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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 7J8
Division X. Drugs Acting on the Nervous and Muscular
Systems 732
Drugs Acting on the Muscles 732
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 C202H4 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 S04 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. (2120 F.). Infected clothing, bedding, etc., may be
heated in a dry-air chamber to between 93. 50 and 1490 C. (2000 and
3000 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.); YV §*•
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.); y3 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 y2 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.; iy2 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.
(yA 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. (y1^ 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. (Ty2 Sr-)
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 2300 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 oz0 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. (2l/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.) ; iy2 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.) ; 7V2 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. (y2 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 (H2S), 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 y2 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; y2 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.; y2 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.) ; y2 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. (i1/? 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. ; y2 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. (y2 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. ; y2 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. (y2 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.) ; 7l/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. (iy2 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. (TL gr.), by subcutaneous injection;
zinc sulphate, 1.20 gm. (20 gr.), or copper sulphate, .30 gm. (5 gr.),
in 250 c.c. {y2 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. (y2 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. (y2 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.
I97
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.) ; 7Y2
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.) ; 7V2 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.; y4 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. (2x/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.) ; 7V2 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.;
TV 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 &r0 > concentrated phosphoric acid, .10 c.c (il/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. ; y2 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 il/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 y8 gr.
Sodii Cacodylas.— Sodium Cacodylate. Dose, .05 to .15 gm.;
% to 2y2 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(CH3)2), (not official), and so-
dium cacodylate (AsONa(CH3)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 2l/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 (AsCH303Na2H202), 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.) ; y5 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.); ffo 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 y3 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.) ; 7V2 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.) ; 7V2 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.; y5 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 gm- (tV §r0-
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.); 7y2 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. ; y2 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
342 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.) ; y5 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 8T-)> giyen 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 gm- ; yV Sr- 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.) ; 7y2 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 1200 F. (480 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 1250 F. (510 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.; y2 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 y2 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.) ; iy2 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.) ; 7y2 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 y2 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. ; 1400 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 &**•)> and 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. (iT/2 to 5 dr.) of tannic acid dissolved in 2 litres
(4 pints) of water, with the addition of 2 c.c. (30 Til) 0f
laudanum and 45 gm. (iy2 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.) ; 7y2 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.) ; 7V2 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. (il/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; y4 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. (y2 oz.) ; oil of eucalyptus,
.30 c.c. (5 TrL). 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.; y4 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.; y6 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 iJ/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. ; y2 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. (y2 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 gr-)- In 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.) ; iy2 £*•
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. (2120 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 gr0 piUs or capsules. Olive oil, in doses increasing from
15 to 90 c.c. (y2 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 37.80 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; y2 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. (y2 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 albumin.
476 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Gelatin.
It is used as a basis for capsules, lozenges, bougies, supposi-
tories and pessaries, as a coating for pills, and as a protective
covering in certain diseases of the skin. An admirable basis
for throat pastilles is the following, known as glycogelatin :
gelatin, 2; glycerin, 5; orange flower water, 5; colored with
carmine. Each should weigh 2 gm. (30 gr.), and any desired
medicinal agent may be incorporated in such pastilles. As a
covering for the skin Unna's zinc-gelatins, which are dis-
pensed in small cubes, are extremely serviceable. After being
melted they are painted over the affected surface, and the part
is then covered with a layer of cotton wool. Perhaps those in
most frequent use are zinc gelatin with ichthyol, 1 to 5 per
cent., with phenol, 1 to 3 per cent, with sulphur, 5 per cent.,
and with resorcinol, 2 per cent. As an antidote, gelatin is of
especial value against iodine, bromine and the alums, but re-
quires too much time for its preparation, as for this purpose it
should be broken up and reduced to the consistency of honey by
being soaked for half an hour in water. Sterilized gelatin in
solution has been administered subcutaneously to increase the
coagulability of the blood in aneurism.
STARCH.
AMYLUM.— Starch, Corn Starch.
Preparation.
Glyceritum Amyli. — Glycerite of Starch.
Action of Starch.
Starch is demulcent and nutritive. It and its derivative,
grape-sugar, are the chief members of the non-nitrogenous
group of alimentary principles known as carbohydrates. In
the animal economy starch undergoes digestion by ptyalin, pan-
creatin and the secretion of the intestinal glands, which convert
it first into soluble dextrin and then into grape-sugar, in which
form it passes into the blood. The non-nitrogenous principles
SUGAR OF MILK. 477
(starches, sugars and fats) are mainly concerned in heat-pro-
duction. The excessive consumption of starchy food delays
tissue-metamorphosis, causes a redundancy of fat, and often
gives rise to acidity and flatulence. Undigested starch passes
into the faeces, and the urine may become saccharine.
Therapeutics of Starch.
Medicinally starch is inert, and it is used principally on ac-
count of its mechanical properties, which make it a good basis
for dusting powders and insufflations. The mucilage (i to 40),
which is made by gradually adding the starch and then boiling
and stirring for a few minutes, is a convenient basis for
enemata. It may also be used as a basis for ointments and to
suspend insoluble powders or oils, though it is open to the
objection that it keeps badly. The glycerite is a very soothing
local emollient, and is also employed as a basis for suppositories.
A starch poultice (made by enclosing clear starch, prepared as
in the laundry, between folds of soft muslin) is also a very
soothing application in inflammatory conditions of the eye or
lids. Mixed with glue, starch makes an excellent stiff bandage
for surgical purposes. Starch is employed as an antidote in
poisoning by iodine or bromine.
SUGAR OF MILK.
SACCHARUM LACTIS.— Sugar of Milk. (Lactose.)
Action of Sugar of Milk.
Sugar of milk is a non-nitrogenous, bland article of diet,
which is less apt to ferment in the gastro-intestinal tract than
cane- or grape-sugar. It is stated by some authorities to be
a very active diuretic, especially when cardiac dropsy is present.
Therapeutics of Sugar of Milk.
Being very hard, and also but slightly deliquescent, it is a
valuable excipient for powders requiring the minute subdivis-
ion of their medicinal constituent and as a diluent to bring
478 PHARMACOLOGY AND THERAPEUTICS.
extracts to the required strength. It has been used as a carbo-
hydrate food in consumption and other wasting diseases, and,
on account of its smaller liability to ferment, is preferred to
cane-sugar for the sweetening of infant's food. It is also a
serviceable food in acute febrile diseases, and, being tasteless
and easily soluble in most fluids, it may often be taken with
advantage to the extent of 30 to 60 gm. (1 or 2 oz.) a day.
According to the observers mentioned above, it is a diuretic
which may be employed with good results in cardiac dropsy.
By them it is claimed that it causes a greater excretion of
urine than any other drug, acting even more powerfully than
caffeine, and without any of the disadvantages of the latter.
It is said, however, that its diuretic action is but very slight in
cases where extensive renal disease exists.
MUSTARD.
1. SINAPIS ALBA. — White Mustard. Dose (emetic), 8 gm.;
120 gr.
2. SINAPIS NIGRA.— Black Mustard. Dose (emetic), 8 gm.;
120 gr.
Preparation.
Charta Sinapis. — Mustard Paper.
3. OLEUM SINAPIS VOLATILE.— Volatile Oil of Mustard.
Dose, 0.008 c.c; y8 rty.
Unofficial Preparation.
Linamentum Sinapis Compositum (U. S. P., 1890). — Com-
pound Liniment of Mustard.
Action of Mustard.
External. — Oil of mustard differs from the other volatile oils
in that it produces a markedly greater irritation. Being ex-
tremely diffusible, it has a very deep action, without producing
very profound destruction of the surface. Locally applied, mus-
tard is a rubefacient, counter-irritant, and nervous stimulant,
causing heat, redness, and severe burning pain. These effects
MUSTARD. 479
are produced by its action in dilating the blood-vessels and
irritating the sensory nerves. The stimulation of the latter is
followed by their paralysis, in consequence of which there re-
sults a local loss of sensibility. If the application is sufficiently
prolonged, it induces vesication, the irritation of the vessels
leading to the transudation of plasma, which raises the epider-
mis and thus forms vesicles or blisters. The blistering caused
by it is more painful and heals less rapidly than that of can-
tharides, which is no doubt due to the fact that the oil of mus-
tard penetrates more deeply into the tissues and thus sets up
more extensive inflammation. When the crude drug, mois-
tened, is applied to the skin, the oil is found to form only
slowly, so that the action of the irritant becomes continuously
more intense. The excitation of the sensory nerves caused by
the external application of mustard is sufficiently powerful to
induce more or less reflex stimulation of the heart and respira-
tion, and sometimes to restore consciousness to those suffering
from syncope.
