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Full text of "Pharmacology and therapeutics"

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PHARMACOLOGY 

AND 

THERAPEUTICS 



WILCOX 



B\ THE SAME AUTHOR 



MATERIA MEDICA AND PHARMACY 

In the companion book on Materia Medica and 
Pharmacy full attention is given to pharmaceutical 
processes, to the various kinds of preparations, with 
their dosage, and to the art of prescribing ; after which 
the description of remedies is taken up in detail. The 
list of therapeutic agents is divided into two main parts, 
under the heads of Inorganic and Organic Materia 
Medica, and the general classification adopted is one 
based on the groupings of the articles according to the 
class and chemical division or natural order to which 
each belongs. In order to make the book more com- 
plete, condensed descriptions of the action and thera- 
peutic use of all the remedies have been appended. 

The two works combined offer, it is believed, a very 
complete and up-to-date presentation of the whole sub- 
ject of Materia Medica and Therapeutics. 



,' 



PHARMACOLOGY 



AND 



THERAPEUTICS 




BY 

REYNOLD WEBB WILCOX, M.A., M.D., LLD. 

PROFESSOR OF MEDICINE AT THE NEW YORK POST-GRADUATE MEDICAL SCHOOL AND 

ATTENDING PHYSICIAN TO THE HOSPITAL; CONSULTING PHYSICIAN TO THE NASSAU 

HOSPITAL; VISITING PHYSICIAN TO ST. MARK'S HOSPITAL; EX-PRESIDENT CF 

THE AMERICAN THERAPEUTIC SOCIETY J FELLOW OF THE AMERICAN 

ACADEMY OF MEDICINE; VICE-CHAIRMAN OF THE REVISION 

COMMITTEE OF THE UNITED STATES PHARMACOPOEIA ; 

ETC. 



SIXTH EDITION 

Based on the Fifth Edition of White and Wilcox' s 
' ' Materia Medica and Therapeutics ' ' 



PHILADELPHIA 
P. BLAKISTON'S SON & CO. 

IOI2 WALNUT STREET 
I905 






*%i 



a* A 



LIBRARY of CONGRESS 
Two Copies Received 

DEC 19 1905 

Copyrizht Entry 

CLASS (X. XXc. No. 

COPY B. 






Copyright, 1905, by P. Blakiston's Son & Co 



"Authority to use for comment the Pharmacopceia of the United 
States of America, Eighth Decennial Revision, in this volume, has been 
granted by the Board of Trustees of the United States Pharmacopoeia! 
Convention, which Board of Trustees is in no way responsible for the 
accuracy of any translations of the official weights or measures or for 
any statement as to strength of official preparations." 



Press of 

The New Era Printing Company 

Lancaster, Pa. 



PREFACE. 



( 



In revising White's Materia Medica and Therapeutics to 
bring it into harmony with the United States Pharmacopoeia, 
so much additional matter has been introduced into the five 
American editions that it seemed advisable to re-write the book. 
The eighth decennial revision of the Pharmacopoeia has given 
the opportunity. /The many advances in the subjects here 
treated have necessitated the division of the work into two dis- 
tinct parts, the first being devoted to Materia Medica and 
Pharmacy, and this, the second, to Pharmacology and Thera- 
peutics. Tt is hoped that this natural separation of the subjects 
will be acceptable to the physician and the student. \/ In the 
present work the classification employed is based on the par- 
ticular physiological systems upon which the various drugs or 
other agents principally act. There is a complete list of drugs 
and preparations, without special description, except as to 
dosage, and very elaborate accounts of their physiological action 
and therapeutics are given. In these descriptions the effort has 
been made to present the latest views of the highest authorities 
in these departments, and to render the book as practically use- 
ful as possible by full details regarding treatment. The two 
works combined offer, it is believed, a very complete and " up- 
to-date " presentation of the whole subject of Materia Medica 
and Therapeutics. 

For valuable assistance, in revision and in proof-reading, the 
author would acknowledge the esteemed services of Doctor P. 
Brynberg Porter. 

The Author. 



CONTENTS. 



Page. 

Definitions i 

Modes of Administration of Drugs 2 

Doses (Posology) 5 

Pharmacological and Therapeutical Actions 8 

Relation between Chemical Constitution and Physiological 

Action 9 

Theory of Ions 10 

Division I. Drugs Acting upon Organisms which Infect the 

Human Body, or upon Processes Going on Outside It... 14 

Antiseptics 14, 19 

Anthelmintics 17, 112 

Antiparasitics 18, 122 

Antiperiodics 18, 128 

Division II. Drugs Acting on the Blood 148 

Drugs Acting on the Plasma 148, 152 

Drugs Acting on the Red Corpuscles '. 149, 220 

Drugs Acting on the White Corpuscles 151 

Division III. Drugs Acting on the Cardiac Mechanism 249 

Drugs Acting upon the Heart Directly 250, 253 

Drugs Acting upon the Vagus Centre 252, 305 

Drugs Acting upon the Accelerating Centre 253, 323 

Division IV. Drugs Acting on the Vessels 324 

Drugs Acting Locally on Vessels 325, 329 

Vaso-dilators 325, 329 

Vaso-constrictors 327, 380 

Emollients and Demulcents 328, 438 

Drugs which act on the Vaso-motor Centres 329 

Division V. Drugs Acting on the Skin 493 

Diaphoretics 494, 496 

Anhidrotics 495 

Drugs Producing a Rash on the Skin 496 

Division VI. Substances Acting on the Urinary System.... 509 

Drugs Increasing the Quantity of Urine Secreted 509, 516 

Drugs Diminishing the Quantity of Urine Secreted 512 

Drugs Rendering the Urine Acid 512 

vii 



Vlll CONTENTS. 

Page. 

Drugs Rendering the Urine Alkaline 512 

Antilithitics 512 

Lithontriptics 513 

Drugs Preventing the Urine from Decomposing 514, 538 

Drugs Altering the Composition of the Urine 514 

Drugs Acting on the Bladder and Urethra 515 

Diuretics 516 

Division VII. Drugs Acting on the Bodily Heat 553 

Antipyretics 553, 556 

Drugs which Cause a Rise of Temperature 555 

Division VIII. Drugs Acting on the Respiration 567 

Drugs Altering the Composition of the Air Inhaled 568 

Drugs Acting on the Respiratory Centre 569, 573 

Drugs Affecting the Bronchial Secretion , 570, 581 

Drugs Relaxing Spasm of the Muscular Coat of the Bronchial 

Tubes, or Antispasmodics 571, 600 

Drugs Acting on the Vessels of the Bronchi 571 

Expectorants 572 

Drugs which May Sometimes Produce Cheyne-Stokes Breath- 
ing 573 

Division IX. Drugs Acting on the Digestive Apparatus 606 

Drugs Acting on the Teeth 606 

Drugs Acting on the Salivary Glands 607 

Drugs Acting on the Stomach 609, 627 

Drugs Acting on the Intestines 617, 680 

Drugs Acting on the Liver 624 

Stomachics 627 

Gastric Sedatives 673 

Purgatives 680 

Laxatives 680 

Simple Purgatives 686 

Drastic Purgatives 697 

Intestinal Antiseptics 7 J 8 

Division X. Drugs Acting on the Nervous and Muscular 

Systems 732 

Drugs Acting on the Muscles 73 2 

Drugs Acting on the Peripheral Endings of Motor Nerves. 732, 744 
Drugs Acting on the Peripheral Endings of Sensory Nerves. 733, 756 

Drugs Acting on the Trunks of Nerves 735 

Drugs Acting on the Spinal Cord 735. 772 

Drugs Acting on the Brain 737, 802 



i 



CONTENTS. IX 

Page. 

Drugs Acting on the Eye 742 

Drugs Acting on the Ear 744 

Drugs Acting. on the Sympathetic System 744 

Drugs Increasing the Irritability of the Anterior Cornua 

of the Spinal Cord 772 

Drugs which Depress the Activity of the Anterior Cornua. 783 

General Cerebral Stimulants 802 

General Cerebral Depressants 843 

General Anaesthetics 888 

Division XL Drugs Acting on the Organs of Generation 908 

Aphrodisiacs 908, 911 

Anaphrodisiacs 909 

Ecbolics or Oxytocics " 909, 919 

Emmenagogues 910, 930 

Substances which Depress Uterine Action 910, 932 

Drugs Acting on the Secretion of Milk 911 

Division XII. Antitoxins and Serums 933 

Division XIII. Organic Extracts 945 

Division XIV. Drugs Acting on Metabolism 960 

Alteratives 960 

Tonics 960 

Division XV. Drugs which Have no Marked Therapeutic 

Properties 986 

Index 997 



PHARMACOLOGY AND 
THERAPEUTICS 



DEFINITIONS. 

Therapeutics. — The application of remedial agents in the 
treatment of disease. It includes : 

General Therapeutics. — The application of curative 
agents other than drugs and medicines. E. g., diet, 
climate, baths, venesection. 
Rational Therapeutics. — Therapeutics based upon Phar- 
maco-dynamics. E. g., the use of digitalis for mitral 
disease. 
Empirical Therapeutics. — Therapeutics based upon clin- 
ical experiences only. E. g., the use of colchicum for 
gout. 
With the exception of such incidental allusion to other 
agents as occasion may require, in this work will be 
considered only that part of Therapeutics which is 
concerned with drugs. 
Pharmacology. — The study of Materia Medica and Thera- 
peutics, including the origin, history, properties and uses of 
drugs and medicines. It includes : 

Pharmacognosy. — The study of the physical and chem- 
ical characters of drugs, and the art of identifying and 
selecting them in accordance with those characters. 
Pharmaco-Dynamics. — The study of the action of 
remedial agents upon the organism of man. or the 
lower animals in a state of health. 
Therapeutics. — Although the correct definition of this 
term is as given above, yet it is. for want of a better 
one. often used as the name of the branch of study 
which deals with Therapeutics. Therapo-Dynamics 
2 i 



2 PHARMACOLOGY AND THERAPEUTICS. 

has been used in the same sense, but is faulty. Expe- 
rimental Therapeutics has been suggested, but is not 
comprehensive. 
Toxicology. — The study of the nature, effects and detection 
of poisons, substances which, introduced into the body inoppor- 
tunely or in excessive amounts, are capable of destroying life. 
Courses of study and treatises upon Toxicology are, for conveni- 
ence, commonly made to include the subject of antidotes and 
treatment, although this is, strictly speaking, a part of Thera- 
peutics. 

Attention must be paid to the manner, quantity and form in 
which drugs are given before entering upon a description of 
their actions and uses. 

MODES OF ADMINISTRATION OF DRUGS. 

(a) Into the blood-vessels by injection. — This method, while fre- 
quently employed in experimental researches upon animals, is resorted 
to only under extraordinary circumstances in the human subject. It is 
most commonly used for infusion of what is known as normal saline 
solution {see Sodium Chloride) after profuse haemorrhage and in vari- 
ous forms of toxaemia. Among the objections to intra-venous injection 
are the difficulty of finding the collapsed veins and the danger, in punc- 
turing a vein, of wounding the opposite wall of the vessel. Again, 
phlebitis is very liable to result, and thrombosis or embolism may pos- 
sibly be caused. As a rule, hypodermoclysis {see below) is therefore 
preferable ; but if the symptoms are very urgent, the tissues cedematous 
from dropsy, or the circulation too feeble to insure absorption, infusion 
should be practiced without hesitation. It is the most prompt method 
in cases of shock, and it has even been proposed, with a view to the 
prevention of shock, that the free use of intravascular hot saline infu- 
sion, injected while the patient is still under the anaesthetic, should be 
adopted as a matter of routine, after all severe operations. This, how- 
ever, should not be practiced before the operation, unless under excep- 
tional circumstances, for the increased arterial tension would be likely 
to cause increased haemorrhage during operative procedures. Intraarte- 
rial, as well as intra-venous, infusion is sometimes practiced. 

{b) Into the subcutaneous tissues by hypodermatic injection. — A 
perfectly clean syringe, fitted with an aseptic hollow silver needle, 
should be used for the injection. A part of the body is selected (com- 



MODES OF ADMINISTRATION OF DRUGS. 3 

monly the external surface of the fore-arm), where the skin is lax. 
The skin is raised between the thumb and forefinger of one hand, and 
with the other hand the needle is inserted under it for about an inch, 
care being taken to avoid muscles and veins. The syringe is slowly 
emptied, then withdrawn, and slight pressure is made for a moment 
over the puncture. The bulk of an injection, as a rule, should be 
about .30 c.c. (5 m.). In order that abscesses may not result, the fluid 
should be aseptic, non-irritating, and free from solid particles. If not 
freshly prepared, it is advisable that a little boric acid should be added 
to it. Much the most convenient and satisfactory plan is to keep the 
drugs for hypodermatic use in the form of soluble tablets, and to dis- 
solve one in the required quantity of water at the time the injection 
is called for. The advantage of this method is that it secures a much 
more rapid absorption than when the drug is given by the mouth, and 
it is ordinarily employed when the promptest possible effects are 
desired. 

Hypodermoclysis. By the bedside is placed an aseptic jar containing 
sterilized warm normal salt saline solution, to which air gains access 
only by means of a glass tube filled with sterilized cotton. From the 
lower part of this vessel extends a tube fitted to a trocar, which should 
be made aseptic. The skin over the part chosen for the infusion (pref- 
erably the ilio-lumbar region — the space between the highest part of the 
crest of the ilium and the lower border of the ribs) having also been 
rendered aseptic, the trocar is thrust into the subcutaneous tissue, and 
the solution allowed to flow at a rate not exceeding 4 c.c. (1 fl. dr.) to 
each 500 gm. (1 pound) of body-weight in each fifteen minutes. The 
necessary pressure is obtained by the elevation of the container, and 
absorption of the fluid is aided by gentle massage. This procedure has 
been employed with advantage to replace the fluid lost from the body 
through haemorrhage or through excessive purging, as in cholera ; also 
to wash from the body various impurities circulating in the blood and 
lymph and to flush the kidneys. It has likewise proved of service in 
cases of surgical shock and of threatened death from anaesthetics. Hy- 
podermoclysis, however, is slower than other methods in shock, on ac- 
count of the poor general circulation, and is also open to the objec- 
tions that the introduction of a proper amount of fluid (1^2 to 2 litres — 
3 to 4 pints) requires quite a number of punctures, which cause pain 
subsequently, and that such a bulk of fluid causes such tension of the 
tissues that at the temperature best adapted to prevent shock (48.8° 
C. — i2o = F.) sloughing may possibly result. 

Enteroclysis is also employed in shock and allied conditions, and not 



4 PHARMACOLOGY AND THERAPEUTICS. 

infrequently in association with intravascular infusion. This consists 
of the irrigation of the intestine, commonly with a saline solution, and 
it is most satisfactorily practiced by means of a double-current tube. 
With a return-flow tube in use the fluid does not cool, since fresh hot 
fluid is continually entering to replace the cooler which passes out. 
The method is of service in warding off shock, and has been resorted 
to for this purpose after surgical operations. 

(c) Into serous cavities by injection. — This method is employed only 
to secure certain local effects in such cavities themselves, as to wash 
out antiseptically the pleura after it has been opened or to cause adhe- 
sive inflammation in the tunica vaginalis by the injection of irritants. 
It has been proposed to introduce hot saline infusion directly into the 
abdominal cavity by means of a hollow needle for the purpose of com- 
bating shock. Also when this cavity is opened, as in coeliotomy, it 
may be flushed with hot saline infusion for the same purpose. 

(d) Into mucous cavities. — The most common way of administering 
drugs is naturally by the mouth, so that they may be absorbed from the 
mucous membrane of the stomach or intestine. Circumstances condu- 
cive to rapidity of absorption are an empty stomach and a ready solu- 
bility of the drug in the gastro-intestinal secretions. When it is in- 
tended that the drug shall act only in the intestine, pills, made pur- 
posely insoluble in the ga*stric fluids, are administered. It is probable 
that some drugs are excreted in the bile by the liver, and so never reach 
the general circulation. Pains should be taken to prescribe drugs in as 
palatable a form as possible and so combined as not to cause irritation. 

It is sometimes advisable to administer drugs by the rectum, supposi- 
tories being employed for solids, and enemata or clysters for liquids. 
The fact must not be lost sight of that they are not then so readily 
dissolved or absorbed as when given by the mouth. 

Drugs are also used for local effects, as by the urethra or vagina 
(injections, bougies, pessaries), or by the respiratory passages (in- 
halations, cigarettes, sprays or nebulae for inhalations; insufflations 
for blowing into the nose, throat and larynx ; pigmenta, gargarismata, 
trochisci, for a local effect on the mouth and pharynx ; nasal douches 
for the nose). Sprays are given by means of an atomizer. Sometimes 
volatile drugs, as ether, chloroform and amyl nitrite, are inhaled for 
their general effect. 

(e) By the skin. — Certain drugs may be absorbed from the skin if 
mixed with some fatty substance, especially hydrous wool-fat. In this 
way mercury may be absorbed by being rubbed in. Some may also be 
absorbed from the skin when they are volatilized. In this way mercury 



DOSES. 5 

is introduced into the system by fumigation. The chief purpose, how- 
ever, for which drugs are applied to the skin is to secure their local 
effects, and for this they are employed in ointments, cerates, plasters, 
etc. 

To the eye and ear they are applied in washes and injections. 

DOSES. 

The study of doses is called Posology. In determining the dose the 
following points deserve attention : 

1. Age. — The adult dose is that for a person between twenty and 
sixty years old, but for women the dose should be somewhat smaller 
than for men. 

For Children under twelve Cowling's rule — divide age at next birth- 
day by twenty-four — is the simplest and is generally of sufficient exact- 
ness. It must be borne in mind, however, that in the case of certain 
drugs the dose may be relatively larger than for adults, while in that 
of others they must be relatively smaller. Thus, children bear iron, 
alcohol, arsenic, belladonna, hydrated chloral, rhubarb, and cod liver oil 
remarkably well, but can take only very small doses of opium and its 
preparations. 

For persons above sixty the dose should be slightly diminished as the 
age advances. 

2. Weight. — In pharmacological experiments upon animals, in which 
it is customary to express the dose as a proportion of the weight, it 
has been found that if the same amount of poison be distributed through 
the tissues of a large individual as of a small one, less is contained in 
any given organ of the former, and less effect is therefore observed. 
This no doubt holds true as regards man also ; so that somewhat larger 
doses of drugs should be prescribed for very large persons than for 
those of ordinary stature, while in the case of persons of unusually 
small size the dose should be proportionately diminished. 

3. Habit. — A person who takes a drug continuously usually becomes 
less and less susceptible to its influence. Thus, an opium habitue after 
a time finds it necessary to use enormous doses of the drug in order 
to secure the desired effect. With strychnine and some other similar 
drugs, however, the susceptibility increases, instead of diminishing, and 
among purgatives cascara sagrada appears to be an exception as regards 
habit. 

■A. Idiosyncrasy. — Many individual differences in the matter of sus- 
ceptibility are met with. These idiosyncrasies, which have frequently 
been observed with almost all commonly used drugs, consist of extra- 
ordinary sensitiveness, or tolerance, or of entirely atypical actions. 



O PHARMACOLOGY AND THERAPEUTICS. 

5. Time of Administration. — Drugs must be given with careful at- 
tention to the time which they require to produce their appropriate 
effects. Thus, some hypnotics have to be administered several hours 
before it is desired that the patient should go to sleep for the night, 
while for others to act but little time is needed. In order to cause 
a morning evacuation of the bowels, slowly acting purgatives must be 
taken the evening before, but promptly acting ones simply before break- 
fast. Drugs which are readily decomposed by the contents of the stom- 
ach should be given when that viscus is empty, preferably a half hour 
before the meal time. Experience has shown that the body is gener- 
ally more resistant in the morning than in the evening, especially in 
the case of narcotic drugs. 

6. Mode of Administration. — Drugs being absorbed much more rap- 
idly from the subcutaneous tissue than from the stomach and upper 
portion of the intestinal canal, smaller doses are required when they 
are administered hypodermatically than by the mouth. On the other 
hand, their absorption is slower from the rectum ; therefore to produce 
the desired effect, the rectal dose must be larger. 

7. Mental Influences. — The mental condition of the patient some- 
times has more or less influence on the effectiveness of drugs. Thus, 
if his mind is particularly fixed on the action of a hypnotic, so that he 
feels convinced that he will sleep, quite a small dose may answer the 
purpose ; but if, on the contrary, he is laboring under considerable 
mental excitement and feels that it is quite impossible for him to sleep, 
an unusually large dose may be required. 

8. Other Temporary Conditions. — Various other temporary condi- 
tions may influence the activity of drugs. As the drug is diluted by 
the stomach contents, absorption takes place more slowly after a meal 
than when the stomach is empty, and any local irritant action is less 
marked. Irritation of the stomach or intestine may also modify the 
effects of drugs, and vomiting and diarrhoea naturally tend to diminish 
their activity by quickly removing them from the alimentary canal. 
During pregnancy drugs must be used with great care. Purgatives may 
induce pelvic congestion, and thus lead to abortion, while drugs causing 
a marked fall of blood-pressure may have the result of asphyxiation of 
the foetus. Drugs acting directly upon the uterus are naturally to be 
avoided, and also those whose effects may be transmitted from the 
mother to the child and do injury to the latter. During lactation cer- 
tain drugs are excreted in the milk, and these may either act on the 
child or render the milk distasteful to it. At the time of menstruation 
all very active drugs must either be given with great caution or tern- 



DOSES. / 

porarily intermitted, and as purgatives tend to increase the flow, they 
should generally be avoided. 

9. Temperature. — The action of drugs often being in part chemical, 
the temperature may be a factor of some importance in determining 
their effects in the case of cold-blooded animals and excised structures, 
but as in man the temperature range is so limited, this element may be 
practically disregarded in Medicine. 

10. Preparation of a Drug. — As a rule, a smaller dose of a soluble 
preparation, as a tincture, will be required than of a solid preparation, 
as a pill, which may be only slowly dissolved before absorption can 
occur, although in the latter case much depends upon the process of 
manufacture. Pills which have been manufactured for a long time may 
be entirely insoluble. 

11. Rate of Excretion'. — In order to produce a prompt effect, a 
smaller dose (other things being equal) will naturally be required of a 
drug that is excreted rapidly than of one the excretion of which is 
slow. It is also true that, in order to maintain a continuous effect from 
drugs which are rapidly excreted, the doses must be repeated at shorter 
intervals. 

12. Cumulative Action. — It sometimes occurs that in a person who 
has been taking a drug for some time without the manifestation of any 
untoward effects, symptoms of poisoning suddenly make their appear- 
ance, or, at all events, that small doses of certain drugs taken repeat- 
edly for a considerable period eventually give rise to symptoms which 
are more marked than those caused by a single dose. Such a result 
is attributed to the cumulative action of the drug, causing an acquired 
susceptibility, in consequence of which a given dose will produce more 
pronounced effects than it did originally. This is the opposite of habit- 
uation, and it may be due to any one of the following causes : (a) 
Greater capacity for absorption than excretion, as in the case of lead 
and mercury. (&) Inconstant absorption, successive doses of the drug 
lying unabsorbed in the alimentary canal until such time as the condi- 
tions, in consequence of some alteration in the intestinal contents, may 
become favorable to absorption, when the whole amount is taken into 
the system at once. This is sometimes met with in the case of digi- 
talis, (c) Summation of effects, the effect of the preceding dose not 
having disappeared when the succeeding dose is given, (d) Sudden 
arrest in the excretion of the drug. For instance, it is thought prob- 
able that in the case of digitalis the renal vessels become contracted 
when the quantity of the drug in the tissues has reached a certain 
amount, so that excretion can no longer take place. It has been sug- 



8 PHARMACOLOGY AND THERAPEUTICS. 

gested also that the organism is subject to what may be called an edu- 
cation to the effects of drugs, particularly in the case of certain ones 
acting upon the central nervous system. Under this hypothesis the fact 
that the susceptibility to strychnine increases with its administration 
would be explained by the central nervous system's becoming educated 
to the stimulating actions and responding more readily to them. Cumu- 
lative action, it should be noted, may occur along with tolerance. Thus 
it is found that the tolerance of certain tissues for nicotine does not 
protect others from the effects of the abuse of tobacco. 

13. Disease. — The action of drugs is liable to be greatly modified by 
disease. This is seen, for instance, in the case of antipyretics, which 
have little or no influence upon normal temperature, but have a pro- 
nounced effect in reducing pyrexia. The dose also must sometimes be 
changed very much on account of the conditions produced by disease. 
Thus, in peritonitis it is a matter of common observation that enormous 
doses of opium are borne perfectly well. The same is true also in many 
instances of hepatic, renal and other very severe forms of colic. 

The tendency of modern therapeutics is towards smaller and more 
frequently repeated doses. 

PHARMACOLOGICAL AND THERAPEUTICAL ACTIONS. 

By the action of a drug is ordinarily meant its physiological 
action. 

The primary action is that due to the unaltered drug. The emetic 
action of such drugs as zinc sulphate is an illustration of this. 

The secondary action is that due to compounds formed from the 
drug in the body. Thus, genito-urinary disinfectants like cubeb and 
copaiba owe their effects in this regard to a combination with glycuronic 
acid, in which form they are excreted by the kidneys. 

The local action is that produced at the point of application before 
the drug enters the circulation. 

The direct action is that produced upon organs and tissues with 
which it comes into immediate contact. 

The indirect or remote action is that produced as a secondary result 
of the direct effect. The paralysis of the heart caused by chloroform 
is a direct effect, while the fall of blood-pressure which results from 
this is an indirect effect of the drug. 

The general or systemic action is the effect produced by the drug 
after absorption, and is due to its elective affinity for certain organs 
to which it is carried by the blood. Most active drugs have an elective 



PHARMACOLOGICAL AXD THERAPEUTICAL ACTIONS. 9 

affinity for special organs, as the heart or the central nervous system. 
Xot only this, but they attack certain definite tissues. Among those 
which select the central nervous system, for example, some act pri- 
marily upon the cerebral cortex, some upon the medulla oblongata, and 
some upon the spinal cord. It is sometimes the case that a drug has 
the effect of altering different structures in directly opposite ways. 
Atropine depresses the peripheral terminations of the secretory nerves, 
but stimulates the brain, while curara paralyzes the peripheral 
motor nerve endings, but stimulates the spinal cord. Different drugs 
show great differences in the extent of the field of their activity, and 
with most poisons the scope of this depends largely on the quantity 
administered. Hence, one which in small doses affects the medulla 
oblongata only, in larger doses may extend its influence to the brain and 
spinal cord, and when given in still larger amount act also on the heart 
and other organs. It is to be noted that the local effects of a drug may 
be entirely different in character from its general action ; so that while 
it acts as an irritant at the point of application, it may be a depressant 
to the brain when it is carried thence in the circulation. For the rea- 
son that they are not absorbed or are absorbed in inactive forms, some 
drugs have only a local action. Others, again, have only a local action 
because they are excreted or deposited with such rapidity that there is 
not a sufficient quantity in the blood at any one time to produce any 
general effects. Many powerful poisons, on the other hand, show only 
an elective affinity for some internal organ to which they are conveyed 
in the circulation, and have little or no local action. 

Relation between Chemical Constitution and Physiological Ac- 
tion. — While it is true that in a general way drugs closely resembling 
each other as to their chemical composition and properties produce 
similar effects upon the organism, as seen, for instance, in the case of 
the heavy metals, yet it is found that when their physiological action 
is carefully followed* out, considerable differences in their effects are 
discovered. This is due to the circumstance that certain factors are 
met with which are apparently quite independent of their chemical con- 
stitution, or, at all events, which it is impossible to deduce from the 
latter. It is worthy of attention that the position of the radicals in the 
molecule is sometimes of great physiological importance. Thus, resor- 
cinol (metadihydroxy-benzene) has a very sweet taste, while pyrocatechin 
(orthodihydroxy-benzene) is bitter. Moreover, substitution of one radical 
for another in organic compounds often greatly modifies the action. It 
can be stated, then, that it may be inferred with some probability that 
any substance belonging to a chemical group of similar constitution will 



10 PHARMACOLOGY AND THERAPEUTICS. 

give rise to symptoms resembling in general character those of the 
other members of the group, provided that it does not contain some 
radical which renders it inactive or gives it a more powerful action in 
some other direction. At the same time, the details of its action 
can be determined only by actual experiment. It is also equally true 
that the details of the chemical behavior of such substance can be 
ascertained only by performing the necessary reactions, and the point 
has therefore been well taken that as there is no prospect at the present 
time of explaining the latter from its constitution, there is still less 
hope that much advance will be made in the near future in formulating 
the laws governing the details of its pharmacological effects. 

The Theory of Ions. — It remains to speak in this connection of the 
theory of electrolytic dissociation and the underlying doctrine of the 
ions, which, there is every reason to believe, will, by opening up new 
methods of investigation, prove of the utmost importance in elucidating 
certain aspects of physiological action and affording a rational explana- 
tion of many obscure therapeutic facts. Furthermore, it gives promise 
of varied therapeutic possibilities in the future. According to this 
theory, when acids, bases and salts which, since they conduct the elec- 
tric current, are termed electrolytes, are dissolved, either all or a part 
of the molecules are split up by the solvent into simpler substances, 
the electrically charged atoms or groups of atoms known as ions. In 
other words, ions are those constituent parts of the molecules which, 
under the directive influence of an electric current, travel in opposite 
directions through the solution. Those which take on a positive charge 
are called kations, and those assuming a negative charge, anions. A 
simple illustration is afforded in the case of hydrochloric acid, a solu- 
tion of which is made up not only of HC1 molecules, but also of H 
ions and CI ions. When such a solution is completely dissociated, it 
would be put down as H+ and CI — . It is a fact, however, that while 
in a solution of hydrochloric acid there are dissociated chlorine ions, it 
does not contain free chlorine in the condition met with in a solution 
of chlorine gas. In solutions of a chloride the existence of chlorine 
cannot be demonstrated by its physical properties, but its presence can 
always be recognized by its reactions. The circumstance that all chlo- 
rides, by reason of their chlorine, yield a certain set of reactions which 
are precisely the same, whatever the associated element may be, is re- 
garded as one of the strongest proofs of the correctness of the disso- 
ciation theory. Since all chlorides thus give off free chlorine-ions on 
solution, notwithstanding that each one in its solid condition is charac- 
terized by its own special properties, it becomes clear why they present 



PHARMACOLOGICAL AND THERAPEUTICAL ACTIONS. I I 

a common set of reactions. The importance is insisted upon of the 
fact that only those portions of the substance which are ionized are 
chemically active, the ionized condition being necessary for the rapid 
reactions which electrolytes display. With the exception of hydrogen 
dioxide, water, the universal solvent of the body, seems to cause the best 
dissociation of molecules into ions. Formic acid comes next in this 
regard, then nitric acid ; methyl alcohol is superior to ethyl alcohol, ace- 
tone and various ethereal salts follow, and the hydrocarbons are of 
only feeble power. It has been found by experiment that only those 
substances which afford abnormal osmotic pressure in solution are capa- 
ble of conducting the electric current, and if they are dissolved in other 
solvents in which they behave normally, they lose this power. With 
our present knowledge concerning the mode of action of electro- 
lytes, it is evident that the ions which conduct the current must al- 
ways be present, i. e., they are not formed by the current. The ions 
naturally act as molecules, and so increase the osmotic pressure. The 
ions which are formed from a substance, it has been shown, must neces- 
sarily be charged very heavily with electricity ; otherwise they would 
not conduct the current. For example, in a solution of acetic acid 
there are undissociated molecules of C 2 2 H 4 and ions of H -f- and 
CH3COO — . Since the ions are charged with electricity, they do not 
behave as they would in the molecular state, i. e., they are not given off 
as gases. Furthermore, it is a fact that some ions are always charged 
with positive electricity, while others are charged with negative ; but no 
ion is known which is 'at one time positive and at another negative. 

The physiological as well as the chemical effects of most of the elec- 
trolytes have been found to be entirely dependent upon their constitu- 
ent ions, quite irrespective of the nature of their molecules. Thus, all 
acids are characterized by H ions, and it is in consequence of this that 
they all have certain general properties, while the differences between 
the solutions of different acids containing the same number of H ions 
depend upon the difference between their anions. The kation of acids 
is hydrogen; the anion of bases is the hydroxyl group (OH). The 
general conclusion to be arrived at is, then, that the physiological effects 
of an electrolyte are for the most part determined by the character of 
its ions. While the principal characteristics of most of the substances 
which are of importance in therapeutics are fairly well known, it is a 
desideratum to understand why or how it is that they produce their 
special effects, and so far as the electrolytes are concerned the theory 
of ions would seem to largely supply such knowledge. For instance, 
the long-recognized community of the reactions of the dissolved salts 



12 PHARMACOLOGY AND THERAPEUTICS. 

of a given metal (being the same with respect to that metal whether 
the chloride, sulphate, nitrate, or other salt is employed), received no 
adequate explanation until the promulgation of this theory. In the solid 
state, and when undissociated in solution, each salt has individual at- 
tributes ; while in dilute solution, when dissociation is usually more or 
less complete, the properties of the salt are merely the sum of the 
properties of its ions. If, therefore, a series of salts contains a com- 
mon ion, the properties of this will be common to all its members. As 
an illustration of this the behavior of iron salts has been cited. While 
all the simple salts exhibit common chemical reactions and have a 
very similar physiological action, compounds such as the ferrocyanides, 
for instance, neither yield the reactions of iron o"r exhibit the influence 
of the metal in their physiological effects. The explanation .would seem 
to be that the simple salts yield metallic ions on dissociation, but the 
ferrocyanides yield the group ferrocyanogen, neither the chemical be- 
havior or the physiological action of which is identical with that of 
iron itself. It is plain that when a dissociable body is administered, 
not one, but two separate agents are put in action in the tissues, so that 
the effect of each of the ions must be taken into consideration. In the 
great majority of such substances in the organic materia medica, how- 
ever, the action of one ion is so much more powerful than the other 
that the less important one may be practically disregarded. This is 
especially true of the more toxic bodies. In the case of morphine sul- 
phate, for instance, while this exists in the body as a morphine and 
a sulphate-ion, the action of the former ion is so much more powerful 
than the other that the sulphate-ion is of no consequence. Evidence 
of this is furnished by the fact that morphine hydrochloride, which in 
the body is dissociated into morphine and chlorine-ions, has practically 
the same action as morphine sulphate. With less poisonous substances, 
however, both the ions may exert a more or less powerful influence. 
Thus, we find that quite different symptoms are produced by potassium 
sulphate and potassium bromide, and this is because here larger amounts 
can be administered, and the S0 4 and Br ions are present in sufficient 
quantities to elicit their specific actions, which are quite as important 
as that of the K-ion. What are ordinarily called the strongest acids 
and the 'strongest bases are those which, in a given solution, are most 
ionized. The effects of an ion can be determined only by administer- 
ing it along with another in the form of a salt, but certain ions, it has 
been pointed out, are so inactive in the tissues that, if any effect is 
noted after a compound of which they form part, the action can be 
ascribed with certainty to the other ion, unless the change arises from 



PHARMACOLOGICAL AXD THERAPEUTICAL ACTIONS. I 3 

alteration of the physical properties of the fluids. Thus, the sodium 
ion and the chloride ion have been ascertained to be both practically 
inert, except in so far as they change the osmotic pressure ; hence if 
a sodium salt or a chloride be found to cause some change which is 
not due to the physical alteration, the action is to be attributed to the 
other ion of the molecule. By osmotic pressure is meant the resis- 
tance offered by a non-permeating salt to the passage through a partially 
permeable membrane of the fluid in which it is dissolved ; and this varies 
with the number of molecules and ions. (For additional remarks on 
the subject of osmosis see Sodium Chloride.) 

Some further points deserve attention. Many observations point to 
the conclusion that the irritability of muscle and nerve depend upon 
the presence in them of compounds of proteid with the various ions, 
sodium, potassium and calcium, in definite proportion. Furthermore, 
it has been demonstrated by experiment that the physiological effects 
of certain drugs can be modified in definite ways by the addition of 
chosen radicals to the molecule. Thus, the convulsive action of strych- 
nine, brucine and thebaine on the spinal cord is changed to a paralyzing 
effect by the introduction of methyl into the molecule. Again, the in- 
troduction of chlorine-ions into certain fatty molecules increases their 
narcotic and toxic properties. The results of these recent investiga- 
tions would seem to afford ground for the opinion that in the forces 
of ionic attraction and repulsion is to be found the explanation of the 
rouleau formation of red blood-corpuscles, the agglutination of bacteria 
in appropriate media, and the obscure facts of chemotaxis, illustrated 
by the attraction or repulsion which certain chemical media have for 
some bacteria and for leucocytes. Protoplasmic movements doubtless 
take place by means of ions, the electricity-bearing portions breaking 
down when in solution, and it has been suggested that toxic and anti- 
toxic effects may be due to various alterations in the composition of 
protoplasm forming living tissue. If a toxin which depends for its 
activity on a large number of monovalent anions can be controlled, by 
a small number of bivalent anions, or even ions of much higher valence 
(thus requiring a smaller quantity), the question of remedy is apparent. 
So, among "antiseptics, picric and salicylic acids may be destructive to 
low forms of life because they are easily dissociated in the tissue elec- 
trolytes and liberate large numbers of poisonous hydrogen kations. 
Mercuric bichloride and copper kations are for the same reason effec- 
tive, but the solution of a mercury salt in strong alcohol (a substance 
in which no electrolytic dissociation occurs) has no germicidal proper- 
ties. The neutralization of the effects of carbolic acid by concentrated 



14 PHARMACOLOGY AND THERAPEUTICS. 

alcohol is susceptible of a similar explanation. Under ordinary condi- 
tions, ions of high valence are markedly disinfectant ; those of lower 
valence less so. As regards mercury salts, dissociation may be re- 
tarded by the introduction into an aqueous solution of either alcohol 
or of another salt dissociating the same anions. For example, calomel 
treated with increasing proportions of sodium chloride shows a steady 
decrease of toxicity, the cause of which is the progressive suppression 
of the formation of mercury ions. The dissociating power of a solvent 
is believed to be a function of all the physical or chemical properties 
of a substance, and not of any one of them. The results of a great 
number of experiments all tend to demonstrate the chemical inertness 
of molecules. As the reactions proceed, and the ions already present 
are used up, it is found that the molecules are gradually dissociated and 
furnish new ions, which then enter into the reaction. The chemistry 
of atoms and molecules has thus given place to the chemistry of ions. 

The classification of drugs which is adopted here is one in accordance 
with the parts on which they act. 

Division I. — Drugs acting upon Organisms which infect 
the Human Body, or upon Processes going on outside it. 

A. Antiseptics are drugs which prevent the growth of micro- 
organisms, destroy or render innocuous the toxic products of 
their action upon the tissues of the body, or interfere with the 
absorption of such products. By some the use of the word 
antiseptic is limited to those substances which restrain the de- 
velopment of micro-organisms, while those which destroy the 
vitality of the latter are designated as germicides or disinfect- 
ants. The term disinfectant, by extension, is applied to those 
agents which kill non-pathogenic bacteria, as well as to those 
which destroy disease germs. Much discrepancy of statement 
is to be found regarding the fact of certain drugs being really 
antiseptics and as to the relative power of various antiseptics, 
owing to the circumstance that antiseptics act differently upon 
different organisms, while the difference between inhibiting the 
growth of micro-organisms and destroying their vitality has 
been lost sight of. There are also certain factors determining 
the efficiency of an antiseptic which ought to be taken into 
consideration. Among these are the following: The nature of 



DRUGS ACTING UPON INFECTIOUS ORGANISMS. . I 5 

the antiseptic agent, the strength in which it is used, the temper- 
ature at which it acts, the nature and number of the micro- 
organisms, the nature and quantity of the associated material, 
and the time of exposure. In testing the value of any antiseptic 
it is requisite that all instruments and substances employed in 
the procedure should first be exposed to a temperature sufficient 
to destroy any adventitious bacteria. A cultivating medium, 
such as agar-agar jelly, having been placed in two test-tubes, 
the substance to be tested, in suitable solution, is added to one 
of them ; after which some fluid containing the micro-organisms 
selected is poured into both the tubes. Both are then plugged 
with sterilized cotton to prevent the entrance of germs from the 
air, and observation from time to time will show how far the 
development of the micro-organisms has been interfered with 
by the supposed antiseptic. As the potency of an antiseptic is 
dependent upon so many circumstances, it is impossible to deter- 
mine with exactness the relative efficiency of various agents. 
In the following list some of the most powerful and generally 
used antiseptics are placed first. 

1. Heat is the best antiseptic, but there must be a temperature of 
at least ioo° C. (212 F.). Infected clothing, bedding, etc., may be 
heated in a dry-air chamber to between 93. 5 and 149 C. (200 and 
300 F.), but, on account of its superior penetrating qualities, steam, 
driven, under pressure, through the articles is decidedly preferable. In- 
stead of this, the infected material may be boiled in water. Surgical 
instruments are generally disinfected in this way, but one per cent, of 
washing soda (sodium carbonate) should be added to the water to pre- 
vent their rusting. 

2. Corrosive Mercuric Chloride. — A solution of 1 in 1000 is com- 
monly used for disinfecting the hands and is sometimes employed in 
surgery and obstetrics. For most uses, however, one part to 3000 or 
5000 of water, or even weaker, is the limit of safety. Gauze of the 
strength of 1 to 2000 will blister, if the skin is damp. 

3. Formaldehyde, the official solution of which contains at least 37 
per cent., by weight, has extraordinary power as a surface disinfectant, 
greater indeed than that of any known substance. . It is especially use- 
ful for the disinfection of rooms and their contents when volatilized 
from a specially constructed lamp. 



1 6 PHARMACOLOGY AND THERAPEUTICS. 

4. Chlorine for most purposes is too irritating, but the gas (which 
is generated by the action of hydrochloric acid on potassium chlorate 
or manganese dioxide) may be used to disinfect rooms. It is open to 
the objection that it attacks and bleaches many substances. 

5. Phenol, or Carbolic Acid, is used but infrequently. If surgical 
instruments have been previously sterilized, the use of phenol indicates 
a distrust, on the part of the surgeon, of his assistants. 

6. Lysol, 7, Creolin, and various cresol compounds are powerful anti- 
septics and employed to a large extent. 

8. Chorinated Lime is the best antiseptic for all excreta. 

9. Bromine, and, 10, Iodine, are rarely used, as they are too irri- 
tating. 

11. Quinine, and, 12, Salicylic acid, are too expensive for ordinary 
use. 

13. Iodoform is used for dusting upon wounds, sores, etc., but is 
objectionable on account of its extremely disagreeable odor. It should 
be previously sterilized. 

14. Boric acid is used for many surgical purposes. Since in about 
a two and one-half per cent, solution it inhibits the growth of most 
bacilli, it may be employed to preserve solutions intended for hypoder- 
matic use. 

15. Zinc chloride, and, 16, Potassium permanganate, are much used 
for domestic purposes. 

17. Solution of Hydrogen dioxide is the principal ingredient of 
various popular disinfectants. 

18. Sulphurous acid, generated by the burning of sulphur, is used to 
disinfect rooms. It should always be associated with moisture. 

19. Creosote, 20, Benzoin, 21, Zinc sulphate, 22, Ferric oxide, 23, 
Thymol, 24, Alcohol, 25, Balsam of Tolu, 26, Balsam of Peru, are not 
much used. 

As to internal antisepsis, the objection has often been raised 
that there are no known drugs which when swallowed or inhaled 
will with certainty destroy micro-organisms, either in the gastro- 
intestinal tract or respiratory passages, unless they are suffici- 
ently concentrated to injure or prove fatal to the patient. By 
some authorities, however, it is claimed that calomel, naphthol 
and some other agents are capable of destroying certain varieties 
of micro-organisms in the stomach and intestines ; and, whether 
this is the case or not, it is undoubtedly a fact (and one that is 



DRUGS ACTING UPON INFECTIOUS ORGANISMS. 1/ 

often lost sight of) that an infinitely small amount of a remedy 
which could not be administered in sufficient amounts to destroy, 
will often completely inhibit the growth of micro-organisms. 
Such drugs should therefore be classed as internal antiseptics. 

Antizymotics are agents which arrest fermentation, and are 
sometimes divided into two groups, antiseptics and disinfectants. 
The fermentative processes may be caused by organized fer- 
ments, such as bacteria and the yeast-plant, or by unorganized 
ferments (enzymes), such as pepsin, diastase, ptyalin, etc. 

Deodorants, or deodorizers, are substances which destroy foul 
smells. The volatile deodorants are mainly oxidizing and 
deoxiding substances which act chemically on the noxious 
effluvia, while the non-volatile deodorants are mainly absorbents, 
which condense and decompose them. Many antiseptics and 
disinfectants are also deodorants. Charcoal is often called a 
disinfectant, but is merely a deodorizer. 

B. Anthelmintics are agents which kill (vermicides) or expel 
(vermifuges) parasitic worms infesting the alimentary canal. 
Three kinds only of such parasites are commonly met with in 
the temperate zone : 

(i) Tape-worm (Tenia solium and Tenia mediocanellata). Anthel- 
mintics: Aspidium (mostly used), Oleum Terebinthinse, Kamala, 
Cusso, Granatum, Pelletierine Tannate (easily administered and very 
efficient), and Pepo. 

(2) Round-worm (Ascaris lumbricoides). Anthelmintics: Santonin, 
Chenopodium, and Spigelia and Senna. 

(3) Thread-worm (Oxyuris vermicularis). Anthelmintics: Rectal in- 
jections of salt water, infusion of quassia, solutions of iron salts, or 
diluted oil of turpentine are commonly recommended. It is probable, 
however, that ordinary rectal injections are useless. Large soap and 
water enemata, the patient being in the knee-chest position, give the 
best results. Lime water is often very efficient. In the case of chil- 
dren it is advised that the lower bowel should be first emptied by an 
injection of warm soap and water. The child should then be placed 
upon a bed with its buttocks elevated, and the tube of the syringe be 
passed gently within the inner sphincter. The fluid (soap and water, 
lime water, or salt and water), previously warmed, must be injected with 
some little force, so that it may be lodged in the upper part of the rec- 



I 8 PHARMACOLOGY AND THERAPEUTICS. 

turn ; otherwise expulsive efforts will be immediately excited. It is best 
that the enema should be given at bedtime in order that it may be re- 
tained for a sufficient length of time. 

Anthelmintics for the tape or round-worm should be given 
when the alimentary tract is empty, to ensure their coming 
in contact with the parasite, and a purgative is therefore 
usually given a few hours before the anthelmintic. If the latter 
is itself not also a cathartic, another dose of purgative medicine 
should be administered after it, to bring away the worm or 
worms. When aspidium is employed castor oil should always 
be avoided, as its use is attended with considerable danger. In 
the case of tape-worm, in order to see whether the head is dis- 
charged, each stool should be received into a separate vessel, 
then mixed with water, and filtered through coarse muslin. 

C. Antiparasitics or parasiticides are substances which destroy 
parasites. The term is usually applied to those which are 
destructive to the animal and vegetable parasites found upon 
the cutaneous surface. 

(i) For the various forms of tinea the following are used: Mercurial 
preparations, especially the oleate, tincture of iodine, glycerite of 
phenol, an ointment of pyrogallic acid, a boric acid lotion, a sali- 
cylic acid lotion, sulphurous acid, formaldehyde and thymol; and 
if the patches are small, severe irritants, as croton oil, cantharides, 
and chrysarobin ointment. Tinea versicolor never requires severe 
irritants. 

(2) As parasiticides for itch, sulphur ointment, Balsam of Peru, and 
Styrax are all effectual. 

(3) Pediculi vestimentorum will be killed by any mild parasiticide. 
Unguentum Staphisagriae, unofficial ; 1 part powdered seed, 2 parts each, 
olive oil and lard, is often used. 

(4) Pediculi capitis and pediculi pubis are also easily killed by mild 
parasiticides ; mercurials or Unguentum Staphisagriae are commonly 
employed. 

D. Antiperiodics are drugs which in diseases which recur 
periodically lessen the severity of the paroxysms or arrest their 
return. Some, and probably all, act as direct poisons to the 
micro-organism causing the disease. 



MERCURY. 19 

They are cinchona bark, quinine and its salts (by far the most pow- 
erful), quinidine, cinchonine, cinchonidine, arsenic trioxide, eucalyp- 
tus, hydrastis, salicin, salicylic acid, and berberine. They are used 
for all forms of malarial fever and neuralgia. 

(All doses of official drugs and preparations are to be under- 
stood as the " average approximate (but neither a minimum nor 
a maximum) dose for adults.") 

A. Antiseptics. 
MERCURY. 

1. HYDRARGYRUM.— Mercury. (Quicksilver.) 

Preparations. 

1. Emplastrum Hydrargyri. — Mercurial Plaster. 

2. Unguentum Hydrargyri. — Mercurial Ointment. 

3. Unguentum Hydrargyri Dilutum. — Blue Ointment. 

4. Hydrargyrum Ammoniatum. — Ammoniated Mercury. 
(White Precipitate. Mercuric Ammonio-Chloride.) 

5. Unguentum Hydrargyri Ammoniati. — Ointment of Am- 
moniated Mercury. (White Precipitate Ointment.) 

6. Hydrargyrum cum Creta. — Mercury with Chalk. (Gray 
Powder.) Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

7. Massa Hydrargyri. — Mass of Mercury. (Blue Mass.) 
Dose, 0.250 gm. (250 milligm.); 4 gr. 

2. HYDRARGYRI CHLORIDUM CORROSIVUM. — Corrosive 

Mercuric Chloride. (Corrosive Sublimate. Mercuric Bichloride. Cor- 
rosive Chloride of Mercury.) Dose, 0.003 gm. (3 milligm.); Y V §*• 

3. HYDRARGYRI CHLORIDUM METE.— Mild Mercurous Chlo- 
ride. (Calomel. Mild Chloride of Mercury. Subchloride of Mercury.) 
Dose (laxative), 0.125 gm. (125 milligm.); 2 gr.; (alterative), 0.065 
gm. (65 milligm.); 1 gr. 

Preparation. 

Pilulae Catharticse Composite.— Compound Cathartic Pills. 
Dose, 2 pills. 



20 PHARMACOLOGY AND THERAPEUTICS. 

Preparation. 

4. HYDRARGYRI IODIDUM FLAVUM.— Yellow Mercurous Io- 
dide. (Mercury Protiodide. Yellow or Green Mercury Iodide.) Dose, 
0.010 gm. (10 milligm.); y 3 gr. 

5. HYDRARGYRI IODIDUM RUBRUM.— Red Mercuric Iodide. 
(Mercury Biniodide. Red Iodide of Mercury.) Dose, 0.003 gm. (3 
milligm.); ^ gr. 

Liquor Arseni et Hydrargyri Iodidi. — Solution of Arsenic 
and Mercuric Iodides. (Donovan's Solution.) Dose, 0.1 C.C.; 

6. HYDRARGYRI OXIDUM FLAVUM.— Yellow Mercuric Oxide. 

Preparations. 

1. Unguentum Hydrargyri Oxidi Flavi. — Ointment of Yel- 
low Mercuric Oxide. 

2. Oleatum Hydrargyri. — Oleate of Mercury. 

7. HYDRARGYRI OXIDUM RUBRUM.— Red Mercuric Oxide. 
(Red Precipitate.) 

Preparation. 
Unguentum Hydrargyri Oxidi Rubri. — Ointment of Red 
Mercuric Oxide. (Red Precipitate Ointment.) 

8. LIQUOR HYDRARGYRI NITRATIS.— Solution of Mercuric 
Nitrate. 

9. UNGUENTUM HYDRARGYRI NITRATIS. — Ointment of 
Mercuric Nitrate. (Citrine Ointment.) 

Unofficial Preparations. 

Ammoniae et Hydrargyri Chloridum. — Ammonio-Mercuric 
Chloride. (Sal Alembroth.) 

Emplastrum Ammoniaci cum Hydrargyro (U. S. P., 1890). — 
. Ammoniac Plaster with Mercury. 

Hydrargyri Carbolas. — Mercuric Carbolate. Dose, 0.02 to 
0.03 gm.; y, to y 2 gr. 

Hydrargyri Cyanidum (U. S. P., 1890). — Mercuric Cyanide. 
Dose, 0.001 to 0.008 gm.; ^ to T \ gr. 

Hydrargyri et Zinci Cyanidum.— Mercuro-Zinc Cyanide. 

Hydrargyri Formamidas. — Mercuric Formamidate. Dose, 
hypodermatically, 1 C.C.; 15 tl\,. 



MERCURY. 2 1 

Hydrargyri Oxidum Nigrum. — Black Mercurous Oxide. 

Hydrargyri Subsulphas Flavus (U. S. P., 1890). — Yellow 
Mercuric Subsulphate. (Turpeth Mineral.) Dose, 0.12 to 0.21 
gm.; 2 to 4 gr., as an emetic. 

Hydrargyri Sulphidum Rubrum. — Mercuric Sulphide. (Cin- 
nabar. Red Sulphide of Mercury.) 

Hydrargyri Tannas. — Mercurous Tannate. Dose, 0.06 to 0.12 
gm.; 1 to 2 gr. 

Hydrargyrol. — Hydrargyrol. (Mercury Paraphenylthionate.) 

Hydrargyrum Colloidale. — Colloid Mercury. Dose, 0.09 to 
0.18 gm.; iy 2 to 3 gr. 

Lotio Hydrargyri Flava (B. P.). — Yellow Mercurial Lotion. 
(Yellow Wash.) 

Lotio Hydrargyri Nigra (B. P.). — Black Mercurial Lotion. 
(Black Wash.) 

Mercurol. — Mercurol. 

Pilulae Antimonii Compositae (U. S. P., 1890). — Compound 
Pills of Antimony. Dose, 1 to 3 pills. 

Action of Mercury and its Salts. 
External. — Locally the metal itself and many of its salts are 
inert. The action of others varies from that of a mild stimu- 
lant to the effect of a powerful irritant and escharotic. Thus, 
the acid solution of mercuric nitrate is strongly caustic. Mer- 
cury and its salts are readily absorbed by the skin, so that the 
physiological effects of the drug can all be produced by inunc- 
tion. When metallic mercury, rubbed into fine globules, is 
applied to the integument in ointment, it passes into the gland 
ducts and along the roots of the hairs, and, after being oxidized. 
is dissolved and taken up into the tissues. It is also possible 
for the vapor to be absorbed by the mucous membrane of the 
lungs, and this pulmonary absorption of the drug is not at all 
uncommon when mercurial preparations (many of which are 
very volatile) are applied to the skin. Some of these prepara- 
tions, when thus locally applied, have considerable efficiency in 
allaying itching, however produced, and a large number of 
them (among which may be mentioned the oleate, oxide, am- 



22 PHARMACOLOGY AND THERAPEUTICS. 

moniate and corrosive chloride) are anti-parasitic, destroying 
the animal and vegetable parasites which infest the skin. 
Mercury, it has been proved, is possessed of great germicidal 
power. 

Lower Forms of Life. — Its germicidal potency is due to the 
fact that it is poisonous not only to the higher plants and ani- 
mals, but also to lower organisms. Whenever it comes into 
intimate contact with albumins, it forms the albuminate and 
destroys life, and there can be no question that corrosive mercu- 
ric chloride and the other soluble salts of mercury are among 
the most important antiseptics at present known. It has been 
demonstrated that the bichloride in the strength of i to 50,000 
destroys infusoria in about twenty minutes, and that even a 
solution of one part in one million destroys algae in the course 
of a few days. While the bacteria are somewhat more resist- 
ant than these, it is claimed that a solution of 1 to 1,000,000 will 
delay the development of some of them, and the anthrax 
bacillus, it has been found, fails to grow in blood which con- 
tains 1 part in 8,000. At the same time, it is now regarded as 
indubitable that the germicidal power of the bichloride has been 
considerably over-estimated; for, while it has been commonly 
accepted that a strength of 1 to 1,000 is sufficient to completely 
disinfect fluids within a few hours, it has been proved that 
anthrax spores, after having been exposed to the action of a 1 
per cent, solution for many hours, are still capable of develop- 
ing as soon as the antiseptic is removed. Calomel, it has been 
demonstrated, has some effect as an intestinal antiseptic; but, 
owing to the difficulty of bringing them into intimate contact 
with the microbes, the insoluble salts are naturally much less 
efficient as germicides than the soluble ones. 

Internal. — Mercury, unlike other metals, has, as is shown by 
its powerful germicidal influence, a strong specific action on 
protoplasm, and this property is due to its marked affinity for 
nitrogenous molecules. While its different salts have different 
external actions, yet after absorption their effects on the sys- 
tem are as a rule much the same. Both the local and general 



MERCURY. 23 

effects of a soluble salt, such as the bichloride, are more pro- 
nounced than those of one like calomel (which is entirely in- 
soluble in water) since it comes into more intimate contact with 
the tissues, and so acts more energetically locally, while it is 
also absorbed more rapidly and in larger amount. When, how- 
ever, a sufficient quantity of mercury in the form of calomel 
has been absorbed, the general effects are the same as if an 
equal amount had been taken up by the tissues as perchloride. 
When mercury is absorbed, it has been shown that it circulates 
in the blood in the form of the albuminate, which is insoluble 
in water, but is rendered soluble by excess of proteid, and, also 
by such quantities of sodium chloride as are met with in the 
tissues. It has- a marked corrosive action, which, as has been 
pointed out, is the more powerful because the precipitate formed 
with proteids is less insoluble in the surrounding fluids of the 
body, and is therefore more flocculent and affords less protec- 
tion to the surface, than those formed by the other heavy 
metals; so that this destructive influence is not limited to the 
surface of a tissue, but extends into the deeper cells. 

Absorption and Elimination. — When mercury is administered 
regularly for a considerable time, elimination, which appears to 
take place irregularly and intermittently, fails to keep pace with 
absorption. It disappears from the blood and is then deposited, 
in less soluble form, in the tissues and organs, and it has been 
found that this accumulation is especially liable to occur in cer- 
tain parts of the body like the kidneys, the intestinal walls, the 
liver, the spinal cord, and the medullary cavities of long bones. 
Absorption of the drug may take place from all surfaces, and 
is said to be especially rapid from serous ones. It is excreted 
principally by the bowels, but also to some extent in the urine, 
saliva, perspiration and milk. The excretion by the kidneys, 
which begins in about two hours after ingestion, has been 
noted as long as six months after the use of mercury has been 
discontinued. Mercury has been found in serum and in pus 
from ulcers. 

Alimentary Tract. — The first evidences of mercurialism are 



24 PHARMACOLOGY AND THERAPEUTICS. 

met with in the mouth. The initiatory symptoms are usually 
a slight fetor of the breath, which is sooner or later accom- 
panied by a disagreeable metallic taste, and tenderness of the 
teeth when they are forcibly brought together or knocked with 
a metallic substance. These are followed by stomatitis, spongi- 
ness of the gums, swelling of the tongue, and profuse salivation. 
That this condition is not due to any local action of the mercury 
is shown by the fact that it results in exactly the same way 
when the drug is administered by inunction or by subcutaneous 
injection. The salivation is apparently due to the direct effect 
of the agent on the secretory apparatus, and sometimes it is the 
very first symptom to make its appearance. If the administra- 
tion be continued, the quantity of saliva poured out becomes 
enormous; it is altered in character, contains mercury, and 
irritates the skin over which it flows. The fetor is excessive 
and the gums are intensely inflamed, being marked by a dark 
red line at the junction of the teeth, and bleeding at the 
slightest touch. Both the parotid and submaxillary glands are 
enlarged and tender. The teeth become loosened in their 
sockets and may drop out, and excoriations caused by the irri- 
tation of the drug lead to the formation of ulcers, particularly 
where there are accumulations of microbes, as around carious 
teeth. Finally, the maxillary bones undergo necrosis, as a re- 
sult of the penetration of these ulcers, which sets up periostitis. 
Children under the age of three years are seldom salivated, but 
they are not exempt from the other effects of mercury on the 
system. In the stomach the action of the drug is less marked 
than in the mouth, but it may produce more or less hyperemia, 
and in cases of poisoning this is accompanied by small haemor- 
rhages. In the small intestine also it has comparatively little 
effect, but in the caecum and colon it gives rise to well-marked 
lesions. These consist of congestion and tumefaction of the 
mucous membrane, which later result in necrotic patches of 
considerable extent and ulcers about the folds; the appearances 
presented being practically identical with those met with in 
chronic dysentery. Perforation of the gut may eventually 



MERCURY. 2 5 

occur. The intestinal inflammation is naturally accompanied by- 
excessive purging and intense abdominal pain, with tenesmus. 
The stools, which are fluid in character and sometimes present 
a rice-water appearance, contain blood, mucus and shreds of 
mucous membrane. Small doses of the insoluble salts, how- 
ever, usually cause loose passages without any griping or strain- 
ing. They pass through the stomach undissolved, it is be- 
lieved, but in the intestine, where time is afforded for the ex- 
ercise of their affinity for epithelium, they become partially dis- 
solved and produce the characteristic irritant effect of the drug. 
While a small proportion of such preparations is absorbed from 
the bowel, by far the greater part passes off unchanged in the 
faeces. It is possible, therefore, for very large doses of calomel 
to be taken without giving rise to any serious disturbance of 
the system. That salt, it has been found, exerts no action on 
the digestive ferments, but it has the effect of limiting the 
decomposition of food by retarding putrefaction in the intestine ; 
its antiseptic action being aided by the removal of the decom- 
posing mass in consequence of the increased peristalsis which 
iv induces. After the use of calomel a diminution of the double 
sulphates in the urine is noted, and this is to be attributed as 
much to its cathartic as to its antiseptic qualities. When calo- 
mel is administered it is likely that a small portion will be 
changed into the corrosive chloride, thus enhancing its anti- 
septic effects. Further, it should be noted that the same 
transformation may take place after prolonged trituration with 
milk sugar. 

Liver. — At the present time it is held that there is no 
sufficient evidence, either experimental or clinical, to show 
that, with the exception of the corrosive chloride, which in- 
creases the biliary secretion, the liver is in any way directly 
affected by mercurials. It was formerly universally believed 
and taught that calomel and some of the other mercurial purges 
increase the secretion of bile, but this has been demonstrated, 
both in the case of man and of animals, to be a mistake. This 
opinion was apparently based on the spinach-green color of 



26 PHARMACOLOGY AND THERAPEUTICS. 

the stools after the administration of calomel, but the latter 
is now known to be due to the circumstance that the bile is 
preserved by this drug from putrefaction in the intestine. 
Mercury, it has been shown, acts in the bowel even when the 
bile is suppressed, and the stools are often of a greenish color, 
which has been thought to be due to a metallic compound formed 
in the bowel, but which really results from bile pigment. Com- 
monly this is decomposed by the microbes in the intestine, with 
the formation of the faecal pigment, but mercury prevents, by 
its antiseptic properties, the growth of the microbes, and the 
bile therefore appears in the stools undecomposed and having 
its ordinary color. It is true that so-called " biliousness " is 
very frequently relieved by mercurials, but this is readily ex- 
plained by the fact that the condition thus designated is one not 
dependent upon the liver, but a disorder of the alimentary tract. 
In this and other affections where the good effects of mercury 
were supposed to be due to its power to increase the flow of bile, 
equally satisfactory results may be obtained by the use of 
other remedies not regarded as cholagogues. At the same time, 
it is true, as mentioned, that the corrosive chloride does actu- 
ally have some effect in increasing the amount of bile, and it 
may possibly be the case that occasionally when calomel is 
administered, some of it, owing to the presence of special condi- 
tions, is converted into that salt. 

Kidneys. — Although it has recently been shown that mercury 
in the form of calomel has a decided diuretic action in rabbits, 
in other animals and in the normal human subject it generally 
has but a comparatively feeble influence on the kidneys. When 
dropsy due to cardiac disease is present, however, it has been 
found that a moderate dose of calomel induces marked diuresis. 
In the accumulations of fluid resulting from cirrhosis of the 
liver and from renal disease its action in this respect is much 
less constant, but in many instances is still quite pronounced. 
While the question has not as yet been definitely determined, it 
seems probable that, since calomel and other salts of mercury 
are known to have an irritant effect upon the kidneys, the 



MERCURY. 27 

diuresis produced by them is due to their direct action upon the 
renal epithelium. When small amounts of mercury are taken, 
the excretion of the drug by the kidneys has not been found to 
cause any pathological changes in the organs, but if the ad- 
ministration is continued for a considerable length of time, it 
gives rise to interstitial and glomerular nephritis; while large 
amounts induce parenchymatous nephritis with glycosuria. The 
relative quantity of mercury excreted by the kidneys is said to 
be increased by the inflammatory changes occasioned. In acute 
mercurial poisoning, when death does not result in a few hours, 
anuria is frequently observed. While the whole kidney is con- 
gested and the glomeruli are acutely inflamed, the most dis- 
tinctive feature met with is a necrosis of the epithelium of the 
tubules in portions of the cortex; and the anuria is the result 
of these pathological changes. As in the case of certain other 
drugs, such as bismuth and aloin, there is sometimes a deposit 
of lime in the kidneys. In mercurial poisoning this is very 
generally noted in rabbits, but less frequently in dogs and in 
man. When it occurs, the tubules are found to be filled with 
a deposit of calcium phosphate, which is occasionally mixed 
with some chalk. It is thought most probable that this is 
thrown out in the necrosed cells and that, as these break up, 
it passes into the tubules. As a rule, the more marked the 
intestinal disturbance, the less pronounced are the destructive 
changes in the kidney in cases of poisoning, and it has been 
found that the latter changes are most frequently caused by 
corrosive mercuric chloride. 

Nervous System. — Mercury has comparatively little effect 
on the central nervous system. In acute poisoning the only 
symptoms observed are secondary to the fall of blood-pressure, 
while consciousness is preserved to the last. In chronic poison- 
ing, however, there are not infrequently noticed tremor, 
erythism and hallucinations, which appear to be of central 
origin. Sometimes there is a dulling of the faculties. The 
general muscular weakness observed is believed to be due, not 
to any affection of the peripheral muscles and nerves, but to 



28 PHARMACOLOGY AND THERAPEUTICS. 

alterations in the centres. The paralysis which is sometimes 
seen in the limbs of workers in mercury has, on the other hand, 
been attributed to the action of the drug on the peripheral 
nerves, destroying the myeline sheath, and the areas of partial 
anaesthesia and the pains in the joints are also probably due 
to peripheral changes. When peripheral neuritis occurs, it 
takes place much later than in the case of lead poisoning. In 
man the muscles do not appear to be directly acted upon in 
either acute or chronic poisoning. Even when paralysis is 
developed, they maintain their irritability and do not undergo 
atrophy. In some instances, especially when the tremor is pro- 
nounced, the reflex excitability of the spinal cord is found to be 
exaggerated, but as a rule it remains unaffected. 

Circulation and Respiration. — In some cases of acute poison- 
ing patches of fatty degeneration have been found in the heart. 
For the most part, mercury has but little direct action on the 
circulation, and such changes as occur in the pulse are attri- 
butable to the shock and collapse in acute, and to the cachexia 
and malnutrition in chronic, poisoning. When general poisoning 
is caused by the intravenous injection of the drug, however, it 
is found that there occurs a very marked fall of blood-pressure, 
which is due to a direct paralyzing action on the heart (involv- 
ing both ganglia and muscle) and on the blood-vessels. The 
respiration is affected only indirectly. The marked breathless- 
ness which is sometimes observed in cases of chronic poisoning 
has been ascribed to the general muscular weakness. 

The Blood and Nutrition.— In health the red corpuscles and 
the haemoglobin appear to be at first augmented and afterwards 
diminished, and while the number of newly formed leucocytes 
has been found to be increased, this is more than counterbal- 
anced by the decline in the older cells. In syphilis it has been 
noted that a pronounced decline in the amount of haemoglobin 
is followed by an increase to beyond that present before the 
treatment was commenced, while there have been found fewer 
newly formed leucocytes, and more mature ones, after mercury. 
It would appear, therefore, that the blood reaction is different 



MERCURY. 29 

in health from that in syphilis, and that it varies in the succes- 
sive stages of that disease. Large doses of the drug destroy the 
crasis of the blood and impair the general nutrition. Whether 
mercury affects the nutrition in any way except through its 
action on the alimentary canal is not definitely known. It has 
been stated by some authors that the urea is increased by the 
use of small doses, but the investigation of these metabolic 
effects is very inconclusive and difficult, on account of the ex- 
tensive action of mercury on the kidneys and intestine, and 
the prolonged administration of the drug is necessarily restricted 
to experiments on animals and on syphilitics. Very small doses 
may perhaps act in much the same manner, and have the same 
beneficial effect upon metabolism, as small doses of arsenic, the 
subject gaining in weight, etc. It seems to be fairly well 
established that in animals, at all events, the nutrition and 
weight are increased by minute doses of mercury given for 
some time. Chronic mercurial poisoning affects metabolism 
profoundly, producing marked cachexia. 

The Skin. — The excretion of mercury through the skin may 
produce various cutaneous affections. The most common erup- 
tion is a polymorphic erythema, more or less resembling that 
of scarlet fever. In other cases it is erysipelatous in charac- 
ter, with subcutaneous cedematous swelling, and still other 
forms are urticaria, roseola, pemphigus and purpura. Some- 
times there is produced a very severe eczema, which eventually 
becomes pustular, and this is said to occur most frequently as 
the result of inunction. Usually the eruption is evanescent, 
being followed by desquamation in two or three days ; but cases 
have been observed in which there has been a grave generalized 
dermatitis, with marked swelling of the face and extremities, 
excessive desquamation, subcutaneous infiltration, excoriation, 
fever, disturbance of the respiration, and prostration, resulting 
even in death. 

Temperature. — Mercury in itself has no effect on the body 
temperature, but in severe ptyalism and in the more serious 
cutaneous affections caused by it there is always more or less 



30 PHARMACOLOGY AND THERAPEUTICS. 

febrile reaction. In collapse resulting from poisoning by the 
drug the temperature may fall several degrees below the normal. 

Therapeutics of Mercury and its Salts. 
External. Antiseptic Action. — Mercurials, and especially the 
bichloride, are at the present time used very extensively for 
antiseptic purposes in surgery and midwifery. Of the numer- 
ous methods which have been proposed for disinfecting the 
hands, two, those of Welch and Fiirbringer (which is much 
simpler), are considered trustworthy. They are described as 
follows: Welch's method: (i) The hands and nails are thor- 
oughly cleansed with hot water and soap, the water to be as 
hot as can be borne, and the brush used to have been first 
sterilized with steam. This preliminary brushing should occupy 
from three to five minutes. (2) The hands are rinsed in 
clean, warm water. (3) They are next immersed for one or 
two minutes in a warm, saturated solution of potassium perman- 
ganate, and while in this solution they are thoroughly rubbed 
with a sterilized swab of absorbent cotton. (4) They are next 
placed in a warm, saturated solution of oxalic acid, and kept 
there until completely decolorized. (5) They are then 
thoroughly washed in clean, sterilized water or salt solution. 
(6) Finally, they are immersed for two minutes in 1 to 500 
corrosive sublimate solution, rinsed in water, and dried. Fiir- 
bringer's method: (1) Remove all dirt under and around the 
nails. (2) Brush nails and skin of hands thoroughly with soap 
and hot water. (3) Immerse in alcohol, 95 per cent., for not 
less than a minute, and before this evaporates (4) plunge the 
hands in 1 to 500 corrosive sublimate or 3 per cent, carbolic acid 
solution, and thoroughly wash them for at least a minute; after 
which the hands may be rinsed in warm water and dried. On 
account of the difficulty of thoroughly disinfecting the hands, 
however, many surgeons have now adopted the practice of wear- 
ing rubber gloves when operating, and such gloves are also 
often used by obstetricians. For washing the walls or 
floors of infected rooms and furniture, linen and other articles, 



MERCURY. 3 I 

and for soaking towels, lint, sponges, etc., used in operations, 
a corrosive sublimate solution of the strength of I to 1,000 is 
usually employed. The corrosive chloride cannot be used for 
disinfecting metallic instruments, as mercury becomes deposited 
upon them. The use of this salt for vaginal injections and 
otherwise in obstetrics is believed to have been one of the 
principal factors in the remarkable reduction of the death-rate 
which has in recent years been noted in lying-in hospitals. 

In preparing a surface of the body for operation the part is 
generally scrubbed with green soap and warm water, and, after 
being shaved, is cleansed with ether or alcohol. It is then 
irrigated with a I to 1,000 bichloride solution, but if the skin is 
at all broken a very much weaker one is employed. For a 
single washing of wounds or cavities the strength should not 
exceed i to 2,000, and weaker solutions are preferable. For 
continued irrigation it should not exceed 1 to 10,000, and even 
this strength has been known, when used in the peritoneal 
cavity, to give rise to toxic symptoms. Gauze washed in a 
weak bichloride solution is frequently used as a dressing after 
operations. In using the bichloride and other preparations of 
mercury as antiseptics it is often advisable to add about 5 parts 
of tartaric, citric or hydrochloric acid to 1 of the mercurial in 
the solution employed, in order to prevent its uniting with the 
albumin of the tissues. Otherwise an insoluble and useless 
mercury albuminate may be formed, and the antiseptic value of 
the fluid be destroyed. Bichloride solutions should as a rule 
be freshly prepared, but if it is necessary for any reason to keep 
them for some length of time, either sodium chloride or a weak 
acid should be added to prevent decomposition of the bichloride. 
Bichloride tablets, tinted blue for safety, which are made of 
such a strength that one dissolved in a pint of water makes a 
solution of 1 to 500, are extremely convenient for ready use. 
Mercuric biniodide (1 to 4,000 to 1 to 20,000) has been used to 
a small extent as an aniseptic, and in eye surgery is said to be 
preferred by some to the bichloride, on account of its being less 
irritating than the latter. The mixed mercury and zinc cyanide, 



$2 PHARMACOLOGY AND THERAPEUTICS. 

as suggested by Lister, is unirritating. It is said to have but 
slight germicidal value, but its inhibitory power is so great that 
a solution of I to 1,200 will permanently prevent putrefaction in 
animal fluids. Cyanide gauze may be made actively germicidal 
by impregnation with a solution of 1 to 4,000 of corrosive 
mercuric chloride. The following reaction may be used to 
determine whether the corrosive mercuric chloride with which 
gauze has been impregnated has partially changed into the 
mild chloride : If a black color appears upon application of 
lime water, calomel is present. 

Irritant Action. — The Unguentum Hydrargyri Iodidi Rubri, 
B. P. (mercuric iodide, 2; benzoated lard, 48), is employed as 
a dressing to indolent scrofulous and syphilitic ulcers. The acid 
solution of mercuric nitrate is of service in the treatment of 
warts, chancroids, syphilitic condylomata, mucous patches, and 
ulcers of the mouth, while citrine and red precipitate ointments, 
properly diluted, may often be applied with advantage to ulcers 
and sores, whether syphilitic or not, when a stimulating effect 
is desired. The application of solution of the nitrate is painful 
and may cause haemorrhage, and it should be used with caution 
on account of the danger of giving rise to sloughing. It is 
recommended that it should never be employed for venereal 
ulcers in full strength, and as a substitute for its application 
Ricord's method of treatment may be adopted. This consists 
of washing the sores or condylomata with solution of chlorin- 
ated soda, and, after drying with absorbent cotton, dusting calo-. 
mel, or equal parts of calomel and starch, over the surface. 
When a milder preparation is required, black wash (Lotio Hy- 
drargyri Nigra, B. P. — Calomel, 1; glycerin, 8; mucilage of 
tragacanth, 20; lime water, to 160) ; is also very commonly 
used. 

Antiparasitic Action. — Mercurial preparations are among our 
most valuable applications in external parasitic affections. For 
destroying lice upon the head white precipitate ointment, dilute 
citrine ointment, and corrosive sublimate, in the form of a wash, 
are all used, and the same agents, particularly the latter, are 



MERCURY. 33 

also efficient in such conditions as scabies, favus, ringworm, 
tinea sycosis, and pityriasis versicolor. The oleate of mercury 
is employed to some extent for the same purposes, but it should 
be considerably reduced in strength for most cases. The oleate 
diluted with oleic acid, with the addition of one-eighth part of 
ether, has been recommended by some. Unguentum Hydrargyri 
Oleatis B. P. (Oleate of mercury, i; benzoated lard, 3), may 
also be used. Caution should be exercised in not applying 
mercurials over too large an area, on account of the risk of 
the production of toxic effects through absorption. 

Cutaneous Affections. — A weak calomel ointment is often of 
service in itching affections, especially around the anus. The 
Unguentum Hydrargyri Subchloridi, B. P., contains 10 per cent, 
of calomel. In impetigo contagiosa and ecthyma such an oint- 
ment may be applied after separation of the crusts. Calomel 
ointments, as well as white precipitate ointment with the addi- 
tion of a little menthol and cocaine, are also beneficial in herpes, 
herpes zoster, seborrhcea, and eczema, especially of the genital 
organs. An ointment which is highly esteemed in many skin 
diseases is composed of equal parts of diluted mercuric nitrate, 
zinc oxide and lead acetate ointments. The B. P. Unguentum 
Hydrargyri Nitratis Dilutum consists of 20 per cent, mercuric 
nitrate ointment, with paraffin. For chronic psoriasis and 
eczema, especially of the hands and feet, an ointment composed 
of equal parts of mercuric nitrate ointment and lanolin, with a 
varying amount of oil of juniper, has been found efficient. 
Black wash and yellow wash (Lotio Hydrargyri Flava, B. P.: 
corrosive mercuric chloride, 1 ; lime water, 240) may also be 
used to allay the itching of such cutaneous affections as pruritus 
senilis and urticaria, if the disease is not too extensive in area. 
For the local treatment of variolous pustules and also of erysipe- 
las it has been recommended that the surface should be sprayed 
with a solution containing 1 gm. (15 gr.), each, of corrosive 
mercuric chloride and either citric or tartaric acid, 5 c.c. (80 ^l) 
of 90 per cent, alcohol, and a sufficient quantity of sulphuric 
ether to make 90 c.c. (3 fl. dr.). The following application has 

4 



34 PHARMACOLOGY AND THERAPEUTICS. 

also been found highly successful in erysipelas : Resorcinol (or 
naphthalene), 5; ichthyol, 5; mercurial ointment, 40; lanolin, 
50. When the skin is not too tender, it is advised that the 
proportion of ichthyol should be increased. After the affected 
parts have been anointed with this they are covered with 
oiled silk or other impermeable material, and then enveloped 
in a light dressing and bandaged. 

Diseases of the Eye and Ear. — In ophthalmic practice the 
ointment of yellow mercuric oxide, known as Pagenstecher's 
ointment or ophthalmic salve, is largely employed. Calomel is 
also used as a sedative application in conjunctivitis and other 
affections. Before applying calomel to the eye, however, it 
should first be ascertained whether the patient has had a course 
of iodine treatment, since, if this is the case, a caustic com- 
pound may be formed between the mercury and iodine which 
may set up violent inflammation of the conjunctiva and the 
lids, possibly resulting in almost complete loss of vision. 
Largely diluted citrine ointment is sometimes used in the place 
of Pagenstecher's ointment in the treatment of chronic bleph- 
aritis, tinea tarsi, and eczema. Favorable results have been 
reported from the subconjunctival injection of a small quan- 
tity (0.12 c.c. — 2 HI) of 1 to 1000 solution of mercuric bichlo- 
ride in iritis (both syphilitic and non-syphilitic), choroido- 
iritis, exudative choroiditis, central choroido-retinitis, and de- 
tachment of the retina. Mercuric cyanide has sometimes been 
employed instead of the bichloride. This method of treatment 
has also proved successful in some cases of sympathetic ophthal- 
mia, but appears to have failed in keratitis. It is stated to be 
not adapted to cases in which the stasis of the local circulation 
prevents, either wholly or in part, absorption of the injected 
fluid. In ear affections an ointment of yellow mercuric oxide, 
0.32-0.65 gm. (5 to 10 gr.) to 30 gm. (1 oz.) of lard or cold 
cream, is used to a considerable extent to subdue inflammatory 
action. 

Absorbent Action. — Oleate of mercury and the various mer- 
curial ointments are used to a considerable extent to reduce 



MERCURY. 35 

swellings and promote the absorption of subcutaneous effusions 
and the general products of inflammatory action. They are not, 
however, superior in efficiency to other agents for such pur- 
poses, and have the disadvantage of introducing the poison 
mercury into the system. While in some instances the con- 
stitutional effects of the latter may not be contra-indicated, in 
many others they may prove decidedly objectionable and even 
dangerous. The likelihood of the occurrence of such absorption 
and its possible consequences should always be borne in mind. 
Mercurial ointment, blue ointment, Scott's ointment (Unguen- 
tum Hydrargyri Compositum, B. P., which consists of mercurial 
ointment, 10; yellow wax, 6; olive oil, 6; and camphor 3), or 
the oleate in an ointment, may be applied in affections of the 
joints, orchitis and chronically enlarged glands. Chronic peri- 
tonitis has sometimes been treated with success by the use of a 
binder spread with one of these preparations or the Linimentum 
Hydrargyri, B. P., which consists of equal parts of mercurial 
ointment, solution of ammonia, and camphor liniment. The 
ointment of red mercuric iodide, somewhat diluted and applied 
before a hot fire or in the direct sunlight, is said, in numerous 
instances, to have speedily reduced goitre and enlarged spleen. 
Internal. Alimentary Canal. — One of the most important 
internal uses of mercury is as a purge, and the two preparations 
employed for this purpose are blue mass and calomel. In the 
condition commonly known as biliousness, which is character- 
ized by lassitude, headache, constipation, nausea, yellowish- 
coated tongue, yellow conjunctivse, and more or less " muddi- 
ness " of the skin, either of these drugs at night, followed by a 
hydragogue cathartic in the morning, will often completely 
relieve the symptoms, which are due, not to hepatic derange- 
ment, but to disorders resulting from the putrefactive changes 
in the gastro-intestinal tract which are responsible for the con- 
version of the green bile pigments into those of the faeces. 
The dark, greenish stools following the use of mercurials is 
explained by the abolition or lessening of these putrefactive 
changes. The principal action of the mercurials, it is believed, 



36 PHARMACOLOGY AND THERAPEUTICS. 

is exercised partly upon the glandular system of the gastro- 
intestinal tract, and partly upon the, bacteria of the region, 
which, after being destroyed by the antiseptic properties of 
the mercurial, are swept away by the succeeding purge. Blue 
mass is less certain and less energetic in its action than calo- 
mel. In conditions where there are loss of appetite, tympanites, 
jaundice and whitish or clay-colored stools, and which are 
believed to be due to a catarrhal state of the mucous membrane 
of the hepatic duct and of the intestine, mercurials have long 
been highly esteemed on account of their supposed cholagogue 
action. It is true that they are generally efficient in removing 
the symptoms, but it is in the manner just referred to, and it 
has been found that such salines as sodium phosphate, mag- 
nesium sulphate and Rochelle salt will often answer equally 
well. In conditions like the above and in others where there is 
constipation, instead of giving a single full dose of blue pill or 
calomel, the practice has now become quite commonly adopted 
of prescribing the latter in small doses, such as .016 to .006 gm. 
(y A to-j^gr.), thoroughly triturated with sugar of milk and 
repeated every hour until a movement is secured. Some physi- 
cians stop the calomel after four or five doses have been taken, 
and give a dose of bitter water or Rochelle salt the next morn- 
ing. Others give the calomel every fifteen minutes until six 
doses of .006 gm. (y 1 ^ gr.) have been taken, and four hours 
afterward, a saline. The efficiency of the calomel is believed 
by many to be increased by combining with each dose .13 gm. 
(2 gr.) of sodium bicarbonate. The action of repeated small 
doses of calomel has been found to be entirely satisfactory, 
while this plan of administration is much more comfortable for 
the patient than the use of large doses. Mercurials are usually 
well borne by infants and children. Gray powder (Hydrargy- 
rum cum Creta), in minute doses, has been advised for the sud- 
den vomiting immediately after the ingestion of food sometimes 
observed in children. In cholera infantum and in other diar- 
rhceal diseases, both acute and chronic, it may also often be 
used with good effect. In cases of diarrhoea due to the pres- 



MERCURY. 37 

ence of some irritant in the intestinal tract, one or two doses 
will not infrequently prove curative by removing the offending 
material. Gray powder is a very useful purgative for children, 
and also for adults when a very mild effect is desired. Its ac- 
tion does not, as a rule, cause any griping, which is sometimes 
quite marked in the case of calomel. On account of their anti- 
septic effects in the intestine, mercurials are given to a con- 
siderable extent, especially in Germany, in typhoid fever. Some 
physicians make it a practice to commence their treatment of 
this disease with calomel. Calomel has also been recommended 
in Asiatic cholera, but it cannot be said that the results from it 
have proved very satisfactory. Formerly large doses at con- 
siderable intervals were often employed, but at the present time, 
when its use is resorted to here, it is more commonly given in 
small doses, frequently repeated, and also combined with opium, 
chalk, piperine, etc. It is stated, however, that large doses 
(1.30 to 4 gm. ; 20 gr. to 1 dr.) sometimes appear to arrest 
vomiting when other means fail, though given in such amounts 
it is liable to produce excessive ptyalism when reaction sets in. 
Cardiac and Inflammatory Diseases. — In valvular disease of 
the heart with dropsy mercury sometimes proves of great ser- 
vice when combined with digitalis and squill, as in Guy's diuretic 
pill, which is composed as follows: Blue pill, powdered squill, 
and powdered digitalis, each, .06 gm. (1 gr.) ; extract of hyo- 
scyamus, .10 gm. (gr. 1^2). The drug is considered by many a 
very valuable antiphlogistic agent, provided that its use be 
restricted to the treatment of inflammatory action of a sthenic 
type. Some authorities believe it to be the best remedy in 
sthenic endocarditis, and useful also in myocarditis and peri- 
carditis. While mercuric bichloride is sometimes used instead 
of calomel in these affections, for the reason that it does not 
produce catharsis, it has not usually been found as efficacious 
as calomel. When the latter is given as an antiphlogistic, 
opium is commonly combined with it, not only to prevent its 
acting on the bowels, but also to relieve pain and irritation. In 
meningitis resulting from head injuries it has been recom- 



3 8 PHARMACOLOGY AND THERAPEUTICS. 

mended that a powder containing .015 gm. (% gr.) each of 
calomel and powdered opium should be given every hour for 
five or six hours, while at the same time an ice-bag is kept 
applied to the head. In the early stages of diphtheria and 
croup mercury is thought to exert distinct prophylactic power. 
It is generally given in the form of the bichloride, but some 
advocate, as preferable, the use of calomel, administered in 
small repeated doses in dry powders, believing that the good 
effect of the mercurial is at least in part due to its diffusion 
over the diseased surface, and the consequent antiseptic influ- 
ence thus produced. In both pneumonia and pleurisy large 
doses of calomel have been highly recommended by certain 
clinicians, but the weight of opinion is to the effect that mercury 
is of decidedly less value in parenchymatous inflammations, 
such as pneumonia and hepatitis, than in those of a serous, 
character, like pleurisy, pericarditis and peritonitis. It should 
be carefully borne in mind that it ought never to be given in 
asthenic inflammatory conditions, and that in employing it as 
an antiphlogistic it should be exhibited during the stage of 
exudation, and to facilitate the absorption of the newly organ- 
ized lymph. In the treatment of iritis the use of mercury has 
proved especially successful, and it is the common practice in 
this affection to push the remedy to the point of ptyalism when- 
ever the tendency towards the exudation of lymph is marked. 
Although the matter has never as yet been practically demon- 
strated, there is considerable ground for the belief that the 
drug has the effect of diminishing the fibrin in the blood, and 
as in inflammatory conditions the latter is known to be in- 
creased, it has been supposed that there is a certain antagonism 
between the processes of mercurialization and of inflammation. 
Before leaving this branch of the subject, however, the state- 
ment should be made that many modern authorities believe 
that mercury has little or no remedial influence in acute in- 
flammation, either in the serous membranes or elsewhere, and 
that as it is commonly combined with opium, whatever benefit 
is noted from such treatment in inflammatory affections is to 



MERCURY. 39 

be attributed to that drug. In iritis, in which the efficacy of 
mercurials is admitted by all, it is contended that the good 
result is due to the fact that this disease is almost universally of 
syphilitic origin. With the growth of this opinion in the pro- 
fession the antiphlogistic use of mercury has undoubtedly be- 
come much more restricted than formerly. The various forms 
of the drug are now very commonly administered in the form of 
triturates, made with sugar of milk, which contain about 10 
per cent, of the mercurial preparation. Thus minutely sub- 
divided, the remedy is found to be more readily absorbed. 

Syphilis. — Undoubtedly the most important of all the uses of 
mercury is in the treatment of syphilis. Whatever question 
there may be as to its special utility in other conditions, all are 
agreed as to its preeminent value in this disease. Like quinine 
in malarial fever, it is universally conceded to be a true specific, 
although its precise mode of action has not as yet been deter- 
mined. While some authorities have contended that its cura- 
tive influence is due simply to the general effects upon metab- 
olism, it seems altogether probable that this is attributable to a 
specific toxicity for the syphilitic virus, which, when the drug is 
adequately exhibited, finally results in the complete destruction 
of the latter. Some eminent syphilographers hold that the 
action of mercury is to clear away from the tissues the products 
of a specific inflammation, or at least to relieve tissues encum- 
bered with superfluous and obstructive material; but whether 
it develops a specific destructive action on the virus or not, the 
fact remains that mercury is employed in syphilis because 
experience has shown indisputably that it cures the disease. 
In order to secure the most satisfactory results it is requisite 
that its administration should be commenced at the earliest pos- 
sible moment and that it should be continued for a considerable 
period after all manifestations of the disorder have disappeared. 
Its value in syphilitic condylomata, ulcerations, etc., has already 
been referred to, but here its local application is not sufficient, 
and an internal mercurial course should be entered upon just as 
soon as the diagnosis is established. This should never be dis- 



40 PHARMACOLOGY AND THERAPEUTICS. 

continued under one year, and it is not infrequently necessary 
to maintain it, with periods of intermission, for several years. 
While all are agreed as to the efficacy of the drug in the first 
and second stages of syphilis, authorities differ as to its value 
in the third stage. As a rule, however, in the tertiary period 
it will be found that the best results can be obtained by the 
mixed treatment, as it is called, mercurials in combination with 
the iodides, particularly potassium iodide. In most cases in 
which the disease is recognized early and in which mercurial 
treatment is promptly instituted and faithfully carried out, no 
tertiary symptoms occur and the use of the iodide is entirely 
uncalled for. The dose of the remedy should be carefully regu- 
lated in accordance with the circumstances of each individual 
case. The effort should be made, it is recommended, to give 
the largest amount that can be borne without the production 
of gastric, buccal, or other irritation; in other words, to over- 
whelm the disease without detriment to the general condition 
of the patient. In the earlier stages the proto-salts of mercury 
(and particularly mercurous iodide, known as the yellow iodide) 
are considered the most serviceable; later in the disease, espe- 
cially when used in conjunction with potassium iodide, it is 
customary to employ the persalts, the bichloride and biniodide 
being the most esteemed. By some authorities the subcutaneous 
injection of mercurials is recommended, and under special cir- 
cumstances these agents are introduced into the system in 
various other ways than by the mouth. Mercury is as efficient 
in congenital syphilis as in the acquired form. 

Mercurol is a chemical combination of nucleinic acid and 
mercury, the former being obtained from yeast. It is sometimes 
employed in a 2 per cent, solution as an injection in gonorrhoea. 
This apparently destroys the gonococci, lessens the severity of 
the inflammation, and tends to prevent the development of com- 
plications. It does not entirely stop the discharge in some cases. 
It has also been used in the local treatment of other purulent 
conditions of a specific character, such as conjunctivitis, oph- 
thalmia neonatorum, and otitis media, and also as an antiseptic 
dressing. 



MERCURY. 41 

Sal Alembroth has useful antiseptic properties, and one of its 
advantages is that it does not combine so readily with albumin 
as corrosive mercuric chloride. For antiseptic purposes it is 
generally employed in the form of gauze (containing 1 per cent, 
of the sal alembroth) or wool (with 2 per cent.). Both are 
tinted with aniline blue, and as the latter is bleached by the 
discharge, it can readily be seen when it has soaked through. 
Sal alembroth, in doses of .02 gm. (-i gr.) to .60 c.c. (10 HI) of 
water, is considered a convenient and non-irritating prepara- 
tion for hypodermatic use in the treatment of syphilis. The 
precautions mentioned below (p. 44) should be observed. 

Mercuro-Zinc Cyanide. — As an antiseptic, this has been 
claimed to possess the advantages of being non-volatile, unirri- 
tating, insoluble in water, and soluble only in three thousand 
parts of blood serum; so that it is not easily washed off from 
gauze by discharges from wounds. Its germicidal value, how- 
ever, is stated to be very slight, though its inhibitory power is 
such that a one-twelve-hundredth solution will permanently pre- 
vent putrefaction in animal fluids. In order that mercuro-zinc 
cyanide gauze may be made actively germicidal it is recom- 
mended that it should be impregnated with a solution of one to 
four thousand of corrosive sublimate. The gauze and wool, as 
usually prepared, contain 3 per cent, of the salt each, and are 
both tinted pink. Mercuro-zinc cyanide has also been used 
in the form of an ointment. 

Hydrargyrol, which chemically considered is mercury para- 
phenyl thionate, has been proposed as a substitute for corrosive 
mercuric chloride in antiseptic surgery. It is claimed that, 
while precipitating alkaloids and basic toxins, it does not pre- 
cipitate albumin, and that a solution of 4 to 1000 is non-irritant 
to the mucous membrane or skin and is not injurious to surg- 
ical instruments. Its toxic properties, as shown by experiments 
upon animals, are decidedly less marked than those of corrosive 
sublimate. 

Colloid Mercury has been put forward as a reliable antisyphi- 
litic, the advantages of which consist in the facility with which 



42 PHARMACOLOGY AND THERAPEUTICS. 

it is absorbed, the fact that it does not irritate the skin, its slow 
and enduring action, and its comparatively slight virulence. It 
is said to be effective also, when incorporated in ointments and 
plasters, for the treatment of epididymitis, arthritis, lymphade- 
nitis, etc. Internally, in pill form, it has been recommended 
as a substitute for blue pill and mercurous protiodide, as well 
as for corrosive mercuric chloride. 

Modes of administration of mercurials. — (i) By the mouth. — A num- 
ber of the preparations of mercury most commonly used for internal 
administration have already been spoken of. Among those not as yet 
mentioned is mercurous tannate, the dose of which is .06 to .12 gm. (1 
to 2 gr.) given in a tablet triturate or pill. It is used to a considerable 
extent in the treatment of syphilis, and is well thought of by many. It 
is asserted that it passes unchanged through the stomach, but is rapidly 
absorbed in the small intestine, and that it does not irritate the alimen- 
tary canal. The Liquor Hydrargyri Perchloridi, B. P. (corrosive mer- 
curic chloride, 1 ; ammonium chloride, 1 ; water, 1000), is a favorite 
preparation, and is frequently combined with potassium iodide in ter- 
tiary syphilis. The usual dose is 4 to 8 c.c. (1 to 2 fl. dr.). When 
used with potassium iodide, there is formed mercuric iodide, which is 
kept in solution by the excess of the potassium iodide. Mercurous 
iodide should never be given at the same time as potassium iodide, as 
the latter immediately converts it into red mercuric iodide and metallic 
mercury. Gray powder, as has been mentioned, is much used in the 
intestinal disorders of children. It is also the most generally satisfac- 
tory preparation for internal administration in syphilis of early life. 
The ordinary dose is .03 to .06 gm. (H to 1 gr.), which should be given 
frequently enough to bring the system under the influence of the drug 
without affecting the bowels. By some high authorities it is consid- 
ered the best preparation for continued use in syphilitic adults, as well 
as children. Mercuric carbolate has been found quite efficient. It is 
readily absorbed and it is said that it may be given for a long time 
without producing ptyalism. For syphilitic ulcerations of the mouth a 
very good wash may be made of corrosive mercuric chloride, .24 gm. 
(4 gr.), in 30.0 c.c. (10 fl. oz.) of water, to which is added 4 c.c. (1 fl. 
dr.) of diluted hydrochloric acid and a little glycerin. In syphilitic 
ulceration of the tongue troches of liquorice, each containing .003 gm. 
(to £*".) of the bichloride, are sometimes employed. Allowed to dissolve 
in the mouth, they produce a constitutional as well as a local effect. 
Mercurials are not well borne by patients suffering from Bright's dis- 



MERCURY. 43 

ease, in whom ptyalism is more readily induced than in others, nor in 
gouty or scrofulous subjects. In the latter, mercurialization may give 
rise to very serious results, and where there is a gouty tendency neural- 
gia is often caused by small doses. 

(2) By the rectum. — By the use of suppositories patients can be 
brought very rapidly under the influence of the drug, and occasionally 
this method will be found of service. Each suppository may contain .30 
gm. (5 gr.) of mercurial ointment. 

(3) Endermatically. — Mercurials, externally applied, produce a gen- 
eral, as well as a local, effect, on account of their ready absorption. 
Reference has already been made to the use of various lotions in sores, 
ulcers and syphilitic condylomata, and the preparations in powder, par- 
ticularly calomel, are often dusted on the surface in these conditions. 
Mercury is now never administered by the strict endermatic method, 
which consists of removing the cuticle by a blister or other means and 
applying the medicinal agent directly to the true skin, as it is a pain- 
ful procedure and the systemic effects of the drug may be much more 
satisfactorily obtained in other ways. 

(4) By inunction. — Mercury applied by inunction is quickly absorbed, 
and this method has a well-recognized position in the treatment of 
syphilis. Among the other conditions in which it has been found of 
service is gonorrheal rheumatism. It is used to a considerable extent 
in the treatment of infants and young children affected with congenital 
or acquired syphilis, and also in the case of adults when it is desired 
to bring the system rapidly under the influence of the drug, and at the 
same time to avoid disturbance of the digestive apparatus. Either mer- 
curial ointment or the oleate of mercury may be used for this purpose, 
and the latter possesses the advantage of not staining the clothing. It 
is customary to rub a piece about the size of a marble upon the inner 
side of the thigh or arm once or twice a day, and it is advised to change 
the application from place to place on account of the local irritation 
sometimes caused by the mercury. A hot bath previous to each inunc- 
tion no doubt assists absorption. If the patient does not apply the mer- 
curial himself, it is advisable that the person doing so, in order to avoid 
accidental salivation, should be protected by a bladder or a rubber glove, 
and should also wash his hands thoroughly with soap after each appli- 
cation. Another plan is to rub the ointment on the soles of the feet, 
so that the exercise of walking may promote absorption of the remedy. 
In the case of children it is often smeared upon the abdomen, after 
which the latter is covered with a flannel binder. It should be noted 
that in the eighth revision of the U. S. Pharmacopoeia there has been 



44 PHARMACOLOGY AND THERAPEUTICS. 

introduced an Unguentum Hydrargyri Dilutum (mercurial ointment, 
670; petrolatum, 330), with the name Blue Ointment, a designation 
which formerly was commonly applied to the official Unguentum 
Hydrargyri (mercurial ointment). At the present day it is not re- 
garded as necessary that mercurials should be rubbed into the skin 
with friction, as it has been found that the mere fact of spreading 
them upon the surface of the body and leaving them in contact with 
the skin is sufficient to secure the physiological effects of the drug. It 
is asserted that in Paris syphilis has been successfully treated by the 
application over the spleen of a plaster composed of calomel, 20, castor 
oil, 6, and diachylon plaster, 60 parts ; ptyalism being prevented by the 
alternate use and disuse of the plaster for periods of eight days at a 
time. Another method of external application is to paint the patient's 
back, after bathing, with a solution of gutta percha in chloroform, to 
which has been added a quarter of its weight of calomel. After the 
chloroform has evaporated the skin remains coated with a mercurial 
varnish. Calomel soap, made by triturating pure olive oil soap with 
calomel in the proportion of one to two or three, has been used by 
some as a substitute for mercurial ointment. It is cleanly and non-irri- 
tating to the skin, and its use is said to constitute an efficient method 
of mercurialization. A rare complication which has been attributed to 
the effect of mercury on the system is polyneuritis, and it is said that 
this has especially been noted after the very free use of mercurial in- 
unctions. 

(5) Hypodermatically. — This method is now practiced to a consid- 
erable extent in special cases, and is a cleanly, rapid and efficient way 
of producing the constitutional effects of mercury without gastrointes- 
tinal irritation. It is said to be more successful than any other in pre- 
venting relapses in syphilis. The corrosive chloride is usually selected 
for this purpose, and if properly employed seldom produces local irrita- 
tion, although instances have been recorded in which it gave rise to 
abscesses and sloughing. Care should be taken that the syringe and 
needle are aseptic, and it is recommended that the needle should be 
deeply inserted, preferably into the muscles on the outer side of the 
gluteal region. If much pain is caused by the injections, a piece of ice 
may be held over the spot both before and after the insertion of the 
needle, or cocaine may be injected immediately before the mercurial. 
But one injection a day should be given, and it is advised that this 
should be at bedtime. A solution of .06 gm. (1 gr.) of corrosive chlo- 
ride in 8 c.c. (2 fl. dr.) of distilled water may be employed, and of this 
.60 c.c. (10 m.) may be administered at first, and the dose gradually 



MERCURY. 45 

increased until 3 c.c. (50 m.) is reached, or until constitutional effects 
are observed. As soon as this is the case the dose should be reduced 
to the minimum. In some old cases of syphilis, in emaciated, broken- 
down subjects, it is recommended, instead of using daily injections in 
small doses, to give as much as .015 to .02 gra. (% to )/$ gr.) two or 
three times a week. A large number of mercurial preparations have 
been proposed for subcutaneous injection, but none of them appears to 
have any distinct advantage over corrosive sublimate ; while most of 
them have been found considerably more dangerous. Among them may 
be mentioned mercuric formamidate, which is neutral in reaction, readily 
combines with water, does not coagulate albumin, and is not precipitated 
by alkalies. While generally well tolerated, the formamidate injections 
have proved very much less reliable than those of the bichloride, and 
relapses are stated to have been extraordinarily common after their use. 
The subcutaneous employment of sal alembroth has already been referred 
to. Gray oil, which consists of mercury, lanolin and olive oil, is more 
or less used for subcutaneous injection, and by some is preferred to 
any other preparation for this purpose. Some clinicians have reported 
very favorable results from the use of hypodermatic injections in 
infantile syphilis, particularly, of corrosive sublimate and of gray oil. 
A form in which the bichloride is said to be less liable to produce pain 
or irritation than in simple watery solution is the glutin-peptone sub- 
limate, which contains 25 per cent, of the drug. In using mercurials 
hypodermatically points of importance are to see that the part is well 
rubbed immediately after the injection, so as to dispel the local accumu- 
lation of fluid, and that injections are not given on successive days at 
spots near to each other. One of the evil effects which are liable to 
be produced by the continued and free administration of mercurials is 
nephritis, and it has been found that the safest method of mercurializa- 
tion, so far as the kidneys are concerned, is by the hypodermatic em- 
ployment of the corrosive chloride, while the most dangerous is prob- 
ably the use of inunctions. Very deep intra-muscular injections are 
advocated by some authorities as not only painless, but productive of 
the best practical results. A Pravaz syringe-full of a preparation con- 
sisting of purified mercury, 20 ; lanolin, 5 ; vaselin, 35, is injected deep 
into the tissues of the back once in fifteen or twenty days. 

(6) Intravenous injection. — This method has been recommended by 
some as having certain advantages, one of them being stated to be more 
rapid absorption and therapeutic effect than by any other. It possesses 
certain disadvantages also, and the opinion has been expressed by good 
authorities that it should not be preferably used in cases, of syphilig 



46 PHARMACOLOGY AND THERAPEUTICS. 

easily amenable to ordinary treatment or in the early stages of the dis- 
ease, though it is of special value in obstinate cases resisting other 
treatment ; also in advanced cases of organic syphilis, or when immedi- 
ate relief is urgently called for by reason of pain, encroachments on a 
vital part, or rapid destruction of tissue. Cases of cerebral syphilis 
which had proved unamenable to ordinary treatment have been reported 
in which this method was attended with excellent results. The injec- 
tion, which was practiced daily, was usually made into the superficial 
veins in front of the elbow, and the dose of corrosive sublimate (the 
preparation employed) was gradually increased from .0004 gm. ( T y2 S r -) 
to .0027 gm. ( Jj gr.). Mercuric cyanide has also been used for intra- 
venous injection, and is preferred by some to the bichloride. One c.c. 
(15 m.) of a 10 per cent, solution, made with distilled water, is injected 
into a vein at the bend of the elbow, after a rubber tube has been tied 
around the arm above. Before the injection is made the needle is first 
inserted and then unscrewed, to note by the flow of blood that it has 
entered the vessel. It is claimed that neither thrombosis nor embolism 
has been observed in consequence of the procedure. By some writers, 
however, intravenous injections are considered so dangerous as to ren- 
der this method unjustifiable. Certainly neither intravenous nor hypo- 
dermatic injection should be resorted to in the ordinary routine treat- 
ment of syphilis. 

(7) Fumigation. — Mercurial fumigations often prove highly service- 
able in syphilis, and by some the most satisfactory method of treating 
the secondary eruptions upon the skin is believed to be by fumigation 
with calomel two or three times a week, accompanied by the administra- 
tion of the iodides internally, with tonics whenever necessary, and proper 
attention to the general health. The black oxide and the red sulphide, 
neither of which is now official, are also used for fumigations. The 
method is as follows : The patient, having taken a warm bath to prepare 
the skin for absorption, sits upon a chair and is covered with a large 
blanket or rubber cloth (a mackintosh cloak serves very well for the 
purpose), which is gathered in closely about his neck and extends down 
to the floor all around. The mercurial preparation, say 1.20 gm. (20 
gr.) of calomel, is placed in a porcelain or metallic dish, over a spirit 
lamp, underneath the chair. The most satisfactory apparatus is one in 
which the alcohol flame sublimes the calomel and boils water at the 
same time, and is made of sheet iron or tin plate. The centre, on which 
the mercurial is placed, is flattened, and around this is a circular depres- 
sion, which is about one-third filled with water. The heat produced gen- 
erally causes profuse sweating, and the mercury, after having become 



MERCURY. 47 

volatilized, is deposited upon the cutaneous surface. In about twenty 
minutes the lamp is extinguished, and the patient is then wrapped in 
blankets and put to bed with the mercury still adhering to his skin. 

(8) Inhalation. — Inhalation is occasionally used independently of 
fumigation, and not infrequently in connection with the latter, the mer- 
curial preparation being volatilized in the same manner. When it is 
desired to practice it in conjunction with fumigation the patient is di- 
rected to inhale for two or three separate minutes during the bath. In 
doing this he should not put his head under the cloak or blanket, but 
simply allow some of the vapor to escape from the, upper part, and 
breathe it mixed with a large proportion of common air. When inhala- 
tions are employed separately the amount of calomel used should not 
exceed .260 to .325 gm. (4 to 5 gr.), and the face should be held six 
or eight inches from the receptacle. Unless a local action on the buc- 
cal mucous membrane is desired, it is advisable that the mouth should 
be rinsed out with potassium chlorate solution in order to prevent the 
occurrence of mercurial stomatitis. 

(9) Baths of 12 gm. (3 dr.) of corrosive mercuric chloride, with 4 
c.c. (1 fl. dr.) of hydrochloric acid, or of 4 to 8 gm. (1 to 2 dr.) of 
the chloride, with twice as much common salt, to each bath, were for- 
merly used to some extent for syphilitic subjects with skin-lesions, but 
are now very rarely resorted to. Remarkably successful results, how- 
ever, have recently been reported in the treatment of small-pox, even 
of the most serious type, by means of corrosive sublimate baths. Twice 
a day a bath-tub was brought to the patient's bedside and filled with 
a warm (40.5° C— 105° F.) solution of the bichloride (1 to 10,000), 
when the patient was immersed, except the head and shoulders, for ten 
or twelve minutes, the nurse gently rubbing the entire body with a 
soft cloth during the bath. 

TOXICOLOGY. 
Acute poisoning is not infrequently met with, and corrosive subli- 
mate and white precipitate are the preparations usually taken. Corro- 
sive mercuric chloride in toxic dose at once produces a metallic taste 
in the mouth and intense pain in the throat and stomach, quickly fol- 
lowed by severe retching and vomiting. Soon there is hsematemesis, 
and violent purging also sets in, the stools at first being serous and 
afterwards bloody in character. The urine becomes very scanty, and 
contains albumin, blood and casts. The pulse becomes weak and rapid, 
the temperature is lowered, and there is marked depression of all the 
vital powers, often ending fatally in a short time. After death the 



48 PHARMACOLOGY AND THERAPEUTICS. 

principal lesions customarily found are marked membranous colitis and 
parenchymatous and hemorrhagic nephritis, with widespread degenera- 
tion of the renal epithelium and, less commonly, a peculiar deposit of 
calcium phosphate. Treatment. — In case of acute poisoning the stomach 
should be evacuated by means of the stomach-tube, if possible. If this 
is not available, vomiting should be promoted by mustard and luke-warm 
water or apomorphine, or by irritation of the fauces. Albumin, in the 
form of the white of an egg (one being sufficient for .24 gm. — 4 gr. — 
of the corrosive chloride, the albuminate redissolving in an excess), 
milk and flour are useful. Tannic acid may also be given to protect 
the mucous membrarfe. 

Chronic Poisoning. — Except in workers in mercury, this is now much 
more rarely observed than formerly, when it was the common practice 
to give large doses of the drug. The characteristic salivation, stomati- 
tis, and other effects of mercurialization have already been described. 
Occasionally metabolism was so profoundly affected that the resulting 
cachexia ended in death. The tremor frequently seen in those who 
work in the metal and inhale the vapor resembles paralysis agitans, 
and the muscular weakness has been designated " mercurial palsy." A 
low grade but obstinate inflammation of the tongue or the lips, which 
proceeds to ulceration, sometimes extends, as gangrene, to the cheeks 
and produces frightful deformity of the face. Treatment. — As in other 
chronic metal poisoning, the object of the treatment should be to pro- 
mote elimination by all possible channels. Sulphur baths and ordinary 
hot baths are of service. Diuretics may be given to assist the kidneys 
in carrying off the mercury, and the drinking of as much water as can 
be conveniently borne should be enjoined. The bowels should be kept 
free, but if diarrhoea is present it may call for treatment by opiates or 
other remedies. Opium is also sometimes required for the relief of 
pain, and the other symptoms should be treated on general principles. 
It is commonly believed that potassium and sodium iodide have some 
effect in causing the elimination of the metal, and while this claim has 
been disputed by some, it has never been disproved. Care should be 
taken, however, that the doses are not too large, since attention has 
been called to the fact that the combination of iodine with mercury in 
the tissues produces a soluble salt which is very active and which may 
secondarily cause mercurial intoxication of the system. Belladonna is 
sometimes required to diminish the excessive activity of the salivary 
glands, and in all cases a potassium chlorate solution is useful as a 
mouth-wash in the treatment of salivation and stomatitis. Incidentally 
it may be remarked that it is the prevalent opinion that the free use 



FORMALDEHYDE. 49 

of such a mouth-wash, together with frequent and careful brushing of 
the teeth, is of material service in warding off ptyalism during the con- 
tinued administration of mercurials. Tincture of myrrh is frequently 
added to it, and tannic acid solution is also sometimes employed as a 
mouth-wash. Careful attention should always be paid to hygiene, and 
the general cachexia be combated by the most nutritious food, and 
such tonic or other remedies as may be called for. In establishments 
where mercury is used in the arts the same prophylaxis as in the case 
of lead is recommended. 

FORMALDEHYDE. 

FORMALDEHYDUM.— Formaldehyde. (Not official.) 

Preparation. 
Liquor Formaldehydi. — Solution of Formaldehyde. (For- 
malin. Formol.) 

Unofficial Preparations. 
Amyloformum. — Amyloform. 
Dextroformum. — Dextroform. 
Glutoformum. — Glutoform. (Glutol.) 
Glycoformalinum. — Glycoformalin. 
Faraformum. — Paraform. (Paraformaldehyde.) 

Action of Formaldehyde. 
Formaldehyde is regarded as equal in germicidal power to 
corrosive mercuric chloride, while, on account of its volatility, 
which enables it to diffuse much more rapidly, it can be used 
for purposes to which the latter is not adapted. At the same 
time, it is only slightly poisonous to the higher animals. When 
the vapor is inhaled, its most characteristic effect is marked 
irritation of the respiratory mucous membrane, causing bron- 
chial catarrh and a prickling and burning sensation in the 
nose and throat. Even when present in the atmosphere in very 
minute amount it gives rise to violent irritation of the air-pas- 
sages. It also excites increased secretion from the salivary and 
lachrymal glands. The powerful action of formaldehyde on 

5 



50 PHARMACOLOGY AND THERAPEUTICS. 

microbes and on mucous membranes has been attributed to its 
combining with some amide group in the proteids. Egg albumin 
and serum to which formaldehyde solution has been added is 
not, it is stated, precipitated by heat and is less easily digested by 
ferments, while casein so treated is not coagulated by the rennet 
ferment. The urine of animals to which it is given, even in 
moderate quantities, is found to be incapable of putrefaction. 
Experimental research has shown that a i per cent, aqueous 
solution will destroy all pathogenic spores within an hour. 
The drug has also a very powerful influence on various forms 
of organic matter, one part in four thousand completely decolor- 
izing wine, precipitating the extractive and coloring matters. 
The efficiency of urotropin, now so much used as a genito-urin- 
ary antiseptic, is thought to be due to the liberation of formal- 
dehyde from it. The penetrating power of the gas has been 
found to depend largely upon conditions of moisture, but under 
favorable circumstances is very considerable. When the watery 
solution is swallowed by animals its first effect is the production 
of nausea and vomiting. The blood-pressure is increased at 
first and the cardiac rhythm is retarded, as the result, it would 
appear, of stimulation, direct or indirect, of the medullary 
centres. As the poisoning progresses, narcosis and coma are 
produced, and in rabbits convulsions and opisthotonos. In 
dogs the respiration is very markedly quickened a considerable 
time before death. It has been shown that a portion at least 
of the formaldehyde which is absorbed passes through the 
tissues unchanged and is excreted in the urine, and it is thought 
not unlikely that the whole of it may do so. Some observers 
declare that it is a blood poison, causing alteration in the form 
of the cells and leading to the production of hsematin, and 
accordingly believe it probable that this effect is the chief 
factor in the intoxication caused by it. The fact has been 
noted that when administered hypodermatically formaldehyde 
produces less severe symptoms than when taken by the mouth, 
and this would seem to indicate that the effects caused by it 
are largely the result of its local action. So far as known, no 



FORMALDEHYDE. 5 1 

case has occurred in which it has caused in the human subject 
symptoms other than those of local irritation. One case has 
been reported in which a man took several ounces of formalin, 
by mistake, and recovered from its effects in three days, and 
another in which 30 c.c. (1 fl. oz.) was swallowed, and the 
patient recovered in a week. Externally applied, formaldehyde 
has the effect of hardening the skin. 

Therapeutics of Formaldehyde. 
The great practical value of formaldehyde as an antiseptic, 
disinfectant, deodorizer and germicide is now universally ac- 
knowledged, and the literature on the subject has become very 
voluminous. In the report of a series of careful experiments 
made under the supervision of the Health Department of New 
York City the following were among the conclusions reached: 
Formaldehyde gas is the best disinfectant at present known for 
the disinfection of infected dwellings. It is inferior in pene- 
trative power to steam and dry heat at 230 F., but for the 
disinfection of fine wearing apparel, furs, leather, upholstering, 
books and the like, which are injured by great heat, it is better 
adapted than any other disinfectant. It is superior to sulphur 
dioxide as a disinfectant for dwellings because (1) it is more 
efficient and rapid in its action; (2) it is less injurious in its 
effects on household goods; (3) it is less toxic to the higher 
forms of animal life; (4) when supplied from a generator 
placed outside the room and watched by an attendant, there is 
less danger of fire. It is claimed that by the addition of 10 per 
cent, of glycerin to the solution of formaldehyde the polymeriza- 
tion of the latter by heat is prevented, and hence that the so- 
called gly co formalin (consisting of formaldehyde, 30 parts, 
glycerin, 10 parts, and water, 60 parts), is superior for disin- 
fecting purposes to the ordinary aqueous solution. This pre- 
paration has been used to a considerable extent and appears to 
be very efficient, but has certain disadvantages, two of which 
are the sticky condition many articles are found in after its 
use, from a coating of glycerin, and the persistency of the odor 



52 PHARMACOLOGY AND THERAPEUTICS. 

left by it. Although its irritant action is objectionable, and 
the pain caused by the application of even a weak solution to 
ulcerated surfaces is very considerable, formaldehyde has been 
employed to quite a large extent in surgery, particularly in in- 
fected wounds, tubercular ulcers and abscesses, and infectious 
inflammations of the mucous membranes. The pain, it is found, 
can be obviated by the previous application of cocaine used in 
glycerin (i to 4 per cent.) ; also, it does not cause so much pain 
when applied to a mucous surface. A one per cent, solution of 
formaldehyde is often efficient, but by some it is thought some- 
times better to apply a rather strong solution once or twice than 
a weaker one more frequently. Among the affections in which 
this agent has been found useful may be mentioned parasitic 
stomatitis, ozsena, atrophic rhinitis, blepharitis, mucopurulent 
and follicular conjunctivitis, septic abrasions or ulcerations of 
the cornea (solutions of 1 part of formalin in 200 to 3000), the 
packing and drainage of pus cavities and sinuses, etc., in the 
place of iodoform gauze, tuberculous joints (by injection), 
puerperal sepsis (by packing the vagina), and lacerations of the 
perineum or cervix uteri. In the form of inhalations or sprays 
it has been employed in pertussis, bronchitis, influenza, diph- 
theria, the angina of scarlet fever, and pulmonary tuberculosis. 
In dermatology also it has been used to a considerable extent, 
being found beneficial in lupus, psoriasis, acne rosacea (by 
intradermal injection), in axillary and palmar hyperidrosis, and 
in sweating of the feet. It is reported to be of service in the 
treatment of the night sweats of phthisis, the skin being tanned 
with an application of a solution made according to the follow- 
ing formula: Formalin, 50 gm. (i£4 oz J Absolute Alcohol, 
50 gm. (i^4 oz.). This solution is applied to different parts 
of the body alternately, a protecting covering being employed 
over the part painted. The sweating is stated to be arrested 
almost immediately, and that part of the body keeps free from it 
for from five days to a month ; after which the treatment is re- 
peated. At the present time formaldehyde is used to a con- 
siderable extent in dentistry, as well as in veterinary practice. 



