Full text of "Materia medica and therapeutics, inorganic substances;"

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P. S. O'R^'LLY & STAFF

JNO.E.HARKIS, M, D.,

BLOOMIN--ON. IND

MATEEIA MEDICA

THEEAPETJTICS

INORGANIC SUBSTANCES

CHARLES D. F. PHILLIPS, M.D.

MEMBER OF THE BOYAL COLLEGE OF PHYSICIANS, ETC. ; LATE LECTTTREB ON MATEBIA MEDICA AND
THERAPEUTICS AT THE WKSTlJISSTEi: HOSPITAL MEMCAL SCHOOL

(gbiteb onb Qlbapteb to tfye H. 6. f)l)armac0:peeicj

BY
^1

LAURENCE JOHNSON, A.M., M.D.

LECTCTBEB OS MEDICAL BOTANY, MEDICAL DEPARTMENT OF THE UNIVERSITY OF THE CITY OF NEW YOBK :
FELLOW OF THE NEW YOBK ACADEMY OF MEDICINE, ETC.

VOLUME II.

NEW YORK
WILLIAM WOOD & COMPANY

1882

v 3 l

OOPTBIGHT

WILLIAM WOOD & COMPANY
1883

TROW*S

PRINTING AND BOOKBINDING COMPANY

301-3x3 Ea** Twelfth Street

NKW YORK

CONTENTS OF VOL. II.

PAOK

ARGENTUM SILVER 1

COMPOUNDS OP SILVER 1-25

Absorption and Elimination, 2 ; " Argyria," 3 ; Physiological Action, Ex-
ternal, 4 ; Internal, 5 ; Therapeutical Action, External, 8 (Caustic, As-
tringent, Counter-irritant) ; Internal, 18 ; Preparations and Dose, 23 ;
Mode of Administration, 24.

ARSENICUM ARSENIC AND COMPOUND& . . 25-71

Absorption and Elimination, 28 ; Physiological Action, External, 28 ; In-
ternal, 30 ; Toxic Action, 40 ; Tolerance, 41 ; Arsenical Wall-papers, 43 ;
Antidotes, 44 ; Therapeutical Action, External, 45 ; Internal, 46 ; Prep-
arations and Dose, 69 ; Mode of Administration, 70.

AURUM GOLD AND COMPOUNDS ....... . ................................ 71-76

Absorption and Elimination, 72 ; Physiological Action, 73 ; Therapeuti-
cal Action, External and Internal, 74 ; Preparations and Dose, 76.

BARIUM BARYTA ................................................ _____ 77-79

Absorption and Elimination, 77 ; Physiological Action, 77 ; Therapeuti-
cal Action, 78 ; Preparations and Dose, 79.

BISMUTHUM BISMUTH ....................................... .......... 79

COMPOUNDS OF BISMUTH .............................................. 80-91

Absorption and Elimination, 81 ; Physiological Action, External and In-
ternal, 82 ; Therapeutical Action, External, 85 ; Internal, 86 ; Prepara-
tions and Dose, 89 ; Adulterations, 90.

IV CONTENTS.

PAGE

CADMIUM 91-93

Absorption and Elimination, 92 ; Physiological Action, 92 ; Therapeuti-
cal Action, 93 ; Preparations and Dose, 93.

CALCIUM LIME 93

COMPOUNDS OF LIME 93-113

Absorption and Elimination, 97 ; Physiological Action, External and In-
ternal, 98 ; Lime in Potable Waters, 100 ; Goitre, 101 ; Therapeutical
Action, External, 102; Internal, 105 ; Preparations and Dose, 112.

CERIUM OXALATE OF CERIUM 113-116

Physiological Action, 114; Therapeutical Action, 114; Preparation and
Dose, 115.

CUPRUM COPPER. 116

COMPOUNDS OF COPPER 116-129

Absorption and Elimination, 117 ; Physiological Action, External, 118 ;
Internal, 119; Toxic Action, 120; " Cuprismus," 120; Antidotes, 122;
Therapeutical Action, External, 123 ; Internal, 124 ; Preparations and
Dose, 129.

FERRUM IRON 129

COMPOUNDS OF IRON 130-181

Absorption and Elimination, 136 ; Physiological Action, External, 140 ;
Internal, 141 ; Different Action of Proto- and Per-salts, 145 ; Therapeu-
tical Action, External and Internal, 148 ; Preparations and Dose, Mode
of Administration, 179.

HYDRARGYRUM MERCURY 181

COMPOUNDS OF MERCURY : . . 182-226

Absorption and Elimination of Metallic Mercury, 186 ; of Calomel, 189 ;
of Corrosive Sublimate, etc., 190; Physiological Action, External, 192;
Internal, 193; ' Mercurialism," 204 ; Antidotes, 204 ; Therapeutical Ac-
tion, External, 204 ; Internal, 212 ; Preparations and Dose, 223 ; Inunc-
tion, 225 ; Hypodermic Use, 226 ; Vapor Bath, 226.

CONTENTS. V

PAGE

LITHIUM 227

COMPOUNDS OP LITHIUM 227-232

Absorption and Elimination, 228 ; Physiological Action, Internal, 228 ;
Therapeutical Action, External and Internal, 230; Preparations and
Dose, 232.

MAGNESIUM AND COMPOUNDS 232-243

Absorption and Elimination, 234 ; Physiological Action, 234 ; Theory of
Purgative Action, 235 ; Therapeutical Action, 239 ; Preparations and
Dose, 242.

MANGANESIUM MANGANESE AND COMPOUNDS 243-248

Absorption and Elimination, 244 ; Physiological Action, 244 ; Therapeu-
tical Action, External and Internal, 246 ; Preparations and Dose, 248.

PLUMBUM LEAD AND COMPOUNDS 249-263

Absorption and Elimination, 250 ; Physiological Action, External, 251 ;
Internal, Toxic Action, 251 ; Plumbism, 252 ; Theories of, 254; Modes
of, 257 ; Idiosyncrasy, 258 ; Therapeutical Action, External, 258 ; In-
ternal, 260; Preparations and Dose, 262.

POTASSIUM KALIUM AND COMPOUNDS 263-286

Absorption and Elimination, 268 ; Physiological Action, Oxidation, 268 ;
Therapeutical Action, External, 274 ; Internal, 278 ; Preparations and
Dose, 286.

SODIUM NATRIUM 287

COMPOUNDS OF SODIUM 287-303

Absorption and Elimination, 291 ; Physiological Action, External and
Internal, 292; Therapeutical Action, External, 296; Internal, 298;
Preparations and Dose, 303.

STANNUM TIN 304-305

Therapeutical Action, 304 ; Preparations and Dose, 305.

VI CONTENTS.

PAGE

ZINCUM ZINC AND COMPOUNDS 805-314

Absorption and Elimination, 307 ; Physiological Action, External and In-
ternal, 307 ; Therapeutical Action, External, 309 ; Internal, 311 ; Prep-
arations and Dose, 314.

INDEX OF REMEDIES 315

INDEX OF DISEASES. . 324

MATERIA MEDICA

AND

THERAPEUTICS.

INORG-ANIC SUBSTANCES.

AKGENTUM SILVER, Ag,=108.

THIS metal occurs pure, but more often in alloy, as with lead (galena),
or combined with sulphur (argentite), chlorine (horn silver), and with
iodine, bromine, etc.

Refined silver is placed in the Pharmacopoaia as a source of the ni-
trate, but is otherwise used only in the form of silver-leaf as a coating
for pills: its officinal compounds are the nitrate and the oxide.

AEGENTI NITRAS NITRATE OF SILVER, AgNO 3) =.170.

Prepared by crystallization from a solution of pure silver in dilute ni-
tric acid: when fused and solidified in moulds, it constitutes the small
pencils known as " lunar caustic."

CHARACTERS AND TESTS. The crystals are tabular and colorless, and
form a neutral solution with distilled water: sp. gr. 4.3. They are solu-
ble in four parts of rectified spirit; when pure they do not blacken on
mere exposure to light, but do so, and readily decompose, on continued
contact with any organic substance.

An aqueous solution of the nitrate is precipitated by any soluble
chloride, a characteristic curdy-white chloride of silver being formed,
which becomes dark on exposure to the air: it is soluble in ammonia, in-
soluble in nitric acid. A black sulphide of silver is precipitated from a
solution of the nitrate by passing through it sulphuretted hydrogen.
VOL. II. 1

MATERIA MEDICA AND THERAPEUTICS.

ARGENTI OXIDUM OXIDE OF SILVER, Ag 2 O,=232.

PREPARATION. By precipitation from a solution of the nitrate by
means of lime-water.

CHARACTERS AND TESTS. Occurs as an olive-brown powder: sp. gr.
7.2. It is reduced to the metallic state by a red heat, is soluble in ammo-
nia and in nitric acid, but slightly soluble in water, to which it gives a
metallic taste and an alkaline reaction.

Chloride of Silver, AgCl (not officinal). Readily obtained by decom-
posing any silver salt with hydrochloric acid, when it precipitates as a
white caseous powder (horn silver): it darkens on exposure, and is solu-
ble only in ammonia and in hydrochloric acid.

The A-mmonio-chloride (not officinal) is an unstable salt soluble in
water. The Chloro-albuminate, the iodide, and the double iodide of sil-
ver and potash are soluble salts that do not coagulate albumen. The
hyposulphite of soda and silver is astringent and less irritant than the
nitrate; the cyanide is said to be more readily absorbed.

ABSORPTION AND ELIMINATION. Nitrate of silver, when taken into
the stomach, forms with mucus and epithelium a thin pellicle, which, to
some extent, hinders absorption. The chemical change which all silver
salts undergo, more or less, when in contact with the gastric secretions,
results in the formation of a double chloride of silver and sodium, and
although ordinary chloride of silver is insoluble in water, this double
chloride is readily dissolved by the gastric fluids; its combination with
peptones is also soluble (Bogolowsky: Virchow's Archiv, xlvi., 18G9, and
others). As chloride and albuminate it probably passes into the blood,
and circulates with it, being retained in solution by the alkaline serum
(Rouget), though Frommann thought that it separated in the molecular
form (Archiv fur Path. Anat., 1859). Dragendorff considers that the
chemical changes occur chiefly in the duodenum, and that the gastric juice
being here neutralized by the bile, silver sulphide is ultimately formed:
certainly, of unabsorbed silver compounds, the greater part passes off by
the bowel as sulphuret, coloring gray or black the mucous membrane and
the faeces. More of the salt will be absorbed if given in solution in dis-
tilled water on an empty stomach, than when given in pill in the ordinary
manner. Riemer has shown that in pills (? bread) four-fifths of the silver
nitrate is decomposed even before administration (Archiv der Jleilk., xvi.,
1875). The same observer also sought to prove that molecule.s of silver
pass in a mechanical manner through the intestinal walls, but Fragstein
could detect no absorption of freshly precipitated silver-chloride intro-
duced into the intestine of frogs (Berlin. Klin. Woch., 1877). Orfila and
Heller failed to find traces of silver in the blood after its administration;
but Orfila and Panizza found it in the urine (Husemann), and Cloez iso-

SILVER. 3

lated a globule of the metal from the collected urine of several patients at
the Salpotriere. It has been found also in the liver and the bile, and some
is eliminated by the cutaneous glands. Rozsahezzi found it in the intes-
tinal contents after its hypodermic injection (Archiv JClebs, 1878).

The most important practical point is, that elimination of silver salts
by any channel occurs but slowly, so that if they are taken continuously
for a long time, the reduced metal becomes deposited in the tissues, giv-
ing them a dark -gray coloration, known as " argyria" The gums show
the earliest indication of this condition by a bluish line (which is darker
than that produced by lead), and parts exposed to light show the color
more than others thus the lunula of the nail (Falck), the eyes, the face
and hands are affected early; the deposit is in the true skin (corium).
Neumann has recently examined minutely a portion of the skin of a man
who had partial argyria from frequent applications of nitrate to reduce
large papillae on his tongue: dark granules of the metal were found in
the upper part of the cutis, in the wall of the sweat-gland, in the con-
nective tissue of hair-follicles, in sarcolemma, neurilemma, and the middle
coat of vessels; none were deposited in the epidermis, the mucous layer,
or the epithelial lining of hair-follicles or sweat-glands (Medical Rec-
ord, 1877). That the coloring is partly due to the influence of light is
shown by cases in which the viscera Avere seen to darken after exposure
(Huet, Frommann, Fragstein), but the more active circulation of exposed
parts is another factor in their coloration.

If the drug be stopped on the earliest appearance of affection of the
gums, the general discoloration is not likely to occur. This was shown
in the case of a woman who took nitrate of silver for two months at first
gr., and later 2 gr. daily swelling and redness of gums, with a purple
line at the edges, appeared, and there was much tenderness of mouth
with metallic odor of breath; but, on ceasing the medicine, these symp-
toms subsided (Bulletin de Therapeutique, v., 1871, p. 86). In other cases
when large quantities have been taken, every part of the body has been
affected. Van Geuns reports that a youth took about gr. of the ni-
trate daily (with occasional intervals), from his fourteenth to his nine-
teenth year, none afterward: he died of phthisis at the age of thirty-five,
and not only was the skin colored, but also the cerebral and spinal mem-
branes, the laryngeal and bronchial membranes, the peritoneum, the
papillre, and malpighian bodies of the kidney, the marrow, and the bones;
the nervous, the hepatic, and other parts of the renal tissue were reported
normal. Heynsius concluded on analvsis that the dark granules were not

v v O

chloride of silver (for ammonia did not affect them), nor oxide, but mi-
nutely divided particles of the reduced metal, and this conclusion is now
generally accepted (Abstract, Dublin Quarterly Journal, August, 1858).
Charcot has recorded the presence of silver round the renal glomeruli
and in the Malpighian pyramids, and Liouville has made a similar obser-

4 MATERIA MEDICA AND THERAPEUTICS.

ration as to the kidneys, and also as to the choroid plexus of a patient
who had taken 110 gr. in the course of nine months, three years before
his death. Virchow recorded renal argyria after absorption from con-
nective tissue. Several cases are quoted by Stille, by Sieveking, by
Riemer, and others (Schmidt's Jahrbucher, ii., 1875, p. 295): many of
them seem to have died of phthisis several years after the administra-
tion.

Argyria may even follow local applications of nitrate, as in the case of
a girl whose throat was repeatedly cauterized perhaps fifty times in the
course of twelve months; she is said to have swallowed the products
( Gazette de Paris, xxviii., 1874). It has occurred also after tracheotomy,
the wound having been pencilled "for a long time" ("Dictionary Ency-
clopedia," v., vi.), and in a woman after the continued use of a nitrate
pomade for dyeing the hair.

It is important to ascertain, if possible, what quantity of the drug is
liable to produce coloration, and the time during which its use may be
safely continued. The actual amount deposited is certainly very small:
Versmann found only 0.047 per cent, in the liver in a well-marked case, but
Krahmer estimated that there must be the residue of at least 1 oz. of the
salt to cause discoloration: from 3 to 5 oz. are mentioned as the quanti-
ties taken in several instances, but, judging from Liouville's case, it is
probable that less than 1 oz. might suffice. Six weeks has been named as
a safe limit of time for the continued administration of the drug, and I
should think it almost impossible for any ordinary dose to produce bad
results within that period.

The sulphide was the salt used in the first authentic recorded case of
coloration (Weigel): the iodide is said to be free from this risk, and no
case has been traced to it, but Husemann considers this as accidental: the
double iodide of silver and potash is also regarded as less liable to be de-
posited (Delioux).

PHYSIOLOGICAL ACTION (EXTERNAL). If moistened nitrate of silver
be applied lightly to the skin, it combines with albuminous material, and
leaves a white stain, which soon darkens on exposure to air or light,
because of its reduction to metallic silver; the darkened epidermis peels
off in a few days' time. Strong applications, such as the moistened stick,
or solutions of 1 to 2 dr. in the ounce, cause more or less severe burning
pain, and, in delicate skins, vesication. On mucous membranes, or moist
denuded surfaces, a whitish layer is formed by combination with chlo-
rides and albuminous secretion: this layer soon becomes gray and then
dark, and when it peels off may leave the part tender. Applied to a
suppurating surface, the solid nitrate combines with the purulent secre-
tions to form a grayish layer, stimulates the healing process, and causes
some burning pain and redness near the part: when the superficial eschar
falls, as it does in twenty-four to forty-eight hours, fresh and healthy

SILVER.

granulations are usually found on the wound. The action cannot extend
deeply because of the pellicle which is formed, and the so-called " caustic "
effect of nitrate of silver must be distinguished from that of destructive
agents, such as potash or acids, for it is produced by coagulating and
hardening organic tissues, rather than by destroying them. The affinity
of the salt for albumen, and its forming with it an insoluble compound,
explain most of the local effects of the nitrate. 1

A solution of about 20 gr. per ounce brushed over a moderately in-
flamed part not only discolors it, but reduces its size, controlling inflam-
mation, and constringing the blood-vessels. The conjunctiva has some-
times been discolored by continuous use (to it) of medicinal drops, and
in this and other very sensitive parts, such as the schneiderian, buccal, or
urethral membranes, much pain, irritation, and increased secretion follow
the use of strong solutions. Weak solutions (1 to 3 gr. in 1 oz.) have an
astringent and slightly stimulant action, and do not cause pain except to
a delicate membrane like the conjunctiva. Silver solutions possess, also,
antiseptic power, in degree somewhat proportionate to their strength,
and dependent in part, though not wholly, on coagulation of albumen.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Small
doses of the oxide ( to ^ gr.), and still smaller ones of the nitrate of sil-
ver ( gr.), are usually well borne by the stomach; but the latter salt
produces a metallic, bitter taste in the mouth, and, unless well diluted,
causes burning sensations in the fauces. In -fa to 1-gr. doses it is apt to
induce nausea or vomiting, pain, and diarrhoea; headache and vertigo are
usual accompaniments. The continued use of smaller medicinal doses im-
. pairs the appetite, and may induce intestinal catarrh and hemorrhage.
Any amount over 4 or 5 gr. would be usually rejected by vomiting,
otherwise it would excite inflammation. After death from toxic doses,
the gastro-intesthial membrane has been found soft, eroded, or covered
with gray patches. In chronic cases the muscular and mucous coats be-
come hardened and thickened.

Nervous System. The main point determined by modern investiga-
tion into the action of silver compounds is their special effect upon the
nervous system. The best experiments have been made upon animals by
hypodermic injection of hyposulphites and albuminates of silver, which
do not coagulate albumen. Charcot and Ball reported, as usual results of
such injection, paraplegia and paresis of pulmonary nerves, probably re-
flex in character, leading to profuse bronchial secretion and asphyxia
(Gazette Med., 1864). Rouget found that in mammalia, small doses

1 The chemical formula of the s'lver-albumen compound seems to vary under dif-
ferent conditions. Lassaigne gives 84.5 per cent, albumen, 15.5 of nitric oxide of
silver; Mulder, 16 of the latter in one experiment, 8.9 in another; Krahmer, nearly
12 per cent. Delioux pointed orit that the affinity of the nitrate for albumen is
greater than it is for chlorine (Husemann).

6 MATEBIA MEDICA AND THERAPEUTICS.

caused excitement somewhat like strychnia; toxic doses induced convul-
sion and asphyxia. Batrachians got convulsions or tetanic spasm with
suspension of voluntary movement, of reflex action, and of respiration,
while circulation continued; weakness, torpor, somnolence, and paralysis
also occurred in various degrees (Archives de PhysioL, 1873). Professor
Curci, experimenting on animals with hypodermic injections of hyposul-
phite of silver, reports that at first they stimulate sensory nerves, and
through them the posterior columns of the spinal cord, so that sensibility
to impressions and reflex excitability are increased this condition extends
more or less to the motor nerve-tracts, muscular irritability is heightened,
and tetanus may be produced: afterward follows a secondary effect of
paresis of sensory nerve-centres, and of those connected with respiration;
ultimately reflex action is arrested, and respiration and circulation cease.
We may accept these facts without assenting to the conclusions drawn
by Professor Curci from them, viz., that since silver compounds ultimately
paralyze, they cannot be of service in paralysis, myelitis, etc., but are
only indicated in spasmodic disorders, especially such as affect respira-
tion (Medical Record, 1877).

Bogolowsky, in his experiments, sometimes found the spinal cord so
far affected that the bladder became greatly distended.

An exceptional illustration of the nerve-effects of the drug on man, may
be found in the case of a man accustomed for twelve months to dye his
hair and beard with a strong solution, and who suffered general weakness,
confusion of thought, loss of memory, tinnitus aurium, and defective
sight, which symptoms ceased soon after stopping the dye (Bresgen:
Schmidt's Jahrbucher, 1874, Bd. clxii.). Within my own experience I
have known men suffering from the same cause, with giddiness, vertigo,
and marked nerve-depression, amounting almost to melancholia, and re-
covering quickly after ceasing the application. Convulsions occur in
children after toxic doses of the nitrate, but they are probably reflex i.e.,
dependent upon gastric irritation (British Medical Journal, i., 1871).

Circulatory System. After intravenous injections of silver salts, the
blood has been found dark, pitchy, impaired as to coagulating power, and
containing small crystals, and " whitish granulations," which were sup-
posed to be chloride of silver (Rabuteau), but are more probably haematin
and protein (Rouget). Ecchymoses have occurred, and, together with
the asphyxia and increased bronchial secretion, have been attributed to
the altered chemical condition of blood (Krahmer, Monograph, 1845), but
such alteration is not produced (in acute form) by silver administered in
any other way than by direct injection into the blood. Even toxic doses
given in other ways do not alter that fluid beyond some lessened colora-
tion of the corpuscles and increase of fibrin (Bogolowsky, loc. cit.,
Rouget); the spectrum remains normal. But after the continuous use
of full doses of albuminate or phosphate of silver, the blood-condition

SILVER. 7

certainly becomes impaired; the fluid is found to be thinner and darker,
and it tends to stagnate in, and transude through, the vessels, while the
corpuscles part with hsemo-globulin, and become pale, transparent, and
angular or oval, with projections: according to Bogolowsky, they do not
contain silver, as sometimes asserted.

Sudden arrest of the heart's action, as well as asphyxia with profuse
bronchial secretion, were symptoms noted by Charcot and Ball after in-
jections of silver nitrate into the veins of animals. Rabuteau, arguing
from the same results, considered the drug to be a " cardiac poison," but
it is clear that when thus injected directly into the circulation, the pro-
duction of thrombosis or embolism may complicate and obscure the
special effects of any substance. Rouget found that after hypodermic in-
jection of toxic doses in the lower animals, the heart continued beating
after respiration had ceased i.e., it was not "poisoned;" nor is there
any clinical evidence of the salt depressing the circulation, unless in a
secondary manner during irritant or chronic poisoning.

Respiratory System. Orfila first described asphyxia as a result of in-
jecting silver nitrate into the veins, and after death he found partial con-
solidation of the lungs, and excessive secretion in the bronchial tubes
(Toxicology). Several observers have corroborated these results, and it
has been a question whether they are mainly mechanical from thrombosis,
etc., or reflex effects of lung-irritation (Charcot), or dependent upon direct
irritation and paresis of the respiratory centre in the bulb, and of the
neighboring vaso-motor centre. The recent observations of Rouget point
to the latter conclusion. He found that in most animals urgent dyspnoea
occurred, and, post-mortem, the lungs proved to be healthy in texture,
but much contracted in volume the muscular tissue of the bronchi being
in a state of spasm similar to that of asthma. In adult specimens of only
one order of animals (carnivora) did he find the excessive secretion de-
scribed by Orfila, and he considered that only in these were the vaso-
motor centres affected. That the main effect is exerted on the central
rather than on peripheral nerve-elements he further supported by show-
ing that nerves and muscles retained electric excitability after death.
Still more recent observations by Rozsahezzi on rabbits show that in
chronic poisoning by silver there is constantly hyperaemia of laryngeal
and tracheal membranes, also of the lungs, and in these organs often
oedema was found, with congestion, ecchymoses, effusions, cheesy masses,
and sometimes a condition resembling phthisis (Archiv Iflebs, August,
1878).

Nutrition. Krahmer concluded from observations on himself, that
the presence of silver in the system lessened oxygenation and the excre-
tion of urea, of uric acid, and of the watery constituents of urine; the
non-nitrogenous elements were, however, increased, and the sp. gr. ren-
dered higher. If the administration of silver salts be continued beyond

8 MATERIA MEDICA AND THERAPEUTICS.

a certain point, cachexia sets in, appetite and digestion are impaired, ca-
tarrh and effusions take place, the temperature is lowered, and the action
of the heart and lungs weakened. The general debility and emaciation
are mainly dependent upon gastric irritation, but the drug seems to exert
a special " alterative effect " on tissue-change. Dr. H. Wood classes it
with "mineral astringents," Dr. Bartholow with "agents increasing
waste," but I think it better placed among those that " moderate or re-
tard nutritive processes " (Rabuteau). The recent observations of Roz-
sahezzi show a very marked diminution of tissue-change and of weight,
under the continued influence of small doses of nitrate. This occurred
even while the animal was taking a good amount of food, and when no
increased excretion could account for the loss; he thinks it indirect from
impaired blood and muscle-condition.

He finds (as opposed to Bogolowsky) that small doses cause a rise in
temperature, but agrees with Falck that large ones lower it.

When death has followed the long-continued use of the drug, the epi-
thelial structures, and the solid tissues generally the liver, heart, mus-
cles, kidneys, etc. have been found in a state of "cloudy swelling" and
fatty, degeneration, and the metal has been detected in most parts of the
body.

Fatal Dose (Acute Poisoning). This varies with the gastric ^pndi-
tion, period of vomiting, and of treatment, etc.: 30 gr. of nitrate have
caused death in one case, while 1 oz. has failed to do so in another (that
of Poumarede). Large doses have been neutralized by excess of natural
mucus, or of albuminous food.

SYNERGISTS. As regards local effects, the nitrate is allied with irri-
tants and caustics, such as iodine and arsenic. In its general action, es-
pecially in therapeutical doses, a resemblance may also be found with
these medicines as well as with compounds of chlorine, bromine, and salts
of bismuth, and in a less degree, of zinc. Some analogy with strychnia
has been traced (Charcot).

ANTAGONISTS AND INCOMPATIBLES. Sulphuric, hydrochloric, and tar-
taric acids and their compounds are chemically incompatible: also alkalies
and their carbonates, astringent infusions, and lime-water; also creosote
(v. p. 24). All soluble chlorides and cyanides are incompatible, since
they precipitate an insoluble chloride of silver; most natural waters do
so because they contain common salt: this salt is the best antidote to
poisonous doses of the drug, and should be given freely so as. to cause
emesis as well as to neutralize the poison.

THERAPEUTICAL ACTION (EXTERNAL). Nitrate of silver may be ap-
plied either (1) as a caustic, (2) astringent and alterative, (3) counter-
irritant, or (4) as a direct irritant.

1. Caustic. Lupus. In cases of tubercular and ulcerating lupus the
" lunar caustic " is sometimes suitable, and in the hands of Hebra, Neu-

SILVER. 9

mann, and others, has given good results. No ordinary application or
simple pencilling will be of any service, for it will not extend deeply
enough, but a well-pointed " stick " should be firmly pressed into the soft
tissue, in various directions and until hard tissue is met with : this is an
extremely painful process, and in my experience can seldom be thoroughly
done except under chloroform. As a rule, I prefer the nitrates of mercury
or of zinc, but silver has the advantage sometimes where the face is affect-
ed, because its action can be so precisely limited to the diseased part,
and does not cause so marked a cicatrix. Dr. Piffard recommends fine
needles to be coated with the caustic and passed into the growth, finding
this to be less painful than Hebra's method. Soothing applications, such
as poultices and lead lotions, should be made after the cauterization, which
may require repetition once or even twice weekly for some time. M.
Claude specially recommends the double iodide of silver and potash (in-
ternally) in lupus and skin-disorders.

Warty Growths Corns, etc. The use of the stick-nitrate for destruc-
tion of these growths is familiar in practice, and is safe and painless,
though not very quick in its results, for only a thin layer can be acted
upon at each application: the part should be thoroughly softened and
pared before the remedy is applied.

Carcinoma. For the removal of cancerous growths, Thiersch has em-
ployed injections into their substance of solutions of 1 part of nitrate in
2,000 or 3,000 parts of water; this is followed by a similar injection of
dilute chloride of sodium (1 in 1,000), and is said to cause quick disinte-
gration and wasting of the morbid tissue. There is some independent
confirmation of his results, but usually suppuration and sloughing have
occurred an effect which Thiersch did not intend (Archives Generate,
January, 1867). I am not aware that the method has been extensively
tried.

Poisoned and Dissection Wounds. In such wounds a liquid and
penetrating caustic, like nitric acid or potash, is more thorough in its
effects, but nitrate of silver, being portable and at hand, has often been
employed with good result; its antiseptic power is a recommendation.
Mr. Youatt reports that he was bitten several times by rabid animals, and
after a free use of this remedy had no ill results; but the degree of
security given must vary with the thoroughness and time of the applica-
tion.

Variolous and other Pustules. Lunar caustic has proved useful some-
times in aborting purulent formations. The absence of pitting after
small-pox being dependent upon the small size and limited inflammation
of the pustules, Velpeau and others have endeavored to secure such a
result by puncturing the vesicle on the third or fourth day, and touching
the interior with a fine point of the nitrate; and if well carried out this
plan has often succeeded. It is painful, tedious, and not free from

10 MATERIA MEDICA AND THERAPEUTICS.

danger, but the plan devised by Dr. F. Bowen is an improvement upon
it, and is much more feasible: the vesicle is to be punctured with a fine
needle dipped in a solution of the salt (20 gr. to 1 oz.); a nurse can do
this quite well. In one case all the parts thus treated recovered per-
fectly, while the vesicles that were untouched left deep scars (quoted by
Ringer). Mr. Higginbottom recommends painting of the face with the
same strong solution that he used for erysipelas (80 gr. to \ oz.), but this
is too painful for ordinary use.

Molluscum Contagiosum. The rounded, white, firm tumors of this
malady are efficiently treated by evacuating their contents and applying
nitrate of silver to the interior, as above described for variola.

Chancre. Opinions have differed as to the possibility of preventing
venereal infection by applications of nitrate to the sore soon after its ap-
pearance; authorities in favor of such practice are to be found among
earlier writers, but modern opinion is decidedly against it. Hunter,
Ricord, and Acton (writing in 1846) agree in stating that if the com-
mencing chancre, the vesicle or pustule be thoroughly cauterized within
three to five days of its origin the cure is rapid, and systemic infection
very rare; but they agree also that if the sore be indurated no effect is
produced, so that some of the cases they relied upon were probably " soft
and non-infecting chancre: " on the other hand, Diday, Langston Parker,
and others, have thus destroyed chancres within a few hours of their ap-
pearance, and yet an indurated sore and secondary symptoms have fol-
lowed. We must conclude that cauterization of a true Hunterian chancre
at any stage will not prevent its development or the occurrence of sec-
ondary symptoms.

Early cauterization of soft chancres will, however, sometimes cause
rapid healing, and is a good treatment for sloughing or rapid spreading;
but it is very painful, and the sore will usually heal under simple treat-
ment. In syphilitic ulcers of the leg I have seen solid gelatinous f ungat-
ing growths, which are well treated locally by pushing in a point of caustic
and breaking them down freely with it, as already described under lupus.
For syphilitic cracks, fissures, and ulcers on tongue and cheeks, the solid
nitrate applied daily is very useful.

Granulations. A minor degree of the caustic action of nitrate of
silver will repress exuberant granulations in wounds; they should be
pencilled every day or every second day.

2. Astringent and Alterative. By the latter term we mean to ex-
press the modifying effect exerted on tissues, and especially on mucous
membranes, whereby an unhealthy condition, usually inflammatory in its
nature, is subdued, and healthy action is set up in its place. Trousseau
taught that this effect is due to the new agent (nitrate of silver) causing
a more powerful inflammation than the original one which it displaces,
afterward itself subsiding; and this idea he developed at length under

SILVER. 1 1

the term, "medication irritaute substitutive" (" Materia Medica," i., 537),
but we cannot prove the occurrence of any substitutive inflammation of
this kind. We refer the effects of the remedy partly to its known phys-
ical properties of constricting vessels, of coagulating and disinfecting se-
cretion, and of forming an adherent protective membrane; also, in cer-
tain conditions, e.g., in ulceration, the vessels immediately acted on being
constringed, those in the neighborhood receive a better supply of blood,
and the processes of repair are quickened. The remedial power which is
special to the drug, which distinguishes it from other astringents, and by
which it modifies nutritive processes, we cau only express by the term
alterative.

In many forms of disorder accompanied by discharge, whether hemor-
rhagic, mucous, serous, or purulent, the nitrate, either solid or in injec-
tion or spray, is very valuable. (Delioux recommends the hyposulphite
of soda and silver as equally astringent and less irritant.)

Hemorrhage. In cases of continued oozing from small points in the
skin or mucous membranes, such as occurs after leech-bites, a finely-
pointed stick of nitrate firmly pressed on the part is a good astringent.
In bleeding from the mucous membrane of the bladder, such as accom-
panies vesical tumor, injections should be made, beginning with weak
solutions, and increasing the strength by degrees if necessary. Mr.
Christopher Heath speaks highly of this plan, and I have seen several
instances of its successful use in his hands.

Chronic Cystitis. After washing out the bladder, a solution contain-
ing 1 to 2 gr. in 1 oz. of distilled water should be injected and allowed
to remain for some minutes, or until micturition occurs; this lessens the
muco-purulent ropy secretion from the vesical membrane: Mr. Reeves
has used with success 20 gr. in 1 oz. (Lancet, i., 1853).

Gonorrhoea. At the commencement an injection containing 30 or
even 60 gr. to the ounce has sometimes succeeded in aborting the mal-
ady, but it causes severe pain, and may lead to serious inflammation. In
the female, a similar solution applied thoroughly, per speculum, to the
vagina, has given better results, and offers less risk on account of the
anatomical conditions; but, as a rule, the frequent use of a weaker solu-
tion is more advisable. I recommend, so soon as the acute inflammatory
stage begins to subside, an injection containing to 1 gr. in the ounce
every three or four hours; or sometimes a strength of only 1 gr. in 8 oz.,
to be injected every half-hour for the first eight hours, and afterward
every four hours until cure is effected, which should be in twenty-four to
forty-eight hours. I have had most excellent results in many obstinate
cases from this method; it should not be wholly omitted at the end of
forty-eight hours, but used once, or twice, or, if the discharge continues,
a little oftener for the following two or three days.

JBalatiitis. Gonorrhceal inflammation of the glans penis is effectually

12 MATERIA MEDICA AND THERAPEUTICS.

treated by the frequent use of a weak lotion (1 gr. in 1 oz.) in addition
to light pencilling with the solid stick.

Spermatorrhoea. The treatment by local application of a strong so-
lution to the prostatic urethra in the neighborhood of the openings of
the seminal ducts was strongly commended by Lallemand, but his state-
ments are exaggerated; it is useful sometimes, but should not be em-
ployed without due consideration: I have seen serious consequences fol-
low it.

Leucorrhoea. Injections of silver nitrate have been found effectual
in the vaginal form of this disorder, the strength of application being
proportioned to the duration of the malady: a drawback to its use is the
staining of linen. (There are several varieties of leucorrhoea, and each
must be treated on its own merits, as some will require internal remedies
as well as injections the checking of discharge by this or other astrin-
gents is only one part of successful treatment.)

In iiterine leucorrhcea the discharge is glairy and stiffens the linen,
and is accompanied with distinct suffering. It is usually connected with
cervicitis or endometritis, and in chronic stages, especially when the os
uteri is patulous, solutions, and even the solid nitrate, have been passed
into the uterine cavity with good result (Dr. Henry Bennet): this, how-
ever, has led to some abuse of the remedy, and I have seen very painful
symptoms connected with induration of the cervix and narrowing of the
canal as a consequence of too prolonged a course of cauterization.

Granular Erosion of Cervix (formerly known as uleeration). 'The
nitrate has been much used in this condition, but the solid salt can exer-
cise only a limited influence. In chronic cases, where the part is en-
larged, and the epithelium so long absent that the bared villi resemble
granulations, I have found benefit from recently prepared iodide of silver,
as recommended by Dr. Henry Wright. 1 All mechanical causes of erosion
of cervix, such as impacted faeces, must be considered, and if present,
treated at the same time.

Real uleeration of the cervix, as distinguished from erosion, is usually
connected with syphilis, struma, or malignant disease, and although the
nitrate has been often used for it, more potent remedies, such as the
acid nitrate of mercury, are really required.

Uleeration. When an ordinary ulcerated surface is discharging
freely, a lotion of moderate strength is usually more suitable than the
solid nitrate, because it does not involve confinement of discharge under
a limiting membrane (though, indeed, such membrane may be punctured
if necessary).

1 To a little of the strong sih'er solution ( 3 j. in j.) a few drops of tinct. iod. are
added, and the iodide of silver precipitates at once in white flakes, which should be
quickly applied through the speculum (Uterine Disorders, p. 260).

SILVER. 13

The best use of the solid stick is made in indolent ulcers with pale
small granulations, and but slight discharge. The remedy should be
lightly applied over the central parts, avoiding the new tissue at the
margins, and under this stimulus, and the protection of the film which is
formed, healing will be much quickened. The brittle stick nitrate is
superior to the prepared points of " lunar caustic," for it is more solu-
ble. Cuthill insists on the importance of stimulating an ulcer rather by
dots and lines of silver nitrate than by coating its whole surface, bet-
ter exit for discharge being thus given (Edinburgh Medical Journal,
1877).

Purulent Ophthalmia. In the ophthalmia of new-born children, and
also in the epidemic and the gonorrhceal forms of the disorder, solutions
of nitrate are extremely valuable, though they often cause severe pain
for a time. The lids should be separated and the eye cleansed by a
stream of tepid water, and in acute, not very severe cases, a few drops of
a solution (2 to 5 gr. in 1 oz.) should be instilled in very severe cases
with chemosis, a strength of 20 or 30 gr. in the ounce may be employed
once or twice daily, but should be followed by a syringeful of plain
water, or of weak salt-solution, in order to neutralize any excess of ni-
trate (v. p. 23). In chronic cases, especially when scrofulous in charac-
ter, with thickened conjunctiva, photophobia, lachrymation, etc., the
solid stick may be lightly used to the lids with advantage ; but in all
cases the liability to discoloration must be remembered, and the remedy
not be used too often nor too long ; when ulceration is present, or the
membrane not entire, other remedies should be preferred.

Otorrhcea, with perforation of tympanum and with tendency to forma-
tion of polypus, is best treated by touching the tympanic mucosa with a
concentrated solution of the nitrate: the discharge should be daily re-
moved by ordinary antiseptic lotion.

Ozcena Coryza. In chronic nasal discharges, if the bones be not
seriously affected, and in ordinary coryza, benefit may be derived from
injections of nitrate of silver (2 to 5 gr. in 1 oz.). In the former condi-
tion, a cleansing and disinfectant nasal douche should first be used, and
afterward the astringent should be injected from behind forward by
means of a curved tube passed to the back of the fauces, and connected
with a rubber ball.

Nitrate of silver in various forms is an important agent in the treat-
ment of diseases of the throat and air passages, but its strong and caus-
tic action is invoked much less frequently now than formerly; we require
rather the astringent or alterative action to relieve congested, or brace
relaxed parts. Dawosky concludes, after extensive experience, that,
whenever local applications are required for congested mucous mem-
branes, nitrate of silver gives the best results; besides its chemical influence,
it stimulates the congested vessels to contract and get rid of their excess

14 MATERIA MEDICA AND THERAPEUTICS.

of blood. For congested conditions of the fauces with adherent secre-
tion and patches of redness and swelling, he recommends a strength of 1
part in 8 (Medical Record, March, 1878), but I think it better to begin
at least with half this proportion.

Tonsillitis. In the early stage of this inflammation it must be at
least before suppuration has set in a strong solution (30 to 60 gr. to 1
oz.) applied once in twenty-four hours will sometimes abort further prog-
ress. Judgment is required to determine the suitability of cases for this
treatment, for if the inflammation be advanced and active, irritant appli-
cations tend to increase it. In sloughing ulceration about the fauces,
strong nitrate solutions are sometimes serviceable, and are better than
the solid caustic; but more active disinfectants, such as iodine or carbolic
acid, are still better.

Diphtheria. In diphtheritic inflammation with membranous deposit,
I cannot recommend the strong nitrate; if the part be irritated it is more
liable to inflame, and if the membrane be roughly detached the absorbents
more readily receive morbid material, so that, although this remedy was
at one time commended, I am satisfied that the use of a solvent or disin-
fectant spray is more serviceable, and is far more thoroughly and easily
effected. Strong nitrate of silver is not a suitable local remedy for mem-
branous croup (laryngeal diphtheria), or acute congestion of the larynx.
I have seen almost fatal suffocative spasm of the vocal cords induced by
the application of the solid nitrate in the latter condition. Guillon, how-
ever, states that the insufflation of finely powdered nitrate may be very
useful (Medical Record, 1877); sometimes a weak spray (1 gr. to 1 oz.)
has been of service.

(Edema Glottidis Chronic Congestion. This severe form of oedema
is sometimes quite controlled by strong silver-solutions, which may obvi-
ate the necessity for scarification or more serious procedures. In chronic
laryngeal and faucial congestion, a curved brush carrying a solution of
20 to 30 gr. to the ounce may be applied with the help of a mirror to the
exact part affected, and with very good result. Dr. Horace Green and
Dr. Hughes Bennett were early advocates of this method of treatment.
Many surgeons, however, now prefer solutions of copper, zinc, or iron, as
causing less irritation, and less risk of after-contraction, than the silver
salt. A weak spray is of very little service in these conditions, and the
use of the brush has largely superseded the method of insufflation which
was approved by Trousseau. He used 3 gr. of the nitrate mixed in fine
powder with 60 gr. of sugar of milk, and this was blown into the patient's
mouth during a deep inspiration, by which some of it was carried into
the larynx.

Laryngeal Phthisis. The solution is, according to my own experi-
ence, of much service in the early stage of this disease, and has been
recommended by the late Hughes Bennett, Marcet, and Sawyer, but ob-

SILVER. 15

jected to by L. Thomas (British Medical Journal, i., 1878). It has been
advised in malignant disease.

Relaxed Throat, etc, It is, however, in chronic relaxed conditions of
the fauces and pharynx, with dysphagia and constant discomfort, aching
in the throat, cough, and hawking of phlegm, that the remedy gives most
relief. There is no acute inflammation present, and the affected parts
are either pale with prominent follicles, or swollen and of purplish color,
with more or less viscid, yellowish secretion. In " clergyman's sore
throat," the follicles of the pharynx mainly are affected, and in all these
cases a solution of 20 gr. to the ounce, with glycerin, should be applied
once daily, or on alternate days, while tannin, borax, etc., are used in the
intervals.

In aphonia connected with local debility and relaxation, silver appli-
cations relieve by their astringent tonic action, and in hysterical aphonia
the irritation excited is often sufficient to restore the voice.

Relief may also be given to obstinate coughs arising from relaxed fau-
cial conditions, and not amenable to internal remedies, by a solution con-
taining about 5 to 10 gr. in the ounce, applied once or twice daily.

Chronic Bronchitis. In cases accompanied with profuse muco-puru-
lent discharge, I have often proved the efficacy of a spray containing ni-
trate of silver. I use only weak solutions from 1 to 4 gr. in the ounce
and find that they alter and restrain the secretion in a very satisfactory
manner.

Erysipelas. The power of the remedy in this disease depends much
on the mode of its application; the mere drawing of a line of caustic
round the inflamed margin (as sometimes practised) is illusory. The
best method is that of Mr. Higginbottom, who advises previous cleansing
of the part with soap and water, then with pure water, and afterward the
thorough application of a saturated solution (20 gr. in each fluid drachm)
two or three times over the whole affected surface, and beyond it on the
healthy skin for about two inches. This is effective in the superficial
forms of erysipelas, but not, according to my experience, when much
oedema or cellulitis are present, and I am reluctant to advise it over an
extensive surface, or in the idiopathic form. It causes severe burning
pain, and in the latter condition, at least, does not always stay the in-
flammation, so that I prefer milder applications and appropriate internal
medication.

Whitlow Furuncle Erythema. These conditions are sometimes
advantageously treated by the method of Higginbottom, but the solution
may be made weaker, and nitrous ether employed as the vehicle: it does
not dissolve so much as water, but 30 to 40 gr. in the ounce will be
strong enough; this should be painted over the affected finger, or the
commencing boil, or the inflamed and irritable patch. Chilblains are
relieved by it, and it is said to prevent a threatened eruption of herpes if

16 JIATERIA MEDICA AND THERAPEUTICS.

used early enough. To bedsore, in any stage, a solution of 5 to 10 gr. in
the ounce may be applied with advantage.

Eczema. The use of strong nitrate of silver in eczema should be re-
served for chronic patches with much infiltration. Nitrous ether proves
the best vehicle, because it dissolves sebaceous or fat.ty secretions, and
allows the remedy to act better on the distended capillaries 30 to 40 gr.
in the ounce may be used. Eczema in the neighborhood of ulceration
yields to lotions of moderate strength. For eczematous or aphthous con-
ditions affecting the genital organs, or the nipple, and commonly accom-
panied with severe itching and irritation, a solution containing 4 or 5 gr.
in the ounce should be first used in cases that are somewhat acute; but,
if relief be not given, a paint containing 30 to 40 gn in the ounce should
be carefully and lightly brushed over the part. Quite the best treatment
for fissured nipples is to touch them thoroughly but lightly with a fine
point of nitrate: all secretion should be cleansed from the part before
such applications, and warm fomentations should be ready for use after-
ward, as the pain may be severe. In abrasions or aphthous conditions
about the mouth, the solid nitrate is one of the best remedies, although
a painful one.

Hums and Scalds. In superficial burns the strong solution has been
applied, and to deeper injuries, when the true skin is affected, the solid
stick has been used with the object both of forming a covering from air,
and of lessening the degree of cicatrization (Fricke). This method has
not met with general support, but a modified plan was recommended by
Mr. Skey, who used a lotion containing about 6 gr. in 1 oz. for infants,
and twice that strength for adults, covering the part immediately after-
ward with cotton wool (Lancet, ii., 1861). A mixture with linseed oil
has been commended (Wernher), and the solid stick is always useful in
later stages when ulcerations are slow to heal. Hebra applies it once or
twice daily, especially where there is liability to adhesions.

3. Counter-irritant. The action of the remedy when applied locally
in superficial inflammations, has earned for it the title of " caustique
antiphlogistique," but we cannot recognize in it any distinctly caustic
action, any more than we can verify the production of a " substitutive in-
flammation," which replaces for a time the original malady, and then it-
self subsides (v. p. 11). The main factor in the result is an astringent
effect on the vessels and nutritive processes, but there are cases in which,
when the nitrate is applied to some other than the affected part, it will
relieve by an action which may properly be called counter-irritant or de-
rivative, the "medication irritante transpositive " of Trousseau. Thus,
Liston and Elliotson treated erysipelas by its application to the neigh-
boring sound skin, and Lubanski, Egan, and others treated amenorrhcea
by pencilling the os uteri (Dublin Journal, 1848).

Orchitis Synovitis. In these deeper-seated inflammations benefit

SILVER. 17

may be obtained from strong nitrate of silver applied on this principle of
counter-irritation. The best position for the application has been much
discussed, some placing it as near the part as possible, others insisting
that it shall be between the heart and the inflamed tissue, and others that
it shall affect vessels which receive their supply from a different source
than the affected part. The simple rule adopted by Mr. F. Jordan, with
much success, is to apply the nitrate over the adjacent vascular territory ;
thus, in orchitis he acts upon the great vessels in the groin and front of
the thigh (Practitioner, vol. ii.). In synovitis it is used round the affected
joint, though iodine is usually preferred in this disorder.

In irritation of the prostate gland or seminal ducts, it may be applied
to the perineum, rather than to the urethral membrane itself.

4. As a Direct-irritant (the " medication excitative " of Trousseau),
the nitrate finds some applications.

Hydrocele. The solid stick may be applied, for instance, to the inte-
rior of a hydrocel'e-sac after evacuating the contents, but an injection
through a trocar is more under control: the object is to excite sufficient
inflammation to induce adhesion (this is now better effected by iodine).

Tumors. Small cystic or fatty tumors may be cured by inducing
moderate suppuration, and one of the best means for this purpose is
the injection into their substance of a few drops of solution containing
1 part of silver nitrate in 6 or 8 of water; this mode of treatment was
specially introduced by Luton, who termed it " parenchymatous substi-
tution."

Neuralgia Sciatica. Luton applied the deep injection of this salt
also to the treatment of these maladies.

In sciatica of chronic and obstinate character, 10 to 20 drops of the so-
lution injected deeply near the seat of pain will lead to a localized sup-
puration which sometimes quite cures the original malady: it is best used
in the nates at the point of emergence of the sciatic nerve.

In other chronic obstinate neuralgia, and, according to Le Dentu, in
any deep-seated neuralgic pain of any part, similar treatment has proved
of service: of a solution containing 1 part of nitrate in 5 of water he in
jects deep into the cellular tissue 2 or 3 drops: this causes acute pain for
the moment, and sometimes a small abscess afterward, but never serious
trouble (Medical Record, 1877). Bureau, in a recent thesis (Paris, 1877),
sums up very favorably the experience recorded up to the present time
of this method of treatment; it is said to be both certain and rapid in its,
effects, and not to cause much irritation of the deep tissues. Luton him-
self used a 10 per cent., also a 5 per cent, solution, and others one of 25
per cent., injecting 5 min. all with successful results.

In Chronic Joint- Disease, Synovitis, etc., equally good results have
been recorded from the method of Luton i.e., deep injections into the
joint-cavity (Medical Record, November, December, 1877). The process
VOL. II. 2

18 MATERIA MEDIC A AND THERAPEUTICS.

may be compared with that of Thiersch for cancer, in which weak solu-
tions only are used, and suppuration is not intended (v. p. 9).

THERAPEUTICAL ACTION (INTERNAL). The value of silver compounds
is acknowledged in certain disorders of the gastro-intestinal mucous mem-
brane, and of the central nervous system. In the former their action is
a local one, doubtless of the same character as that exerted upon the ex-
ternal surface; in the latter they are given for a " constitutional" effect
of tonic or indirectly sedative character, which may perhaps be resolved
into a regulating or astringent effect upon the capillaries (Hudson, Lane).
In support of this view has been quoted the power also possessed by these
salts of moderating uterine and other discharges, but this is perhaps only
contingent on the improved state of the stomach-functions; in the present
state of our knowledge, however, the record of clinical facts is of more
importance to us than the theories formed to explain them.

Dyspepsia Chronic Gastritis Chronic Gastric Catarrh. The ni-
trate and the oxide are both valuable in many of these cases, and in judging
of their suitability in a given instance, it is not easy, nor is it essential, to
draw a definite line between functional and organic disorder. Gastric pain,
especially when severe, and coming on some time after food, with ten-
derness, distension, pyrosis, and vomiting, are sufficient indications. Dr. J.
Johnson, one of the earliest observers of this use of the nitrate, found that
mental depression, or motor disturbance of convulsive character, furnished
additional indications for it (" On Indigestion," 1826). Dr. Symonds
recommended it "in nervous irritability with passive or chronic conges-
tion of the stomach." In Dr. Hudson's cases, pain of very acute charac-
ter and long duration, with distension, thirst, constipation, and vomiting
of sour fluid, were relieved within one or two weeks, but he gave the
remedy (^-gr. doses) with opium (^ gr.), and hop (Dublin Journal, May,
1840). Dr. Osborne, a distinguished Dublin physician, found it valuable
in gastralgia with "sour vomiting" (1831), and more recently we find
Dr. Spender praising it as the "best remedy in pyrosis" (Practitioner,
October, 1868), and Dr. H. Wood, "in vomiting of much yeasty fluid."
I should attribute importance to its disinfecting properties in such cases.
Dr. Wilson Fox also adds his testimony to the " well-established reputa-
tion of the silver salts in chronic gastric catarrh," and places them next
to bismuth: he would generally prescribe them, however, with opium,
while Frerichs, also a high authority, gave them with belladonna. The
absence or the presence of constipation will be a useful guide to the choice
of these adjuvants. In gastritis, Dr. A. Fleming obtained very good re-
sults from the nitrate, and his mode of using it would seem to obviate, if
that be necessary, the objection urged by Brinton,and to some extent by
Husemann, viz., that the smallness of the dose, and the dilution and chemi-
cal change of the drug, must make it almost inert. Dr. Fleming was ac-
customed to order oz. only of distilled water containing from 1 to 4 gr.

SILVER. 19

of the salt, to be taken fasting 1 , and in the recumbent position, the pa-
tient then to turn himself from side to side, so as to insure contact of the
remedy with different parts of the stomach-wall. In some cases he even
injected the dose directly into the viscus, with a syring-e and perforated
tube (Medical Times, i., 1859). Dr. Hartshorn valued the nitrate in
chronic gastritis; he gave it in pill (American Journal, July, 1849). My
own use of the remedy has been generally in doses of -$ to gr. every
four or six hours in distilled water, and I have certainly observed from it
much relief of discomfort and pain, flatulence, heartburn, and pyrosis,
yet there is some uncertainty in its action (v\ p. 24). Women suffering
from the above symptoms, together with severe retching and vomiting of
tenacious fluid, and a too frequent and profuse menstruation, are almost
always relieved by it, but the maladies in question assume so many phases,
and are more or less amenable to so many forms of treatment, that we
cannot be surprised at difference of opinion as to the true value of this
one.

It has naturally been thought that risk of caustic and irritant effects
might be obviated, and equally good curative effects obtained by the use
of the oxide of silver instead of the nitrate, and this was brought promi-
nently before the profession by Mr. Lane ( Medico- Chirurgical Review,
July, 184041), and afterward, in a special treatise, by Sir James Eyre.
The former records a number of cases with severe but intermittent gas-
trodynia, general uneasiness, nausea, and watery eructation, almost all
relieved quickly by ^ or -gr. doses of the oxide: nothing is said about
diet or other adjuvant treatment. Mr. Lane states further, that if or-
ganic mischief have resulted if the tongue be tumid and cracked, and
the pain constant, or the ejected fluid " glairy" (as in Todd's "follicular
gastric dyspepsia"), then the remedy is of no service; but it is not neces-
sary to adopt these limitations if other indications for the remedy exist.

Uterine Disorders. Dr. Hudson and others remarked the great im-
provement in certain uterine symptoms during the exhibition of silver,
and recorded cure of many cases of menorrhagia, of uterine leucorrhosa,
and of painful menstruation, though not with the scientific precision now
expected. Many cases occurred at the menopause, some during preg-
nancy, and in several a previous long sterility was followed by fecunda-
tion: simple vaginal leucorrhcea was not benefited.

Guided partly by this marked sympathy between the gastric and the
uterine conditions, I have prescribed the oxide for nervous highly-sensi-
tive women suffering from gastrodynia and pyrosis, with coincident uter-
ine flux, and have often seen marked and immediate improvement in
both symptoms, and without any drawback. The use of the medicine
need not, however, be restricted to such cases; its action is somewhat
similar to that of bismuth, and it may be used if that should fail to re-
lieve. It has the advantage of being effective in a much smaller dose:

20 MATKRIA MKDICA AND TIIETiAPEUTICS.

-Jj to j gr. is usually quite sufficient, and in the form of a minute pill
this is readily taken. I have not seen the irritation from it which has
sometimes been described, nor the salivation which might be produced
by its too prolonged use, nor any symptoms of argyria. It should not,
however, be continued for many weeks consecutively. It is useful for
cases in which arsenic also relieves, and an interesting fact is that this
remedy and bismuth have often an equally good influence over uterine
loss when connected or coincident with gastric disorder.

In the cardialgia and vomiting of pregnancy I have found it useful
when many other remedies fail to give the slightest relief.

Gastric Ulcer. In so serious an organic disease, which must, of ne-
cessity, often end fatally, it is not surprising if the powers of the silver
compounds have been called in question. Cases of marked relief, if not
cure, by these remedies have, however, been recorded (Stille), and it
seems reasonable to allow that if they can relieve ordinary gastritis, they
may relieve the same condition when dependent on a local lesion; they
lessen local congestion and local nerve-irritation, and in some cases, at
least, they form a protective layer of albuminate, and probably thus re-
lieve the pain of gastric ulcer.

Jaundice. Dr. Peebles (U.S.) has recorded several cases of jaundice
in which rapid improvement followed the use of nitrate of silver given in
f-gr. doses twice daily for two to ten days: he attributes its good effects
to its modifying the state of the mucous membrane, and relieving a chronic
gastro-enteritis, and lessening the obstruction of gall-ducts by diminish-
ing glairy mucus (American Quarterly Journal, July, 1849).

In catarrhal jaundice, with pain and functional stomach-disorder,
Dr. Bartholow reports good results from similar treatment, which he
compares to that by mercury or arsenic.

Chronic Diarrhoea Dysentery. I have obtained great benefit from
nitrate and oxide of silver in many forms of these disorders in serous
diarrhoea, in chronic and periodic forms, in diarrhoea after fever, and in
that of dysenteric character.

Graves preferred the nitrate (which he gave in grain doses) to any
other astringent or to opium, but (as remarked by Stille) he avoided it
in cases of ulceration, when really its advantages may best be proved.
Dr. J. MacGregor reports several cases of exhausting diarrhoea during
advanced phthisis, in which the relief was marked and immediate; he
gave the remedy also in 1-gr. doses with gr. of opium, and in enema
(British and Foreign Review, September, 1841). I have myself often
found it of the greatest advantage in such cases, restraining the profuse
discharge, and aiding to strengthen the patient; I have given from ^ to
1 gr. In the form of enema, containing 3 to 4 gr. in 2 oz. of distilled
water, it is a valuable remedy for chronic dysentery and ulcerative con-
ditions of the rectum; the enema may be repeated every six to twelve

SILVER. 21

hours for three or four times, if necessary. If ulceration or congestion
be situated higher up in the intestine, the nitrate is best given by the
mouth in pill, since it is thus most likely to reach the affected part un-
altered, and to exert the local action which is desired. The chloride of
silver has also been used with advantage in chronic dysentery.

Diarrhoea of Children. The nitrate has been recommended by Trous-
seau, Mauthner, etc. I do not think it advisable for acute cases, for it
is uncertain in action, but, in prolonged and obstinate cases, a few doses
often act well; they may be given by the mouth or rectum.

Typhoid Fever. Dr. Pepper has recorded fifty cases of typhoid fever
in which, after the second week, the medicinal treatment was nitrate of
silver (^ gr.), with small quantities of belladonna and opium; only one
case was fatal, and he considers that these remedies act favorably by
limiting follicular catarrh and modifying its secondary effects (Boston
Journal, October, 1877).

Diseases of the Nervous System. It is curious that silver was early
appropriated to the treatment of cerebral disorders by the theories of
astrology, which associated both the metal and the malady with the influ-
ence of the moon: by the time of Linnseus its medicinal virtues were so
far distrusted that he describes only its " power as political, its use, com-
mercial." It retained, however, some reputation in epilepsy, and of late
years there has been further evidence of a neuro-tonic power exerted by
it rather upon the spinal than the cerebral nervous system, as illustrated
in some forms of paralysis.

Epilepsy. Unless we are wholly to reject past records and the opin-
ion of distinguished physicians, the nitrate has given good results in a
large number of epileptic cases. Heiin considered it the best of reme-
dies, and Trousseau, who used also the chloride, places the silver salts
second only to belladonna (" Traite," Ed., 1868). We need not, how-
ever, quote many authorities to the same effect: we recognize that it has
relieved, sometimes even seemed to cure, cases of this disease, and may,
therefore, under certain conditions, relieve others. We should not, with
Krahmer, consider it most suited for the robust, with symptoms of head
congestion, but rather for the delicate with morbidly irritable and suscep-
tible nerve-system, and a languid state of the organic functions (Stille);
it is in the pallid and anaemic that strychnia acts well sometimes (Tyrrell),
and it is in similar cases that I should be hopeful of good results from
silver. Curci considers that it does good in epilepsy connected with
spinal disease, but when dependent on local lesion as hemorrhage, soft-
ening, or tumor the malady is not influenced by it. More definite indi-
cations we cannot at present lay down, and must acknowledge that, of
any given number of cases, the majority at least will not yield to this
remedy, and others, if they receive temporary benefit in the prolonging of
the interval or lessened severity of the attacks, will ultimately relapse.

22 MATERIA MEDICA AND THERAPEUTICS.

The greatest objection to nitrate of silver, and one which has led to its
comparative disuse, is the possibility of its discoloring the patient, and
this even without curing his malady 1 have seen epileptics discolored
by the medicine, and yet suffering as severely as ever from their convul-
sions. Unfortunately the nature of the disease requires a long continu-
ance of treatment, and therefore a medicine must be preferred which
shall, at least, not inflict so visible an injury, and we need seldom pre-
scribe the silver salt until a fair trial has been made of bromides, of bel-
ladonna, etc. If, however, it be decided upon, then a purgative should
be given at the commencement of, and occasionally during treatment;
the remedy should be omitted for a few days at intervals, and the gums
should be carefully watched for signs of systemic saturation. The use
of nitrate for epilepsy in children has been objected to by Loobenstein,
but I have seen it of service in chronic cases. Brenner recommends the
chloride in infantile convulsions, and also in the brain-affections of
typhus. Niemann found advantage from the ammonio-chloride in epi-
lepsy and melancholia.

Paralysis Ataxia. We cannot speak with any confidence of the
power of silver compounds to relieve serious or chronic cases of this kind,
though there are not wanting records of improvement, more or less marked,
obtained under their use. Wunderlich reported seven cases of ataxy
arrested in progress under 5-gr. doses, two or three times daily; while
Charcot and Vulpian related five cases that had lasted respectively two,
four, five, and two of them fifteen years. A pill containing ^ to f gr.
of nitrate was given daily for from thirty-five to sixty days, and in every
case, in the course of a week, improvement commenced as to sensibility,
power of placing the limbs, as to sight, and especially as to lessening of
pain (" Memoire sur le Nitrate," Bulletin de Therapeutique, 1862). The
report of such cases caused much sensation, but Topinard, who criticises
them closely, asserts that in some the diagnosis was imperfect, and that
admitting it in the others to be correct, there were unsuccessful cases to
be compared with them, and many others unrecorded (" De 1'Ataxie Loco-
motrice," Paris, 1864). He has collected altogether twenty-eight cases,
more or less favorable to the efficacy of the nitrate, and nine unfavorable;
to these, he has added seventeen cases carefully noted under his own
observation: commencing with -fa gr. daily, he continued it for ninety
days, interrupting the course every eight days for a week; then gr.
was given for four months. In the first case reported, no good result
was obtained, though erections recurred; at the end of the treatment
the patient was worse, and the same has to be said of eleven other cases:
in the remaining five there was some amelioration of symptoms. Alt-
haus, on the other hand, has had, on the whole, a favorable experience
with this remedy, and I believe that I have seen benefit from it in re-
lieving the " lightning pains," and in arresting, for some time at least,

SILVER. 23

disorder that was progressing, but it is no specific against locomotor
ataxy.

Diphtheritic and Mercurial Palsy. A case of the former kind, cured
under the use of nitrate, is recorded (American Journal Medical /Sci-
ence, April, 1865, p. 485), but I am not aware of others. Fairly rapid
recovery in six instances of mercurial palsy is reported by Sernentini
with doses of from to 3 gr. daily (quoted by Dr. Waring).

Nerve- Debility Headache. In some few cases of nerve-debility and
depression connected with overwork, anxiety, or excess, and exhibiting
hypochondriacal symptoms morbid fear, impaired mental capacity, and
frequent rather deep-seated fixed headache I have seen improvement
under the use of nitrate, and have felt justified in connecting it with this
drug, because iron, and bromides, and other remedies had been used
without advantage, and the patient's mode of life and circumstances were
not altered when the silver was commenced.

In hysterical or nervous headache it was valued by Dr. Graves, and
others have found it useful in neuralgia, for which Paterson recommends
especially the iodide. If the headache be accompanied with constipation
or gastric disorder, an occasional laxative is required.

Various Diseases. Other disorders, which may either be called " ner-
vous " in character, or are connected at least with reflex nerve-disorder,
and which the salts of silver have been found sometimes to relieve, are
such as chorea, angina pectoris (Copland, Diet.), spasmodic asthma
(Waring, Ourci), palpitation (Kopp), vertigo (Rademacher), pertussis
(Berger): for this last iodide is especially recommended. They have been
given also in more general diseases, as intermittents (Sokolow), diabetes,
and phthisis (Brady, Moore), the object desired in these latter cases be-
ing mainly to lessen the excessive discharges from the kidneys, the skin,
and the bowels; in some instances they have certainly succeeded, though
we could not expect them to alter the ultimate termination of such mala-
dies. In dropsy the nitrate was given by Boerhaave as a purgative in 2-
gr. doses, and has been more lately commended by Dreyer (Husemann).
In syphilis the chloride and oxide were given by Serres and others, but
their value has been disproved by Ricord. The ammonio-chloride has
been used as a cathartic and a vermifuge.

PREPARATIONS AND DOSE. Argenti nitras : dose, % to ^ gr. (B.P.);
it may vary from -fa to \ gr., and more has been sometimes prescribed.
Argenti oxidum : dose, ^ to 2 gr. in the form of pill.

The dose of the chloride is about the same as that of the oxide,
though upward of 30 gr. have been given without gastric pain (Trous-
seau): the dose of iodide and other salts is also about the same as the
oxide.

As a caustic the solid nitrate may be used alone, or " mitigated "
e.g., with nitrate of potash (Crayons de Barral, de Desmarres), or with

24 MATERIA MEDIC A AND THERAPEUTICS.

sulphate also (Guyot). In default of a metal, or caoutchouc, or quill
holder, melted sealing-wax forms a convenient coating, and a file, or fric-
tion with wet lint, sharpens the point better than a knife : for small fis-
tula or numerous leech-bites, a silver probe, dipped as required in the
melted salt, is very convenient. The finely powdered nitrate, diluted (as
with sugar), has been used for the throat and larynx, and abroad, charpie,
dipped in a strong solution and dried, is used as a dressing for indolent
wounds, and known as the black or caustic charpie of Riboli (Husemann).

Of solutions, 40 gr. in the ounce will prove caustic to mucous mem-
branes, and from 80 gr. upward caustic to the skin; distilled water, gly-
cerin, or nitrous ether may be used as solvents (v. p. 14) ; opium may
be added to diminish pain, and after a strong application the part, espe-
cially if it be the eye, should be bathed with warm salt water to neutral-
ize any excess of caustic 20 gr. to the ounce is a useful strength for an
astringent solution, but a proportion of 10, 5, and even 1 gr. to the ounce
is suitable according to the condition of the affected part, and may be
used in lotion, injection, or collyrium, as already described, it being re-
membered that the weaker solutions require to be used the more fre-
quently : the disadvantage of the salt staining linen must be borne in
mind.

Both the nitrate and oxide have been used in stimulating and astrin-
gent ointments : thus, in the Hamburg Pharm., 15 gr. are ordered with
1 dr. of Peruvian balsam and oz. of zinc ointment (Ungt. Nigrum), and
Lane used the oxide in specific and other ulceration, but I do not think
ointments a good form of the remedy.

Since the salts of silver are readily decomposed, they should be mixed
as little as possible with organic or mineral substances, and haloids, sul-
phides, alkalies, soaps, tannin, and astringent extracts should be excluded
from prescriptions for silver compounds: it is important to mention, also,
the exclusion of creosote, for explosions have occurred from its trituration
with oxide of silver and organic substances. Solutions of the nitrate for
internal use should be kept as much as possible from air and light, and
are therefore commonly ordered in covered or dark-glass bottles: they
may be made with distilled water or with glycerin, and sometimes a few
drops of nitric acid are added to prevent reduction; syrup may be given
with it for children. Delioux prescribed it with an equal part of salt in
a weak, sweet, albuminous solution (white of egg), and Deniau added to
this a small proportion of bromide of potassium to redissolve the precip-
itate; but, in such combinations, the object of which is to secure solubility
and absorption, we are not giving the nitrate, but a complex chloro-albu-
minate. Discoloration of the lips and teeth, and nauseous taste, are,
however, drawbacks to the use of any solutions. A pill may be made
with crumb of bread according to an old and well-known formula (Bou-
din) : the decomposition into chloride that may occur is unimportant (v.

AESENIC. 25

p. 2). Argilla and silica and chocolate have been recommended as ve-
hicles.

The oxide is always given in pill or confection, and this form is to be
preferred for " constitutional " effects, or for an action on the lower parts
of the intestinal tract. It is usual to direct a patient taking these medi-
cines to abstain from much salted food before or after the dose, as likely
to hinder absorption into the blood.

[PREPARATIONS, U. S. P. Argenti cyanidum, used in preparing hy-
drocyanic acid; Argenti nitras ; Argenti nitras fusa ; Argenti oxidum.~]

AESENICUM AESENIC, As, =75.

The name arsenic is applied by common usage both to the element
and to its oxide, which is more correctly termed arsenious anhydride; it
it also called white arsenic, or arsenious acid.

The element, formerly classed with metals, now with metalloids, occurs
sometimes native, but generally in alloy with iron, copper, and other
metals, as oxide and sulphide. Nearly all sulphur contains some arsenic,
and from these different compounds it is liable to pass undesignedly into
many pharmaceutical preparations. Mineral waters also frequently con-
tain it; Tripier has noted its almost constant occurrence in chalybeate,
and Thenard in saline springs, though in minute proportion: those of
Plombieres contain but 0.0008 gr., Vichy 0.01 gr., and La Bourboule (the
largest amount) -fa gr. in 16 oz.

CHARACTERS. The metalloid is a steel-gray solid of metallic brilliancy,
readily oxidizing and tarnishing on exposure to air. It volatilizes at a
dull heat, the colorless vapor having a garlic-like odor. It burns when
heated in the air.

ACIDUM ARSENIOSUM ARSENIOUS ACID, OR ARSENIOUS ANHY-
DRIDE-WHITE ARSENIC, As a 3 ,=198.

PREPARATION AND CHARACTERS. Arsenious acid is prepared by sub-
limation from arsenical ores, and condenses in the cooler parts of the re-
tort as a heavy powder, fine and white, like flour; in the hotter parts, it
forms a vitreous mass, transparent and amorphous, which becomes, on
exposure to air, opaque and crystalline, and is usually seen in smooth
milk-white or yellowish pieces not unlike porcelain, and stratified in ap-
pearance according to the different opacity of its layers; the change from
the amorphous to the crystalline form is accompanied with phosphores-
cence (one of several of its analogies with phosphorus). The two forms

26 MATERIA MEDICA AND THERAPEUTICS.

differ in density and in solubility, the transparent acid dissolving in about
100, the opaque in about 80 parts of water at 15 C.

The powder is not readily wetted by water, so that it is apt to remain
floating on the surface, or adherent to the sides of a vessel. Organic
products, milk or mucus, render it less, acids and alkalies more, soluble;
oils and alcohol also dissolve it. It crystallizes from a saturated solution,
or after slow sublimation in minute shining octahedra, or in rhombic
prisms (like oxide of antimony, with which it is isomorphous): sprinkled
on a red-hot surface, it evolves scarcely visible vapors of metallic arsenic,
which have an odor like garlic, and, at a few inches from the hot surface,
change to dense white odorless smoke, being the acid re-formed by oxida-
tion. Arsenious acid itself has no smell: its taste is sharp and rather
nauseating (Hirtz), but, in such small quantities as may be taken for
trial, nothing more than a slight sweetness and grittiness will be de-
tected (Christison).

LIQUOR ARSENICAL1S ARSENICAL SOLUTION FOWLER'S SOLU-
TION.

PREPARATION. By boiling together arsenious acid and carbonate of
potash, and adding to the solution (when cold) tincture of lavender, and
sufficient water to preserve a proportion of 4 gr. in the ounce.

CHARACTERS. A reddish, alkaline liquid, with the odor of lavender:
it contains a mixture of arsenite and carbonate of potash.

LIQUOR ARSEN1C1 HYDROCHLOR1CUS HYDROCHLORIC SOLUTION

OF ARSENIC.

PREPARATION. By boiling arsenious acid with hydrochloric acid and
distilled water, preserving a proportion of 4 gr. to 1 oz. (This solution
corresponds in strength with liquor arsenicalis; it is nearly three times
the strength of liquor arsenici chloridi, London, and of the original acid
solution of De Valangin.)

CHARACTERS. A colorless liquid of acid reaction and sp. gr. 1.009.

SOD^E ARSENIASARSENIATE OF SODA.

PREPARATION. By heating together arsenious acid, nitrate and car-
bonate of soda, dissolving and crystallizing.

The liquor sodce arseniatis contains 4 gr. of the anhydrous salt in 1
oz. of distilled water.

CHARACTERS. The salt occurs in colorless transparent prisms soluble
in water and alkaline in reaction: the solution is also colorless and alka-
line.

AKSENIC. 27

Arsenic Acid, As 2 O 6 , the higher oxide of arsenic, is also white and
solid, but is so soluble as to be almost deliquescent, and it has a strong-
acid reaction. It is not employed in medicine in its free state, but in
combination with soda and iron. In the arts it is largely used in the print-
ing of cotton stuffs, and in the manufacture of aniline dyes.

Ferri Arsenias Arseniate of Iron, Fe 3 As 2 O 8 (v. p. 134).

Liquor Arsenici et Hydrargyri Ilydriodatis. A solution (not of-
ficinal) containing a double iodide of arsenic and mercury, has long been
in use under the name of its proposer Mr. Donovan, of Dublin (1839).
It is a pale-greenish colored liquid, having no odor, but a styptic taste;
it probably contains the red iodide of mercury and ter-iodide of arsenic.
In each fluid drachm there is about -fa gr. arsenic, ^ gr. mercury, gr.
iodine.

TESTS. 1. Sulphuretted hydrogen gives a bright yellow precipitate
of arsenious sulphide (As a S 3 ) in acid solutions of arsenious acid or the
arsenites.

2. Hume's Test. Ammonio-nitrate of silver gives a lemon-yellow
precipitate of arsenite of silver (Ag 3 AsO 3 ) in solution of arsenious acid,
or the arsenites. The same silver-salt gives a similar reaction with phos-
phoric acid, but with arsenic acid and the arseniates, a chocolate-colored
precipitate of arseniate of silver (Ag 3 AsO 4 ).

3. Ammonio-sulphate of copper gives with compounds either of ar-
senious or arsenic acid a light-green precipitate of arsenite of copper (Cu
HAsOJ, Scheele's green.

4. Marshes Test. Generate hydrogen by the action of a hot solution
of caustic potash or soda on zinc (Zn + 2KHO = K 2 ZnO 2 4-H 2 ). Fleit-
mann has shown that antimony will not combine with this form of hydro-
gen, but that arsenic will. Place the solution to be tested in a " Marsh's
apparatus," and if arsenic be present it will combine with the nascent
hydrogen to form arseniuretted hydrogen (As 2 O 3 -f 6H 3 = 3H 2 O + 2AsH 3 ).
On igniting the jet of gas (which burns with a bluish flame), and depres-
sing upon it a cold porcelain plate, an arsenical stain will be deposited,
while the hydrogen is burned off into water. The stain has the following
characters: (a) metallic brilliancy; (b) hair-brown color; (c) volatility;
(d) solubility in chloride of lime; (e) non-solubility in cold disulphide of
ammonium; (f) when evaporated with a drop of nitro-hydrochloric acid
it yields a residue of arsenic acid, which gives a brickdust-red turbidity
on the addition of nitrate of silver.

5. Reinscfi's Test. A piece of copper foil, when boiled in an acid
solution of an arsenical compound, will become slate-gray from the depo-
sition of a fine film of metallic arsenic. This test, to be complete, must
be verified by heating the coated copper in a narrow glass tube, when
metallic arsenic will sublime, and be deposited in a ring on the cooler
part.

28 MATERIA MEDICA AND THERAPEUTICS.

For the " reduction test " of white arsenic, it should be placed with
" black flux " in a similar tube perfectly dry, and, on heating first the
charcoal and then the arsenic, the latter sublimes and is deposited in a
metallic ring as above mentioned.

ABSORPTION AND ELIMINATION. Since the observations of Schmidt,
Mialhe, and others, metallic arsenic has been considered inert. Recently,
however, Schroff has shown that it may exert a strongly poisonous ac-
tion, and that doses of 8 to 15 gr. have caused gangrene of the stom-
ach and death in thirty to forty hours (Zeitschrift der Arzte, i., 1858). It
is probably oxidized before absorption.

Arsenious acid in all its combinations, and by whatever channel intro-
duced by mouth or by rectum, by the lungs or by the skin is readily
absorbed, and has been detected in the blood a few minutes after its ad-
ministration. It passes out by the skin and mucous membranes, by the
various glands, as the salivary and even the lachrymal, but mainly by the
kidneys.

The rapidity of elimination varies; in some cases, none of the sub-
stance could be detected in the secretions three days after the last dose,
but in Ludwig's observations on animals, if small quantities were given
for a fortnight and then omitted, the urine was not quite free till three
weeks afterward (Medical Record, 1877). Gubler gives six weeks as the
time during which it may continue to pass out, and when it has ceased
to do so it may reappear after administration of iodide of potassium;
hence it seems probable that elimination is not always complete, and
that of what is taken, a part may be deposited in the tissues and occa-
sion so-called " cumulative " effects. Recently, arsenic has been found
to be specially deposited in the nervous system; thus, if in fresh muscle
1 part is found, the proportion in liver is 10.8, in brain 36.5, and in spinal
cord 37.3 (Scolosuboff: Annales d'Hygiene, January, 1876). This be-
came a matter of great importance in a recent French trial (Danval),
when the experts were blamed for not examining the brain and cord
(British Medical Journal, ii., 1878, p. 73); these parts should henceforth
be analyzed as carefully as the abdominal viscera. Caillol (de Poncy)
offers some analyses to show that arsenic partly displaces phosphorus in
nerve-compounds (Medical Record, 1878). If any be contained in the
body at death, it may be detected after an almost indefinite period.

PHYSIOLOGICAL ACTION (EXTERNAL). Preparations containing arse-
nic produce local irritation, inflammation, or destruction of tissue, in vary-
ing degree, according to the strength and character of the application.
Dry white arsenic in mass may not injure the unbroken skin, but arseni-
cal powders are apt to produce eruptions of various kinds on exposed
surfaces, and especially irritative effects on the pudenda, in those who
are employed in the manufacture of green dresses, wall papers, artificial
flowers, etc. (Annales d 1 Hygiene ; Dr. Guy: British Medical Journal,

ARSENIC. 20

ii., 1863, etc.). Perforation of the septum nasi has been noted, and anal
ulceration has followed the local use of a green paper colored with arse-
nite of copper. Arsenic dissolved or moistened is still more irritating,
and those who use it, for instance, in sheep-washing, generally suffer
from eczema of the scrotum, etc. (Lancet, 1857). Those who work with
arsenical powders are liable also to various degrees of acute and chronic
arsenical poisoning; and green colors are not the only dangerous ones:
fuchsine, a red dye, contains much arsenic (Ludwig: Medical Record,
1877), and blue gloves have shown arsenic on analysis (British Medical
Journal, ii., 1878). The use of green-colored cards has caused a disease
of the nails resembling psoriasis, and green hat-lining has caused eczema
(Farquharson: British Medical Journal, ii., 1879). The external use of
a violet powder adulterated with arsenic proved fatal to thirteen chil-
dren out of twenty-nine subjected to it (British Medical Journal, ii.,
1878).

The continued application of a strong arsenical compound has a cau-
stic, destructive effect, which is not simply a chemical one, like that of
caustic acids or alkalies, and is not exerted on the dead subject (Hirtz),
but is produced by interference with nutritive processes in the part, caus-
ing rather a condensation and "mummifying" of tissue than an actual
destruction (Gubler). It is much more active in unhealthy, ill-nourished
tissue (e.g., that of lupus), than it is in normal tissues. Very strong ar-
senical applications produce much local inflammation, and so far interfere
with the action of absorbents that the effect remains local only; but un-
less in such strong concentrated form, arsenic is readily absorbed, es-
pecially from wounds and mucous surfaces; hence its surgical use has
led to serious constitutional symptoms, and even to death. Roux de-
scribes the application of an arsenical ointment 1 part in 32 over a
space of 1 square inches of a cancerous breast for one night only, and
death from poisoning on the second day. Sir Astley Cooper relates a
fatal case from the use of an arsenical solution to a " fungus of the eye "
(Lancet, i., 1837).

Arsenical paste applied to an inflamed tooth-pulp has also proved
fatal, and Graham has recorded vomiting, severe pain, convulsion, and
death from the use of a plaster containing half its weight of arsenic to a
cancerous breast (Glasgow Medical Journal, 18G9); the prescriber of the
plaster was tried for homicide, and many similar cases have been before
the law courts.

The antiseptic power of arsenic deserves mention: it is largely utilized
in the dissecting room, and seems to have retarded the process of post-
mortem decay in some cases of poisoning when large amounts have been
used. The recent researches of Johannsohn assign it, however, but a
limited power: he found that small quantities checked fermentation in
yeast and syrup, but only for a time: in lactic fermentation it diminished

30 MATERIA MEDICA AND THERAPEUTICS.

the growth of one fungus, but favored another. The same thing occurred
in urine: it exerted no influence on non-organized ferments, such as pep-
sin, amygdalin, etc. (Archiv fur Exper. Path., Bd. ii., p. 106).

PHYSIOLOGICAL ACTION (INTERNAL). The blood and the nutrition-
processes are altered by arsenious acid and its compounds, but the symp-
toms of its physiological action are mainly evidenced in the alimentary
canal, the mucous membranes, and the nervous system, and in different
cases these parts are affected in different degree, according to the dose,
the time and mode of its administration, and the constitution of the in-
dividual.

Digestive System.. Very small doses, such as -fa to -^ gr., may be
taken for some time without other effects than such as are of stimulant
and tonic character e.g., improvement of appetite, sense of warmth at
the stomach, and general invigoration; but usually, sooner or later, these
symptoms are replaced by those of irritation and malaise. Trousseau
quotes from Koepl the case of a servant who, desiring to get rid of a
severe mistress, mixed with her food for some time very small doses of
arsenic: the mistress, however, improved in appearance and in stoutness,
and the plot was only detected after the use of a large poisonous dose.
Doses of ^ to \ gr. are liable to produce soreness of mouth, with some
salivation and dysphagia, foetid or sour taste, thirst, heat and constriction
in pharynx, with nausea or vomiting, gastric pain, flatulence amounting
to tympanitis, and diarrhoea. Vaudrey found copious pultaceous stools
follow the medicinal use of arsenic without toxic symptoms. One of the
early symptoms of the physiological action of the drug is a slimy silvery
aspect of tongue, "as if nitrate of silver had been lightly applied" (Beg-
bie), an appearance produced by a thin coating of mucus secreted under
the influence of irritation. After continued doses, the tongue becomes
red or brown, cracked and tremulous, the gums bleed, and the buccal
membrane becomes covered with aphthous or even membranous patches
like a true diphtheritic condition (British Medical Journal, \., 1862).
Vomiting becomes so frequent that all food is rejected, and emaciation
sets in rapidly, an effect which has been termed " tabes arsenicalis."

After poisonous doses, which may be stated at 2 gr. and upward, the
symptoms already described become intensified; pain especially of most
severe burning, cramping, spasmodic character comes on within half
to one hour, in the region of the stomach and navel, spreading thence
over the whole abdomen, which becomes contracted and hard: the ejecta
are offensive, and yellowish or greenish in color, not unlike bile (unless,
as often occurs in cases of poisoning, soot or indigo has been mixed with
the arsenic); hiccough attends the vomiting and purging; the latter be-
comes involuntary, and is accompanied with severe tenesmus, and the
general symptoms may closely simulate those of cholera (Lancet, ii.,
1870).

ARSENIC. 31

On the other hand, in some exceptional cases, the vomiting 1 has been
only moderate, and there has been complaint of coldness rather than heat;
in others, there has been almost entire absence of pain, the patient re-
maining in a dull and semi-narcotized condition, and in several even se-
vere cases, a remission of symptoms has occurred for some days before
death (cf. Taylor: Guy's Reports, 1850).

In experimenting with frogs, Dr. A. Lesser found that intestinal peri-
stalsis was increased by arsenic, and local tetanic contractions occurred
from immediate irritation of ganglia in the intestinal coat (not indirectly
from influence of the central nervous system): gastro-enteritis was also
produced by the drug, but he did not, as Bohm did, find it more poison-
ous when given by the mouth than by a vein. It was eliminated by
the intestinal mucous membrane (Virchow's Archiv, 1878; Lancet, ii.),
and we may add here that by whatever channel toxic doses of the drug
are given to men or animals, gastric inflammation is commonly deter-
mined.

Nervous System. The early effects of very small doses are usually
tonic in character, there being a general sense of improved power. The
same fact was noted when describing effects on the digestive system, and
it is possibly not a primary nerve-tonic effect, but rather dependent on
improvement in appetite and assimilation of food.

Full medicinal doses, long-continued, give rise to numbness and prick-
ing sensations with tremor or stiffness of limbs.

Irritant doses cause gastric pain, as already described; sometimes
headache has been a marked symptom, as, for instance, in a large number
of children who each received about 1 gr. of white arsenic in milk ("Tay-
lor on Poisons," p. 295), and in many persons poisoned by the accidental
admixture of a small quantity of arsenic in bread: they suffered also from
a feeling of constriction over the forehead, vertigo, and tinnitus (Dr.
Feltz: Lancet, i., 1880), from visual sensations of light or flame, prostra-
tion, and feebleness of lower extremities, and in these, as well as in
other cases, pain in the back has been urgent (British Medical Journal,
i., 1873). Sometimes the extremities have been very sensitive. Restless-
ness, insomnia, grinding of teeth, giddiness, irritability, and depression
are frequent symptoms.

The effects of poisonous doses (6 to 8 gr.) are often ushered in with
rigor, profound depression, and extreme anxiety. Restless tossing of
arms is commonly noted, and later, numbness, cramps, and twitchings of
all muscles. The oesophageal spasms may simulate those of hydrophobia,
and the muscular cramps may amount to opisthotonos convulsions alter-
nate with delirium, the special senses become impaired or lost, the mental
faculties torpid (the stupor may suggest narcotic poisoning), and syncope
or collapse may close the scene. There may be local palsies, as of limbs
and sphincters in the course of arsenical poisoning, and, as the effect of

32 MATERIA MEDICA AND THERAPEUTICS.

the drug in this direction is not so generally known, we may, with advan-
tage, speak of it more fully.

Arsenic exerts a paralyzing influence certainly upon sensory and mo-
tor, and we may say probably upon vaso-motor nerves also. Dr. Sklarek,
experimenting on the frog, found that arsenical injections, in minute quan-
tities, destroyed common sensibility, probably by influence on the cord
(Reichert's Archiv, 1866). Lesser, while verifying this, noted a transient
increase in reflex irritability, then diminution of it, then cessation; after
some time the frog became completely paralyzed.

Drs. Ringer and Murrell, remarking that paralysis occurs in the same
order after mechanical arrest of circulation (as by ligature or excision of
heart), instituted experiments to show whether the latter was the real
factor in Sklarek's results, and concluded that they were due rather to a
toxic action on the central nervous system; peripheral motor nerves re-
tained their function for some time, for the muscles continued to contract
under direct galvanic stimulus; ultimately both nerves and muscles were
paralyzed by arsenic, and they ceased to re-act long before similar mus-
cles did in a brainless frog, and the observers named concluded that "ar-
senious acid is a protoplasmic poison, affecting first the more highly or-
ganized nervous centres, next the nerves, and last the muscles: . . . that
it is a poison to all nitrogenous tissues (Journal of Physiology, i., 1878-
79, pp. 227, 228).

Clinical records clearly indicate paralysis as a symptom of arsenical
action. So early as 1711 Morgagni notes " tremor of limbs, and palsy of
feet" (Op., vol. iii., Trans. Alexander, Letter 59). Mr. Trend reports
the case of a pregnant girl, who took 2 gr. twice daily for three months,
and besides intestinal symptoms, suffered from pricking pain in both legs,
impaired sensation, and loss of power (British MedicalJournal, ii., 1858).
Partial paralysis and numbness from habitual taking of the drug are re-
corded in Schmidt (Bd. clxv., p. 238), and tremor and partial palsy from
exposure to arsenical vapor in aniline works, by Dr. G. de Mussy (Lancet,
i., 1876). Dr. Leroy (d'Etiolles), who has written specially on the subject,
describes a case of paraplegia succeeding to acute arsenical symptoms after
the application of a caustic paste to a cancerous breast, and another ag-
gravated case of paraplegia, weakness and anaesthesia of arms with diar-
rhoea, and ultimately death from marasmus (Gazette Ilebdom., 1857).

Christison has remarked that arsenical palsy resembles that of lead in
its character, and Gubler and Duchenne have found it sometimes indenti-
cal. Leroy, however, points out that it not so invariably affects the ex-
tensors, and that it is more generalized.

The wasting of limbs is more general, and they may become semi-
flexed; when all are affected, the upper recover before the lower, a point
of difference from cerebral palsies. An average duration is from four to
ten months, and the prognosis is favorable under treatment.

ARSENIC. 33

Circulatory System. After administration of arsenic, analysis has de-
tected it in the clot i.e., united with globules, and not simply dissolved
in the serum. Claude Bernard taught that it acted on the corpuscles in
such manner as to diminish the activity of interchange of oxygen and
carbonic acid (Medical Times, ii., 1861). The experiments of Brodie had
already indicated undue fluidity of blood as an effect of arsenic, and mod-
ern observations refer this condition to a solvent action on haemoglobin:
thus, if arseniuretted hydrogen be passed into defibrinated blood, it be-
comes black, and gives with the spectroscope one large dark band instead
of the two normal ones; by degrees, the spectrum wholly disappears, the
haemoglobin is destroyed, and the liquid turns yellowish-green. It seems
probable that the same gas is developed to some extent from arseniates
absorbed into the living organism, and that it exerts a similar destructive
action on the globules; this would explain the anaemia, and the consequent
oedema and anasarca, met with after continued use of even medicinal
doses, as well as the icteric tint of skin, and the petechiae and hemor-
rhages in cases of poisoning. Though there is evidence that in certain
forms of anaemia the number of the corpuscles is increased under arsenic
(Gowers: Practitioner, July, 1878, and Bramwell), there can be no doubt,
that an opposite result follows both its long-continued use in disease, and
any appreciable quantity of it taken by healthy persons. Thus, Lemare-
Piquot (Honfleur), suffering from cerebral congestion, had himself bled
many times, and by careful observations of the proportion of clot to se-
rum showed that the continued use of arsenic could markedly lessen the
former. The normal maximnm proportion of clot he reckoned at 54 per
cent. ; with any amount above this, cerebral symptoms, such as giddiness
and oppression, appeared. In October, 1845, when suffering from such
a condition, he found, on being bled, that the proportion of clot was 68
per cent., the serum being at 32 per cent. only. During the next four
years he was bled more than twenty times with but partial and temporary
relief. In March, 1849, he began the use of arsenical solution in small
doses twice daily, at that time his proportion of clot being 69 per cent.
After one month's arsenical treatment he felt well, and the proportion
found on bleeding was reduced to 52 per cent. In succeeding years the
same result occurred several times; he illustrated it also in other cases,
and concluded, both from analyses and clinical results, that arsenic always
rendered the blood less plastic, and lessened the number of globules (Bul-
letin de Therapeutique, t. Ivii., 1859). More recently Cutler and Bradford
also found red and white corpuscles to 'be diminished in number under
arsenical medication, and Malcolm Morris reports diminution in some
cases of psoriasis when the general health was good e.g., F., aged twen-
ty-three, on August 14th, showed 58 corpuscles in each square (of Dr.
Gowers' instrument), was ordered Fowler's solution (TTt,v. ter die), and on
21st showed 48 only per square: continuing treatment, on September llth
VOL. II. 3

34 MATERIA MEDICA AND THERAPEUTICS.

there were only 37.3 the eruption was nearly gone {Practitioner, 1880).
The force and frequency of the heart's action and the activity of the
capillary circulation are usually increased by minute doses (Feltz, Har-
less) and especially in weakly persons (u. p. 35) : larger quantities induce
palpitation with quick, small, and irregular pulse ; the face is flushed,
while the extremities are cold.

Poisonous doses markedly depress the circulation, and ultimately ar-
rest heart-action (in diastole) in the lower animals, as found by Sklarek
in batrachia and in cats there was no previous stage of excitement
(Reichert's Archiv, 18G6). Although the frog lives on for ten minutes
after arrest of cardiac action, no stimulus will re-excite this, and yet ir-
ritability of cardiac muscular tissue persists, so that Sklarek concluded
that arsenic paralyzed the motor ganglia of the heart. Unterberger also
records a very pronounced fall in the blood-pressure and pulse-rate
(Archiv. filr Exper. JPathoL, Bd. ii.). There is clearly a direct depres-
sant effect on the heart in fact, this causes death in cold-blooded ani-
mals, though not usually in warm-blooded. Some palsy of vaso-motor
nerves is also indicated, and, according to several experiments, this is lim-
ited to the abdominal division of those nerves: the exact explanation,
however, requires further development. Though Lesser \erified Sklarek's
observations he did not come to the same conclusion that arsenic causes
death by paralysis of the heart, but denies it for the simple reason that
frogs survive excision of the heart for more than thirty minutes, while
arsenic kills them in ten minutes. Ringer and Murrell found (in frogs)
a varying effect upon the heart, it being sometimes completely arrested,
sometimes continuing to beat after complete general paralysis, but they
explained the difference by a variation in dose; a large one being quickly
absorbed and conveyed to the heart arrests it at once, leaving little for
the circulation to distribute, while a small dose paralyzes the central
nervous system before the heart (loc. cit.). In warm-blooded animals the
pulse-rate was increased at first by small and medium doses injected into
the veins, afterward it was diminished; by a large dose it was decreased
at once, and blood-pressure reduced. The increase of the pulse-rate was
traced to lessened influence of the vagus, and increased action of car-
diac ganglia, the decrease of pulse-rate to contrary conditions. Stimula-
tion of vaso-motor centres was not marked unless injections were made
directly into the carotid, and Lesser could not verify paralysis of those cen-
tres under any conditions (Virchow's Archiv, 1878). In the human sub-
ject, the pulse usually becomes weak, rapid, and gradually more irregular
till heart-action ceases : venous stasis naturally occurs, and there is pallor,
lividity, and finally cyanosis of the surface and of visible mucous mem-
branes.

Respiratory System. Lesser verified a markedly stimulant effect of
small doses, both on the respiratory centre and on the pulmonary ter-

ARSENIC. 35

minations of the vagi ; large quantities, on the other hand, extinguish
nerve-irritability in these parts. That the effect is directly on the centre
is clear from its occurrence even after section of the trunks of vagi, but
when these nerves are entire the effect is greater, so that they have some
share in it. Small doses taken under certain conditions as, for instance,
by the Styrian mountaineers render the respiration easier, less labored,
and less hurried under severe exertion. On the other hand, even medici-
nal doses, if long continued, will induce in some persons a dyspnoea,
allied to that of emphysema or even asthma, with dry cough or hawking
of .mucus. This I have verified several times in the subjects of eczema,
observing its cessation with the omission of the drug, and its return
under arsenical influence; there may be also hoarseness, coryza, tonsilli-
tis, or even, according to some observers, bronchitis (McCall Anderson),
probably from irritation excited in the bronchial mucous membrane by
the elimination of the drug; it has certainly some special determination
to the pulmonary tract. After large poisonous doses the dyspnoea is often
urgent, and the respiration stertorous.

Cutaneous System. In frogs, one effect of arsenic is to cause a ready
peeling or stripping of the whole cuticle some hours after hypodermic
injection (Ringer and Murrell). In man, small doses, continued for a
limited time, improve the skin-condition, and often (but not always) im-
part freshness and ruddiness to the complexion, while in animals they
render the hairy coat more glossy and bright. Kohler remarks that
since arsenic is eliminated by the sweat-gland -(especially when they are
acting vicariously for the kidneys), there is nothing remarkable in its
modifying the circulation and nutrition of the skin, and its effects are
explained by a capillary congestion and the presence of more blood in
the superficial vessels, and this again has been attributed to a vaso-motor
palsy allowing dilatation of such vessels.

Rabuteau thinks such a view cannot be accepted, because tempera-
ture is not raised as it is in experimental vaso-motor palsy i.e., after
sections of sympathetic. This, I think, is a question of degree the rise
might be more or less according to the amount of paralysis induced by a
drug it would not be so complete as after section. Moreover, Harless
reports a distinct rise, though recent experiments indicate a fall of tem-
perature as the more usual condition connected with arsenical action
(Lolliot). Rabuteau prefers to explain the florid color by an " altered
appearance of the globules."

When the drug is omitted after continuous use, an opposite condition
one of pallor and anaemia is said to follow (Medical Times, ii., 1854).
Certainly arsenic, if long continued, leads to an unhealthy, dry, and
somewhat scaly condition of skin, which has been called by some pity-
riasis, and by others even psoriasis, though I have never seen anything
like a true case of the latter malady thus caused. Rabuteau observes,

36 MATERIA MEDICA AND THERAPEUTICS.

" We never see squamous affections from arsenic, contrary to the asser-
tions of homoeopaths " (" Elements," p. 200).

Perhaps the extreme and most characteristic cutaneous result of ar-
senical saturation is a brown color of the face and various parts of the
body (Kirchgasser: Centralblatt fur Med,, 1868). It is not common, but
has been sometimes seen in such a form as to resemble argyria. Prof.
Wilson gives the following illustration: A lady had taken for fifteen
months comparatively large doses of arsenic for gutta rosacea, and two
months after commencing the medicine, a change of color had been no-
ticed in the skin, first over the abdomen, then or* the breast, neck, face,
and hands. When seen by Prof. Wilson the face was yellowish-brown,
the eyeball dark, the whole body colored more or less; chronic erythema
affected the palms, there were hard dry points at the sweat-glands, the
eyelids and the extremities were cedematous (Journal of Cutaneous Medi-
cine^ vol. i., p. 354). In some of Mr. Hogg's cases, children got a " dusky
skin-eruption in patches " from arsenical wall-papers (British Medical
Journal, i., 1879). Such a condition depends not on chemical combina-
tion (as with silver) but on abnormal pigmentation (Gubler).

Cold clammy perspirations have also been connected with arsenical
action, and pustules and ulcerations have sometimes followed it. In
acute cases, either of poisoning or of unusual susceptibility to the action
of the drug, patches of erythema or of urticaria (local congestions of
skin) and even acute general lichen may occur. Macnab recorded an
eruption like measles produced by 3-min. doses of Fowler's solution daily
for three weeks (Medical Times, i., 1868), and Wyss says that he traced
to it a case of alopecia areata from affection of the trophic nerves of
hair-follicles (Archiv der Heilk., 1870, Hft. i.).

Among rarer consequences, erysipelas with bulke has been credited
to arsenic, herpes has been traced to it by Mr. Hutchinson, and an obsti-
nate eczema by Dr. Balfour (Edinburgh Medical Journal, 1860). Dr.
Imbert Gourbeyre has specially written on arsenical eruptions, and, in
cases of acute poisoning when the patient survived several days, has
seen them petechial, papular, vesicular, and pustular.

A degree of cutaneous swelling, characteristic enough to have re-
ceived the name " oedema arsenicalis" usually occurs first about the eye-
lids and suborbital tissues, and is one of the earliest symptoms of consti-
tutional action. In severe cases it may affect the extremities and even
the trunk, and amount to general anasarca, as recorded so early as 1819,
(Edinburgh Medical Journal, v., 15). In Dr. Feltz's cases already re-
ferred to, there occurred, on the second or third day, swelling of the eye-
lids and conjunctivas in some instances of the whole face, with a rash
like scarlatina or urticaria. In most of them there was itching of the sur-
face, and scratching gave rise to an urticarial rash; in one man the same
eruption, together with herpes, appeared on the scrotum.

ARSENIC. 37

Mucous Membranes. We have already noted characteristic arseni-
cal effects upon the membrane of the mouth and intestinal canal. The
lips, the nose, especially at its orifice, the anus, and the vulva often be-
come similarly irritated and inflamed, and urethritis has been traced to
medicinal doses of arsenic (Medical Record, 1878). On the mucous mem-
brane of the eye the effect of the drug is often very early seen, so that it
becomes a useful index of the degree of physiological action. Itching
about the lids is first complained of, and a rough sensation as of dust in
the eye; the conjunctiva is seen to be congested, and purulent secretion
may be formed. Conjunctivitis is a frequent symptom in arsenical poi-
soning, and Dr. Taylor describes " tumid, everted lids and painful vision "
in patients affected by arsenical papers, etc. ( Ophthalmic Hospital Report,
1859, and British Medical Journal, ii., 1871).

Glandular System. Under small doses of arsenic the secretions are
increased, especially of those glands by which the drug is eliminated. In-
crease of quantity of the saliva is exceptional in acute poisoning, but oc-
curs when absorption takes place slowly and gradually. The bile, the
intestinal secretions, and, generally speaking, the urine are augmented
under its use; and if there be no diuresis the perspiration is commonly
stimulated, and arsenic can be detected in it (Kohler: Ilandbuch, p.
724). Hoffmann, Glauber, Agricola, and Pott have even recommended
arsenic for a diaphoretic effect, and I have myself sometimes observed
this from it.

Osseous System. Struck by Wegner's observations on bone-changes
under phosphorus, and following up the paper of Maas, " On the Influence
of Arsenic in Bone-growth, and its Value in Surgical Therapeutics "
(1872), Th. Gies has recently published some careful and interesting ex-
periments which well illustrate such influence (Archiv fur Exper. Path.,
etc., Bd. viii., Hft. iii., December, 1877). Using at first young rabbits
badly nourished, he found that arsenic destroyed them without causing
bone-change; but having, by careful food, secured for fresh animals ap-
parently more resisting power, the same daily doses (0.005 to 0.002
gramme arsenious acid) continued for nineteen to thirty -four days, seemed
to improve their condition, as compared with rabbits from the same litter,
and fed in the same manner (but without arsenic): the former were
larger, heavier, with clearer skin, and healthier-looking than the latter,
and after death the respective bones could be at once distinguished. In
the long bones of the arsenic-eaters was a special thick layer (arsen-
schichte) of bone between the epiphysis and the shaft; the shaft also was
thicker, and in bones, such as the ribs and the vertebras, the structure
was much more dense, and harder to divide, than in normal animals; the
new structure was true bone, but the bone-corpuscles and Haversian
canals were smaller than the average. Comparative experiments were
made with many rabbits, .cocks, and pigs, and in such manner as to

38 MATERIA. MEDICA AND THERAPEUTICS.

leave no doubt whatever that increased growth and condensation of
bony tissue were traceable to the action of arsenic. In old animals,
where epiphyseal gHowth had ceased, increase of thickness of bones oc-
curred: on the other hand, if the doses were increased beyond a certain
point, resorption of bone occurred, and symptoms of poisoning set in.
Bones purposely fractured had not united under the treatment, for their
small size made it impossible to keep them in position, but a false joint
formed, and much callus was round the broken ends;' there was fatty de-
generation of all internal organs. Gies does not adopt Wegner's view of
increased stimulus given to bone-formation, but rather that of Cunze and
Lolliot, that arsenic diminishes tissue-change, especially as regards carbo-
hydrates, and hence follow increased deposit and insufficient removal of
organic particles.

Genital System. This system often shares in the general stimulation
and irritation induced by small doses of arsenic, as has been noticed in
the arsenic-eaters of Styria, and in experiments on animals. Gies espe-
cially remarked it in the cocks used for his observations on bone-growth
(loc. cit.). Clinically, Prof. Charcot was led in two cases to a contrary
conclusion, but Devergie showed that this could not be sustained, and
that stimulation to some extent was not unusual (Bulletin de Thtrapeu-
tique, 1864); this, however, is not such as to preclude the medicinal use
of the drug, and it finds its place in the treatment of amenorrhoea.

In arsenical poisoning, inflammation of the genitals has been said to
occur (Hunt), and certainly much irritation of them has been present,
especially in women; but it would seem to be connected rather with the
general irritation of mucous membrane than with these special organs.
'The young of animals subjected to an arsenical course were born dead,
but fully developed; their birth was delayed rather than premature (Th.
Gies, loc. cit.), and no markedly injurious effect can be traced on the
uterus. In many instances of arsenic being taken by pregnant women,
even when with fatal results, abortion has not occurred ( Guy's Reports,
vol. vii.).

Urinary System. The urine is commonly increased in quantity for a
time under small doses, but with their continuance renal irritation may be
induced, so that the secretion is lessened, and elimination of the drug im-
peded. Hence it is an important practical point to examine the urinary
condition during arsenical treatment, and to use, if necessary, alkaline
diuretics. Lolliot traced hfematuria and albuminuria to arsenic, and, in a
case of pythisis, carefully recorded by Dr. Weir Mitchell, albuminus urine
was induced by 4 to 12 min. of Fowler's solution given daily for a few
weeks; anasarca also set in, and these conditions ceased and then re-
curred concurrently with omitting and resuming the medicine (New York
Medical Journal, vol. i.). After poisonous doses the urine, though at
first it may be passed too often, soon becomes scanty, and its evacuation

ARSENIC. 39

causes scalding pain and tenesmus; it may contain blood, albumen, and
casts, and sooner or later becomes suppressed; urethritis has been already
mentioned.

Urinary Excretion in Relation to Tissue-change. The estimation of
urea and other constituents of the urine furnishes important evidence as
to the influence of arsenic upon general nutrition and tissue-change, for
it is clear that if the principal urinary ingredients are increased under its
use, tissue-changes must be going on rapidly, and vice versa. There has
been some contradiction between observers on these points. Sabelin re-
corded increased excretion of urea under arsenic (from 12 to 28 gr.); also
marked increase in the chlorides and earthy phosphates, and proportionate
diminution of uric acid an incompletely oxidized product (hence G. See
argued that the drug favored oxidation and promoted metamorphosis
(" Nouv. Diet.," Art. Asthme) he has, however, himself since withdrawn
these views). Fokker published two analyses showing a slight increase of
urea after 0.01-gramme doses (Schmidt's Jahrb., Bd. clviii.), and Gaeth-
gens recorded the same in two dogs taking soda arseniate; also decidedly
increased tissue-change under toxic doses (Centralblatt fiir Med., 18*75,
No. 32, s. 529, and 1876, No. 47, s. 833). Binz and Schulz, relying upon
these observations, and noting also that hypodermic injection of arseni-
ous acid did not produce a local caustiff effect but inflammation in distant
organs e.g., the stomach have recently argued that " this substance, in
contact with living protoplasm, acts in the tissues as an oxidizing agent
or carrier from one albuminous molecule to another, being converted dur-
ing this process into arsenic acid, then reduced, again oxidized, and again
reduced " ( Centralblatt filr Med., ii., 1879; Medical Times, i., 1879). But I
think the evidence insufficient for the conclusion, and all observations upon
fasting animals are open to the fallacy that urea may be increased by the
fasting, and consequent absorption of fat (Forster: Zeitschrift fur Biol-
ogic, xi., s. 522). The dogs utilized by Gaethgens were kept many days
on "water only, and a careful examination of the whole question leads to
the conclusion that the " tissue-change of inanition " is almost surely the
explanation of what he attributed to arsenic (F. A. Falck: Archiv fur
Exper. Path., August, 1877, Bd. vii.). Von Bock attributed any change
he could observe to the effect of fasting (Zeitschrift f 'fir Biologic, vii., s.
418-432), and held that arsenic acid in ordinary doses exerted no essen-
tial influence on tissue-change.

Others have concluded positively that it lessens excretion and change.
Thus Lolliot, in a careful thesis, records many observations and analyses,
from which he makes evident a diminution of urea and carbonic acid
under arsenic; he asserts, also, that it lowers temperature, and is a " medi-
cament d'epargne " it lessens the activity both of nutrition and denutri-
tion (" 3tude Physiol. de 1' Arsenic," Paris, 1868). Kohler classes it with
tea, coffee, cocoa, as " sparmittel " diminishing oxidation processes

40 MATERIA MED10A AND THERAPEUTICS.

(Handbuch der PhysioL TJierapeutik, 1876). In recent experiments by
Dr. Tamassia (Pavia), toxic doses of white arsenic given to animals, pro-
gressively lowered temperature up to, and after death (Medical Record,
January, 1878). Animals accustomed to an arsenical ration became py-
rexial and emaciated on its withdrawal, implying that some moderating
power had been removed. There is still, however, a discrepancy in the
observations on temperature; Harless reported a slight rise from small
doses, and Billroth, gradually increasing the dose to 40 min. daily in a
case of asthma, reported a febrile access in the evenings up to 101 F.
( Wiener Woch., 1871, No. 44).

Schmidt and Brettschneider found the excretion of urea and of car-
bonic acid under arsenic diminished 20 to 40 per cent. ; phosphates also
diminished. Schmidt and Stiirzwage likewise report diminution of car-
bonic acid and urea in rabbits under minute doses (Schmidt's Jahrb.,
Bd. clviii., pp. 13-15), and Rabuteau states that the elimination of urea
in a dog was lessened for three weeks after a few doses of arsenious acid,
at one time as much as 60 per cent.; he attributes its effect in lessening
tissue-change to an action on the blood-corpuscles.

I conclude that although some contradiction exists on this point be-
tween good authorities, yet the balance of recent evidence points to
lessened excretion, and consequently to lessened tissue-change as an effect
of arsenic.

Acute and Chronic Poisoning. Although not here concerned with
cases of poisoning further than as they illustrate physiological action, we
may note that if death occurs from large doses of several drachms, and in
the course of a few hours, it is generally from cardiac palsy, and is pre-
ceded by excessive prostration and fainting. If 1 or 2 dr. have been
taken, and the patient survives two or three days, the symptoms will be
mainly those of severe gastric and intestinal inflammation, as already de-
scribed, and the post-mortem appearances will correspond; while with
doses of 2 to 10 gr., when the patient survives much longer, and yet dies
ultimately from the'effects, these will be evidenced rather in the nervous
system (Hunt). If the poisoning be very chronic, and result from con-
tinued doses of -fa to gr., a general irritation of the system is apparent
from the symptoms of erethism or pyrexia with chills, redness of eyes and
of orifices of nose and anus, vesication on palms and soles, with dryness
of skin and brownish spots, pain in head and joints and abdomen, with
vomiting, purging, and gradual marasmus. The soreness of mouth and
salivation have sometimes suggested mercury as the poisonous agent,
and sometimes the general condition has been mistaken for phthisis, or
for typhoid. Gaethgens further suggests points of resemblance with
diabetes and with phosphorus-poisoning ( Centralblatt fur Med., 1875,
Bd. xiii., p. 32, Abstract in Schmidt, 1876). An instructive case which,
for a time, completely deceived the medical attendants, and yet which

ARSENIC. 41

reveals exactly the physiological action of arsenic as we have described it
including renal and nerve-symptoms is that of Mrs. Wooller as col-
lated by Sir R. Christison (Edinburgh Medical Journal, 1855).

PATHOLOGICAL CHANGES. In cases of acute poisoning, the principal
changes occur in the stomach and intestinal tract; redness and inflamma-
tion of these parts may be found within a few hours of administration;
ulceration is not uncommon, gangrene and perforation are rare. In ex-
ceptional cases no marked redness has appeared, though arsenic has been
found in the stomach (Taylor). Under full arsenical influence there is
marked tendency to fatty degeneration of all tissues; in acute cases this
is preceded by inflammatory change, and according to Dr. Pinkham (Bos-
ton) it may be induced within forty-four hours (Medical Times, ii., 1878).
Jaundice occurs, and after death the liver-cells, the renal tubules, and the
intestinal glands are found choked with granules and fat-globules, their
epithelium being detached or destroyed. Salkowsky found these changes
in poisoned animals within three to six days, the glycogenic function of
the liver being impaired very early (Virchow's Archiv, Bd. xxxiv. ); it is
noteworthy that in such cases the fourth ventricle may be punctured
without causing glycosuria. Virchow described a swollen state of
Peyer's patches and the solitary glands, with fatty degeneration of epithe-
lium and " rice-water " secretion containing a fungus that had been
thought peculiar to cholera (Archiv, Bd. i., 1870). C. Gies has recently
given additional evidence of fatty degeneration of tissue under continued
small doses of arsenic, but notes also that the subcutaneous fat was in-
creased, and the animals gained weight. Increase of fat and of weight
have been observed in chronic arsenical poisoning in man (Boston Jour-
nal, 1876).

TOLEBAXCE. Arsenic Eating. Under certain conditions the system
may be brought to " tolerate " full, and even toxic doses of arsenic as of
some other drugs, without showing the usual physiological effects. To pro-
duce such result, it is necessary to begin with very small doses, and in-
crease them by degrees: thus Flandin, giving at first -^ gr. of arsenious
acid to animals, gave, after nine months of progressive increase, 15 gr.
per diem without poisonous symptoms (quoted by Stille).

Taylor distinguishes between "habit" and "tolerance," meaning, by
the latter term, only that power of bearing large doses which is shown in
certain exceptional states without any preparation ; thus, opium may be
tolerated in tetanus, alcohol in fever, and antimony in pneumonia; and
with regard to the ordinary form of tolerance as induced by habit, he re-
marks that it is mainly restricted to products of the vegetable or organic
kingdom as opium, tobacco, ether, strychnia. He doubts whether any
human being can obtain by habit any real tolerance of such mineral drugs
as corrosive sublimate and arsenic; and certainly experiments on the
point can never be pushed far in our own experience.