Internal. G astro -intestinal Tract. — Mustard is also a power-
ful irritant to the alimentary canal. In small amounts it is
taken as a condiment and stimulates the appetite. It has gen-
erally been supposed to increase the secretion of gastric juice,
but this is said not to be the case. Large doses irritate the
stomach and produce prompt vomiting, which, in consequence
of the reflex stimulation of the heart and respiration caused by
the drug, is not attended with the depression usually resulting
from emetics. The emetic effect is increased by giving the
mustard in a considerable quantity of lukewarm water. The
oil of mustard is an energetic irritant, a single drop upon the
tongue producing an intense burning pain in the nose, throat
and stomach. Mustard seeds, swallowed whole, have a laxative
effect upon the bowels, and as they are discharged in the faeces
without perceptible change, would appear to act merely by
mechanically stimulating the intestine.
General Action. — Upon the organs and tissues mustard, in
ordinary doses, has very little appreciable effect, but very large
48O PHARMACOLOGY AND THERAPEUTICS.
doses of the oil prove fatal to rabbits. The action of the
heart is at first increased and then diminished, the respiration
becomes impeded, insensibility follows, and a fall of surface
temperature precedes death. Post mortem there is found red-
ness, but only slight inflammation, of the gastro-intestinal tract,
with destruction of the epithelium. The kidneys are also hyper-
semic, and the blood is said to smell of mustard.
Therapeutics of Mustard.
External. — A mustard plaster or sinapism is a very useful
means of relieving pain in gastralgia, colic, neuralgia, chest
affections, lumbago, and a great variety of other conditions.
While the application itself may be temporarily painful, the
secondary effect, both as to the pain due to the mustard and
that from the condition present, is soothing, in consequence of
the loss of sensibility resulting from the paralysis of the sensory
nerves produced by the drug. Sinapisms are prepared by mix-
ing mustard (to which an equal quantity of flour is usually
added to render the effect less severe), with warm water to a
smooth paste, which is spread upon linen. A layer of muslin
or thin unglazed paper is usually placed between the mustard
and the skin. As a rule, they are best applied a little distance
from the seat of pain. Thus, to relieve headache they are most
serviceable when placed at the nape of the neck. Sinapisms are
also applied to the epigastrium in persistent vomiting, to the
loins in suppression of urine, to the precordial region in
threatened syncope, and to the calves of the legs and other
parts of the body in narcotic poisoning, asphyxia or syncope.
In the latter conditions the object is, of course, to arouse the
nervous system, but in all cases of insensibility care should
be taken that the application is not continued too long, on ac-
count of the danger of causing vesication or even more serious
local trouble. In the case of children the proportion of mus-
tard employed should not exceed one-fourth. The mustard
leaves and papers sold in the shops are very convenient for
ready use. They are generally very strong, however, and one
MUSTARD. 48I
or two layers of moistened linen should be placed between the
sinapism and the skin to prevent too great an action. In the
official Charta Sinapis a surface of 60 square c.c. contains
about 4 gm. of black mustard deprived of oil. One advan-
tage which mustard possesses for the purpose of revulsion is
the readiness with which its action may be controlled by the
regulation of the strength of the application and the time which
it is allowed to remain. In many cases it is desirable to main-
tain for hours a mild, equable, counter-irritant impression, and
this may be done by adding about one-sixteenth part of mus-
tard to a flaxseed poultice. In bronchitis, pleurisy or pneu-
monia a "jacket poultice" is often applied to the chest, and
the larger the poultice the more pronounced is the effect upon
the internal organs. Large mustard poultices are also used with
advantage in acute inflammations of the abdominal viscera.
When it is desired to dilate the peripheral vessels over a large
area, in order to withdraw blood from internal parts and thus
produce a " derivative effect," a hot bath to which mustard is
added (1 to 128) is often serviceable. A general mustard bath
is chiefly employed for children in the early stages of febrile
diseases or bronchitis. In older persons a hot mustard foot-
bath (which ought to reach nearly to the knees) is useful for
the relief of incipient common colds and various febrile con-
ditions. A hot mustard sitz-bath is commonly employed, just
before the expected period, to induce menstruation. In place
of the sitz-bath the foot-bath is sometimes used for this pur-
pose, as well as to relieve the congestive headaches, hot flush-
ings, and nervous symptoms often met with at the time of the
menopause.
Internal. — A tumblerful of lukewarm water, with the addi-
tion of 4 to 15 gm. (1 to 4 teaspoonfuls) of mustard is in
general use as an emetic, and is especially advantageous in
cases of narcotic poisoning by reason of the reflex stimulation
caused by the mustard. Otherwise the drug is not very often
employed internally, except as a condiment, though it may
occasionally prove of service. White mustard seeds have some
32
482 PHARMACOLOGY AND THERAPEUTICS.
reputation as an emmenagogue, and obstinate hiccough is said
to have been relieved by an infusion of mustard, 4 gm. (1 tea-
spoonful) to 120 c.c. (4 fl. oz.) of water. In the treatment of
dropsy a mustard- whey, made by boiling 15 gm. (y2 oz.) of
mustard-flour in 500 c.c. (1 pint) of milk, and an alcoholic solu-
tion of the oil of mustard have both been sometimes used with
good effect, and the latter preparation has been found of more
or less service in chronic bronchial and gastric catarrh.
OIL OF CAJTTPUT.
OLEUM CAJUPUTL— Oil of Cajuput. Dose, 0.5 c.c; 8 TTl .
Unofficial Preparation.
Oleum Miaouli. — Oil of Miaouli. Dose, .12 to .60 gm.; 2 to
10 grs. daily.
Action of Oil of Cajuput.
The action of oil of cajuput, externally and internally, is
identical with that of the oil of cloves.
Therapeutics of Oil of Cajuput.
External. — Being a strong, stimulating rubefacient and irri-
tant, it is rubbed into the skin — usually diluted with olive oil —
in a variety of conditions such as muscular rheumatism, chil-
blains, nervous headaches, and chronic inflammatory affections
of the joints and periosteum, as well as in such cutaneous
diseases as chronic eczema, psoriasis and rosacea. In alopecia
it is used as an ingredient of various stimulating ointments.
On account of its parasiticidal properties it is also of service
in the treatment of tinea, scabies, etc. Like many other oils
of its class, it will relieve toothache if introduced into the
hollow of the carious tooth. To some individuals its strong
odor makes it rather objectionable as an application.
Internal. — Being a stimulant carminative, it is useful in flatu-
lent colic and other varieties of dyspepsia, and it is also of ser-
vice in spasmodic affections of the stomach and bowels. In
EUCALYPTUS. 483
these conditions it is usually associated with other remedies.
It sometimes proves successful in relieving nervous dysphagia,
vomiting, hiccough, dyspncea and dysmenorrhea. It has been
given as a diffusible stimulant in typhoid and other low fevers,
and in doses of 1 to 4 c.c. (15 to 60 ni) has even yielded good
results in the collapse stage of cholera. It is furthermore said
to have been used with benefit in chronic rheumatism, laryn-
gitis, bronchitis and catarrh of the bladder, as well as in ele-
phantiasis and certain other skin diseases. It has also been ad-
ministered as a vermifuge, and prescribed, in the form of an
emulsion, as an injection for thread-worms. As an internal
remedy it may be taken on sugar or swallowed in capsules.
Oil of Miaouli. — It seems probable that more or less of the
cajuput oil of commerce is derived from two trees of New
Caledonia, the Melaleuca flaviftora and the Melaleuca viridi-
Uora. The oil of miaouli, or niaouli, which is distilled from
their leaves, is described as of a pale-yellow color and anal-
ogous in chemical composition to terpinol, and is said to pos-
sess properties very similar to those of oil of cajuput. It is
reported to have been used with benefit in bronchitis and to
have a marked effect in diminishing the expectoration in pul-
monary tuberculosis, and it has also been employed for the pur-
poses for which oil of cajuput is usually given. It is best ad-
ministered in capsules.
EUCALYPTUS.
1. EUCALYPTUS.— Eucalyptus. Dose, 2 gm.; 30 gr.
Preparation.
Fluidextractum Eucalypti. — Fluidextract of Eucalyptus.
Dose, 2 c.c; 30 TTL-
2. OLEUM EUCALYPTI.— Oil of Eucalyptus. Dose, 0.5 c.c;
8 Tt\. >
3. EUCALYPTOL.— Eucalyptol. Cineol. Dose, 0.3 c.c; 5 TT],.
484 PHARMACOLOGY AND THERAPEUTICS.
Action of Eucalyptus.
External. — Oil of eucalyptus is a very active disinfectant.
