capsules  or  dis- 
solved in  some  aromatic  water  or  in  milk.  It  should  never  be 
dispensed  in  powders,  since  it  absorbs  carbonic  acid  from  the  air 
and  undergoes  decomposition. 

It  is  preferable  to  give  the  drug  in  solution  ;  and  it  can  be  easily 
associated  with  digitalis  and  similar  remedies,  but  when  used  with 
the  cardiac  remedies  the  doses  of  diuretin  should  be  smaller. 

When  giving  this  drug  in  cases  of  marked  ascites,  or  for  the 
removal  of  large  quantities  of  dropsical  fluid,  the  first  doses  should 
be  small  and  gradually  increased  to  the  maximum  amount  or  until 
the  desired  effect  be  produced,  lest  by  a  too  sudden  removal  of  the 
fluid  alarming  collapse  ensue. 

As  acids  are  incompatible  with  the  drug,  diuretin  should  not  be 
given  immediately  after  meals,  but  its  administration  postponed  for 
about  three  hours,  to  avoid  unpleasant  symptoms  arising  from  the 
action  of  the  gastric  juice  upon  the  remedy. 

The  practice  of  adding  fruit  syrups  or  juices  to  a  solution  of 
diuretin  for  the  purpose  of  rendering  it  more  palatable  should  be 
strictly  avoided,  since  the  theobromine  is  precipitated  by  the  vege- 
table acids  as  a  thick  white  sediment. 


654  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

The  maximum  daily  amount  which  can  be  safely  administered 
is  150  grains  (9.72  Gm.).  The  average  daily  amount  is  45  to  105 
grains  (2.9-7.0  Gm.),  given  in  divided  doses  of  about  15  grains 
(i.o  Gm.)  each. 

If  diuresis  is  not  increased  in  six  days,  the  use  of  the  drug 
should  be  suspended  and  recourse  to  other  treatment  adopted. 

Piperazlnum— Piperazini— Piperazin. 

(PiPERAZIDINE;    ETHYLENEIMINE;    DiETHYI.ENEDIAMINE  ;    DiSPERMINE.) 

Origin. — Obtained  by  the  action  of  Ammonia  on  Bromide  or 
Chloride  of  Ethylene. 

Description  and  Properties. — It  occurs  as  a  crystalline  solid, 
exceedingly  soluble  in  water,  the  solution  being  practically  taste- 
less. When  exposed  to  the  air  the  drug  is  very  deliquescent, 
becoming  completely  liquefied  on  long  exposure. 

Dose. — 5-15  grains  (0.3-1. o  Gm.). 

Antagonists  and  Incompatibles. — The  incompatibles  are  alka- 
loids, tannic  acid,  preparations  of  cinchona,  salts  of  iron,  alum, 
Donovan's  solution,  acetanihd,  phenacetine,  and  sodium  salicylate. 

Synergists. — Lithium  and  its  salts  and  the  lithontriptics  enhance 
the  therapeutic  action  of  piperazin. 

Physiological  Action  and  Therapeutics. — The  drug  apparently 
has  no  effect  whatever  upon  either  the  Digestive,  Circulatory,  or 
Respiratory  Systems.  Excessive  doses,  however,  have  affected  the 
Nervous  System,  producing  certain  untoward  manifestations,  such 
as  muscular  tremors,  hallucinations,  and  clonic  spasms. 

The  drug  is  non-irritating  when  apphed  to  mucous  membranes. 

Piperazin  is  rapidly  absorbed  from  the  stomach,  circulates  in 
the  blood  unchanged,  and  reaches  the  concretions  of  urates  and 
gouty  deposits,  neutralizing  and  dissolving  them,  thus  hastening 
their  removal  from  the  body.  Piperazin  may  be  detected  in  the 
urine  two  hours  after  ingestion. 

The  only  important  action  of  piperazin  is  its  property  of  dis- 
solving uric  acid,  with  which  it  forms  a  neutral  and  exceedingly 
soluble  salt,  piperazin  urate,  said  to  be  seven  times  more  soluble  in 
water  than  lithium  urate. 

The  superiority  of  piperazin  over  lithium  carbonate  as  a  uric- 
acid  solvent  has  been  indubitably  established. 

Under  the  administration  of  piperazin  there  is  an  enormous  in- 
crease in  the  amount  of  urea,  with  a  corresponding  decrease  in  the 
elimination  of  uric  acid,  indicating  that  there  is  active  oxidation. 


DIURETICS.  655 

While  greatly  increasing  the  amount  of  urea  eliminated,  neither 
the  volume  of  urine  nor  the  acid  reaction  of  that  fluid  is  ordinarily- 
influenced.  Moreover,  while  in  certain  cases  diuresis  is  consider- 
ably augmented,  the  specific  gravity  of  the  urine  is  lowered,  al- 
though the  urine  never  becomes  alkaline  or  even  neutral. 

Therapeutics. — Externally  and  Locally. — A  solution  of  pipera- 
zin  (i  to  2  per  cent.)  in  a  mixture  of  water  and  alcohol  (i  to  4,  re- 
spectively) has  been  applied  locally  to  gouty  joints  and  swellings 
with  beneficial  results.  A  similar  solution  is  equally  effective  in 
relieving  the  pain,  allaying  the  inflammation,  and  hastening  the 
healing  of  gouty  sores. 

Solutions  of  piperazin  may  be  injected  into  the  bladder  in  order 
to  dissolve  vesical  calculi. 

The  drug  has  been  recommended  for  local  hypodermic  injection 
in  gout,  although  Wittsock,  who  used  it  in  this  manner  consider- 
ably, claims  that  the  subcutaneous  administration  of  piperazin  is 
painful  and  dangerous,  causing  inflammation  with  tendency  to 
abscess. 

Internally. — Piperazin  is  one  of  the  most  useful  remedies  in  gout. 
Its  efficacy  in  this  disease  is  said  to  be  enhanced  by  combining 
with  it  phenocoU  hydrochloride  or  phenacetin. 

Renal  and  vesical  calculi  of  the  uric-acid  variety  are  dissolved 
by  the  free  administration  of  piperazin.  It  has  even  proved  bene- 
ficial in  chronic  cystitis  and  chronic  rheumatic  arthritis. 

Gruber  has  advocated  the  use  of  the  drug  in  diabetes  mellitus, 
and  it  has  proved  to  be  of  service  in  renal  colic  and  hematuria. 

It  is  in  the  uric-acid  diathesis,  however,  that  the  drug  is  par- 
ticularly useful.  The  pruritus  of  this  condition  and  other  manifes- 
tations so  frequently  resulting  from  imperfect  elimination  of  nitrog- 
enous material  are  promptly  relieved  by  the  internal  administra- 
tion of  this  remedy. 

Contraindioations. — None  of  importance  can  be  named. 

Administration. — Piperazin  is  best  given  in  aerated  water,  al- 
though it  may  be  acceptably  administered  in  distilled  water  and 
syrup,  orange  flower  water,  or  other  agreeable  vehicle. 

Saccharlnum—Saccharini— Saccharin. 

(Anhydro-ortho-sulphamin-benzoic  Acid  ;  Benzoyl-sulphonic-imide  ;  Gluside  ; 

Glucusimide.) 

Origin. — A  derivative  of  the  aromatic  series,  prepared  by  a 
complicated  process  from  Toluene. 


656  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Description  and  Properties. — A  white,  crystalline  powder,  of 
an  acid  reaction,  a  faint,  amygdaloid  odor,  and  an  intensely  sweet 
taste.  One  part  of  saccharin  in  70,000  parts  of  water  will  impart 
to  the  solution  a  decidedly  saccharine  flavor,  the  drug  being  nearly 
300  times  sweeter  than  cane-sugar. 

Saccharin  is  slightly  soluble  in  water,  1  :  400 ;  soluble  in  30 
parts  of  alcohol ;  and  freely  soluble  in  glycerin.  The  commercial 
article  is  usually  very  impure. 

Dose. — \—2  grains  (0.03-0. 12  Gm.). 

Physiological  Action. — In  a  neutral  or  alkaline  medium  sac- 
charin acts  as  an  antiseptic.  Internally  it  exerts  no  notable  influ- 
ence. It  is  said  that  when  mixed  with  food  it  interferes  with  the 
action  of  saliva  upon  starch,  and  it  is  thought  to  retard  the  action 
of  the  other  digestive  ferments.  The  drug  is  not  decomposed  in 
the  body,  and  is  ehminated  by  the  kidneys  unchanged,  increasing 
the  amount  of  chlorides  excreted  in  the  urine,  which  fluid  is  so 
influenced  by  the  drug  that  it  does  not  so  readily  undergo  fer- 
mentation. 

Therapeutics. — Externally  and  Locally. — Saccharin  is  used  as 
a  mouth-wash,  being  especially  beneficial  in  aphthce.  Felici  of 
Rome  highly  recommends  the  application  of  a  solution  of  saccharin 
in  ozena. 

Internally. — The  principal  use  of  the  drug  is  as  a  substitute  for 
sugar  in  cases  of  diabetes.  > 

Dr.  James  Little  recommends  saccharin  in  chronic  cystitis  with 
ammoniacal  urine. 

The  drug  is  extensively  used  in  various  elixirs,  syrups,  etc.  to 
overcome  the  bitterness  of  quinine  and  other  bitter  alkaloids. 

Administration. — Saccharin  should  be  given  in  solution. 


GROUP  XIV.— CATHARTICS. 

Cathartics  or  Purgatives  are  substances  which  produce  in- 
testinal evacuations— either  (i)  by  increasing  peristalsis,  (2)  by 
augmenting  secretion,  or  (3)  by  diminishing  absorption. 

Physiological  Action. — In  order  to  produce  evacuations  from 
the  bowels  drugs  act  (i)  locally — 

{a)  Upon  the  muscles  and  glands  of  the  intestines ; 

{B)  Auerbach's  and  Meissner's  ganglia ; 

(c)  Ends  of  the  afferent  nerves  in  mucous  membranes  of  the 


CATHARTICS.  657 

intestines,  passing  respectively  to  Auerbach's  and  Meiss- 

ner's  ganglia ; 
(fl?)  Ends  of  local  efferent  nerves,  passing  from  Auerbach's 

and  Meissner's  ganglia  to  the  intestinal  muscles  and 

glands. 
(2)  They  act  through  the  coordinating  mechanism— 

(a)  By  acting  upon  the  peripheral  endings  of  the  afferent 

nerves  which  pass  from  the  intestinal  mucous  membrane 

to  the  six  intestinal  centers  in  the  brain ; 
{U)  Upon  the  six  centers  in  the  brain ; 
if)  Upon  the  six  sets  of  efferent  nerves  which  pass  from  the 

six  centers  in  the  brain  through  the  various  abdominal 

ganglia  to  the  intestine,  terminating  in  Auerbach's  and 

Meissner's  ganglia  in  the  walls  of  the  arterioles ; 
(d^  Probably  by  acting  upon  certain  abdominal  ganglia,  such 

as  the  suprarenal  and  mesenteric  plexuses  and  similar 

ganglia. 
Intestinal  peristalsis  may  be  increased  by  stimulation  of — 

1 .  The  intestinal  muscles  (moderate  stimulation) ; 

2.  The  afferent  nerves  connecting  the  intestinal  mucous  mem- 

brane with  Auerbach's  ganglia; 

3.  Auerbach's  ganglia ; 

4.  The  ends  of  the  efferent  nerves  passing  from  Auerbach's 

ganglia  to  the  intestinal  muscles; 

5.  The  ends  of  the  afferent  nerves  passing  from  the.  intestinal 

mucous  membrane  to  the  brain  ; 

6.  The  motor  centers  in  the  brain  ; 

7.  The  ends  of  the  motor  nerves  terminating  in  Auerbach's 

ganglia. 
Depression  of — 

8.  The  inhibitory  motor  center ; 

9.  The  ends  of  the  inhibitory  motor  nerves  terminating  in 

Auerbach's  ganglia; 
10.  The  inhibitory  motor  center  in  the  suprarenal  plexus. 
It  will  be  seen  that  any  substance  which  stimulates  the  motor 
apparatus  or  depresses  the  inhibitory  motor  mechanism  will  increase 
peristalsis. 

Intestinal  secretion  may  be  promoted  by  stimulation  of — 

1 .  The  secretory  cells  ; 

2.  The  ends  of  the  afferent  nerves  passing  from  the  intes- 

tinal mucous  membrane  to  Meissner's  plexus ; 

42 


658  A   TEXT-BOOK  OF  MA  TERIA   MEDIC  A. 

3.  Meissner's  ganglia; 

4.  The  ends  of  the  efferent  nerves  passing  from  Meissner's 

ganglia  to  the  intestinal  glands ; 

5.  The    ends    of   afferent    nerves   in  the    intestinal    mucous 

membrane  which  pass  from  the  secretory  center  in  the 
brain ; 

6.  The  secretory  center  in  the  brain ; 

7.  The  ends  of  the  secretory  fibers  from  the  brain  terminat- 

ing in  Meissner's  ganglia. 
Depression  of — 

8.  The  inhibitory  secretory  center  in  the  brain ; 

9.  The  ends  of  the  inhibitory  secretory  fibers  from  the  brain 

terminating  in  Meissner's  plexus  ; 

10.  The  inhibitory  secretoiy  center  in  the  superior  mesenteric 

plexus  ; 

11.  The  afferent  nerves  in  the  intestinal  mucous  membrane 

which  pass  to  the  vaso-constrictor  center  in  the  brain ; 

12.  The  vaso-constrictor  center  in  the  brain; 

13.  The  ends  of  the  vaso-constrictor  nerves  from  the  brain 

terminating  in  the  ganglia  in  the  walls  of  the  arterioles. 
Similar  actions   upon  the  vaso-dilator  apparatus  would  affect 
intestinal  secretion. 

It  is  obvious  that  intestinal  secretion  may  be  promoted  by  any 
substance  which  serves  to  stimulate  the  secretory  or  the  vaso- 
dilator apparatus,  or  to  depress  the  inhibitory  secretory  or  vaso- 
constrictor mechanism. 

The  methods  by  which  absorption  is  diminished  are  not  thor- 
oughly understood,  but  it  is  known  that — 

I .  By  increasing  peristalsis  and  hastening  the  removal  of  fluid 
from  the  bowels  absorption  takes  place  less  rapidly ; 

2.  By  giving  drugs — e.  g.  magnesium  sulphate — having  high 

osmotic  equivalents,  with  a  great  affinity  for  water,  the 
absorption  of  fluid  is  prevented ; 

3.  Substances  which  in  some  manner  affect  the  columnar 

epithelium  of  the  intestinal  glands  retard  absorption ; 

4.  Drugs  which   diminish   the    circulation    in  the   intestinal 

mucous  membranes  act  as  deterrents  to  the  absorptive 
process. 
Cathartics  may  be  classified  according  to  their  various  actions, 
the  following  table  serving  to  show  how  and  where  the  various 
drugs  exert  their  several  influences : 


CATHARTICS. 


659 


/. 


Classification  according  to  their  Mode  of  Action. 


Laxatives. 
Cassia. 
Castor  oil. 
Cascara  sagrada. 

*  Glycerin. 

*  Magnesia. 

*  Magnesium  carbonate. 
Manna. 

Sulphur. 
Taraxacum. 

There  are   certain   drugs 
which  are  not  classed    as 
cathartics,  which  are  some- 
times prescribed  by  physi- 
cians as  laxatives,  such  as — 
Belladonna.* 
Ergot.* 
Hyoscyamus.* 
Nux  vomica.* 
Physostigma.* 
Stramonium.* 

Certain  articles  of  diet  are 
laxative,  such  as  bran  bis- 
cuit, brown  bread,  ginger- 
bread, oatmeal,  figs,  honey, 
molasses,  prunes,  raspber- 
ries, strawberries,  tama- 
rinds, olive  oil,  etc. 


Simple  purgatives. 
Aloes. 
Calomel.* 
Cascara  sagrada 

(full  doses). 
Castor  oil   (full 

doses). 
Ox-gall. 
Rhubarb. 
Euonymus. 
Iris. 

Juglans. 
Leptandra. 
Senna. 


Hydragogue  purgatives. 
Croton  oil  (small 

doses). 
Elaterin. 
Gamboge. 

Salines. 
Magnesium  citrate. 
Magnesium  sulphate. 
Potassium  bitartrate.* 
Potassium  sulphate. 
Potassium  tartrate.* 
Potassium  and  sodium 

tartrate. 
Sodium  phosphate. 
Sodium  sulphate. 


Drastic  purgatives. 
Cathartic  acid  (hy- 

podermically). 
Colocynth. 
Croton  oil. 
Elaterin. 
Gamboge. 
Jalap. 
Scammony. 
Podophyllin 


2.  Classification  according  to  their  Manner  of  reaching  the  Intestinal 

Mechanism. 


By  first  contact. 
Nearly  all  the  drugs  used  as  cathartics. 


By  circulation  contact. 
Belladonna.* 
Morphine.* 
Muscarine.* 
Physostigma.* 
Pilocarpine.* 
Strychnine.* 


By  excretion  contact. 
Aloes. 
Castor  oil. 
Croton  oil. 
Colocynth. 
Elateriura. 
Podophyllin. 
Rhubarb. 
Senna. 


3- 


Conditions  of  the  Intestines  affecting  the  Action  of  Drugs. 


Drugs  requiring  the  presence  of 
an  alkali  or  bile  to  act. 

Aloes. 
Elaterium. 
Gamboge. 
Jalap. 


Drugs  requiring  the  presence 
of  an  acid  to  act. 

Magnesium  carbonate.* 

Magnesia.* 


Drugs  not  requiring  the  presence 
of  either  alkali,  bile,  or  acid. 

Castor  oil. 
Colocynth. 
Croton  oil. 
Euonymin. 


(Drugs  marked  with  an  asterisk  (*)  are  here  given  in  detail ;  others  are  described 
elsewhere.) 


66o 


A    TEXT-BOOK  OF  MATERIA  MEDICA. 


Drugs  requiring  the  presence  of 
an  allcali  or  bile  to  act. 

Scammony. 
Sulphur. 


Drugs  not  requiring  the  presence 
of  either  alkali,  bile,  or  acid. 

Iris. 

Leptandra. 
Magnesium  citrate. 
Magnesium  sulphate. 
Podophyllin. 

Potassium  and  sodium  tar- 
trate. 
Rhubarb. 
Senna. 
Sodium  phosphate. 


Classification  according  to  the  Anatomical  Portion  of  the  Intestinal 
Canal  on  which  they  Act. 


Small  intestine 

:.                                  Colon. 

Descending  colon  and  rectum. 

Calomel.* 

Colocynth. 

Aloes. 

Castor  oil. 

Croton  oil. 

Jalap. 

Elaterium. 

Leptandra. 

Gamboge. 

Podophyllin. 

Magnesium  citrate. 

Rhubarb. 

Magnesium  sulphate. 

Scammony. 

Potassium  bitartrate.* 

Senna. 

Potassium  sulphate. 
Potassium  tartrate.* 
Potassium  and  sodium  tartrate. 
Sodium  sulphate. 

J.  Classification  of  Cathartics  according  to 

1  Other  Actions. 

Stomachics. 

Hepatic  stimulants  and            Galactagognes. 
cholagogues 

Rendering  the      Increasing 
milk                menstrual 
purgative.                flow. 

Aloes. 

Aloes.                                    Castor  oil. 

Aloes.                Aloes. 

Cascara  sagrada. 

Colocynth. 

Castor  oil. 

^uonymin. 

Colchicin. 

Rhubarb. 

Leptandrin. 

Euonymin. 

Senna. 

Iridin. 

Iridin. 

There    are 

Rhubarb. 

Leptandrin. 
Podophyllin. 
Sodium  phosphate. 
Sodium  sulphate. 

Cholagogues. 
Aloes.             Mercury  with  chalk.* 
Calomel.*       Pil.  hydrargyri.* 
Colocynth.     Podophyllin. 
Euonymin.     Rhubarb. 
Iridin. 

probably   some 
other  cathartics 
that  affect  the 
milk. 

(Drugs  marked  with  an  asterisk  (*)  are  here  given  iti  detail;  others  are  described 
elsewhere.) 


CATHARTICS.  66i 

It  is  apparent  that  certain  drugs  produce  various  effects,  and 
that  their  mode  of  action  varies  according  to  the  size  of  the  dose 
and  occasionally  with  the  idiosyncrasy  of  the  patient. 

Nearly  all  cathartic  drugs  act  by  some  local  influence  upon  the 
intestinal  mucous  membranes  previous  to  absorption  ;  others,  again, 
affect  the  bowels  after  they  have  entered  the  circulation — strych- 
nine, for  example,  physostigmine,  pilocarpine,  etc.,  acting  in  this 
manner. 

Certain  other  drugs,  such  as  podophyllin,  colocynth,  etc.,  if  in- 
jected into  the  circulation  are  excreted  by  the  mucous  membrane 
of  the  intestines,  and  by  their  irritation  produce  catharsis. 

The  condition  of  the  intestinal  canal  has  much  to  do  with  the 
activity  of  certain  drugs.  Thus  certain  medicines  produce  cathar- 
sis regardless  of  the  reaction  of  intestinal  fluids ;  others  are  inert 
without  the  presence  of  bile  or  other  alkaline  fluids  or  salts ;  and 
still  a  third  class  occasion  catharsis  only  when  after  ingestion  they 
come  in  contact  with  an  acid.  Of  the  last  mentioned,  magnesium 
carbonate  is  an  excellent  example,  the  drug  being  inert  unless  it  be 
acted  upon  by  an  acid  in  the  stomach  or  bowels. 

It  is  a  remarkable  fact  that,  as  is  shown  in  the  tables,  different 
cathartics  act  more  energetically  upon  different  portions  of  the  in- 
testines. The  action  of  calomel,  for  instance,  is  almost  entirely 
confined  to  the  duodenum,  while  aloes  acts  only  upon  the  descend- 
ing colon  and  the  rectum. 

In  selecting  a  cathartic,  therefore,  a  knowledge  of  the  part  of  the 
intestinal  canal  to  be  acted  upon  and  the  locality  in  which  the  drug 
operates  is  necessary  in  order  to  secure  the  most  satisfactory  results. 

Many  cathartics  contain  principles  which  render  them  tonic  to 
the  stomach  ;  others  greatly  stimulate  the  secretion  of  bile  (hepatic 
stimulants)  ;  while  the  cholagogues  merely  hasten  the  expulsion  of 
bile  from  the  intestinal  canal,  preventing  its  absorption. 

Certain   drugs,  being  excreted  in  the   milk,  which  it  renders 

purgative,  are  well  adapted  for  administration  to  the  nursing  mother 

in   order  to  produce  catharsis   in  the  infant.     Castor  oil,  greatly 

augmenting  the  secretion   of  milk,  is  an  excellent  medium  as  a 

-laxative  in  such  cases. 

Aloes  increases  the  menstrual  flow ;  other  drugs  promote  the 
secretion  of  urine,  etc. 

Therapeutics. — Cathartics  are  employed — 

I.  To  remove  feces  and  produce  a  simple  evacuation  of  the  bowels. 
The  Laxatives  are  best  adapted  for  this  purpose. 


662  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

2.  For  the  relief  of  chronic  constipation.  For  this  purpose  great 
judgment  is  requisite  in  the  selection  of  a  drug  or  combination  of 
agents,  it  being  important  to  determine  whether  there  is  diminished 
peristalsis  or  secretion  ;  whether  there  exists  an  atonic  condition  of 
the  intestinal  muscles ;  or  whether  the  disorder  is  located  in  the 
small  intestine,  the  colon,  or  the  rectum. 

3.  To  remove  frorn  the  bowels  noxious  substances  or  pathogenic 
matter.  For  this  purpose  the  mercurial  preparations,  calomel  or 
gray  powder,  are  best,  since  they  are  not  only  active  cathartics,  but 
bactericides  as  well. 

4.  To  stimulate  the  torpid  liver.  For  this  purpose  the  hepatic 
stimulants  would  naturally  be  employed. 

5.  To  lessen  the  activity  of  the  liver,  s.sv!\\y^\o\x's,  CQT\dcAAor\s.  In 
such  cases  the  cholagogue  cathartics  should  be  used. 

6.  To  deplete  the  gastro-duodenal  mucous  membrane,  where  the 
congested  and  swollen  mucous  membrane  obstructs  the  outflow  of 
bile,  resulting  in  jaundice.  In  this  condition  the  salines,  especially 
the  sodium  salts,  are  the  most  efficient  cathartics. 

7.  To  promote  absorption  and  remove  dropsical  effusions  in  cer- 
tain diseases  of  the  heart,  liver,  and  kidneys.  Here  active  cathar- 
sis is  necessary,  the  hydragogue  cathartics  being  indicated. 

8.  To  remove  urea,  etc.,  from  the  blood.  Occasionally  in  certain 
renal  diseases  the  functional  activity  of  the  kidneys  is  so  defective 
that  waste  matter,  urea,  etc.,  rapidly  accumulates  in  the  system, 
occasioning  uremic  convulsions,  coma,  or  other  serious  symptoms. 
In  such  cases  it  may  be  necessary  to  give  a  drastic  purgative,  such 
as  croton  oil,  which  acts  rapidly,  causing  profuse  watery  stools. 

9.  To  lower  the  blood-pressure  where  high  arterial  tension  aggra- 
vates a  malady,  as  at  the  onset  of  many  acute  diseases,  and  in 
cerebral  hemorrhage,  meningitis,  etc.  In  these  conditions  it  is 
necessary  to  employ  such  drugs  as,  by  dilating  the  intestinal  blood- 
vessels, drain  the  blood  away  from  other  organs  and  cause  abun- 
dant watery  discharges  from  the  bowels.  Hydragogue  or  drastic 
purgatives  answer  the  required  purpose. 

10.  For  the  relief  of  hemorrhoids,  in  which  cases  the  mild  laxa- 
tives, such  as  sulphur,  senna,  etc.,  are  serviceable. 

11.  To  aid  the  restoration  of  the  catamenia.  For  this  purpose 
aloes  is  usually  employed,  particularly  if  it  be  necessary  to  deter- 
mine more  blood  to  the  pelvic  organs.  If  depletion  be  required, 
the  selection  should  be  made  from  the  hydragogue  cathartics. 

12.  To  purge  the  nursing  infant  through  the  mother's  milk.     For 


CATHARTICS.  663 

this  purpose  such  drugs  as  rhubarb,  senna,  and  castor  oil  may  be 
administered  to  the  mother. 

13.  To  lower  the  temperature  in  fever,  in  which  cases  the  sahne 
cathartics  may  be  advantageously  employed. 

Contraindications. — Active  catharsis  by  the  more  powerful 
hydragogue  or  drastic  purgatives  would  be  contraindicated  in  ap- 
pendicitis, peritonitis,  typhlitis,  intussusception,  pregnancy;  and 
typhoid  fever,  or  Where  there  is  inflammation  of  the  mucous  mem- 
brane of  the  gastro-intestinal  tract. 

Administration. — Probably  no  group  of  medicines  demands 
greater  judgment  in  administration  than  Cathartics. 

Ordinarily,  the  efficiency  of  these  agents  is  increased  and  their 
operation  rendered  less  irritant  by  associating  drugs  acting  upon 
different  portions  of  the  alimentary  canal.  Their  action,  too,  is 
more  prompt  and  certain  when  the  remedies  are  given  upon  an 
empty  stomach  and  the  efficiency  of  their  operation  is  enhanced 
by  exercise  and  diminished  by  sleep. 

The  action  of  cathartics  is  promoted  by  the  addition  of  small 
doses  of  emetics,  mydriatics,  quinine,  and  bitters,  quinine  especially 
strengthening  the  action  of  magnesium  sulphate.  Mild  diluent 
beverages  also  promote  the  activity  of  cathartics.  Cold  applied 
to  the  abdomen,  enemata,  massage  of  the  abdominal  walls,  and 
electricity,  all  act  as  adjuvant  measures  in  the  employment  of 
purgative  medicines. 

As  has  been  previously  suggested,  a  knowledge  of  the  portion 
of  the  intestinal  canal  upon  which  the  various  cathartics  act  is  of 
primary  importance.  Thus,  if  it  be  necessary  to  influence  only 
the  duodenum,  calomel  or  podophyllin  should  be  used ;  if  the 
small  intestine,  senna  or  jalap  ;  if  the  descending  colon  or  rectum, 
aloes, — the  drugs  acting  upon  these  organs  alone. 

Moreover,  due  consideration  should  be  given  to  the  proper  time 
for  the  administration  of  the  different  cathartics,  the  resinoid  pur- 
gatives acting  best  when  taken  at  night  or  before  dinner,  and  the 
salines  when  taken  in  the  morning  before  breakfast. 

The  mode  of  administration  is  also  of  great  importance,  in 
order  to  obtain  from  these  agents  the  fullest  benefit.  The  salines, 
for  instance,  act  best  when  given  in  solution  in  either  very  cold  or 
very  hot  water,  their  activity  being  enhanced  by  association  with 
bitters,  iron,  or  sulphuric  acid.  On  the  other  hand,  the  resinoid 
drugs  should  be  administered  in  the  form  of  pills,  and  if,  for  any 
reason,  it  is  desirable  that  the  drug  should  enter  the  intestine  with- 


664  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

out  coming  in  contact  with  the  mucous  membrane  of  the  stomach, 
the  drug  may  be  given  in  the  form  of  pills  coated  with  keratin, 
which  is  unaffected  by  the  gastric  juice,  but  readily  dissolved  in 
the  alkaline  intestinal  juices. 

In  the  following  detailed  description  cathartic  drugs  are  grouped 
according  to  their  modus  operandi,  the  mildest  drugs  or  laxatives 
being  first  considered. 

LAXATIVES. 

Certain  substances  never  produce  active  purgation,  but  simply 
unload  the  bowels  by  slightly  increasing  both  peristalsis  and  secre- 
tion, expelling  the  feces  in  a  softened  though  solid  and  formed 
condition,  without  irritation  and  without  perceptibly  affecting  the 
general  system. 

These  agents  are  especially  useful  where  we  wish  to  evacuate 
the  bowels  with  the  least  possible  local  derangement,  as  in  simple 
constipation  from  dyspepsia,  in  children,  pregnant  women,  con- 
valescents from  acute  disease,  or  patients  affected  with  hemorrhoids, 
hernia,  affections  of  the  rectum  or  womb,  typhoid  fever,  early 
simple  diarrhea,  or  in  inflammation  or  surgical  operations  about 
the  abdomen  and  pelvis. 

Besides  the  laxative  drugs  mentioned  below  there  are  many 
articles    of    diet   which    by   purely    mechanical    action    produce 
catharsis,  such  as  oatmeal,  brown  bread,  whole  flour,  molasses,  < 
prunes,  figs,  etc. 


Cassia  Fistula— Cassiae  FTstulae— Cassia  Fistula. 

XT.  S.  P. 

(Purging  Cassia.) 

Origin. — The  fruit  of  Cassia  Fistula  L.,  a  tree  30  to  50  feet 
(9-15  M.)  high,  indigenous  in  the  East  Indies. 

Description  and  Properties. — Cylindrical,  i  J  to  2  feet  (45-60 
Cm.)  long,  nearly  i  inch  (25  Mm.)  in  diameter,  blackish-brown, 
somewhat  veined,  the  sutures  smooth,  forming  two  longitudinal 
bands ;  indehiscent,  internally  divided  transversely  into  numerous 
cells,  each  containing  a  reddish-brown,  glossy,  flattish-ovate  seed 
imbedded  in  a  blackish-brown  sweet  pulp ;  odor  resembling  that 
of  prunes. 

Dose. — 1-2  drachms  (4.0-8.0  Gm.). 


CATHARTICS.  665 

Official  Preparation. 

ConfSctio  SSnnae — Confectionis  SSnnae — Confection  of  Senna. — Described 
Tinder  Senna,  p.  681. 

Physiological  Action  and  Therapeutics. — Cassia  is  a  mild  and 
pleasant  laxative.  It  is  seldom  given  alone,  however,  but  forms  an 
ingredient  in  the  confection  of  senna. 

Oleum  Riclni— Olei  RicTni— Castor  Oil.    TJ.  S.  P. 

Origin. — A  fixed  oil  expressed  from  the  seed  of  Ricinus  com- 
munis L.,  a  plant  indigenous  in  Southern  Asia  and  cultivated  in 
temperate  countries  for  ornament  and  other  purposes,  remaining 
a  large  annual. 

Description  and  Properties. — A  pale-yellowish  or  almost  color- 
less, transparent,  viscid  hquid,  having  a  faint,  mild  odor  and  a 
bland,  afterward  slightly  acrid  and  generally  offensive  taste.  Solu- 
ble in  an  equal  volume  of  alcohol  and  in  all  proportions  in  abso- 
lute alcohol.     Castor  oil  should  be  kept  in  well-stoppered  bottles. 

Dose. — \-2  fluidounces  (8.0-60.  Cc.) 

Physiological  Action. — Externally  and  Locally. — Castor  oil — 
like  other  bland  fixed  oils,  such  as  almond  oil,  olive  oil,  etc. — is 
sedative  and  protective  when  applied  to  the  skin  or  mucous 
membranes. 

Internally. — The  only  important  action  is  upon  the  gastro- 
intestinal tract,  the  effects  of  the  drug  being  those  of  a  mild  yet 
efficient  purgative.  Castor  oil  requires  from  four  to  six  hours  to. 
operate,  its  action  being  usually  attended  with  little  pain.  Indeed, 
the  author  is  inclined  to  attribute  anodyne  properties  to  the  drug, 
since  it  has  frequently  occurred  to  him  in  practice  that  a  dose  of 
castor  oil  given  to  a  child  suffering  with  colicky  pains,  while  pro- 
ducing no  movement  of  the  bowels,  served  to  allay  the  distress 
and  cause  the  patient  to  sink  into  a  quiet  sleep. 

The  purgative  principle  of  castor  oil  rapidly  enters  the  blood, 
increasing  the  secretion  of  the  mother's  milk  and  imparting  to  it 
purgative  properties. 

The  leaves  of  the  castor-oil  plant,  applied  to  the  breasts  in  the 
form  of  a  poultice,  greatly  augment  the  secretion  of  milk. 

Castor  beans  have  in  several  cases  caused  the  death  of  persons 
who  have  eaten  them.  The  symptoms  were — violent  abdominal 
pain,  vomiting,  purging,  collapse,  and  fatal  results.  Post-mortem 
examinations  have  revealed  evidences  of  severe  inflammation  in 
the  stomach  and  intestines. 


666  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Castor  oil  should  not  be  used  as  an  habitual  laxative,  its  con- 
tinual employment  being  liable  to  occasion  constipation  with  all 
its  attendant  evils. 

Therapeutics. — Castor  oil  is  used  alone  or  associated  with  bal- 
sam of  Peru  as  a  sedative  protectant  dressing  for  superficial  ulcera- 
tions. The  drug  is  also  serviceable  in  various  diseases  of  the  skin 
and  mouth. 

It  is  probably  superior  to  all  other  laxatives,  and  is  applicable 
to  all  conditions  for  which  laxatives  are  employed.  In  large  doses 
it  is  one  of  the  best  purgatives  to  give  in  conjunction  with  an 
anthelmintic. 

Administration. — The  unpleasant  taste  of  castor  oil  is  the  only 
objection  to  its  use.  Yet  it  can  be  rendered  quite  palatable  by 
mixing  it  with  an  equal  quantity  of  glycerin,  to  which  may  be 
added  a  few  drops  of  oil  of  cinnamon  or  oil  of  wintergreen. 

Various  other  devices  for  disguising  the  taste  have  been  adopted,, 
such  as  enveloping  the  oil  in  the  froth  of  beer,  ale,  o/  porter,  or 
washing  out  the  mouth  with  brandy  or  whiskey  previous  to  admin- 
istration, and  allowing  the  patient  to  swallow  the  oil  quickly,  when 
it  will  not  adhere  to  the  mouth  and  fauces,  especially  if  followed 
by  a  drink  of  some  alcoholic  Hquid. 

In  the  form  of  an  emulsion  the  taste  of  the  oil  is  well  disguised. 
There  are  also  soft  capsules  of  castor  oil  which  are  of  course  taste- 
less, yet  they  are  too  bulky  to  be  popular. 

Castor-oil  emulsion  may  be  used  as  an  enema  when  a  mild 
injection  is  required. 

Rhamnus  Purshiana— Rhamni  Purshianae-Cas- 
cara  Sagrada.     JJ.  S.  I*. 

Origin. — The  bark  of  Rhamnus  Purshiana  D.  C,  a  shrub  or 
small  tree  15  to  20  feet  (4.5-6  M.)  high,  indigenous  on  the  Pacific 
coast  of  North  America  from  the  British  possessions  southward  to 
Northern  California. 

Description  and  Properties. — Quills  or  curved  pieces  about 
i  to  4  inches  (3-10  Cm.)  long  and  about  -^  inch  (2  Mm.)  thick; 
outer  surface  brownish-gray  and  whitish,  the  young  bark  with 
numerous,  rather  broad,  pale-colored  warts  ;  inner  surface  yellow- 
ish to  Hght  brownish,  becoming  dark  brown  with  age ;  smooth  or 
finely  striate,  fracture  short,  yellowish,  in  the  inner  layer  of  thick 
bark  somewhat  fibrous  ;  inodorous  ;  taste  bitter. 

The  bark  contains  red,  yellow,  and  brown  resins,  tannic,  malic. 


CATHARTICS.  667 

and  oxalic  acids,  a  volatile  oil,  and  a  neutral,  crystalline   sub- 
stance. 

Dose. — 30-60  grains  (2.0-4.0  Gm.). 

Official  Preparation. 
ExtrSctum   Rhamni   Purshianae    Fluidum— ExtrScti   RhSmni   Purshianse 
Fluidi— Fluid  Extract  of  Rhamnus  Purshiana.— Z>oj.',  %-\  fluidrachm  r  I  0-40 
Cc).  ^  ' 

Unofficial  Preparations. 

Certain  pharmaceutical  cliemists,  in  order  to  overcome  the  bitter  taste  of  cascara 
have  devised  various  preparations,  such  as — 

Cascara  Cordial. 

Aromatic  Fluid  Extract  of  Cascara. 

Elixir  of  Cascara,  etc. 

Messrs.  Parke,  Davis  &  Co.  of  Detroit  offer  a  concentrated  preparation  of  the  drug, 
known  as  Cascarin,  which  is  almost  tasteless  and  soluble  in  water.  Dose,  %-%,  grain 
(0.01-0.03  Gm-)- 

Physiological  Action. — Cascara  sagrada  is  a  peculiarly  efficient 
laxative,  although  in  certain  individuals  it  appears  to  be  inert  unless 
associated  with  other  purgatives.  The  bitter  principle  it  contains 
gives  to  the  drug  stomachic  properties,  and  it  is  also  said  to  stimu- 
late slightly  the  functional  activity  of  the  liver. 

The  action  of  cascara  is  seldom  attended  with  irritation  or  un- 
pleasant symptoms,  the  drug  requiring  from  six  to  ten  hours  to 
operate. 

Therapeutics. — Cascara  is  a  very  valuable  laxative,  being  em- 
ployed chiefly  to  overcome  habitual  constipation  due  to  simple  tor- 
por of  the  colon  without  associated  disease.  The  drug  is  not 
adapted  for  rapid  evacuation  of  the  bowels,  but  rather  for  regulating 
their  action. 

Administration. — The  fluid  and  solid  extracts  are  usually  em- 
ployed, although  the  cascara  cordial  and  the  aromatic  fluid 
extract,  while  requiring  larger  doses,  are  so  palatable  that  they 
have  become  deservedly  popular. 

Whatever  be  the  preparation  used  in  cases  of  habitual  consti- 
pation, it  should  be  given  in  small  but  repeated  doses,  gradually 
diminished  until  a  natural  action  of  the  bowels  shall  have  been 
established.  The  drug  should ,  be  administered  upon  an  empty 
stomach  and  in  as  diluted  a  condition  as  possible. 

Mag-nesia—Mag-nesiae— Magnesia.    JJ.  S.  I*. 

(Light  Magnesia;  Calcined  Magnesia.) 
Origin,  description,  and  properties  given  under  "Alkalies,"  p.  1 56. 
Dose. — 5-60  grains  (0.32-4.0  Gm.). 


668  A    TEXT-BOOK  OF  MATERIA    MEDIC  A. 

Magnesii  Carbonas— Magnesii  Carbonatis— Magr- 
nesium  Carbonate.    TJ.  S.  P- 

Origin,  description,  and  properties  given  under  "  Alkalies,"  p. 
156. 

Dose. — ^2  drachms  (1.0-8.0  Gm.). 

Physiological  Action. — Both  magnesia  and  magnesium  car- 
bonate are  mild  antacid  laxatives,  requiring  the  presence  of  an 
acid  in  the  stomach  and  bowels  to  render  them  active.  Occasion- 
ally, when  there  is  marked  acidity  of  the  stomach,  magnesium 
carbonate  occasions  flatulence. 

When  taken  in  large  amounts  or  for  a  long  time  magnesia  tends 
to  accumulate  in  the  intestines.  This  untoward  effect  may  be  pre- 
vented by  administering  with  the  drug  lemonade,  the  acid  of  which 
increases  the  solubility  of  the  magnesia. 

Therapeutics. — Magnesium  carbonate  as  a  protective  powder 
is  an  effective  agent  in  the  treatment  of  dermatitis  of  the  external 
auditory  passage.  The  drug  is  a  valuable  antidote  to  counteract 
the  effects  of  phosphorus-poisoning  in  the  throat. 

Both  MAGNESIA  and  magnesium  carbonate  are  mild  alkalies, 
and  may  be  used  for  the  same  purposes  as  the  alkalies.  They  are 
serviceable  antidotes  to  poisoning  from  mineral  and  oxalic  acids 
and  many  mineral  salts.  They  are  pleasant  laxatives,  being  ex- 
tensively employed  for  children. 

Manna— Mannae— Manna.    U.S.  P. 

Origin. — The  concrete,  saccharine  exudation  of  Fraxitius  Ornus 
L.,  a  slender  tree  indigenous  on  the  northern  shore  of  the  Mediter- 
ranean from  Asia  Minor  west  to  Spain. 

Description  and  Properties. — Flatfish,  somewhat  three-edged 
pieces,  about  8  inches  (20  Cm.)  long  and  2  inches  (5  Cm.)  broad 
(usually  smaller),  friable,  externally  yellowish-white,  internally 
white,  porous,  and  crystalline;  or  fragments  of  different  sizes, 
brownish-white  and  somewhat  glutinous  on  the  surface,  internally 
white  and  crystalline  ;  odor  honey-like ;  taste  sweet,  slightly  bitter, 
and  faintly  acrid.  Manna  contains  a  resin,  the  purgative  principle, 
besides  mannite,  fraxin,  and  sugar. 

Dose. — ^i  ounce  (16.0-32.0  Gm.),  dissolved  in  hot  water. 

Official  Preparation. 

Infusum  SSnnae  CompOsitum — Infusi  SSnnae  CompSsiti— Compound  Infu- 
sion of  Senna.— See  Senna,  p.  681. 


CATHARTICS.  669 

Physiological  Action  and  Therapeutics. — Manna  is  a  laxative, 
cholagogue,  and  nutrient.  Its  mild  laxative  action  renders  the 
drug  peculiarly  efficient  in  constipated  conditions  of  pregnant 
women,  and  children  and  persons  suffering  from  piles  or  irritation 
of  the  genito-urinary  tract. 

The  drug  is  slow  in  its  action,  tending  to  confine  the  bowels 
after  the  primary  laxative  effect. 

Sulphur  Sublimatum— Sulphuris  Sublimati— Sub- 
limed Sulphur,    v.  S.  JP. 

Origin. — Obtained  from  Crude  Sulphur  by  sublimation. 

Description  and  Properties. — A  fine  yellow  powder,  having  a 
slight  characteristic  odor  and  a  faintly  acid  taste.  Insoluble  in 
water ;  slightly  soluble  in  absolute  alcohol ;  more  readily  soluble 
in  benzin,  benzol,  oil  of  turpentine  and  many  other  oils,  as  well  as 
in  ether,  chloroform,  and  boiling  aqueous  solutions  of  alkaline 
hydrates. 

Dose. — 15-60  grains  (1.0-4.0  Gm.). 

Official  Preparations. 

SfilphurLotum — Sfllphuris  Loti — Washed  Sulphur. —  Origin. — Sublimed  Sul- 
phur, loO;  Water,  100;  Ammonia  Water,  10;  digested,  filtered,  drained,  and  dried. 

Description  and  Properties. — A  fine  yellow  powder  without  odor  or  taste.  Insoluble 
in  water,  but  soluble  in  the  substances  which  dissolve  sulphur. 

Dose. — 15-60  grains  (1.0-4.0  Gm.). 

UnguSntum  Stilphuris — Ungu6nti  Siilphuris— Sulphur  Ointment. — Washed 
Sulphur,  300 ;  Benzoinated  Lard,  700.     For  external  use. 

Washed  sulphur  is  an  ingredient  of  compound  liquorice  powder. 

Sulphur  Praecipitatum— Sulphuris  Prsecipitati— 
Precipitated  Sulphur.    V.  S.  I*. 

(Milk  OF  Sulphur  ;  Lac  Sulphur.) 

Origin. — Sublimed  Sulphur  is  boiled  with  Slaked  Lime  and 
Water.  To  the  solution  is  added  Hydrochloric  Acid,  which  throws 
down  Sulphur  as  a  fine  precipitate,  the  powder  being  washed  and 
dried. 

Description  and  Properties. — A  fine  amorphous  powder  of  a 
pale-yellow  color,  without  odor  or  taste.     Insoluble  in'  water. 

Dose. — 15-60  grains  (1.O-4.O  Gm.). 

Physiological  Action. — Externally  and  Locally. — Sulphur  is  an 
active  parasiticide,  antiseptic,  and  keratoplastic  agent.  Upon  the 
skin  the  drug  of  itself  has  no  influence ;  a  portion  of  it,  however. 


670  A    TEXT-BOOK  OF  MA  TERIA   MEDIC  A. 

is  converted  into  hydrogen  sulphide,  which  acts  as  a  mild  cutane- 
ous irritant. 

Internally. — As  observed,  sulphur  proper  has  no  action  either 
externally  or  locally,  although  it  is  a  normal  constituent  of  nearly 
all  the  solids  and  fluids  of  the  body.  When  ingested  some  of  it 
is  converted  into  hydrogen  sulphide  and  other  sulphides,  which 
increase  the  intestinal  secretions  and  promote  peristalsis. 

The  drug  is  chiefly  excreted  with  the  stools,  which  are  rendered 
soft  and  semi-liquid.  A  portion  of  the  hydrogen  sulphide  formed 
is  eliminated  through  the  kidneys,  lungs,  skin,  and  milk-glands. 
The  drug  is  usually  found  in  the  urine  as  sulphate. 

There  is  imparted  to  the  breath  the  offensive  odor  of  hydrogen 
sulphide,  and  the  minute  portion  eliminated  through  the  skin  is  suf- 
ficient to  discolor  silver  ornaments  in  contact  with  the  body-surface. 

While  hydrogen  sulphide  is  a  powerful  poison,  decomposing 
the  blood  and  paralyzing  the  nervous  and  muscular  systems,  the 
amount  formed  and  absorbed  under  the  administration  of  sulphur 
is  too  small  to  produce  marked  toxic  symptoms,  even  when  large 
amounts  of  sulphur  have  been  ingested,  there  is  produced  only 
violent  vomiting  and  purging,  a  slight  elevation  of  temperature, 
and  a  distinct  odor  of  hydrogen  sulphide  in  the  breath. 

When  sulphur  is  used  in  full  doses  for  a  long  time,  it  tends  to 
impair  the  quality  of  the  blood  and  produce  muscular  weakness. 
Occasionally  untoward  manifestations,  such  as  miliary  eruption  and 
eczema,  accompany  either  the  external  application  or  the  ingestion 
of  the  drug. 

As  a  laxative  sulphur  is  slow  and  mild,  although  it  occasionally 
causes  considerable  flatus,  in  some  cases  rendering  the  drug  objec- 
tionable as  a  purgative. 

Therapeutics. — Externally  and  Locally. — While  classed  among 
laxative  drugs,  sulphur  is  a  most  eiificient  remedy  in  many  diseases 
of  the  skin,  nose,  throat,  etc.,  the  external  uses  of  sulphur  being 
very  numerous. 

The  drug  is  perhaps  the  most  serviceable  parasiticide  we  possess 
in  scabies,  sulphur  ointment  well  rubbed  into  the  skin  being  usually 
sufficient  to  destroy  the  parasite. 

Even  diseases  induced  by  vegetable  parasites,  such  as  tinea 
versicolor,  etc.,  are  cured  by  inunctions  of  sulphur  ointment. 

The  drug  is  successfully  employed  in  the  treatment  of  infil- 
trated eczema,  impetigo,  sycosis,  ecthyma,  acne,  comedo,  and  psoriasis. 

The  flowers  of  sulphur  is  an  old  domestic  remedy,  and  quite 


CATHARTICS.  671 

an  eiificient  one,  in  diphtheria  and  pharyngitis.  Finally,  Coroden 
and  Duchane  have  both  reported  the  successful  treatment  of 
sciatica  by  enveloping  the  affected  limb  in  precipitated  sulphur, 
the  profuse  sweating  induced  being  followed  by  a  decided  allevi- 
ation of  pain. 

When  SULPHUR  is  burned  sulphur  dioxide  is  formed,  a  powerful 
germicide.  By  the  fumes  rooms  and  clothing  may  be  disinfected, 
fumigation  by  sulphur  being  a  common  procedure  to  destroy 
the  germs  of  typhoid  fever,  tuberculosis,  cholera,  diphtheria,  small- 
pox, etc. 

Internally. — The  principal  internal  use  of  sulphur  is  as  a  mild 
laxative,  the  drug  being  especially  indicated  for  persons  afflicted 
with  hemorrhoids  or  anal  fissure. 

Lozenges  are  prepared  containing  sulphur  and  cream  of  tartar, 
which,  if  taken  daily  for  some  time,  will  overcome  habitual  consti- 
pation, being  especially  serviceable  in  constipation  due  to  disease 
of  the  liver. 

Sulphur  has  been  used  internally,  and  occasionally  with  con- 
siderable success,  in  bronchitis,  chronic  rheumatism,  and  ecser7ta 
attended  with  much  itching. 

Administration. — Sulphur  may  be  given  in  the  form  of  loz- 
enges or  mixed  with  molasses — either  alone  or  associated  with  cream 
of  tartar,  which  is  said  to  enhance  the  action  of  sulphur.  Milk 
and  syrup  have  been  used  as  vehicles  in  the  administration  of  the 

drug. 

Sulphurous  baths,  both  natural  and  artificial,  have  been  em- 
ployed in  the  treatment  of  rheumatism,  gotit,  and  some  cutaneous 
affections.  Not  only  for  these  purposes,  but  for  their  laxative 
influence  as  well,  sulphurous  waters  are  held  in  great  repute. 

Taraxacum— Taraxaci— Taraxacum.    JJ.  S.  r. 

(Dandelion.) 

Origin.— The  root  of  Taraxacum  officinale  Weber,  a  perennial, 
acaulescent  herb  found  in  most  countries  of  the  northern  hemi- 
sphere. 

Description  and  Properties.- Slightly  conical,  about  12  inches 
(30  Cm.)  long  and  \  to  i  inch  (12-25  Mm.)  thick  above,  crowned 
with  several  short,  thickish  heads,  somewhat  branched,  dark  brown, 
longitudinally  wrinkled ;  when  dry  breaking  with  a  short  fracture, 
showing  a  yellowish,  porous  central  axis  surrounded  by  a  thick,' 


673  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

white  bark  containing  numerous  milk-vessels  arranged  in  con- 
centric circles  ;   inodorous  ;  bitter. 

The  drug  contains  a  bitter  principle,  taraxdcin,  besides  inulin,_ 
resin,  sugar,  and  mucilaginous  substances. 

Dose. — 1-4  drachms  (4.0-1 5.0  Gm.). 

Official  Preparations. 

Extractum  TarSxaci — ExtrScti  TarSxaci — Extract  of  Taraxacum. — Dose, 
5-60  grains   {0.3-4.0  Gm.). 

ExtrSctum  TarSxaci  Fluidum — ExtrScti  TarSxaci  Fluidi — Fluid  Extract 
of  Taraxacum. — Dose,  1-4  fluidrachms  (4.0-15.0  Cc). 

Physiological  Action  and  Therapeutics. — Taraxacum  is  a 
stomachic  tonic,  diuretic,  laxative,  cholagogue,  and  feeble  hepatic 
stimulant.  It  has  been  a  popular  remedy  for  constipation  associated 
with  hepatic  congestion  and  atonic  dyspepsia,  yet  the  drug  is  now  less 
employed  than  formerly,  in  actual  practice  being  usually  united 
with  other  laxatives. 

The  extract  or  fluid  extract  may  be  given,  the  latter  and  the 
expressed  juice  being  the  more  active. 

SIMPLE  PURGATIVES. 

These  difier  from  laxatives  only  in  degree,  the  former  being 
more  active,  exciting  greater  peristaltic  action  and  causing  a  larger 
secretion  from  the  intestinal  glands.  Simple  purgatives  usually  oc- 
casion one  or  more  copious  and  somewhat  liquid  stools,  frequently 
accompanied  by  considerable  irritation  and  griping. 

Aloe— Aloes— Aloes.    TJ.  S.  P. 

Origin. — The  inspissated  juice  of  the  leaves  of  Aloe  {A.  vera 
(L.)  Webb;  A.  Perryi  Baker),  a  plant  resembling  the  so-called 
century  plant  {Agave  Americana),  indigenous  in  India  and  North- 
eastern Africa,  and  naturalized  along  the  shores  of  the  Mediter- 
ranean and  in  the  West  Indies. 

Official  Varieties. 

Aloe  BarbadSnsis  —  Aloes  BarbadSnsis  —  Ba'rbadoes  Aloes  (CuRAgoA. 
Aloes). —  Origin. — Prepared  from  Aloe  vera. 

Habitat. — Island  of  Barbadoes. 

Description  and  Properties. — Hard  masses,  orange-brown,  opaque,  translucent  on 
the  edges;  fracture  waxy  or  resinous,  somewhat  conchoidal;  odor  saffron-like;  taste 
strongly  bitter. 


CATHARTICS.  673 

Dose. — \-\o  grains  (0.03-0.6  Gm.). 

Aloe  Socotrina — Aloe  Socotrmse — Socotrine  Aloes. —  Origin. — Obtained  from 
Aloe  Perryi, 

Habitat. — Island  of  Socotra  in  the  Strait  of  Bab-el-Mandeb. 

Description  and  Properties. — Hard  masses,  occasionally  soft  in  the  interior,  opaque, 
yellowish-brown,  orange-brown,  or  dark  ruby-red,  not  greenish,  translucent  on  the  edges ; 
fracture  resinous,  somewhat  conchoidal.  When  breathed  upon  it  emits  a  fragrant,  saf- 
fron-like odor.  Taste  peculiar,  strongly  bitter.  Almost  entirely  soluble  in  alcohol  and 
in  4  parts  of  boiling  water.  The  aqueous  solution  becomes  turbid  on  cooling  and  yields 
a  deposit.     Examined  under  the  microscope,  Socotrine  aloes  exhibits  numerous  crystals. 

The  active  principle  of  the  various  Aloes  is  alo'in,  a  neutral  prin- 
ciple, varying  in  chemical  composition  and  physical  properties 
according  to  the  species  from  which  it  is  derived ;  thus  the  sub- 
stance from  Barbadoes  aloes  (barbaloin)  is  soluble  in  60  parts  of 
water,  20  parts  of  alcohol,  and  470  parts  of  ether ;  that  from  Soco- 
trine aloes  (socaloin)  is  soluble  in  60  parts  of  water,  30  parts  of 
absolute  alcohol,  and  380  parts  of  ether. 

Natalo'in,  obtained  from  the  unofficial  Cape  aloes,  may  be  distinguished  from  the 
official  aloin  by  heating  the  former  with  a  drop  or  two  of  sulphuric  acid  and  exposing  it 
to  the  vapor  of  nitric  acid,  when  nataloin  changes  to  a  blue  color;  barbaloin  and  soca- 
loin are  unaffected  by  this  test.  Nitric  acid  applied  to  barbaloin  gives  a  crimson  color, 
which  rapidly  fades ;  the  crimson  color  imparted  to  nataloin  is  permanent,  while  no 
color  is  produced  when  nitric  acid  is  applied  to  socaloin. 

Dose. — \-\o  grains  (0.03-0.6  Gm.). 

Official  Preparations. 

ExtrSctum  Aloes — Extract!  Aloes— Extract  of  Aloes. — Dose,  J-6  grains 
(0.03-0.4  Gm.). 

Aloe  Purificata — Aloes  Purificatae — Purified  Aloes. — Dose,  ^-10  grains  (0.03- 
0.6  Gm.). 

Extrilctum  Colocynthidis  Cotnp6situin — ExtrScti  Colocynthidis  Compfisiti 
— Compound  Extract  of  Colocynth. — Dose,  5-25  grains  (0.3-1.6  Gm.). 

The  following  official  preparations  are  prepared  from  purified  aloes  : 

Pllulae  Aloes — Pllulas  (ace.)  Aloes — Pills  of  Aloes. — Dose,  i  to  4  pills. 

Pilulse  Aloes  et  Asafcetidse — Pllulas  (ace.)  Aloes  et  Asafoetidse — Pills  of 
Aloes  and  Asafetida. — Each  pill  contains  about  i\  grains  (0.085  Gm.)  of  each. — 
Dose,  I  to  5  pills. 

PHulae  Aloes  et  F6rri— Pilulas  (ace.)  Aloes  et  FSrri— Pills  of  Aloes  and 
Iron. — Each  pill  contains  about  i  grain  (0.06  Gm.),  each,  of  Aloes,  dried  Ferrous  Sul- 
phate, and  Aromatic  Powder. — Dose,  I  to  4  pills. 

Pllulje  Aloes  et  Mastiches— Pllulas  (ace.)  Aloes  et  Mastiches— Pills  of 
Aloes  and  Mastich.— Each  pill  contains  about  2  grains  (0.12  Gm.),  together  with 
Mastich  and  Red  Rose. — Dose,  I  to  3  pills. 

PJlulse  Aloes  et  Myrrhae— Pilulas  (ace.)  Aloes  et  Myrrhae— Pills  of  Aloes 
and  Myrrh.— Each  pill  contains  2  grains  (0.12  Gm.),  together  with  Myrrh  and  Aromatic 
Powder. — Dose,  I  to  3  pills. 
43    :; 


674  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Pllulae  Rhei  CompSsitae — Pllulas  (ace.)  Rhei  CompSsitas— Compound  Pills 
of  Rhubarb. — Each  pill  contains  i  grain  (0.06  Gm.)  of  Aloes. — Dose,  I  to  3  pills. 

Tinctura  Aloes — Tincturae  Aloes — Tincture  of  Aloes  (10  per  cent.). — Dose, 
\-\  fluidrachm  (2.0-4.0  Cc). 

Tinctura  Aloes  et  MJ^rrhse — Tinctiirse  Aloes  et  Myrrhse — Tincture  of  Aloes 
and  Myrrh  (10  per  cent,  of  each,  with  Glycerin  10  per  cent.). — Dose,  1-2J  fluidrachras 
(2.0-10.0  Cc). 

Tinctiira  Benzoini  CompSsita — -Tinctiirae  Benzoini  CompSsitae — Compound 
Tincture  of  Benzoin  (2  per  cent,  of  Aloes). — Dose,  10-40  minims  (0.6-2.6  Cc). 

Aloinum — Aloini — Aloin.  U.  S.  P. — Origin. — A  neutral  principle  obtained  from 
several  varieties  of  Aloes. 

Description  and  Properties. — Minute,  acicular  crystals,  or  a  micro-ciystalline  pow- 
der, varying  in  color  from  yellow  to  yellowish-brown ;  odorless  or  possessing  a  slight 
odor  of  aloes,  of  a  characteristic,  bitter  taste,  and  permanent  in  the  air.  The  solubilities 
of  barbaloin  and  socaloin  are  given  above. 

Dose. — J-2  grains  (0.03-0.12  Gm.). 

Physiological  Action. — Aloes  has  no  local  action,  although 
the  drug  is  readily  absorbed  from  ulcers  or  abraded  surfaces. 

Internally,  it  is  stomachic,  increasing  the  secretions  from  the 
gastro-intestinal  tract.  It  pi:obably  increases  the  secretion  of  bile. 
Its  principal  action  appears  to  be  upon  the  colon,  the  muscular 
coat  of  which  it  stimulates,  besides  augmenting  the  secretion  from 
the  large  intestine. 

In  from  ten  to  fifteen  hours  after  the  ingestion  of  the  drug  it 
causes  soft,  dark-colored  evacuations,  its  action  being  usually 
attended  with  more  or  less  griping  pain. 

The  blood-supply  to  the  lower  bowel  and  pelvic  viscera  is 
increased  by  aloes ;  and  the  drug,  if  used  habitually,  may  bring 
on  or  aggravate  hemorrhoids.  The  menstrual  function  is  stimu- 
lated, the  drug  being  quite  a  decided  emmenagogue. 

Aloes  is  readily  absorbed ;  it  is  thrown  off  through  the  bowels 
and  kidneys,  and  is  found  also  in  the  milk. 

Therapeutics. — The  principal  use  of  aloes  is  as  a  purgative  in 
habitual  constipation  due  to  a  torpid  condition  of  the  large  intestine. 
Jaundice  resulting  from  hepatic  congestion  is  well  treated  with 
aloes  and  blue  pill. 

Pills  of  aloes  and  iron  are  useful  adjuvants  to  other  remedies 
in  the  treatment  of  chlorosis.  Amenorrhea,  which  is  such  a  common 
condition  in  chlorosis,  is  relieved  by  aloes.  Pills  of  aloes  and  iron 
are  equally  valuable  in  menorrhagia  arising  from  debility. 

Contraindications. — Aloes  is  ordinarily  contraindicated  in  hem- 
orrhoids, although  those  cases  attended  with  a  mucous  discharge 
are  frequently  benefited  by  it.     The  drug  is  considered  objection- 


CATHARTICS.  675 

able  in  pregnancy,  in  persons  of  plethoric,  bilious,  or  hemorrhagic 
constitution,  and  in  menorrhagia  of  the  strong  and  full-blooded. 

Administration.— When  desired  as  a  purgative,  aloes  in  pill 
form  is  preferable  to  the  liquid  preparations,  and  the  drug  may 
be  given  alone  or  associated  with  other  purgatives,  tonics,  or 
antispasmodics. 

Aloin  is  perhaps  to  be  preferred  to  aloes,  as  it  gripes  less  and 
may  be  given  in  smaller  doses. 

As  a  purgative  aloes  ranks  between  rhubarb  and  senna. 

Fel  Bovis— Fellis  Bo  vis— Oxgall.    V.  S.  B. 

(Fel  Tauri.) 

Origin. — The  fresh  bile  of  Bos  Taurus  L. 

Description  and  Properties. — A  brownish-green  or  dark-green, 
somewhat  viscid  liquid,  having  a  peculiar,  unpleasant  odor  and 
a  disagreeable,  bitter  taste. 

Dose. — S-15  grains  (0.3-1.0  Gm.). 

Official  Preparation. 

F6I  Bovis  Purificatum— Fgllis  Bovis  Purificati— Purified  0-!i%a\S..— Descrip- 
tion and  Properties. — A  yellowish-green,  soft  solid,  having  a  peculiar  odor  and  a  partly 
sweet  and  partly  bitter  taste.     Very  soluble  in  water  and  in  alcohol. 

Dose. — 5-15  grains  (0.3-1.0  Gm.). 

Physiological  Action  and  Therapeutics. — Like  bile,  oxgall 
augments  the  duodenal  secretions,  emulsionizes  fats,  and  increases 
intestinal  peristalsis.  The  drug  liquefies  the  bile,  and  acts  as  a 
cholagogue  and  purgative.  It  is  a  useful  cathartic  when  the  stools 
are  very  offensive  and  of  a  light  clay  color,  indicating  a  deficient 
biliary  secretion.  The  drug  is  serviceable  in  jaundice  due  to 
obstruction  of  the  common  duct  by  inspissated  bile  or  mucus. 
Impacted  feces  are  readily  removed  by  an  enema  containing  1 5  or 
20  grains  (i. 0-1.3  Gm.)  of  oxgall.  The  drug  is  an  efficient  intes- 
tinal antiseptic,  and  may  be  beneficially  employed  for  that  purpose 
in  typhoid  fever  and  intestinal  fermentation. 

Oxgall  is  usually  given  in  pill  form. 

Rheum— Rhel— Rhubarb.     TJ.  8.  P. 

Origin. — The  root  of  Rheum  officinale  Baillon,  a  plant  indigen- 
ous in  the  western  and  northwestern  portions  of  China. 

Description  and  Properties. — In  cylindrical,  conical,  or  flattish 


676  A    TEXT-BOOK  OF  MATERIA    MEDIC  A. 

segments,  deprived  of  the  dark-brown,  corky  layer,  smoothish  or 
somewhat  wrinkled,  externally  covered  with  a  bright  yellowish- 
brown  powder,  marked  with  white,  elongated  meshes,  containing 
a  white,  rather  spongy  tissue,  and  a  number  of  short,  reddish- 
brown  or  brownish-yellow  striae  ;  compact,  hard ;  fracture  uneven ; 
internally  white,  with  numerous  red,  irregularly-curved,  and  inter- 
rupted medullary  rays,  which  are  radially  parallel  only  near  the 
cambium  line  ;  odor  somewhat  peculiar,  aromatic  ;  taste  bitter,  some- 
what astringent.  When  chewed,  rhubarb  feels  gritty  between  the 
teeth  and  imparts  a  yellow  color  to  the  saliva.  Rhubarb  which 
is  very  porous,  or  has  a  prominently  mucilaginous  taste,  or  is  of 
a  dark-brown  color  internally,  should  be  rejected. 

The  drug  contains  the  following  constituents :  chrysophan 
(and  chrysophanic  acid),  emodin,  aparetin,  phaeoretin,  erythroretin, 
rheumic  acid,  and  rheotannic  acid,  besides  starch,  calcium  oxalate, 
etc. 

Dose. — 5-30  grains  (0.32-1.94  Gm.). 

Official  Preparations. 

ExtrSctum  Rhei — Extracti  Rhei — Extract  of  Rhubarb.-T-Z'oj^,  3-15  grains 
(o.ig-i.o  Gm.). 

ExtrSctum  Rhei  Fliiidum— Extracti  Rhei  Fliiidi— Fluid  Extract  of  Rhubarb 
(this  preparation  is  used  in  Mistura  Rhei  at  Sodae  and  in  Syrupus  Rhei). — Dose,  5-60 
minims  (0.3-4.0  Cc). 

PJlulse  Rhei — Pllulas  (ace.)  Rhei — Pills  of  Rhubarb. — Each  pill  contains  3 
grains  (0.19  Gm.).     Dose,  i  to  5  pills. 

Pllulae  Rhei  Compdsitae — Pllulas  (ace.)  Rhei  CompSsitas — Compound 
Rhubarb  Pills. — Each  pill  contains  about  2  grains  (0.12  Gm.)  of  Rhubarb,  with  puri- 
fied Aloes  l^  grains  (0.09  Gm.),  Myrrh,  and  Oil  of  Peppermint.     Dose,  I  to  3  pills. 

Pfilvis  Rhei  Comp&situs — Piilveris  Rhei  CompSsiti — Compound  Rhubarb 
Powder  (Gregory's  Powder) — (25  per  cent.,  with  Magnesia  and  Ginger). — Dose,  ^- 
I  drachm  (2.0-4.0  Gm.). 

Tinctiira  Rhei — Tinctiirae  Rhei — Tincture  of  Rhubarb  (10  per  cent.,  with 
Cardamom). — Dose,  ^-4  fluidrachms  (2.0-15.0  Cc). 

Tinctiira  Rhei  AromStica — Tinctiirae  Rhei  AromSticae — Aromatic  Tincture 
of  Rhubarb  (20  per  cent.,  with  Cassia,  Cinnamon,  Cloves,  and  Nutmeg). — Dose,  1-3 
fluidrachms  (4.0-12.0  Cc). 

This  preparation  is  used  to  malje  Syrupus  Rhei  Aromaticus. 

Tinctura  Rhei  Diilcis — Tinctiirae  Rhei  Diilcis — Sweet  Tincture  of  Rhubarb 
(10  per  cent.,  with  Glycyrrhiza,  Anise,  and  Cardamom). — Dose,  %.-^  fluidrachms  (2.0- 
15.0  Cc). 

Mistura  Rhei  et  Sodae — Mistiirae  Rhei  et  Sodae— Mixture  of  Rhubarb  and 
Soda. — Formula:  Sodium  Bicarbonate,  35;  Fluid  Extract  of  Rhubarb,  15;  Fluid 
Extract  of  Ipecac,  3;  Glycerin,  350;  Spirit  of  Peppermint,  35;  Water,  to  1000. — Dose, 
%-2  fluidounces  (8.0-60.0  Cc). 

syrupus   Rhei — Syrupi  Rhei — Syrup  of  Rhubarb. — Formula:  Fluid  Extract 


CA  THAR  TICS.  677 

of  Rhubarb,   100 ;   Potassium   Carbonate,    10 ;   Spirit  of  Cinnamon,  4;   Glycerin,  50; 
Water  and  Syrup,  to  1000.— Dose,  1-4  fluidrachms  (4.0-15.0  Cc). 

Syrupus  Rhei  AromSticus — Syrupi  Rhei  Aromatici— Aromatic  Syrup  of 
Rhubarb.— Formula :  Aromatic  Tincture  of  Riiubarb,  150;  Syrup,  850. — Dose,  yi-2 
fluidrachms  (2.0-8.0  Cc). 

Physiological  Action  and  Therapeutics. — Rhubarb  in  mod- 
erate doses  is  a  stomachic,  acting  similarly  to  the  aromatic  bitters, 
increasing  secretion,  peristalsis,  vascularity,  and  absorption,  thereby 
aiding  digestion  and  serving  as  a  tonic.  In  larger  doses  it  is  a 
mild  cathartic,  producing  in  from  four  to  eight  hours  a  soft  yellow- 
ish-brown evacuation,  not  watery,  which  is  not  infrequently  accom- 
panied by  griping. 

It  undoubtedly  shghtly  increases  the  secretion  of  bile,  though 
it  is  by  no  means  an  active  cholagogue. 

After  full  doses  of  rhubarb  have  been  taken  the  purgative  action 
is  succeeded  by  quiescence  of  the  bowels,  the  constipation  being 
the  result  of  the  action  of  the  astringent  constituents  of  the  rhu- 
barb. Small  doses,  however,  taken  daily,  serve  a  useful  purpose 
in  relieving  habitual  constipation,  without  in  the  least  impairing 
digestion. 

The  drug  is  excreted  with  the  feces,  urine,  perspiration,  and 
milk;  the  urine  is  slightly  increased  in  amount,  and  together 
with  the  perspiration  and  milk,  is  colored  yellow.  The  milk 
acquires   a  bitter  taste  and  purgative  properties. 

Rhubarb  is  one  of  the  best  purgatives  for  children  suffering 
from  diarrhea  caused  by  irritating  ingesta  in  the  bowels  or  to  cold ; 
it  is  also  of  value  in  some  cases  of  dysentery.  Summer  diarrhea 
vf  children  is  often  cured  by  some  preparation  of  rhubarb  alone, 
the  diarrhea  ceasing  after  a  free  purge  by  the  drug. 

As  a  simple  laxative  for  children  it  is  a  valuable  remedy,  owing 
to  its  secondary  tonic  and  astringent  effects,  and  is  recommended 
as  a  laxative  to  expel  thread-worms. 

When  hemorrhoids  are  connected  with  constipation,  much  relief 
may  be  obtained  by  the  gentle  action  of  rhubarb. 

Administration. — Rhubarb  is  seldom  given  alone,  because  of 
the  griping  it  occasions.  For  children  the  syrups  are  excellent 
preparations,  and  the  mixture  of  rhubarb  and  soda  is  an  appropri- 
ate remedy  when  the  secretions  of  the  stomach  and  bowels  are 
unduly  acid. 

In  habitual  constipation  of  adults  the  simple  rhubarb  pill  is  an 
efficient  preparation. 


678  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

The  choice  of  the  preparation  will  depend  largely  upon  the 
individual  case. 

Euonymus— Euonymi— Euonymus.  V.  S.  -P. 

(Wahoo.) 

Origin. — The  bark  of  the  root  of  Euonymus  atropurpureus 
Jacquin,  a  shrub  6  to  10  or  14  feet  (1.8  to  3  or  4.2  M.)  high,  found 
growing  in  shady  woods  of  the  northern  and  middle  section  of  the 
United  States  east  of  the  Mississippi. 

Description  and  Properties. — In  quilled  or  curved  pieces  ^  to 
\  inch  (2  to  5  Mm.)  thick ;  outer  surface  ash-gray,  with  blackish 
patches,  detached  in  thin  and  small  scales ;  inner  surface  whitish 
or  slightly  tawny,  smooth ;  fracture  smooth,  whitish,  the  inner 
layers  of  a  laminated  appearance ;  nearly  inodorous ;  taste  sweet- 
ish, somewhat  bitter  and  acrid. 

The  chief  constituent  of  the  drug  is  a  resin,  euonymin. 

Dose. — 1-2  drachms  (4.0-8.0  Gm.). 

Official  Preparation. 

Extractum  EuSnymi — ExtrScti  Eu6nymi — Extract  of  Euonymus. — Dose, 
1-5  grains  (0.06-0.3  Gm.). 

Eu6nymin   (unofficial). — Origin. — A  resin   from   the  root   and  stem-bark  of 

Euonymus  atropurpureus  Jacquin. 

Description  and  Properties. — A  brown  or  greenish-brown  hygroscopic  powder  with 
a  feebly  bitter  taste,  soluble  in  water,  almost  insoluble  in  alcohol  and  ether. 

Dose. — 1^-3  grains  (0.01-0.19  Gm.). 

Physiological  Action  and  Therapeutics. — Euonymus  resem- 
bles rhubarb  in  its  action,  but  is  milder,  small  doses  being  stimu- 
lant to  the  stomach.  The  drug  is  an  active  hepatic  stimulant, 
increasing  the  secretion  of  bile  and  facilitating  its  excretion  into  the 
intestine.  It  is  excreted  by  the  kidneys  and  broncho-pulmonary 
mucous  membrane,  being  a  mild  diuretic  and  expectorant.  Euony- 
mus is  an  excellent  cathartic,  particularly  in  cases  of  constipation 
attended  with  impaired  functional  activity  of  the  liver. 

Euonymin  is  the  preparation  usually  employed,  although  the 
official  extract  of  euonymus  is  a  reliable  preparation. 

Tris— Tridis— Iris.    TJ.8.P. 

(Blue  Flag.) 
Origin. — The   rhizome   and  roots  of  Iris  versicolor  L.,  found 
growing  in  wet  and  swampy  meadows  from  Canada  southward  to 
Florida  and  westward  to  Minnesota  and  Arkansas. 


CATHARTICS.  679 

Description  and  Properties. — Rhizome  of  horizontal  growth, 
consisting  of  joints  2  to  4  inches  (5  to  10  Cm.)  long,  cylindrical  in 
the  lower  half,  flattish  near  the  upper  extremity,  and  terminated 
by  a  circular  scar,  annulated  from  the  leaf-sheaths,  grayish-brown ; 
roots  long,  simple,  crowded  near  the  broad  end ;  odor  slight ;  taste 
acrid  and  nauseous.  The  drug  contains  an  acrid  resin,  iridin,  fixed 
oil,  starch,  gum,  tannin,  sugar,  and  indications  of  an  alkaloid. 

Dose. — 10-30  grains  (0.6-2.0  Gm.). 

Official  Preparations. 

ExtrSctum  Iridis — Extract!  Iridis — Extract  of  l-n^.—Dose,  1-3  grains  (0.06- 
0.2  Gm.). 

ExtrSctutn  Iridis  Fluidum — ExtrScti  Iridis  Fliiidi — Fluid  Extract  of  Iris. 
— Dose,  10-30  minims  (0.6-2.0  Cc). 

Iridin  (unofficial). — Dose,  1-3  grains  (0.06-0.2  Gm.). 

Physiological  Action  and  Therapeutics. — Iris  is  similar  in  its 
action  to  euonymus,  although  it  is  more  apt  to  disturb  the  stomach 
and  occasion  nausea.  It  is  actively  purgative  and  possesses  diu- 
retic properties.  Like  euonymus,  it  is  a  hepatic  stimulant,  and 
may  be  used  for  the  same  purposes  as  the  former  drug.  It  may 
be  used  in  dropsy,  and  has  been  found  to  be  an  efficient  cathartic 
in  malarial  and  catarrhal  jaundice  and  bilious  remittent,  fever.  It 
exerts  a  specific  influence  in  enlargement  of  the  thyroid  gland. 

The  dried  drug  is  inert,  the  fluid  extract  and  iridin  being  the 
most  reliable  preparations  to  use. 

Juglans— Jugrlandis— Juglans.     TJ.  S.  -P. 

(Butternut.) 

Origin. — The  bark  of  the  root  of  Juglans  cinerea  L.,  a  tree 
30  to  40  feet  (9-12  M.)  high,  growing  in  forest  and  bottom-lands, 
in  Canada,  and  the  greater  portion  of  the  United  States  westward 
to  Missouri  and  Arkansas. 

Description  and  Properties. — In  flat  or  curved  pieces,  from  \ 
to  \  inch  (3  to  6  Mm.)  thick ;  the  outer  surface  dark  gray  and 
nearly  smooth  or  deprived  of  the  soft  cork,  and  deep  brown ;  the 
inner  surface  smooth  and  striate ;  transverse  fracture  short,  deli- 
cately checkered,  whitish  and  brown ;  odor  feeble ;  taste  bitter  and 
somewhat  acrid.  The  drug  contains  a  bitter,  oily  extractive, 
juglandic  acid,  two  other  acids,  and  various  salts. 

Dose. — 1-2  drachms  (4.0-8.0  Gm.). 


,68o  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Official  Preparation. 

ExtrSctum  JuglSndis — ExtrScti  JuglSndis  —Extract  of  Juglans. — Dose,  5-30 
grains  (0.3-2.0  Gm.). 

Physiological  Action  and  Therapeutics. — The  action  and 
medical  uses  of  this  drug  are  analogous  to  those  of  euonymus. 

Leptandra— Leptandrae— Leptandra.    U.  S.T. 

(Culver's  Root.) 

Origin. — The  rhizome  and  roots  of  Veronica  virginica  L.,  a 
plant  indigenous  in  Canada,  and  in  the  United  States  as  far  west  as 
the  Mississippi  Valley. 

Description  and  Properties. — Of  horizontal  growth,  from  4  to 
6  inches  (10  to  15  Cm.)  long  and  about  \  inch  (6  Mm.)  thick,  some- 
what flattened,  bent  and  branched,  deep  blackish-brown,  with  cup- 
shaped  scars  on  the  upper  side,  hard,  of  a  woody  fracture,  with  a 
thin,  blackish  bark,  a  hard,  yellowish  wood,  and  a  large,  purplish- 
brown,  about  six-rayed  pith;  roots  thin,  wrinkled,  very  fragile; 
inodorous ;  taste  bitter  and  feebly  acrid. 

Leptandra  contains  a  crystalline  glucosid,  leptandrin,  besides 
tannin,  gum,  and  a  small  quantity  of  volatile  oil. 

Dose. — 15-60  grains  (1.0-4.0  Gm.). 

Official  Preparations. 

ExtrSctum  Leptandrae — Extract!  Leptandrae — Extract  of  Leptandra. — Dose, 
1-5  grains  (0.06-0.3  Gtn.). 

ExtrSctum  LeptSndrae  Fluidum— Extract!  Leptandrse  Fluidi — Fluid  Ex- 
tract of  Leptandra. — -Dose,  15-60  minims  (1.0-4.0  Co.). 

The  Pilulae  Catharticse  Vegetabiles  contain  ^  grain  (o.oi  Gm.)  of  Extract  of 
Leptandra  to  eacli  pill. 

Leptandrin  (unofficial). — Dose,  1-3  grains  (0,06-0.2  Gm.). 

Physiological  Action  and  Therapeutics. — The  action  of  lep- 
tandra is  similar  to  the  actions  of  euonymus,  iris,  and  juglans,  the 
green  root,  however,  being  more  of  an  irritant  to  the  gastro-intes- 
tinal  tract,  possessing  marked  emeto-cathartic  properties. 

It  is  an  active  hepatic  stimulant,  and  may  be  advantageously 
employed  for  the  same  purposes  as  euonymus,  iris,  etc. 

Senna— Sennse— Senna.  JJ.  S.  I*. 

Origin. — The  leaflets  of  Cassia  acutifolia  Delile  (Alexandria 
senna)  and  of  Cassia  angustifoHa  Vahl  (India  senna),  small  shrubs 


CATHARTICS.  68i 

found  in  Upper  Egypt  and  southward  to  Nubia,  Sennaar,  and  Kor- 
dofan,  and  farther  westward  in  tropical  Africa  (Cassia  acutifolid),  and 
in  Southwestern  Arabia,  along  the  Somali  coast  of  Africa,  and  east- 
ward in  Northern  India  {Cassia  angustifolid). 

Description  and  Properties. — Alexandria  senna  consists  of 
leaflets  about  i  inch  (25  Mm.)  long  and  \  inch  (10  Mm.)  broad, 
lanceolate  or  lance-oval,  subcoriaceous,  brittle,  rather  pointed,  un- 
equally oblique  at  the  base,  entire,  grayish-green,  somewhat  pubes- 
cent ;  of  a  peculiar  odor  and  a  nauseous,  bitter  taste. 

India  senna  consists  of  leaflets  i  to  2  inches  (2.5-5  Cm.)  long 
and  f  to  \  inch  (10-15  Mm.)  broad,  lanceolate,  acute,  unequally 
oblique  at  the  base,  entire,  thin,  yellowish-green  or  dull  green, 
nearly  smooth ;  odor  peculiar,  somewhat  tea-like ;  taste  mucilagi- 
nous, bitter,  and  nauseous. 

Senna  contains  a  sulphuretted  glucosid,  cathartic  acid,  to  which 
the  purgative  properties  of  the  drug  are  due.  Senna  also  contains 
^hrysophan,  besides  sennacrol  and  sennapicrin  (two  bitter  princi- 
ples), catharto-mannite,  mucilage,  etc. 

Dose. — 10  grains-3  drachms  (0.6-12.0  Gm.). 

Official  Preparations. 

ConfSctio  SSnnse — Confectionis  Sfennae — Confection  of  Senna. — 10  per  cent., 
with  Cassia  Fistula,  Tamarind,  Prune,  Fig,  Sugar,  and  Oil  of  CoriandeV.  Dose,  1-3 
drachms  (4.0-12.0  Gm.). 

Extractum  S6nnE  Fluidum — ExtrScti  S6nna  Fliiidi — Fluid  Extract  of 
Senna. — Dcse,  10  minims-3  fluidrachms  (0.6-11.09  Cc). 

Infusum  S6nnae  CompSsitum— Infusi  S6nnae  Comp6siti— Compound  Infu- 
sion of  Senna. — 6  per  cent.,  with  Manna  and  Magnesium  Sulphate,  each,  12  per  cent., 
and  Fennel  2  per  cent.     Dose,  1-2^  fluidounces  (30.0-75.0  Cc). 

PClvis  Glycyrrhizae  Comp6situs — Pfilveris  Glycyrrhizae  Comp5siti — Com- 
pound Powder  of  Glycyrrhiza. — Formula;  Senna,  180;  Glycyrrhiza,  236;  Oil  of 
Fennel,  4;  Washed  Sulphur,  80;  Sugar,  Joo.     Dose,  yi-2  drachms  (2.0-8.0  Gm.). 

Sj^rupus  SSnnse — Syrupi  S6nnae — Syrup  of  Senna  (25  per  cent.).— Z'o.ff,  }^-x 
fluidounce  (8.0-3.0  Cc). 

Cathartic  Acid,  Cathartinic  Acid  (unofficial).— On;f2».— An  active  principle 
obtained  from  the  leaves  of  various  species  of  Cassia. 

Description  and  Properties. — It  occurs  as  brown,  hygroscopic  scales,  freely  soluble  in 
water  and  in  alcohol. 

Dose. — 2-6  grains  (0.12-0.38  Gm.). 

Physiological  Action  and  Therapeutics.' — Senna  is  an  active 
purgative,  acting  upon  nearly  the  entire  intestinal  tract,  increasing 
both  peristalsis  and  intestinal  secretion,  although  having  but  little 
effect  upon  the  biliary  secretion.  It  is  apt  to  occasion  much  flatu- 
lence and  griping  unless  it  is  associated  with  aromatics.    Full  doses 


682  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

open  the  bowels  in  from  four  to  eight  hours,  producing  one  or 
more  copious  liquid,  yellow  stools,  but  never  occasioning  hyper- 
catharsis,  and  the  purgation  is  not  followed  by  constipation. 

An  infusion  of  senna,  if  injected  into  the  veins,  excites  both 
vomiting  and  purging. 

Some  persons  are  so  susceptible  to  the  influence  of  senna  as  to 
be  purged  even  by  its  odor. 

The  drug,  or  some  constituent  of  it,  is  eliminated  by  the  urine, 
to  which  it  imparts  a  red  color,  and  by  the  milk,  rendering  it  pur- 
gative. 

The  various  preparations  of  senna  are  very  efficient  purgatives 
in  cases  of  simple  constipation  or  in  cases  oi  fecal  accumulation  in 
the  colon. 

Infusion  of  senna  is  an  admirable  purgative  with  which  to  suc- 
ceed the  administration  of  blue  pill.  In  cases  of  biliousness  there  is 
probably  no  better  treatment  than  calomel  or  blue  pill  at  night  and 
infusion  of  senna  in  the  morning. 

Habitual  constipation  and  the  constipation  of  pregnancy  are  safely 
and  agreeably  treated  by  compound  liquorice  powder. 

Administration. — Senna  is  seldom  given  alone,  but  is  generally 
associated  with  some  corrective  to  prevent  griping. 

The  infusion,  compound  liquorice  powder,  syrup,  and  confection 
of  senna  are  employed. 

The  compound  liquorice  powder  and  the  confection  being  the 
mildest  and  pleasantest,  the  latter  preparation,  when  coated  with 
chocolate,  is  readily  taken  by  children,  and  in  this  form  is  the  well- 
known  laxative  "  Tamar  Indien." 

HYDRAGOGUE   PURGATIVES. 
These  drugs  are  more  active  than  the  preceding  class,  pro- 
ducing an  abundant  secretion  from  the  intestinal  mucous  mem- 
brane, removing  a  large  quantity  of  water  from  the  blood-vessels, 
and  producing  several  copious,  watery  stools. 

Oleum  Tiglii— Olei  TTglii-Croton  Oil.    TI.  8.  JP. 

Origin.— A  fixed  oil  expressed  from  the  seed  of  Croton  Tiglium 
L.,  indigenous  in  Hindostan  and  some  of  the  East  Indian  and 
Philippine  islands. 

Description  and  Properties.— A  pale-yellow  or  brownish-yel- 
low, somewhat  viscid,  and  slightly  fluorescent  liquid,  having  a  slight, 
fatty  odor,  and  a  mild,  oily,  afterward  acrid  and  burning,  taste 


CATHARTICS.  685 

{^great  caution  is  necessary  in  tasting).  Croton  oil  should  be  kept 
in  small,  well-stoppered  bottles,  and  should  be  handled  with  caution, 
for  when  applied  to  the  skin  it  produces  rubefaction  or  a  pustular 
eruption. 

When  fresh,  croton  oil  is  soluble  in  about  60  parts  of  alcohol,, 
the  solubility  increasing  by  age. 

The  drug  contains  several  volatile  acids,  of  which  tiglinic  acid 
is  the  characteristic  one ;  besides  this,  it  contains  lauric,  myristic, 
palmitic,  stearic,  formic,  acetic,  isobutyric,  and  isovalerianic  acids. 

Dose. — \-2  minims  (0.01-0.12  Cc.)  on  a  lump  of  sugar  or  mixed 
with  some  bland  oil. 

Physiological  Action. — Externally  and  Locally. — Croton  oil  is 
a  powerful  irritant  when  applied  to  the  skin,  exciting  inflammation 
and  quickly  producing  vesication,  which  rapidly  merges  into  pus- 
tules closely  resembling  those  of  variola,  and  perhaps  lasting  sev- 
eral days.  In  many  cases  permanent  cicatrices  mark  the  site  of 
these  pustules. 

If  the  drug  be  rubbed  over  the  abdomen,  it  may  produce  pur- 
gation. 

Internally. -^'Wh&n  a  drop  or  two  of  croton  oil  is  taken  into  the 
stomach  it  occasions  a  sense  of  heat  in  the  epigastrium,  which  is 
soon  succeeded  by  griping  and  abdominal  pain,  and  in  from  half  an 
hour  to  two  hours  after  the  ingestion  of  the  drug  there  are  pro- 
duced profuse  watery  stools,  with  considerable  burning  and  irrita- 
tion about  the  anus. 

The  drug  greatly  increases  the  vascularity  of,  and  the  secretion 
from,  the  gastro-intestinal  tract,  without  specially  influencing  the 
biliary  secretion. 

Large  doses  produce  violent  gastro-enteritis,  hypercatharsis,. 
with  great  prostration  and  collapse  resembling  that   of  cholera. 

In  case  of  poisoning  the  stomach  should  be  immediately  evacu- 
ated, and  demulcent  drinks  freely  given.  Opium  and  stimulants 
may  be  necessary. 

Therapeutics. — Externally  and  Locally. — The  external  use  of 
croton  oil  is  comparatively  limited. 

It  is  occasionally  painted  over  the  seat  of  pain  in  intercostal 
neuralgia,  while  a  liniment  of  croton  oil  applied  to  the  chest  is  said 
to  be  beneficial  in  phthisis  and  chronic  bronchitis.  The  same  prep- 
aration is  recommended  as  a  local  application  in  congestive  dysmen- 
orrhea and  chronic  congestion  of  the  uterus. 
'      Croton  oil  has  been  put  to  many  other  uses,  but  the  results 


684  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

obtained  are  so  unsatisfactory  that  it  is  needless  to  enumerate 
them. 

Internally. — The  drug  is  used  as  a  purgative,  as  a  rule  only  in 
cases  of  emergency,  and  then  a  single  dose  is  usually  sufficient. 
It  is  employed  in  such  cases  as  intestinal  obstruction  from  accumu- 
lated feces  produced  by  torpor  of  the  bowels,  diseases  of  the  nervous 
system,  lead-poisoning,  etc.  In  lead  colic  it  is  probably  superior  to 
all  other  purgatives. 

Croton  oil  is  sometimes  employed  for  its  revulsive  action  in 
apoplexy. 

As  a  purgative  it  is  frequently  given  to  lunatics,  because,  on 
account  of  the  smallness  of  the  dose,  it  may  be  easily  placed  on 
the  back  of  the  tongue,  where  it  is  quickly  swallowed  reflexly. 

Contraindications. — The  drug  should  never  be  given  to  preg- 
nant women,  to  children,  nor  to  patients  suffering  from  hemor- 
rhoids, peritonitis,  gastritis,  or  enteritis. 

Administration. — Croton  oil  may  be  given  in  emulsion,  or 
mixed  with  some  bland  oil,  or  dropped  on  a  piece  of  loaf  sugar,  or 
in  pill  form. 

The  best  excipient  for  pills  of  croton  oil  is  breadcrumb. 

ElaterTnum— Elaterlni— Elaterin.    TJ.  S.  J*. 

Origin. — A  neutral  principle  obtained  from  Elaterium,  a  sub- 
stance deposited  by  the  juice  of  the  fruit  of  Ecballium  elaterium 
L.,  commonly  known  as  "  squirting  cucumber,"  a  vine  growing  in 
the  Mediterranean  regions  of  Europe,  Africa,  and  Asia. 