42 MATERTA MEDIC A AND THERAPEUTICS.

Yet, on the other hand, evidence in the affirmative does exist. I
understand that at Whitbeck (Cumberland) the inhabitants habitually
use a natural water which contains nearly a grain of arsenic in the gallon,
and are remarkably healthy and long-lived ( Chemical News, August,
1860). Professor La Rue reports the case of a man who so far accus-
tomed himself to the drug that he could take 3 or 4 gr. " without more
effect than cold water " (Boston Medical and /Surgical Journal, 1866) ; but
the main evidence seems curiously localized in parts of Austria and Styria,
nor can it be any longer dismissed as " pure fable " (Christison) or a
" Styrian theory " (Taylor), since the reports of Vogt and Tschudi in
1854 (Medical Times, ii.; Wiener Med. Woch., No. 28). M. Heisch, a
trustworthy witness, has recorded his personal experience to the effect
that he took 3 gr. as a daily dose for many years; he began it, when ap-
pointed director of arsenic works at Salzburg, with the object of protect-
ing himself from the effects of the fumes; he retained good health, but
when he attempted to leave off the drug suffered from restlessness, in-
somnia, faintness, and finally from lung-symptoms {Lancet, 1860). Pro-
fessor Schafer records that -^ to -j^ gr. is an initial dose commonly used
for the first fortnight, then it is omitted for the same period, and then
resumed and gradually increased to 5 gr. or more (Nothnagel, p. 241)
Heisch says that 23 gr. have been taken for a dose. Arsenious acid is
the usual form, but sometimes orpiment is substituted. Dr. Maclagan
saw doses of several grains swallowed, and he afterward detected arsenic
in the urine (Edinburgh Medical Journal, 1864); and I have myself
learnt from persons at Salzburg that the habit was very common, and have
seen men who had taken from 5 to 10 gr. daily for many years, with oc-
casional intermissions, and who looked robust and healthy. Near Harz-
burg they have the curious custom of regulating their doses by the moon
they gradually increase to the full moon, and then diminish and take
purgatives of aloes: some avoid drinking with their dose of arsenic, others
avoid fat, and others keep to a farinaceous diet, but the majority eat and
drink anything. The practice prevails mostly, if not entirely, among
the working-classes, but is not confined to men. Its effect is said to be
to increase fat and stoutness, and yet to render them more equal to exer-
tion, and especially to mountain-climbing without difficulty of breathing;
also to give freshness to the complexion, brightness to the eye, and gen-
eral vigor to bodily function. 1 It is agreed that much depression and
emaciation occur on the withdrawal of the drug from those who are ac-
customed to it, and although a certain number who commence early to

1 Gubler explains these effects by diminished oxidation and tissue-change (v. p.
40), suggesting the connection of muscular fatigue with formation of sarco-lactic
acid ; he presumes this to be lessened by arsenic alike in thoracic, respiratory, and
other muscles. They can therefore work longer, there is less carbonic acid to be dis-
charged by the lung, and less labor or hurry in respiration.

ARSENIC. 43

take it continue its use to an advanced age, yet it is said, and we can well
believe it, that it does much harm and even proves fatal in an insidious
manner to many persons, especially among the young. We cannot de-
pend upon securing an indiscriminate tolerance of arsenic; nothing of
the kind has been reported in this country, but on the contrary many
have suffered from a foolish imitation of the Styrian custom.

Effects of Arsenical Wall-Papers, etc. It is now clearly ascertained,
though the knowledge is comparatively recent, that all the serious symp-
toms already described may be produced, in greater or less degree, by
arsenical emanations from wall-papers and paints, hangings, dresses, or-
naments, etc.; and not only from the green colors containing arsenite of
copper, and which have long been suspected, but also from red, drab,
blue, gray, and enamel papers generally (.British Medical Journal, ii.,
1871), arid from aniline colors fixed by arsenical mordants in carpets, cur-
tains, etc. (Taylor: "On Poisons," 3d Ed., p. 353). Soon after the ear-
liest observations on the subject, in 1858, Mr. Phillips (the chemist con-
sulted by the Board of Trade) stated that a more than bearable heat
would be required to volatilize arsenic, but Fleck has pointed out that the
contact of moist organic substances (such as sizing) readily disengages
arseniuretted hydrogen from Schweinfurt green (Zeitschrift fur Biologic,
Bd. viii., 1872), and Hamberg has verified its presence in the air of rooms
(Pharmaceutical Journal, August, 1874). This gas is a very powerful
poison. Gehlen, the chemist, was killed by a small quantity, and in
some recent cases it caused severe epistaxis, haematuria, and jaundice
(Comptes Rendus, 1863; Gazette de Paris, No. 18, 1873). Usually, how-
ever, the injury is done by material particles of arsenical dust (Chevalier:
Annales d'Hygiene, vol. xii., p. 49). Some time ago I met with many
cases of catarrh, irritation of mucous membrane, etc., which proved to be
due to this cause, and I can quite corroborate the observations made by
Mr. Clarke, of Bristol (in a careful paper in British Medical Journal, i.,
1873), who finds that in one set of cases dyspepsia, nausea, sore throat,
and conjunctivitis are the prominent symptoms, while in another nerve-
troubles, headache, irritability, prostration, and ^restlessness are more
complained of, though dyspepsia, and especially coated tongue, are not
absent; in a third group the prostration, headache, and nervous excite-
ment simulate a mild typhoid. He records violent sneezing, and also
an eruption of eczema and of nasal ulceration as exceptional symptoms,
and further points out that a case of ordinary illness may be much ag-
gravated by an arsenical atmosphere, and that some patients are much
more sensitive to it than others. Arsenic was detected in the secretions
of several of Mr. Clarke's patients. The symptoms are generally worse
in a damp atmosphere, and in the evening when the room is heated. Dr.
Hinds describes " depression, faintness, nausea, and colic," after reading
by gaslight in a green-papered room (Medical Times, 1857). Mr. White-

44 MATERIA MEDICA AND THERAPEUTICS.

head reports similar symptoms in a youth every time he occupied a cer-
tain bedroom only (British Medical Journal, 1858).

The real cause of chronic ill-health may be long unsuspected, and a
striking case is related of the simulation of various forms of disease in
one family for upward of twelve years before their true cause was discov-
ered in arsenical wall-papers (British Medical Journal, ii., 1871). Dr.
G. Johnson has reported the case of a medical practitioner, in whom
chronic dyspepsia, catarrh, cough, and even asthma were due entirely to
the same agency (Medical Times, ii., 1874). Similar symptoms have fol-
lowed, though less frequently, from painted walls, gas-shades, etc. (Base-
do w, in Monthly Metrospect Medical Science, 1849; New Sydenham
Society's Year Book, 1860, etc.). Dr. F. Brown (Boston) has reported
several interesting and important cases of chronic illness from arsenical
paints and wall-papers: he notes that most of the patients had increased
in weight (Boston Medical and Surgical Journal, 1876). Some years ago
arsenic was purposely used for clarifying candles, and thus serious effects
were produced, which still sometimes follow the use of candles colored
green. Arsenical poisoning has occasionally occurred from cigars (New
Sydenham Society's Year Book, viii., p. 432), and from green cigar-hold-
ers (British Medical Journal, i., 1879). Mr. Jabez Hogg has drawn spe-
cial attention to eye-inflammation from arsenical papers and to other ill-
nesses produced by them (Sanitary Record, April, 1879).

SYNEKGISTS. Antimony is the most complete analogue of arsenic,
except that the former is a more certain emetic: phosphorus also is allied
in action.

The effect of small doses, upon the nervous system especially, is allied
to and supported by quinine and by alkaline bromides, while the tonic
influence of similar doses on the vaso-motor nerves (leading to contrac-
tion of vessels, at least temporarily) is allied to that of acids, astringents,
ergot, and cold applications. Doses sufficient to lessen oxidation and
combustion act somewhat like cyanides and other substances which pre-
vent these processes.

ANTAGONISTS II*COMPATIBLES. Diffusible stimulants, alcohol,
warmth, and, according to Gubler, opium, are the vital antagonists to
arsenic. Iron, in the form of hydrated peroxide, magnesia, calcined or as
hydrate, lime, animal charcoal, and astringents generally, are chemical
or mechanical antidotes. Iron and magnesia have power over arsenic in
solution, since they precipitate the poison in an insoluble form.; with solid
arsenic " they have no more effect than powdered brick-dust " (Taylor).
A mixture of hydrate of magnesia and persulphate of iron is best to use,
and the resulting sulphate tends to act on the bowels. The " antidotum
arsenici " of the German and other Pharmacopoeias contains calcined
magnesia 7 parts in 120 of water, solution of persulphate of iron (sp. gr.
1318) 60 parts in 120 of water: the two parts to be kept separately and

ARSENIC. 45

mixed at the moment of administration. Pure dialyzed iron is not anti-
dotal, but according to Mattison becomes serviceable if salt be added to
it (Medical Record, 1878), since this precipitates a hydrate.

In cases of poisoning, vomiting should be produced and promoted as
early as possible, by ipecacuanha or zinc sulphate: nor is antimony so
undesirable as has been stated; many cases have recovered under its use
(Morgagni, and Gazette des Ilopitaux, August, 1844, etc.), also after in-
fusion of tobacco (Medical Times, i., 1857). Milk and demulcent drinks
containing, e.g., eggs, flour, or fats, should be given, and large frequent
doses of any of the antidotes named, a tablespoonful of the iron com-
pound every five to ten minutes (British Medical Journal, ii., 1863).

THERAPEUTICAL ACTIOX (EXTERNAL). Parasitic Diseases. In sca-
bies, and in phtheiriasis, arsenic has sometimes been used, and a lotion
containing a small proportion 1 with soft soap and spirit of wine has been
much commended: it is painful in application, and has not seemed to me
so good as other remedies; neither is the use of this substance free from
danger, for an arsenical salve applied for scabies has produced poisonous
effects.

For ascarides Trousseau recommended an injection of -|- gr. of white
arsenic in 4 oz. of water; it is not often used, but would probably be
effective. M. Boudin used the same remedy in larger doses, but it is un-
necessarily dangerous.

X/upus Cancer. In these maladies the caustic action of arsenic is
often extremely valuable, and the powdered drug may be used sufficiently
strong to destroy diseased tissue without affecting the adjacent sound
skin. For chronic superficial lupus, especially of the face, Hebra recom-
mends " Cosme's paste," containing 20 gr. of arsenious acid and 60 gr.
of cinnabar in 1 oz. of rose ointment (cold cream): this is spread on linen,
and applied firmly for twenty-four hours, and then renewed for the same
period, a third application being made if required. I have often used
this with good results; at first there is little change produced, but by the
second day the growth turns gray, and by the third day commences to
slough, and may be separated in a poultice. Pain and oedema may occur,
but can be relieved by sedatives and warm applications. Among many
hundred cases thus treated no poisonous symptoms have been reported.

In epithelial cancer arsenic has long been used. Rousselot combined
it with cinnabar, and Dupuytren with calomel, and Mr. Marsden has writ-
ten in praise of its association with an equal part of mucilage. The paste
commonly known in Ireland by the name of Miss Plunkett's is prepared
with arsenious acid, sulphur, and two species of ranunculus: it often acts
powerfully.

1 Arsenious acid 1 part, carbonate potash 20 parts, soap spirit 200 parts, water 2,000
parts. (Soap spirit is made with equal parts of soft soap and spirit of wine.)

46 MATEKIA MEDICA AND THERAPEUTICS.

As already stated, caution is required in the external use of arsenic:
not that it should be applied in a more diluted form, for then its absorp-
tion would be even more probable, but only a limited area not more
than one square inch should be covered at one time. Dr. Walshe has
specially insisted that its use should be restricted to superficial cancer.
From the internal administration of arsenic I have had good results in
epithelioma (v. p. 66).

Dental Surgery. Arsenious acid is in daily use for destroying the
nerve-filaments in a tooth-pulp before filling the cavity, and it is still con-
sidered one of the best agents for the purpose. It is true that violent
symptoms have sometimes followed its use, which always needs caution:
still osteitis and its accompanying pain might occur after any destructive
application, and we may fairly consider that -^ gr., especially when com-
bined, as it usually is, with a little morphia, is free from any serious risk
of arsenical irritation.

Rheumatic Gout. Baths containing from 15 to 30 gr. of arseniate
of soda, with a few ounces of the carbonate of soda, have been well
spoken of by Dr. Gucneau de Mussy, as relieving both the pain and the
deformity consequent upon rheumatic arthritis. There is some evi-
dence in favor of the internal use of the remedy for this malady (v.
p. 51).

THERAPEUTICAL ACTION (INTERNAL). The therapeutical powers of
arsenic, which are many and various, may be traced along the same lines
as its physiological action, and without implying any definite limits as to
the pathology of the under-mentioned diseases, we may, for the sake of
clearness, arrange them in four groups for consideration in detail: (a)
General or blood-diseases, such as intermittent fever, phthisis, struma, lym-
phoma, anaemia, chronic rheumatism, diabetes; (>) more specially nerve-
disorders, neuralgias, asthma, chorea, tremor; (c) disorders connected
mainly with capillary congestion, cerebral, renal, uterine, or cutaneous;
(d) disorders affecting chiefly mucous membranes, coryza, chronic bron-
chitis, dyspepsia, gastric catarrh, vomiting, diarrhoea, English cholera,
gastric ulcer.

Intermittent Fever Ague. Long used as an empirical remedy for
ague, in the East, its more scientific employment dates from Slevogt, of
Jena, in 1700. 1 Condemned by Baron Storck, it was reintroduced by
Dr. Fowler, of Stafford, in 1786, after experience of the effects of a
"patent ague drop" which contained it; and again condemned by Brous-

1 Of the older writers on this subject, Melcbior Frick, and the two Plencitz, of Vi-
enna, deserve mention. The former says " Experientia nos docebit, arsenicum in
febribus intermittentibus adhibitum omnes eas dotea possidere, quibus optima reme-
dia prasdita ease debeat" (Paradoxa de Venenis, 1710). Of the practice of the latter
at the Orphans' Asylum, Harless reports " Ej usque (arsenici) usu in millenis fere
febrium intermitteutium casibus, rare frustrates fuisse affirmant."

ARSENIC. 47

sais. Its value was finally re-established by Boudin, in 1842, after a pro-
longed experience in Algeria (" On Intermittent Fevers," Paris, 1842).
The English physician reported several hundred, but M. Boudin, four thou-
sand cases, almost all successful. The former was accustomed to press the
remedy to its "operative" or physiological effects; the latter aimed at
inducing " tolerance," commencing with fractional doses every quarter-
hour, so as to introduce as much as possible into the blood, and to " sub-
stitute an arsenical for a paludal saturation." The names of Sistach,
Millet, Fremy, and Isnard are associated also with records of large num-
bers of successful cases, while opposite experiences may be found in the
works of Gintrac, Oesterlen, and G. See.

In 1860, Mr. J. Turner reported such favorable results with -J-dr. doses
of Fowler's solution, given every second hour for four or five doses, that
the Director-General recommended the plan to army officers (Medical
Times, ii., 1871), and Dr. Chappell supported it with an account of
eighty cures out of one hundred and forty cases (Medical Times, i., 1861).
The same dose was used by Dr. Broderick, but not without sickness
(British and Foreign Review, 1866). These observers found, as did
Fowler, Rayer, and others, that much better results in curing ague were
obtained with large doses, as of 30 to 40 drops, than with ordinary, full,
or unusual doses up to 20 drops; but Sistach and others observed that as
soon as the fever ceased, the system ceased to " tolerate " such quantities,
and there is always a possibility of the remedy doing harm. Quite re-
cently has been recorded the case of a physician, aged fifty, who took 12
drops of Fowler's solution twice daily for about three months with ap-
parent benefit to the intermittent, but he got diminished secretion of
urine, colic, tenesmus, weak heart, etc., and died rather suddenly with
vomiting and syncope; his attendant (in South America) traced his symp-
toms to arsenic, and Dr. A. S. Taylor concurs. It must be said, however,
that an ordinary cerebral attack i.e., independent of arsenic is not ex-
cluded by the history given (Medical Record, February, 1879).

We cannot doubt that arsenic, suitably administered, is an effective
remedy for ague, but on comparing it with quinine, and allowing for a
percentage of spontaneous recoveries from mild attacks, we conclude
that the latter remedy is still to be preferred for severe and acute cases,
and in "pernicious" or "malignant" forms; also it acts better usually
in tertian ague. When, however, it has failed to cure such cases even
in excessive or long-continued doses, or when the malady is of moderate
severity, subacute or chronic, especially of quartan type and accompanied
with marked oedema and prostration, then arsenic is specially indicated.
The element 'of risk may be much lessened by careful attention to the
urine and the general symptoms.

Splenic or hepatic hypertrophy may be another indication for it, as
Boudin suggested. It is good in malarious cachexia (when quinine often

48 MATERIA MEDICA AND THERAPEUTICS.

renders but little service), also when jaundice is present; further it has
some prophylactic power, and assists in preventing relapse.

I have records of nineteen cases of severe chronic ague of the quartan
type, all successfully treated by arsenic. Most of the patients were
Americans who had taken quinine very largely, being in the habit of car-
rying it in their pockets and taking from 5 to 20 gr. whenever they fan-
cied an attack was impending. Many of them had clean, red, irritable
tongues, and were suffering from oedema or anaemia; in most of them the
spleen was enlarged, and in some the liver. I prescribed the liquor ar-
senicalis in 5 to 10-min. doses thrice daily, and the result of this treat-
ment was uniformly good. Both quinine and arsenic have been credited
with an " anti-zymotic " power of destroying malarial germs in the blood.
As regards the prevention of relapse, Hirtz, judging from 120 cases,
found quinine and arsenic nearly equal; probably the best results may be
obtained by a judicious combination of them both, full doses of the former
being given to ward off an impending paroxysm, and arsenic in the in-
tervals: this mode of treatment I have frequently adopted with success.
Prof. Gubler uses arsenic in ague as a -sedative, and " indirect reconstitu-
ent," and connects its anti-relapse efficacy with its permanent deposition
in the tissues.

Phthisis. For the employment of arsenic in chest diseases we may
go back as far as Dioscorides, who states that " sandarach " (probably the
sulphuret) " is given to patients suffering with lung-suppuration, and
mixed with resin is inhaled in vapor for obstinate cough." Dr. Bed-
does used it early in this century, and recently the value of the drug in
certain stages of tubercular phthisis has attracted renewed attention.
Herard and Moutard-Martin have especially recorded good results from
it in relieving the lung-congestion and the general pyrexia of early
stages; at the same time the latter physician observes that it is most
efficacious when phthisis assumes a slow torpid course, acute tuberculo-
sis not being modified by it. " It has a reconstituting action, and modi-
fies secondarily the pulmonary lesion " in suitable cases (Lancet, i., 1868).

Before suppuration of tubercular deposits has taken place, I have
found arsenical solution in 2 or 3-min. doses, three times daily, give par-
ticularly good results; it is well to combine it with a course of cod-liver
oil and change of climate, and it should be continued for weeks or even
months if possible. I agree with the account given by Isnard (which is
still more favorable), for he found it relieve profuse sweatings, improve
appetite, and promote in some favorable cases not only healing of cavities
but absorption of tubercle {Bulletin de Therapeutique, t. Ixxvii.). It
controls diarrhoea in these cases in a very marked way.

Cersoy traces to arsenic an effect which has been also attributed to it
in bronchitis, and which really accords with what we know of its physio-
logical action viz., the lessening of congestion both in the bronchial

AKSENIC. 49

mucous membrane and in peritubercular lung-tissue; thus he finds that it
benefits haemoptysis ( Gazette des Hopitaux, 1869). Prof. Stille thinks
it probable that any benefit conferred in phthisis is due to an influence
upon the accompanying bronchitis.

Massart is almost alone in his recommendation of an arseniate of gold ',
which, in doses of ^ to ^ gr., he found useful even in advanced cases
(Revue de Therapeutique, 1860, p. 21). The general opinion of French
observers, however, would restrict the value of arsenic to early stages,
or to the relief of certain symptoms: thus Nouat agrees as to the good re-
sults of yo-to -jV-gr- doses given early in the malady, and finds that in later
stages, especially in the cases mostly seen in hospital practice, benefit is
exceptional (Lancet, i., 1870); and Trousseau, while recording improve-
ment as to diarrhoea, hectic, expectoration, and cough, does not speak of
cures, but of the gradual development of the malady and the formation
of fresh tubercle. He prescribed cigarettes containing arseniate of soda,
and pilules of arsenious acid.

I do not find many English observations on this subject, nor has this
medication for phthisis been generally adopted among us. Dr. Williams

says, " I have tried it only to a limited extent It has only seemed

to be useful in chronic cases with asthmatic or cutaneous complication,
but well deserves further investigation " (" Pulmonary Consumption," p.
362). Dr. Ringer suggests that allowance must be made for a natural
improvement in some forms of phthisis, but has himself seen instances
of recovery under its use " in children with general tuberculosis," and
" in adults suffering from subacute and chronic forms." He corroborates
also, to some extent, the statement that it will reduce temperature
(Handbook). Dr. Sanger reports, from the convalescent hospital at
Seaford, favorable results in a large number of phthisical patients to
whom he gave 5-min. doses of Fowler's solution, but he generally combined
it with iron or hyposulphites (Lancet, i., 1869). Dr. Leared based a
favorable opinion upon observation of nine cases, but finds the remedy
"trying to the digestive system" (Medical Times, i., 1863), and this I
believe to be a very common result owing to the dose prescribed being
too large. Dr. Bartholow, without offering detailed evidence, affirms that
" we have no single drug of equal utility in the chronic forms of phthisis,
but it is not' serviceable in caseous pneumonia .... neither is it bene-
ficial when much hectic is present with rapid disintegration of pulmonary
tissues."

Struma Strumous Ophthalmia. In chronic cases of glandular en-
largement, pallor, and anaemia, occurring in subjects with the ordinary
evidences of struma, arseniate of soda is often beneficial; it improves ap-
petite and color, seeming to stimulate the lymphatic and arterial systems.
I have frequently known Fowler's solution prove serviceable in strumous
ophthalmia, giving relief to the redness and swelling of lids, as well as to
VOL. II. 4

50 MATERIA MEDIC A AND THERAPEUTICS,

conjunctival congestion and excessive secretion. It has seemed also to
help in cicatrizing ulcers, and in diminishing the exudation which would
produce leucoma. Mr. Oglesby speaks of its special value in that form of
strumous ophthalmia which is accompanied by herpes (Practitioner, vol.
it).

Strumous Cachexia Lymphoma. Prof. Bouchut restricted the value
of arsenic in glandular disease to cases where this was superficial and
limited, and where cachexia was not present, but later experience has
proved the remedy to be more generally useful than he believed. I have
seen it of much service, especially when combined with iron, in relieving
cachexia, and Billroth has recorded a remarkable case that of a woman,
aged forty, in whom the cervical, axillary, and other glands, as well as
the spleen, were affected, and who recovered under Fowler's solution,
taking 5 to 20 drops for a dose. Billroth's observations have not been
often repeated, but have been recently supported by Dr. Winiwarter.
He records good results in cases of malignant lymphoma, or Hodgkins'
disease, a malady limited to lymphatic structures, and to be distinguished
from a sarcoma commencing in the glands, and spreading from thence.
In the latter condition arsenic has no influence: neither is " Hodgkins'
disease " to be confounded with scrofula, for there is no tendency to sup-
puration; nor with leukaemia, for th.ere is no increase of white corpuscles.
The malady referred to occurs in strong young persons, often begins in
the cervical glands, which enlarge separately, and it is fatal if left un-
treated; it has*been observed to follow intermittent fever. Under the
use of arsenic, continued for three or four months or more, and also in-
jected into the tumors, they have disappeared, at least for several years,
and the patients have become convalescent. It is recommended to begin
with 5 min. of Fowler's solution and 5 min. of tinct. ferri night and morn-
ing, cautiously increasing the dose up to 30 to 40 min., or to the produc-
tion of physiological effects (Strieker's Jahrb.^ 1877, part ii.).

Chlorosis. In this disease arsenic often acts particularly well, and
has been strongly recommended by Isnard.

Progressive Pernicious Ancemia. The remarkable and serious malady
now known under this name, and which was first described by Dr. Ad-
dison as "idiopathic anasmia," has proved sometimes amenable to arsenic.
It occurs often, without appreciable cause, about or beyond middle age,
the patient becoming blanched and waxy-looking, sometimes jaundiced,
and suffering later from oedema, dyspnoea, giddiness, and coldness. The
blood is found to be dull-red in color, and the red corpuscles to be dimin-
ished and altered; retinal and other hemorrhage may occur, also oc-
casional attacks of vomiting and diarrhoea. The patient remains, or be-
comes, fat rather than emaciated, yet the disease has usually ended
fatally by exhaustion and collapse in spite of iron and food, etc. Dr.
Bramwell has recently recorded a typical case, which was carefully treated

ARSENIC. 51

in hospital for three weeks with full doses of quinine and iron, and later
phosphorized cod-liver oil, and yet steadily got worse until 2 min. of
liquor arsenicalis were given thrice daily, the other remedies being
stopped. The dose was gradually increased to 16 min. thrice daily, and
" the after-progress of the case may be described as one of slow but un-
interrupted improvement." In a month's time he was able to attend as
an out-patient, and continuing to take arsenic considered himself well,
and resumed work. His color improved, cardiac murmurs disappeared,
and the condition of the blood was found to be normal (Medical Times,
ii., 1877). Such a case, in conjunction with others, offers much encour-
agement in the use of the remedy, and serves to illustrate further its
alliance with phosphorus, which drug has also proved useful in some
similar cases (v. p. 55).

Dr. Lockie has lately published illustrations of the value of arsenic as
a "blood and cardiac tonic in anaemia" (British Medical Journal, ii.,
1878). Dr. M. Finney has recently reported three well-marked cases of
"pernicious anaemia," two of which recovered under arsenic, and he calls
it " one of our surest tonics to the blood-making organs " (British Medi-
cal Journal, i., 1880). Dr. Withers Moore informs me that in a similar
case (idiopathic anaemia), under his care at the Sussex County Hospital,
arsenic also proved of service. The patient, a woman, aged thirty-two,
showed characteristic symptoms of the malady nine months after a bad
confinement, and after frequent epistaxis: she was extremely pale and
feeble; the red corpuscles of the blood were few, small, and altered in
shape, the white corpuscles not increased in number. For the first three
months of her stay in hospital iron was tried in various forms without
any benefit whatever; for the last two months she got 3 min. of Fowler's
solution thrice daily, and ultimately left convalescent. The case was a
typical and severe one, with occasional pyrexial attacks, raising the tem-
perature to 104 F., and even, on one occasion, to 106 F. These attacks
were controlled by full doses of quinine, but excepting this arsenic was
the only medicinal agent used during the stage of recovery.

Chronic Rheumatism Chronic Rheumatic Arthritis. In the con-
dition now designated by the latter term, the value of arsenic has been
frequently shown since its recommendation by Haygarth, and the elder
Bardsley in Manchester (Medical Reports, p. 32). I quite agree with
the latter physician in his opinion that the remedy promises well in cases
where the vital powers are diminished, and the ends of the bones, the
periosteum, capsules, and ligaments are swollen; under the continued use
of the drug I have known the joints return to their natural size. Sir R.
Christison records a similar experience in cases of " nodosity of joints,"
and Dr. W. Begbie describes fully the case of a man with swellings of
the small joints of hands and feet, very painful, especially at night and
in changeable weather, and almost preventing any movement. The pa-

52 MATERIA MEDICA AND THERAPEUTICS.

tient had received no benefit from a long trial of many remedies, but
under a course of Fowler's solution recovered the use of the joints, and
was able to resume his work. Dr. Fuller speaks highly of the remedy in
"chronic rheumatism," and especially in rheumatic arthritis, when the
skin is dry and inactive, and the patient chilly.

Snake-bite. Among blood diseases we may include this form of
blood-poisoning, and although it is difficult to credit arsenic with efficacy
in such cases, we must admit not only a long tradition in its favor in
India (v. Dr. Russell's " History of Indian Serpents "), but some amount
of clinical evidence. A compound of white arsenic with black pepper
and native herbs is the popular form, known as " Tanjore pill," but Mr.
Ireland used 2-dr. doses of the liquor arsenicalis with 10 min. of tinct.
opii every half-hour for four successive hours in five cases, and all of
them recovered, although other patients died from similar bites (Jfedico-
Chirurgical Transactions, ii., p. 393). No doubt, the system, under ab-
normal influences, can tolerate larger doses than in its healthy state.

Diabetes. Like most other medicines, arsenic has been tried in this
malady, and it has received commendation. Dr. B. W. Foster says that
he has seen it act well in improving nutrition and lessening thirst, but
not in diminishing the excretion of sugar; hence, he considers it acts
mainly by saving the waste of albuminous tissues (" Clinical Medicine,"
p. 208). Dr. Bartholow finds it beneficial in thin subjects with defective
assimilating power, but not in the " stout subjects " who suffer from boils
and carbuncles. I have frequently prescribed it in both stout and thin
subjects, with good results, but as a rule it only acts as a palliative,
checking the sudden emaciation and prostration and relieving the exces-
sive thirst and dryness of mouth. In several cases it lessened for a con-
siderable time the quantity of urine, and in some instances appeared to
diminish the sugar; it certainly in nearly all cases improved digestion.

Neuralgia. Arsenic holds a chief place among remedies for neural-
gia. Dr. Fowler's original reports contain several conclusive cases, al-
though their relief seems somewhat counterbalanced by the gastric
symptoms, which he did not scruple to produce. Maculloch, in a well-
known " Treatise on Malaria," speaks highly of arsenic in confirmed neu-
ralgia; and Romberg, a still higher authority, notes its value especially
in facial neuralgia, and in forms connected with uterine or ovarian dis-
ease. Anaemia is also an indication for its use, and full doses are neces-
sary. Among modern French observers, Isnard reports many cures of
various typical neuralgise, and of ordinary neuralgic pain (" De 1'Arsenic
dans la Pathologic du Systeme Nerveux "). M. Boudin found it invari-
ably succeed in periodic probably malarial forms, and M. Cahen has
published sixty-five successive cases of almost uniformerly good result
(Archives de Med., 1863). Borella devotes a long chapter of his work in
praise of arsenic, to its value in nerve-disorders (Brussels, 1866). Of

ARSENIC. 53

modern German writings on the subject we may quote Erb, who adopts
mainly the views of Isnard, considering the remedy as " a neurosthenic
tonic," with the power of restoring order to disturbed action. He places
it in the first rank among specific remedies, not only in recent and peri-
odic cases, but also in chronic forms of purely idiopathic neuralgia. In
the facial variety and in sciatica, he endorses its high reputation, but in
the latter affection places its value below that of turpentine ("Ziemssen's
Cyclopaedia"). In the treatment of sciatica, arsenic is most suitable
when the pain is deep-seated, worst at night, but with occasional marked
intermissions, and temporarily relieved by hot applications.

Sir Thomas Watson notes the great use of the drug in hemicrania or
migraine (Op. cit., i., p. 733), and successful results in various cases from
full doses of Fowler's solution were published by Mr. Thomas Turner, of
Manchester (Medical Times, ii., 1861). Dr. Anstie, in his "Treatise on
Neuralgia," speaks of arsenic as " one of the most powerful weapons in the
physician's hands," " likely to act best in affections of the fifth and of- the
vagus nerves, but probably the most generally effective remedy in almost
any given case." He looked upon it as calculated to improve the quality
of the blood, to stimulate the nerve-system, and oppose periodic (disor-
dered) action. The same physician also pointed out the connection and
frequent interdependence of gastralgia, angina pectoris, and asthma, as
neuroses of different branches of the vagus, and he illustrated this con-
nection by the history of families in which these affections occurred in
alternate generations. From my own extensive trial of arsenical medica-
tion in neuralgias, and especially of the fifth pair of nerves, I also con-
clude it to be almost our best remedy, particularly, as in my own person,
when the pain felt is of burning stinging character, and when the attack
is connected with miasmatic influence.

Gastralgia is a term properly restricted to painful affections of the
stomach unconnected with organic disease or inflammation, or even with
ordinary dyspepsia. Such cases are not very frequent nor very easy of
diagnosis, but occur especially in females during youth, and at the climac-
teric period, and are accompanied with other evidences of impaired nerve-
power: sometimes they are reflex (being connected with uterine derange-
ment), and sometime malarial (Niemeyer). Trousseau describes attacks
dependent on exhaustion, and Budd on alcoholism. The nerve-character is
evident when, as in Dr. Anstie's cases, the malady alternates with attacks
of asthma, and Tessier (Journal de Med. de Lyon, 1848) and Anstie
agree in estimating highly the value of arsenic in such cases. Dr. Clif-
ford Allbutt speaks of gastralgia as readily distinguishable from dyspep-
sia, and described sudden violent pain in the gastric region and back, and
another form less severe and more gradual in onset, and irregular as to
time, and unconnected with eating (Liverpool and Manchester Reports,
1873). Dr. Leared also restricts the term to a nerve-disorder with cramp-

54 MATERIA MEDICA AND THERAPEUTICS.

like, fixed or diffused pain, coming at irregular intervals, often at night,
accompanied by prostration, followed by bilious vomiting, and occurring
generally in middle-aged persons from mental anxiety (British Medical
Journal, 1867). Such cases furnish a special indication for arsenic, and
Allbutt says it is, for such, the " king of remedies," only I would interpret
" gastralgia " in a wider sense, and without attempting to diagnose it
rigorously from dyspepsia, would include under the term many forms of
painful stomach-disorder, not inflammatory nor organic. In this sense it
is used by Barras (" Traite sur les Gastralgies ") and other French writers,
and a reference to the observers I have named will show that, in their
cases, such symptoms as flatulence, vomiting, and pain increased by food,
were often present, and although the tongue might be clean, and certain
dyspeptic symptoms absent for a time, yet they would readily occur, and
to restrict the use of the remedy to purely nervous attacks is needlessly
to limit its value: we shall see, in fact, that in gastric catarrh it is an ex-
cellent medicine.

The following is one of many cases of climacteric gastralgia, compli-
cated with dyspepsia at times, and relieved by arsenic. Mrs. S., aged
forty-three, auburn hair, thin, describes very acute pain in upper front
chest, and sometimes in the back about the second dorsal vertebra and
interscapular region, almost constant; sometimes easier after food, some-
times worse: no vomiting, pyrosis, or heematemesis: no physical signs in
the chest, no evident hepatic disease, and bowels regular. Pulse 64. No
heart or lung complication. Youngest child is five years old. Menstru-
ation lately irregular and prof use; has some prolapsus and back-pain, dis-
tinct from her gastric pain. Nursed her husband anxiously for two
years, during which time the pain first came on, and is now often brought
on and always aggravated by mental worry, of which she has much.
The pain is generally worst on waking, about 2 A.M. ; gets better after
breakfast, and worse again in the evening: it is sometimes referred to the
epigastrium and left shoulder, and described as " like a hot bar pressing,"
or " like a hand gripping." Arsenic relieved the pain more effectively than
any other remedy tried, and although during attacks of painful digestion
nux vomica given before food did much good, according to the patient's
own statement, the steady use of arsenical solution was always the most
effective.

Angina Pectoris. This malady, even if primarily dependent on cal-
careous or other degeneration, is mainly a neurosis, and nearly -100 years
ago was successfully treated with arsenious acid by Alexander. Philipp
and others record very striking benefit in cases that had been rebellious
to quinine (Sydenham Society's Year Book, 1865-66), and I can fully
bear out Dr. Anstie's testimony to the great relief given by arsenic to pa-
tients suddenly attacked with spasmodic pain, embarrassed heart-action,
and sense of impending death: he found the medicine reduce the severe

ARSENIC. 55

attacks to little more than a tightness of the chest, and it availed most in
anaemic patients, suffering from overwork and anxiety. (Reference may
also be made to cases in Berlin. Klin. Woch., 18G5, and Archives Gen.,
1863.)

Spasmodic Asthma Asthma JVervosum. In this, the third of the
trio of vagus neuroses, Dr. Anstie also records good results, but others
had preceded him in this observation. We have already noted its im-
proving the breathing-power of mountaineers, and this had suggested to
Kappel its use in asthma. Rilliet speaks highly of it (Bulletin Med. du
N^ord, 1863), and also Trousseau, who used it partly in cigarette (Bulle-
tin, 1861). Dr. Leared recommends a form of cigarette containing gr.
of arsenic with a little nitre (Lancet, i., 1863). Dr. Thorowgood, while
laying stress on the frequent gastric causation of asthma, and its special
treatment, has found arsenic useful in gouty and rheumatic cases, and
Riegel notes its value in preventing relapses in " bronchial asthma," and
in the form which occurs alternately with some cutaneous diseases, known
as " herpetic asthma " (" Ziemssen's Cyclopaedia," iv., p. 582). Dr. Berkart
seems to attribute any good effect more to improving the nutrition, appe-
tite, and digestion, and to negative any specific virtues (" On Asthma,"
1879). One method of its application is by spray, which has been used with
much success by Wistinghausen (Petersburg Med. Zeits., 1862), and more
recently by Dr. Wahltuch, of Manchester: the latter used arseniates of
potash, soda, or ammonia in spray containing ^ to % gr. at first twice daily,
and by degrees less frequently; his excellent results were, however, ren-
dered less certain for clinical purposes by the concurrent use of galvanism
and other remedies (British Medical Journal, ii., 1877).

Martelli has recently reported immediate relief to an asthmatic parox-
ysm from the hypodermic injection of Fowler's solution (1 part to 2 of
water): the cure was complete after 2 dr. used at intervals in divided
doses in this manner (Medical Record, 1878). Arsenic acts best in sim-
ple cases of idiopathic or spasmodic asthma of neurotic origin: but it lias
done well in cases dependent on bronchitis, emphysema, or cardiac dis-
ease. In cases due to compression of air-tubes by enlarged glands it may
be carefully tried (Berkart). The solution should be administered in
5-min. doses, three or four times daily, during the intervals between the
attacks, and should be persevered with for many weeks, and, in some in-
stances, for months, but the dose under these circumstances should be
decreased. For upward of twenty years I have used it in these cases
with unmistakable success.

Chorea. From the time of Girdlestone, 1806 (London Medical and
Physiological Journal), there has been a large accumulation of evidence as
to the value of arsenic in chorea. Reese, of New York, in 1840, describes
cures in two hundred children under 6 to S-min. doses of Fowler's solu-
tion twice daily. Rayer corroborates his results ( Union Medicale, 1847).

56 MATERIA MEDICA AND THERAPEUTICS.

Romberg calls it " the foremost remedy," when given in sufficient doses
(Klin. Ergebnisse, 1856), and records severe cases one of eight years'
duration, rebellious to many other medicines, but cured in two months
by arsenic; and another patient had been unable for six months to stand
or speak, having such violent choreic movements, yet recovered after
two months of treatment with 4 min. of Fowler's solution thrice daily.
The well-known names of Aran, Henoch, Steiner, and Barthez may also
be cited as authorities in the same direction; and continental work with
regard to it is fully summarized in the thesis of M. Gelle (" Hopital des
Enfants," Paris, 1860). He quotes cases where improvement was mani-
fest within eight days, three days, and even forty-eight and thirty-six
hours respectively, but concludes that from five to eight days is an aver-
age period. He gives also several cases equal in severity to those of
Romberg, and expresses similar conclusions viz.: that some failures of
the remedy may be expected in neurotic, sanguineous subjects, but very
great success in the lymphatic, chlorotic, and cachectic. M. Aran urges
the rapid attainment of a full dose rather than a long-continued small
one (Sydenham Society^s Year Book, 1859). Dr. Steiner, on the other
hand, commences with 1 min., and considers 8 min. should be the maxi-
mum daily dose: within fourteen days he expects improvement.

Among English observers there is a large preponderance, though by
no means a consensus of opinion in favor of arsenic as the best remedy
for chorea. Gregory, Babington, and many others have all written to
this effect. Dr. Radcliffe fully agrees as to the efficacy of the medicine,
but, having been obliged sometimes to discontinue it on account of gas-
tric disturbance, he adopted its hypodermic use, and in some cases, espe-
cially of localized choreic action, with signal benefit; thus, in a woman in
whom the neck-muscles were affected, and who was not relieved by a long
trial of sedatives, 1 to 12 min. of Fowler's solution were injected locally,
and, before the fourth injection, improvement had taken place. He recom-
mends dilution with half water; in some cases he has preferred the en-
dermic use of the remedy on a blistered surface (" Reynold's System,"
vol. ii.). Schmidt has also practised hypodermic injection with success
(Wiener Med. TFbcA.,1871, No. 44). Dr. Anstie records the severe case
of a girl who had been treated in hospital with camphor, cod-liver oil,
bromides, and zinc, also with succus conii in the dose of many ounces
daily, yet without relief, and who recovered under 3 to 5-min. doses of
Fowler's solution : he used at the same time ether spray to the spine, but
this application has not proved itself of such power as he then thought
it (Practitioner, June, 1874), and therefore I do not believe that it much
influenced the result. Dr. Ringer considers arsenic as by far the best
remedy in simple chorea; he remarks that failure may be owing to small-
ness of dose; also that children above five years of age bear nearly as
much as adults, and that girls seem to require more than boys. Dr.

ARSENIC. 57

Eustace Smith and others have also specially noted the tolerance of cho-
reic children for arsenic, and the necessity of full doses to secure success
(British Medical Journal, i., 1875). In my own practice, for upward of
twenty-five years, I have seldom known arsenic fail to cure simple chorea,
although many of my cases were severe and of long duration, and quite
incapacitated for the ordinary duties of life 3 to 10 min. of Fowler's so-
lution thrice daily has been the dose usually prescribed by me, but I have
frequently observed no permanent good effects follow until the develop-
ment of some of the slighter physiological symptoms.

From the above quotations and remarks, though they represent an
ample experience, we must not conclude that the value of this remedy is
equally acknowledged by all. The counter-claims of iron, of zinc, of bella-
donna, etc., are urged by some observers, and the natural tendency to
cure of the malady under favorable conditions is still more strongly in-
sisted upon by others. Vogel, the distinguished Russian professor, classes
arsenic with " a number of empirical remedies that are more praised than
curative." Dr. Wilks attributes much more importance to rest (British
Medical Journal, ii., 1876), and my colleague, Dr. Sturges, includes
arsenic among a number of other " useless medicines " (" Lectures on
Chorea," 1876). In estimating the value of any remedy, we are con-
stantly met by the difficulty of proving how far we have affected the
course of nature; this difficulty is not greater with the present medicine
than with others, and even allowing that chorea will recover with proper
rest, food, and management, yet I am clearly of opinion that arsenic will
promote, and quicken, and confirm the cure. I cannot affirm that it will
always, of itself, and in despite of circumstances, control the disease.
Judging from private practice and from hospital in-patient records, a
large number of cases recover while taking arsenic, either far more
quickly than is consistent with the ordinary course of the malady, or
(making the contrast more striking) recover after many powerful reme-
dies have been tried without effect under equal conditions. The ordinary
duration of a chorea well managed, but without medicines, has been
stated as six to eight weeks; if it continues three months Jaccoud con-
siders it chronic, almost incurable, yet we have already quoted and have
seen many cases that improved within two or three days, and recovered
within three to five weeks, and we have quoted also cases of cure after a
duration of many years. A certain proportion of cases of chorea are
connected with embolism, and these were excluded by Dr. Anstie from
the range of the beneficial action of this drug, but from what we know
of its value in cerebral congestions, we should think it often appropriate
even in such serious conditions. In markedly anaemic patients we might
prefer iron, or at least combine it; and if sexual excitation were present,
as in the case of some girls at puberty, we might substitute bromides or
antispasmodics; acute rheumatic symptoms would also modify the treat-

58 MATERIA MEDIC A AND THERAPEUTICS.

ment, but with these exceptions we must consider arsenic a most valuable
agent in all varieties of the malady.

Tremor Ataxia. Allied to the use of arsenic in chorea, is its use
(which, however, is much less markedly beneficial) in these nerve-condi-
tions. Tremor may be due to various causes, which are often central and
connected with organic disease, and scarcely amenable to treatment; but
Eulenburg reports several cases successfully treated by hypodermic injec-
tion of 2 to 3 min. of Fowler's solution diluted with two parts of water
(Berlin. Klin. Wbch., 1872, No. 46). Isnard says the remedy is valuable
in ataxia developed during acute fevers; he gives it even during febrile
accessions.

Congestive disorders. The value of arsenic in the following group
of cases seems best explained by its power, in small doses, to regulate
and equalize the circulation in capillary blood-vessels.

Cerebral Congestion. As a preventive of apoplexy, the remedy has a
traditional, and perhaps not an easily proved, reputation, but one that
would be quite in accord with our view of its action. Lemare-Piquot,
after relating marked relief to giddiness, sense of oppression, epistaxis,
and other premonitory symptoms, both in his own case and that of five
other persons about sixty years of age, reasonably restricts its use to
cases of cerebral congestion occurring in the strong and plethoric, who
have an excess of blood-corpuscles (v. p. 33). He recommends from 4
milligr. to 1 ctgr. daily for about a month, taken at meal-times, and
founds his latest conclusion upon forty-four cases occurring without
one death (Bulletin de Therapeutique, 1859, and JRecherches sur PApo-
plexie, Paris, 1860). Cahen, writing upon its value in congestions gen-
erally, and cerebral hyperaemia in particular, traces it, as we do, to a
regulating influence on vaso-motor nerves (Archives de Med., September,
1863), and Dr. Handfield Jones expresses similar views. Hirtz has had
reason to think it efficacious in obviating apoplexy, and suggests that it
would tend to prevent atheromatous degeneration (" Nouveau Diet.").
It is extremely useful in cerebral congestion, and especially when there
is puffiness below the eyes, drowsiness, and mental torpor, with sluggish,
venous circulation, and suspicion of commencing atheroma. By a similar
action, perhaps, it benefits the melancholy and those suffering from hypo-
chondriasis, especially aged persons.

Epilepsy has been plausibly connected with congestion in and near
the medulla oblongata, and certainly the older writers, such as Alexander
and Duncan, have recorded cases cured under arsenical treatment. It is
of necessity no more a universal cure than any other medicine is, but
there seem to be some cases specially amenable to it for instance, those
that are connected, however remotely, with malaria. We must note a
case recorded under the supervision of Dr. Bristowe, that of a lad of
fourteen, described as anaemic, but free from evident organic disease, and

ARSENIC. 59

who had suffered severely from epileptic attacks, mainly nocturnal, for
about two years, and afterward from attacks, day and night, so frequently
that he remained unconscious for some days, and was apparently dying;
being roused, however, from this condition, he remained partly paraplegic,
and the fits, preceded by screaming and by an aura in the feet, recurred on
movement of the legs, or on excitement; for nearly a month he took zinc
sulphate in increasing doses with valerian, but remained in the same state,
sometimes disturbing the ward for a whole night; he was then ordered
5-min. doses of Fowler's solution thrice daily, and although he was not
made aware of any change in treatment, the -attacks ceased at once for
many days; they recurred for a time under excitement, and the numbness
of lower limbs persisted for some days; eventually, however, he got quite
well. There is evidently some alliance between such a case and cases of
chorea, but the periods of insensibility indicate a more serious condition;
the exact character of the " fits " is not, however, described (Medical
Times, i., 1862).

Dr. Clemens (Frankfort) strongly recommends a " liquor arsenici bro-
midi," which he has used for twenty years in the treatment of epilepsy of
all varieties with much success; it has relieved even in cases connected
with thickening of skull and congenital malformation (Medical Record,
1877). This preparation is said to be more reliable than Fowler's, and to
act well without increase of the daily dose: it is made by boiling potash
carbonate and arsenious acid, of each 1 dr. in \ pint of water: making up
to 12 oz., adding 2 dr. of bromine, and mixing thoroughly.

Cardiac Weakness Mitral Disease Venous Congestion. For such
conditions, arsenic is often found serviceable, and under its use dyspnoea
on exertion, the palpitation, the faintness, and the oedema of extremities
have all improved. Dr. Papillaud has verified similar improvement, and
also marked relief to palpitation, but he generally alternated or combined
the remedy with antimony (Bulletin de FAcademie de Med., December,
1870, p. 885).

When intermittent pulse occurs from cardiac weakness, whether of
temporary character or dependent on degeneration or mitral disease, ar-
senic is often serviceable, as it is also in the same condition when due to
nerve-causes. Darwin relates a case of " regular intermission " cured by
4-min. doses of a saturated solution of the drug (Headland, p. 197). I
have seen numerous cases cured by the continued use of 2 to 5-min. doses
of Fowler's solution after each principal meal. Under such circumstances
it often produces a marked diuretic action, which is quickly followed, in
many instances, by disappearance of any swelling, and by relief of the
dyspnoea, faintness, and palpitation.

Albuminuria. The influence of arsenic upon this condition is well
worthy of further investigation. A case of "acute renal anasarca " in a
woman, aged nineteen, is briefly recorded from Dr. F. Farre's practice

60 MATERIA MED1CA AND THERAPEUTICS.

(Lancet, i., 1862); six weeks after the commencement of the attack she
developed psoriasis, for which Fowler's solution was prescribed, and
under its influence the albumen disappeared, and the patient gained flesh
and strength. I have for many years used it in albuminuria following
scarlatina; it removes the dry inactive condition of the skin, checks thirst,
and causes a copious flow of urine, which gradually becomes less loaded
with 'albumen; should dyspnoea be present, the remedy quickly relieves
it, and the oedema of face and body disappears. In 1876 a case came
under my care of chronic character, occurring in a builder, aged forty-
three, of dissipated though hard-working habits; he had general anasarca
and epileptiform convulsions, which were relieved for a time by laxatives,
but the amount of albumen was uninfluenced by them, or by a long-con-
tinued use of iron. Fowler's solution was substituted, and the albumen
diminished and soon ceased to appear; then, omitting the medicine, a
relapse occurred; this again yielded on resuming the remedy, and the
albumen, anasarca, and convulsions all disappeared, and in two to three
months the patient's health was quite re-established, and he has since
been quite well. I have also treated by liquor arsenicalis, with excellent
results, numerous cases of temporary or intermittent albuminous urine
dependent on imperfect digestion.

Dr. Brunton has discussed this subject in an interesting and scientific
paper (Practitioner, June, 1877): he remarks on the important distinc-
tion between " true and false" albuminuria (Gubler), including under
the latter term, not only the presence of albumen from pus or blood, but
also the so-called Bence Jones' albumen, egg-albumen, the albumen ab-
sorbed from the intestine after imperfect digestion : it is a case of the
latter kind that is recorded by him as being much benefited by arsenic,
and it had several peculiarities. The patient was aged thirty-three, sallow
and thin; the first symptom was great fatigue on exertion, then albu-
minuria was noticed (on examination for life insurance): it was at first
present only during the summer; it came on after work and ceased on
rest; it ceased also under strychnine (but this caused headache and sick-
ness), and it ceased during quiet residence at the seaside. Fatty food
brought it on, and meat taken in the morning, not when taken at night.
Quinine .and phosphoric acid at once increased the quantity, but rigid
adherence to a farinaceous diet quite controlled it, and there were other
evidences of its direct connection with digestion. After many years of
treatment, including milk-diet, sea-voyages, digitalis, hydrarg. c. creta,
etc., Dr. Brunton ordered 3 min. of Fowler's solution at meal-times,
"and almost at once the albumen disappeared, and the patient was able
to do much more work than usual, without its return." Later, the med-
icine was changed for hypophosphite of soda, and the albumen returned,
to cease again on resuming arsenic. The whole case is very interesting,
but we need only mention further that pancreatine, which increases pan-

AKSENIC. 61

creatic digestion and aids in the solution of albumen, was also found
beneficial. This affection should be classed under faulty digestion or as-
similation rather than as renal disorder. The special form of chronic
albuminuria in which I have proved its value is that dependent upon ve-
nous congestion, mitral disease, or emphysema, after the right ventricle
has begun to yield, but it deserves a trial also in cases where the actual
kidney structure and epithelial lining are affected. I have carefully
watched many of these latter cases in which the beneficial action of ar-
senic was very marked.

Uterine Congestion.- -This condition may accompany either menor-
rhagia or amenorrhoaa, and that arsenic may remedy either symptom is,
therefore, not contradictory. ,In the former, the catamenia being too
copious and too frequent (leucorrhosa often occurring in the intervals), and
the patient becoming weak and ansemic, small doses of from 2 to 6 min.
thrice daily will be found to lessen the flow and to improve appetite and
general health. Mr. Hunt has recorded some striking cases of uterine
hemorrhage at various intervals after labor or miscarriage, some accom-
panied with symptoms only of irritable uterus, "but for the most part
atonic in character" (Medico- Chirurgical Transactions, vol. xxi.); all
improved under arsenic. Sir C. Locock found great advantage from it in
similar cases. Dr. A. Burns, from experience of it in all varieties of
uterine hemorrhage, has reason to express the greatest confidence in the
remedy, and records several cases treated by rather large doses, 10 to 20
min. repeated every fifteen to twenty minutes (American Journal Medi-
cal Sciences, October, 1859).

Amenorrhcea. When this depends upon congestion or torpor of the
uterus, or is connected with anaemia or chlorosis, I have known arsenic
succeed well, and have several times found that when iron preparations
had been taken without marked result, the addition of arsenic was quick-
ly followed by relief it seemed to act as a regulator of the circulation
and as an uterine tonic.

Hemorrhoids. The efficacy of arsenic in this form of venous conges-
tion has been sometimes well shown; thus, in one case, a gentleman had
suffered for many years, and had undergone cauterizing and other opera-
tions, when this remedy was given to him for hay-asthma, and he found
his hemorrhoids to be more relieved in a few days than under any other
treatment. Relapses occurred more than once, but always yielded in a
few days to 8-min. doses of Fowler's solution (Parvin, in J3raithwaitc 's
Retrospect, ii., 1866). I can recommend it strongly in painful hemor-
rhoids, and also for ordinary external piles.

Cutaneous Disease. Arsenic is largely used by the profession, almost
as a routine remedy, in cutaneous disease, but its value has been variously
estimated by specialists of experience. We may exclude at once from its
influence the ordinary acute exanthemata, also nasvus, parasitic and syph-

62 MATEKIA MEDICA AND THERAPEUTICS.

ilitic eruptions, and the rarer maladies of scleroderma, keloid, xanthel-
asma, and true leprosy. We may exclude also all forms of skin disease
while in the acute stage, or while accompanied by marked inflammatory
reaction, and then, speaking generally, we may say that as we have noted
arsenic to be valuable in rheumatic, malarial, and neurotic affections, so
is it also valuable in most cutaneous manifestations of these conditions.
With regard to the last-mentioned, my own experience agrees rather
with that of Hunt and of Anstie, as against Bazin and others, that in
neurdtic subjects with highly strung excitable natures, arsenic is less
readily borne, and more usually causes diarrhoaa.

The forms of skin disease in which the remedy is of generally accepted
value, are such as psoriasis, eczema in the dry or scaling stage, pemphi-
gus, lichen, alopecia, and chronic urticaria; and those in which its pow-
ers are more controverted are acne, lupus, ichthyosis, herpes zoster, 1 sy-
cosis, prurigo, epithelioma, cancer, and elephantiasis grsecorum.

Psoriasis. From the time of Girdlestone (1806), Willan and Bate-
man, Biett and Cazenave, arsenic has held the first place in the treatment
of this malady. Modern dermatologists agree upon this point, but some,
as the late Mr. Startin and Mr. Hunt, rely upon this drug much more
positively than others. The preference of Hebra for local over any con-
stitutional treatment is well known, but even he recognizes " a decided
curative action of arsenic in this form of disease." Dr. Tilbury Fox in-
clines to restrict its use to the more typical cases, especially those of
chronic character and accompanied with nerve-debility; on the other
hand, many cases will be found to occur in persons otherwise strong, and
in such cases after preliminary purgative treatment I have found the
remedy useful. " Before undertaking to deal with psoriasis," remarks
Gaskoin, "it is necessary to know all about arsenic" ("Treatise on
Psoriasis "). Its success, however, is, as Stille remarks, by no means
uniform, and any want of due attention to the excretions, to the presence
of gouty or other constitutional tendencies, or to the proper regulation
of dose, will readily prevent a satisfactory result. It can by no means be
considered a specific, but as a valuable agent only under certain condi-
tions; neither can it be accurately stated that " the more chronic the mal-
ady the more suited it is for this remedy," for after it has lasted for
eight or ten years I have seldom found it amenable, and Devergie has
recorded a similar experience ("Maladies de la Peau ").

Mr. Malcolm Morris notes that sometimes arsenic not only does no
good in psoriasis, but harm, in rendering the patches more hypenemic
and irritable; he finds it impossible, however, to diagnose the cases in
which this may occur (Pb'actitioner, 1880).

1 The reason for doubting the value of arsenic in herpes is that it is a disorder of
definite course, which must develop, but the neuralgic pain, if severe, is markedly
lessened by arsenic (v. p. 67).

ARSENIC. 63

In judging of its true power, we must allow for the natural improve-
ment of the malady in certain circumstances, e.g., on the cessation of lac-
tation, at changes of climate or of season, etc., also for the effect of ex-
ternal treatment by tar or bathing carried on at the same time. But
after these allowances there remain, no doubt, many cases which show
improvement distinctly from arsenic; the best illustrations are seen in
children, and then in older persons in whom the attack is comparatively
recent yet not in an acute stage; chronic cases that have been left un-
treated often do well, but previous irregular trials diminish the chances
of recovery. In any case, if cure be effected, freedom from relapse can-
not be guaranteed (Wilson); Hunt has shown how important it is to se-
cure a due action of the absorbents, and also that one preparation may
succeed when another has failed; for instance, to one of two girls simi-
larly affected, he gave the potash, and to the other the soda solution; for
a time both did well, and then both ceased to improve, but later on, when
he exchanged their medicines, they progressed to cure (Journal of Cuta-
neous Medicine).

Eczema. In this, which is a catarrhal form of disease, arsenic has not
so large a measure of success as in the last mentioned; still it is often
very useful, and especially in combination with other remedies. Acute
cases not only receive no benefit, but I have seen them much aggravated
by it; the proper period for its use requires, therefore, careful considera-
tion. It is very suitable in scaly which are of necessity rather chronic
stages, and have received the distinct name of " eczema squamosum "
in superficial subacute forms with moderate infiltration, and in cases with
persistent irregular patches about the scrotum, anus, or vulva (Rayer), or
about the hands or fingers (Duhring). Sometimes the later stages of a
chronic infantile eczema seem much benefited by the addition of the drug
to iron or cod-liver oil, and sometimes an infant has been successfully
treated by arsenical medication through the mother (Begbie, Anderson).
The last-named observer, in his excellent special treatise, estimates the
value of arsenic highly: he points out, as others have done, that children
will readily bear a proportionately large dose; at the same time, he notes
that there is much tendency to " catching cold," or even bronchitis, dur-
ing an arsenical course, also he insists on the necessity for its prolonged
continuance. Mr. Erasmus Wilson considers that the treatment of ecze-
ma resolves itself into that of " debility," and advocates the use of ar-
senic "as a nerve-tonic and stimulant to cutaneous function;" 1 ami
generally combines it with a non-astringent preparation of iron, as the
vinum. My own use of arsenic in ordinary eczema is rather the exception
than the rule, and I am much in accord with Dr. Piffard, who, after call-
ing this mode of treatment " empirical, as opposed to rational," and quot-
ing the prevalent opinion, " that if only sufficient of the remedy be used,
the eruption must yield," states that, in his experience, it sometimes does

D-t MATERIA MEDICA AND THERAPEUTICS.

harm and at other times has no influence, though in a minority of cases
will give brilliant results: these may be hoped for in the dry scaly stages
when extensive tracts of surface are affected (" On Skin Diseases," 1870) ;
I would add, and when there are persistent patches oh the pudenda or
extremities, as already described.

Pemphigus. There is an ephemeral form of this malady in which one
or two crops of bullse come out, and subside under mild general treat-
ment; there is also a syphilitic form, mainly congenital, and an epidemic
form which occurs sometimes in lying-in and in children's hospitals, and
is connected probably with blood-poisoning; in none of these do we ex-
pect benefit from arsenic. There is a fourth form, occurring sometimes in
the later months of pregnancy, which may be severe, and although it tends
to subside after parturition, yet may receive some benefit from the reme-
dy; but the variety of the malady to which we would specially refer is
that known as " pemphigus diutinus, in which the blebs come out freely,
often symmetrically, and extensively which often lasts long, and almost
invariably exhibits its constitutional origin in a marked tendency to re-
cur." Mr. Hutchinson, from whom I quote, has certainly furnished us
with valuable evidence of the great power of arsenic in this variety, and
although by Hebra and others it is commonly held to be incurable, and
often fatal, Mr. Hutchinson " has never met but with one case that resisted
this treatment, and has come to consider the malady as one of the most
hopeful " (Medical Times, ii., 1875). He furnishes an abstract of twenty-
six cases that have been under his own observation, and refers to others in
the practice of Hillier, Wilks, Fagge, Startin, etc.: many of them had re-
lapses, but these were mild in character. In many, the influence of the
medicine was proved by the rapid improvement, and by relapse, on resump-
tion and omission of it respectively, and in at least one case it appeared
to prevent a patient's death. A delicate man, aged forty-four, recently
become subject to epileptic attacks, presented a general rash, at first very
like herpes, and attacking the face and extremities. There was much
prostration, and the patient was treated with quinine and iron, and lib-
eral diet, yet became extremely emaciated, and as the pemphigus charac-
ter became more developed, he was covered with large superficial sores
and completely prostrated; then the tonics were stopped, and 4 min. of
Fowler's solution prescribed, and from that day no fresh blebs appeared
until a few weeks later when nearly well and able to leave his bed: it was
then found that his medicine had been omitted for three days, and on re-
suming it, the blebs at once receded, and six weeks afterward he was in
good health and wholly free from eruption (Op. cit., p. 625). Dr.
James Russell has also published a well-marked case in a child in whom
the numerous relapses were always distinctly controlled by arsenic (Medi-
cal Times). On the other hand must be noted the observations of the
late Dr. Tilbury Fox: "There is no specific for pemphigus; arsenic is

ARSENIC. 65

declared to be one, but it often signally fails to cure the disease, and I
have seen quinine, in full doses, do much more good."

In Lichen Simplex, and certainly in its more chronic forms, the value
of arsenic is generally conceded. Dr. Liveing's expression is, " In chronic
lichen it is the only remedy; " but, as a rule, alkalies are required in ad-
dition, and mercurial treatment may succeed still better. A similar ob-
servation would apply to another form of papular disease true prurigo.

In Lichen flames, Mr. Morris (loc. cit.) and others speaks well of it.
Thus, a lady, aged fifty, with an itching eruption of flat-topped violet-
colored papules, slightly scaly, situated on .the inner side of the thighs
and outer sides of forearms, took 8 min. of liquor sodas arseniatis, at first
twice and then three times daily, and the eruption faded in one month,
and the treatment being continued for a time, no relapse occurred (how
long the eruption had lasted is not stated). He considers arsenic " an
invaluable remedy." Dr. Fox has, however, seen no benefit from it.

In the more generalized form of the malady, Hebra, who names it
" lichen ruber," places much reliance on the " Tanjore pills " (arsenic
with black pepper).

Alopecia. From the effect of arsenic in improving the coat of horses,
it has been plausibly thought to have a special power in promoting hair-
growth, and certainly after any sources of baldness, such as syphilis, dys-
pepsia, or local irritation, have been treated and removed, the internal
administration of small doses may be carefully carried out for a time with
advantage. Hunt practised this treatment successfully.

Chronic Urticaria is often relieved under arsenic, but any evident
intestinal disorder should, if possible, be remedied in the first instance.

Acne. In acne it should be the exception to prescribe arsenic. Mr.
E. Wilson goes so far as to say that " no one having even a rudimentary
acquaintance with cutaneous pathology and therapeutics would think of
doing so," and yet I have certainly seen cases cured by this remedy after
others had failed. According to Dr. Bulkley, this has occurred with all
forms of acne the simple, the indurated, and the rosaceous and his
best results have been attained with De Valangin's solution of chloride.
Dr. Duhring speaks well of it in the indolent papular form, and many
special authorities might be quoted to the same effect. This does not
seem to me so unreasonable as it does to Mr. Wilson, for acne is fre-
quently connected with gastric and uterine irritation, and we have seen
that arsenic has great power to relieve various forms of this malady.

In " bromic acne " the pustular rash which frequently follows the
use of full doses of any bromide arsenic is decidedly useful. If given con-
currently with the bromide it will often prevent any skin trouble (Bartho-
low; also Gowers, Lancet, i., 1878), and I can corroborate this observa-
tion.

Lupus. There are differences of opinion as to its value in lupus: Mr.
VOL. II. 5

66 MATERIA MEDICA AND THERAPEUTICS.

Hunt, for instance, and Mr. Milton esteeming it highly, and recommend-
ing its continuous administration for months or years; but others, and,
indeed, the majority of observers, recording no definite result from it. 1
have never been able to satisfy myself that it controlled the disease, al-
though the local caustic effect is, as already mentioned, highly valuable.

Ichthyosis is congenital, and, though it may be relieved, is scarcely
curable; the evidence as to the value of arsenic in its treatment is but
slight.

Herpes Zoster. Trousseau has observed that the pain in the course
of affected nerves, which is often severe and long persistent in the zos-
ter of elderly persons, may be relieved by arsenical medication, though
this will not cut short the course of the attack itself (" Clinical Medi-
cine ").

In Sycosis, non-parasitic in character, there is much evidence of the
value of the drug, and this would accord with what we know of it in
other cases of pus-formation. Dr. Laycock has used an arsenicated gly-
cerin (2 dr. of Fowler's solution in 10 dr.) as a local application, with
good results; it is somewhat strong, and acts as a " substitutive irritant "
(Medical Times, ii., 1864).

Erysipelatous Inflammation of a phlegmonous typo is liable to give
rise to sloughing, but if, at the first appearance of this change, small
doses of arsenic be administered, together with a generous diet, the more
severe results may be warded off, and even after sloughing has taken
place, arsenic will often control it effectually.

In Hospital Gangrene the results obtained strongly incline me to
consider it very beneficial. In twelve cases in which I have tried it, giv-
ing 4 to 10 min. of Fowler's solution every two or four hours, I was well
satisfied with the result, especially as arsenic was the only active treat-
ment used; no local caustics were needed. In various other affections of
gangrenous character the same remedy has proved very reliable.

The so-called " cancrum oris " and ulcerations about the tongue often
receive benefit from the same treatment.

Epithelioma, etc. Cases of this disease affecting the lip, the tongue,
the scrotum (chimne} r -sweep's cancer), etc., are stated to have been cured
by its internal administration; and although Hirtz concludes that all re-
ports of true cancer being cured by arsenic internally are founded on
mala fides, or bad diagnosis, yet there is some trustworthy evidence of its
relieving cancerous pain in the stomach and in the uterus. Sir C. Locock
mentions his own confidence in it, together with cases from his practice,
and from that of Brodie and Sir A. Cooper (Lancet, 1837), and Mr. Hunt
records a marked instance of relief under small doses frequently repeated,
not amounting to more than 10 min. in twenty-four hours. The case
was said to be undoubted uterine cancer, and the relief given was greater
than from morphia: as a rule, a pill was preferred, containing ^ gr. or

ARSENIC. 67

less. Fordyce Barker also speaks highly of its power to relieve pain and
improve the general condition, in doses of about 3 min. of Fowler's solu-
tion (American Journal of Obstetrics, November, 1870). Dr. Walshe has
written specially to recommend the iodide of arsenic as most valuable
(Dublin Quarterly Journal, August, 1857, v., p. 9). I have given Fow-
ler's solution internally in many cases of epithelioma, when the disease
was extending rapidly, and have known it apparently retard for a con-
siderable time the progress of the malady, relieve the pain, and improve
the general condition. Cases where the lower lip or the scrotum was
affected have given me the best results: the dose usually prescribed was
5 min. thrice daily.

Elephantiasis Gfrcecorum (Leprosy}. Dr. Waring says that for this
almost incurable disease arsenic is still highly esteemed in India, and Dr.
Benet (formerly of Lahore) records benefit from the Tanjore pill (Gazette
des Hopitaux, December, 1842). The external application of arsenious
acid is also reported to have cured (Dublin Medical Press, 1864), but this
must be exceptional.

Disorders of Mucous Membranes. Without implying that the fol-
lowing maladies are solely disorders of mucous membranes, it will be
found convenient to group them under this heading. The value of arse-
nic in them is very marked, but is of comparatively recent recognition,
and has not yet been noticed in many text-books.

Coryza Bronchial Catarrh flay Asthma. In these disorders, in
which a profuse secretion is connected with local irritation, and with gen-
erally depressed nerve-power, Fowler's solution is often effectual, and it
is especially so in patients subject to paroxysmal sneezing, with much
itching about the alse nasi. Dr. Mackenzie had previously reported satis-
factory cases of catarrh treated by doses of 3 min. and upward (London
Medical Journal, July, 1851).

Chronic bronchitis. I have witnessed marked improvement under
the continued internal arsenical treatment of chronic bronchitis, for which
cigarettes and inhalations are sometimes even more suitable than ordinary
doses. Bretonneau and Trousseau have recorded good results, and the lat-
ter devised a simple cigarette, made with suitable paper, soaked in solution
of arseniate of soda, or of potash (1 to 4 gr. in 20 gr. of water for twenty
cigarettes). Four or five mouthfuls are inhaled several times daily; more
often when the patient becomes accustomed to it. M. Papillaud recom-
mends, in chronic bronchitis and emphysema, a combination of the drug
with antimony (an arseniate of antimony), and considering the relations
between these two substances, the recommendation is likely to prove very
good (Gazette de Paris, 1865, No. 43, etc.).

Dyspepsia. In many cases even of irritative dyspepsia, when the
tongue is furred, with red edges and tips, and there is pain after food
and heartburn, and tendency to diarrhoea after eating, I have had ample

68 MATERIA MEDICA AND THERAPEUTICS.

experience of the value of Fowler's solution given in 2 or 3-min. doses
after meals. Dr. Thorowgood finds that it acts best when the attack
seems localized in the stomach, and is independent, e.g., of hepatic con-
gestion (Practitioner, 1870). Dr. Anstie, whose first published observa-
tions were directed to the value of arsenic in gastralgia, previously
mentioned to me its equal efficacy in the dyspeptic conditions described.

Vomiting Diarrhoea. In chronic forms of vomiting connected with
ordinary dyspepsia, and in that of alcoholism which occurs usually in the
early morning, and is of a bilious character, with painful straining, arsenic
is of ten useful: also in the retching and vomiting of pregnancy I have
obtained excellent results from 2 to 5-min. doses. Dr. Decamp has highly
recommended the same treatment {Philadelphia Medical and Surgical
Reporter, 1872, No. 27), and Bartholow mentions, as additional indica-
tions for it, the rejection of the food, streaked with blood, or blood only,
also gastralgia and interscapular pain. It is not only serviceable in cases
of the rapid passage of half-digested food occurring very soon after
meals, but also in cases where the motions are frequent, watery, contain-
ing mucus, offensive and irritating to the anus, and even when bloody
and dysenteric in character and accompanied with tenesmus, prostration,
and vomiting. In true dysentery, especially when of malarial origin, and
verging into a chronic state, arsenic is often of the greatest value.

Chronic Gastric Catarrh. In cases of this malady marked by op-
pression and discomfort after eating, with a sense of weakness and
emptiness at the stomach, thirst, offensive breath, coated and red-edged
tongue, flatulence and pyrosis, with rejection of glairy acid fluid, and
general symptoms of depression, coldness of extremities, and emaciation,
I have had ample experience of the good effect of small doses. In acute
gastric catarrh also, I have not been often disappointed, though a more
cautious use is needed, but in the chronic forms, especially when co-
existing with emphysema, with chronic bronchitis, or with phthisis, arsenic
always gives some relief. Germain speaks favorably of the treatment
{Gazette Hebdomadaire, 1860), and Trousseau remarks that the evidence
in its favor is such as to warrant a fair trial of it. Many mineral waters
that have a reputation in chronic gastric maladies contain an appreciable
quantity of arsenic, notably those of Mont Dore, Plombieres, and Bus-
sang. Dr. Wilson Fox, however, while referring to the favorable reports
of others, states that "he has not had successful results himself, possibly
because he has not seen definite indication for the remedy ";. sometimes
it seemed to aggravate the malady (" Reynolds' System," ii., p. 884).

Gastro-enteritis "English Cholera." 1 " 1 Fowler's solution is an effec-
tive medicine in severe cases of this disorder. I have seen it give relief
when the patient was suffering from retching and bilious or sanguineous
vomiting, passing white, odorless, or slimy flocculent stools, with pain,
tympanitis, and tenesmus; other symptoms present have been thickly-

ARSENIC. 69

coated tongue, thirst, pyrexia and prostration, muscular cramps, scanty
urine, pinched and anxious features. Even when the stage of collapse
has commenced, and the surface is dusky and covered with cold perspira-
tion, the medicine has seemed to me of great service 5 min. every one
or two hours was the dose given, lessening it as the patient improved.
Black has written very fully in praise of this remedy in English cholera,
recommending 10 to 15 drops every ten to fifteen minutes till the sym-
toms abate, then less frequently. He has found this most valuable in
various forms of choleraic attack, but especially in serious cases con*
nected with defective drainage, and presenting the symptoms of vomit-
ing, purging, and rapid collapse; he records several instances of immediate
and striking improvement (Lancet, ii., 1857). Dr. Hitchman speaks
equally strongly, and describes fully the indications for arsenical treat-
ment in such cases (loc. cit., p. 535).

Cholera Infantum. This term has been applied to dysenteric diar-
rhffia in children, probably because of the collapse so readily induced;
The child looks pale and thin, and refuses food, the motions are very fre-
quent and brown, offensive, and mixed with blood; tenesmus also is com-
monly present, and often with such symptoms minim doses of Fowler's
solution produce excellent results.

Gastric Ulcer. Not only in chronic inflammation, but in ulceration
of the mucous membrane of the stomach, I have seen very beneficial re-
sults from arsenic, the appetite returning, and the thirst, the vomiting,
and the pain subsiding, so that the patients became strong and stout who
had before been weak and emaciated. Dr. Ringer has observed similar
results, and states that he has seen relief from this remedy in chronic ul-
cer after failure of the more commonly-used medicines (Op. cit., p. 253).

1 usually prescribe 1 to 5-min. doses four times daily with a little nour-
ishment.

PREPARATIONS AND DOSE. Acidum arseniosum : dose, -fa to y 1 ^ gr. in
solution or pill. Liquor arsenicalis Fowler's solution (4 gr. in 1 fl. oz.):
dose, 2 to 8 min. Liquor arsenici hydrochloricus (4 gr. in 1 fl. oz.) : dose,

2 to 8 min. Sodce arsenias : dose, ^ to -J gr. Liquor soda} arseniatis (4
gr. in 1 fl. oz.): dose, 5 to 10 min. Liquor arsenici et hydrargyri hydri-
odatis (not officinal): dose, 10 min. to fl. dr., diluted, and given with
the usual precautions for preparations of arsenic. Ferri arsenias: dose,

TV to i r -

Liquor arsenicalis, if long kept, is liable to vary in strength on ac-
count of the deposition of a thin film of metallic arsenic; the compound
tincture of lavender contained in it is nauseous to some palates, and
would be better omitted.

The solution of chloride is liable to become cloudy in warm weather,
from the development of a fungus: this may be prevented by the addi-
tion of a little perchloride of iron (Hunt).

70 MATERIA MEDICA AND THERAPEUTICS.

In acute or subacute maladies, as of the stomach or intestine, small
doses, 1 or 2 min., either every hour, or every four or six hours, are suit-
able; in chorea, or neuralgia, or struma, where there is no visceral irrita-
tion, the dose may be gradually raised to 10 or even 15 min., and in
chronic conditions of ague, or of cutaneous disease, the secret of success
will be found in securing the tolerance of a moderate dose for a consider-
able time.

In agues, it is true that a large dose may be required, arid may be
well borne during a certain condition of the system, but so soon as that
condition is relieved the large dose cannot be tolerated.

In skin diseases, large doses are never desirable, and any increase be-
yond 4 or 5 min. should take place only after this dose has been used
three or four weeks without physiological symptoms. This remark refers
especially to the potash and to the acid solutions, not to that of the ar-
seniate of soda, for although nominally of the same strength, the last-
mentioned is markedly milder, and is often better borne in doses of G to 8
min., or more, than the others in less quantities. The remedy, sufficiently
diluted, should always be given in several such moderate quantities daily,
rather than in one full dose, and always at a meal, or with some food, so
as to secure absorption and lessen the degree of local irritation; the
symptoms of its physiological action, such as irritation of conjunctivas,
oedema, nausea, etc., should be constantly watched for, and the dose di-
minished rather than entirely omitted, if the reason for its administration
remain.

In some obstinate cases, especially of chorea and of skin disease, it is
justifiable and not harmful to keep up a moderate degree of physiologi-
cal action for some time, but this must be done very cautiously. It is a
matter of daily experience that the secretions must be in good order if
we are to expect the full advantage of the remedy in chronic disease.
Mr. Hunt observes, " Above all, the bowels must not be allowed to act
sluggishly. In many cases a full dose of calomel and compound colocynth
pill will be required two or three times a week, and these doses are some-
times essential to the cure. If the legs, or feet, or abdomen become oede-
matous, and the urine scanty, the case will not go on well till we have
roused the kidneys to vigorous action by full doses of spiritus setheris
nitrosi and acetate of potash, etc." (Journal of Cutaneous Medicine, ii.,
p. 353).

The administration and the powers of arsenic in combination with
other remedies require special consideration. We have already noted
that it enhances the value of iron, for instance, in amenorrhcea, anaemia,
struma, eczema, etc., and Messrs. Young and Postans have introduced a
good effervescing citrate of arsenic and iron, which I have often found ser-
viceable. The direct combination of iodine and arsenic has been esteemed
by some practitioners on the Continent and in Ireland, especially by Neli-

GOLD. 71

gan: from -5*5- to ^gr. in pill thrice daily has been given. The same phy-
sician employed also an ioduretted solution, containing 5 min. of Fow-
ler's solution, 1 gr. of iodide of potassium, and gr. of iodine in 1 dr. of
orange syrup; it is rather agreeable, and keeps well, and has given good
results. He found this preferable to Donovan's solution (Dublin Jour-
nal, vols. xvi., xviii., xxii.), (y. p. 27). This has been specially used in
syphilitic skin disease, but it is, as Mr. Hunt observes, though " very ac-
tive, yet a most unmanageable preparation." The mercury is liable to
injure the general health of some weakly subjects, and to interfere with
the effects of arsenic or of iodine, which are quite powerful enough, and
require special caution as to their own effects. Dr. Clemens, of Frank-
fort, recommends a direct combination of arsenious acid and bromine, and
Ferris and Co. prepare a liquor arsenici bromati.

[PREPARATIONS, U. S. P. Acidum arseniosum ; Arsenici iodidum
dose, -gV to -j^ grain ; Arsenicum / Liquor arsenici chloridi ; dose, 2 to 8
minims; Liquor arsenici et hydrargyri iodidi / dose, 2 to 10 minims ;
Liquor potassii arsenitis Fowler's solution; dose 2 to 8 minims.]

AURUM GOLD, Au, = 196.6 (not officinal).

This " king of metals," as it was formerly termed, is found native in
the "veins " of rocks, and as gold-dust or nuggets in the sands of certain
plains and rivers; it is separated by washing, or by means of mercury,
which is afterward driven off by heat; it occurs also in alloy with silver,
copper, and iron, but not as an oxide, nor in any other than the metallic
form.

CHARACTERS AND TESTS. When pure it is of yellow color, having a
tinge of green by reflected light, and is decidedly greenish when liquefied;
it is of great density (sp. gr. 19.5), and is remarkably malleable, 280,000
thin leaves making only one inch in thickness. It is less easily oxidized
than any other metal, and will not combine with oxygen by direct action,
only through the medium of another oxide: thus the protoxide of gold is
prepared by adding solution of potash to one of protochloride; it precipi-
tates as a green pc>wder. Gold combines also with chlorine and iodine,
not with nitrogen or hydrogen. It is soluble only in a mixture of nitric
with hydrochloric acid (aqua regia).

PULV18 AURlPOWDER OF GOLD (not officinal).

PREPARATION. By triturating gold leaf with some hard crystals, as of
potassic sulphate, or with some glutinous substance as honey; and after

72 MATERIA MEDIC A AND THERAPEUTICS.

complete disintegration of the metal, the foreign ingredient is removed
by washing the resulting powder retains the color of the metal.

COMPOUNDS OP GOLD.

AURIPERCHLORIDUMPERCHLORIDEOF GOLD " POTABLE GOLD"
OF ALCHEMISTS, AuCl s ,-303 (not officinal).

PREPARATION, etc. By dissolving the metal in nitro-hydrochloric
acid, with gentle heat. On evaporating, yellow crystals of the salt are
left in combination with some free acid (AuCl 3 2HClH 2 0). After the
acid has been driven off, the color of the crystals is red, and they have
the composition AuCL. This salt is used in photography and in analyt-
ical chemistry, and a solution of it, freed from excess of acid, is placed
in the appendix to the Pharmacopoeia as a test solution for atropia.

AURI PEROXIDUM PEROXIDE OF GOLD ." AURIC ACID," Au,O 3 , =

441.2 (not officinal).

PREPARATION, etc. By treating the perchloride with magnesia, wash-
ing the precipitate, and digesting in dilute nitric acid, which removes the
magnesia. The peroxide forms, when dried, a brown powder, insoluble in
water, and decomposed by exposure to light.

AURI ET SOD II CHLOR1DUM CHLORIDE OF GOLD AND SODIUM,
AuCl 3 NaC12H 2 O (not officinal).

PREPARATION, etc. By mixing in solution about 5 parts of chloride
of gold and 1 part of chloride of sodium, and evaporating to crystalliza-
tion; long, four-sided prisms are left, of deep yellow color. This combi-
nation, which is deliquescent arid soluble in water, is the form most com-
monly prescribed; it has a nauseous taste, and should not therefore be
given in solution.

AURI 10DIDUM IODIDE OF GOLD, Aul, (not officinal).

PREPARATION, etc. By mixing solutions of iodide of potassium and
perchloride of gold. The precipitate, when collected, washed, and dried,
forms a greenish yellow powder, insoluble in cold, but slightly soluble in
boiling water.

ABSORPTION AND ELIMINATION. Salts of gold are readily decomposed
by organic substances, and they coagulate albumen, but when the soluble
chlorides are given internally they become absorbed to some extent,

GOLD. 73

probably in the intestine, as oxides combined with albumen. When
rubbed upon the gums and tongue, according to an old-fashioned method
of administration, they are also absorbed, but are liable to cause much
local irritation. Neither metallic gold nor the oxides can be absorbed
(although poisoning by gold leaf is said to be an aristocratic method of
suicide in China), nor is an ointment containing either these or the chlo-
rides likely to produce any effect through the skin.

Elimination occurs through the liver, the intestinal canal, and the
kidneys, but is very slow (Husemann): the urine is colored yellow during
the process. Rabuteau maintains that the -elimination of gold is never
complete, some of the metal being reduced and deposited, especially in
the epithelial and nerve-tissues; for on examining these parts in the
body of a rat that had died after taking 15 gr. of gold chloride in four-
teen days, he found the contour of epithelium from the intestinal tract
to be very strongly marked, as by nitrate of silver, and the axis-cylinder
of the nerve-tubules to be colored slightly green; he considers that this
deposition of the metal explains why gold seems more active than mer-
cury, for having nearly the same atomic weight and specific heat, their
properties should (according to the analogies of other substances as ob-
served by him) be also very similar, were it not that the gold is less
completely eliminated (Op. cit.). We must remark, however, upon this
point, that though mercury may, as a rule, be more readily eliminated
than gold, yet it has also often, been found deposited in bone, liver, and
other parts of the body, long after its administration.

PHYSIOLOGICAL ACTION (EXTERNAL). The chloride of gold has an
irritant and caustic effect, and stains the skin of a yellow color, which
becomes violet, and later black, from reduction of the metal.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Small doses
increase appetite and digestive power, and stimulate the secreting or-
gans; but under larger or continued doses, this stimulation readily passes
into irritation, and there are often dry ness of the tongue, redness of the
pharynx, and some gastric irritation, with colic and diarrhoea (Cullerier);
on the other hand, though the intestinal secretions are increased, consti-
pation has been noticed by several observers.

Glandular System. Salivation has been commonly described as a
result of this medicine, and is said to occur after a longer period, and
with less marked stomatitis, than when produced by mercury. Martini
met with it (ptyalism) only after the long-continued use of small doses, and
found that the double chloride of gold and sodium might be taken for many
months without injurious effect; only in one case did ptyalism occur, and
then one-third of an ounce had been taken (Schmidt's Jahrb., June 23,
1870). The secretion of the sweat-glands is increased, especially during
the night, and this alternates with or accompanies an increase in the
quantity of urine (Gozzi, Bologna, 1817). The stimulation of the glandu-

74 MATERIA MEDICA AND THERAPEUTICS.

lar system and of growth is said to be such that adenitis has followed the
use of gold, and tumors of osseous or of glandular character have become
painful and inflamed (Percy: Rapport a P Academic). Some excitement
of the genital organs occurs, so that in men priapism may be caused,
and in women the catamenia increased (Legrand: " De 1'Or").

Nervous System. The intellectual powers are said to be stimulated
by gold somewhat in the same manner as by alcohol.

Toxic Effects. A peculiar febrile condition " auric fever " includ-
ing headache and many of the above-mentioned symptoms, as sweating
and diuresis, may supervene if a course of the remedy be continued for
two to four weeks, and seems to be analogous to mercurial fever (Niel:
Recherches, Paris, 1820, etc.). In animals, general emaciation and convul-
sive twitchings have preceded death, and besides the evidence of metallic
deposition in the tissues, Rabuteau records a yellow coloration of the
gastro-intestinal mucous membrane. Large doses of gold compounds may
certainly cause gastritis and death, with cramp and other severe nerve-
symptoms (Majendie).

SYNERGISTS. Mercurials.

ANTAGONISTS INCOMPATIBLES. Albumen in any form milk, flour,
etc.

THERAPEUTICAL ACTION (EXTERNAL). As a caustic, the chloride has
been used by Landolfi and Recamier in lupus and in carcinoma. Legrand
employed it as a caustic in ulceration of the neck of the uterus, and also
as a lotion and a vaginal injection (Op. cit.). Mechanically, the gold
leaf is employed by dentists for stopping teeth, and by druggists for
coating pills.

THERAPEUTICAL ACTION (INTERNAL). In former times, when fanci-
ful analogies of color or of accidental qualities largely determined opinion
as to the medicinal value of any substance, gold was praised as a remedy
for melancholy, and for the dyspepsia often connected with it, and after
several centuries of disuse its therapeutical power has been, to some ex-
tent, revived mainly by a few French and Italian physicians. The double
chloride of gold and sodium is the preparation most recommended; it
bears somewhat the same relation to the pure metal as corrosive sublimate
does to mercury.

Syphilis. M. Chrestien, of Montpellier, and later, M. Legrand, have
reported many cases of both primary and secondary syphilis cured under
the influence of gold, and Trousseau observes that such results are now
well proven and incontestable. Chancres and condylomata have got well
under this remedy in a manner not likely to be due to nature, and in my
own experience its efficacy has been still better seen in the later develop-
ments, such as ulceration in the nose and larynx, cutaneous syphilides,
hard nodes, etc. It is said to cure without local applications, but often
an " unguentum auri " has been used in addition. Gold may especially

GOLD. 75

be employed in Jong-standing cases with chronic periostitis, and when
mercury has been already given to saturation.

Dietrich, while denying to gold any true anti-syphilitic power, thought
it most valuable for mercurial cachexia (Journal des Connaissances Med.-
Chir., 1840), but this has not been corroborated by many observers.
Auric fever may occur during a course of the remedy, and for a time the
general health may suffer, and the local manifestations may be more ir-
ritable, but on lessening the dose, pyrexia subsides, and good effects are
more conspicuous.

Scrofula. Advocates of the medicinal -use of gold especially Niel
and Legrand have spoken strongly of its value in scrofulous disease of
the bones, in glandular enlargements, " white swelling," goitre, and even
elephantiasis; but Yelpeau and others have not corroborated their good
results in hospital practice. No doubt, as Trousseau remarks, the treat-
ment of scrofula among the poor really requires more than any drug can
effect, and it would be unfair to discredit gold altogether because it has
not cured some hospital patients. I think myself that it may prove a use-
ful adjunct, or at least a good alternative treatment. Majendie and
Roux have reported some illustrations of its value, and Mr. Chatterley has
recorded a case of extensive and indolent scrofulous ulcer affecting the
right foot, unrelieved by iodide of iron, etc., but cured by small doses of
gold chloride (Lancet, ii., 1852, p. 455); also another case of cure of a ca-
chectic child suffering from enlarged and indurated cervical glands (Medi-
cal Times, i., 1854, p. 447); he recommended ^ gr. mixed with orris-root
to be rubbed on the tongue for one to five minutes daily.

A case of hypertrophy of tongue with induration, which was probably
syphilitic or scrofulous in character, was cured by the use of 1.5 gr. in-
ternally, and local frictions with 1 gr. mixed with lard (American Medi-
cal Journal, vol. xix., p. 514).

It is probable that the so-called cures of cancer by aurum have really
been of scrofulous ulceration.

Uterine Disorders. Noggerath refers to the value of this medicine
in amenorrhoea, and in chronic ovaritis, and says it is suitable for cases of
the former dependent upon torpor; it should not be given during preg-
nancy, nor to persons liable to undue flooding. Martini states that it is
serviceable in cases with a tendency to abortion, in chronic metritis, and in
sterility " dependent upon atrophy of the vaginal portion of the uterus,"
also in ovarian dropsy. He observed benefit from it as regards mental
symptoms of hysterical character, and especially when these were con-
nected with definite uterine disorder or disease (Schmidt's Jahrl)., loc.
cit.).

Chronic Bfighfs Disease. Dr. Bartholow draws special attention to
the value of salts of gold in the treatment of granular and fibroid disease
of the kidney and " depurative disease." He has observed remarkable

76 MATERIA MEDICA AND THERAPEUTICS.

improvement from the persistent use of small doses of the chlorides
3*0 t ?V S r -> turee times daily (" Materia Medica," p. 188). They are not
suitable for acute stages.

Dyspepsia, etc. Dr. Bartholow is also one of the most decided of
modern writers in recommending small doses (^ gr.) of the double chlo-
ride for " nervous dyspepsia," as " indicated by a red glazed tongue, epi-
gastric pain, increased after food, and tendency to relaxation of the
bowels: also in duodenal and biliary catarrh, and jaundice." Vertigo
and vertiginous sensations, connected with stomach disorder, are often
relieved by small doses of gold chlorides, but plethora and increased in-
tracranial blood-pressure contra-indicate their use. On the other hand,
they do good in cerebral ariasmia, so that they may be prescribed when
bromides would not be suitable. Melancholia and hypochondriasis with
depression are often connected with gastric disorder and with cerebral
anaemia, and are susceptible, to some extent, of relief by the same
remedy.

ffemi-AncBSthesia. I must not omit to notice the most modern ap-
plication of gold as a remedy, and that is in its metallic form in "metallo-
therapy," as developed mainly in Paris by Charcot and others. It seems
that rather a large proportion of nervous patients on the Continent suffer
from impaired sensation of one-half of the body, and that by the applica-
tion of two metals, as a gold and a copper coin over several nerve-trunks,
sensation may be " transferred," returning to the affected side in about a
quarter of an hour, but often leaving, at the same time, the previously
sound side. Such a peculiar circumstance is not yet wholly explained,
but has been connected with a gentle galvanic action (Medical Record,
187879). Dr. A. Hughes Bennett and others explain the phenomena
rather by " expectant attention," and I believe that mental influences of
various kinds are a much more likely explanation than any specific prop-
erties of metals thus applied.

PREPARATIONS AND DOSE. Fine gold, and the solution of the chlo-
ride, are placed in the appendix to the B. P., but no directions for their
internal use are given. Pulvis auri: dose, to gr. gradually in-
creased to 2 to 3 gr. may be given in pill with confection of roses, but
is not a good form. Syrupus auri, containing 24 gr. to the ounce, has
been used by way of friction on the tongue, but cannot be depended upon.
ITnguentum auri, dr. to the ounce of lard not dependable. Chloride
of gold and sodium: dose, -^j- to fa gr. once or twice daily, in -pill the
best preparation, but its irritant and poisonous properties should be re-
membered. Teroxide of gold : dose, -fa gr. twice or thrice daily. Iodide
of gold (French codex): dose, -fa to -fa gr., said to be more active than
corrosive sublimate.

BARIUM. 77

BARIUM, Ba,= 137.0.

A brilliant white metal, not met with in the native state, but abun-
dantly as the base of an alkaline earth called baryta, or barytes (an oxide),
which occurs extensively as native sulphate (BaSO 4 , heavy spar, its most
common compound) and native carbonate (witherite).

BARYTA, BaO,=153.

CHARACTERS AND TESTS. A grayish-white, earthy-looking substance,
heavy, sp. gr. 5.4, of sharp caustic taste and strongly alkaline reaction;
sprinkled with water it becomes hot, and slakes with energetic action,
falling into a fine white powder, = hydrate of baryta, BaH 2 O 2 , which con-
tains 10 per cent, water, and is soluble in 10 parts of boiling water.
Baryta has, like lime, a strong affinity for sulphuric and carbonic acids.

SARII CHLORIDUM CHLORIDE OF BARIUM, BaCl 4 3H,O. =244.

Is placed in the appendix as a test for sulphuric acid.

CHARACTERS AND TESTS. Occurs in translucent soluble crystals,
which have a bitter acrid taste. The solution gives with any soluble sul-
phate a heavy white precipitate, unaffected by nitric acid.

Carbonate of Baryta is a white insoluble powder.

ABSORPTION AND ELIMINATION. We have no very accurate observa-
tions on these points, but Orfila detected the chloride of barium in the
liver, spleen, and kidneys of animals poisoned by it (Annales d" "Hygiene,
ii., 1842).

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Small closes
(iV to gr.) of the chloride exert a stimulant effect on the stomach-func-
tions, increase the appetite, and often produce loose stools. Larger
doses prove irritant or caustic; three grains, taken several times daily,
soon induce a sense of pressure at the epigastrium, nausea, vomiting,
and purging, with faintness (Fergusson: Dublin Journal, February,
1844). One drachm caused much vomiting and purging, and death from
convulsion in seventeen hours (Walsh: Lancet, 1859). Half an ounce
caused similar irritant symptoms, and death in two hours evidence of
severe gastro-intestinal inflammation was found (Taylor). The nitrate
and acetate of baryta have also caused death, and the carbonate is com-
monly used as a poison for rats and mice. Although one teaspoonful is
said to have destroyed life, much larger doses have been taken without
fatal result.

Nervous System. The nerve-symptoms caused by toxic doses of ba-
rium compounds, are clonic convulsions and motor paralysis, with impair-

t
78 MATERIA MEDIC A AND THERAPEUTICS.

merit of reflex excitability. From the slow respiration observed in cases
of poisoning 1 , it has been concluded that the vagi become paralyzed
(Walsh). According to Cyon, the nerve-lesion caused is central, for
even in advanced poisoning- the muscular irritability and the sensibility
of peripheral nerves remain intact (Reichert's Archiv, 1866, No. 2). Se-
vere pains in head, throbbing in the temples, giddiness, dimness of sight,
double vision, deafness, and tinnitus have been experienced: also muscu-
lar cramp, especially in the legs.

Circulatory System. The heart-action is at first stimulated, after-
ward quickly and powerfully depressed, by full doses of barium com-
pounds. After some palpitation, the pulse becomes irregular, feeble, or
imperceptible, and the surface cold and pale. Bohm concludes that they
first stimulate and then paralyze the automatic heart-ganglia. Onsum
suggested that baryta compounds caused embolism by precipitation of
the sulphates of blood (Virchow's Archiv, Bd. xxviii.), but Cyon has
shown both that the normal sulphates exist in very small amount, and
that if they are artificially increased, still no precipitate occurs on giving
baryta (loc. cit.).

Glandular System. We have not clear evidence of the effect of ba-
ryta on this system, but it is presumed to exert some absorptive " deob-
struent " power on inflamed or hardened lymphatic glands. Small doses
increase the secretion of urine and of perspiration (Waring).

SYNERGISTS. Lime and other alkaline earths. The chloride of ba-
rium has some analogies with corrosive sublimate.

INCOMPATIBLES. All sulphates are chemically incompatible with ba-
rium salts, forming insoluble compounds. The sulphates of soda and
magnesia have been used as antidotes in cases of poisoning (Walsh),
also white of egg and sugared wine (Perondi: Bulletin de 27ierapeu-
tique, t. x.).

THERAPEUTICAL ACTION (EXTERNAL). Depilation. Dr. McCall An-
derson recommends the sulphide of barium for removing superfluous hair,
one part of it being made into a paste with four parts of zinc oxide and a
little water; this should be left on the part for about three minutes, and
then washed off.

Ophthalmia. Dr. Pay recommends a collyrium of barium chloride
(1 to 2 gr. in 10 oz.) in scrofulous ophthalmias (Rev. Med., 1840), but it
is not now much used.

THERAPEUTICAL ACTION (INTERNAL^. Scrofulosis, etc. Barium
chloride was introduced at the end of last century as effective in scrof-
ulous and syphilitic dyscrasia?, in gonorrhoea, white swelling, etc. (Craw-
ford, 1780). Lisfranc and Torget used it in such cases and in glan-
dular tumors, and reported much advantage from it; the former began
with gr. every hour, and increased the dose to much larger quantities
than we should consider safe (40 gr.). In a child, many glandular tumors

BISMUTH. 79

subsided under a month's treatment, but frictions with iodide of potas-
sium were used at the same time (American Journal, 1838, No. 45, Bnl-
letin de Therapeutique, 1840). Mr. K. Phillips recommended barium
chloride as superior to iodine in many cases marked by pallor, languid cir-
culation, and irritable mucous membranes (" On Scrofula," 1846), and
Mr. Balman used it in chlorotic and cachectic states generally (Medical
Times, ii., 1851). In amenorrhcea he gave -J to 1. gr. doses with per-
chloride of iron. Many cases of successful treatment of scrofulous joint-
disease, of ophthalmia, and of enlarged glands by barium chloride (y 1 ^ gr.
doses), were recorded some years ago (Ranking, 1846).

Epilepsy ', Tetanus, etc. Ilufeland introduced this remedy for epilepsy
in scrofulous subjects, but it is now seldom used. Brown-Sequard, how-
ever, while reporting against its efficacy, remarks that it may diminish
reflex excitability, and therefore deserves trial in tetanus and in paralysis
agitans. A somewhat doubtful case of traumatic tetanus is said to have
recovered under the use of about 16 gr. of the chloride, given in twenty-
four hours (Edinburgh Medical Journal, 1862). In satyriasis, or exces-
sive sexual desire, it has also been employed. Dr. Hammond recommends
it in diffuse and multiple cerebral sclerosis.

PREPARATIONS AND DOSE. Barii chloridum : the dose mentioned by
Dr. Garrod and others is from to 2 gr., but Mr. Kennedy, after much
experience, maintains that -fa to -fa gr. is much more suitable and safer
to commence with ; very few persons, he says, can bear ^ gr. without irrita-
tion (Lancet, ii., 1873, p. 28). The United States Pharmacopoeia contains
a liquor barii chloridi (1 part in 4 of distilled water); the dose ordered is
5 min.

As an eye-lotion, from 1 to 2 gr. may be ordered with 10 oz. of water.
As a depilatory, 1 part of sulphi'de to 4 of excipient.

[PREPARATIONS, U. S. P. Barii carbonas and Liquor barii chloridi.]

BISMUTHUM BISMUTH, Bi, = 210 (MARCOSITA).

This substance, which is now, like antimony, classed among metal-
loids, occurs native, and also as an oxide, as a sulphide, and variously
combined in metallic ores with silver, iron, copper, arsenic, etc.

PREPARATION. The Pharmacopoeia directs the preparation of a
"purified bismuth," by fusion with nitrate of potash, but the process is
not very satisfactory.

CHARACTERS. The metalloid is gray-colored with a roseate tinge, and
may be obtained in masses of cubical, iridescent crystals; it is tasteless
and inodorous, heavy, hard, brittle, and, like antimony, volatilizes at a
strong heat, and expands on cooling.

80 MATEEIA MEDIC A AND THERAPEUTICS.

BISMUTHI OXIDUM OXIDE OF BISMUTH B1SMUTHOUS OX.1DE
SESQ Ul OXIDE, Bi 2 O s , =468.

PREPARATION. By boiling the subnitrate with excess of solution of
soda.

CHARACTERS. A smooth, yellowish powder insoluble in water, pre-
sumed to be more definite in composition, and more constantly pure than
other bismuth compounds (R. "W. Smith).

BISMUTH1 SUBNITRAS SUBNITRATE OF BISMUTH WHITE BIS-
MUTHSPANISH WHITE, Bi 3 3 2HN03,=546.

PREPARATION. The true nitrate (ternitrate), which is crystalline,
soluble, and more active and irritant than the subsalt, is formed by dis-
solving the metalloid in nitric acid, and when this solution is poured into
a large quantity of water it is decomposed, the subnitrate of bismuth fall-
ing as a white precipitate, and the supernitrate remaining in solution.

It was known as nitrate in an earlier Pharmacoposia, and is still some-
times described under that name (Ringer); it has been termed also tris-
nitrate, and hence some confusion between the properties of really differ-
ent compounds.

CHARACTERS AND TESTS. The subnitrate is crystalline, but when
well prepared, should be in smooth and fine powder. It is heavy, whitish
in color, becoming yellowish-gray on exposure to light from the forma-
tion of some sulphide, or from the presence of silver; it is insoluble in
water, soluble in nitric acid. It contains sometimes such an amount of
acid as to effervesce when mixed with a carbonate (Martindale). A solu-
tion of bismuth subnitrate and sodium hydrate in water and glycerin is
the Lowe test for sugar in urine: it has the advantage of being stable,
and is recommended by Dr. W. Gr. Smith (British Medical Journal, ii.,
1879).

LIQ UOR B1SMUTHI ET AMMONIA CITRA TISSOL UTION OF CITRA TE
OF BISMUTH AND AMMONIA.

PREPARATION. By dissolving purified bismuth in nitric acid, and then
adding citric acid and solution of ammonia until the precipitate at first
formed is redissolved. (A better form for this preparation has been
published Pharmaceutical Journal, 1866.)

CHARACTERS AND TESTS. A colorless liquid, of saline metallic taste,
miscible with water. Liquor potassee precipitates the white hydrate, and
hydrochloric acid the white oxychloride, but an excess of acid redissolves
this as chloride. The officinal solution is described as neutral, or slightly

BISMUTH. 81

alkaline, but it frequently contains an excess of nitric acid, much more
than the original preparation of Schacht.

mSMUTHl CARBONAS CARBONATE OF BISMUTH, 2^Bi 2 Co 6 )H 2 O,=1042.

PREPARATION. By adding a concentrated solution of bismuth in
nitric acid to an excess of carbonate of ammonia in cold solution.

CHARACTERS AND TESTS. The salt which precipitates is a hydrated
oxycarbonate, which is, like the subnitrate, insoluble in water, but is more
soluble in the gastric juice, and has antacid properties.

On passing a current of sulphuretted hydrogen through an acid solu-
tion of a bismuth salt, the black sulphide of bismuth (Bi 2 S 3 ) will be
thrown down. Concentrated acid solutions of bismuth salts poured into
water give a white precipitate of subsalt, e.g., the nitrate when thus
treated yields the subnitrate. Caustic alkali added to a solution of a bis-
muth salt precipitates the white hydrate of bismuth (Bi 2 3 H 2 O). Papers
saturated with sulpho-cyanide of potassium are colored yellow by soluble
bismuth salts.

ABSORPTION AND ELIMINATION. Bismuth, in substance, is not ab-
sorbed by the skin, and the supposed instances of poisonous effects from
its use as a cosmetic are not trustworthy (Husemann). A soluble bis-
muth salt, such as the ammonio-citrate, is, however, quickly absorbed
from the cellular tissue after hypodermic injection.

Much difference exists in the degree of absorption of bismuth com-
pounds taken by the mouth, and the difference is proportionate to their
solubility. The acetate, the double tartrate, and the ammonio-citrate
dissolve in the gastric fluids, and are readily absorbed, while the oxide
and subcarbonate are but slightly soluble, and the ordinary subnitrate
still less so.

Headland taught that it was as insoluble as charcoal, but Orfila and
Lewald have detected the drug in the liver, in the milk, and the urine,
after its administration, though in the latter secretion it appeared later
than other metallic salts usually do. Bergeret and Mayenfon detected
it in the same fluids, and in the serous exudations of dropsy, and after
giving small doses to rabbits they found it, within half an hour, in the
blood, the spleen, the muscles, etc., and continued to find traces of it for
eight days after administration. In one man they also found it five days
after; in another, testing sixty-two days afterward, they did not find any
(Journal de VAnatomie, 1873). We may conclude, therefore, that some
amount of absorption even of the subnitrate occurs (and probably as
chloride), although the greater part of what has been taken has been
found unchanged in the stomach in 1 some cases, or altered to a bluish tint
in the small intestine, or converted into the black sulphide in the colon
or rectum, or has been eliminated with the fasces during life. Dr. Levick
VOL. II. 6

82 MATERIA MEDICA AND THERAPEUTICS.

mentions a case of phthisical diarrhoea, in which 20 gr. were taken four
times daily for some weeks, and the whole intestinal canal was found to
be lined by the bismuth powder (American Medical Journal, July, 1858).
It is probable that more absorption occurs with small doses (such as the
grain or less used originally by Odier, of Geneva), than with the very
large ones (several hundred grains daily) prescribed by Monneret.

PHYSIOLOGICAL ACTION (EXTERNAL). The pulverulent bismuth com-
pounds have an absorbent and protective effect: they are also somewhat
astringent and sedative. The crystallized nitrate, especially when dis-
solved in .glycerin, is also astringent, but is more irritating, even some-
what caustic.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive /System. Bismuth,
taken in a pulverulent form, exerts upon the gastric mucous membrane a
sedative, slightly astringent effect, similar to that already described as its
external action. Taken in a liquid (more soluble) form, the effects are
still of the same kind, but produced by smaller doses and with more ten-
dency to irritation. Whether pure bismuth salts, when taken internally,
can exert an irritant poisonous action, or are in the largest doses practi-
cally innocuous, has been much disputed. Orfila and Meyer, in experi-
ments on animals, found that both the nitrate and the subnitrate, in doses
of 1 to 2 dr., caused vomiting, tremor, depression, and death, with post-
mortem evidence of gastro-enteritis (" Toxicologie," ii., p. 10 ; and Wib-
mer : " Wirkungen," etc., i., p. 423). Kerner also records a case of a man
who took 40 gr. of the subnitrate, and suffered from gastric oppression,
and burning pain, bitter taste, thirst, loss of appetite, eructation, gripinir,
bilious vomiting and relaxation, with vertigo, dimness of sight, and head-
ache the pulse was small and tense; and another case a man who swal-
lowed 2 dr. (mixed with cream of tartar), and died after violent symptoms
of irritant poisoning, such as burning pain in the throat, purging, vomit-
ing, cramps, suppression of urine, tremor, and paralysis: after death, in-
flammation and even gangrene were found in the course of the alimentary
tract (Wibmer, loc. cit.). Sobernheim subjoins to these cases, one that
after a 2-dr. dose proved fatal in nine days, with similar symptoms, in-
cluding also delirium and general swelling of the face, limbs, and abdo-
men: in this instance also, inflammation and gangrene of the stomach and
intestines were found (" Arzneimittellehre," 6th Ed., p. 265). Trousseau
alludes to a similar case recorded by Pott in 1739, and Dr. Traill reports
one where vomiting and pain followed the taking of 6 dr. (in divided
doses). Christison describes " bismuth, in its saline combinations, as an
active poison," and Taylor quotes some of the above cases as " proving
that a substance very slightly soluble in water may exert a powerfully
poisonous action on the human system."

On the other hand we must place the strong evidence of Trousseau
and Monneret, and the daily experience of a majority of practitioners.

BISMUTH. 83

Trousseau states that during a very extensive use of the well-prepared
subriitrate in doses of from 15 to GO gr., he has never seen the slightest
accident, or the least cause for apprehension (" Materia Medica," i.), while
Monneret prescribed the enormous doses of 150 up to 900 gr. per diem,
without any inconvenience resulting. He noted only slight constipation
with lessened odor and blackened color of the faeces; there was no thirst,
nausea, or pain, nor any evidence of inflammation, and the appetite was
rather increased than diminished. Such doses as the above are not likely
to be now prescribed, but many physicians order 10, 20, or 30 gr. several
times daily without any evil result.

Trousseau and others explain the toxic symptoms above noted by the
presence of arsenic as an impurity, and in some cases correctly, as shown
by Taylor. II. C. Wood also records a case of bloody purging from the
use of an adulterated drug, and the effects are certainly those of an irri-
tant poison. Still, as a rule, there is no evidence of the requisite amount
of arsenic for serious results, even in the most adulterated specimens of
bismuth. Stille speaks of one-sixth of 1 per cent, as the maximum pro-
portion found, while Parral and Gamier ascertained that preparations
containing 0.129 per cent, did not poison dogs, even in doses of 200 to
500 gr. (see also Adulteration).

Monneret suggested that in the above cases, either a previous illness
became suddenly exaggerated, or an excess of soluble nitrate acted as an
irritant: the last alternative seems possible after recent evidence that
soluble compounds of bismuth have an activity hitherto not supposed in
pure preparations. The acetate (according to Bricka), the double tar-
trate (Rabuteau), and the ammonio-citrate (Stephanowitsch) given in
large doses, produce poisonous symptoms very like those of the allied
metals, gold and quicksilver. Rabuteau " at first held the classical opin-
ion as to the remarkable harmlessness of bismuth," but his observations
with the double tartrate, or " emetic" of bismuth and potash (C 4 H 4 K
(BiO)O g ) have convinced him that slight solubility explains the general
absence of dynamic effects after large doses of the ordinary preparations.
The tartrate is soluble in water without decomposition, and gives a me-
tallic taste like that of ordinary " tartar emetic," it causes vomiting, and
30 to 60 gr. prove fatal to small dogs. In connection with this observa-
tion, it is noteworthy that in Kerner's fatal case, the patient took cream
of tartar with his dose of bismuth, and the salt referred to by Rabuteau
would probably be formed. Stephanowitsch records of the ammonio-
citrate that its hypodermic injection, in the proportion of 1 gramme to
each 1,000 grammes of body-weight, will kill animals, and that salivation
and buccal abscess follow its use, as well as steatosis of liver, kidneys,
and heart. The liver glycogen disappears under its prolonged adminis-
tration (Lebedeff).

Although, therefore, some of the older cases were connected with the

84 MATERIA MEDICA AND THERAPEUTICS.

presence of arsenic, yet bismuth cannot be held entirely innocuous, and
its activity clearly depends upon its solubility. The oxide, the subcar-
bonate, and subnitrate, though but slightly soluble, may be taken up to
some extent, especially when small doses are used. Thus, Odier, of Ge-
neva, gave only a few grains, or less than a grain, and noticed occasion-
ally vomiting, diarrhoea, a sense of heat, vertigo, and drowsiness. M.
Guersant has noted colic and " sense of anxiety," and Rabuteau some
general sedation, like the effect of antimony, and I have observed some
clinical evidence in the same direction; but the existence of a chronic
form of bismuth poisoning, marked by anaemia, swelling of gums, hemor-
rhage, etc., as described by Lussanna in man, 1 and by Stephanowitsch in
animals, has not been further verified. The only observation bearing
upon it that I have found is one by Dr. Brinton, who states that if the
subnitrate be taken continuously it will cause a bluish-red line on the
gums, " similar to, but wider and more red than that known to be caused
by lead " (" Diseases of Stomach," first edition, p. 197). I have not
found this noted by any other observer, but lead has been suggested as
an adulterant in the preparations used by Lussanna.

The action of Liquor Bismuthi differs somewhat from that of the solid
compounds, and probably represents rather the real activity of the drug,
independently of the mechanical effect of a powder; it is more irritant (H.
Wood), and it has failed to relieve gastric pain when the subnitrate has
succeeded (Macnamara). The carbonate is said to be less liable to irri-
tate than the subnitrate, and yet to be more soluble in the gastric juice
(Hannon); it does not perhaps absorb intestinal gases so readily as the
subnitrate or oxide, but has better antacid powers, and is not so likely to
constipate. The observer named, traced to it also some primary sedative
effects, like those described by Rabuteau of the nitrate, viz., weakening
and slowing of pulse, lessened appetite, and increased excretion of urine,
but found that its continued use improved strength and vigor like iron
preparations.

SYNERGISTS. Mechanical absorbents and antacids and sedatives.
Magnesia is specially suited for combination with bismuth salts.