Old oil is said to have greater antiseptic power than new, and
this is thought to be due to the larger amount of ozone which
it contains. As regards the antiseptic properties of eucalyptus
oil, ozone is regarded as its most valuable constituent, and next
to this come the pinenes and other terpenes, which are not only
antiseptic in themselves, but are the agents in the production
of the ozone. Recent experiments indicate that eucalyptol is
the weakest antiseptic of all, and that it is chiefly valuable as
a carrier of ozone. Oil of eucalyptus is a rubefacient, but less
irritant to the skin than oil of turpentine and some other volatile
oils. If evaporation is prevented, however, it will produce vesi-
cation, and even pustulation.
Internal. Gastro-intcstinal Tract. — Ordinarily it produces
very much the same effects as oil of turpentine in small doses,
but large amounts of it are capable of exciting indigestion with
eructations, and nausea, vomiting and diarrhoea, with severe
abdominal pain.
Circulation. — In doses such as promote appetite and diges-
tion it increases the heart's action and causes a rise of blood-
pressure ; effects which are no doubt due to the reflex stimula-
tion from the stomach. Large doses depress the heart and
cause a fall of blood-pressure, at the same time producing great
muscular weakness and lowered temperature. As the arterial
pressure falls in animals after section of the spinal cord or of
the vagi, as well as after atropine, eucalyptus has been thought
to act directly upon the heart. The leucocytes of the blood are
restricted in their movements, diapedesis is prevented, and pus
formation diminished. The surface of the red corpuscles has
been observed to appear wrinkled, and the nucleus, when pres-
ent, more distinct.
Respiration. — While small doses slightly accelerate the re-
spiration, large doses depress it, and in toxic amount it causes
paralysis of this function by direct action on the respiratory
centre in the medulla.
EUCALYPTUS. 485
Nervous System. — As in the case of turpentine, the stimula-
tion of the central nervous system is only very transient, and
is followed by marked depression. It is stated to be even a
more pronounced depressant than turpentine, though conscious-
ness is retained for a longer time. Under large or toxic doses
the brain, medulla, and spinal cord are all affected, the reflexes
are abolished, and loss of sensation in the lower limbs may
occur. Small doses have the effect of stimulating mental
activity.
Spleen. — Like quinine, eucalyptus, it is believed by some,
has the power of causing contraction of the spleen, though
to a much smaller degree. It has also been thought to be more
or less antiperiodic, but that it has any specific action of this
kind is denied by competent authorities, on the ground that it
has the same constituents as several other oils, and seems to
have no peculiar qualities.
Absorption and Excretion. — It is absorbed from the skin,
respiratory mucous membrane, and alimentary canal, and is'
excreted by the skin, the respiratory and other mucous mem-
branes, and the kidneys. It imparts its odor to the breath
and the urine, and is somewhat irritant at the points of elimi-
nation. It therefore has more or less action as a diaphoretic,
expectorant, diuretic, and stimulant to the genito-urinary tract.
In a case of fatal poisoning by oil of eucalyptus death was
preceded by great embarrassment of respiration. Post mortem
there was found a large quantity of blood in the pleural cavi-
ties, the lungs were collapsed and bloodless, and the right heart
contained frothy blood.
Therapeutics of Eucalyptus.
External. — It is used as an antiseptic in surgery, and is pre-
ferred by some to phenol, as it is said to be three times as
energetic as the latter. As a wash or dressing for wounds,
sores, etc., and especially for chronic, indolent, or unhealthy
ulcers, the tincture or the water of eucalyptus (neither official),
or a weak solution of the oil in alcohol, may be employed. An
486 PHARMACOLOGY AND THERAPEUTICS.
ointment of eucalyptus, containing 10 per cent, of the oil, is
official in the British Pharmacopoeia, and a eucalyptus gauze is
also available. A soap (sapo eucalyptoli), containing 5 per
cent, of the oil, is of service in the treatment of foul wounds
or ulcers and of bromidrosis. An ointment composed of
eucalyptus, 8 ; iodoform, 1 ; hard paraffin, 40 ; vaseline, 40, is
a good application for chancres and chancroids, and the oil
in the form of an emulsion (1 to 50), may be advantageously
used as an injection in gonorrhoea. The oil has been employed
as a mild counter-irritant in affections of the chest and of the
joints, and its local stimulant effects sometimes prove valuable
in the treatment of anidrosis and of alopecia when a thickened
and vitiated sebum occludes the glands and covers the scalp.
It is a serviceable addition to other medicaments in ointments
for chronic eczema and other cutaneous affections. A 10 per
cent, solution of eucalyptol in pure alcohol has been used as a
local antiseptic application in diphtheria, and the oil in a
vaporized state has been employed for inhalations in this dis-
ease. Similar inhalations may likewise be given in pulmonary
tuberculosis, dilated bronchi, bronchitis with fetid expectora-
tion, gangrene of the lungs, ozsena, etc. In phthisis not much
is to be hoped for in the way of permanent benefit, as the tuber-
cle bacillus has been found to be peculiarly resistant to the
action of the volatile oils. In asthma, eucalyptus-leaves are
sometimes smoked in cigarettes made with stramonium-leaves
and belladonna or cocoa, but how much of the benefit derived
from their use is attributable to the eucalyptus seems rather
uncertain. A decoction of the leaves is an efficient local appli-
cation in stomatitis, pharyngitis, tonsillitis, etc., after the sub-
sidence of the acute stage. It may also be used as an injec-
tion for thread-worms. In cancer of the rectum or uterus the
topical application of eucalyptus frequently diminishes the
amount and fetor of the discharges.
It is worth noting that eucalyptus is of service in preserving
solutions of alkaloids designed for hypodermatic use. An
aqueous preparation will prevent the development of the peni-
EUCALYPTUS. 487
cillium which rapidly destroys the alkaloid when the solution
is made with simple distilled water.
Internal. — Eucalyptus is useful as a stomachic and carmina-
tive, provided no inflammatory action is present, in atonic dys-
pepsia, and in chronic gastric and intestinal catarrh. In con-
sequence of its action the alimentary tract becomes more
healthy, and no longer affords a place of development for para-
sites, and it is especially efficient in the form of vomiting and
indigestion caused by sarcinse. In convalescence from acute
disease, in debility arising from defective assimilation, and in
cachectic conditions generally, it strengthens the action of the
heart and often constitutes a satisfactory tonic and stimulant.
Hysteria, neurasthenia, chorea, and similar conditions, as well
as cerebral anaemia, may be benefited by eucalyptus, and, like
oil of cajuput, it is likely to be of service in the nervous phe-
nomena which characterize the climacteric period. It has been
known to afford decided relief in the headache which accom-
panies epidemic influenza, and may sometimes likewise prove
efficacious in migraine and other forms of headache. The
remedy is especially valuable in subacute and chronic catarrhal
affections of the bronchial mucous membrane and that of the
genito-urinary organs, by both of which it is excreted. There
seems to be no question of its value in the declining stage of
pneumonia, in pulmonary gangrene, in chronic bronchitis, and
particularly in bronchorrhcea and fetid bronchitis. It has been
given in tuberculosis, in the hope that in its excretion through
the lungs it would exercise an antiseptic action. The objection
has been raised, however, that the traces excreted in this way
are quite incapable of any noticeable effect on microbial growth,
while, as has been mentioned, the tubercle bacillus appears to
be peculiarly resistant to this class of remedies. Among the
genito-urinary affections in which it has been found of ser-
vice may be mentioned chronic desquamative nephritis, granular
degeneration of the kidneys, pyelonephritis, hydronephrosis,
gleet, vaginitis, and particularly chronic catarrh of the bladder.
In these conditions it is necessary, however, to administer it
488 PHARMACOLOGY AND THERAPEUTICS.
with caution and not to use it too long continuously, on account
of the danger of exciting renal congestion and irritation. In
the hope that it might prove beneficial as an antipyretic and in-
ternal antiseptic, oil of eucalyptus has been given both by the
mouth and by hypodermatic injection in pyaemia, septicaemia
and puerperal fever, as well as in typhoid and scarlet fevers.
While the results from its use have sometimes appeared to be
favorable, the remedy would seem to possess no special advan-
tages over the other volatile oils. For subcutaneous use it is
diluted with olive oil (i to 4).
There is considerable difference of opinion as to the value
of eucalyptus in malarial fever. By some it was at one time
thought, like quinine, to have a specific action in this disease,
but this opinion has now been abandoned by most observers.
If it has any such effect at all, it is positive that it is vastly
inferior to that of the cinchona preparations. At the same
time, it appears to have a certain amount of usefulness as a
remedy for malarial conditions, and some of the most experi-
enced clinicians have found it very serviceable in the con-
valescence from intermittent and remittent fevers and in chronic
malarial poisoning. While it cannot by any means take the
place of quinine in arresting the paroxysms or preventing re-
lapses at the septenary periods, it is asserted that it is even
more useful than that remedy for reconstructing the damages
in the organs of assimilation occasioned by the malarial in-
fection. It has sometimes proved curative in cases where
quinine had failed. Eucalyptus trees have been largely culti-
vated in malarial regions, with the effect of often improving
markedly the healthfulness of such districts. This result has
been attributed in part to the action of the eucalyptus in puri-
fying the atmosphere in its vicinity by its aseptic emanations,
but it would seem to be due rather to the drying of the soil,
in consequence of the large amount of water withdrawn from
it by the rapidly growing tree.