CHLORINE. 53 

Injections of its solution have proved remarkably successful in 
bovine anthrax. One of the useful applications of formalde- 
hyde is in the preservation of human bodies and of anatomical 
and pathological specimens. It is also largely employed as a 
fixing agent in histological work. For Urotropin (hexamethyl- 
enamine), which is obtained by the action of ammonia on 
formaldehyde, see Division VI., page 509. 

Paraform, the polymeric form of formaldehyde, which is a 
colorless, crystalline powder, insoluble in water, and gives off 
formaldehyde gas when slowly heated, is sometimes employed 
for disinfecting purposes. It is stated that instruments may be 
absolutely disinfected in fifteen minutes by the evaporation 
by means of heat of .30 gm. (5 gr.) of paraform in a chamber 
one cubic foot square. A 5 per cent, solution of paraform has 
been highly recommended as a caustic agent for the treatment 
of cutaneous growths of various kinds, such as warts and the 
like. 

G-lutol is a combination of formaldehyde and gelatin which is 
employed as an antiseptic powder. Drying on the surfaces of 
wounds or ulcers, it seals them and renders them sterile, and 
it is said to be especially efficacious in burns. Other antiseptic 
dressings are Amyloform and Dextroform, compounds of 
formaldehyde with starch and dextrin respectively. 

CHLORINE. 

CHLORUM.— Chlorine. (Not official.) 

Preparations. 

1. Calx Chlorinata (Calx Chlorata, U. S. P., 1890). — Chlorin- 
ated Lime. Chlorinated Calcium Oxide. (Bleaching Powder.) 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

2. Liquor Chlori Compositus (Replacing Aqua Chlori, U. 
S. P., 1890). — Compound Solution of Chlorine. Chlorine Water. 
Dose, 4 c.c.; 1 fl. dr. 

3. Liquor Sodae Chlorinatae (Liquor Sodae Chloratse, U. S. 
P., 1890). — Solution of Chlorinated Soda. (Labarraque's Solu- 
tion.) Dose, 1 c.c; 15 n\. 



54 PHARMACOLOGY AND THERAPEUTICS. 

Unofficial Preparation. 
Electrozonum. — Electrozone. 

Action of Chlorine. 

External. — Chlorine gas, which is soluble in water in the 
proportion of two volumes to one, is greenish in color and has 
a penetrating and peculiar odor. It is intensely irritating to 
mucous membranes, and air containing even a small proportion 
of it affects the eyes, nose, fauces, larynx, bronchi and lungs. 
It is also a fact that it acts more energetically upon the deeper 
than upon the upper respiratory passages, so that an amount of 
the gas which gives rise to comparatively little irritation of the 
nose and pharynx may excite bronchitis and pulmonary conges- 
tion and haemorrhage. It has been found that while one volume 
of chlorine vapor in one million parts of air causes a certain 
amount of irritation, ten volumes in the same quantity of air, 
if inhaled for some time, will induce such serious effects as 
severe bronchitis and haemorrhage and inflammation of the 
lungs. Applied to the cutaneous surface, chlorine water pro- 
duces heat and redness, and, if the gas is prevented from escap- 
ing, will give rise to vesication. The germicidal action of chlo- 
rine is very pronounced, and in the presence of moisture it is 
one of the most powerful of disinfectants and deodorizers. 

Internal. — Chlorine has a marked affinity for hydrogen, and 
as a result of its combining with the hydrogen of water, nascent 
oxygen is set free and acts on the tissues. When taken inter- 
nally, chlorine is largely converted into hydrochloric acid, 
which afterwards becomes changed to chlorides during the 
process of absorption. A portion of it, however, it is thought, 
may form proteid compounds in the body. The claim that it 
is excreted in the free state in the urine is now held to be 
unfounded, as well as the statement that free chlorine has been 
recognized in the brain after death from its inhalation. It is 
poisonous chiefly by its local action. Except in small doses, 
chlorine water causes corrosive and intense inflammation of 
the mouth, throat and stomach, with the production of collapse. 



CHLORINE. 55 

After fatal poisoning from the inhalation of the gas, however, 
the gastric mucous membrane is found to remain unaffected. 
Apart from its local action, chlorine is said to have a narcotic 
effect upon the brain, and this has been attributed to the action 
of the proteid compounds mentioned. 

Therapeutics of Chlorine. 

External. — As a disinfectant chlorine has the disadvantage 
of injuring colored fabrics and wearing apparel. It may also 
cause inconvenient or even dangerous symptoms in persons 
using it, unless handled with great caution. It is regarded as 
inferior to sulphurous acid anhydride, and still more so to 
formaldehyde, not from its being weaker in action, but be- 
cause it is more difficult to apply in sufficient quantity. The 
room to be disinfected by it should be hermetically sealed, after 
the removal or protection of all metals and of fabrics likely to 
be injured or bleached. The gas can be generated from com- 
mon salt, 18; manganese dioxide, 15; and sulphuric acid, 45; 
in iced water, 21 parts by weight. As it is heavier than atmo- 
spheric air, the vessel should be placed on a high shelf, in 
order that the chlorine may be diffused throughout the room. 
For chlorine disinfection of rooms chlorinated lime, with the 
addition of acid in excess, is used by many. To disinfect hands, 
moistened chlorinated lime is spread over the hands, next a 
large crystal of washing soda is held in the hands, and they 
are washed, with rubbing, under water until a cooling sensation 
is experienced. The best disinfectant for excreta is fresh chlo- 
rinated lime, i; dissolved in water, 16. 960 c.c. (one quart) 
is placed in the receptacle into which the dejecta are received, 
and left one hour. It may also be used with good effect in 
drains, sinks, closets, urinals, etc. 

When exposed in the sick room, chlorinated lime acts 
rather as a deodorizer than as a disinfectant. The chlo- 
rinated preparations, in dilute solution, are very useful for 
destroying fetor in scarlet fever, diphtheria, aphtha? and gan- 
grene, and also in gangrenous wounds, sloughing ulcers, foul 



56 PHARMACOLOGY AND THERAPEUTICS. 

discharges, etc. The preparation known as electrozone, which 
consists of sea-water the alkaline chlorides of which have been 
converted into hypochlorites by electrolysis, is said to have 
about the same antiseptic strength as Liquor Sodae Chlorinatae. 
Chlorinated oil (olive oil saturated with chlorine) has been 
found a very efficient remedy in scabies. Chlorine water is 
sometimes used as an antiseptic in eye operations and diseases. 
A wash consisting of strong hydrochloric acid, .30 c.c. (5 Al) ; 
potassium chlorate, .60 gm. (10 gr.) ; water, 30 c.c. (1 fl. oz.), 
which gives off free chlorine, is serviceable for syringing the 
nose and fauces in scarlet fever, and a combination of the 
tincture of ferric chloride with potassium chlorate, in which 
some free chlorine is also evolved, constitutes an excellent 
antiseptic gargle. A strong solution of chlorinated soda makes 
a useful application for the bites of snakes and insects, and in 
Australia chlorinated lime, freshly prepared, is used in solu- 
tions of varying strength by hypodermatic injection as an 
antidote to serpent venom; the remedy being inserted into 
several points about the wound. 

Internal. — Chlorine water, in weak solution, is somewhat 
stimulant and tonic to the stomach. It has been successfully 
used, well diluted, in the diarrhcea of typhoid fever, particularly 
in markedly se'ptic patients. After the administration of doses 
of 4 c.c. (1 fl. dr.) every hour the temperature falls, the intellect 
brightens, the tongue clears, and betterment goes on to recovery 
in many apparently hopeless cases. This remedy was formerly 
considered of service in chronic affections of the liver, but 
is seldom used now for the purpose of acting on this organ. 

TOXICOLOGY. 

In poisoning with chlorine taken by the mouth alkalies should be 
given to neutralize the acid formed, and albumin, in the form of eggs, 
etc., is also of service. Narcotics may be called for to allay pain. In 
poisoning by inhalation, steam may be inhaled to diminish the irritation. 
Ammoniacal gas may also be given for the purpose of forming am- 
monium chloride, but it should be remembered that the ammonia is 
Itself irritant. 



PHENOL. 57 

PHENOL. 

1. PHENOL (Acidum Carbolicum, U. S. P., 1890).— Phenol. (Car- 
bolic Acid.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. 

Preparations. 

1. Glyceritum Phenolis. — Glycerite of Phenol. Dose, 0.3 c.c; 
5 Til. 

2. TJnguentum Phenolis. — Ointment of Phenol. 

2. PHENOL LIQUEFACTUM.— Liquefied Phenol. Dose, 0.05 c.c.; 

1 Til. 

3. CRESOL.— Cresol. (Tricresol.) Dose, 0.05 C.C.; 1 TT\.. 

Preparation. 
Liquor Cresolis Compositus. — Compound Solution of Cresol. 

Unofficial Preparations. 
Chlorophenol. — Chlorophenol. 
Phenosalylum. — Phenosalyl. 

Action of Phenol. 
External. — Phenol is an antizymotic of considerable energy, 
and, while not so powerful as some other agents of this class, at 
times constitutes a useful antiseptic and disinfectant. In suf- 
ficient strength it is poisonous to all varieties of protoplasm, 
but, like other antiseptics, it is much less toxic to microbes than 
to the protozoa and other simple forms of life. Again, it af- 
fects some species of microbes much less powerfully than 
others, and it has been found that it takes as long as two days 
for the destruction of the spores of the anthrax bacilli by a 
five per cent, solution. It has also been found, however, that 
the development and reproduction of many micro-organisms is 
greatly interfered with, or altogether prevented, as long as 
they remain in a solution of one part of carbolic acid to 400-600 
of water. It seems to be well established, moreover, that one 
per cent, in an aqueous solution will destroy with certainty the 
virulence of ordinary septic and purulent matters, of the tubercle 



58 PHARMACOLOGY AND THERAPEUTICS. 

bacillus, and of the micrococcus of fowl-cholera. While some 
of the putrefaction germs are also destroyed by solutions of 
this strength, it is requisite that the action should be maintained 
for about two hours in order to insure this, and for the destruc- 
tion of the infection of vaccine and of glanders a two per cent, 
solution is required. In oily solution the antiseptic influence 
of carbolic acid is extremely slight. 

Phenol has the property of precipitating albumins and other 
proteids in solution, and also whenever it comes in contact with 
the tissues, and its action in this respect has been compared 
with that of alcohol, in which the proteid is precipitated, it is 
alleged, not because an insoluble compound is formed, but be- 
cause of a change in the nature of the solvent. Hence it is 
argued that carbolic acid must penetrate more thoroughly than 
the metallic antiseptics, which are rendered insoluble by the 
albumin they meet, and whose action therefore tends to remain 
confined to the surface. In sufficient concentration carbolic 
acid has a mild escharotic action. When applied momentarily 
to the cutaneous surface it produces at first a burning sensation 
and a white discoloration, followed by a reddish stain, which 
gradually fades away as the skin desquamates. If the applica- 
tion be prolonged, a white opaque scar is formed, which after- 
wards becomes red and shining. When in the course of a few 
days it falls off, it leaves a light brown stain, which may persist 
for several weeks. If prevented from evaporating, the acid, by 
penetrating to the deeper tissues, may produce extensive dry 
gangrene of the part. Carbolic acid is a decided local anaes- 
thetic. The application of a solution even as weak as five per 
cent, at first causes a sense of tingling and warmth, and this is 
followed by one of numbness, as an accompaniment of opacity 
and shrinking of the epidermis. If a strong solution is em- 
ployed, the numbness amounts to almost complete anaesthesia. 
On the mucous membrane the acid has an escharotic effect 
which varies in degree according to the strength of the solu- 
tion. Applied to wounds or abraded surfaces, a five per cent, 
solution causes pain and irritation and the formation of a 
pellicle from the precipitation of proteids. 



PHENOL. 59 

Internal. G 'astro-intestinal Tract. — When taken in concen- 
trated form phenol causes burning pain, of short duration, and 
white eschars of the mouth, oesophagus and stomach (the 
mucous membrane appearing as if brushed over with a strong 
solution of silver nitrate and becoming hard and dry like 
leather), and, if death does not result at once, gives rise to 
violent gastro-enteritis, with its attendant vomiting and purging. 
The matters vomited have the characteristic odor of the drug. 
If taken in therapeutic doses, it produces a cooling and rather 
grateful sedative feeling in the stomach, and the bowels are 
unaffected by it. 

Blood. — According to the observations of some, the number of 
red blood-corpuscles is reduced. In toxic doses it sometimes 
appears to have a disintegrating effect on these cells. In one 
case of poisoning in man the presence of haemoglobin in the 
urine indicated the destruction of some of the corpuscles, and 
occasionally such destruction has been noted as a result of the 
direct injection of carbolic acid into the blood-vessels of ani- 
mals. While it gives rise to the slow formation of methsemo- 
globin when added to defibrinated blood, it has been found that 
this does not take place in the living animal. 

Circulation. — It has been demonstrated that one of the 
characteristic effects of carbolic acid, in large doses, is the 
reduction of the arterial pressure, and this appears to be princi- 
pally due to depression of the vaso-motor centre in the medulla 
oblongata. Weakness and slowness of the heart are observed, 
though at an earlier period there is cardiac acceleration, which 
is thought to result from the direct action of the drug on the 
muscle or on the regulating nerves. 

Respiration. — The respiration, like the heart, is accelerated, 
and as this quickening occurs previous to the increased muscular 
movement caused by the drug, it has been attributed to action 
on the medullary centre, which is first stimulated and subse- 
quently paralyzed; so that the breathing ultimately fails al- 
together. 

Nervous System. — The most marked effects of phenol after 



60 PHARMACOLOGY AND THERAPEUTICS. 

its absorption into the blood are upon the central nervous sys- 
tem. In mammalian animals it causes, with or without a pre- 
liminary stage of depression, marked muscular tremor, which 
at intervals is interrupted by sudden twitches in different 
muscles, and later by clonic convulsions. The respiration and 
the heart, as mentioned, are at first accelerated, but afterwards 
become slow, irregular and weak. The movements grow pro- 
gressively more feeble and appear at longer intervals, and the 
animal passes into a state of collapse, in which, however, the 
sensibility to pain is often preserved. Finally, death occurs 
from asphyxia. After very large doses the collapse may be 
immediate. No convulsions are observed, and the heart and 
respiration often cease simultaneously. In most cases there is 
an increased secretion of saliva, perspiration and tears, which 
is thought to be of central origin and possibly associated with 
the nausea and vomiting present. Frequently also the temper- 
ature falls far below the normal. In the frog a period of 
depression always precedes the increased movement. In man 
convulsions are comparatively rare, but delirium and excite- 
ment are sometimes seen. When the quantity of carbolic acid 
taken is large, immediate unconsciousness may occur, and death 
result in a few minutes, but how far this is due to the extensive 
local corrosion and how far to direct action on the central 
nervous system is unknown. Increased irritability of the spinal 
cord appears to be the cause of the convulsions in the frog, 
which are similar to those seen after strychnine, and of the 
sudden contractions of the muscles in mammals, but the clonic 
convulsions and the presistent muscular tremor observed in the 
latter point to a cerebral origin. The infrequency of convul- 
sions in man has not as yet been accounted for. The pupils, it 
may be noted, are almost invariably contracted in phenol 
poisoning; which is doubtless due to paralysis of the radiating 
fibres, the circular fibres being left unopposed. 

Temperature. — Phenol, in sufficiently large doses, causes a 
reduction of temperature which, as in the case of the antipyretic 
group, is probably due to some alteration effected in the heat- 



PHENOL. 6 1 

regulating nervous mechanism, resulting also in an increase in 
the dissipation of heat. In cases of poisoning, however, the fall 
would seem to be very largely due to the collapse. While it 
undoubtedly possesses the power of reducing the temperature to 
some extent in fever, ordinary medicinal doses of carbolic acid 
have very little effect in this direction in the normal subject. 
Urine. — It is a fact of considerable interest that the produc- 
tion of phenol occurs normally in the body, and that it is a 
constituent of the urine of man, as well as that of cattle, 
horses, dogs and probably other animals. It has been found to 
be constantly present also in normal human faeces, and it is 
considered probable that the acid is formed in the organism as a 
late product of the pancreatic digestion. Its elimination by the 
urine appears to be markedly affected by different diseases and 
conditions, being vastly increased in ileus, and diminished in 
anaemia, scurvy, tuberculosis and scrofula. One of the charac- 
teristic effects of the absorption of carbolic acid is a peculiar 
smokiness of the urine. The discoloration varies in intensity in 
different cases. It is often a dusky green, which may change 
to dark brown or even black. It has been found that the 
acid passes through the tissues largely unoxidized, but a certain 
proportion of it is partially oxidized to pyrocatechin and hydro- 
quinone, which combine in the body with sulphuric and gly- 
curonic acid and are excreted in the urine as double (ethereal) 
sulphates and phenol, pyrocatechin and hydroquinone glycuro- 
nates. Pyrocatechin and hydroquinone are unstable bodies, 
and their oxidation products are doubtless the cause of the dark 
urine; pyrocatechin can only exist in alkaline urine, so that it 
cannot be the sole cause of the dark color. The presence in 
the urine of these results of carbolic acid is recognized by 
reactions after distillation. The distillate gives a blue color 
with neutral ferric chloride, and a white crystalline precipitate 
of tribromophenol with bromine water, showing the presence of 
sulphocarbolic acid. The inorganic sulphates are usually ab- 
sent. This is determined by the use of the barium chloride test, 
which does not precipitate the combined sulphates (sulphocar- 



62 PHARMACOLOGY AND THERAPEUTICS. 

bolates) (Sonnenberg's test). The depth of the discoloration 
of the urine is said to depend on the quantity of dioxybenzols 
present, and not on that of phenol sulphate. Hence a darker 
shade is apt to be observed when the absorption of carbolic acid 
has occurred from an open wound (which presents conditions 
especially favorable to oxidation) than from much larger 
amounts absorbed from the alimentary canal. 

Therapeutics of Phenol. 
External. — Phenol was formerly employed in the form of a 
spray, with the idea of rendering the surrounding air antiseptic, 
during surgical operations, but is no longer used in this way, 
and in the treatment of wounds in general it has been largely 
superseded by germicides recognized as more efficient. By some 
surgeons, however, it is still held in esteem; carbolic lotion (i 
in 40) being used for the washing of wounds and carbolized 
gauze (bleached cotton gauze medicated with half its weight 
of a mixture of carbolic acid, 1 ; resin, 4 ; paraffin, 4) as an anti- 
septic dressing. It is also employed to a considerable extent as 
a disinfectant for surgical instruments, soiled linen, and hospital 
apparatus, and as a disinfectant and deodorant for bed-pans, 
privies, drains, etc. For the latter purposes and on the walls 
and floors the crude acid is preferable, as its principal impurity, 
cresol (cresylic acid) is a very powerful disinfectant, and also 
because it is cheaper in cost. As a local application carbolic 
acid is one of the most highly esteemed remedies, and is em- 
ployed in a great variety of conditions. It has sometimes been 
applied undiluted to wounds and burns, turning the tissues 
white and also exerting a haemostatic influence. Afterwards 
the surfaces are cleansed with sterilized water. The more 
usual form in which the acid is used in the treatment of burns 
is in that of carbolized oil. In carbuncle or malignant pustule, 
after incision and scraping, the undiluted acid acts as an anti- 
septic, and also relieves pain by its anaesthetic effect. Among 
the other conditions in which its application, undiluted, has 
proved efficient may be mentioned ulcers of the cervix uteri, 



PHENOL. • 63 

chronic endo-cervicitis and endometritis, lupus, mucous patches, 
condylomata and cauliform excrescences. Even in scirrhus 
such applications, together with the daily injection of a five 
per cent, solution of the acid beneath the cancerous growth, has 
been thought to limit the extension and retard the progress of 
the disease. In performing minor surgical operations local 
anaesthesia may be secured either by brushing over the surface 
with the pure acid or by soaking the part, when this is prac- 
ticable, for ten minutes in a 30 per cent, solution. A strong 
solution (such as 1 in 20) will alleviate itching from almost any 
cause, and on account of this anaesthetic action carbolic acid 
has been called the " opium of the skin." Its anti-pruritic and 
parasiticidal qualities render it a useful remedy in a large 
number of cutaneous affections. In vesicular eczema, ery- 
thema and in dermatitis, especially from poisonous substances, 
the following formula is strongly recommended; liquefied phe- 
nol, .36 c.c. (6 TR.) ; powdered zinc carbonate, 30 gm. (1 oz.) ; 
lime water and glycerin, aa 90 c.c. (3 fl. oz.). An ointment 
containing sulphur and camphor with carbolic acid has been 
found most effective in many pruritic skin diseases, especially 
papular eczema, psoriasis, lichen and urticaria. Scabies is said 
to have been cured by friction with carbolized oil of the strength 
of 1 to 15. The glycerite is a very serviceable form, and it 
may be used (generally diluted) with good results in such 
affections as prurigo, tinea versicolor, tinea tonsurans, and the 
other forms of tinea. It is also applied as a stimulant to indo- 
lent ulcers and to the patches of aphthous stomatitis. A car- 
bolic lotion, to which glycerin or sweet oil may be added, is 
very efficient in allaying the itching of jaundice. It has like- 
wise been used to prevent pitting from small-pox, and an oint- 
ment containing carbolic acid and camphor has proved of ser- 
vice in alleviating the itching accompanying that disease. In 
the vulvitis or leucorrhcea of young girls, injections of the acid, 
in the strength of 5 parts to 1000 of water (pads of lint 
saturated with the same solution being used to separate the 
inflamed parts in the intervals) are said to be beneficial, and 



64 PHARMACOLOGY AND THERAPEUTICS. 

in the gonorrhoea of females a somewhat stronger solution, to 
which alcohol or cologne water is added. The strong acid is 
generally successful in relieving the pain of a carious tooth, 
but the pledget of cotton on which it is inserted into the cavity 
should be covered with dry cotton, in order to prevent its 
coming in contact with the gum and possibly causing sloughing. 
In ulcerated sore throat, tonsillitis, diphtheria and other throat 
affections a one per cent, solution in water and glycerin is 
useful as a gargle or wash for cleansing purposes, and also for 
the alleviation of pain, while a concentrated solution in glycerin 
is sometimes applied as a mild caustic. In " hay-fever," influ- 
enza and acute and chronic nasal catarrh, also, weak solutions 
are topically used to a large extent (frequently by means of 
the atomizer), and a favorite one is that of Dobell, which con- 
tains, in addition to carbolic acid, sodium borate and sodium 
bicarbonate, with glycerin. In acute coryza the combination of 
the fumes of carbolic acid and iodine is often very beneficial. 
For this purpose a mixture of the acid and tincture of iodine, 
dropped upon a sponge placed in a wide-mouthed bottle, may 
be volatilized by wrapping the latter in a cloth wrung out of 
hot water, or even by the heat of the hand. The spray from a 
steam atomizer supplied with a 5 per cent, solution of the 
acid alone is also of service, and in acute conjunctivitis marked 
relief is afforded by holding the eye open in a spray of this 
kind. The use of the following formula has been very highly 
commended in the treatment of whooping-cough; Phenol, .36 
gm. (6 gr.) ; menthol (4 per cent, solution), 15 c.c. (4 fl. dr.) ; 
cocaine hydrochlorate (3 per cent, solution), 11 c.c. (3 fl. dr.) ; 
glycerin, 4 c.c. (1 fl. dr.); cherry-laurel water, 30 c.c. (1 fl. 
oz.). This mixture is to be inhaled every three hours, from an 
atomizer, the nozzle of which is inserted as far as possible into 
the mouth of the patient. 

The deep-seated injection of phenol has been successfully 
practised in the treatment of lupus, ulcerations, poisoned 
wounds, erysipelas, secondary syphilitic abscesses, fistulae, en- 
larged bursas, synovitis, etc. In synovitis the injections are 



PHEXOL. 65 

made into the affected joint. A solution of the strength of 
from 2 to 5 per cent, is commonly employed, but in the case of 
hydrocele the pure acid is sometimes injected into the sac, after 
the removal of the fluid. Piles are also efficiently treated with 
injections of carbolic acid, either pure or diluted with oil, but 
some accidents have been reported from the procedure. In the 
early stage of boils and carbuncles the formation of pus is 
said to be prevented by the use in this way of weak solutions, 
and gangrenous and necrotic anthrax has been reported to be 
cured by frequent injections of a 3 per cent, solution. It is 
recommended that the hypodermatic needle should be inserted 
obliquely to the centre of the inflamed tissue (the skin having 
been first anaesthetized by the application of the acid or an 
ether spray), and that it should not be connected with the 
syringe until it has been observed whether any blood escapes 
from it. which would indicate that it had entered a vein. It 
may also be mentioned that good results have been claimed 
from the parenchymatous injection of phenol in pleuro-pneu- 
monia. septic puerperal fever, acute and subacute rheumatism, 
malarial fever, tetanus and other diseases. 

Internal. — Phenol is a very useful remedy in gastro-intestinal 
irritation, especially in cases associated with or dependent upon 
fermentative changes from imperfect digestion, and also where 
the disturbance is characterized by a nervous element. Vomit- 
ing and flatulence, as well as gastrodynia. may often be re- 
lieved by it, and it is of great service in many cases of diar- 
rhoea. For the latter condition it is very generally combined 
with bismuth subnitrate (.60 to 1.20 gm. ; 10 to 20 gr.), and 
administered either in emulsion or in capsules. Carbolic acid 
has been tried in a number of zymotic diseases, and while opin- 
ions differ as to its efficacy, considerable evidence has accu- 
mulated in its favor. In a part of India where the mortality 
from typhoid fever had previously been very great, admirable 
results in this disease were obtained from the use of a mixture 
containing carbolic acid and spirit of chloroform. The pure 
acid has also been employed successfully. .16 gm. (2 l / 2 gr.) 
6 



66 PHARMACOLOGY AND THERAPEUTICS. 

being administered at a time, in the form of a pill coated with 
keratin, in order to delay solution until after passing into the 
intestine. Another way of exhibiting phenol in typhoid which 
has won considerable favor is in conjunction with tincture of 
iodine, the two remedies sometimes being given in infusion of 
digitalis. When iodine and phenol are thus employed together, 
a colorless carbolate is said to be formed when they are dropped 
into water. The most remarkable results from carbolic acid 
have been reported in the treatment of scarlet fever. In this 
plan of treatment the acid is given in doses of from .06 to .36 
gm. (1 to 6 gr.), according to the age of the child, freely diluted, 
every two hours. The remedy is designedly pressed to the point 
of causing carboluria, and this condition is maintained until 
the fever is fully abated. So far from this proving injurious 
to the kidneys, it has been found that renal complication, which 
ordinarily occurs quite frequently in this disease, is exceedingly 
rare; while the cases thus treated prove in other respects very 
mild. It would seem, therefore, that the opinion which has 
prevailed in the profession, that when the urine begins to 
assume a smoky hue it should be regarded as a warning of 
danger, is an erroneous one. It is stated, furthermore, that the 
infection communicated by these carbolized patients is extra- 
ordinarily light, but yet sufficient to confer permanent immunity; 
so that it has been urged that it is better to let children take 
the disease in this modified form, rather than to leave them to 
the chance of contracting it later in its normal virulence. 
Where this was refused, however, it has been found that light 
carbolization of those exposed gives immunity for the time 
being. Strong evidence has also been educed of the great 
value of large doses of phenol in the treatment of influenza, 
particularly in the later stages of the disease, which often prove 
so intractable. In tetanus it is claimed that as good results 
have been obtained from carbolic acid as from the use of anti- 
toxin. It is usually given hypodermatically in a two per cent, 
solution, from .30 to 1 gm. (5-15 gr.) being administered in the 
twenty-four hours. It is thought by some authorities that it 



PHENOL. 67 

neutralizes the tetanus poison in the same manner as the anti- 
toxin. Its use is advocated on the ground that in addition to 
being an antidote to the toxin, it acts as an anaesthetic and 
general antiseptic. In erysipelas it has been given by the 
mouth and subcutaneously, as well as by deep-seated injection 
at the affected part. Large doses by hypodermatic injection 
have been recommended in bubonic plague, and cases of re- 
covery under this treatment have been reported. Phenol ap- 
pears to have a distinctly curative effect in malarial fevers, and 
the combination of the acid with iodine in chronic malarial 
infection, as well as in the more acute cases after quinine has 
stopped the paroxysms, has been found of great value. In 
gangrene of the lung the internal administration of carbolic 
acid combined with the use of a weak solution by atomization 
is said to be very advantageous. In this condition, however, 
as well as in pulmonary tuberculosis, creosote is generally con- 
sidered preferable at the present time. 

Cresol has an action very similar to that of phenol, while its 
germicidal power is said to be nearly three times as great as 
that of the latter. It may be used internally and in surgery for 
the same purposes as carbolic acid. It has been recommended, 
in a 1 to 1000 solution, as a solvent for atropine and other 
drugs employed in ophthalmic practice; it being claimed that 
such solutions are non-irritant and that they remain free from 
bacteria. 

Chlorophenols. — By the action of chlorine upon carbolic acid 
a mixture of ortho- and parachlorphenol is produced, and if 
the action is sufficiently continued, trichlorphenol results. It is 
alleged that these compounds are very powerful germicides, 
the 2 per cent, solution being stronger than the 5 per cent, 
carbolic acid solution, and but slightly weaker than the one- 
thousandth solution of mercuric chloride. 

Phenosalyl is an antiseptic mixture composed of 90 parts of 
phenol, 10 parts of salicylic acid, 20 parts of lactic acid, and 1 
part of menthol. It is said to possess much greater antiseptic 
power and to be considerably less poisonous than carbolic acid. 



68 PHARMACOLOGY AND THERAPEUTICS. 



TOXICOLOGY. 

Phenol is employed for suicidal purposes far more frequently than any 
other poison, principally for the reason that it can be so readily ob- 
tained, and also, no doubt, because its lethal action, if the dose is suf- 
ficiently large, is so extremely prompt. Death has been known to occur 
within three minutes! In surgical practice the free use of the drug is 
not unattended with danger. Cases have been observed in which pa- 
tients have passed, immediately after the application of carbolic dress- 
ings, into a condition of collapse similar to the shock following severe 
injuries or surgical operations. Of five such cases related by one au- 
thor, recovery took place in only one instance. In other cases the 
poisoning occurs gradually and insidiously, and may be mistaken for 
septicaemia. The correct diagnosis can be determined by an examina- 
tion of the urine. Cases have been reported in which, in addition to 
wounded surfaces, poisoning has occurred from absorption from the 
skin, the rectum, and the uterine and other cavities. The effects of 
the drug when taken by the mouth have already been described. Be- 
sides the local action of the acid, the warnings of danger have been 
pointed out to be sudden vertigo, contracted pupils, pallor of the face, 
enfeebled circulation, and embarrassed respiration. If the amount 
taken is sufficiently large, the patient rapidly passes into insensibility. 
The symptoms frequently resemble very closely those of apoplexy, but 
the odor of carbolic acid may generally be detected in the breath and 
the characteristic corrosion produced by the acid be found to be present 
on an examination of the mouth. It is a fact, deserving of note that in 
some instances where consciousness had been restored and the condition 
otherwise become markedly improved, the patient after a number of 
hours sank rather suddenly into fatal collapse. 

Post-mortem. — If death has occurred quickly, the tissues and organs 
will smell distinctly of the drug. The mucous membrane of the mouth, 
pharynx, oesophagus and stomach, wherever acted upon by the poison, 
is found to be corrugated, tough and discolored. It is generally whitish, 
changing to a brownish color, and the corrosions may be surrounded by 
a zone of inflammatory redness. In some instances, where the pure 
liquid acid has been swallowed, the appearance is that of a broad choco- 
late-colored slough, extending continuously from the lips down into the 
stomach, and involving more or less of the gastric mucous membrane. 
The blood is dark-colored and generally coagulated in the heart and 
great venous trunks, although it has been maintained by some authori- 
ties that in consequence of the alteration in its character caused by the 
drug it coagulates with difficulty. While, however, the heart may be 



PHENOL. 69 

distended with loose clots, it is sometimes found empty and contracted. 
Acute fatty degeneration of the heart, as well as of the liver, kidneys 
and other organs, it is asserted, has been found in some cases. 

Treatment. — Many of the cases of poisoning met with present very 
little hope of amelioration from whatever measures may be adopted. 
If the drug has been taken by the mouth, the stomach should be promptly 
evacuated by means of the stomach-pump or the hypodermatic adminis- 
tration of apomorphine hydrochloride, and demulcents, such as white 
of egg or thick soap-suds, given. Oils should not be used, as they are 
liable to increase the absorption of the poison. Saccharated lime should 
be administered, in the hope that an insoluble combination may be 
formed in the stomach. Soap is also considered a chemical antidote. 
In view of the fact that in the tissues carbolic acid forms a compara- 
tively harmless compound with sulphuric acid, the exhibition of sodium 
sulphate has been advocated by many authorities ; but it is stated that 
practically this is of little or no benefit, either because the tissues are 
entirely paralyzed by the excess of carbolic acid, or more probably be- 
cause the latter does not combine with sulphates as such in the body, 
but with organic sulphur compounds which are only in process of being 
oxidized to sulphuric acid. It is of the utmost importance to immedi- 
ately give stimulants freely, such as ether or brandy subcutaneously. 
Alcohol should also be given by the mouth, as pure alcohol is the most 
important antidote to phenol known. Success in this treatment demands 
that the acid and alcohol should be brought in contact ; therefore if the 
acid has been swallowed for some time alcohol may not be efficacious. 
Atropine has also been recommended as an antidote, experiments on 
animals showing results which point strongly to the existence of the 
antagonism, and it is reported to have succeeded in some very unpromis- 
ing cases. At all events, such stimulants to the central nervous system 
as atropine, camphor and caffeine are generally called for, and artificial 
respiration should be resorted to in all serious cases. Hot applications 
and friction should also be employed to combat collapse. Cider vinegar 
is stated to be one of the antidotes of carbolic acid, having the effect 
when applied to a cutaneous or mucous surface which has been burnt 
by it of causing the prompt disappearance of the characteristic white 
eschar produced by the acid, and also of preventing subsequent scarring 
to a large extent. As it is supposed to be equally efficacious when the 
poison has been taken into the stomach, vinegar diluted with an equal 
quantity of water may be given if the patient is able to swallow. This 
article has the advantage of being always procurable without delay. 
When practicable, the patient's bowels should be moved with sodium, 



JO PHARMACOLOGY AND THERAPEUTICS. 

or magnesium, sulphate, and it is advised that the soluble sulphates 
should be administered in small doses for several days, with the idea 
of facilitating the elimination of the phenol from the system. 

THE PHENOSULPHONATES. 

1. SODII PHENOSULPHONAS (Sodii Sulphocarbolas, U. S. P., 
1890). — Sodium Phenosulphonate. (Sodium Sulphocarbolate.) Dose, 
0.250 gm. (250 milligm.) ; 4 gr. 

2. ZINCI PHENOSULPHONAS.— Zinc Phenosulphonate. (Zinc 
Sulphocarbolate.) Dose, 0.125 gm. (125 milligm.); 2 gr. 

Action of Sodium Phenosulphonate. 
It is less irritant and less poisonous than phenol, and while 
it is stated to possess less antiseptic power than the latter, has 
considerable efficiency as a gastro-intestinal antiseptic and dis- 
infectant. It does not cause smoky discoloration of the urine, 
and appears to be excreted in that fluid unchanged. 

Therapeutics of Sodium Phenosulphonate. 
The sulphocarbolates were introduced for the purpose of 
securing, if possible, the antiseptic and antipyretic action of 
phenol without the caustic and depressing action of the drug. 
While sodium phenosulphonate does not perhaps altogether 
maintain the position anticipated for it, it may in some instances 
be used with advantage as a substitute for carbolic acid. It 
is employed as a topical application to inflamed and diseased 
mucous membranes, and internally as a remedy for fermentative 
dyspepsia. It has also been given in typhoid fever and other 
infectious diseases, such as septicaemia, puerperal fever, and 
the exanthemata, and successful cases have been reported from 
its use even in malignant endocarditis. 

Action of Zinc Phenosulphonate. 
It is antiseptic, but less actively so than phenol, and its 
action is the same as sodium phenosulphonate and other pheno- 
sulphonates, except that it is decidedly more astringent. 



LYSOL. J I 

Therapeutics of Zixc Phenosulphonate. 
It is employed as an astringent for indolent or foul ulcers, 
and in subacute inflammations of mucous membrane, in solu- 
tions which are somewhat stronger than those of zinc sulphate 
in use. It is thought by some that it may replace the sulphate 
as an astringent. Internally it has been used to some extent as 
an intestinal antiseptic, and has been recommended in typhoid 
fever as having the advantage, over the phenol-and-iodine treat- 
ment, of being less depressing to the heart and less injurious to 
the kidneys. Some good results have been reported from doses 
of .12 to .20 gm. (2 to 3 gr.) four or rive times a day. 

LYSOL. 
LYSOL.— Lysol. (Xot official.) Dose, 0.06 to 0.50 gm.; 1 to 8 gr. 

Action of Lysol. 
Lysol is an antiseptic, about one eighth as poisonous as car- 
bolic acid, and even less poisonous than creolin {see p. 72). In 
sufficient quantity, however, it may produce fall of temperature 
and general depression, with nephritis, and a few fatalities have 
been reported from its use. Experimental research is said to 
have shown that both in pure cultures and in mixed masses of 
pathogenetic bacteria it acts more energetically as a germicide 
than either phenol or creolin; also that, except in strong 
solution, it is non-irritating, so that wounds may be absolutely 
disinfected by spraying with a 3 per cent, solution. Solutions 
of this strength, and even weaker ones, may produce a slight 
burning when applied to mucous membranes, but it is only 
transient. A solution of 1 part in 200 has been found to de- 
stroy streptococci in fifteen minutes. 

Therapeutics of Lysol. 
The official cresol has the same properties and uses as lysol. 
The latter is used locally in from one half to two per cent, aque- 
ous solution. The literature is extensive and generally favor- 
able. The value of this agent as an antiseptic has been con- 



72 PHARMACOLOGY AND THERAPEUTICS. 

firmed by many surgeons, although some of them have found 
it a little more irritating than was at first supposed to be the 
case. It is employed in much the same conditions as creolin, 
and has also been successfully tried in the treatment of lupus, 
pityriasis versicolor, and other skin diseases. It is used to 
some extent in obstetrical and gynaecological practice. Being 
readily soluble, a good antiseptic and deodorant, and inexpen- 
sive in cost, it is very serviceable for the disinfection of stools, 
sputa, privies, walls, floors, etc. It does not injure either 
metallic or rubber instruments, but, like creolin, it renders 
them difficult to grasp firmly. On celluloid articles it has a 
deleterious action. For cleansing the hands a one per cent, 
solution may be used, but it is said to be necessary that 
the water should be so hot as to be just short of boiling, 
which would make it somewhat painful when the hands 
are first introduced. Internally lysol has been given with good 
results in dyspepsia, in doses of .06 to .50 gm. (1 to 8 gr.), the 
taste being disguised with peppermint. It is stated that the 
use of about 500 c.c. (1 pint) of a 1 per cent, solution as an 
enema three times daily has been found of service in dysentery. 

Izal, which is chiefly used in England, is a coal tar deriva- 
tive possessing similar properties and employed for the same 
purposes. 

CREOLIN. 

CREOLINUM.— Creolin. (Not official.) 

Action of Creolin. 
Creolin is a non-irritating antiseptic of considerable activity, 
though its germicidal power has been overrated by some writers. 
Its internal administration is said to have produced restlessness, 
anxiety, nausea, amblyopia and a tendency to syncope, at the 
same time giving rise to a peculiar strong taste of tea or of 
smoke. In some of the cases observed the urine was dark- 
colored and markedly albuminous. The case is recorded of an 
infant three weeks old who was fatally poisoned by thirty drops 
of the undiluted drug. The chief symptoms were those of 



CREOLIX. 73 

violent irritation of the mouth and the upper respiratory and 
digestive tracts, and death occurred chiefly through inflamma- 
tion of the glottis. Creolin. however, is one of the least toxic 
of all the powerful antiseptics. It has the additional advantage 
of exerting a local influence resembling that of oily or muci- 
laginous preparations, instead of the irritating effect of carbolic 
acid. As compared with the latter agent, its germicidal power 
is somewhat smaller, since it is not efficient, in solutions con- 
taining albumin, in the strength of less than I to ioo; but as 
its poisonous qualities are decidedly less marked, it can be used 
in stronger solutions than phenol. For practical purposes, 
therefore, it is really a more powerful antiseptic. Toxic symp- 
toms have been observed but rarely from the use of creolin. 

Therapeutics of Creolin. 
As an antiseptic, creolin is frequently employed in place of 
carbolic acid. It is used pure, in 2 per cent, solution, in an 
ointment in gauze (5 to 10 per cent.), or as a soap (10 per 
cent.). It has been found of service in obstetrical and gynaeco- 
logical practice, and in diseases of the eye. ear, nose and throat, 
as well as in general surgery. In gonorrhoea it is used both in 
the form of bougies and of injections with olive oil (1 to 3). It 
is an excellent disinfectant for the hands, a 5 per cent, solution 
neither cracking the skin nor benumbing the sensory nerves. 
It is not well adapted for cleansing instruments, however, as 
the opacity of its solution prevents them from being seen at the 
bottom of the vessel. It also covers them with a soapy film.- 
which renders them somewhat slippery. While it does not 
corrode metal, it acts rapidly upon caoutchouc and gutta-percha. 
Its use by enema has proved valuable in both acute and chronic 
dysentery and in the diarrhceal diseases of children. The 
strength of the solution for injection should be about 5 to 1000 
for adults, and weaker than this for infants. It has been given 
internally in gastric fermentation, dysentery and typhoid fever. 
It has been recommended as a deodorant to iodoform. A 
mixture of from 1 to 2 per cent, produces a compound known 



74 PHARMACOLOGY AND THERAPEUTICS. 

as creolin-iodoform, with a faint aromatic odor, which is be- 
lieved to possess the therapeutic properties of iodoform. The 
creolin may be removed from it by water, leaving the iodoform. 
Jeyes' disinfectant preparations contain creolin. The official 
cresol can well be employed in place of creolin. 

IODINE. 

1. IODOFORMUM.— Iodoform. Dose, 0.250 gm. (250 milligm.) ; 
4 gr. 

Preparation. 
Unguentum Iodoformi. — Iodoform Ointment. 

2. THYMOLIS IODIDUM.— Thymol Iodide. (Aristol.) 

3. IODOLUM.— Iodol. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Unofficial Preparations. 
Europhenum. — Europhen. (Di-isobutyl-ortho-cresol Iodide.) 
Losophanum. — Losophan. (Tri-iodo-meta-cresol.) 
Acidum Di-iodosalicylicum. — Di-iodosalicylic Acid. 
Sozoiodolum. — Sozoiodol. (Soziodolic Acid.) 
Acidum Iodosalicylicum. — Iodosalicylic Acid. 

Action of Iodoform. 
External. — Locally iodoform is capable of inducing analgesia 
of the rectum and the bladder, and when applied in considerable 
quantity to wounded surfaces also has considerable anaesthetic 
effect. In exceptional instances (for the most part confined 
to individuals with a predisposition to cutaneous affections) it 
gives rise to a certain amount of irritation, or efflorescence, 
and even to papular or eczematous eruptions, in the vicinity of 
such surfaces. On sound integument it ordinarily has no local 
action. Although it was formerly believed to be of very pro- 
nounced antiseptic value, it has since been demonstrated that 
this opinion was founded on a misapprehension; pathogenic 
microbes frequently developing as rapidly after having been 
exposed to its action as in the control cultures. When it was 
shown that iodoform itself has no germicidal properties, the 



IODINE. 75 

theory was advanced that it only acts as an antiseptic after its 
decomposition, this resulting in the liberation of free iodine, 
which exerts an antiseptic influence. According to the best 
authorities, however, more recent investigations indicate 
that microbes found in wounds under iodoform treatment 
are not retarded or weakened in their development; proving, 
apparently, that the beneficial effects of such treatment are not 
due to any poisonous action on the germs. At present it is 
held that whatever benefits attend the use of iodoform dress- 
ings must be explained on the ground of a supposed action on 
the wounded surface, in consequence of which it secretes less 
fluid, and thus affords a less suitable medium for the growth of 
the germs. It is thought also that such growth may to some 
extent be retarded by the formation by the iodoform of a crust, 
which mechanically prevents microbes from penetrating to the 
wounded surface. The favorable results which have been 
observed from the application of iodoform to tuberculous ulcers 
of the larynx, tuberculous abscesses, and similar conditions are 
probably due to its beneficial effect on the granulation tissue, 
rather than to a specific action upon tuberculous disease, which 
many have regarded it as possessing. 

Internal. — From moderate amounts of iodoform the most 
constant symptoms produced are headache, more or less nausea 
and vomiting, and an unpleasant taste and smell of the drug 
in the nose and mouth. When it is taken into the system in 
larger quantities there is experienced the same taste and odor, 
the headache is accompanied with giddiness, and the patient is 
restless, uncomfortable, and unable to sleep. The action of the 
heart is feeble and accelerated, the pulse sometimes reaching 
180, and there is a rise of temperature to 104° F., or even 
higher. From the first there is anxiety and a general depression 
which increases as the case progresses. This deepens into true 
melancholia, with hallucinations, generally succeeded by violent 
delirium and mania, which may last for days or terminate in 
a shorter time in fatal collapse. In exceptional instances there 
is an entire absence of signs of cerebral excitement, and the 



y6 PHARMACOLOGY AND THERAPEUTICS. 

patient sinks into a profound sleep, ending in coma and col- 
lapse. Of all the symptoms of iodoform intoxication, the most 
characteristic are the delirium and mania. They are not de- 
veloped in the same intensity and of equal duration by any other 
poison, but it is not known what changes take place in the brain. 
In striking contrast to the case of man, it is stated that no 
similar effects have been observed in animals. The cerebral 
symptoms appear to be attributable to iodoform which circu- 
lates unchanged in the blood. Some of the other symptoms 
are no doubt due to iodine set free by the decomposition of a 
considerable portion of the iodoform and to the iodides which 
some of the nascent iodine forms by combining with the alka- 
lies of the fluids. After iodoform absorption iodine is present 
in the saliva, perspiration and other secretions, but it is found 
to be chiefly excreted in the urine in the form of iodides. The 
elimination from the tissues seems to be very slow, since iodides 
are stated to have been detected in the urine more than a month 
after the administration of iodoform. When renal disease is 
present, the drug should always be used with caution, as under 
these circumstances excretion takes place even more slowly 
than usual, and the iodoform products are liable to accumulate 
in the tissues. The cardiac acceleration noted is thought to be 
probably caused by abnormal activity of the cells of the thyroid 
gland, as the thyroid secretion has been found to be very con- 
siderably increased by iodoform, like other substances from 
which iodine is liberated in the tissues. Children, it is stated, 
are less susceptible to the poisonous effects of iodoform than 
adults. While iodoform is absorbed slowly by the alimentary 
canal, it is taken up quite freely in wounds, and many cases 
of poisoning have occurred in this way. 

Therapeutics of Iodoform. 

External. — Whatever may be the explanation of its local 

action, there can be no question of the great practical value of 

iodoform as a surgical dressing. In the last twenty years it 

has had an enormous vogue, and while, on account of its ex- 



IODINE. 77 

tremely disagreeable odor and the numerous accidents which 
have attended its use, various substitutes for it have been pro- 
posed and have proved more or less successful, it is still em- 
ployed to a very considerable extent. To attempt to recount all 
the various conditions in which it has proved of service would 
be an interminable task, and is unnecessary here. One of its 
most important applications, and that which first directed gen- 
eral attention to its usefulness, is as a dressing for wounds. 
The common practice is to sprinkle it freely upon the part and 
secure it in place by a dry dressing. Since iodoform is not, as 
explained above, itself antiseptic, it must, before being used, 
be either sterilized or disinfected by washing in a I to 2000 solu- 
tion of corrosive mercuric chloride solution, and preserved, 
while damp, in closed sterilized jars. It is employed in the treat- 
ment of all sorts of wounds, ulcers and sores, and is found 
especially serviceable in tuberculous and syphilitic ulcerations. 
Usually the dry powder is simply dusted upon them, but iodo- 
form is also employed in a variety of different combinations. 
One of these is a solution in collodion (1 part of iodoform to 12 
of flexible collodion), which is painted over wounds, venereal 
sores, etc., with good effect. Another is a mixture of equal 
parts of iodoform, glycerin and alcohol, which is used for in- 
jecting tuberculous abscesses. For the relief of chronic cystitis 
injections have been given of iodoform dissolved in ether 
(1 in 8), of iodoform, starch and water, and of a solution of 
iodoform in glycerin and water. The latter may be made as 
follows : Iodoform, moistened with alcohol, 1 ; boiling water, 2 ; 
glycerin 7, and it is also useful for injection into abscess cavi- 
ties, sinuses, etc. In fissure of the anus and diseased and pain- 
ful conditions of the rectum the iodoform suppository (B. P., 
each .20 gm. ; 3 gr. in .80 gm. ; 12 gr. of oil of theobroma) 
serves an excellent purpose. Similar vaginal suppositories have 
been largely used in affections of the uterus and vagina, and 
powdered iodoform is sometimes introduced into the dilated 
cervix uteri by insufflation. In the uterus, the urethra and in 
the nose, as well as in sinuses and other deep and narrow 



yS PHARMACOLOGY AND THERAPEUTICS. 

cavities, bougies made with cocoa-butter, mucilage and glycerin, 
or gelatin, may be employed. Mixed with bismuth subnitrate 
and starch it is used with benefit, by insufflation, for ozaena, 
ulcers of the mouth and fauces, and tuberculous ulcerations of 
the larynx. Syphilitic ulcers of the pharynx are sometimes 
treated also with the ethereal solution and with gelatin lozenges 
each containing .06 or .12 gm. (1 to 2 gr.) of iodoform. In 
ozaena, whether of the simple or syphilitic form, iodoform may 
be used in an ointment prepared with vaselin, or by means of 
absorbent cotton impregnated with it, instead of by insufflation. 
Iodoform cotton is useful as an application to the rectum and 
vagina, as well as the nostrils. In various forms iodoform is 
employed to a considerable extent in diseases of the eye and 
ear. In chronic suppuration of the middle ear, but more 
especially of the internal auditory canal, it is regarded by many 
as excelling all other applications in diminishing the discharge, 
correcting its fetor, and restoring the part to its normal condi- 
tion. Iodoform gauze, which may be made by saturating the 
material with a concentrated ethereal solution and afterwards 
drying, is much used in operations involving the peritoneum, 
intestine, etc., and in contused, complicated and other wounds 
where good drainage is required. It is efficient also in the treat- 
ment of open cancer, buboes, boils and carbuncles after incision, 
many of the lesions of scrofula, lupus and syphilis, and a variety 
of other conditions. A 4 per cent, solution of iodoform in oil 
of turpentine, administered in the form of inhalation, may some- 
times be used with advantage in laryngeal tuberculosis, bron- 
chorrhcea, and other affections of the respiratory apparatus, and 
good results have been reported from iodoform injections in 
the treatment of goitre and of tuberculous joints and lymphatic 
glands. A number of cases of tuberculosis of the bladder are 
reported to have shown more or less improvement under the 
use of a mixture of iodoform and vaselin. A novel use has 
recently been made of the drug, in the form of " iodoform 
plugs," employed for filling up cavities produced by diseased 
tissues, and the treatment is stated to have been especially sue- 



IODINE. 79 

cessful in bone cavities. They are composed as follows : Iodo- 
form, 3 to 6; spermaceti, 4; oil of sesame, 2. In exceptional 
instances iodoform, instead of having a healing and beneficial 
effect upon wounds, sores, ulcers, etc., causes marked irritation, 
necessitating its replacement by other applications. As the 
disagreeable odor of iodoform constitutes a very serious objec- 
tion to its use, various means have been tried to obviate this, 
but none of them with very marked success. Among the agents 
which have been employed to conceal the odor may be men- 
tioned musk, cumarin, creolin and balsam of Peru, and the oils 
of eucalyptus, turpentine, bergamot, geranium, peppermint, 
sassafras, cinnamon, lavender and thyme. Of these, oil of 
geranium (1 to 25) is probably the best. Some believe that 
the odor of iodoform is preferable to that of musk. By keep- 
ing a Tonka bean or ground roasted coffee with it, the odor is 
lessened. It is claimed that the odor will rapidly disappear 
from the hands of the surgeon if they be washed with orange 
flower water or with flaxseed meal in water. It has been 
pointed out also that as chloroform and ether are solvents of 
iodoform, they may be successfully used for removing its odor 
from the hands, nails and clothing. An " odorless iodoform " 
has been put upon the market, which is said to differ from ordi- 
nary iodoform only in that hydrogen is absent from its formula. 
It is claimed that it is equally efficient with the latter, but 
whether this claim is justified seems to be as yet undetermined. 
Internal. — On account of the great success of iodoform in 
surgery as a supposed antiseptic, it was anticipated that it 
would prove of decided benefit internally in many of the 
infectious diseases, and on account of the large amount of 
iodine in its composition (with the advantages of being non- 
irritant and having an organic nature), more especially in such 
affections as syphilis, scrofula and tuberculosis. It was there- 
fore given an extended trial, both by the mouth and by sub- 
cutaneous injection; but the expectations in regard to its 
efficacy were not at all realized, and although occasional reports 
of its use in various affections still continue to be published, it 



80 PHARMACOLOGY AND THERAPEUTICS. 

has been practically abandoned as an internal remedy by the 
mass of the profession. 

TOXICOLOGY. 

Many deaths have been occasioned by the too free use of iodoform 
as an external application, and in the aged especially more or less severe 
poisoning is liable to occur from this cause. A surgeon who has em- 
ployed iodoform in several thousand cases without a single instance of 
poisoning attributes this favorable result to the following circumstances : 
that he did not use large quantities of the remedy, that the wound was 
not subjected to pressure, and that carbolic acid was not employed at 
the same time. It is a recognized fact, however, that in certain indi- 
viduals there is an idiosyncrasy which renders them peculiarly suscep- 
tible to the action of the iodides in general, and often particularly so 
to iodoform. It has been found that in some instances this idiosyncrasy 
develops suddenly and without warning ; grave toxic symptoms occurring 
at once and death quickly ensuing, notwithstanding the withdrawal of 
the remedy. The following test for iodoform intoxication is of value 
if the patient is not at the same time using other preparations contain- 
ing iodine : A few drops of the urine is mixed with a small quantity of 
calomel on a white plate, by means of a glass rod ; when a well-marked 
yellow discoloration will be produced if the urine contains sufficient io- 
dine to indicate the absorption of a dangerous amount of iodoform. 

Post-mortem. — Fatty degeneration of the heart, liver, kidneys and 
muscles is generally found. Among the other conditions observed are 
ecchymoses in the kidneys, beneath the endocardium, and in other parts 
of the body, congestion of the meninges, and reddening of the mucous 
membrane of the gastro-intestinal tract, frequently associated with 
degeneration of the epithelial cells. 

Treatment. — The first measure to be adopted is the complete removal 
of all iodoform that has been applied and the washing of the part with 
a solution of sodium bicarbonate. In the milder cases of poisoning 
nothing further than this may be required. In more serious cases 
stimulants are called for, and small doses of tincture of opium fre- 
quently repeated, are recommended by some authorities as being espe- 
cially useful. At the same time elimination should be promoted by 
sponging the body with warm water and the free administration of 
diaphoretics and diluents, such as potassium acetate, lemonade, etc. 
Potassium bicarbonate, .60 gm. (10 gr.) of which may be given every 
hour, is thought to have the effect of counteracting the toxic effects 
of iodoform, and potassium bromide, which is more active as a solvent 
for this substance than any other salt, is also considered an antidote. 



IODINE. 8 1 

Action of Thymol Iodide. 

Aristol is non-irritant and in its general local action resembles 
iodoform. It is, however, less desiccant than the latter, as the 
thymol appears to have some effect in increasing moisture. It 
possesses the great advantage of being practically odorless. It 
is claimed to be non-toxic, but it is possible for its prolonged 
use to give rise to chronic iodine poisoning. It has been 
demonstrated to have no influence upon the lower organisms, 
and is not, therefore, directly antiseptic. In regard to its 
elimination, very little is known, but it would seem to be 
partially decomposed in the system. Iodine has been found 
present in the urine of animals to which it was given in con- 
siderable quantities, but no traces of thymol have been de- 
tected. 

Therapeutics of Thymol Iodide. 

Aristol has proved in many respects a very useful substitute 
for iodoform. In surgery when dusted upon serous membranes, 
however, it tends to prevent their adhesion, and in the treat- 
ment of wounds and sores it is contra-indicated when secretion 
is free. It is used for the same purpose as iodoform in cutane- 
ous affections, such as lupus, psoriasis and eczema, in syphilitic 
lesions, and in a great variety of diseased conditions of the 
mucous membranes, and is very efficacious in the treatment of 
burns. It is employed as a powder and in flexible collodion, 
solutions in oil or ether, and ointments made with lanolin or 
vaselin. Heat should not be used in dispensing it, as the iodine 
in its composition is readily set free; and it should not be mixed 
with alkalies, metallic oxides, or starch. 

Action of Iodol. 
Iodol is a cicatrizing agent with properties similar to those 
of iodoform, as a substitute for which it was first introduced. 
It is without odor and does not produce stomatitis or nasal 
catarrh. It is decomposed in the tissues, and iodides are 
excreted in the urine. Its iodine is said to be less easily split 
off the molecule than that of iodoform, and it has been found 
7 



82 PHARMACOLOGY AND THERAPEUTICS. 

less liable to cause poisoning than the latter; but in very large 
doses it gives rise to symptoms in animals similar to those pro- 
duced by iodoform, while its prolonged administration may 
result in fatal fatty degeneration of the internal organs. Its 
surgical use is reported in one instance to have occasioned dizzi- 
ness, marked rise of temperature, vomiting, small irregular 
pulse of 136, albuminuria, and apathy, which continued for 
several days. Iodine was found in the urine for two weeks. 
Experiments have shown that iodol is absorbed quite slowly, 
and to this fact is attributed its greater safety than iodoform 
as a topical application. Locally it appears to have a very 
superficial caustic effect, forming a whitish film on ulcerated 
surfaces, but not a scab. 

Therapeutics of Iodol. 
It may be used for all the same purposes as iodoform, and 
iodol gauze, cotton, ointment, bougies, pastils, etc., correspond- 
ing to those made with iodoform, are now supplied. It is 
largely employed in powder and also in solutions of various 
kinds. That known as Mazzoni's consists of iodol, 1 ; alcohol, 
16; glycerin, 34. An ethereal solution (4 gm. to 30 c.c. ; 1 dr. 
to 1 fl. oz.) has the advantage of leaving the remedy deposited, 
after the evaporation of the ether, in a minutely divided state. 
In ointment (10 per cent.) it has sometimes been substituted 
for the iodine preparations. Painted over and around the 
affected part in a 10 per cent, solution in collodion, it is re- 
ported to have proved successful in aborting erysipelas. Inter- 
nally it has been used in the place of potassium iodide, and it is 
said to be of value in tertiary syphilis, in quantities of from 
0.4 to 2 gm. (6 to 30 gr.) a day. Favorable results are also 
said to have been obtained with it in diabetes. 

Action of Europhen. 
Europhen has considerable value as a local germicide and 
bactericide, and its antiseptic properties, it is thought, depend 
mainly on the fact that it is a phenol derivative, rather than on 



BORON. 83 

its containing iodine. In some respects it differs markedly from 
iodoform and from iodol. Thus, iodine is not liberated by the 
tissues, and, so far as the iodine in it is concerned, europhen 
passes through the body unchanged. It has a specific aromatic 
odor, which is not unpleasant to most persons, and is said to 
be entirely non-toxic. It is incompatible with starch, metallic 
oxides, and the preparations of mercury. 

Therapeutics of Europhen. 
It is used in the treatment of wounds for the other purposes 
for which iodoform is employed, and in the same quantities as 
the latter. It has been found efficacious in burns, chancres and 
syphilitic ulcers and in psoriasis, eczema, lupus and other skin 
affections, as well as in diseases of the nose, throat and ear. 
Mixed with collodion it is applied to buboes. It is largely 
used in ointments of a strength varying from 1 to 10 per cent. 
It has considerable value as a haemostatic, and is regarded as 
especially advantageous whenever a dry antiseptic application 
is required. 

Various other iodoform substitutes (not official) are found in the 
market. The only advantage they have over iodoform is in the mat- 
ter of odor. The principal ones are the following : 

Losophan contains 80.0 per cent, of iodine. 

Di-iodosalicylic acid " 66.0 " 

Sozoiodol " 54.0 " 

Iodosalicylic acid " 50.0 " 

BORON. 

1. ACIDUM BORICUM.— Boric Acid. (Boracic Acid.) Dose, 
0.500 gm. (500 milligm.) ; iy 2 gr. 

Preparations. 

1. Glyceritum Boroglycerini. — Glycerite of Boroglycerin. 
(Solution of Boroglyceride.) 

2. Cataplasma Kaolini. — Cataplasm of Kaolin. 



84 PHARMACOLOGY AND THERAPEUTICS. 

3. Liquor Antisepticus. — Antiseptic Solution. Dose, 4 c.c; 
1 fl. dr. 

4. Unguentum Acidi Borici. — Ointment of Boric Acid. 

2. SODII BORAS.— Sodium Borate. (Borax. Sodium Pyroborate.) 
Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. 

Unofficial Preparations. 
Mistura Magnesii Boro-citratis. — Mixture of Magnesium 
Boro-citrate. Dose, 16 c.c.; 4 fl. dr. 

Potassii Tartra-boras. — Potassium Tartra-borate. Dose, 1.20 
gm.; 20 gr. 

Unguentum Boroglycerini. — Boroglycerin (or Boroglyceride). 
Ointment. 

Action of Boric Acid and Borax. 

External. — Experiments have shown that while boric acid 
and borax are inefficient as germicides, they have some antiseptic 
power. The growth of almost all forms of bacilli is arrested by 
a 2^2 per cent, solution, but the microbes are not destroyed, 
and it is stated that even the anthrax bacilli are capable of 
further growth after exposure to a 4 per cent, solution for 
twenty-four hours. They would seem, therefore, to be of ser- 
vice as mild antiseptics, but to be valueless as disinfectants. 
A saturated solution of boric acid in broth will prevent putrefac- 
tion, and this agent is employed to a large extent in the preser- 
vation of milk, meats and other kinds of food. When applied 
in concentrated form to denuded surfaces, it is somewhat 
irritating and mildly astringent; in solution, while slightly 
astringent, it is sedative rather than irritating. Borax has no 
irritant effect. Its alkalinity renders it a cleansing agent of 
some efficiency and also adds to its sedative action. Its pro- 
longed use, as well as that of boric acid, is liable to give rise 
to scaly eruptions of the skin. 

Internal. — Taken in moderate amount borax does not affect 
the digestion and assimilation of food, but larger quantities 
retard the absorption of proteids and fats and increase the bulk 



BORON. 85 

of the faeces. Both borax and boric acid are found to be 
rapidly absorbed by the bowel, and not to affect the intestinal 
putrefaction. Their excretion, which occurs principally by the 
urine, is completed within twenty-four hours. The urine is 
rendered alkaline by borax, if taken in sufficient amounts, as by 
other alkalies; while boric acid, which is excreted in part un- 
changed and in part as borates, increases its acidity. Borax 
seems to be excreted unchanged. Both these substances have 
generally been regarded as having something of a diuretic 
effect, but so far from this being the fact, the latest researches 
go to show that the urine is really diminished in amount under 
their use. Borax is thought by some to have a somewhat stimu- 
lating influence upon the uterus, and is said to have produced 
abortion in certain instances. It is argued, therefore, that it 
cannot be employed with impunity in women. In some cases 
even moderate amounts of boric acid and borax have a mild 
aperient action, while in large doses they are gastro-intestinal 
irritants, and cause vomiting and purging. Other symptoms 
produced by toxic quantities are dryness of the throat and 
dysphagia, profound muscular weakness, lumbar pain and 
vesical tenesmus, with albuminuria and sometimes hematuria, 
dimness of vision, headache, sleeplessness, and nervous depres- 
sion; which may be followed by fatal collapse. A rise of tem- 
perature is frequently observed, and in the course of two or 
three days, if death does not previously occur, eruptions which 
are described as scaly, papular or eczematous, appear upon the 
skin. When the drugs are given by the mouth it is stated that 
nausea, vomiting and diarrhoea appear earlier and are apt to be 
more severe than if they are used in any other way, but the 
same character of symptoms may result from their free applica- 
tion in the rectum, vagina and other parts. They are rapidly 
absorbed from all mucous membranes and from lesions, and a 
number of serious cases of poisoning have been reported from 
the use of boric acid as an antiseptic dressing. In chronic 
poisoning, the condition known as borism, the symptoms are 
often much the same as in cases of acute poisoning. The cu- 



86 PHARMACOLOGY AND THERAPEUTICS. 

taneous manifestations, however, are more prominent, and 
may constitute the only positive indication of toxic action, 
though there are generally evidences of more or less renal and 
gastro-intestinal irritation. (Edema of the face and extremi- 
ties may occur in consequence of the former, and it is advisable 
that whenever these drugs are given in full doses, a careful 
watch should be kept upon the state of the urine. The hair is 
apt to become dry and fall out, and the eruption on the skin 
may assume the form of seborrhceic eczema, reddish patches 
which desquamate like psoriasis, or papules attended with much 
itching. The commonest form of eruption is said to be a scaly 
one, resembling seborrhceic dermatitis, but usually attended 
with much more oedema. In some cases there are marked dry- 
ness of the skin and mucous membranes, with Assuring of the 
lips and striation of the nails, and a blue line, resembling that 
of lead poisoning, has been observed upon the gums. The 
question of the effect of the continued and habitual introduction 
into the body of boric acid or borax, as employed in the preser- 
vation of food, is one of interest. The results of recent careful 
experiments conducted by the Bureau of Chemistry, United 
States Department of Agriculture, show, on the whole, that one 
half gramme (y/ 2 grains) a day is too much for the normal man 
to receive regularly; while on the other hand the normal man 
can receive one half gramme of boric acid, or of borax ex- 
pressed in terms of boric acid, for a limited period of time 
without much danger of impairment of health. The main ob- 
jection to the use, as food preservatives, of these and other 
antiseptics which are harmless in small doses seems to rest 
upon the fraud in permitting inferior goods to be disposed of 
as a first-class article. This applies particularly to meats and 
milk, although the addition of small quantities may sometimes 
be beneficial by delaying the souring of the latter. If larger 
amounts are used for fraudulent purposes, the milk is apt to be 
kept too long and be of inferior quality, while the quantity of 
preservative may be sufficient to prove injurious to infants 
taking it habitually. 



BOROX. 87 

Therapeutics of Boric Acid and Borax. 
External. — These drugs are used to a much greater extent 
externally than internally, and., especially on account of their 
non-irritating qualities, are largely employed as local antiseptics. 
Occasionally they are used in powder. The saturated solution 
of boric acid (4 per cent.) may be applied to wounds, ulcers 
and sores to protect them against infection or decomposition. 
It is efficacious in phlegmonous erysipelas and in a number 
of chronic scaly and parasitic skin eruptions. It is especially 
recommended in the troublesome form of tinea known as 
trichophytosis gcnito-cruralis, which affects the scrotum and 
inner side of the thigh, and it is considered the best remedy for 
fetid perspiration. It is also of service as an injection when 
there are purulent discharges, as in otorrhcea and leucorrhoea, 
and to wash out cavities after operations. The irrigation should 
not be continued too long, however, as toxic symptoms have 
been produced in this way. The same caution applies to wash- 
ing out the large intestine with this solution, which has been 
found of service in colitis ; tannic acid being sometimes added to 
it. Boric solutions, the strength of which may be varied ac- 
cording to circumstances, are very useful in conjunctivitis and 
other inflammations of the mucous membranes, and, applied 
upon lint or absorbent cotton, as a dressing for burns and 
scalds. The Glyceritum Boroglycerini, well diluted, also 
answers well as an antiseptic wash in ophthalmia, ozsena, 
pharyngitis, urethritis, vaginitis, etc.. and likewise for wounds 
and granulating surfaces. For washing out the bladder in cys- 
titis Thompson's fluid (consisting of borax, 1; glycerin, 2; 
water, 2), diluted with eight times as much water, is commonly 
employed; and one of the most important antiseptic solutions 
is that of Thiersch, consisting of boric acid. 12 ; salicylic 
acid, 2; water, 1000. The glycerin of the B. P., which is 
borax, 1 ; water, 2 ; glycerin, 4, and the honey of borax of the 
B. P. (which is borax, 2; glycerin, 1; clarified honey, 16), are 
much used in aphthous sore mouth. This is also often treated by 
the application of borax mixed with powdered sugar. The 



88 PHARMACOLOGY AND THERAPEUTICS. 

following is an excellent mouth-wash: Glycerin of borax 
(B. P.), 6; tincture of myrrh, i; water, to 48. For sunburn, 
pruritis and other skin affections, as well as for wounds, ulcers, 
etc., boric acid ointments such as the official one will often be 
found serviceable. The ointment of the B. P. consists of boric 
acid, 1; paraffin ointment (soft paraffin, 3; hard paraffin, 7; 
melted together), 9. Lister's ointment consists of boric acid, 1; 
white wax, 1 ; paraffin, 2 ; almond oil, 2. An ointment of boro- 
glyceride (not official) is made of glycerin, 92; boric acid, 62; 
by heating. Greene's ointment is prepared by melting one part 
each of spermaceti and white wax with six parts of vaselin, and 
adding, while hot, two to four parts of a saturated glycerite of 
boric acid. For application to extensive burns it would be ad- 
visable to dilute most of these ointments. Boric lint and boric 
cotton, made by steeping the materials in a saturated solution of 
boric acid at the boiling-point, are used to a considerable extent 
in surgery, gynaecology, etc. The external use, as well as the 
internal administration, of boric acid and the borates should be 
employed with caution when disease of the kidneys is present. 
Boric acid may be used to preserve solutions intended for hypo- 
dermatic use. 

Internal. — Internally boric acid is almost exclusively given 
for correcting the fetor of fermentative dyspepsia and in cases 
of cystitis with decomposing urine, where it is also used in 
solution for irrigation of the bladder. In ammoniacal cystitis 
it tends to render the urine acid (probably by checking the fer- 
mentation, and also because it is excreted in part as boric acid), 
and has a beneficial effect upon the vesical mucous membrane. 
It should be given in full doses, in diluted watery solution, and 
its administration should occasionally be suspended. Borax is 
sometimes of service in relieving irritability of the bladder. 
Although at one time several observers reported beneficial ef- 
fects from the use of the latter drug in typhoid fever, the treat- 
ment never won the confidence of the profession, and has been 
practically abandoned. It has been tried to a considerable ex- 
tent in epilepsy, but for the most part with disappointing re- 



POTASSIUM PERMANGANATE. 89 

suits. While far less efficient than the bromides., it is, in the 
quantity in which it is required to produce any effect in this 
disease, much more dangerous. It is said to be apparently of 
most service in cases where these agents fail and in those in 
which the epilepsy is associated with gross organic disease. 
Among the other conditions in which it has been employed are 
dysmenorrhea, amenorrhea and uterine haemorrhage, as well 
as inertia of the uterus during labor. It is sometimes taken 
in very large doses for the purpose of criminally causing abor- 
tion. That it really has any action on the uterus would seem 
to be problematical. It is thought by some to be of value as 
a solvent for uric acid calculi; but here again grave doubts 
have been expressed as to its efficacy. Another boric acid salt, 
magnesium borocitrate, has also been strongly urged for this 
purpose, but in the opinion of other authorities potassium tartra- 
borate is preferable, on the ground that the potash compounds 
of uric acid are more soluble than the soda compounds. It is 
obtained by heating together until dissolved 4 parts of potas- 
sium bitartrate, 1 part of boric acid, and ten parts of water. 
The solution is then evaporated to dryness and the residue 
powdered. 1.20 gm. (20 gr.) should be given three or four 
times a day in a large quantity of water. The unpleasant taste 
of borax may be covered with liquorice, or. preferably, with 
syrup of orange-peel. 

POTASSIUM PERMANGANATE. 

POTASSI PEEMANGANAS.— Potassium Permanganate. Dose, 
0.065 gm. (65 milligm.) ; 1 gr. 

Action of Potassium Permanganate. 
External. — Kept dry. it is a permanent salt, but in the presence 
of moisture it rapidly gives up its oxygen and is converted into 
manganese dioxide. In powder it has some effect on living 
tissues, and acts as a mild caustic. In concentrated solutions 
it causes irritation and even corrosion of the skin. When a 
solution comes in contact with proteids. such as albumin, it 



90 PHARMACOLOGY AND THERAPEUTICS. 

at once parts with some of the oxygen which it contains, and 
the latter unites with the albumin. It is therefore a powerful 
oxidizing agent and, in consequence, is poisonous to proto- 
plasm. It has very considerable germicidal activity, but this 
is short-lived for the reason that it so quickly parts with its 
oxygen; after which it becomes inert. Experiment has shown 
that 0.12 per cent, (i part in 833) will destroy the micrococci 
of pus in two hours. Except in very superficial infection, 
however, its antiseptic value is smaller than that of many 
other agents, since, on account of the rapidity of its reduction, 
it fails to penetrate deeply, and its action is limited to the skin 
and the surface of the mucous membranes. Within a limited 
sphere it is a very efficient disinfectant and deodorant. 

Internal. — It is not absorbed in sufficient amount to have any 
general action. When taken in poisonous quantities, the re- 
sulting phenomena are entirely local. This local action is 
manifested in gastro-enteritis and irritation or inflammation 
of the kidneys. The lack of general action, according to some 
authorities, holds true even when it is introduced into the 
circulation by subcutaneous or intravenous injection. Accord- 
ing to others, in acute poisoning the blood-pressure falls, from 
depression and paralysis of the vaso-motor centre, while the 
heart is not affected until much later. Injected thus into the 
circulation, it is excreted principally by the intestinal epithe- 
lium and to a smaller extent by the kidneys. When taken by 
the mouth, very little appears to be absorbed from the stomach 
and intestines. In the mouth weak solutions of potassium per- 
manganate have a sweetish but astringent and unpleasant taste, 
and there, as well as in the stomach, it is quickly reduced to 
the dioxide and loses its oxidizing power. On account of its 
caustic action this remedy, when taken in the form of pills or 
tablets, sometimes occasions considerable gastric irritation and 
pains. In the blood of man and animals traces of manganese 
are very frequently found, but it has been shown that this 
metal is not an essential constituent of the body; being appar- 
ently absorbed accidentally with the food. The theory that 



POTASSIUM PERMANGANATE. 9 I 

manganese salts could replace iron in the body has been proved 
to be untenable. 

Therapeutics of Potassium Permanganate. 
External. — One objection to its use, when large quantities are 
required, is its expensiveness. Another objection is that it 
stains fabrics. The stain may be removed by the application 
of sulphurous acid, but as this results in the formation of sul- 
phuric acid, the fabric should be promptly rinsed in water. As 
an antiseptic it may be used to wash wounds, sores and ulcers 
in a solution of the strength of 4 gm. (1 dr.) to 500 c.c. 
(1 pint). For application to mucous membranes, as in a 
gargle or lotion for swabbing the throat in diphtheria, scarlet 
fever, and other diseases, the proportion should be about 1.20 
gm. (20 gr.) to 500 c.c. (1 pint). Such solutions are em- 
ployed in necrosis of the jaw, cancer of the tongue, and gener- 
ally in affections causing foul breath. They are useful also 
for correcting fetor in various other conditions, such as ozaena, 
bromidrosis of the feet, etc. Solutions of the strength of .06 to 
.26 gm. (1 to 4 gr.) to 500 c.c. (1 pint) may be employed as 
injections for gonorrhoea and leucorrhcea, and for washing out 
the stomach, bladder, uterus, abscess cavities, etc. One ad- 
vantage connected with the use of potassium permanganate in 
this way is that it can be readily seen when it has lost its 
efficiency by the change in the color of its solutions. As soon 
as it has become reduced to the dioxide, by giving up its oxygen, 
these turn dark brown, and so long therefore as such injections 
return with their pink color retained, the assurance may be 
felt that the parts are being properly cleansed. It is asserted 
that potassium permanganate, owing to its properties as an 
oxidizing agent, is the most efficient antidote to snake-venom, 
if placed in the wound before the poison is absorbed. It is also 
recommended that it should be injected subcutaneously about 
the seat of the bite. As a local application in erysipelas its 
solutions have been found beneficial. As a deodorizer for 
sputa, stools, drains, etc., and for washing utensils it is used 



92 PHARMACOLOGY AND THERAPEUTICS. 

in the proportion of about i to 150. The Liquor Potassi Per- 
manganatis of the B. P. contains 1 part of the permanganate 
to 100 of distilled water, and Condy's fluid is a solution of 50 
gm. (8 gr.) in 30 c.c. (1 fl. oz.) of distilled water. Potassium 
permanganate is one of the best known disinfectants for the 
hands. They should be washed in its saturated solution, which 
stains them a deep purple, and immediately decolorized with 
a saturated solution of oxalic acid. 

Internal. — On account of its disagreeable taste, potassium 
permanganate should preferably be given in the form of pills 
or compressed tablets. As many substances tend to reduce it, 
it is considered best that the pills should be made with kaolin 
and soft paraffin, but cacao butter and rosin cerate are also 
used as excipients. For the dyspepsia and flatulence which so 
constantly accompany excessive fat, and also for the reduction 
of the obesity itself, the permanganate is a remedy of consider- 
able value. It often affords relief to patients suffering from 
lithaemic conditions, with pain in the lumbar region and intesti- 
nal indigestion, associated with frequent micturition, acid urine, 
and much brick-dust sediment ; while it favors the conversion of 
uric acid into urea, and thus tends to prevent the formation of 
uric acid calculi. On account of its oxidizing properties it is 
also sometimes of service in acute rheumatism. Potassium per- 
manganate has been much extolled as an emmenagogue, but in 
the large doses in which it is advised for this purpose (12 to 30 
gm. ; 2 to 5 gr.), it is almost certain to create gastric disturb- 
ance. Very few stomachs will tolerate more than one grain of 
the salt, and the dose given for the B. P. solution, which is 
equivalent to from 1.2 to 2.4 grains, is therefore rather large 
for most persons. As it is in fact reduced in the stomach to 
the dioxide, tha't salt is preferable in amenorrhcea. If manga- 
nese is of any use in anaemia, which has not yet been proven, it 
probably acts in the same way as iron. The iron-manganese 
preparations, so much lauded, owe their efficiency, if they pos- 
sess any, to the iron which they contain in varying amounts. 
Potassium permanganate oxidizes morphine, and is therefore 



HYDROGEN DIOXIDE. 93 

an antidote to morphine poisoning. About two grains in solu- 
tion should be given for each grain (estimated) of morphine 
swallowed, and the stomach should be immediately and re- 
peatedly washed out with repetitions of the antidote. It has 
been shown that during the acute stage of morphine poisoning 
there is a continuous excretion from the walls of the stomach 
of the morphine, which is subsequently reabsorbed either from 
the stomach or the intestine. Potassium permanganate has 
also been recommended, internally as well as locally, in snake- 
bite and erysipelas, and in septicaemia and puerperal fever. 

HYDROGEN DIOXIDE. 

AQUA HYDROGENII DIOXIDL— Solution of Hydrogen Dioxide. 
(Solution of Hydrogen Peroxide.) Dose, 4 C.C.; 1 fl. dr. 

Action of Hydrogen Dioxide. 
Hydrogen dioxide readily yields oxygen to all oxidizable 
substances. When taken internally it gives oxygen to the blood, 
stimulates the nervous system, and increases urinary secretion. 
In the blood the oxygen set free may cause the formation of 
emboli and lead to serious consequences. A death is recorded 
in which the fatal result is thought to have been due to this 
cause (the solution of hydrogen dioxide having been employed 
to wash out the pleural cavity) ; and in several instances 
hemiplegia is said to have been observed, apparently from em- 
bolism of the cerebral arteries. The different organs and tissues 
have been found to vary considerably in their power of causing 
the catalytic decomposition of the dioxide, the red corpuscles 
of the blood and the liver cells being the most active, and it is 
now believed that this action of the tissue cells is closely asso- 
ciated with the presence of nucleo-proteids, and not with fer- 
ment action, as formerly held. It is a non-poisonous and 
powerful antiseptic. It decomposes pus and probably destroys 
the microbes of suppuration. Its antiseptic activity is of com- 
paratively short duration, however, ending as soon as all the 
oxygen is liberated. 



94 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Hydrogen Dioxide. 
Hydrogen dioxide seems to have a favorable action in some 
forms of dyspepsia, and to improve digestion. In diphtheria it 
is useful as a cleansing agent and for absorbing false mem- 
branes, but should be used in glass or hard rubber instruments. 
Some commercial preparations are very acid, and therefore too 
irritating for this purpose. This acidity may be neutralized by 
adding twice its quantity of lime water. It will check bleed- 
ing, but from small vessels only. It is of great value in cleans- 
ing wounds, ulcers and fistulous tracts, and for surgical dress- 
ings ; the cessation of frothing indicates the destruction of pus. 
But the converse of this is not true, for it will froth with 
perfectly normal blood. It should not be injected into a sup- 
purating cavity unless there is a free outlet for the escape of 
the gas which is formed. Its most popular use is for bleach- 
ing the hair, and in hirsuties it has been found to retard the 
growth of hair. It is employed to a considerable extent as an 
injection in gonorrhoea on account of its activity in destroying 
the gonococcus and arresting the formation of pus. It is also 
useful in the treatment of leucorrhoea, otorrhoea, ozsena, 
tonsillitis, chancre, etc., and has proved of service as an irri- 
gating agent in ulcerative blepharitis, purulent conjunctivitis, 
granular conjunctivitis, and other eye affections. A useful ap- 
plication of the dioxide is in the treatment of gunpowder burns, 
in which it is stated to absolutely remove the black stain which 
ordinarily remains permanently. The solution (U. S. P.) 
should be applied on the first or second day after the burn, and 
in such a way that it may get thoroughly into the centre of 
each pigment spot. It is necessary to prick each point well 
open, when the bubbling resulting from the use of the dioxide 
will remove the inorganic remains of the powder. Hydrogen 
dioxide has been highly recommended as a local anaesthetic. 
Injected under the epidermis it is claimed that it produces imme- 
diate and complete analgesia of the whole skin, and it is stated 
to have been used successfully in this way in opening abscesses, 
cutting off redundant tissue in ingrowing toe-nails, in opening 



CHARCOAL. 95 

the pleural cavity, and even in performing laparotomy. It 
is a well-recognized fact that a small amount of the solution, 
poured over the closely adhering dressing of a wound, will 
not only relieve the pain incident to the removal of the dress- 
ing, but also alleviate any irritation that may be set up. Good 
results have been reported from the use of the vapor of hydro- 
gen dioxide in the treatment of whooping-cough. A solution 
of the strength of 12 volumes is employed, and of this 80 gm. 
(3 oz.) is poured upon a linen cloth about three feet square, 
which is suspended in the room occupied by the patient. It is 
advised that two small rooms should be*used, one for the day 
and one for the night, and that the solution should be replen- 
ished every four hours. Internal treatment may be given at 
the same time. In cases of persistent vomiting repeated sips 
of a weak solution sometimes prove efficient. The claims that 
have been brought forward for the utility of hydrogen dioxide 
in low fevers, epilepsy, diabetes, uraemia and other grave con- 
stitutional states have never been substantiated, and it appears 
to possess no distinct value in internal medication. Its use by 
hypodermatic injection is attended with special risk, on account 
of the liability to the formation of emboli, which may either 
plug up the cerebral arteries or, lodging in the lungs, produce 
fatal asphyxia. 

CHARCOAL. 

1. CARBO ANIMALIS.— Animal Charcoal. 

2. CARBO ANIMALIS PURIFICATUS.— Purified Animal Char- 
coal. 

3. CARBO LIGNL— Charcoal. (Wood Charcoal.) Dose, 1 gm.; 
15 gr. 

Action of Charcoal. 
External. — Charcoal is an oxidizing agent and a deodorant. 
Owing to its porous character, it is an active absorbent of gases, 
which become condensed in its interstices. It thus ordinarily 
contains oxygen in large amount, being capable of absorbing 
eighteen times its own volume of this substance. The latter, in 



96 PHARMACOLOGY AND THERAPEUTICS. 

consequence apparently, of its condensed state, is possessed of 
special activity. When, therefore, charcoal is brought into con- 
tact with decomposing organic matter, it absorbs the gases, 
which of itself tends to remove the foul odor, while the oxygen 
effects the oxidation of the matter to its simplest combinations. 
Charcoal possesses the property of absorbing, in addition to 
gases, many colloid bodies, such as the coloring matter of plants 
and proteids, and has the power of oxidizing organic matters in 
solution or in the solid form. It appears to act when moist 
almost as efficiently as in the dry state, as is shown by its ac- 
tivity in oxidizing organic impurities in water when charcoal 
filters are used. In time its power of oxidation becomes ex- 
hausted, the rapidity with which this takes place depending 
upon the amount of organic matter with which it comes in 
contact; but this may be restored by heating the charcoal to 
redness. It is incorrect to speak of charcoal as a disinfectant 
(though it is popularly regarded in this light), as it is not ger- 
micidal or antiseptic, having no influence upon living organisms. 

Internal. — Charcoal is altogether inert, as regards any effect 
upon the system, except in so far as by reason of its absorbent 
and oxidizing properties it may check meteorism and flatulence. 
By its mechanical action on the intestinal walls it sometimes 
serves, when taken in large doses, as a mild laxative, and also 
has some effect in clearing away mucus. It passes through 
the alimentary canal unabsorbed, and is found unchanged in 
the faeces. 

Therapeutics of Charcoal. 

External. — Charcoal makes a cheap and efficient deodorant 
and absorbent application to cancerous sores with offensive dis- 
charges, foul ulcers, gangrenous wounds, etc. As, however, 
large quantities are required and as it is very dirty, ordinary 
antiseptic and disinfectant dressings will generally be found 
more serviceable in such conditions. It may be used as a 
powder, made into a thin paste with water, or mixed with 
poultices. The most cleanly way of employing it is in thin bags 
of fine texture. Charcoal is sometimes used as a tooth-powder, 



CHARCOAL. 9/ 

but it should not be recommended, because it abrades the enamel 
of the teeth and discolors the gums. In pharmacy it is useful as 
a decolorizing agent and for filtering; but charcoal niters are 
objectionable in the household because unless renewed very 
frequently they not only lose their virtues but may become 
breeding-places for infectious germs. 

Internal. — It is most conveniently administered in tablets or 
capsules, but is sometimes given mixed with water. In some 
cases charcoal biscuits are preferred. Among the conditions 
in which it has been found of sen-ice are the following : Decom- 
position of the contents of the stomach, flatulent dyspepsia at- 
tended with fetid breath, gastralgia, acidity, heartburn or foul 
eructations, intestinal indigestion with meteorism, diarrhoea, 
dysentery, and ulceration of the intestines with foul stools. In 
choleriform diarrhoea, both in adults and children, finely 
powdered charcoal, given in milk diluted with water and 
sweetened, has been found efficient, and in epidemic dysentery 
good results have been obtained from the remedy, administered 
both by the mouth and the rectum. In some instances it 
answers well in the vomiting of pregnancy. Large doses, when 
not accompanied with a sufficient amount of water, have been 
known to cause intestinal obstruction. In view of the fact that 
charcoal has the power of removing alkaloids from solutions, 
it has been recommended in diseased conditions resulting from 
the formation in the alimentary canal of toxins and ptomaines 
of an alkaloidal nature. It is also said to be sometimes useful 
as an antidote in poisoning by phosphorus and by such alkaloids 
as morphine and strychnine, by removing the toxic agent from 
solution. Purified animal charcoal is preferred for this pur- 
pose, and it is advised that after its use the stomach should be 
evacuated by the stomach-pump or emetics. It is stated that 
15 gm. (y 2 oz.) of the charcoal, which should be rubbed up 
with sufficient water to make a thin liquid, will render inert 
about .06 gm. (1 gr.) of alkaloid. 



98 PHARMACOLOGY AND THERAPEUTICS. 

SULPHUR. 

1. SULPHUR SUBLIMATUM.— Sublimed Sulphur. (Flowers of 
Sulphur.) Dose, 4 gm.; 60 gr. 

2. SULPHUR PR^CIPITATUM.— Precipitated Sulphur. (Lac 
Sulphuris — Milk of Sulphur.) Dose, 4 gm.; 60 gr. 

3. SULPHUR LOTUM.— Washed Sulphur. Dose, 4 gm.; 60 gr. 

Preparation. 
Unguentum Sulphuris. — Sulphur Ointment. 

Action of Sulphur. 
External. — Sulphur is itself entirely inert, and whatever 
effects it has upon the system, whether internal or external, are 
due to the agency of sulphides resulting from solution in the 
secretions and of hydrosulphuric acid (H 2 S), or hydrogen sul- 
phide. The sulphides, being weak salts, readily yield them- 
selves to the formation of the free acid. Although they them- 
selves no doubt have some irritant action, in addition to that of 
the latter, hydrogen sulphide differs from them in being an 
acid, with extremely marked irritant properties, and also in 
being a gas (sulphuretted hydrogen). It is a very powerful 
poison, which even in small amount is destructive to most forms 
of life. Thus it has been found that the microbes of putrefac- 
tion, which produce it themselves, are eventually killed by it, 
unless it escapes freely. Its toxic effects on the system are 
due in part to its local irritation and in part to direct action on 
the brain and medulla. When inhaled in concentrated form it 
produces death almost instantly, and a very dilute vapor of it 
induces irritation of the eyes, nose and throat and a reflex in- 
crease in the secretion of tears, saliva and mucus. Upon the 
skin and mucous membranes sulphur has a stimulant, irritant 
effect and also a parasiticidal and antiseptic action. The con- 
version of free sulphur into sulphides is ordinarily a somewhat 
slow process, and as it can exert any influence only in propor- 
tion to the extent to which such conversion takes place, the 
irritation produced by it is apt to be mild and prolonged. This, 



SULPHUR. 99 

it has been pointed out, is the secret of its therapeutic success. 
Applied to skin already inflamed, however, it is apt to act as 
a severe irritant, and to raw surfaces, such as wounds and 
ulcers, as a powerful caustic. The sulphides, in contact with 
the skin, have a solvent action upon the horny epidermis and 
the hair. Absorption may take place from the cutaneous sur- 
face, as well as the alimentary canal. 

Internal. — When sulphur is taken by the mouth, much the 
larger portion of it passes without change through the ali- 
mentary canal, and is so discharged in the faeces. The re- 
mainder is converted by the alkaline fluids of the intestine into 
sulphides, which form some hydrogen sulphide and, after being 
absorbed into the blood, are oxidized rapidly and excreted 
principally by the urine, as sulphates and in obscure organic 
combination. In some instances experiment has shown the 
urea in the urine to be considerably increased, but whether the 
nitrogenous waste is as a rule augmented by the sulphides has 
not as yet been determined. A small amount of the converted 
sulphur is excreted by the lungs, in consequence of which the 
characteristic odor of hydrogen sulphide may be imparted to 
the breath. The sulphur compounds, by reason of their irri- 
tant effect, act locally upon the intestine, causing increased 
peristalsis and mild purgation, with soft stools and but little 
griping, They also have an antiseptic action in the intestines. 
Under large doses of sulphur the symptoms of intestinal irrita- 
tion may be more severe than those mentioned, the evacuations 
assuming a bloody character. The drug has a slight diaphoretic 
action, the cutaneous secretions being stimulated to some extent 
during its elimination. Hydrogen sulphide is excreted in 
minute amount by the skin (so that silver articles about the 
persons of those taking sulphur may be discolored), and also in 
the milk of nursing women. When injected intravenously in 
mammals the sulphides induce violent convulsions, which are 
apparently of cerebral origin, since it has been shown that they 
do not occur in the hind limbs after section of the spinal cord. 
Their action on the blood is to reduce the oxyhemoglobin and 



IOO PHARMACOLOGY AND THERAPEUTICS. 

so diminish the processes of oxidation, while at the same time 
there is formed a compound known as sulpho-methaemoglobin or 
as sulpho-haemoglobin, which is considered more nearly related 
to methaemoglobin than to haemoglobin. The blood changes 
were formerly supposed to be the cause of death in poisoning, 
but it is now known that this is owing to direct action on the 
central nervous system. The respiration, which is at first ac- 
celerated, later becomes dyspnceic and finally ceases; the fatal 
result being due to this, together with the paralysis of the 
vasomotor centre. The heart is apparently affected only indi- 
rectly through the failure of respiration and the fall of blood- 
pressure. While the effects of sulphur are due entirely to the 
action of the sulphides and hydrogen sulphide into which it is 
changed in the intestine, therapeutically it is never given in 
sufficient amounts to elicit the toxic action of these agents upon 
the system. Clinically, advantage is taken of its especial ten- 
dency to act upon the skin and mucous membranes. 

Therapeutics of Sulphur. 
External. — Inunction with sulphur has always been considered 
the typical remedy for scabies, but at the present time balsam 
of Peru, which makes an efficient and much more agreeable 
application, is used to a considerable extent in its stead. The 
sulphur treatment should be inaugurated with a warm bath 
lasting about twenty minutes, after which the patient should 
be scrubbed all over, with the exception of the head and face, 
with soft soap or potash, for the purpose of breaking open the 
furrows and exposing the acari or itch-insects. Next the sur- 
face should be rinsed with clean water and dried, and then sul- 
phur ointment should be thoroughly rubbed in with friction. 
The official ointment in full strength sometimes gives rise to 
an erythematous or papular, eczematous or pustular, eruption, 
and it is therefore generally well to dilute it. The following 
application may be used: Oil of cade, 4 c.c. (1 fl. dr.) ; sulphur 
ointment, 8 gm. (2 dr.) ; lanolin, 19.5 gm. (5 dr.). The patient 
should then go to bed, sleeping in flannel, and the next morn- 



SULPHUR. 10 1 

ing should wash himself clean and put on clean underclothing. 
One such application is generally sufficient to effect a cure, but 
it may be repeated once or twice. In order to prevent reinfec- 
tion by the parasite, the bed linen and the clothing previously 
worn should either be destroyed or disinfected by baking or 
thorough boiling. Sulphur is also employed for pediculosis and 
the various forms of tinea, as well as chronic acne, rosacea, 
eczema, psoriasis, and other skin diseases. In acne of the face it 
should be used with caution, especially if the sebaceous follicles 
are in a patulous condition, as the sulphur, getting into their 
openings, is liable to cause black points. Many of the parasitic 
affections are best treated by means of sulphur-vapor baths, 
and potassium sulphide baths are useful in syphilis. Insuffla- 
tions of powdered sulphur are sometimes made into the throat 
or nose in diphtheria, scarlet fever, and other infectious dis- 
eases, and ointments containing sulphur have been applied to 
the skin in scarlet fever, measles, small-pox and erysipelas. In 
alopecia circumscripta sulphur is sometimes of service in pro- 
moting the growth of the hair. Associated with live steam, 
the fumes of burning sulphur may be relied upon to disinfect 
rooms, ships, etc. Moisture is essential for the success of the 
process. {See Sulphurous Acid.) 

Internal. — The continued use of small doses of sulphur may 
prove useful in such affections as acne, sycosis, psoriasis and 
chronic eczema, and especially when the upper layer of the skin 
and the glands are affected, as well as in loss of hair and dis- 
eased conditions of the nails. It is a very good laxative, espe- 
cially for children, and washed sulphur is one of the ingredients 
of the popular compound liquorice powder {see Senna). The 
sulphur lozenge of the B. P. contains .30 gm. (5 gr.) of pre- 
cipitated sulphur and .06 gm. (1 gr.) of acid potassium tartrate, 
and one or two of these at night generally answers very well 
in cases of mild constipation. On account of its lack of griping 
and the softness of the stools it causes, sulphur is very useful 
in piles, fistula and other rectal affections, and as a laxative 
after operations upon the pelvic organs. It is also thought to 



102 PHARMACOLOGY AND THERAPEUTICS. 

be of service in disordered conditions of the liver, for which 
the various mineral waters containing sulphur and its salts 
may likewise prove beneficial. Such waters, as for instance 
those of Richfield Springs, are useful for chronic rheumatism, 
as well as for chronic sore throat, bronchitis, etc., especially 
associated with digestive difficulties or a gouty or rheumatic 
diathesis, and for lead poisoning and various skin diseases, in- 
cluding the late secondary eruptions of syphilis. They are used 
both internally and in baths. 

4. SODII SULPHIS.— Sodium Sulphite. Dose, 1 gm.; 15 gr. 

5. SODII BISULPHIS.— Sodium Bisulphite. Dose, 0.500 gm. (500 
milligm.) ; 7 y 2 SX- 

6. SODII THIOSTJLPHAS (Sodii Hyposulphis, U. S. P., 1890).— 
Sodium Thiosulphate. (Sodium Hyposulphite.) Dose, 1 gm.; 15 gr. 

Unofficial Preparation. 
Potassii Sulphis. — Potassium Sulphide. 

Action of Sodium Sulphite, Bisulphite and 
Thiosulphate. 
They tend to arrest putrefaction and other forms of fermen- 
tation, being moderately powerful antiseptics for the reason 
that they withdraw oxygen from organic matter in order to 
oxidize themselves to sulphates. Injected into animals they 
have a decidedly toxic effect. In frogs they produce paralysis 
of the central nervous system (commencing in the brain and 
descending to the spinal cord), and of the muscles and periph- 
eral nerve endings, and the heart comes to a standstill in 
diastole. In mammals the action is exerted chiefly upon the 
medulla oblongata and the heart, and the respiration fails a 
little before the latter. As they are slowly absorbed from the 
alimentary canal, and a portion is changed to the harmless 
sulphate before reaching the blood, much larger quantities are 
required to poison animals by the mouth than by subcutaneous 
injection. Large doses of sulphite have been taken by man 



SULPHUR. 103 

without the production of toxic symptoms, but most of the prep- 
arations are said to contain a very considerable amount of sul- 
phate. In some instances comparatively small quantities have 
given rise to more or less gastro-intestinal irritation. As it 
has been found that even small doses, when given daily to 
animals, cause haemorrhages in different parts of the body, the 
use of these salts for the purpose of preserving wines, meats, 
etc., should be condemned. 

Therapeutics of Sodium Sulphite, Bisulphite and 
Thiosulphate. 
Their therapeutic application is of somewhat limited range. 
Sodium sulphite, in the form of a wash (4 gm. ; 1 dr. to 30 c.c. ; 
1 fl. oz.) is of service in aphthous sore mouth, and has also 
been locally used for various parasitic skin diseases. It may 
be given with advantage in some forms of gastric fermentation, 
and is especially useful in yeasty vomitings where the sulphurous 
acid liberated from the salt in the stomach by the acid of the 
yeasty matter has the effect of destroying the microscopic fungi 
present (sarcina ventriculi and torula cerevisicz) . It was be- 
lieved at one time that the sulphites would prove highly efficient 
in pyaemia and various zymotic diseases, from their supposed 
action as antiseptics in the blood; but the hopes thus entertained 
have proved entirely fallacious. Atomized solution of sodium 
sulphite or thiosulphate may be inhaled in gangrene of the lung, 
fetid bronchitis, etc. Locally applied, in a solution of 2 gm. 
(30 gr.) to 30 c.c. (1 fl. oz), the thiosulphate is useful in poison- 
ing from Rhus toxicodendron and in pruritus from other causes. 
This salt, in doses of from .60 to 2 gm. (10 to 30 gr.) every four 
hours, is also said to be of value in malarial haematuria. 

7. CALX SULPHURATA.— Sulphurated Lime. (Crude Calcium 
Sulphide.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. 

8. SULPHURIS IODIDUM.— Sulphur Iodide. 

Unofficial Preparation. 
Potassa Sulphurata (U. S. P., 1890). — Sulphurated Potassa. 
(Liver of Sulphur.) 



104 PHARMACOLOGY AND THERAPEUTICS. 

Action of Sulphurated Potash, Sulphurated Lime, and 

Sulphur Iodide. 
External. — These preparations are irritant, and are powerful 
parasiticides. The local action of sulphur iodide resembles that 
of iodine, and when diluted it is a stimulant to the glands of 
the skin and aids the absorption of inflammatory exudation. 

Internal. — Sulphurated lime is less irritant than sulphurated 
potash, and small doses may cause a sensation of warmth at the 
epigastrium and also have a slight laxative effect. Both of 
these substances in large doses excite gastro-enteritis. In the 
case of the potash preparation, considerable hydrogen sulphide 
is formed from its decomposition in the alimentary canal, and 
the absorption of this may produce poisoning so severe as to 
cause death in a short time. Small doses act in a similar man- 
ner to sulphur, but occasion more local irritation. Sulphurated 
lime is believed to have a special influence in preventing or 
limiting suppuration. The action of sulphur iodide is essentially 
that of iodine, the proportion of sulphur not being sufficient to 
produce any effect in the small doses in which alone it can be 
given. 

Therapeutics of Sulphurated Potash, Sulphurated Lime, 
and Sulphur Iodide. 
External. — Scabies may be cured by ointments made with 
either of these substances, and a weak sulphurated potash oint- 
ment (.30 to 1.20 gm. ; 5 to 20 gr., to 30 gm. ; 1 oz.) is used 
to some extent for this purpose. The alkalinity of the drug- 
assists in penetrating the epidermis, but renders the applica- 
tion more or less irritating; so that if it is employed after the 
skin has been softened by a warm bath it may excite a trouble- 
some eczema. In the treatment of scabies, Vleminckx's solu- 
tion, which is made by boiling 165 parts of freshly slaked lime 
with 250 parts of sublimed sulphur in water, sufficient to make 
1000 parts, and the active agent of which is calcium penta- 
sulphide, is sometimes preferred to an ointment. It should be 
applied with a somewhat stiff brush or a piece of lint. Oint- 



SULPHUR. 105 

ments containing 2 gm. (30 gr.) of sulphurated potash to 30 gm. 
(1 oz.) are used with benefit in rosacea and acne indurata, but 
care should be taken that they are applied to the affected parts 
only. Chronic eczema and psoriasis are sometimes treated with 
warm baths made with sulphurated potash, 1 ; water, 960, in 
imitation of the natural sulphide waters, such as those of Aix- 
la-Chapelle, as are also various forms of chronic rheumatic 
trouble. Calcium sulphide may be used as a depilatory, in the 
form of a paste made by passing hydrogen sulphide into a 
thick milky mixture of lime and water, but is less satisfactory 
than barium sulphide. An ointment of sulphur iodide, of the 
strength of 2 gm. (30 gr.) to 30 gm. (1 oz.), is useful in ring- 
worm and other parasitic skin diseases, as well as in lupus vul- 
garis and other forms of cutaneous tuberculosis and in rosacea 
and acne indurata. If there is much irritation present, it 
should be used in greater dilution. An objection to the oint- 
ment is its tendency to speedy decomposition. 

Internal. — Sulphurated potash and sulphur iodide are rarely 
given internally. In order to obtain the effects of sulphurated 
lime on the process of suppuration the dose should be repeated at 
very frequent intervals. It is useful in the prevention and treat- 
ment of styes, boils, carbuncles, abscesses, etc. It has also been 
used with advantage in acne, ezcema, ophthalmia and sores in 
scrofulous children, the suppuration of tuberculous glands, and 
acute tonsillitis, especially in strumous patients; and one case 
of elephantiasis is recorded in which it was successfully em- 
ployed. The natural sulphide waters, such as those of the Blue 
Lick Springs of Kentucky, which are said to be almost identical 
with the well known Harrowgate water of England, are bene- 
ficial in habitual constipation from deficient intestinal secretion, 
and in obesity, engorgement of the pelvic viscera in women, and 
haemorrhoids in both sexes, when dependent upon torpid portal 
circulation. Their prolonged use has also been attended with 
good effects in glandular affections, hepatic, splenic, prostatic, 
etc. They should be discontinued when anaemia is threatened, 
and if given at all in anaemic subjects should be associated with 



106 PHARMACOLOGY AND THERAPEUTICS. 

suitable tonic treatment. In France sulphur iodide is asserted 
to have proved of great service in human glanders. 

9. ACIDUM SULPHUROSUM.— Sulphurous Acid. Dose, 2 c.c; 
30 m,. 

Action of Sulphurous Acid. 

External. — Sulphurous acid is characterized by its strong 
affinity for oxygen and is a disinfectant, deodorizer and para- 
siticide. Through its powerful reducing action it becomes 
oxidized to sulphuric acid, and is rendered highly poisonous, 
(independently of its acidity), to parasitic organisms, especially 
those of a vegetable character. By it the activity of unformed 
ferments is also abolished or diminished. Thus, it has been 
found that i part in 1300 will arrest the action of pepsin, 1 in 
8600 that of ptyalin and diastase, and 1 in 20,000 that of myrosin 
and emulsin. The official solution has no effect upon the 
unbroken skin, but is more irritant to raw surfaces than many 
other equally powerful antiseptics. It is also strongly irritant 
to mucous membranes. 

Internal, — In concentrated form sulphur dioxide is entirely 
irrespirable, causing spasm of the glottis. Even when inhaled 
in the strength of 5 parts in 10,000 the gas is decidedly irritant 
to the respiratory mucous membrane, and when a little less 
diluted excites catarrhal inflammation of the tract. It pene- 
trates the tissues more rapidly than most other mineral acids. 
In solution it has the same irritant action on the mucous mem- 
branes as others of equivalent strength, while upon the contents 
of the stomach it has an antiseptic effect and also interferes 
with the action of the digestive ferments. It is excreted by 
the kidneys and alimentary canal in the form of sulphates, to 
which it is oxidized during absorption and in the tissues. The 
sulphites are said to be capable of causing death by paralyzing 
the heart, as well as the respiratory and other motor nerve- 
centres, but are so rapidly and completely changed into sul- 
phates that unless given in enormous amount they are found to 
exert very little influence upon the system. 



SULPHUR. I07 

Therapeutics of Sulphurous Acid. 

External. — For disinfecting the holds of ships sulphur diox- 
ide, generated from burning sulphur, is largely used associated 
with steam; but in the case of apartments it has been to a 
considerable extent replaced by formaldehyde, which is more 
efficient and does not, like it, injure fabrics. When it is em- 
ployed for this purpose at least three pounds of sulphur should 
be burned for each thousand cubic feet of space (the sulphur 
candles now to be found in pharmacies furnishing the most con- 
venient method), after the room has been rendered as air-tight 
as possible. The action of the sulphurous acid is much more 
efficient when the air is saturated with moisture, and if steam 
cannot be used the walls and floors should be first sprayed with 
water. The room must be kept closed for about twenty hours. 
Scabies may be cured very rapidly by exposing the patient, his 
head excepted, to the action of sulphur dioxide, generated by 
burning 46.7 gm. (12 dr.) of sulphur in a suitable closed appa- 
ratus. Extreme care should be observed, however, to prevent 
the inhalation of the smallest amount of the poisonous gas. 
Sulphurous acid, generally considerably diluted, is sometimes 
employed as a spray or gargle in diphtheria, scarlet fever and 
septic sore-throat and as a spray in chronic bronchitis with 
profuse and fetid expectoration. Its local application is of 
service in thrush, pruritus, and parasitic skin affections, such as 
the various forms of tinea, as well as for chilblains and for foul 
ulcers and sloughing or gangrenous wounds. 

Internal. — It may be used in cases of dilated stomach, with 
fermentation and the presence of sarcinse and torulse, and of in- 
digestion with pyrosis or the vomiting of acid matters due to 
acid fermentation of the starchy or saccharine elements of the 
food; but it should be borne in mind that while it may prevent 
abnormal fermentation, it is also liable to interfere with the 
action of the normal ferments. It has been recommended in 
certain cutaneous diseases, such as urticaria and purpura, after 
other methods have failed. In the treatment of purpura it may 
be combined with the fluidextract of ergot. 



108 PHARMACOLOGY AND THERAPEUTICS. 

THYMOL. 

THYMOL.— Thymol. Dose, 0.125 gm. (125 milligm.); 2 gr. 

Preparations. 

1. Thymolis Iodidum. — Thymol Iodide. See p. 8i. 

2. Cataplasma Kaolini. — Cataplasm of Kaolin. 

3. Liquor Antisepticus. — Antiseptic Solution. Dose, 4 c.c; 
1 fl. dr. 

Action of Thymol. 
Thymol was introduced as a substitute for phenol, which 
it resembles in its effects though it causes less stimula- 
tion of the central nervous system. It is also more slowly ab- 
sorbed, less irritant to wounded surfaces, and less poisonous to 
the higher animals and man than that drug." As regards its 
influence on fermentation and putrefaction, it has been shown to 
have a very decided antiseptic action, but although considerably 
more powerfully antiseptic than carbolic acid, it is less soluble 
in the fluids of the body, and has not, consequently, been able to 
replace it. A persistent acrid sensation in the fauces is 
caused by thymol. Although it rarely produces vomiting, large 
doses cause a feeling of warmth about the epigastrium, and 
quite frequently diarrhoea. In from half an hour to an hour, 
more or less profuse sweating is apt to occur. It also causes 
a reduction of temperature, but is regarded as less certain and 
more dangerous as an antipyretic than salicylic acid, to which 
its composition indicates a close correspondence. Convulsions 
and tremors are rarely induced in either frogs or mammals, and 
under toxic quantities the animal, after a stage of gradually 
increasing weakness and apathy, generally sinks into fatal col- 
lapse. Thymol has been found to excite a greater amount of 
irritation in the kidneys than phenol, and under its use the 
urine may contain blood, as well as albumin. The urinary 
secretion is sometimes increased, and is of a dark greenish hue, 
due to the presence of a green coloring substance. This be- 
comes blue on the addition of acid, and is thought to be nearly 



THYMOL. IO9 

related to but not identical with indigo. Experimental research 
has shown that thymol is excreted in the urine in combination 
with sulphuric and glycuronic acids, partly unchanged and 
partly oxidized to thymol-hydroquinone. 

Therapeutics of Thymol. 
The addition of a little alcohol renders possible the prepara- 
tion of a 1 to 1000 aqueous solution, which for some purposes 
may require weakening. As an antiseptic surgical dressing 
and in dermatology thymol has been used in solution and in the 
form of gauze and of ointment. One objection to its employ- 
ment is that its odor is likely to attract house flies. A product 
obtained by the condensation of thymol and chlormethyl-salicylic 
acid has recently been claimed to possess remarkable antiseptic 
properties. It is soluble in alcohol, ether and diluted alkaline 
solutions, and with alkalies salts are formed which are soluble 
in water. Thymol is quite an efficient antiparasitic, and a solu- 
tion in alcohol or ether (1 in 15) may be employed in ring-worm 
and pityriasis versicolor. An ointment containing .65 gm. to 
30 gm. (10 gr. to 1 oz.) has proved of service in psoriasis, 
eczema, acne, alopecia circumscripta, and other skin diseases. 
In the treatment of burns, especially in children, its application 
has been recommended in combination with Carron oil (Lini- 
mentum Calcis). Thymol is used to some extent in dentistry, 
and on account of its agreeable taste is quite frequently em- 
ployed as a detergent antiseptic in ulcerated and diseased con- 
ditions of the mouth and fauces. A glycerite (1 in 200) makes 
a good mouth-wash. A solution has sometimes been used by 
inhalation with advantage in bronchitis, laryngitis and whoop- 
ing-cough and as a disinfectant in diphtheria, phthisis and 
gangrene of the lung. For catarrh of the upper air-passages 
inhalations of the following mixture are highly spoken of: 
Thymol, menthol and carbolic acid, each .32 gm. (5 gr.) ; oil of 
eucalyptus, 60 c.c. (2 fl. oz.) ; oil of wild pine, 90 c.c. (3 fl. oz.) ; 
20 or 30 drops to be placed on a sponge or piece of cotton, or 
a teaspoonful may be added to boiling water and the steam in- 



I IO PHARMACOLOGY AND, THERAPEUTICS. 

haled. Thymol solutions are useful injections in gonorrhoea 
and vesical catarrh. Thymol is an internal antiseptic of some 
value. In gastric and intestinal catarrh it often acts favorably 
by arresting fermentation and stimulating digestion. In large 
doses (up to 2 gm. ; 30 gr.) it is an efficient anthelmintic for 
the Ankylostoma duodenale. On account of the danger of 
toxic effects, the patient should be warned not to take any sol- 
vent of thymol, such as alcohol, oils, etc., after the administra- 
tion of the remedy. Thymol carbonate, under the name of 
thymotal, has been recently recommended as especially valuable 
in ankylostomiasis. Thymol, both alone and in combination 
with gallic acid, is reported to have been used successfully in 
some cases of chyluria of filarious origin. It is of no practical 
value as an antipyretic, as the doses required to affect the 
temperature in fevers are so large as to be extremely apt to 
cause dangerous depression of the vital powers. As an internal 
remedy thymol has been recommended in acute rheumatism, 
tuberculosis, diabetes, typhoid fever, and other constitutional 
diseases, but has proved entirely inefficient. 

BALSAM OF PERU. 

BALSAMUM PERUVIANUM.— Balsam of Peru. Dose, 1 gm.; 
15 gr. 

Action of Balsam of Peru. 
It is a general stimulant, with a special tendency to the 
mucous membranes. On the skin it produces slight reddening, 
and its external application is occasionally followed by an ery- 
thematous, urticarial, or eczematous eruption. It has some 
antiseptic property, and is efficient in the destruction of animal 
and vegetable parasites. It also allays itching of the skin and 
mucous membranes. By its stimulating action on wounds and 
sores it facilitates the repair of tissue. Internally it is stomachic, 
carminative and expectorant. In large doses it may act as a 
gastro-intestinal irritant, inducing vomiting and purging, but 
in smaller quantities causes some heat of skin and stimulates the 
circulation. It is excreted by the skin, kidneys and respiratory 



BALSAM OF PERU. I I I 

mucous membrane, and during its elimination is believed to 
stimulate and have a tendency to disinfect the secretions from 
these parts. The fact that in some cases, after large doses, 
the addition of acid to the urine is followed by the formation of 
an abundant precipitate has led to the opinion that the drug 
has an irritant action on the kidneys ; but in most instances the 
precipitate is found to be dissolved by alcohol, which would go 
to show that it consists of resin, and not albumin. In one case, 
however, it is stated that an inunction of 18.5 c.c. (5 fl. dr.) 
of the balsam gave rise to nephritis and dropsy. 