INCOMPATIBLES. Acids are said to be incompatible with the subni-
trate of bismuth (Gubler), and some have advised the omission of all
acids from the diet during its administration. Practically, however,

1 Dr. Lussanna remarks that Honneret's results with large doses " have destroyed
the Orfilian scarecrow," but his own conclusions are almost as alarming as those of
Orfila. From large doses, used apparently chiefly in tuberculous diarrhoea, he wit-
nessed no irritation, nor any arrest of .the malady, but supervention of a " colliquative
and scorbutic state," connected, he presumes, with a solvent action on globulin he
traces a profuse epistaxis in a case of mesenteric tuberculosis to the use of bismuth,
but gives no sufficient details of the cases on which his exceptional conclusions are
based .

BISMUTH. 85

their effect is only to favor the production of the more soluble nitrate,
which should, in suitable dose, act favorably without discomfort, and a
few minims of nitric acid are not infrequently prescribed with it; they
should be omitted, however, if a merely protective effect is desired from
an insoluble preparation. Bismuth prescribed with a strong solution of
iodide of potassium precipitates as a red iodide, which is insoluble and ap-
parently inactive (British Medical Journal, ii., 1870).

THERAPEUTICAL ACTION (EXTERNAL). Erythema, Eczema, etc. In
these and allied forms of congestive and inflammatory skin disease, bis-
muth compounds are often extremely useful, -by virtue of their absorbent,
astringent, and soothing properties. In erythema and erysipelas, inter-
trigo, and bedsore they may be applied in powder, alone, or diluted with
starch or magnesia, or made into a cream with water and glycerin, or
into an ointment in the proportion of 30 to 120 gr. in the ounce of pre-
pared lard, cold cream, or vaseline. (Dr. McCall Anderson, in praising
this ointment, notes that it should not be made with benzoated lard, or
else, for some unexplained reason, it becomes liable to irritate.) An
oleate of bismuth is also a good preparation: according to Dr. Louis
Lewis, oleic acid may be made to take up 20 per cent, of oxide (Pharma-
ceutical Journal, December, 1876).

In the acute stages of eczema, when there is much irritability and
much serous discharge, these preparations are also very serviceable; they
seem to be sufficiently astringent, yet not so much so as lead, zinc, or
tannin, and will often act better than those remedies. In later stages,
when there is infiltration with redness and scaliness, a stronger solution
of the soluble nitrate in glycerin becomes suitable.

In the erythema connected with acne of the face, bismuth forms a
good ingredient in soothing lotions: a small quantity of corrosive subli-
mate (2 gr. to 8 or 10 oz. of liquid) is often combined with great advan-
tage, when sulphur and other stimulants could not be borne.

As a cosmetic under the name of "blanc de perle," bismuth salts
have long been celebrated: they are liable to become darkened by con-
tact with sulphur in any form (e.g., the sulphuretted hydrogen of ordi-
nary gas, etc.), some proportion of the black sulphide being generated.

For chaps, and fissures about the hands, lips, nipples, etc., bismuth
ointment is very good, and especially with a little tincture of benzoin (20
to 30 min. to 1 oz.). Trousseau specially commends it for anal fissure
(Bulletin de TJierapeutique, v., p. G3), and others for ulceration of the
septum nasi, and excoriations of the cervix uteri. Follin used a glyce-
role, containing 1 or 2 parts in 3 of the liquid, for chronic granular con-
junctivitis.

Catarrh Chronic Discharges. Monneret recommended the insuffla-
tion of bismuth powders for coryza, and in chronic catarrhal conditions
Soubrier used a snuff containing 4 parts of the subnitrate with 8 of

86 MATERIA MEDIC A AND THERAPEUTICS.

liquorice and 30 of iodide of sulphur (Bulletin, 1859). For acute cases
Dr. Ferrier has lately reintroduced a formula containing ^ to 1 gr. of
morphia, well triturated with 60 gr. each of the subnitrate and of gum
acacia, and this often acts well in cutting short a troublesome " cold in
the head; " this I have frequently prescribed, but find patients discon-
tinue it on account of its causing frontal headache and clogging of the
nostrils. In leucorrhoea bismuth has been applied in powder or paste, on
charpie, or as injection in the proportion of 1 to 8 of water, and has been
used with advantage in gonorrhoea and gleet (Caby).

THERAPEUTICAL ACTION (INTERNAL). Dyspepsia. According to
Monneret, " pain arising during digestion, from whatever cause," may be
relieved by mixing the subnitrate freely with the food, but more definite
indications may be given. Gastric pains dependent on indigestible food,
marked constipation or hepatic congestion, require emesis or purgation,
while in vomiting connected with fermentation of food, dilatation of
stomach, etc., antiseptic remedies and perhaps washing out of the viscus
may be necessary.

Bismuth is specially indicated in cases of difficult digestion with ten-
dency to diarrhoea, in subacute or chronic gastritis, and gastralgia with
marked irritability of mucous membrane: for such cases, Odier first in-
troduced it (in Geneva, 1786); he describes severe gastric pain as fre-
quent among the servants there who lift and carry on their heads large
vessels of water the pain was either spasmodic, sudden, intense, and re-
lieved by pressure, or more persistent and accompanied with sensations
of gnawing, sinking, and pulsation; eructation, nausea, and vomiting oc-
curred in greater or less degree, and the general health and mental state
became much depressed. Such cases were much relieved by bismuth in
moderate doses; and Marcet, Bardsley, and other English physicians
have published similar experiences.

Nothnagel finds it especially useful when pain occurs after food in
badly nourished overworked persons; but when there is marked anaemia
or a general neuralgic condition it. is not so serviceable alone, nor is it
very permanent in its good effects. Prussic acid, or opium, alkalies, and
later iron and bitters, may be conjoined with it. Caizergues especially
praises a combination of 4 gr. with -J gr. of extract of belladonna
in the gastralgia of chlorosis (London Journal of Medical Science,
1851).

When acid pyrosis is a marked symptom, bismuth is particularly in-
dicated either alone, or, if acidity be marked and constipation usual, then
combined with magnesia. According to Trousseau, if the rejected fluid
be insipid, glairy, or sour ropy phlegm, bismuth alone is contra-indicated,
but in most cases it deserves trial, requiring only that constipation be
remedied. The nausea and vomiting of gastric irritation is commonly
amenab^ to bismuth, reflex vomiting, such as that of pregnancy, not so

BISMUTH. 87

(Husemann); this is an argument in favor of the local protective effect
of the drug.

In infantile vomiting, which is frequently dependent on acidity or ill-
digested food, and accompanied by diarrhoea and pain, bismuth is exceed-
ingly useful, being, as it is, practically harmless and tasteless 1 to 2 gr.
may be placed on the infant's tongue with a moistened finger. A minute
dose of creosote, fa of a drop, may often be usefully combined (British
Medical Journal, ii., 1875).

In Ulceration of the /Stomach, when pain is very severe and exhaust-
ing, and when vomiting is frequent, much relief may be given by full
doses; and I have noticed that distressing thirst has been rather relieved
than increased by the remedy. Dr. Brinton attached great value to it;
it is often given with opium in such cases.

In Malignant Disease even, I have found bismuth palliate for a time
the most severe symptoms; and in both these conditions it acts mainly
by forming a smooth layer over exposed and hypersensitive nerves,
and so preventing the contact of food and unhealthy secretions : to
obtain such a result it is evident that more than ordinary doses are re-
quired.

Gastro- Uterine Irritation. Trousseau undervalued the virtues of bis-
muth when he held it unsuited fqr gastric pain connected with leucorrhoea.
It has really a special sphere of action in various uterine disorders which
induce or follow on gastric derangement, as has been well shown by F.
W. Mackenzie (London Journal of Medicine, 1857). His cases seemed to
prove the stomach primarily at fault, since complaint was made of pain,
sinking, flatulence, etc., before the ordinary symptoms of uterine irritation
appeared; bismuth greatly relieved them, and my own experience is
somewhat to the same effect. In dysmenorrhoea, with severe pain in the
back, hips, legs, and hypogastric region, palpitation, etc., I have often
given it with good effect, and in uterine hemorrhage (profuse menstrua-
tion) it has proved strikingly efficacious when recognized styptics had
failed, being thus allied in action with oxide of silver and arsenic; ap-
parently a sedative influence is exerted both on the stomach and the
uterus through the mucous tract and connected nerve-ganglia.

Diarrhoea. In irritative diarrhoea, with red tongue, nausea, heart-
burn, griping pain, worse after meals, and frequent ill-formed stools, I have
found bismuth invaluable. In some persons, mostly women, such a con-
dition becomes habitual, and even ordinary articles of diet may cause
severe aggravation of symptoms; the constant use of this remedy, how-
ever, gives them the greatest relief, and enables them to take food with
comparative comfort; much flatulence is often present, and sometimes
the diarrhoea depends on irritation from the development of sulphuretted
hydrogen (Chambers). Bismuth is then also very suitable, for it com-
bines readily with that gas and absorbs it (Practitioner, 1869); sometimes

88 MATERIA MEDICA AND THERAPEUTICS.

charcoal, or aromatic chalk powder, or rhubarb, may be added with much
advantage.

Infantile Diarrhoea. When infants at the breast suffer from eructa-
tions, sour vomiting, diarrhoea, light-colored papescent stools of bad odor,
with crampy pains in the stomach, I have always found bismuth act well.
In that form of diarrhoea which so readily affects children while being
weaned, or during hot weather, or that "which continues even after irrita-
tion has been removed, it is also of great service; from 1 to 5 gr. may be
given several times daily to children of one year and under. Weller pre-
scribed for children as much as 30 to GO gr. of subnitrate every hour
(interdicting milk during the treatment), with no other than good results
(Deutsches Archiv, quoted American Journal, 1870).

The ulcerative diarrJioea a'nd aphthous -condition connected with
phthisis is alleviated by full doses. Traube (one of the first to recommend
the remedy in such cases) supports the view of its acting mainly as a
mechanical protective, lessening local irritation, and consequently reflex
peristalsis. We have already referred to a case in which the powder was
found to line the whole tract, and it is evident that for such protective
effect large doses are necessary. Dr. T. Thompson, who prescribed about
5 gr. of the subnitrate with magnesia and mucilage, and Monneret, who
gave many drachms for a dose, are strong advocates of its advantages.
The latter observer states that he had seen many persons who were ap-
parently dying with tuberculous diarrhoaa, restored for a time to com-
parative health (" Medico-Chirurgical Transactions," v., p. 31, and Bul-
letin, v., p. 47), but the results of others have not been so favorable.
The persistent diarrhoaa of enteric fever is sometimes well treated in the
same manner.

Dysentery. M. Brassac, of the French naval service, records the best
results from bismuth in epidemic dysentery. Finding little or no benefit
from small doses, he followed the teaching of Monneret, and beginning
with 230 to 300 gr. daily, increased to more than 1,000 gr.; he divided
this into about five doses, according to the case, giving it in broth or
milk, or sometimes by enema, and so long as more than one stool oc-
curred in the day. This plan was very successful, and had no ill result;
as a rule, his patients began at once to eat better and to gain strength
(quoted Edinburgh Medical Journal, 1867). Trousseau also used bis-
muth injections in dysentery (Lancet, i., 1855), and more recently Dr.
Houghton writes from Borneo, concerning their great value in subacute
and chronic cases in tropical climates; he prescribes 30 gr. with mucilage
to be injected two or three times daily, and retained if possible (Lancet,
ii., 1879). In acute and chronic colitis, Laseque also used, with the best
results, enemata of 30 to 150 gr. with egg or mucilage.

Cholera. In the epidemic at Warsaw, in 1831, it was highly ap-
proved by Leo, and in later epidemics at Paris it was commended by

BISMUTH. 89

Trousseau, and very largely used for the premonitory diarrhoea; at the
commencement of the attack only, a little opium may be added with
advantage; afterward, two full doses of bismuth daily will suffice.

The reputation which has been sometimes claimed for bismuth as a
valuable remedy in intermittent fever, and in nervous disorders, as epi-
lepsy, cephalalgia, asthma, and in whooping-cough, must be traced either
to its relieving gastric complications of such maladies, or to the presence
of contained arsenic: it has not been sustained in recent times.

PREPARATIONS AND DOSE. Bismuthi oxidum : dose, 5 to 15 gr. or
more. Bismuthi subnitras : dose, 5 to 20 gr. or more (see below).
Trochisci bismuthi: dose, 1 to 6 lozenges (each lozenge contains 2 gr.
with lime and magnesia). Liquor bisrnuthi et ammonice citratis : dose,
^ to 1 fl. dr. and upward (contains 3 gr. of oxide in each fluid drachm).
The preparation of Schacht is said to contain only 1 gr. of oxide in each
drachm: dose, 1 to 4 dr. Bismuthi carbonas : dose, 5 to 20 gr. or more.

Preparations of bismuth should be taken about a quarter of an hour
before, or with meals, and if a mechanical protective effect is most de-
sired, acids are better avoided during the medication.

Subnitrate. The dose should depend upon its molecular state. Thus, if
it be very dry and likely to become caked together in the stomach, very
large doses may not act at all, or may cause irritation, while if moistened
or formed into hydrate, or carefully mixed with some other fine powder,
moderate doses will give a much better result. Thus, Quesneville took
80 grammes without much advantage, but afterward using the drug
thoroughly soaked in water, soon obtained good effects with 5 to 10
grammes; his "bismuth-cream" is a valuable preparation, better known
abroad than in this country. Doses of ! to 2 dr. are now seldom used,
5 or 10 gr. representing an average prescription for adults. Much more
may, however, be given in organic disease when there is erosion or ulcer-
ation of the alimentary surface; milk or almond emulsion is a good vehi-
cle. The subriitrate forms a part of the " poudre de Wendt," also of the
powder of Robert Thomas; combined with magnesia it is "Patterson's,
or American powder," and with pepsin, the "poudre de Royer."

The liquor bismuthi et ammonias citratis is miscible with water and
spirit, but not with alkalies without precipitation. The so-called " lac
bismuthi" (Symes) contains the hydrate mechanically suspended.

A lactate, a tannate, and a valerianate of bismuth have been de-
scribed: the first is a soluble salt, and may be given in small doses; the
compound with tannin is designed to favor its astringent, and the valeri-
anate any nerve-tonic powers. A citrate of iron and bismuth is some-
times useful.

Besides these, there are many private preparations, as of bismuth and
pepsin, bismuth and strychnia, etc.

A glycerole of the neutral nitrate is best prepared by dissolving oz.

90 MATERIA MEDICA AND THERAPEUTICS.

of the crystallized salt in 2 dr. of pure glycerin and an equal quantity of
distilled water, afterward adding glycerin to 6 oz. Uhguentum bismuthi
may be prepared with $ to 1 dr. of any bismuth salt in 1 oz. of cold
cream (not benzoated). An oleate is made with oleic acid and the oxide
in strengths of from 10 to 20 per cent. A lotion or injection is made
with 1 part to 8 of liquid. Pessaries are made containing 15 gr. in each.

[PREPARATIONS, U. S. P. Bismuthum, Bismuthi subcarbonas, and
Bismuthi subnitras.]

ADULTERATIONS. Besides being variable in its chemical constitution,
in the amount of oxide and of acid present, the subnitrate may contain
added carbonate, and phosphate of lime, carbonate of lead, subchloride
of bismuth, and other metals introduced in the process of manufacture,
also certain natural impurities not removed e.g., traces of iron, copper,
silver, and arsenic. The last is the most important, although no official
test for its presence in bismuth is given. In the older preparations it
was probably always present, and, so long ago as 1743, Geoffrey expressed
his fear of bad results from it (" Materia Medica "). In later times, Dr.
Taylor found it in three out of five specimens; and Mr. Edin found it in
many specimens of liquor bismuthi when it was first introduced (Pharma-
ceutical Journal, 1868).

The practical bearing of such adulteration was illustrated in a trial
for arsenical poisoning at Philadelphia about twenty years ago. It was
proved that bismuth " nitrate " had been prescribed shortly before death:
a specimen of the particular salt dispensed could not be found, but, of ten
others purchased in the city, a majority contained arsenic, and although
the irritant symptoms had commenced before bismuth was prescribed, and
the proportion of arsenic found in the viscera was much more than bis-
muth adulteration would account for, yet the trial was stopped, and the
accused person discharged (American Medical Journal, July, 1858).

At the present time, however, adulteration with arsenic is exceptional.
Of six chance specimens examined under the direction of Dr. Anstie, not
one contained it (Practitioner, 1871); and Professor Siebold, after much
experience, reports that it is now rarely found (Pharmaceutical Journal,
December, 1875). Of seven samples of the basic nitrate of the United
States Pharmacopoeia, one only contained arsenic .33 per cent. (Op. cit.,
November, 1875). In the oxide he often found traces of sodium and lead,
and commonly subchloride and subnitrate.

Selenium and tellurium have been found in some specimens of bismuth
salts, and a Colorado ore of the metalloid has been found to contain 34
per cent, of tellurium. This may explain the offensive alliaceous odor
which is sometimes given to the breath by special samples of bismuth
preparations. It resembles that of arseniuretted hydrogen, and has nat-
urally been attributed to that gas, and yet not correctly; and the absence
of the poison in certain offending samples has been proved by analysis

CADMIUM. 91

(Pharmaceutical Journal, December, 1875); neither can the odor be
traced to prussic acid or other usual ingredients in bismuth mixtures:
while we know that tellurium can impart an offensive odor, for Sir James
Simpson made trial of the drug, and Dr. Maclagan relates that on one
occasion a student took a dose which obliged him to sit apart from the
class for the rest of a session! (Edinburgh Medical Journal, December,
1854).

The carbonate of bismuth is liable to contain chlorides, also sodium,
and sometimes lead. In five specimens examined by Prescott no arsenic
was found (Pharmaceutical Journal}.

CADMIUM, Cd,=112.

This is a somewhat rare metal, found associated with zinc in nearly
all its ores, and obtained from these by distillation.

CHARACTERS AND TESTS. Tin-white and lustrous, fibrous in fracture,
ductile and malleable, of sp. gr. 8.6 to 8.9. In air, at ordinary tempera-
tures, it tarnishes gradually; heated strongly it takes fire, and burns to a
brown oxide, CdO; at 176 F. it becomes very brittle, and fuses at 442
F. Treated with dilute mineral acids, it sets free hydrogen, and forms a
colorless solution; this, when further diluted, gives with sulphuretted
hydrogen a bright yellow precipitate of cadmium sulphide (CdS), insol-
uble in ammonium sulphide. Caustic and carbonated alkalies give witli
cadmium salts gelatinous white precipitates, which, except in the case of
ammonia, are insoluble in excess. Zinc precipitates metallic cadmium.

CADMII IODIDUM IODIDE OF CADMIUM, CdI 2 ,-3G6.

PREPARATION. By the direct combination of the metal with iodine
in the presence of water.

CHARACTERS AND TESTS. Occurs in flat, micaceous white crystals, of
pearly lustre, which melt at 600 F. into an amber-colored fluid; they are
anhydrous, permanent in air, but decompose at a dull-red heat, with evo-
lution of iodine in vapor. In water and spirit they are freely soluble,
the solution being acid to test paper, and answering to the tests for cad-
rnium already mentioned.

The Sulphate of Cadmium is officinal in the United States. It occurs
in oblique, rhombic prisms, translucent and colorless, like those of zinc
sulphate; it has an acid, astringent taste, effloresces on exposure, and
dissolves readily in water.

The JBromide of Cadmium resembles the analogous salt of ammonium,
and has been taken by mistake for it; it is used in photography.

92 MATERIA MEDIC A AND THERAPEUTICS.

ABSORPTION AND ELIMINATION. Cadmium salts coagulate and com-
bine with albumen, but these albuminates dissolve in an excess of the
salt, especially in excess of a double salt, such as the chloride of cadmium
and sodium; even in alkaline chlorides they are partially soluble, so that
we can readily understand their absorption from the stomach. Absorp-
tion occurs also after their injection into the cellular tissue, the bowel,
etc., as evidenced by the finding of cadmium compounds in the organs
and secretions (Marine: Schmidt's Jahrb., iii., 1867).

Elimination of the drug begins soon after its administration, and
takes place mainly by the kidneys.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Cadmium
compounds, except the sulphide, resemble each other in action. The sul-
phide, though considered poisonous by van Hasselt, has been given to
animals in drachm doses daily for a week, without evident effect, and is
therefore pronounced inert by Marme. The oxide, chloride, sulphate,
iodide, etc., given in doses of to 2 gr., cause pain at the epigastrium,
vomiting, and purging, and in somewhat larger doses gastro-enteritis,
which may pass on to ulceration. Similar effects follow their hypoder-
mic injection, and after toxic doses given in this manner, the gastro-in-
testinal mucous membrane has been found inflamed; irritation and sup-
puration also occur at the site of injection. The continued administration
of small doses induces a chronic form of poisoning marked by dyspepsia
and emaciation, which in animals has terminated in death from exhaustion.
In the case of two ladies who took by accident a quantity of bromide of
cadmium (not less than 5, or more than 16 gr). pungent taste and sensa-
tions in mouth and throat were felt, and burning pain at the epigastrium,
vomiting and purging set in, and continued for five hours, and after
recovery the stomach remained very irritable (Wheeler: JBoston Medi-
cal and Surgical Journal, October, 1876). In a man who took 9 gr. of a
cadmium salt, salivation, colic, and catharsis followed in the course of an
hour, and four hours afterward, violent vomiting, gastralgia, and tenesmus
(Burdach). In a dog, death has followed the injection of ^ to gr. into
a vein, or the giving of 5 to 9 gr. by the mouth.

Nervous and Circulatory Systems. Foret has described, in cases of
poisoning by cadmium carbonate, besides the symptoms of gastric irrita-
tion giddiness, prostration, loss of consciousness, cramp, and slowing of
respiration and heart-action. In the ladies above mentioned, somnolence
was marked after subsidence of the irritant symptoms.

SYNERGISTS. Salts of zinc and lead.

ANTIDOTES. In acute poisoning by cadmium salts, the alkaline car-
bonates with albumen (white of egg) are the best antidotes. In Marine's
experiments, injections of dilute soda solutions into the stomach soon
after the exhibition of the poison quite prevented bad effects.

THERAPEUTICAL ACTION (EXTERNAL). The only officinal salt, the

LIME. 93

iodide, is used in the form of ointment in glandular scrofulosis, and has
been recommended by Guibert and Garrod. Other physicians have pre-
scribed it in splenic enlargement and in strumous skin disease (Waring).
I have used it repeatedly in cases of enlarged glands, of nodes, and of
chronic joint inflammation, with satisfactory result. It does not stain the
skin, like iodide of lead, but is liable to cause irritation unless diluted.

In Ophthalmic Surgery cadmium sulphate has been used more as an
astringent in lotion or ointment for dyscrasic inflammation of the eye,
and for corneal opacities (leucoma), (Grafe, Kopp, Middlemore).

THERAPEUTICAL ACTION (INTERNAL). The sulphate of cadmium has
been recommended in syphilis, rheumatism, and gout (Grimand), but
there is, at present, little evidence of its special powers.

Gonorrhoea Leucorrhcea. In these maladies injections of sulphate
of cadmium have been used by Lincke, but possess no evident advantage
over injections of sulphate of zinc.

PREPARATIONS AND DOSE. Unguentum cadmii iodidi (contains 62 gr.
in 1 oz. of simple ointment). Cadmii sulphas: dose, y 1 ^ to gr. ; iovcol-
lyrium, to 4 gr. in 1 oz. of rose-water (Fronmuller); for ointment, 4 gr.
in 1 oz. of lard; for injection, 2 gr. in 1 oz. of water; these formulae seem
somewhat inconsistent with Bouchardat's statement that the salt is ten
times as powerful as the sulphate of zinc.

[PREPARATIONS, U. S. P. Cadmium and Cadmii sulphas.]

CALCIUM LIME, Ca,=40.

Calcium is a grayish-white metal, the basic radical of lime, and its com-
pounds: as a carbonate it occurs naturally in chalk, marble, etc.; as a.
sulphate in gypsum; as phosphate- and carbonate in shells, bones, and
various organic tissues; and as silicate and fluoride in various minerals and
vegetables. When heated, it becomes quickly oxidized and converted
into lime calx: inflamed, it burns with a bright light.

CALX, C&0,=56LIMEQUrCK-L2ME.

PREPARATION. Lime is commonly prepared from its carbonate (mar-
ble or limestone) by heating it to full redness to drive off the carbonic
acid.

CHARACTERS AND TESTS. A grayish-white solid, of sp. gr. 3.18, of
alkaline, caustic taste. When water is poured on it to the amount of
about three-fourths of its weight, it swells up, evolving great heat (up to
500 F.), and falls into a soft, white powder, in which the oxide is com-

94 MATERIA MEDICA AKD THERAPEUTICS.

bined with one molecule of water (hydrate of calcium, CaH.,O a , = 74); the
process is called " slaking."

C ALOIS HYDRAS SLAKED LIME, CaHiO,,=74

PREPARATION. From quick-lime, as already described.

CHARACTERS AND TESTS. The hydrate of lime, though it can absorb
31 per cent, of its weight of water, remains perfectly dry, and is itself
very sparingly soluble in water (1 in 900), and less soluble in hot than in
cold water; at 32 F. twice as much lime is dissolved as at 212 F. At
ordinary temperatures water dissolves only about gr. to the ounce, but its
solvent power is increased by syrup or by glycerin to the extent of nearly
8 gr. to the ounce. Lime does not melt at the highest temperature, and
hence its use for the electric and oxy hydrogen lights; sp. gr. 2.078.

The chief test for lime is the white precipitate formed with oxalate of
ammonium, insoluble in acetic acid, but soluble in hydrochloric or nitric
acid. Lime readily absorbs carbonic acid, the presence of which is de-
tected by effervescence with acids. (This power of absorbing CO 2 has
been utilized by Liebig to purify close rooms, for lime placed in them
will, by such absorption, create a partial vacuum, to supply which air
passes, in through crevices. The same absorptive power partly causes the
dampness of a new house, for the lime of mortar absorbs the carbonic
acid of the air and the breath, leaving the moisture to condense on the
walls.)

The Liquor Calcis of the Pharmacopoeia is a solution in water con-
taining about T% gr. to the ounce (that being its point of saturation). It
is prepared by digesting slaked lime in eighty times its weight of cold
water for some hours, and is a colorless liquid when recently made, but
on exposure to air, or if breathed into, an insoluble carbonate readily
forms and precipitates. If warmed, the liquor calcis becomes turbid from
deposition of some of the lime. It forms an ingredient in the black and
the yellow " mercurial wash."

Liquor Calcis Saccharatus. Saccharated lime-water is prepared by
mixing slaked lime with twice its weight of sugar, and digesting in water
for a few hours; it becomes yellowish by keeping; its taste is more caus-
tic and unpleasant than that of the simple liquor; it contains 7.11 gr. of
lime per ounce.

Linimentum Calcis is an emulsion or soap formed with equal parts of
lime-water and olive oil, and containing an oleate of calcium.

CALCIS CARBON AS CARBONATE OF LIME, CaCO 3 , = 100.

Three forms are officinal: (1) Greta chalk the native, friable, and
not pure carbonate; (2) Greta preparata prepared chalk the same sub-

LIME. 95

stance well washed, or " elutriated," after being reduced to fine powder;
and (3) Calcis carbonas prcecipitata precipitated carbonate of lime.

1. Ordinary chalk is used only to produce carbonic acid gas in the
making of carbonates, etc.

2. Prepared chalk occurs either in white powder or in small conical
masses. The process of " olutriation " consists in treating the powder
with a large quantity of water, allowing it to stand for a time, decanting
from heavy particles, and allowing the milky liquid to gradually deposit
this form is used in mistura cretas and pulvis cretas aromaticus.

3. Precipitated carbonate of lime is prepared by mixing a solution of
carbonate of soda in excess, and at a boiling temperature, with solution
of chloride of calcium. Carbonate of lime and chloride of sodium are
formed, and the precipitate is washed until all the latter salt is removed.
This preparation being crystalline and somewhat gritty, constitutes an
ingredient of tooth powders, but is not otherwise recommended except
in bismuth lozenges.

CALOI1 CHLOR1DUM CHLORIDE OF CALCIUM, CaCl,6H. 2 O,=219.

PREPARATION. By neutralizing hydrochloric acid with chalk or white
marble, and adding to the solution a little chlorinated lime and slaked
lime. In the first process carbonic acid is evolved and chloride of cal-
cium formed:

2IIC1 + CaCO 3 = CaCl, + C0 8 + H 2 O.

In the second process the added lime frees the solution from iron and
magnesia; it should then be filtered and evaporated to dry ness at a tem-
perature of 400 F. If the solution be simply evaporated, the chloride is
left combined with water CaCl Q 6(H O), and it is only at a heat sufficient
to fuse the mass that it parts with all its water.

CHARACTERS AND TESTS. This salt has a great absorber.t power for
water, is deliquescent, and very soluble; it occurs in crystals, or in whit-
ish crystalline fragments of bitter, acrid, saline taste. It must be dis-
tinguished from calx chlorata (chloride of lime), and does not, like that
compound, evolve chlorine on addition of hydrochloric acid.

CALX CHLORATA CHLORIDE OF LIME CHLORINATED LIME.

PREPARATION. By saturating moist slaked lime with chlorine gas
CaH 2 O 2 + 2Cl H^O + CaOClj but as to its exact constitution there is
still some difference of opinion. Many chemists, following Balard, con-
sider it to be a mixture of chloride and hypochlorite of calcium, which
would correspond to the above formula doubled / thus, SCaOCl^ = CaCl 2
-j-CaCl.jO.,, and this, with the addition of two atoms of water, is the for-
mula adopted by Garrod.

96 MATERIA MEDICA AND THERAPEUTICS.

CHARACTERS AND TESTS. Occurs in whitish powder or lumps, having
the odor of chlorine, and an acrid, caustic taste; if it contain much chlo-
ride of calcium it will be moist. It is unstable in composition, readily
giving off chlorine when exposed to the air, and being decomposed by
any acid. When pure it is wholly soluble in water, but it generally con-
tains some free hydrate, and is only partially soluble. It has powerful
deodorant and bleaching properties, which depend on the presence of
chlorine, and the purity-test is directed to estimating the amount of this
gas (chlorimetry). Thus, by adding hydrochloric acid to chlorinated
lime, chlorine gas is liberated, and this being brought into contact with
iodide of potassium sets free an equivalent amount of iodine, which is
estimated by hyposulphite of sodium.

Liquor Calcis Chlorates Solution of Chlorinated Lime contains
about 13 gr. of available chlorine to each fluid ounce of water.

Vapor Chlori Chlorine Inhalation. Prepared by moistening 2 oz.
of chlorinated lime with cold water in a suitable apparatus (u. p. 124).

CALCIS PHOSPHAS PHOSPHATE OF LIME.

Officinal in two forms: (1) os ustum bone-ash; (2) pure tribasic
phosphate.

PREPARATION. (1) Os Ustum. When bones are calcined in close
vessels, the residue consists of earthy salts mixed with charcoal (carbo
animalis); but when calcined in open vessels, all animal and carbonaceous
matter is burnt off, and the white friable residue consists mainly of phos-
phate and carbonate of lime (bone-earth, bone-ash). This, when treated
with hydrochloric acid, and afterward with ammonia, is changed into (2)
tribasic (or tricalcic) phosphate, Ca 3 2(PO 4 ), which is washed and dried at
212, and forms a crystalline white powder, insoluble in water, soluble in
acids. It has been found to contain lead (Duquesnel).

This form is the one most commonly found in nature, sometimes
almost pure (phosphorite) or in friable masses, like chalk (osteoliths), or
in the fossil faeces of ancient saurians (coprolites), in shells and sedi-
mentary earths. From the soil it is absorbed by plants, by the help of
water and carbonic acid, and is determined specially to the seed. From
plants it is received by herbivorous animals, and in their flesh and blood
and bone it is sought by the carnivora. It has been said that the amount
of phosphate of lime found in different animals is proportionate to the
activity of their movements (Dusart and Blache). (The salt was obtained
formerly for medical use from the excrement of dogs when hard and
white, as it is passed after they have eaten many bones / it was known
as " album grascum.")

Besides the tribasic phosphate there are two others, a neutral and an
acid phosphate. The former, Ca !1 H. 1 2(PO 4 ), is a white, crystalline pow-

LIME. 97

der, tasteless and insoluble; it occurs in some (carbonated) mineral
waters, and may be prepared by mixing neutral phosphate of soda with
chloride of calcium. The acid phosphate, CaH 4 2(POJ, is very soluble,
and even deliquescent, and is left in solution when sulphate of lime is
precipitated after treating bone-ash with sulphuric acid.

ABSORPTION AND ELIMINATION. The various salts of lime differ
somewhat as to their absorption and their action. The tribasic and neu-
tral phosphates, in small doses (less than 5 or 6 gr.), with but little
water, are whollv absorbed under the influence of the acid gastric secre-
tion; but if given with much water, the acids are so far diluted that they
do not act upon the insoluble drug, and it passes off mainly by the fasces.
If large doses be given, the greater part passes out unchanged.

Gouriet has suggested that the solubility necessary for securing the
absorption of lime phosphate is effected partly by means of the phosphate
of soda contained in the saliva, partly by the phosphate of ammonia and
the acids in the gastric juice; when it has passed into the veins, solubil-
ity is still further assisted by the carbonic acid present in venous blood.
During respiratory combustion, when carbonic acid is given off and lactic
and other acids altered, the phosphate that has been taken is only
retained in solution by the help of the normal alkaline phosphates of
the blood: if these be in small proportion the lime salts become soon
deposited (more in bone than in other tissues), and little passes in the
urine; if, however, in any given case the alkaline phosphates be in ex-
cess, then most of the lime salt is retained in solution in the blood until
it is (mainly) excreted through the kidneys (lancet, ii., 18GO, p. 251).
This explanation seems rather too chemical, and it must be compared
with the important observations more recently made by Paquelin and
Jolly. They conclude that the tribasic phosphate of lime is not acted
upon in the stomach, unless it be by part becoming super-phosphate, and
this again is precipitated in the intestine under the influence of alka-
line biliary and pancreatic secretions, as insoluble phosphate; it is not
capable of absorption, except in very small quantities; the circulation
conveys very little, and the tissues, except bones, contain only traces;
the bile has rather more. A certain amount of lime must enter the sys-
tem from the food, and does so mostly as carbonate, which becomes
changed and prepared for absorption by contact with alkaline phosphates
and gastric acids, but artificial phosphates are eliminated almost entirely
unchanged, only some of the acid being absorbed. Hence they conclude
.that the addition of such compounds to the food is rather an obstacle to
nutrition, and that even the soluble acid preparations (lacto-phosphates,
etc.) act only as acid principles, and pass out of the system as phosphates
of another base. The lime phosphate contained in urine and phosphatic
calculi, even when primary, is said to be almost entirely formed within
the bladder. These views, as they are not quite in accordance with com-
VOL. II. 7

98 MATERIA MEDIC A AND THERAPEUTICS.

monly received clinical evidence, seem to require confirmation, but they
suggest moderate expectation of cure by lime salts.

Tfie bicarbonate, as occurring in carrara water, is soluble by virtue of
the excess of carbonic acid, and readily absorbed. The neutral carbonate,
in small doses (5 or 6 gr.), is soluble in the gastric juice, and is absorbed
as a chloride. The chloride itself, in similar doses, and diluted sufficiently
to disguise its caustic taste (as \vith 3 oz. of sugared water), becomes ab-
sorbed without gastric disturbance; but larger doses are apt to cause a
sense of oppression, with nausea and diarrhoea. Unduly large doses
of lime-water, or of phosphates or carbonates, may also cause gastro-
intestinal irritation.

Of that which is absorbed, an equivalent quantity is eliminated, ex-
cept during the period of growth, and especially of bone-development.
There seems to be a power of laying-by some of the substance for this
purpose, for, e.g., during the early months of pregnancy, bony growths
(osteophytes) sometimes form in the bone of the parent, which diminish
with the growth of the foetus. The eliminated portion is found in the
urine, as acid phosphate, and in many other secretions, such as the pan-
creatic juice, and the semen; some may be detected also in plastic exuda-
tions; sometimes it forms calculi. It is of ten deposited in tumors, fatty,
fibrous, and sarcomatous, and in old inflammatory exudations, as in tu-
bercle of lung and strumous glands. About 45 gr. are daily eliminated
by an adult man (Husemann).

PHYSIOLOGICAL ACTION" (EXTERNAL). Lime unslaked, or "quick,"
decomposes and destroys organic matter, and is used sometimes as a caus-
tic, more often as a disinfectant, e.g., in dissecting rooms and in grave-
yards; its affinity for water, and its ready combination with sulphur (as
in sulphuretted hydrogen), will explain its good effects. It is used by
tanners to remove the hair from hides, and by farmers as a fertilizing
agent. Its action upon the living skin is irritant and to some extent
caustic, but, as it has less " diffusion power," is more superficial and more
limited than that of the alkalies proper potash and soda. On the mu-
cous membranes, however, its effects may be very severe, as when by ac-
cident it enters the eye, or when too strong a solution of it, or of its
haloid salts, is taken into the mouth. Local inflammation and ulceration
may follow, and even a fatal result be produced when the stomach is
affected.

Weak solutions or the neutral salts, carbonate and phosphate, in
powder, have a local astringent and sedative effect. The " lime-water "
of the Pharmacopoeia is not strong enough to be caustic, but controls
secretion, especially from mucous membranes, and renders any tissues
pale and dry.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Lime-water
and lime carbonates, when taken internally in moderate doses, produce

LIME. 99

similar local astringent and sedative effects, and act also as absorbents
and antacids. The phosphate is a mechanical astringent to some extent,
but the sulphate may alternately confine and relax the bowels, according
to the irritation produced.

Circulatory System. Xo effect upon this system is commonly traced
to lime compounds, but full doses of the chloride are said to produce some-
times the symptoms of a " muscular poison " like potash, with lowering
of temperature, slowing of pulse, and arrest of heart-action (Rabuteau and
others: Comptes Rendus, February 10, 1873).

Nutrition. The most interesting point in the physiological action of
lime salts is their influence on nutrition, the necessity of phosphate for
healthy growth, whether vegetable or animal, being especially evident.
Experiments with plants have shown that the phosphates are in close
relation with the nitrogenous elements. If, for instance, the nitrogenous
husk or coating of a seed be removed, the phosphates are removed with
it, and in the starchy part of the grain none are found. In the leaves
they occur in the parenchyma, not in the nervules, and generally are
most abundant in the cellular parts of vegetables wherein nutrition and
reproduction are most active (Liebig). Wheat, planted in earth contain-
ing phosphates, germinates and thrives, but if all phosphate of lime be
removed, it germinates, indeed, but soon dies. Peas (which contain a
larger proportion of azotized matter), when similarly treated, germinate
and even bear a crop, but if this crop be sown in a soil without phosphates,
it does not flower (Georges Ville: Conferences, Paris, 1865, Rabuteau).
That the improvement in nutrition is not due to the presence or absence
of phosphorus as such, but to phosphate of lime, is shown by experiments
on birds. Wheat contains a large quantity of phosphate of potash, and
when pigeons are fed upon this alone, and are prevented from getting
any carbonate or other salts of lime, they waste away, and their bones
become weak and brittle. If, on the other hand, they can obtain lime in
any form, it becomes changed into a chloride during digestion, and com-
bining with the alkaline phosphates of wheat, provides them with lime
phosphates, and secures or favors their due nutrition (Chossat).

There is also evidence that lime phosphates serve especially to nourish
cartilage, bone, tendon, and muscle, so that they have been fairly called
" restorative or analeptic tonics " to the locomotor organs, as iron is to
the blood, or phosphorus to the nerve-tissue. Thus, as the result of ob-
servations on the reproduction of the shell in crabs, Schmidt found that
a combination of phosphate of lime and albuminous material was most
favorable for the formation of osteoid cells; phosphate was required for
the first growth, though carbonate was formed later. Mr. Bridgman noted
the formation of " artificial cartilage " by the passage of an electrical
current through a viscous solution of carbonate of lime (Hughes Bennett:
Lancet, i., 1863, p. 5). Beneke found that phosphate of lime was

100 MATERIA MEDIC A AND THERAPEUTICS.

specially abundant in plastic exudations and wherever new growth was
going on, and he adopted the microscope as a ready means of its detec-
tion for if a drop of sulphuric acid be added to the liquid, crystals of
lime sulphate are very quickly formed (Lancet, i., 1851, p. 432). The
organism can assimilate phosphate of lime either in the soluble acid form
(for the liquids and soft tissues), or to some extent in the basic insoluble
form (for the skeleton); but its effects are produced slowly, and without
the evident stimulation which we associate with the action of wine, iron,
or quinine, so that we describe such lime compounds rather as restoratives
than as general tonics, and as modifying rather than stimulating nutri-
tion. (As a readily noticed, though slight evidence, of the effect of lime
phosphates on nutrition, Rabuteau notes that white spots on the nails
often disappear under their use.)

Besides their effects on ossification, etc., M. Mouries, a distinguished
chemist, has described a special effect of lime salts upon " irritability," or
vital organic changes, so that if these salts are absent, assimilation and
nutrition do not go on, and emaciation and death ensue, while if they are
simply deficient, various degrees of lymphatic and osseous disease are
produced. He has calculated especially that the food of those who live
in towns is deficient in these principles, and that while every one ought
to have at least 90 gr. daily, many, women especially, receive only about
half that quantity; hence a secretion of poor milk and consequent weakly
children, and he claims that by the use of a certain food containing lime
phosphate with albumen, the proportion of still-born and of rachitic chil-
dren in many families has been markedly reduced (quoted by Trousseau).

Any difference in the amount of urea and carbonic acid excreted under
the influence of phosphate of lime is not exactly ascertained. The chlo-
ride of calcium is said to increase the amount of urine (Giacomini); and
it is probable that like other chlorides it increases the excretion of urea
(Rabuteau).

Lime in Potable Waters. Waters that do not contain lime are flat
and insipid, while a proportion of from 7 to even 20 gr. of carbonate in
the gallon is compatible with their being good, wholesome, and pleasant
(Parkes); such waters may be rendered sufficiently " soft " by boiling.
Hardness dependent upon a soluble bicarbonate of lime is best treated
by Clark's process, of adding slaked lime, which precipitates an insoluble
carbonate.

Lime sulphate is contained in water from selenitic rocks, and a pro-
portion of from 6 to 21 gr. per gallon must be considered unwholesome;
it is liable to irritate the bowels, causing alternately diarrhoea and consti-
pation, as was verified, especially in some prisons and hospitals of Paris,
by Parent Duchatelet; such water is not much softened by boiling.

Nitrate of lime is sometimes found in drinking water, being derived
probably from organic sources; it is likely to cause diarrhoea.

LIME. 101

Water from magnesian limestone, containing magnesia with some
carbonate, and 4 to 12 gr, per gallon of sulphate of lime, has been con-
sidered specially likely to cause goitre / but professional opinion, though
still divided on this question, is now more inclined to the negative view.

Dr. McClelland (in an able report on the medical topography of Ben-
gal) certainly gave remarkable instances from many villages scattered
over a large district where the inhabitants, though living close together,
were affected with goitre or not, according as to whether they drank or
not of certain wells, to which they were restricted according to caste;
and he found that the wells used by goitrous persons contained up to 25
per cent, carbonate of lime (Abstract in British and Foreign Review,
1861. i., p. 42 ; and Watson's " Practice of Physic," vol. i., 3d ed.); the
presence of magnesia is not mentioned. Dr. Inglis, in his treatise on the
subject, Dr. Coindet, of Geneva, and other authorities, have agreed in
blaming lime-waters mainly for the production of goitre, and its greater
prevalence along ranges of lime-rock, as in Nottinghamshire, Derbyshire,
and in parts of South America, are quoted in favor of the same view.
Some connection has been further traced between this cause and cretinism,
as well as goitre; and Kolliker and others maintain, not without the sup-
port of post-mortem evidence, that by the habitual use of such lime com-
pounds ossification is increased at the base of the skull, so that the cranial
foramina become narrowed, and the supply of blood to the brain lessened
(British and Foreign Review, January, 1SG1, p. 46). On the other hand,
Dr. Mitchell has published a careful report upon the " Nithsdale neck,"
prevalent in that part of the south of Scotland, and has shown that some
other element than water must be concerned. It is true that many of the
wells used contained from 4 to 14 gr. of carbonate in the gallon (with
magnesia), but that limit is compatible with health, and several wells in
the same district contained the same quantity, and even to 24 gr., with-
out the production of any goitre (British and Foreign Review, April,
1862).

SYNERGISTS. Alkaline and earthy bases have a similar absorbent ac-
tion to that of the carbonate of lime, and reconstituents generally, such
as iron and cod-liver oil, are adjuvants to the lime phosphates; aromatics
also are often well combined.

ANTAGONISTS AND INCOMPATIBLES. Mineral acids, laxatives, and irri-
tants either decompose or neutralize the action of lime compounds, with
the exception of phosphoric acid, which is sometimes used with the acid
phosphate, to render it more soluble.

Saccharated lime is said to be a specially good antidote to carbolic
acid, and the following is Ferraud's formula: IJ. Sugar 15 parts, water
40 parts; dissolve, and mix thoroughly with quick-lime 5 parts (Lancet,
i., 1876).

Hypochlorite of lime is an antidote for sulphuretted hydrogen.

102 MATERIA MEDICA AND THERAPEUTICS.

THERAPEUTICAL ACTION (EXTERNAL). Epithelioma. A mixture of
quick-lime (2 parts) and caustic potash (1 part) is sometimes a useful es-
charotic for superficial forms of epithelial cancer; it should be mixed,
just before using, with sufficient alcohol to form a paste (" Vienna
paste"), and spread over a suitable aperture in diachylon plaster pre-
viously placed on the part; its action begins immediately, and lasts for
about half an hour; the eschar is dark-colored, and separates in from ten
to twelve days. A proportion of 6 parts of lime to 5 of potash is recom-
mended by some authors, and for application to deeper-seated parts, such
as the neck of the uterus, a combination of 1 part of lime with 2 of pot-
ash is used, especially by French surgeons (" caustique Filhos "); it is
fused by heat, and poured into a small mould of lead, which can be cut
away as the caustic is required.

Chronic Tonsillitis. A mixture of equal parts of lime and caustic
soda has been recommended under the name of " London paste " for oc-
casional application to chronic conditions of enlarged tonsil (Mackenzie),
but has not come into general use.

Onychia. Prof. Vanzetti has recommended the application of caustic
lime in preference to nitrate of lead for onychia maligna, and has reported
two successful cases, in one of which the application was renewed several
times, and in the other it was left in continuous contact (Practitioner,
vol. xiii.).

As a Depilatory to remove superfluous hair, lime is sometimes used
with arsenic (as in the Turkish " Rusma "), or in the form of a hydrated
sulphide, prepared by passing hydrogen through a mixture containing 2
parts of lime with 3 parts of water: when saturated with the gas, this
forms a greenish jelly, which is spread upon the part for a few minutes,
and then removed with an ivory knife (Trousseau).

As a Moxa, or to produce an issue, a fragment of lime may be slaked
on the skin by adding to it a few drops of water; much heat is produced,
and the neighboring skin requires to be protected.

As a Vapor JSath, a piece of unslaked lime half the size of a man's
closed hand is wrapped in a moist cloth, and this again in a dry one
doubled several times, and fastened securely : and if one of these packets
be placed on either side of a patient while in bed, the moist heat soon
induces a copious perspiration lasting for one or two hours (Serre d'Alais:
^Bulletin de Therapeutique, 1846). Dr. Hassall has recommended this as
a ready means of establishing reaction in cholera, and others .have used
it in tetanus.

Hay-Fever. In this malady the vapor evolved from lime chloride has
been found serviceable, when the air of the patient's house is impregnated
with it as far as possible; the solution should be used as a wash to the face
and hands. It is reasonably presumed to act by destroying a fermentative
or " germ " source of irritation to the mucous membranes (Elliotson).

LIME. 103

Croup and Diphtheria. In the form of a warm, finely atomized spray,
solutions of lime (1 in 30) have been much commended as chemical sol-
vents of croupous membrane. Forster, Biermer, and others have shown
that such membranes, and especially their fibrinous constituents, are sol-
uble in lime-water (Archiv der Jleilkunde, v., p. 522), but doubts have
been expressed whether such an effect can be usefully and practically
obtained in the living body. Biermer treated a true case of membra-
nous croup (verified by rejection of membrane) by means of a warm lime-
spray, and although the patient was in great peril, he obtained relief and
finally recovered ; this physician, however, generally gave calomel at the
same time (British and Foreign Jteview, July, 18G5). Kuchenmeister
has recorded several good cases treated successfully by the spray (Bulle-
tin Gen., April, 1865), and the experience of Steiner proved that diph-
theritic layers on the fauces were dissolved by it in a marked manner:
subsequently, however, the growths formed again, and could not be con-
trolled by the remedy (Jahrb. fur Kinderheilk., 1870). Beigel has report-
ed good results with it in croup, and Geiger, of Philadelphia, in diph-
theria (Practitioner, i., p. 101); but Senator has more recently written
against its employment, even from a theoretical point of view, and doubts
its power of dissolving membranes "in situ." Gottstein and others con-
sider the direct application of lime-water to the larynx by means of a
brush to be more advantageous than the spray, and Albers, of Berlin, in
desperate cases has injected the solution into the larynx from below, pass-
ing his syringe between the tracheal rings: cough was caused, and shreds
of membrane were ejected (Berlin. Klin. Woch., February 1, 1869 ;
Ranking, i., 1870). The experience of the profession is not yet such as
to enable us to decide the real value of lime-water applied locally in the
treatment of these affections, but my own results have not been largely
in its favor. Mackenzie finds it useful " when the false membrane is not
very thick " (" On Diphtheria," p. 69).

Lactic acid and carbonate of lithia act similarly, and even better, in
dissolving croupous membranes; Kuchenmeister, however, still maintains
the superiority of lime-water. Sanne recommends the saccharate.

Cancrum Oris Ulcerations. Applied in substance or in solution,
the chloride of lime is a valuable antiseptic and stimulant to fetid dis-
charging surfaces. In cancrum oris, a little of the dry powder may be
applied by the finger, and washed away immediately afterward, and in
unhealthy ulcerations about the gums in general, and in salivation, a
wash may be used containing 2 dr. to the pint of water, with glycerin, or
ordinary lime-water may be used with nearly equal benefit.

A proportion of 1 to 10 or 15 of water has been found extremely use-
ful, applied as a compress in cases of ruptured perineum, when the torn
surface is apt to discharge offensively, and in unhealthy and indolent ul-
cerations of any part, the same remedy, or even ordinary lirne-water, will

10J: MATERIA MEDICA AND TIIEEAPEUTICS.

diminish discharge, cleanse the surface, and promote a healthy action.
Chloride of lime lotions are also good in erysipelas.

Skin Diseases. In pustular and erythematous skin diseases, prepara-
tions of lime are often very useful. In chronic acne, I have often ordered
lime-water, mixed with an equal part of rose-water, and applied three or
four times daily with the best results. In ecthyma, it is commended by
Mr. Wilson, and in the discharging stages of eczema and impetigo, it
makes a useful lotion. In impetigo capitis, and in fissured nipples, lime-
water mixed with oil is good. In chronic eczematous and scrofulous
disease, lime salts are often useful when given internally (Tilbury Fox
speaks well of " saccharated wheat phosphate " in such conditions). Caz-
enave thought the chloride good in lupus. In carbuncles and boils, a
compress soaked in lime-water and covered with oiled silk, often acts
beneficially; it checks inflammation, soothes pain, and promotes suppura-
tion more quickly than ordinary poultices. In erythema and the pruritus
of reddened and irritable skin, lime-water has a sedative, moderately con-
stringing effect, and may be used either alone, or as a vehicle for other
similar remedies. In pruritus pudendi it is often useful when applied
freely and tepid, and in osmidrosis it will relieve the unpleasant secretion
from the sweat-glands. Dusting powders containing precipitated car-
bonate of lime are used for erysipelas and erythema, and in cases of much
sebaceous secretion, especially about the face. Combined with lard as
" chalk-ointment " it is often a good application for indolent and irritable
sores. In tinea capitis, after thorough cleansing, lime-water may be
brushed in, but as a rule stronger remedies are necessary: a lotion of
chloride is more satisfactory. In scabies, a strength of 1 oz. of chloride
to 1 pint of water has been found sufficient to cure, but a more depend-
able preparation is made by boiling together 1 part of quick-lime and 2
of sulphur with 10 of water; this should be constantly stirred till well
mixed, and then the liquid poured off for use; it is too strong to be
rubbed in like sulphur ointment, but should be applied lightly with a
brush, and afterward removed with a warm sponge, if necessary (Lancet,
i., 1865). Pharmaceutists now commonly make such a preparation under
the name of liquor calcis c. sulphure (vol. i., p. 33).

Burns and Scalds. Lime-water, mixed with an equal part of linseed-
oil (Carron-oil), or better, of olive-oil, was long since commended by Boyle
and by Velpeau as a suitable dressing for the early stages of burns in
every degree, and, though rather unpleasant, it has come into general
use. It may be applied on carded cotton, and if the skin be unbroken,
resolution of inflammation is promoted by it, and if suppuration occur, the
liniment controls it, and hastens cicatrization. It relieves pain and in-
flammation in cases of wasp and other stings (Dauverne).

In severe cases of Small-pox, Dr. Joseph Bell recommended the same
liniment to be applied to the face on cotton wool, carefully arranged to

LIME. 105

cover the affected part, but leaving apertures for the eyes, nose, and
mouth. The wool should be fastened with another covering or with tape,
so as to prevent admission of air, and by this means pitting may be pre-
vented or decidedly lessened. An improved formula is a saturated su-
crate of lime, made with lime, sugar, water, and glycerin; it forms a cool,
drying varnish, and for burns may be diluted with oil, or ether may be
added (PharmaceuticalJournal, October, 1873).

Chronic Discharges. In chronic mucous arid purulent discharges,
lotions and injections of lime-water exert a most beneficial influence, as
maybe observed in chronic urethritis and in leucorrhcea, syphilitic or
otherwise; in the former, a combination with mercurial oxides, such as
the " black or yellow wash," is still more potent, and is in daily use for
all forms of syphilitic ulceration.

The profuse nasal discharge, so usual in scarlatina and also muco-
purulent otorrho3a, may be well and safely treated by washing out the
affected parts with a tepid injection of milk and lime-water three or four
times daily: over the affected ear a compress of lime-water, worn at
night, is often advantageous. In chronic purulent ophthalmia a lotion
containing chloride of lime is effective.

Ascarides. Rectal injection of a few ounces of lime-water several
times repeated is effectual in curing ascarides, and Dr. Price, of Margate,
and Kuchenmeister have reported some successful instances of this treat-
ment (Lancet, i., 1864); it has long been a favorite prescription of mine.

THERAPEUTICAL ACTION (INTERNAL). Lime-water was formerly much
esteemed as an internal medicine, and was given not only as an antacid
and astringent, but also as an antiseptic, and especially as a lithontriptic
or solvent of calculi. It was not unfrequently given in excess, and pro-
duced irritant effects, but its use now is more restricted, and the doses
given are smaller and more diluted.

Dyspepsia Vomiting. When digestion is accompanied with dis-
comfort and oppression, or with acidity, pyrosis, and flatulence, espe-
cially if there be a tendency to diarrhoea, and to acidity of urine, lime-
water and the carbonate of lime are often more serviceable than alkalies,
because they are not only antacid but astringent. I have found them
specially useful in the dyspepsia of chlorotic women, marked by the
above symptoms, and generally by craving for acids and dislike to ani-
mal food. When flatulent distension affects the lower bowel, lime-water
has been used in enema as absorbent of carbonic and other gases. Dr.
Habershon has recommended the carbolate of lime in such conditions
(Lancet, i., 1868). For cases of acid dyspepsia, when flatulent distension
is not so prominent a symptom, but when there are heartburn and pain
with evidence of gastric congestion, the bicarbonate of lime, dissolved
with an excess of carbonic acid in the slightly effervescent form known
as carrara water, is very useful, for it is less nauseous to some patients,

106 MATERIA MEDICA AND THERAPEUTICS.

and more easily tolerated than lime-water, so that more of it may be given
at a time; it may be mixed with an equal part of milk, while of lime-water
not more than one-eighth part should be used.

For the special symptom of nausea and vomiting 1 from irritative gas-
tric conditions, milk and lime-water is a simple and often effective treat-
ment; given frequently in small quantities, iced, it provides digestible
nourishment which is sometimes better retained than any other. It is
valuable in the vomiting of pregnancy, and even in that of gastric ulcer,
in which latter malady only a dessertspoonful in a wineglassful of milk
should be tried at a time. The lime acts partly as a sedative to the mu-
cous membranes, partly as an antacid, and partly mechanically by break-
ing up the curd of milk; hence it is particularly useful as an addition to
cow's milk for children brought up by hand, only in any case where con-
stipation is marked, soda-water may be substituted for a time.

Mr. Metcalfe Johnson has written highly of the value of hydrated
phosphate of lime in the sickness of pregnancy; and Dr. Leared of the
chloride (|- dr. to 1 dr. liq. calcis chloridi) in sarcinous vomiting. Dr.
Cleland specially recommends the saccharate as a better antacid than
magnesia, and useful in dyspepsia dependent on either too little or too
great secretion of gastric juice; it does not constipate like other lime
compounds; it may, however, cause nausea if taken on an empty stomach
(Edinburgh Medical Journal, 1859).

Carrara water is suitable for taking with wine at the later meals, and
several other natural mineral waters containing lime are of acknowledged
value in gouty and acid forms of dyspepsia generally (vol. i., p. 173):
Seltzer contains 3 gr. of carbonate in the pint, Pyrmont 4, Kreuzbrunnen
4.13 with much carbonic acid, Wildungen 5.4 to 9.7, and Pouges (a Spa
between Paris and Lyons) contains as much as 12 gr., and is of great
repute. Dr. Basham found such waters especially suitable for hypochon-
driacal, but not for anaemic cases.

Intestinal Catarrh Diarrhoea. Lime-water and lime carbonate are
useful in these conditions, especially if gastro-intestinal acidity be present,
as it usually is in young children; the breath is then offensive, the motions
frequent, loose, greenish, sour-smelling, and deficient in bile; the abdomen
is distended, cramping pain occurs at intervals with drawing-up of legs,
and there is often sickness. Restriction to milk and broth diet, with the
addition of 1 or 2-gr. doses of carbonate of lime, will often cure this dis-
order; in the diarrhoea of dentition as well as in the more chronic forms
connected with strumous or mesenteric disease, such treatment is spe-
cially indicated. (Castor-oil may be required at first to remove any
cause of direct irritation such as undigested food, mucus, etc., and the
use of insoluble lime salts should not be prolonged more than neces-
sary, otherwise irritation or some degree of obstruction may be caused.)

In chronic diarrhoea dependent upon relaxed condition of the ali-

LIME. 107

mentary canal, and also when kept up by ulceration of the bowel, I have
used lime preparations with the best possible effect. Bretonneau recom-
mended them in enema for these cases.

In the diarrhoea of enteric fever, and of tuberculosis, milk and lime-
water may prove of great, if only temporary service, but should not be
used in large quantity if hemorrhage or symptoms of acute inflammation
be present. The alkaline earth is plausibly supposed to combine with
the secretions of the ulcerations and to form a layer which protects the
terminations of sensitive nerves against contact with the contents of the
bowels. Mialhe especially applied this explanation to the phosphate of
lime, which salt has been much used in the treatment of diarrhoea and of
acidity, and owing partly to its phosphoric element, is considered to exert
a special restorative power: according to him, if given with bread and
sugar it becomes changed by the slight acid of the former and by the
gastric acids into a soluble acid salt, which does not itself coagulate
albuminoid material, but when brought into contact with a small pro-
portion of alkali, becomes converted into an insoluble basic phosphate of
gelatinous character, which protects the mucous membrane, and checks
diarrhoea.

This salt was the principal ingredient in the "white decoction "of
Sydenham. The quinovate of lime is specially commended by Kerner
(v. " Vegetable Kingdom ").

Aphthous Conditions of the mouth and alimentary tract, when occur-
ring in infants, with green but not necessarily liquid stools, may often be
cured by lime-water or prepared chalk.

Bone Disease Fractures. Piorry furnishes evidence of the value of
phosphates in osteo-malacia, or softening of the bones generally, also in
spinal caries or " Pott's disease " (Gazette des Hopitaux, 1856), and I have
certainly seen them very beneficial in cases of caries and joint disease.
Reasoning from the observation that birds with a broken limb lay eggs
without shell during the process of repair, Dr. Fletcher was led to ad-
minister a mixture of calcined bone, prepared chalk, and lime-water in cases
of fracture (in man), and reported several cases of very early union of long
bones (Lancet, 1846). Milne Edwards made similar observations on dogs
and rabbits, producing fractures as nearly as possible alike, and then
finding that the animals who got lime phosphate recovered more rapidly
than the others; and M. Gosselin found the same results in men ( Comptes
Rendus, xiii., p. 631 ; and British and Foreign Review, July, 1856): on
the other hand, it has been pointed out that in fractures of old persons,
in whom the bones are brittle, lime salts are better avoided. They have
been strongly recommended during pregnancy and lactation in enfeebled
mothers, both to relieve their neuralgia, debility, and dyspepsia, and also
to favor the development of healthy non-rachitic children (Der Prakt.
A.rzt, May, 1869); and I have for years recommended their use in back-

108 MATERIA MEDICA AND THERAPEUTICS.

ward dentition, delayed power of walking, and retarded closure of the
fontanelles. These are usual signs of a rachitic tendency, and in the fully-
developed malady of rachitis, saccharated lime is strongly to be recom-
mended. It is true that although parts of the bones become softened in
this disease, and are deficient in lime, often at the same time, lime phos-
phates are largely excreted in the urine, so that the fault is one rather of
mal-assimilation than of actual deficiency, yet I agree with Dr. Ringer
that the administration of lime, and especially of lime-phosphate, " ap-
pears to control this defective and perverse nutrition, and to induce
healthy growth, so as to" favor consolidation of the skeleton and improve
the condition of soft parts," and that practically they are extremely
valuable, though not always alone curative. He compares this use of it
to that of iron in anaemia, where the fault is equally one of want of as-
similation rather than of quantity. As already mentioned under the
physiological action of lime (v. p. 99), it has been objected that it is so
little soluble that quite sufficient may be introduced with ordinary food,
and that to give it in medicine rather interferes than otherwise with
normal nutrition (Paquelin and Jolly); but practically we do not find it
so. Considering, however, the evident insolubility of ordinary tribasic
phosphate, M. Dusart and others have introduced acid solutions lacto-
phosphates which have come much into vogue, and are sometimes very
suitable, but it must be remembered that often in unhealthy rachitic
children most of the secretions are already too acid, and need rather to
be neutralized by a basic earthy salt, and any excess of acid would tend
rather to dissolve osseous salts, and cause them to be eliminated, not de-
posited. It may often be better to give the ordinary salt (phosphate) re-
cently prepared, if possible, and with flour or milk, and to trust the stomach
to absorb what is needed, and the surplus will pass through the intestine,
not injuriously. The combination of lime phosphate with sodium chlo-
ride (calcaria phosphorica salita) has been found very soluble (Sabellin,
Dorogow, Husemann, p. 724). The sulpho-carbolates of lime have been
specially recommended in rickets, but Dr. C. Ritchie did not find them
serviceable (Medical Times, i., 1871).

There is reason to think that natural salts of lime, such as have re-
cently passed through organic structures, are preferable to such as have
been deposited as mineral. Thus, Piorry recommended, in bone-soften-
ing and spinal curvature, fine filings of fresh bone, 1 oz., to be taken in
milk or rice-milk, and found it succeed when proper light, warmth, and
food had failed (Gazette des Hopitaux, 1856, No. 139; Medical Times,
i., 1857).

Others have derived medicinal phosphates from the vegetable king-
dom. Thus Dr. Hake and Dr. Tilbury Fox recommend a strong decoc-
tion of good bran to be made and evaporated, and the residue mixed with
sugar; and a preparation of this kind known as " saccharated wheat phos-

LIME. 109

phates " has come largely into use for mal-nutrition, rickets, etc. (Medi-
cal Times, i., 18G6). It may be desirable to state again that the advan-
tage of lime salts in bone disease is not traced simply to chemical arid
physical processes, but also to direct improvement of digestion, absorp-
tion, and nutrition.

Struma Glandular Disease. Lime-water was long since commended
for the treatment of suppurating glands, and of ulcerations, as well inter-
nally as locally (Shapter, Pereira). The phosphate was especially found
serviceable, though not always curative, in the different manifestations
of scrofula, by Beneke (Lancet, 1851), and by Stone (New Orleans Medi-
cal Journal, and Bulletin Gen., 1852, t. xlii., p. 229); while Beddoes, Four-
croy, A. T. Thomson, and more lately Dr. W. Begbie, have reported very
good results from the chloride. Dr. Beddoes collected upward of one
hundred cases, including many of so-called " tabes mesenterica," and Dr.
Begbie has corroborated the good results to be obtained from doses of
10 to 20 gr. daily. He records also good cases of the subsidence of en-
larged parotid and lymphatic glands under the same medicine, when
iodine and cod-liver oil had failed to cure (Edinburgh Medical Journal,
July, 1872). It must be stated, however, that in the experience of most
other observers, these latter remedies have superseded lime salts, and
that Mr. Benjamin Phillips and other writers on scrofula have expressed
themselves much less favorably concerning them.

Of late years, a mineral water in the West Indies has obtained great
repute in the treatment of glandular enlargements, and has been found
to contain calcium chloride, though in small proportion. The "Bridge of
Allan " waters contain it, and have a purgative effect in consequence. I
have myself given the chloride a fair trial in 1 to 5-gr. doses twice daily
for lymphatic disease in children, and have sometimes seen good results
from it when persevered with; though, as a rule, I prefer the carbonate
to other lime compounds.

The use of sulphide of calcium in strumous and scrofulous sores and
enlarged glands, and in localized suppurations of any kind, will be found
fully discussed under sulphur.

Anaemia. In anaemia and debility, the consequence of overwork, of
close confinement, etc., Dr. Ringer speaks highly of the phosphate of
lime, especially when combined with the carbonate and with iron.

Chorea. Rodolfi has recorded cases of chorea treated by lime chlo-
ride, 7 to 15 gr. in twenty-four hours, and finds it suitable for all cases
provided that there is no " cerebral hypera?mia; " improvement began at
once, and cure resulted in about sixteen days (Medical Times, i., 18G9).
Aperients were also given, and, as Jaccoud remarks, belladonna was
combined with the lime, so the results must be held doubtful.

In nerve-disorder with sleeplessness, and in infantile convulsion, Dr.
Hammond has found the bromide of calcium more readily taken and

110 MATERIA MEDICA AND THERAPEUTICS.

more effective than that of potassium, and I. can to some extent verify
his observations.

Phthisis Chronic Bronchitis, In the early stages of phthisical
anaemia and debility, especially in excitable florid persons with tendency
to headache and dyspepsia, also when in later stages profuse sweating,
or expectoration, or diarrhoea is present, or when the menses are frequent
or profuse, the carbonate or phosphates of lime often exert a good influ-
ence in lessening such discharges and in improving strength; even when
actual softening has occurred and cavities formed, I have given these
salts with the object of assisting cretaceous degeneration, and often with
benefit. Lime well supplements cod-liver oil, and the two remedies may be
suitably combined, since they form an emulsion readily taken by children
1 parts of lime-water to 1 of cod-liver oil is perhaps the best proportion
(Medical Times, i., 18C2, p. 399). Van den Corput, a Belgian physician,
though praising this combination, recommends rather the chloride flavored
with anise or such proportions of lime-water, etc., as will make a solid
jelly (" jecoro-calcaire savou "), which is still better taken (Medical
Times, ii., 1870, p. 624); it has not, however, come much into use in this
country. Cod-liver oil does not mix well with syrup of-lacto-phosphates,
and is liable to become rancid when in contact with it. At a hospital in
Moscow excellent results were obtained in the treatment of phthisis by
freshly calcined bone.

The hypophosphites of lime were introduced as the best compound
for the treatment of phthisis, owing their value in part to the base, and
in part to the hypophosphorous acid contained. The rather extravagant
praise which was bestowed upon them has not been supported by the
majority of the profession, and opinions are still divided as to their real
powers. I believe myself that they are sometimes of much service. Ra-
buteau remarks that as hypophosphites raise animal temperature, the
phosphates would seem more rational remedies for phthisis; that dogs
never have phthisis (?), probably because they eat so much bone; also
that phosphates are commonly in excess in the urine of the phthisical,
and therefore to supply them artificially is reasonable. Charters has lately
published illustrations of their value in night-sweats (Lancet, i., 1876),
and Gugot has made a similar observation (Husemann). Mr. Pidduck
specially praises the iodide of calcium in struma and phthisis; it is taste-
less, non-irritant, readily decomposed, but not readily producing iodism
(Medical Times, i., 1858). Dr. Sawyer states that he has seen, in chronic
phthisis, better results from calcium chloride than from other medicines,
hypophosphites of lime and soda included. He recommends 10 gr. of the
chloride with 1 dr. of water and of glycerin, to be taken in milk after
meals, and finds this often "check night-sweats, increase weight, and dry
up pulmonary lesion " (Uritish Medical Journal, i., 1880).

In chronic bronchitis, I have frequently seen lime-water, and also car-

LIME. Ill

bonate of lime, act well in diminishing profuse expectoration and trouble-
some cough; it should be given internally, and the lime-water applied
locally by an atomizer. ,

In Gangrene of the Lung, Dr. Graves advised the chloride with opium.

Cancer. Besides the local application of lime-water and lime chlorides
to cancerous sores, a power has been claimed for these remedies taken
internally to diminish malignant growths; thus, a curious case, in which
an extensive mammary cancer separated and fell off after a prolonged
use of lime carbonate, is recorded by Dr. Peter Hood (Lancet, ii., 1867,
p. 454); the patient was advanced in years, and for a long time took the
carbonate, as prepared from the inner side of oyster shells, 10 to 20 gr.
twice dailv. Another case, cured under the same remedy, is also men-
tioned.

(If the taking of lime salts have any power in inducing the cretifica-
tion of tubercle and there is some clinical evidence to that effect and
if they can diminish the blood-supply of a fibroid tumor and hasten cre-
taceous degeneration of it, as suggested by Mr. Spencer Wells, then it is
not unreasonable to expect advantage from them in some cases of cancer-
ous degeneration, but I am not aware of other evidence in this direction.)

Uterine Disorder Menorrhagia Fibroid Tumor. There is a gen-
eral consensus of opinion as to the power of lime salts to relieve uterine
hemorrhage. Dr. Rigby published a marked case dependent on "fibrous
tumor" (Medical Times, ii., 1854) treated by the chloride, and Dr. Rog-
ers, Dr. Routh, and others have recorded similar experience; doses of 10
drops of the liquor calcis chloridi, increasing by degrees to 30 or 40 drops,
and continued for some months, are recommended (Ranking, 1871; Lan-
cet, 1873). In too' early and too profuse menstruation, I have been ac-
customed for many years to prescribe the carbonate of lime with much
success. Mr. Spencer Wells believes that the chloride acts by leading to
atheroma of vessels, and hence is useful in lessening the growth of uterine
fibroids, and may even cause their disappearance (British Medical Jour-
nal, i., 1868). Certainly, in some instances under my care, uterine and
other tumors have diminished under treatment by carbonate and chloride
of lime.

It is true, as remarked by Dr. Meadows, that large quantities have
been given to many patients with uterine fibroid tumor without any re-
sult, and he ridicules the idea of any possible promotion of calcification
by such means (Lancet, ii., 1873, p. 3) : he argues that a natural process
of atrophy may occur, and that calcareous degeneration is only a conse-
quence, not a cause of this. Dr. Meadows ridicules equally the idea of
lime curing rachitis: but no reasoning from probabilities should prevent
our appreciating clinical facts.

Uric Acid Deposits Calculus. In these maladies, lime has by no
means retained the reputation it formerly held, but may certainly give

112 MATEEIA MEDICA AND THERAPEUTICS.

some relief. The secret remedy of a Mrs. Stephens received so much
commendation, that Parliament purchased the recipe for 5,000 about one
hundred years ago, and it was found to be mainly of calcined egg-shells
(lime carbonate) and soap, with vegetable bitters, and though much of the
benefit must be set down to the alkali of the soap, yet Whytt obtained
very good results afterward from simple lime-water. Lime salts may re-
lieve vesical pain and inflammation, and by a constringing and sedative
effect on the mucous membrane of the bladder may lessen the ropy dis-
charge and the general sensibility; a solvent action may also be exerted,
but not probably to a great degree; the benzoate of lime has been cred-
ited with more decided effect. Lime-water should also be injected, after
washing out the viscus with soothing mucilaginous liquids. Professor
Stille remarks, " There is reason to believe that uric acid gravel may be
dissolved and eliminated under the use of lime compounds. How far
they are superior to the carbonates of the alkalies for this purpose will
depend chiefly on the state of the digestive organs when these are fee-
ble, lime-water is the better preparation."

The waters of Wildungen, which are much used in lithiasis, owe their
efficacy principally to lime carbonate (vol. i., p. 172).

Diabetes Mellitus. Kissel reports two cases cured by lime-water, im-
provement being for several weeks very slow, but afterward rapid and
marked. My own experience, however, has convinced rne that this is in-
ferior to many other remedies.

Albuminuria. On account of the power of lime salts to dissolve or-
ganic membranes, they have been recommended in chronic Bright's dis-
ease, and in post-scarlatinal albuminuria "to dissolve proteinous infiltra-
tions of the kidney." Kuchenmeister reports cases treated by large doses
of lime-water and soluble lime salts, with immediate and marked increase
in the quantity of urine passed, and with corresponding subsidence of the
dropsy. The amount of albumen was lessened, but sometimes slight
hemorrhage occurred (Ranking, 1869 ; Rev. Med., February, 1870).
His results have not been widely corroborated, but Baudon reports a
case in which the iodide of calcium seemed to succeed after iodide
of potassium failed; quinine and iron were given also (Practitioner, i.,
1869).

From our knowledge of the styptic properties of lime salts, we should
rather expect them to restrain renal hemorrhage than to cause it, and
Stromeyer and Caspari report the value of the phosphate for this purpose.

PREPARATIONS AND DOSE. Liquor colds : dose, % to 2 fl. oz. or more
(contains gr. to the ounce). Liquor calcis saccharatus : dose, 15 min.
to 1 fl. dr. (contains 7.11 gr. to the ounce). Linimentum calcis (lime-
water and olive-oil, equal parts). Greta prceparata : dose, 10 to 60 gr.
Mistura cretce : dose, 1 to 2 fl. oz. (contains chalk oz., gum-acacia oz.,
syrup oz., cinnamon water to 8 oz.). Pulvis cretce aromaticus : dose,

CERIUM. 113

10 to 60 gr. (contains cinnamon, nutmeg, saffron, cloves, chalk, carda-
moms, sugar). Pule is cretce aromaticus c, opio : dose, 10 to 60 gr.
(contains 1 gr. of pulv. opii in 40). Galcii chloridum : dose, 2 to 10 gr.
Vapor chlori (made with chlorinated lime). Calcis phosphas : dose, 2
to 20 gr. or more. Calcis hypophosphis : dose, 2 to 10 gr. Besides
these officinal preparations, there are many compounds such as the iodide,
the bromide, and the carbolate of calcium of which the lime is the less
active ingredient, and of which the properties are mainly those of iodine,
bromine, etc. There are also many private preparations of lime, such as
the lacto-phosphate, the compound syrup of the phosphates (Parrish),
and others. A number of formulae for lime sucrates, hypophosphites,
etc., are given in the Pharmaceutical Journal, June, 1877.

The sulphide of calcium is not officinal: convenient granules of it
containing -^ gr. and up to 1 gr. are now prepared.

Various formulae for " phosphated bread " and natural forms of phos-
phate have been published. Superphosphate of lime 3- oz., carbonate of
iron \ oz., butter and sugar, of each lb., flour f lb., treacle lb., make
80 cakes (Medical Times, i., 1859). Acid phosphate of lime and moist
carbonate of soda may be used as a good "baking powder" (Horsford,
Ranking, ii., 1860). Chevrier has an aerated water containing tribasic
phosphate (Pharmaceutical Journal, September, 1874). Dannecy recom-
mends to wash and powder beef bones, and boil them for an hour with
carbonate of soda and water, then to wash in a filter to dry and sieve
(Bulletin de Therapeutique, March 15, 1858).

[PREPARATIONS, U. S. P. Calcii carbonas proecipitata ; Cretce proe-
parata ; Mistura cretce : prepared chalk troyounce, glycerin fluid
ounce, gum arabic 120 grains, cinnamon water, water, each 4 fluid ounces;
Trochisci cretae, : prepared chalk 4 troyounces, gum arabic 1 troyounce,
nutmeg 60 grains, sugar 6 troyounces, make 480 troches. Calcii chlo-
ridum Calcii hypophosphis ; Calcii phosphas prazcipitata Calx ;
Liquor colds lime-water; Linimentum calcis : lime-water 8 fluid
ounces, flaxseed-oil 7 troyounces. Calx chlorinata chlorinated lime.]

CERIUM, Ce,=141.

This metal, which -is not a common one, was discovered by Berzelius,
in a Swedish ore called cerite or heavy-stone a silicate of iron, calcium,
lanthanium, didymium, and cerium, which last is obtained from it in the
form of a gray metallic powder: oxalic acid is used in the process, and
hence oxalate of cerium is the best known commercial salt: it is the only
one officinal.

VOL. H. 8

114 MATERIA J1EDICA AND THERAPEUTICS.

CERII OXALASOXALATE OF CERIUM, Ce 2 3(C 2 4 )9H,O,=708.

PREPARATION. By mixing a solution of any soluble salt of cerium
the chloride) with solution of oxalate of ammonia tho oxalate of
cerium precipitates.

CHARACTERS AND TESTS. A white granular powder, which when
heated to redness gives a reddish-brown residue of impure oxide, soluble
in boiling hydrochloric acid without effervescence. This solution gives,
with sulphate of potash, a white double sulphate of potassium and cerium:
the oxalate itself is insoluble in water. The soluble salts, such as the
chloride and nitrate, have a sweet astringent taste: with alkalies and
their carbonates they give yellowish-white precipitates.

PHYSIOLOGICAL ACTION (INTERNAL). There is some clinical evidence
in favor of attributing to cerium a sedative action upon the gastric mu-
cous membrane and upon the nervous system, and especially on reflex
excitability, but I am not aware of any physiological research as to the
properties of this drug.

STNERGISTS. Bismuth, silver, and cyanides.

THERAPEUTICAL ACTION (INTERNAL). Vomiting of Pregnancy, etc.
Sir J. Simpson introduced the oxalate of cerium " as a sedative tonic re-
sembling bismuth and silver," valuable in irritative dyspepsia and vomit-
ing, especially when dependent on pregnancy (Edinburgh Monthly Jour-
nal, December, 1854; and Medical Times, i., 1855). Several years later
he wrote strongly in favor of its especial and proved value in the last-
mentioned condition and in sympathetic uterine vomiting generally. Pie
calls it "the simplest and surest remedy," states that he has cured with
it more cases than with any other single medicine, and records several
illustrations of its prompt and effective action in obstinate cases which
had resisted all ordinary treatment: he gave 1 to 2-gr. doses in pill (Medi-
cal Times, ii., 1859). Dr. C. Lee and Dr. "W. Curran have recorded sim-
ilar experience, but the latter rather confused his results by giving bro-
mide and bark at the same time. Dr. C. K. Mills (U. S.) found that the
nausea and vomiting of pregnancy almost always yielded promptly to a
few doses: of eleven cases reported, ten were relieved permanently, one
only for a time. Similar symptoms associated with dysmenorrhosa, flexion,
and other uterine disorders, and with hysteria from anxiety, grief, over-
work, and the like, were also relieved by cerium. Obstinate vomiting
occurring in the course of phthisis, and during typhoid fever, was suc-
cessfully treated by 2 to 3-gr. doses ( Medical Record, March, 1876). The
amount of published evidence as to the general use of the drug is meagre,
but I have myself often obtained excellent results from it. Dr. Image,
in a recent paper, attributes occasional disappointment to the use of too
small doses: he recommends 10 gr. with tragacanth, tincture of orange,

CERIUM. 115

and water, every four hours, the first dose being taken half an hour before
rising. He quotes a case in which vomiting always had commenced in
the fourth week of pregnancy and lasted till the eighth month, but with
this remedy the attacks, though recurring at intervals, were invariably
checked in two or three days, and of a great many cases of pregnancy
with vomiting, not a single one was unrelieved by the same treatment
(Practitioner, June, 1878). He found it also efficacious in nausea from
uterine irritation, and I have had similar experience on many occasions.
I have not required to use so large a dose, but it should certainly be tried
if smaller ones fail. Dr. Busey has lately recommended oxalate of cerium
to obviate the nausea and headache produced in some persons by opium,
just as Da Costa recommended bromide, and others coffee; it has the ad-
vantage of small bulk and of tastelessness (Practitioner, i., 1879, p. 214).

Dyspepsia Gastrodynia, etc. Simpson recommended the oxalate in
primary as well as in reflex gastric disorder, and Dr. C. Lee has given in-
stances of its value in pyrosis, in phthisical and atonic dyspepsia; it may
be used in the class of cases in which bismuth is indicated. Dr. Mills
found it act best when morbid sympathetic influences were a main cause
of the indigestion, and depressed or deranged innervation of the stomach
existed: in diarrhoea from nerve-irritation, cerium was also successful;
" it seems to have the power of diminishing reflex excitability of the ali-
mentary tract; "in dysentery, gastric ulcer, cancer, gastro-enteritis, he
tried the medicine, but with less satisfactory result (Medical Record,
March, 1876).

11 Chronic Cough." Mr. Clark has recorded cases of chronic lung-
disorder with some partial consolidation, and accompanied with dyspnoea
on exertion and violent morning cough producing sickness, the symptoms
were much relieved by the (apparently) sedative effect of oxalate of
cerium, given in 5-gr. doses half an hour before rising (Practitioner,
April, 1878).

^Epilepsy. Dr. Ramskill has recorded two cases of epilepsy preceded
by a " gastric aura " I.e., " a sense of faintness, and of something turn-
ing upside down at the epigastrium " which were benefited by the
oxalate of cerium, when belladonna and bromides had failed to relieve.
Cases of epilepsy without this aura were not benefited, and Dr. Ramskill
suggests that in the gastric cases there was a primary failure of action in
the splanchnic nerves, that the medicine acted as a sedative and conser-
vator of their power, and that this influence being conveyed to the me-
dulla lessened its excitability (Medical Times, i., 1862). The cerium salt
has at least this advantage over nitrate of silver, that it will not darken
the skin.

PREPARATION AND DOSE. Cerii oxalas: dose, 1 to 5 gr. or more
according to Dr. Image, 10 gr. For an infant or child under two years,
i to gr.

116 MATEEIA MEDICA AND THERAPEUTICS.

[PREPARATION, U. S. P. Cerii oxalas.]

ADULTERATIONS. Mr. H. Greenish asserts that commercial oxalate of
cerium contains a large proportion of the oxalates of lanthanium and didy-
mium, and that the pharmacopceial test does not exclude their presence;
this may possibly account for failure in some cases (Medical Record, 1877).

CUPRUM COPPEK, Cu,=63.4.

This metal (which has its name from Cyprus) is now obtained chiefly
from the mines of Cornwall, of the Pyrenees, and of Fahlun in Sweden,
in the form of a double sulphide with iron (copper pyrites, Cu^Fe^S,):
an oxide, a sub- or red oxide (cuprite), and an oxycarbonate (malachite),
also occur, as well as arseniates, phosphates, etc.

The metal is extracted from the ores by a process of roasting and
fusion; a purer form by electrolytic decomposition of the pure sulphate.

Brass is a compound of copper with zinc (but often contains some
lead), and bronze is an alloy of copper, tin, and zinc: ordinary commer-
cial copper may contain arsenic.

CHARACTERS AND TESTS. Copper is the only red metal; it is lustrous,
malleable, and ductile, of sp. gr. 8.92; unaltered in dry and cool air, in
moist air it becomes coated with hydrated carbonate, and at a red heat is
oxidized. In contact with acids, alkalies, or fats, it is readily acted on,
with formation of various green compounds, acetates, or oxides, commonly
known as verdigris. It is soluble in nitric acid, in sulphuric acid with
heat, and in hydrochloric acid if air be present, also in ammonia. It
forms cuprous and cupric salts.

Tests may be remembered by their color, as (1) the red test, shown by
immersing clean iron in an acid solution of copper, when the red metal
will be deposited; (2) the blue test, shown by the coloration produced
with excess of ammonia; (3) the brown test, by the bulky reddish-brown
precipitate which occurs with ferrocyanide of potassium (R. W. Smith).

CUPR1 8ULPHA8 SULPHATE OF COPPER BLUE VITRIOL COP-
PERAS, OR BLUE STONE, CuSO<,5HoO,=249.4.

PREPARATION. By dissolving copper in sulphuric acid, with the aid
of heat,

Cu + 2H a SO 4 , = CuS0 4 , + 2H 2 O, + SO 3 ,

treating the product with hot water, filtering, and crystallizing.

CHARACTERS AND TESTS. Occurs in oblique prisms of deep blue
color, and metallic styptic taste; soluble in 4 parts of cold, and 2 of
boiling water, insoluble in alcohol, efflorescing slightly in dry air. The

COPPER. 117

anhydrous salt is white, but turns blue when moistened with water, and
hence serves as a test for the presence of water in absolute alcohol. The
sulphate answers to the tests for copper already given, and like other
sulphates, gives a white precipitate of sulphate of baryta with barium
chloride.

Ammonia- Sulphate of Copper in solution is used as a test for the
presence of sulphides in liq. ammonite fort., and also as a test for arse-
nious acid, with which it produces a light-green precipitate of arsenite of
copper (Scheele's green).

SUBACETATE OF COPPER VERDIGRIS AERUGO, Cu(C 2 H 3 2 ) 2 CuO.

PREPARATION. Manufactured by exposing copper plates to the action
of pyroligneous acid.

CHARACTERS. Occurs in powder, or lumps of small crystals, bluish-
green in color, of sour odor, and metallic taste. A solution is officinal
as a test for butyric acid in valerianate of zinc; the acid is precipitated
by it.

ABSORPTION AND ELIMINATION. Metallic copper, even when pow-
dered, is not usually absorbed. Drouard gave large doses to animals,
without any result (Paris, 1802), but when finely divided, some may be
rendered soluble by the gastric acids, and traces may be detected in
the urine and saliva (Mialhe, Mitscherlich, Portal). Copper coins have
often been swallowed with impunity, but profuse salivation is recorded
in the case of a child after swallowing a penny (Barton, quoted by Gub-
ler). That the sulphate can be absorbed from wounds has been both
affirmed and denied. Langenbeck and Stadeler have traced poisonous
symptoms to this cause only when fatty acids were present, but Blodig
reported vomiting from a single application of cupric caustic to the con-
junctiva: such absorption, though it may occur, is certainly not frequent
(Husemann). Workers with alloys or salts of copper absorb it, for their
secretions, hair, and teeth may be colored green by it during life; it has
been found in their urine, and after death in the bones, and even in the
earth in which they are buried (Millon: Bulletin de VAcad'emie de Mede-
cine, t. xii.). Soluble salts of copper combine with albuminous secre-
tions and form a bluish coagulum; this, when resulting from a salt of an
organic acid (as the acetate) is still soluble, but from a salt of a mineral
acid (as the sulphate) it is more resistent (Mitscherlich). In any case,
only a portion of even a moderate dose is absorbed into the blood, and
this probably as an albuminate the larger portion passes off by the
bowel, and appears in the dark brown faeces as sulphate.

Elimination occurs by the bile, the saliva, and bronchial secretion
(Flandrin and Danger: Annales de Therapeutique, vol. i.) : these ob-
servers did not detect it in the urine, but others have done so. Elimina-

118 MATERIA MED1CA AND THERAPEUTICS.

tion is slow, for Orfila found copper in the viscera seventy days after its
use had been omitted. It is apt to be deposited in the liver especially.

It must be recognized as a very usual constituent of the normal or-
ganism. Sargeaux detected it in the blood of many animals, and Odling
and Taylor in the liver, kidneys, and other organs, irrespective of poi-
soning ( Guy's Reports, 1866). In the bodies of domestic animals fed on
vegetable food Wackenroder found no perceptible amount of copper, but
in snails and shell-fish comparatively much; in man and carnivorous ani-
mals he found also a rather large proportion both of copper and lead, and
concluded that they were derived from the nutritive or medicinal sub-
stances taken (Abstract in British and Foreign Review, 1855). Odling
and Dupre found copper in bread, flour, shell-fish, etc., and in the human
liver and kidneys, not invariably, but usually (Guy^s Reports, 1858).
Stevenson remarked that copper might be derived in the course of an
analysis from a copper lamp used for incineration, so that the greatest
care is required in such investigations (Lancet, ii., 1872). Schwartz-
enbach found 0.004 gramme of copper and rather more lead in 2,100
grammes of liver (British and Foreign Review, January, 1857); Orfila
had reported ten times as much. More recently, the average amount
found in the entire liver and kidneys in fourteen bodies was 2 to 3
milligr. (- s to -fa gr.), and it was found also in the foatus. The speci-
mens used in the investigation were carefully chosen as not having been
exposed to absorption of copper, and the metal was excluded from all
apparatus employed. We may therefore conclude that any quantity
above 4 milligr. (^ gr.) found in these organs is abnormal, and results
from direct administration of the drug (Bergeron and 1'Hote, quoted
Lancet, i., 1875, p. 255). In the case of the two wives of Moreau, 120
milligr. and 80 milligr. were found respectively (British Medical Journal,
ii., 1874, and i., 1875). In a case where ammonio-sulphate of copper had
been taken three months before death, nearly 300 milligr. (4 gr.) were
obtained from the liver, a good instance of its slow elimination (Bourne-
vette and Yvon: Revue Scientiftque, 1874, p. 859). Rabuteau found 16
ctgr. (2 gr.) in 1,000 grammes liver also three months after the last dose
43 grammes in all of ammonio-sulphate had been taken ( Gazette Heb-
domadaire, March, 1877).

PHYSIOLOGICAL ACTION (EXTERNAL). The sulphate, which is the salt
most commonly used, has little action on the sound skin, but when applied
to wounds or mucous membranes, it coagulates the albumen, and forms a
thin film on the surface. The pure salt, or its concentrated solution, acts
as a caustic; weaker solutions act as stimulants and astringents, both
forms producing more or less condensation of the neighboring tissues.
They exert, also, some antiseptic power, partly by decomposing sulphu-
retted hydrogen, and partly by destroying low organisms, whether animal
or vegetable. Any conclusions drawn from the effects of the smoke and

COPPER. 119

vapors of copper foundries are rendered doubtful by the coexistence of
sulphurous acid, arsenic, etc. Vegetable life of all kinds is destroyed in
the immediate neighborhood of such works.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. In the lower
animals, salts of copper seem to be uncertain in their effects, at least
when given by the mouth. According to Orfila, vomiting is the earliest
and most marked symptom, and Drouard found that 12 gr. of sulphate
caused fatal gastric inflammation in dogs. On the other hand, Galippi
could not poison dogs with pure copper salts, for small doses were toler-
ated, and large ones were so nauseous that he could not get enough swal-
lowed or retained (Bulletin de Therapeutique^ 1875). Ducom and Burq
also report that dogs can take from 15 to 60 gr. daily of soluble salts of
copper for a varying time without ill-effect on the general condition, with
the exception of vomiting at first; long continuance of this medication
at length impaired appetite and digestion, and thus led to death from
exhaustion (Bulletin de Therapeutique, 1875).

In man, small doses (^ giv) of a soluble salt of copper exert a tonic
astringent action, but if continued for a long time impair appetite and
digestion, and cause diarrhoea from irritation. The effects of frequently
repeated minute doses have lately excited special attention, on account
of the adulteration with copper of many preserved vegetables. Thus, in
the French preserved green peas, 0.31 to 0.56 gr. has been found in each
tin, and by some chemists, and even medical men, this quantity has been
pronounced injurious (M. Pasteur and others: British Medical Journal,
1876-77). Vulpian, however, says that any copper compound contained
is insoluble and harmless, and that no evidence exists to the contrary; and
Galippi, after the crucial test of eating them freely for some time, found
no bad result (British Medical Journal, i., 1877). In a 4-lb. loaf of bread
.4 to 1.8 gr. has been found, and the latter amount might become serious
(Medical Times, i., 1871, p. 509). Doses of 1 to 3 gr. induce a sense of
constriction in the gullet, and vomiting occurs in a few minutes without
much nausea, and is commonly attended with diarrhoea; 5 to 15 gr. act
as a powerful irritant emetic.

Lauder Brunton and West have experimented to ascertain whether
cupric salts cause vomiting by irritation of the stomach or of the vomi-
tive centre in the medulla. Into the jugular vein of cats they injected
a neutral albuminate of copper (which would not cause coagulation of
blood), and retching and vomiting followed. Previous section of the
vagi did not prevent the retching, but it did prevent evacuation of the
stomach, and after section of the vagi and the splanchnic nerves neither
retching nor vomiting occurred: hence they conclude that these symp-
toms depend upon gastro-intestinal irritation, not upon a direct excite-
ment of the central organs (St. Bartholomew's Hospital Reports, 1S7G).

Toxic Action. Half an ounce given at one time by the mouth pro-

120 MATERIA 3IED1CA AND THERAPEUTICS.

duces severe symptoms of irritant poisoning, including metallic taste,
feeling of constriction, thirst, salivation, nausea, vomiting, purging, and
severe cramping pain with tenesrnus; the abdomen is distended and ten-
der, the evacuations greenish or containing blood; the face may be
flushed and swollen, the gums ulcerated, and sometimes jaundice occurs;
death may follow from enteritis or exhaustion within a few hours or
days. From 1 to 2 oz. of sulphate or acetate may be reckoned a fatal
dose, though recovery has occurred after 5 oz., when vomiting has been
free (Toussaint and others); in practice a fatal issue is rare.

Blandet asserts that enteritis, though commonly produced by carbon-
ate or acetate of copper, does not occur from the sulphate, and in one
case, where 300 gr. were taken, vomiting, suppression of urine, and sub-
sultus occurred, yet recovery took place without enteritis {Medical
Times, i., 1874); the danger of the drug has doubtless been exaggerated,
and Honerkopf gave in seventy-two cases, 5 grammes, and in eighteen
cases, nearly 3 grammes without injury, but in other cases enteritis has
been caused by it.

Acute copper -poisoning occurs most often from accidental contamina-
tion of food cooked in copper vessels, which, when perfectly clean and
pure, are not harmful, but under the influence of air and moisture, vine-
gar, salt, or hot fats, carbonate, acetate, and oxychlorides of copper are
formed, and the admixture of these salts (" verdigris ") with the food is
exceedingly injurious, causing severe colic, vomiting, headache, and py-
rexia; tympanitis is sometimes very marked, and numbness and tremor
of the limbs have been noted (Taylor, Armstrong: Medical Times, 1844).
Similar symptoms, with scanty urine and excoriations about the mouth,
followed the use of water boiled in a copper kettle, and of injections from
a brass syringe (Amyot: Medical Times, 1859; Boggs: Lancet, 18G9).
An epidemic, much resembling dysentery, occurred on board an Indian
emigrant ship from using copper for the cooking of rice with ghee or
butter (Moore: Lancet, 1846). If only one portion of the contaminated
food has been taken recovery is usually rapid and complete, in proportion
to the amount of vomiting; but if more be taken and not rejected, there
remains a tendency to colic, vomiting, or diarrhoea, with much debility.
Should death follow, there will be found intense redness of the intestinal
tract or actual ulceration, according to the stage of the poisoning; perfo-
ration is rare (Taylor).

Chronic Copper-Poisoning "Cuprismus Chronicus" While by
some observers this condition has been described as marked and frequent,
by others its existence has been denied, and the symptoms explained by
adulteration with lead, etc. The truth lies between extreme views
some amount of copper-poisoning may be traced among workers with
the metal, but it is not very serious. Working in pure metallic copper
without heat causes no bad symptoms (Ilirt, Maisonneuve), but particles

COPPEK. 121

of oxide and cupric salts in the air of heated rooms may induce dyspnoea
and laryngeal spasm. " Gold-printers," working with brass-alloy in fine
powder, sometimes get vomiting, gastric pain, and anaemia; the hair be-
comes green-colored (Taylor). Dr. G. Harley has described a case of
.sudden colic with nausea, but neither diarrhoea nor constipation, in a
copper-plate printer after cleaning plates coated with verdigris: there
was a purple line on the gums (Lancet, 1863). Blandet was the first to
describe a more serious chronic cuprismus as existent in Paris workshops,
and marked, besides the green coloration, by colic with remissions, fever,
lassitude, nausea, bilious vomiting, and diarrhoea, alternating with con-
stipation ( Gazette Medicate, 1845). Sir D. Corrigan recorded seven in-
stances in brass-founders and engineers with similar symptoms, also
emaciation, cough, and night-sweats; but two of these had organic lung
disease, and the cases are not conclusive (Dublin Hospital Gazette, 1854).
A band of light or reddish-purple on the gum-margin is described as
characteristic, but really indicates an inflammatory condition which may
arise from other causes (Bucquoy: Union M'edicale, i., 1874). Bailly
describes the true copper bluish-green or blue line as on the teeth only,
not on the gum, which, however, was commonly inflamed: by analysis he
detected copper in the blue line. Perron reported the prevalence of dys-
pepsia, " enteritis," and phthisis, among Swiss watchmakers working
with an alloy of gold and copper; they had green coloration of the teeth,
but mal-hygiene was a more likely explanation of their impaired health
(Medical Times, 1861). Dr. Clapton brought before the Clinical Society
cases of irritative dyspepsia in a flower-girl and a copper-smith, but his
inquiries about copper-workers verified the absence of any special dis-
ease among them (" Transactions," vol. iii.). Chevallier, after an exhaust-
ive inquiry, concluded Blandet's statement to be exaggerated, and failed
to verify a true "copper colic " (Annales de Hygiene, 1859); any severe
cases were found complicated by the presence of lead in the material
used. Christison and Chomel reached the same conclusion. Hirt, while
allowing that verdigris-makers may suffer from intestinal catarrh, and
even from some amount of paralysis, blames rather lead, zinc, or arsenic
in observed cases of severe " colic." I have known brass-founders get
periodic attacks of colic and vomiting followed by rigors a condition
known in the workshops as " brass-founders' ague," and induced when
the alloy is malted, and they are much exposed to its vapor but have
connected it rather with zinc or arsenic than copper. Pecholier and Pie-
tra Santa, reporting on the health of verdigris-workers, describe local
irritation of mucous membranes, but otherwise good health: they note
especially the absence of colic and of chlorosis (Medical Times, 18G4); and
Maisonneuve concluded that though gastro-intestinal disorder may be
induced by such work, the symptoms are neither severe nor persistent
(Ranking, i., 1865).

122 MATERIA MEDICA AND THERAPEUTICS.

Pathological Changes. In animals that had taken copper for a long
time Mair observed softening and degeneration of the liver, and in one
case of poisoning by the sulphate Maschka attributed the jaundice to fatty
degeneration. The kidneys were similarly affected (Sydenham Society's
Year Book, 1873).

Nervo-Muscular System. If f gr. of oxide of copper be injected
under the skin of a rabbit, there will quickly follow unsteadiness in walk-
ing-, which will gradually pass into complete motor paralysis: the respira-
tions and pulse become feeble, and muscular irritability becomes less, till
finally death occurs from paralysis of respiratory muscles (Harnack :
Schmidt's Jahrb., 1874). Falck noted very similar effects, with fall of
temperature and progressive general paresis, ending in death from car-
diac palsy, after hypodermic injection of sulphate, nitrate, and chlorate
of copper (Deutsche Klinik, 1859) ; sensation was unimpaired, and the
paralysis was limited to striped muscular tissue.

It has been remarked that many emetic medicines, e.g., antimony and
apomorphia, produce also muscular paralysis, and there may be some di-
rect connection between it and severe vomiting: in Falck's experiments,
however (with hypodermic injections), vomiting was not produced. In
cases of acute copper-poisoning in men the nerve-symptoms are such as
headache, giddiness, prostration, restlessness, tremor, subsultus tendi-
num, convulsion alternating with stupor or comparative clearness of
mind, and sometimes a motor or sensory palsy, partial and temporary in
character: such symptoms are mainly secondary to the gastric irritation.

Respiratory and other Systems. There is not much to be safid about
the special action of copper on other parts of the body, but in the course
of acute poisoning, respiration becomes hurried and labored, the pulse
small and usually quickened, and the extremities cold; suppression of
urine has been recorded, but among workers in copper, absorbing slight
amounts daily, diuresis was a usual symptom (Clapton).

SYNEEGISTS. Salts of lead and zinc, silver and gold, are allied in ac-
tion to those of copper. Depressing vital conditions favor the develop-
ment of its irritant properties.

ANTAGONISTS INCOMPATIBLES. Metallic sulphides, alkalies, and alka-
line earths, iodides, and vegetable infusions containing tannin, are chemi-
cally incompatible with salts of copper: sugar also reduces them. In
cases of poisoning, the action of sugar is too slow to be effective, and
magnesia, though it may retard bad effects, does not wholly prevent them,
since the hydrated oxide of copper is soluble. Sulphide of iron decom-
poses copper salts, forming an insoluble cupric sulphide, and may be
used, but the best antidote is said to be ferrocyanide of potassium (yellow
prussiate of potash), which should be given freely: the resulting copper
salt is insoluble (Medical Times, ii., 1854). Albumen, which may be given
in the form of egg and milk, forms an albuminate of copper, but this is

COPPER. 123

not inert and should be removed afterward by the stomach-pump (Schros-
der). In phosphorus-poisoning, copper, though praised by Bamberger,
is not so good as turpentine (v. pp. 43-44).

THERAPEUTICAL ACTION" (EXTERNAL). Applied in lotion, ointment,
powder, or crystal, sulphate of copper, " blue-stone," or " blue-vitriol,"
acts as a stimulating astringent, or a moderately severe caustic. It unites
with albuminous secretions to form an insoluble albuminate of copper,
which, acting like a new cuticle, protects the injured part from the at-
mosphere, and promotes the healing process. Equal parts of sulphate of
copper, alum, and nitre, fused with four parts of camphor, form a caustic
of some celebrity known as " lapis divinus," or green-stone.

Tinea Tarsi Trachoma. In these chronic, recurrent disorders of
the eye-lashes and lids, the crusts and muco-purulent discharge, and in
severe cases the lashes, should be carefully removed, and a crystal of cop-
per sulphate lightly applied to the affected parts. This treatment has
the recommendation of Sir W. "Wilde (Dublin Quarterly Journal, No.
10), of Galezowski, and other authorities, and Mr. Williams (Boston) has
published good practical instructions concerning it (Ranking, ii., 1870).
I myself commonly prefer this remedy to either zinc or silver, since it is
milder, and causes less, pain; I generally combine with it the use of a
dilute mercurial ointment.

Aphthous Stomatitis. Sulphate of copper, either applied lightly in
substance, or brushed over the affected part in strong solution, removes
the white curdy deposit and induces healing of abrasions and ulcerations
about the gums: 10 gr. mixed with about 1 oz. of honey is a good form
for its use in children. Sir James Paget recommends a gargle contain-
ing 1 to 2 gr. of sulphate in 1 oz. of water, as useful in salivation, free
purging being secured at the same time (Medical Times, i., 1858). A
similar lotion will destroy diphtheritic membrane.

Indolent Ulcer Rectal Ulceration. The solid crystal of the sulphate
is a good stimulant to indolent ulcers, and a good caustic for exuberant
granulations. Dissolved and used as an injection it is of service in vari-
ous forms of ulceration affecting the rectum, especially, according to Mr.
C. Heath's experience, in the later syphilitic forms, when the dorsal sur-
face, or sometimes the whole circumference of the bowel within two
inches of the anus, is affected, and there is much muco-purulent discharge.
For such cases Mr. Heath recommends an injection containing about 10
gr. of sulphate to the pint, a fourth part to be used at one time, and re-
tained for ten minutes: this has an excellent astringent effect, and should
be combined with the use of mercurial ointments locally, and iodides in-
ternally (Z/ancet, i., 1873).

Cancer. The arsenite of copper is said to be a valuable application
for cancerous sores. Mr. Taylor (Liverpool) used it with an equal part
of mucilage, and found it a good escharotic, disinfectant, and at the same

124 MATERIA MEDIC A AND THERAPEUTICS.

time sedative dressing (Lancet, ii., 1864) ; it has not, however, been much
used.

Skin Diseases. In parasitic cases, such as ringworm and scabies, the
sulphate of copper has been applied with success: in the former Dr. Graves
recommended a wash containing 10 gr. in the ounce, a strength which
may, with advantage, be doubled: an ointment containing a similar pro-
portion mixed with lard has cured scabies (Lancet, i., 1846). In ichthyo-
sis, this ointment has also been recommended by Mr. E. Wilson, and the
solid crystal is often used for verruca (wart) and molluscura.

Gonorrhoea Leucorrhcea Gleet. In these disorders an injection
containing sulphate of copper, 1 to 2 gr. in the ounce, is often a useful
alternative to injections of zinc or lead, or it may be combined especially
with the acetate of lead. Dewees and also Diday have shown the value
of cupric injections in such cases (Archives Gen., xviii., p. 385), and Dr.
P. Foster has more recently illustrated the same (Medical Times, ii.,
1873). In balanitis a copper lotion is useful.

jBubo, etc. Good results have been obtained after surgical evacuation
of a suppurating bubo, from injecting a weak solution of copper sulphate
into the cavity. M. Danielli found this quickly diminish the secretion,
which after simple opening is very apt to re-form (Bulletin de Therapeu-
tique, 1868). M. Diday recommended a strength of 3 gr. to the ounce.
The solid sulphate is a good application to syphilitic cracks, patches, and
ulceration about the mouth and tongue.

Hydrocele. As an injection for hydrocele, 2 to 8 parts of sulphate in
200 to 250 of water have been used with success. Dr. Pereira (Oporto)
states that twenty-one out of twenty-five cases were cured with this treat-
ment (Medical Times, i., 1861).

Caries Fistulous Tracts. Strong stimulating and astringent lotions
are sometimes of service in these conditions, especially after the carious
bone has been removed or the fistula divided. The "liquor Villati " has
been much used abroad in such cases without previous operation. It is
made with \ oz. of sulphate of copper and of zinc, and 1 oz. of lead sub-
acetate, dissolved in 7 oz. of vinegar; M. Notta and M. Xelaton have
used this with advantage, but it is painful, and should not be injected
more than two or three times in a week ( Union Medicale, 1866).

THERAPEUTICAL ACTION (INTERNAL). In small doses the salts of cop-
per exert a tonic influence upon the nervous system, and an astringent
effect on mucous membranes, while doses of 1 gr. and upward are emetic.
The salts in question clearly resemble in action those of zinc, but are
somewhat more irritant.

Chorea. Although preparations of copper are not now much used in
this affection, I can refer to some very good results from the sulphate in
my own experience, and especially in cases connected with taenia and
other intestinal worms. I think it well worthy of use in cases where there

COPPER. 125

is even a suspicion of their existence; it will aid their expulsion if pres-
ent, and in any case act as a good nervine tonic. I have seen permanent
good results from ^ gr. given three times daily, though sometimes this
dose needs to be gradually increased.

Hysteria. In some cases of hysteria, with general debility, shyness,
muscular twitching, etc., marked benefit may be derived from the same
treatment.

Epilepsy. It is probable that of the older cases called epilepsy, and
reported as cured by copper, a large proportion were hysterical, but Voisin
reports from the practice of Herpiri (Geneva) several illustrations of its
power to cure chronic and obstinate cases of true epilepsy. He generally
used the ammonio-sulphate alone, or alternately with zinc, for many
months; the cure continued permanent some years afterward (Bulletin
de Thbrapeutique, i., 1870). Halford made great use of copper combined
with quinine in this malady (Medical Times, i., 1858), but general experi-
ence is not in its favor. Charcot has published a case carefully treated
for three months with full doses of the ammonio-sulphate, but the con-
vulsive attacks were rather increased during its use (British Medical
Journal, i., 1875). I have given the sulphate and the acetate in varying
doses and for long periods in many cases, but have not seen benefit from
them in true epilepsy, although for epileptiform attacks dependent upon
intestinal worms, they have several times proved useful.

Spasmodic Asthma. In cases where there occur well- marked parox-
ysms, terminating in the ejection of quantities of mucus, small doses of
sulphate of copper repeated frequently until vomiting occurs will usually
give relief; but independently of vomiting, in asthma of more purely
nervous type, I have observed benefit from - gr. and upward, given
every one to three hours during the attacks, and continued night and
morning in the intervals, so as to secure a tonic effect on the nervous
system.

Whooping- Cough, in the early spasmodic stage, is often relieved by
the same remedy, especially if moderate emesis be produced.

Emphysema Chronic Bronchitis. I have seen relief given to the
dyspnoea dependent on these conditions by small doses of sulphate of
copper continued for some time. I believe it acts partly through the
nervous system, and partly like other astringents, by lessening the amount
of secretion in the bronchi, and so permitting free access of air.

Tapeicorm. I have often known taenise dislodged and passed under
the use of small doses of the sulphate; about gr. in solution is a suitable
amount to commence with, and may be given every morning, fasting. If
this dose be steadily and gradually increased, upward of 3 to 5 gr. may
be administered without causing vomiting or purging; but should these
symptoms occur, the medicine is better omitted for the time, to be re-
sumed in smaller doses if required again. This treatment should be con-

126 MATERIA MEDICA AND THERAPEUTICS.

tinued for eight to ten days or longer, an occasional dose of castor-oil
being given when necessary.

Chronic Diarrhoea and Dysentery. Sulphate of copper is an excel-
lent remedy in these disorders, given in doses of \ to 1 gr., three or four
times daily. Elliotson highly recommended it in somewhat larger doses,
and generally combined with opium in a pill (" Medico-Chirurgical Trans-
actions," vol. xiii. ), but if opium be really required for pain, I find it bet-
ter given separately, especially in the form of Dover's powder, at bed-
time. Morehead also recommends this treatment (" Diseases of India," i.).
In infantile diarrhoea, objection has been taken to the use of copper, but
I have seen it act most beneficially in obstinate cajses, not only when
chronic, but also when acute in character, and especially when connected
with dentition the dose may vary from -fa to ^ gr. several times dailv.
Pereira specially recommends the remedy in ^V-gr. dose. Eisenmann has
also recorded its value in the diarrhoea of dentition, and of weaning, and
states that he has seen many cases treated by it and cured, when others,
not so treated, have become chronic and ended in marasmus (Bulletin,
June 30, 1859).

In the diarrhoea of phthisis, dependent, as it commonly is, on ulcera-
tion of the intestine, we often require to use different forms of astringents,
and the sulphate of copper is a valuable alternative. Small doses only
should be used, in order to avoid nausea and irritation ^ gr. with the
same quantity of opium is advised by Sir T. Watson (" Lectures," ii., p.
216).

In Enteric Fever with severe diarrhoea, a similar combination is highly
praised by Dr. John Harley ("Reynolds' System/' i., p. 419), who " con-
siders it more efficacious than any other medicine." The dose may be
increased up to 1 gr., but must be kept small enough to avoid vomiting;
quite small doses rather allay gastric irritability.

Cholera.- In this malady, the sulphate has been considered by some
physicians so. valuable as to be almost a specific. I cannot place gre*at
reliance upon it, though I have sometimes observed it relieve the cramps,
the retching and purging, and strengthen the weak intermittent pulse,
and assist in warding off collapse. The careful observations of Gutmann
have rendered improbable any specific action of the drug.

Some prophylactic power against cholera has been claimed for copper,
for the neighborhood of towns where large copper-works are situated,
such as Swansea, Birmingham, Rio Tinto, has been markedly free from
the disease, but other circumstances, and other components of the vapor,
such as sulphurous acid, must be taken into consideration (Medical Times,
ii., 1854, ii., 1871). A similar immunity is recorded at the large powder
factory at Madras, where the mixed chemicals are said to be exposed to a
temperature of 500 F., which would be sufficient to develop sulphurous
acid from the sulphur (Mr. Parker: Lancet, ii., 1873). More important is

COPPER. 127

the fact, that among more than 5,000 copper-workers in Paris, not one
was attacked by cholera, during an epidemic which affected other work-
men in the proportion of about 1 in every 140; and of the former, not
one died of cholera in the course of five epidemics (Burq: .Lancet, ii.,
1873). Dr. Clapton also remarked that the copper-workers seemed to
have almost complete immunity from cholera and from choleraic diarrhrea,
when it was very prevalent among the neighbors, and the same observa-
tion has been made by others. Still, such prophylactic virtue of copper
is not usually recognized, perhaps because it is difficult to understand, but
Dr. Clapton suggests as some explanation, the disinfectant power of the
metal, and its destructive action upon fungi; the subject deserves further
investigation.