Description  and  Properties. — Minute,  white,  hexagonal  scales 
or  prismatic  crystals,  without  odor,  and  having  a  slightly  acrid, 
bitter  taste;  permanent  in  the  air;  soluble  in  4250  parts  of  water 
and  337  parts  of  alcohol. 

Dose. — -^^-^  grain  (0.002-0.005  Gm.). 

Official  Preparation. 

Trituratio   Elaterlni— Triturationis   Elaterlni— Trituration   of   Elaterin.— 

Dose,  about  f  grain  (0.05  Gm.). 

Physiological  Action  and  Therapeutics. — Elaterin  is  the  most 
powerful  hydragogue  purgative  known. 

The  drug  greatly  increases  the  salivary,  gastric,  and  intestinal 
secretions,  as  well  as  those  from  the  liver  and  pancreas. 

It  is  a  violent  purgative,  whether  given  internally  or  injected 


CATHARTICS.  685 

subcutaneously,  producing  abundant  watery  evacuations  attended 
with  much  griping  pain  and  great  prostration. 

Elaterin  is  indicated  where  profuse  serous  discharges  are  de- 
sired, as  in  cases  of  congestion  of  the  brain  and  lungs,  ascites,  and 
chronic  nephritis. 

Contraindications. — The  drug  is  not  permissible  in  inflamma- 
tory conditions  of  the  gastro-intestinal  tract,  nor  in  pregnancy, 
and  it  should  be  administered  with  much  care,  if  at  all,  in  heart 
disease. 

Administration. — The  drug  may  be  given  in  pill  form,  in  alco- 
holic solution,  or  in  the  form  of  the  trituration.  Elaterin  varies 
greatly  in  strength,  which  suggests  caution  in  its  use. 


Cambogia— Cam  bogiae— Gamboge.    V.  S.  J*. 

Origin. — A  gum-resin  obtained  from  Garcinia  Hanburii  Hooker 
filius,  a  medium-sized  tree,  indigenous  in  Siam,  Cambodia,  and 
Cochin  China. 

Description  and  Properties. — In  cylindrical  pieces,  sometimes 
hollow  in  the  center,  i  to  2  inches  (2  to  5  Cm.)  in  diameter,  longi- 
tudinally striate  on  the  surface ;  fracture  flattish-conchoidal,  of  a 
waxy  luster,  orange-red;  in  powder  bright  yellow;  inodorous; 
taste  very  acrid;  the  powder  sternutatory.  Gamboge  is  partly 
soluble  in  alcohol  and  in  ether. 

Dose. — 1-5  grains  (0.06-0.32  Gm.). 

Official  Preparation. 

PUulae  Cathartics  Comp6sitse — PUulas  (ace.)  Cath^rticas  CompOsitas — 
Compound  Cathartic  Pills. — Dose,  1-3  pills. 

Physiological  Action  and  Therapeutics. — Gamboge  is  a  vio- 
lent hydragogue  purgative,  exciting  active  peristalsis  and  greatly 
augmenting  the  secretion  from  the  intestinal  glands,  although  not 
increasing  the  secretion  of  bile.  Small  and  repeated  doses  are 
slightly  diuretic,  coloring  the  urine  yellow. 

Gamboge  is  seldom  given  alone,  being  usually  associated  with 
other  purgatives.  It  is  used  in  combination  when  a  hydragogue 
action  by  the  kidneys  as  well  as  the  bowels  is  desired.  It  is 
thought  to  be  of  use  in  hepatic  congestion  arising  from  malarial 
causes.  The  drug  is  an  efficient  anthelmintic,  and  is  occasionally 
prescribed  with  vermicide  medicines. 


686  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

SALINES. 

Magnesii  Citras  Effervescens— Magrnesii  Citratis 
Effervescentis— Effervescent  Magnesium  Ci- 
trate.    V.  S.  I*. 

Formula:  Magnesium  Carbonate,  lo  ;  Citric  Acid,  46 ;  Sodium 
Bicarbonate,  34 ;  Sugar,  8 ; ,  Alcohol  and  Distilled  Water,  a  suf- 
ficient quantity. 

Description  and  Properties. — A  white,  coarsely  granular  salt, 
without  odor,  and  having  a  mildly  acidulous,  refreshing  taste. 
Deliquescent  on  exposure  to  the  air.  Soluble,  with  copious  effer- 
vescence, in  2  parts  of  water;  almost  insoluble  in  alcohol.  The 
product  should  be  kept  in  well-closed  vessels. 

Dose. — |-i  ounce  (8.0-32.0  Gm.). 

Liquor  Mag^nesii  Citratis— Liquoris  iVlagnesii  Citratis 
—Solution  of  IVIagrnesium  Citrate.     U.  S.  JP. 

Formula:  Dissolve  Magnesium  Carbonate,  15,  in  a  solution  of 
Citric  Acid,  30 ;  add  Syrup  of  Citric  Acid,  60 ;  then  Crystals  of 
Potassium  Bicarbonate,  25.  Cork  the  bottle  and  wire  immediately. 
The  product  effervesces  when  uncorked. 

Dose. — 2-8  fluidounces  (60.0-237.0  Cc). 

Magnesii  Sulphas— Magnesii  Sulphatis— Magne- 
sium Sulphate.     U.  8.  -P. 

(Epsom  Salt.) 

Origin. — Obtained  by  the  action  of  Sulphuric  Acid  upon  native 
Magnesium  Carbonate,  treated  with  Water,  filtered,  and  the  filtrate 
evaporated  to  crystallization. 

Description  and  Properties.— Small,  colorless,  rhombic  prisms 
or  acicular  crystals,  without  odor,  and  having  a  cooling,  saline, 
and  bitter  taste;  slowly  efflorescent  in  dry  air.  Soluble  in  1.5 
parts  of  water ;  insoluble  in  alcohol. 

Dose. — |-i  ounce  (8.0-32.0  Gm.). 

Antagonists  and  Incompatibles.— Magnesium  sulphate  is  in- 
compatible with  alkaline  carbonates,  phosphoric  acid,  phosphates, 
lead  acetate,  silver  nitrate,  and  lime  water. 

Synergists. — Saline  purgatives. 

Potassii  Sulphas— Potassii  Sulphatis— Potassium 
Sulphate.    U.  S.  I*. 

Origin.— Prepared  by  adding  Potassium  Carbonate  to  Acid 
Potassium  Sulphate. 


CA  THAR  TICS.  687 

Description  and  Properties. — Hard,  colorless,  transparent,  six- 
sided,  rhombic  prisms  terminated  by  pyramids,  or  in  white  powder ; 
odorless,  and  having  a  somewhat  bitter,  saline  taste.  Permanent 
in  the  air.  Soluble  in  about  9.5  parts  of  water,  insoluble  in 
alcohol. 

Dose. — J-4  drachms  (2.0-16.0  Gm.). 

Potassii  et  Sodii  Tartras— Potassii  et  Sodii  Tartrdtis 
—Potassium  and  Sodium  Tartrate.    TI.  S.  JP. 

(RocHELLE  Salt.) 

Origin. — Prepared  by  adding  Acid  Potassium  Tartrate  to  a  hot 
solution  of  Sodium  Carbonate. 

Description  and  Properties. — Colorless,  transparent  rhombic 
prisms,  or  a  white  powder,  odorless,  and  having  a  cooling,  saline 
taste.  The  crystals  slightly  effloresce  in  dry  air.  Soluble  in  1.4 
parts   of  water,  almost  insoluble  in  alcohol. 

Dose. — 30  grains-i  ounce  (2.0—32.0  Gm.). 

Official  Preparation. 

Ptilvis  EffervSscens  Compftsitus — Ptilveris  Effervesc6ntis  CompSsiti — 
Compound  Effervescing  Powder  (Seidlitz  Powder).— Each  powder  has  of  Ro- 
thelle  Salt,  120  grains  (8.0  Gm.) ;  of  Sodium  Bicarbonate,  40  grains  (3.0  Gm.),  mixed 
in  a  blue  paper;  and  of  Tartaric  Acid,  35  grains  (2.26  Gm.),  in  a  white  paper. 

Dose. — One  or  two  of  each  dissolved  separately  in  separate  quantities  of  water,  the 
solutions  poured  together  and  drunk  while  effervescing. 

Sodii  PliospFias— Sodii  PFiospViatis— Sodium  Piios- 
phate.     TJ.  8.  JP. 

(Sodium  Orthophosphate.) 

Origin. — Prepared  by  digesting  Bone  Ash  with  Sulphuric  Acid. 
The  solution  is  filtered,  and  to  it  is  added  Sodium  Carbonate,  and 
the  filtrate  evaporated  to  crystallization. 

Description  and  Properties. — Large,  colorless,  monoclinic 
prisms,  odorless,  and  having  a  cooling,  saline  taste.  The  crys- 
tals effloresce  in  the  air,  and  gradually  lose  S  molecules  of  water 
of  crystalHzation.  Soluble  in  5.8  parts  of  water;  insoluble  in 
alcohol.  Sodium  phosphate  should  be  kept  in  well-stoppered 
bottles,  in  a  cool  place. 

Dose. — 5  grains-i  ounce  (0.32-32.0  Gm.). 


688  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Sodii  Sulphas— Sodii  Sulphatis— Sodium  Sulphate. 

JJ.  S.  P. 

(Glauber's  Salt.) 

Origin. — The  residue  left  in  the  manufacture  of  Hydrochloric 
Acid  from  Salt  is  neutralized  with  Sodium  Carbonate. 

Description  and  Properties. — Large,  colorless,  transparent, 
monoclinic  prisms  or  granular  crystals ;  odorless,  and  having  a 
bitter,  saline  taste.  The  salt  effloresces  rapidly  in  the  air,  and 
finally  loses  all  its  water  of  crystallization.  Soluble  in  2.8  parts 
of  water  and  in  glycerin ;  insoluble  in  alcohol. 

Dose. — 1-8  drachms  (4.0-32.0  Gm.). 


Physiological  Action  and  Therapeutics  of  the  Salines. — These 
preparations  greatly  augment  the  intestinal  secretions,  their  activity 
depending  upon  the  nature  and  amount  of  the  salt  and  the  strength 
of  its  solution ;  the  greater  the  amount  of  the  solution,  the  sooner 
the  purgative  action  is  produced. 

Save  the  sulphate  and  phosphate  of  sodium,  which  are  mild 
hepatic  stimulants,  the  salines  have  no  effect  upon  the  biliary 
secretions. 

The  sodium  salts  are  more  efficient  than  the  potassium  salts  as 
purgatives,  owing  to  the  slower  absorption  of  the  former,  which 
enables  them  to  act  more  directly  upon  the  intestinal  canal. 

Purgation  by  the  salines  is  painless,  and  occurs  usually  in  from 
two  to  three  hours  after  administration,  there  being  ordinarily  two 
or  three  watery  evacuations. 

In  cases  of  habitual  constipation,  particularly  that  associated 
with  tht  gouty  diathesis,  there  are  no  better  purgatives  than  the  salts 
OF  SODIUM  or  mineral  waters  containing  them,  such  as  Carlsbad, 
Marienbad,  Hunyadi  Janos,  etc. 

For  -children  there  is  no  better  purgative  than  sodium  phos- 
phate, especially  where  the  stools  show  a  deficiency  of  bile.  In 
duodenal  catarrh  excellent  results  are  obtained  by  this  drug ;  also 
in  chronic  rheumatism,  and  to  retard  the  formation  of  biliary  calculi. 

Concentrated  saline  purgatives  are  efficient  remedies  for  the 
removal  of  dropsical  and  pleuritic  effusions. 

Magnesium  sulphate,  combined  with  dilute  sulphuric  acid,  is 
the  most  efficient  treatment  in  cases  of  chronic  lead-poisoning. 

RocHELLE  salt  and  Seidlitz  powder  are  pleasant  and  useful 
purgatives  in  cases  of  biliousness,  migraine,  etc.     Solution  of  mag- 


CA  THAR  TICS.  689 

NESiUM  CITRATE  is  uscd  for  the  same  purpose,  but,  while  very- 
palatable  and  acceptable  to  the  stomach,  is  not  always  reliable, 
besides  being  apt  to  occasion  slight  griping. 

Administration. — The  salines  should  be  taken  dissolved  in 
plenty  of  water,  and  ordinarily  should  be  administered  in  the 
morning,  when  the  stomach  is  empty. 

DRASTIC  PURGATIVES. 

These  drugs  are  even  harsher  in  their  action  than  hydragogue 
purgatives,  exciting  violent  peristalsis,  and  in  large  doses  producing 
gastro-enteritis  and  all  the  symptoms  occasioned  by  an  irritant 
poison.  The  evacuations  produced  by  these  drugs  are  numerous, 
copious,  and  watery,  attended  with  much  griping  pain,  tenesmus, 
and  borborygmi. 

ColocJ^nthis— Colocynthidis-Colocynth.    U.  S.  I*. 

Origin. — The  fruit  of  Citrullus  Colocynthis  Schroder,  deprived 
of  its  rind.  The  colocynth  plant  is  indigenous  in  Japan  and  is 
cultivated  and  naturalized  in  Spain. 

Description  and  Properties. — From  2  to  4  inches  (5-10  Gm.) 
in  diameter;  globular;  white  or  yellowish-white,  light,  spongy; 
readily  breaking  into  three  wedge-shaped  pieces,  each  containing, 
near  the  rounded  surface,  many  flat,  ovate,  brown  seeds ;  inodor- 
ous; taste  intensely  bitter. 

The  active  constituent  of  colocynth  is  colocynthin,  a  glucosid, 
of  which  there  is  present  about  2  per  cent.  Colocynth  also  con- 
tains resin,  gum,  and  an  amyloid  principle. 

Dose. — 5-10  grains  (0.3-0.6  Gm.). 

Official  Preparations. 

ExtiSctum  Coloc5^nthidis — ExtrScti  Colocynthidis — Extract  of  Colocynth. 
Dose,  J-2  grains  (0.03-0.13  Gm.). 

Extractum  Colocj^nthidis  Comp6situm — ExtrScti  Colocynthidis  Compfisiti 
— Compound  Extract  of  Colocynth. — Extract  of  Colocynth  16  per  cent.,  with  Aloes, 
Scammony,  Cardamom,  and  Soap. 

Dose. — 5-25  grains  (0.3-1.6  Gm.). 

Compound  Extract  of  Colocynth  enters  into  the  following  pills : 

PHulae  CathSrticse  CompSsitae  (8  per  cent.). 

PUulse  Cath^rticse  Vegetabiles  (5  per  cent.). 

Physiological  Action  and  Therapeutics. — The  action  of  colo- 
cynth is  very  similar  to  that  of  elaterin.     In  small  doses,  however, 
44 


690  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

it  rather  acts  as  a  stomachic,  improving  the  appetite  and  augment- 
ing the  secretions  of  the  whole  gastro-intestinal  tract.  Colocynth 
is  quite  a  decided  hepatic  stimulant  and  cholagogue. 

Pills  containing  colocynth  are  useful  to  produce  abundant 
watery  evacuations,  as  is  necessary  sometimes  in  the  treatment  of 
hepatic  and  renal  diseases  where  there  is  constipation  and  ascites. 

The  drug  should  be  employed  only  when  there  is  some  marked 
indication  for  its  use,  as  colocynth,  like  the  other  drastics,  is  too 
irritant  for  habitual  use. 

Gastro-intestinal  inflammation,  pregnancy,  etc.,  would  contra- 
indicate  its  use. 

Jalapa—Jalapae— Jalap.    V.  S.  I*. 

Origin. — The  tuberous  root  of  Ipomcea  Jalapa  Nuttall,  a  twin- 
ing herbaceous  perennial  growing  in  damp  and  shady  woods  on 
the  eastern  slope  of  the  Mexican  Andes.  It  has  been  introduced 
into  India  and  Jamaica. 

Description  and  Properties. — Napiform,  pyriform,  or  oblong, 
varying  in  size,  the  large  roots  incised,  more  or  less  wrinkled,  dark 
brown,  with  lighter-colored  spots  and  short,  transverse  ridges; 
hard,  compact,  internally  pale  grayish-brown,  with  numerous  con- 
centric circles  composed  of  small  resin-cells  ;  fracture  resinous,  not 
fibrous ;  odor  slight,  but  peculiar,  smoky,  and  sweetish ;  taste 
sweetish  and  acrid. 

Jalap  contains  two  resins,  one  hard,  the  other  soft,  the  former, 
termed  jalapin  or  convolvulin,  being  the  active  principle  of  the 
drug.  According  to  the  U.  S.  Pharmacopoeia,  there  must  be  not 
less  than  12  per  cent,  of  resin,  of  which  not  less  than  10  per  cent, 
must  be  soluble  in  ether. 

Dose. — 5-30  grains  (0.32-2.0  Gm.). 

Official  Preparations. 

ExtrSctum  Jalapse — Extracti  Jalapse — Extract  of  Jalap. — Dose,  2-5  grains 
(0.13-0.3  Gm.). 

Pfilvis  Jalapse  Comp6situs — Pfilveris  Jalaps  Coinp6siti — Compound  Jalap 
Powder  (35  per  cent.,  with  Potassium  Bitartrate). —  Dose,  15-60  grains  (1.0-4.0  Gm.). 

Resina  Jalapse — Resinae  Jalapse — Resin  of  Jalap. — Description  and  Proper- 
ties.— Yellowish-brown  or  brown  masses  or  fragments,  breaking  with  a  resinous,  glossy 
fracture,  translucent  at  the  edges,  or  a  yellowish-gray  or  yellowish-brown  powder,  having 
a  slight,  peculiar  odor,  and  a  somewhat  acrid  taste.  Pennanent  in  the  air.  Soluble  in 
alcohol  in  all  proportions. 

Dose. — 2-5  gi-ains  (0.13-0.3  Gm.). 

Extract  of  Jalap  is  one  of  the  ingredients  of  Pllulae  Catharticse  Comp&sitse 
and  PKlulse  Catharticse  Vegetabiles. 


CATHARTICS.  691 

Physiological  Action  and  Therapeutics.  —  The  purgative 
action  of  jalap  is  developed  in  the  duodenum,  where  it  comes  in 
contact  with  the  bile.  The  secretion  from  the  intestinal  glands  is 
greatly  augmented,  as  well  as  the  vascularity  and  peristalsis  of  the 
intestines.     The  biliary  flow  is  but  little  affected. 

Purgation  is  produced  by  jalap  in  three  or  four  hours,  the 
evacuations  being  profuse  and  watery  and  attended  with  griping 
pain. 

Jalap — or,  preferably,  the  compound  jalap  powder — is  a  reliable 
hydragogue  cathartic  for  the  removal  of  dropsical  effusions,  being 
especially  appropriate  for  nephritic  patients. 

Small  doses  of  jalap  are  serviceable  in  constipation  due  to  de- 
ficient intestinal  secretion. 

The  drug  is  frequently  associated  with  anthelmintic  medicines 
as  a  vermifuge. 

Scammonium— Scammonii— Scammony.    TJ.  S.  P. 

Origin. — A  resinous  exudation  from  the  living  root  of  Convol- 
■vulus  Scammonia  L.,  a  herbaceous,  twining  perennial,  growing 
in  Syria,  Asia  Minor,  and  Greece. 

Description  and  Properties. — Occurring  in  irregular  angular 
pieces  or  circular  cakes,  greenish-gray  or  blackish,  internally  por- 
ous, and  breaking  with  an  angular  fracture,  of  a  resinous  luster ; 
odor  peculiar,  somewhat  cheese-like ;  taste  slightly  acrid ;  powder 
gray  or  greenish-gray. 

It  contains  a  resin,  jalapin,  which  is  the  active  principle,  besides 
gum,  starch,  etc. 

Dose. — 1-15  grains  (0.06-1.0  Gm.). 

Official  Preparation. 

Resina  Scammonii — Resinae  Scammonii — Resin  of  Scammony. — Descrip- 
■tion  and  Properties. — Yellowish-brown  or  brownish-yellow  masses  or  fragments,  break- 
ing with  a  glossy,  resinous  fracture,  translucent  at  the  edges,  or  a  yellowish-white  or 
grayish-white  powder,  having  a  faint,  peculiar  odor,  and  a  slight,  peculiar  taste.  Soluble 
in  alcohol  in  all  proportions. 

Dose. — 1-8  grains  (0.06-0.5  Gm.). 

Physiological  Action  and  Therapeutics. — The  action  of  scam- 
mony is  identical  with  that  of  jalap,  save  that  it  stimulates  the 
muscular  coat  of  the  intestines  more,  producing  more  irritation 
and  griping  than  jalap,  though  not  increasing  secretion  so  much 
.as  the  latter  drug. 


692  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

The  therapeutics  are  the  same  as  for  jalap. 

The  drug  may  be  given  in  powder,  emulsion,  or  in  milk,  but  is 
inactive  in  pilular  form. 

PodophJ^llum—PodophS^Ui— Podophyllum.   XJ.  S.  P. 

(May  Apple.) 

Origin. — The  rhizome  and  roots  of  Podophyllum  peltatum  L.,  an 
herbaceous  perennial  growing  in  rich  woodlands  in  Canada  and  the 
United  States. 

Description  and  Properties. — Of  horizontal  growth,  consisting 
of  joints  about  2  inches  (5  Cm.)  long,  flattish  cyhndrical,  about 
\  inch  (6  Mm.)  thick,  but  somewhat  enlarged  at  the  end,  which 
has  a  circular  scar  on  the  upper  side,  a  tuft  of  about  ten  nearly 
simple,  fragile  roots  on  the  lower  side,  and  is  sometimes  branched 
laterally ;  smooth  or  somewhat  wrinkled,  orange-brown,  internally 
white  and  mealy,  with  a  circle  of  small  wood-bundles  ;  pith  large; 
nearly  inodorous ;  taste  sweetish,  somewhat  bitter  and  acrid. 

Podophyllum  contains  a  resin,  podophyllin,  composed  princi- 
pally of  podophyllotoxin,  which  is  probably  a  mixture  of  picropodo- 
phyllin,  the  purgative  principle,  and  podophyllinic  acid,  an  inactive 
resin  acid.  Among  other  constituents  of  the  drug  are  several 
minor  resins  and  a  coloring  principle. 

Dose. — 5-20  grains  (0.32-1.29  Gm.). 

Official  Preparations.  , 

Extrdctum  PodophyUi — Extr^cti  Podophylli — Extract  of  Podophyllum. — 

Dose,  1-3  grains  (0.06-0.2  Gm.) 

ExtrSctum  Podophylli  Fluidum — Extrdcti  PodophyUi  Fluidi — Fluid  Ex- 
tract of  Podophyllum. — Dose,  5-20  minims  (0.32-1.29  Co.). 

Resina  Podophylli — Resinae  PodophJ^Ui — Resin  of  Podophyllum. — Descrip- 
tion and  Properties. — An  amorphous  powder,  varying  in  color  from  grayish-white  to 
pale  greenish-yellow  or  yellowish-green,  turning  darker  when  exposed  to  heat;  having 
a  slight  peculiar  odor  and  a  peculiar,  faintly  bitter  taste;  permanent  in  the  air;  soluble 
in  alcohol  in  all  proportions. 

Dose. — \-\  grain  (0.008-0.06  Gm.). 

Podophyllotaxin  (unofficial). — Dose,  yJ^-jV  gi'ain  (0.0006-0.006  Gm.). 

Physiological  Action  and  Therapeutics. — The  powdered  root 
is  an  irritant  to  the  skin,  and  when  inhaled  occasions  a  decided 
irritation  of  the  eyes  and  respiratory  passages.  It  is  absorbed 
when  applied  to  ulcers  and  raw  surfaces,  producing  its  character- 
istic purgative  effects.    The  drug  is  a  gastro-intestinal  irritant,  being 


ANTHELMINTICS.  693 

apt  to  excite  nausea,  in  full  doses  producing  salivation  and  greatly 
augmenting  the  intestinal  secretions,  and  especially  the  bile.  Under 
full  doses  of  podophyllum  there  is  marked  peristalsis,  attended 
with  severe  griping  pains,  and  in  the  course  of  ten  or  twelve  hours 
there  is  produced  a  complete  evacuation  of  the  bowels,  the  feces 
being  liquid  and  deeply  stained  with '  bile. 

The  drug  being  one  of  the  most  active  hepatic  stimulants  and 
cholagogues  in  the  Pharmacopoeia,  it  is  a  peculiarly  appropriate 
remedy  iri  that  condition  known  as  torpor  of  the  liver.  The  con- 
stipation attending  hepatic  cirrhosis  and  cancer,  as  well  as  that  from 
any  hepatic  disorder,  is  well  treated  by  podophyllum. 

The  slowness  and  completeness  of  its  action,  together  with  its 
property  of  stimulating  the  functional  activity  of  the  liver,  renders 
the  drug  extremely  serviceable  in  the  treatment  of  habitual  consti- 
pation from  any  cause. 

It  should,  however,  be  associated  with  antispasmodics,  such  as 
hyoscyamus  or  belladonna,  to  overcome  its  griping.  When  asso- 
ciated with  other  purgatives  care  should  be  exercised  to  select 
those  only  which,  like  itself,  are  tardy  in  their  action. 

Owing  to  the  susceptibility  of  certain  persons  to  the  drug, 
the  dosage  should  be  small  at  first  and  gradually  increased  as 
necessary. 


GROUP   XV.— ANTHELMINTICS. 
Anthelmintics  are  remedies   which   kill   or   expel   intestinal 
worms.     Those  drugs  which  kill  the  parasites  are  called  vermi- 
cides, and  those  which  simply  promote  their  expulsion  are  called 
vermifuges} 

The  vermicides  are — 

Aspidium,  Kamala, 

Chenopodium,  Oleum  Terebinthinse,* 

Cusso,  Pepo, 

Granatum,  Santonica. 

The  vermifuges  are — 

Calomel,*  Spigelia. 

Hydragogue  Purgatives,* 
Anthelmintics  are  here  divided  according  to  the  kind  of  intesti- 
nal parasite  against  which  they  are  employed. 

The  Oxyuris  vermicularis  is  the  small  worm,  often  called  seat- 

1  Drugs  marked  with  an  asterisk  (*)  are  considered  elsewhere. 


694  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

worm  or  thread-worm,  that  infests  the  large  intestine  and  rectum. 
The  Ascaris  lumbricoides  is  the  common  round-worm,  found  chiefly 
in  the  small  intestine. 

The  T(2ni(B  are  the  tape-worms. 
Remedies  employed  against  the  Oxyuris  vermicularis : 
A  weak  solution  of  Carbolic  Acid,*     Lime  Water,* 
Infusion  of  Quassia,*  Calomel,* 

Decoction  of  Aloes.,*  Oleum  Terebinthinse.* 

Remedies  employed  against  the  Ascaris  lumbricoides : 
Chenopodium,  Calomel,* 

Santonica,  Hydragogue  Purgatives,* 

Spigelia,  Oleum  Terebinthinse.* 

Remedies  employed  against  the  Tcenia  Solium  and  other  varieties 
of  Tcenia: 
Aspidium,  Kamala, 

Cusso,  Pepo, 

Granatum,  Oleum  Terebinthinse.* 

Chenopodium— Chenopodii— Chenopodium.  JJ. S.F. 

(American  Wormseed.) 

Origin. — The  fruit  of  Chenopodium  ambrosioides  L.,  and  the 
variety  anthelminticum  Gray,  plants  indigenous  in  the  West  Indies, 
and  Central  and  South  America,  and  naturalized  in  the  United 
States. 

Description  and  Properties. — Nearly  ^  inch  (2  Mm.)  in  diam- 
eter, depressed  globular,  dull  greenish  or  brownish,  the  integu- 
ments friable,  and  containing  a  lenticular,  obtusely-edged,  glossy, 
black  seed.  It  has  a  peculiar,  somewhat  terebinthinate  odor,  and 
a  bitterish,  pungent  taste.  It  contains  a  volatile  oil,  to  which  its 
medical  properties  are  due. 

Dose. — 15-30  grains  (1.0-2.0  Gm.). 

Oleum  Chenopodii— Olei  Chenopodii— Oleum  Che- 
nopodii.    U.S.I'. 

(Oil  of  American  Wormseed.) 
Origin. — A  volatile  oil  distilled  from  Chenopodium. 
Description  and  Properties. — A  thin,  colorless  or  yellowish 

liquid,  having  a  peculiar  penetrating,  somewhat   camphoraceous 

odor,  and  a  pungent  and  bitterish  taste. 
Dose. — 2-10  minims  (0.12-0.6  Cc). 


ANTHELMINTICS.  695 

Physiological  Action  and  Therapeutics. — Both  the  powdered 
SEED  and  the  oil  are  efficient  anthelmintics,  particularly  useful  to 
expel  round-worms  {Ascarides  lumbricoides)  from  children.  The 
drug  should  invariably  be  followed  by  a  brisk  cathartic.  The 
powder  may  be  given  suspended  in  molasses,  or  the  oil  may  be 
given  dropped  upon  loaf-sugar,  or  in  the  form  of  an  emulsion,  or 
enclosed  in  capsules. 

Santonica— Santonicae— Santonica.    TJ.  S.  P. 

(Levant  Wormseed.) 

Origin. — The  unexpanded  flower-heads  of  Artemisia  pauciflora 
Weber,  a  plant  growing  in  Asia  and  exclusively  collected  in  North- 
ern Turkestan. 

Description  and  Properties. — From  yj-  to  ^  inch  (2  to  3  Mm.) 
long,  oblong-ovoid,  obtuse,  smooth,  somewhat  glossy,  grayish- 
green,  after  exposure  to  light  brownish-green,  consisting  of  an  in- 
volucre of  about  twelve  to  eighteen  closely  imbricated,  glandular 
scales  with  a  broad  midrib,  enclosing  four  or  five  rudimentary 
florets ;  odor  strong,  peculiar,  somewhat  camphoraceous ;  taste 
aromatic  and  bitter.  The  drug  contains  about  2  per  cent,  of  a 
neutral  principle,  santonin,  to  which  its  anthelmintic  properties  are 
due.  It  also  contains  about  i  per  cent,  of  an  unimportant  volatile 
oil.  ' 

Dose. — 10-60  grains  (0.6-4.0  Gm.). 

Santonlnum—Santonlni— Santonin.    TJ.  8.  P. 

Origin. — A  neutral  principle  obtained  from  Santonica. 

Description  and  Properties. — Colorless,  shining,  flattened,  pris- 
matic crystals,  odorless,  and  nearly  tasteless  when  first  put  into  the 
mouth,  but  afterward  developing  a  bitter  taste ;  not  altered  by  ex- 
posure to  air,  but  turning  yellow  on  exposure  to  light.  Nearly 
insoluble  in  cold  water ;  soluble  in  40  parts  of  alcohol.  Santonin 
should  be  kept  in  dark,  amber-colored  vials,  and  should  not  be 
exposed  to  light. 

Dose. — \-i  grain  (0.016-0.06  Gm.)  for  a  child;  1-5  grains 
(0.06-0.32  Gm.)  for  an  adult. 

Official  Preparation. 

Trochlsci  Santomni— Trochifscos  (ace.)  Santonini — Troches  of  Santonin. — 
Each  troche  contains  \  grain  (0.03  Gm.). — Dose,  2  (child)  to  10  troches  (adult). 


696  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

Physiological  Action  and  Therapeutics. — In  full  or  large 
doses  santonin  may  excite  nausea  or  vomiting,  with  abdominal 
pain,  diarrhea,  eructations,  borborygmi,  and  great  thirst.  It  readily 
enters  the  blood,  where  it  exists  as  sodium  santoninate.  Large 
doses  may  cause  giddiness,  headache,  hallucinations  of  smell  and 
taste,  tremors,  and  a  species  of  depression,  the  combination  of 
symptoms  forming  what  is  called  santonin  intoxication. 

The  drug  is  chiefly  eliminated  through  the  kidneys,  small 
amounts  of  santonin  even  imparting  to  the  urine  a  distinct  yellow 
color  if  the  urine  is  acid,  and  a  decided  purplish  or  even  red  color 
if  the  urine  is  alkaline.  Under  certain  circumstances  when  the 
urine  is  decidedly  alkaline,  as  in  cases  of  cystitis,  the  administra- 
tion of  santonin  may  produce  so  marked  a  discoloration  of  the 
urine  as  to  suggest  hematuria. 

Probably  the  most  remarkable  phenomenon  attending  the  inges- 
tion of  medicinal  doses  of  santonin  is  that  of  xanthopsia  or  yellow 
vision,  which  may  continue  for  several  hours.  According  to  Rose, 
"  there  occasionally  appears  before  the  peculiar  yellow  sight,  after 
large  doses  of  santonin,  a  violet  color  of  the  field  of  vision :  the 
intensity  of  this  color  is  in  proportion  to  the  darkness  of  the  objects 
looked  at.  All  light  objects,  such  as  windows,  paper,  etc.,  appear 
actually  yellow.  Red  and  blue  appear  often  in  their  complementary 
colors,  orange  and  green,  so  that  carmine-red  appears  pale,  madder- 
red  a  bronze  color,  and  the  sky  and  blue  objects  green.  This, 
however,  is  not  always  the  case,  and  it  has  been  noticed  after  the 
employment  of  santonin  that  red  appears  violet  or  light,  and  dark 
objects  appear  orange  to  one  person,  and  to  another  green." 
(Quoted  from  Lewin.)  This  peculiar  effect  of  santonin  is  due, 
according  to  Rose,  to  a  nervous  change  in  the  retina  or  in  the  brain. 

Affections  of  the  skin — e.  g.  urticaria — have  occasionally  fol- 
lowed the  administration  of  santonin.  Decidedly  poisonous  effects 
have  sometimes  been  produced  by  comparatively  small  amounts  of 
the  drug.  The  symptoms  of  a  fatal  case  from  over-dose  of  santonin 
were  convulsions  accompanied  by  unconsciousness,  twitching  of  the 
eyeballs,  dilated  pupils,  cold  sweat,  weak  pulse,  feeble  respiration, 
and,  after  some  hours,  sudden  death. 

In  case  of  poisoning  by  santonin  the  remedial  measures  are  in- 
ternal and  external  stimulants,  eliminants,  and  artificial  respiration. 
Santonin  is  certainly  a  most  efficient  remedy  against  the  ascaris, 
and  to  a  less  extent  it  is  of  use  against  the  oxyuris.  It  has  no 
effect  on  the  tcznia. 


ANTHELMINTICS.  697 

The  drug  should  be  given  on  an  empty  stomach,  either  alone  or 
associated  with  calomel,  and  followed  in  two  or  three  hours  by 
-castor  oil  or  other  brisk  cathartic.  It  may  be  administered  in  the 
form  of  a  powder  mixed  with  sugar  or  jelly,  or  in  pills  or  cap- 
sules.    Troches  of  santonin  are  much  used  and  are  very  efficient. 

Spigelia— Spigeliae— Spigelia.    TJ.  S.  JP. 

(PiNKROOT.) 

Origin. — The  rhizome  and  roots  of  Spigelia  marilandica  L., 
a  plant  growing  in  rich  shady  woods,  chiefly  in  the  southern  part 
of  the  United  States,  but  found  as  far  northward  as  Pennsylvania 
and  Wisconsin. 

Description  and  Properties. — Of  horizontal  growth,  about  2 
inches  (5  Cm.)  or  more  long,  about  -I-  inch  (3  Mm.)  thick,  dark 
purplish-brown,  bent,  somewhat  branched  on  the  upper  side,  with 
cup-shaped  scars ;  on  the  lower  side  with  numerous  thin,  brittle, 
light-colored  roots  about  4  inches  (10  Cm.)  long;  the  rhizome 
internally  with  a  whitish  wood  and  a  pith  which  is  usually  dark 
colored  or  decayed ;  odor  somewhat  aromatic ;  taste  sweetish, 
bitter,  and  pungent. 

It  contains  a  volatile  alkaloid,  spigeline,  which  is  the  active 
principle. 

Dose. — |— 2  drachms  (1.0-8.0  Gm.). 

Official  Preparation. 

Extractum  Spigeliae  Fltiidum — Extract!  Spigelise  Fltiidi — Fluid  Extract 
•of  Spigelia. — Dose,  J-2  fiuidrachms  (1.0-8.0  Cc). 

Physiological  Action  and  Therapeutics. — Spigelia  is  a  pow- 
erful anthelmintic,  being  a  decided  vermifuge  against  the  Ascaris 
lumbricoides.  When  given  alone  and  in  full  doses  it  may  produce 
symptoms  of  narcotic  poisoning.  This  may  be  obviated  by  asso- 
ciating it  with  cathartics  and  aromatics. 

The  drug  may  be  administered  in  the  form  of  a  tea,  associated 
"with  senna,  fennel,  or  other  aromatics.  The  fluid  extract  is  a  reli- 
■able  preparation. 

Remedies  employed  against  the  different  varieties  of  Tcenia  : 
AspTdium— AspTdii— Aspidium.    U.  S.  J*. 

(Male  Fern.) 
Origin. — The  rhizome  of  Dryopteri?  Filix  mas  Schott  and  of 
Dryopteris  marginalis  Gray,  plants  indigenous  in  North  America, 


698  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

a  portion  of  South  America,  Asia,  Europe,  and  some  parts  of 
Africa. 

Description  and  Properties. — From  3  to  6  inches  (7  to  15  Cm.) 
long, -I  to  I  inch  (12  to  25  Mm.)  thick,  and,  together  with  the 
closely  imbricated,  dark-brown,  roundish,  and  slightly  curved 
stipe-remnants,  2  to  3  inches  (50  to  75  Mm.)  in  diameter;  densely 
covered  with  brown,  glossy,  transparent,  and  soil,  chaffy  scales ; 
internally  pale  green,  rather  spongy ;  vascular  bundles  about  ten 
{Dryopteris  Filix  mas)  or  six  {Dryopteris  marginalis)  in  number, 
arranged  in  an  interrupted  circle;  odor  slight,  but  disagreeable; 
taste  sweetish,  acrid,  somewhat  bitter,  astringent,  and  nauseous. 
Aspidium  contains  filicic  acid,  tannaspidic  acid,  pteritannic  acid, 
filicin  (filicic  acid  anhydride),  fixed  oil,  a  trace  of  volatile  oil,  and 
chlorophyl. 

Dose. — \-2  drachms  (2.0-8.0  Gm.). 

Official  Preparation. 

Oleoresina  Aspldii— Oleoreslnae  AspMii — Oleoresin  of  Aspidium. — Dose, 
\-\  fluidraclim  (1.0-4.0  Cc). 

Note. — Oleoresin  of  aspidium  usually  deposits,  on  standing,  a  granular  crystalline 
substance.  This  should  be  thoroughly  mixed  with  the  liquid  portion  before  use.  The 
oleoresin  should  be  kept  in  well-stoppered  bottles. 

Physiological  Action  and  Therapeutics. — Aspidium  is  the 
most  reliable  tceniacide  known  to  materia  medica.  Though  it  is 
employed  against  both  the  armed  and  unarmed  varieties  of  tape- 
worm, it  is  nevertheless  against  the  latter  that  it  is  specially  effec- 
tive. In  the  cases  of  armed  taeniae  special  precautions  must  be 
taken  to  ensure  success. 

The  drug  possesses  tonic  and  astringent  properties,  and  if  taken 
in  very  large  doses  may  occasion  nausea,  vomiting,  diarrhea,  and 
gastric  and  abdominal  pains. 

Several  fatal  cases  of  poisoning  have  occurred,  and  it  is  believed 
that  the  fatalities  were  due  not  so  much  to  excessive  dose  as  to 
increased  absorption  of  the  drug  through  the  influence  of  the 
castor  oil  that  had  been  administered  with  it. 

When  given  for  the  expulsion  of  tape-worm  the  bowels  should 
first  be  emptied  by  a  castor-oil  purge,  and  then  the  oleoresin  be 
administered  in  gelatin  capsules  or  in  emulsion. 

Previous  to  the  exhibition  of  the  anthelmintic  the  patient  should 
for  at  least  twenty-four  hours  live  on  exceedingly  spare  diet,  and 
the  medicine  then  be  given  in  the  morning  fasting.     A  few  hours 


ANTHELMINTICS.  699 

later  an  active  purge  of  about  i  ounce  (30.0  Cc.)  of  castor  oil  or 
calomel  and  jalap  should  be  given  to  expel  the  dead  worm,  which 
should  be  carefully  examined  for  the  head.  If  the  head  did  not 
pass,  the  treatment  should  be  repeated  the  following  day  or  soon 
after. 

Cusso— Cusso— Kousso.    TJ.  S.  J». 

(Brayera.) 

Origin. — The  female  inflorescence  of  Hagenia  Abyssinica  (Bruce) 
Gmelin,  a  handsome  tree  40  to  50  feet  (12  to  18  M.)  high,  in- 
digenous on  the  table-land  and  in  the  mountainous  districts  of 
Abyssinia. 

Description  and  Properties. — In  bundles,  rolls,  or  compressed 
clusters  consisting  of  panicles  about  10  inches  (25.0  Cm.)  long, 
with  a  sheathing  bract  at  the  base  of  each  branch ;  the  two  round- 
ish bracts  at  the  base  of  each  flower  and  the  four  or  five  obovate 
outer  sepals  are  of  a  reddish  color,  membranous  and  veiny ;  calyx 
top-shaped,  hairy,  enclosing  two  carpels  or  nutlets;  odor  slight, 
fragrant,  and  tea-like;  taste  bitter,  acrid,  and  nauseous. 

It  contains  a  neutral  active  principle,  kosin,  a  tasteless  and  an 
acid  resin,  and  about  24  per  cent,  of  tannin. 

Dose. — 2-4  drachms  (8.0-16.0  Gm.). 

Official  Preparation. 

Extractum  Ciisso  Fluidum — ExtrScti  Ctisso  Fluidi — Fluid  Extract  of 
Cusso. — Dose,  1-4.  fluidrachms  (4.0-15.G  Cc). 

Kosin — Koussein  (unofficial). — Origin. — The  active  principle  from  the  flowers 
and  unripe  fruits  of  Hagenia  Abyssinica   (Bruce)   Gmelin. 

Description  and  Properties. — An  amorphous  yellowish  crystalline  powder  having  a 
pungent  bitter  taste.     Insoluble  in  water,  but  readily  soluble  in  alcohol  and  in  ether. 

Dose,  15-30  grains  (1.0-2.0  Gm.),  to  be  divided  into  four  doses  and  taken  at  inter- 
vals of  half  an  hour. 

Physiological  Action  and  Therapeutics. — The  action  of  kousso 
upon  the  digestive  tract,  under  large  doses,  is  similar  to  the  action 
of  aspidium.  It  is  a  reliable  anthelmintic  for  all  species  of  tape- 
worm. The  fluid  extract  should  be  given  in  the  form  of  an  emul- 
sion, the  patient  having  previously  fasted,  and  the  exhibition  of  the 
drug  followed  in  a  few  hours  by  a  large  dose  of  castor  oil. 

Granatum—Granati— Pomegranate.    TJ.  8.  F. 

Origin. — The  bark  of  the  stem  and  root  of  Punica  Granatum 
L.,  a  shrub  or  small  tree  about  20  feet  (6  M.)  high,  indigenous 
in  Southwestern  Asia  from  Northern  India  to  Palestine. 


700  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Description  and  Properties. — In  thin  quills  or  fragments  from 
2  to  4  inches  (5  to  10  Cm.)  long  and  from  -^^  to  \  inch  (i.  to  3. 
Mm.)  thick ;  outer  surface  yellowish-gray,  somewhat  warty  or 
longitudinally  and  reticulately  ridged ;  the  stem-bark  often  partly 
covered  with  blackish  lichens ;  the  thicker  pieces  of  the  root-bark 
more  or  less  scaly  externally ;  inner  surface  smooth,  finely  striate, 
grayish-yellow ;  fracture  short,  granular,  greenish-yellow,  indis- 
tinctly radiate ;  inodorous ;  taste  astringent,  very  slightly  bitter. 

It  contains  as  its  active  constituent  a  liquid  alkaloid,  pelletierine, 
with  its  three  allied  alkaloids,  methyl-pelletierine,  pseudo-pelletierine, 
and  iso-pelletierine ,  besides  mannite  and  punico-tannic  acid. 

Dose. — J-iJ  drachms  (2.0-6.0  Gm.). 

Unofficial  Preparations. 

Pelletierine. —  Origin. — An  alkaloid  derived  from  tlie  root-bark  of  Punica  gratia- 
iu7n  L. 

Description  and  Properties. — A  colorless  liquid.  Soluble  in  20  parts  of  water  and 
miscible  in  all  proportions  with  alcohol.  It  forms  crystalUne  salts  with  acids,  the  prin- 
cipal one  being  the  tannate. 

There  are  also  the  sulphate,  hydrobromate  and  hydrochlorate. 

Pelletierinae  TSnnas — Pelletierlnse  Tannatis — Pelletierine  Tannate. — De- 
scription and  Properties. — A  yellowish,  hygroscopic,  odorless  powder,  with  a  pungent 
astringent  taste.     Soluble  in  700  parts  of  water  and  in  80  parts  of  alcohol. 

Dose. — 1-5  grains  (0.06-0.32  Gm.). 

Physiological  Action  and  Therapeutics. — Locally  pomegran- 
ate is  astringent.  In  large  doses  it  excites  vomiting,  acts  as  a 
purgative,  paralyzes  the  motor  nerves,  but  does  not  affect  sensa- 
tion, and  dilates  the  capillaries. 

Pomegranate  and  its  alkaloid,  pelletierine,  are  efficient  anthel- 
mintics for  tape-worm. 

Like  other  anthelmintics,  the  drug  should  be  given  on  an  empty 
stomach,  and  if  the  bowels  are  not  freely  moved  by  the  remedy,  an 
active  cathartic  should  follow  its  administration. 

A  decoction  of  the  bark  may  be  used,  but,  owing  to  the  diffi- 
culty in  obtaining  the  fresh  drug,  which  alone  possesses  anthel- 
mintic properties,  the  tannate  of  pelletierine,  which  is  always 
reliable,  is  usually  administered. 

Kamala— Kamalae— Kamala.   TJ.  S.  P. 

(ROTTLERA.) 

Origin. — The  glands  and  hairs  from  the  capsules  of  Mallotus 
Philippinensis  (Lamarck)  Mueller,  Arg.,  a  large  shrub  or  small  tree 


ANTHELMINTICS.  701 

growing  wild  in  Australia,  Eastern  China,  India,  Southern  Arabia, 
and  Abyssinia. 

Description  and  Properties. — A  granular,  mobile,  brick-red  or 
brownish-red  powder,  inodorous  and  nearly  tasteless,  imparting  a 
deep-red  color  to  alkaline  liquids,  alcohol,  ether,  or  chloroform, 
and  a  pale  yellow  tinge  to  boiling  water.  Under  the  microscope  it 
is  seen  to  consist  of  stellately  arranged,  colorless  hairs,  mixed  with 
depressed-globular  glands,  containing  numerous  red,  club-shaped 
vesicles.  It  contains  a  resinous  coloring  matter,  rottlerin,  and 
several  resins. 

Dose. — 1-2  drachms  (4.0-8.0  Gm.). 

Physiological  Action  and  Therapeutics. — Kamala  is  a  gastro- 
intestinal irritant  and  purgative,  and  an  efficient  anthelmintic  against 
the  Tcenia  solium,  as  well  as  the  Oxyuris  vermicularis  and  the  Ascaris 
lumbricoides.  The  drug  should  be  taken  suspended  in  syrup,  and 
followed  by  a  full  dose  of  castor  oil. 

Pepo—Peponis— Pumpkin  Seed.    TJ.  S.  I*. 

Origin. — The  seed  of  Cucurbita  Pepo  L.,  the  common  pumpkin, 
indigenous  in  tropical  Asia  and  America,  and  cultivated  through- 
out the  temperate  zones. 

Description  and  Properties. — About  f  inch  (2  Cm.)  long, 
broadly-ovate,  flat,  white  or  whitish,  nearly  smooth,  with  a  shallow 
groove  parallel  to  the  edge ;  containing  a  short,  conical  radicle  and 
two  flat  cotyledons  ;  inodorous  ;  taste  bland  and  oily.  It  contains 
an  acrid  resin,  supposed  to  be  the  active  principle,  and  from  30  to 
35  per  cent,  of  a  thick  red  fixed  oil. 

Dose. — 1-3  ounces  (32.0-94.0  Gm.). 

Physiological  Action  and  Therapeutics. — Pumpkin  seed  ranks 
next  to  aspidium  as  a  remedy  for  the  destruction  of  tape-worm, 
and  has  the  advantage  of  being  free  from  any  disagreeable  taste  or 
unpleasant  action.  For  administration  the  fresh  pumpkin  seeds 
should  be  beaten  into  a  paste  with  powdered  sugar  and  diluted 
with  milk  or  water  to  about  i  pint  (473.17  Cc).  Previous  to  its 
administration  the  patient  should  fast  for  twenty-four  hours,  when 
the  bowels  should  be  flushed  out  with  a  large  saline  purgative.' 
A  portion  of  the  emulsion  of  pumpkin  seed  is  then  to  be  taken, 
preferably  in  the  morning,  and  the  balance  taken  in  two  doses  at 
intervals  of  about  two  hours,  the  patient  meanwhile  remaining  in 
bed  to  prevent,  as  far  as  possible,  disturbance  of  the  stomach. 


702 


A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 


Three  or  four  hours  after  the  last  dose  of  the  emulsion  has  been 
taken  the  patient  should  be  given  a  full  dose  of  castor  oil. 


GROUP    XVI.— EMMENAGOGUES  AND   ECBOLICS. 

Emmenagogues  are  remedies  which  restore  or  increase  the  men- 
strual flow.  They  are  divided,  according  to  their  action,  into  two 
classes.  Those  which  act  upon  the  uterine  muscle  or  mucous 
membrane  are  said  to  be  direct ;  those  which  influence  the  uterus 
by  afiecting  the  general  health  of  the  body,  or  by  altering  the 
blood-supply  of  the  parts,  or  by  influencing  the  nervous  system, 
are  said  to  be  indirect. 

The  principal  Direct  Emmenagogues  are — 


Ergot, 

Borax, 

Digitalis, 

Rue, 

Savine, 

Hydrastis, 

Quinine, 

Caulophyllum, 

Asafetida, 

Tansy, 

Myrrh, 

Apiol, 

Guaiac, 

Hedeoma. 

Cantharides, 

The  Indirect  Emmenagogues  are — 

Iron  and  the  Hematics, 

Cinnamon, 

Cod  Liver  Oil, 

Aloes. 

Strychnine, 

(  Hot  foot-bath. 

Baths      I  Hot  hip-bath. 

I  Mustard  bath. 

Leeches /i;°g^"^tals. 
y  To  thighs. 

c  Baths. 
Mustard  I  Poultices  to  thighs. 
(  Stupes. 
EcBOLics  or  Oxytocics  are  remedies  which  act  directly  upon  the 
uterine  muscular  fibers,  inducing  uterine  contraction,  and  are  chiefly 
used  during  or  immediately  after  parturition  to  produce  or  increase 
uterine  action.     They,  are  therefore  contraindicated  before  parturi- 
tion, lest  they  induce  abortion,  although  they  are  often  used  crimi- 
nally for  this  purpose. 

The  exact  manner  in  which  ecbohcs  act  is  unknown,  but  it  is 


EMMENAGOGUES  AND  ECBOLICS.  703 

supposed  that  they  act  directly  by  stimulating  the  uterine  center 
in  the  cord  or  reflexly  through  uterine  congestion. 

In  small  doses  many  of  the  acholics  are  emmenagogue,  while 
many  of  the  direct  emmenagogues  are  ecbolic. 

The  only  justifiable  uses  for  ecbolics  are  in  parturition,  with 
uterine  inertia  and  unobstructed  and  well-dilated  maternal  parts, 
when  it  is  desired  to  hasten  the  delivery  of  the  child,  or,  second, 
to  induce  firm  contraction  of  the  uterus,  and  thus  prevent  or  check 
uterine  hemorrhage  after  the  birth  of  the  child. 
The  principal  Ecbolics  are — 

Ergot,  Oil  of  Rue, 

Ustilago,  Borax, 

Hydrastis,  Pilocarpine, 

Savine,  Potassium  Permanganate, 

Quinine,  Strong  Purgatives. 

Cotton  Root  Bark, 

Drugs  which  have  not  been  considered  elsewhere  in  the  present 
-work  will  now  be  described. 

Sablna—Sablnae— Savine.    TJ.  S.  JP. 

Origin. — The  tops  of  Juniperus  Sabina  L.,  a  small  ever- 
green procumbent  or  erect  shrub,  distributed  throughout  the 
greater  portion  of  Europe,  Siberia,  Canada,  and  the  Northern 
United  States. 

Description  and  Properties. — Short,  thin,  subquadrangular 
branchlets ;  leaves  rather  dark  green,  in  four  rows,  opposite,  scale- 
like, ovate-lanceolate,  more  or  less  acute,  appressed,  imbricated, 
on  the  back  with  a  shallow  groove  containing  an  oblong  or  round- 
ish gland ;  odor  peculiar,  terebinthinate ;  taste  nauseous,  resinous, 
and  bitter. 

It  contains  2  per  cent,  of  a  volatile  oil,  tannin,  resin,  gum,  etc. 

Dose. — 5-15  grains  (0.3-1.0  Gm.). 

Official  Preparation. 

ExtrSctum  Sabinse  Fluidum — ExtrScti  Sablnae  Fluidi — Fluid  Extract  of 
Ravine. — Dose,  5-15  minims  (0.3-I.0  Cc). 

Oleum  Sablnae— Olei  Sabinse— Oil  of  Savine. 

V.  S.  J?. 

Origin. — A  volatile  oil  distilled  from  Savine. 

Description  and  Properties. — A  colorless  or  yellowish  liquid 


704  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

having  a  peculiar  terebinthinate  odor  and  a  pungent,  bitterish,  and 
camphoraceous  taste.  It  becomes  darker  and  thicker  by  age  and 
exposure  to  the  air.     Soluble  in  an  equal  volume  of  alcohol. 

Dose. — 1-5  minims  (0.06-0.3  Cc). 

Physiological  Action  and  Therapeutics. — The  action  of  savine 
depends  on  the  presence  of  the  volatile  oil,  and  this  oil  differs  in 
its  local  external  effect  from  the  oil  of  turpentine  merely  in  that 
the  oil  of  savine  is  more  active.  It  occasions  much  irritation,  vesi- 
cation, and  even  pustulation  when  applied  to  the  skin.  Taken 
internally  in  small  doses,  it  produces  a  sensation  of  heat  in  the 
epigastrium,  with  flatulence  and  frequently  nausea.  Toxic  doses 
excite  violent  gastro-enteritis. 

The  drug  stimulates  the  circulation,  and  later,  under  full  me- 
dicinal doses,  depresses  it.  It  is  rapidly  absorbed,  and  is  excreted 
by  various  channels,  increasing  the  urinary  and  bronchial  excre- 
tions. These  excretions,  as  well  as  the  sweat  and  breath,  smell 
strongly  of  the  drug. 

Savine  is  a  decided  irritant  to  the  uterus  and  ovaries,  inducing 
marked  hyperemia  of  those  organs,  and  promoting  contractions  of 
the  pregnant  uterus. 

Toxic  doses  produce  symptoms  similar  to  those  occasioned  by 
oil  of  turpentine — violent  gastro-enteritis,  suppressed  or  bloody 
urine,  great  depression,  etc.  The  treatment  in  poisoning  by  oil  of 
savine  would  be  full  doses  of  Epsom  salt,  demulcents,  anodynes, 
and  stimulants  if  necessary. 

Savine  in  the  form  of  an  ointment  is  used  as  a  stimulant  appli- 
cation to  keep  up  the  discharge  from  blisters.  An  alcoholic  solu- 
tion of  oil  of  savine,  5-30  minims  (0.3-1.8  Cc.)  to  i  ounce  (30.0 
Cc),  is  used  in  alopecia  pityroides. 

Oil  of  savine  is  a  very  efficient  remedy  in  amenorrhea,  and  is 
also  of  benefit  in  certain  cases  of  menorrhagia  due  to  an  enlarged 
and  passively  congested  uterus.  The  hemorrhage  following  abor- 
tion is  usually  well  controlled  by  this  remedy. 

The  powder  or  fluid  extract  may  be  given,  but  the  oil  is  the 
most  effective  preparation,  and  may  be  prescribed  in  capsules,  pills, 
or  emulsion.     It  should  be  given  cautiously. 

Ruta— Rutae— Rue.     (Unofficial.) 

Origin. — The  leaves  of  Ruta  graveolens  L.,  an  herbaceous  or 
suffruticose  perennial  2  or  3  feet  (60  or  90  Cm.)  high,  indigenous 
in  Southern  Europe. 


EMMENAGOGUES  AND  ECBOLICS  705 

Description  and  Properties. — The  leaves  are  ternate,  the  leaf- 
lets being  obovate-oblong,  yellowish-green,  thickly  dotted  with 
minute,  transparent  oil-vesicles.  They  have  a  peculiar,  strongly 
balsamic  odor,  and  possess  an  aromatic,  bitter,  and  acrid  taste. 

The  principal  constituent  of  rue  is  a  volatile  oil. 

Dose. — 5-20  grains  (0.3-1.3  Gm.). 

Oleum   Rutae— -Olei  Rutae— Oil  of  Rue.     (Unofficial.) 

Origin. — A  volatile  oil  distilled  from  Ruta  graveolens  L. 

Description  and  Properties. — A  colorless  or  greenish-yellow 
liquid  with  the  peculiar  odor  of  the  plant,  and  a  pungent,  some- 
what acrid,  bitterish  taste.     Soluble  in  an  equal  weight  of  alcohol. 

Dose. — 2-5  minims  (o.i  3-0.3  Cc). 

Physiological  Action  and  Therapeutics. — The  action  of  oil 
of  rue  is  analogous  to  that  of  oil  of  savine,  though  less  powerful. 
It  is  used  for  the  same  purposes  also,  and  has  occasionally  been 
employed  in  hysteria. 

The  oil  should  be  administered  in  capsules. 

Caulophyilum— Caulophylli— Caulophyllum. 
V.  S.  JP. 

(Blue  Cohosh.) 

Origin. — The  rhizome  and  roots  of  Caulophyllum  Thalictroides 
(L.)  Michaux,  a  smooth  and  glaucous  perennial,  found  in  rich 
woodlands  from  Canada  south  to  Carolina  and  Kentucky. 

Description  and  Properties. — Rhizome  of  horizontal  growth, 
about  4  inches  (10  Cm.)  long  and  about  i  to  |-  inch  (6  to  10  Mm.) 
thick,  bent;  on  the  upper  side  with  broad,  concave  stem-scars 
and  short,  knotty  branches ;  externally  grayish-brown,  internally 
whitish,  tough,  and  woody.  Roots  numerous,  matted,  about  4 
inches  (lo  Cm.)  long  and  -^-^  inch  (i  Mm.)  thick,  rather  tough; 
nearly  inodorous ;  taste  sweetish,  slightly  bitter,  and  somewhat 
acrid. 

Caulophyllum  contains  an  odorless,  colorless,  and  tasteless  alka- 
loid, caulophyllin,  besides  resins,  tannin,  starch,  gum,  etc. 

Dose. — 5-30  grains  (0.3-2.0  Gm.). 

Physiological  Action  and  Therapeutics. — Blue  cohosh  is  em- 
menagogue,  antispasmodic,  diuretic,  and  demulcent.  It  is  quite  an 
efficient  remedy  to  increase  the  force  of  uterine  contractions,  and 
is  of  service  in  the  treatment  of  spasmodic  dysmenorrhea. 

It  is  usually  given  in  the  form  of  a  decoction. 
45 


7o6  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Tanacetum—Tanaceti— Tansy.     U.  8.  P. 

Origin. — The  leaves  and  tops  of  Tanacetum  vulgare  L.,  a 
perennial  herb  indigenous  in  Europe  and  Central  Asia,  and  nat- 
uralized in  many  parts  of  North  America. 

Description  and  Properties. — Leaves  about  6  inches  (15.24 
Cm.)  long,  bipinnatifid,  the  segments  oblong,  obtuse,  serrate,  or 
incised,  smooth,  dark  green,  and  glandular;  flower-heads  corym- 
bose, with  an  imbricated  involucre,  a  convex,  naked  receptacle,  and 
numerous  yellow  tubular  florets;  odor  strongly  aromatic;  taste 
pungent  and  bitter. 

It  contains  a  volatile  oil  and  a  bitter  principle,  tanacetin,  besides 
tannin,  resin,  etc. 

Dose. — 15-60  grains  (1.0-4.0  Gm.),  in  infusion. 

Physiological  Action  and  Therapeutics. — In  moderate  doses 
tansy  acts  as  an  aromatic  bitter.  Excessive  amounts  produce  all 
the  symptoms  of  an  irritant  narcotic — vomiting,  purging,  severe 
abdominal  pain,  loss  of  consciousness,  convulsions,  and  great  car- 
diac and  respiratory  weakness,  death  usually  resulting  from  paral- 
ysis of  respiration. 

The  drug  is  regarded  as  an  efficient  remedy  in  amenorrhea,  and 
is  extensively  employed  in  domestic  practice  in  hysteria  and  colic, 
and  topically  for  bruises,  sprains,  muscular  rheumatism,  etc. 

It  is  used  in  the  rural  districts  to  promote  or  restore  menstrua- 
tion, and  occasionally  is  employed  with  criminal  intent  as  an  abor- 
tifacient,  but  usually  with  negative  results. 

The  drug  may  be  given  in  the  form  of  an  infusion,  i  ounce  to 
I  pint  (32.0  Gm.-473.17  Cc),  of  which  i  or  2  ounces  (30.0  or  60.0 
Cc.)  may  be  taken  at  a  dose. 

The  oil  of  tansy  is  occasionally  prescribed  in  doses  of  1-5 
minims  (0.06-0.3  Cc). 

PetroselTnum—PetroselTni— Parsley. 

Origin. — The  root  of  Pctrosclinum  sativum  (Hoffmann),  Apium 
Petroselinum  L.,  a  plant  indigenous  in  Southern  Europe,  and  much 
cultivated  for  culinary  purposes. 

Description  and  Properties. — The  root  is  tapering,  from  4  to 
8  inches  (10-20  Cm.)  long,  about  |  inch  (12  Mm.)  thick;  exter- 
nally yellowish  or  light  brown ;  odor  aromatic ;  taste  sweetish  and 
aromatic. 

It  contains  a  volatile  oil  and  apiol,  the  chief  constituent. 

Dose. — 30-60  grains  (2.0-4.0  Gm.). 


EMMENAGOGUES  AND  ECBOLICS.  707 

Apiolum — Apioli — Apiol  (Unofficial). — Origin.— h.  camphor  obtained  from  the 
fruit  of  Petroselinuin  sativum  Hoffmann. 

Description  and  Properties. — White  needles,  of  a,  feeble,  parsley  odor.  Insoluble 
in  water,  but  freely  soluble  in  alcohol  and  in  ether. 

Dose. — 10-15  grains  (0.6-1.0  Gm.). 

Physiological  Action  and  Therapeutics. — The  root  is  carmin- 
ative, laxative,  and  diuretic.  Apiol  is  an  active  emmenagogue. 
Given  in  excessive  doses,  it  occasions  severe  frontal  headache, 
dizziness,  and  ringing  in  the  ears.  It  causes  a  rapid  rise  of  blood- 
pressure,  due  to  increased  cardiac  action  and  stimulation  of  the 
vaso-motor  centers. 

Apiol,  or  Chapoteaut's  apioline,  is  usually  prescribed,  and  is 
an  efficient  remedy  in  amenorrhea,  dysmenorrhea,  and  as  an  anti- 
periodic  in  malarial  affections.  As  an  emmenagogue  in  cases  of 
scanty  or  deficient  menstruation  apioline  is  very  effective. 

The  drug  is  best  given  in  capsules,  as  prepared  by  Chapoteaut,* 
one  or  two  capsules  being  taken  after  meals  three  times  a  day. 

Hedeoma— Hedeomse— Hedeoma.  TJ.  S.  -P. 

(Pennyroyal.) 

Origin. — The  leaves  and  tops  of  Hedeoma  pulegioides  (L.)  Per- 
soon,  an  annual  herb  indigenous  in  North  America. 

Description  and  Properties. — Leaves  opposite,  short-petioled, 
about  \  inch  (12  Mm.)  long,  oblong-ovate,  obscurely  serrate,  glan- 
dular beneath ;  branches  roundish-quadrangular,  hairy ;  flowers  in 
small,  axillary  cymules,  with  a  tubular-ovoid,  bilabiate,  and  five- 
toothed  calyx,  and  a  pale-blue,  spotted,  bilabiate  corolla,  containing 
two  sterile  and  two  fertile  exserted  stamens ;  odor  strong,  mint-like ; 
taste  warm  and  pungent.     Its  virtues  depend  upon  a  volatile  oil. 

Dose. — 15-60  grains  (1.0-4.0  Gm.)  in  infusion. 

Oleum  Hedeomae— Olei  Hedeomae— Oil  of  Hede- 
oma.    Tf.  S.  P. 

(Oil  of  Pennyroyal.) 

Origin. — A  volatile  oil  distilled  from  Hedeoma. 

Description  and  Properties. — A  pale-yellowish,  limpid  liquid, 
having  a  characteristic,  pungent,  mint-like  odor  and  taste.   It  should 

'  M.  Chapoteaut  has  prepared  from  the  alcoholic  solution  of  a  petrol-ethereal  extract 
a  thick  reddish  liquid,  to  which  he  has  given  the  name  Apioline.  This  substance  he 
claims  to  be  the  true  active  principle,  and  it  is  dispensed  in  capsules  containing  3  minims 
(0.18  Cc.)  each. 


7o8  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

be  kept  in  well-stoppered  bottles,  in  a  cool  place,  protected  from 
light. 

Dose. — 2-IO  minims  (0.1-0.6  Cc). 

Physiological  Action  and  Therapeutics. — Hedeoma  is  aro- 
matic, stimulant,  caripinative,  and  emmenagogue,  while  the  oil  is 
rubefacient  if  rubbed  into  the  skin. 

The  herb  is  given  in  the  form  of  a  hot  infusion  to  bring  on 
retarded  or  suspended  menstruation  and  for  the  relief  oi  flatulent 
colic,  pharyngitis,  bronchitis,  etc.,  as  well  as  to  dissipate  congestions 
of  various  parts. 

The  OIL  OF  HEDEOMA  is  an  active  emmenagogue,  and  is  used 
to  increase  the  rubefacient  effect  of  various  embrocations. 


GROUP   XVII.— ASTRINGENTS. 

Astringents  are  medicines  which  cause  the  contraction  of  living 
tissues,  diminishing  the  amount  of  blood  or  other  fluid  in  them,  and 
reducing  hemorrhage,  or,  through  their  constipating  action,  limiting 
the  intestinal  secretions  as  well  as  those  from  mucous  membranes 
generally. 

They  act  chemically  upon  the  tissues,  and,  when  taken  inter- 
nally, their  influence  is  similar  to  that  of  tonics,  invigorating  the 
various  structures  of  the  body,  their  principal  use  being,  in  cases 
of  relaxed  conditions  of  the  muscles  and  fibers  or  of  the  mucous 
membranes  characterized  by  excessive  secretion. 

Astringents  are  more  or  less  irritating,  and  should  therefore  not 
be  employed,  as  a  rule,  in  acute  inflammatory  conditions.  There 
are,  however,  four  exceptions — lead  acetate  or  subacetate,  bismuth 
subnitrate  or  subcarbonate,  cerium  oxalate,  and  silver  nitrate— 
which  are  sedative  astringents  and  would  be  indicated  in  acute 
inflammatory  states. 

Astringents  vary  in  the  intensity  of  their  action,  their  strength 
being  directly  proportionate  to  the  condensation  of  tissue.  Herein 
lies  the  chief  difierence  between  astringents  and  caustics.  If  the 
heavy  metals  be  arranged  according  to  their  astringent  properties, 
the  feeblest  at  one  extreme  and  the  strongest  at  the  other,  it  will 
be  observed  that  the  least  astringent  is  the  most  caustic,  and  the 
most  astringent  the  least  caustic,  the  order  being  as  follows  :  lead 
(astringent),  iron,  zinc,  copper,  silver,  tin,  mercury  {caustic),  lead 
being  the  most  astringent  and  least  caustic,  and  mercury  the  most 
caustic  and  least  astringent. 


ASTRINGENTS.  709 

The  explanation  of  these  diverse  properties  is  that  the  astrin- 
gents expel  the  fluid  from  the  protoplasm,  contracting  or  constring- 
ing  the  tissue  and  causing,  it  to  occupy  less  space ;  whereas  the 
caustics  relax  the  eschar,  reducing  the  space  it  occupies.  The 
caustic  action  of  a  mineral  salt  depends  both  upon  the  nature  of 
the  base  and  the  acid  radical.  In  other  words,  the  salt  and  the 
products  of  its  action  must  both  be  somewhat  soluble  in  water, 
otherwise  the  eschar  will  be  firm,  and  the  drug  will  therefore  act 
as  an  astringent. 

The  chlorides  of  the  heavy  metals  are  usually  soluble,  and  are 
generally  the  more  caustic,  as,  for  instance,  zinc  chloride,  mercuric 
chloride  (corrosive  sublimate),  etc.  Should  a  chloride  be  insoluble 
in  water,  it  will  not  act  as  a  caustic — as,  for  example,  the  insoluble, 
and  consequently  inert,  silver  chloride. 

Certain  drugs  which  in  a  concentrated  state  are  caustic  are,  if 
sufficiently  diluted,  astringent,  as  is  the  case  with  sulphuric  acid. 

An  astringent  drug  employed  to  check  hemorrhage  is  called  a 
styptic,  the  subsulphate  of  iron  being  extensively  used  as  such. 

Astringents  differ  in  some  respects  from  other  groups  of  medi- 
cines, in  that  they  do  not,  as  a  rule,  assist  one  another  by  combi- 
nation. They  are  divisible  into — (i)  Vegetable  astringents ;  (2) 
mineral  astringents.  The  vegetable  astringents  mentioned  in  this 
group,  beginning  with  the  type,  are — 

Tannic  Acid,  Kino,  Rhus  Glabra, 

Gallic  Acid,  Krameria,  Rosa  Gallica, 

Galla,  Hematoxylon,  Rubus. 

Quercus  Alba,  Hamamelis, 

Catechu,  Geranium, 

Cinnamon  also  possesses  considerable  astringent  properties,  but 
is  classed  among  the  Aromatics. 

The  mineral  astringents,  beginning  with  the  type,  are — 
Lead,  Silver,  Bismuth, 

Zinc,  Alum,  Cerium  Oxalate. 

Copper, 

Certain  salts  of  iron  are  powerfully  astringent,  although  classed 
with  iron  under  the  Restoratives.  Diluted  sulphuric  and  nitric  acids 
also  possess  marked  astringent  properties.     (See  Mineral  Acids.) 

Antagonists  and  Inoompatibles. — The  vegetable  astringents 
are  incompatible  with  the  salts  of  iron  (ferric  and  ferrous),  and  also 
with  the  salts  of  lead,  silver,  antimony,  and  copper ;  with  the  alka- 


7IO  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

loids,  the  glucosids,  and  gelatin  ;  and  with  the  alkalies  and  mineral 
acids  and  emulsions.  Spirit  of  nitrous  ether  is  incompatible  with 
gallic  acid. 

Synergists. — Tonics   and  bitters,   and  also    agents    increasing 
waste,  favor  the  action  of  vegetable  astringents. 

VEGETABLE  ASTRINGENTS. 

Acidum  Tannicum— Acidi  Tannici— Tannic  Acid. 

V.  S.  I*. 

Origin. — An  organic  acid  obtained  from  Nutgall. 

Description  and  Properties. — A  light-yellowish,  amorphous 
powder,  usually  cohering  in  the  form  of  glistening  scales  or  spongy 
masses ;  odorless  or  with  a  faint  characteristic  odor  and  a  strongly 
astringent  taste ;  gradually  turning  darker  when  exposed  to  air  and 
light.  Soluble  in  about  i  part  of  water  and  in  0.6  part  of  alcohol ; 
very  soluble  in  boiling  water  and  in  boiling  alcohol ;  also  soluble 
in  about  i  part  of  glycerin  with  the  assistance  of  a  moderate  heat ; 
freely  soluble  in  diluted  alcohol  and  sparingly  in  absolute  alcohol ; 
almost  insoluble  in  absolute  ether,  chloroform,  benzol,  or  benzin. 

Dose. — 1-20  grains  (0.06-1.2  Gm.). 

Official  Preparations. 

Collodium  Stypticum — CoUodii  StJ^ptici — Styptic  Collodion. — Used  exter- 
nally and  locally.     (Tannic  Acid,  20;  Alcohol,  5;  Ether,  25;  Collodion,  to  100.) 

Glyceritum  Acidi  Tannici — Glyceriti  Acidi  Tannici — Glycerite  of  Tannic 
Acid. — Used  externally  and  locally.     (Tannic  Acid,  20;  Glycerin,  80.) 

Trochlsci  Acidi  TSnnici — Trochiscos  (ace.)  Acidi  TSnnici — Troches  of 
Tannic  Acid. — Dose,  i  to  3  troches. 

UnguSntum  Acidi  Tannici — UnguSnti  Acidi  TSnnici — Ointment  of  Tannic 
Acid.— Used  externally  and  locally.     (Tannic  Acid,  20;  Benzoated  Lard,  80.) 

Physiological  Action. — Externally. — Tannic  acid  has  little  if 
any  effect  upon  the  unbroken  skin.  Upon  raw  surfaces,  however, 
it  acts  as  a  powerful  astringent,  contracting  the  tissues  and  coagu- 
lating the  albumin.  Urticaria  and  erythema  sometimes  follow  its 
use. 

Internally. — Digestive  System. — By  coagulating  the  albumins 
tannic  acid  imparts  a  dryness  to  the  mouth,  accompanied  by  a  sen- 
sation of  puckering.  It  partially  paralyzes  the  sensory  nerve- 
endings,  thus  blunting  the  sense  of  taste.  Large  doses  produce 
vomiting  by  an  irritant  action,  while  diarrhea,  followed  by  consti- 
pation, may  be  present. 


ASTRINGENTS.  711 

By  its  action  on  the  stomach  pepsin  is  precipitated,  albumin  co- 
agulated, and  the  secretion  of  gastric  juice  diminished,  all  of  which 
actions  tend  to  impair  the  digestive  function.  There  is  a  partial 
conversion  of  the  tannic  acid  into  gallic  and  pyrogallic  acids.  To 
facilitate  absorption  there  must  be  a  preliminary  conversion  of 
tannic  into  gallic  acid,  and  this  reaction  takes  place  in  the  intestine. 
A  diminution  of  peristalsis  is  followed  by  constipation. 

Circulatory  System. — Its  astringent  property  makes  tannic  acid 
a  valuable  hemostatic.  It  arrests  hemorrhage  by  contracting  the 
blood-vessels.  The  blood  absorbs  it  as  gallic  acid,  and  is  not 
affected  by  it. 

Nervous  System. — No  special  effect  has  been  observed. 

Respiratory  System. — Save  in  arresting  hemorrhage  of  the  lungs, 
no  influence  is  known. 

Absorption  and  Elimination. — Being  absorbed  as  gallic  acid,  the 
kidneys  eliminate  it  in  that  form.  A  doubtful  action  ascribed  to  it 
by  some  authorities  is  that  of  diminishing  albuminuria. 

Uterus. — No  special  influence  other  than  arresting  hemorrhage 
has  been  noted. 

Untoward  Action. — A  dose  of  3  grains  (0.2  Gm.)  may  cause 
pain  in  the  stomach  and  intestines.  Following  such  a  dose,  there 
may  be  coating  of  the  tongue,  thirst,  eructation  of  gas,  and  tenes- 
mus.    A  tendency  to  hemorrhoidal  congestion  is  enhanced. 

Therapeutics. — Externally  and  Locally. — Tannic  acid  is  a  val- 
uable application  for  bed-sores  and  ulcers.  Its  astringent  property 
is  of  use  in  cases  of  intertrigo,  impetigo,  sycosis,  sore  nipples,  and 
eczema  of  the  chronic,  desquamating  variety.  It  is  beneficial  in 
hyperidrosis  of  the  hands  and  feet,  of  the  axillcs  and  genitals.  A 
solution  of  the  acid  has  been  found  of  advantage  in  erysipelas  and 
lymphangitis. 

The  GLYCERiTE  OF  TANNIN,  applied  locally  in  cases  of  otorrhea 
and  ozena  as  sequelae  of  scarlet  fever  or  measles,  is  of  great  benefit. 
The  same  preparation  or  a  powder  may  be  used  in  stomatitis,  ton- 
sillitis, and  pharyngitis,  as  well  as  in  cases  of  spongy  or  ulcerous 
gums.  The  lozenges  are  beneficial  in  whooping  cough.  Sup- 
positories OF  TANNIC  ACID  ^lxq  &Xi^\oy e.di  iox  hemorrhoids,  fissure, 
prolapse,  and  rectal  ulcers. 

An  AQUEOUS  SOLUTION  OF  TANNIC  ACID  is  vcry  useful  in  leucor- 
rhea.  The  glycerite  and  iodoform  tannin  are  excellent  agents  in 
inflammation  of  the  cervix  uteri.  Tannic  acid  also  dispels  the  odor 
and  allays  the  discharges  in  carcinoma  uteri,  being  applied  as  a 


712  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

vaginal  douche.  It  is  useful  as  a  lotion  in  herpes  and  alopecia  cir- 
cumscripta. Injection  of  the  acid  or  insufflation  of  the  powder  into 
the  urethra  is  of  some  value  in  gonorrhea.  In  hemoptysis  an  aque- 
ous solution  (5—10  grains  to  the  ounce  of  water)  may  be  used  as 
a  spray.  In  acute  dysentery  much  benefit  may  be  derived  from 
an  enema  of  10  grains  of  tannin  added  to  a  4  per  cent,  solution  of 
boric  acid.    It  lessens  pain  and  tenesmus  and  controls  hemorrhage. 

Internally. — For  other  than  local  action  gallic  is  preferable  to 
tannic  acid,  the  latter  not  being  absorbable.  Tannic  acid  is  styptic 
in  hematemesis  and  intestinal  hemorrhage  and  checks  diarrhea.  It 
forms  tannates  when  given  as  an  antidote  for  poisoning  by  alkaloids 
and  tartar  emetic.  Since  these  tannates  are  more  or  less  soluble, 
however,  some  drug  should  be  given  as  a  purgative. 

Contraindications. — From  comparative  absorbability  of  tannic 
and  gallic  acids  the  former  is  preferable  for  local,  the  latter  for 
systemic,  effects. 

Administration. — For  hematemesis  powders  of  I0-20  grains 
are  given.  For  effect  upon  the  intestines  it  should  be  administered 
in  pills,  3-5  grains,  or  it  may  be  dissolved  in  the  stomach.  Locally 
it  may  be  applied  as  a  solution,  glycerite,  powder,  suppository,  or 
an  ointment.  Styptic  collodion  is  a  protection  to  lacerated  or 
incised  wounds. 

Acidum  Gallicum— Acidi  Gallici— Gallic  Acid. 
V.  S.  JP. 

Origin. — An  organic  acid  usually  prepared  from  Tannic  Acid. 

Description  and  Properties. — White  or  pale  fawn-colored, 
silky,  interlaced  needles  or  triclinic  prisms;  odorless,  having  an 
astringent  or  slightly  acidulous  taste ;  permanent  in  the  air.  Sol- 
uble in  100  parts  of  water  and  in  5  parts  of  alcohol. 

Dose. — 5-20  grains  (0.3-1.2  Gm.). 

Physiological  Action. — Gallic  acid  resembles  tannic  acid  in 
its  action,  but  does  not  coagulate  albumin,  and  therefore  does  not 
possess  the  local  influence  of  the  latter.  It  is  eliminated  by  the 
kidneys  as  gallic  acid. 

Therapeutics. — Externally  and  Locally. — Gallic  acid  is  seldom 
used  externally.  Locally,  tannic  acid  is  preferable,  but  gallic  acid 
is  effectual  applied  as  a  glycerite,  i  drachm- 1  ounce  (4.0-32.0  Gm.), 
in  cases  of  tonsillitis  and  pharyngitis.  Gallic  acid  and  stramonium 
ointment  in  equal  parts  form  an  unguent  for  hemorrhoids.  In 
alcoholic  solution  it  is  applied  to  the  membrane  of  diphtheria. 


ASTRINGENTS.  713 

Internally. — Gallic  acid  is  chiefly  serviceable  in  hemorrhage  from 
the  stomach,  intestines,  lungs,  and  kidneys,  It  is  employed  in  men- 
orrhagia,  but  ergot  is  better.  It  reduces  albumin  in  some  forms 
of  Bright s  disease,  and  is  useful  in  checking  excessive  sweating  and 
bronchorrhea.  In  chronic  phthisis  it  relieves  the  night-sweats  and 
reduces  profuse  expectoration.  Cystitis,  dysentery,  and  chronic  diar- 
rhea are  benefited  by  its  use.  It  checks  suppuration  and  stays  the 
progress  oi  pyelitis  asid  pyelo-nephritis.  Used  in  conjunction  with 
opium,  it  has  been  found  beneficial  in  diabetes  insipidus. 

Pyrogallic  acid  is  of  use  in  acne,  but  produces  a  discoloration 
of  the  skin. 

Pyrogallol,  2  grains  (.12  Gm.),  is  used  in  internal  hemorrhage. 
As  an  ointment,  i  drachm-i  ounce  (4.0-32.0  Gm.),  it  is  palliative 
in  psoriasis,  and  it  is  also  beneficial  in  lupus  and  epithelioma. 

Gallanol,  the  analid  of  gallic  acid,  is  a  bactericide,  and  is  use- 
ful m  psoriasis  in  the  form  of  a  powder  or  in  an  ointment  (i  to  30). 
It  is  also  used  in  alcoholic  solutions  of  10  per  cent,  strength.  It 
relieves  the  pruritus  of  chronic  eczema.  In  favus  and  tricophytosis 
a  mixture  is  used  consisting  of  gallanol  10  parts,  ammonia  i  part, 
and  alcohol  50  parts. 

Gallicine,  methyl  ether  of  gallic  acid,  applied  in  finely  divided 
form  with  a  brush,  is  of  benefit  in  keratitis  and  conjunctivitis,  as 
well  as  in  eczema  of  the  eyelids. 

Administration. — Gallic  acid  is  not  to  be  combined  with  iron. 
It  is  administered  in  powder  or  pill  form.  The  glycerite  and  the 
ointment  are  used  locally. 

Galla— Gallse— Nutgall.    V.  S.  P. 

Origin. — An  excrescence  on  Quercus  Lusitanica  Lamarck,  caused 
by  the  punctures  and  deposited  ova  of  Cynips  galla  tinctoria 
Olivier. 

Quercus  Lusitanica  is  a  small  tree,  or  oftener  a  shrub,  4  to  6 
feet  (1.2- 1. 8  M.)  high,  indigenous  in  the  basin  of  the  Mediter- 
ranean. 

Description  and  Properties. — Nutgalls  are  subglobular,  about 
I  inch  (25  Mm.)  in  diameter,  more  or  less  tuberculated  above, 
otherwise  smooth,  heavy,  hard;  often  with  a  circular  hole  near 
the  middle  communicating  with  the  central  cavity  containing  either 
the  partly  developed  insect  or  pulverulent  remains  of  it ;  inodor- 
ous ;  taste  strongly  astringent. 

Galla  in  substance  is  seldom  given  internally. 


714  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Official  Preparations. 

Tinctura  GaUse— Tincturae  GSllae — Tincture  of  Nutgall.— i?oJ«,  i  to  2  fluid- 
drachms  {4.0-8.0  Gm.). 

UnguSntum  CSlla — UnguSnti  GSUae — Ointment  of  Nutgall. — Used  exter- 
nally. 

Physiological  Action. — Its  action  is  that  of  tannic  acid,  which 
is  derived  from  galls. 

Therapeutics. — Externally  and  Locally. — Galla,  in  combination 
with  stramonium  liniment  or  i  drachm  (4.0  Gm.)  of  powdered 
opium  to  each  ounce  (32.0  Gm.)  of  nutgall  ointment,  is  an  excellent 
application  for  external  hemorrhoids.  For  ecsema  of  the  scalp, 
herpes,  fissured  nipples,  indolent  ulcers,  and  chilblains  nutgall  oint- 
ment has  proved  beneficial,  as  well  as  for  alopecia  circumscripta 
and  rectal  prolapse.  One  part  of  powdered  galls  to  seven  or  eight 
of  vaseline  is  a  most  excellent  application  for  lessening  the  cica- 
tricial contraction  following  extensive  burns.  Galla  is  used  little 
locally,  but  is  recommended  as  a  gargle  and  wash,  being  applied 
to  the  relaxed  mucous  membranes  of  the  mouth,  vagina,  and 
rectum. 

Internally. — Tannic  and  gallic  acids  are  preferable  in  severe 
diarrhea  and  dysentery,  an  infusion  or  decoction  being  used  as  an 
enema. 

Administration. — Galls  are  used  mostly  in  the  form  of  an 
infusion  or  ointment.     The  tincture  is  seldom  employed. 

QuSrcus  Alba— Quercus  Albsg— White  Oak, 

u.  s.  p. 

Origin. — The  bark  of  Quercus  alba  L.  The  oaks  are  shrubs 
or  trees  growing  chiefly  in  the  temperate  zone,  often  forming  exten- 
sive forests.  The  white  oak  is  a  stately  tree,  60  to  80  feet  (18-24 
M.)  high,  found  from  Canada  to  Florida  and  west  to  Wisconsin 
and  Eastern  Texas. 

Description  and  Properties. — In  nearly  flat  pieces  deprived  of 
the  corky  layer,  about  \  inch  (5  Mm.),  pale  brown ;  inner  surface 
with  short,  sharp,  longitudinal  ridges;  tough  and  of  a  coarse, 
fibrous  fracture,  a  faint,  tan-like  odor,  and  a  strongly  astringent 
taste.  As  found  in  the  shops,  it  is  usually  an  irregularly  coarse 
fibrous  powder,  which  does  not  tinge  the  saliva  yellow. 

Dose. — Seldom  given  in  substance.  A  decoction  is  sometimes 
given  internally,  but  the  chief  use  of  the  drug  is  for  external  or 
local  application. 


ASTRINGENTS.  715 

Physiological  Action. — The  general  action  is  that  of  tannic 
acid. 

Therapeutics. — Externally  and  Locally. — It  is  used  for  chapped 
nipples,  gangrene,  ulcers,  and  dermatitis  venenata.  It  is  of  value 
as  an  ointment  in  hemorrhoids,  prolapsus  ani,  anal  fissure,  and  leu- 
corrhea.  The  drug  is  also  serviceable  in  relaxed  uvula  and  as  a 
tooth-powder.  It  stains  the  linen,  however,  which  somewhat  limits 
its  use.  Pessaries  made  of  the  bark  have  been  used  to  check 
uterine  hemorrhage.  For  hernia  the  concentrated  fluid  extract  is 
injected  into  the  tissues  for  the  purpose  of  exciting  inflammation 
and  consequent  contraction  of  the  hernial  ring. 

Internally. — It  reduces  bronchial  discharge,  hemoptysis,  serous 
diarrhea,  and  dysentery. 

Administration. — Externally  it  is  used  as  a  poultice — chiefly 
in  the  form  of  the  powdered  bark.  The  decoction  is  employed 
almost  exclusively  as  an  injection  and  for  internal  administration. 
The  laity  were  formerly  wont  to  roast  the  acorns  and  chew  them, 
or  grate  them  and  mix  the  gratings  with  cocoa  or  chocolate, 
behaving  them  to  be  a  cure  for  diarrhea  as  well  as  for  flatulent 
dyspepsia  and  scrofula. 

Catechu— Catechu— Catechu.    JJ.  8.  P. 

Origin. — An  extract  prepared  from  the  wood  of  Acacia  catechu 
(Linn,  fil.)  Willd.,  a  ti;ee  30  to  40  feet  (9-12  M.)  high,  indigenous 
in  the  East  Indies  and  Ceylon. 

Description  and  Properties. — Occurring  in  irregular  masses, 
containing  fragments  of  leaves ;  dark-brown,  brittle,  somewhat 
porous  and  glossy  when  freshly  broken.  It  is  nearly  inodorous 
and  has  a  strongly  astringent  and  sweetish  taste. 

Dose. — 10-30  grains  (0.6-2.0  Gm.). 

Official  Preparations. 

Tinctura  CStechu  CompSsita — Tincturse  CStechu  CompSsitae — Compound 
Tincture  of  Catechu.— i^Mf,  \-2  fluidrachms  (2.0-8.0  Cc).  (Catechu,  100;  Cassia 
Cinnamon,  50;  by  maceration  and  percolation  with  Diluted  Alcohol  to  1000.) 

Trochisci  Catechu— Trochiscos  (ace.)  CStechu— Troches  of  Catechu.— 
Dose,  I  to  6  troches.     (Each  troche  contains  I  grain  (0.06  Gm.)  of  catechu.) 

Physiological  Action. — Catechu  does  not  differ  in  its  action 
from  tannic  acid.  It  is  to  be  preferred  to  kino,  however,  since  its 
operation  is  more  energetic. 

Therapeutics. — Externally  and  Locally. — Though  used  but 
little  externally,  it  is  a  very  efficient  remedy  for  ulcerated  nipples 


7l6  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

and  chronic  ulcers,  the  form  employed  being  that  of  a  lotion,  used 
either  alone  or  in  combination  with  copper  sulphate  or  alum. 
Catechu  is  of  service  in  constringing  relaxed  tissues,  and  is  used 
as  a  mouth-wash  in  spongy  gums,  ptyalism,  and  relaxation  of  the 
uvula.  It  is  also  of  use  as  a  gargle  in  pharyngitis  and  chronic  sore 
throat  of  public  speakers  and  users  of  tobacco.  In  gonorrhea  and 
leucorrhea  an  injection  of  2-3  drachms  (8.0-12.0  Gm.)  of  the 
tincture  in  5-6  ounces  (160.0-192.0  Gm.)  of  water  is  beneficial. 

Catechu  has  been  used  by  persons  suffering  from  pyrosis.  It  is 
claimed  that  chewing  a  small  pellet  of  the  drug  diminishes  the 
coating  of  mucus  on  the  mucous  membrane  of  the  stomach.  It 
is  applied  to  aphthce  in  stomatitis. 

Internally. — Its  prevailing  use  is  in  chronic  serous  diarrheas, 
but  the  administration  must  be  preceded  by  a  saline  purge  in 
order  to  secure  the  fullest  effect.  Catechu  checks  uterine  hemor- 
rhage and  the  secretions  in  bronchitis  and  chronic  phthisis. 

Administration. — The  troche  is  best  used  in  chronic  pharyn- 
gitis and  relaxed  buccal  mucous  membranes,  or  a  piece  of  the 
drug  may  be  chewed  with  beneficial  results.  For  diarrhea  the 
compound  tincture,  with  a  little  morphia  or  the  official  chalk 
mixture,  is  the  best  form  for  use. 

Kino— Kino— Kino.     TI.  8.  JP. 

Origin. — The  inspissated  juice  of  Pterocarpus  marsupianum 
Roxburgh,  a  tree  (called  buja  in  Bengal)  60  to  80  feet  (18-24  M.) 
high,  indigenous  in  India  and  Ceylon. 

Description  and  Properties.— Small,  angular,  dark  brownish- 
red  and  transparent;  inodorous,  very  astringent  and  sweetish, 
coloring  the  saliva  deep  red.  Soluble  in  alcohol,  nearly  insoluble 
in  ether,  and  only  slightly  soluble  in  cold  water. 

Dose. — 10-20  grains  (0.6-1.2  Gm.). 

Official  Preparation. 

Tinctura  Kino— Tincturae  Kino— Tincture  of  •K.vaa.—Dose,  i_2  fluidrachms 
(1.0-8.0  Cc). 

Physiological  Action.— Its  action  is  similar  to  that  of  tannic 
acid.     It  colors  the  saliva  red. 