Therapeutics of Balsam of Peru. 
External. — Balsam of Peru has long been used, either pure or 
diluted, as an application to wounds, compound fractures, and 
indolent sores. As a stimulating dressing for sluggish granu- 
lations a 5 to 10 per cent, solution in castor oil is frequently 
employed. This substance, saturating a number of layers of 
gauze, over which oiled silk or a starch bandage is applied, is 
very efficient in maintaining drainage in wounds, abscesses, 
burns, etc. It is also an excellent deodorant, and is said to 
cover to a large extent the disagreeable odor of iodoform when 
it is used in connection with it. Balsam of Peru is a good 
local application for diphtheria, for chilblains, and for sore 
nipples and cracked lips, and is useful in moderating the dis- 
charge of pus in chronic catarrhal conditions of the nose, the 
ears or the vagina. When used for fissured nipples it should 
be removed before the child is allowed to nurse. One case of 
fatal gastritis in an infant six days old is recorded which is 
stated to have been caused by balsam of Peru applied to the 
mother's nipples. It is one of the best known remedies for 
pruritus vulva and other varieties of pruritus, especially the 
senile, and is generally applied pure in these conditions. It is 
successful in removing leucoplakia, or local epithelial thickening 
of the mucous membrane, and is of considerable* service in 
chronic inflammatory diseases of the skin, especially eczema. 
One of its principal uses is as a parasiticide in ringworm, pedi- 



I I 2 PHARMACOLOGY AND THERAPEUTICS. 

culosis, and scabies, and for this purpose an ointment consist- 
ing of balsam of Peru, 20; olive oil, 50; petrolatum, 100, may- 
be employed. For scabies it should be employed in the same 
manner as sulphur ointment (see p. 100). It is as efficient as 
the latter, killing the eggs as well as the acarus, and is at the 
same time much more agreeable to the patient. Sometimes the 
balsam is used in combination with sulphur. 

Internal. — It is often a very useful remedy in chronic bron- 
chitis and bronchorrhcea, as well as at times in chronic intestinal 
catarrh and dysentery. It has also been employed in the gastro- 
intestinal disorders of childhood. It may be given alone in 
capsules or emulsion, or in mixtures with other drugs. Some 
time ago it was claimed that by the use in phthisis of subcu- 
taneous and intravenous injections of balsam of Peru and its 
chief constituent cinnamic acid, as well as of its sodium salt, 
hetol, a specific inflammation of the diseased areas might be set 
up, which would subsequently result in cicatrization of the tuber- 
culous nodules. Most of those who have employed this treat- 
ment, however, pronounce against it, and it has not been re- 
ceived with general favor, as no conclusive evidence has been 
presented that the alleged effects are produced. At the same 
time, when given by the mouth or by inhalation, its expectorant 
action may no doubt sometimes be of more or less service in 
this disease. Other uses of the balsam are in the treatment of 
gleet, leucorrhcea and chronic laryngitis (by inhalation). 

B. Anthelmintics. 
MALE FERN. 
ASPIDIUM.— Male Fern. Dose, 4 gm.; 60 gr. 

Preparation. 
Oleoresina Aspidii. — Oleoresin of Aspidium. Dose, 2 gm.; 
30 gr. 

Action of Male Fern. 
When given in ordinary doses this drug generally passes 
through the system, even when some absorption takes place, 



MALE FERN. I I 3 

without giving rise to any symptoms, though there may be 
slight intestinal disturbance. When large quantities are taken, 
or if for any reason an unusual amount of its active constitu- 
ents become absorbed, alarming and even fatal results may be 
observed. Recently several cases of poisoning have been re- 
ported, presumably not due to an excessive dose, but to the fact 
that castor oil was administered at the same time, with the 
effect of notably increasing the absorption of filicic acid. The 
toxic symptoms consist of nausea, vomiting, purging, intense 
abdominal pain, muscular weakness, cramps in the extremities, 
tremors, increased reflexes, confusion of ideas, and somnolence 
deepening into coma, with collapse. The secretion of urine is 
apt to be diminished. In many cases disturbances of vision, or 
even complete loss of sight, occur, without any distinct ophthal- 
moscopic appearances, and sometimes there are convulsions, 
which may be tetanic in character and accompanied with opis- 
thotonos. In a considerable proportion of instances icterus is 
present, and is thought to probably result from the duodenal 
catarrh, though it may possibly be due to destruction of the 
red corpuscles of the blood. After death the gastro-intestinal 
mucous membrane is found to be congested, swollen, and some- 
times dotted with ecchymoses, and degeneration of the nerve- 
fibres is also observed. The treatment recommended for poison- 
ing by aspidium is the administration of magnesium sulphate 
by the mouth and ammonia by subcutaneous injection. 

Therapeutics of Male Fern. 
Aspidium acts as a direct poison to tape-worms, and is one 
of the most certain of all remedies for these entozoa. It is also 
used against the Ankylostoma duodenale, and the ethereal ex- 
tract of male fern has proved of service in the treatment of 
cysticercus disease. In cases of the latter the result is stated 
to have been especially favorable when the lesions were situated 
in the subcutaneous or muscular tissues. The drug is considered 
more successful against the Taenia solium (the armed variety of 
tape-worm) and the Bothriocephalic latus (for which it is 
9 



114 PHARMACOLOGY AND THERAPEUTICS. 

especially efficient) than against the Tcunia medio-canellata. For 
a day before taking the medicine the patient should use a liquid 
diet, such as milk or beef-tea. On the following morning, the 
bowels having been previously evacuated, he should take, fast- 
ing, a full dose of the oleoresin, which may be administered in 
pills or capsules or in a draught made up with mucilage and 
flavored with ginger, cinnamon or peppermint. A good way 
also to give it is with an equal quantity of aromatic syrup of 
rhubarb. It is sometimes advised that the dose should be re- 
peated in two or three hours. In the middle of the day the 
patient may eat a full meal, and in the evening should take a 
brisk cathartic. Castor oil or other oils should not be used, on 
account of the danger of increasing the absorption of filicic 
acid, and thus causing toxic symptoms. The head of the tape- 
worm should be carefully searched for in the stools. 

KAMALA. 

KAMALA (U. S. P., 1890; no longer official).— Kamala. (Rott- 
lera.) Dose, 4 to 8 gm.; 1 to 2 dr. 

Action of Kamala. 

Kamala is an anthelmintic, and also a somewhat drastic 
purgative. As a rule, it does not cause nausea or vomiting, but 
sometimes this is the case. As it imparts its virtues to alcohol, 
a tincture made from it is quite as efficient a vermicide as the 
powder. 

Therapeutics of Kamala. 

It will kill the Tcunia solium, and probably also the Oxyuris 
vermicularis and the Ascaris lumbricoides. For tape-worm it 
is customary to give one full dose of the powder, mixed with 
syrup, to which a little hyoscyamus is added to prevent griping, 
and the parasite is often expelled dead at the third or fourth 
stool after the use of the drug. If one dose proves insufficient, 
it may be repeated every three hours until five or six doses 
have been taken. In the East kamala is employed, in the 
form of ointment, in the treatment of various skin diseases, 



POMEGRANATE. 115 

particularly scabies. In Europe it has been successfully used 
in herpetic ring-worm. 

KOUSSO. 

CUSSO.— Kousso. (Brayera. Kooso.) Dose, 16 gm.; 240 gr. 

Unofficial Preparation. 
Koussinum.— Koussin. Dose, 1.20 to 2.40 gm.; 20 to 40 gr. 

Action of Kousso. 
Kousso is an anthelmintic and gastro-intestinal irritant. 
Koussin is thought to be less liable to produce nausea than the 
drug itself. According to recent authorities the active principle - 
of cusso is kosotoxin, a non-nitrogenous neutral principle, 
which is stated to be an energetic paralyzant to all muscles, in- 
cluding the heart, and also of the motor nerve-endings. It has 
been alleged that cusso is capable of bringing on abortion, but 
such action upon the uterus has never been conclusively shown. 

Therapeutics of Kousso. 

It is used exclusively in the treatment of tape-worm, and its 
efficiency appears to depend considerably on the freshness of 
the flowers employed. Objections to its use are that it is 
often retained with difficulty and is apt to create intestinal 
distress. It may be administered in an infusion or in the form 
of the fluid extract, and should be taken in the morning on an 
empty stomach. 

Koussin has been given with good results. It is most con- 
veniently administered in capsules. 

POMEGRANATE. 

GRANATUM. — Pomegranate. Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Granati. — Fluidextract of Granatum. Dose, 
2 c.c; 30 tc\.. 



i 1 6 pharmacology and therapeutics. 

Action of Pomegranate. 

On account of the large amount of tannin which it contains, 
pomegranate is apt to disturb the stomach and cause nausea 
and vomiting. It also occasions flatulence and intestinal pain, 
and sometimes, but not always, acts freely on the bowels. Other 
symptoms produced by large doses of the drug are general weak- 
ness, muscular tremors and cramps, particularly in the leg- 
muscles, hebetude, vertigo, and mental confusion, without loss 
of consciousness. The urine is increased in quantity. Like 
male fern, pomegranate frequently causes disturbances of 
vision and diplopia, mydriasis and amaurosis have been ob- 
served. 

Therapeutics of Pomegranate. 

Pomegranate is exceedingly unpalatable and is so liable to 
cause emesis that the purpose of the drug may be thus defeated. 
When retained by the stomach it is usually an efficient remedy 
for tape-worm. It is best administered in decoction (B. P., i to 
5; dose, 15 to 60 c.c; y 2 to 2 fl. oz.), and of this several doses 
may be taken, fasting, at intervals of an hour. It should be 
preceded by a brisk cathartic, and, if the remedy does not have 
a purgative effect, followed by another. In case the patient 
is unable to take the decoction in this way it is recommended 
that the requisite quantity should be evaporated in a water-bath 
to a pilular consistency and administered in capsules, preceded 
and followed by a cathartic. On account of its powerful as- 
tringent properties pomegranate is sometimes employed for the 
same purposes as tannic acid and other astringent remedies. 
Thus, the decoction has been used as an injection in gonorrhoea, 
leucorrhcea, etc., and, flavored wth orange or aromatics, as a 
gargle for sore-throat and relaxed states of the fauces. Inter- 
nally pomegranate has been advantageously employed in the 
diarrhoea and dysentery of hot climates, and also in Meniere's 
disease. 

PELLETIEEIKffi TANNAi=>.— Pelletierine Tannate. Dose, 0.250 
gm. (250 milligm.) ; 4 gr, 



PUMPKIN SEED. \\J 

Action of Pelletierine Tannate. 
Pelletierine, the mixture of active principles of pomegranate, 
in sufficient quantity, acts like curare, causing paralysis of the 
motor nerves, without affecting sensation or muscular contractil- 
ity. In the frog it also acts upon the heart muscle, the pulsa- 
tions being slowed, although they may temporarily increase in 
force. It has been proved experimentally to have a specific 
toxic action on tape-worms, a solution of one part in 10,000 
causing their death in ten minutes, while other intestinal worms 
were unaffected by stronger solutions. For practical purposes 
pelletierine tannate is the most effective and least dangerous 
form of the drug, as its insolubility no doubt prevents its rapid 
absorption and ensures its prolonged contact with the worm. 

Therapeutics of Pelletierine Tannate. 
It is one of the most reliable of tseniafuges, and is decidedly 
preferable to pomegranate itself on account of the facility 
with which it can be taken and its freedom from nauseating 
properties. It is usually given in capsules, and, like pomegran- 
ate, should be preceded and followed by a purgative. It should 
be administered with great caution to children. Pelletierine 
has been found successful in affording relief in paralysis of 
the third and sixth nerves. 

PUMPKIN SEED. 

PEPO.— Pepo. (Pumpkin Seed.) Dose, 30 gin.; 1 oz. 

Action of Pumpkin Seed. 
Pepo is one of the most efficient and at the same time harm- 
less taeniafuges. It has no purgative action or other known 
physiological effects. 

Therapeutics of Pumpkin Seed. 
It is employed exclusively as an anthelmintic for the tape- 
worm, and is preferably given in the form of emulsion. 60 gm. 
(2 oz.) of the fresh seed are powdered in a mortar, with 240 c.c. 



Il8 PHARMACOLOGY AND THERAPEUTICS. 

(8 fl. oz.) of water, until the husks are loosened and an emul- 
sion is made. The mixture is then strained, and the whole 
amount taken fasting. By some it is maintained, however, that 
the effect is better if the husks are retained in the emulsion. 
Sometimes the seeds are beaten into a paste with milk and white 
sugar. The resin, in doses of I gm. (15 gr.), and the expressed 
oil, which is bland and unirritating, in doses of 15 c.c. (4 fl. dr.), 
have been used as substitutes for the seeds, and are said to be 
equally efficient. Some practitioners are in the habit of asso- 
ciating the oleoresin of male fern with pumpkin seed in the 
treatment of tape-worm, and others of adding pomegranate to 
this combination. 

SANTONIN. 

1. SANTONICA.— Santonica. (Levant Wormseed.) 

2. SANTONINUM.— Santonin. Dose, 0.065 gm. (65 milligm.) ; 
1 gr. 

Preparation. 
Trochisci Santonini. — Troches of Santonin. 

Action of Santonin. 
Santonin is a very efficient vermifuge for the Ascaris lum- 
bricoides. Its modus operandi is not definitely understood. It 
has generally been supposed that it has a specific destructive 
action upon ascarides; but experiment outside the body has 
demonstrated that it is not directly fatal to these parasites, and 
the most satisfactory explanation of the anthelmintic action of 
the drug is that it renders the small intestine so disagreeable 
a habitat for them that they are driven down into the lower 
bowel, from which they are dislodged by the purgative medicine 
employed in connection with the santonin. On the human 
system santonin has distinct effects, resulting from its absorp- 
tion, the most characteristic of which is a derangement of color 
vision. There is also a discoloration of the urine (lemon-yel- 
low or saffron when the latter is acid, and carmine or purplish 
red when it is alkaline), similar to that resulting from chryso- 
phanic acid, as in rhubarb and senna. The faeces, likewise, 



SANTONIN. II9 

sometimes assume a deep yellow color. Ordinarily a portion of 
the santonin is dissolved by the alkalies in the stomach, with 
which it forms soluble and absorbable santoninates, while the 
remainder passes into the intestine; but under special circum- 
stances the greater part of the drug may be absorbed in the 
stomach and cause general intoxication of the system. Santonin 
always undergoes some oxidation in the tissues, and is said to 
be excreted in the urine and faeces in several forms, two of 
which have been found to be oxysantonins. Even small doses 
give rise to xanthopsia, or yellow vision. In this disorder 
white light has at first a violet hue, usually lasting but a short 
time, and then a greenish-yellow color, which tints the entire 
field of vision; and the same has occasionally been observed 
with amyl nitrite. The power of seeing in dim light is also 
stated to be lessened. These effects have been demonstrated to 
be peripheral, and consequently are not due to discoloration of 
the media of the eye. The symptoms produced by large doses of 
santonin are much the same in man as in other animals. Those 
observed in experiments on dogs have been found to be as fol- 
lows : Twitching of the muscles of the head, often beginning on 
one side; followed by rolling of the eyes, grinding of the teeth, 
flexion and extension of the neck and rotation of the head from 
side to side, later by regular epileptiform convulsions, in which 
the animal is first thrown into opisthotonos and then into clonic 
spasms of the limbs and trunk. These are interrupted by inter- 
vals of repose, during which a momentary contraction of all the 
muscles of the body may take place. During the convulsive 
seizures the respiration is irregular and insufficient, and in 
fatal cases it fails to return after the convulsion passes off, and 
the animal dies of asphyxia. In man aphasia has occasionally 
been noted, and some mental confusion, as well as nausea and 
vomiting, may result from doses too small to cause convulsions. 
The epileptiform convulsions are believed to be due principally 
to stimulation of the cortex and the brief contractions in the 
intervals of repose to increased activity of the parts between the 
cerebral peduncles and the medulla. That the medullary centres 



120 PHARMACOLOGY AND THERAPEUTICS. 

are comparatively little affected seems to be shown by the fact 
that the respiration, interfered with during the spasms, returns 
to its ordinary rate and strength during the intervals. The 
circulation is found to be deranged only by the asphyxia, while 
the heart continues to beat long after the respiration has ceased. 
Santonin lowers the temperature, and this is attributed to its 
action on the central nervous system. 

Therapeutics of Santonin. 
Santonin is now almost universally used as a remedy for 
round-worms. Upon tape-worms and the Oxyuris vermicularis 
it has very little effect. In addition to its efficiency, it is espe- 
cially serviceable on account of the ease with which it can be 
administered to children. Owing to its insolubility in water 
its taste is only very slightly bitter, and it may be readily given 
in powdered sugar or sprinkled upon bread and honey. It is 
generally most effective when exhibited two or three times a 
day until five or six doses have been taken, when a cathartic 
is to be administered. Lozenges containing it are not to be 
commended, as they may fail to dissolve. Santonin has at 
times been tried in amaurosis, epilepsy, suppressio mensium, 
and other conditions, but is now probably exclusively employed 
as an anthelmintic. Sodium santoninate, on account of the 
untoward effects to which it has- given rise, should not be 
administered. 

TOXICOLOGY. 

Symptoms. — A number of deaths from santonin are on record, and 
in a few exceptional instances serious or even fatal effects have been 
caused by quite small doses. The danger of poisoning is lessened if 
the drug is given in castor oil. In cases of poisoning by santonin, in 
addition to the nervous phenomena described, there are generally 
marked pallor and coldness of the surface, with a blue tint around the 
eyes or involving the whole face, dilatation of the pupils, and sweat- 
ing, which is sometimes very profuse. As has been mentioned, the 
temperature is reduced, and there may be gastric or intestinal pain. 

Treatment. — Evacuation of the stomach and bowels. Ammonia, or 
strychnine sulphate hypodermatically. The convulsions may be con- 
trolled by ether or chloroform. 



SPIGELIA. 121 



SPIGELIA. 



SPIGELIA.— Spigelia. (Pinkroot. Carolina Pink.) Dose, 4 gm.; 
CO gr« 

Preparation. 
Fluidextractum Spigelian — Fluidextract of Spigelia. Dose, 
4 c.c; 1 fl. dr. 

Unofficial Preparation. 
Fluidextractum Spigelian et Senna?. — Fluidextract of Spigelia 
and Senna. Dose, 8 to 15 C.C.; 2 to 4 fl. dr. for an adult; 2 
to 4 C.C.; y 2 to 1 fl. dr., for a child two years old. 

Action of Spigelia. 
Spigelia is an efficient anthelmintic against the round-worm, 
and appears to act very much in the same way as santonin. 
Given in sufficient amount, it has toxic effects upon the human 
subject and upon animals. In the dog or cat its subcutaneous 
injection gives rise to retching and vomiting, muscular weak- 
ness and incoordination, hurried and dyspnceic respiration, 
mydriasis, exophthalmia, and restlessness, followed by somno- 
lence, coma and death from failure of the respiratory centre. 
Small quantities, given by the mouth, produce no symptoms, but 
large doses, especially in the case of children, may cause flush- 
ing and dryness of the skin, frequently associated with cedem- 
atous swelling of the face, and such cerebral symptoms as 
vertigo, dimness of vision, spasm of the facial muscles, stupor 
and even convulsions. Experiment has shown that toxic doses 
slow and weaken the heart's action and depress the motor spinal 
cord and the respiratory centre. 

Therapeutics of Spigelia. 
Spigelia has long been a popular and reliable remedy for 
lumbricoid worms. It is much less liable to give rise to symp- 
toms of narcotic poisoning when it is given in combination with 
a cathartic, and senna is usually employed for this purpose. 
Santonin is sometimes prescribed in connection with the fluid- 
extracts of spigelia and senna. The fluidextract of spigelia and 



122 PHARMACOLOGY AND THERAPEUTICS. 

senna, which contained a small proportion each of the oils of 
anise and caraway, was formerly official. It is a very good 
preparation, and pleasant to take. The dose of spigelia, com- 
bined with a cathartic, should be repeated every four hours 
until a purgative effect is produced. 

CHENOPOPODIUM. 

Unofficial Preparation. 
CHENOPODIUM (U. S. P., 1890).— Chenopodium. (Ameri- 
can Wormseed.) Dose, 1 to 2 gm.; 15 to 30 gr. 

OLEUM CHENOPODIL— Oil of Chenopodium. Dose, 0.2 c.c; 
3 TTl. 

Action of Chenopodium. 
Wormseed is one of the most efficient anthelmintics, particu- 
larly against Ascarides. The oil acts as a stimulant to the 
circulation and nervous system. It is said to increase the 
cardiac rate and to promote the secretions of the skin, bronchi 
and kidneys. Chenopodium album, known as white goose-foot 
and hog-weed, is possessed of some haemostatic properties. 

Therapeutics of Chenopodium. 
The oil has sometimes been given in infantile colic, flatulent 
dyspepsia, chorea, hysteria, neurasthenia, chronic malaria, and 
amenorrhcea, but at the present time is used almost exclusively 
as an anthelmintic. For this purpose it may be given dropped 
on lump sugar, in capsules, or in emulsion. The dose is usually 
repeated three times a day, before meals, for two days, when a 
cathartic should be ordered. It is, no doubt, the safest vermi- 
fuge in case the mucous membrane is inflamed, as it not only 
causes the expulsion of the worms, but also appears to have 
a beneficial action upon the intestinal irritation. 

C. Antiparasitics. 

CHRYSAROBIN. 

CHRYSAROBINUM.— Chrysarobin. Dose, 0.030 gm. (30 mil- 
ligm.) ; y 2 gr. 



CHRYSAROBIN. 1 23 

Preparation. 
Unguentum Chrysarobini. — Chrysarobin Ointment. 

Action of Chrysarobin. 

External. — Chrysarobin has a deep and strong local irritant 
action. Applied to the skin it induces itching, redness and 
swelling, and in some instances follicular or furuncular derma- 
titis. It stains the skin and clothing a dark yellowish-brown or 
purple color, which may, however, be removed by a weak solu- 
tion of chlorinated lime or caustic soda, provided no soap or 
alkali has been used. Its application to the skin has been 
known to cause slight albuminuria. A certain amount is ab- 
sorbed from the skin, and if it is applied over an extended area 
it may give rise to constitutional symptoms. It is also irritant 
to mucous membranes. Small quantities will excite conjuncti- 
vitis, and the inflammation set up by it is sometimes so severe 
as to result in corneal ulceration. It is said that those engaged 
in collecting the drug (goa powder) often suffer from irritation 
of the face and eyes, with palpebral oedema. In a dilute form 
chrysarobin acts as a reducing agent, having the property of 
taking oxygen from the tissues and promoting the growth of 
normal epithelium. The drug is a vegetable parasiticide, being- 
poisonous to organisms of a fungous type. 

Internal. — Chrysarobin is a decided gastro-intestinal irritant. 
It produces copious, watery, brownish-colored stools, with re- 
peated vomiting, but not much nausea. The greater part of it 
passes through the tissues unchanged; the remainder is ab- 
sorbed and undergoes oxidation to chrysophanic acid. The 
portion absorbed is excreted in the urine, to which it imparts a 
yellow color, which turns to red upon the addition of alkalies. 
In animals it has been observed to cause severe nephritis (in 
which the glomeruli were less affected than the epithelium of 
the tubules), with albumin and sometimes blood in the urine. 

Therapeutics of Chrysarobin. 
It is largely used locally for its stimulating action in certain 
chronic inflammatory diseases of the skin, and also for its cura- 



124 PHARMACOLOGY AND THERAPEUTICS. 

tive effect upon vegetable parasitic eruptions, such as the vari- 
ous forms of tinea. In the former class it is of service in the 
treatment of eczema, acne rosacea, lupus vulgaris, and especially 
psoriasis, in which it is considered by many the best known ex- 
ternal remedy. It should always be used with caution, as it is 
liable to set up dermatitis of the surrounding integument. It is 
recommended that the official ointment should be considerably 
diluted before application, on account of the danger of exciting 
too much inflammatory reaction. In many instances the best 
way to use it is in the form of a pigment composed of chrysa- 
robin, I ; solution of gutta percha (made by decantation of gutta 
percha, i; lead carbonate, i; chloroform, 9), 9. This can be 
painted with accuracy on the parts desired, and is less liable to 
stain. Another cleanly manner of employing chrysarobin is by 
dissolving 1 part in 7 parts of chloroform, and stirring an equal 
quantity of soft petroleum into the mass ; applying by means of 
a brush. It may also be conveniently applied in the form of a 
stick made up with rosin, yellow wax and olive oil. Chrysa- 
robin should rarely or never be used on the face, on account 
of the danger of inducing oedema of the eyelids or conjunctivi- 
tis. For the same reason it should also be used with great cau- 
tion on the scalp. Alopecia circumscripta and ringworm of the 
scalp, however, have both been very successfully treated by 
means of it. It is affirmed by some that the action of this drug 
upon certain cutaneous affections is not only local but also con- 
stitutional, the opinion being expressed that, absorbed from one 
part of the skin (as, for instance, one limb), it is capable of 
exerting a beneficial influence upon other parts of the skin (as 
another limb) to which it has not been directly applied. How- 
ever this may be, there seems to be little question that in many 
of the conditions in which chrysarobin has been employed 
equally good results may be obtained by other remedies which 
are not so irritating and so liable to give rise to unpleasant 
effects. Excellent results have been claimed in external 
haemorrhoids from the use of a salve containing chrysarobin, 
iodoform and extract of belladonna, and in internal haemor- 



STAPHISAGRIA. I 25 

rhoids from suppositories made up with the same ingredients. 
The extremely irritating effect of chrysarobin upon the intes- 
tinal tract, when given internally, renders it practically useless 
as a cathartic or systemic remedy. It has been tried in small, 
repeated doses, especially in psoriasis, but the vomiting, grip- 
ing, purging, and depression resulting have necessitated its 
abandonment. 

STAPHISAGRIA. 

STAPHISAGRIA.— Staphisagria. (Stavesacre.) Dose, 0.065 gm. 
(C5 milligm.); 1 gr. 

Preparation. 
Fluidextractum Staphisagrise. — Fluidextract of Staphisagria. 
Dose, 0.05 c.c; 1 TTL- 

Unofficial Preparation. 
Delphinina.— Delphinine. Dose, 0.001 to 0.008 gm.; -^ to 

Action of Staphisagria. 
It is a parasiticide and is irritating to the skin, producing ery- 
thematous inflammation. Taken internally it is a gastrointesti- 
nal irritant and a depressant to the motor nerves, heart and 
respiration, causing death by asphyxia. 

Therapeutics of Staphisagria. 
It is principally used in pediculosis, and may be applied in 
the form of ointment (B. P. Staphisagria, 4; yellow wax, 2; 
benzoated lard, 17). Sometimes the dry powder is dusted over 
the affected surface, and sometimes the fluidextract is used in 
combination with diluted acetic acid. An oil has also 
been extracted from the seeds by ether, and it is applied 
in an ointment (4 c.c; 1 fl. dr. to 30 gm. ; 1 oz. of lard) or 
diluted with from 6 to 12 parts of almond or olive oil. These 
applications are also efficient in scabies and in prurigo senilis. 
In using staphisagria externally care should be taken not to 
apply it to an abraded scalp, and only upon the unbroken skin. 
A case is recorded in which its too free use upon a child was 



I 



126 PHARMACOLOGY AND THERAPEUTICS. 

attended with fatal results. Delphinine has been employed both 
externally and internally, principally for neuralgic affections, 
but is not as efficient as various other remedies. It is very 
much less poisonous than aconitine. 

Unofficial Preparations. 
PICROTOXINUM (U. S. P., 1890).— Picrotoxin. Dose, 
0.0005 to 0.001 gm.; T ^ to ^ gr. 

Decoctum Cocculi. — Decoction of Cocculus. Dose, 4 to 8 
c.c; 1 to 2 fl. dr. 

Tinctura Cocculi. — Tincture of Cocculus. Dose, 0.12 to 1 
c.c; 2 to 15 TT1 . 

Action of Picrotoxin. 

External. — Picrotoxin, being very destructive to lower forms 
of life, is an energetic parasiticide. 

Internal. — It is a powerful poison, causing vomiting, accelera- 
tion of respiration, slowing of the pulse and palpitation of the 
heart, stupor and unconsciousness, tonic spasms passing into 
clonic, collapse, repetition of convulsions, and asphyxia. The 
clonic spasms are entirely different from those produced by 
strychnine, and the central nervous effects of the drug are due 
mainly to its action on the medulla oblongata; the spinal cord 
and the higher parts of the brain remaining comparatively little 
affected. As the result of the intense stimulation of the 
medulla, there is clonic contraction of the muscles throughout 
the body. In the frog, spasm of the laryngeal muscles, by pre- 
venting the escape of air from the lungs, leads to a characteristic 
bloating of the animal. It has been found that picrotoxin, like 
other convulsive poisons, tends to lower the temperature when 
given in quantities insufficient to cause the spasms. In very 
small doses it appears to act as a bitter tonic to the gastro- 
intestinal tract, increasing secretion and promoting peristalsis. 

Therapeutics of Picrotoxin. 
External. — In an ointment of the cocculus seeds in lard (1 to 
6) cocculus is efficient in destroying pediculi and the acarus sca~ 



PICROTOXIN. 127 

bei and for the relief of trichophytosis, tinea versicolor, and 
other parasitic affections, but its use is attended with consider- 
able danger from poisoning. Care is therefore necessary, and 
abraded surfaces should be avoided. There is less risk if a 
solution (15 c.c. ; 4 fl. dr. of the tincture to 120 c.c. ; 4 fl. oz. 
of water) or decoction (1 to 16) is applied to the scalp for a 
few minutes for phthiriasis, or lousiness, and then washed 
off with warm water. Two or three daily applications may be 
sufficient. As the best way of employing this remedy, however, 
in the treatment of animal and vegetable parasitic affections, it 
is recommended that a small quantity of picrotoxin (not exceed- 
ing 1 per cent.) be prescribed in combination with mercuric 
oleate ointment (B. P. — Mercuric oleate, 20; benzoated lard, 
60). 

Internal. — Picrotoxin has been advised in atonic conditions 
of the stomach and cases of torpor of the intestines dependent 
upon deficient secretion and paresis of the muscular layer. In 
migraine associated with the menstrual period and in nervous 
dysmenorrhea it is said sometimes to afford relief if given a 
day or two before the flow. Some observers have found it of 
benefit in epilepsy, especially of the nocturnal and anaemic types 
and in cases attributable to onanism, while others assert that it 
really tends to aggravate the paroxysms. It has been tried in 
other nervous diseases, such as chorea, infantile convulsions, 
and various forms of paralysis, but the results thus far have 
not been such as to inspire confidence in its efficacy. There is 
one application of the drug, however, in which all appear to 
agree as to its utility, at least in many instances, namely in the 
treatment of the night-sweats of phthisis. It does not produce 
the disagreeable dryness of the skin and throat caused by atro- 
pine, and not infrequently succeeds in cases where the latter 
fails. It acts less promptly than that remedy, however, and it 
is generally necessary to repeat the dose for four nights in suc- 
cession before the sweating is completely controlled. The effect 
thus produced then lasts for from ten to fourteen days. This 
action of picrotoxin has been explained by its influence in in- 



128 PHARMACOLOGY AND THERAPEUTICS. 

creasing the respiration, which, through the partial asphyxia 
caused, prevents the stimulation of the mechanism of perspira- 
tion. In order to secure the desired result more quickly it may 
be given three times a day. It is also useful in other forms of 
hyperidrosis. It is administered in tablets or pills or in solu- 
tion, and to keep better it is recommended that glacial acetic 
acid should be added to the latter. It is also sometimes injected 
hypodermatically, and tablets containing .0006 gm. (y^-g- gr.) 
each are prepared for this purpose. As it has been demon- 
strated by experimental research that picrotoxin is the physio- 
logical antagonist of chloral in rabbits and other animals, it 
would seem likely to prove of service in the treatment of poison- 
ing by that drug. Conversely, in cases of poisoning by picro- 
toxin chloral should be used, together with anaesthetics, to con- 
trol the spasms. The combined administration of chloral, mor- 
phine and minimal doses of atropine has recently been recom- 
mended as the result of animal experiments. 

D. Antiperiodics. 
CINCHONA. 

1. CINCHONA.— Cinchona. Dose, 1 gm.; 15 gr. 

Preparations. 

1. Fluidextractum Cinchonae. — Fluidextract of Cinchona. 
Dose, 1 c.c; 15 m,. 

2. Tinctura Cinchonae. — Tincture of Cinchona. Dose, 4 c.c; 
1 fl. dr. 

2. CINCHONA RUBRA.— Red Cinchona. Dose, 1 gm.; 15 gr. 

Preparation. 
Tinctura Cinchonae Composita. — Compound Tincture of Cin- 
chona. Dose, 4 c.c; 1 fl. dr. 

3. QTJININA— Quinine. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Preparations. 
1. Elixir Ferri, Quininae et Strychninae Phosphatum.— 
Elixir of Iron, Quinine and Strychnine Phosphates. Dose, 4 
c.c; 1 fl. dr. 



CINCHONA. 129 

2. Glyceritum Ferri, Quininse et Strychninae Phosphatum. — 
Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, 
1 C.C.; 15 TTL- 

3. Syrupus Ferri, Quininae et Strychninae Phosphatum. — 
Syrup of Iron, Quinine and Strychnine Phosphates. Dose, 4 
c.c; 1 fl. dr. 

4. Syrupus Hypophosphitum Compositus. — Compound Syrup 
of Hypophosphites. Dose, 8 c.c.; 2 fl. dr. 

4. QUININE SULPHAS.— Quinine Sulphate. Dose, 0.250 gm. 
(250 milligm.); 4 gr. 

5. QUININE BISULPHAS.— Quinine Bisulphate. Dose, 0.250 
gm. (250 milligm.); 4 gr. 

6. QUININE HYDROBROMIDUM. — Quinine Hydrobromide. 
Dose, 0.250 gm. (250 milligm.); 4 gr. 

7. QUININE HYDROCHLORIDUM. — Quinine Hydrochloride. 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

8. QUININE SALICYLAS.— Quinine Salicylate. Dose, 0.250 gm. 
(250 milligm.) ; 4 gr. 

9. OLEATUM QUININE.— Oleate of Quinine. 

10. CINCHONINiE SULPHAS. — Cinchonine Sulphate. Dose, 
0.250 gm. (250 milligm.) ; 4 gr. 

11. CINCHONIDINiE SULPHAS.— Cinchonidine Sulphate. Dose, 
0.250 gm. (250 milligm.) ; 4 gr. 

Unofficial Preparations. 

1. Extractum Cinchonas (U. S. P., 1890). — Extract of Cin- 
chona. Dose, 0.30 to 2 gm.; 4 to 30 gr. 

2. Infusum Cinchonae (U. S. P., 1890). — Infusion of Cinchona. 
Dose, 30 to 60 c.c; 1 to 2 fl. oz. 

3. Cinchonina. — Cinchonine. Dose, 0.050 to 2 gm.; 1 to 30 
gr. 

4. Cinchonidinae Salicylas. — Cinchonidine Salicylate. Dose, 
0.060 to 1.20 gm.; 1 to 20 gr. 

5. Quininae Carbamas.— Quinine Carbamide. (Quinine Urea.) 
Dose, 0.30 to 1.20 gm.; 5 to 20 gr. 

10 



130 PHARMACOLOGY AND THERAPEUTICS. 

6. Quininae Kinas.— Quinine Kinate. Dose, 0.30 to 1.20 gm.; 
5 to 20 gr. 

7. Quininae Sulphovinas.— Quinine Sulphovinate. Dose, 0.30 
to 1.20 gm.; 5 to 20 gr. 

8. Quininae Tannas. — Quinine Tannate. Dose, 0.050 to 1.20 
gm.; 1 to 20 gr. 

9. Quininae Valerianas (U. S. P., 1890).— Quinine Valerianate. 
Dose, 0.050 to 2 gm.; 1 to 30 gr. 

10. Quinidinae Sulphas (U. S. P., 1890).— Quinidine Sulphate. 
Dose, 0.050 to 1.20 gm.; 1 to 20 gr. 

Action of Cinchona and its Alkaloids. 

Cinchona owes its effects on the organism almost entirely to 
the quinine in it. The bark, however, is more of a gastric 
irritant than quinine and is also a decided astringent, while on 
account of its bulk its active principles are more slowly ab- 
sorbed. Large doses of it have been known to cause an ap- 
parently well-marked febrile paroxysm, beginning with chill 
and terminating with slight perspiration, but quinine, while its 
untimely use may reproduce the paroxysm with more or less 
severity in a malarial subject, has been found incapable of ex- 
citing such symptoms in a healthy individual. Quinine sul- 
phate, bisulphate, hydrochloride and hydrobromide have the 
same action as quinine itself. The action of the drug may be 
most conveniently studied from the effects of quinine sulphate, 
which from its general use is commonly known simply as 
quinine. 

External. — Quinine has little or no influence upon sound 
skin, but is distinctly irritant to mucous membranes and raw 
surfaces. It is recognized as a protoplasm poison, its action 
extending with but little variation throughout most forms of 
living matter, and generally consisting in a transient augmen- 
tation of activity which is followed by depression and death. 
Quinine solutions, therefore, have considerable antiseptic 
power, while the lactic, butyric and alcoholic fermentations, 
through the effects of the alkaloid on the organisms, are either 



CINCHONA. 131 

retarded or completely prevented. It appears to have an 
elective action, however, since it has been found devoid of in- 
fluence upon some of the lower forms, as, for instance, the com- 
mon mold penicillium, which grows freely in its solutions. 
This same selective action is also observed in its effects on the 
ferments of the higher animals. Thus, in artificial experiments 
it has been found that while the gastric and pancreatic ferments 
are rendered less active by the addition of quinine, the drug has 
practically no effect on the action of ptyalin and diastase. In 
brief, from the results of careful experimental research it has 
been concluded that quinine hinders some, if not all, of the 
processes which normally occur in living matter and are ex- 
pressed in movement and various chemical products, and also 
that this action is not confined to the intact protoplasm, but 
extends to the ferments. In regard to the amount of its anti- 
septic power, most observers have found this equal to or greater 
than that of carbolic and salicylic acids, but considerably less 
than the salts of mercury and silver. About 0.2 per cent, solu- 
tions are antiseptic; this strength, it is stated, preventing acetic 
and butyric fermentations and the decomposition of albuminous 
substances. Some bacilli are quite susceptible to its influence; 
others, especially anthrax spores and the spirillum of relapsing 
fever, are found more refractory. 

Internal. Alimentary Canal. — Its chief action here is that 
of a vegetable bitter. The bitter taste is marked and pro- 
longed. The gustatory and gastric nerves are stimulated re- 
flexly, inducing more or less increase in the salivary and gastric 
secretions. It is, then, a stomachic tonic, promoting appetite 
and digestion. It is a question how far its antizymotic action, 
which if unrestrained would exert some slight retarding influ- 
ence on the gastric juice, and so tend to interfere with digestion, 
is really operative ; but it seems probable that this is more than 
counterbalanced by the reflex effects on the stomach and the 
mild stimulation of the gastric mucous membrane. In large doses 
it may cause nausea and vomiting. On the intestine quinine 
has no well-marked effects except it be given in large amount, 



132 PHARMACOLOGY AND THERAPEUTICS. 

when it acts as an irritant and may cause diarrhoea, which in 
exceptional instances may be characterized by bloody stools. 
The preparations of cinchona bark, owing to the presence of 
tannic acid, sometimes exercise an astringent effect upon the 
intestinal mucous membrane, and cause constipation. When 
taken into the stomach quinine is dissolved by the acid gastric 
juice, and quinine chloride is formed. If not promptly ab- 
sorbed, however, it passes into the intestine and is liable to be 
precipitated by the alkaline secretions, which form with it 
insoluble salts ; so that under these circumstances a consider- 
able portion of the quinine escapes absorption and is discharged 
in the faeces. 

Blood. — Quinine has been shown to have a special action upon 
the blood, which, however, is merely an illustration of its effects 
on the tissues generally. 

(a) White corpuscles. — When a small quantity is added to a 
drop of blood on the warm stage of the microscope it is ob- 
served that the normal changes in form and position of the leu- 
cocytes are at once stopped, while these cells become spherical 
in shape, darker in color and granular, and shortly disintegrate 
into debris. Similar results are observed in the mesentery of 
the frog when quinine is applied locally, and if the part be 
slightly irritated, so as to set up inflammatory action, the leuco- 
cytes do not accumulate in the tissues, as would be the case 
without the application of the drug; while if the quinine is 
applied after such irritation has been resorted to, the outpour- 
ing of the leucocytes through the capillary walls (diapedesis) 
is at once arrested. The same thing occurs when quinine is 
injected into the circulation, and the leucocytes, which assume 
a spherical form, are considerably diminished in number. 
While, however, these changes are due, no doubt, to the poison- 
ous action of the drug on the white corpuscles, it has been 
pointed out that it would be unjustifiable to infer from such 
experiments that quinine, in therapeutic doses, inhibits the 
movements of these cells in the human body. At the same time 
it is unquestionably true that in man ordinary quantities of qui- 



CINCHONA. I33 

nine, even when absorbed from the gastro-intestinal tract, have 
the effect of diminishing the number of leucocytes. 

(6) Red corpuscles. — On these it appears to have but little 
effect. It is true that certain observers have described an in- 
crease in size and others a destructive influence on the red cor- 
puscles, but it has been found that this does not occur under 
ordinary circumstances. It should be stated, however, that one 
authority-, as the result of observations made upon himself, 
arrived at the conclusion that quinine has a direct effect in 
increasing the number of the red corpuscles. 

(c) Other effects on the blood. — Quinine has additional ef- 
fects on the blood by reason of its action on processes attributa- 
ble to unorganized ferments. Thus, the addition of quinine to 
drawn blood prevents the acid fermentation which normally 
takes place in it as the result of the oxidation of certain un- 
known substances at the expense of the oxyhemoglobin, which 
it partially reduces. That quinine exercises an inhibiting influ- 
ence on the oxidizing action of the blood is shown by the fact 
that blood to which the drug is added fails to decolorize indigo 
or to form the blue oxidation product of guaiac. It therefore 
lessens the ozonizing power of the blood; but although the oxi- 
dizing energy of the latter is diminished, and oxygen is given 
off less readily, it has been found that the haemoglobin is appa- 
rently uninfluenced. Another action which is stated to be re- 
tarded by the presence of quinine is the coagulation of the 
blood. 

Heart and Circulation. — On the isolated frog's heart it is 
found that the action of quinine, which is entirely muscular, 
consists in slowing of the organ and a marked diminution in 
the strength of its contractions. In mammals it causes at 
first contraction of the arterioles and a quickening of the heart's 
action, which are followed by dilation of the vessels and a slow- 
ing and weakening of the cardiac contractions. These effects 
are believed to be probably due to the direct influence of the 
alkaloid on the muscular structure of the circulatory system, 
although by some the acceleration has been attributed to de- 



134 PHARMACOLOGY AND THERAPEUTICS. 

pression of the inhibitory mechanism in the heart or in the 
medulla. Accompanying the acceleration of the pulse there is 
a rise of blood-pressure, which seems to depend mainly on the 
vaso-constriction. It has been found that the pulse-rate in 
general follows the blood-pressure, but that during the fall it 
does not sink so rapidly and markedly as the pressure. In fatal 
poisoning the heart is stated to be generally very much weakened 
when the respiration stops, but continues to beat for some time 
afterwards. Quinine very frequently causes derangement of 
the sense of hearing and less commonly derangement of that of 
sight, which are believed to be due to vascular changes, rather 
than to any effect upon the brain. In the one case there are 
deafness and ringing in the ears and in the other defective 
color-vision, contraction of the visual field, and in some in- 
stances temporary blindness. The disorders of hearing are 
attributed to congestion of the auditory canal and those of 
sight to a very marked contraction of the retinal vessels, which 
may even be obliterated; but why quinine should produce these 
opposite vascular effects in the eye and the ear still remains 
unexplained. The congestion of the membrana tympani has 
been known to result in inflammation which caused permanent 
impairment of the hearing, and the constriction of the retinal 
vessels may be so severe as to cause degeneration of the gan- 
glion cells and ascending atrophy of the optic nerve. 

Respiration. — In moderate doses quinine slightly stimulates 
the respiration, but in large ones acts as a depressant. In ani- 
mals lethal amounts cause death through failure of the respira- 
tion. In exceptional instances quinine induces an asthmatic 
condition, characterized by a feeling of suffocation and rapid, 
noisy and irregular breathing. 

Cerebrum. — The activity of the brain is thought to be stimu- 
lated by small doses of quinine, which even seem to exhilarate 
in susceptible individuals. Large doses produce a sense of 
heaviness and fullness, with depression, confusion of ideas, hal- 
lucinations and difficulty of speech, and, in addition, there are 
sometimes observed giddiness or vertigo, uncertainty of gait, 



CINCHONA. 135 

and slowness of the pulse. The mental depression may deepen 
into melancholia or even dementia (which is generally cura- 
ble) ; while in some instances, instead of depression there is 
excitement, which may amount to mania. Collapse may follow. 
One effect of quinine on the cerebrum is of special interest from 
a therapeutic point of view, and that is the diminished appre- 
ciation of pain which is caused by it. By some the blindness 
and deafness resulting from large doses are thought to be prob- 
ably partly central in origin. From poisonous amounts of qui- 
nine administered to animals the only cerebral effects noted are 
said to be general depression and muscular weakness. 

Spinal Cord and Nerves: — In frogs quinine, in toxic doses, 
causes a temporary increase of reflex excitability, which is fol- 
lowed by the loss of spontaneous movements and paralysis of 
the spinal cord, as well as arrest of respiration. In mammals 
small quantities are said to have the effect of stimulating the 
spinal cord, which is afterwards depressed. It is stated that 
solutions of quinine when applied locally, even in sufficient 
strength to cause marked abnormalities in the muscular con- 
traction, do not lessen the irritability of the nerve trunks, and 
that no satisfactory proof has been offered that the alkaloid 
affects the peripheral ends of the motor or sensory nerves. 

Muscles. — Experiment shows that the strength of the contrac- 
tions may be increased as much as six times by moderate 
amounts of quinine, but the muscle is much more quickly fa- 
tigued than the unpoisoned muscle, so that its total work is less. 
As the same effect is observed in curarized muscle, it undoubt- 
edly depends upon a direct action on the muscle-fibre. Some- 
what stronger doses are found to lower the contraction from 
the beginning, while large quantities produce a rigor analogous 
to that caused by caffeine. Quinine thus acts upon muscle in 
the same way as upon the simpler organisms, at first augment- 
ing its energy and then weakening it. 

Uterus. — There is considerable evidence to show that quinine 
stimulates uterine contractions when labor has already com- 
menced. In some cases it also appears to increase the men- 



I36 PHARMACOLOGY AND THERAPEUTICS. 

strual flow, but it is improbable that it is capable of exciting 
abortion, as claimed by some. Its action in uterine inertia may 
perhaps be due in part to its action on unstriped muscle, such 
as it appears to have in the case of the arterioles, and in part 
to its effect in arousing the general nervous forces of the sys- 
tem. It tends to prevent post-mortem haemorrhage by causing 
contraction of the uterus. 

Urine. — Quinine has sometimes, but not constantly, the effect 
of somewhat increasing the amount of urine, an action which 
is thought to be due to its influence upon the renal epithelium, 
by which it is excreted. Quinine is found in the urine within 
half an hour after its ingestion by the mouth, and about one-half 
the quantity absorbed is stated to be excreted within six hours. 
After this its elimination takes place less rapidly, and traces 
may be discovered in the urine seventy-two hours after its in- 
gestion. Even in very small doses quinine has a pronounced 
effect on metabolism, or tissue change. In the excretion of 
nitrogen there is at first a slight increase and then a marked 
diminution, which, with large doses, may amount to 39 per cent. 
This is the result of the powerfully depressant action of qui- 
nine on the elimination of all the nitrogenous excretory prin- 
ciples, and especially urea and uric acid. In contrast to this, 
and somewhat contrary to what one would naturally be led to 
expect, is the slight influence of quinine upon the oxidation of 
the body; the quantity of oxygen absorbed and of carbon diox- 
ide given off being practically unaffected by even large medici- 
nal doses. While quinine is excreted chiefly through the kid- 
neys, it appears to be diffused from the blood to a limited ex- 
tent through various other channels, and has been detected in 
the tears, saliva, sweat and milk, as well as in the bile and in 
dropsical effusions. 

Temperature. — In the normal subject quinine sometimes has 
the effect of reducing the body temperature to a small extent. 
In other instances the temperature remains entirely unaffected, 
while in still others it undergoes a slight rise. As a rule, it 
may be stated, small doses cause this slight rise, while doses 



CINCHONA. 137 

considerably larger, but not sufficient to produce marked col- 
lapse, occasion an insignificant fall of temperature. In febrile 
conditions, however, it has a decided antipyretic effect, though 
not so marked as that of drugs of the antipyrine and salicylic 
acid classes. The fact that this action may be produced after 
division of the spinal cord shows that it does not depend upon 
any influence exerted upon the central nervous system, and it is 
now generally accepted that the temperature-reducing property 
of quinine is due to the direct action of the alkaloid upon the 
tissues. It is true that the excretion of carbon dioxide is gen- 
erally regarded as an index of chemical changes resulting in 
the liberation of energy and consequently of heat; but, while, as 
has been seen, quinine ordinarily does not seem to affect this 
to any appreciable extent, it is thought extremely probable that 
the antipyretic action of the drug is due to its retarding the 
metabolism. In support of this hypothesis it has been sug- 
gested that the presence of fever poisons throws the tissues into 
a state of augmented activity, in which they are more suscepti- 
ble to the sedative action of the drug, and that even in the nor- 
mal organism a reduction of the temperature might be induced 
if a sufficient quantity could be taken without exciting other 
symptoms. In this connection attention is called to the fact 
that in fever the nitrogenous decomposition is much increased, 
while quinine has a directly opposite effect; and it is pointed 
out that the diminution in the nitrogenous metabolism may 
also lead to an increased resistance being offered to the cause 
of the fever, or may lessen the poisonous products circulating 
in the blood. Furthermore, it is argued, the bacteria causing 
fever may themselves be rendered less active by the alkaloid, 
although this antiseptic action is probably of subordinate im- 
portance, since many of the pathogenic forms have been found 
to offer great resistance to it. Other authorities hold, some- 
what in the same line, that as it is an indubitable fact that the 
production of heat is diminished by quinine in fever, we are 
forced to the conclusion that oxidation or combustion (as shown 
by the excretion of carbon dioxide) is not the only source of 



I38 PHARMACOLOGY AND THERAPEUTICS. 

heat; that heat may also be liberated by other changes — by the 
splitting or hydration of nitrogenous molecules, in the course 
of which the nitrogen is converted into urea; and that these 
changes are those which are hindered by quinine. If then it 
be supposed that this form of heat production is, as seems prob- 
able, especially prominent in fever, the fact that quinine acts 
on febrile, and not on normal temperature, would also be ex- 
plained. 

Cinchonism is the name given to the train of symptoms to 
which doses of .60 gm. (10 gr.), or more, of quinine are liable 
to give rise. The most characteristic of these are a sense of 
fullness in the head, tinnitus aurium, and slight deafness. From 
larger amounts these symptoms may be augmented, and in addi- 
tion the patient may suffer from disorders of vision, sometimes 
amounting to blindness, and the severe cerebral disturbances 
which have already been mentioned. The susceptibility to the 
physiological effects of the drug differs very greatly in different 
individuals, and various idiosyncrasies as regards its influence 
have frequently been noted. Occasionally it is the cause of 
cutaneous eruptions, such as erythema, urticaria, herpes, pur- 
pura, etc., and instances have even been reported in which the 
affection was gangrenous. A peculiar rash has also been ob- 
served among workers in cinchona bark. A case has been re- 
corded in which .004 (-^ gr.) of quinine repeatedly produced 
an erythematous or bullous eruption, and .20 gm. (3 gr.) has 
been known to be followed by severe constitutional disturbance, 
hsematemesis and bloody stools. Gastro-intestinal irritation is 
not infrequently occasioned by comparatively small doses, and 
in a very few instances albuminuria and hematuria have re- 
sulted from it. Death from quinine is of extremely rare occur- 
rence. Enormous doses have sometimes been taken without 
peril to life, and it seems probable that in these cases a large 
proportion of the drug passed through the system without being 
absorbed. Hydrobromic acid has been found in many in- 
stances to prevent the ringing in the ears or headache caused 
by it, and from 2 to 7.5 c.c. (^ to 2 fl. dr.) of the diluted acid 



CINCHONA. I39 

may be given with ordinary doses of quinine. The bromides 
may also be used for this purpose, and ergotin likewise is said 
to diminish the liability to cinchonism. In respect to their 
effects on the brain, morphine and quinine are regarded as 
antagonistic, and in respect to their action on the sympathetic 
system, on the heart, and on the temperature, quinine and atro- 
pine. The latter drug is said to be successful in combating the 
annoying cutaneous effects sometimes caused by quinine. 

Relative Action of the Alkaloids. — The other alkaloids re- 
semble quinine very closely in their effects on the system, but 
are weaker in their action. Quinidine is most likely quinine, 
while cinchonine and cinchonidine differ from the latter in 
having a convulsant influence; in consequence of which the 
stage of stimulation in their action on the central nervous sys- 
tem is more marked. This tendency to produce convulsions, 
which are of an epileptiform character, is said to be much the 
more pronounced in the case of cinchonidine, which, but for its 
resemblance in other features to quinine, might, it is held, be 
classed among the convulsive poisons. The relative antipyretic 
effect of the alkaloids has been set down as follows: Quinine, 
100; quinidine, 90; cinchonidine, 70; cinchonine, 40. 

Therapeutics of Cinchona and its Alkaloids. 
External. — The expensiveness of quinine renders it unavail- 
able, as a rule, for antiseptic purposes. A one per cent, solution 
of quinine sulphate is sometimes used, however, as an applica- 
tion to unhealthy sores and infected wounds, and a five per cent, 
solution as a wash in diphtheria, an injection in otorrhcea, hay- 
fever, gonorrhoea and chronic cystitis, and an insufflation in 
whooping-cough. An attack of hay-fever, if the catarrhal irri- 
tation is confined to the nares and fauces, may in some instances 
be arrested by the topical application by means of a camel's-hair 
brush, or in the form of a spray, of a solution of quinine hydro- 
chloride (.25 to .50 gm. ; 4 to 8 gr. ; to 30 c.c. ; 1 fl. oz. of 
water). Powdered quinine sulphate, dusted upon chancroids, is 
said to promote rapid healing. 



I40 PHARMACOLOGY AND THERAPEUTICS. 

Internal. — G 'astro-intestinal Tract. — The preparations of cin- 
chona are used to a large extent in digestive troubles, especially 
when associated with a debilitated state of the system, and, if 
their administration is not maintained for too long a time, gen- 
erally serve an excellent purpose. In conditions such as atonic 
dyspepsia and gastric catarrh they may often be combined ad- 
vantageously with the mineral acids. They are contra-indi- 
cated in all inflammatory states of the gastro-intestinal mucous 
membrane, but where the latter is relaxed and there is more 
or less diarrhoea without inflammation, preparations of the red 
bark are likely to be of great benefit. In many cases the com- 
pound tincture, which contains other stomachics also, is to be 
commended. (The name of " Huxham's tincture" is often 
applied, incorrectly, to this preparation.) In the gastric catarrh 
of drunkards the alkaloid quinine, generally combined with 
acids, is considered of special service. Quinine is one of the 
most commonly used of all tonics, and in the small quantities 
required for this purpose may generally be continued for a very 
considerable time without causing any impairment of digestion 
or absorption. It is frequently given associated with iron, and 
is apt to be prescribed especially with the tincture of ferric 
chloride, the free acid in which readily dissolves it. Strychnine 
is also often added to combinations of quinine and iron, as in 
the official elixir, glycerite and syrup. The tonic dose of qui- 
nine sulphate or hydrochloride is from .03 to .12 gm. (^ to 
2 gr.), and the latter salt is not infrequently preferred to the 
sulphate on account of its greater solubility. In many in- 
stances both as a tonic and an antiperiodic, cinchonidine salicyl- 
ate (not official) is preferable to quinine sulphate, and may 
be prescribed in doses of from .30 to .60 gm. (5 to 10 gr.). 

Antipyretic Effect. — While quinine was formerly much in 
vogue as an antipyretic, at the present time, except in the case 
of malarial fever, it is seldom employed in this capacity, since 
in the comparatively rare instances where it is deemed advisa- 
ble to reduce the temperature by means of drugs this can be 
much more certainly and efficiently accomplished by the coal- 



CINCHONA. 141 

tar derivatives, such as antipyrine, phenacetine and acetanilide. 
Where for any reason it is desirable to use quinine in febrile 
conditions for this purpose it should be given preferably in a 
single dose of from 1.20 to 2.40 gm. (20 to 40 gr.) for an adult. 
It may be administered in tablets or capsules, suspended in milk, 
or in solution. For dissolving the hydrochloride only water, in 
sufficient quantity, is required, but in the case of the sulphate 
it is necessary to add acid. With these large doses it is ad- 
visable to give sodium or potassium bromide, in order to avoid 
the disagreeable tinnitus which is likely to be set up by the 
drug. The diluted hydrobromic acid is an excellent solvent, 
and, at the same time, will relieve the ringing in the ears. In 
a considerable proportion of cases the antipyretic action of 
quinine may be relied upon, and, like the other antipyretics, it 
will be found most efficient at a time when the temperature has 
a natural tendency to fall. Usually about two hours elapse 
before the antipyretic effect manifests itself, and it should 
therefore be given at that interval before an expected decline 
in temperature. Quinine, it is worth noting, possesses the 
advantages over the coal-tar antipyretics of a more prolonged 
action and of exposing the patient to much less risk of collapse. 
It is therefore still prescribed to some extent in surgical fever. 
Specific Action. — One of the most positive effects in the whole 
range of Medicine is that of quinine, and to a less pronounced 
degree the other alkaloids of cinchona, in arresting the parox- 
ysms of malarial fever. It is now known that this result is 
due to the directly poisonous action of the drug upon the Plas- 
modium malariae, which infests the blood and is the specific 
cause of the disease. Outside the body a 1 to 10,000 solution of 
quinine will immediately arrest the movements of the hsemato- 
zoon, and the same thing is found to occur when the alkaloid 
is circulating in the blood. Here it prevents the entrance of 
the spores into the red-corpuscles, in which their cycle of 
development solely takes place. About three hours after the 
administration of quinine by the mouth it is stated that the 
erdoglobular forms met with in tertian and quartan fever be- 



142 PHARMACOLOGY AND THERAPEUTICS. 

come immobile and granular, and lose their affinity for certain 
stains; while several hours later they may be seen deformed 
and segmented. Experimental research has shown that quinine 
does not act equally on the parasite in all its stages; its most 
powerful effect being upon the forms which are just breaking 
into spores and upon the free-swimming organisms, while its 
action is much weaker upon the older segmenting bodies, and 
least upon the young endoglobular forms. Since it has been 
found that these last exist in the blood just before the paroxysm, 
their sporulation giving rise to the characteristic chill with its 
ensuing febrile reaction, quinine, on account of the inefficiency 
of its action upon them, will have little or no effect in counter- 
acting the paroxysm then impending. If, however, it is given 
at this time it will, it is argued, be present in the blood when 
the spores are liberated, and as these, as has been seen, are most 
susceptible to its action, it will be able (if the quantity adminis- 
tered has been sufficiently large) to destroy them, and thus 
prevent the development of the new cycle. It is advisable, 
therefore, that the alkaloid should be given several hours be- 
fore the expected paroxysm, so as to allow time for absorp- 
tion. The powerful destructive action which quinine exerts 
on the malarial parasite, both in and outside the body, is ex- 
actly the same as that which is observed in the case of amoebae 
and other similar forms. It is explained by the effects of 
the alkaloid as a protoplasmic poison, by virtue of which it acts 
more strongly (specifically) on the lower forms of life than on 
the higher, and hence can be introduced into the human body 
with perfect safety in quantities which are sufficient to destroy 
such simple organisms. In addition to this direct action, it is 
held by some that quinine has an indirect action, manifesting 
itself in an alteration of the environment, in consequence of 
which the latter is rendered less favorable to the growth of 
the parasite. As an example of this is cited the diminished 
readiness with which the red blood-corpuscles part with their 
oxygen after the addition of quinine. Both theory and experi- 
ence, it has been observed, point to the decline of the fever as 






CINCHONA. I43 

the most advantageous time for the administration of the drug. 
Some prefer to give a single large dose (usually about 1 gm. ; 
15 gr.), and others divided doses, of about .30 gm. (5 gr.), at 
intervals between the attacks. Since the elimination of quinine 
takes place with considerable rapidity, the maximum curative 
effect is believed to be obtained by the administration of the 
whole amount required in one dose, rather than by a succession 
of small doses. As the result of a very extended observation 
one of the best authorities on this subject states that according 
to his experience the most effective method of treating an inter- 
mittent is to give a full dose of quinine (.60 gm. ; 10 gr.) in the 
sweating stage, and the same quantity five hours before the time 
of the next paroxysm. He has also found that the anti-periodic 
property of quinine is increased, while the cerebral effects of 
large doses are diminished, by combination with morphine. If 
in any case a very prompt effect is desired, from 1 to 2 gm. (15 
to 30 gr.) of quinine carbamide (not official), which is very 
soluble, may be administered hypodermatically ; a smaller dose, 
.30 to .50 gm. (5 to 8 gr.) in an hour or two, is almost in- 
variably successful in preventing the next immediate chill. 
After the paroxysms have been overcome the remedy should 
not be entirely abandoned, but, for at least three weeks, on the 
seventh day from the date when the last one appeared full 
cinchonism should be produced, by the use of from .60 to 1 gm. 
(10 to 15 gr.) of quinine; as the attacks show a decided tend- 
ency to recur in cycles of seven days. It has been found that 
the action of quinine is materially assisted by the continuous 
administration of arsenic during the intermissions, and until the 
third septenary period has passed. Quinine is both curative 
and prophylactic, and it has in numberless instances been 
proved that its regular administration in very moderate quan- 
tities (from .20 to .30 gm. ; 3 to 5 gr. a day) will absolutely or 
to a large degree protect persons living in malarious regions 
from ague. If the malarial poison is concentrated and active, 
and the conditions are otherwise unfavorable, the amount 
should be doubled; and it is to be noted that an enormous ex- 



144 PHARMACOLOGY AND THERAPEUTICS. 

perience has now shown that the drug when taken thus as a 
prophylactic is entirely free from injurious effects. In re- 
mittent fever the best plan of administration is to give from 
1.20 to 2 gm. (20 to 30 gr.) of quinine in a single dose once or 
twice each day until the temperature is reduced to normal. 
In the pernicious variety of malarial fever the patient's life 
is in imminent danger, and not only are large doses of quinine, 
from 1.20 to 3.60 gm. (20 to 60 gr.) demanded, but they must 
be given promptly; so that administration by the stomach, 
rectum and hypodermatic injection may be in turn or simul- 
taneously practiced. In any severe attack of ague Clark's pow- 
der, which consists of quinine, 10; powdered capsicum, 4; 
powdered opium, 1 part, may be resorted to. This is usually 
given in 1.00 gm. (15 gr.) doses, and is said to be more effica- 
cious in the treatment of the disorder than larger doses of 
quinine when given alone. In chronic malarial infection quinine 
is less curative than in the acute; the principal reason for this 
probably being the presence of certain structural alterations re- 
sulting therefrom in the liver, spleen, kidneys, intestines or 
central nervous system. Here quinine salicylate and cinchoni- 
dine salicylate are said to be especially effective, and they may 
often be combined advantageously, according to circumstances, 
with iron, arsenic or cholagogue cathartics such as the prepara- 
tions of podophyllum. When an individual has once suffered 
from malaria any subsequent affection which he has is apt to 
assume a malarial type. This is especially true of neuralgia, 
which is often located in the forehead and has received the 
name of "brow-ague." It generally yields promptly to quinine, 
which is also sometimes of service in neuralgias not of ma- 
larial origin. Not only superficial neuralgias in various por- 
tions of the body, but also neuralgic pains in any of the deep- 
seated organs, may be an expression of the malarial cachexia 
as affecting the sensory nervous system ; while its influence 
on the motor apparatus may be shown by such disorders as 
chorea, epilepsy, asthma, hiccough, laryngismus stridulus, and 
spasmodic stricture of the urethra. These neuroses, it has 



CINCHONA. 145 

been found, may either be substituted for the ordinary malarial 
paroxysm (chill, fever and sweating) or may assume a period- 
ical character in consequence of having occurred in a system 
already affected with malaria. They are to be distinguished 
from other functional nervous- affections by the more uniform 
periodicity in the recurrence of the paroxysms, and if the 
patient is known to have previously suffered from malarial in- 
fection the diagnosis is usually simple. In the case of ma- 
larial neuralgias particularly, morphine is of material service as 
an adjunct to the action of quinine. Malarial diarrhoea, dysen- 
tery and jaundice may sometimes be promptly relieved by 
quinine, but if these depend on structural alterations in the liver 
or the intestinal glands they are naturally more intractable. 
Hsematuria of malarial origin usually requires large doses of 
the remedy. Warburg's tincture is a remedy which has long 
enjoyed a considerable reputation in the treatment of malarial 
infection, especially in the tropics. It contains quinine sul- 
phate, 80; Socatrine aloes, 100; opium. 1; rhubarb, 32; cam- 
phor, 8; with a number of aromatics and menstruum to 4000. 
The proportion of quinine is about .60 gm. (10 gr.) to 30 c.c. 
(1 fl. oz.) of menstruum, and the dose is 4 to 15 c.c. (1 to 4 
fl. dr.). It may now be obtained in tablets, each of which rep- 
resents 4 c.c. (1 fl. dr.) of the preparation. In many instances 
Warburg's tincture is prescribed without the aloes. In enlarged 
spleen (ague-cake) and in conditions, such as malarial jaundice, 
where there is great irritability of the stomach or of the in- 
testinal mucous membrane, as well as in all cases where it 
becomes necessary to secure the promptest possible effect, it is 
advisable that quinine should be administered subcutaneously. 
The simple alkaloid and quinine sulphate are not adapted for 
this purpose, as they produce too much irritation, and have even 
been known to give rise to tetanus; and hence it is requisite to 
use some more soluble preparation of quinine, such as quinine 
carbamide (quinine urea), hydrochloride, kinate, or sulpho- 
vinate. 
Other Uses.— Quinine has been employed in a great variety 
11 



I46 PHARMACOLOGY AND THERAPEUTICS. 

of conditions besides those already mentioned, and in many of 
them with good results. There is no question of its distinct 
value in the treatment of whooping-cough, which there is good 
reason to suppose is a microbic disease. In order to get the 
full benefit of its remedial agency, however, it should be slowly 
swallowed in solution, so that it may act locally on the mucous 
membrane of the fauces as well as produce an internal effect; 
and given in this way its intensely bitter taste proves an almost 
insuperable objection, as it is extremely difficult to get children 
to take it. Still, in other forms it has been found of consider- 
able service by a number of observers. It may therefore be 
given in capsules or combined with chocolate or administered 
by the rectum in suppositories or enemata. It is advised that 
in the case of an infant under one year the treatment should 
be commenced with as many centigrammes as its age in months, 
and that older children should take daily as many decigrammes 
as their age in years. In no case, however, should the amount 
taken in a single day exceed 1.5 gm. (23 gr.). To children 
the tannate is not infrequently given, as it is practically taste- 
less, and made into tablets with chocolate is readily taken. As 
it contains much less quinine, the dose should be twice as large 
as the sulphate. In influenza, quinine, either alone or combined 
with other remedies, has been used with some success, and it 
is also claimed that it is of value as a prophylactic in this dis- 
ease. When an attack has commenced it is said that its early 
administration tends to prevent or diminish cardiac complica- 
tions, as well as other complications and sequelae. In certain 
cerebral affections it is of decided benefit. In the case of el- 
derly people it improves the intra-cranial circulation, and so 
relieves a group of symptoms depending on sluggishness of the 
latter which has been described as follows: Headache, vertigo, 
failure of memory and despondency, associated with a slow 
pulse, an atheromatous degeneration of the vessels, puffiness of 
the eyelids, and dilatation of the superficial veins of the head. 
In the adynamic form of delirium tremens small doses of qui- 
nine are of service in tranquilizing the patient, and in the pre- 



CINCHONA. 147 

liminary stage of the affection known as " the horrors " has 
been found useful, especially when combined with a mineral 
acid, by correcting the digestion and invigorating the cerebral 
motor centres. In some forms of insanity, and particularly the 
puerperal variety, where there is much weakness and the sur- 
face is cold and clammy, quinine is also likely to prove beneficial. 
In headache and in neuralgias in various localities, as well as in 
chorea and epilepsy which are not dependent upon a malarial 
cachexia, it may prove useful, provided that anaemia is present 
and lies at the seat of the nervous derangement; but not other- 
wise. The laryngismus stridulus to which rachitic children are 
subject is said to be ameliorated especially by quinine hydrobro- 
mide. As an adjuvant to other treatment, quinine is of value 
in adynamic diseases, such as diphtheria and in surgical affec- 
tions, where it aids in sustaining the vital powers and tends 
to check the formation of pus ; as well as in cutaneous diseases 
like erysipelas, erythema nodosum, ecthyma and 'impetigo, 
where there is an enfeebled condition of the system. A com- 
mon cold may often be successfully aborted by the adminis- 
tration of .60 gm. (10 gr.) of quinine with .03 gm. ( T / 2 gr.), 
or less, of morphine at the onset of the attack. Quinine has 
also been found of service in asthma and hay-fever after the 
subsidence of the acute symptoms, in chronic bronchitis with 
bronchorrhcea, and in the night-sweats of pulmonary tubercu- 
losis. For the latter, doses of from .90 to 1.20 gm. (15 to 
20 gr.) are required. A full dose is frequently given previous 
to the passage of the catheter or urethral sound, in order to 
prevent the occurrence of a chill. Quinine is found useful by 
obstetricians in promoting uterine contractions after labor 
has once commenced, and is also thought to materially reduce 
the danger from sepsis. As an emmenagogue in anaemic sub- 
jects it is often combined with iron, and iron and quinine 
citrate is a good preparation for this purpose. There are 
certain classes of cases in which quinine should, if possible, 
be avoided. Among these may be mentioned : Idiosyncrasy, 
in consequence of which quite small doses produce very severe 



I48 PHARMACOLOGY AND THERAPEUTICS. 

cinchonism, acute or subacute disease of the middle ear, gastro- 
intestinal irritation, meningitis, and inflammation of the genito- 
urinary tract. 

Division II. — Drugs Acting on the Blood. 
A. Drugs Acting on the Plasma. — Substances of various kinds 
are capable, after absorption, of existing in solution in the 
plasma, and those which act as purgatives, diuretics and dia- 
phoretics must necessarily alter the composition of the plasma 
by abstracting substances from it. The object for which drugs 
are given to act on the plasma is to increase its alkalinity. 
Were it even desirable to render it acid, no agent is at present 
known which is able to accomplish this, or even to reduce to 
any extent the natural alkalinity of the plasma. The mineral 
acids, as is well known, can exist in it only in the form of 
neutral salts. 

The alkalizers of the plasma are salts of — 

(1) Potassium. (4) Lithium. 

(2) Sodium. (5) Magnesium. 

(3) Ammonium. (6) Calcium. 

This is approximately the order of their alkalizing power, potassium 
being undoubtedly the most powerful, while calcium is very feeble. 

It has been found that in the plasma the decomposition of the 
citrates and tartrates of these metals into alkaline carbonates 
takes place, and one of the purposes for which alkalies are 
administered is to cause, if possible, the formation of soluble 
urates by their combination with uric acid. Furthermore, the 
excretion of the urates is promoted by the diuretic action of 
the alkalies. 

Therapeutics. — Alkalies are consequently ver.y largely em- 
ployed in the treatment of gouty conditions, which are charac- 
terized by an excess of uric acid or an analogous substance 
in the plasma. Lithium preparations have been regarded by 
many as especially beneficial in such cases, but there is no rea- 
son to suppose that this is a fact, particularly as the solubility 



DRUGS ACTING ON THE BLOOD. 1 49 

of the urates is not increased by lithium. What is important 
is that the preparation selected should be one that is not apt 
to disturb the digestion, since the remedy must usually be 
continued for a considerable period; hence potassium citrate 
and lithium citrate are favorite salts, and the numerous natural 
alkaline waters are also very largely used. No doubt, one 
of the chief services which the latter render is the flushing 
of the system with a large amount of fluid. 

On the hypothesis that acute articular rheumatism is due 
to a materies morbi of the plasma (by many believed to be lactic 
acid), which is generated within the body, large doses of the 
alkalies were long given in this and other affections involving 
a so-called rheumatic diathesis, with the idea of neutralizing 
and eliminating such morbid principle from the blood. This 
treatment, however, has now been practically supplanted by 
the use of salicylic acid and its compounds. 

In chronic lead poisoning potassium iodide has been and is 
still almost universally employed. It has been supposed to 
promote the elimination by the kidneys of the lead, which 
accumulates in the tissues in a very sparingly soluble form, 
though it has now been denied that this salt has any effect 
on its excretion either by the urine or the intestine, by which 
most of the lead is known to make its escape from the body. 

Purgatives, diaphoretics and diuretics necessarily have the 
effect of altering the composition of the plasma, and hence are 
frequently employed in the treatment of local or general 
cedema and of effusion into serous cavities, for the purpose 
of draining off fluid from the plasma. They are also used to 
facilitate the excretion of poisons from the blood in conditions 
such as uraemia and cholsemia. Venesection, transfusion and 
the intravenous injection of watery solutions naturally alter 
the composition of the plasma directly. 

B. Drugs Acting on the Red Corpuscles. — The most impor- 
tant are those which are capable of increasing the amount of 
haemoglobin. It is a fact, however, that there are no known 
drugs which will increase the amount of iron in perfectly 



I50 PHARMACOLOGY AND THERAPEUTICS. 

healthy blood; hence, in a strict sense, the action of all such 
agents much be regarded rather as a pathological than a physi- 
ological one. These drugs are called Haematinics. 



They are — 

(1) Iron and its salts. 

(2) Arsenic trioxide. 

(3) Potassium permanga- 

nate (doubtful). 



(5) Hydrochloric acid 
(4) Copper salts 

(6) Potassium salts 

(7) Phosphorus 



M doubtful). 



They increase the quantity of haemoglobin in each red cor- 
puscle, as well as the number of these corpuscles. Their effects 
are materially assisted by all measures which tend to improve 
the digestion and the general health. The mode of action of 
these haematinics is still obscure, and will be discussed under 
each drug. Iron is by far the most important and efficient. 

Indirect haematinics are drugs which are of service by re- 
moving some obvious cause for a deficiency of haemoglobin 
(the condition known as anaemia), such as mercury, given 
for syphilis, quinine, for ague, etc. 

Alcohol and quinine slightly diminish the oxygenating power of the 
blood by increasing the stability of the oxyhemoglobin. Citrates and 
tartrates of the alkaline metals are partially oxidized to carbonates at 
the expense of the oxygen of the red blood-corpuscles. 

The red blood-corpuscles are believed to be increased in size by oxy- 
gen and hydrocyanic acid, and to be rendered smaller by morphine and 
carbon dioxide, as well as by quinine, when, with a high temperature, as 
is probably the case, they are a little larger than normal. By small doses 
of mercury they are said to be increased in number. 

In consequence of the presence of a large amount of sodium chloride, 
the red corpuscles pass rapidly through the walls of the capillaries. 

Quinine and hydrocyanic acid diminish the ozonizing power of the 
blood. 

Certain drugs destroy life by altering the composition of the 
haemoglobin, and so preventing it from uniting with oxygen. 
Whatever their therapeutic effects, they are therefore of consid- 
erable importance from a physiological and toxicological point 
of view. Thus, carbon dioxide expels the oxygen from oxy- 



DRUGS ACTING ON THE BLOOD. I 5 I 

haemoglobin; hydrocyanic acid forms cyano-haemoglobin ; potas- 
sium chlorate, the nitrites, especially amyl nitrite, and most of 
the antipyretics (antipyrine and its compounds excepted) con- 
vert the haemoglobin into methaemoglobin ; acetanilide, amyl 
nitrite, potassium chlorate and pyrogallic acid destroy the red 
corpuscles. 

Phosphorus, arsenic, hydrogen sulphide, turpentine, iodine, and sul- 
phur also reduce oxyhemoglobin. 

Hydrocyanic acid, alcohol, chloroform, quinine, morphine, nicotine, 
strychnine and brucine have the effect of diminishing the oxidation of 
freshly drawn blood which is exposed to the air. 

C. Drugs Acting on the White Corpuscles. — Normally the 
white corpuscles undergo constant changes of form and position 
exactly similar to those of the amoeba, and it is found that gen- 
erally those drugs which are poisons to the amoebae are, when 
applied in sufficient concentration (which is rarely the case 
in the human body), toxic to the leucocytes. All irritants 
which set up inflammatory action have the effect of causing 
the passage of white corpuscles through the capillary walls; 
while all the cinchona alkaloids, and especially quinine, have 
the property of arresting this migration. Berberine sulphate 
and acetanilide act in a similar way. 

Veratrine destroys white co'rpuscles when applied to them outside the 
body. 

Camphor, myrrh and other aromatics are said to increase their pro- 
duction by increasing absorption from the intestine, while quinine, it 
is asserted, diminishes their number in the blood. 

A few other facts relative to the action of certain drugs 
upon the blood may be noted. Poisonous doses of mercury 
increase the fluidity of the blood, impair its coagulability, and 
diminish its solids. Phosphorus may also prevent the blood 
from clotting as readily as usual, and sometimes may cause it 
to remain fluid for forty-eight hours or more, but this is 
thought to be probably secondary to changes produced in the 
intestine and liver, rather than a direct effect of the poison. 



152 PHARMACOLOGY AND THERAPEUTICS. 

Various astringents and calcium salts (especially the chloride), 
on the other hand, promote coagulation. Cod liver oil in- 
creases the solids of the blood. 

A. Drugs Acting on the Plasma. 
POTASSIUM. 

1. POTASSII HYDROXIDUM (Potassa, U. S. P., 1890).— Potas- 
sium Hydroxide. (Potassa. Potassium Hydrate. Caustic Potash.) 

Preparations. 
Liquor Potassii Hydroxidi (Liquor Potassae, U. S. P., 1890). 
— Solution of Potassium Hydroxide. (Solution of Potassa.) 
Dose, 1 c.c; 15 n\. 

Liquor Cresolis Compositus. — Compound Solution of Cresol. 

Unofficial Preparations. 
Potassa Cum Calce (U. S. P., 1890). — Potassa with Lime. 
(Vienna Caustic. Vienna Paste.) 

Potassa Sulphurata (U. S. P., 1890). — Sulphurated Potassa. 
(Liver of Sulphur.) 

Action of Potassium Hydroxide. 

In the hydrates and carbonates of the alkalies the action of 
their basic metallic constituents is now known to be of little 
practical importance, the alkalinity of the substance mainly de- 
termining its pharmacological effects. The metallic ion serves 
for the most part as merely the means of applying the non- 
metallic constituent. It is incorrect, therefore, to regard potassa 
as typifying the action of potassium on the system. The in- 
fluence of the potassium ion is much more evident in other 
salts, and notably the chloride, in which the Cl-ion is quite 
inactive, while the K-ion is the energetic constituent. 

Action of Potassium Salts in General. — In the salts of the 
latter character it is seen that potassium has a distinctly 
toxic action, the principal effects of which are depression of the 
central nervous system and of the heart. That the heart is 



POTASSIUM. I53 

injuriously affected by the potassium salts in large amount is 
shown by the pulse becoming much slower and weaker and 
by a sudden fall of arterial pressure. In animals, when these 
salts are injected into the circulation, the cause of death is 
cardiac failure. But while in cases of poisoning by quantities 
far in excess of therapeutic doses the special toxic action of 
potassium upon the heart may, no doubt, have an important 
share in bringing about the fatal result, the effects noted are 
in many instances believed to be due to the action of the poison 
upon the alimentary canal. Upon the brain and the motor and 
sensory nerves, and upon the spinal cord especially, as well 
as upon the heart and the muscles in general, potassium salts 
exert a pronounced depressant influence. In poisoning by 
them in the frog the central action is shown by the spontaneous 
movements becoming weak and slowly performed, while in 
mammals the chief nervous symptoms are great muscular weak- 
ness and apathy. The respiration, it is stated, becomes rapid 
and labored, probably from the anaemia of the centres, and death 
in often preceded by weak and asphyxial convulsions. 

It is a fact, however, that when administered in ordinary 
medicinal doses these salts are not at any time present in the 
blood (owing to the rapidity of excretion) in sufficient quanti- 
ties to produce marked toxic effects, such as are observed when 
they are injected directly into the circulation of animals. Their 
poisonous action upon the heart has given rise to exaggerated 
apprehensions of the danger of using them in therapeutics, and 
it should therefore be borne in mind that only very large quanti- 
ties have any effect at all upon the heart, especially when given 
by the mouth. In this connection it has been pointed out that 
very much larger quantities of potash are taken daily in the 
food by thousands of persons than are ever prescribed in medi- 
cine, the amount of it in the food of some classes being esti- 
mated at from 50 to 100 gm. (i 1 /? to 3 oz.) per day. Still, the 
possibility of causing undesirable cardiac depression when 
potassium salts are given in large and long-continued doses 
should lead to a certain amount of caution in their use, and 



154 PHARMACOLOGY AND THERAPEUTICS. 

especially in the case of persons suffering from cardiac disease. 
It is also well to remember that when administered in con- 
siderable quantity for an extended period they are likely, as 
has been found, to have the effect of dissolving out the haematin 
from the red corpuscles, and so produce a dyscrasia, with im- 
poverishment and excessive fluidity of the blood. 

External. — In concentrated form potassium hydroxide has a 
powerful irritant and caustic action, partly in consequence of its 
combining with the water of the part to which it is applied. In 
addition, it combines with the tissue elements to form alkaline 
albuminates, and with the fats to form soaps. In this way it 
dissolves the skin and produces necrosis of the deeper tissues. 
The surface generally becomes coated with a semitransparent 
crust, and this eschar is subsequently separated by inflammation 
from the uninjured parts, leaving an ulcer. As potash forms 
soluble compounds with the proteids, it is only slowly neutralized 
by the tissues, so that it penetrates more readily than many other 
corrosives. In weak solution it thoroughly cleanses the skin 
by dissolving the superficial layer of the stratum comeum and 
the oily secretions of the glands, but if applied for some time 
it penetrates more deeply and may excite slight irritation and 
redness. On the mucous membranes it effects solution of 
mucus. Very dilute solutions apparently have a sedative effect; 
strong solutions destroy all living tissues with which they come 
in contact. 

Internal. Alimentary Tract. Mouth. — It has the character- 
istic alkaline taste of the hydrates and carbonates. In very 
weak solution it simply causes a reflex flow of saliva. In more 
concentrated form it dissolves the mucous secretions and the 
superficial layers of the lining membrane, the irritation chang- 
ing to a bright red the lips, tongue and general surface of the 
oral cavity, which feel soapy to the touch. Still stronger solu- 
tions have, as on the skin, a powerful escharotic effect, which 
extends to the throat and oesophagus, and may either prove 
immediately fatal or give rise to subsequent cicatrization and 
stenosis. The accidental swallowing of caustic alkalies is prob- 






POTASSIUM. I55 

ably the most frequent cause of cicatricial stricture of the 
oesophagus. 

Stomach. — As in the oesophagus, concentrated solutions pro- 
duce an amount of corrosion sufficient to destroy life in a short 
time, or which may be followed subsequently by gastric ulcer or 
scar-formation. They may prove immediately fatal by causing 
perforation into the peritoneal cavity. Small quantities of the 
drug appear to be soon neutralized by the hydrochloric acid of 
the gastric juice, and act no longer from their alkalinity, but 
merely from their effects as a salt, if at all. Larger quantities 
render the contents of the stomach neutral or alkaline, diminish 
the activity of the pepsin, and tend to prevent gastric diges- 
tion. It has been demonstrated that the alkalies have no effect 
whatever on the activity of the secretory glands of the stomach, 
while, on the other hand, they may affect the juice already 
secreted by making it neutral, or even alkaline, and thus com- 
pletely interfere with its usefulness. In hyperacidity of the 
stomach, however, they may prove of benefit by lessening the 
amount of free acid present. 

Intestines. — It is thought to be absorbed in combination with 
proteids or as a carbonate, and disappears rapidly from both 
the stomach and small intestine. In the latter it is found to 
have an indirect effect, in consequence of its diminishing the 
acidity of the gastric juice. Hence the secretion of the pan- 
creas, which is normally stimulated by the acid fluid passing 
from the pylorus, is materially lessened. While, however, this 
again may render digestion less complete, the greater alkalinity 
of the intestinal contents no doubt tends to increase the effi- 
ciency of the pancreatic juice already secreted. Contrary to 
what was formerly believed, it has been conclusively shown that 
alkaline salts do not increase the secretion of bile, are not ex- 
creted in it, and do not cause any change in its reaction. It 
is therefore inferred that any effect which these may exert in 
affections of the liver are due to their effects in the duodenum. 
In therapeutic doses they apparently have no effect on intesti- 
nal putrefaction, but it is stated that very large quantities (15 



I56 PHARMACOLOGY AND THERAPEUTICS. 

gm. ; y 2 oz.) increase the putrefaction, in consequence prob- 
ably of their neutralizing the disinfectant gastric juice. 

Blood. — It is believed to exist in the blood chiefly as the car- 
bonate. The alkalinity of that fluid, like that of the body in 
general, is increased; but the organism rapidly frees itself from 
the excess of alkali by excreting alkaline salts. It is stated that 
the blood of rabbits treated with alkalies is more strongly ger- 
micidal than usual, and that under these circumstances the ani- 
mals show an increased resistance to infection with anthrax 
bacilli. 

Respiratory Passages. — The bronchial secretion appears to 
be increased in quantity and also rendered less viscid. Mucin 
is more soluble in alkaline media, so that the alkalies dissolve 
any accumulations of mucus or make them more fluid. 

Nervous System. — Among the effects, in addition to those 
of its corrosive action in the alimentary tract, which caustic 
potash causes from the destruction of the tissues with which 
it comes in contact, the reflex influence on the central nervous 
system is of great importance. In consequence of this, when 
the dose is large, shock may appear so rapidly and be of such 
violence as to completely overshadow the local symptoms, and 
death may occur from cardiac paralysis before these have had 
time to develop. 

Urine. — The secretion of urine is increased, partly in con- 
sequence of the salt-action and partly, apparently, as the re- 
sult of an irritant effect upon the renal epithelium. The abso- 
lute amount of all salts excreted is increased, although their 
percentage is naturally lessened. The urine is temporarily ren- 
dered less acid or even alkaline. It generally soon regains its 
acidity, but under the use of repeated doses of sufficient amount 
its reaction may be kept alkaline indefinitely. Excretion takes 
place chiefly by the urine. 

Metabolism. — In view of the fact that outside the body cer- 
tain substances undergo oxidation much sooner in alkaline solu- 
tion than when neutral, and also on account of the importance, 
as regards their functions, of the alkaline reaction of the tissues. 



POTASSIUM. 157 

it might be' expected that an increase in the alkalinity of the 
fluids of the body would have the effect of increasing oxida- 
tion and promoting the general metabolism. There is, how- 
ever, no direct evidence that this is the case, and it is now 
recognized that the alkalies have less influence upon tissue- 
change than was formerly believed. The change in reaction, it 
is pointed out, can only be very brief, and is apparently not 
marked enough, or not of such a nature, as to be capable of 
demonstration by methods at present available. According to 
the observation of the best authorities the excretion of urea 
is sometimes increased and sometimes diminished, the explana- 
tion of this probably being that the local action of the alkali 
on the alimentary tract sometimes causes an increased forma- 
tion and destruction of the white corpuscles of the blood, and 
thus increases the uric acid. Some of the most reliable ob- 
servers have found that very large doses decrease the amount 
of the latter in the urine, while smaller ones have no effect on 
it. As regards the oxidation in the tissues, it is concluded that 
the amount of tissue waste is but little affected by the increased 
alkalinity of the blood, and that the slight changes observed 
may vary not only in different species, but in different persons, 
and even in the same person at different times. The cause of 
this individual variation is attributed either to difference in the 
amount of acid formed in the tissues or to differences in the 
local effect of the alkalies in the alimentary tract. 

Therapeutics of Potassium Hydroxide. 
External. — Caustic potash was formerly employed to make 
issues. It is sometimes used in the destruction of lupus car- 
cinomatous growths, etc., but its effects are somewhat difficult 
to limit, and great care should be taken in its application. On 
account of the thorough and penetrating character of its eschar- 
otic action it is to be preferred when a very deep and decided 
influence is desired, as after the bite of a venomous snake or 
rabid dog. For cauterizing morbid or cicatricial tissue it is 
often best to employ it in the form of Potassa cum Calce, which 



I58 PHARMACOLOGY AND THERAPEUTICS. 

is milder in its operation and more manageable than pure 
potassa. In using it it is generally first reduced to a paste 
with a little alcohol, its action being limited laterally by means 
of adhesive plaster and in depth by the duration of the applica- 
tion. After the withdrawal of the caustic, diluted vinegar 
may be applied in order to neutralize any alkali that may remain, 
and this is sometimes followed by a poultice. It is often of ser- 
vice in phagedena. Caustic potash is employed after operations 
for the cure of fistula, for the purpose of preventing immediate 
union. It also proves a very satisfactory agent in the treat- 
ment of ingrowing toe-nail. The portion of nail to be removed 
is painted with a 40 per cent, solution of it, with the effect of 
rapidly softening its upper layer to such an extent that it can 
be readily scraped off. This procedure is repeated until the 
nail which remains is only a thin scale, which can be excised 
with fine scissors. Liquor Potassii Hydroxidi may be employed 
to dissolve oily secretions and thoroughly cleanse the skin before 
operations, and, diluted, is sometimes used to remove the epider- 
mis in some forms of chronic cutaneous disease. In like man- 
ner it softens callosities, such as corns and bunions, resulting 
from the effects of local pressure. In sufficiently weak solution 
its sedative influence tends to allay itching, and the following 
combination has been found efficient in pruritus: Solution of 
potassium hydroxide, 4; phenol, 4 to 8; flaxseed oil, 30. 

Internal. — Potash is not often used internally, except at 
times as an antacid for the relief of acid dyspepsia. It has 
been claimed that it is sometimes successful in reducing obesity, 
a result attributed to its stimulation of the processes of meta- 
bolism, with consequent increased oxidation of proteids and 
fats ; but it seems more probable that in cases of this kind it 
acts by slowly poisoning the patient, producing disorganization 
of the blood and interfering with nutrition. It has been used 
with good results in acne of the face, and is stated to be of 
service in both promoting and relieving strangury from can- 
tharides. Potash, however, is liable to cause gastric irritation, 
and hence to obtain the effects of alkalies upon internal organs 



POTASSIUM. 159 

potassium, bicarbonate, citrate and acetate are usually employed 
in preference to it. 

TOXICOLOGY. 
See Sodium Hydroxide. 

2. POTASSII CARBON AS.— Potassium Carbonate. (Salt of Tar- 
tar.) Dose, 1 gm.; 15 gr. 

3. POTASSII BICARBONAS.— Potassium Bicarbonate. Dose, 2 
gm.; 30 gr. 

Action of Potassium Carbonate. 
The action of potassium carbonate is essentially the same as 
that of potassium hydroxide, except that it is much less corro- 
sive. In solution it rarely induces actual lesions of the skin 
unless after very prolonged application. 

Therapeutics of Potassium Carbonate. 
In weak solution or as a paste it is sometimes used externally 
for the relief of itching in cutaneous diseases. It is also em- 
ployed in baths, where its irritant action on the skin is made 
use of to soften the epidermis and cause stimulation of extensive 
areas, as is often desirable in such affections as ichthyosis. 
For internal use potassium bicarbonate is almost invariably 
preferred, as the carbonates are too irritating to the stomach. 
It enters into the composition of the Pilulae Ferri Carbonatis. 

Action of Potassium Bicarbonate. 
The hydrates are much more powerful solvents than the car- 
bonates, and these than the bicarbonates. Hence potassium 
bicarbonate is but very feebly caustic. Otherwise its pharma- 
cological action is the same as that of the carbonate. 

Therapeutics of Potassium Bicarbonate. 

Stomach. — While it is always advisable to remove the cause, 

if possible, the alkalies often serve a very useful purpose in the 

treatment of dyspepsia. Sodium bicarbonate is much more 

generally relied upon to give relief, particularly in cases of 



l6o PHARMACOLOGY AND THERAPEUTICS. 

hyperacidity, than potassium bicarbonate. Where no excessive 
acidity exists, however, the latter is often preferred, and is 
commonly efficacious in relieving the distention and discomfort. 
It should be given in small doses and well diluted, so that it 
may not irritate the stomach. Alkalies are of great service 
when there is impaired digestion of fats, not only preventing 
the formation of butyric acid, but also assisting the emulsi- 
fication and absorption of the fats. In affections of the liver, 
and when from any cause the flow of bile into the intestine is 
interfered with, they are likewise useful in promoting the di- 
gestion and absorption of fats. In these conditions potassium 
bicarbonate is considered preferable to other alkaline remedies. 
Potash water may be used as a substitute for soda water. It 
is made by passing carbon dioxide gas, under a pressure of 
four atmospheres, into an aqueous solution of potassium bi- 
carbonate of the strength of half of one per cent. Potassium 
bicarbonate should not be employed as an alkali in cases of 
poisoning by mineral acids, on account of the evolution of 
carbon dioxide gas which is likely to result. 

Blood. — The absorption of both hydrates and carbonates leads 
to an increase in the alkalinity of the blood and tissues. Po- 
tassium bicarbonate and other alkalies have been used very 
extensively in the treatment of gout, rheumatism and the so- 
called uric acid diathesis generally. The explanation offered 
of their action in these conditions was that the increased oxi- 
dation caused by them results in the destruction of a larger 
amount of the uric acid, while, in addition, the latter, being 
neutralized in the tissues, is excreted more easily and has less 
tendency to be deposited. In the light of our present knowledge 
neither of these theories appears to be tenable. At the same 
time, there is abundant clinical evidence that the alkalies are 
of some value in gout and rheumatism, although in the treatment 
of the latter disease they have to a large extent fallen into dis- 
use since the introduction of the salicylates. It must be con- 
fessed, therefore, that their mode of action is not clearly under- 
stood, though there is some ground for the belief that these 



POTASSIUM. l6l 

agents may influence the formation, rather than the excretion, 
of uric acid. In acute rheumatism it has been shown that any 
influence exerted by the alkaline treatment in cutting short the 
disease, lowering temperature, and relieving pain, is in no 
way comparable to that of the salicylates, which as has been 
mentioned, have now to a great degree superseded alkalies in 
• the treatment of that affection. The opinion is still held by 
many experienced observers, however, that alkalies have a 
decided effect in preventing and relieving cardiac complications, 
and thus succeed, to some extent, it is claimed, where the sali- 
cylates fail. Hence it is the practice of some to associate the 
latter with alkalies. In acute rheumatism potassium bicarbon- 
ate may be given in doses of 1.20 to 2.40 gm. (20 to 40 gr.) 
every two to four hours, or 15 gm. (y 2 oz.), or more, may be 
dissolved in barley water, and administered as a drink during 
the twenty-four hours. As the remedy is very distasteful to 
most persons, it may be given in effervescence with lemon- juice, 
or with citric acid solution. An equal quantity of potassium 
citrate is sometimes prescribed with the carbonate when given 
in this way. It has been found that the alkaline treatment, 
however well adapted it may be to plethoric and muscular 
individuals, is not usually suited to the delicate and anaemic. 

Other Uses. — Potassium bicarbonate is not infrequently used 
with benefit in jaundice and gall-stone. It probably has no 
direct effect on the bile, except perhaps in increasing its liquid- 
ity, but affords relief principally by lessening duodenal irrita- 
tion. In bronchitis, added to other expectorants, it serves to 
increase the secretion and render it less viscid and tenacious. 

4. POTASSII ACETAS.— Potassium Acetate. Dose, 2 gm.; 30 gr. 

5. POTASSII CITRAS.— Potassium Citrate. Dose, 1 gm.; 15 gr. 

Preparation. 
Liquor Potassii Citratis. — Solution of Potassium Citrate. 
Dose, 16 c.c; 4 fl. dr. 

6. POTASSII CITRAS EFFERVESCENS.— Effervescent Potas- 
sium Citrate. Dose, 4 gm.; 60 gr. 

12 



1 62 PHARMACOLOGY AND THERAPEUTICS. 

Acton of Potassium Citrate and Acetate. 

External. — Potassium citrate is a salt of neutral or very 
slightly acid reaction. The acetate is perfectly neutral, and 
neither of them has any external action. 

Internal. — They are the least irritating to the stomach of 
all the potassium salts, and, with the exception of the tartrates, 
the citrate is the least offensive to the palate. They have the 
advantage of not neutralizing the gastric juice, or in any way 
affecting the digestion except from their salt-action, which' 
may be minimized by administration in dilute solution. Being 
decomposed in the body, with the formation of carbonates, 
they exert an alkaline action after absorption, and this has 
the effect of increasing the alkalinity of the blood and of the 
urine, and of producing free diuresis. On account of its influ- 
ence on the urinary secretion the acetate was formerly known 
as sal diureticus. The citrate is not so readily absorbed as the 
acetate, and therefore tends to act on the bowels. It is not 
cathartic, however, except when given in large quantities. 
They both have some diaphoretic action, which is rather more 
marked in the case of the citrate. Potassium acetate, like 
other acetates, is technically a food, as its oxidation supplies 
energy to the body. Since the acetates, however do not lessen 
the nitrogenous tissue-change, they are incapable of replacing 
the fats and carbohydrates, and as they derange the stomach 
in the same way as common salt and also alter the character 
and amount of the urine, they are found to be practically 
useless as foods. 

Therapeutics of Potassium Citrate and Acetate. 
Blood. — Both these salts are largely -employed in gouty con- 
ditions, and were formerly much used also in the alkaline 
treatment of acute rheumatism. The citrate dissolved in an 
excess of lemon juice affords the most agreeable method of 
securing the influence of an alkaline potassium salt upon the 
system. They have some antiscorbutic effect, but are not so 
efficient in the prevention and treatment of scurvy as lemon- 
juice, lime-juice, and fresh vegetables. 



POTASSIUM. 163 

Kidneys. — They are constantly used for their diuretic effect 
in feverishness, scarlatinal dropsy, chronic renal disease, gen- 
eral dropsy from valvular disease of the heart, and other con- 
ditions. Alkaline diuretics are of very little value, however, in 
dropsical accumulations in the various cavities, The best effects 
are usually obtained from a combination of diuretic remedies, 
and the following mixture will be found serviceable : Potassium 
acetate, 1.20 gm. (20 gr.) ; tincture of squill, .60 c.c. (10 HI) ; 
'spirit of nitrous ether, 2.00 c.c. (30 HI) ; juice of broom, 4.00 
c.c. (1 fl. dr.) ; water, to 30.00 c.c. (1 fl. oz.). Juice of broom, 
B. P., is obtained by bruising fresh broom tops, expressing the 
juice, adding one-third part of alcohol, and filtering after seven 
days. In irritation of the urinary organs resulting from an 
excess of acid and in inflammatory conditions of the passages, 
in which the acid urine acts as an irritant, they are of great 
service by rendering the urine alkaline, and they possess the 
advantage over other potassium salts of not affecting the 
stomach or interfering with digestion. In such conditions the 
Liquor Potassii Citratis is highly esteemed. It was long the 
opinion, and is still held by many, that the continued use of 
these salts will effect the solution of renal calculi, which are 
usually composed principally of uric acid. It has been shown, 
however, that the alkaline treatment is incapable of removing 
calculus either in the bladder or kidney. While outside the 
body free alkalies and their carbonates dissolve uric acid quite 
readily, it is found that the solution of the alkalies formed in 
the urine is extremely dilute, the reaction, except under large 
doses, being in fact not even constantly neutral. On the other 
hand, it is pointed out, even the alkaline urates are by no means 
very soluble bodies, and are formed only with difficulty except 
in strong alkaline solutions. Some authorities contend that the 
alkalies, not being excreted as such, nor as carbonates, can- 
not convert free uric acid into soluble alkaline urates, but at 
most into acid urates, which are almost as insoluble as uric 
acid itself. Hence, it would be absolutely impossible to effect 
in this wav the solution of even verv small calculi. The fact 



164 PHARMACOLOGY AND THERAPEUTICS. 

that in certain instances alkaline treatment has been observed 
to cause the breaking up of large stones into small fragments 
is explained on the hypothesis that the calculi were composed 
originally of small fragments glued together by mucus, and 
that the alkali caused the solution of the latter. Furthermore, 
it is claimed that the alkalies are to some extent objectionable 
in vesical calculus, inasmuch as alkaline urine is liable to de- 
posit phosphates in the bladder, and thus rather to increase the 
size of the stone than to diminish it. Still, there can be no 
question that in any of the forms of irritation of the urinary 
passages (from gravel, stone, cystitis, stricture, enlarged pros- 
tate, etc.), such agents as potassium citrate and acetate afford 
great relief whenever the urine is acid in reaction. There is 
also high authority for the opinion that they are of utility in 
the prevention of uric acid gravel, it. being held that the most 
potent factor in determining the precipitation of free crystal- 
line uric acid in the urinary passages is a high degree of 
acidity in the urine; so that if the latter be rendered alkaline, 
or only faintly acid, no such precipitation can occur. In the 
daytime the alkaline tide following the ingestion of meals will 
usually keep the urine from attaining an acidity sufficient for 
the precipitation to occur, but during the fasting hours of the 
night the opportunity for this is afforded. Hence, it is ad- 
vised that a moderately large dose of an alkali, such as 2.50 
to 4.00 gm. (40 to 60 gr.) of potassium citrate should be taken at 
bedtime. In case this is not sufficient to prevent the hyper- 
acidity during all the hours of sleep, a second dose should be 
taken in the course of the night, while in exceptional instances 
the tendency to uric acid precipitation may be so great as to 
require the use of the remedy in the daytime also. This pre- 
ventive treatment, it can readily be seen, may be materially 
aided by a judicious arrangement of the meals, so as to avoid 
unnecessarily prolonged periods of fasting. 

Skin. — In feverish conditions, such as frequently result from 
an ordinary cold, they are of service on account of their diapho- 
retic as well as their diuretic action. 



POTASSIUM. 165 

Respiratory Passages. — Like potassium bicarbonate, they are 
of considerable utility in bronchitis, assisting the action of 
other expectorants by increasing the secretion and by render- 
ing it more fluid and more easily expectorated. 

7. POTASSII SULPHAS.— Potassium Sulphate. Dose, 2 gm.; 30 
gr. 

8. POTASSII BITARTItAS.— Potassium Bitartrate. (Acid Potas- 
sium Tartrate. Cream of Tartar.) Dose (diuretic), 2 gm.; 30 gr. 

Action of Potassium Bitartrate and Sulphate. 

External. — The aqueous solution of potassium bitartrate has 
an acid reaction on litmus paper, but it is only slightly acid, 
while the sulphate is neutral. Neither has any external action. 

Internal. Intestines. — They are hydragogue saline cathartics, 
drawing fluid from the blood and tissues into the intestine, and 
consequently rendering the blood more concentrated than usual. 
This leads to a sensation of thirst and to a lessened excretion 
of fluid by the kidneys and other glands. They produce rather 
profuse watery stools, with practically no irritation or griping. 
To the sulphate, however, the last statement applies only when 
it is given in comparatively small doses (.60 to 2.40 gm. ; 10 to 
40 gr.) and freely diluted. In large doses and when insuffi- 
ciently diluted it is a powerful irritant, and from 45 to 60 gm. 
(13^2 to 2 oz.) has been known to cause fatal gastro-enteritis, 
while 15 gm. (4 dr.), if not properly diluted, may give rise to 
grave symptoms. In France it is stated to be used as a popu- 
lar abortifacient ; the ecbolic effect being secondary to the in- 
flammation produced in the alimentary canal. 

Liver. — Potassium sulphate has been supposed to have some 
action in increasing the biliary secretion, but, as in the case of 
other saline purgatives regarded as cholagogues, this has now 
been shown to be incorrect. 

Kidneys. — The bitartrate, which is but slowly absorbed, is to 
a large extent excreted unchanged in the urine and faeces. 
That portion which is absorbed is converted into carbonate, 
which has a decided diuretic effect and also tends to render the 



1 66 PHARMACOLOGY AND THERAPEUTICS. 

urine alkaline. All the Sulphate is believed to be excreted un- 
changed; consequently, it has no remote effects. 

Therapeutics of Potassium Sulphate and Bitartrate. 

G astro-Intestinal Tract. — Potassium sulphate, while used to 
some extent in Europe, is rarely ever prescribed in this coun- 
try; magnesium and sodium sulphates being much preferred 
to it. The bitartrate is frequently employed as a cooling 
aperient, and for this purpose a dose of it (2 to 8 gm. ; y 2 to 
'2 dr.) may be dissolved in a glass of hot water, and sipped 
during dressing in the morning. Its use should not be con- 
tinued regularly too long, however, as it is liable to impair 
nutrition. In doses of 15 to 30 gm. (y 2 to 1 oz.) it is a valuable 
hydragogue cathartic, particularly in dropsy and uraemia. It 
is often combined with senna, magnesia or sulphur, or with 
jalap, as in compound jalap powder. With sulphur or with 
confection of senna it constitutes a convenient laxative when 
haemorrhoids are present. With magnesia it is sometimes pre- 
scribed in habitual vomiting arising from gastric acidity and 
also in the vomiting of pregnancy. 

Kidneys. — The bitartrate is highly esteemed as a diuretic, 
and 30 gm. (1 oz.) in 500 c.c. (1 pint) of infusion of juniper- 
berries, taken in divided doses during the twenty-four hours, 
is often very serviceable in dropsy. This is too irritating to 
the kidneys, however, to be used in acute desquamative nephritis. 
Cream of tartar whey is made by dissolving about 8 gm. (2 dr.) 
of the bitartrate in 500 c.c. (1 pint) of milk. The beverage 
known as "imperial" (potus imperialis) may be used with ad- 
vantage in some febrile affections. It consists of potassium 
bitartrate, 4 gm. (1 dr.); saccharin, .06 gm. (1 gr.) ; oil of 
lemon, .20 c.c. (3 Ttl) ; to 500 c.c. (1 pint) boiling water. The 
bitartrate is also conveniently given in ordinary lemonade, the 
salt being dissolved in hot water and the solution allowed to 
cool before the lemons are added to it. Compound jalap powder 
is rendered more efficient, both as a diuretic and a purgative 
by the addition of .60 gm. (10 gr.) of potassium bitartrate to 
each dose. 



POTASSIUM. 167 

Liver. — In hepatic cirrhosis,, whether due to alcoholism or 
other causes, as well as in chronic peritonitis, good results are 
said to be sometimes obtained from potassium bitartrate. Both 
the bitartrate and the sulphate have been used in gall-stone 
disease. 

9. POTASSII NITRAS.— Potassium Nitrate. (Xitre. Saltpetre.) 
Dose, 0.500 gm. (500 milligm.) ; 7 l / 2 gr. 

Action of Potassium Nitrate. 

External. — It has no action on the unabraded skin, but is 
irritant to mucous membranes and raw surfaces. 

Internal. — Gastro-Intestinal Tract. — In small doses it is un- 
irritating. In large quantities it is a decided gastro-intestinal 
irritant, producing nausea, vomiting, intense burning pain in 
the stomach, and sometimes purging. In some instances blood 
is present in the matters vomited and in the stools. After death 
there is found congestion of the stomach and intestines, and 
there may be extravasations of blood. Even ulceration and cor- 
rosion of the mucous membrane have been observed. When 
it is very freely diluted, however, the local irritant action of 
the drug is in great measure prevented, and very considerable 
quantities may be taken without serious results. 

Blood. — External to the body, nitrates have the effect of 
preventing the coagulation of the blood and of dissolving 
clots already formed. In the body they are said to have some 
influence on the red blood-corpuscles, which become crenated; 
but it is thought that this is probably merely the salt-action, 
and not any specific nitrate effect. By reason of its high 
diffusion power potassium nitrate rapidly passes into the blood 
unchanged. 

Heart. — It is so violently irritant that the local symptoms 
produced by toxic quantities are apt to overshadow the effects 
on the system of its potassium ion. The latter, however, is 
depressant to the heart, weakening its movements and finally 
arresting them. 

Nervous System and Muscles. — Sometimes the nervous symp- 



1 68 PHARMACOLOGY AND THERAPEUTICS. 

toms predominate, and the collapse caused by the drug may 
be accompanied with paralysis of the lower extremities. It 
tends to exert a paralyzing- influence upon the spinal cord, 
and produces great muscular weakness and reduction of reflex 
sensibility. It also tends to paralyze unstriped muscular fibre. 

Respiration. — Large doses retard the respiration. 

Skin. — It has a slight diaphoretic effect. 

Kidneys. — In moderate amounts it has considerable diuretic 
influence, which is believed to be due in part to the salt-action 
and partly to a true stimulation of the kidney, such as is ex- 
erted by many other intestinal irritants. Large quantities 
tend to produce renal inflammation and hematuria, and in some 
cases of poisoning the kidney is recorded to have presented 
the lesions of acute nephritis, and also haemorrhages. 

Elimination. — Some of the nitrate given by the mouth is 
usually found unchanged in the urine, but the greater portion 
disappears in the tissues. Its fate in the body is not certainly 
known, but it is supposed that it is reduced first to the nitrite, 
and then to ammonia, or that it is eventually excreted by the 
lungs as free nitrogen. Some of the nitrate is apparently 
excreted in the saliva and perspiration; it may be unchanged, 
although it is said to be rapidly reduced to nitrite in these 
secretions, and may in fact be changed to this form in the 
secretory cells. 

Therapeutics of Potassium Nitrate. 
It was formerly used to a large extent in febrile diseases, 
and especially acute rheumatism. At the present time, however, 
its internal administration for any purpose has been in great 
measure abandoned. It is stated, however, to be sometimes of 
value in the treatment of haemorrhage, more particularly haemop- 
tysis accompanied with febrile movement, and to have been 
given with advantage in purpura simplex (in 60 gm. ; 10 gr. 
doses) and purpura haemorrhagica (in doses of from .60 to 4 
gm. ; 10 to 60 gr.). As a diuretic it has been almost entirely 
superseded by the citrate and acetate, but is still used by some 



POTASSIUM. 169 

as an ingredient of diuretic mixtures, with digitalis and other 
drugs. When given internally it is recommended that it should 
be carbonated in order that its absorption may be accelerated 
and the gastric irritation proportionately lessened. A small 
amount (.12 gm. ; 2 gr.) in a glass of sweetened water will, 
it is said, relieve the hoarseness to which speakers and singers 
are liable. By reason of its influence on the respiration and 
on unstriped muscular fibre, potassium nitrate acts as an anti- 
spasmodic, and the one great purpose for which it is now em- 
ployed is the relief of the symptom asthma. For the treat- 
ment of this, linen or blotting paper, dipped in a saturated 
solution of nitre and then dried, is burned, and the patient 
inhales the fumes. It is advised by some that the paper should 
be also dipped in a solution of potassium chlorate. The fumes 
may be diffused generally in the room, or if a more concentrated 
effect is desired the paper may be burned under a funnel, from 
the mouth of which the patient inspires. The nitrate is a com- 
mon ingredient of so-called asthma powders, and is also some- 
times used in the form of cigarettes. Powdered nitre, moistened 
with water and applied to the face night and morning, is useful 
for removing freckles. 

10. POTASSII CHLORAS.— Potassium Chlorate. Dose, 0.250 gm. 
(250 milligm.) ; 4 gr. 

Preparation. 
Trochisci Potassii Chloratis. — Troches of Potassium Chlorate. 

Action of Potassium Chlorate. 

External. — Locally it is disinfectant and stimulant to mucous 
membranes. It is easily decomposed by septic tissues, and the 
nascent oxygen given off acts as a stimulant and antiseptic to 
them. 

Internal. Stomach and Intestines. — Small doses have no 
effect. Sometimes the only effect in the alimentary canal of 
large doses is to cause some nausea and vomiting. In other 
instances the irritation caused by it is sufficient to excite gastro- 
enteritis. The first symptom is often prolonged and violent 



170 PHARMACOLOGY AND THERAPEUTICS. 

vomiting. There is severe gastric pain, and this may be fol- 
lowed by profuse diarrhoea. In subacute poisoning vomiting 
and diarrhoea are also observed, and the matter vomited usually 
contains bile, and sometimes blood. The nausea and vomiting 
are believed to be principally due to the local salt-action of the 
drug, but that this is not their only cause seems to be shown 
by the fact that vomiting has been observed in animals in 
which the chlorate was injected subcutaneously. After death 
swelling and ecchymosis of the mucous membrane of the 
stomach and intestines have been found. 

Blood. — When added to blood, either outside or in the body, 
it causes the formation of methaemoglobin from the conversion 
of haemoglobin ; so that its administration in toxic quantity may 
produce an actual asphyxia. It also has the effect of subse- 
quently causing the destruction of the red blood-cells, with re- 
sulting liberation of proteids. In the most acute form of in- 
toxication death is due chiefly to asphyxia caused by the 
reduction of a large amount of haemoglobin, but if the quantity 
of methaemoglobin thus formed is smaller, it is found that the 
latter gradually disappears. Hence, in the subacute form of 
poisoning sufficient haemoglobin remains untransformed to con- 
tinue the respiration of the tissues. When cases of this kind 
terminate fatally some of the red corpuscles are found altered 
in shape, others are colorless, and in some the pigment, in- 
stead of being generally diffused, is aggregated in masses. No 
methaemoglobin may be discovered, but the debris of the cor- 
puscles can be found in the liver, spleen, bone-marrow and 
renal tubules. In acute poisoning the color of the blood is very 
dark and the methaemoglobin absorption band is found present 
in the spectrum. 

Heart and other Organs. — Toxic doses are likely to cause 
great failure of the heart's action, excessive dyspnoea, and 
marked cyanosis of the surface. Increase in the amount of 
bile pigment results from the excessive destruction of red blood- 
corpuscles, and the absorption of the pigment from the bile 
capillaries may cause jaundice. After death both the liver and 



POTASSIUM. I/I 

spleen have been found enlarged, from the deposition of the 
debris in them. 

Nervous System. — Among the nervous symptoms noted are 
headache, delirium, tonic and clonic spasms, coma, and a 
peculiar stiffness of the extremities. These are believed to be 
due, not to any specific effect upon the central nervous system, 
apart from the salt-action of the chlorates, but to the blood 
changes caused by the drug and to the uraemia resulting from 
its effects in the kidneys. The course of the poisoning may be 
very rapid, death having been known to be caused in two and 
a half hours; but usually it does not occur for several days. 
The fatal result may be due either to asphyxia, to collapse from 
cardiac weakness, or to uraemia. Death from uraemic symptoms 
may follow as late as a week after the appearance of the first 
signs of poisoning, while in several instances complete re- 
covery has occurred where the most severe effects had been 
caused. A rare effect of potassium chlorate is the production 
on the skin of an erythematous, vesicular or papular eruption. 

Kidneys. — The effects of potassium chlorate in the kidneys 
are of great interest. In the subacute form of poisoning the 
products of the destruction of the red blood-corpuscles are ex- 
creted in the urine, and in consequence the renal tubules be- 
come stopped up with brown granular masses. These are found 
to be in part forced downwards and to appear in the urine as 
casts, but may produce an almost complete suppression of urine 
and the consequent symptoms of uraemia. Probably as the re- 
sult of the plugging of the tubules, the epithelial cells may per- 
haps become inflamed, but often, it is stated, no actual nephritis 
is present. The opinion formerly held that the chlorate be- 
comes reduced and yields its oxygen in the system has been 
shown to be entirely incorrect. It passes unchanged through 
the body, being principally excreted in the urine, from which 
90 to 96 per cent, of the amount given by the mouth has been 
recovered. It is also excreted in small quantities in the per- 
spiration, saliva, tears, and probably all the other secretions, 
and is stated to pass from the mother to the foetus in utero. 



172 PHARMACOLOGY AND THERAPEUTICS. 

While the secondary effect of potassium chlorate may tend to 
produce suppression of the urine, through the results in the 
kidneys of its destructive influence on the red blood cells, the 
absorption of concentrated solutions is often shortly followed 
by considerable diuresis, from an action upon the kidney similar 
to the local salt-action in the stomach which induces nausea 
and vomiting. 