Croup (Laryngo-Tracheal Diphtheria]. In this malady the sulphate
of copper has been highly esteemed, especially by German and French
physicians, since its first introduction by Hoffmann; he used it mainly as
an emetic, but the question has arisen whether it does not exert a specific
action upon the false membrane. Kissel, who reports successful cases
from the use of non-emetic doses of the acetate, supports this view
(Journal fur Pharmaco-dynamik,), and Missoux, who also speaks highly
of the remedy, but who gave 5-gr. doses, argues in favor of specific action,
because the false membrane, after becoming detached, either does not
form again, or if it does so is no longer so plastic, tough, and adherent
(Bulletin de Therapeutique, December, 1858, abstract in Medico- Chirur-
gical Iteview, ii., 1859). In judging of the curative results, we must bear
in mind the distinction between simple catarrhal laryngitis and the mem-
branous form (true croup), since the former is more likely than the latter
to have a favorable issue independently of treatment, but allowing for
this, there can be no doubt that most of the cases of Godfrey arid of
Beringuier were of the more serious malady; these observers used emetic
doses (2 to 4 gr.) and also depletion. Trousseau used it mainly as an
emetic, in doses of 5 gr., twice repeated (Gazette des Hopitaux, No. 39).
I do not ignore the six fatal cases, recorded by Dr. Hannay (London
Medical Gazette, July, 1840), nor the adverse opinion of Nothnagel, who
fears its injurious effects on the intestinal tract, but still I consider the
remedy of value. Dr. Crighton states (Edinburgh Medical Journal^
May, 1868) that out of fifty cases of croup treated by him with the sul-
phate, only six died; he gave gr. every ten to fifteen minutes till vomit-
ing or marked relief occurred; but even these doses are rather large for
children, and, in fact, he records that two of them had violent diarrhoea.
I recommend doses of ^ to gr. for children, to be given every quarter to
half hour until vomiting is induced; then the dose should be diminished
and given at longer intervals so as to avoid too severe effects, and later it
may be increased again should it become necessary to produce emesis.
This plan may be adopted in true croup during the stage of development

128 MATERIA MEDICA AND THERAPEUTICS.

of the membrane when there is a dry barking cough, and sense of con-
striction across the chest, with much difficulty of respiration: and it is
also serviceable in cases where a loose catarrhal cough assumes a dry
croupy character, when there is partial aphonia, and often some sanguin-
eous discharge from the throat and nostril.

The following notes of an illustrative case have been furnished to me
by Dr. Mackey: E. S., a girl, aged three, was hoarse on April 7th; on
the 9th became feverish and restless, with hurried, loud, and stridulo'us
respiration, and clutching at the throat; there was no exudation on ton-
sils: has had castor-oil, poultices, and steaming, now ordered 6 min. of
ipecacuanha and 6 of antimonial wine every hour: vomited after the
third dose, but the oppression continuing, a teaspoonful of the ipecacu-
anha wine was given and caused freer vomiting.

On the 10th there was, however, no relief, the stridulous croupy
breathing being more marked, the face flushed, not very dusky; pulse
120, respiration 36; drowsy, yet restless. (10 A.M.): to omit other treat-
ment and. take % gr. of copper sulphate every half-hour in water. (1.30
P.M.): has had four doses; vomited freely after the first two, and slept
comfortably; is better, pulse 110, respiration 32. (6 P.M.): one dose
since; vomited and moderately purged; pulse 110, respiration 28, tem-
perature 100; speaks better, and smiles, (llth, 9 A.M.): has slept fairly
well, lying down; had two doses, and vomited after each; looks much
better; respiration 32, temperature 98; bowels moved once. 12th: Con-
valescent, though still some stridor when asleep; an occasional dose of
the copper relieves sensibly. The child got quite well.

Diphtheria. In the ordinary form of diphtheria the sulphate of cop-
per has also been found useful by some observers. Dr. W. Squire speaks
of it as one of the most effectual emetics, and recommends a solution of
5 gr. to the ounce to be given in divided doses a teaspoonful only to
young children, so as to induce moderate vomiting (" Reynolds' System,"
i., p. 147, second edition). In cases of formation of diphtheritic mem-
brane on the cutaneous, or nasal, or vulvar surface, lotions of the sul-
phate are found to destroy it, and to prevent its re-formation.

Intermittent fever. In obstinate quartans, more particularly, the
salt has been commended by Hoffmann, Chapman, and others, in -gr.
doses, combined with opium, but it has not come into general use.

Phosphorus- Poisoning. Bamberger, Eulenburg, and others have
recommended the sulphate as an antidote in this form of poisoning,
which is not uncommon in Germany; the salt certainly is reduced by
phosphorus, and it is supposed that the latter may be coated with the
metal, and thus rendered inert (v. vol. i., p. 43): an emetic effect also is
serviceable, as it is also in narcotic and other cases of poisoning (Noth-
nagel, p. 333).

Syphilis. Aime Martin and Oberlin have recently published the re-

IRON. 129

suits of fifty cases of secondary and tertiary syphilitic affections treated
with sulphate of copper; in many of these it is said to have acted more
promptly than mercury; only in one patient vomiting took place on the
first day, but very soon the metal was borne well; a green margin of the
gums without an inflamed state of the mucous membrane was observed
in a few cases, but disappeared soon; the remedy was given in solution,
and 4 to 8 or 12 milligr. were used daily. To a full bath 20 grammes
were added (Gazette Medicale de Paris, November 15, 1880). Zeissl
has tried copper in syphilis, but his results were only partly satisfactory
( Wien. Med. Presse, November 29, 1880).

PREPARATIONS AND DOSE. Cupri sulphas : as a tonic and astringent,
gr. to 1 or 2 gr. ; as emetic, 5 to 8 gr. (for adults) best administered
in divided doses at short intervals; a child may have -^-to gr., according
to age and strength, repeated every five to fifteen minutes till vomiting
occur ; it should then be omitted for a time, or purging may succeed.
The oxide of copper has been used in doses of to 1 or 2 gr., and the
double chloride with ammonium in or -gr. doses, every two or three
hours. A tinctura cupri acetici has obtained some favor on the Continent
under the auspices of Rademacher. It is prepared by mixing 24 parts of
copper with 30 parts of acetate of lead in 136 parts of distilled water:
boiling this in copper vessels, then adding 104 parts of spirit, and macer-
ating for four weeks in a closed glass vessel, then filtering. It forms a
green liquid of metallic taste, and is the chief remedy for all " copper
diseases," and " especially for hypersemite, stases, and exudations " 5 to
15 drops and upward are given thrice daily (Kissel, Husemann). As a
lotion, 1 to 2 gr. of sulphate in the ounce, as a parasiticide, 10 to 20 gr.
to the ounce may be used, and a stimulating astringent ointment may be
made with ung. sambuci in the same proportion.

[PREPARATIONS, U. S. P. Cuprum ammoniatum, Cupri subacetas,
and Cupri sulphas,~\

FERBUM IRON, Fe, = 56.

Iron, the most abundant and the most useful of metals, occurs exten-
sively in the mineral kingdom, its principal ores being either oxides, as the
magnetic iron ore, or carbonates, as clay iron-stone. It occurs also in many
mineral, so-called chalybeate waters, generally as carbonate with excess of
carbonic acid, sometimes as ferrous chloride or sulphate. In the animal
kingdom it is an essential constituent of blood, being contained, though
only in minute quantity, in the haemoglobin of the red corpuscles. It
occurs largely also in the vegetable kingdom, and may be traced in the
VOL. II. 9

130 JIATERIA MEDICA AND THERAPEUTICS.

ashes of almost all plants. Sometimes the pure metal is found native,
and is then commonly supposed to be of meteoric origin.

CHARACTERS AND TESTS. Iron is hard, malleable, ductile, and of great
tenacity; sp. gr. 7.7. Exposed to moist air, it becomes covered with a
reddish layer rust which is mainly hydrated sesquioxide. It forms two
distinct classes of compounds known as proto- or ferrous salts, and per- or
ferric salts; in the former, it combines with not more than two atoms
of a monad, as Cl or I; in the latter, it requires three, or, as most con-
sider, six atoms of a monad for saturation (" Smith's Commentary "). The
ferrous or proto-salts are commonly lighter in color, less astringent, and
less soluble in alcohol; they have a marked tendency to absorb oxygen,
and to become ferric compounds, hence most of the officinal ferrous salts
are in a partially oxidized state, but to some, sugar is added to prevent
such change as in syrupus ferri iodidi, and ferri carbonas saccharata.
Ferric or per-salts are generally brownish-yellow, astringent, and soluble in
alcohol, and are not prone to change: within the body, however, they are
probably reduced to proto-salts.

The general tests for iron are (1) the color test, with tannic or gallic
acid; (2) the precipitate and blue color produced by ferro-cyanide; and
(3) by ferrid-cyanide of potash. (1) Tannins change the per-salts of iron
bluish-black, and act similarly, though more slowly, with proto-salts. (2)
The yellow prussiate of potash (ferro-cyanide) gives a deep blue precipi-
tate with per-salts of iron, and a whitish or light blue one with proto-salts.
(3) The red prussiate (ferrid-cyanide) gives no precipitate with the per-
salts, but the liquid becomes of a dark color: a deep blue precipitate with
proto-salts (Turnbull's blue).

Sulphuretted hydrogen and ammonium sulphide are also used as tests
for iron salts; thus, in acid solutions of pure ferrous salts, the former
gives no precipitate, while with ferric salts it throws down a nearly white
precipitate of sulphur, with reduction to the ferrous state: Fe 2 Cl 6 + H 2 S
2FeCl a + 2HCl + S. The same tests will also precipitate any copper
contained in acid solutions of iron salts.

By acids iron is readily dissolved, with formation of metallic salts and
evolution of hydrogen.

COMPOUNDS OF IRON.

The large number of officinal iron compounds may be with advantage
considered in the following order: The preparations of the metal itself
and its oxides; the astringent preparations; and those which are not at
all, or not markedly, astringent.

IRON. 131

FERRUM RED ACTUM REDUCED IRON l QUEVENNS?S IRON.

Jtfetallic iron is introduced in the form of soft or wrought iron wire,
or nails free from rust, and also combined with some oxide, as ferrum re-
dactum.

PREPARATION. By passing a stream of hydrogen at red heat over
the hydrated peroxide Fe J O 3 H a O+H (i =4H. 1 O+Fe !1 . At the same time,
by incomplete reduction, some magnetic oxide is formed 3Fe a O 3

CHARACTERS. Pure reduced iron is an impalpable grayish-black pow-
der, strongly magnetic, and showing metallic streaks on firm pressure.
The oxide can be separated from the metal, and its amount ascertained
by digestion with iodine and iodide of potassium, which dissolves the
metal alone; of this, it should contain at least 50 per cent.; a little sul-
phide is sometimes present, and is liable to cause disagreeable eructation.

FERRI OXIDUM MAGNETICUM MAGNETIC OXIDE OF IRON,

Fe 3 O 4 ,=232.

Black oxide containing about 20 per cent, of water.

PREPARATION. This being a mixture of proto- and peroxide, is pre-
pared by adding a mixed solution of proto- and persulphate of iron to an
excess of soda; the precipitate is washed and dried at a moderate tem-
perature (120), for at a greater heat it would absorb oxygen.

CHARACTERS AND TESTS. A brownish-black powder, tasteless,
strongly magnetic, and soluble in acids without effervescence: bubbles
of hydrogen would show the presence of metallic iron.

FERRI PEROXIDUM HUMIDUM MOIST PEROXIDE OF IRON,

Fe a 6HO,=214.

PREPARATION. By pouring solution of persulphate of iron into ex-
cess of soda, and washing away the sodium sulphate: a similar precipi-
tate would be thrown down by potash or ammonia.

CHARACTERS. A pasty mass, reddish-brown in color, and containing
water, both combined and uncombined, to the amount of nearly 90 per
cent.: it is the only iron preparation used in the moist state: it dissolves
readily in cold dilute hydrochloric acid.

1 "Reduced" iron means the metal minutely divided by chemical process as dis-
tinguished from simple filings or powder (mechanical division) ; the percentage of
metal in this form is often small (Pharmaceutical Journal, August, 1875).

132 MATERIA MEDIC A AND THERAPEUTICS.

FEBRI PEROXIDUM HYDRATUMHYDRATED PEROXIDE OF IRON,

Fe 2 O 3 H 2 O,=178.

PREPARATION. By drying the moist peroxide last described at a
temperature of 212, and reducing to powder.

CHARACTERS. A tasteless powder, distinguished from the magnetic
oxide by its dark-brown color, and its being non-magnetic.

(The astringent preparations of iron are mainly those which are formed
by direct solution of the metal in the strong mineral acids, and include
the chloride, nitrate, and sulphate.)

LIQUOR FERR1 PERCHLOR1D1 FORTIORSTRONGER SOLUTION OF
PERGHLORIDE OF IRON, (Fe 2 Cl 6 ,)=325.

PREPARATION. By dissolving iron wire in an excess of hydrochloric
acid (by which a ferrous chloride is obtained), and treating this with ni-
tric acid to peroxidation thus

Fe+2HCl=FeCl 2 +H 2 .

+ 6HCl=3Fe a Cl 6 +2NO+4H a O.

Sufficient distilled water is added to give a sp. gr. of 1.44. The per-salt
could not be fermed by the first-mentioned acid alone, because the nas-
cent hydrogen which is set free, reduces ferric salts to the ferrous state.

CHARACTERS. The liquid is at first black from the combination of
some nitric oxide (NO) with ferrous salt, but on heating the mixture the
gas is expelled, and an orange-brown solution remains: it generally con-
tains some free acid, and has a very strong styptic taste.

Liquor et Tinctiira Ferri Perchloridi (y. p. 180).

LIQUOR FERRI PERN1TRATIS SOLUTION OF PERNITRATE OF
IRON, Fe 2 6N0 3 ,=484.

PREPARATION, etc. By dissolving iron wire in nitric acid, and dilut-
ing to the proper strength, and a sp. gr. of 1.107. It is a clear solution
of reddish-brown color, acid and astringent.

LIQUOR FERRI PERSULPHATIS SOLUTION OF PERSULPHATE OF

IRON, Fe 2 3S0 4> 400.

PREPARATION, etc. By boiling a solution of the proto-sulphate with
some additional sulphuric and some nitric acid. A dense solution of
reddish-brown color; very astringent.

IRCWT. 133

FERR1 SULPHAS SULPHATE OF IRON, FeSO 4 7H 2 O.

The proto-sulphate of iron is the salt from which the greater number
of the other, compounds are prepared. Three forms of it are officinal
ferri sulphas (green vitriol), ferri sulphas exsiccata, and ferri sulphas
granulata.

PREPARATION. By dissolving iron wire in dilute sulphuric acid, and
crystallizing.

CHARACTERS. The sulphate occurs in oblique rhombic prisms, of
greenish-blue color and very styptic taste, soluble in water, insoluble in
spirit. Exposed to air, it absorbs oxygen and turns brown from forma-
tion of ferric sulphate: if the crystals be rich green in color, some ferric
oxide is present, but if nearly free from any ferric salt, the precipitate
with yellow prussiate of potash will be nearly white. The crystals efflo-
resce slightly in dry air; at 238 F. they lose most of their water of crys-
tallization, and at 400 only one atom of water is retained, and the salt
becomes a yellowish-gray powder.

Ferri Stdphas Exsiccata Dried Sulphate of Iron (FeSO 4 H 2 O).
This does not alter on exposure, and is not gritty: 3 gr. are equal to 5
gr. of the crystallized salt.

FERRI SULPHAS GRANULATA GRANULATED SULPHATE OF IRON.

PREPARATIONS By filtering a boiling solution of ordinary sulphate
into cold rectified spirit, constantly stirring.

CHARACTERS. Occurs in small green granules which are stable, and
if carefully dried retain their properties many years.

TINCTURA FERRI ACETATIS TINCTURE OF ACETATE OF IRON.

PREPARATION. By adding an alcoholic solution of acetate of potash
to one of persulphate of iron, agitating for an hour, and filtering from
the precipitate of sulphate of potash, which is insoluble in spirit.

CHARACTERS. A deep-red liquid which is apt to decompose and be-
come muddy; its taste is not unpleasant, and its degree of astringency
moderate.

FERRI CARBONA8 SACCHARATASACCHARATED CARBONATE OF

IRON, FeCO 3 ,=116.

PREPARATION. By adding carbonate of ammonium to ferrous sulphate,
each salt being dissolved in boiling water, so as to avoid the presence of
air; the precipitate is collected, washed, and rubbed with sugar.

CHARACTERS. The precipitate is at first white, then green and finally

134 MATERIA MEDIC A AND THERAPEUTICS.

becomes red from absorption of oxygen and formation of ferric oxide.
There is no ferric carbonate, but what is often sold as carbonate is a brown
ferric oxyhydrate containing only a trace of the desired salt, which is
very unstable and prone to oxidation; to preserve it from this as far as
possible, it is rubbed up with sugar.

FERRI 10DID UM- IODIDE OF IRON, Fel a ,=310.

PREPARATION. By heating together iron wire with twice its weight
of iodine, and eight times its weight of water, until the solution becomes
colorless; it is then filtered and evaporated to solidity.

CHARACTERS. A crystalline, green substance with a tinge of brown,
containing about 18 per cent, water of crystallization and a little oxide of
iron, without odor, deliquescent, soluble in equal parts of water, forming
a greenish solution which very readily absorbs oxygen, and changes into
free iodine and ferric peroxide. It is decomposed also by heat, emitting
colored vapors of iodine; the altered solution may, however, be restored
by warming with more iodine and iron, and may be preserved in strength
by keeping a piece of iron in it; so that as iodine is liberated, it can re-
combine to iodide. Syrup will preserve to a great extent, and it is in the
form of syrup that it is most frequently ordered (v. p. 179); it is incom-
patible with alkalies and their carbonates.

A Bromide of Iron is prepared similarly by direct combination, and
is sometimes prescribed, but is not yet officinal.

FERRI ARSENIAS ARSENIATE OF IRON, Fe 3 A S2 O 8 , =446.

PREPARATION. From a solution of sulphate by the addition of a mixed
solution of arseniate, and of acetate of soda: the precipitate is filtered
and dried at a low temperature to avoid oxidation. In this process,
arseniate of iron, sulphate of soda, and free acetic acid are formed;
without the acetate of soda, free sulphuric acid would be present, and
this would dissolve the iron salt: the decomposition is complex.

CHARACTERS. Arseniate of iron is an amorphous powder, white when
first formed, but becoming gray or greenish-blue from absorption of oxy-
gen: insoluble in water; soluble in hydrochloric acid. Thrown on live
coals it evolves the garlic odor of arsenic, and is essentially an arsenical
remedy, for the quantity of iron in any admissible dose is insignificant.

FERRI PHOSPHAS PHOSPHATE OF IRON, Fe 3 P a O 8 , =358.

PREPARATION. By a process analogous to that for the arseniate; sul-
phate of iron is precipitated by phosphate of soda, some acetate of soda
being also added to neutralize any free sulphuric acid that would be

IKON. 135

liberated from the iron salt. The precipitate is dried at low temperature
to prevent oxidation.

CHARACTERS. A slate-blue amorphous powder, almost tasteless, in-
soluble in water, soluble in acids.

Syrupus Ferri Phosphatis (v. p. 180 ).

Another group of iron compounds may be made of the scaly prepara-
tions, which are compounds of the metal and often of some other drug in
addition, with a vegetable acid, such as tartaric or citric acid.

FERRUM TARTARATITMTARTARATED IRON.

PREPARATION. Freshly precipitated peroxide of iron is dissolved in
solution of acid tartarate of potash and allowed to stand for twenty-four
hours, concentrated at a moderate temperature, and poured, when of
syrupy consistence, on flat plates to solidify.

CHARACTERS. Occurs in dark garnet-colored scales; soluble in water,
sparingly so in spirit. If boiled with potash or soda it deposits peroxide
of iron, but is distinguished from the ammonio-citrate by not evolving
ammonia under the same conditions, and also by leaving an alkaline ash.

FERRI ET AMMONIA CITRAS CITRATE OF IRON AND AMMONIA.

PREPARATION. By dissolving freshly precipitated peroxide of iron
.in citric acid with heat, adding ammonia to neutralization, evaporating
to consistence of syrup, and then drying in thin layers on plates.

CHARACTERS. Occurs in transparent ruby-red scales, of sweet astrin-
gent taste and slightly acid reaction, soluble in water, almost insoluble in
spirit. If boiled with soda or potash, it evolves ammonia, but alkaline
carbonates do not readily decompose it, and it may, therefore, be given
with them in effervescence with citric acid: the iron salt should be put
into the acid solution.

FERRI ET qUINI^l CITRAS CITRATE OF IRON AND QUININE.

PREPARATION. By dissolving freshly precipitated peroxide of iron
and quinine in solution of citric acid, adding ammonia and evaporating
to dryness at moderate temperature. The product is a triple citrate of
iron, quinine, and ammonium, and contains both a ferrous and a ferric
compound.

CHARACTERS AND TESTS. Occurs in greenish-yellow scales which be-
come darker by age; they are at first deliquescent and very soluble in
cold water, but become less so on exposure to light; it has a chalybeate,
and at the same time a bitter taste. It should contain 20 per cent, of
Fe 2 O s , and 16 per cent, of quinia, but the proportion of the latter varies,

136 MATEKIA MEDIC A AND THERAPEUTICS.

falling sometimes to 4 per cent. The solution is slightly acid: soda pre-
cipitates the reddish-brown peroxide Fe 3 O 3 , and ammonia a white deposit
of quinia.

The citrate of quinine with iron and zinc, and with iron and strychnia,
and many other double compounds, have also been prepared in granular
effervescent form.

ABSOBPTION AND ELIMINATION. If, in former times, the absorption
of any medicine was commonly denied, with us the absorption of all is
now commonly accepted as a necessary condition of their acting on the
system, and yet the absorption of medicinal doses of iron has been doubted
by some eminent men, and mainly because chemists, after giving the
drug to animals, have often failed to detect an increased quantity of it
in the vena portae, and have sometimes failed to find any in the urine.

On appeal to the clinical evidence of improved color and tone after
the use of iron, the objectors attribute such results to a local tonic action
upon the gastric mucous membrane leading to improved digestion; but
besides that iron salts have often rather a contrary effect, it would not,
in any case, account for all that we see, nor for the chemical changes
produced in the blood. It seems more reasonable to allow that the medi-
cine, which we can prove to be, to some extent, soluble in the gastric
fluids, should be really absorbed, at least to the extent of its solubility.
From most articles of diet certainly traces of iron are absorbed, as we
know from detecting the metal in the blood and tissues: if there be some
failure in the supply, or in its assimilation, then color and strength fail,
(just as when iron is removed from a soil, white vegetables and chlorotic
oats spring up from it), and conversely health and color usually return
when suitable ferric preparations are added to the nutriment or to the
soil. Definite facts in proof of absorption are such as the following:
Tiedemann and Gmelin administered to a horse about 6 dr. of sulphate
of iron, and found an increased amount of the metal in blood from the
splenic and hepatic veins, and in some experiments, in the lymph also.
Manghini recorded a distinct increase in the amount of iron in the blood of
dogs when he added the metal to their food (Bayle: " Biblio. de Therap.,"
v., iv.). Wohler, though he failed to detect iron in the urine after giving
various preparations of it to animals, yet succeeded in detecting it by
means of tincture of galls in the urine of patients taking chalybeate wa-
ters; he also noted its occasional presence in calculi and in urinary sedi-
ments (Treviranus : Zeitschrift, vol. i., 1824, p. 302). Quevenne, in
his careful and admirable memoir, says that only a minute quantity can
be detected in normal urine, but that after medicinal doses the amount
is increased slightly: in the bile and faeces the increase is greater (Bou-
chardat: Archives de Physiol., etc., No. 2, October, 1854). Schroff found
that when small doses were given to animals, elimination by the kidneys
was evident, and began sooner, and continued longer, than after larger

137

doses; he recorded also the curious fact (and Becquerel corroborated
him), that even during the use of equal and continued doses, the amount
passed in the urine was subject to much fluctuation, implying- that that
secretion was not the best gauge of absorption. Bence Jones speaks of
detecting iron in the urine within ten minutes of the administration of a
soluble salt, also of the rapid diffusion of another portion of it into the
textures and corpuscles (Lectures, Medical Times, ii., 18GO, p. 245), and
Delioux de Savignac affirms that it may be readily and frequently found
in all the secretions ( Gazette Med. de Paris, April 25, 1874). Bistrow
verified the presence of nearly double the ordinary amount of iron in the
milk of a goat after the administration of 15 to 40 gr. of lactate of iron;
elimination of increased amount began in the milk forty-eight hours after
giving the dose, implying a slow absorption or long detention in the tis-
sues (Husemann). In Dr. Marcet's classical case of a man who had swal-
lowed several knives, particles found in the bile were attracted by the
magnet, and that liquid contained more than double the normal amount
of iron (" Philos. Trans.," xii.).

More modern observations are those of Rabuteau, who passed through
a tube varying amounts of protochloride of iron into the stomach of dogs,
which were killed a few hours afterward; the stomach was found to con-
tain only a small amount of the compound, the intestine somewhat more,
but the greater part had passed into the blood, which was found on anal-
ysis to contain, in these cases, distinctly more iron than under ordinary
conditions (Journal de Therapeutique, 1875).' In another series of ex-
periments he injected the same salt directly into a vein; it did not cause
coagulation on the contrary, it increased the fluidity of the blood, and
yet no increased amount of iron was found in the urine. The greater
part of what was injected passed away by the intestine, proving again
that failure to find the metal in the urine is no proof of its non-absorption
into the blood; similarly, the protoxide was injected in large doses by
Papi, and was found unchanged in bile and faeces, but not at all in urine
(Husemann).

I cannot doubt that a true absorption of iron compounds occurs from
the gastro-intestinal mucous membrane, though it may be often partial
and incomplete, and is certainly rather slow and limited: it varies accord-
ing to the preparation used, the reaction of gastric juices, and the state
of the stomach as to food, etc. Woronichin showed that while chloride
of sodium promoted the assimilation of iron, chloride of potassium much
increased its elimination ( Wiener Med. Wbch., ii., 1868), and Brucke de-
monstrated in rabbits, that after a certain period the system, or more ac-
curately the corpuscles, became so charged with the substance that it was
no longer retained in the tissues, but passed almost wholly in the urine
(Husemann).

With reference to the absorption of iron from the cellular tissue, C.

138 MATERIA MEDICA AND THERAPEUTICS.

Bernard performed a well-known experiment, injecting ferro-cyanide of
potassium into the thigh of an animal, and solution of lactate of iron into
its neck; the spot in the thigh remained unchanged in color, but the neck
quickly showed blue, 'imply ing that the cyanide had been taken into the
circulation, and so reached the iron, but the lactate of iron had not trav-
elled to the cyanide. Soluble salts, however, are certainly absorbed from
wounds, and from the bared skin (Husemann), and recently, good effects
have been obtained from hypodermic injection of a double salt (pyrophos-
phate and citrate) " in pernicious anaemia," after failure of ordinary
means (Huguenin: Schmidt's Jahrb., Bd. clxxiii., 1877). The observa-
tions of Hamburger as to the absorptive powers of the vagina (tampons
soaked in iron solution being introduced into it) were vitiated by his con-
fining analyses to the urine elimination by that secretion being, as we
have seen, very uncertain and he could come to no definite conclusion
(Prager Vierteljahrschrift, 1876, p. 145).

If doubts have been expressed as to the fact of iron absorption, there
has been still more controversy as to the mode in which it is effected,
and this, indeed, may differ according to the preparation employed.
The finely divided metal, " reduced iron," is first oxidized by the help of
water (for if the compound contain any sulphur, disengaged hydrogen
makes itself evident as a sulphuret in eructations). The protoxide and
the carbonate, themselves not soluble enough for absorption, are ren-
dered so by the hydrochloric acid of the gastric juice (as evidenced by
experiments with the gastric juice of dogs) ; the protochloride does not
coagulate albumen, and is readily absorbed. The sesquioxide becomes
first perchloride and then protochloride, and is absorbed as such (Rabu-
teau).

It was formerly held that all proto-salts became quickly changed in
the system into per-salts, because this change so readily occurs outside
the body, but various conditions will prevent or even invert it. Thus,
Quevenne notes that a natural protocarbonate remains as such in many
mineral waters that per-salts are reduced by alkaline tartrates, by
charcoal, or simply by cold and that the ethereal " tincture of steel " is
rendered colorless and reduced to protochloride by mere exposure to
the air and light. Stenhouse found the per-salts to be reduced by or-
ganic substances generally, and 0. Bernard, after injecting a per-salt
into the jugular vein, recovered only a proto-salt from the urine. In
short, it is probable that if iron exists at all in the system as a per-salt it
is only for a time, and under the temporary influence of an increased
amount of oxygen; its rapid change from one condition of oxidation to
another is possibly in accord with a general law of the organism (Que-
venne).

Salts of the organic acids, the citrates, lactates, and tartrates, may be
absorbed directly into the blood, the acid becoming quickly oxidized or

IRON. 139

" burnt off," and the metallic base left free to combine with the blood
constituents. Rabuteau suggests that a carbonate of iron may be
formed, as are carbonates of the alkalies after administration of alkaline
citrates, etc.

The potassio-tartrate or tartarized iron has seemed to be more readily
assimilated than any other preparation (Leras, Mialhe). The iodide of
iron exhibits the properties of iodine rather than of the metal, and has
proved more irritating than simple iron compounds. The whole of the
iodine has been found eliminated in the urine after a few days, while but
little of the iron has passed out (Quevenne, Melsens), proving that com-
plete separation of the constituents occurs in the system.

Salts of the mineral acids the chloride, nitrate, and sulphate if
given so diluted as not seriously to constringe the gastric membrane,
nor to coagulate albumen, may be absorbed directly into the blood, and
much more quickly than the metallic preparations. (Mialhe suggests that
the blood-alkalies combine with, or neutralize, the acids so as to leave
the metal free for oxidation or combination.) Stronger solutions must,
for their first effect, coagulate the albuminous material they meet with
in the stomach. Mitscherlich found a " proto-albuminate " of iron in the
stomach of rabbits; but, within certain limits, this compound is soluble
both in excess of the iron solution, and in fresh quantities of albumen.
Gubler, indeed, recommends it as a good form for administration, being
both active and non-irritant. It has been generally held that this com-
pound of iron was absorbed and circulated as a per-albuminate, but, accord-
ing to Dietl, proto-albuminates are much more soluble than the per-salts
(Schmidt's Jahrb., 1874); the same has been said of proto-chlorides, but
practically both forms are available. The precipitates formed by per-salts
with albumen are soluble under various conditions; using 1^ part of ferric
chloride to an albuminous solution, H. Rose found the precipitate dissolve
in an excess of the salt, and when quite fresh, even the " blood-alkalies "
dissolved it. When albumen came into contact with weak iron prepara-
tions a few drops of weak acid, or sometimes of alkali, were enough to
help solution in the gastric juice (Dietl). As qualifying the observation
of Lersch that albumen could supply the place of acids as a solvent for
iron in the gastric juice, Dietl found that iron albuminate was soluble in
soda solutions, that iron phospho-albuminate was soluble in contact with
phosphate of soda, and that alkaline phosphates generally favored the
absorption of iron salts after they had become albuminates (Schmidt, loc.
cit.).

It is probable that iron is not only absorbed as an albuminate, but
eliminated mainly by membranes having albuminous secretions, such as
mucous and serous membranes. Dr. Ringer refers to experiments in
which, after being injected into the blood, most of the iron was detected
on the mucous lining of the intestine, the bronchi, the gall and urinary

140 MATERIA MEDIC A AND THERAPEUTICS.

bladder, and the serous membrane of pericardium, etc. Gubler relies on
such facts to explain the astringent action of iron on various parts distant
from the stomach, reasoning that the metal becomes separated by such
secreting surfaces from the albumen with which it has been combined,
and then recovers and exerts its natural astringency (cf. vol. i., p. 228).

To resume: of the three groups of preparations the first comprising
the reduced metal and carbonate; the second, astringent acid soluble
compounds; and the third, soluble non-astringent ones all are suscepti-
ble of absorption under favorable conditions, the first comparatively
slowly, the second (when diluted) quickly, and the third group to a
medium extent. This fact becomes of importance in guiding our choice
of a preparation in different maladies. Of either group a certain pro-
portion, according to the dose, the condition of the stomach, etc., may
remain unacted upon, and consequently unabsorbed, and pass into the
intestine mechanically mingled with the food; at this stage some further
proportion is absorbed under the influence of fats (Mialhe), or of alkaline
secretions, or of bile. It has long been recognized that the bile contains
a relatively large proportion of iron, and Lusanna argued that the greater
part, if not all, of the administered metal passed only into the portal cir-
culation from the mesenteric vein, and was eliminated by the bile. More
recently the fact has been used as an argument to show that the effete
blood-corpuscles are broken up in the liver, and furnish to the bile its
large proportion; thus, Dr. Young, after many analyses, fixing .0065 as
the amount of iron contained in the 100 grammes of human bile, calculated
it to represent 6.63 grammes of corpuscles (Journal of Anatomy and Phy-
siology, 1871). However it be, iron is largely eliminated in that secretion,
but any amount that passes through the intestine is liable to be changed
into tannate or sulphide, and so to color blackish the fecal mass; if this
be of ordinary consistence, its external surface, which is alkaline, will be
found more deeply stained than the inner part, which is slightly acid
(Quevenne). In suckling children, the coloration will not occur, and if
the salt be very completely absorbed, as are small doses of proto-chloride
(Rabuteau), or of tartrate (Stille), it will not be noticed for some days, or
until the system is saturated. Again, if the iron pass without any as-
similation, it is also said not to color the stools, so that this effect has
been considered, though I believe incorrectly, some guide to' the absorp-
tion of the drug (Kraus, in Ranking, i., 1872, p. 272).

PHYSIOLOGICAL ACTION (EXTERNAL). Compounds of iron- with the
mineral acids act as caustics, irritants, or simple astringents, according to
the kind and strength of preparation used; they are also, to some extent,
antiseptic. A caustic, destructive action is exerted by the solid per-
chloride, especially upon raw surfaces or mucous membranes, but it is not
so deep or thorough as that of the mineral acids alone, because of the
rapid coagulation of albumen. The astringent effect of dilute prepara-

IRON. 141

tions is explained partly by such coagulation, and partly by the constric-
tion of capillaries induced.

Kulischer has made curious experiments to test the comparative effects
of certain astringents and heemostatics; having divided some blood-ves-
sels in the limbs of frogs, he stayed the bleeding with different astringents
applied for various lengths of time, and then injected liquid into the
larger blood-vessels, and calculated the amount of force required to re-
open those that had been divided and closed; from his results he con-
cluded that of iron solutions a strength of 30 per cent, gave the best re-
sults, and the good effect was proportioned rather to such strength than
to the duration of its application (Schmidt's Jahrb., Bd. clxix., 1876).
Some researches by Rosenstirn upon the same subject, though conducted
in a different manner, show also how much the action is dependent upon
a definite strength of solution, and enable us to compare the effect of iron
with that of other astringents. He examined and measured, under the
microscope, the amount of contraction of blood-vessels in a frog's mesen-
tery after application of 10 per cent, solutions of nitrate of siver, acetate
of lead, and perchloride of iron, and the last acted not at all; he then
used 50 per cent, solutions, and found the iron one very effective it nar-
rowed both veins and arteries at the place of application, arrested circu-
lation, and acted as a true styptic on the blood itself; the adjacent ves-
sels became dilated.

The coagulum formed in the living vessel by perchloride of iron is
soluble, to some extent, in the stream of alkaline blood, and especially so
if the astringent solution used be unduly weak; it is also soluble in
slightly acid liquids, but is rendered more consistent by combining the
iron with alkaline chlorides (Piazza: JSulletin de Therapetitique, 1868).
The blood-clot, with lactate of iron, is said to form more slowly, and to
be more permanent.

The antiseptic powers of astringent iron preparations are connected
with the coagulation of albumen, and strong solutions are fatal to the
lower forms of vegetable life. Ferreil ascertained that the neutral strong
solution of perchloride arrested decomposition in a blood-clot (when it
had commenced), and formed with fresh blood a coagulum that remained
unaltered for many months ( Union Medieale, 1859, p. 374). Similar ob-
servations have been repeated since, but the irritant, properties of the
strong iron chloride preparations make them less suitable for surgical
disinfectant purposes than they would otherwise be, and carbolates, sul-
phates, etc., have superseded them.

PHYSIOLOGICAL ACTION (INTERNAL). Circulatory System. Under
the ordinary use of neutral preparations of the drug, the pulse becomes
more full and forcible, and the color of face and mucous membranes more
florid. It is commonly said that if they be pressed beyond a certain
point, symptoms of plethora and of congestion set in, as shown by flushes

142 MATERIA MEDIC A AND THERAPEUTICS.

and giddiness, engorged viscera, and tendency to hemorrhage; but if the
patient have good air and exercise, and moderate food, such effects are
not likely to occur. The blood will not take up more than a certain
amount, and will protect itself by non-absorption, rather than by elimi-
nation. Hirtz even asserts that he has never seen congestive symptoms,
vertigo, etc., except from the excessive use of chalybeate waters contain-
ing carbonic acid, to which he attributed them (Nouveau Diet.).

According to Sasse and Pokrowsky, the use of iron salts increases the
heart-action, and Laschkewitsch proved increased blood-pressure in ani-
mals taking even small doses (Husemann). In illustration of the effect
of large doses (though complicated by alcohol), may be quoted the case
of a woman who swallowed 1 oz. of the tincture of perchloride, during an
excited condition; the pulse became quick and small, the eyes injected,
and the face flushed; convulsive attacks occurred, but were probably hys-
terical; she recovered after free vomiting (Warburton: Lancet, i., 1869).
In disease, on the other hand, there is evidence sometimes of a sedative,
effect on the circulation. Giacomini records a slow and feeble pulse,
pallor, etc., after 20 to 40 gr. of carbonate; and Pize found it lower the
pulse and quiet the circulation in purpura and chlorosis, when accompa-
nied with palpitation; in the former case, some gastric irritation was
probably caused; in the latter, good effects resulted probably from im-
proved blood-condition. I have known the acetate quiet the circulation
when the perchloride did not do so.

Action on JBlood. According to Nasse, there exists in 1,000 parts of
blood, 0.832 of iron oxide. Haemoglobin contains 0.42 per cent, as a con-
stant quantity; most of it is in direct organic union with the red corpus-
cles, in the proportion of about 1 part of iron to every 230 (Gorup Bes-
anez); when dried, they contain seven times as much as the fibrine, and
four times as much as the serum (Boussingault). Being required then
for the normal constitution of red blood, iron is essentially a food, but
since illness follows deficiency in the number or quantity of corpuscles,
and iron in substance will often remedy such illness, it equally comes
within our province as a medicine, and from its curative effects, we may,
inverting the general rule, deduce some part of its physiological action.
That it can increase the number of red corpuscles is shown by the obser-
vations, e.g., of Rabuteau, who counted them by Malassez's method, in a
case of chlorosis before and after twenty days' treatment by protochloride
of iron: he found the number in a cubic millimetre to be near-ly doubled
{Gazette des Hopitaux, January, 1875); and in a specimen analyzed by
Prof. Simon, the globulin and hasmatin were more than trebled (" Animal
Chemistry," Sydenham Society). I need not multiply examples of this
fact (though it has been denied), but there is something further to be
learnt from the recent and careful observations of Hayem, on the blood of
anaemic persons ( Comptes JRendus, 1876, p. 985). He found that in cases of

IRON. 143

moderate chlorosis, the number of corpuscles was not markedly less than
normal, but they were altered in shape and size, apparently in consist-
ence, but most markedly in color-power, so that a given quantity showed
a red tint not deeper than that of half the number of normal corpuscles.
Further, after a course of iron, the number of corpuscles in the same pa-
tient was not always increased, sometimes it was diminished, but then
the corpuscles individually had grown larger and of normal shape, and of
so good a color as to equal even a greater number of the ordinary kind;
he concludes then that iron acts by improving the internal nutrition of
the globules, " it solicits them " to take up more haematin, more coloring
matter. These observations confirm the older ones of Le Canu (These,
1847), that iron is the main constituent of haematin, is inseparable from
the coloring matter, and must be at least an important element in the
color itself. Hayem's conclusions are of still more importance as bearing
on the assertions of Denis and of C. Bernard, that there is no real defi-
ciency of iron in chlorotic blood, because they prove such a definite change
in its vital characters under the medicinal use of the drug. Granted that
there is no numerical, there is clearly a physical or a vital change pro-
duced by iron; and although it may be true that ordinary nutriment con-
tains as much iron as should be wanted (Bernard), yet it seems equally
true that we may sometimes have to give much that we may get a little
absorbed (Gubler), that we must therefore give it " en masse," as we do,
and (apart from all theory) Hayem furnishes us with a rational basis for
our therapeusis. That the proportion of iron can vary in blood is proved
by the analyses of Picard ( Comptes Itendus, November, 1874) ; in 100
c.c. taken from three dogs respectively young, adult, and weakened by
hemorrhage, he found that the amount of iron was .092, .065, and .041,
and he established also the fact of a definite and constant relation be-
tween the amount of iron in any specimen of blood, and the amount
of contained oxygen as liberated in vacuo from quantities of 100 c.c.

If it be asked how iron adds itself to the corpuscles and promotes
their growth, we must recognize that it is not by mechanical addition to
the formed corpuscle, or else the proportion in chlorotic blood could be
at once increased, and failure to cure would not occur, nor relapse be so
frequent. An observation by Quevenne throws some light upon the pro-
cess; he found in proteid solutions withdrawn from the stomach of dogs
more abundant precipitates of nutrient material if meat or wine, or iron
especially had formed part of a meal, and suggested that in the portal
vein a similar precipitate occurs (from the meeting of currents from
splenic and mesenteric vessels both laden with the results of digestion in
intimate contact with the added iron), that such precipitate is at least
precursory to the formation of globules, and that at this stage iron ex-
erts its blood-forming power (" M6moire," etc.). It would seem that
better corpuscles are formed when (the vital processes being fairly ac-

14:4 MATERIA MEDICA AND THERAPEUTICS.

live) one of their essential constituents is presented in unusual abun-
dance for absorption. It becomes then combined with them in some
organic, rather than chemical or mechanical union; and besides such di-
rect action in the formation of globules, iron exerts special stimulating
power over the blood-glands, which power, indeed, is by Trousseau and
others considered more important than the last-mentioned. Further,
when even a few new corpuscles have been formed, they add fresh nerve-
energy and improve digestion, and the blood-forming process becomes
still more actively assisted. Iron has been variously thought to be in
the corpuscles in its metallic state, as phosphorus exists in the brain (Le
Canu, Mulder), or as a free phosphate (Fourcroy), or as a peroxide (Denis,
Mialhe, and a majority of observers). A precise chemical theory was
elaborated by Liebig, who taught its presence as peroxide on account of
its reactions with sulphuric acid, and found that this hydrated peroxide,
in contact with moist organic membrane in partly closed vessels, could
change to a protocarbonate, and on free exposure to oxygen could change
back again, with evolution of carbonic acid: so that venous blood was
held to contain a protocarbonate, and recently aerated blood a peroxide.
It is difficult to accept so entirely chemical a theory, which implies that
the element is more loosely combined with the corpuscle more distinct
from its substance than it can be; other difficulties are stated in physi-
ological works, and Liebig's view, though highly ingenious, and contain-
ing no doubt a partial truth, can only be accepted as an hypothesis.

Oxidizing Power. To the metallic element in the corpuscles has been
somewhat fancifully attributed an electrical and a polarizing action, and
even a power of increasing heat by mechanical friction ! There is a gen-
eral and better-founded opinion that it greatly aids in the conveyance of
oxygen and in oxidation (a main function of the corpuscles), and some
modern researches support this opinion thus, Schonbein, quoted by Dr.
A. Sasse, proved that animals without blood-corpuscles were suffocated in
oxygen as much as others in nitrogen; that the gas must become changed
into ozone and antozone in order to be fully efficient, and that iron, or
corpuscles, will effect this change. Iodized paper is turned blue both by
ferric solutions and by diluted blood, and peroxide of iron can change into
protoxide and ozone. As an illustration, he quotes the spread of rust on
steel, or " iron mould " on linen, the stain extending by formation of
ozone, which corrodes the adjacent particles of the steel, while the re-
duced oxide attracts fresh oxygen from the air. Similarly, it is argued,
the iron in the corpuscle continues alternately to attract and to give up
oxygen, and to become a proto- or a per-salt until finally excreted
(Schmidt's Jahrb., v., 1865).

If iron, when taken into the system, does aid oxidation it should raise
the temperature and increase tissue-change, but the amount of scientific
evidence on the subject is unfortunately small. The observations of W.

IKON. 145

Pokrowsky, though valuable and often quoted, were made on patients
seriously ill and recently removed to hospitals, and seem scarcely sufficient
for the conclusions drawn from them. In five out of six cases the tem-
perature was slightly raised ; in one (a case of phthisis with haemoptysis,
taking small doses of tinctura ferri) it was lowered; the pulse was either
changed or slightly increased, the elimination of urea was augmented,
and weight was gained. In one case the rise of temperature followed
within five hours of the dose, and it occurred equally in the cases where
temperature was previously normal. It should be noted that the syrup
of iodide of iron was chiefly used, and the iodine must be allowed for as
influencing tissue-change; also that Pokrowsky himself, while recording
improved nutrition, traces it only to " improved tone of capillary vessels,"
not to increased oxidation (Virchow's ArcJdv, Bd. xxii., v. 6); he states
that he acted as a student under Dr. Botkin. I find no reference to other
observations by the latter upon healthy men, as mentioned by Sasse.

Some recent analyses by Rabuteau would seem to support the sup-
position of increased oxidation, but they refer only to the renal secretion;
comparing the results of five days when taking daily 12 ctgr. of perchlo-
ride of iron with the same period, on the same diet, but without the iron,
he concluded that it did not affect the quantity of his urine, but aug-
mented its acidity and its solid constituents and urea (10 per cent.).
Phosphoric acid was lessened, as it usually is, under cod-liver oil and
other restoratives.

The researches of Picard (v. p. 143) proving a definite ratio between
the amount of iron and of oxygen contained in the blood, are of impor-
tance in this connection, and it is an axiom that iron preparations exert
their best curative effect when the supply of oxygen is ample; but the
conclusion of Sasse that iron can supply the place of red corpuscles as
an ozonizing agent in the body can scarcely be correct; were it so, the
cure of anaamia and chlorosis would be more certain than it is. We can
but consider iron as an adjuvant, and as being, when in the corpuscles,
subject to other than merely chemical laws.

Different Action of Proto- and Per-salts. The important experiments
of Blake, so far as they can be practically applied, would point to a
marked difference between the action of proto- and per-salts on the blood
and the circulation. Injecting 10 gr. of protosulphate (in solution) into
the jugular vein of a dog, there occurred a quick but temporary depression
of the heart-action and blood-pressure; with 28 gr. heart-action stopped,
and pressure fell to zero; 70 gr., in divided doses, caused a gradual gen-
eral dulness, and death from asthenia the right cavities of the heart
were distended with dark blood, the left contained 1 oz. of brighter color,
but the coagulating power was lost.

When 2 gr. of persulphate, dissolved in 2 oz. of water, were injected
into the same vessel, pressure was diminished for a brief time, but quickly
VOL. II. 10

146 MATEEIA MEDIC A AND THERAPEUTICS.

rose again when 3 gr. more were given; death soon followed; the left
heart-cavities were empty and contracted, the right distended, the blood
coagulated at once when exposed; the lungs were bright scarlet and con-
tracted, and Dr. Blake attributed death to contraction of their capillaries
preventing the supply of arterial blood to the left heart. Five grains
thrown into the axillary artery raised the blood-pressure at once from 6
to 12 degrees (by the haemadynamometer) ; death followed, and both
sides of the heart contained dark blood, implying that the lung-contrac-
tion was overcome in this instance, but only by an extreme degree of
pressure. The obstruction of the lung-capillaries might be caused by a
physical change in the blood, rather than by contraction of the vessels,
but the quantity seems too small for the former effect, and an analogous
contraction of vessels is produced by digitalis, which proves its possibil-
ity.

The general results of the experiments go to demonstrate that proto-
salts lower cardiac irritability, and in toxic doses arrest heart-action, cause
slow respiration, sedation of nerve-system, and death by depression: per-
salts, on the other hand, have no direct action on the heart, certainly do not
lessen its irritability; they cause symptoms of pressure on the nerve-cen-
tres, and death through interference with the pulmonary circulation, cut-
ting off the supply to the left heart. Collaterally, it is argued that proto-
salts cannot be readily oxidized in the blood, or else some " peroxide-ef-
fects " would be developed from 70 gr. of a proto-salt; and that per-salts
are not readily reduced, or the effects of such small quantities would not
be so persistent (Journal of Anatomy and Physiology, 1869), but re-
. viewing all the experiments and conclusions, we must doubt whether the
mechanical forcing of substances into the blood-current can be held to
compare with natural absorption and assimilation. The difference, how-
ever, exerted by the two classes of salts upon coagulation, has an impor-
tant bearing upon their use for local injections, on the formation and solu-
tion of clot, on embolism, etc.

Digestive System. Most of the soluble salts of iron have an inky as-
tringent taste, and by continued use, stain the teeth and mouth of a dark
color (tannate of iron). Compounds with a mineral acid exert a local
astringent action on the mouth and stomach, and if the dose be small and.
diluted, may improve the tone and the functional power of the gastric
membrane: but these, or any other preparation, if given in undue quan-
tity, may irritate, and cause indigestion (from lessened secretion), with
sense of weight, nausea, or diarrhoea.

Quevenne experimented with gastric fluid withdrawn through a fistula
from the stomach of dogs, and judged of the effects of iron on digestion
by the precipitates of peptones obtained from the fluid at certain periods
after a meal. There was less precipitate when the juice was acid than
when partly neutralized, but he concluded that various forms of iron, given

147

with food, improved the character and amount of the precipitate: they
did not increase the proportion of pepsine, nor alter the duration of the
digestive process, but were quite readily absorbed, and the dogs thrived
and gained flesh under their use. On the other hand, when given with-
out food, and especially in the metallic form, iron did not stimulate the
formation of sufficient secretion to dissolve itself, but acted as a foreign
body, and impaired digestion: 10 to 20 gr. of reduced iron would cause
diarrhoea, hence a reason for the ordinary rule of ordering iron prepara-
tions at the time of a meal, and in small doses (2 to 3 gr.). The sulphate
and chloride of iron have sometimes, by mistake or for criminal purposes,
been taken in large quantities (1 oz. and upward), and have caused vio-
lent pain and vomiting, with other symptoms of irritant poisoning, and
gastro-enteritis, but have rarely proved fatal (Taylor).

Secretion. Astringent preparations will usually lessen the secretions,
especially those of the gastro-intestinal tract. Upon the kidney, in health,
the effect as to quantity of secretion is not much, but some irritation of
the bladder and the urinary tract may lead to increased frequency of mic-
turition. In some persons, however, and in some diseases, iron prepara-
tions, especially the tincture of the chloride, the citrate, and the tartrate,
have proved good diuretics, directly or indirectly: the tincture, in fact, is
termed by Simpson a "renal purgative" when recommending it in "sur-
gical fever" (Medical Times, i., 1859, p. 517). The secretion of milk has
diminished or ceased in cows drinking a ferruginous water, and in some
suckling women taking a course of iron (Martin) ; Bistrow records a sim-
ilar result in a goat under the use of lactate of iron : on the other hand,
there is clinical evidence that non-astringent preparations taken by anse-
mic women during lactation will improve the secretion as well as the gen-
eral health (Routh: Medical Times, i., 1859). The effect is clearly that
of a restorative, and as we find so often in the use of iron, it will vary
with the preparation and the patient taking it.

Generative System. From an early period iron has had the repute
of specially stimulating this system. A classical cure of impotence by
iron-rust among the Argonauts is commonly quoted, and we may rescue
from oblivion the curious marriage-contract said to be common at one
time among the burghers of Frankfort, to the effect that their wives
should not visit the iron springs of Schwalbach more than twice in their
lives, for fear of being too fruitful (Dr. Jacques, These, Paris, 1843).
There is clinical evidence of its value in sexual debility, and in derange-
ment or suppression of the ovarian function, but it seems more explicable
by a general tonic and heematinic power than by a special local action,
though Trousseau attributes to iron aphrodisiac power. The tincture of
the chloride is in somewhat common use as a supposed abortifacient.
Taylor regards it as a dangerous drug for pregnant women, but his ex-
amples scarcely corroborate this, and the clinical evidence and experience

148 MATERIA MEDIC A AND THERAPEUTICS.

as to medicinal doses mentioned later on (v. p. 173) tend to an opposite
conclusion. We may recognize, however, that very large doses of as-
tringent preparations are not safe they may injure by general irritation
or local congestion, as shown in some cases reported in Medical Times,
ii., 1860, p. 81

SYNERGISTS. Manganese, and most tonics and acids: as astringent,
ergot, turpentine, etc.

ANTAGONISTS INCOMPATIBLES. Weakening and fluidifying agents
such as alkalies and mercurials: the former are also, together with sul-
phur and tannin, chemically incompatible with most iron preparations..
Gubler mentions nicotine as antagonistic.

THEBAPEUTICAL ACTION (EXTERNAL AND INTERNAL). In this in-
stance I find it undesirable to separate the external from the internal ap-
plication of the remedy, for they are very closely connected, and if one
set of observers prefer the one in any particular form of disease, parallel
observations will be found in favor of the other; thus it is as regards
hemorrhage, diphtheria, erysipelas, and even varix.

Iron in the metallic form was in early use as an astringent and robo-
rant, though we note the absence of any mention of it in Hippocrates. In
extraordinary demand at the early part of the last century, as a secret
remedy, and under the name of " Elixir d'Or," " Gouttes d'Or," " Tein-
ture de Bestuchef," etc., the perchloride solution with ether was priced
at a golden louis per \ oz., procured pensions and promotions for its
makers, and served as a present for sovereigns; but when its last paten-
tee revealed the secret, "for fear his death should lose it to the world,"
and when Catherine of Russia purchased the precious recipe for many
thousand rubles, and presenting it to the St. Petersburg College of
Medicine allowed it to be published (1780), this remedy which had been
held to cure "gout and epilepsy, cramps and paralysis, rheumatism and
hypochondriasis," sank into an obscurity as little deserved as was its pre-
vious reputation. Bayle, whose treatise is an excellent epitome of the
therapeutical knowledge of his time, mentions only the metal and the
carbonate as remedies in neuralgia and chlorosis (Biblio. de Therap., iv.,
1837), and the use of soluble ferric compounds a use so frequent and
so valuable in modern practice that we may wonder how our predecessors
fared without it dates really from about 1850.

Hemorrhage. The astringent compounds of iron with a mineral acid
are excellent local styptics in all forms of capillary hemorrhage, such as
from leech-bites, wounded gums, hemorrhoids, bleeding from the nose,
etc. The part should be thoroughly cleansed from clot, and then a plug
or compress moistened with the solution should be firmly pressed upon it,
or in cavities an injection (diluted) may suffice. Sir James Simpson
strongly commended a solution of the perchloride in glycerin, used it
freely for all forms of hemorrhage, and with special success in some se-

IRON. 149

vere cases of bleeding from the vagina and uterus (Medical Times, i.,
1858, p. 79). Demarquay, Lallemand, and Deleau were using the same
haemostatic with great advantage in France about the same time (Ga-
zette des Hopitaux, 1858-59).

The liquor ferri perchloridi fortior (British Pharmacopoeia) is quite
serviceable for the purpose, but is more acid, and proves often more irri-
tating than need be, and may be well diluted with an equal part of water
or glycerin. The liquor ferri sulphatis is preferred by many surgeons,
and by others the liquor ferri subsulphatis, or Monsel's solution l of the
U. S. Pharmacopoeia; this is made with sulphate of iron, sulphuric and
nitric acids, and is much less caustic and irritant than our solution; it is
used in rectal hemorrhage 1 part to 4 of water (Allingham: Lancet, i.,
1874) and the "haemostatic cotton" used by Marion Sims is prepared
with it. The so-called " iron alum " is probably an equally effective
preparation.

Tonsillar Hemorrhage Wounds. Wetherby, of New York, records
a very severe case of bleeding from the tonsil (cases which are specially
anxious ones, on account of the proximity of the carotid) completely con-
trolled by the application of Monsel's solution (Ranking, ii., 1866); and
I have seen instances in which a large vessel must have been wounded by
an incision in the tonsil, effectively treated by the local use of tincture of
the perchloride; it should always be tried before more serious measures
are commenced. As styptic applications to the bleeding surfaces of
wounds, iron compounds are not so suitable as some others, because they
necessarily prevent union by " the first intention," and they leave a coag-
ulum, on the separation of which hemorrhage is apt to recur. Maison-
neuve, however, performed some of his boldest and most brillant oper-
ations with their help; thus, he removed a growth occupying half the
face and head, and involving numerous vessels, applying perchloride on
pledgets of charpie at almost every stroke of the knife, and so that the
weakened boy lost but little blood; a brown eschar formed, and separated
about the twentieth day (Medico- Chimrgical Review, ii., 1856). Bour-
gade applied perchloride to the bleeding surface immediately after all
operations calculating to render them by this means "as painless and as
safe as if caustic had been used instead of the knife " and to prevent
septicaemia; the application was painful for a few hours, but not much
pus formed, and granulation occurred in a healthy manner. He reports
ninety-five cases ( Union Medicale, 1867, No. 104). The perchloride is
still thus used sometimes in operating upon soft tissues in ansernic sub-
jects when hemorrhage is likely to be serious. I have seen it applied
in the removal of a cancerous tongue and of a cancerous breast, and also

1 The original Monsel's solution was made with persulphate, as described by him
(Recueil des Memoires, t. xvii., 1856, quoted by Buisson).

150 MATERIA MEDICA AND THERAPEUTICS.

in a thigh-amputation, and in each case secondary hemorrhage occurred,
and I was not at all satisfied with the action of the styptic; further, it is
not free from risk of causing embolism.

Haemoptysis. In various forms of haemoptysis, phthisical and other-
wise, preparations of iron are useful if active febrile reaction is not present.
For internal use I prefer the acetate, or sometimes the sulphate, to other
preparations, and they are especially indicated in the passive hemorrhage
of anaemic weakly subjects (of the acetate, I give the tincture in 5 to 20-
min. doses every half-hour to two hours). Caution is needed as to their
internal use in phthisis (v. p. 173), but their local use in spray or powder
is advisable whenever the loss is severe or alarming. A striking case, in
which death seemed imminent, and in which the insufflation of powdered
sulphate at once and permanently controlled the bleeding, is given by
Wetherby (Ranking, ii., 1866). Brondgeest (Brussels) treated successfully
three phthisical cases by an atomized spray containing the chloride (Bul-
letin de Therapeutique, 1866, t. Ixxii.), and Cornil has related similar
results.

I have treated several severe cases with satisfactory results by an
" iron spray " containing either ^ part of liquor ferri perchloridi, or 1 to
2 gr. of sulphate in the ounce of glycerin and water. It might be thought
that blood thus coagulated in situ would increase a tendency to lung-con-
gestion or chronic pneumonic phthisis, but practically I have not found it
do so.

Epistaxis. When this occurs frequently in patients already anaemic,
or when the amount of blood lost threatens to bring on anaemia, iron will
be found of great value, and especially in the form of acetate or per-
chloride: it should be commenced as soon as possible, while the hemor-
rhage is going on, and continued for some time after it ceases. I have
seen this treatment useful in the severe epistaxis of habitual drunkards;
it is not, however, always safe for epistaxis occurring in the old, or those
disposed to apoplexy.

Hcematemesis. I have frequently treated this form of hemorrhage
successfully by means of the perchloride of iron given internally; it has a
direct local styptic effect, and in some aggravated cases, when the hem-
orrhage has occurred frequently, it has arrested it at the time, apparently
prevented relapse, and certainly lessened after ill-effects, such as anaemia.
In recent acute cases, ipecacuanha powder in doses of 1 or 2 gr. is more
efficacious, but in semi-acute cases it is well to alternate this remedy
(every half-hour to every two or three hours) with 15 to 30 min. of the
iron tincture in water. I have known this method check severe hemor-
rhage in a case of gastric ulceration. after other remedies had failed, and
Mr. Bowles records similar instances: he used 1 dr. of the tincture in 1
oz. of water, giving it after the stomach had been emptied by emesis, so
that it could directly reach the bleeding part (British Medical Journal,

IRON. 151

i., 1872). Deleau, Pleischl, and others have also recorded excellent re-
sults from this treatment (Medical Times, i., 1857, Medico- Chirurgical
Review, 1859), and it might with advantage be more generally adopted.
Iron alum (a double sulphate of iron and ammonia) is also very valuable
in this and other forms of internal hemorrhage (Lancet, i., 1871, p. 806).

Intestinal Hemorrhage. Perchloride is often useful in hemorrhage
from the bowel, and I have known it answer well. Several cases, some-
what obscure in character, but recovering under perchloride, are given in
Bulletin de Therapeutique, 1877. The ordinary cause of such hemor-
rhage would be either cirrhosis of the liver or ulceration, and I do riot
think iron suitable for the former condition, but in the latter it is more
indicated, since we know that it relieves hemorrhage from gastric ulcer.
In the diarrhoea and hemorrhage of enteric fever, benefit has commonly
been derived from its use. Dr. Russell Reynolds has used the perchloride
(Medical Times, i., 1867, p. 32), and Dr. Broadbent the sulphate in en-
teric fever (British Medical Journal, ii., 1869), but I have not met with
any published conclusions as to the value of these remedies. "Iron
alum " I should myself prefer as a styptic in such cases.

Hcematuria. The internal administration of perchloride of iron is
not desirable in acute renal congestion, but I have occasionally met with
chronic recurrent hemorrhage, apparently from the kidney, the subjects
of which were anaemic and suffering from chilliness, nausea, faintness,
etc., and who received much benefit from the perchloride. The dose
should be from 15 to 30 min. every six hours, and its efficacy may often
be increased by 2-gr. doses of ipecacuanha powder, given midway be-
tween. A very successful case illustrative of treatment by perchloride is
reported by Vigla ( Gazette des Hopitaux, 1858). In urethral and vesi-
cal bleeding the same treatment is very serviceable, and in the latter
malady iron injections into the bladder have been employed with advan-
tage, but the solution must be weak, for if rapid and solid coagulation of
blood within the viscus were produced, the effects might be worse than
those of the hemorrhage itself.

Purpura Scorbutus. Iron has sometimes succeeded well in purpura
of passive character, but is not of much advantage in the bleeding of true
scorbutus. Both the sulphate and the perchloride have cured cases when
other remedies, such as sulphuric acid and change of diet, have had no
effect. Homolle was the first physician to recommend the sulphate
( Union Medicale, No. 135, 1856), and Dauvergne, recording a striking
instance of benefit from the perchloride, remarks that it acts better in
cases with large effusion (in plagues) than in the merely petechial forms,
and this I believe from my own experience to be correct (Bulletin de
Therapeutique, 1867). Other cases may be found in Bulletin, 1868, Brit-
ish and Foreign Review, i., 1861, and Medical Times, ii., 1861, p. 501;
they include one patient at seventy, arid one a child; in one the malady

152 MATEEIA MEDIC A AND THERAPEUTICS.

was connected with deficient supply of animal food; the arseniate an-
swered well in another case (Lancet, ii., 1872).

Uterine Hemorrhage. All cases of uterine hemorrhage must be care-
fully considered from every point of view, before resorting to medicinal
or local styptic treatment. In a large number of such cases iron is highly
useful, but it must not prevent the proper manual and surgical manage-
ment of, for instance, retained placenta or fibroid growth, nor the deple-
tive treatment of a congested uterus. In menorrhagia occurring in the
young or the delicate, and accompanied with a general lax anaemic condi-
tion, and often with intercurrent leucorrhoaa, the sulphate or perchloride
are suitable as internal medicines; the former, with sulphate of magnesia,
is especially good. The excessive loss, as well as other and general
symptoms which often occur at the climacteric period, may be also re-
lieved by these remedies.

Uterine Cancer, etc. Simpson knew the value of perchloride in re-
lieving the hemorrhage and discharge of cancer, and French surgeons
equally proved it. The liq. ferri fort, is exceedingly serviceable, as shown
in a good paper by Dr. Gibb, of Newcastle; he either filled the vagina
with a dilute solution for a few minutes, or plugged with tampons, or
painted the strong liquor on the affected part, and so far relieved bleed-
ing and pain, and improved the local condition, as to give, at least, a
period of comfort (Lancet, ii., 1874, p. 830). I have myself used the
same application with excellent results, and my colleague Dr. Potter con-
stantly uses in cancerous cases a plug of lint or cotton wool soaked in a
solution of liquor ferri perchlor. fortior and glycerin (equal parts), and
firmly pressed against the uterine surface, the vagina being filled with
wool soaked in glycerin. Another method is to apply the saturated solu-
tion of perchloride to the affected surface on a Playfair's uterine probe
wrapped with cotton wool; this is best in cases when the vagina will not
tolerate the presence of tampons.

In cancer other than uterine its application is also valued by myself
and many observers independently of 'its power as a haemostatic: it con-
stringes and modifies the affected surfaces, inducing a less rapid growth.
Iron cannot cure cancer, but the debility and the anaemia dependent upon
it may be much relieved by a course of it.

Villous Growth. A severe and obstinate menorrhagia, dependent on
this cause, was successfully treated by Breslau with an intra-uterine in-
jection of equal parts of liquor ferri (Bavarian) and water; it was made
through a catheter, left only one minute and then withdrawn (1858).
This was one of the earliest cases of the kind, and illustrates a method
which I have several times employed with advantage; but a more modern
and often curative practice is to scrape the surface of the lining mem-
brane with a curette.

Fibroid Tumor. If the patient is suffering from marked anaemia and

IRON. 153

from continued loss when she first applies for advice, considerable relief
to the symptom may be given for a time by the internal administration
of the perchloride, especially when combined with ergot; it may possibly
be required as a styptic to the cut surface after incision of the cervix; in
cases of emergency, plugging of the vagina with saturated tampons is a
valuable temporary resource.

Puerperal Hemorrhage. The local application of so excellent a remedy
has not been neglected in this perhaps the most anxious form of hemor-
rhage with which we have to deal. Sometimes the use of plugs or
tampons steeped in the solution, and packed in the vagina, has seemed
the best mode of treatment, but it is not free from risk, for it may only
conceal serious internal hemorrhage, and moreover, the prolonged contact
of strong preparations, even though at the time painless, has been fol-
lowed by serious loss of substance, and permanent contraction and cicatrix
(Gazette des Hopitaux, 1869, No. 113). In post-partum hemorrhage, the
rapid application of a saturated sponge to the interior of a non-contract-
ing uterus has proved efficient (Barnes), but the contact of a strong
solution so quickly corrugates the membrane of the vagina and the os
uteri, as to cause difficulty in carrying the instrument far enough, or in
withdrawing it (Braxton Hicks, Norris).

Intra-uterine Injections. Few surgical procedures have more widely
and earnestly engaged professional attention of late years than the intra-
uterine injection of strong ferric solutions. Schreier, of Hamburg, was
accustomed to use weak injections (5- to 1 dr. in 4 oz. water) for hemor-
rhage, either before or after delivery (Medical Times, ii., 1855), and still
weaker injections (1 dr. to the pint) have long been practised in the
Vienna school, if cold and ergot failed. Ford recorded the successful
arrest of severe hemorrhage after abortion by intra-uterine injection of
ferric sulphate (1 dr. in 4 oz. water), also three other cases (American
Journal, April, 1868). Probably other instances might be found, but
general interest in the subject was first thoroughly aroused by Dr. Barnes.
The mode adopted by him was to mix ^ pint of the liq. ferri perchlor.
fort., B. P., with water up to 1 quart, and to inject this slowly through a
Higginson's syringe, of which the delivery pipe was passed well to the
fundus uteri; by this plan he was satisfied that life had been saved several
times, and he held it specially applicable to cases when contractile power
could not be roused, and the uterus remained dilated and inert after a
prolonged labor. The styptic mechanically stayed the hemorrhage by
sealing the vessels, and usually induced also uterine contraction (Medical
Times, i., 1865; also Lancet, i., 1869, and British Medical Journal, ii.,
1873). Dr. Hugh Norris (Somerset) recorded a similar experience about
the same time (British Medical Journal, 1869-70). Cases for and against
were soon reported from different parts of the country, and it was not
long before a vehement controversy arose, tinged, unfortunately, with

154 IIATERIA MEDICA AND THERAPEUTICS.

some personal animus. A case of secondary hemorrhage really dependent
upon retained placenta, but in which several injections of perchloride so-
lution (the last one being of the strong and undiluted tincture) had been
practised, died ultimately of septicaemia, and furnished the text for a
full discussion at the Obstetrical Society. Such a case was not really
illustrative of Dr. Barnes' mode of treatment, and, although it proved
fatal, the opinion of practical and experienced accoucheurs such as Brax-
ton Hicks, Play fair, Potter, Edis, Murray, etc., was expressed decidedly in
favor of such injections in suitable cases (Lancet, i., 1873, pp. 306, 407).
On the other hand, Graily Hewitt, Routh, Bantock, and Snow Beck, re-
ferred to other instances in which such injections did apparently cause
septicaemia and embolism. In Dublin, the favorable experience of Dr.
Barnes was amply corroborated by Dr. Lombe Athill, while Dr. E. Ken-
nedy took a much more cautious view, and urged the reservation of the
method for a dernier ressort (Dublin Journal of Medical Science, May,
1874).

In Edinburgh, the discussion of an unsuccessful case showed a-balance
of opinion against the procedure. Dr. Mathews Duncan especially ques-
tioned its propriety, though Dr. Alexander Simpson expressed a more
favorable view (Edinburgh Medical Journal, February, 1875). In
France, if we may judge by the observations of M. Budin, of the Mater-
nite, professional opinion is decidedly adverse (Bulletin de T/ierapeutigiie,
1876, p. 89). In Germany ferric injections seem to have been scarcely
tried, for no account of them is to be found in the Archiv, Zeitschrift,
Centralblatt fur Gyncecologie, nor any comments on German cases in
Schmidt or Virchow and Hersch Jahrsbericht.

An impartial estimate of English writings on the subject leads to the
conclusion that the greater part of the favorable testimony comes from
those who have really used the method of Dr. Barnes, while objections
are made chiefly by those who have not ventured to try it. The latter
urge (1) that the proper object in the treatment of post-partum hemor-
rhage is to secure uterine contraction (not simply a plugging of the ves-
sels with clot), and that cold, friction, etc., are better and safer agents
for the purpose; (2) that there is too great tendency to neglect these
measures for the more energetic iron treatment; and (3), which is most
important, that such treatment exposes the patient to grave risk from the
formation of emboli or the injection of air into veins, or the forcing of
fluid through the Fallopian tubes. The first objection as to uterine con-
traction is met by the statement that highly experienced men have, in
some instances, failed to secure uterine contraction by any ordinary
means, and have succeeded with the ferric injection, and have thus stayed
severe hemorrhage, and probably sa\ r ed life, without any ill-result; but
much weight must be allowed to the other objections. It is within my
own experience that iron injections have sometimes been employed far

IRON. 155

too soon, from over-anxiety to stay what I should consider not excessive
hemorrhage, and which would have yielded, I believe, to cold and the
judicious use of ergot. I am also cognizant of at least five cases in which
death has followed apparently from embolism, and yet I do not blame the
principle of the treatment so much as some defect in carrying it out. Thus,
sometimes the uterus has not been properly emptied of clot beforehand;
sometimes the solution has not been strong enough, and at other times
the exit has not been free. The greatest care is required as to all these
points. The patient should be on her back, the womb emptied of clot
and gently compressed, the uterine tube should be long enough (about
9 in.) to reach to the fundus, the solution should be of about 2 oz. dry
perchloride to 12 oz. water, or 2 oz. liquor ferri perchloridi fort, to 10
oz. water, free from air, and injected slowly and steadily, and the os must
be patulous, and the exit quite free, so that no undue pressure or disten-
tion should force fluid into vessels or through the Fallopian tubes. If these
precautions be all adopted, I believe the ferric injections may be used
with safety and with the best results, even in most serious cases; they are
an important addition to our means of saving life, but of late years the
injection of hot water into the uterus has been found to be as efficacious
as solution of iron and devoid of its dangers, and promises to entirely
replace it in practice.

Injections in Aneurism, etc. In 1852 Pravaz, of Lyons, excited the
utmost interest by his discovery of the coagulating powers of ferric per-
chloride, its effects when injected into the vessels of animals, and its suc-
cessful use in various forms of aneurism. His observations were con-
firmed and extended by Giraldes, Broca, and others, who formulated
rules for securing a good and firm clot, and obviating the dangers of in-
flammation and embolism which were soon found to be involved. The
greatest importance was attached to the purity and neutrality of the
preparation, its due density and proportioned amount to the size of the
aneurism, and to the securing of pressure on the vessel above and below
the seat of operation. Five drops of an aqueous solution at 30 density
(Beaume) = 1.261 sp. gr., or 10 drops at 20 (1.160), was the calcula-
tion for each cubic centimetre (15 gr. ) of blood to be acted upon (Giral-
des). Dieulafoy has calculated even less than this. If too strong a
solution, as of 45 to 50 (Beaume) =sp. gr. 1.449 to 1.526, be used, the
vascular coats may become inflamed or gangrenous, and, if compression
be omitted, embolism certainly may occur; and it will be found that
some fault in these respects would explain most of the serious and fatal
results which excited the vehement opposition of Malgaigne and others
to the new procedure.

I think that scarcely sufficient importance has been attached to some
of the successful cases notably to one of aneurismal tumor of the orbit
recorded by an American surgeon (Brainard: Lancet, ii., 1853). The

156 MATERIA MEDICA AND THERAPEUTICS.

ligature of one carotid had given only temporary relief, and the actual
cautery still less, but a complete cure resulted from several injections of
the lactate of iron (8 gr. to 1 dr.). Brainard considered this salt more
suitable than the perchloride, as acting more slowly, and with less irrita-
tion or tendency to suppuration. Bribosia (Brussels), in a special trea-
tise on the use of coagulant injections, considers them best adapted for
such aneurisms as contain more liquid blood than fibrine, and are situated
on the smaller arteries (e.g., those of the cranium), and not too near the
trunk. It must be acknowledged, however, that the general opinion of
modern surgeons is adverse to the use of the perchloride as a coagulant
in aneurism: Mr. Hart points out that compression of the affected vessel
above and below the sac is a sine qud non, and when this can be obtained
usually safer methods of treatment may be employed (" Holmes' System,"
vol. iii., 2d Ed., 1870). Marsacci, in a recent work, came to the same
conclusion; Gross and Erichsen also discourage it, though the latter
speaks of curing with i a gluteal aneurism after some suppuration
(" Science and Art of Surgery ").

Ncevus Erectile Tumor. The application of ferric injections to
these cases, though often successful, was soon found to require as much
caution as in the more serious malady of aneurism. Thirty drops of the
tincture injected into a nsevus of the scalp caused erysipelas and slough-
ing before cure resulted (Medical Times, ii., 1853); in a few cases, situ-
ated about the face, immediate death resulted, this being sometimes
clearly due to a clot formed in a large vein (Archives de Medecine, No-
vember, 1868; Lancet, ii., 1867). In a few other cases cerebral embolism
and softening or pysemia followed (Lancet, i., 1874; Bulletin de Thera-
peutique, 1873). On the other hand, Mr. Cooper Forster had good suc-
cess after dividing the nsevus-tissue subcutaneously and then injecting a
" few drops " (Medical Times, 1853, p. 654). Mr. Morgan made an ex-
cellent cure of a large erectile tumor of scalp, using circular compression
by plaster and pasteboard; and other good results might be adduced,
and, with very great care, might, I believe, be still obtained, but by com-
mon consent the operation has been discontinued on account of its dan-
ger (G. Buchanan: "Lecture," Braithwaite, ii., 1875). A recent Paris
thesis, however, re-directs attention to the subject, and presents it in a
favorable light (Auguste Rigaud: These, Paris, 1876).

Another and a safer method of using the perchloride in nsevus is de-
scribed by Leclerc, who applied it on pledgets of lint to the part, and ob-
tained a cure at the expense of some erythema and suppuration. Guillot
used it after first destroying the epidermis with caustic potash, and Guer-
sant after vesication (Bulletin de Thtrapeutique, t. Ixvii.).

Varix. Varices, without pain or ulceration, should seldom be inter-
fered with by external treatment; but I have frequently known a very
marked improvement in them while patients were under a regular course

IRON. 157

of 15 to 30 min. of the perchloride of iron, three times a day, for other
affections. To judge by the recorded results of iron injections in varix,
a large amount of success has been obtained with much less risk than in
the last-named diseases; but yet the method is not generally approved
by most modern authorities. Minor reports five good cases in which
either the scrotum or the legs were affected, and three or four drops of a
solution of persulphate (1 part in 4 of water) were sufficient for cure; the
patient was in the upright position, and pressure was carefully applied
above and below the seat of puncture (Ranking, ii., 18GO). Sentoux, col-
lecting 126 cases, found 100 cured, 19 relieved, 6 unaffected, and only 1
death. Denuce reports many successful cases (Moniteur des Sciences
Medicales, November 15, 1862; British and Foreign Review, April,
1862); the perchloride was used with certain precautions. Desgranges
thought the method, with ordinary care, to be free from danger 2 drops
sufficed for the largest varicose lobule. He notes the improvement in
varicose ulcers after the operation (Abstract: British and Foreign Re-
view, ii., 1858). Morgan, of Dublin, succeeded in obliterating part of the
saphena vein by injecting 5 drops of Monsel's solution in two places,
carefully isolated: coagulum formed in fifteen minutes, and the case did
well; in another, with irregular dilatation, and large varicose clusters
about the knee, the same method of injection above and below was
equally successful (Medical Press, July 14, 1869). Brainard's experi-
ments on the formation of clot in veins under the use of sulphate were
very satisfactory (loc. cit); and Gross, speaking of naavus, and discourag-
ing the use of perchloride, yet says that by " Monsel's solution any case
of arterial or venous tumor, unless very bulky, may generally be promptly
and effectually cured" ("System of Surgery"); this would seem suffi-
cient to warrant a further trial.

Haemorrhoids. The perchloride is not only frequently of service as a
styptic injection into the rectum to relieve bleeding from internal haem-
orrhoids, but has been used sometimes by direct injection into the tumors,
and has cured when other expedients have failed (Colles: Dublin Journal,
June, 1874). Monsel's solution succeeded equally well in two cases of
large external piles under Mr. Morgan (Medical Press, 1869). Haemor-
rhoids occurring in anaemic or debilitated patients with copious bleeding,
are in my experience often well treated by the internal administration of
the perchloride.

Relaxed and Discharging Surfaces Relaxed Throat, etc. The liquor
ferri perchloridi, with a little glycerin added, is a good astringent locally
and internally in catarrhal sore throat, and in relaxed conditions of fauces
with mucous secretion: also in the cedematous, honey-combed condition
which remains after follicular tonsillitis, or more serious throat inflamma-
tions.

Leucorrhaza. In catarrhal and relaxed conditions of the vaginal mu-

158 MATEKIA MEDICA AND THERAPEUTICS.

cous membrane, injections containing about 1 dr. of the tincture, or 10 gr.
of sulphate of iron in each % pint of water, are often useful, but they have
the drawback of staining linen. When the leucorrhcea is mainly depend-
ent upon general debility, the internal administration of iron is often
sufficient to relieve, without any injection; and in severe cases, occurring
in anaemic and cachectic females with cedematous swelling (from excessive
blood-losses), I have found the citrate of iron and quinine useful. Mont-
gomery commonly recommended the pernitrate for leucorrhoea.

Gonorrhoea. In the chronic stages of urethral inflammation, sulphate
of iron forms a good injection. I recommend about 12 gr. with -J oz. of
laudanum, in 8 or 10 oz. of water a little to be used three times a day;
another form, recommended by Dr. Ringer, contains ^ dr. of the per-
chloride tincture, with 1 dr. of laudanum in pint water. " It often
speedily checks the discharge, and relieves pain on micturition." Baru-
del, writing from a large experience, would absolutely restrict the local
use of perchloride to chronic cases, but he advocates it internally for all
forms of urethritis, acute and chronic (Medico- Chirurgical Review, i.,
1859, p. 244). I would not myself recommend its use, even internally,
in acute stages, but in the later ones of gonorrhoea, or gleet, full doses
of 10 to 15 min. are of real advantage. Pereira recommended the remedy
in combination with tincture of cantharides.

Phagedcenic TTlceration. The combined internal and external use
of tinct. ferri perchloridi is advised by Ricord (Medical Times, i., 1859).
Roget adduced instances of it curing chancre when applied early, and he
maintained that the local use of an acid solution directly after exposure
would prevent gonorrhoeal, and even syphilitic contagion (" Traite sur le
Perchlorure de Fer," 1860, Paris). Rabuteau speaks favorably of the
remedy substituting only citric acid for the more irritant hydrochloric.
He adopts the following formula ]J. Tinct. ferri perchloridi (30 Beaume,
= 0.879 sp. gr.), 12 grammes; acidi citrici, 4 grammes; aquae, 24 grammes:
solve f. lotio.

Spermatorrhoea. For seminal losses occurring in the young and de-
bilitated, tincture of iron is of great use; it should be given in full doses
twice daily, and preferably not at night; plenty of outdoor exercise
should be conjoined with its use.

Enuresis. When this occurs in scrofulous children, or in those
affected with worms, the perchloride or phosphate of iron gives ready
help. One teaspoonful of Parrish's food, twice daily, in water, is an ex-
cellent remedy for the nocturnal as well as the diurnal form when arising
from irritability of the mucous membrane of the bladder. The alterna-
tion of iron with tincture of belladonna, or bromide of potash, acts still
better if there be much spasm of the sphincter, and combination with ergot
has also succeeded well (Guimaud: Bulletin de Tfierapeutique, v., 63).
Da Costa strongly recommends the bromide of iron in this malady.

IRON. 159

Vesical Catarrh. There can be no doubt that iron has a special de-
termination to the mucous membrane of the urinary tract, and my own
experience, as well as that of others, has proved its great value in
catarrhal affections of the bladder. The carbonated iron waters of
Schwalbach are especially recommended (Schmidt's Jahrb., 1877, Bd.
clxxiv., p. 84), and are certainly less irritant than the acid preparations.
In cases of catarrh and hemorrhage, following the injudicious use of the
catheter, weak injections of tinct. ferri, retained for about half a min-
ute, check the Hemorrhage and cure the catarrhal condition (Medical
Times, ii., 1870; see also Hasmaturia). Other instances of the value of
iron in vesical catarrh are reported by Vigla (Medical Times, 1857-58).

Purulent Ophthalmia. Bathing with ferric lotions and painting with
the tinct. ferri have proved useful in chronic purulent conditions of the
conjunctiva, and similar treatment has sometimes dispersed corneal opa-
cities and healed scrofulous corneal ulceration (Gazette des Ilopitaux,
February, 1862).

Skin Diseases. In congestive and exudative forms of skin disease
much benefit may be obtained from the tincture of iron; thus, severe
pruritis may be relieved by it (Lancet, ii., 1874, p. 715). In a case of
chronic infiltrated eczema, when tarry preparations had failed, painting
with the tincture, and afterwards with collodion, not only cured the in-
tense itching, but also the malady itself, leaving only a dry and brown,
but sound skin, and I have seen a case of pityriasis rubra in which the
intensely red, dry, and scaly condition was more relieved by the applica-
tion of this remedy combined with glycerin than by anything else.
Lichen agrius is also relieved by it. Devergie drew attention to its value
in chronic pustular disorders, such as rupia, ecthyma, and impetigo or
pustular eczema (Medical Times, ii., 1860), in which it may be locally
applied as well as taken internally. It is a good application forvariolous
pustules (Medical Times, ii., 1856, p. 498, Ranking, ii., 1866), and has
favorably influenced the course of anthrax; a striking case is reported by
Dauvergne (Bulletin, 1867).

Herpes. Baudon found immediate good results from painting the
vesicles of herpes with tinct. ferri perchlor, and glycerin; he recommended
opening the larger vesicles for the application, but Gressy obtained
equally good results without opening them, using a concentrated alcoholic
solution, which gave rapid relief (Bulletin, t. Ixiii.). An ointment con-
taining 6 to 10 gr. of sulphate of iron in the ounce is recommended by
Palmer (Medical Times, ii., 1861, p. 24).

Ringworm. The local use of iron in ringworm is an old practice,
which has been recently revived (British Medical Journal, i., 1877).
After cleansing the part, tincture of perchloride may be painted upon it
three or four times, at a day or two's interval; a brown scale forms, which
should be left undisturbed, glycerin will lessen the sense of dryness and

160 MATERIA MEDICA AND THERAPEUTICS.

constriction. I have found this treatment succeed in slight and recent
cases; also in old ones, after more active remedies had been used, and
it has the advantage of being not so unpleasant as some other applica-
tions.

Onychia In-growing N^ails. Very successful results have been ob-
tained by using the perchloride locally; for instance, a delicate girl, who
had suffered for several years and undergone removal of the nail and
most ordinary modes of treatment without relief, was cured mainly by
the use of an ointment made with perchloride, and a few applications of
the solid compound: the latter gives pain and requires to be almost im-
mediately washed away (Bulletin, 1853). The persulphate has been used
in other cases (Medical Times, ii., 1868, p. 257).

Necrosis of Bone. Injections of perchloride have a good effect in
chronic sinuses; sometimes they act better when manganese is added
(British Medical Journal, ii., 1871).

Ulcerations. In chronic indolent ulceration the perchloride is a good
stimulant; also the carbonate, finely powdered, has been applied in sub-
stance to old and excavated ulcers of the leg, and with good bandaging
has succeeded well (Lancet, i., 1862). The salicylate of iron is said to
indie a useful lotion (Edinburgh Medical Journal, 1877).

Hospital Gangrene. The perchloride and Monsel's solution have been
largely used as local applications, especially in military practice. Sal-
leron gives a very favorable report of these from experience in the Cri-
mean hospitals and elsewhere (Buisson, " Traite, " etc., and Medico-Chir-
urgical Review, ii., 1860). A "gangrenous throat" was also treated
successfully with perchloride ( Medico- Chirurgical Review, i., 1861).

Polypus Tumor. The perchloride has been applied, it is said suc-
cessfully, to the cure of polypus nasi by injections, and by continued con-
tact (Boston Medical and Surgical Journal, 1861). It has been injected
also into the substance of tumors, and one case is on record when it was
selected for injection into a laryngeal growth, but, a drop of the fluid es-
caping, sudden death followed from laryngeal spasm ( Union Medicale,
1873).

Erysipelas. Preparations of iron have been largely used, both exter-
nally and internally, in the treatment of this malady. A strong ointment
or lotion of the sulphate (about 1 in 4) was . recommended by Velpeau
after many comparative trials with other remedies; it does not, however,
always prevent the extension of the inflammation (Bulletin, 1855). Mr.
Hulke recommends a lotion containing 10 gr. in the ounce (British
Medical Journal, ii., 1871). The application of equal parts of liq. ferri
and spiritus vini rect. would seem still more valuable (Oswald White,
British Medical Journal, i., 1876); and Mr. Foster, of Leeds, obtained so
much success by painting the ordinary tincture of perchloride over ery-
sipelatous surfaces, that this plan became known as the " Leeds method; "

IRON. 161

it was applied also to inflamed lymphatics, breasts, etc., and seems to
have been especially useful in erysipelas after vaccination (Lodge, Medi-
cal Times, i., 1875). Mr. Hamilton Bell was the first to publish cases of
remarkable benefit from the internal administration of the same remedy,
or rather of the old " tincture of muriate of iron; " he gave 20 to 30 drops
every three hours, so that sometimes 2 oz. were taken in eight days
(Edinburgh Monthly Journal, 1852). In severe cases of "idiopathic"
erysipelas, the spread of inflammation was arrested, the pulse lowered,
and the fever relieved, and equally good results were reported by Balfour,
Begfcie, and other eminent men; and although Lehmann writes more re-
cently in praise of the treatment (Lancet, i., 1880), we cannot concede to
ferrum the " specific " virtue in erysipelas that has been claimed for it,
nor is it the best remedy for every case. Todd curtly denied its efficacy
(Medical Times, i., 1860); also H. Bennet and Estlander found it useless
in traumatic cases (Medical Times, ii., 1871).

Dr. Marshall (Dover), after relating two acute cases well cured by
20-min. doses (and purging), states that he has found the remedy of less
use in the traumatic form (British Medical Journal, i., 1872). The
limited experience of Parkes need not weigh with us, because his cases
received only 10-min. doses or less, and were therefore not tests of the
method in question; but Aran, commenting on ten satisfactory cases re-
corded by Mathez (These, Paris, 1857), points out that iron is not the best
remedy for young, robust subjects with high fever.

It is fair to add that Mr. C. Bell still maintains its very great value in
all forms of erysipelas, and attributes the failures of other practitioners
to the use of too small doses, or of less excellent preparations; he states
that under his own care patients have recovered so soon as the old " tinc-
ture of muriate " was substituted for the modern " perchloride." The
former, made with sesquioxide and hydrochloric acid, contains more free
chlorine and some protochloride of iron, but the present tincture of the
B.P. is a more definite preparation; any difference in curative power can
be ascertained only by clinical experience, and Mr. C. Bell's observations
deserve attention (Edinburgh Medical Journal, August, 1876). Some
observers have sought an indication for iron in the locality affected, find-
ing it least useful for erysipelas of the head or trunk; but Pirrie has ob-
tained the best results in such cases. I think that in choosing a remedy
for erysipelas we should look rather to the general constitution of the
patient, the nature of the tissues affected, and the character of the in-
flammation; thus, I find iron to be really. the best remedy in anaemic,
weak patients, or in lymphatic constitutions when there is rapid extension
or flitting of the inflammation, when the affected surface is dark-red or
bluish, when the pyrexia is slight, and when, owing to debility, the attack
tends to linger.

In the erysipelas consequent on surgical operations it is also useful if
VOL. II. 11

1C2 MATEKIA MEDICA AND THERAPEUTICS.

the subject has been reduced by long-continued suppuration or other cau-
ses of exhaustion. I believe it has also some prophylactic power.

Diphtheria. This malady is clearly allied to erysipelas, and has been
successfully treated by the same preparations of iron, both locallv and
internally. Some of the earliest observers recommended the application
of perchloride to the seat of exudation, on the ground of the effused
membrane being parasitic (Jodin, Laycock), but fungus elements are not
essential to diphtheria, and other physicians, regarding exudation as only
one sign of constitutional infection, discouraged the use of such local
means as might irritate: Trousseau, for instance, was disappointed $n a
strong tincture of perchloride used " as a caustic," and such application
is not to be recommended; his remarks, however, do not apply to the
use of a more dilute form, for blood-poisoning may occur from the affect-
ed surfaces, and I entirely agree with Dr. Heslop, Sir William Jenner,
Dr. George Johnson, and others, that judicious local disinfection is very
important and advantageous; various remedies may serve, but the gentle
application of diluted ferric solutions has given very good results in com-
petent hands. Dr. Nelson (New York), after ample experience of several
methods of treatment, expresses the strongest conviction in favor of local
applications of Monsel's solution (liq. ferri subsulphatis) diluted with gly-
cerin and water; among forty cases thus treated he had only three deaths
(New York Medical Journal, January, 1874). Dr. Billington, in an
excellent practical essay, maintains that diphtheria is at first a local affec-
tion, and to be treated most successfully by early local disinfection; he has
used lime-water, carbolic acid, etc., but gives a decided preference to the
tinct. ferri perchlor., 2 parts, to 1 of glycerin; this he paints especially
over the tough adherent membranes, and'all adjacent parts. Three hun-
dred cases treated upon this principle show a large percentage of recov-
eries, and other physicians corroborate Dr. Billington's results (New
York Medical Record, March 25, 1876).

Bertheau describes, in a recent thesis, a severe epidemic of " diphthe-
rite " affecting two hundred and twenty people (Indre), and in which the
most useful of all the means employed was the local application of tinct.
ferri perchlor. (30 Beaume); when the membrane was unusually thick,
this was painted on three or four times daily (" Du Traitement de Diph-
therite," etc., Paris, 187G). Dr. Fera applies the finely powdered sulphate
of iron freely to the affected part, and attributes to this the successful
termination of eighty cases, while De Sabbata speaks in equally favorable
terms of the use of an acid solution of the same salt (London Medical
Review, November, 1876).

Referring now to my own experience, I find detailed notes of twenty-
seven consecutive cases of diphtheria, in which the perchloride was used
locally or internally; for the local application I employed an atomizer
with equal parts of the solution and water, and continued its use for five

IKON. 163

to ten minutes every hour or two. In six cases no internal medication
was ordered, but, besides using the spray, the throat was swabbed out
with solution of perchloride mixed with an equal part of glycerin, two or
three times in twenty-four hours. The age in these six cases varied from
five to nine years, and five of them recovered; but the attack lingered
longer, and its course was more unsatisfactory, and convalescence more
tedious than in other instances when internal treatment was conjoined:
one child, aged four years, had nasal diphtheria, and sank on the third
day. In another series of six cases, including children of from two to
seve"n years, I gave minute doses of iodide of mercury (^ to -j^gr.) and
also liquor arsenicalis, and used freely a spray of perchloride of iron lo-
cally, and these six cases did well. The remaining fifteen, varying in age
from two to ten years, were also treated by the spray, and in addition
they received from 10 to 20 min. of the liquor ferri perchlor. every one
or two hours, and of these cases twelve recovered. Nine of the total
number had albumen in the urine on being first seen by me, and three,
hsematuria; another had severe epistaxis, and all showed much exhaus-
tion, with more or less dyspno&a and delirium. The iron given internally
seemed to exert a sedative effect on the circulation, lowering the fre-
quency of the pulse, and rendering it more full and forcible. I have never
seen hemorrhage, or albuminuria, or congestive symptoms of any kind
which could fairly be traced to its action, and am indeed satisfied that its
effect on the course of the disease is beneficial, though we cannot, any
more than in erysipelas, consider it a "specific."

Admitting, however, that twenty-seven cases do not furnish sufficient
basis for a positive conclusion, it will be desirable to review briefly the
experience of previous observers. This we shall find to be strongly in
favor of the iron treatment. Dr. Godfrey, of Enfield, reported three
cases of " diphtherite " treated by the perchloride at the very commence-
ment of the epidemic, and speaks of it as the best remedy (Lancet, ii.,
1857). It was strongly recommended to the profession at about the
same time by Aubrun, in France, and soon after by Dr. Ileslop in this
country (1858-59). The mortality before that date was most severe
thus, of twenty-six cases related by Aubrun, and treated without iron,
twenty-two died. In the next series of cases, in which he used the
remedy both internally and locally, out of twenty-seven three only died,
and in another series of twelve cases there were no deaths at all ( Gazette
des Hopitaux, 1859); nor does it seem that any natural lessening of vir-
ulence in the epidemic accounted for this striking and suggestive differ-
ence.

Aubrun was most particular in his method of administration, ordering
one or two teaspoonfuls of a solution every five to fifteen minutes through
the day and night, for the first three days of the attack, " because usually
membranes would be detached, or would cease to form after that time "

164 MATERIA MEDICA AND THERAPEUTICS.

then the medicine could be taken less frequently ( Comptcs Rendus,
I860, t. li.). Da Silva, commencing with only the local application of
perchloride, soon found improved results from using it internally, and
recorded many successful cases ( Gazette des Hopitaux, Fev., 1859). Is-
nard was a still more earnest advocate for this treatment. Following

Aubrun in the principle that " iron strengthened the vital power " he
reasoned also that it might prevent exudation just as it might hemor-
rhage, rendering the blood more plastic and also less liable to contami-
nation (blood-poisoning) : and, acting as an alterative on the mucous
membrane of the respiratory tract it was better than alkalies, for they
were too slow in action and too lowering; it should be given early and
repeatedly so as to influence the blood-condition as soon as possible; in
support of his reasoning he adduced thirty-nine cases, of which thirty-five
got well in a natural manner, and two after tracheotomy. Dr. Heslop,
after referring to the then excessive mortality of diphtheria, and the
failure of all accepted modes of treatment, records several striking cases
of recovery from almost hopeless conditions under the internal use of
tinct. ferri perchlor: he conjoined with it local applications of dilute
hydrochloric acid: at the same time that he praises the remedy, he cau-
tions against regarding it as " a specific " (Medical Times, i., 1858). Mr.
Pound relates equally favorable results (British Medical Journal, i.,
1858), and Mr. Houghton (Dudley) contributes four striking cases of re-
covery under very unfavorable conditions (Dublin Journal, February,
1859). A very severe epidemic in the fen country was controlled, accord-
ing to Mr. Stiles, by the same treatment (British Medical Journal, ii.,
1858), and, of fifty-six cases, reported by Mr. Prangley, two only died after
commencing the remedies: he used iodine locally and perchloride with
potash chlorate internally. Mr. Salter contributed additional testimony
to the same effect, and altogether the change of tone, and of the amount
of mortality recorded in writings of this period, abundantly testify to the
benefit derived from iron tincture, allowing even for accidental circum-
stances. Mr. Fisher attaches much importance to the use of a prelimin-
ary emetic or purge (Lancet, ii., 1862), and Dr. George Johnson, agreeing
that treatment with perchloride internally is the most successful of all,
conjoins with it local chlorine applications (Lancet, i., 1875). Sir W.
Jenner, careful to place mere medical treatment in a subordinate position,
states that in his experience benefit has accrued from the perchloride, as
from other medicines, only in certain cases suited for it (" Clinical Lec-
tures"), while Dr. Wade expresses some distrust of the remedy, fearing
it may increase the renal congestion, for he has found, in fatal cases,
more pronounced alteration in the kidneys of patients treated by iron
than in others (Lancet, ii., 1862): he would prefer iodide and chlorate of
potash. Certainly there are arguments in favor of Dr. Wade's view, but
it is not supported by my own experience, and I think it will be conceded,

IRON. 165

that the illustrations and authorities already given, furnish ample 'evi-
dence of the value of perchloride of iron in diphtheria. The appearance
of albumen, blood, or tube-casts in the urine does not contra-indicate the
use of iron in this disease, but, on the contrary, calls for its administration;
and when blood or tube-casts are present the iron should be given in con-
junction with nitric or hydrochloric acid: under the same conditions
stimulants should be judiciously regulated, but seldom withdrawn. Or-
dinary diuretics are injurious, but as a rule demulcents should be freely
taken. Patients should be well nourished with beef-tea, soups, eggs,
milk in any form, chicken panada, etc., and ice sucked or swallowed is
very agreeable and relieves the painful condition of the fauces: the skin
should be kept clean and warm, and the house and room well ventilated;
aperients, as a rule, weaken the patient and cause an extension of the
exudation in the throat; all these and other matters as they arise should
be carefully attended to during the administration of any iron prepara-
tion in diphtheria.

Scarlatina Scarlatinal Angina Variola. In many of these cases
I have used the perchloride internally, and applied it to the throat mixed
with equal parts of glycerin and water, or through an atomizer, with
satisfactory results, but I recommend it most in cases which assume a
malignant or putrid form; benefit is often obtained by painting the
swollen cervical glands with the liquor ferri.

I have treated many cases of articular inflammation occurring during
scarlatina, and closely resembling articular rheumatism, showing high
temperature and great prostration, with 5 to 10-min. doses of tincture
of perchloride three or four times daily, with excellent results, the joints
being also painted with the liq. ferri perchlor. Meade writes to recom-
mend the same medicine in frequent doses of 10 to 15 min. (Medical
Times, i., 1858); and Arlidge believes it to be not only valuable as a
remedy during the attack, but as a preventive of dropsy (British Medical
Journal, ii., 1871). Fears have been expressed as in the case of diph-
theria of its increasing renal congestion, but I have never seen injurious
effects which could reasonably be traced to it, and Dr. Crighton makes
the same observation (British Medical Journal, i., 1869). He considers
that any risk of this kind may be obviated or lessened by combining
liquor ammonise acetatis with the iron compound, thus assisting the action
of the skin, and I believe the combination to be very serviceable in febrile
and inflammatory cases.

The perchloride has sometimes been used with very good effect to re-
lieve the throat-condition in variola (Medical Record, January, 1873),
and the course of the malady itself seems to have been favorably modified;
half-drachm doses of the tincture were given every four hours in a severe
case occurring in the seventh month of pregnancy, and the patient did
well (Ranking, ii., 1866).

166 MATERIA MEDICA AND THERAPEUTICS.

* Rheumatism, Acute and Subacute. To ascertain the value (or the
reverse) of iron in acute rheumatism, I must refer rather to the expe-
rience of others than to my own. Petrequin seems to have been the first
to use it, and he reported marked advantage from doses of 40 to 80 min.
given in the course of twenty-four hours; he prescribed it with lemonade,
and he made trial also of the sulphate and the citrates (" Traite Pratique
des Eaux Minerales," These, Paris, 1855, p. 533). Dr. Russell Reynolds
led to use the remedy by consideration of its value in erysipelas
brought before the profession a series of eight cases in which the average
duration of high temperature was shortened (to five and a half days as
against fifteen), and in several of which pain was quickly relieved and no
discomfort produced; but, on the other hand, one patient died comatose,
after delirium, and another of pneumonia and pericarditis, while a feeble
or intermittent pulse of 56 to 60 caused anxiety in two of the others; it
is to be noted that most of these patients had some cardiac inflammation
before coming under treatment, yet the results can scarcely be considered
favorable (British Medical Journal, ii., 1869). In another series of cases,
however, Dr. Reynolds was able to record greater success; thus, out of a
total of sixty-five, 44 per cent, of first attacks were convalescent in the
course of a week, and most of those suffering from second, third, or fourth
attacks, in the second week; one-half of the whole number were severe
cases, yet the temperature became normal within fifteen days; hyper-
pyrexia occurred in three, and proved fatal in two, instances (British
Medical Journal, ii., 1872).

If we examine other observations that have been published on this
subject, we find satisfactory results obtained by Mr. Bott (British Medi-
cal Journal, i., 1870), and the record of six cases successfully treated
with perchloride by Dr. Dyce (British Medical Journal, i., 1876); and
Dr. Rose finds the remedy " prophylactic of rheumatism " (Lancet, ii.,
1871), but, on the other hand, of three cases treated by Dr. Buck, one
had urgent dyspnoaa, and one unusual cardiac pain (British Medical
Journal, i., 1870), and of three cases recorded by Mr. Greene, one died
with cardiac lesions, and one had tetanic spasms, so that it seems desira-
ble to ask (with Dr. Trestrail) whether the perchloride given in acute
rheumatism may not increase the disordered blood-condition, and the ten-
dency to embolism, and to embarrassed pulmonary circulation: at least,
we must say that there is at present much more doubt as to the suitabil-
ity of this remedy in acute rheumatism than in erysipelas or diphtheria,
and it has not commanded the same amount of professional confidence;
and yet when the urine is alkaline (as in several of Dr. Reynolds' cases),
and the patient is very anasmic and feeble, tincture of steel seems quite
appropriate; also rheumatic pain is often relieved by it, and it has de-
cided value in the anasmic condition following acute attacks, and in sub-
acute and chronic varieties of rheumatism. The late esteemed Dr. Anstie

IRON. 167

drew attention to its power of cutting short subacute cases as observed
among the out-patients at the Westminster Hospital; in such as were
really rheumatic (and not gouty) in character, with sallow patchy face,
deep furring of tongue, oily moisture of skin, obscure aching of limbs,
slight rise of temperature, and trouble of respiration, he found that 30 to
40-min. doses, given three to six times in the twenty-four hours, often ar-
rested the progress and relieved the symptoms in a few days; this occurred
in seventeen cases out of twenty-nine (Practitioner, September, 1871).

Chronic Rheumatism. Ferrum is useful in primary chronic rheuma-
tism, also in cases when the patient is much reduced in strength and flesh
after an acute attack; it should be continued for some time, for its favor-
able effects are but slowly produced.

Rheumatoid Arthritis. Dr. Garrod recommends iodide of iron " in
some cases of 'rheumatoid arthritis, especially when the joint-pains are
increased by the heat of the bed." I have tried it, but have not myself
seen good results from it.

Anosmia. The various preparations of iron form our most dependa-
ble remedies in ordinary and simple cases of ansemia and chlorosis, and
indeed their good effects are usually so evident that iron was, at one
time, considered a panacea for all forms of these affections, but, in reality,
if prescribed injudiciously, it may not only fail to cure, but may produce
ill-results, and observation of such instances has led some observers to de-
preciate a remedy which had been considered so universally curative.
Thus, Trasbot has recently denied to it any reconstituent or hsematinic
power, while Dujardin Beaumetz holds the employment of iron in anaemia
" une grande illusion therapeutique " (Journal de Therapeutique, 1S7G).
The former observer states that, in experiments on dogs he obtained better
haematinic results from lime phosphate, coffee, and wine, than he did from*
iron, which proved simply exciting; and Dujardin Beaumetz relies upon
an argument of C. Bernard's, that even if the normal amount of iron in
the blood of chlorotics be diminished, it is only by a very small amount
(10 or 20 centigrammes) more than which is introduced, daily in the food:
but the true answer to such observations is, that all theory, and even all
physiological experiment, must stand or fall by the clinical results obtained
on man (Mialhe and others in Gazette Hebdom., Mars, 1S7G), and in the
majority of cases these are satisfactory. The objections of Trousseau were
limited to the use of iron in "false chlorosis" that is to say, in cases
when the suppression of the menses, pallor, etc., were really connected
with incipient phthisis, which malady he found to be accelerated by
ferruginous medicines (" Traite," vol. i.). His observations have been
corroborated by Millet (Bulletin, 1862), but the cases quoted by the latter
author illustrate mainly the injudicious domestic use of certain prepara-
tions without due examination of the patient, and his remarks apply only
to the abuse, not to the medical and proper prescription of the remedy.

168 MATERIA MEDICA AND THERAPEUTICS.

By the terms " anaemia "or " aglobulia,* we understand a condition in
which the red blood-corpuscles are fewer than in normal health ; instead
of being in the proportion of 130 parts per 1,000 of the blood, they may
be at 80 or GO, or even less, and this may arise from direct loss of corpuscles
(hemorrhage), or from insufficient formation of new ones on account of
disease, or bad air, or unsuitable food, and under such conditions the
corpuscles that are formed are small and misshapen. The most marked
symptom of anaemia is pallor, which affects the mucous membranes as well as
the skin, and may be noted in the conjunctivae, the gums, and the lips; other
symptoms are difficulty of breathing, especially on exertion, lassitude,
mental and bodily, malaise, restlessness, dyspepsia, constipation, head-
ache, neuralgia, and palpitation: the pupils are commonly dilated. Some
varieties of anaemia benefit by iron more than others, and it is not easy to
lay down definite rules concerning them. If there be much dyspepsia
this should first be treated by other appropriate means; but on the other
hand, the simple atonic dyspepsia of anaemic persons is very amenable
to iron. Congestive headache is a contra-indication, but the pulsating
acute headache which follows profuse hemorrhage really requires iron
medication; important points for securing its good effects are, to obviate
constipation by aperients if necessary, and to secure sufficient oxygen for
the proper assimilation of the remedy, and I think that many failures in
the treatment of anaemia are traceable to want of management on these
points.

Direct anaemia dependent upon excessive hemorrhage; or the indirect
anaemia which follows loss of animal fluids generally (such as in obstinate
leucorrhcea, empyema, and purulent formations, seminal losses, profuse
perspiration, diarrhoea, prolonged lactation, or too frequent pregnancies);
*also the anaemia produced by acute disease, such as rheumatism, and that
connected with inanition when the albuminous constituents of blood are
really most deficient; all these forms, though complicated with extreme
debility and general hydraemia, may gradually improve with good food,
rest, and pure air (especially if the cause be removed), but iron, given in
suitable doses and not so as to disorder the stomach, will greatly assist
and hasten recovery.

In other cases, the best dietetic measures alone are insufficient, and
iron is indispensable for cure: in the congenital anremia of children born
after profuse uterine hemorrhage, or whose parents were affected with
anaemia, tuberculosis, constitutional syphilis, or other exhausting diseases,
iron is of special value; also in strumous and rachitic cases (when the
iodide or the phosphate is the most suitable form), but it requires to be
continued for a long time. I have always found, in the treatment of
simple anaemia, that when, under the judicious use of iron, etc., the blood
assumes a healthy aspect, and the formidable symptoms disappear, if the
iron medication is not persevered with for a considerable time longer,

IKON. 16 ( J

the malady returns in an aggravated degree. Ansemia arising from severe
and continuous mental strain is best treated by the phosphate conjoined
with cod-liver oil many cases have come under my observation when
this treatment proved highly beneficial. In the anaemia due to mal-hy-
giene, to sedentary pursuits, prolonged residence in a town atmosphere,
or continued exposure to carbonic acid, iron compounds are also markedly
useful. In all these forms their advantage has been often verified by the
enumeration of the blood-corpuscles, and estimation of the amount of
coloring matter.

Idiopathic or " Pernicious " Anaemia is an extremely interesting but
obscure form of disease, connected mainly with the glandular system; it
is insidious and fatal, and iron, at least in the forms usually employed,
has seemed to possess little or no remedial power against it: arsenic, and
perhaps phosphorus, have succeeded better (v. p. 50). Quite recently,
however, benefit has been reported even in this malady from the hypoder-
""mic use of iron, and Da Costa has further exemplified the value of this
resource by the cure of an obstinate case of chlorosis with hypodermic in-
jections of " dialysed iron " in 15-min. doses (British Medical Journal, i.,
1878). I should consider this an additional proof that in many cases
where iron is said to have failed, it is because of its not being given in a
form that can be assimilated.

In ordinary goitre, iron alone is inefficient, and in exophthalmic goitre,
although anaemia is commonly a marked symptom, I have not seen much
advantage from it. In the anaemia of incipient phthisis it must be given
with caution (v. p. 173); and in that connected with diabetes arid malig-
nant or malarious disease, its effects, though often good, are rather un-
certain.

The success of iron in anasmia will clearly vary with the different
causes, forms, and degrees of the malady, and an accurate knowledge of
them is a great help toward cure of the disease, and confidence in the
power of the drug. Cases coming under treatment at an early stage
usually admit of a favorable prognosis, but when the anaemia is congen-
ital, or occurs at the climacteric period, recovery is more uncertain, and
the anaemia of old people (unless when directly consequent on an acute
illness) is the least tractable of all; intercurrent disease, especially if of
febrile or inflammatory character, renders the prognosis as to the anaemic
condition, very doubtful.

It is worth while, even at the present time, to refer briefly to two of
the earliest facts which fixed the value of iron in suitable cases of anaemia.
An endemic malady, apparently unknown at the time (1804), attacked
the workers in the mines of Anzim (coal); it was probably anaemia from
carbonic acid poisoning, for they became pale, feeble, short of breath,
and died of asthenia, or chest disease. Treatment by quinine, opium,
good food, etc., failed to relieve, and four cases were sent to a hospital

170 MATEKIA MEDICA AND THEEAPEUTICS.

in Paris for the opinion of the physicians: of the four men, one died short-
ly, and at the section, Halle, noticing the exsanguine appearance of the
body, thought of iron, and prescribed it for the others, who got well,
and returning home cured their companion's with the same remedy (Que-
venne: " Memoire," etc.). Something similar occurred at the mines of
Schemnitz (metal mines), where the workers at one time died rapidly
with "aneemia, asthma, phthisis, and dropsy," when the epidemic was
stayed with iron medicines by Hoffinger (Ozaman : " Histoire des Epi-
demies ").

Chlorosis. The relationship of chlorosis to anaemia is not exactly
clear, but it has this in common with it that the number of red cor-
puscles is diminished, and that those which are visible are mostly small,
some are shrivelled and irregular, and all are pale-colored; the serum is in
excess: in causation, also, it is allied, as it occurs often in young girls
obliged to live in close, ill-ventilated rooms or workshops, and it has
also, sometimes, seemed directly due to the hemorrhage of the first men-
struation (Wade).

As an entirely primary disease it seldom occurs in any but unmarried
women, and chiefly from thirteen to twenty-four years of age; if it occur
later in life, it is usually traced to frequent confinements coming rapidly
one after another, and especially if the women nurse their children. It
is connected with deranged menstruation and certain sexual causes which
we are at present unable to distinguish accurately: it occurs either before
the menses have appeared, or after symptoms of disordered menstruation
have continued for some months; dysmenorrhoea and leucorrhoea are fre-
quent precursors of it. It is often hereditary; the children of tuberculous
parents and delicate women with irritable nervous systems are the most
susceptible to it: sometimes, in exceptional cases, menstruation is too
frequent and profuse. The patient is subject to most of the symptoms
already described under anaemia, especially dyspnoea, palpitation, head-
ache, giddiness, and dyspepsia: the face is cedematous and pallid, with a
greenish hue; the condition lasts longer than ordinary anaemia, and re-
lapses are still more liable to occur.

The cure of this affection is often readily accomplished with suitable
diet, pure air, exercise, healthy mental occupation, and a steady course
of iron, which latter is almost a specific in all simple cases. It was for-
merly thought that the metal acted by supplying some deficiency in the
blood, or at least by directly increasing the number of corpuscles. Behier
considered that it was always indicated when he found, on microscopical
examination, that the red globules were reduced to a proportion of 80
per 1,000, and to some extent this is a guide. General improvement will
usually occur pari passu with an increase in their number toward the
normal amount, but it must be understood that the action of iron is not
simply a mechanical or chemical one. Claude Bernard has shown by an-

IRON. 171

alysis that the metal, as such, is not always deficient in amount in chloro-
tic blood, and Hayem has shown that the number of corpuscles is not al-
ways diminished before, nor increased after the use of iron; on the other
hand, the latter observer has clearly shown that the size, and color, and
" vital character " of the corpuscles are remarkably improved by it. It
acts, therefore, as a stimulus in some manner peculiar to itself, or, as
others have expressed it, it has a " dynamic or vital influence " which
chemistry alone will not explain (Trousseau, etc. ; see also Physiological
Action).