Therapeutics.— £rfer««//j/  and  Locally.— Kino  is  an  efficient 
dressing  for  _^abby,  indolent  ulcers,  acting  as  a  stimulant.  Yet  the 
other  astringents  deserve  precedence.  As  a  gargle  in  pharyngitis 
and  relaxed  uvula  kino  is  valuable,  but,  owing  to  its  disagreeable 


ASTRINGENTS.  717 

taste,  krameria  is  to  be  preferred.  Owing  to  its  speedy  action,  it 
checks  the  hemorrhage  in  epistaxis  where  other  astringents  fail. 
In  leucorrhea  and  gonorrhea  an  infusion  or  injection  is  serviceable. 

Internally. — In  the  polyuria  of  diabetes,  in  menorrhagia,  the 
sweating  of  phthisis,  and  pyrosis  it  has  been  used  to  some  advan- 
tage ;  also  in  dysentery  and  chronic  diarrheas  with  profuse  serous 
discharges.     It  is  less  irritating  than  the  other  astringents. 

Administration. — The  powder  is  used  as  an  insufflation  in 
epistaxis,  and  is  dusted  on  ulcers.  In  diarrhea  it  is  best  to  use  kino 
in  combination  with  opium  or  chalk  mixture.  The  tincture  is  used 
internally. 

Krameria— Krameriae— Krameria.    TI.  S.  JP. 

(Rhatany.) 

Origin. — The  root  of  Krameria  triandra  Ruiz  et  Pavon,  and  of 
Krameria  ixina  L.,  a  low  shrub  with  spreading  branches,  native  to 
Bolivia  and  Peru,  growing  in  sandy  localities  in  the  mountains  at 
an  altitude  of  3000  to  8000  feet  (900-2440  M.). 

Description  and  Properties. — From  i  to  \\  inches  (25-38 
Mm.)  thick,  knotty  and  several-headed  above,  branched  below,  the 
branches  long ;  bark  smooth,  or  in  the  thinner  pieces  scaly,  deep 
rust-brown,- Jij—^  inch  (1-2  Mm.)  thick,  very  astringent,  inodor- 
ous; wood  pale,  brownish-red,  tough,  with  fine  medullary  rays, 
nearly  tasteless.  The  root  of  Krameria  ixina  (Savanilla  rhatany)  is 
less  knotty  and  slenderer,  and  has  a  dark  purplish-brown  bark 
about  \  inch  (3  Mm.)  thick. 

Dose. — 8-30  grains  (0.5-2.0  Gm.). 

Official  Preparations. 

Extractum  KrameriEe — Extracti  Krameriae— Extract  of  Krameria.— ZJ^f, 
S-IO  grains  (0.3-0.6  Gm.). 

ExtrSctum  Krameriae  Fluidum— ExtrScti  Krameriae  Fluidi— Fluid  Extract 
of  Krameria. — Dose,  5-30  minims  (0.3-2.0  Cc). 

Tinctura  Kramerise- Tincturae  Krameriae— Tincture  of  Krameria. — Dose, 
\~2  drachms  (2.0-8.0  Co.). 

TrocMsci  Krameriae— Troch&cos  (ace.)  Krameriae— Troches  of  Krameria. 
— Dose,  I  to  5  troches.     (Each  troche  contains  I  grain  (0.06  Gm.). 

Syrupus  Krameriae— SJ^rupi  Krameriae— Syrup  of  Krameria.— /?««,  ^-4 
fluidrachms  (2.0-16.0  Cc). 

Physiological  Action. — The  action  of  krameria  is  identical  with 
that  of  tannic  acid. 

Therapeutics. — Externally  and  Locally. — Its  value  as  a  topical 
application  is  of  little  consequence,  but  it  has  served  satisfactorily 


7l8  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

as  an  ointment  for  hemorrhoids.  It  is  used  as  an  infusion  or  injec- 
tion of  the  diluted  tincture  or  fluid  extract  in  leiicorrhea,  gleet,  and 
especially  in  anal  fissure,  for  which  it  has  been  highly  recom- 
mended, since  it  checks  the  accumulation  of  feces  in  the  rectum  by 
constricting  its  walls,  rendering  defecation  less  painful  and  prevent- 
ing the  formation  of  ulcers.  The  powder  is  used  in  epistaxis  and 
rectal  bleeding,  also  in  prolapsus  ani  and  ozena  of  a  non-specific 
nature.  It  is  used  extensively  in  the  preparation  of  tooth-powders, 
being  especially  beneficial  where  the  gums  display  a  tendency  to 
bleed  readily.  A  mouth-wash  and  gargle  are  used  in  ptyalism, 
spongy  gums,  pharyngitis,  and  relaxation  of  the  uvula. 

Internally. — Krameria  has  gained  a  wide  reputation  for  allaying 
habitual,  but  not  profuse,  uterine  hemorrhage.  It  may  be  used, to 
check  intestinal  hemorrhages,  hematuria,  hematemesis,  and  hemopty- 
sis, but  the  other  astringents  are  preferable.  It  is  a  good  tonic  for 
debilitated  patients.  It  is  also  used  in  chronic  diarrhea  and  dysen- 
tery and  in  incontinence  of  urine. 

Administration. — The  powder  is  used  in  the  nose  and  rectum 
either  by  insufflation  or  by  means  of  a  pledget  of  cotton.  As  an 
injection  and  enema  the  fluid  extract  is  used.  In  fissure  of  the 
anus  the  rectum  must  be  emptied  first  by  an  enema ;  then  a  solu- 
tion of  the  extract,  i  drachm  (4.0  Gm.)  to  i  ounce  (30.0  Cc.)  of 
water,  is  emptied  into  the  bowel  and  allowed  to  run  out,  repeating 
the  process  several  times.  This  procedure  is  .very  painful  at  first, 
but  as  the  fissure  gradually  heals  the  operation  will  cause  the 
patient  little  if  any  pain.  Keep  the  bowels  open  with  a  mild 
saline  laxative.  The  success  attending  the  operation  warrants  any 
discomfort  which  the  patient  may  experience.  The  nasal  douche 
is  best  in  ozena,  followed  by  an  insufflation  of  the  powder. 

Haematoxylon— Haematoxyli— Haematoxylon. 

TJ.  8.  P. 

(Logwood.) 

Origin. — The  heart-wood  of  Hcematoxylon  Campechianum  L.,  a 
tree  30  to  40  feet  (9-12  M.)  high,  indigenous  on  the  shores  of  the 
Gulf  of  Campeachy  and  in  certain  parts  of  South  America. 

Description  and  Properties. — Heavy,  hard,  externally  pur- 
plish-black, internally  brownish-red,  marked  with  concentric  cir- 
cles, splitting  irregularly;  odor  faint,  agreeable,  taste  sweetish, 
astringent.     When  chewed  it  colors  the  saliva  dark  pink. 

Only  the  preparations  of  Hasmatoxylon  are  used  internally. 


ASTRINGENTS.  719 

Official  Preparation. 

Extractum  Haemat6xyli — Extracti  Haematttxyli — Extract  of  Hsematoxy- 
lon. — Dose,  5-15  grains  (0.3-1.0  Gm.). 

Physiological  Action. — Its  astringent  properties  are  due  to  the 
tannin  which  haematoxylon  contains. 

Therapeutics. — Externally  and  Locally. — It  is  a  valuable  anti- 
septic, as  well  as  a  healing  application  in  gangrene  and  foul- 
smelling  sores.     It  is  also  beneficial  as  an  injection  in  leucorrhea. 

Internally. — Haematoxylon  has  a  very  agreeable,  sweetish  taste ; 
hence  it  is  well  taken  by  children.  It  is  of  marked  benefit  in  in- 
fantile diarrhea,  but  has  the  disadvantage  of  coloring  the  dis- 
charges and  diaper  blood-red,  causing  much  alarm  to  the  mother. 
The  urine  is  also  colored.  It  arrests  internal  hemorrhage  and 
sweating,  and  is  also  used  in  dysentery,  tuberculous  diarrhea,  and 
atonic  dyspepsia.  Some  authorities  claim  that  h^matoxylon  causes 
phlebites. 

Administration. — In  diarrhea  a  decoction  with  a  little  aromatic 
sulphuric  acid  is  the  best  preparation.  To  it  may  be  added  a  little 
syrup  of  ginger  and  camphorated  tincture  of  opium.  The  decoc- 
tion is,  in  fact,  the  best  preparation  to  use. 

Hamamelis— Hamamelidis— Hamamelis.    TJ.  S.  JP. 

(Witch-hazel.) 

Origin. — The  leaves  of  Hama^nelis  Virginica  L.,  a  shrub  6  to 
10  feet  (1.8-3.0  M.)  high,  growing  in  damp  woods  and  thickets  in 
Canada  and  the  United  States. 

Description  and  Properties. — Short-petiolate,  about  4  inches 
(10  Cm.)  long,  obovate  or  oval,  slightly  heart-shaped  and  obHque 
at  the  base,  sinuate-toothed,  thickish,  nearly  smooth,  inodorous ; 
taste  astringent  and  bitter. 

Official  Preparation. 
Extractum  HamamSlidis  Fluidum— Extract!  HamamSlidis  Fluidi — Fluid 
Extract  of  Hamamelis. — Dose,  ^-2  fluidrachms  (2.0-8.0  Cc). 

Physiological  Action. — The  action  of  tannic  acid  is  also  that 
of  hamamelis,  save  that  the  latter  has  a  somewhat  different  influ- 
ence upon  the  circulation. 

Circulatory  System. — Hamamelis  acts  on  the  muscular  fibers  of 
the  veins,  the  modus  operandi,  however,  not  being  satisfactorily 
•determined.     Large   doses   produce   severe   throbbing  headache. 


720  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

Therapeutics. — Externally  and  Locally. — For  sprains  and  bruises 
hamamelis  is  a  favorite  application,  although  some  authorities  re- 
gard it  merely  as  a  placebo.  Locally,  the  fluid  extract,  with  the 
addition  of  one-third  its  volume  of  glycerin,  has  been  used  in 
urticaria,  rhus-poisoning,  and  phlegmasia  dolens.  Owing  to  its 
marked  sedative  properties,  hamamelis  ointment  is  extremely 
beneficial  in  varicose  ulcers,  ecsema,  herpes,  seborrhea,  and  acne 
rosacea,  as  well  as  in  checking  excessive  secretions.  It  is  also 
efficient  in  carbuncle,  freckles,  hyperidrosis,  lupus  erythematosus, 
burns,  and  frost-bites. 

The  local  action  of  the  drug  is  important.  The  distilled 
EXTRACT,  diluted  with  alcohol  or  water,  is  applied  to  inflamed  gums, 
the  nasal  mucous  membrane  after  removal  of  polypi,  and  in  pharyn- 
gitis as  a  spray.  As  a  suppository  or  applied  by  means  of  a  piece 
of  cotton  or  wool  soaked  with  the  fluid  extract,  hamamelis  affords 
a  most  grateful  relief  in  bleeding  piles,  especially  the  internal  vari- 
ety. In  cystitis  and  hemorrhage  from  the  bladder  an  injection  of 
the  diluted  fluid  extract  or  distilled  extract  is  very  valuable, 
besides  being  a  most  reliable  topical  application  in  capillary  hemor- 
rhage from  wounds,  epistaxis,  and  bleeding  after  extraction  of  teeth. 
The  ointment  is  used  in  rectal  fissures  and  ulcers,  and  the  lotion 
has  been  employed  to  some  extent  in  chronic  rheumatism,  since 
it  relieves  the  pain  and  stiffness  in  the  muscles  and  joints.  The 
decoction,  with  a  little  boric  acid  and  a  i  per  cent,  solution  of 
creasote,  has  been  recommended  as  a  gonorrheal  injection. 

Internally. — Given  internally,  hamamelis  enhances  the  results 
obtained  by  the  local  application  in  bleeding  piles,  leucorrhea,  and 
gonorrhea,  and,  owing  to  its  peculiar  action  upon  the  veins,  in 
varicose  veins.  It  lessens  the  pain  of  dysmenorrhea,  while  by  its 
use  in  menorrhagia  the  flow  is  remarkably  diminished.  It  i§  highly 
beneficial  in  internal  hemorrhages,  hemoptysis,  hematuria,  hemateme- 
sis,  and  especially  in  uterine  hemorrhages.  It  reduces  suppuration 
in  pyelitis  and  the  excessive  morbid  discharge  in  chronic  bronchitis. 
It  is  a  valuable  remedy  in  purpura  hemorrhagica,  chronic  enteritis, 
diarrhea,  dysentery,  and  varicocele.  Hamamelis  also  prevents 
abortion. 

Administration. — The  best  preparation,  both  for  internal  and 
external  use,  is  the  distilled  extract,  although  it  is  not  official.  The 
ointment  and  lotion  are  used  externally,  and  the  fluid  extract 
internally.  The  preparations  of  hamamelis  to  be  found  in  drug- 
stores are  unreliable  unless  they  be  perfectly  fresh.     Some  of  the 


ASTRINGENTS.  731 

proprietary  preparations  are  concocted  with  extreme  care  and 
accuracy,  and  are  often  much  more  efficient  than  the  official 
articles  which  have  been  standing  in  the  shops  for  a  long  while, 
possibly  exposed  to  the  air. 

Geranium— Geranii— Geranium.     V.  S.  JP. 

(Cranesbill.) 

Origin. — The  rhizome  of  Geranium  maculatum.  L.,  a  perennial 
herb  with  a  stem  2  to  3  feet  (30-60  Cm.)  high,  very  common  in 
Canada  and  the  United  States  westward  as  far  as  Kansas. 

Description  and  Properties. — Growth  horizontal,  cylindrical, 
2  to  3  inches  (5-7  Cm.)  long  and  about  \  inch  (i  Cm.)  thick; 
rather  sharply  tuberculated,  longitudinally  wrinkled,  dark  brown ; 
bark  thin ;  wood-wedges  yellowish,  small,  forming  a  circle  near  the 
cambium  line;  medullary  rays  broad,  central  pith  large;  roots 
thin,  fragile,  inodorous ;  taste  strongly  astringent. 

Dose. — 20-40  grains  (1.2-2.40  Gm.). 

Official  Preparation. 

ExtrSctum  Geranii  Fluidum — ExtrScti  Geranii  Fluidj — Fluid  Extract  of 
Geranium. — Dose,  20-40  minims  (1.2-2.40  Cc). 

Physiological  Action. — The  action  of  geranium  corresponds 
with  that  of  tannic  acid. 

Therapeutics. — Externally  and  Locally. — Geranium  is  not  used 
externally.  Its  local  action  is  varied.  It  is  serviceable  as  an 
astringent  gargle  in  sore  throat ;  as  a  mouth- wash  in  aphthous 
stomatitis ;  in  relaxed  conditions  of  the  rectum,  vagina,  and  throat ; 
in  buccal  ulcer,  metrorrhagia,  and  anal  fissure  ;  in  prolapsus  ani  and 
epistaxis.  It  has  also  proved  valuable  as  an  injection  in  leucorrhea,^ 
gonorrhea,  and  gleet. 

Internally. — Owing  to  its  agreeable  taste,  it  is  useful  in  infantile 
diarrhea  and  for  persons  having  weak  stomachs.  In  the  early 
stages  of  phthisis  it  is  very  beneficial,  as  it  reduces  the  fever  and 
pulse-rate,  at  the  same  time  checking  the  night-sweats,  cough,, 
expectoration,  and  hemoptysis.  Under  it  the  patient's  appetite  im- 
proves and  he  gains  in  weight.  The  fluid  extract,  in  combination 
with  an  aromatic,  gives  perceptible  temporary  relief  in  rapid  a£Ute- 
phthisis  attended  with  severe,  distressing  cough  and  debilitating; 
night-sweats.     It   has   also   been    used  to  advantage  in  internal. 


46 


722  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Administration. — Locally,  the  powdered  root  and  fluid  extracts 
are  used,  but  the  fluid  extract  diluted  with  water  is  preferable. 
For  an  injection  a  decoction,  i  ounce  (32.0  Gm.)  to  1-2  pints 
(512.0-1024.0  Gm.)  of  water,  is  used,  and  the  decoction  in  milk 
is  of  service  in  infantile  diarrhea.  Prof  Johnson  claims  that  gera- 
nium contains  mucilaginous  material  which,  acting  as  a  demulcent, 
makes  the  decoction  a  much  more  desirable  preparation  than  a 
simple  solution  of  tannin. 

Rhus  Glabra— Rhois  Glabrae— Rhus  Glabra.    TJ.  S.  JP. 

(Sumach.) 

Origin. — The  fruit  of  Ukus  glabra  L.,  a  shrub  or  suffruticose 
plant  about  12  feet  (3.6  M.)  high,  growing  in  rocky  or  barren  soil 
in  North  America. 

Description  and  Properties. — Subglobular,  about  \  inch  (3 
Mm.)  in  diameter,  drupaceous,  crimson,  densely  hairy,  containing 
a  roundish-  oblong,  smooth  putamen ;  inodorous  ;  taste  acidulous. 

Dose. — The  preparations  only  are  used  internally. 

Official  Preparation. 

ExtrSctum  Rhois  Glabrae  Fluidum — Extrdcti  Rhois  Glabrae  Fliiidi — Fluid 
Extract  of  Rhus  Glabra. — Dose,  \-i  fluidrachm  (1.0-4.0  Cc). 

Allied  Species. 
Rhtis  AromStica — Rhtis  AromSticae — Sweet  Sumach. 

Unofficial  Preparation. 

Extractum  Rhois  AromSticae  Fliiidum — ExtrScti  Rhois  AromSticae  Fluidi 
— Fluid  Extract  of  Rhus  Aromatica.— iJof^,  5  minims-i  fluidrachm  (0.3-4.0  Cc). 

Physiological  Action. — The  action  of  Rhus  glabra  resembles 
that  of  tannic  acid. 

Therapeutics. — Externally  and  Locally. — An  infusion  or  the 
FLUID  EXTRACT  is  used  as  a  topical  application  for  ulcers  and  in- 
flamed wounds.  The  infusion  is  an  excellent  mouth-wash  in 
spongy  gums,  ptyalism,  pharyngitis,  aphthous  stomatitis,  and  tonsil- 
litis. It  can  be  used  alone,  but  is  much  more  efiicient  when  com- 
bined with  potassium  chlorate  and  glycerin,  adding  a  little  menthol, 
2-3  grains  (.12-20  Gm.),  to  make  the  mixture  more  agreeable.  It 
is  also  of  service  as  an  injection  in  leucorrhea. 

Internally. — Rhus  glabra  acts  well  in  staying  incontinence  of 
urine  and  hematuria.    A  dose  of  10-30  drops  of  the  fluid  extract. 


ASTRINGENTS.  723 

taken  two  or  three  times  daily,  has  produced  complete  temporary- 
suspension  of  nocturnal  eneuresis  of  children,  as  well  as  senile 
eneuresis. 

Administration. — The  fluid  extract  is  used  exclusively. 

Rosa  Gallica— Rosae  Gallicae— Red  Rose.   TJ.  S.  I*. 

Origin. — The  petals  of  Rosa  gallica  L.,  collected  before  ex- 
panding. 

Description  and  Properties. — Usually  occurring  in  small  cones 
consisting  of  numerous  imbricated,  roundish,  retuse,  deep  purple- 
colored,  yellow-clawed  petals,  having  a  roseate  odor  and  a  bitterish, 
slightly  acidulous,  and  distinctly  astringent,  taste. 

Official  Preparations. 

ConfSctio  Rosse — Confectionis  Ross — Confection  of  Rose. — Used  as  an 
excipient  in  pill  masses.  ' 

Extr^ctum  Rosae  Fluidum — ExtT^cti  RosEe  Fliiidi — Fluid  EiKtract  of  Rose. 
— Used  chiefly  as  a  vehicle. 

Physiological  Action. — It  acts  like  tannic  acid. 

Therapeutics. — Externally  and  Locally. — The  ointment  is  used 
for  chapped  lips  and  hands,  and  also  for  superficial  burns  and  in 
erythema. 

The  FLUID  EXTRACT  is  used  as  an  application  to  inflamed  eyes, 
buccal,  aural,  and  anal  ulcers,  and  in  aphthous  stomatitis.  It  has 
been  employed  in  conjunction  with  sodium  salicylate  to  prevent 
the  pitting  of  small-pox.  Its  chief  use,  however,  is  as  a  vehicle 
and  flavoring  extract. 

Internally. — It  is  practically  -of  but  little  value  as  an  internal 
agent,  although  it  exerts  some  action  in  checking  profuse  sweats 
and  in  uterine  hemorrhages. 

Administration. — The  fluid  extract  is  mainly  used,  an  infusion 
of  which  is  given  internally.  The  fresh  leaves,  crushed,  are  ser- 
viceable as  a  poultice. 

Rubus—Rubi— Blackberry.     TJ.  S.  P. 

Origin. — The  root-bark  of  Rubus  villosus  Ait.,  Rubus  Canaden- 
sis L.,  and  Rubus  trivialis  Mx.,  common  shrubby  North  American 
plants. 

Description  and  Properties. — Thin,  tough,  flexible  bands,  outer 
surface  blackish  or  blackish-gray,  inner  surface  pale-brownish,  some- 


724  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

times  with  strips  of  whitish,  tasteless  wood  adhering ;  inodorous ; 
taste  strongly  astringent,  somewhat  bitter. 

Official  Preparation. 

ExtrSctum  Rubi  Fluidum — ExtrScti  Rubi  Fluidi — Fluid  Extract  of  Rubus. 

— Dose,  \^2  fluidrachms  (2.0-8.0  Cc). 

Physiological  Action. — Identical  with  that  of  tannic  acid. 

Therapeutics. — Internally. — The  fluid  extract  is  used  in  the 
summer  diarrhea  of  children — practically  its  only  employment.  An 
infusion  of  the  leaves  is  claimed  by  Popoff  to  be  an  excellent 
remedy  for  debility  of  the  bladder. 

Administration. — The  fluid  extract  and  the  infusion  are  used 
as  medicinal  agents.  The  syrupus  rubi  idaei  is  used  only  as  a 
vehicle.  Blackberry  cordial  and  blackberry  brandy  are  favorite 
modes  of  administration.  It  is  commonly  beheved  by  the  laity 
that  the  various  blackberry  and  raspberry  preserves  are  efficacious 
as  remedies  ;  on  the  contrary,  they  are  highly  irritating,  because  of 
the  seeds  present  in  them. 

MINERAL   ASTRINGENTS. 

Plumbum— Plumbi— Lead. 

The  salts  of  lead  only  are  used  in  medicine. 

Plumbi  Acetas— Plumbi  Acetatis— Lead  Acetate. 

V.  S.  I>. 

(Sugar  of  Lead.) 

Origin. — Metallic  Lead  is  dissolved,  in  the  presence  of  air,  in 
Acetic  Acid,  or  Lead  Oxide  is  dissolved  by  the  aid  of  a  gentle  heat 
in  Acetic  Acid  and  Water,  the  solution  being  filtered,  evaporated, 
and  crystallized. 

Description  and  Properties. — Colorless,  shining,  transparent, 
monoclinic  prisms  or  plates,  or  heavy,  white,  crystalline  masses,  or 
granular  crystals,  having  a  faintly  acetous  odor  and  a  sweetish, 
astringent,  and  afterward  metallic  taste.  On  exposure  to  the  air 
efflorescent  and  absorbing  carbon  dioxide.  Soluble  in  203  parts 
of  water  and  in  21  parts  of  alcohol,  in  0.5  part  of  boiling  water, 
and  in  i  part  of  boiling  alcohol.  Lead  acetate  should  be  kept  in 
well-stoppered  bottles. 

Dose. — ^5  grains  (0.03-0.3  Gm.). 


ASTRINGENTS.  725 

Official  Preparations. 

Liquor  Plflmbi  Subacetatis— Liquoris  PWmbi  Subacetatis— Solution  of 
Lead  Subacetate  (Goulard's  Extract).— Used  externally  and  locally.  (The  solu- 
tion contains  about  25  per  cent,  of  Lead  Subacetate.) 

Liquor  Plttmbi  Subacetatis  Dilutus— Liquoris  Plfimbi  Subacetatis  Diluti 
.r,  —Diluted  Solution  of  Lead  Subacetate  (Lead  Water).— Used  externally  and 
locally.     (It  contains  3  per  cent,  of  Lead  Subacetate.) 

Ceratum  Pltimbi  Subacetatis— Cerati  Pltimbi  Subacetatis— Cerate  of  Lead 
Subacetate  (Goulard's  Cerate).— Used  externally  and  locally.  (Goulard's  Extract, 
20;  Camphor  Cerate,  80  parts.) 

Unofficial  Preparation. 

Linimgntum  Pltimbi  Subacetatis— Linimenti  Pltimbi  Subacetatis— Lini- 
ment of  Lead  Subacetate. — Used  externally  and  locally.  (40  parts  of  Lead  Sub- 
acetate to  60  p.arts  of  Cotton  Seed  Oil.) 

Plumbi  Carbonas— Plumbi  Carbonatis— Lead  Car- 
bonate.   TJ.  S.  JP. 

(White  Lead.) 

Origin. — Obtained  by  passing  Carbon-dioxide  Gas  througii  a 
solution  of  Lead  Acetate,  or  by  adding  an  Alkali  Carbonate  to 
a  solution  of  a  Neutral  Lead  Salt. 

Description  and  Properties. — A  heavy,  white,  opaque  powder 
or  a  pulverulent  mass,  without  odor  or  taste.  Permanent  in  the 
air.  Insoluble  in  water  or  alcohol,  but  soluble  in  acetic  or  diluted 
acetic  acid,  with  effervescence.  Lead  carbonate  should  be  kept  in 
well-stoppered  bottles.     Used  externally  and  locally. 

Official  Preparation. 

UnguSntum  Pltimbi  Carbonatis — UnguSnti  Pltimbi  Carbonatis — Ointment 
of  Lead  Carbonate  (10  per  cent.). — Used  externally  and  locally. 

Plumbi  lodidum— Plumbi  lodidi— Lead  Iodide. 

TJ.  S.  P. 

Origin. — Obtained  by  mixing  a  solution  of  Lead  Nitrate  and 
Potassium  Iodide,  and  drying  the  precipitate. 

Description  and  Properties. — A  heavy,  bright-yellow  powder 
without  odor  or  taste.  Permanent  in  the  air.  Soluble  in  about 
2000  parts  of  water  and  in  about  200  parts  of  boiling  water,  sep- 
arating from  the  latter  solution  in  brilliant  golden-yellow  spangles 
or  crystalline  lamins.  Very  slightly  soluble  in  alcohol,  but  sol- 
uble, without  color,  in  solutions  of  the  fixed  alkalies,  in  concen- 


726  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

trated  solutions  of  the  acetates,  of  the  alkalies,  potassium  iodide, 
and  sodium  hyposulphite,  and  in  a   hot  solution   of  ammonium 
chloride.     Lead  iodide  should  be  kept  in  well-stoppered  bottles. 
Dose. — \  grain  (o.  1 3  Gm.). 

Official  Preparation. 

Ungu6ntum  Pliimbi  lodidi— Ungufinti  Pliimbi  lodidi— Ointment  of  Lead 
Iodide  (10  per  cent.). — Used  externally  and  locally. 

Plumbi  NTtras— Plumbi  Nitratis— Lead  Nitrate. 

V.  S.  I*. 

Origin. — Prepared  by  dissolving  Lead  in  Diluted  Nitric  Acid. 

Description  and  Properties. — Colorless,  transparent,  octahedral 
crystals,  or  white,  nearly  opaque  crystals,  without  odor  and  having 
a  sweetish,  astringent,  and  afterward  metallic  taste.  Permanent  in 
the  air!  Soluble  in  2  parts  of  water ;  almost  insoluble  in  alcohol. 
Used  externally  and  locally. 

Plumbi  Oxidum— Plumbi  Oxidi— Lead  Oxide. 

u.  s.  r. 

(Litharge.) 

Origin. — Obtained  by  roasting  Lead  in  air. 

Description  and  Properties. — A  heavy,  yellowish  or  reddish- 
yellow  powder  or  minute  scales,  without  odor  or  taste.  On  expo- 
sure to  the  air  it  slowly  absorbs  moisture  and  carbon  dioxide. 
Almost  insoluble  in  water  and  insoluble  in  alcohol.  Soluble  in 
acetic  or  diluted  nitric  acid  and  in  warm  solutions  of  the  fixed 
alkalies.  Lead  oxide  should  be  kept  in  well-closed  vessels.  Used 
externally  and  locally. 

Official  Preparations. 

Empiastrum  Pliimbi — Ei.  ,>?iastri  Pliimbi — Lead  Plaster  (Diachylon  Plas- 
ter).— Used  externally  and  locall^. 

(Lead  Oxide  or  Lead  Plaster  is  contained  in  Empiastrum  Ammoniaci  cum  Hydrar- 
gyro  and  in  Emplastra  Ferri,  Hydrargyri,  Opii,  Resinae,  and  Saponis.) 

UnguSntum  Diachylon — Ungufinti  Diachylon — Diachylon  Ointment. — 
(Lead  Plaster,  500;  Olive  Oil,  490;  Oil  of  Lavender  Flowers,  10.)  Used  externally 
and  locally. 

Physiologipal  Action. — Lead  per  se  is  practically  inert ;  some 
of  its  salts,  however,  particularly  the  acetate,  possess  valuable 
therapeutic  properties. 


ASTRINGENTS.    .  727 

Externally  and  Locally. — Applied  to  the  unbroken  skin,  lead 
salts  have  little  if  any  effect,  yet  they  act  readily  upon  denuded 
surfaces,  blanching  the  tissue  of  the  parts  by  contraction  of  the 
small  blood-vessels.  In  sores  and  ulcers  they  coagulate  the 
albumin  of  the  discharge  and  the  protoplasm  of  the  neighboring 
superficial  cells,  thus  forming  a  protective  coating  for  the  healthier 
structure  beneath. 

These  salts  have  likewise  a  sedative  action  because  of  the 
decreased  local  circulation  and  the  presumably  depressant  effect 
upon  the  nerve  endings.  Moreover,  by  virtue  of  their  astringency 
they  furnish  valuable  hemostatic  and  antiphlogistic  remedies.  In 
some  cases  the  skin  is  discolored  by  their  use. 

Internally. — Digestive  System. — Lead  acts  immediately  in  the 
mouth,  causing  a  sweet,  styptic  taste  and  coagulating  the  mucus. 
It  contracts  the  cells  and  vessels  of  the  entire  alimentary  canal, 
inducing  dryness  by  diminished  secretion.  Consequent  to  the  dis- 
turbed physiological  functions  of  the  digestive  tract,  the  peristaltic 
movements  diminish,  and  constipation  necessarily  ensues. 

Circulatory  System. — The  heart's  action  is  slowed  through  the 
branches  of  the  vagus  by  irritation  of  the  cardiac  inhibitory  center. 
The  pulse  is  lessened  in  volume  and  frequency,  and  lacks  regularity. 

The  blood  takes  up  the  lead  as  an  albuminate,  which  soon 
passes  into  the  tissues.  While  yet  in  the  vascular  system  it  inter- 
feres with  the  nutritive  function  of  the  corpuscles,  producing  by 
their  destruction  a  watery  condition  of  the  blood.  This  explains 
the  anemia  usually  present  in  cases  of  plumbism  or  lead-poisoning. 

Nervous  System. — Both  sensory  and  motor  functions  become 
deranged,  especially  the  latter.  This  central  irritation  causes  a  dis- 
turbance, and  finally  paralysis,  of  various  muscles.  The  involun- 
tary muscles  appear  to  be  most  affected,  and  of  these  primarily  the 
intestinal ;  hence,  with  the  assistant  local  effect,  arise  distressing 
abdominal  pains  and  spasms.  The  cardiac  center  and  vagal 
branches  to  the  heart  are  influenced,  as  already  stated. 

Respiratory  System. — The  irritation  produced  in  the  respiratory 
centre  has  an  inhibitory  action  through  the  vagus  upon  the  respira- 
tion. 

Absorption  and  Elimination. — The  preparations  of  lead  are  con- 
verted in  the  stomach  into  an  albuminate,  and  thence  taken  up  by 
the  blood,  very  little  absorption  taking  place  in  the  intestine,  where 
the  lead  is  converted  into  an  insoluble  sulphide.  It  is  absorbed  by 
the  abraded  skin,  and  enters  directly  into  combination  with  the 


728  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

albumin  of  the  tissues.  A  portion  of  the  lead  albuminate  is  elimi- 
nated by  the  liver  with  the  bile  into  the  intestine,  where,  being  con- 
verted into  a  sulphide,  it  is  excreted  in  that  form  with  the  feces. 
The  skin,  kidneys,  and  mammary  glands  assist  in  its  elimination. 

Lead  is  not  easily  removed  from  the  whole  system,  owing  to  its 
retention  by  the  ubiquitous  albumin  ;  consequently  some  alterative, 
such  as  potassium  iodide,  should  be  administered. 

Uterus. — Under  the  influence  of  lead,  abortion  is  liable  to  occur 
or  the  child  be  still-born.  This  is  probably  due  to  a  disturbance 
of  the  quality  and  quantity  of  the  blood-supply  to  the  affected 
parts. 

Untoward  Action. — Undesirable  results  have  followed  the  ad- 
ministration of  medicinal  doses  of  lead  acetate,  evidently  arising 
from  insufificient  elimination.  Baker  observed  loss  of  appetite, ^as- 
tralgia,  constipation,  and  paralysis  of  three  weeks'  duration.  This 
last  symptom  occurred  in  the  hand  of  a  man  who  had  taken  i  grain 
(.06  Gm.)  of  lead  acetate  twice  daily  for  four  days  to  relieve  hema- 
turia. In  another  case  attacks  of  colic,  lasting  several  months,  fol- 
lowed the  exhibition  of  4  grains  (.25  Gm.)  of  the  same  salt  for 
three  days.  Tanquere  des  Planches  suggests  caution  in  too  free 
an  administration  of  lead  preparations,  as  being  prone  to  occasion 
disagreeable  symptoms. 

The  external  application  of  lead  solutions  and  ointments  some- 
times produces  unpleasant  effects,  such  as  discoloration  of  the  skin. 
In  the  mucous  membrane  lead  rarely  excites  symptoms  of  poison- 
ing, a  single  case  being  reported  where  lead  water  compresses 
were  applied  to  the  eye.  Gastric  pains  have  occurred  after  re- 
peated applications  of  such  compresses  to  a  contused  shoulder,  the 
pains  ceasing  with  their  withdrawal  and  reappearing  with  a  renewal 
of  the  treatment.  Colic  and  paralysis  of  the  member  have  fol- 
lowed washing  of  a  large  ulcer  of  the  leg  with  lead  water,  these 
symptoms  disappearing  upon  a  withdrawal  of  the  drug.  In  still 
another  case  a  sweetish,  styptic  taste  in  the  mouth  and  stiffness  of 
the  neck  resulted  from  the  external  use  of  the  solution. 

Poisoning. — Cases  of  acute  poisoning  are  in  therapeutics  for- 
tunately rare,  the  acetate — the  form  generally  given — producing 
emesis,  thus  preventing  toxic  effects  of  the  drug. 

The  first  symptom  of  poisoning  is  a  sweetish,  metallic  taste, 
soon  followed  by  nausea  and  vomiting  of  a  white,  milky  fluid  con- 
taining curdy  material — the  result  of  a  combination  of  the  exces- 
sive lead  with  the  hydrochloric  acid  of  the  gastric  juice,  and  the 


ASTRINGENTS. 


729 


formation  of  lead  chloride.  Constipation  and  subsequent  diarrhea 
usually  occur,  with  black  passages,  the  discoloration  being  caused 
by  the  sulphide  of  lead  formed  in  the  intestinal  canal.  There  is 
severe,  persistent  pain  in  the  abdominal  muscles,  which  are  rigid 
and  contracted,  while  a  retraction  of  the  abdominal  walls  is  clearly 
perceptible.  There  are  great  thirst,  and  possibly  cramps  in  the 
calves  of  the  legs,  neuralgic  pains,  muscular  twitchings,  vertigo, 
stupor,  anesthesia,  and  paralysis.  Tenesmus  is  present,  and  the 
face  is  pale  and  the  lips  livid.  A  blue  line,  due  to  a  deposit  of  the 
sulphide,  is  usually  found  on  the  gums  near  the  incisor  teeth.  As 
a  rule,  the  liver  is  retracted  and  often  diminished  in  size.  The  pulse 
is  rapid  and  tense  at  first,  becoming  weak,  compressible,  and  slow. 

Treatment  of  Poisoning. — Evacuation  of  the  stomach  is  impera- 
tive? the  process  being  more  or  less  assisted  by  the  emetic  property 
of  the  drug.  Some  sulphate  should  be  administered  in  order  to 
form  an  insoluble  lead  compound.  Epsom  and  Glauber's  salts  are 
the  best  antidotes,  since  they  are  readily  soluble  and  easily  ob- 
tained; acting,  moreover,  as  a  purge,  they  empty  the  intestinal 
canal.  Opium  will  serve  to  relieve  pain  and  irritation,  while  to 
maintain  bodily  temperature  hot  applications  can  be  used  on  the 
feet  and  abdomen. 

Chronic  Poisoning. — The  acute  form  of  poisoning  just  considered 
is  alw.ays  produced  by  a  soluble  lead  salt ;  chronic  plumbism,  on 
the  contrary,  is  invariably  caused  by  an  insoluble  salt.  The  symp- 
toms are  numerous  and  manifold,  there  being  no  physiological  dis- 
turbance of  the  acute  which  is  not  present  in  the  chronic  condition. 
The  train  of  untoward  symptoms  is  occasioned  by  long-continued 
medicinal  use  of  lead  preparations.  Very  frequent  sources  of 
poisoning  are :  drinking  water  conveyed  in  lead  pipes,  and  foods 
colored  with  chrome  yellow  and  those  contained  in  cans  soldered 
with  lead.  It  is  especially  liable  to  occur  among  painters  (colica 
pictonum),  manufacturers  of  lead  salts,  color-grinders,  and  type- 
setters and  founders. 

Wrist-drop,  bilateral,  resulting  from  paralysis  of  the  extensor 
muscles  of  the  forearm,  is  one  of  the  most  prominent  symptoms, 
although  not  a  constant  occurrence.  The  supinator  longus,  being 
also  a  flexor,  usually  escapes  this  influence.  Colic,  sharp  abdom- 
inal pains,  chiefly  in  the  umbiUcal  region,  retraction  of  the  abdom- 
inal muscles  and  cramps,  and  paralysis  of  the  calves  of  the  legs 
may  be  present  in  plumbism — or  "  saturnism,"  as  it  is  sometimes 
termed,  a  word  transmitted  to  us  from  medieval  alchemy.     Obsti- 


730  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

nate  constipation,  with  the  passage  of  clay-colored  stools,  as  has 
been  stated,  necessarily  occurs ;  and  anorexia,  gastralgia,  and 
arthralgia  are  seldom  absent.  The  liver,  the  most  important  me- 
dium in  the  elimination  of  the  poison,  in  severe  cases  becomes 
overtaxed  and  reduced  in  size.  The  tongue  is  white  and  coated, 
and  the  skin,  lips,  and  mucous  membranes  are  discolored.  A  blue 
line  on  the  anterior  gums  is  pathognomonic,  although  it  may  be 
absent  in  those  who  take  special  care  of  the  teeth. 

Headache,  deHrium,  and  epileptiform  convulsions,  constituting 
encephalopathia  saturnina,  may  occur,  being  usually  due  to  uremia 
induced  by  insufficient  elimination  of  the  poison.  Albuminuria, 
cirrhosis,  and  contraction  of  the  kidneys,  with  diminished  excretion 
of  uric  acid,  are  present,  and  amblyopia  and  amaurosis  may  be  in- 
cluded among  the  symptoms.  The  heart  and  the  entire  vascular 
system  are,  as  has  been  said,  considerably  deranged.  Multiple 
neuritis,  anterior  poliomyelitis,  and  atrophy  of  the  nerve-trunks, 
with  resultant  muscular  wasting  and  loss  of  power,  gradually  mani- 
fest themselves.  Gout  sometimes  occurs,  and,  as  noted  in  acute 
poisoning,  miscarriage  is  liable  to  take  place. 

Treatment  of  Poisoning. — The  sulphates  are  given  for  their 
chemical  and  purgative  effects,  yet  in  chronic  plumbism  the  hepatic 
purgatives — calomel,  gamboge,  jalap,  etc. — are  preferable.  Opium 
and  morphine  relieve  pain  and  spasms,  being  claimed  by  some 
authorities  as  specifics  in  lead-poisoning.  Sulphuric-acid  lemonade 
and  plenty  of  milk  have  been  found  beneficial.  Potassium  iodide 
in  ten-grain  doses,  three  times  daily,  has  an  eliminative  effect.  The 
cerebral  symptoms  may  be  alleviated  by  a  diaphoretic,  such  as 
pilocarpin  or  an  alcohol  sweat. 

In  progressive  paralysis  strychnine  is  widely  employed.  Fara- 
dization of  the  muscles,  if  they  respond,  or  otherwise  galvanization, 
should  be  used  to  increase  muscular  force  and  prevent  atrophy. 

Plumbi  Acetatis. — This  being  the  typical  lead  salt,  its  action 
will  be  first  considered. 

Therapeutics. — Externally  and  Locally. — It  acts  as  a  sedative 
as  well  as  an  astringent  in  acute  inflammations,  such  as  eczema  (not 
chronic),  impetigo,  lichen,  and  erythema ;  but  it  must  not  be  used 
stronger  than  lo  grains  (0.64  Gm.)  to  i  ounce  (30.0  Cc.)  of  water. 

It  is  of  service  as  an  injection  in  gonorrhea,  leucorrhea,  gleet, 
and  otorrhea.  In  combination  with  opium  it  makes  a  good  topical 
application  for  hemorrhoids,  hs,  a  gargle  it  is  of  some  value,  and 
is  also  serviceable  in  orchitis,  synovitis,  and  paronychia. 


ASTRINGENTS.  731 

Internally. — Its  most  important  use  is  in  checking  hemorrhages, 
in  which  it  is  associated  with  opium,  although  it  is  chemically  in- 
compatible with  that  drug.  It  is  of  service  in  hemorrhage  in  typhoid 
fever,  yellow  fever,  hemoptysis,  and  gastric  ulcer.  It  lowers  the 
heart's  action,  constringing  the  arterioles,  in  this  respect  resembling 
digitalis,  combined  with  which  drug  it  is  beneficial  in  hypertrophy 
of  the  heart. 

Morbid  discharges,  such  as  the  night-sweats  and  diarrhea  of  phthi- 
sis and  the  diarrhea  of  typhoid,  dysentery,  cholera  infantum,  secretions 
in  bronchorrhea,  and  serous  diarrhea,  are  effectually  checked  by  the 
acetate  of  lead  and  opium,  which  diminishes  the  pain,  griping,  and 
tenesmus  attending  the  respective  affections.  By  far  its  most  fre- 
quent use,  however,  is  in  serous  diarrheas,  the  drug  acting  very 
quickly  and  efficiently,  and  being  both  sedative  and  astringent. 

Given  in  chronic  gastritis  with  pain,  lead  acetate  affords  marked 
relief  It  was  at  one  time  advocated  in  internal  aneufjsm,  but  is 
of  little  if  any  value  in  this  respect. 

Liquor  Plumbi  Subacetatis. — This  preparation  is  used  exten- 
sively for  bruises,  sprains,  acute  eczema,  and  as  a  cooling  application 
in  ecthyma,  erysipelas,  and  all  kinds  oi  inflammations ;  it  should 
be  well  diluted.  It  also  relieves  the  itching  of  urticaria,  pruritus 
pudendi,  and  eczema. 

A  felon   may   be   aborted    by   saturating   bread-crumbs    with 

Goulard's  solution,  making  a  poultice,  and  placing  it  over  the  finger. 

Plumbi   Iodidi. — Used  very  little.     It   acts  beneficially  when 

employed  as  an  ointment  applied^to  enlarged  lymphatic  glands  and 

spleen  ;  also  for  psoriasis  and  chronic  eczem.a. 

It  is  given  in  1-2  grain-  (0.06-0. 12  Gm.)  doses  to  reduce  malarial 
spleen. 

Carbonate  of  lead  is  used  only  externallj'-,  in  the  form  of  an 
ointment,  for  burns,  scalds,  erysipelas,  and  intertrigo.  It  should 
never  be  applied  to  abraded  surfaces,  as  it  is  rapidly  absorbed.  It 
should  be  mixed  with  linseed  oil. 

Plumbi  Oxidum. — Hebryre  commends  an  application  of  equal 
parts  of  lead  plaster  and  linseed  oil  for  sweating  of  the  feet.  It  is 
chiefly  used  in  the  preparation  of  diachylon  or  lead-plaster,  emplas- 
trum  saponis  and  emplastrum  resinae  being  also  prepared  with  the 
oxide. 

Plumbi  Nitras. — Used  with  good  results  in  onychia  and  also 
in  the  manufacture  of  Ledoyne's  disinfectant.  It  is  an  excellent 
remedy  for  fissured  nipples,  care  being  taken  to  wash  the  nipple 


732  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

before  suckling.  Should  the  fissures  be  deep,  it  is  well  to  wash 
the  nipple  with  morphine  sulphate  or  a  little  cocaine,  as  the  lead 
application  is  exceedingly  painful. 

It  destroys  the  fetid  odor  arising  from  gangrenous  sores  and 
offensive  discharges  from  the  ears,  nostrils,  rectum,  and  vagina. 
It  has  also  proved  serviceable  in  epithelioma. 

Chloride  of  lead  and  tannate  of  lead  have  been  used  ex- 
ternally as  ointments — the  chloride  to  allay /«?'«  and  arrest  morbid 
growths,  and  the  tannate  in  threatening  bed-sores. 

Administration. — Locally  a  watery  solution  of  lead  acetate,  lo 
grains  (0.64  Gm.)  to  i  ounce  (30.0  Cc),  is  used.  Powdered  opium 
can  be  added,  i  drachm  to  the  pint  of  water.  Applied  to  mucous 
membranes  or  used  as  an  injection,  2  grains  (0.12  Gm.)  to  i  ounce 
(30.0  Cc.)  of  water,  or  5  grains  (0.32  Gm.)  of  the  acetate  and  5  (0.32 
Gm.)  of  zinc  sulphate  in  i  ounce  (30.O  Cc.)  of  water — rose-water, 
for  instance — proves  a  most  efficient  application.  Suppositories  for 
hemorrhoids  may  contain  i  grain  (0.06  Gm.)  of  opium  to  3-5  grains 
(0.19-0.32  Gm.)  of  the  acetate.  The  pilulae  plumbi  cum  opio — lead 
acetate  3  grains  (0.19  Gm.),  opium  i  grain  (0.06  Gm.) — is  mostly  used 
internally,  one  pill  being  taken  every  three  hours.  In  dysentery  and 
cholera  infantum  an  enema  containing  5  grains  (0.32  Gm.)  of  lead 
acetate  to  i  grain  (0.06  Gm.)  of  opium,  or  \  grain  (0.03  Gm.)  of 
morphine  to  i  ounce  (30.O  Cc.)  of  water,  gives  excellent  results. 

Should  there  be  any  abrasion  of  the  skin,  lead  subacetate  must 
not  be  used,  as  it  prevents  healing  by  constringing  the  edges  of 
the  wound. 

It  is  not  used  internally. 

Solution  of  subacetate  of  lead  is  most  frequently  used  in  union 
with  opium,  forming  the  well-known  L.  and  L.,  or  lead-water-and* 
laudanum,  solution.  It  is  also  used  in  conjunction  with  glycerin, 
I  ounce  of  each,  or  as  Goulard's  cerate,  consisting  of  20  parts 
Goulard's  extract  to  80  parts  camphor  cerate. 

For  ulcers,  fissured  nipples,  and  epithelioma  lead  nitrate  is  used, 
chiefly  in  the  powdered  form.  In  the  nose,  ears,  vagina,  and  rectum 
a  douche  (2-5  grains  (o.  1 3-0.3  2  Gm.)  to  i  ounce  (30.0  Cc.)  of  water) 
is  used.  A  solution  of  10  grains  (0.64  Gm.)  to  i  ounce  (30.0  Cc.) 
of  glycerin  or  brandy  is  a  very  good  application  for  sore  nipples. 

Zincum— ZTnci — Zinc.     U.  S.  I*. 

Origin. — Obtained  by  roasting  the  native  Zinc  Sulphide  or  Car- 
bonate, tod  reducing  the  resulting  oxide  with  charcoal. 


ASTRINGENTS.  733 

Description  and  Properties. — A  bluish-white  metal,  showing 
a  crystalline  fracture  and  having  a  specific  gravity  ranging  from  6.9 
when  it  is  cast  to  7.2  after  it  is  rolled.  Soluble  in  diluted  sulphuric 
or  hydrochloric  acid,  with  evolution  of  hydrogen  gas. 

Metallic  zinc  occurs  in  the  form  of  thin  sheets  or  in  irregular, 
granulated  pieces,  or  moulded  into  thin  pencils,  or  in  a  state  of 
fine  powder. 

The  following  salts  of  zinc  are  ofiScial : 

ZKnci  Acetas — ZInci  Acetatis — Zinc  Acetate. —  Origin. — Obtained  by  dissolv- 
ing Zinc  Acetate  in  Acetic  Acid  and  Water  and  boiling :  zinc  acetate  crystallizes  out. 

Description  and  Properties. — Soft,  white,  six-sided,  monoclinic  plates,  of  a  pearly 
luster,  having  a  faintly  acetous  odor  and  an  astringent  metallic  taste.  Exposed  to  the 
air,  the  salt  gradually  effloresces  and  loses  some  of-  its  acid.  Soluble  in  2.7  parts  of 
water  and  36  parts  of  alcohol.     Zinc  acetate  should  be  kept  in  well-stoppered  bottles. 

Dose. — As  a  tonic,  ^-2  grains  (0.03-0.12  Gm.) ;  as  an  emetic,  10-30  grains 
(0.6-2.0  Gm.);  but  principally  used   externally  and  locally. 

Zlnci  Carbonas  Praecipitatus — Zinci  Carbonatis  Praecipitati —  Precipitated 
Zinc  Carbonate. —  Origin. — Prepared  by  pouring  together  solutions  of  Zinc  Sulphate 
and  Sodium  Carbonate,  and  drying  the  precipitated  zinc  salt. 

Description  and  Properties. — An  impalpable  white  powder,  of  somewhat  variable 
chemical  composition,  without  odor  or  taste ;  permanent  in  the  air.  Insoluble  in  water 
or  alcohol. 

Dose. — 2-3  grains  (0.12-0. 1 8  Gm.).     Chiefly  used  externally. 

Zinci  lodidum— Zinci  lodidi— Zinc  Iodide.— 0?7^;«.— Prepared  by  dissolving 
Zinc  Oxide  or  Carbonate  in  Hydriodic  Acid. 

Description  and  Properties. — A  white,  granular  powder,  odorless,  having  a  sharp, 
saline,  and  metallic  taste.  Very  deliquescent,  and  liable  to  absorb  oxygen  from  the  air, 
becoming  brown  from  liberated  iodine.  Readily  soluble  in  water,  alcohol,  or  ether. 
Zinc  iodide  should  be  kept  in  small  glass-stoppered  bottles. 

Dose. — ^-2  grains  (0.03-0.12  Gm.).     Also  used  externally. 

Zinci  Oxidum— ZKnci  Oxidi— Zinc  Oxide.— On^».— Prepared  by  heating  Zinc 
Carbonate  to  redness  in  a  crucible. 

Description  and  Properties.— K-a  amorphous  white  powder  without  odor  or  taste. 
Insoluble  in  water  or  alcohol.     It  should  be  kept  in  well-stoppered  bottles. 

Dose. — J^-S  grains  (0.015-0.3  Gm.). 

Official  Preparations. 
Ungugntum  Zlnci  Oxidi— UnguSnti  Zinci  Oxidi— Ointment  of  Zinc  Oxide 

(20  per  cent.). — Used  externally  and  locally. 

Zlnci  Stilphas— Z!nci  Sulphatis— Zinc  Sulphate.— On^w.— Prepared  by  dis- 
solving Granulated  Zinc  in  Sulphuric  Acid,  certain  precautions  being  taken  to  remove 
impurities. 

Description  and  Properties.— Colorless,  transparent,  rhombic  crystals,  without  odor, 
and  having  an  astringent,  metallic  taste.  Efflorescent  in  dry  air.  Soluble  in  0.6  part 
of  water  and  in  3  parts  of  glycerin ;  insoluble  in  alcohol.  Zinc  sulphate  should  be  kept 
in  well-stoppered  bottles. 

Dose.—l-T,  gr^ns  (0.06-0.18  Gm.);  as  an  emetic,  10-60  grains  (0.6-4.9-Qip.), 

Antagonists  and  Incompatibles. — The  salts  of  zinc  areVmcom- 


734  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

patible  with  the  vegetable  astringents,  alkalies  and  their  carbonates, 
lime  water,  the  sulphides,  silver  nitrate,  lead  acetate,  and  milk. 

Synergists. — The  same  as  for  lead. 

The  metallic  form  is  not  used  in  medicine. 

Physiological  Action. — Externally  and  Locally. — The  zinc  salts 
resemble  the  lead  salts  in  their  action,  but  they  are  less  pow-erful 
astringents.  They  are  also  to  a  slight  extent  hemostatic.  The 
chloride  is  exceedingly  caustic. 

Internally. — Digestive  System. — The  sulphate  of  zinc  and,  in  a 
slight  degree,  the  carbonate  are  specific  emetics,  causing  rapid 
emesis,  with  but  little  nausea  or  depression.  Their  modus  operandi 
is  not  definitely  known,  but  it  is  believed  that  their  effects  are 
partly  due  to  local  action  on  the  stomach,  and  partly  to  stimulation 
of  the  vomiting  center  in  the  medulla. 

Vomiting  is  also  produced  by  injecting  a  solution  of  the  salt 
into  the  circulation ;  but  this  is  doubtless  owing  to  the  fact  that 
the  salt  is  excreted  by  the  stomach,  and  that  it  also  exerts  an 
influence  on  the  medullary  center. 

The  salts  of  zinc  also  act  as  astringents  upon  the  gastro-intes- 
tinal  mucous  membrane. 

Circulatory  System. — Practically  nothing  is  known  of  the  action 
of  zinc  salts  on  the  heart,  blood,  and  vessels.  They  exist  in  the 
blood  as  albuminates,  in  close  relation  with  the  red  corpuscles. 

Nervous  System. — Zinc  valerianate  acts  as  a  sedative,  but  this 
action  is  wholly  dependent  upon  the  valerian. 

The  salts  are  also  astringents  and  possess  some  tonic  properties. 
They  may  cause  transverse  myelitis. 

Absorption  and  Elimination. — The  zinc  salts  are  absorbed  from 
the  stomach  or  enter  directly  into  the  circulation  when  injected. 
They  are  eliminated  by  the  liver  and  kidneys,  but  mainly  by  the 
intestinal  glands.  Zinc  salts  do  not  accumulate  so  rapidly  as  mer- 
cury, lead,  and  copper. 

Untoward  Action. — 3-5  grains  (0.19-O.32  Gm.)  have  produced 
nausea  and  gastric  oppression,  while  if  the  zinc  salt  reaches  the  intes- 
tines diarrhea  results.  When  taken  on  a  full  stomach  the  salts  form  an 
insoluble  albuminate  which  undergoes  the  regular  digestive  process. 

Repeated  small  doses,  3  grains  (0.19  Gm.),  have  produced  gastric 
oppression,  eructations,  slight  confusion  of  thought,  dizziness,  bodily 
exhaustion,  thirst,  gastralgia,  vomiting,  and  diarrhea.  Zinc  dyscra- 
sia  may  follow,  characterized  by  obstinate  constipation,  emaciation, 
and  anemia. 


ASTRINGENTS.  735 

Poisoning. — Continued  use  or  excessive  doses  of  zinc  will  pro- 
duce poisoning,  with  symptoms  resembling  those  of  lead-poisoning. 
Chronic  zinc-poisoning  is  rare. 

Treatment  of  Poisoning. — Chemical  antidotes  are  the  bicarbon- 
ates  of  soda  and  potassium.  Flour  and  water,  soapsuds,  and  milk 
are  also  beneficial.  Morphine  given  hypodermically  relieves  the 
vomiting.  Laxatives  and  potassium  iodide  may  serve  later  to 
assist  in  eliminating  the  zinc. 

Therapeutics. — Zinc  Oxide. — Externally  and  Locally. — The 
ointment  or  powder  is  used  in  chronic  eczema,  intertrigo,  burns,  fis- 
sured nipples,  anal  fissure,  ulcers,  and  skin  diseases.  In  combination 
with  linseed  oil  the  oxide  has  also  been  used  in  erysipelas.  The 
drug  has  proved  useful  as  an  injection  in  leucorrhea. 

Internally. — Associated  with  bismuth,  sodium  bicarbonate,  or 
belladonna,  it  is  very  effective  in  diarrhea — particularly  the  summer 
diarrhea  of  children — and  dysentery. 

It  is  a  most  excellent  remedy  for  colliquative  sweating  and  the 
sweating  of  phthisis,  and  also  serves  to  check  the  profuse  secretion 
of  bronckorrhea,  although  its  use  may  occasion  disordered  diges- 
tion, since  zinc  is  but  sparingly  soluble. 

It  has  been  used  extensively  in  the  treatment  of  hysteria,  spas- 
modic asthma,  chorea,  and  epilepsy ;  yet,  even  though  it  is  claimed 
to  be  a  specific,  its  action  as  such  is  exceedingly  doubtful. 

Zinc  oxide  has  proved  highly  beneficial  in  whooping  cough^  de- 
lirium, tremens,  and  chronic  alcoholism — especially  the  two  latter, 
which  are  attended  with  considerable  nervousness. 

The  oxide  is  also  valuable  in  gastralgia. 

Zinc  Acetate. — It  is  used  only  externally  and  as  an  injection  in 
gonorrhea  and  leucorrhea.    In  conjunctivitis  it  is  useful  as  a  collyrium. 

Zinc  Sulphate. — Externally  and  Locally. — The  external  use  is 
chiefly  in  weeping  eczema,  pruritus,  and  ulcers.  Locally  it  is  of  ser- 
vice as  a  wash  in  ophthalmia  and  conjunctivitis,  and  as  an  injection 
in  gonorrhea,  leucorrhea,  vulvitis,  and  otitis.  It  is  also  used  in  gan- 
grenous stomatitis,  cancrum  oris,  and  as  a  gargle  in  enlarged  tonsils 
and  relaxed  sore  throat.  In  nasal  polypi  the  powder  is  insufflated, 
the  solution  being  applied  to  the  stump  after  removal  of  the  poly- 
pus. It  dries  up  soft  tumors  near  the  vagina,  anus,  and  female 
urethra.  It  is  also  used  in  lupus  exedens  and  cancer  of  the  breast, 
but  does  not  act  upon  parts  covered  by  epithelium.  Its  application 
is  very  painful,  but  the  eschar  does  not  tend  to  spread,  and  sepa- 
rates much  more  readily  than  those  of  many  other  caustics. 


736  A    TEXT-BOOK" -.OF  MATERIA   MEDICA. 

Internally. — Its  chief  use  is  that  of  an  emetic  after  ingestion  of 
poison,  irritating  foods,  and  especially  narcotics,  as  well  as  where 
the  air-passages  are  obstructed,  as  in  croup  and  diphtheria. 

It  acts  as  an  astringent  in  chronic  diarrhea  and  dysentery  when 
associated  with  opium  and  ipecac.  It  is  serviceable  in  typhoid  fever ^ 
flatulent  dyspepsia,  coursing  oxularia,  spasmodic  asthma,  and  whoop- 
ing cough.  Like  the  other  zinc  salts,  it  has  also  been  used  in 
hysteria,  chorea,  epilepsy,  and  angina  pectoris. 

Zinc  Carbonate. — This  preparation  is  used  only  externally,  for 
blisters,  weeping  eczema,  and  intertrigo.  It  is  employed  in  the  form 
of  a  powder,  but  generally  as  an  ointment — cardamine  ointment. 

Zinc  Iodide. — This  salt  is  but  little  used,  but  is  of  some  value 
as  a  gonorrheal  injection,  as  an  application  to  enlarged  and  indu- 
rated tonsils,  and  in  scrofulous  glands. 

Zinc  phosphide  and  zinc  valerianate  are  used  only  for  the 
benefit  derived  from  the  phosphide  and  valerian,  and  may  properly 
be  omitted  here. 

Administration. — Externally  the  powder  or  ointment  of  zinc 
oxide  is  used,  or  the  drug  may  be  mixed  with  powdered  starch, 
lycopodium,  or  acacia.  Before  applying  these  preparations  it  is 
well  to  wash  the  parts  with  a  weak  solution  of  carbolic  acid. 

Internally,  \  grain  (o.oi  Gm.)  zinc  oxide  and  3  grains  (0.19  Gm.) 
sodium  bicarbonate  are  given  in  diarrhea,  or,  if  preferable,  bismuth 
subnitrate  10  grains  (0.64  Gm.),  pepsin  (Sheffer's)  3  grains  (0.19  Gm.), 
and  zinc  oxide  \-\  grain  (0.03-0.06  Gm.),  with  a  little  opium  added. 

As  an  injection  a  combination  of  10  grains  (0.64  Gm.)  each  of  zinc 
sulphate  and  lead  acetate  is  used,  the  two  salts  interacting  and  pro- 
ducing lead  sulphate — which  is  precipitated  and  insoluble — and  zinc 
acetate. 

Locally  and  externally  the  dry  powder  of  zinc  sulphate  is 
used,  or  a  mixture  of  zinc  sulphate  10  grains  (0.64  Gm.),  aqua  rosse 

4  ounces  (118.29  Cc),  and  glycerin  i  drachm  (4.0  Cc),  as  a  lotion. 
As  an  injection  it  is  associated  with  lead  acetate,  forming  the  zinc 
acetate  and  lead  sulphate.    In  ophthalmia  neonatorum  zinc  sulphate 

5  grains  (0.32  Gm.),  morphine  sulphate  3  grains  (0.19  Gm.),  and 
aqua  rosse  i  ounce  (30  Cc),  perhaps  with  atropine  added,  form 
an  excellent  mixture. 

Internally,  in  dyspepsia  1-2  grains  (0.06-0.12  Gm.)  may  be  given, 
and  fq'^  intestinal  affections  i  grain  (0.06  Gm.)  each  of  the  sulphate, 
powdered  opium,  and  ipecac  three  times  daily.  To  produce  emesis- 
5  grains  (0.32  Gm.)  are  sufficient. 


ASTRINGENTS.  737 

The  collyrium  consists  of  J  grain  (0.03  Gm.)  of  the  salt  in  i 
ounce  (30  Cc.)  of  rose  water. 

Cupri  Sulphas— Cupri  Sulphatis— Copper  Sulphate. 

TI.  8.  P. 

Origin. — Prepared  by  heating  Copper  and  Sulphuric  Acid  to- 
gether, dissolving  the  soluble  product  in  hot  Water,  and  evaporating. 

Description  and  Properties. — Large,  transparent,  deep  blue 
triclinic  crystals,  odorless,  of  a  nauseous,  metallic  taste ;  slowly 
efflorescent  in  dry  air.  Soluble  in  about  2.6  parts  of  water  and  in 
0.5  part  of  boiling  water ;  almost  insoluble  in  alcohol. 

Dose. — \-^  grain  (0.008-0.03  Gm.),  as  an  astringent;  as  an 
emetic,  2-20  grains  (0.12-1.2  Gm.). 

Antagonists  and  Incompatibles. — Alkalies  and  their  carbon- 
ates, the  sulphides,  mineral  salts  (except  the  sulphates),  lime  water, 
the  iodides,  and  vegetable  astringents. 

Synergists. — The  same  as  for  lead. 

Physiological  Action. — Copper  sulphate^  is  the  salt  mostly 
used,  and  the  only  official  preparation.  Its  action  is  therefore  given 
as  characteristic  of  that  of  cuprum. 

Externally. — Applied  to  the  unbroken  skin,  it  produces  little 
effect,  but  on  raw  surfaces  or  mucous  membranes  it  acts  as  a  pain- 
ful caustic  and  astringent.     It  also  possesses  antiseptic  properties. 

Internally. — Digestive  System. — It  acts  as  an  irritant,  causing 
vomiting  of  greenish  matter,  though  nausea  does  not  follow  the 
emesis.  The  secretions  are  augmented,  and  salivation  and  purging 
of  blood  and  mucus  are  attendant  consequences  of  its  ingestion. 
Should  emesis  be  delayed,  the  stomach  should  immediately  be 
emptied,  otherwise  the  copper  is  liable  to  produce  inflammation. 

Circulatory  System. — Copper  exists  normally  in  the  blood,  and 
acts  as  a  tonic,  being  present  in  the  circulation  as  an  albuminate. 
It  depresses  the  heart's  action,  causing  a  small,  weak,  rapid  pulse. 

Nervous  System. — It  acts  as  a  depressant. 

Respiratory  System. — Its  influence  is  to  hasten  and  depress  the 
respiratory  movements. 

Absorption  and  Elimination. — Copper  salts  are  slowly  absorbed, 
tending  to  accumulate  in  the  liver.  The  drug  is  eliminated  by  the 
liver,  kidneys,  salivary  glands,  and  intestinal  canal. 

Poisoning. — ^Acute  poisoning   results   from   the    inhalation   of 
cupreous  fumes,  eating  fruits  cooked  in  copper  vessels,  or  from 
an  overdose  of  a  copper  salt. 
47 


738  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

When  inhaled  the  first  symptoms  are  those  of  bronchial  catarrh 
and  irritation.  Internally  administered,  the  symptoms  do  not  usually 
appear  at  once,  but  after  an  hour's  interval  there  are  manifest  a 
strong  metallic  taste  in  the  mouth,  burning  and  constriction  of  the 
pharynx  and  fauces,  salivation  and  vomiting  of  greenish  matter,  and 
purging,  the  passages  after  a  while  containing  mucus  streaked  with 
blood.  There  are  present  also  burning  in  the  epigastrium  and 
griping,  colicky  pains. 

Copper  enters  the  circulation  quickly,  it  being  highly  diffusible. 
A  characteristic  symptom  of  poisoning  is  a  green  line  on  the  gums. 
Sometimes  jaundice  may  be  present,  and  headache,  convulsions, 
suppression  of  urine,  cardiac  depression,  and  hurried  respiration  are 
among  the  graver  symptoms. 

Treatment  of  Poisoning. — A  chemical  antidote  should  be  given 
at  once,  potassium  ferrocyanide  being  the  best,  as  it  forms  an  in- 
soluble copper  cyanide.  Other  recourses  are  white  of  egg,  milk, 
sweet  oil,  emetics,  and  the  use  of  the  stomach-pump.  A  mustard 
plaster,  with  a  little  opium  added  to  allay  the  pain  and  irritation, 
may  be  applied  over  the  pit  of  the  stomach  as  a  counter-irritant. 
Should  vomiting  have  already  occurred,  emetics  should  be  with- 
held. 

Chronic  poisoning  usually  results  from  long-continued  use  of 
the  medicine.  The  symptoms  are  the  same  as  those  of  acute  poi- 
soning, with  the  following  superadded :  paresis  of  the  limbs,  paral- 
ysis, incoordination  of  muscles,  atrophy  of  the  liver,  with  fatty 
degeneration  of  the  liver-cells,  and  proliferous  growth  of  the  con- 
nective tissue.  There  may  also  be  present  congestion  of  the  lungs 
and  fatty  degeneration  of  the  kidney,  together  with  bronchial 
catarrh.     The  treatment  is  the  same  as  for  acute  poisoning. 

Therapeutics. — Externally  and  Locally. — Copper  sulphate 
stimulates  old,  flabby,  granulating  ulcers.  Ring-worm,  scabies,  and 
tinea  sycosis  derive  great  benefit  from  its  use. 

The  crystal  or  solution,  2  grains  to  i  ounce  (0.12-32.0  Gm.)  of 
water,  is  used  extensively  in  conjunctivitis,  tinea  tarsi,  and  trachoma  , 
condylomata,  and  as  a  gargle  in  relaxed  sore  throat.  The  aphthse 
in  aphthous  stomatitis  are  benefited  by  touching  with  the  copper- 
sulphate  solution.  It  is  also  used  as  an  injection  in  gonorrhea  and 
gleet,  2  grains  to  i  ounce  (0.12-32.0  Gm.).  It  is  also  valuable  in 
mercurial  sore  mouth  and  gangrene  of  the  pharynx. 

Internally. — Copper  sulphate  is  the  chemical  antidote  for 
phosphorus-poisoning,  yet  it  should  be  given  with  great  caution, 


ASTRINGENTS.  y;^^ 

lest  of  itself  it  produce  acute  poisoning.  It  is  a  speedy  emetic, 
since  it  acts  directly  upon  the  stomach.  If  emesis  is  not  produced 
by  the  first  dose,  sulphate  of  zinc  or  mustard  may  be  employed. 
It  is  used  as  an  emetic  in  croup. 

In  chorea,  hysteria,  and  epilepsy  copper  is  beneficial.  In  chronic 
dysentery  and  diarrhea  an  enema  of  a  pint  of  water  (512.0  Gm.) 
and  10  grains  (0.6  Gm.)  of  sulphate  of  copper  is  an  efficient 
remedy,  being  by  some  authors  considered  the  best  metallic 
astringent  in  chronic  dysentery. 

Copper  associated  with  arsenic  is  highly  beneficial  in  anemia, 
building  up  the  blood  and  adding  firmness  to  the  flesh. 

Oleate  of  copper  is  used  in  the  skin  aflfections  mentioned. 

Nitrate  and  acetate  of  copper  act  like  the  sulphate. 

Arsenite  of  copper  has  been  suggested  as  a  remedy  in  anemia, 
and  has  been  used  in  doses  of  -^  grain  (0.0006  Gm.)  in  diarrhea 
and  cholera  infantum. 

Administration. — For  an  enema  in  diarrhea  and  dysentery  it 
maybe  combined  with  opium — 2  grains  to  i  ounce  (0.12-32.0  Gm.) 
of  water  being  used.  For  eye  affections  the  crystal  or  solution 
is  employed.  In  addition  to  the  enema  copper  sulphate,  i  grain 
(0.06  Gm.)  may  be  united  with  magnesium  sulphate  i  ounce 
(32.0  Gm.)  and  i  drachm  (4.0  Gm.)  diluted  sulphuric  acid  in  4 
ounces  (128.0  Gm.)  of  water,  a  tablespoonful  of  the  mixture  being 
given  every  three  or  four  hours.  To  produce  emesis  10-15  grains 
(0.6-1  Gm.)  are  dissolved  in  about  5  ounces  (160.0  Gm.)  of  water, 
a  tablespoonful  being  given  every  ten  minutes  until  vomiting  is 
produced. 

Argrenti  Cyanidum— Argenti  Cyanidi— Silver  Cya- 
nide.    JJ.  S.  P. 

Origin. — Obtained  by  distilling  a  solution  of  Potassium  Ferro- 
cyanide  acidulated  with  Sulphuric  Acid,  the  distillate  passing  into 
a  receiver  containing  a  solution  of  Silver  Nitrate.  The  process 
should  be  continued  until  the  distillate  no  longer  produces  a 
precipitate  in  the  receiver.  The  precipitate  is  finally  washed  with 
distilled  water  and  dried. 

Description  and  Properties. — A  white  powder,  without  odor 
or  taste ;  permanent  in  dry  air,  but  gradually  turning  brown  on 
exposure  to  light.  Insoluble  in  water,  alcohol,  or  cold  nitric  acid ; 
soluble  in  boiling  nitric  acid,  ammonia  water,  and   solution    of 


740  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

sodium  hyposulphite  or  potassium  cyanide.  It  should  be  kept  in 
dark,  amber-cplored  vials,  protected  from  light.    Not  used  internally. 

Official  Preparation. 

Acidum  Hydrocyanicum  Dilutum— Acidi  HydrocySnici  Diluti— Diluted 
Hydrocyanic  Acid  (Prussic  KaT,).—Dose,  2-5  minims  (0.12-0.3  Gm.).  (Described 
under  Hydrocyanic  Acid,  page  519.) 

Argenti  lodidum— Argent!  lodidi— Silver  Iodide. 

V.  8.  P. 

Origin. — Prepared  from  Silver  Nitrate  and  Potassium  Iodide, 
washing  and  drying  the  precipitate. 

Description  and  Properties. — A  heavy,  amorphous,  light-yel- 
lowish powder,  unaltered  by  light  if  pure,  but  generally  becoming 
somewhat  greenish-yellow;  without  odor  or  taste.  Insoluble  in 
water  and  alcohol.  Silver  iodide  should  be  kept  in  dark,  amber- 
colored  vials,  protected  from  light. 

Dose. — ^i  grain  (0.015-0.06  Gm.). 

Argenti  NTtras— Argenti  Nitratis— Silver  Nitrate. 

U.  8.  P. 

Origin. — Obtained  by  dissolving  Silver  in  Nitric  Acid  with  the 
aid  of  heat,  evaporating,  and  crystalhzing. 

Description  and  Properties. — Colorless,  transparent,  tabular, 
rhombic  crystals,  becoming  gray  or  grayish-black  on  exposure  to 
light  in  presence  of  organic  matter.  Without  odor,  but  having  a 
bitter,  caustic,  and  strongly  metallic  taste.  Soluble  in  0.6  part  of 
water  and  in  26  parts  of  alcohol.  It  should  be  kept  in  dark, 
amber-colored  vials,  protected  from  light. 

Dose. — J-i  grain  (0.0.15-0.06  Gm.). 

Official  Preparations. 

Arggnti  NItras   Dilfltus — ArgSnti  Nitratis  Diliiti — Diluted  Silver  Nitrate 

(Mitigated  Caustic). —  Origin. — Prepared  by  fusing  together  Silver  Nitrate  30,  and 
Potassium  Nitrate  60,  and  casting  in  suitable  moulds. 

Description  and  Properties. — A  white,  hard  solid,  generally  in  the  form  of  pencils 
or  cones  of  a  finely  granular  fracture,  becoming  gray  or  grayish-black  on  exposure  to 
light  in  the  presence  of  organic  matter;  odorless,  having  a  caustic,  metallic  taste,  neutral 
to  litmus-paper.     It  should  be  kept  in  dark,  amber-colored  vials.     Used  externally. 

Arggnti  NItras  Fiisus — ArgSnti  Nitratis  Fiisi — Moulded  Silver  Nitrate 
(Lunar  Caustic). — Origin. — Obtained  by  melting  Silver  Nitrate  100,  Hydrochloric 
Acid  4,  and  pouring  the  melted  mass  into  suitable  moulds. 

Description  qnd  Properties. — A  white,  hard  solid,  usually  cone-  or  pencil-shaped,  of 


ASTRINGENTS.  741 

a  fibrous  fracture,  becoming  gray  or  grayish-black  on  exposure  to  light  in  presence  of 
organic  matter ;  odorless,  having  a  bitter,  caustic,  and  strongly  metallic  taste.  Soluble 
in  0.6  part  of  water  and  in  26  parts  of  alcohol.  The  product  should  be  kept  in  dark, 
amber-colored  vials,  protected  from  light.     Used  externally  and  locally. 


Argenti  Oxidum— Argrenti  Oxidi— Silver  Oxide. 

U.  8.  I*. 

Origin. — Prepared  by  shaking  a  solution  of  Silver  Nitrate  with 
solution  of  Potassa  and  washing  the  precipitate. 

Description  and  Properties. — A  heavy,  dark,  brownish-black 
powder,  liable  to  reduction  by  exposure  to  light ;  odorless,  with  a 
metallic  taste;  very  slightly  soluble  in  water  and  insoluble  in 
alcohol. 

Dose. — |— 2  grains  (0.03-0.12  Gm.). 


Antagonists  and  Incompatibles. — The  silver  nitrate  is  incom- 
patible with  the  alkalies  and  their  carbonates,  chlorides,  hydro- 
chloric and  tannic  acids,  potassium  iodide,  solutions  of  arsenic,  and 
many  of  the  organic  acids. 

Silver  oxide  is  rapidly  oxidized,  forming  explosive  compounds 
with  chlorides  and  organic  substances. 

Synergists. — Preparations  of  copper,  lead,  and  zinc  aid  the 
action  of  silver  salts. 

The  silver  nitrate  and  its  preparations  and  the  silver  oxide  are 
the  only  salts  which  possess  any  value  as  astringents  or  caustics. 
The  silver  nitrate  is  the  typical  astringent  salt,  and  its  physiological 
action  will  be  hereafter  considered. 

Physiological  Action. — Metallic  silver  is  practically  of  no  use 
in  medicine,  though  of  great  value  in  surgery,  because  of  its  inert- 
ness.    Silver  nitrate  is  the  salt  of  silver  chieily  employed. 

Externally  and  Locally. — It  is  a  powerful  caustic,  but  does  not 
wound  very  deeply,  as  it  forms  an  eschar  by  coagulating  the  albu- 
min of  the  tissue,  thus  protecting  the  underlying  structures.  The 
eschar  is  white,  but  on  exposure  to  light  very  soon  becomes  black, 
owing  to  the  fact  that  the  silver  is  reduced  to  its  metallic  state. 

Like  lead  salts,  silver  salts  are  hemostatic.  They  are  severely 
irritant  to  mucous  membranes  when  used  in  solution. 

Internally. — Digestive  System. — The  drug  causes  increased  secre- 
tion of  intestinal  glands  and  larger  flow  of  bile.  Silver  salts  are 
changed  in  the  stomach  into  peptonates  and  albuminates.     Under 


743  A    TEXT-BOOK  OF  MA  TERIA   MEDIC  A. 

ordinary  doses  nutrition  is  promoted  ;  by  large  doses  it  is  impaired, 
with  resulting  loss  of  flesh  and  weight. 

Circulatory  System.— The  heart  is  stimulated  by  small  doses, 
and  the  blood  becomes  darker  and  contains  less  fibrin.  The 
red  corpuscles  lose  shape  and  color  and  the  hemoglobin  is  con- 
verted into  hematin.  Large  doses  depress  cardiac  action,  while 
thrombosis  and  embolism  may  ensue. 

Nervous  System. — In  small  doses  silver  salts  are  tonic ;  in  large 
doses  they  produce  epileptiform  convulsions  and  paralysis  of  centric 
origin. 

Respiratory  System. — The  primary  effect  of  the  drug  is  to  stim- 
ulate respiration.  Large  doses,  however,  cause  death  by  paralysis 
of  the  respiratory  center. 

Absorption  and  Elimination. — It  is  absorbed  from  the  stomach  . 
and  eliminated  very  slowly,  chiefly  by  the  feces,  a  small  portion 
being  excreted  by  the  kidneys. 

Temperature. — At  first  increased ;  afterward,  through  the  blood- 
changes,  lowered. 

Untoward  Action. — Long-continued  use  of  silver  nitrate  pro- 
duces discoloration  of  the  skin — either  general  or  more  pronounced 
in  particular  spots,  such  as  the  face.  Even  when  the  skin  is  per- 
fectly intact  the  application  of  nitrate  of  silver  will  discolor  it, 
\  grain  (.016  Gm.)  having  caused  palpitation  of  the  heart  and  irreg- 
ular pulse.     Silver  is  very  apt  to  accumulate  in  the  tissues. 

Poisoning. — A  poisonous  dose  of  silver  nitrate  produces  a  violent 
gastro-enteritis.  The  earliest  symptom  is  an  intense  pain  in  the 
abdomen,  followed  by  vomiting  and  purging.  The  abdominal 
muscles  are  hard  and  retracted,  the  face  livid  and  covered  with 
perspiration  and  wearing  an  anxious  expression.  The  lips  are 
blanched,  gradually  becoming  black ;  the  vomited  matter  is  black- 
ish and  sometimes  resembles  milk-curds. 

Epileptiform  convulsions,  delirium,  and  paralysis  ensue,  the 
latter  symptom  being  of  centric  origin. 

Death  results  from  cessation  of  respiration,  due  to  the  centric 
paralysis.  A  large  amount  of  mucus  is  thrown  into  the  bronchial 
tubes  by  the  lining  mucosa. 

Treatment  of  Poisoning. — The  chemical  antidote  is  common  salt. 
It  is  essential  to  protect  the  mucous  membrane  of  the  esophagus 
and  stomach,  and  at  the  same  time  dilute  the  poison  as  much  as 
possible,  for  which  purposes  large  quantities  of  salt  water  and  soap 
water  or  milk  are  valuable.     Opium  allays  the  pain  and  irritation. 


ASTRINGENTS.  743 

Chronic  poisoning,  or  argyria,  results  from  prolonged  medicinal 
use  of  silver  nitrate  or  its  employment  as  a  hair-dye  for  any  length 
of  time.  The  drug  is  deposited  in  all  parts  of  the  body,  being 
especially  manifest  in  a  slaty,  permanent  discoloration  of  the  skin. 
The  first  symptoms  are  discoloration  of  the  sclerotic  conjunctivae 
and  a  dark  hne  on  the  inner  side  of  the  lips.  Ulcerative  stomatitis 
may  occur,  or  even  gastric  ulcer. 

.  Treatment  of  Chronic  Poisoning. — Iodide  of  potassium  or  hypo- 
sulphite of  soda  will  aid  in  eliminating  the  poison.  Baths  of  the 
hyposulphites  or  lotions  of  cyanide  of  potassium  may  produce 
absorption  and  excretion  of  the  silver  deposits,  but  the  discolora- 
tion is  rarely  removed  in  any  way. 

Therapeutics. — Externally  and  Locally. — A  very  important  use 
of  SILVER  NITRATE  is  that  of  preventing  ophthalmia  neonatorum, 
a  2  per  cent,  solution  being  dropped  into  the  eyes.  For  adults  a  2 
to  4  per  cent,  solution  is  used  in  various  forms  of  conjunctivitis,  the 
eyelids  being  painted  with  a  camel's-hair  brush,  and  the  solution 
being  washed  off  immediately  to  prevent  discoloration.  The  nitrate- 
of-silver  stick  may  also  be  used. 

Felons,  boils,  and  bed-sores  may  be  aborted  by  the  use  of  a  strong 
solution — 20  grains  to  i  ounce — of  silver  nitrate. 

An  injection  of  2-3  grains  (.12-20  Gm.)  is  beneficial  in  subacute 
gonorrhea  and  leucorrhea.  This  may  also  be  used  as  a  wash  in 
pruritus  ani  and  vulvcz,  to  relieve  the  itching.  The  stick  may  be 
applied  to  uterine  ulcers. 

As  a  caustic  it  is  used  in  indolent  ulcers  and  chancroids,  stimu- 
lating them  and  producing  a  healthy  granulating  surface. 

A  solution  painted  over  the  eruption  of  variola  is  supposed  to 
prevent  pitting.  The  vesicles  may  also  be  punctured  with  a  needle 
and  the  silver  nitrate  then  introduced. 

The  pain  and  swelling  of  orchitis  and  epididymitis  are  consid- 
erably relieved  by  painting  the  scrotum  with  a  solution  of  this 
salt. 

After  a  cold,  when  the  throat  feels  raw  and  sore,  a  gargle  of  60 
grains  (4.0  Gm.)  to  the  ounce  (30.0  Cc.)  is  very  gratifying,  and  the 
same  may  be  used  in  inflammations  of  the  pharynx,  fauces,  and 
mouth.  A  spray  of  40  grains  (2.59  Gm.)  to  the  ounce  (30.0  Cc.) 
is  very  effective  in  laryngeal  croup,  trachitis,  chronic  ulceration  of  the 
larynx,  and  whooping  cough.  The  caustic  pencil  is  used  in  tonsil- 
litis, sore  nipples,  mercurial  sore  mozith,  and  poisoned,  lacerated,  and 
punctured  wounds.     A  solution  of  1-2  grains  (.06— .12  Cc.)  to  the 


744  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

ounce  (30.0  Cc.)  is  valuable  in  otorrhea,  vesical  catarrh,  and 
balanitis. 

Internally. — Dr.  Pepper  recommends  this  salt  in  intestinal  ulcer- 
ations, given  in  keratin-coated  pills.  It  is  a  cure  for  gastric  ulcer, 
in  which  it  may  be  combined  with  opium.  Gastralgia  and  chronic 
gastritis,  ulceration  of  the  rectum,  dysentery,  and  diarrhea  of  typhoid 
have  been  remarkably  benefited  by  its  use.  For  stomach  affections 
\-\  grain  (.01-016  Gm.)  is  given,  and  for  intestinal  an  enema  of 
3-10  grains  (.20-.64  Gm.)  to  the  ounce  (30.0  Cc). 

It  has  been  used  in  congested  conditions  of  the  cord,  locomotor 
ataxia,  epilepsy,  and  chorea.  It  is  the  only  remedy  of  any  value  in 
locomotor  ataxia ;  but,  owing  to  the  discoloration  it  produces,  it 
cannot  be  used  continuously,  and  in  many  cases  it  fails  entirely. 

Argentic  iodide  was  once  used  extensively  in  the  treatment 
of  syphilis,  but  is  now  obsolete. 

Argentic  oxide  is  not  so  active  as  the  nitrate.  It  has  been 
employed  for  checking  sweats,  and,  owing  to  its  less  caustic  action, 
it  may  be  preferable  to  the  nitrate  in  gastric  idcer  and  gastralgia. 

Administration. — The  dose  of  silver  nitrate  is  \-\  grain  (.01- 
.016  Gm.),  and  for  a  constitutional  effect  should  always  be  given  in 
pill  form  during  the  process  of  digestion. 

The  keratin-coated  pill  is  to  be  administered  for  intestinal  dis- 
orders, and  when  a  local  action  on  the  alimentary  canal  is  desired 
an  ordinary  pill  should  be  given  one  to  two  hours  before  meals. 

It  is  well  to  discontinue  the  drug  for  a  short  time  after  three  or 
four  weeks'  treatment,  the  salt  being  so  slowly  eliminated  that  its 
prolonged  use  is  very  apt  to  result  in  argyria. 

Pi.-c%an:va..— Origin. — A  soluble  compound  of  Silver  and  Casein,  first  prepared  by 
Rohmann  and  Liebreich. 

Description  and  Properties. — A  dilute  solution  of  this  substance  in  water  is  opales- 
cent; opaque  when  concentrated,  but  immediately  cleared  by  the  addition  of  ammonia 
or  carbonate  of  soda.     Used  externally  and  locally. 

Physiological  Action  and  Therapeutics. — Argonin  is  a  very  powerful,  non-irritating 
germicide.  The  addition  of  a  little  ammonia  to  a  solution  of  argonin  vastly  increases 
its  bactericidal  power,  but  deprives  the  drug  of  its  bland,  non-irritating  character.  It 
appears  to  lack  astringent  properties,  and  concentrated  solutions  are  neither  corrosive 
nor  irritant. 

From  experimental  research  Meyer  concludes  that  argonin  has  a  strong  disinfectin" 
influence  upon  certain  bacteria,  particularly  the  gonococcus,  investigation  having  shown 
that  a  1 :  30,000  solution  of  ammoniacal  argonin  completely  suspended  the  growth  of 
this  microbe  for  five  minutes. 

Jadassohn,  who  has  had  an  extensive  experience  with  argonin  in  the  treatment  of 
gonorrhea,  draws  the  following  conclusions :  ( I )  i  .5  to  2  per  cent,  solutions  exert  a  rap- 
idly destructive  action  upon  gonococci.     (2)  Strong  solutions  are  devoid  of  inflammatory 


ASTRINGENTS.  745 

or  corrosive  action,  and  are  consequently  adapted  to  the  treatment  of  acute  gonorrhea 
of  the  anterior  and  posterior  urethra  in  men,  and  of  the  uterus  and  urethra  in  women. 
(3)  It  appears  to  lack  astringent  properties,  so  that  purely  anticatarrhal  treatment  will 
indicate  the  assistance  of  other  remedies. 

Alumen— AlQminis— Alum.    JJ.  S.  JP. 

Origin. — Prepared  by  a  complicated  process  from  a  mixture  of 
Aluminum  Silicate  and  Iron  Sulphide  by  roasting,  lixiviating  with 
water,  concentrating  the  solution,  and,  while  hot,  mixing  with  Po- 
tassium Chloride.  Upon  cooling  the  alum  separates  as  a  crystal- 
line powder,  which  is  puriiied  by  one  or  two  recrystallizations. 

Description  and  Properi;ies. — Large,  colorless,  octahedral  crys- 
tals, sometimes  modified  by  cubes,  or  crystalline  fragments,  without 
odor,  but  having  a  sweetish  and  strongly  astringent  taste.  On 
exposure  to  the  air  the  crystals  are  liable  to  absorb  ammonia  and 
acquire  a  whitish  coating.  Soluble  in  9  parts  of  water  and  0.3  part 
of  boiling  water ;  also  freely  soluble  in  warm  glycerin.  Insoluble 
in  alcohol. 

Dose. — 5-40  grains  (0.3-2.60  Gm.) ;  as  an  emetic,  1-2  drachms 
(4.0-8.0  Gm.). 

Official  Preparation. 

Alumen  Exsiccatum — Aluminis  Exsiccati — Dried  Alum  (Burnt  Alum). — 
■  Origin. — Alum  heated  until  it  is  deprived  of  its  water  of  crystallization. 

Description  and  Properties. — A  white,  granular  powder,  without  odor,  possessing  a 
sweetish,  astringent  taste  and  attracting  moisture  from  the  air.     Very  slowly  but  com- 
pletely soluble  in  20  parts  of  water,  and  quickly  soluble  in  0.7  part  of  boiling  water. 
Dose. — 1-5  grains  (0.06-0.3  Gm.). 

Unofficial  Preparation. 

Aluminis  Glycerftum — Aluminis  Glyceriti — Glycerite  of  Alum  (20  per  cent, 
alum). — Used  externally. 

Allied  Compounds. 

Aliimnol — Altlmnol — Alumnol. —  Origin. — This  substance  was  discovered  by 
Filehne  of  Breslau,  and  is  a  mixture  of  Aluminum  Salts  of  Naphthol-sulphonic  Acid, 
containing  about  J  per  cent,  of  aluminum  and  15  per  cent,  of  sulphur. 

Description  and  Properties. — It  occurs  as  a  light,  odorless,  white  or  reddish-white, 
non-hygroscopic  powder.  It  possesses  a  sweetish  and  astringent  taste,  and  is  readily 
soluble  in  water  or  glycerin,  less  so  in  alcohol,  and  insoluble  in  ether. 

While  becoming  darker  on  exposure  to  the  air,  its  properties  are  unaffected.  Used 
externally  and  locally. 

Aluminum  Aceto-tartrate. — Origin. — First  prepared  by  Athenstadt  by  dissolving 
.  5  parts  of  Basic  Aluminum  Acetate  in  a  suflScient  quantity  of  water  by  the  aid  of  2  parts 
of  Tartaric  Acid,  and  evaporating  the  solution  to  dryness. 


746  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Description  and  Properties.— \1  occurs  in  shining,  almost  colorless,  amorphous, 
masses,  with  a  faint,  acetous  odor  and  an  acidulous  astringent  taste.  Soluble  m  water; 
insoluble  in  alcohol.     Used  externally  and  locally. 

Aluminum  Boroformate.— O^^m.— Prepai-ed  by  heating  together  Bono  Acid, 
Formic  Acid,  and  Alumina. 

Antagonists  and  Incompatibles.— The  alkalies  and  their  car- 
bonates ;  lead,  mercury,  and  iron  salts ;  tartrates  and  tannic  acid. 
Synergists.— The  vegetable  and  mineral  astringents. 

Alumini  Hydras— Alum ini  Hydratis— Aluminum 
Hydrate.     V.8.T. 

Origin. — This  substance  is  found  in  nature  as  the  rare  crystal- 
line mineral  gibbsite  of  North  America — the  diaspore  of  Eastern 
Europe.  The  aluminum  hydrate  may  be  prepared  by  precipitating 
the  solution  of  an  aluminum  salt  with  an  alkali  or  alkali  carbonate. 

