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Full text of "A text-book of materia medica, therapeutics, and pharmacology"

p 



Effi'MffimiSl 






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. ya i5 

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 4uooVQ TrTi- 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'^ ^idstax h. 

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. 



lyo 



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 ' 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 th