With regard to the preparation that is most suitable, we may refer to
the observations of M. Coste. He made trial of different forms in 118
cases, fifty-five being of chlorosis, and he concluded that the choice of
any particular one was not in itself important, if irritation of the stom-
ach did not result every preparation that did not irritate produced the
good effects of iron; the reduced metal, taken at meal times in small
quantities, proved on the whole the most satisfactory form, and the ex-
periments of Quevenne, and the observations of Chomel, Trousseau, and
others, are to the same effect. Sydenham obtained remarkable success
with iron filings and iron wine, and, as a rule, we may say that the sim-
pler the form used the better, and chemical theories as to solubility, etc.,
do not guide as to the therapeutical result. The ferrum redactum, the
oxides and proto-salts. especially the carbonate, are certainly to be pre-
ferred in the earlier stages of chlorosis, unless the occurrence of mucous
or other discharges indicate a necessity for astringents: sometimes the
metal itself causes unpleasant eructation, and the oxides are liable to
adulteration, and hence the recently precipitated carbonate, which is not
astringent or irritant, is preferred by many, and in the form of mist.
ferri comp., or Griffith's mixture, has had great repute in the treatment of
ansernic amenorrhoaa. The " Pilules de Blaud " contain carbonate of potash
and sulphate of iron, and have for many years retained a high reputation
in the treatment of chlorosis, especially on the Continent (Nierneyer): his
original memoir, recording thirty successful cases, is republished by Bayle,
and will repay perusal (Biblio. de Th'erapeutique Journal, iv., 1837). I
have but little personal experience of the value of the hydrated oxide, or
" dialysed iron," which seems pure and non-irritant ; the doubts ex-
pressed about it seem to be mainly theoretical (Bouchardat: Bulletin,
January, 1878; Medical Times, 1878; British Medical Journal, ii., 1878).
I have had excellent results from a protochloride, and sometimes the
citrate with ammonia wilt be borne better than any other. Dornetz specially
recommends an albuminate (see Preparations), and in the anaemia so com-
mon in Japan, and traceable to intestinal catarrh, found it better borne
than any other form. I have seldom seen the astringent forms, when
given in a right dose, and at a proper time, produce any injurious effect
on a weak or irritable stomach; indeed, in many such cases I have found

172 MATEKIA MEDICA AND THERAPEUTICS.

them particularly suitable, and we need not be deterred from their use by
fear of irritating effects: astringent preparations, such as the perchloride
and sulphate, should be used in cases of " menorrhagic chlorosis," for it
is found practically better to treat the anaemia in such cases than to omit
iron for fear of increasing hemorrhage (Trousseau). This applies espe-
cially to cases where the discharge is profuse and frequent, but pale and
imperfectly coagulating; but, even when it is florid in character, iron may
be ordered with advantage, if due attention be first given to such svmp-
toms as hepatic congestion and constipation. Astringent preparations
are also useful if there be a tendency to palpitation, general relaxation,
or undue discharges of any kind, and also when impairment of nerve-
power is a marked symptom. Aloes is often added to reduced iron or
iron carbonate, in phlegmatic subjects, and sulphate of magnesia to medi-
cines containing iron sulphate, especially if the patient be plethoric;
sometimes small doses of belladonna will regulate the bowels, preventing
constipation better than either of these aperients. In all cases, success
will depend not upon giving a large quantity of the medicine, but upon
securing its due assimilation; for this purpose, air and exercise are im-
portant, and fatty food certainly aids the digestion of iron (Nasse: Brit-
ish Medical Journal, ii., 1877). Jeannel found that an oleo-stearate of iron,
prepared with the sulphate and white soap, was very well borne: nitro-
hydrochloric acid baths also favor the absorption of iron (Chambers: Med-
ical Times, i., 1862).

It is important in all cases to continue the remedy sufficiently long,
and not to omit it on the first symptoms of improvement; permanent
benefit can seldom be expected under five or six months.

In cases where iron had not been given properly, and when it after-
ward failed to produce due effect, I have found great advantage from
arsenic alone, or in conjunction with iron. Manganese has also been
recommended (Petrequin).

Anosmia of Pregnancy. We consider iron not a direct, but an in-
direct emmenagogue, by virtue of its improving the blood-condition; but
since the continued use of the mineral can cause congestion of the pelvic,
as well as of other organs, it becomes an important question as to whether
its use is admissible or is dangerous during pregnancy. Certainly the
perchloride has been in frequent popular use as an abortifacient, but the
evidence of its power for this purpose is not cogent (v. p. 147). Its use
has often furnished occasion for prosecutions, but few cases of its really
causing abortion are recognized, and, in many of these, as well as when
the sulphate has been used, the effect seems to have followed from violent
irritation of the intestinal canal. It is true that cases in which abortion
is deliberately produced would not, as a rule, find their way into the pub-
lic press; but, allowing for this, I find a general impression gaining ground
that iron may be taken during pregnancy without injurious effects.

IRON. 173

Ramsbotham and Barnes recommend it, the latter stating that he has never
seen harm from it (Lancet, i., 1874, p. 768). It was stated during a recent
trial that 10-gr. doses of ammonio-citrate of iron were dangerous to a
pregnant woman, but Dr. Woodman contradicted this from his own ex-
perience, and Dr. Graily Hewitt said that he and others constantly pre-
scribed it during pregnancy (British Medical Journal, i., 1870). Dr.
Bassett brought before the Obstetrical Society many cases illustrating the
value of the citrate and tartrate of iron in averting miscarriage and serious
hemorrhage in delicate women, and there seems to have been no difference
of opinion upon the subject (Lancet, i., 1874, p. 768): he considers that
the addition of an alkali to the iron medicine renders it better borne, and
points out that aperients should be given occasionally during the course.
I can corroborate the experience of Dr. Bassett, and I think that the
neutral preparations of iron are the most suitable during pregnancy,
though some observers speak well even of the perchloride (Day: British
Medical Journal, i., 1870). Trousseau remarks that iron has no direct
emmenagogue power, and Hirtz has never seen any objection to using
iron in the anasmia of pregnancy, though he has not found it very useful
(" Diet, de Med.") ; altogether we must conclude that the older fears of
injury from its moderate medicinal use were unfounded.

Phthisis. A great deal of fear has been expressed about the use of
iron in this malady, and it has been said by eminent observers to hasten
and aggravate its course, especially when given in full doses and in the
early stages (Trousseau, Millet: Bulletin de Ttierapeutique, 1862, etc.).
If there be acute pyrexia and evidence of pulmonary congestion, leading
to florid haemoptysis, then I think that iron is better avoided, because it
can increase blood-pressure and congestion, and stimulates blood-forma-
tion, and in any case it should be given with much caution during the
early stages of the malady, and special attention should be directed to
supplying at the same time any deficiency of fatty food, and to securing
a due supply of oxygen (Dobell: British Medical Journal, i., 1867).
Iodide of iron is one of the best preparations to use, especially in " scrof-
ulous phthisis," and it should be combined, if possible, with cod-liver or
other oils. In later stages of phthisis, all are agreed as to the value of
iron in relieving many of the most distressing symptoms and much assist-
ing any measure of recovery that can be obtained: the astringent prep-
arations control purulent formations and discharges of various kinds,
such as expectoration and passive htemoptysis, diarrhoea, and profuse
perspiration, and they often improve the strength and the appetite.
Bonorden used the sulphate in a number of cases, giving from 2 to 4
gr. every two hours for several days at a time: the dose seems large,
but he obtained very good results (Schmidt's Jahrb., May, 18.52). Dr.
Thompson employed chiefly the perchloride at the Brompton Consumption
Hospital, and calculated the effects of iron medication in more than 1,500

174 MATEEIA MEDICA AND THERAPEUTICS.

cases, 54.6 per cent, were found " improved," 23 per cent, much im-
proved, and only 21 per cent, not improved. He does not give the de-
tails of any cases, nor does he mention the stages of the disease when
iron was used, but states generally that the patients grew stronger, and
were able to eat better, and suffered less from flatulence, diarrhoea, night-
sweats, and haemoptysis: he considers that iron is clearly required in the
treatment of phthisis, because " it improves the condition of the blood,"
and he advocates its continued but moderate use " as a food " (Practi-
tioner, vol. i.). Others have written special treatises in favor of this
medication. Dr. Cotton obtained favorable results from the iodide and
ammonio-citrate (Medical Times, i., 1860), and Sir Thomas Watson rec-
ommends iron in non-inflammatory forms of phthisis, " and finds the
mist, ferri comp. very useful when it is well borne: " if sweating be pro-
fuse, he uses the perchloride. Dr. Cameron recommends the basic iodate
of iron as better than the iodide: it contains 51 per cent, iodine and 11
per cent, iron (Dublin Quarterly, May, 1869).

Chronic Bronchitis Emphysema. In chronic bronchitis, with pro-
fuse expectoration, I have found iron compounds, especially the perchlo-
ride and the phosphate, often useful; besides improving the general
health, they lessen the amount of secretion and modify its character. In
emphysema the perchloride is often valuable for its tonic power and its
action on the capillaries, as well as for improving the impaired blood-
condition.

Cardiac Disease. Cardiac pain and dyspnoea may often be relieved
by iron preparations, which act probably in an indirect manner i.e., by
improving the blood in the first instance, hence their advantage is seen
most in cases of anaemia: in such conditions, occurring after acute rheu-
matism, even the physical signs murmurs, etc. may improve under a
course of iron (Jones: Medical Times, 1861). Increased frequency of
pulse is not, in itself, a contra-indication, but only when increase of
tension is also detected. In mitral disease with dropsy, the acetate or
perchloride is especially useful if combined with diuretics: in fatty de-
generation of the heart, in any form of chronic valvular disease, and in
dilatation, iron is often serviceable, especially when combined with dig-
italis.

Serous Effusions Dropsy. Iron acts powerfully in dropsy resulting
from a state of anaemia or hydraemia of the system, and good effects may
be obtained from 3 to 5 gr. of ferrum redactum taken at meal times, or
15 to 30 min. of tincture of perchloride about half an hour after meals.
Dropsy dependent upon mitral disease is best treated by iron and digitalis
(in addition to purgatives), and dropsy connected with albuminuria is
very amenable to the same combination: it should not be used during
acute renal congestion (cf. Rotta: "Fer en Hydropisie," Anmiaire de
Th'erapeutigue, 1857). Husemann praises it in "cachectic dropsy," and

IRON. 175

in that form which is connected with chronic nephritis and amyloid de-
generation of the kidney. Dr. Anstie has written strongly in favor of
the tincture of iron -in chronic pleuritic effusion, and my own experience
quite corroborates his observations.

AlbuminurioL The astringent preparations of iron are often exceed-
ino'ly useful in controlling the loss of albumen by the urine: we must
remember, however, that it is also possible to do harm by these remedies
in renal diseases, and I have seen congestion increased by recourse to
them during the acute stage. The best effect is certainly obtained at the
decline of this stage, when the urine is free from blood or inflammatory
casts, when pain in the back, and in the head, and the general febrile con-
ditions are relieved, but the patient is pallid, weak, and suffering from
more or less anaemia and dropsy; then the value of such preparations as
the perchloride or acetate is often very marked, both as regards the gen-
eral health and the discharge of albumen. Dr. Hassall, indeed, attributes
these good effects more to a reconstituent action on the blood, " than to
any direct astringent power, because he could not detect either the metal,
or the acid combined with it (hydrochloric), in his analysis of the urine"
(Lancet, ii., 1864). Dr. Parkes was one of the first to show, by quanti-
tative analysis, the gradual lessening and final cure of the discharge of
albumen under the influence of perchloride; this was in a subacute case,
when the early inflammation had subsided, and hospital nursing and
the use of gallic acid had quite failed to relieve (Medical Times, ii., 1854).
In all cases of this kind it is desirable to feel one's way with iron prepara-
tions, to begin at first with a small dose; and the recommendation of my
late friend Dr. Basham, to combine with it the acetate of ammonia, is a
very good one. The addition of ergot will increase the astringent effect
(v. Gazette M'ed. de Lyon, October, 1862), and in albuminuria following
scarlatina, especially when dropsy is present, tincture or infusion of
digitalis, alternately with tincture of perchloride of iron, is a very valu-
able prescription: it increases the flow of urine, at the same time that by
its action on the blood and the capillaries it restrains the transudation of
albumen: Dr. Goodfellow and Dr. Cheadle have reported favorable re-
sults with it (Medical Times, 1871; Ranking, i., 1873).

In chronic forms of albuminuria iron will' require consideration: it is
often extremely useful, improving the blood-condition more than any
other remedy, and Dr. Lionel Beale testifies to its good effects even in
chronic structural change and fatty degeneration (Medical Time*, i.,
1865, p. 29), but the cases in which it does harm are those with granular
kidney, when the heart is large, the pulse hard and of high tension, and
when there is much tendency to headache (Dickinson: Lancet, i., 1870).
Hirtz says that he has seen it hasten a fatal termination by uraemia, less-
ening the amount of urine, and increasing that of urea ("Nouv. Diet.,' 1
Art. Fer), so that its effects should always be carefully watched: a very

176 MATERIA MEDICA AND THERAPEUTICS.

important point when ordering iron in any case of albuminuria is to ob-
viate constipation.

Chyluria. The perchloride of iron has sometimes proved very useful
in cases of this kind, even when they have lasted for several years {Lan-
cet, ii., 1862).

Diabetes. Carbonated iron waters are much esteemed as adjuvants
in the management of diabetes; and Dr. Mackey informs me that the
bromide of iron, or rather a combination of bromide of potassium and
citrate of iron, has given better results than any other medicine in his
experience. Of course, the diet and hygiene must be regulated, and
when we can more accurately distinguish the varieties of the malady we
may find that certain medicines are more appropriate to some forms than
to others, but meanwhile I believe the bromide of iron is available in any
ordinary chronic case: I have frequently seen the general health improve,
and the amount of sugar grow less under its use.

Dyspepsia. Although iron is contra-indicated in cases of acute and
irritative dyspepsia and mal-assimilation, yet certain forms of " atonic
dyspepsia " which are connected with debility and impaired blood-condi-
tion are well treated by it. There are the general symptoms of anaemia,
and also a sense of weight and heaviness after food, and impaired appe-
tite, rather than of acute pain, and the preparations usually most suitable
are such as the citrate or ammonio-citrate combined with soda and ca-
lumba, or reduced iron with nux vomica: the headache which often ac-
companies this condition is also relieved by these medicines: when there
is much general relaxation, or gastric catarrh of chronic character, the
perchloride, preferably with quassia, is valuable. In the dyspepsia of
chlorosis, iron will often not agree if the tongue be furred, or the urine
loaded; but if these conditions are present only in a minor degree, then
the citrate may be used in effervescence with soda (Budd: "On Dyspep-
sia "). Dr. Milner Fothergill, in an article " When not to give Iron,"
insists on the importance of clean tongue and freedom from " bilious-
ness; " and he quotes Sir J. Fayrer to the same effect (Practitioner,
1877); he remarks also that toleration of it diminishes with age.

Diarrhoea. In simple cases, occurring in weakly children, and con-
tinuing after preventable causes have been removed, the vinum ferri is a
mild but very useful astringent tonic, which is often sufficient both to
stay the discharge, and to prevent its recurrence. In more serious cases
of chronic mucous diarrhoea with slimy, bloody, offensive stools, and te-
nesmus, whether met with in adults or in children, the best preparation is
the liquor ferri pernitratis, in doses of from 1 to 5 drops, as originally rec-
ommended by Neligan, and I have seen also much benefit from its use in
the colliquative diarrhoea of phthisis. Dr. Graves specially advised it in
the " nervous diarrhrea " which is liable to occur from emotional causes,
and is more frequent in women: in cases with nausea and impaired ap-

IRON. 177

petite, calumba may be well added to the iron (British Medical Journal,
ii., 1870; Dr. Cookc).

Dysentery. I cannot recommend iron preparations during the acute
stage of dysentery, for I believe there are much better remedies, but
some practitioners have found iron valuable. Bandon reports twelve
cases suffering with tormina and very frequent sanguineous stools, which
were treated by 12 to 30 min. doses of steel tincture internally, at the
same time that about 12 min. with water (and sometimes laudanum) were
injected; these cases were much relieved or cured within a week (Bulle-
tin de Therapeutique, folio 71). Blanvillon corroborated these results
(Gazette des Hopitaux, No. 130), and the same medication was largely
used during the last German war (Lancet, ii., 1870): as a general rule, it
is better restricted to chronic stages of dysentery, and for the anaemia
and debility attendant upon this condition it is of great value.

Cholera. Iron is one of the numberless remedies recommended for
cholera, but I have very little personal experience of its use: it would, of
course, not be depended upon alone, and Robiquet has reported a num-
ber of successful cases treated by the citrate and by reduced iron with
quinine; frictions, and warmth, and nutriment being also conjoined (-Tow-
nal de Medecine, October, 1873; Practitioner, vol. xi., p. 452).

Nervous Disorders Hypochondriasis, etc. The nervous system na-
turally suffers when it does not receive a due supply of healthy blood:
depression and a sense of oppression will be felt, and hysterical and hy-
pochondriacal symptoms will be more or less pronounced: in such cases,
iron is often a valuable adjunct to other treatment, and is especially suit-
able when combined with bromides. In the nerve-symptoms which com-
monly occur in women at the climacteric period, including restlessness,
anxiety, fluttering and sinking at the epigastrium, giddiness, clavus, and
sometimes menorrhagia, the perchloride, with or without bromide, relieves
much.

Dipsomania. Morbid craving for drink, and alcoholic insomnia, have
been controlled by drachm doses of tincture of iron when many other
remedies have failed (Medical Times, i., 1875). The sulphate has also
given relief in such cases, especially when combined with aromatics.

Neuralgia. Before the introduction of many modern remedies for
neuralgia, large doses of the carbonate or oxide of iron were much relied
upon, and when there is a chlorotic anaemic condition of system they are
of service. I should not myself consider iron a remedy for " idiopathic
neuralgia," but some observers have attributed to it almost a specific
power, especially in neuralgise of the fifth nerve: thus, Mr. Hutchinson
recommends it in "prosopalgia," and, according to Schobelt, the phosphate
of iron acts well in neuralgia of the teeth: the citrate of iron and quinine
is a very good form when the remedy has to be long continued.

When neuralgia of the stomach occurs in anaemic or chlorotic patients,
VOL. II. 12

178 MATERIA MEDICA AND TIIERAPEUTICS.

who complain of cramping pain and distension, accompanied with nausea
and vomiting of mucus and water, principally before breakfast, and of
frequent acid and insipid eructations after meals iron is useful, espe-
cially when the neuralgia depends on loss of blood or on protracted diar-
rhoea; I have notes of many such cases cured by it.

Chorea. When this disorder is dependent upon anaemia, iron is clear-
ly indicated, and may prove of great service, as it did in the hands of
Elliotson, who used large doses of oxide {Medical Times, i., 1869, p. 136).
Sir T. Watson recommends the carbonate. Many cases occur about the
time of commencing puberty, and others evince obscure rheumatic symp-
toms: and in these also iron is useful, but it often acts better when taken
in conjunction with arsenic.

Epilepsy. Ferruginous medicines were at one time esteemed in the
treatment of epilepsy or of attacks resembling it, but as diagnosis be-
came more exact, and as more reliable remedies were discovered, iron
passed out of use. Brown-Sequard taught that although it might im-
prove the blood-condition, it tended to aggravate the malady itself; and
H. Jackson, after much observation, expressed the same opinion. Dr.
Gowers, writing more recently, acknowledges that it is sometimes the
case, but, on the other hand, he has found that iron has a true place in
the therapeusis of epilepsy: he has observed benefit from it in cases that
are on the borderland between epilepsy and hysteria, and in others when
the attacks were limited to the night-time, and in many of these cases
the improvement was fairly permanent: he suggests, and I should think
very plausibly, that it acts, like other metals (as silver or zinc seems to
do in such cases), as a nerve-tonic, rather than simply by hsematinic
properties (Practitioner, October, 1877). Fabre has published a thesis
showing the value of the medicine (" Fer contre 1'Epilepsie," Paris, 1853).
On the whole, we may conclude that iron has been unduly discredited in
epileptic or epileptiform conditions. I think that when it arises from
onanism, or when a patient is anaemic, it should be used, but generally in
combination with bromides.

Constitutional Syphilis. This malady, like all others in which a poi-
sonous material circulates in the blood, much impairs the condition of
that fluid, rendering the corpuscles fewer, smaller, and paler; and, in such
cases, iron becomes very serviceable, though it will not take the place of
more special remedies for the principal disease. Ricord recommended
the potassio-tartrate even in primary syphilis, and especially for phage-
dsenic ulceration in debilitated subjects: the theory sustained in opposition
to him by certain French writers, that iron aids the development of the
malady, is not tenable. The iodide of iron I have found very useful in
the later stages of syphilis in cachectic subjects.

Struma Rachitis. In the different forms of disease included under
these headings, and characterized by enlarged or suppurating glands,

IRON. 179

irritable mucous membranes, caries, and swelling of knee and elbow joints,
emaciation, etc., iron, although much lauded by Hufeland, is not so ser-
viceable when given alone as are certain alteratives iodine, lime, etc.
but when combined with such remedies it is of great value for the ca-
chexia, anaemia, and torpor of the blood-forming glands, which are usual
accompaniments; I have, indeed, found the iodide of iron to be an excel-
lent remedy for most affections of a scrofulous type. The perchloride,
as already mentioned, is a good external application for discharging
glands. The vinum ferri, or an alkaline citrate with arornatics, is very
useful in the mucous diarrhoea of rachitic children.

Worms. The astringent tonic effect of perchloride on the gastro-in-
testinal mucous membrane, renders it a good adjunct to purgative treat-
ment for these parasites, and a useful prophylactic. When diluted, it
may be injected into the rectum for destroying ascarides: I generally use
about 1 dr. of the liquor in 4 oz. of infusion of quassia: a stronger solu-
tion is liable to cause unnecessary pain.

PREPARATIONS AND DOSE. Iron preparations, especially the liquid
astringent forms, discolor the teeth and stain the tongue black they
should be taken through a glass tube: glycerin lessens the rough astrin-
gent taste, and a gargle of milk will relieve it (Guibout). A lotion of
quadroxalate of* potash (^ dr. in pint of rose-water) will remove the
black staining.

Mistura ferri aromatica (made with iron wire, cinchona, calumba, and
aromatics): dose, 1 to 2 fl.oz. Vinum ferri (made with iron wire and
sherry): dose, 1 to 2 fl.dr. and upward. Ferrum redactum: dose, 2 to
6 gr. for adults; to 1 gr. for children. Trochisci ferri redacti: each
lozenge contains a grain of reduced iron. Reduced iron may be taken
with advantage during a meal, the powder being mixed up with the food.

Ferri oxidum magneticum : dose, 3 to 5 gr. or more. Ferri peroxidum
hydratum : dose, 10 to 60 gr. or more in treacle or honey. Emplastrum
ferri Chalybeate plaster (contains hydrated peroxide of iron, Burgundy
pitch, and lead plaster). Ferri peroxidum humidum : dose, 2 to 4 dr.

Ferri carbonas saccharata : dose, 5 to 20 gr. or more. Mistura ferri
composita (contains sulphate of iron, carbonate of potash, nutmeg, sugar,
and rose-water): dose, 1 to 2 fl.oz. Pilula ferri carbonatis (contains sac-
charated carbonate of iron and confection of roses) : dose, 5 to 20 gr. or
more.

Ferri iodidum: dose, 1 to 5 gr. or more. Syrupus ferri iodidi (con-
tains iodine 2 parts, iron 1 part, with sugar and water): dose, 20 to GO
min. : each fluid drachm of the syrup contains nearly four grains and a
half of iodide of iron. Pilula ferri iodidi : dose, 3 to 8 gr. or more;
one grain of iodide of iron is contained in about 3 gr. of the pill.

Ferri sulphas : dose, 3 to 5 gr.: the "Pilules de Blaud" contain car-
bonate of potash with sulphate of iron. Ferri sulphas exsiccata: dose,

180 HATEKIA MEDICA AND THERAPEUTICS.

4- to 3 gr. or more (3 gr. with 2 of manna make a good pill). Fcrri sul-
phas granulata : dose, 3 to 5 gr.

Ferri arsenias: dose, y'g- gradually increased to gr. in pill. Ferri
phottphas: dose, 5 to 10 gr. Syrupusferri phosphatis : dose, 1 dr. and
upward (contains soda and phosphoric acid with 1 gr. of the iron salt in
each fl. dr.; is colorless when fresh).

Liquor ferri perchloridi fortior : dose, 3 to 10 min. Liquor ferri
perchloridi ' (contains 1 part of the last-mentioned to 3 of distilled water,
Lp. gr. .995): dose, 10 to 30 min. or more. Tinctura ferri perchloridi
(contains 1 part of the stronger solution to 3 of rectified spirit, sp. gr.
.995): dose, 10 to 30 min. or more. Ferri pernitratis liquor : dose, 30 to
60 min. Ferri per sulphat is liquor (chiefly used in preparing other ferru-
ginous salts).

Ferri et ammonias citras: dose, 5 to 10 gr. or more. Vinum ferri
citratis (prepared with orange wine): dose, 1 to 4 dr. Ferrum tartara-
tum : dose, 5 to 20 gr. Ferri et quinice citras : dose, 5 to 20 gr. Tinc-
tura ferri acetatis: dose, 5 to 30 min.

[PREPAKATIONS, U. S. P. Ferrum redactum Mistura ferri compo-
sita: myrrh, sugar, each 60 gr., carbonate of potassium 25 gr., sulphate
of iron 20 gr., spirit of lavender -\ fluidounce, rose-water 74- fluidounces;
dose, 1 to 2 fluidounces; Pilula ferri carbonatis : sulphate of iron 8
troyounces, carbonate of sodium 9 troyounces, clarified honey 3 troy-
ounces, sugar 2 troyounces, boiling water 2 pints, syrup sufficient;
dose, 2 to 10 grains; Ferri subcarbonas ; Trochisci ferri subcarbonatis
(they contain 5 gr. each of the subcarbonate); Emplastnim ferri / Ferri
chloridum ; Liquor ferri chloridi; Tinctura ferri chloridi; Ferri ci-
tras; Liquor ferri citratis ; Ferri et ammonii citras ; Ferri et ammonii
sulphas / Ferri et ammonii tartras / Fcrri et potassii tartras / Ferri et
quinice citras / Ferri et strychnia? citras ; dose, 3 to 5 gr. ; Syrupusferri
iodidi ; Pilula ferri iodidi ; Fcrri lactas ; Ferri oxalas ; dose, 2 to 3
gr. ; Liquor ferri nitratis Fcrri oxidum hydratum (used as an antidote
to arsenic); Ferri phosphas ; Ferri pyrophosphas ; Ferri sulphas ; Ferri
sulphas exsiccata ; Liquor ferri subsulphatis (MonseVs styptic) ; Liquor
ferri tersulphatis (used in preparations); Pilulce/ ferri con/posifce : myrrh
36 gr., carbonate of sodium, sulphate of iron, each 18 gr., syrup sufficient:
make 24 pills; Ferri sulphuretum.]

' The tincture of perchloride often becomes turbid, which is due to it not contain-
ing sufficient chlorine, part of this gas being driven off by the long process of evap-
oration which is required in order to drive off nitric acid; the quantity of aci.l
ordered in B.P. is 25 per cent, over the quantity required by chemical calculation,
and Schacht finds that by using less (20 per cent, less) he obtains a preparation having
less hyponitrons ether, and which keeps better (Pharmaceutical Journal, September,
1872). The U. S. Pharmacopoeia specially provides for the development of muriatic
ether in the tincture.

MERC UK Y. 181

7?he non-officinal preparations are very numerous, and include the
following:

Preparations of Tisy (French): these are all proto-salts, and are sent
out in capsules as of Fer iodure, etc.; analysis shows the quantity con-
tained in each capsule to be very small, and not constant (Practitioner,
vol. vii.).

Preparations of Creuse (American): these are double salts, such as a
phosphate with ammonio-citrate non-astringent: he has also a tasteless
iodide and chloride (Pharmaceutical Journal, May, 1873, and February,
1874).

Preparations of JRobiquet (French): these are double salts, as a citro-
ammoniacal phosphate; they are not definite in composition. Prepara-
tion of Bechamp (French): this is a peroxychloride, obtained by treating
neutral perchloride with a varying quantity of peroxide; it is tasteless,
not caustic or irritant, but haemostatic (Medical Record, 1874, p. 795).
The preparations of Lebarqui, JBravais, /Squire, Chateaud, and Man-
yhan are different forms of oxide " dialysed," " soluble," colloid. Van
den Corpuffs preparation is a double citrate of iron and magnesia (Bel-
gian): that of Saquet is a pyrophosphate with soda, ammonia, and malt
extract. Lightfoofs solution is said to be a magnetic phosphate.

Besides these, we have in more common use Bromide of iron : dose,
1 to 5 gr. Pyrophosphate of iron : dose, 5 to 10 gr. Hypophosphite of
iron syrup: dose, 1 dr. (Pharmaceutical Journal, v., vii.). ParrisWs
syrup of phosphates (compound), containing in each drachm 1 gr. phos-
phate of iron with soda and potash; Dr. Frederick Churchill's syrup
(v. British Medical Journal, March, 1880); Beef and iron wine (Bur-
roughs); MonseVs solution (liq. ferri subsulphatis); and many others.

HYDRARGYRUM MERCURY QUICKSILVER, Hg, =200.

Mercury is most frequently found in combination with sulphur, as
native sulphide or cinnabar, in mines in Almaden, Ydria,* China, Peru,
Japan, and California. It is obtained from the ore by fusion with lime,
which combines with the sulphur, while the mercury distils over. It oc-
curs, also, as a natural amalgam with silver " argental mercury " com-
bined with chlorine in small gray crystals, known as "horn mercury;"
also more rarely as an iodide, and sometimes in a pure state " virgin
mercury."

CHARACTERS AND TESTS. Mercury is a silvery-white metal, with
bluish lustre, and is fluid at ordinary temperatures. When pure, it has
neither taste nor smell; it readidly oxidizes on exposure to the air, but
does not tarnish. Should tarnishing occur, it implies the presence of

182 MATERIA MEDICA AND THERAPEUTICS.

other metals, as lead, zinc, or bismuth; it is susceptible of such division,
that it may be squeezed in minute globules through chamois leather. On
agitation with alcohol, ether, or turpentine, or on trituration with sul-
phur or unctuous substances, it loses its Quid character. With other
metals, and even with hydrogen, it forms soft compounds termed amal-
gams, and a mere trace of it will leave a white stain on silver or gold.
It has a sp. gr. of 13.59, which is exceeded only by that of gold and plati-
num, is slightly volatile at ordinary temperatures, boils at 662 F., and
freezes at 39 F., becoming crystalline, tough, malleable, and sonorous.
Its specific heat is low, but it is a good conductor, and has a regular rate
of expansion and contraction, hence it is well suited for thermometric
and barometric purposes: from its power of combining readily with silver
and gold, and yet afterward quickly volatilizing on being heated, it is
valuable in the arts of gilding and silvering, and alloyed with tinfoil it
forms the reflecting surface of mirrors.

Hydrochloric acid has no action on mercury, and hence the chlorides
cannot be prepared in a direct manner. Sulphuric acid, when boiling,
and nitric acid, whether cold or hot, form respectively salts of different
degrees of saturation proto- or sub-salts which are known as mercurous,
and per-salts, known as mercuric, and which have much more active pow-
ers than the former.

The per-salts of mercury are many of them (as the perchloride and
red iodide) soluble in ether when the sub-salts are not, so that by this
agent they may be' separated from each other.

If any salt of mercury be heated in a test tube with sodic carbonate,
the pure metal will sublime, and it may be obtained from its various com-
binations by distillation. With sulphuretted hydrogen in excess, mercurial
compounds give a black precipitate of sulphide; but the best general test
is the deposition of metallic mercury upon bright copper. It may be
applied by heating any mercurial salt with a strip of copper and a few
drops of hydrochloric acid, and, if the copper be afterward heated, small
globules of quicksilver may be obtained as a sublimate.

COMPOUNDS OF MERCURY.

HTDRARGYRI SUBCHLORWUMCALOMELASMERCURIUS DULCI8
SUBGHLOR1DE OF MERCURY, OR MERGUROUS CHLORIDE CAL-
OMEL, Hg 3 Cl a ,=471.

PREPARATION. (1) Ten parts of sulphate of mercury are triturated
with seven of metallic mercury and a little water, so that a subsulphate
is formed thus

(2) Chloride of sodium is then added with trituration, the mixture is

MERCURY. 183

heated, and tho subchloride of mercury sublimes as vapor, while sulphate
of sodium is left thus

Hg a S0 4 +2NaCl=Na s SO 4 +Hg,Cl t .

A large condensing chamber is required in order to obtain a. fine powder,
and this is washed with hot water in order to remove any perchloride
that may be formed.

CHARACTERS AND TESTS. Calomel usually occurs as a heavy, dull,
white powder, which is rendered yellow by trituration or by gentle heat:
if sublimed in a small chamber, fibrous crystalline lumps are produced.
The sp. gr. is 7.2. It has no taste, and hence its name of mercurius dul-
cis. It is not acted upon by hot water, ether, alcohol, or dilute acids,
but potash or soda decomposes it with precipitation of the black oxide
of mercury. Prussia acid also turns calomel black by causing the separa-
tion of metallic mercury. Pure calomel is entirely volatilized by heat, and
warm ether shaken with it should leave no residue on evaporation (show-
ing the absence of corrosive sublimate).

EYDRARGYR1 PERCHLORIDUMPERCHLORIDE OF MERCURY COR-
ROSIVE SUBLIMATE, HgCl 2 ,=271.

PREPARATION. By subliming dry mercuric sulphate with four-fifths
of its weight of dried sodium chloride, 2 or 3 per cent, of oxide of man-
ganese being previously added to the mixture. The reaction is as
follows:

HgSO 4 + 2NaCl= HgCl 2 + Na 2 SO 4 .

Sulphate of soda being left, and corrosive sublimate condensing in the
cooler part of the subliming apparatus. It will be noticed that the man-
ganese has no share in the decomposition; it is introduced in order that
it may set free from the excess of sodic chloride some free chlorine to
combine with any calomel that may be formed, and convert it into cor-
rosive sublimate: calomel would be formed if the mercuric sulphate con-
tained any mercurous salt, as it i apt to do. " The fumes are extremely
acrid and poisonous " (Miller).

CHARACTERS AND TESTS. Corrosive sublimate occurs in white crys-
talline heavy masses sp. gr. 5.2 it is entirely volatilized by heat, is solu-
ble in 16 parts of cold and 3 of boiling water, soluble also in alcohol, and
still more so in ether. The strong mineral acids dissolve it without de-
composition. Alkaline chlorides render it more soluble in water, and
hence ammonium chloride is introduced into the officinal solution of the
sublimate, and it forms with it a double salt (sal-alembroth). A simple
solution in water readily decomposes, calomel being precipitated, and if
exposed to light and to contact with organic substances, metallic mer-
cury separates. Ammonia gives a white precipitate of ammonio-chloride,
potassic iodide produces the red iodide, potash a precipitate of the yellow

184 MATEKIA MEDICA AND THERAPEUTICS.

oxide, and nitrate of silver a curdy white silver chloride. Albumen also
combines directly with corrosive sublimate, and precipitates its solutions.
Liquor Hydraryyri Perchloridi Solution of Perchloride of Mercury
(v. p. 224).

HYDRARGYRUM AMMONIATUMAMMONIATED MERCURY WHITE
PRECIPITA TE, NH 2 HgCl, =251 .5.

PREPARATION. By adding solution of corrosive sublimate to ammo-
nia, chloride of ammonium is formed, and an ammonio-chloride of mer-
cury precipitated

HgCl, + 2NH 3 = NHJIgCl + NH 4 C1.

The ammonium salt is removed by washing, after filtration.

CHARACTERS AND TESTS. This compound occurs as a heavy white
powder, or in small cones marked by the linen filters: it has a metallic
taste; no odor; is insoluble in cold water, alcohol, and ether; soluble in
warm acids; decomposed by caustic potash, evolving ammonia, while yel-
low oxide of mercury is precipitated. Boiled with chloride of tin it gives
a precipitate first gray and then black, from the presence first of subchlor-
ide and metallic mercury, and next of the metal wholly; this has been
called the magpie test. " Chlorine and bromine both act violently on
white precipitate, forming mercuric chloride or bromide, the action in
many cases being attended with explosion. With iodine, an explosion
almost invariably takes placa after a few minutes: it would appear that
iodide of nitrogen is formed " (" Miller's Elements of Chemistry," 1878).

HYDRAROYRI 10DIDUM V1RIDE GREEN IODIDE OF MERCURY,

BfJ*=<NML

PREPARATION. By triturating together mercury and iodine in proper
atomic proportions: some rectified spirit is added in order to dissolve the
iodine, and to lessen, by evaporation, the heat evolved in the process.

CHARACTERS AND TESTS. The pure mercurous iodide is a yellow
powder, but according to the mode of preparation, or degree of exposure
to light, becomes greenish, and olive-colored or even black; it is insoluble
in water or ether; entirely volatilized when rapidly heated, but if warmed
slowly in a test tube, it yields a yellow sublimate (pure mercurous iodide),
metallic mercury being left: the yellow sublimate turns red on friction.

HYDRARGYRI IODIDUM RUBRUMRED IODIDE OF MERCURY,

HgI 2 ,=454.

PREPARATION. By mixing together boiling solutions of iodide of po-
tassium and corrosive sublimate: doubie decomposition ensues, and the
red iodide is precipitated.

HgCl J +2KI=2KCl + HgT J .

MEKCUKY. 185

CHARACTERS AND TESTS. A crystalline red powder, which becomes
yellow when gently heated, and again red upon friction or after cooling:
this change in color is due to a change in crystalline form, the yellow
crystals being rhomboidal, the red, octahedral prisms. The salt is insol-
uble in water, soluble in ether and solutions of iodide of potassium. The
presence of iodine may be verified by starch producing a blue color in a
solution which has been digested with soda and acidified with nitric acid.

HYDRARGYRI OXIDUM FLAVUM YELLOW OXIDE OF MERCURY,

HgO, =216.

PREPARATION. By adding solution of perchloride of mercury to ex-
cess of solution of soda: chloride of sodium and water are formed, and
the yellow mercuric oxide precipitates.

CHARACTERS AND TESTS. A smooth yellow heavy powder, becoming
gray on exposure to light; it is insoluble in water, readily soluble in acid,
entirely volatilized by heat, being resolved into oxygen and mercurial va-
por. This oxide is an allotropic form of the red oxide; it is smoother,
and combines more readily with certain acids; it is better adapted for
ointment used on delicate surfaces, as the eyelids, and is preferred for
the preparation of oleates.

HYDRARGYRI OXIDUM RUBRUMRED OXIDE OF MERCURY RED
PRECIPITATE, HgO, =216.

PREPARATION. By triturating and heating nitrate of mercury with
an equivalent of metallic mercury: nitrous oxide gas is given off.
Hg2NO 3 + Hg=2HgO+2NCv

CHARACTERS AND TESTS. An orange-red crystalline powder, almost
insoluble in water, soluble in acids, the solution giving a yellow precipi-
tate with caustic potash in excess, and a white one with ammonia; it is
wholly volatilized by a heat below redness, and was the salt from which
Priestley first disengaged oxygen (by .means of a lens and sun-light).

LIQUOR HYDRARGYRI N1TRATIS AC1DUSACID SOLUTION OF
NITRATE OF MERCURY, Hg2NO 3 ,=324.

PREPARATION. By dissolving mercury in cold, slightly diluted nitric
acid, when mercurous nitrate is formed.

3Hg+4HNO 3 =3HgNO 3 + 2H,O+NO.
By subsequent boiling, this is changed into the mercuric nitrate.

3HgN0 3 +4HN0 3 =3(Hg2NO 3 ) + 2
Free nitric acid is also contained in the solution.

186 MATERIA MEDICA AND THERAPEUTICS.

CHARACTERS AND TESTS. A colorless, strongly acid solution, from which
excess of caustic potash precipitates the yellow oxide; water also de-
composes the solution, precipitating oxynitrates. The presence of nitric
acid is shown by the darkening of crystals of ferrous sulphate when in-
troduced.

HYDRAROYRI SULPHURETUMSULPHURET OF MERCURY CIN-
NABAR, HgS,=232 (not officinal).

PREPARATION (L. P). By melting together, with proper precautions,
equivalents of mercury and sulphur, triturating the mixture, and then
subliming.

CHARACTERS AND TESTS. In dark-scarlet crystalline masses, which,
when powdered, become vermilion; volatilizes on heating; on reduction
with potash, the metallic mercury separates.

HYDRARGYRI SULPHAS SULPHATE OF MERCURY, HgSO 4 ,=296.

PREPARATION. By heating mercury with sulphuric acid, sulphurous
acid gas escapes, and mercuric sulphate and water are formed, as repre-
sented in this formula:

Hg+2H a S0 4 =HgS0 4 +SO a +2H s O.
The mixture is then evaporated to dryness.

CHARACTERS. A heavy white crystalline powder, which is decomposed
by water into a soluble acid sulphate and a yellow oxysulphate, known
as turpeth mineral.

HYDRARGYRI CYANIDUM CYANIDE OF MERCURY, HgCy a (not

officinal).

PREPARATION. By dissolving 1 part of ferro-cyanide of potassium in
15 of boiling water, adding 2 parts of mercuric sulphate, heating for ten
minutes, filtering, and cooling to crystallization: besides the cyanide,
mercury, ferric sulphate, and sulphate of potassium are formed in this
process.

CHARACTERS AND TESTS. Rectangular prisms, sometimes transparent,
generally opaque and white, taste metallic. Is stable in air, soluble in
water, sparingly so in alcohol.

ABSORPTION AND ELIMINATION. Metallic Mercury. The question
whether mercury can be absorbed in its metallic state, either by the skin
or the digestive tract, has scarcely yet passed from the region of debate,
and contradictory facts have been alleged concerning it. Von Hasselt
found the metal in the blood of mercurialized persons (Stille), and Colson
obtained a deposit of it from a brass plate placed for a time in contact

MERCURY. 187

with blood drawn from a patient who had taken the drug (Archives Gen.,
xii., p. 86). Claude Bernard filled the medullary cavity of a dog's femur
with quicksilver, closed the perforation with wax, and allowed the soft
parts to heal; three months afterward most of the metal had disappeared
from the bone, and was found in small globules encysted on the surface
of the lungs. In another dog the metal was injected into the jugular
vein, and twenty-five days afterward found " divise a, 1'infini," in the
cardiac tissue under the pericardium, so that it would not remain in the
blood, though taken up by it. Oesterlen used mercurial frictions on cats,
giving them also internally pills of blue ointment, and he Imported the
finding of mercurial globules, not only in the skin, but in most of the or-
gans. Overbeck confirmed these results on rabbits (quoted by Stille),
and Blomberg detected mercurial corpuscles in cats to which he had given
pills of citrine ointment (" Treatise on Absorption of Mercury," Hel-
singfors, 1868). The latter observer used mercurial friction on the arm
of a dead body, and found globules in the corium and mucous layers, but
not deeper.

Such observations would seem conclusive, but that Barensprung,
Rindfleisch, and others find it impossible to verify them: they have made
the frictions and given the pills, but they cannot find the metal in the
blood, nor yet in the corium. Autenrieth could find no amalgam on
plates of gold introduced into the subcutaneous tissue under the place of
friction, and Gubler and Neumann, while they recognized the metal in
the sweat-glands and hair-follicles, could trace it no further. Rindfleisch,
it is true, found mercury once in mesenteric glands after giving mercurial
pills, but there were ulcerations in the intestinal mucous coat which might
have permitted the passage of the metallic globules (Archiv fur Derma-
tol., iii., 1870). The most recent observations are those of Fleischer, who
concludes from numerous experiments, that " frictions with mercurial
ointment cause the penetration of metallic particles into the superficial
layers of epidermis, but not deeper: " and a consideration of the whole
evidence warrants this negative conclusion, that although metallic mer-
cury, when administered by the mouth in substance, or actually placed
within the tissues, may circulate and be deposited, it does not seem to be
altered or absorbed in the ordinary sense, and when applied by friction it
usually does not pass either into the deeper tissues or into the blood.

The physiological effects of mercurial frictions must be connected,
therefore, with its absorption in some other form: either mercurial vapor
is inhaled during the process, or a sebacic oxide of mercury enters through
the skin. As to the former point, we know that sometimes salivation has
occurred in a wife, six hours after a friction made by the husband upon
himself only, both living in rather a small room (Samelsohn, quoted by
Hallopeau); and additional evidence in favor of such an effect is furnished
by the delicate observations of Merget. He demonstrated that mercury

188 MATERIA MEDICA AND THERAPEUTICS.

volatilized at all temperatures, and, by means of iridium-paper (which
showed a dark stain on contact with the vapor), he proved its presence
on the hands or other parts of the body of persons who had spent only a
few hours in a workshop where it had been used ( Comptes JRendus, De-
cember, 1871). That the mercurial vapor is not absorbed only by the
lungs is evident from a carefully devised experiment by Fleischer (Er-
langen): he caused frictions to be made upon an arm while the patient
with face covered by a mask breathed only external air; the limb was
then carefully wrapped in wool and oiled silk for sixty hours, and during
that time tH% presence of mercury (in very small quantity) was verified in
the urine.

We may state then that mercurial vapor is absorbed, not only by tho
lungs but also by the skin, and indeed the results of ordinary fumiga-
tions when the head is external to the apparatus would be sufficient
to prove this. Gubler holds that the sweat-glands are the active agents
in this absorption, and Rohrig admits that mercury in vapor can pass
through the epidermis (Strieker's Jahrb., ii. 1873). It is probable also
that some may be absorbed as oxide in combination with fatty acids
(sebacic), or acids contained in the perspiration (Christison). Biiren-
sprung and others have proved the presence of such oxide in " blue oint-
ment;" Nevins calculated it at 1 part in 100, and Voit, analyzing por-
tions of skin which had been rubbed with it, found the oxide constantly
present. A soluble double salt may be formed with the chlorides of the
perspiration (Miiller), and, if mercurial oxides be given internally, Voit
argues that the chlorides of the blood can change suboxide into calomel
and peroxide into perchloride, which salts then combine with sodium
chloride and albumen.

Metallic mercury, given by the mouth, usually passes off unchanged
by the bowel; in the rare cases where it has given rise to constitutional
effects, a portion has probably been oxidized or changed into sublimate.
In the very finely divided form, when the metal is " extinguished " by
continued friction with chalk (gray powder), or with confection of roses
(blue pill), Rabuteau thinks it may be directly absorbed from the intes-
tine, but no doubt some oxidation occurs during trituration, and the
oxide would be soluble more readily in the acid of the gastric juice; mer-
cury in a volatile form would also be disengaged from such compounds as
readily within the body as without, at the same temperature. Mercurial
ointment or pill, introduced as a suppository into the rectum, produces
physiological effects perhaps more quickly than by the stomach. In the
various trades which require the handling of quicksilver such as barome-
ter- and mirror-making, gilding, and skin-dressing, and again, in miners at
Almaden and elsewhere the physiological effects produced are mainly
traceable to inhalation of the vapor.

Calomel. Calomel being not only insoluble, like metallic mercury, in

MERCURY. 189

ordinary liquids, but being also non-volatile, there lias been still more
speculation as to how it could reach the current of the circulation.

According to the classic theory of Mialhe, it becomes, like other mer-
curial compounds, changed more or less into the soluble perchloride by
the action of the gastric fluids, and is absorbed only to the extent of such
change. Mialhe argued from the results obtained by heating together
calomel and ammonium chloride in a test tube, but Buchheim and others
failed to verify any formation of perchloride in such a mixture at the
temperature of the body. Rutherford, experimenting more recently, di-
gested 5 gr. of pure calomel in distilled water, with .02 per cent, of free
hydrochloric acid (the same proportion as in gastric juice) at 100 F.
for seventeen hours, and obtained % gr. of perchloride, but it is unlikely
that even so much as this would be formed in the stomach; and the
action of calomel so far differs from that of corrosive sublimate as to
render it, clinically speaking, improbable that it only depends upon some
formation of the latter. Rabuteau, however, maintains that calomel does
become changed into perchloride and metallic mercury; also that this
perchloride combining with soda salts forms chloride of sodium, and sets
free more of the metal that under the influence of such changes the com-
pounds are absorbed acids and alkalies being afterward eliminated, and
the metallic mercury in part deposited. In this view, though complex,
there seems some analogy with what is known of the behavior of salts of
gold, silver, and some other metals, and calomel certainly resembles in
action preparations of metallic mercury otherwise we have no proofs
of such direct absorption of it, but rather the reverse.

Various observers have directed attention to the possibility of calomel
being rendered soluble in other combinations, e.g., with albumen (Buch-
heim), or as a double salt formed with chlorides of the blood (Graham).
Headland pointed out that bile exerts some solvent power on calomel
(Lancet, i., 1858), and Gubler asserts that an excess of various organic
materials albumen, mucous, epithelium acts similarly; some limit, how-
ever, must be placed to this observation, for the excess of mucin in the
stomach of a dog entirely prevented the absorption of calomel that had
been in jected into the stomach (Rutherford, Exper. 38). An experiment
of Tuson's is more to the point: he placed in one vessel calomel witli
dilute hydrochloric acid, and in another the same mixture with a propor-
tion of pepsine : after digestion for an equal number of hours sulphuretted
hydrogen was passed into the solutions and produced a black precipitate
in that with pepsine, but none in the other, proving clearly the effect of
the organic subtance in promoting the solution of the calomel (Medical
Times, i. , 1872, p. 518). Jeannel pointed out the importance of fatty
matters for the solution of calomel: in the presence of an alkaline carbon-
ate, it is readily decomposed with precipitation of gray oxide; of this lat-
ter a small proportion is retained in solution by the water, but if a fatty

190 MATERIA MEDICA AND THERAPEUTICS.

oil be mixed with the alkaline solution, this proportion is very much in-
creased: the same might readily occur in the intestine (Abstract :
Schmidts Jahrb., 1869, Bd. cxliii., s. 9).

It is quite possible, as H. Wood remarks, that in consequence of the
varying composition of the intestinal fluids and the complex chemical
relations of calomel, its solution and ultimate absorption may be accom-
plished in several ways: when more chlorides are present some per-
chloride may be formed, and when sulphuretted hydrogen is in excess
it may produce some amount of soluble sulphide.

Dr. Law, of Dublin, was the first to notice how much the absorption
of calomel could be promoted, especially in severe illness, by minute sub-
division of the dose, giving, e.g., T ^ gr. every hour (Dublin Quarterly
Journal, xiv., p. 393). Trousseau amply corroborated this observation,
and it is, d priori, reasonable, for the smaller quantities more readily
come in contact with the intestinal fluids to form the double salts or
soluble compounds described.

Bellini indicated a difference in the mode of absorption of calomel ac-
cording to the condition of the stomach: thus, when taken fasting, only
a small amount was at first dissolved, with formation of double chloride
of mercury and sodium, and lactate of mercury; more was dissolved in the
intestine, under the influence of alkaline carbonate, an oxide of mercury
being at first formed, and then a double salt; in the large intestine a sul-
phide was formed (except in the case of infants). Introduced into the
stomach during digestion, it was wholly, or almost wholly, decomposed
under the action of proteinous substances, metallic mercury being formed
and a soluble albuminate.

From the cellular tissue some calomel may be absorbed, since consti-
tutional effects have been produced by its hypodermic injection when
simply suspended in liquid, but the major part remains unabsorbed, and
frequently causes abscess.

Corrosive Sublimate. The absorption of corrosive sublimate may be
realized without much difficulty, because it is soluble in ordinary fluids;
an albuminate of mercury may form in the stomach, but is probably not
absorbed as such: the formation of a double salt with sodium is more
likely, and the same occurs with iodides and bromides of mercury: saline
or albuminous solutions of perchloride and aqueous solutions of cyanide
are also readily absorbed from the cellular tissue.

The chlorides and iodides may also be absorbed from blistered surfaces
(endermic method), and probably then also, double salts with albuminous
and alkaline constituents of the serum are formed.

Elimination. Although we cannot state positively the form in which
mercury circulates or is deposited within the system, whether in a vola-
tile form at first, or as very finely divided metal, or oxide, or as an albu-
minate, or (which is more probable) as a double chloride with soda or

MERCURY. 191

ammonium and albumen, yet we can be satisfied of its detection under
certain circumstances, in every organ, and in every secretion. With the
blood it seems so closely associated, that destructive distillation is usually
required for its detection, and in the milk, and even in the urine, there
has been difficulty in finding it, so that some observers have reported
against its presence (Kohler: Practitioner, vol. xvii. ; Cullerier: British
and Foreign Review, ii., 1852), but the more modern researches of Per-
sonne, Binz, Hamburger, and others, can leave no reasonable doubt on
the subject. Heller detected mercury in the foatus borne by a salivated
mother, and in the urine of an infant whose nurse was taking calomel.
Sometimes, however, it may not be discovered after inunction, though
readily after the use of mercurial suppositories (Prag. Med. Wbch., iv.,
1877; Lancet, ii., 1877). (The modern and accurate. method of detecting
mercury is by electrolysis.)

The question of its elimination by the milk is one of much impor-
tance, for large establishments have been formed in Paris for the treat-
ment of syphilitic infants especially, through the milk of nurses or of
goats that have taken mercury: such treatment is constantly adopted
with good result, and there is abundant clinical evidence of its value.
With regard to the time during which mercury remains in the system, it
is ascertained that of a single dose elimination is rapid, and is apparently
completed within twenty-four hours; for -J- gr. of perchloride having been
taken, the urine contained traces for that period, but not afterward; and
.075 gramme (about 1 gr.) having been injected under the skin of a rab-
bit, none could be discovered in any part of the body four days after-
ward (Mayen9on and Bergeret: Robin's Journal of Anatomy, No. 1;
Lancet, i., 1873). M. Byasson injected \ gr. of sublimate under his own
skin, and found mercury in the urine two hours afterward, and at the
end of four hours in the saliva, but after twenty-four hours he detected
no more. If treatment have been continued for some time, mercury may
be found in the urine for several days afterward; thus, in the urine of two
patients who took ^ gr. daily for ten to twelve days, the drug was found
for four or five days after treatment had been omitted.

During a mercurial course, the greater part of the drug is eliminated
almost as soon as taken, but some remains in the tissues and passes out
insensibly; and when the doses have been large and long-continued,
some may be retained in the organism for months or even for years. It is,
in fact, impossible to recognize exactly when its elimination is complete,
though it is probably not so prolonged as that of gold, lead, or silver
(Husemann). Years after its prolonged administration, unusual perspi-
rations may develop dark mercurial stains on the linen, or a white coat-
ing be given to a piece of copper on handling it (W. Pope, quoted by
Stille). Salivation may reappear without apparent cause (unless a chill);
sometimes it has been traced to the use of sulphurated mineral waters,

192 MATEKIA MEDICA AND THERAPEUTICS.

and occurred in one patient ten years after taking 1 the medicine (Har-
tung, quoted by Hallopeau). I have myself seen five patients, while
under the influence of nitric acid, suffer from salivation and other physi-
ological symptoms of mercury, and none of these had taken that drug
for over eighteen months previously: I considered it clearly traceable to
the mercury in the system, and not to the acid. The metal has been
found in the liver of a workwoman who had not, for twelve months pre-
viously, been exposed to mercurial vapors, and in the liver and kidneys
of another who died of phthisis six months after leaving her work at a
mirror factory (Kussmaul, Gorup Besanez: Wien, Med. Wbch. y 1SG2).

Melsens pointed out (1844) that iodide of potassium favored the elim-
ination of mercury as well as of lead, and in many cases it has been found
that elimination, which had ceased, has been renewed under the influence
of the iodide; yet this influence is not always sufficient to complete the
process, for Kussmaul found a quantity of mercury in the viscera of a
patient who had taken none for four months, and who, in the course of a
month, had taken 2 oz. of the iodide.

Riederer has made experiments to ascertain the quantity of mercury
that may be found in different organs or secretions: of about 10 gr. of
calomel given to a dog in thirty-one days, he recovered four-fifths the
largest proportion from the faeces, the next from the urine, the liver, the
thoracic viscera and brain, and the least from the muscles (quoted by Hal-
lopeau, p. 58). Other observers agree that on section of an animal sub-
jected to the action of mercury, the largest amounts are found in the
liver and kidneys (and not in consequence of their containing more blood
than other viscera, for the blood contained a much less proportion of the
drug); it must therefore be considered to have a special determination
to the liver and kidneys, and it is eliminated mainly by the bile and the
urine; in this respect it resembles other metals.

PHYSIOLOGICAL ACTIOX (EXTERNAL). The local action of mercury
varies according as to whether the metal itself is used, or one of its solu-
ble or insoluble compounds, and of course according to the strength of
the preparation; and on account of the volatility and the ready absorp-
tion of the drug, its local use often induces its systemic effects.

Metallic mercury produces upon the skin no other local effect than a
sense of coldness. Mercurial ointment applied by friction is usually well
borne, but sometimes excites a red or vesicular eruption (mercurial ecze-
ma), more or less intense; ointment of the red oxide is painful to sen-
sitive parts, and that of the red iodide may irritate very severely, even
to vesication: if not perfectly fresh an additional source of irritation is
found in rancid lard: good calomel ointment is rather soothing than
otherwise.

A strength of 2 gr. of corrosive sublimate in the ounce of liquid suf-
fices to destroy parasitic life; a stronger lotion irritates. Cloquet, the

MERCURY. 193

distinguished anatomist, suffered from severe local and general symptoms
after handling some preparations steeped in a strong solution. A pro-
portion of 10 gr. to the drachm of alcohol vesicates, and when applied to
the scalp has caused death in a child (J^ancet, ii., 1871). In two other
children, the use to the scalp of an ointment containing 120 gr. to the
ounce of tallow also caused death (Dublin Journal, August, 1854). The
solution of the metal in nitric acid (liquor hydrargyri nitratis acidus) is a
powerful and painful caustic, and its application has sometimes, thougli
not frequently, been followed by severe general symptoms: it combines
with albumen and fibrine, producing a white eschar.

On the mucous membrane of the intestinal tract mercurial compounds
may exert a local action of the same nature as upon the skin. Quicksil-
ver, in doses of oz. or more, will usually pass through the intestine by
its mechanical weight, and unaltered; sometimes it has caused perforation.

PHYSIOLOGICAL ACTION (INTERNAL). In studying the action of this
medicine, it is more than usually important to distinguish between the
effects of small and of large doses. Modern observation shows us that
the former are rather of tonic and constructive character, while older
records have told us only too well the fatally destructive results of the
" heroic " administration of the drug. I do not mean simply that one
grain, e.g., of calomel has a different effect from twenty: we must esti-
mate the dose rather by what is absorbed of it, and by the results shown,
especially by the state of the mouth and the secretions. Practically we
can either give the medicine so as to cure without marked effect upon
these, or so as to produce only moderate effects, and it is this "slight
mercurialization" which requires to be distinguished from the severe form
which should be called rather mercurial poisoning, and is accompanied
with stomatitis, salivation, diarrhoea, cachexia, etc. A similar difference
of degree exists, of course, in the action of all powerful medicines, but it
requires more attention in the present instance, because our predecessors
thought to give benefit only by what we consider a poisonous action of
the drug,^and it consequently fell into undeserved discredit. There is,
further, a chronic form of mercurial poisoning which may still be met
with in various trades, and this differs in some respects from any condi-
tion produced by modern medication.

Circulatory System. Recent observations as to the action of mercury
on the blood illustrate well its different effects, since they show that, in
quite small doses, it increases the number of red corpuscles, and improves
the blood-condition. Grassi proved this by analyses, and Wilbouchewitz
counted carefully under the microscope the average number contained in
a millimetre-cube, and his patients (ten in number) then took either gr.
of sublimate daily, or ^ gr. of proto-iodide: during the first fortnight of
treatment the increase of corpuscles amounted to nearly one million.

These patients were syphilitic, and probably the anaemia of their
VOL. II. 13

194 MATERIA MEDICA AND THERAPEUTICS.

malady was benefited by the antidotal action of the mercury, for the remedy
being continued beyond a certain time (and thus allowed to accumulate
in the blood), the red globules diminished in number, so that, by the end
of the second fortnight, they counted the same as before any treatment.
Mercury being then omitted altogether, the corpuscles increased again
within a week's time. The inference is clear too much of the drug im-
paired the blood-condition, but a little improved it. When it was omitted,
and when, after a few days' time, only a small proportion remained in the
blood, the original improvement was again observed: the white globules
varied in an inverse ratio (Archives de Physiologie, 1874). Keyes repeated
these observations, and concluded that small doses of mercury increase
the blood-corpuscles in all subjects, whether syphilitic or not; and further,
that this increase is not temporary: he has never seen hypoglobulism
i.e.) a lessened average number of corpuscles, caused by small doses
(American Journal, January, 187G). Possibly the difference between
these two observers may arise from difference in dosage, Wilbouchewitz
giving the rather large quantity of " gr. sublimate daily;" no doubt
mercury in any form, continued long enough, and absorbed, will produce
a. destructive effect on the corpuscles, and a condition of "spansemia."
Long ago, Bretonneau and Dumont reported that the blood-clot in mer-
curialized animals was either absent or was soft and diffluent. Headland's
expression is that mercury " disintegrates and decomposes the blood "
(Lancet, i., 1858), and Wright's analysis showed it to be more fluid and
less coagulable than normal, its albumen, fibrine, and red globules being
diminished, and a foatid, fatty material being formed in it. Gubler has
also corroborated this destructive effect, and yet Lemaire and Gelis found
"mercurial treatment to increase plasticity of blood." Autenrieth ques-
tions the analysis of Wright, and more lately Overbeck found in animals
poisoned by mercury the venous blood dark and thick, the arterial blood
clear and coagulating well, fibrine increased: probably these results were
connected with inflammatory reactions, but, if verified, they tell much
against any available " aplastic power" of mercury in inflammation;
still, the ultimate effect of the drug is destructive. Polotebnow, adding
mercurial albuminate to the blood of dogs, found the corpuscles rapidly
destroyed, with loss of hjematine and pigment (Schmidt's Jahrb., 1865,
125, 3). Wilbouchewitz, giving calomel to rabbits (and not in large
doses), noted a rapid diminution of corpuscles. Trousseau found that
leech-bites that had ceased bleeding, bled again in patients submitted to
mercurial treatment, but beyond any single fact is the general expe-
rience that too much of the drug induces after a period of malaise,
restlessness, and febrile symptoms a chlorotic pallor of the skin, with
signs of enfeebled circulation, distress in breathing, intermittent pulse,
and palpitation; such a condition, when fully developed, is difficult of
cure; it may last long, and end fatally.

MERCURY. 195

Fothergill includes mercury among his "cardiac depressants," and G.
Harley, having injected sublimate into the femoral vein of a dog, found
that cardiac paralysis was produced before intestinal contractions ceased
("Proceedings of the Royal Society," 1864).

Nutrition. Nutrition is so closely connected with haematosis that we
shall be prepared for the modern observations that it also may be improved
by small doses of mercury. Keyes found this to be the case the weight
of his subjects increased under their course, and the remedy acted "as a
tonic." Hufeland had previously made a similar observation, and Basset,
Liegeois, and others corroborate it: the last-named observer considers
sublimate in minute doses "comme un rc'constituant des plus puissants "
(Annales de Dermatol., i., ii., 1870), and M. Clerc reports the same ex-
perience (Gazette de Paris, 1872, p. 481): it has been verified also, inde-
pendently of syphilis, on animals, and especially rabbits.

On the important question of urinary excretion the principal evidence
is negative. We need more research in this direction, but so .far the
evidence does not favor the theory of mercury (in small doses) curing
disease by increase of tissue-change that it lowers the temperature in
animals (except during the stage of " erethism "), and that it does the
same in fever (Wunderlich), I should take as evidence of its lessening
change, rather than the contrary, as Husemann does. Altogether, at
least in the doses under consideration, mercury merits the name of
"moderator of nutrition," rather than of alterative (Rabuteau); and in
this role we can see its analogy with small doses of arsenic, antimony, etc.,
under which, as is well recognized, weight may be gained, and nutrition
improved. Under full or poisonous doses, when the blood-corpuscles are
destroyed, the secretions are rendered profuse, and digestion impossible,
nutrition is, of course, profoundly impaired, and waste of tissue progres-
ses most rapidly.

Digestive System. Small (therapeutical) doses of any preparation are
usually well borne by the stomach. Rabuteau cites cases where many
hundred pilules of proto-iodide have been taken in the course of one to
three years without any gastric disturbance: yet we must allow for some
idiosyncrasy in this respect, and practically we find that those who have
resided long in the tropics, and fair, delicate women and chronic dyspep-
tics are very sensitive. It is not, however, possible to say beforehand
what amount of mercury will produce the characteristic effects on any
given case a single friction or a few grains may produce in one patient
what many weeks of treatment will not do in another. Single doses of
calomel from 1 to 5, 10, or even more grains produce thin and " bilious "
stools without much griping. If the intestine of an animal be examined
after such actions, it will be found reddened, especially in the upper part,
and its glands stimulated. As a rule, ordinary care will early detect
symptoms of constitutional action in the mouth, such as a sense of heat,

19C MATERIA MEDIC A AND THERAPEUTICS.

metallic taste, sticky coating of the tongue, increased flow of saliva, and
perhaps slight tenderness of the gums. On continuance of the medicine,
these latter symptoms increase and diarrhoea occurs, with some nausea.
The stools, at first feculent, become thin and sometimes papescent with
mucus, sometimes yellow, or dark or grass-green (the latter especially in
children: they have been compared to " chopped spinach"): sometimes
blood appears in the motions, and severe colic and tenesmus occur. The
tongue is said to show a greenish coating with two longitudinal red
stripes (Traube). In severe cases, when the poisonous action of mercury
has been induced, intense stomatitis appears, with swelling of the tongue
and gums, membranous deposit, fetor, loosening of teeth, and severe pain
and difficulty in mastication. The salivary glands become enlarged and
tender, and a vast amount of secretion pours from the mouth: 10 Ibs. of
it have been secreted in twenty-four hours: at first viscid as usual, it soon
becomes thin and very watery, containing albumen, mucus, and alkaline
chloride (Thompson). Children and the aged are seldom salivated
Graves suggests because their salivary glands are " inapt " diarrhoea or
prostration is with them the earliest symptom. Salivation is connected,
too, with local causes: it comes on more quickly when the mouth is un-
clean, and may be almost wholly prevented by great care with the teeth:
dental caries will determine it; it is said to commence by the last molar
of the side on which the patient mostly sleeps (Ricord): also the irritation
of a wisdom-tooth, or of a pipe, will influence it.

Such fajts have led to the supposition that salivation is only second-
ary to buccal soreness, but this is incorrect: it may be induced by rub-
bing mercury over the parotid, and before any irritation is produced.
Ricordi detected the drug in saliva drawn from Steno's duct, by a cathe-
ter, in animals, when calomel had been injected beneath the skin; and
salivation occurs, as we know, independently of mouth-irritation from the
action, e.g., of gold, iodine, various acids, etc., as well as during preg-
nancy and certain diseases. The safe test of a mercurial salivation is de-
tection of the metal in the secretion. Women seem to be more readily
affected in this way than men, and the subjects of granular kidney, of
scrofula, and of scorbutus are peculiary susceptible (Christison and
others). It occurs more frequently under fractional (non-purgative) doses
of calomel, or inunction of blue ointment, than from fumigation, supposi-
tories, or injections: it is markedly less under the use of sublimate,
iodide, or cyanide, than of insoluble preparations, either on account of
the smaller dose of the former employed, or of some peculiarity in their
elimination. Ulceration, or sloughing of the gums, hemorrhage, periosti-
tis, and prostration of even fatal character have occasionally followed a
profuse salivation, and necrosis, scars, and contractions have accompanied
even recovery.

We have seen that a local action, irritant in character, is exerted by

MERCURY. 197

most compounds of mercury on the alimentary tract; but IT. Wood
speaks of calomel as "free from all irritant properties," and Lente ar-
gues that large doses (one teaspoonful) act in a sedative manner (New
York Journal, 1870, vol. xi.) this was the argument of Annesley, but it
is not a safe one to act upon. The irritation excited by corrosive sublimate
in toxic doses is, however, the most severe: there is an acrid taste, and a
sense of burning and constriction in the mouth and fauces, with whiten-
ing and shrivelling of mucous membrane if the dose be concentrated:
vomiting and purging with tenesmus usually occur, with passage of blood,
suppression of urine, and general symptoms of gastro-enteritis: after
death, signs of inflammation, contraction, or ulceration have been found,
especially in the stomach and upper part of the intestine, and that this
is not merely a local effect is proved by its occurrence when the drug
has been administered by the skin. Profound depression is usually a
symptom of sublimate poisoning, and is sometimes more marked than
pain, vomiting, or purging; salivation is by no means constant in acute
cases.

The iodides of mercury act much like corrosive sublimate, the red
iodide being more actively irritant than the -green one. The red oxide
produces similar lesions of the intestinal canal (Orfila); it is not given in-
ternally in medical practice, nor is the ammonio-chloride (white precipi-
tate), but in a case when a large quantity of the latter compound caused
death, the stomach was found contracted, and its lining membrane ecchy-
inosed (Guy's Reports, 1874). The liquor hydrargyri nitratis has pro-
duced intensely severe effects on the intestinal tract, and irritant poison-
ing has followed the accidental use of the sulphides and the cyanide of
mercury.

Glandular System, Liver, etc. Most of the glandular organs are lia-
ble to become congested, and stimulated under the influence of mercury.
This has been noted not only of the salivary glands as already described,
but also of the pancreas and intestinal glands, the kidneys and the liver,
the testis and lymphatic glands of axilla and groin (C. II. Jones: Medico-
Chirurgical Transactions, vol. xxxv., etc.). As illustrating the effect
on the pancreas, Dr. Copland recorded a case, where, in addition to sali-
vation, deep-seated epigastric pain set in, with nausea and diarrhoea of
thin fluid resembling saliva; after death the gland was found large and
congested. Radziejewski found, on analyses of the stools after giving
calomel, a large proportion of leucin, tyrosin, and indol (pancreatic secre-
tion), which he did not find after other purgatives (Reichert's Archiv,
1870). That calomel also stimulates the intestinal glands has been de-
monstrated by Rutherford.

The mode of its action on the liver is still a subject of discussion, and
the conclusions of some physiologists on this subject are opposed to those
of many practical physicians. Up to a recent period, mercury was uni-

198 MATERIA MEDICA AND THERAPEUTICS.

versally regarded as a typical " cholagogue," in the sense of its stimulat-
ing both the secretion and the excretion of bile, and hence was commonly
employed, both in cases of deficient secretion to stimulate, and in cases
of excessive secretion to " carry off " the excess.

The early experiments of Murray were taken to corroborate the theory
of "cholagogue" action, for, after giving purgative doses of calomel to
dogs, he found increased discharge of bile, mucus, and serum from the
bowels (quoted by Morehead, 1841). Buchheim also reported an increase
in the amount of bile discharged by dogs with biliary fistulas. Still more
important evidence was furnished by the analyses of Michea, which were
made first upon the normal stools of six healthy subjects without detect-
ing bile; then, with nearly like result, upon the green stools of persons
suffering from diarrho3a; then upon the greenish motions which occurred
in eight healthy persons after taking calomel, and in all of which bile
was clearly detected; and lastly, upon discharges produced by different
saline and resinous purgatives, and in which no bile was found (Lancet,
i., 1849). Although these observations show an increased discharge of
bile under calomel it is clear that they do not necessarily prove an in-
creased secretion by the liver-cells, and therefore experiments on animals
as to this point were undertaken. Kolliker and Miiller, after giving cal-
omel to dogs with biliary fistulse and collecting the bile discharged, report-
ed contradictory results the secretion being in one instance increased,
while in two others it was diminished (1855). Scott, experimenting with
large doses of calomel on four dogs (also with fistulse), recorded diminu-
tion of both fluid and solid biliary constituents in all the animals (Beale's
Archives, i., 1858). Mosler, with two dogs, obtained a similar result
(Virchow's Archiv, xxxii.); and Hughes Bennett, reasoning from the
experiments of the Edinburgh committee, announced, as a positive fact,
that mercury really lessened the biliary secretion in man as well as in
animals (1868). The experiments on which this physician founded his
important conclusions require a brief consideration: they were made upon
forty-one animals, and on account of difficulties in the operations, etc.,
results considered satisfactory were only obtained in nine instances in
four of these calomel was used : a permanent fistulous opening into the
gall-bladder was very carefully effected, and about fourteen days after-
ward the bile was collected on a sponge. The first dog, before taking
any drug, secreted a daily average of 82 gr. bile-fluids, and 5 gr. of bile-
solids; after taking 4 to 12 gr. calomel daily, it secreted only a daily to-
tal average of 60 gr. ; but it must be noted that the animal's condition
was much impaired, it took little food, and soon afterward died. The
second dog got smaller doses (^ gr.) every hour; the general health be-
came affected, and it soon died: the average bile-secretion was about the
same, before and after giving the drug. The third dog received some
blue pill in addition to the small doses of calomel, and the bile-average

MERCURY. 199

was diminished one-half; the animal suffered much. The fourth dog got
purgative doses, with an average bile-diminution while under their influ-
ence; on one day, however, when blue pill was given, the average was
increased (British Medical Journal, i., 1869). Such results scarcely
warranted Dr. Bennett's conclusions, which were, indeed, publicly contro-
verted by Christison, Fraser, and other members of the same committee.
Rohrig (of Kreuznach) reported that large doses of calomel slightly in-
creased the bile-secretion (Strieker's Jahrb., ii., 1873), but we may take
the more recent experiments of Rutherford and Vignal as showing, so far
as experimental research can show, that the drug does not really do so.
They proved (1) " that doses of 10 gr., 5 gr., or 2 gr., several times re-
peated, placed (without bile) in the duodenum of a fasting dog, produced
a purgative effect varying with the dose, but so far from increasing bile-
secretion, usually diminished it; (2) that there is no difference in the result
if the calomel be given in 1-gr. dose, several times repeated, mixed witli
bile and introduced into the duodenum " (British Medical Journal, ii.,
1875-76; Practitioner, December, 1879). On the other hand, the same
observers found that corrosive sublimate in doses of and T 1 ^ gr. power-
fully stimulated the secretion of bile, while it did not stimulate the intes-
tinal glands (British Medical Journal, ii., 1877). They further instituted
experiments which showed that calomel does not become changed into
corrosive sublimate to any appreciable amount under the influence of the
organic secretions. Rutherford himself notes that the experiments re-
ferred to do not prove anything as to the action of mercury on the bile-
expelling apparatus, and we may grant that they are correct without any
denial of the clinical fact that a purgative dose of calomel will increase
the amount of bile discharged by the bowel; it may do this, not neces-
sarily by a previous stimulation of the liver, but either by irritating to
unusual contraction the gall-bladder and gall-ducts, or by lessening a con-
gested condition of these parts, through the discharge induced from in-
testinal glands.

Dr. Lauder Brunton has further pointed out that the clinical fact of
calomel relieving " bilious conditions," receives from the experiments of
Schiff and Lusana an explanation not at all inconsistent with Ruther-
ford's conclusions (Practitioner, vol. xii.); these experiments go to prove
that the liver not only secretes bile, but also excretes it, separating from
the blood a part of that which (normally) circulates in it: for after
effecting biliary fistulas in animals, bile flowed at first freely afterward,
in much diminished amount, independently of any drugs. This diminu-
tion was accounted for by the passing away of bile so soon as formed,
and the consequent impossibility of its being reabsorbed from the duode-
num into the circulation, to be again excreted, for if fresh bile were
passed into the blood by intravenous or cutaneous injection, then the
amount of excreted bile was a^ain increased. Schiff further showed not

200 MATERIA MEDIC A AND THERAPEUTICS.

only that bile can thus circulate without giving rise to jaundice, but that
it probably always does so, passing from the liver to the duodenum,
thence into the blood, and so to the liver again, a portion only, more or
less changed, passing out by the faeces.

This tallies with the observation of Murchison, that " by increasing
the elimination of bile, and lessening the amount circulating in the portal
blood, mercury is a t'rue cholagogue, relieving the liver thus, more than
by merely stimulating it to increased secretion " (Lancet, i., 1874). The
green, liquid, spinach-like stools produced by calomel have been variously
attributed to intestinal irritation, to altered htematin (Golding Bird,
1845), and to subsulphate of mercury (Thudichum); it is possible that
they may contain sometimes mercurial compounds, but they certainly
often contain bile. According to Simon's analysis of the fifth stool
passed after a large dose of calomel, it was fluid, green, without faecal
odor, of acid reaction, and contained mucus and epithelial cells, fat, choles-
terin, bilin, and bile-pigments no mercury whatever (" Animal Chemis-
try," vol. ii.).

Genito-Urinary System. Women affected with mercurialism are
liable to abort (Colson, Lize), yet it is equally proved that syphilitic wo-
men should be treated with medicinal doses, for in such doses mercury
may save them from abortion (M. F. Weber, 1875). The influence on
menstruation is not constant; generally, this will be diminished, but
sometimes much increased.

Lusana found that mercurialism in fowls prevented the laying of
eggs, and Gaspard, that the vapor of quicksilver prevented eggs from
coming to maturity.

Small (therapeutical) doses exert no marked effect on the kidneys,
but we have seen that the drug is largely eliminated by those organs.
Overbeck, indeed, found leuciri and results of disintegrated albumen in
the urine of animals (Husemann), but E. R. Harvey, experimenting on
dogs, found the quantity of urine unaffected, the phosphates always di-
minished, the urea not increased beyond a normal variation (British and
Foreign Jteview, i., 1SG2). Von Bock could find no definite change in
the excretion of nitrogen or uric acid (1869). Bouchard reported a di-
minution of urea, but his patient had urajrnia (1874); and more recently,
Conty, after observation on twelve syphilitics, taking therapeutic doses
of proto-iodide, could verify no definite alteration. During pronounced
mercurialism albuminuria may occur with or without hrematuria (Pavy,
Overbeck, Kiissmaul). After death, congestion and fatty degeneration
have been found (Balogh and others); and Ollivier has pointed out the
analogy between such conditions and those produced by lead.

The albuminuria does not necessarily imply altered renal structure,
it may be dependent only upon general dyscrasia and loading of the
blood with organic debris (Gubler), but, in severe or prolonged cases, stea-

HEBCURY. 201

tosis is very probable. Bouchard has recorded two important illustra-
tions; in one case of acute mercurialism, five days after salivation had
commenced, suppression of urine occurred, and on the ninth day the pa-
tient died comatose, and a very large amount of urea was found in the
blood, almost proving that uraemia was the cause of death. We have
not details of the second case, but in both the Malpighian bodies were
found to contain, or to be changed into, mineral matter, proved to be car-
bonate of lime (Ilallopeau, p. 113). This condition is very interesting
when compared with Salkowski's results in rabbits; he injected fractional
doses of sublimate, of iodide, and of calomel, and after death, found con-
stantly lime and soda deposits in the Malpighian bodies; the urine be-
came pale and contained sugar. Cornil also found calcareous deposits,
and Kletzinski reported diabetes.

Nervous System. From the medicinal use of mercury we seldom see
definite effects on the nervous system, beyond a temporary malaise, chilli-
ness, depression, or erethism; the severe symptoms of neuralgia, tremor,
convulsion, or paralysis are met with only in persons exceptionally, or for
a prolonged period, exposed to its action, such as those who work with it
and suffer from a "chronic mercurial poisoning." A grain of calomel or
blue pill has been taken every night for more than forty years without
other than good effects apparently, for one cannot argue much from fatty
degeneration, at the age of seventy-four (Medical Times, ii., 1867). On
the other hand, tremor has developed in one night under the influence of
strong mercurial fumes (Christison), but, as a rule, the slow and con-
tinued absorption by the skin and the lungs of metallic quicksilver or its
vapor is the cause of symptoms such as those we are now considering.
Anstie pointed out that sensory nerves were sometimes affected by it,
" a selective affinity " being shown for the fifth, whence an attack of
severe and persistent facial neuralgia; but severe pain may also affect the
head generally, or all the limbs (Lancet, ii., 1872); the pains are usually
made worse by warmth; tingling or other alterations of sensibility may
be experienced; there may be partial anaesthesia or analgesia which either
varies, as in hysterical subjects, or may be permanent; abnormal sensa-
tions of cold are also described. Tremor is the most constant symptom
of chronic mercurialism: all the workmen in mercurial mines suffer from
it, and sometimes it is the only symptom apparent, there being neither
salivation, nor erethism: it commences usually in the lips and the tongue,
and soon affects the upper extremities; it is most marked, like the tremor
of sclerosis, under the influence of voluntary movements, or of fatigue;
it may exist in all degrees up to severe convulsive movement affecting
the whole body (called "calambres" at Almaden): slight cases of tremor
are curable in a few weeks; more serious ones last for months or years,
and yet the subjects continue to walk and to work. The tremors cease
during sleep, and also, it is said, during intoxication; this is an interest-

202 MATEBIA MEDICA AND THERAPEUTICS.

in"- fact, as also is the transmission of the malady by inheritance, so that
children are born in the state of tremor.

The phenomena of exaggerated action pass, after a time, into those
of paralysis, so that one or more muscles may cease to answer properly
to the will, though muscular power is retained (as in locornotor ataxy);
the extensors are often effected: sometimes the paralysis is temporary,
and of hemiplegic character; electro-muscular contractibility is preserved,
but atrophy of muscles may occur.

It remains to note the mental condition in chronic mercurialism: emo-
tional sensibility is generally heightened, the patient is timid and easily
excited, intelligence is weakened, and a delirious condition (like that of
delirium tremens) occurs in paroxysms; sleeplessness is marked. We
cannot say that true epilepsy is produced, though the convulsive attacks
may have been called by that name, but giddiness and noises in the ears,
musc<e, nausea, and tendency to fall, constitute a condition resembling
at least "petit mal." It is not likely that apoplexy can be directly con-
nected with mercurial poisoning.

With regard to the pathology of the nerve-symptoms described, Anstie
suggested that the cortical gray matter was mainly affected. Ross, in his
able paper, seems to think that an effect on the connective tissue of the
nerves would explain it (Practitioner, 1870). Mercury has been found
by analysis in the brain, but we can scarcely consider its effects to be
directly and locally poisonous to the nerve-cells: we may gain some light
from the changes discovered in cases of alcoholic or saturnine saturation
of the nervous centres, and those we find to be mainly chronic inflamma-
tion and fatty degeneration (Lancereaux, Vulpian).

Cutaneous System. We have spoken of the local irritation that may
be excited by mercurial frictions. There may be merely erythema with
much itching, or an eczematous (vesicular) rash, or even erysipelas and
gangrene (Stille). The internal use of mercury may also, exceptionally,
give rise to eruptions, of which Bazin has distinguished three forms,
" hydrargyria mitis, febrilis, and maligna," showing either a simple efflor-
escence about the thighs, the scrotum, abdomen, and axillae, or a more
intense form with vesicles, or one still more severe with general oadema
and purpuric rash. The general symptoms in such cases may be serious:'
desquamation occurs in the milder forms about the eighth or tenth day;
malignant forms (which I have never seen) may give rise to adenitis, ab-
scess, or ulceration. Occasionally, owing to idiosyncrasy, a scarlatinoid
rash may be excited by a single dose, as by f gr. of proto-iodide in a case
recorded by M. Fournier (Hallopeau): one application of acid nitrate pro-
duced the same effect, as also did a few Dupuytren's pills ( \ gr. sublimate).
If cachectic ulceration be present, the action of mercury is likely to in-
crease it, and ulcerations in the mouth especially may be caused by it:
they are more irregular and less indurated than syphilitic ulcers.

MERCUHY. 203

In exceptional cases, the secretion of sweat has been increased, it
being 1 of a clammy character and fetid odor: a general brown color of
skin or the occurrence of rupia and ecthyma has been sometimes
noted, but it is not true that eruptions really equivalent to syphilitic
eruptions are produced by mercury.

The hair and nails are said to have fallen off under its use. The teetli
are said to show the effect of the drug, especially when administered in
infancy, by a deficiency in the enamel, most marked in the first molars
(Hutchinson: Medical Times, ii., 1876, p. 242; Laycock, i., 1862, p. 450);
but this is not yet an established fact.

With regard to the tissues of the eye, we have evidence that iritis and
retinitis may be produced by the continued employment of mercury, but
a more usual condition is conjunctivitis, which occurs with the ordinary
symptoms, such as suffused redness and injection, smarting, burning, and
some excoriation and purulent secretion.

Osseous System. A form of periostitis occurs sometimes during a
course of mercury, and it has been a question whether this is due to the
remedy or to the malady (syphilis), for which it is commonly prescribed.
Pereira thinks the latter supposition correct, but Graves states that he
has seen periostitis occur in patients mercurialized for some other illness,
and who had never contracted syphilis, and to this I can add my own tes-
timony, having witnessed such an occurrence several times. The tibia,
the bones of the forearm, the clavicle, sternum, and frontal bones are
those more commonly affected, and the pains, intermittent at first, are
increased by warmth, or by changes of temperature, though sometimes
relieved by a low temperature. The articular ends of the bones are lia-
ble to be affected, and even caries may be produced.

SYNERGISTS. Agents which fluidify the blood and secretions, such as
alkalies, favor a similar action in mercury. Oxygen, dilute acids, arid
alkaline chlorides favor the transformation and absorption of metallic
mercury, and hence assist its action. Bellini, however, concluded that
these agents lessened the effect of mercurial chlorides and iodides by pre-
venting the action of carbonated alkalies upon those salts in the intestine,
and impairing the formation of double salts: magnesia he found distinctly
adjuvant, it giving rise. to a double chloride with mercury. Carbonate of
soda has been found to increase its purgative effect (Hunt: British and
Foreign Review, ii., 1852), and rhubarb, colocynth, jalap, or other purga-
tives are used to aid its action on the liver or intestine.

Alkaline iodides markedly increase the constitutional action of mer-
cury Wreden has especially shown this (Central Zeitung, 99, 1874, and
British Medical Journal}. A skin rubbed with blue ointment, and then
after an interval, and after cleansing, rubbed with iodine ointment, be-
comes much inflamed, evidently from a chemical combination (biniodide
of mercury). Milk, bromides, sulphites, and prussic acid, are also said to

204 MATER1A MEDIC A AND THERAPEUTICS.

increase the effect of mercurial compounds (Bellini), and the good effects
of mercurial treatment in syphilis are specially aided by the concurrent
use of the sulphurous waters of Aix-la-Chapelle (British Medical Journal,
i., 1874, p. 108).

ANTAGONISTS AND INCOMPATIBLES. Sulphur, especially in the form
of sulphuretted hydrogen, antagonizes the physiological action of mer-
curial compounds, whatever their therapeutical relations may be (see
above). Chlorate of potash controls, to some extent, its salivating
powers; astringents, such as alum and tannin, lessen fluxes, and tonics
and stimulants oppose mercurial cachexia.

Finely divided iron, or zinc, or gold, acts as a mechanical antidote in
cases of mercurial poisoning (Johnston: American Journal, April, 1863),
but albumen is, perhaps, more efficient: the white of one egg is calculated
to form an insoluble compound with 25 centigrammes (about 3 gr.) of
sublimate (Peschier).

Treatment of Mercurial Poisoning (Acute). By an emetic of ipeca-
cuanha, if necessary, the poison should be as far as possible removed, and
then albuminous demulcent drinks freely administered. The white and
yolks of raw eggs with milk are very suitable, or gluten may be prepared
by washing flour in a muslin bag under a stream of water, or the flour
itself may be given in a paste (Tanner). Opium may be required for the
pain and purging, and, for the mouth-condition, gargles of alum or borax.
For salivation sulphur has been strongly commended, and to promote
elimination, when the acute symptoms have subsided, the iodide of potas-
sium is to be advised. The symptoms of poisoning by corrosive sublimate
are sometimes insidious, and after evacuating the stomach a principal in-
dication is to sustain the strength. In a man under Dr. Mackey's obser-
vation, who had taken sublimate with suicidal intent and in large' quan-
tity, there were, at first, no symptoms, so that doubt was thrown on the
history given with him when first brought to the Queen's Hospital. The
stomach-pump was used, and for some days afterward he complained of
nothing but slight abdominal pain and weakness. Milk and beef-tea
were given perhaps not in sufficient quantity and stimulants were
not ordered: he died in about a week, apparently more from asthenia
than from irritant poisoning, but an inflammatory condition of the large
intestine was found.

THERAPEUTICAL ACTION (EXTERNAL). The destructive effect of mer-
curial compounds upon the lower forms of animal and vegetable life is ex-
tensively utilized in the treatment of parasitic diseases.

Phtheiriasls. When pediculi infest the head or the clothing, oint-
ments containing the red oxide, or the ammonio-chloride (white precipi-
tate), will often suffice to cure, and have the advantage of being free
from unpleasant color or odor: mercurial fumigations may sometimes be
required for the body. For the pediculus pubis, blue ointment is com-

MERCURY. 205

monly prescribed, but it is not a pleasant application, and I have seen it
produce much irritation. As in all cases when the hair is affected, de-
struction of the eggs or "nits," which are closely attached to the hair, is
important for cure, and, for this purpose, weak lotions of sublimate are
good (2 to 3 gr. to 1 pint water), or strong lotions of vinegar, followed by
the use of a dusting powder or ointment containing calomel or white pre-
cipitate.

Tinea Tonsurans Pityriasis Favus. The parasitic growths upon
which these unsightly maladies depend are destroyed by lotions contain-
ing 1 or 2 gr. of corrosive sublimate in the ounce, which should be applied
once or twice daily after cleansing: ointments containing the same, or
the ammonio-chloride, are also useful. Their curative effect, like that of
all similar remedies, is dependent somewhat on the state of the general
health in ringworm of the scalp, and in favus, but in ordinary ringworm
of the body (tinea circinata), and in pityriasis versicolor, a few applica-
tions will suffice for cure.

Dr. Alder Smith has recommended the oleates of mercury as having
more penetrating power, and records their proving curative in chronic and
obstinate cases not amenable to lotions, blisters, etc.: for children under
eight he uses a strength of 5 per cent., and, for others who can bear it, 10
per cent., mixed with acetic ether, 1 part to 7; after cutting the hair
close, thorough washing, and drying, this is rubbed into the whole scalp
regularly night and morning, a cap or turban being worn to keep any of
the preparation off the face: it is important that the head should not be
washed more than once a fortnight. Mercurial remedies should not be
used too concentrated, or over too large a surface, for fear of producing
severe constitutional effects; and it is well to remember that blistering
increases the absorptive power of the skin (New York Medical Journal,
July, 1858). Under the heading of " absorption " we have mentioned cases
in which death followed inunction of the scalp for ringworm, and would
refer again to one in which a single painting with a vesicating solution of
sublimate (gr. x. ad 3 i. ), caused salivation and death from mercurial
poisoning (British Medical Journal, 1871). I have myself seen a case
in which death resulted from the local use of a strong sublimate ointment,
and more than one case in which serious symptoms resulted.

Other Skin Diseases. In many non-parasitic forms of skin disease,
mercurials are useful locally; sometimes by a "resolvent" action or
quickening of the functions of the absorbents; sometimes by stimulating
the epithelial and other tissues also; sometimes by exciting irritation of
"substitutive character;" and in some cases by a powerful caustic effect.
In syphilitic affections they exert a "specific" power, and in many cases
their local action is supplemented by a varying amount of general action
consequent on absorption. The late Mr. Startin, perhaps an empirical
but certainly a successful practitioner in his specialty, and Mr. Naylor,

206 MATERIA MEDICA AND THERAPEUTICS.

who followed him, were accustomed to introduce mercury in some form
into the treatment of almost all their cases; and if we do not use it so
much, it is only that we have become more cautious than our predeces-
sors as to doing harm by remedies.

M. Gubler has specially drawn attention to the cure sometimes ob-
tained by mercurial treatment in very chronic skin-inflammation, such as
psoriasis and eczema, and observes that it is a last resource not to be
neglected, even if it be not easy to explain its action.

Eczema, Herpes. In the acute inflammatory stages of eczema mer-
curials are usually unsuitable as being irritant, but Dr. Spender speaks
highly of the use of lotio hydrarg. nigra in eczema rubrum: he adds gly-
cerin, and applies it fresh three times in twenty-four hours, without oiled
silk (British Medical Journal, i., 1878, p. 286). In subacute and chronic
stages, with thickening from infiltration of the cellular tissue, moderate
crusting, scaling, and dryness of skin, mercurial ointments are very ser-
viceable; that of the red oxide often irritates, even at this stage, and that
of the ammonio-chloride, diluted 1 in 4 or 8, is more generally suitable:
Niemeyer specially commends it for chronic eczematous patches on the
face. When there is more than average secretion or irritation, better re-
sults are obtained by a combination with equal parts of lead, or of zinc
ointment, and a formula much used for eczema capitis at the Skin Hos-
pital is the following: I. Plumbi acet. gr. x. ; zinci oxidi, hydrarg. sub-
chlor., ung. hydrarg. nitrat., aa gr. xx. ; olei palmse purif. fl. f ss. ; adipis
recentis ss., misce: such ointments are useful in the chronic general
eczema of childhood especially.

For eczema mammae, which is often very obstinate, Hebra uses sub-
limate-lotions (1 in 120), but they require great care if any lactation is
continued. For eczema of the genitals, Devergie recommended a very
much weaker solution of the same; Gueneau de Mussy prefers calomel
(15 gr. to oz. of lard). For eczema about the hands, and especially for
"cracks " about the fingers and nails, an oleate of 5 per cent, strength is
said to be very efficacious (Practitioner, vol. x.). I have found an oint-
ment of hydrarg. am. chlor. gr. v. to | j. very useful for eczema capitis
et aurium after thorough removal of the crusts, also for all cases of chronic
eczema. In (non-parasitic) sycosis, mercurial ointments combined with
sulphur give the best results. In herpes preputialis, calomel is a useful
dusting powder.

Erythema Ephelides (Freckles). Many cosmetic waters owe their
efficacy to a minute proportion of sublimate, or to an albuminate of mer-
cury. M. Hardy's formula for the treatment of freckles contains lead
acetate and zinc sulphate of each 40 gr., sublimate 8 gr., with alcohol 2
oz., and distilled water 4 oz. ; it acts by slightly irritating the epidermis,
so that this exfoliates quickly. For a more decided effect Hebra uses a
stronger solution (about 4 gr. to 1 oz.), applying it for four hours till the

MERCURY. 207

skin grows red, or even is blistered, and then under soothing applications
it peels off, leaving a new surface. For ordinary erythema of the face, a
lotion containing 1 to 2 gr. in 4 oz. of almond mixture, with or without
bismuth or zinc oxide, and spirits of wine, is very useful.

Acne. The last formula is suitable for many cases of acne when sul-
phur would not be well borne; but the pustules of this disorder may often
be aborted with still more satisfactory results by means of the acid nitrate
of mercury. The apex of the pustules should be lightly touched with
this, on a glass brush, or a match point, and the drop of liquid should be
soon removed by blotting paper or sponge: some temporary irritation
may be expected.

Psoriasis. The application just described (of acid nitrate) has been
recommended also for chronic patches of psoriasis, and especially for such
as occur along the forehead at the roots of the hair, but it should be used
with great caution. The ointments of white and of red precipitate have
a certain value for psoriasis of the face, or scalp, or hands, because they
have no unpleasant color or smell, but they are seldom so efficacious as
tarry preparations. The iodides, with iodide of potassium, are also re-
commended (Rochard, Lailler).

Prurigo Chronic Lichen Pruritus. In all itching papular erup-
tions, hot dilute solutions of the perchloride are likely to give relief.
Trousseau recommends a strength of 12 gr. to the pint, and justly lays
stress upon the importance of its being used hot.

Inprurigo the ointment of ammoniated mercury either alone, or com-
bined with hydrocyanic acid, or with lead compounds, often gives relief,
and calomel ointment is a good remedy for pruritus ani, and for pruritus
of the scalp connected with chronic eczema or pityriasis.

Erysipelas Eruption of Small-pox. Evidence may be found both
for and against the use of mercurial ointment (ung. hydrarg.) in these
conditions (Stille). The application cannot be depended on for the arrest
of erysipelas, but it has some power to relieve the burning pain, and to
lessen the chances of pitting in small-pox: it certainly can prevent the
maturation of a vaccine vesicle. The late Dr. Hughes Bennett thought
highly of this treatment, and Mr. J. F. Marson says that a mercurial plas-
ter in use at the Children's Hospital, in Paris, answers well: it is a modi-
fication of the emplastrum Vigo c. mercuric, and contains 25 parts
mercurial ointment with 10 of yellow wax and 6 of black pitch; it is
most suitable for semi-confluent cases, where the patient can use a little
care, for in severely confluent attacks the application would soon be
rubbed off by the restless movements (" Reynolds' System," vol. i.).
There is also some risk of salivation, and other forms of ointment answer
equally well, so that, although I have tried mercurial preparations in such
cases, I have latterly abandoned their use.

Inflamed Lymphatics Adenitis, etc. When the parotid, the testis,

208 MATEIilA MEDICA AND THERAPEUTICS.

or the mammary gland is inflamed, gentle frictions with mercurial oint-
ment, or applications of it on lint, are suitable: in chronic superficial
glandular swellings resulting from inflammation, or especially from sy-
philis, and also to procure absorption of inflammatory products in an early
stage before suppuration has occurred, the same treatment is useful. The
5 to 10 per cent, solution of the oleate painted on night and morning is
excellent, and I have known it succeed quickly in some cases where ordi-
nary blue ointment had failed. For inflammatory and congestive condi-
tions of the uterus, but more particularly of the ovaries, a combination of
mercurial and belladonna ointments in equal parts applied externally is
sometimes useful. It has been recommended even in fibroid growths.

Serous Jffiusions Pleurisy Ilydrocele. I have not been able to
satisfy myself of distinct benefit from mercurial frictions in pleuritic or
pericardial effusions, though they have been considered useful by others:
in hydrocele in children Kock uses an ointment of the cyanide (1 part in
4), rubbing a very small quantity into the scrotum daily for three to six
weeks unless erythema supervene: in such cases I have sometimes suc-
cessfully employed, as a paint, a 2 to 10 per cent, solution of the oleate.

Goitre (Cysto- Adenoma of the Thyroid Gland). In true goitre, as
distinguished from fibroid or purely cystic enlargements, an ointment of
the red iodide of mercury succeeds, according to the large Indian experi-
ence of my colleague, Mr. Macnamara, better than any other remedy. 1
The strength he recommends is of 15 gr. to the ounce of cerate, more
than this causing unnecessary pain and soreness. A thin coating of such
an ointment should be smeared over the goitre, which should then be ex-
posed to the full rays of the sun, or at least to bright light: artificial heat
is not so effective (Frodsham: Lancet, i., 1860). Within half an hour
smarting and burning are felt, and in another hour a blister forms, which
needs to be treated oniy in the usual way. The good effects of the red
iodide continue long after this blister has healed, the tumor decreas-
ing day by day for several weeks. One application of the ointment
every two months is sufficient for the most extreme cases. Mr. Macna-
mara has often seen tumors which extended from the chin to the breasts
disappear after two or three applications; from ordinary blisters he has
never seen benefit in such cases, and the expensive iodine ointment was
found to act very slowly, compared to the mercurial preparation: he has
never seen salivation produced by the red iodide, though it is said to have
occurred in some exceptional cases.

Splenic and Glandular Enlargements. Mr. Macnamara has also
found the ointment of red iodide of mercury useful in the treatment of

1 The credit of this application has been variously ascribed to Major Holmes,
Captain Cunningham, or Grant. Mr. Macnamara's experience is based on 23,000
cases.

MERCUJRY. 209

" spleen," meaning the chronic enlargement resulting from ague or ma-
laria (ague cake): he gives at the same time "ague powders" (quinine).
At Netley this ointment forms part of the accepted treatment for such
cases, phosphates of iron, quinine, and strychnia being given internally
(Murchison: British Medical Journal, i., 1867). Dr. Andrew reports
advantage from the same ointment at St. Bartholomew's Hospital (Lan-
cet, i., 1869). Of course, in the enlarged spleen, consequent on mechani-
cal impediments to circulation, heart-disease, etc., or on blood-poisoning,
as in typhoid, or on amyloid, or other structural degenerations, mercurial
ointments are useless, and even in malarial enlargements harm may be
done by them, because splenic disease seems to render the system pecu-
liarly liable to salivation and other ill-effects of mercury. Sir Joseph
Fayrer has observed serious results from its use in splenic cachexia, with
tenderness of the organ and much debility (Medical Times, i., 1874).
Mr. Macnamara, however, as above remarked, has never seen salivation
from a judicious use of the iodide ointment, and in all chronic cases it
ought to receive a fair trial.

The ointment is equally applicable in cases of strumous enlargement
of lymphatic glands.

Inflamed Joints. In any persistent articular inflammations, whether
traumatic, gouty, or rheumatic, mercurial ointments or oleates are useful
applied with friction two or three times daily. Mr. Scott (Bromley)
earned a high reputation by his successful treatment of " white swel-
ling," chronic synovitis, etc., with a mixture of mercurial ointment, cam-
phor, soap, and cerate, applied on strips of lint firmly covered with plas-
ter strapping. Although this method is useful I commonly prefer gentle
friction with an ointment of the ammonio-chloride, beginning with a
strength of 1 part of the officinal ointment to 4 of simple cerate, and
using afterward 1 part in 8 two or three times daily. Under this simple
treatment, with rest, I have known good results, which other remedies had
failed to procure: thus, in one case of chronic inflammation of the wrist-
joint, where able surgical and hydropathic treatment had been fairly
tried, this ointment relieved more than any other means, and in several
cases of chronic disease of knee-joint already condemned to amputation,
the limb has been saved (though with stiffened joint) by this application. 1

1 Mr. Marshall introduced, for these and other cases, the use of direct compounds
of mercurial salts with oleic acid, as being u more elegant, economical, and effica-
cious." He recommends the yellow oxide to be precipitated by caustic potash from a
solution in nitric acid, and then dissolved in oleic acid according to definite propor-
tions 5 or 10 per cent, or stronger; the weaker solutions are clear, pale, yellow li-
quids, the stronger are opaque and unctuous, and, being rather irritant, may cause
pain. Mr. Marshall recommends 1 gr. of morphia to the drachm of ointment when
much pain is present, as in pleuritis, and paints 10 to 30 drops over the affected part
(Lancet, i.. 1872). Morphia dissolves readily in oleic acid, and may thus be combined
with the mercury.

Vol.. II. 14

210 MATERIA MEDIC A AND THERAPEUTICS.

Ulcerations Whitlow. In chronic indolent or suppurating- sores,
even when non-specific, the " black or yellow " lotions containing the
respective oxides are very good applications the ointment of the red
oxide is a valuable stimulant. Martin has strongly recommended blue
ointment in whitlow, rubbing it in every hour, in intervals of poulticing.
I have also used this treatment with some advantage, but the frictions
need not be so frequent. Chronic indolent ulcers of the leg, whether
syphilitic or not, often heal quickly with small doses of mercury, and lo-
tions or ointment of the same, when applied to a similar condition, pro-
duce cicatrization.

Syphilitic Ulcerations and Eruptions. It is in these forms of disease
that the efficacy of mercurial lotions and ointments is the most marked.
For condylomata, calomel with astringents is a good dusting powder, but
the acid nitrate, lightly applied, is still more effective: one application
will sometimes destroy the growths when nitric acid alone, and other
caustics have failed (Practitioner, August, 1874). The acid nitrate is
also the best agent to employ in the rare cases when it is desired to de-
stroy a chancre by caustic in its early stages. As a dressing for hard
chancre and for squamous and ulcerative forms of cutaneous syphilide,
the " emplastrum mercuriale " (Prussian form) is much commended by
Dr. Liveing. It contains metallic mercury (3 oz.), turpentine (1|- oz.),
and lead plaster (12 oz.).

For generalized syphilitic eruptions, especially those of papular or
scaly character, baths of corrosive sublimate have been recommended by
Baume, Trousseau, and others; but their proportion of oz. to each
bath I think too large: haadache, drowsiness, and sometimes colic and
diarrhosa, were produced, and the skin irritated by them. Baths contain-
ing only 10 to 15 gr. have been found very useful for syphilitic infants.

Epithelioma Lupus. Cases of epithelioma have been cured by re-
peated painting with the acid nitrate of mercury, the morbid growth being
destroyed in layers (Gay: British Medical Journal, i., 1862); and this
mode of treatment is applicable with due care in instances where operation
is not desirable. It has been used to the cervix uteri, but has sometimes
caused severe salivation, so that it has not been generally adopted:
bromine is more suitable.

Extending patches of lupus are often controlled by the nitrate, but it
is not so useful in the erythematous, as in the ulcerative and discharging
forms: its application is very painful, and should not be repeated more
than once or twice weekly, and should be followed by soothing remedies.
In chronic torpid ulcerative conditions, M. Lailler recommends an oint-
ment containing the red iodide with iodide of potassium (about 7 gr. of
each in 3 oz.), it is useful but irritant: it may be applied stronger to non-
ulcerative forms. Cinnabar is combined with arsenic in " Cosme's paste,"
which is very useful for superficial lupus patches about the face: three

MERCURY. 211

applications are usually made, for twenty-four hours each time (u.
p. 45).

Diseases of Mucous Membrane Syphilitic Throat, Tongue, etc. In
ulcerative conditions due to syphilis, gargles of " black-wash " or ap-
plications of calomel in substance are most useful: more active effects
are, however, to be obtained from painting with dilute acid nitrate 1
part in 8 or in 1C: 1 min. to 1 oz. of water is sufficient for a spray (Lyster:
Liverpool Hospital Reports, 1870). Trousseau used cigarettes for these
and for laryngeal affections. A gargle of bicyanide of mercury ( gr. to
1 oz.) is most useful when black- wash and other preparations fail.

For syphilitic and other ulcerations of the ScJmeiderian membrane,
an ointment of the gray oxide is preferred ( 3 ss. ad 3 ss.): a powder con-
taining cyanide of mercury and camphor may be cautiously used.

In Ozcena, injections of black or yellow mercurial lotion are of some
service, with powders for insufflation, containing calomel, bismuth, and
white sugar.

In Chronic Angina, good results have been obtained from the local
use of the diluted acid nitrate of mercury (1 part to 6). It has relieved
"nervous cough," and also, it is said, spasmodic asthma (Bulletin de
Therapeutique, xxiii., 1842) this would be of reflex character.

For Chronic Laryngitis and Eustachian Catarrh, Dr. Nevins has
written in favor of mercurial vapor: it may be obtained from cigarettes
made with blotting-paper soaked in a solution of nitrate (Trousseau).

In Strumous and Catarrhal Ophthalmia a lotion of corrosive subli-
mate is one of the best remedies, especially in conjunction with the inter-
nal use of the same preparation, or of calomel: 1 or 2 gr. of the sublimate
are to be dissolved in 6 oz. of water, and of this, 2 dr. with an equal part
of hot water applied three times daily. Under this lotion the conjunc-
tival redness is lessened, the corneal pustules and ulcerations of the lids
heal, while the discharge, the lachrymation, photophobia, and irritability
of the adjacent mucous membrane all diminish. In this affection is well
seen the special power of mercury to check threatening suppuration and
to heal ulceration.

In Blepharitis, when the sebaceous glands near the cilise become in-
flamed or obstructed, causing redness, crusting, and irritation, mercurial
lotions, or ointments, applied at bedtime after due cleansing, are very
serviceable. Calomel ointment is the mildest, that of the red oxide the
most energetic (B. Carter), but that of the freshly precipitated yellow
oxide, introduced by Pagenstecher, is now the most generally used ( Oph-
thalin. Review, v. ii., 115). I have been well satisfied with the effect of
white precipitate ointment diluted with three or four parts of lard, and
Haltenhoff (Geneva) prefers this.

Hordeolum (or " stye ") is often best treated by applications of the
same three or four times daily.

212 MATERIA MEDICA AND THERAPEUTICS.

Phlyctenular Ophthalmia and JTeratitis of scrofulous character have
been cured by insufflations of calomel.

THERAPEUTICAL ACTION (INTERNAL). A general effect may be ob-
tained, as we have already seen, from local applications made in several
ways by inunction, by endermic painting, or hypodermic injection, as
well as by suppository or fumigation. These methods, which will be more
fully described afterward, are utilized for mercury more than for other
drugs, yet the ordinary mode of administration is simpler, and with due
attention to the mouth and the digestion, is more satisfactory when the
conditions of the illness admit of it.

Inflammatory Diseases. From the time that Robert Hamilton de-
scribed his successful treatment of inflammation by calomel and opium
(" Duncan's Commentaries," 1764) down to perhaps twenty or thirty years
ago, mercury in some form was, in English practice at least, the almost
universal remedy both for acute inflammations, and for their results, such
as effusions, adhesions, and indurations. Trousseau described mercurials
as " les antiphlogistiques les plus puissants " more active, perhaps, than
blood-letting and Nothnagel remarks that at one time the name of any
malady ending in " itis " seemed sufficient to indicate their use. Sir
Thomas Watson, in the later editions of his classic lectures, quotes his
own earlier opinion that " mercury is a very powerful agent in controlling
inflammation, especially when acute and ' adhesive ' in character, also in
preventing exudation," but owns that this can be said no longer " it re-
quires much qualification " (5th Ed., 1871). This is perhaps the most im-
portant point in which modern experience and opinion would discredit
the therapeutical power of mercury. It is not denied that full doses can
act destructively on the blood and the tissues, though we have given some
evidence against its aplastic energy (v. p. 194), but modern clinical ex-
perience affirms that it has not great, but comparatively little power over
acute inflammatory disorders, that these often run a natural course
toward recovery independent of mercurial, or other medicinal treatment,
and that when it is pressed to a full effect convalescence is protracted by
greater ansemia and debility. (The unquestioned good results recorded
from the treatment of Hamilton, which led to its general adoption, have
been plausibly attributed to the opium rather than to the mercury.}
Sufficient account of the evils that followed was not made by our prede-
cessors, who, knowing too little of the natural history of disease, attrib-
uted all bad sequelae to it rather than to the medicines, and considered
themselves successful if, when "the disease was subdued," life at least
was saved.

We cannot, on the other hand, agree with the assertion that mercury
is never useful but always injurious in inflammation. There is evidence
of its advantage in certain conditions, though this evidence is not so con-
sistent nor so general as of its value in syphilis. It will certainly remedy

MEKCURY. 213

some of the results of inflammation, as chronic effusions in joints or lungs,
and, as Dr. Stephenson remarks when narrating such cases, no number of
instances in which the medicine has been abused, or even has failed, can
contradict the cases in which it has conferred evident benefit (Edinburgh
MedicalJournal, 1871). Dr. Ilabershon allows its value in cases of retained
secretion, dropsy, gastric disorder, as a purgative, and as anti-syphilitic,
but objects to its use in all degenerations and passive congestions, in
fevers and exhausted conditions, in diseases of mucous membrane, in
rheumatism, and all inflammations of lung, brain, etc. (Pamphlet on
Mercury, British and Foreign Review, ii., 1860). For my own part, I
still hold it useful in many chronic inflammations, whether syphilitic or
not, affecting mucous and parenchymatous tissues, and having a general
tendency to suppuration and ulceration, but I am satisfied that it should
never be pushed to salivation.

Meningitis, and Cerebral Disorders. The principal difficulty in judg-
ing of the effects of mercury in meningitis, and of the relative value of
recorded cases, lies in the uncertainty of diagnosis. Cases of cerebral
congestion, in children especially, present at first symptoms very similar
to those of simple meningitis, such as pain in the head, vomiting, injec-
tion of the eyes, excitement followed by semi-coma, pyrexia, and even
convulsion. Many years ago I usually treated such cases with minute
doses of perchloride or iodide of mercury, and, as I thought, with mod-
erately good results, but further experience has not satisfied me on this
point. Many surgeons prescribe it in traumatic cases, and believe it re-
lieves the fulness of the cerebral vessels, and although Dr. Ramskill
("Reynolds' System"), Stromeyer, and some other authorities might be
quoted as still commending mercurial influence in meningitis, the general
tendency of modern opinion is decidedly against its value. In many re-
cent text-books, in Dr. Bristowe's for instance, it is not even mentioned.
When the malady follows on febrile or eruptive diseases, or spreads from
caries e.g., in the ear-bones mercury is not likely to relieve it, and in
other idiopathic or at least non-tubercular cases, I think aconite, bella-
donna, and bromides are of more importance in the early stages, and
nourishment and perhaps iodides in the later ones. In cases presumed
tuberculous I use iodide of potassium, generally with cinchona. Dr.
Copeman, when narrating several cases of apoplexy and cerebral disorder
in illustration of the beneficial action of mercury, fully adopts the prop-
osition that it cannot prevent inflammation, but may cause absorption of
its results effusions, adhesions, etc. : he strongly advises its use, there-
fore, in all inflammations of vital organs, after the acute stage is passed
(Medico- Chirurgical Review, i., 1872). I have seen it of some service in
such cases, but many remain quite unaffected by it.