Description  and  Properties. — A  white,  light,  amorphous  pow- 
der, odorless  and  tasteless,  permanent  in  dry  air.  Insoluble  in 
water  or  alcohol,  but  completely  soluble  in  hydrochloric  or  sul- 
phuric acid,  and  also  in  potassium  or  sodium  hydrate  T.  S. 

Dose. — 3-6  grains  (0.2-0.4  Gm.). 

Alumini  Sulphas— Alumini  Sulphatis— Aluminum 
Sulphate.     V.  S.  P. 

Origin. — It  is  occasionally  found  as  an  efflorescence  near  vol- 
canoes and  upon  alum-slate.  For  medicinal  use  it  should  be  pre- 
pared from  Aluminum  Hydrioxide,  by  dissolving  it  in  the  requisite 
quantity  of  Dilute  Sulphuric  Acid. 

Description  and  Properties. — A  white,  crystalline  powder, 
having  a  sweetish  and  afterward  astringent  taste ;  permanent  in  the 
air.  Soluble  in  i  .2  parts  of  water,  and  much  more  freely  in  boiling 
water ;  insoluble  in  alcohol.     Used  externally. 

Description  and  Properties. — It  occurs  in  pearl-like  crystals 
or  crystalline  scales,  which  are  very  soluble  in  water.  It  contains 
33.5  per  cent,  of  alumina.     Used  externally  and  locally. 

Sozal, — Origin. — Obtained  by  dissolving  Aluminum  Hydrate  in  Phenol-sulphonic 
Acid. 

Description  and  Properties. — A  crystalline  substance  having  an  astringent  taste  and 
a  faint  odor  of  carbolic  acid.  It  is  freely  soluble  in  water,  glycerin,  and  alcohol.  Used 
externally  and  locally. 

Physiological  Action. — Externally  and  Locally. — Alum  con- 
tracts the  small  blood-vessels  and  coagulates  the  albumin  in  the 


ASTRINGENTS.  747 

tissues,  but  in  order  to  have  any  effect  it  must  be  applied  to  a 
denuded  surface.  It  is  also  mildly  escharotic.  Applied  to  the 
unbroken  skin,  it  thickens  and  hardens  it. 

Internally. — Digestive  Systeni.-^Ws,  first  effect  when  taken  into 
the  mouth  is  to  excite  the  salivary  secretion,  the  albumin  in  it,  as 
well  as  that  of  the  buccal  mucous  membrane,  being  precipitated. 
When  its  astringent  action  takes  effect  the  secretions  are  dimin- 
ished and  the  mucous  membrane  of  the  mouth  and  toneue  is 
blanched  and  puckered.  The  enamel  of  the  teeth  is  affected, 
breaking  under  its  influence. 

The  digestive  juices  are  diminished  in  quantity  and  the  pepsin 
precipitated.  Constipation  follows,  though  it  may  be  preceded  by 
a  slight  diarrhea. 

Taken  in  large  doses,  alum  produces  nausea,  vomiting,  purging, 
and  abdominal  pain. 

Circulatory  System. — Notwithstanding  the  fact  that  alum  coag- 
ulates albumin,  it  is  nevertheless  absorbed  into  the  blood-vessels, 
and  by  contracting  them  lessens  all  the  secretions  and  arrests 
hemorrhage.  When  injected  directly  into  the  blood  it  produces 
thrombi  and  .emboH. 

Nervous  System. — Spasms  are  relieved  by  alum,  but  this  action 
is  in  all  probability  dependent  upon  contraction  of  the  blood- 
vessels. 

Absorption  and  Elimination. — As  stated,  alum  is  absorbed  by 
the  blood-vessels ;  it  is  eliminated  by  the  kidneys  and  liver. 

Untoward  Action. — The  prolonged  use  of  alum  is  very  apt  to 
produce  a  cough  in  persons  having  sensitive  bronchi. 

Therapeutics. — Externally  and  Locally. — Alum  is  used  to  de- 
stroy exuberant  granulations  and  verrucosities.  It  is  an  excellent 
hemostatic  in  epistaxis  and  bleeding  from  the  gums,  vagina,  rectum, 
bladder,  bites,  and  sockets  of  extracted  teeth. 

It  is  much  used  for  sore  throat  by  public  speakers  and  singers, 
and  is  also  efficient  in  tonsillitis,  particularly  the  follicular  form, 
gangrenous  pharyngitis,  stomatitis  ulcerosa,  relaxation  of  the  uvula 
and  pharyngeal  mucous  mem.brane,  swollen  and  overriding  gums, 
and  mercurial  ptyalism. 

The  destructive  effect  of  alum  upon  the  teeth  must  always  be 
borne  in  mind :  the  alum  stick  or  a  swab  is  preferable  whenever 
possible.  If  a  mouth-wash  or  gargle  be  necessary,  wash  and  brush 
the  teeth  well  immediately  after  using  the  alum. 

Five  grains  (.32  Gm.)  to  i  ounce  (30.0  Cc.)  of  water  is  an  excel- 


748  A    TEXT-BOOK  OF  MATERIA  MEDICA. 

lent  preparation  for  ophthalmia,  conjunctivitis,  and  trachoma,  but 
must  not  be  used  if  there  is  any  corneal  inflammation,  as  it  is  apt 
to  cause  ulcers.  By  adding  milk  or  white  of  egg  to  the  mixture 
its  efficiency  is  greatly  increased.  This  preparation  is  also  very 
serviceable  in  preventing  the  discoloration  of  a  "  black  eye."  An 
injection  of  5-10  grains  (.32-.64  Gm.)  to  the  ounce  (30.0  Cc.)  of 
water  is  much  used  in  gonorrhea,  leucorrhea,  and  gleet,  and  also 
for  washing  the  vulva  in  pruritus. 

Sweating  of  feet,  hands,  and  axillcB,  when  excessive  and  fetid,  is 
checked  by  the  application  of  a  lotion  or  powdered  alum. 

Soaking  a  piece  of  cotton  or  lint  with  alum  and  placing  it  under 
an  ingrowing  toe-nail  affords  marked  relief 

Chilblains,  old  sores,  and  ulcers  are  also  benefited  by  the  use  of 
alum. 

A  spray,  gargle,  or  insufflation  has  been  used  with  good  results 
in  diphtheria,  bronchorrhea,  chronic  laryngitis,  aphonia  due  to  atony, 
bronchitis,  and  whooping  cough. 

Internally. — Alum  operates  advantageously  as  an  astringent  in 
arresting  gastric  and  intestinal  hem.orrhages,  hematuria,  and  inenor- 
rhagia.  The  diarrheas  of  typhoid  fever  and  chronic  dysentery,  and 
occasionally  the  acute  forms,  are  strikingly  benefited  by  an  alum 
enema. 

It  has  been  used  in  polyuria  and  diabetes  mellitus,  though  in  the 
later  affection  it  is  of  little  value. 

Although  alum  produces,  it  also  relieves,  constipation  when 
flatus  has  existed  for  some  time,  and  atony  of  the  bowel  diminished 
peristalsis. 

Given  in  emetic  doses  in  membranous  croup,  it  loosens  the 
membrane,  and  as  this  is  expelled  it  lessens  the  chance  of  another 
one  forming  by  constringing  the  mucosa  and  blood-vessels,  and 
thus  preventing  further  exudation. 

By  checking  absorption  and  producing  emesis  alum  serves  as  an 
antidote  for  lead-poisoning,  and  is  an  efficient  remedy  in  lead  colic. 

Alumen  exsiccatum  is  employed  chiefly  as  an  escharotic  for 
fungous  growths,  and  to  stimulate  indolent  ulcers  and  mucous 
membranes  with  morbid  secretions. 

Whenever  the  drug  is  used  as  a  powder  externally  or  for  insuf- 
flation, powdered  dried  alum  is  the  form  to  use. 

Administration.— The  emetic  dose  of  alum  is  1-2  drachms 
(4.0-8.0  Gm.)  in  syrup.  Warm  water  will  increase  its  action  when 
retching  begins. 


ASTRINGENTS.  749 

For  internal  use,  5-10  grains  (.32-.64  Gm.),  mixed  with  a  little 
simple  syrup  or  syrup  of  orange  peel  to  prevent  nausea,  will  be 
found  beneficial.  For  coUyria,  2-3  grains  (.12-.20  Gm.)  in  i  ounce 
(30.0  Cc.)  of  water,  or  the  alum  curd,  as  already  mentioned,  may 
serve  best.  The  curd  may  be  separated  by  adding  2  drachms  (8.0 
Gm.)  of  alum  to  i  pint  (473.  Cc.)  of  milk,  boiling,  and  straining. 

The  gargle  and  injection  can  be  used  in  strengths  of  5-20  grains 
(.32-1.29  Gm.)  to  I  drachm  (4.0  Gm.).  For  insufflation  the  dried 
alum  is  employed. 


Bismuthi   CTtras— Bismuth!   Citratis— Bismuth   Ci- 
trate.    V.  S.  JP. 

Origin. — Bismuth  Subnitrate  and  Citric  Acid  are  boiled  in  suf- 
ficient Water,  and  the  precipitate  washed  and  dried. 

Description  and  Properties. — A  white,  amorphous  or  micro- 
crystalline  powder,  odorless  and  tasteless,  permanent  in  the  air. 
Insoluble  in  water  or  alcohol,  but  soluble  in  ammonia  water  and  in 
solutions  of  the  citrates  of  the  alkalies. 

Dose. — 1-3  grains  (0.06-0.2  Gm.). 

Official  Preparation. 

Bismuthi  et  Ammonii  Citras — Bistnuthi  et  Ammonii  Citratis — Bismuth 
and  Ammonium  Citrate. —  Origin. — Prepared  by  mixing  Bismuth  Citrate  with  Dis- 
tilled Water  to  make  a  paste,  adding  sufficient  Ammonia  Water  to  make  a  solution,  filter- 
ing, evaporating,  and  drying  on  plates  of  glass. 

Description  and  Properties. — Small,  shining,  pearly,  or  translucent  scales,  odorless, 
with  a  slightly  acidulous  and  metallic  taste,  becoming  opaque  on  exposure  to  the  air. 
Very  soluble  in  water,  but  sparingly  soluble  in  alcohol.  The  product  should  be  kept  in 
well-stoppered  bottles,  protected  from  light. 

Dose. — l-io  grains  (0.06-0.6  Gm.). 

Bismuthi  Subcarbonas— Bismijthi  Subcarbonatis— 
Bismuth  Subcarbonate.     ?7.  8.  P. 

Origin. — Obtained  by  dissolving  purified  Bismuth  in  Nitric 
Acid  and  Water,  decanting  and  filtering,  mixing  with  Ammonia 
Water,  washing  the  precipitate  and  dissolving  in  Nitric  Acid.  The 
solution  is  then  mixed  with  a  solution  of  Sodium  Carbonate,  and 
the  resulting  precipitate  collected  and  washed. 

Description  and  Properties. — A  white  or  pale  yellowish-white 
powder,  of  somewhat  varying  chemical  composition,  odorless  and 
tasteless,  permanent  in  the  air.     Insoluble  in  water  or  alcohol,  but 


750  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

completely  soluble  in   nitric   or  hydrochloric  acid,  with  copious 
effervescence. 

Dose. — 5-20  grains  (0.3-1.2  Gm.). 

Bismuthi   Subnltras— Bismuthi  Subnitratis— Bis- 
muth Subnitrate.    U.S.  P. 

Origin. — Prepared  by  dissolving  purified  Bismuth  in  Nitric  Acid 
and  Water,  concentrating  by  evaporation,  adding  more  water,  stir- 
ring well,  and  washing  and  drying  the  precipitated  bismuth  sub- 
nitrate. 

Description  and  Properties. — A  heavy  white  powder,  of  some- 
what varying  chemical  composition,  odorless  and  almost  tasteless, 
permanent  in  the  air.  Nearly  insoluble  in  water  and  insoluble  in 
alcohol,  but  readily  soluble  in  nitric  or  hydrochloric  acid. 

Dose. — 5-20  grains  (0.3-1.2  Gm.). 

Allied  Compounds. 

Bismuthi  SaHcylas — Bismiithi  Salicylatis — Bismuth  Salicylate. — Dose,  i- 
20  grains  (0.06-1.2  Gm.). 

BismQthi  Subiodidum — Bismiithi  Subiodidi — Bismuth  Subiodide. — Used 
externally. 

Bismuth  Naphtholate. — Dose,  15-30  grains  (1.0-2.0  Gm.). 

Bismuth  Tribromphenate. — Dose,  60-75  grains  (4.0-5.0  Gm.). 

Dermatol  (Bismuth  Subgallate). — Description  and  Properties. — A  finesaffton- 
yellow  powder,  odorless,  non-hygroscopic,  unaffected  by  exposure  to  air  or  light,  insoluble 
in  water,  alcohol,  or  ether. 

Dose. — 15-30  grains  (1.0-2.0  Gm). 

Dermol  (Bismuth  Chrysophanate). — Description  and  Properties. — An  amor- 
phous yellow  powder,  neutral  in  reaction,  insoluble  in  water  or  alcohol.  Used  externally 
and  locally. 

Thioform. — A  combination  of  Bismuth,  Sulphur,  and  Salicylic  Acid. 
Description  and  Properties. — A  Ught,  grayish-yellow  powder,  odorless  and  tasteless, 
insoluble  in  water,  alcohol,  or  ether.     Used  externally  and  locally. 

Antagonists  and  Incompatibles. — The  salts  of  bismuth  are 
insoluble,  and  should  not  be  prescribed  with  other  agents  in 
solution. 

Synergists. — The  sedative  action  of  bismuth  upon  the  stomach 
may  be  increased  by  calomel  and  cerium  oxalate,  and  pepsin  may 
be  given  as  a  substitute  for  this  purpose.  The  astringency  of  the 
bismuth  salts  may  be  enhanced  by  opium  and  tannic  acid. 

Physiological  Action. — Externally. — Bismuth  salts  are  mildly 
astringent,  but  have  no  effect  upon  the  unbroken  skin. 

Internally. -^Digestive   System, — Bismuth    is   insoluble    in    the 


ASTRINGENTS.  751 

gastro-intestinal  juices.  It  coats  the  mucous  membrane,  lessening 
secretions  and  absorbing  excess  of  free  acids,  at  the  same  time  act- 
ing as  a  sedative  and  feeble  astringent.  The  tongue  and  stools  are 
tinged  a  dark  clay  color,  due  to  conversion  into  the  sulphide.  The 
soluble  salts  are  absorbed  very  slowly,  and  increase  thfe  appetite 
and  digestion,  constipation  being  the  result. 

Circulatory  System. — A  minute  quantity  passes  into  the  blood, 
acting  as  a  tonic. 

Nervous  System. — Bismuth  salts  are  sedative  to  the  peripheral 
nerve-endings. 

Absorption  and  Elimination. — The  salts  of  bismuth  are  absorbed 
into  the  circulation,  and  are  eliminated  by  the  urine,  liver,  and  feces. 

Untoward  Action. — Odier  noticed  nausea,  and  Weenesk  vomit- 
ing, colicky  pains,  diarrhea,  or  constipation,  headache,  sensation  of 
heat,  dizziness,  and  general  debility. 

Poisoning. — It  has  always  been  assumed  that  cases  of  poisoning 
are  due  to  the  lead  and  arsenic  contained  in  the  bismuth  prepara- 
tions, but  Carnot  and  Riche  found  these  metals  present  in  such 
quantities  as  to  be  practically  inert. 

The  symptoms  are  similar  to  those  of  lead-poisoning.  Large 
concretions  may  be  found  in  the  intestines,  and  sloughs  in  the 
mouth  and  gastro-intestinal  canal  may  be  present,  as  well  as 
desquamative  nephritis  and  albuminuria. 

Treatm,ent  of  Poisoning. — Lavage,  demulcents,  and  chemical  anti- 
dotes for  arsenic,  magnesium,  and  calcium ;  best  of  all,  freshly 
precipitated  hydrated  oxide  of  iron. 

Therapeutics. — Externally  and  Locally. — Bismuth  subnitrate 
is  serviceable  in  intertrigo,  erythema,  acne  rosacea,  as  a  protective 
dressing  for  wounds,  ulcer's,  and  epithelioma,  and  as  an  application 
for  chapped  nipples  and  hands,  relieving  the  smarting  and  itching. 
It  is   also  of  use  in  fissure,  prolapsus  ani,  and  superficial  burns. 

It  is  used  as  an  injection  in  gonorrhea,  leucorrhea,  and  ozena, 
and  was  formerly  used  as  an  insufflation  in  acute  nasal  catarrh, 
■  being  abandoned  because  of  the  arsenic  which  it  sometimes  con- 
tains. „.It  serves  as  a  wash  in  aphthous  stomatitis,  mild  cases  of 
mercurial  salivation,  and  cancrum  oris,  as  well  as  for  the  fetid 
sweating  of  feet  and  other  parts,  and  for  chancres  and  phlegmonous 
erysipelas.  It  has  also  proved  beneficial  in  chronic  conjunctivitis 
and  granular  lids  or  trachoma. 

Internally. — It  allays  irritation,  and  is  consequently  useful  in 
irritative  vomiting  and  diarrhea.     Gastric  pain  is  relieved  by  it. 


753  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

It  is  valuable  in  pyrosis,  chronic  diarrhea,  gastric  ulcer,  chronic 
dysentery,  diarrhea  of  typhoid,  early  stages  of  cholera  and  cholera 
infantum,  and  in  the  gastritis  due  to  alcohol. 

The  CITRATE  OF  BISMUTH  AND  AMMONIUM  is  very  solublc,  and 
should  be  used  only  for  local  applications. 

The  OXIDE  is  insoluble,  and  combined  with  morphine  has  been 
used  as  a  snuff  in  ozena  and  nasal  catarrh. 

SuBCARBONATE  OF  BISMUTH  is  not  used  in  medicine. 

Salicylate  of  bismuth  reduces  the  pulse  and  temperature  in 
typhoid  fever,  and  also  corrects  the  fetid  stools. 

Bismuth  subgallate,  or  dermatol,  was  first  used  by  Heintz 
and  Liebrecht,  being  intended  as  a  substitute  for  iodoform ;  but  it 
is  very  astringent,  although  not  irritating.  The  preparation  is  used 
in  weeping  eczema,  otitis  media,  herpes,  wounds,  burns,  diarrhea,  and 
dysentery.  In  stagnant  ulcers  it  is  of  no  service,  since  they  need 
stimulation. 

Bismuth  citrate  is  insoluble,  and  is  of  no  service  medicinally. 

Besides  the  foregoing  preparations  there  is  a  tannate  of  bis- 
muth, used  to  some  extent  in  diarrhea,  gonorrhea,  leucorrhea,  and 
ophthalmia. 

Phosphate  of  bismuth  is  the  least  soluble  of  all  the  bismuth 
compounds,  a:nd  is  used,  but  rarely,  in  diarrhea,  dysentery,  gastral- 
gia,  and  dyspepsia. 

Subiodide  of  bismuth  is  used  as  a  substitute  for  the  subnitrate, 
and  is  of  special  value  in  chronic  ulcers.  It  is  supposed  to  be 
slightly  anesthetic. 

Valerianate  of  bismuth  is  of  no  medicinal  value. 

Subbenzoate  of  bismuth  is  mildly  escharotic. 

Administration. — The  drug  is  used  externally  as  a  powder  or 
ointment  in  combination  with  naphthalin  or  vaseline,  to  which  a 
little  morphine  may  be  added.  Belladonna,  opium,  and  oleate  of 
bismuth  are  also  used. 

For  gastralgia  and  dyspepsia,  pepsin  or  magnesium  and  calcium 
phosphate  may  be  combined  with  bismuth.  If  a  cathartic  is  desir- 
able, rhubarb  may  be  added. 

Bismuth,  aromatic  powder,  and  carbonas  liqui  make  an  excel- 
lent combination  in  flatulent  dyspepsia. 

In  infantile  diarrhea  and  summer  complaint  bismuth  i  grain 
(.06  Gm.),  syrupus  aurantii  15  minims  (.92  Cc),  and  calumba  15 
minims  (.92  Cc.)  are  efficacious,  particularly  as  they  allay  the 
alternating  pain. 


ASTRINGENTS.  753 

Bismuth,  5-15  grains  (.32-1.0  Gm.),  is  given  for  stomach  affec- 
tions, and  15  grains  (i.o  Gm.)  to  i  drachm  (4.0  Gm.)  for  intestinal 
disorders,  one  to  two  hours  after  meals  as  the  stomach  is  emptied. 

Cerii  Oxalas— Cerii  Oxalatis— Cerium^Oxalate. 

17.  S.  P. 

(Cerous  Oxalate.) 

Origin. — Prepared  by  a  complicated  process  by  the  action  of 
acids,  etc.  upon  the  powdered  mineral. 

Description  and  Properties. — A  white,  granular  powder,  with- 
out odor  or  taste,  and  permanent  in  the  air.  Insoluble  in  water, 
alcohol,  or  ether. 

Dose. — 1-8  grains  (0.06-0.5  Gm.). 

Physiological  Action. — The  physiological  action  of  this  drug 
is  imperfectly  understood  :  it  is  supposed  to  be  a  nervous  sedative. 

Therapeutics. — Internally. — Its  widest  application  is  in  the  vom- 
iting of  pregnancy,  but  it  also  controls  the  emesis  of  uterine  disease 
and  of  dyspepsia,  due  to  gastric  acidity  or  deranged  innervation  of 
the  stomachj  as  in  sea-sickness. 

It  does  not  derange  digestion,  and  is  therefore  of  value  in 
checking  the  cough  of  phthisis  and  bronchitis,  especially  when 
accompanied  by  vomiting. 

Simpson  regarded  it  as  almost  a  specific  in  chorea.  In  combi- 
nation with  bismuth  it  is  useful  in  checking  diarrhea. 

Administration. — Cerium  oxalate  is  usually  administered  in  pill 
form,  1-3  grains  (.06-.20  Gm.)  three  times  daily,  but  the  powder 
is  used  when  the  drug  is  associated  with  other  remedies. 

48 


TOPICAL  REMEDIES. 

GROUP   XVIIL— CAUSTICS   OR   ESCHAROTICS. 

Caustics  are  medicines  which  destroy  the  tissues  to  which  they 
are  appHed.  They  excite  inflammation  and  vascular  dilatation  of 
the  surrounding  area.  The  eschar  produced  by  these  drugs  is 
separated  from  the  living  tissues  by  the  inflammation  and  suppura- 
tion produced. 

When  a  drug  acts  as  a  caustic — that  is,  when  it  destroys  a  cir- 
cumscribed portion  of  living  tissue — it  penetrates  deeper  in  pro- 
portion as  the  product  of  its  action  (?'.  e.  the  eschar)  is  looser,  and 
is  shallower  in  proportion  as  the  eschar  is  firmer  or  more  com- 
pact. This  is  the  essential  difference  between  Astringents  and 
Caustics ;  the  former  contract  the  tissues,  causing  the  protoplasm 
to  be  firmer  and  occupy  less  space ;  the  latter  cause  th.e  protoplasm 
to  be  softer  and  occupy  more  space.  It  will  be  seen,  therefore, 
that  the  more  caustic  a  drug  is,  the  less  astringent  it  is,  and  vice 
versd. 

The  caustic  action  of  a  drug  depends  upon  whether  the  drug 
and  its  products  are  both  soluble  in  water ;  for  if  the  medicine  is 
not  soluble  in  water,  it  cannot  have  a  caustic  action,  and  if  the 
products  of  the  caustic  action  are  not  soluble  in  water,  the  eschar 
will  be  firm,  the  drug  acting  more  as  an  astringent  than  as  a 
caustic. 

For  example,  the  chlorides  of  the  heavy  metals,  such  as  mer- 
curic chloride,  zinc  chloride,  etc.,  are  usually  freely  soluble  in 
water,  and  are,  as  a  rule,  the  most  caustic  of  the  metallic  salts. 
Should  a  metallic  chloride  be  insoluble  in  water,  it  will  have  no 
caustic  action — e.g.  silver  chloride. 

If  the  heavy  metals  be  arranged  in  a  series,  placing  at  one  end 
the  most  astringent  salts,  and  at  the  other  the  least  astringent,  it 
will  be  noticed  that  those  salts  which  are  the  least  astringent  are 
the  most  caustic,  becoming  less  and  less  caustic  as  they  are  more 
and  more  astringent. 

Most  Astringent.  Least  Astringent. 

Lead,  Iron,  Zinc,  Copper,  Silver,  Tin,  Mercury. 

Least  Caustic.  Mg^t  CausHc. 

754 


CAUSTICS  OR  ESCHAROTICS.  755 

Caustics  act — 

1.  By  abstracting  the  water  of  the  tissues ; 

2.  By  combining  with  the  albumin  of  the  tissues ; 

3.  By  corrosive  oxidation. 

The  important  caustics,  arranged  according  to  their  mode  of 
action,  are  enumerated  below. 

Caustics  which  act  by  abstracting  the  water  from  the  tissues  : 
Arsenious  Acid,  Potassa  and  Lime, 

Antimony  Chloride,  Caustic  Soda, 

Carbolic  Acid,  Glacial  Acetic  Acid, 

Chromic  Acid,  Lime, 

Caustic  Potash,  Mineral  Acids. 

Caustics  which  act  by  combining  with  the  albumin  of  the  part  : 
Alum  (burnt).  Mercuric  Oxide, 

Copper  Sulphate,  Silver  Nitrate, 

Mercuric  Chloride,  Zinc  Chloride, 

Mercuric  Nitrate,  Zinc  Sulphate. 

Caustic  which  acts  by  corrosive  oxidation  : 
Bromine. 

Caustics  are  employed — 

1.  To  destroy  excrescences  on  the  skin  or  mucous  membranes, 
and  to  effect  the  destruction  or  removal  of  malignant  growths,  as 
in  cases  of  warts,  condylomata,  polypi,  hipus,  epithelioma,  etc. ; 

2.  To  open  abscesses,  or  to  maintain  a  chronic  irritation,  or  to 
stimulate  indolent  sinuses,  ulcers,  etc. ; 

3.  To  destroy  and  prevent  the  absorption  of  the  virus  from  the 
bites  of  rabid  and  venomous  animals,  and  for  the  destruction  of 
chancres  and  malignant  pustules. 

Those  escharotics  which  have  not  been  discussed  elsewhere 
will  now  be  considered  in  detail : 

Liquor  Antimonii  Chl5ricli— Liquoris  Antimonii 
Chloridi— Solution  of  Antimony  Chloride.  (Unofficial.) 

(Butter  of  Antimony.) 

Origin. — Prepared  by  the  action  of  Hydrochloric  Acid  upon 
Purified  Black  Antimony. 

Description  and  Properties. — A  yellowish  or  yellowish-red 
liquid,  having  the  specific  gravity  1.47,  and  yielding  with  water  a 
white  precipitate  of  antimonious  oxychloride  {powder  of  Algaroth). 

Used  externally  as  a  caustic. 


756  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Physiological  Action  and  Therapeutics. — Solution  of  anti- 
mony CHLORIDE  is  one  of  the  most  powerful  caustics  employed  m 
surgery.  It  is  a  violent  corrosive  poison,  toxic  doses  producmg 
complete  general  collapse,  corroding  and  charring  any  living  tissue 
with  which  it  comes  in  contact.  The  treatment  of  poisoning  by 
butter  of  antimony  would  be— chalk,  magnesia,  demulcent  drinks, 
tannic  acid,  anodynes,  and  stimulants  if  necessary. 

Solution  of  chloride  of  antimony  may  be  used  as  a  caustic 
for  the  bites  of  rabid  animals  and  venomous  reptiles,  chancres,  con- 
dylomata, malignant  pustules,  etc. 

The  preparation  should  be  cautiously  applied  with  a  camel's- 
hair  pencil. 

Acidum  Chromicum— Acidi  Chromici— Chromic 
Acid.    V.8.P. 

(Chromic  Trioxide;  Chromic  Anhydride.) 

Origin. — Dissolve  Potassium  Bichromate  in  Sulphuric  Acid 
and  Water;  decant,  heat  with  more  Sulphuric  Acid;  cool,  and 
crystallize. 

Description  and  Properties. — Small,  needle-shaped  crystals 
or  rhombic  prisms,  of  a  dark  purplish-red  color  and  metallic 
luster;  odorless;  destructive  of  animal  and  vegetable  tissues; 
deliquescent  in  moist  air.  Very  soluble  in  water,  forming  an 
orange-red  solution.  When  brought  in  contact  with  alcohol, 
ether,  glycerin,  and  other  organic  solvents  decomposition  takes 
place,  sometimes  with  dangerous  violence.  Chromic  acid  should 
be  kept  in  glass-stoppered  bottles,  and  great  caution  should  be 
observed  to  avoid  bringing  it  in  contact  with  organic  substances, 
such  as  cork,  tannic  acid,  sugar,  alcohol,  etc.,  as  dangerous  acci- 
dents are  liable  to  result.     Used  externally. 

Physiological  Action  and  Therapeutics. — Chromic  acid  is 
a  powerful  caustic,  deodorant,  and  disinfectant.  It  coagulates 
albumin  and  oxidizes  organic  matter.  Its  action  is  slow,  and  the 
pain  following  its  application  is  usually  of  shorter  duration  than 
that  of  most  caustics.  Weak  solutions  are  stimulant,  astringent, 
and  alterative. 

Chromic  acid  is  used  in  the  form  of  a  paste  or  in  solutions  of 
various  strengths  for  the  removal  of  syphilitic  warts,  vegetations, 
condylomata,  etc.  As  a  caustic  and  stimulant  application  in  many 
diseases  of  ear,  nose,  and  throat  it  serves  a  valuable  purpose,  as  in 
nasal  polypi,  enlarged  tonsils,  chronic  and  syphilitic  laryngitis,  laryn- 


CAUSTICS  OR  ESCHAROTICS.  757 

geal  papillovtata,  chronic  superficial  glossitis,  tuberculosis  of  the 
tongue,  ozena,  ulcerations  of  the  mouth,  etc. 

A  lo  per  cent,  solution  of  chromic  acid  has  been  found  service- 
able in  the  treatment  of  hyperidrosis. 

A  solution  of  i  part  of  chromic  acid  in  40  parts  of  water  makes 
an  efficient  lotion  for  disinfecting  foul  ulcers  and  as  an  injection  in 
gonorrhea,  leucorrhea,  etc. 

Sessile  piles  and  salivary  fistulce  are  efficiently  treated  by  touch- 
ing the  parts  with  pure  chromic  acid. 

Potassa— Potassae—Potassa.    JJ.  S,  JP. 

(Potassium  Hydrate;  Potassium  Hydroxide;  Caustic  Potash.) 

Origin. — Prepared  by  evaporating  Liquor  Potassae,  fusing  the 
residue,  and  pouring  into  clean  cylindrical  moulds  which  have  been 
previously  warmed. 

Description  and  Properties. — Dry,  white,  translucent  pencils, 
or  fused  masses,  hard  and  brittle,  showing  a  crystalline  fracture ; 
odorless  or  having  a  faint  odor  of  lye,  and  of  a  very  acrid  and 
caustic  taste.  Because  of  its  active  effect  upon  organic  tissues  it 
should  be  tasted  and  handled  with  exceeding  care.  Exposed  to 
the  air,  it  rapidly  absorbs  carbon  dioxide  and  moisture,  and 
deliquesces.  Soluble  in  about  0.5  part  of  water  and  in  2  parts 
of  alcohol.  Potassa  should  be  kept  in  well-stoppered  bottles 
made  of  hard  glass.     Used  externally. 

Potassa  cum  Calce— Potassae  cum  Calce— Potassa 
with  Lime.    U.S.I'. 

(Vienna  Caustic  or  Vienna  Paste.) 

Origin. — Prepared  by  rubbing  together  equal  parts  of  Potassa 
and  Lime  in  a  warm  iron  mortar. 

Description  and  Properties. — ^A  grayish-white  powder,  deli- 
quescent, having  a  strongly  alkaline  reaction.     Used  externally. 

Soda— Sodse— Soda.    U.  S.  JP. 

(Sodium  Hydrate;  Sodium  Hydroxide;  Caustic  Soda.) 

Origin. — Prepared  from  a  solution  of  Soda  in  the  same  manner 
as  described  under  Potassa. 

Description  and  Properties. — Dry,  white,  translucent  pencils 
or  fused  masses,  showing  a  crystalline  fracture,  odorless,  and 
having  an  acrid  and  caustic  taste.     Great  caution  is  necessary  in 


758  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

tasting  and  handling  it,  as  it  rapidly  destroys  organic  tissues. 
Exposed  to  the  air,  it  rapidly  deliquesces,  absorbs  carbon  dioxide, 
and  becomes  covered  with  a  dry  coating  of  carbonate.  Soluble  in 
1.7  parts  of  water,  very  soluble  in  alcohol.  Soda  should  be  kept 
in  well-stoppered  bottles  made  of  hard  glass.     Used  externally. 

Physiological  Action  and  Therapeutics.— Potassa  is  one  of 
the  strongest  and  most  penetrating,  caustics  known.  It  possesses 
the  property  of  abstracting  water  from  the  tissues,  neutraUzing  free 
acids,  decomposing  nitrogenous  compounds,  and  of  forming  solu- 
tions of  fibrin,  albumin,  and  gelatin. 

When  applied  to  the  soft  tissues  it  occasions  severe  pain,  and 
produces  a  moist,  ashen,  and  then  black,  leathery  slough,  which 
leaves  a  granulating  ulcer  behind  it. 

When  potassa  is  taken  internally  in  immoderate  doses  it  pro- 
duces all  the  symptoms  of  corrosive  poisoning.  Small  doses,  freely 
diluted,  have  the  same  action  as  the  alkalies. 

As  a  caustic,  potassa  is  used  for  the  same  purposes  as  the  caus- 
tics previously  described. 

Potassa  with  lime  in  its  operation  is  similar  to,  but  milder 
than,  potassa. 

The  action  and  therapeutics  of  soda  are  identical  with  those  of 
potassa,  save  that  soda  is  less  depressing  to  the  heart,  muscular 
and  nervous  systems.  It  is  not  used  so  much  as  potassa,  the 
latter  preparation  usually  being  preferred  as  a  caustic. 

To  limit  the  caustic  action  of  these  drugs  a  piece  of  adhesive 
plaster  should  be  applied  first,  with  an  aperture  of  the  size  desired. 
Upon  the  skin  exposed  in  the  hole  in  the  plaster  the  caustic  is 
placed,  the  skin  having  been  previously  moistened.  The  caustic 
action  may  be  arrested  at  any  time  by  wetting  the  part  with  vinegar. 

Acidum  Aceticum  Glaciale— Acidi  Acetici  Glacialis 
—Glacial  Acetic  Acid.    JJ.  S.  JP. 

Origin. — Prepared  by  distilling  dry  Sodium  Acetate  with  strong 
Sulphuric  Acid. 

Description  and  Properties. — A  clear,  colorless  liquid,  of  a 
strong,  vinegar-like  odor,  and  a  very  pungent,  purely  acid  taste. 
Its  specific  gravity  at  15°  C.  (59°  F.)  should  not  be  higher  than 
1.058,  corresponding  to  at  least  99  per  cent,  of  absolute  acid. 
Used  externally. 

Physiological  Action  and  Therapeutics. — Glacial  acetic  acid  is 
a  powerful  corrosive  poison,  having  an  action  similar  to  that  of  the 


CAUSTICS  OR  ESCHAROTICS.  759 

mineral  acids.     The  drug  is  principally  used  as  a  caustic  for  the 
removal  of  warts  and  corns,  and  occasionally  for  blistering  the  skin. 

Caix— Calcis— Lime.    TJ.S.P. 

Origin. — Obtained  by  burning  White  Marble,  Oyster  Shells,  or 
the  purest  varieties  of  natural  Calcium  Carbonate. 

Description  and  Properties. — Hard,  white  or  grayish-white 
masses,  which,  in  contact  with  air,  gradually  attract  moisture  and 
carbon  dioxide,  and  fall  to  a  white  powder ;  odorless ;  of  a  sharp, 
caustic  taste.  Soluble  in  about  750  parts  of  water;  insoluble  in 
alcohol.     Used  externally. 

Physiological  Action  and  Therapeutics. — Quicklime  when 
used  undiluted  is  caustic,  producing  effects  similar  to  those  de- 
scribed under  Potassa. 

For  caustic  purposes  it  is  usually  mixed  with  potassa  (potassa 
cum  calce).  When  lime  is  given  in  diluted  solution,  it  acts  as  an 
astringent  and  antacid.     (See  Liquor  Calcis,  p.  155.) 

The  conditions  for  which  lime  is  employed  as  a  caustic  are  men- 
tioned under  Potassa. 

ZTnci  Chl5ridum— ZTnci  Chloridi— Zinc  Chloride. 

TI.  S.  P. 

Origin. — Prepared  by  dissolving  Zinc  in  boiling  Hydrochloric 
Acid.  To  the  solution  is  added  first  Nitric  Acid,  then  Zinc  Car- 
bonate to  precipitate  the  impurities.     Filter  and  finally  evaporate. 

Description  and  Properties. — A  white,  granular  powder  or 
porcelain-like  masses,  irregular  or  moulded  into  pencils ;  odorless ; 
of  such  intensely  caustic  properties  as  to  make  tasting  dangerous, 
unless  the  salt  be  dissolved  in  much  water,  when  it  has  an  astrin- 
gent, metalHc  taste.  Very  deliquescent ;  soluble  in  about  0.3  part 
of  water,  forming  a  clear  solution  ;  very  soluble  in  alcohol.  Zinc 
chloride  should  be  kept  in  small,  glass-stoppered  bottles. 

Used  externally. 

Physiological  Action  and  Therapeutics. — Zinc  chloride  is 
caustic,  antiseptic,  disinfectant,  excitant,  astringent,  and  slightly 
hemostatic,  according  to  the  strength  of  the  preparation.  Its  caus- 
tic action  is  painful,  yet,  while  the  drug  penetrates  very  deeply, 
limited  to  the  seat  of  application. 

Poisoning  by  zinc  chloride  is  evidenced  by  all  the  symptoms 
produced  by  a  violent  corrosive  irritant  poison. 


760  A    TEXT-BOOK  OF  MA  TERIA   MEDIC  A. 

The  drug  formerly  enjoyed  quite  a  reputation  as  a  remedy  tor 
cancer,  especially  epithelioma,  in  which  case  it  was  used  m  the 
form  of  "  caustic  arrows  "  inserted  in  the  base  of  the  growth  so  as 
to  separate  it  from  the  healthy  tissues. 

It  is  used  as  a  paste  and  lotion  for  morbid  growths,  lupus 
exedens,  putrid  ulcers,  ncevi,  and  syphilitic  sores. 

Solutions  of  zinc  chloride  are  injected  into  polypi  and  scrofu- 
lous glands,  and  for  the  destruction  of  the  pulp  of  decayed  teeth. 

A  weak  solution  of  zinc  chloride  is  an  efficient  injection  in 
gonorrhea,  leucorrhea,  and  hemorrhagic  endometritis. 

For  caustic  purposes  the  zinc  chloride  itself  may  be  used,  or 
a  paste  prepared  with  starch,  gypsum,  flour,  anhydrous  sulphate 
of  lime,  or  powdered  althea.  Mayet's  paste  consists  of  zinc  chlo- 
ride 8  parts,  zinc  oxide  i  part,  dried  wheat  flour  7  parts,  and  water 
I  part.  The  cuticle  must  always  be  removed  before  applying 
the  paste,  strong  water  of  ammonia  answering  for  this  purpose. 

Bromum—Bromi— Bromine.     TI.S.F. 

Origin. — It  is  found  both  in  sea-water  and  in  saline  springs,  but 
is  chiefly  obtained  from  the  mother-liquors  of  salt-works  in  the 
United  States  and  at  Strassfurth,  Germany. 

Description  and  Properties. — A  heavy,  dark  brownish-red, 
mobile  liquid,  evolving,  even  at  ordinary  temperatures,  a  yellowish- 
red  vapor,  highly  irritating  to  the  eyes  and  lungs,  and  having  a 
peculiar  suffocating  odor,  resembling  that  of  chlorine.  Soluble  in 
30  parts  of  water  and  readily  soluble  in  alcohol  or  ether.  Bromine 
should  be  kept  in  glass-stoppered  bottles,  in  a  cool  place. 

Used  externally. 

Physiological  Action  and  Therapeutics. — Bromine  is  a  power- 
ful corrosive  irritant,  the  fumes  of  which  occasion  severe  irritation 
of  the  eyes  and  respiratory  passages,  with  cough,  hoarseness,  and 
dyspnea.  When  taken  into  the  stomach  it  produces  all  the  symp- 
toms of  corrosive  poisoning. 

The  drug  is  an  active  caustic,  deodorant,  and  disinfectant.  It 
was  formerly  extensively  employed,  particularly  during  the  Civil 
War  of  the  United  States,  for  the  treatment  of  hospital  gangrene, 
for  which  it  is  a  most  efficient  remedy.  Bromine  has  also  been  used 
as  an  injection  (i  part  to  3  of  alcohol)  in  various  forms  of  cancer. 
Owing  to  the  pain  attending  the  operation,  however,  the  treatment 
has  not  been  generally  adopted. 

Bromine  is  an  efficient  disinfectant,  and  has  been  employed  to 


VESICANTS  AND  EPISPASTICS.  761 

<lisinfect  and  deodorize  the  atmosphere  of  hospitals,  etc.  Berlin 
sanitary  officials  declare  that  "  3^  ounces  of  bromine  can  disinfect 
a  space  of  918  cubic  feet,  and  deodorize  a  space  of  70CX)  cubic  feet." 


GROUP   XIX.— VESICANTS   AND   EPISPASTICS. 

These  are  drugs  which  excite  more  or  less  local  inflammation 
when  applied  to  the  skin ;  the  inflammatory  condition  is  accom- 
panied by  an  effusion  of  serum  between  the  epidermis  and  dermis — 
i.  e.  a  blister. 

The  principal  Vesicants  are — 

Acetic  Acid  (glacial),  Mezereon, 

Ammonia  (the  confined  vapor).  Mustard  (volatile  oil), 

Cantharides,  Rhus  Toxicodendron. 
Iodine, 

There  are  certain  drugs  which  affect  certain  parts  of  the  skin — 
for  instance,  the  orifices  of  the  sudoriferous  glands — in  a  special 
manner,  and  their  action  on  these  parts  is  such  as  to  give  rise  to  » 
pustules  rather,  than  blisters.  Drugs  which  affect  the  skin  in  this 
manner  are  called  Pustulants.  The  following-named  drugs  are 
the  most  important  of  them : 

Croton  Oil,  Silver  Nitrate, 

Tartar  Emetic,  Ipecac. 

Therapeutics. — Vesicants  are  employed  as  local  stimulants  in 
chronic  ulcers  and  to  facilitate  the  absorption  of  effusions,  as  in 
chronic  synovitis  or  chronic  thickening  about  the  joints. 

Blisters  are  also  of  use  in  endocarditis,  neuralgias,  sciatica,  chronic 
pericarditis,  pleurisy,  hysterical  paralysis,  and  aphonia,  cerebral  or 
spinal  meningitis,  etc. 

Pustulants  are  more  particularly  employed  to  maintain  a  con- 
tinuous though  moderate  irritation  in  chronic  inflammations.  They 
are  used  for  the  same  class  of  cases  as  vesicants,  but  are  preferable 
"when  it  is  desirable  to  prolong  the  local  irritation  without  exciting 
too  much  inflammation. 

Contraindications. — Vesicants  are  usually  contraindicated  in 
acute  inflammations  and  in  inflammation  of  the  cutaneous  tissues, 
as  rubeola  and  scarlatina.  Vesicants  are  not  permissible  in  preg- 
nancy, debility,  scorbutus,  and  purpura,  or  in  extreme  infancy  and 
old  age.     They  should  not  be  applied  over  the  scrotum  or  the 


762  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

mammary  glands,  nor  over  bony  prominences  where  the  heahng" 
processes  are  apt  to  be  retarded. 

All  the  vesicants  and  pustulants  have,  with  two  exceptions,  been 
discussed  elsewhere. 

Cantharis— Cantharidis— Cantharides.    V.  8.  P. 

(Spanish  Flies.) 

Origin. — Cantharis  vesicatoria  De  Geer,  a  beetle  indigenous  to 
Southern  and  Central  Europe,  and  found  eastward  as  far  as  West- 
ern Asia. 

Description  and  Properties. — About  i  inch  (25  Mm.)  long  and 
\  inch  (6  Mm.)  broad ;  flattish-cylindrical,  with  filiform  antennae, 
black  in  the  upper  part,  and  with  long  wing-cases  and  ample, 
membranous,  transparent,  brownish  wings,  elsewhere  of  a  shining, 
coppery-green  color.  The  powder  is  grayish-brown,  and  contains 
green  shining  particles.  Odor  strong  and  disagreeable ;  taste  slight, 
afterward  acrid. 

Cantharides  contains  a  fatty  crystallizable  body,  cantharidin, 
which  is  the  active  principle,  a  volatile  oil  also  possessing  vesica- 
tory properties,  and  a  green  oil  closely  allied  to  chlorophyl. 

Used  externally. 

Official  Preparations. 

Ceratum  Cantharidis— Cerati  Cantharidis— Cantharides  Cerate.— Cantha- 
rides, 320;  Yellow  Wax,  i8o;  Resin,  i8o;  Lard,  220;  Oil  of  Turpentine,  150.— Used 
externally. 

Collodium  Cantharidatum— Collodii  Cantharidati — Cantharidal  Collodion 
(Blistering  Collodion). — Used  externally. 

Tinctura  Cantharidis— TinctiirK  Cantharidis— Tincture  of  Cantharides.— 
Dose,  1-15  minims  (o.o5-i.o  Cc). 

The  Cantharides'  Cerate  is  an  ingredient  of  Emplastrum  Picis  Cantharidatum. 

Antagonists  and  Incompatibles. — There  are  no  known  physi- 
ological antagonists  or  incompatibles. 

Synergists.— Members  of  this  group  enhance  the  vesicating 
action  of  cantharides.  Its  aphrodisiac  action  is  aided  by  phos- 
phorus and  strychnine. 

Physiological  Action. — Externally  and  Zc?ca//j/.— Cantharides 
is  a  slow  though  very  powerful  irritant.  When  the  drug  is  applied 
to  the  skin  or  mucous  membrane  it  excites  a  tingling,  burning  pain, 
with  marked  redness  of  the  cuticle.  In  the  course  of  three  or  four 
hours  after  the  application  of  cantharides  there  are  formed  numer- 


VESICANTS  AND  EPISPASTICS.  763 

ous  vesicles  which  soon  coalesce,  forming  one  large  bleb  full  of 
clear  serum. 

The  drug  not  only  causes  vascular  dilatation  of  the  part  to 
which  it  is  applied,  but  reflexly  dilates  the  blood-vessels  of  the 
deep-seated  organs  underneath,  thus  acting  as  a  counter-irritant. 

The  active  principle  of  cantharides  may  be  absorbed  through 
the  skin,  producing  its  constitutional  effects. 

Internally. — Digestive  System. — Moderate  doses  of  cantharides 
produce  a  sensation  of  heat  in  the  stomach,  and  may  even  occasion 
gastrodynia.  Large  amounts  occasion  severe  gastro-intestinal  irri- 
tation. There  is  a  sense  of  constriction  in  the  esophagus,  a  burning 
heat  in  the  throat,  ptyalism,  intense  gastric  pain,  nausea,  and  vomit- 
ing of  glairy  mucus  often  containing  blood.  There  is  great  tender- 
ness over  the  abdomen,  fibrinous  and  sometimes  bloody  stools, 
attended  by  griping  pain  and  tenesmus. 

Circulatory  System. — Full  medicinal  doses  excite  the  heart, 
increasing  the  force  and  rapidity  of  its  action,  and  elevate  arterial 
tension.  Under  large  doses  the  pulse  and  arterial  pressure  fall, 
and  there  is  great  depression  of  the  entire  circulatory  system. 

Nervous  System. — Small  doses  have  no  influence  on  the  nervous 
system  other  than  would  be  produced  by  stimulation  of  the 
circulation.  Excessive  amounts  have  produced  marked  cerebral 
effects,  consisting  of  partial  or  general  convulsions,  coma,  and 
insensibility. 

Respiratory  System. — No  effect  follows  medicinal  doses ;  toxic 
amounts  accelerate  and  weaken  the  respiration. 

Absorption  and  Elimination. — The  active  principle  of  cantharides 
is  rapidly  absorbed' into  the  blood,  and  in  large  doses  produces 
marked  irritation  of  the  genito-urinary  organs.  There  is  at  first 
increase  of  urine,  which  is  soon  greatly  diminished  in  amount,  and 
which  may  be  albuminous  or  bloody.  There  is  strangury  and  fre- 
quent desire  to  micturate,  and  severe  pain  in  the  loins  and  bladder. 
The  local  irritation  is  apt  to  occasion  priapism,  with  frequently 
erotic  excitement  and  seminal  emissions.  There  may  also  be 
swelling  and  inflammation  of  the  external  genitals.  In  women 
cantharides  may  also  occasion  .increased  sexual  desire,  cause  abor- 
tion, or  induce  menstruation.  Yet  amatory  desire  does  not  always 
follow  the  ingestion  of  cantharides,  even  in  large  doses.  Indeed, 
the  aphrodisiac  effect  of  the  drug  is  usually  more  manifest  under 
small  or  full  medicinal  doses  than  from  the  ingestion  of  immoderate 
amounts.     The  drug  is  principally  eliminated  by  the  kidneys. 


764  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

Temperature. — The  temperature  is  at  first  elevated  by  excessive 
amounts,  but  declines  together  with  the  depression  of  the  circu- 
latory system. 

Uterus. — The  uterus  and  female  genital  organs  are  stimulated  by 
the  drug,  as  has  been  previously  described. 

Untoward  Action. — The  untoward  manifestations  do  not  differ 
from  the  symptoms  produced  by  excessive  amounts,  as  described 
under  the  different  systems.  These  various  untoward  effects  vary 
in  intensity  according  to  the  individuality  of  the  patient. 

Poisoning. — Toxic  amounts  of  cantharides  produce  violent  gastro- 
intestinal and  genito-urinary  inflammation.  The  general  symptoms 
are  great  pain  in  the  throat,  stomach,  and  bowels,  excessive  thirst, 
vomiting  of  bloody  mucus,  frequent  stools  which  may  contain  blood, 
burnihg  pain  in  the  kidneys,  strangury,  scanty,  albuminous,  and 
bloody  urine,  painful  erections  of  the  penis,  seminal  emissions,  swell- 
ing and  inflammation  of  the  external  genitals,  a  rapid,  small,  and 
weak  pulse,  accelerated  respiration,  skin  hot  and  dry,  congestion  of 
the  face,  pain  in  the  head,  delirium,  trembling,  partial  or  general 
convulsions,  and  coma.  The  post-mortem  appearances  are  swell- 
ing, ecchymoses,  and  sometimes  gangrene  of  the  mucous  mem- 
brane of  the  alimentary  canal.  The  kidneys  are  enlarged  and 
engorged,  and  are  in  a  condition  of  parenchymatous  and  desquam- 
ative nephritis. 

Treatment  of  Poisoning. — The  stomach  should  be  emptied,  and 
demulcents,  stimulants,  and  opiates  given  as  necessary.  Oils  and 
fats  should  be  avoided,  as  they  increase  the  solubility  and  favor  the 
absorption  of  cantharidin. 

Therapeutics. — Externally  and  Locally. — A  cantharidal  blis- 
ter is  frequently  of  service  as  a  revulsive  when  there  is  a  local  tend- 
ency to  congestion.  The  drug  is  applied  to  the  chest  in  the  second 
stage  of  pneumonia  and  in  pleurisy,  and  "  flying "  blisters  are 
beneficial  in  hydrothorax  and  chronic  pleurisy. 

The  cure  of  boils  and  carbuncles  has  been  hastened  by  applying 
a  cantharidal  blister  to  the  indurated  spot. 

The  drug  is  also  of  service  to  stimulate  indolent  ulcers,  fistultz, 
etc. 

A  blister  over  the  region  of  the  heart  will  often  afford  marked 
relief  in  pericarditis. 

A  CANTHARIDAL  PLASTER  applied  over  the  course  of  the  affected 
nerve  frequently  affords  great  relief  from  pain  in  neuralgia  and 
some  forms  of  sciatica. 


VESICANTS  AND  EPISPASTICS.  765 

In  certain  diseases  of  the  brain  and  spinal  cord  blisters  applied 
to  the  nape  of  the  neck  or  along  the  course  of  the  cord,  a  little  to 
one  side  of  the  vertebrae,  will  often  favorably  influence  the  course 
of  the  disease. 

Blisters  are  frequently  of  service  in  synovitis  and  periostitis  of 
the  larger  bones.  A  blister  applied  to  the  epigastrium  will  some- 
times allay  gastric  pain  and  obstinate  vomiting. 

Blistering  over  the  region  of  the  ovary  is  an  efficient  means  of 
relieving  the  symptoms  of  chronic  ovaritis,  and  a  blister  applied  to 
the-  mastoid  region  will  frequently  be  of  benefit  in  otitis  media. 

Small  patches  of  tinea  tonsurans  and  of  tinea  circinata  may  be 
removed  by  blistering. 

Liniments  and  lotions  containing  tincture  of  cantharides  are 
among  the  best  means  of  curing  alopecia. 

The  National  Dispensatory  aptly  gives  the  general  uses  for 
cantharides  in  the  form  of  blisters  as  follows :  "  i,  to  stimulate 
the  whole  or  a  particular  part  of  the  system;  2,  to  promote  the 
absorption  or  prevent  the  accumulation  of  inflammatory  exuda- 
tions ;  3,  to  recall  suppressed  discharges ;  4,  to  act  as  a  depletory ; 
5,  to  promote  the  cure  of  internal  diseases  by  counter-irritation  of 
the  skin." 

Internally. — Certain  diseases  of  the  genito-urinary  organs,  as 
debility  of  the  bladder  with  accompanying  incontinence  of  urine, 
chronic  pyelitis,  chronic  catarrh  of  the  bladder,  etc.,  are  benefited 
by  small  doses  of  tincture  of  cantharides. 

Small  doses  of  this  preparation  are  sometimes  serviceable  in  the 
treatment  of  acute  desquamative  nephritis.  Diabetes  insipidus  has 
been  arrested  by  the  internal  administration  of  cantharides. 

Gleet,  prostaiorrhea,  and  spermatorrhea  are  benefited  by  this 
drug.  Menorrhagia  and  am.enorrhea  occurring  in  debilitated  women 
will  often  be  benefited  by  cantharides. 

Tincture  of  cantharides,  with  tincture  of  iron,  tincture  of  nux 
vomica,  and  phosphoric  acid,  is  an  efficient  combination  in  impo- 
tence, the  result  of  old  age,  sexual  excesses,  or  masturbation. 

In  scaly  skiri  diseases  cantharides  often  proves  very  serviceable 
after  arsenic  and  the  external  application  of  tarry  preparations  have 
failed. 

Cantharidin  and  potassium  cantharidate  have  been  recom- 
mended by  Professor  Liebreich  as  efficient  remedies  in  tuberculosis. 

Hypodermic  injections  not  exceeding  y^  grain  (0.0006  Gm.)  of 
cantharidin  are  used,  and  in  some  cases  apparently  have  been 


766  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

followed  by  good  results.  The  treatment,  however,  has  not  proved 
sufficiently  successful  to  warrant  its  employment  to  the  exclusion 
of  other  measures. 

Administration. — A  cantharidal  blister  should  not  be  allowed 
to  remain  on  the  skin  for  more  than  twelve  or  twenty-four  hours, 
six  to  eight  hours  usually  being  sufficient. 

When  blebs  are  formed,  they  should  be  carefully  opened  at 
their  most  dependent  parts.  When  the  serum  has  drained  away 
the  part  should  be  dressed  with  a  layer  of  borated  cotton  kept  in 
place  by  the  aid  of  a  few  strips  of  adhesive  plaster.  Should  the 
blistering  by  cantharides  occasion  too  great  pain,  a  poultice  made 
of  breadcrumb  and  solution  of  subacetate  of  lead,  to  which  is 
added  ^  or  ^  grain  (0.008  or  o.oi  Gm.)  of  morphine  sulphate  or 
other  soothing  application,  should  be  apphed  to  the  blistered  part. 
The  obstinate  ulcers  which  sometimes  follow  the  use  of  cantharides 
blisters  may  be  treated  effectively  by  Goulard's  cerate. 

It  is  said  that  the  strangury  which  plasters  of  cantharides  fre- 
quently cause  may  be  prevented  by  sprinkling  the  surface  of  the 
plaster  with  powdered  camphor  or  sodium  bicarbonate. 

For  internal  use  the  tincture  of  cantharides  is  the  only  prepara- 
tion to  employ. 

Sinapis  Alba— STnapis  Albae— White  Mustard. 

JJ.  S.  J». 

Origin. — The  seed  of  Brassica  alba  L.,  Hooker  filius  et  Thomp- 
son. 

Sinapis  Nigra— STnapis  NTgrrse— Black  Mustard. 

TJ.  S.  JP. 

Origin. — The  seed  of  Brassica  nigra  L.,  Koch. 

Both  the  white  and  black  mustard  are  annual  plants,  indigenous 
in  Southern  Europe  and  Western  Asia,  cultivated,  and  sometimes 
found  wild,  in  the  United  States. 

Description  and  Properties. — White  mustard  seeds  are 
almost  globular,  about  ^V  inch  (2  Mm.)  in  diameter,  with  a  circular 
hilum;  testa  yellowish,  finely  pitted,  hard;  embryo  oily,  with  a 
curved  radicle  and  two  cotyledons,  one  folded  over  the  other ;  free 
from  starch  ;  inodorous  ;  taste  pungent  and  acrid. 

Black  mustard  seeds  resemble  the  preceding  in  shape,  but  have 
a  diameter  only  of  ^^  inch  (i  Mm.);  blackish-brown  or  deep  red- 


VESICANTS  AND  EPISPASTICS.  767 

dish-brown,  with  a  testa  covered  with  shallow  pits,  and  when 
crushed  and  macerated  with  water  acquiring  a  strong  and  pungent 
odor. 

White  mustard  seed  contains  an  almost  tasteless,  yellowish, 
fixed  oil,  and  a  substance  known  as  sinalbin,  which  is  the  chief  con- 
stituent. This  substance  may  be  converted  into  allyl  sulphocyanide 
(a  volatile  oil)  by  the  action  of  the  ferment  myrosin  and  water. 
Black  mustard  seeds  contain  the  same  fixed  oil  as  the  white  mus- 
tard, and  a  glucosid,  sinigrin,  which  by  the  action  upon  it  of  myro- 
sin in  contact  with  water  converts  it  into  sulphocyanate  of  acrinyl 
(the  volatile  oil  of  mustard).  To  this  volatile  oil  of  mustard,  which 
is  official,  is  due  both  the  pungent  taste  and  odor  of  the  moistened 
powder. 

Dose. — 1-4  drachms  (4.0-15.0  Gm.). 

Official  Preparation  {of  Black  Mustard  Seed). 
Charta  Slnapis — Chartae  SKnapis — Mustard  Paper. 

Oleum  Sinapis  Volatile— Olei  STnapls  Volatilis— Vol- 
atile Oil  of  Mustard.    U.S.I*. 

Origin. — A  volatile  oil  obtained  from  Black  Mustard  by  macera- 
tion with  Water  and  subsequent  distillation. 

Description  and  Properties. — A  colorless  or  pale  yellow,  limpid, 
and  strongly  refractive  liquid,  having  a  very  pungent  and  acrid  odor 
and  taste.  Freely  soluble  in  alcohol,  ether,  or  carbon  disulphide. 
Used  externally. 

Official  Preparation. 

Linimfentum  SKnapis  Coinp6situm — LinimSnti  Stnapis  Compftsiti — Com- 
pound Liniment  of  Mustard. — Formula:  Volatile  Oil  of  Mustard,  30;  Fluid  Ex- 
tract of  Mezereum,  200;  Camphor,  60;  Castor  Oil,  150 ;  Alcohol,  to  1000,  by  solution. 
Used  externally. 

Physiologioal  Action. — Externally  and  Locally. — Mustard  is 
irritant,  counter-irritant,  rubefacient,  and  vesicant.  Any  degree  of 
irritation,  from  slight  redness  of  the  skin  to  severe  blistering,  may 
be  produced  by  mustard.  It  is  more  rapid  in  its  action  than  can- 
tharides,  and  when  applied  ta  the  skin  there  is  produced  almost 
immediately  a  sensation  of  warmth,  which  rapidly  passes  into  a 
severe  burning  pain.  This  irritation  of  the  sensory  nerves  is  suc- 
ceeded by  paralysis  and  more  or  less  loss  of  sensation,  so  that  if 
mustard  be  allowed  to  remain  on  the  skin  until  blistering  ensues 
there  is  a  decided  diminution  of  pain. 


768  A    TEXT-BOOK  OF  MA  TERIA   MEDIC  A. 

The  local  application  of  mustard  reflexly  stimulates  the  heart 
and  respiration. 

Internally. — Mustard  in  small  amounts  is  taken  as  a  condiment, 
and  is  a  powerful  stimulant  of  the  gastro-intestinal  tract.  Large 
doses  irritate  the  stomach  and  act  as  an  emetic,  producing  prompt 
emesis  without  depression,  owing  to  the  reflex  stimulation  of  the 
heart  and  respiration. 

The  volatile  oil  of  mustard  is  never  intentionally  given  inter- 
nally. It  is  a  powerful  caustic  irritant,  a  single  drop  upon  the 
tongue  producing  an  intense  burning  pain  in  the  throat,  stomach,, 
and  nose. 

Therapeutics. — Externally  and  Locally. — Mustard  may  be  used 
locally  for  the  same  purposes  as  cantharides,  being  superior  to  the 
latter-named  drug  when  a  simple  rubefacient  effect  is  desired. 
Mustard  when  applied  locally  is  more  of  a  stimulant  to  the  circu- 
latory and  respiratory  systems  than  cantharides,  and  is  therefore  an 
efficient  remedy  in  syncope,  asphyxia,  and  coma. 

As  a  stimulant  in  these  conditions,  a  large  mustard  poultice  is 
applied  to  the  legs. 

A  MUSTARD  BATH,  in  the  strength  of  i  drachm  (4.0  Gm.)  to  i 
gallon  (3785.43  Cc.)  of  water,  is  an  efficient  means  of  breaking  up 
a  cold,  and  if  properly  used  is  of  service  when  the  rash  in  measles 
or  scarlet  fever  has  receded. 

The  menses  may  often  be  re-established  when  suppressed  by  a 
MUSTARD  siTZ-BATH,  taken  at  the  time  of  the  expected  period. 

Internally. — Other  than  the  use  of  mustard  as  a  condiment,  the 
drug  is  given  only  to  produce  vomiting,  being  one  of  the  best 
emetics  in  indigestion  and  narcotic  poisoning. 

Obstinate  hiccough  has  sometimes  been  arrested  by  an  infusion 

OF  MUSTARD. 

Administration. — A  mustard  plaster,  or  sinapism,  is  prepared 
by  mixing  equal  parts  of  wheaten  or  rye  flour  with  water  to  the 
consistence  of  a  thick  paste,  which  is  spread  on  linen  or  cotton 
cloth  and  applied  to  the  skin.  A  dampened  piece  of  gauze  inter- 
posed between  the  plaster  and  the  skin  will  prevent  the  former 
from  adhering. 

A  mustard  cataplasm  is  a  weaker  preparation.  A  flaxseed  or 
cornmeal  poultice  is  made,  to  which  a  small  quantity  of  ground 
mustard  is  added.  This  is  intended  to  maintain  a  gentler  but  more 
prolonged  action  than  the  sinapism. 

"  Mustard  leaves,"  or  plasters  which  may  be  obtained  ready  pre- 


RUBEFACIENTS.  769 

pared  at  drug-stores,  are  intended  to  be  simply  dipped  in  water  and 
applied  to  the  skin.  Their  activity  may  be  lessened  by  interposing 
a  thin  piece  of  linen  or  cotton  cloth  between  the  plaster  and  the 
skin. 

Liniments  containing  oil  of  mustard  are  efficient  rubefacients, 
care  being  taken  to  adapt  the  strength  of  the  preparation  to  the 
delicacy  of  the  skin. 

When  mustard  is  taken  as  an  emetic,  it  is  given  in  the  form  of 
an  infusion,  in  the  proportion  of  i,  2,  or  3  drachms  (4.0,  8.0,  or 
12.0  Gm.)  to  I  pint  (473.17  Cc.)  of  water. 

A  preparation  known  as  mustard  whey  is  sometimes  given.  It 
is  prepared  by  boiling  \\  ounces  (46.65  Gm.)  of  bruised  mustard 
seed  in  a  mixture  of  i  pint  (473.17  Cc.)  of  milk  and  i  quart  (946.35 
Cc.)  of  water,  until  it  is  curdled,  when  the  whey  should  be 
strained  off. 

GROUP   XX.— RUBEFACIENTS. 

These  are  drugs  which,  when  locally  applied,  are  intended  to 
produce  temporary  redness  and  congestion  of  the  skin.  Some 
of  them  are  vesicant  if  applied  in  full  strength,  and  if  their  contact 
with  the  skin  be  sufficiently  prolonged,  vesication,  or  even  total 
destruction  of  tissue,  may  result. 

The  following  list  embraces  the  principal  rubefacient  drugs  : 

Ammonia,  Menthol, 

Alcohol,  Mezereon, 

Arnica,  Mustard, 

Camphor,  Oil  of  Cajuput, 

Capsicum,  Oil  of  Turpentine, 

Chloroform,  Pitch, 

Ether,  Volatile  Oils. 
Iodine, 
Hot  water  and  friction  are  also  rubefacient  agents. 

Rubefacients  are  used  for  their  influence  upon  the  skin  itself 
or  for  their  effect  on  deep-seated  structures. 

Rubefacients  are  efficient  means  of  relieving  neuralgic  pains, 
conditions  of  nervous  debility,  nervous  excitement,  the  sense  of 
fatigue,  and  as  an  aid  in  narcotic  poisoning,  also  to  hasten  the 
absorptioti  of  inflammatory  exudates,  to  remove  the  swelling  and 
restore  the  function  of  chronically  inflamed  joints,  etc. 
49 


770  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Rubefacients  should  ordinarily  be  applied  with  friction,  as  rub- 
bing of  the  skin  aids  the  action  of  many  of  them. 

Save  one,  all  the  rubefacients  mentioned  in  the  preceding  list 
have  been  considered  elsewhere  in  the  present  work. 

Pix  Burgundica— Picis  Burgrundicae— Burgundy 
Pitch.    JJ.S.B. 

Origin. — The  prepared  resinous  preparation  of  Abies  excelsa 
Poiret,  the  spruce  fir,  or  Norway  spruce,  a  stately  tree  growing 
in  Northern  Asia  and  Northern  Europe,  and  frequently  cultivated 
in  the  United  States. 

Description  and  Properties. — Hard,  yet  gradually  taking  the 
form  of  the  vessel  in  which  it  is  kept,  brittle,  with  a  shining,  con- 
choidal  fracture,  opaque  or  translucent,  reddish-brown  or  yellowish- 
brown  ;  odor  agreeably  terebinthinate ;  taste  aromatic,  sweetish, 
not  bitter.  It  is  almost  entirely  soluble  in  glacial  acetic  acid  or  in 
boiling  alcohol,  and  partly  soluble  in  cold  alcohol. 

Burgundy  pitch  contains  a  resin  and  a  volatile  oil  in  variable 
proportion. 

Used  externally. 

Official  Preparations. 

Empiastrura  PIcis  Burgtindicae — EmplSstri  Picis  Burgiindicse — Burgundy 
Pitch  Plaster. — Contains  go  per  cent,  of  Burgundy  Pitch.     Used  externally. 

Empiastrum  Picis  Cantharidatum — Empiastri  Picis  Cantharidati — Can- 
tharidal  Pitch  Plaster  (Warming  Plaster). — Contains  8  per  cent,  of  Cerate  of 
Cantharides.     Used  externally. 

Burgundy  Pitch  is  contained  in  EmplSstrum  F6rri  and  EmplSstrum  Opii. 

Physiological  Action  and  Therapeutics. — Burgundy  pitch 
when  appHed  to  the  skin  in  the  form  of  a  plaster  occasions  red- 
ness and  a  papular  eruption,  accompanied  by  itching.  If  the  plaster 
is  allowed  to  remain  in  contact  with  a  delicate  skin  for  too  long 
a  period,  there  may  be  produced  a  vesicular  or  even  pustular 
eruption. 

The  chief  uses  of  Burgundy  pitch  plaster  are  to  protect,  sustain, 
or  stimulate  the  part  to  which  it  is  applied. 

The  plaster  is  an  efficient  remedy  in  subacute  and  chronic 
pleurisy,  chronic  bronchitis,  lumbago,  muscular  rheumatism,  etc. 

Before  applying  a  Burgundy  pitch  plaster  to  a  hairy  skin,  the 
hair  should  be  shaved  off  The  removal  of  the  plaster  may  be 
facilitated  by  warming  it,  applying  to  the  back  of  the  plaster 
a  hot  bottle  or  hot  water-bag.     Any  particles  of  pitch  which  may 


EMOLLIENTS,  DEMULCENTS,   ETC. 


771 


adhere  to  the  surface  of  the  skin  may  be  removed  by  washing 
with  warm  alcohol. 


GROUP   XXL— EMOLLIENTS,   DEMULCENTS,   AND 
PROTECTIVE  AGENTS. 

Emollients  are  substances  which  soften,  relax,  and  protect  the 
tissues  to  which  they  are  applied  They  relieve  pain  and  tension 
by  diminishing  heat  and  lessening  the  pressure  on  the  nerves. 

The  principal  emoUients  are — 
Glycerin, 


Soap  Liniment, 
Starch, 


Fats  and  Oils, 


Lard, 
Olive  Oil, 
Almond  Oil, 
Spermaceti, 
Linseed  Oil, 
Cacao  Butter, 
Petroleum, 
Paraiifin, 
Petrolatum, 
Vaseline,  etc. 


Hot  Fomentations, 


Poultices, 


Linseed  Meal, 
Oatmeal, 
Bran, 
Bread, 
Flour, 
Figs,  etc. 

Demulcents  are  substances  which  soothe  and  protect  the  parts 
to  which  they  are  applied.  They  are  generally  of  a  mucilaginous 
nature,  and  are  employed  for  their  action  upon  mucous  membranes, 
while  emollients  are  principally  used  on  the  skin.  The  important 
demulcents  are —  ^ 

Acacia,  Marshmallow,  Sassafras-pith, 

Barley,  Liquorice,  Isinglass, 

Cetraria,  Starch,  Honey, 

Almond,  Tragacanth,  "      Gelatin, 

Flaxseed,  Glycerin,  Bland  Oils. 

Slippery  Elm,  White  of  Egg, 


772  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Both  Emollients  and  Demulcents  are  exceedingly  useful  agents 
to  relieve  irritation  of  the  Skin  in  certain  cutaneous  diseases ;  by- 
softening  the  skin  and  mucous  membranes  they  also  prevent  crack- 
ing or  chapping  from  exposure  to  cold.  They  are  also  efficient 
agents  to  prevent  bed-sores  and  to  lessen  friction  between  approx- 
imating surfaces,  as  between  the  nates  and  about  the  groins  of 
children. 

Demulcents  are  employed  internally  with  good  results  when 
there  is  an  irritated  or  inflamed  condition  of  mucous  membranes, 
whether  of  the  respiratory,  gastro-  intestinal  or  genito-urinary  tracts, 
as  in  bronchitis,  gastritis,  enteritis,  diarrhea,  dysentery,  strangury, 
cystitis,  etc. 

Demulcents — such  as  flaxseed,  slippery  elm,  marshmallow, 
or  SASSAFRAS-PITH — are  very  agreeable  and  efficient  agents  to  quench 
thirst  and  to  relieve  the  irritation  of  mucous  surfaces  in  febrile 
affections. 

Protectives  are  agents  used  to  mechanically  cover  and  protect 
injured  or  diseased  surfaces  from  extraneous  influences,  as  from 
air,  water,  etc. 

Certain  agents  classed  as  protectives  are  employed  for  their 
absorptive  power  of  taking  up  by  capillary  attraction  any  moisture 
or  fluid  present. 

They  are  useful  agents  as  protective  coatings  to  bed-sores  or  to 
excoriated,  abraded,  or  burned  surfaces. 
The  principal  protectives  are — 
Collodion, 

Solution  of  Gutta-percha, 
Solution  of  Sodium  Silicate, 
Court-plaster  (Emplastrum  Ichthyocollae), 
Lycopodium, 
Charcoal, 
Animal  Charcoal, 
Purified  Cotton. 
The  Emollients,  Demulcents,  and  Protectives  which  are  deemed 
sufficiently  important  to  merit  more  consideration  than  has  been 
given  them  elsewhere  in  the  present  work,  will  be  now  considered. 

Glycerinum—Glycerini— Glycerin.    JJ.  S.  J?. 

Origin. — A  hquid  obtained  by  the  decomposition  of  vegetable 
,or  animal  fats  or  fixed  oils,  and  containing  not  less  than  95  per 
cent,  of  absolute  glycerin. 


EMOLLIENTS,   DEMULCENTS,   ETC.  773 

Description  and  Properties. — A  clear,  colorless  liquid,  of  a 
thick,  syrupy  consistence,  oily  to  the  touch,  odorless,  very  sweet 
and  slightly  warm  to  the  taste.  When  exposed  to  the  air,  it 
slowly  abstracts  moisture.  Specific  gravity  not  less  than  1.250. 
Soluble  in  all  proportions  in  water  or  alcohol ;  also  soluble  in  a 
mixture  of  3  parts  of  alcohol  and  i  part  of  ether,  but  insoluble 
in  ether,  chloroform,  carbon  disulphide,  benzin,  benzol,  and  fixed 
or  volatile  oils. 

Dose. — 5-60  minims  (0.3-4.0  Cc). 

Official  Preparations. 

Glyceritum  Amyli — Glyceriti  Amyli — Glycerite  of  Starch.— Starch,  10 ;  Water, 
10;  Glycerin,  80.     Used  internally  or  externally. 

Glyceritum  VitfeUi— Glyceriti  Vit611i— Glycerite  of  Yolk  of  Egg  (Glyco- 
kin). — Fresh  Yolk  of  Egg,  45  ;  Glycerin,  55.     Used  freely  internally  or  externally. 

Suppositoria  Glycerini^Suppositoria  (ace.)  Glycerini — Suppositories  of 
Glycerin. — (Each  suppository  contains  93  grains  (6.0  Gm.)  of  glycerin.)  Used  as  re- 
quired. 

Glycerin  is  also  contained  in  the  following  official  preparations : 

Glyceritum  Acidi  CarbOlici,  Glyceritum  Acidi  Tannici,  Glyceritum  Boro- 
glycerini,  Glyceritum  Hydrastis,  Mucilago  TragacSnthae,  MSssa  HydrSrgyri 
Pllulse  PhSsphori,  and  in  many  extracts  and  fluid  extracts. 

Antagonists  and  Inoompatibles. — Glycerin  is  incompatible 
with  potassium  permanganate  and  with  chromic  acid. 

Synergists. — Its  emollient  properties  may  be  enhanced  by 
emollients  and  demulcents. 

Physiological  Action. — Externally  and  Locally. — When  gly- 
cerin is  applied  to  the  skin  or  mucous  membrane  it  is  ordinarily 
bland  and  unirritating,  although  in  certain  cases  the  drug  occasions 
a  sensation  of  burning  and  smarting,  which  may  be  due  either  to 
an  impure  preparation,  the  rapid  absorption  of  water  from  the 
tissues,  or  merely  to  a  marked  idiosyncrasy  on  the  part  of  the 
patient.  Should  the  pure  drug  show  a  tendency  to  irritate  the 
skin,  the  glycerin  should  be  properly  diluted  with  water. 

Preparations  more  concentrated  than  the  specific  gravity  recom- 
mended by  the  U.  S.  Pharmacopoeia — viz.  1.25 — should  be  avoided, 
because  of  their  irritating  properties. 

•  Glycerin  abstracts  water  from  the  tissues,  and  is  rapidly  absorbed 
through  the  skin.  It  possesses  marked  diffusive  power,  teing 
capable  of  diffusing  itself  freely  over  and  through  organic  matter. 

Internally. — The  principal  action  of  glycerin  when  taken  inter- 


774  '-i    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

nally  is  that  of  a  purgative.  The  drug  purges  when  given  by  the 
rectum,  either  as  enema  or  in  the  form  of  a  suppository. 

Glycerin  is  readily  absorbed  from  the  alimentary  canal,  and  it 
is  thought  by  some  physicians  to  undergo  oxidation,  thereby  act- 
ing as  a  food  and  increasing  body-weight.  Other  competent  inves- 
tigators allege  that  it  is  not  in  the  least  degree  nutritious. 

When  immoderate  amounts  of  the  drug  are  taken,  it  may  be 
detected  in  the  urine,  while  under  excessive  doses  effects  may  be 
produced  similar  to  those  resulting  from  alcoholic  poisoning. 

Following  the  ingestion  of  very  large  doses,  there  may  be 
extreme  muscular  weakness,  dryness  of  mucous  membranes,  dark- 
colored  urine,  collapse,  and  death.  The  drug  is  not  considered 
poisonous,  excessive  amounts  being  necessary  to  produce  the 
symptoms  above  described. 

Therapeutics. — Externally  and  Locally. — Glycerin  is  a  popular 
and  efficient  remedy  for  chapped  hands  and  slight  excoriations. 

Fissured  nipples  and  fissure  of  the  anus  are  well  treated  with 
pure  GLYCERIN  or  with  glycerin  and  tannic  acid.  The  drug  also 
makes  an  efficient  application  to  bed-sores. 

Glycerin  is  employed  as  an  injection  in  gonorrhea.  It  may  be 
used  alone  or  medicated  with  bismuth  subnitrate  or  with  extract 
of  opium. 

Glycerin  is  one  of  the  best  solvents  for  hardened  ceruiiten,  and 
tampons  wet  with  glycerin  or  with  glycerite  qf  tannic  acid  are 
very  serviceable  in  leucorrhea  and  erosion  of  the  cervix,  and  endo- 
metritis with  congestion  and  subinvolution  of  the  uterus. 

Glycerin  possesses  marked  antipruritic  properties,  and,  whether 
applied  pure  or  combined  with  oils  or  ointments,  will  allay  itching 
of  most  affections  of  the  skin. 

Lotions  or  diluted  aqueous  soLUTIO^fs  of  glycerin  are  fre- 
quently employed  in  various  diseases  of  the  ear,  nose,  and  throat, 
such  2iS  fissure  of  the  tongue,  chronic  laryngitis,  chronic  nasal  catarrh, 
coryza,  pharyngitis,  etc. 

A  mixture  of  glycerin  and  water  will  lessen  or  prevent  dry- 
ness of  the  mouth  from  fever  or  other  causes. 

Glycerin  is  an  efficient  topical  remedy  for  the  reduction  of 
edema  of  the  prepuce,  and  is  a  serviceable  antiseptic  dressing  for 
wounds,  carbuncles,  boils,  etc. 

Glycerite  of  starch  is  an  excellent  soothing  emollient  in 
acute  eczema,  and  quite  an  efficient  preparation  to  prevent  pitting  in 
variola. 


EMOLLIENTS,   DEMULCENTS,   ETC.  775 

Glyconin  (glycerite  of  yolk  of  egg)  makes  an  agreeable,  sooth- 
ing application  in  erysipelas,  fissured  nipples,  etc. 

Internally. — The  principal  internal  use  for  glycerin  is  for  the 
relief  of  habitual  constipation,  being  far  more  efficient  in  habitual 
than  in  occasional  constipation,  and  more  generally  applicable  to 
females  than  to  males,  and  to  those  cases  where  the  fecal  mass  is 
retained  in  the  rectum  than  in  the  sigmoid  flexure  or  above  it. 
For  the  purpose  of  relieving  constipation  it  may  be  given  by  the 
mouth,  alone  or  associated  with  castor  oil,  or  i  or  2  fluidrachms 
(4.0-8.0  Cc.)  injected  into  the  rectum,  or,  which  perhaps  is.  the 
most  agreeable  method,  by  the  insertion  into  the  rectum  of  a 

GLYCERIN    SUPPOSITORY. 

Glycerin  is  said  to  relieve  the  acidity,  pyrosis,  and  flatulence  of 
dyspepsia. 

It  has  been  employed  in  diabetes,  but  without  favorable  results. 

Administration. — Whether  glycerin  be  used  externally  or  in- 
ternally, it  should  always  be  chemically  pure,  otherwise  much  irri- 
tation may  be  produced. 

For  external  use  it  may  be  used  pure  or  mixed  with  water,  or 
in  various  lotions,  ointments,  etc. 

Internally  it  is  seldom  given  alone,  but  with  syrups,  water, 
wine,  or  other  alcoholic  liquors. 

Oleum  OlTvae— Olei  Ollvae— Olive  Oil.    U.S. P. 

Origin. — The  fixed  oil  expressed  from  the  fruit  of  Olea  Europcea 
L.,  a  shrubby,  thorny,  medium-sized  tree,  indigenous  in  Western 
Asia,  but  cultivated  in  the  countries  bordering  on  the  Mediter- 
ranean and  in  the  Southern  United  States,  California,  and  several 
South  American  and  other  countries. 

Description  and  Properties. — A  pale  yellow  or  light  greenish- 
yellow,  oily  liquid,  having  a  slight,  peculiar  odor,  and,  a  nutty, 
oleaginous  taste,  with  a  faintly  acrid  after-taste.  Very  sparingly 
soluble  in  alcohol,  but  readily  soluble  in  ether,  chloroform,  or  car- 
bon disulphide.  Olive  oil  should  be  kept  in  well-stoppered  bottles 
in  a  cool  place. 

Dose. — Freely. 

Physiological  Action  and  Therapeutics. — Olive  oil  is  a  singu- 
larly bland  and  agreeable  oil,  and  very  useful  as  an  emollient  and 
demulcent.  It  serves  as  an  efficient  protective  to  the  skin,  from 
which  it  is  readily  absorbed.     As  a  lenitive  and  protective  in  cases 


T]6  A    TEXT-BOOK  OF  MATERIA    MEDICA. 

of  superficial  wounds,  bruises,  excoriations,  burns,  bites  and  stings  of 
insects,  sprains,  etc.  it  serves  a  valuable  purpose. 

It  is  extensively  employed  by  dermatologists  to  soften  and  facili- 
tate the  removal  of  crusts,  scales,  and  epithelial  debris  of  various 
cutaneous  disorders. 

The  application  of  warm  olive  oil,  made  with  gentle  friction  to 
painfid  and  engorged  mammary  glands  during  pregnancy  and  after 
parturition,  generally  lessens  the  pain  and  swelling. 

The  drug  is  an  efficient  palliative  in  painful  deglutition,  and  is 
son\etimes  injected  into  the  rectum  as  a  soothing  emollient  in  dys- 
entery, and  to  destroy  "  seat-worms "  and  allay  the  irritation  pro- 
duced by  them. 

Frequently  the  forcible  injection  into  the  urethra  of  olive  oil 
will  dilate  an  unusually  tight  stricture,  pa.rt\y  overcoming  the  dif- 
ficulty to  the  introduction  of  a  sound. 

Olive  oil  is  habitually  employed  as  a  lubricant  for  sounds,  cathe- 
ters, specula,  pessaries,  etc. 

Where  a  fat  or  an  oil  is  not  contraindicated,  olive  oil  is  one  of 
the  most  efficient  demulcents  to  administer  in  cases  of  poisoning 
from  corrosive  irritating  drugs. 

Olive  oil  is  a  useful  and  pleasant  laxative,  and  is  used  to  a  con- 
siderable extent  for  that  purpose.  The  oil  is  also  credited  with 
facilitating  the  discharge  oi  gall-stones.  It  unquestionably  increases 
the  secretion  of  bile,  which  may  account  for  its  apparent  influence 
in  favoring  the  expulsion  of  these  concretions. 

Oleum  Amygdalae  Expressum— Olei  Amygdalae  Ex- 
press!—Expressed  Oil  of  Almond.     U.S.JP. 

Origin. — A  fixed  oil  expressed  from  Bitter  or  Sweet  Almond 
{Prunus  Amygdalus,  var.  amara  and  dulcis,  De  Candolle),  a  tree  15 
to  20  feet  (s  to  6  M.)  high,  indigenous  in  Western  Asia  and  culti- 
vated in  subtropical  countries. 

Description  and  Properties. — A  clear,  pale  straw-colored  or 
colorless,  oily  liquid,  almost  inodorous,  and  having  a  mild,  nutty 
taste.  Only  slightly  soluble  in  alcohol ;  soluble  in  ether,  and  in 
chloroform  in  all  proportions.  It  should  be  kept  in  well-stoppered 
bottles,  in  a  cool  place. 

Dose.— 1-4  fluidrachms  (4.0-8.0  Cc). 

Expressed  Oil  of  Almond  is  contained  in  Unguentum  Aquae 
Rosse. 

Phy^ologioal  Action  and  Therapeutics. — The  expressed  oil 


EMOLLIENTS,  DEMULCENTS,  ETC.  777 

of  almond  is  a  peculiarly  bland  and  agreeably  efficient  demulcent 
and  emollient,  being  used  both  externally  and  internally  for  the 
same  purposes  as  olive  oil. 

Oleum  LTni— Olei  Lini— Linseed  Oil.    JJ.  S.  I*. 

(Oil  of  Flaxseed.) 

Origin. — A  fixed  oil  expressed  without  heat  from  the  seed  of 
Linum  Usitatissimum  L. 

Description  and  Properties. — A  yellowish  or  yellow,  oily  liquid, 
having  a  slight,  peculiar  odor,  and  a  bland  taste.  When  exposed 
to  the  air  it  gradually  thickens  and  acquires  a  strong  odor  and 
taste ;  and  if  spread  in  a  thin  layer  on  a  glass  plate,  and  allowed  to 
stand  in  a  warm  place,  it  is  gradually  converted  into  a  hard,  trans- 
parent, resin-like  mass.  Soluble  in  about  lo  parts  of  absolute  alco- 
hol, and,  in  all  proportions,  in  ether,  chloroform,  benzin,  carbon 
disulphide,  or  oil  of  turpentine.  Linseed  oil  should  be  kept  in 
well-stoppered  bottles. 

Dose. — \-2  fluidounces  (15.0-60.0  Cc). 

Physiological  Action  and  Therapeutics. — The  action  and  uses 
of  flaxseed  oil  are  similar  to  those  of  olive  oil.  One  of  its  most 
important  uses,  when  mixed  with  an  equal  quantity  of  lime  water, 
is  in  the  treatment  of  burns. 

The  linseed  itself  is  used  extensively  as  a  domestic  demulcent 
in  the  form  of  a  tea,  for  cough,  etc.,  while  the  ground  hnseed  makes 
an  excellent  poultice  for  all  deep-seated  inflammations. 

Acacia— Acaciae— Acacia.    JJ.  S.  JP. 

(Gum  Arabic.) 

Origin. — A  gummy  exudation  from  Acacia  Senegal  Willdenow, 
a  small  tree  about  20  feet  (6  M.)  high,  found  in  India  and  Africa, 
especially  in  the  district  of  Khartoum,  westward  to  Senegambia. 

Description  and  Properties. — In  roundish  tears  of  various 
sizes,  or  broken  into  angular  fragments,  with  a  glass-like,  some- 
times iridescent  fracture,  opaque  from  numerous  fissures,  but  trans- 
parent and  nearly  colorless  in  thin  pieces ;  nearly  inodorous,  taste 
insipid,  mucilaginous ;  insoluble  in  alcohol,  but  soluble  in  water, 
forming  a  thick  mucilaginous  liquid.  Acacia  should  be  slowly  but 
completely  soluble  in  2  parts  of  water. 

Official  Preparations. 
Mucilago  Acaciae— MucilSginis  AcScise— Mucilage  of  Acacia  (34  per  cent.). 
— Dose,  freely. 


y/S  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

Syrupus  Acacise — Syrupi  AcSciae — Syrup  of  Acacia. — Dose,  freely. 

Acacia  is  contained  in  Emulsum  Amygdalae,  Pulvis  Cretse  Compositus,  and 

in  some  trochisci. 

Physiological  Action  and  Therapeutics. — Acacia  is  a  valuable 
demulcent,  and  gum  water  is  in  ordinary  use  to  serve  as  a  protective 
to  inflamed  and  irritated  mucous  membranes  of  the  respiratory, 
alimentary,  and  genito-urinary  tracts,  as  in  cases  of  pharyngitis, 
laryngitis,  dysejitery,  gastritis,  typhoid  fever,  and  in  febrile  affections 
generally.  The  mucilage  of  acacia  is  sometimes  used  as  a  pro- 
tective for  superficial  burns,  excoriations,  etc. 


Cetraria— Cetrariae— Cetraria.    Tf.  S.  JP. 

(Iceland  Moss.) 

Origin. — Cetraria  Islandica  L.,  fronds  of  a  lichen  indigenous  in 
the  Northern  Hemisphere. 

Description  and  Properties. — From  2  to  4  inches  (5  to  10  Cm.) 
long,  foliaceous,  irregularly  branched  into  fringed  and  channelled 
lobes,  brownish  above,  whitish  beneath,  and  marked  with  small, 
depressed  spots ;  brittle  and  inodorous ;  when  softened  in  water, 
cartilaginous,  and  having  a  slight  odor ;  its  taste  is  mucilaginous 
and  bitter. 

Official  Preparation. 
DecSctum  Cetrariae — Dec6cti  Cetrariae — Decoction  of  Cetraria. 

Physiological  Action  and  Therapeutics. — Cetraria  is  a  demul- 
cent and  tonic,  and  may  be  used  for  the  same  purposes  as  acacia. 
It  is,  however,  more  nutritious  than  acacia,  and  is  used  to  a  con- 
siderable extent  for  chronic  pulmonary  affections. 

Ulmus— Olmi— Elm.     V.S.JP. 

(Slippery  Elm.) 

Origin. — The  inner  bark  of  Ulmus  fulva  Michaux,  a  medium- 
sized  tree,  from  30  to  60  feet  (9  to  18  M.)  high,  found  in  the 
United  States  and  Canada. 

Description  and  Properties. — In  flat  pieces,  varying  in  length 
and  width,  about  \  inch  (3  Mm.)  thick,  tough,  pale  brownish-white, 
the  inner  surface  finely  ridged;  fracture  fibrous  and  mealy;  the 
transverse  section  delicately  checkered ;  odor  slight,  peculiar ;  taste 
mucilaginous,  insipid. 


EMOLLIENTS,   DEMULCENTS,   ETC.  779 

Official  Preparation. 

Mucilago  Ulmi— MucilSginis  Ulmi— Mucilage  of  'EXm.—Dose,  freely. 

Physiological  Action  and  Therapeutics. — Elm  is  a  decided 
demulcent  and  possesses  nutritive  properties.  It  is  pleasant  to  the 
taste  and  does  not  readily  disturb  the  stomach.  It  is  principally 
used  as  a  demulcent  in  diseases  of  the  gastro-intestinal  and  genito- 
urinary tracts,  as  diarrhea,  dysentery,  cystitis,  urethritis,  etc.  The 
fibrous  bark  is  moulded  into  tents  used  to  dilate  the  neck  of  the 
uterus,  fistulous  openings,  etc. 

Althaea— Althaeas— Althaea.    V.  S.  I*. 

(Marshmallow.) 

Origin. — The  root  of  Althcea  officinalis  L.,  a  perennial  herb  in- 
digenous in  the  temperate  portion  of  Northern  and  Western  Asia 
and  in  the  greater  part  of  Europe. 