In most instances eucalyptol can be substituted for the oil
with advantage.
ARNICA. 489
OIL OF ROSEMARY.
OLEUM ROSMARINI.— Oil of Rosemary. Dose, 0.2 C.C.; 3 TF\.
Action of Oil of Rosemary.
The action of oil of rosemary is like that of other similar
volatile oils. It is said, especially when inhaled, to reduce the
body-heat and impart to the urine a violaceous odor.
Therapeutics of Oil of Rosemary.
Rosemary was formerly employed to some extent as an era-
menagogue, galactagogue and diuretic., but is not now used with
these actions in view. The chief use of the oil is as an external
stimulant in lotions, liniments and ointments. In facial acne
it is thought to have a special beneficial action. It is frequently
prescribed with tincture of cantharides and Cologne water in
alopecia resulting from defective nutrition of the hair-bulbs,
and, on account of its parasiticidal property, it is efficacious in
applications for scabies and the different varieties of pediculosis.
As an ingredient of rubefacient liniments it is serviceable for
sprains and painful joints, and the compound rosemary oint-
ment of the German Pharmacopoeia (consisting of one part
each of the oils of rosemary and juniper-berries in thirty parts
of ointment), may be employed in neuralgia, lumbago, chronic
rheumatism, etc. Oil of rosemary is also largely used simply
to give a pleasant scent to lotions and other preparations for
external use.
Internally, it is occasionally given as a carminative in flat-
ulence and colic and as a stimulant in hysteria accompanied
by depressed spirits.
It enters into the composition of soap liniment and the com-
pound tincture of lavender.
ARNICA.
ARNICA. — Arnica (Arnicae Flores, U. S. P., 1890). Dose, 1 gm.J
15 gr.
Preparation.
Tinctura Arnicae. — Tincture of Arnica. Dose, 1 c.c; 15 n\.
490 PHARMACOLOGY AND THERAPEUTICS.
Unofficial Preparation.
Trimethylamini Hydrochloras. — Trimethylamine Hydrochlo-
rate. Dose, 0.12 to 0.30 gm.; 2 to 5 gr.
ARNICA RADIX (U. S. P., 1890; no longer official).— Arnica
Root. Dose, 0.30 to 1.20 gm.; 5 to 20 gr.
Unofficial Preparations.
1. Extractum Arnicae Radicis (U. S. P., 1890). — Extract of
Arnica Root. Dose, .30 to 1.20 gm.; 5 to 20 gr.
2. Extractum Arnicae Fluidum (U. S. P., 1890). — Fluidextract
of Arnica Root. Dose, .30 to 1.20 C.C.; 5 to 20 nT..
3. Tinctura Arnicae Radicis (U. S. P., 1890). — Tincture of
Arnica Root. Dose, .30 to .60 c.c; 5 to 10 n\.
4. Emplastrum Arnicae (U. S. P., 1890). — Arnica Plaster.
Action of Arnica.
On account of its volatile oil, arnica has the same action as
the volatile oils in general. In large doses it is a gastroin-
testinal irritant, causing vomiting and purging, and also pro-
duces headache, unconsciousness, fall of temperature, paralysis
of the nervous system (motor and sensory), and sometimes
collapse and death. In some cases convulsions occur. In
moderate doses it slows the pulse, raises the blood-pressure
slightly, and stimulates the vagus nerves, while toxic amounts
produce a rapid pulse from paralysis of these nerves. Arnica
is excreted mainly by the kidneys and mucous membranes.
Therapeutics of Arnica.
External. — The diluted tincture is used for myalgia, sprains,
bruises and external inflammations generally, and is a very
popular domestic remedy for such affections. It should not
be applied if the skin is broken, and should always be used
with caution if the integument is sensitive. Some individuals
appear to have a special indiosyncrasy in respect to arnica, and
in such there may be caused by it violent cutaneous inflamma-
tion, with the production of pustules, or even distinct bullae,
ARNICA. 491
attended with severe constitutional symptoms. The idiosyn-
crasy is found to be often marked in the gouty. It is said,
however, that this untoward action has not been observed from
preparations made from the root. Some authorities assert that
any good effects which tincture of arnica may have, such as
causing absorption of ecchymoses, are in reality due to the
alcohol; on the other hand, it is claimed that the infusion (not
official), which is made with water only, is even more efficacious
as a local application than the tincture. The aqueous prepara-
tion, it is also said, promotes the rapid union of cut surfaces.
Clinical experience shows that arnica often has a very effec-
tive local action, particularly in rheumatism, boils, abscesses,
and in all thickened conditions of the integument, and that it
also has some influence over haemorrhages. For boils, ab-
scesses and thickening of the skin an application consisting
of equal parts of fluidextract of arnica root (not official),
soap liniment, and tincture of opium is recommended, and for
haemorrhages, one of equal parts of fluidextract of arnica root
and distilled witchhazel water, to be used on lint or muslin.
A rheumatic joint may be covered with cloths saturated with
the latter combination, which is often more efficient when ap-
plied hot. Arnica plaster sometimes affords a very useful
means of employing the drug locally.
Internal. — Except as a stomachic, carminative and reflex
stimulant, when given in small doses, many writers consider
arnica, internally, as too unreliable in its effects to be of much
therapeutic value. Others, however, confidently assert that it
is a remedy of distinct usefulness in a very considerable variety
of conditions. Thus, it is claimed that ecchymoses are rapidly
dispersed by its internal, as well as its external administration,
and that for internal contusions from shock or concussion its
use by the mouth has proved very efficacious. Furthermore,
that it has rendered good service in typhus and typhoid fevers
(as a stimulant and antipyretic), delirium tremens, rheumatism
and rheumatic gout, epistaxis, haemoptysis and other haemor-
rhages, amaurosis, concussion of the brain, paralysis of the
492 PHARMACOLOGY AND THERAPEUTICS.
bladder, and chronic dysentery. The assertion is made that it
has often checked an exhausting diarrhoea after many other
remedies have failed, and that in aqueous preparation it has
given great satisfaction in idiopathic mania, after the first ex-
citement has diminished. It has also been found beneficial in
acute eczema, in erysipelas, and in other cutaneous affections
of gouty or rheumatic origin. Many of these claims would
seem to be exaggerated.
Trimethylamine (C3H0N), a compound which is frequently
incorrectly called propylamine, with which it is isomeric, has
been obtained from arnica flowers and those of several other
plants, as well as from decomposing albuminous substances,
such as herring-pickle and human urine. In its pure state it
is a colorless, thin, and strongly alkaline liquid, having a marked
ammoniacal odor modified by the peculiar odor of herring-
pickle, and boiling at 9.80 C. (49. 6° F.), while at ordinary
temperatures it is a colorless inflammable gas. It is readily
soluble in water and alcohol. The hydrochlorate, its most stable
salt, which crystallizes in white or colorless prisms and is very
deliquescent, is also freely soluble in water and alcohol. In
doses of .12 gm. (2 gr.) every three hours it is said to be a
powerful antipyretic, and it has been used with considerable suc-
cess in acute rheumatism and gout. In chronic rheumatism a
liniment (1 to 3 of glycerin) has also afforded great relief; and
it has been suggested that the fact that arnica contains tri-
methylamine is probably the true explanation of the utility of
that drug in rheumatic and gouty affections. Trimethylamine,
when given to the extent of 1 to 1.30 gm. (15 to 20 gr.) a day,
has been reported as efficient in the treatment of chorea, greatly
moderating the spasmodic movements when not altogether pre-
venting them.
MEZEREUM.
MEZEREUM.— Mezereum. (Mezereon.) Dose, 0.500 gm. (500
milligm.); 7V2 gr.
Preparation.
Fluidextractum Mezerei. — Fluidextract of Mezereum.
ELEMI. 493
Action of Mezereum.
External. — Mezereum has the same action as volatile oils
generally. It is a powerful rubefacient and vesicant externally.
Internal. — It is a gastric stimulant, producing in large doses,
vomiting and diarrhoea.
Therapeutics of Mezereum.
External. — It has been used chiefly in the compound mustard
liniment (no longer official), where it excites the same effects
and is employed for the same purposes as the oil of mustard.
Almost its only other external use at present is to keep open
an issue, a procedure which is now very rarely employed. Un-
guentum Mezerei was official in U. S. P., 1880. In the mouth,
however, mezereum-bark has been successfully employed to
relieve toothache, and also as a sialogogue.