Chronic Hydrocephalus. Of this disease, Golis recorded a large
number of cures under ^ to ^ gr. doses of calomel twice daily, and mercu-

214 MATERIA MEDICA AND THERAPEUTICS.

rial inunctions of the scalp, but his results were not confirmed by other
observers. Sir T. Watson refers to two remarkable cases cured by a
mixture of metallic mercury 10 gr., fresh squill 5 gr., and manna, taken
three times daily for three weeks: it caused weakness, emaciation and di-
uresis, but not ptyalism. I have not myself seen any good result in this
condition from mercury.

Pericarditis. To treat this inflammation without mercury would, a
generation ago, have been reckoned almost criminal, and men no less
eminent than Graves and Stokes have left their emphatic testimony in its
favor the latter gave 20 gr. of calomel once or twice daily. Yet soon
afterward, Markham and Walshe began to doubt its value, and Todd de-
nied it wholly. Watson says, " I am obliged to recant my advice as to
giving mercury in acute pericarditis " (" Lectures," 1871), and Hay den
is almost alone among modern writers in still recommending calomel and
antimony (" Diseases of Heart," 1870). Waters, Austin Flint, and
Loomis have discarded mercurials, and Sibson, in his able monograph,
does not even mention them ("Reynolds' System," vol. iv.). Dr. Garrod
states that full mercurial treatment of the joint-affection in rheumatism
will not prevent pericarditis, and it would seem, therefore, scarcely likely to
arrest it after its commencement: further, as it is almost always connected
with, or dependent upon, rheumatism, its treatment should naturally be
conducted on the same principles, and as we do not now give mercury for
the main disease, why should we do so for one of its local manifestations ?
I have myself carefully watched its effects several times, and although the
bruit and other physical signs have varied during the attack, I have never
been able to satisfy myself of a definite influence of the drug upon the
malady; on the contrary, I have seen this prolonged to more than an
ordinary duration, while the gums have been sore. In subacute or chronic
cases, where effusion has occurred and is persistent, I have seen bene-
fit from small doses of sublimate or gray powder and mercurial applica-
tions locally, but when the effusion is very large, the pulse feeble, and
cardiac paralysis threatening, any excess of mercury must be carefully
avoided (Nothnagel).

Endocarditis. In rheumatic endocarditis, on account of the still
more serious issues involved in exudation and adhesion, more advocates
are to be found for the use of mercury in the hope, at least, of controlling
such results. I cannot dogmatize on this question, but I place more con-
fidence in opium and rest.

Pleuritis. Fuller and Walshe may be named among modern advo-
cates of mercurial treatment in pleurisy, but for the acute stage I cannot
see its advantage, since aconite, salines, belladonna, or morphia, with
suitable local applications, give usually all the good results that can be
expected from medicines. When effusion has occurred, however, I be-
lieve that mercury may be of considerable service in stimulating the ab-

MERCURY. 215

sorbents; and in some cases, when hectic has set in and there have been
signs of commencing' pus-formation, small doses of corrosive sublimate
have seemed to me advantageous. I have also noted benefit from this
medicine in pleuritis occurring in puerperal women, and a similar obser-
vation is recorded by Nothnagel. In no case should it be pushed to the
production of salivation or anjemia.

Peritonitis. Velpeau was the great advocate for a thorough mercu-
rial treatment of this inflammation, and by enormous doses of calomel
used concurrently with inunctions, he expected so to alter the blood in a
few hours as " to prevent its furnishing the elements of a severe inflamma-
tion." Trousseau adopted for some time a similar method, for which he
substituted later that of Dr. Law, giving minute doses frequently.
Without accepting Velpeau's theory, it may be said that mercurial treat-
ment or rather calomel with opium has been less completely aban-
doned in this inflammation than in many others. Watson certainly says
" he is doubtful if it has ever done good, while if it purge it must do
harm," but I believe that small doses of calomel or of sublimate (y-J-g- to
g^o gr.) have conduced to the recovery of some of my cases of acute and
" idiopathic" peritonitis. I have generally given them every one to three
hours alternately with aconite, and used opium as required for relief of
pain. In localized forms of peritonitis, occurring, for instance, after per-
foration, or from peri-typhlitis, opium is the most important remedy.

Pneumonia. In the early stages of acute pneumonia, formerly
treated by calomel and antimony, I cannot recommend mercurials, but
the time for using them with advantage is when secondary fever arises,
and there is reason to fear purulent degeneration. So far as I can judge,
they have seemed to exert some power in preventing this, for certain
cases of the kind have improved on commencing the use of sublimate,
and others have relapsed on its omission. In pleuro-pneumonia, with
copious effusion, the sama remedy is still more clearly indicated, and in
chronic interstitial pneumonia it sometimes has excellent effect. Some-
times a syphilitic or strumous deposit occurs in the lung, rendering it par-
tially solid, and giving the physical signs of a pneumonia, and these de-
posits, especially when of the former nature, seem to " melt away " under
the moderate action of mercury: but careful diagnosis of such cases is
required, for in true tubercular deposit the drug is injurious. Graves
speaks highly of mercury " in scrofulous inflammation of the lung."

^Bronchitis. In acute cases, with much congestion of mucous mem-
brane and scanty expectoration, small doses of perchloride are often use-
ful. In certain cases narrated by Thorowgood, blue pill with squill was
given with apparent advantage, when there was " severe cough at night,
pyrexia with loaded urine, dyspnoea, some lividity of lips, difficult scanty
expectoration, with rales, and perhaps impaired resonance " (Practitioner,
i., 1878) i this treatment is more suitable for robust adults than for the

216 MATERIA MEDIC A AND THERAPEUTICS.

aged. In catarrhal bronchitis passing into pneumonia, frictions of the
chest with oleate of mercury are said to be useful.

Coryza. In ordinary coryza, especially when there is much sneezing,
I have often found small doses of gray powder cure more quickly than
any other remedy. Catarrh affecting the Eustachian tube is also well
treated in the same manner.

Diphtheria Croup (Laryngeal Diphtheria). Stille, after giving
many authorities in favor of the mercurial treatment of diphtheritic dis-
ease, says himself " that it appears urgent that the system should be
brought under mercurial influence as speedily as possible," and following
Albers, he recommends gr. of calomel every hour, and a scruple of mer-
curial ointment to be rubbed at intervals into the thighs. Trousseau,
finding that the direct application of calomel to external diphtheritic sur-
faces modified favorably their condition, recommended its use by insuffla-
tion, or by allowing it to mingle slowly with the saliva; this has not,
however, given much result. Bretonneau used mercurials freely, but his
mortality was great, and contributed to induce a general distrust of the
treatment. West, however (Ed. 1859), still considered calomel useful
for " counteracting the tendency to formation of false membrane and
preventing lung-inflammation." I have been myself much disappointed
with the action of calomel in these respects, but the red iodide and the
cyanide of mercury, in doses of -fa to -fa gr. every two to four hours,
have exerted a more favorable influence in some severe cases. It is very
important to watch their action carefully, and not to induce salivation,
for according to general experience " this promotes rather than checks
the spread of exudation " (Mackenzie), and certainly, as a general rule,
other remedies of a tonic or antiseptic character are often to be preferred
to mercurials.

Tonsillitis, etc. In ordinary tonsillitis, and even in suppuration about
the fauces, I have seen much advantage from small doses of hydrarg. c.
creta. In early stages of quinsy, in ulcerated sore throat, and even in
the "putrid" form (cynanche maligna), gr. given every two to four
hours has induced rapid improvement. It does not exclude the use of
aconite or belladonna if indicated by high temperature or much pain.
In parotitis (" mumps "), also in glossitis, " cancrum oris," and cracks
and ulcerations about the mouth and lips, the same treatment is very
effective. For relaxed congested conditions of the faucial membrane the
value of dilute solution of mercurial nitrate has been already indicated.

Scarlatina. The small doses of hydrarg. c. creta just mentioned I
have found equally useful in the severe specific sore throat of scarlatina,
especially when the cervical glands and adjacent cellular tissue are in-
flamed and swollen, and when there is ulceration or even a tendency to
gangrene.

Morbilli. Half-grain or quarter-grain doses of gray powder given

MERCURY. 217

every four hours will also control the catarrhal symptoms of measles:
when the conjunctivas and mucous lining of the nose, mouth, and throat
are inflamed, and even when ulceration is present, they render excellent
service.

Variola. When the eruption is passing into the pustular stage, and
when secondary fever is setting in, I can recommend -gr. doses of hy-
drarg. c. creta, every three to four hours, for a few days. Unless the
gums show signs of tenderness, this treatment tends to check and limit
suppuration, and consequently to lessen in some degree the chances of
pitting. The local use of mercurial ointment has been already mentioned
(v. p. 207).

Enteric Fever. We need not here refer to the older method of treat-
ing this fever by repeated purgative doses of calomel (v. Stille), a method
not now advocated; but several eminent physicians abroad Traube,
Wunderlich, Liebermeister, and others have recently recommended a
" specific" treatment for the first nine days of this fever by calomel, giv-
ing 10 gr. in a single dose the first day, and 8 gr. (in divided doses) daily
for three or four days afterward. They claim for these doses an antipy-
retic effect, and a power of lessening both the duration and the mortality
of the disease (Medical Times, ii., 1876). I have not had experience of
this treatment, nor, although foreign statistics show good results, has it
made way in this country. An early moderate purgative dose is, how-
ever, often advisable, and Black has written to recommend one or two 5-
gr. doses of calomel during the first week, as "antiseptic" (Lancet, i.,
1875). Corrosive sublimate in minute quantities has also proved valua-
ble in typhoid diarrhoea (British Medical Journal, i., 1874), and this is
in accord with my experience, but with these exceptions mercury is not
indicated in the treatment of this fever.

Puerperal Fever. Traube has also revived mercurial treatment in
some cases of this disease not for the general blood-poisoning but at
the commencement, when phlegmonous inflammation is spreading from
the uterus, and involving other parts, e.g., the peritoneum or pleura. He
considers that a rapid and energetic mercurializing by calomel and inunc-
tion gives the best results, and states that such cases bear large doses,
and that improvement generally coincides with the first signs of saliva-
tion. Spiegelberg especially observed the good influence of corrosive
sublimate in similar conditions he gave -^ gr. at a time (Nothnagel).
Concerning this treatment, I can only say that I have not had occasion
to adopt it, aconite, opium, quinine, etc., seeming to be much more de-
sirable remedies.

Erysipelas. In many cases of phlegmonous erysipelas, especially
when occurring in strumous subjects, I have found the internal adminis-
tration of corrosive sublimate distinctly useful.

Syphilis. In 1497 Gilinus first employed mercury in the treatment

218 MATERIA J1EDICA AND THERAPEUTICS.

of the then epidemic of syphilis, borrowing his practice from that of the
Arabians in skin diseases, and using only external applications, by fric-
tion, bath, or fumigation. Several serious accidents that occurred from
the remedy as used by empirics contributed to discredit it, and in 1517
it was almost entirely superseded by guaiacum. Not long afterward,
however, the internal administration of corrosive sublimate, red precipi-
tate, and calomel became general, and by the time of Boerhaave was car-
ried to such excess that mercurial treatment was not considered thorough
and satisfactory till it secured the ejection of three or four pounds of
saliva in twenty-four hours. But some protest against such abuse was
not wanting, and between mercurialists and anti-mercurialists sprung up
a controversy which has lasted to our own time. In the early part of
this century a reaction of opinion against the extravagant use of the drug
in syphilis became general thanks mainly to Rose and Guthrie, Thom-
son and Abernethy and it was proved that syphilis sometimes tended
to spontaneous cure, and yielded to non-mercurial treatment. Later on,
an important distinction was made out between the soft or non-infective,
and the hard infective sore, and professional opinion pronounced strongly
in favor of mercury for the latter, while allowing it unnecessary in the
former, and in gonorrhoea. This was clearly evidenced in the report of
the Admiralty Commissioners on the subject, which records the opinions
of forty eminent practitioners (1864). Among others, Sir James Paget
called mercury "a specific if the patient could take it well; in favorable
cases it would prevent secondary symptoms, and at least it would shorten
their duration." Mr. Hutchinson speaks of it as a " true vital antidote,
and if given early, as really stopping the development of symptoms, and
absolutely curing the disease." While agreeing in the main with this
conclusion, I do not discard wholly the use of mercury in soft chancre,
for I find that small doses cause the sore to heal more quickly than any
other medicine.

Constitutional syphilis is commonly divided into three stages, fairly
well distinguished as primary, secondary, and tertiary, and the best pe-
riod for giving the remedy has been much discussed. Some have main-
tained that its early exhibition only defers the appearance of secondaries,
and it is better for these to appear and then to give mercury till they dis-
appear; but the best authorities favor early commencement. Ricord gave
mercury generally the iodide so soon as the hard chancre was distinctly
diagnosed, and insisting on a year's continuance of treatment, was satis-
fied that he prevented secondary symptoms. Barallier supported the
same conclusion after much experience among sailors. The majority of
British surgeons follow this practice at present, and it seems to me the
right one>

On the other hand, most are agreed that in tertiary stages of syphilis,
mercury is not a desirable remedy, and Dr. Wilks finds a reason for this

MERCURY. 219

in the different processes which occur at different periods of the malady.
In the primary and secondary periods, plastic lymph is being effused, but
in later stages degeneration is going on; mercury causes absorption of
the effused products, but its further action can only assist degeneration,
induce cachexia, and be thus injurious (Guy's Reports, vol. ix.). As
clinical evidence of this, if any were needed, reference might be made to
the cases recorded by Mr. Hutchinson, where phagedasnic ulceration in
delicate subjects distinctly increased under the influence of mercury
(London Hospital Reports, vol. ii.). Also, if any syphilitic sore be much
inflamed, or if aggravated dyspepsia, amemia, phthisis, or albuminuria is
present, special treatment for these conditions must be instituted inde-
pendently of mercury. Pregnancy has been, by some, considered a bar
to due mercurial treatment, but, in my opinion, the danger of miscarriage
in the mother, and of injury to the infant, are greater from syphilis than
from mercury.

In any case, a moderate use of the drug must be the rule. It is true
that Trousseau and Pidoux blame a relaxation of the old methods for
what they consider the present gravity of the disorder; but the large
majority of the best authorities, including Ricord, Sigmund, and Hutch-
inson, deprecate full mercurialization, and find the best effects from small
doses continued for a long time. Sigmund states that of nearly 9,000
patients treated in the Vienna Hospital, 8,500 showed no sign of saliva-
tion, but were cured as permanently as those salivated (Medico- Chirur-
gical Review, July, 1858). Slight tenderness of the gums may be safely
and properly produced as evidence of systemic influence, and a method,
sometimes successful, is to give fractional doses (-^ gr.) of calomel every
hour; given in this manner, 3 gr. may suffice for the purpose (Law, Dub-
lin). In all forms of tertiary syphilis, rupia, and deep ulcerations, espe-
cially of mucous membranes, tongue, and fauces, gummata, visceral
syphilis, and most syphilitic nerve-affections, the great remedy is not mer-
cury, but iodide of potassium, though in hereditary syphilis mercury is
still to be preferred.

In syphilitic iritis and retinitis, the early and sufficient use of mer-
cury is perhaps more clearly indicated than in any other .inflammation,
and they are the only conditions in which Ricord held even salivation
justified. Watson has graphically described how effused lymph in the
anterior chamber may be seen to " melt away," under the influence of
the drug; but unfortunately, this is evident only in syphilitic cases. I
often combine with its internal use, collyria of corrosive sublimate, 1 to
2 gr. in 6 oz. of water with opium, or an ointment of ammonio-chloride
with belladonna for frictions round the orbit, with good success; but the
same treatment cannot be depended upon in rheumatic or traumatic
cases.

In syphilitic laryngitis also, mercury must be promptly and freely

220 MATERIA MEDIC A AND THERAPEUTICS.

used, for in acute cases life is rapidly endangered by the disease. Syph-
ilitic infants, as a rule, develop only a subacute form of this disease,
which may be treated less actively by moderate frictions with very satis-
factory result. (For catarrhal laryngitis, mercury is not indicated.)

Scrofula. Not only in syphilitic, but also in scrofulous diseases, small
doses of mercury are useful. I know that this is not so commonly rec-
ognized, but or 1-gr. doses of hydrarg. c. creta twice daily will often be
found of great advantage in purulent discharges from the eye, ear, etc., as
also in chronic glandular swellings.

Hepatitis. Annesley recommended in this inflammation, large doses of
calomel to the production of salivation, which he looked upon as " deriv-
ative," and no doubt at one time, as Maclean observes, " faith in calomel
may be said to have attained in India to the dignity of a dogma." He,
himself, strongly objects to any systematic use of mercury, and suggests
that if it has gained credit for preventing suppuration, this has been in
cases which were really of "peri-hepatitis" and not likely to end in ab-
scess; in a large experience he has never seen it arrest suppuration, and
"disbelieves in any such power" ("Reynolds' System," vol. iii.). More-
head and Waring agree in this opinion, and Massy reports serious impair-
ment of health after its free exhibition. These authors may be taken as
representing the present state of general opinion, but I think they have
been too strongly prejudiced against the remedy by its excessive use, or
abuse, and that small continued doses, stopping short of any full physio-
logical effect, may still be found of advantage in commencing hepatitis;
occasionally, larger (purgative) doses act well. In chronic forms of liver
inflammation, when the viscus is large and tender, mercury is also suit-
able, though if marked cachexia be present, or suppuration be fully de-
veloped, the drug is better avoided.

Cirrhosis. Monneret has strongly recommended moderate doses of
blue pill in cirrhosis with dropsy (Archives Gen., September, 1851), stat-
ing that after the numerous stools and copious sweatings induced, effusions
are often absorbed, without any ill-effects from salivation. Barallier cor-
roborated this experience, and further reported a case, not far advanced,
which was cured by this treatment (Dictionnaire). I have certainly had
the best effects from mercury in cirrhotic dropsy, but have generally used
purgative doses of blue pill, or calomel, followed by salines, and in the
intervals of purgation have given nux vomica and other tonics. Under
such treatment large abdominal effusions have passed away six times in
one case, at different intervals, so that the patient was restored to com-
parative health for some time, and this without any mercurial ill-effects.
The diagnosis was verified post-mortem, but I cannot say that I have seen
the malady permanently cured by this or any other treatment.

Hepatic Congestion Constipation. In torpor, or subacute conges-
tion of the liver, marked by coated tongue, yellowish countenance, head-

MERCURY. 221

ache, nausea, depression, light-colored stools, etc., a moderate mercurial
purge, especially with a saline, will commonly relieve more quickly than
anv other medication (unless it be sometimes podophyllin), and no amount
of experiment on animals can alter this clinical fact. The great expe-
rience and authority of Murchison quite corroborate this (Lancet, 1874),
and Dr. Duckworth has lately drawn renewed attention to the good re-
sults of calomel in acute gastric catarrh and " biliousness " (Practitioner,
July, 1876). In chronic cases of this kind it is, however, advisable not
to resort frequently to this remedy, but to depend rather upon diet,
hygiene, and saline or vegetable aperients, though small doses ^ to $
gr. of corrosive sublimate at bedtime have a good effect. The use of
metallic mercury as a purgative might be thought obsolete, but an in-
stance of it has been recently recorded, where obstinate obstruction and
vomiting were present: 1 oz. of quicksilver was given in two doses at
half an hour's interval; it soon acted, and recovery followed (Lancet, i.,
1874, p. 54). I have myself used it in two cases lately: one was that of
a boy, aged eight, who had had obstruction for five days, and although
under active and competent treatment, continued to get worse, with
vomiting, pain and accumulation over ilio-csecal valve, distension, etc.
Surgical interference was desired by the parents, but in consultation it
was agreed to try mercury first, and 1 oz. was given in the manner just
described. It was readily taken, and some of it soon passed, but with-
out producing a motion; the symptoms improved, and on the following
morning we gave castor-oil, which acted well, and the child soon recovered.
The whole of the quicksilver passed was collected and weighed and found
to amount exactly to the ounce taken. In a second case, a girl, aged
between five and six, the obstruction had lasted several days, and the
vomiting and other symptoms were persistent in spite of croton oil, etc.
I recommended, at first, treatment by opium, which was steadily con-
tinued for three days, but without benefit; castor-oil was then given but
was rejected; we then gave 2 dr. of quicksilver, in five minutes afterward
another 2 dr., and in half an hour a third and similar dose. It made its
appearance from the rectum in about two hours, bringing wind but not
much fecal matter; we followed up the mineral with castor-oil, which
was retained and acted, and the child gradually got well.

Vomiting. In some forms of obstinate vomiting, dependent upon
disordered stomach, with hepatic congestion, 3 to 5 gr. of calomel in pill
or powder, have a most beneficial effect. The dose should be followed
after a few hours by a saline purge.

Diarrhoea (Infantile). When the motions are green, curdled, watery,
and offensive, small doses (J gr.) of gray powder act very well, especially
when combined with bismuth, and the same powders are useful when
curdled milk is frequently rejected from the stomach. When there is a
simple diarrhoea, with whitish stools, Dr. Stephenson thinks that rhubarb

222 MATERIA MEDICA AND THEEAPEUTICS.

and soda should replace the mercurial, for fear the latter should depress
the strength (Edinburgh Medical Journal, 1871), and certainly, if it be
continued unwisely, it may do so by irritating the mucou~s membrane,
etc., but I have never seen ill-effects from the minute doses above recom-
mended. For infantile watery diarrhoea -j-J-^j- to -fa gr. of corrosive sub-
limate after each motion acts well (with due care). I think this is now a
common experience; I have acted upon it for twenty-five years. In the
acute diarrhoea and colic of adults, one of the best methods of treatment
is the use of a pill of calomel (3 gr.) with opium (1 gr. or gr.), followed,
after three or four hours, by castor-oil or other laxatives.

Dysentery. In acute dysentery, with violent pain, severe prostration
and frequent muco-sanguineous stools, small doses of corrosive sublimate,
given at short intervals, commonly relieve in a few hours, and almost
in a " specific " manner certainly better than any other remedy I have
known. Sublimate is equally useful in the " white dysentery " of Ceylon
and India. I have seen the best results from it when opium, lead, and
other astringents had proved useless. I thus agree with Wood, who as-
serts that in this malady " no remedial influence is more effective than
that of mercury," rather than with Maclean, who deprecates its use in all
forms and stages. I can only suppose that the injurious effects traced
by him and by others to calomel, etc., resulted from doses that were too
large.

Cholera. Dr. Maclean equally objects to any preparation of mercury
in cholera, as " useless in collapse and dangerous when reviving " (Lancet,
1866), but although I am not myself an advocate for the calomel treat-
ment, the results obtained by Dr. Ayre, of Hull, deserve attention. He
gave to -fa gr. calomel every ten minutes or every four hours, according
to circumstances; it rarely salivated, but produced apparently good re-
sults in a majority of cases. Bloxam and some other observers have fol-
lowed the same plan with advantage, and Niemeyer speaks well of calomel
treatment. What is desired is to stimulate by this means a secretion of
bile and to promote elimination, for we know that the reappearance of
bile in choleraic stools is a favorable sign; besides this, large doses of
calomel (dr.) have been said " to restore warmth " (British and Foreign
Review, i., 1870). Kohler thinks that its good effects are owing to the
disinfecting property of the drug when brought into contact with the
contents of the intestines. Of fifty-six cases, some of which received 200
gr. in two days, twenty-one died, but the reporter seems to think the results
favorable to the treatment by calomel (Lancet, i., 1874). The general ex-
perience of the profession has not, however, adopted it, and it is clearly not
free from danger, for under certain conditions a quantity of the medicine
may remain for a time unabsorbed, and afterward produce serious toxic
effects.

Intestinal Worms. Calomel is a very suitable vermifuge in cases of

MERCURY. 223

ascarides. Both the round and the thread worms are expelled under the
influence of 2 to 5 gr., which may be given early in the morning and fol-
lowed in a few hours by a purgative draught. It is usual to combine the
dose with powdered jalap, but I have found the mercurial alone sufficient,
and it is more readily taken. Dr. Stille speaks well of the effect of a
small portion of mercurial ointment placed in the rectum daily at bed-
time, for destroying ascarides, also of the injection of to 1 gr. of corro-
sive sublimate dissolved in water, but I doubt the wisdom of this treat-
ment.

PREPARATIONS AND DOSE. Hydrargyrum cum, cretd (contains 1 part
of the metal to 2 of prepared chalk, rubbed together until globules cease
to be visible): dose, for children, ^ to 2 gr., less or more; for adults, 3 to
8 gr., or less. Pilula hydrargyri (contains 2 parts of the metal with 3 of
confection of roses, and 1 of powdered liquorice root) : dose, as a purga-
tive, 3 to 10 gr. ; for constitutional effects, 2 to 3 gr. three times daily
may be well combined with quinine. Emplastrum hydrargyri (made with
mercury, olive-oil, sulphur, and lead plaster). Emplastrum ammoniaci
cum hydrargyro (contains gum ammoniac in place of lead plaster, or, in
other words, ammoniacum and mercury plaster). An emplastrum mer-
curiale of the Prussian pharmacy is much used by Hebra and others in
the treatment of syphilides, acne, etc., and is made according to the fol-
lowing formula: IJ. Mercury 3 iij., turpentine | iss., lead plaster xij.
TJnguentum hydrargyri (contains 1 part of mercury, 1 of prepared lard,
and a little suet): this preparation should be lead-colored; from ^ to 2
dr. may be rubbed into the arm-pit or inner side of the thigh at one or
several frictions in the course of the day, according to the rapidity of
the effect desired. A pleasanter compound than the officinal ointment
may be prepared from the following formula of Magne Lehrens, of Tou-
louse: Mercury 1,000 grammes, oil of sweet almonds 20 grammes, balsam
of Peru 20 grammes, lard 960 grammes. The metal disappears rapidly
in the oil and balsam, and the result is a smooth pomade, blue, agreeable
in odor, and easily kept. Mr. Marshall's formula for oleates, already
mentioned, is designed to prevent some of the unpleasantness of the ordi-
nary blue ointment, and the following form, used in the marine hospital
of Toulon, is calculated to produce constitutional effects without saliva-
tion: IJ. Slaked lime gr. xxx., chloride of ammonium gr. viij., sulphur
gr. xxx., mercurial ointment gr. clxxx. This ointment dries very readily,
and is prescribed in double the ordinary quantity. Hydrargyri olcas :
made 5 to 10 per cent, and upward (v. p. 209). Uhguentum hydrargyri
compositum (contains mercurial ointment, yellow wax, and olive-oil and
camphor): this combines the medicinal properties of mercurial ointment
and camphor, to which wax and oil are added to give a suitable consist-
ence; it is used as a stimulant to swollen glands, and for chronic inflam-
mation of joints, and represents " Scott's ointment." Linimentum hi/-

224 MATERIA MEDICA AKD THERAPEUTICS.

drargyri (contains equal parts of blue ointment, solution of ammonia, and
camphor liniment): it should be a lead-colored cream; this readily pro-
duces salivation. Suppositoria hydrargyri (contain mercurial ointment,
benzoated lard, white wax, and oil of theobroma): there are 5 gr. of blue
ointment in each suppository.

Hydrargyri subchloridum : dose, as a purgative, for children, 2 to 3
gr. ; for adults, 2 to 5 gr. ; for constitutional effects |- to 1 gr. or more,
frequently repeated, or -fa gr. may be given every hour (3 to 4 gr. in this
manner sometimes produce mercurial action), or ^ to ^ gr. or more may
be given night and morning combined with a fractional quantity of opium.
Lotio hydrargyri nigra (contains 3 gr. of calomel to the ounce of lime-
water). Pilula hydrargyri subchloridi composita Plummets pill (con-
tains calomel, sulphurated antimony, guaiac resin, and castor-oil): each
5 gr. of the pill mass contains 1 gr. of calomel and 1 gr. of sulphurated
antimony; calomel should not be given with alkaline carbonates, as cor-
rosive sublimate is liable to be formed. Unguentum hydrargyri subchlo-
ridi (G gr. of this ointment contain 1 gr. of calomel). Hydrargyri per-
chloridum: dose, -$ to ^ gr. in solution or in pill: but very much smaller
doses are used. Liquor hydrargyri percfdoridi (contains 3- gr. of per-
chloride and gr. of ammonium chloride to each fluid ounce, or fa gr. of
each to the drachm): dose, to 2 dr., i.e., -fa to gr., but I prefer smaller
doses, as mentioned above. Lotio hydrargyri flava (contains 18 gr. of
corrosive sublimate in 10 oz. of lime-water).

Hydrargyrum ammoniatum (" white precipitate ") : not used inter-
nally. Unguentum, hydrargyri ammoniati : 1 part of ammoniated mer-
cury in 8 of ointment.

Hydrargyri iodidum viride : dose, to 3 gr. Hydrargyri iodidum
rubrum: dose, T *g- to ^ gr., or less or more. Unguentum hydrargyri
iodidi rubri: 1 part in 28 of ointment.

Hydrargyri oxidum jlavum : used in the preparation of the oleate of
mercury. Hydrargyri oxidum rubrum : for external use. Unguentum
hydrargyri oxidi rubri (contains red oxide of mercury, yellow wax, and
oil of almonds ): there is about 1 gr. of red oxide in 8 gr. of the oint-
ment.

Hydrargyri nitratis liquor acidus : used externally. Unguentum.
hydrargyri nitratis (citrine ointment): 1 part in 15.

Hydrargyri sulphuretum "artificial cinnabar" (not officinal): not
used internally. Its fumes are used in syphilitic skin diseases," as ecthy-
ma; also in syphilitic sore throat by inhalation, 30 gr. being heated on
an iron plate and placed under the patient, who should be wrapped in a
blanket; or the vapor may be inhaled through a funnel. Hydrargyri
sulphas : not given as a remedy, but used in the preparation of corrosive
sublimate and calomel.

[PREPARATIONS, U. S. P. Hydrargyrum ; Hydrargyrum cum creta

HEKOUKY. 225

(mercury 3 parts, prepared chalk 5 parts); Emplastrum hydrargyri /
PllulcB hydrargyri : mercury 384 gr., confection of rose 576 gr., liquorice-
root 92 gr. ; make 384 pills; Unguentum hydrargyri (mercury 2 parts,
lard, suet, each 1 part); Hydrargyrum ammoniatum (white precipitate);
Unguentum hydrargyri ammoniati : ammoniated mercury 40 gr., oint-
ment 1 troyounce; Hydrargyri chloridum corroswum ; Hydrargyrt
chloridum mite (calomel); Hydrargyri cyanidum: dose, -fa to ^ gr. ;
Hydrargyri iodidum rubrum ; Unguentum hydrargyri iodidi rubri : red
iodide of mercury 60 gr., ointment 420 gr. ; Hydrargyri iodidum viride
(protiodide) ; Liquor hydrargyri nitratis / Unguentum hydrargyri nitra-
tis (citrine ointment); Hydrargyri oxidum fiavum Unguentum hydrar-
gyri oxidiflavi: yellow oxide of mercury GO gr., ointment 420 gr. ; Ily-
drargyri oxidum rubrum (red precipitate); Unguentum hydrargyri oxidi
rubri : red oxide of mercury 60 gr., ointment 420 gr. ; Hydrargyri sulphas
flava (Turpeth mineral); Hydrargyri sulphuretum rubrum.]

Inunction. The patient should be prepared for a course of mercurial
inunction by simple dieting and by warm baths: and during it should be
clothed in flannel and avoid exposure. When making the frictions him-
self, he should rub thoroughly in his hand the prescribed quantity of oint-
ment, and then slowly and forcibly anoint certain parts of the body in a
definite order: it is usual to choose the axillae and the groins, but practi-
cally it is better to avoid parts with abundant hair-follicles. According
to the German method of Zeissl, the inner side of both upper arms is first
treated, on the next night the inner side of the thighs, then of the fore-
arms, then of the legs, afterward of the groin and of the back, so that an
interval of several days is allowed between the friction of any one part,
in order to avoid local soreness. The evening is the best time for the
application, and warmth promotes its effect: the part should be kept cov-
ered during the night, and be cleansed on the following morning. When
the patient is too ill, or for any reason is unable to apply the ointment
himself, the attendant who uses it should protect his own hand with a
leather or caoutchouc glove. In young children frictions are often made
on the inner side of the soles of the feet, or a piece of ointment is simply
placed on the inner side of a thin flannel binder. For adults, $ dr. up to
2 dr. represents an average amount of mercurial ointment for daily use;
but sometimes, as in peritonitis, 1 dr. has been ordered every hour: it is
important that no rancid ointment be used, or severe irritation may be
induced by it. This method of treatment has the advantage of saving
the digestive tract from any direct irritation from the drug, and, accord-
ing to Sir B. Brodie, " it cures better and injures the constitution less."
This, however, scarcely holds true in view of the modern cautious admin
istration of mercury, and the method of inunction is less often adopted
than formerly, since it is, at the best, troublesome and uncleanly.

The enderrnic application of mercury is effected by dressing a blis-
VOL. IL 15

226 MATERIA MEDIC A AND THERAPEUTICS.

tered surface with blue ointment or sometimes with calomel. From the
latter, purging has resulted, but, as a rule, the endermic method is em-
ployed for a local stimulating action on the absorbents, as in pleuritic,
pericardial, or joint effusion, rather than to affect the general system.

Hypodermic Injection. The best form for this purpose has been
much discussed; Lewin, one of the first to recommend it, used 5 milligr.
of corrosive sublimate, but this is too much. Dr. Walker gave -$ gr. in
10 minims of water and glycerin, and obtained good results in second-
ary syphilis without serious drawback, but Stohr, Greenfield, and others
have reported local irritation, abscess, and even gangrene without thera-
peutical advantage. Liegeois added a minute quantity of morphia,
but Staub's solution of albuminate of mercury secured more general
approval. It is prepared with two separate solutions, thus: Corrosive
sublimate, 1.25 gr. ; chloride of ammonium, 1.25 gr. ; chloride of sodium,
4.15 gr. ; distilled water, 60 gr.: dissolve and filter. The second solution
is made with the white of an egg very thoroughly agitated with 60
grammes of distilled water and filtered; the two liquids are then inti-
mately mixed, and directed to be kept from the air as much as possible.
The solution should, in fact, be prepared fresh as required, for it will not
keep. One gramme contains 1 milligr. of the salt, and the dose should
be about 1 centigr. daily at two injections. M. Bouilhon has recom-
mended a solution containing a double iodide of mercury and sodium
(Practitioner, 1869), and Scarenzi and Recordi the injection of calomel
suspended in gum (Practitioner, 1870).

Stern's injection is made with 2 parts of sublimate and 20 of salt to
1,000 of water, and this does not precipitate albumen, and is a good form
(Lancet, i., 1871), but Mr. Cullingworth, after many experiments, ob-
tained by far the best of results with a minimum of local irritation by a
solution of bicyanide, using 2 gr. with oz. glycerin and 4 oz. of dis-
tilled water (10 min.^yig- gr.) fa gr. made the gums tender (Lancet, i.,
1874), Duncan, of Edinburgh, reports good results from the same
(British Medical Journal, ii., 1874).

The advantages of the hypodermic method are facility of dosage and
rapidity of effect, cleanliness, and freedom from gastric irritation, yet the
unpleasant results which have sometimes attended it have quite prevented
its general adoption.

The Mercurial Vapor Bath is the best method of application for some
cases especially of syphilitic cutaneous disease. In it calomel or sulphide
of mercury is vaporized in conjunction with steam, and becomes deposited
as finely divided powder on the body of the patient, as he is seated un-
clothed over the lamp. Care should be taken that the vapor be not in-
haled, or profuse salivation may occur.

LITHIUM. 227

LITHIUM, L,=7.

This metal has not been found native. It occurs in the mineral king-
dom as an oxide, chloride, silicate, or fluoride with potassium and alumin-
ium (the lepidolite or rose mica of Bohemia). Bunsen and Matthiessen
isolated it by means of electricity (1855).

Supposed at one time to be found in minerals only, it was named
At0iog, stony, but it is now recognized not only in many mineral waters,
but in seas and rivers, vines and many fruits, the ashes of plants, and in
most of our vegetable food (Bence Jones).

CHARACTERS. It is soft, silvery-white, and easily oxidizes: it floats
upon water, and is the lightest known metal, the sp. gr. being 0.593G.

COMPOUNDS OF LITHIUM.

LITHIA OXIDE OF LITHIUM, L 2 O,=30.

CHARACTERS AND TESTS. Occurs in white granules, forms salts with
acids, and has a high power of saturation, 15 parts neutralizing as much
acid as 41 of soda or 47 of potash. For uric acid it has a special affinity,
and will abstract it from portions of gouty bone and cartilage placed in
warm solutions of the drug (Garrod).

The most characteristic tests for lithium are the carmine red color it
imparts to flame, and the two lines which it develops on the spectrum,
viz., one bright red line at point 82 of the micrometer, and one pale
yellow line at 94. Of substances which resemble it, potassium has its red
line at 68, sodium its yellow line at 100, and strontium has an additional
line of blue.

LITHIA CARBON AS CARBONATE OF LITHIA, L 3 C0 3 ,=74.

PREPARATION. From sulphate or chloride of lithium by adding car-
bonate of ammonium.

CHARACTERS. Occurs in white powder, or crystalline grains, having
an alkaline taste and reaction: is insoluble in alcohol, but slightly soluble
in water (1 part in 100, or about 4 gr. to the ounce): carbonic acid in-
creases the solubility to 5 parts per 100.

LITHI^E CITRAS CITRATE OF LITHIA, L 3 C 6 H f ,O 7 ,=210.

PREPARATION. By dissolving the carbonate in citric acid, evaporat-
ing the liquid, and drying and pulverizing the residue.

CHARACTERS. A white amorphous powder, anhydrous, deliquescing

228 MATERIA MEDIC A AND THERAPEUTICS.

on exposure, entirely soluble iu two and a half times its weight of water:
it is somewhat unstable in composition, and requires to be carefully kept
from the air.

Some other compounds of lithia are likely to be used, but are not
officinal.

The urate is very soluble, more so than the urates of potash or soda.

The benzoate, which is prepared from the carbonate by adding benzoic
acid to the hot solution (Pharmaceutical Journal, July, 1875), occurs in
glistening, pearly scales, of soapy feel, acid reaction, and cool, sweetish
taste: it is soluble in three and a half parts of cold water, and ten of
alcohol it is thus more soluble than the carbonate, while it is more stable
than the citrate, and has the advantage of containing an acid itself valu-
able in the treatment of urinary deposits.

A. ferruginous benzoate of lithia has been prepared by M. Trehyon
(Progres Medicale, July 25, 1874) and is recommended both as a non-ir-
ritant form of benzoic acid, and as a tonic and preventive of the anaemia
produced more or less by all alkalies.

The bromide may be prepared by direct combination, and obtained in
transparent crystals which are deliquescent. It contains a large propor-
tion of bromide (92 percent.), while the analogous salt of potassium con-
tains only 66, and of sodium 78 per cent. (S. Weir Mitchell: American
Quarterly Journal, October, 1870). The salt is used for photographic
purposes.

ABSORPTION AND ELIMINATION. Lithia salts are rapidly absorbed:
thus, from the experiments of Dr. Bence Jones, it appears that if 3 gr.
of the chloride be given to an animal on an empty stomach, it may be
detected even in the cartilage of the hip-joint, and the aqueous humor of
the eye in a quarter of an hour: 7 gr. having been given to a parturient
woman eight hours before delivery, lithia was afterward detected in every
part of the umbilical cord, and 20 gr. of the carbonate having been taken
three and a half hours before an operation for cataract, ample traces of
lithia were detected in the lens when removed: four days afterward,
lithia could still be detected in the secretions, and was not wholly elimi-
nated till the end of seven days ("Lectures," p. 16). It is excreted chiefly
by the kidneys.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Lithia salts
act much like the alkalies upon the gastric secretions, the carbonate
especially is a direct antacid. Small doses are readily borne, but doses
of 30 to 50 gr. of carbonate such as were used by Charcot give rise,
after a few days, to cardialgia and dyspepsia (Note to French edition
of Garrod on Gout). Rabuteau also states, that though he, at one time,
recommended 15 to 30 gr. per diem, his later experience proved that
dyspepsia and even vomiting were caused by these quantities. Climent
records similar results iu his own person (" Traitement de la Gravelle,

LITHIUM. 229

etc.," These, Paris, 1874), and although lithiated waters e.g., at Baden-
Baden at first improve appetite and digestion, they quickly give rise to
sickness and diarrhoea if taken in excess (Althaus).

Circulatory System. Carbonate of lithia increases the alkalinity of
the blood more quickly than potash or soda compounds (Garrod). Th-e
same salt, given in large doses (80 gr.), rapidly diminishes the number of
red blood-corpuscles, and induces ana?mia, like the alkaline carbonates
(Climent, op. cit.). A much less quantity than 80 gr. seems to exert a
depressant effect on the heart in weakly subjects lithia in this respect,
again, resembling potash in its action but it does not depress so much as
that salt (Garrod). Several observers agree in the conclusion that bromide
of lithium, a salt with especially sedative powers, exerts a less lowering ef-
fect upon the heart than bromide of potassium (Roubaud: Archives Gen., i.,
1875, Levy, These, Gazette Medicate de Paris, 1875, No. 27), but frogs
and some warm-blooded animals may die under toxic doses of lithia, with
cardiac arrest in diastole (Husemann, Hesse).

Nervous System. Lithia is said to depress the general nerve-power,
and a slight degree of tremor or twitching has been sometimes noticed
under its continued use, but I am not aware of any serious effects of this
kind.

Urinary System. The quantity of urine is generally increased under
lithia, but analyses are not uniform as regards solid urinary products.
Thus, M. Levy, using the bromide of lithia in gouty subjects, found the
excretion of urea and uric acid rather lessened ( Gazette Medicate de Paris,
November 27, 1875). In healthy subjects, however, Moss found both
liquid and solid constituents much increased (American Journal, April,
1861). Diuresis is usually a marked effect of lithia. One or two doses of
1 to 4 gr. may not. produce it, but if continued they do so, and commonly
render soluble any urate deposit. In some persons one bottle of lithia
water (about 4 gr. ) will cause copious secretion, but the effect varies
somewhat, possibly according to the amount of acid in the system. Dr.
Garrod found lithia more active in this respect than potash, 20 to 30 gr.
of the former citrate equalling 2 to 3 dr. of the latter. Moss corroborated
this (loc. cit.).

Benzoate of lithia seems to have special powers in this respect, for it
is very soluble, and the benzoic acid, changing in the system into hip-
puric acid, combines with alkalies to form hippurates, which are more
soluble and more readily eliminated than urates. The diuretic action of
any salt of lithia is much increased by free dilution.

SYNEBGISTS. Lithia is akin to potash, soda, and alkaline earths gen-
erally, but the characters of some of its salts indicate a special chemical
analogy with magnesia. Thus, the carbonate is decomposed by heat, re-
quires 100 parts of water for solution, but is more soluble in presence
of carbonic acid: the phosphate is insoluble, the chloride and nitrate are

230 MATEKIA MEDICA AND THERAPEUTICS.

deliquescent; there is no alum or bisulphate of lithia. Agents promoting
waste, such as mercury and the iodides, also favor the constitutional ac-
tion of this and allied medicines.

ANTAGONISTS AND INCOMPATIBLES. Acids, acidulous and metallic
salts.

THERAPEUTICAL ACTION (EXTERNAL). Gouty Concretions Stiff
Joints. These may often be well treated by a lotion containing about 5
gr. of any soluble lithia salt in the ounce of rose-water, kept constantly
applied on lint, covered with oiled silk. I have generally combined this
application with the occasional local use of iodine and the internal giving
of lithia, and have known the concretions and the stiffness to be removed.
A pomade containing oleo-stearate of lithia has been recommended for
friction in similar cases (Duquesnel). Lithia lotions are useful also if the
skin be broken near gouty joints. Such sores do not readily heal, be-
cause the urate of soda permeates the connective tissue near them, and
an alkaline salt neutralizes the acid and promotes healing.

THERAPEUTICAL ACTION (INTERNAL). Gout. The treatment of gout
varies somewhat, according to the acuteness or otherwise of the attack.
During acute gout, lithia is often useful as an adjuvant or an alternative
to alkalies, colchicum, etc., but it is during the intervals, when the urine
is loaded and the joints obscurely painful, that the habitual use of small
quantities is most advantageous. According to Dr. Garrod it lessens the
frequency of the attacks, diminishes uric acid deposits, sometimes causes
the absorption of concretions, and even wholly removes the gouty dys-
crasia. Reasoning from the power of lithia in warm solution to dissolve
uric compounds out of gouty bone external to the body, he presumes that
it can exert an analogous effect within the system, and favor the elimi-
nation of the materies morbi in the form of urate of lithia. Wagner
found, after ample experience, that treatment by lithia shortened the
duration of acute attacks, and prolonged the intervals of freedom: it re-
lieved pain and promoted elimination by diuresis. He gave from to
5-gr. doses of the carbonate in an aromatic bkter, continuing them dur-
ing the interval between the attacks for many weeks (Schmidfs Jahrb.,
i., 1875, p. 232). Strieker reports a case in which gouty concretions on
the finger-joints disappeared in a few weeks under a course of lithia
(quoted by Garrod). Ditterich, while estimating the remedy highly,
would restrict its use to chronic forms of gout or chronic illness of any
kind, if dependent upon excess of uric acid. He found that doses of 5
to 10 gr. were liable to induce dyspepsia, and recommended not more
than 1 gr. for a single dose, or 15 gr. in twenty-four hours: he generally
observed relief in seven to fourteen days without drawback (Schmidt's
Jahrb., October, 1870). When acidity of stomach is present, the carbon-
ate should be given, because it is a more direct antacid than the other
salts; if, however, there is no marked gastric derangement, the neutral

LITHIUM. 231

citrate is to be preferred. It is decomposed within the system, and
eliminated as carbonate in the urine. The ferruginous benzoate of lithia
is much recommended by Dalkiewicz in his essay (" Sur la Goutte," 1873),
by Malley, and other French physicians (Medical Record, November,
1874).

The Baden-Baden waters, though very useful in gout and in gouty
headache, concretions, etc., are said to increase the joint pains during
their early use (Althaus). There is only one spring, the Murquelle at
Baden-Baden, which is distinguished for a considerable quantity of lithia,
viz., 0.4 gr. of the chloride of lithium in 16 oz. Next to the Murquelle
is the Fettquelle, in the same place, with 0.23 gr. of chloride of lithium,
and a spring in Elster, with 0.76 of carbonate of lithia (Braun, p. 479).

With the exception of Dr. Garrod's writings, there are but few Eng-
lish observations on the treatment of gout by lithia, though the remedy
must be largely used. It does not always give the satisfactory results
that have been claimed for it, and some practitioners are still sceptical as
to its real value.

Uric Acid Gravel Calculus. When this occurs, independently of
distinct gouty attacks, lithia salts, amply diluted, often act well, render-
ing the " gravel " soluble and the urine clear. According to the observa-
tions of G. de Mussy and others, the bromide of lithia exerts a high de-
gree of solvent or lithontriptic power (Roubaud: Archives Gen., 1875).

Lithiated injections into the bladder for direct solution of uric con-
cretions were proposed by A. Ure and Aschenbrennen. The former ob-
server ascertained that an oxaluric calculus placed in a 4-gr. warm solu-
tion of a lithia salt lost 5 gr. in weight in five hours, but his practical
application of this knowledge to the treatment of calculus within the liv-
ing bladder has not proved very satisfactory. The patient got some
temporary relief from the lithiated injections, and they were presumed
to have softened the calculus, but did not reduce its size. Lithotrity was
performed, but ultimately the man died (Lancet, ii., 1860). Mr. Ure
directs attention to the necessity of avoiding lithia when phosphate of
soda is present in the urine, otherwise an insoluble triple phosphate is
formed.

Gouty and other. Neuroses. In the forms of irritative or melancholic
nerve-disorders which sometimes accompany the uric acid diathesis, and
in some forms of hysteria, the bromide of lithia promises to be extremely
useful. The observers already quoted agree in attributing to it a marked
sedative effect on the sensory nerves, and upon the spinal cord, and reflex
sensibility, without much depression of the circulation: its action, in
short, is more that of bromine than of lithia.

Epilepsy. In true epilepsy, bromide of lithia was used by M. Levy
and by Dr. Weir Mitchell. The latter physician found that it was de-
termined to the skin much like other bromides, but it proved a better

232 MATEKIA MEDIC A AND THERAPEUTICS.

hypnotic, and in moderate doses of 10 to 20 gr., relieved or cured epi-
lepsy after larger doses of other bromides had lost their effect (American
Quarterly Journal, October, 1870).

Acute and Chronic Rheumatism. I have used lithia salts in these
disorders, but with indifferent result.

Croup and Diphtheria. Foerster, of Dresden, has recommended in-
halation of a vaporized solution of carbonate of lithia as a solvent of the
false membranes in- these diseases.

PREPARATIONS AND DOSE. Lithice carbonas : dose, 3 to 6 gr. (B. P).
German physicians recommend less than this. The diuretic effect is in-
creased by free dilution, and the liquor lithice effiervescens, B. P., which
contains gr. to the ounce, is a good form: dose, 5 to 10 oz. Lithice
citras : dose, 5 to 10 gr. (B. P.). I recommend less than these doses.
Zlromo-citrate of lithia in an effervescent water, containing also potash
and soda, is prepared by some London chemists (Lancet, i., 1874); also
a "granular effervescent citrate," which is a convenient and portable
form, and contains 4; or 5 gr. in each drachm. Urate and benzoate of
lithia: dose, 1 to 4 gr. Bromide of lithia (as a nerve sedative): dose, 10
to 20 gr. A lotion should contain 4 or 5 gr. of any soluble salt in each
ounce. A vesical injection, 20 or 60 gr. of a soluble lithia salt in 4 oz. of
water.

[PREPARATIONS, U. S. P. Lithii carbonas, Lithii citras.]

MAGNESIUM, Mg,=24.

This metal is not found native, but may be isolated by decomposing
its chloride with potassium or sodium. In combination it is widely dif-
fused, a carbonate occurring in magnesite and limestone rocks, a sulphate
and chloride in sea-water, in many mineral waters, and in almost all
spring-water: a silicate forms talc, meerschaum, etc., and is present in.
small quantity in all soils, whence it passes (mainly as a phosphate) into
plants and animals.

CHARACTERS. Magnesium is white, lustrous, hard, and very light (sp.
gr. 1.74). It readily oxidizes, and when lighted burns with intense bril-
liancy.

COMPOUNDS OF MAGNESIUM.

MAGNESIUM OXIDE MAO NESIA MAGNESIA LEVIS-LIGHT MAG-
NESIA, MgO,=40.

The two oxides, identical in composition, differ in the arrangement of
their molecules, and, consequently, in their weight.

PREPARATION. By strongly heating the heavy and light carbonates

MAGNESIUM. 233

respectively, until all carbonic acid is driven off: hence the name " cal-
cined magnesia."

CHARACTERS. Magnesia and light magnesia occur as white powders,
almost tasteless: the heavier form is called simply " magnesia" and is
smoother than " magnesia levis," and more readily miscible with water.
A given weight of the light variety occupies three and a half times the
bulk of the same weight of the condensed magnesia. (There is no advan-
tage in retaining both in the Pharmacopoeia.) Both forms are almost in-
soluble in water, but their solubility is increased by heat; they absorb
water, and if kept long in it, may form a concrete mass of " hydrate."
They are soluble in acids.

MAGNESIA CARBONAS CARBONATE OF MAGNESIA MAGNESIA
C ARSON A8 LEVIS LIGHT CARBONATE OF MAGNESIA, 3(MgCo 3 ;MgO
5H,O,=382.

PREPARATION. By dissolving in boiling water and then mixing sul-
phate of magnesia, and carbonate of soda, evaporating, and then washing
and drying the precipitate. To prepare the light variety, the first solution
is effected in a large quantity of cold water, which is afterward boiled.
The result of the decomposition is an oxycarbonate, which is hydrated,
and sulphate of soda is removed by washing. Thus:

4MgS0 4 + 4Na 2 CO 3 + 5H 2 O = 3MgCO 3 MgO5H 2 O + 4Na a SO 4 4- CO a .

CHARACTERS. The carbonates are white powders, soluble in acids with
effervescence. The light form appears under the microscope partly amor-
phous, with slender prisms intermixed. Their solubility in plain water
is slight, but it is much increased by carbonic acid, which converts them
into bicarbonates.

MAGNESIA SULPHAS SULPHATE OF MAGNESIA EPSOM SALTS,

MgSO 4 7H 2 O,=246.

PREPARATION. By evaporating sea-water or saline springs also
from dolomite, by treating with sulphuric acid: soluble sulphate of mag-
nesia is dissolved out and crystallized, insoluble lime sulphate is left.

CHARACTERS AND TESTS. Occurs usually in small acicular opaque
or whitish crystals, but may be obtained in large, transparent, rhombic
prisms. The pure crystals are somewhat efflorescent; but if they contain
chloride of magnesium they are moist or deliquescent. Iron is an occa-
sional impurity, and gives a reddish tint to the solution.

The small acicular crystals resemble those of zinc sulphate, with which,
indeed, they are isomorphous: they maybe distinguished (1) by the taste,
magnesia sulphate being bitter and nauseous, zinc sulphate astringent; (2)
ammonium sulphide gives with magnesia no precipitate, but with zinc a

234 MATERIA MEDICA AND THERAPEUTICS.

white one of sulphide (ZnS); (3) caustic potash gives with magnesia a
white precipitate insoluble in excess, with zinc, a white precipitate soluble
in excess. The rhombic prisms resemble those of oxalic acid: the latter
are markedly acid to the taste, and are colored a purplish brown by com-
mon ink; magnesia sulphate is not affected by it (except blackened where
touched).

ABSORPTION AND ELIMINATION. Magnesia and its carbonates and
neutral salts, such as the citrate and tartrate, are changed into chlorides
in the stomach, and absorbed either wholly or in part according to the
amount taken and the condition of the gastric fluids (Buchheim and
others): not more than 15 gr. at a time is changed (Rabuteau); the un-
absorbed portion passes on into the intestine, and under the influence of
albuminous secretions, or of carbonic or other acids, especially in the
large intestine, an additional amount becomes absorbed, and any residue
passes unchanged with the faeces, or under certain circumstances ac-
cumulates in the bowel, and forms concretions. Absorption varies with
the degree of acidity of the intestinal tract, and if this be not marked,
lemonade or other acidulous drinks will be required to secure solution.
We need scarcely say that absorption varies also with the nerve-condition
(v. p. 237). Part of the absorbed magnesia appears in the urine as a
triple phosphate.

The sulphate of magnesia, given in small doses, is wholly absorbed
without producing definite physiological effects. Of large and purgative
doses, part only is absorbed, and passes out by the urine or other emunc-
tories. Part of the sulphuric acid of the sulphate is withdrawn by potash
and soda salts met with in the bowel, and the magnesia is almost wholly
excreted with the motions combined, more or less, with effete bile-pro-
ducts (Buchheim).

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. Magnesia
and its carbonate act as direct antacids and local sedatives; also, when
given in powder, as mechanical absorbents. A dose of 30 gr. and upward,
given to an adult under conditions favorable for absorption, produces,
after eight or ten hours, moderate semi-solid motions, of less than normal
odor. It has been stated that the effect of these preparations, though
less quickly produced, lasts longer than that of stronger cathartics, and is
often more copious, 1 dr. of magnesia causing more evacuation than 1 oz. of
Glauber's salt (Trousseau) also, that their effect increases with continu-
ous use, so that bloody and mucous stools may occur after some time. On
the other hand, if the drug accumulates in the intestine, mechanical ob-
struction may be caused by it, and concretions of ammonio-magnesian
phosphate, mixed with mucus and debris of food, have sometimes formed
when large quantities of magnesia or its carbonate in solid form have
been taken; as much as 2 pints (Gubler) and "several pounds" (Brodie)
of such concretions have been found in the colon, and Dr. G. de Mussy

MAGNESIUM. 235

required a mallet and chisel to remove one from the rectum (Medical
Times, ii., 1879).

Peritonitis and even perforation have followed from such obstruction,
and I have myself seen one fatal case of the kind. The patient was an
actor, accustomed to hurried, irregular meals, and to consuming large
quantities of magnesia (for constipation), and on making a post-mortem
examination the large intestine was found blocked up by magnesian
concretions.

(When a moderate degree only of such a condition is suspected, full
doses of vinegar deserve a trial.)

The citrate of magnesia acts as a mild, but efficient and somewhat
quicker laxative, and being more soluble than the oxide or carbonate, is
free from risk of concretion.

The sulphate, in small doses, acts as a gastric sedative, and if not
sufficient to purge, often exerts a diuretic effect, especially if the skin be
kept cool: 1 to 2 dr. freely diluted, and taken on an empty stomach, will
usually produce several watery stools without colic but with some disten-
sion, rumbling, and sense of chilliness. The bitter, unpleasant taste, if
uncorrected by carminatives, may induce nausea and debility, but these
symptoms subside when the purgative effect commences. The pulse and
temperature are lowered by the action, and some malaise may be felt
from it; more or less subsequent constipation will also be noticed: the
biliary secretion is not increased by it (Rutherford).

Much larger quantities (1 to 2 oz.) are sometimes taken by ignorant
or careless persons, and if given to the weakly may cause serious depres-
sion, amounting to syncope, with or without severe purging: Christison
refers to a fatal issue from a dose of 2 oz. On the other hand, it has been
stated that minute quantities (1^- gr.), given by hypodermic injection,
will induce characteristic serous motions (Luton: Gazette Ilebdom., 1874),
but Caville could not verify this result on dogs, and Professor Gubler's
trials resulted only in local abscess, so that we cannot depend on Luton's
method.

It is, however, ascertained that when even large doses are injected
into the veins, no purgation is caused (Moreau, Rabuteau), but rather
constipation, and this fact bears upon an explanation of the medicine's
action. [Cl. Bernard has stated that the intravenous injection of soda
sulphate causes as much purging as its internal administration (Le9ons,
p. 85), but later observers are very clear as to the contrary.]

Theory of Action. Poiseuille, and also Liebig, taught that the pur-
gative action of salines when taken by the mouth was due to osmosis of
serum from the vessels into the intestine, and in support of this view
Moreau found that on including a portion of intestine (of an animal)
between two ligatures, and injecting into it a drachm of Epsom salts
dissolved in a little water, afterward returning the intestine to the ab-

236 MATERIA MEDICA AND THERAPEUTICS.

dominal cavity, a large quantity of fluid was poured into the ligatured
portion within twenty-four hours (Archives Gen., 1872). Vulpian cor-
roborated these observations, but noted also intestinal catarrh, which
others have not done ( Gazette Jlebdom., May, 1873). Dr. Lauder Brun-
ton has recorded, in an interesting paper, results similar to those of
Moreau (Practitioner, vol. xii.). By means of ligatures he made three
loops of intestine, and injecting into the middle one a measured quantity
of water with a few grains of magnesise sulphas, and into the others the
same amount of water only, found, after a few hours, that the middle one
contained treble the quantity of fluid injected, while the others were
empty. He experimented also with concentrated solutions passed into
the middle loop, always with similar result, and suggests that it is pro-
duced by a direct stimulation of the intestinal mucous membrane. Ruther-
ford and Vignal also consider the drug a pure stimulant to the same
membrane; this, however, was not found congested in the experiments,
and although Brunton thinks that the structure of the intestine renders
the osmotic theory unlikely, I believe that it best explains the facts with
which we are acquainted.

For instance, constipation occurs if sulphate of magnesia be injected
into the veins, and it may be presumed that an osmotic current is then
directed from the bowel to the blood, and thus the intestinal contents
are deprived of ordinary moisture: also constipation results from taking
(by the mouth) small doses of 5 to 10 gr., and these may be supposed to
become absorbed quickly into the circulation, and to act as if directly in-
jected into it (as just described): again the purgative effect of full doses
(draining off fluid) is followed by constipation. (Rabuteau explains this
last fact by supposing a small portion at first absorbed, and producing its
physical (endosmotic) effect several hours afterward, but I think it more
probably a natural reaction connected with loss of fluid and empty con-
dition of intestine.)

Some eminent writers, chiefly German, have offered other explanations
which require a brief notice. Radziejewski observed, in experiments on
animals, that the faeces were quite liquid when passing from the small to
the large intestine, and argued that saline purgatives simply hurried them
through in this liquid state, and that the larger quantity of fluid in stools
procured by purgatives could not come from the blood, or even the
glands, because on analysis the proportion of albumen in them -was found
too little for such a source (Reichert's Archiv, 1870, 39, 77). Thiry, ex-
perimenting with the peculiar form of intestinal fistula devised by him-
self, and formed by a separated portion of bowel communicating with the
external surface of the abdomen, found that although local irritation
would excite secretion in it, saline purgatives, such as soda sulphate,
would not do so, and concluded, with Radziejewski, that they simply
increased peristalsis. Buchheim taught that besides this, on account of

MAGNESIUM. . 237

their low diffusion-power, they did not readily pass through the intestinal
membrane, but, remaining- in the canal, retained the water in which they
were given, and also much of the natural watery secretion from liver,
pancreas, and glands (a very large quantity, according to Kiihne), and so
carried from the intestine a large quantity of fluid without necessarily
drawing it from the blood by endosmosis, or from the glands by stimula-
tion. These reasonings, although ingenious, seem to me answered or
qualified by the later experiments of Moreau and of Brunton. Thiry's
fistula disarranges normal structure too much to furnish a strong basis
for hypothesis, while Legros and Onimus have satisfied us that peristalsis
per se is but little increased by sulphate of magnesia (Journal d'Anat.,
Robin, 1869). The purgative action of saline is not, however, a mere
physical occurrence, the same in any membrane, living or dead; it implies
integrity of nerve-supply, for Moreau found that no endosmosis occurred
in an intestinal loop if he divided its connecting nerves.

Urinary System. Magnesia has sometimes caused the solution of
uric acid deposits when alkalies have failed to do so, and Mr. Brande
pointed out that it could render the urine alkaline, more permanently, if
more slowly, than potash or soda. Thus, 2 dr. of soda gave a maximum
of alkalinity in a quarter of an hour, 1 dr. of magnesia only at the end of
six hours, and dr. in twelve hours (" Philos. Trans.," 1810). A deposit
of triple phosphate occurred, but since earthy salts can be passed in only
limited quantities in the urine (Neubauer and others), it is of interest to
know precisely how magnesia rendered the secretion alkaline. Caulet
concluded from recent researches that both it and lime do so only indi-
rectly through the digestive organs i.e., they neutralize a part of the
acid of the gastric juice, and consequently more soda is excreted with
the urine, and becomes the direct agent in determining its alkalinity. In
support of this, he finds on analysis no increase in the amount of earthy
salts in the urine (rendered alkaline under administration of magnesia),
but marked excess of soda (Bulletin de Therapeutique, 1875). In further
support of this observation, we have the fact that during normal diges-
tion, when the acid of gastric juice is being neutralized and withdrawn
from the system, acidity of urine becomes less, and in some stomach-dis-
orders is even replaced by alkalinity (Roberts, Jones).

An observation from comparative anatomy is also of interest. If
much lime or magnesia were to be excreted by the urine in conjunction
with uric and phosphoric acid, the insoluble salts formed would render the
secretion solid, or nearly so, as it is in birds and reptiles. Such a secre-
tion would not readily pass through the narrow urinary channels of the
human race, and therefore alkaline earths pass out rather through the
bowel, while in herbivora, the urine of which must be fluid and yet con-
tain much earthy salt, the acids are excreted by the bowel (Caulet).

Glandular System. Some observers have attributed to magnesia an

238 MATERIA MEDICA AND THERAPEUTICS.

alterative action, and Grange, Bouchardat, "and others state that its ha-
bitual use, as in drinking water, will cause goitre. Some support is given
to this idea by the fact that enlargement of the thyroid gland in mice
has followed after mixing magnesia with their food (Gubler), but on the
other hand, many waters from goitrous districts have been analyzed with-
out finding in them a trace of magnesia ( Medico- Chirurgical Review, i.,
1862, p. 512).

Toxic Action. Jolyet and Cahours report magnesian sulphate to be
the most toxic of neutral purgative salts, 30 to 90 gr. having caused sud-
den death in dogs, when injected into the veins. Vulpian noted abolition
of voluntary and reflex movements in a frog poisoned by the salt, and its
effect has been compared to that of curare, but this comparison requires fur-
ther support before it can be accepted (Archives de Physiol., Fev., 1869).

SYNERGISTS. Absorbent substances, such as charcoal and manganese,
aid the mechanical effect of magnesia in powder. Its purgative effects
are aided by acids, by the sulphate and citrate of magnesia, and other
neutral salts. It is usual to combine the sulphate and carbonate in a
mixture, but unless care be exercised they are liable to form lumps which
are not readily soluble. The analogues of sulphate of magnesia are the
sulphates, phosphates, tartrates, sulphovinates of potash and soda, and
the chlorides of sodium and magnesium. Water, cold, and refrigerants
generally are other adjuvants of its action. Dr. Laycock found quinine
aid the purgative effect of magnesia sulphate, 1 gr. of quinine with only
1 scruple of the salt, given every three or four hours, acting as well as
much larger doses given without the tonic: he supposed this to depend
upon improvement of nerve-power (Medical Times, i., 1863, p. 54).

ANTAGONISTS AND INCOMPATIBLES. Acids given with magnesia de-
stroy its absorbent powers, though increasing purgation; on the other
hand, alkalies- antagonize its purgative effects by neutralizing gastric
acidity. Alcohol, aromatics, and opium lessen its anti-febrile and deple-
tory effects. With regard to opium, Buchheim and Wagner observed
that if it be brought in contact with mucous membrane before the saline,
no increased flow of liquid occurs, but liquid is absorbed from the mem-
brane: they concluded that opium favored the absorption of the salt, but
we hold rather that it acted like Moreau's section of the nerve-supply
narcotizing the terminals, dulling the sense of irritation, and so prevent-
ing a flow of liquid toward the part while absorption from it went on
as usual (Gubler).

Magnesia as an Antidote to Arsenic, Cobalt, and Phosphorus. Mag-
nesia forms a rather insoluble salt with arsenious acid, and is ordered in
the German Pharmacopoeia as part of the officinal "antidotum arsenici." '

1 Seven parts of magnesia mixed with 120 parts of water are to be kept in one bot-
tle, and 60 parts of liquor ferri persulphatis, with 120 of water, in another bottle. The

MAGNESIUM. 239

Schroff proved magnesia to possess antidotal powers in cases of poisoning
by arsenic and cobalt, if given early (Medico- Chirurgical Review, i.,
1859). Sugar and magnesia mixed together have been found useful
(Lancet, ii., 1873, p. 157). Orfila proposed it as an antidote to phospho-
rus, and there is some but not conclusive evidence in its favor (Medico-
Chirurgical Review, i., 1857).

THERAPEUTICAL ACTION (EXTERNAL). Magnesia being smooth, light,
non-irritant, and antacid, makes a good absorbent dusting powder. It
has been used for ervthema, erysipelas, and similar inflammatory condi-
tions of the skin, and also for atonic ulcers, exposed surfaces, and in-
flamed wounds.

THERAPEUTICAL ACTION (INTERNAL). Dyspepsia. In acidity, pyro-
sis, and allied symptoms of irritative dyspepsia, such as heartburn, flatu-
lence, colic, or constipation, magnesia and its carbonate are very useful,
and their efficacy may be increased by the addition of bismuth or of car-
minatives: such symptoms are often brought on by food containing too
much fat, and this point should be attended to. Headache, accompanied
with nausea and mental depression, often occurs in the conditions de-
scribed, and may be relieved by magnesia. When vomiting is a trouble-
some symptom in the dyspepsia either of children or adults, and in the
vomiting of pregnancy, magnesia often acts well. An effervescent solu-
tion of the carbonate or citrate is a good form, but 5 to 10-gr. doses of
the sulphate will sometimes act better. I have known this succeed in
the vomiting of albuminuria, and in cases where hepatic derangement was
more marked than acidity.

Acidity and Diarrhoea of Children. The mild antacid and laxative
action of magnesia, and its slight taste, render it a very suitable remedy
for the acidity of stomach which so readily occurs in children; it is valu-
able both when constipation is present, and when unwholesome food has
caused irritative diarrhoea (marked by red furred tongue, and greenish,
sour, and liquid motions): 2 to 10 gr. of the carbonate may be given
thrice daily, its antacid action only being desired, and its purgative effect
avoided, unless with the first dose. On several occasions I have known
4 gr. severely purge an infant at the breast. When the attack is clearly
traceable to unsuitable food, " Gregory's powder," containing rhubarb
and ginger, with the magnesia, is a popular and very useful combination.

Constipation. In the constipation of delicate persons, especially of
pregnant women, also of those subject to gout or rheumatism, hemor-
rhoids, or other rectal affections, magnesia is a valuable mild laxative;
if required frequently, it should be taken in solution (fluid magnesia),
and with lemon-juice, if the system be free from acidity. The citrate or

two preparations are mixed only at the time of their being requ red: hydrated perox-
ide of iron is precipitated, and sulphate of magnesia remains in solution 4 to 6 dr.
of this should be given every quarter of an hour in warm water (Binz).

240 MATERIA JIEDICA AND THERAPEUTICS.

the sulphate are useful aperients at the commencement of a febrile attack
of almost any kind, their action being rapid and more or less depletory;
the former may be given effervescing in mild cases, but when a full and
decided effect is desired, 1 or 2 dr. or more of the sulphate should be
used; sometimes it is given in lemonade or acid infusion of roses, but
general experience has proved that it acts best with tincture and infusion
of senna. In habitual constipation J- to 1 dr. given in a glass of lemonade
or aromatic water, in the early morning, will often answer every purpose.
Dr. Fleming found the addition of small quantities of atropia advanta-
geous (British Medical Journal, ii., 1865): it is more usual now, and I be-
lieve better, to make use of the magnesian salts in combination with
others, as they are found in many natural mineral waters, such as Seidlitz,
Pullna, Friedrichshall, or Hunyadi Janos, half a glass or a glass of such
waters being ordered with warm water in the early morning. To obviate
constipation and headache during the use of astringent tonics, moderate
doses of the sulphate may be usefully added to medicines containing sul-
phate of quinine, iron, acids, etc.

Obstruction. In cases of intestinal obstruction dependent upon hard-
ened faeces, full doses of the sulphate, freely diluted and given every four
hours, often succeed well; sometimes the action may be favorably as-
sisted by belladonna.

Plumbism. In cases of colic and constipation dependent upon lead-
poisoning, sulphate of magnesia is a valuable agent; it should be used in
conjunction with iodide of potassium, and Dr. Lauder Brunton has well
shown that if the latter remedy removes from the tissues the metal in
soluble combination, yet it is readily reabsorbed unless the bowels be
freely and regularly moved (Practitioner, vol. xii.): -oz. doses may be re-
quired. Dr. Copland and others used the sulphate with sulphuric acid
before the special value of the iodide was known.

Jaundice. Although the sulphate has no specific cholagogue action,
it is a very suitable aperient in cases of jaundice. Dr. Budd recommends
it in combination with the carbonate and aromatics, but I generally pre-
fer one of the mineral waters before mentioned.

Diarrhoza. In intestinal irritation and diarrhoea dependent upon un-
wholesome food, and especially stone-fruit, sulphate of magnesia is a good
evacuant, because it produces so little irritation. In cases of severe
dysenteric diarrhoea from this cause I have often given drachm doses at
intervals of six hours, for three or four doses, with the best results.

Enteritis Dysentery. Dr. H. Wood speaks of the sulphate of mag-
nesia as the best aperient in enteritis and colitis, when one is required:
(usually treatment by opium is to be preferred).

In true dysentery there is much evidence as to the value of the same
salt, although it is not generally known. Trousseau called attention to
it in 1826 (Archives Gen., v., xiv.), Giacomini recognized it ("Treatise

MAGNESIUM. 241

on Materia Medica "), and Stille confirmed their observations: he gave
about 60 gr., freely diluted, every two hours, \vith the result of at once
diminishing tenesmus and bloody discharges, arid inducing watery fecu-
lent stools: the treatment should be commenced early, and is best suited
for sthenic cases: an occasional opiate at night may be given during the
treatment. That the same method is equally available for chronic and
debilitated cases is shown by the experience of Mr. Ford in Melbourne,
when dysentery was for a long time epidemic and more severe in char-
acter than he had ever seen it in this country. Some of his patients
(medical men and others) had suffered for many months, with only tem-
porary relief from chalk mixture, laudanum, etc., when he gave them
drachm doses of the sulphate, with 20 min. of sulphuric acid, every four
hours, and a blue pill, with opium (1 gr.), at night. Mustard was applied
over the abdomen, and farinaceous diet ordered. In the course of twenty-
four to thirty-six hours, the dejections became feculent, with less blood,
and in about nine days all irritation had usually subsided. Mr. Ford
adopted this method on the hypothesis that excessive action prevailed in
one part of the intestine (the colon), while the rest of it was inactive;
and he hoped to "restore unity of action," and also to " eliminate morbid
material." However this may be, he is able to report that, in seven years
of extensive practice, he did not lose one case of dysentery in the adult
(Australian Journal and Ranking 's Abstract, i., 1859).

Hemorrhage. Sulphate of magnesia is a valuable adjunct to astrin-
gent remedies for hemorrhage, because it helps to lessen arterial tension
and capillary congestion at the same time that it obviates constipation.
In menorrhagia it may be given with sulphuric acid; in haemoptysis, with
ergot, acid, and digitalis (H. Dobell); and in hcematemesis, with alum
and opium (Barlow).

Dysmenorrhvea. In delayed and obstructed menstruation, when the
discharge is scanty, dark, and of glutinous character, I have long pre-
scribed the carbonate of magnesia with beneficial results, and especially
when the irregularity is attended with sick headache and mental depres-
sion; it is most indicated in rheumatic subjects. Five to sixty or ninety
grains may be given, according as to whether the constitutional, the
laxative, or fully purgative action is required. The small dose should be
given each night for the first fortnight after the cessation of the menses,
and the larger doses during the latter fortnight, or especially before or
during the period, or when headache and depression are present.

Lithiasis Uric Acid Diathesis. The power of magnesia to dissolve
uric acid and to lessen its formation, whether directly or indirectly, has
already been mentioned. Among other instances, Mr. Brande records
that of a man, aged sixty, accustomed to pass much uric acid, and even
calculi, and who had taken daily either 9 dr. of " subcarbonate " of soda,
or 3 of potash, for more than a year without good effect, yet under the
VOL. II. 16

242 MATERIA MEDICA AND THERAPEUTICS.

use of 60 gr. of magnesia thrice a day. the acid soon diminished in
amount, and after three weeks of continuous treatment it seldom recurred.
Since Mr. Brande's memoir (1810) the remedy has been often used in
similar cases. Sir B. Brodie combined 6 gr. of magnesia with 12 of pot-
ash bicarbonate and 15 of bitartrate, and it often acted well.

Chronic Gout. Magnesia, in combination with its sulphate, and
sometimes with colchicum in addition, was largely used by Sir Charles
Scudamore, and with satisfactory result. It is especially adapted for the
gastric derangements to which gouty patients are liable. In rheumatism
its value is not so evident.

Diabetes. In this malady, magnesia has been found useful by Hufe-
land, Willis, and others. It can only be considered as a palliative of some
symptoms.

Warts. Several curious observations have been recorded to the effect
that warts disappear after a few weeks' use of carbonate of magnesia.

Irritant Poisoning. As already mentioned, magnesia carbonate forms
nearly insoluble compounds with arsenic and cobalt, and besides being
used as an antidote to those poisons, it has been given with more or less
success in cases of poisoning by corrosive sublimate, mercurial oxide, and
salts of copper. It is perhaps best suited to neutralize the action of the
strong acids, whether mineral or vegetable, and acts well when mixed
with charcoal. When used for oxalic acid poisoning, large quantities
must be given to form a basic insoluble salt (Husemann).

PREPARATIONS AND DOSE. Magnesia magnesia levis : dose, as an
antacid, 10 to 20 gr.; as a purgative or adjunct, 20 to 60 gr. or more
4 to 8 gr. will purge an infant at the breast; children of about ten years
require 30 to 40 gr. The pulvis rhei compositus (Gregory's powder) con-
tains 6 parts with every 2 of rhurbarb and 1 of ginger. Magnesiad car-
bonas magnesias carbonas levis : dose, 10 to 60 gr. ; 10 to 20 gr. as an-
tacid, 20 to 60 gr. or more as a purgative. Liquor magnesice carbonatis
should contain nearly 13 gr. in the ounce, but does not well retain this
amount. The solutions of Henry, of Dinneford, and of Murray are
original preparations of the same active ingredient (about 10 gr. to the
ounce), and a convenient "double strength " preparation has been intro-
duced by Kinmond. The bismuth lozenges B. P. contain about 2 gr. of
the carbonate of magnesia. Liquor magnesice citratis, the "limonade
purgative " of the French codex, may be taken in doses of 5 to 10 fl. oz.
A " granular effervescent citrate of magnesia " is in popular demand, but
was proved at a trial under the Adulteration Act a few years ago to be
in reality a citro-tartrate of soda (Pharmaceutical Journal, 1873). I
believe that an article containing at least some citrate of magnesia is now
supplied. Magnesilyne is another form of the same remedy. Rochelle
salt has also been found as an adulteration of it (Pharmaceutical Journal,
February, 1873). In consequence of the high price of citric acid, a for-

MANGANESE. 243

mula for producing a meta-tartrate of magnesia has been published (Bul-
letin, i., 1873). In the same journal, M. Martin records the rather
important observation that even carefully prepared citrate, which is per-
fectly soluble when fresh, is apt to change with age into a subsalt, and
to become insoluble. A " boro-citrate," made by dissolving a borate of
magnesia in citric acid, has been recommended by Kohler for acid urinary
deposits (Medical Times, ii., 1879). Magnesias sulphas: dose, 10 to 20
gr. for irritable conditions of the stomach, or in combination with astrin-
gents or tonics; when given with senna or other purgatives 30 to 60 or
120 gr., according to the frequency of repetition. For diuretic effects 20
to 60 gr., as a purgative in a single dose 2 dr. to \ oz., according to the
habit of the patient. Coffee and infusions containing tannin disguise
the nauseous taste. Enema magnesia? sulphatis (contains 1 oz. of the salt
with 1 of olive oil, and 15 of mucilage starch). The mist, sennas, com-
posita contains somewhat more than a drachm in each fluid ounce com-
bined with senna and aromatics.

[PREPARATIONS, U. S. P. Magnesia; Trochisci magnesice: magnesia
3 troyounces, nutmeg 60 gr., sugar 9 troyounces, mucilage of tragacanth
sufficient; make 480 troches; Magnesii carbonas / Liquor magnesii cit-
ratis / Magnesii sulphas. ]

MANGAKESIUM MANGANESE, Mn,=55.

Manganese is found in many ores, and generally associated with iron ;
the most common one is the black oxide, or per-oxide (pyrolusite), which
is found abundantly in Great Britain and in various parts of Europe.

CHARACTERS. Manganese is a grayish-white metal, hard and brittle,
of sp. gr. 8. It emits a peculiar odor in a moist atmosphere, or if han-
dled. When pure it oxidizes readily in the air, and hence is kept under
naphtha, or in sealed glass tubes; it is dissolved by dilute sulphuric acid.

COMPOUNDS or MANGANESE.

MANGANESII OXIDUM NIGRTJM BLACK OXIDE OF MANGANESE,

MnO,,=87.

CHARACTERS AND TESTS. Occurs in brilliant needle-shaped crystals,
or in compact masses, but is usually met with in the shops as a dull,
earthy, dark-brown or black powder, which contains iron and other im-
purities. Treated with hydrochloric acid it causes evolution of chlorine,
thus

244 MATERIA MEDICA AND THERAPEUTICS.

When heated to redness, it gives off oxygen and leaves a residue of red
oxide of manganese

3MnO 2 (heated) =Mn s O 4 + O 3

Sulphuretted hydrogen causes in manganic solutions a flesh-colored pre-
cipitate of sulphide.

Manganesii Oxidum Preparatum (not officinal). The prepared oxide
is obtained by digesting the powdered black oxide in dilute hydrochloric
acid for twenty-four hours, then levigating and drying.

MANGANESII SULPHAS SULPHATE OF MANGANESE, MnSO 4 5H,O,=

241 (not officinal).

CHARACTERS. Occurs in colorless, or pale rose-colored, transparent
crystals, freely soluble in water.

The double sulphate, the double carbonate, and the double iodide, with
iron, are sometimes prescribed ; less frequently such compounds as the
lactate, phosphate, citrate, and valerianate of manganese (Hannon, Gui-
bert). None of them are officinal.

Permanganate of potash (v. p. 267).

ABSORPTION AND ELIMINATION. Salts of manganese undergo prob-
ably the same changes in the stomach as salts of iron, and are absorbed
as albuminates, or as chlorides. The metal, like others, is eliminated
mainly by the bile and the intestinal tract. \V. Turner found distinct
evidence of manganese in the urine of a diabetic patient who had been
taking permanganate of potash freely for three weeks, showing that it is,
at any rate, partly eliminated by the kidneys (Edinburgh Medical Jour-
nal, vol. vi., 1861).

PHYSIOLOGICAL, ACTION (INTERNAL). Circulatory System. The pres-
ence of manganese as an essential element of the corpuscles has been re-
lied upon as a guide to its action, but it seems to be rather an accidental
than a normal constituent of the blood. Wurzer, in 1830, first announced
its presence, and Millon, Hannon, and Burin-Dubuisson corroborated this,
while Melsens, Bonnewzn, and others, could find no manganese on re-
peated analyses; Melsens operated on 7 kilogr. of blood from twenty-one
different persons. M. Glenard analyzed, in various ways, blood from
forty subjects of varying age and sex, and found the metal in one case
only. He concluded " that manganese is not an essential element of hu-
man blood; it may be found accidentally, but only in minute amount; it
does not enter by the lungs or skin, as proved in the case of a miner "
(Gazette Medicale de I/yon, 1854). I have not met with any series of
analyses for manganese since those quoted. M. Riche, the latest ob-
server, who finds the galvanic test to be exceedingly delicate, has de-
tected minute quantities in the blood of bullocks, etc., but has not tested
human blood often enough to speak with authority (Medical Record,

MANGANESE. 245

1877). Bartholow, however, considers the question decided affirmatively,
and even gives the proportion of manganese to iron in the red corpuscles
(human) as 1 to 20. If this be so, we may agree that the administration
of manganese would be likely to improve the nutrition and the color of
the corpuscles in a direct manner, but so much as this cannot yet be posi-
tively stated from physiological research. That manganese has a similar
action to that of iron has been often stated, but must be considered prob-
lematical (Husemann), and indeed, the increased blood-pressure caused
by the latter is not produced by the former drug.

According to Laschkewitz, the organic salts of manganese, in moder-
ate doses, slow the pulse and the heart-action, and cause lowering of
blood-pressure, and paralysis of muscles and nerves, which iron certainly
does not. After death from manganese poisoning the heart is found di-
lated, and does not respond to electrical stimulation.

Nervous System. Certain nerve-phenomena, whether direct or indi-
rect, are determined by manganese salts. Toxic doses cause death with
convulsions, and to 1 gramme injected into the veins of rabbits or dogs
produces cramp and death from heart-palsy, or else faintness and weak-
ness and slower death with fatty degeneration (Laschkewitz). The pupils
are dilated, the temperature unaffected. Rabuteau injected a little more
than 1 gramme into a vein of the hind leg of a bitch, and at first there
were no symptoms, but on the following day tetanic convulsions set in,
with trismus and opisthotonos, and death followed shortly afterward:
the white substance of the spinal cord was shrunken, the gray matter
congested.

Large doses given for a long period induce effects analogous to those
of zinc progressive wasting and feebleness, a staggering gait, and para-
plegia (Bartholow).

Digestive System. The saccharated carbonate of manganese has no
peculiar taste, the sulphate is styptic, metallic, and disagreeable. Small
doses (5 to 10 gr.) of these salts are said to promote appetite and diges-
tion, but larger quantities are apt to irritate, and cause vomiting and
purging. The oxide, which is gritty on the tongue, is said to exert rather
a sedative action on the gastric membrane.

The sulphate of manganese has been especially credited with the
power of stimulating the secretion of bile since the observations of C. G.
Gmelin, who found in animals poisoned by large doses, inflammation of
the stomach, intestines, etc., and " so large an amount of bile poured out
that the whole tract was colored like yellow wax." He reported a less
degree of the same effect in man, and Mr. Ure also found that 60 to 120
gr. acted as a cholagogue purgative (Pereira). Dr. Goolden took various
doses, from 1 up to 30 gr., before any vomiting occurred, but states that
as a rule 10 to 20 gr. will cause some nausea and free purging with co-
pious secretion of bile (Lancet, 1840, and i., 1878). Dr. Rutherford, how-

246 MATEKIA MEDICA AND THERAPEUTICS.

ever, failed to corroborate this experience, at least in animals, for after
giving 60 gr. to a dog the biliary secretion was at once lessened and severe
diarrhoea occurred. After death the mucous membrane of the small in-
testine was found pulpy, "as if the epithelium had been dissolved by
caustic." In another dog a dose of 20 gr. equally caused lessening of
bile, although benzoate of soda given afterward had power to restimu-
late its secretion. Dr. Rutherford concludes that the drug is a powerful
intestinal, but not an hepatic stimulant, acting very like sulphate of mag-
nesia (v. p. 235). Nitrogenous excretion is increased by it. Poisonous
doses induce acute fatty degeneration of the liver, like phosphorus.

SYNERGISTS. Iron may be considered as allied in action to manga-
nese within the limits of the preceding observations; the two substances
are constantly associated in nature. Copper, silver, and zinc have allied
effects on the nervous system. Goolden speaks of sulphate of manganese
as substitutive for mercury as regards the action on the liver, but this is
doubtful. He says also that it aids the action of sulphate of magnesia,
and Rutherford has shown some analogy between these two salts.

ANTAGONISTS AND INCOMPATIBLES. Caustic alkalies and salts of lead,
silver, and mercury are chemically (not therapeutically) incompatible with
manganese. Tannic acid and vegetable astringents are not incompatible,
as they are with iron.

THERAPEUTICAL ACTION (EXTERNAL). Hemorrhage, etc. The chlo-
ride of manganese and iron has been used by M. Petrequin, in preference
to the simple perchloride of iron, as a local haemostatic; and in Italy it
has been applied to necrosed bone, and injected into fistulous tracts and
hydroceles (Practitioner, vol. v., p. 375), but it has no proved advantage
over other well-known remedies.

Skin Disease. The same remark applies to the use of an ointment
made with the oxide of manganese ( 3 ij. to j. adipis), which has been
recommended in scabies and ringworm, and, combined with sulphur, in
porrigo.

Disinfectant. Free chlorine is readily and cheaply generated by act-
ing on peroxide of manganese with hydrochloric acid, or by heating a
mixture of common salt and peroxide with sulphuric acid and water
(equal parts). The former process is recommended in the Swedish Phar-
macopoeia, 1 part of peroxide (pyrolusite) and 4 of acid being ordered:
the latter process is that known by the name of Guy ton Morveau: a mix-
ture of manganese oxide 7 grammes, and 10 grammes of salt, with sul-
phuric acid and water, of each 20 parts, will disinfect a space of 30 c.m.

THERAPEUTICAL ACTION (INTERNAL). Anaemia Chlorosis. Manga-
nese was introduced into practice mainly by M. Hannon, of Brussels,
with special reference to the treatment of these conditions. He argued
that, during digestion, sulphuretted hydrogen is formed, and reacts on
the ferrous and manganic compounds contained in the intestines, chang-

MANGANESE. 247

ing them into insoluble sulphides, and thus removing essential elements of
haematosin. This happens especially (he supposes) in chlorosis, and the
remedy is to supply more of a metal which can form such sulphides, and
prevent the removal of essential elements of the organism. Hence, bis-
muth, lead, and copper are said to prove as serviceable as iron or manga-
nese, though the latter are better assimilated (Presse Medicale JBelge, 1850,
and Guibert). M. Harmon goes even further than this, and describes
three forms of chlorosis, according as there is a deficiency in the blood of
iron only, of manganese only, or of both metals. Thus, in the first case,
there are "earthy tint of skin, weakness of locomotor system, slow, regu-
lar pulse, diarrhoea, and fluid menstrual discharge." In the second case,
" color of skin and mucous membranes normal, pain in muscles, constipa-
tion, amenorrhoea." In the third case, " waxy tint, bluish sclerotics, oede-
ma, serious nerve-disturbance, derangement of circulation, dyspnoea, low
temperature, uterine pain." According to such symptoms does he recom-
mend either iron alone, manganese alone, or a combination of both metals.
It is evident that these statements are largely theoretical; and, apart from
the fact that even the necessary presence of manganese in the blood of
healthy persons is doubtful, an appeal to clinical results does not bear out
the suggestion of its great importance as a haematinic remedy rather
the contrary. M. Harmon himself reported very good effects from it, and
Dr. Steer (Cheltenham) saw benefit in chlorotic anaemia, traumatic anaa-
mia, and in phthisis, and in anaemia of children; but he used saccharated
carbonate of manganese with iron, not manganese alone. In uterine leu-
corrhcea of pale weakly subjects, he gave it with ergot; for constipation,
with aloes; for dyspepsia, with soda and rhubarb (Medical Times, ii.,
1853). Sir J. Simpson found the phosphate sometimes useful in amenor-
rhoea, given either with or without iron, but says very little about it
(Medical Times, i., 1861, p. 517). Dr. Broadbent, using the chloride
and sulphate, reported some favorable, some negative, results. Mr. Car-
ter used it with no good effect (" Clinical Society's Transactions "), while
Dr. Garrod failed to cure every case of anaemia in which he employed
the manganese salts alone, and the subsequent administration of iron was
always followed by rapid improvement. It is true that M. Petrequin was
an enthusiastic advocate for the remedy in all forms of impaired blood-
condition, including intermittent fever, phthisis, and cancer, but the gen-
eral experience of the profession is not with him or M. Hannon. All we
can at present say is, that in obstinate cases of chlorosis not cured by
iron, the conjunction with manganese should receive further trial.

Hepatic Disorder. I have already mentioned that Mr. Ure found 1
to 2 dr. of the sulphate act as a cholagogue purgative (Pereira), and Dr.
Goolden gave it in cases of enlarged liver with dark or pale stools, and
jaundice, when no abscess or acute symptoms were present. Most of the
patients (at the Dreadnought Hospital) were in weak condition, having

248 MATERIA 1IEDICA AND THERAPEUTICS.

returned from India, and he sought for a non-mercurial remedy to stimu-
late the liver. He says that 10 or 20 gr. of sulphate of manganese,
though at first it excited nausea or vomiting, soon acted on the bowels
to the marked relief of the patient, and with rapid clearing away of the
jaundice (Lancet, 1840). This favorable result has, however, not been
corroborated by the experience of others, but recently Dr. Goolden has
written to direct attention again to the subject, stating that he has con-
tinued to use the remedy with success in hepatic dropsy, hemorrhoids,
bronchial congestion, hypochondriasis, etc.: he usually combines it with
Epsom salts, in a glass of effervescent water (Lancet, i., 1878).

Polli and Galamini state that they have cured cases of biliary calculus
by peroxide of manganese, given in gramme doses daily as an electuary:
they explain the solution of the calculi by the action of oxygen from the
peroxide upon the cholesterine (Gazette de Paris, 1856).

Gastrodynia Pyrosis, Dr. Leared found that purified oxide of man-
ganese had decided power in relieving these disorders; he describes epi-
gastric pain, severe and radiating, coming on not immediately, but soon
after food, worse after albuminous food; the tongue generally red and
patchy, and the malady connected with too rapid shedding of epithelium
and exposure of a hyper-sensitive mucous surface; pyrosis and vomiting
are sometimes present.

Bismuth is a usual and excellent remedy for such a condition, but Dr.
Leared found manganese relieve it often more quickly, with the advan-
tage of not causing constipation. He states that he has treated several
hundred such cases with satisfaction, before venturing to recommend it
(Ranking, i., 1864). No mention is made of a drawback described by
Dr. Goddard Rogers, whose patients found the medicine so gritty and
unpleasant that they could scarcely continue it. He reports two cases of
gastralgia, " severe pain with occasional vomiting," one case of stomach
derangement sympathetic with the uterus, and one of pyrosis, with " irri-
table mucous membrane." All these got well rather quickly, with 10-gr.
doses of the oxide (Lancet, i., 1864, ii., 1865). We have not, however,
heard much of this remedy from other observers.

PEEPABATIONS AND DOSE. Manganesii oxidum preparatum : dose,
5 to 10 gr. ^Manganesii sulphas: dose, 10 to 20 gr. as a purgative.
Ferri et manganesii carbonas saccharata: dose, 5 to 10 gr. as a hsema-
tinic. Solutions of manganese salts are apt to change color on .exposure
to the air.

[PBEPABATIONS, U. S. P. Manganesii oxidum nigrum, and Manga-
nesii sulphas.]

LEAD. 249

PLUMBUM LEAD, Pb,=207.

This metal, rarely found in its native state, occurs more often combined
with sulphur or oxygen. Its commonest ore is galena, a glistening gray
sulphide, PbS, from which the metal is obtained by roasting it in a cur-
rent of air; it is not used in medicine.

COMPOUNDS OF LEAD.

PLTJMB1 OXIDUM OXIDE OF LEAD LITHARGE, PbO,=223.

PREPARATION. By roasting lead ores with access of air, when the
oxide is formed in a melted state, and separates on cooling.

CHARACTERS AND TESTS. Occurs in small glistening red or yellowish-
red scales, which should dissolve without effervescence in dilute acids, but
after exposure for some time to the air, the scales slowly absorb carbonic
acid and may then give some effervescence; they are soluble also in ex-
cess of potash.

The following tests are applicable to this, and to all soluble salts of
lead: (1) Sulphuric acid and soluble sulphates give a white precipitate
(sulphate of lead) insoluble in dilute acids; (2) iodide or chromate of
potassium gives a yellow precipitate of iodide or chromate of lead; (3)
sulphuretted hydrogen or sulphide of ammonium gives a black precipi-
tate of sulphide of lead, but if the proportion of lead be minute, the color
is brown rather than black (W. G. Smith).

PLUMBI ACET A3 ACETATE OF LEAD " SUGAR OF LEAD," Pb(C 2 H 3

O s ) a 3H 2 O,=379.

PREPARATION. By dissolving lead oxide in slight excess of acetic
acid by aid of gentle heat, then crystallizing.

CHARACTERS. Occurs in white crystalline lumps, not unlike sugar, or
in large four-sided prisms. The odor is somewhat sweet and acid, and
the taste at first sweet, afterward astringent. It effloresces in air, and
is soluble in water; with distilled water the solution is clear, but with
ordinary water it is turbid from the formation of carbonate of lead with
the alkaline carbonates always contained in such water; a few drops of
acetic acid will dissolve the carbonate and clear the solution.

LIQUOR PLUMBI SUBACETAT1S -SOLUTION OF SUBACETATE OF
LEAD 11 GOULARD EXTRACT," Pb(C 2 H 3 O 2 )*PbO(in water), =548.

PREPARATION. By boiling neutral acetate of lead with two-thirds of
its weight of oxide of lead, then filtering, and adding distilled water: a
basic or subacetate of lead is formed.

250 MATEEIA MEDICA AND THERAPEUTICS.

CHARACTERS. A colorless liquid of alkaline reaction and sweetish as-
tringent taste. It quickly absorbs carbonic acid from the air, and be-
comes turbid from formation of carbonate. It gives precipitates with
most vegetable coloring matters, with tannin, and with many animal sub-
stances, especially albumen. With gum it forms an opaque white jelly,
which the acetate of lead does not. It answers to the other tests of lead
already mentioned.

PLUMBI CARBONA8 CARBONATE OF LEAD "WHITE LEAD," 2PbC

O 3 PbO,H a O,=775.

PREPARATION. No process is given in the Pharmacopoeia, but the
carbonate is prepared on a large scale by exposing thin sheets or gratings
of lead, placed in earthen pots, to the combined action of acetic acid, air,
and carbonic acid gas.

CHARACTERS. A heavy white powder, insoluble in water, but readily
soluble in dilute acids, with effervescence.

PLUMBI IODIDUM IODIDE OF LEAD, PbI 2 ,=461.

PREPARATION. By precipitating a clear solution of nitrate of lead
with iodide of potassium, washing, and desiccating.

CHARACTERS. A bright yellow powder, darkened by heat, almost in-
soluble in cold water, soluble in boiling water, from which it is deposited
in golden crystalline scales; soluble in solution of acetate of sodium. It
fuses and sublimes yellow, but soon gives off violet vapor (Garrod).

PLUMBI NITRAS NITRATE OF LEAD, Pb(NO 3 ) 2 ,=:283.

PREPARATION. By dissolving lead, or its oxide or carbonate, in boil-
ing nitric acid, slightly diluted, then crystallizing out.

CHARACTERS. Octahedral crystals of white waxy appearance, and
sweetish, astringent taste, soluble in water and alcohol, not efflorescent.

ABSORPTION AND ELIMINATION. Soluble lead compounds, when intro-
duced into the stomach, are transformed probably into chlorides, but in
any case are readily absorbed, as shown by clinical results; it is presumed
that they circulate mainly as albuminates.

Workers in lead, such as compositors, plumbers, and painters, absorb
the metal in part by the skin, in part by the lungs, and sometimes di-
rectly with the food (from eating with unwashed hands), and injurious
effects are not uncommon from the application of cosmetics and dyes con-
taining lead, to the skin and hair (v. p. 257). Once within the system
lead remains for a long time, in small quantities at least, and may be de-
posited in different organs. It has been found not only in the blood and

LEAD. 251

in the liver, spleen, and kidney, but also in the muscles and bones, and
Chatin recovered 3 milligr. of lead sulphide from 150 grammes of
the upper cervical cord the tissue was dark gray in color (Comptes
Rendus, Soc. de. Biol., t. iv., 1862). Lead is eliminated chiefly in the
form of chloride through the liver, kidneys, skin, and mucous membranes,
especially those of the urinary tract; the process is markedly promoted
by iodide of potassium.

(It will be seen from the above observations that I cannot accept the
conclusions of Mayen9on, " that lead is not absorbed by the skin," and
that after being taken, " its elimination is prompt and complete " Med-
ical Times, i., 1873, p. 489).

PHYSIOLOGICAL ACTION (EXTERNAL). Solutions of acetate and nitrate
of lead, if not too strong, exert a local astringent and sedative action,
coagulating albumen, contracting the vessels, blanching the tissue, and
controlling congestion if present; on the other hand, if the solution be
too strong, and be applied to a delicate part, such as the conjunctiva, it ex-
cites severe irritation. The carbonate of lead, applied in fine powder, is
sedative and slightly astringent. The iodide is slightly stimulant and
absorbent. The nitrate and chloride decompose sulphuretted hydrogen,
combining with the sulphur, and hence they act as deodorants.

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. The acetate
and subacetate of lead are the only salts of this metal given internally,
and the effect of moderate medicinal doses upon the intestinal tract is to
diminish its secretions and to occasion sometimes slight colic. The more
pronounced effects of poisonous doses vary with the mode of receiving
them, and may be acute, subacute, or chronic in character.

Acute poisoning. After a dose of from 1 to 2 oz. the symptoms
begin quickly with the characteristic taste of the drug, followed, perhaps,
in a quarter of an hour by burning and pricking in the gullet, nausea
and vomiting, but the vomiting caused by the poison alone is not usually
severe; there is uneasiness in the stomach sometimes followed by violent
colic, but the pain intermits, and it may be relieved by pressure. There is
usually constipation, but sometimes an attack of purging, the faeces being
dark, and containing lead sulphide.

Subacute poisoning may be illustrated by cases which occurred at
Stourbridge in 1849, when acetate of lead was mixed by accident with
flour at a miller's. Upward of five hundred persons were attacked, a few
days after eating the bread, with a sense of constriction about the throat
and stomach, cramping pain near the umbilicus, and rigidity of abdominal
muscles; sickness occurred only in a minority of the cases, and did not
last long; there was obstinate constipation and a general lessening of
secretion; a dark blue line on the gums was noted. No cases were fatal,
but severe symptoms continued for a long time, and sometimes recurred
after apparent convalescence.

252 MATEBIA MEDICA AND THEKAPEUTIC3.

The subject of chronic lead-poisoning is exceedingly interesting to
the practical physician, but concerns us at present only as illustrating the
physiological action of the drug. Some of its symptoms have occurred
from the medicinal use of the acetate, and from the continued use of
minute quantities rather than from massive doses. Thus, Sir R. Christi-
son gave 18 gr. in two days without injurious effects, while T 1 ^ gr. given
two or three times daily for two months caused fatal poisoning in a child
(Letheby, Taylor). As a rule, it may be said that the worst effects of
any medicinal use of lead limit themselves to an attack of colic, and the
severe symptoms about to be described need not be feared from it: 5-gr.
doses of acetate are largely used at Brompton Hospital without bad re-
sults.

The ordinary " lead colic," or plumbism, is traceable most frequently
either to the mechanical use of metallic lead, its oxides or carbonates, or
to the solution of these salts in drinking-water, etc. (v. p. 257). After
some general malaise, disordered taste, dryness of mouth, fetid breath,
anorexia, and constipation, pain will usually be the most marked symp-
tom, but is not so invariably; Dr. Garrod finds it absent in 2 or 3 per
cent, of cases. When fully developed, it is much more intense than or-
dinary colic; it is referred mainly to the region of the navel (the colon),
but darts rapidly, like neuralgic pain, in many directions, toward the
loins, the scrotum, the chest, and the thighs: it has a twisting, tearing char-
acter, so that German miners name it commonly " Hiitten Katze " (" cat
of mines "). It comes on in paroxysms, remaining constant but dull in the
intervals, and the whole attack lasting from a few minutes to several
hours; it is often worse at night, but its recurrence is irregular. Relief
is found from firm pressure and altered position, and the sufferer either
lies flat on his face, pressing the abdomen, or is doubled up, bending his
legs, or rises suddenly, still pressing the painful part with his hands, till
a violent paroxysm again sends him to bed. Restlessness is extreme, and
the whole attention is concentrated on the pain. The abdominal walls
are rigid, knotty, and drawn in, there is commonly tenesmus, and the
rectum has been felt to contract and relax spasmodically. The liver is
retracted (Potain) or actually lessened in size; the intestines also are
drawn into less space from contraction of their muscular coat, and in pro-
longed cases, after the abdominal fat has been absorbed, the retraction
of the belly becomes very striking.

Tariquerel (Trait'e, des Maladies de Plomb, Paris, 1839) and Burton
(" Medico-Chirurgical Transactions," 1840) were the first to describe as
common in plumbism a dark blue or gray line along the free edge of the
gum, together with a brownish coloration of the teeth. Though a valua-
ble sign, and often present, it is not always so, nor does it necessarily
imply saturation of the system with the mineral; it varies in its time of
appearance according to the dose, but has been seen within twenty-four

LEAD. 253

hours of administration of one large quantity (Burton): 20 to 30 gr.,
in divided doses, may develop it, and when once seen it is very persistent;
similar colored patches may often be found on the buccal mucous mem-
brane. The coloring depends on formation and deposition of lead sul-
phide from the sulphuretted hydrogen evolved from particles of food left
about the teeth (Tomes), and by perfect cleanliness it may be prevented.
According to Dr. Hillipn Fagge, it is distributed in rounded loops corre-
sponding with vascular papillae of mucous membrane, and depends on
small pigmented granules, some of which are external to, others within
the small vessels. He concludes that the gas from food-particles diffuses
into the gum-textures, and then combines with lead circulating in blood
or plasma, so that particles of lead sulphide are really precipitated a
similar condition may be present in the intestinal membrane. Iodide of
potassium sometimes induces its rapid development (Lancet, i., 1876, p.
709).

We cannot so readily explain the pathology of the colic. It is in part
dependent on constipation, or accumulated mucus within the canal, for
it is relieved when purgation is secured; yet Briquet claims to have re-
lieved more quickly by faradaism of the abdominal wall without any ape-
rient effect. It is dependent partly also on irregular muscular contrac-
tion of the intestinal tube, following on partial paralysis and spasmodic
peristalsis; other characters again show it connected with an enteric neu-
ralgia (v. p. 254).

In acute poisoning, the gastro-intestinal mucous membrane has been
found coated with a whitish-gray layer of coagulated mucus containing
the poison, and there have been patches of abrasion, congestion, or in-
flammation. In chronic cases the membrane is congested, softened, and
discolored, the walls are thickened, and the canal irregularly contracted;
sometimes intussusceptions are found; the coils of intestine are closely
packed together. In chronic plumbism, emaciation is notable, especially
about the face.

Nervo- Muscular System. Ordinary medicinal doses do not usually
produce definite effects on the nerves or muscles, but in acute poisoning
from large quantities, besides the pain and cramp already mentioned,
general prostration is a marked symptom. There may be also giddiness
or stupor, numbness or paralysis, and, in fatal cases, convulsion. In the
subacute cases at Stourbridge, the nervo-muscular symptoms were cramp
and rigidity of muscles, numbness, and partial palsy of lower extremities,
and collapse: the mental faculties were unimpaired.

But it is in chronic plumbism that affections of the nerves and mus-
cles become marked and significant, various forms of paralysis almost
always appearing. The most common is a paralysis of the extensors and
supinators of the forearm, leading to a condition known as " wrist
drop," from the peculiar manner in which the hand hangs down when

254 JIATERIA JIEDICA AISTD THERAPEUTICS.

the limb is extended. This occurs more often on the right side than the
left the fingers and wrists are flexed and the hand prone, the elbow
stands out from the side, and the forearm bends on the arm wasting of
the affected muscles quickly follows, and especially of the small muscles
of the thumb.

A special plastic or fungoid form of synovitis in the sheath of the ex-
tensor tendons has been described (Gubler: Britisfy Medical Journal, ii.,
1878).

Sometimes other muscles are affected thus, strabismus has been
noted from paralysis of ocular recti, and aphonia from laryngeal palsy.
Occasionally hemiplegia occurs, more rarely still paraplegia, and in ad-
vanced cases the extensors, at least of the lower limbs, are more or less
affected. Death has resulted from paralysis of respiratory muscles. Of
the special senses, sight is the most often affected, amblyopia occurring,
or amaurosis from anaesthesia of optic nerve; in such cases the pupil is
dilated. It is not uncommon for the hearing to suffer, and common sen-
sibility is often altered. There is usually partial anaesthesia, though
sometimes, as in the Claremont cases, excessive hypersesthesia is de-
veloped.

During an attack of lead colic the intellect is, as a rule, clear, but in
continued cases the moral courage and the spirits give way, and some-
times in the course of the illness distinct delirium occurs, generally of
the form " delirium of dread," not unlike delirium tremens. The patient
is extremely fearful of being alone, especially at night, and has visions
of black and creeping things. Three remarkable illustrations occurring
in women-workers at a lead-factory are furnished from the London Hos-
pital (Medical Times, \., 1869). Other cerebral symptoms, such as head-
ache, delirium, epileptiform convulsions, and coma, have been recorded;
insomnia is usual.

Theories of Plumbism. Whether the muscles or nerves are primarily
affected, and in the latter case whether the peripheral branches or the
centres are most at fault, has been much debated. Giacomini attributed
the colic to direct muscular irritation from deposition of the metal in the
abdominal muscles and the diaphragm, pointing out that superficial pres-
sure often gives pain, even over the iliac crests (where the intestines are
not), while firm supporting pressure relieves. Briquet, acting upon this
theory, faradized the skin of the abdomen with a metallic brush, and thus
relieved the pain by counter-irritation. That the paralysis also depends
on deposition of the metal in the muscles is suggested by the frequency
with which the right arm is affected in lead-workers, it being more ex-
posed to the poison than the left.

Tanquerel maintained that the colic was due to irritation of the great
ganglionic centres, though signs of this could only be found in one out
of forty post-mortem examinations. It may be noted, however, that gal-

LEAD. 255

vanism of the sympathetic nerve-centres has been said to cause elimina-
tion of the poison quickly, and to cure palsy of the forearm without
direct local treatment (Medical Times, i., 1877).

Eulenburg considers lead colic " a mixed neurosis of motor-sensory
nature, in which the splanchnic nerves and vaso-motor branches from the
aortic plexus are affected " (Medical Times, i., 1870). He points out the
special determination of lead to the muscular system and its powerful
local effect in causing contraction of involuntary muscles.

Heubel argues that the peripheral intra-muscular extremities of nerves
are at fault rather than main trunks (" Bleive<rgiftung," Berlin, 1871), and
Althaus apparently takes the same view (Medical Times, i., 1874, p. 548).
On the other hand, Bernhardt asserts that the real lesion is in the gray
matter of the cord (Medical Record, 1878), and most modern observations
point to the same conclusion, at least in chronic conditions; lead has been
found in its substance in some cases (Chatin, v. p. 251), and a granular
partly atrophic state of spinal cells has been verified in one instance by
Lancereaux. The affected muscles and corresponding nerve-trunks are
much atrophied, so that sometimes scarcely one normal fibre can be
found.

Circulatory System. Full medicinal doses of the acetate slightly
lower the force and frequency of the pulse (Laidlaw). In hemorrhagic
cases and in pneumonia this effect is often marked. Strohl found a
diminution of ten to fifteen beats per minute after daily doses of 25 to 50
ctgr., and Rabuteau verified a pulse-rate below that of health; it has been
explained by a direct action on the muscular structure of the heart. In
cases of acute lead-poisoning, the pulse has been sometimes quickened, but
has become slow in the stage of collapse. In subaciite cases it is markedly
slow and feeble. During a paroxysm of colic in the course of plumbism
the pulse is of characteristic wiry hardness, and generally lowered in
frequency, while the heart-action is so weakened as to be scarcely per-
ceptible. In half the large number of cases recorded by Tanquerel, the
pulse-rate was from 30 to 60 per minute, the hardness and slowness being
usually proportioned to the amount of pain; exceptionally the frequency
was increased. The peripheral circulation is commonly impeded, and
arterial ana?mia leads to pallor and chilliness, though in two cases re-
corded by Murchison a rise of temperature (102) was found (Lancet, i.,
1868). In chronic conditions of lead-poisoning the pulse is small, hard,
and usually slow, and the sallow, bloodless skin has an icteric tint, anaemia
is commonly marked, and there is more than normal water in the blood as
well as fewer red globules; Malassez states, however, that these are in-
creased in size (Archives de PhysioL, 1874). Cardiac murmurs are usual
in lead-workers, and it is said that the heart and great vessels have been
found smaller than usual after death. Henle considers that the vessels
are contracted (during life) by direct irritation of their muscular coat by

256 MATERIA MKDICA AND THERAPEUTICS.

lead circulating with the blood; certainly vascular tension is much in-
creased in plumbism, as clearly shown by the sphygmogram of Dr. A.
Frank (Dent. Arch. Klin. Med., Bd. xvi., Hft. 3). German observers,
besides corroborating this, have demonstrated the antagonistic effect of
pilocarpin during attacks of colic; very soon after its hypodermic injec-
tion the tracing shows greatly lessened tension, and simultaneously the
pain is relieved. Nitrite of amyl acts similarly (Medical Record, 1876).

Genito-urinary System. Chronic lead-poisoning often leads to abor-
tion, and if this does not occur, the children born are delicate. Of ]23
conceptions among lead-workers, 50 children only were born alive, and
of these but 14 survived infancy. It would seem that the influence of
one parent only affected by lead is enough to produce these results (M.
Paul: Archives de Meet., 1860). Amenorrhcea has been clearly traced by
Dr. Dowse to working in lead.

The influence exerted by this drug upon the kidney is of great practi-
cal importance: albuminuria is not uncommon in acute plumbism, and is
then connected probably with altered blood-conditions, but in chronic
cases a directly injurious action is exerted on the kidney structure, lead-
ing to fatty or albuminoid degeneration. Dr. Shearman has recorded two
remarkable instances of albuminuria in one family, clearly traceable to
the use of drinking-water impregnated with lead characteristic palsy
was also present. The cases recovered for a time after removing the
cause, but later, one died of apoplexy, the other of albuminuria (Practi-
tioner, vol. xii.).

During a paroxysm of colic the kidney secretion is diminished, and is
passed with difficulty. It is proved, also, that the withdrawal of urates
from the blood in its passage through the kidneys is lessened under the
influence of lead, and the amount of uric acid excreted by the same or-
gans is lessened, hence a larger than normal amount remains in the blood,
and the patient becomes exposed to gouty attacks. Indeed, both Dr.
Garrod and Dr. Ringer have developed acute gout in susceptible subjects
by the administration of lead salts, and the former has calculated that 33
per cent, of gouty patients had been exposed in some manner to the ac-
tion of lead. Pains about the joints, and urate deposits, are not uncom-
mon in saturnine cachexia. Dr. Wilks adds testimony to their frequency
(British Medical Journal, i., 1875).