Therapeutics of Potassium Chlorate. 
In the case of no drug has a greater change of opinion taken 
place than as regards potassium chlorate. Under the supposi- 
tion that it yielded its oxygen to the blood it was for many 
years extensively used in adynamic fevers and in diphtheria 
and other diseases attributed to blood-poisoning. Its internal 
use, however, is now regarded as of little value, and may cause 
toxic symptoms ; but locally it has distinctly curative effects 
upon mucous membrane in such conditions as catarrhal in- 
flammation of the mouth and fauces, aphthous, ulcerative and 
mercurial stomatitis, and thrush, or nursing sore-mouth, as 
well as in acute tonsilitis. Its local action is not clearly under- 
stood. It has been suggested that it is an oxidizing disinfectant, 
but there appears to be no ground for supposing that it is 
changed here any more than in the tissues in general. It may 
be applied in the form of a wash or gargle, and is sometimes 
associated with other agents. In young children solutions of 
it are used with glycerin, honey or syrup to wash out the mouth. 
Of course, it is essential to the success of the treatment that 
the general condition of the patient should also be carefully 
looked after. It is sometimes given internally in solution, or 
in the form of lozenges, with the idea of obtaining its local 
effect while being swallowed and a subsequent similar effect 
from its excretion in the saliva. If it has no beneficial systemic 
action it would seem preferable to depend entirely on its local 
application, which can be repeated as often as the circumstances 
require, and thus avoid the possibility of poisoning the patient. 
On account of this danger the use of potassium chlorate lozenges 
is condemned by some authorities. If the salt is employed 



POTASSIUM. 173 

internally it should always be administered with great caution, 
and pains should be taken to avoid giving it on an empty 
stomach. In diphtheria it has been thought especially effective 
in combination with tincture of ferric chloride and hydrochloric 
acid, in which, in addition to the local influence of the chlorate 
and the tonic effect of the iron, the action of free chlorine, gen- 
erated in the mixture, is obtained. It should not be exhibited 
in full doses, however, on account of the depressing effects 
upon the heart, as well as the danger of renal trouble. A tea- 
spoonful of the following may be given undiluted every two 
hours: To 4 gm. (1 dr.) of powdered potassium chlorate, mixed 
with 6 c.c. (iy 2 fl. dr.) of hydrochloric acid, are added 8 c.c. 
(2 fl. dr.) of tincture of ferric chloride and enough water to 
make 120 c.c. (4 fl. oz.). In order to render it less disagreeable 
to the taste a considerable proportion of the water may be sub- 
stituted by glycerin or a syrup such as that of blood orange. 
Diluted, this mixture makes an excellent gargle. Solutions 
of potassium chlorate which may be combined with a few drops 
of laudanum to secure retention, injected into the rectum at 
bed-time, are said to be of great service in haemorrhoids, and 
large enemata composed of them are sometimes employed in 
chronic dysentery and other diseases of the lower bowel. A 
solution in glycerin (one part to ten) has been highly com- 
mended as a dressing for ill-conditioned wounds and ulcers. 

TOXICOLOGY. 
As potassium chlorate is very largely used as a domestic remedy and 
is not regarded by the laity as a toxic agent, accidental poisoning from 
it is not unlikely to occur. The injurious effects of the drug have al- 
ready been sufficiently described. In the treatment the stomach should 
be promptly evacuated if there is reason to suppose that any of the salt 
still remains in it. Demulcents such as white of egg, milk, flaxseed tea, 
or mucilage of acacia may be used, and ice given to control the vomit- 
ing. Each case should be treated according to the special symptoms 
met with. Cardiac stimulants or stimulants to the central nervous sys- 
tem may be called for. As the destructive action of the chlorate upon 
the blood is believed to be less liable to occur when the latter is more 



174 PHARMACOLOGY AND THERAPEUTICS. 

alkaline than usual, the alkaline carbonates should generally be given in 
the hope of preventing or checking these effects. After the acute symp- 
toms have passed off the administration of diuretics and large quantities 
of fluid is recommended for the purpose of washing out the kidneys and 
preventing the accumulation of detritus in the tubules. 

SODIUM. 

1. SODII HYDROXIDUM (Soda, U. S. P., 1890).— Sodium Hy- 
droxide. (Caustic Soda. Sodium Hydrate.) 

Preparation. 
Liquor Sodii Hydroxidi (Liquor Sodae, U. S. P., 1890). — 
Solution of Sodium Hydroxide. (Solution of Soda.) Dose, 1 
C.C.; 15 TTt. 

Action of Sodium Hydroxide. 
Its action is practically the same as that of potash. The 
principal difference between the effects of the sodium and 
potassium salts, when given in large amount, is the depressant 
influence of the latter upon the cardiac, muscular and nervous 
systems. It must be borne in mind, however, that soda and 
the sodium carbonates, like the potassium hydrate and carbon- 
ates, depend chiefly for their activity on their alkalinity, and not 
on their metallic constituent. It is their hydroxyl ion which 
induces the alkaline reaction of the solutions and determines 
their physiological effects. 

Therapeutics of Sodium Hydroxide. 
It is very little used. Potash is almost always preferred. 

TOXICOLOGY. 

Poisoning by caustic alkalies is not very commonly met with. In 
addition to potash and soda, it may be caused by the impure potassium 
carbonate (pearlash) or sodium carbonate (soap lees), which contain 
these alkalies. The carbonates, however, are much less corrosive than 
the hydrates. 

Symptoms. — The symptoms are those of a violent corrosive poison: 
burning heat in the throat and stomach, intense thirst, salivation, vom- 
iting of blood-stained matter, agonizing abdominal pain accompanied 



SODIUM. 175 

with diarrhoea, feeble pulse, cold, clammy skin, and general collapse. 
The lips, mouth, tongue and throat become swollen and assume a bright 
red color. The larynx is apt to be involved in the corrosive action, and 
oedema of the larynx may cause death in a very brief time. If the 
patient should survive the immediate effects of the poison he is very 
likely to suffer from more or less extensive ulceration or cicatrization 
of the mucous membrane of the throat, oesophagus or stomach, which 
may subsequently prove fatal. In very exceptional instances the local 
action may be comparatively slight, and the principal effect of the poison 
expend itself upon the nervous system, with the result of producing 
muscular weakness, paralysis of the lower extremities, weak cardiac 
action, and coma : and, as has been stated, very large doses cause death 
suddenly, through paralysis of the heart, before the local inflammation 
has had time to develop. 

Post-mortem Appearances.* — The mucous membrane, wherever the 
caustic has come in contact with it, is dark-colored, inflamed and cov- 
ered with a grayish membrane. The sloughs may be very extensive and 
deep, and there may even be complete destruction of a portion of the 
stomach wall. In the event of the patient's having survived long enough 
for such sequel to occur, there will naturally be found evidences of peri- 
tonitis resulting from this lesion. In the oesophagus the points espe- 
cially affected will generally be found at its two ends and at the place 
where it crosses the left bronchus, and in the stomach, at the pylorus. 

Treatment. — The stomach should be evacuated as promptly as pos- 
sible, but it is not safe to use the stomach-pump for this purpose, as 
the tube is liable to perforate the corroded wall of the oesophagus or 
stomach. Any one of the following emetics may be resorted to : Apo- 
morphine hydrochloride, .006 gm. ( T L gr.), by subcutaneous injection; 
zinc sulphate, 1.20 gm. (20 gr.), or copper sulphate, .30 gm. (5 gr.), 
in 250 c.c. {y 2 pint) of tepid water; powdered ipecacuanha, 2.00 gm. 
(30 gr.) or wine or syrup of ipecacuanha, 30 c.c. (1 fl. oz.). The prep- 
arations of ipecacuanha should not be employed if other emetics are 
available, as this drug, which produces vomiting chiefly by its influence 
on the medulla oblongata, is not sufficiently prompt in its action. If 
none of these agents is quickly attainable, domestic remedies such as 
mustard, 16 gm. (1 tablespoonful) or common salt, 30 gm. (2 table- 
spoonfuls), may be administered in 250 c.c. (y 2 pint) of tepid water. 
At all events, plenty of lukewarm water should be given, and vomiting 
promoted by tickling the fauces. As soon as the stomach has been 
emptied some form of dilute acid should be employed. The organic 
acids — acetic, citric or tartaric — are the best, and vinegar is almost 



I76 PHARMACOLOGY AND THERAPEUTICS. 

always within easy reach. In place of it, lemon juice, acetic acid, or 
solution of citric acid (all of which should be well diluted with water) 
may be used. Demulcents such as white of egg, olive oil, or flaxseed 
tea are of service, and measures to counteract shock, heart-failure, and 
collapse, such as the application of warmth, the exhibition of stimulants, 
etc., are also generally called for. 

2. SODII CARBONAS MONOHYDRAS.— Monohydrated Sodium 
Carbonate. Dose, 0.250 gm. (250 milligm.) ; 1 gr. 

Unofficial Preparation. 
Sodii Carbonas Exsiccatus (U. S. P., 1890).— Dried Sodium 
Carbonate. Dose, .30 to 1.00 gm.; 5 to 15 gr. 

Action of Sodium Carbonate and the Dried Carbonate. 
As in the case of potassium, the carbonate is much less cor- 
rosive than the hydrate. With this exception, the action is 
the same as that of soda. Sodium carbonate is, however, 
decidedly more irritating than the bicarbonate. 

Therapeutics of Sodium Carbonate and the Dried Car- 
bonate. 
A one per cent, solution of sodium carbonate is used for 
boiling surgical instruments in the process of sterilization, in 
order to prevent their rusting. The carbonate is also employed 
externally to some extent in the treatment of skin diseases in 
which the eruption is of a dry character, as lichen, prurigo, 
ichthyosis, psoriasis and pityriasis, and especially in the form 
of baths. From 125 to 450 gm. (4 to 16 oz.) is dissolved in a 
sufficient quantity of tepid water, and it is advised that each 
bath should be at least an hour in duration. It has the effect 
of stimulating the affected portions of the skin, and at the 
same time of removing sebaceous and acid secretions. If, how- 
ever, there is already an irritable condition present, but a 
small quantity of the alkali should be used, and mucilage or 
bran may be added to the water to render the bath more 
bland. This treatment is generally unsuitable for vesicular 
and pustular eruptions, but may occasionally prove of service 



SODIUM. 177 

iii them if the solution is made very weak. Lotions containing 
sodium carbonate have been used in certain local eruptions, 
especially those of the scalp, and also in pruritus vulvae. The 
salt is rarely employed internally except as it occurs in alka- 
line mineral waters. As an antidote to acids in corrosive poison- 
ing, however, it is regarded as preferable to the bicarbonate, 
for the reason that less carbon dioxide is formed. 

3. SODII BICARBONAS.— Sodium Bicarbonate. (Baking Soda. 
Soda.) Dose, 1 gm.; 15 gr. 

Preparation. 
Trochisci Sodii Bicarbonatis. — Troches of Sodium Bicar- 
bonate. 

Action of Sodium Bicarbonate. 
As regards general alkaline properties the action of sodium bi- 
carbonate is the same as that of potassium bicarbonate, but it 
differs from it in being less rapidly absorbed from the alimentary 
canal. It is much more grateful to the stomach than either 
sodium or potassium carbonate. 

Therapeutics of Sodium Bicarbonate. 

External. — Either in saturated solution or as a fine powder 
sodium bicarbonate, locally applied, is the best remedy to relieve 
the pain from burns. Of late it has been strongly recommended 
to be used for packing to prevent pain after operations upon 
the vagina. To relieve itching a lotion of .50 gm. (7 gr.) to 
30 c.c. (1 fl. oz.) may be employed, and a saturated solution 
has been found an efficient cure in poisoning by Rhus toxi- 
codendron. Applied in powder to the tonsils in the initial 
stage of acute tonsilitis, it is claimed that it will often prevent 
the further development of the disease. 

Internal. — In dyspeptic conditions, and especially hyperacidity 

of the stomach, it is much more commonly used than any other 

alkali. Among the symptoms for the relief of which it may be 

employed are heartburn, sour eructations, aphthae, oesophageal 

13 



I78 PHARMACOLOGY AND THERAPEUTICS. 

spasm, cramp in the stomach, colic, and irregular diarrhoea. In 
cases of hyperacidity it is given after meals, often affording 
immediate relief, and, like other alkaline preparations, it should 
be always well diluted in order to avoid undue irritation. 
When the secretion does not seem to contain an excessive 
amount of acid it is sometimes prescribed before meals, and 
it may then be combined with other stomachics, such as bitters 
or volatile oils. Dilute solutions of the alkalies act as mild 
irritants to the stomach wall, and thus, it is thought, improve 
its circulation, and lessen pain, eructation and distention in 
the same way as other slight gastric irritants, such as the 
volatile oils, while in the case of the carbonates and bicarbonates 
this carminative action is strengthened by the carbon dioxide 
liberated by the hydrochloric acid. Furthermore, by their mild 
irritant action they increase mucus-secretion, and as they also 
have the effect of liquefying tenacious mucus, they serve to 
improve the condition of the stomach. If there is hyperacidity 
in the intestine, rather than the stomach, sodium bicarbonate is 
not suitable, because it is likely to be neutralized or absorbed 
before reaching the seat of trouble. In this case the insoluble 
alkaline earths or their carbonates should be advised. While 
the immediate result of potassium bicarbonate in hyperacidity 
of the stomach is highly beneficial, the after-effect is to in- 
crease the production of acid; so that those who habitually use 
the remedy for acid indigestion are extremely apt to suffer 
severely from acidity. It is very serviceable in the acid diar- 
rhoea of infants and young children, where it is often given 
combined with demulcents or with the aromatic syrup of rhu- 
barb. An important application of the salt is as an emetic in 
narcotic stupor when other emetics fail to act. From 2 to 4 
gm. (30 to 60 gr.) in solution in water is given to the patient 
(by means of the stomach tube if necessary), and this is fol- 
lowed by a similar quantity of tartaric acid. Brisk effervescence 
results, and the contents of the stomach are evacuated. The 
same expedient has been successfully tried in intussusception, in 
this case the two drugs being successively injected mto the 



SODIUM. 179 

rectum. Strong pressure being made on the anus to prevent 
its escape, the gas generated urges its way upward and forces 
the invaginated gut back to its normal position. A stomach or 
bowel much softened by inflammation or weakened by ulceration 
would constitute a contraindication to this practice. Brilliant 
results have been reported from the use of sodium bicarbonate 
and carbonate in the treatment of diabetic coma, when given 
early enough and in sufficient amount. If the alkali is used 
in the early stages before coma sets in, it is advised that it 
should be given in quantities of about 40 gm. (10 dr.) a day, 
while if coma has already supervened the amount should be 
100 or 200 gm. (25 or 50 dr.). If catharsis occurs after these 
large doses, so much of the alkali may escape by the bowels 
that it may be impossible to secure the absorption of a sufficient 
quantity. In this event it should be given by intravenous in- 
jection of 0.3 per cent, solution of the crystallized salt, as 
hypodermatic injection is apt to cause sloughing. It is insisted 
on that the administration of the remedy should not be left 
until coma actually occurs, as it may then be too late, and it 
is recommended that the treatment should be instituted as soon 
as the urine gives the characteristic reaction of acetone with 
ferric chloride. In digestive troubles sodium bicarbonate is 
often combined with gentian, and a common gastric sedative 
mixture consists of .60 gm. (10 gr.) each of sodium bicarbonate 
and bismuth subcarbonate, suspended in mucilage. A useful 
stomach powder for children is composed of .06 or .12 gm. 
(1 or 2 gr.) of the bicarbonate and .06 gm. (1 gr.) of pulver- 
ized rhubarb, with a little sugar. Effervescing soda water may 
be made from sodium bicarbonate in the same way as potash 
water from potassium carbonate (see p. 160). In commerce 
these waters contain neither potash or soda, but the carbon 
dioxide has some effect as a carminative. 

4. SODII SULPHAS.— Sodium Sulphate. (Glauber's Salt.) Dose, 
16 gm.; 240 gr. 

5. SODII PHOSPHAS.— Sodium Phosphate. Dose, 2 gm.; 30 gr. 



l8o PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Sodii Phosphas Effervescens.— Effervescent Sodium Phos- 
phate. Dose, 8 gm.; 120 gr. 

2. Sodii Phosphas Exsiccatus. — Exsiccated Sodium Phos- 
phate. Dose, 1 gm.; 15 gr. 

3. Liquor Sodii Phosphatis Compositus.— Compound Solution 
of Sodium Phosphate. Dose, 8 C.C.; 2 fl. dr. 

6. POTASSII ET SODII TARTRAS.— Potassium and Sodium Tar- 
trate. (Rochelle Salt.) Dose, 8 gm.; 120 gr. 

Preparation. 
Pulvis Effervescens Compositus. — Compound Effervescing 
Powder. (Seidlitz Powder.) Dose, one set of two powders. 

Action of Sodium Sulphate and Phosphate, and of 
Potassium and Sodium Tartrate. 

Internal. Intestines. — These are typical saline cathartics, 
differing from vegetable cathartics in not causing irritation of 
the intestine, except when given in very large quantities. They 
owe their action, not to irritation, but to retarded absorption, 
and their characteristic effect is due to their acid constituent. 
Saline cathartics cause the abstraction of fluid from the blood 
and its accumulation in the intestine. The quantity of liquid 
accumulated depends upon the nature and amount of the salt 
and the strength of the solution employed, and it has been found 
that the maximum amount corresponds closely to the quantity 
required to form a 5 or 6 per cent, solution of the salt em- 
ployed. The liquid withdrawn from the blood is quickly re- 
placed by liquid abstracted from the tissues, but there is a 
secondary concentration of the blood later, resulting from the 
subsequent diuresis occasioned by the portion of the salt ab- 
sorbed. After the maximum of accumulation in the intestine 
is reached, the fluid is gradually absorbed, and a soft painless 
motion generally occurs within two or three hours after the 
administration of the drug. The sulphate is the most active 
of these sodium salt cathartics, and it forms an important con- 



SODIUM. l8l 

stituent of many well-known mineral waters. It is the chief 
ingredient of Carlsbad, Marienbad, Franzensbad, Tarasp, Villa- 
cabras and Rubinat Condal waters, and occurs in association 
with magnesium sulphate in Friedrichshall, Hunyadi Janos, 
Apenta, Seidlitz, Kissingen, Pullna, yEsculap and Franz Joseph 
waters. Both the sulphate and phosphate are mild cholagogues, 
and Carlsbad waters have been shown to increase the amount, 
as well as the solid constituents, of bile. 

Blood and Kidneys. — On account of the slowness of their 
absorption they have less influence than the corresponding 
salts of potassium in rendering the blood and urine alkaline 
and in causing diuresis. It is said, however, that the basic 
portion of sodium sulphate is excreted much more quickly than 
the acid, so that the urine may be rendered alkaline temporarily. 
It is also stated that the intravenous injection of this salt pro- 
duces a copious diuresis. 

Therapeutics of Sodium Sulphate and Phosphate, and of 
Potassium and Sodium Tartrate. 
On account of its extremely nauseous taste, the sulphate is 
rarely used in this country, except as it occurs in the various 
aperient mineral waters. The taste may be in some degree dis- 
guised by the addition of a few drops of aromatic sulphuric 
acid, or by giving it in lemonade. In dysentery good results 
have been obtained from it in daily quantities of 10 gm. (2^ 
dr.). Its use as an antidote in carbolic acid poisoning, which 
was at one time recommended, on the supposition that it forms 
sulphocarbolates, which are not so poisonous, has been shown 
to be quite without effect on the progress of the intoxication. 
This, it is believed, is due to the fact that phenol does not 
combine with sulphates, as such, in the body, but with or- 
ganic sulphur compounds which are only in process of being 
oxidized to sulphuric acid. Rochelle salt is employed to a very 
considerable extent as a mild saline purgative. Although 
much less efficient, it is far less disagreeable to take than 
either magnesium or sodium sulphate, and is especially accept- 



l82 PHARMACOLOGY AND THERAPEUTICS. 

able in Seidlitz powders (Pulvis Effervescens Compositus), 
which form an effervescing draught. In small repeated doses 
it does not purge, and serves to render the urine alkaline. 
The phosphate is not so powerful a cathartic as the sulphate, 
but is also less offensive to the palate, and is used more or less 
in the case of children. Both these salts are often of service 
in gall-stones, probably chiefly by improving the condition of 
the mucous membrane of the intestine. The phosphate is 
useful in various affections of the liver, and is thought of 
especial value in cirrhosis, if commenced early and persistently 
administered. The belief has been expressed that it has the 
power to retard the development of the changes taking place 
in this disease, and, possibly, under favorable circumstances, 
to arrest them and to restore a comparatively normal functional 
state. By correcting a catarrhal condition of the duodenum 
its persevering employment is often efficacious in the prevention 
of biliary calculus. This salt is also useful in catarrhal jaun- 
dice. It is stated to have seemed very beneficial in the hepatic 
form of diabetes, and that it is of great service, especially when 
combined with sodium arsenate, in obese subjects when a suc- 
cession of boils portends the development of diabetes. When 
dissolved in a proper amount of water the following powder 
constitutes a good imitation of Hunyadi Janos, iEsculap, Franz 
Joseph and other natural waters: 2 gm. (30 gr.) each of sodium 
sulphate and magnesium sulphate, and .06 gm. (1 gr.) each of 
sodium chloride and sodium bicarbonate; dose, 4 to 15 gm. 
(1 to 4 dr.). The combination of 60 gm. (2 oz.) of sodium 
phosphate, 15 gm. (4 dr.) of sodium sulphate, and 2 
gm. (30 gr.) of potassium iodide, taken m sufficient 
laxative doses and well diluted upon risin'g, is said to be 
very efficient in such cases as are benefited by Carlsbad 
waters. All such remedies are more active when used hot. 
There can be no question of the value of the Carlsbad treat- 
ment in many cases of cholelithiasis, gouty dyspepsia, catarrh 
of the stomach and intestines, obesity, and other conditions, 
but it is highly probable that the benefit derived from it is 



SODIUM. I83 

largely due to the change in habits and the restricted diet pre- 
scribed, as well as to the medicinal virtue of the waters. In 
administering all saline cathartics it' should be borne in mind 
that they produce their proper effect only when given in solu- 
tions of a certain degree of dilution. Often it appears that 
just in proportion to the dilution of such a salt is its relative 
efficiency as a purgative, and this is well illustrated in the 
case of the natural mineral waters that have been referred to, 
which are purgative in quantities which contain only an incon- 
siderable proportion of the neutral salts. The phosphates 
have been supposed to be of benefit in nervous diseases, on 
the theory that these were due to the insufficiency of phosphorus 
in the brain, but there is high authority for the statement that 
the animal organism is unable to form combinations between 
phosphates and proteids. At the same time some neurological 
clinicians claim to have obtained good results from the use 
of sodium phosphate in a number of these affections. In 
tri-facial neuralgia, neurasthenia and hysteria it is stated that 
the results are often very satisf acton*. Subcutaneous injec- 
tions were employed of a mixture consisting of sodium phos- 
phate. 2 gm. (30 gr.), rectified spirit, 4 c.c. (1 fl. 5), and distilled 
water, 120 c.c. (4 fl. oz.). Of this 1 c.c. (15 1*1) were injected 
daily, and the amount gradually increased to 3 c.c. (45 ni). 
While believed to have only a palliative effect in organic dis- 
orders of nerve centers, this method is reported to have been 
attended with marked improvement in certain cases of loco- 
motor ataxia. 

7. SODII CHLORIDUM. — Sodium Chloride. (Common Salt.) 
Dose (emetic), 16 gm.; 240 gr. 

Actiox of Sodium Chloride. 
Sodium chloride, which is an important constituent of the 
animal economy, has practically no specific action. Its effects 
are limited to the alteration in the fluids produced by its excess 
or deficiency, and they present a typical example of what is 
known as salt action. As its molecular weight is small and 



I84 PHARMACOLOGY AND THERAPEUTICS. 

as it dissociates readily into its two ions, it possesses great 
osmotic power. This is made use of in the preservation of 
meats, which it effects by causing the withdrawal of their 
fluids and in this way rendering them hard and unfavorable 
for the development of microbes. Strong salt solutions, placed 
in contact with skin or mucous membrane, withdraw fluid 
from the surface cells, and this, together with the passage of 
salt into them, causes some irritation. They also withdraw fluid 
from the red blood-corpuscles, which shrink in size, and from 
muscle, the vitality of which is impaired. On the other hand, 
with very dilute solutions these all become swollen and soft- 
ened from the absorption of fluid. Salt solutions which are 
more concentrated than the blood-plasma are called hypertonic, 
those which are weaker than it, hypotonic, and those which are 
of the same osmotic pressure as the plasma, isotonic. When 
two solutions are separated by a semi-permeable membrane, 
neither of the salts in solution being able to penetrate the 
membrane, water accumulates on the side of the solution 
having the highest osmotic pressure. The osmotic pressure 
of a given substance is proportional to the number of molecules 
per volume of solution. A 0.7 per cent, solution of sodium 
chloride is called the normal or physiological saline solution 
because it is supposed to be isotonic or indifferent to the 
living tissues. As a matter of fact, however, it is probable 
that every cell and fluid in the body has its specific osmotic 
pressure, with a consequent variation in the concentration of 
the sodium chloride solution isotonic with it. The active tis- 
sues of the body contain a very large proportion of water, 
and physical continuity between these media is established by 
the inter-cellular and intra-cellular lymph. It would naturally 
be supposed, and experiment has shown this to be the case, 
that the normal distribution of water between the blood, lymph 
and solid tissues is maintained through the nicest physiological 
adjustment, the direct working factor of which is probably 
the force of osmosis. When the blood loses water, this is 
replaced by fluid drawn from the lymph, which in turn makes 



SODIUM. 185 

good its loss from the solid tissues. When a dilute solution of 
sodium chloride which has a lower osmotic pressure than the 
blood is introduced in excess into a vein, the hydrsemic 
plethora thus produced begins at once to diminish, owing to 
the rapid transudation of the fluid through the capillary walls, 
not of the muscles, but of the intestine and peritoneum. In 
the interchange of bodily fluids, however, the forces of filtra- 
tion and diffusion complicate those of osmosis in the trans- 
ference of material. For the occurrence of osmotic interchange 
the separating membrane must be permeable to water, but im- 
permeable to substances dissolved in it; and the capillary wall, 
which separates the blood from the lymph, is not of this char- 
acter, since through it there may take place both filtration 
due to difference of hydrostatic pressure and diffusion of sub- 
stances in solution. The laws of osmosis have been thus 
summarized: (1) Solutions separated by a membrane per- 
meable to water tend to have an identical molecular composition. 
(2) If the membrane is perfectly permeable to both solvent and 
dissolved substance the exchange of molecules will take place 
without change in pressure or volume. (3) If the membrane 
is less permeable to the dissolved substance than to the solvent, 
an increase of liquid, or increase of tension, will occur in the 
stronger solution. (4) If a membrane is differently permeable 
to one dissolved substance than to another, equimolecular solu- 
tions of the less diffusible substance will be hyperisotonic 
(hypertonic) to the more diffusible. 

In the mouth and fauces strong solutions of sodium chloride 
have an astringent action, while in the stomach they may have 
an emetic effect from the irritation caused by the withdrawal 
of fluid and the impartation of salt to the mucous cells. They 
are also capable of exerting a purgative action. A small amount 
of sodium chloride in the food, by rendering the latter more 
palatable, no doubt often has the effect of increasing the flow 
of gastric juice through reflex influence; but it would seem 
that stomachic digestion is not always improved by it, since it 
has been found that even small quantities diminish the acidity 



1 86 PHARMACOLOGY AND THERAPEUTICS. 

of this secretion. Mineral waters in which common salt is 
the chief constituent have no direct effect on the secretion, but 
appear to alter the nutrition of the gastric mucous membrane. 
Thus it is found that in some individuals the hydrochloric acid 
is increased by these waters, while in others it is lessened. 
Hypertonic and isotonic salt solutions are absorbed in the 
stomach and intestine, as well as hypotonic ones, and in order 
to explain this it is necessary to assume that there exists a 
constant natural tendency for fluids and some salts to pass 
inwards from the lumen of the gastro-intestinal tract. Hypo- 
tonic solutions are naturally absorbed rapidly, while isotonic 
ones are absorbed more slowly, because in their case the 
natural flow alone is active. With hypertonic solutions the 
absorption' is still slower, for the reason that the natural flow 
is at first antagonized by the osmotic pressure-current, which 
is in the opposite direction. Hence, for a time the fluid in 
the canal may actually be increased, by the abstraction of liquid 
from the blood; but as the absorption of salt is all the while 
taking place, the concentration of the fluid is gradually reduced 
until it becomes isotonic, and it is then absorbed. In the 
serous cavities it is stated that when salt solution is injected, 
absorption takes place in the same way as from the stomach 
and intestine, except that osmosis plays a more important part 
than in them. The blood and lymph are in turn affected by the 
processes occurring in the alimentary canal, and while the 
details of the changes which take place between these are 
not clearly understood, it is established that the absorption of 
salt, as well as of water, leads to an augmentation of the nor- 
mal exchange of the two fluids. Again, the changes in the 
blood and lymph are followed by an increased activity of the 
excretory organs. The flow of urine is increased to some 
extent by the absorption of salt solution from the alimentary 
canal, and to a notable degree by the injection of such a solution 
into the circulation, and this is believed to be the result of 
salt-action, and not of any direct effect produced upon the 
renal cells. The saliva is also increased, partly by a reflex 



SODIUM. 187 

from the mouth and partly because a portion of the salt is 
excreted by the salivary glands. While any salt solution caus- 
ing an acceleration in the movement of the fluids of the 
body necessarily tends to facilitate the excretion of waste 
products, the elimination thus caused is much smaller than 
has generally been supposed to be the case, and recent investi- 
gations indicate that salt tends to lessen the proteid metabolism 
through acting directly on the cells. This action is stated to 
be so slight, however, that the resulting fall in the nitrogen 
eliminated is concealed by the increase caused by the more 
complete flushing. Both sodium chloride and the potassium 
salts augment the salts of the urine. While carnivorous ani- 
mals and hunting peoples require no salt and often have a 
distaste for it, in consequence of their food containing so large 
a proportion of sodium salts, common salt forms an important 
article of diet with all creatures living largely or exclusively 
on vegetable food, in whom the potash in the food causes an 
intense craving for it. The cause of this desire for salt has 
been explained as follows : Blood plasma contains much sodium 
chloride, vegetable foods contain a large amount of potassium 
salts ; when, therefore, these salts of potassium reach the blood, 
potassium chloride and the sodium salt of the acid which was 
combined with the potassium are formed. This and the potas- 
sium chloride are excreted by the kidneys, and the blood loses 
its sodium chloride, which loss is therefore made up by taking 
sodium chloride with the food. Some doubt is said to have 
been recently thrown on this explanation by the discovery of 
certain African tribes living on vegetable substances alone, and 
yet using the ashes of plants, which contain more potash than 
soda, as civilized peoples use ordinary salt. As sodium chloride 
is the most important of the mineral constituents of the body, 
so far as regards its general distribution and the active part 
which it takes in the internal phenomena of nutrition, the 
ingestion of an adequate amount of it is essential to the mainte- 
nance of health, and the deprivation of it leads to general 
weakness, oedema and anaemia. 



1 88 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Sodium Chloride. 

Locally it is used to limit the action of silver nitrate when 
applied to mucous membrane, as a gargle in ordinary sore 
throat or in atomized solution in subacute and chronic affec- 
tions of the pharynx and larynx, in douches for the treatment 
of nasal catarrh and ozaena, as an injection for the vagina and 
rectum, and as a wash for indolent ulcers, hives and pruritus 
vulvae, as well as for the stings and bites of insects. As a rule, 
the solution used for affections of the mucous membrane should 
not exceed a strength of 1.20 gm. (20 gr.) to 500 c.c. (1 pint) 
of water, as stronger solutions are likely to be painful and to 
aggravate the disease. Rectal injections of strong solutions of 
salt, which by removing mucus serve to render the bowel unfit 
for the habitation of the parasite, constitute one of the best 
methods of treatment for the Oxyuris vermicularis. A solu- 
tion of it in whiskey is a popular remedy for muscular rheu- 
matism and for bruises, sprains, glandular swellings, etc., and 
hot salt enclosed in bags is a good application in lumbago and 
other forms of myalgia and in colic, dysmenorrhcea, toothache 
and other painful conditions. In the strength of Yi per cent, 
it makes an invigorating as well as cleansing bath, and in a 
5 per cent, solution has been recommended as more agreeable 
and useful than soap baths in subacute eczema, psoriasis, etc. 
Concentrated hot salt baths, like those of Droitwich and Nant- 
wich, are beneficial in chronic rheumatism and sciatica. Sea- 
bathing, as is well known, has a pleasant general stimulating 
effect, and its beneficial results are largely due to the abundant 
presence of sodium chloride in the water. 

Internally it is used at times as an emetic, and from 15 to 
30 gm. (1 to 2 tablespoonfuls) in 250 c.c. (y 2 pint) of tepid 
water are generally successful in causing a prompt evacuation 
of the stomach. In poisoning by silver nitrate it arrests the 
corrosive action by the formation of insoluble silver chloride. 
Its efficiency as an emetic is increased by combining it with 
mustard water. Administered in the form of natural mineral 
waters in which it is a principal ingredient, or in carbon dioxide 



SODIUM. 189 

water, it often proves of service in gastric disorders, and espe- 
cially dyspepsia attended with decomposition of food in the 
stomach, with resulting flatulence, acidity and pain. Salt meat, 
olives and other saline articles tend to prevent alcoholic in- 
toxication, and enemata of salt and water are employed with 
success to rouse drunkards from their lethargy or abate their 
delirious outbreaks. In conditions where the body has lost 
much fluid, as from haemorrhage and in Asiatic cholera, life has 
repeatedly been apparently saved by the intravenous injections 
of solutions of salt in distilled or boiled water, with the addi- 
tion sometimes of a small amount of sodium sulphate or car- 
bonate, calcium chloride, or other alkali ; and normal saline 
solution is now commonly given in this way or by hypoder- 
moclysis (see p. 3), as a substitute for transfusion of blood. 
This may be prepared by dissolving 4 gm. (60 gr.) of common 
salt in 500 c.c. (1 pint) of boiling water, and allowing the solu- 
tion to cool to 37. 7° C. (ioo° F.). It is often desirable, how- 
ever, to use it at a considerably higher temperature than this. 
Recently an effort has been made to secure a solution which 
might be free from the disadvantages found in the actual use 
of saline infusions whether used by the intravenous method, 
by hypodermoclysis or by injection into the peritoneal cavity. 
Although its content of sodium chloride is higher than that 
given above the following has been lately recommended: So- 
dium chloride, 0.9; calcium chloride, 0.026; potassium chloride, 
0.01 ; distilled water, 99.064. Salt solution has also been em- 
ployed in uraemia and similar intoxications, and in such condi- 
tions subcutaneous injection is preferred by some. In the case 
of insane patients who refused to take food the use of salt solu- 
tion by hypodermoclysis has sometimes been found of service, 
as it has the effect of exciting hunger and thirst. In poisoning 
by carbon dioxide and by coal gas good results have been re- 
ported from this procedure or the intravenous injection of a 
salt solution, after a preliminary bleeding. Intestinal lavage 
with normal saline solution, by means of the rectal irrigator, 
is almost certain to have a marked diuretic effect, as it has 



I9O PHARMACOLOGY AND THERAPEUTICS. 

been pointed out that the association of action between the 
lower bowel and the kidneys is such that a movement of the 
bowels can scarcely take place without simultaneously in- 
ducing a urinary flow. It is therefore of great service in various 
conditions, and especially acute nephritis. In colitis, particularly 
when chronic, medicinal remedies not infrequently fail to com- 
plete the cure until supplemented by the local effects of this 
lavage. The beneficial influence of the enteroclysis may be en- 
hanced by the addition to the fluid of antiseptic and anodyne 
agents. Auto-infection from retention of putrid contents in 
the colon may give rise to grave cerebral symptoms, and the 
same conditions are often met with in cholera infantum; here 
such intestinal irrigation is indicated, both to combat the toxic 
infection and to secure the beneficial effects of the saline on 
the blood, after it has been drained of its salts by the watery 
evacuations. This procedure may also prove valuable against 
the toxaemia in fevers, particularly typhoid fever. 

8. SODII NITRAS.— Sodium Nitrate. Dose, 1 gm.; 15 gr. 

Action of Sodium Nitrate. 
Its action is practically the same as that of potassium nitrate, 
except that it is much less depressant to the heart. In dilute 
solution it may be taken in large amount without producing any 
effect except diuresis. It is a less efficient diuretic than potas- 
sium nitrate, however, as it lacks the stimulating influence upon 
the kidney which is due to the potassium constituent of the 
latter salt. In concentrated form it acts as a gastro-intestinal 
irritant and may cause purgation, with the result of lessening 
the force or frequency of the heart's action and of lowering 
the temperature. 

Therapeutics of Sodium Nitrate. 
At the present day it is very rarely employed in practical 
medicine. Formerly it was chiefly used in diarrhoea and dysen- 
tery, in daily doses of from 30 to 60 gm. (1 to 2 oz.) dissolved 



SODIUM. I9I 

in a large quantity of water. It has been considered of service 
in relieving maniacal excitement, in daily quantities of from 3 
to 5 gm. (45 to 75 gr.), and in two patients who suffered from 
epilepsy of psychical origin it is said that the attacks could be 
prevented by the exhibition of 6 gm. (1^2 dr.) immediately 
after the appearance of the aura. 

9. SODII ACETAS.— Sodium Acetate. Dose, 1 gm.; 15 gr. 

Action of Sodium Acetate. 
The same as potassium acetate, both resembling the chlorides 
and therefore owing any effect they possess to the salt-action. 
In the. body, however, they are oxidized, with the formation of 
carbonates, and hence their action before absorption is that of 
the chloride, and afterwards that of the carbonate. The re- 
sult is that the alkalinity of the blood and of the urine, as 
well as the amount of the latter, is increased. A mixture of 
equal parts of sodium acetate and potassium nitrate explode 
with great violence. 

Therapeutics of Sodium Acetate. 
It is employed principally to yield acetic acid by the action 
of sulphuric acid, and although it has decided diuretic prop- 
erties, is seldom prescribed medicinally. By some, however, it 
is considered more efficient as a diuretic, as well as milder and 
less apt to derange the digestion, than potassium acetate. It 
has been given as an antacid in acute rheumatism and as a 
diuretic in dropsies, and also used in irritation of the genito- 
urinary apparatus and gout. 

10. SODII CHLORAS.— Sodium Chlorate. Dose, 0.250 gm. (250 
milligm.) ; 4 gr. 

Action of Sodium Chlorate. 
Practically the same as that of potassium chlorate. The 
effects produced by both salts are principally due to their 
chlorate ion. 



192 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Sodium Chlorate. 
It has never been used to anything like the extent of the 
potassium chlorate, but is occasionally employed as a substi- 
tute for the latter in affections of the mouth and throat. Its 
greater solubility, it may be said, permits of stronger solutions. 
As a gargle or wash a 2 to 5 per cent, solution may be pre- 
scribed. It has been used with asserted remarkable results in 
cancer of the stomach, but the large doses employed would seem 
to be attended with considerable danger from chlorate poison- 
ing. 

11. SODII PYROPHOSPHAS.— Sodium Pyrophosphate. Dose, 2 
gm.; 30 gr. 

Action of Sodium Pyrophosphate. 
Sodium pyrophosphate has the same therapeutical action as 
sodium phosphate. 

Therapeutics of Sodium Pyrophosphate. 
Its principal use is in pharmacy, and it is rarely, if ever, 
employed as a medicine. 

12. SODII CITRAS.— Sodium Citrate. Dose, 1 gm.; 15 gr. 

Action of Sodium Citrate. 
It is a cooling and mild purgative, similar in its action to 
magnesium citrate. 

Therapeutics of Sodium Citrate. 
It may be given in cases where a pleasant saline laxative is 
required. 

13. SODII iETHYLAS (Not official).— Sodium Ethylate. 

Preparation. 
Liquor Sodii iEthylatis (Not official). — Solution of Sodium 
Ethylate. 



SODIUM. I93 

Action of Sodium Ethylate. 
When it is applied to living tissues the following effects 
have been observed: 1, a removal of water from the tissue; 2, 
the destructive action of the resulting caustic soda; 3, coagula- 
tion from the alcohol that is reproduced; 4, prevention of 
decomposition in the resulting dead tissue. It is stated that 
the liberated alcohol coagulates the albuminous compounds in 
its neighborhood, and thus limits the caustic action of the soda, 
and that the red blood-corpuscles become disintegrated, and 
then crystalline, while the white are for a time unaffected. 
When used for local pathological conditions it affects the sur- 
rounding healthy skin to but a slight extent, its action being 
restricted to the spot on which it is applied; and it produces 
scarcely any scarring. As compared with the action of nitric 
acid, there is but little destruction of the epidermis, while the 
pain caused by it is less severe than that from the acid. 

Therapeutics of Sodium Ethylate. 
It is used exclusively for its local effects, and is by some 
considered the best of all caustics. Its corrosive action is very 
speedy and energetic, and it has been employed especially for 
the destruction of naevi. It is customary to apply it, by 
means of a glass rod, for two or three days successively, and 
when the eschar thus formed has fallen off the treatment is 
repeated, if necessary. The pain caused by it may be mitigated 
by mixing it with laudanum, and in pendulous vascular tumors 
the risk of too great haemorrhage may be avoided by diluting 
the ethylate with alcohol, so as to promote coagulation. This 
caustic is also used with advantage in a variety of other condi- 
tions, such as tattoo, hypertrichosis, warts, moles, callous ulcers, 
nasal polypus, haemorrhoids, lupus, epithelioma, and melanotic 
growths. A 10 per cent, watery solution, applied after curet- 
ting, has been found valuable in the treatment of lupus erythema- 
tosus, and it is stated that a 20 per cent, liniment, made with 
olive oil, if well rubbed in daily, will usually cure psoriasis in 
a comparatively short time. Sodium ethylate has also been 



194 PHARMACOLOGY AND THERAPEUTICS. 

employed in ringworm and other skin affections. Applied di- 
rectly to the unbroken skin, it is asserted that its destructive 
action is less painful than would be expected, and that when 
pain is felt it may be quickly checked by dropping upon the 
part a little chloroform. The caustic alcohols may be used 
in combination with local anaethesia from cold. Potassium and 
sodium alcohol, added to amyl-hydride, dissolve the hydride 
and produce a caustic solution. A part rendered quite dead to 
pain by freezing with ether spray may be directly destroyed, 
it is said, by the subcutaneous injection of caustic alcohol — a 
practice very important in the treatment of poisoned wounds; 
and it has been suggested that cystic tumors might be cured 
by such injections, after destruction of the sensibility of the 
parts by cold. 

AMMONIUM. 

1. AQUA AMMONITE FORTIOR.— Stronger Ammonia Water. 

Preparation. 
Spiritus Ammonias. — Spirit of Ammonia. Dose, 1 c.c; 15 n\. 

2. AQUA AMMONIAS.— Ammonia Water. Dose, 1 C.C.; 15 H\.. 

Preparations. 

1. Linimentum Ammonise. — Ammonia Liniment. (Volatile 
Liniment.) 

2. Spiritus Ammoniae Aromaticus. — Aromatic Spirit of Am- 
monia. Dose, 2 c.c; 30 n\. 

Action of Solutions of Ammonia. 
External. — Applied to the skin ammonia solutions of moderate 
strength are rubefacient. Strong solutions cause a sensation 
of burning pain and, if the part is covered, will give rise to 
vesication. Ammonia differs from the other alkalies in being 
more volatile, in consequence of which it penetrates more rap- 
idly and deeply. It passes through the stratum corneum of the epi- 
dermis without dissolving it, and produces the blisters by its ac- 



AMMONIUM. I95 

tion on the lower layers of the skin. At the same time it is less 
corrosive and less enduring in its effects than the fixed alkalies, 
although, if the application is continued sufficiently long, 
sloughing will result. 

Internal. Eyes, Nose and Air Passages. — Vapor of ammonia, 
in contact with the eye, causes severe pain and inflammation. 
When inhaled it is also irritating, occasioning smarting, sneez- 
ing, lachrymation and coughing, with reflex acceleration of the 
pulse and respiration. If sufficiently concentrated, it is likely 
to cause spasm of the glottis or such swelling of the mucous 
membrane of the larynx and trachea as to induce asphyxia. 
Animals immersed in such vapors become asphyxiated, and 5 
parts of ammonia in 10,000 are considered dangerous. 

Stomach. — In the mouth, fauces, oesophagus and stomach 
concentrated solutions produce corrosions similar in character 
to those resulting from caustic potash and soda, but as the 
gas evaporates rapidly from ammonia solutions, some of the 
vapor generally escapes into the respiratory passages, and in 
the manner described tends to produce asphyxia, which may 
result in death very suddenly. In dilute solution ammonia acts 
as a mild gastric stimulant. Like other alkalies, it renders the 
gastric juice less acid and tends to liquefy the mucus in the 
stomach. 

Skin, Mucous Membrane, and Salivary Glands. — Ammonia 
and its salts have considerable effect in increasing the secre- 
tions, especially the saliva, mucus and perspiration. The 
diaphoresis has been attributed to their action on the central 
nervous system, and the increase in the saliva and mucus to 
a reflex stimualtion from mucous membranes due to a salt action, 
to direct stimulation of the secreting centres, and to local 
salt-action upon the secretory cells themselves. It is considered 
doubtful, however, whether these agents, although having a 
direct action upon the central nervous system when injected 
into the circulation, are capable of producing any such effect 
when they are absorbed from the stomach. The ammonium 
salts are said to be excreted largely into the mouth by the saliva, 



I96 PHARMACOLOGY AND THERAPEUTICS. 

as also by the lungs, mainly in the form of carbonate. In 
this way the local action is exerted twice (when the salt is 
applied and when it is excreted), and this excretion in the 
form of carbonate also tends to liquefy the mucus on account 
of the alkaline action. 

Blood. — Little is known of the behaviour of ammonia in the 
blood, although when injected in poisonous quantities it has 
been found to prevent the blood from taking up oxygen. 
It was at one time supposed by some observers that the coagu- 
lation of the blood was caused by the escape of ammonia, but 
it is now known that this is not the case. Still, ammonia helps 
to maintain the fluidity of the blood, while its presence, in 
sufficient quantity, serves to hold the fibrin in solution. Thus, 
having the property of dissolving fibrin, it is believed to diminish 
the local liability of the blood to coagulate, and also to be 
capable of dissolving clots, in cases of thrombosis. 

Heart and Circulation. — Upon the circulation ammonia acts 
as a powerful, but fleeting stimulant. When it is inhaled, the 
irritation of the nasal mucous membrane causes a reflex stimula- 
tion of the vaso-motor centre, and consequent constriction of 
the arterioles and increased blood-pressure. The cardiac action 
may be temporarily slowed by inhibitory reflexes. Also when 
ammonia is injected in moderate amounts into the circulation, 
the blood-pressure rises from the contraction of the peripheral 
vessels caused by stimulation of the vaso-motor centre. The 
heart itself is sometimes slowed from increased activity of the 
inhibitory centre, and sometimes accelerated; whether in 
consequence of action on the cardiac muscle or on the accelera- 
tion centre is not known. The pulse-rate and the pulse-force, 
as well as the blood-pressure, are usually increased, and the 
rise in the arterial pressure is followed, if the dose has been 
sufficiently large, by a decided fall, ending in permanent diastolic 
arrest of the heart. If by means of intravenous injection the 
ammonia reaches the heart in large amount in concentrated 
form, the organ at once ceases to beat, in consequence of 
paralysis of its muscular walls. Any effect that solutions of 



AMMONIUM. 



I 9 7 



ammonia, when taken by the mouth, may have in stimulating 
cardiac action, is probably not due to a direct influence upon 
the heart, but to an action exerted reflexly from the gastric 
irritation. 

Respiration. — From the reflex stimulation of the respiratory 
centre in the medulla, when ammonia is inhaled, the respiration 
is at first checked, and then rendered fuller and deeper. So, 
when the drug is injected subcutaneously or intravenously the 
respiration often ceases for a moment, and then becomes very 
much accelerated, while in some instances it is deepened; this 
increase in respiration being due to stimulation of the respira- 
tory centre. As to the preliminary pause, it has been attributed 
by some to action on the vagus terminations in the lungs, while 
this is denied by others, and it is thought probable that it is 
due simply to excessive stimulation of the respiratory centre. 
The breathing finally stops in respiratory tetanus. 

Nervous System and Muscles. — The action on the central 
nervous system consists of a stimulation, especially of the 
medulla oblongata and spinal cord. According to some ob- 
servers the brain is found to be rather depressed, so that there 
is somnolence. Others believe that the brain is first stimulated, 
and that this action inhibits the reflexes. Then, as the stimula- 
tion passes downwards, the spinal cord is acted on in turn, and 
the reflexes are exaggerated. The rise of arterial pressure and 
the quickening of the respiration, from the action on the medul- 
lary centres, have already been mentioned. When the drug is 
injected into the circulation tetanic convulsions may occur, 
though appearing rather late, and they resemble strychnine 
spasms quite closely. As they persist after division of the 
cervical cord and destruction of the brain and medulla ob- 
longata, they would appear to be due to changes in the spinal 
cord such as are observed in poisoning by strychnine. During 
the convulsions the respiration is arrested and the blood-pres- 
sure becomes extremely high. If the amount injected into the 
circulation be sufficiently large, the stimulation is followed by 
paralysis of the central nervous system, and death is caused by 



I90 PHARMACOLOGY AND THERAPEUTICS. 

asphyxia. The muscles are acted on by ammonia in much the 
same way as by potassium, although it is stated that a prelimi- 
nary stage of augmented irritability not met with in the case 
of the latter has been observed by some investigators. Under 
the effects of potassium the contraction of the muscle of the 
frog appears to be somewhat greater in height, though shorter 
in length, while there is less tendency to contracture; and muscle 
exposed in a solution of potassium chloride dies very much 
sooner than in an isotonic solution of sodium chloride. 

Kidneys. — Ammonia differs from the -fixed alkalies in not 
increasing the alkalinity of the blood and in not reducing the 
acidity of the urine or rendering it alkaline. This is because 
it is changed to urea in the body, and is excreted in this form 
in the urine. The flow of urine is sometimes, but not always, 
increased by the administration of the salts of ammonia; when 
this is the case it is said to be due simply to the increase of 
urea. 

Therapeutics of Solutions of Ammonia. 

External. — The stronger water of ammonia is sometimes 
used as a rubefacient and vesicant. This solution, however, 
will generally be found too strong for use in its unmixed state, 
and where a prompt and sufficiently powerful counter-irritant 
effect is indicated, as is sometimes the case in various neuralgic, 
gouty, rheumatic, spasmodic and inflammatory affections, it 
may be combined, in the proportion of five parts to eight, with 
a diluent liquid composed of spirit of camphor and rosemary. 
If a very quick effect is called for, the proportion should be five 
to three. A convenient method of application is to fill the 
cover of an ointment-box, or other suitable receptacle, with 
lint, and, having saturated it with the lotion, press it upon 
the part. The ammonia is thus prevented from escaping, and 
a definite boundary given to the action desired. The less 
diluted mixture will generally produce rubefaction in from one 
to eight minutes, and vesication in from three to ten minutes. 
In severe neuralgias the skin may be blistered at points where 
the affected nerve is found to be tender. Care should be always 



AMMONIUM. I99 

taken, however, that the application should not be continued too 
long, as sloughing may then result. A salt of morphine may- 
be added to the solution employed. In some cases " thimble- 
blistering " is advised ; in which small areas over the painful 
spots are vesicated by means of undiluted stronger water of 
ammonia dropped upon absorbent cotton and confined with a 
thimble or watch-glass in contact with the skin. Ammonia is 
not often used for epispastic purposes, as the blisters produced 
by it are more painful and slow to heal than those of other 
vesicants. It is especially applicable, however, when vesication 
is desired in cases of renal disease, in which cantharides is 
contra-indicated. Aqua Ammonias is a very good application 
for the stings and bites of insects. The stronger water is often 
applied in snake-bite, but so far as any antidotal action is con- 
cerned it would seem to be of no service, as ammonia has been 
shown to have no effect on the toxalbumins of snake-poison. 
The inhalation of Aqua Ammonias is of great value in cases 
of syncope ; held to the nostrils of persons who have fainted, 
by its effect on the mucous membrane, it usually produces, 
through reflex influence, very prompt stimulation of the heart 
and respiration. In all cases of suspended animation, whether 
from syncope or asphyxia, it may be employed, but with caution, 
on account of the possibility of its giving rise to inflammation 
of the fauces, glottis and larynx. Ammonia is the basis of most 
of the " smelling salts " in popular use, the ordinary form of 
which consists of the carbonate reinforced with some of the 
strong solution of ammonia and flavored with oil of lavender. 
Ammonia water is much used in liniments, usually combined 
with olive or other oil, and also in washes to prevent the hair 
from falling out or to stimulate its growth. Amenorrhoea, as 
well as leucorrhcea, is said to have sometimes been successfully 
treated by vaginal injections of a weak solution of ammonia. 
Such solutions have also been used in the treatment of super- 
ficial burns and frost-bite, and, in association with hot water, for 
sponging the surface for the relief of general exhaustion or 
depression of the nervous system in low fevers. The early 



200 PHARMACOLOGY AND THERAPEUTICS. 

inhalation of dilute vapor of ammonia may perhaps sometimes 
arrest the development of catarrhal affections of the throat 
and air passages, and also prove of service in chronic dry- 
ness of the pharynx and chronic hoarseness. It has been known, 
it is said, to delay or prevent the paroxysms of whooping-cough 
and epilepsy. 

Internal. — In the stomach ammonia in solution acts as a 
stimulant antacid, and is useful in heart-burn, sick-headache, 
etc., but in dyspeptic conditions it is not used alone so much 
as in combination with the carbonate in the Spiritus Ammoniae 
Aromaticus. In sudden paralysis of the heart from chloroform 
narcosis, poisonous gases, or toxic agents such as hydrocyanic 
acid, nicotine, etc., or in collapse from any cause, it may be 
intravenously injected — 4 to 8 c.c. (1 to 2 11. dr.) of Aqua 
Ammoniae with an equal quantity of water. Injected subcu- 
taneously, it almost invariably produces a slough. Intravenous 
injections of ammonia are also called for when sudden throm- 
bosis of a large venous trunk occurs, as, for example, in the 
pulmonary artery, after uterine haemorrhage. They may even 
be employed when thrombosis is threatened, but has not actually 
taken place, as in the puerperal state, after free haemorrhage, 
when the circulation is depressed from weak heart. In chloro- 
form narcosis this procedure not infrequently fails, and the 
reason for this is believed to be because the heart stops sud- 
denly and completely, so that before the injection can be prac- 
ticed the cardiac ganglia have entirely ceased to functionate. 
The opinion has been expressed that 'failure has sometimes re- 
sulted in other classes of cases because a sufficient quantity of 
ammonia was not employed, and a case is on record in which 
a patient is stated to have been saved from inevitable death 
from the effects of the gases of a privy vault by no less than 
twelve intravenous injections of the stronger water of ammo- 
nia, the whole amount thrown into the circulation being 8.624 
c.c. (140 ui). The repetition of the injection should naturally 
depend on the effects noted, and it is advised that the limit to 
the amount of ammonia used should be determined by the state 



AMMONIUM. 20I 

of the heart. Notwithstanding the negative results obtained in 
experimental researches, many instances have been reported in 
which ammonia injections seemed to be efficacious in poisoning 
by venomous serpents. In such cases the beneficial results were 
no doubt due to the prompt and energetic stimulation, rather 
than to any antidotal value of the remedy. 

3. AMMONII CARBONAS.— Ammonium Carbonate. (Bakers' Am- 
monia. Hartshorn. Sal Volatile.) Dose, 0.250 gm. (250 milligm.) ; 
4 gr. 

Preparation. 
Elixir Ferri, Quininse et Strychninae Phosphatum. — Elixir 
of Iron, Quinine and Strychnine Phosphates. Dose, 4 C.C.; 1 
fl. dr. 

Action of Ammonium Carbonate. 
The pharmacological effects of the carbonate are similar to 
those of solutions of ammonia. Although not so corrosive as 
the latter, when swallowed in sufficient quantity it acts as an 
irritant poison. Slight gastric irritation is produced by moder- 
ate amounts, and nausea and vomiting by larger doses. It 
has expectorant properties of great value, as it not only in- 
creases the bronchial mucous secretion and renders it more fluid, 
but reflexly stimulates the respiratory centre in the medulla 
oblongata. In the urine it is excreted as urea. 

Therapeutics of Ammonium Carbonate. 
The carbonate, either in solution, or in the form of aromatic 
spirit of ammonia, is given very frequently in cases of collapse 
and heart-failure, or where such conditions are threatened. 
Here the stimulating influence exerted by it is probably not, as 
has been generally supposed, directly upon the heart and 
respiratory centre in the medulla, but a reflex effect resulting 
from the gastric irritation. When thrown into the circulation, 
however, either by subcutaneous or intra-venous injection, there 
can be no question that it has a direct action upon the medullary 
centres, and thus causes a powerful, though evanescent, stim- 



202 PHARMACOLOGY AND THERAPEUTICS. 

illation. In less serious depression resulting from various 
causes Spiritus Ammonise Aromaticus is a favorite remedy, 
and generally answers very well for temporary purposes; giv- 
ing a feeling of increased strength, or even of exhilaration, and 
increasing the warmth of the surface. It is useful as a gastric 
stimulant and carminative, and is employed especially in cases 
of headache attended with acidity of the stomach and flatulent 
eructations. It is also of service in the sour stomach and 
tympanites met with particularly in hysterical women, and 
will sometimes prevent or abort paroxysms of hysteria. In 
nervous headaches, whether attended with nausea or not, it 
often affords relief. Ammonium carbonate is likely to prove 
successful in the treatment of delirium tremens when the latter 
is associated with cerebral anaemia and weak heart action. It 
sometimes counteracts even a high degree of alcoholic intoxi- 
cation, and is serviceable in the dyspepsia of drunkards from 
its stimulant and antacid properties, as well as its action in 
dissolving the tenacious mucus coating the stomach. In doses 
of from .30 to .60 gm. (5 to 10 gr.), administered with .60 c.c 
(10 ni) of tincture of capsicum in 30 c.c. (1 fl. oz.) of some 
bitter infusion, it is very efficient in relieving the sinking sen- 
sations and craving for stimulants experienced by subjects of 
alcoholism. It is a valuable cardiac and nervous stimulant in 
syncope, heart-exhaustion, and all typhoid conditions, and may 
therefore at times be employed with advantage in adynamic 
forms of pneumonia, scarlet fever, measles, small-pox and 
erysipelas, as well as in typhus and typhoid fevers. As it is 
quickly eliminated, it is best given in small doses repeated at 
short intervals. By some, however, its administration in typhus 
and typhoid fevers has been regarded as improper, on the 
ground that in these diseases the ammonia in the blood is 
increased beyond the normal. In pneumonia it has been pointed 
out that to stimulate the heart merely, when an obstacle exists 
in the pulmonary circulation, is of doubtful utility; but am- 
monium carbonate, by liquefying the exudation, also relieves 
obstruction of the air-sacs, and is thus a remedy of great value. 



AMMONIUM. 203 

It is sometimes prescribed with good effect in infusion of 
senega, which is a stimulant expectorant. In bronchitis and 
broncho-pneumonia it is often given in association with other 
expectorants, and is perhaps most used in the case of children 
and old people. It is especially esteemed in the capillary bron- 
chitis of the young, and is employed by surgeons in the treat- 
ment of children after operations to overcome the respiratory 
and circulatory depression produced by the anaesthetic. In 
rather large and frequently repeated doses it may prove effica- 
cious in aborting a cold. On account of its alkalinity, ammo- 
nium carbonate should not be prescribed in a mixture with 
either the vinegar or syrup of squill, the latter being made from 
the vinegar. It is sometimes used as an emetic, in doses of 2 
gm. (30 gr.) for an adult, and is less depressant than many 
other agents employed for this purpose. In diabetes it has been 
thought to sometimes prove of service, and its use has been 
strongly recommended in the treatment of cystinuria. 

4. AMMONII CHLORIDUM.— Ammonium Chloride. (Sal Am- 
moniac, Ammonium Muriate.) Dose, 0.500 gm. (500 milligm.) ; 7Y 2 
gr. 

Preparation. 
Trochisci Ammonii Chloridi. — Troches of Ammonium Chlo- 
ride. 

Action of Ammonium Chloride. 
Applied locally to mucous membranes, it stimulates their se- 
cretion. After absorption it also acts upon these membranes, 
rendering the secretions of the stomach and the bronchial 
mucous membrane less tenacious, as well as increasing their 
amount. Injected into the circulation, it has, like ammonia 
and its carbonate, a stimulating action on the central nervous 
system, but when absorbed from the alimentary canal, it ap- 
parently has no such direct effect, though reflexly it may cause 
some stimulation. When swallowed in considerable quantity 
it may induce irritation and vomiting, but only through its 
action as a salt. Solutions of the chloride are rapidly absorbed 
from the stomach and intestine, and permeate the red blood- 



204 PHARMACOLOGY AND THERAPEUTICS. 

corpuscles with great facility. It apparently has some action 
on the liver, and it is thought probable that this is explained 
by its increasing the excretion of urea by the kidneys. In the 
body it is changed to urea, and this transformation seems to 
take place principally in the liver. When urea is formed from 
it hydrochloric acid is liberated in the tissues, and this, it is 
stated, would act as a poison, were it not neutralized at once 
by ammonia being formed in the tissues themselves. It seems 
to have some effect in increasing the urine, as well as the 
secretion of the salivary and sweat glands. It is said to 
be excreted to some extent by the salivary glands, but its elimi- 
nation takes place principally by the kidneys. 

Therapeutics of Ammonium Chloride. 
In consequence of its decided action on mucous membranes, 
ammonium chloride (either in its nascent state, as generated 
by the action of hydrochloric acid on ammonia, or in the form 
of an atomized watery solution), is largely used by inhalation 
in pharyngitis, otitis media, laryngitis, bronchitis, etc., and 
especially when these conditions are chronic. In both acute 
and chronic pharyngitis and bronchitis it is frequently admin- 
istered in the form of troches or compressed tablets. It is also 
a favorite ingredient of expectorant mixtures. Combined with 
potassium iodide, tincture of ipecacuanha, and brown mixture, 
it is regarded as of special value in acute catarrhal pneumonia. 
It is sometimes employed with good effect in so-called bilious- 
ness, with coated tongue, decreased secretion of the intestinal 
juices, scanty, high-colored urine, etc., and in various hepatic 
affections, such as chronic torpor of the liver, chronic hepatitis, 
and catarrh of the bile-ducts with jaundice, it is often of great 
service. In the first stage of cirrhosis it has also been found 
useful by some authorities. The disagreeable taste of the drug 
may be covered to a considerable extent by liquorice or by 
the fluidextract of taraxacum. The former would naturally 
be preferred as a vehicle for affections of the respiratory ap- 
paratus, and the latter in hepatic disorders. In these taraxacum 



AMMONIUM. 205 

is used by many practitioners, although it would appear that 
there is no sufficient ground for the belief that it has a specific 
action on the liver. Formerly ammonium chloride was some- 
times given in malarial fever, and large doses of it have been 
recommended in neuralgia. By those who have found it useful 
it is believed to be chiefly serviceable in neuralgias depending 
upon cold, and tincture of aconite has sometimes been asso- 
ciated with it. It has also been thought beneficial in myalgia 
and chronic muscular rheumatism. Like the other preparations 
of ammonia, it is employed in acute alcoholism, and 2 gm. (30 
gr.) in 250 c.c. ( l / 2 pint) of water, swallowed at one draught, 
is said to be sometimes remarkably efficient in the case of 
patients on the verge of delirium tremens. By some it is con- 
sidered a very useful remedy in the subacute gastric and intes- 
tinal catarrh of children, in doses of from .12 to 1 gm. (2 to 
: 5 & r -)> preferably given with liquorice and water to mask the 
taste. It is also beneficial in some cases of gastric catarrh in 
adults, and .60 gm. (10 gr.), given half an hour before meals, 
it is asserted, will afford extraordinary relief in painful dys- 
pepsia due to hyperacidity of the stomach. In tropical dysen- 
tery good results have been reported from its use. When 
this remedy is administered in the form of compressed pills 
it is advised that a large draught of water or milk be taken 
simultaneously to protect the stomach. The local application 
of ammonium chloride is not resorted to at the present time 
to such an extent as was formerly the case. Its stimulating 
action has been made use of to arrest the progress of gangrene, 
especially of the senile variety ; cataplasms or local baths con- 
taining it being applied according to the situation of the dis- 
ease. In weak solution it has been employed as a wash for 
ulcers and a vaginal injection for leucorrhoea, and in stronger 
solution as a stimulant and resolvent in contusions, contused 
and lacerated wounds, sprains, enlarged bursae and joints, in- 
dolent tumors, etc. A solution of from 8 to 15 gm. (2 to 4 dr.) 
to 500 c.c. (1 pint) of water removes ecchymosis from con- 
tusions, and is also applicable to subacute epididymitis. In 



206~ PHARMACOLOGY AND THERAPEUTICS. 

local inflammations the cold produced by it in dissolving may 
sometimes be taken advantage of. Five parts of ammonium 
chloride with 5 parts of potassium nitrate and 16 parts of 
water will cause a very considerable lowering of the thermom- 
eter, and such a mixture, applied in a bladder, has been em- 
ployed for the reduction of hernial tumors. It forms a useful 
ingredient in errhine powders, and a solution of 8 gm. (2 dr.) 
to 120 c.c. (4 fl. oz.) of water is an efficient topical application 
in rhus poisoning. 

5. LIQUOR AMMONII ACETATIS.— Solution of Ammonium Ace- 
tate. (Spirit of Mindererus.) Dose, 16 C.C.; 4 fl. dr. 

Action of Ammonium Acetate. 
Locally the acetate acts in the same way as the chloride, but 
in the tissues it undergoes oxidation and the whole of it is 
converted into urea; so that while the urea of the urine is in- 
creased, there is no increase in its ammonia. In the case of 
the chloride, the net result of the effects produced upon the 
system is that the urea excretion is but little changed, while 
the ammonia of the urine is much increased. Ammonium ace- 
tate causes an increase not only of the solid constituents of the 
urine, but also of its fluid, and it stimulates the secretion of the 
skin as well as that of the kidneys. 

Therapeutics of Ammonium Acetate. 
On account of its diaphoretic and diuretic properties, it is 
sometimes prescribed in fever, either alone or together with 
more powerful remedies. Except as a vehicle for the latter, 
however, it is much more rarely employed now than formerly. 
In typhoid fever it has been found that the diarrhoea may be 
increased by it. It used to be given very frequently combined 
with spirit of nitrous ether, and in mild febrile conditions in 
children is still employed to some extent thus associated. 
Solution of ammonium acetate sometimes proves very grateful 
to fever patients when administered with an equal quantity of 
carbon dioxide water. In sick headache from 4 to 8 c.c. (1 to 



LITHIUM. 207 

2 fl. dr.) repeated every hour, is often very efficacious, and this 
remedy may also be given with good results in acute alcoholism. 
As a diuretic it is employed as an adjuvant in the treatment of 
scarlatinous dropsy and of chronic Bright's disease. 

6. AMMONII NITRAS (U. S. P., 1890; no longer official).— Am- 
monium Nitrate. 

Action of Ammonium Nitrate. 
It has the general action of the nitrates, being a gastro- 
intestinal irritant and renal stimulant. 

Therapeutics of Ammonium Nitrate. 
It is used to prepare nitrous oxide gas, freezing mixtures, 
and artificial cold applications. 

LITHIUM. 

1. LITHII CARBONAS.— Lithium Carbonate. Dose, 0.500 gm. 
(500 milligm.) ; 7V 2 gr. 

2. LITHII CITRAS.— Lithium Citrate. Dose, 0.500 gm. (500 mil- 
ligm.) ; 71/2 gr. 

Preparation. 
Lithii Citras Effervescens. — Effervescent Lithium Citrate. 
Dose, 8 gm.; 120 gr. 

3. LITHII VANADAS (Unofficial).— Lithium Vanadate. Dose, 
.003 gm.; ^ gr. 

Action of Lithium Carbonate and Citrate. 
Lithium is believed to possess an action midway between 
sodium and potassium, but comparatively little is known of the 
physiological effects of its salts. When given to dogs by the 
mouth in sufficient quantity they have been found to produce 
severe gastro-intestinal irritation, with diminished secretion of 
bile. Injected into mammals they have caused marked weak- 
ness, gastric disturbance, diuresis, increasing dyspnoea, fall of 
temperature, and death (often preceded by convulsions), from 



208 PHARMACOLOGY AND THERAPEUTICS. 

arrest of the respiration. The heart of the frog is arrested in 
diastole, but lithium acts much less powerfully on the mamma- 
lian heart than potassium. It appears to be depressant to the 
motor nerves, as well as the spinal cord, and to weaken muscu- 
lar contraction. These salts in medicinal doses rarely give rise 
to any definite symptoms in man, unless it be an increased flow 
of urine, but large quantities may cause gastric derangement 
and possibly some muscular twitching. In the body lithium 
slightly increases the nitrogen excretion. The citrate is less 
disagreeable to the taste and less liable to irritate the stomach 
(though in occasional instances it produces nausea and vomit- 
ing) than the carbonate, and its effects are the same, as the 
citric acid is consumed in the system and a lithium carbonate 
formed and excreted in the urine. Lithium salts are capable of 
rendering the urine very strongly alkaline. 

Therapeutics of Lithium Carbonate and Citrate. 
Lithium salts are useful alkaline remedies, and are employed 
to a considerable extent in the treatment of rheumatism and 
gouty affections, especially of a subacute and chronic charac- 
ter. They have been much lauded in the so-called uric diathesis, 
but while outside the body lithia exhibits great solvent power 
over uric acid, with which it forms a biurate that is more 
soluble than the corresponding salts of the other alkali metals, 
it has been pointed out that in the system it has a greater 
affinity for the acid sodium phosphate in the blood, and prac- 
tically leaves the uric acid to itself. There is unquestionably a 
large amount of clinical evidence going to show the beneficial ef- 
fects of lithium salts in gouty cases and where there is a ten- 
dency to uric acid, sand and gravel ; but there is reason to believe 
that in the body fluids the amount of lithium introduced by 
ordinary dosage can exercise no solvent influence upon gouty 
deposits, and it is now the opinion of many of the best authori- 
ties that the large amount of water generally taken with lithia 
has more to do with relieving the conditions in question than 
the drug itself. Most of the popular lithia waters contain 



MAGNESIUM. 209 

lithium salts only in minute proportions, and whatever value 
is to be ascribed to them is no doubt principally due to their 
effect in dissolving effete materials resulting from imperfect 
elimination of tissue-waste. Lithium salts have no power to 
dissolve calculi, but are often of service in alkalizing the urine, 
as well as in increasing its amount and thus rendering it more 
dilute. On the whole, it would appear that their influence is 
somewhat limited, but that as a minor remedy they possess a 
certain amount of usefulness in gouty cases. In diabetes where 
there is a gouty taint remarkably good results have been 
claimed from the use of lithium carbonate or citrate with. 
sodium arsenate. Lithia solutions have been applied exter- 
nally to gouty joints and ulcers, with asserted good results. 
While it is maintained that such applications relieve the pain 
of gouty inflammation and aid the disappearance of deposits, 
they would seem to have no effect in preventing the formation 
of the latter. Gouty conjunctivitis is also said to be relieved 
by washing the eye with a 1 to 500 solution of lithium car- 
bonate. 

Lithium Vanadate closely resembles arsenic in its actions, 
and like arsenic it has been used as an alterative. It has also 
been recommended for the treatment of diabetes, in which it 
is claimed that it reduces the sugar in the urine one-half. 

MAGNESIUM. 

1. MAGNESII SULPHAS.— Magnesium Sulphate. (Epsom Salt.) 
Dose, 16 gm.; 240 gr. 

Preparation. 

Magnesii Sulphas Effervescens.— Effervescent Magnesium 
Sulphate. Dose, 16 gm.; 240 gr. 

2. MAGNESII CARBONAS.— Magnesium Carbonate. Dose, 3 
gm.; 45 gr. 

Preparation. 

Liquor Magnesii Citratis.— Solution of Magnesium Citrate. 
Dose, 360 c.c; 12 fl. oz. 

15 



2IO PHARMACOLOGY AND THERAPEUTICS. 

Unofficial Preparations. 
Magnesii Citras Effervescens (U. S. P., 1890). — Effervescent 
Magnesium Citrate. Dose, 8 to 30 gm.; y 4 to 1 OZ. 

Mistura Magnesiae et Asafoetidse. — Mixture of Magnesia and 
Asafetida. (Dewees' Carminative.) Dose, 1.20 C.C.; 20 TT\,. 

3. MAGNESII OXIDUM.— Magnesium Oxide. Magnesia. (Light 
Magnesia. Calcined Magnesia.) Dose, 2 gm.| 30 gr. 

4. MAGNESII OXIDUM PONDEROSUM. — Heavy Magnesium 

Oxide. Heavy Magnesia. Dose, 2 gm.; 30 gr. 

Action of Magnesium Salts. 

External. — None. 

Internal. — When injected intravenously, magnesium pro- 
duces much the same effects as potassium, causing paralysis of 
the heart and central nervous system ; but such results are 
never observed when it. is taken by the mouth, as the salts ap- 
pear to be rapidly excreted by the kidneys. Magnesium ox- 
ide and carbonate differ from the other saline cathartics in 
being very insoluble and in having an alkaline reaction, and 
in many ways they act like the alkalies, sodium and potassium. 
In the stomach they are partly converted into magnesium 
chloride, while in the intestine the carbon dioxide present may 
dissolve a part by forming the bicarbonate. They have a mild 
purgative action, and at the same time any excessive acidity in 
the gastro-intestinal tract is overcome by their alkalinity. 
Magnesium sulphate is a much more powerful cathartic. When 
this salt is converted into the bicarbonate in the small intes- 
tine, sodium sulphate is formed, and as the latter is, of course, 
also cathartic, the effect produced is doubly great. Its action 
is as a rule very satisfactory, large watery stools being pro- 
duced, with but little nausea or griping, and on account of 
its non-irritating qualities it will often be retained by the 
stomach when other remedies of its class are rejected. Like 
other alkalies, magnesium oxide and carbonate are diuretic 
and have the effect of promoting the alkalinity of the blood 
and urine, but on account of the difficulty with which they are 



MAGNESIUM. 211 

absorbed, this effect is less pronounced than in the case of 
sodium and potassium salts. The magnesium of the urine is 
increased by the administration of magnesium salts, especially 
if they fail to act on the bowels, but some of the magnesium 
may perhaps be excreted by the intestine and some even ap- 
pear in the milk. In the frog these salts are asserted to paralyze 
the muscles in the same way as potassium, but in mammals 
this is not the case even when they are intravenously injected, 
the animal dying from the action on the heart and central ner- 
vous system before the muscular action is induced. It is a fact 
worthy of note that in some instances the formation of large 
concretions in the bowel, resulting in obstruction, has been 
caused by the prolonged use of considerable amounts of mag- 
nesium oxide. 

Therapeutics of Magnesium Salts. 
Magnesium oxide and carbonate are used as mild antacid 
laxatives. They are favorite remedies in sick headache, espe- 
cially when accompanied by acidity and constipation, and in 
the digestive derangements of children. For the correction of 
acidity the carbonate is preferable if gastric irritability is pres- 
ent, as the carbon dioxide which is set free by the action of 
the acid met with in the stomach serves as a local sedative and 
anodyne. If these preparations do not enter into combination 
with the stomach acid, it is found that no laxative effect is 
produced, and under these circumstances the latter can be 
secured by following their administration with a solution of 
citric acid. In the intestinal indigestion of infants attended 
with flatulent colic magnesia is frequently given in association 
with carminatives, as in the Mistura Magnesise et Asafcetidae 
which was formerly official (Dewees' carminative). On ac- 
count of its antacid property it is also often combined with 
other cathartics. It has been prescribed in lithiasis and gouty 
affections, but in these is much less efficient than other alkalies, 
on account of the small amount of it which is absorbed. In 
order to produce alkaline effects upon the blood and urine it 
should therefore never be given except in cases where the 



212 PHARMACOLOGY AND THERAPEUTICS. 

potassium or sodium salts cannot be borne. Magnesium ox- 
ide and carbonate form insoluble compounds with mineral 
acids, oxalic acid, and the salts of arsenic, copper and mercury, 
while by their alkaline effect on the contents of the stomach 
they retard the absorption of alkaloids. In emergency they 
may therefore be used as antidotes to all these substances, but 
as to secure the desired effect they must be given very freely, 
their bulk makes them objectionable. Magnesia is to be pre- 
ferred, as the carbonate gives off carbon dioxide gas. As an 
antidote to arsenic trioxide in solution it is inferior to ferric 
hydrate, but in the absence of the latter may be resorted to. 
For this purpose it should be freshly precipitated. Magnesium 
sulphate is one of the best and most largely employed of saline 
cathartics. The commonly accepted view is that, like other 
purgatives of its class, it acts by abstracting water from the 
intestinal blood-vessels. It is frequently employed for the 
varieties of constipation associated with hepatic disorder, gout, 
or excessive uric acid, and especially in the form of natural 
mineral waters. It is an important constituent of most of the 
aperient waters. Whenever a thorough purgative action is de- 
sired, it should be given in concentrated form, so as to make 
its solution of as high a percentage as possible, and in cases 
of dropsy from 30 to 60 gm. (1 to 2 oz.) should be taken before 
breakfast, or on an empty stomach, in as little water as will 
dissolve the salt. The efficiency of the drug is greater if the 
amount prescribed is administered in divided doses every fifteen 
minutes until the whole is taken. For habitual constipation in 
those of full habit and active circulation a daily morning dose 
of a teaspoonful is often a permanently effective remedy, and 
where constipation, congestion of the pelvic viscera, and anaemia 
coexist it may be advantageously combined with ferric sul- 
phate, manganese sulphate, and dilute sulphuric acid. The 
disagreeable taste of Epsom salt may be very satisfactorily 
covered by coffee, and the following method of preparation has 
been recommended: Boil for two minutes in an earthen vessel 
30 gm. (1 oz.) of magnesium sulphate and 10 gm. (2 x / 2 dr.) of 



MAGNESIUM. 21 3 

roasted copper in 500 c.c. (1 pint) of water; then remove from 
the fire, allow it to " draw " for a few minutes, and strain. 
Magnesium sulphate may be given by the rectum for the double 
purpose of unloading the bowels and producing a depletant 
effect. It is useful with glycerin in concentrated enema for 
thorough cleansing of the bowels before surgical operations 
(glycerin, 30 c.c; 1 oz., in a saturated solution of magnesium 
sulphate, in hot water, 90 c.c; 3 oz., which is allowed to cool). 
Although theoretically it has been inferred that a saline cathar- 
tic injected intravenously or subcutaneously is incapable of 
causing purgation, practically it is found that a purgative 
action is thus produced; so that magnesium sulphate can also 
be used hypodermatically in dose of 20 gm. (3 gr.), which fre- 
quently will cause a watery evacuation. In operations during 
which the abdomen is opened, the subsequent intestinal paralysis 
may be prevented from causing constipation by injecting into 
the small intestine through a cannula 30 c.c. (one ounce) of a 
saturated solution of magnesium sulphate. The wound in the 
bowel should be closed by a Lembert stitch. 

Being non-irritant, magnesium sulphate may be given freely 
when inflammation is present, and in enteritis and peritonitis it 
is quite commonly used for its depletant action. It is also 
claimed that it' is better than ipecacuanha in the treatment of 
tropical and other dysenteries, and for this purpose is recom- 
mended to be administered in 4 c.c (1 fl. dr.) doses of a satu- 
rated solution with .60 to 1 c.c. (10 to 15 ^l) of aromatic sul- 
phuric acid every two hours. It is especially adapted to the 
acute stage, and morphine sulphate may be combined with it, or 
starch enemata with laudanum employed in addition. In lead- 
poisoning it is also of great service, especially if associated with 
sulphuric acid. Thus combined with sulphuric acid it some- 
times is efficacious in arresting bleeding from piles, especially 
if the state of the haemorrhoidal vessels be due to constipation, 
and it may also serve to relieve uterine haemorrhage caused 
by the presence of a fibroid, or by subinvolution, and conges- 
tion of the pelvic viscera. In impaction of the caecum, with re- 



214 PHARMACOLOGY AND THERAPEUTICS. 

suiting typhlitis, it will often liquefy the faecal masses and de- 
plete the vessels, and thus remove the obstruction without caus- 
ing any irritation. Among other conditions calling for the 
use of an active saline cathartic such as magnesium sulphate 
may be mentioned cholaemia, uraemia, oedema of the brain, and 
increased intra-cranial blood-pressure from whatever cause. 
The citrate is a cooling purgative, which operates mildly. It is 
very widely employed on account of its acceptability to the 
stomach and the facility with which it may be taken, and is 
often especially useful in the case of children. 

CALCIUM. 

1. CRETA PR^EPARATA. — Prepared Chalk. (Drop Chalk.) 
Dose, 1 gm.; 15 gr. 

Preparations. 

1. Pulvis Cretae Compositus. — Compound Chalk Powder. 
Dose, 2 gm.; 30 gr. 

2. Mistura Cretae. — Chalk Mixture. Dose, 16 c.c; 4 fl. dr. 

3. Hydrargyrum Cum Creta.— Mercury with Chalk. Dose, 
0.250 gm. (250 milligm.) ; 4 gr. 

Unofficial Preparation. 
Trochisci Cretae (U. S. P., 1890). — Troches of Chalk. Dose, 
ad libitum. 

2. CALCII CARBONAS PR^ECIPITATUS.— Precipitated Calcium 
Carbonate. Dose, 1 gm.; 15 gr. 

Action of Prepared Chalk and Calcium Carbonate. 

External. — Mildly astringent and desiccant. 

Internal. — Calcium carbonate is an antacid, absorbent and 
astringent, though its action in the latter capacity has not yet 
been explained. The great proportion of it taken leaves the 
body in the stools entirely unabsorbed. Such absorption as 
occurs has been found to take place in the upper part of the 
intestine, but the bulk of that which is absorbed appears to be 
re-excreted into the intestine. There is no evidence that it has 



CALCIUM. 215 

any diuretic action. The animal carbonates are said to be less 
liable to derange the stomach than the mineral preparations 
of calcium. 

Therapeutics of Prepared Chalk and Calcium Carbonate. 

External. — Prepared chalk is a good dusting-powder in moist 
eczema, intertrigo and hyperidrosis, and is sometimes used as 
a protective dressing for ulcers and sores. It is largely em- 
ployed, sometimes alone and sometimes with other substances, 
as a dentifrice, because of its mechanical action and also on 
account of its antacid, astringent and sedative effect upon the 
gums and buccal mucous membrane. The following are good 
formulae for tooth-powders : Potassium chlorate, 4 ; powdered 
soap, 8 ; carbolic acid, 2 ; oil of cinnamon, 1 ; precipitated cal- 
cium carbonate to 48 parts. Prepared chalk, 15; powdered 
blue flag flowers, 15; powdered cuttle-fish bone, 8 parts; oil 
of lemon, 1 part. 

Internal. — Chalk mixture is a useful remedy in diarrhoea, 
especially when the intestinal discharges are acid, and opiates 
and astringents are frequently added to it. It should generally 
be preceded by an evacuant to remove undigested food or other 
irritating substances. It is principally employed in the case 
of children. Compound chalk powder and mercury with chalk 
are also used in the treatment of diarrhoea. Calcium carbonate 
is given as a restorative and antacid in acid indigestion. Natural 
mineral waters which contain salts of calcium as prominent 
constituents, such as those of Contrexeville, Wildungen, Vittel, 
Clarendon and Waukesha, have gained considerable reputation 
for the treatment of uric acid gravel and other affections of the 
urinary system ; but it seems probable that the benefit derived 
from them is principally due to the large amount of liquid 
swallowed. They are used in quantities of from 1500 to 3000 
c.c. (3 to 6 pints) a day, and should be taken between meals 
in order to avoid indigestion from the excessive amount of fluid. 

3. CALX. — Lime. Calcium Oxide. (Burned Lime.) 



2l6 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Liquor Calcis. — Lime Water. Solution of Calcium Hy- 
droxide. Dose, 16 c.c; 4 fl. dr. 

2. Linimentum Calcis. — Lime Liniment. (Liniment of Cal- 
cium Oxide.) (Carron Oil.) 

3. Syrupus Calcis. — Syrup of Lime. Syrup of Calcium Hy- 
droxide. (Syrup of Lime.) Dose, 2 c.c; 30 n\. 

Action of Lime. 
External. — Lime water, which is mildly astringent, is also 
slightly caustic, but less so than the syrup. Slaked lime is a 
corrosive and disinfectant. The unslaked lime is changed 
at once to the hydrate in the presence of water, but the hydrate 
differs from those of the caustic alkalies in being much less 
soluble. Hence it does not penetrate so deeply or spread so 
widely. 

Internal. — Lime is antacid and astringent. The reason for 
its astringent action is unknown, but it has been suggested that 
it is probably due to its forming an insoluble compound with 
the surface proteids, in the same way as tannic acid, or to its 
being deposited as the carbonate or phosphate, and thus protect- 
ing the epithelium from irritation. It has the effect of allaying 
vomiting and it causes a subdivision of the coagula formed by 
milk in the stomach. It acts as an antidote to zinc chloride, 
oxalic acid, and mineral acids. The salts of lime are present in 
very large amount in the normal tissues, and it has been demon- 
strated that lime is required by the higher organisms, both 
animals and plants, for some of their functions. 

Therapeutics of Lime. 
External. — As a caustic it is seldom employed alone, but is 
generally combined with caustic potash (forming Vienna paste) 
or with caustic soda to form what is known as London paste. 
Lime water is used as a wash for foul and gangrenous ulcers 
and, either alone or combined with glycerin, in the treatment of 
acute vesicular eczema. It affords marked relief in the pruritus 



CALCIUM. 2 1/ 

which sometimes becomes intolerable in eczema and other in- 
flammatory affections of the skin and the itching experienced 
by the aged. It is also useful as an injection for thread-worms, 
leucorrhcea, gleet, and ulcerations of the bladder, and Lini- 
mentum Calcis is a standard remedy for burns. As the false 
membranes of diphtheria, croup, plastic bronchitis, etc., are com- 
posed largely of mucus, they may be broken down by alkalies, 
and for this purpose lime water is quite commonly employed. 
A lime water spray, produced by the atomizer, may be inhaled 
by the patient, or the patient may inhale the vapors arising 
from lime undergoing the process of slaking with water. 

Internal. — Lime water is very largely used in the treatment 
of vomiting, and for this purpose is generally given with 
milk, in varying proportion. It is constantly added to the 
milk of infants and invalids, as it prevents the formation of 
bulky coagula, and milk thus treated is more easily digested 
and less liable to cause intestinal disturbance. In cases of acid 
poisoning the syrup should be employed, or lime shaken up 
with water (milk of lime), as lime water contains too little 
of the base to be of service. Lime is especially valuable in 
the treatment of oxalic poisoning. As an antacid in the stomach 
it is inferior to many other alkalies, since it tends to delay the 
evacuation of the contents. Lime water and the syrup are 
both used as astringents in diarrhoea, more particularly in 
children, and when the stomach is irritable. In dyspepsia ac- 
companied with vomiting of food a diet exclusively composed 
of lime water and milk is often more effectual than any other 
plan of treatment. Lime water has sometimes been used in 
the treatment of rickets arid bone-softening, but when the fact 
is considered that this contains really less lime than cow's 
milk, it is difficult to see how it can be of any service in such 
conditions. Indeed, the utility of giving lime salts at all in 
rickets has been disputed, as it is contended that the disease 
is not due to a lack of lime in the food nor in the tissues gener- 
ally, but to some abnormal condition which prevents the lime 
salts from being deposited in the bones, although they may be 



2l8 PHARMACOLOGY AND THERAPEUTICS. 

present in abundance in the blood. It has been claimed that 
some improvement has occasionally been observed in cases 
in which the blood seemed less capable of coagulating them 
normally — particularly haemophilia and aneurism — as a result 
of the use of lime, but it has again been contended that the 
deficient coagulability is scarcely likely to be due to lack 
of the lime salts, since much more is taken in the food than is 
sufficient for the organism, and the medicinal lime preparations 
are not more easily absorbed than the combinations present 
in food. The urine of persons who take large quantities of 
lime water is stated to be often alkaline, and sometimes am- 
moniacal. The latter circumstance has been explained as due 
to the presence of calcium carbamate, which readily undergoes 
ammoniacal disintegration. 

4. CALCII PHOSPHAS PR^CIPITATUS.— Precipitated Calcium 
Phosphate. Dose, 1 gm.; 15 gr. 

Preparation. 
Syrupus Calcii Lactophosphatis. — Syrup of Calcium Lacto- 
phosphate. Dose, 8 c.c; 2 fl. dr. 

Action of Calcium Phosphate. 
So far as regards its mass, calcium phosphate is, next to 
water, the most important of the inorganic constituents of the 
body, and in all the solid tissues it is of service by giving to 
them their proper consistence and solidity. Thus, in the enamel 
of the teeth, the hardest tissue of the body, its quantity is no 
less than 885 parts in 1000, while in the bones there are 576 to 
the 1000. The large amount of it required by the system is 
supplied by the food (meats, vegetables, eggs, milk, bread and 
cereals all containing it), and a deficiency of the salt in the 
food leads to softening of the bones. The great proportion 
of the lime taken either in the food or as a remedy is found 
to leave the body in the faeces entirely unabsorbed, while a 
small quantity of it, whether it is taken in a soluble or insoluble 
form, is absorbed from the alimentary canal. This portion 



CALCIUM. 219 

circulates in the blood (in combination with proteids, it is 
thought), and is slowly excreted, unless there is a deficiency in 
the supply of lime, when it may be utilized by the tissues. 
When larger quantities are injected intravenously or subcu- 
taneously, it is stated that the calcium of the blood remains 
abnormally high for some time, but that all the lime thus in- 
jected is not in the circulation throughout its stay in the body; 
some of it being temporarily deposited in some unknown organ, 
from whence it is gradually withdrawn and excreted after 
the first excess is eliminated. The lime is excreted in part in 
the urine, but for the most part through the epithelium of the 
large intestine. 

Therapeutics of Calcium Phosphate. 
Notwithstanding the theoretical objections which have been 
urged against the utility of lime salts in rickets, calcium phos- 
phate has been largely employed in the treatment of this dis- 
ease, and with alleged good results. When used in rickets it 
is important that it should be made from bones. By some pe- 
diatrists the syrup of calcium lactophosphate is given the pref- 
erence, and this preparation is also used to a large extent in 
tuberculosis and other debilitated conditions of the system. 
Pregnant and nursing women are treated with calcium phos- 
phate for the purpose of supplying lime salts for the bones 
of the child. It is frequently combined with other phosphates, 
such as those of iron, sodium and potassium, in the treatment 
of rickets, mollities ossium, the different forms of scrofula, and 
anaemic conditions generally. It has also been thought useful 
in facilitating the union of fractured bones, and in experiments 
upon dogs and rabbits it is asserted that in fractures the callus 
forms more quickly under its use than without it. Being inert 
and almost insoluble, it is sometimes employed as a constituent 
of pills containing essential oils, and as it prevents agglutina- 
tion, is also used as a diluent for powders. 

5. CALCII CHLORIDUM.— Calciuni Chloride. Dose, 0.500 gm. 
(500 milligm.) ; 7V 2 gr. 



2 20 PHARMACOLOGY AND THERAPEUTICS. 

Action of Calcium Chloride. 
Calcium chloride is an irritant and resolvent. It is ex- 
tremely deliquescent, and its power of absorbing water is 
utilized for the dehydration of alcohol and ether and for other 
purposes. Outside the body it hastens the coagulation of the 
blood and produces a firmer clot. 

Therapeutics of Calcium Chloride. 
On account of its solubility in water calcium chloride is 
readily administered, and it has been employed in the treatment 
of chronic bronchitis, pneumonia, and phthisis and has been 
recommended for gastric catarrh and fermentative dyspepsia. 
Its most important use is for the haemorrhages of scurvy and 
haemophilia; one large daily dose of 2 gm. (30 gr.) is preferable 
to smaller ones frequently repeated. If maximum doses are 
administered for several days previously, it is often possible 
to perform operations upon bleeders. It may be of use in 
haematemesis and haemoptysis, and, possibly, also for aneurism. 
It is said to sometimes cause the resolution of glandular swell- 
ings and the calcification of the cicatrization of tuberculous de- 
posits, and also to be of service in lupus and other skin diseases. 

B. Drugs Acting on the Red Corpuscles. 

IRON. 

1. FERRUM.— Iron. 

2. FERRUM REDUCTUM.— Reduced Iron. (Quevenr.e's Iron. 
Iron by Hydrogen.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. 

3. FERRI SULPHAS.— Ferrous Sulphate. Dose, 0.200 gm. (200 
milligm.); 3 gr. 

Preparations. 

1. Ferri Sulphas Exsiccatus. — Exsiccated Ferrous Sulphate. 
Dose, 0.125 gr. (125 milligm.) ; 2 gr. 

2. Ferri Sulphas G-ranulatus. — Granulated Ferrous Sulphate. 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

3. Mistura Ferri Composita. — Compound Iron Mixture. 
Dose, 16 c.c: 4 fl. dr. 



IRON. 22 1 

4. Pilulse Ferri Carbonatis. — Pills of Ferrous Carbonate. 
(Ferruginous Pills. Chalybeate Pills. Blaud's Pills.) Dose, 2 
pills. 

4. FERRI CARBONAS SACCHARATUS.— Saccharated Ferrous 
Carbonate. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

5. MASSA FERRI CARBONATIS.— Mass of Ferrous Carbonate. 
(Vallet's Mass.) Dose, 0.250 gm. (250 milligm.); 4 gr. 

6. SYRUPUS FERRI IODIDL— Syrup of Ferrous Iodide. Dose, 
1 c.c; 15 tt\,. 

7. PILULE FERRI IODIDL— Pills of Ferrous Iodide. Dose, 2 
pills. 

8. FERRI CHLORIDUM.— Ferric Chloride. Dose, 0.065 gm. (65 
milligm.) ; 1 gr. 

9. LIQUOR FERRI CHLORIDL— Solution of Ferric Chloride. 
Dose, 0.1 c.c; V/ 2 n\,. 

Preparations. 

1. Tinctura Ferri Chloridi. — Tincture of Ferric Chloride. 
Dose, 0.5 c.c; 8 1ii. 

2. Liquor Ferri et Ammonii Acetatis. — Solution of Iron and 
Ammonium Acetate. Dose, 16 C.C.; 4 fl. dr. 

10. LIQUOR FERRI TERSULPHATIS.— Solution of Ferric Sul- 
phate. 

11. LIQUOR FERRI SUBSULPHATIS.— Solution of Ferric Sub- 
sulphate. Dose, 0.2 c.c; 3 Til. 

12. FERRI HYDROXIDUM (Ferri Oxidum Hydratum, U. S. P., 
1890). — Ferric Hydroxide. (Hydrated Ferric Oxide.) 

13. FERRI HYDROXIDUM CUM MAGNESII OXIDO (Ferri 
Oxidum Hydratum cum Magnesia, U. S. P., 1890). — Ferric Hydroxide 
with Magnesium Oxide. Dose (arsenical antidote), 120 C.C.; 4 fl. OZ. 

14. FERRI ET AMMONII SULPHAS.— Ferric Ammonium Sul- 
phate. (Ammonio-Ferric Alum.) Dose, 0.500 gm. ' (500 milligm.) ; 
IV2 gr. 

15. FERRI PHOSPHAS SOLUBILIS.— Soluble Ferric Phosphate. 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 



22 2 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Syrupus Ferri, Quininae et Strychninae Phosphatum.— 

Syrup of Iron, Quinine and Strychnine Phosphates. (Easton's 
Syrup. Syrupus Trium Phosphatum.) Dose, 4 gm.; 1 fl. dr. 

2. Elixir Ferri, Quininae et Strychninae Phosphatum. — 

Elixir of Iron, Quinine and Strychnine Phosphates. Dose, 4 
c.c.; 1 fl. dr. 

3. Glyceritum Ferri, Quininae et Strychninae Phosphatum. 

- — Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, 

1 c.c; 15 ul. 

16. FERRI ET AMMONII TARTRAS.— Iron and Ammonium 
Tartrate. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

17. FERRI ET POTASSII TARTRAS.— Iron and Potassium Tar- 
trate. (Tartarated Iron.) Dose, 0.250 gm. (250 milligm.); 4 gr. 

18. FERRI CITRAS.— Ferric Citrate. Dose, 0.250 gm. (250 mil- 
ligm.) ; 4 gr. 

19. FERRI ET AMMONII CITRAS.— Iron and Ammonium Citrate. 
Dose, 0.250 gm. (250 milligm.); 4 gr. 

Preparation. 
Vinum Ferri (Vinum Ferri Citratis, U. S. P., 1890). — Wine 
of Iron. (Wine of Ferric Citrate.) Dose, 8 C.C.; 2 fl. dr. 

20. FERRI ET QUININE CITRAS.— Iron and Quinine Citrate. 
Dose, 0.250 gm. (250 milligm.); 4 gr. 

Preparation. 
Vinum Ferri Amarum.— Bitter Wine of Iron. Dose, 8 c.c; 

2 fl. dr. 

21. FERRI ET QUININE CITRAS SOLUBILIS.— Soluble Iron 
and Quinine Citrate. Dose, 0.250 gm. (250 milligm.); 4 gr. 

22. FERRI ET STRYCHNINE CITRAS.— Iron and Strychnine 
Citrate. Dose, 0.125 gm. (125 milligm.); 2 gr. 

23. FERRI PYROPHOSPHAS SOLUBILIS.— Soluble Ferric Pyro- 
phosphate. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

24. FERRI HYPOPHOSPHIS. — Ferric Hypophosphite. Dose, 
0.200 gm. (200 milligm.); 3 gr. 



IRON. 22 3 

Preparation. 
Syrupus Hypophosphitum Compositus. — Compound Syrup of 
Hypophosphites. Dose, 8 C.C.; 2 fl. dr. 

Unofficial Preparations. 
Syrupus Hypophosphitum cum Ferro (U. S. P., 1890). — Syrup 
of Hypophosphites with Iron. Dose, i to 8 C.C.; 1 to 2 fl. dr. 

Ferri Iodidum Saccharatum (U. S. P... 1890). — Saccharated 
Ferrous Iodide. Dose, 0.30 to 1 gm.; 5 to 15 gr. 

Ferri Lactas (U. S. P., 1890). — Ferrous Lactate. Dose, 0.06 
to 0.30 gm.; 1 to 5 gr. 

Liquor Ferri Nitratis (U. S. P., 1890). — Solution of Ferric 
Nitrate. Dose, 0.12 to 0.60 c.c; 2 to 10 TT[. 

Liquor Ferri Citratis (U. S. P., 1890). — Solution of Ferric 
Citrate. Dose, 0.30 to 1 c.c; 5 to 15 TT1 . 

Liquor Ferri Acetatis (U. S. P., 1890). — Solution of Ferric 
Acetate. Dose, 0.12 to 0.60 c.c; 2 to 10 TT\. 

Emplastrum Ferri (U. S. P., 1890). — Iron Plaster. (Strength- 
ening Plaster.) 

Trochisci Ferri (U. S. P., 1890). — Troches of Iron. Dose, 
1 to 2 troches. 

Ferri Valerianas (U. S. P. ; 1890). — Ferric Valerianate. Dose, 
0.06 to 0.20 gm.; 1 to 3 gr. 

Ferri Arsenas. — Iron Arsenate. Dose, 0.005 to 0.008 gm.; 
T V to Vs gr. 

Ferrum Dialysatum. — Dialyzed Iron. Dose, 0.30 to 2 c.c; 

5 to 30 TTl. 

Ferratinum. — Ferratin. Dose, 0.10 to 0.50 gm.; V/ 2 to 8 gr. 

Action of Iron and its Salts. 
External. — While the salts of iron and their solutions have 
no action on the unbroken skin, on the abraded cuticle and on 
mucous membrane they have a powerful astringent effect by 
reason of their property of precipitating proteids ; so that all 
albuminous fluids are coagulated by them. In consequence 



224 PHARMACOLOGY AND THERAPEUTICS. 

of this action on the blood, as well as their effect on the vessels 
themselves, by which the calibre of the latter is diminished 
by the contraction of the coagulated albumin, they tend to arrest 
haemorrhage, and constitute in fact the most efficient local 
haemostatics at our command. While, however, some of the 
iron salts, such as the chloride, the nitrate, and the sulphate, 
have very marked astringent value, others are practically inert 
in this respect. Solutions of both ferrous and ferric salts have 
more or less antiseptic, germicidal and disinfectant activity, 
and since, in addition to arresting putrefaction, they neutralize 
the sulphur and ammonium compounds given off from decay- 
ing matter, they are also deodorizers. Ferric oxides, further- 
more, have the power of converting oxygen into ozone. 

Internal. Mouth. — Most of the preparations of iron have 
a peculiar metallic and astringent taste, known as chalybeate, 
which is most pronounced in the case of the persalts. The in- 
soluble and albuminous ones should be practically tasteless. 
The blackening of the teeth and tongue which is liable to result 
from the use of iron preparations has been supposed to be due 
to the formation of iron tannate from the tannic acid of the 
food or from the sulphur present in carious teeth or in the tar- 
tar. To avoid this it is advisable to take them through a glass 
tube and immediately afterwards to brush the teeth. The free 
acid in the tincture of ferric chloride or the acidity of the 
chloride itself will destroy the dental enamel even if diluted 
with eight parts of water. 

G astro -intestinal Tract. — In the stomach almost all the iron 
salts, it is supposed, form chlorides to a greater or less ex- 
tent, and are then changed into albuminates. Ferric chloride 
is said to be the only one of them which does not abstract 
hydrochloric acid from the gastric juice, and it is believed that 
it is probably to this circumstance that its peculiar value as 
a chalybeate remedy is due. Inorganic salts, if taken in suffi- 
cient quantity, act as gastro-intestinal irritants, causing pain 
and discomfort, with nausea and vomiting, and sometimes purg- 
ing. The more strongly acid ones have a more or less marked 



IRON. 225 

caustic effect upon the stomach, in consequence of the acid 
liberated after the formation of chlorides, and this is the -case 
even with preparations of ferric chloride, which always con- 
tain free acid. Hence those preparations which are not at all 
or but slightly acid, such as reduced iron, ferrous carbonate, 
and the unofficial dialyzed iron, do not as a rule cause digestive 
trouble, though it can also be said that they are generally not 
so efficient as the stronger preparations. However, this free 
acid may be neutralized by the addition of sodium bicarbonate, 
so that the tincture of ferric chloride will be acid only so far 
as the basic ferric chloride has an acid reaction; nor does 
this neutralization impair its therapeutic properties, for hydro- 
chloric acid is added to it in the stomach. An effective prep- 
aration is now made, in which these disadvantages of the tinc- 
ture of ferric chloride are removed, which is known as Weld's 
syrup of ferric chloride. As ferric chloride is strongly astrin- 
gent, most iron salts have an astringent action on the stomach, 
the degree of astringency depending upon the amount of the 
chloride which is formed from the gastric juice or is otherwise 
present. In the duodenum it is believed that the iron com- 
pounds, having been changed from chlorides into albuminates 
in the stomach, may in part be absorbed in solution, or precipi- 
tated and taken up as solids by the epithelial cells and the leuco- 
cytes, while the great bulk is carried on into the lower parts of 
the intestine. Under medicinal doses the secretions of the ali- 
mentary canal show a tendency to diminish, with the produc- 
tion of constipation, with hard, dry stools, while the faeces are 
blackened from the formation of ferrous sulphide and tannate. 
Absorption and Excretion. — The absorption of iron has been 
the subject of much discussion, but it seems to be now well 
established that inorganic iron salts, as well as the organic, 
are absorbed by the intestine. While authorities differ as to 
whether organic iron given by the mouth increases the amount 
of iron in the urine or not, the preponderance of evidence is 
to the effect that the quantity which is normally excreted in 
the urine (0.5 to 1.5 mg.) is not affected by the internal admin- 
16 



226 PHARMACOLOGY AND THERAPEUTICS. 

istration of either the organic or inorganic preparations. Hence 
the fact that an iron salt given by the mouth does not increase 
the urinary iron affords no ground for the assumption that it 
has not been absorbed. Neither does the iron absorbed increase 
the amount of iron in the bile or other excretions. The latest 
results of experimental researches would seem to indicate that 
the small part of the iron which in the duodenum is absorbed 
by the epithelium and leucocytes passes through the lymph 
channels to the mesenteric glands, and thence through the 
thoracic duct to the blood-vessels. It is then deposited in the 
spleen, where it may undergo some changes in form; later it 
is taken up by the blood and deposited in the liver and perhaps 
in the bone marrow. Where the supply of iron has been inade- 
quate for the formation of haemoglobin, it is thought that the 
originally inorganic iron is probably worked into higher forms, 
and eventually into haemoglobin in the liver, and that ferratin 
(which is an iron-containing proteid) is one of the intermediate 
steps in this synthesis. When there is no such deficiency, 
however, the liver slowly yields its store of iron to the blood, 
which carries it to the caecum and large intestine, by the epi- 
thelium of which it is finally excreted. Iron is normally present 
in all the tissues and secretions, but the greater portion of the 
total quantity in the body (estimated to be about 2.5 to 3.5 gm. ; 
40 to 55 gr., in a healthy adult), is to be found in the blood as 
haemoglobin. While some .0054 to .0108 gm. ( T ^ to i- gr.) of 
iron is taken in the food per diem, about the same amount is 
excreted, chiefly in the faeces and to a much smaller extent in 
the urine. Any excess of elimination following subcutaneous 
injection or excessive absorption from the intestine, it may 
be noted, takes place through the intestinal mucous membrane. 
Blood. — It is very much open to question whether an increase 
in the number of red blood-corpuscles or any other especial effect 
on the blood, is caused by the administration of iron in health. 
In many cases of anaemia, however, and particularly of chlorosis, 
the remedy has the effect of rapidly increasing both the num- 
ber of these corpuscles and the amount of haemoglobin in the 



IRON. 227 

blood. Iron is therefore said to be a haematinic, and as an 
improvement in the quality of the blood results in an improve- 
ment in the functions of the various organs of the body, it is 
also regarded as a tonic. Although the latest investigations 
show that inorganic iron follows the same course in the tissues 
as food iron, in the treatment of anaemic conditions it may some- 
times have a much more satisfactory effect than the latter. 
Thus, it has been pointed out that food-iron is always accom- 
panied by a large amount of colloid material, which may ma- 
terially delay its absorption, in particular as it seems absorb- 
able in only a very small part of the alimentary tract, the 
duodenum; inorganic iron on the other hand is much less 
completely enveloped and may be more easily absorbed. More- 
over, the iron preparations are used in much larger amounts 
than the food-irons, since to obtain the same effect from the 
latter it would be necessary to give more of them than could 
be digested. Accordingly, certain cases of chlorosis are met 
with in which little or no improvement seems to result from 
the use of foods containing iron, but which recover rapidly 
under inorganic iron. 

General Symptoms. — The general effects of iron upon the 
system, it has been found, can be obtained only by the intra- 
venous injection of double salts, like sodio-ferric tartrate, which 
do not coagulate the blood and at the same time are capable of 
freeing the iron ion in the tissues. From the results of ex- 
perimentation it would appear that iron, like the other heavy 
metals, has a specific irritant effect on the gastro-intestinal 
mucous membrane, and to a less extent on the kidney. It also 
depresses and eventually paralyzes the central nervous system, 
though how far this is the result of direct action and how far 
it is secondary to its effects in the alimentary canal is as yet 
unknown. The heart is apparently but little affected, though 
towards the end a rapid fall of blood-pressure is noticed. 
Post-mortem there is found swelling and congestion of the 
mucous membrane of the stomach and intestine, with numerous 
small blood extravasations in many instances. 



228 PHARMACOLOGY AND THERAPEUTICS. 

Remote Effects. — In addition to the improvement of the gen- 
eral system in anaemic subjects derived from the continued ad- 
ministration of iron, it has been thought that this agent has a 
direct effect on the kidneys (as a mild diuretic), as well as 
upon the menstrual function. More oxygen is carried to all the 
tissues, however, and it is possible that these supposed specific 
effects, which are not of a marked character, are simply the 
result of the benefit from the remedy in which the whole body 
shares. That the iron salts should have any remote astringent 
or haemostatic action, as has been contended by some, has never 
been demonstrated, and on theoretical grounds would seem to 
be highly improbable. Indeed, it is held by high authorities 
that to give iron in cases of metrorrhagia or menorrhagia is 
only to increase the loss of blood. The continued use of 
ferruginous preparations is liable to interfere with the diges- 
tion, and may produce gastric oppression, and even nausea and 
vomiting. In addition, they may give rise to acne, and in rare 
instances to symptoms of plethora and vascular excitement, 
with possibly haemorrhages from the mucous membranes. Ex- 
ceptionally also they may induce irritation of the kidneys, 
while in gouty subjects iron is apt to be badly borne. In gen- 
eral, the ferrous salts are likely to produce less disturbance in 
the system than the ferric ones, and the preparations which are 
best tolerated are reduced iron, the phosphate, and the pyro- 
phosphate. 

Therapeutics of Iron and its Salts. 
External. — Liquor Ferri Subsulphatis (Monsel's solution) and 
solutions of the sulphate, chloride and nitrate have long been 
held in the highest repute as local haemostatics, and are usually 
employed on lint or cotton, the special method of application 
depending on the part where the haemorrhage occurs. These 
preparations, however, form very disagreeable clots, which 
readily decompose and give rise to septic infection. The 
astringent salts of iron are not to be recommended in either 
superficial or deep wounds, where the haemorrhage can usually 



IRON. 229 

be controlled with more satisfactory results by properly ap- 
plied pressure. As an astringent for painting on the parts in 
pharyngitis or tonsillitis Liquor Ferri Chloridi, diluted with 
an equal quantity of water, is of service, or a solution of 1 
part of ferric chloride in 4 of glycerin may be used. The 
aqueous .solution of the chloride has also been employed as a 
spray for haemoptysis, but is objectionable for this purpose, as 
it is very liable to excite coughing. The tincture of ferric 
chloride has been highly recommended as a local application 
to the throat in diphtheria, and in erysipelas is sometimes painted 
over the inflamed surface. A wash containing .12 to .3 gm. (2 
to 5 gr.) of the sulphate to 30 c.c. (1 fl. oz.) of water is often 
useful in chronic and indolent ulcers, and a solution of the sul- 
phate (1 to 480) has also been used in gleet. 

Internal. Gastro-intestinal Tract. — In haemorrhage of the 
stomach, from whatever cause, the astringent preparations may 
often be employed with advantage. If the bleeding is profuse, 
4 c.c. (1 fl. dr.) of Liquor Ferri Chloridi, with 4 c.c. (1 fl. dr.) 
of glycerin to facilitate swallowing, should be given every hour 
or oftener; but such large quantities are not required in milder 
cases. Intestinal haemorrhage may also be treated in the same 
way, though the success of the remedy will depend largely on 
the location of the trouble. 

It is a common practice to counteract the tendency of the 
salts of iron to cause constipation by combining purgatives 
with them, but this method interferes with the time during 
which iron remains in the intestines, and it is better to admin- 
ister the laxative separately, so that the dose can be regulated 
according to circumstances. A pill of ferrous sulphate and ex- 
tract of nux vomica is often found very effectual in the treat- 
ment of chronic constipation. Here the active agent would 
seem to be the nux vomica, although it has been claimed by 
some that such constipation may be overcome by large doses 
of ferrous sulphate alone. At least, the constipating effect of 
iron salts is no doubt often much exaggerated. They have 
sometimes been given for diarrhoea, but this can be more satis- 
factorily treated by many other drugs. 



23O PHARMACOLOGY AND THERAPEUTICS. 

Thread- worms may be killed by a rectal injection of 4 c.c. 
(1 fl. dr.) of the tincture of ferric chloride in 250 c.c. (half a 
pint) of water, with the patient in the knee-chest position. 

One of the most efficient means of treating arsenical poison- 
ing is by ferric hydroxide with magnesium oxide. To prepare 
this for use a mixture of magnesium oxide (10 gm.) with 
sufficient water to make a homogeneous, thin magma is added 
gradually to solution of ferric sulphate, 40 c.c, mixed with 125 
c.c. of water, and the product is then shaken until a uniform, 
smooth mixture results. For the rapid preparation of this 
antidote it is advised that the diluted solution of ferric sulphate 
and the mixture of magnesium oxide with water should always 
be kept in readiness, in separate bottles. It should be given in 
large doses and frequently repeated. Another arsenical anti- 
dote is prepared by mixing together 90 c.c. (3 fl. oz.) of solu- 
tion of ferric sulphate and 30 gm. (1 oz.) of sodium car- 
bonate diluted with water, and of this, 15 c.c. ( z / 2 fl. oz.) should 
be given at short intervals. The insoluble arsenite which is 
formed in the body may be gotten rid of by a large dose of 
some simple purgative, such as magnesium sulphate. Poison- 
ing by arsenic may be also successfully treated by a dose of 
common salt or of sodium bicarbonate, followed by 30 c.c. (1 
fl. oz.) of dialyzed iron (which is useless as an iron prepara- 
tion), diluted with water. 

Ferruginous preparations are often administered with ad- 
vantage for the purpose of improving the appetite and digestion, 
and it is held by some that the chief use of iron as a remedy, 
even in anaemia, is to promote the digestive function. To aid 
appetite and digestion ferrous sulphate will usually be found 
the most serviceable preparation. 

Blood. — As has been stated, the administration of iron in 
anaemia, and especially chlorosis, often rapidly increases the 
amount of haemoglobin and the number of red corpuscles; and 
it is to restore these to their normal quantity that the ferrugi- 
nous preparations are most commonly given. It is to be noted, 
however, that they are useless in pernicious anaemia and of little 



IRON. 23 1 

value, if any, in the anaemia of leukaemia, exophthalmic goitre, 
and Hodgkin's disease. In common forms of anaemia which 
are secondary to some special cause, such as haemorrhage, lead 
poisoning, malaria, scurvy, etc., the removal of the cause is 
essential to recovery, but the use of iron salts is often of great 
service in aiding the latter. It has frequently been observed 
that iron has very little, if any, beneficial effect upon anaemic 
patients when it does not increase the desire for food and the 
ability to digest it, and in the anaemic condition, therefore, 
ferruginous preparations should be given not only for the 
purpose of restoring the quantity of the elements in which the 
blood is deficient, but also to increase the energy of the primary 
assimilation. To secure the latter object increasing quantities 
of the more active astringent salts, especially the sulphate and 
the chloride, are best. Large doses of these are frequently 
well borne, though it is worth noting that considerable amounts 
of the sulphate have been known to occasion obstruction of 
the bowels. When they produce any untoward effects they 
should be replaced by other preparations, preference being 
given to the most astringent ones which will be tolerated by 
the stomach. The styptic taste of the astringent compounds 
may be concealed by administering them with 4 c.c. (1 fl. dr.) 
of glycerin, which also has the effect of reducing some of the 
ferric to a ferrous salt, and this substance is frequently added 
to the tincture of ferric chloride. To restore the amount of 
haemoglobin and the number of red corpuscles, small doses — .06 
to .12 gm. (1 to 2 gr.) — of reduced iron or of the carbonate, 
or some one of the combinations with vegetable acids, are 
usually the most serviceable. As the scale preparations rarely 
disagree, they are much used for patients with weak digestion, 
and small doses can generally be continued for an indefinite 
period. The red wines and natural chalybeate waters, such 
as those of La Bourboule, Levico, Flitwick and the Columbian 
spring, Saratoga, may also prove useful. The numerous other 
symptoms besides dyspepsia which are dependent upon anaemic 
conditions, such as constipation, neuralgia, amenorrhcea, etc., 



232 PHARMACOLOGY AND THERAPEUTICS. 

are naturally improved by the treatment of the anaemia with 
iron. In chlorosis better results are often obtained from com- 
binations of iron with strychnine or arsenic than from iron 
alone. Easton's syrup (Syrupus Ferri, Quininae et Strychninae 
Phosphatum) and Easton's pill (Pilula Trium Phosphatum), 
which consists of quinine, .06 gm. (1 gr.) ; strychnine, .002 gm. 
(ti & r > concentrated phosphoric acid, .10 c.c (i l / 2 HI) ; and 
liquorice powder to .30 gm. (5 gr.) are much employed in con- 
valescence after serious illness and in anaemia and chlorosis gen- 
erally. Iron arsenate, although not official, is an excellent 
remedy in chlorosis. Good results have sometimes been claimed 
from ferrous iodide in cases of rheumatoid arthritis, and this 
preparation is very largely used for rachitic and scrofulous 
children, especially in association with codliver oil. The tinc- 
ture of ferric chloride, in doses of .60 to 1.20 c.c. (10 to 20 HI), 
sometimes as often as every hour, has proved beneficial in 
diphtheria and other severe diseases affecting the throat, and 
this is a favorite remedy in erysipelas. As the administration 
of iron tends to elevate the temperature in the sick, however, 
ferruginous preparations are generally inadvisable in other 
febrile diseases. Some individuals cannot take iron at all, on 
account of the severe headache or indigestion which it in- 
duces. Iron should always be administered when the stomach 
is full (after meals), except when given for follicular ton- 
silitis, diphtheria, erysipelas, gastric haemorrhage, or arsenical 
poisoning. 

Kidneys. — It would seem that iron probably has some specific 
action on the kidney, though its diuretic effect is comparatively 
slight. In Bright's disease the tincture of ferric chloride is 
constantly resorted to, both for its tonic and diuretic properties. 
Liquor Ferri et Ammonii Acetatis (Basham's mixture), an 
elegant preparation which is useful as a diaphoretic as well 
as a diuretic, has long been a favorite prescription in the 
anaemia of both acute and chronic parenchymatous nephritis. 