Description  and  Properties. — In  cylindrical  or  somewhat  con- 
ical pieces,  from  4  to  6  inches  (10  to  15  Cm.)  long,  about  \  inch 
(12.7  Mm.)  thick,  deeply  wrinkled,  deprived  of  the  brown  corky 
layer  and  small  roots ;  externally  white,  marked  with  a  number 
of  circular  spots,  and  of  a  somewhat  hairy  appearance  from  the 
loosened  bast-fibres ;  internally  whitish  and  fleshy.  It  breaks  with 
a  short,  granular,  and  mealy  fracture,  and  has  a  faint,  aromatic  odor 
and  a'  sweetish,  mucilaginous  taste.  It  contains  asparagin,  muci- 
lage,'sugar,  and  pectin. 

Official  Preparation. 
Syrupus  Althiese — Syrupi  Althiise. — Syrup  of  Althaea. — Dose,  freely. 

Physiological  Action  and  Therapeutics. — Marshmallow  is 
emollient,  demulcent,  and  protective,  and  is  an  efficient  protective 
and  emollient  in  irritable  and  inflamed  conditions  of  the  skin,  and 
a  highly  efficacious  demulcent  in  all  inflammatory  and  irritable 
conditions  of  the  respiratory ,  digestive,  and  urinary  organs. 

Tragacantha— Tragacanthae— Tragacanth.    TJ.  S.I*. 

Origin. — A  gummy  exudation  from  Astragalus  gummifer  Labil- 
lardiere,  and  from  other  species  of  Astragalus,  low  shrubs,  indige- 
nous in  a  portion  of  the  territory  lying  between  Eastern  Persia  and 
Greece. 

Description  and  Properties. — In  narrow  or  broad  bands,  more 
or  less  curved  or  contorted,  marked  by  parallel  lines  or  ridges, 
white  or  faintly  yellowish,  translucent,  horn-like,  and  tough.     It 


ySo  A    TEXT-BOOK  OF  MATERIA   MEDICA. 

contains  33  per  cent,  of  a  gum,  bassorin,  which  is  only  sUghtly 
soluble  in  water; 

Official  Preparation. 
Mucilago  Tragacanthffi— Muciiaginis  Tragacanthae-Mucilage  of  Traga- 
canth. — Dose,  freely. 

Physiological  Action  and  Therapeutics. — Tragacanth  is  de- 
mulcent and  nutritious,  and  may  be  used  for  the  same  purposes 
as  acacia,  Iceland  moss,  etc.  The  mucilage  of  tragacanth  is  sin- 
gularly efficacious  as  a  soothing  emollient  in  chapped  hands  and 
irritable  conditions  of  the  skin. 

Sassafras  Medulla— Sassafras  Medullae— Sassafras 
Pith.    TJ.  S.  P. 

Origin. — The  pith  of  Sassafras  variifolium  (Salisbury)  0. 
Kuntze,  a  tree  indigenous  in  North  America. 

Description  and  Properties. — In  slender,  cyHndrical  pieces, 
often  curved  or  coiled,  light,  spongy,  white,  inodorous,  and  insipid. 
Macerated  in  water,  it  forms  a  mucilaginous  liquid,  which  is  not 
precipitated  by  the  addition  of  alcohol. 

Official  Preparation. 

Mucilago  sassafras  Medttllse— Muciiaginis  Sassafras  Medfillse— Mucilage 
of  Sassafras  Pith. — Dose,  freely. 

Physiological  Action  and  Therapeutics. — Mucilage  of  Sassa- 
fras Pith  is  an  agreeable  demulcent  and  a  mild  local  stimulant,  and 
may  be  used  for  the  same  purposes  as  slippery  elm,  tragacanth, 
acacia,  etc.     It  forms  a  pleasant  vehicle  for  more  active  remedies. 

IchthyocoUa—Ichthyocollae— Isinglass.    JJ.  S.  JP. 

Origin. — The  swimming-bladder  of  Acipetiser  Huso  L.  and  of 
other  species  of  Acipenser. 

Description  and  Properties. — In  separate  sheets,  sometimes 
rolled,  of  a  horny  or  pearly  appearance ;  whitish  or  yellowish, 
semi-transparent,  iridescent,  inodorous,  insipid ;  almost  entirely 
soluble  in  boiling  water  and  in  boiling  alcohol.  A  solution  of 
isinglass  in  24  parts  of  boiling  water  forms,  on  cooling,  a  trans- 
parent jelly. 

Dose. — Freely. 


EMOLLIENTS,   DEMULCENTS,   ETC.  781 

Official  Preparation. 

Empiastrum  IchthyocOUae — Empiastri  IchthyocOllae — Isinglass  Plaster — 
(Court  Plaster). 

Physiological  Action  and  Therapeutics. — Isinglass  is  emol- 
lient, demulcent,  and  protective,  and  possesses  nutritive  properties. 
Isinglass  plaster  is  commonly  employed  to  protect  abraded  sur- 
faces and  slight  cuts  of  the  skin.  It  should  be  moistened  with 
pure  water  and  never  with  saliva. 

Lycopodium— Lycopodii— Lycopodium.    77.  S.F. 

Origin. — The  spores  of  Lycopodium  clavatum  L.  and  of  other 
species  of  Lycopodium,  low-creeping  perennials  found  in  dry 
woods  distributed  over  the  greater  portion  of  the  globe. 

Description  and  Properties. — A  fine  powder,  pale  yellowish, 
very  mobile,  inodorous,  tasteless,  floating  upon  water  and  not 
wetted  by  it,  but  sinking  on  being  boiled  with  it,  and  burning 
quickly  when  thrown  into  a  flame.  Under  the  microscope  the 
spores  are  seen  to  be  sphaero-tetrahedral,  the  surfaces  marked  with 
reticulated  ridges,  and  the  edges  beset  with  short  projections. 
Lycopodium  contains  a  fixed  oil  and  a  minute  quantity  of  a  volatile 
base,  methylamine.     Used  principally  externally. 

Physiological  Action  and  Therapeutics. — Lycopodium  is  an 
admirable  protective,  and  possesses  great  power  of  absorbing  oils. 
Its  lightness,  dryness,  and  absorptive  power  render  it  an  excellent 
dusting  powder  for  excoriated  surfaces,  eczema,  herpes,  intertrigo 
erysipelas,  superficial  ulcers,  etc. 

Its  peculiar  property  of  not  being  wetted  with  water  makes  it 
a  valuable  protective  to  prevent  irritation  or  chafing  caused  by  the 
urine  or  alvine  dejections  of  infants. 

The  drug  is  used  as  a  basis  for  insufflations  and  in  pharmacy 
to  prevent  the  adhesion  of  pills. 


782  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

PRESCRIPTIONS. 


A  PRESCRIPTION  (L.  prcB,  for ;  scribo,  I  write)  is  an  order  on  the 
pharmacist  to  compound  for  the  patient  certain  medicines  intended 
to  meet  the  requirements  of  the  individual  case.  Considering  it  as 
an  order,  therefore,  it  should  begin  with  the  Name  of  the  person  for 
whom  it  is  designed  and  the  Date  on  which  it  is  written.  In  some 
cases  it  may  be  advisable  to  omit  the  name,  but  the  date  should 
never  be  omitted. 

The  date  is  often  indicated  by  the  calendar  number,  instead  of 
the  name  of  the  month,  thus :  3.  |  March,  3d  month  |  10.  |  day  of 
the  month  |  '96.  |  year  |  .  Unfortunately,  there  is  no  uniform 
usage  in  this  respect,  some  persons  writing  the  number  and  others 
the  day  of  the  month  first,  so  that  a  druggist  unfamiliar  with  the 
custom  of  the  physician  could  not  know  whether  3.  10.  '96.  meant 
March  loth  or  October  3d  of  the  year.  The  Latin  numerals  are 
also  employed  to  designate  the  month  :  III.  10.  '96.  To  avoid  all 
chance  of  error,  it  is  best  to  abbreviate  the  month  or  write  it  in 
full:  March  10,  1896.  The  importance  of  the  date  is  manifest 
from  its  value  to  the  physician  or  pharmacist  as  a  reference,  and 
the  possibility  of  its  evidence  being  required  in  medico-legal 
contingencies. 

After  the  name  and  date  comes  the  prescription  proper,  the 
name  of  the  article  required  or  the  ingredients  in  case  of  a  mixture. 
In  the  latter  instance  the  various  ingredients  are  written  in  a  cer- 
tain order  or  sequence  with  reference  to  their  medicinal  action  or 
importance,  which  usually  is  also  in  accord  with  their  pharma- 
ceutical requirements  for  satisfactory  dispensing. 

For  the  purpose  of  examination  a  regular  prescription  may  be 
divided  into  six  parts  : 

1.  The  name  of  the  patient  and  the  date  of  the  order; 

2.  The  superscription,  or  heading,  indicated  by  the  symbol  !^, 
standing  for  the  Latin  word  Recipe,  "  take  ;  " 

3.  The  inscription,  expressing  the  names  and  quantities  of  the 
ingredients ; 

4.  The  subscription,  being  instructions  to  the  pharmacist  or 
compounder ; 

5 .  The  signature,  containing  directions  to  the  patient  or  attendant ; 

6.  The  Name  of  the  Physician. 


PRESCRIPTIONS.  783 

Example : 

^}  Olei  morrhuae, 
Vini  albi, 

Glyceriti  vitelli,  q.  s.  ad 
Fiat  emulsum.^ 
,  Sig.  Tablespoonful  after  meals.* 

Here  the  small  numeral  or  exponent,  ',  is  the  superscription  ;  ^, 
the  inscription  ;  *,  the  subscription  ;  *,  the  signature. 

A  typical  prescription  consists  of  a  formula  of  four  divisions : 

The  Basis,  or  principal  active  agent ; 

The  Adjuvant,  or  auxiliary,  to  aid  the  action  of  the  Basis ; 

The  Corrective,  to  correct  or  modify  its  action ; 

The  Vehicle,  to  give  proper  form  or  taste  to  the  whole. 

Each  ingredient  should  have  a  separate  Une,  although  it  is  not 
necessary  that  all  prescriptions  should  include  the  above  complete 
formula. 

Combination  of  Drugs. 

In  writing  a  prescription  we  assume  that  it  is  intended,  as  should 
■always  be  the  case,  to  fulfil  a  single  therapeutic  purpose  only ;  and 
we  are  to  decide  first,  whether  the  medicine  shall  be  administered 
in  a  solid  or  in  a  liquid  form ;  and  second,  whether  a  single  medi- 
cine shall  be  prescribed  or  a  combination  of  remedies. 

The  drug  upon  which  we  base  our  expectations  of  success,  the 
Basis  of  the  inscription,  should  always  be  written  first,  and  this 
drug  may  be  the  only  one  required.  Frequently,  however,  some 
other  drug  is  necessary  to  assist  the  action  of  the  Basis,  which 
substance  would  be  the  Adjuvant  (Lat.  adjuvare,  to  assist).  No 
general  rule  can  be  laid  down  in  this  matter.  The  course  to  pursue 
will  depend  entirely  upon  the  therapeutic  indication,  the  physio- 
logical action  of  the  drug,  and  the  idiosyncrasies  of  the  patient. 
The  tendency  to-day,  among  many  able  therapeutists  and  clinicians, 
is  to  prescribe  single  drugs  or  simple  combinations,  while  the  pre- 
scriptions of  former  times  are  good  examples  of  polypharmacy. 
There  is,  at  all  events,  danger  in  going  to  the  extreme  of  sacrificing 
therapeutic  efficiency  to  simplicity  of  form  and  elegant  pharmacy ; 
and  it  must  be  confessed  that  such  compounds  as  Warburg's  tinc- 

^  In  ancient  times  it  was  customary  to  preface  a  prescription  with  a  pious  invocation 
to  Jupiter  or  some  guardian  deity.  These  prayers  were  finally  abbreviated,  until  they 
came  to  be  expressed  by  the  simple  astronomical  sign  QJ.,  symbol  of  the  planet  Jupiter. 
The  upright  stroke  across  the  letter  R  heading  modern  prescriptions  is  a  curious  relic  of 
■the  above  heathen  usage  condensed  in  the  planetary  sign. 


784  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

ture  and  the  bolus  prescribed  by  Dr.  Graves  in  the  treatment  of 
dropsical  patients  prove  the  efficacy  of  polypharmacy  in  many 
cases. 

Curare  Base  To  cure 


Cito 

Adjuvant 

Quickly 

Tuto 

Corrective 

Safely 

Et  jucunde 

Vehicle 

Excipient 

>■  And  pleasantly. 

or 
Diluent 

The  hackneyed  rule  of  Asclepiades  that  medicines  should 
always  be  so  combined  as  to  cure  quickly,  safely,  and  pleasantly 
(curare,  cito,  tuto,  et  jucunde)  has  resulted  in  the  adoption  of  the 
above  form  of  inscription. 

The  theoretical  prescriber  writes  by  rule,  religiously  avoids 
incompatibles,  and  would  be  shocked  by,  and  have  little  respect 
for,  a  physician  who  should  deliberately  include  in  the  same  pre- 
scription the  names  of  substances  directly  antagonistic  to  each 
other  physiologically.  The  subject  will  be  further  discussed  here- 
after. 

As  a  general  rule,  we .  prescribe  only  one  drug  to  provoke 
emesis,  and  a  combination  of  several  if  we  wish  a  diuretic.  A 
purgative  is  usually  multiple,  but  if  the  selection  be  castor  oil  or 
croton  oil,  it  will  be  single. 

After  we  have  selected  the  Basis,  or  chief  ingredient,  of  our 
prescription,  the  next  point  to  determine  is  whether  we  can  add 
anything  which  will  in  any  manner  be  of  real  assistance  to  that 
Basis.  This  ingredient,  or  Adjuvant,  as  it  is  called — has  usually  a 
physiological  action  similar  to  that  produced  by  combining  two 
cathartics  or  two  diuretics  acting  upon  different  portions  of  the 
intestines  or  kidneys.  Sometimes,  however,  an  Adjuvant  may 
differ  in  its  effects — as  sulphuric  acid  serves  as  an  Adjuvant  to 
quinine,  by  favoring  its  absorption  and  thereby  hastening  and 
increasing  its  action,  as  mercury  assists  the  action  of  squills  upon 
the  kidneys,  or  iron  acts  as  an  Adjuvant  to  a  cardiac  stimulant. 

The  Adjuvant,  as  a  rule,  should  not  be  directly  opposed  in  its 
action  to  that  of  the  Basis,  as  chloral  k  to  strychnine,  a  diuretic  to 
a  diaphoretic,  or  a  typical  cardiac  stimulant  to  a  cardiac  depressant. 

Having  chosen  the  Adjuvant,  the  next  point  to  consider  is 
whether  the  action  of  the  drugs  selected  may  not  be  rendered 
more  kindly  through  the  addition  of  some  other  substance  as  a 


PRESCRIPTIONS.  785 

corrective.  A  substance  may  be  added  which  will  correct  some 
disagreeable  effect  of  the  active  agents  by  producing  a  medicinal 
impression  upon  the  patient.  Extract  of  belladonna  or  hyoscya- 
mus  relieves  the  griping  occasioned  by  some  of  the  more  violent 
cathartics,  like  podophyllin,  and  other  well-known  instances  of  this 
kind  are  those  of  the  aromatic  spirit  of  ammonia,  which  mitigates 
the  unpleasant  symptoms  of  iodism,  and  hydrobromic  acid,  which 
lessens  the  untoward  action  of  quinine. 

Again,  a  corrective  may  act  by  producing  some  chemical  effect 
upon  the  Basis — as  salicylic  acid  is  rendered  more  soluble  and  less 
irritating  by  combining  it  with  sodium  carbonate  or  bicarbonate, 
forming  the  sodium  salicylate. 

Great  care  and  thought  should  ht  given  not  only  to  the  Basis, 
Adjuvant,  and  Corrective,  but  also  to  the  Vehicle,  which  claims 
equal  attention.  A  prescription  is  often  rendered  more  kindly,  and 
no  less  efficient,  through  the  medium  of  some  substance  producing 
a  more  agreeable  taste.  It  is  a  mistaken  idea  that  medicines,  in 
order  to  be  effective,  should  be  repulsive  to  the  patient.  The 
homeopath's  success  is  largely  due  to  the  very  agreeable  taste  of 
his  remedies.  The  mere  caprice  of  the  patient,  however,  should 
not  be  considered  in  the  choice  of  a  remedy  when,  in  the  best 
judgment  of  the  physician,  it  is  indicated.  Still,  it  is  well  to  study 
carefully  the  art  of  prescribing  agreeable  doses,  so  far  as  may  be 
compatible  with  fidelity  to  science.  It  is  to  be  noted  that  pleasant- 
ness of  taste  is  far  "more  important  in  the  case  of  fluids  than  in  that 
of  solids. 

Aromatic  elixirs,  syrups,  aromatic  waters,  etc.  are  in  frequent 
use  as  Vehicles,  yet  it  must  be  remembered  that  oftentimes  a  sen- 
sitive patient  repudiates  sweets  and  syrupy  mixtures.  In  many 
cases  simple  syrup  or  pure  water  serves,  after  all,  as  the  best  vehi- 
cle, although  the  physician's  choice  must  be  governed  mainly  by 
experience. 

It  will  be  observed  that  in  the  body  of  the  present  work,  in  the 
majority  of  cases,  the  method  of  administration  is  fully  explained. 
It  may  here  be  noted  that  liquids  are  much  more  readily  absorbed 
than  soHds,  yet  adults  usually  prefer  to  take  medicines  in  the  solid 
form,  such  as  pills,  capsules,  powders,  and  tablets.  In  illness  the 
patient's  condition  is  often  such  that  the  gastric  and  intestinal  secre- 
tions are  greatly  reduced,  and  there  may  not  be  sufficient  fluid  to 
dissolve  the  solid,  so  as  to  render  it  in  a  condition  to  be  absorbed. 
It  frequently  happens,  for  instance,  that  pills  are  voided  with  the 

50 


786  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

stools  unchanged,  and,  on  the  other  hand,  solid  substances,  such  as 
pills  or  capsules,  may  remain  in  the  intestinal  canal  until  the  secre- 
tions are  restored,  when  the  accumulated  medicine  will  all  be  acted 
on  at  once,  and,  passing  into  solution,  be  absorbed  in  excessive 
doses.  Such  is  the  frequent  cause  of  the  cumulative  effect  which 
sometimes  occurs,  not  without  serious  consequences. 

Even  alkaloidal  salts,  which  are  readily  soluble,  are,  perhaps,  in 
many  instances,  best  given  in  solution. 

Infants  require  liquid  medicines,  water  or  syrup  being  the  best 
vehicle.  Bitter  medicines,  like  quinine,  may  be  given  in  aromatic 
elixir  of  liquorice  or  syrup  of  yerba  santa.  As  a  general  rule  the 
metals  and  their  compounds  should  be  administered  in  the  form  of 
pills  or  in  a  small  quantity  of  fluid.  The  purgative  salts,  potas- 
sium iodide,  and  the  diuretics,  are  best  given  in  large  quantities  of 
fluid. 

Prof  H.  C.  Wood,  M.  D.,  has  written  so  clearly  upon  the  art  of 
combining,  or,  more  correctly  speaking,  associating,  medicines  that 
we  cannot  do  better  than  quote  his  observations  verbatim: 

"  The  art  of  combining  medicines  is  not  a  difficult  one,  but  in 
practice  certain  principles  should  not  be  lost  sight  of  Chief  of 
these  are,  to  prescribe  as  few  remedies  as  possible,  and  to  use  no 
powerful  drug  without  a  very  distinct  idea  of  what  it  is  intended  to 
do.  Whenever  it  is  desired  to  give  a  powerful  remedy  in  increasing 
doses  until  its  physiological  effect  is  produced,  it  should  always  be 
given  by  itself  Thus,  it  may  be  necessary  to  give  arsenic  so  as  to 
impress  the  system,  at  the  same  time  that  iron  is  indicated ;  but  the 
two  remedies  should  be  given  separately,  so  that  the  dose  of  either 
can  be  increased  or  diminished  independently  of  the  other." 

The  principles  of  combination  formulated  below  were  long  ago 
enunciated  by  Dr.  Paris,  but  are^  to-day  as  imperative  as  ever. 
Medicines  are  combined — 

"First.  To  augment,  correct,  or  modify  the  action  of  a  medicine. 
Thus,  purgatives  act  much  more  kindly  when  a  number  of  them 
are  united  together.  The  chief  reason  of  this  probably  is  that,  as 
different  remedies  affect  different  portions  of  the  gut,  the  whole  in- 
testine is  best  reached  by  a  union  of  the  diverse  substances.  It 
may  take  an  intense  irritation  of  the  mucous  membrane  to  purge 
as  actively  as  does  a  mild  irritation  of  both  the  mucous  membrane 
and  the  muscular  coat. 

"  There  are  powerful  medicines  which  act  similarly  upon  some 
parts  of  the  organism,  but  dissimilarly  upon  other  parts.     By  com- 


PHESCR/PTIONS.  787 

billing  such  remedies  powerful  effects  can  be  obtained  at  the  points 
where  the  two  hnes  of  action  cross  each  other,  without  influencing 
to  a  great  extent  other  portions  of  the  system.  Thus,  chloral  pro- 
duces sleep  by  its  action  upon  the  brain,  and  also  has  a  distinct 
influence  upon  the  heart,  but  none  upon  the  intestinal  tract.  Mor- 
phine acts  upon  the  brain,  and  does  not  influence  the  heart,  but  has 
a  powerful  effect  upon  the  intestinal  tract.  By  combining  chloral 
and  morphine  we  get  an  overwhelming  conjoined  influence  upon 
the  brain  in  producing  sleep,  with  the  least  possible  disturbance  of 
the  heart  and  of  the  intestinal  tract. 

"  Second.  To  obtain  the  joint  action  of  two  or  more  diverse 
remedies.  Thus,  in  a  cough-mixture  morphine  may  be  included  to 
quiet  the  cough,  whilst  ipecacuanha  and  squill  (in  accordance  with 
the  first  principle)  are  added  to  affect  the  mucous  membrane.  The 
appHcation  of  this  principle  requires  caution,  or  the  practitioner 
will  be  led  into  that  chief  abomination — polypharmacy.  It  is  worse 
than  futile  to  attempt  to  prescribe  for  every  symptom.  It  is  the 
underlying  cause  of  the  disorder,  or  the  under-stratum  of  bodily 
condition,  which  must  be  sought  out  and  prescribed  for  simply. 

"  Third.  To  obtain  a  special  combination  which  is  really  a  new 
remedy,  or  which  experience  has  shown  acts  almost  ds  a  new 
remedy.  Thus,  when  to  potassium  iodide  in  solution  corrosive 
sublimate  is  added  a  new  chemical  compound  (potassio-mercuric 
iodide)  is  formed,  which  experience  has  shown  to  be  of  great  value 
in  syphilitic  diseases.  Griffith's  antihectic  mixture  (mistura  ferri 
comp.)  is  another  instance  of  the  use  of  chemical  changes,  the 
protocarbonate  of  iron  (ferrous  carbonate)  being  formed  out  of 
the  sulphate  of  the  metal  and  the  potassium  carbonate.  In  the 
famous  Dover's  powder  no  chemical  change  occurs,  but  the  ordi- 
nary action  of  opium  upon  the  skin  is  so  enhanced  by  the  ipecac 
that  the  combination  may  be  looked  upon  almost  as  a  new  remedy. 

"Fourth.  To  afford  a  suitable  form.  Thus,  acacia  is  added  to 
make  an  emulsion,  or  confection  of  rose  to  make  a  pill.  In  the 
choice  of  excipients  care  should  be  exercised  to  select  a  substance 
free  from  medicinal  properties,  having  no  chemical  incompatibility 
with  the  medicinal  agent  and  of  suitable  physical  character.  Bread- 
crumb often  makes  a  good  excipient  for  pills,  but  with  silver 
nitrate  it  is  chemically  incompatible,  on  account  of  the  sodium 
chloride  it  contains. 

"  When  writing  a  prescription  the  utmost  care  should  be  taken 
to  use. such  excipients  that  the  combination  should  not  only  be 


788  A    TEXT-BOOR'  OF  MA  TERIA  MEDICA. 

attractive  to  the  eye,  but  also  as  little  repulsive  to  the  palate  as 
may  be.  Whenever  possible  the  pill  form  should  be  employed 
with  bitter  or  disagreeable  medicines.  The  pill  may  be  readily- 
coated  with  silver-foil;  tonic  pills  may  be  coated  with  iron  hy 
shaking  or  rolling  them  in  ferri  pulvis  while  soft  and  sticky. 
Sugar-coated  pills  and  '  compressed  pills '  are  apt  to  get  so  hard 
and  insoluble  that  their  use  requires  caution.  In  regard  to  mixtures,, 
flavoring  oils  should  be  freely  used,  and  the  power  of  glycerin  to 
conceal  the  disagreeable  taste  of  many  substances  should  be 
remembered." ' 

As  vehicles  for  liquid  mixtures  for  internal  use  the  following 
classes  of  official  preparations  are  best  adapted — The  aromatic 
waters :  rose,  anise,  fennel,  and  the  mints  when  flavor  alone  is 
desired,  the  most  delightful  flavor  of  all  being  orange  flower 
water.  The  aromatic  syrups :  orange,  orange  flower,  and  tolu 
when  it  is  desired  to  disguise  the  taste  and  to  suspend  resinous  or 
otherwise  sparingly  soluble  substances  in  the  mixture.  The  elixirs 
when  in  addition  to  agreeable  flavor  it  is  desirable  to  employ  a 
vehicle  as  a  solvent  for  certain  salts  not  readily  soluble  in  water  or 
syrups.  The  elixirs  containing  about  25  per  cent,  of  alcohol,  they 
are  useful  vehicles  for  tinctures  and  fluid  extracts  of  resinous 
drugs  such  as  cubeb,  buchu,  uva  ursi,  valerian,  viburnum,  etc. 

When  flavor  alone  is  desired  the  elixir  aromaticum,  U.  S.  Ph.,. 
a  delightful  combination  of  orange  and  other  aromatics,  should 
be  used.  To  disguise  the  taste  of  bitter  drugs,  as  in  the  last  men- 
tioned, elixirs  of  licorice,  or  of  eriodictyon  (yerba  salita)  are  mostly 
employed. 

Incompatibility. 

Due  regard  is  to  be  paid  to  the  mutual  chemical,  pharmaceutical,, 
and  therapeutical  relations  of  the  drugs  combined  in  a  prescription. 

When  different  substances,  whether  liquid  or  solid,  are  com- 
bined or  associated  and  undergo  a  more  or  less  complete  change,, 
they  are  said  to  be  incompatible,  the  incompatibility  consisting  of 
three  kinds  :  chemical,  pharmaceutical,  and  therapeutical,  although 
the  last  division  is  not  scientifically  correct,  since  one  substance 
cannot  be  therapeutically  incompatible  with  another,  although  it 
may  be  a  physiological  antagonist. 

The  incompatibles  and  antagonists  of  the  different  substances 
are  fully  mentioned  under  the  respective  drugs.  The  principles 
governing  incompatibility,  however,  may  well  be  considered  here. 

'  Therapeutics,  7th  edition,  pp.  108  et  seq. 


PRESCRIPTIONS.  789 

Chemical  incompatibility  is  of  the  most  importance. 
The  commonest  forms  of  chemical  incompatibility  occur  under 
the  following  conditions : 

1.  When  a  new  and  insoluble  salt  is  formed,  resulting  from  a 
mixture  of  solutions  of  soluble  salts.  Example  (i) :  mixing  solutions 
of  lead  acetate  and  zinc  sulphate,  both  soluble  salts,  but  producing 
by  chemical  decomposition  a  new  and  insoluble  salt,  the  sulphate 
of  lead,  which  is  precipitated. 

2.  By  the  addition  of  a  strong  acid  to  solutions  of  salts  of 
weak  or  volatile  acids,  such  as  carbonates  and  bicarbonates,  with 
resulting  decomposition.  Example  (2) :  ammonium  carbonate,  the 
salt  of  a  weak  acid  radical,  added  to  syrup  of  squills,  containing 
acetic  acid,  causes  decomposition  to  take  place,  with  effervescence 
and  the  liberation  of  carbonic  acid  gas. 

3.  Salts  of  a  feeble  or  volatile  base  are  decomposed  by  the 
addition  of  a  strong  alkali.  Example  (3) :  the  evolution  of  ammonia 
when  a  strong  alkali  is  added  to  ammonia  alum,  and  when  chloral 
hydrate  is  decomposed  by  alkalies,  such  as  aromatic  spirit  of 
ammonia,  lime  solution,  etc. 

4.  Alkaloids,  or  their  salts,  are  thrown  out  of  solution  or  pre- 
cipitated from  their  solutions  by  the  addition  of  alkalies  or  alkaline 
salts.  Example  (4)  :  sulphate  of  strychnine  in  solution  is  precipitated 
as  the  insoluble  bromide  of  strychnine  by  the  addition  of  a  larger 
proportion  of  potassium  bromide.  Quinine  sulphate  is  precipitated 
as  insoluble  quinine  acetate  when  mixed  with  a  solution  of  potas- 
sium acetate. 

5.  Tannic  and  gallic  acids  and  preparations  containing  them, 
as  well  as  many  other  vegetable  acids,  produce  discoloration  or 
precipitation  of  iron  and  many  of  its  compounds.  Example  (5) :  ink 
is  the  best  illustration  of  this  incompatibility.  Writing  fluids  are 
usually  combinations  of  tannic  or  gallic  acid  with  some  preparation 
of  iron.  Add  the  tincture  of  ferric  chloride  to  tincture  of  cinchona, 
and  notice  the  discoloration. 

There  are  certain  preparations  of  iron,  like  the  compounds  with 
ammonium  or  sodium  citrate  (see  tinct.  ferri  citro-chloride,  N.  F., 
tasteless  tincture  of  iron)  which  produce  little  discoloration  with 
vegetable  astringents,  and  none  at  all  with  vegetable  preparations 
containing  no  tannic  or  gallic  acid. 

Pharmaceutical  incompatibility  is  the  production  of  fewer  or 
more  insoluble  substances  in  mixtures  or  preparations  of  vegetable 
drugs,  associated  or  not  with  any  chemical  compounds.     Pharma- 


790 


A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 


ceutical  incompatibility  may  occur  in  liquids  or  solids,  although 
much  more  frequent  in  liquid  mixtures,  causing  a  separation  of 
either  inert  or  active  ingredients.  Examples :  vegetable  tinctures 
of  resinous  drugs  with  water,  such  as  tincture  of  guaiac  and  water; 
copaiba  and  oils  with  aqueous  preparations ;  spirit  of  nitrous  ether 
with  mucilage  of  acacia,  etc.  The  separation  or  precipitation  may 
frequently  be  prevented  by  the  intervention  of  some  viscid  sub- 
stance, such  as  syrup,  glucose,  glycerin,  mucilage  of  acacia,  etc. 

Incompatibility  may  be  both  chemical  and  pharmaceutical.  In 
the  following  list  the  substances  which  cannot  be  classed  as  incom- 
patible under  any  of  the  above  divisions  are  given  for  reference : 


Substance. 


Incompatible  with 

ji       ■  f  Alcohol,   alcoholic   and   ethereal   tinctures ;  *   borax ;    ferric 

l        chloride;    lead  salts. 
Acids  in  general    . 


chloride;    lead  salts. 
Alkalies,  alkaline  solutions;    metallic  oxides. 


Acid. 

Arsenous. 
Salicylic    .    .    . 

Tannic  .    . 

Bismuth. 

Subnitrate     .    . 
Chloral. 

Hydrate     .    .    . 

Iodine ... 

Lead. 

Acetate .    . 

Alercury. 

Bichloride     .    . 

Mild  chloride   . 
(Calomel) 
Potassium. 

Chlorate    .    .    . 

Iodide   .    . 

Permanganate  . 

Sodiutn. 

Bicarbonate  .    . 
Bromide    .    . 

Silver. 

Nitrate  .... 


I 


■J   Ferric  hydrate;  magnesia;   lime  water. 

Iron  compounds ;  potassium  iodide ;  *  lime  water. 
Alkalies,  carbonates  and  bicarbonates ;   lime  water;  chlorine 
water;  albumin;  gelatin. 

<    Calomel;*  sulphur;  tannin. 

r  Alkalies,  carbonates ;  *  ammonium  and  mercury  compounds ; 
I        potassium  bromide  and  alcohol. 

f  Ammonia;*  alkalies,  carbonates;  chloral;  metallic  salts; 
I        starch.* 

{Acacia;  acid  hydrochlor. ;  acid  sulphuric  and  sulphates; 
ammon.  chloride;  carbonates;  lime  water,  iodine;  potas- 
sium iodide;  tannin. 

•j   Potassium  iodide  ;_*  salts,  carbonates ;  tannin ;  borax. 

f  Acids,  acid  salts;  alkalies,  carbonates;  ammon.  chloride; 
\        iodine ;  potassium  iodide ;  ferric  chloride,  iodide ;  sulphur. 

J   Acids,  mineral ;  calomel ;  organic  substances ;  sulphur. 

f  Acids,  acid  salts ;  alkaloids ;  iron ;  lead  and  mercury  salts ; 
I        potassium  chlorate ;   silver  nitrate  ;  chlorine  water. 

(  Ammonia,  salts ;  alcohol ;  glycerin ;  ethereal  oils ;  organic 
/        substances. 

j   Acids,  acid  salts ;  acid,  tannic;  alkaloids;   metallic  salts. 

\  Acids,  mineral ;  chlorine  water ;  mercury  compounds. 

(  Acids,  acetic,  hydrochloric,  hydrocyanic,  sulphuric,  tartaric,  and 
■j  their  salts;  alkalies,  carbonates;  iodine;  potass,  iodide, 
*■        bromide;  sulphur. 

Those  marked  with  an  *  are  sometimes  directed  to  be  compounded  for  the  purpose 
of  effecting  some  special  change  or  producing  new  compounds. 


PRESCRIPTIONS.  791 

Among  the  above,  potassium  permanganate  forms  an  explosive 
mixture  with  glycerin ;  so  does  chromic  acid.  Chlorates  of  potas- 
sium, etc.  explode  when  triturated  with  sulphur.  The  strong  acids, 
nitric  and  sulphuric  acids,  and  especially  mixtures  of  these,  react 
so  strongly  with  volatile  oils  (hydrocarbons)  as  to  cause  explosion. 
Iodine  affects  these  oils  in  the  same  way — fulminates. 

It  not  infrequently  happens  that  the  physician  intentionally 
writes  a  chemically  incompatible  prescription.  "  Black  wash  "  and 
"  yellow  wash  "  are  examples.  Other  instances  are  such  pharma- 
copceial  preparations  as  liquor  ammonii  acetatis,  mistura  ferri  com- 
posita,  and  liquor  magnesii  citratis. 

Physiological  antagonists  are  often  given  together,  as  atropine 
and  morphine,  or  aconite  and  digitalis  in  certain  cases  of  cardiac 
arrhythmia. 

No  general  rule  can  be  laid  down  for  the  avoidance  of  so-called 
therapeutical  incompatibility.  Some  of  our  most  valuable  drugs 
contain  active  principles  which  are  physiologically  opposed  to  each 
other  in  their  action ;  instance  :  jaborandi,  which  contains  two  abso- 
lutely antagonistic  alkaloids,  pilocarpine  and  jaborine,  the  latter  in 
small  quantity,  yet  sufficient  to  control  the  action  of  the  former. 
Digitalis  contains  several  distinct  principles,  one  of  which,  digi- 
tonin,  is  the  direct  antagonist  of  the  others. 

Opium  is  a  conspicuous  example  of  a  complex  remedy,  con- 
taining, besides  gum,  sugar,  etc.,  eighteen  different  alkaloids,  two 
neutral  principles,  and  two  peculiar  acids ;  so  that  a  prescriber  of 
this  drug,  while  he  may,  perhaps,  flatter  himself  that  he  is  con- 
forming strictly  to  the  present  notions  of  pharmaceutical  simplicity, 
is  in  effect  a  polypharmacist  of  most  pronounced  type.  Moreover, 
not  only  are  the  constituents  of  opium  very  numerous,  but,  like , 
others  mentioned,  the  drug  affords  in  its  theba'ine  and  morphine 
a  further  illustration  of  direct  physiological  antagonism. 

The  author  cannot  too  strongly  recommend  that  physicians 
ignorant  of  the  physiological  action  of  drugs  in  large  and  small 
doses,  if  they  prescribe  at  all,  should  avoid  including  many  reme- 
dies in  one  prescription.  Such  practitioners  had  best  adhere  to  a 
single  remedy  or  adopt  homeopathy.  But,  given  a  competent  and 
thorough  knowledge  of  the  action  of  drugs  and  the  exact  condi- 
tion of  the  patient,  the  physician  is  justified  in  giving  one  or  twenty 
drugs  in  the  same  prescription,  since  he  is  perfectly  familiar  with 
the  several  agents  of  relief,  and  can  foretell  with  nicety  the  effect 
to  be  produced  by  their  combination ;  and  in  all  cases  a  physician 


792  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

should  be  as  certain  of  the  action,  strength,  and  reliabiHty  of  the 
drugs  he  administers  as  the  surgeon  of  the  aseptic  condition  of  his 
hands  and  instruments. 

Estimation  of  Amounts  in  a  Prescription. 

Having  decided  upon  the  various  ingredients  which  are  to  enter 
into  the  prescription,  the  next  consideration  is  the  amount  of  each 
desirable. 

In  the  first  place,  do  not  prescribe  more  than  the  prognosis 
seems  to  call  for.  If  in  your  judgment  the  patient  will  not  require 
medicine  more  than  five  or  six  days,  and  not  oftener  than  three 
times  a  day,  a  two-ounce  mixture  should  be  prescribed  if  a  liquid, 
or  the  required  number  of  pills,  powder,  capsules,  etc.  if  a  solid, 
is  desired. 

In  prescribing  liquid  medicines  note  must  be  taken  of  the 
several  sizes  of  medicine-vials,  their  capacities  being  in  this  coun- 
try 1,2,  and  4  fluidrachms,  and  i,  2,  3,  4,  6,  8,  12,  and  16  fluid- 
ounces.  In  the  larger  cities  vials  may  also  be  had  of  metric 
capacities — 30,  60,  90,  120,  240,  and  500  Cc.  While  it  is  not 
essential,  it  is  in  much  better  taste  to  have  a  prescribed  mixture 
aggregate  just  a  bottleful  of  one  of  the  above  sizes.  Where  two 
different  mixtures  for  the  same  person  are  prescribed,  or  differ- 
ent mixtures  for  different  persons  in  the  same  house  or  family, 
it  is  well  to  order  them  put  up  in  vials  of  different  sizes  to  avoid 
confusing  the  medicine.  This  is  especially  desirable  when  both 
internal  and  external  remedies  are  prescribed  for  the  same  person. 

The  amounts  of  the  ingredients  requisite  for  any  given  prescrip- 
tion are  determined  in  various  ways.  The  amount  of  the  active 
,  ingredients  will  of  course  be  the  product  of  two  factors,  the  quan- 
tity of  dose  and  the  number  of  doses  required ;  and  the  quantities 
must  be  such  as  can  be  expressed  in  the  system  of  weights  and 
measures  adopted,  and  indicated  by  round  numbers  such  as  best 
conform  to  the  relation  between  the  denominations  of  the  particular 
system  followed  in  the  prescription. 

There  is  no  difficulty,  in  computing  the  amounts  in  a  solid  mix- 
ture, powders,  pills,  or  suppositories,  especially  if  ten  or  its  multiple 
is  prescribed,  nor  in  external  preparations,  where  the  strength  is 
expressed  by  percentage,  and  are  therefore  most  conveniently  and 
accurately  prescribed  according  to  the  metric  system ;  but  many 
additional  considerations  occur  in  estimating  amounts  in  fluid 
mixtures. 


PRESCRIPTIONS.  793 

Frequently  solids  like  salts,  etc.  are  prescribed  in  solution,  but 
their  bulk  may  be  safely  disregarded  in  the  estimation  of  amounts 
of  the  hquid  measure ;  for  a  solid  in  the  quantity  usually  prescribed 
increases  the  whole  volume  of  the  solution  but  very  little.  Ordi- 
narily a  fluidrachm  (4.0  Cc),  or  a  teaspoonful,  should  not  contain 
over  5  grains  (33  Gm.),  nor  a  tablespoonful,  or  4  fluidrachms  (15.0 
Cc),  over  20  grains  (1.29  Gm.),  of  a  solid  in  solution,  unless  the 
substance  be  very  bland,  when  twice  these  quantities  are  permissible. 

The  following  is  a  very  simple  rule  for  estimating  amounts  in 
Apothecaries'  Measure : 

In  an  eight-ounce  mixture,  the  dose  being  a  drachm,  take  as 
many  drachms  of  the  medicine  as  there  are  wanted  minims  or 
grains  to  the  dose.  It  will  be  observed  that  in  this  case  the  basis 
is  an  ^^f^^ounce  mixture,  yet  it  typifies  the  rule,  which,  when 
thoroughly  understood,  may  easily  be  applied  to  a  four-ounce  or  a 
two-ounce  mixture,  one-half  or  one-fourth  as  many  drachms ; 
"while  if  the  dose  is  to  be  a  dessertspoonful,  or  two  drachms,  it  is 
only  necessary  to  take  one-half  as  many  drachms  to  an  eight-ounce 
mixture,  reducing  for  smaller  mixtures  in  accordance  with  the  rule. 
If  the  dose  be  a  tablespoonful,  or  four  drachms,  one-fourth  as  many 
drachms  must  be  taken  to  an  eight-ounce  mixture  as  there  are 
minims  or  grains  to  the  dose.  This  rule,  while  not  fractionally 
«xact,  is  sufficiently  accurate  for  all  practical  purposes. 

Examples :  We  desire  to  give  an  eight-ounce  mixture,  with  a 
drachm  for  a  dose,  each  dose  to  contain  12  grains  of  potassium 
bromide  and  10  grains  of  chloral,  the  vehicle  to  be  syrup  of  orange 
and  water.  We  have  here,  then,  64  doses  of  a  drachm  each  :  to  be 
■exact,  therefore,  we  should  have  768  grains  of  potassium  bromide, 
or  1 2  drachms  and  48  grains ;  but,  following  the  rule,  we  put  in 
the  mixture  12  drachms,  since  we  desire  12  grains  to  the  dose. 
Of  chloral  we  would  require  exactly  640  grains,  or  10  drachms 
and  40  grains,  but  we  use  the  round  number,  10  drachms,  in  the 
mixture.  We  see  that  in  each  case  there  is  but  the  fraction  of  a 
grain  short  in  the  dose. 

The  prescription  would  consequently  be  written  as  follows : 

'Sf.  Potassii  bromidi,  3xij ; 

Chloralis,  3x ; 

Syrupi  aurantii,  |iv ; 

Aquae,  q.  s.  ad  |viij. 

M.  et  ft.  sol.     Sig.  Teaspoonful  for  a  dose. 


794  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

This  is  more  of  each  ingredient  than  should  be  prescribed  in  a, 
fluidrachm.  It  were  better,  then,  that  the  dose  should  be  a  dessert- 
spoonful, or  two  drachms;  and  in  order  that  the  two  teaspoonfuls 
should  contain  only  12  grains  of  potassium  bromide  and  10  grains 
of  chloral,  the  whole  amount  of  the  medicament  must  be  divided 
by  2 — i.  e.  the  prescription  should  read : 

"Sf.  Potassii  bromidi,  3vj ; 

Chloralis,  3v ; 

Syrupi  aurantii,  Siv ; 

Aquse,  q.  s.  ad  gviij. 

M.  et  ft.  sol.     Sig.  A  dessertspoonful  for  a  dose. 

In  case  the  prescription  be  for  a  four-ounce  mixture,  with  a 
dessertspoonful  for  a  dose,  the  amounts  of  the  solid  substances 
would,  of  course,  be  one-half,  and  if  for  a  two-ounce  mixture,  one- 
fourth  of  the  above. 

When  writing  a  prescription  put  down  first  all  the  ingredients 
which  are  to  enter  into  the  combination,  and  after  the  last  one, 
which  is  usually  the  vehicle,  write  the  whole  amount ;  i.  e.  if  it  is 
to  be  a  four-ounce  mixture,  write  after  the  name  of  the  vehicle 
"  q.  s.  ad  f  §iv."  Then  begin  with  the  Basis,  the  first  ingredient, 
and  write  the  amount  required  in  the  whole  mixture.  In  other 
words,  decide  upon  the  doses  to  be  given  after  the  medicines  have 
been  selected. 

It  is  important  to  adopt  as  a  golden  rule  to  carefully  and  delib- 
erately read  over  the  entire  prescription  before  it  is  handed  to  the 
patient,  and  more  especially  to  scrutinize  each  item  and  the  quanti- 
ties to  guard  against  transposition  of  the  latter,  which  otherwise 
may  result  in  a  fatal  error. 

The  next  thing  to  be  determined  is  the  manner  in  which  the 
medicine  should  be  measured  out  to  the  patient  for  internal  use. 
A  graduated  medicine-glass  is  always  preferable  to  a  domestic 
measure,  and  should  be  ordered  in  all  cases..  Teaspoons,  as 
well  as  dessertspoons  and  tablespoons,  vary  considerably,  besides, 
owing  to  adhesion,  may,  according  to  the  manner  in  which  they 
are  filled,  show  a  variation  of  nearly  50  per  cent,  in  their  capacity. 
A  teaspoonful,  considered  to  be  equivalent  to  one  fluidrachm,  may 
contain  from  one-half  to  two  fluidrachms ;  a  dessertspoonful,  which 
should  be  equivalent  to  two  fluidrachms,  and  a  tablespoonful,  equal 
to  one-half  fluidounce,  vary  almost  as  much  in  capacity. 

It  is  necessary  to  be  exact  in  the  administration  of  medicines,  it 


PRESCRIPTIONS. 


795 


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796  A    TEXT-BOOK  OF  MATERIA  MEDIC  A. 

being  well  known  that  the  action  of  drugs  varies  greatly  with  the 
size  of  the  dose,  small  doses  in  their  action  being  often  directly 
opposite  to  large  doses. 

Ordinarily,  it  is  unwise  to  prescribe  medicines  to  be  dropped 
out,  since  a  drop  varies  greatly  in  dimension  according  to  the  vis- 
cosity and  specific  gravity  of  the  fluid,  the  shape,  size,  and  charac- 
ter of  the  neck  and  lip  of  the  bottle,  as  well  as  its  degree  of  fulness, 
and  the  steadiness  of  the  hand  in  dropping. 

In  computing  doses  of  powerful  medicines,  therefore,  always 
estimate  for  minims  instead  of  drops. 

Direct  the  use  of  a  "  dropper  "  or  minim  pipette  for  the  admin- 
istration of  liquids  by  drop  doses,  such  as  Fowler's  solution, 
collyria,  etc.  There  are  exactly  sixty  minims  of  any  fluid  to  one 
fluidrachm,  while  sixty  drops  may  be  fewer  or  more  than  one 
drachm,  as  the  following  list  shows : 

Drops  in  f  Sj  Weight  of  f  5j . 

(60  M.).  Gr.  Gm. 

Acidum  Carbolicum m  59  3-82 

Acidum  Sulphuricum  Aromaticum  ....    146  53  3-43 

^ther  Fortior 176  39  2-52 

Chloroformum  Purificatum 250  80  5.18 

Creasotum 122  56|  3.66 

Ext.  Belladonna  Fluidum 156  57  3-69 

Ext.  Colchici  Radicis  Fluidum 160  55  3-S6 

Ext.  Digitalis  Fluidum 134  62  ^.o\ 

Liq.  lodi  Compositus 63  59  3.82 

Liq.  Potassii  Arsenitis 57  55  3-5^ 

Oleum.  Caryophylli 130  57  3.69 

Oleum  Tiglii 104  50  3.24 

Spiritus  Ammonise  Aromaticus 142  48  3. 1 1 

Syrupus  Ferri  lodidi 65  77  4-98 

Syrupus  Scillse  Compositus 102  70  4.53 

Tinctura  Aconiti 146  46  2.98 

Tinctura  Belladonnse 137  53  3-43 

Tinctura  Cantharidis 131  51  3.33 

Tinctura  Ferri  Chloridi 150  53  3.43 

Tinctura  Nucis  Vomicae 140  44  2.85 

Tinctura  Opii 130  53  3.43 

Tinctura  Veratri  Viridis 145  46  2.98 

Vinum  Colchici  Seminis  1 1 1  54  3-49 


Language  and  Grammatical  Construction  of  Prescriptions. 

A  prescription  is  written  partly  in  Latin,  partly  in  English.  The 
name  of  the  patient  and  the  date  should  be  in  English ;  the  super- 
scription in  Latin  abbreviations ;  the  inscription  in  Latin ;  the  sub- 


PRESCRIPTIONS.  797 

scription  in  Latin  or  Latin  abbreviations;  and  the  signature,  or 
directions  to  the  patient,  in  English. 

A  prescription  properly  and  unmistakably  written  is  a  cardinal 
requisite  to  the  successful  administration  of  medicine,  no  less  than 
to  its  correct  preparation  by  the  druggist.  Every  practitioner  and 
pharmacist  should  possess  some  knowledge  of  Latin  grammar,  yet 
by  the  observance  of  a  few  simple  rules  one  wholly  ignorant  of 
the  language  may  acquire  a  proper  use  of  the  forms  generally 
adopted ;  and  a  little  study,  aided  by  constant  practice,  will  soon 
fix  in  the  memory  the  peculiarities  of  gender,  case,  and  number, 
together  with  the  agreement  of  adjectives,  to  be  met  with  in  all 
prescriptions. 

It  is  to  be  observed  that  the  Latin  tongue  has  been  chosen 
as  the  medium  of  medical  and  pharmaceutical  instructions  because 
of  its  conciseness,  stability,  and  universal  acceptance  by  the  scien- 
tific world.  Moreover,  the  Latin  name  is  specific,  while  the  English 
name  may  refer  to  several  drugs  of  entirely  different  properties : 
for  instance,  "Snake  root,"  applied  by  residents  of  this  or  that 
locality  to  Cimicifuga  racemosa,  Aristolochia  serpentaria,  Asarum 
Canadense,  Eupatorium  aromaticum,  Polygala  Senega,  etc. 

To  begin  with,  then,  the  prescription-writer  must  endeavor  to 
lay  aside  English  and  familiarize  himself  with  various  Latin  verbs 
(most  of  them  in  the  imperative,  or  commanding,  mood) ;  a  long  list 
of  drugs  and  medicines,  to  be  correctly  written  and  pronounced ; 
a  limited  number  of  adjectives,  agreeing  in  gender,  case,  and  number 
with  the  nouns  they  qualify ;  a  few  prepositions  governing  certain 
fixed  cases ;  and  a  small  number  of  terms  and  phrases  of  general 
importance.     Let  us  consider  them  seriatim. 

Verbs. 

The  first  item  of  a  prescription  is  a  verb :  recipe,  "  take,"  the 
sign  being  'Sf.  One  need  not  know  the  conjugation  of  the  Latin 
reclpere  to  understand  the  import  of  this  order.  Such  imperatives 
simply  signify  the  instructions  of  the  physician. 

A  very  few  verbs  are  used  in  the  subjunctive  mood,  having  the 
force  of  the  imperative,  such  as  flat,  pi.  fiant,  "  let  it,  or  them, 
be  made  (into,  in  pllulas) ;  or  "  let be  made,"  as  in  the  ex- 
pression/z«/  mistura,  "let  a  mixture  be  made";  sufflclat,  "may 
suffice,"  as  in  the  common  instruction,  abbreviated  "  q.  s.,"  quantum 
sufflciat,  "  as  much  as  may  be  required  " ;  ne  repetatur,  "  do  not  let 
it  be  repeated,"  or  "  do  not  repeat ";  balliat,  "  let  it  boil." 


798  A    TEXT-BOOK  OF  MA  TERIA   MEDICA , 

A  future  passive  participle  is  also  frequently  used :  dividendus, 
like  an  adjective  agreeing  with  the  noun  in  gender,  case,  and  num- 
ber, and  signifying  "  to  be  divided  (into),"  as  in  the  order  in  tro- 
chlscos  dividenda  (mSssa),  "  to  be  divided  into  troches,"  though  the 
imperative  divide,  ''  divide  into,"  is  often  used. 

Nouns. 

These  form  by  far  the  largest  vocabulary,  including  all  official 
and  nearly  all  unofficial  drugs  and  medicines,  together  with  their 
compounds.  A  considerable  number,  ending  in  a,  are  of  the  first 
declension,  all  feminine.'     Example : 

Si}tg'u/ar. 

Nominative.  —  Oliva       —  Olive  (subject). 

Genitive.        —  Ollvae       —  of  Olive. 

Accusative.   —  Olivam    —  Olive  (object). 

Ablative.       —  Oliva       —  with  Olive. 

Plural. 

Nom.  —  Ollvae  —  Olives  (subject). 

Gen.     —  Olivarum     —  of  Olives. 

Ace.    —  Ohvas  —  Olives  (object). 

Abl.     —  Olivis  —  with  Olives. 

[The  Latin  dative  and  vocative  cases  are  never  used,  and  the  plural  number  rarely.] 

An  extensive  list  of  medical  agents  ends  in  us  (generally 
masculine)  or  urn,  on  (neuter),  and  are  of  the  second  declension. 
(Prinos,  masc,  is  exceptional.)     Example: 

Sifigular. 
Nom.  —  Oleum     —     Oil  (subject). 
Gen.    —  Olei         —    of  Oil. 
Ace.    —  Oleum     —     Oil  (object). 
Abl.    —  Oleo        —     with  Oil. 

Plural. 
Nom.  —  Olea    —     Oils  (subject). 
Gen.    —  Oleorum,  Oleiim  —  of  Oils. 
Ace.    —  Olea    —     Oils  (object). 
Abl.    —  Oleis    —     with  Oils. 

'  The  genders  of  nouns  are  given  as  a  guide  to  the  agreement  of  adjectives. 


PRESCRIPTIONS.  799 

It  may  be  noted,  in  passing,  that  the  genitive  singular  is  almost 
exclusively  used  in  prescription-writing. 

We  are  now  prepared  to  analyze  a  simple  prescription  and 
understand  its  elements. 

Referring  to  the  foregoing  examples,  suppose  we  wish  the  drug- 
gist to  supply  three  drachms  of  olive  oil.    We  prescribe  as  follows : 

IJs.  Olei  Ollvae  giij. 

Recipe,  Take  of  oil  of  olives  three  drachms. 

It  must  be  borne  in  mind  that  the  direct  object  of  the  imperative 
recipe  in  this  example,  as  well  as  in  all  similar  cases,  is  not  the 
medicine  oleum,  but  the  amount  of  it  prescribed,  as  indicated  by 
the  Roman  numerals  and  the  symbol  of  Apothecaries'  weight, 
which,  written  in  full,  would  be  tres  drachmas  (ace).  In  this  class 
of  prescriptions,  therefore,  including  nearly  all  in  use,  we  need  con- 
sider only  the  genitive,  the  accusative  or  grammatical  object  of  the 
verb  being  expressed  in  the  quantity  symbolically  indicated. 

It  will  be  noted,  moreover,  that  the  construction,  or  order,  of 
the  Latin  words  is  the  reverse  of  English  usage.  Yet  it  is  evi- 
dent that  a  grocer's  clerk,  for  instance,  might  well,  and  frequently 
does,  employ  the  same  mode  of  expression : 

(of)  Granulated  Sugar  lbs  10 — 

a  construction  precisely  analogous  to  that  of  the  above  prescrip- 
tion, which  simple  form  may  be  taken  as  a  type  for  all,  subject  to 
such  modifications  as  the  nature  of  the  drug  and  the  treatment 
may  require. 

Nouns  of  the  second  declension  ending  in  on,  all  neuter,  are  of 
Greek  derivation,  and  are  declined  like  oleum.     Example : 

Singular. 
Nom.  —  Toxicodendron. 
Gen.    —  Toxicodendri. 
Ace.    —  Toxicodendron. 
Abl.    —  Toxicodendro,  etc. 

Pnnos,  also  of  Greek  origin,  is  declined: 

Nom.  —  Prmos. 
Gen.    —  Prini. 
Ace.    —  Prinon. 
Abl.    —  Prmo,  etc. 


8oo 


A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 


The  remaining  nouns  of  the  second  declension  all  end  in  us 
(with  four  exceptions,  masculine),  and  are  declined  like  the  follow- 
ing example : 

Nom.  —  Juniperus. 

Gen.    —  Juniperi. 

Ace.    —  Juniperum. 

Abl.     —  Junipero,  etc. 


Indeed,  all  prescription 

nouns 

ending  in  us  are  of  the  second 

declension,  save  seven : 

Nom. 

Gen. 

Rhus, 

Rhois,           3d  fern. 

CSrnus, 

Cornus,     K^h  fern. 
Quercus,  J 

Qufircus, 

Fructus, 

Frflctus,  ~v 
HaQstus, 

Haustus, 

Potus, 

■D_.             >  4th  masc. 
Potus,        1  ^ 

Spiritus, 

Spiritus,  . 

The  four  exceptions  to  tt 

le  masculine  gender  mentioned  are : 

Juniperus,  " 

Prunus, 

-  all  fem. 

Sambucus, 

Ulmus 

,        J 

With  these — to  be  committed  to  memory — the  second  declen- 
sion ends,  so  far  as  it  concerns  the  prescription-writer. 

While  touching  upon  the  fourth  declension  it  may  be  well  to- 
complete  the  study  of  it,  there  being  but  six  nouns,  ending  is  u^, 
of  this  declension  (Rhus  is  of  the  third).  They  are,  as  already 
enumerated : 

COrnus, 

Quercus, 

Fructus, 

Haustus, 

Potus, 

Spiritus, 


and  are  thus  declined : 


Singular. 
Nom.  —  Spiritus. 
Gen.     —  Spiritus. 
Ace.    —  Spiritism. 
Abl.     —  Spiritu. 


PRESCRIPTIONS.  8oi. 

Plural. 
Nom.  —  Spiritus. 
Gen.    —  Spiritum. 
Ace.    —  Spiritus. 
Abl.    —  Spiritibus. 

We  now  come  to  the  third  declension,  to  which  belong  all 
nouns  not  included  in  the  foregoing  first,  second,  and  fourth,  the 
fifth  Latin  declension,  like  the  dative  and  vocative  cases,  not 
being  used  in  prescriptions.  All  nouns,  with  seventeen  exceptions, 
having  terminations  other  than  a  (except  four),  us,  um,  and  on,  are 
of  the  third  declension. 

Here  the  changes  from  nominative  to  genitive  and  other  cases 
are  quite  variable,  and  may  be  best  remembered  by  arranging  the 
nouns  in  groups  according  to  their  nominative  endings,  with  ex- 
amples of  their  several  declensions. 

Group  I. — Thirty-three  nouns  ending  in  as  make  the  genitive 
in  aits.  All  are  masculine  save  Asclepias  (Gen.  Asclepiadis),  which 
is  feminine,  and  all  are  names  of  salts.     Example : 

Singular. 
Nom.  —  Nitras. 
Gen.    —  Nitratis. 
Ace.    —  Nitratem. 
Abl.    —  Nitrate,  etc. 
Group  II. — 

Nouns  ending  in  is  : 
{a)  Genitive  unchanged  ;  all  feminine. 

Ex.  Nom.  Cannabis ;  Gen.  Cannabis. 
{b)  Genitive  changing  into  ttis,  all  masculine. 

Ex.  Nom.  Arsenis ;  Gen.  Arsenitis. 
{c)  Genitive  changing  into  idis,  all  feminine. 

Ex.  Nom.  Hamamelis;  Gen.  HamamSlidis. 
{d)  Genitive  changing  into  eris,  one  only,  masculine. 
Ex.  Nom.  Pulvis ;  Gen.  Pfllveris; 

Group  III. — 

Nouns  ending  in  o,  all  feminine  except  Carbo,  Pepo,  and 
Sapo,  which  are  masculine: 
{a)  Genitive  ending  in  onis. 

Ex.  Nom.  Lotio ;  Gen.  Lotionis. 
(J?)  Genitive  ending  in  inis. 

Ex.  Nom.  Mueilago ;  Gen.  Mucilaginis. 

51 


8o2  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Group  IV. — 

Nouns  ending  in  x,  masculine  or  feminine : 
{a)  Genitive  ending  in  els. 

Ex.  Nom.  Borax ;  Gen.  BOracis. 
{b)  Genitive  ending  in  els,  and  the  last  vowel  of  the  nomina- 
tive {/)  changed  to  i. 
Ex.  Nom.  Rum^x;  Gen.  Rumzcis. 

Group  V. — 

Nouns  ending  in  r,  masculine  or  neuter  : 
Genitive  simply  adds  Is. 

Ex.  Nom.  Liquor;  Gen.  Liquoris. 

Group  VI. — 

Nouns  ending  in  a,  all  neuter : 
Genitive  ends  in  Atis. 

Ex.  Nom.  Enema ;  Gen.  Enematis. 

Group  VII. — 

Nouns  ending  in  s,  masculine  or  feminine : 
Genitive  ends  in  is. 

Ex.  Nom.  Adeps  ;  Gen.  Adipis. 

Group  VIII. — 

Nouns  ending  in  /,  all  neuter  : 
(«)  Genitive  simply  adds  Is. 

Ex.  Nom.  Chloral;  Gen.  Chloralis. 
(^)  Genitive  doubles  /  and  adds  is. 

Ex.  Nom.  Mel ;  Gen.  MeUis. 

Group  IX. — 

Nouns  ending  in  n,  all  neuter : 
(«)  Genitive  ending  in  onis  (nominative  in  oil). 

Ex.  Nom.  Limon ;  Gen.  Limonis. 
(Jj)  Genitive  ending  in  inis  (nominative  in  en). 
Ex.  Nom.  Semen  ;  Gen.  Seminis. 
[Erigeron  has  the  genitive  ErigerOntis.J 

Group  X. — 

One  noun  ending  in  c,  neuter : 
Genitive  simply  adds  Is. 

Ex.  Nom.  Lac;  Gen.  Lactis. 

In  conclusion,  there  are  a  number  of  indeclinable  nouns,  such 
being  all  neuter,  of  various  endings  and  derivations. 


PRESCRIPTIONS. 


803 


Adjectives. 

These  are  many,  and,  as  has  been  said,  their  agreement  in 
gender,  case,  and  number  with  the  nouns  they  qualify  is  of  para- 
mount importance  in  correct  prescription-writing.  They  are  de- 
clined like  nouns  of  different  declensions,  having  the  same  cases 
and  numbers,  and  may  be  divided  into  two  classes. 

Class  I.  includes  all  but  fourteen  of  the  adjectives  used  in  pre- 
scriptions. The  nominative  has  three  distinct  endings  :  us,  mascu- 
line, declined  like  the  second  declension  of  nouns ;  a,  feminine, 
declined  like  the  first  declension ;  and  um,  neuter,  declined  like  the 
second  declension.     Example : 

Singular. 


(2d  ded.) 

(ist  decl.) 

(2d  decl.) 

Masc. 

Fern. 

Neut. 

Nom. 

Fluidus, 

Fluida, 

Fluidum. 

Gen. 

Fluidi, 

Fluidse, 

Fluidi. 

Ace. 

Fluidum, 

Fluidam, 

Fluidum. 

Abi. 

Fluido, 

Fluida, 

Fluido. 

Plural. 
Nom.  Fluidi,  Fluidse,        Fluida. 

Gen.     Fluidorum,    Fluidarum,  Fluidorum. 
Ace.     Fluidos,         Fluidas,        Fluida. 
Abl.     Fluidis,  Fluidis,        Fluidis. 

Class  II.  includes  the  remaining  fourteen  adjectives  in  use. 
These,  with  few  exceptions,  have  two,  instead  of  three  endings : 
one  in  is  for  both  mascuHne  and  feminine  genders,  and  another 
in  e  for  the  neuter.  Adjectives  of  this  class  are  declined  like  nouns 
of  the  third  declension.     Example  : 


Singular. 

Masc.  and  Fern. 

Neut. 

Nom.    Dulcis, 

Dulce. 

Gen.     Dalcis, 

DQlcis. 

Ace.     Dulcem, 

Dolce. 

Abl.      DQlci, 

Dulci. 

(The  form  Dalce  is  sometimes  wrongly  used  for  the  ablative.) 

8o4 


A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 


Plural. 


Nom. 

Dulces, 

DQlcia. 

Gen. 

Dulcium, 

Dalcium. 

Ace. 

Dulces, 

Dulcia. 

Abl. 

Dulcibus, 

DQlcibus. 

The  exceptions  in  nominative  endings  are — 


(I) 


Nom. 
Gen. 
Ace. 
Abl. 


Singular. 

Masc.  and  Fern. 

Effervescens, 

Effervescfintis, 

Effervescgntem, 


Neut. 

Effervescens. 

Effervescentis. 

Effervescens. 


Effervescente,  or  -i,  Effervescente,  or  u 


Plural. 

Nom.  Effervescentes, 

Gen.  Efifervescentium, 

Ace.  Effervescentes, 

Abl.  Effervescentibus. 


Effervescentia. 
Effervescentium. 
Effervescentia. 
Effervescentibus, 


Singular. 

(2)     Nom.  Tricolor, 

Gen.  Trieoloris, 

Aec.  Tricolorem, 

Abl.  Tricolore,  or  -i. 


Tricolor. 
Trieoloris. 
Tricolor. 
Tricolore,  or  -i. 


Plural. 

Nom.  Trieolores, 

Gen.  Tricolorum, 

Aec.  Trieolores, 

Abl.  TricolOribus, 

Singular. 

Masc,  and  Fern. 

(3)     Nom.  F6rtior, 

Gen.  Fortioris, 

Ace.  Fortiorem, 

Abl.  Fortiore,  or  -i, 


Trieolora. 
Tricolorum. 
Trieolora. 
TricolSribus. 


Neut. 

Fortius. 
Fortioris. 
Fortius. 
Fortiore,  or  -i. 


PRESCRIPTIONS.  805 

Plural. 

Nom.  Fortiores,  Fortiora. 

Gen.    Fortiorum,  Fortiorum. 

Ace.    Fortiores,  Fortiora. 

Abl.     FortiOribus,  FortiOribus. 

Numerals  as  far  as  quatuor  are  declined  like  adjectives  of  three 
terminations : 

Singular. 


Masc. 

Fern. 

Neut. 

(i)  Nom. 

Unus, 

Una, 

Unum. 

Gen. 

Unius, 

Unius, 

Unius. 

Ace. 

Unum, 

Unam, 

Unum. 

Abl. 

Uno, 

Una, 
Plural 

Uno. 

(2)  Nom. 

Duo, 

Duae, 

Duo. 

Gen. 

Duorum, 

Duarum, 

Duorum. 

Ace. 

Duos, 

Duas, 

Duo. 

Abl. 

Duobus, 

Duabus, 
Plural 

Duobus. 

Masc. 

Fern. 

Neut. 

(3)  Nom. 

Tres, 

Tres, 

Tria. 

Gen. 

Trium, 

Trium, 

Trium. 

Ace. 

Tres, 

Tres, 

Tria. 

Abl. 

Tribus, 

Tribus, 

Tribus. 

[The  ordinal  numbers,  primus,  secflndus,  tgrtius,  etc.,  are  not 
used  in  prescription-writing.] 


Conjunctions — Adverbs. 

Conjunctions  are  rare,  except  it,  and.  Adverbs  are  very  seldom 
employed. 

Prepositions. 

Three  prepositions  govern  the  accusative  case :  dd,  to,  up  to ; 
In,  into ;  and  supra,  upon.     Others  are  rarely  used. 

Two  prepositions,  oftenest  used,  govern  the  ablative  case :  cUm, 
with,  s.ndpro,  for. 


8o6  A    TEXT-BOOK  OF  MA  TERIA  MEDICA. 

Words  and  Phrases. 

Ad  libitum,  at  pleasure. 

Ad  saturdnduui,  to  saturation. 

Ana,  aa,  of  each. 

Bene,  well, 

Bis,  twice. 

Bis  indies,  twice  a  day. 

Clbus,  food. 

Cochleare  medium,  a  dessertspoon(ful). 

Cochleare  magnum,  a  tablespoon(ful). 

Cochleare  pdrvuni,  a  teaspoon(ful). 

Collutorium,  a  mouth-wash. 

Dein,  afterward. 

Dimldius,  half 

Dosus,  a  dose. 

Et,  and. 

Extlnde  supra,  spread  upon. 

Gradatim,  gradually. 

Gutta,  a  drop. 

Guttdtim,  drop  by  drop. 

Hora,  an  hour. 

In  dies,  daily. 

Lagena,  a  bottle. 

Libra,  a  pound. 

Llnteum,  lint. 

Mane,  in  the  morning. 

J/««f  pruno,  early  in  the  morning. 

i!/z<:«  />««w,  a  breadcrumb. 

iV5«,  not. 

NOcte,  at  night. 

Numerus,  a  number. 

Numei'o,  in  number. 

Octarius,  a  pint. 

Partes  cequales,  in  equal  parts. 

/V5  r^  «a^«,  as  required. 

Quantum  sufficiat,  q.  s.,  as  much  as  is  necessary. 

Quaqua  hord,  every  hour. 

Saturatus,  saturated. 

Scdtula,  a  box. 

Seinel,  once. 


PRESCRIPTIONS.  807 

Semlssis,  ss.,  a  half. 
Semidrdchma,  half  a  drachm. 
Simul,  together. 
Sine,  without. 
Stdtim,  immediately. 
Tales,  such. 

Tales  doses,  such  doses. 
Tere  simul,  rub  together. 
Ter  in  die,  three  times  a  day. 

These  complete  the  list  of  Latin  parts  of  speech,  conjugations, 
declensions,  etc.,  with  which  the  prescription-writer  is  likely  to  be 
concerned. 

There  are  niceties  of  Latin  construction  which,  to  one  acquainted 
with  that  idiom,  will  readily  occur  in  scanning  the  order  of  words  in 
certain  medicinal  compounds.  Having  the  sanction  of  professional 
usage,  the  departure  from  the  classic  arrangement  is  of  slight 
importance,  and  it  is  certainly  in  accordance  with  the  clearer,  more 
direct  English  form.  Instance  the  construction  in  what  are  known 
as  "  Galenical  Preparations "  (an  objectionable  adjective,  by  the 
way,  being  at  variance  with  the  rules  of  etymology,  since  the  c  of 
the  derivative  is  wanting  in  the  parent  word  Galen).  In  writing 
these  the  nominative — UnguSntum,  Mistura,  Tinctura,  etc. — is 
placed  first,  as,  Ungufintum  Zinci  Oxidi,  etc.  Oleum  Mdrrhuae 
is  also  an  example,  and  others  are  not  uncommon,  apart  from  the 
Galenical  order. 

The  practical  difficulties  in  writing  prescriptions  correctly  are 
largely  eliminated  by  the  almost  exclusive  use  of  the  genitive.  Yet 
it  is  necessary  to  understand  clearly  the  use  of  the  accusative  in  all 
cases  where  the  medicine  is  prepared  from  the  mass  according  to 
certain  established  formulae,  and  moulded  in  certain  forms,  if  not 
already  prepared,  as  in  the  condition  of  pills,  troches,  etc.,  which 
are  the  immediate  object  of  the  imperative  recipe,  and  cannot  be 
placed  in  the  genitive. 

Example : 

'Sf.  Pilulas  (not  Pilularum)  Ferri  lodidi  (a  number). 

Where  the  mass  is  mentioned  or  implied  in  the  prescription,  the 
general  rule  of  the  genitive  is  followed,  as :  I^s.  Ungugnti  Bella- 
donnae  (a  portion) ;  and  where  the  terms  flat,  fiant  are  expressed, 
the  nominative  is  naturally  used,  as,  for  example. 


8o8  A    TEXT-BOOK  OF  MA  TERIA   MEDICA. 

I|«.  Massae  hydrargyri,  gr  xxx ; 

Flant  pilulse  No.  x. 
Sig.  Take  one  at  bed-time. 

Here  pllulce  is  the  subject  of  the  Latin  irregular  verb  signifying 
"  to  be  made,"  no  case  save  the  nominative  being  admissible. 

It  has  been  presumed  in  the  foregoing  pages  that  all  prescrip- 
tions are  to  be  written  in  full— a  practice  which,  could  it  meet  with 
universal  acceptance,  would  not  infrequently  be  of  vital  importance 
alike  to  patient  and  practitioner.  Custom,  however— and  in  certain 
cases  advantageously — has  authorized  the  extensive  use  oi  abbrevia- 
tions, although  the  dangers  of  carelessness  or  ignorance  in  their 
employment  will  be  apparent  if  we  consider  that,  for  example, 
Amman,  may  mean  either  Ammonia  or  Ammoniacum;  Chlor., 
Chlorum,  Chloral,  Chloroformum,  Chloras,  or  Chloridum ;  Hyd. 
Chlor.,  Hydrate  of  Chloral  or  Hydrargyri  Chloridum  Corrosivum 
or  Mite ;  Sulph.,  Sulphur,  Sulphas,  Sulphidum,  or  Sulphis ;  Zinc. 
Pkos.,  Zinci  Phosphas  or  Zinci  Phosphidum. 

These  are  but  few  of  the  many  instances  of  ambiguity  occa- 
sioned by  inadvertence  or  want  of  familiarity  with  the  full  Latin 
form,  or  at  least  its  recognized  and  unmistakable  abbreviation. 

In  conclusion,  let  the  writer  of  prescriptions  be  warned  against 
too  great  haste  and  a  chirography  which  none  but  its  author  'can 
decipher — a  deficiency  for  which  he  alone  is  responsible,  though 
the  onus  may  fall  upon  the  luckless  druggist  or  his  bewildered 
clerk. 

With  regard  to  form,  it  has  been  our  object  to  show  that  there 
is  really  little  difficulty  in  writing  good  prescription  Latin,  and 
where  the  slightest  chance  of  error  exists  the  ampler  expression,  as 
we  have  strongly  urged,  should  be  used.  A  clear,  business-like 
method,  deliberately  chosen  and  consistently  pursued,  will  render 
this  important  item  of  the  physician's  labor  simple,  agreeable,  and 
efficient. 

It  is  necessary  not  only  that  the  directions  to  the  patient  should 
be  written  in  perfectly  legible  English  and  in  full,  but  that  they 
should  contain  the  exact  dose,  time  for,  and  method  of  taking,  and, 
in  short,  every  detail  which  it  may  be  advisable  for  the  patient  and 
nurse  to  know,  clearly  and  intelligibly  expressed.  A  physician  is 
seldom  justified  in  writing  merely  "As  directed,"  the  full  directions 
being  the  only  clue  to  the  safety  of  the  medicine.  Moreover, 
verbal  instructions  to  the  patient  or  attendant  may  be  partially  or 


PRESCRIPTIONS.  809 

€ven  wholly  forgotten,  or  confounded  with  directions  relating  to 
other  matters  connected  with  the  case,  and  thus  the  welfare  of  the 
patient  be  endangered. 

All  preparations  intended  for  external  or  local  application  or  for 
injections  should  be  marked  accordingly,  "  For  External  Use,"  etc. ; 
and  if  the  agent  be  a  poisonous  mixture,  a  "  Not-to-be-taken  "  label 
should  be  attached  to  the  bottle.  If  a  mixture  is  ordered  contain- 
ing an  insoluble  substance,  a  "  Shake-well  "  label  should  be  used. 

Should  it  be  necessary  to  prescribe  an  extraordinary  dose  of 
sonie  powerful  drug,  the  name  of  the  remedy  should  be  under- 
scored or  attention  called  to  it  by  a  X,  referring  to  the  bottom  of 
the  prescription,  where  should  be  written :  "  Large  dose  intended," 
or  "  Dose  of  above  correct,"  or  something  to  indicate  to  the  phar- 
macist that  the  writer  is  fully  aware  of  the  unusual  amount,  and 
thus  save  delay  in  consulting  with  the  physician — which  a  careful 
and  competent  druggist  would  otherwise  do.  Should  it,  in  the 
■opinion  of  the  physician,  be  undesirable  to  repeat  the  prescription,  he 
should  write  at  the  bottom,  "  Do  not  repeat,"  or  the  customary 
Latin,  "  Ne  repetatur." 

Every  prescriber  should  be  supplied  with  suitable  prescription- 
blanks  arranged  in  the  form  of  pads  conveniently  carried  in  the 
pocket,  a  suitable  size  being  four  by  five  inches.  The  paper  should 
be  of  linen,  of  good  quality;  otherwise  it  is  liable  to  become 
detached  from  the  druggist's  files  and  lost. 

It  is  certainly  advisable  for  the  physician  to  write  his  prescrip- 
tions invariably  in  ink,  since  pencil  is  easily  erased,  and  a  pre- 
scription thus  perishable  would  be  of  little  use  in  medico-legal 
emergencies.  Besides,  an  unscrupulous  druggist  who  had  been 
careless  in  compounding  the  remedy  might  easily  change  the  pencil 
instructions  to  conform  to  his  mistake.  Finally,  the  pencil-writing 
is  always  liable  to  be  erased  or  partially  obliterated  when  carried 
for  some  time  or  subjected  to  frequent  handling. 

The  prescription-blank  should  have  printed  neatly  upon  one 
margin  or  the  back  the  physician's  residence  and  office,  together 
with  hours  for  consultation,  and  telephone  number  if  he  has  one. 
This  advertises  the  physician  to  some  extent  in  a  legitimate  way, 
besides  enabling  the  patient  or  druggist  to  communicate  with  him 
readily  if  necessary. 

It  is  a  matter  of  personal  taste  whether  the  druggist's  name 
should  appear  upon  the  blank.  Considerations  of  courtesy  and  the 
possible  event  of  loss  or  of  legal  contingencies  may  weigh  with 


8lO  A    TEXT-BOOK  OF  MATERIA   MEDIC  A. 

some  practitioners,  though  others  are  of  the  opinion  that  it  is  un- 
desirable to  print  anything  on  the  blank  save  the  physician's  name, 
office,  hours,  and  telephone  number. 

The  prescription  should  always  be  signed  by  the  writer  in  full, 
that  professional  responsibility  and  identity  jnay  be  assured,  the 
academic  "  M.  D."  being  preferable  as  a  title  td^"  Dr.,"  which  is 
applicable  to  various  professions — often  of  questionable  repute  and 
authenticity. 

In  concluding  these  practical  hints,  the  author  cannot  too 
strongly  impress  upon  the  student  the  importance  of  always  writing 
as  clear,  legible,  complete,  and  classical  a  prescription  as  possible. 
In  a  new  community  the  reputation  of  the  recent  graduate  is  often 
dependent  upon  the  character  of  the  prescription  he  writes.  The 
druggist  invariably  scans  his  instructions  from  the  new  doctor  criti- 
cally, and  the  laity  and  the  profession  will  soon  learn  the  young 
aspirant's  proficiency  or  ignorance  by  his  pubhc  committal  in  a  pre- 
scription. No  matter  how  able  a  diagnostician,  pathologist,  or  bac- 
teriologist he  may  be,  if  his  first  effort  in  prescription-writing  be 
illegible,  poor  Latin  or  for  a  hopelessly  incompatible  mixture,  the 
druggist  will  label,  classify,  and  measure  him  with  the  keenness  of 
professional  insight ;  the  judgment  will  go  forth  quietly;  and  years 
of  successful  practice  may  not  serve  to  eradicate  that  first  unfavor- 
able impression. 


CLINICAL  INDEX. 


Abrasions — 

Isinglass,  781 

Potassium  nitrate,  590 

Protectives,  772 
Abscess — 

Calcium  phosphate,  206 

Cocaine,  496 

Cod  liver  oil,  136 

Onion  poultice,  620 

Phytolacca,  585 

Solution  of  ammonium  acetate,  597 
Acidity  of  Stomach — 

Alkalies,  162 
_.     Ammonium  preparations,  575 
Acne — 

Fowler's  solution,  241 

Hydrastine  ointment,  485 

Ichthyol,  326 

Phosphorus,  203 

Pyrogallic  acid,  713 

Quinine,  2i6 

Salicylic  acid,  316 

Sulphur,  670 
Acne  Rosacea — 

Bismuth  subnitrate,  751 

Ergot,  481 

Hamamelis,  720 

Ichthyol,  326 

Resorcin,  324 
Aconite-poisoning — 

Atropine,  460 

Digitalis,  545 
Adenitis — 

Camphorated  naphtol,  322 

Pilocarpine,  595 

Potassium  iodide,  252 
After-pains — 

Black  haw,  518 

Camphor,  387 
Albuminuria — 

Arsenic,  ,243 
Alcoholic  Tremor — 

Cocaine,  497 
Alcoholism — 

Aromatic  spirit  of  ammonia,  575 

Cocaine,  497 

Coffee,  558 

Solution  of  ammonium  acetate,  597 

Strychnine,  473 

Tincture  of  lupulin,  445 

Zinc  oxide,  735 


Alopecia — 

Aqua  ammonia,  575 

Capsicum,  365 

Nutgall  ointment,  714 

Pilocarpine,  595 

Quinine,  215 

Savine,  704 

Tannic  acid,  711 

Tincture  of  cantharides,  765 

Turpentine,  643 
Amaurosis — 

Strychnine,  472 
Amblyopia — 

Pilocarpine,  595 
Amenorrhea  — 

Aloes,  674 

Ammonium  chloride,  61 7 

Apioline,  707 

Ergot,  480 

Guaiac,  260 

Iron,  196 

Quinine,  216 

Sanguinaria,  266 

Savine,  704 

Senega,  626 

Tansy,  706 

Tincture  of  cantharides,  765 
Anal  Fissure — 

Belladonna  ointment,  459 

Bismuth  subnitrate,  751 

Chloral,  417 

Cocaine,  496 

Fluid  extract  of  hydrastis,  485 

Geranium,  721 

Glycerin,  774 

Iodoform,  331 

Krameria,  718 

Red  rose,  723 

Sulphur,  671 

Tannic  acid,  711 

Tincture  of  iodine,  252 

White  oak,  715 

Zinc  oxide,  735 
Anemia — 

Arsenic,  242 

Bone  marrow,  219 

Cod  liver  oil,  135 

Copper,  739 

Digitalis,  543 

Hypophosphites,  206 

Iron,  195 

811 


8l2 


CLINICAL  INDEX. 


Anemia — 

Manganese,  198 

Nuclein,  219 

Phosphoric  acid,  143 

Potassium  chlorate,  351 

Potassium  permanganate,  347 

Red  wine,  571 

Strychnine,  471 
Aneurysm — 

Digitalis,  543 

Diuretin,  653 

Ergot,  480 

Iodides,  252 

Lead  acetate,  731 
Angina  Pectoris — 

AUyl  tribromide,  620 

Amyl  nitrite,  526 

Arsenic,  243 

Cactus,  552 

Chloral,  418 

Compound  spirit  of  ether,  400 

Hydrogen  dioxide,  352 

Phosphorus,  203 

Zinc  sulphate,  736 
Anginose  Scarlatina — 

Sodium  sulphocarbolate,  308 
Anorexia — 

Simple  bitters,  178 
Anosmia — 

Strychnine,  470 
Anthrax — 

Serum-therapy,  300 
Aortic  Regurgitation — 

Adonidin,  553 

Cactus,  552 

Digitalis,  541 
Apepsia — 

Pepsin,  130 
Aphonia — 

Alum,  748 

Blisters,  761 

Bromides,  533 

Nitric  acid,  143 

Potassium  bichromate,  349 
Aphthae — 

Borax,  345 

Catechu,  716 

Magnesia,  164 

Red  rose,  723 

Rhus  glabra,  722 

Saccharine,  656 

Sodium  bicarbonate,  1 62 

Sodium  sulphocarbolate,  308 
Apoplexy — 

Croton  oil,  684 
Arrhythmia  — 

Cactus,  552 

Nitroglycerin,  526 
Arsenical  Poisoning — 

Hydrated  sesquioxide  of  iron,  240 

Lime  water,  164 

Magnesia,  240 
Arterio-sclerosis — 

Diuretin,  653 


Arterio-sclerosis — 

Nitroglycerin,  526 
Arthritis,  Chronic — 

Cod  liver  oil,  135 
Ascarides — 

Carbolic  acid,  307 
Ascites — 

Colchicum,  257 

Colocynth,  690 

Copaiba,  648 

Diuretin,  652 

Elaterin,  685 
Aspergillus — 

Salicylic  acid,  316 
Asphyxia — • 

Alcohol,  570 

Mustard,  768 
Asthenopia — 

Physostigmine,  512 
Asthma — 

Adonidin,  553 

AUyl  tribromide,  620 

Amyl  nitrite,  526 

Arsenic,  241 

Belladonna,  459 

Bromides,  533 

Caffeine,  558 

Chloral,  418 

Cocaine,  497 

Colchicum,  257 

Conium,  501 

Grindelia,  507 

Hydrogen  dioxide,  352 

Hyoscyamus,  464 

Iodides,  253 

Ipecac,  612 

Lobelia,  614 

Nitre-paper,  591 

Opium,  438 

Physostigma,  513 

Pilocarpine,  595 

Quinine,  215 

Spartein  sulphate,  551 

Stramonium,  461 

Strychni/ie,  472 

Terpin  hydrate,  628 

Zinc  oxide,  735 

Zinc  sulphate,  736 
Atheroma — 

Cod  liver  oil,  136 
Aural  Catarrh — 

Ammonium  chloride,  61 7 

Balanitis — 

Alumnol,  322 
Silver  nitrate,  744 
Bed-sores — 
Alcohol,  569 
Emollients,  772 
Glycerin,  774 
Lead  tannate,  732 
Protectives,  772 
Silver  nitrate,  743 
Tannic  acid,  711 


CLINICAL  INDEX. 


813 


Belladonna-poisonings 

Pilocarjjine,  596^ 
Biliary  Calculi — ' 
Sodium  phosphate,  688 
Turpentine,  644 
Biliousness — 
Calomel,  232 
Citric  acid,  149 
Seidlitz  powder,  688 
Senna,  682 
Bites  of  Insects — 
Ammonia  water,  575 
Olive  oil,  776 
Rhus  toxicodendron,  488 
Bites  of  Rabid  Animals — 
Carbolic  acid,  306 

Solution  of  chloride  of  antimony,  756 
Sulphuric  acid,  142 
Bites  of  Venomous  Reptiles — 

Solution  of  chloride  of  antimony,  756 
Bladder,  Chronic  Catarrh  of — 

Tincture  of  cautharides,  765 
Bladder,  Debility  of— 

Fluid  extract  of  blackberry,  724 
Tincture  of  cantharides,  765 
Bladder,  Paralysis  of — 

Arnica,  589 
Bladder,  Spasm  of — 

Cannabis,  450 
Blepharitis  Marginalis — 

Yellow-oxide-of-mercury  ointment,  231 
Blepharospasm — 

Coniiim,  501 
Boils- 
Belladonna  ointment,  458 
Cantharidal  blister,  764 
Glycerin,  774 
Menthol,  375 
Silver  nitrate,  743 
Tar,  624 
Brain,  Congestion  of — 

Elaterin,  685 
Bright's  Disease — 
Alkalies,  163 
Cod  liver  oil,  136 
Digitalis,  545 
Gallic  acid,  713 
Iron,  195 
Pilocarpirre,  595 
Scoparius,  551 
Spirit  of  nitrous  ether,  598 
Strophanthus,  549 
Bromidrosis — 
Chloral,  417 

Hydrastine  ointment,  485 
Potassium  permanganate,  347 
Bronchitis — 
Acetanilid,  391 
Alum,  748 
Ammoniacum,  387 
Ammonium  carbonate,  576 
Ammonium  chloride,  617 
Ammonium  preparations,  164 
Apomorphine,  604 


Bronchitis — 

Arsenic,  241 

Asafetida,  387 

Balsam  of  tolu,  619 

Benzoic  acid,  335 
■     Buchu,  638 

Burgundy-pitch  plaster,  770 

Calomel,  233 

Cannabis,  450 

Catechu,  716 

Codeine,  443 

Cod  liver  oil,  135 

Colchicum,  257 

Copaiba,  648 

Creosote,  309 

Croton  oil,  683 

Demulcents,  772 

Digitalis,  544 

Eucalyptus,  343 

Grindelia,  507 

Hamamelis,  720 

Hedeoma,  708 

Hydrastis,  485 

Hyposulphites;  355 

Iodides,  253 

Iron,  195 

Lime  water,  164 

Liquorice,  621 

Lobelia,  614 

Myrrh,  337 

Nitric  acid,  143 

Onion  poultice,  620 

Opium,  438 

Physostigma,  513 

Sanguinaria,  266 

Senega,  626 

Squill,  636 

Strychnine,  472 

Sulphur,  671 

Syrup  of  garUc,  620 

Tar,  624 

Tartar  emetic,  608 

Terebene,  627 

Terpin  hydrate,  628 

Turpentine,  644 

Wild  cherry,  178 

Wine  of  ipecac,  610 
Bronchorrhea — 

Alum,  748 

Asafetida,  387 

Carbolic  acid,  306 

Copaiba,  648 

Eucalyptus,  343 

Gallic  acid,  713 

Lead  acetate,  731 

Myrrh,  337 

Pilocarpine,  595 

Senega,  626 

Terebene,  627 

Turpentine,  644 

Zinc  oxide,  735 
Bruises — 

Ammonium  chloride,  617 

Arnica,  589 


8i4 


CLINICAL  INDEX. 


Bruises — 

Camphor  liniment,  386 

Hamamelis,  720 

Olive  oil,  776 

Potassium  nitrate,  590 

Solution  of  lead  subacetate,  731 

Tansy,  706 
Buboes — 

Ammonium  chloride,  617 

Hydrogen  dioxide,  352 

Iodoform,  330 

Phytolacca,  585 

Salol,  319 

Tincture  of  iodine,  251 
Buccal  Ulcer — 

Geranium,  721 

Red  rose,  723 
Burns — 

Acacia,  778 

Bismuth  subgallate,  752 

Bismuth  subnitrate,  751 

Carbolic  acid,  306 

Cocaine  ointment,  496 

Hamamelis,  720 

Lead  carbonate,  732 

Lime  water,  162 

Linseed  oil,  777 

Menthol,  375 

Nutgall  ointment,  714 

Ointment  of  rose,  723 

Olive  oil,  776 

Phytolacca,  585 

Protectives,  772 

Rhus  toxicodendron,  488 

Salol,  319 

Sodium  bicarbonate,  l6l 

Terebene,  627 

Zinc  oxide,  735 

Calculi — 

Ammonium  benzoate,  336 
Callositas — 

Salicylic  acid,  315 
Cancer — 

Arsenic,  240 

Bromine,  760 

Calendula,  178 

Carbolic  acid,  306 

Conium,  500 

Hydrastine  ointment,  485 

Nitrate  of  sanguinarine,  265 

Podophyllum,  693 

Spermine,  217 

Sulphuric  acid,  142 

Zinc  chloride,  760 

Zinc  sulphate,  736 
Cancer  of  Cervix — 

Nitric  acid,  142 
Cancer  of  Stomach — 

Arsenic,  243 

Pepsin,  130 
Cancer  of  Tongue — 

Potassium  permanganate,  347 


Cancer  of  Uterus — 

Chloral,  416 

Pepsin,  130 

Potassium  permanganate,  347 

Tannic  acid,  711 
Cancer  of  Vagina — 

Potassium  permanganate,  347 
Cancrum  Oris — 

Bismuth  subnitrate,  751 

Zinc  sulphate,  736 
Capillary  Bronchitis — 

Alcohol,  570 

Ammonium  iodide,  253 

Serpentaria,  179 

Turpentine,  644 
Carbuncle — 

Belladonna  ointment,  458 

Cantharidal  blister,  764 

Ergot,  480 

Glycerin,  774 

Hamamelis,  720 

Serum-therapy,  300 
Cardiac  Depression — 

Caffeine,  558 
Cardiac  Irritability — 

Bromides,  533 
Cardiac  Pain — 

Belladonna,  460 
Caries  of  the  Temporal  Bone- 
Turpentine,  643 
Catarrh — 

Benzoic  acid,  335 

Borax,  345 

Boric  acid,  345 

Dobell's  solution,  162 

Eucalyptus,  341 

Hydrastis,  485 

Potassium  permanganate,  347 

Sodium  sulphocarbolate,  308 
Catarrh  of  Stomach — 

Capsicum,  365 
Cellulitis — 

Digitalis,  544 
Cerebral  Anemia — 

Phosphorus,  203 
Cerebral  Hemorrhage — 

Phosphorus,  203 
Cerebral  Hyperemia — 

Belladonna,  460 

Colchicum,  257 

Ergot,  481 
Cerebro-spinal  Meningitis — 

Aconite,  580 

Alcohol,  570 

Blisters,  761 

Ergot,  481 

Gelsemium,  505 
Cerumen,  Impacted — 

Glycerin,  774 

Liquor  potasSEe,  161 

Papain,  132 
Cervix,  Erosion  of — 

Glycerin,  774 


CLINICAL  INDEX. 