Glandular System. By the ordinary medicinal use of the drug all
secretions are diminished. According to Rutherford, the acetate of lead
is the only substance which lessens the secretion of bile without causing
purgation, and he considers this action to be direct, not indirect or reflex;
it is overcome by salicylate of soda. He connects the constipation partly
with this action on the liver, partly with similar action on the intestinal
glands (British Medical Journal, ii., 1878). Heubel attributes the icteric
condition frequent in plumbism to contraction of the bile-ducts (muscular

LEAD. 257

fibres). During an attack of colic, all the secretions are diminished ex-
cept that of the skin (Alderson: " Lumleian Lectures," 1852, Lancet).

Modes of Chronic Lead-poisoning. Of the different workers in lead,
oxide of lead, or " white lead" (carbonate), those who grind it in factories
are most liable to suffer, though less so now that the powder is ground
with water (Taylor); but house-painters and coach-painters, plumbers,
pewterers, and compositors, makers of certain white glazed cards, hat
pressers, bleachers of Brussels lace, and glazers of pottery, are often af-
fected. Severe symptoms have sometimes arisen from sleeping in a new-
ly-painted room, or from breathing the sm.oke of burning painted wood.
Among exceptional and little suspected causes of plumbism, are the hand-
ling of vulcanized rubber and black horse-hair colored by lead sulphide,
the use of hair washes, dyes, and cosmetics containing lead salts, breath-
ing dust from "American cloth" whitened with lead salts, and in the
process of making yellow cord fusees (chromate of lead). Poisonous
symptoms have followed in an infant after the application of strong lead
lotions to the mother's nipples, and in children from yellow confectionery
(chromate); the chewing of "tea lead" (in which tea is wrapt), the using
of snuff that had been wrapped in similar " foil," the use of soda water
from lead "syphons" (British Medical Journal, 1874-75) (free tartaric
acid is said to help in this case) bathing in water impregnated from a
leaden pipe, the drinking of wine from bottles which had been cleansed
with shot have all caused plumbism.

Two curious epidemics have occurred one at Taunton, another in
France from flour ground .between millstones that had been mended
with lead (British MedicaUournal, 1877; Medical Times, i., 1878), and
even the handling of lead machines, as in ice-cream making, or cameo
polishing, or cleaning " beer engines " or brass handles (as engineers do),
has induced colic.

There is some reason to think that the " dry colic," or enteric neural-
gia, of tropical countries is connected with lead. Gubler gives instruc-
tive instances of its development from the use of lead cosmetics in Creoles
(Medical Record, 1876), and it is said to have become more common since
steam-boats have been more used ! (Medical Record, 1876). Mialhe and
other French physicians also speak of lead colic being frequent on ship-
board, and connect it with the action of a saline atmosphere on lead en-
gines, etc.

But excepting the trades first mentioned, the most frequent source of
lead-poisoning is the use of drinking-water impregnated with the metal
or some of its compounds. Bad symptoms have resulted from so small
an amount as -fa gr. per gallon, and 1 gr. per gallon is a surely dangerous
dose. It is to be noted that the freer the water from saline ingredients,
the more readily it takes up a soluble carbonate formed on the metal pipe
or cistern. Its formation and solubility are also favored by much organic
VOL. II. 17

258 MATERIA MED JO A AND THERAPEUTICS.

impurity, free access of oxygen, a little nitric acid (as may happen after
thunder-showers), or the presence of a second metal (iron as well as lead).
Carbonic acid in pure water also favors solubility, although in certain cir-
cumstances it may act differently. Lime and other saline constituents
will, on the other hand, if present in the water, lessen liability to contam-
ination by forming insoluble coatings on the metal: otherwise, no doubt,
plumbism would be still more common than it is.

Idiosyncrasy. There is a great difference in the susceptibility of
different individuals to the poisonous action of lead as may be verified
in any large factory and it is comparable to what has been noticed with
arsenical wall-papers, etc. One attack of colic strongly predisposes to
another, which may follow after a long interval from comparatively
slight cause thus, a man who had suffered as a house-painter, turned
game-keeper, and got an attack long afterward from stirring shot in
water with his hands (British Medical Journal, i., 1877).

SYNEBGISTS. The depressing influence of lead upon the circulation is
assisted by digitalis, ergot, veratrum, prolonged cold, etc.; its astringent
action by metallic salts of copper and zinc particularly. The other metals,
especially mercury, antimony, and copper, have a similar effect in lessen-
ing nutrition.

ANTAGONISTS AND iNCOMPATiBLEs. Sulphate and carbonate of lime,
carbonic acid, acids mineral and vegetable, alkalies, iodide of potassium,
opiam, albuminous solutions, and most vegetable astringents are chemi-
cally incompatible, and most of these may be used in the treatment of-
lead-poisoning. In acute cases, when the *drug has been taken by the
mouth, emetics or the stomach-pump should be used, and sulphate of soda
or magnesia given in milk or mucilage. In chronic cases, alkaline iodide
should be given internally, and sulphur baths should be used, containing
about 7 oz. of sulphuret of potassium. During half an hour of bathing,
frictions should be employed, and soap should be freely used afterward
(Eulenburg). Electricity should be applied to the affected muscles
faradaism if it causes contraction, if not, the continuous current three or
four times weekly for about a quarter of an hour, whether it induces con-
traction or no: in curable cases it will ultimately do so. Purgatives
should be freely given. Fatty food is said to antagonize the develop-
ment of plumbism in lead-workers, and a long prevalent colic in large
lead-works at Birmingham was stopped by the free use of a " treacle
beer," containing sulphuric acid (Lancet, i., I860). Washing the hands
before eating, etc., is important, and washing with petroleum is said to be
prophylactic (British Medical Journal, ii., 1877).

Pilocarpin and amyl nitrite antagonize the increased arterial tension
which occurs in chronic cases (v. p. 256).

THERAPEUTICAL ACTION (EXTEENAL). Disinfectant Power. A. solu-
tion of lead nitrate (Ledoyen's disinfectant) has been in use for many

LEAD. 259

years, and acts by decomposing sulphuretted hydrogen, but has no other
good effect; it is comparatively expensive, and its black precipitate is
sometimes objectionable: Dr. Goolden has, however, recently recom-
mended as applicable to many cases, solution of chloride of lead, although
it also can act only on sulphuretted hydrogen. He prepares it by dis-
solving $ dr. of powdered nitrate of lead in one pint of boiling water, and
mixing this with 2 dr. of common salt in 2 gallons of water. The pre-
cipitate which falls is in part carbonate of lime, in part carbonate of lead,
and the clear supernatant fluid is a saturated solution of lead chloride.
This quickly removes the smell of foul drains, ship-holds, etc., and cloths
wrung out of it, and placed about a room, neutralize organic emanations,
e.g., from crowded assemblies, fetid suppuration, etc. It was used with
much advantage on board the Thunderer after a gun-explosion (Lancet,
ii., 1875, ii., 1876 ; British Medical Journal, ii., 1876, p. 323).

Inflamed Surfaces. A solution of subacetate of lead is still, perhaps,
the most frequently used of all remedies in the external inflammatory
conditions for which it was introduced by Goulard, of Montpelier, more
than 100 years ago.

In erysipelas it proves cooling and astringent, and a good formula for
its use is that given by Christison, Murchison, and others (Medical Times,
i., 1867, p. 523), viz., 4 gr. each of lead acetate and of powdered opium
in an ounce of warm water. The meconate of lead is formed, and pre-
cipitates, but gives an effective therapeutical result; a more elegant form
combines the lead salt with acetic acid and acetate of morphia. Dr.
Lawson speaks well of a solution of acetate, 10 to 20 gr. in \ oz. each of
plain water and lime-water, for all kinds of burns, wounds, and ulcers
(Lancet, ii., 1875). Mr. Freer, from much practical experience, recom-
mends the carbonate of lead with linseed oil (white paint) in preference
to the acetate, or indeed to any other application; it has the advantage
over nitrate of silver of being painless, and it often relieves very quickly
(Lancet, i., 1859). It is good not only in erysipelas, but in burns, car-
buncles, eczemas, etc., since it excludes air and exerts a sedative effect
it may be applied with a feather, and a fresh coat put on every two hours
or so, and left to peel off in a few days. A more elegant mode of using
the carbonate is with glycerin, 1 dr. to 4 gr. of the powder, and 1 oz. of
cerate; this is useful for erythema.

Conjunctivitis. Warm lead lotions, with or without opium, are very
serviceable in ordinary catarrhal cases, but it is important they should
not be ordered if the corneal surface be abraded, or else an opaque white
deposit may be left.

Eczema. In cases of moist discharging eczema, lead lotions are often
soothing and sometimes curative; a combination of the liquor plumbi 1
oz., with glycerin - oz., and cherry-laurel water 3^- oz., is very good for
subacute cases, but may require. dilution. Mr. B. Squire gives the pref-

260 MATERIA MEDIC A AND THERAPEUTICS.

erence to a glycerole of subacetate of lead, in the preparation of which
glycerin is used instead of the water of the officinal liquor (Medical
Times, i., 1876): 1 part of this in 4 of glycerin or of vaseline is a useful
strength. Equal parts of the liquor plumbi and glycerin have given me
as good results in chronic eczematous conditions, and more especially in
mentagra. In some cases, the iodide of lead ointment will be found use-
ful.

Wounds. Mr. Hutchinson has strongly recommended the continuous
use of lead lotions in operative surgery. Within about six hours of any
serious amputation he applies over and near the part, compresses soaked
in a lotion containing oz. of liquor plumbi, and 1 oz. of spirit of wine,
in a pint of water, and kept constantly moistened every half-hour for
several days and nights. This constant attention is essential to success,
and is the only troublesome part of the treatment, which seems to prevent
inflammation, to have some antiseptic power, and certainly to promote
union by first intention no poisonous symptoms have been observed
from it (Lancet, i., 1875). Zeissl advocated a similar dressing for bubo,
after observing the unfavorable results of routine treatment by incision,
etc., as carried out in certain German hospitals; he kept the surface con-
stantly covered with linen soaked in solution of basic acetate of lead, and
found that inflammation and suppuration were much controlled, and con-
valescence hastened (Medical Times, i., 1872, p. 521).

Onychia. Powdered nitrate of lead I have found a remarkably good
resource in cases of onychia, and it has quickly benefited when ordinary
treatment had failed (Marsh, MacCormac, Scott, etc., British Medical
Journal, i., 1874). Professor Perizzi was the first to draw attention to
this.

Sore Nipples. Dr. Fordyce Barker speaks highly of the nitrate of
lead (10 to 15 gr. in the ounce of glycerin) as an application to sore nip-
ples (Medical Times, ii., 1873, p. 503).

Enlarged Glands, etc. The ointment of lead iodide is often useful in
chronic adenitis and splenic enlargements, also in chronic synovitis.

Leiicorrhcea, etc. In cases of purulent and muco-purulent discharge
from the vagina, the urethra, the ear, etc., lead lotion is very useful, and
may be used at any stage, since, if sufficiently dilute, it does not irritate,
like alum and some other astringents. If, however, improvement is not
obtained from weak dilutions, the full strength should be tried, and zinc
sulphate may be added in the proportion of 1 or 2 gr. to the ounce of
lead lotion.

THERAPEUTICAL ACTION (INTERNAL). Hemorrhage. The acetate of
lead has decided power over many forms of internal hemorrhage, and is
still in frequent use, though not so much so as formerly. Dr. Elliotson
often prescribed it in 2 to 3-gr. doses; Dr. Stokes says "nothing can be
more striking than its power to arrest the discharge in chronic bronchial

LEAD. 261

hemorrhage," and I have more than once verified this. Dr. C. J. B. Wil-
liams recommended 3 gr. with opium every hour or half-hour in cases of
haemoptysis, taking care to give a daily dose of purgative salts (Lancet,
i., 1862). In the hemorrhage of enteric fever, acetate of lead is often
valuable.

In an obstinate case of hcematuria (renal), after failure of tannin,
iron, and other remedies, grain doses of lead acetate, with gr. of opium,
given every six hours, soon arrested all bleeding; a blue line appeared
on the gums within a week of this treatment (Gull: Lancet, i., 1866).
In uterine hemorrhage, acetate of lead with opium is often suitable. Dr.
Dewees used it largely in plethoric menorrhagia and in hemorrhage oc-
curring during pregnancy.

Dr. Workman has written to advocate a novel prescription, which
theory would scarcely seem to justify, though the practice is said to be
advantageous; he gives the acetate in to 1 dr. doses without any
opium; this causes diarrho3a, but no other bad symptoms, and produces,
he says, the best results in haemoptysis and also in uterine hemorrhage,
and causes contraction of the uterus (Medical Record, 1878).

Phthisis Chronic Bronchitis. At one time, acetate of lead was
thought valuable in consumption, and it may relieve some of the symp-
toms, such as profuse sweating, expectoration, and diarrhoaa, but the
cases said to be cured by it were probably of chronic bronchitis, with ex-
cessive secretion. M. Beau has, however, written comparatively lately
to advocate again the advantages of lead treatment in phthisis, recom-
mending the carbonate in gradually increasing doses (Lancet, ii., 1861).
He founded his practice upon some cases of phthisis which recovered
after working in lead-factories, and concludes that a moderate degree of
lead-poisoning is antagonistic to the malady but such an opinion is not
generally accepted. I need scarcely say that other physicians condemn
the use of lead salts in phthisis "as worse than useless" (Medical Times,
i., 1860, p. 435). The truth probably lies between the two extremes, but
a decided objection to any continued use of the drug is its impairment of
appetite.

Pneumonia. Under the use of lead acetate, a good proportion of
success in the treatment of pneumonia has been reported by Brandes,
Strohl, Leudet, and others (British Medical Journal, i., 1863).

Aneurism. Since the observations of Dupuytren, who reported three
cases of aortic aneurism relieved by lead acetate (together with small
bleedings and i;est), this remedy has been tried by many physicians. Dr.
Owen Rees reported a case of acute popliteal aneurism (Lancet, i., 1805),
with thin walls, and no coagula in the sac, which did not improve under
pressure, and was thought incurable without operation; on October 29th,
3 gr. of acetate with opium were ordered thrice daily, the diet was not
restricted, nor rest enforced: on November 1st, there was a slight blue

262 MATERIA MEDICA AND THERAPEUTICS.

line on the gums: on November 5th, the dose was increased to 5 gr., and
this was continued for twenty-six days, when the remedy was stopped on
account of colic: aneurismal pulsation had ceased. On December 31st
the man was at work, and on January 17th reported cured. This rather
striking instance I have not found supported by the results of others,
though Dr. A. Clark reports a case of thoracic aneurism in which 2 gr.
of acetate with opium were given thrice daily for two months, and the
patient got better; he was kept constantly at rest (Medical Times, ii.,
1867, p. 566). Stille remarks that the sacculated form of aneurism can
only be cured by coagulation of blood in the sac, and in so far as acetate
of lead promotes this, it assists a cure, but in the fusiform aneurism, with
symmetrical distension, no mere astringent can exert a salutary power.
Bellingham objects to the use of lead in any case, and Mr. T. Holmes,
who has known aneurism develop during the course of a lead colic, as-
serts that the acetate is of no real value in the treatment of the malady
(Lancet, i., 1872). Dr. Bristowe points out that it may help to quiet the
circulation, but cannot really coagulate blood within the vessels, other-
wise its administration would lead to danger from thrombosis or embo-
lism. From a general review of the evidence at present before us, I
should conclude that although individual cases of apparent benefit may
be cited, as a rule very little can be expected in aneurism from the use of
lead.

Diarrhoea Dysentery. Stille has collected a large amount of evi-
dence, American and foreign, in favor of lead acetate as a remedv in
many forms of these disorders. Graves and others have recommended it
in cholera. It certainly exerts a powerfully astringent effect, but should
not be used without due regard to the elimination of irritating material
by previous purgation if necessary. In some cases of obstinate diarrhosa
among the ill-fed children of the poor, I have found it exceedingly useful.

PREPARATIONS AND DOSE. Plumbi acetas : dose, to 3 gr. or
more. Pihda plumbi cum opio : dose, 4 to 8 gr. (1 gr. of opium in 8 gr.
of the pill mass). Plumbi iodidum : dose, to 1 gr. Suppositoria
plumbi composita: (1 gr. of opium and 3 gr. of acetate in each). The
following are for external use only: Plumbi oxidum; Etnplastrum plum-
bi (diachylon); Emplastrum plumbi iodidi; Unguentum plumbi acetatis;
Liquor plumbi subacetatis (Goulard extract); Liquor plumbi subacetatis
dilutus (Goulard water) ; Unguentum plumbi subacetatis comp. (contains
camphor, wax, and oil better made with vaseline) ; Plumbi carbonas ;
Unguentum plumbi carbonatis ; Plumbi nitras.

[PREPARATIONS, U. S. P. Plumbi acetas ; Ceratum plumbi acetatis :
solution of subacetate of lead 2 fluid ounces, white wax 4 troy-
ounces, olive-oil 8 troyounces, camphor 30 gr. ; Linimentum plumbi
subacetatis : olive-oil 3 troyounces, solution of subacetate of lead 2 troy-
ounces; Liquor plumbi subacetatis ; Liquor plumbi subacetatis dilutus ;

POTASSIUM. 263

Suppositoria plumbi : acetate of lead 36 gr., oil of theobroma 324 gr. ;
make 12 suppositories; Suppositoria plumbi et opii : acetate of lead 36
gr., extract of opium 6 gr., oil of theobroma 318 gr. ; make 12 supposi-
tories; Plumbi car bonas; Unguentum plumb i carbonatis (60 gr. in 1 oz.);
Plumbi lodidum; Unguentum plumbi iodidi (60 gr. in 1 oz.); Plumbi
nitras / Plumbi oxidum Emplastrum plumbi.]

POTASSIUM KALIUM, K,=39.

This metal has not been found native, but its various compounds are
very widely diffused. The nitrate occurs in various soils, and the chloride
in mines, the tartrate in the juice of the grape and other fruit, and carbo-
nates and chlorides are found in the ashes of all woods and plants; chloride
of potassium abounds especially in the seeds of leguminosas (Berthier).
From vegetables this salt passes into the animal organism, and hence the
milk and the urine of herbivora contain much more of it than the same
secretions of carnivora: the blood-globules and the contractile substance
of muscle contain a comparatively large proportion of it.

CHARACTERS. The metal itself is soft and silvery white, so light (sp.
gr. .865) that it floats on water, and with such affinity for oxygen that it
abstracts that gas from the water, thus setting free hydrogen which ig-
nites and burns with a violet purple flame, characteristic of the presence
of potassium. Some liquid devoid of oxygen like benzine is therefore
required for keeping the metal; if exposed to the air it rapidly oxidizes
to potash.

COMPOUNDS OF POTASH.
Potassii iodidum (v. vol. i., p. 59). Potassii bromidum (v. vol. i., p. 97).

LIQUOR POTASS^ SOLUTION OF POTASH, KHO,=56.

PREPARATION". By adding slaked lime to a boiling solution of about
twice its weight of carbonate of potash; carbonate of lime subsides, and
the clear solution of potash is transferred by means of a syphon to a bot-
tle, which should be of green glass.

K a CO 3 + CaH 2 O 2 = 2KHO + CaCO 3 .

(The solution would corrode wool or other organic niters, and would dis-
solve lead in white glass.)

CHARACTERS AND TESTS. A colorless liquid of acrid taste, and
strongly alkaline reaction; sp. gr. 1.058; contains nearly 6 per cent, of
caustic potash, or 27 gr. in the fl. oz. ; it feels soapy when rubbed between
the fingers, on account of its solvent action on the cuticle; it corrodes

264 MATERIA MEDICA AND THERAPEUTICS.

animal and vegetable substances, and forms soluble soaps with oily and
fatty bodies. It is liable to contain carbonate of potash, lime, sulphates,
chlorides and alumina. The best general test for potash salts in solution
is perchloride of platinum, which precipitates a yellow double chloride.

POTASSA CAU8T1CA CAUSTIC POTASH HYDRATE OF POTASH
POTASS1C HYDRATE, KHO,=56.

PREPARATION. By rapidly evaporating the liquor to dryness in a
clean silver or iron vessel, then fusing and pouring into suitable moulds.

CHARACTERS AND TESTS. Occurs in hard fibrous pencils, which should
be white, but are often bluish in color; of peculiar nauseous odor, and
acrid taste. It has a strong affinity for water and carbonic acid, and
readily deliquesces if exposed to the air: is soluble also in alcohol. Heat
is evolved during its solution in water.

POTASSES CARBONAS CARBONATE OF POTASH, K 2 CO 3 ,=138.

PREPARATION. From the ashes of plants which consist of a soluble
carbonate, and insoluble salts of lime, silica, etc. The carbonate is dis-
solved out by frequent washing with water, which is then evaporated,
and the residue fused to a brown stony mass the crude potashes of com-
merce (black potash). This is purified by calcination in a furnace, the
dull white residue being termed " pearl-ash," and this again is further
purified by solution in a small quantity of water, filtering, and evaporat-
ing to dryness. The carbonate may also be obtained by heating to red-
ness the bicarbonate.

CHARACTERS AND TESTS. Occurs in small white opaque crystalline
grains, having strong alkaline taste and reaction; it is distinguished from
the bicarbonate and from sodium salts by its great affinity for water, for
on exposure it soon deliquesces into a thick liquid.

POTASS^ BIG ARBON AS BICARBONATE OF POTASH, KHCO 3 ,=100.

PREPARATION. By passing carbonic acid gas through a strong solu-
tion of carbonate of potash; the stream of gas should be disengaged
slowly but continuously for a week: crystals of bicarbonate are gradually
deposited.

K,CO 3 + H S O + CO,, = 2KHCO 3 .

CHARACTERS AND TESTS. These crystals are large, transparent, color-
less, rhombic prisms, which are not deliquescent and not caustic; they
are soluble in four parts of cold, and less than their own weight of boil-
ing water, insoluble in alcohol: nearly neutral to test paper.

POTASSIUM. 265

POTASS^ AC ETAS ACETATE OF POTASH, KC 3 H 3 O S , =98.

PREPARATION. By neutralizing acetic acid with carbonate of potash;
the acetic takes the place of carbonic acid, which is liberated with effer-
vescence.

K.CO, + 2HC,H S 0, = 2KC,H 3 S + H,O + CO 2 .

The liquid is evaporated, and the salt dried, melted, and crystallized.

CHARACTERS AND TESTS. Occurs in white, smooth, glistening, and
generally long pieces, which are soft, fibrous in texture, and unctuous to
the touch: neutral in reaction, very deliquescent, and soluble in alcohol,
as well as in water.

POT ASS j CITRAS CITRATE OF POTASH, K 3 C 6 H 6 O 7 ,=306.

PREPARATION. By neutralizing carbonate of potash with citric acid;
a reaction similar to the last-mentioned occurs, but this acid being triba-
sic, requires three equivalents of carbonate for saturation.

3K 1 CO i +2H,C.H 6 O 1 =2K 1 C e H.O T +3H a O+3CO s .

CHARACTERS AND TESTS. Citrate of potash is a white, granular, crys-
talline powder, deliquescent, soluble in water, insoluble in alcohol. It is
charred by hot sulphuric acid, and its solution gives a precipitate with
chloride of calcium Tanly when boiled a test which distinguishes it from
tartrate of potash.

POTASS^! TARTRAS TARTRATE OF POTASH, K 2 C 4 H,O<,,=226.

PREPARATION. By boiling the acid tartrate with carbonate of potash
and water, when an equivalent of hydrogen in the acid salt is replaced by
one of potassium, and carbonic acid given off.

2KHC 4 H 4 6 + K,C0 3 = 2K 3 C 4 H 4 O 6 + H,O + CO,.
The liquid is then concentrated to crystallization.

CHARACTERS. Occurs in small granular crystals, deliquescent, soluble,
neutral in reaction, and somewhat bitter in taste.

POTASS^E TARTRAS ACID A ACID TARTRATE OF POTASH CREAM
OF TARTAR, KHC 4 H 4 O 6 ,=188.

PREPARATION. Grape-juice contains a large quantity of this salt,
which is retained in solution by the saccharine matter. When this latter
is converted into alcohol by fermentation, the acid tartrate is gradually
deposited inside the wine casks, and is known as " crude tartar," or
" argol," and this, when purified by recrystallization, constitutes " cream
of tartar," a name originally given to the fine crystals which were " skim-
med off " the evaporating liquid.

266 MATERIA MEDICA AND THERAPEUTICS.

CHARACTERS AND TESTS. Occurs as a gritty white powder, or in
fragments of cakes. It is distinguished from the neutral tartrate by its
very sparing solubility in water, viz., 1 in 180 parts: in spirit it is in-
soluble, like other tartrates. It chars on exposure to heat, giving off in-
flammable gas and an odor of burnt sugar.

POTASS^ SULPHAS SULPHATE OF POTASH, K 3 SO,=174.

PREPARATION. There is no process directed in the Pharmacopoaia,
but the salt may be prepared from the residue left in the manufacture of
nitric acid, this residue being an impure acid sulphate, which is converted
into the neutral salt by treatment with lime, and afterward with carbon-
ate of potash and sulphuric acid.

CHARACTERS AND TESTS. A very hard crystalline salt, sparingly
soluble in cold water; decrepitates on heating: has a bitter, rather nau-
seous taste.

POTASSA SULPHURATA- SULPHURATED POTASH (HEPAR SUL-

PHURIS).

PREPARATION. By fusing together carbonate of .potassium and sub-
limed sulphur.

CHARACTERS AND TESTS. From its liver color, when fresh, it was
formerly called " liver of sulphur," but it rapidly absorbs oxygen from
the air and becomes green, and ultimately dull white, sulphate of potash
being formed. It evolves sulphuretted hydrogen on the addition of any
acid.

POTASS^ N1TRAS NITRATE OF POTASH NITRE SALTPETRE, KNO,,

=101.

PREPARATION. Nitrates occur naturally in many waters, soils, and
plants, but are mainly obtained either from certain soils in India by solu-
tion in water, or from artificial " nitre beds," i.e., heaps of manure and
vegetable refuse, wood ashes and calcareous earth, which are exposed to
the action of air and sun. The nitrogen of the organic matter .is slowly
oxidized into nitric acid, which combines with the bases present (potash,
etc.), and the nitrates so formed are removed by washing.

CHARACTERS AND TESTS. Occurs in white crystalline fragments, or in
striated, long, six-sided prisms, which are transparent. It is soluble in
water, and has a cooling taste; at a red heat it deflagrates. When fused
and cast into round moulds, it is known as " sal prunelle;" abroad, these
are often colored purple (like a plum: prunelle a sloe).

POTASSIUM. 267

POTASS^ CHLORAS CHLORATE OF POTASH, KC1O 8 , =122.5.

PREPARATION. By passing chlorine gas over a mixture of potash car-
bonate and excess of slaked lirne; chlorinated lime and chlorinated potash
are first formed, and the latter is then converted into chlorate of potash
on boiling; but the reaction may be simply expressed thus

6Cl a + K 2 CO 3 + 6CaH 8 O 2 = 2KC1O S + CaC0 3 + 5CaCl 2 + 6H,O.

CHARACTERS AND TESTS. Chlorate of potash occurs in pearly-white,
hard, crystalline plates, which are slightly soluble in water, and have a
cooling taste. Rubbed with sulphur, or phosphorus, or tannic acid, or
catechu, etc., the salt explodes; treated with sulphuric acid, it becomes
red, and gives off vapors of chlorine peroxide.

POTASS^E PERMANGANAS PERMANGANATE OF POTASH, KMnO 4 ,=

158.

PREPARATION. The principal steps of the process are (1 ) to prepare
manganate of potassium (K 2 MnO 4 ); (2) to convert this into permanga-
nate (KMnOJ by boiling. Black oxide of manganese, caustic potash, and
potassic chlorate are fused together, and a dark green mass of manganate
of potash obtained.

3MnO,+6KHO + KClO,=3K a MnO 4 + KCl+3H a O.

This manganate, when boiled, filtered, and acidified with sulphuric acid,
yields a purple solution of the permanganate.

3K,MnO 4 + 2H 2 O = 2KMnO 4 + 4KHO + MnO 2 .

The green manganate, when turning into the purple permanganate, under-
goes several changes of color, and hence has received the name, " mineral
chameleon:" finally, the solution is evaporated, and the crystals purified.

CHARACTERS AND TESTS. Occurs in dark purple acicular crystals,
one of which will impart its color to a large quantity of water. It yields
up most of its oxygen (five-eighths) very readily; and if only a little
spirit be boiled with its solution, it changes to yellowish brown, on ac-
count of its reduction to the state of peroxide. A similar brown stain is
left on the hands when washed in it, on account of its oxidation from
contact with the organic substance. In distilled water, the purple color
may remain two years without change. (Manganese stains are removed
by oxalic acid " salts of lemon.")

POTASSES BICHROMAS BICHROMATE OF POTASH, K a Cr 2 O 7 ,=295.

PREPARATION. By roasting chrome iron-ore with a mixture of car-
bonate of potash and chalk; yellow chromate of potash is formed, and
yields the red bichromate when treated with sulphuric acid.

268 AIATERIA MEDICA AND THERAPEUTICS.

CHARACTERS AND TESTS. Occurs in large, red, transparent, four-
sided tables, soluble in ten times their weight of water. The solution
readily gives up part of its oxygen, and when acidified with sulphuric
acid, turns green from reduction of the chromic acid, and formation of
green sulphate of chromium.

ABSORPTION AND ELIMINATION. Liquor potasses, taken on an empty
stomach, is quickly absorbed; it then combines, probably, with carbonic
acid in the blood, and is eliminated by the kidneys, mainly in combina-
tion with sulphuric acid (Parkes: Medico- Chirurgical Review, 1853).
When taken with food, or in very small doses at any time, it forms with
the gastric acid a chloride, and as such is absorbed; its elimination under
these conditions is not recognized so readily.

The carbonates, when taken in small doses, are absorbed as chlorides;
of large doses, the greater part passes out by the kidneys unchanged:
a single large dose (2 dr.) is eliminated more quickly than the same
amount given in divided doses (Thompson: Medico- Chirurgical Review,
ii., 1864). The acetate and citrate are reduced in the system to carbonate,
and eliminated as such; the tartrate is commonly unchanged. The chlo-
ride, chlorate, and nitrate are absorbed very rapidly, and have been de-
tected in the urine, the saliva, etc., within five minutes after being taken.

Much interest attaches to the chemical changes which the chlorate
undergoes in the system; it was believed to become a chloride, parting
with its oxygen to the blood and tissues (Fourcroy) the proportion even
of oxygen furnished was calculated (Garnett). Gubler and some other
modern observers also think it possible that a partial reduction of the
salt may occur within the body, but it is difficult to reconcile this with
the chemical fact of its being found unchanged in the urine passed after
its administration (Wohler, 1824), as also in the saliva, milk, tears, bron-
chial mucus, etc. (Isambert). Rabuteau, taking himself small doses, also
found the drug imchanged in the secretions, and of one large dose of 5
grammes, recovered 4.873 grammes from the urine within thirty-six hours
( Gazette Med. de Paris, 1868). Hence it seems improbable that the chlor-
ate should decompose and give up oxygen at the temperature of the body,
and yet there is some clinical evidence of its improving oxygenation in
whatever mode this may be effected (v. vol. i., p. 19, and vol. ii., p. 282).

When nitrate of potash has been taken in large doses (270 gr. in
twenty-four hours), the greater part has been found unchanged in the
urine the rest probably passing as sulphate by the intestines (Taylor:
Guy's Reports, 1863); that a certain amount of potash salt passes off in
this manner has been shown by Kramer (Annales d'Hygiene, i., 1843).

PHYSIOLOGICAL ACTION, Oxidation and Nutrition. How far alka-
lies, as such, contribute to oxidation, has long been a question of interest,
and it is one of great practical importance. Organic substances, such as
bile and haernatin, when exposed to air outside the body, certainly oxidize

POTASSIUM. 269

more quickly when in contact with potash (Chevreul, 1825) : olein, again,
is not acted on by ozone alone, but if potash be added, oxidation sets in
at once. We know, also, that albumen, dissolved in water, changes but
slowly, while the addition of alkali induces immediate oxidation, and in
the ordinary test for diabetic sugar, potash deprives of oxygen even a
metallic oxide.

Physiological chemists did not fail to trace a similar action within the
body. Lehmann and Mialhe taught that alkalies were powerful promot-
ers of systemic oxidation, and augmented the excretion of urea arid car-
bonic acid. Liebig fully adopted the same view, teaching that they pro-
moted the combustion of " respiratory foods," and pointing out that if
organic acids (gallic, citric, etc.) were taken alone, they passed off almost
wholly unchanged, but if in combination with alkalies, e.g., as citrate of
potash, the acid was " burnt off " in the system, and the alkali passed as
a carbonate. The experiments of Frerichs illustrated the same point; he
gave urate of potash to rabbits, and yet found no uric acid in the urine,
for it became changed into oxalic acid and urea, the excretion of the lat-
ter being much increased.

Bence Jones concluded that alkalies, though they could not themselves
give up oxygen, decidedly assisted oxidation of organic substances within
the body by promoting the formation of acids (" Lectures," and Lancet,
i., 1867, p. 202), and Parkes found, in a series of analyses, that the or-
ganic material and sulphuric acid excreted in the urine were markedly
increased under the use of liquor potassae, which acted, he considered, by
increasing the oxidation of sulphur and protein tissues; for this effect it
had to be given at least eight hours after food ( Medico- Chirurgical Re-
view, 1853). Similar results did not follow the use of acetate or nitrate
of potash in Parkes's experiments, but Dr. Golding Bird reported a con-
siderable increase of urea and other urinary solids in the case of a dog
submitted to the action of 3 dr. of the acetate (" On Urinary Deposits").
Dr. Reginald Thompson proved by several series of observations, that the
amount of\ phosphoric acid in urine was increased by the administration
of carbonate of potash (Medico- Chirurgical Review, ii., 1864).

Besides the cases reported by Dr. Parkes, we have clinical evidence
from Dr. Austin Flint of much increase in the urinary solids of a number
of patients taking nitrate of potash, and Dr. Basham, observing specially
cases of lithic acid diathesis, not only found the urea increased under the
use of potash, but oxalic acid appeared as uric acid lessened, and oxalic
acid and urea are recognized products of the oxidation of uric acid.

We might almost conclude from the preceding statements that the
question as to alkalies increasing oxidation was answered in the affirma-
tive, and yet practical experience shows that some qualifying statement
is required, for do we not see marked asthenia, pallor, and anaemia pro-
duced in many persons by full doses of alkali, and in all persons by their

270 MATERIA MEDIC A AND THERAPEUTICS.

continued use ? (so that Trousseau speaks of their doing more harm than
the abuse of iodine or mercury); and moreover, is not temperature re-
duced by salts of potash, so that they are used as anti-pyretics ? whereas,
if they increased oxidation, the results should be opposite to these. (Dr.
Ridge argues that although some amount of alkali promotes oxidation,
the "secondary effect "is to retard it Medical Times, ii., 1871.) To
advance knowledge in this direction, Rabuteau has recently recorded the
results obtained on himself, on Constant (of Smyrna), and on a third per-
son (a woman). Each took 5 to 6 grammes of bicarbonate of soda or pot-
ash for five to ten days. The full dose of bicarbonate of potash produced
a slight diuretic effect, but 5 grammes none at all; urea was markedly
and progressively diminished, and depression and anaemia were induced:
analogous results were obtained by Ritter, of Nancy; 5 grammes of chlo-
rate equally diminished urea (Fouilhoux, These, Paris, 1874), and 10-
gramme doses of nitrate acted in a similar manner (Jovitzu).

The explanation of such contradictory results turns largely upon the
question of dosage, as with many other medicines. Large quantities,
like those last referred to, will pass out unchanged and quickly, and in
their passage so far deteriorate the blood-condition and impair the func-
tion of the alimentary tract as to induce asthenia and diminish nutrition;
hence, evidently Dr. Parkes's supposition that increasing the dose of
potash will proportionately increase oxidation cannot be sustained. Small
doses* on the other hand, not only help to saponify fatty food, but aid its
oxidation, and that of carbonaceous material generally, improve the di-
gestion, and raise the temperature.

Rabuteau himself confirms these statements, and explains these effects
of small doses by their change into chloride in the stomach, and their
acting as chlorides rather than as alkalies; under the influence of 5-
gramme doses of chloride of potassium he found the excretion of urea
increased by 20 per cent.

That potash salts are essential for the development of the animal tis-
sues is shown by the fact that food which in itself is not sufficiently nu-
tritious, such as over-stewed meat, recovers its properties on the addition
of these salts and of a little sodium chloride (Binz); the absence of
potash salts seems to be at least one cause of scurvy (Garrod). If, on
the other hand, we give meat broth which is very rich in potash salts,
without adding any other nutrient, tissue-change becomes so acceler-
ated that animals thus fed die earlier than others kept without food.

Experiments with plants show also how necessary potassium is for
cell-nutrition; if it be excluded from their soil and water no growth
takes place, for without its presence in the chlorophyll granules no starch
is produced.

Souligoux, in a recent treatise, emphasizes the necessity of a due
amount of alkali for carrying on all the vital processes, and brings evi-

POTASSIUM. 271

. i

dence to show that a large part of its good effect lies in its favoring
proper electrical reactions and currents within the organism (" Etude sur
les Alcalins," 1878, Paris).

Circulatory System. A certain amount of potash salt is essential, as
we have seen, for the proper constitution and action of the corpuscles,
and the chloride seems to be the best suited for this purpose (Rabuteau);
but the prolonged use of the remedy in any combination has an unfavor-
able effect. Loffler has reported the results in five of his students who
took doses of from 1 to 5 dr. of alkaline carbonates for several days, and
then allowed blood to be taken from a vein. It was found to be like
" cherry juice " in color and density, the red corpuscles were paler, and
the white ones more numerous than normal; there was excess of water
and of fatty material, and the clot was less firm and elastic than it ought
to be (Schmidt's Jahrb., 1848). A curious illustration of the diminished
coagulating power of the blood under the influence of nitrate of potash
is furnished by Dr. Stevens, who had occasion to bleed a man who had
lately taken an ounce of that salt, and was surprised to find the venous
blood red, and not at all coagulable (Lancet, ii., 1862, quoted by Dr.
Basham). In animals, after injection of nitrate, the result is similar
(Rabuteau).

Martin Solon, having analyzed blood drawn from the vein of a robust
man suffering from acute rheumatism, and treated by nitre, found the
fibrine diminished, though the inflammatory process was still ' at its
height; ten days afterward, when the remedy was no longer being taken,
the blood-clot was dense and buffed (Bulletin de Therapeutique, 1843).
That the drug cannot, however, be depended upon for antagonizing the
effects of disease is shown by the fact of fibrinous deposits having been
found on the heart-valves in patients dying during its free administration
(Medical Times, i., 1863).

Both this salt and the chlorate have the power of rendering venous
blood bright red, and much stress was laid upon this change by the early
advocates of the direct oxygenation theory (Stevens, O'Shaughnessy :
Lancet, ii., 1831), but Isambert, after making fresh experiments, asserts
that their statements on this point are incorrect ( Gazette Med., 1874), and
although the change does occur, it varies with physical conditions, and
is dependent rather on altered osmosis than on difference in oxygenation.

Small doses of the potassium salts (excepting the permanganate) cause
a fall in the pulse-rate, but a rise in the arterial pressure, probably through
the vaso-motor nerves; this effect is usually only temporary (Aubert,
Dehn). Full doses lower both pulse-rate and blood-pressure. The low-
ered pressure may, or may not, be followed by a rise according to the
dose employed. Parkes found a full dose of liquor potasses render the
pulse small and slow, but a copious secretion of urine explained this effect.
Under the nitrate the pulse-frequency came down in a few days from 70

272 MATEEIA MEDIOA AND THERAPEUTICS.

to G4 (Rabuteau, p. 229), and the chlorate, according to Socquet, of
Lyons, has a similar sedative action. Some observers report a quickened
circulation, especially after venous injection of chlorate (Gubler) ; Jacobi
speaks of this salt congesting the kidney (Medical Times, i., 1876), and
Osborn of its congesting the brain (Lancet, ii., 1859); but such effects
must be exceptional. The observations of Black (1839), and of Bouchar-
dat (1844), and the experiments of Podocsepow (Virchow's Archiv, Bd.
xxxiii., p. 505), of Guttman, Aubert, Dehn, and others agree in assigning
to potash salts a distinctively depressing effect on the heart-action. Their
injection in frogs quickly lessens the force of the blood-current, and finally
arrests the heart in diastole: 10 gr. of chloride injected into the jugular
vein of the smaller animals cause instant cardiac death, and since the
heart-muscle in such cases is found insensitive to electricity (Traube), and
since previous section of the vagi has no influence on the result, we con-
clude that the cardiac arrest is due to a direct paralysis of the muscu-
lar substance. This paralysis is commonly preceded by increased activity,
but finally it becomes complete, so that the heart-muscle ceases to react
to any ordinary stimulus. If, however, the potash chloride be introduced
gradually into the system through the stomach, then cardiac contractility
is not entirely destroyed by it.

The bitartrate of potash has some power of arresting hemorrhage, es-
pecially from the kidney (Ramskill and others, Ranking, i., 1867); it pos-
sibly lessens congestion by diuresis or purgation. Albuminuria has oc-
curred under the influence of nitrate.

Nervo-Mitscular System. Large doses of potassium salts lower the
reflex irritability of certain parts of the spinal cord (Binz), but many
observers consider this to be only secondary to depression of the circula-
tion. The fall of temperature adduced is attributed to the same cause.
In warm-blooded animals motor power is weakened, probably from a
direct alteration in the chemical constitution of muscular elements, for
electrical reaction remains. (On the other hand, Ramskill finds baths of
sulphuret of potassium to be the most effective stimulant to muscular ac-
tion during such diseases as wasting palsy Medical Times, ii., 1860.)
In healthy men a sense of weight and fatigue is often felt in the limbs
after absorption of the more easily diffusible salts, as the nitrate, oxalate,.
chloride, iodide, or bromide; local anaesthesia of various parts of the body
has been described as a result of drachm doses of bicarbonate (British
Medical Journal, ii., 1876). There seems, however, to be some idiosyn-
crasy with regard to such effects, and although full doses usually depress
the nerve-functions, Dr. Prout refers to pronounced nerve-excitement,
and even convulsion in some cases, as connected with an excess of alkali,
and the chlorate of potash is said to have caused headache and cerebral
congestion (u. p. 272). Isambert considered it a nervine sedative, but
" this action was not evident in healthy persons " {Medical Times, it,.

POTASSIUM. 273

1856). Rabuteau finds the "perchlorate " to produce giddiness and other
symptoms like those of quinine. Liquor potassas has been used to quiet
the spasms of tetanus (Lancet, i., 1861).

Dr. Thompson traces the nerve-depression commonly caused by alka-
lies to an increased excretion of phosphoric acid under their use (v. p. 269).

Glandular System Mucous Membranes. Dilute alkaline solutions
taken into the stomach before meals augment the secretion of gastric
juice (Blondlot, C. Bernard), for if digestion is to continue, fresh secre-
tion must occur to compensate for what is neutralized; also the chlorides
that are formed augment the secretion (Rabuteau). " They favor the
outward osmosis of those constituents of the blood from which the acid
of the stomach is elaborated " (Bartholow). But alkalies given in too
large or too concentrated a dose arrest the secretion, and if given soon
after a meal prevent even a normal amount of acidity. Dr. Ringer for-
mulates a general proposition thus: "Alkalies applied to the orifices of
glands with acid secretions increase their secreting power, while alkalies
applied in a corresponding way to glands with alkaline secretion lessen or
check this secretion;" and I think that, as a general rule, and with due
regard to the strength of solution, this may be held true.

The increased secretion of saliva caused by direct application of
alkalies is thick, whitish, and cloudy; it is not large in amount, and there
is some doubt as to whether it is true secretion or (as Kiibne thinks) the
result of a rapid degeneration of the gland. A similar fluid results from
irritation of the sympathetic nerves of the submaxillary gland, and hence
the alkali has been thought to act through the sympathetic. The chlorate
of potash sometimes acts so as to produce a degree of salivation.

Under the influence of alkalies taken internally, the bile and pancrea-
tic juice are increased in amount, and rendered more fluid. The sulphate
of potash given internally has special power in this direction (Rutherford),
more than magnesia. The bronchial secretions are also increased and
fluidified by alkalies, and the movements of ciliated epithelium are
rendered more active by them.

Secretion from the intestinal glands is augmented, especially by full
doses of the potash salts of mineral acids: 2 or 3 dr., e.g., of the sulphate
cause watery purging; larger quantities sometimes irritate much: -oz.
doses have been used in France as abortifacient with serious effects (Mow-
bray), and 2 oz. have caused death (Taylor).

The nitrate in small doses is absorbed and produces some constipation,
but in full doses and well diluted causes diarrhoaa (Martin Solon, 1843).
Orfila reported violent irritation of the mucous membrane from its use,
and an ounce has caused death with irritant symptoms and depression,
though this is exceptional. The experiments of Rognetta indicated only a
moderate degree of congestion no inflammation; and ounce doses, when
well diluted, have been given medicinally without serious result.
VOL. II. 18

274 MATERIA MEDIC A AND THERAPEUTICS.

The chlorate may also irritate mucous membranes, and in large doses
has sometimes, though rarely, caused death through this effect, e.g., in a
patient with phthisis, who took 300 gr. daily for four days, and in the
case of Dr. Fountain, who unfortunately took an ounce in order to orove
his conviction of its innocent character (Stille).

The bichromate in small doses increases all the secretions, in large
doses acts as an irritant poison, and induces suppression of urine.

The urine is often markedly increased in quantity by liquor potassae
(Parkes), by the bicarbonate and the chlorate, but still more by the bitar-
trate, nitrate, acetate, and citrate; the increase is not always decided,
unless the urine is rendered alkaline. There is a marked difference in
different compounds as to their production of alkalinity: thus, a single
dose of 40 gr. of acetate alkalinized the urine in a few hours, and then
was not all changed, but of the bicarbonate several drachm doses were re-
quired. In febrile diseases, salines, such as nitrate of potash, may cause
at first marked lessening of excretion, afterward increase (Parkes: Medical
Times, i., 1855). In cases of irritant poisoning by the potash salts of the
mineral acids, suppression of urine has occurred, probably reflex in char-
acter.

SYNERGISTS AND ANTAGONISTS. The other alkalies are allied in
chemical action to the salts of potash, and acids are the chemical antago-
nists. Gubler suggests that soda is antagonistic to potash (dynamically)
in its action on the blood and on respiratory combustion, because potash
only, not soda, is contained normally in corpuscles, and under certain
conditions may be replaced by the latter when given in full doses.

THERAPEUTICAL ACTION (EXTERNAL). Caustic potash has been used
in surgery for the same purpose as other powerful caustics, and has the
special characteristics of being deliquescent and of dissolving and deeply
penetrating the tissues; parts near the seat of its application should there-
fore be protected by plaster, or by oil, and the cauterized place should be
sponged with dilute vinegar to prevent undue action. The slough caused
by it is leathery, soft, dark-colored, and moist, not dry like that of nitrate
of silver: it separates after a variable time, according to its thickness.

Issues Abscess Bubo, etc. For the purpose of making an issue, or
of opening a large collection of matter, such as a chronic or " cold "
abscess, caustic potash was formerly often, and for the latter purpose is
still occasionally, used. Macnamara has found better results from it than
from the knife in opening bubo (Ranking, i., 1872), and others recom-
mend it in carbuncle. It causes pain but no hemorrhage, and makes a
good free opening for the escape of the slough.

Caries Necrosis, etc. Caustic potash and concentrated solutions of
the carbonate have been recommended in these conditions, but sulphuric
acid is to be preferred (Medical Times, ii., 1860; Lancet, i., 1870). In
ununited fracture, potash has been used to vivify the ends of the bones.

POTASSIUM. 275

Varix Ncevus. It is said to have the power of obliterating the
trunk of a varicose vein (Bonnet), and also of destroying superficial naevi
(Wardrop); but the application is painful, and is apt to leave a very evi-
dent cicatrix. Powdered nitrate of potash kept in contact with the
naevus, is said to give a better result in slight cases.

In Hospital Gangrene, the part may be first dressed with the solid
caustic, and afterward with a lotion containing it in gradually diminish-
ing proportion 400 cases are said to have been treated successfully by
this means (Restelle: British and Foreign JReview, October, 1850). Lo-
tions of permanganate and of chlorate are also valuable.

Strumous Vlceration. In strumous ulceration of superficial and indo-
lent character, with livid undermined edges, and affecting extensive
surfaces on the trunk or extremities, caustic potash lightly applied to
the margin often stimulates to satisfactory healing.

Lupus. For cases of ulcerative lupus in which the strumous char-
acter is most marked, caustic potash is sometimes a good agent; we do
not apply it generally for lupus about the face, because of the un-
sightly cicatrix which is apt to follow its use; but in Vienna it is in fre-
quent request, and is found to succeed when other remedies have failed.

Epithelioma. The disadvantage of the deliquescent character of pot-
ash may be obviated, and its efficacy rather increased by combination
with caustic lime, two parts of the latter to one of the former constitut-
ing "Vienna paste;" it should be kept dry, and moistened only with a
little spirit as required. Epithelioma affecting the lip has been sometimes
cured by successive applications of this caustic, but it is painful and
tedious. The chlorate, given internally and applied locally, has also been
said to arrest and cure epithelioma^ and certain Paris surgeons especially
have reported well of the local use of concentrated solutions. I have ob-
served several cases treated in this manner, but without substantial benefit.
Uterine Vlceration. Pure caustic potash has been applied to ulcera-
tions and hyperplasise of the cervix uteri, and although disastrous results,
such as contraction and cicatrix have occasionally followed, it may be of de-
cided service, in skilled hands, not only for irregular ulcerative conditions,
but also in chronic cervicitis with induration (areolar hyperplasia); in such
cases it may be applied about every ten days for several times, and free
injections of vinegar and water should be used afterward. Dr. Henry
Bennet recommended it or the lime compound " as a last resource," and
the Vienna paste is sometimes serviceable. French surgeons use the
same remedy, with an additional quantity of lime, carefully prepared in
lead or iron tubes (caustic of Filhos, of Robiquet).

Primary Syphilitic Ulcers, Warts, etc., have been sometimes destroyed
by caustic potash. The bichromate is very useful for this purpose.

Urethral Stricture has been treated by the application of caustic pot-
ash to the affected part, and in some cases of cartilaginous hardness, and

276 MATERIA MEDIC A AND THERAPEUTICS.

of unusual irritability, it apparently proved useful with due precautions
but the majority of modern surgeons rightly, I think, object to any
direct caustic application in such cases.

Leucorrhoea Gonorrhoea. In the former affection, when the dis-
charge is profuse and strongly alkaline, and either transparent or white,
coming probably from the glands of the cervix uteri, a weak alkaline in-
jection (1 dr. of bicarbonate to the pint), thoroughly applied, will often
relieve; but injections of chlorate (2 dr. to the pint) act better, especially
if the discharge be at all purulent (American Medico- Chirurgical Review,
November, 1858). The permanganate should be used if there be a dis-
agreeable odor.

In gonorrhosa, injections of the permanganate (1 to 5 gr. to the
ounce) have been highly praised, especially in the second stage (Medical
Times, ii., 1862). In many cases they certainly act well, but care should
be taken to begin with a weak solution, for I have known pain and irri-
tation produced by such injections. Besides the local applications of
potash salts, the scalding and burning pain in micturition may be much
relieved by the bicarbonate, or perhaps better by the acetate and nitrate,
given internally with mucilage, etc.; it is said even that the attack may
be cured by them (Lancet, ii., 1850, p. 507). In chronic cystitis with
fetid urine, injections containing chlorate (4 gr. to 1 oz.) are recom-
mended by Braxton Hicks.

In-growing Nail, etc. This troublesome affection may be well treated
by means of dilute liquor potassae (2 dr. to the ounce of water) constantly
applied on lint, between the nail and the soft tissues, so as to thin the
nail and render it flexible, when it can be rubbed or pared away (Norton :
Lancet, i., 1869).

Unhealthy Wounds. Several compounds of potash have valuable dis-
infectant and also alterative properties, especially the permanganate
(Condy's fluid) and the chlorate, and when used in the form of lotion
prove of the greatest service in removing fo3tor and promoting healthy
action. For the bites of rabid animals its penetrating and alkaline
powers render liquor potassse valuable; in snake-bite especially it should
be applied locally as well as given internally; it fluidifies the blood and
promotes bleeding from the bitten part (v. p. 285).

Stomatitis Diphtheria. In aphthous conditions and unhealthy ul-
cerations about the gums, palate, or tonsils, gargles containing the
chlorate or permanganate are very good (v. p. 283). In diphtheria, both
these salts have proved of great service (Ranking, i., 1865). A useful
proportion of the permanganate for local application is about 10 gr. to
the pint of water.

Eczema. A weak lotion of bicarbonate of potash (or of soda), 30
to 60 gr. in the pint, will often relieve the early discharging stages of ec-
zema, and a stronger application (caustic potash, 5 to 20 gr. in the ounce)

POTASSIUM. 277

is a useful stimulant to patches in the chronic stage; although painful, it
markedly relieves the itching, which is often worse than pain. The Ger-
man school especially have reduced to a system the application of potash,
in the form of their sapo viridis (" schmeier-seife "), which is made by
boiling some animal oil with potash and its carbonate; it forms a soft
amber-green compound, more elegant than our " soft soap." Of this a
general bath is prepared with 1 dr. to the pint, a second strength (1 dr.
to |- oz. of water) is used for infiltrated subacute patches, and a third
(1 dr. to 2 dr. of water) acts as a caustic for very chronic cases; besides
these the German codex contains a " spirit of soap," etc. The solution
of selected strength should be thoroughly brushed in, and the irritation
quickly relieved by a stream of cold water. The use of such remedies is
painful, and causes profuse serous secretion from the part; before com-
mencing a course of them, vascular irritation should be subdued by cold
water, etc., and afterward it will be found desirable to use some emolli-
ent, such as glycerin or oil, otherwise the skin becomes harsh and dry.
There can be no doubt that in some chronic forms, and especially in
chronic eczema of the scalp, the soft-soap treatment gives remarkably
good results (Medical Times, i., 1860.)

Sebaceous Disorder Acne, etc. In cases of greasy skin and of ob-
structed follicles, soft soap is a good remedy. In the former it cleanses
and tends to lessen secretion; in the latter it dissolves obstruction, but it
should be used cautiously if much inflammation be present. Alkaline
drops or injections are useful for softening and evacuating hardened ceru-
men in the meatus.

Scabies Ringworm. Preparations of potash (soft soap, etc.) are in-
directly useful in parasitic disorders by softening the epidermis and
removing secretion, and thus allowing the more direct contact of sulphur
or similar remedies, hence the carbonate is a frequent ingredient in po-
mades for scabies. The sulphocyanide of potassium is a direct parasiti-
cide, and has been commended by Dr. Gee in ringworm ( oz. in 8 oz. of
water).

Psoriasis. The diffused forms of this disease may be much relieved
by alkaline baths (potash and soda carbonates together, of each 3 oz. in
the bath), and thickly accumulated scales may be removed by frictions
with soft soap. Oil of cade may be usefully combined with the same
remedy (soft soap, rectified spirit, oil of cade, equal parts). Ilebra ap-
plies to severe cases a daily friction with soft soap for many days, not
using a bath during the course, but keeping the patient in blankets.
This is, however, a painful process, on account of the great tension of
skin induced whenever strong potash applications are made to the gen-
eral surface.

Lichen Urticaria, etc. Weak solutions of potash salts or liquor po-
tassse relieve the itching and irritation of these disorders, also of pruritus,

278 MATEEIA MEDICA AJSTD THERAPEUTICS.

and to some extent of pruritus vulvae. A lotion made by boiling oz.
of potassa sulphurata in 1 pint of water, is very useful.

Rheumatism, etc. The carbonate of potash, dissolved in a bath of
warm water, is often useful to relieve pain in the joints, and irritable
eruptions in rheumatic and gouty subjects. The sulphuret of potash, on
the other hand, furnishes a bath which stimulates especially the mus-
cular system, and has proved useful in plumbism, in locomotor ataxy,
and other forms of paralysis; it has the distinctive properties of sulphur.
The silicate of potash, or " liquid glass," applied on saturated band-
.ages, makes an excellent splint for fractures (Darby: Medical Times, ii.,
1870).

THERAPEUTICAL ACTION (INTERNAL). Dyspepsia. In cases of irrita-
tive dyspepsia, especially when occurring in stout and rheumatic or
gouty persons, and marked by red tongue, acid eructations, or pyrosis,
with nausea and discomfort after meals, the liquor potassas or bicarbon-
ate of potash, taken at that time (after meals), often gives relief; in
gouty cases, and when the urine is loaded, they are to be preferred to
soda. In cases of atonic dyspepsia, however, with pale coated tongue
and much weight after food, small doses of alkali are best given before
a meal, and if continued for some time should be combined with a bitter
infusion. In cases of " biliousness," with yellowish complexion and con-
junctiva?, headache, nausea, etc., and even in actual catarrhal jaundice,
salts of potash are good adjuvants (Golding Bird, Bartholow). Dr.
Todd recommended the sulphuret (10 gr.) when the " mucous follicles
were implicated."

In vomiting connected with the condition just described, or with
other functional or even organic gastric disorder, or occurring at the com-
mencement of inflammatory fevers, the bicarbonate of potash is advan-
tageously given in effervescence with citric acid.

Acid Poisoning. In cases of poisoning by the mineral acids, bicar-
bonate of potash may be employed not only to neutralize the acid, but
as an emetic, by giving first a large dose of the alkali, and a suitable
quantity of citric acid some minutes afterward. The amount of car-
bonic acid evolved distends the stomach so as to assist discharge of its
contents.

Lithiasis Calculus. In cases of excessive secretion of uric acid,
potash salts are useful by assisting oxidation of the acid to some extent,
and also by furnishing a base with which the acid is readily eliminated
in a soluble form; they should be considered, however, rather palliative
than curative, and attention should be equally directed to diet and hy-
giene during their use.

The continued administration of potash had, at one time, much repu-
tation in the treatment of uric acid calculus, and Dr. William Roberts
(Manchester) has shown, by careful experiments, that benefit may be ex-

POTASSIUM. 279

pected from it under certain conditions. It is specially adapted for renal
calculi which cannot be reached in any other way, and for small vesical
calculi consisting either of uric acid or of cystine. The acetate and cit-
rate of potash are the best to use, and in order to secure a sufficient and
continuous alkalescence of the urine, 30 gr. for children, 40 gr. for adults,
of either salt must be taken at intervals of about three hours. This
quantity will give to the urine an alkalinity equal to 3 or 4 gr. of carbon-
ate in the pint, which may be kept up for several weeks without injury
to the general health, but the urine must be frequently examined, and if
it become ammoniacal the treatment should be omitted.

As an illustration of its occasional value may be cited the case of the
Rev. V. Harcourt, who, at the age of eighty, continued it for three
months, rendering the urine alkaline to the extent of 20 to 25 gr. per
pint, with relief to many painful symptoms, and with much advantage
(Medical Times, ii., 1869). For phosphatic calculi, potash is, of course,
unsuitable.

Skin Disease. Several forms of cutaneous disease are connected with
a gouty or rheumatic diathesis, especially forms of eczema and psoriasis;
in such cases the urine is often scanty and loaded, and then alkaline
diuretics are of service. Mr. Easton has shown the advantages of the
acetate (Edinburgh Monthly Journal, May, 1850); the liquor potassas is
also given successfully.

Acute Rheumatism. Up to comparatively recent times, alkaline
treatment, by potash especially, was accepted as the best for rheumatic
fever. Among its principal supporters, Dr. Fuller claimed that it would
prevent cardiac lesions, for such lesions did not occur in any of a large
number of cases thoroughly brought under the influence of alkalies
(Lancet, ii., 1862). He argued that these remedies not simply neutralized
abnormal acidity, but restored normal alkaline conditions, maintained
fibrine soluble, exerted a sedative influence on the circulation, and favored
complete metamorphosis of tissue; he pointed out, also, that for a fair
trial correct diagnosis was essential, and that true rheumatism should not
be confounded with the gonorrhceal affection, with rheumatic gout, pyae-
mia, etc., and such a mistake would account for failures; he approved of
a compound prescription thus, I. Liq. ammon. acetat. 3 ij., soda? bi-
carb. 3 iss., potas. acetat. 3 ss., with citric acid in effervescence.

Sir Thomas Watson recommended liquor potassas, arid Dr. Parkes
made use of it (Medico- Chirurgical Revieic, 1864), but it is not really so
suitable as the neutral salts. Todd preferred the bicarbonate or acetate
in -J-dr. doses every three hours (Ranking, i., 1869). Dickinson has writ-
ten in favor of the same method, and Golding Bird in favor of the ace-
tate specially, while Dr. Basham was a constant advocate of the nitrate
(Lancet, 1848, and ii., 1862); he used large doses, from 1 to 3 oz. daily,
in 4 pints of barley water. Dr. Wade found the best results from a com-

280 MATEEIA MEDICA AND THERAPEUTICS.

bination of these two salts in moderate doses, 15 to 20 gr. of acetate with
8 to 10 of nitrate, and other observers have corroborated his experience
(Fleischman: Lancet, i., 1869, etc.). On the other hand, Dr. Sutton con-
cluded that none of these remedies could influence the course of rheuma-
tic fever, or prevent heart-complications, though they might allay pain
(" Medico-Chirurgical Transactions," vol. Hi.). Dr. Ringer, from his own
observation, came to a similar conclusion, while Dr. Ridge and others
have argued that they are injurious (Medical Times, ii., 1871). No doubt
the continued use of large doses may induce depressing anaemia, and con-
sequent tedious convalescence, and now that the salicylates and other
remedies are better known, we are not so dependent on alkaline medica-
tion; it must, however, be held a valuable resource in cases marked by
high degree of acidity and loaded urine, and its judicious use may greatly
relieve. In my own practice I commonly combine iodide of potassium
with bicarbonate in effervescence.

Ague. Nitrate of potash has been given successfully in ague 10 gr.
every two or three hours (in brandy) ; it increases the secretions, notably
the perspiration and urine, and is said to be as sure a specific as quinine,
leaving even less tendency to relapse! (Ranking, i., 18G9).

Specific Fevers. Alkalies, especially in effervescence, greatly relieve
the thirst and other distressing symptoms in various fevers, and they
promote elimination by the skin and the kidneys, etc. The chlorate has
been recommended in enteric fever by Chomel, but has not been largely
given; in scarlet fever, I, with others, have found it of much advantage
(Watson, Copland); even in yellow fever, in the later stages, it is said to
do good (Medical Times, i., 1875).

Diphtheria. Chlorate of potash in full doses, either alone or combined
with iodide, has seemed very useful to many observers (Squire, Hillier,
Perrin, Henoch, Vogel). I quite agree with them; I have for twenty
years used it more or less with advantage. In America, it is commonly
given with chloride of ammonium. Recently Dr. Ciattaglia (Rome) has
recorded his very successful results with doses of 10 to 15 grammes daily;
but in addition he thoroughly applied to the affected part a wash of
chloral 1 dr. in 5 of glycerin (Lancet, i., 1876).

The permanganate of potash has also proved useful in diphtheria, as
well internally as locally (Copland: Lancet, i., 1863, p. 151, and Ranking,
i., 1865, p. 55). I can add my testimony to its value, though it is right
to recognize the statements of Dr. II. C. Wood, that he "has never seen
the chlorate do a particle of good in such maladies as scarlet fever, diph-
theria, etc.," and with regard to th permanganate, "as immediate de-
composition of it must occur in the stomach, the absurdity of its internal
use needs only to be pointed out " (" Elements of Therapeutics," 473
586).

Croup. Liquor potassas has been used in croup both locally and in-

POTASSIUM. 281

ternally. Certainly it will dissolve fibrinous membrane outside the body,
and to some, but not to a great, extent may be available in the form of
spray ( or 1 dr. to 1 oz. of water). It has been compared to mercury
in its constitutional effect of fluidifying secretion and of promoting ab-
sorption, but it acts too slowly to be depended upon for so acute a mal-
ady as croup. Iodide of potassium is more effective, and the acetate of
potash seems to have sometimes acted well. The bichromate I have oc-
casionally used locally and internally, with excellent effect, in true mem-
branous croup.

Pneumonia. The nitrate of potash is said to be valuable in the early
stages {Dublin Quarterly Journal, July, 1873), but as Dr. Jones, who
commends it, used also antimony and ipecacuanha, we cannot verify its
precise effects.

Bronchitis Catarrh. When expectoration is scanty, viscid, and
brought up with difficulty, either in early or later stages of bronchitis,
alkalies often relieve, and may be taken with other expectorants. The
liquor potassae in doses of 10 to 15 min. is one of the most suitable forms:
the nitrate is also useful, and is commonly combined with Dover's pow-
der, or with antimony and tinct. camph. co. (Graves: "Clinical Lectures").
Laborde has found the chlorate very .serviceable, both in acute and chronic
catarrhal bronchitis: it modifies and dilutes the expectoration, which
gradually lessens in amount; the respiratory sounds become normal, the
cough is relieved, and appetite improved (Bulletin, October, 1864). In
ordinary catarrh I have found the chlorate a very good remedy; it is rec-
ommended also by Dr. Sedgwick (British Medical Journal, i., 1873).

Asthma. The inhalation of fumes of "nitre paper" is often valuable
in this malady, and I, with others, strongly recommend it, especially for
spasmodic asthma, though it is often available also in the bronchitic form,
if congestion be not very acute. The paper may be made with thick
blotting-paper, saturating it in a hot solution of nitrate of potash (4 oz.
to pint), then drying and dividing it as required. In some cases a lit-
tle of this is sufficient, and a less strength of solution is desirable, but in
others relief is not obtained till the room is filled with the vapor ( Times,
i., 1874, p. 64). Dr. Murrell has recently reported much relief from thick
strong papers covered with crystals of nitrate or chlorate; when lighted
they give out "dense volumes of smoke" (British Medical Journal, i.,
1881). Sometimes, however, especially if there be extensive or active
congestion, such treatment proves irritant, and its first use therefore re-
quires watching.

Pertussis. The carbonate of potash was at one time in good repute
in the treatment of whooping-cough, but we cannot expect more from it
than the thinning of tracheal and bronchial secretion, and a slight seda-
tive effect on the mucous membrane. The acetate has been especially
recommended (Practitioner, vol. ii.), also the sulphuret; the latter is giv-

282 MATERIA MEDIC A AND THERAPEUTICS.

en in doses of 1 gr. per year up to four years, after that age in the pro-
portion of gr. per year. It is important that its solution should be
freshly prepared: it is rather nauseous, and acts sometimes as an emetic,
but if continued for four or five days will usually do good (Ranking, i.,
1869, p. 65).

Phthisis. The value of chlorate of potash in phthisis has been much
disputed: by some it has been esteemed a specific, ana though it really
cannot be called so, it has the power of relieving at least some of the
symptoms. Dr. Fountain introduced it with the hypothesis that it gave
up oxygen to the blood (v. Physiological Action), 'and seems to have
found benefit from the salt, not only in consumption, but in various dis-
orders with impeded respiration (Medical Times, ii., 1859, American
Journal, I860). 1 Dr. Harkin records that in the first or second stages of
phthisis doses of 5 to 20 gr. improved color and strength, and diminished
cough and diarrhoea (Dublin Quarterly, November, 1861). Dr. Symonds
considered it of service in promoting the healing of vomicae (British
Medical Journal, i., 1868), and Spender, pointing out that full doses may
readily be given, because of its great solubility in boiling water, "regrets
that its value in phthisis is not better known " (British and Foreign He-
view, i., 1872). On the other hand, Dr. Flint's observations satisfied him
of benefit from the drug in only one out of fourteen cases, mostly ad-
vanced (American Quarterly Heview and Medical Times, ii., 1861). Dr.
Cotton could trace no definite effects to it, though it seemed to improve
the vigor of cachectic individuals generally. I have myself known the
carbonate as well as the chlorate relieve pleuritic stitches, diminish pro-
fuse purulent expectoration, and check copious perspiration.

Chronic Hoarseness Aphonia. In these conditions, whether con-
nected with chronic chest-disorder (not laryngeal phthisis) or with over-
exertion in talking or singing, I have frequently prescribed from 5 to 15
min. of liquor potassae with advantage; in fact this simple remedy, given
every four hours for a few days, has quickly relieved and sometimes quite
cured the symptoms.

Struma Asthenia. Many observers agree in attributing benefit to
the chlorate in strumous asthenic conditions, more or less allied to phthi-
sis. Dr. Harkin used it in all forms of scrofulous glandular ulcerations.
Mr. Weeden Cooke praised it in " scrofula," and in the generally im-
paired condition which follows exanthematous disease (Lancet, ii., 1869).
It has also acted well in improving the general state during pregnancy,
and even in preventing the recurrence of abortion (Edinburgh Medical
Journal, 1866). The early reputation of potash in struma was founded

1 Mr. Whymper has recently reported its good effects in relieving headache, and
other symptoms induced by highly rarefied air, at an altitude, e.g., of 16,500 feet on
Chimborazo ; it was recommended to him by Dr. Marcet.

POTASSIUM. 283

mainly on the success of Brandish with liquor potassas, but good air and
hygiene were essential elements in his cures. This medicine will some-
times induce the absorption of glandular tumors, but cannot be consid-
ered curative of the constitutional taint; it is now practically replaced by
iodide of iron and cod-liver oil.

Suppuration Ulceration of Mouth. In cases of suppuration, such
as carbuncle or continued eruption of boils, or discharging wounded sur-
faces, also in sloughing or gangrene, the chlorate and permanganate have
been found useful internally as well as locally, but it is especially in ulcer-
ation about the mouth, the gums, and the fauces that chlorate of potash
is most valuable. Mr. Hutchinson has recorded many cases occurring in
unhealthy children, and very obstinate until this remedy was given in full
doses of from 10 to 30 gr. (Medical Times, ii., 1856). Mr. Hunt" intro-
duced it as a specific in ulcerative and gangrenous stomatitis (" Medico-
Chirurgical Transactions," xxvi.), and I consider it a most valuable rem-
edy when used internally and locally in these affections. In relaxed sore
throat and catarrhal pharyngitis the chlorate is often serviceable, and is
commonly prescribed in the form of lozenge.

In mercurial stomatitis it has proved useful (Herpin, Hutchinson,
etc.), and Ricord administered it with mercury to obviate injurious effects
from the latter. Sir T. Watson quotes a formula containing the chlorate
10 gr., with an equal quantity of sulphur, as " almost a specific," but my
own experience is rather that of Bartholow and some other observers,
viz., that the chlorate does not give, in mercurial maladies, the same good
results as in ordinary stomatitis.

Diarrhoea. The chlorate of potash has been recommended in dysen-
tery, and even in inflammatory diarrhoea (Amisy : Lancet, ii., 1872, p. 300).
Marotti considers the acetate valuable in gastro-intestinal disorder con-
nected with chronic catarrhal conditions and increased secretion of mucus
in the alimentary canal, an.d marked by coated tongue and anorexia
(Practitioner, vol. ii.), but I think we have more dependable remedies.
I should rather avoid it in acute conditions of this kind, but in the form
connected with advanced stages of chronic nerve-disorder and cachexia, or
" vaso-paraly tic " diarrhoea, its use is more indicated. The chlorate is an
ingredient in the " saline treatment " of cholera.

Constipation. The sulphate of potash acts as a mild aperient, and is
suitable for cases of dyspepsia with deficient biliary secretion, or hemor-
rhoids; it is often combined with rhubarb, especially for children (West,
Hillier). Dr. Dickinson recommends it in doses of 10 to 20 gr. as a good
laxative in albuminuria (Lancet, i., 1876, p. 628); in larger doses it is apt
to cause griping. The acid tartrate is also used as an aperient, especially
in cases of hemorrhoids and of dropsy, since it produces a copious watery
secretion into the intestinal canal, but it should be combined with some
more active agent to secure efficient expulsive effect; thus it is ordered

284 MATEBIA MEDICA AND THERAPEUTICS.

with sulphur in the confectio sulphuris, and with jalap in the puivis ja-
lapse compositus.

Purpura Scorbutus Hemorrhage. In purpura simplex, 10-gr. doses
of nitrate of potash have been sometimes useful, and even in hemorrhagic
purpura the same remedy in large doses (10 to 60 gr.) has been recom-
mended (Carlyon). The advantage of potash salts in true scurvy is not
clear, but for the special ulceration of the gums, the chlorate is certainly
good (Lancet, ii., 1860, etc.). Both the nitrate and the tartrate are of
service in the treatment of capillary hemorrhage; the former has been
used, especially in haemoptysis accompanied with febrile excitment (Gib-
bon), and the latter in hemorrhage from the kidney, bladder, and rectum.
Half-drachm doses of the acid tartrate quickly arrested a hemorrhage
connected with a malignant growth of the bladder, and 2 dr. is an effi-
cient dose for relieving the loss of blood from piles (Ramskill: British
Medical Journal, i., 1867).

Cirrhosis of the Liver. The acid tartrate of potash is said to be " of
singular value in alcoholic cirrhosis " (Gull: Lancet, i., 1866, p. 6).

Obesity. There are on record some remarkable cases in which the use
of potash salts, and especially of liquor potassae, has reduced the amount
of fat deposited, but these remedies are by no means always effective for
this purpose, nor should they be employed without real necessity and due
care, for fear of inducing a spansemic condition. In a case of local exces-
sive deposit of fat round the neck of a girl, which was very unsightly, and
for which no available treatment could be at first suggested, the use of 15
to 20 min. doses of liquor potassas ter die, led to marked improvement,
and so quickly as to be clearly traceable to the remedy (Lancet, i., 1873).
In some other cases of fatty tumor, liquor potassse has also been given
with success as regards diminution of the growth.

Diabetes. The use of alkalies in this malady was at one time largely
adopted, in the hope that their property of assisting oxidation would be
of direct service, but this hope has been in the main disappointed. The
permanganate especially was recommended by Sampson (Lancet, i.,
1853), and also by Ramskill (Medical Times, ii., 1867), but has not
proved reliable (Bence Jones, Basham, and others) : it seems, however,
to have the power of relieving the intense thirst of the malady. The
compound alkaline waters of Vichy, Carlsbad, etc., really ameliorate many
cases (v. vol. L, p. 161). The nitrate, chlorate, and tartrate are. also ser-
viceable in polydipsia, and are given dissolved in water or lemonade: the
citrate in effervescence may give much temporary relief.

Albuminuria Dropsy. The use of alkaline diuretics is advanta-
geous in the early stages of this malady, the citrate of potash or the ace-
tate being the most suitable; they are presumed to act directly on the
kidney, washing away debris and epithelium, which obstruct the tubules.
In later stages, when dropsy is present, and indeed in all forms of dropsy,

POTASSIUM. 285

20-gr. doses of the acetate, or half that quantity of nitrate, given in con-
junction with digitalis, squill, or other vegetable diuretics, often secure
a copious secretion from the kidneys.

Cyanosis. Although, as before remarked, the theory of oxidation of
the blood by means of chlorate of potash cannot be scientifically main-
tained, yet I have certainly seen benefit from that salt in cases of con-
genital cyanosis: the color and the temperature have both improved un-
der its continued use. Dr. Balthazer Foster has recorded two remarkable
cases, in which he obtained similar results (" Clinical .Medicine "). Mr.
Harding found it (the chlorate) useful "in cases with lividity, and cold-
ness of lips and extremities, and symptoms of obstructed circulation "
(Medical Times, ii., 1861), and Dr. Fountain and others have had the
same experience.

Tetanus Chorea. The power of potash to alter and diminish the
contractility of muscular tissue, furnishes some theoretical ground for an
old method of treatment of tetanus by means of potash-baths, and the
internal administration of the carbonate, "the method of Stiitz " (Huse-
mann): practically, this is not often employed, but some cases in which
it was successful may be found recorded (Lancet, i., 1861). In chorea,
also, baths of the same kind have been found beneficial by G. See and by
Hillier. The internal administration of potash may be desirable, for a
time, at least, in cases with rheumatic taint, but must not be pushed to
the production of spansemia.

Blood- Poisoning Pycemia. The influence of potash upon oxidation,
and upon the blood-condition, have led to its employment in cases of
absorption of poisonous material.

Savory has found it of distinct value, not in acute, but in chronic
pyjemia (Lancet, i., 1867, p. 202), and Sir James Paget records the disap-
pearance of a chronic pysemic abscess under the use of liquor potassce
(St. Bartholomew's Hospital Reports, vol. i.).

Snake-bite. Dr. Shortt, the eminent ophiologist of Madras, has re-
corded indisputable evidence of its value when quickly and largely used
after the bite of venomous snakes. He gives it in several ways in order
to saturate the blood as soon as possible: thus internally, 20 min. are or-
dered with 1 oz. of brandy and oz. of water; 1 dr. is injected into the
veins every hour, and general and local bathing with a strong solution (4
oz. to the bath) is constantly practised (Medical Times, ii., 1873). 1

Syphilis. By those who decry or discourage the use of mercury in
syphilis, the chlorate of potash is much depended upon as a substitute,
especially in infantile forms of the disorder (Drysdale: Dublin Press,

1 M. de Lacerda has recently reported that intravenous injection of a 1 per cent.
solution of permanganate, soon after an injection of snake venom, has proved anti-
dotal in dogs (October, 1881).

286 MATEKIA MEDIC A AND THERAPEUTICS.

December, 1862). I believe that it may contribute to the healing of
ulceration in this as in other cachexice, but I cannot attribute to it spe-
cial anti-syphilitic power. More has been claimed for the bichromate,
and it seems to have proved sometimes useful, especially in ulcerated
throat (syphilitic) and in iritis; a pill containing ^V to i e r -> w ^ ta opium,
is the best way of giving it, for its solution is apt to nauseate. In large
doses it is an irritant poison, and its action as a remedy has not been well
proved nor extensively tried. I have myself been greatly disappointed
with its effects in some obstinate cases of syphilitic disease.

PREPARATIONS AND DOSE. Potassii bromidum (v. vol. i., p. 119). Po-
tassii iodidum ; Linimentum potassii iodidi cum sapone (v. vol. i., p. 94).
Liquor potassce : dose, 10 to 60 min., freely diluted. Potassa caustica.
Potassce carbonas : dose, 10 to 20 gr., freely diluted. Potassce bicarbonas :
dose, 10 to 30 gr. as an antacid, etc. ; in acute rheumatism, 30 to 60 gr.
every four hours, freely diluted with water. Liquor potassce ejfervescens :
" potash water," dose, 4 to 8 oz. (contains gr. in the ounce). Potassce
acetas : dose, 10 to 60 gr. as a diuretic; 120 gr. and upward as a purga-
tive. Potassce citras : dose, 20 to 60 gr. Potassce tartras : dose, 20 to 60
gr. as a diuretic and alterative; 120 to 200 gr. as a purgative. Potassce
tartras acida : dose, 20 to 60 gr. as a refrigerant or diuretic; 120 to 300
gr. as a hydragogue purgative (contained in confect. sulphuris). Potassce
sutyhas : dose, 20 to 120 gr. as a purgative; smaller doses as an altera-
tive. Potassce nitras : dose, 5 to 20 gr. as a refrigerant and diuretic; 20
to 30 gr. as a vascular sedative. Potassce chloras : dose, 5 to 20 gr.
Trochisci potassce chloratis : 5 gr. in each lozenge. Potassce permanga-
nas : dose, to 4 gr. Liquor potassce permanganatis (contains 4 gr. to
the ounce for external use, 1 fl. dr. to 5 or 10 oz. of water). Potassa
sulphurata: dose, 3 to 6 gr. in pill (often used in much smaller doses in
pill or in water fa gr. or even less for children). Unguentum potassce
sulphurate (should be recently prepared). Sapo mollis.

[PREPARATIONS, U. S. P. Potassa; Potassa cum, calce (equal parts
of potash and lime) ; Liquor potassce ; Potassii acetas ; Liquor potassii
arsenitis (4 gr. in 1 oz.); Potassii bicarbonas; Potassii bitartras ; Po-
tassii bromidum ; Potassii carbonas ; Potassii carbonas pura ; Potassii
chloras ; Trochisci potassii chloratis (5 gr. of the salt in each); Potassii
citras; Liquor potassii citratis; Mistura potassii citratis neutral mix-
ture; Potassii iodidum ; Unguentum potassii iodidi (60 gr. in 1 oz.);
Potassii nitras ; Potassii permanganas ; Liquor potassii permanganatis
(4 gr. in 1 oz. ) ; Potassii sulphas ; Potassii sulphuretum ; Potassii tar-
tras ; Potassii et sodii tartras Rochelle salt; Pidveres effervescentes
aperientes Seidlitz powders.]

SODIUM. 287

SODIUM XATKIUM, Ka,=23.

This metal does not occur native, but in various combinations is found
extensively throughout all the kingdoms of nature; the chloride espe-
cially is abundant in the animal organism, also in sea-water, in many
mineral springs and marine plants, as well as in mineral formations. The
nitrate of soda occurs as an efflorescence on the soil in some countries.

CHARACTERS AND TESTS. Sodium, the metallic base of soda and its
compounds, is of waxy consistence, and silver-white color. It has a great
affinity for oxygen, and when placed upon water floats like potassium,
producing effervescence from escape of hydrogen, and combining with the
oxygen of the water to form soda: the sp. gr. is 0.972. Sodium is the
only metal of which the ordinary salts are all soluble in water, and there-
fore do not furnish precipitation tests: we have, however, an excellent
reaction in the flame-test, i.e., the communication of an intensely yellow
color to a clear flame; so delicate is this test, and so universally diffused
are the compounds of sodium, that it is difficult to obtain a flame per-
fectly free from all traces of them (Smith).

COMPOUNDS OF SODA.

SODA CAUSTIC A CAUSTIC SODA HYDE ATE OF SODA, NaHO,=40.

PREPARATION. By evaporating liquor sodse to dryness in a silver or
clean iron vessel; the process is conducted as rapidly as possible to pre-
vent absorption of carbonic acid, arid plantinum, glass, or porcelain ves-
sels are not admissible because the alkali would act upon them. A pure
hydrate is now prepared by decomposing water with* metallic sodium.

CHARACTERS. Occurs in whitish cakes or pieces which are highly al-
kaline and corrosive: it is not so deliquescent as potash.

LIQUOR SOD ^E SOLUTION OF SODA.

PREPARATION. By adding slaked lime to hot solution of carbonate of
sodium, Na 2 CO s + CaH a O 2 -CaCO 3 + 2NaHO.

CHARACTERS. A colorless liquid, of intensely caustic taste, contain-
ing nearly 19 gr. of caustic soda to the ounce.

CARBON AS CARBONATE OF SODA, Na 2 CO 3 10H 2 0,=286.

PREPARATION. This is carried out on a large scale for commercial
purposes, and is not described in the Pharmacopeia. The combustion

288 MATERIA MEDIC A AND THERAPEUTICS.

of sea plants formerly furnished us with crude soda-ash, or " barilla,"
from which the carbonate was prepared, but it is now generally obtained
from common salt (chloride of sodium) either by Leblanc's process of
treatment with sulphuric acid, to form a sulphate known as " salt-cake,"
which is strongly heated in a furnace with chalk and charcoal, and after-
ward the carbonate is crystallized out; or by "the ammonia process," in
which the bicarbonate of ammonia precipitates from the salt solution a
bicarbonate of soda, and from this the carbonic acid is driven off by heat,
to be utilized in other steps of the manufacture.

CHARACTERS. Occurs in large rhombic crystals, colorless and trans-
parent when fresh, but readily efflorescing on exposure to air; of nau-
seous alkaline taste, very soluble in water, not at all in alcohol: they con-
tain 63 per cent, of water of crystallization, which they lose at a sufficient
heat. Twenty grains of carbonate of soda neutralize 9.7 gr. of citric and
10.5 of tartaric acid.

Sodce Carbonas exsiccata, or dried carbonate of soda, being the same
salt deprived of water and powdered, is introduced as a separate prepara-
tion for convenience in dispensing: 1 gr. =about 2 gr. of the crystallized
salt.

SOD^l BICARBONAS BICARBONATE OF SODA, NaHCO 3 ,=84.

PREPARATION. By passing a stream of carbonic acid gas into a mix-
ture containing two parts of the crystallized and three parts of the dried
carbonate, until the gas ceases to be absorbed. (If the ordinary carbon-
ate only were used, the mass would become too moist, and the crys-
tals too large): by a special arrangement of vessels, the delivery of the
carbonic acid is made continuous, as in the case of bicarbonate of pot-
ash.

CHARACTERS. Occurs in small snow-white grains or scales, or in
opaque white powder, slightly alkaline, and somewhat caustic to the
taste, permanent in the air, and soluble in water. Good commercial bi-
carbonate commonly contains 2 or 3 per cent, of carbonate. Twenty
grains of the former salt neutralize 16.7 gr. of citric and 17.8 of tartaric
acid.

Sodce Arsenias (v. p. 26).

SOD^l SULPHAS SULPHATE OF SODA GLAUBERS SALT,
Na 2 S0 4 10H 2 0,=322.

PREPARATION. In the process for making hydrochloric acid, an acid
sulphate of soda is formed by the action of sulphuric acid on common
salt, and if this acid sulphate be neutralized with carbonate of soda, the
neutral sulphate may be crystallized out.

SODIUM. 289

CHARACTERS. Occurs in transparent colorless six-sided prisms, which
are deeply channelled; they are efflorescent in the air, and have a saline
bitter taste and neutral reaction.

ACETAS ACETATE OF SODA, NaC 5 H 3 ;1 3H s O,=136.

PREPARATION, etc. By neutralizing carbonate of soda with acetic
acid: occurs in long striated prisms, which slowly effloresce, and have a
sharp, bitter taste.

HYPOSULPniS HYPOSULPHITE OF SODA (SODIC THIOSUL-
PHATE), NaaHiSjCMHaO (not officinal).

PREPARATION, etc. By warming a solution of the sulphite with pow-
dered sulphur: occurs in large colorless oblique prisms, which are very
soluble in water, not in alcohol.

SOD^E NITRAS NITRATE OF SODA, NaNO 3 ,=85.

PREPARATION, etc. This salt is found native in Peru and Chili, and
is purified by crystallization from water. It occurs in the form of obtuse
rhomboids, resembling cubes, deliquescent, and very soluble.

PHOSPHAS PHOSPHATE OF SODA, N 3 HP0 4 12H 2 O, =358.

PREPARATION. Obtained from bone-ash, which is mainly phosphate of
lime, by rather a complex process, of which the essential steps are two,
viz.: (1) The bone-ash is digested with sulphuric acid, when an acid
phosphate is formed and remains in solution, and an insoluble sulphate
precipitates. (2) The filtered solution containing the acid phosphate of
lime is then treated with carbonate of soda to slight alkalinity, when
phosphate of soda is formed, filtered, and re-crystallized.

CHARACTERS. Occurs in large, transparent, rhombic prisms, which
quickly effloresce in the air; they are faintly alkaline, very soluble in
water, and have a mild saline taste.

SOD^E HYPOP110SPHI8HYPOPHOSPHITE OF SODA, NaPH,O,,=83.

PREPARATION. By adding carbonate of soda to solution of hypophos-
phite of lime, so long as a precipitate (carbonate of lime) is formed; this
is filtered off, and the solution evaporated cautiously.

CHARACTERS. A white, crystalline, bitter salt, deliquescent, and very
VOL. IL 19

290 MATERIA MEDICA AND THERAPEUTICS.

soluble in water and spirit. It readily decomposes, so that explosions
occur with it on mixture, for instance, with chlorate of potash and fric-
tion; and when heated to redness it ignites, and gives off phosphuretted
hydrogen.

SODJE B1BORAS BORAX, Na 2 B 4 O,10H a O,=382.

PREPARATION. Found native in a crude form in Thibet, India, Cali-
fornia, etc. ; also prepared by neutralizing boracic acid with carbonate of
soda.

CHARACTERS. Occurs in flattened semi-transparent prisms, of slightly
alkaline reaction and saline taste, soluble in water, and efflorescing in the
air. Its solubility is increased by glycerin and by cream of tartar, and
from its solutions boracic acid is precipitated by any mineral acid: it
gives a green color to flame. When heated it dissolves in its water of
crystallization, and at red heat forms a transparent glass much used as a
flux for mineral substances in blow-pipe operations.

LIQUOR SODJE CHLORATE SOLUTION OF CHLORINATED SODA.

PREPARATION. By passing washed chlorine gas through a solution of
carbonate of soda, till a sp. gr. of 1.06 is reached. The resulting solution
contains hypochlorite of soda, with some chloride and bicarbonate of the
same.

CHARACTERS. A .colorless alkaline liquid, with the odor of chlorine,
and a pungent taste; sp. gr. 1.103; it bleaches vegetable colors, effer-
vesces with acids, and readily e.volves chlorine.

SOD II CHLOR1DUM CHLORIDE OF SODIUM COMMON SALT,

NaCl,=58.5.

Is found native in." rock-salt " and saline waters.

CHARACTERS. Occurs in transparent cubes or small white grains, solu-
ble in water, and if pure, permanent in air: deliquescent, if containing
chloride of calcium or magnesium.

SODA TARTARATATARTARATED SODATARTRATE OF SODA AND
POTASH ROCHELLE SALT, NaKC4HO 6 4H 2 O,=282.

PREPARATION. By adding cream of tartar to a hot strong solution of
carbonate of soda, so long as effervescence continues, then filtering and
crystallizing.

SODIUM. 291

CHARACTERS. Occurs in large, colorless, rhombic prisms, or halves of
prisms, which have been compared to tombstones: they are neutral in re-
action, soluble in water, and of saline rather bitter taste.

CITRO-TARTRAS EFFERVESCENT EFFERVESCENT CITRO-
T ART RATE OF SODA.

PREPARATION, etc. By mixing bicarbonate of soda with citric and
tartaric acids, at considerable heat (200 F.); with constant stirring, this
salt is obtained as a granular powder, which effervesces on contact with
water.

ABSORPTION AND ELIMINATION. The salts of soda, like those of pot-
ash, are highly diffusible and readily absorbed. Small doses become
changed in the stomach into chloride, but large quantities undergo this
change only in part, the rest being absorbed unchanged; from the rectum
also, soda salts are absorbed without chemical decomposition. In the
blood they circulate as albuminates, carbonates, phosphates, etc., and are
eliminated mainly by the urine: the carbonates, nitrates, and other salts
of mineral acids in their natural state, but citrates and other salts of
vegetable acids pass out as carbonates.

The time that elapses between absorption and some elimination is not
precisely known, but is short, for the nitrate and an excess of chloride
have been found in saliva and urine within a few minutes after the taking
of those salts; also, a very large quantity (60 grammes) of nitrate has
been taken in divided doses during a day without injury, while half the
amount in one dose has proved poisonous.

The chloride taken into, or formed in the stomach, is said to decom-
pose into hydrochloric acid and soda, the former passing into the blood
to combine again there with soda (bicarbonate), while the latter is elimin-
ated, not only by the kidneys, but also by the salivary glands, the liver, the
pancreas, etc. (Bidder and Schmidt). The chloride is never completely
eliminated from the system even if it be. excluded from the diet: on the
other hand, if an excessive quantity be taken, most of it is rapidly got
rid of: thus, Lehmann, analyzing his blood before and during the action
of a salt-dose or salted diet, found the proportion of salt in the blood to
be very similar, the excess being passed out by the kidneys almost as
soon as taken (cf. p. 298).

Chloride of sodium in the air, or in finely-divided spray, is absorbed
from the pulmonary mucous membrane even more quickly than from the
stomach. It does not seem to be absorbed through the unbroken skin,
or at least whatever passes, e.g., during a salt-bath, into the epidermis or
corium, passes out again in the same b,ath (Clemens). Soda salts, like
alkalies generally, are eliminated to a slight extent by the mucous mem-
branes, especially by those of the respiratory tract, the secretion of which

292 J1ATERIA MEDICA AND THERAPEUTICS.

they tend to increase and make thinner: they exercise a remarkable
stimulant effect upon the vibratile movements of ciliated epithelium,
which they revivify after apparent extinction (Virchow).

PHYSIOLOGICAL ACTION (EXTERNAL). The hydrate of soda exerts a
local caustic effect, consequent upon its great affinity for water and its
power of dissolving nitrogenous tissues. The carbonate, applied in solu-
tion, dissolves sebaceous and fatty secretions, and if concentrated, acts
as an irritant. Solutions of chloride redden and stimulate the skin, and
if applied to a surface denuded of epithelium, excite much smarting and
flow of serum; redness is then masked by whitish opacity of the albumi-
nous secretion, and the same whitish appearance may be observed on the
inner aspect of the buccal mucous membrane after eating much salted
food (Gubler). Strong saline baths may cause cutaneous eruptions.

Salt has a local stimulant or irritant effect on nerve-tissue, and for
some physiological experiments, C. Bernard considered it more effective
than galvanism. If the exposed sciatic nerve of a frog be dipped in salt
and water, immediate spasmodic contraction of muscles occurs in the
limb: if the tympanic nerve be so treated, saliva is secreted (Jfedical
Times, ii., 1861).

PHYSIOLOGICAL ACTION (INTERNAL). Oxidation and Nutrition.
Under potassium has been summarized evidence as to the action of alka-
lies on oxidation, and with regard to the carbonates of soda, we may
equally conclude that while large and continued doses induce anaemia
and asthenia, small quantities, given for a moderate time, help to sapon-
ify fatty food, to aid its oxidation, and that of carbonaceous material
generally, to improve digestion, and to raise temperature. This is espe-
cially the case with the chloride of sodium, and indeed Rabuteau teaches
that it is by conversion into this salt that the other sodium compounds
produce the good effects mentioned. Confirming conclusions already
published by Voit (British and Foreign Review, ii., 1862), he showed
that the chloride increased " vital combustion," for while taking an extra
daily dose of 10 grammes of salt, his excretion of urea was 20 per cent,
more, and his temperature was half a degree higher than when under a
dietary from which salt was excluded. Similarly Kaupp found that with
taking 1 gramme of salt, the amount of urea excreted was increased 4
ctgr., the other soluble constituents of the urine being diminished. Ac-
cording to Zabelin, salt favors absorption of phosphates specially, and
rather hinders their excretion, which effect would, to some extent, favor
nutrition.

Falck found also increased excretion of urea after giving salt to fast-
ing animals (1872), while Mvinch reported, from large doses, continued
for a few days, at first diminished excretion and gain in weight: afterward
a contrary effect (Archiv Verein Gfemeinshft., Bd. vi.).

The carbonate, according to the majority of observers, diminishes the

SODIUM. 293

excretion of uric acid, and as this acid results from insufficient oxida-
tion, its diminished excretion implies improvement in oxidation. The
reported increase of excretion of carbonic acid requires proof, but is ren-
dered probable by the increase which follows injection of lactate of soda
into the veins (Husemann). Animals improve under a ration of salt
their coat becomes smoother, their vigor greater, their flesh more healthy,
and if, at the same time, their weight is not increased (Boussingault and
Dailly: Comptes Rendus, 1847), it is because the vital processes and com-
bustions all go on with greater energy. We have negative evidence to
the same effect in the sufferings consequent on deprivation of salt, as in
the American War of Independence, and more lately during the siege of
Metz, and Barbier records that certain Russian serfs, deprived for a time
of salt (from motives of economy), suffered so much (becoming albuminu-
ric and dropsical), that their lords were forced to supply them with it
again ( Gazette Medicale, 1838). On the other hand, it is curious that
the Tlascalans are said to have lived for half a century without salt (Pres-
cott), and certain Aryan tribes never use it (Fick) it is possible that
the atmosphere, as near the coast, may supply to them what is really ne-
cessary.

We must repeat that the above-mentioned good effects of ordinary
salt, and of alkaline compounds, are obtained only within certain limits
of dose an excess of the former causes not only thirst and disordered
digestion, but impaired blood-conditions, and under daily 5-gramme
doses of bicarbonate the urea is diminished, and anaemia and prostration
induced (Rabuteau): the nitrate and sulphate also diminish urea (Jovitzu
and others), lower temperature, and slow the circulation: it is probably
from alteration of the blood that these effects arise. According to Gutt-
man, if the legs of frogs are immersed in strong solutions of salt, unrest
and local swelling occur, then muscular contraction, and ultimately cata-
ract is developed (Medical Times, i., 1860).

Digestive System. What has been stated under potassium as to the in-
fluence of alkalies upon digestion and secretion applies equally to the alka-
line salts of soda, but the chloride of sodium has a special value, perhaps
from its furnishing in part the gastric acid; it aids the solution of albumi-
nous substances, and increases the amount of saliva and gastric juice. Bar-
deleben proved this by observations on dogs with gastric fistula, though,
indeed, many other salts, and even mechanical irritants, will provoke a
temporary increase in the gastric secretion. Rabuteau found that salted
diet increased also the degree of its acidity, whether from irritation, or
from the special properties of the chloride itself; certainly digestion suf-
fers by its absence (Klein and Verson). The good effects are shown
by small doses of 15 to 60 gr. Large quantities tend rather to coagu-
late albumen, while very large and concentrated doses cause vomiting-,
watery purging, and even gastritis: in, China, they are said to be used

294 JIATERIA MEDICA AND THERAPEUTICS.

for suicidal purposes. Injection of much salt into the crural vein of dogs
causes ptyalism, intestinal gurgling, and temporary lessening of the
spleen (Podocaepow).

Different osmotic currents are determined by the different modes of
administration; when either the chloride or sulphate of soda is injected
into the blood, or taken in small quantities that can be quickly absorbed,
constipation follows, while large amounts, given at one time, induce
hyper-secretion and consequent purgation.

The action on bile-secretion is not certainly known : Nasse, experi-
menting with animals, found it lessened, but observations made after the
use of alkaline waters show an increase (Grossmann), and this would be
in accord with analogy. Rutherford has shown that sulphate of soda
has marked cholagogue properties. According to Pavy, the carbonate
not only increases the bile, but also the percentage of fat in the liver,
and when introduced into the portal system causes the disappearance of
hepatine, without formation of sugar ( Guy's Reports, 1861, " Proc. Roy.
Soc.," vol. x.-xi., Medical Times, i., 1865): also the saccharine urine
which commonly follows certain traumatic lesions of the sympathetic,
does not occur if much soda be previously introduced into the blood;
these are curious facts, of which we do not at present see the full bear-
ing (cf. p. 301).

Circulatory System. It is an important difference between potash
and soda, that the former is an active cardiac depressant and poison,
while the latter has no definite effect on the heart-muscle or the circula-
tion. Frogs, it is true, die, but only slowly, after the injection of very
large quantities (Podocjepow, Guttmann), while upward of 100 gr. of soda
carbonate have been introduced into the vein of a dog with but slight
and temporary malaise and muscular weakness (Grandeau: Robin's Jour-
nal, 1864). Upon man, large doses seem to have but little effect in di-
rectly depressing the circulation.

The chloride of sodium, in small or moderate doses, increases the num-
ber of corpuscles; thus Plouviez had analyses made of his own blood
before and after a course of salt, lasting two months, during which he
took daily 150 gr. of salt besides his ordinary allowance, and at the end
of the time the red globules were augmented 10 per cent., the fibrine was
increased, the albumen diminished ( Comptes Rendus, 1847, t. xxv.).

Rabuteau states that blood-corpuscles placed under the microscope
disintegrate much less rapidly when salt is added than with simple water,
and from this and general physiological results concludes that any influ-
ence of salt in apparently increasing the number of globules is exerted
by conserving them, rather than by supplying food for fresh ones, as iron
does.

According to Bergeret, omission of salt from a dietary leads to pallor,
languor, oedema, and a chlorotic condition, the corpuscles are dissolved,

SODIUM. 295

and fibrine deposited (Abstract, Ranking, i., 1871; cf. p. 296), but on the
other hand, the continued use of soda, as of any other alkali, lessens the
number of red corpuscles and deteriorates the blood (Loffler, v. p. 270).

Whether the excessive use of highly salted food is the main cause of
scorbutic conditions, such as occur in sailors and at whale-fisheries, may
be considered doubtful; they may arise from the hardships of such life,
from deficiency of potash, of vegetables, etc., but it would almost seem
as if either great (relative) excess or deficiency of the element led to
equally injurious consequences. Prussac found that when frogs were
placed in concentrated salt solutions or had them injected into the lymph
sacs, copious "wandering" of red corpuscles took place from uninjured
vessels, and also capillary hemorrhage (cf. p. 293).

External to the body, salt reddens and liquefies blood-clot. The
change in color is attributed by Gubler to liberation of carbonic acid and
absorption of oxygen by the haemoglobin. It is permanent, but I do not
think it more than a physical change due to altered osmosis; it may be
produced by many other saline compounds.

Soda is more abundant in the serum, while potash occurs most in the
red globules, and excessive doses of the former alkali may alter this nor-
mal relationship, and thus interfere with respiratory combustion and with
nutrition.

The proportion of sodium chloride in normal blood has been variously
estimated at from 3 to 5 per 1,000. It is diminished in various morbid
states, such as cholera, diabetes (Nasse), jaundice, chlorosis; in pneumo-
nia, on the contrary, its elimination is checked, and hence an excess re-
mains in the blood (Beale: Lancet, i., 1852; Bergeron: "These de Paris,"
1866, and others).

Nervous System. There is some (not cogent) clinical evidence that
excess of soda in the blood leads to convulsive action of the nervous sys-
tem (Laycock: Medical Times, i., 1863; Hunt: Medical Times, 185G);
most observers think an excess of little import.

Urinary System. With regard to the influence of soda salts on diure-
sis, opinions are divided, partly, perhaps, because of the different doses
employed. Usually some increase in the quantity of urine passed is
observed in patients taking carbonates, especially in those with acid dys-
pepsia, but it is not always the same with healthy persons. Munch
found, in five subjects, when perspiration or diarrhoea did not occur, in-
creased excretion of water as the principal effect of 3 to G or 9-gramme
doses of carbonate, but Rabuteau and Constant could not verify any
increase with 5-gramme doses, given daily. A continued weak alkales-
cence of the urine may be secured from about 3-gramme doses of bicar-
bonate of soda, taken thrice daily at meal-times, while one daily dose of
5 gr. will give alkalinity only for two or three hours even 1 gramme
will do this if taken fasting. Much dilution or warmth of the liquid in

296 MATERTA MEDICA AND THERAPEUTICS.

which the drug is taken promotes the alkalescence of urine, and it lasts
longer in weak or elderly persons.

The chloride will produce the same effect, though not so quickly as
the carbonate, and under its use earthy phosphates replace free acids
(Munch).

Glandular System. Milk is secreted in increased quantity under the
influence of salt. This fact, indicated by Saive, but denied by Boussin-
gault, has been confirmed recently (Rabuteau). In Brazil and some other
countries there is a popular custom of watering the food of milch cows
with salt water to increase their milk.

SYNEEGISTS. The chemical action of the alkaline salts of soda is
shared by other alkalies, the physiological action of the chloride of so-
dium by other chlorides, both as stimulant of hrematosis and as irritant
in large doses; as digestive stimulant, other condiments assist its power.

ANTAGONISTS INOOMPATIBLES. Acids antagonize the chemical ef-
fects of alkaline salts of soda, though the vegetable acids are often added
to them to secure liberation of carbonic acid gas and formation of neu-
tral salts. Mucilaginous substances lessen the local irritant effects of ex-
cessive doses of chloride, nitrate, etc., and the chloride itself is a suitable
antidote for nitrate of silver. Prussia acid and cyanides, perhaps also
arsenic and antimony, antagonize the hsematinic effects of chloride of so-
dium.

THERAPEUTICAL ACTION (EXTERNAL). Strumous Ulceration, etc.
For destroying unhealthy growths, the edges of strumous ulceration,
etc., caustic soda has been sometimes used. It is less deliquescent than
potash, but yet is very diffusible, and readily extends its action: it there-
fore requires the precaution of protecting adjacent parts, and of neutral-
izing with weak vinegar or oil after application.

Glandular Scrofulosis. A strong solution of salt locally applied is a
good resolvent of enlarged and hard glands: sea-bathing is useful for the
same purpose.

Frictions with a pomade containing salt cause a pustular eruption,
and have been used over the chest in phthisis (Medical Times, ii., 1859).

Hoarseness Catarrh. A piece of borax allowed to dissolve slowly
in. the mouth sometimes cures these conditions. A spray containing
salt (gr. iv.-v. ad. j.) is also useful.

A simple mode of stimulating the external surface in some, chronic
catarrhs and relaxed throat-conditions, is sponging or bathing of the
neck and chest in salt water night and morning, following this with
friction.

Unhealthy Wounds. Solution of chlorinated soda mixed with water
in various strengths makes an excellent detergent and disinfectant gargle,
lotion, or injection, but is rather a preparation of chlorine than of soda.

Corneal Opacity. Mr. Henry Power has recorded good results from

SODIUM. 297

the local application of powdered sulphate of soda to the cornea, though it
is liable to cause severe irritation for a time (Practitioner, September, 1868).

Lupus. The acetate of soda, though not often used, has remarkable
power in lessening the granulations and crusting of strurnous and lupoid
ulceration: a lotion containing from 10 to 20 gr. in the ounce of water
may be applied on compress, or injected into sinuses. In lupus the solid
crystals may be lightly applied for a caustic effect (Anderson: Lancet,
ii., 1869).

Pruritus Eczema, etc. In several forms of skin disease, attended
with itching, lotions containing a small proportion of carbonate or borate
of soda, 1 to 2 dr. in pint, are often serviceable. In urticaria, lichen,
and the early inflammatory stages of eczema, when alkaline oozing oc-
curs, the same lotion will give relief, but in the last case it should be
made weaker still 20 to 30 gr. in the pint; or, again, 20 gr. of the
carbonate of soda may be usefully combined with an ounce of zinc oint-
ment. In several forms of papular and scaly eruptions, such as lichen and
psoriasis, baths containing about 4 to 6 oz. of carbonate of soda are very
useful, being sedative as well as detergent. For common chilblains a
strong solution of salt in water is a good domestic remedy; borax with
glycerin is also good.

A weak lotion of borax is also often useful in cases of ordinary sore
nipple; Sir Astley Cooper commonly prescribed it with spirit of wine.
For slight cases of fissured sore tongue or buccal irritation, the glycerine
of borax is pleasant and efficient.

Tinea Versicolor and even mild cases of tinea tonsurans (ringworm)
mav be cured by the same remedy. For the irritation and scaling con-
nected with so-called pityriasls capitis a lotion containing borax, cam-
phor, and rosemary is a good application.

Aphthae, etc. Aphthous conditions affecting the mouth and fauces
are often treated with borax mixed with honey or dissolved in glycerin;
a solution of chloride will also succeed sometimes. Aphthous conditions
affecting the vulva, and the very irritating " pruritus pudendi " in either
sex, may be much relieved by warm lotions or by paints containing borax.
Laycock has spoken well of the use of borax in diphtheria (Medical
Times, i., 1858, p. 548), but we have more dependable remedies.

Acne Simplex. A liberal use of soap with hot water is often neces-
sary in this disorder, and a borax lotion is of service.

Burns. In burns and scalds, especially of the first degree, a satura-
ted solution of the bicarbonate, applied constantly on moistened cloth,
quickly relieves the burning pain.

JJental Caries. Toothache, connected with open carious teeth, may
often be relieved by the local use of carbonate of soda ( dr. in the ounce
of warm water); it probably acts by neutralizing acid or irritant secretions
(Duckworth: Practitioner, 1875).

298 MATERIA MEDIC A AND THERAPEUTICS.

Rheumatism Gout. Soda baths are also useful in relieving pains of
rheumatic character in the joints and muscles. Basham recommended basic
phosphate of soda in powder as a good application for enlarged and pain-
ful gouty joints (Medical Times, ii., 1848), and it has some advantage over
liquid applications; it may be applied on moistened spongio-piline. Hot
salt in flannel is often a convenient mode of applying warmth to rheuma-
tic or painful parts: in similar cases Dr. H. Bennett used "soda poul-
tices" (Times, ii., 1853, p. 502). 1

Leucorrhcea Cystitis. Injections containing carbonate of soda (1 to
2 dr. in the pint) form a simple and often efficacious remedy in cases of
vaginal leucorrhoea with white, alkaline discharge, and in chronic cystitis
an injection of borax, glycerin, and warm water is very soothing. The
silicate of soda has been lately recommended for the same purpose; it
coagulates albuminous material, and is antiseptic (Ranking, i., 1873).

Ascarides, etc. A strong injection of salt into the rectum is an
efficient cure for these parasites, and is best given with quassia or other
bitter. Salt is also taken internally to prevent recurrence of thread or
round worms, and so strong at one time was the belief in its efficacy, that
an ancient law in Holland deprived certain criminals of salt in their diet,
in order to allow intestinal worms to develop and devour the victims!

Leeches are very sensitive to the action of salt; it will make them
disgorge blood they have swallowed, and a saline injection will dislodge
them from the rectum or vagina. It is advisable to administer the same
remedy freely should they by accident have passed from the nose or
mouth to the stomach.

Fractures, etc. The silicate of soda (water-glass) is used like the
analogous salt of potash. Bandages soaked in the fluid harden into a
light firm support in twenty-four to forty-eight hours.

THERAPEUTICAL ACTION (INTERNAL). Comparing soda with potash,
we find the former more indicated in disorders of the stomach, the primae
viae, and the liver, while the latter, acting better as a diuretic and a solv-
ent of uric acid, is more appropriate in renal congestions and lithiuria.

Dyspepsia. Soda salts are very useful in several forms of indiges-
tion, but the dose and mode of administration vary somewhat according
to the conditions present. In cases of atonic dyspepsia connected with
deficient secretion of gastric juice, the bicarbonate in small doses of 5 to
10 gr. should be given, and shortly before a meal, on the principle already
alluded to, viz., that an alkali causes increase of an acid secretion, for
though on first contact it neutralizes the acid it meets with, additional
acid is very quickly poured out so as to leave an excess. The alkali
may, in some cases, be very suitably combined with an aromatic, as in

1 Soda salts are, by some practitioners. giv3n internally for rheumatism, like pot-
ash (v. p. 279) : the use of the salicylate will be discussed under salicylic acid.

SODIUM. 299

"Gregory's powder," with ginger only, or with a bitter-like tincture of
orange or infusion of gentian. On the other hand, in cases of acid dys-
pepsia, with thickly coated or red shining tongue, sour eructations, heart-
burn, and flatulence, larger doses of the bicarbonate (15 to 20 gr.) should
be given an hour or more after a meal, according to the time at which
the symptoms come on; in this case, also, the remedy may be well com-
bined with an aromatic or stimulant, as ammonia or peppermint. Soda
is especially useful for the dyspepsia of those who live in towns, eating
and drinking freely, and taking little exercise. If the urine be scanty
and irritating, nitre may be given at the same time, and according to Dr.
Budd, an occasional blue pill. A dry skin and very furred tongue are
other indications for soda, while for those who live in the country, take
more vegetable food, and perspire freely, acids usually agree better
(Medical Times, i., 1854). If larger doses of soda be continued too long,
or taken at the wrong time, " it becomes a contest between the scomach
and the doctor."

The familiar use of salt is of no small importance in stimulating ap-
petite and digestion, and advantage is sometimes gained by varying the
kind used: thus, Maldon salt is in crisp flakes, Lymington salt in deli-
quescent cubes, etc. (Medical Times, i., 1864). The principal ingredient
in Vichy water is the bicarbonate of soda, but it contains minor or minute
quantities of sulphate, phosphate, arseniate, borate, and chlorine: this
saline water may be very useful in simple slow digestion, with constipa-
tion and loss of appetite, and when gastralgia is not a prominent symp-
tom (H. Weber: Medical Times, ii., 1861). Dr. Symonds states that
"duodenal dyspepsia," with its attendant " bilious headache," may often
be obviated for a long period by the daily taking of a tumblerful of "salt
and water" before breakfast (Medical Times, i., 1858). An effervescent
soda carbonate, or sulphate, is often efficacious in such headaches.

Lientery. In the lientery of young children, Rabuteau has found salt
curative after other remedies had failed (op. cit. p. 104).

In Vomiting or Diarrhoea connected with acidity, or with incomplete
digestion of fatty food, the bicarbonate of soda, with an aromatic, such
as cinnamon, is very good. In children with coated, irritable, or aphthous
tongue, it may be combined with a little gray powder, and for adults,
especially if colic is present, it may be given in effervescence with opium.
In cases of dyspepsia, etc., in weakly subjects, the use of alkalies must
not be too long continued.

Hepatic Disorders. For congestion of the liver, with deficient secre-
tion of bile, soda is of proved value in several combinations, and it re-
lieves such symptoms as have been already described under dyspepsia.

Phosphate of soda especially is said to promote the flow of bile, and
acting in full doses as a gentle laxative, it is useful in " bilious or sick
headache," and in catarrhal jaundice. It has some value, also, in pre-

300 MATERIA MEDICA A5fD THERAPEUTICS.

venting biliary calculus, which condition arises generally from continued
catarrh of the bile-duct and inspissation of mucus and bile. (Vichy
water presents a good natural combination for such cases and for chronic
hepatic congestion.) The salt cannot be expected to control fully devel-
oped attacks of biliary colic, but if a dose of 20 or 30 gr. be taken regu-
larly before meals for some months, it seems to have the power of lessen-
ing the calculi, or preventing fresh formations (Bartholow, p. 80); from
larger doses (1 to 2 dr.) of the carbonate in copious draughts of hot water,
Dr. Prout has often seen immediate relief even during the attack of
colic.