Internal.— Internally its use is now practically restricted to
its administration, in combination with sarsaparilla, as an alter-
ative in syphilis, chronic rheumatism, and chronic skin diseases,
in all of which its value is very doubtful. It is an ingredient
of both the compound decoction (no longer official) and the
compound fluidextract of sarsaparilla.
ELEMI.
ELEMI.— Manila Elemi (not official).
Action of Elemi.
Elemi acts like volatile oils generally.
Therapeutics of Elemi.
It is only used as a stimulating disinfectant ointment which
was formerly official in B. P. as elemi, 1 ; ointment, 4. In this
country it is very rarely prescribed.
Division V. — Drugs Acting on the Skin.
While the drugs described in Division IV act on the cutaneous
vessels, in addition we have —
494 PHARMACOLOGY AND THERAPEUTICS.
A. Diaphoretics, or drugs which increase the amount of per-
spiration. These may do this: (i) By affecting the circula-
tion in the skin. This may be locally (by local irritation) or
systemically. In the latter case the action may be an indi-
rect one, and due to a rise of general blood-pressure if the
cutaneous vessels are not at the same time constricted; or a
direct one, due either to stimulation, direct or reflex, of the
central dilator mechanism of the cutaneous vessels, or to
paralysis of the vaso-constrictor mechanism of these vessels.
(2) By directly augmenting the secretory activity of the cells of
the sweat glands, either through stimulation, direct or reflex,
of the sweat centres in the spinal cord, or through peripheral
stimulation of the terminations of the nerves in the glandular
cells themselves. As it is difficult to decide whether drugs
acting on the vessels do not affect the other parts of the
mechanism, and also whether a drug acts on the gland-cells or
on the nerve endings, diaphoretics will be considered under
two headings only: (a) those acting peripherally, and (b)
those acting centrally. These are differentiated by observing
whether the drug acts on a part of the skin after- division of the
nerves going to it or whether it acts after destruction of the
spinal cord.
(a) Diaphoretics acting peripherally : Pilocarpine greatly increases
the amount of sweat, acting on the nerve terminations in the gland-
cells, but not on the vessels. Nicotine also acts peripherally. Local
applications of warmth, and Alcohol taken internally perhaps act in
the same way in addition to their vascular action.
(b) Diaphoretics acting centrally:
(1) Antimony salts.
(2) Ammonium acetate.
(3) Ammonium citrate.
(4) Ipecacuanha.
(5) Opium.
(6) Camphor.
(c) Diaphoretics zvhose mode of action is doubtful: Potassium Ci-
trate and acetate, senega, cubeb, colchicum, salicin, lobelia, arnica and
aconite. All these, except the first two, are very feeble.
When a diaphoretic acts very powerfully it is called a Sudorific,
DRUGS ACTING ON THE SKIN. 495
B. Anhidrotics, or Antihidrotics, drugs which diminish the
amount of perspiration. The part on which these act is de-
termined in the same way as in the case of diaphoretics.
(a) Anhidrotics acting peripherally : Atropine is very powerful; it
acts on the terminations of the nerves in the glands, and hyoscyamus
and stramonium apparently act in the same way. The local applica-
tion of cold has a similar action.
(b) Anhidrotics the mode of action of which is doubtful:
(1) Acids.
(2) Nux vomica.
(3) Quinine.
(4) Picrotoxin.
(5) Zinc salts.
(6) Salicylic acid.
(7) Camphoric acid.
Therapeutics. — Diaphoretics are used for the following pur-
poses: (1) To remove fluid from the body, as hy causing the
absorption of exudates. (2) To relieve diseased and overtaxed
kidneys; for this purpose pilocarpine is much used. (3) To
remove poisons introduced from without. or formed in the body.
Pilocarpine is also used to promote excretion by the sweat in
uraemia and similar conditions. (4) To re-establish disturbed
circulation in the skin, in order to relieve internal congestions,
break up an incipient " cold," bring out the rash in exanthemata,
promote defective nutrition of the skin in certain cutaneous
diseases, etc. The increased vascularity of the skin is also made
use of to facilitate the absorption of local medicaments, such
as ointments. Diaphoretics act as mild antipyretics. (5) To
increase the alkalinity of the tissues, as in gout, oxybutyric acid
coma (diabetes), etc. For this purpose drugs which directly
stimulate the glandular activity are required, as the sweat is
acid only when produced in this manner. It has been shown
that an injection of pilocarpine is so effective in removing acid
that it will render the urine of a healthy person markedly alka-
line. In general, the sweat which results from increased circu-
lation contains less solid matters and is more alkaline, while
that resulting from direct action on the glands is more con-
centrated and less alkaline. This is the character of the cold
sweat which carbon dioxide produces by stimulating the sweat
496
PHARMACOLOGY AND THERAPEUTICS.
centres, and which is often of serious import in the course of
a disease, as indicating asphyxia. Certain drugs when taken
internally are excreted in the sweat. Among them may be men-
tioned iodine, iodides, and tartaric, succinic and benzoic acid,
the latter in the form of hippuric acid.
Anhidrotics are employed to a limited extent either for gen-
eral conditions, as phthisis, or for local conditions, as hyperi-
drosis of the hands or feet. Little or nothing is known of the
effect of drugs on the sebaceous secretion, though iodides and
some other substances are excreted in the sebum.
Certain drugs, when taken internally in large doses, produce
a rash on the skin, possibly because in the course of their ex-
cretion through the skin they irritate it. Such are —
(0 Copaiba.
(2) Cubeb.
(3) Bromides.
(4) Iodides.
(5) Turpentine.
(6) Belladonna.
(7) Hydrated chloral.
(8) Opium.
(9) Quinine.
(10) Salicylic acid.
(11) Arsenical salts.
(12) Acetanilide.
(13) Antipyrine.
(14) Phenacetine.
(15) Chloralamide.
(16) Antitoxins.
(17) Serums.
(18) Silver salts may discolor
the skin.
(19) Sulphonal.
The following quite rarely produce an eruption :
(1) Iron.
(2) Strychnine.
(3) Creosote.
(4) Mercury.
(5) Veratrum.
(6) Digitalis.
(7) Sulphur.
(8) Antimony.
(9) Santonin.
(10) Cod liver oil.
Diaphoretics.
PILOCARPUS.
1. PILOCARPUS.— Pilocarpus. (Jaborandi.) Dose, 2 gm.; 30 gr.
Preparation.
Fluidextractum Pilocarpi. — Fluidextract of Pilocarpus.
Dose, 2 c.c; 30 tt\,.
2. PILOCARPINE HYDROCHLORIDUM.— Pilocarpine Hydro-
chloride. Dose, 0.010 gm. (10 milligm.); y5 gr.
pilocarpus. 497
3. PILOCARPINE NITRAS.— Pilocarpine Nitrate. Dose, 0.010
gm. (10 milligm.) ; y5 gr.
Action of Pilocarpus.
External. — None.
Internal. G 'astro-intestinal Tract. — Pilocarpine, which is
promptly absorbed, is a glandular stimulant of extraordinary
power. Its first effect is seen in a marked increase of the
saliva, which contains an abundance of salts and ptyalin, and
will readily convert starch into sugar. There is a feeling of
warmth in the mouth, and often a sensation of tenseness about
the salivary glands. The seat of the stimulation is the termina-
tions of the secretory nerves. That it does not reside in the
cells is shown by the fact that the action of the drug is instantly
antagonized by atropine, which acts upon the nervous struc-
tures alone, and not upon the secretory cells ; and that it is not
central in character is evident from the fact that section of
the secretory nerves does not materially alter the action.
Nausea, retching and vomiting are occasionally observed, and
there is always some increase in the gastric and pancreatic
secretions. Whether there is any increase in the intestinal
secretion is still unsettled, though this seems highly probable.
Peristalsis is increased by the contraction of the intestinal
muscle from the stimulation of its peripheral nervous apparatus.
Unstriped muscle generally, with the exception of that of the
blood-vessels, appears to be thrown into contraction, but this
action is more marked in the bowel than elsewhere; so that
repeated diarrhceic evacuations occur, accompanied with more
or less colic. This muscular action also takes place inde-
pendently of the central nervous system, and is antagonized by
atropine in the same way as the effect on the glandular secre-
tions. The secretion of bile is not directly affected.
Eye. — Myosis (contraction of the pupil) and spasm of accom-
modation are produced through stimulation of the motor oculi
terminations. The intra-ocular tension is reduced, after a tem-
porary increase; myosis being generally attended with lowered
tension.