815 


Chafing  of  the  Skin — 

Lycopodium,  781 
Chancre — 
Acetanilid,  390 
Alumnol,  322 

Bismuth  benzoate,  335 

Bismuth  subnitrate,  751 

Fluid  extract  of  hydrastis,  485 

Iodoform,  330 

Solution  of  chloride  of  antimony,  756 

Sulphuric  acid,  142 
Chancroid — 

Acetanilid,  390 

Bismuth  benzoate,  335 

Carbolic  acid,  306 

Fluid  extract  of  hydrastis,  485 

Iodoform,  330 

Potassium  bichromate,  349 

Salicylic  acid,  315 

Silver  nitrate,  743 
Chapping — 

Bismuth  subnitrate,  75 1 

Camphor  ice,  386 

Compound  tincture  of  benzoin,  335 

Glycerin,  774 

Ointment  of  rose,  723 

Tragacanth,  780 
Chilblain — 

Aconite,  579 

Alum,  748 

Ammonia  liniment,  575 

Camphor  liniment,  386 

Capsicum,  365 

Carbolic  acid,  306 

Nutgall  ointment,  714 

Rhus  toxicodendron,  488 
Chills— 

Strophanthus,  549 
Chloasma — 

Nitric  acid,  142 

Tincture  of  iodine,  252 
Chloroform-poisoning — 

Ammonia,  575 

Amyl  nitrite,  526 

Atropine,  460 

Strychnine,  473 
Chlorosis — 

Aloes,  674 

Arsenic,  243 

Hypophosphites,  2o5 

Iron,  195 

Manganese,  198 

Potassium  chlorate,  351 

Red  wine,  571 

Sti7chnine,  471 
•Cholera — 

Bismuth  subnitrate,  752 

Calomel  and  opium,  233 

Camphor,  387 

Chloral,  418 

Opium,  438 

Salicylic  acid,  317 

Salol,  319 

>>enim-therapy,  295 


Cholera — 

Sulphur,  671 

Sulphuric  acid,  144 
Cholera  Infantum — 

Bismuth  subnitrate,  752 

Lead  acetate,  731 
Cholera  Morbus — 

Chloral,  418 

Opium,  438 

Salol,  319 
Chordee — 

Camphor,  386 

Cannabis,  450 

Colchicum,  257 

Hop  poultice,  445 

Monobromated  camphor,  387 
Chorea — 

Acetanilid,  391 

Arsenic,  242 

Asafetida,  387 

Cerium  oxalate,  753 

Chloral,  417 

Cocaine,  497 

Conium,  501 

Copper  sulphate,  739 

Curare,  515 

Exalgine,  395 

Gelsemium,  504 

Hyoscine,  464 

Iron,  1 95 

Opium,  438 

Physostigma,  513 

Picrotoxin,  475 

Quinine,  215 

Salicylic  acid,  316 

Silver  nitrate,  744 

Spermine,  217 

Strychnine,  472 

Zinc  oxide,  735 

Zinc  sulphate,  736 
Cinchonism — 

Diluted  hydrobromic  acid,  534 
Cirrhosis  of  Kidneys — 

Potassium  iodide,  253 
Cirrhosis  of  Liver — 

Calomel,  232 

Iodoform,  331 

Potassium  iodide,  253 
Colchicum -poisoning — 

Potassium  permanganate,  348 
Colds- 
Aconite,  579 

Citric  acid,  149 

Fluid  extract  of  pilocarpus,  596 

Mustard  bath,  768 
Colic — 

Belladonna,  460 

Chloral,  417 

Ginger,  372 

Hedeoma,  708 

Hyoscyamus,  464 

Tansy,  706 
Collapse — 

Alcohol,  570 


8i6 


CLINICAL  INDEX. 


Collapse — 

Digitalis,  543 
Coma — 

Mustard,  768 
Comedo — 

Salicylic  acid,  316 

Sulphur,  670 
Condylomata — 

Chromic  acid,  756 

Copper  sulphate,  738 

Resorcin,  324 

Solution  of  chloride  of  antimony,  756 
Congestion  of  Lungs — 

Ergot,  481 
Congestive  Chill — 

Opium,  438 
Conj  unctivitis — 

Alum,  748 

Bismuth  subnitrate,  751 

Boric  acid,  345 

Copper  sulphate,  738 

Gallicine,  713 

Hydrastine  hydrochlorate,  485 

Morphine  sulphate,  438 

Nitrate  of  sanguinarine,  265 

Silver  nitrate,  743 

Zinc  acetate,  735 

Zinc  sulphate,  736 
Constipation — 

Aloes,  674 

Arsenic,  243 

Asaferida,  386 

Belladonna,  459 

Cascara  sagrada,  667 

Cassia  fistula,  664 

Castor  oil,  666 

Colocynth,  6go 

Euonymus,  678 

Glycerin,  775 

Hydrastine,  485 

Jalap,  6gi 

Magnesia,  668 

Magnesium  carbonate,  668 

Manna,  669 

Oxgall,  675 

Physostigma,  513 

Podophyllum,  693 

Rhubarb,  677 

Senna,  682 

Sodium  salts,  688 

Strychnine,  471 

Sulphur,  671 

Taraxacum,  672 
Contusions — 

Alcohol,  569 

Calendula,  178 

Solution  of  ammonium  acetate,  597 
Convalescence- 
Alcohol,  569 

Cod  liver  oil,  136 

Simple  bitters,  178 

Wine  of  coca,  497 
Convulsions — 

Chloral,  417 


Corneal  Ulcer — 

Physostigmine,  512 
Corns — 

Acetic  acid,  148 

Arsenic,  240 

Glacial  acetic  acid,  759 

Potassium  bichromate,  349 

Salicylic  acid,  315 
Corrosive  Poisoning — 

Olive  oil,  776 
Coryza — 

Ammonium  chloride,  617 

Antipyrine,  392 

Camphor,  386 

Camphoric  acid,  387 

Cocaine,  496 

Dover's  powder,  439 

Gelsemium,  505 

Glycerin,  774 

Iodine,  vapor  of,  252 

Oil  of  Scotch  fir,  622 

Salicylic  acid,  316 

Solution  of  ammonium  acetate,  597 

Whiskey,  S7I 
Cough — 

Apomorphine,  604 

Benzoic  acid,  335 

Bromides,  532 

Cannabis,  450 

Cerium  oxalate,  753 

Coniine,  501 

Cubeb,  65 1 

Geranium,  721 

Grindelia,  507 

Hydrocyanic  acid,  522 

Ipecac,  610 

Lactucarium,  446 

Linseed  tea,  777 

Liquorice,  621 

Spirit  of  nitrous  ether,  598 

Strychnine,  472 

Sumbul,  517 

Terebene,  627 

Turpentine,  644 
Cracked  Nipples — 

Bismuth  subnitrate,  751 

Brandy,  569 

Chloral,  417 

Compound  tincture  of  benzoin,  335 

White  oak,  715 
Cretinism — 

Thyroid  extract,  2i8 
Croup — 

Alum,  748 

Ipecac,  611 

Lactic  acid,  I46 

Papain,  132 

Pepsin,  130 

Senega,  626 

Silver  nitrate,  743 

Tartar  emetic,  608 

Zinc  sulphate,  736 
Crusts,  Removal  of — 
I      Olive  oil,  776 


CLINICAL  INDEX. 


817 


Cuts — 

Isinglass,  781 
Cystitis — 

Antipyrine,  392 
Belladonna,  460 
Benzoic  acid,  335 
Boric  acid,  345 
Buchu,  638 
Camphoric  acid,  387 
Copaiba,  648 
Demulcents,  772 
Elm,  779 
Gallic  acid,  713 
Hamamelis,  720 
Hydrogen  dioxide,  352 
Hyoscyamus,  464 
Lactic  acid,  146 
Myrrh,  337 
Piperazin,  655 
Quinine,  215 
Resorcin,  324 
Saccharin,  656 
Salol,  319 
Turpentine,  644 

Deafness — 

Iodine,  vapor  of,  252 
Deglutition,  Painful — 

Olive  oil,  776 
Delirium  of  Fevers — 

Diluted  hydrobromic  acid,  534 
Delirium  Tremens — 

Arnica,  589 

Aromatic  spirit  of  asnmonia,  575 

Bromides,  533 

Bromoform,  534 

Camphor,  387 

Chamomile,  178 

Digitalis,  544 

Hyoscine,  464 

Strychnine,  472 

Tincture  of  lupnlin,  445 

Zinc  oxide,  735 
Dementia — 

Eucalyptus,  341 

Hyoscine,  464 
Dermatitis — 

Ichthyol,  326 

Magnesium  carbonate,  1 62 

White  oak,  715 
Diabetes  Insipidus — 

Ergot,  481 

GalHc  acid,  713 

Lime  water,  164 

Pilocarpine,  596 

Tincture  of  cantharides,  765 

Valerian,  388     . 
Diabetes  Mellitus — 

Alum,  748 

Ammonium  bromide,  533 

Antipyrine,  392 

Arsenic,  243 

Cod  liver  oil,  136 

Extract  of  pancreas,  220 

52 


Diabetes  Mellitus — 

Glycerin,  775 
Guaiacol,  312 
Hydrogen  dioxide,  352 
Iodoform,  331 
Iron,  196 
Lactic  acid,  146 
Phosphoric  acid,  144 
Piperazin,  655 
Saccharin,  656 
Strychnine,  473 
Thymol,  377 
Valerian,  388 
Diarrhea — 
Alum,  748 
Arnica,  589 
Arsenic,  242 
Bismuth  phosphate,  752 
Bismuth  subgallate,  752 
Bismuth  subnitrate,  752 
Bismuth  tannate,  752 
Borax,  346 
Boric  acid,  346 
Brandy,  570 
Bromides,  532 
Caffeine,  558 
Camphor,  387 
Catechu,  716 
Cerium  oxalate,  753 
Chalk  mixture,  164 
Colchicum,  257 
Copaiba,  648 
Copper  sulphate,  739 
Demulcents,  772 
Digitalis,  544 
Elm,  779 
Ergot,  481 
Erythrophleum,  637 
Eucalyptus,  341 

Fluid  extract  of  blackberry,  724 
Gallic  acid,  713 
Ginger,  372 
Hamamelis,  720 
Hematoxylon,  719 
Hope's  camphor  mixture,  143 
Hydronaphtol,  322 
Infusion  of  nutgall,  714 
Ipecac,  611 
Iron,  196 
Kino,  717 
Krameria,  718 
Lactic  acid,  146 
Lead  acetate,  731 
Lime  vifater,  164 
Pepsin,  130 
Prepared  chalk,  164 
Quinine,  215 
Resorcin,  325 
Rhubarb,  677 
Salicylic  acid,  317 
Salol,  319 
Sodium  nitrate,  591 
Sodium  sulphocarbolate,  308 
Strychnine,. 47 1 


8i8 


CLINICAL  INDEX. 


Diarrhea — 

Sulphuric  acid,  144 

Tannic  acid,  712 

Thymol,  377 

White  oak,  715 

Zinc  oxide,  735 

Zinc  sulphate,  736 

Zinc  sulphocarbolate,  308 
Digestive  Disorders — 

Nuclein,  219 
Digestive    Organs,   Inflamed    Condi- 
tions of — 

Althjea,  779 
Dilatation  of  Heart — 

Digitalis,  542 

Ergot,  480 
Dilatation  of  Stomach — 

Carbolic  acid,  307 

Physostigma,  513 
Diphtheria — 

Alcohol,  570 

Alum,  748 

Balsam  of  tolu,  619 

Bichloride  of  mercury,  233 

Chloral,  417 

Chlorine  water,  356 

Eucalyptus,  343 

Gallic  acid,  712 

Hydrochloric  acid,  142 

Hydronaphtol,  322 

Hyposulphites,  355 

Ipecac,  611 

Iron,  tincture  of  chloride  of,  194 

Lactic  acid,  146 

Papain,  132 

Pepsin,  130 

Potassium  permanganate,  347 

Resorcin,  324 

Salicylic  acid,  316 

Serum-therapy,  283 

Sodium  sulphocarbolate,  308 

Sulphur,  671 

Sulphurous  acid,  353 

Tartaric  acid,  149 

Thymol,  377 

Turpentine,  644 

Zinc  sulphate,  736 
Diphtheritic  Paralysis — 

Strychnine,  472 
Dropsy — 

Caffeine,  558 

Copaiba,  648 

Digitalis,  545 

Diuretin,  652 

Iris,  679 

Jalap,  691 

Juniper,  640 

Potassium  bitartrate,  163 

Potassium  iodide,  253 

Salines,  688 

Solution  of  ammonium  acetate,  597 

Squill,  636 
Dryness  of  the  Mouth — 

Glycerin,  774 


Duodenal  Catarrh — 

Salol,  319 

Sanguinaria,  266 

Sodium  phosphate,  688 
Dysentery — 

Acacia,  778 

Alum,  748 

Arnica,  589 

Bismuth  phosphate,  752 

Bismuth  subgallate,  752 

Bismuth  subnitrate,  752 

Carbolic  acid,  307 

Colchicum,  257 

Copaiba,,  648 

Copper  sulphate,  739 

Corrosive  chloride  of  mercury,  232 

Demulcents,  772 

Elm,  779 

Ergot,  481 

Erythrophleum,  637 

Gallic  acid,  713 

Geranium,  721 

Hamamelis,  720 

Hematoxylon,  719 

Hydronaphtol,  322 

Infusion  of  nutgall,  714 

Ipecac,  611 

Iron,  196 

Kino,  717 

Krameria,  718 

Lactic  acid,  146 

Lead  acetate,  731 

Lime  water,  164 

Olive  oil,  776 

Opium,  438 

Quinine,  215 

Rhubarb,  677 

Silver  nitrate,  744 

Sodium  nitrate,  591 

Tannic  acid,  712 

Thymol,  377 

White  oak,  715 

Zinc  oxide,  735 

Zinc  sulphate,  736 
Dysmenorrhea — 

Acetanilid,  391 

Ammonium  chloride,  617 

Amyl  nitrite,  526 

Apioline,  707 

Arsenic,  241 

Black  haw,  518 

Camphor,  387 

Cannal)is,  450 

Caulophyllum,  705 

Croton  oil,  683 

Ergot,  480 

Gelsemiuni,  505 

Guaiac,  260 

Hamamelis,  720 

Hydrastine,  486 

Picrotoxin,  476 

Sanguinaria,  266 

Solution  of  ammonium  acetate,  597 

Spirit  of  nitrous  ether,  598 


CLINICAL  INDEX. 


819 


Dysmenorrhea — 

Sumbul,  517 
Dyspepsia — 

Alcohol,  569 

Alkalies,  162 

Ammonium  preparations,  164 

Asafetida,  386 

Bismuth  phosphate,  752 

Carbolic  acid,  307 

Cerium  oxalate,  753 

Colchicum,  257 

Erythrophleum,  637 

Hematoxylon,  719 

Hops,  445 

Hydrochloric  acid,  142 

Hydrocyanic  acid,  522 

Ipecac,  6i  i 

Lactic  acid,  146 

Manganese  sulphate,  198 

Myrrh,  337 

Pepsin,  130 

Potassium  bichromate,  349 

Quinine,  216 

Resorcin,  325 

Simple  bitters,  178 

Sodium  sulphocarbolate,  308 

Strontium  bromide,  533 

Strychnine,  470 

Sulphurous  acid,  354 

Taraxacum,  672 

Terebene,  627 

Xanthoxylum,  269 

Zii^c  sulphate,  736 
Dysphonia — 

Bromides,  533 
Dyspnea — 

Amyl  nitrite,  526 

Aspidosperma,  516 

Bromides,  533 

Grindelia,  507- 

Hydrogen  dioxide,  352 

Ear,  Diseases  of — 

Aristol,  331 

Calendula,  178 

Ichthyol,  326 

lodoforra,  331 

Liquor  potassse,  161 

Nitric  acid,  142 

Sodium  bicarbonate,  162 
Earache — 

Hops,  445 

Oil  of  cloves,  368 

Onion,  620 
Ecchymoses — 

Arnica,  589 
Eclampsia,  Infantile — 

Picrotoxin,  475 
Ecthyma — 

Quinine,  216 

Solution  of  lead  subacetate,  731 

Sulphur,  670 
Eczema — 

Anderson's  powder,  386 


Eczema — 

Arsenic,  241 

Belladonna,  459 

Bismuth  subgallate,  752 

Black  wash,  162 

Calomel,  231 

CarboMc  acid,  306 

Cod  liver  oil,  135 

Coffee,  558 

Colchicum,  257 

Eucalyptus,  341 

Fluid  extract  of  pilocarpus,  595 

Galla,  714 

Gallicine,  713 

Gelsemium,  505 

Glycerite  of  starch,  754 

Grindelia,  507 

Hamamelis,  720 

Hydrocyanic  acid,  522 

Ichthyol,  326 

Lead  acetate,  730 

Lead  iodide,  732 

Lycopodium,  781 

Menthol,  375 

Papain,  132 

Phytolacca,  585 

Potassium  chlorate,  351 

Prepared  chalk,  162 

Resorcin,  324 

Rhus  toxicodendron,  48S 

Salicylic  acid,  315 

Salol,  319 

Sodium  carbonate,  162 

Solution  of  lead  subacetate,  731 

Sulphur,  670 

Tannic  acid,  711 

Tar,  624 

Yellow  wash,  162 

Zinc  carbonate,  736 

Zinc  oxide,  735 

Zinc  sulphate,  736 
Edema  of  the  Prepuce — 

Glycerin,  774 
Emphysema — 

Physostigma,  513 

Terebene,  627 

Turpentine,  644 
Empyema — 

Hydrogen  dioxide,  352 

Tincture  of  iodine,  252 
Endarteritis — 

Iodides,  252 

Marcury,  232 
Endocarditis — 

Blisters,  761 

Carbolic  acid,  306 

Quinine,  215 
Endometritis — 

Carbolic  acid,  306 

Glycerite  of  tannic  acid,  774 

Hydrogen  dioxide,  352 

Solution  of  zinc  chloride,  760 

Tincture  of  iodine,  252 


820 


CLINICAL  INDEX. 


Enlarged  Tonsils — 

Chromic  acid,  756 
Enteralgia — 

Belladonna,  459 

Hyoscyamus,  464 
Enteritis- — 

Demulcents,  772 

Hamamelis,  720 
Entero-colitis — 

Salicylic  acid,  317 
Enuresis — 

Camphoric  acid,  387 

Rhus  glabra,  723 
Epididymitis — 

Ammonium  chloride,  617 

Mercurial  ointment,  231 

Silver  nitrate,  743 
Epilepsy — 

Acetanilid,  391 

Amyl  nitrite,  526 

Borax,  346 

Brain-extract,  219 

Bromides,  532 

Chloral,  418 

Coniine  hydrobromate,  501 

Copper  sulphate,  739 

Curare,  515 

Digitalis,  544 

Hydrastine  hydrochlorate,  486 

Hydrogen  dioxide,  352 

Phosphorus,  203 

Physostigraa,  513 

Picrotoxin,  475 

Silver  nitrate,  744 

Strychnine,  472 

Zinc  oxide,  735 

Zinc  sulphate,  736 
Epistaxis— 

Acetanilid,  390 

Acetic  acid,  148 

Alum,  747 

Arnica,  589 

Digitalis,  544 

Ether,  400 

Geranium,  721 

Hamamelis,  720 

Kino,  717 

Krkmeria,  718 

Sulphuric  acid,  142 
Epithelioma — 

Arsenic,  243 

Bismuth  subnitrate,  751 

Ergot,  480 

Lead  nitrate,  732 

Nitric  acid,  142 

Pyrogallol,  713 

Zinc  chloride,  760 
Erysipelas — 

Alcohol,  571 

Belladonna,  460 

Bismuth  subnitrate,  751 

Carbolic  acid,  306 

Fluid  extract  of  pilocarpus,  595 

Glycerin,  775 


Erysipelas — 

Guaiacol,  312 

Hyposulphites,  355 

Ichthyol,  326 

Iron,  196 

Lead  carbonate,  732 

Lycopodium,  781 

Prepared  chalk,  162 

Quinine,  215 

Rhus  toxicodendron,  488 

Salicylic  acid,  315 

Solution  of  lead  subacetate,  731 

Tannic  acid,  711 

Turpentine,  644 

Zinc  oxide,  735 
Erythema — 

Anderson's  powder,  386 

Bismuth  subnitrate,  751 

Ergot,  481 

Hamamelis,  720 

Hydrocyanic  acid,  522 

Ichthyol,  326 

Lead  acetate,  730 

Rhus  toxicodendron,  488 
Exanthemata — 

Acetanilid,  390 

Acetic  acid,  148 

Ammonium  carbonate,  575 

Ammonium  chloride,  617 

Camphor,  387 

Cod  liver  oil,  135 

Opium,  440 

Solution  of  ammonium  acetate,  597 
Excoriations — 

Acacia,  778 

Glycerin,  774 

Olive  oil,  776 

Protectives,  772 

Tar,  624 
Exophthalmic  Goiter — 

Belladonna,  460 

Bromides,  533 

Digitalis,  543 

Ergot,  481 

Thyroid  extract,  218 
Eye,  Diseases  of — 

Fluid  extract  of  red  rose,  723, 

Iodoform,  331 

Physostigmine,  512 

Fainting — 

Ammonia  water,  575 

Cubeb,  651 
Fatty  Heart- 
Caffeine,  558 
Fauces,  Inflammation  of — 

Salicylic  acid,  316 
Favus — 

Carbolic  acid,  306 

Gallanol,  713 

Hyposulphites,  355 

Phytolacca,  585 
Febrile  Affections — 

Acacia,  778 


CLINICAL  INDEX. 


821 


Febrile  Affections — 

Acetanilid,  390 

Aconite,  579 

Citric  acid,  149 

Demulcents,  772 

Hydrochloric  acid,  143 

Opium,  439 

Potassium  nitrate,  591 

Sodium  bromide,  533 

Spirit  of  nitrous  ether,  598 

Tartar  emetic,  608 
Felons — 

Chloral,  417 

Cocaine,  496 

Silver  nitrate,  743 

Solution  of  lead  subacetate,  731 
Fermentation — 

Salicylic  acid,  317 
Fissured  Nipples — 

Galla,  714 

■Glycerin,  774 

Lead  nitrate,  732 

Tar,  624 

Zinc  oxide,  735 
Fistula- 
Calcium  phosphate,  206 

Cantharidal  blister,  764 

Cod  liver  oil,  136 

Hydrogen  dioxide,  352 

Iodoform,  331 
Fistulous  Discharges — 

Quinine,  215 
Fistulous  Openings,  to  Dilate — 

Elm,  779 
Flatulence — 

Anise,  360 

Asafetida,  386 

Brandy,  570 

Camphor,  387 

Compound  spirit  of  ether,  400 

Ginger,  372 

Glycerin,  775 

Hops,  445 

Physostigma,  513 

Salicylic  acid,  317 

Spirit  of  nitrous  ether,  598 

Turpentine,  644 
Freckles — 

Hamamelis,  720 

Potassium  nitrate,  591 
Frost-bite — 

Alcohol,  569 

Compound  tincture  of  benzoin,  335 

Hamamelis,  720 

Galactorrhea — 

Ergot,  481 
Gall-stones — 

Olive  oil,  776 
Gangrene — 

Ammonium  chloride,  617 

Bromine,  760 

Carbolic  acid,  306 

Hematoxylon,  719 


Gangrene — 

Lead  nitrate,  732 

Nitric  acid,  142 

White  oak,  715 
Gangrene  of  Lungs — 

Carbolic  acid,  306 

Eucalyptus,  343 

Hyposulphites,  355 

Salicylic  acid,  316 
Gangrene  of  Pharynx — 

Alum,  747 

Copper  sulphate,  738 
Gangrenous  Sores — 

Solution  of  chlorinated  soda,  357 
Gastralgia — 

Acetanilid,  391 

Arsenic,  242 

Belladonna,  459 

Bismuth  phosphate,  752 

Brandy,  570 

Coca,  497 

Compound  spirit  of  ether,  400 

Manganese  dioxide,  19S 

Menthol,  375 

Resorcin,  324 

Silver  nitrate,  744 

Silver  oxide,  744 

Zinc  oxide,  735 
Gastric  Acidity — 

Glycerin,  775 
Gastric  Catarrh — 

Iodoform,  331 

Salicylic  acid,  317 

Simple  bitters,  178 

Strychnine,  471 
Gastric  Fermentation — 

Hyposulphites,  355 

Potassium  permanganate,  347 
Gastric  Pain — 

Hydrocyanic  acid,  522 
Gastric  Ulcer — 

Arsenic,  243 

Bismuth  subnitrate,  752 

Lead  acetate,  731 

Manganese  dioxide,  198 

Potassium  bichromate,  349 

Silver  nitrate,  744 

Silver  oxide,  744 
Gastritis — 

Acacia,  778 

Arsenic,  242 

Bismuth  subnitrate,  752 

Demulcents,  772 

Lead  acetate,  73 1 

Resorcin,  325 

Silver  nitrate,  744 
Gastrodynia — 

Codeine,  443 
General  Debility — 

Digitalis,  543 
Gingivitis — 

Borax,  345 

Boric  acid,  345 

Hydronaphtol,  322 


823 


CLINICAL  INDEX. 


Glandular  Enlargements — 

Ammonium  chloride,  617 
Solution  of  ammonium  acetate,  597 
Gleet- 
Alum,  748 
Buchu,  638 
Copaiba,  648 
Copper  sulphate,  738 
Geranium,  721 
Krameria,  718 
Lead  acetate,  730 
Tar  water,  624 
Tincture  of  cantharides,  765 
Turpentine,  644 
Glossitis — 

Chromic  acid,  757 
Goiter — 

Ammonium  chloride,  617 

Carbolic  acid,  306 

Red-iodide-of-mercury  ointment,  232 

Tincture  of  iodine,  252 
Gonorrhea — 

Acetic  acid,  148 

Alum,  748 

Alumnol,  322 

Argonin,  744 

Bismuth  subnitrate,  751 

Bismuth  tannate,  752 

Boric  acid,  345 

Buchu,  638 

Cannabis,  450 

Catechu,  716 

Chloral,  416 

Chromic  acid,  757 

Colchicum,  257 

Copaiba,  648 

Copper  sulphate,  738 

Geranium,  721 

Glycerin,  774 

Grindelia,  507 

Hamamelis,  720 

Hydrastin,  484 

Hydrogen  dioxide,  352 

Kino,  717 

Lead  acetate,  730 

Oil  of  santal,  648 

Potassium  permanganate,  347 

Quinine  bisulphate,  215 

Resorcin,  324 

Salol,  319 

Silver  nitrate,  743 

Sodium  sulphocarbolate,  308 

Solution  of  zinc  chloride,  760 

Tannic  acid,  711 

Turpentine,  644 

Zinc  acetate,  735 

Zinc  sulphate,  736 
Gout — 

Alkalies,  162 

Arnica,  589 

Colchicum,  257 

Guaiac,  260 

Lactic  acid,  146 

Lithium  carbonate,  162 


Gout— 

Piperazin,  655 

Potassium  iodide,  253 

Salicylic  acid,  316 

Tincture  of  iodine,  25 1 
Gouty  Diathesis — 

Lithium  preparations,  164 

Sodium  salts,  688 
Gouty  Sores — 

Piperazin,  655 
Granular  Lids — 

Bismuth  subnitrate,  751 
Granulations — 

Alum,  747 

Nitric  acid,  142 
Gummata — 

Iodides,  252 

Hay  Fever — 

Ammonium  iodide,  253 

Arsenic,  243 

Cannabis,  450 

Cocaine,  496 

Grindelia,  507 

Quinine,  215 

Resorcin,  324 

Terpin  hydrate,  628 
Headache — 

Acetanilid,  391 

Aromatic  spirit  of  ammonia,  575 

Arsenic,  242 

Bromides,  532 

Butyl-chloral  hydrate,  422 

Caffeine,  55^ 

Cannabis,  450 

Cubeb,  651 

Ergot,  481 

Menthol,  375 

Quinine,  215 

Salicylic  acid,  316 

Spirit  of  nitrous  ether,  598 

Valerian,  388 
Heart,  Fatty  Degeneration  of — 

Iodine,  253 
Heart,  Functional  Disorders  of — 

Cactus,  552 
Heart,  Functional  Irregularity  of- 

Adonidin,  553 

Strychnine,  471 
Heart,  Valvular  Diseases  of — 

Iodine,  253 
Hebephrenia — 

Brain-extract,  220 
Hematemesis — 

Alum,  748 

Gallic  acid,  712 

Hamamelis,  720 

Ipecac,  61 1 

Iron,  196 

Krameria,  718 

Sulphuric  acid,  144 

Tannic  acid,  712 

Turpentine,  644 


CLINICAL  INDEX. 


833 


Hematuria — 

Alum,  748 

Hamamelis,  720 

Krameria,  718 

Kperazin,  655 

Rhus  glabra,  722 

Turpentine,  644 
Hemiplegia — 

Strychnine,  472 
Hemoptysis — 

Acetanilid,  390 

Arnica,  589 
'    Digitalis,  544 

Fluid  extract  of  hydrastis,  486 

Gallic  acid,  712 

Gelsemium,  505 

Geranium,  721 

Hamamelis,  720 

Iodoform,  331 

Ipecac,  612 

Krameria,  718 

Lead  acetate,  731 

Tannic  acid,  711 

Turpentine,  644 

White  oak,  715 
Hemorrhage — 

Alcohol,  570 

Alum,  747 

Digitalis,  543 

Geranium,  721 

Hamamelis,  720 

Iron,  196 

Lead  acetate,  731 

Opium,  439 

Pyrogallol,  713 

Turpentine,  644 
Hemorrhage,  Intestinal — 

Gallic  acid,  712 

Sulphuric  acid,  144 
Hemorrhage,  Renal — 

Gallic  acid,  712 
Hemorrhage,  Uterine — 

Nitric  acid,  142 

Sulphuric  acid,  144 
H  emorrhoids — 

Belladonna  ointment,  459 

Chromic  acid,  757 

Cocaine,  496 

Ergot,  480 

Galla,  714 

Gallic  acid,  712 

Hamamelis,  720 

Iodoform,  331 

Krameria,  718 

Lead  acetate,  730 

Manna,  669 

Menthol,  375 

Nitric  acid,  142 

Potassium  bromide,  532 

Rhubarb,  677 

Stramonium  ointment,  462 

Sulphur,  671 

Tannic  acid,  711 

White  oak,  715 


Hepatic  Cirrhosis— 

Podophyllum,  693 
Hepatic  Congestion — 

Calomel,  232 

Gamboge,  685 

Taraxacum,  672 
Hepatic  Disorders — 

Nitric  acid,  143 
Hepatitis — 

Calomel,  233 
Hernia — 

Caffeine,  558 

Fluid  extract  of  white  oak,  715 
Herpes — 

Aconite,  579 

Bismuth  subgallate,  752 

Galla,  714 

Hamamelis,  720 

Ichthyol,  326 

Lycopodium,  781 

Rhus  toxicodendron,  488 

Salicylic  acid,  316 

Tannic  acid,  711 
Herpes  of  Buccal  Cavity — 

Potassium  chloraffe,  351 
Hiccough — 

Chloral,  418 

Coffee,  558 

Compound  spirit  of  ether,  400 

Infusion  of  mustard,  768/ 

Nitroglycerin,  527 

Pilocarpine,  595 
Hoarseness — 

Borax,  345 

Boric  acid,  345 

Compound  tincture  of  benzoin,  335 

Cubeb,  651 

Licorice,  621 

Potassium  bichromate,  349 
Hodgkin's  Disease — 

Arsenic,  241 
Hydrocele — 

Chloral,  416 

Tincture  of  iodine,  252 
Hydrocyanic- Acid-poisoning — 

Aminbnia,  575 

Potassium  permanganate,  348 
Hydrophobia — 

Coniine,  501 

Curare,  515 

Hydrastine  hydrochlorate,  486 

Opium,  438 
Hydrothorax — 

Cantharidal  blisters,  764 
Hyperidrosis — • 

Chloral,  417 

Chromic  acid,  757 

Hamamelis,  720 

Hydrastine  ointment,  485 

Tannic  acid,  711 
Hyperpyrexia,  Rheumatic — 

Salicylic  acid,  316 
Hypertrophy  of  Heart — 

Aconite,  579 


824 


CLINICAL  INDEX. 


Hypertrophy  of  Heart — 

Lead  acetate,  731 
Hypochondria — 

Arsenic,  243 

Colchicum,  257 

Diluted  nitrohydrochloric  acid,  143 

Valerian,  388 
Hysteria — 

AUyl  tribromide,  620 

Asiifetida,  386 

Belladonna,  459 

Brain-extract,  219 

Compound  spirit  of  ether,  400 

Copper  sulphate,  739 

Oil  of  rue,  705 

Sanguinaria,  266 

Sumbul,  517 

Tansy,  706 

Valerian,  388 

Zinc  oxide,  735 

Zinc  sulphate,  736 
Hysterical  Convulsions — 

Hyoscine,  464 
Hysterical  Paralysis — 

Blisters,  761 

Ileo-colitis — 

Calomel,  232 

Gray  powder,  232 
Impetigo — 

Hyposulphites,  355 

Lead  acetate,  730 

Quinine,  216 

Salicylic  acid,  315 

Sulphur,  670 

Tannic  acid,  711 
Impotence — 

Alcohol,  571 

Cannabis,  450 

Phosphorus,  203 

Sanguinaria,  266 

Tincture  of  cantharides,  765 
Incontinence  of  Urine — 

Ammonium  benzoate,  336 

Belladonna,  459 

Buchu,  638 

Ergot,  481 

Hyoscyamus,  464 

Iron,  196 

Krameria,  718 

Rhus  glabra,  722 

Rhus  toxicodendron,  488 

Tincture  of  cantharides,  765 

Tincture  of  nux  vomica,  470 

Turpentine,  644 
Indigestion — 

Bromides,  532 

Hydrochloric  acid,  143 
Infantile  Convulsions — 

Allyl  tribromide,  620 

Asafetida,  386 

Bromides,  532 

Chloral,  417 

Conium,  501 


Infantile  Convulsions — 

Physostigma,  513  '■ 

Inflamed  Gums — 

Hamamelis,  720 
Inflammation  of  Nose — 

Carbolic  acid,  306 
Inflammation  of  Throat — 

Carbolic  acid,  306 
Inflammations — 

Hop  poultice,  445 

Linseed  poultice,  777 

Mercury,  232 
Inflammatory     Exudates,    to   Hasten 
Absorption  of — 

Rubefacients,  769 
Influenza — 

Acetanilid,  391 

Salicylic  acid,  317  - 

Serum-therapy,  298 

Solution  of  ammonium  acetate,  597 
Ingrowing  Toe-nail — 

Alum,  748 

Liquor  potassas,  161 
Insanity — 

Hyoscine,  464 

Sulphonal,  425 

Thyroid  extract,  218 
Insomnia — 

Bromides,  532 

Chloral,  417 

Chloral  formamide,  421 

Convallaria,  554 

Hyoscine,  464 

Opium,  438 

Paraldehyde,  426 

Phosphorus,  203 
Intermittent  Fever — 

Ammonium  chloride,  617 

Antipyrine,  392 

Ai-senic,  242 

Erythrophleum,  637 

Hydrastine,  485 

Ipecac,  612 

Nitric  acid,  143 

Phenocoll,  394 

Quinine,  216 

Resorcin,  325 

Salicylic  acid,  316 
Intertrigo — 

Bismuth  subnitrate,  751 

Lead  carbonate,  732 

Lycopodium,  781 

Tannic  acid,  711 

Zinc  carbonate,  736 

Zinc  oxide,  735 
Intestinal  Catarrh — 

Copaiba,  648 

Salol,  319 

Turpentine,  644 
Intestinal  Dilatation — 

Physostigma,  513 
Intestinal  Fermentation — 

Oxgall,  675 

Sulphurous  acid,  354 


CLINICAL  INDEX. 


825 


Intestinal  Hemorrhage — 

Alum,  748 

Hematoxylon,  719 

Krameria,  718 

Tannic  acid,  712 
Intestinal  Obstruction — 

Croton  oil,  684 
Intestinal  Torpor — 

Picrotoxin,  475 
Intestinal  Ulcerations — 

Silver  nitrate,  744 
Irido-choroiditis — 

Salicylic  acid,  316 
Iritis — 

Calomel,  233 
Irritable  Conditions  of  the  Heart — 

Hydrocyanic  acid,  522 

Strophanthus,  549 
Irritation,  Relief  of — 

Cod  liver  oil,  135 

Jaborandi-poisoning — 

Atropine,  460 
Jaundice — 

Aloes,  674 

Citric  acid,  149 

Hydrastine,  485 

Iodoform,  331 

Iris,  679 

Iron,  195 

Manganese  sulphate,  198 

Oxgall,  675 

Pilocarpine,  596 

Quinine,  215 

Salol,  319 
Joints,  Inflammation  of — 

Digitalis,  541 

Rubefacients,  769 

Keratitis — 

Gallicine,  713 

Yellow-oxide-of-mercury  ointment,  231 
Kidneys,  Congestion  of — 

Digitalis,  541 

Juniper,  640 

Spirit  of  nitrous  ether,  598 

Laryngeal  Catarrh — 

Compound  tincture  of  benzoin,  33S 

Turpentine,  644 
Laryngeal  Papillomata — 

Chromic  acid,  757 
Laryngismus  Stridulus — 

Bromides,  533 

Chloral,  417 
Laryngitis — 

Acacia,  778 

Aconite,  579 

Alum,  748 

Ammonium  chloride,  617 

Camphor,  386 

Carbolic  acid,  306 

Chromic  acid,  756 

Glycerin,  774 


Laryngitis — 

Iodine,  252 

Resorcin,  324 

Salol,  319 

Sanguinaria,  266 

Senega,  626 

Subsulphate  of  mercury,  233 

Succus  conii,  501 

Tartar  emetic,  608 
Larynx,  Chronic  Ulceration  of- 

Silver  nitrate,  743 
Larynx,  Congestion  of — 

Creasote,  309 
Lead-poisoning — 

Alum,  748 

Croton  oil,  684 

Magnesium  sulphate,  688 

Sulphuric  acid,  144 
Lentigo — 

Tincture  of  iodine,  252 
Lepra — 

Arsenic,  241 

Phosphorus,  203 
Leucorrhea — 

Alum,  748 

Bismuth  subnitrate,  751 

Bismuth  tannate,  752 

Boric  acid,  345 

Catecliu,  716 

Chromic  acid,  757 

Cocculus,  476 

Ergot,  481 

Fluid  extract  of  hydrastis,  485 

Geranium,  721 

Glycerite  of  tannic  acid,  774 

Grindelia,  507 

Hamamelis,  720 

Hematoxylon,  719 

Iron,  196 

Kino,  717 

Krameria,  718 

Lead  acetate,  73° 

Lime  water,  162 

Myrrh,  337 

Potassium  permanganate,  347 

Rhus  glabra,  722 

Silver  nitrate,  743 

Solution  of  zinc  chloride,  760 

Tannic  acid,  711 

Tar  water,  624 

White  oak,  715 

Zinc  acetate,  735 

Zinc  oxide,  735 

Zinc  sulphate,  736 
Leukemic — 

Arsenic,  241 
Lichen — 

Fowler's  solution,  241 

Lead  acetate,  730 

Sulphuric  acid,  144 
Lithemia — 

Alkalies,  163 

Buchu,  638 

Lactic  acid,  146 


826 


CLINICAL  INDEX. 


Lithemia — 

Nitric  acid,  143 
Lithiasis — 

Potassium  permanganate,  347 
Liver,  Torpor  of — 

Podophyllum,  693 
Locomotor  Ataxia — - 

Acetanilid,  391 

Brain-extract,  219 

Caffeine,  558 

Mercury,  232 

Nitroglycerin,  527 

Phosphorus,  202 

Physostigma,  513 

Silver  nitrate,  744 
Lumbago — 

Acetanilid,  391 

Burgundy-pitch  plaster,  770 

Capsicum,  365 

Guaiac,  260 

Salicylic  acid,  316 

Turpentine,  643 
Lungs,  Chronic  Affections  of— 

Mercury,  232 
Lungs,  Congestion  of — 

Digitalis,  544 

Elaterin,  685 
Lungs,  Inflammation  of — 

Gelsemium,  505 
Lupus- 
Carbolic  acid,  306 

Chloride  of  zinc,  760 

Copaiba,  647 

Hamamelis,  720 

Ichthyol,  326 

Phosphorus,  203 

Pyrogallol,  713 

Salicylic  acid,  315 

Tincture  of  iodine,  252 

Zinc  sulphate,  736 
Lymphadenoma — 

Phosphorus,  203 
Lymphangitis — 

Tannic  acid,  711 
Lymphatic  Enlargements — 

Ichthyol,  326 

Lead  iodide,  732 
Lymphoma — 

Arsenic,  241 

Malaria — 

Antipyrine,  392 

Apioline,  707 

Carbolic  acid,  307 

Citric  acid,  149 

Eucalyptus,  342 

Hydrastine,  485 

Nuclein,  219 

Pilocarpine,  595 

Quinine,  215 
Malarial  Fever — 

Ammonium  iodide,  253  , 

Amyl  nitrite,  526 

Quinine,  215 


Malarial  Fever — 

Simple  bitters,  178 
Malignant  Pustule — 

Iodoform,  330 

Solution  of  chloride  of  antimony,  756 
Mammary     Glands,     Enlarged     and 
Painful- 
Olive  oil,  776 

Solution  of  ainmonium  acetate,  597 
Mania — 

Acetanilid,  391 

Arnica,  589 

Bromoform,  534 

Camphor,  387 

Cannabis,  450 

Conium,  501 

Digitalis,  544 

Gelsemium,  504 

Hydrocyanic  acid,  522 

Hyoscine,  464 
Marasmus — 

Bichloride  of  mercury,  233 

Cod  liver  oil,  135 
Mastitis — 

Ammonium  chloride,  617 

Phytolacca,  585 
Measles — 

Mustard  bath,  768 
Melancholia — 

Arsenic,  243 

Cannabis,  450 

Diluted  nitrohydrochlorlc  acid,  145 

Hydrocyanic  acid,  522 

Wine  of  coca,  497 
Meniere's  Disease — 

Gelsemium,  505 
Meningitis — 

Calomel,  232 

Digitahs,  544 

Iodides,  252 
Menopause,  Disturbances  of — 

Bromides,  533 
Menorrhagia — 

Aloes,  674 

Alum,  748 

Belladonna,  460 

Black  haw,  518 

Bromides,  533 

Cannabis,  450 

Conium,  501 

Digitalis,  544 

Ergot,  480 

Gallic  acid,  712 

Hamamelis,  720 

Iron,  196 

Kino,  717 

Savine,  704 

Solution  of  ammonium  acetate,  597 

Tincture  of  cantharides,  765 

Turpentine,  644 
Menses,  to  Restore  or  Increase — 

Emmenagogues  and  ecbolics,  702 

Hedeoma,  708 

Mustard  sitz-bath,  768 


CLINICAL  INDEX. 


827 


Mercurial  Sore  Mouth — 

Silver  nitrate,  743 
Metritis,  Chronic^ 

Cannabis,  450 

Ergot,  480 

Tincture  of  iodine,  252 
M  etrorrhagia — 

Geranium,  721 
Migraine — 

Butyl-chloral  hydrate,  422 

Caffeine,  558 

Cannabis,  450 

Gelsemium,  505 

Picrotoxin,  476 

Seidlitz  powder,  688 

Solution  of  ammonium  acetate,  597 
Mitral  Regurgitation — 

Adonidin,  553 

Digitalis,  542 
Mitral  Stenosis — 

Strophanthus,  548 
Moles — 

Nitric  acid,  142 
Morbid  Growths — 

Zinc  chloride,  760 
Morphine-poisoning — 

Potassium  permanganate,  347 

Strychnine,  473 
Mouth,  Diseases  of — 

Potassium  citrate,  161  -..^^^ 

Potassium  tartrate,  161  "" 

Mouth,  Ulcerations  of — 

Chromic  acid,  757 
Mucous   Membranes    Inflamed   Con- 
ditions of — 

Demulcents,  77? 
Mucous  Patches — 

Potassium  chlorate,  351 
Mumps — 

Pilocarpine,  595 
Muscarine-poisoning — 

Digitalis,  545 

Potassium  permanganate,  348 
Myalgia — 

Ammonium  chloride,  618 

Salol,  319 

Turpentine,  643 
Myelitis — 

Ergot,  481 

PhenocoU,  394 

Strychnine,  472 
Myocarditis — 

Cactus,  552 

Caffeine,  558 

Diuretin,  653 
Myxedema — 

Thyroid  extract,  218 

Narcotic  Poisoning — 

Alcohol,  .570 

Mustard,  768 

Rubefacients,  769 
Nasal  Catarrh — 
,  Bismuth  oxide,  752 


Nasal  Catarrh — 

Bismuth  subnitrate,  751 

Glycerin,  774 

Oil  of  Scotch  fir,  622 
Nasal  Polypi — 

Chromic  acid,  756 

Nitrate  of  sanguinarine,  265 

Zinc  sulphate,  736 
Nausea — 

Compound  spirit  of  ether,  400 

Hydrochloric  acid,  143 

Menthol,  375  • 

Spirit  of  nitrous  ether,  598 
Neoplasms — 

Cocaine,  496 
Nephritis — 

Amyl  nitrite,  526 

Elaterin,  685 

Mercury,  232 

Potassium  bitartrate,  163 

Potassium  iodide,  253 

Scoparius,  551  • 

Terpin  hydrate,  628 

Tincture  of  cantharides,  765 
Nervous  Debility — 

Rubefacients,  769 
Nervous  Diseases — 

Cod  liver  oil,  136 

Iron,  195 
Nervous  Excitement — 

Rubefacients,  769 
Nervous  Irritability — 

Bromides,  533 
Nervousness' — 

Lactucarium,  446 
Neuralgia —    - 

Acetanilid,  391 

Aconite,  579 

Ammonium  chloride,  618 

Arsenic,  242 

Belladonna  plaster,  459 

Blisters,  761 

Butyl-chloral  hydrate,  422 

Camphor-chloral,  386 

Camphorated  chloral,  417 

Cannabis,  450 

Cantharidal  blister,  764 

Capsicum,  365 

Chloral,  418 

Colchicum,  257 

Convallaria,  554 

Croton  oil,  683 

Ether,  400 

Gelsemium,  505 

Hydrocyanic  acid,  522 

Hyoscyamus,  464 

Iron,  195 

Oil  of  cloves,  368 

PhenocoU,  394 

Phosphorus,  203 

Quinine,  215 

Rubefacients,  769 

Salicylic  acid,  317 

Strychnine,  472 


828 


CLINICAL  INDEX. 


Neuralgia — 

Terpin  hydrate,  628 

Veratrine  ointment,  584 
Neurasthenia — 

Alcohol,  571 

Brain-extract,  217 

Phosphoric  acid,  143 

Phosphorus,  202 

Sumbul,  517 
Neuritis — 

Acetanilid,  391 

Salol,  319 

Tincture  of  iodine,  251 
Nevi — 

Chloride  of  zinc,  760 

Nitric  acid,  142 
Night-blindness — 

Strychnine,  472 
Night-sweats — 

Camphoric  acid,  387 

Fluid  extract  of  Hydrastis,  486 

Gallic  acid,  713 

Geranium,  721 

Lead  acetate,  731 

Physostigma,  513 

Picrotoxin,  475 

Strychnine,  473 
Nocturnal  Emissions — 

Digitalis,  544 
Noma — 

Hydrochloric  acid,  141 
Nose,  Diseases  of — 

Aristol,  331 

Ichthyol,  326 

Iodoform,  331 

Nitric  acid,  142 
Nymphomania — 

Bromides,  533 
Nystagmus — 

Physostigmine  sulphate,  S 1 2 

Obesity— 

Phytolacca,  586 

Thyroid  extract,  219 
Offensive  Discharges — 

Lead  nitrate,  732 
Onychia — 

Lead  nitrate,  732 

Tincture  of  iodine,  251 
Ophthalmia — 

Alum,  748 

Bismuth  tannate,  752 

Potassium  permanganate,  347 

Silver  nitrate,  743 

Zinc  sulphate,  736 
Opium  Habit — 

Cocaine,  497 
Opium  -poisoning — 

Caffeine,  558 

Picrotoxin,  475 
Orchitis — 

Ammonium  chlor^ide,  617 

Belladonna  ointment,  459 

Hop  poultice,  445 


Orchitis — 

Lead  acetate,  730 

Mercurial  ointment,  231 

Silver  nitrate,  743 
Os  Uteri,  Rigidity  of — 

Ipecac,  612 
Osteitis — 

Hydrochloric  acid,  142 
Osteomalacia — 

Lime  vifater,  164 

Phosphorus,  203 
Otitis — 

Antipyrine,  392 

Bismuth  subgallate,  752 

Cantharidal  blister,  765 

Carbolic  acid,  306 

Cod  liver  oil,  136 

Zinc  sulphate,  736 
Otorrhea — 

Carbolic  acid,  306 

Le^d  acetate,  730 

Salicylic  acid,  316 

Silver  nitrate,  744 

Tannic  acid,  711 
Ovarian  Neuralgia — 

Sumbul,  517 
Ovaritis — 

Cantharidal  blister,  765 
Oxalic- acid  -poisoning — 

Potassium  peimanganate,  348 
Oxaluria — 

Lactic  acid,  146 

Nitric  acid,  143 

Zinc  sulphate,  736 
Ozena — 

Bismuth  oxide,  752 

Bismuth  subnitrate,  751 

Camphor,  386 

Camphorated  naphtol,  322 

Chromic  acid,  757 

Cod  liver  oil,  136 

Krameria,  718 

Myrrh,  337 

Potassium  permanganate,  347 

Quinine,  215 

Saccharin,  656 

Salol,  319 

Solution  of  chlorinated  soda,  357 

Tannic  acid,  711 

Pachymeningitis — 

Red-iodide-of-mercury  ointment,  232 
Pain — 

Ether,  400 

Opium,  438 
Palpitation  of  Heart — 

Aconite,  579 

Compound  spirit  of  ether,  400 
Palsy— 

Brain-extract,  220 
Pannus — 

Yellow-oxide-of-mercury  ointment,  231 
Paralysis — 

Biain-extract,  220 


CLINICAL  INDEX. 


829 


Paralysis — 

Cocculus,  475 

Cubeb,  651 

Iodides,  252 

Mezereum,  267 

Phosphorus,  203 

Rhus  toxicodendron,  488 

Strychnine,  472 
Paralysis  Agitans — 

Borax,  346 

Cocaine,  497 

Conium,  501 

Gelsemium,  504 

Hyoscine,  464 

Sparteine  sulphate,  551 
Paralytic  Mydriasis — 

Physostigmine,  S'2 
Paraplegia — 

Phosphorus,  202 

Physostigma,  513 

Strychnine,  472 
Parasitic  Skin  Diseases — 

Chlorine  water,  356 

Cocculus,  475 

Salicylic  acid,  315 

Sulphurous  acid,  353 
Paronychia — 

Lead  acetate,  730 
Pelvic  Cellulitis — 

Mercurial  ointment,  231 
Pemphigus — 

Fowler's  solution,  241 

Rhus  toxicodendron,  488 
Pericarditis — 

Blisters,  761 

Calomel,  233 

Cantharidal  blister,  764 

Diuretin,  653 

Iodides,  253 

Squill,  636 
Periodical  Fevers — 

Nitric  acid,  143 
Periostitis — 

Cantharidal  blister,  765 

Iodides,  252 

Tincture  of  iodine,  251 
Peritonitis — 

Aconite,  579 

Opium,  439 

Turpentine,  643 
Pernicious  Anemia — 

Arsenic,  241 

Phosphorus,  203 
Phagedenic  Sores — 
'  Potassium  chlorate,  351 

Solution  of  nitrate  of  mercury,  232 
Pharyngitis — 

Acacia,  778 

Aconite,  579 

Alcohol,  569 

Ammonium  chloride,  617 

Aromatic  spirit  of  ammonia,  575 

Balsam  of  tolu,  619 

Borax,  345 


Pharyngitis — 

Boric  acid,  345 

Calendula,  178 

Camphoric  acid,  387 

Capsicum,  365 

Catechu,  716 

Ergot,  480 

Gallic  acid,  712 

Glycerin,  774 

Guaiac,  260 

Hamamelis,  720 

Hedeoma,  708 

Kino,  716 

Krameria,  718 

Myrrh,  337 

Phytolacca,  585 

Potassium  bichromate,  349 

Potassium  bromide,  532 

Potassium  chlorate,  351 

Potassium  nitrate,  590 

Resorcin,  324 

Rhus  glabra,  722 

Sodium  benzoate,  336 

Sodium  bicarbonate,  161 

Solution  of  ammonium  acetate,  597 

Sulphur,  671 

Sulphurous  acid,  353 

Tannic  acid,  711 

Tincture  of  hydrastis,  485 

Tincture  of  iodine,  252 

Xanthoxylum,  269 
Pharynx,  Catarrhal  Affections  of — 

Compound  tincture  of  benzoin,  335 
Phimosis — 

Cocaine,  496 
Phlegmasia  Dolens — 

Hamamelis,  720 
Phlyctenular  Ophthalmia — 

Yellow-oxide-of-mercury  ointment,  231 
Phosphorus-poisoning — 

Magnesium  carbonate,  668 

Ozonized  oil  of  turpentine,  644 

Potassium  permanganate,  348 
Photophobia — 

Physostigmine,  512 
Phthiriasis — 

Pilocarpine,  596 
Phthisis — 

Acetanilid,  390 

Alcohol,  571 

Arsenic,  242 

Benzoic  acid,  335    .      ' 

Catechu,  716  "^ 

Codeine,  443 

Creasote,  309 

Croton  oil,  680 

Gallic  acid,  713 

Geranium,  721 

Guaiacol,  312 

Iodine,  252 

Iodoform,  331 

Quinine,  215 

Salicylic  acid,  316 

Sulphurous  acid,  353 


830 


CLINICAL  INDEX. 


Phthisis- 
Tar,  624 

Terebene,  627 

Thymol,  377 

Wild  chei-ry,  178 
Physostigmine-poisoning — 

Atropine,  460 

Strychnine,  473 
Pityriasis — 

Acetic  acid,  148 

Aromatic  spirit  of  ammonia,  162 

Resorcin,  324 
Pleura,  Chronic  Affections  of— 

Mercury,  232 
Pleurisy-*- 

Aconite,  579 

Blisters,  761 

Burgundy  pitch  plaster,  770 

Cantharidal  blister,  764 

Coniine,  501 

Gelsemium,  505 

Iodides,  253 

Opium,  439 

Quinine,  215 

Salicylic  acid,  317 

Squill,  636 

Tincture  of  iodine,  251 

Turpentine,  643 
Pleuritic  Effusion — 

Caffeine,  558 

Digitalis,  545 

Diuretin,  652 

Pilocarpine,  595 

Salines,  688 
Pneumonia — 

Acetanilid,  390 

Aconite,  579 

Alcohol,  .570 

Ammonium  carbonate,  575 

Ammonium  iodide,  253 

Apomorphine,  604 

Arsenic,  243 

Aspidosperma,  516 

Calomel,  233 

Cantharidal  blister,  764 

Coniine,  501 

Digitalis,  544 

Grindelia,  507 

Hydrogen  dioxide,  352 

Iodides,  253 

Ipecac,  612 

Potassium  nitrate,  591 

Quinine,  215 

Senega,  626 

Serpentaria,  178 

Serum-therapy,  293 

Strychnine,  471 

Turpentine,  644 
Pneumothorax — 

Carbolic  acid,  306 
Poisoning — 

Apomorphine,  604 
Poisoning  from  Noxious  Gases — 

Ammonia,  575 


Poisoning  from  Venomous  Reptiles- 
Alcohol,  570 

Ammonia,  575 
Polypi— 

Hamamelis,  720 

Zinc  chloride,  760 
Polyuria — 

Alum,  748 

Kino,  717 
Portal  Congestion — 

Colchicum,  257 
Post-partum  Hemorrhage — 

Digitalis,  544 

Ergot,  480 

Ether,  400 

Sodio-benzoate  of  caffeine,  558 

Strychnine,  473 
Priapism — 

Lupulin,  445 
Prickly  Heat — 

Citric  acid,  148 
Proctitis — 

Copaiba,  648 
Progressive  Paralysis  of  the  Insane- 

Physostigma,  513 
Prolapsus  Ani — 

Bismuth  subnitrate,  751 

Ergot,  480 

Geranium,  721 

Krameria,  718 

Nitric  acid,  142 

Strychnine,  471 

Tannic  acid,  711 

White  oak,  715 
Prolapsus  of  Iris — 

Physostigmine,  512 
Prolapsus  Uteri — 

Iron,  19s 
Prostate  Gland,  Enlargement  of — 

Ergot,  480 
Prostatitis — 

Belladonna,  460 

Hyoscyamus,  464 
Prostatorrhea — 

Iron,  196 

Tincture  of  cantharides,  765 

Turpentine,  644 
Prurigo — 

Ergot,  481 

Fowler's  solution,  241 

Sulphuric  acid,  144 
Pruritus — : 

Aconite,  579 

Alum,  748 

Camphorated  chloral,  417 

Cannabis,  450 

Carbolic  acid,  306 

Ether,  400 

Gallanol,  713 

Gelsemium,  505 

Hydrocyanic  acid,  522 

Menthol,  375 

Nitric  acid,  142 

Pilocarpine,  596 


CLINICAL   INDEX. 


831 


Pruritus — 

Piperazin,  655 

Salicylic  acid,  317 

Solution  of  lead  subacetate,  731 

Tar,  624 

Zinc  sulphate,  736 
Pruritus  Ani — 

Silver  nitrate,  743 
Pruritus  Vulvae — 

Silver  nitrate,  743 
Psoriasis — 

Ammonium  carbonate,  S7S 

Arsenic,  241 

Copaiba,  647 

Eucalyptus,  341 

Gallanol,  713 

Lead  iodide,  732 

Phosphorus,  203 

Pilocarpine,  596 

Pyrogallol,  713 

Resorcin,  324 

Salicylic  acid,  315 

Strophanthus,  549 

Sulphur,  670 

Thyroid  extract,  21 9 

Turpentine,  643 
Ptyalism — 

Alum,  747 

Bismuth  subnitrate,  751 

Catechu,  716 

Copper  sulphate,  738 

Krameria,  718 

Myrrh,  337 

Pilocarpine,  595 

Potassium  chlorate,  351 

Rhus  glabra,  722 
Puerperal  Eclampsia — 

Amyl  nitrite,  526 

Conium,  501 
Puerperal  Fever — 

Opium,  439 

Quinine,  215 

Terebene,  627 

Turpentine,  644 
Pulmonary  Affections,  Chronic — 

Cetraria,  778 

Nuclein,  219 

Turpentine,  644 
Purpura — 

Digitalis,  544 

Ergot,  481 

Hamamelis,  720 

Sulphuric  acid,  144 

Turpentine,  644 
Putrid  Sore  Throat — 

Potassium  permanganate,  347 
Pyelitis — 

Benzoic  acid,  335 

Buchu,  638 

Copaiba,  648 

Gallic  acid,  713 

Tincture  of  cantharides,  765 
Pyelo-nephritis — 

Gallic  acid,  713 


Pyemia — 

Alcohol,  571 

Iron,  196 

Quinine,  215 
Pyonephrosis — 

Turpentine,  644 
Pyorrhea  Alveolaris — 

Hydronaphtol,  322 

Tincture  of  iodine,  252 
Pyrosis — 

Bismuth  subnitrate,  752 

Catechu,  716 

Glycerin,  775 

Kino,  717 

Manganese  dioxide,  198 

Rabies — 

Serum-therapy,  300 
Rachitis — 

Cod  liver  oil,  135 

Lime  water,  164 

Phosphorus,  203 
Rectal  Bleeding— 

Krameria,  718 
Rectal  Fissure — 

Hamamelis,  720 
Rectal  Prolapse — 

Nutgall  ointment,  714 
Rectal  Ulcer  — 

Fluid  extract  of  hydrastis,  485 

Hamamelis,  720 

Potassium  chlorate,  351 

Silver  nitrate,  744 

Tannic  acid,  711 
Relaxed  Uvula — 

Capsicum,  365 

White  oalt,  715 
Remittent  Fever — 

Gelsemium,  505 

Ipecac,  612 

Iris,  679 
Renal  Calculi — 

Piperazin,  655 
Renal  Colic — 

Piperazin,  655 
Renal  Hemorrhage — 

Physostigma,  513 
Respiratory  Organs,  Inflamed  Condi- 
tions of— 

Althaea,  779 
Restlessness  of  Fever — 

Convallaria,  554 
Retention  of  Urine — 

Strychnine,  472 
Rheumatic  Affections — 

Rhus  toxicodendron,  488 
Rheumatic  Arthritis — 

Piperazin,  655 

Salicyhc  acid,  316 
Rheumatic  Pains — 

Turpentine,  643 
Rheumatism — 

Acetanilid,  390  '  ^  >i 

Aconite,  579 


832 


CLINICAL  INDEX. 


Rheumatism — 

Alkalies,  163 

Ammonia  liniment,  575 

Ammonium  chloride,  618 

Arnica,  589 

Arsenic,  Z43 

Asaprol,  322 

Aspidospermine,  517 

Belladonna  plaster,  459 

Betol,  322 

Bromides,  533 

Buchu,  638 

Burgundy-pitch  plaster,  770 

Camphoric  acid,  387 

Citric  acid,  149 

Cod  liver  oil,  135 

Colchicum,  257 

Guaiac,  260 

Hamamelis,  720 

Mezereon,  267 

PhenocoU,  394 

Phytolacca,  585 

Potassium  iodide,  253 

Potassium  nitrate,  591 

Salicylic  acid,  316 

Sanguinaria,  266 

Senega,  626 

Sodium  bicarbonate,  161 

Sodium  phosphate,  688 

Solution  of  ammonium  acetate,  597 

Sulphur,  671 

Tansy,  706 

Tincture  of  camphor,  569 

Tincture  of  iodine,  251 
Rheumatoid  Arthritis — 

Alkalies,  163 

Arsenic,  243 

Cod  liver  oil,  135 

Colchicum,  257 
Rhinitis — 

Nitrate  of  sanguinarine,  265 
Rhus-poisoning — 

Grindelia,  507 

Hamamelis,  720 

Serpentaria,  1 79 
Ringworm — 

Acetic  acid,  148 

Compound  tincture  of  benzoin,  335 

Copper  sulphate,  738 

Salicylic  acid,  317 

Salivary  Fistula — 

Arsenic,  240 

Chromic  acid,  757 
Scabies — 

Copper  sulphate,  738 

Hyposulphites,  355 

Sulphur  ointment,  670 
Scales,  Removal  of — 

Olive  oil,  775 
Scarlatina — 

Belladonna,  459 
Scarlatinal  Angina — 

Sanguinaria,  265 


Scarlet  Fever — 

Digitalis,  544 

Mustard  bath,  768 
Sciatica — 

Acetanilid,  391 

Bhsters,  761 

Cantharidal  blisters,  764 

Colchicine,  257 

Ether,  400 

Nitroglycerin,  527 

PhenocoU,  394 

Potassium  iodide,  253 

Salicylic  acid,  316 

Sulphur,  671 
Sclerosis — 

Mercury,  232 

Potassium  iodide,  252 
Sclerotitis — 

Salicylic  acid,  316 
Scrofula — 

Cod  liver  oil,  135 

Hypophosphites,  206 

Iron  iodide,  195 

Phytolacca,  585 

Potassium  iodide,  252 

Sarsaparilla,  262 
Scrofulous  Glands — 

Zinc  chloride,  760 
Scrofulous  Sores — 

Conium,  501 

Phosphoric  acid,  142 
Scurvy — 

Citric  acid,  149 

Sulphuric  acid,  144 
Sea-sickness — 

Acetanilid,  391 

Belladonna,  460 

Chloral,  418 

Chloral  foramide,  422 

Cocaine,  497 
Seat-worms — 

Quassia,  178 
Sebaceous  Cysts — 

Ether,  400 
Seborrhea — 

Hamamelis,  720 

Hydrastine  ointment,  485 

Resorcin,  324 
Seminal  Emissions — 

Iron,  196 
Senile  Debility^ 

Brain-extract,  219 

Spermine,  217 
Senile  Gangrene — 

Camphor,  387 
Septicemia — 

Alcohol,  571 

Iron,  196 

Quinine,  215 

Serum-therapy,  296 
Sequestra — 

Hydrochloric  acid,  142 
Sexual  Excitement — 

Monobromated  camphor,  387 


CLINICAL  INDEX: 


833 


Shock- 
Digitalis,  543 

Ether,  400 

Opium,  439 
Skin,  Diseases  of — 

Acetic  acid,  148 

Aristol,  331 

Cod  liver  oil,  135 

Eucalyptus,  341 

Hydrochloric  acid,  143 

Iodoform,  331 

Liquor  potassae,  161 

Potassium  carbonate,  161 

Sulphuric  acid,  144 
Skin,  Irritable  and  Inflamed  Condi- 
tions of — 

Althaea,  779 
Sleeplessness — 

Lactucarium,  446 
Small-pox — 

Alcohol,  570 

Sulphur,  671 
Sore  Nipples — 

Silver  nitrate,  743 

Tannic  acid,  711 
Sore  Throat — 

Acetic  acid,  148 

Alum,  747 

Hydrochloric  acid,  141 

Liquorice,  621 
Sores,  Foul-smelling — 

Hematoxylon,  719 
Spasmodic  Rigidity  of  Os  Uteri — 

Belladonna  ointment,  459 

Chloral,  418 
Spermatorrhea — 

Belladonna,  460 

Bromides,  533 

Camphoric  acid,  387 

Digitalis,  544 

Ergot,  481 

Gelsemium,  505 

Lupulin,  445 

Strychnine,  473 

Tincture  of  cantharides,  765 

Turpentine,  644 
Spinal  Congestion — 

Belladonna,  460 

Ergot,  481 
Spinal  Diseases — 

Acetanilid,  391 
Spinal  Meningitis — 

Blisters,  761 
Splenic  Enlargements — 

Ergot,  481 

Lead  iodide,  732 

Red-iodide-of-mercury  ointment,  232 
Spongy  Gums — 

Catechu,  716 

Krameria,  718 

Myrrh,  337 

Rhus  glabra,  722 

Tannic  acid,  711 

Tincture  of  benzoin,  335  ■ 

53 


Sprains — 

Alcohol,  569 

Arnica,  589 

Calendula,  178 

Camphor  liniment,  386 

Hamamelis,  720 

Olive  oil,  776 

Rhus  toxicodendron,  488 

Solution  of  lead  subacetate,  731 

Tansy,  706 
Sthenic  Fevers — 

Chloral,  419 
Stomatitis — 

Alum,  747 

Bismuth  subnitrate,  751 

Chlorine  vifater,  356 

Copper  sulphate,  738 

Geranium,  721 

Salicylic  acid,  316 

Tannic  acid,  711 

Thymol,  377 

Zinc  sulphate,  736 
Strabismus — 

Bromides,  532 
Strangury- 
Demulcents,  772 

Onion  poultice,  620 
Stricture — 

Aconite,  579 

Olive  oil,  776 
Strumous  Affections — 

Sanguinaria,  266 
Strychnine-poisoning — 

Amyl  nitrite,  526 

Bromides,  532 

Chloral,  418 

Coniine,  501 

Hydrasline  hydrochlorate,  486 

Potassium  permanganate,  348 
Subinvolution — 

Cannabis,  450 

Ergot,  482 

Glycerite  of  tannic  acid,  774 
Sweating- 
Alcohol,  569 

Alum,  748 

Belladonna,  459 

Bismuth  subnitrate,  75' 

Camphoric  acid,  387 

Ergot,  481 

Gallic  acid,  713 

Hematoxylon,  7 19 

Kino,  717 

Lead  oxide,  732 

Pilocarpine,  595 

Red  rose,  723 

Silver  oxide,  744 

Sulphuric  acid,  144 

Zinc  oxide,  735 
Swellings,  Glandular — 

Tincture  of  iodine,  251 
Swellings,  Inflammatory — 

Ammonium  chloride,  617 

Hyposulphites,  355 


834 


CLINICAL  INDEX. 


Sycosis — 

Phytolacca,  585 
Resorcin,  324 

Salicylic  acid,  315 

Salol,  319 

Sulpiiur,  670 

Tannic  acid,  711 
Sympathetic  Cough — 

Asafetida,  387 
Syncope — 

Alcoiiol,  570 

Mustard,  768 
Synovitis — 

Belladonna  ointment,  458 

Cantharidal  blister,  765 

Ichthyol,  326 

Iodoform,  330 

Lead  acetate,  730 

Mercurial  ointment,  231 

Tincture  of  iodine,  25 1 

Vesicants,  761 
Syphilis — 

Arsenic,  243 

Bromides,  533 

Chloride  of  zinc,  760 

Chromic  acid,  756 

Cod  liver  oil,  136 

Guaiac,  260 

Iodides,  252 

lodofonn,  331 

Iron  iodide,  195 

Mercurial  preparations,  231 

Mezereon,  267 

Nitric  acid,  143 

Papain,   132 

Phytolacca,  585 

Sanguinaria,  266 

Sarsaparilla,  262 

Serum-therapy,  296 

Silver  iodide,  744 

Thyroid  extract,  2ig 

Tabes  Dorsalis — 

Acetanilid,  391 
Tape-worms — 

Carbolic  acid,  307 

Ether,  400 

Kousso,  699 

Male  fern,  698 

Pomegranate,  700 

Pumpkin  seed,  701 

Salicylic  acid,  317 
Tetanus — 

Acetanilid,  391 

Amyl  nitrite,  526 

Bromides,  533 

Chloral,  418 

Conium,  501 

Curare,  515 

Gelsemium,  504 

Opium,  438 

Physostignia,  513 

Salicylic  acid,  316 

Serum-therapy,  281 


Tetanus — 

Strychnine,  472 

Thyroid  extract,  219 
Tetany— 

Thyroid  extract,  218 
Thirst,  to  Quench — 

Demulcents,  772 
Thread-worms — 

Rhubarb,  677 
Throat,  Acute  Inflammation  of — 

Tartar  emetic,  607 
Throat,  Diseases  of — 

Aristol,  331 

Iodoform,  331 

Liquor  potassse,  161 

Nitric  acid,  142 

Pilocarpine,  595 
Throat,  Relaxed — 

Myrrh,  337 
Thrombosis — 

Ammonia,  576 
Thrush- 
Sodium  bicarbonate,  162 

Sodium  sulphocarbolate,  308 
Thyroid  Gland,  Enlargement  of — 

Iris,  679 
Tic  Doloureux — 

Aconite,  579 

Butyl-chloral  hydrate,  422 

Strychnine,  472 

Veratrine  ointment,  584 
Tinea  Capitis — 

Carbolic  acid,  306 
Tinea  Circinata — 

Cantharidal  blister,  765 

Carbolic  acid,  306 
Tinea  Sycosis — 

Copper  sulphate,  738 
Tinea  Tarsi — 

Copper  sulphate,  738 
Tinea  Tonsurans — 

Cantharidal  blister,  765 

Carbolic  acid,  306 

Hydronaphtol,  322 

Tincture  of  iodine,  252 

Turpentine,  643 
Tinea  Versicolor — 

Sulphur  ointment,  670 
Toadstool-poisoning — 

Atropine,  460 
Tobacco  Habit — 

Cocaine,  497 

Strophanthus,  549 
Tongue,  Fissure  of — 

Glycerin,  774 
Tongue,  Tuberculosis  of — 

Chromic  acid,  757 
Tonsillitis — 

Aconite,  579 

Alum,  747 

Camphorated  naphtol,  322 

Gallic  acid,  712 

Guaiac,  260 

Guaiacol,  312 


CLINICAL  INDEX. 


835 


Tonsillitis — 

Phytolacca,  585 

Quinine,  215 

Rhus  glabra,  722 

Salicylic  acid,  316 

Silver  nitrate,  743 

Sodium  bicarbonate,  161 

Sodium  sulphocarbolate,  308 

Tannic  acid,  711 
Tonsils,  Enlarged — 

Zinc  iodide,  736 

Zinc  sulphate,  736 
Toothache — 

Campho-phenique,  306 

Camphorated  chloral,  41 7 

Capsicum,  365 

Creosote,  309 

Oil  of  cloves,  368 
Torticollis — 

Capsicum,  365 
Trachea,  Congestion  of — 

Creosote,  309 
Tracheitis — 

Ipecac,  611 

Silver  nitrate,  743 

Terpin  hydrate,  628 
Trachoma — 

Alum,  748 

Bismuth  subnitrate,  751 
Trichophytosis — 

Gallonal,  713 
Tubercular  Joints — 

Iodoform,  330 
Tuberculosis — 

Benzoyl-eugenol,  369 

Bone-marrow,  219 

Camphorated  naphtol,  322 

Cantharidin,  765 

Cod  liver  oil,  135 

Creosote,  309 

Guaiacol,  312 

Hydronaphtol,  322 

Hypophosphites,  206 

Iron,  195 

Nuclein,  219 

Phosphoric  acid,  142 

Serum-therapy,  291 

Sulphur,  671 
Tuberculous  Ulceration — 

Calcium  phosphate,  206 

Lactic  acid,  146 
Turgescence  of  Nasal  Mucous  Mem- 
brane— 

Cubeb,  650 
Tylosis — 

Salicylic  acid,  315 
Tympanitis — 

Asafetida,  387 

Turpentine,  644 
Tyfrhoid  Fever — 

.^6acia,  778 
.  Alcohol,  570 

Bismuth  salicylate,  75^ 

Borax,  346 


Typhoid  Fever — 

Camphor,  387 
Carbolic  acid,  307 
Digitalis,  544 
Eucalyptus,  342 
Hydrochloric  acid,  143 
Hydronaphtol,  322 
Hyposulphites,  355 
Nuclein,  219 
Oxgall,  67s 

Potassium  chlorate,  351 
Quinine,  216 
Salicylic  acid,  316 
Serpentaria,  179 
Serum-therapy,  297 
Sodium  sulphocarbolate,  308 
Strychnine,  471 
Sulphur,  671 
Thymol,  377 
Turpentine,  644 
Zinc  sulphate,  736 
Tjrphus  Fever — 
Alcohol,  570 
Camphor,  387 
Serpentaria,  179 

Ulcerated  Nipples — 

Catechu,  715 
Ulceration,  Phagedenic — 

Nitric  acid,  142 
Ulcerations,  Superficial — 

Castor  oil,  666 
Ulcer  of  Cervix — 

Carbolic  acid,  306 
Ulcer  of  Stomach — 

Pepsin,  130 

Resorcin,  325 
Ulcerous  Gums — 

Tannic  acid,  711 
Ulcers — 

Alcohol,  569 

Alum,  748 

Alumnol,  322 

Aristol,  331 

Bismuth  benzoate,  335 

Bismuth  subgallate,  752 

Bismuth  subiodide,  752 

Bismuth  subnitrate,  751 

Camphor  ointment,  386 

Cantharidal  Ulster,  764 

Carbolic  acid,  306 

Catechu,  715 

Chloral,  416 

Chloride  of  zinc,  760 

Chromic  acid,  757 

Copaiba,  647 

Copper  sulphate,  738 

Fluid  extract  of  hydrastis,  485 

Galla,  714 

Grindelia,  507 

Hydrogen  dioxide,  352 

Iodoform,  330 

Iron  sulphate,  194 

Kino,  716 


836 


CLINICAL  INDEX. 


Ulcers — 

Lycopodium,  781 

Nitrate  of  sanguinarine,  265 

Nuclein,  219 

Phytolacca,  585 

Potassium  bromide,  532 

Potassium  chlorate,  351 

Potassium  permanganate,  347 

Resorcin,  324 

Rhus  glabra,  722 

Silver  nitrate,  743 

Solution  of  chlorinated  soda,  357 

Tannic  acid,  711 

Tar,  624 

Terebene,  627 

Vesicants,  761 

White  oak,  715 

Zinc  oxide,  735 

Zinc  sulphate,  736 
Ulcers  of  Mouth  and  Throat — 

Tincture  of  hydrastis,  485 
Ulcers,  Syphilitic — 

Carbolic  acid,  306 

Resorcin,  345 
Ulcers,  Venereal — 

Calomel,  231 
Uremia — 

Opium,  438 

Pilocarpine,  595 
Uremic  Convulsions — 

Chloral,  418 
Urethral  Caruncles — 

Cocaine,  495 
Urethritis — 

Buchu,  638 

Elm,  779 
Uric-acid  Diathesis — 

Lithium  bromide,  533 

Lithium  preparations,  164 
Urinary  Organs,  Inflamed  Conditions 
of— 

Althsea,  779 
Urticaria — 

Alcohol,  569 

Anderson's  powder,  386 

Citric  acid,  148 

Copaiba,  648 

Ergot,  481 

Ether,  400 

Hamamelis,  720 

Hydrocyanic  acid,  522 

Menthol,  375 

Solution  of  lead  subacetate,  731 
Uterine  Cancer — 

Conium,  501 

Iodoform,  330 

Terebene,  627 
Uterine  Contraction,  to  Stimulate — 

Quinine,  216 
Uterine  Fibroids — 

Ergot,  480 
Uterine  Hemorrhage — 

Alcohol,  569 

Catechu,  716 


Uterine  Hemorrhage — 

Cinnamon,  362 

Ergot,  480 

Hamamelis,  720 

Hydrastine,  485 

Ipecac,  611 

Krameria,  718 

Red  rose,  723 

Senegin,  626 

White  oak,  715 
Uterine  Polypi — 

Ergot,  480 
Uterine  Tumors — 

Ergot,  482 
Uterine  Ulcerations — 

Fluid  extract  of  hydrastis,  485 

Iodoform,  330 
Uterus,  Congestion  of — 

Croton  oil,  683 

Glycerite  of  tannic  acid,  774 
Uterus,  to  Dilate  Neck  of — 

Elm,  779 
Uvula,  Relaxation  of — 

Alum,  747 

Catechu,  716 

Kino,  716 

Krameria,  718 

Vaginal  Ulcerations — 

Fluid  extract  of  hydrastis,  485 
Vaginitis — 

Ammonium  chloride,  617 

Copaiba,  648 

Grindelia,  507 

Lime  water,  162 
Valvular  Diseases  of  Heart — 

Convallaria,  554 

Digitalis,  541 

Sparteine  sulphate,  551 

Strophanthus,  54S 
Varicocele — 

Ergot,  480 

Hamamelis,  720 
Varicose  Ulcers — 

Hamamelis,  720 
Varicose  Veins — 

Ergot,  480 

Hamamelis,  720 
Variola — 

Glycerite  of  starch,  774 
Venereal  Sores — 

Black  wash,  162 

Hydrogen  dioxide,  352 

Salol,  319 

Solution  of  nitrate  of  mercury,  232 

Yellow  wash,  162 
Venereal  Warts — 

Nitric  acid,  142 
Verruca — 

Alum,  747 

Salicylic  acid,  315 
Vertigo — 

Cubeb,  651 

Valerian,  388 


CLINICAL  INDEX. 


837 


Vesical  Calculi — 

Piperazin,  655 
"Vesical  Catarrh — 

Silver  nitrate,  744 

Tar  water,  624 

Thymol,  377 
"Vesical  Tenesmus — 

Hyoscyamus,  464 
Vomiting — 

Ammonium  bromide,  533 

Bismuth  subnitrate,  751 

Calomel,  232 

Cantharidal  blister,  765 

Champagne,  570 

Cocaine,  497 

Cray  powder,  232 

Hydrochloric  acid,  143 

Hydrocyanic  acid,  522 

Ipecac,  611 

Lime  water,  162 

Menthol,  375 

Quinine,  216 

Strychnine,  471 
Vomiting  of  Pregnancy — 

Ammonium  bromide,  533 

Cerium  oxalate,  753 

Chloral,  418 

Strychnine,  471 
Vomiting  of  Uterine  Disease- 
Cerium  oxalate,  753 
Vulvitis — 

Zinc  sulphate,  736 

Warts — 

Acetic  acid,  148 

/Arsenic,  240 

Glacial  acetic  acid,  758 

Potassium  bichromate,  349 

Salicylic  acid,  315 
Wasting  Diseases — 

Cod  liver  oil,  135 

Phosphoric  acid,  143 
Whooping  Cough — 

Acetanilid,  391 

Alum,  748 

Ammonium  chloride,  617 

Asafetida,  387 

Belladonna,  459 

Bromides,  S33 


Whooping  Cough — 

Bromoform,  533 

Chloral,  417 

Cod  liver  oil,  135 

Coffee,  558 

Conium,  501 

Ergot,  481 

Gelsemium,  504 

Grindelia,  507 

Hydrocyanic  acid,  522 

Hyoscyamus,  464 

Ouabain,  549 

Quinine,  216 

Resorcin,  324 

Silver  nitrate,  743 

Syrup  of  garlic,  620  ~ 

Tannic  acid,  711 

Terebene,  627 

Zinc  oxide,  735 

Zinc  sulphate,  736 
Worms — 

Anthelmintics,  693 

Chenopodium,  695 

Kamala,  701 

Olive  oil,  776 

Santonin,  696 

Spigelia,  697 
Wounds — 

Alcohol,  569 

Bismuth  subgallate,  752 

Bismuth  subnitrate,  751 

Campho-phenique,  386 

Chlorine  water,  356 

Compound  tincture  of  benzoin,  334 

Glycerin,  774 

Iodoform,  330 

Olive  oil,  776 

Resorcin,  324 

Rhus  glabra,  722 

Salol,  319 

Silver  nitrate,  743 

Sulphurous  acid,  353 

Terebene,  627 

Turpentine,  643 

Yellow  Fever — 

Hyposulphites,  35s    ■ 
Turpentine,  644 


GENERAL  INDEX. 


Note. — The  bold-face  figures   indicate   the  pages   on  which   the   drugs  are  treated 
in  extenso. 


Absolute  alcohol,  560 
Abstracta,  96 
Abstracts,  96 
Acacia,  771,  777 
Aceta,  82 
Acetanilid,  388 
Acetanilidum,  388 
Acetic  acid,  146 
glacial,  761 
ether,  408 
Acetum  opii,  428 
sanguinarise,  264 
scilla,  63s 
Acid  phosphates,  53 
Acidum  aceticum,  146 
dilutum,  147 
glaciale,  758 
arsenosum,  234 
benzoicum,  332 
boricum,  344 
camphoricum,  381 
carbolicum,  302 
iodatum,  303 
chromicum,  756 
citricum,  147 
gallicum,  712 

hydrobromicum  dilutum,  529 
hydrochloricum,  138 

dilutuni,  138 
hydrocyanicum  dilutum,  519)  74^ 
hypophosphorosum  dilutum,  205 
lacticum,  144 

dilutum,  138 
nitricum,  139 

dilutum,  139 
nitrohydrochloricum,  I38,  139 

dilutum,  138,  139 
phosphoricum,  138 
salicylicum,  313 
sulphuricum,  138 
aromaticum,  139 
dilutum,  136 
sulphurosum,  353 
tannicum,  710 
tartaricum,  147 
Aconite,  576 
Aconitine,  577 
Aco'nitum,  576 
Adeps  benzoinatus,  332 
Adhesive  plaster,  123 
Adonis  vernalis,  552 


^ther,  397 

Albuminate  of  iron,  190 
Alcohol,  559,  602,  769 

absolutum,  560 

deodoratum,  560 
Alcoholic  extract  of  belladonna  leaves,  452 

eye-wash,  58 
Ale,  562 

Alkali  solutions,  53 
Alkalies,  149,  615 
Alkaline  salt  solutions,  52 
Allium,  619 

cepa,  619 
Allspice,  369 
Almond,  771 

oil,  771 
Almonds,  comp.,  102 
Aloe,  672 

barbadensis,  672 

purificata,  673 

socatrina,  673 
Aloes,  672,  702 
Aloin,  674 
Aloinum,  674 
Althsea,  779 
Alum,  709,  745 

(burnt),  755 
Alumen,  745 

exsiccatum,  745 
Alumini  hydras,  746 

sulphas,  746 
Aluminis  glyceritum,  745 
Aluminum  aceto-tartrate,  745 

boroformate,  746 

hydrate,  746 

sulphate,  746 
Alumnol,  320-322,  745 
American  hellebore,  580 

wormseed,  694 
Ammonia,  769 

(confined  vapor),  761 

liniment,  573 

water,  573 
Ammoniac,  380 

plaster  with  mercury,  223,  380 
Ammoniacum,  380 
Ammoniated  glycyrrhizin,  621 

mercury,  222 

tincture  of  guaiac,  259 
of  valerian,  382 
Ammonii  benzoas,  332 


840 


GENERAL  INDEX. 


Ammonii  bromidum,  527 

carbonas,  156,  573 

chloridum,  616 

valerianas,  382 
Ammonio-ferric  alum,  186 

sulphate,  r86 

tartrate,  186 
Ammonium,  602 

benzoate,  332 

bromide,  527 

carbonate,  156,  573 

chloride,  615,  616 

iodide,  245 

iodidum,  245 

valerianate,  382 
Amyl  nitris,  523 

nitrite,  523,  602 
Amylene  hydrate,  410 
Anemonin,  586 
Anesthetics,  396 

Anhydro-ortho-sulphanin-benzoic  acid,  655 
Animal  charcoal,  772 

extracts,  217 
Anise,  359 

water,  360 
Anisum,  359 
Anthelmintics,  693 
Anthemis,  172 

Antimonii  et  potassii  tartras,  604 
Antimony  chloride,  755 

and  potassium  tartrate,  5oo,  601,  615 
Antipyrine,  392 
Antiseptol,  327 
Antispasmodics,  379 
Apiol,  702,  707 
Apiolum,  707 
Apomorphine,  615 

hydrochlorate,  600 
Aqua  acidi  carbolici,  302 

ammonia  fortior,  572 

ammonise,  573 

anisi,  360 

camphorse,  381 

chlori,  355 

chloroformi,  403 

cinnamomi,  362 

creasoti,  309 

eucalypti,  339 

foeniculi,  364 

hydrogenii  dioxidi,  351 

menthae  piperitas,  374 
viridis,  376 

picis  liquidse,  622 
Aquae  medicatse,  5 1 
Aqueous  fluid  extract  of  senna,  94 
Argenti  cyanidum,  739 

iodidum,  248,  740 

nitras,  740 

dilutus,  589,  740 
fusus,  740 

oxidum,  741 
Argonin,  744 
Aristol,  327 
Arnica,  769 


Arnica  floras,  587 

flowers,  587 

plaster,  587 

radix,  587 

root,  587 
Aromatic  bitters,  172 

powder,  361,  371 
of  chalk,  154 
and  opium,  154 

spirit  of  ammonia,  573 

sulphuric  acid,  139 

syrup  of  rhubarb,  677 

tincture  of  rhubarb,  676 

waters — official,  51 
Aromatics,  357 
Arsem  iodidum,  235 
Arsenic  iodide,  235 

solutions,  52 

trioxide,  234 
Arsenious  acid,  755 
Arsenous  acid,  234 
Asafetida,  379,  702 
Asaprol,  32O-322 
Asparagin  hydrargyrate,  226 
Aspidium,  693,  694,  697 
Aspidosperma,  515 
Aspidospermine,  516 
Astringents,  708 
Atropa  mandragora,  453 
Atropina,  452 
Atropinse  sulphas,  453 
Atropine,  452 

compared  with  morphine,  457 

sulphate,  453 

Bacilli,  113 

Balsam  of  copaiba,  645 

of  Peru,  337 

of  tolu,  615,  618 
Balsamum  Peruvianum,  337 

tolutanum,  618 

tranquillans,  117 
Bandages — antiseptic  dressings,  125 
Barbadoes  aloes,  672 
Barker's  pills,  1 1 1 
Barley,  771 
Basham's  mixture,  52 
Basic  mercuric  sulphate,  226 
Basilicon,  121 

Bateman's  pectoral  drops,  89 
Baths,  702 
Battery-fluid,  54 
Bay  rum,  57 
Bearberry,  638 
Beef  and  wine,  83 

wine,  and  iron,  83 

wine,  iron,  and  cinchona,  84 
Beer,  562 
Belladonna,  659 

leaves,  45 1 

liniment,  452 

ointment,  452 

plaster,  452 

root,  452 


GENERAL  INDEX. 


841 


Belladonnas  folia,  451 

radix, 452 
Benzoate  of  bismuth,  333 

of  menthol,  333,  375 
Benzoated  lard,  332 
Benzoic  acid,  332 
Benzoin,  331 
Benzoinum,  331 
Benzonaphtol,  320,  321 
Benzosal,  310 
Benzoyl-eugenol,  368 
Benzoyl-sulphonic-imide,  655 
Bestucheff's  tincture,  88 
Beta-naphtol,  320 
Betol,  321,  322 
Biniodide  of  mercury,  224 
Birch  tar,  623 
JSismuth,  709 

and  ammonium  citrate,  749 

chrysophenate,  750 

citrate,  749 

naphtholate,  750 

salicylate,  750 . 

subcarbonate,  749 

subgallate,  750 

subiodide,  750 

subnitrate,  750 

tribromphenate,  750 
Bismuthi  et  ammonii  citras,  749 

benzoas,  333 

citras,  749 

salicylas,  750 

subcarbonas,  749 

subiodidum,  750 

subnitras,  750 
Bitter  wine  of  iron,  184 
Bitters,  170 
Black  cohosh,  61 

draught,  81 

drop,  82 

haw,  71,  618 

mustard,  766 

oxide  of  manganese,  197 

pepper,  366 

wash,  226 
Blackberry,  723 

aromatic,  64 

cordial,  71 
Bland  oils,  771 
Blaud's  pills,  109,  190 
Blistering  cerate,  1 20 

collodion,  117,  762 

paper,  124 
Blood-root,  263 
Blue  cohosh,  705 

flag,  678 

mass,  106,  222 

ointment,  119,  222 

pill,  222 
Bolus,  113 
Bone-marrow,  219 
Boracic  acid,  344 
Borax,  343,  702.  703 
Bougies,  122 


Boulton's  solution,  54 

Brain-extract,  219 

Bran,  771 

Brandy,  57,  560 

Brayera,  699 

Bread,  771 

Bromide  of  iodine,  248 

Bromides,  527,  602 

Bromine,  756,  760 

Bromoform,  529 

Bromum,  760 

Broom,  549 

Brown  mixture,  73,  621 

Brown-S^quard's  antineuralgic  pills,  1 10 

Buchu,  630,  637 

Buckthorn,  68 

berries,  64 
Burgundy  pitch,  770 

-pitch  plaster,  770 
Burnt  alum,  745 
Butter  of  antimony,  755 
Butternut,  679 
Butyl-chloral  hydrate,  422 

Cacao  butter,  771 
Cactus,  552 
Caffeina,  554 

citrata,  554 

effervescens,  555 
Caffeine,  554 

citrate,  554 
Calabar  bean,  508 
Calamus,  372 
Calcii  bromidum,  528 

carbonas  prsecipitatus,  154 

hypophosphis,  204 

phosphas  prsecipitatus,  204 

sulphocarbolas,  307 
Calcined  magnesia,  156,  667 
Calcium  bromide,  528 

hypophosphite,  204 

sulphocarbolate,  307 
Calendula,  1 71 
Calomel,  223,  659 

and  jalap  powder,  102 
Calumba,  171 
Calx,  759 

chlorata,  356 
Cambogia,  685 
Camphor,  380,  769 

ice,  121 

liniment,  381 

water,  381 
Camphora,  380 

carbolisata,  303 

monobromata,  381 
Camphorated  carbolic  acid,  303 

chloral,  410 

naphtol,  321,  322 

tincture  of  opium,  381,  428 
Camphoric  acid,  381 
Canada  liniment,  114 

-pitch  plaster,  124 

snake-root,  61 


842 


GENERAL  INDEX. 