In fatty degeneration of the liver we have the authority of Dr. Mur-
chison for saying that large quantities of common salt, eaten with the
food, have proved useful, and there is at least encouragement to try sa-
line waters in this condition (" Clinical Lectures," p. 51). In the case of
ill-conditioned children passing pale and pasty stools, 5 or 10 gr. of the
phosphate taken with meals, will often serve to regulate digestion and
improve nutrition (Stephenson).

Renal Diseases. In cases of calculous (uric acid) diathesis, if it be
desired to keep the system under the continued influence of alkalies, the
salts of soda have sometimes been preferred in weakly dyspeptic subjects,
being less depressing than those of potash commonly used. The waters
of Vichy have a special reputation in such conditions, and under their
influence a urate of soda replaces uric acid in the urine, and is more read-
ily eliminated. The phosphate was especially commended by Liebig and
by Golding Bird as a solvent of lithic deposit.

In Albuminuria it has been recommended to supply alkalies freely to
the blood in order to lessen the liability to inflammation, and to dissolve
fibrinous deposits. It has been taught also that they further the oxida-
tion which is deficient in this dyscrasia, but they can only do so in a
slight degree, if at all. Soda, like other alkalies, may be occasionally
useful in relieving the dyspeptic symptoms, but is no cure for albumi-
nuria, and its prolonged use is contra-indicated by the tendency to anae-
mia.

Diabetes. Speaking not of the temporary and accidental passage of
sugar into the urine, but of the more permanent malady, diabetes, we
find that small doses bf bicarbonate or of chloride of sodium often lessen
the amount of sugar passed (Clarke of New York, and others). -

The citrate, to 1 dr., used, instead of common salt, with the food, is
said " to cure saccharine urine " (Ranking, ii., 1866), and alkaline waters
have been largely used in the treatment of this condition. At Vichy
and similar springs it is found that stout diabetics derive advantage from
the waters, when thin and pale patients do not. Transitory cases, such
as have arisen from temporary nerve-causes, from carbuncle, etc., often
do well at Vichy, and even old-standing cases have been relieved, but

SODIUM. 301

those with marked lesion of the pulmonary or digestive organs are not
suitable for this treatment.

Ebstein reports favorably of Carlsbad and other alkaline waters, espe-
cially for mild cases (Medical Times, i., 1875). According to the theory
of Mialhe, they should help to oxidize burn up sugar in the system,
but their use cannot be based on this hypothesis. Poggiale fed dogs
with non-nitrogenous food starch and sugar to which he added enough
soda to render alkaline the urine, but their blood contained as much glu-
cose as that of dogs fed without any soda; also he injected glucose into
the blood of rabbits, and again injected it mixed with soda, in each case
finding sugar in the urine, while under tartaric acid the sugar disappeared
(Bulletin de FAcademie, 1866, cf. p. 294). Bouchardat, on the other
hand, points out that alkalies may act dangerously in increasing both
fluidity of the blood, and tendency to apoplexy or pulmonary congestion,
and Rabuteau cites several cases that died soon after commencing Vichy
treatment. He suggests that whatever benefit is derived from soda salts
is really due to the chloride, and according to Nasse and others this salt
is deficient in the blood of diabetic patients. Martin Solon (Bulletin
Generale, 1842-43), Constant (These, 1844), and Bouchardat have re-
ported some clinical illustrations of the good effects of salt given as medi-
cine to such subjects.

Struma Phthisis. Some writers have much insisted on the thera-
peutical virtues of salt in these diseases. Durand Fardel reported in-
stances of benefit, and Amedee Latour reduced its administration to a
system; he gave it to well-fed goats, and then used the goats' saline
milk largely in the diet of his patients; he employed also all hygienic
means, and obtained good results (Union Medicale, 1851-56, Brochure,
1857). Pietra Santa is another advocate for the systematic use of salt
in phthisis, recommending a " syrupus natrii chlorati." Dr. Cotton,
however, could not trace any definite effects from salt in his treatment
at Brompton Hospital. The saline baths of Soden, in Nassau, have a
reputation in similar cases, and in obstinate chronic catarrh the waters of
Ems are often prescribed with advantage.

Intermittent Fever. There is evidence of a favorable influence being
exerted by salt in ague and some of its complications. Piory used it,
and Gintrac gave 30 grammes daily with success except in quartans; he
did not verify reduction of the spleen (Bordeaux, 1850), but Herschel
and Rondelet have done so after a more prolonged use of the remedy.
At Bruges, forty-eight cases were reported, and all of them, except the
quartans, were convalescent in three to four days, after taking from 30
to 45 grammes of salt daily, freely diluted; it cleansed the furred tongue
and improved appetite. Out of fifty-two cases reported from Africa the
greater number were cured with 15-gramme doses of salt ( Union Medicale,
1851), and Villemin states that, according to his experience at Damas-

302 MATERIA MEDIC A AND THERAPEUTICS.

cus, common salt stopped attacks of ague six times out of every seven,
-oz. doses being given two, three, or four times ( Gazette Hebdom.
de Med., March, 1854). Mareschkin, a Russian physician, has recently
given further evidence to the same effect (Bulletin Generate de Thera-
peutique, vol. li., p. 183).

Cholera. The carbonate of soda has been used both by the stomach
and by injection in cases of cholera, but the chloride has been more de-
pended upon.

A reasonable argument may be given for its employment, for a main
fact in the disease is profuse discharge by osmosis from the vessels of the
intestinal tract into the alimentary canal; this by itself can determine
the cyanosis, shrunk features, blood stasis, etc. It depends upon a
change in the albuminous constituents of the blood, and is increased by
desquamation of intestinal epithelium, while by saline injections the
physical conditions may be so far altered as to lessen such osmosis. Both
rectal and venous injections have been used, and benefit also has been
traced to salt given by the mouth in cases when the power of absorption
has been retained.

During an epidemic at St. Petersburg (1830) salt water and salt milk
relieved as much as any other remedies. In 1835, at Paris, Bracton re-
ported fifty cases of Asiatic cholera treated with common salt, and only
one was fatal; two tablespoonfuls were given dissolved in 6 oz. of water.
Chomel, Aran, Richard, and others reported good results from the same
treatment in the epidemic of 1865. On the other hand, Husemann con-
cludes that the use of salt has no really good effect, and states that its
intravenous injection has sometimes caused asphyxia. The question can-
not yet be considered decided.

For Dysentery, the sulphate of soda has been much commended by
American writers: 1 dr. is given with -J- gr. pf morphia every two hours,
until natural, though loose, evacuations occur; this treatment is said to
control the malady in two or three days (Neio York Medical Record,
February, 1872).

Constipation. On the other hand, the same remedy -(soda sulphate),
when given in larger doses of - oz., is a useful saline purge in inflamma-
tory conditions, and is an ingredient in several natural aperient waters:
if given with sulphate of magnesia or acid tartrate of potash, smaller
doses (1 to 2 dr.) may be used. The phosphate of soda acts in the same
manner on the intestinal tract, and has a more decided diuretic action;
it renders the urine alkaline. Tartarated soda is an ingredient of Seid-
litz powders.

Uterine Inertia. Borax has some stimulating effect upon the uterus,
as shown by its increasing contraction during labor; it has been used in
lingering cases, though generally combined with ergot and cinnamon; it
is nauseous in taste. Borax has been given also in amenorrhcea, with or

SODIUM. 303

without aloes, and in dysmenorrhcea with belladonna, but is not in gen-
eral use. Since this is the only soda salt that acts upon the uterine sys-
tem, it probably does so through the boracic acid.

JEpistaxis Embolism. Common salt is an ordinary domestic remedy
for bleeding at the nose, and even for haemoptysis, and cases of the
former are sometimes favorably influenced by it when given in drachm
doses. Some attribute any benefit from salt in hemorrhage to the nausea
excited, but it is more likely from a reflex contraction of vessels conse-
quent on irritation of gastric nerves (Husemann). It has been stated
that in embolism,, the collateral circulation becomes better established
under the influence of an alkali (soda carbonate), though the thrombus
itself is not affected (British and Foreign Review, ii., 1861).

PREPARATIONS AND DOSE. Liquor sodce : dose, 10 to 60 min. freely
diluted. Soda caustica. Sodce carbonas : dose, 10 to 30 gr. or more.
Sodce carbonas exsiccata : dose, 5 to 15 gr. Sodce bicarbonas : dose, 10
to 60 gr. Liquor sodce ejfervescens soda water : dose, 2 to 10 oz. or
more each pint contains 30 gr. of bicarbonate of soda. Trochisci sodce
bicarbonatis : dose, 1 to 6 each lozenge contains 5 gr. Sodce arsenias
(v. Arsenic). Sodce sulphas : dose, to 1 oz. Sodce acetas : dose, 20 to
60 gr. Sodce sidphis (not officinal): dose, '20 to 60 gr. (v. Sulphurous
Acid). Sodce hyposidphis (not officinal): dose, 20 to 60 gr. Sodce ni-
tras (for making the arseniate). Sodce phosphas : dose, as a diuretic, 30
to 120 gr. ; purgative, % to 1 oz. given in mutton broth it is almost
tasteless. Sodce hypojihosphis : dose, 5 to 10 gr. (v. Phosphorus). Borax:
dose, 10 to 60 gr. Mel boracis : contains 54 gr. of borax to 1 oz. of
honey. Glycerinum boracis : contains 1 part to 4. Liquor sodce chlo-
ratce ; dose, 10 to 20 min. internally, diluted with 1 or 2 oz. of water; as
gargle, to 1 oz. to pint water. Cataplasma sodce chloratce (solution
of chlorinated soda 2 oz., linseed meal 4 oz., water 8 oz.). Sodii chlori-
dum: dose, oz. or more as an emetic. Soda tartarata (Rochelle salt) :
dose, as a diuretic, 30 to 60 gr. ; purgative, 2 to 4 dr. Sodce citro-tartras
effervescens: dose, 60 gr. to 2 dr. Sodce valerianas (v. Valerian).

[PREPARATIONS, U. S. P. Soda ; Liquor sodce ; Liquor sodce cJilo-
rinatce ; Sodii acetas ; Sodii arsenias ; Liquor sodii arseniatis (4 gr. in
1 oz.); Sodii bicarbonas ; Pulveres effervescentes ; Trochisci sodii bicar-
bonatis (3 gr. of the salt in each) ; Sodii boras ; Glyceritum sodii
boratis : borate of sodium 2 troyounces, glycerin -J pint; Mel sodii bo-
ratis : borate of sodium 60 gr., clarified honey 1 troy ounce; Sodii car-
bonas; Sodii carbonas exsiccata; Sodii chloridum; Sodii hypophosphis ;
Sodii hyposulphis ; Sodii phosphas ; Sodii sulphas.]

304 MATERIA MEDICA AND THERAPEUTICS.

ST ANNUM TIN, Sn,=118 (not officinal).

This metal is known to occur only in the mineral kingdom, and in
minute quantity in the water of Sadschiitz.

CHARACTERS AND TESTS. Silver-white in color, with a tinge of yellow,
and high metallic lustre, unaffected by moisture or exposure, inelastic,
but flexible; when rubbed it imparts to the fingers a peculiar odor. It is
a good conductor of heat and electricity, has a sp. gr. of 7.292, melts at
442 F., and at a higher temperature burns with a brilliant white light;
at ordinary temperatures it is not brittle, but when heated to near the
fusing point may be easily powdered. Nitric acid does not act upon it,
except in presence of water; hydrochloric acid dissolves it with evolution
of hydrogen.

Solution of chloride of tin, SnCl a (Appendix, B. P.), absorbs oxygen
readily, and hence is a powerful deoxidizing agent. It reduces to the
metallic state the salts of mercury, silver, gold, etc., and is made use of
for this purpose; also as a test for ammoniated mercury.

PHYSIOLOGICAL ACTION (INTERNAL). The metal itself is inert, but if
taken into the stomach may be so far acted on by acids or saline sub-
stances as to be rendered soluble in the form of chloride, and may then
produce some irritant effects. The fact of such a change sometimes oc-
curring, and sometimes not, may explain the disagreement between the
results of Orfila, who considered oxide of tin to be a poison, and Schu-
barth, who considered it inert.

It has been said that fatty, or acid, or simply albuminous articles of
food, after having been kept in tinned vessels (free from lead) have some-
times occasioned colic and vomiting, but this must be exceptional. We
may note that arsenic is a usual constituent of tin-ores, and in small
quantity it is generally present in all tin that has not been carefully puri-
fied, and irritant effects may have occurred from it (Gubler).

The chloride, or "butter of tin," is stated to exert a tonic, anti-
spasmodic effect, when given in small quantities, but in large doses it
causes muscular twitching, convulsion, and paralysis; also some gastro-
intestinal irritation, with dryness of mouth and throat.

THERAPEUTICAL ACTION. Intestinal Worms. The powder of tin (tin
filings) has been used as a vermifuge in cases of lumbricus and tscnia.

Trousseau remarks that of all metals after mercury, tin has been in
the highest repute as anthelmintic, and many secret vermifuges contain
either the finely powdered metal or its sulphide: from 30 gr. to oz. have
been given in electuary. Alston gave 1 oz. at a time, but severely
irritant effects sometimes followed. Professor Stillo quotes several au-
thorities in favor of the remedy, and Dr. Graves speaks well of it ("Lec-
tures," ii., p. 248), but it is not now much used, because more dependable

ZINC. 305

medicines have been found. It is supposed to act either mechanically or
by disengagement of hydrogen or other chemical effects. Salts of di-
stann-ethyl have a strong purgative action (Jolyet and Cahours).

In Epilepsy, Chorea, and allied forms of nerve-disorder, the chloride
of tin has been given with benefit, according to the observations of Dr.
Schlessinger ( Medico- Chirurgical Jleview, October, 1838, and April,
1846).

In Chronic Skin Diseases, the same physician recommends it both in-
ternally and in lotion, but its real value is not ascertained.

PREPARATIONS AND DOSE. Pulvis stanni (not officinal) : dose, 20 to
40 gr. as a vermifuge it may be given in honey or treacle three or four
times daily for several days, and should then be followed by a cathartic.
Stanni chloridum : dose, -fa to gr. two or three times daily in pill or in
chloric ether a lotion may be made with 1 gr. to the ounce.

ZINCUM ZINC, Zn,=65.

This mineral is obtained, for commercial purposes, mainly from two
ores the carbonate (calamine) arid the sulphide (blende) by distillation
with carbon. It has been found also in plants which grow on the cala-
mine hills of Rhenish Prussia. It is liable to contain arsenic, iron, cop-
per, and sulphur. Alloyed with copper, zinc forms brass; with nickel,
"German silver." It is extensively used in galvanic combinations, and
forms the positive plate of many voltaic batteries; as a coating on iron
(galvanized iron) it protects from oxidation. Granulated zinc is prepared
by pouring the molten metal into cold water.

CHARACTERS AND TESTS. Zinc is a brittle bluish-white metal, which
at a red heat burns with a brilliant flame, and emits white fumes of oxide;
sp. gr. 7. It is the only metal which yields a white sulphide with sulphide
of ammonium, and hence this reaction is the characteristic test for it.
Fixed and volatile alkalies also give with zinc white precipitates, soluble
in excess of the reagents.

*
COMPOUNDS OF ZINC.

ZINC1 OXIDUM OXIDE OF ZINC, ZnO,=81.

PREPARATION. By exposure of the carbonate to a dull red heat until
all the carbonic acid is driven off. " Hubbuck's " oxide of zinc is ob-
tained by combustion of the metal in air.

CHARACTERS AND TESTS. A white heavy powder, without taste or
odor, insoluble in water, soluble in acids; moderate heat renders it yel-
VOL. II. 20

306 MATERIA MEDICA AND THERAPEUTICS.

low. Commercial specimens are often impure from presence of carbon-
ates, sulphates, chlorides, iron, etc.

ZINCI CHLORIDUM- CHLORIDE OF ZINC, ZnCl,,=136.

PREPAKATION. By dissolving zinc in hydrochloric acid, and evaporat-
ing the solution; chlorine water is then added (to combine as chloride
with the iron usually present), and afterward zinc carbonate, which forms
more zinc chloride and precipitates ferric oxide.

CHARACTERS. Chloride of zinc is soft, white or semi-transparent,
crystalline or waxy, and is met with either in opaque tablets or in pen-
cils like nitrate of silver. It is very soluble and deliquescent, but if
mixed with an equal part of oxide (oxychloride), may be kept dry for a
long time.

ZINCI SULPHAS SULPHATE OF ZINC WHITE VITRIOL,
ZnSO 4 7H 2 O,=287.

PREPARATION. By dissolving zinc in dilute sulphuric acid: chlorine
water and carbonic of zinc are added, as in the last preparation, and for
the same purpose, viz., to remove any iron that may be present.

CHARACTERS. Occurs in prismatic crystals, which may be large or
small. The latter much resemble in appearance those of sulphate of
magnesia, but their strong styptic taste will distinguish them from the
bitter maguesian salt (v. p. 233) : they redden litmus and effloresce in
air.

ZINCI CARBONAS CARBONATE OF ZINC, ZnCO 3 (ZnO) 2 2H 2 O, =341.4.

PREPARATION. By adding carbonate of sodium to a boiling solution
of sulphate of zinc, and drying the precipitate; if cold solutions be used,
the precipitate is gelatinous. (The compound formed is really a hydrated
oxycarbonate, as in the formula.)

CHARACTERS. A soft, white powder, resembling magnesia, insoluble
in water, tasteless and inodorous. The native impure carbonate (cala-
mine, lapis calaminaris) was formerly officinal, but the pink powder sold
under that name was almost always spurious, consisting of barium sul-
phate colored with iron.

ZINCI ACETAS ACETATE OF ZINC, Zn(C i H 3 O 2 ) 2 2H i O,=219.

PREPARAT ON, etc. By dissolving the carbonate in acetic acid. Oc-
curs in thin, ustrous, micaceous plates, having a sharp astringent taste.

ZINC. 307

ZINCI VALERIAN AS VALER1ANATE OF ZINC, Zn(C.H,O,),=267.

PREPARATION. By mixing concentrated solutions of sulphate of zinc
and valerianate of sodium.

CHARACTERS.- Occurs in brilliant scaly crystals, which have an odor
of valerian, and a metallic taste; soluble slightly in cold water or ether,
freely in hot water and in alcohol. It is liable to be contaminated with
butyrate of /.inc.

ABSORPTION AND ELIMINATION". Soluble salts of zinc, such as the
chloride, sulphate, and acetate, are readily absorbed, and pass into the
blood probably as albuminates. The oxide and the carbonate are also
dissolved to some extent by the acids of the gastric juice, and then slowly
absorbed; independently of clinical evidence of this, the oxide has been
detected by Schlossberger in the urine, and by Micbaelis in venous blood.

Zinc does not seem to be deposited in the tissues in the same manner,
or for so long a period, as mercury, lead, or copper, although recently
Lechartier and Bellamy have detected it in the bodies of animals to
whom the metal had been previously administered (Medical JKecord, \.,
1877). The soluble salts are eliminated soon after being taken, but the
insoluble ones are not found in the excretions until four or five days after-
ward (Michaelis). The metal passes out mainly by the bile and the intes-
tinal secretions; in smaller amount by the urine.

PHYSIOLOGICAL ACTION (EXTERNAL). The oxide and the carbonate
of zinc, in powder, act mechanically as absorbents and sedatives. The
sulphate and the acetate, in the solid state, act as efficient, but not very
severe, caustics, if the epidermis be removed: in dilute solution they act
as astringents. The chloride and nitrate exert a strongly caustic effect
by virtue of their affinity for water, and their power of coagulating albu-
minous material; the former especially, being deliquescent, penetrates
deeply into the tissues, and causes severe burning pain; the eschar pro-
duced is white and hard, and separates in five or six days; when formed
from deep tissues it is of spongy character, but dry on exposed surfaces.
Zinc chloride is a powerful disinfectant, and even in dilute solution
proves fatal to germs, vibriones, etc.; according to Calvert's experiments,
it is only equalled in efficacy by mercurial chlorides and the tar acids
(Lancet, ii., 1873; Medical Times, ii., 1852, p. 101).

PHYSIOLOGICAL ACTION (INTERNAL). Digestive System. The oxide
and carbonate, in doses of a grain and less, exert an astringent and some-
what sedative action on the gastro-intestinal tract, markedly lessening
its secretions. The sulphate, in small, non-irritant doses, is still more
astringent. All zinc compounds have a tendency to excite nausea and
irritation of the stomach; the oxide and the carbonate, though tasteless,
show this effect when given in doses of from 1 to 5 gr. and upward.
The soluble salts have a styptic metallic taste, and the sulphate, in doses

308 3IATERIA MEDICA AND THEKAPEUTICS.

of 5 to 10 gr. and upward, acts as a prompt and thorough emetic without
much nausea or prostration, though often with diarrhoea: this action is
not purely a local one, because it is equally produced by intravenous in-
jection of the salt. Emesis, however, is not a constant effect, for if the
drug be taken at first in small doses and continued regularly, a certain
tolerance is established, and then 10 to 20-gr. doses may be taken with-
out disorder of the stomach. Caution is required in the continuance
even of small doses, since they have been said to cause ulceration of mu-
cous membrane, and ultimately symptoms like those of lead-poisoning,
such as emaciation, anaemia, debility, fetor of breath, constipation, and
colic, also tremor, paralysis, etc. Symptoms of acute irritant poisoning,
such as pain, vomiting, convulsion, and collapse, have followed doses of
30 to 60 gr., and sometimes concentrated solutions have caused death
(Medical Times, ii., 1862, p. 252), but the salt has rarely proved fatal,
because of its being so soon rejected; persons have recovered after taking
an ounce or even more.

The chloride is much more corrosive in character, and is unsuited for
internal use 5 to 10 gr. have produced severe irritant symptoms. It
has been a not infrequent source of fatal poisoning in the form of Sir
W. Burnett's disinfecting fluid, which is an impure solution of it, some-
what oily in character, and either colorless or of yellowish tinge, from
the presence of some ferric oxide: it has been mistaken for fluid mag-
nesia, for mineral waters, and for pale ale, the fact of its frothing up
when shaken contributing to its resemblance to the last-mentioned : one
fl. oz. has been found to contain from 100 to 372 gr. of solid chloride
(Taylor), 200 gr. (R. "W. Smith), and less than that quantity has proved
fatal, though not invariably.

Nervous System. The oxide of zinc has been credited with a special
action on the nervous system, of tonic character in small, but depres-
sant in large doses. Dr. Marcet traced drowsiness to its use, and others
have recorded giddiness after taking it, and generally depressed ner-
vous and mental conditions from the prolonged continuance of large
doses (Medical Times, 1858; Medico- Chirurgical Review, ii., 1861).
In cases of ultimate recovery from the effects of large doses of zinc
salts there have been, besides the gastric symptoms, signs of impaired
nerve-power, with perversion of taste and smell, tremor, or partial paral-
ysis. Exposure to fumes of the molten metal, as in the course of cer-
tain metallic castings, gives rise to a curious train of symptoms, mainly
nervous, and commonly known as " brass-founders' ague," and including
general malaise, tightness of chest, a cold stage with rigors, followed by a
hot stage with profuse sweating. These symptoms may recur periodi-
cally for several days (H. Greenhow, quoted Lancet, i., 1863 v. p. 541).

Cutaneous System. The internal administration of the oxide or other
astringent zinc salts checks the secretions of the skin.

ZINC. 309

SYNERGISTS. The oxides of silver and of bismuth are much allied in
action with oxide of zinc: henbane and belladonna promote its power of
controlling perspiration (v. p. 312). The chloride of zinc resembles in
corrosive and disinfectant properties the chloride of mercury, and both
the chloride and nitrate are allied in action with other mineral caustics.

ANTAGONISTS. The chemical antidotes in cases of poisoning by the
corrosive compounds of zinc are lime-water, alkaline carbonates, and tan-
nic acid; these should be given in mucilage or milk. Valerianate of zinc
is decomposed by acids and by most metallic salts. Purgatives and
diaphoretics interfere with the action of zinc salts.

THERAPEUTICAL ACTION (EXTERNAL). Lupus Cancer, etc. The
chloride of zinc was first introduced as a secret remedy for cancer by
Canquoin in Paris in 1837, and was combined with sanguinaria in the
paste of Dr. Fell, which had a temporary popularity (Medical Times, i.,
1858, p. 11). Veiel recorded excellent results from its use in lupus
( Medico- Chirurgical ^Review, ii., 1860), and it is certainly a very reliable
escharotic. I have seen immediate improvement from it, in some very
severe cases, especially of facial lupus and rodent ulcer. It has dis-
advantages in being deliquescent, and hence readily penetrating adjacent
healthy tissues and disposing to hemorrhage, but when mixed with flour,
zinc oxides, or better still with lime sulphate or gutta-percha, it becomes
quite manageable. The nitrate of zinc, though not in such frequent use,
has, perhaps, advantages over the chloride; according to Mr. Marshall, it
penetrates deeper, and causes less pain: in lupus it was commended by
Dr. Tilbury Fox, and I have had very successful results with it, generally
using a paste made with equal parts of nitrate, flour, and mucilage spread
on lint.

Both this salt and the chloride are equally applicable to all forms of
strumous and syphilitic ulceration. Franchi reports arrest in some very
severe cases of this kind, when acid nitrate of mercury, iodine, etc., had
been tried, without success (Gazette Med. de Paris, February, 1870).
Maisonneuve used the chloride made into firm paste with flour in the
form of fleche's (" arrowheads "), which he thrust into incisions all round
a morbid growth, thus destroying a zone of tissue and separating the
tumor; but this process is more painful and prolonged than the use of
the knife, and does not prevent recurrence better than an equally exten-
sive incision.

Sir J. Y. Simpson advocated sulphate of zinc in powder as the best
caustic for these maladies, whether affecting the uterus or other parts: it
is simple, easily applied and managed, safe, efficient, fairly rapid in action
(five or six days), and does not deliquesce. In cases where the epithelium
was destroyed, he applied the anhydrous salt in fine powder or mixed
with glycerin into a paste (1 oz. of sulphate to 1 dr. of glycerin). In
other cases, e.g., of cancer of the breast, he mixed the salt with sulphuric

310 MATERIA MEDICA AND THERAPEUTICS.

acid and scored the part with a quill at successive applications {Medical
Times, i., 1857, and 1859); he records many good results, which were to
some extent corroborated, but his practice has not been largely followed.
Mr. Erichsen found it very painful (Medical Times, i., 1857, p. 238).

Warts Ncevi. The strong chloride is useful for destroying warts
and superficial nsevi. Mr. Weeden Cooke has suggested a convenient
mode of applying it, viz., by soaking lint in the deliquescent salt, drying
it, and cutting off suitable pieces when required: if covered it will pre-
serve its power for many weeks (Medico- Chirurgical Revieiv, January,
1866).

"Wounds; Mr. C. de Morgan, and others, recommended the sponging
of recent wounds, whether from accident or operation, with strong solu-
tions of zinc chloride (20 to 40 gr. in the ounce), on disinfectant principles,
i.e., to destroy "germs" (Lancet, i., 1866; Medico- Chirurgical Review,
January, 1866). This seems to have good effect in lessening risk of septi-
caemia, etc., but has in a measure been superseded by the more detailed
and exact method of Lister. It is, however, still largely used, and is
valuable in many cases, especially where Listerism cannot be carried out:
it cleanses the wound and any old sinuses, and lessens and prevents
suppuration. Some surgeons employ it especially after excision of ma-
lignant tumors.

Eczema Erythema. The oxide and the carbonate of zinc, and "cala-
mine " (impure native carbonate), form useful sedative, absorbent, and
protective powders for inflamed surfaces, and sometimes are indicated
when serous discharge is present: they are generally mixed with ^ or \
part of a neutral powder, such as that of orris-root, starch, or magnesia.
They may be used also suspended in mucilaginous liquids as a good
lotion, e.g., for erythematous acne of the face, or in the form of ointment
mixed with oleic acid oleate of zinc (Crocker: British Medical Jour-
nal, i., 1879), or vaseline, or the benzoated lard of Mr. Erasmus Wilson :
benzoated zinc ointment, when properly made, is an excellent application
for irritative and eczematous conditions. A lotion containing 5 gr. of
sulphate in the ounce, relieves the itching of eczema and other skin dis-
eases, but is liable at first to cause some smarting.

Relaxed or Discharging Mucous Surfaces. For ordinary relaxed or
discharging surfaces, when astringents are indicated, the sulphate of zinc
is one of the best: from 1 to 2 gr. in the ounce of distilled water is a
usual strength, and combined with a stimulant, such as spirit of rosemary
or lavender, this forms the ordinary "red lotion" of many hospitals, and
is suitable for any indolent atonic ulcerations: sulpho-carbolate of zinc
also forms a good detergent lotion (Lancet, ii., 1868, p. 763).

For catarrhal throat affections accompanied with deafness, Dr. Druitt
finds zinc sulphate in solution act better than ordinary acid gargles, and
Mr. Nunn reports similarly as to the chloride (Medical Times, i., 1857,

ZINC. 311

pp. 210,247): a spray containing this is excellent for relaxed pharynx
and congested vocal cords.

In catarrhal conjunctivitis, and otorrhoea, collyria and weak warm in-
jections of the same salts (2 gr. to the ounce of water) are useful, and 4
gr. to the ounce is a good strength for injection in ozoena ; morphia,
atropia, or carbolic acid may be combined with the astringent.

The chloride lotion is also valuable in gonorrhoeal and purulent oph-
thalmia, and Mr. Hutchinson reports it as less painful than silver nitrate,
and sometimes completing the cure when that remedy failed (London
Hospital Report, 1867-68).

In leucorrhoea and gonorrhoea, injections containing 1 to 2 gr. of zinc
sulphate or sulpho-carbolate to the ounce, are very suitable after the
early acute stage has subsided (Medical Times, ii., 1870, p. 454, etc.);
they are sometimes better combined with an equal quantity of lead ace-
tate. As a general rule, the more acute the condition, the more fre-
quently should a weak solution (|- gr. or less in the ounce) be applied,
and as the inflammation becomes less or passes into a chronic stage, one
or two applications daily of a double or treble strength are best. Some
time ago I recommended to Dr. Ringer's notice the prescription of a very
dilute injection of sulphate (1 to 2 gr. in the pint of water) to be used
every hour or-half-hour from the commencement of a gonorrhoaal attack,
and his experience supports mine, that this can arrest the disorder in
twenty-four to forty -eight hours; care is required so as to avoid risk of
pain and swelling of the testicles, i.e., the injection must be used less often,
or left off, if any such symptoms set in. A stronger solution (1 to 10 gr.
in the ounce) is advisable, but used less frequently, in more chronic cases
(Lloyd: Lancet, ii., 1850; W. Cooke: Medical Times, i., 1860, p. 127).
The chloride, and indeed many other astringent salts, may be used in a
similar manner with advantage.

THERAPEUTICAL ACTION (INTERNAL). Narcotic and other Poison-
ing. Zinc sulphate is a good emetic for cases of this kind: 10 gr. in
warm water is an average dose, but 20 gr. is the amount preferred by
many practitioners; if the mouth be firmly closed, it may be adminis-
tered by a tube passed through the nose to the gullet, or by the stomach-
pump through a gag, and if the larger dose be used, its after-rejection
must be secured. When an emetic is given by the stomach, its bulk has
an effect in securing the result: thus, the greater quantity of warm water
that can.be given with the zinc sulphate the better it will act: time also
makes a difference, for smaller doses given slowly have acted better than
large ones quickly swallowed. In some cases a few grains have been
given by intravenous injection, and have produced emesis.

Gastralgia Diarrhoea. Prof. Gubler, having remarked the analo-
gous effects of the oxides of zinc and of bismuth, suggested the substi-
tution of the former when expense was an object, and experience has

312 MATERIA MEDIC A AND THERAPEUTICS.

proved that the zinc compound will often act in an extremely satisfac-
tory manner in relieving gastric pain, especially when this is followed by
diarrhosa of undigested food; it has, however, more tendency to nauseate
than the bismuth salt. The dose should commence at 1 gr., and not ex-
ceed 3 gr., and should not, as a rule, be given on an empty stomach.

In dyspepsia connected with oxaluria, Bartholow has found the sul-
phate useful, and Gillespie recommends it {Boston Journal, May, 1868).

Dr. Brakenridge, of Edinburgh, was one of the first to draw atten-
tion to the value of zinc oxide in infantile diarrhoea (Medical Times, i.,
1873), and I have, in common with many others, found it an efficient
and non-irritant astringent.

In chronic diarrhoea, and even in dysentery, the oxide has acted very
favorably (Bulletin de Therapeutique, March, 1877), but the sulphate has
more decided powers.

Bronchorrhcea. Excessive secretion from the bronchial tubes is con-
trolled by the oxide and by the sulphate of zinc (Barlow).

Hyperidrosis. I can entertain no doubt of the power of zinc oxide
to control excessive sweating in phthisis and other exhausting diseases,
although it has been denied by some observers. Dr. T. Thompson, one
of the first to record this effect, found it increased, as we should expect,
by conjunction of the zinc with henbane extract he prescribed 4 gr. of
each substance (Medical Times, i., 1854, p. 190); and W. Curran and
others have corroborated his observations (Lancet, i., 1854, ii., 1868). I
generally order 1 or 2 gr. of the oxide with the same quantity of extract
of henbane, to be taken at bed-time, and again in the course of the night
if necessary.

Epilepsy. The value of zinc salts in disorders of the nervous system
has been much disputed, some physicians, as M. Herpin, recording ex-
traordinary results from them, and others, as M. Gubler, denying to them
any power.

There can be little doubt that the high estimate formed by M. Herpin
of the efficacy of the oxide, and later of the lactate of zinc, in epilepsy, is
unfoxinded no other observer has verified his results at the same time
we cannot deny altogether their efficacy in some cases. Dr. Wilks has
seen benefit from the oxide (Medical Times, i., 1869, p. 84), and Dr.
Sieveking records successful results, though he does not value it highly.
Dr. Russell Reynolds has known it serviceable, and Dr. Radcliffe, noting
its effect in causing ana?mia, suggests that it might best be tried in- mark-
edly congestive cases (Lancet, i., 1863). Others have thought it more
applicable when the epilepsy was complicated with gastric disorder, and
others again have seen the best results from it when used in conjunction
with bromides or digitalis (Lancet, ii., 1868; Medical Times, ii., 1874, p.
481).

Charcot has observed benefit from the bromide of zinc (British Medi-

ZINC. 313

cal Journal, November, 1877), but Dr. Gowers, in his recent lectures,
considers that salt of little value, and has found it badly borne. The
oxide, however, in his experience, proved sometimes useful, relieving
three cases out of ten submitted to it (Lancet, i., 1880, p. 553).

Chorea. There is much evidence as to the value both of oxide and
sulphate of zinc in this malady, more perhaps in favor of the latter; it
requires to be given in gradually increasing doses up to 15 to 20 gr.
(Barlow). In recording many cases, all of which derived some benefit,
Mr. Marsh, of the Children's Hospital, remarks that no definite indica-
tion for the sulphate could be verified, but that a harsh, dry skin became
soft during its administration (Lancet, ii., 1871); it was well borne. In
chorea affecting strumous children, I can speak well of the iodide of
zinc. Dr. Barlow was the first to recommend it (Medical Times, ii.,
1857).

Chronic Alcoholism. Dr. Marcet made many observations on the
treatment of this condition, and published a special essay to illustrate
the value of zinc oxide in controlling the unsteadiness and the tremor
which are its usual accompaniments (" Chronic Alcoholic Intoxication,"
London, 1860; Lancet, i., 1859). Dr. Anstie accorded some, but not so
much, value to the drug in the same conditions.

In Hysteria and Debility, if anaemia be not extreme, zinc salts often
prove useful, but more especially when combined with other nerve-tonics:
thus, Dr. Barnes speaks very favorably of zinc with phosphoric acid
(phosphate of zinc) (Lancet, i., 1858, p. 119), and has recently re-stated
his opinion as to its value in convulsive diseases of women (Lancet, i.,
1873, p. 621). Vigier finds the phosphide of zinc acts mo^e quickly than
phosphorus itself (Bulletin, January, 1876), and the valerianate, although
decried by many observers, certainly relieves in some cases. Zinc oxide
may be combined with camphor, galbanum, sumbul, etc.

Spasmodic Cough Asthma. Both the oxide and the sulphate of
zinc, especially in conjunction with belladonna, have been found to re-
lieve spasmodic cough, whooping-cough, etc. (Fuller: Lancet, ii., I860).
In the intervals of spasmodic asthma, they are given as prophylactics
(Symonds: British Medical Journal, i., 1868). The valerianate has been
successfully used for obstinate hiccough and for hysterical cough (G.
Harley: Medical Times, ii., 1863), but although of some value, is uncer-
tain in its action. In laryngeal spasm, sometimes, 5 to 6-gr. doses will
succeed when smaller ones fail (Medical Times, i., 1858, p. 475).

Nervous Headache Neuralgia. The valerianate is valuable in ner-
vous headache, and it is especially useful for cases of neuralgia con-
nected with uterine derangement.

Tremor. In tremor connected with mercurial and arsenical poisoning,
Gueneau de Mussy found phosphide of zinc effective (Lancet, i., 1876,
p. 208). I have tried it in the tremor of sclerosis, but without result.

314 MATERIA MEDICA AND THERAPEUTICS.

Rheumatism. Among the rarer uses of zinc salts may be mentioned
that of the cyanide in articular rheumatism; it was strongly commended
by Luton, as relieving pain and lowering vascular excitement (Bulletin,
January, 1875). Other observers find it also of some, but not definite,
value; it is apt to cause headache (Medical Record, i., 1877).

PREPARATIONS AND DOSE. Zinci oxidum : dose, 1 to 10 gr. or more,
in pill or powder. Unguentum zinci : made with oxide of zinc and ben-
zoated lard. Zinci carbonas : dose, 1 to 10 gr., in pill or powder. Zinci
sulphas : dose, as a tonic or astringent, 1 to 5 gr. or upward, in pill or
solution; as an emetic, 10 to 30 gr. ; for an injection or lotion, from 1 to
10 gr. in the ounce of water. Zinci acetas : dose, 1 to 2 gr. as a tonic;
10 to 20 gr. as an emetic; as an injection or lotion, 1 to 10 gr. to the
ounce of water. Zinci valerianas : dose, 1 to 5 gr. and upward. Zinci
chloridum : dose, to 2 gr. Pasta zinci chloridi : made with flour and
mucilage. Liquor zinci chloridi, British Pharmacopoeia (contains about
36 gr. in the fluid ounce, v. p. 308), not used internally. Zinci nitras (not
officinal): used as a caustic in paste.

[PREPARATIONS, U. S. P. Zinci acetas / Zinci carbonas prceeipitata ;
Ceratum zinci carbonatis (1 part to 5 of ointment); Zinci chloridum ;
Liquor zinci chloridi ; Zinci oxidum ; Unguentum zinci oxidi (80 gr.
in 1 oz.); Zinci sulphas ; Zinci valerianas.]

INDEX.

REMEDIES.

ACETATE OF AMMONIA, i., 251

alumina, i., 266

copper, ii., 117, 129

iron, ii, 133

lead, ii., 249

potash, ii., 264

soda, ii., 289

zinc, ii., 306
Acetic acid, i, 180
Acetum, i., 181
Acidum aceticum, i., 180
dilutum, L, 180
glaciale, i., 180

bromhydricum, i., 119

carbontcum, i, 184

citricum, i., 189

hydrochloricum, i., 191
dilutum. i. , 199

nitro-hydrochloricum dilutnm, i., 199

hydrocyanicum dilutum, L, 202

nitricum, i. , 215
dilutum, i., 221

phosphoricum dilutum, i., 221

sulphuncum, i., 227
aromaticum, i., 233
dilutum, i., 233

sulphurosum, i., 233

tartaricum. i., 247
^Erugo, ii, 117
Air, compressed, i, 6
Alumen, i, 265, 275

exsiccatum, i, 275
Aluminium, i., 265
Alums, i, 265
Ammonia, i, 249
Ammonite acetatis liquor, i., 251

benzoas, i. , 252

carbonas, i., 165

Ammonias citratia liquor, i., 253

linimentum, i, 264

liquor, i. , 250, 264
fortior. i., 250

nitras, i., 264

phosphas, i., 252

spiritus aromaticus, i, 264

foetidus, i, 264
Ammoniated mercury, ii., 184
Ammonii bromidum, i, 98

chloridum, i., 251

iodidum, i , 59, 94

snlphidum, i, 252
Ammonio-citrate of iron, ii, 135
Antimouial wine, i , 297

ointment, i, 298

powder, i., 298
Antimonii chloridi liquor, i. , 276

oxidum, i., 276, 298
Antimonium, i., 275

nigrum, i., 276

snlphuratum, i., 275

tartaratum, i., 277
Aqua, i, 125

fortis, i., 215

Pagliari, i. , 271
Argluti chloridum, ii, 1

nitras, ii. , 1

oxidum, ii, 2
Argentum, i., 298
Argol, ii, 265
Aromatic mixture of iron, ii., 179

powder of chalk, ii., 113

sulphuric acid, i., 231
Araeniate of iron, ii. , 134

soda, ii. , 26
Arsenic, white, ii. , 25
Arsenical is liquor, ii., 26

316

INDEX.

Arsenici et hydrargyri hydriodatis liquor,
ii., 26

hydrochloricus liquor, ii. , 26
Arsenicum, ii., 25
Arsenious acid, ii., 25
Auri iodidum, ii. , 72

perchloridum, ii. , 72

peroxidum, ii., 72

pulvis. ii., 71

et sodii chloridum, ii., 72

syrupus, ii. , 76

unguentum, ii., 76
Aurum, ii., 71

BARII CAKBONAS, ii., 77

chloridum, ii., 77

chloridi liquor, ii. , 79
Barium, ii., 77
Baryta, ii. , 77
Bath, blanket, i., 134

cold, i., 125

douche, i., 128

foot, i., 130

hot, i., 131

mustard, i. , 134

pack, i., 130

Russian, i. , 133

shallow, i., 127

sitz, i., 129

spinal, i.. 128

steam, i., 132

sulphur, i. , 34

towel, i., 126

Turkish, i., 133
Bathing, sea, i., 150
Bechamp's preparation of iron, ii., 180
Biborate of soda, ii., 290
Bicarbonate of potash, ii. , 264

of soda, ii., 280
"Bismuth-cream," ii., 89
Bismuthi et ammonias citratis liquor, ii.,
80

carbonas, ii., 81

oleas, ii., 90

oxidum, ii. , 80

subnitras, ii., 80

trochisci, ii. , 89

unguentum, ii. , 90
Bismuthum, ii., 79
Black antimony, i. , 276
Black oxide of manganese, ii., 243
Blaud, pilule de, ii., 179
Blue pill, ii., 223
Bone black, i., 18

Borax, ii.. 290
Bromides, alkaline, i., 97, 98
Bromine, i., 94
Burnett's solution, ii., 308
Burnt alum, i. , 265
Butter of antimony; i., 276

CADMII BROMIDTJM, ii., 91

iodidum, ii., 91

iodidi unguentum, ii., 93

sulphis, ii., 91
Cadmium, ii. , 91
Calamine, ii., 306
Calcii bromidum, i, 98

chloridum, ii., 95

sulphidum, i. , 22
Calcis carbonas, ii., 94

hydras, ii. , 93

hypophosphis, ii., 113

linimentum, ii., 113

liquor, ii. , 112

saccharatus, ii. , 112

phosphas, ii., 95

sulphis, i. , 234

c. sulphure solutio, i., 34
Calcium, ii., 93
Calomel, ii., 182
Calx, ii., 93

chlorata, ii., 95
Carbo animalis, i., 18

purificatus, i., 18

ligni, i. , 18
Carbonate of ammonia, i., 165

bismuth, ii.. 81

iron, ii., 133

lead, ii., 250

lime, ii. , 94

lithia, ii.,227

magnesia, ii., 233

manganese, ii., 249

potash, ii., 264

soda, ii., 287

dried, ii., 288

zinc, ii., 306
Carbonic acid, i., 184
Carbonis cataplasma, i. , 20
Caustic potash, ii., 264

soda, ii. , 287
Cerii oxalas, ii., 114
Cerium, ii., 113
Chalk, mixture, ii., 192

prepared, ii., 113
Chalybeate waters, i., 176
Charcoal, i., 18

INDEX.

317

Chlorate of potash, ii, 267
Chlorine,!., 120
Chlori liquor, i., 120

vapor, i., 124
Chloride of ammonium, i., 251

antimony, i., 276

calcium, ii., 95

silver, ii. , 1

sodium, ii., 290

tin, it, 305

zinc, ii., 306
Chlorinated lime, ii. , 96
Cinnabar, ii., 185
Citrate of ammonia, i., 251

bismuth and ammonia, ii., 80

iron and ammonia, ii., 135
and quinine, ii., 135

lithia, ii., 227

magnesia, ii., 243

potash, ii., 264
Citric acid, L, 189
Compresses, i., 131
Copperas, ii., 116
Corrosive sublimate, ii., 183
Cosme's paste, ii., 210
Cream of tartar, ii., 265
Creta, ii., 113
Cupri acetici tinctura, ii. , 129

ammonio sulphas, ii., 116

subacetas, ii., 116

sulphas, ii., 116
Cuprum, ii., 116

DE VALANGIN'S SOLUTION, ii, 26
Dialyzed iron, ii. , 180
Disinfectants, . Oxygen.

sulphur.

iodine.

iodoform.

bromine.

chlorine.

hydrochloric acid.

nitric peroxide.

sulphurous acid.

arsenic.

calcium.

cuprum.

ferrum.

hydrargyrum.

manganese.

plumbum.

zinc.
Donovan's solution, ii., 27

Douche, i., 127, 128
spinal, i., 128

EMPLASTRUM FERRI, ii., 179

hydrargyri, ii., 223

plumbi, ii., 262

iodidi, ii., 262

Enema magnesias sulphatis, ii. , 243
Epsom salts, ii. , 233

i
FERRI ACETATIS TINCTURA, ii., 133

et ammonias citras, ii., 135

arsenias, ii., 134

Bravais, ii., 180

bromidum, ii., 134, 180

carbonas saccharata, ii., 133

carbonatis pilula, ii., 179

emplastrum, ii. , 179

iodidum, ii., 134

iodidi pilula, ii., 179
syrupus, ii., 179

et manganesii carbonas saccharata, ii. >
249

mistura aromatica, ii., 179
composita, ii., 179

oxidum magneticum, ii., 131

perchloridi liquor, ii , 179
fortior, ii, 132

tinctura, ii., 179

pernitratis liquor, ii., 132

peroxidum humidum, ii, 131
hydratum, ii. , 131

persulphatis liquor, ii. , 132

phosphas, ii, 134

phosphatis syrupus, ii. , 179

et quinias citras, ii, 135

redacti trochisci, ii, 179

sulphas, ii, 133

exsiccata, ii., 133
granulata, ii, 133

vinum, ii, 179
Ferrum, ii, 129

redactum, ii., 131

tartaratum, ii, 135
Filhos, caustique de, ii, 102
Flowers of sulphur, i, 21
Fomentations, i. , 132
Fowler's solution, ii., 26

GLACIAL ACETIC ACID, i, 180
Glauber's salt, ii, 288
Glycerole of bismuth, ii, 90

borax, ii, 303

lead, ii., 260

318

INDEX.

Gold, ii., 71

Goulard extract, ii. , 262
Gray powder, ii., 233
Gregory's powder, ii., 242
Green iodide of mercury, ii., 184
Griffith's mixture, ii., 179

HEPAR SCLPHURIS, i., 22 ; ii., 266
Holsverck, lozenges of, i. , 33
Hydrargyri ammoniati unguentum, ii.,

cyaniduin, ii., 186

emplastrum, ii., 223

iodidum rubrum, ii., 184

viride, ii., 184
Hydrargyri iodidi rubri unguentum, ii.,
224

liniinentum, ii., 223

lotio flava, ii., 224
nigra, ii., 224

nitratis, liquor acidus, ii. , 185
unguentum, ii., 224

oleas, ii., 223

oxidum flavum, iL, 185
rubrum, ii, 184

oxidi rubri unguentum, ii., 224

perchloridum, ii., 184

perchloridi liquor, ii., 224

pilula, ii.. 223

subchloridum, ii., 182

subchioiidi unguentum, iL, 224
pilula coraposita, ii., 224

sulphas, ii., 186

sulphuretum, ii., 186

suppositoria, ii., 224

unguentum, ii., 223

compositum, ii., 224
Hydrargyrum, ii., 181

ammoniatum, ii., 184

c. creta, ii., 223

sulphuretum, ii., 186
Hydrate of potash, ii., 264

of soda, 287

Hydrated peroxide of iron, ii., 132
Hydrobromic ether, i., 198
Hydrochloric acid, i., 191
Hydrochloric solution of arsenic, ii. , 26
Hydrocyanic acid, dilute, i., 202
Hydrogen, i., 16

peroxide of, i., 16
Hypochloride of sulphur, i., 22
Hypophosphite of iron, iL, 180

lime, ii., 113

soda, ii., 289
Hyposulphite of soda, i, 234 ; ii., 289

INHALATION OP AMMONIA, 1 , 359
chloride, L, 261

arsenical vapor, ii., 67

bromine, L, 96

carbonic acid, i. , 187

chlorine, i. , 124

hydrocyanic acid, L, 214

iodine, L, 72

mercurial vapor, iL, 210, 211

steam, L, 136

sulphurous acid, L, 240
lodi, lirjiinentum, L, 93

liquor, i., 93

tinctura. L, 93

unguentum, L, 93

vapor, L, 93
Iodide of ammonium, L, 59, 94

cadmium, ii., 91

iron, ii., 134

lead, ii., 250

potassium, L, 59

sodium, L, 59

sulphur, i., 27
Iodine, i., 58
lodoform, i., 59

collodion, i., 94

ointment, i , 94
Iron-alum, i., 265
Iron preparations, n. Ferrum.

KALIUM, . POTASSIUM.
Kermes mineral, L, 276

LAC BISMUTHI, ii. , 90

sulphuris, i., 21, 34
Lactate of iron, ii., 92
Lacto-phosphate of lime, ii. , 97, 113
Lapis divinus, ii. , 123
Lead. v. Plumbum.
Ledoy en's solution, ii., 258
Lehren's mercurial ointment, ii., 223
Lightfoot's solution of iron, ii., 180
Lime, v. Calx.
Linimentum ammoniae, i., 264

calcis, ii. , 112

hydrargyri, ii., 223

iodi, i., 93

potassii iodidi c. sapone, ii., 286
jiquor ammoniae acetatis, L, 251
citratis, L, 251

antimonii chloridi, i., 276

arsenicalis, ii., 2J

arsenici bromidi, ii., 59

INDEX.

319

Liquor arsenic! et hydrargyri hydriodatis,

ii., 27

arsenic! hydrochloricus, ii. , 26
bismuth! and ammonias citratis, ii.,

80
calcis, ii., 112

chloratas, ii., 96
saccharatus, ii., 112
chlori, i., 120
ferri percbloridi, ii., 180
fortior, ii., 132
pernitratis, ii., 132
ferri persulpbatis, ii. , 132
hydrargyri nitratis acidus, ii., 185

perchloridi, ii., 224
iodi, i., 93

lithiae effervescens, ii. , 232
magnesia? carbonatis, ii., 242

citratis, ii. , 246
plumbi subacetatis, ii. , 249

dilutus, ii., 262
potassse, ii., 263

effervescens, ii. , 286
permanganatis, ii. , 286
sodse, ii., 287

. arseniatis, ii., 27
chloratae, ii., 290
effervescens, ii., 303
zinci chloridi, ii., 314
Litharge, ii., 249
Lithia, ii. , 227

benzoas, ii., 228
bromo citras, ii., 232
carbonas, ii., 227
citras, ii., 227
uras, ii., 228

Lithise liquor effervescens, ii., 232
Lithil bromidum, i., 98
Lithium, ii., 226
Lotio hydrargyri flava, ii. , 225

nigra, ii., 224
plumbi, ii., 259
Lowe test, ii., 80

MAGNESIA, ii., 232

levis, ii. , 232
Magnesia? boro-citras, ii., 242

carbonas, ii. , 233

carbonatis liquor, ii. , 242

citratis liquor, ii., 242

levis, ii., 233

sulphas, ii., 233, 242

sulphatis enema, ii., 243

sulphis, i., 234

Magnesium, ii., 232
Magnesii bromidum, i, 98
Magnesilyne, ii. , 243
Magnetic oxide of iron, ii. , 131
Mauganesii oxidum nigrum, ii., 243

sulphas, ii. , 243
Manganesium, ii., 243
Munghan's iron, ii., 179
Marcosita, ii., 75
Marine acid, i, 191
Mentel's solution of alum, i., 272
Mercurial inunction, ii., 224

hypodermic injection, ii., 226

ointment, ii. , 22-j

pill, ii., 223

plaster, ii., 223

suppository, ii. , 224

vapor bath, ii. , 226
Mercury, v. Hydrargyrum.

hypodermic use of, ii., 226
Milk of sulphur, i., 21, 34
Mineral baths and waters, i., 153

chameleon, ii., 268
Mindererus spirit, i., 251
Mistura cretae, ii., 113

ferri aromatica, ii., 179
composita, ii., 179
Monsel's solution, ii., 157, 180
Mustard pack, i. , 134

NATRIUM, v. SODIUM.
Nitrate of ammonia, i., 264

lead, ii., 250, 258

mercury, ii., 185

potash, ii., 266

silver, ii., 1

soda, ii., 289

zinc, ii. , 312
Nitre, ii., 266
Nitric acid, i. , 215
Nitric oxide, i. , 215
Nitric per xide, L, 215, 216
Nitro-hydrochloric acid, i., 199
Nitrogen, i., 15

OINTMENT, v. UNGUENTUM.
Oleate of bismuth, ii. , 90

mercury, ii., 224

zinc, ii.. 232

Oleum phosphoratum, i. , 57
Oxalate of cerium, iL, 114
Oxide of antimony, i., 276, 298

bismuth, ii. , 80

copper, ii. , 129

320

INDEX.

Oxide of iron, ii. . 131

lead, ii., 249

manganese, ii., 243

mercury, ii., 184

silver, ii. , 1

zinc, ii., 305
Oxygen, i., 1 .
Oxymel, i., 183
Oyster shell, i., 22
Ozone, i., 1, 7

PACK, DRY, i., 134

mustard, i., 134

wet, i, 130

Patterson's powder, ii , 89
Parrish's syrup, ii., 180
Perchloride of iron, ii., 132

of mercury, ii. , 183
Permanganate of potash, ii., 267
Perm'trate of iron, ii., 132
Peroxide of hydrogen, i , 16

iron, ii., 131

Persulphate of iron, ii., 132
Phosphate of ammonia, L, 252, 263

iron, ii., 134

lime, ii. . 96

soda, ii., 289
Phosphide of zinc, i. , 36
Phosphoric acid, i., 221
Phosphori pilula, i., 57

tincturse, j., 57
Phosphorus, i , 35
Pilula ferri carbonatis, ii., 179
iodidi, ii., 179

hydrargyri, ii., 223

subchloridi comp., ii., 224

phosphori, i., 57

plumbi c. opio, ii. , 262
Plumbi acetas, ii., 249

acetatis unguentum, ii, 262

carbonas, ii, 250

carbonatis unguentum, ii, 262

emplastrum, ii, 262

iodidum, ii., 250

iodidi emplastrum, ii, 262

nitras, ii., 250, 258

c. opio pilula, ii., 262

oxidum, ii., 249

subacetatis liquor, ii., 250
dilutus, ii., 262
unguentum compositum, ii., 262

suppositoria composita, ii. , 262
Plumbum, ii., 249
Potassa caustica, ii., 264

Potassa fralphurata, i., 22 ; ii, 266
Potassse acetas, ii., 265

bicarhonas, ii., 264

bichromas, ii.-, 267

carbonas, ii, 264

chloras. ii., 267

chloratis trochisci, ii. , 286

citras, ii, 265

liquor, ii., 263

effervescens, ii, 286

nitras, ii., 266

permanganas, ii., 267

permanganatis liquor, ii , 286

sulphas, i., 234; ii, 266

sulphuratae lotio, i, 34
balneum, i. , 34
unguentum, ii., 286

tartras. ii., 265

tartras acid a, ii, 265
Potassii bromidum, i., 97

iodidum, i, 59

iodidi c. sapone linimentum, ii, 286
Potassium, ii., 263
Poudre de Royer, ii , 89

Wendt, ii, 89
Precipitated chalk, ii., 112

sulphur, i. , 21
Prussia acid, dilute, i. , 202
Pulvis antimonialis, i. , 298

cretse aromaticus, ii., 113
c. opio, ii, 113

rhei comp., ii, 242
Pyrophosphate of iron, ii., 180

QUEVENNESlRON, ii, 131
Quicksilver, . Hydrargyrum.

REDUCED IRON, ii, 131
Robiquet, preparations of, ii., 180
Rochelle salt, ii., 290

SACCHARATED CARBONATE OF IRON, ii.,
133

and manganese, ii., 249
Saccharate of lime, ii., 112
Sal-ammoniac, i., 251

volatile, i., 264
Sanitas," i, 16
Saltpetre, ii., 266
Sapo duris, ii., 286
Sapo mollis, ii, 286
Sea-bathing, i, 150
Seidlitz powder, i., 248
Silver, i, 298

INDEX.

321

Soap, ii., 286

Soda caustica, ii. , 287

tartarata, ii., 290
Sodas acetas, ii, 289

arsenias, ii. , 26

biboras, ii., 290

bicarbonas, ii. , 288

bicarbonatis trochiaci, it, 303

carbonas, ii., 287

exsiccata, ii. , 288

chlorate cataplasma, ii., 303
liquor, ii., 290

citro tartras effervescens, ii., 291

hypophosphis, ii. , 290

hyposulphis, L, 234; ii., 289

liquor, ii., 287

effervescens, ii., 303

nitras, ii., 289

phosphas, ii.,.289

sulphas, ii., 288

sulphis, i., 234

thiosulphate, ii., 289

valerianas, ii., 303
Sodii chloridum, ii., 290

bromidum, i., 98

iodidum, i. , 59
Sodium, ii., 287
Solution, v. Liquor.
Spanish white, ii., 80
Spirits of ammonia, i. , 269

of mindererus, i. , 251

of salt, i., 191
Stanni pulvis, ii., 305

chloridum, ii., 305
Stannum, ii., 304
Subacetate of copper, ii., 117

of lead, ii., 249

Subcarbonate of bismuth, ii, , 81
Subchloride of mercury, ii, 180
Subnitrate of bismuth, ii., 80
Sugar of lead, ii. , 249
Sulphate of alumina, i., 265

cadmium, ii., 91

copper, ii., 116

iron, ii., 133

magnesia, ii. , 233

manganese, ii. , 244

mercury, ii., 186

potash, i., 234; ii., 266

soda, ii., 288

zinc, ii. , 306
Sulphide of ammonium, i., 252

calcium, i., 22

mercury, ii., 186

VOL. II. 21

I Sulphites, alkaline, L, 234
Sulphur, i., 21

precipitatum, i, 21

sublimatum, i. , 21
Sulphurated antimony, i, 276

potash, i., 22; ii., 266
Sulphuric acid, i., 227
Sulphuris balneum co., L, 34

conf ectio, i , 33

hypochloridum, i., 22

iodidum, i., 27

lotio c. calce, i. , 34

unguentum, i., 34
dilutum, i., 34
Sulphurous acid, i., 233
Suppositoria hydrargyri, ii., 224

plumbi comp., ii. , 262
Syrupus ferri iodidi, ii., 179
phosphatis, ii., 179

TANNATE OP BISMUTH, ii., 90
Tartar emetic, i., 277
Tartarated antimony, i., 277

iron, ii., 135

soda, ii., 290
Tartrate of potash, ii., 286

soda and potash, ii., 290
Tin, ii., 304
Tinctura cupri acetici, ii. , 129

ferri acetatis, ii., 133
perchloridi, ii., 180

iodi, i., 93

Tisy, preparations of, ii., 180
Trochisci bismuthi. ii. , 89

potassas chloratis, ii. , 286

sodas bicarbonatis, ii. , 303

UNGUENTUM ANTIMONII TARTARATI,

i., 298

bismuthi, ii., 90
cadmii iodidi, ii. , 93
citrinum, ii., 225
hydrargyri, ii., 223

ammoniati, ii., 225

comp., ii., 223

iodidi rubri, ii., 225

nitratis, ii., 225

oxidi rubri, ii., 225
flavi, ii. , 185

subchloridi, ii., 223
iodi, i., 93

plumbi acetatis, ii., 262
plumbi carbonatis, ii. . 262

iodidi, ii., 249

322

INDEX.

Unguentum plumbi sabacetatis comp., ii.,

262

potassse sulphuratae, ii., 286
potassii iodidi, i., 59
sulphuris, i. . 34

dilutuin, i., 34

iodidi, i , 27

zinci, ii., 314

VALERIAN ATE OP BISMUTH, ii., 90

zinc, ii., 307

Van den Corput's iron, ii., 181
Vapor, v. Inhalation.
Verdigris, iL, 117
Vienna paste, ii., 275
Vinegar, i., 181
Vinum antimoniale, i., 298

ferri, ii., 179

ferri citratis, ii., 180
Vitriol, blue, iL, 116

green, ii., 133

white, ii., 306

WATER, i. , 125

Waters, Aix-les-Bains, i., 170

Aix-la-Chapelle, i., 170

Alkaline, i., 155

Apollinaris, i., 157

Baden-Baden, i., 165

Bagneres de Luchon, i., 169

Bareges, L, 169

Bath, i., 175

Beulah Spa, i., 160

Bilin, i., 157

Bitter, i., 155, 159

Booklet, L, 177

Builth, L, 172

Buxton, i., 174

Carbonic Acid, L , 154

Carlsbad, i., 161

Cauterets, i., 169

Chalybeate, i., 156, 176

Cheltenham, i., 160

CLASSIFICATION OP, i., 154

Common Salt, i., 155, 163

Compound Soda, i., 155, 161

Driburg, i., 177

Droitwich, i., 167

Earthy Mineral, i., 156

Eaux Bonnes, i., 168
Chaudes, L, 168

Ems, i., 158

Epsom, i., 160

Franzensbad, i., 162

Waters. Friedrichshall, i., 159
Gastein, i., 175
Gieshubel, i., 157
Harrogate, i., 171, 178
Homburg. i., 163
Hunyadi Janos, i., 160
indifferent, i., 156
Inselbad, i., 174
KilbuTn, i., 160
Kissingen, i., 164
Kniebis, i., 177
Konigsworth, i., 177
Kreutb, i., 167
Kreuznach, i., 166
Leamington, L, 160
Leuk, i., 173
Lippspringe, L, 173
Lisdoonvarna, i., 172
Llandrindrod, i,, 172
Llanwityd, i. , 172
Luhatschowltz, i. , 159
Marienbad, i, 162
Mineral, i. , 153
Moffat, i., 172
Mont Dore, i., 158
Muriatic Soda, i., 155, 158
Neuenahr, L, 157
Pfaffers, i, 175
Plombieres, i., 175
Ponticosa. i., 168
Pullna, i., 160
Purton, i., 160
Pyrmont, i., 178
Ragatz, i., 175
Rehme, i., 166
Reichenhall, i., 165
St. Moritz, i., 177
St. Sauveur, i, 169
Saline, i., 155
Santa Catarina, i. , 177
Salzbrunn, i. , 158
Scarborough, i., 1GO
Schlangenbad, i, 176
Schwalbach, i., 178
Seidlitz, i., 160
Soden, i. , 165
Spa, i., 178
Strathpeffer, i., 172
Streatham, i., 160
Sulphur, i., 155, 168
Tarasp, i., 163
Teplitz, i.. 175
Tunbridge Wells, i., 178
Vals, i., 157

INDEX.

323

Waters, Vichy, i., 156
Weilbach, i.,171
Weissenburg, i., 173
Weisbaden, i., 164
Wildbad, i., 176
Wildungen, i., 172
Woodhall, i., 167

Wet sheet, i., 126
towels, L, 126

White arsenic, ii., 25
bismuth, ii. , 80
lead, ii., 250
precipitate, ii., 184
vitriol, Ii., 306

Wine of antimony, i. , 298

Wine of iron, ii., 179

ZlNCi ACETAS, ii., 306
carbonas, ii. , 306
chloridum, ii., 306
chloridi liquor, ii., 314

pasta, ii., 314
nitras, ii., 314
oleis, ii., 310
oxidum, ii., 305
phosphidum, i., 36
sulphas, ii. , 306
unguentum, ii., 314
valerianas, ii., 307

Zincum, ii., 305

INDEX.

DISEASES.

ABORTION.

Iron, ii., 147, 172
ABSCESS.

Ammonia, i, 257

Iodine, i., 78

Lime, ii., 108

Phosphorus, i. , 55

Potash, Caustic, ii., 274, 285, 311

Sulphides, Sulphur, i., 29

v. Boil, Carbuncle.
ACIDITY, v. DYSPEPSIA.
ACID POISONING.

Alkalies, ii., 278
ACNE.

Alkalies, ii., 277

Ammonia, i., 257

Arsenic, ii, 65

Calcium, ii., 99

Iodine, i., 82

Mercury, ii., 207

Nitro-hydrochloric acid, i., 201

Phosphorus, i., 55

Sulphur, i, 27, 28

Water, i.. 146
ADENITIS.

Ammonia, i., 257

Arsenic, ii., 49

Bromides, i., 117

Gold, ii., 73

Iodine, L, 70. 86

lodoform, i., 70

Iron, ii., 179

Lead, ii., 259, 261

Lime, ii., 108

Mineral Waters, i., 163, 168

Mercury, ii.. 207, 220

Sulphur, i., 28

AGUE.

Antimony, i., 289
Arsenic, ii., 46
Bromides, i., 118
Common Salt, ii., 301
Copper, ii., 128
Iodine, i., 85
Nitre, ii., 280
Sulphurous Acid, i., 246
Water, i., 143

ALBUMIN0RIA.

Alkalies, ii., 284

Alum, i., 272

Ammonia, i., 263

Arsenic, ii., 59

Calcium, ii, 112

Gold, ii., 75

Iodides, i, 90

Iron, ii., 175

Lead, ii., 256, 260

Oxygen, i, 13

Soda Salts, ii., 300

Water, i., 145, 149
ALCOHOLISM.

Ammonia, i, 258

Arsenic, ii., 67

Bromides, i, 115

Iron, ii, 177

Zinc, ii, 313

v. Delirium Tremens.
ALOPECIA.

Ammonia, i., 257

Arsenic, ii., 65

Iodine, i., 82

Nitric Acid, i, 218
AMAUROSIS.

Phosphorus, i., 50

INDEX.

325

AMENORRH03A.

Ammonia, i., 257

Arsenic, ii. , 61

Borax, ii., 302

Barium, ii., 79

Gold, ii., 75

Iron, ii., 169

Iodides, i., 93

Magnesia, ii., 241

Sulphur, i., 33

Sitz Bath, i., 129
ANAEMIA.

Arsenic, ii., 50

Calcium, ii., 109

Chalybeate Waters, i., 156, 176

Iron, ii., 167

Manganese, ii., 246

Oxygen, i., 13

Phosphorus, i., 55
- Sea-bathing, i., 153
ANEURISM.

Iodides, i., 91

Iron, ii., 155

Lead, ii., 261
ANGINA (SORE THROAT).

Alum, i., 269

Ammonia, i., 261

Carbonic Acid, i., 188

Chlorine, i., 123

Chlorate of Potash, ii., 281

Hydrochloric Acid, i., 196

Iodides, i., 90

Iron, ii., 165

Mercury, ii., 211, 217

Sea-water, i., 152

Silver, ii., 14

Sulphur, i., 31
Waters, i. , 168

Sulphuric Acid, i., 231

Sulphurous Acid, i., 239

Zinc, ii., 311
ANGINA PECTORIS.

Arsenic, it , 54

Bromides, i., 112

Iron, ii., 174

Phosphorus, i., 47

Silver, ii., 23
APHONIA.

Ammonia, i., 261

Nitric Acid, i., 221

Silver, ii., 14

Zinc, ii., 311

v. Hoarseness.

APHTHAE.

Alum, i., 269

Borax, ii., 297

Calcium, ii. , 107

Chlorate of Potash, ii., 276

Chlorine, i,, 123

Copper, ii., 123

Hydrochloric Acid, i., 196

Sulphurous Acid, i. , 239
APOPLEXY.

Arsenic, ii., 58

Bromides, i., 117

Ice, i., 147

Iodides, i., 85

Mercury, ii., 213

Phosphorus, i. , 47, 50

Silver, ii., 22
ARTHRITIS.

Alkaline Waters, i. , 156

Arsenic', ii., 51

Bromine i. , 97

Iodine, i., 85

Lead Lotion, ii., 259

Mercury, ii., 209

Potash, ii., 277

Sulphur, i., 28, 33

Water, i., 150

ASCARIDES.

Arsenic, ii., 51
Calcium, ii., 105
Carbon, i., 20
Iron, ii., 179
Mercury, ii., 223
' Salt, ii., 298
Sulphur, i., 33
Tin, ii., 304

ASCITES.

Iodine, i., 75,91

Iron, ii., 174

Potash, ii., 285

Mercury, ii. , 220

i). Albuminuria Cirrhosis

Mitral Disease.
ASPHYXIA.

Chlorate of Potash, ii., 281

Oxygen, i., 8

Peroxide of Hydrogen, i., 17

v. Asthma.
ASTHMA.

Alum, i., 275

Antimony, i., 297

Arsenic, ii., 54

Bromides, i., 112

326

INDEX.

ASTHMA continued.

Carbonic Acid, i. , 188

Copper, ii., 125

Hydrocyanic Acid, i. , 214

Iodine, i., 89

Nitre, ii., 281

Oxygen, i., 9

Silver, ii., 23

Sulphur, i., 31

Sulphuric Acid, i., 289

Zinc, ii., 313
ATAXIA.

Arsenic, ii., 58

Iodides, i., 85

Phosphorus, i., 51

Silver, ii., 22

Sulphur, i., 32

BACKACHE.

Water, i., 148
BALANITIS.

Bismuth, ii., 79

Calomel, ii., 206

lodoform, i., 80

Lead, ii., 259

Silver, ii., 11

Zinc, ii. , 311
BEDSORE.

lodoform, i., 79

Lead, iL, 259

Silver, ii., 15

Zinc, ii., 310
BITES, POISONED.

Ammonia, i.. 257

Arsenic, ii., 56

Potash, ii., 285
BLEPHARITIS.

Copper, ii, 123

Iodine, i, 81

Lead, ii., 259

Mercury, ii., 211

Sulphur, i, 27

v. Conjunctivitis.
BOIL.

Arsenic, ii., 14

Calcium, ii., 104

Phosphorus, i., 55

Silver, ii. , 14

Sulphites, i, 242

Sulphur, L, 29
BRIGHT' s DISEASE.

v. Albuminuria.
BROMISM.

Arsenic, i. , 106

BROMISM continued.

Coffee, ii., 65
BRONCHIECTASIS.

Chlorine, L, 124

Iodine, i., 81

Zinc, ii., 312
BRONCHITIS.

Air, Compressed, i., 11

Alkalies, ii., 281

Alum, i.,275

Ammonia, i., 260, 261

Antimony, i., 291

Arsenic, ii., 67

Calcium, ii., 110

Carbonic Acid, i. , 188

Copper, ii., 125

Iodine, i. , 89

Iron, ii. , 174

Lead, ii., 261

Nitric Acid, i. , 221

Nitro-hydrochloric Acid, i., 200

Oxygen, i., 11

Phosphorus, i., 53

Silver, ii., 15

Sulphur, i., 31

Sulphurous Acid, i., 239

Water, i.. 139

Zinc, ii., 312
BRONCHOCELE.

Barium, ii., 78

Bromides, i., 114, 118

Gold, ii.,74

Iodine, i., 71, 92

Iron, ii., 169

Lime Waters, ii., 101

Mercury, ii. , 208

Phosphorus, i., 56
BRUISES.

Sulphurous Acid, i., 237

Water, i., 137
BUBO.

Copper, ii., 124

lodoform, i., 80

Iron, ii., 96, 179

Mercury, ii., 207, 210

Nitric Acid, i., 217

Potash, Caustic, ii., 274

Sulphur, i., 29

Water, i., 139
BURNS.

Bicarbonate of Soda, it , 297

Calcium, ii., 104

Iodine, i., 81

Lead, ii., 259

INDEX.

327

BURNS continued.
Silver, ii., 16
Sulphur, i., 27
Water, i., 138, 147

CALCULUS.

Calcium, ii. , 111

Hydrochloric Acid, i., 198

Lithia, ii., 231

Magnesia, ii., 237, 242

Mineral Waters, i. , 155

Potassium, Salts of, ii., 278

Nitre-hydrochloric Acid, i., 200

Phosphoric Acid, i. , 225

Soda Salts, ii., 300

Water, i., 138, 150
CANCER.

Acetic Acid, i., 182

Antimony, i., 287

Arsenic, ii., 45

Calcium, ii., Ill

Citric Acid, i., 190

Copper ii., 123

Gold, ii.,74

lodoform, i. , 72, 80

Iron, ii., 74

Nitric Acid, i., 217

Potash, ii., 274

SUver, ii., 9

Zinc, ii., 309

v. Epithelioma.
CANCER OF STOMACH.

Arsenic, ii., 66

Bismuth, ii. , 86

Charcoal, i. , 20

Hydrocyanic Acid, i., 212

Silver, ii, 20
CANCRUM ORIS.

Calcium, ii. . 103

Mercury, ii., 210

Nitric Acid, i., 217

Silver, ii. , 12

v. Aphthae.
CARBUNCLE.

Calcium, ii. , 104

Silver, ii. , 15

Sulphur, i., 29

#. Abscess.
CARIES.

Calcium, ii. , 107

Common-salt Waters, i., 155

Copper, ii., 124

Phosphoric Acid, i. , 226

Phosphorus, i. , 55

CARIES continued.

Potash, Caustic, ii., 274

Sea-bathing, L, 154

Soda Salts, ii. . 297

Sulphuric Acid, i., 230

Zinc, ii., 310
CATARRH.

Ammonia i., 261

Bismuth, ii. , 85

Borax, ii., 297

Bromine, i., 96

Chlorate of Potash, ii., 281

Iodine, i., 81

SaltWater, ii., 296

Soda Waters, i. , 155 .

Sulphurous Acid, i. , 239

Water, i., 139

v. Coryza.
CELLULITIS.

Water, i., 138

v. Erysipelas.
CHANCRE.

Bromine, i. . 96

Chlorine, L, 123

lodoform, i., 80

Iron, ii., 158

Lead, ii. , 260

Silver, ii., 10

Water, i., 138

Zinc, ii., 311

v. Syphilis.
CHILBLAINS.

Iodine, i, 79, 81

Sulphurous Acid, i, 238

v. Erythema.
CHLOASMA.

Borax, ii., 297

Mercury, ii. , 205

Sulphurous Acid, L , 237
CHLOROSIS.

Arsenic, ii., 50

Iron, ii., 170

Manganese, ii., 246

Oxygen, L, 13

v. Anaemia.
CHOLERA.

Arsenic, ii. , 68

Bismuth, ii., 88

Bromides, i. . 113

Copper, ii., 126

Iron, ii, 177

Lead, ii., 262

Mercury, ii. , 222

Soda Salts, ii., 301

328

INDEX.

CHOLEKA continued.

Sulphur,!., 33

Sulphuric Acid, i., 232

Sulphurous Acid, ii., 245

Water, i., 146

v. Diarrhoea.
CHOREA.

Antimony, i, 29

Arsenic, ii., 55

Bromides, i., 110

Calcium, ii. , 109

Copper, ii., 124

Iodine, i. , 86

Iron, ii.,177

Potash Salts, ii., 285

Silver, il, 23

Tin, ii., 305

Water, L, 148

Zinc, ii., 313
CHYLURIA.

Iron, ii., 176
CIRRHOSIS OP LIVER.

Acid Tartrate of Potash, ii, 284

Nitro -hydrochloric Acid, i., 200

0. Ascites Hepatic Disease.
CLIMACTERIC.

Ammonia, i., 262

Bromides, i., Ill

Iron, ii., 177

Zinc, ii., 313
COLIC.

Ammonia, i. , 262

Antimony, i. , 294

Bromides, i., 112

Water, i., 146

v. Plumbism.
COLITIS.

v. Dysentery.
COLLAPSE.

Ammonia, i. , 258, 259

'. Exhaustion.

CONDYLOMA.

Mercury, ii., 210

Nitric Acid, i., 218

v. Syphilis
CONGESTION, CEREBRAL.

Arsenic, ii., 58

Bromides, i , 117

Water, i., 147

v. Apoplexy
CONGESTION, HEPATIC.

Ammonium Chloride, i., 262

Chlorine, i., 124

Oxygen, i. , 12

CONGESTION, HEPATIC continued.

Sulphur, i., 33

Water, i., 145

v. Hepatic Disease.
CONGESTION, LARYNGEAL.

Silver, ii., 14

Zinc, ii., 311

. Croup.
CONGESTION, PULMONARY.

Antimony, i., 291

Hydrogen, i., 17

Iodine, i., 73

Phosphorus, v i., 52

v. Phthisis.
CONGESTION, SPINAL.

Arsenic, ii., 58

Bromides, i. , 117

Water, i., 138
CONJUNCTIVITIS.

Alum, i.,270

Antimony, i., 290

Arsenic, ii., 49

Iodine, i. , 80

Iron, ii., 159

Lead, ii.,259

Mercury, ii., 211, 212

Nitric Acid, i., 220

Phosphoric Acid, i. , 226

Silver, ii., 13

Sulphur, i. 27, 29

Zinc, ii., 311

v. Blepharitis.
CONSTIPATION.

Alum, i., 273

Antimony, i. , 295

Magnesia, ii., 239

Mercury, ii., 220

Nitric Acid, i., 220

Potash Salts, ii. , 283

Saline Bitter Waters, i. , 155

Soda Salts, ii. , 302

Sulphur, i., 32

Water, L, 149
CONSUMPTION.

v. Phthisis.
CONVULSIONS.

Antimony, i. , 296

Bromides, i., 109

Water, i., 148

v. Epilepsy.
CORNS.

Nitric Acid, i., 218

Silver, ii., 9

Sulphurous Acid, i., 238

INDEX.

329

CORYZA.

Arsenic, ii., 67

Mercury, iL, 216

Silver, ii., 13

v. Catarrh.
COUGH.

Cerium, ii., 115

Zinc, ii., 313

v. Pertussis.
CROUP.

Alum, i., 274

Ammonia, i., 260

Antimony, i., 293

Bromides, i., 97

Calcium, ii. , 103

Copper, iL, 127

Iodine, i., 72, 90

Lithia, ii., 232

Mercury, ii. , 216

Potash, Salts of, ii., 280

Sulphur, i, 32

Water, L, 139
CYANOSIS.

Chlorate of Potash, ii., 285

Hydrogen, L, 17

Oxygen, i., 9
CYSTITIS.

Alum, i., 271

Ammonia, i., 263

Bromides, i., 114

Carbonate of Soda, ii., 298

Carbonic Acid, L, 186

Iron, ii. , 159

Nitric Acid, i. , 219

Phosphoric Acid, i., 225

Silver, ii. , 11

Water, i., 139
CYSTS.

Bromides, i., 119

Iodine, i., 73, 76, 87

Silver, ii., 17

DEBILITY.

Iron, ii, 167, 177

Nitric Acid, i., 219

Phosphoric Acid, i., 224

Sea-bathing, i., 152

Silver, ii., 23

Zinc, ii., 312

v. Exhaustion.
DELIRIUM DELIRIUM TREMENS.

Antimony, i., 296

Bromides, i, 115

Hydrocyanic Acid, i., 214

DELIRIUM DELIRIUM TREMENS COM.

Water, i., 147

v. Alcoholism.
DEMENTIA.

Phosphorus, L, 91
DENTITION.

Bromides, i. , 109
DIABETES.

Alkalies, ii., 284

Alum, i., 272

Ammonia, i., 263

Arsenic, ii. , 52

Calcium, ii. , 111

Carlsbad Waters, L, 161

Iron, ii., 176

Bromide of, ii., 176

Magnesia, ii., 242

Oxygen, i., 13

Peroxide of Hydrogen, i., 17

Phosphoric Acid, L, 225

Soda Salts, ii.,300

DIARRH03A.

Acetic Acid, i., 183
Alum, L, 272
Arsenic, ii., 67
Bicarbonate of Soda, ii., 299
Bismuth, ii., 87
Bromides, i., 113
Calcium, iL, 106
Carbon, i., 20
Chlorate of Potash, iL, 283
Copper, ii., 126
Hydrochloric Acid, i., 225, 226
Iodine, L, 93
Iron, iL, 176, 179
Lead, ii., 262
Magnesia, ii., 239, 240
Mercury, ii. , 221
Nitric Acid, i., 219
Phosphoric Acid, i. , 226
Phosphorus, L, 54
Silver, ii., 20
Sulphur, L, 33
Sulphuric Acid, i., 293
Sulphurous Acid, i., 245
Water, L, 146
Zinc, ii. , 312
DIPHTHERIA.
Alum, L, 269
Bromides, L, 117
Bromine, i., 97
Calcium, ii., 103
Compress, i. , 145
Copper, ii. , 128

330

INDEX.

DIPHTHERIA continued.

Hydrochloric Acid, i, 196

Ice, i, 145

Iodine, L, 72, 90

Iron, ii., 161

Lithia, ii. , 232

Mercury, ii., 216

Potassium, Salts of, ii., 276, 280

Silver, ii., 14

Sulphur, i. , 30

Sulphurous Acid, i. , 244
DIPSOMANIA.

Iron, ii., 177

v. Alcoholism.
DKOPSY.

Iron, ii., 174

Potash Salts, ii., 284

v. Ascites.
DYSENTERY.

Alum, i., 272

Bismuth, ii., 88

Carbon, L, 22

Copper, ii., 126

Iodine, i., 93

Iron, ii., 177

Lead, ii., 262

Magnesium, ii., 240

Mercury, ii., 222

Potash Salts, ii., 283

Silver, ii., 20

Soda Salts, ii., 302

Sulphur, i., 33

Sulphurous Acid, i., 245

Water, i. , 146
DYSMENORRHCE A .

Ammonia, i. , 262

Magnesia, ii., 241

v. Amenorrhcea.
DYSPEPSIA.

Alkalies, ii. , 278

Ammonia, i., 262

Arsenic, ii., 67

Bismuth, ii., 86

Calcium, ii., 105

Carbon, i. , 19

Carbonic Acid, i., 189

Cerium, ii., 115

Citric Acid, i. , 191

Gold, ii., 75

Hydrochloric Acid, i 196

Hydrocyanic Acid, i. 212

Iron, ii., 176

Magnesia, ii, 239

Mercury, ii. 221

DYSPEPSIA continued

Nitric Acid, i. , 219

Nitro-hydrochloric Acid, i., 201

Peroxide of Hydrogen, i., 17

Sea-bathing, i., 152

Silver, ii., 18

Soda Salts, ii., 298

Turkish Bath, i., 145

Zinc, ii., 312

0. Constipation.
DYSPHAGIA.

Bromides, i. Ill
DYSPHONIA.

v. Hoarseness.
DYSPNOSA, CARDIAC.

t>. Angina Pectoris.
DYSPN<EA, PULMONARY.

v. Congestion Asthma
Emphysema.

ECTHYMA.

Calcium, ii., 104

Iron, ii., 159
ECTROPION ENTROPION.

Sulphuric Acid, i , 231

v. Blepharitis
ECZEMA.

Alum, i. , 269

Antimony, i., 290

Arsenic, ii., 63

Bismuth, ii., 84

Bromides, i 97

Calcium, ii., 104

Hydrochloric Acid, i., 199

Iron, ii., 159

Lead, ii., 259

Mercury, i., 109; ii., 206

Potassium, Salts of, ii., 276

Silver, ii., 15

Soda Salts, ii , 297

Sulphur, i., 26

Water, i., 146

Zinc, ii, 310

EFFUSION, PERICARDIAL, i, 76
EFFUSION, PLEURAL, i, 74

. Pleurisy.
ELEPHANTIASIS.

Arsenic, ii., 67
EMBOLISM.

Ammonia, i. 259

Soda Salts, ii. , 303
EMPHYSEMA.

Antimony, i. , 297

Arsenic, ii., 67

INDEX.

331

BMPH YSEMA continued,

Copper, ii., 125

Iron, ii., 174

Oxygen, i., 9
EMPYEMA.

Chlorine, i., 122

Iodine, i. , 75

Iron, ii., 108, 179

Oxygen, i., 11
ENDOCARDITIS.

Mercury, ii., 214
ENTERITIS.

Magnesia, ii., 240

Mercury, ii., 215

. Colic Dysentery.
ENTERODYNIA.

Hydrocyanic Acid, i., 212

v. Colic.
ENURESIS.

Bromides, i., 112

Iron, ii., 158
EPHELIDES.

Lime, ii. , 104

Mercury, ii., 206
EPILEPSY.

Antimony, i., 296

Arsenic, ii., 58

Barium, ii. , 79

Bromides, i., 105

Cerium, ii., 115

Copper, ii., 125

Gold, ii., 79

Iodine, i., 86

Iron, ii., 178

Lithia, ii., 231

Phosphorus, i., 51

Silver, ii , 21

Tin, ii., 305

Water, i., 148

Zinc, ii., 312
EPISTAXIS.

Alum, i, 271

Common Salt, ii., 303

Hot Water, i., 136

Iron, ii., 150

Phosphorus, i, 48

. Haemorrhage.
EPITHELIOMA.

Arsenic, ii., 66

Bromide, i. 105

Calcium, ii., 102

Mercury, ii., 210

Potash, Caustic, ii., 275
Chlorate, ii., 275

EPITHELTOMA continued.

v. Cancer.
ERYSIPELAS.

Arsenic, ii., 66

Bromine, i., 96

Calcium, ii., 104

Iodine, i., 81

Iron, ii., 160

Lead, ii., 259

Mercury, ii., 207, 217

Silver, ii., 15

Sulphurous Acid, i., 238, 244
ERYTHEMA.

Bismuth, ii., 84

Calcium, ii. , 104

Iron, ii., 159

Mercury, ii., 206

Silver, ii., 15

Zinc, ii., 310
EXHAUSTION.

Ammonia, i., 259

Phosphorus, i. , 47, 48, 49

v. Debility.

EXOPHTHALMOS.

v. Bronchocele.
EYE DISEASES.

Hydrocyanic Acid, i., 212
v. Conjunctivitis, etc.

FATTY DEGENERATION.

Phosphorus, i. , 48
FAVUS.

Mercury, ii., 205

Sulphur, i., 25

Sulphurous Acid, i., 237
FEVER.

Alkalies, ii., 280

Ammonia, i. , 260

Antimony, i., 288, 290

Hydrochloric Acid, i., 197

Nitric Acid, i, 220

Phosphoric Acid. i. , 224

Sulphuric Acid, i., 232

Water, i. , 140
FEVER. PUERPERAL.

Mercury, ii., 217

Sulphurous Acid, i. , 243

Water, i., 142
FEVER, RHEUMATIC.

Alkalies, ii., 279

Antimony, i., 289

Blanket Bath, i., 142

Iodides, i., 84

Iron, ii., 11

332

INDEX.

FEVER, RHEUMATIC continued.

Water, I, 143
FEVER, TYPHOID.

Alkalies, ii., 280

Ammonia, i. , 260

Antimony, i., 288

Carbon, L, 20

Copper, ii., 126

Mercury, ii., 217

Silver, ii., 21

Sulphurous Acid, i., 244

Water, i., 143, 149
FEVER, TYPHUS.

Ammonia, i., 260
FIBROMA OF UTERUS.

Ammonia, i., 262

Bromides, i., 118

Calcium, ii., Ill

Iodine, i., 92

Iron, iL, 152

Kreuznach Waters, i., 119

Mercury, ii., 208
FISSURE OP ANUS.

Bromides, i. , 104, 112

lodoform, i., 79

Mercury, ii., 210

Sulphur, i., 33
FISTULA.

Copper, ii., 124

Iodine, i., 79

Zinc, iL, 310
FLATULENCE.

v. Dyspepsia.
FRACTURE.

Calcium, ii., 107

Phosphorus, i., 55

Silicate of Soda, ii., 298

Sulphurous Acid, i., 238
FRAGILITAS, OSSIUM.

Calcium, ii., 107

GANGRENE.

Alumina, i, 269

Arsenic, ii., 66

Bromine, i., 96

Charcoal, i., 19

Chlorine, i., 124

Iron, ii., 160

Oxygen, i., 8

Potash, ii., 275

Sulphuric Acid, i. , 238
GASTRALGIA GASTRODYNIA.

Arsenic, ii., 53

GASTRALGIA GASTRODYNIA continued.

Cerium, ii., 115

Manganese, ii., 248

Prussia Acid, i., 212

Zinc, ii., 311

v. Dyspepsia.
GASTRIC CATARRH.

Alum, i. , 272

Arsenic, ii., 68

Bismuth, ii. , 86

Silver, ii., 18

v. Dyspepsia.
GASTRO-ENTERITIS.

v. Colic Dysentery.
GINGIVITIS.

Alum, i. , 269

Chlorate of Potash, ii., 282

Iodine, i., 80
GLANDULAR ENLARGEMENT.

v. Adenitis Struma.
GOITRE.

v. Bronchocele.

GONORRHCEA.

Alum, i. , 270

Antimony, i., 290

Bismuth, ii., 86

Bromide, i., 113

Cadmium, ii., 93

Copper, ii., 124

Iodine, i., 80

Iron, ii., 158

Lead, ii., 260

Potash Salts, ii., 276

Silver, ii., 11

Zinc, ii., 311
GOUT.

Carbolic Acid, i. , 187

Hydrochloric Acid, i., 199

Iodine, i., 85

Lithia, ii., 230

Magnesia, ii. , 242

Mineral Waters, i., 155

Soda, ii., 298

Water, i., 133, 150
GOUT, RHEUMATIC.

Arsenic, ii., 46

Iodides, i., 85

Iron, ii., 167

Sulphur, i., 32
GRAVEL.

Potash, ii., 278

Water, i., 150

0. Gout.

INDEX.

333

GUMMA.

Iodine, i., 80
r. Syphilis.

ILEMATEMESIS H^M AT URI A .

Alum, i., 272

Iron, ii., 150, 151
HEMOPTYSIS.

Alum, i , 272

Common Salt, ii. , 303

Iron, ii., 150

Phosphoric Acid, i,, 226
HAEMORRHAGE.

Acetic Acid, i., 183

Alum, i., 271, 272

Ammonia, i., 263

Iron, ii., 148, 151, 153

Lead, ii., 258, 260

Magnesia, ii., 241

Manganese, ii. , 246

Phosphoric Acid, i.. 226

Potash Salts, ii., 284

Silver, ii., 11

Sulphuric Acid, i., 232

Water, i., 136
HAIR, FALLING OFF OF.

D. Alopecia.
HAIR, SUPERFLUOUS.

Barium, ii., 78

Lime, ii. , 102
HAT ASTHMA.

Arsenic, ii., 67

Iodine, L, 90

Lime, ii., 102

Sulphuric Acid, i. , 239 .
HEADACHE.

Bromides, i., 110

Hydrochloric Acid, i. , 197

Mercury, ii., 208

Phosphorus, i., 50

Prussic Acid, i., 211

Silver, ii., 23

Zinc, ii., 313

77. Anaemia Dyspepsia.
HEART DISEASE.

Arsenic, ii., 59

Iron, ii., 174

r. Angina Pectoris.
HEMIAN^ESTHESIA.

Gold, ii., 75
HEMORRHOIDS.

v. Piles.
HEPATIC DISEASE.

Ammonia, i., 262

HEPATIC DISEASE continued.

Manganese, ii. , 247

Mercury, ii., 220

Nitric Acid, i., 219

Nitro-hydrochloric Acid, i., 200

Soda, ii., 299

v. Cirrhosis Congestion.
HERNIA.

Ice Water, L, 138
HERPES.

Arsenic, ii., 66

Iron, ii., 159

Mercury, ii., 206

Phosphorus, L, 47

Zinc, ii., 310
HOARSENESa

Alum, i., 269

Ammonia, i., 261

Borax, ii., 296

Potash, ii., 282

HORDEOLUM.

Mercury, ii., 211
HYDROCELE.

Copper, ii., 124

Silver, ii., 17

v. Cysts.
HYDROCEPHALUS.

Bromides, i., 117

Iodides, i. , 87

Mercury, ii., 213

v. Convulsion.
HYDROPHOBIA.

Oxygen, i., 14

Water, L, 148
HYDROTHORAX.

Iodine, i., 75

Iron, ii., 174

. Ascites.
HYPERIDHOSIS.

Acetic Acid, i., 183

Tartaric Acid, i. , 249

Zinc, ii., 312
HYPERPYREXIA.

Water, i, 141
HYPOCHONDRIASIS.

Antimony, i., 296

Iron, ii., 177

Phosphorus, i., 47

Sea-bathing, i., 152

Water, i , 147

T. Debility.
HYSTERIA.

Ammonia, i., 262

Bromides, i., Ill

334

INDEX.

HYSTERIA continued.
Copper, ii., 125
Gold, ii., 75
Iron, ii.. 177
Phosphorus, i., 51
Zinc, ii., 313

ICHTHYOSIS.

Arsenic, ii., 66

Copper, ii., 123

Water, i., 146
IMPETIGO.

Iron, ii., 129

Lime, ii., 104

Nitric Acid, i., 221

Sulphurous Acid, i. , 243

. Eczema.
IMPOTENCE.

Phosphorus, i., 49

Water, i., 147

v. Debility.
INFLAMMATION.

Ammonia, i., 257

Antimony, i., 290

Iodine, i., 91

Lead, ii., 239

Mercury, ii., 212

Water, i., 146
INGROWING NAIL.

Iron, ii. , 159

Potash, ii., 276
INSOMNIA.

Antimony, i, 288

Bromides, i., 114

Water, i., 147
INTERMITTENT PULSE.

Arsenic, ii.. 59
INTESTINAL ULCERATION.

Copper, ii., 123, 126

Phosphorus, i., 54

. Dysentery Typhoid Fever.
IRRITATION, SPINAL.

Phosphorus, i., 50

JAUNDICE.

Magnesia, ii. . 240
Mineral Waters, i., 155
Silver, ii., 20
Water, i. , 145
v. Hepatic Disease.

LARYNGEAL PHTHISIS.

Silver, ii., 14
LARYNGISMUS.

Antimony, i., 294

LARYNGISMUS continued.

Bromides, i., Ill

Water, i., 139

v. Convulsion.
LEUCOCYTH^MIA.

Arsenic, ii., 50

Phosphorus, i., 55
LEUCOMA.

Soda Sulphate, ii., 296
LEUCORKHCEA.

Alum, i., 270

Bismuth, ii., 86

Bromides, i., 113

Cadmium, ii., 93

Copper, ii., 124

Iodine, i., 73

Iron, ii., 157

Lime, ii., 105

Lead, ii., 260

Mineral Waters, i., 155

Potash Salts, ii., 276

Silver, ii., 12

Soda Salts, ii.,298

Zinc, ii., 311
LICHEN.

Arsenic, ii., 65

Iron, ii., 159

Lead, ii., 259

Mercury, ii. , 207

Prussia Acid, i. , 211

Potash Salts, ii.,277

Water, i., 146

v. Eczema.

LlTHIASIS.

Alkalies, ii., 278

Magnesia, ii. , 241

v. Gravel.
LIVER.

v. Hepatic Disease.
LOCOMOTOR ATAXY.

Phosphorus, i., 51

v. Ataxia.
LUMBAGO.

Antimony, i., 290

Iodides, i., 84

Sulphur, i. , 20

v. Rheumatism.

LUMBRICUS.

t>. Worms.
LUPUS.

Acetate of Soda, ii. , 297
Acetic Acid, i., 182
Antimony, i., 287
Arsenic, ii., 45

INDEX.

335

LUPUS continued.
Gold, ii., 73
Iodine, i., 81, 86
Mercury, ii., 210
Nitric Acid, i. 217
Phosphorus, i. 54
Potash, ii., 275
Zinc, ii., 309

LYMPHADE NOM A.
Arsenic, ii. , 50
Phosphorus, i., 55

LYMPHANGITIS.

Mercury, ii., 207
. Adenitis.

MAMMARY GROWTHS.
Iodine, i., 72

MANIA.

Antimony, i., 239
Bromides, i. , 116
Prussia Acid, i., 214
Water, i., 147

MEASLES.

Ammonia, i., 260
Antimony, i., 289
Mercury, ii., 217
Water, i., 145

MELANCHOLIA.

Antimony, i., 239
Phosphorus, i., 52
Water, i., 147
v. Hypochondriasis.

MENINGITIS.

Antimony, i., 286
Bromides, i., 117
Iodine, i., 87
Mercury, ii., 213
Water, i., 147

MENOKRHAGIA.
Alum, i., 272
Arsenic, ii., 61
Bismuth, ii., 87
Bromide, i., 113
Iodine, i., 73
Iron, ii., 151
Lime, ii., Ill
Magnesia, ii., 241
Nitric Acid, i., 217
Phosphoric Acid, i., 226
Phosphorus, i., 50
Silver, ii., 19
Sulphuric Acid, i., 232

MERCUKIALISM.
Alum, i., 269

MERCURIALISM continued.

Chlorate of Potash, ii. , 283

Hydrochloric Acid, L, 196

Iodine, i., 83

Sulphur, i., 32
MIGRAINE.

Ammonia, i., 261

v. Headache.
MITRAL DISEASE.

Arsenic, ii., 59

Iron, ii., 174

v. Heart Disease.

MOLLUSCUM CONTAGIOSUM.

Copper, ii., 123
Silver, ii., 10

N^EVUS.

Acetic Acid, i. , 182

Antimony, i., 287

Iron, ii. , 156
. Nitric Acid, i., 218

Potash, ii., 275

Zinc, ii. , 310
NECROSIS.

Iron, ii., 160

Potash, ii.,274

v. Caries.
NEPHRITIS.

Antimony, i., 294

Water, i., 145, 149

v. Albuminuria.
NEURALGIA.

Ammonia, i., 257, 261

Arsenic, ii., 52

Bromides, i., 110

Iodine, i., 86

Iron, ii., 177

Phosphorus, i., 46

Prussic Acid, i., 211

Silver, ii., 17

Zinc, ii., 313

OBESITY.

Acetic Acid, i. , 183

Potash Salts, ii., 284
(EDEMA GLOTTIDIS.

Silver, ii., 14

v. Angina.
ONYCHTA.

Iodine, i., 80

Iron, ii., 164

Lead, ii., 260

Lime, ii., 102

Mercury, ii., 209

Sulphurous Acid, i., 239

336

INDEX.

ORCHITIS.

Ammonia, i., 257

Antimony, i., 287

Iodine, i., 71

Lead, ii., 259

Mercury, ii., 207

Silver, ii., 16

Water, i., 138
OSMIDROSIS.

Charcoal, i., 20

Lime, ii., 104
OSTEOMALACIA.

Lime, ii., 107
OTORRHCEA.

Alum, i., 270

lodof orm, i. , 81

Iron, i., 80

Lead, ii., 259

Lime, ii. , 105

Nitric Acid, i., 220

Phosphorus, i. , 54

Silver, ii., 13

Zinc, ii., 311
OXALURIA.

Hydrochloric Acid, i. , 198

Nitro-hydrocbloric Acid, i. , 200

Phosphoric Acid, i., 225

. Dyspepsia.
OVARITIS.

Antimony, i., 287

Bromides, i., Ill

Iodine, i., 73

Mercury, ii., 208

Alum, i., 270
Bromine, i., 96
Iodine, i., 81
Mercury, ii., 211
Potash Salts, ii., 276
Silver, ii., 13
Zinc, ii., 311

PALPITATION.

Bromides, i., 112

Hydrocyanic Acid, i. , 214

Sulphuric Acid, i. , 233

V. Heart Disease.
PARALYSIS.

Carbonic Acid, i., 187

Iodine, i. , 85

Phosphorus, i., 50

Silver, ii., 22

Sulphur, i., 32

Water, i., 148

PARALYSIS continued.

v. Ataxia.
PEMPHIGUS.

Arsenic, ii., 64

Phosphorus, i., 55
PERICARDITIS.

Iodine, i., 76

Mercury, ii., 214

v. Rheumatism.
PERITONITIS.

Iodine, i., 73

Mercury, ii., 215

Water, i., 146
PERTUSSIS.

Alkalies, ii., 281

Alum, i., 274

Ammonia, i., 260

Bromides, i., Ill

Copper, ii., 125

Hydrocyanic Acid, i., 213

Nitric Acid, i. , 220

Oxygen, i., 11

Peroxide of Hydrogen, i., 17

Potash, ii., 281

Zinc, ii., 313
PHAGED^ENA.

Iron, ii., 158

Nitric Acid, i., 217

Sulphurous Acid, i , 239

Water, i.,138

v. Ulceration.
PHOSPH AT URI A.

Iron, ii., 177

Nitric Acid, i., 219

Phosphoric Acid, i., 225
PHOSPHORUS POISONING.

Copper, i., 44; ii.,128
PHTHEIRIASIS.

Arsenic, ii., 45

Mercury, ii. , 204
PHTHISIS.

Antimony, i., 287

Arsenic, ii. , 48

Bromides, i., 114

Carbonic Acid, i., 188

Chlorine, i., 124

Hydrocyanic Acid, i., 213

Iodine, i., 72, 88

Iron, ii., 173

Lead, ii., 261

Lime Salts, ii., 109

Nitrogen, i., 15

Oxygen, i. , 11

Peroxide of Hydrogen, i., 18

INDEX.

PHTHISIS continued.

Phosphoric Acid, i., 225

Phosphorus, i., 53

Potash Chlorate, ii. , 282

Soda Salts, ii., 301

Sulphur, i., 31

Sulphuric Acid, i., 233

Sulphurous Acid, i., 239

Water, i., 139

Waters, Mineral, i., 156

Zinc, ii., 312
PILES.

Arsenic, ii., 61

Bismuth, ii. , 85

Bromide, i., 105

Iodine, i. , 79

Iron, ii., 157

Lead, ii., 261

Mercury, ii, 220

Nitric Acid, L, 217

Sulphur, i., 32

Water, i., 113
PITYRIASIS CAPITIS.

Iodine, i., 82

Mercury, ii., 206

Potash, ii., 2T6

Soda, ii., 297
PITYRIASIS RUBRA.

lion, ii., 159

Water, i., 146
PITYRIASIS VERSICOLOR.

v. Chloasma.
PLEURISY.

Ammonia, i., 260

Iodine, i., 72, 75

Iron, ii., 174

Mercury, ii., 208, 214

Oxygen, L, 11

Phosphorus, i., 53
PLUMBISM.

Alum, i., 273

Iodine, i., 83

Magnesia, ii., 239

Sulphur, i., 32

Sulphuric Acid, L, 233
PNEUMONIA.

Ammonia, i., 260

Antimony, i, 291

Hydrochloric Acid, i. , 199

Iodine, L, 88

Lead, ii., 261

Mercury, ii., 215

Phosphorus, i., 52

Sulphides, i, 29

VOL. II. 22

POLYPUS NAST.

Alum, i., 270

Iron, ii., 160
PREGNANCY.

Iron, ii., 173
PROLAPSUS.

Alum, i., 270

Nitric Acid, L, 218

v. Leucorrhcea.
PROSTATITIS.

Ammonia, L, 2G3

Antimony, i., 290

Iodine, i., 72

v. Adenitis.
PRURIQO PRURITUS.

Ammonia, i. , 257

Hydrocyanic Acid, i. , 21 1

Iodine, i.,82

Iron, ii., 159

Lime Salts, ii. , 104

Mercury, ii., 207

Nitric Acid, L, 218

Soda Salts, ii., 297

Sulphur, i., 26

Sulphuric Acid, i. , 231

Sulphurous Acid, L , 237

Water, i, 146
PSORIASIS.

Acetic Acid, i., 182

Arsenic, ii., 62

Iodine, L , 82

Mercury, ii., 207

Nitric Acid, i., 220

Phosphorus, i., 54

Potash Salts, ii, 277

Sulphur, i , 26

Water, i, 146

PURPURA.

Iron, ii., 151
Potash Salts, ii., 284

PYAEMIA.

Ammonia, i., 258
Potash Salts, ii., 285
Sulphurous Acid, i, 243

PYROSIS.

Bismuth, ii., 87
Manganese, ii, 248
Sulphurous Acid, i , 246
v. Dyspepsia.

RACHITIS.

Iodine, i, 86
Iron, ii., 178
Lime, ii, 108

338

INDEX.

RACHITIS continued.

Nitro-hydrochloric Acid, i. , 200

Phosphoric Acid, i., 225, 226

Phosphorus, i., 55
RELAXED THROAT.

Silver, ii., 14

Sulphurous Acid, i, 239

v. Angina.
RHECMATISM.

Ammonia, i., 257

Arsenic, ii., 51

Baths,i., 133, 143

Bromides, i., 117

Citric Acid, i., 190

Iodine, i., 84

Iron, ii., 166

Lithia, ii., 232

Mineral Waters, i., 156

Nitro-hydrochloric Acid, i., 201

Potash Salts, ii., 278

Soda Salts, ii., 298

Sulphur, i, 28, 32

Zinc, ii., 314

v. Rheumatic Fever.
RUPIA.

Iron, ii., 159

Nitric Acid, i., 220

v. Syphilis.

SATTKIASIS.

Bromides, i., 116

Phosphorus, i., 50
SCABIES.

Arsenic, ii., 45

Lime Salts, ii., 104

Manganese, ii., 246

Potash Salts., ii., 277

Sulphur, i., 24

Sulphuric Acid, i, 231
SCARLATINA.

Acetic Acid, i., 183

Alkalies, ii., 280

Ammonia, i., 260

Antimony, i., 289

Bromides, i. , 131

Hydrochloric Acid, i., 198

Iron, ii., 165

Meicury, ii., 216

Potash Chlorate, ii., 280

Sulphur, i., 31

Water, i., 144
SCIATICA.

Arsenic, ii. , 53

Copper, ii., 123

SCIATICA continued.

Iodides, i., 86

Nitro-hydrochloric Acid, i., 201

Silver, ii., 17

Sulphur, i., 28

r. Rheumatism.
SCROFULA.

Arsenic, ii., 49

Barium, ii., 78

Bromides, i., 96, 97

Cadmium, ii., 93

Gold, ii., 74 *

Iodine, i., 70, 86

Iron, ii., 179

Lime Salts, ii., 109

Mercury, ii., 220

Phosphoric Acid, i. , 225

Potash Chlorate, ii. , 282

Sea-bathing, i., 152

Soda Salts, ii., 296, 301

Sulphur, i.,28
SCURVY.

Citric Acid, i, 190

Iron, ii., 151

Phosphoric Acid, i. , 226

Pciash Salts, ii., 284
SEPTICAEMIA.

Ammonia, i., 258. 259

Potash, ii., 285

Sulphurous Acid, i., 243
SHOCK.

Ammonia, i., 258

f>. Collapse Exhaustion
SMALL-POX:.

Antimony, i. , 289

Hydrochloric Acid, i., 198

Iron, ii. , 165

Lime Salts, ii., 105

Mercury, ii., 207, 217

Sulphurous Acid, i., 244

Water, i., 145
SNAKE BITE.

. Bites.
SORE NIPPLE.

Borax, ii., 297

Lead, ii. , 260

Silver ii. , 16

Sulphurous Acid, t, 238
SORE THROAT.

1). Angina.
SPERMATORKIKEA.

Acetic Acid, i., 183

Bromides, i. , 113

Iron, ii., 158

INDEX.

339

SPERMATORRHCEA continued.

Phosphorus, i., 49

Silver, ii., 12
SPINA BIKIDA.

Iodine, i. , 72
SPLENIC ENLARGEMENT 1 .

Bromides, i., 117

Iodides, i., 91

Lead, ii., 260

Mercury, ii., 208

v. Ague.
SPRAINS.

Sea-bathing, i., 152

Sulphurous Acid, i., 238
STINGS.

Ammonia, i., 257

v. Bites.
STOMATITIS.

Alum, i., 269

Potash Chlorate, ii., 283

t>. Aphthae.
STRICTURE, URETHRAL.

Potash, ii., 275

Water, i., 138
STRYCHNIA POISONING.

Bromides, i., 109

Iodine, i., 70

Oxygen, i., 14
SUNSTROKE.

Water, L, 147

v. Congestion, Cerebral.
SUPPURATION.

Potash Salts, ii. , 283

Sulphur, i., 29

v. Abscess.
SYCOSIS.

Arsenic, ii., 66

Iodine, i., 82

Mercury, ii., 206

Sulphur, i., 26
SYNOVITIS.

Iodine, i.. 74

Lead, ii., 260

Mercury, ii., 208

Silver, ii., 16

v. Arthritis.
SYPHILIS.

Copper, ii. , 169

Gold, ii ,74

Hydrochloric Acid, i., 199

Iodine, i. , 83

Iron, ii., 178

Mercury, ii., 210, 217

Nitric Acid, i. , 220

SYPHILIS continued.

Nitro-hydrochloric Acid. i. , 200
Potash Salts, ii., 275,285
Sulphur, i., 29
Sulphurous Acid, i., 246
Water, L, 149

TAPEWORM.

Copper, ii, 126

v. Worms.
TENESMUS.

Bromides, i, 112
TETANUS.

Barium, ii., 79

Bromides, i., 109

Gold, ii., 79

Oxygen, i., 14

Potash Salts, ii., 285

Water, i, 148
THROMBOSIS.

Ammonia, i., 259
TINEA TARSI.

Copper, ii., 122

77. Blepharitis.
TINEA TONSURANS.

Acetic Acid, L, 183

Iodine,!, 82

Iron, ii., 159

Lime, ii., 104

Manganese, ii., 246

Mercury, ii., 205

Potash Salts, ii., 277

Prussic Acid, i., 212

Sulphuric Acid, i., 231

Sulphurous Acid, i., 237
TINEA VERSICOLOR.

v. Chloasma.
TONSILS, ENLARGED.

Bromides, i, 118

Iodine, i , 71

Iron, ii., 179

Lime, ii., 102
TONSILLITIS.

Alum, i., 269

Antimony, i. , 290

Mercury, ii., 216

Silver, ii. , 14

v. Angina.
TOOTHACHE.

Alum, i., 269

Soda, ii., 297
TREMOR.

Arsenic, ii., 58

Phosphorus, i., 51

340

INDEX.

TREMOR continued.

Silver, ii., 23

Zinc, ii., 313
TUMOR, FIBROID.

t>. Fibroma.
TUMOR, OVARIAN.

v. Cysts.

ULCERATION.

Bromides, i., 104

Copper, ii., 123

Iodine, i., 79

Iron, ii., 160

Lead, ii., 259

Lime, ii., 103

Mercury, ii., 210

Nitric Acid, i., 218

Oxygen, i. , 8

Potash, ii., 275

Silver, ii, 12

Sulphurous Ac id, i., 238

Water, i., 137
UREMIA.

Water, i., 148

. Albuminuria Convulsion.
URETHRITIS.

Bromides, i., 114

Chlorine, i., 123

. Gonorrhoea.
URTICARIA.

Arsenic, ii., 65

Bromides, i., 114

Potash Salts, ii. , 277

Prussic Acid, i., 211

. Pruritus.
UTERINE CONGESTION, etc.

Arsenic, ii. , 61

Bromides, i., Ill

Gold, iL, 73

Iodine, i., 73, 92

Lime, ii. , 111

Nitric Acid, i., 217

Potash, ii., 275

Silver, ii., 12, 19

v. Cancer Menorrhagia, etc.

VAGUS, IRRITATION OP.

Bromides, i., 113
VAKICOCELE.

Water, i., 139

VARIX.

Iron, ii., 156

Potash, ii., 275
VERTIGO.

Bromides, i., 110

Prussic Acid, i., 214

v. Dyspepsia.
VOMITING.

Alkalies, ii., 278

Arsenic, ii.,67

Bromides, i., 113

Carbonic Acid, i., 189

Cerium, ii., 114

Iodine, i., 93

Lime, ii., 105

Mercury, ii., 221

Prussic Acid, i., 213

Soda Salts, ii. , 299

Sulphurous Acid, i., 227
VULVITIS.

Alum, i., 271

Lead, ii., 259

Silver, ii., 12

WARTS.

Copper, ii., 124

Magnesia, ii., 242

Nitric Acid, i., 218

Potash, ii., 275

Silver, ii., 9

Zinc, ii. , 310
WHITLOW.

. Onychia.
WORMS.

Copper, ii. , 126

Iron, ii., 179

Mercury, ii., 222

Tin, ii., 304

0. Ascarides.
WOUNDS.

Carbonic Acid, i. , 187

Chlorine, ii. , 296

Lead, ii., 259, 260

Potash Salts, ii., 276

Silver, ii., 9

Sulphurous Acid, i., 238

Water, i., 137

Zinc, it, 310

V. Ulceration,

DATE DUE

"HINTED IN U S A

UC SOUTHERN REGIONAL LIBRARY FACILITY

A 000 500 571 5

QV k
J67m
1882
v.2
Johnson, Laurence.

Materia medica and therapeutics

MEDICAL SCIENCES LIBRARY

UNIVERSITY OF CALIFORNIA, IRVINE
IRVINE, CALIFORNIA 92664