The Different Preparations of Iron. — While many of these 
are quite strongly astringent, others are practically non- 



IRON. 233 

astringent. There are some, viz., the iodide, the arsenate, the 
phosphate, iron and quinine citrate, and iron and strychnine 
citrate, in which the drugs with which the iron is com- 
bined increase their value and give them special applica- 
tions. While it has been thought that the arsenate must be 
exhibited in such small doses, in order to avoid arsenical poison- 
ing, that the iron in it can have little or no effect, clinicians 
have found that practically this preparation is by no means so 
actively toxic as is generally supposed, and that in compara- 
tively large doses it is an excellent remedy, particularly in 
chlorosis. In any case where arsenic is indicated in which 
such doses are not well borne, it is better to administer the 
two drugs separately. Ferric phosphate, which always con- 
tains some free phosphoric acid, is a reliable hsematinic, and 
it is a very palatable preparation. It has been largely used for 
children, and especially in rickets, under the idea that the 
phosphorus in it would promote the growth of bones. Parish's 
food, known also as Squire's chemical food, and Dusart's syrup 
both have for their chief ingredient ferric phosphate; the dose 
of each is 2 to 8 c.c. ; y 2 to 2 fl. dr. While in ferrous iodide 
the proportion of iron to iodine is small (1 to 9), it is a very 
useful preparation, although it is especially liable to injure the 
teeth. The iron and quinine citrate is a favorite mild prepara- 
tion for slight cases of anaemia, but must not be prescribed 
with alkalies, as they precipitate the quinine. Ferratin (not 
official) is claimed to be the characteristic iron compound of 
the liver. It is an acid albuminate, prepared artificially, and 
is used in doses from i l / 2 gr. ; .10 gm. to 8 gr. ; .50 gm. No 
evidence, experimental or clinical, has as yet been brought 
forward, which, outside of theoretical reasoning, makes the 
superiority of this over the older iron compounds probable. 
Since it is practically tasteless it is easily administered. Prac- 
tically all of the albuminates and peptonates to be found in the 
shops are worthless as hsematinics. 



234 PHARMACOLOGY AND THERAPEUTICS. 

ARSENIC. 

1. ARSENI TRIOXIDUM (Acidum Arsenosum, U. S. P., 1890).— 
Arsenic Trioxide. (Arsenous Acid. White Arsenic.) Dose, 0.002 
gm. (2 milligm.) ; ^ gr. 

Preparations. 

1. Liquor Potassii Arsenitis. — Solution of Potassium Arsen- 
ite. (Fowler's Solution.) Dose, 0.2 C.C.; 3 TT\,. 

2. Liquor Acidi Arsenosi. — Solution of Arsenous Acid. Dose, 
0.2 c.c; 3 nl. 

2. SODII ARSENAS.— Sodium Arsenate. Dose, 0.005 gm. (5 mil- 
ligm.) ; T \ gr. 

3. SODII ARSENAS EXSICCATUS.— Exsiccated Sodium Arsen- 
ate. Dose, 0.003 gm. (3 milligm.) ; ^\ gr. 

Preparation. 
Liquor Sodii Arsenatis. — Solution of Sodium Arsenate. 
(Pearson's Solution.) Dose, 0.2 c.c; 3 Tit- 

4. ARSENI IODIDUM.— Arsenous Iodide. Dose, 0.005 gm. (5 mil- 
ligm.) ; T \ gr. 

Preparation. 
Liquor .Arseni et Hydrargyri Iodidi. — Solution of Arsenous 
and Mercuric Iodides. (Donovan's Solution.) Dose, 0.1 C.C.; 

1% ni. 

Unofficial Preparations. 
Oleatum Arseni. — Oleate of Arsenic. 

Unguentum Arseni Oleati. — Ointment of Oleate of Arsenic. 
Acidum Cacodylicum. — Cacodylic Acid. Dose, .24 gm.; 4 gr. 

Ferri Arsenas. — Iron Arsenate. Dose, 0.005 gm. to 0.008 
gm.; T \ to y 8 gr. 

Sodii Cacodylas.— Sodium Cacodylate. Dose, .05 to .15 gm.; 
% to 2y 2 gl"., hypodermatically. 

Action of Arsenical Compounds. 
External. — Arsenic trioxide has no effect on the unbroken 
skin, unless it is repeatedly applied or allowed to remain in con- 






ARSENIC. 235 

tact with it for some time, when it may occasion redness or erup- 
tions of various kinds. Upon denuded surfaces and mucous 
membrane it has a considerable though slow caustic action. It 
acts much more energetically upon the higher than upon the 
lower organisms, and is not therefore of value as a germicide. 
While arsenic is toxic to all animals having a central nervous 
system and to most of the higher plants, it is not so to all 
lower organisms, and hence cannot be regarded as a general 
protoplasmic poison. It has the property of preserving animal 
tissues almost indefinitely. When metallic arsenic in a state 
of fine division is rubbed into the skin some toxic symptoms are 
observed which are thought to be due to its absorption in the 
form of an oxide. 

Internal. Alimentary Canal. — Toxic doses of arsenical prep- 
arations produce an acute gastro- enteritis. How far this is 
due to local action is now considered somewhat uncertain. As 
has been stated, the caustic action occurs but slowly, and the 
post-mortem findings show that the corrosion is seldom ex- 
tensive. Moreover, it has been found that the gastro-enteritis 
may be obtained with equal facility by injecting arsenic into 
the circulation. From the fact that under these circumstances 
some arsenic is excreted into the alimentary canal there may no 
doubt be some local action, but it is held that the quantity thus 
excreted is quite insufficient to account for the symptoms. 
Still further, it is known that arsenical compounds do not, like 
the corrosive poisons, change proteids in solution. The action 
of arsenic on the alimentary canal cannot therefore be re- 
garded as due to any ordinary form of corrosion. No matter 
how it is introduced into the system, the first and most marked 
effects are observed in the intestine. In consequence of the 
capillary paralysis produced by the drug there results an exuda- 
tion, which, having caused the throwing off of the epithelium 
in shreds, is poured out into the gut, where it becomes in great 
part coagulated. The epithelial coat of the intestine is found 
to have undergone fatty degeneration, and the degenerated 
epithelium sometimes closely resembles false membrane. The 



236 PHARMACOLOGY AND THERAPEUTICS. 

effect of this action is to set up a diarrhoea with stools having a 
"rice water" appearance, due to the shreds of mucous membrane 
and coagulated exudation which characterize them. Attention 
has been called to the fact that the pathology of this condition is 
exactly the same as that of Asiatic cholera, so that without 
a history it is impossible to distinguish between the two ex- 
cept by chemical examination of the dejecta. In exceptional 
instances the dilatation of the capillaries caused is so extreme 
that they become ruptured, and there result ecchymoses upon 
the mucous membrane, or even haemorrhage into the intestine 
or stomach, with bloody stools or vomiting. In therapeutic 
doses arsenic acts as a gastric stimulant, the dilatation of the 
vessels causing an increased flow of gastric juice; and in the 
same way the secretions of the duodenum are stimulated. It 
both increases the appetite and promotes digestion, and its 
specific action on the epithelium is no doubt concerned in the 
production of this effect. 

Blood-vessels and Circulation. — Mention has been made of 
the paralysis of the capillary vessels produced by arsenic. It 
is now believed by many that this capillary paralysis explains 
the whole course of the toxic action of the drug; the phenomena 
noted resembling those produced by an irritant inflammation, 
one of the essential features of which is increased permeability 
of the capillaries. In arsenical poisoning there is an early 
and pronounced fall of blood-pressure, and this has been demon- 
strated to be almost entirely vascular in origin. The vascular 
paralysis occasioned is mainly peripheral, and as the arterioles 
are found to be still capable of contracting, it is assumed that 
the structures beyond them, namely the capillaries, which more- 
over, are known to have become more permeable, are the seat 
of the paralysis. In addition, however, arsenic has some direct 
action upon the heart, paralyzing its rhythmic power and also 
depressing its contractility. In the excised heart of the frog 
the rapidity and force of the heart are diminished till the organ 
finally stops. Some of the most recent investigators, in ac- 
counting for the fall of blood-pressure, explain that the vaso- 



ARSENIC. 237 

motor centre and later the splanchnic nerves lose their control 
over the vessels. The dilatation of the mesenteric vessels leads 
to very marked congestion of the stomach and intestine, and, 
along with the lessened efficiency of the heart, reduces the 
pressure to zero. It would seem, therefore, that arsenic is 
poisonous chiefly from its depressant action on the vessels of 
the splanchnic area. 

Blood. — Opinions differ somewhat as to the action of arsenic 
on the blood. Some observers have found that in the normal 
subject it diminishes the number of the red corpuscles, but does 
not alter the total haemoglobin of the blood. Others find the 
blood-cells and haemoglobin unaltered by arsenic in normal 
animals, but describe the bone-marrow as evidently in a state 
of unusual activity, indicated by its increased vascularity, 
greater number of red corpuscles, and lessened fat-cells. In a 
case of pernicious anaemia recently examined it was noted that 
arsenic increased the number of newly formed red corpuscles, 
but that the number of more mature ones was diminished. 
While the action of arsenic is still obscure, it may be stated 
that the amount of haemoglobin does not seem to be affected by 
it, and that in certain diseases in which deficiency of the red 
corpuscles is a prominent symptom its administration is known 
to be capable of increasing their number, while in chlorosis and 
in health it apparently does not do so. In conditions of general 
poor health any improvement in the blood under its use has by 
many been attributed to improved appetite and increased nutri- 
tional activity. 

Respiration. — The respiration is temporarily accelerated by 
the intravenous injection of arsenic. In cases of poisoning in 
man it is only late that it is seriously affected, but it ceases 
before the heart. The failure of respiration is thought to be 
due to exhaustion and low blood-pressure, rather than to any 
specific action on the respiratory centre. 

Nervous System. — In frogs arsenic produces a descending 
paralysis, and it is recognized that in them the brain, spinal 
cord, and nerve terminations are directly acted on by it. In 



238 PHARMACOLOGY AND THERAPEUTICS. 

mammals, however, there is no evidence of such direct action 
in acute poisoning, though in chronic poisoning, as well as after 
a single large but not immediately fatal dose, lesions have 
sometimes been observed either in the spinal cord or the peri- 
pheral nerves. 

Absorption and Excretion. — Arsenic is taken into the blood 
with great facility, and that absorption may take place even 
from the unbroken skin is shown by the fact that cases of 
poisoning occur from the use of cosmetic preparations contain- 
ing the drug. It is excreted in the urine, faeces, sweat, and all 
the other excretions, though chiefly by the kidney, and the 
process is a very slow one. It is stored in all the organs ; some 
authorities stating that it is found, after absorption, in largest 
quantity in the liver, while others deny this. By means of the 
placental circulation it may also pass from the mother to the 
foetus. A minute amount of arsenic is normally present in the 
thyroid and thymus glands, the brain, and the skin in man, but 
none is found in the liver. Owing to its more intense action 
on the alimentary canal, the effect of arsenic on metabolism is 
not so liable to be noted as in the case of phosphorus, but it 
is very much the same. While the nitrogen of the urine is 
considerably increased, it is somewhat uncertain whether this 
is to be attributed to an increase in the urea or of other nitrog- 
enous substances. The ammonia seems to be increased, while 
the glycogen of the liver disappears entirely, and the liver is 
apparently incapable of forming it from the sugar of the food. 
The fatty degeneration which characterizes its action on the 
gastric and intestinal epithelium is also found in the liver and 
kidney, the muscle-cells of the heart, the blood-vessels and 
striated muscles, and the lining membrane of the alveoli of the 
lungs. While arsenic, like phosphorus, lessens the oxidation 
of the tissues and causes fatty degeneration of the cells of 
various organs, it seems probable that it may also increase the 
waste of the proteids of the body directly, though the increase 
in the nitrogen of the urine may possibly be secondary to the 
other features. The fatty degeneration which occurs may have 






ARSENIC. 239 

the same results as in phosphorus poisoning. The liver is found 
to be somewhat enlarged, while the pressure on the bile ducts 
prevents the escape of bile into the intestine. Jaundice, how- 
ever, is but rarely a very marked feature of arsenical poison- 
ing, and may be entirely absent. The improvement in nutrition 
under arsenic in doses insufficient to induce chronic poisoning 
is not well understood, though it may be that more of the food 
is utilized by the digestive apparatus, while at the same time 
less proteid is decomposed by the tissues. While it cannot be 
regarded at present that the effects of arsenic on the nutrition 
are definitely established, it is a recognized fact that as long 
as the drug does not interfere with digestion and absorption, 
it increases the excretion of nitrogen. Under these circum- 
stances it also causes increased deposition of fat. In the moun- 
tainous districts of Styria many of the inhabitants regularly 
eat white arsenic with the result of an increase in appetite, 
weight and strength and an improvement in the complexion. 
They gradually accustom themselves to use quantities which 
would prove fatal to ordinary individuals, and this tolerance 
seems the more remarkable as it has never been found possible 
to secure such an acquired immunity in the case of animals. It 
has been suggested that an antitoxin may be developed in these 
people. Usually, it is said, large doses are taken by them once 
or twice a week, and no fluid is swallowed for some time after- 
wards, so that some of the poison may pass through the bowel 
unabsorbed. These Styrian peasants generally live to old age, 
and no toxic symptoms are observed in them. On the other 
hand, the miners of Reichenstein, who are constantly exposed 
to arsenic, as it is contained in large quantities in the ore, are 
shortlived. They are described as very subject in childhood to 
severe rickets and in adult life to dropsies and respiratory dis- 
eases; while they offer little resistance to microbial infection 
and frequently present the cutaneous and nervous symptoms 
of arsenical poisoning. A characteristic feature of the con- 
tinued use of arsenic in many instances is the imparting to the 
breath and sweat of the odor of garlic. The excretion of 



24O PHARMACOLOGY AND THERAPEUTICS. 

arsenic takes place so slowly that the drug may be discovered 
in the urine five months after the last dose has been taken, and 
it is well known that arsenic may be found many years after 
death in the bodies of those who have taken it during life. 
Even in toxic doses, however, it is not always capable of pre- 
serving the body from corruption, since in the intestines of per- 
sons who have been poisoned with arsenic trioxide, examined 
some months after death, the poison has been found in the 
state of yellow arsenic sulphide, into which it has been con- 
verted by the hydrogen sulphide developed by the putrefactive 
process taking place in the bowel. 

Untoward Effects. — In very susceptible persons there have 
occasionally been noticed, from the use of medicinal doses, cer- 
tain effects which differ from the ordinary symptoms of chronic 
or arsenical poisoning. Among them may be mentioned rest- 
lessness, headache, alopecia circumscripta, bronchitis and 
hoarseness; more rarely, epistaxis, amblyopia, and anaphrodisia. 

Therapeutics of Arsenical Compounds. 
External. — Arsenic trioxide, either pure or as a paste, was 
formerly much more used than at present as a caustic for 
destroying growths of various kinds. Marsden's paste con- 
sists of arsenic trioxide, 1 ; powdered acacia, 2 parts. Another 
paste which was once very popular consisted of arsenous acid, 
1 ; charcoal, 1 ; red mercuric sulphide, 4 parts ; and water 
sufficient to make a paste. Unless it is used in sufficient 
strength to make the mass of dead tissue slough out quickly, 
there is danger of the patient becoming poisoned, as the arsenic 
is rapidly absorbed. A caustic powder may be made of arsenic 
trioxide, 1; calomel, 8; vermilion antimony sulphide, 8 parts. 
Liquor Potassii Arsenitis is sometimes used as an application 
for corns. The ointment of oleate of arsenic (not official) 
makes a useful application in the treatment of old ulcers, epithe- 
lioma and lupus. Its efficiency is increased by the addition of 
a small amount of zinc chloride, and morphine sulphate may be 
incorporated with it to allay pain. Arsenous iodide in ointment 



ARSENIC. 24I 

(.30 gm. ; 5 gr. to 4 gm. ; 1 dr.) has been found a valuable 
stimulating application in old dry eczema. For lupus it may 
be made stronger, or may be combined with mercuric chloride. 
Mercurial ointment containing from 5 to 10 per cent, of 
arsenic has been advised for warts. Arsenic trioxide is now 
much employed for killing the nerves of teeth. As this requires 
several days, it illustrates the slowness of the corrosive action 
of arsenic. 

Internal. Alimentary Canal. — A course of arsenical treat- 
ment should always be commenced with small doses ; for in- 
stance, .20 to .25 c.c. (3 or 4 R) of Liquor Potassii Arsenitis, 
or .001 to .0015 gm. (-g-^ to J ? gr.) of arsenic trioxide in pill or 
tablet. The dose should usually then be gradually increased. In 
this way the gastric pain, nausea, diarrhoea and other symp- 
toms of poisoning which the drug is liable to produce may be 
avoided. Another precaution which should commonly be ob- 
served is to administer arsenic immediately after eating, in order 
that it may be diluted by the contents of a full stomach. When 
the dose used is minute, however, it is often best to give it be- 
fore meals. As a rule, children bear arsenic well, while the aged 
do not. As arsenic increases the appetite, it is useful as a 
tonic in many conditions, and it is also found of service in 
some forms of dyspepsia. Small doses sometimes check vomit- 
ing, and especially that variety in which there is simple regurgi- 
tation of the food. Liquor Potassii Arsenitis, in doses of .06 or 
.12 c.c. (1 or 2 TTL) before each meal proves efficient in some 
cases of the vomiting of pregnancy, as well as in the vomiting 
of chronic gastric catarrh, especially the alcoholic form. It is 
also very beneficial, given in the same way, in what is known 
as irritative dyspepsia, which is characterized by a red and 
pointed tongue, poor appetite, and distress after meals, the 
presence of the food causing intestinal pain, and the desire to 
go to stool. Arsenic in these small doses is furthermore of 
service in chronic gastric ulcer and also in cancer of the 
stomach, where it diminishes the pain and checks the vomiting; 
while gastrodynia and enteralgia, when idiopathic, are often 
17 



242 PHARMACOLOGY AND THERAPEUTICS. 

promptly relieved by it. In some of the conditions mentioned 
the effects of the arsenic are found to be increased by the con- 
joint administration of a little laudanum. In the treatment of 
stomach disorders it must be borne in mind that only small 
doses are admissi-ble, as larger ones will serve to irritate the 
mucous membrane, and thus defeat the end in view. Occa- 
sionally it will be found that arsenic is capable of controlling- 
diarrhoeas which prove unamenable to other remedies. It is 
especially useful in that form of diarrhoea dependent upon an 
intolerance of the presence of food, where the undigested ali- 
ment is evacuated soon after it is swallowed. Chronic diarrhoea 
and dysentery, particularly when due to malarial cachexia, may 
also often be greatly benefited by it. In these cases it is best 
to give .12 c.c. (2 HI) of Liquor Potassii Arsenitis with .30 
c.c. (5 TTL) of laudanum before meals. Arsenic has even been 
proposed as an appropriate remedy in Asiatic cholera. In cases 
of constipation where there is deficient intestinal secretion, with 
dry faeces, it sometimes acts well. It has proved of service in 
catarrhal jaundice, and is especially recommended when the 
trouble is of malarial origin. 

Remote Effects. — Arsenic is used to some extent in the 
treatment of anaemia, and especially in cases of what is desig- 
nated primary anaemia, including leucocythaemia, exophthalmic 
goitre, Hodgkin's disease, and pernicious anaemia. It may per- 
haps prove of service, but in these conditions all remedies 
sometimes seem without effect. In chlorosis and in cases of 
anaemia where iron disagrees with the patient or proves un- 
successful it is worthy of trial, and is considered by some 
clinicians one of the most valuable agents in the pharmacopoeia. 
In these disorders the efficiency of iron is at times much in- 
creased by the addition of arsenic. Although much inferior to 
that drug, it is next to quinine the most efficient remedy in 
malarial infection which we possess. It is in chronic cases that 
it is especially beneficial. Reference has already been made 
to its value in intestinal disorders due to such infection, and 
it is also of service (though distinctly less than quinine) in 



ARSENIC. 243 

various other affections when of malarial origin, such as hemi- 
crania and other neuralgias. As a prophylactic against malaria 
some of the observations made apparently indicate that arsenic 
is superior even to quinine. In a considerable number of ner- 
vous conditions, whether there is a malarial taint present or not, 
it is of value. Among these may be mentioned cerebral con- 
gestion, melancholy and hypochondria of the aged, and espe- 
cially chorea. In the latter it should be given in rapidly in- 
creasing doses. In paralysis agitans, as well as in local chorea 
and histrionic spasm, the subcutaneous injection of Fowler's 
solution or Pearson's solution of sodium arsenate (solution of 
sodium arsenate, U. S. P., 10 c.c. ; distilled water, 90 c.c.) has 
sometimes proved of great service. Arsenic employed by this 
method is also an efficient remedy in lymphadenoma and in 
malarial hypertrophy of the liver and spleen, and has been 
known to be successful in obstinate cases of general malaria 
which have resisted the action of quinine. Used either inter- 
nally or locally (often by fumigation in the form of arsenical 
cigarettes) arsenic is useful in chronic bronchitis, emphysema, 
spasmodic asthma, " hay asthma," chronic pneumonia (fibroid 
phthisis), and even pulmonary tuberculosis when the course of 
the disease is very slow. Arsenous iodide, .30 c.c. (5 ni) after 
each meal of a 1 per cent, solution, increased to .90 c.c. (15 TTi) 
or 1.20 c.c. (20 HI), has been found of value in the bronchitis 
of strumous children. In both acute and chronic coryza the 
fumes of arsenical cigarettes, snuffed into the nares, are of 
service. Such cigarettes may be made by saturating bibulous 
paper in a solution of 1 gm. (15 gr.) of potassium arsenate to 
30 c.c. (1 fl. oz.) of water. In short breathing from cardiac 
weakness, especially in elderly persons, arsenic is apt to afford 
relief, and attacks of angina pectoris may sometimes be lessened 
or prevented by the persistent use of the drug in the interval. 
A course of . arsenic often has a valuable tonic influence in 
organic heart disease, and under its use dyspnoea, palpitation, 
intermittency of the pulse, and oedema improve. It has been 
found very useful in a certain form of chronic arthritis, in 



244 PHARMACOLOGY AND THERAPEUTICS, 

which the joints become stiff and painful in consequence of 
a peculiar state of the nervous system; the trophic nerves being 
involved and the condition one allied to neuralgia. As to its 
value in the kind of chronic rheumatism or rheumatic gout 
which is accompanied by nodosities of the joints authorities 
differ. By some it is claimed that it is of considerable service 
in those forms of chronic rheumatism in which potassium iodide 
is commonly employed, and that it is often advantageous to 
administer these two alteratives alternately for periods of 
three or four weeks. Arsenic has been employed with good 
effect in albuminuria following scarlatina, and also appears to 
be useful in certain forms of chronic albuminuria. It is 
thought to be of considerable value in diabetes of hepatic origin, 
and at the present time Clemens' bromide solution (consisting 
of a solution in water of arsenic trioxide, bromide and potassium 
bicarbonate) is much in favor as a remedy for diabetes. Good 
results have also been claimed from the persevering use of 
small doses of arsenic in cirrhosis of the liver, in epithelioma, 
and in rodent ulcer, while some have believed that it is useful in 
scirrhus, especially as the disease manifests itself in the 
stomach, and in retarding the growth of uterine cancer. There 
appears to be good evidence that arsenic in large doses restrains 
the growth of sarcomata, particularly of the fusiform-cell va- 
riety. 

One of the most useful and general applications of the drug 
is in the treatment of diseases of the skin. As it exerts its in- 
fluence chiefly upon the epidermis, its action being upon nutri- 
tion through the nerves, diseases affecting the more superficial 
strata of the integument are most amenable to it, while it pro- 
duces a less marked effect upon those having their seat in the 
deeper structures. It should not be employed when there 
is great heat, burning, intense itching, or rapid cell-change, and 
should therefore rarely be prescribed in the acute inflammatory 
stage of any cutaneous affection. It is of great value in many 
cases of psoriasis, in certain varieties of eczema, especially in 
chronic squamous and papular forms of the disease, in acne of 



ARSENIC. 245 

the small papular variety, especially in neurotic cases, in certain 
glandular hypersecretory diseases of neurotic origin, such as 
seborrhcea and hyperidrosis, in lichen, and in pemphigus. It 
should be avoided in acute eczema unless the case is distinctly 
neurotic. It is sometimes of service in chronic urticaria, and 
also in morphcea, alopecia circumscripta, and other atropic dis- 
eases. Dermatologists hold that in all diseases of the skin be- 
fore arsenic is prescribed the digestive tract should be carefully 
investigated, and if any abnormal condition is shown, that this 
should be rectified. It is sometimes found that syphilitic affec- 
tions can be better treated by the combination of mercury with 
arsenic than by mercury alone, and Donovan's solution (Liquor 
Arseni et Hydrargyri Iodidi) is especially useful in old 
syphilitic skin lesions. Furunculosis may be successfully treated 
by the persistent use of arsenic, and small doses of it are 
said to have a curative effect upon warts. Given in associa- 
tion with the bromides, it is useful in lessening or preventing 
the disfiguring acne which so frequently results from the con- 
tinued administration of these drugs. 

The springs of Levico and La Bourboule contain arsenic tri- 
oxide. Strong Levico contains .005 gm. (-^ gr.) of arsenic 
trioxide and 2 gm. (30 gr.) of iron to 500 c.c. (1 pint) ; weak 
Levico, .0005 gm. ( t ^-q gr.) and 0.5 gm. (8 gr.) respectively. 
La Bourboule contains .005 gm. ( T ^.gr.) of arsenous acid and a 
trace of iron to 500 c.c. (1 pint). These waters should always 
be taken with the meals. 

Cacodylic acid (AsO(OH)0(CH 3 ) 2 ), (not official), and so- 
dium cacodylate (AsONa(CH 3 ) 2 ), (not official) have recently 
been proposed as eligible methods for the administration of 
arsenic. The former contains 58 per cent, of arsenic. Their 
solubility, relatively small toxicity, and the diminished local 
irritation which they produce are advantages to be borne in 
mind. The best form of administration is as sodium cacodylate, 
given hypodermatically in daily amount of from .05 to 15 gm. 
(24 to 2 l / 2 gr.), in solution. By this method the arsenic is 
fully efficacious, no alliaceous odor is given to the breath or 



246 PHARMACOLOGY AND THERAPEUTICS. 

perspiration, and gastric and intestinal disturbances do not 
supervene. Prolonged use, however, may set up albuminuria. 
By the rectum it produces less irritation and the odor of garlic 
is not so pronounced as after the use of Fowler's solution. This 
method is preferable in the treatment of tuberculosis, diabetes, 
Basedow's disease, and leukaemia. It has been objected against 
the use of the cacodylates that if they can be administered in 
comparatively large doses without producing characteristic 
symptoms of the action of arsenic, it must be because the arsenic 
ion has been rendered inert; the reason for this probably being 
that in these substances there is formed so firm and stable a 
union of the arsenic with other ingredients that no dissociating 
influence to which it is subjected in the body is capable of 
setting free the active arsenic ion from the combination. It 
is also claimed that in several diseases in which the older 
arsenical compounds are given with advantage no therapeutic 
results assignable to arsenic have been obtained from the caco- 
dylates; and, furthermore, that when these are administered, 
they pass through the system and are eliminated in such stable 
combinations with organic bodies that they fail to react to the 
usual tests for arsenates, and fail to yield arsenicum when sub- 
jected to the dissociating influence of Marsh's process. To 
these objections it may be answered that while the cacodylates 
are absorbed but slowly and the arsenic ion is dissociated with 
difficulty, they do produce distinct arsenical effects in the body, 
as has been unquestionably shown by the fact that cases are on 
record in which poisoning with the characteristic symptoms of 
arsenic has occurred. In addition, this has been demonstrated 
by the fact that in some diseases, at all events, in which the 
ordinary compounds are known to be efficient, equally good re- 
sults have been obtained from the use of the cacodylates. In 
seeking for a cause for this discrepancy between observers at- 
tention should be called to the fact that the strongest objection 
to the use of the cacodylates has been made by those who have 
administered them by the mouth. When given hypodermatic- 
ally several disadvantages are obviated; the garlic-like odor of 



ARSENIC. 247 

the breath, intestinal irritation, etc. Quite lately a new com- 
pound, disodic-methyl-arsenate (AsCH 3 3 Na 2 H 2 2 ), to which 
the name of arrhenal has been given, has been brought forward 

as an agent which, it is asserted, is free from certain alleged 
disadvantages of other similar compounds, and for which some- 
what extravagant claims have been made for its efficacy in 
bronchitis, tuberculosis, chorea, syphilis, anaemia, adenitis, 
leukaemia, malaria, and other affections. These claims have 
already been disputed, and it is as yet too soon to form any 
positive opinion regarding its merits. It is stated to be non- 
toxic, and is given in quite large doses, ranging from .18 to 2.5 
gm. (3 to 40 gr.) daily. 

TOXICOLOGY. 

Acute Poisoning. — Arsenic is used to a very considerable extent for 
poisonous purposes. The forms most employed are Scheele's and Paris 
Green (cupric arsenite), and Schweinfurth's Green (a compound of 
cupric arsenite and arsenate). Symptoms. — As the pathology of the 
effects of arsenical salts in the alimentary canal is practically the same 
as that of Asiatic cholera, so the symptoms of poisoning by them gen- 
erally resemble very closely those met with in that disease. Large 
doses frequently produce no distress for a considerable time, but in the 
course of half an hour, or perhaps longer, the patient experiences a 
sense of constriction in the fauces, with dysphagia. About the same 
time he begins to suffer from slight epigastric pain, which soon becomes 
extreme, and spreads over the abdomen. It is accompanied with faint- 
ness, nausea and excessive vomiting, and later by profuse watery diar- 
rhoea, with tenesmus and intense thirst. The matter vomited and the 
stools may contain blood, but this is not infrequently absent. The pa- 
tient also suffers from muscular cramps, headache and dizziness, and 
gradually sinks into collapse, with coldness of the extremities, pallor, 
small and feeble pulse, and sighing respiration. This condition passes 
into one of coma, followed by death, which may or may not be pre- 
ceded by convulsions. Exceptional cases have been noted in which the 
only symptoms were those of collapse and coma. Death may perhaps 
occur within twenty-four hours, but more commonly the vital powers 
are not exhausted for considerably longer than this, and the patient 
may linger for several days. Not infrequently it is found to be the 
case that he recovers from the acute symptoms only to develop those 
of chronic arsenical poisoning. 



248 PHARMACOLOGY AND THERAPEUTICS. 

Post-mortem. — The mucous membrane of the gastro-intestinal tract is 
generally red and swollen, while its epithelial coat in many places can 
be readily detached and is found to be in a state of fatty degeneration. 
As a rule, no erosion is observed unless the arsenic has been swallowed 
in powder, when, if the latter has remained for some time in contact 
with the wall of the stomach, there may perhaps be some erosion, as 
well as more marked congestion, as the result of its local action. In 
the intestine the swelling and congestion of the mucous membrane is 
most pronounced around Peyer's patches, and the bowel generally con- 
tains a considerable quantity of thin fluid with flakes of membrane, like 
the rice-water discharges of cholera. Haemorrhage is only occasionally 
met with, but in both the stomach and intestine small particles of ar- 
senic are not infrequently observed. 

Treatment. — It is important that the stomach should be completely 
emptied as soon as possible, either by washing out or the use of emetics 
(see p. 175), choice being made of those least depressing and least 
irritating. On account of the insolubility of arsenic it is advisable that 
the stomach washing should be continued for some time. At the same 
time large quantities of freshly prepared ferric hydroxide with mag- 
nesium oxide (see p. 230) or dialyzed iron should be given ; if these 
cannot be obtained, magnesia (preferably light magnesia) shaken up 
with water. The antidote must be repeated at intervals as long as the 
acute symptoms continue. If neither magnesia nor the iron prepara- 
tions are procurable, dependence must be placed on large doses of 
castor oil and water. For the collapse subcutaneous injections of 
brandy or ether may be given, and warm applications made to the 
abdomen and extremities. 

Chronic Poisoning. — When arsenic is given medicinally, too large 
doses may induce slight symptoms of poisoning, such as abdominal pain, 
loss of appetite, nausea, indigestion, mild diarrhoea, pumness of the eye- 
lids, injection of the conjunctiva, and watering of the eyes and nose. 

Cutaneous eruptions are also sometimes caused, and while these may 
be due in part to circulatory derangements, they are believed to result 
chiefly from a direct action of the drug on the skin. They may be 
erythematous, papular, vesicular or pustular in character, and may be 
attended with erysipelatous swelling. Herpes zoster, it is said, has been 
caused by its prolonged administration. As arsenic is very extensively 
used in the arts, particularly in the manufacture of wall papers and 
fabrics, accidental poisoning is not infrequent among workers in arsenic 
and may occur in persons using articles which contain it. The evidence 
in regard to chronic poisoning from occupancy of rooms decorated with 



DRUGS ACTING ON CARDIAC MECHANISM. 249 

arsenical wall paper is somewhat contradictory, but the facts point 
towards its probability. Quite as often the poisoning is due to the 
arsenic which is a contamination of aniline dyes as it is to the arsenical 
pigments, so that the color should not be depended upon, but rather a 
chemical examination. 

As the arsenical poisoning goes on, a catarrhal condition of the mu- 
cous membrane of the nose and throat is developed, with much sneezing 
and coughing, cutaneous eruptions of various kinds appear, and, in some 
instances, a curious pigmentation of the skin occurs (arsenic melanosis) ; 
while eventually the hair and nails fall out. Swelling of the liver, with 
jaundice, is sometimes met with, and the later phases of the disorder 
are characterized by sensory and motor disturbances in localized areas 
(generally in the hands and feet), the result of polyneuritis. There 
are acute pain and formication in the extremities, followed by sensory 
paralysis, with symptoms resembling those of locomotor ataxia. This 
again is succeeded by motor paralysis, which as a rule is confined to the 
extremities, but may possibly invade the trunk. It is generally sym- 
metrical and the affected muscles (more commonly the extensors than 
the flexors) atrophy quite rapidly. Herpes of the face or trunk, of 
nervous origin, is a common symptom. In very prolonged cases the 
patient may sink into an apathetic, semi-idiotic condition, or may be- 
come epileptic. After death from chronic poisoning, in addition to the 
gastro-intestinal and nervous lesions, there is found fatty degeneration 
of most of the organs of the body, and particularly the liver, kidneys, 
stomach and muscles, including the heart. 

The tests for arsenic are so simple that every physician should be 
able to make use of them. They are: (1) Reinsch's. — Hydrochloric 
acid and a clean slip of copper are boiled in the suspected liquid. Bluish 
spots indicate the poison. (2) Marsh's. — Diluted sulphuric acid and 
zinc are introduced into a flask with the suspected liquid. The gas issu- 
ing from the tube is ignited and the flame allowed to impinge upon a 
clean porcelain plate forming a steel-white mirror if arsenic be present ; 
or the delivery tube may be heated when the mirror will be deposited 
upon it. This mirror is distinguished from that produced by antimony 
by its solubility in potassium hypochlorite if arsenic is the cause. 

Division III. — Drugs Acting on the Cardiac Mechanism. 
While it was formerly supposed that the spontaneous im- 
pulses originating in the heart, which normally commence in 
the sinus venosus and extend downwards over the auricle and 
ventricle to the apex, had their birth in the cardiac ganglia, the 



2 50 PHARMACOLOGY AND THERAPEUTICS. 

real function of these ganglia (which may possibly be a nutri- 
tive one), is still practically unknown, and there is now at 
command considerable evidence to the effect that it is in con- 
sequence of impulses originating in themselves that the muscu- 
lar fibres contract. The contractile function of the muscular 
fibres is, however, subject to two opposing influences, one that 
of the accelerator nerve-fibres connected with the sympathetic, 
which tends to augment it, and the other that of the pneumo- 
gastric, or vagus, which tends to inhibit it. In studying the 
effects of drugs on the heart, therefore, all that we are called 
upon to consider is their action on the muscular structure of 
the heart, on the nerve-fibres distributed to it from the vagus 
and the sympathetic, and on the vagus and accelerator centres 
in the medulla oblongata. These centres, it may be stated, are 
extremely sensitive to afferent impulses conveyed from various 
parts of the body, as well as from the heart itself. Our knowl- 
edge of the action of drugs upon the human heart is necessarily 
somewhat imperfect, since it is principally derived from experi- 
mentation on animals, in connection with which there are a 
number of difficulties and sources of error. Thus, many ex- 
periments cannot be satisfactorily made upon the mammalian 
heart, and hence the cold-blooded animals have been made use 
of to a large extent. As some differences have been observed 
among them (as, for instance, between the frog and the tor- 
toise) it is a question how far deductions from experiments 
upon the hearts of warm-blooded animals, among which, again, 
decided differences are sometimes found, are applicable to the 
human heart. A uniformity of effect will naturally go far to 
establish the character of any given action as regards man, but 
in general we have to depend largely on probabilities in this 
matter. Attention may here be directed to one point of inter- 
est; the action of a large dose of a drug is as a rule the oppo- 
site of that of a moderate dose. 

A. Drugs Acting Upon the Heart Directly. — Our knowledge 
of these has been derived from the application to the heart of 
a solution of the drug externally, or by means of a transfusion 



DRUGS ACTING ON CARDIAC MECHANISM. 25 I 

cannula, and by the action of the drug upon the excised heart 
or section of a heart. Since the apex probably contains no 
nerves, it is customary to conclude that if a drug has an action 
on the isolated apex it acts exclusively upon the muscles ; but 
as it is always a difficult matter to decide whether a drug acts 
upon the muscle fibre itself or upon the fine nerves between the 
fibres, it will be found advisable to make no attempt to distin- 
guish between these actions. In studying the nervous influ- 
ences affecting the heart's action much more attention has been 
paid to the inhibitory or vagus than to the accelerating mechan- 
ism. The effect of stimulating the muscle is the same as that 
of stimulating the accelerator fibres, and consists in an augmen- 
tation of either the rate or the force of the beat, or both. On 
the other hand, stimulation of the vagus fibres or its cardiac 
terminations may cause a diminution in either the rate or the 
force of the beat, or both; while the paralyzing of either the 
accelerator or vagus terminations naturally produces an effect 
just the opposite to their stimulation. As it is very difficult to 
decide whether drugs act upon the muscle or on the nerve- 
endings, it will be most convenient to classify those which act 
locally on the heart by the effect they produce, without refer- 
ence to this point. 

Drugs increasing the force of the contraction : 

(1) Digitalis. (6) Caffeine. 

(2) Strophanthus. (7) Veratrine. 

(3) Adonidin. (8) Erythrophloeum. 

(4) Squill. (9) Barium Salts. 

(5) Convallaria Majalis. 

In frogs these drugs, in large doses, always cause arrest of the heart 
in systole ; in mammals the final arrest may be in diastole with some, 
e. g., digitalis. They all slow the pulse. 

(10) Camphor. | (13) Dilute solutions of zinc 

(11) Musk. double salts. 

(12) Dilute solutions of cop- j (14) Dilute solutions of chloral. 

per double salts. I (15) Physostigmine. 

These drugs have the same action without the final arrest in systole. 
The rate of the pulse is not markedly altered. 



252 



PHARMACOLOGY AND THERAPEUTICS. 



Drugs the chief action of which is to decrease the force of the con- 
traction, usually with stoppage in diastole : 



(1) Diluted acids. 

(2) Strong solutions of salts 

of the alkaline metals. 

(3) Strong solutions of ba- 

rium salts. 

(4) Strong solutions of cop- 

per double salts. 

(5) Strong solutions of zinc 

double salts. 



(6) Strong solutions of chloral. 

(7) Muscarine. 

(8) Pilocarpine. 

(9) Saponin (large doses). 

(10) Apomorphine. 

(11) Emetine. 

(12) Salicylic acid (large doses). 



Drugs an important action of which is to increase the rate of the car- 
diac beat: 



(1) Atropine. 

(2) Hyoscyamine. 

(3) Daturine. 



(4) Duboisine. 

(5) Cocaine. 

(6) Saponin. 



Drugs an important action of which is to slozv the rate of the cardiac 
beat (see also first list given above) : 

(1) Muscarine. (2) Pilocarpine. 

Drugs which increase both the force and the number of the beats: 



(1) Ammonium salts. 

(2) Alcohol. 

(3) Ether. 

(4) Chloroform. 

(5) Cactus. 



(6) Anaesthetics. 

(7) Arsenical salts. 

(8) Quinine. 

(9) Strychnine. 



Drugs which decrease both the force and the number of the beats. 



(1) Antimony salts. 

(2) Aconite. 

(3) Hydrocyanic acid. 



(4) Ergot. 

(5) Veratrum. 

(6) Cevadilla. 



B. Drugs Acting on the Vagus Centre. — It may be concluded 
that a drug acts on the vagus centre when it is found that while 
it has the effect of altering the beat of the heart, such altera- 
tion may be counteracted either by section of the vagi or by 
stimulation of the peripheral end of the nerve, if only one of 
the vagi be cut. 



DIGITALIS. 



253 



Drugs which stimulate the vagus centre: that is to say, the pulse is 
slowed, but this slowing disappears on section of the vagi : 



(1) Chloroform. 

(2) Hydrated Chloral. 

(3) Butyl-chloral hydrate. 

(4) Aconite. 

(5) Veratrum. 

(6) Nicotine. 

(7) Digitalis. 

(8) Sparteine. 

(9) Strophanthus. 
(10) Squill. 



(11) Convallaria Majalis. 

(12) Hydrocyanic acid. 

(13) Cocaine (large doses). 

(14) Staphisagr ia ( Delphinine ) . 

(15) Atropine ■>. Only very 

(16) Hyoscyamine L e a r 1 y in 

(17) Daturine J their action. 

(18) Increased blood-pressure. 

(19) Venous blood. 



Drugs which depress the vagus centre: Large doses of the drugs men- 
tioned in the last list, and drugs which diminish the blood-pressure, such 
as amyl nitrite, nitroglycerin and the nitrites. 

C. Drugs Acting on the Accelerating Centre. — So far as 

known, there are no drugs which have the effect of depressing 
this. Probably some stimulate it, for their administration ren- 
ders the pulse still more rapid after the vagi have been cut. 



They are — 

(1) Ammonia. 

(2) Caffeine. 

(3) Picrotoxin. 



(4) Cactus. 

(5) Delphinine. 

(6) Any drugs which make 

the blood venous. 



Therapeutics. — The drugs most used for their action on the 
heart are digitalis, strophanthus, ammonium salts, sparteine, 
squill, convallaria majalis, caffeine, alcohol, ether, chloroform, 
cactus, strychnine, belladonna, aconite, antimony, and hydro- 
cyanic acid. The various indications for which they are 
severally given will be mentioned under each drug. 



A. Drugs Acting Upon the Heart Directly. 
DIGITALIS. 

DIGITALIS.— Digitalis. (Foxglove.) Dose, 0.065 gm, (65 mil- 
ligm.); 1 gr. 



2 54 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Extractum Digitalis.— Extract of Digitalis. Dose, 0.010 
gm. (10 milligm.) ; y 5 gr. 

2. Fluidextractum Digitalis. — Fluidextract of Digitalis. 
Dose, 0.05 c.c.; 1 TTt- 

3. Infusum Digitalis. — Infusion of Digitalis. Dose, 8 c.c; 
2 fl. dr. 

4. Tinctura Digitalis. — Tincture of Digitalis, Dose, 5 c.c; 
15 HI. 

Unofficial Preparations. 
Digitalinum. — Digitalin. Dose, 1 mg.; ^ ¥ gr. 



Digitoxinum. — Digitoxin. Dose, .00025 to .00032 gm.; 



i 

2S0 



Action of Digitalis. 

External. — It has but little effect on the skin; its principal 
local action being on the mucous membranes, where the primary 
irritation caused by it is not infrequently followed by paralysis 
of the nerve endings. 

Internal. G astro-intestinal Tract. — It causes gastrointesti- 
nal irritation, and in large doses gives rise to gastritis and 
purging, with green stools. There is some ground for suppos- 
ing that these disturbances are in part at least of centric origin. 

Blood. — It has no appreciable effect upon the blood. 

Heart. — Digitalis has a pronounced effect upon the heart. 
This is due principally to its direct action on the cardiac .mus- 
cle, but also, in part, to stimulation of the vagus apparatus, both 
in the medulla and peripherally. Applied locally to the heart 
of a frog, digitalis is capable of causing tonic contraction of the 
organ. It will also increase the force of the contraction when 
applied to the isolated apex, in which no nerves are believed to 
exist, and act on the embryonic heart of the chick before the 
nerves are developed. 

The influence digitalis exerts may be divided into three 
stages. In the first, or therapeutic, stage the rhythm of the 
heart is markedly slowed, and the ventricles, emptying them- 



DIGITALIS. 255 

selves more thoroughly than under normal conditions, become 
diminished in size. As the contraction of the ventricle is more 
complete, the blood is expelled into the vessels under greater 
pressure than normally. Relaxation of the ventricle during 
diastole is also increased in the healthy heart, but if the organ 
is weak and dilated, digitalis tends to diminish the relaxation. 
The auricles are slowed, as well as the ventricles, but in general 
they are not so much affected as the ventricles. The diastole is 
prolonged, the force of the systole increased, and the size of the 
individual pulse-wave also increased. If the heart is beating at 
its normal rate the diastole is increased by digitalis, but if the 
beat is slow, and the slowness is due to weakness of the cardiac 
muscle, the diastole is diminished instead. The slowing of the 
pulse caused by the drug is apparently due to a simultaneous 
stimulation of both the central and peripheral vagus apparatus, 
since it has been demonstrated that in the mammal the admin- 
istration of atropine entirely does away with this slowing. 
Moreover, if section of the vagi is made, the slowing is much 
less than when these nerves are left intact, and may be alto- 
gether absent. Under digitalis the work done by the heart is 
much greater than normal, and the slowness developed is not 
sufficient to counterbalance the increased output at each ventri- 
cular contraction. 

In the second stage the pulse is very slow and irregular, for 
the reason that the inhibitory mechanism is powerfully stimu- 
lated. During diastole the ventricle dilates more completely 
than usual, while its systole varies in force. The contraction 
of the auricle becomes much weakened, and sometimes the 
rhythm of the latter is different from that of the ventricle. 
Under certain circumstances this stage may be absent. 

The third stage is always developed if a sufficient quantity 
of the drug be given. In this the heart's action becomes ex- 
tremely fast and irregular. This accelerated rate is believed to 
be due, not to paralysis of the pneumogastric centres and car- 
diac peripheral filaments, but to such an increased excitability 
of the heart muscle that the inhibitory apparatus can no longer 



256 PHARMACOLOGY AND THERAPEUTICS. 

hold it in check. The rhythm of the ventricle continues to in- 
crease, but the strength of its contractions diminishes. The 
output of the heart continues much augmented during the first 
part of the third stage, and then rapidly declines. The auricle 
passes into the condition known as delirium cordis, and finally 
the ventricle also. Then the circulation is arrested; after 
which the heart dilates to an extreme degree. 

The action of digitalis on the heart has been very carefully 
studied in the frog, and it is found that in general its effects on 
the mammalian heart resemble those on the batrachian. The 
contraction, however, is not prolonged as it is in the latter, and 
the inhibitory action is of greater importance. In the frog the 
drug causes systolic arrest of the heart, while in man the arrest 
is in diastole. The reason for this difference is supposed to 
be that the mammalian heart is not capable of continuous 
systole. 

Vessels. — Digitalis has the effect of markedly increasing the 
biood-pressure in the vessels. Three factors are concerned in 
producing this result namely: The expulsion from the heart of 
more blood than usual and at a higher pressure, the stimulation 
of the vaso-motor centres, and the direct action of the drug on 
the vessels themselves, exciting a condition of abnormal activity 
in their muscular coats, and thus diminishing their calibre. If 
digitalis is injected into a frog and a small artery in its foot 
is measured, it will be found that during the action of the drug 
the calibre of the vessel is diminished to about three fourths 
its natural size; and the mammalian kidney is also found to 
decrease in size under digitalis. That the constriction of the 
arteries from digitalis is to a great extent a muscular action is 
shown by the fact that it occurs in organs which have been 
excised, even for several hours; but, as this constriction is not 
as marked as when the drug is administered under normal con- 
ditions, the agency of the vaso-constrictor centres must also 
be recognized. While the blood-pressure rises in the arteries 
the velocity of the current diminishes, and as the pressure rises 
in the arteries it declines in the veins; both these effects indi- 
cating an increased resistance. 



DIGITALIS. 2 57 

Under toxic doses of digitalis the blood-pressure in the 
vessels diminishes with the extreme slowing of the heart, but 
as the latter becomes accelerated it again rises to a pronounced 
degree; this result being due to the quickened heart and con- 
traction of the arterioles. Then, as the heart becomes irregu- 
lar, the blood-pressure declines until it finally reaches zero 
when the heart stops. This fall results from the decreasing 
efficiency of the cardiac contractions and from vaso-motor 
paralysis. 

Some former experiments, made for the purpose of demon- 
strating the action of digitalis and its allies upon the vessels, 
have recently been repeated. The new experiments were con- 
ducted on dogs. Two entirely different methods were em- 
ployed: in one the amount of blood flowing out of the veins of 
different regions was registered after a sufficient amount of 
atropine had been given to overcome the slowing of the 
pulse; in the other the plethysmograph was used. The ex- 
periments showed that the increased blood-pressure is due to 
increased heart action and contraction of the vessels, and that 
the latter is due to peripheral action which, in the case of 
digitoxin, is general. In the case of the other glycosides ex- 
amined (digitalin, convallamarin, strophanthin) the action is 
restricted to the splanchnic area. There is, however, some 
active constriction going on here in the peripheral vessels, yet 
this is overcome by a passive dilatation, owing to reflux of 
blood from the intestines and an active reflex dilatation set up 
by the splanchnic contraction. The general narrowing of the 
pathway of the blood seen with digitoxin gives a high resistance 
which must be overcome by the heart; strophanthin, etc., open 
the vessels of the periphery, and this materially relieves this 
organ. 

Kidney. — In dropsy, especially when due to cardiac disease, 
there is no question as to the value of digitalis as a diuretic, 
though its action has been explained in a variety of ways. It 
has been disputed, however, whether in health it has any effect 
on the renal secretion. The weight of authority seems to favor 
18 



258 PHARMACOLOGY AND THERAPEUTICS. 

the view that it does exert some diuretic action, but this has 
proved so variable as to lead to the conclusion that it is prob- 
ably, to a large extent at least, of an indirect, rather than a di- 
rect, nature. Nearly all are agreed that the kidneys are 
affected principally through changes in the circulation, and per- 
haps the most satisfactory explanation of this is that the diure- 
sis is due to the cardiac action of the drug. Under this hypo- 
thesis it is supposed that arterial accumulation, with diminished 
venous pressure, leads to an increased flow of lymph into the 
blood-vessels. The blood is thus diluted, and the kidneys incited 
to special activity, while at the same time the nutrition of the 
organs is improved. In addition to this indirect action, there is 
some ground for believing that digitalis exerts a limited in- 
fluence directly upon the renal epithelium, on which it probably 
acts as a mild irritant. By the diuretic action of the drug the 
fluid of the urine is said to be much more largely increased than 
the solids. As to its effect upon the urea and other urinary 
constituents, the reports of various observers have been so con- 
flicting that no definite conclusions can be arrived at. 

Temperature. — In health digitalis, in medicinal doses, has 
little or no effect on the temperature. In febrile conditions it 
has an antipyretic action, but this is somewhat uncertain. 
Toxic doses cause a sustained reduction of temperature, 
amounting to several degrees, but their first effect is to increase 
it. It is thought by some that this temporary elevation may be 
due to the local irritation of the drug, and that if this can be 
avoided the fall will occur without the antecedent rise. Others 
explain the phenomena observed as follows: Owing to the in- 
creased resistance from diminution of the calibre of the arter- 
ioles, the actual energy expended by the heart is in part con- 
verted into heat. Subsequently the slowing of the circulation, 
especially through the lungs, hinders the combustion process, 
and hence the fall of temperature. 

Respiration. — It has little or no effect on respiration unless 
taken in toxic quantity, when, it is said, the respiratory move- 
ments become deep and rapid from central nervous stimulation. 



DIGITALIS. 259 

Nervous System and Muscles. — In therapeutic doses the only 
effect of digitalis appears to be the stimulation of the inhibitory 
cardiac and the vaso-motor centres in the medulla oblongata. 
Toxic doses, however, stimulate other centres, and general 
convulsions may eventually result. They diminish reflex ac- 
tivity by directly exciting the reflex inhibitory centres of 
Setschenow in the medulla, and afterwards by depressing the 
spinal cord. Finally the motor nerve-trunks are depressed and 
the muscles are paralyzed. While the cerebrum is not directly 
affected by digitalis, the disturbances in its circulation caused 
by the drug are liable to give rise to severe headache, excessive 
vomiting, dizziness, vertigo, confusion of sight, and possibly 
hallucinations and delirium. In some instances the whole field 
of vision is said to be blue and in others yellow. Exophthalmos 
occurs, and a peculiar blue color of the sclerotic has been quite 
constantly noted in acute poisoning. 

Uterus. — Digitalis appears to have some influence on the 
non-striated muscular fibres throughout the body, and it thus 
acts like ergot in causing contraction of the uterus. 

Therapeutics of Digitalis. 

External. — Digitalis is sometimes used externally in the form 
of a poultice made from the leaves, and placed over the loins in 
cases of renal congestion. It has also been found serviceable 
in chilblains, in the form of a lotion in which tincture of digi- 
talis is combined with thymol, alcohol and glycerin. 

Internal. — The most important use of digitalis is in affections 
of the heart, in which it is of very great value. It is indicated, 
in general, when the cardiac action is rapid and feeble, with 
low arterial tension, and contra-indicated when the cardiac ac- 
tion is strong and arterial tension high. It not only slows 
and steadies the heart, but also improves the nutrition of its 
walls by its stimulating influence on the pneumogastric nerve, 
as well as by increasing the blood supply of the heart muscle by 
rendering the systole more complete and prolonging the diastole. 
By its action the pressure in the coronary arteries is increased, 



26o PHARMACOLOGY AND THERAPEUTICS. 

and more time allowed for their filling. The benefit derived 
from the drug in not too inveterate cardiac disease is often in a 
measure permanent, by reason of the assistance which it affords 
in the production of compensatory hypertrophy. The relief of 
the circulation caused by it may in time bring about permanent 
nutritive changes in the heart-muscle, which is stimulated to 
such a marked degree by it, and dilatation is clearly less apt to 
occur when the muscular fibre is toned up and acting vigorously 
than when it is lax and acting feebly. The constriction of the 
peripheral vessels caused by it has been thought by some to con- 
stitute a valid objection to the use of digitalis, but this may 
not really be sufficient to seriously interfere with the increased 
cardiac power secured, while if such is the case, it may be 
counteracted by means of drugs having an opposing action, as 
will be more particularly dwelt upon later. 

Cumulative Effect and Contra-indications. — Digitalis should 
always be administered with caution, and it is advisable to 
commence with small doses, which may afterwards be gradu- 
ally increased, if necessary. A patient taking full doses of the 
drug should preferably be kept in the recumbent posture. 
When, under its influence, the pulse has become much reduced, 
on rising the heart is sometimes suddenly found unequal to 
maintaining the circulation in face of the increased resistance 
in the arterioles, and against the force of gravity ; so that fatal 
syncope may occur. Digitalis should always be stopped as 
soon as symptoms of gastro-intestinal irritation supervene, or 
the pulse becomes abnormally slow. In case the tincture is 
employed, what is known as the fat-free tincture of digitalis 
will be found less likely to disagree with the stomach than the 
official preparation. In this the fixed oil of the leaf and its free 
acids are eliminated. It must not be forgotten that digitalis 
has a cumulative effect, and this is probably due to vaso-spasm 
and to the fact that if the drug is too closely pressed it is not 
excreted by the kidneys as fast as it is absorbed, and conse- 
quently accumulates in the system. It sometimes happens, there- 



DIGITALIS. 26l 

fore, that, without any increase in the dose, individuals who 
have been kept on digitalis for a long period suddenly develop 
symptoms of poisoning by it. Such an untoward result may be 
avoided if the doses are given at proper intervals; the effects 
of each being allowed to subside before the next is administered. 
The plan has been adopted by some of stopping the remedy for 
several days at the end of each week. Others continue it for 
ten days, then intermit for four days and begin again. It 
should be kept up no longer than is necessary to re-establish 
compensation. Digitalis is contra-indicated in cases where, 
with dilatation there is extensive degeneration of the muscular 
wall, as the muscle is likely to be too weak to respond to its 
stimulus. Under these circumstances, the digitalis increasing 
the pressure against which the heart has to contract, the most 
serious results may occur. Thus the systole becomes even 
weaker than before its administration, and cerebral anaemia, 
syncope, and perhaps sudden death may ensue. Some individ- 
uals are unable to take digitalis at all, on account of the nausea 
which it produces. 

Mitral Regurgitation. — It is especially valuable in those cases 
of mitral disease in which compensation (that is, the adapta- 
tion of the organs of circulation to the unusual conditions im- 
posed upon them by the valvular lesion), has begun to fail. In 
mitral insufficiency the good effect caused by it is principally 
due to its tonic action in tending to produce a permanent sys- 
tolic condition, in consequence of which the rings of the valves 
are narrowed and brought together, and the orifice rendered 
smaller. In this way it abolishes the effects of the distention 
and tends to lessen the insufficiency. As regards the adminis- 
tration of digitalis, cases of mitral regurgitaton have been 
divided into three groups, as follows : ( 1 ) Those in which the 
ventricle is but little enlarged, while the nutrition of its 
muscular wall is still well-preserved, and which may be at- 
tended with perhaps no inconvenience except more or less 
dyspnoea (usually but slight) on exertion. (2) Those in which 
cardiac dropsy, of greater or less extent, is present. (3) Those 



262 PHARMACOLOGY AND THERAPEUTICS. 

in which, with extensive dilatation, there is little or no cardiac 
dropsy, but well-marked symptoms of pulmonary congestion. 
In the last two varieties digitalis is of the greatest service. By 
increasing the force of the left ventricle's contraction it causes 
the approximation of the mitral flaps, thus reducing the amount 
of the regurgitation and diminishing venous congestion. Under 
the action of the drug the increased force of the systole will 
throw proportionately more blood through the aortic orifice than 
through the partially open and obstructed mitral valve, and, the 
larger orifice eventually gaining on the smaller, more blood will 
pass into the general circulation, and the pulmonic vessels be 
relieved. The prolonged diastole will also be of service in 
allowing more time for the blood to flow into the left ventricle. 
Thus, both the auricles and ventricles gain increased power to 
empty themselves, and the longer intervals between the pulsa- 
tions enable the former to more completely discharge their con- 
tents into the ventricles. The favorable action of the drug, 
therefore, is seen (1) in increasing the length of the diastole 
and thus improving the nutrition of the cardiac walls; (2) in 
increasing the tonic contraction of the heart, and thereby dimin- 
ishing the size of the dilated cavity; (3) in increasing the 
force of the pulsations; and (4) in causing more slowness and 
regularity in the cardiac rhythm. The general improvement 
in the circulation caused by it has an excellent effect in reliev- 
ing the cardiac pain and distress and the dyspnoea and cyanosis 
incident to the disease, and the more a case of mitral regurgita- 
tion is characterized by the oedematous type the more efficient 
will the drug prove. In addition, therefore, to its direct action 
on the heart, the beneficial effects of digitalis are shown in a 
variety of ways. One of the most prompt results of its ad- 
ministration is a marked increase in the quantity of urine, and 
hence it is of essential service in relieving cardiac dropsy. 
Here it not only regulates the circulation, by its action on the 
heart, and causes the evacuation of the surplus fluid through 
the kidneys, but also acts directly on the vessels by increasing 
vasomotor force. In some cases the diuretic effect of digitalis is 



DIGITALIS. 263 

materially assisted by the administration in connection with it of 
an alkaline diuretic, such as potassium bitartrate or citrate, and 
occasionally it may be found that diuresis can be established 
only after free purgation. Owing to the disordered circulation, 
sleeplessness is often a marked symptom of serious cardiac 
disease. The normal relationship between the cerebral vessels 
and the general circulation is not maintained, and by restoring 
this balance digitalis gives the patient ability to sleep. The 
dyspnoea is relieved by the action of the drug in establishing a 
more efficient pulmonary circulation. By improving the venous 
flow towards the heart it will thus be of service in counteract- 
ing the venous engorgement and oedema of the lungs, the right 
side of the heart, the liver, the kidneys, and the subcutaneous 
tissues so commonly met with. 

There are some instances of mitral regurgitation in which 
digitalis seems to be indicated and yet in which it proves in- 
jurious rather than beneficial. This may b.e due, in a portion 
of the cases at least, to its causing too great a strain upon the 
auricle. The ventricle, as has been stated, is more affected by 
the drug than the auricle, and as with a very patulous mitral 
valve the blood is readily backed upon the auricle, the latter, 
already too weak for the ventricle, cannot well withstand the 
strain imposed upon it by the ventricle thus stimulated. Con- 
versely to the statement previously made, the less closely a case 
of mitral regurgitation approaches the oedematous type, the less 
the benefit which is likely to be derived from digitalis in it. 

Mitral Stenosis. — In most cases of mitral stenosis the same 
benefit will attend the administration of digitalis as in cases of 
regurgitation. The increased resistance here leads to the 
same general results as the leakage in mitral insufficiency, 
and, like the latter, it can be successfully combated by the 
effect of the drug in strengthening the heart-beat. The length- 
ening of the diastole caused by it will allow more time for the 
auricle, the contracting power of which is at the same time 
increased, to empty itself into the ventricle through the con- 
stricted orifice. The ventricle, thus more perfectly filled, sends 



264 PHARMACOLOGY AND THERAPEUTICS. 

out more blood into the systemic circulation. In addition, the 
circulation is further improved by the stimulating effect of the 
digitalis on the right ventricle, which enables it to overcome the 
tendency to congestion arising from the obstruction on the left 
side of the heart, and affords it greater power to force the 
blood through the lungs. It is possible, however, that the 
increased work of the right ventricle, combined with the steno- 
sis of the mitral valve, may tend to produce congestion of the 
pulmonary vessels, with the result of lessening the oxygenation 
of the blood and so interfering with the nutrition of the heart. 
On the other hand, the slowing of the organ will afford the 
lungs more time in which to empty into the heart; so that in 
the great majority of well-selected cases the beneficial effects 
of digitalis will greatly over-balance any possible evil ones. It 
is only necessary to add that the general amelioration of symp- 
toms caused by it is much the same as in the case of mitral 
1 egurgitation. 

Diseases of the Tricuspid Valve. — In both tricuspid constric- 
tion and insufficiency digitalis is of service in the same manner 
as in mitral disease, and it has been found particularly useful 
in cases of regurgitation with dilated right ventricle. As a 
rule, however, it does not appear to be as beneficial in tricuspid 
affections as in those of the mitral valve. As in the case of the 
latter, the rational signs furnish, for the most part, clearer 
indications for the use of digitalis than the physical. Thus, it 
is indicated when the cardiac action is rapid and feeble and the 
tension of the pulse low, and when there are cough, dyspnoea, 
pulsating jugulars, duskiness of the countenance, scanty, high- 
colored urine, and general dropsy. 

Diseases of the Aortic Valve. — There is a considerable diver- 
sity of opinion as to the advisability of giving digitalis in aortic 
disease. While, however, a few authorities assert that its dis- 
advantages are more than offset by its advantages, there can 
be but little question that in uncomplicated aortic regurgitation 
the drug is injurious, rather than beneficial. It increases the 
work of the heart, and the prolonged diastole caused by it 



DIGITALIS. 265 

favors the return of blood through the imperfectly closed orifice 
and exposes the ventricular wall to excessive strain; so that 
there is danger of syncope. In aortic stenosis, before com- 
pensatory hypertrophy has occurred, it may sometimes be of 
service. There is more or less obstruction to the normal 
flow of blood out of the heart, and digitalis will increase the 
ventricular force, so that it may overcome the difficulty. 
After the impediment to the circulation caused by the valvular 
defect has been compensated by a sufficient amount of cardiac 
hypertrophy it is not only useless, but may give rise to serious 
and even fatal results. But when aortic constriction leads to 
mitral incompetence and regurgitation, it may be given with 
advantage. 

So also in aortic regurgitation, when the marked cardiac 
dilatation apt to be caused by the condition has given rise to 
mitral insufficiency, digitalis is of great value. There are other 
cases of aortic regurgitation in which benefit is likely to result 
from its use; namely, those in which there is considerable dila- 
tation of the left ventricle, perhaps of sudden onset, and in 
which the prominent symptoms will be found to be shortness of 
breath, precordial pain, and anxiety. While digitalis is gener- 
ally contra-indicated in aortic regurgitation, especially when 
the latter, as is often the case, accompanies aortic constriction, 
yet when the heart-muscle fails and the hypertrophy is not 
compensatory, it is useful in both aortic insufficiency and con- 
striction. In all cases of aortic valvular disease the effects of 
the drug should be very carefully watched. 

It has been well said that the indication for giving or with- 
holding digitalis in the treatment of valvular disease of the 
heart rests not so much upon the particular valvular lesion that 
is present as on the effects which have been produced by this 
upon the cardiac wall. A knowledge of the relation of the 
heart-muscle to the work required of it in any individual case 
is much more important, therefore, from a therapeutic point of 
view, than a recognition of the pathological condition of one 
or more of the valves. In general terms it may be stated that 



266 PHARMACOLOGY AND THERAPEUTICS. 

digitalis is of special value in all conditions in which dilatation 
of the heart cavities has been brought about by failure of the 
muscular wall as a result of valvular disease. 

Constriction of the peripheral vessels which, as has been seen, 
is one of the chief physiological effects of digitalis, is sometimes 
so marked as to interfere materially with the successful use of 
the remedy in cardiac affections. When this is the case it may 
be counteracted to a considerable extent by the simultaneous 
administration of drugs causing vaso-dilatation, such as the 
nitrites. Nitroglycerin is a very useful agent for relaxing the 
spasm, and as its effect lasts but a short time while that of the 
digitalis is prolonged, it should be given at much more frequent 
intervals than the latter. As digitalis acts very slowly and 
maintains its effect for a long time, it may be sufficient, after 
its primary effects have been obtained, to administer it only 
once a day, for the purpose of continuing its influence. 

Cardiac Disease Other Than Valvular. — In palpitation due to 
over-exertion or heart-strain and in cardiac dilatation and 
asthenia digitalis is of decided value. In the " irritable heart 
of soldiers," a condition associated with muscular weakness and 
supposed to be dependent upon exhaustion of the inhibitory 
nerves, it has been found better than any other remedy. When, 
however, cardiac hypertrophy has occurred it is of but little 
service. The same remarks apply to the case of those indi- 
viduals who have engaged to excess in athletic exercise and 
who are troubled with more or less shortness of breath, but 
without any appreciable valvular lesion of the heart. In 
these cases the apex is often found to be a little outside its nor- 
mal position. Digitalis is frequently prescribed in tachycardia 
(rapid heart), but if acceleration of the rhythm is the only 
symptom observed, other drugs, such as aconite, may generally 
be substituted for it with advantage. In functional derange- 
ments of the heart, usually the result of faulty digestion, char- 
acterized by irregularity and palpitation, digitalis is indicated 
and will prove of essential service if it can be given in such a 
way as not to disagree with the stomach. In many such sub- 



DIGITALIS. 267 

jects, however, on account of its liability to increase the indi- 
gestion, its administration is found impracticable, and the main 
reliance for relief of the condition must be placed on treatment 
directed to the dyspepsia on which it depends. In certain cases 
of the functional trouble met with in highly neurotic subjects 
it is of marked benefit, but in a large number of these it fails 
to give relief. It is of great value in the weakness of the heart 
resulting from typhoid and scarlet fevers, pneumonia, rheu- 
matism, pericarditis and other acute diseases, even if no 
valvular lesion is present. The beneficial action of the drug is 
seen in the increased efficiency of the contractions and in the 
prolonged diastole, which allows more time for the cardiac 
muscle to rest. In these cases its effect may often be increased 
by combining it with caffeine or ammonia. If the latter is 
used, 8 c.c. (2 fl. dr.) of the infusion of digitalis may be given, 
with .20 c.c. (3 fll) of stronger ammonia water, in a little 
water. It is often desirable to administer digitalis in combina- 
tion with iron; but when its fluid preparations are associated 
with salts of the latter the mixture is rendered inky by the ac- 
tion of the iron, on the tannic acid in the digitalis. This diffi- 
culty may be obviated by adding a little diluted phosphoric 
acid, which acts as a clarifying agent, or a pill may be used 
composed of powdered digitalis leaves and dried ferrous sul- 
phate. Digitalis is also useful as a stimulant in cardiac weak- 
ness resulting from such causes as haemorrhage, injury, poison- 
ing and shock. In cases of this kind, on account of the slow- 
ness of its action, it should be preceded by ammonia and alcohol 
if the symptoms are urgent; or its slowness of action may be 
overcome by administering it hypodermatically. For this pur- 
pose tincture of digitalis is preferable to digitalin on account of 
its being much less liable to produce local irritation. Digitalis 
is particularly indicated in poisoning by aconite, muscarine and 
the nitrites, to which, as regards action on the heart, it is the 
physiological antidote. In organic non-valvular diseases of 
the heart dependent on degeneration of the cardiac muscle it 
should be used with extreme caution, if at all; and in many 



268 PHARMACOLOGY AND THERAPEUTICS. 

such its effects are decidedly injurious. In fatty and other 
degenerations, such as those resulting from alcohol and from 
chronic nephritis, the muscle is not in a condition to respond to 
the stimulation of the drug, while the peripheral resistance is 
increased from the vascular constriction caused by its action. 
Under these circumstances it is possible that some of the degen- 
erated fibres may rupture. In dilatation of the right side of 
the heart associated with chronic disease of the lungs digitalis 
may sometimes prove of service, but this is the exception rather 
than the rule. In the palpitation which is often such a dis- 
tressing feature of phthisis it has been found useful. 

Bright's Disease. — In renal dropsy from acute desquamative 
nephritis (tubal nephritis) digitalis, given in the form of infu- 
sion, has been found of considerable value. While a number of 
days may elapse before much effect is produced, the flow of 
urine is sometimes enormous, and this fact is regarded by some 
authorities as going to show that digitalis has a direct action 
on the glomeruli of the kidney. Although it is not infrequently 
given in acute Bright's disease, however, it has been questioned 
whether, if it has the effect of causing dilatation of the renal 
arteries, it is proper to increase the circulation in any acutely 
inflamed organ. Furthermore, even in the early stages the 
arterial tension is somewhat raised, and it is undesirable to 
increase this. In chronic Bright's disease the arterial tension 
is still further increased, and as, in addition, digitalis is an un- 
certain diuretic where the heart is not affected, the drug is 
contra-indicated, especially in cases of chronic tubal nephritis 
uncomplicated by cardiac disease. Still another reason why it 
should not be employed is the fact that it retards the elimination 
of urea and the chlorides. In many cases of granular, con- 
tracted, or cirrhotic kidney, however, where the cardiac hyper- 
trophy induced has not succeeded in overcoming the peripheral 
resistance (and in consequence there has occurred dilatation of 
the left ventricle and of the mitral orifice, with resulting 
regurgitation), digitalis, acting in the same manner as in cases 
of mitral regurgitation without renal disease, renders efficient 



DIGITALIS. 269 

service. In this condition the well-known diuretic pill consist- 
ing of calomel, digitalis, and squill, .06 gm. (1 gr.) each, made 
up with extract of hyoscyamus, may be used. 

Exophthalmic Goitre. — It has been used to a considerable 
extent in this affection, but has proved an uncertain remedy. 
Even after a long course of it, the condition often remains un- 
improved. Still, it would seem to be worth trying, as it is said 
sometimes to be remarkably successful in controlling the symp- 
toms. It may be combined advantageously with iron, ergot 
and zinc bromide. Even in incurable cases the cardiac irregu- 
larities and the dilatation of the cervical vessels are sometimes 
ameliorated, while cases purely functional in character, in 
young subjects, have been reported to be cured by digitalis. 

Bronchitis and Pneumonia. — In chronic bronchitis with pro- 
fuse secretion it has been found of more or less service in 
diminishing the secretion and pulmonary congestion, and conse- 
quently the dyspnoea, sweating and progressive loss of strength 
caused by them. It is also sometimes serviceable in chronic 
bronchitis with interstitial pneumonia (fibroid lung), when ac- 
companied with dyspnoea, secondary dilatation of the right 
heart, and general anasarca. Here, in cases in which its action 
is satisfactory, it lessens the cough and expectoration, tones up 
the weakened and laboring heart, and reduces the oedema. In 
the second stage of acute pneumonia, in cases where the heart, 
with almost empty arteries, is laboring and unable to do its 
work properly, it has proved of very great value. In any form 
of pneumonia (whether adynamic or not) when the right heart 
is becoming unable to force the blood through pulmonic capil- 
laries which are compressed by the existing exudation, digitalis 
may be found extremely useful. In the bronchitis and broncho- 
pneumonia of children it may also prove beneficial. 

Scarlet Fever. — Some authorities recommend digitalis highly 
in this disease, in which it is claimed that it reduces the tem- 
perature and maintains the action of the kidneys; thus dimin- 
ishing the two principal sources of danger. From a teaspoon- 
ful to a tablespoonful (according to age) of the infusion may 
be given every two, three or four hours. 



27O PHARMACOLOGY AND THERAPEUTICS. 

In various adynamic fevers digitalis is sometimes of the 
greatest value in sustaining the heart's action during a crisis 
or period of special strain upon the organ. 

Alcoholism. — In chronic alcoholism digitalis, in moderate 
doses, may prove of service, on account of the stimulating effect 
of the agent on the circulation. As to its value in delirium 
tremens authorities differ. While some maintain that it is 
practically useless, others assert that excellent results may be 
obtained from it, especially in cases where the pulse is very 
weak and compressible. The rest and sleep which, it is claimed, 
follow its administration are believed to be due to the cardiac 
stimulation and increased flow of blood to the nerve-centres 
caused by it. While enormous doses of the drug — 15, c.c. 
( l / 2 fl. oz.) of the tincture being the usual dose — are generally 
tolerated in these cases, probably because by long habit the 
heart has become benumbed to the influence of stimulants, their 
use is not altogether unattended with danger. Some who be- 
lieve in the efficacy of digitalis in this condition regard these 
large doses as unnecessary, and also hold that the infusion is 
preferable to the tincture. Of the infusion it is advised that 
15 c.c, or one tablespoonful, be given every four hours. Digi- 
talis is sometimes given in the young and robust, with marked 
cerebral hyperemia, but it is probably more efficacious in pale 
subjects with a tendency to cyanosis, in whom there is cerebral 
anaemia, with effusion and oedema. As has been mentioned, 
there is a remarkable tolerance for digitalis in this affection, 
but since the use of the drug is occasionally followed by fatal 
results, it would seem to be the part of prudence to carefully 
select the cases in which it is employed and to avoid excessive 
doses. 

Spermatorrhoea. — Digitalis has decided value as an anaphro- 
disiac. It has been found that it is capable of temporarily but 
completely annulling the activity of the sexual organs, and it is 
therefore of service in preventing erections of the penis due to. 
local irritation, and also nocturnal seminal emissions and other 
effects of genital excitement. It is adapted to cases of sperma- 



DIGITALIS. 271 

torrhoea in which there is an atonic condition, shown by feeble 
erections, frequent emissions, and cold hands and feet (where 
it may advantageously be combined with ergot), and also to the 
spermatorrhoea of plethora. In the latter it is claimed that 
better results can be obtained from digitalis in combination 
with potassium bromide than from any other treatment. In this 
condition 15 c.c. { l / 2 fl. oz.) of infusion of digitalis, with 1.20 
gm. (20 gr.) of potassium bromide may be given night and 
morning for a week, and after that at night only. 

Hemorrhage. — Digitalis is occasionally prescribed as a 
haemostatic, but is unreliable because the increased blood-pres- 
sure to which it gives rise may excite still greater haemorrhage. 
While it causes constriction of the vessels, it also accelerates 
the flow of blood through them. It may sometimes prove use- 
ful, however, in haemorrhage from a large surface, as in the 
haemorrhagic diathesis and in pulmonary haemorrhage. It has 
been found of advantage in cases of haemorrhage in the first 
stage of pneumonia and in haemoptysis due to disease of the 
mitral valve. 

Uterus. — If, as seems to be the case, digitalis has the power 
of inducing uterine contractions, it would naturally be expected 
that it would be of service in haemorrhages of that organ. In 
practice it has been found in cases of menorrhagia that shortly 
after a large dose of the infusion has been taken severe pains 
resembling those of labor come on. There is a momentary 
profuse discharge of blood and clots, if the latter be present, 
and this is followed by arrest of the flow for hours. The drug 
is stated to be particularly advantageous in menorrhagia or 
metrorrhagia occurring in plethoric individuals and in cases 
where the haemorrhage is dependent upon mitral disease. Both 
mitral regurgitation and stenosis, by increasing the blood-pres- 
sure in the uterine veins, sometimes give rise to menorrhagia 
of a peculiarly obstinate kind. Digitalis has also been used 
successfully to arrest post-partum haemorrhage, but is much in- 
ferior to ergot in this regard. 

Antagonists. — Reference has already been incidentally made 



272 PHARMACOLOGY AND THERAPEUTICS. 

to the antagonism between digitalis and aconite and other 
drugs. Aconite, while it also slows the heart, does so by 
dilating the peripheral vessels and lowering the blood-pressure, 
and is a cardiac poison; directly lowering the action of the 
cardiac motor ganglia and thus weakening instead of strength- 
ening the pulsation. Aconite acts quickly and digitalis very 
slowly, and this interferes to some extent with the efficacy of 
the latter in poisoning by the former. Opium, aconite, mus- 
carine, lobelia, the nitrites and other agents antagonize some of 
the actions of digitalis, but the antagonism does not extend 
throughout the whole range of their effects. Saponin and 
senegin, to which it is closely allied, are considered to be most 
complete physiological antagonists to digitalis. Tannin is the 
chemical antidote. 

STROPHANTHUS. 

1. STROPHANTHUS.— Strophanthus. Dose, 0.065 gm. (65 mil- 
ligm.); 1 gr. 

Preparation. 
Tinctura Strophanthi. — Tincture of Strophantus. Dose, 
0.5 c.c.; 8 Til. 

2. STROPHANTHINUM.— Strophanthin. Dose, 0.0003 gm. (0.3 
milligm.); f fo gr. 

Action of Strophanthus. 

External. — It has no action on the skin, but causes marked 
irritation of mucous membranes. Locally strophanthin is an 
anaesthetic, rapid in action and durable in effect, but so irritating 
that its application to the eye, for instance, is liable to set up 
inflammation or even ulceration. 

Internal. G astro -intestinal Tract. — In small doses it pro- 
motes appetite and digestion, and in larger ones it does not 
ordinarily cause gastro-intestinal derangement. It is true that, 
as in the case of digitalis, vomiting and diarrhoea are sometimes 
occasioned by strophanthus, but it will generally be found that 
these disturbances result from preparations from which the fixed 



STROPHANTHUS. 273 

oil contained in the seeds has not been extracted. The tinct- 
ure, prepared from strophanthus kombe (pubescent variety), 
does not give rise to them; while fluidextracts made from this 
and other species cause digestive disturbances varying from 
simple inappetence, nausea and vomiting to abdominal pain and 
diarrhoea. Strophanthin, used hypodermatically, is not irritat- 
ing to the digestive tract. 

Muscles. — Strophanthus is essentially a muscle poison, as 
shown in experiments upon the frog with the African kombe 
arrow poison, which is made from the plant. Its first effect is 
to increase the tonicity of the muscular fibre, and when the 
muscle dies it does not go into relaxation, but passes directly 
from life into post-mortem rigidity. It occasions stiffness of 
the limbs and afterward complete loss of voluntary movement. 
Its influence is more generalized than that of digitalis, which, 
while acting on all the muscular tissue, has a more special ac- 
tion on the heart and the muscle of the arterial wall. The 
physiological as well as the toxic action of strophanthus are 
mainly exerted on both the heart and the voluntary muscles, so 
that when full effects are produced on the cardiac muscle the 
general muscular system is decidedly affected. In toxic doses 
it paralyzes muscular tissue, not through the nervous system, 
but by direct contact, and when contractility has once been 
destroyed by its action, no stimulus will reexcite it. 

Heart. — Strophanthus being believed to exert its action upon 
muscular tissue by direct contact through the blood, and the 
heart naturally receiving a much larger supply of blood in the 
same length of time than any other muscle, that organ is 
promptly and decidedly influenced by the drug. By proper 
regulation of the amount administered the heart may be acted 
upon while the muscles in general remain practically unaffected. 
In moderate doses strophanthus has the same effect on the heart 
as digitalis, stimulating the tonic contraction of the cardiac 
muscle, increasing the force of the ventricular systole, prolong- 
ing the diastole, lowering and regulating, the rhythm, and caus- 
ing a pronounced though slow rise in the arterial pressure by 
19 



274 PHARMACOLOGY AND THERAPEUTICS. 

the increased force in the cardiac contractions. While some 
authorities deny that it acts on the pneumogastric like digitalis, 
and others assert that it has a similar influence on the inhibitory 
mechanism, there can be no question that it does have the effect 
of slowing the rate of the beat. Apparently this is a result 
of its direct cardiac action. If it has any influence at all upon 
the innervation of the heart, this would seem to be but tem- 
porary. In large amounts the drug paralyzes the heart, leaving 
its muscle completely rigid for the reason given above. 

Vessels. — The latest researches show that strophanthus, 
through its characteristic action on all muscular tissue, includ- 
ing that in the arterial walls, has a decided influence upon the 
vaso-motor system; but the constriction of the peripheral ves- 
sels due to it is considerably less marked than that caused by 
digitalis. This is the most important point of difference be- 
tween the two agents. Under the effect of digitalis, which 
powerfully contracts the vessels, and thus occasions a greater 
rise of blood-pressure than strophanthus, the work of the heart 
is much increased by the resulting resistance, and for this rea- 
son the latter is the safer remedy of the two. 

Kidneys. — Strophanthus is an efficient diuretic, increasing the 
quantity of urine not only in cases of cardiac disease, but also 
in healthy men and animals, and this diuretic influence is 
apparently exerted not only through the increased force of the 
heart and the effect on the circulation caused by it, but also 
through direct action upon the secreting structure of the kid- 
neys. The correctness of this view seems to have been con- 
firmed by the renal lesions observed in poisoning by strophan- 
thus and by oncometric experiments indicating that it produces 
no marked congestion of the kidneys. 

Nervous System. — As has been stated, the pronounced effects 
which it has upon the heart and muscles are in all probability 
due solely to its direct action by contact, through the blood, and 
not through the agency of any influence it exerts upon the 
nervous system. On the latter, so far as known, it has no 
action. 



STROPHANTHUS. 275 

Respiration. — Strophanthus appears to have no action on 
the respiratory centres. In experiments upon frogs it was 
found that the respiration continued for some length of time 
after the heart stopped, and the conclusion that the cessation of 
respiration was due to muscular influence was reached. 

Temperature. — It is antipyretic within a limited range, be- 
cause under its administration the consumption of oxygen is 
smaller and the processes of combustion are depressed. 

Absorption and Elimination. — Since its active principle is 
soluble in less than its own weight of water, strophanthus 
possesses the diffusibility of a soluble crystalloid; hence the 
prompt results from its administration. Again, its active prin- 
ciple escapes with the urine, so that we also have ready elimi- 
nation. This, however, is somewhat slower than its absorption, 
and there is, therefore, an overlapping of effect from too fre- 
quently repeated doses. Habit does not seem to impair the 
therapeutic usefulness of the drug. 

Therapeutics of Strophanthus. 
Having the same general effects, strophanthus is employed 
to fulfil the same indications as digitalis. On the heart it acts 
more promptly, though probably less permanently than the 
latter. As the indication is generally as much to diminish the 
resistance to the heart as to increase the amount of work which 
the organ is capable of doing, strophanthus has the great advan- 
tage over digitalis of not greatly constricting the arterioles. 
If, therefore, the heart is feeble and the arterial tension high ; 
strophanthus is decidedly to be preferred, unless some agent, 
like nitroglycerin, which has the effect of causing dilatation of 
the peripheral vessels should be given in connection with the 
digitalis. In those cases where digitalis does harm by so over- 
stimulating the ventricle that the auricle cannot thoroughly 
empty itself, and hence becomes congested, strophanthus is 
sometimes of the greatest service. Where extensive degenera- 
tion of the arterial coats is present, so that the increased pres- 
sure in the interior of the vessels may lead to rupture of their 



276 PHARMACOLOGY AND THERAPEUTICS. 

walls, strophanthus, as causing a less extensive rise in the 
blood-pressure than digitalis, should be employed if the admin- 
istration of a cardiac stimulant is called for. Its superiority 
as a diuretic renders it particularly valuable in oedema of the 
lungs or cases of general cardiac dropsy. It is often given 
advantageously in combination with digitalis, especially where 
free diuresis is desired, and is also much relied upon to take 
the place of the latter where its administration has to be sus- 
pended either on account of gastric irritation or for the pre- 
vention of cumulative effects. It is of great value in the car- 
diac diseases of children, in which digitalis is very apt to fail, 
and excellent results may also be obtained with it in corpulent 
individuals. Of especial importance should be considered its 
administration for the weak hearts of anaemia and chlorosis, in 
order that nutrition may be improved; for so-called irritable 
hearts, where the pain and palpitation are relieved; for de- 
bilitated hearts, associated with dyspeptic symptoms, and par- 
ticularly flatulence (which usually disappears) ; and in the aged 
when there is vertigo as the result of cerebral anaemia. It is also 
said to be particularly useful in the progressive heart-failure 
of elderly patients, with attacks of dyspnoea simulating angina. 
The advantages which strophanthus possesses over digitalis 
may be summoned up as (1) greater rapidity, modifying the 
pulse-rate within an hour; (2) less marked vaso-constrictor 
effects; (3) greater diuretic powers; (4) no disturbance of 
digestion from properly made preparations; (5) absence of so- 
called cumulation; (6) greater value in children; and (7) 
greater safety in the aged. 

The therapeutic indications for the use of strophanthus are, 
then: (1) Rapidly recurring cardiac systoles of lessened force 
and irregular rhythm. We get, first, a more vigorous con- 
traction of the ventricle, with a slowing of the pulse-rate and 
consequently a lengthening of the diastole, which is the period 
of rest for the heart; next comes the disappearance of irregu- 
larity of rhythm; and, lastly, from improved intracardiac 
nutrition, a permanent strengthening of the heart-muscle. (2) 



STROPHANTHUS. 277 

The comparative insignificance of its vaso-motor effects enables 
us to use this remedy in those instances of permanent high 
tension which are met with in some forms of Bright's disease, 
in arterio-sclerosis, and in the rigid arteries of the aged. (3) 
Whenever diuresis can be promoted by increased blood-tension 
resulting from more vigorous cardiac contractions this may be 
expected from the use of this remedy. (4) The rapidly ap- 
pearing effects of its administration, together with its regular 
elimination, make it the drug of choice when the symptoms are 
urgent. (5) The absence of digestive disturbances from ther- 
apeutic doses and slight likelihood of habituation to its admin- 
istration make it important when long-continued use is neces- 
sary. It should, therefore, be the remedy of choice in all cases, 

(1) in which we wish to establish compensation; (2) of arter- 
ial degeneration in which a remedy which causes more ener- 
getic cardiac contraction is required; (3) of cardiac disease 
when a diuretic is necessary; (4) of weak or irritable hearts; 
(5) of cardiac disease in childhood or old age. 

The instances in which failure will follow its administration 
are those of (1) advanced degeneration of the myocardium; 

(2) extreme mechanical obstruction to the circulation from 
valvular incompetency or obstruction; and (3) a combination 
of these. It will readily be understood that in fully com- 
pensated hearts this — as well as other drugs of the same type — 
is unnecessary, and when over-compensation exists it will likely 
aggravate the condition. It may be said, therefore, that success 
in the administration of strophanthus requires: I. An active, 
well-made preparation from a reliable source. 2. Avoidance of 
its use in fully or over-compensated hearts and in those which 
present advanced muscular degeneration or mechanical defects 
of high degree. 3. The use of not too large or too frequently 
repeated doses. Careful observation has shown that the dose 
of 0.30 c.c. (5 HI) of a reliable tincture three or, possibly, four 
times a day is sufficient. 

Strophanthus has been found of service in exophthalmic 
goitre, and, administered in combination with hoang-nan, it 



27 8 PHARMACOLOGY AND THERAPEUTICS. 

has also given good results in psoriasis, especially in cases at- 
tended with marked congestion of the integument. 

ADONIDIN. 

ADONIDINUM.— Adonidin (not official). Dose, 0.01 to 0.02 gm.; 
% to y 3 gr. 

Action of Adonidin. 
Adonidin has the same physiological action as digitalis, and 
produces its effects more promptly than the latter. In the frog- 
it causes tonic contraction of the heart and slows the pulse-rate. 
It increases the force of the systole, and finally produces arrest. 
In mammals it slows and strengthens the heart's action, and 
whilst diminishing the pulse-rate, very markedly increases the 
arterial pressure. It raises the general vascular tension by 
causing constriction of the arterioles, but the contraction is not 
so persistent as under the use of digitalis. The slowing of the 
rate is no doubt due to stimulation of the inhibitory nerves, 
since it is prevented by their previous section, while the rise 
in arterial pressure is chiefly attributable to the direct action of 
the drug on the heart. Under the continuance of full doses the 
primary rise is followed by a marked depression, and this late 
fall is believed to be the result, at least in great part, of vaso- 
motor paralysis. In toxic doses it is found to paralyze the 
terminals of the pneumogastric, excite the accelerator apparatus 
of the heart, and finally cause paralysis of the cardiac motor 
nerves. Adonidin renders the respiratory movements more 
full and less frequent. It also probably increases the flow of 
urine, its diuretic action being due to its effect on the circula- 
tion rather than to any direct influence on the secreting struct- 
ure of the kidneys. In many subjects it seems to cause more or 
less nausea, vomiting and purging. It is rapidly eliminated 
from the system, and therefore does not appear to have any 
cumulative tendency. 



SQUILL. 279 

Therapeutics of Adonidin. 
It is used for the same kinds of cases as digitalis. It has been 
found less certainly beneficial than the latter in valvular disease 
of the heart, but may prove a satisfactory substitute for it in 
cases in which that drug fails or is not well borne. As its action 
is more prompt, adonidin sometimes serves a useful purpose in 
beginning the regulation of the cardiac movements before digi- 
talis has had time to produce its effect. In addition to cases of 
organic disease, it has been found of service in functional 
irregularity, and especially in palpitation without any lesion of 
the heart. In combination with the bromides it is also said to be 
used with success in the treatment of epilepsy. The irritating 
properties of this drug prevent its subcutaneous use, and even 
prolonged administration by the mouth. 

SQUILL. 
SCILLA.— Squill. Dose, 0.125 gm. (125 milligm.) ; 2 gr. 

Preparations. 

1. Acetum Scillae. — Vinegar of Squill. Dose, 1 c.c; 15 TT\.. 

2. Fluidextractum Scillae. — Fluidextract of Squill. Dose, 0.1 
c.c; 1% Til. 

3. Syrupus Scillae. — Syrup of Squill. Dose, 2 c.c; 30 Til. 

4. Syrupus Scillae Compositus. — Compound Syrup of Squill. 
(Hive Syrup.) Dose, 2 c.c; 30 Til. 

5. Tinctura Scillae. — Tincture of Squill. Dose, 1 c.c; 15 tt\.. 

Action of Squill. 
The application of squill to the external integument is capable 
of producing the characteristic effects of the drug on the system. 
It affects the heart and arterial system in the same manner as 
digitalis, but its action on the heart, and especially on the periph- 
eral vessels, is less marked and decidedly less persistent than 
that of digitalis. The increased arterial pressure caused by it 
is due, it is believed, partly to the augmented cardiac force 
and partly to a peripherally produced vaso-motor contraction. 



280 PHARMACOLOGY AND THERAPEUTICS. 

It is a much more violent gastro-intestinal irritant than digi- 
talis ; causing, in sufficient doses, marked abdominal pain, vomit- 
ing, purging, and even fatal gastro-enteritis. Even small doses 
are liable to cause nausea. Another pronounced action of 
squill is that of an expectorant, and this, like its effect to a 
great extent on the gastro-intestinal tract, is probably produced 
during excretion. In passing through the bronchial mucous 
membrane it sets up an irritation which stimulates the blood- 
vessels of the part, and thus increases the functional activity oi 
the membrane. In addition to these actions, it is an efficient 
diuretic, promoting the activity of the renal circulation, and 
largely increasing the watery portion of the urine. It is stimu- 
lating to the kidneys, and in excessive doses gives rise to such 
an amount of irritation as to cause strangury and diminished 
secretion, the urine often being bloody and albuminous. The 
renal inflammation may even be so violent as to result in com- 
plete suppression. 

Therapeutics of Squill. 
Squill has been called the " harsh digitalis." In cardiac dis- 
ease, with or without dropsy, it is not prescribed alone, as 
digitalis, strophanthus and other heart stimulants are more effi- 
cient, as well as less toxic, in their effects. It may, however, be 
combined with digitalis with advantage, especially in dropsical 
cases, and a very favorite diuretic pill is composed of squill, 
digitalis and calomel, .06 gm. (1 gr.) each, made up with ex- 
tract of hyoscyamus, .09 gm. (1^ gr.)- This is sometimes 
known as Guy's triplex pill. Squill was formerly much in 
vogue in the treatment of renal dropsy, but is now rarely or 
never employed in cases of this kind, on account of its irritating 
effect upon the kidneys. It is valuable in dropsy not dependent 
on renal disease when the system is in an atonic condition, and 
it has been found of service, especially in combination with 
calomel, in serous effusion into the pleura and the pericar- 
dium resulting from chronic inflammation of the parts. When 
the stomach is intolerant of the drug, it may be sdmin- 



CONVALLARIA. 28 1 

istered by rubbing its tincture, with that of digitalis, into the 
skin, or by applying compresses saturated with these to the 
abdomen, and covering them with an impermeable dressing. 
Squill is principally used, however, in subacute and chronic 
bronchitis and emphysema, and, given in suitable doses and in 
connection with other appropriate drugs, is a most valuable 
remedy. It is more particularly indicated when the sputa are 
tenacious and coughed up with difficulty, and it is therefore 
desirable to employ with it an agent which increases the expira- 
tory force. As a stimulating expectorant, it is especially useful 
in the second stage of bronchitis, when secretion is scanty or so 
excessive as to need proper stimulation of the mucous mem- 
brane to bring on a healthy action. It should not be given in 
cases of phthisis or other chronic disease where there is any 
gastric irritation. Neither the syrup nor the vinegar of 
squill should be prescribed with ammonium carbonate, as the 
latter is incompatible with acetic acid, which is contained in 
both these preparations. 

CONVALLARIA. 

CONVALLARIA.— Convallaria. (Lily of the Valley.) Dose, 0.500 
gm. (500 milligm.) ; 7V 2 gr. 

Preparation. 
Fluidextractum Convallariae. — Fluidextract of Convallaria. 
Dose, 0.5 c.c; 8 Ttl. 

Action of Convallaria. 
In moderate doses convallaria has been found to at first slow 
the heart and raise the arterial tension, while subsequently the 
pulse is somewhat quickened. Section of the pneumogastric 
does not interfere with these actions. At the same time that the 
heart is thus affected, respiration is deepened and to some ex- 
tent slowed. It is a decided cathartic, increasing peristalsis and 
having an action on the bowels intermediate between those of 
scammony and aloes. It also acts to some extent on the kidneys. 



282 PHARMACOLOGY AND THERAPEUTICS. 

Under toxic doses the respiratory movements become very full 
and slow, the reflex function of the cord is abolished, and the 
heart is paralyzed. Death is caused by the direct action of the 
drug on the heart. It appears to have no cumulative action. 

Therapeutics of Convallaria. 
Convallaria has been used extensively in the same range of 
cases as digitalis. It is said to act more powerfully upon the 
right heart than the latter, but this is probably not true. The 
reports of the results of its employment in cardiac disease, how- 
ever, have been by no means uniformly favorable, and a more 
extended experience seems to indicate that this drug is very 
unreliable. It is, however, free from most of the undesirable 
effects of digitalis, to which reference has been made, and in 
dropsical cases especially it has sometimes proved of service. 
Some writers assert that it is particularly useful in cases of 
arhythmia and " cardiac hurry." At the present time con- 
vallaria is employed very little. 

CAFFEINE. 
CAFFEINA.— Caffeine. (Theine. Guaranine.) Dose, 0.065 gm. 
(65 milligm.); 1 gr. 

Preparations. 

1. Caffeina Citrata. — Citrated Caffeine. Dose, 0.125 gm. 
(125 milligm.); 2 gr. 

2. Caffeina Citrata Effervescens. — Effervescent Citrated Caf- 
feine. Dose, 4 gm.; 60 gr. 

3. Pulvis Acetanilidi Compositus. — Compound Acetanilide 
Powder. Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. 

Unofficial Preparations. 
Caffeinae Sodio-Benzoas. — Caffeine Sodium Benzoate. Dose, 
0.125 to 0.60 gm.; 2 to 10 gr. 

Caffeinae Sodio-Salicylas. — Caffeine Sodium Salicylate 
Dose, 0.125 to 0.60 gm.; 2 to 10 gr. 



CAFFEINE. 283 

Action of Caffeine. 

External. — Roasted coffee, especially in the form of powder, 
appears to have some disinfecting and deodorizing power. 

Internal. Alimentary Canal. — Coffee in small amounts is a 
stomachic tonic, and generally has a somewhat laxative effect; 
increasing (probably by reason of its volatile oils) the peristaltic 
movements of the intestine. The so-called biliousness sometimes 
caused by its habitual use is probably occasioned by the em- 
pyreumatic oil, caffeol or caffeone, which is one of its constitu- 
ents and which, if taken alone, is likely to disorder the diges- 
tion. The excessive use of both tea and coffee is liable to give 
rise to indigestion, acidity and heart-burn. Such use of tea is 
more prone than that of coffee to produce injurious effects in 
the alimentary canal, as well as elsewhere, partly perhaps be- 
cause, as a rule, more of the former than of the latter is con- \ 
sumed, and also because the effects of the continued action of 
the tannin in the tea are no doubt even more deleterious than 
those of caffeine. They not infrequently induce chronic con- 
stipation and cause very serious interference with digestion. 
The teeth of tea-tasters are very liable to decay. 

Heart. — From recent careful experiments on the dog's heart 
the effect of caffeine appears to consist in (1) an acceleration 
of the rhythm without further change; (2) a shortening of the 
movements, commencing in the auricle and spreading to the 
ventricle; and, in large doses, (3) auriculo-ventricular arhyth- 
mia, terminating in fibrillary contractions of the auricle, and 
finally of the ventricle. The primary acceleration would seem 
to be due to stimulation of the most irritable part of the heart, 
the so-called excito-motor apparatus, and as no further change 
in the movements is seen, the action of the drug at this stage 
appears to be confined to this area. The second change may 
be due in part to the acceleration, and thus be considered a 
secondary effect of the increased irritability of the excito-motor 
area; but it may also be ascribed, it is thought, to the action 
of the caffeine on the muscle of the auricle and ventricle, and 
may thus indicate that the influence of the drug has extended 



284 PHARMACOLOGY AND THERAPEUTICS. 

to these less susceptible parts of the heart. The third stage, that 
of arhythmia, is believed to be due to the ventricular irritability 
having been so greatly increased as to give rise to an idioventri- 
cular rhythm. The interference of the two rhythms then ex- 
plains the major part of the variation in the strength of systole 
and the extent of diastole. The idioventricular rhythm indi- 
cates that the characteristic stimulant action on the cardiac 
muscle has extended to the ventricle. When this has attained 
a sufficient height it leads to fibrillary contractions in the ven- 
tricle ; the previous appearance of these in the auricle appearing 
to indicate that the stimulant influence spreads to this before 
it reaches the ventricle. The action of caffeine on the mamma- 
lian heart thus appears to consist in a descending stimulation, 
which begins in the excitomotor area at the junction of the 
auricle and great veins, and extends into the auricles and finally 
to the ventricles. The effects can be explained by direct action 
on the muscle, without the necessity of appealing to any ner- 
vous apparatus, and these experiments do not support the idea 
that the nervous apparatus of the heart is involved in the effects. 
Comparing the action of caffeine on the dog's heart with that 
of digitalis, it is found that, as far as the direct action on the 
heart is concerned, they resemble each other in both affecting 
only the heart muscle. But while in the case of digitalis the 
earliest changes seen are in the strength of systole and extent 
of diastole in the ventricle and auricle, the stimulation exer- 
cised by caffeine begins in the excitomotor area and descends 
to the auricle and then to the ventricle, and its effects on the 
rhythm (as far as these are caused by direct action on the 
heart) are of secondary importance. Furthermore, the pri- 
mary changes induced by digitalis are not so much evidenced 
by increased irritability of the parts affected as by increased 
contractibility and lessened dilatation (increased tone), while 
there is no evidence of such a change in the late stages of 
caffeine poisoning, in which the ventricle is directly affected. 

Vessels. — Caffeine stimulates the vaso-motor centre, and 
under its influence the blood-vessels are therefore contracted, 



CAFFEINE. 285 

causing a marked rise in the arterial pressure. The muscle-fiore 

in the walls of the vessels, in common with the muscles in gen- 
eral, is also acted upon by the drug. Under small doses the 
constriction of the arteries, which is of comparatively short 
duration, is followed by an expansion of much longer duration, 
but with larger doses the subsequent dilatation does not occur. 
After repeated intravenous injection caffeine is found to fail 
to produce vascular dilatation, and soon each injection is fol- 
lowed only by vascular constriction. It has been demonstrated 
that the vaso-constriction caused by the drug is principally the 
result of central stimulation by the fact that this effect is very 
largely interfered with by chloral, which paralyzes the vaso- 
motor centre. That the rise of pressure is not due to increased 
cardiac energy is shown by its absence in preparations of the 
isolated mammalian heart. 

Muscles. — Small doses increase the excitability of the muscles,\ 
augmenting the quickness and force of their contraction. Under 
larger doses the height of the contraction of the muscle is less, 
the maximum load it is capable of lifting is smaller, and the 
muscle is exhausted by tetanus more quickly than a normal 
muscle. The contraction then becomes smaller and smaller, 
and the muscle gradually passes into rigor. In mammals much 
larger quantities of the drug are required to induce rigor than 
to paralyze the respiration. 

Respiration. — Respiration is quickened and strengthened by 
caffeine, which has a stimulating effect upon the respiratory 
centre in the medulla. This effect is shown in the improvement 
in the respiration caused by it in cases of poisoning by alcohol, 
opium and other drugs, but it is much less marked in the normal 
condition of the system. In toxic doses it produces first quicken- 
ing and then paralysis of the medullary centre. 

Nervous System. — Caffeine is a rapidly-acting stimulant to 
the cerebrum, medulla oblongata, and spinal cord. In its effect 
upon the cerebral centres the blood-supply would seem to bear 
an important part; it being probable that the circulation in 
the brain is affected indirectly by the changes produced in the 



286 PHARMACOLOGY AND THERAPEUTICS. 

general circulation. Any agent which causes general arterial 
constriction will tend to passively induce dilatation of the 
cerebral vessels, and hence it may be supposed that such dila- 
tation accompanies the general vaso-constriction due to the 
exhibition of caffeine. In the cerebrum the drug affects the 
psychic functions, and is without doubt the most certain and 
effective stimulant that we have to the nerve centres connected 
with the intellectual faculties. Consciousness is enjoyed to the 
fullest extent, all drowsiness is banished, and the highest mental 
powers have full play. The cerebral stimulation caused by it 
differs from that due to opium in that the reasoning faculty is 
not less affected than the imagination and in that the excitation 
is not incoordinate. Caffeine acts on the same parts as are 
first affected by alcohol and other agents of its class; but alters 
them in the opposite direction. They are the centres which are 
also first paralyzed, to some degree at least, by morphine and 
cannabis indica. Caffeine is therefore an efficient antidote for 
these, and especially for alcohol, since the medullary and spinal 
effects are also antagonistic. The sleeplessness often caused 
by tea and coffee is probably due in part to stimulation of the 
nerve centres and partly to the indirect effect of the dilatation 
of the cerebral blood-vessels caused by the constriction of the 
vessels of the body generally. In addition to tea and coffee, 
cocoa, coca, kola, guarana and the various other substances 
which have long been in use as beverages in different parts of 
the world all contain either caffeine or analogous alkaloids. 
They impart a sense of grateful refreshment, relieve fatigue, 
mental and muscular, and increase the capacity for physical 
exertion and endurance. The effect of caffeine on the acuteness 
of the senses is shown by the greater accuracy of touch under 
its influence. While the results of the drug taken in moderate 
quantity are of distinct benefit in intellectual work, larger 
amounts are apt to render connected thought more difficult, as 
impressions follow each other so rapidly that the attention 
becomes distracted. These larger doses often over-stimulate 
the cerebral circulation, causing pain and a sense of fullness 



CAFFEINE. 287 

in the head, restlessness and insomnia, with more or less con- 
fusion of mind, or even hallucinations and delirium. Sometimes 
tinnitus aurium and flashes of light before the eyes indicate 
derangement of the special senses. v'The pulse becomes rapid 
and irregular, and cardiac uneasiness or palpitation may occur; 
while in some instances convulsive movements of the hand 
and tremor in different parts of the body are noted. It is stated 
that such effects as these are induced only with difficulty in 
habitual tea or coffee drinkers; so that the continued use of 
small quantities of caffeine would seem to give rise to tolerance. 
Toxic doses, administered to animals, occasion rise of tem- 
perature, convulsions and general paralysis, but the temperature 
declines when paralysis supervenes. In the medulla, while 
caffeine has a marked stimulant effect on the activity of the 
vaso-motor and respiratory centres, it exerts practically no 
action on the vagus centre. In the spinal cord it excites reflex 
activity. It causes convulsions in the frog, and that these are 
not of cerebral origin is shown by the fact that section of the 
upper cord does not prevent them. On the other hand, destruc- 
tion of the cord does have the effect of preventing them, so 
that they are no doubt spinal. The effects of caffeine on the 
cord are reflex irritability, then tremors, and finally tetanus. 
They closely resemble those of strychnine, but are very much 
smaller, and occur only with relatively larger doses. This 
tetanus, which, like that of strychnine, is located in the cord, 
shows the same intermittent character and also involves the 
respiratory muscles in the same manner. It occurs both in 
mammals and frogs, but the dose required for the former is 
considerably larger than that necessary to give a vaso-motor, 
cardiac or diuretic effect. The motor nerves appear not to be 
affected by caffeine, but the sensory nerves are apparently 
slightly influenced by it. 

Kidneys. — Caffeine, in small doses, usually has a marked 
effect in increasing diuresis. It is a matter of common obser- 
vation that both tea and coffee augment the flow of urine to a 
much greater extent than the same amount of water, and this 



288 PHARMACOLOGY AND THERAPEUTICS. 

has been shown to be due to the caffeine which they contain. 
It was formerly supposed that the diuretic influence of this 
agent was principally owing, as in the case of digitalis, to an 
increase of cardiac energy which improved the renal circula- 
tion, but this is now known not to be so, since it has been shown 
that when changes in the circulation are prevented from taking 
place the same increased flow of urine occurs under its influ- 
ence. While the vascular expansion following the primary 
constriction of the vessels 'caused by small doses of the drug no 
doubt assists in the promotion of diuresis, the latter is mainly 
due to the direct action which it has in stimulating the renal 
epithelium. The increased activity of the secretory cells oc- 
casioned by it is also accompanied by a slight dilatation of the 
vessels of the part which is analogous to the vascular dilatation 
in a muscle undergoing contraction. But this tendency to pro- 
duce a dilatation of the renal vessels is always liable to be 
counteracted by the pronounced action of the caffeine on the 
vasomotor centre, which, on the other hand, tends to constrict 
the vessels. Such constriction has the effect of diminishing, 
and many even inhibit, the secretion of urine. Sometimes, 
therefore, it is found that the administration of caffeine not 
only produces no diuresis, but has the directly contrary effect; 
for if the contraction of the arterioles caused by it is great 
enough, the epithelial cells, however active they may be, can, 
owing to the interference with their blood-supply, secrete but 
little. Consequently, it will be seen that caffeine is by no 
means a certain diuretic, and in cases where it thus fails meas- 
ures must be taken which will prevent its action on the central 
nervous system. Under the diuretic effects of caffeine both the 
solids and the fluids in the urine are increased, but the former 
to a less extent than the latter. It is said that the excretion 
of alkalies, and especially sodium, is augmented even out of 
proportion to the diuresis. 

Metabolism. — The effect of caffeine upon tissue waste has 
been much investigated, with very contradictory results. Ac- 
cording to some of the latest and best authorities it causes a 



CAFFEINE. 289 

slight rise of temperature, partly by its action on the central 
nervous system, and more particularly by its direct muscular 
effects. In consequence of this, it is claimed, it also increases 
the metabolism, that is, the production of urea and carbon- 
dioxide. If this view is correct, the older one that it lessens 
metabolism is consequently erroneous. Caffeine is excreted in 
the urine in small quantities, but a considerable proportion of it 
is probably decomposed, with the formation of xanthin, which 
is further broken up into urea. 

Therapeutics of Caffeine. 
Heart. — As caffeine cannot be administered subcutaneously 
alone, owing to its decomposition in the presence of water, it 
is necessary, for this purpose, to combine it with sodium salicy- 
late or benzoate. The following solution will answer well for 
hypodermatic use: Caffeine, 40, sodium salicylate, 30, distilled 
water, 60 parts. In cardiac disease caffeine has been employed 
to a considerable extent as a substitute for digitalis, but as has 
been seen, its action on the heart is different from that of the 
latter and cannot, therefore, take its place. As a rapidly-acting 
cardiac stimulant it may prove of service in a variety of con- 
ditions, and in certain cases with feeble action of the heart it 
also does good by increasing the general blood-pressure, through 
its constricting influence on the arterioles, and thus producing 
a more efficient circulation. Its chief utility in heart affections, 
however, is in cases attended with dropsy, where by its marked 
diuretic action it proves highly efficacious in a considerable pro- 
portion of instances. It may often be combined with advantage 
with digitalis, strophanthus, or other drugs having a similar 
cardiac action. The preparations of caffeine are useful also 
when combined with antipyrine or acetanilide derivatives to 
counteract their depressing influence upon the heart, as in 
the official compound acetanilide powder given above. Caffeine 
sometimes causes so much insomnia that its use has to be dis- 
continued, and it is alleged that occasionally it sets up con- 
siderable smarting in the penis and even a mild form of ure- 



29O PHARMACOLOGY AND THERAPEUTICS. 

thritis. The nervous phenomena and the irregularity of the 
heart's action sometimes occasioned by tea and coffee are gen- 
erally recognized. 

Kidney. — The physiological action of the drug shows it to 
be within certain limitations a diuretic of great value. It is a 
fact worthy of note and to be borne carefully in mind in the 
therapeutic use of caffeine, that the diuresis is produced by 
smaller doses than those required for any other of its effects. 
This constitutes a point of great practical importance, for the 
smaller doses, while sufficient to bring about the desired effect 
on the kidneys, do not as a rule affect the central nervous sys- 
tem to such an extent as to cause the antagonistic vaso-constric- 
tion which so seriously interferes with the renal function. Even 
when given in the smallest supposedly effective dose, however, 
its effect upon the urine is somewhat variable, and in order to 
secure satisfactory diuresis it is therefore sometimes advisable 
to administer with it some such agent as chloral or paraldehyde 
which diminishes the excitability of the medullary centres. It 
should seldom or never be employed in acute inflammatory 
conditions of the kidney, because stimulants are contra-indi- 
cated when the part they influence is inflamed; but it is some- 
times of service in chronic Bright's disease, especially when 
there is marked cardiac failure. When, however, the secreting 
cells are in such a state as to be incapable of stimulation, it 
will naturally prove inefficient; so that in renal dropsy it may 
be said to be useful in inverse ratio to the amount of damage 
suffered by the kidneys. In simple cardiac dropsy, where it 
often acts so effectively, the epithelial structures are not dis- 
eased, but only passively congested. As a diuretic, caffeine is 
now regarded as decidedly inferior to theobromine, and the 
reasons alleged for this are: (1) because the diuresis is less 
certain and often accompanied by nervous symptoms such as 
restlessness and insomnia, and (2) because the secretion is 
smaller and lasts for a shorter time. Theobromine, while having 
an action similar to that of caffeine, has a much less pronounced 
effect upon the central nervous system. 



CAFFEINE. 29I 

Nervous System. — As a stimulant to the central nervous sys- 
tem, and especially to the respiratory centres, caffeine is of 
great service in cases of poisoning by opium and by alcohol. 
In the treatment of the former strong black coffee has long 
been in use, and caffeine might perhaps be substituted for it 
with benefit. Hot coffee, however, has the advantage of adding 
to the heat of the body, which is apt to be quite cold. It has 
been ascertained by experiment that within narrow limits there 
is a direct physiological antagonism between caffeine and 
morphine. In the insomnia of chronic alcoholism caffeine, in 
small doses given subcutaneously, has also been found useful. 
On the other hand, it is sometimes taken, in larger quantity, to 
produce wakefulness and increase the vigor of the mental 
powers during excessive use. So, in despondency and hypo- 
chondriasis and in neurasthenia it sometimes has a good effect. 
In migraine and other forms of nervous headache, such as 
hemicrania, with or without gastric derangement, it is much 
used. In this class of affections it is not so efficient as anti- 
pyrine; but it may often be advantageously combined with the 
latter, and, in addition, sometimes with one of the bromides. 
Some observers have also found it especially efficient when given 
in connection with phenacetine. If the headache is due, as is 
often the case, to errors of refraction, much benefit can hardly 
be expected from it. In trigeminal, cervico-brachial, and other 
neuralgias, particularly when given in combination with some 
of the coal-tar products, it often affords relief. Or, it may be 
administered alone hypodermatically. In the adynamia of 
typhoid and other acute fevers it may at times prove useful, 
either alone or as an adjuvant to alcoholic and other stimulants. 
In some forms of malarial fever it is claimed that strong coffee 
has a curative effect. One reason that caffeine, as sold in the 
markets, so frequently gives rise to the peculiar nervous and 
renal by-effects that it does is because theine made from the 
sweepings of the tea-houses is substituted for caffeine. 

Alimentary Tract. — Caffeine is a stomachic tonic, improving 
the appetite and digestion, and it has been found of service in 



292 PHARMACOLOGY AND THERAPEUTICS. 

convalescence from various acute diseases. In nervous dys- 
pepsias and in chronic catarrh of the stomach with occasional 
attacks of migraine it is often useful. So also in the diarrhoea 
of phthisis and of typhoid fever, and in ordinary atonic diar- 
rhoea, as well as in cholera infantum and in cholera morbus, 
especially when dependent on agencies affecting the nervous 
system. In affections of this character the sodium benzoate or 
the sodium salicylate, in combination with nux vomica or 
strychnine, may sometimes be used with advantage. 

Respiration. — In certain cases of asthma it is of value; the 
paroxysm being promptly relieved by it. In many instances, 
however, it has little or no beneficial effect. In pneumonia or 
in congestion of the lungs, with weak heart, in elderly in- 
dividuals, it sometimes proves of material service. 

Uterus. — The sodium benzoate has been recommended in 
puerperal haemorrhage, the statement being made that when 
given subcutaneously it acts more promptly than ergot. 

As the solubility of caffeine citrate is variable, caffeine is 
best given as such, but it is recommended that a dose of 
sodium salicylate half as large as that of the caffeine should 
be administered with it to insure the solution of the caffeine. 

GUARANA. 
GUARANA.— Guarana. Dose, 2 gm.; 30 gr. 

Preparation. 
Fluidextractum Guaranse. — Fluidextract of Guarana. Dose, 
2 c.c.; 30 TTt. 

Action of Guarana. 
Guarana is habitually used as a beverage by the South Amer- 
ican Indians who make it. Its effects on the system are mainly 
those of its alkaloid, although it contains sufficient tannic acid 
to have an appreciable influence. 

Therapeutics of Guarana. 
In medicine guarana is employed almost exclusively for the 
relief of headache. The forms of headache in which it is most 



COLA. 293 

serviceable are the nervous sick headache which recurs at short 
intervals, especially in women at the menstrual periods, and 
that which follows a debauch, when the head throbs and the 
eyes are bloodshot. In many instances, however, guarana, like 
most other remedies, gradually loses its power over such attacks, 
and may eventually aggravate them. In the headache of 
chlorosis guarana is said to be efficient in combination with 
cannabis indica. Almost the only other purpose for which the 
drug is now used is in the treatment of atonic chronic diarrhoea. 
By the Indians it is considered valuable in the prevention and 
cure of bowel complaints. 