33
498 PHARMACOLOGY AND THERAPEUTICS.
Skin. — Shortly after the augmentation of the salivary secre-
tion begins, there follow a flow of tears and excessive perspira-
tion. The effect on the sweat glands is so pronounced as to
leave no question that pilocarpus is the most efficient diaphoretic
of all known drugs. The general increase in the secretions is
found to be mainly due to water. Although the solids are in-
creased also, yet, owing to the excess of fluid poured out, their
percentage is diminished. After a single subcutaneous dose of
pilocarpine the water lost in the sweat, saliva, mucus, and other
secretions may amount to 3785 c.c. (1 gallon). The loss of
weight is naturally very great also, and this has been set down
at from 2 to 4 kilogrammes (4J/2 to 9 pounds). The mucous
glands of the mouth, throat, nose and deeper respiratory pas-
sages, as well as the ceruminous glands of the ears, all partici-
pate in the activity induced by the pilocarpine stimulation. The
effect upon the secretion of milk is doubtful. Under a course
of pilocarpus the hair grows more luxuriantly, but it becomes
quite coarse.
Circulation. — In man pilocarpine is found to give a marked
acceleration to the pulse, with increased blood-pressure and later
with arhythmia. This is attributed to vagus paralysis, though
the rise of blood-pressure is believed to be partly due to a
stimulation of the vaso-motor centres. Under large doses there
follow muscular slowing and weakening of the heart, with fall
of blood-pressure; and this action is judged to be on the cardiac
muscle directly. In rabbits, it is stated, there is a primary
vagus stimulation, which is shown by slowing of the heart and
fall of blood-pressure, and this action sometimes occurs in
man also. The increased activity of the glands is accom-
panied by an acceleration of the blood current through them,
with dilatation of the vessels, and this is believed to be probably
not due to the direct action of the drug on the latter, but simply
a result of the stimulus imparted to the glands. After pilo-
carpine there is frequently noticed a redness of the skin, espe-
cially of the face, and this is no doubt due to the vascular dila-
tation accompanying the increased activity of the sweat glands.
pilocarpus. 499
The sugar of the blood has been found increased, a result
attributed to the action of pilocarpine on the terminations of
the nerves in the liver which regulate the glycogenic function
of that organ.
Respiration. — The respiration is often quick and dyspnoeic,
and rales may be heard over the bronchi, denoting an accumu-
lation of mucus in them ; the bronchial secretion being markedly
augmented. The effect on the respiration of ordinary doses is
merely an indirect one, resulting from changes in the circula-
tion which diminish the amount of blood passing through the
lungs and tend to produce asphyxial dyspnoea.
Central Nervous System. — In experiments on animals it is
found that the action here is weak and appears late; being en-
tirely overshadowed by the peripheral actions. It is described as
follows : The effects are mainly depressing. Vasomotor paraly-
sis is a rather early and prominent symptom; it leads to dyspnoea.
Later, the respiratory centre is also depressed. (Edema of the
lungs (consisting rather in the aspiration of bronchial effusion
than in a true serous effusion), consequent on the weakened
heart and obstruction of the bronchi by mucus, is a frequent
occurrence. The motor centres, especially those of the cord,
show some stimulation (increased reflexes, tremors, convul-
sions), and later paralysis.
Urinary Organs. — The urine, like the bile, does not seem to
be affected directly, although it may be reduced in quantity
or otherwise modified by the withdrawal of a large amount of
fluid from the body by the sweat and other secretions. The
bladder muscle participates in the general contraction of un-
striped muscular fibre induced by the drug, and repeated evacua-
tion and straining may occur. Pilocarpine is excreted un-
changed in the urine.
Uterus. — The spleen and bronchi contract under the influence
of pilocarpine upon unstriped muscle, and the uterus is sup-
posed to be affected in the same manner. In occasional in-
stances abortion has been attributed to the action of the drug.
Temperature. — In consequence of the hyperaemia of the skin
500 PHARMACOLOGY AND THERAPEUTICS.
the temperature is apt to be temporarily elevated, but there
soon follows a decided fall, which is apparently due in great
measure to the evaporation of the perspiration. The decline in
body-heat is maintained on an average for about four and a
half hours.
The most important effects of pilocarpine on the system are
the diaphoresis, the salivation, and the myosis. The antagonism
to atropine is complete with both glands and muscles. The
alkaloid pilocarpine is more generally employed than pilocarpus
itself, as it is more prompt and efficient in its action, as well as
less liable to disagree with the stomach. Children usually bear
large doses of it well.
Jaborine, having an action like that of atropine, opposes the
effects of pilocarpine, but although the amount of it varies in
different specimens of pilocarpus leaves, there is never a suffi-
cient quantity to entirely overcome the action of the principal
alkaloid of the drug.
Therapeutics of Pilocarpine.
External. — For promoting the growth of the hair an oint-
ment composed of pilocarpine hydrochloride, I ; petrolatum,
60 ; lanolin, 60 ; may be used, or a lotion : Pilocarpine hydro-
chloride, 1; quinine hydrochloride, 4; glycerin, 60; rose water,
180. The following, applied with friction, is more stimulating
to the scalp: Fluidextract of pilocarpus, 15; soap liniment, 15;
perfumed spirit (not now official), 60. Pilocarpus and its
preparations also have the effect of rendering the hair darker
in color. The fluidextract has been employed as a local appli-
cation in eczema and erysipelas. Pilocarpine is used topically
as a myotic in many eye affections. Lozenges containing .001
gm. (¥^-gr.) are said to relieve dryness of the throat.
Internal. — Pilocarpine may be used whenever a prompt dia-
phoretic effect is desired. It is most commonly employed to
produce sweating in cases of Bright's disease. The usual prac-
tice is to administer .01 gm. (*. gr.), or more, of pilocarpine
hydrochloride, in the evening, aiding the sweating by wrapping
the patient, who should be naked, in warm blankets, applying
PILOCARPUS. 501
heat to the feet, and administering hot drinks. As soon as the
sweating has ceased he should be rubbed dry and left in a dry
blanket. In this affection the drug is often of great service by
relieving the strain on the kidneys, by eliminating toxins from
the blood and diminishing the inflammatory condition in the
kidneys by lowering the blood-pressure. On account of its
depressing action on the heart, it should always be used with
great caution when there is any cardiac disease present, and
alcohol or strychnine may often be administered with advan-
tage to guard against depression of that organ. By some, pilo-
carpine is never employed in chronic parenchymatous nephritis,
and the opinion is held generally that it is contra-indicated in
the nephritis of middle or advanced age associated with cardiac
changes. Theoretically it is the most prompt and efficient
remedy at our disposal in uraemia, and in many instances it is
practically of great service. In dropsy due to organic disease
of the heart it is generally too depressing, and fatal results may
attend its use. It may be used in pleurisy with effusion, but is
not so efficient as some other remedies. Injected subcutaneously
every second day, it has proved successful in the treatment of
some cases of catarrhal jaundice of a persistent type. Its ad-
ministration by the same method has been highly recommended
as a preventive and curative measure in the early stages of
erysipelas, and has been found effective in cases of obstinate
aural vertigo. Deafness resulting from disease of the auditory
nerve or its terminations is sometimes relieved by pilocarpine,
and the drug is often given internally for deafness due to otitis
media sicca. Locally applied, pilocarpine is of service as an
ocular tonic to relieve pain after excessive use of the eyes, and
in small doses internally has been shown to be a good remedy in
tobacco and alcoholic amblyopia. Among other diseases of
the eye in which it has been employed are detachment of the
retina, chronic iritis, keratitis, haemorrhages into the vitreous,
haemorrhages and exudations of the retina, glaucoma, atrophic
choroiditis, and commencing atrophy of the optic nerve. When
given hypodermatically it is sometimes successful in stopping
502 PHARMACOLOGY AND THERAPEUTICS.
hiccough, and also in arresting paroxysms of spasmodic asthma.
Efficient aid to the action of iodides and mercurials in the re-
moval of exudations has been found to be rendered by the
use of pilocarpine or pilocarpus, which is here given chiefly
for the purpose of increasing the rate at which the exudates
liquefied by the agents mentioned are taken up and excreted.
In the case of gummata it is advised that the adjuvant remedy
should be exhibited once or twice a day. For the attempted re-
moval of inflammatory deposits such as those met with in
chronic pneumonia and chronic pleurisy, it is thought prefer-
able to give pilocarpine for three or four days at a time, and
then to discontinue its use until the following week. The
dosage and frequency of administration must be regulated by
the degree of action, and an amount which will cause but little
sweating and salivation is said to suffice. In subacute and mus-
cular rheumatism, as well as in dry and scaly skin eruptions,
it may often be used with great advantage. Injected subcu-
taneously, pilocarpine is sometimes successfully employed as an
antidote in belladonna or atropine poisoning.
TOXICOLOGY.
Death very rarely results from the use of pilocarpus or its alkaloid.
When it does occur, it is by paralysis of the heart or oedema of the
lungs. Treatment. — Atropine is a physiological antidote. In addition
to its use, the general treatment of alkaloidal poisoning is called for.