Cannabin  tannate,  411 
Cannabine  tannate,  446 
Cannabinone,  446 
Cannabis  Indica,  446 
Cantharidal  collodion,  762 

pitch  plaster,  770 
Cantharides,  702,  761,  762 

cerate,  762 
Cantharidis  paper,  124 
Cantharis,  762 
Capsicum,  364,  769 

plaster,  365 
Caraway,  377 

Carbasus  acidi  carbolici,  302 
Carbolated  oil,  302 
Carbolic  acid,  302,  755 
Carbolic-acid  gauze,  302 

plaster,  303 

water,  302 
Carbon  tetrachloride,  408 
Cardamom,  370 
Cardamomum,  37O 
Cardiac  stimulants,  534 
Carron  oil,  114 
Carum,  377 
Caryophyllus,  367 
Casca  bark,  637 
Cascara  sagrada,  70,  666 
Cascarilla,  173 
Cassia  cinnamon,  361 

fistula,  664 
Castor  oil,  665 
Catarrh  snuff,  102 
Catechol,  323 
Catechu,  709,  715 
Cathartic  acid,  681 
Cathartics,  656 
Cathartinic  acid,  681 
Caulophyllum,  702,  705 
Caustic  potash,  755,  757 
■  soda,  755,  757 
Caustics  (escharotics),  125,  754 
Cayenne  pepper,  364 
Celery  compound,  66 
Cerata,  120,  121 
Cerate  of  lead  subacetate,  725 
Cerates,  120 
Ceratum  cantharidis,  762 

plumbi  subacetatis,  725 
Cerii  oxalas,  753 
Cerium  oxalate,  709,  753 
Cerous  oxalate,  753 
Cetraria,  771,  778 
Cevadilla,  581 
Ceylon  cinnamon,  361 
Chalk  mixture,  72 
Chalybeate  pills,  1O9,  190 
Chamomile,  172 
Channing's  solution,  54 
Chapman's  dinner  pill,  no 

mixture,  74 
Charcoal,  772 
Charta  potassii  nitratis,  589 

sinapis,  767 


Chemical  food,  63 

waters,  official,  51 
Chenopodium,  693,  694 
Chinconidinse  sulphas,  209 
Chinoidine,  210 
Chinoidinum,  210 
Chinolin,  210 

tartras,  210 

tartrate,  210 
Chirata,  172 
Chloral,  410,  692 
Chloral  ammonium,  411 

butylicum,  422 

formamide,  420 

formidatum,  420 

glycerite,  410 

menthol,  375 

phenol,  410 

urethane,  411,  420 
Chloralamide,  420 
Chloralofee,  411,  420 
Chlor-ammonium,  420 
Chloride  of  lime,  356 
Chlorinated  lime,  356 
Chlorine  water,  355 
Chlorodyne,  403 
Chlorofortn,  403,  769 

anodyne,  74 

emulsion,  403 

liniment,  403 

water,  403 
Chloroformum,  463 
Chlorohydrophosphate  of  lime,  6r 
Cholera  mixture,  74 
Chromic  acid,  755,  756 

anhydride,  756 

triOxide,  756 
Churchill's  iodine  caustic,  55 

tincture  of  iodine,  88 
Cimicifuga,  61 
Cinchona,  207 

rubra,  208 
Cinchonidinse  salicylas,  210 
Cinchonidine  salicylate,  210 

sulphate,  209 
Cinchonina,  209 
Cinchoninse  iodosulphas,  210 

sulphas,  209 
Cinchonine,  209 

iodosulphate,  327 

sulphate,  209 
Cinnamomum,  360 
Cinnamon,  360,  702 

water,  362 
Cinnamyl-eugenol,  368 
Citric  acid,  147 
Citrine  ointment,  226 
Clemens'  solution,  55 
Cloves,  367 
Coca,  68,  488 
Cocaina,  489 
Cocainse  hydrochloras,  489 

phenas,  489 
Cocaine,  489 


GENERAL  INDEX. 


843 


Cocaine  hydrochlorate,  489 

phenate,  489 
Cocculus,  473 
Indicus,  473 
Codeina,  429 
Codeine,  429 
Cod  liver  oil,  132,  702 
Coffee,  62 
Colchicum,  254 
Cold  cream,  119 
Cole's  dinner  pill,  1 10 
CoUodia,  official,  117 
Collodion,  772 
Collodium  stypticum,  710 

cantharidatum,  762 
Colocynth,  689 
Colocynthis,  689 
Colorless  tincture  of  iodine,  88 
Columbo,  171 

Comparative  action  of  alkalies,  160 
Composition  powder,  102 
Compound  anise  powder,  103 
cathartic  pills,  685 
chalk  powder,  154 
decoction  of  sarsaparilla,  261 
effervescing  powder,  687 
extract  of  colocynth,  673,  689 
fluid  extract  of  sarsaparilla,  261 

of  stillingia,  263 
infusion  of  senna,  363,  668,  681 
iron  mixture,  180,  336 
jalap  powder,  690 
liniment  of  mustard,  767 
liquorice  powder,  364 
mixture  of  glycyirhiza,  621 
pills  of  antimony,  259 

of  rhubarb,  674 
powder  of  glycyrrhiza,  621,  681 
of  jalap,  151 
of  morphine,  429 
of  rhubarb,  372 
rhubarb  pills,  676 

powder,  676 
solution  of  iodine,  245 
spirit  of  aether,  397 

of  juniper,  363,  364,  378,  640 
syrup  of  sarsaparilla,  261 
of  squill,  605,  625,  635 
of  stillingia,  263 
tincture  of  benzoin,  332,  618,  674 
of  cardamom,  361,  370,  378 
of  catechu,  361 
of  cinchona,  174,  209 
-  of  gentian,  171 
of  lavender,  361,  373 
Compressed  pills,  113 
Confectio  rosse,  723 

sennae,  363 
Confection  of  rose,  723 

of  senna,  363,  681 
Confectiones,  104,  105 
Confections,  104 
Coniina,  498 
Coniinse  hydrobromas,  498 


Coniine,  498 

hydrobromate,  494 
Conium,  498 

juice,  498 
Conserve  of  rose,  105 
Convallamarin,  553 
Convallamarinum,  553 
Convallaria,  553 
Convallarin,  553 
Copaiba,  630,  645 
Copper,  709 

sulphate,  737,  755 
Coriander,  362 
Coriandrum,  362 
Corn  collodion,  118 
Corrosive  chloride  of  mercury,  223 

mercuric  chloride,  223 

sublimate,  223 
Cotton  root  bark,  482,  703 
Court  plaster,  772,  780 
Coxe's  hive  syrup;  60 
Cramp  bark,  519 
Cranesbill,  721 
Cream  of  tartar,  151 
Creasote,  308 

water,  309 
Creasotum,  308 
Creosols,  303 
Creta  prseparata,  154 
Croton  chloral,  422 

collodion,  118 

oil,  682,  761 
Cubeb,  649 
Cubeba,  648 
Culver's  root,  680 
Cupri  arsenis,  236 

sulphas,  737 
Cupric  arsenite,  236 
Curapoa  aloes,  672 

cordial,  65 
Curare,  513 
Cusso,  693,  694,  699 

Daley's  carminative,  73 
Damiana,  71 
Dandelion,  669 
Decocta,  82 
Decoction  of  cetraria,  778 

of  stillingia,  263 
Decoctions,  82 
Decoctum  cetrariae,  778 

sarsaparillse  corapositnm,  261 

stillingise,  263 
Definitions,  34 
Demulcents,  771 
Denarcotized  opium,  428 
Deodorant  solution,  56 
Deodorized  alcohol,  560 

opium,  428 
Dermatol,  75° 
Dermol,  750 
Dewees'  carminative,  75 

tincture  of  guaiac,  88 
Diachylon,  123 


844 


GENERAL  INDEX. 


Diachylon  ointment,  726 

plaster,  726 
Dialyzed  iron,  190 
Diaphoretics,  592 
Diethylendiamine,  654 
Diethyl-sulphon-diethyl-methane,  423 
Diethyl-sulphon-methyl-ethyl-methane,  423 
Digestants,  129 
Digitalin,  537 
Digitalinum,  537 
Digitalis,  537,  702 
Digitoxin,  538 
Diluted  acetic  acid,  147 

hydrobromic  acid,  529 

hydrochloric  acid,  138 

hydrocyanic  acid,  519,  740 

hypophosphorous  acid,  205 

nitric  acid,  139 

nitrohydrochloric  acid,  IBS,  139 

phosphoric  acid,  138 

silver  nitrate,  589,  740 

solution  of  lead  subacetate,  725 

sulphuric  acid,  139 
Dimethyl  ether,  408 
Dinner  pill,  109 
Disease  medicines,  129 
Dispensatory,  24 
Dispermin,  654 
Dithymol  di-iodide,  327 
Diuretin,  555,  630,  651 
Dobell's  solution,  56,  303 
Donovan's  solution,  52,  236 
Dover's  powder,  loi,  428 
Drastic  purgatives,  689 
Dried  alum,  745 

ferrous  sulphate,  188 

sodium  carbonate,  153 
Dry  acid  wines,  562 
Dysmenorrhea  mixture,  87 

EcBOLics,  702 

Effervescent  Carlsbad  salt,  104 

citrated  caffeine,  55s 

Kissingen  salt,  104 

magnesium  citrate,  686 

salts,  103 

Vichy  salt,  104 
Effervescing  saline  water,  56 
Elaterin,  684 
Elaterinum,  684 
Electuar.  sennse,  105 
Elixir  aurantium  compositum,  83 

calisaya,  67 

of  paraldehyde,  426 

of  phosphorus,  199 

paraldehydi,  426 

phosphori,  199 

purgans,  70 
Elixiria,  64-71 
EUxirs,  74 

medicinal,  66 
Elm,  778 
Emetics,  599 
Emmenagogues,  702 


Emollients,  771 
Emplastra,  122-124 
Emplastrum  acidi  carbolici,  303 

ammoniaci  cum  hydrargyro,  223,  380 

arnicae,  587 

belladonnae,  452 

capsici,  365 

ferri,  189,  77° 

hydrargyri,  223 

ichthyocollae,  772,  780 

opii,  428,  770 

picis  Burgundicae,  77° 
cantharidatum,  762,  770 

plumbi,  726 
Emulsion  of  ammoniac,  380 

of  asafetida,  379 
Emulsiones,  77~79 
Emulsions,  76 
Emulsum  ammoniaci,  380 

asafoetidse,  379 

chloroformi,  403 

guaiaci,  259 
Epispastics,  761 
Epsom  salt,  686 
Ergot,  476,  659,  702,  703 

of  rye,  471       ' 
Ergota,  476 
Ergotin,  477 

Erythrophleum,  630,  637 
Escharotics,  754 
Eserine  salicylate,  508 

sulphate,  508    ■ 
Essence  of  ginger,  57 

of  nutmeg,  367 

of  peppermint,  374 

of  spearmint,  376 

of  wintergreen,  373 
Ether,  769 

Ethereal  tinctures,  89 
Ethyl  bromide,  407 

carbamate,  41 1 

chloride,  407 

iodide,  407 

urethane,  411 
Ethylene  bichloride,  407 

bromide,  407 

chloride,  407 

iodide,  407 
Ethylenimine,  654 
Ethylidene  chloride,  407 
Eucalyptol,  339 
Eucalyptus,  338 

water,  339 
Eugenol-acetamide,  368 
Euonymin,  678 
Euonymus,  678 
European  hellebore,  581 
Europhen,  328 
Exalgine,  395 
Expectorants,  614 
Expressed  oil  of  almond,  776 
Extract  of  aconite,  576 

of  aloes,  673 

of  arnica  root,  587 


GENERAL  INDEX. 


845 


Extract  of  cinchona,  209 
of  colchicum  root,  254 
of  colocynth,  689 
&f  conium,  498 
of  convallaria,  553 
of  digitalis,  537 
of  ergot,  476 
of  euonymus,  678 
of  gentian,  171 
of  glycyrrhiza,  621 
of  hematoxylon,  719 
of  hyoscyamus,  462 
of  iris,  679 
of  jalap,  690 
of  juglans,  680 
of  krameria,  717 
of  leptandra,  680 
,  of  nux  vomica,  465 
of  opium,  428 
of  pancreas,  220 
of  physostigma,  508 
of  podophyllin,  692 
Of  Pulsatilla,  586 
of  quassia,  170 
of  rhubarb,  676 
of  taraxacum,  672 
of  uva  ursi,  639 
Extracta,  95 

fluida,  90-94 
Extractive  preparations,  79 
Extracts,  95 

official,  table  of  average  doses,  96 
Extractum  aconiti,  576 
.fluidum,  576 
aloes,  673 
arnicae  radicis,  587 

fluidum,  587 
aspidospermatis  fluidum,  516 
belladbnnse  foliorum  alcoholicum,  452 

radicis  fluidum,  452 
cacti  fluidum,  552 
calami  fluidum,  372 
calendulae  fluidum,  172 
calumbae  fluidum,  171 
cannabis  indicje,  446 

fluidum,  446 
capsici  fluidum,  365 
chiratse  fluidum,  172 
cinchonse,  209 
fluidum,  209 
cocse  fluidum,  489 
cocculi  fluidum,  474 
colchici  radicis,  254 
fluidum,  254 
seminis  fluidum,  255 
colocynthidis,  689 

cpmpositum,  673,  689 
conii,  498 

fluidum,  498 
convallarise  fluidum,  553 
cubebse  fluidum,  649 
cusso  fluidum,  699 
digitalis,  537 
fluidum,  537 


Extractum  ergotae,  476 
fluidum,  477 
eucalypti  fluidum,  338 
euonymi,  678 
gelsemii  fluidum,  502 
gentianse,  171 
fluidum,  171 
geranii  fluidum,  721 
glycyrrhiza;,  621 
fluidum,  621 
purum,  621 
gossypii  radicis  fluidum,  482 
grindelise  fluidum,  506 
hsematoxyli,  719 
hamamelidis  fluidum,  719 
hydrastis  fluidum,  483 
hyoscyami,  462 
fluidum,  462 
ipecacuanhae  fluidum,  608 
iridis,  679 

fluidum,  679 
jalapse,  690' 
juglandis,  680 
juniperi  fructus  fluidum,  640 
kramerise,  717 
fluidum,  717 
leptandrae,  680 
fluidum,  680 
lobelize  fluidum,  613 
lupulini  fluidum,  444 
mezerei  fluidum,  267 
nucis  vomicse,  465 

fluidum,  465 
opii,  428 

physostigmatis,  508 
phytolaccae  radicis  fluidum,  585 
pilocarpi  fluidum,  592 
podophylli,  692 
fluidum,  692 
Pulsatilla,  586 
quassiae,  170 

fluidum,  170 
rhei,  676 

fluidum,  676 
rhois  aromaticEe  fluidum,  722 

glabrae  fluidum,  722 
rosje  fluidum,  723 
rubi  fluidum,  724 
sabiuse  fluidum,  703 
sanguinariae  fluidum,  264 
sarsaparillae  fluidum,  261 

compositum,  261 
scillse  fluidum,  635 
scoparii  fluidum,  549 
senegae  fluidum,  625 
sennse  fluidum,  681 
serpentariae  fluidum,  174 
spigelise  fluidum,  697 
stillingise  fluidum,  263 
compositum,  263 
stramonii  seminis,  461 

fluidum,  461 
taraxaci,  672 
fluidum,  672 


346 


GENERAL  INDEX. 


Extractum  uvfe  ursi,  639 
fluidum,  639 
Valerianae  fluidum,  382 
veratri  viridis  fluidum,  581 
viburni  opuli  fluidum,  519 
prunifolii  fluidum,  518 
xanthoxyli  fluidum,  268 
zingiberis  fluidum,  371 

False  hellebore,  552 
Fats  and  oils,  132 
Fehling's  solution,  54 
Fel  bovis,  675 

pufificatum,  675 

tauri,  67s 
Fennel,  363 

water,  364 
Fennel's  guaiac  mixture,  87 
Ferrated  extract  of  apples,  88 
Ferratin,  190 
Ferri  albuminas,  190 

arsenas,  190 

carbonas  saccharatus,  180 

chloridum,  181 

citras,  182 

et  ammonii  citras,  183 
sulphas,  186 
tartras,  186 

et  potassii  tartras,  186 

et  quininas  citras,  1 83 
solubilis,  184 

et  strychninse  citras,  184,  466 

hypophosphis,  187 

iodidum  saccharatum,  181 

lactas,  185 

oxidum  hydratum,  185 
cum  magnesise,  185 

phosphas  solubilis,  186 

pyrophosphas  solubilis,  187 

sulphas,  188 
exsiccatus,  188 
granulatus,  188 

valerianas,  187,  382 
Ferric  ammonium  sulphate,  186 

chloride,  l8i 

citrate,  1 82 

hydrate,  185 

with  magnesia,  185 

hydroxide,  185 

hypophosphite,  187 

valerianate,  187>  382 
Ferrous  chloride,  62 

lactate,  185  1 

sulphate,  188 
Ferruginous  pills,  109,  190 
F'errum  dialysatum,  190 

reductum,  179 
Figs,  771 
Fish  berry,  473 
Flaxseed,  771 
Flour,  771 

Fluid  extract  of  aconite,  576 
of  arnica  root,  587 
of  aspidosperma,  516 


Fluid  extract  of  belladonna  root,  452 
of  black  haw,  518 
of  cactus,  552 
of  calamus,  372 
of  calendula,  172 
of  calumba,  171 
of  capsicum,  365 
of  chirata,  172 
of  cinchona,  209 
of  coca,  489 
of  cocculus,  474 
of  colchicum  root,  254 

seed,  255 
of  conium,  498 
of  cotton-root  bark,  482 
of  cramp  bark,  519 
of  cubeb,  649 
of  cusso,  699 
of  digitalis,  537 
of  ergot,  477 
of  eucalyptus,  338 
of  gelsemium,  502 
of  gentian,  171 
of  geranium,  721 
of  ginger,  371 
of  glycyrrhiza,  621 
of  grindelia,  506 
of  hamamelis,  719 
of  hydrastis,  483 
of  hyoscyamus,  462 
of  Indian  cannabis,  446 
of  ipecacuanha,  608 
of  iris,  679 

of  juniper  berries,  640 
of  krameria,  717 
of  leptandra,  680 
of  lobelia,  613 
of  lupulin,  444 
of  mezereon,  267 
of  nux  vomica,  465 
of  Phytolacca  root,  585 
of  pilocarpus,  592 
of  podophyllum,  692 
of  quassia,  170 
of  rhubarb,  676 
of  rhus  aromatica,  722 

glabra,  722 
of  rose,  723 
of  rubus,  724 
of  sanguinaria,  264 
of  sareaparilla,  261 
of  savine,  703 
of  scoparius,  549 
of  senega,  625 
of  senna,  681 
of  serpentaria,  l^ 
of  spigelia,  697 
of  squill,  635 
of  stillingia,  263 
of  stramonium  seed,  461 
of  taraxacum.  672 
of  II va  ursi,  639 
of  valerian,  382 
of  veratrum  viride,  581 


GENERAL  INDEX. 


847 


lid  extract  of  xanthoxylum,  268 

lid  extracts,  90 

lorescein,  323 

miculum,  363 

mentations,  125 

rmamidate  of  mercury,  226 

rmic  ether,  408 

tier's  solution,  52,  235 

iglove,  537 

incis's  triplex  pill,  112 

rench  mixture,"  54 

able  pills,  113 

dberry's  mixture,  75 
Ibanum  plaster,  124 
lla.  709,  713 
Ilic  acid,  709,  712 
mboge,  685 
rlic,  61S,  619 
3tric  sedatives,  6oi 
strin,  220 
latin,  771 
Isemina,  502 
Isemium,  502 
iitian,  170 
Qtiana,  170 
ranium,  709,  721 
',  57,  561 
iger,  371 

icial  acetic  acid,  755,  758 
luber's  salt,  688 
>bules,  112 
icusimide,  655 
iside,  65s 

'cerin,  659,  771,  772 
'cerinum,  772 
'cerita,  71,  72 
'cerite  of  alum,  745 
if  boroglycerin,  344 
if  carbolic  acid,  302 
if  glyceryl  borate,  344 
if.  hydrastis,  483 
if  starch,  773 
if  tannic  acid,  710 
if  tar,  623 
if  yolk  of  egg,  773 
ceritum  acidi  carbolici,  302,  773 
tannici,  710,  773 

myli.  773 

oroglycerini,  344,  773 

ydrastis,  483,  773 

icis  liquidee,  623 

item,  773 

cerole  of  pepsin,  72 

conin,  773 

cyiThiza,  620 

cyrrhizinum  ammoniatum,  621 

Ifrey's  cordial,  75 

den  seal,  483 

isypii  radicis  cortex,  482 

ilard's  cerate,  121,  725 

xtract,  725 

natum,  693,  694,  699 

nulated  ferrous  sulphate,  1 88 


Granules,  112 

Green  iodide  of  mercury,  224 

Griffith's  mixture,  72,  180 

Grindelia,  505,  615 

Gross's  antineuralgic  pills,  110 

Guaiac,  258,  702 

emulsion,  259 
Guaiaci  lignum,  258 

resina,  258 
Guaiacol,  310 

benzoate,  310 

carbonate,  311 

di-iodide,  311 

di-iodidum,  311 

salicylate,  3 1 1 
Guaiacoli  benzoas,  310 

carbonas,  311 

salicylas,  311 
Guaiacolum,  310 
Guaiacum  wood,  258 
Guaramine,  555 
Gum  Arabic,  777 

H^MALBUMIN,  191 
Hsemoferrum,  191 
Haemogallol,  I  go 
Haemoglobin,  191 
Haemol,  190 
Hall's  dinner  pill,  no 

solution  of  strychnine,  56 
Hamamelis,  709,  719 
Heart-extract,  220 
Hebra's  ointment,  119 
Hedeoma,  702,  707 
Heliotropin,  366 
Hematics,  179,  702 
Hematoxylon,  709,  718 
Hemlock,  498 
Henbane,  462 
Hiera  picra,  102 
Hive  syrup,  605 
Hoffman's  anodyne,  58,  397 
Homatropina,  453 
Honey,  771 
Hope's  mixture,  73 
Hops,  443 
Hot  drops,  88 
Humulus,  443 
Huxham's  tincture,  86 
Hydragogue  purgatives,  682 
Hydvargj'ri  chloridum  mite,  223 
corrosivum,  223 

cyanidum,  224 

formaraidatum,  226 

iodidum  flavum,  224 
rubrum,  224 
viride,  224 

oxidum  flavum,  22$ 
rubrum,  225 

salicylas,  226 

subsulphas  flavus,  226 

tannas,  226 
Hydrargyrum,  221 

ammoniatum,  222 


848 


GENERAL  INDEX. 


Hydrargyrum  cum  creta,  154,  222 
Hydrastina,  483 
Hydrastinse  hydrochloras,  483 
Hydrastine,  483 

hydrochlorate,  483 
Hydrastis,  483,  702,  703 
Hydrated  oxide  of  iron,  185  ^ 

Hydrochloric  acid,  138 
Hydrocyanic  acid,  602 
Hydrogen  peroxide,  51 
Hydronaphtol,  321,  322 
Hydroquinol,  323 
Hydroquinone,  323 
HyosciuEe  hydrobromas,  462 
Hyoscine  hydrobromate,  411,  462 
Hyoscyami  sulphas,  463 
Hyoscyaminse  hydrobromas,  463 
Hyoscyamine  hydrobromate,  463 

sulphate,  463 
Hyoscyamus,  462,  659 
Hypnal,  411,  420 
Hypophosphite  of  iron,  62 

of  lime,  61 
and  soda,  61 

Ice,  601 

Iceland  moss,  778 
Ichthyocolla,  780 
Ichthyol,  325 
Ichthyolum,  325 
Indian  tobacco,  612 
Infusa,  81,  82 
Infused  oils,  117 
Infusion  of  cinchona,  209 

of  convallaria,  553 

of  digitalis,  537 

of  hops,  444 

of  juniper,  640 

of  pilocarpus,  592 

of  wild  cherry,  174 
Infusions,  81 
Infusum  cinchonse,  209 

convallarise,  553 

digitalis,  537 

humuli,  444 

juniperi,  640 

pilocarpi,  593 

pruni  Virginians;,  174 

sennas  compositum,  363,  668,  681 
lodi  bromidum,  248 

chloridum,  248 
Iodide  of  calcium,  61 

of  iron  and  manganese,  62 
Iodine,  244,  761,  769 

caustic,  55 

chloride,  248 

ointment,  245 

trichloride,  248 
Iodized  collodion,  118 

carbolic  acid,  303 
Iodoform,  327 

collodion,  118 

and  naphtalin  powder,  102 
lodoformum,  327 


lodol,  328 
lodum,  244 
Ipecac,  608,  761 
Ipecacuanha,  600,  608,  61 5 
Iridin,  679 
Iris,  678 
Irish  moss,  62 
Iron,  702 

and  ammonium  tartrate,  1 86 
citrate,  183 

and  potassium  tartrate,  186 

and  quinine  citrate,  183 

and  strychnine  citrate,  1 84 

arsenate,  190 

by  hydrogen,  179 

plaster,  189 

quinine  chloride,  191 

solutions,  52 
Isinglass,  771,  780 

plaster,  780 

Jaborandi,  69,  592 
Jaborine,  593 

Jackson's  pectoral  syrup,  63 
Jalap,  690 
Jalapa,  690 
James's  powder,  loi 
Jamestown  weed,  460 
Janeway's  pills,  1 10 
Javelle  water,  55 
Jimson  weed,  460 
Juglans,  679 
Juniper,  630,  639 

berries,  639 
Juniperus,  639 

Kamala,  693,  694,  700 
Kino,  709,  716 
Kosin,  699 
Kdussein,  699 
Koussa,  699 
Krameria,  709,  717 

Labarraque's  solution,  53,  356 

Lac  sulphur,  669 

Lactic  acid,  144 

Lactophosphate  of  lime  with  iron,  62 

of  iron,  62 
Lactucarium,  445 
Lady  Webster's  dinner  pills,  109 
Lafayette  mixture,  74 
Lamellae,  113 
Lard,  771 
Laudanum,  428 
Laughing  gas,  409 
Laxative  elixir,  70 
Laxatives,  664 
Lead,  709,  724 

acetate,  724 

carbonate,  725 

iodide,  247,  725 

nitrate,  726 

oxide,  726 

plaster,  726 


GENERAL  INDEX. 


849 


ad  water,  53,  725 

eches,  702 

ptandra,  680 

ptandrin,  680 

vant  wormseed,  695 

;ht  magnesia,  156j  667 

red  wines,  562 

jnum  vitae,  258 

iy  of  the  valley,  553 

me,  755,  759 

juice  and  pepsin,  71 

liniment,  155 

water,  53,  155 

niment  of  lead  subacetate,  725 

nimenta,  114,  115 

niments,  114 

nimentum  album,  115 

ammoniae,  573 

belladonnee,  452 

calcis,  15s 

camphorae,  381 

chloroformi,  403 

plumbi  subacetatis,  725 

saponis,  381 

sinapis  compositum,  767 

nseed  meal,  771 

oil,  771,  777 

quid  mixtures — internal,  72 

rennet,  56 

quor  acidi  arsenosi,  235 

ammonii  acetatis,  596 

antimonii  chloridi,  755 

arseni  bromidi,  236 

arsenii  bromidi,  55 

et  auri  bromidi,  236 

et  hydrargyri  iodidi,  225,  236 
calcis,  15s 
ferri  acetatis,  182 

chloridi,  182 

citratis,  183 

dialysatus,  190 

et  ammonii  acetatis,  182,  597 

nitratis,  189 

oxychlorati,  190 

peptonati,  190 

subsulphatis,  188 

tersulphatis,  189 
hydrargyri  nitratis,  226 
iodi  compositus,  245 
magnesii  citratis,  686 
mangano-ferri  peptonatus,  1 90 
plumbi  subacetatis,  725 

dilutus,  725 
potassae,  150 

arsenitis,  235 
sedans,  518 
sodse,  152 

chloratae,  356 
sodii  arsenatis,  236 

boratis  compositus,  303 

carbolatus,  303 
quores,  51 
unofficial,  53-57 
quorice,  63,  615,  620,  771 

,         54 


Liquorice  root,  620 

Litharge,  726 

Lithii  bromidum,  528 

benzoas,  333 

carbonas,  155 

citras,  155 

effervescens,  156 

salicylas,  313 
Lithium  bromide,  528 

benzoate,  333 

carbonate,  155 

citrate,  155 

salicylate,  313 
Lobelia,  600,  605,  612 
Local  anti-emetics,  601 
Logwood,  718 

Loomis's  diarrhea  mixture,  74 
Losophene,  328 
Lotio  flava,  226 

nigra,  226 
Lotiones,  115,  116 
Lugol's  solution,  53 
Lunar  caustic,  740 
Lupulin,  443 
Lupulinum,  443 
Lycopodium,  772,  781 
Lysol,  623 

Mace,  366 

Macis,  366 

Magendie's  solution  of  morphine,  55 

Magnesia,  659,  667 

Magnesii  carbonas,  156,  668 

sulphas,  686 

effervescens,  686 

sulphocarbolas,  307 
Magnesium  carbonate,  156,  659,  668 

sulphate,  686 

sulphocarbolate,  307 
Male  fern,  697 
Mandrake,  453 
Manganese,  197 

dioxide,  197 

sulphate,  197 
Mangani  dioxidum,  197 

sulphas,  197 
Manganum,  197 
Manna,  668 
Marigold,  171 
Marshmallow,  771,  779 
Mass  of  copaiba,  646 

of  ferrous  carbonate,  180 

of  "mercury,  222 
Massa  ferri  carbonatis,  180 

copaibse,  646 

hydrargyri,  222,  773 
Massae,  106 
Masses,  106 
May  apple,  692 
Meadow-saffron,  254 
Medicated  cottons,  126 

dressings,  126 

gauzes — carbasa,  126 

waters,  51 


850 


GENERAL  INDEX. 


Medicines,  administration  of,  29 
classification  of,  24 
disease,  26 
dosage,  31 
symptom,  26 
Medullin,  220 
Mentha  piperita,  374 

viridis,  375 
Menthol,  375,  769 

benzoas,  333 
Mercurial  ointment,  222 

plaster,  223 
Mercuric  chloride,  75S 
cyanide,  224 
nitrate,  75S 
oxide,  7SS 
Mercurous  salicylate,  226 

tannate,  226 
Mercury,  221 

with  chalk,  154,  222,  660 
Metallorum  amarse,  112 
Methyl  chloride,  407 
Methylacetanilide,  395 
Methylal,  408 
Methylen,  408 
Methylene  bichloride,  407 
Methylic  ether,  408 
Metric  system,  42 
Mezereon,  266,  761,  7^9 
Mezereum,  266 
Mild  chloride  of  mercury,  223 

mercurous  chloride,  223 
Milk  of  sulphur,  669 
Mineral  acids,  137,  755 
astringents,  709,  724 
waters,  165 
Mistura  antidysenterica,  73 

ferri  composita,  180,  336        ' 
glycyrrhizse  composita,  621 
opii  alkalina,  75  ~" 

rhei  et  sodae,  153,  676 
solvens  simplex,  73 
Misturs,  72-76 
Mitigated  caustic,  740 
Mixture  of  chloral  and  bromide,  73 

of  rhubarb  and  soda,  153,  676 
Monobromated  camphor,  381 
Monsel's  solution,  52,  188 
Morphina,  429 
MorphinEe  acetas,  429 
hydrochloras,  429 
sulphas,  429 
Morphine,  659 
acetate,  429 
hydrochlorate,  429 
.(^  sulphate,  429 

Mother's  salve,  120 
Motor  excitants,  464 
Moulded  silver  nitrate,  740 
Mucilage  of  acacia,  777 
of  elm,  779 
of  sassafras  pith,  780 
of  tragacanth,  780 
Mucilages,  72 


Mucilagines,  72 
Mucilago  acacise,  777 

sassafras  meduUae,  780 

tragacanthffi,  773,  780 

ulmi,  779 
Muriatic  acid,  138 
Muscarine,  659 
Muscle-extract,  220 
Mustard,  702,  766,  769 

paper,  767 

volatile  oil,  761 
Myristica,  366 
Myrrh,  336,  702 
Myrrha,  336 

Naphtalin,  320 

Naphtalinum,  320 

Naphtol,  320 

Naphto-salol,  321 

Native  mineral  springs,  list  of,  168 

Neutral  mixture,  52 

Nitre,  389 

Nitric  acid,  139 

Nitroglycerin,  602 

pills.  III 
Nitrohydrochloric  acid,  138,  13!) 
Nitrous  oxide,  409 
Nutgall,  713 
Nutmeg,  366 
Nux  vomica,  465,  659 

Oatmeal,  771 
Official — officinal,  23 
Oil  of  allspice,  369 

of  American  wormseed,  694 

of  anise,  359 

of  cade,  623 

of  cajuput,  369,  769 

of  caraway,  378 

of  chenopodium,  694 

of  cinnamon,  361 

of  cloves,  368 

of  copaiba,  646 

of  coriander,  363 

of  cubeb,  649 

of  eucalyptus,  338 

of  fennel,  364 

of  flaxseed,  777 

of  hedeoma,  707 

of  juniper,  639 
"of  lavender  flowers,  373 

of  nutmeg,  367 

of  pennyroyal,  707 

of  peppermint,  374 

of  pine,  622 

of  rue,  703,  705 

of  sandalwood,  648 

of  savine,  703 

of  Scotch  fir,  615,  622 

of  tar,  622 

of  turpentine,  769 

of  wintergreen,  373 
Ointment  of  ammoniated  mercury,  222 

of  carbolic  acid,  302 


GENERAL  INDEX. 


851 


Ointment  of  iodoform,  327 

of  lead  carbonate,  725 
iodide,  726 

of  mercuric  nitrate,  226 

of  potassium  iodide,  246 

of  red  mercuric  oxide,  225 

of  sulphur  iodide,  247 

of  tannic  acid,  710 

of  yellow  mercuric  oxide,  225 

of  zinc  oxide,  733 
Oleata,  official,  116 

unofficial,  117 
Oleate  of  aconite,  577 

of  sodium,  56 

of  veratrine,  581 
Oleates,  116,  117 
Oleatum  aconitinse,  577 

veratrinse,  581 
Oleoresin  of  aspidium,  697 

of  capsicum,  365 

of  cubeb,  649 

of  ginger,  371 

of  lupulin,  444 

of  pepper,  366 
Oleoresina  aspidii,  697 

capsici,  365 

cubebae,  649 

lupulini,  444 

piperis,  366 

zingiberis,  371 
Oleoresinae,  97 
Oleoresins,  97 
Oleum  acidi  carbolici,  302 

amygdalae  expressum,  776 

anisi,  359 

cadinum,  623 

cajuputi,  369 

cari,  378 

caryophylli,  368 

chenopodii,  694 

cinnamomi,  361 

copaibae,  646 

coriandri,  363 

cubeb^,  649 

eucalypti,  338 

foeniculi,  364 

gaultherise,  373 

hedeoma,  707 

juniperi,  639 

lavandul^  florum,  373 

lini,  777 

menthse  piperitse,  374 

morrhuse,  132 

myristicse,  367 

olivse,  775 

phosphoratum,  199 

picis  liquidse,  622 

pimentse,  369 

pini  sylvestris,  615,  622 

ricini,  665 

rusci,  623 

rutfe,  705 

sabinee,  783 

santali,  648 


Oleum  sinapis  volatile,  767 

templinum,  622 

tiglii,  682 
Olive  oil,  771,  775 
Onion,  615,  619 
Opii  pulvis,  428 
Opium,  427,  602 

compared  with  its  alkaloids,  442 

deodoratum,  428 

plaster,  428 
Opodeldoc,  115 
Organotherapy,  217 
Orthodioxylbenzene,  323 
Ouabain,  547 
Ovarin,  220 
Oxgall,  67s 

Oxysulphate  of  iron,  54 
Oxytocics,  702 

Pancreatic  solution,  55 
Pancreatin,  131 
Pancreatinum,  131 
Papain,   131 
Papers,  124 
Paradioxybenzene,  323 
Paraffin,  771 
Paraldehyde,  425 
Paraldehydum,  425 
Paregoric,  86,  428 
Parrish's  camphor  mixture,  73 
Parsley,  706 
Parvules,  112 
Pearson's  solution,  236 
Pelletierinae  tannas,  700 
Pelletierine,  700 

tannate,  700 
Pennyroyal,  707 
Pental,  408 
Pepo,  693,  694,  701 
Pepper,  366 
Peppermint,  374 
Pepsin,  129 
Pepsinum,  129 

saccharatum,  130 
Peptonizing  powder,  102 
Petrolatum,  771 
Petroleum,  771 
Petroselinum,  706 
Pharmaceutical  preparations,  49 
Pharmacology,  21 
Pharmacopoeia,  23 
Pheasant's  eye,  552 
Phenacetin,  393 
PhenocoU,  394 
Phenol-camphor,  303 

iodatum,  303 

-sodique,  56,  303 
Phenyl  salicylate,  318 
Phosphatic  emulsion,  79 
Phosphorated  oil,  199 
Phosphoric  acid,  138 
Phosphorus,  198 
Physostigma,  608,  6S9 
Physostigminse  hydrobromas,  509 


852 


GENERAL  INDEX. 


Physostigminse,  salicylas,  508 

sulphas,  508 
Physostigmine  hydrobromate,  509 
salicylate,  508 
sulphate,  508 
Phytolacca  fruit,  584 

root,  584 
Phytolaccse  fructus,  584 

radix,  584 
Picrotoxin,  474 
Picrotoxinum,  474 
Pills,  107 
of  aloes,  673 

and  asafetida,  379,  673 
and  iron,  189,  673 
and  mastich,  673 
and  myrrh,  336,  673 
of  asafetida,  379 
of  ferrous  carbonate,  190 

iodide,  181 
of  opium,  428 
of  phosphorus,  199 
of  rhubarb,  676 
Pilocarpinas  hydrochloras,  592 
Pilocarpine,  592,  659,  703 

hydrochlorate,  592 
Pilocarpus,  592,  615 
Pilulee,  107-112 
aloes,  673 

et  asafoetidae,  379,  673 
et  ferri,  189,  673 
et  mastiches,  673 
et  myrrhas,  336,  673 
antimonii  composite,  259 
asafoetidae,  379 
catharticse  compositse,  685,  689,  690 

vegetabiles,  680,  689,  690 
Cochia,  III 
ferri  carbonatis,  190 
iodidi,  l8i 

et  quininse  compositas,  112 
hydrargyri,  222,  660 
official,  109 
opii,  428 

phosphori,  199,  773 
rhei,  676 

compositas,  674,  676 
unofficial,  109-I12 
Pimenta,  369 
Pinkroot,  697 
Piper,  366 
Piperazidine,  654 
Piperazinum,  654 
Piperin,  366 
Piperinum,  366 
Piperonal,  366 
Pitch,  769 
Pix  betulEE,  623 
Burgundica,  770 
liquida,  622. 
Pixol,  623 
Plaster-mull,  125 
Plaster-of- Paris  bandages,  127 
Plasters,  122 


Plumbi  acetas,  724 

carbonas,  725 

iodidura,  247,  725 

nitras,  726 

oxidum,  726 
Plumbum,  724 
Plummer's  pills,  259 
Plummet's  pills,  109 
Podophyllotoxin,  692 
Podophyllum,  692 
Poison  ivy,  486 
Poke  root,  584 
Pomegranate,  699 
Port  wine,  561 
Porter,  562 
Potassa,  757 

and  hme,  755 

with  lime,  757 
Potassii  acetas,  150 

bicarbonas,  150 

bichromas,  348 

bitartras,  151 

bromidum,  527 

carbonas,  151 

chloras,  349 

citras,  151 

cyanidum,  523 

et  sodii  tartras,  687 

hypophosphis,  205 

iodidum,  246 

nitras,  589 

permanganas,  346 

sulphas,  686 

sulphocarbolas,  307 

tartras,  152 
Potassio-ferric  tartrate,  186 
Potassium  acetate,  150 

and  sodium  tartrate,  687 

bicarbonate,  150 

bichromate,  348 

bitartrate,  151,  659 

bromide,  527 

carbonate,  151 

chlorate,  349 

citrate,  151 

cum  calcii,  757 

cyanide,  523 

hydrate,  757 

hydroxide,  757 

hypophosphite,  205 

iodide,  246,  615 

nitrate,  589 
paper,  589 

permanganate,  346,  703 

sulphate,  686 

sulphocarbolate,  307 

tai-trate,  152,  659 
Poultice  (cataplasm),  125 
Powder  of  ipecac  and  opium,  428,  609 
Powdered  opium,  428 
Powders,  100 

unofficial,  loi 
Precipitated  calcium  carbonate,  154 
phosphate,  204 


GENERAL  INDEX. 


853 


Precipitated  sulphur,  669 

zinc  carbonate,  733 
Preparations  for  external  use,  1 13 
of  ammonium,   156 
of  calcium,  154 
of  iron,  179 
of  lithium,  155 
of  magnesium,  156 
of  sodium,  152 
Prepared  chalk,  154 
Prescription-writing,  796 
Prescriptions,  782 
Prickly  ash,  268 
Proof  spirit,  561 
Protective  agents,  771 
Protoxide  of  mercury,  224 
Prunus  Virginiana,  173 
Prussic  acid,  519,  740 
Pulsatilla,  586 
Pulveres,  100-103 
Pulvis  aromaticus,  361,  371 
cretse  aromaticus,  154 
cum  opio,  154 
compositus,  154 
digestivus,  102 
effervescens  compositus,  687 
glycyrrhizse  compositus,  364,  621,  681 
ipecacuanhse  et  opii,  428,  609 
jalapae  compositus,  151,  690 
morphinae  compositus,  429 
rhei  compositus,  372,  676 
Pumpkin  seed,  700 
Purging  cassia,  664 
Purified  aloes,  673 
cotton,  772 
oxgall,  67s 
Pyrocatechin,  323 

Quassia,  170 
Quebrachine,  516 
Quebracho,  615 
Queen's  root,  262 
Quercus  alba,  709,  714 
Quevenne's  iron,  179 
Quicksilver,  221 
Quinetum,  210 
Quinidinae  sulphas,  209 
Quinidine  sulphate,  209,  210 
Quininse  bisulphas,  209 

hydrobromas,  209 

hydrochloras,  210 
carbamidata,  211 

sulphas,  210 

valerianas,  2  ID 
Quinine,  209,  702,  703 

bisulphate,  209 

hydrobromate,  209 

hydrochlorate,  210 

valerianate,  210 

Rectified  spirit,  561 
Red  cinchona,  208 

iodide  of  mercury,  224 

mercuric  iodide,  224,  225 


Red  precipitate,  225 

rose,  723 

wine,  561 
Reduced  iron,  179 
Remedies,  21 
Renin,  220 
Resin  of  copaiba,  646 

of  jalap,  690 

of  podophyllum,  692 

of  scammony,  691 
Resina  copaibae,  646 

jalapK,  690 

podophyUi,  692 

scammonii,  691 
Resinas,  98 
Resins,  98 
Resopyrine,  323 
Resorcin,  323 
Resorcinum,  323 
Restoratives,  129 
Rhamnus  Purshiana,  666 
Rhatany,  717 
Rheum,  675 
Rhubarb,  675 
Rhus  aromatica,  722 

glabra,  709,  722 

toxicodendron,  486,  761 
Rochelle  salt,  687 
Rosa  gallica,  709,  723 
Rottlera,  700 
Rotulae,  113 
Rubefacients,  769 
Rubi  compositum,  70 
Rubus,  709,  723 
Rue,  702,  704 
Rum,  561 
Ruta,  704 

Sabina,  703 

Saccharated  ferrous  iodide,  181 

carbonate,  180 
Saccharin,  655 
Saccharine  substances,  615 
Saccharinum,  655 
Salicin,  319 
Salicinum,  319 

Salicylated  powder  of  talcum,  103 
Sahnaphtol,  321 
Salol,  318 
Saltpetre,  589 
Sanguinaria,  263 
Sanguinarine  nitrate,  264 
Santonica,  693-695 
Santonin,  695 
Santoninum,  695 
Saponin,  615 
Sarsaparilla,  261 
Sassafras  medulla,  780 

pith,  771,  780 
Savine,  702,  703 
Scammonium,  691 
Scammony,  691 
Scilla,  634 
Scoparine,  550 


854 


GENERAL  INDEX. 


Scoparius,  549 
Scopola  carniolica,  453 

japonica,  453 
Sebadilla,  581 
Seidlitz  powder,  loi,  687 
Senega,  615,  625 
Senna,  680 
aromatic,  64 
compound,  64 
Serpentaria,  174 
Serum-therapy,  269 
Sherry  wine,  561 
Silver,  709 

cyanide,  739 
iodide,  248,  740 

nitrate,  740,  755,  761 

oxide,  741 
Simple  bitters,  170 

cerate,  120 

purgatives,  672 
Sinapis  alba,  766 

nigra,  766 
Slippery  elm,  771,  778 
Smith's  solution  of  bromine,  53 
Soap  liniment,  381,  771 
Socotrine  aloes,  673 
Soda,  757 

mint,  75 
Sodii  acetas,  152 

arsenas,  236 

benzoas,  333 

bicarbonas,  152 

bisulphis,  354 

boras,  343 

bromidum,  527 

carbonas,  153 
exsiccatus,  153 

hypophosphis,  204 

hyposulpliis,  354 

iodidum,  246 

nit-ras,  591 

nitris,  525 

phosphas,  687 
'~~-  salicylas,  313 

sulphas,  688 

sulphis,  354 

sulphocarbolas,  307 
Sodio-salicylate  of  theobromine,  651 
Sodio-theobromine  salicylate,  555 
Sodium  acetate,  152 

arsenate,  236 

benzoate,  333 

bicarbonate,  152 

bisulphite,  354 

borate,  343 

bromide,  527 

carbonate,  153 

hydrate,  757 

hydroxide,  757 

hypophosphite,  204 

hyposulphite,  354 

iodide,  246 

nitrate,  591 

nitrite,  525 


Sodium  orthophosphate,  687 
phosphate,  687 
salicylate,  313 
sulphate,  688 
sulphite,  354 
sulphocarbolate,  307 
Solid  mixtures,  internal  use,  99 

opodeldoc,  115 
Soluble.ferric  phosphate,  186 
pyrophosphate,   187 
iron  and  quinine  citrate,  184 
saccharated  iron,  63 
Solution  of  ammonium  acetate,  596 
of  antimony  chloride,  755 
of  arsenic  and  gold  bromide,  236 
and  mercuric  iodide,  225,  236 
bromide,  236 
of  arsenous  acid,  235 
of  basic  ferric  sulphate,  188 
of  boroglyceride,  344 
of  calcium  hydrate,  155 
of  chlorinated  lime,  356 

potassa,  55 
of  ferric  acetate,  182 
chloride,  182 
citrate,  183 
nitrate,  189 
subsulphate,  188 
sulphate,  189 
of  ferrous  chloride,  54 
of  gutta-percha,  772 
of  hydrogen  dioxide,  351 
of  iodide  of  mercury  and  potassium,  54 
of  iron  and  ammonium  acetate,  182j  597 
of  lead  subacetate,  725 
of  liine,  155 

of  magnesium  citrate,  686 
of  mercuric  nitrate,  226 
of  oxysulpliuret  of  calcium,  54 
of  peptonate  of  iron,  190 
and  manganese,  190 
of  potash,  150 
of  potassium  arsenite,  235 
of  saccharin,  55 
of  soda,  152 
of  sodium  arsenate,  236 
hydrate,  152 
silicate,  772 
Solutions,  51 

of  metallic  compounds,  53 
Sozal,  746 
Sozoiodol,  328 
Spanish  flies,  762 
Sparkling  wines,  561 
Sparteine  sulphas,  550 
Sparteine  sulphate,  550 
Spearmint,  375 

water,  376 
Spermaceti,  771 
Spice  plaster,  124 
Spigelia,  693,  694,  697 
Spirit  of  ammonia,  572 
of  anise,  360 
of  camphor,  381 


GENERAL  INDEX. 


855 


Spirit  of  chloroform,  403 

of  cinnamon,  362 

of  ether,  397 

of  gaultheria,  373 

of  glonoin,  525 

of  juniper,  640 

of  lavender,  373 

of  nitroglycerin,  525 

of  nitrous  ether,  598 

of  nutmeg,  367 

of  peppermint,  374 

of  phosphorus,  199 

of  soap,  58 

of  spearmint,  376 
Spirits,  57,  58 
Spiritus  aetheris,  397 
compositus,  397 
nitrosi,  598 

ammonias,  572 

aromaticus,  157,  573 

anisi,  360 

auiantii  compositus,  360 

camphorse,  381 

chloroformi,  403 

cinnamomi,  362 

frumenti,  560 

gaultheriae,  373 

glonoini,  525 
-    juniperi,  640 

compositus,  363,  364,  378,  640 

lavandulse,  373 

menthse  piperitae,  374 
viridis,  376 

Mindererus,  52 

myristicK,  367 

phosphori,  199 

rectificatus,  561 

vini  gallici,  560 
Spleen-mixture,  75 
Spongiopiline,  125 
Squibb's  podophyllum  pills,  112 

rhubarb  mixture,  75 
Squill,  630,  634 
Starch,  771 
Stillingia,  262 

comp.,  94 
St.  John  Long's  liniment,  115 
Stokes's  expectorant,  75 

liniment,  115 
Stramonii  folia,  460 

semen,  461 
Stramonium,  659 

leaves,  460 

seed,  461 
Strengthening  plaster,  123,  189 
Stronger  ammonia  vpater,  572 
Strontii  bromidum,  528 

iodidi,  246 
Strontium  bromide,  528 

iodide,  246 
Strophanthin,  547 
Strophanthus,  546 
Strychnine,  465,  659,  702 
Styptic  collodion,  710 


Sublimed  sulphur,  669 
Succu's  conii,  498 
Sugar  of  lead,  724 
Sulphaminol,  328 
Sulphonal,  423 
Sulphur  iodide,  247 

lotum,  669 

ointment,  669 

prsecipitatum,  669 

sublimatum,  669 
Sulphuric  acid,  138 
Sulphuris  iodidum,  247 
Sulphurous  acid,  353 
Sumach,  722 
Sumbul,  517 
Sun  mixture,  74 
Suppositoria,  121,  122 

glycerini,  773 
Suppositories,  121 

of  glycerin,  773 
Sweet  flag,  372 

spirit  of  nitre,  58,  598 

sumach,  722 

tincture  of  rhubarb,  87,  676 

wines,  562 
Syrup  of  acacia,  778 

of  althaea,  779 

of  calcium  lactophosphate,  145 

of  citric  acid,  147 

of  Dover's  powder,  63 

of  ferrous  iodide,  181 

of  garlic,  619 

of  ginger,  372 

of  hydriodic  acid,  245 

of  hypophosphites,  205 
with  iron,  185,  205 

of  ipecac,  609 

of  lactucarium,  445 

of  morphine,  63 

of   phosphates    of    iron,    quinine,    and 
strychnine,   185 

of  rhubarb,  676 

of  senega,  625 

of  senna,  68 1 

of  squill,  635. 

of  tar,  622 

of  tolu,  618 

of  wild  cherry,  174 
Syrups,  58 
Syrupus  acacias,  778 

acidi  citrici,  147 
hydriodici,  24S 

allii,  619 

althffise,  779 

calcii  lactophosphatis,  145 

corrigens,  62 

ferri  iodidi,  181 

quininae,   et  strychninse    phosphatum, 
185,  466 

hypophosphitum,  205 
cum  ferro,  185,  205 

ipecacuanhse,  609 

krameria,  717 

lactucarii,  445 


856 


GENERAL  INDEX. 


Syrupus  picis  liquidse,  622 

pruni  Virginianse,  174 

rhei,  676 

aromaticus,  677 

sarsaparillse  compositus,  261,  360 

scillse,  635 

compositus,  60S,  625,  635 

senegas,  625 

sennse,  681 

stillingise  compositus,  263 

tolutanus,  618 

zingiberis,  372 
Systemic  anti-emetics,  602 

Tanacetum,  706 
Tannic  acid,  709,  710 
Tansy,  702,  706 
Tar,  72,  615 

alkaline,  55 

compound  ointment,  120 

mixture,  75 

ointment,  622 

water,  622 
Taraxacum,  669 
Tartar  emetic,  604,  761 
Tartaric  acid,  147 
Tartrated  antimony,  604 
Tasteless  syrup  of  iodide  of  iron,  62 

tincture  of  iron,  88 
Terebene,  615,  627 
Terebenum,  627 
Terpene  hydrate,  615 
Terpin  hydrate,  628 
Terpini  hydras,  628 
Terpinol,  628 
Tetrochlormethane,  408 
Tetronal,  423 
Theine,  555 
Theobromine,  555 
Therapeutics,  22 
Thielmann's  mixture,  74 
Thioform,  750 
Thiol,  325 
Thiolum,  325 
Thioresorcin,  323 

Thompson's  solution  of  phosphorus,  55 
Thorn  apple,  460 
Thymacetin,  376 
Thymol,  376 
Tinctura  aconiti,  576 

aloes,  674 

and  myrrhse,  336,  674 

arnicas  fiorum,  587 
radicis,  588 

asafoetidje,  379 

belladonnse  foliorum,  452 
•  benzoini,  332 

composita,  332,  618,  674 

cacti,  552 

calendulse,  172 

calumbse,  171 

cannabis  indicfe,  446 

cantharidis,  762 

capsici,  365 


Tinctura  cardamom!,  370 

composita,  361,  370,  378 
catechu  composita,  361,  715 
chiratse,  172 
cinchonae,  209 

composita,  174,  209 
cinnamomi,  361 
coccuh,  474 
colchici  seminis,  255 
conii,  498 
cubebae,  649 
digitalis,  537 
ergotae,  477 
eucalypti,  339 
ferri  acetatis,  190 

chloridi,  182 
gallse,  713 

gentianas  composita,  171 
guaiaci,  259 

ammoniata,  259 
humuli,  444 
hydrastis,  483 
hyoscyami,  462 
iodi,  245 

ipecacuanha  et  opii,  428,  60^ 
kino,  716 
krameriae,  717 
lactucarii,  445 

lavandulae  composita,  361,  373- 
lobeliae,  613 
nucis  vomicae,  465 
opii,  428 

camphorata,  360,  381,  428 

deodorati,  428 
physostigmatis,  508 
pulsatillae,  586 
quassiae,  170 
rhei,  676 

aiomatica,  676 

dulcis,  676 
rhois  toxicodendri,  487 
sanguinaris,  264 
scillae,  635 
serpentaris,  174 
stillingiae,  263 
stramonii  seminis,  461 
slrophanthi,  547 
sumbul,  517 
tolutana,  618 
Valerianae,  382 

ammoniata,  382 
veratri  viridis,  581 
zingiberis,  372 
Tincture  of  aconite,  576 
of  aloes,  674 

and  myrrh,  336,  G74 
of  arnica  flowers,  587 

root,  588 
of  asafetida,  379 
of  belladonna  leaves,  452 
of  benzoin,  332 
of  cactus,  552 
of  calendula,  172 
of  calumba,  171 


GENERAL  INDEX. 


857 


Tincture  of  cantharides,  762 

of  capsicum,  365 

of  cardamom,  370 

of  chirata,  172 

of  cinchona,  209 

of  cinnamon,  36 1 

of  cocculus,  474 

of  colchicum  seed,  255 

of  conium,  498 

of  cubeb,  649 

of  cudbear,  89 

of  deodorized  opium,  428 

of  digitalis,  537 

of  Dover's  powder,  428 

of  ergot,  477 

of  eucalyptus,  339 

of  ferric  acetate,  190 
chloride,  182 

of  ginger,  372 

of  guaiac,  259 

of  hops,  444 

of  hydrastis,  483 

of  hyoscyamus,  462 

of  Indian  cannabis,  446 

of  iodine,  245 

of  ipecac  and  opium,  4:28j  609 

of  kino,  716 

of  krameria,  717 

of  lactucarium,  445 

of  lobelia,  613 

of  lupulin,  444 

of  nutgall,  713 

of  opium,  428 

of  phosphorus,  199 

of  physostigma,  508 

of  poppy,  89 

of  Pulsatilla,  586 

of  quassia,  170 

of  rhubarb,  676 

of  rhus  toxicodendron,  487 

of  serpentaria,  1 74 

of  squill,  635 

of  stillingia,  263 

of  stramonium  seed,  461 

of  strophanthus,  547 

of  sumbul,  517 

of  tolu,  618 

of  valerian,  382 

of  veratrum  viride,  581 
Tinctures,  84 
Tolu  solubile,  90 
Topical  remedies,  754 
Tragacanth,  771,  779 
Tragacantha,  779 
Trional,  423 
Triplex  pills,  112 
Trituratio  ekterini,  684 
Trituration  of  elaterin,  684 
Troches,  105 

of  ammonium  chloride,  616 

of  catechu,  715 

of  chalk,  154 

of  cubeb,  649 

of  ginger,  372 


Troches  of  ipecac,  609 

of  iron,  189 

of  krameria,  717 

of  liquorice  and  opium,  428 

of  morphine  and  ipecac,  429,  609 

of  peppermint,  374 

of  potassium  chlorate,  349 

of  santonin,  695 

of  sodium  bicarbonate,  153 

of  tannic  acid,  710 
Trochisci  acidi  tannici,  710 

ammonii  chloridi,  616 

catechu,  715 

cretse,  154 

ferri,  189 

glycyrrhizae  et  opii,  360,  428 

ipecacuanhse,  609 

kramerise,  717 

menthse  piperitse,  374 

morphinse  et  ipecacuanhse,  429,  609 

potassii  chloratis,  349 

santonini,  695 

sodii  bicarbonatis,  1 53 

zingiberis,  372 
TuUey's  powder,  loi 
Tumenol,  326 
Tumenolum,  326 
Turlington's  balsam,  85 
Turner's  cerate,  120 
Turpentine,  630 
Turpeth  mineral,  226 


Ulmus,  778 
Unguenta,  1 18- 120 
Unguentum  acidi  carbolici,  302 
tannici,  710 
belladonnse,  452 
camphoratum,  120 
diachylon,  726 
hydrargyri,  222 
ammoniati,  222 
nitratis,  226 
oxidi  flavi,  225 
rubri,  225 
iodi,  245 
iodoform!,  327 
matris,  120 
picis  hquidse,  622 
plumbi  carbonatis,  725 

iodidi,  726 
potassii  iodidi,  246 
stramonii,  461 
sulphuris,  669 
iodidi,  247 
veratrinae,  581 
zinci  carbonatis  impuri,  120 
oxidi,  733 
Ural,  411,  420 
Uralium,  41 1 
Urea,  630 
Urethane,  411,  420 


Ustilago,  703 
Uva  ursi,  630,  638 


GENERAL  INDEX. 


Valerian,  381 
Valeriana,  38 1 
Vallet's  mass,  106,  180 
Vaseline,  771 
Vegetable  acids,  146 

astringents,  709 
Velpeau's  diarrhea  mixture,  74 
Veratrina,  581 
Veratrine,  581 

ointment,  581 
Veratrum  album,  581 

viride,  580 
Vermicides,  693 
Vermifuges,  693 
Vesicants,"  761 
Viburnum  opulus,  519 

prunifoliura,  518 
Vienna  caustic,  757 

paste,  757 
Villate's  solution,  73 
Vina,  82-84 
Vinegar  of  opium,  428 

of  sanguinaria,  264 

of  squill,  635 
Vinegars,  82 
Vinum  album,  561 

antimonii,  605 

ferri  amarum,  184 
citratis,  183 

colchici  radicis,  254 
seminis,  255 

ergotae,  477 

ipecacuanhse,  609 

opii,  428 

picis,  623 

rubrum,  561 
Virginia  snake  root,  \  74 
Vleminck's  solution  or  lotion,  54 
Volatile  oil  of  mustard,  767 

oils,  769 

Wahoo,  68,  678 
Warburg's  pills,  ill 

tincture,  87,  88 
Warming  plaster,  123,  770 
Washed  sulphur,  669 
Washes,  115 

Weights  and  measures,  40 
Whiskey,  57,  560 
White  arsenic,  234 

ash,  84 

hellebore,  581 

lead,  725 


White  mustard,  766 

oak,  714 

of  egg,  771 

pine  compound,  64 

wine,  561 
Wild  cherry,  84,  173 

ferrated,  84 
Wilkinson's  ointment,  120 
Wine  of  antimony,  605 

of  colchicum  root,  254 
seed,  255 

of  ergot,  477 

of  ferric  citrate,  183 

of  ipecac,  609 

of  opium,  428 

of  tar,  623 
Wines,  82 
Woorari,  513 

Xanthoxylum,  268 

Yellow  iodide  of  mercury,  224. 

jasmine,  502 

mercuric  oxide,  225 
subsulphate,  226 

mercurous  iodide,  224 

wash,  226 
Verba  santa,  62 

Zedoary  comp.,  90 
Zinc,  709,  732 

acetate,  733 

bromide,  528 

chloride,  755,  759 

iodide,  247,  733 

oxide,  733 

phosphide,  206 

sulphate,  733,  7SS 

sulphocarbolate,  307 

valerianate,  382 
Zinci  acetas,  733 

bromidum,  528 

carbonas  prsecipitatus,  733 

chloridum,  759 

iodidum,  247,  733 

oxidum,  733 

phosphidum,  206 

sulphas,  733 

sulphocarbolas,.  307 

valerianas,  382 
Zincum,  732 
Zingiber,  371 


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PUBLISHED  BY 


W.  g.  gauHslep^,  ^25  Walnut  gbeet, 
J)l7ilaslelpl2ia. 


lUTR.  SAUNDERS,  in  presenting  to  the  profession  thefol-t 
A"l  lowing  list  of  publications,  begs  to  state  that  the  aim 
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address  (post-paid)  on  receipt  of  the  price  herein  given. 


COISTTE^TS. 


Anatomy.  page 

Haynes,  Manual  of  Anatomy 24 

Nancrede,  Anatomy  and  Manual  of  Dissection  .    16 
Nancrede,  Essentials  of  Anatomy  .  ,  .26 

Bacteriology. 

Ball,  Essentials  of  Bacteriology 26 

Crookshank,  A  Text-Book  of  Bacteriology  .  13 

Frothingham,  Laboratory  Guide 20 

McFarland,  Text-Book  of  Pathogenic  Bacteria  .  15 

Botany.. 

Eastin,  Laboratory  Exercises  in  Botany  ...      .20 
Chemistry  and  Pliyslcs. 

Brockway,  Essentials  of  Physics 26 

Wolff,  Essentials  of  Chemistry  .  .      .   26 

Children. 

*An  American  Text-Book  of  Diseases  of  Children    8 

Griffith,  Care  of  the  Baby 21 

Powell,  Essentials  of  Diseases  of  Children  26 

Clinical  Charts,  Diet,  and  Biet  liists. 

Hart,  Diet  In  Sickness  and  in  Health      .  .  22 

Keen,  Operation  Blank    .  ....  19 

Lain6,  Temperature  Chart 16 

Meigs,  Feeding  in  Early  Infancy    .  .  14 

Starr,  Diets  for  Infants  and  Children  22 

Thomas,  Detachable  Diet  Lists,  etc.  ...  22 

Biag^nosis. 

Cohen  and  Eshner.  Essentials  of  Diagnosis  .  .  .  26 

MacDonald,  Surgical  Diagnosis  and  Treatment .  27 

Vierordt  and  Stuart.  Medical  Diagnosis    ....  10 
Corwin,  Essentials  'of  the  Physical  Diagnosis  of 

the  Thorax .  .  ...  18 

Bictionaries, 

Keating  and  Hamilton,  New  Pronouncing  Dic- 
tionary of  Medicine 10 

Morten,  Nurses'  Dictionary  of  Medical  Terms  .   22 
Saunders'  Pocket  Medical  Lexicon    , , .       .         .17 

Ear. 

Gleason,  Essentials  of  Diseases  of  the  Ear         .  26 
Electricity. 

Stewart  and  Lawranee,  Essentials  of  Medical 
Electricity         .       .  26 

Embryology. 

Heisler,  Text-Book  of  Embryology      .  .  . 


27 


Eye,  Nose,  and  Throat. 


De  Schweinitz,  Diseases  of  the  Eye 14 

Jackson  and  Gleason,  Essentials  of  Diseases  of 

Eye,  Nose,  and  Throat 26 

Kyle,  Manual  of  Diseases  of  Nose  and  Throat .  .   24 

Oenito-nrinary. 

Hyde,  Syphilis  and  the  Venereal  Diseases    ...    24 
Martin,  Essentials  of  Minor  Surgery,  Bandaging 

and  Venereal  Diseases 26 

Saundby,  Renal  and  Urinary  Diseases ...  27 

Oynecology. 

*An  American  Text-Book  of  Gynecoloev  1 

Cragm,  Essentials  of  Gvnecology  .                       '  26 

Garrigues,  Diseases  of  Women    .             "      '  '  '  is 

Long,  Syllabus  of  Gynecology  .      ..!!!!.'!  19 

Histology. 

Clarkson,  Text-Book  of  Histology  ....  15 

Eifc  Insurance. 

Keating,  How  to  Examine  for  Life  Insurance  .  .  21 
Materia  Medica  and  Therapeutics. 

''■^"j^^merican  Text  Book  of  Applied  Therapeu- 

Butler,  Text-Book  of  Materia  Me'dica,  'Therapeu-  ^ 

tics,  and  Pharmacology  .  27 

Cerna,  Notes  on  the  Newe^  Remedies  '.'.''  17 
ttcs                   Materia  Medlca  and  Therapeu- 

Morris,  Essentials  of  Materia  Me'dica,  etc.  '  26 
2 


pag: 

Saunders'  Pocket  Medical  Formulary J 

Stevens,  Manual  of  Therapeutics  -  .   ■   -   -.  •  •  ■  1 

Thornton,  Dose-Book  and  Prescription- Wntmg.  2 

Warren,  Surgical  Pathology  and  Therapeutics  .  1 

Medical  Jurisprudence. 
Chapman,    Medical    Jurisprudence   and   Toxi- 
cology     2- 

Semple,  Essentials  of  Legal  Medicine,  etc.   .  .  .  2( 

Medicine. 

*An  American  Text-Book  of  Practice ; 

■^Gould  and  Pyle,  Anomalies  and  Curiosities  of 

Medicine z 

Lockwood,  Manual  of  the  Practice  of  Medicine  24 

Morris,  Essentials  of  the  Practice  of  Medicine  .  26 
Saunders'  American  Year-Book  of  Medicine  and 

Surgery 28 

Stevens,  Manual  of  the  Practice  of  Medicine  .  .  16 

Nervons  Diseases  and  Insanity. 

Burr,  Manual  of  Nervous  Diseases 24 

Shaw,EssentialsofNervousDiseasesand Insanity  26 

JKnrsing'. 

Griffith,  Care  of  the  Baby 21 

Hampton,  Nursing :  its  Principles  and  Practice  21 

Stoney,  Practical  Points  in  Priyate  Nursing ...  13 

Obstetrics. 

*An  American  Text-Book  of  Obstetrics 5 

Ashton,  Essentials  of  Obstetrics  .      .  26 

Boisliniere,  Obstetric  Accidents  .  .         .  .      .  .  20 

Dorland,  Manual  of  Obstetrics 24 

Norris,  Syllabus  of  Obstetrical  Lectures  .      ...  19 

Pattaologry. 

Semple,   Essentials  of  Pathology  and  Morbid 

Anatomy 26 

Senn,  Pathology   and  Surgical  Treatment  of 

Tumors n 

Stengel,  Manual  of  Pathology  ....'.'.''  24 

Warren,  Surgical  Pathology  and  Therapeutics .  11 

Pharmacy. 

Sayre,  Essentials  of  Pharmacy 26 

Physiology. 

*An  American  Tex^Book  of  Physiology   .  .      .3 
Hare,  Essentials  of  Physiology   ........      26 

Raymond,  Manual  of  Physiologr 


12 

26 


Stewart,  A  Manua^  of  Physiology 

Sbiagraphy. 

Rowland,  Archives  of  Clinical  Skiagraphy 

Skin. 

''Pictorial  Atlas  of  Skin  Diseases    .   . 
Stelwagon,  Essentials  of  Diseases  of  the  Skin 

Surgery. 

''An  American  Text-Book  of  Surgerv  6 

Beck,  Surgical  Asepsis  .   ......             "   '  "  '  24 

DaCosta,  Manual  of  Surgery                         '  '  "  '  24 

Keen,  Operation  Blank                19 

MSSri^4lSK/l'^?|e7/^""°^  '-^^'^^^^^  ■  i 

Martin,  Essentials  of  Minor  Surgery,  etc  "    26 

Pye,  Elementary  Bandaging  and  Surgical  Dress- 

„      '"g    , 27 

Saunders'  American  Year-Book  of  Medicine  and 

Surgery 28 

Senn,  Pathology  and  Surgical   Treatment  of 

Senn,  Syllabus  of  Surgery  .  '  19 

Warren,  Surgical  Pathology  and  Therapeutics '.   11 

Urine. 

Wolff,  Essentials  of  Examination  of  Urine 


26 


Miscellaneous. 

Gross,  Autobiography  of 
Saunders'  New  Aid  Series  of  Manuals" 
Saunders'  Question  Cumpends 
Thresh,  Water  and  Water  Supplies 


.  .   .    12 

.   23,24 

25,26 

.    .       15 


CA  TALOGUE  OF  MEDICAL   WORKS. 


For  Sale  by  Subscription. 


AN  AMERICAN  TEXT-BOOK  OF  PHYSIOLOGY.  Edited  by 
William  H.  Howell,  Ph.  D.,  M.  D.,  Professor  of  Physiology  in  the  Johns 
Hopkins  University,  Baltimore,  Md.  One  handsome  octavo  volume  of  1052 
pages,  fully  illustrated.  Prices:  Cloth,  ;j6.oo  net;  Sheep  or  Half- Morocco, 
^7.00  net. 

This  work  is  the  most  notable  attempt  yet  made  in  America  to  combine  in  one 
volume  the  entire  subject  of  Human  Physiology  by  well-known  teachers  who  have 
given  especial  study  to  that  part  of  the  subject  upon  which  they  write.  The 
completed  work  represents  the  present  status  of  the  science  of  Physiology,  par- 
ticularly from  the  standpoint  of  the  student  of  medicine  and  of  the  medical 
practitioner. 

American  teachers  of  physiology  have  not  been  altogether  satisfied  with  the 
text-books  at  their  disposal.  The  defects  of  most  of  the  older  books  are  that  they 
have  not  kept  pace  with  the  rapid  changes  in  modern  physiology,  while  few  if  any 
of  the  newer  books  have  been  uniformly  satisfactory  in  their  treatment  of  all  parts 
of  this  many-sided  science.  Indeed,  the  literature  of  experimental  physiology  is 
so  great  that  it  would  seem  to  be  almost  impossible  for  any  one  teacher  to  keep 
thoroughly  informed  on  all  topics. 

The  collaboration  of  several  teachers  in  the  preparation  of  an  elementary  text- 
book of  physiology  is  unusual,  the  almost  invariable  rule  heretofore  having  been 
for  a  single  author  to  write  the  entire  book.  One  of  the  advantages  to  be  derived 
from  this  collaboration  method  is  that  the  more  limited  literature  necessary  fbr 
consultation  by  each  author  has  enabled  him  to  base  his  elementary  account  upon 
a  comprehensive  knowledge  of  the  subject  assigned  to  him  ;  another,  and  perhaps 
the  most  important,  advantage,  is  that  the  student  gains  the  point  of  view  of  a 
number  of  teachers.  In  a  measure  he  reaps  the  same  benefit  as  would  be  obtained 
by  following  courses  of  instruction  under  different  teachers.  The  different  stand- 
points assumed,  and  the  differences  in  emphasis  laid  upon  the  various  lines  of  pro- 
cedure, chemical,  physical,  and  anatomical,  should  give  the  student  a  better  insight 
into  the  methods  of  the  science  as  it  exists  to-day.  The  work  will  also  be  found 
useful  to  many  medical  practitioners  who  may  wish  to  keep  in  touch  with  the 
development  of  modern  physiology. 

The  main  divisions  of  the  subject-matter  are  as  follows  :  General  Physiology  of 
Muscle  and  Nerve— Secretion— Chemistry  of  Digestion  and  Nutrition— Movements 
of  the  Alimentary  Canal,  Bladder,  and  Ureter— Blood  and  Lymph— Circulation— 
Respiration— Animal  Heat— Central  Nervous  System— Special  Senses— Special 
Muscular  Mechanisms— Reproduction— Chemistry  of  the  Animal  Body. 

CONTRIBUTORS: 


HENEY  P.  BOWDITCH,  M.  D., 

Professor  of  Physiology,  Harvard  Medical  School. 

JOHN  G.  CUETIS,  M.  D., 

Professor  of  Physiology,  Columbia  University,  N.  Y. 
(College  of  Physicians  and  Surgeons). 

EENKY  H.  DONALDSON,  Ph.  D., 

Head-Professor  of  Neurology,  University  of  Chicago. 

W.  H.  HOWELL,  Ph.  D.,  M.  D., 

Professor  of  Physiology,  Johns  Hopkins  University. 

FSEDEEIC  S.  LEE,  Ph.  D., 

Adjunct  Prof,  of  Physiology,  Columbia  University, 
N.  Y.  (College  of  Physicians  and  Surgeons), 


WAREEN  P.  LOMBARD,  M.  D., 

Professor  of  Physiology,  University  of  Michigan. 

GRAHAM  LUSK,  Ph.D., 

Professor  of  Physiology,  Yale  Medical  School. 

W.  T.  PORTER,  M.  D., 

Assistant  Professor  of  Physiology,  Harvard  Medical 
School. 

EDWARD  T.  REICHEET,  M.  D., 

Professor  of  Physiology,  University  of  Pennsylvania. 

HENEY  SEWALL,  Ph.  D.,  M.  D., 

Professor  of  Physiology,  Medical  Department,  Uni- 
versity of  Denver. 


W.  B.  SAUNDERS'  ILLUSTRATED 


For  Sale  by  Subscription. 


AN  AMERICAN  TEXT-BOOK  OF  APPLIED  THERAPEU- 
TICS. For  the  Use  of  Practitioners  and  Students.  Edited  by 
James  C.  Wilson,  M.  D.,  Professor  of  the  Practice  of  Medicine  and  of 
Clinical  Medicine  in  the  Jefferson  Medical  College.  One  handsome  octavo 
volume  of  1326  pages.  Illustrated.  Prices:  Cloth,  ^7-oo  net;  Sheep  or 
Half- Morocco,  ;g8.oo  net. 

The  arrangement  of  this  volume  has  been  based,  so  far  as  possible,  upon  mod- 
ern pathologic  doctrines,  beginning  with  the  intoxications  and  following  with 
infections,  diseases  due  to  internal  parasites,  diseases  of  undetermined  origin,  and 
finally  the  disorders  of  the  several  bodily  systems — digestive,  respiratory,  circu- 
latory, renal,  nervous,  and  cutaneous.  It  was  thought  proper  to  include  also  a 
consideration  of  the  disorders  of  pregnancy. 

The  list  of  contributors  comprises  the  names  of  maiiy  who  have  acquired  dis- 
tinction as  practitioners  and  teachers  of  practice,  of  clinical  medicine,  and  of  the 
specialties. 

CONTRIBUTORS: 


Dr.  I.  E.  Atkinson,  Baltimore,  Md. 
Sanger  Brown,  Chicago,  111. 
John  B.  Chapin,  Philadelphia,  Pa. 
William  C.  Dabney,  Charlottesville,  Va. 
John  Chalmers  DaCosta,  Phila.,  Pa. 
I.  N.  Danforth,  Chicago,  111. 
John  L.  Dawson,  Jr.,  Charleston,  S.  C. 
F.  X.  Dercum,  Philadelphia,  Pa. 
George  Dock,  Ann  Arbor,  Mich. 
Robert  T.  Edes,  Jamaica  Plain,  Mass. 
Augustus  A.  Eshner,  Philadelphia,  Pa. 
J.  T.  Eskridge,  Denver,  Col. 
F.  Forchheimer,  Cincinnati,  O. 
Carl  Frese,  Philadelphia,  Pa. 
Edwin  E.  Graham,  Philadelphia,  Pa. 
John  Guiteras,  Philadelphia,  Pa, 
Frederick  P.  Henry,  Philadelphia,  Pa. 
Guy  Hinsdale,  Philadelphia,  Pa. 
Orville  Horwitz,  Philadelphia,  Pa. 
W.  W.  Johnston,  Washington,  D.  C. 
Ernest  Laplace,  Philadelphia,  Pa. 
A.  Laveran,  Paris,  France. 


Dr.  James  Hendrie  Lloyd,  Phila.,  Pa. 
John  Noland  Mackenzie,  Bait.,  Md. 
J.  W.  McLaughlin,  Austin,  Texas. 
A.  Lawrence  Mason,  Boston,  Mass. 
Charles  K.  Mills,  Philadelphia,  Pa. 
John  K.  Mitchell,  Philadelphia,  Pa. 
W.  P.  Northrup,  New  York  City. 
William  Osier,  Baltimore,  Md. 
Frederick  A.  Packard,  Phila.,  Pa. 
Theophilus  Parvin,  Philadelphia,  Pa. 
Beaven  Rake,  London,  England. 
E.  O.  Shakespeare,  Philadelphia,  Pa. 
Wharton  Sinkler,  Philadelphia,  Pa. 
Louis  Starr,  Philadelphia,  Pa. 
Henry  W.  Stelwagon,  Phila.,  Pa. 
James  Stewart,  Montreal,  Canada. 
Charles  G.  Stockton,  Buffalo,  N.  Y. 
James  Tyson,  Philadelphia,  Pa. 
Victor  C.  Vaughan,  Ann  Arbor,  Mich. 
James  T.  Whittaker,  Cincinnati,  O. 
J.  C.  Wilson,  Philadelphia,  Pa. 


The  articles,  with  two  exceptions,  are  the  contributions  of  American  writers. 
Written  from  the  standpoint  of  the  practitioner,  the  aim  of  the  work  is  to  facili- 
tate the  application  ot  knowledge  to  the  prevention,  the  cure,  and  the  alleviation 
of  disease.  The  endeavor  throughout  has  been  to  conform  to  the  title  of  the 
book— Applied  Therapeutics— to  indicate  the  course  of  treatment  to  be  pursued 
at  the  bedside,  rather  than  to  name  a  list  of  drugs  that  have  been  used  at  one 
time  or  another. 

While  the  scientific  superiority  and  the  practical  desirability  of  the  metric 
system  of  weights  and  measures  is  admitted,  it  has  not  been  deemed  best  to 
discard  entirely  the  older  system  of  figures,  so  that  both  sets  have  been  eiven 
where  occasion  demanded.  •  ^ 


CATALOGUE  OF  MEDICAL    WORKS. 


For  Sale  by  Subscription. 


AN  AMERICAN  TEXT-BOOK  OF  OBSTETRICS.  Edited  by  Rich- 
ard C.  NoRRis,  M.  D.;  Art  Editor,  Robert  L.  Dickinson,  M.  D.  One 
handsome  octavo  volume  of  over  looo  pages,  with  nearly  900  colored  and 
half-tone  illustrations.     Prices:  Cloth,  I7.00;  Sheep  or  Half-Morocco,  ^8.00. 

The  advent  of  each  successive  volume  of  the  series  of  the  American  Text- 
Books  has  been  signalized  by  the  most  flattering  comment  from  both  the  Press  and 
the  Profession.  The  high  consideration  received  by  these  text-books,  and  their 
attainment  to  an  authoritative  position  in  current  medical  literature,  have  been 
matters  of  deep  international  interest,  which  finds  its  fullest  expression  in  the 
demand  for  these  publications  from  all  parts  of  the  civilized  world. 

In  the  preparation  of  the  "  American  Text-Book  of  Obstetrics  "  the  editor 
has  called  to  his  aid  proficient  collaborators  whose  professional  prominence  entitles 
them  to  recognition,  and  whose  disquisitions  exemplify  Practical  Obstetrics. 
While  these  writers  were  each  assigned  special  themes  for  discussion,  the  correla- 
tion of  the  subject-matter  is,  nevertheless,  such  as  ensures  logical  connection  in 
treatment,  the  deductions  of  which  thoroughly  represent  the  latest  advances  in  the 
science,  and  which  elucidate  the  best  modern  methods  of  procedure. 

The  more  conspicuous  feature  of  the  treatise  is  its  wealth  of  illustrative  matter. 
The  production  of  the  illustrations  had  been  in  progress  for  several  years,  under 
the  personal  supervision  of  Robert  L.  Dickinson,  M.  D.,  to  whose  artistic  judg- 
ment and  professional  experience  is  due  the  most  sumptuously  illustrated 
work  of  the  period.  By  means  of  the  photographic  art,  combined  with  the 
skill  of  the  artist  and  draughtsman,  conventional  illustration  is .  superseded  by 
rational  methods  of  delineation. 

Furthermore,  the  volume  is  a  revelation  as  to  the  possibilities  that  may  be 
reached  in  mechanical  execution,  through  the  unsparing  hand  of  its  publisher. 


CONTRIBUTORS  : 


Dr.  James  C.  Cameron. 
Edward  P.  Davis. 
Robert  L.  Dickinson. 
Charles  Warrington  Earle. 
James  H.  Elheridge. 
Barton  Cooke  Hirst. 
Henry  J.  Garrigues. 
Charles  Jewett. 


Dr.  Howard  A.  Kelly. 
Richard  C.  Norris. 
Chauncey  D,  Palmer. 
Theophilus  Parvin. 
George  A.  Piersol. 
Edward  Reynolds. 
Henry  Schwarz. 


"  At  first  glance  we  are  overwhelmed  by  the  magnitude  of  this  work  in  several  respects,  viz. : 
■  First,  by  the  size  of  the  volume,  then  by  the  array  of  eminent  teachers  in  this  department  who  have 
taken  part  in  its  production,  then  by  the  profuseness  and  character  of  the  illustrations,  and  last,  but 
not  least,  the  conciseness  and  clearness  with  which  the  text  is  rendered.  This  is  an  entirely  new 
composition,  embodying  the  highest  knowledge  of  the  art  as  it  stands  to-day  by  authors  who  occupy 
the  front  rank  in  their  specialty,  and  there  are  many  of  them.  We  cannot  turn  over  these  pages 
without  being  struck  by  the  superb  illustrations  which  adorn  so  many  of  them.  We  are  confident 
that  this  most  practical  work  will  find  instant  appreciation  by  practitioners  as  well  as  students."— 
New  York  Medical  Times. 


Permit  me  to  say  that  your  American  Text-Book  of  Obstetrics  is  the  most  magnificent  medical 
work  that  I  have  ever  seen.  I  congratulate  you  and  thank  you  for  this  superb  work,  which  alone  is 
su£5cient  to  place  you  first  in  the  ranks  of  medical  pubhshers. 

With  profound  respect  I  am  sincerely  yours, 

Alex.  J.  C.  Skene. 


IV.  B.  SAUNDERS  ILLUSTRATED 


For  Sale  by  Subscription. 


AN  AMERICAN  TEXT-BOOK  OF  SURGERY,  Edited  by  Wil- 
liam W.  Keen,  M.  D.,  LL.D.,  and  J,  William  White,  M.  D.,  Ph.  D. 
Forming  one  handsome  royal-octavo  volume  of  1250  pages  (10x7  inches), 
with  500  wood-cuts  in  text,  and  37  colored  and  half-tone  plates,  many  of 
them  engraved  from  original  photographs  and  drawings  furnished  by  the 
authors;.     Prices  :   Cloth,  ;?7.oo  ;  Sheep  or  Half-Morocco,  ^8.00  net. 

SECOND  EDITION,  REVISED  AND  ENLARGED,  * 

With  a  Section  devoted  to  "The  Use  of  the  Rontgen  Rays  in  Surgery." 

The  want  of  a  text-book  which  could  be  used  by  the  practitioner  and  at  the 
same  time  be  recommended  to  the  medical  student  has  been  deeply  felt,  especially 
by  teachers  of  surgery ;  hence,  when  it  was  sug- 
gested to  a  number  of  these  that  it  would  be 
well  to  unite  in  preparing  a  text-book  of  this 
description,  great  unanimity  of  opinion  was 
found  to  exist,  and  the  gentlemen  below  named 
gladly  consented  to  join  in  its  production. 

Especial  prominence  has  been  given  to  Surg- 
ical Bacteriology,  a  feature  which  is  believed  to 
be  unique  in  a  surgical  text-book  in  the  English 
language.  Asepsis  and  Antisepsis  have  received 
particular  attention.  The  text  is  brought  well 
up  to  date  in  such  important  branches  as  cere- 
bral, spinal,  intestinal,  and  pelvic  surgery,  the 
most  important  and  newest  operations  in  these 
departments  being  described  and  illustrated. 

The  text  of  the  entire  book  has  been  sub- 
mitted to  all  the  authors  for  their  mutual  criti- 
cism and  revision — an  idea  in  book-making 
that  is  entirely  new  and  original.  The  book  as 
a  whole,  therefore,  expresses  on  all  the  im- 
portant surgical  topics  of  the  day  the  consensus 
of    opinion   of   the    eminent   surgeons    who   Jiave    joined    in    its    preparation. 

One  of  the  most  attractive  features  of  the  book  is  its  ill.ustrations.  Very  many 
of  them  are  original  and  faithful  reproductions  of  photographs  taken  directly  from 
patients  or  from  specimens,  and  the  modern  improvements  in  the  art  of  engraving 
have  enabled  the  publisher  to  produce  illustrations  which  it  is  believed  are  superior 
to  those  in  any  similai;  work. 


specimen  Illustration  {largely  reduced). 


CONTRIBUTORS: 


Dr.  Charles  H.  Burnett,  Philadelphia. 
Phineas  S.  Conner,  Cincinnati. 
Frederic  S.  Dennis,  New  York. 
William  W.  Keen,  Philadelphia. 
Charles  B.  Nancrede,  Ann  Arbor,  Mich. 
Roswell  Park,  Buffalo,  N.  Y. 
Lewis  S.  Pilcher,  Brooklyn,  N.  Y. 


Dr.  Nicholas  Senn,  Chicago. 

Francis  J.  Shepherd,  Montreal,  Canada. 

Lewis  A.  Stimson,  New  York. 

William  Thomson,  Philadelphia. 

J.  Collins  Warren,  Boston. 

J.  William  White,  Philadelphia. 


it  ;=  „f  text-book  IS  a  fair  reHex  of  the  present  position  of  American  surgery,  we  must  admit 

hi  1       '^'ly-'t  °'''^""  °^  "'"''  ^°<1  *^'  English*^  surgeons  will  have  to  ifok  very  carefuU^o 
their  laurels  if  they  are  to  preserve  a  position  in  the  van  of  surgical  ^^x^c&<,^."-LondInlaml 

artl^JJ'lf  ^°™^"^^^  °f '.*>«  teachings  contained  in  this  work  needs  no  stronger  guarantee  than  is 
alforded  by  the  names  of  its  authors."— jMsfAVa/  News,  Philadelphia. 


CATALOGUE  OF  MEDICAL    WORKS. 


For  Sale  by  Subscription. 


AN  AMERICAN  TEXT-BOOK  ON  THE  THEORY  AND 
PRACTICE  OF  MEDICINE.  By  American  Teachers.  Edited 
by  William  Pepper,  M.  D.,  LL.D.,  Provost  and  Professor  of  the  Theory 
and  Practice  of  Medicine  and  of  Clinical  Medicine  in  the  University  of 
Pennsylvania.  Complete  in  two  handsome  royal- octavo  volumes  of  about 
looo  i^kges  each,  with  illustrations  to  elucidate  the  text  wherever  necessary. 
Price  per  Volume :  Cloth,  ^5.00  net ;    Sheep  or  Half- Morocco,  g6.oo  net. 

VOLUME   I.  CONTAINS: 


Hygiene. — Fevers  (Ephemeral,  Simple  Con- 
tinued, Typhus,  Typhoid,  Epidemic  Cerebro- 
spinal Meningitis,  and  Relapsing). — Scarlatina, 
Measles,  Rotheln,  Variola,  Varioloid,  Vaccinia, 
Varicella,   Mumps,  Whooping-cough,   Anthrax, 


Hydrophobia,  Trichinosis,  Actinomycosis,  Glan- 
ders, and  Tetanus.  —  Tuberculosis,  Scrofula, 
Syphilis,  Diphtheria,  Erysipelas,  Malaria,  Chol- 
era, and  Yellow  Fever. — Nervous,  Muscular,  and 
Mental  Diseases. 


VOLUME    II.  CONTAINS: 


Urine  (Chemistry  and  Microscopy). — Kidney 
and  Lungs. — Air-passages  (Larynx  and  Bronchi) 
and  Pleura.  —  Pharynx,  CEsophagus,  Stomach 
and  Intestines  (including  Intestinal  Parasites), 
Heart,  Aorta,  Arteries  and  Veins. — Peritoneum, 


Liver,  and  Pancreas. — Diathetic  Diseases  (Rheu- 
matism, Rheumatoid  Arthritis,  Gout,  Lithsemia, 
and  Diabetes). — Blood  and  Spleen. — Inflamma- 
tion, Embolism,  Thrombosis,  Fever,  and  Bacte- 
riology. 


The  articles  are  not  written  as  though  addressed  to  students  in  lectures,  but  are 
exhaustive  descriptions  of  diseases,  with  the  newest  facts  as  regards  Causation, 
Symptomatology,  Diagnosis,  Prognosis,  and  Treatment,  including  a  large  number 
of  approved  formulae.  The  recent  advances  made  in  the  study  of  the  bacterial 
origin  of  various  diseases  are  fully  described,  as  well  as  the  bearing  of  the  know- 
ledge so  gained  upon  prevention  and  cure.  The  subjects  of  Bacteriology  as  a 
whole  and  of  Immunity  are  fully  considered  in  a  separate  section. 

Methods  of  diagnosis  are  given  the  most  minute  and  careful  attention,  thus 
enabling  the  reader  to  learn  the  very  latest  methods  of  investigation  without  con- 
sulting works  specially  devoted  to  the  subject. 


CONTRIBUTORS: 


Dr.  J.  S.  Billings,  Philadelphia. 
Francis  Delafield,  Nevif  York. 
Reginald  H.  Fitz,  Boston. 
James  W.  Holland,  Philadelphia. 
Henry  M.  Lyman,  Chicago. 
William  Osier,  Baltimore. 


Dr.  William  Pepper,  Philadelphia. 

W.  Gilman  Thompson,  New  York. 
W.  H.  Welch,  Baltimore. 
James  T.  Whittaker,  Cincinnati. 
James  C.  Wilson,  Philadelphia. 
Horatio  C.  Wood,  Philadelphia. 


"  We  reviewed  the  first  volume  of  this  work,  and  said :  '  It  is  undoubtedly  one  of  the  best  text' 
books  on  the  practice  of  medicine  which  we  possess.'  A  consideration  of  the  second  and  last 
Tolume  leads  us  to  modify  that  verdict  and  to  say  that  the  completed  work  is,  in  our  opinion,  the 
BEST  of  its  kind  it  has  ever  been  our  fortune  to  see.  It  is.  complete,  thorough,  accurate,  and  clear. 
It  is  well  written,  well  arranged,  well  printed,  well  illustrated,  and  well  bound.  If  is  a  model  of 
what  the  modern  text-book  should  be."— ^ra/  York  Medical  Journal. 

"  A  library  ujfcn  modern  medical  art.  The  work  must  promote  the  wider  diffusion  of  sound 
knowledge." — American  Lancet. 