COLA. 

COLA.— Cola (not official). Dose, 1 gm.; 15 gr. 

Action of Cola. 
It is somewhat stimulating to the digestion and is like coca 
in enabling the body to undergo unusual exercise without 
fatigue. Its effects on the nervous system appear to be much 
the same as those of caffeine. Partly in consequence of its 
increasing the force and frequency of the pulse, the blood 
tension rises and metabolism is carried on more rapidly. As 
it contains a larger proportion of theobromine, it is said to have 
a more pronounced diuretic action than caffeine. 

Therapeutics of Cola. 
It has been used in various phases of debility, including 
diarrhoeas in the debilitated, in irregularity of the heart's action, 
as a vehicle for the administration of cardiac stimulants, in 
migraine, and in neuralgia and other nervous disorders. It is no 
doubt of most benefit in diseases characterized by great nervous 
weakness and in convalescence from acute diseases in which 
wasting is pronounced, of which typhoid fever is the type. It 
has a marked effect in relieving the mental depression, while the 
diminution of the natural tendency to faintness, the disappear- 
ance of nervous irritability, and the acquisition of the ability to 



294 PHARMACOLOGY AND THERAPEUTICS. 

undergo muscular exertion, under its use, are well established 
facts. When fatiguing literary work or monotonous mental ap- 
plication is called for, kola probably affords greater assistance 
than any other drug. It may be of service in those occasional 
instances of morbid somnolence which can be definitely stated to 
be not dependent upon dyspepsia in its various forms, diabetes, 
lithsemia, gout, nervous exhaustion, or malarial disease. It is 
also of value in the performance of muscular feats, from the 
caffeine which it contains in a nascent condition. It is highly 
prized by the natives of equatorial Africa, who take it to enable 
them to endure long exertion without fatigue, and use it as a 
masticatory. It is also reputed to render bad water palatable 
and tainted meat palatable. The most effective manner of em- 
ploying the drug is said to be by slow mastication and swallow- 
ing the saliva. 

ERYTHROPHLOEUM. 

ERYTHROPHLCEUM. — Erythrophloeum (not official). (Sassy 
Bark.) 

Unofficial Preparation. 
Tinctura Erythrophloei. — Tincture of Erythrophloeum. Dose, 
0.30 to 0.60 c.c; 5 to 10 Til.. 

ERYTHROPHLCEINA. — Erythrophlceine (not official). Dose, 
0.0015 to 0.0020 gin.; ^ to ^ gr. 

Action of Erythrophlceum. . 
Under its influence the heart is at first slowed; later its action 
becomes rapid. The ventricles contract regularly and stop in 
systole, while the auricles may continue to beat. This slowing 
is remarkable (i) from the regularity and energy of the sys- 
toles, and (2) from the fact that during the slowing the uni- 
form blood-pressure is not altered by respiratory movements. 
The blood-pressure rises because (1) of the increased energy of 
the heart and (2) of the contraction of the blood-vessels; this 
condition persists until the heart becomes irregular, when it 
falls. The respiratory movements are at first slower and fuller, 
but when the heart grows feeble they become accelerated, and 



ERYTHOPHLCEUM. 295 

during the period of weak and irregular cardiac action produce 
the so-called respiratory oscillations in blood-pressure. Moder- 
ate amounts increase diuresis; larger doses produce vomiting 
and increased peristalsis; poisonous doses induce convulsions, 
later, marked weakness of all muscles, and, finally, death. The 
mode of action may be summed up as that of a muscle-poison 
acting primarily upon the heart for the reason that the latter 
receives a larger quantity of poisoned blood. Still, its sphere 
of influence appears to be the inhibitory, rather than the muscu- 
lar system, and upon the vagus its action resembles that of 
digitalis. It is a vaso-constrictor by acting on the vessels them- 
selves, on the vaso-motor nerves, or on some vaso-motor centre 
not in the medulla, but probably in or around the vessels them- 
selves. The respiration is influenced through the pulmonary 
branches of the vagus. Erythrophlceum is a sternutatory because 
the powdered bark is irritant to the nasal mucous membrane, 
it causes vomiting by reason of its solutions possessing the same 
property, and it is diuretic for the same reason and under the 
same conditions as digitalis. Its ability to slow the heart is 
rather greater than that of digitalis, but it is more decidedly a 
gastric irritant. Its vaso-constrictor properties are practically 
those of digitalis and ergot combined. It is rather less cumu- 
lative than digitalis ; using this term in the same sense in which 
it is applied to the latter. 

The alkaloid is locally anaesthetic, but although the anaesthetic 
condition induced by it lasts several hours, practically it is in- 
ferior to cocaine, since it dims the cornea and causes myosis, 
headache, giddiness and even syncope. Its employment for this 
purpose has therefore been abandoned. 

Therapeutics of Erythrophlceum. 
The field of use for erythrophlceum, of which a 10 per cent, 
tincture has been recommended in dose of from .30 to .60 c.c. 
(5 to 10 HI), by the British Pharmaceutical Conference, would 
seem to be limited to the heart and blood-vessels in cardiac dis- 
ease whether accompanied by dropsy or not. The indications 



296 .PHARMACOLOGY AND THERAPEUTICS. 

for its employment are identical with those for digitalis. As 
to constancy of effect in slowing the heart, strengthening the 
pulse, and promoting diuresis, digitalis is rather more reliable. 
The use of this remedy should, then, be confined to those cases 
of fairly competent heart with low vascular tension in which 
it will show its effects more rapidly and markedly, and to those 
cases in which digitalis has lost its usefulness or has utterly 
failed. 

CAMPHOR. 

1. CAMPHORA.— Camphor. Dose, 0.125 gm. (125 milligm.) ; 
2 gr. 

Preparations. 

1. Linimentum Camphorae. — Camphor Liniment. (Camphor- 
ated Oil.) 

2. Ceratum Camphorae. — Camphor Cerate. 

3. Aqua Camphorae. — Camphor Water. Dose, 8 c.c; 2 fl. 
dr. 

4. Spiritus Camphorae. — Spirit of Camphor. Dose, 1 c.c; 
15 TTL. 

2. CAMPHORA MONOBROMATA. — Monobromated Camphor. 
Dose, 0.125 gm. (125 milligm.); 2 gr. 

3. ACIDUM CAMPHORICUM.— Camphoric Acid. Dose, 1 gm.; 
15 gr. 

Action of Camphor. 

External. — Like the volatile oils, camphor acts as an irritant 
to the skin and mucous membranes. It is a direct cutaneous 
stimulant, causing redness, itching and warmth, owing to a 
local dilatation of the vessels. Later this sense of warmth is 
followed by some degree of local anaesthesia from paralysis of 
the sensory nerves. On mucous membrane it produces similar 
irritation, as indicated by congestion and smarting. It has 
some antiseptic action, but this is considerably weaker than 
some of the substances of the phenol group, and also than 
many of the volatile oils. 

Internal. G astro-intestinal Tract. — In small doses it is 



CAMPHOR. 297 

stomachic and carminative, inducing a feeling of warmth and 
comfort in the stomach. Here, as on the cutaneous surface, it 
causes dilatation of the vessels, and thus has a mildly stimulat- 
ing effect on the secretion of gastric juice and on peristalsis. 
In larger amounts it may produce sufficient irritation to cause 
nausea and vomiting. In medicinal doses it has little action on 
the intestines themselves, but it exerts quite an efficient anti- 
septic influence in the bowel, as it is found that the amount of 
combined sulphates in the urine is diminished by it. 

Absorption and Excretion. — Camphor is absorbed with con- 
siderable rapidity from the stomach and intestine, as well as 
from the skin and the respiratory mucous membrane when in 
contact with them. After absorption it is converted into cam- 
phorol, a body in which one atom of H in camphor is replaced 
by OH, and this combines with glycuronic acid and is excreted 
in part in the urine as camphor-glycuronic acid. An amido- 
derivative of this acid is formed at the same time, and is also 
found in the urine. Camphorol acts like camphor, but its 
glycuronic combinations are inert, so that the effects of cam- 
phor are observed to pass off quickly in such animals as the 
dog, in which these combinations are rapidly formed. In ani- 
mals poisoned with camphor a considerable quantity of glucose 
is said to be frequently present in the urine. 

Blood. — It is said to increase the number of leucocytes in the 
blood. 

Heart and Circulation. — While the effects of camphor on the 
mammalian heart are as yet but very imperfectly known, it may 
be stated that the heart is generally slowed by the drug, while 
the contractions are at the same time greatly strengthened. 
This appears to be due rather to a direct stimulation of the 
cardiac muscle than to the influence of the regulating nerves. 
There may, however, be some slight reflex stimulation of the 
organ. On the normal heart camphor usually produces 
lengthening of the systole and shortening of the diastole, some- 
what after the manner of digitalis, and the pulse becomes fuller, 
stronger and slower. The blood-pressure may either rise or 



298 PHARMACOLOGY AND THERAPEUTICS. 

show alternate rise and fall. Such variations are found to 
persist after convulsive movements have been prevented by 
curara, and it is therefore believed that the rise is mainly caused 
by a stimulation of the vaso-motor centre, and that this stimula- 
tion is intermittent in character, since the variations mentioned 
are independent of the respiration. The stimulation of the 
heart and the reflexes, especially those arising from the stomach 
also, no doubt, contribute to the rise in blood-pressure. 

Respiration. — The respiration is usually but slightly affected, 
but as a rule becomes slower and deeper under large doses. 
Some observers find the rate as well as the volume increased 
by it. During the convulsions caused by camphor in animals 
the respiration is arrested, and in the intervals may be accel- 
erated in consequence of the muscular exertion during the 
spasms. Whether any excretion of the drug takes place by the 
lungs is not positively known, but the breath of persons using 
it sometimes smells of it, and it is thought probable that some 
camphor or some derivative from it is excreted by the bronchial 
mucous membrane, the vascularity and secretion of which is 
thus stimulated. It is generally regarded as an expectorant of 
somewhat feeble power. 

Nervous System. — The action of camphor on the central ner- 
vous system in mammals has been found to consist in stimula- 
tion, followed by paralysis of the cerebral areas and probably 
of other intracranial centres, with less marked effect on the 
spinal cord. As regards the brain the stimulant symptoms begin 
in man with excitement, impulsive movements, confusion and 
delirium with hallucinations, and these are followed by epilepti- 
form convulsions. In the lower animals the symptoms are simi- 
lar: wild excitement and epileptiform convulsions, followed by 
depression, stupor and collapse. The convulsions have generally 
been attributed to stimulation of the medulla oblongata, but the 
epileptiform character of the attacks points to an affection of 
the cerebral cortex, and experimenters have found that re- 
moval of the cortex prevented the convulsions in mammals, 
though in the pigeon convulsions continued after the cerebrum 



CAMPHOR. 299 

had been removed. On the whole, there seems to be good reason 
for supposing that these seizures have their origin, at least 
partly, in the higher areas of the nervous axis. The first evi- 
dence of stimulation of the medulla is vertigo. Later all the 
medullary centres are stimulated : the respiration is increased 
in volume, the blood-pressure rises, and the face and skin be- 
come flushed in consequence of the stimulation of the vaso- 
dilator centre. Under sufficiently large doses the medulla is 
paralyzed, and collapse ensues, with death from failure of the 
respiration. Sometimes, however, the respiration ceases during 
a convulsion, and fails to return when it passes off. In man the 
epileptiform convulsions alternate with intervals of quiet and un- 
consciousness, until the patient sinks into complete stupor; and 
in exceptional instances of poisoning there is no stage of ex- 
citement, the patient at once falling into a condition of drowsi- 
ness, unconsciousness and stupor. As regards the spinal cord, 
in mammals there is observed some stimulation, followed by 
paralysis, but this is unimportant and does not occur until late. 
In the frog, on the other hand, the spinal paralysis is found to 
be so pronounced as to entirely obscure any effect the drug may 
have upon the higher nervous centres. The reflexes, which do 
not seem to be much affected at first, later disappear, and the 
animal lies completely paralyzed. The susceptibility to the 
effects of camphor varies very greatly in different individuals. 
.30 to .60 gm. (5 to 10 gr.) will produce in some persons a con- 
siderable amount of exhilaration, while in others the only effect 
observed will be a sense of comfort and restfulness. 

Temperature. — In health the temperature is not affected, but 
in fever, camphor has, like many aromatic bodies, some anti- 
pyretic action. 

Muscles. — On the striped muscles of the frog, when directly 
exposed to its solutions or vapor, camphor has a curara-like 
action, weakening and paralyzing them; but this is not observed 
in mammals. In certain experiments, made with a Mosso's 
ergograph, the drug sometimes seemed greatly to increase the 
energy and endurance of human muscles, but in other instances 
failed to have any influence. 



300 PHARMACOLOGY AND THERAPEUTICS. 

Skin. — The fact that in those using camphor the sweat some- 
times smells strongly of the drug points to some excretion of it 
by the skin. It has a mild diaphoretic action, and this may be 
due in part to its effects on the central nervous system. 

Sexual Organs. — Occasionally camphor has the effect of in- 
ducing dysuria. In small doses it' sometimes appears to in- 
crease the sexual appetite; but any such effect is probably to be 
attributed merely to its general stimulant action on the circula- 
tion. In large doses it has been held by many to be anaphro- 
disiac. 

Therapeutics of Camphor. 

External. — On account of its stimulating properties, camphor 
is probably employed more extensively as an ingredient of lini- 
ments of various kinds than any other drug. Thus, as a mild 
irritant or counter-irritant it is rubbed into the skin, in one 
form or another, for the relief of internal inflammations, chronic 
inflammatory induration, chronic rheumatism, etc. In such 
conditions as myalgia, sciatica, lumbago and neuralgia of 
superficial nerves it also answers the same purpose, and in addi- 
tion, by its effect in inducing local anaesthesia, serves to allay 
the pain. Camphor and hydrated chloral triturated together 
form a clear liquid which will take up morphine, atropine and 
other alkaloids in considerable quantity, and such a solution can 
be mixed with chloroform without precipitation. The resulting 
mixture constitutes a topical application of great power in the 
treatment of pain and inflammation ; and it may be either painted 
on the affected part with a camel's-hair brush or applied on 
absorbent cotton or lint which is then covered with oiled silk. 
The official chloroform liniment is made of chloroform, 300; 
soap liniment (of which camphor is an ingredient), 700; and 
a Chloroformum Camphorse may be prepared by dissolving cam- 
phor, 2, in chloroform, 1. The liquid preparations of camphor 
with chloral, thymol and carbolic acid are excellent local 
anodynes for neuralgia, and may also be applied on cotton 
to the cavities of aching teeth. A warm flaxseed poultice to 
which camphor and morphine have been added is a good ex- 



CAMPHOR. 3OI 

ternal application for the relief of toothache. The solution of 
camphor in ether has been applied locally with benefit in ery- 
sipelas, and powdered camphor, freely sprinkled over the sur- 
face, is sometimes successful in preventing pitting of the face 
from small-pox. Powdered camphor has also been used with 
success upon specific ulcers of the genitals, and is an efficient 
application for indolent ulcers. For the latter the camphor oint- 
ment of the National Formulary (camphor, 22; white wax, 11; 
lard, 67) may likewise be employed. Camphor, 14, combines 
with salicylic acid, 1 1, with the aid of heat, and in the form 
of ointment has been used in chronic ulcers and in lupus. In 
chilblains ointments or liniments containing camphor are often 
useful. For chapping or roughness of the skin camphor may 
be employed in the form of Ceratum Camphorse or incorporated 
in suet or lanolin. Either alone or in combination with other 
agents it is of service in relieving the itching of eczema and 
other cutaneous affections. A combination of camphor, 3, and 
phenol, 1, is a valuable antiseptic and anodyne dressing 
for wounds, and on account of its anaesthetic properties is 
useful in the treatment of inverted toe-nail. It may also be 
locally applied with benefit in pharyngitis or tonsillitis, herpes, 
erysipelas, vaginitis, vulvitis and paresthesia of the vulva and 
other parts. It may likewise be used to overcome the fetor of 
lochial discharges. Fluids having valuable antiseptic powers 
are also formed from camphor with salol and with betanaphthol. 
Mixtures of camphor with menthol, of various strengths, are 
employed in acute nasal catarrh, pharyngitis and laryngitis, in 
hypertrophic rhinitis, and in diseases of the ear. The vapor of 
camphor is inhaled with some relief in coryza and also in 
some forms of headache. In the household the spirit or " eau 
sedative," applied on a handkerchief or a flannel bandage, is 
a popular remedy for headaches and various neuralgic pains. 
Camphor enters into the composition of many dentifrices. 

Internal. — Camphor is contra-indicated in inflammatory dis- 
eases of the gastro-intestinal mucous membranes It is much 
used as a carminative, particularly in neurotic individuals. A 



302 PHARMACOLOGY AND THERAPEUTICS. 

few drops of the spirit will often give relief in hysterical vomit- 
ing, and camphor water with compound tincture of lavender is 
an excellent remedy for flatulence, especially hysterical flatu- 
lence. With the addition of laudanum this mixture is very 
useful in ordinary diarrhoeas. Camphor in combination with 
opium is very largely used in the treatment of diarrhoea, and 
even in the preliminary diarrhoea of Asiatic cholera has fre- 
quently proved of the greatest service. Hope's camphor 
mixture, when freshly made with nitrous, rather than nitric, 
acid, is a useful preparation and is especially well adapted 
for diarrhoea of relaxation in elderly subjects. Either rhu- 
barb, capsicum, chloroform or some astringent is often added 
to the preparations of camphor and opium in diarrhoea 
mixtures. Camphor is very commonly used for aborting 
colds and in the treatment of cold in the head. A very 
good "cold powder" consists of camphor (dissolved in 
ether), 5; ammonium carbonate, 4; powdered opium, 1. The 
dose of it ranges from .20 to .60 gm. (3 to 10 gr.). It has been 
found of value in breaking up colds when taken in time, and in 
modifying their force when taken later. For the treatment of 
acute coryza an excellent combination consists of camphor, 
quinine and fluidextract of belladonna, administered in pill or 
tablet. As camphor tends to allay cough and promote expec- 
toration, it is a common ingredient of cough mixtures and is 
much employed in the form of paregoric. Camphor is used 
especially in chronic bronchitis, emphysema, and capillary 
bronchitis. It has also been found of service as a stimulant 
in so-called typhoid pneumonia. It was formerly employed 
to a considerable extent in the treatment of asthma, but has 
now been superseded by other remedies which have proved more 
efficient. Administered with spirit of chloroform and compound 
tincture of lavender, spirit of camphor has been given with ad- 
vantage in influenza. In typhus and typhoid fever and in the 
exanthemata generally it has long been used as a cardiac stimu- 
lant and also for the purpose of quieting delirium, subsultus or 
restlessness. In Tokio, Japan, excellent results have been re- 



CAMPHOR. 3O3 

ported from the use of camphor, to the exclusion of other 
medication, in the treatment of typhoid fever, the observations 
extending over a period of five years. The regular amount 
administered daily was 1 gm. (15 gr.). In senile gangrene 
and hospital grangrene large doses of camphor have proved of 
value, while the powdered drug has been applied with advantage 
to the sloughing surfaces. According to some authorities, 
2 gm. (30 gr.) a day may be given hypodermatically (in the 
form of a 10 per cent, solution of olive oil) in the profound 
adynamia of acute endocarditis, typhoid fever, pneumonia, etc., 
with the happiest result. It is stated that the addition of a 
few drops of camphor to a small enema of ordinary water will 
produce a prompt evacuation of .the bowels. A elyster of cam- 
phor is also an effective remedy against thread-worms. The 
use of large doses of camphor in abnormal sexual excitement 
and in chordee, as well as in severe convulsive disorders such 
as whooping-cough, epilepsy and puerperal convulsions, has to 
a large extent passed out of vogue, though monobromated cam- 
phor is still employed in some of these conditions. A full 
dose of camphor is sometimes given to arrest the strangury 
produced by cantharides used for blistering. Combined with 
opium it has been quite generally employed, in the form of 
suppositories, after operations upon the urethra, etc., though at 
the present time surgeons are inclined to entirely dispense with 
the use of narcotics and anodynes both before and after such 
operations. Suppositories of this kind are found of service, 
however, in cystitis, enlarged prostate, and other affections of 
the genito-urinary organs. Camphor is a common remedy in 
attacks of nervousness and hysteria, and in hysterical convul- 
sions is a useful antispasmodic. In some cases of delirium 
tremens it works quite satisfactorily, but in maniacal excite- 
ment, melancholia and erotomania it is a very uncertain agent. 
It is extremely useful in nervous dysmenorrhcea and, combined 
with morphine, is commonly relied upon for the relief of after- 
pains. There are, indeed, many conditions met with in women 
to the alleviation of which no one remedv seems so well 



304 PHARMACOLOGY AND THERAPEUTICS. 

adapted as camphor. Monobromated camphor is used as 
a nervous sedative. Its action is not identical with that of 
the bromides, however, as the bromine is present in a differ- 
ent form, and it is stated that no bromine ion is liberated; so 
that the bromine effect would seem to be quite limited. Cam- 
phoric acid is successfully administered for colliquative sweat- 
ing, e. g., that of pulmonary tuberculosis. The daily amount of 
from 1 to 5 gm. (15 to 75 gr.) should be given in the evening 
in divided doses at short intervals, either dry upon the tongue 
or in starch wafers. It has been used with success also in 
hyperidrosis occurring in a variety of cases which were non- 
tuberculous. 

MUSK. 

MOSCHUS.— Musk. Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

Preparation. 
Tinctura Moschi. — Tincture of Musk. Dose, 4 c.c; 1 fl. dr. 

Action of Musk. 
Musk is regarded as stimulant and antispasmodic. It is sup- 
posed to act in the same way as camphor, but almost nothing 
is definitely known in regard to this substance. The odoriferous 
matter, which is believed to be the active principle, has scarcely 
been examined. According to some early observations musk 
was found to cause headache, giddiness and confusion, with a 
feeling of weight and uneasiness in the stomach; later, de- 
pression and drowsiness, and eventually sleep. Tremors and 
even convulsive movements were also sometimes noticed, and 
the pulse was said to be accelerated and quickened. A later 
investigator, however, reported (in 1888) that he could find no 
effects from the administration of musk to men or animals. 

Therapeutics of Musk. 
In recent years the use of musk has been almost entirely dis- 
carded. Its effects appear to be very uncertain at best, and 
as most of the musk on the market is adulterated, and moreover 



ACONITE. 305 

its price is extremely high, there would seem to be very little 
reason for retaining the drug in medicine. Its therapeutic use 
has always been almost purely empirical, and it has been sug- 
gested that it was probably thought that a substance with such 
a powerful odor could not but possess a marked physiological 
action, although no such action was ever demonstrated. Musk 
has been mainly used in spasmodic diseases, such as chorea, 
whooping-cough, hiccough, and laryngismus stridulus, and as 
a stimulant in asthenic conditions, especially in pneumonia and 
delirium tremens and in typhus, typhoid and other fevers. At 
present it is said to be most often prescribed for the extreme 
weakness which follows typhoid fever. It is usually adminis- 
tered in pill. 

B. Drugs Acting on the Vagus Centre. 
ACONITE. 

1. ACONITUM.— Aconite. Dose, 0.065 gm. (65 milligm.) ; 1 gr. 

Preparations. 

1. Fluidextractum Aconiti. — Fluidextract of Aconite. Dose, 
0.05 C.C.; 1 TTL. 

2. Tinctura Aconiti. — Tincture of Aconite. Dose, 0.6 c.c; 
10 TTL- The strength of this tincture has been reduced from 35 
gm. of aconite in 100 c.c. (U. S. P., 1890) to 10 gm. in 100 c.c. 

2. ACONITINA.— Aconitine. Dose, 0.00015 gm. (0.15 milligm.); 

Unofficial Preparations. 
Extractum Accniti. — Extract of Aconite (U. S. P., 1890). 
Dose, 0.010 gm.; y 5 gr. 

Unguentum Aconitinse. — Aconitine Ointment. 
Colloidum Amyle.— Amyl Colloid. (Anodyne Colloid.) 

Action of Aconite. 
The action of aconite is due chiefly to its constituent, acon- 
itine, which is recognized as the most toxic of all known 
alkaloids. 



306 PHARMACOLOGY AND THERAPEUTICS. 

External. — Locally it is an irritant, but, unlike other local 
irritants, it does not cause redness, blistering or other sign of 
inflammation. Applied to the skin or mucous membrane, it 
soon affects the peripheral ends of the sensory nerves, causing 
itching, tingling and burning. This stimulation is followed by 
numbness, and later by complete paralysis of sensation in the 
part. Inhaled through the nostrils, it gives rise to sneezing 
and symptoms of coryza, with an icy cold sensation. 

Internal. G astro -intestinal Tract. — When taken by the 
mouth it causes a disagreeable prickling and sense of constric- 
tion in the fauces. Other mucous membranes become affected, 
and various reflexes, such as sneezing, coughing, increased flow 
of saliva, nausea and vomiting, may be produced by the irri- 
tation of the sensory terminations. This stimulation is suc- 
ceeded by a depression which gives rise to a sense of numbness 
in the different surfaces. Unless the dose is excessive, purg- 
ing is not caused, and even then it occurs only in occasional 
instances. 

Heart and Circulation. — The action of aconite on the heart is 
somewhat complex, and, if given in sufficient amount, it has the 
effect of successively stimulating and paralyzing all the differ- 
ent parts of the organ's mechanism. Under small doses the 
only symptoms produced are those due to stimulation of the 
vagus centres in the medulla, the primary action of the drug. 
As a result, the rate of the heart is slowed, the diastole is in- 
creased, the systole is diminished, and there is a fall in blood- 
pressure. That these effects are due to stimulation of the 
inhibitory centres is shown by the fact that if the vagus is 
divided the heart-beat returns to the normal. With larger 
doses the primary slowing action is the same, but this is soon 
followed by results due to the direct action of the drug upon 
the heart itself, as well as its influence upon the vaso-motor 
centres. The rhythm becomes markedly accelerated, instead of 
abnormally slow. This acceleration has been attributed to 
paralysis of the vagus terminals, but that it is not due entirely or 
principally to this is shown by the fact that it occurs after 



ACONITE. 



30/ 



section of the vagus. There is evidently a powerful stimulation 
of the cardiac muscle, and the action of the heart becomes not 
only very rapid but also extremely irregular. The blood- 
pressure likewise becomes exceedingly irregular, now falling 
to zero, and now rising again to a considerable extent. The 
contractions of both the auricle and ventricle are imperfect 
and very unequal, the one part often beating at a different rate 
from the other. The ventricular action tends to become more 
rapid than the auricular, and the increasing irritability of the 
heart eventually results in delirium cordis. Finally the vaso- 
motor centres become paralyzed and lose their function. 
There is always in the end a complete fall in pressure from 
paralysis of the heart and blood-vessels. Clinically it appears 
that the peripheral vessels are dilated, and this effect is some- 
times very marked. Aconite has been named the " vegetable 
lancet." 

Xeri'ous System. — There is still considerable uncertainty as 
to the mode and order in which the different parts of the 
nervous system are affected by aconite, and one reason for this 
is that the symptoms due to the action of the drug on the 
central nervous system are to a greater or less extent obscured 
by its effects on the peripheral nerve terminals. On the cere- 
brum it has apparently but little influence. In cases of poison- 
ing by it the intellectual faculties are not affected, and con- 
sciousness usually remains to the end. If the latter is lost or 
impaired this may be due to changes in the circulation and 
respiration, or possibly to collapse resulting from paralysis of 
the medullary centres. Xear the end carbonic acid narcosis 
may supervene. Aconite has decided effects on the medulla, 
and its action on the vagus centre has already been referred 
to. It is also believed that it affects the vaso-constrictor centre 
and that the vomiting so frequently present is due. at' least in 
part, to increased irritability of the medullary centres. There 
is dilatation of the pupil, and this is regarded as due to stimu- 
lation of the central dilator apparatus, while the convulsions 
which are not infrequently observed are also attributed largely 



308 PHARMACOLOGY AND THERAPEUTICS. 

to central stimulation. The spasms have been thought to he 
chiefly respiratory, but the fact that they are not altogether 
absent in frogs, and not always relieved by artificial respiration 
in mammals, indicates, it is held, an effect, in part, central. 
The action of aconite on the spinal cord has not as yet been 
definitely determined, but the reflex function of the cord is 
apparently impaired by it. Some authorities hold that it 
primarily stimulates the motor portion of the cord, and at a very 
late period in its toxic action causes centric motor depression. 
Its action on the motor spinal cord, however, is believed to be 
entirely subservient to its influence on the peripheral nerves. 
The weight of evidence goes to show that it causes paralysis 
of the sensory nerves, commencing at their peripheral termi- 
nations and extending eventually to the centre of sensation in 
the cord, and that the loss of reflex activity noted is due, at 
least in great part, to the peripheral paralysis; furthermore, 
that the motor nerves, upon which it exerts a feeble depressing 
influence, are not affected until after the sensory nerves. 
Under toxic doses of aconite the special senses may be more or 
less interfered with, and the general sensibility is always greatly 
diminished, so that marked anaesthesia of the surface is a 
prominent characteristic. 

Respiration. — In moderate doses aconite usually has the effect 
of quieting the respiratory movements. Under toxic doses the 
respiration is at first quickened, but soon becomes very slow and 
labored. When the full effect of the drug is produced both 
inspiration and expiration are prolonged, and the latter is fol- 
lowed by a long pause. Between the primary quickening and 
the subsequent permanent slowing the respiration is some- 
times very irregular, and from the first there is always marked 
dyspnoea. The respiratory trouble has been shown not to be 
due to action on the phrenic terminations, and it does not re- 
sult from stimulation of the vagus endings in the lungs, be- 
cause section of the vagi does not prevent the slowing. It 
seems certain, therefore, that it is caused by the depressing 
action of the drug upon the respiratory centre in the medulla; 



ACONITE. 3O9 

and it has been found that paralysis of this centre begins early. 
It may sometimes occur that the heart ceases before the re- 
spiratory movements, but paralysis of the respiratory centre, 
rather than cardiac paralysis, constitutes the usual cause of 
death in aconite poisoning. The paralysis of this centre prog- 
resses more quickly than that of any other, and it is possible, 
therefore, for death to take place from asphyxia while the 
rest of the central nervous system still continues irritable, as 
shown by the occurrence of convulsions. 

Temperature. — Attention has been called by certain observers 
to the peculiar effect (one that is unique) which aconite has of 
causing a chilly sensation that occurs before either the tem- 
perature or the circulation through the skin is changed. This, 
it is thought, must result from a stimulation of certain tempera- 
ture nerves. Both in febrile conditions and in the normal state 
aconite has the effect of markedly reducing the temperature. 
It is not positively known in what manner this fall is brought 
about, but it seems probable that it is due in great part to the 
influence of the drug upon the nervous centres regulating heat 
production and to its action on the circulation. A considerable 
amount of radiation, it might be expected, would take place 
from the surface of the body in consequence of the lowering of 
the blood-pressure and dilatation of the peripheral vessels 
caused by it, and the increase of perspiration which is also one 
of its effects no doubt assists in the reduction of the tempera- 
ture. The lessening of the supply of oxygen to the tissues 
occasioned by the interference with the circulation and respira- 
tion is shown by the cyanotic appearance of the mucous mem- 
branes, and this, it is believed, is largely instrumental in causing 
the fall. 

Skin. — Profuse sweating is an almost constant symptom when 
large doses of aconite are taken. Whether it has any direct 
action on the perspiratory glands or not is not definitely known, 
but the dilatation of the cutaneous vessels to which reference 
has been made would seem, by increasing the blood-supply of 
the parts, to facilitate an increased sudoriparous excretion. It 



3IO PHARMACOLOGY AND THERAPEUTICS. 

is probable, therefore, that aconite does have some positive 
diaphoretic action, but, even if this is the case, the cold 
perspiration so commonly observed is undoubtedly largely 
attributable to the collapse induced by the drug. In occasional 
instances an erythematous rash is caused by it. 

Kidneys. — Aconite has some influence on the kidneys, but 
this diuretic action is one of its minor effects. It thus in- 
creases elimination to a certain extent, and not only the watery, 
but the solid constituents, of the urine are said to be aug- 
mented by it. Aconitine is excreted mainly through the kid- 
neys. 

Benzaconine. — Benzaconine is very much less poisonous than 
aconitine, the toxic effect of the latter being found by experi- 
ment to be nearly two hundred and fifty times greater in warm- 
blooded animals. In many of its actions it is also distinctly 
opposed to aconitine. It slows the pulse-rate, and its special 
effect on the heart, when given in sufficient quantity, is to 
retard the systole of the ventricles, so that eventually there 
may be only one beat of the latter to two or even three of the 
auricles. Section of the vagus, it is found, does not materially 
affect this action, which therefore appears to be chiefly on the 
cardiac muscle, and which naturally occasions a marked re- 
duction of blood-pressure. The alkaloid is thus the physiological 
antagonist of digitalin. It depresses the vaso-motor centre, but 
this occurs quite late in its toxic action. It acts powerfully on 
the motor nerves, but affects the sensory nerves only at a late 
stage, if at all. By some of the best authorities it is denied 
that it has any influence on the sensory terminations, and prac- 
tically it is found that it does not produce tingling or numbness 
of the mucous membranes. Unlike aconitine, it gives rise to a 
lethargic or semi-comatose condition. In very large doses it 
has a depressing effect upon respiration, but it causes a very 
slight reduction of temperature. 

Aconine. — This is a very feeble agent, but, given in sufficient 
quantity, it has the effect of strengthening the heart-beat. Its 
action is distinctly opposed to that of aconitine, as it stimulates 



ACONITE. 3 I I 

ventricular contraction and so tends to prevent cardiac ase- 
quence and inco-ordination. It does not affect the vasomotor 
centre, but has a stimulating effect on the roots of the vagi. 
Like curare, it paralyzes the terminations of the motor nerves, 
the suspension of function lasting for a considerable time; but 
the paralysis is not preceded by any excitement or spasmodic 
action. When death is caused by it this is in consequence of 
failure of the respiration, which is probably of peripheral origin 
rather than dependent upon depression of the respiratory centre 
in the medulla. It is thought to be unlikely that the alkaloids 
aconine and benzaconine have any influence on the action of 
aconite preparations, but the question is still an undecided one. 

Therapeutics of Aconite. 
External. — The benumbing effects of aconite when locally 
applied have naturally suggested its external use in a variety 
of painful affections, and it is sometimes of considerable service, 
especially in facial and other neuralgias. Among the other con- 
ditions in which it has been employed are pruritus, prurigo, papu- 
lar eczema, chilblains and herpes zoster. In the last-named affec- 
tion care must be taken not to apply it to ruptured vesicles, and 
any preparation containing it should be used with great caution, 
if at all, upon an abraded cutaneous surface, on account of 
the danger of absorption. It is also used locally for the relief 
of the pain of chronic rheumatism, gout, myalgia, and inflamma- 
tions of the structures of the eye and ear. In the different con- 
ditions mentioned above it may be applied either in the form of 
the tincture or in an ointment or liniment. The official aconitine 
ointment of the B. P. (aconitine dissolved in alcohol, i; oleic 
acid, 8; benzoinated lard, 41) is a very expensive preparation, 
and as a substitute for this the liniment (B. P., a 40 per cent, 
solution of powdered aconite root in alcohol, to which 2 per cent, 
of camphor is added), may be painted on with a camel's hair 
brush. Other useful liniments are the Linimentum Aconiti Com- 
positum (not official), known as A. B. C. liniment because it 
contains equal parts of aconite, belladonna and camphor lini- 



312 PHARMACOLOGY AND THERArEUTICS. 

ments, and the " Baltimore liniment," consisting of tincture of 
aconite and chloroform with soap liniment. Occasionally deep- 
seated pains, such as syphilitic pains in the bones and those due 
to sciatica are relieved by such liniments or by aconitine oint- 
ment, and sometimes veratrine may be advantageously combined 
with aconitine in local applications. 

Internal. — While aconite is contra-indicated in all cases where 
the heart is weak and in adynamic conditions in general, it has 
a considerable range of usefulness, and it would seem probable 
that at the present time it is not employed to as great extent as 
it really deserves. In the early stages of acute inflammatory 
diseases it often acts very happily, and the more promptly it is 
resorted to the greater will be the benefit derived from it. It 
reduces the temperature and the arterial tension, quiets the 
heart, allays pain by its influence on the sensory nervous sys- 
tem, and promotes elimination by its action on the skin and kid- 
neys. By its additional effect of slowing the respiratory move- 
ments it is of special value in some of the acute affections of 
the organs of respiration, the work of which is thus materially 
lessened. Among the conditions in which it can be used with 
advantage, if administered sufficiently early, may be mentioned 
coryza, pharyngitis, tonsillitis, bronchitis, pleurisy, pericarditis, 
gonorrhoea, urethral fever resulting from the passage of in- 
struments, congestion and inflammation of the liver, peritonitis, 
puerperal metritis and peritonitis, inflammation of the cerebral 
and spinal meninges, cerebro-spinal meningitis, and the active 
fever of acute cerebral congestion. It will be understood, how- 
ever, that it should never be given when the disease present is 
of an adynamic type, nor should its use be continued after 
effusion has taken place in the serous inflammations or after 
the febrile movement has abated in the others. The best prep- 
aration for internal use is the tincture, and the exhibition of 
this in minute quantities at frequent intervals during the day, 
followed by a full dose of Dover's powder at night, is con- 
sidered one of the best ways to " break up a cold." In catarrhal 
and fibrinous pneumonia it is more particularly useful before 



ACONITE. 3 I 3 

exudation has occurred, but may sometimes be continued after- 
ward in order to combat the inflammatory processes. In acute 
pleurisy before the stage of effusion and in some other inflamma- 
tions, notably peritonitis, great benefit may be derived by com- 
bining it with some preparation of opium, such as the deodorized 
tincture. In what are known as irritative fevers, especially 
among children, it is an extremely useful remedy. In small and 
repeated doses it usually brings about a free diaphoresis, and 
then the temperature promptly falls. It has been highly com- 
mended in the early stage of scarlatina, as not only reducing 
the temperature and acting favorably on the skin and kidneys, 
but also checking the nasal, faucial and aural inflammations 
which often constitute such serious complications and sequelae 
of the disease. In measles it sometimes serves the purpose of 
arresting the catarrhal pneumonia which is one of the most 
dangerous complications of this affection. At times it is also 
of service in the hot stage of the paroxysms of malarial fever. 
In typhoid and other continued fevers of asthenic character it 
should be carefully avoided, and it is also contra-indicated in 
inflammatory conditions of the gastro-intestinal mucous mem- 
brane. One of the diseases in which it has been employed with 
the best effect is erysipelas of the non-traumatic variety, and 
especially facial erysipelas. When, however, the affection is 
of an adynamic type and the eruption presents a dusky appear- 
ance, belladonna should be resorted to instead of aconite. 
Aconite may be of service in acute rheumatism when there is 
much heat and a dry skin, instead of the more common sweating, 
and if it is desirable to bring about a very free action of the 
skin it is recommended to combine it with pilocarpine and anti- 
pyrine. It is also sometimes beneficial in muscular rheumatism 
when there is considerable temperature. 

In conditions in which there is high arterial tension, chiefly 
of cardiac origin, aconite is a remedy of the greatest possible 
value. It is especially indicated in cases without valvular dis- 
ease in which there is hypertrophy and over-action of the heart, 
and likewise when with valvular disease there is excessive com- 



314 PHARMACOLOGY AND THERAPEUTICS. 

pensation. It is particularly useful in cardiac neuroses. In 
simple nervous palpitation of the heart it is of great service, 
and it has sometimes also been found to relieve the pain 
of aneurism. While it has the power of allaying over-excite- 
ment of the sensitive nerves, it has little effect in relieving such 
affections as migraine, where the pain is of central origin. It 
has a certain amount of value in the treatment of neuralgias, 
but is generally less efficient when given internally than when 
locally applied, and is inferior in such affections to some other 
remedies at our command. It should be stated, however, that 
very satisfactory results have been reported from the use of 
Duquesnel's aconitine in trigeminal neuralgia. While not 
affording relief in all cases, in a considerable proportion of in- 
stances it was found to be remarkably successful. It is of 
more or less service in acute maniacal delirium and other mental 
affections, where vascular excitement and high arterial tension 
are present, but gelsemium has proved more efficient in this 
class of cases. It sometimes has an excellent effect in con- 
trolling the vomiting of pregnancy, and this has generally been 
attributed to its influence upon the peripheral sensory system, 
but may perhaps be due to its action in benumbing the sensory 
reflex centres. In gonorrhoea it is thought to prevent chordee 
by its effect on the nervous centres. It may prove useful in 
spasmodic croup, and in certain cases of asthma, if adminis- 
tered early, it affords relief. It sometimes acts well in acute 
suppression of the menses from cold, and it has been found a 
valuable remedy in congestive dysmenorrhea in the full-blooded. 
In epistaxis occurring in plethoric subjects it is also of service. 
Finally, aconite is said to be an antidote to the sting of the 
scorpion. 

TOXICOLOGY. 

Symptoms. — If the dose is sufficiently large, death (probably due to 
cardiac paralysis) may occur almost instantaneously. When the quan- 
tity taken is smaller, the effects of the drug are soon felt. The charac- 
teristic burning and prickling in the mouth, followed by a sense of 
numbness, extends to the stomach, and eventually to the skin. There 



VERATRUM. 315 

is a profuse flow of saliva and in some cases vomiting, while the cuta- 
neous surface becomes covered with a cold sweat. The pulse, at first 
slow as well as feeble, may afterwards become very rapid and scarcely 
perceptible. The respiration is labored, shallow, and accompanied by 
marked dyspnoea. The patient's face is pale and anxious and there is 
great restlessness and general distress, with a sense of extreme fatigue 
and a loss of muscular power. With tingling and numbness in the 
extremities and more or less over the surface, there is a diminished 
sensibility to pain. The pupils remain dilated. Convulsions frequently 
precede death, which is generally due to paralysis of the respiratory 
centre, perhaps aided by anaemia of the medulla, but may be caused by 
paralysis of the heart. Under lethal doses the fatal result usually oc- 
curs in from two to six hours. 

The post-mortem appearances met with are not constant, but are 
generally such as are characteristic of death from asphyxia. 

Treatment. — Emetics may be tried, but will probably fail on account 
of the benumbed condition of the gastric mucous membrane. If the 
symptoms are very severe, it is better not to attempt to excite vomit- 
ing, on account of the risk of its causing fatal syncope. The stomach 
must therefore be evacuated by means of a stomach-pump or tube. The 
patient should be kept flat on his back, with the feet somewhat higher 
than the head, and artificial respiration should be resorted to as soon 
as difficulty of breathing occurs. His body should be wrapped in 
blankets and hot water bottles applied to the soles of the feet, or other 
means employed to maintain the temperature. Tannic acid is to some 
extent an antidote to aconite and may be tried ; but is not to be de- 
pended upon. The main reliance must be upon stimulation. By the 
mouth ammonia and alcoholic stimulants may be administered, and for 
hypodermatic use it is recommended that ether, alcohol, and digitalis 
be given in the order named ; the ether acting most promptly and sup- 
porting the heart until the alcohol can be absorbed, and the alcohol 
continuing the support until the digitalis, which is the physiological 
antagonist of aconite but acts slowly, has had time to produce its effects. 
In addition, strychnine should also be given subcutaneously in full 
doses, as a stimulant to the heart and respiration. If the case seems 
to require it, ammonia may be injected into the veins, and the inhala- 
tion of amyl nitrite may be cautiously employed. Other agents which 
partially antagonize the effects upon the heart and respiration are caf- 
feine and atropine. 

VERATRUM. 

1. VERATRUM (Veratrum Viride, U. S. P., 1890).— Veratrum. 
Dose, 0.125 gm. (125 milligm.) ; 2 gr. 



3 l6 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Fluidextractum Veratri. — Fluidextract of Veratrum. 
Dose, 0.1 c.c; V/ 2 Tib 

2. Tinctura Veratri. — Tincture of Veratrum. Dose, 1 c.c; 
15 til. 

2. VERATRINA.— Veratrine. Dose, 0.002 gm. (2 milligm.) ; ^ 
gr. 

1. Oleatum Veratrinae. — Oleate of Veratrine. 

2. TJnguentum Veratrinae. — Veratrine Ointment. 

Unofficial Preparation. 
Colloidum Amyle. — Amyl Colloid. (Anodyne Colloid.) 

Action of Veratrum. 

The alkaloids of veratrum have been the subject of consider- 
able discussion, but according to the latest authorities, while 
jervine is known to have some action on the system, the activity 
of the drug is really due to veratrine. The latter has a chemical 
composition similar to aconitine, and has practically the same 
action on the central nervous system and the sensory termina- 
tions, but shows, in addition, a peculiar action in prolonging 
the relaxation of striped and cardiac muscle, which is entirely 
absent in aconitine poisoning. The action of veratrum and 
veratrine may, therefore, be considered together. It is neces- 
sary to state, however, that veratrine as found in the shops 
is a mixture of alkaloids generally derived from plants other 
than veratrum viride and veratrum album. The official vera- 
trine is a mixture of alkaloids obtained from the seed of Asa- 
grcea officinalis. 

External. — Applied to the skin the alkaloid veratrine, and 
to a less degree the drug itself, produces a feeling of warmth 
and prickling, followed by a sensation of coldness and by numb- 
ness and anaesthesia. Applied to the mucous membrane of the 
nose and throat, it causes violent sneezing and coughing, and 
a minute portion placed upon the tongue gives rise to burning 
pain and free salivation. These phenomena, as in the case of 



VERATRUM. 3 I 7 

aconite, are due to stimulation of the peripheral endings of the 
sensory nerves. 

Internal. — Gastro-intcstinal Tract. — When full doses are 
taken there are produced burning in the mouth, which spreads 
to the stomach, well-marked salivation, nausea and vomiting, 
and generally purgation accompanied by severe colic. The 
retching and vomiting, which are violent and persistent, have 
been attributed by some to central action and by others to irri- 
tation of the sensory nerve endings, and it seems probable that 
both of these are concerned in their causation. It has been 
supposed that the drug increases the biliary secretion, but the 
amount of bile often noted in the vomit may be simply due to 
the severity of the emesis, which causes the evacuation of the 
contents not only of the stomach but of the gall bladder also. 

Muscles. — There is marked prolongation in the relaxation 
of muscles after contraction, which takes place normally, but 
is more complete than under ordinary circumstances. If a 
tracing be taken of the contraction of a muscle it will be seen 
that the height of the contraction is slightly increased, and that 
instead of the almost instantaneous return to the base-line seen 
in the normal tracing, the curve shows generally a slight undula- 
tion and then a very slow fall, the period of relaxation being 
from twenty to thirty times as long as in the unpoisoned muscle. 
This prolonged relaxation would at first sight appear like 
tetanus, but is entirely free from any element of spasm or rigidity. 
It has been found that it is accompanied by an increased for- 
mation of heat and use of material, and that it is lessened by 
fatigue, cold and other muscle-depressing agents, while in- 
creased by moderate heat. It must therefore be looked upon 
as an expression of greater functional activity, a prolonged con- 
tracture rather than a loss of elasticity. The irritability and 
absolute strength are also increased, so that the muscle re- 
acts to weaker stimuli and contracts against a greater weight 
than usual. That the phenomena noted are not due ■ to any 
nervous influence is shown by the fact that excised muscles 
show exactly the same reaction. It has been found that in the 



3 l8 PHARMACOLOGY AND THERAPEUTICS. 

frog the muscles are finally paralyzed, but that this does not 
occur in mammals because in them the respiratory centre fails 
long before the quantity of veratrine necessary to produce this 
effect has been absorbed. 

Heart and Circulation. — In the frog's heart the ventricular 
muscle is affected by veratrine in very much the same way as 
ordinary striated muscle. The auricular muscle, consisting for 
the most part of unstriated fibres, is much less powerfully in- 
fluenced by it, and in consequence the auricle is found to make 
two, or even three, beats to one of the ventricle. In the mamma- 
lian heart investigation shows that there is no such prolongation 
of the systole as is seen in the frog, but it has been proved that 
a slight stimulating action is exercised by the drug. The prin- 
cipal cardiac effects observed, however, are due to the influence 
exerted upon the medullary centres. As in the case of aconite, 
there is a primary stimulation of the vagus centre, resulting 
in a slowing of the heart's rate and a reduction of arterial pres- 
sure. At the same time constriction of the peripheral vessels 
is produced through stimulation of the vaso-motor centre. After 
larger quantities the pulse is accelerated, the vaso-motor centre 
being depressed and the terminations of the, vagus paralyzed. 
If, in the human subject, while it is depressed the posture is 
changed from the recumbent to the upright, the pulse at once 
becomes extremely rapid and thready. 

Respiration. — The effects on respiration, due to depression of 
the respiratory centre in the medulla, are much the same as 
those of aconite. The breathing is slow and labored and at- 
tended with dyspnoea, and after lethal doses death usually re- 
sults from paralysis of respiration. 

Nervous System. — That the drug has decided actions on the 
medullary centres has already been seen. It also has a stimu- 
lating effect on the spinal cord, but the influence exerted by it 
on the highest cerebral centres is probably but slight, though 
the convulsions produced by it are believed, as in the case of 
aconite, to be due to central stimulation. It acts to some extent 
on the motor nerves, and its effects on the sensory nerve end- 



VERATRUM. 3I9 

ings have been previously mentioned. After large doses the 
stimulation of the central and peripheral nervous system is suc- 
ceeded by paralysis. 

Skin. — It produces free sweating, but this is probably the re- 
sult of arterial depression, rather than of any specific diaphoretic 
action. 

Temperature. — There is generally under its influence a con- 
siderable reduction in temperature, which is thought to be due 
to the increased heat-dissipation resulting from vaso-motor 
paralysis and the slowing of the circulation. In cases, how- 
ever, where the convulsions are marked, increased heat-produc- 
tion is caused by the violent movements, and the temperature 
is even higher than normal. 

Therapeutics of Veratrum. 
Veratrum is a prompt and sure circulatory depressant, and 
its administration is safe because, the physiological action of 
the drug giving warning of danger, its use can be stopped in 
time to prevent accidents. In cardiac cases where there is ex- 
cessive hypertrophy, and drugs of the digitalis class are contra- 
indicated, it is less advantageous than aconite, which is more 
persistent in its effects and not so apt to cause gastric disturb- 
ance, but in a number of other affections where the aim is to re- 
duce arterial action it is held in deservedly high repute. Thus, 
in the early stages of sthenic croupous pneumonia it has long 
been considered one of the most reliable of remedies, quieting 
the increased action of the heart, lowering the temperature, and 
lessening the congestion of the lung. It may also be used with 
advantage, if given sufficiently early, when only hyperemia is 
present, in pleurisy, hepatitis, cerebritis, maniacal delirium, 
mania a potu, with strong, bounding pulse, and other sthenic 
conditions. If its employment is maintained after the primary 
stage of congestion, however, it can only do harm. In acute 
gastritis and peritonitis it is generally contra-indicated on ac- 
count of its irritating effect upon the stomach, though in peri- 
tonitis it may sometimes be of service if carefully watched. In 



320 PHARMACOLOGY AND THERAPEUTICS. 

aneurism where there is marked disturbance of the circulation 
and high pressure its cautious use is recommended, to decrease 
the pressure and prevent rupture of the diseased vessel; and it 
may prove a valuable adjunct to rest and other means of treat- 
ment. The production of vomiting should be avoided, if possi- 
ble, and the patient should therefore be kept in a strictly recum- 
bent position, while a small amount of opium may be given with 
the remedy. With the various surgical expedients, such as 
forced flexion, compression and ligation, for the cure of aneurism 
it has also sometimes been employed, with excellent results, for 
lessening the force of the blood-current and the rapidity of the 
pulse-rate. The action of veratrum is regarded as similar to 
a depletion, but without the permanent loss of blood, and on 
account of its influence in causing depression it has been desig- 
nated as " the younger brother of tartar emetic." 

The very marked efficiency of the drug (especially in the 
form of Norwood's tincture) in puerperal eclampsia has been 
attested by a large accumulation of the most trustworthy evi- 
dence, and by many physicians it is considered by far the best 
remedy at command in this condition. Its good effects have 
generally been attributed mainly to the depressing influence of 
the drug upon the motor tracts of the spinal cord; but, while 
this influence no doubt contributes in some measure to the 
beneficial results, its action in this respect is neither so energetic 
or sure as a number of other drugs, and its effect must there- 
fore be regarded as due to a very considerable extent to its 
action on the circulatory system. In puerperal convulsions the 
spasmodic condition is generally associated with abnormally 
high intravascular tension, and veratrum would consequently 
seem to be especially indicated. In this affection it has been 
pointed out that it possesses the double recommendation — (i) 
that it affords a certain and rapid means of lowering the blood- 
pressure; (2) that although it is not cumulative to any marked 
degree, its action is long maintained, and may be perpetuated by 
a repetition of small doses. Sometimes, however, quite large 
doses are well borne, and successful cases have been reported 



VERATRUM. 32 I 

where as much as 1.20 c.c. (20 1U) of Norwood's tincture has 
been given every hour for five consecutive days and nights. In 
the early stage of peritonitis, phlebitis and other inflammatory 
affections of the puerperal state it may also prove of service, if 
there is no cardiac weakness or general adynamia. Among the 
various other diseases in which its early use is said to have been 
attended with satisfactory results are acute rheumatism and 
tonsillitis, in the latter instance combined with morphine. It 
has also been given in the case of certain wounds which tend 
to dangerous results, like those of the head, pericardium, heart 
and peritoneum, with the idea of securing, by means of the 
diminished arterial movement caused by it, as little motion of 
the affected part as possible. It should never be employed to 
produce vomiting, as it is too harsh and depressing in its effects. 
Notwithstanding the criticisms of those who regard it as a type 
of those cardiac sedatives which tend, it is claimed, to retain in 
the blood all that is injurious in it and at the same time to re- 
duce the patient to a state of utter wretchedness, veratrum 
undoubtedly has a legitimate, though limited, field in thera- 
peutics, and, within its proper range, is still esteemed by a large 
number of practitioners as a remedy of great value. 

Therapeutics of Veratrine. 
External. — Veratrine (as an oleate or ointment) is chiefly 
employed, either alone or in combination with other remedies, 
in the external treatment of neuralgia, myalgia, herpes zoster, 
acute gout, and other painful affections. Used locally it has 
also been found of service in alopecia circumscripta, chloasma, 
and chronic swelling and stiffness of the joints. For ordinary 
use the official ointment is too strong, and should be reduced 
one-half or more, or the oleate may be substituted for it. In 
a weakened form it is sometimes employed in infantile paralysis, 
for the alleged purpose of improving the nutrition of the affected 
muscles. In the external application of veratrine preparations 
care should always be taken to avoid abrasions of the cuticle, 
on account of the danger of absorption. They should likewise 



322 PHARMACOLOGY AND THERAPEUTICS. 

be used with caution near the eye, as violent inflammation of 
the conjunctiva will be set up if any of the veratrine comes in 
contact with it. {See also Amyl Colloid, below.) 

Internal. — Veratrine is very rarely given internally. It has, 
indeed, been suggested by one authority that as its activity is 
due to this alkaloid, veratrum might well be dropped from 
the Pharmacopoeia, but the fact remains that veratrum is 
still held in high repute as a circulatory depressant, while 
veratrine is practically discarded. Probably the chief reason 
for this is the dangerousness with which the alkaloid is re- 
garded, and it is authentically recorded that alarming symptoms 
have been produced by a dose of only 0.004 g m - (tV § r 0- 

Action of Amyl Colloid. 
The object of this preparation is to obtain in an elegant and 
convenient way the local anaesthetic action of both aconitine and 
veratrine, aided by the evaporation of amyl hydride. It is 
found extremely difficult, however, to make a clear solution. 

Therapeutics of Amyl Colloid. 
In neuralgia, sciatica, and other similar affections it is painted 
on the skin over the painful areas, and its anaesthetic effect may 
be still further promoted by the application of warm moist 
spongiopiline over the film formed by the collodion. 

TOXICOLOGY. 

Notwithstanding the severity of the symptoms caused by it, and 
although it has often been given with great freedom, fatal results 
have very seldom been noted from the use of veratrum. This is 
probably explained, at least to a considerable extent, by its prompt 
ejection from the stomach in consequence of the emesis produced by 
large doses taken by the mouth. As most of the symptoms of poison- 
ing by the drug have already been given, a further detailed description 
is unnecessary. There is often very severe abdominal pain, and head- 
ache and giddiness are common. There may or may not be muscular 
twitchings. After veratrine especially the convulsive movements are 
sometimes very marked. There is extreme debility, the features are 



CACTUS. 323 

pinched, and there is usually great pallor, with a cold and clammy skin. 
The medullary and spinal centres become paralyzed, and death results 
from respiratory collapse, adjuvated by failure of the circulation. The 
post-mortem changes are not characteristic. 

Treatment. — The treatment is practically the same as in aconite 
poisoning, though the contents of the stomach are usually efficiently 
evacuated by the action of the drug itself. Atropine has proved of 
some value in the poisoning of animals by veratrine, and its use is sug- 
gested on account of its action on the respiratory centre and on the 
vagus terminations in the heart. As the poison is rapidly excreted 
through the urine, it has also been recommended to administer hot tea 
as a diuretic. 

C. Drugs Acting on the Accelerating Centre. 
CACTUS. 
Unofficial Preparations. 
Cereus G-randifLorus. — Cereus Grandiflorus. (Night-blooming 
Cereus.) Dose, 0.30 to 0.60 gm.; 5 to 10 gr. 

Fluidextractum Cacti. — Fluidextract of Cactus. Dose, 0.60 
to 2 c.c; 10 to 30 TTL - 

Action of Cactus. 
Cactus is non-irritating, but the crude drug is said to be 
used as a counter-irritant, and to produce pustulation. The 
action of cactus is upon the intra-cardiac ganglia and acceler- 
ator nerves, through the cardiac plexus of the sympathetic, and 
there is not any interference with the inhibitory nerves, nor, 
indeed, does its administration produce any very marked vaso- 
motor changes. It shortens the ventricular diastole, thus quick- 
ening the pulse, and increases the blood-pressure. Cactus is also 
said to have a stimulating effect upon the spinal nerve-centres 
and to increase the general nerve-tone. 

Therapeutics of Cactus. 
It is useful in cardiac weakness, that is, relative incompetency ; 
in convalescence from typhoid fever; in simple eccentric cardiac 
dilatation; in functional cardiac diseases, from tea, coffee, tobacco 



324 PHARMACOLOGY AND THERAPEUTICS. 

and alcohol, dyspepsia, exophthalmic goitre, neurasthenia of 
the climacteric, sexual exhaustion ; in the " slow heart," from 
over-stimulation of the pneumogastric or degeneration of the 
muscular wall of the ventricles. It is of very great use in aortic 
regurgitation, but is absolutely contra-indicated in mitral 
stenosis, thus being of value in those cases where the use of 
digitalis is inadmissible. It has also been found of service in 
some cases of angina pectoris, more particularly pseudo-angina. 
Cactus has a sphere of action entirely its own; not, however, 
replacing other remedies used for cardiac disease, though it 
is useful in many cases where these drugs are not only dan- 
gerous, but absolutely contra-indicated. Failures to obtain re- 
sults depend upon the fact that many adulterated specimens are 
found in the shops, or upon the use of inert, dried material. 
If made from the green plant, as it should always be, the fluid- 
extract is of a peculiar green color. Cactus, in the form of 
this preparation, is the only remedy known which will quicken 
a slow heart. It deserves a better recognition in cases of this 
kind, few indeed, yet nevertheless presenting themselves, for in 
such it oftentimes yields brilliant results. 

Division IV. — Drugs Acting on the Vessels. 
The effects are usually determined (1) by direct observation 
of alterations caused by the drug in the size of the vessels of 
some thin structure, such as the ear of the rabbit, the wing 
of the bat, or the web, lung, mesentery, tongue or mylo-hyoid 
muscle of the frog; (2) by observing the rate at which the blood 
flows from the cut vessel of an animal, both under and without 
the influence of the drug. In order to exclude influences acting 
on the cardiac mechanism, the maintenance of an artificial cir- 
culation is quite commonly resorted to, and destruction of the 
spinal cord or section of the nerves supplying the part is re- 
quired to determine whether the changes observed are due to 
local or central effects. When alterations in the vessels result 
from the local application of a drug it is often uncertain, if 
the nerves supplying the part are not divided, whether the effect 



DRUGS ACTING LOCALLY ON VESSELS. 325 

is reflex or direct. It is probable that some of the drugs act 
by the vaso-constrictor and some by the vaso-dilator nerves, 
both of which kinds of nerves connect the vessels with the 
central nervous system; but they can be classified only gen- 
erally into those drugs which dilate or constrict the vessels by 
local action and those which do so through their action on 
the central nervous system. In the case of those acting locally 
it is impossible to determine whether they affect the muscular 
coat of the vessel or the nerve terminations. It can readily 
be seen that drugs which act on the heart or on a large area 
will have a considerable effect upon the general blood-pressure. 
Drugs are applied to the interior of vessels by injecting them 
into the circulation. 

A. Drugs acting locally on Vessels. 
1. Vaso-dilators. 

Drugs which, when locally applied to vessels, dilate them: 



(16) All volatile oils, as oils of 
turpentine, and many sub- 
stances containing them, 
as mustard, horse-radish, 
etc. 



(1) Liquor Ammonise. 

(2) Silver nitrate -\ 

(3) Zinc chloride r (strong) 

(4) Copper sulphate 

(5) Mercuric nitrate. 

(6) Arsenic trioxide. (17) Senega. 

(7) Antimony and potassium (18) Chrysarobin. 

tartrate. (19) Ipecacuanha. 

(8) Iodine. (20) Capsicum. 

(9) Chlorine. (21) Croton oil. 

(10) Mineral acids (strong). (22) Camphor. 

(11) Alcohol. ") If prevented (23) Cantharides. 

(12) Ether. I from evapo- (24) Phosphorus. 

(13) Chloroform. J rating. (25) Warmth, if transiently ap- 

(14) Phenol. plied. (When long applied 

(15) Creosote. it contracts blood-vessels.) 

Irritants. — All of the above, as they dilate the vessels, are often 
spoken of as vascular irritants. 

Rubefacients are drugs which, in consequence of the vascular 
dilatation caused by them, redden the skin when they are applied 



326 PHARMACOLOGY AND THERAPEUTICS. 

to it. Desquamation frequently follows if the action has con- 
tinued for some time. All the above are rubefacients. 

Vesicants. — With many of these drugs the irritant effect is 
sufficient to produce inflammation, and when they cause the 
exudation of serum between the epidermis and the true skin 
and the formation of vesicles or blisters they are known as 
vesicants; e. g., cantharides. 

Pustulants are drugs which produce small discrete suppura- 
tions, the distinct and separate points of inflammation being 
situated at the orifices of the skin glands. They do not affect 
the intervening tissue, probably for the reason that they cannot 
pass through the horny epidermis; e. g., croton oil. 

Escharotics. — With the most powerful of these drugs the irri- 
tation is sufficient to destroy the vitality of the tissues with 
which they came in contact, forming a slough, and to cause 
vascular dilatation in the surrounding parts. They are known 
as eschartics or caustics ; e. g., zinc chloride. 

Counter-irritants. — When any of these drugs are employed 
to produce a reflex influence on a part more or less remote from 
the point of application, they are termed counter-irritants. The 
exact nature of the effects of counter-irritation on internal 
organs has not been determined, but it is considered most prob- 
able that an alteration in the calibre of the vessels and in the 
sensory nerves or their terminations is induced, and that such 
changes may cause or be accompanied by a distinct alteration 
in the activity of the organs. 

The following, when inhaled, dilate peripheral vessels by acting lo- 
cally on them: 



(1) Amyl nitrite. 

(2) Nitroglycerin. 

(3) Sodium nitrite. 



(4) Ethyl nitrite. 

(5) Spiritus aetheris nitrosi. 

(6) Erythrol tetranitrate. 



Drugs which, taken by the mouth, dilate arterioles by acting locally 
on them: 



(1) Caffeine. 

(2) Amyl nitrite. 

(3) Nitroglycerin. 

(4) Sodium nitrite. 



(5) Ethyl nitrite. 

(6) Spiritus aetheris nitrosi. 

(7) Erythrol tetranitrate. 

(8) Nicotine. 



DRUGS ACTING LOCALLY ON VESSELS. 



327 



2. Vaso-constrictors. 

Drugs which, taken by the mouth, contract arterioles by acting locally 
on them: 

(1) Suprarenal extract. (4) Caffeine (early in its ac- 

(2) Barium salts. tion). 

(3) Ergot. (5) Digitalis. 

(6) Physostigmine. 



The following have been shown by experiments to cause contraction 
of small arteries through which they circulate : copper, zinc, tin and 
platinum salts, powerful contraction ; lithium, calcium, strontium, mag- 
nesium, cadmium, nickel, cobalt and iron salts, slight contraction. 

Drugs which, when locally applied to vessels, contract them: 

These may act in two ways: (1) by contracting the muscular 
coat of the vessels; (2) by coagulating the albuminous fluids 
around them, the coagulum by its contraction constricting the 
vessels. 



Those which act on the muscular coat of the vessels 



(1) Cold, temporarily applied. 
(If cold is long continued 
it dilates blood-vessels.) 

(2) Cocaine. 

(3) Lead salts. 

(4) Dilute solutions of silver 

salts. 



(5) Diluted sulphuric acid. 

(6) Alum. 

(7) Hamamelis. 

(8) Ergot. 

(9) Hydrastis. 

(10) Acetanilide. 

(11) Antipyrine. 



Those which coagulate the albuminous -fluids around the vessels: 



(1) Tannic acid and all sub- 
stances containing it : e. g., 
nutgall, krameria, kino, I 
haematoxylon, hamamelis, 
cinnamon, eucalyptus gum, 
and gambir. 

(2) Lead salts. 



(3) Silver salts. 

(4) Zinc salts. 

(5) Copper salts. 

(6) Alum. 

(7) Ferric salts. 

(8) Bismuth salts to a slight 
extent. 



Astringents are drugs which diminish the size of the vessels, 
and thus decrease the amount of exudation from them. They 
produce contraction of muscular fibre by direct irritation and 



328 PHARMACOLOGY AND THERAPEUTICS. 

condensation of other tissues by precipitating albumin and 
gelatin. 

Styptics, or Haemostatics, are drugs which stop bleeding. 
Among them are included all astringents, the most important of 
them being cold, lead and copper salts, hamamelis, ergot, hy- 
drastis, tannic acid, and especially the salts of iron, which 
coagulate escaping blood, while the clot thus formed tends to 
prevent further haemorrhage. Matico leaves, applied to a bleed- 
ing surface, act as a mechanical haemostatic, the numerous hairs 
on their underside favoring coagulation; and cobwebs have a 
similar effect. 

3. Emollients and Demulcents. 

Emollients are substances which soften and relax the parts 
to which they are applied. They serve to relieve tension, dimin- 
ish pressure on the nerves, and also protect inflamed surfaces 
from the air and from friction. 

Common emollients are substances soaked in warm water, as hot 
fomentations and poultices, fats of various sorts, as lard and lanolin 
(hydrous wool-fat) and non-irritating oils, as olive oil, spermaceti, 
petrolatum, vaseline, etc. 

Demulcents are substances which protect and soothe the 
tissues to which they are applied, and are often of a mucilagi- 
nous nature. This name is ordinarily employed for substances 
used for mucous membranes, and that of emollient for those 
used for the skin. Among demulcents may be mentioned gelatin, 
isinglass, glycerin, gum, honey, flaxseed, starch, and white of 

egg- 

Therapeutics. — Drugs which locally dilate vessels are fre- 
quently used as stimulating applications for indolent ulcers and 
sores, as well as to promote the absorption of inflammatory 
products ; also as counter-irritants in various diseased conditions 
in internal organs. Drugs, such as the nitrites, which by their 
central action cause dilatation of all the vessels of the body, 
are employed in cardiac diseases, where the relief which they 
afford is no doubt largely due to their thus diminishing the work 



DRUGS ACTING ON VASO-MOTOR CENTERS. 



329 



of the heart. Others having this general vaso-dilator action 
are used more particularly to cause diaphoresis. 

Astringents are used chiefly as styptics, but also to diminish 
secretion from mucous membranes and check excessive dis- 
charges generally, as well as to obviate relaxed vascular condi- 
tions. 

B. Drugs which act on the Vaso-motor Centres. 

Drugs which, by their action on the vaso-motor centres, dilate the 
vessels : 

(1) Belladonna. 



(2) Stramonium. 

(3) Hyoscyamus. 

(4) Alcohol. 

(5) Ether. 

(6) Chloroform. 

(7) Hydrated chloral. 

(8) Antimony and Potassium 

Tartrate. 



(9) Aconite. 

(10) Ipecacuanha. 

(11) Lobelia. 

(12) Tobacco. 

(13) Veratrine. 

(14) Hydrocyanic acid. 

(15) Opium. 



Some of the substances, which in small doses contract the vessels by 
central action, in large doses dilate them ; viz., digitalis and squill. 

Drugs which, by their action on vaso-motor centres, cause contrac- 
tion of vessels: 



(1) Ergot. 

(2) Digitalis. 

(3) Strophanthus. 

(4) Sparteine. 

(5) Squill. 

(6) Physostigmine. 



(7) Cocaine. 

(8) Hydrastis. 

(9) Hamamelis. 

(10) Strychnine. 

(11) Lead salts 

(12) Ammonia 



(slightly). 



Also, for a very short early period of their action, some substances 
whose main action is to dilate the vessels by their central action ; viz., 
belladonna, stramonium, hyoscyamus, alcohol, ether, chloroform, hydro- 
cyanic acid, and veratrine. 



A. Drugs Acting Locally on Vessels. 

I. Vaso-dilators. 
THE ACIDS. 
1. ACIDUM SULPHURICUM.— Sulphuric Acid. (Oil of Vitriol.) 



330 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Acidum Sulphuricum Dilutum. — Diluted Sulphuric Acid. 
Dose, 2 c.c; 30 ni. 

2. Acidum Sulphuricum Aromaticum. — Aromatic Sulphuric 
Acid. Dose, 1 c.c; 15 m.. 

2. ACIDUM NITRICUM.— Nitric Acid. 

Preparations. 

1. Acidum Nitricum Dilutum. — Diluted Nitric Acid. Dose, 
2 c.c; 30 Hi. 

2. Acidum Nitrohydrochloricum. — Nitrohydrochloric Acid. 
(Nitromuriatic Acid.) Dose, 0.2 C.C.; 3 T1J,. 

3. Acidum Nitrohydrochloricum Dilutum. — Diluted Nitro- 
hydrochloric Acid. Dose, 1 c.c; 15 TTt. 

3. ACIDUM HYDROCHLOEICUM.— Hydrochloric Acid. (Muri- 
atic Acid.) 

Preparations. 

1. Acidum Hydrochloricum Dilutum. — Diluted Hydrochloric 
Acid. Dose, 1 c.c; 15 TT\.. 

2. Acidum Nitrohydrochloricum. — Nitrohydrochloric Acid. 
Dose, 0.2 c.c; 3 n\. 

3. Acidum Nitrohydrochloricum Dilutum. — Diluted Nitro- 
hydrochloric Acid. Dose, 1 c.c; 15 TTL- 

4. ACIDUM PHOSPHORICUM.— Phosphoric Acid. 

Preparations. 

1. Acidum Phosphoricum Dilutum. — Diluted Phosphoric 
Acid. Dose, 2 c.c; 30 TH,. 

2. Elixir Ferri, Quininae et Strychninae Phosphatum. — 
Elixir of Iron, Quinine et Strychnine Phosphates. Dose, 4 C.C. J 
1 fl. dr. 

3. Glyceritum Ferri, Quininae et Strychninae Phosphatum. 
— Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, 
1 C.c; 15 TTL. 

4. Syrupus Ferri, Quininae et Strychninae Phosphatum.— 

Syrup of Iron, Quinine and Strychnine Phosphates. Dose, 4 
c.c; 1 fl. dr. 



THE ACIDS. 331 

5. ACIDUM ACETICUM.— Acetic Acid. 

Preparation. 
Acidum Aceticum Dilutum. — Diluted Acetic Acid. Dose, 
2 c.c; 30 TTL. 

6. ACIDUM ACETICUM GLACIALE.— Glacial Acetic Acid. 

7. ACIDUM TRICHLOEACETICUM.— Trichloracetic Acid. 

8. ACIDUM CITRICUM.— Citric Acid. Dose, 0.500 gin. (500 mil- 
ligm.); 7y 2 gr. 

Preparations. 

1. Syrupus Acidi Citrici. — Syrup of Citric Acid. 

2. Liquor Sodii Phosphatis Compositus. — Compound Solu- 
tion of Sodium Phosphate. Dose, 8 c.c; 2 fl. dr. 

9. ACIDUM TARTARICUM.— Tartaric Acid. Dose, 0.500 gin. 
(500 milligm.) ; 7% gr. 

10. ACIDUM LACTICUM.— Lactic Acid. Dose, 2 c.c; 30 ill. 

Action of Sulphuric, Nitric, Hydrochloric, Phosphoric, 
Acetic, Citric, Tartaric and Lactic Acids. 
External. — All these acids are powerful local irritants. The 
least so is citric. While its concentrated solution does not affect 
the sound skin, it is irritant to mucous membranes and abraded 
surfaces. Next to this comes tartaric, the saturated solution 
of which acts upon the unabraded skin, and when applied to a 
raw surface produces more considerable irritation, with pain 
and heat. The remaining acids are very energetic caustics, and 
even when in very dilute solution cause an irritation which may 
amount to vesication. The nature of the escharotic action 
varies to some extent with the constituents of the tissues with 
which they come in contact, but, on the whole, is found to con- 
sist in withdrawal of water, the formation of acid albumins, 
softening of the connective tissue and epithelium, and, in special 
situations, solution of calcareous material. The most typical 
acids in regard to the local action are sulphuric and hydro- 
chloric. Nitric causes the same effects, but differs in its 



332 PHARMACOLOGY AND THERAPEUTICS. 

chemical action, by which xanthoproteic acid is produced from 
the proteids. Owing to the fact that it does not redissolve the 
albumin it precipitates, its area of action is somewhat limited; 
but nitrohydrochloric is very energetic. Nitric acid, because of 
its special chemical action, stains the skin a deep yellow and 
causes a yellow eschar, while sulphuric, in consequence of its 
leaving the carbon untouched, blackens the surface and causes 
a brown or black eschar. The latter causes necrosis of the skin 
and subcutaneous tissues, which is accompanied by intense pain 
and, if the surface involved is large, by symptoms of shock and 
collapse such as are met with in severe burns. Ricord's paste is 
composed of sulphuric acid and willow charcoal; Michel's, of 
sulphuric acid and asbestos. Hydrochloric acid, though less 
liable to cause wholesale destruction of the skin than sulphuric, 
penetrates the epidermis and causes vesication. Phosphoric is 
considerably less irritant, but causes redness and even blister- 
ing when applied in concentrated solution. Glacial acetic acid 
is especially applicable when a limited action is desired. The 
corrosive action of the acids is much more intense upon mucous 
membranes than upon the skin, and even small quantities of 
strong sulphuric acid striking the eye are sufficient to destroy 
the sight. 

As all the more powerful acids unite with and coagulate 
albumin, solutions of these which are not sufficiently strong to 
form a slough (which by its separation is likely to cause bleed- 
ing), act as astringents and haemostatics, both by coagulating 
the blood, and thus plugging the vessels, and by coagulating 
the albumin in the tissues, with the effect of constricting the 
vessels. Weak solutions, moreover, are cooling to the skin in 
febrile conditions, and hence they are classed also as refriger- 
ants. Citric acid is added to tablets of corrosive mercuric chlor- 
ide so that when these are dissolved in making solutions the 
antiseptic shall penetrate into the tissues. Tartaric acid is used 
for the same purpose. As most living matter is neutral or 
slightly alkaline in reaction, and appears to be incapable of ex- 
isting in acid media, the acids are protoplasm poisons and anti- 
septics of some power. 



THE ACIDS. 333 

Alimentary Canal — In the mouth, oesophagus and stomach 
complete destruction of the mucous membrane results from the 
corrosive action of strong acids wherever they come in contact 
with the membrane. As in the case of the caustic alkalies, per- 
foration of the oesophagus or stomach may be produced, causing 
immediate death, with symptoms of shock and collapse, or if the 
corrosion does not go to this extent, cicatrices may result which 
eventually lead to a fatal termination. While hydrochloric and 
the stronger organic acids are capable of causing corrosion of 
the mucous membranes, this is not usually so extensive as that 
produced by sulphuric and nitric acid. In the mouth the diluted 
acids have a characteristic sour and pungent taste, and, as it 
is popularly expressed, " set the teeth on edge." They also soften 
the dental enamel. The saliva being alkaline, they augment its 
secretion, and thus serve to allay thirst by keeping the mouth 
moist. In both the mouth and throat they cause an astringent 
feeling in consequence of their coagulating the superficial layers 
of proteids. When the gastric juice is deficient in acid, acids 
taken after a meal, by remedying this, assist digestion, but it 
seems to be the case that if given before or during meals they 
tend to check the flow of the gastric juice. As the latter, when 
normal, contains about 0.2 per cent, of hydrochloric acid, this 
acid, so far as both experimental and clinical results at present 
indicate, is undoubtedly the best for administration when the 
amount of acid secreted by the gastric mucous membrane is 
deficient. Recent researches have shown, however, that pepsin 
is excreted in actual combination with the hydrochloric acid, so 
that it would seem to be impossible to completely replace the 
deficiency of acid in the stomach by giving hydrochloric acid 
by the mouth. The prolonged treatment of animals with acids 
has been found to be followed by anaemia and loss of flesh and 
strength, a result which is thought to be attributable to the dis- 
turbance of the digestion induced, rather than to any specific 
action of the acids. If free acid penetrates into the intestinal 
canal it acts as a very powerful irritant and produces increased 
peristalsis, but as acids given by the mouth are usually absorbed 



334 PHARMACOLOGY AND THERAPEUTICS. 

before passing the pylorus, this cathartic action is practically 
seen only when acids are generated in the intestine itself. As 
a rule, acids quickly become converted into neutral salts, but 
some, especially sulphuric, preserve, it is said, their astringent 
action in the intestine. According to some authorities, the in- 
creased flow of pancreatic juice and of bile which has been 
ascribed to acids is probably too small to be of any value, but 
others are convinced that they do materially increase the amount 
of bile poured into the intestine (this being notably the case 
with nitric acid), while nitrohydrochloric acid is not only a 
cholagogue, but also a hepatic stimulant of considerable power, 
causing actual increase in the activity of the cells of the liver, 
and not merely evacuation of the gall bladder. 

Absorption and Excretion. — Generally the acids are absorbed 
from the alimentary canal with considerable rapidity. • The 
salts formed in the blood and tissues after their absorption are 
quickly excreted by the kidneys. The latter, it is found, retain 
as much alkali as possible in the body, and the result is that they 
excrete the salts in an acid form, and perhaps some free acid. 
Consequently, irritation of the kidneys is sometimes induced, 
with albumin and even blood in the urine, which is rendered 
more acid than usual and causes a sensation of heat and smart- 
ing in the bladder and urethra. Nitric acid, however, is stated 
to be excreted to a small extent as ammonia, and hence to 
slightly increase the alkalinity of the urine. The alkalinity of 
the latter is also increased by acetic, citric and tartaric acids, in 
consequence of their being converted into alkaline carbonates in 
the blood; while lactic acid is either so converted or passes out 
as carbon dioxide in solution in the urine. The acids in general 
increase the ammonia of the urine (the total nitrogen being 
pretty constantly increased to a moderate extent) at the ex- 
pense of the urea, which is accordingly somewhat decreased. 
Just as the secretion of the acid gastric juice is stimulated by 
alkalies introduced into the stomach, acids appear to have the 
power of stimulating alkaline secretions. 

Blood. — Acids may have the effect of reducing the alkalinity 



THE ACIDS. 335 

of the blood, but the reaction of this fluid must necessarily re- 
main slightly alkaline throughout life. It is found that if suffi- 
cient acid be given to an animal to neutralize the alkalies of 
the body, it dies before the blood becomes neutral, although after 
death the latter may be found to be alkaline. Experimentation 
has shown that the diminution of the alkalinity of the blood 
which results from the administration of acids is much more 
pronounced in herbivorous animals than in man and the car- 
nivora; so that in these last no serious symptoms arise from 
this cause. In rabbits the blood-pressure is much lowered by 
the acids, from depression of the vaso-motor centre and the 
heart, and if the poisoning is pushed, the alkalinity of the blood 
becomes so greatly reduced that the tissues are unable to rid 
themselves of their carbon dioxide, and fatal collapse results; 
the heart continuing to beat for some time after the respiration 
has ceased. Even in the last stage of intoxication the injection 
of sodium carbonate, in consequence of the alkali thus supplied 
to the blood and tissues, will have the effect of bringing about 
a rapid recovery. It has been found that the red blood-cor- 
puscles are increased in size by the addition of small quantities 
of acid outside the body, and the amount of phosphates in these 
cells is believed to be increased by the administration of phos- 
phoric acid. In chlorosis it is stated that the number of the 
red corpuscles will be increased by hydrochloric acid, though 
the amount of haemoglobin remains unaltered. 

Therapeutics of Sulphuric, Nitric, Hydrochloric, Phos- 
phoric, Acetic, Citric, Tartaric and Lactic Acids. 
External. — Owing to their marked affinity for water, it is 
difficult to limit the local action of sulphuric and phosphoric 
acids, and consequently nitric acid is much more commonly em- 
ployed as a caustic. It is the preferred escharotic for venereal 
sores, warts, poisoned wounds, sloughing, phagedena and can- 
crum oris, and may be advantageously applied in a variety of 
other conditions, such as uterine ulceration, haemorrhoids and 
prolapse of the bowel. In the form of a foot-bath or lotion 



336 PHARMACOLOGY AND THERAPEUTICS. 

diluted nitric acid is useful in the treatment of chilblains, and 
its addition to the bath has been found of service in such skin 
diseases as impetigo, lepra and acne. Nitric acid is used as 
Heller's test for determining the presence of albumin in the 
urine. At present his process is reversed, i. e., the urine is 
added to the acid. Glacial acetic acid is successfully used for 
warts, corns, ulcers, lupus, epithelioma and nasal hypertrophies, 
as well as for ringworm and other forms of tinea. If much 
pain is occasioned it may be more or less diluted. A mixture 
of 30 parts of acetic acid with 2 parts of salicylic acid is a 
good application for venereal warts. Hydrochloric acid is 
sometimes applied to septic wounds, dissecting wounds, and bites 
of rabid animals, and in combination with pepsin has been 
utilized for the removal of carious and necrotic bone. The un- 
diluted acid is used to destroy warts on the hands of children, 
and has been successfully employed as a counter-irritant in 
sciatica. Three or four coats of it are painted with a small 
brush along the course of the nerve, after which the part is 
wrapped up in cotton. The application may be repeated in 
twenty-four or forty-eight hours, as required. Mixed with an 
equal proportion of honey it has been used as a topical applica- 
tion in diphtheria, care being taken that it should be confined 
strictly to the diseased surface. It has also been recommended 
as an addition to baths in such skin affections as pityriasis and 
tinea. Lactic acid has been advocated as a solvent of false mem- 
brane in diphtheria and croup, though its value in these diseases 
is somewhat problematical. Equal parts of lactic acid and water 
may be applied with a mop, and glycerin is sometimes added 
to the solution. It may also be used as a spray, of the strength 
of 1 to 8. Lactic acid is employed perhaps more frequently than 
any other drug as a local application in tuberculosis of the 
larynx. It is customary to begin with the following: lactic 
acid, 2 ; water, 1 ; glycerin, 1 ; which is applied with a brush. 
The strength of the solution is then gradually increased until 
at length the pure acid is used. Lactic acid is also used as a 
local application for other laryngeal growths, as well as for 



THE ACIDS. 337 

tubercular ulcerations of the tongue and other accessible parts, 
and for caries, lupus and epithelioma. In the external lesions 
of tuberculosis gauze tampons soaked in lactic acid are some- 
times applied, while for tubercular fistulae gelatin bougies con- 
taining the acid may be resorted to. They are composed of a 
paste made by gently heating 50 gm. (13 dr.) each of gelatin, 
lactic acid, and water, and then adding 30 gm. (1 oz.) of 
menthol ; after which the bougies are covered with a coating of 
collodion. In a 20 to 40 per cent, solution lactic acid has proved 
of service in the treatment of suppurative otitis and ulcers of 
the nasal fossa. Any well-diluted acid may be applied to arrest 
slight bleeding, as from leech-bites, piles, etc. Dilute vinegar 
will often answer, but sulphuric acid is particularly useful for 
this purpose, and its astringent effect is also made use of 
locally in the night-sweats of phthisis. Vinegar, properly di- 
luted, is often employed as a refrigerant for bathing the skin in 
fever. In chronic cystitis and phosphatic deposits a very weak 
solution of nitric acid (.06 c.c. ; 1 1U to 30 c.c. ; 1 fl. oz.) has been 
injected with advantage. On account of the intolerance of the 
bladder, such injections should be permitted to escape imme- 
diately. 

Internal. Alimentary Canal. — In consequence of the in- 
jurious effects of acids upon the teeth, it is better that they 
should be taken through a glass tube. Diluted sulphuric 
acid is used to a considerable extent as a prophylactic and 
remedy for lead poisoning, and as a prophylactic measure a 
lemonade made with sulphuric acid is quite commonly taken 
by those employed in lead works and paint factories. This 
treatment is recommended on the ground that the lead taken 
into the system is by this means changed to the insoluble sul- 
phate and is thus less easily absorbed; but it is a fact that 
poisoning may be induced by lead sulphate, so that the utility 
of the measure would seem to be somewhat doubtful. It has 
been found in practice however, that dilute sulphuric acid is 
effective in the treatment of lead-colic and that the constipa- 
tion due to lead is relieved by a combination of sulphuric acid 
23 



338 PHARMACOLOGY AND THERAPEUTICS. 

and magnesium sulphate, while the lead-cachexia is much bene- 
fited by sulphuric acid given in association with quinine and 
ferrous sulphate. On the other hand, sulphuric acid is of no 
service in removing the effects of lead upon the nervous sys- 
tem. Aromatic sulphuric acid, sufficiently diluted with water 
and syrup, makes a pleasant cooling drink for fever patients. 
In gastric and intestinal hemorrhage it acts directly in part, and 
may therefore prove useful, though its action is sometimes dis- 
appointing; and on account of its astringent effect it is often 
of great value in diarrhceic conditions. A combination of aro- 
matic sulphuric acid with opium is considered one of the 
most elficient remedies for summer diarrhcea and cholera, and 
in the treatment of dysentery dilute sulphuric acid may be pre- 
scribed with advantage in association with magnesium sulphate 
and morphine sulphate. Sulphuric acid, being more decidedly 
astringent, is as a rule, to be preferred to nitric and hydro- 
chloric acids in the treatment of diarrhcea, but the latter are 
useful also, and the mineral acids as a class are very efficient 
remedies in summer and colliquative diarrhcea. Whenever the 
stools are painless, watery, of a light color, and alkaline in 
reaction, these agents are indicated. Hope's camphor mixture 
has long been held in repute in such conditions, but it is said 
that when made according to the formula now generally in use 
(Nitric acid 2 c.c. ; y 2 fl. dr.; tincture of opium, 1.20 c.c. ; 
20 Ul ; camphor water, 120 c.c; 4 fl. oz.) ; it is not nearly so 
serviceable as Hope's original formula, in which the acid em- 
ployed was nitrous acid. Prepared in the original way and used 
while fresh, the mixture is regarded as a very efficient, though 
somewhat disagreeable, remedy in serous diarrhceas, as well as 
chronic dysentery connected with disordered secretion of the 
liver and other glands of the alimentary canal. 

As regards the action on the economy of the three prin- 
cipal mineral acids, the general statement has been made 
that sulphuric more promotes astringency, nitric, secretion, 
and hydrochloric, digestion. As previously remarked, hy- 
drochloric acid is the one most appropriate for rectify- 






THE ACIDS. 559 

ing a deficiency in acidity in the gastric juice. In dys- 
pepsia due to this cause it is the most valuable remedy 
which we at present possess, but in many instances the nitro- 
hydrochloric acid is also of great service. For the purpose men- 
tioned these acids have the best effect when taken a little while 
after eating. A very useful combination consists of nitro- 
hydrochloric acid with tincture of nux vomica and some such 
other stomachic tonic as the compound tincture of gentian. Hy- 
drochloric acid is sometimes useful, in association with other 
remedies, in cases of diarrhoea which are characterized by ex- 
cessive putrefaction of the intestinal contents. As a result of 
its administration the double sulphates of the urine are in 
many instances lessened: so that it would seem probable that it 
has the effect of disinfecting the stomach contents, as the hydro- 
chloric acid of the gastric secretion does normally. In the 
variety of dyspepsia in which acid eructations, pyrosis, and 
heartburn occur acids are of decided service, particularly hydro- 
chloric and phosphoric, and they should then be administered 
before meals. It is said that hydrochloric acid prevents the 
lactic fermentation in I to 1,000 dilution, and that in addition 
to its action on the digestive ferment it increases the peristalsis 
of the stomach. Hydrochloric acid is given to a very consider- 
able extent in typhoid fever, where by increasing the secretion 
of mucus it relieves the dryness of the tongue and fauces, and 
where it also no doubt tends to disinfect the intestinal contents. 
In this and other fevers it is believed to be indicated for the 
reason that the normal secretion of hydrochloric acid is much 
diminished when the temperature is raised. It may often be 
advantageously administered in beef-juice. If the diarrhoea is 
troublesome, sulphuric acid may be given in its place. Hydro- 
chloric acid is sometimes of service also in phthisis ; serving to 
supply to the digestive fluids a material in which they are 
deficient (both acid and pepsin in the gastric juice being re- 
duced in this disease), and also to disinfect to some extent the 
alimentary canal. Xitrohydrochloric acid is not, as a rule, so 
efficient as hydrochloric in ordinary dyspepsia. Still, in many 



340 PHARMACOLOGY AND THERAPEUTICS. 

instances it seems to act very satisfactorily, and it is particularly 
indicated when the biliary function needs stimulating. Its 
special value is believed to be in hepatic disorders and jaundice. 
Its mode of action in such conditions is not definitely known, but 
its peculiar composition may possibly afford some explanation. 
This acid contains not only nitric and hydrochloric acid, but 
a number of decomposition products, such as chlorine, nitroxy- 
chloride (NOC1), and nitrous acid. The acids, as is well 
known, are incapable of acting as such except in the alimentary 
canal, but it may be that some of the other constituents of this 
compound, as the chlorine, for instance, have a specific effect on 
the liver. Mucous duodenitis and catarrh of the gall-ducts ac- 
companied by jaundice and jaundice of malarial origin are 
among the affections which have been found to be benefited by it, 
and the experience of physicians practising in tropical countries 
has been favorable to its use in chronic affections of the liver, 
as well as in dysentery and dropsy of hepatic origin. In hepa- 
titis the acid is sometimes not only given internally, but applied 
externally, in the form of a foot-bath or general bath or of a 
compress placed over the liver. It is scarcely possible, however, 
to suppose that it can be absorbed in any quantity from the 
skin; so that any benefit which may be attributable to such ex- 
ternal application would seem to be principally due to the 
counter-irritation caused by it. In acute hepatic diseases and 
such chronic affections as cirrhosis and waxy degeneration 
nitrohydrochloric acid is not thought to be of sevice, as a rule, 
though some authorities advise that it should be tried in the 
early stages of cirrhosis, while the liver is still enlarged. In 
some cases apparently of this character great benefit, it is said, 
has been derived from its use. It is also stated that the wearing 
around the body of a flannel bandage soaked in a solution of 
the acid and covered with oiled silk is serviceable in the first 
stage of cirrhosis, as well as in chronic hepatitis and jaundice. 
Phosphoric acid is sometimes used to make cooling draughts 
in fever, as well as to relieve the thirst in diabetes. Acetic acid 
in the form of vinegar is a popular remedy for obesity. Its 



THE ACIDS. 341 

free use, however, is apt to be attended with more or less 
serious consequences, as it reduces flesh merely by interfering 
with the digestion. The prolonged administration of large quan- 
tities of acids usually proves irritant, and thus, by setting up a 
certain amount of gastritis, hinders the digestion and absorption 
of food. In order to allay the thirst of fever patients lemon 
juice or citric acid itself is used to stimulate the secretion of 
saliva and keep the mouth moist, and lemonade is a common 
beverage in febrile diseases. One or the other of these sub- 
stances thus frequently serves as the basis for cooling drinks, 
and the acid is largely employed, together with alkaline carbon- 
ates, in the preparation of effervescing mixtures which are use- 
ful as gastric sedatives. Citric and tartaric acids also form 
ingredients of various granular effervescent preparations. 
Lactic acid is only occasionally used in the treatment of dys- 
pepsia, as hydrochloric acid is generally much more satisfac- 
tory. At one time, however, under the impression that lactic 
acid was the normal acid of the gastric digestion, it was quite 
extensively employed. 

Remote Effects. — With the exception of citric, tartaric and 
acetic acids, the remote effects of the acids are of comparatively 
little therapeutic importance. Aromatic sulphuric acid was at 
one time quite largely relied upon for checking profuse sweat- 
ing, especially the night-sweats of phthisis. It is occasionally 
so employed with advantage at the present day, but when it is 
used care should always be taken that it is not allowed to inter- 
fere with the digestion. Sulphuric acid was also highly 
esteemed formerly as a remote haemostatic, but is not very often 
used in this capacity now, though some still profess to find it 
serviceable in certain forms of metrorrhagia. In haemoptysis 
it is unquestionably inferior to other remedies. Nitric acid is 
stated to have been at times used with success in the treatment 
of intermittent fever, in which, in order to obtain a curative 
effect, it is insisted that it should be given in full doses every 
four to six hours. This acid has also been found of service, 
after an arrest of the paroxysms of intermittent fever by 



34 2 PHARMACOLOGY AND THERAPEUTICS. 

quinine, in removing the hepatic congestion and the changes in 
the glandular apparatus of the intestines induced by the fever- 
movement. Under these circumstances it is advised that it 
should be combined with the bitters or used instead of aromatic 
sulphuric acid in the preparation of Infusum Cinchonse, for- 
merly official. Chronic bronchitis and hoarseness and the apho- 
nia of singers and public speakers may sometimes be relieved by 
dilute nitric acid in doses of .60 c.c. (10 ni). Both nitric and 
nitro-hydrochloric acids have been used, internally as well as in 
the form of baths, in such diseases of the skin as impetigo, acne 
and erythema nodosum, while sulphuric acid, also employed in- 
ternally and locally, is said to be more or less effective in lichen, 
prurigo, and itching conditions in general. When uric acid is 
in excess in the urine from faulty digestion and assimilation, 
nitric acid is often of great service; the excess of uric acid 
disappearing in consequence of the foods being more adequately 
prepared for admission into the blood. The mineral acids, and 
particularly hydrochloric, have been proposed as remedies for 
acute rheumatism, and tincture of ferric chloride is undoubtedly 
sometimes of benefit in that disease. Lime juice was formerly 
a popular remedy in acute rheumatism, but little can be said 
in its favor. Nitrohydrochloric acid is usually a very efficient 
remedy in oxaluria, a condition which seems to be dependent 
upon defective primary assimilation and is characterized by 
general malaise, a feeling of weakness, great mental depression, 
a sallow complexion, and often eructations of offensive gas, 
together with the presence in the urine of crystals of calcium 
oxalate. It has at times been successfully employed in chronic 
syphilis. Cases occasionally occur in which, in spite of the 
administration of mercury and potassium iodide, specific lesions 
persistently reappear, particularly in the mouth, and it is in 
this class of patients that benefit may sometimes be hoped for 
from the use of nitrohydrochloric acid, although it is in general 
vastly inferior to both of the remedies mentioned in the treat- 
ment of syphilis. Citric, tartaric and acetic acids may be given 
to increase the alkalinity of the blood and to alkalize the urine 



THE ACIDS. 343 

or render it less acid. For an effervescent solution of citric 
acid about 8 parts of the acid may be prescribed along with 7 
parts of sodium bicarbonate, with directions to dissolve the two 
powders separately, mix the solutions, and drink while effer- 
vescing. In large quantities this mixture acts as a saline 
cathartic; in smaller quantities it has the alkalizing effects just 
stated. There is probably no doubt as to the value of lemon and 
lime juice in the prophylaxis and treatment of scurvy. This, 
however, it is stated, is not due to the citric acid, but to some 
unknown property of the fruit juices. Orange juice has proved 
completely successful in the cure of infantile scurvy. It has 
been a common practice to give phosphoric acid to anaemic and 
feeble children for the ostensible purpose of improving the con- 
dition .of the blood and assisting the growth of bones, and to 
employ it in cachectic conditions somewhat generally, on the 
theory that these were due to a deficiency of phosphates in the 
foods and tissues. It has never been shown to be of any benefit, 
however, and experiments seem to have demonstrated that the 
animal tissues are unable to build up phosphorus compounds 
from the inorganic phosphates. Lactic, as well as phosphoric 
acid, has proved useless in the treatment of diabetes, and there 
is reason to believe that the latter may even be injurious in 
this disease. Mineral acids, if their administration is too pro- 
longed, tend to impair the appetite and disturb digestion, causing 
toothache and gastric oppression, and sometimes salivation and 
diarrhoea. In addition, they are liable to produce loss of flesh, 
paleness of the skin, and anaemia. If taken for long periods in 
comparatively large quantities they may induce degenerative 
changes in such organs as the heart, liver and kidneys, as well 
as give rise to the production of methaemoglobin in the blood. 
The prolonged use of nitric acid may occasion erosion of the 
gums and tongue, with loosening of the teeth. 

TOXICOLOGY. 

In toxic doses all these acids are severe gastro-intestinal irritants. 
Tartaric, citric, and lactic acids are very rarely taken as poisons. 



344 PHARMACOLOGY AND THERAPEUTICS. 

Symptoms. — There are intense, burning pains in the mouth, throat, 
stomach and abdomen, difficulty in swallowing, extreme thirst, and vio- 
lent vomiting; the ejected matter containing blood and sometimes shreds 
of mucous membrane. Not infrequently there is diarrhoea, the stools 
showing a dark discoloration from the presence of blood. Some of the 
acid is likely to get into the larynx, causing swelling and consequent 
dyspnoea, from obstruction to respiration. Evidences of shock and 
collapse quickly develop. The respiration is shallow, the pulse rapid 
and weak, and the skin, which shows marked pallor, covered with a 
cold sweat. The temperature falls below normal, and death usually 
occurs within a few hours. When fuming acids are swallowed and espe- 
cially in poisoning with hydrochloric acid, the irritant vapor, passing 
into the respiratory passages, may cause spasm of the glottis or oedema 
of the larynx, with the result of an immediately fatal issue from 
asphyxia. It has been found that as small a proportion of hydrochloric 
acid vapor as i part in 20,000 of air causes sneezing and pain in the 
throat and chest. 

Post-mortem. — There are the characteristic evidences of corrosive 
poisoning in the mouth, oesophagus and stomach, with or without per- 
foration, and sometimes extending into the intestine. The sloughs re- 
sulting from the destruction of the mucous membrane are of a whitish- 
gray color, and haemorrhages are frequently met with. When death 
has been delayed for some time fatty degeneration of the heart, mus- 
cles, liver or kidney may be found, and in these cases a form of necro- 
sis of the renal cells has sometimes been observed. 

Treatment. — Alkalies should be given at once to neutralize the acid, 
though there is a possibility that the stomach may be ruptured by the 
carbon dioxide gas generated from the combination thus formed. The 
best antidote is the insoluble magnesium oxide or carbonate, because 
these are not themselves corrosive, but if neither is procurable, al- 
most any accessible alkali may be resorted to, such as lime, chalk, soap 
or wood ashes. Then demulcents may be given, such as milk, white 
of egg, oil and flaxseed tea, which are useful in protecting the walls 
of the oesophagus and stomach ; and the acid may be rendered less cor- 
rosive by diluting it with large quantities. If strong sulphuric or nitric 
acid has been swallowed, the stomach-tube should not be employed, 
on account of the danger of its extremity passing through the softened 
walls of the gullet or stomach ; otherwise the stomach should be washed 
out. Morphine may be injected hypodermatically to relieve pain, and 
brandy or other stimulants used in the same way to counteract collapse. 



THE ACIDS. 345 

CHROMIUM SALTS. 

1. CHEOMII TRIOXIDUM (Acidum Chromicum, U. S. P., 1890). 
• -Chromium Trioxide. (Chromic Acid. Chromic Anhydride.) 

2. POTASSII DICHROMAS (Potassii Bichromas, U. S. P., 1890). 
-Potassium Dichromate. Dose, 0.010 gm. (10 milligm.) ; y 5 gr. 

Action of Chromium Trioxide. 

External. — Combining, as it does, the action of a metallic 
oxide, an acid, and a strongly oxidizing agent, chromium triox- 
ide is a powerful caustic. By reason of its oxidizing power it is 
also an energetic deodorant and disinfectant. When applied in 
substance it corrodes the skin, as well as other tissues, but it 
causes much less pain than the more penetrating caustic potash. 
Even in dilute solution it is an irritant to the skin, producing 
ulcerations and other lesions, and workmen in factories where 
chromic acid is used are liable to suffer from perforation of the 
nasal septum from the local action of the acid applied acci- 
dentally upon the fingers. 

Internal. — The symptoms produced by large quantities are 
those of gastro-intestinal corrosion, intense pain in the throat 
and stomach, vomiting and purging, with blood in the vomited 
matter and the stools, collapse, and frequently death. Post- 
mortem the lesions met with are those of corrosive poisoning, 
and the mouth and throat show a characteristic yellow dis- 
coloration. In mammalian animals the administration of the 
drug elicits effects similar to those produced by the metals in 
general. Weakness and slowness in the movements are caused, 
and these are followed by albuminuria, and later by diarrhoea 
and vomiting. Sometimes twitching of the muscles or even con- 
vulsions are observed, and then the weakness passes into gen- 
eral paralysis. The heart appears to be little affected, but the 
blood-pressure falls. After death the stomach and intestine 
are found congested, while the mucous membrane is necrosed 
and ulcerated in some parts and covered with ecchymoses in 
others. Haemorrhages are also found in other organs, and 
particularly in the cardiac wall, and parenchymatous nephritis is 



346 . PHARMACOLOGY AND THERAPEUTICS. 

met with. In chronic poisoning interstitial nephritis is said 
to occur. Chromium trioxide is readily absorbed from the 
stomach and intestine. It appears to be excreted principally 
through the kidney, and to a less extent through the intestinal 
epithelium. 

Therapeutics of Chromium Trioxide. 
External. — Chromium trioxide is never employed internally. 
It is used, generally in the strength of 1 per cent., to harden 
cat-gut and kangaroo tendon for surgical purposes. A lotion 
of the same strength is used in Germany to toughen the feet of 
marching soldiers. On account of its disinfectant properties it 
is employed in the form of a lotion, 1 to 40, or even stronger, 
for cleansing foul ulcers and sores and as a local application, 
in various dilutions, in gonorrhoea, leucorrhcea, ozaena, severe 
ulcerations of the mouth, etc. It is also sometimes used 
as a gargle, and for this purpose the solution should not 
be stronger than 1 to 480. The Liquor of the B. P., 
which is one part of chromic acid in 3 o*f water, may 
be employed as a caustic to destroy warts, condylomata 
and other small growths. As the escharotic action tends 
to spread, it should be used with caution. The adjacent sur- 
face should be protected with ointment, and the excess of acid 
promptly removed with an alkaline wash. A solution of chro- 
mium trioxide of the strength of .60 gm. (10 gr.) to 30 c.c. 
(1 fl. oz.), applied once or twice a day, is an excellent remedy 
for enlarged tonsils and syphilitic mucous patches. It has also 
been used in endocervicitis, uterine haemorrhage, hypertrophies 
of the nasal passages, and some malignant growths, and has 
been injected into haemorrhoids. For parasitic skin diseases, 
such as sycosis, lupus and tinea circinata, a solution ten times 
the strength of this may be employed. An ointment containing 

1 gm. (15 gr.) to 30 gm. (1 oz.) is serviceable in favus, after 
the crusts have been removed, and a wash of the strength of 

2 gm. (30 gr.) to 500 c.c. (1 pint) of water, and also contain- 
ing tannic acid, hydrated chloral, and morphine sulphate, has 



THE ACIDS. 347 

been recommended for chronic ulcers. A I per cent, solution 
in water, it is stated, has been found valuable in cases of viper 
bites. The following treatment has proved successful in ranula 
and cystic goitre: The tumors are opened and their contents 
washed out, and, after haemorrhage has ceased, a saturated 
solution of chromium trioxide is freely applied to several points 
of the cyst wall. 

Action of Potassium Dichromate. 

External. — Like chromium trioxide, it is an irritant caustic. 
Its escharotic, as well its antiseptic, action, however, is some- 
what less energetic than that of the trioxide; though the work- 
men engaged in making it are liable to painful ulcerations of 
the hands. Eczema of the hands, moreover, is said to occur in 
those who prepare the dichromate solution used for dyeing pur- 
poses, and material dyed with the latter may produce ulceration 
of the integment. 

Internal. — The effects are essentially the same as those of 
chromium trioxide, and if the quantity swallowed is sufficiently 
large, death may result. Less than 30 gm. (1 oz.) has caused 
unconsciousness in five minutes, with death thirty-five minutes 
later. In two recorded fatal cases of poisoning by it the 
amounts taken were respectively 8 and 15 gm. (2 and 4 dr.). 
In doses of 0.05 gm. (^ gr.) it acts as an emetic. 

Therapeutics of Potassium Dichromate. 

External. — It is used as a caustic for warts, venereal ulcers, 
and mucous patches. Its solution has also been employed as 
a disinfectant wash for sloughing wounds. 

Internal. — It has been recommended for the treatment of 
gastric catarrh and gastric ulcer in dose of from .005 to .01 gm. 
(tV t0 i 8 T -)> gi yen thrice daily on an empty stomach, and is 
reputed to relieve nausea, vomiting and pain. In catarrhal con- . 
ditions of the respiratory tract it has been advocated as an ex- 
pectorant. It has been employed successfully in children, in 
small doses (0.003 g m - ; yV S r - f° r an infant of one year), 
every hour, and it is advised that when the respiration is 



348 PHARMACOLOGY AND THERAPEUTICS. 

seriously embarrassed, the dose should be repeated every fifteen 
to thirty minutes. Favorable results have been reported from 
its use in cases of haematochyluria, some of which depended on 
the presence of filariae, and it has been recommended for the 
treatment of pernicious malarial anaemia. It has also been em- 
ployed in syphilis and chronic rheumatism, but without any 
appreciable results. In cases of poisoning by chromium triox- 
ide or potassium dichromate, soap, an alkaline carbonate, or 
magnesia, together with milk, may be given at once, and the 
stomach washed out. 

TURPENTINE. 

1. TEREBINTHINA.— Turpentine. 

Preparation. 
Ceratum Resinae Compositum. — Compound Rosin Cerate. 

2. OLEUM TEREBINTHINA.— Oil of Turpentine. 

Preparations. 

1. Oleum Terebinthinse Rectificatum. — Rectified Oil of Tur- 
pentine. Dose, 1 c.c; 15 ni. 

2. Emulsum Olei Terebinthinse. — Emulsion of Oil of Tur- 
pentine. Dose, 4 c.c; 1 fl. dr. 

3. Linimentum Terebinthinse. — Turpentine Liniment. 

Unofficial Preparations. 
Sanitas. — Sanitas. 

Terebinthina Chia. — Chian Turpentine. Dose, .30 to 1.20 
gm.; 5 to 20 gr. 

Action of Turpentine. 
External. — Oil of turpentine has the characteristic action of 
the volatile oils in general. On the skin it acts as a rubefacient 
irritant, and counter-irritant, and its prolonged application may 
give rise to vesication or even ulceration. The effects are more 
marked if it is applied with 'friction. Under its external use, 



TURPENTINE. 349 

then, we find produced tingling, a feeling of warmth, and 
reddening of the surface, all of which result from the local 
dilation of blood-vessels caused by it. On mucous membranes 
there is found the same irritation, with redness and congestion, 
pain and smarting. Applied to fresh wounds, it is haemostatic, 
contracting the blood-vessels and aiding coagulation. Oil of 
turpentine is a fairly energetic antiseptic, and it is less irritant 
than many of the more powerful ones. It is absorbed from the 
unbroken skin. 

Internal. Alimentary Canal. — Kept in the mouth, it causes 
the same redness and irritation of the mucous membrane, and 
is apt to excite a reflex secretion of saliva. In the stomach it 
gives rise to a feeling of warmth and comfort and causes some 
reflex stimulation of the heart. It also acts as a carminative, 
accelerating peristalsis and promoting the expulsion of gas. 
Whether the volatile oils have any direct action on the gastric 
secretion is still a disputed point. It has been recently shown 
that from the intestine, as well as the stomach, absorption occurs 
more rapidly in the presence of slight irritants, such as these 
oils. It is still unknown whether the peristaltic movements of 
the bowel are increased by them, though turpentine certainly 
appears to have a marked stimulating effect upon the muscular 
coat of the intestine. It diminishes flatulence and distention, 
and its antiseptic action may be concerned in the production of 
this result. It is anthelmintic, and in sufficiently large doses 
cathartic, the faeces often containing blood. 

Circulation. — Our knowledge of its action on the circulation 
is very imperfect, and the statements of various observers re- 
garding this differ greatly. It appears to produce a very 
slight rise of arterial pressure, increased pulse-rate, and in- 
creased cardiac force. The drug is known to have haemostatic 
properties, and this action is no doubt due to its power of con- 
tracting the vessels. After a large dose the stimulation is fol- 
lowed by depression, the action of the heart growing feeble, the 
blood-pressure falling, and the vessels dilating. 

Nervous System. — In its action on the nerve cells oil of tur- 



350 PHARMACOLOGY AND THERAPEUTICS. 

pentine differs from some of the other volatile oils in that 
the preliminary stimulation caused by large amounts is only 
transitory, being quickly followed by marked weakness and 
depression; with heaviness, unsteady gait, and drowsiness. 
Toxic doses are said to cause paralysis of sensory nerves, loss 
of reflex action, insensibility and coma. The depression of the 
respiratory centre in the medulla is preceded by stimulation, 
the breathing increasing in rapidity and volume. 

Respiration. — Oil of turpentine is in part excreted by the 
bronchial mucous membrane, and during the course of this 
excretion it exerts an irritant action on the respiratory pas- 
sages which may be sufficient to lead to bronchitis. Such ex- 
cretion may be at once stimulating and antiseptic, and turpen- 
tine may also diminish the bronchial secretion in a specific man- 
ner. According to some authors it acts as an expectorant, while 
others consider that it diminishes excessive secretion and allays 
cough. It has consequently been suggested that both statements 
may be true in different pathological conditions and with dif- 
ferent doses of the drug. When inhaled, the vapor of turpen- 
tine has an irritating effect on the bronchial mucous membrane, 
just as the oil does when applied directly to mucous membranes 
and to the skin. The disinfecting agency of the drug is shown 
by the fact that turpentine prevents experimental tuberculosis 
in dogs. 

Kidneys. — It is largely excreted by the kidneys. Its action 
upon these organs is more energetic than that of almost any 
other volatile oil, and especially results in diuresis. Large doses 
are very irritant, lessening the amount of urine, rendering it 
highly colored, and in some cases producing albuminuria, 
hematuria, and even total suppression. This irritant action is 
not confined to the kidneys, but extends to the whole genito- 
urinary tract. There is much aching in the loins, with spas- 
modic pain in the ureters, a sensation of heat in the perineum, 
a constant desire to pass water, without the ability to do so, 
in consequence of the urethral spasm, and a general condition 
of strangury. Priapism may be induced, and an intolerable irri- 






TURPENTINE. 351 

tation may affect all the pelvic organs. In especially susceptible 
individuals symptoms of this character may be caused by even 
moderate amounts of the drug. A characteristic effect of tur- 
pentine is the odor of violets which it imparts to the urine. 

Skin. — There is reason to believe that it is excreted to some 
extent by the skin glands. In persons with an idiosyncrasy to 
turpentine erythematous, papular or vesicular eruptions may 
be caused by both its internal and external use. 

It seems probable that oil of turpentine is excreted in part 
by the intestine and in the bile, milk, and other secretions. 

Temperature. — It appears to have a slight antipyretic action. 

Old oil of turpentine, containing oxygen, is an antidote to 
phosphorus {see phosphorus). The statement has been made 
that this and the French oil are preferable in other respects; 
but this seems questionable. 

Therapeutics of Turpentine. 

External. — Oil of turpentine is highly esteemed as a counter- 
irritant in bronchitis, pneumonia, pleurisy, peritonitis, osteo- 
arthritis, and other inflammatory conditions, and in such pain- 
ful disorders as pleurodynia, neuralgia, myalgia, lumbago and 
old rheumatic pains. It is often employed in the form of a 
stupe, which consists of a piece of flannel heated by steam or 
by being wrung out of hot water, on the surface of which a 
few drops of turpentine are sprinkled just before application. 
Turpentine stupes should be removed as soon as they cause 
pain. Spongiopiline may be used in place of the flannel. A mix- 
ture of equal parts of turpentine and yolk of egg is sometimes 
employed for external applications. In peritonitis a combina- 
tion of oil of turpentine with olive oil and mercurial ointment, 
applied warm upon flannel over the abdomen, has been used 
with advantage. The external application of oil of turpentine 
is also sometimes of service in puerperal fever. When friction 
is desired, as in the case of rheumatic joints, it is advisable to 
use turpentine in the form of a liniment, in which it is often 
associated with other substances. The official liniment, for 



352 PHARMACOLOGY AND THERAPEUTICS. 

most purposes, should be diluted. Preparations containing tur- 
pentine are sometimes employed for topical application in in- 
flammatory affections of the pharynx, tonsils and larynx, and 
in diphtheria the oil has been brushed on the affected parts or 
used by inhalation. In this disease it is stated that advantage 
has been derived from the continuous inhalation of a mixture 
composed of i part each of carbolic acid and oil of eucalyptus 
and 8 parts of oil of turpentine; cloths saturated in the fluid 
being hung or laid near the face of the patient, but not allowed 
to come in contact with the skin. Oil of turpentine has been 
used with success in the treatment of severe burns, accompanied 
by constitutional depression, and it is an excellent antiseptic for 
old suppurating wounds. Care must be taken that it does not 
blister the skin. It is sometimes used as a parasiticide for ring- 
worm, and an ointment of turpentine (B. P., soft soap, 37.5; 
distilled water, 125; camphor, 25; oil of turpentine, 325), is said 
to be advantageous in chronic eczema, psoriasis and alopecia 
circumscripta, as well as a good application for indolent ulcers. 
Sanitas (not official), a very pleasant disinfectant, though not 
so strong as phenol, is an aqueous solution of common turpen- 
tine which has been allowed to oxidize in the air. Its active 
antiseptic principle is hydrogen dioxide, and it contains a lit- 
tle thymol. 