ANTIMONY.
ANTIMONII ET POTASSII TARTRAS.— Antimony and Potas-
sium Tartrate. (Tartar Emetic. Tartarated Antimony.) Dose (ex-
pectorant), 0.005 gm. (5 milligm.); 1 gr.; (emetic) 0.030 gr. (30
Preparations.
1. Vinum Antimonii. — Wine of Antimony. Dose, 1 c.c;
15 m..
2. Syrupus Scillae Compositus. — Compound Syrup of Squill.
(Hive Syrup.) Dose, 2 C.C.; 30 111.
ANTIMONY. 503
Unofficial Preparations.
1. Antimonii Sulphidum (U. S. P., 1890). — Antimony Sul-
phide.
2. Antimonii Sulphidum Purification (U. S. P., 1890).—
Purified Antimony Sulphide. (Purified Black Antimony.)
3. Antimonium Sulphuratum (U. S. P., 1890). — Sulphurated
Antimony. (Kermes mineral.) Dose, 0.01 to 0.05 gm.; % to
1 gr.
4. Pilulae Antimonii Composite (U. S. P., 1890). — Com-
pound Pills of Antimony. (Plummer's Pills.) Dose, 1 to 3
pills.
5. Antimonii Oxidum (U. S. P., 1890). — Antimony Oxide.
Dose, 0.05 to 0.25 gm.; 1 to 4 gr.
6. Pulvis Antimonialis (U. S. P., 1890). — Antimonial Pow-
der. (James' Powder.) Dose, 0.15 to 1 gm.; 3 to 15 gr.
Action of Salts of Antimony.
External. — They are powerful local irritants. Tartar emetic
produces a pustular eruption on the skin, and the Liquor Anti-
monii Chloridi of the B. P., which is a solution of antimony
chloride in hydrochloric acid, is a severe caustic.
Internal. Alimentary Canal. — Antimony acts very much like
arsenic, though differing from the latter in the severity of its
local action and in being absorbed more slowly. In large doses
by the mouth, or if injected into the circulation, its effects are
found to be practically identical with those of arsenic, but
vomiting is always a prominent symptom, the poison being
rapidly excreted into the alimentary canal. The only result of
very small doses of tartar emetic is the production of some
perspiration. In somewhat larger amounts, by its direct action
on the walls of the stomach, it causes nausea and vomiting with
marked prostration and the usual accompaniments of emesis,
such as salivation, sweating and quickened pulse. Like other
antimonial preparations, it is irritant to the intestine if given
in sufficient quantity. (A round mass of metallic antimony
was formerly known as the " family pill," because it could be
504 PHARMACOLOGY AND THERAPEUTICS.
repeatedly used as a laxative.) In poisonous doses tartar
emetic gives rise to violent and continuous vomiting, the vomit,
after the ordinary contents of the stomach have been evacuated,
consisting of slimy mucus, which eventually may have blood
mixed with it. With the vomiting are associated profuse
watery diarrhoea, great muscular weakness, and collapse, with
cold perspiration, clammy skin, and cyanosis of the face and
extremities. This drug when thrown directly into the blood
also produces vomiting, but it is found that much larger quan-
tities are required for this than when it is given by the mouth.
Moreover, a portion of the antimony which is injected intra-
venously is carried to the stomach and intestine, where it causes
local irritation. Some have believed that the emesis is due
to action on the medulla, but from the facts just mentioned it
would appear that this is attributable entirely to its effects as
a gastric irritant. It is true that, when injected into the circu-
lation, it may have an emetic effect even if the stomach is
replaced by a bladder, as has been shown by experiment; but in
explanation of this it has been suggested that although the
antimony cannot act on the stomach under these circumstances,
it may induce vomiting by causing irritation of some other
part of the alimentary tract. While large quantities affect the
gastro-intestinal tract much in the same way as arsenic, caus-
ing hyperemia and swelling of the mucous membrane, medicinal
doses do not cause any such effects. Even with large doses,
however, the intestine may remain unaffected, both because
antimony is, as has been mentioned, absorbed more slowly than
arsenic, and because the larger portion of the poison is usually
gotten rid of by the violent vomiting excited.
Heart and Circulation. — Antimony is a direct depressant to
the cardiac muscle. The temporary acceleration of the pulse
is simply one of the effects of the vomiting, and is succeeded
by a diminution in both the frequency and force of the beat
of the heart. The final stoppage of the organ is found by ex-
periment to take place in diastole. There is no evidence that
the cardiac nerves are affected. There is a continuous fall in
ANTIMCNY. 505
blood-pressure, due in some measure to the weakness of the
heart, but principally to the effect of the drug on some part of
the vaso-motor system. The peripheral nerves and muscle of
the vessels are known to be implicated, though it is uncertain
whether or not the vaso-motor centre shares in the action.
Respiration. — Like the pulse, the respiration is often quick-
ened at first, and may be shallow and irregular from the nausea,
but in cases of poisoning it becomes slow and labored, and
eventually ceases along with the heart. The weakening of this
function is believed to be chiefly due to the disturbance of the
circulation and the irritation of the alimentary canal, though
the respiratory centre may possibly be in some degree directly
acted upon.
Nervous and Muscular Systems. — In the frog the central ner-
vous system has been shown to be directly depressed by anti-
mony. This is thought to be probably the case in mammals also,
though the effects of the poison on the circulation and alimen-
tary canal render the true nature of the nervous action obscure.
There is good authority for stating that the depression and
collapse resulting from the drug are due to the gastric irritation
and slowed circulation, and not to any involvement of the per-
ipheral nerves and muscles, as has been believed by some. In
the frog the voluntary muscular tissue is found to be weakened
to some extent, but only after large doses and at a late stage
of the poisoning.
Temperature. — Antimony, in considerable doses, produces a
marked reduction of temperature, the fall being stated to some-
times amount to 6° C. (42. 8° F.) in animals in the course of
a few hours. This is attributed to the slowness of the circula-
tion, the general depression and collapse, and the profuse
sweating.
Secretion and Excretion. — Such secretions as the sweat, the
saliva, and the mucus of the respiratory tract are increased by
antimony, not in consequence of any direct action upon the
glands, but simply as a result of the emesis caused by the drug.
Its action on the urinary secretion is not very marked. The
506 PHARMACOLOGY AND THERAPEUTICS.
urine is sometimes more or less increased, and sometimes dimin-
ished or even entirely suppressed. This has been explained by
the suggestion that there is a temporary stimulation of the renal
epithelium, but that later, when a larger amount of the anti-
mony has been absorbed, an acute irritation of the kidneys is
excited. The prolonged use of the drug, as in the case of
arsenic, is liable to induce fatty degeneration of many organs
and abrogation of the glycogenic function of the liver, while the
nitrogen of the urine is increased. Very small quantities of anti-
mony, given repeatedly, are stated, however, to augment the
hepatic glycogen and fat, without apparently altering the nitro-
gen of the urine. Antimony is absorbed from the gastro-
intestinal tract and very slowly from the skin, and it passes into
the tissues much more gradually than arsenic; consequently
doses can be chosen whose only action is to produce nausea,
or, if somewhat larger, vomiting. After absorption it is stored
in considerable amount in the liver. It is excreted into the
stomach and intestine, in the urine, and also probably in the bile
and milk.
Therapeutics of Salts of Antimony.
External. — A solution of antimony chloride, known as Butter
of Antimony, was once used as a caustic, but its employment has
been abandoned, as the sore produced is difficult to heal. An
ointment of tartar emetic which was formerly employed as a
counter-irritant has also fallen into disuse, as its application
causes considerable pain. If tartar emetic is persistently rubbed
on the skin, the pustules caused by it may become confluent and
form small abscesses, and, later, extensive necrosis and ulcera-
tion of the integument may be induced.
Internal. — Tartar emetic was at one time given in a large
number of conditions which it is unnecessary to enumerate, as,
on account of its depressing effects, it has been superseded by
other remedies. Almost the only class of affections in which
it is now employed to any extent is diseases of the respiratory
passages, in which it has a limited field of usefulness. In com-
mencing bronchitis it is occasionally given until vomiting
ANTIMONY. 507
occurs, and then continued in smaller doses and at longer in-
tervals. More commonly, in the early stage of acute bronchitis,
it is used in doses insufficient to produce emesis. Here it serves
to promote secretion, diminish fever, induce diaphoresis, and
hasten the elimination of inflammatory products. When a free
secretion of bronchial mucus has once been established, it
should as a rule be discontinued, as after that it is too de-
pressing to constitute a satisfactory expectorant. It is also a
useful remedy in the first stage of acute nasal and pharyngeal
catarrh. It is not a suitable preparation for infants or very
young children, and compound syrup of squill (Coxe's hive
syrup), which is a domestic remedy for croup, has been known
to prove fatal. When an emetic is required in laryngitis, bron-
chitis, or other acute inflammation of the respiratory tract,
ipecacuanha is usually preferable. In acute inflammatory and
febrile diseases, other than those of the air-passages (provided
there is not much irritability of the stomach), minute doses of
tartar emetic (.004 gm. ; J^ gr.) are still highly spoken of by
some writers, and impending attacks of malarial fever are said
to be sometimes successfully aborted by emetic doses of anti-
mony and ipecacuanha. As a diaphoretic tartar emetic has
been very largely supplanted by pilocarpine.