"  A  trusty  counsellor  for  the  practitioner  or  senior  student,  on  which  he  may  implicitly  rely."— 
Sdinburgh  Medical  Journal. 


W.  B.  SAUNDERS'  ILLUSTRATED 


For  Sale  by  Subscription. 


AN  AMERICAN  TEXT-BOOK  OF  THE  DISEASES  OF  CHIL- 
DREN.  By  American  Teachers.  Edited  by  Louis  Starr,  M.  D.j 
assisted  by  Thompson  S.  Westcott,  M.  D.  In  one  handsome  royal-8vo  vol- 
ume of  1 190  pages,  profusely  illustrated  with  wood-cuts,  half-tone  and  colored 
plates.     Prices:   Cloth,  g  7. 00  net ;  Sheep  or  Half-Morocco,  ^8.00  net. 

The  plan  of  this  work  embraces  a  series  of  original  articles  written  "by  some 
iixty  well-known  paediatrists,  representing  collectively  the  teachings  of  the  most 
arominent  medical  schools  and  colleges  of  America.  The  work  is  intended  to  be 
I  PRACTICAL  book,  suitable  for  constant  and  handy  reference  by  the  practitioner 
md  the  advanced  student. 

One  decided  innovation  is  the  large  number  of  authors,  nearly  every  jirticle 
Deing  contributed  by  a  specialist  in  the  line  on  which  he  writes.  This,  while 
entailing  considerable  labor  upon  the  editors,  has  resulted  in  the  publication  of  a 

iVOrk  THOROUGHLY  NEW  AND  ABREAST  OF  THE  TIMES. 

Especial  attention  has  been  given  to  the  consideration  of  the  latest  accepted 
:eaching  upon  the  etiology,  symptoms,  pathology,  diagnosis,  and  treatment  of  the 
iisorders  of  children,  with  the  introduction  of  many  special  formulae  and  thera- 
peutic procedures. 

Special  chapters  embrace  at  unusual  length  the  Diseases  of  the  Eye,  Ear,  Nose 
md  Throat,  and  the  Skin  ;  while  the  introductory  chapters  cover  fully  the  important 
subjects  of  Diet,  Hygiene,  Exercise,  Bathing,  and  the  Chemistry  of  Food.  Trache- 
Jtomy,  Intubation,  Circumcision,  and  such  minor  surgical  procedures  coming 
(yithin  the  province  of  the  medical  practitioner,  are  carefully  considered. 

CONTRIBUTORS: 


Dr.  S,  S.  Adams,  Washington. 

John  Ashhurst,  Jr.,  Philadelphia. 
A.  D.  Blackader,  Montreal,  Canada. 
Dillon  Brown,  New  York. 
Edward  M.  Buckingham,  Boston. 
Charles  W.  Burr,  Philadelphia. 
W.  E.  Casselberry,  Chicago. 
Henry  Dwight  Chapin,  New  York. 
W.  S.  Christopher,  Chicago. 
Archibald  Church,  Chicago. 
Floyd  M.  Crandall,  New  York. 
Andrew  F.  Currier,  New  York. 
Roland  G.  Curtin,  Philadelphia. 
J.  M.  DaCosta,  Philadelphia. 
I.  N.  Danforth,  Chicago. 
Edward  P.  Davis,  Philadelphia. 
John  B.  Deaver,  Philadelphia. 
G.  E.  de  Schweinitz,  Philadelphia. 
John  Doming,  New  York. 
Charles  Warrington  Earle,  Chicago. 
Wm.  A.  Edwards,  San  Diego,  Cal. 
F.  Forchheimer,  Cincinnati. 
J.  Henry  Fruitnight,  New  York. 
Landon  Carter  Gray,  New  York. 
J.  P.  Crozer  Griffith,  Philadelphia. 
W.  A.  Hardaway,  St.  Louis. 
M.  P.  Hatfield,  Chicago. 
Barton  Cooke  Hirst,  Philadelphia. 
H.  lUoway,  Cincinnati. 
Henry  Jackson,  Boston. 
Charles  G.  Jennings,  Detroit. 
Henry  Koplik,  New  York. 


Dr.  Thomas  S.  Latimer,  Baltimore. 
Albert  R.  Leeds,  Hoboken,  N.  J. 
J.  Hendrie  Lloyd,  Philadelphia. 
George  Roe  Lock  wood.  New  York. 
Henry  M.  Lyman,  Chicago. 
Francis  T.  Miles,  Baltimore. 
Charles  K.  Mills,  Philadelphia. 
John  H.  Musser,  Philadelphia. 
Thomas  R.  Neilson,  Philadelphia. 
W.  P.  Norlhrup,  New  York. 
William  Osier,  Baltimore. 
Frederick  A.  Packard,  Philadelphia. 
William  Pepper,  Philadelphia. 
Frederick  Peterson,  New  York. 
W.  T.  Plant,  Syracuse,  New  York. 
William  M.  Powell,  Atlantic  City. 
B.  Alexander  Randall,  Philadelphia. 
Edward  O.  Shakespeare,  Philadelphia. 
F.  C.  Shattuck,  Boston. 
J.  Lewis  Smith,  New  York. 
Louis  Starr,  Philadelphia. 
M.  Allen  Starr,  New  York. 
J.  Madison  Taylor,  Philadelphia. 
Charles  W.  Townsend,  Boston. 
James  Tyson,  Philadelphia. 
W.  S.  Thayer,  Baltimore. 
Victor  C.  Vaughan,  Ann  Arbor,  Mich. 
Thompson  S.  Westcott,  Philadelphia. 
Henry  R.  Wharton,  Philadelphia 
J.  William  White,  Philadelphia. 
J.  C.  Wilson,  Philadelphia. 


CATALOGUE  OF  MEDICAL    WORKS. 


For  Sale  by  Subscription. 


AN  AMERICAN  TEXT-BOOK  OF  GYNECOLOGY,  MEDICAL 
AND  SURGICAL,  for  the  use  of  Students  and  Practitioners. 
Edited  by  J.  M.  Baldy,  M.  D.  Forming  a  handsome  royal-octavo  volume, 
with  360  illustrations  in  text  and  37  colored  and  half-tone  plates.  Prices : 
Cloth,  ;g6.oo  net;  Sheep  or  Half-Morocco,  $7.00  net. 

In  this  volume  all  anatomical  descriptions,  excepting  those  essential  to  a  clear 
understanding  of  the   text,  have  been   omitted,  the   illustrations  being  largely 

depended  upon  to  eluci- 
date the  anatomy  of  the 
parts.  This  work)  which 
is  thoroughly  practical  in 
its  teachings,  is  intended, 
as  its  title  implies,  to  be 
a  working  text-book  for 
physicians  and  students. 
A  clear  line  of  treatment 
has  been  laid  down  in 
every  case,  and  although 
no  attempt  has  been  made 
to  discuss  mooted  points, 
still  the  most  important 
of  these  have  been  flbted 
and  explained.  The  ope- 
irations  recommended  are 
fully  illustrated,  so  that 
the  reader,  having  a  pic- 
ture of  the  procedure  de- 
scribed in  the  text  under 
his  eye,  cannot  fail  to 
grasp  the  idea.  All  ex- 
traneous matter  and  dis- 
cussions have  been  care- 
fully excluded,  the  attempt 
being  made  to  allow  no 
unnecessary  details  to  cumber  the  text.  The  subject-matter  is  brought  up  to  date 
at  every  point,  and  the  work  is  as  nearly  as  possible  the  combined  opinions  of  the 
ten  specialists  who  figure  as  the  authors. 

The  work  is  well  illustrated  throughout  with  wood-cuts,  half-tone  and  colored 
plates,  mostly  selected  from  the  authors'  private  collections. 


specimen  Illustration. 


CONTRIBUTORS: 


Dr.  Henry  T.  Byford. 
John  M.  Baldy. 
Edwin  Cragin. 
J.  H.  Etheridge. 
William  Goodell. 


Dr.  Howard  A.  Kelly. 
Florian  Krug. 
E.  E.  Montgomery. 
William  R.  Pryor. 
George  M.  Tuttle. 


"  The  most  notable  contribution  to  gynecological  literature  since  1887 and  the  most  com- 
plete exponent  of  gynecology  which  we  have.     No  subject  seems  to  have  been  neglected and 

the  gynecologist  and  surgeon  and  the  general  practitioner,  who  has  any  desire  to  practise  diseases 
of  women,  will  find  it  of  practical  value.  In  the  matter  of  illustrations  and  plates  the  book  sur- 
passes anything  we  have  seen." — Boston  Medical  and  Surgical  Journal. 


W.  B.  SAUNDERS'  ILLUSTRATED 


IJKW  PRONOUNCING  DICTIONARY  OF  MEDICINE,  with 
Phonetic  Pronunciation,  Accentuation,  Etymology,  etc.  By  John 
M.  Keating,  M.  D.,  LL.D.,  Fellow  of  the  College  of  Physicians  of  Phila- 
delphia; Vice-President  of  the  American  Paediatric  Society;  Ex-President 
of  the  Association  of  Life  Insurance  Medical  Directors  ;  Editor  "  Cyclopaedia 
of  the  Diseases  of  Children,"  etc. ;  and  Henry  Hamilton,  Author  of  a  "A 
New  Translation  of  Virgil's  ^neid  into  English  Rhyme;"  Co- Author  of 
"Saunders'  Medical  Lexicon,"  etc. ;  with  the  Collaboration  of  J.  Chalmers 
DaCosta,  M.  D.,  and  Frederick  A.  Packard,  M.  D.  With  an  Appendix, 
containing  Important  Tables  of  Bacilli,  Micrococci,  Leucomaines,  Ptomaines; 
Drugs  and  Materials  used  in  Antiseptic  Surgery  ;  Poisons  and  their  Antidotes ; 
Weights  and  Measures ;  Thermometric  Scales ;  New  Official  and  Unofficial 
Drugs,  etc.  One  volume  of  over  800  pages.  Second  Revised  Edition. 
Prices:  Cloth,  $5.00;  Sheep  or  Half-Morocco,  J6. 00  net ;  Half- Russia,  ^6.50 
net,  with  Denison's  Patent  Ready-Reference  Index ;  without  Patent  Index, 
Cloth,  ^4.00  net;  Sheep  or  Half-Morocco,  ^5.00  net. 

"  I  am  much  pleased  with  Keating's  Dictionary,  and  shall  take  pleasure  in  recommending  it 

my  classes."  ,,   ,  ,.  t^ 

Henry  M.  Lyman,  M.  D., 

Professor  of  Principles  and  Practice  of  Medicine,  Ru:h  Medical  College,  Chicago,  III. 

"  I  am  convinced  that  it  will  be  a  very  valuable  adjunct  to  my  study-table,  convenient  in  size 
id  sufficiently  full  for  ordinary  use." 

C.  A.  LiNDSLEY,  M.  D., 
Professor  of  Theory  and  Practice  of  Medicine,  Medical  Deft.  Yale  University; 

Secretary  Connecticut  State  Board  of  Health,  New  Haven,  Conn. 

iIEDICAL  DIAGNOSIS.  By  Dr.  Oswald  Vterordt,  Professor  of  Medi- 
cine at  the  University  of  Heidelberg.  Translated,  with  additions,  from  the 
Second  Enlarged  German  Edition,  with  the  author's  permission,  by  Francis 
H.  Stuart,  A.M.,  M.  D.  Third  and  Revised  Edition.  In  one  handsome 
royal-octavo  volume  of  700  pages,  1 78  fine  wood-cuts  in  text,  many  of  which 
are  in  cqlors.  Prices:  Cloth,  ^4.00  net;  Sheep  or  Half-Morocco,  $%.oo  net; 
Half- Russia,  ls.50  net. 

In  this  work,  as  in  no  other  hitherto  published,  are  given  full  and  accurate 
xplanations  of  the  phenomena  observed  at  the  bedside.  It  is  distinctly  a  clinical 
?ork  by  a  master  teacher,  characterized  by  thoroughness,  fulness,  and  accuracy, 
t  is  a  mine  of  information  upon  the  points  that  are  so  often  passed  over  without 
xplanation.  Especial  attention  has  been  given  to  the  germ-theory  as  a  factor  in 
he  origin  of  disease. 

This  valuable  work  is  now  published  in  German,  English,  Russian,  and  Italian. 
The  issue  of  a  third  American  edition  within  two  years  indicates  the  favor  with  which 
t  has  been  received  by  the  profession. 

"  Rarely  ig  a  book  published  with  which  a  reviewer  can  find  so  little  fault  as  with  the  volume 
lefore  us.  All  the  chapters  are  full,  and  leave  little  to  be  desired  by  the  reader.  Each  particular 
tem  in  the  consideration  of  an  organ  or  apparatus,  which  is  necessary  to  determine  a  diagnosis  of 
,ny  disease  of  that  organ,  is  mentioned ;  nothing  seem^  forgotten.  The  chapters  on  diseases  of  the 
irculatory  and  digestive  apparatus  and  nervous  system  are  especially  full  and  valuable.  Not- 
withstanding a  few  minor  errors  in  translating,  which  are  of  small  importance  to  the  accuracy 
if  the  rest  of  the  volume,  the  reviewer  woijld  repeat  that  the  book  is  one  of  the  best — probably, 
he  best — which  has  fallen  into  his  hands.  An  excellent  and  comprehensive  index  of  nearly  one 
lundred  pages  closes  the  volume." — University  Medical  Magazine,  Philadelphia. 


CATALOGUE  OF  MEDICAL    WORKS. 


PATHOLOGY  AND  SURGICAL  TREATMENT  OF  TUMORS. 

By  N.  Senn,  M.  D.,  Ph.  D.,  LL.  D.,  Professor  of  Surgery  and  of  Clinical 
Surgery,  Rush  Medical  College ;  Professor  of  Surgery,  Chicago  Polyclinic ; 
Attending  Surgeon  to  Presbyterian  Hospital ;  Surgeon-in-Chief,  St.  Joseph's 
Hospital,  Chicago.  710  pages,  515  engravings,  including  full-page  colored 
plates.     Prices:  Cloth,  ^6.00  net;  Half- Morocco,  $7.00  net. 

Books  specially  devoted  to  this  subject  are  few,  and  in  our  text-books  and 
systems  of  surgery  this  part  of  surgical  pathology  is  usually  condensed  to  a  degree 
incompatible  with  its  scientific  and  clinical  importance.  The  author  spent  many 
years  in  collecting  the  material  for  this  work,  and  has  taken  great  pains  to  present 
it  in  a  manner  that  should  prove  useful  as  a  text-book  for  the  student,  a  work 
of  reference  for  the  busy  practitioner,  and  a  reliable,  safe  guide  for  the  surgeon. 
The  more  difficult  operations  are  fully  described  and  illustrated.  More  than  one 
hundred  of  the  illustrations  are  original,  while  the  remainder  were  selected  from 
books  and  medical  journals  not  readily  accessible  to  the  student  and  the  general 
practitioner. 

"  The  appearance  of  such  a  work  is  most  opportune.  ...  In  design  and  execution  the  work  is 
such  as  will  appeal  to  every  student  who  appreciates  the  logical  examination  of  facts  and  the  prac- 
tical exemplification  of  well-digested  clinical  observation." — Medical  Record,  New  York. 

"  The  most  exhaustive  of  any  recent  book  in  English  on  this  subject.  It  is  well  illustrated,  and 
will  doubtless  remain  as  the  principal  monograph  on  the  subject  in  our  language  for  some  years. 

The  book  is  handsomely  illustrated  and  printed and  the  author  has  given  a  notable  and 

lasting  contribution  to  surgery." — Journal  of  American  Medical  Association,  Chicago. 

SURGICAL  PATHOLOGY  AND  THERAPEUTICS.  By' John 
Collins  Warren,  M.  D.,  LL.  D.,  Professor  of  Surgery,  Medical  Depart- 
ment Harvard  University ;  Surgeon  to  the  Massachusetts  General  Hospital, 
etc.  A  handsome  octavo  volume  of  832  pages,  with  136  relief  and  litho- 
graphic illustrations,  33  of  which  are  printed  in  colors,  and  all  of  which  were 
drawn  by  William  J.  Kaula  from  original  specimens.  Prices:  Cloth,  ^6.00 
net;  Half-Morocco,  ^7.00  net. 

"  The  volume  is  for  the  bedside,  the  amphitheatre,  and  the  ward.  It  deals 
with  things  not  as  we  see  them  through  the  microscope  alone,  but  as  the  practitioner 
sees  their  effect  in  his  patients  ;  not  only  as  they  appear  in  and  affect  culture- 
media,  but  also  as  they  influence  the  human  body ;  and,  following  up  the  demon- 
strations of  the  nature  of  diseases,  the  author  points  out  their  logical  treatment" 
{New  York  Medical  Journal).  "  Indeed,  the  volume  may  be  termed  a  modern 
medical  classic,  for  such  is  the  position  to  which  it  has  already  risen  ' '  {Medical 
Age,  Detroit),  "  and  is  the  handsomest  specimen  of  bookmaking  *  *  *  that  has 
ever  been  issued  from  the  American  medical  press ' '  {American  Journal  of  the 
Medicaf  Sciences,  Philadelphia) . 

"Without  Exception,  the  Illustrations  are  the  Best  ever  Seen  in  a  Work  of 

this  Kind. 

"  A  most  striking  and  very  excellent  feature  of  this  book  is  its  illustrations.  Without  exception, 
from  the  point  of  accuracy  and  artistic  merit,  they  are  the  best  ever  seen  in  a  work  of  'h'S  kind. 
*  *  *  Many  of  those  representing  microscopic  pictures  are  so  perfect  in  their  coloring  and  detail  as 
almost  to  give  the  beholder  the  impression  that  he  is  looking  down  the  barrel  of  a  microscope  at  a 
well-mounted  section." — Annals  of  Surgery,  Philadelphia. 


W.   B.    SAUNDERS'    ILLUSTRATED 


UTOBIOGRAPHY  OF  SAMUEL  D.  GROSS,  M.  D.,  Emeritus 
Professor  of  Surgery  in  the  Jefferson  Medical  College  of  Philadelphia,  with 
Reminiscences  of  His  Times  and  Contemporaries.  Edited  by  his  Sons, 
Samuel  W.  Gross,  M.  D.,  LL.D.,  late  Professor  of  Principles  of  Surgery 
and  of  Clinical  Surgery  in  the  Jefferson  Medical  College,  and  A.  Haller 
Gross,  A.  M.,  of  the  Philadelphia  Bar.  Preceded  by  a  Memoir  of  Dr.  Gross, 
by  the  late  Austin  Flint,  M.  D.,  LL.D.  In  two  handsome  volumes,  each  con- 
taining over  400  pages,  demy  8vo,  extra  cloth,  gilt  tops,  with  fine  Frontis- 
piece engraved  on  steel.     Price,  ^5.00  net. 

This  autobiography,  which  was  continued  by  the  late  eminent  surgeon  until 
thin  three  months  before  his  death,  contains  a  full  and  accurate  history  of  his 
rly  struggles,  trials,  and  subsequent  successes,  told  in  a  singularly  interesting 
d  charming  manner,  and  embraces  short  and  graphic  pen-portraits  of  many  of 
e  most  distinguished  men — surgeons,  physicians,  divines,  lawyers,  statesmen, 
ientists,  etc. — with  whom  he  was  brought  in  contact  in  America  and  in  Europe ; 
e  whole  forming  a  retrospect  of  more  than  three-quarters  of  a  century. 

"  Dr.  Gross  .  .  .  was  perhaps  the  most  eminent  exponent  of  medical  science  that  America  has  yet 
)duced.  His  Autobiography,  related  as  it  is  with  a  fulness  and  completeness  seldom  to  be  foimd 
such  works,  is  an  interesting  and  valuable  book.  He  comments  on  many  things,  especially,  of 
irse,  on  Medical  Men  and  Medical  Practice,  in  a  very  interesting  way.  Details  of  profes- 
nal  life  have  also  much  in  them  that  will  be  new." — The  Spectator,  London,  England. 

HE  PICTORIAL  ATLAS  OF  SKIN  DISEASES  AND  SYPH- 
ILITIC AFFECTIONS  (American  Edition).  Translation  from  the 
French.  Edited  by  J.  J.  Pringle,  M.  B.,  F.  R.  C.  P.,  Assistant  Physician 
to,  and  Physician  to  the  department  for  Diseases  of  the  Skin  at,  the  Middle- 
sex Hospital,  London.  Photo-lithochromes  from  the  famous  models  of  der- 
matological  and  syphilitic  cases  in  the  Museum  of  the  Saint-Louis  Hospital, 
Paris,  with  explanatory  wood-cuts  and  text.  In  12  Parts,  at  $3.00  per  Part. 
Parts  I  to  8  now  ready. 

"  The  plates  are  beautifully  executed."— Jonathan  Hutchinson,  M.  D.  (London  Hospital). 

"  I  strongly  recommend  this  Atlas.  The  plates  are  exceedingly  well  executed,  and  will  be 
great  value  to  all  studying  dermatology."— Stephen  Mackenzie,  M.  D.  (London  Hospital). 

"The  plates  in  this  Atlas  are  remarkably  accurate  and  artistic  reproductions  of  typical  ex- 
ples  of  skm  disease.  The  work  will  be  of  great  value  to  the  practitioner  and  student."— 
[LLIAM  Anderson,  M.  D.  (St.  Thomas  Hospital). 

"  If  the  succeeding  parts  of  this  Atlas  are  to  be  similar  to  Part  I,  now  before  us,  we  have  no 
Bitation  m  cordially  recommending  it  to  the  favorable  notice  of  our  readers  as  one  of  the  finest 
rmatological  atlases  with  which  we  are  acquainted."— Cto^ow  Medical  Journal,  Aug.,  1895. 

"Of  all  the  atlases  of  skin  diseases  which  have  been  published  in  recent  years,  the  present  one 
jmises  to  be  of  greatest  interest  and  value,  especially  from  the  standpoint  of  the  gen*al  practi- 
aex."— American  Medico- Surgical  Bulletin,  Vth.  22,  i?,g(). 

"  The  introdiiction  of  explanatory  wood-cuts  in  the  text  is  a  novel  and  most  important  feature 
nch  greatly  furthers  the  easier  understanding  of  the  excellent  plates,  than  which  nothing,  we  ven- 
e  to  say,  has  been  seen  better  in  point  of  correctness,  beauty,  and  general  merit."— A^««  Yorik 
tdtcal  Journal,  Feb.  15,  1896. 

"An  interesting  feature  of  the  Atlas  is  the  descriptive  text,  which  is  written  for  each  picture  by 
;  physician  who  treated  the  case  or  at  whose  instigation  the  models  have  been  made.  We  pre- 
t  for  this  truly  beautiful  work  a  large  circulation  in  all  parts  of  the  medical  world  where  the 
Ties  St.  Louis  and  Baretta  have  preceded  W'—Medical  Record,  N.  Y.,  Feb.  i,  1896. 


CATALOGUE  OF  MEDICAL    WORKS.  13 

PRACTICAL  POINTS  IN  NURSING.  For  Nurses  in  Private 
Practice.  By  Emily  A.  M.  Stoney,  Graduate  of  the  Training-School  for 
Nurses,  Lawrence,  Mass. ;  Superintendent  of  the  Training-School' for  Nurses, 
Carney  Hospital,  South  Boston,  Mass.  456  pages,  handsomely  illustrated 
with  73  engravings  in  the  text,  and  9  colored  and  half-tone  plates.  Cloth. 
Price,  $1.75  net. 

In  this  volume  the  author  explains,  in  popular  language  and  in  the  shortest 
possible  form,  the  entire  range  of /nVa/s  nursing  as  distinguished  irom  hospital 
nursing,  and  the  nurse  is  instructed  how  best  to  meet  the  various  emergencies  of 
medical  and  surgical  cases  when  distant  from  medical  or  surgical  aid  or  when 
thrown  on  her  own  resources. 

An  especially  valuable  feature  of  the  work  will  be  found  in  the  directions  to 
the  nurse  how  to  improvise  everything  ordinarily  needed  in  the  sick-room,  where 
the  embarrassment  of  the  nurse,  owing  to  the  want  of  proper  appliances,  is  fre- 
quently extreme. 

The  work  has  been  logically  divided  into  the  following  sections : 

I.  The  Nurse :  her  responsibilities,  qualifications,  equipment,  etc. 
11.  The  Sick-Room  :  its  selection,  preparation,  and  management. 

III.  The  Patient :  duties  of  the  nurse  in  medical,  surgical,  obstetric,  and  gyne- 

cologic cases. 

IV.  Nursing  in  Accidents  and  Emergencies. 
V.  Nursing  in  Special  Medical  Cases. 

VI.  Nursing  of  the  New-born  and  Sick  Children. 
VII.  Physiology  and  Descriptive  Anatomy.  » 

The  Appendix  contains  much  information  in  compact  form  that  will  be  found 
of  great  value  to  the  nurse,  including  Rules  for  Feeding  the  Sick;  Recipes  for 
Invalid  Foods  and  Beverages  ;  Tables  of  Weights  and  Measures  ;  Table  for  Com- 
puting the  Date  of  Labor ;  List  of  Abbreviations  ;  Dose-List ;  and  a  full  and  com- 
plete Glossary  of  Medical  Terms  and  Nursing  Treatment. 

"  There  are  few  books  intended  for  non-professional  readers  which  can  be  so  cordially  endorsed 
by  a  medical  journal  as  can  this  one." — Therapeutic  Gazette,  Aug.  15,  1896. 

"  This  is  a  well-written,  eminently  practical  volume,  which  covers  the  entire  range  of  private 
nursing  as  distinguished  from  hospital  nursing,  and  instructs  the  nurse  how  best  to  meet  the  various 
emergencies  which  may  arise  and  how  to  prepare  everything  ordinarily  needed  in  the  illness  of  her 
patient." American  Journal  of  Obstetrics  and  Diseases  of  Women  and  Children,  Aug.,  1896. 

"  It  is  a  work  that  the  physician  can  place  in  the  hands  of  his  private  nurses  with  the  assurance 
of  benefit."— O/4/o  Medical  Journal,  Aug.,  1896. 

A  TEXT-BOOK  OF  BACTERIOLOGY,  including  the  Etiology  and 
Prevention  of  Infective  Diseases  and  an  account  of  Yeasts  and 
Moulds,  Haematozoa,  and  Psorosperms.  By  Edgar  M.  Crook- 
shank,  M.  B.,  Professor  of  Comparative  Pathology  and  Bacteriology,  King's 
College,  London.  A  handsome  octavo  volume  of  700  pages,  illustrated  with 
273  engravings  in  the  text,  and  22  original  and  colored  plates.  Price, 
$6.50  net. 

This  book,  though  nominally  a  Fourth  Edition  of  Professor  Crookshank's 
"Manual  of  Bacteriology,"  is  practically  a  new  work,  the  old  one  having 
been  reconstructed,  greatly  enlarged,  revised  throughout,  and  largely  rewritten, 
forming  a  text-book  for  the  Bacteriological  Laboratory,  for  Medical  Officers 
of  Health,  and  for  Veterinary  Inspectors. 


W.  B.  SAUNDERS'  ILLUSTRATED 


[SEASES  OF  THE  EYE.  A  Hand-Book  of  Ophthalmic  Practice. 
By  G.  E.  DE  ScHWEiNiTZ,  M.  D.,  Professor  of  Ophthalmology  in  the  Jetter- 
son  Medical  College,  Philadelphia,  etc.  A  handsome  royal-octavo  volume 
of  679  pages,  with  256  fine  illustrations,  many  of  which  are  original,  and  2 
chromo-lithographic  plates.  Prices:  Cloth,  $4-00  net;  Sheep  or  Half- 
Morocco,  ^S-oo  net. 
The  object  of  this  work  is  to  present  to  the  student,  and  to  the  practitioner  who 
..„,^..^^_  is  beginning  work  in  the  fields  of  ophthal- 

"^°°^^"""°  mology,  a  plain  description  of  the  optical 

defects  and  diseases  of  the  eye.  To  this 
end  special  attention  has  been  paid  to  the 
clinical  side  of  the  question;  and  the 
method  of  examination,  the  symptoma- 
tology leading  to  a  diagnosis,  and  the 
treatment  of  the  various  ocular  defects 
have  been  brought  into  prominence. 

SECOND    EDITION,   REVISED  AND 
GREATLY    ENLARGED. 


Specimen  Utustration. 


The  entire  book  has  been  thoroughly 
revised.  In  addition  to  this  general  re- 
vision, special  paragraphs  on  the  following 
w  matter  have  been  introduced :  Filamentous  Keratitis,  Blood-staining  of  the 
)rnea.  Essential  Phthisis  Bulbi,  Foreign  Bodies  in  the  Lens,  Circinate  Retinitis, 
mmetrical  Changes  at  the  Macula  Lutea  in  Infancy,  Hyaline  Bodies  in  the 
pilla,  Monocular  Diplopia,  Subconjunctival  Injections  of  Germicides,  Infiltra- 
in-Anaesthesia,  and  Sterilization  of  Collyria.  Brief  mention  ofi.Opfhthalmia 
jdosa.  Electric  Ophthalmia,  and  Angioid  Streaks  in  the  Retina  also«finf  s  place. 
1  Appendix  has  been  added,  containing  a  full  description  of  the  method  of  deter- 
ining  the  corneal  astigmatism  with  the  ophthalmometer  of  Javal  and  Schiotz, 
d  the  rotations  of  the  eyes  with  the  tropometer  of  Stevens.  The  chapter  on 
perations  has  been  enlarged  and  rewritten. 

"A  clearly  written,  comprehensive  manual.  .  .  One  which  we  can  commend  to  students  as  a 
iable  text-book,  written  with  an  evident  knowledge  of  the  wants  of  those  entering  upon  the  study 
this  special  branch  of  medical  science." — British  Medical  Journal. 

"  The  work  is  characterized  by  a  lucidity  of  expression  which  leaves  the  reader  in  no  doubt  as 
the  meaning  of  the  language  employed.  .  .  .  We  know  of  no  work  in  which  these  diseases  are 
;alt  with  more  satisfactorily,  and  indications  for  treatment  more  clearly  given,  and  in  harmony  with 
e  practice  of  the  most  advanced  ophthalmologists." — Maritime  Medical  News. 

"  It  is  hardly  too  much  to  say  that  for  the  student  and  practitioner  beginning  the  study  of 
phthalmology,  it  is  the  best  single  volume  at  present  published." — Medical  Neitis. 

"  The  latest  and  one  of  the  best  books  on  Ophthalmology.  The  book  is  thoroughly  up  to  date, 
id  is  certainly  a  work  which  not  only  commends  itself  to  the  student,  but  is  a  ready  reference  for 
e  busy  practitioner." — International  Medical  Magazine. 

'EEDING    IN    EARLY    INFANCY.      By  Arthur  V.  Meigs,   M.  D. 
Bound  in  limp  cloth,  flush  edges.     Price,  25  cents  net. 

Synopsis  :  Analyses  of  Milk — Importance  of  the  Subject  of  Feeding  in  Earlj 
[ifancy— Proportion  of  Casein  and  Sugar  in  Human  Milk — Time  to  Begin  Arti- 
cial  Feeding  of  Infants— Amount  of  Food  to  be  Administered  at  Each  Feeding — 
Qtervals  between  Feedings—  Increase  in  Amount  of  Food  at  Different  Periods  of 
nfant  Development — Umuitableness  of  Condensed  Milk  as  a  Substitute  for  Moth- 
r's  Milk — Objections  to  Sterilization  or  ''Pasteurization"  of  Milk — Advances 
lade  in  the  Method  of  Artificial  Feeding  of  Infants. 


CATALOGUE  OF  MEDICAL   WORKS.  15 

A  TEXT-BOOK  OF  HISTOLOGY,  DESCRIPTIVE  AND  PRAC- 
TICAL. For  the  Use  of  Students.  By  Arthur  Clarkson,  M.  B., 
C.  M.,  Edin.,  formerly  Demonstrator  of  Physiology  in  the  Owen's  College, 
Manchester;  late  Demonstrator  of  Physiology  in  the  Yorkshire  College, 
Leeds.  Large  8vo,  554  pages,  with  22  engravings  in  the  text,  and  174 
beautifully  colored  original  illustrations.  Price,  strongly  bound  in  Cloth, 
|6.oo  net. 

The  purpose  of  the  writer  in  this  work  has  been  to  furnish  the  student  of  His- 
tology, in  one  volume,  with  both  the  descriptive  and  the  practical  part  of  the 
science.  The  first  two  chapters  are  devoted  to  the  consideration  of  the  general 
methods  of  Histology ;  subsequently,  in  each  chapter,  the  structure  of  the  tissue 
or  organ  is  first  systematically  described,  the  student  is  then  taken  tutorially  over , 
the  specimens  illustrating  it,  and,  finally,  an  appendix  affords  a  short  note  of  the 
methods  of  preparation. 

TEXT-BOOK  UPON  THE  PATHOGENIC  BACTERIA.  Spe- 
cially written  for  Students  of  Medicine.  By  Joseph  McFarland, 
M.  D.,  Professor  of  Pathology  and  Bacteriology  in  the  Medico-Chirurgical 
College  of  Philadelphia,  etc.  359  pages,  finely  illustrated.  Cloth.  Price, 
I2.50  net. 

The  Book  presents  a  concise  account  of  the  technical  procedures  necessary  in 
the  study  of  Bacteriology.  It  describes  the  life-history  of  pathogenic  bacteria,  and 
the  pathological  lesions  following  invasions. 

The  wMJi^^tended  to  be  a  text-book  for  the  medical  student  and  fo?  the 
practitic^^^^^^KS  had  no  recent  laboratory  training  in  this  department  of  med- 
ical scie^^^^HI  instructions  given  as  to  needed  apparatus,  cultures,  stainings, 
microscoj^^^^fcinations,  etc.  are  ample  for  the  student's  needs,  and  will  afford 
to  the  phn^^^W  much  information  that  will  interest  and  profit  him. 

"The  author  has  succeeded  admirably  in  presenting  the  essential  details  of  bacteriological 
technics,  together  with  a  judiciously  chosen  summary  of  our  present  l<nowledge  of  pathogenic  bac- 
teria. .  .  .  The  worli,  we  thinli,  should  have  a  wide  circulation  among  English-speaking  students 
of  medicine." — N.  Y.  Medical  Journal,  April  4,  1896. 

A  MANUAL  OF  PHYSIOLOGY,  with  Practical  Exercises.  For 
Students  and  Practitioners.  By  G.  N.  Stewart,  M.  A.,  M.  D.,  D.  Sc, 
lately  Examiner  in  Physiology,  University  of  Aberdeen,  and  of  the  New 
Museums,  Cambridge  University;  Professor  of  Physiology  in  the  Western 
Reserve  University,  Cleveland,  Ohio.  Handsome  octavo  volume  of  800 
pages,  with,  278  illustrations  in  the  text,  and  5  colored  plates.  Price, 
Cloth,  ;^3.So  net. 

"  It  will  make  its  way  by  sheer  force  of  merit,  and  amply  deserves  to  do  so.  It  is  one  of  the 
very  best  English  text-books  on  the  subject." — Lancet, 

"  Of  the  many  text-books  of  physiology  published,  we  do  not  know  of  one  that  so  nearly 
comes  up  to  the  ideal  as  does  Prof.  Stewart's  volume." — British  Medical  Journal. 

15 
"WATER  AND  WATER   SUPPLIES.     By  John  C.  Thresh,  D.  Sc, 

M.  B.,  D.  P.  H.,  Lecturer  on  Public  Health,  King's  College,  London; 
Editor  of  the  "Journal  of  State  Medicine,"  etc.  i2mo,  438  pages,  illus- 
trated. Handsomely  bound  in  Cloth,  with  gold  side  and  back  stamps. 
Price,  ^2.25  net. 


i6 


W.   B.    SAUNDERS'    ILLUSTRATED 


ARCHIVES  OF  CLINICAL  SKIAGRAPHY.  By  Sydney  Rowla^"' 
B.  A.,  Camb.,  late  Scholar  of  Downing  College,  Cambridge,  and  Shuter 
Scholar  of  St.  Bartholomew's  Hospital,  London  ;  Special  Commissioner  to 
"British  Medical  Journal"  for  the  Investigation  of  the  Applications  of  the 
New  Photography  to  Medicine  and  Surgery.  A  series  of  collotype  illustra- 
tions, with  descriptive  text,  illustrating  tlie  applications  of  the  New  Photog- 
raphy to  Medicine  and  Surgery.  Price,  per  Part,  $i.oo.  Parts  I.  to  III. 
now  ready. 

The  object  of  this  publication  is  to  put  on  record  in  permanent  form  some  of 
the  most  striking  applications  of  the  new  photography  to  the  needs  of  Medicine 
and  Surgery. 

The  progress  of  this  new  art  has  been  so  rapid  that,  although  Prof.  Rontgen's 
discovery  is  only  a  thing  of  yesterday,  it  has  already  taken  its  place  among  the 
approved  and  accepted  aids  to  diagnosis. 

ESSENTIALS  OF  ANATOMY  AND  MANUAL  OF  PRACTICAL 
DISSECTION,  containing  "Hints  on  Dissection."  By  Charles  B. 
Nancrede,  M.  D.,  Professor  of  Surgery  and  Clinical  Surgery  in  the  Uni- 
versity of  Michigan,  Ann  Arbor;  Corresponding  Member  of  the  Royal 
Academy  of  Medicine,  Rome,  Italy ;  late  Surgeon  Jefferson  Medical  Col- 
lege, etc.  Fourth  and  revised  edition.  Post  8vo,  over  500  pages,  with 
handsome  full-page  lithographic  plates  in  colors,  and  over  200  illustrations. 
Price :   Extra  Cloth  (or  Oilcloth  for  the  dissection-room),  S2.0Q.net. 

No  pains  nor  expense  has  been  spared  to  make  this  work  th^^^H^austive 
yet  concise  Student's  Manual  of  Anatomy  and  Dissection  ever  pn^^^^Ether  in 
America  or  in  Europe.  The  colored  plates  are  designed  to  ai^^^Hbdent  in 
dissecting  the  muscles,  arteries,  veins,  and  nerves.  The  wood-cu^^^fall  been 
specially  drawn  and  engraved,  and  an  Appendix  added  containin^MRustrations 
representing  the  structure  of  the  entire  human  skeleton,  the  whole  being  based 
on  the  eleventh  editiqn  of  Gray's  Anatomy. 

A  MANUAL  OF  PRACTICE  OF  MEDICINE.  By  A.  A.  Stevens, 
A.  M.,  M.  D.,  Instructor  of  Physical  Diagnosis  in  the  University  of  Pennsyl- 
vania, and  Demonstrator  of  Pathology  in  the  Woman's  Medical  College  of 
Philadelphia.  Specially  intended  for  students  preparing  for  graduation  and 
hospital  examinations.     Post  8vo,  512  pages.     Illustrated.     Price,  $2.50. 

FOURTH    EDITION,   REVISED    AND    ENLARGED. 

Contributions  to  the  science  of  medicine  have  poured  in  so  rapidly  during  the 
last  quarter  of  a  century  that  it  is  well-nigh  impossible  for  the  student,  with  the 
limited  time  at  his  disposal,  to  master  elaborate  treatises  or  to  cull  from  them  that 
knowledge  which  is  absolutely  essential.  From  an  extended  experience  in  teach- 
ing, the  author  has  been  enabled,  by  classification,  to  group  allied  sympt  \ 
by  the  elimination  of  theories  and  redundant  explanations  to  bring  withf"'"^' 
paratively  small  compass  a  complete  outline  of  the  practice  of  medicine  '"  ^  '^°™" 
TEMPERATURE    CHART.       Prepared    by    D.    T.    Laine,    M    n 

8x13^  inches.     Price,  per  pad  of  25  charts,  50  cents    net.     '  ^^^^ 

A  conveniently  arranged  chart  for  recording  Temperature,  with  columns  f^v  a   ■, 
Urinary  and  Fecal  Excretions,  Food,  Remarks,  etc.     On  the  back  of  each  char?  i.-'^^  «n>ounts  nf 
method  of  Brand  in  the  treatment  of  Typhoid  Fever.  ^^^  ^  g'^en  in  i^^^ 


CATALOGUE  OF  MEDICAL    WORKS.  17 

MANUAL  OF  MATERIA  MEDICA  AND  THERAPEUTICS.     By 

A.  A.  Stevens,  A.  M.,  M.  D.,  Instructor  of  Physical  Diagnosis  in  the  Uni- 
versity of  Pennsylvania,  and  Demonstrator  of  Pathology  in  the  Woman's 
Medical  College  of  Philadelphia.     445  pages.     Price,  Cloth,  ^2.25. 

SECOND    EDITION,    REVISED. 

This  wholly  new  volume,  which  is  based  on  the  last  edition  of  the  Pharma- 
copmia,  comprehends  the  following  sections:  Physiological  Action  of  Drugs; 
Drugs;  Remedial  Measures  other  than  Drugs;  Applied  Therapeutics;  Incom- 
patibility in  Prescriptions ;  Table  of  Doses ;  Index  of  Drugs ;  and  Index  of  Dis- 
eases ;  the  treatment  being  elucidated  by  more  than  two  hundred  formulae. 

NOTES  ON  THE  NEWER  REMEDIES:  their  Therapeutic  Appli- 
cations and  Modes  of  Administration.  By  David  Cerna,  M.D.,  Ph.D., 
Demonstrator  of  and  Lecturer  on  Experimental  Therapeutics  in  the  Univer- 
sity of  Pennsylvania.     Post  8vo,  253  pages.     Price,  ^1.25. 

SECOND    EDITION,  RE-WRITTEN    AND    GREATLY    ENLARGED. 

The  work  takes  up  in  alphabetical  order  all  the  newer  remedies,  giving  their 
physical  properties,  solubility,  therapeutic  applications,  administration,  and  chem- 
ical formula. 


SAUNDERS'  POCKET  MEDICAL  FORMULARY.  By  William 
M.  Powell,  M.  D.,  Attending  Physician  to  the  Mercer  House  for  Inivalid 
Womei^^Atlantic  City.  Containing  1750  Formula,  selected  from  se^ral 
hun^^^^^K  best-known  authorities.  Forming  a  handsome  and  convenient 
poc^^^^^Hnion  of  nearly  300  printed  pages,  with  blank  leaves  for  additions ; 
with^^^^^endix  containing  Posological  Table,  Formulae  and  Doses  for 
HypocBB^  Medication,  Poisons  and  their  Antidotes,  Diameters  of  the 
Female  Pelvis  and  Foetal  Head,  Obstetrical  Table,  Diet  List  for  Various  Dis- 
eases, Materials  and  Drugs  used  in  Antiseptic  Surgery,  Treatment  of  Asphyxia 
from  Drowning,  Surgical  Remembrancer,  Tables  of  Incompatibles,  Eruptive 
Fevers,  Weights  and  Measures,  etc.  Third  edition,  revised  and  greatly 
enlarged.  Handsomely  bound  in  morocco,  with  side  index,  wallet,  and  flap. 
Price,  ^1.75  net. 

"  This  little  book,  that  can  be  conveniently  carried  in  the  pocket,  contains  an  immense  amount 
of  material.  It  is  very  useful,  and  as  the  name  of  the  author  of  each  prescription  is  given  is 
unusually  reliable." — New  York  Medical  Record. 

SAUNDERS'  POCKET  MEDICAL  LEXICON;  or,  Dictionary  of 
Terms  and  Words  used  in  Medicine  and  Surgery.  By  John  M. 
Keating,  M.  D.,  Editor  of  "Cyclopedia  of  Diseases  of  Children,"  etc. ; 
Author  of  the  "New  Pronouncing  Dictionary  of  Medicine,"  and  Henrv 
Hamilton,  Author  of  "A  New  Translation  of  Virgil's  ^neid  into  English 
Verse;"  Co- Author  of  a  "New  Pronouncing  Dictionary  of  Medicine." 
A  new  and  revised  edition.  32mo,  282  pages.  Prices:  Cloth,  75  cents; 
Leather  Tucks,  $\.oa. 

"  Remarkably  accurate  in  terminology,  accentuation,  and  definition."— >a«»a/  0/  American 
Medical  Association. 


,8  W.  B.  SAUNDERS'  ILLUSTRATED 


DISEASES  OF  WOMEN.  By  Henry  J.  Garrigues,  A.  M.,  M.  D-,  ^'^°' 
fessor  of  Obstetrics  in  the  New  York  Post-Graduate  Medical  School  and  Hos- 
pital ;  Gynecologist  to  St.  Mark's  Hospital,  and  to  the  German  Dispensary, 
etc.,  New  York  City.  One  octavo  volume  of  nearly  700  pages,  illustrated 
by  300  wood-cuts  and  colored  plates.  Prices:  Cloth,  $4.00  net;  Sheep, 
^5.00  net. 

A  PRACTICAL  work  on  gynaecology  for  the  use  of  students  and  practitioners, 
written  in  a  terse  and  concise  manner.  Th^  importance  of  a  thorough  knowledge 
of  the  anatomy  of  the  female  pelvic  organs  has  been  fully  recognized  by  the 
author,  and  considerable  space  has  been  devoted  to  the  subject.  The  chapters  on 
Operations  and  on  Treatment  are  thoroughly  modern,  and  are  based  upon  the 
large  hospital  and  private  practice  of  the  author.  The  text  is  elucidated  by  a 
large  number  of  illustrations  and  colored  plates,  many  of  them  being  original,  and 
forming  a  complete  atlas  for  studying  embryology  and  the  anatomy  of  the  female 
genitalia,  besides  exemplifying,  whenever  needed,  morbid  conditions,  instruments, 
apparatus,  and  operations. 

EXCERPT   OF   CONTENTS. 

Development  of  the  Female  Genitals. — Anatomy  of  the  Female  Pelvic  Organs. — Physiology. — 
Puberty. — Menstruation  and  Ovulation. — Copulation. — Fecundation. — The  Climacteric. — Etiology 
in  General. — Examinations  in  General. — Treatment  in  General. — Abnormal  Menstruation  and  Me- 
trorrh^ia. — Leucorrhea. — Diseases  of  the  Vulva. — Diseases  of  the  Perineum. — Diseases  of  the 
Vagina. — Diseases  of  the  Uterus. — Diseases  of  the  Fallopian  Tubes. — Diseases  of  the  Ovaries. — 
Diseases  of  the  Pelvis. — Sterility. 

The  reception  accorded  to  this  work  has  been  most  flattering.  In  the 
short  period  -which  has  elapsed  since  its  issue,  it  has  beMM^pted  and 
recommended  as  a  text-book  by  more  than  60  of  the  Me(|^^^|K<^lB  ^°<^ 
Universities  of  the  United  States  and  Canada. 


b^lM^pte 

sb^^^Khe 
in  ^HBKttrac 


"  One  of  the  best  text-books  for  students  and  practitioners  which  has  b^^^^Hlhed  in  the 
English  language ;  it  is  condensed,  clear,  and  comprehensive.  The  profoun^^^^ng  and  great 
clinical  experience  of  the  distinguished  author  find  expression  in  this  book  in  ^BBBittractive  and 
mstructive  form.  Young  practitioners,  to  whom  experienced  consultants  may  not  be  available,  will 
find  in  this  book  invaluable  counsel  and  help." 

Thad.  a.  Reamy,  M.  D.,  LL.D., 
Professor  of  Clinical  Gynecology,  Medical  College  of  Ohio  ;   Gynecologist  to  the  Good 
Samaritan  and  to  the  Cincinnati  Hospitals. 

ESSENTIALS  OF  PHYSICAL  DIAGNOSIS  OF  THE  THO- 
RAX. By  Arthur  M.  Corwin,  A.  M.,  M.  D.,  Demonstrator  of  Physical 
Diagnosis  in  the  Rush  Medical  College,  Chicago ;  Attending  Physician  to 
the  Central  Free  Dispensary,  Department  of  Rhinology,  Laryngology,  and 
Diseases  of  the  Chest.  200  pages.  Illustrated.  Cloth,  flexible  covers. 
Price,  ^1.25  net. 

This  book  was  originally  published  for  the  use  of  students,  but  its  rapid  absorn 
tion  by  the  practitioner  made  it  appear  that  a  wider  field  had  been  reached  Tn 
this  edition  the  author  has  added  to  his  revision  of  the  text  a  section  setting 'f^rth 
the  signs  found  in  each  of  the  diseases  of  the  chest,  thereby  increasing  its  vfi,i»  f^ 
the  general  practitioner  for  post-graduate  study.  ° 

"  It  IS  excellent.  The  student  who  shall  use  it  as  his  guide  to  the  careful  sturti,  f  1,  ■  , 
exploration  upon  normal  and  abnormal  subjects  can  scarcely  fail  to  acquire  a  eood  »Ji  ■  P^jy^'^^^l 
ledge  of  the  %-ah]ec\.."~ Philadelphia  Polyclinic.  1  s     u  workmg  know- 


CATALOGUE  OF  MEDICAL    WORKS.  19 


SYLLABUS  OF  OBSTETRICAL  LECTURES  in  the  Medical 
Department,  University  of  Pennsylvania.  By  Richard  C.  Norris, 
A.  M.,  M.  D.,  Demonstrator  of  Obstetrics  in  the  University  of  Pennsylvania. 
Third  edition,  thoroughly  revised  and  enlarged.  Crown  8vo.  Price,  Cloth, 
interleaved  for  notes,  ^2.00  net. 

"This  work  is  so  far  superior  to  others  on  the  same  subject  that  we  take 
pleasure  m  callmg  attention  briefly  to  its  excellent  features.  It  covers  the  subject 
thoroughly,  and  will  prove  invaluable  both  to  the  student  and  the  practitioner 
The  author  has  mtroduced  a  number  of  valuable  hints  which  would  only  occur 
to  one  who  was  himself  an  experienced  teacher  of  obstetrics.  The  subject-matter 
is  clear,  forcible,  and  modern.  We  are  especially  pleased  with  the  portion  devoted 
to  the  practical  duties  of  the  accoucheur,  care  of  the  child,  etc.  The  paragraphs 
on  antiseptics  are  admirable ;  there  is  no  doubtful  tone  in  the  directions  given. 
No  details  are  regarded  as  unimportant ;  no  minor  matters  omitted.  We  venture 
to  say  that  even  the  old  practitioner  will  find  useful  hints  in  this  direction  which 
he  cannot  afford  to  despise." — Medical  Record. 

A  SYLLABUS  OF  GYNECOLOGY,  arranged  in  conformity  with 
"  An  American  Text-Book  of  Gynecology."  By  J.  W.  Long,  M.  D., 
Professor  of  Diseases  of  Women  and  Children,  Medical  College  of  Virginia, 
etc.     Price,  Cloth  (interleaved),  ^i.oo  net. 

Based  upon  the  teaching  and  methods  laid  down  in  the  larger  work,  this  will 
not  only  be  useful  as  a  supplementary  volume,  but  to  those  who  do  not  already 
possess  the  Text-Book  it  Avill  also  have  an  independent  value  as  an  aid  to  the  jfrac- 
titioner  in-  gynecological  work,  and  to  the  student  as  a  guide  in  the  lecture-room, 
as  the  subject  is  presented  in  a  manner  systematic,  succinct,  and  practical. 

A  SYLLABUS  OF  LECTURES  ON  THE  PRACTICE  OF  SUR- 
GERY,' arranged  in  conformity  with  "  An  American  Text-Book 
of  Surgery."  By  Nicholas  Senn,  M.  D.,  Ph.  D.,  Professor  of  Surgery  in 
Rush  Medical  College,  Chicago,  and  in  the  Chicago  Polyclinic.    Price,  |2.oo. 

This  excellent  work  of  its  eminent  author,  himself  one  of  the  contributors  to 
"An  American  Text-Book  of  Surgery,"  will  prove  of  exceptional  value  to  the 
advanced  student  who  has  adopted  that  work  as  his  text-book.  It  is  not  only  the 
syllabus  of  an  unrivalled  course  of  surgical  practice,  but  it  is  also  an  epitome  of, 
or  supplement  to  the  larger  work. 

AN  OPERATION  BLANK,  with  Lists  of  Instruments,  etc.  re- 
quired in  Various  Operations.  Prepared  by  W.  W.  Keen,  M.  D., 
LL.D.,  Professor  of  Principles  of  Surgery  in  the  Jefferson  Medical  College, 
Philadelphia.  Price  per  pad,  containing  Blanks  for  fifty  operations,  50 
cents  net. 

SECOND  EDITION,  REVISED  FORM. 

A  convenient  blank  (suitable  for  all  operations),  giving  complete  instructions 
regarding  necessary  preparation  of  patient,  etc.,  with  a  full  list  of  dressings  and 
medicines  to  be  employed.  On  the  back  of  each  blank  is  a  list  of  instruments 
used — viz.  general  instruments,  etc.,  required  for  all  operations;  and  special  in- 
struments for  surgery  of  the  brain  and  spine,  mouth  and  throat,  abdomen,  rectum, 
male  and  female  genito-urinary  organs,  the  bones,  etc.  The  whole  forming  a  neat 
pad,  arranged  for  hanging  on  the  wall  of  a  surgeon's  office  or  in  the  hospital 
operating-room. 


W.  B.  SAUNDERS'  ILLUSTRATED 


LABORATORY  EXERCISES  IN  BOTANY.  By  Edson  S.  Bastin, 
M.  A.,  Professor  of  Materia  Medica  and  Botany  in  the  Philadelphia  Col- 
lege of  Pharmacy.  Octavo  volume  of  536  pages,  vv^ith  87  plates.  Price, 
Cloth,  $2.50. 

This  work  is  intended  for  the  beginner  and  the  advanced  student,  and  it  fully 
covers  the  structure  of  flowering  plants,  roots,   ordinary  stems,  rhizomes,  tubers, 
bulbs,  leaves,  flowers,  fruits,  and  seeds.     Particular  attention  is  given  to  the  gross  , 
and  microscopical  structure  of  plants,  and  to  those  used  in  medicine.     The  illus- 
trations fully  elucidate  the  text,  and  the  complete  index  facilitates  reference. 


»       Trailing  Arbutus  (Epigea  repens). 
Specimen  lUustrtition. 

LABORATORY   GUIDE    FOR    THE    BACTERIOLOGIST.      By 

Langdon  Frothingham,  M,  D.  V.,  Assistant  in  Bacteriology  and  Veterinary 
Science,  Sheffield  Scientific  School,  Yale  University.  Illustrated.  Price, 
Cloth,  75  cents. 

The  technical  methods  involved  in  bacteria-culture,  methods  of  staining  and 
microscopical  study  are  fully  described  and  arranged  as  simply  and  concisely  as 
possible.     The  book  is  especially  intended  for  use  in  laboratory  work. 

OBSTETRIC  ACCIDENTS,  EMERGENCIES,  AND  OPERA- 
TIONS.  By  L.  Ch.  Boisliniere,  M.  D.,  late  Emeritus  Professor  of  Ob- 
stetrics in  the  St.  Louis  Medical  College.  381  pages,  handsomely  illustrated. 
Price,  g2.oo  net. 

"For  the  use  of  the  practitioner  who,  when  away  from  home,  has  not  the 
opportumty  of  consulting  a  library  or  of  calling  a  friend  in  consultation  He 
then,  being  thrown  upon  his  own  resources,  will  find  this  book  of  benefit  in 
guiding  and  assisting  him  in  emergencies." 


CA  TALOGUE  OF  MEDICAL    WORKS. 


HOW  TO  EXAMINE  FOR  LIFE  INSURANCE.  By  John  M. 
Keating,  M.  D.,  Fellow  of  the  College  of  Physicians  and  Surgeons  of  Phila- 
delphia ;  Vice-President  of  the  American  Paediatric  Society ;  Ex-President 
of  the  Association  of  Life  Insurance  Medical  Directors.  Royal  8vo,  211 
pages,  with  two  large  half-tone  illustrations,  and  a  plate  prepared  by  Dr. 
'  McClellan  from  special  dissections  \  also,  numerous  cuts  to  elucidate  the  text. 
Price,  in  Cloth,  ;g2.oo  net. 

"  This  is  by  far  the  most  useful  book  which  has  yet  appeared  on  insurance  examination,  a  sub- 
ject of  growing  interest  and  importance.  Not  the  least  valuable  portion  of  the  volume  is  Part  II., 
which  consists  of  instructions  issued  to  their  examining  physicians  by  twenty-four  representative 
companies  of  this  country.  As  the  proofs  of  these  instructions  were  corrected  by  the  directors  of  1 
the  companies,  they  form  the  latest  instructions  obtainable.  If  for  these  alone  the  book  should  be 
at  the  right  hand  of  every  physician  interested  in  this  special  branch  of  medical  science." —  The 
Medical  News,  Philadelphia. 

THE  CARE  OF  THE  BABY.  By  J.  P.  Crozer  Griffith,  M.  D.,  Clftii- 
cal  Professor  of  Diseases  of  Children,  University  of  Pennsylvania ;  Physician 
to  the  Children's  Hospital,  Philadelphia,  etc.  392  pages,  with  67  illustrations 
in  the  text,  and  5  plates.     i2mo.     Price,  $1.^0. 

A  reliable  guide  not  only  for  mothers,  but  also  for  medical  students  and  prac-' 
titioners  whose  opportunities  for  observing  children  have  been  limited. 

"  The  whole  book  is  characterized  by  rare  good  sense,  and  is  evidently  viritten  by  a  master 
hand.  It  can  be  read  with  benefit  not  only  by  mothers,  but  by  medical  students  and  by  any  prac- 
titioners who  have  not  had  large  opportunities  for  observing  children." — American  yournal  of 
Obstetrics,  July,  1895. 

"  The  best  book  for  the  use  of  the  young  mother  with  which  we  are  acquainted.  .  .  .  There 
are  very  few  general  practitioners  who  could  not  read  the  book  through  with  advantage." — Archives 
of  Pediatrics,  Aug.,  1895. 

"  No  better  book  of  its  kind  has  come  under  our  notice  for  some  time.  Although  intended 
primarily  for  mothers  and  nurses,  it  will  well  repay  perusal  by  medical  students." — Birmingham 
Medical  Review,  Oct.,  1895. 

"  This  is  one  of  the  best  works  of  its  kind  that  has  been  presented  to  the  people  for  many  a 
day." — Maryland  Medical  Journal,  Aug.  13,  1895. 

NURSING:  ITS  PRINCIPLES  AND  PRACTICE.  By  Isabel  Adams 
Hampton,  Graduate  of  the  New  York  Training  School  for  Nurses  attached  to 
Bellevue  Hospital ;  Superintendent  of  Nurses,  and  Principal  of  the  Training 
School  for  Nurses,  Johns  Hopkins  Hospital,  Baltimore,  Md. ;  late  Superin- 
tendent of  Nurses,  Illinois  Training  School  for  Nurses,  Chicago,  111.  In  one 
very  handsome  i2mo  volume  of  484  pages,  profusely  illustrated.  Price, 
Cloth,  ;g2.oo  net. 

This  original  work  on  the  important  subject  of  nursing  is  at  once  compre- 
hensive and  systematic.  It  is  written  in  a  clear,  accurate,  and  readable  style,  suit- 
able alike  to  the  student  and  the  lay  reader.  Such  a  work  has  long  been  a  deside- 
ratum with  those  intrusted  with  the  management  of  hospitals  and  the  instruction 
of  nurses  in  training-schools.  It  is  also  of  especial  value  to  the  graduate  nurse 
who  desires  to  acquire  a  practical  working  knowledge  of  the  care  of  the  sick  and 
the  hygiene  of  the  sick-room. 


JV.  B.  SAUNDERS'   ILLUSTRATED  CATALOGUE. 


NURSE'S  DICTIONARY  of  Medical  Terms  and  Nursing  Treat- 
ment, containing  Definitions  of  the  Principal  Medical  and  Nursing  Terms 
and  Abbreviations ;  of  the  Instruments,  Drugs,  Diseases,  Accidents,  Treat- 
ments, Physiological  Names,  Operations,  Foods,  Appliances,  etc.  encountered 
in  the  ward  or  in  the  sick-room.  Compiled  for  the  use  of  nurses.  By 
HoNNOR  Morten,  Author  of  "How  to  Become  a  Nurse,"  "Sketches  of 
Hospital  Life,"  etc.     i6mo,  140  pages.     Price,  Cloth,  ^i.oo. 

This  little  volume  is  intended  merely  as  a  small  reference-book  which  can  be 
consulted  at  the  bedside  or  in  the  ward.  It  gives  sufficient  explanation  to  the 
nurse  to  enable  her  to  comprehend  a  case  until  she  has  leisiire  to  look  up  larger 
and  fuller  works  on  the  subject. 

DIET  IN  SICKNESS  AND  IN  HEALTH.  By  Mrs.  Ernest  Hart, 
formerly  Student  of  the  Faculty  of  Medicine  of  Paris  and  of  the  London 
School  ■  of  Medicine  for  Women ;  with  an  Introduction  by  Sir  Henry 
Thompson,  F.  R.  C.  S.,  M.  D.,  London.  220  pages;  illustrated.  Price, 
Cloth,  ^1.50. 

Useful  to  those  who  have  to  nurse,  feed,  and  prescribe  for  the  sick.  ...  In 
each  case  the  accepted  causation  of  the  disease  and  the  reasons  for  the  special 
diet  prescribed  are  briefly  described.  Medical  men  will  find  the  dietaries  and 
recipes  practically  useful,  and  likely  to  save  them  trouble  in  directing  the  dietetic 
treatment  of  patients. 

"  We  recommend  it  cordially  to  the  attention  of  all  practitioners  ;  .  .  .  .  both  to  them  and  to 
their  patients  it  may  be  of  the  greatest  service." — -Medical  Journal,  New  York. 

DIETS  FOR  INFANTS  AND  CHILDREN  IN  HEALTH  AND  IN 
DISEASE.  By  Louis  Starr,  M.  D.,  Editor  of  "An  American  Text- 
Book  of  the  Diseases  of  Children. ' '  230  blanks  (pocket-book  size),  per- 
forated and  neatly  bound  in  flexible  morocco.     Price,  ^1.25  net. 

The  first  series  of  blanks  are  prepared  for  the  first  seven  months  of  infant  life ; 
each  blank  indicates  the  ingredients,  but  not  the  quantities,  of  the  food,  the  latter 
directions  being  left  for  the  physician.  After  the  seventh  month,  modifications 
being  less  necessary,  the  diet  lists  are  printed  in  full.  FormulcB  for  the  prepara- 
tion of  diluents  and  foods  are  appended. 

DIET  LISTS  AND  SICK-ROOM  DIETARY.  By  Jerome  B.  Thomas, 
M.  D.,  Visiting  Physician  to  the  Home  for  Friendless  Women  and  Children 
and  to  the  Newsboys'  Home ;  Assistant  Visiting  Physician  to  the  Kings  County 
Hospital;  Assistant  Bacteriologist,  Brooklyn  Health  Department.  Price, 
^1.50.     Send  for  sample  sheet. 

There  is  here  offered,  in  portable  form,  as  an  efficient  aid  to  the  better  practice 
of  Therapeutics,  a  collection  of  detachable  Diet  Lists  and  a  Sick-room  Dietary. 
It  meets  a  want,  for  the  busy  practitioner  has  but  little  time  to  write  out  Systems 
of  Diet  appropriate  to  his  patients,  or  to  describe  the  preparation  of  their  food. 
Compiled  from  the  most  modern  works  on  dietetics,  the  Dietary  offers  a  variety 
of  easily-digested  foods. 

"  A  convenience  that  will  be  appreciated  by  the  physician."— i¥i?rfzVo/  Journal,  New  York. 

"The  work  is  an  excellent  one,  and  ought  to  be  welcomed  by  physician,  patient,  and  nurse 
alike." — Indian  Lancet,  Calcutta. 


Practical,  Exhaustive.  Authoritative. 


SAUNDERS' 

NEW  AID  SERIES  OF  MANUALS. 

FOR 

STUDENTS   AND   PRACTITIONERS. 


Mr.  Saunders  is  pleased  to  announce  the  successful  issue  of  several  volumes 
of  his  NEW  AID  SERIES  OF  MANUALS,  which  have  received  the 
most  flattering  commendations  from  Students  and  Practitioners  and 

the  Press.  As  publisher  of  the  Standard  Series  of  Question  Compends, 
and  through  intimate  relations  with  leading  members  of  the  medical  profession, 
Mr.  Saunders  has  been  enabled  to  study  progressively  the  essential  desiderata  in 
practical  "  self-helps  "  for  students  and  physicians. 

This  study  has  manifested  that,  while  the  published  "Question  Compends" 
earn  the  highest  appreciation  of  students,  whom  they  serve  in  reviewing  their 
studies  preparatory  to  examination,  there  is  special  need  of  thoroughly  reliable 
handbooks  on  the  leading  branches  of  Medicine  and  Surgery,  each  subject  being 
compactly  and  authoritatively  written,  and  exhaustive  in  detail,  without  the  intro- 
duction of  cases  and  foreign  subject-matter  which  so  largely  expand  ordinary  text- 
books. 

The  Saunders  Aid  Series  will  not  merely  be  condensations  from 
present  literature,  but  will  be  ably  written  by  well-known  authors 
and  practitioners,  most  of  them  being  teachers  in  representative 
American  Colleges.  This  new  series,  therefore,  will  form  an  admirable  col- 
lection of  advanced  lectures,  which  will  be  invaluable  aids  to  students  in  reading 
and  in  comprehending  the  contents  of  "  recommended  "  works. 

Each  Manual  will  further  be  distinguished  by  the  beauty  of  the  new  type ;'  by 

the  quality  of  the  paper  and  printing ;  by  the  copious  use  of  illustrations ;  by  the 

attractive  binding  in  cloth;   and  by  the  extremely  low  price  at  which 

they  will  be  sold. 

23 


Saunders'  New  Aid  Series  of  Manuals. 


VOLUMES  PUBLISHED. 


PHYSIOLOGY,  by  Joseph  Howard  Baymond,  A.  M.,  M.  D.,  Professor  of  Phyd- 
ology  and  Hygiene  and  Lecturer  on  Gynecology  in  the  Long  Island  College  Hos- 
pital ;  Director  of  Physiology  in  the  Hoagland  Laboratory ;  formerly  Lecturer  on 
Physiology  and  Hygiene  in  the  Brooklyn  Normal  School  for  Physical  Education; 
Ex-Vice- President  of  the  American  Public  Health  Association  ;  Ex-Health  Ommis- 
sioner,  City  of  Brooklyn,  eta     Illustrated,     fl.25  net. 

SURGERY,  General  and  Operative,  by  John  Chaimees  DaCosta,  M.  D.,  Demon- 
strator of  Surgery,  Jefferson  Medical  College,  Philadelphia;  Chief  Assistant  Sur- 
geon, Jefferson  Medical  College  Hospital ;  Surgical  Registrar,  Philadelphia  Hospital, 
etc.     188  illustrations  and  13  plates.     (Double  number.)     $2.50  net 

DOSE-BOOK  AND  MANUAL  OF  PRESCRIPTION-WRITING,  by  E.  Q. 
Thobnton,  M.  D.,  Demonstrator  of  Therapeutics,  Jefferson  Medical  College,  Phila^ 
delphia.     Illustrated.     Price,  cloth,  $1.25  net. 

SURGICAL  ASEPSIS,  by  Cabl  Beck,  M.  D.,  Surgeon  to  St.  Mark's  Hospital  and 
to  the  New  York  German  Poliklinik,  etc.     Illustrated.    Price,  cloth,  $1.25  net. 

MEDICAL  JURISPRUDENCE,  by  Henbt  C.  Chapman,  M.  D.,  Professor  of  Insti- 
tutes of  Medicine  and  Medical  Jurisprudence  in  the  Jefferson  Medical  College  of 
Philadelphia ;  Member  of  the  College  of  Physicians  of  Philadelphia,  of  the  Acade- 
my of  Natural  Sciences,  of  the  American  Philosophical  Society,  and  of  the  Zoologi- 
cal Society  of  Philadelphia.     Illustrated.     ^1.50  net. 

SYPHILIS  AND  THE  VENEREAL  DISEASES,  by  Jambs  Nevins  Hyde, 
M.D.,  Professor  of  Skin  and  Venereal  Diseases,  and  Frank  H.  Montgomery, 
M.  D.,  Lecturer  on  Dermatology  and  Genito-Urinary  Diseases,  in  Bush  Medical 
College,  Chicago.     Profusely  Illustrated.     (Double  number.)    $2.50  net. 

PRACTICE  OF  MEDICINE,  by  George  Eoe  Lockwood,  M.  D.,  Professor  of 
Practice  in  the  Woman's  Medical  College  of  the  New  York  Infirmary;  Instructor 
of  Physical  Diagnosis  of  the  Medical  Department  of  Columbia  College;  Attending 
Physician  to  the  Colored  Hospital;  Pathologist  to  the  French  Hospital;  Member 
of  the  New  York  Academy  of  Medicine,  of  the  Pathological  Society,  of  the  Clinical 
Society,  etc.     Illustrated.     (Double  number.)     $2.50  net. 

MANUAL  OF  ANATOMY,   by    Irving  S.  Haynes,  M.  D.,  Adjunct  Professor  of 
Anatomy   and   Demonstrator   of    Anatomv.    Medical   Department   of   the    New   York 
University,  etc.     Beautifully  Illustrated.     (Double  number.)     Price,  $2.50  net. 

MANUAL  OF  OBSTETRICS,  by  W.  A.  Newman  Dorland,  M.  D.,  Asat.  Demon- 
strator of  Obstetrics,  University  of  Pennsylvania;  Chief  of  Gynecological  Dispen- 
sary, Pennsylvania  Hospital;  Member  of  Philadelphia  Obstetrical  Society  etc 
Profusely  illustrated.     (Double  number.)     Price,  $2.50  net. 


VOLUMES  IN  PREPARATION. 

^^^^^^??.,°^  WOMEN,  by  J.  Bland  Sutton,  F.  E.  C.  S.,  Assistant  Surgeon  to 
the  Middlesex  Hospital,  London,  and  Arthur  Edward  Gjles,  M.  D.  Hand- 
somely illustrated.     (Double  number.)  , 

NOSE  AND  THROAT,  by  D.  Beaden  Kyle,  M.  D.,  Chief  Laryngologist  of  the  St. 
Agnes  Hospital,  Philadelphia;  Bacteriologist  of  the  Orthopedic  Hospital  and 
Inhrmary  for  Nervous  Diseases;  Instructor  in  Clinical  Microscopy  and  Assistant 
Demonstrator  of  Pathology  in  the  Jefferson  Medical  College,  etc. 

NERVOUS  DISEASES,  by  Charles  W.  Burr,  M.  D.,  Clinical  Professor  of  Nervous 
Diseases  Medico-Chirurgical  College,  Philadelphia ;  Pathologist  to  the  Orthopjedic 
Hospital  and  Infirmary  for  Nervous  Diseases;  Visiting  Physician  to  the  St.  Joseph 

thP*»,,^wlpf=  nf  rhfi.fJi^''??^'^  ^''i  *'^®  ^^?  ^«''«S'  «•*  "lose  intervals,  earefhUy-prepared  works  on 
the  subjects  of  Children,  Gynecology,  Hygiene,  etc.,  by  prominent  specialists.    ^    ^  "^  ""'^'^  °" 

24 


SAUNDERS'  QUESTION  COMPENDS. 

Arranged  in  Question  and  Answer  Form. 

THE  LATEST,  CHEAPEST,  AND  BEST  ILLUSTRATED  SERIES 
OP  COMPENDS  EVER  ISSUED. 


Now  the  Standard  Authorities  in  Medical  Literature 

WITH 

Students  and  Practitioners  in  every  City  of  the  United  States 

and  Canada. 


THE  REASON   ^VHY 

They  are  the  advance  guard  of  "Student's  Helps" — that  do  help;  they  are  the  leaders  in 
their  special  line,  well  and  authoritatively  written  by  able  men^  who,  as  teachers  in  the  large  col- 
legeSy  know  exactly  what  is  wanted  by  a  student  preparing  for  his  examinations.  The  judgment 
exercised  in  the  selection  of  authors  is  fully  demonstrated  by  their  professional  elevation.  Chosen 
from  the  ranks  of  Demonstrators,  Quiz-masters,  and  Assistants,  most  of  them  have  become  Pro- 
fessors and  Lecturers  in  their  respective  colleges. 

Each  book  is  of  convenient  size  (5x7  inches),  containing  on  an  average  250  pages,  profusely 
illustrated,  and  elegantly  printed  in  clear,  readable  type,  on  fine  paper. 

The  entire  series,  numbering  tvifenty-three  volumes,  has  been  kept  thoroughly  revised  and 
enlarged  when  necessary,  many  of  them  being  in  their  fourth  and  fifth  editions. 

TO  SUM  UP. 

Although  there  are  numerous  other  Quizzes,  Manuals,  Aids,  etc.  in  the  market,  none  of  them 
approach  the  "  Blue  Series  of  Question  Compends ;"  and  the  claim  is  made  for  the  following  points 
of  excellence ; 

r.   Professional  distinction  and  reputation  of  authors. 

2.  Conciseness,  clearness,  and  soundness  of  treatment. 

3.  Size  of  type  and  quality  of  paper  and  binding. 

*4t*  Any  of  these  Compends  will  be  mailed  on  receipt  of  price  (see  over  for  List). 

2S 


26  IV.  B.  SAUNDERS'  ILLUSTRATED 


Saunders'  Question-Compend  Series. 

-~*»>  — 

je@»  Price,  Cloth,  ai.OO  per  copy,  except  when  otherwise  noted. 

1  ESSENTIALS    OF    PHYSIOLOGY.     3d  edition.     Illustrated.     Revised  and  enlarged. 

By  H.  A.  Hare,  M.  D.     (Price,  JSi.oo  net.) 

2  ESSENTIALS  OF  SURGERY.     Sth  edition,  with  an  Appendix  on  Antiseptic  Surgery. 

90  illustrations.     By  Edward  Martin,  M.  D. 
3.  ESSENTIALS  OF  ANATOMY.      5th  edition,  with  an  Appendix.      180  illustrations.     By 

Charles  B.  Nancrede,  M.  D. 
4    ESSENTIALS  OF  MEDICAL   CHEMISTRY,  ORGANIC  AND   INORGANIC. 

4th  edition,  revised,  with  an  Appendix.     By  Lawrence  Wolff,  M.  D. 

5.  ESSENTIALS  OF    OBSTETRICS.     3d  edition,  revised  and  enlarged.     75  illustrations. 

By  W.  Easterly  Ashton,  M.  D. 

6.  ESSENTIALS    OF    PATHOLOGY    AND    MORBID    ANATOMY.     6th   thousand. 

46  illustrations.     By  C.  E.  Armand   Semple,  M.  D. 

7  ESSENTIALS     OF    MATERIA     MEDICA,     THERAPEUTICS,    AND     PRE- 

SCRIPTION-WRITING.    4th  edition.     By  Henry  Morris,  M.  D. 

8  Q    ESSENTIALS    OF    PRACTICE    OF    MEDICINE.     By   Henry   Morris,  M.  D. 
'  An  Appendix  on  Urine  Examination.     Illustrated.     By  Lawrence  Wolff,  M.  D. 

3d  edition,  enlarged  by  some  300  Essential  Formulae,  selected  from  eminent  authorities, 
by  Wm.  M.  Powell,  M.  D.     (Double  number,  price  $2.00.) 

10.  'ESSENTIALS    OF    GYN.ffiCOLOGY.      3d  edition,   revised.      With   62   illustrations. 

By  Edwin  B.  Cragin,  M.  D. 

11.  ESSENTIALS  OF  DISEASES  OF  THE  SKIN.     3d  edition,  revised  and  enlarged. 

71  letter-press  cuts  and  15  half-tone  illustrations.     By  Henry  W.  Stelwagon,  M.  D. 
(Price,  $1.00  net.) 

12.  ESSENTIALS    OF    MINOR    SURGERY,  BANDAGING,  AND    VENEREAL 

DISEASES.      2d   edition,   revised   and   enlarged.      78   illustrations.      By   Edward 
Martin,  M.  D. 

13.  ESSENTIALS   OF   LEGAL   MEDICINE,  TOXICOLOGY,    AND    HYGIENE. 

130  illustrations.     By  C.  E.  Armand  Semple,  M.  D. 

14.  ESSENTIALS  OF  DISEASES  OF  THE  EYE,  NOSE,  AND   THROAT.     124 

illustrations.     2d   edition,  revised.     By    Edward  Jackson,  M.  D.,  and   E.  Baldwin 
Gleason,  M.  D. 

15.  ESSENTIALS  OF  DISEASES  OF  CHILDREN.      2d    edition.      By  William  M. 

Powell,  M.  D. 

i5.  ESSENTIALS    OF    EXAMINATION    OF    URINE.      Colored    "  VoGEL   Scale," 
and  numerous  illustrations.     By  Lawrence  Wolff,  M.  D.     (Price,  75  cents.) 

17.  ESSENTIALS    OF   DIAGNOSIS.     By   S.  Solis-Cohen,  M.  D.,  and  A.  A.  Eshner, 

M.  D.     55  illustrations,  some  in  colors.    (Price,  $1.50  net.) 

18.  ESSENTIALS   OF    PRACTICE    OF  PHARMACY.     By  L.  E.  Sayre.     2d  edition, 

revised  and  enlarged. 

20.  ESSENTIALS    OF    BACTERIOLOGY.       2d  edition.      81    illusbrations.      By   M.    V. 
Ball,  M.  D. 

ai.  ESSENTIALS    OF   NERVOUS  DISEASES  AND  INSANITY.     48   illustrations. 
2d  edition,  revised.     By  John  C.  Shaw,  M.  D. 

22.  ESSENTIALS    OF    MEDICAL    PHYSICS.     155    illustrations.     2d   edition,   revised- 

By  Fred  J.  Brockway,  M.  D.     (Price,  $1.00  net.) 

23.  ESSENTIALS    OF  MEDICAL   ELECTRICITY.     65   illustrations.     By  David   D. 

Stewart,  M.  D.,  and  Edward  S.  Lawrance,  M.  D. 

24.  ESSENTIALS   OF    DISEASES    OF   THE   EAR.     By  E.  B.  Gleason,  M.  D.     89 

illustrations. 


CATALOGUE  OF  MEDICAL   WORKS.  27 

JUST  PUBLISHED. 


A  TEXT-BOOK  OF  MATERIA  MEDICA,  THERAPEUTICS, 
AND  PHARMACOLOGY.  By  George  F.  Butler,  Ph.  G.,  M.  D., 
Professor  of  Materia  Medica  and  of  Clinical  Medicine  in  the  College  of 
Physicians  and  Surgeons,  Chicago  ;  Professor  of  Materia  Medica  and  Thera- 
peutics, Northwestern  University,  Woman's  Medical  School,  etc.  8vo,  858 
pages.  Illustrated.  Prices :  Cloth,  ^4.00  net ;  Sheep  or  Half-Morocco,  $S-°°  ^'^'^■ 

A  clear,  concise,  and  practical  text-book,  adapted  for  permanent  reference  no 
less  than  for  the  requirements  of  the  class-room.  The  arrangement  (embodying 
the  synthetic  classification  of  drugs  based  upon  therapeutic  affinities)  is  believed 
to  be  at  once  the  most  philosophical  and  rational,  as  well  as  that  best  calculated  to 
engage  the  interest  of  thoge  to  whom  the  academic  study  of  the  subject  is  wont 'to 
offer  no  little  perplexity. 

Special  attention  has  been  given  to  the  Pharmaceutical  section,  which  is 
exceptionally  lucid  and  complete. 

LECTURES    ON    RENAL    AND    URINARY    DISEASES.       By 

Robert  Saundby,  M.  D.  Edin.,  Fellow  of  the  Royal  College  of  Physicians, 
London,  and  of  the  Royal  Medico-Chirurgical  Society;  Physician  to  the 
General  Hospital;  Consulting  Physician  to  the  Eye  Hospital  and  to  the 
Hospital  for  Diseases  of  Women ;  Professor  of  Medicine  in  Mason  College, 
Birmingham,  etc.  8vo,  434  pages,  with  numerous  illustrations  and  4  colored 
plates.     Price,  Cloth,  $2.50  net. 

In  these  Lectures,  which  are  a  re-issue  in  one  volume  of  the  author's  well- 
known  works  on  Bright' s  Disease  and  Diabetes,  there  is  given,  within  a  modest 
compass,  a  review  of  the  present  state  of  knowledge  of  these  important  affections, 
with  such  additions  and  suggestions  as  have  resulted  from  the  author's  thirteen 
years'  clinical  and  pathological  study  of  the  subjects.  The  lectures  have  been 
carefully  revised  and  much  new  matter  added  to  them.  There  has  also  been  added 
a  section  dealing  with  "Miscellaneous  Affections  of  the  Kidney,"  making  the 
book  more  complete  as  a  work  of  reference. 

ELEMENTARY    BANDAGING   AND    SURGICAL    DRESSING, 

with  Directions  concerning  the  Immediate  Treatment  of  Cases  of  Emergency. 
For  the  use  of  Dressers  and  Nurses.  By  Walter  Pye,  F.  R.  C.  S.,  late 
Surgeon  to  St.  Mary's  Hospital,  London.  Small  i2mo,  with  over  80  illus- 
trations.    Cloth,  flexible  covers.     Price,  75  cents  net. 

This  little  book  is  chiefly  a  condensation  of  those  portions  of  Pye's  "  Surgical 
Handicraft ' '  which  deal  with  bandaging,  splinting,  etc. ,  and  of  those  which  treat 
of  the  management  in  the  first  instance  of  cases  of  emergency.  Within  its  own 
limits,  however,  the  book  is  complete,  and  it  is  hoped  that  it  will  prove  extremely 
useful  to  students  when  they  begin  their  work  in  the  wards  and  casualty  rooms, 
and  useful  also  to  surgical  nurses  and  dressers. 

"  The  directions  are  clear  and  the  illustrations  are  good." — London  Lancet. 

"  The  author  writes  well,  the  diagrams  are  clear,  and  the  book  itself  is  small  and  portable, 
although  the  paper  and  type  are  good." — British  Medical  Journal. 

"  One  of  the  most  useful  little  works  for  dressers  and  nurses.  The  author  truly  says  that  it  is  '  a 
very  little  book,'  but  it  is  large  in  usefulness." — Chemist  and  Druggist. 


JUST  ISSUED.  SOLD   BY   SUBSCRIPTION. 

ANOMALIES 

AND 

CURIOSITIES  OF  MEDICINE. 

BY 
GEORGE  M.  GOULD,  M.  D., 

AND 

WALTER  L.  PYLE,  M.  D. 

Several  years  of  exhaustive  research  have  been  spent  by  the  authors 
in  the  great  medical  libraries  of  the  United  States  and  Europe  in  col- 
lecting the  material  for  this  work.  Medical  literature  of  all  ages 
and  all  languages  has  been  carefully  searched,  as  a  glance  at  the. 
Bibliographic  Index  will  show.  The  facts,  which  will  be  of  extreme 
value  to  the  author  and  lecturer,  have  been  arranged  and  anno- 
tated, and  full  reference  footnotes  given,  indicating  whence  they  have 
been  obtained. 

In  view  of  the  persistent  and  dominant  interest  in  the  anomalous 
and  curious,  a  thorough  and  systematic  collection  of  this  kind 
(the  first  of  which  the  authors  have  knowledge)  must  have  its  own 
peculiar  sphere  of  usefulness. 

As  a  complete  and  authoritative  Book  of  Reference  it  will  be 
of  value  not  only  to  members  of  the  medical  profession,  but  to  all 
persons  interested  in  general  scientific,  sociologic,  and  medico-legal 
topics ;  in  fact,  the  general  interest  of  the  subject  and  the  dearth  of 
any  complete  work  upon  it  make  this  volume  one  of  the  most 
important  literary  innovations  of  the  day. 

An  especially  valuable  feature  of  the  book  consists  of  the  Indexing. 
Besides  a  complete  and  comprehensive  General  Index,  containing 
numerous  cross-references  to  the  subjects  discussed,  and  the  names 
of  the  authors  of  the  more  important  reports,  there  is  a  convenient 
Bibliographic  Index  and  a  Table  of  Contents. 

The  plan  has  been  adopted  of  printing  the  topical  headings  in 
bold-face  type,  the  reader  being  thereby  enabled  to  tell  at  a  glance 
the  subject-matter  of  any  particular  paragraph  or  page. 

Illustrations  have  been  freely  employed  throughout  the  work, 
there  being  165  relief  cuts  and  130  half-tones  in  the  text,  and  12 
colored  and  half-tone  full  page  plates— a  total  of  over  320  separate 
figures. 

The  careful  rendering  of  the  text  and  references,  the  wealth  of  illus- 
trations, the  mechanical  skill  represented  in  the  typography,  the  print- 
ing, and  the  binding,  combine  to  make  this  book  one  of  the  most 
attractive  medical  publications  ever  issued. 


Handsome    Imperial  Octavo  Volume  of  S6S  Pages. 
PRICES:    Cloth,  $6. GO  net;    Half  Morocco,  $7. DO  net. 


IN  PREPARATION  FOR  EARLY   PUBLICATION. 


AN  AMERICAN  TEXT-BOOK  OF  QENITO-URINARY  AND  SKIN  DISEASES. 

Edited  by  L.  Bolton  Bangs,  M.  D.,  Late  Professor  of  Genito-Urinary  and  Venereal  Dis- 
-i:  i,;,_     eases,  New  York  Post-Graduate  Medical  School  and  Hospital,  and  William  A.  Hard- 
AWAY,  M.  D.,  Professor  of  Diseases  of  the  Skin,  Missouri  Medical  College. 

AN  AMERICAN  TEXT=BOOK  OF  DISEASES  OF  THE  EYE,  EAR,  NOSE,  AND 
THROAT, 

Edited  by  G.  E.  de  Schweinitz,  M.  D.,  Professor  of  Ophthalmology  in  the  Jefferson 
Medical  College, -and  B.  Alexander  Randall,  M.  D.,  Professor  of  Diseases  of  the  Ear 
in  the  University  of  Pennsylvania  and  in  the  Philadelphia  Polyclinic. 

MACDONALD'S  SURGICAL  DIAGNOSIS  AND  TREATMENT. 

Surgical  Diagnosis  and  Treatment.  By  J.  W.  Macdonald,  M.  D.,  Graduate  of 
Medicine  of  the  University  of  Edinburgh ;  Licentiate  of  the  Royal  College  of  Surgeons, 
Edinburgh;  Professor  of  the  Practice  of  Surgery  and  of  Clinical  Surgery,  Minneapolis 
College  of  Physicians  and  Surgeons. 

ANDERS'  THEORY  AND  PRACTICE  OF  MEDICINE. 

A  Text=Book  of  the  Theory  and  Practice  of  Medicine.  By  James  M.  Anders, 
M.  D.,  Ph.  D.,  LL.D.,  Professor  of  the  Theory  and  Practice  of  Medicine  and  of  Clinical 
Medicine,  Medico-Chirurgical  College,  Philadelphia. 

SENN'S  GENITO=URINARY  TUBERCULOSIS. 

Tuberculosis  of  the  Genito=Urinary  Apparatus,  Male  and  Female.  By  Nich- 
olas Senn,  M.  D.,  Ph.  D.,  LL.D.,  Professor  of  the  Practice  of  Surgery  and  of  Clinical 
Surgery,  Rush  Medical  College,  Chicago. 

PENROSE'S  GYNECOLOGY. 

A  Text-Book  of  Gynecology.  By  Charles  B.  Penrose,  M.  D.,  Professor  of  Gyne- 
cology, University  of  Pennsylvania. 

HIRST'S  OBSTETRICS. 

A  Text=Book  of  Obstetrics.  By  Barton  Cooke  Hirst,  M.  D.,  Professor  of  Obstet- 
rics, University  of  Pennsylvania. 

MOORE'S  ORTHOPEDIC  SURGERY, 

A  Manual  of  Orthopedic  Surgery.  By  James  E.  Moore,  M.  D.,  Professor  of 
Orthopedics  and  Adjunct  Professor  of  Clinical  Surgery,  University  of  Minnesota,  College 
of  Medicine  and  Surgery. 

HEISLER'S   EMBRYOLOGY. 

A  Text=Book  of  Embryology.  By  John  C.  Heisler,  M.  D.,  Prosector  to  the  Pro- 
fessor of  Anatomy,   Medical  Department  of  the  University  of  Pennsylvania. 


New  Volume  in  Saunders'  Aid  Series. 

SUTTON  AND  GILES'  DISEASES  OF  WOMEN, 

Diseases  of  Women.  By  J.  Bland  Sutton,  F  R.C.S.,  Assistant  Surgeon  to  the 
Middlesex  Hospital,  and  Surgeon  to  the  Chelsea  Hospital  for  Women,  London;  and 
Arthur  E.  Giles,  M.  D.,  B.  Sc.  Lond.,  F.  R.  C.  S.  Edin.,  Assistant  Surgeon  to  the  Chelsea 
Hospital  for  Women,  London.      Handsomely  Illustrated. 


NOW  READY— VOLUMES  FOR   1896  AND  1897. 


SAUNDERS' 

American  Year-Book  of  Medicine  and  Surgery 

COLLECTED  AM)  ARRANGED  BY  EfflNEFT  AMERICAN  SPECIALISTS  AND  TEACHERS, 

UNDER    THE    EDITORIAL    CHARGE    OF 

GEORGE  M.  GOULD,  M.  D. 


Notwithstanding  the  rapid  multiplication  of  medical  and  surgical  works, 
still  these  publications  fail  to  meet  fully  the  requirements  of  the  general  physician, 
inasmuch  as  he  feels  the  need  of  something  more  than  mere  text-books  of  well- 
known  principles  of  medical  science.  Mr.  Saunders  has  long  been  impressed  with 
this  fact,  which  is  confirmed  by  the  unanimity  of  expression  from  the  profession 
at  large,  as  indicated  by  advices  from  his  large  corps  of  canvassers. 

This '  deficiency  would  best  be  met  by  current  journalistic  literature,  but 
most  practitioners  have  scant  access  to  this  almost  unlimited  source  of  informa- 
tion, and  the  busy  practiser  has  but  little  time  to  search  out  in  periodicals  the 
many  interesting  cases,  whose  study  would  doubtless  be  of  inestimable  value  in  his 
practice.  Therefore,  a  work  which  places  before  the  physician  in  convenient  form 
an  epitomization  of  this  literature  hy  persons  competent  to  pronounce  upon 

The  Value  of  a  Discovery  or  of  a  Method  of  Treatment 
cannot  but  command  his  highest  appreciation.     It  is  this  critical  and  judicial 
ftinction  that  will  be  assumed  by  the  Editorial  stafi"  of  the  "  American  Year-Book 
of  Medicine  and  Surgery." 

It  is  the  special  purpose  of  the  Editor,  whose  experience  peculiarly  qualifies 
him  for  the  preparation  of  this  work,  not  only  to  review  the  contributions 
to  American  journals,  but  also  the  methods  and  discoveries  reported  in  the 
leading  medical  journals  of  Europe,  thus  enlarging  the  survey  and  making  the 
work  characteristically  international.  These  reviews  will  not  simply  be  a  series 
of  undigested  abstracts  indiscriminately  run  together,  nor  will  they  be  retro- 
spective of  "news"  one  or  two  years  old,  but  the  treatment  presented  will  be 
synthetic  and  dogmatic,  and  will  include  only  what  is  new.  Moreover  through 
expert  condensation  by  experienced  writers,  these  discussions  will  be 

Comprised  in  a  Single  Volume  of  about  1200  Pages. 

The  work  will  be  replete  with  original  and  selected  illustrations'  skilfully 
reproduced,  for  the  most  part,  in  Mr.  Saunders'  own  stni-s  established  for 
the  purpose,,  thus  ensuring  accuracy  in  delineation,  affording  eflScient  aids  to  a 
right  comprehension  of  the  text,  and  adding  to  the  attractiveness  of  thr  volume. 

Prices:  Cloth,  $6.50J^t7H^lfMorocco,  $7.50  net. 

W.  B.  SAUNDERS,  Publisher, 

925  "Walnut  Street,  Philadelphia. 


F^