Internal. Stomach and Intestines. — For internal use the rec- 
tified oil only should be prescribed. It is not very frequently 
employed as a stomachic, but is used to a considerable extent 
as an intestinal carminative; and flatulence may often be 
promptly relieved by a few drops on a lump of sugar. It is 
regarded as especially indicated in persistent flatulence result- 
ing from a paretic condition of the muscular coat, and it has 
been shown to possess curative power in chronic intestinal 
catarrh. Among the indications for its administration may be 
mentioned a dry and glazed tongue, tympanitic distention of 
the abdomen, and stools which are either fluid or consist of 
scybala mixed with mucus and pale, watery blood. It is thus 
a valuable remedy in subacute dysentery, where it is often given 



TURPENTINE. 353 

in an emulsion with almond oil and opium. In these cases it 
is believed that it gives tonicity to the vessels and to the mus- 
cular fibres of the intestines, arrests the putrefactive and fer- 
mentative processes which take place in the vitiated mucus and 
articles of food, and by increasing the cutaneous capillary cir- 
culation relieves congestion of internal organs. From our 
knowledge of the physiological effects of oil of turpentine it 
would naturally be supposed that it might prove of service in 
typhoid fever, both as a haemostatic and an antiseptic, and in 
many cases of this disease it is found to be of the greatest 
practical value. Here it not only acts as a local stimulant to 
the ulcerated bowel, but also exerts a beneficial influence upon 
the general state of the system. Two conditions or stages 
in the disease have been pointed out in which it is especially 
useful. The first is when at about the end of the second week 
the tongue becomes very dry, red, chapped, and perhaps coated 
in the centre with a brownish fur, and at the same time marked 
meteorism develops. 0.6 c.c. (10 ni) of the oil of turpentine 
given every two hours during the day and every three hours 
in the night will be found in many instances to do away with 
these unfavorable signs. The second is when the ulceration of 
Peyer's patches proves slow to heal, so that there is a constant 
tendency to the recurrence of diarrhoea, and convalescence is 
thus delayed. Here the remedy seems to act almost as a specific. 
It is stated that the typhoid fever bacillus will not develop in 
air containing diluted vapor of turpentine, and dies when the 
air is saturated with the vapor, while thymol appears to be even 
more efficient than turpentine. The intestinal haemorrhage of 
typhoid may also often be successfully treated with oil of 
turpentine. Administered in the form of an enema, in some 
such vehicle as mucilage of starch, it is very effective in reliev- 
ing flatulence of the bowels, and where there is impaction of 
the caecum or rectum castor oil is frequently combined with it 
in the injection. Turpentine has also been used by enema 
as a derivative in insolation or sunstroke and in cerebro-spinal 
meningitis, as well as a remedy for thread-worms. Given in- 
24 



354 PHARMACOLOGY AND THERAPEUTICS. 

ternally, oil of turpentine is efficacious in the treatment of 
tape-worm, but as the dose required for this purpose is large, 
it may produce strangury and other constitutional effects. For 
this reason castor oil or other purgative should be promptly 
administered after it, and many advise that the purgative should 
be combined with it. A combination of equal parts of turpen- 
tine and ether (Durand's remedy) at one time acquired con- 
siderable reputation in the treatment of biliary calculi. While 
during the acute attack of biliary colic it is inferior to other 
remedies, as morphine and hydrated chloral, clinical experience 
seems to have shown that in the after-treatment its occasional 
administration may sometimes be of service as an adjuvant 
to other measures. In yellow fever, puerperal septicaemia, and 
other febrile diseases, as well as in typhoid, oil of turpentine has 
been successfully employed as a stimulant and antiseptic. In 
affections of this class it is recommended that for the intestinal 
complications the dose, as a rule, should be small and frequently 
repeated, while as a stimulant to the vaso-motor nervous sys- 
tem it should be somewhat larger and repeated at somewhat 
longer intervals. 

Circulation. — It is contraindicated where there is active 
haemorrhage and a condition of plethora, in hypertrophy of the 
heart, and when advanced atheroma of the cerebral arteries is 
believed to be present. In the passive haemorrhages in ataxic 
cases, where there is a condition of debility, relaxation of the 
vessels, and an impoverished condition of the blood, it is of 
great service. It may be given in haemorrhages from the 
stomach, bowels, lungs, etc., and is also efficacious in the 
haemorrhagic transudations met with in purpura, scurvy, and 
allied states. 

Respiration. — For the purpose of inhalation turpentine may 
generally be replaced with advantage by the Vapor Olei Pini 
(see p. 356), especially as the latter is much more agreeable, 
but it is occasionally used internally in chronic bronchitis with 
profuse expectoration (especially when the latter has a fetid 
odor), and in gangrene of the lung. It may also be employed 



TURPENTINE. 355 

in pneumonia and capillary bronchitis with marked depression 
of the vital powers and enfeeblement of the circulation, and 
particularly when these affections occur in the course of typhus 
or typhoid fever and similar diseases. Here it is often applied 
externally, as well as given by the mouth. 

Genito -urinary Tract. — Turpentine would no doubt be more 
generally employed than it is in a variety of affections (as it 
unquestionably has a considerable number of useful applica- 
tions), were it not that it is so disagreeable to take, and also 
because of the fact that it is so liable to cause inflammation of 
the kidneys. On the latter account it must always be adminis- 
tered with caution, and it is, of course, entirely contra-indi- 
cated when renal disease is present. An exception as regards 
the latter, however, is sometimes made in the case of chronic 
pyelitis, where the oil of turpentine, as well as those of copaiba 
and cubeb, may have a good effect in changing the condition 
of the mucous membrane and limiting the formation of pus; 
also in hydro- and pyo-nephrosis, where by actual contact it 
may alter the relaxed state of the vessels and the patholog- 
ical secretions of the mucous membrane. In these conditions it- 
should always be given in small doses and its effects watched 
with extreme care. In incontinence of urine, due to atony of 
the muscular coat of the bladder and not to spasm, and in 
chronic cystitis, gleet, spermatorrhcea and prostatorrhcea, when 
the discharges characterizing these affections are the result 
of relaxed conditions, turpentine, in moderate doses, may not 
infrequently be administered with considerable benefit. In all 
these cases it should be borne in mind that, with the exception 
of cantharides, oil of turpentine is the most actively stimulating 
of all the diuretics, so that it must be resorted to only when a 
stimulant effect is called for. It is never employed to increase 
the flow of urine for the purpose of affecting serous effusions, 
being used as a diuretic simply for its local influence upon the 
kidneys. -Excessive diuresis sometimes is apparently dependent 
upon a relaxed condition of these organs, and under these cir- 
cumstances oil of turpentine may be of service. 



356 PHARMACOLOGY AND THERAPEUTICS. 

Chian turpentine (not official) is an oleo-resin obtained from 
Pistacia terebinthus. It has been recommended for the cure 
of scirrhus and other malignant disease, especially of the uterus, 
it being insisted that for this purpose the drug should be pure 
and that its administration should not only be begun early, but 
should be continued for a year after the manifestations of the 
disease have disappeared or the tumor has been removed by 
operation. Its value in cancer, however, has never been satis- 
factorily demonstrated. In doses of from 0.30 to 1 gm. (5 to 
15 gr.) this agent has proved of service in pityriasis rubra. 
It is stated that the solid form is not an eligible method of 
administration when it is to be continued for a considerable 
length of time, as it has been known to accumulate and form 
a mass in the stomach. 

CANADA TURPENTINE. 

TEREBINTHINA CANADENSIS.— Canada Turpentine. (Canada 
Balsam. Balsam of Fir.) 

Action of Canada Turpentine. 
Its action is the same as that of oil of turpentine. 

Therapeutics of Canada Turpentine. 
Under the names of Canada balsam and balsam of fir, as well 
as the deceptive title of " balm of Gilead," Canada turpentine 
has been used to a considerable extent, especially in the treat- 
ment of chronic bronchitis. It is principally employed (in con- 
sequence of its physical property of drying), for forming an 
adhesive varnish. 

FIR-WOOD OIL. 

Unofficial Preparations. 
Oleum Pini. — Oil of Pine. (Fir-wood Oil. Pinol.) 
Vapor Olei Pini. — Vapor of Oil of Pine. 






OIL OF ERIGERON. 357 

Action of Fir-wood Oil. 
The action of oil of pine is the same as that of oil of turpen- 
tine. 

Therapeutics of Fir-wood Oil. 

This oil is used locally or by inhalation. It is much more 
agreeable than the oil of turpentine, and is employed in various 
sprays and inhalations in the treatment of acute coryza, nasal 
catarrh and many diseases of the respiratory passages. It is 
especially useful as a stimulating, disinfectant expectorant in- 
halation in chronic bronchitis or laryngitis. 

OIL OF ERIGERON. 
OLEUM ERIGERONTIS.— Oil of Erigeron. (Oil of Fleabane.) 
Dose, 1 c.c; 15 TT\.. 

Action of the Oil of Erigeron. 
It has the same general effects as oil of turpentine, but is 
less irritant. 

Therapeutics of the Oil of Erigeron. 

While it is less irritant, it is also less efficient than oil of tur- 
pentine. Externally it is often applied to prevent insects from 
injuring the skin. It has been used in diarrhoea, dysentery and 
haemorrhages, in much the same way as oil of turpentine. It 
has the advantage over the latter of being much less unpleasant 
to take, and has been found by some an effective remedy in 
haemoptysis, as well as in menorrhagia and in metrorrhagia, 
when of passive character. In acute congestion of the kid- 
neys it is contra-indicated, but in the strictly chronic forms 
of renal disease it is thought to lessen the waste of albumin, 
and at the same time to improve the general condition of the 
patient. 

TAR. 

PIX LIQUIDA.— Tar. Dose, 0.500 gm. (500 milligm.) ; 7y 2 gr. 



358 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Syrupus Picis Liquidae. — Syrup of Tar. Dose, 4 c.c; 1 
fl. dr. 

2. Unguentum Picis Liquidae. 

OLEUM PICIS LIQUID^.— Oil of Tar. Dose, 0.2 C.C.; 3 Til. 

Unofficial Preparation. 
Pixol. — Pixol. 

Action of Tar. 

External. — Though its effects are somewhat less pronounced, 
tar is, like oil of turpentine, a local irritant, by reason of its 
action in dilating the blood-vessels. If its application is pro- 
longed, it is likely to induce an eruption of red papules, some 
of which may suppurate, constituting what is known as " tar 
acne." This is sometimes met with in those who work in tar 
or are much exposed to its fumes. When applied over a large 
area, absorption from the skin may give rise to toxic symp- 
toms resembling those of phenol poisoning. In less concen- 
trated form it relieves itching, an effect which has been 
attributed to its reducing the sensibility of the sensory nerve 
terminations. The vapor, when inhaled, has a local antiseptic 
and stimulant action on the respiratory mucous membrane. 
Tar has very valuable antiseptic and disinfectant properties, 
and on account of its cheapness it is especially serviceable for 
the disinfection of excrementa, premises, etc. 

Internal. — In small doses it has the effect of stimulating the 
circulation and increasing the secretions. It is excreted by the 
respiratory mucous membrane and the kidneys, and acts as a 
stimulant and antiseptic during elimination. It is thus both 
a diuretic and expectorant. In large doses it produces head- 
ache, epigastric and abdominal pain, general malaise, indi- 
gestion, vomiting of dark-colored matter, loose black stools, and 
blackish-brown urine, which smells of tar and may contain 
blood or albumin. The urine may possibly be clear when 
passed, but on standing it throws down a dark deposit. The 
symptoms, it will be seen, have considerable resemblance to 
those of phenol poisoning. 



tar. 359 

Therapeutics of Tar. 
External. — Wood tar is the only official form of tar, but coal 
tar is often used in medicine. The prepared form of it is 
made by simply heating and stirring coal tar at 120 F. (48 C.) 
for an hour. The chief use of tar is for the local treatment of 
certain forms of skin disease, and for this purpose it is applied 
in lotions, paints, ointments, plasters, soaps and baths. The 
official ointment is liable to cause more or less irritation, and 
should generally be diluted. In order to prepare an unirritating 
tar ointment, it has been advised that the tar be previously 
allowed to stand for several weeks in a warm place. It will 
be found that it separates into two layers, the upper of which 
is thin and syrupy, and is destitute of irritant properties. 
Liquor Picis Carbonis (not official) is a favorite preparation 
for many skin diseases. It may be made thus : Dissolve rosin 
soap (see Rosin), I, in alcohol, 8; add prepared coal tar, 4; 
digest at 125 F. (51 C.) for two days, allow it to cool, then 
decant and filter. An ointment of 3 parts of lard with 1 of 
this solution may be made. Liquor Picis Carbonis Detergens 
(not official) is an alcoholic solution of ordinary coal tar, which 
is used externally in skin diseases, diluted in 20 parts of water. 
Tar is especially useful in scaly affections, such as psoriasis. 
Among the other skin diseases in which it is serviceable may 
be mentioned lichen, chronic eczema, comedo, sycosis, pemphi- 
gus, prurigo, and lupus erythematosus and vulgaris, as well as 
scabies and tinea. An alkaline tar-water, made by adding tar, 
8 c.c. (2 fl. dr.) and caustic potash, 4 gm. (1 dr.) to water, 
150 c.c. (5 fl. oz.), is a good application in eczema. A weakened 
tar ointment, by reason of its mildly anaesthetic action, is use- 
ful in relieving pruritus ani and other itching affections. The 
tar-water which was formerly official (made by mixing 1 part 
of tar with 4 of water) is an efficient antiseptic application to 
unhealthy wounds or sores. This preparation used with an 
atomizer or vaporized by heat is beneficial in acute pharyngitis 
and laryngitis, as well as in chronic catarrhal affections of 
the air-passages. It has been found of service in winter cough, 



360 PHARMACOLOGY AND THERAPEUTICS. 

and is said to materially lessen the tendency to taking cold. 
Sufferers from chronic bronchitis sometimes derive consider- 
able benefit from the fumes given off from tar which is allowed 
to simmer in a vessel placed on a stove in the room occupied by 
them. In ozsena the inhalation of the fumes of a mixture con- 
taining tar, camphor, potassium iodide, and tincture of iodine, 
placed upon a water-bath, has been recommended. In the 
treatment of haemorrhoids the application of a preparation con- 
sisting of tar, 3, extract of belladonna leaves, 3, and glycerite 
of starch, 30, has been found useful. In some individuals there 
is an intolerance of tar, so that even the smallest quantity will 
be found to excite irritation and cause a papular, eczematous 
eruption. 

Internal. — Except as a remedy for some chronic diseases of 
the skin, tar is used internally almost exclusively as an ex- 
pectorant. Wood tar only is given for bronchial affections, 
and it is in the chronic forms of these that it proves especially 
valuable. It may be prescribed in pill, as the syrup, or as the 
French preparation, Eau de Goudron. Vinum Picis Liquidae 
(not official), which is a saturated solution of tar in sherry wine 
and the dose of which is 4 to 15 c.c. (1 to 4 fl. dr.), is used 
to a considerable extent. An excellent cough mixture consists 
of the syrups of tar and wild cherry, with .003 gm. (-g-^-gr.) of 
apomorphine hydrochloride in each dose. The dose of tar- 
water is 500 c.c. (1 pint) daily. The latter has been found of 
service in some cases of chronic pulmonary tuberculosis; quiet- 
ing cough, checking diarrhoea, and improving the appetite and 
digestion. In chronic diseases of the skin the internal admin- 
istration of wood tar is sometimes a valuable adjunct to local 
treatment, and the action of small doses has been found espe- 
cially favorable in psoriasis and eczema. Tar has also occa- 
sionally been given internally in haemorrhoids and in catarrh 
of the urinary tract. 

Pixol, disinfectant and antiseptic, is a compound made by dis- 
solving green soap in tar and slowly adding a solution of either 
potash or soda in water. It is a syrupy liquid which, in 5 per 



OIL OF CADE. 361 

cent, dilution, has been used for disinfecting linen and washing 
the hands. A 10 per cent, solution is said to be an efficient 
disinfectant of excrementa, and it is extremely cheap. A solu- 
tion of this strength, it is asserted, is fatal to the micro-organ- 
isms of suppuration, anthrax, typhoid fever, and cholera. 

OIL OF CADE. 
OLEUM CADINUM.— Oil of Cade. (Juniper Tar Oil.) 

Action of Oil of Cade. 

It has much the same action on the skin as tar, but its 
preparations have decidedly less odor and are less injurious to 
the clothing. 

Therapeutics of Oil of Cade. 

Oil of cade is too stimulating for most acute eruptions, but 
is used with benefit in chronic eczema, psoriasis, pityriasis 
rubra, lichen, prurigo, and various forms of pruritus. It is also 
an efficient parasiticide in favus and other varieties of tinea. 
It is sometimes applied in full strength and sometimes diluted 
with a bland oil, and is also made into ointments, and especially 
into soaps. A common formula consists of oil of cade, 1 ; soft 
soap, 4; alcohol, 4. An ointment made by melting with it an 
equal part of yellow wax is a stronger and also a more agreeable 
preparation. A mixture of oil of cade in acetone collodion has 
been recommended as having special advantages in psoriasis, 
lichenoid eczema, simple chronic lichen, lichen planus, and in 
nummular and seborrhceic eczemas. " Haarlem oil," which is 
said to be composed of equal parts of oil of cade and oil of 
juniper berries, has had a considerable vogue in chronic affec- 
tions of the kidneys and bladder. As an anthelmintic oil of 
cade has been given in doses of .15 to .30 gm. (3 to 6 ni), 
repeated several times a day. 



362 PHARMACOLOGY AND THERAPEUTICS. 

BURGUNDY PITCH. 

Unofficial Preparations. 

Pix Burgundica (U. S. P., 1890). — Burgundy Pitch. 

Emplastrum Picis Burgundicse (U. S. P., 1890). — Burgundy 
Pitch Plaster. 

Emplastrum Picis Cantharidatum (U. S. P., 1890). — Can- 
tharidal Pitch Plaster. (Warming Plaster.) 

Retinol. — Retinol. (Resinol. Codol.) 

Action of Burgundy Pitch. 
Burgundy pitch is stimulating to the skin, and, applied as a 
plaster, produces itching, redness, and sometimes a papular 
eruption. Upon a delicate integument it may occasion a vesicu- 
lar, or even a pustular, eruption, with superficial ulcers. 

Uses of Burgundy Pitch. 

It is employed as a basis for a number of plasters, and in 
this form it is in general use to protect, sustain and stimulate 
the parts to which it is applied. These plasters are often very 
useful as mild counter-irritants in lumbago and other forms of 
muscular rheumatism, chronic rheumatic swellings, and affec- 
tions of the chest and abdomen; and obstinate cases of sciatica 
are sometimes cured by enveloping the buttock and thigh in a 
Burgundy pitch plaster, and leaving it permanently in place. 
In pulmonary diseases a plaster of proper dimensions gives to 
the chest a greatly-needed mechanical support during the act 
of coughing. The cantharidal pitch plaster is especially service- 
able for its revulsive effect, as its counter-irritant action is 
somewhat greater than that of the simple pitch plaster, though 
less than is caused by a blister. Burgundy pitch has been 
thought to have some special action upon the rectum, and for 
haemorrhoids has sometimes been given in the form of pills. 

Retinol (resinol), a yellowish, oily liquid, is a product ob- 
tained by the distillation of Burgundy pitch. It has consider- 
able antiseptic power and is non-irritating, but is not soluble 



ROSIN. 363 

in water. When applied over a surface it forms a varnish-like 
coating. Its principal use is as a solvent for various alkaloids 
and for such other medicinal agents as iodol, salol, thymol io- 
dide, chrysarobin, cocaine, phenol and phosphorus. The solu- 
tion of phosphorus is said to be very stable and serviceable for 
both internal and external use. Retinol has been applied on 
tampons, with borax and other substances, and also used in 
suppositories, in the treatment of vaginitis, and has been in- 
jected into the bladder, in a 5 to 10 per cent, solution, in sub- 
acute cystitis. It is an excellent vehicle for medicaments in 
diseases of the skin, and in a large number of these affections, 
either alone or as an antiseptic excipient for other substances, 
it is stated to have given good results. It mixes readily with 
fats, oils, lanolin, glycerin and petrolatum. The following has 
been employed as a topical application in diphtheria: Retinol, 
15; camphor, 2; naphthol, 1. In ophthalmological practice re- 
tinol, mixed with lanolin, has been used for conjunctivitis, 
simple or gonorrhceal, and for affections of the lids and tear- 
ducts, as well as for the preparation of dressings and the pro- 
tection of instruments. Internally, retinol has been given, in 
capsules, in the treatment of gonorrhoea. 

ROSIN. 

RESINA. — Rosin. (Resin. Colophony.) Dose, 0.250 gm. (250 
milligm.); 4 gr. 

Preparations. 

1. Ceratum Resinse.— Rosin Cerate. (Basilicon Ointment.) 

2. Ceratum Resinae Compositum. — Compound Rosin Cerate. 

Unofficial Preparation. 
Emplastrum Resinse (U. S. P., 1890). — Resin Plaster. (Ad- 
hesive Plaster.) 

Action of Resin. 
Locally rosin is antiseptic and slightly irritating; internally 
it is antiseptic and astringent in its effects upon the intestines. 
It has the property of preventing the oxidization of fatty sub- 
stances, and thus contributes to the preservation of ointments. 



364 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Rosin. 

Rosin cerate is a good dressing for indolent or unhealthy 
ulcers and wounds, promoting cicatrization and granulation, as 
well as acting as a disinfectant. It is also sometimes applied 
to burns and chilblains. Compound rosin cerate (Deshler's 
salve) is more stimulating, as it contains crude turpentine. 
The chief use of rosin is in plasters, which it renders adhesive 
and more or less stimulating. In some persons the skin is so 
sensitive that the simple Emplastrum Resinae will excite very- 
considerable irritation. Rosin soap is made from rosin, 6; 
caustic soda, 1 ; water, 25 ; which are boiled together in an 
evaporating dish for two hours, after which the soap is 
separated by a strainer and dried on a water-bath. In chronic 
bronchitis and winter cough the fumes from boiling rosin 
may sometimes be inhaled with advantage. Rosin was at 
one time employed in diarrhceal affections, in which it had 
some vogue as a domestic remedy, but is now seldom given in- 
ternally. 

FRANKINCENSE. 

THUS AMERICANUM (B. P., not official).— Frankincense. 

Action of Frankincense. 
It has the same effects as rosin. 

Therapeutics of Frankincense. 
Its toughness and adhesiveness make it a useful constituent 
of plasters. It is an ingredient of Emplastrum Picis (B. P.). 

AMYL NITRITE. 
AMYLIS NITRIS.— Amyl Nitrite. Dose, 0.2 c.c; 3 TTL- 

Action of Amyl Nitrite. 
External. — Amyl nitrite has no irritating or destructive quali- 
ties, but it causes loss of functional power in tissues with which 
it is brought into contact. When externally applied, therefore, 



AMYL NITRITE. 365 

it temporarily diminishes the activity of the sensory nerves. 

Internal. — When it is taken into the system by inhalation, the 
usual mode of administration, its characteristic effects are pro- 
duced with extraordinary rapidity, and if the dose is small 
they are evanescent. 

Circulation. — Immediately on its inhalation there follow 
marked flushing of the face, pain, heat, and a sense of fullness 
in the head, giddiness, throbbing of the temporal and carotid 
arteries, and a rapid and tumultuous action of the heart. Some- 
times, it is stated, the cardiac disturbance is distinctly manifest 
before the other symptoms. While the area of redness usually 
corresponds with that involved in blushing, it may extend over 
the entire trunk, and the flushing is due to the dilatation of the 
peripheral blood-vessels, both arteries and veins. It is supposed 
that these vessels in the face and neck occupy a somewhat ex- 
ceptional position as regards their innervation and their sus- 
ceptibility to the action of drugs, and as the meningeal vessels 
are also concerned in the dilatation, the various symptoms men- 
tioned are readily accounted for. The vascular dilatation 
spreads from the parts originally affected over the entire body, 
although the vessels of the extremities are involved to a less 
extent than those of the abdominal region. It seems prob- 
able that depression of the vaso-constrictor centre is concerned 
to some extent in the general vascular dilatation, but this has 
never as yet been demonstrated, and is certainly not the main 
cause, since it has been shown positively that amyl nitrite pro- 
duces dilatation by acting on peripheral structures. The seat 
of action of the drug is held to be the unstriated muscle of the 
arteries and veins, and the depression of this tissue and of the 
nerve terminations is now generally considered as the essential 
cause of the dilatation. That there is, however, an early cen- 
tral action, which later is overshadowed by this peripheral in- 
fluence, it is thought may perhaps be indicated by the rapidity 
with which the flushing of the face comes on and disappears. 
In experiments upon animals it has been found that the vascular 
dilatation is followed by a marked decline in blood-pressure, and 



366 PHARMACOLOGY AND THERAPEUTICS. 

in this it is believed that the heart is not concerned. The great 
acceleration of the heart has been mentioned, and in conse- 
quence of this there may at first perhaps be even a rise of blood- 
pressure, the dilatation being more than overcome by the quick- 
ened beat; but as the dilatation extends throughout the body 
the relaxation, particularly in the splanchnic area, soon has the 
effect of producing a profound fall in the blood-pressure. It 
also causes a dicrotic pulse. The tachycardia is generally 
attributed to a depression of the inhibitory (vagus) centre in 
the medulla, though vasomotor paralysis would also produce a 
rapid pulse, and by some it is thought that there is present, in 
addition, a feeble direct action on the heart. Large doses of 
amyl nitrite slow and weaken the cardiac contractions and 
finally arrest them, owing to direct muscular depression; but 
this direct action on the heart muscle, it is found, is produced 
much less readily than that on arterial muscle. While the drug 
has such a marked influence in accelerating the beat, no per- 
ceptible alteration in the force of the latter is caused by it. 

Respiration. — The quickness of the action of amyl nitrite is 
due to the extraordinary rapidity with which it is absorbed, 
especially through the lungs, and its first effects resemble very 
closely an incipient asphyxia. Sometimes, as in the case of 
ether, chloroform and other similar agents, the breath is held 
in the beginning, in consequence of a reflex from the nasal 
mucous membrane. Under the stimulating effect of the drug 
upon the respiratory centre in the medulla the respiration • is 
quickened and deepened, but if the inhalation is maintained 
sufficiently long, this effect is replaced by a depressing one, 
and, in consequence, the respiratory movements are rendered 
more slow and shallow, death eventually occurring from 
asphyxia due to a complete paralysis of the centre. 

Blood. — The immediate cause of the asphyxia is the produc- 
tion of methaemoglobin, a compound which parts with its oxygen 
much less readily than oxyhemoglobin, but which is eventually 
broken up by the tissues. The nitrites, however, unlike most 
other agents which change haemoglobin into methaemoglobin, do 



AMYL NITRITE. 367 

not have the power of causing destruction of the red corpuscles ; 
so that the only action is interference with oxidation. This 
effect is seen in the change of the color of the blood to a dark 
chocolate in animals. In man very little of the methsemoglobin 
formation process usually occurs, and even after the inhalation 
of very large amounts of amyl nitrite such discoloration 
of the blood is said to be scarcely ever observed. 

Kidneys. — The only effect of the drug on the urinary secre- 
tion appears to be one dependent upon its action on the cir- 
culatory system. If, therefore, the renal arterioles are relatively 
more dilated than those of the general circulation, the flow of 
urine will be increased, while if the reverse of this condition 
is present, it will be diminished. Its diuretic influence is never 
very marked, and if large amounts are taken, so that the 
blood-pressure is reduced to a low point, complete anuria may 
result. Sometimes in animals there is persistent glycosuria, and 
it is thought that this may perhaps be due to the partial 
asphyxiation of the tissues resulting from the formation of 
methaemoglobin. Amyl nitrite when given either by the mouth 
or by subcutaneous injection acts much less quickly and power- 
fully than when absorbed by the lungs, and it is stated that 
when administered hypodermatically it generally gives rise 
to glycosuria and slight diuresis. 

Nervous System. — Amyl nitrite is not known to exert any 
influence on the higher cerebral centres. The spinal cord is 
not acted upon in mammals, but is depressed in the frog. Its 
effects on the vagus and respiratory centres in the medulla 
have been mentioned. While, as stated, action upon the vaso- 
motor centre has not been demonstrated, it seems probable that 
the drug does possess such action; which, however, must be 
quite insignificant when compared with its effects on the peri- 
pheral vaso-constrictor mechanism. It acts not only upon the 
muscular coats of the vessels, but also produces slow paralysis 
of muscle of all kinds with which it comes in contact. The 
pain and sense of fullness in the head, as well as the giddiness 
and other symptoms following immediately upon inhalation, 



368 PHARMACOLOGY AND THERAPEUTICS. 

result from the vascular dilatation, in which the cerebral circu- 
lation fully participates, and the headache may persist for a 
considerable time. If large quantities are inhaled, there may 
be unsteadiness of gait and some confusion and restlessness. 
The pupils are dilated and disturbances of vision are apt to 
occur. -Some individuals in looking at a dark object on a white 
background see it surrounded by a yellow circle, outside of 
which there is a blue circle. Convulsions are not infrequently 
observed in animals. They are probably of cerebral origin, 
and, if so, due to direct action upon the nerve cells, and not 
dependent on the circulatory changes. Some authorities, how- 
ever, believe them to be due to anaemia of the brain, while 
others regard them as probably secondary to the asphyxia. 

Therapeutics of Amyl Nitrite. 
Heart and Blood-vessels. — In attacks of angina pectoris amyl 
nitrite is of great service, provided the arterial tension is high. 
When the rise of blood-pressure is due to a nervous contracture 
of the vessels, it is certain to give relief. In many instances 
where valvular disease of the heart is present, as well as in 
those in which there is merely functional disorder, it acts most 
promptly and efficiently. The nitrites are regarded as the most 
powerful pressure depressants known, and the action of amyl 
nitrite in the dyspnoea of cases of cardiac disease may, it is 
thought, be due to its lowering the pressure in the systemic 
arteries and thus relieving the heart. Its beneficial effects would 
not therefore result from any direct action on the heart, but 
from its decreasing the resistance against which the systole 
is performed. Its physiological action in accelerating the pulse- 
rate has led to its recommendation in all forms of sudden heart- 
failure, even when such failure is dependent upon fatty degen- 
eration or other disease of the heart itself. It may be stated, 
however, that in very advanced degeneration of the cardiac 
muscle fibre it is distinctly contra-indicated, since, the blood- 
pressure already being low, any further reduction may induce 
syncope from cerebral anaemia, while the heart may be still fur- 



AMYL NITRITE. 369 

ther weakened by the lessening of its nutrition from lowered 
pressure in the coronary arteries. The use of the drug would 
also seem to be unsafe when advanced degeneration of the 
cerebral vessels exists. It may be employed in all cases in 
which, there being no contraindication to its use present, it is 
desired to reduce the arterial tension. In practice it is found 
that dyspnoeic attacks connected with heart failure from valvu- 
lar disease and other causes are not infrequently relieved by 
it. In spite of the fact that amyl nitrite, if used freely, is ca- 
pable of producing syncope by its depressing influence on the 
heart, it is claimed that in many cases of syncope and collapse, 
depending on a variety of conditions, recovery has attended 
its administration by inhalation. 

It has even been recommended and used in chloroform syn- 
cope, and a considerable number of instances have been re- 
corded in which the patients, it is asserted, were rescued by 
it from impending death. On the other hand, it is the opinion 
of some of the highest authorities on the action of drugs that 
these patients recovered in spite of and not in consequence 01 
its use. It would appear to be strongly contra-indicated, they 
state, in those cases in which it is true that the heart is de- 
pressed, but in which the arterial tension is practically zero; 
and its use is especially irrational if, as has been suggested, the 
failure of the respiration is partly due to anaemia of the central 
nervous system. The reasoning of those who advocate the ex- 
hibition of amyl nitrite is as follows : It is certain that chloro- 
form contracts, and that amyl nitrite dilates, the capillaries of 
the brain and of the skin of the face; under the former the 
patient grows pale, under the latter he is flushed. In experi- 
ments upon animals if the nitrite be used in excessive dose, 
cyanosis arises in consequence of venous engorgement. Experi- 
ments have also shown that if it is given in full doses to an 
animal already narcotized by chloroform, it deepens instead of 
relieving the narcotism, while if it be administered in moderate 
quantities, either by inhalation or hypodermatically, it revives 
the heart's action and removes the pallor caused by the chloro- 
25 



370 PHARMACOLOGY AND THERAPEUTICS. 

form. The salutary or pernicious effects of the nitrite therefore 
being due to the amount of it administered, they regard its 
beneficial action as happily illustrated in the cases referred to. 
In threatened death from chloroform the plan has been adopted 
by some of placing over the patient's face a little lint on which 
amyl nitrite is sprinkled, and at the same time carrying on 
artificial respiration. A small amount of the vapor may no 
doubt be of service in certain cases of syncope and cardiac 
failure where deep inhalations might perhaps be a source of 
danger. In heart-failure from fright, for instance, it has often 
proved of great value in single whiffs, but if it does not afford 
relief at once it is worse than useless to continue it. 

Aside from cardiac affections, it is especially indicated in 
various morbid conditions resulting from vaso-motor spasm, 
and may be employed in all cases in which dilatation of the 
capillaries is likely to prove of service. For relaxing general 
spasm and spasm of either vaso-motor muscular fibres or 
the voluntary or involuntary muscles it is a highly esteemed 
remedy. In tetanus and in strychnine poisoning it is worth 
trying and may prove of distinct value. It should be used 
between the spasms or else administered by subcutaneous in- 
jection, as the respiratory cramp interferes with its absorption 
by inhalation. Good results have been reported from its em- 
ployment in trismus nascentium. In hydrophobia, although 
having no effect in checking the progress of the disease, it 
may prove of service in alleviating suffering and in enabling 
the patient to take food and drink. In persistent hiccough the 
inhalation of amyl nitrite has been known to arrest the spasm 
of the diaphragm after various other measures had failed. 

Considerable attention has been paid to its use in the treat- 
ment of epilepsy. There can be no question of its utility in 
many cases in which the paroxysm is preceded by an aura 
giving the patient warning of its onset. By relieving the vaso- 
motor spasm of the cerebral vessels it often serves to prevent 
the occurrence of the fit if inhaled in time, and consequently 
epileptics who have such a warning of impending seizures 






AMYL NITRITE. 371 

should always be provided with a supply of the nitrite, which 
can be most conveniently used when put up in little glass cap- 
sules known as "pearls," each containing .30 gm. (5 1U), 
which can be readily crushed in the handkerchief. After the 
paroxym has commenced the remedy is hardly likely to be of 
much service, except in those cases which are apparently de- 
pendent on a vaso-motor spasm of the vessels supplying the 
motor areas, and if resorted to should be employed with cau- 
tion, because its early effects will be obscured by the patient's 
condition. In what is known as the status epilepticus, however, 
where there is a series of recurring paroxysms, it has some- 
times been found of great service in putting a stop to the con- 
vulsions. One of the uses of amyl nitrite is as a means of 
diagnosis between true petil mal and cases in which that affec- 
tion is simulated by attacks caused by temporary congestion 
of the nerve-centres. In the latter the nitrite, instead of 
alleviating the condition, intensifies the paroxysm. It should 
be mentioned that certain authorities regard this agent of little 
or no value in spasmodic seizures, such as epilepsy, and state 
that in some cases it even seems to increase the tendency to 
convulsions. Good results have been claimed by some from 
its use in the treatment of puerperal eclampsia, but it should 
never be employed in this disorder when the convulsions con- 
tinue after parturition or come on subsequently to the birth 
of the child, on account of the great danger of its inducing 
haemorrhage by relaxing the uterus. It is also stated to be 
useful for relieving after-pains, but its administration for this 
purpose is contra-indicated for the same reason. In any con- 
vulsive disorder in which the condition is regarded as attribu- 
table to a vaso-motor spasm of the vessels supplying the motor 
areas it would naturally be likely to prove beneficial. In many 
cases of hysterical convulsions, whatever may be the primary 
cause of the nervous trouble, such a state of vaso-motor spasm 
undoubtedly exists, if only a link in the pathological chain, and 
in practice it has not infrequently been found to arrest the 
paroxysms, while not controlling other symptoms. In infantile 



U 2 PHARMACOLOGY AND THERAPEUTICS. 

convulsions it has also sometimes proved of service. Amyl 
nitrite is antagonistic to ergot in its action. It may therefore 
be given to counteract the evil effects of this drug, and its 
inhalation has been known to promptly reduce hour-glass con- 
traction of the uterus caused by the latter. 

It may often be used with advantage in various painful affec- 
tions in which there is a spasmodic element, and among these 
may be mentioned spasmodic dysmenorrhcea, angiospastic hemi- 
crania, and chordee. In those cases of migraine in which there 
is local vasomotor spasm, causing contraction of the capillaries, 
it is a most valuable remedy; but if, instead of a pallid there 
is a flushed countenance, with conjunctival injection, it will 
only aggravate the patient's suffering. As to headache in gen- 
eral, it will sometimes relieve and sometimes increase the pain, 
its beneficial effect or the reverse depending largely on whether 
the arterioles are constricted or dilated. Neuralgia of the fifth 
nerve and other neuralgias are at times relieved and in some 
instances cured by it. If the pain is mitigated or removed by 
it, but subsequently returns, the inhalations should be repeated 
from time to time as required. In that distressing affection 
tinnitus aiirium, which is also often very obstinate, decided 
benefit has been derived from its use in a considerable propor- 
tion of cases. 

In its action of relieving spasm of the muscular system gen- 
erally, as well as of the arterioles, are included the bronchial 
tubes, and hence it has been found a valuable remedy for the 
symptom asthma. In the paroxysms of typical asthma it 
usually, though not always, affords immediate and complete 
relief. What interferes to a considerable extent with its use- 
fulness, however, is the fact that the patient rapidly becomes 
accustomed to its employment, and hence increasing doses are 
necessary when it has to be administered frequently in the 
same case, in order to overcome the diminution in the effects 
resulting from repetition. This naturally applies to other affec- 
tions also. Amyl nitrite may often be used with advantage in 
the treatment of catarrhal spasm or pseudo-croup of children 



AMYL NITRITE. 373 

and of the various forms of laryngismus ; and in some instances 
is of service in Cheyne-Stokes respiration. In whooping-cough 
it is of no value. While it was at one time thought by some 
that it allayed the violence of the cough and shortened the 
paroxysms, the remedy has now been practically abandoned in 
that disease. It is said to have sometimes proved efficacious in 
the vomiting of pregnancy, and there can be little question of 
its beneficial effect in many, though by no means all, cases of 
seasickness. In intermittent fever it will abort the cold stage 
of the paroxysm, but has no influence upon the ensuing hot 
stage. It would seem that the drug might be decidedly valu- 
able in the dangerous algid stage of pernicious malarial fever. 
It has been recommended as an injection, much diluted, in 
chronic cystitis, where the secretion is catarrhal and has a bad 
odor. Fetor from the putrefaction of- other secretions and ex- 
udations, and from gangrene, the decomposition of morbid 
growths, etc., it is said, may also be corrected by solutions of 
amyl nitrite. 

TOXICOLOGY. 

So far as known, only one death has occurred from the use of amyl 
nitrite (in this case a patient suffering from pulmonary tuberculosis 
took a large quantity by inhalation) ; but in a considerable number of 
instances very alarming symptoms have been caused by it, and several 
cases are on record in which very small, and even minute, doses pro- 
duced unconsciousness. 

Treatment. — In case of serious symptoms arising from its use vomit- 
ing may be caused, if necessary, by apomorphine or other emetics. Its 
effects should then be counteracted by the employment of artificial res- 
piration and by the subcutaneous injection of strychnine and digitalis, 
the latter of which has an antagonistic action on the circulatory system. 
Other measures recommended are the exhibition of ammonia by inhala- 
tion, by the mouth, or by intra-venous injection, and the hypodermatic 
use of atropine or ether. At the same time cold water or an ice bag 
may be applied to the head, and a sinapism to the epigastrium. A hot 
mustard foot-bath may also be given, the patient being kept in a re- 
cumbent position. 



374 PHARMACOLOGY AND THERAPEUTICS. 

NITROGLYCERIN. 

SPIRITUS GLYCERYLIS NITRATIS (Spiritus Glonoini, U. S. P., 
1890). — Spirit of Glyceryl Trinitrate. Spirit of Nitroglycerin. (Spirit 
of Glonoin.) Dose, 0.05 C.C.; 1 TT[. 

Action of Nitroglycerin. 
It is at first sweetish to the taste, but afterwards gives an 
impression of aromatic pungency. Its action is practically the 
same as that of amyl nitrite, but its effects on the system are 
produced with less rapidity and last considerably longer. The 
headache caused by it is frontal, and of great severity, and 
often persists for hours after the other effects have disap- 
peared. Nitroglycerin is a nitrate, and similarity of its action 
to that of amyl nitrite and other nitrites is due to the fact that 
it is readily converted into nitrites in the presence of alkalies, 
a change which has been demonstrated to take place in the 
blood. It is thought probable that the action of all the nitrite 
group is due to the effects of nitrous acid. There, appears to 
be a very great difference in the susceptibility of different in- 
dividuals to the influence of nitroglycerin. While in one person 
0.0013 gm. (-^L- grain) may give rise to its full physiological 
effects, it may take twenty-five times that amount to produce 
the same result in another. Very small doses have been known 
to cause unconsciousness and complete disappearance of the 
pulse at the wrist. After toxic quantities there is a marked fail- 
ure of cardiac action. A number of deaths have been reported 
from over-doses of the drug, and in these cases there were 
vomiting and purging, while the immediate cause of the fatal 
result seemed to be failure of the respiration. It may be men- 
tioned that, after gradually increasing the quantity, as much 
as 0.39 gm. (6 grains) of nitroglycerin for a dose has been 
given regularly, not only without any serious consequences, but 
with apparent advantage. 

Therapeutics of Nitroglycerin. 
Its most important use is for the relief of symptoms asso- 
ciated with the high tension pulse of chronic renal degeneration. 



NITROGLYCERIN. 375 

Here the dose should be rapidly increased until relief is ob- 
tained. In general, it is much relied upon in cases of habitual 
high pressure, especially of arterial sclerosis in which the in- 
creased peripheral resistance is developing, or has produced, in- 
creased cardiac power. It is also of service in many of the 
affections in which amyl nitrite is used, and has the advantage 
of being more lasting in its effects. Among these may be 
mentioned asthma, angina pectoris, cardiac failure, seasickness, 
reflex vomiting, gastralgia, hepatic colic, hiccough, laryngismus, 
neuralgia of the fifth nerve, migraine (when the face is not 
flushed from dilated vessels), neuralgic dysmenorrhea, epilepsy, 
and tetanus. In some cases of chorea it is also said to have 
been efficient. In angina pectoris (in which amyl nitrite is 
generally to be preferred if the utmost promptitude is required), 
it will naturally prove of the most benefit in cases characterized 
by high tension of the peripheral vessels. A very happy appli- 
cation of nitroglycerin is in the warding off of anticipated 
attacks of angina. A patient subject to such may take a suffi- 
cient dose of the remedy a few minutes before making any 
exertion which experience has shown is likely to bring on a 
paroxysm, or he may be able to prevent the attacks by using 
minute doses at frequent intervals during the entire day. In 
heart troubles, whether valvular disease is present or not, it 
often affords the most efficient relief, and in all the various 
forms of cardiac dyspnoea it is of the greatest possible service. 
It appears to do good by restoring or approximately restoring, 
at least for a time, the normal relationship between the force 
of the heart's action and the resistance of the vessels, and the 
pulmonary circulation itself is no doubt favorably affected by 
its action. Its beneficial effects are not so much due to any 
direct action on the heart as to its diminishing the resistance 
against which the systole is performed; so that the contraction 
of the ventricle is rendered more complete, and the output of 
the heart increased. It has been noted that the continuous want 
of breath met with in some cases of cardiac failure is less 



376 PHARMACOLOGY AND THERAPEUTICS. 

amenable to such relief than dyspncea which is more paroxysmal 
in character. Nitroglycerin may often be combined very ad- 
vantageously with digitalis in organic disease of the heart, in 
order to neutralize the marked vaso-constriction caused by that 
drug. Digitalis has unquestionably been used far too indis- 
criminately in cardiac affections; but it has been remarked by 
those who have had good opportunities for observation that 
during the past few years, in which the nitrites have been 
commonly used in this way, digitalis has been productive of 
much less harmful results than formerly. Nitroglycerin is, 
then, an efficient and generally safe remedy, and it can be given, 
in sufficient quantity to secure the desired action, for long 
periods without ill effects. In cases of valvular disease in which 
the cardiac muscle is incapable of being stimulated to increased 
force by digitalis (as in fatty degeneration), and in which that 
drug does harm instead of good, it may be used as a last resort, 
effecting relief if not contributing to a cure. 

In the treatment of anaemia, in its ordinary form and in the 
pernicious variety, it has proved a valuable agent. Here the 
assimilative processes are generally so imperfectly performed 
that the food taken cannot be utilized in blood-making, while 
the organs concerned in the latter may be in a pathological con- 
dition, or functionally torpid. To bring about a proper activity 
of the nutrition it is necessary to restore the organs of circula- 
tion and admit the fullest nutrient supply to all the tissues ; and 
this, it is believed, nitroglycerin is of great assistance in accom- 
plishing. It has been recommended in the algid stage of cholera 
and, injected subcutaneously, has been found of service in 
poisoning by illuminating gas. The severe headache which it is 
apt to produce is found in a considerable proportion of cases 
to disappear after repeated employment. 

SODIUM NITRITE. 
SODII NITRIS.— Sodium Nitrite. Dose, 0.065 gm. (65 milligm.) ; 
1 gr. 



NITROGLYCERIN. 377 

Action of Sodium Nitrite. 

External. — Locally applied, sodium nitrite, like amyl nitrite- 
tends to destroy the functional activity of the tissues. 

Internal. — Under the effect of a moderate dose of sodium 
nitrite the heart's action is slightly quickened and the pulse 
tension falls. There may or may not be some feeling of full- 
ness in the head, but not often any throbbing, and there is gen- 
erally no flushing of the face. With larger doses the fall of 
tension is very marked and the same characteristic symptoms 
in general are produced as in the case of amyl nitrite. Some- 
times profuse perspiration and more or less cyanosis are seen, 
and faintness and nausea may occur. In those specially sus- 
ceptible to the influence of the drug partial unconsciousness and 
collapse may result. It appears to have a depressing action 
upon muscular tissue, and in the frog, contrary to the effect 
of amyl nitrite, the muscles are paralyzed before the spinal 
cord. It is both absorbed and eliminated more slowly than 
either amyl nitrite or nitroglycerin, and its effects on the system 
are very much more permanent than those of the former and 
considerably more lasting than those of the latter. One dis- 
advantage connected with its administration is the eructations 
to which it frequently gives rise, in consequence of the fact that 
part of its nitrous acid is liberated by the action of the gastric 
juice before absorption can take place. Some irritation of the 
gastro-intestinal mucous membrane also is liable to be caused 
by the nitric acid formed from it. The greater part of the 
nitrite which is absorbed is excreted as nitrate in the urine, but 
some of it may remain unoxidized. In experiments on small 
animals, such as cats and guinea-pigs, it has been found that 
lethal amounts of sodium nitrite produce general sedation, mus- 
cular paresis, slowing of the heart, fall of arterial tension, 
cyanosis, asphyxia and paralysis, while after death the heart 
and lungs are seen to be gorged with black or chocolate-colored 
blood. 



378 PHARMACOLOGY AND THERAPEUTICS. 

Therapeutics of Sodium Nitrite. 
The action of this agent, though apparently milder and less 
certain in effect, is analogous to that of amyl nitrite and 
nitroglycerin, and it may be employed in the various condi- 
tions in which these drugs are of service. As a mat- 
ter of fact, however, it is much more rarely used in med- 
ical practice than either of them. Wherever an immediate 
and powerful effect is desired they are both to be preferred to 
it, and while its effects may be more lasting, nitroglycerin is 
so extremely easy of administration that its repetition at suffi- 
ciently frequent intervals will prolong its influence to any re- 
quired extent. In some cases, however, it may be found to 
act more satisfactorily than nitroglycerin, and as it is much 
less likely to produce severe headache than the latter, it may 
be advantageously substituted for it in patients in whom the 
headache proves an objection. As sodium nitrite is liable to be 
decomposed by the gastric acids, it has been recommended that 
it should be given in an alkaline solution. 

SPIRIT OF NITROUS ETHER. 

SPIRITUS ^GTHERIS NITROSL— Spirit of Nitrous Ether. 
(Sweet Spirit of Nitre.) Dose, 2 c.c; 30 TTt- 

Action of Spirit of Nitrous Ether. 

External. — When applied to the cutaneous surface it quickly 
evaporates, giving rise to a slightly anaesthetic effect. 

Internal. — Spirit of nitrous ether, although it has long been 
extremely popular as a diaphoretic and a diuretic, has been 
found to have in reality little action upon either the skin or 
the kidneys, while it is inefficient in the reduction of tempera- 
ture. Its principal value is as a carminative and diffusible 
stimulant. It also has some antispasmodic influence, and acts 
as a mild sedative to the nervous and circulatory systems. Its 
physiological action as a nitrite is but feeble as compared with 
that of amyl nitrite, sodium nitrite, or nitroglycerin, its effects 
in this respect being overcome or modified by the alcohol enter- 



ERYTHROL TETRANITRATE. 379 

ing into its composition. In the case of a child of three years 
who died from taking 120 c.c. (4 ounces) of the spirit, the 
symptoms were those of alcoholic poisoning, with the addition 
of vomiting and purging. It should not be kept too long, as it 
is liable to turn acid after a time. 

Therapeutics of Spirit of Nitrous Ether. 
This time-honored remedy, so long and universally given as 
a diuretic, diaphoretic and antipyretic, no longer enjoys the 
vogue that it formerly held. It has, however, a limited sphere 
of usefulness. It may be given with good effect to children, 
particularly, suffering from feverishness with nervous symp- 
toms or mental excitement. Here it often has a pleasantly 
calmative influence, quieting the restlessness and promoting 
sleep. On account of its stimulating qualities it is especially 
serviceable in adynamic conditions. It is a grateful stomachic 
and carminative, and is useful, especially when associated with 
aromatic spirit of ammonia, in allaying nausea and causing the 
expulsion of flatus. In asthma and bronchitis it may be of 
assistance in relieving spasm and increasing the secretions of 
the mucous membrane, and it is frequently employed as a con- 
stituent in expectorant mixtures. It is also used to some ex- 
tent in combination with diuretics. Externally, it sometimes 
proves a soothing application to the forehead in neuralgic head- 
ache. 

ERYTHROL TETRANITRATE. 

ERYTHROL NITRAS.— Erythrol Nitrate, not official. (Erythrol 
Tetranitrate. Tetranitrole.) Dose, .03 to .06 gm.; y 2 to 1 gr. 

Action of Erythrol Tetranitrate. 
Like nitroglycerin, this is a dangerous explosive, and at 
least one fatal accident has occurred from its trituration in a 
mortar (with glucose). It has the same general action as the 
nitrites, causing dilatation of the vessels and a marked fall in 
blood-pressure, together with the formation of methsemoglobin. 
In the case of this drug and mannitol hexanitrate the charac- 






380 PHARMACOLOGY AND THERAPEUTICS. 

teristic effects on the system are produced more slowly and 
gradually, and last for a longer time, than under the influence 
of any others of the group. Its alcoholic solution is explosive, 
and it is therefore recommended that it should always be used 
in tablet form. 

. Therapeutics of Erythrol Tetranitrate. 
It is highly recommended in the treatment of angina pectoris, 
although, like other members of the nitrite series, it sometimes 
fails to give relief. It is often of special value, however, in 
warding off attacks of angina, for, while its influence is not 
exerted for half an hour or longer after ingestion, it is capa- 
ble of preventing the attacks for four or five hours. Some 
authorities, indeed, advise that the remedy should be used for 
this purpose solely; but this is a great mistake, as it has proved 
of very marked service in other conditions also. It is considered 
by many to be the best of the series for the relief of some of 
the symptoms of Bright's disease, and in cardiac affections, 
whether associated with renal trouble or not, it can often be 
relied upon with great confidence. This drug, it can scarcely 
be doubted, has not as yet been as generally employed as its 
merits deserve, and there can be little question that for con- 
stant use erythrol tetranitrate, properly administered; is superior 
to the more evanescent nitroglycerin and the somewhat uncer- 
tain sodium nitrite. It has been recently recommended in lead- 
poisoning with high arterial tension. 

2. Vaso-constrictors. 

SUPRARENAL GLAND. 

GLANDULE SUPRARENALES SICOE.— Desiccated Suprarenal 
Glands. (Suprarenal Extract.) Dose, 0.250 gm. (250 milligm.) ; 
4 gr. 

Suprarenal Gland is a vaso-constrictor of the first importance, 
but will be considered in association with the other Organic 
Extracts, in Division XIII. 



BARIUM SALTS. 38 I 

BARIUM SALTS. 

Unofficial Preparations. 

1. Barii Dioxidum (U. S. P., 1890).— Barium Dioxide. 
(Barium Peroxide.) 

2. Barii Sulphidum. — Barium Sulphide. 

3. Barii Chloridum.— Barium Chloride. Dose, .006 to .03 
gin.; tV to y 2 gr- 

Action of Barium Salts. 
By its local action in the alimentary canal barium causes 
gastro-enteritis and some degree of corrosion. It is absorbed 
to a considerable extent, and the most conspicuous of its sys- 
temic effects are on the circulation. Barium chloride causes 
the cardiac contractions to become slower and more forcible, 
acting like digitalis. The blood-vessels are constricted, and 
the blood pressure rises. The increased tension caused by it 
may be due in part to the action on the heart, but is chiefly 
attributable to a very marked contraction of the muscular walls 
of the vessels. The plain muscular fibres of the intestine may 
be excited, and the peristalsis is increased. In these respects 
it resembles ergot, as well as digitalis. It acts like veratrine 
when applied locally to voluntary muscles, prolonging the con- 
traction; but this effect is done away with by the application 
of potassium salts. In warm-blooded animals barium salts, 
injected intravenously, by stimulating the spinal cord and 
medulla oblongata, induce violent tonic and clonic spasms. By 
sufficient quantities the central nervous system is finally para- 
lyzed. Barium is excreted in the urine and probably in the 
faeces. When given in very dilute solutions the amount absorbed 
is small, and it is then deposited in the bones. 

Therapeutics of Barium Salts. 

These are not often given, but the chloride has been used 

for mitral insufficiency accompanied by irregularity of the heart, 

for haemorrhage, and as a stimulant in atony of the bladder or 

intestine. Formerly it was given in nervous diseases. The 



382 PHARMACOLOGY AND THERAPEUTICS. 

waters of Llangammarch wells contain .40 gm. (6.7 gr.) to 
4545 c.c. (Imperial gallon) of barium chloride, and have been 
used in cardiac cases. The sulphide has been used as a de- 
pilatory. 

TOXICOLOGY. 

Symptoms. — Poisonous doses cause salivation, thirst, vomiting, purg- 
ing, difficulty of breathing, a slow pulse, and, from the action on the 
spinal cord, paralysis of the limbs. The heart is arrested in systole. 

Treatment. — Poisoning should be treated by non-irritant emetics and 
draughts of weak solution of sodium or magnesium sulphate, followed 
by albuminous drinks, and diffusible stimulants. 

TANNIC ACID. 

QUERCUS.— White Oak. Dose, 1 gm.; 15 gr. 

Preparation. 
Fluidextractum Quercus. — Fluidextract of Quercus. Dose, 1 
c.c; 15 TTL- 

GALLA. — Nutgall. Dose, 0.500 gm. (500 milligm.) ; iy 2 gr. 

Preparations. 

1. Tinctura Gallae. — Tincture of Nutgall. Dose, 4 c.c; 1 
fl. dr. 

2. Unguentum Gallae. — Nutgall Ointment. 

ACIDUM TANNICUM.— Tannic Acid. (Tannin.) Dose, 0.500 
gm. (500 milligm.) ; 7y 2 gr. 

Preparations. 

1. Collodium Stypticum. — Styptic Collodion. 

2. Glyceritum Acidi Tannici. — Glycerite of Tannic Acid. 
Dose, 2 c.c; 30 irt. 

3. Unguentum Acidi Tannici. — Ointment of Tannic Acid. 

4. Trochisci Acidi Tannici. — Troches of Tannic Acid. 

Unofficial Preparations. 

Iodo-tanninum. — Iodo-tannin. 

Tannalbinum. — Tannalbin. Dose, .30 gm.; 5 gr. 

Tannigenum.— Tannigen. Dose, .30 to 2 gm.; 5 to 30 gr. 



TAXXIC ACID. 383 

Action of Tannic Acid. 

External. — Locally, tannic acid is an astringent and haemo- 
static, and its characteristic effect is the precipitation of albu- 
mins and other proteids, as well as gelatin and many alkaloids 
and glucosides. The precipitate thus formed is dense and re- 
sists putrefaction. This action occurs when the acid is applied 
to animal tissue, as in the tanning of leather, and the result is 
that the hide becomes harder, tougher, and somewhat shrunken, 
but retains its flexibility. Tannic acid is very slightly irritant, 
but this effect is more than counterbalanced by its astringent 
action. It apparently has no action on the unbroken skin, but 
on mucous membrane it has the effect of causing more or less 
coagulation in the cells, by direct action on the cells themselves; 
precipitating the albumin of the secretions (which it dimin- 
ishes), and forming a layer of albumin tannate which is pro- 
tective and antiseptic. Applied to a bleeding surface, it thus 
has a haemostatic action, coagulating the effused blood and 
plugging the vessels with clots, and still further tending to 
check haemorrhage by the constriction of the vessels caused by 
the contraction of the coagulum formed within the tissues. 

Internal. — Its taste is bitter, and in the mouth it produces a 
feeling of dryness, stiffness, and puckering. Very soon the 
sense of taste is partially lost, and the movements of the tongue 
are somewhat interfered with in consequence of the coagulation 
of the superficial layers of proteids both within and without 
the epithelium. This causes a roughness of the surface of the 
mucous membrane, so that the tongue cannot glide over it easily, 
as in the normal condition. In the throat the same feeling of 
astringency is experiencecd. Nausea and vomiting may some- 
times be caused by the drug, but this is not very often the case. 
In the intestines it diminishes the mucous and other glandular 
secretions, so that constipation results, and the faeces become 
dry, hard and scanty. The increased consistency of the stools 
is thought to be due to the layer of coagulated proteid acting 
as a protective to the bowel, lessening its irritability, and thus 
retarding its movements; so that there is longer time for the 



384 PHARMACOLOGY AND THERAPEUTICS. 

absorption of the fluid part of its contents. In the stomach 
tannic acid is found to combine with and precipitate any pro- 
teid substance with which it comes in contact, but, as digestion 
proceeds, such combination is broken up, the peptones not com- 
bining with this agent in acid solution ; and the astringent action 
is therefore exercised on the walls of the stomach and intes- 
tines. When given in large amount, however, it sometimes 
causes gastro-intestinal irritation and diarrhoea. Only about 
one per cent, of the tannic acid swallowed reappears in the ex- 
cretions, either as tannic or gallic acid; the rest would seem to 
undergo complete oxidation in the tissues. A small proportion 
is occasionally eliminated by the bowel unchanged, but the 
greater part is converted into gallic acid, some of which often 
passes out both in the stools and the urine. No evidence of 
any weight has been educed that tannic acid exerts any in- 
fluence after it has been absorbed. It does not exist in the 
tissues as such, but only in the form of traces of sodium 
gallate or tannate, too small to have any astringent effect; and 
it would appear, therefore, that its action is in fact limited to 
the point of application. As to its effects on blood-vessels, the 
most recent experiments show that solutions of less strength 
than y 2 per cent, cause constriction of the mesenteric vessels 
of the frog or rabbit when applied directly, while more con- 
centrated solutions occasion transient constriction, followed by 
dilatation. When it is injected intravenously, the precipitate 
produced is found to lead to the formation of emboli. 

Tannic acid is the chief principle of all the vegetable astring- 
ents. The tannic acid present is not always the same chemical 
body, but the various acids, such as catechutannic, kinotannic, 
etc., all have in common the power of precipitating albumins 
and other properties characteristic of pure tannin. The dif- 
ferences in the intensity of their effects is explained by the facts 
that some are more energetic precipitators of albumin than 
others, and that many of the drugs contain gum, resin and 
other matters which affect the solubility of the tannins. 



TANNIC ACID. 385 

Therapeutics of Tannic Acid. 

External. — Tannic acid is a very useful remedy, and its appli- 
cations are quite extensive both in surgery and medicine. It is 
employed to control bleeding in various parts of the body, and 
it may, if practicable, be dusted on the part, or be applied in 
the form of the glycerite or of styptic collodion. The latter 
is of special service in uniting incised wounds and protecting 
lacerated wounds. When applied on wounded or abraded sur- 
faces it checks the oozing and forms a firm coating in which 
the coagulated blood and secretions participate, and which ex- 
cludes the air from the part. In order to produce special effects 
on the diseased surface various agents, such as phenol, io- 
dine, or morphine, may be incorporated in the preparation, 
as desired, and carbolized styptic colloid, in which advantage is 
taken of the antiseptic and styptic properties of carbolic acid, 
is a very efficient haemostatic. It is prepared by adding ten 
per cent, of phenol to the official styptic collodion. 

Aside from its astringent and haemostatic effects, tannin is of 
value locally for removing fetor and for preventing or checking 
putrefactive changes in the tissues. Among the conditions in 
which its application in various forms is useful may be men- 
tioned aphthous ulceration of the mouth, spongy gums, mer- 
curial salivation, relaxation of the uvula, pharyngitis, nasal 
catarrh, otorrhoea, laryngitis, chronic inflammations of the 
conjunctiva, leucorrhcea, urethritis, cystitis, haemorrhoids, 
burns, chilblains, ulcers and other sores, and moist cutaneous 
eruptions. For local use the glycerite is probably the most 
generally satisfactory preparation of tannic acid, and the 
official strength may be readily altered to suit special condi- 
tions. A very concentrated solution, two parts of glycerin to 
one of tannin, may be made by the aid of moderate heat. 
This will be found very useful to prevent sore nipples if applied 
daily during the later months of pregnancy. The glycerite, in 
the strength of one part to eight of water, makes an excellent 
gargle. For pharyngitis and tonsillitis the troches are con- 
venient, and a spray (1 to 2 in 100 of water) or an insufflation 
26 



386 PHARMACOLOGY AND THERAPEUTICS. 

of tannic acid and starch may be used for the larynx, as well 
as the fauces. A powder made with one part of tannin to 30 
parts of orris — or marshmallow — root has been employed as a 
snuff to arrest acute coryza in its forming stage, and an oint- 
ment containing .06 gm. (1 gr.) of tannin and 8 gm. (2 dr.) of 
simple ointment has been applied to the nostrils, on a roll of 
soft linen or paper, for the same purpose in infants. In chronic 
nasal catarrh powdered tannin is sometimes used by insufflation, 
and in the treatment of nasal polypi a 10 per cent, solution in 
water has been employed. In ozaena and other affections at- 
tended with fetor tannin-wool (made by soaking cotton-wool in 
water, at 6o° C. ; 140 F., saturated with tannic acid, and 
drying the wool), has been found of service. The ointment 
of nutgall and opium (1 to 14 of nutgall ointment) is a favorite 
application for piles. In affections of the rectum tannic acid 
is recommended in the form of a suppository containing .20 gm. 
(3 &**•)> an d in those of the uterus in the form of a pencil 
about an inch in length, made with 4 parts of the acid to 1 of 
tragacanth. The glycerite, as well as iodoform-tannin, is re- 
garded as an excellent application for catarrhal inflammation 
of the cervix uteri, and even in cancer of the uterus is efficient 
in moderating the discharge and allaying odor. The benefit 
from it may be increased by combining with it the glycerite 
of phenol. Solutions (1 to 50) in water may be injected 
into the bladder for cystitis and into the urethra in the treat- 
ment of subacute gonorrhoea and gleet. Gonorrhoea has also 
been treated by filling the urethra once or twice daily with 
a powder consisting of equal parts of tannic acid, iodoform 
and thalline sulphate, introduced through a metal tube. In 
women a watery solution may be used as a vaginal injection, 
or the vagina may be packed with gauze covered with tannin. 
The decoction of oak bark, employed as a high rectal injection, 
destroys the thread-worm. A preparation of nutgall dissolved 
in glycerin was formerly used as an injection into hernial sacs 
(Heaton's method). The temporary results were excellent, but 
sooner or later failures occurred in a large percentage of cases. 



TANNIC ACID. 387 

A solution of tannic acid in tincture of benzoin (1 to 4) is said 
to tend to repress the development of the pustules of small-pox. 
A tannic acid lotion or ointment is sometimes of service in 
such skin affections as herpes, intertrigo, and weeping eczema, 
checking the discharge and allaying itching and irritation. 
Made into a pomade, it has been found of benefit in dandruff, 
and it is also useful in alopecia circumscripta. Introduced into 
a carious cavity, it not infrequently relieves toothache. A con- 
centrated solution is an excellent palliative remedy in ingrown 
toe-nail, especially when there are fungous growths, and is 
useful also for hardening tender feet. Ulcers of the rectum and 
anus and fissures of the anus are sometimes effectively treated 
by the application of the powder of tannin, tannin and iodoform, 
or iodo-tannin (solution of iodine in tannic acid). 

In acute dysentery good results have been obtained by the 
use of hot enemata consisting of a 4 per cent, solution of boric 
acid in which 0.60 gm. (10 gr.) of tannin is dissolved, with the 
addition of a few drops of laudanum. In the early stage of 
cholera, also, tannic acid enemata, carried beyond the ileo-csecal 
valve, have proved of service; the injections being composed 
of 6 to 20 gm. (i T / 2 to 5 dr.) of tannic acid dissolved in 2 litres 
(4 pints) of water, with the addition of 2 c.c. (30 Til) f 
laudanum and 45 gm. (iy 2 oz.) of powdered gum arabic. 

Internal. — As an internal remedy pure tannic acid is of little 
value. It is often prescribed in internal haemorrhages such as 
haemoptysis, metrorrhagia and haematuria, but it is doubtful 
whether, except in those of the gastro-intestinal tract, where, 
if given in sufficient quantity, there may be some opportunity for 
it to exert its local action, it really does any good in these con- 
ditions. Even for haemorrhage from the stomach or intestine 
other remedies are to be preferred. If employed in haemop- 
tysis, an atomized solution will afford the best chance of suc- 
cess. In excessive sweating, bronchorrhoea and leucorrhcea its 
internal administration has no effect in diminishing the dis- 
charge. In certain forms of diarrhoea its astringent action is 
of considerable value, and it may prove useful in checking the 



388 PHARMACOLOGY AND THERAPEUTICS. 

looseness of the bowels sometimes caused by such remedies as 
codliver oil. In these cases, however, the pure drug is seldom 
used, as it is liable to derange the stomach and to form com- 
pounds with the albumins before it reaches the intestine, and 
such agents as kino, gambir, and krameria, which owe their 
astringent qualities to tannic acid, are generally selected in 
the treatment. Remedies of this kind, whose activity depends 
on their containing tannic acid, differ from the pure drug in 
that the acid is only slowly dissolved out from the colloid mass, 
and therefore acts less on the stomach and affects a greater 
length of intestine. In chronic albuminuria the acid, in various 
forms, has been recommended for the purpose of checking the 
drain of albumin from the blood; but opinion is very divided 
as regards its efficacy, and it would seem altogether probable 
that it has no effect either in lessening the albumin in the urine 
or preventing its increase. As a temporary expedient in cases of 
poisoning with metallic compounds, such as tartar emetic, and 
with alkaloids, the exhibition of tannic acid may serve a useful 
purpose ; but it should always be followed by the prompt empty- 
ing of the stomach, as otherwise the tannate formed becomes 
gradually dissolved in the fluids of the alimentary canal. Cer- 
tain individuals, it has been found, are peculiarly susceptible 
to the action of tannic acid, which in such cases produces local 
irritation, and even inflammation, wherever it is applied. This 
remedy should never be used hypodermatically. 

Tannalbin (not official) is a tannin albuminate which has 
been subjected to a dry heat of 230°-248° F. (uo°-i20° C.) 
for several hours. It is a faintly yellow, tasteless powder con- 
taining about 50 per cent, of tannic acid. Laboratory experi- 
ments have shown that it is not easily decomposed by an arti- 
ficial gastric juice, but it is rapidly separated into its constituents 
in an alkaline medium or by an artificial solution of the pan- 
creatic ferments. This preparation accordingly passes through 
the stomach unchanged, and may not be broken up until it has 
got well down into the intestine. Tannalbin is preferably 
given in wafers at frequent intervals. It has been used with 



GALLIC ACID. 389 

considerable success in chronic diarrhoeas, even in cases in 
which intestinal ulceration was present. It has also been highly 
commended in gastric catarrh, and is said to have been found 
useful in diminishing the amount of albumin in chronic albumi- 
nuria. 

Tannigen (not official), the acetic acid ester of tannic acid, 
is prepared by the action of glacial acetic acid on tannic acid. It 
is a tasteless, odorless powder, insoluble in water, and is be- 
lieved to pass unchanged through the stomach and to be slowly 
decomposed in the intestines, thus exerting an astringent effect 
in them. This preparation also is usually prescribed in wafers. 
It has been used to a considerable extent in the diar- 
rhoeas of children, in whom its tastelessness renders its ad- 
ministration very advantageous, and it has proved especially 
serviceable in entero-colitis. In chronic intestinal troubles it 
is said to have been found less successful than in acute. Some 
observers, however, recommend it in chronic cases, and espe- 
cially in the diarrhoea of phthisis. It does not disturb the diges- 
tion, and has proved efficient in the treatment of gastric catarrh 
with excessive secretion of mucus. Locally applied, it appears 
to act well in catarrhal affections of the mucous membrane, and 
the powder may be used by insufflation in chronic rhinitis and 
laryngitis. 

GALLIC ACID. 

1. ACIDUM GALLICUM.— Gallic Acid. Dose, 1 gm.; 15 gr. 

2. PYROGALLOL.— Pyrogallol. 

Unofficial Preparations. 
Gallacetophenonum. — Gallacetophenone. 
Lenigallol.— Lenigallol. (Pyrogallol Triacetate.) 

Action of Gallic Acid. 

Gallic acid, given by the mouth, is absorbed, and, as has been 

stated, is excreted to some extent by the kidneys; but much 

of it disappears in the tissues, apparently by oxidation. It does 

not, like tannic acid, precipitate proteids, and has therefore no 



390 PHARMACOLOGY AND THERAPEUTICS. 

local styptic or astringent effect. It can be taken in very large 
quantity without producing any symptoms, its action being 
simply that of a weak organic acid. 

Therapeutics of Gallic Acid. 
It has been employed to a very considerable extent to pro- 
duce the supposed remote astringent effects of tannic acid, 
which, as has been seen, becomes largely converted into it in 
the body. Thus, it has been commonly given in the treatment 
of haemorrhage of all kinds and to some extent also in albumi- 
nuria. With our present knowledge, however, it seems prob- 
able that it has little, if any, therapeutic value. At the same 
time, it should be stated that it is still maintained by some clini- 
cians of repute that it should be prescribed when astringent 
effects on the tissues elsewhere than the intestinal canal are 
desired, and that in the treatment of renal haemorrhage it is more 
uniformly successful than any other remedy. It is also claimed 
that it is very serviceable in pyelitis, pyelo-nephritis, and catarrh 
of the bladder, as well as in chronic bronchial catarrh when 
the latter is the sequel of acute bronchitis or the result of the 
irritation extending from disease of the parenchyma of the 
lung, or when it is produced by mitral or tricuspid regurgita- 
tion. Others hold that, combined with opium, it is one of the 
best remedies in diabetes insipidus, and is even useful in dia- 
betes mellitus; but it is probably the fact that whatever benefit 
may be found in these cases is due entirely to the effect of the 
opium. It is also stated to have proved efficient in pyrosis, 
which is an annoying symptom of various dyspeptic conditions. 

Action of Pyrogallol. 
In its effects on the system, as well as chemically, pyrogallol 
is more nearly related to phenol than to gallic acid. When 
administered in large quantities to animals it gives rise to ner- 
vous symptoms analogous to those caused by carbolic acid, but 
in man, even in poisonous doses, it does not produce these ner- 
vous symptoms, or at all events to a very small extent; while 



GALLIC ACID. 39 1 

the other phenomena are similar to those observed in animals 
when smaller quantities are exhibited. The poison acts not so 
much directly on the central nervous system as upon the blood 
and, secondarily, upon the kidneys. The red corpuscles become 
shrunken and angular, and the greater part of their haemo- 
globin, escaping into the plasma, is converted into methsemo- 
globin, so that marked dyspnoea is likely to result. The color 
of the blood is changed to a brownish-red, in consequence of 
which the skin and mucous membranes become discolored, and 
if the toxic effect is not too acute, icterus follows, and both 
haemoglobin and methaemoglobin are excreted in the urine. It 
is not known whether the methaemoglobin is a direct result of 
the reduction of the haemoglobin by the pyrogallic acid, or 
whether this action is accompanied by a secondary oxidation. 
In the kidney the poison sets up an inflammatory process, which 
is indicated by the presence in the urine of albumin, epithelium, 
casts and the products of blood-decomposition, and which may 
lead to the production of uraemic convulsions. Pyrogallol is 
excreted in the urine partly as an ethereal combination with 
sulphuric acid and partly as unknown oxidized products, which 
give the secretion a dark brown or black color. When the re- 
sult is fatal, death appears to be due to the changes in the blood 
and nephritis resulting therefrom, rather than to any direct ef- 
fects of the drug on the central nervous system. In dogs poi- 
soned by it, it is said, hepatic lesions are produced identical with 
those caused by phosphorus. Poisoning, it has been shown by 
experiment, may readily take place by cutaneous absorption. 
The mineral acids act as antidotes to its effects. Pyrogallol 
precipitates albumin, and has a deep and strong local irritant 
action. In a 1 or 2 per cent, solution it is decidedly antiseptic. 
When it is applied in solution or ointment, it stains the skin, 
but not permanently; linen and clothing are, however, perma- 
nently darkened. To avoid the staining it has been proposed 
to dissolve the remedy in flexible collodion, 1 or 2 to 24. Its 
incautious application may cause inflammation of the skin, 
which may result in extensive ulceration and sloughing. A 



392 PHARMACOLOGY AND THERAPEUTICS. 

German dermatologist has recently stated that pyrogallol is 
a benzin with three hydroxyl groups, each of which may be 
replaced by acid radicals. Lenigallol, or pyrogallol triacetate, 
he describes as a mild preparation (ointments containing even 
50 per cent, causing no irritation when applied under a band- 
age), which is decomposed by the strongly alkaline perspira- 
tion, producing the characteristic darkening of pyrogallol, to- 
gether with its remedial action in cutaneous affections. 

Therapeutics of Pyrogallol. 
It is rarely given internally, and is almost exclusively used 
in the local treatment of various diseases of the skin. It should 
not be applied over too large a surface, on account of the 
danger of absorption, and fatal cases have occurred from the 
free use of an ointment on extensive cutaneous lesions. Con- 
sequently, chrysarobin, and also gallacetophenone, a derivative 
of pyrogallol, have been recommended and more or less ex- 
tensively employed as substitutes for it. If experience should 
confirm the efficacy of lenigallol, it might likewise be used with 
advantage in many instances in place of it. The curative effect 
of pyrogallol in skin affections is usually attributed to its irri- 
tant and antiseptic properties, but is referred by some to its 
reducing action. It undoubtedly has very considerable ger- 
micidal power. It may be employed either in the form of 
an ointment, or dissolved in flexible collodion or alcohol with 
the addition of a little glycerin. Jarisch's ointment (1 to 8) 
is entirely too strong for ordinary use; 1 or 2 parts (or even 
less) of pyrogallic acid to 48 of lard or lanolin will generally 
be found more satisfactory. Psoriasis, pityriasis versicolor, 
ringworm, ulcer, sloughing phagedena, and syphilitic lesions 
of the integument are among the affections in which it has 
proved of value. It has also sometimes been used with good 
effect in such serious diseases as lupus, leprosy and epithelioma. 
Before pyrogallol is employed vaseline should generally be thor- 
oughly applied, and wiped off, to remove scales and other 
morbid products. In some conditions it is recommended that 



GAMBIR. 393 

the remedy should be mixed with a powder, such as kaolin or 
starch, and dusted over the affected part. 

Occasionally it has been given internally, in frequently re- 
peated doses of .06 gm. (1 gr.), as a haemostatic in menor- 
rhagia, haemoptysis and haematemesis, but this practice has 
never received general favor, and more evidence is needed of 
its efficacy. 

GAMBIR. 

GAMBIR.— Gambir. (Replacing Catechu, U. S. P., 1890.) Dose, 1 
gm.; 15 gr. 

Preparations. 

1. Tinctura Gambir Composita. — Compound Tincture of 
Gambir. Dose, 4 c.c; 1 fl. dr. 

2. Trochisci Gambir. — Troches of Gambir. 

Action of Gambir. 
Gambir is a powerful astringent. It owes its astringent 
property to the tannic acid entering into its composition, and 
aside from this has no special action. 

Therapeutics of Gambir. 
The compound tincture is a favorite remedy in diarrhoea 
arising from various causes. If there is any source of irrita- 
tion in the intestinal tract, or if a considerable quantity of 
mucus in the discharges indicates a catarrhal condition of the 
bowel, its administration should be preceded by a purge, such 
as castor oil or magnesium sulphate. In the case of children 
it is often given in combination with paregoric and chalk mix- 
ture. It may be used to check internal haemorrhages, like 
haemoptysis and haematuria, and also in albuminuria, but is not 
reliable for these purposes. Locally it has a number of useful 
applications. In relaxation of the soft palate and uvula and 
in simple pharyngitis it may be employed in troches or in the 
form of a gargle. It is also used as a mouth-wash for spongy 
gums and as an ingredient of dentifrices. An infusion of gam- 
bir, thrown up the nostrils, will frequently arrest epistaxis. It 



394 PHARMACOLOGY AND THERAPEUTICS. 

is serviceable likewise in gonorrhoea and leucorrhcea and in 
relaxed conditions of the vagina. 

KRAMERIA. 
KRAMERIA. — Krameria. (Rhatany.) Dose, 1 gm.; 15 gr. 
Preparations. 

1. Extractum Krameriae. — Extract of Krameria. Dose, 0.500 
gm. (500 milligm.) ; 7y 2 gr- 

2. Fluidextractum Krameriae. — Fluidextract of Krameria. 
Dose, 1 c.c.; 15 rrt- 

3. Tinctura Krameriae. — Tincture of Krameria. Dose, 4 
c.c; 1 fl. dr. 

4. Trochisci Krameriae. — Troches of Krameria. 

5. Syrupus Krameriae. — Syrup of Krameria. Dose, 4 c.c; 
1 fl. dr. 

Action of Krameria. 
Krameria, like gambir, is a powerful astringent, and its 
action also is due to the tannic acid it contains. In small doses 
it is slightly tonic. 

Therapeutics of Krameria. 
It is used in the same class of cases as gambir, and, in addi- 
tion, sometimes as a stomachic and tonic. The fluidextract is 
especially valuable in diarrhoea, and may also be used in gastric 
and intestinal haemorrhage. In incontinence of urine from de- 
bility of the urinary organs it has been thought to be of benefit. 
Bleeding from the nose, the rectum, and other accessible parts 
may be stopped by locally applying the drug in powder or in 
infusion. The infusion (B. P., I to 20), as a gargle, and the 
troches are very efficient in relaxed conditions of the throat. 
The B. P. has a troche containing .06 gm. (1 gr.) of the 
extract and .003 gm. (^ gr.) of cocaine hydrochloride, with 
a fruit basis. Locally krameria is used with good effect 
in dysentery (by injection), and has enjoyed considerable repu- 
tation as a remedy for fissure of the anus. In the latter con- 






kino. 395 

dition it is believed, by constringing its walls, to prevent the 
formation in the rectum of large faecal masses, which would 
tend to stretch the fissure and render defecation more painful, 
and also to promote the healing of the lesion by diminishing the 
supply of blood to the part. In order to keep the bowels from 
becoming confined it is recommended that powdered belladonna 
root, in doses of .06 gm. (1 gr.), or less, be given at night. In 
fissured nipples a mixture of the extract with white of egg 
may be employed. In non-syphilitic ozsena an infusion of 
krameria, especially in association with chlorinated soda or cal- 
cium chloride, is sometimes of service as a nasal douche. Other 
conditions in which the drug may be used locally with advan- 
tage are sponginess of the gums, leucorrhcea, gonorrhoea and 
gleet. 

KINO. 

KINO.— Kino. Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. 

Preparation. 
Tinctura Kino. — Tincture of Kino. Dose, 4 c.c; 1 fl. dr. 

Action of Kino. 
Kino is another powerful astringent. Kinotannic acid has the 
same effects as tannic acid, and the action of the drug is almost 
identical with that of gambir. 

Therapeutics of Kino. 
The compound powder (B. P., kino, 75; opium, 5; cinnamon, 
20) is used especially for gastro-intestinal disorders attended 
with diarrhoea. In diarrhoea kino, gambir, krameria and others 
of the vegetable astringents act more efficiently than pure tannic 
acid, for the reason, as has been stated, that the latter is apt 
to form compounds with the albumins and exerts its astringent 
influence on a smaller portion of the intestinal tract. The 
tincture of kino is considered one of the most efficient means 
of combating the atonic diarrhoea resulting from the disuse of 
opium or morphine. Owing to the tendency of its gummy 



396 PHARMACOLOGY AND THERAPEUTICS. 

matter to coagulate, it is less eligible than gambir for use 
in connection with chalk mixture. It is often serviceable 
in relieving pyrosis. Locally kino has not, as a rule, been 
found as efficient as a haemostatic as tannic acid, but the in- 
fusion often acts promptly in checking epistaxis. The tincture 
is sometimes applied as a stimulant dressing to indolent ulcers, 
and is also employed in astringent gargles and in mixtures for 
injection in gonorrhoea. 

LOGWOOD. 
ILffiMATOXYLON.— Haematoxylon. (Logwood.) 

Preparation. 
Extractum Haematoxyli. — Extract of Haematoxylon. Dose, 
1 gm.; 15 gr. 

Action of Logwood. 
Haematoxylon is astringent and tonic. When chewed it 
colors the saliva a deep pink. It is unirritating, and does not 
cause constipation. It colors the urine and stools red, and also 
stains linen with which it comes in contact. It has been known, 
it is said, to give rise to phlebitis, and in very large doses is 
capable of producing fatal gastro-enteritis in animals. It is 
very feebly antiseptic. 

Therapeutics of Logwood. 
In the treatment of diarrhoea it may be combined with other 
astringents, with chalk, and with opium to check peristalsis. 
On account of its being pleasant to take and devoid of irritating 
qualities, it was formerly employed to a considerable extent in 
children's diarrhoeas; but its liability to stain the clothing ren- 
dered it objectionable, and of late it has been but little used, 
especially since the general adoption of dietetic and antiseptic 
methods in these affections. It is considered of decided value, 
however, in tuberculous diarrhoea and diarrhoeas of relaxation. 
The following formula, the proportions of which may be varied 
to suit individual cases, will often be found efficient, as well 



WITCHHAZEL. 397 

as agreeable to the patient: Extract of haematoxylon, 8 gm. 
(2 dr.) ; aromatic sulphuric acid, 12 c.c. (3 fl. dr.) ; paregoric, 
45 c.c. (i l / 2 fl. oz.) ; syrup of ginger, up to 120 c.c. (6 fl. oz.). 
Dose, a teaspoonful, properly diluted. Externally, logwood is 
said to display some antiseptic and healing qualities in the treat- 
ment of gangrenous and ill-conditioned sores, and a decoction 
made from it may be used as an astringent in leucorrhcea and 
bleeding piles. 

WITCHHAZEL. 

HAMAMELIDIS CORTEX.— Hamamelis Bark. Dose, 2 gm.; 30 
gr. 

HAMAMELIDIS FOLIA (Hamamelis, U. S. P., 1890).— Hamamelis 
Leaves. Dose, 2 gm.; 30 gr. 

Preparations. 

1. Fluidextractum Hamamelidis Foliorum. — Fluidextract of 
Hamamelis Leaves. Dose, 2 C.C.; 30 TIT,. 

2. Aqua Hamamelidis. — Hamamelis Water. Dose, 8 c.c; 2 
fl. dr. 

Action of Witchhazel. 
Hamamelis, containing as it does, a considerable proportion 
of tannic acid, is astringent and haemostatic. Although extrava- 
gant claims as to the powers of this drug have been made from 
time to time, no experimentation has shown that it has any 
physiological action beyond that which might be expected from 
an agent rich in tannin. That it has a special influence over 
the venous circulation, analogous to that of aconite on the 
arterial system, as believed by some, has never been proved. 
In full doses it is said to sometimes produce severe throbbing 
pain in the head. 

Therapeutics of Witchhazel. 
Witchhazel is used internally to a very limited extent, not- 
withstanding the fact that certain authorities claim that its 
combined internal and external administration is of great effi- 
ciency in a variety of conditions, such as haemorrhoids (par- 



398 PHARMACOLOGY AND THERAPEUTICS. 

ticularly of the bleeding variety), varicose veins and ulcers, 
varicocele, venous congestions, threatening local inflammations, 
leucorrhoea, and subacute gonorrhoea. Internally, they would 
have us believe, it is of great service in haemorrhages from the 
nose, stomach, lungs, rectum, uterus and kidneys, in purpura 
hemorrhagica, in diarrhoea, enteritis and dysentery, in pyelitis 
and cystitis, in chronic bronchitis attended by copious dis- 
charge and the night-sweats of phthisis, in phlegmasia dolens, 
and in dysmenorrhoea and threatened abortion. When so much 
is claimed for a remedy one cannot but feel somewhat skeptical 
as to its real efficacy, and the mass of the medical profession 
is by no means as yet convinced that it is such a panacea. Ex- 
ternally, hamamelis is believed to have a sedative as well as 
astringent action upon congested or inflamed tissues, and an 
extract distilled from the fresh leaves (hazeline), especially, 
constitutes a useful and agreeable application in a considerable 
variety of conditions. Thus, it is used for sprains, bruises, and 
superficial inflammations, and, diluted, in inflammations of the 
gums, pharyngitis and nasal catarrh. Hamamelis is also em- 
ployed locally in the form of the fluidextract of the leaves 
and as an ointment (B. P., 1 to 10, made from the fluid- 
extract). The former, diluted, may be injected into the bladder 
in cases of catarrhal inflammation or haemorrhage, and is com- 
monly efficient in the treatment of capillary haemorrhage from 
wounds, epistaxis, spongy gums, bleeding sockets after the ex- 
traction of teeth, and bleeding piles. It is also used as a lotion 
for freckles, hyperidrosis, carbuncle and lupus erythematosus, 
and to relieve the pain and stiffness of chronic rheumatism. 
The ointment is recommended in burns, erysipelas, eczema, 
herpes, seborrhoea, acne and rosacea, intertrigo and sunburn, 
as well as in ulcers of the anus or rectum and fissures of the 
anus. A preparation of witchhazel in popular use is known 
as Pond's extract. It is said to be made by distilling the bark 
with very weak alcohol (6 per cent.), and no doubt owes its 
great pecuniary success more to the extensive manner in which 
it has been advertised and to the credulity of the public than 



GERANIUM. 399 

to any pronounced virtue that the remedy possesses. The new 
official Aqua Hamamelidis, made from hamamelis bark, ioo; 
water, 200; alcohol, 15, may be used for the same purposes as 
the fluidextract of the leaves. Taken altogether, hamamelis 
has not as yet been proved of such marked therapeutical value 
that its loss from the Pharmacopoeia would be very seriously 
missed. 

RHUS GLABRA. 

RHUS GLABRA.— Rhus Glabra. (Sumach.) Dose, 1 gin.; 15 gr. 

Preparation. 
Fluidextractum Rhois Glabrae. — Fluidextract of Rhus Glabra. 
Dose, 1 c.c; 15 in.. 

Action of Rhus Glabra. 
Sumach fruit is astringent and refrigerant. 

Therapeutics of Rhus Glabra. 

The fluidextract, when diluted, affords a simple and quite 
effective gargle for inflammation and ulceration of the throat. 
It is also of service in the treatment of aphthae and other forms 
of stomatitis, including that produced by mercury. The glandu- 
lar excrescences on the leaves are powerfully astringent, and a 
decoction made from the leaves or the inner bark of the root 
may be used for the same purposes, as well as for a wash and 
dressing for wounds and ulcers. An infusion of the strength 
of 30 gm. (1 oz.) to 500 c.c. (1 pint) is also sometimes em- 
ployed. Internally these preparations may occasionally be 
found of service in mild catarrhal affections of the stomach 
and bowels. 

GERANIUM. 

GERANIUM.— Geranium. (Cranesbill.) Dose, 1 gm.; 15 gr. 

Preparation. 
Fluidextractum Geranii.— Fluidextract of Geranium. Dose, 
1 c.c; 15 m.. 



400 PHARMACOLOGY AND THERAPEUTICS. 

Unofficial Preparation. 
Decoctum Geranii. — Decoction of Geranium. Dose, 30 to 60 
c.c; 1 to 2 fl. oz. 

Action of Geranium. 
Geranium is one of the best indigenous astringents, and, on 
account of the absence of unpleasant taste and irritating quali- 
ties, it is well adapted for use in the case of children and per- 
sons with very delicate stomachs. It has some tonic action, 
improving the appetite and digestion, and promoting nutrition. 

Therapeutics of Geranium. 
It is very useful in diarrhoea and dysentery, and also in 
the various haemorrhages. It is sometimes given to children 
boiled in milk. Among its other uses are the following: As 
an application to indolent ulcers, as an injection in gonorrhoea, 
gleet, leucorrhcea, fissure of the anus, etc., and as a gargle in 
relaxed or ulcerated conditions of the throat. In catarrhal 
inflammations the decoction is not infrequently more serviceable 
than a simple solution of tannic acid, which is thought to be 
probably due to the fact that there is present mucilaginous 
material, which acts as a demulcent. 

BLACKBERRY. 

RUBUS.— Rubus. (Blackberry.) Dose, 1 gm.; 15 gr. 

Preparations. 

1. Fluidextractum Rubi. — Fluidextract of Rubus. Dose, 1 
c.c; 15 TTL. 

2. Syrupus Rubi. — Syrup of Rubus. Dose, 4 c.c; 1 fl. dr. 

Action of Blackberry. 
The preparations made from blackberry root are tonic and 
.slightly astringent. 

Therapeutics of Blackberry. 
These preparations are used for diarrhoea; blackberry brandy 
is a common domestic remedy. The most efficient one, how- 



RED GUM. 4OI 

ever, is the flmdextract. The fruit, either raw, cooked or pre- 
served, has no astringent quality, and is only likely to prove 
injurious, since the hard seeds serve to increase the intestinal 
irritation. 

RUMEX. 
RUMEX.— Rumex (U. S. P., 1890; no longer official). (Yellow 
Dock.) Dose, 1 to 4 gm.; 15 to 60 gr. 

Unofficial Preparations. 

1. Extractum Rumicis Fluidum (U. S. P., 1890). — Fluidex- 
tract of Rumex. Dose, 1 to 4 c.c; y 4 to 1 fl. dr. 

2. Decoctum Rumicis. — Decoction of Rumex. Dose, 60 c.c; 
2 fl. oz. 

Action of Rumex. 

Rumex is astringent, slightly tonic and alterative. The roots 
of some species unite a laxative with the tonic and astringent 
property, and their action has been compared to that of rhubarb. 
Taken very largely, the leaves are said to have produced poi- 
sonous effects. 

Therapeutics of Rumex. 

It has been used in syphilis, scorbutic disorders, and cuta- 
neous eruptions. Some species of rumex, given in hot decoc- 
tion, have been thought efficient in intermittent fevers, and 
others in chronic congestion of the liver with a gouty tendency. 
It is said to possess a selective action on the mucous membrane 
of the larynx and to afford relief in many cases of laryngeal 
irritation with catarrhal symptoms. The fresh leaf when 
bruised is a popular antidote to the eruption caused by the 
stinging nettle, and the decoction is sometimes applied externally 
in glandular swellings and various skin diseases. 

RED GUM. 

EUCALYPTI GUMML— Eucalyptus Gum (B. P., not official). 
(Red Gum.) Dose, .12 to .60 gm.; 2 to 10 gr. 

Action of Red Gum. 
Red gum is a useful astringent and has the advantage over 
27 



402 PHARMACOLOGY AND THERAPEUTICS. 

some others of its class that its effects upon mucous mem- 
branes are peculiarly permanent. It closely resembles kino, but 
does not equal that drug in astringency. 

Therapeutics of Red Gum. 
It is employed in the same kinds of cases as kino and other 
vegetable astringents. One of its chief uses is, in the form of 
lozenges, in relaxed and other conditions of the throat requiring 
an astringent. These lozenges usually contain .06 gm. (1 gr.), 
and are made with fruit paste. Internally it is given in 
decoction (1 to 40) and fluidextract (red gum, 7; water, 21; 
alcohol, 1) ; the dose of the one for diarrhoea being 8 to 15 c.c. 
(2 to 4 fl. dr.), and of the other, 2 to 4 c.c. { l / 2 to 1 fl. dr.). 
The decoction is frequently employed as a gargle, and the 
fluidextract is much esteemed as a basis for gargles. Injected 
into the nose the latter is often efficient in arresting epistaxis, 
and in the strength of 1 to 10 it may be injected into the rec- 
tum or vagina, or used as a mouth-wash. The fluidextract, 
unlike that of sumach, remains clear after being diluted with 
water. A suppository containing 30 gm. (5 gr.) is sometimes 
of service in haemorrhoids. 

COTO. 

Unofficial Preparations. 
Coto.— Coto Bark. Dose, .06 to .60 gm.; 1 to 10 gr. 
Cotoinum. — Cotoin. Dose, .06 to .12 gm.; 1 to 2 gr. 
Paracotoinum. — Paracotoin. Dose, .12 to .30 gm.; 2 to 5 gr. 

Action of Coto. 
Coto is not astringent, but, on account of the character of 
its therapeutic effects, may be given a place with this class of 
medicinal agents. It is irritant to the skin and to mucous mem- 
branes. The powder, rubbed on the integument, is said to pro- 
duce heat and redness, and in doses of 1 gm. (15 gr.) it has 
caused persistent burning pain in the stomach, followed by re- 
peated vomiting. In doses of .06 gm. (1 gr.) it is found to in- 



LEAD SALTS. 403 

crease the appetite and also to have a somewhat constipating 
effect. Cotoin appears to pass through the stomach unchanged, 
and is absorbed in the small intestine. It has been classed 
among antiseptics, but while it may have the power of retarding 
putrefaction outside the body, it has been demonstrated that it 
has no antiseptic action in the alimentary canal. When in- 
jected intravenously or perfused through the mesenteric blood- 
vessels in animals, it has the effect of causing marked dilata- 
tion of the intestinal vessels. This appears to be its principal 
physiological action, and to the improved nutrition and in- 
creased absorptive power which by this means it produces it is 
believed that the beneficial effects of the drug in intestinal dis- 
eases are to be attributed. After its internal administration it 
has been noted that the urine assumes a dark-red color on the 
addition of nitric acid. 

Therapeutics of Coto. 
Because coto produces absorption, coto bark and cotoin have 
established a reputation as remedies for diarrhcea, whether in- 
fantile, in phthisis or in typhoid fever. It also checks salivation 
and night-sweats. It is especially recommended for children 
suffering from marasmus with intestinal troubles. Asiatic 
cholera has been successfully treated by the subcutaneous in- 
jection of paracotoin in .20 gm. (3 gr.) doses, although this 
substance, which is a constituent of the paracoto bark, is much 
weaker than cotoin. It seems probable that whenever there is 
a tendency to acute inflammation of the gastro-intestinal tract 
this remedy should be used with considerable caution. A 10 
per cent, tincture of coto has been recommended by the British 
Pharmaceutical Conference; dose, .60 c.c. (10 "HI); every 2 
hours, with mucilage or syrup to suspend the large amount of 
resin which it contains. It should not be combined with Mistura 
Cretse. 

LEAD SALTS. 

1. PLUMBI OXIDUM.— Lead Oxide. (Litharge.) 



404 PHARMACOLOGY AND THERAPEUTICS. 

Preparations. 

1. Emplastrum Plumbi. — Lead Plaster. 

2. Emplastrum Adhaesivum. — Adhesive Plaster. 

3. Unguentum Diachylon. — Diachylon Ointment. 

2. PLUMBI ACETAS.— Lead Acetate. (Sugar of Lead.) Dose, 
0.065 gm. (65 milligm.) ; 1 gr. 

Preparations. 

1. Liquor Plumbi Subacetatis. — Solution of Lead Subacetate. 
(Goulard's Extract.) 

2. Liquor Plumbi Subacetatis Dilutus. — Diluted solution of 
Lead Subacetate. (Lead Water.) 

3. Ceratum Plumbi Subacetatis. — Cerate of Lead Subace- 
tate. (Goulard's Cerate.) 

3. PLUMBI NITRAS.— Lead Nitrate. 

4. PLUMBI IODIDUM.— Lead Iodide. 

Unofficial Preparations of Lead. 
Plumbi Carbonas. — Lead Carbonate (U. S. P., 1890). 

Unguentum Plumbi Carbonatis. — Ointment of Lead Carbon- 
ate (U. S. P., 1890). 

Unguentum Plumbi Iodidi. — Ointment of Lead Iodide (U. S. 
P., 1890). 

Action of Lead Salts. 
External. — Upon the unbroken skin the salts of lead have 
little or no action, though the integument is discolored by the 
use of some of them. Upon denuded surfaces they have a 
decided astringent effect, causing the contraction of the small 
blood-vessels, and in the case of sores and ulcers coagulating 
the albumin of the discharge and the protoplasm of the neigh- 
boring superficial cells; in consequence of which a protective 
coating is formed for the healthier structure beneath. In addi- 
tion, by reason of the local depletion resulting from vasocon- 
striction and also, it is thought, because of a depressant effect 
upon the sensory nerve-endings, they have a marked sedative 



LEAD SALTS. 405 

action. Any of these salts, if sufficiently concentrated and 
applied in sufficient amount, may be irritant and to a certain 
extent corrosive. 

Internal. Alimentary Canal. — From the mouth downward 
the lead salts have the same powerfully astringent effect upon 
the mucous membrane of the alimentary tract as upon the 
abraded skin. While they may occasion sufficient corrosion to 
be absorbed, this absorption never appears to be of sufficient 
extent to produce acute fatal poisoning from systemic effects. 
Almost the only result caused by ordinary doses is constipation. 
When given in large amounts they act as gastro-intestinal irri- 
tants, causing salivation, thirst, difficult of swallowing, abdomi- 
nal pain, vomiting and diarrhoea. There is a burning, sweet- 
ish taste in the mouth, and the vomited matter consists of 
whitish fluid containing curdy material, the color being due 
to the formation of lead chloride from a combination of 
the excessive lead with the hydrochloric acid of the gas- 
tric juice. In consequence of the astringent action of lead 
salts, the purging is not as marked as in the case of most 
irritant poisons, and sometimes there is constipation. If the 
bowels are moved, the passages are likely to be of a blackish 
hue from the presence of lead sulphide, and both the stools and 
the matters vomited may contain blood. 

Absorption and Excretion. — In whatever form or whatever 
doses lead is given, a small quantity is promptly absorbed, and 
while this may be incapable of producing any immediate symp- 
toms, its excretion is very slow, and consequently cumulative 
action is liable to result. Lead has been shown to be always 
absorbed in the form of soluble proteid combinations, and these 
may be formed from lead compounds which are perfectly in- 
soluble in water or acids. Even lead sulphate, one of the most 
insoluble of substances, will be absorbed in sufficient amount to 
produce poisoning, and hence, as previously mentioned (see 
P- 337) » sulphuric acid is of comparatively little value as a 
prophylactic in those exposed by their work to the action of 
lead. Lead is excreted in the secretion of the intestinal epi- 



406 PHARMACOLOGY AND THERAPEUTICS. 

thelium, the urine, bile, saliva and milk, and probably by the 
glands of the skin. Chronic lead-poisoning may sometimes be 
detected, it is said, by painting the integument with ammonium 
sulphide, which under these circumstances stains it black from 
the formation of lead sulphide. In the form of the sulphide 
the lead is sometimes deposited on the edge of the gums, giving 
the characteristic " lead line," which is also known as Burton's 
line. This is due to the presence of hydrogen sulphide produced 
by the action of bacteria, and is not often met with where the 
teeth are sound and kept clean. In the kidneys lead causes 
decided irritation during the process of excretion ; so that 
nephritis is found to be a frequent result of acute poisoning and 
an invariable one of chronic poisoning. A remarkable circum- 
stance in connection with lead-poisoning is the frequency of 
gout in its subjects. It is asserted by those who have had the 
largest experience with this disease that in one-fourth of the 
cases there is a history of saturnism; so that it would appear 
that the latter predisposes to gout, if it does not actually cause 
it. In districts where ordinary gout is rare, however, it is 
said that lead-poisoning seldom leads to it. The nephritis of 
chronic poisoning is sometimes, no doubt, in part secondary to 
this disease. It may also be in part secondary to the arterio- 
sclerosis resulting from fatty degeneration of the blood-vessels 
induced by the lead. Fatty degenerations are likewise found 
in the kidneys, liver, and other organs. The lead which is re- 
tained in the body is stored in the liver, kidneys, brain, bones 
and muscles, but chiefly in the liver. Only traces of it are 
found in the blood. 

Blood. — In chronic lead-poisoning there is always anaemia, 
which is due at first to the constriction of the peripheral vessels 
and subsequently to diminution of haemoglobin and the number 
of red corpuscles. The white corpuscles are generally, though 
not invariably, increased. Not infrequently jaundice results 
from the breaking up of red corpuscles and the liberation of 
large amounts of haemoglobin. 

Nervous System and Muscles. — In what is known as en- 



LEAD SALTS. 4O7 

cephalopathia saturnalis the disorders met with are for the most 
part of cerebral origin, although the lower divisions of the 
central nervous system are sometimes also involved. Upon the 
cortex, which is chiefly affected, there is produced an irritation, 
followed by paralysis, and the effects are both sensory and 
motor, the latter being the more pronounced. There are usually 
muscular contractures and then choreic movements. In some 
instances convulsions occur, and these are sometimes due to 
uraemia resulting from the nephritis, and sometimes to the lead 
itself. Later, paralysis succeeds the motor stimulation. In ad- 
dition, there is delirium, followed by depression and finally by 
coma, and the latter may also be uremic. In autopsies of some 
of the patients dying from lead-poisoning atrophy of parts of 
the cerebrum or haemorrhages, as well as disease of the blood- 
vessels, has been observed. In prolonged cases of lead-poison- 
ing degenerative changes may occur in the anterior columns of 
the spinal cord. On the motor system the effects produced are 
neuritis, paralysis and atrophy. Their usual seat is no doubt 
in the peripheral nerves and muscle cells, though the central 
nervous system would appear to be involved in some instances. 
In chronic poisoning in animals there is early muscular fatigue, 
which is followed by paralysis, and later by total atrophy. The 
heart is liable to be similarly affected, and even quite early 
in the poisoning; especially if the lead-salt is injected directly 
into the blood. The effect upon the motor peripheral nerves 
is believed to be very much like the direct muscular action. A 
common characteristic of lead-poisoning is the " drop wrist " 
or " painter's palsy," and this is probably attributable in part 
to paralysis of the extensor muscles and partly to the active 
contracture of the opposing flexor muscles. The most promi- 
nent of the peripheral effects is lead colic, a phenomenon which 
is due to violent contraction of the intestinal muscles, probably 
from stimulation of the nerve endings. As it is largely relieved 
by nitrites and other agents which dilate the blood-vessels, it 
is inferred that a primary vaso-constriction is one of its causes. 
As the spasm of the intestine forces the blood out of the 



408 PHARMACOLOGY AND THERAPEUTICS. 

splanchnic area, the general blood-pressure is raised and the 
pulse is slowed and rendered hard and tense. The pain, which 
is intense and grinding in character, . is located principally in 
the umbilical region, and the abdomen is retracted and hard. 
Paroxysms of the most acute agony are followed by intervals 
of comparative ease. The colic lasts for several days, or a 
week, and then disappears, but is apt to recur at intervals. 
Other affections, apparently, of the peripheral nerves are 
anaesthesia of various parts, lasting perhaps one or two weeks, 
and lead arthralgia, which consists of sharp lancinating or 
boring pains in the joints, bones, or the flexor muscles around 
the joints, and which generally appears and disappears quite 
suddenly. Neuralgias are occasionally observed, and these are 
probably sometimes due to peripheral neuritis and sometimes 
of central origin. One of the rarer phenomena of lead-poison- 
ing is amblyopia, in which the sight may be lost entirely or only 
rendered somewhat dim. This may be due to optic neuritis 
(which, unless arrested early, leads to atrophy of the nerve), 
to uraemia with an effusion into the optic sheath, or to albumi- 
nuric retinitis. 

Uterus. — Lead is very fatal to the life of the foetus, and under 
its influence abortion is liable to occur, or the child be still- 
born. It has been suggested that this result is probably due, 
in part at least, to the poor quality and diminished quantity of 
the blood supply. 

Therapeutics of Lead Salts. 
External. — Lead salts, in the form of lotions and ointments, 
are used, for both their sedative and astringent action, in a 
great variety of acute local inflammations. A very serviceable 
preparation is the glycerin of the subacetate of the B. P. (lead 
acetate, 10; lead oxide, 7; glycerin, 40; water, 24; boiled 
together), which should ordinarily be diluted fourfold with 
glycerin or milk. The Liquor Plumbi Subacetatis is sometimes 
successful in aborting a felon. For most other purposes it is 
apt to be too irritating, but the diluted solution, as well as the 



LEAD SALTS. 4O9 

cerate of lead subacetate (which should also usually be diluted), 
may be applied with advantage to contusions, acute eczema, 
erysipelas, and inflammations of various kinds. The solution 
may also be employed to allay itching in such affections as 
urticaria, paresthesia, etc. A lotion of lead and opium has 
long been a favorite application for relieving pain and inflam- 
mation. It may be prepared by mixing 30 gm. (5 gr.) of ex- 
tract of opium with 30 c.c. (1 fl. oz.) each of lead water and 
water, or may be made as follows: Solution of lead acetate, 15; 
tincture of opium, 30; distilled water, 120. Lead lotions, to 
which zinc sulphate is often added, are used for injections in 
gonorrhoea, gleet, vulvitis, leucorrhcea and otorrhcea. They 
were formerly also employed in conjunctivitis, but have been 
abandoned as applications for the eye; for if ulceration of the 
cornea be present, the white precipitate formed is liable to 
lead to permanent opacity. Y\ "hite-lead paint is a good applica- 
tion for burns and scalds where the skin is unbroken, and lead 
carbonate, mixed wtih olive oil and with the addition of a 
few drops of creosote, is recommended for erysipelas, burns, 
and for bruises, especially when the surface has a blue or dark 
discoloration. The following is an efficacious dusting-powder in 
acute eczema, herpes and seborrhcea: Lead carbonate, 8 gm. 
(2 dr.) ; zinc carbonate, 15 gm. (y 2 oz.) ; oil of eucalyptus, 
.30 c.c. (5 Tr L). Diachylon ointment mixed with an equal quan- 
tity of zinc oleate ointment and mercuric oleate ointment forms 
a transparent ointment, which will be found of service in a 
considerable number of conditions. Diachylon ointment is use- 
ful in seborrhcea, hyperidrosis, eczema, dermatitis, herpes zoster, 
and sycosis. Hebra*s diachylon ointment is made by melting 
equal, parts, by weight, of lead plaster and flaxseed oil, to 
which a proportion of balsam of Peru and a little oil of laven- 
der are sometimes added. Even in chronic diseases of the skin 
lead salts are often of service on account of their soothing and 
astringent effects. Lead plaster is excellent for preventing bed- 
sores and as a basis for other plasters, and is used by surgeons 
to protect parts of the body exposed to chafing by splints or 



410 PHARMACOLOGY AND THERAPEUTICS. 

other apparatus. Lead iodide ointment is a useful resolvent for 
glandular swellings, scrofulous tumors, goitre, chronic synovitis, 
etc., and, applied with steady friction, is said to be especially 
serviceable in acute mastitis with threatened suppuration. It 
may also be applied in acne and other cutaneous affections. A 
two per cent, solution of lead nitrate in glycerin is a very effi- 
cient application for fissured nipple, care being always taken 
to thoroughly remove all traces of it before the child is allowed 
to nurse. The nitrate, in very dilute solution, may be used 
also as a wash in leucorrhcea and to correct the fetid odor 
of discharges from ulcers, etc. Lead acetate, on account of its 
astringent action, is occasionally employed for mouth-washes 
and gargles, but other agents are ordinarily preferred for those 
purposes. In haemorrhoids, when there is much pain and a 
sense of burning heat at the anus, the addition of lead water 
to the ointments frequently used in these cases often affords 
marked relief. 

Internal. — Lead iodide, it is said, has been given in order to 
reduce enlargement of the spleen due to malaria. Practically, 
however, the only lead salt which is used for internal adminis- 
tration is the acetate, which is highly prized for its astringent 
and haemostatic effects. It has been largely employed for the 
purpose of arresting haemorrhage from the lungs, but is more 
especially adapted to the haematemesis accompanying gastric 
ulcer. In this affection it is also a very useful remedy in other 
ways; not only relieving pain, but modifying the ulcerated sur- 
face and checking inflammatory action as well. It is likewise of 
service in chronic catarrh of the stomach, with gastralgia and 
pyrosis. Theoretically it is incompatible with preparations of 
opium, but notwithstanding this, it is very often advantageously 
combined with them in painful affections of the stomach, as well 
as in various forms of diarrhoea. It is in the latter that lead ace- 
tate is most frequently used, and it is also relied upon for con- 
trolling intestinal haemorrhage, such as is liable to be met with 
in typhoid fever and tuberculosis. For these purposes a very 
satisfactory preparation is found in the Pilula Plumbi cum Opio 



LEAD SALTS. 4 I I 

of the B. P. (lead acetate, .20 gm. (3 gr.) ; opium, .06 gm. 
(1 gr.)). In choleraic diarrhoea, powders consisting of lead 
acetate, opium and camphor may be employed, or a mixture in 
which the acetate is associated with acetic acid and the tincture 
of deodorized opium. For the diarrhoea of typhoid, bismuth 
is usually preferable to lead acetate and opium. In rectal 
haemorrhage from various causes and in both acute and chronic 
dysentery the last-named remedies are of great service when 
employed locally, either by suppositories or enemata, and the 
following enema will be found useful in relieving the tenesmus 
of acute dysentery: lead acetate, .24 gm. (4 gr.) ; morphine 
acetate, .03 gm. ( J / 2 gr.) ; hot water, .30 c.c. (1 fl. oz.). Al- 
though now prescribed comparatively rarely in haemoptysis, 
lead acetate seems in some cases to act quite efficiently, and in 
this condition, as well as in caseous pneumonia, it has some- 
times been combined with digitalis and opium. Formerly the 
acetate was given in hypertrophy of the heart under the sup- 
position that it retarded the action of that organ, and also in 
internal aneurism. It is of some value in checking the night- 
sweats of pulmonary tuberculosis, and diminishes the copious 
secretion sometimes accompanying chronic bronchitis. It is 
open to the objection, however, of causing constipation. 

If lead acetate is administered for any length of time there 
is more or less risk of plumbism being induced, and some per- 
sons are peculiarly susceptible to the poisonous action of the 
drug. Its effects should therefore always be watched with 
care. Even the external application of lead solutions or oint- 
ments have occasionally been attended by colic and other un- 
toward symptoms. 

TOXICOLOGY. 

Acute Lead Poisoning. — The acetate is most frequently taken, and 
a very large quantity of it is required to produce a fatal effect. Owing 
to the fact that so much of the drug is generally vomited, cases 
of acute poisoning rarely terminate fatally. The gastro-intestinal symp- 
toms have already been described. They are followed by great weak- 
ness, coldness of the surface, and collapse. In some cases in which 



412 PHARMACOLOGY AND THERAPEUTICS. 

recovery took place the patients have been known to suffer from 
chronic lead poisoning, but it has been pointed out that apart from 
these nothing in the course of the acute poisoning suggests the absorp- 
tion of lead ; all the symptoms being obviously due to the local effects 
on the alimentary tract, and to the subsequent collapse. Post-mortem. 
— In the stomach and intestine such signs of irritant poisoning as red- 
ness, excoriation and softening are found. 

Treatment. — The stomach should be washed out or emetics {see p. 
J75) given. The precipitation of the lead should then be attempted 
by the administration of sodium or magnesium sulphate, or, if such 
sulphates are not procurable, by white of egg or milk, forming an insol- 
uble albuminate. If collapse is present, it should be combated by the 
administration of stimulants, by hypodermatic injection or by the mouth, 
and the external application of warmth. 

Chronic Lead Poisoning. — This is so common that the sources of 
accidental poisoning should be borne in mind. The most important 
are : soft water, carbonated waters and alcoholic drinks (beer) which 
have passed through lead pipes or been stored in receptacles lined with 
lead. The occupations of painters (colica pictonum), plumbers, type- 
setters, gold miners, white lead workers, potters, glaziers (Devonshire 
colic), because the men will not wash their hands before meals nor use 
ordinary care ; lead hair dyes and face powders, biting leaded white 
thread, eating certain canned fruits (lead solder), sheet-lead (tin-foil) 
about tobacco, filling holes in mill stones with lead, playing with tin (lead) 
soldiers by children, use of lead carbonate ointment on burns, lead bullets 
in flesh, white or red lead used for preparing rubber for vulcanizing, lead 
plates in dentistry, the use of lead chromate to color buns yellowish, 
have all been followed by chronic plumbism. Most of the symptoms 
and effects have been mentioned. Not only the extensors of the hand, 
but any muscle may be paralyzed (sometimes almost all the muscles 
of the body seem to be affected), and it is a clinical observation that 
such muscles are very refractory to electricity. The supinator longus, 
however, usually escapes, the reason for this apparently being that the 
supinator is not an extensor muscle. Lead is regarded as perhaps the 
best example of a poison which is comparatively free from danger in 
a single dose, however large, but which becomes fatal in the most min- 
ute doses, if these are taken for a sufficiently long time. 

Treatment. — The first thing to be done is the removal of the patient 
from the danger of further poisoning. In the general treatment reli- 
ance is placed upon potassium iodide, saline purgatives, diuretics, and 
the use of hot baths and massage to promote elimination, and the im- 



LEAD SALTS. 413 

provement, by appropriate measures, of the patient's nutrition and 
strength. Potassium iodide is universally employed, and appears to 
have a remedial effect, though the manner of its action is not clearly 
understood. It has generally been supposed to accelerate the elimina- 
tion of the poison by the kidneys, but recently it has been denied that 
it has any influence on the excretion either by the urine or by the intes- 
tine, by which most of the lead escapes from the body. Baths of sul- 
phurated potassa are quite efficient, especially if the patient is after- 
wards well soaped, then thoroughly rinsed off, and finally rubbed down 
with a rough towel. For the various effects of lead in the system spe- 
cial treatment is required. For the colic, opium or morphine is often 
necessary, alum, in .12 gm. (2 gr.) doses, is of great service, and sul- 
phuric acid is also useful {see p. 337). In a considerable number of cases 
of chronic lead poisoning it is found that cathartics fail to act unless 
morphine is given to overcome the intestinal inhibition produced by the 
irritation resulting from the lead. Opiates may also be required for 
the relief of the arthralgia. For the paralysis strychnine may be used, 
but the main reliance is to be placed on electrical stimulation and 
massage. If the muscles contract in response to the faradic current, 
this should be employed, but if they do not, the galvanic current. Ne- 
phritis and gout due to plumbism should be treated in the same way as 
if resulting from other causes, while the cerebral symptoms must be 
dealt with according to the special manifestations present. 

The following method may be employed to determine the presence 
of lead in the urine : Administer potassium iodide for four days, in the 
meanwhile collecting the urine. Evaporate the latter to 500 c.c. (1 pint), 
and filter. Pass hydrogen sulphide gas through the urine thus concen- 
trated, when a black precipitate will form if lead is present. Other 
substances give a black precipitate with hydrogen sulphide, but none 
such is likely to be present in the urine. A simple test for lead in the 
system is to paint a small area of skin with a six per cent, solution of 
sodium sulphite. If lead is present the painted area will darken after 
a few days. Patients using face enamels containing lead will find the 
skin blackened on taking baths in water containing hydrogen sulphide 
(Richfield Springs). 

Prophylaxis is of the greatest importance, and the public should be 
more generally instructed in regard to the insidious dangers of lead. 
Special precautions are required in lead works and paint factories, and 
in exposed trades. Dust should be avoided as much as possible, and 
where this is necessarily present, thorough ventilation of the rooms 
should be insisted upon. The necesssity of frequent bathing and of 



4I4 PHARMACOLOGY AND THERAPEUTICS. 

thorough washing before meals ought to be impressed upon the work- 
men. Food should not be permitted upon the premises, and the cloth- 
ing should be changed before leaving the works. The habitual employ- 
ment of milk in large quantity as a food has been recommended as of 
service. Sulphuric acid lemonade is quite generally made use of as a 
prophylactic, but little reliance can be placed upon it. Weak and anae- 
mic men ought not to be admitted as operatives in lead factories, and 
it is advisable that women should not be employed at all in them. 

SILVER SALTS. 

1. ARGENTI NITRAS.— Silver Nitrate. Dose, 0.010 gm. (10 mil- 
ligm.); y- gr. 

Preparations. 

1. Argenti Nitras Mitigatus (Argenti Nitras Dilutus, U. S. 
P., 1890). — Mitigated Silver Nitrate. (Mitigated Caustic.) 

2. Argenti Nitras Fusus. — Moulded Silver Nitrate. (Lunar 
Caustic.) 

2. ARGENTI OXIDUM.— Silver Oxide. Dose, 0.065 gm. (65 mil- 
ligm.) ; 1 gr. 

3. ARGENTI CYANIDUM.— Silver Cyanide. 

Unofficial Preparations of Silver. 

Argenti Iodidum (U. S. P., 1890).— Silver Iodide. Dose, 
0.015 to 0.06 gm.; y 4 to 1 gr. 

Argenti Citras.— Silver Citrate. (Itrol.) 

Argenti Fluoridum. — Silver Fluoride. 

Argenti et Sodii Hyposulphis. — Silver and Sodium Hyposul- 
phite. 

Argenti Lactas. — Silver Lactate. (Actol.) 

Argentum Colloidale.— Colloid Silver. Dose, .01 gm.; y 6 gr. 

Argentaminum. — Argentamine. 

Argoninum. — Argonin. (Silver Caseinate.) 

Argyrol.— Argyrol. (Silver Vitellin.) Dose, .30 to .60 gm.; 
5 to 10 gr. 

Larginum. — Largin. 

Protargol. — Protargol. 



SILVER SALTS. 4I 5 

Action of Silver Salts. 

External. — The local action of silver salts is in general simi- 
lar to that of lead salts — astringent and haemostatic — but they are 
more irritant and corrosive, especially the nitrate. The astring- 
ent effect produced by them is due to the formation of a protec- 
tive layer of albumin. While dilute solutions of the nitrate 
may possibly have some vaso-constrictor effect, if the salt is 
applied in sufficient strength to induce irritation, the blood-ves- 
sels will become dilated in consequence of this. Even in dilute 
solution silver is apt to be slightly irritating to the skin, pro- 
ducing redness and itching, while stronger solutions vesicate, 
and the solid nitrate causes an eschar. This is at first of a 
whitish color, but later turns black from the reduction of silver 
in light. The corrosive action of silver is less deep than that 
of some other metals, as its penetration is interfered with by 
the precipitation of silver albuminate. On abraded surfaces and 
mucous membranes dilute solutions act as astringents, but con- 
centrated ones are irritant and caustic. The silver salts possess 
very considerable antiseptic power, and, like other astringents, 
they tend to diminish suppuration by rendering the walls of 
the blood-vessels less permeable to inflammatory products. At 
the same time, they tend to prevent the further penetration of 
bacteria, and hinder their development by rendering the culture- 
ground unsuitable. Silver nitrate not only coagulates the pro- 
teids of the micro-organisms, but is also antiseptic from the 
specific effects of the metal, as is shown by the fact that silver 
albuminate is likewise an active disinfectant. The nitrate is 
employed by histologists for staining epithelium for micro- 
scopical purposes. 

Internal. — Unlike the lead salts, those of silver appear to 
have no astringent action when administered internally. In 
the stomach the soluble salts are probably converted into the 
chloride and albuminate, though the form in which the metal is 
absorbed is uncertain. As it is reduced to the inactive metallic 
state soon after entering the body, the use of silver does not 
lead to general poisoning. When it is given for prolonged 



41 6 PHARMACOLOGY AND THERAPEUTICS. 

periods, however, a slight proportion of the metal ingested is 
absorbed, this absorption being shown by a pigmentation of 
the skin and mucous membranes (argyria). Such discoloration 
is due to the deposit of minute granules which were formerly 
supposed to consist of metallic silver, but which are now 
thought to be an organic compound. They are found also in 
many internal organs, but are chiefly present in the connective 
tissues of the body. Argyria is sometimes observed in the 
workers in artificial pearls, who use silver as a pigment, and 
it may also result from the prolonged use of silver nitrate solu- 
tion as a local application to the eye, nose and throat. In man 
this pigmentation appears to be the only evidence of absorption. 
It is believed that most of the silver passes through the ali- 
mentary canal unabsorbed, and that none of the very small 
proportion which is taken up is eliminated; the entire amount 
remaining imbedded indefinitely in the tissues. In animals, how- 
ever, some is excreted by the epithelium of the alimentary canal. 
When silver is introduced into the circulation by subcutaneous 
or intravenous injection, its effects are found to differ from 
those of other metals in the predominance of nervous symp- 
toms. In mammals the action is chiefly upon the central ner- 
vous system, and especially the medulla oblongata, as shown by 
a rise of blood-pressure and slowing of the pulse, in consequence 
of increased activity of the vaso-motor and vagus centres. 
This stimulation is followed by paralysis ; the blood-pressure 
falling, and the respiration becoming slow and labored and then 
failing altogether. The heart is comparatively unaffected, and 
may continue to beat for some time after the respiration has 
ceased. There is also motor paralysis, beginning in the lower 
extremities. The secretion of bronchial mucus may be so 
markedly increased that it may lead to asphyxia, and this is 
thought to be due to injury to the epithelium. In cold-blooded 
animals violent convulsions, resembling those from strychnine 
and followed by paralysis, have been observed. Silver nitrate, 
in solid form or concentrated solution, is a gastro-intestinal irri- 
tant and corrosive. 



SILVER SALTS. 417 

Therapeutics of Silver. 

External. — Silver foil, or metallic silver in very thin sheets, 
is used as a surgical dressing for wounds and burns. It consti- 
tutes a protective covering which may be painlessly removed and 
renewed and which prevents or curtails suppuration. It is also 
said to reduce shock. Silver nitrate is in universal use as a caus- 
tic whenever a limited and clearly defined action is required, 
but is of no value for producing a deep or extensive escharotic 
effect. It is often applied to the bites of dogs and other ani- 
mals, but it is a dangerous caustic to employ in deep bites, for 
the pellicle of silver albuminate retains the poison in the wound. 
The solid nitrate is used also to destroy warts and other 
growths, to restrain the bleeding from leech-bites, and as an 
application for ulcers of the mouth, rectum and other parts, 
for venereal sores, and in catarrh of the cervix uteri. It is 
said to be of service when applied to the scrotum in acute 
epididymitis or orchitis, and in lymphangitis of the forearm from 
a poisoned wound of the finger, if applied along the course 
of the affected vessels. In erysipelas the disease may sometimes 
be arrested, it is claimed, by delimiting the affected area with 
silver nitrate. Boils or a stye on the eye have been aborted 
by its early use, and it has also been employed with good re- 
sults in eczema, lichen, herpes and other cutaneous affections 
when occurring in circumscribed patches. For tinea tricophy- 
tosis a solution in nitrous ether (2.60 gm. to 30 c.c. ; 40 gr. to 
1 fl. oz.) may be used. The mitigated caustic is a good appli- 
cation to granular lids, chancroids, small-pox vesicles (to pre- 
vent pitting), and in general to excite a healthy action of granu- 
lar surfaces. The injection of a strong solution of silver 
nitrate in the early stage of the disease has been advocated by 
some as a method of aborting gonorrhoea. Buboes have been 
successfully treated by the injection, after puncture, of a 2 per 
cent, solution of the nitrate, and in punctured wounds the in- 
jection of a solution of the strength of .60 gm. (10 gr.) to 30 
c.c. (1 fl. oz.), after the wound has been disinfected, has been 
recommended for preventing the development of tetanus. 
28 



41 8 PHARMACOLOGY AND THERAPEUTICS. 

Uniting, as it does, an irritant stimulating, with an astringent, 
effect, lotions of the salt, the strength of which is usually about 
.30 gm. (5 gr.) to 30 c.c. (1 fl. oz.) of water, are often of 
great service as an application for chronic pharyngitis or laryn- 
gitis and indolent ulcers, or as an injection in gleet or inflam- 
mation of the cervix uteri, while weaker solutions are used for 
various forms of ophthalmia. Ophthalmia neonatorum is suc- 
cessfully treated by early applications of a 1 per cent, aqueous 
solution of silver nitrate. This is commonly known as Crede's 
method, but the original formula as prescribed by him was double 
this strength. In spasmodic stricture of the oesophagus the oc- 
casional use of a very weak solution by means of a sponge pro- 
bang may prove of service. A solution containing 1.20 gm. (20 
gr.) to 30 c.c. (1 fl. oz.) is efficient in pruritus vulvae and in 
the prevention of bed sores, and the injection in small quan- 
tities of a solution varying from this strength up to one which 
is three or four times as concentrated into the sac of a hydrocele 
or cystic tumor has been attended with good results. Irrigation 
of the bowel with a solution of from .30 to .60 gm. (5 to 10 gr.) 
to 30 c.c. (1 fl. oz.) is often useful in pseudomembranous en- 
teritis, while prolapsed rectum, especially in children, is bene- 
fited by cauterization with mitigated silver nitrate. 

A useful injection in gonorrhoea is silver caseinate (Argonin, 
not official) in 1.5 per cent, solution which causes the speedy 
disappearance of gonococci, but since this is not astringent, 
other remedies must be employed to relieve the inflammation. 
Silver lactate (Actol, not official) is used as an antiseptic in 
sore throat, gonorrhoea, etc., in a 2 per cent, solution. Silver 
citrate (Itrol, not official) in 1 to 4000 solution is employed for 
the same purpose. Protargol (not official), a proteid compound 
containing 8 per cent, of silver easily soluble in water, is used 
as an injection for gonorrhoea. The usual strength is 1 per 
cent. Argentamine (not official), a 10 per cent, solution of 
silver nitrate in a 10 per cent, solution of ethylendiamine, has 
been used in gonorrhoea and conjunctivitis in a 1 to 4000 solu- 
tion; also as a disinfectant. This sterilizes a pure culture of 



SILVER SALTS. 419 

gonococci in from five to seven minutes. It can be used in as 
strong a solution as 1 to 1000 in the urethra, it penetrates deeply 
into the tissues without altering them, and by the seventh day 
the discharge is usually quite thin and gonococci can hardly be 
found. It then disappears rapidly. The iodide possesses the 
general properties of the nitrate. 

Silver, soluble in water, an allotropic form discovered about 
1890, now termed colloidal silver (not official), has recently 
been well received and has obtained a permanent place in thera- 
peutics. It is employed as a 15 per cent, ointment (Crede) by 
inunction. It has been used successfully for chronic furun- 
culosis, phlebitis and other septic processes. Largin (not offi- 
cial) is an albumin-silver compound, containing in the air- 
dried condition 11 per cent, of silver, which is said to be a 
powerful astringent and germicide, non-irritant, and not pre- 
cipitated by chlorides or albumin. It is used in gonorrhoea in 
solutions of from % to i J / 2 per cent. Silver fluoride (not 
official) has been recommended as an efficient application in 
anthrax. It is a dark-colored hygroscopic mass, readily soluble 
in water, equal in caustic effect to the nitrate, and powerfully 
antiseptic, being destructive to the anthrax bacillus, while non- 
toxic to man. Silver and sodium hyposulphite (not official), 
which is also very soluble in water and does not coagulate 
albumin, or stain the skin or the clothing, is preferred by some 
to silver nitrate for local application to the throat, on account 
of its being less disagreeable to the taste. 

Argyrol or silver vitellin (not official) is a very recent prep- 
aration, which, it is claimed, is distinguished from other silver 
salts by the high amount of silver it contains (30 per cent.), its 
intense penetrating action on the tissues, its freedom from irri- 
tating properties, and its power to allay the signs and symptoms 
of inflammation. In spite of its large percentage of silver, a 
20 per cent, solution of argyrol may be dropped in the normal 
conjunctival sac without producing irritation or discomfort, 
while the penetrating action of the salt is demonstrated by its 
action on catgut, a strand of which, after immersion in the 



420 PHARMACOLOGY AND THERAPEUTICS. 

solution, is found to be penetrated through and through with 
the argyrol. Hence it is argued that argyrol will exert the 
antiseptic effects of silver in the deep submucous structures 
where, in most pathological conditions, pathogenic organisms 
find and maintain lodgment in spite of energetic measures to 
eradicate them. Practically the remedy, topically applied, has 
proved of service in various diseases of the eye, ear, nose, 
throat and genito-urinary organs, as well as in a number of 
surgical conditions. It appears to be especially efficient in the 
treatment of gonorrhoea (which may sometimes be aborted by 
it) and of purulent conjunctivitis (of the new born, gonorrhceal, 
etc.). In trachoma the lids may be painted with a 25 per cent, 
solution, and a 2 per cent, solution, used by instillation, is said 
to be a certain prophylactic against ophthalmia neonatorum. It 
is stated to be the only silver salt which does not permanently 
stain the conjunctiva. Laryngologists who have employed 
argyrol in different conditions of the larynx and pharynx re- 
port that it seems to be quite as effective as silver nitrate, while 
it is far more agreeable to the patient. Argyrol has also been 
used internally, in place of silver nitrate, in the treatment of 
gastric ulcer, gastritis, gastro-enteritis, etc. It is claimed for it 
that, taken internally, it is absolutely non-toxic, is not absorbed, 
and is unchanged in the stomach or intestine; hence, with it, it 
is possible to secure the local effects of silver directly upon the 
affected portions of the mucous membrane. It is advised that 
it should be taken, in doses of .30 to .60 gm. (5 to 10 grs.), in 
capsules, followed by a glass of water, three times a day. 

Internal. — Silver salts were formerly employed to a con- 
siderable extent in nervous diseases, in which they were sup- 
posed to be in some way efficacious, and the nitrate especially 
was largely used in the treatment of epilepsy. At the present 
day its long continued administration is wholly unjustifiable on 
account of the objectionable discoloration of the skin to which 
it gives rise, while we have at our disposal other remedies which 
are far more efficient. Indeed, it seems very unlikely that sil- 
ver reaches the central nervous system in any other form than 



SILVER SALTS. . 42 1 

inert granules. There are, however, some conditions met with 
in the alimentary canal in which it is considered of value, and 
if it is not used too freely, or for too long consecutive periods, 
there would appear to be little risk of inducing argyria. There 
is no case on record, it is stated, of the latter having been 
caused by less than 30 gm. (1 oz.) of silver nitrate. The gums 
should be examined from time to time, as it has been found that 
the cutaneous pigmentation is preceded by the development on 
the edge of the gum of a dark line, which is removable by a 
course of acid potassium tartrate. On account of the conversion 
which takes place in silver salts upon reaching the stomach it is 
somewhat perplexing to explain the remedial action of silver 
nitrate as an internal remedy, but clinical experience seems to 
show that it is of service in gastric ulcer and in chronic gastric 
catarrh and gastritis accompanied with sour eructations or 
with vomiting after meals. In the treatment of ulcer it is 
recommended that it should be given in pill form with extract 
of hyoscyamus or opium. Combined with opium it has been 
found effective in the diarrhoea of phthisis, and with opium and 
ipecacuanha, in the diarrhoea of typhoid fever. It has also been 
employed in other forms of diarrhoea and in dysentery. In in- 
testinal ulceration it has been highly recommended, it being 
advised that under these circumstances the drug should be 
administered in hard or keratin-coated pills, in order that it 
may pass through the stomach without being chemically 
changed. In ulceration of the caecum and rectum, as well as 
in dysentery, rectal or colonic injections of silver nitrate are 
no doubt preferable. From .60 to 1.20 gm. (10 to 20 gr.) to 500 
c.c. (1 pint) of water may be employed for this purpose. For 
high injections a flexible tube should be used, and the bowel 
should be washed out with tepid water previous to the intro- 
duction of the silver solution. As silver nitrate when given by 
the mouth is usually associated with opium or other remedies, 
it would seem open to question whether much of the benefit 
apparently attending its use in affections of the gastro-intestinal 
tract may not in reality be due to these other drugs. For use 



422 .PHARMACOLOGY AND THERAPEUTICS. 

in stomach troubles some prefer silver oxide to the nitrate, 
on account of its less caustic qualities. 

Colloidal silver, which is entirely soluble in water and in 
albuminous fluids, is unirritating, so that it can be administered 
hypodermatically and intravenously as well as by inunction, as 
is mentioned above. For internal use, to prevent its conversion 
into a chloride in the stomach, it is first dissolved in equal parts 
of albumin and glycerin. The dose of o.i gm. ( gr.) may be 
given two or three times daily. It is claimed that it has a very 
beneficial influence and often affords a rapid cure in recent and 
also in chronic sepsis when secondary changes in the vital 
organs have not occurred. It seems to inhibit the action of 
staphylococci and streptococci, or destroy them altogether. It 
has been used in various conditions: osteomyelitis, so-called 
gonorrhceal rheumatism, puerperal fever, cerebro-spinal menin- 
gitis, and septic processes in general. Thus far no instance of 
argyria from its use has been reported. 

TOXICOLOGY. 

The nitrate sometimes causes acute poisoning. 

Symptoms. — These are intense pain in the abdomen and muscular 
spasm, followed by vomiting, and generally purging. The face is livid 
and covered with perspiration. The vomited matter is black and con- 
tains coagulated mucus. If the salt is in solution, the mucous mem- 
brane of the mouth will be covered with a grayish-white membrane, 
which afterwards becomes dark-colored. Should the case terminate 
fatally, the post-mortem appearances are those commonly met with in 
acute corrosive poisoning. Chronic poisoning or argyria shows itself 
by a permanent slaty discoloration of the skin, conjunctivae and labial 
mucous membrane and ulcerations in the digestive tract. 

Treatment. — This consists of administering a solution of sodium chlo- 
ride (common salt), soothing the mucous membranes by injection of 
milk, and relieving pain with opium. The chronic form is avoided by 
interrupting the treatment, using eliminating remedies, and preventing 
staining of the skin by baths of sodium hyposulphite. 

ZINC SALTS. 

1. ZINCUM.— Zinc. 

2. ZINCI CHLORIDUM.— Zinc Chloride. (Butter of Zinc.) 






ZINC SALTS. 423 

Preparation. 
Liquor Zinci Chloridi. — Solution of Zinc Chloride. 

3. ZINCI SULPHAS.— Zinc Sulphate. (White Vitriol.) Dose 
(emetic), 1 gm.; 15 gr. 

4. ZINCI CARBONAS PR^CIPITATUS.— Precipitated Zinc Car- 
bonate. 

5. ZINCI OXIDUM.— Zinc Oxide. Dose, 0.250 gm. (250 mil- 
ligm.); 4 gr. 

Preparation. 
Unguentum Zinci Oxidi. — Ointment of Zinc Oxide. 

6. ZINCI ACETAS.— Zinc Acetate. Dose, 0.125 gm. (125 mil- 
ligm.) ; 2 gr. 

7. ZINCI STEARAS.— Zinc Stearate. 

Preparation. 
Unguentum Zinci Stearatis. — Ointment of Zinc Stearate. 

Unofficial Preparation of Zinc. 
Oleatum Zinci (U. S. P., 1890).— Oleate of Zinc. 

Action of Zinc Salts. 

External. — Zinc chloride is an energetic corrosive. It causes 
much pain and penetrates deeply, but is valuable as a caustic 
for the reason that its action is limited to the seat of application. 
It is strongly antiseptic, and constitutes the chief ingredient of 
Burnett's fluid, a well-known domestic disinfectant. Solutions 
of the chloride of moderate strength are excitant, astringent and 
slightly haemostatic. The other zinc salts are also astringent 
and mildly haemostatic, thus acting like those of silver and lead, 
though their action is less powerful. The most active of them 
are the sulphate and acetate, the oxide, stearate and precipi- 
tated carbonate being quite feeble astringents. 

Internal. — Zinc chloride is a violent corrosive poison to the 
alimentary canal, causing a burning pain in the mouth, throat 
and abdomen, with vomiting and purging, followed by collapse. 
The matter vomited is likely to contain blood and shreds of 



424 PHARMACOLOGY AND THERAPEUTICS. 

mucous membrane, and the stools may also contain blood. 
Zinc salts, as a rule, act as astringents upon the gastro-intestinal 
mucous membrane, as well as upon the abraded skin and ulcer- 
ated surfaces. They are believed to have a somewhat specific 
irritant action, affecting at first exclusively the nerve structures 
in the stomach which form the starting point of the vomiting 
reflex; consequently emesis occurs before there is time for 
corrosion, and even very large amounts may be free from dan- 
ger. The most typical in its action is the sulphate, which in 
doses of I to 1.20 gm. (15 to 20 gr.) is a very prompt emetic. 
Its action is so rapid that there is no time for nausea, and its 
depressing effects are also very slight. 

Remote Effects. — The general action of zinc salts can be 
observed only when they are thrown directly into the circula- 
tion. Injected intravenously, they appear to depress the cen- 
tral nervous system, and to a less extent the heart and volun- 
tary muscles, and to cause irritation and congestion of the 
gastro-intestinal mucous membrane, as well as inflammation of 
the kidney. Emesis is one of the effects produced, and this is 
thought to be probably due to the inflammation of the stomach 
induced by the metal, rather than to any direct action upon 
the medullary centre for vomiting. Zinc has been found to 
possess a special affinity for the haemoglobin of the blood, 
with which it forms a compound (zinc-haemol), but its ad- 
ministration has no effect on the formation of haemoglobin. 
Zinc is excreted by the stomach and intestinal walls, and 
in much smaller amounts in the bile and urine. Of the 
zinc absorbed from the stomach and intestine, most is found 
to be contained in the liver and bile. Less of it is met 
with in the spleen, kidney, thyroid and pancreas, and very 
little in the other tissues. It is said that the exhibition of 155 
gm. of zinc carbonate, in the course of 335 days, induced no 
appreciable effects in the dog, and that the continued adminis- 
tration of zinc salts has no effect in man, except those of dis- 
ordered digestion and constipation. Workers in zinc are occa- 
sionally the subjects of what is known as " brassfounders' ague," 



ZINC SALTS. 425 

an affection which is apparently due to the fumes of zinc which 
escape in the process of casting. After a period of general 
malaise, followed by prolonged rigors and shivering, soreness 
of the chest occurs, accompanied by coughing and headache. 
Then profuse perspiration supervenes and the patient falls into 
a deep sleep, from which he awakes in ordinary health. A 
number of obscure nervous conditions have been described as 
being caused by zinc in those who work with the metal, but 
they appear to be extremely rare, and when present may pos- 
sibly be due to arsenic, lead, or other impurities occurring in 
zinc compounds. 

Therapeutics of Zinc Salts. 
External. — Zinc chloride is an effective caustic for morbid 
growths, such as epitheliomata, nsevi, warts and condylomata, 
and for gangrenous sores. It may be applied in the form of a 
pencil made with plaster-of-Paris or of a paste made with 
starch, flour or dried gypsum. Canquoin's paste is a mixture 
of zinc chloride in varying strength with wheat flour and water. 
In malignant disease of the uterus the chloride has been used 
both in paste and in saturated solution applied by means of a 
tampon. Injections of zinc chloride (about 1 c.c. ; 15 Til of 
a 1 per cent, solution) have sometimes been made into the 
tissues in the vicinity of the fracture, for the purpose of pro- 
moting the union of fractured bones, and in a case of recurrent 
luxation of the shoulder the tendency to dislocation is stated 
to have been overcome by a number of injections of .12 c.c. 
(2 TT1) of a 10 per cent, solution into the anterior superior por- 
tion of the capsule below the acromion process. The same 
plan of treatment has also been applied in tuberculosis of joints 
and in lupus, and even in the early stages of pulmonary tuber- 
culosis minute quantities of such solutions have been injected 
into the lung, with the object of favoring the formation of 
fibrous tissue and thus arresting the disease. Liquor Zinci 
Chloridi, much diluted, may be employed as a detergent and 
stimulating application to old sores and as a disinfectant for 






426 PHARMACOLOGY AND THERAPEUTICS. 

wounds. Either the Liquor, or Burnett's fluid (which is a 
somewhat stronger solution), is sometimes used to disinfect 
faeces, urinals, closets, etc. Piatt's chlorides is said to consist 
of various salts of zinc, chiefly the chloride, in saturated 
solution. Lotio Rubra, a solution of the sulphate (generally 
about 1 to 240), colored red with compound tincture of lavender, 
is used as an astringent application to abraded surfaces, ulcers, 
etc., and as an injection in gonorrhoea, leucorrhcea, or otitis. 
Either alone or combined with other agents, zinc sulphate is 
very commonly employed as an injection in gonorrhoea and 
gleet and as a collyrium in conjunctivitis. The acetate (.03 to 
.06 c.c. ; y 2 to 1 gr.) in rose-water (30 c.c. ; 1 fl. oz.) is also 
useful for the latter purpose. The oxide, stearate and precipi- 
tated carbonate, either dusted on the part or in the form of oint- 
ment, may be employed in a great variety of conditions where 
only a mild astringent effect is required. The ointment of zinc 
oxide is perhaps more widely used than any other as a protective 
and slightly astringent application to acute skin affections, and 
to it are frequently added phenol, oil of cade, tar, and various 
other agents, according to the case, for the treatment of eczema, 
herpes, erysipelas, burns, etc. What is known as Unguentum 
Metallorum, which consists of equal parts of the ointments of 
zinc oxide, lead acetate, and diluted mercuric nitrate, is a ser- 
viceable application for some forms of eczema and other skin 
diseases, as well as for sores and ulcers. Another useful oint- 
ment, which has the advantage of being transparent, is the one 
already referred to (see p. 409) composed of equal parts of zinc 
oleate, mercuric oleate, and diachylon ointment. For pruritus 
the following combination is recommended : Zinc oxide, 25 ; 
gelatin, 20 ; glycerin, 60 ; water, to 480. This compound is to be 
melted and applied with a brush, after which the part should be 
covered with cotton. Unna's zinc-glue, which, when rubbed 
into the gauze or muslin of a bandage, forms a stiff surgical 
dressing, consists of 10 parts of zinc oxide, and 30 parts each 
of gelatin, glycerin and water. Good preparations of calamine 
(purified zinc carbonate), which is efficacious as a mild astring- 



ZINC SALTS. 427 

ent for cutaneous affections, are the following: An ointment 
with benzoated lard (1 to 5) and a lotion consisting of calamine, 
3; zinc oxide, 3; glycerin, 4; lime-water, 16; water, 60. 

Internal. Alimentary Canal. — Zinc chloride is not given in- 
ternally. The sulphate was formerly much employed to pro- 
duce vomiting in cases of croup, but has now for the most part 
been superseded by other remedies. It is, however, a very ser- 
viceable emetic in narcotic and other poisoning, where prompt 
and efficient action is required. It is quite safe so long as the 
mucous membrane is intact, for under these circumstances it is 
not absorbed. Practically, however, it always produces some 
irritation of the gastric walls, and its use should therefore be 
limited to cases in which the poison is not injurious to the stom- 
ach itself. Its only advantage over apomorphine appears to con- 
sist in a less degree of nausea and depression. In doses of .03 
to .12 gm. (y 2 to 2 gr.) it has been found to afford great relief 
in that form of dyspepsia which gives rise to oxaluria. Both 
the sulphate and oxide are occasionally given in chronic diar- 
rhoea and dysentery. The oxide is useful in gastralgia, and has 
been recommended, usually in association with other drugs, 
when the following conditions are present: pain after eating, 
nausea, and intestinal pain, succeeded by prompt evacuation 
of the bowels, the faeces being made up largely of undigested 
food. In the summer diarrhoea of children it is sometimes ad- 
ministered with bismuth and pepsin, and to diminish the crav- 
ing for alcohol and relieve the gastric catarrh of drunkards it 
has been employed in combination with piperin. 

Remote Effects. — The preparations of zinc have been thought 
to exert an antispasmodic influence upon the nervous system, 
and the sulphate and oxide were formerly employed to a con- 
siderable extent in the treatment of such affections as epilepsy, 
chorea, hysteria and whooping-cough. Their efficacy is doubt- 
ful, however, and they have now largely fallen into disuse as 
nervous depressants. The oxide is of some service in checking 
the night-sweats of phthisis, particularly when combined with 
extract of belladonna, but it is quite likely to interfere with 



428 PHARMACOLOGY AND THERAPEUTICS. 

the digestion. Trousseau's pill for this purpose consists of zinc 
oxide, .30 gm. (5 gr.), with extract of hyoscyamus, .06 gm. 
(1 gr.). Zinc bromide, iodide, phenosulphonate and valerate 
are considered elsewhere. 

TOXICOLOGY. 

The appearances met with after death from zinc chloride are those 
which commonly characterize the action of a gastro-intestinal irritant. 
The sulphate, in large doses, also acts as an irritant poison, producing 
colicky pains, diarrhoea and prostration. 

Treatment. — The salt itself usually produces such prompt and copious 
vomiting that other emetics are scarcely required, but these may be 
given (see p. 175), or the stomach may be washed out. Demulcents 
should then be administered : lime-water, mucilaginous drinks, and al- 
bumin freely in the form of eggs or milk. 

COPPER SULPHATE. 
CUPRI SULPHAS.— Copper Sulphate. (Cupric Sulphate. Blue 
Vitriol. Bluestone.) Dose (astringent), 0.010 gm. (10 milligm.) ; 
i/ 5 gr.; (emetic) 0.250 gm. (250 milligm.); 4 gr. 

Unofficial Preparation of Copper. 
Oleatum Cupri. — Oleate of Copper. 

Action of Copper Sulphate. 

External. — Used in substance, it is somewhat corrosive. In 
solution it acts like zinc sulphate, but is more strongly astringent 
and antiseptic. 

Internal. Alimentary Canal. — In moderate doses it is a 
prompt and efficient emetic, acting in precisely the same man- 
ner as zinc sulphate, though it is more irritant. In large quan- 
tities it causes corrosion of the gastro-intestinal mucous mem- 
brane, with violent vomiting and purging. In small doses it 
is markedly astringent. 

Remote Effects. — Small amounts may be taken for an indefi- 
nite period without giving rise to any appreciable effect, so 
that the general action of copper salts in man is unknown. In 
animals their intravenous injection in sufficient quantity in- 
duces paralysis of the spontaneous movements and of the heart 






COPPER SULPHATE. 429 

and respiration, the respiration failing somewhat earlier than 
the heart. The blood-pressure at first rises, and afterwards falls, 
in consequence of the failure of the vaso-motor nerves to main- 
tain the contraction of the vessels, as well as from the weakness 
of the heart itself. According to most observers, no emesis is 
induced, so that it seems certain that the vomiting resulting 
from the administration of copper salts by the mouth is due 
to the gastric irritation, and not to any direct action on the 
central nervous system. If the animal survives long enough, 
violent and perhaps bloody diarrhoea is generally observed. 
Copper is absorbed from the stomach and intestine, and also 
from other mucous membranes and from wounds, and the metal 
is stored chiefly in the liver, though it is found in smaller 
amount in the spleen, kidney and thyroid. It is excreted in the 
intestinal secretions, bile, urine, saliva and milk, and is said to 
pass from the mother to the foetus in utero. It is stated to 
have a strong affinity for haemoglobin, forming with it a com- 
pound called cuprohsemol, but, like zinc, does not increase the 
haemoglobin of the blood. Animals have been fed with food 
containing considerable amounts of copper for many months at 
a time without showing any special evidence of poisoning, and 
this metal, it is said, is found so regularly in the tissues of man 
and animals that it may be regarded as a normal constituent, 
although its function is quite unknown and it may be merely 
stored up on its way to excretion. 

Therapeutics of Copper Sulphate. 
External. — As a caustic it is milder in action and also less 
painful than silver nitrate. In solid form or powder it is applied 
to indolent ulcers and granulations, syphilitic and other sores in 
the mouth and throat, granular lids, corneal ulcers, etc. In 
weak aqueous solution it is sometimes employed in subacute 
conjunctivitis, but the acetate is preferable for this purpose. 
In place of the pure sulphate, what is known as Lapis Divinus 
may be used as a caustic. It consists of copper sulphate, potas- 
sium nitrate, and alum, each 24 parts, and camphor, 1 part. 



430 PHARMACOLOGY AND THERAPEUTICS. 

The camphor is added after the other ingredients have been 
fused together, and the whole mass is then cast into cylindrical 
moulds. Lotions of copper sulphate are more strongly astringent 
than those made with zinc sulphate, but are often employed for 
the same purposes in the strength of about i to 240. In this 
strength it may be instilled into the eye. Somewhat more con- 
centrated solutions have a mild haemostatic effect, and the solid 
salt is also serviceable for checking haemorrhage from slight 
wounds, leech bites, and irritable ulcers. Associated with zinc 
sulphate and lead acetate, or with fluid extract of geranium or 
other remedies, copper sulphate is used to a considerable ex- 
tent in gonorrhoea, and weak solutions of it also make good 
injections for vaginitis, leucorrhcea and gleet, as well as good 
stimulant dressings for chancres and chancroids. In the 
strength of from .60 to 1.20 gm. (10 to 20 gr.) to 30 c.c. (1 fl. 
oz.) of menstruum it is sometimes thrown into the bowel for 
the relief of chronic diarrhoea and dysentery and of acute 
diarrhoea of severe form, and a solution of .30 to .60 gm. (5 
to 10 gr.) in 30 c.c. in glycerin has been recommended as an 
injection in pseudomembranous enteritis. An aqueous solution 
of .30 gm. (5 gr.) or more to 30 c.c. (1 fl. oz.) may be used 
with good effect as a gargle in relaxed sore throat and as an 
application for hyperidrosis or bromidrosis. A solution of 30 
gm. (1 oz.) in 500 c.c. (1 pint) of water is said to be very 
efficacious in the treatment of scabies, and in weaker solutions 
and ointments copper sulphate is of service in psoriasis, sycosis 
and other forms of tinea, acne, chronic eczema, and other skin 
diseases. Thus, oleate of copper (not official), made with lano- 
lin into a 10 to 20 per cent, ointment, is an excellent parasiticide 
for ringworm. 

Internal. — As an emetic it is used in the same class of cases 
as zinc sulphate. As it is more irritant than the latter, the 
stomach should be promptly evacuated by some other means 
in any case in which it fails to produce vomiting. On account 
of its irritant effect some would restrict its use as an emetic to 
cases of phosphorus poisoning, in which it has been supposed 



COPPER SULPHATE. 43 I 

to be particularly serviceable on account of the possible deposi- 
tion of copper on the particles of phosphorus preventing the 
absorption of the latter. It is extremely doubtful, however, 
whether copper sulphate is especially valuable in this way. In 
acute dysentery it may be given with advantage combined with 
magnesium sulphate and dilute sulphuric acid, and, after the 
acute symptoms have subsided, with morphine or opium. Asso- 
ciated with opium, it is a useful palliative astringent in the 
diarrhoea of phthisis, and of all the metallic astringents in 
use, it has been pronounced the most effective in chronic diar- 
rhoea and chronic dysentery. It is regarded as indicated when 
colicky pains and tenesmus are present, and the stools, partly 
feculent, contain mucus streaked with blood, and it may be 
given in pill form in doses of .005 gm. (yL- gr.) combined with 
the same amount of morphine sulphate and .12 gm. (2 gr.) of 
quinine sulphate. When tolerance of the copper sulphate is 
established, it is advised that the dose should gradually be in- 
creased to .015 gm. (34 g r -)- I n gastro-intestinal catarrh 
also minute doses of it are of service. In some states of the 
body, particularly in cutaneous affections of the dry type and 
in persons with tubercular tendencies, it is thought to act like 
arsenic, and may be given in cases in which that drug is not 
well borne. It has been used in anaemia and chlorosis, and 
has also been recommended in the treatment of syphilis. 

TOXICOLOGY. 

Acute poisoning. — The copper is apt to give a blue or green tinge 
to the vomit and faeces, and later blood appears in them from the cor- 
rosion of the mucous membrane. There is intense abdominal pain, and 
the usual symptoms of acute corrosive poisoning may follow — collapse, 
with weak pulse and respiration, cold, clammy skin, dizziness, uncon- 
sciousness, delirium, coma, convulsions and paralysis. 

Chronic poisoning. — This is a matter of great practical interest. 
Preserved peas and other vegetables, the green color of which is due 
to preparation with copper, are in common use by the public. Copper 
is also added to flour to improve the bread made from it, and it may 
enter the food from the use of cooking utensils made of this metal 



432 PHARMACOLOGY AND THERAPEUTICS. 

and in a variety of other ways. No deleterious effects appear, as a 
rule, to result from such introduction of copper into the system, and it 
has been disputed whether chronic copper poisoning occurs in man at 
all ; especially as it is claimed that copper may be taken directly, either 
in the form of the metal or of its soluble salts, for prolonged periods 
without the production of any symptoms except perhaps more or less 
nausea and the evidences of a mild intestinal catarrh. Still, the facts 
show unquestionably that instances of chronic poisoning are occasion- 
ally met with. Among workers in copper and brass the skin and hair 
not infrequently have a greenish tint, while the upper borders of the 
teeth may show a green discoloration which is known as the " copper 
line." In addition, colic and diarrhoea, or acute febrile attacks of gas- 
trointestinal catarrh, which may be followed by local paralysis, are 
sometimes observed, and the following symptoms have also been noted : 
anaemia, wasting, dyspepsia, tremors, headache, vague pains, pharyngeal 
and laryngeal catarrh with occasional haemoptysis and aphonia, and 
profuse secretion of sweat, which may be of a greenish hue. The oc- 
currence of these various manifestations has been attributed in part 
to the deposit of copper dust upon the skin, hair and teeth, and in part 
to the lead, arsenic and other poisons often associated with copper. It 
would seem altogether probable that in a considerable proportion of 
instances such an explanation will suffice for the symptoms present, but, 
on the other hand, certain cases come under observation from time to 
time in which the evidences of chronic poisoning are indisputably due 
to copper alone. 

Treatment. — For acute poisoning give albumin, milk or magnesia. 
Potassium ferrocyanide is the chemical antidote. Then promptly empty 
the stomach and saturate the system with potassium iodide. Chronic 
poisoning is best treated by the administration of fifteen drops of diluted 
phosphoric acid before each meal, the ingestion of large quantities of 
milk, and thorough daily evacuation of the bowels with magnesium or 
sodium sulphate. 

ALUMINUM SALTS. 

1. ALUMEN. — Alum. (Aluminum and Potassium Sulphate. Potas- 
sium Alum.) Dose, 0.500 gm. (500 milligm.) ; iy 2 £*• 

Preparation. 
Alumen Exsiccatum. — Dried Alum. (Burnt Alum.) • 

2. ALUMINI HYDROXIDUM.— Aluminum Hydroxide. (Alumi- 
num Hydrate.) 

3. ALUMINI SULPHAS.— Aluminum Sulphate. 



ALUMINUM SALTS. 433 

Unofficial Preparations of Aluminum. 
Alumini Acetas. — Aluminum Acetate. 
Glyceritum Aluminis. — Glycerite of Alum. 
Alumnol. — Alumnol. (Aluminum Naphthol-Sulphonate.) 

Action of Aluminum Salts. 

External. — Aluminum salts in solution are astringent and 
haemostatic, throwing down a layer of precipitated albumin on 
the surface of mucous membranes and on raw surfaces; also 
coagulating the albumin in the underlying tissues, and thus con- 
stricting the blood-vessels. In concentrated form they act as 
irritants, and dried alum, by reason of its marked avidity for 
water, is somewhat escharotic. On account of their property 
of precipitating proteids aluminum salts are antiseptic, as well 
as astringent, and in particular the acetate (not official) in 
saturated solution is a very penetrating antiseptic. In haemor- 
rhage, when the leaking vessels can be directly reached, alum 
is a valuable haemostatic, as it acts in three ways to arrest the 
bleeding: coagulating the albumin, constringing the parts, 
and, by crystallizing when applied in large amounts on lint, 
affording a surface which is rough and aids coagulation. 

Internal. Alimentary Tract. — They have a purely local 
action, not being absorbed to any extent from the alimentary 
canal, and even very large amounts cause only a local exudative 
inflammation (in consequence of the precipitation of proteids) 
which is characterized by nausea and vomiting and in extreme 
cases by purging. In small doses they act as astringents upon 
the mucous membrane of the mouth, stomach and intestine, and 
usually cause constipation. In larger doses they are mechanical 
emetics. On account of the lack of absorption, no symptoms of 
general poisoning are induced by their internal administration, 
and their long-continued use is never attended with evidences 
of chronic poisoning. Locally, however, they have, as has been 
mentioned, a decided action, and it is probably true that their 
continued administration in even small doses will produce dele- 
terious effects. 
29 



434 PHARMACOLOGY AND THERAPEUTICS. 

Remote Effects. — The general action of aluminum salts is 
seen only when they are thrown directly into the circulation. 
Aluminum, like various other metals, acts on the intestine and 
kidney, and also appears to have a direct action on the brain. 
The intoxication is a very slow one, the symptoms appearing 
only several days after the intravenous injection, at a time when 
the metal has entirely disappeared from the blood, and has be- 
come fixed in the cells. In mammals the first symptoms are ob- 
served in from three to five days, and are found to consist in 
constipation, rapid loss of weight, weakness, torpor and vomit- 
ing. Later, marked abnormalities in movement and sensation 
are noticed, such as tremor, jerking movements, clonic con- 
vulsions, paresis of the hind legs, anaesthesia of the mouth and 
throat, and lessened sensation over all parts of the body. 
Eventually diarrhoea and albuminuria are generally noted. 
After death there are found swelling and congestion of the 
gastro-intestinal mucous membrane, fatty degeneration of the 
liver and kidney, and haemorrhages in the cortex of the latter 
organ; while aluminum is found in the urine. It has recently 
been shown also that the nerve cells of the spinal cord and 
medulla oblongata, and particularly those of the lower cranial 
nerves, undergo degeneration. What little aluminum is ab- 
sorbed from the alum salts of the food is thought to be rapidly 
excreted by the intestine and perhaps by the kidney. 

Therapeutics of Aluminum Salts. 
External. — Alum is in general use as a local astringent. 
Thus, solutions of it are applied on lint or injected in the vul- 
vitis of children, and are used as injections in leucorrhoea, 
gonorrhoea, gleet, chronic cystitis, dysentery, and haemorrhage 
from the rectum. Alum, dissolved in infusion of logwood, is 
often an efficient application for prolapsus of the rectum in 
children. In powder or strong solution it is serviceable as a 
styptic for capillary haemorrhage from wounds, haemorrhage 
after tooth-extraction, leech bites, epistaxis, bleeding from the 
gums, bleeding piles, etc. An excellent styptic combination 



ALUMINUM SALTS. 435 

consists of equal parts of glycerite of alum (not official), alcohol 
and soap liniment. The topical application of powdered alum 
is sometimes very useful in chronic pharyngitis, tonsillitis and 
nasal catarrh, and in ozsena the nasal chambers may be irrigated 
with a solution containing 4 gm. (1 dr.) to 500 c.c. (1 pint) 
of water. A solution of about the strength of .30 gm. (5 gr.) 
to 30 c.c. (1 fl. oz.) of water is employed as a gargle, and 
gargling the throat with alum dissolved in a decoction of barley, 
to which a small quantity of honey of roses is added, is said 
to be of service to speakers or singers if practised shortly be- 
fore using the voice. Alum has been used in solution as a 
mouth wash for ulcerative stomatitis and mercurial ptyalism, but 
is objectionable for this purpose, as well as for making gargles, 
as it attacks the enamel of the teeth. For conjunctivitis a watery 
solution of the glycerite may be employed as a collyrium, and 
alum curd (2 gm. ; 30 gr., of alum beaten up with the white of 
a fresh egg) is also sometimes applied externally. A solution 
containing .30 gm. (5 gr.) each of alum, copper sulphate, zinc 
sulphate, and ferrous sulphate, to 30 c.c. (1 fl. oz.) of distilled 
water, to be brushed upon the inside of the lids, once daily, 
has been recommended in chronic granular conjunctivitis. The 
local astringent action of alum may be utilized for weeping 
eczema and purpura, and, dissolved in water to which whiskey 
or alcohol is added, it may be sponged over the surface for 
night-sweats or excessive sweating of the feet or hands, or 
employed to harden the nipples of pregnant women. Alum 
solutions are also more or less effective in the treatment of bed 
sores, chilblains, and ingrowing toe-nail. In the latter condi- 
tion a piece of twisted absorbent cotton saturated with a strong 
solution is inserted under the nail. A hot solution will some- 
times relieve pruritus vulvae, and ointments containing alum 
are often useful in herpes and bromidrosis. The dried powder 
is occasionally applied as an escharotic for destroying granu- 
lations and warty growths, and is also used to stimulate in- 
dolent ulcers and mucous membranes with morbid secretions. 
Aluminum naphthol-sulphonate (alumnol, not official), in i 



43^ PHARMACOLOGY AND THERAPEUTICS. 

to 3 per cent, solutions, is an unirritating astringent which, 
although precipitating albumin, dissolves it when in excess, 
and therefore penetrates below the surface. It is used for the 
treatment of acute and chronic inflammations of various mucous 
membranes. 

Internal. — It is said that .60 gm. (10 gr.) of alum, placed 
upon the tongue, will sometimes arrest a paroxysm of asthma. 
Not being depressing, alum is a good emetic, especially for 
children suffering from croup, bronchitis, etc. 4 gm. (1 tea- 
spoonful) of powdered alum, dissolved in syrup, may be given 
every fifteen minutes until vomiting is produced. As an internal 
astringent or haemostatic it is not as a rule as efficient as some 
other remedies, but in the form of alum whey (milk curdled 
by alum), it may often be given with advantage in cases of 
typhoid fever in which the diarrhoea calls for special treatment. 
In intestinal haemorrhage when dependent upon mechanical 
causes, such as cirrhosis, if the mucous membrane is free from 
acute inflammation, and in haematemesis when the haemorrhage 
is passive and the gastric mucous membrane relaxed, alum is 
likely to be of service. It may also be used in catarrh of the 
stomach, especially where there is vomiting of glairy mucus; a 
pill containing .24 gm. (4 gr.) of alum and .06 gm. (1 gr.) of 
extract of gentian being administered three times a day. Alum 
is one of the most effective of all remedies in the treatment of 
lead colic, and by many it is considered to relieve the pain and 
nausea and overcome the constipation of plumbism more 
certainly than any other agent. Its beneficial action is at- 
tributed by some to the fact that, being a sulphate, it 
precipitates any lead salts present in the intestine as in- 
soluble lead sulphates. Others, however, hold that the chem- 
ical theory of its action is entirely inadequate to account 
for its remarkable effects, believing that the conversion of 
any portion of the lead present into the insoluble sul- 
phate would not suffice to quiet pain, relieve flatulence, and 
relax the obstinately constipated bowels. The explanation they 
bring forward is that its action is doubtless dynamical, being 



KAOLIN. 437 

exerted upon the muscular layer of the bowel, on the abnormal 
condition of which the phenomena of lead colic depend. Still 
others, finding that alum is of service when there is no lead in 
the alimentary canal, state that it must act in some way as 
yet unknown. Being a soluble sulphate, as well as an emetic, 
alum may also be used as an antidote in acute lead poisoning. 
In the form of a very fine spray a strong solution of alum, 1.20 
gm. (20 gr.) to 30 c.c. (1 fl. oz.), is sometimes efficacious in 
haemoptysis, and such a spray may also be employed in bron- 
chorrhoea and in chronic catarrh of the pharynx and larynx. 

KAOLIN. 
KAOLINUM.— Kaolin. 

Preparation. 
Cataplasma Kaolini. — Cataplasm of Kaolin. (Kaolin Poul- 
tice.) 

Action of Kaolin. 

Kaolin is emollient and a drying agent; it has the power in 
a pronounced degree of clarifying and decolorizing oils, 
whether animal, vegetable or mineral. 

Therapeutics of Kaolin. 
Kaolin is an efficient dusting powder for inflamed surfaces 
and irritated conditions of the skin. As it is resistant to most 
chemical agents, it is used as a basis for making pills of such 
substances as phosphorus, silver nitrate, and potassium per- 
manganate, in which chemical reaction would ordinarily take 
place. An excellent substitute for poultices is made as follows : 
Kaolin, 1000 parts, is sifted and sterilized by heat; glycerin, 
1000 parts, is added (the heat being continued) and mixed by 
stirring for half an hour. When nearly cool, add boric acid, 
100 parts, and oil of peppermint, 1, oil of wintergreen, 1, and 
oil of eucalyptus, 2 parts. The Cataplasma Kaolini which is 
now official is made as follows: Kaolin, in very fine powder, 
577, is heated at ioo° C. (212 F.), with occasional stirring, 
for one hour, after which boric acid, 45, is mixed intimately 



438 PHARMACOLOGY AND THERAPEUTICS. 

with it and the mixture thoroughly incorporated with glycerin, 
375. Finally, thymol, 0.5, dissolved in methyl salicylate, 2, and 
oil of peppermint, 0.5, are added, and a homogeneous mass 
produced. Kaolin is employed to quite a large extent in 
clarifying oils, such as lard and cotton-seed oils and mineral 
lubricating oils, as well as wine, beer, honey, syrups, etc. 

3. Emollients and Demulcents. 

STEARIC ACID. 

ACIDUM STEARICUM.— Stearic Acid. 

Preparations. 
Zinci Stearas. — Zinc Stearate. 
Unguentum Zinci Stearatis. — Ointment of Zinc Stearate. 

Action of Stearic Acid. 
Stearic acid has no known general action upon man. 

Therapeutics of Stearic Acid. 
Stearic acid is used in the manufacture of glycerin supposi- 
tories. Stearates of zinc and copper (the latter unofficial) 
have been introduced and used with success in the treatment 
of various diseases of the skin and mucous membranes. 

WOOL-FAT. 
ADEPS LAKflB.— Wool-Fat. 

Preparation. 
Adeps Lanae Hydrosus. — Hydrous Wool-Fat. (Lanolin. 
CEsypum.) 

Action of Hydrous Wool-Fat. 
Hydrous wool-fat is very soothing to the skin, and when 
gently rubbed in is more quickly absorbed than most fats. 

Therapeutics of Hydrous Wool-Fat. 
As it assists the glandular functions of the skin, it is useful 
in comedo and anidrosis. In ichthyosis and scleroderma and 



ISINGLASS. 439 

in senile atrophy of the integument it softens the surface, and 
inunction with it is considered one of the best methods of 
obliterating wrinkles. It is serviceable as an application for 
chapped hands and lips, burns, scalds, frost-bite, erythema, 
impetigo contagiosa, dermatitis, erysipelas and acute eczema, 
and, when it contains a sufficient amount of water, is efficient 
in allaying the itching of scarlet fever and other exanthematous 
diseases. In chronic eczema with infiltration and in psoriasis it 
softens the skin and favors the action of remedies which may 
be combined with it. It is often an excellent basis for oint- 
ments expected to act especially upon the skin, but as it passes 
readily through the integument, it is not well adapted for a 
protective. It is a useful vehicle for remedies to be used by 
inunction, and on account of its penetrative power, as well as 
its ready miscibility with mercury, it is of peculiar value in 
the inunction treatment of syphilis. It is employed to a con- 
siderable extent also as a vehicle for cocaine in affections of 
the nose and genito-urinary tract, and for cocaine, morphine, 
atropine and other anodynes in neuralgias and painful joints. 
It is not used internally. 

ISINGLASS. 
ICHTHYOCOLLA (U. S. P., 1890; no longer official).— Isinglass. 
Unofficial Preparation. 
Emplastrum Ichtliyocollse (U. S. P., 1890). — Isinglass Plas- 
ter. (Court Plaster.) 

Action of Isinglass. 
Isinglass is an emollient and nutritive substance. 

Therapeutics of Isinglass. 
It is chiefly used externally as a protective. A better court 
plaster has goldbeaters' skin as a base. Salicylated isinglass 
plaster has the advantage of the antiseptic properties of salicylic 
acid. A codliver-oil jelly may be made by means of isinglass 
which, flavored with the oils of almond, cinnamon and allspice, 
is readily taken by children. 



440 PHARMACOLOGY AND THERAPEUTICS. 

LARD. 

1. ADEPS.— Lard. 

Preparations. 

1. Adeps Benzoinatus. — Benzoinated Lard. 

2. Ceratum. — Cerate. 

3. Ceratum Resinae. — Rosin Cerate. 

4. Ceratum Resinae Compositum. — Compound Rosin Cerate. 

5. Unguentum. — Ointment. 

2. OLEUM ADIPIS.— Lard Oil. 

• Action of Lard. 
Lard is one of the best emollients, its application to the skin 
being followed by a pleasant feeling of softness and flexibility. 
Melting at the temperature of the body, it is readily absorbed 
by the integument. The benzoated lard has the advantage of 
not quickly becoming rancid, but it is irritating to tender skins. 

Therapeutics of Lard. 
Lard has been used with some success as a soothing enema in 
dysentery. When the secretory formation of the skin is im- 
paired or suppressed, inunction with lard serves as a partial 
substitute for the natural secretion, and such inunction is some- 
times employed by professional rubbers as an aid to friction. 
It is also of service in chest affections. Washed lard, beaten 
up with an equal quantity of lime water, and a few drops of 
oil of bitter almond, thymol, or carbolic acid added, is said to 
make an elegant substitute for Carron oil as a dressing for 
burns, as well as for some acute inflammations of the skin. On 
account of its penetrating power, active agents, such as mer- 
cury and the alkaloids, can be combined with lard for adminis- 
tration by inunction, and its chief use in medicine is as a basis 
for ointments. 

SPERMACETI. 

CETACEUM.— Spermaceti. 

Preparation. 
Unguentum Aquae Rosas. — Ointment of Rose Water. 



CHAULMOOGRA OIL. 44 I 

Unofficial Preparation. 
Ceratum Cetacei (U. S. P., 1890). — Spermaceti Cerate. 

Action of Spermaceti. 
Spermaceti is emollient and demulcent. 

Therapeutics of Spermaceti. 
It is used almost entirely as a basis for ointments and cerates. 
In the form of powder, which may be obtained by triturating 
it with a little alcohol, spermaceti is sometimes employed, 
mixed with an equal weight of talc, as a dusting powder for 
the feet, for the purpose of preventing friction. 

EGG. 

Unofficial Preparations. 

1. Vitellus (U. S. P., 1890).— Yolk of Egg. 

2. Glyceritum Vitelli (U. S. P., 1890).— Glycerite of Yolk of 
Egg. (Glyconin.) Dose, freely. 

3. Ovi Albumin. — Egg Albumin. 

Action of Yolk of Egg. 
Yolk of egg is nutritive and emollient. 

Therapeutics of Yolk of Egg. 
It is used to make emulsions. 

Action of Egg Albumin. 
Like the yolk of egg, it is nutritive and emollient. 

Therapeutics of Egg Albumin. 
Egg albumin is an antidote to poisoning by corrosives and 
irritants, especially corrosive -mercuric chloride, copper sul- 
phate, lead salts, and silver nitrate. 

CHAULMOOGRA OIL. 

Unofficial Preparation. 
Oleum Gynocardiae.— Chaulmoogra Oil. Dose, 0.30 to 1.20 
c.c.; 5 to 20 m,. 



442 PHARMACOLOGY AND THERAPEUTICS. 

Action of Chaulmoogra Oil. 

It is a local irritant, apparently similar in character to can- 
tharidin and other agents of its class, though less energetic in 
its action. 

Therapeutics of Chaulmoogra Oil. 

It has been largely employed as a local application for bruises, 
sprains and stiffness by athletes, and also in veterinary practice. 
It is recommended as a stimulant in scaly eczema, psoriasis, 
ichthyosis, syphilitic cutaneous lesions, chronic rheumatism, etc., 
and for such purposes an ointment composed of 3 parts of 
chaulmoogra oil to 8 of lanolin may be employed. It is best 
known as a remedy for leprosy, in which it has been extensively 
tried both externally and internally. It is not apparently cura- 
tive, but the bacilli of the disease present in the blood have 
been shown to decrease in number under its use, and it is un- 
doubtedly one of the best agents at our command in this intract- 
able affection. Internally it is usually administered in capsules. 

PETROLATUM. 
PETROLATUM (Petrolatum Molle, Petrolatum Spissum, U. S. P., 
1890) . — Petrolatum. 
PETROLATUM ALBUM.— White Petrolatum. 
PETROLATUM LIQUIDUM.— Liquid Petrolatum. 

Action of Petrolatum. 

Petrolatum is purely emollient. None of the petroleums are 
nutritive. 

Therapeutics of Petrolatum. 

Petrolatum is used principally as a bland, neutral protective, 
and, because it does not become rancid nor act as an irritant, 
and as it is not affected by acids, alkalies or powerful reducing 
agents, it is employed as a substitute for fatty materials in oint- 
ments. But as it is absorbed with difficulty it is not a suitable 
vehicle for drugs which are intended for absorption through the 
skin. Liquid petrolatum has been used as a local soothing ap- 



cotton. 443 

plication in inflammation of the mucous membrane of the nose, 
throat, larynx, and even of the bronchial tubes, by means of 
an atomizer. It may also be employed as a vehicle for various 
medicinal substances. 

COTTON. 

1. GOSSYPIUM PURIFICATUM.— Purified Cotton. (Absorbent 
Cotton.) 

2. PYROXYLINUM.— Pyroxylin. (Gun Cotton.) 

Preparations. 

1. Collodium. — Collodion. 

2. Collodium Flexile. — Flexible Collodion. 

3. Collodium Cantharidatum. — Cantharidal Collodion. (Blis- 
tering Collodion.) 

4. Collodium Stypticum. — Styptic Collodion. 

3. OLEUM GOSSYPII SEMINIS.— Cotton Seed Oil. Dose, 16 
c.c; 4 fl. dr. 

Action of Cotton. 

None. 

Therapeutics of Cotton. 

Cotton is used in various forms as a covering, protection, or 
support, and also for the topical application of remedies. Ab- 
sorbent cotton, lint and gauze are frequently medicated, e. g., Sal 
Alembroth, 2 per cent.; Boric Acid, 5 or 10 per cent.; Salicylic 
Acid, 5 per cent; Chrysarobin, 10 per cent.; Phenol, 5 per 
cent.; Iodoform, 5, 10 and 50 per cent. The only use of py- 
roxylin is for making collodion, which, when painted on the 
skin, quickly forms a thin and dry protective film over it, in 
consequence of the evaporation of the ether. Flexible collodion 
has the advantage over ordinary collodion of not cracking when 
thus dried on the integument. These preparations are pro- 
tective to small wounds and excoriated surfaces, and are used 
after slight operations. The edges of larger wounds may be 
drawn together and kept in position by strips of gauze, which 
are made to adhere to the skin by the application of several 



444 PHARMACOLOGY AND THERAPEUTICS. 

coats of flexible collodion. Collodion is especially serviceable 
for scalp-wounds, in which it often renders a bandage unneces- 
sary. The contraction and compression resulting from the dry- 
ing of the substance are sometimes utilized in the abortive treat- 
ment of boils and styes, and of the papules of small-pox (to 
prevent pitting), as well as in the treatment of epididymitis (in 
which the testicle and cord are freely painted over with it), 
of umbilical hernia, of varicocele, and of spina bifida. Collo- 
dion may also be applied in superficial burns, in erysipelas, and 
in herpes zoster, and, after the parts have been antiseptically 
cleansed with a phenol solution, it often affords relief in 
pruritus ani. The closing of the orifice of the urethra or the 
prepuce with it at bedtime is sometimes successful in putting 
a stop to nocturnal incontinence of urine in male children. Sev- 
eral cases of tuberculous peritonitis have been reported by 
French physicians in which the repeated application of collo- 
dion to the entire surface of the abdomen was followed by 
recovery. 

Action of Cotton Seed Oil. 
Cotton seed oil is nutrient and emollient. 

Therapeutics of Cotton Seed Oil. 
This is used simply as a bland, nutritious oil, and in lini- 
ments. 

OIL OF THEOBROMA. 
OLEUM THEOBROMATIS.— Oil of Theobroma. (Cacao Butter.) 

Action of Oil of Theobroma. 
Oil of theobroma is nutrient and emollient. 

Therapeutics of Oil of Theobroma. 
Oil of theobroma is used to make suppositories, and as a 
source of stearic acid. It is also used by inunction to improve 
the nutrition of the body. Its slight tendency to become oxi- 
dized renders it serviceable for preserving steel instruments 
from corrosion by exposure to the air. 



FLAXSEED. 445 

FLAXSEED. 

LINUM.— Linseed. Flaxseed. 

OLEUM LINL— Linseed Oil. (Flaxseed Oil.) Dose, 30 C.C.; 1 fl. 
oz. 

Preparation. 

Linimentum Calcis. — Lime Liniment. 

Action of Flaxseed. 
Flaxseed is demulcent and emollient. It has been thought 
by some to have expectorant qualities, but it probably has no 
direct action on the bronchial mucous membrane. It is mildly 
diuretic, and its preparations, if given in sufficient amount, have 
a laxative effect. Its diuretic action, it is believed, may be 
due to the excretion by the kidneys of the resinoid oxidation 
products formed from the oil. 

Therapeutics of Flaxseed. 
Externally the meal (lini farina), in the form of poultices 
(4 to io of boiling water with constant stirring and the basin 
being kept hot), is very extensively used for the purpose of 
applying warmth and moisture, especially in inflammatory con- 
ditions, both superficial and deep-seated. It relaxes the tissues 
and relieves pain. It tends to check inflammation if applied 
early, and accelerates the evacuation of pus after suppuration 
has commenced. The poultice, as ordinarily used, however, is 
uncleanly, and has come to be regarded as a hot-bed for bac- 
teria and not infrequently a means of favoring the extension 
of the infectious process present. It has been suggested as a 
good method of preparing poultices to make several bags of 
suitable size, of either of the fabrics known as Swiss and 
cheese cloth, fill them half-full with flaxseed meal, and then 
sew up the open ends. When wanted for use, one of these 
bags is submerged in boiling water for a few minutes (which 
causes the meal to swell so as to fill the bag), and, after the 
superfluous water has been squeezed out, it is laid on the 
affected part and covered with oiled silk and a bandage. Care 



446 PHARMACOLOGY AND THERAPEUTICS. 

should, of course be taken not to apply the poultice so hot as 
to scald the skin. Flaxseed and other poultices not only pro- 
mote local vascular dilatation, but also have a counter-irritant 
effect. Their action may be increased, if desired, by the addi- 
tion of 1 part of mustard to 16 of the material composing the 
poultice, or by smearing the surface to be covered with equal 
parts of belladonna and glycerin, or sprinkling on it a little 
dry mustard or a few drops of turpentine. Laudanum, or lead- 
water and laudanum, may be incorporated in the poultice or 
applied under it if there is much pain or if the skin is broken. 
Poultices are also sometimes medicated with astringents and 
other agents. Linseed oil, made into an emulsion with an equal 
part of lime-water which is popularly known as Carron oil 
(the official Linimentum Calcis), was long a favorite remedy 
for burns, but as it is uncleanly and has a disagreeable odor, it 
has largely been supplanted by other agents. The oil is also 
sometimes used for laxative purposes as an enema, especially 
in children. An infusion of flaxseed, 15 gm. ( x / 2 oz.) to 500 
c.c. (1 pint), is considered an excellent enema in inflammation 
of the rectum, fissure, piles, etc., and is also used as an injection 
in irritations of the bladder and vagina. Flaxseed mucilage, 
prepared by boiling the seed, has been employed to a con- 
siderable extent as an external application in erysipelatous and 
other cutaneous inflammations, burns, etc., but if allowed to 
get dry it renders the skin stiff. Lead acetate is sometimes dis- 
solved in it, precipitating the solution of lead subacetate. Flax- 
seed tea (flaxseed, 3; liquorice, 1; boiling water, 100; infuse 
for two hours) is a common domestic demulcent, which is used 
especially in acute bronchitis and sore throat. If given hot it 
has a diaphoretic effect, and the large amount of mucilage which 
it contains renders it very soothing to the inflamed mucous 
membrane. In the mouth and pharynx it forms a coating 
which is of service in relieving " tickling of the throat " and 
irritative cough. The hot infusion is also used to a considerable 
extent in enteritis and dysentery and in irritation of the stomach 
and the kidneys, cystitis, strangury, etc. It should never be 



olive oil. 447 

boiled during the process of preparing it, as the application 
of too much heat causes the extraction of more or less of the 
oil, and so renders it less palatable. Lemon and sugar may be 
added, according to the taste of the patient, and it may be taken 
ad libitum. Whole flaxseed, in doses of 15 gm. { J / 2 oz.), is 
occasionally used as a laxative in habitual constipation, and the 
oil in doses of 60 c.c. (2 fl. oz.) has been recommended as a 
laxative in the treatment of haemorrhoids. 

OLIVE OIL. 
OLEUM OLIV^E.— Olive Oil. (Sweet Oil.) Dose, 30 C.C.; 1 fl. oz. 

Unofficial Preparation. 
Eunatrol.— Eunatrol. (Sodium Oleate.) Dose, 2 to 5 gm.; 
30 to 80 grs. daily. 

Action of Olive Oil. 
Olive oil is lubricant, emollient, demulcent, nutritive and 
mildly laxative. Externally applied it acts as a protective to the 
skin, which it renders soft and pliant. When rubbed in with suffi- 
cient friction it is absorbed, and afterwards assimilated by the 
system. Taken by the mouth, it is, like other oils, partly emulsi- 
fied and partly saponified in the intestine, and the olein it con- 
tains is finally deposited in the body as fat. If the quantity 
ingested is larger than can be absorbed, the excess will appear 
unchanged in the urine. 

Therapeutics of Olive Oil. 
External. — It is much used to facilitate the rubbing of joints 
and other parts of the body. It is sometimes employed in mas- 
sage, but lanolin and neat's-foot oil are considered the best 
forms of grease for this purpose. Unless the skin is very 
harsh, dry or scaly, however, the manipulation can usually be 
more efficiently performed without any lubricant. Warm olive 
oil is useful for removing crusts in such conditions as sebor- 
rhcea, eczema and psoriasis. It should not be allowed to get 



448 PHARMACOLOGY AND THERAPEUTICS. 

into the eyes, as it is liable to produce considerable irritation 
if it comes in contact with the conjunctiva. It is a common 
soothing protective in burns and acute inflammatory affections 
of the skin, coating the surface and excluding the air. In the 
former it is sometimes used in place of linseed oil in Linimentum 
Calcis (see p. 446). Carbolized oil (1 to 24) often constitutes 
a good dressing for wounds. Olive oil is employed as an emol- 
lient addition to poultices, and with poultices applied in the 
ordinary way it is of service in preventing them from adhering; 
for this purpose it may either be incorporated in the poultice 
or smeared on the surface to which the latter is to be applied. 
As it is absorbed by the lymphatics when rubbed vigorously into 
the skin, it may be used in this way for the purposes of a food 
in cases where sufficient nourishment cannot be taken by the 
mouth. As a nutritive, however, it is less valuable than codliver 
oil, which is administered to a considerable extent by inunction 
in wasting diseases. Oil inunctions are of great service in 
scarlet fever and other exanthematous diseases. They reduce 
temperature and are very grateful to the patient; allaying the 
burning heat and itching of the skin, and in this way diminish- 
ing excitement and restlessness. Their antipyretic effect is also 
probably due to a considerable extent to their influence in 
mitigating one of the chief sources of distress in this class of 
affections. They are especially valuable in the desquamative 
stage of scarlet fever, where they serve a prophylactic purpose 
by preventing the dispersion of the scales in the atmosphere. 
For inunction in fevers carbolized olive oil (1 to 40) is a very 
good preparation, possessing as it does disinfecting properties; 
though cocoa-butter is a more elegant one, and some consider 
benzoated lard the most satisfactory. By dropping a little 
olive oil into the auditory canal insects can readily be removed 
from the ear. The oil was formerly much used as a lubricant 
for catheters, sounds and other instruments, but vaseline has 
here replaced it to a considerable extent. It is employed as an 
ingredient in many liniments, plasters, ointments and cerates, 
but the foreign article is so frequently adulterated with inferior 



olive oil. 449 

oils that cotton-seed oil is now directed in its place in many 
official preparations. A very large proportion of the olive oil 
of commerce at the present day is known to be in reality cotton- 
seed oil, and there appears, indeed, to be no appreciable differ- 
ence between the physiological and therapeutic properties of the 
two, although cotton-seed oil is not so agreeable in flavor. 
Olive oil is a common application in the bites and stings of in- 
sects, and in some parts of Europe and the east it is used both 
locally and internally in the treatment of snake bites. 

Internal. — From ancient times to the present it has been a 
regular article of diet in olive-growing lands, but, except as an 
ingredient of salad-dressings, it is not much used as a food in 
this country. Taken promptly into the stomach in sufficient 
quantity, it is useful in mitigating the effects of irritating 
poisons, but it should not be employed after phosphorus has 
been swallowed, as the latter dissolves in it. As a laxative it 
is much used (in teaspoonful doses) for infants, and it also 
answers very well sometimes in adults. Where the patient does 
not object to its taste it may be advantageously given with 
food. It is especially recommended in the constipation caused 
by opium and as a demulcent laxative in haemorrhoids and fissure 
of the anus. Occasionally it has been successful, when given 
in large doses, in causing the expulsion of tape-worms. On 
account of its blandness it is frequently prescribed in the form 
of an enema, which may be composed entirely of olive oil or of 
oil and warm mucilage of starch in the proportion of 15 to 18. 
The soap enema (soap, 1 ; warm water, 32), however, is the one 
most generally employed for ordinary purposes. Olive oil is 
sometimes injected into the rectum to get rid of thread- worms, 
but is not as reliable as some other agents. It has been found 
very useful in the case of workmen employed in white-lead 
factories in keeping the bowels free and preventing the absorption 
of the metal, and it is also efficient in the treatment of lead colic 
itself. There is now at command abundant clinical evidence of 
the marked value of olive oil in biliary calculi. While out- 
side the body the oil is a solvent for cholesterin, the chief con- 



45 O PHARMACOLOGY AND THERAPEUTICS. 

stituent of gall-stones, it has been doubted by some if when 
taken internally, even in very large amount, it is possible for 
the oil to exert this solvent action. High authorities claim that 
it does assist materially in the solution of calculi ; but whether 
this is the case or not, there can be no question that it is of 
very great service in cholelithiasis by increasing the watery 
secretion of bile. It is recommended that not less than from 
60 to 250 c.c. (2 to 8 fl. oz.) should be taken daily. It may be 
rendered more palatable by the addition of a small quantity of 
menthol and 4 c.c. (1 fl. dr.) of brandy to each 250 c.c. (half- 
pint), or it may be given in aromatized emulsion with a little 
brandy or whiskey. Certain patients can take it better mixed 
with fish, mashed potatoes, or other kinds of food. Some assert 
that the best results may be obtained by giving from 30 to 60 
c.c. (1 to 2 fl. oz.) of olive oil in hot milk for ten nights in 
succession. The remedy is then omitted for a week, and this 
course is kept up for a number of months. In addition to the 
treatment of the gall-stones themselves, sodium benzoate and 
salicylate are recommended as intestinal antiseptics. Eunatrol, 
or pure sodium oleate, is also stimulating to the biliary secre- 
tion and has been found useful in gall-stone disease. From 
2 to 2.40 gm. (30 to 40 gr.) may be taken daily, in .30 gm. 
(5 g r piU s or capsules. Olive oil, in doses increasing from 
15 to 90 c.c. (y 2 to 3 fl. oz.), is said to have caused the dis- 
appearance of obstructive jaundice. In obstinate and painful 
cases of dry pleurisy a small quantity of the oil, sterilized, has 
been injected into the pleural sac with the idea of imitating 
Nature in providing a lubricating fluid. 

OLEIC ACID. 

ACIDUM OLEICUM.— Oleic Acid. 

Action of Oleic Acid. 
Oleic acid is bland and unirritating, and penetrates the skin 
more readily than fats and oils. 



SOAP. 451 

Therapeutics of Oleic Acid. 
It is not employed by itself in medicine, but used pharma- 
ceutically in the preparation of oleates and also in plasters and 
soaps. Oleates, which are readily soluble in fats, and thereby 
rendered more efficient for local application, are made from 
the alkaloids, not from their salts. If metals are employed, 
the oxides only are chosen. The oleates are used for the pur- 
pose of securing the absorption of drugs through the skin. 
Many substances which are either not absorbed at all or only 
to a very limited extent from aqueous, are freely absorbed from 
oily, solutions, while many which are not soluble in oils dissolve 
in oleic acid. Hence the special utility of the oleates. Besides 
the official oleates, a considerable number of others are also 
now in use. Some of them, such as the oleates of copper and 
mercury, are excellent parasiticides, and this class of prepara- 
tions is steadily growing in favor in the treatment of cutaneous 
affections generally, as well as of a variety of other conditions. 

SOAP. 

1. SAPO.— Soap. (White Castile Soap. Hard Soap.) 

Preparations. 

1. Emplastrum Saponis. — Soap Plaster. 

2. Linimentum Saponis. — Soap Liniment. (Opodeldoc.) 

2. SAPO MOLLIS.— Soft Soap. (Green Soap.) 

Preparation. 
Linimentum Saponis Mollis. — Liniment of Soft Soap. (Tinc- 
tura Saponis Viridis.) 

Unofficial Preparation. 
Sapo ' Animalis (B. P.). — Curd Soap. 

Action of Soap. 
Externally soap is detergent and discutient, combining with 
the fat of the excretions and removing, along with this, epi- 



452 PHARMACOLOGY AND THERAPEUTICS. 

thelial scales, bacteria and dirt, or other foreign matter. In- 
ternally it is laxative and antacid. While it softens the epi- 
dermis, it may set up considerable irritation if applied too long 
or with too much friction, or if the soap used is too strongly 
alkaline or not sufficiently diluted with water. 

Therapeutics of Soap. 
In modern surgery it is customary to scrub the part to be 
operated upon with hard soap and water before washing it 
with an antiseptic solution. Good Castile soap is considered the 
best representative of a pure soap to be had. Hard soap, in 
powder, is used to some extent as an ingredient of dentifrices, 
and it no doubt aids in the preservation of the teeth. In recent 
years it has been considerably employed for medicated soaps, 
which, if judiciously applied, are decidedly beneficial in a 
variety of cutaneous affections. Among the agents commonly 
incorporated in them are sulphur, tar, phenol, mercuric bi- 
chloride, ichthyol, eucalyptol, naphthol and salicylic acid. In 
ordering a medicated soap the desired percentage of the drug 
to be used should be given in the prescription. Soaps are 
ordinarily used for cleansing. Most toilet soaps, it has been 
pointed out, are too strongly alkaline and often contain irritating 
essential oils; while many cheap kinds are made with animal 
fat which has not been properly purified, and therefore liable 
to contain the bacteria of putrefaction and possibly of disease. 
In the case of persons with delicate skins, and especially in- 
fants, it is very important that only a bland and pure article 
should be selected. A carefully prepared glycerin soap is be- 
lieved to be, on the whole, the best for the skin. Soap mixed 
with brown sugar has long been a favorite domestic remedy 
in the local treatment of boils. It makes a useful stimulating 
dressing, and, if applied sufficiently early, appears to mitigate 
the pain as well as quicken suppuration. Soap suppositories 
inserted in the rectum generally cause a prompt evacuation of 
the bowels, and are frequently resorted to in the constipation 
of infants. For use in adults, particularly, their efficiency may 



soap. 453 

be increased by the addition of glycerin. Hard soap is a good 
excipient for pills, and it forms the basis of several of those in 
the Pharmacopoeia. Soap is of considerable value as an anti- 
dote in poisoning by acids and other irritants. It also acts as 
an aid to emetics, and has the great advantage of being always 
accessible. In such cases its use should be resorted to at the 
earliest possible moment and continued until more powerful 
alkalies, such as chalk, magnesia, or sodium bicarbonate, can be 
obtained. A teacupful of solution of soap, in the proportion of 
about one to four, by weight, of water, may be repeated at short 
intervals until the patient has taken all that he can swallow. 
If promptly applied, soapsuds are also an excellent remedy for 
external burns by acids and by phosphorus. Soap was formerly 
used to some extent in dyspepsia attended with inactivity of 
the liver and constipation, and is still occasionally employed in 
acidity of the stomach, as it is readily decomposed by very 
weak acids, which combine with the alkali. Even as an antacid, 
however, it has been largely supplanted by other agents, and 
it is very rarely given internally at all except in combina- 
tion with other agents in pills. By its alkaline properties 
it may afford more or less relief in cystitis, but the claim 
once made for it that it is a solvent for vesical calculi 
has long since been disproved. Soap plaster is protective 
against bed-sores, and is also sometimes used as a support 
about sprained joints. Linimentum Saponis is a cutaneous 
stimulant. It is employed with friction in sprains, stiffness of 
the joints or muscles, etc., and it constitutes the basis of the 
official chloroform liniment. It is also a favorite basis for ex- 
temporaneous liniment prescriptions, and such agents as aconite, 
opium and belladonna are frequently combined with it. 

Soft soap, which is also known as green soap, although it is 
not generally green, but of a brownish color, is much more 
strongly alkaline than hard, and, containing free potassium 
hydroxide, as it does, is decidedly irritant. It has a soft- 
ening effect on tissues with which it comes in contact, 
and is therefore of considerable service in chronic indur- 



454 PHARMACOLOGY AND THERAPEUTICS. 

ations of the skin. One of its uses is to remove crusts 
and epithelial scales in cutaneous affections. It is also of 
value in the general treatment of a number of diseases of 
the skin, and among the more prominent of those in which 
it has proved of service are chronic psoriasis, acne, tinea, and 
even lupus. If there is much itching, it may be combined with 
oil of cade. For chronic eczema it has been found that the 
best form in which to use it is the Linimentum Saponis Mollis, 
which should be well rubbed into the affected part and fol- 
lowed by a soothing application, such as simple cerate. The 
liniment is an excellent cleansing agent for the scalp, especially 
in seborrhoea, and for shampooing purposes it should be diluted 
with three parts of alcohol or Cologne water. When pediculi are 
present it is useful in preparing the way for a parasiticide appli- 
cation by dissolving the adhesion of the nits to the hair shafts. 
This, like the Linimentum Saponis, is also employed as an appli- 
cation, usually enforced by more energetic medicinal agents, 
for sprains, stiff joints, etc. Soft soap is furthermore used 
locally in the treatment of enlarged glands, whether the con- 
dition is a simple inflammatory one or of strumous or syphilitic 
origin. Its external application may be of some service, as well, 
in other strumous or tuberculous conditions, such as disease 
of the mesenteric glands or periostitis, and in exudations into 
serous cavities. One of the most common uses of both hard 
and soft soap is for purgative enemata; but the latter is de- 
cidedly preferable. For this purpose either may be made into 
a lather with 500 c.c. (1 pint) or more of water at a tempera- 
ture of 37.8 C. (ioo° F.). Soap enemata are somewhat liable 
to give rise to an erythematous or urticarial eruption, and this 
appears to be especially the case with those made with hard 
soap. In some individuals such a rash makes its appearance 
regularly after each injection, however often the enema may 
be repeated. This may be due to some irritant in the soap em- 
ployed, or possibly, as some are inclined to believe, may result 
from the solution and consequent absorption of some fsecal 
toxin. Doubt has been expressed whether the rectal injection 



raisins. 455 

of soap and water has any more effect in causing an evacuation 
of the bowels than would an enema of warm water alone or the 
same quantity of thin oatmeal gruel; but it seems altogether 
probable that the soap itself has some purgative action, though 
this may sometimes be but slight. In order to increase the effi- 
ciency of a soap enema it may be advisable to add to it a cer- 
tain amount of castor oil. The quantity of soft soap used is 
usually about 30 c.c. (1 fl. oz.). In some hospitals there is 
employed an enema, known as the " House Mixture," which 
consists of soft soap, molasses and water in varying proportions, 
and to which turpentine and olive oil are added if flatulence be 
present. This, it is claimed, is " as efficient as it is cheap and 
dirty." 

Sapo Animalis, or curd soap, consists chiefly of sodium 
stearate, and, like other soaps, it is detergent. Its solution 
in boiling alcohol, after cooling, forms a jelly-like mass which 
constitutes the basis of hard opodeldoc. Curd soap is also used 
as a basis for plasters, liniments, pills and suppositories. Em- 
plastrum Saponis Fuscum (brown soap plaster, not official) is 
curd soap, 20 ; yellow wax, 25 : olive oil, 40 : lead oxide, 30 ; 
vinegar, 320. 

RAISINS. 

JJYJE. — Raisins (not official). 

Action of Raisixs. 

Raisins are demulcent and nutritive. Taken in bulk, they 
are slightly laxative, but are difficult of digestion and liable to 
produce flatulence. The fresh pulp has some diuretic action, 
which is attributed in great part to the grape-sugar which it 
contains. 

Therapeutics of Raisixs. 

Raisins are used as sweetening and flavoring agents, especially 
in demulcent and amylaceous beverages, such as the infusions 
of flaxseed, rice, oatmeal and barlev. 



45^ PHARMACOLOGY AND THERAPEUTICS. 

SOJA BEAN. 
SOJA HISPIDA.— Soja Bean (not official). 

Action of Soja Bean. 
Soja bean is demulcent and nutritive. In southern Asia it is 
used as a food, and the plant is also cultivated for the purpose 
of preparing from it a sauce called soy. 

Therapeutics of Soja Bean. 
In the dietetic treatment of diabetes it is used, in the form of 
bread and biscuits made from the flour, as a substitute for 
gluten bread. Many patients prefer the taste of these to that 
of the latter, and they have been found quite as efficacious in 
reducing the amount of sugar passed in the urine. 

MALT. 
MALTUM.— Malt. (Byne.) 

Preparation. 
Extractum Malti. — Extract of Malt. Dose, 16 c.c; 4 fl. dr. 

Unofficial Preparation. 
Taka-diastasum. — Taka-diastase. Dose, 0.30 to 0.60 gm.; 
5 to 10 gr. 

Action of Malt. 
Malt is demulcent and nutritive. Many of the malt extracts 
manufactured are quite inert as regards the digestion of starch, 
inasmuch as the diastase of the malt has been destroyed by the 
heat employed in their preparation; but, while thus devoid of 
digestive power, they form a pleasant, easily digested food. 
Alcohol, as well as heat, destroys the ferment, and the liquid 
malts containing alcohol are also worthless for assisting starch 
digestion. Many are only beers of an inferior quality, and the 
best of them are indistinguishable from stout. True extract of 
malt contains no alcohol at all. Taka-diastase, which is named 



MALT. 457 

after its discoverer, Takamine, and is an enzyme derived from 
Enrotium oryza, a fungus of the aspergillus family, has been 
found to be very much more energetic than any of the malt 
extracts, as it digests over one hundred times its own weight 
of starch. As soon as the acidity of the gastric juice exceeds 
o.i per cent, it ceases to act in it, but it is able, no doubt, to 
digest a considerable amount of starch in the mouth and 
stomach before it is destroyed. It is a question of great prac- 
tical interest, however, whether the ordinary digestive juices 
are ever unable to digest the starch of the food, and it may be 
stated, on high authority, that no satisfactory evidence of the 
existence of a supposed class of cases to which the name of 
amylaceous dyspepsia has been given has as yet ever been 
brought forward. Until it is shown that in some instances the 
digestion of starch by the intestinal ferments is insufficiently 
performed, the diastase preparations would seem, therefore, to 
be superfluous. As the opinion is very widely held, however, 
that in many cases the natural ferments do fail to adequately 
perform this function, and that in them diastase to some extent 
supplies their place, it appears to be the part of wisdom, for 
the present at least, to give the latter the benefit of the doubt. 
All malts, consequently, should be rejected which do not con- 
tain at least 4 per cent, of diastase. Maltose, which is a prod- 
uct of the action of the ferment diastase upon starch, leads to 
the formation of fat and constitutes, in many conditions, a very 
excellent food. Its value in this respect rests on the fact that 
it is readily absorbed both in the stomach and small intestine. 
In the system it undergoes a transformation into dextrose, and 
it is not found present as maltose in the tissues. As the malt 
liquors contain malt extract, as well as hops, an aromatic 
bitter, their nutritive, tonic and stomachic qualities are greater 
than those of spirits and wine. At the same time, it must not 
be forgotten that the beneficial effects of these constituents are 
to a very considerable extent diminished by the process of fer- 
mentation; so that the value of such beverages as foods is apt 
to be greatly exaggerated by their habitual consumers. They in- 



45 8 PHARMACOLOGY AND THERAPEUTICS. 

crease the appetite and lead to the deposition of fat, and when 
taken in excess are not infrequently the cause of fatty degenera- 
tion in various organs, more particularly the liver and the 
heart. 

Therapeutics of Malt. 
Malt extracts, the value of which depends principally on the 
amount of maltose they contain, are used in all conditions where 
it is desirable to give a readily assimilable carbohydrate food. 
They are particularly indicated in convalescence from acute 
disorders, in the derangements of the system caused by chronic 
disease, and in cases of wasting and of poor digestion and 
assimilation. They are usually well borne by the stomach, 
and in many instances can be taken by those who reject other 
nutritive agents, such as codliver oil. While not possessing 
all the virtues of the latter in pulmonary tuberculosis, they 
sometimes prove a satisfactory substitute for it. Not infre- 
quently extract of malt is advantageously combined, in emul- 
sion, with codliver oil; the comparatively small dose of the 
latter then required being less apt to disagree with the patient 
than a larger quantity taken by itself. Such emulsions should 
contain about I part of oil to 4 of malt. Malt extracts are very 
largely given for the purpose of assisting the digestion of 
starchy foods. Diastase, it should be remembered, like the fer- 
ments of the saliva and pancreatic fluid, can act only in a 
neutral or alkaline medium. As experiments have demonstrated 
that this agent, when taken into the stomach, must sooner or 
later be completely destroyed by the gastric juice, it has been 
advised that when the diastatic action of malt extract is de- 
sired, it should always be given at the beginning of a meal. 
Usually, however, it is directed to be taken at least two hours 
after a meal, by which time the stomach is presumed to be 
free from the acid gastric juice. By some authorities it is be- 
lieved that in most cases the administration of diastatic ferments 
is of little benefit, and that the great value attached to them 
rests on the fact that they are useful agents in producing pre- 
digested foods. Malt extract may be used to form a syrupy 



sugar. 459 

mixture with preparations of iron or cinchona. The follow- 
ing will often be found serviceable : Ferric pyrophosphate, 2 ; 
water, 3; dissolve and add extract of malt, 95. Dose, 4 to 15 
c.c. (1 to 4 fl. dr.). Malt extract, to which a suitable amount 
of fluidextract of cascara sagrada has been added, is an ex- 
cellent laxative. 

PEARL BARLEY. 

HORDEUM DECORTICATUM.— Pearl Barley (not official). 

Action of Pearl Barley. 
Barley, the best form of which for medicinal use is pearl 
barley, is demulcent and highly nutritious. It contains rather 
more proteid than wheat, and is rich in phosphates and iron. It 
constituted the principal diet on which the Grecian athletes were 
trained. It is one of the blandest and least irritating of fari- 
naceous substances, and is an excellent antiscorbutic. 

Therapeutics of Pearl Barley. 
Barley water (1 to 15 of boiling water) forms a pleasant 
demulcent drink, especially if the throat be dry and inflamed. It 
is the most ancient of fever beverages, and its efficiency in sore 
throat and bronchial affections may be increased by the addi- 
tion of honey. It is used to a considerable extent in various 
inflammatory conditions, especially when the mucous membrane 
of the stomach or the urinary tract is involved. It is also 
given for the diarrhoeas of infants, and its addition to the milk 
of all bottle-fed children has been recommended. For ordi- 
nary use it may be sweetened and flavored with lemon. 

SUGAR. 

SACCHARUM.— Sugar. (Cane Sugar. Sucrose.) 

Preparation. 
Syilipus. — Syrup. 

Unofficial Preparation. 
Levulosum.— Levulose. (Fruit Sugar. Diabetin.) 



460 PHARMACOLOGY AND THERAPEUTICS. 

Action of Sugar. 

Sugar is nutrient, demulcent and antiseptic. It is an anti- 
putrefactive, but not an antifermentative. While essentially a 
food, it contains no nitrogen, and is therefore incapable of sus- 
taining life by itself. It is a hydrocarbon, and in the system 
develops adipose tissue and acts as a respiratory fuel. In the 
healthy individual sugar and sugar-forming food, it is estimated, 
constitute more than one-half of the nourishment required by 
the body. It also has some diuretic action. Eaten freely, it is 
said to interfere with the development of alcoholic intoxication, 
an effect which has been attributed to its retarding gastric 
absorption. 

Therapeutics of Sugar. 

Sugar is used as a sweetening and preservative agent. Syrup 
is used as a vehicle. Syrupus Glucosi (B. P., not official). 
Syrup, 2; liquid glucose of commerce, 1, is used in pharmacy, 
especially in the making of pills, as it forms a neutral basis. 
Sugar is the principal basis of troches, gum pastilles, and 
various other preparations. Mixed with iron preparations, it is 
a protective against oxidation. On account of its attraction 
for water, powdered or granulated sugar, locally applied, makes 
a good styptic (which is also antiseptic), in cases of emergency. 
White sugar does not seem to have any aperient effect, but 
molasses and imperfectly refined sugar intensify intestinal 
action and are considerably used in domestic medicine as mild 
laxatives. When taken in moderation sugar tends to promote 
digestion and allay nervous excitement, and sweetened water 
(cau sucree) is very extensively used for such purposes in 
France and other parts of Europe. In catarrhal affections of 
the air-passages sugar has a soothing effect upon the mucous 
membrane, and the vapor of boiling cane-juice is stated to have 
proved of great value in bronchitis and even pulmonary tuber- 
culosis. Finely powdered lump sugar may relieve the hiccough 
of nursing infants which arises from over-feeding, and lump 
sugar is a common domestic remedy for hiccough in general. 
The chemical compound which sugar forms with lime, calcium 



LIQUORICE. 461 

saccharate (Syrupus Calcis, U. S. P.), is said to be an anti- 
dote to phenol. Sugar is contraindicated in diabetes mellitus, 
obesity, and conditions involving fermentative changes in the 
stomach or intestines. Levulose, a fruit-sugar sold under the 
trade-name of Diabctin, is now extensively used as a food and 
substitute for cane-sugar in cases of diabetes. It is well assimi- 
lated in the disease, a small proportion only being excreted in 
the urine, and is regarded as having the same nutrient value as 
cane-sugar. 

LIQUORICE. 

GLYCYRRHIZA.— Glycyrrhiza. Liquorice Root. Dose, 2 gm.; 
30 gr. 

Preparations. 

1. Extractum Glycyrrhizse. — Extract of Glycyrrhiza. (Ex- 
tract of Liquorice.) Dose, 1 gm.; 15 gr. 

2. Extractum Glycyrrhizse Purum. — Pure Extract of Gly- 
cyrrhiza. Dose, 1 gm.; 15 gr. 

3. Fluidextractum Glycyrrhizse. — Fluidextract of Glycyr- 
rhiza. Dose, 2 c.c; 30 trt- 

4. Elixir Adjuvans. — Adjuvant Elixir. 

5. Glycyrrhizinum Ammoniatum. — Ammoniated Glycyrrhizin. 
Dose, 0.250 gm. (250 milligm.) ; 4 gr. 

6. Mistura Glycyrrhizse Composita. — Compound Mixture of 
Glycyrrhiza. (Brown Mixture.) Dose, 8 C.C.; 2 fl. dr. 

7. Pulvis Glycyrrhizse Compositus. — Compound Powder of 
Glycyrrhiza. Dose, 4 gm.; 60 gr. 

8. Pilulse Laxativse Compositse. — Compound Laxative Pills. 
Dose, 2 pills. 

Action of Liquorice. 
Liquorice is demulcent, expectorant and laxative. Locally it 
has a slightly stimulating action, and it increases the flow of 
saliva and mucus when slowly chewed or sucked. 

Therapeutics of Liquorice. 
In sore throat and bronchitis liquorice is an excellent de- 
mulcent. The hardened extract is a popular remedy for tickling 



462 PHARMACOLOGY AND THERAPEUTICS. 

cough and hoarseness, and Brown Mixture is much used in 
dispensary practice as an expectorant. Liquorice is largely 
employed to conceal the taste of disagreeable medicines and as 
a basis for pills. The root is commonly used as a dusting- 
powder and coating for the latter. The compound liquorice 
powder is a pleasant and efficient laxative, and is especially well 
adapted for pregnant women and children. When necessary, 
it may be advantageously combined with an equal quantity of 
compound jalap powder. The demulcent properties of liquorice 
render it serviceable in irritable conditions of the mucous mem- 
brane of the bladder and intestines, as well as of the air-pas- 
sages. It may also be given with flaxseed tea or barley water 
in various febrile affections. Ammoniated glycyrrhizin pos- 
sesses no advantage over the extract, and is devoid of the 
demulcent properties of the drug. 

SLIPPERY ELM BARK. 
ULMUS.— Elm. (Slippery Elm Bark.) 

Preparation. 
Mucilago Ulmi. — Mucilage of Elm. Dose, 16 c.c; 4 fl. dr. 

Action of Slippery Elm Bark. 
Slippery elm bark is highly demulcent and in some degree 
tonic and nutritive, as well as slightly astringent. 

Therapeutics of Slippery Elm Bark. 
Slippery elm bark is an excellent demulcent, and is especially 
recommended in dysentery, diarrhoea and diseases of the urinary 
passages. It is often employed to make poultices, especially for 
use upon children, because it is lighter than flaxseed. The 
poultices, with lead water, are serviceable in erysipelas and 
various forms of local inflammation ; they may be applied either 
hot or cold. The bark is also used in the dilatation of fistulae, 
strictures and the os uteri, and, in conjunction with various 
medicinal extracts, in the formation of rectal and vaginal sup- 



ACACIA. 463 

positories. When chewed it moistens the mouth and throat, and 
employed in this way it is soothing in irritable conditions of 
the faucial and bronchial mucous membrane. It is stated to 
have sometimes proved successful in the treatment of tape- 
worm. 

ACACIA. 

ACACIA. — Acacia. (Gum Arabic) 

Preparations. 

1. Mucilago Acacise. — Mucilage of Acacia. Dose, 16 c.c; 4 
fl. dr. 

2. Syrupus Acacise. — Syrup of Acacia. 

Action of Acacia. 
Acacia is a valuable demulcent. It has been experimented 
with as a food, but appears to have little or no nutrient quality, 
though it may possibly retard tissue-waste and in this way 
prove capable of prolonging life. 

Therapeutics of Acacia. 
On account of its demulcent properties it is employed at times 
in inflammatory conditions of the bronchial, gastric, vesical 
and intestinal mucous membrane, in which it acts as a local 
palliative. One part dissolved in 30 of water and flavored with 
syrup of lemon, or otherwise, makes a pleasant and serviceable 
beverage. Acacia is also useful as a vehicle for more powerful 
remedies. As a protective to the inflamed surfaces in pharyn- 
gitis, laryngitis, etc., it is commonly used in the form of lozenges, 
in which astringents or other agents may be incorporated in ac- 
cordance with the indications present. To loosen hacking coughs 
it is largely employed with flaxseed in the form of a mucilage, 
flavored with lemon-juice and sweetened, to which liquorice 
is generally added. Mucilage of acacia may sometimes be of 
service in cases of irritant poisoning. One of the chief uses 
of acacia is to emulsify oils and resins. 30 c.c. (1 fl. oz.) of 
most oils or resinous tinctures require 12 c.c. (3 fl. dr.) of 



464 PHARMACOLOGY AND THERAPEUTICS. 

mucilage of acacia for suspension, but copaiba requires 40 c.c. 
(10 fl. dr.). The tendency of the mucilage to undergo acetous 
fermentation, which greatly interferes with its emulsifying 
capacity, may be overcome to some extent by making it with 
tolu or clove water. For the suspension of insoluble powders 
it is not so satisfactory as tragacanth, as it is liable to form 
cements which are difficult to disperse. Externally, acacia has 
a certain amount of utility. Its thick mucilage, to which some 
antiseptic should be added, may be employed as a protective for 
superficial burns, excoriations and ulcers. Powdered acacia 
is sometimes used to arrest bleeding from leech bites and other 
sources of slight haemorrhage. Mixed with one-half its quan- 
tity of powdered arrow-root and one-quarter of borax, together 
with a small amount of camphor, it is serviceable, dusted over 
the surface, for sore nipples. An ointment made with 24 gm. 
(6 dr.) of powdered acacia and 4 gm. (1 dr.) of oleate of zinc 
to 30 gm. (1 oz.) of lanolin, is also a good application in this 
affection, as well as in some diseases of the skin. A snuff com- 
posed of acacia and bismuth subnitrate, to which a little mor- 
phine may be added, is often useful in checking coryza. 

TRAGACANTH. 

TRAGACANTHA.— Tragacanth. 

Preparation. 
Mucilago Tragacanthse. — Mucilage of Tragacanth. Dose, 16 
c.c; 4 fl. dr. 

Unofficial Preparation. 
Bassorinum. — Bassorin. 

Action of Tragacanth. 
Tragacanth is demulcent and slightly nutritive. If given in 
large quantity it is apt to cause indigestion, unless accompanied 
by some antiseptic agent, like creosote or naphtol, in order to 
prevent fermentation. 

Therapeutics of Tragacanth. 
Its chief use is to suspend insoluble powders. The mucilage 



ALMOND. 465 

is better for this purpose than the compound powder (B. P., 
not official), tragacanth, 1; acacia, 1; starch, 1; sugar, 3; 
which, because of its starch, is liable to ferment. More- 
over, acacia is contra-indicated when tragacanth is employed 
as a suspending agent. Tragacanth is less useful than acacia 
as an emulsifying agent for resins and oils, for the reason that 
it is almost insoluble in water. Glycerin of tragacanth (B. P.) 
is sometimes employed as a pill excipient, but is apt to render 
the pills hygroscopic, and glucanth is more generally useful for 
this purpose. It is composed of tragacanth, 1 ; glycerin, 1 ; 
water, 1 ; commercial syrupy glucose, 7. Tragacanth is some- 
times used as a vehicle for medicinal agents in gargles, and 
is a constituent of most of the official troches. It may be em- 
ployed as a demulcent in pharyngitis, gastritis and intestinal 
inflammation. On account of its greater tenacity, its mucilage 
may sometimes be preferable to that of acacia as an external 
protective. Bassorin (found in India gum and in salep) has 
been used as a base for the application of cutaneous medica- 
ments. 

ALMOND. 

1. AMYGDALA AMARA.- Bitter Almond. 

2. OLEUM AMYGDALA AMAE5I.- Oil of Bitter Almond. 
Dose, 0.03 c.c; y 2 n\. 

Preparations. 

1. Aqua Amygdalae Amarae. — Bitter Almond Water. Dose, 
4 c.c; 1 fl. dr. 

2. Spiritus Amygdalae Amarae.— Spirit of Bitter Almond. 
(Essence of Bitter Almond.) Dose, 0.5 C.C.; 8 Tl\. 



in.. 



4. AMYGDALA DULCTS.— Sweet Almond. (Jordan Almond.) 



Preparations. 

1. Emulsum Amygdalae. — Emulsion of Almond. (Milk of 
Almond.) Dose, 120 c.c.; 4 fl. oz. 

2. Syrupus Amygdalae.— Syrup of Almond. Dose, 4 c.c; 1 
fl. dr. 



31 



466 PHARMACOLOGY AND THERAPEUTICS. 

5. OLEUM AMYGDALA EXPRESSUM.— Expressed Oil of Al- 
mond. Dose, 30 c.c; 1 fl. oz. 

Unofficial Preparation of Almond. 
Kesorbinum. — Resorbin. 

Action of Almond. 
The sweet almond is demulcent and nutritive. Bitter almond, 
which differs from it in containing amygdalin, is poisonous in 
large quantities. 

Therapeutics of Almond. 
The official emulsion, formed by triturating sweet almonds 
with water, is a soothing and emollient drink which may prove 
of service in irritations of the pharynx and air-passages, as 
well as of the stomach and intestines. It is also a pleasant 
vehicle for other remedies in various conditions, and is espe- 
cially useful for insoluble drugs. The emulsion of bitter 
almond (not official), in teaspoonful doses, is used for the same 
purposes, and particularly as a vehicle for expectorant medi- 
cines. Both emulsions are employed to some extent as a vehicle 
in gonorrhoea, as they serve to relieve ardor urinse. The com- 
pound powder of almonds, B. P. (sweet almond, 8; sugar, 4; 
acacia, 1) is a palatable basis for powders. The expressed oil 
of almond might be used for the same purposes as olive oil, 
but is more expensive. To most persons it is much more 
palatable than the latter. This oil is used to a considerable 
extent in ointments, producing a whiter preparation than olive 
oil, and is especially useful as an application to the hair. It 
is serviceable for excoriations, chapped hands, and inflamma- 
tory affections of the skin, and also as a local application in 
earache. Internally it may be used as a laxative. One of 
the most important medicinal uses of the sweet almond 
is in the form of bread and biscuits made from almond 
flour. They contain practically no starch, and, being pal- 
atable and nutritious, have proved a very satisfactory sub- 
stitute for the various preparations of wheat flour in the diet 



GLYCERIN. 467 

of diabetics. They are expensive, but with a little care may- 
be made at home; thus reducing the cost to the minimum. 
Almond meal is sometimes used instead of soap for the toilet, 
rendering the skin soft and smooth. Resorbin, made by emulsi- 
fying expressed oil of almond with distilled water and yellow 
wax, gelatin and soap, with the addition of a small quantity of 
lanolin, is a good vehicle for active drugs in the medication 
of the skin, and will, it is said, promote the cutaneous absorp- 
tion of mercury. It has been employed in the treatment of 
ichthyosis, pityriasis, scleroderma, prurigo, seborrhceic eczema, 
and other affections. Sweet almond emulsion, combined with 
bismuth subnitrate and thymol iodide, or with ammonium chlo- 
ride and mercuric bichloride, may be used locally for the re- 
moval of sunburn, freckles and skin pigmentations. With mer- 
curic bichloride alone it is recommended in acne rosacea. As a 
substitute for cherry-laurel water, which is considerably used in 
Europe as a sedative narcotic and which owes its effects to the 
prussic acid which it contains, but which is objectionable from 
its unequal strength, it has been proposed to employ an extem- 
poraneous mixture of amygdalin with emulsion of sweet almond. 

GLYCEKIN. 

GLYCERINUM.— Glycerin. Glycerol. Dose, 4 C.C.; 1 fl. dr. 

Preparations. 

1. Glyceritum Amyli. — Glycerite of Starch. 

2. Glyceritum Phenolis. — Glycerite of Phenol. (Glycerite of 
Carbolic Acid.) Dose, 0.3 c.c; 5 n\,. 

3. Glyceritum Acidi Tannici. — Glycerite of Tannic Acid. 
Dose, 2 c.c; 30 lit. 

4. Glyceritum Boroglycerini. — Glycerite of Boroglycerin. 

5. Glyceritum Hydrastis.— Glycerite of Hydrastis. Dose, 2 
c.c; 30 TTt- 

6. Glyceritum Ferri, Quininae et Strychnine Phosphatum. 

— Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, 
1 c.c; 15 TTt. 



468 PHARMACOLOGY AND THERAPEUTICS. 

7. Suppositoria Glycerini. — Suppositories of Glycerin. 

8. Gelatinum Glycerinatum.— Glycerinated Gelatin. 

Unofficial Preparations. 
Glyceritum Vitelli (U. S. P., 1890).— Glycerite of Yolk of 
Egg. Dose, freely. 

Glycerinum Boracis (B. P.). — Glycerin (or Glycerite) of 
Borax. 

Mel Boracis (B. P.). — Borax Honey. 

Action of Glycerin. 

External. — Glycerin is powerfully hygroscopic. Applied to 
the cutaneous surface, it is somewhat irritant, and even when 
diluted causes a temporary smarting in cuts and abrasions. 
This local irritation is attributable to its great avidity for 
water, in consequence of which it tends to abstract the fluids 
from the tissues. The pain quickly subsides, however, and it 
then acts as a protective to the parts. In its completed action, 
especially when diluted, it is emollient and demulcent to the 
skin and to mucous membranes. When injected into the rec- 
tum, however, it causes, by its irritant action, peristalsis and 
evacuation of the bowels. 

Internal. — In animals large doses of glycerin, injected sub- 
cutaneously, cause death in periods varying from one hour to 
several days according to the amount administered. The symp- 
toms noted are restlessness, acceleration of the heart and re- 
spiration, dryness of the mucous membrane, with marked thirst, 
loss of muscular power, vomiting, bloody urine, fall of tem- 
perature, convulsions, somnolence, coma, and death from failure 
of the respiration. The larger the dose, the more pronounced 
the convulsions, which are tetanic in character. In such cases 
the fall of temperature is preceded by a considerable rise, while 
in the more prolonged cases (in which the dose is not ex- 
cessive), the fall may or may not be preceded by a rise, and 
does not usually occur until quite late in the poisoning. The 
principal change found post mortem is intense pulmonary, renal 



GLYCERIN. 469 

and intestinal congestion, with more or less softening of the 
tissue. Glomerulo-nephritis has sometimes been observed. The 
haemoglobin which appears in the urine when glycerin is sub- 
cutaneously injected in large quantities is due to the destruction 
of the red blood-corpuscles ; although when glycerin is added 
to the drawn blood it does not act as powerfully on it as many 
other agents which produce no haemoglobinuria. The latter 
effect after its subcutaneous injection has been explained on 
the hypothesis that the glycerin remains outside the vessels 
for some time, and withdraws the fluid from the red corpuscles 
as they pass through the poisoned zone. When, however, glyc- 
erin is injected into the blood, it diffuses rapidly throughout the 
body, and the blood-cells are less acted on by the diluted poison. 
Accordingly, it is found that haemoglobin scarcely ever appears 
in the urine after intravenous injection, although this is occa- 
sionally noted when glycerin is given in large doses by the 
mouth. The violent convulsions caused by it would seem to 
indicate that glycerin acts directly on the central nervous sys- 
tem. Notwithstanding the fact that in animals it destroys life 
in a few hours, in man very large doses of glycerin, taken by 
the mouth, ordinarily produce only a mild gastro-intestinal 
irritation. In the case of a man who was accustomed to take 
90 c.c. (3 fl. oz.) daily it is said, however, to have caused ex- 
treme cerebral excitement. Glycerin is rapidly absorbed from 
the intestine and undergoes oxidation in the tissues; only a 
very small fraction of it appearing in the urine. Like alcohol, 
which is also readily absorbed, it therefore acts in some sense 
as a food, and serves to increase the total energy of the body. 
Glycerin, it has been pointed out, tends to increase the non- 
nitrogenous, and not the nitrogenous reserve of the body, its 
combustion saving a certain amount of the fat from being de- 
stroyed. It is, therefore, of only secondary importance as a 
food, although, like alcohol, it may be of value in certain con- 
ditions. As in the case of the latter, it is still regarded as un- 
decided how far it leads to an economy of the nitrogenous 
tissues, as the fats and carbohydrates do. Internally, as 



470 PHARMACOLOGY AND THERAPEUTICS. 

well as externally, glycerin is a good demulcent, but, since 
it is so quickly absorbed, its action does not extend be- 
yond the stomach. It has been claimed by some authors 
that its administration at times occasions the appearance 
in the urine of a substance which reduces cupric oxide 
and gives the fermentation test for sugar, but this is 
stated not to have been confirmed on more careful in- 
vestigation. In some forms of experimental glycosuria glyc- 
erin appears to reduce the amount of sugar present, and it is 
believed that it probably has some effect on the sugar formation 
in the tissues, although no satisfactory explanation of its action 
in this particular has as yet been given. It has been demon- 
strated to have decided value as an antiseptic, and this is 
thought to be due to its well-known hygroscopic properties, in 
consequence of which water is withdrawn from the microbes. 
It is destructive to parasites, both intestinal and external. 

Therapeutics of Glycerin. 
External. — Glycerin is employed to a considerably greater 
extent externally than as an internal remedy. It is an ex- 
tremely useful emollient, and as it does not evaporate or turn 
rancid, and is readily absorbed when rubbed into the skin, it 
has many advantages as a vehicle for the application of active 
medicinal agents. Applied to the mucous membrane by means 
of a camel's hair brush, pure glycerin affords much relief in 
acute coryza. Glycerin, diluted one-half with distilled water, 
or the glycerin of borax (B. P.) is of great service in reliev- 
ing the dryness of the lips, mouth and tongue in fevers, and 
the latter preparation, as well as the honey of borax (B. P.), 
in which glycerin is an ingredient, is also used as a demulcent 
and sedative to the mucous membrane of the mouth and 
pharynx. A solution of morphine in glycerin is sometimes ap- 
plied with a brush to the fauces to allay the irritating cough 
of phthisis. A mixture of glycerin, crystallized sugar, and 
whiskey, which is allowed to trickle down the throat, may also 
be given for the same purpose. Among the many other useful 



GLYCERIN. 47 1 

applications of glycerin are the following: For chapped face 
and hands, sore nipples, and piles it may be combined with 
witchhazel water and rose water; for excoriations, erythema, 
and superficial burns, with lime water and rose water; for 
erythematous or vesicular eczema, burns, and seborrhcea, espe- 
cially about the axilla and the genital organs, with carbolic acid, 
witchhazel water, and either bismuth subnitrate or sodium 
bicarbonate; for freckles and other skin pigmentations with 
lactic acid and rose water, and for pruritus, eczema and urti- 
caria with creosote and oil of peppermint. The latter combina- 
tion may also be used, in the form of a spray, in nasal catarrh, 
pharyngitis and laryngitis. The glycerite of tannin makes an 
excellent astringent application for sore throat (particularly 
chronic follicular pharyngitis), relaxed mucous membranes, and 
other conditions, and it is said that the daily topical use of 
glycerin is capable of causing a steady reduction in the size 
of hypertrophied tonsils. The glycerite of starch is frequently 
employed as a vehicle for the application of astringents to the 
eye, and glycerin and its preparations are also much used in 
ear affections. Glycerized collodion (glycerin, 2; collodion, 
100), which is extremely supple and does not crack and scale 
off from the skin, is less painful than pure collodion, and forms 
a serviceable protective for fissures and abrasions. For fissured 
nipples a liniment composed of one part of tincture of benzoin 
to six or eight of glycerin is also highly recommended. Glyc- 
erin is a convenient vehicle for the absorption of drugs by the 
skin, and one of the most common applications of this use is 
in the case of belladonna, the local anodyne action of which 
may be obtained by rubbing it in mixed with glycerin. Glyc- 
erin, either alone or combined with an astringent or sedative, 
may be employed for the prevention of bed-sores. Glycerin, as 
well as boroglycerin (see p. 88), is used extensively in various 
local applications in the treatment of diseases of women, and 
in congested states of the genital organs it is of special service 
by causing, on account of its affinity with water, an abundant 
serous transudation. For the use of glycerin with kaolin see 
Kaolin (p. 437). 



472 PHARMACOLOGY AND THERAPEUTICS. 

Internal. — On account of its sweetness glycerin is employed 
to a considerable extent as a flavoring agent. Large doses of 
glycerin sometimes cause purgation, but it is not a reliable 
remedy for this purpose, and alone is seldom given by the 
mouth as a laxative, except perhaps in the case of haemorrhoids, 
upon which it is asserted to have a peculiarly soothing effect. 
To produce efficient cathartic action it is advised that it should 
be combined with magnesium sulphate or carbonate, rhubarb, 
and tincture of belladonna. As a laxative, however, it is much 
more frequently administered by the rectum, where 4 to 8 c.c. 
(1 to 2 fl. dr.) produces a prompt evacuation, without pain 
or other disturbance; and the most convenient way to use it 
is in the form of the glycerin suppository. The glycerin is 
said to pass upwards as far as the sigmoid flexure, and even be- 
yond. While, from its contact with the epithelial walls, it may 
thus perhaps increase the peristalsis of the greater part of the 
large intestine, the local irritation of the lower portion of the 
rectum is itself no doubt sufficient to set up reflex movement 
of the bowel. Enemata of glycerin diluted with water, or, 
better, of glycerin combined with flaxseed tea, in the proportion 
of one to four, are of considerable service in dysentery; reliev- 
ing the tenesmus. Glycerin has been advised by some as a food 
in conditions of malnutrition, but, although it forms part of 
the composition of ordinary fats, it proves, as a rule, a very 
inferior substitute for codliver oil and other fatty substances. 
In the form of glyconin (Glyceritum Vitelli), however, it con- 
stitutes an admirable vehicle for the administration of cod- 
liver oil, and, given in this way, it is thought to increase the 
efficiency of the latter. On theoretical grounds it has been 
employed in the treatment of diabetes, but it appears to have 
little or no practical value in that disease. It was formerly 
used to a considerable extent by diabetics as a substitute for 
sugar, but its sweetness is of a kind rather disagreeable to many, 
and its place has now largely been taken by saccharin and 
levulose. Glycerin, it has been found, is capable of destroying 
trichinae in the intestinal tract, and it is therefore a remedy of 



ICELAND MOSS. 473 

distinct value in cases of trichiniasis. Among other conditions 
in which it has been used internally may be mentioned acne, 
vomiting of pregnancy, gallstone disease, and nephrolithiasis. 

ICELAND MOSS. 

Unofficial Preparations. 
Cetraria (U. S. P., 1890). — Cetraria. (Iceland Moss.) 
Decoctum Cetrarise. — Decoction of Cetraria. Dose, 0.30 to 

1.20 c.c; 1 to 4 fl. oz. 
Acidum Cetraricum. — Cetraric Acid. Dose, 0.03 to 0.12 

gm.; V2 to 2 gr. 

Action of Iceland Moss. 

Iceland moss is demulcent, nutritive and mildly tonic. It 
is also stated to have antihaemorrhagic properties. The cetraric 
acid gives its decoction a bitter taste, but this and the other 
acids which the moss contains can be removed, if desired, by 
soaking for some time in dilute alkaline solutions. It has been 
asserted that cetraric acid augments the number of the red and 
to a still greater degree, of the white blood-corpuscles, that it 
increases intestinal paralysis, and that it is a mild stimulant 
to the central nervous system. Intravenously injected, it is said 
to cause an increased secretion of saliva, bile and pancreatic 
juice. 

Therapeutics of Iceland Moss. 

The decoction is demulcent, and may be given in sore throat. 
Cetraria, as well as Irish moss, was formerly supposed to pos- 
sess some peculiar virtue in pulmonary affections, but this 
opinion is no longer held, and it is now almost entirely employed 
as an article of diet for the sick. As a food it is not of very 
high nutritive value, but it may at times serve a useful purpose. 
The jelly formed by boiling may be taken by diabetics and other 
invalids. It should be suitably flavored. The decoction, with 
its acids allowed to remain, may be used as a stomachic tonic 
in cases where the more active agents of this class are not well 
borne. Cetraria has been recommended in haemoptysis, in 



474 PHARMACOLOGY AND THERAPEUTICS. 

which condition it had long been employed by Danish physi- 
cians before it became generally known, and the powder, blown 
into the nostrils, has been found to arrest epistaxis. A tinc- 
ture of cetraria, locally applied, is of service in spongy gums. 
In Iceland the moss is regarded as prophylactic against a form 
of elephantiasis which prevails there. 

Cetraric Acid, given in accordance with the indications de- 
rived from the experiments on animals showing that it augments 
the digestive secretions, is said to have proved beneficial in 
dyspepsia. The acid has also been suggested as a remedy in 
anaemia and chlorosis, especially when associated with consti- 
pation, but no clinical evidence has as yet been educed of its 
utility in such conditions. 

IRISH MOSS. 

CHONDRUS.— Chondrus. (Irish Moss. Carragheen.) Dose, 15 
gm.; 4 dr. (in decoction). 

Action of Irish Moss. 

Irish moss is demulcent and somewhat nutrient, though the 
gum which enters largely into its composition does not digest 
very readily. 

Therapeutics of Irish Moss. 

The decoction (made by boiling 750 c.c. (1^2 pints) of water 
with 15 gm. (y 2 oz.) of the moss down to 500 c.c. (1 pint)) 
was formerly much more generally used than at present, in 
bronchial affections, diarrhoea, dysentery and irritation or in- 
flammation of the genito-urinary tract. Whatever beneficial 
effect it may have had was probably due to its protective quali- 
ties, and also possibly to some extent to the influence on nutri- 
tion of the minute quantity of iodine in it. When made into 
a jelly it is a pleasant article of diet. At one time this was 
supposed to constitute an important food in illness, but it is 
really of little practical value, as only -^ to -^ of the jelly is 
solid matter; the rest being water. Irish moss is also used as 
a vehicle in preparations of bone marrow. 



GELATIN. 475 

MARSHMALLOW. 
ALTERA. — Althaea. (Marshmallow.) 

Unofficial Preparations. 
Syrupus Althaeas (U. S. P., 1890). — Syrup of Althaea. Dose, 
freely. 

Asparaginum. — Asparagin. Dose, 0.06 to 0.12 gin.; 1 to 2 
gr. 

Action of Mash mallow. 
Marshmallow is demulcent, emollient and slightly nutritious. 

Therapeutics of Marshmallow. 
It is a useful demulcent for irritation and inflammation of 
mucous membranes. It is held in popular esteem, especially as 
a remedy for sore throat, and the confections of it are service- 
able in scarlet fever and diphtheria, as well as in ordinary 
pharyngitis. The decoction is sometimes given for gastric irri- 
tation and used locally in irritations of the vagina and of the 
rectum. An excellent emollient poultice is made from the 
powdered root, and, combined with benzoinated lard, marsh- 
mallow is employed as a bland dressing in cutaneous affections. 
It is a constituent in blue mass and in phosphorus pills, to which 
it serves to give the proper consistence, and the syrup is an 
agreeable vehicle. It is thought to be slightly diuretic on ac- 
count of the asparagin contained in it, and in the form of a 
fresh infusion it has been given to children, especially in 
Bright's disease. Asparagin itself has been recommended as a 
diuretic, though its value has not as yet been established. 

GELATIN. 

GELATINUM.— Gelatin. 

Preparation. 
Gelatinum Glycerinatum. — Glycerinated Gelatin. 

Action of Gelatin. 
Gelatin is a demulcent and styptic, and is also believed to be 
to some extent nutrient, as it increases vital action in the same 
direction, though not in the same degree, as