TOXICOLOGY.
Acute Poisoning. — The symptoms resemble those of arsenical poison-
ing (see p. 247). Post-mortem. — There is hyperemia, tumefaction and
erosion, with ecchymoses, of the gastric and intestinal mucous mem-
branes. Pustules may be found in the mouth, oesophagus, stomach and
small intestine, and there may be congestion or inflammation of the
lungs.
Treatment. — Emetics are seldom required, but if the poison does not
cause free vomiting, the stomach should be washed out or emetics ad-
ministered subcutaneously (apomorphine hydrochloride) or by the mouth
(zinc sulphate). A purge may also be given to remove the poison in
the bowel. Tannic acid, in repeated doses of 2 gm. (]/2 dr.), is used
to precipitate the antimony in the stomach, and the tannate thus formed
should be washed out. A form of tannic acid which is usually readily
5<d8 pharmacology and therapeutics.
obtainable is strong tea, which is also serviceable as a stimulant for
the collapse. Mucilaginous drinks may likewise be given freely, and
stimulants by hypodermatic injection, as well as the external applica-
tion of heat, are generally called for.
Chronic Poisoning is very rare, and it is difficult to recognize, as
the symptoms do not present any very definite characteristics. Among
them are described headache, dizziness, depression, indistinct sight,
nausea and vomiting, dyspepsia with more or less gastric pain, diar-
rhoea, loss of flesh, albuminuria, general weakness and exhaustion, and
finally collapse. As the symptoms resemble those of acute gastrointesti-
nal catarrh, poisoning with small, repeated doses of antimony is some-
times resorted to criminally, and an instance of the use of the drug for
homicidal purposes has recently been the subject of judicial inquiry.
Pustular eruptions, it is said, have been observed from the prolonged
internal use of tartar emetic.
Post-mortem. — Antimony is said to be found in the liver, kidneys,
spleen, bones and muscles, and there is also fatty degeneration of the
viscera, especially the liver.
THOROUGHWORT.
EUPATORIUM.— Eupatorium. (Thoroughwort. Boneset.) Dose,
2 gm.; 30 gr.
Preparation.
Fluidextractum Eupatorii. — Fluidextract of Eupatorium.
Dose, 2 c.c; 30 n\.
Action of Thoroughwort.
Thoroughwort is tonic and mildly laxative. It is also dia-
phoretic in infusion, but the diaphoretic properties of the prep-
aration are chiefly due to its hot water.
Therapeutics of Thoroughwort.
It is, like many other substances of vegetable origin, a do-
mestic remedy for the commencement of catarrh, influenza, or
muscular rheumatism.
MARRUBIUM.
MARRUBIUM. — Marrubium. (Horehound.) Dose, 2 gm.; 30 gr.
SUBSTANCES ACTING ON URINARY SYSTEM. 509
Action of Horehound.
Horehound, used as a decoction or an infusion, is in moder-
ate doses diuretic and diaphoretic, and in large doses laxative.
It is probably also a bitter stomachic.
Therapeutics of Horehound.
It may be given to increase the action of the skin and kid-
neys, but its effects are not marked. Horehound candy, slowly
dissolved in the mouth, relieves the relaxed throat of public
speakers.
Division VI. — Substances Acting on the Urinary System.
1. Drugs Increasing the Quantity of Urine Secreted. — These
are called diuretics. The kidneys are susceptible to a variety
of influences. Thus, anatomically they present two distinct
varieties of epithelium and have an extremely abundant supply
of vessels and vaso-motor nerves, while the activity of the
organs is profoundly affected by variations in the quantity of
blood flowing through them. In the present state of our
knowledge it is impossible to say in just what manner many
diuretics act. A considerable number of them, no doubt, are
effective in more ways than one, and the following table, taken
from Brunton but somewhat modified, presents the various
ways in which these agents probably act:
5io
PHARMACOLOGY AND THERAPEUTICS.
Increased car-
diac action.
r Digitalis,
Caffeine,
Alcohol,
Strophanthus,
Generally.
4
General vas-
cular contrac-
. Sparteine,
Erythrophlo3um,
Digitalis,
Squill,
Raise
arterial <
tion.
Convallaria,
Strychnine,
Cold to skin.
pressure.
. Act on vaso-
? same as above.
motor centres.
Broom,
,■ Contract
Caffeine (large
efferent -
doses),
vessels.
x n •<
Buchu,
Uva ursi,
Locally
Locally on
^ kidney.
Juniper,
Turpentine,
^in kidney.
Copaiba,
Cantharides.
Dilate, chiefly
Caffeine,
locally, renal -
Urea.
^ vessels.
.
r Urea,
r
Caffeine,
Increase water excreted.
Theobromine So-
dio-salicylate,
Calomel,
Act on secreting
. Colchicum,
nerves or renal cells. «
Solution of Potas-
sium Hydroxide,
Increase water and solids
Potassium Acetate,
excreted.
Potassium Citrate,
Potassium Nitrate,
Sodium Citrate and
t.
other salines.
Therapeutics. — Diuretics are used chiefly for the following
purposes: (i) To maintain the action of the kidneys. Dimin-
SUBSTANCES ACTING ON URINARY SYSTEM. 5 I I
ished urinary excretion may be purely functional in its origin,
as in fevers. In these it is essential that the action of the kid-
neys should be maintained, and the free use of water is often
very serviceable for this purpose. The ingestion of large quan-
tities of water greatly increases the urinary flow, and may in-
crease not only the amount, but also the solids, of the urine.
Investigation has shown that when the tissues are full of the
products of disintegration the effect of water is very marked,
but that upon the wasting processes of the body it exerts no
influence ; hence, while it may not be possible to produce tissue-
disintegration by water, there would seem to be no question
that water is capable of washing out the retained products of
tissue change. This naturally renders it of value in various
diseases. Intestinal lavage (enteroclysis) with normal saline
solution, by means of the rectal irrigator, has been found one
of the best and most certain of diuretics. Diuretics are used
in cardiac and pulmonary affections when, owing to the general
vascular disturbance, the quantity of urine becomes diminished.
In diseased conditions of the kidney itself the maintenance of
the urinary excretion is urgently demanded, but on account
of organic changes in the renal secretory structures, it is often
the case that diuretics fail to produce their appropriate effect.
In many such conditions it is a question how far it is desirable
to stimulate the diseased organ, and in the great majority of
instances only the mildest diuretics should be prescribed. When
renal inflammation is present, even if it be chronic, irritating
diuretics should be avoided. In acute Bright's disease large
draughts of water at regular intervals not infrequently have
a very favorable effect; not only greatly increasing the amount
of urine, but also lessening the irritation of the kidneys. In
grave cases, with violent irritation of the kidneys and per-
haps suppression of urine, hypodermoclysis has proved of
great benefit. (2) To get rid of fluid in various parts of the
body. For this purpose hydragogue diuretics are employed in
all forms of dropsy. (3) To diminish irritation of the genito-
urinary organs, as from the deposit of solids from the urine.
5 I 2 PHARMACOLOGY AND THERAPEUTICS.
Here diuretics are of great service by diluting the secretion,
and the value of water as an adjuvant to medicinal diuretics
should always be taken advantage of. The alkalies are also of
special utility.
In the use of diuretics it is important to have in mind that
they may act in a variety of ways, and as it is not always pos-
sible to determine the precise cause of the deficiency in the
urinary excretion, it is quite customary to prescribe two or
more of these drugs in combination, in the hope that one of
them at least may prove effective.
2. Drugs Diminishing the Quantity of Urine Secreted. — These
are usually of such a character as to induce acute nephritis
when given in large doses; e. g., turpentine, cantharides, phos-
phorus. Exalgin also is reputed to diminish the quantity of
urine. They are never given for this purpose in medicine.
3. Drugs Rendering the Urine Acid. — Urotropin is the most
reliable remedy to render an alkaline urine acid. The benzoates
are also used for this purpose, as benzoic acid during its pas-
sage through the kidney is converted into hippuric acid, and
they may be given for alkaline decomposition in the urinary
passages. The free use of carbonated water increases the
acidity of the urine. Salicylic acid is capable of slightly in-
creasing it, and also very large doses of citric and tartaric acids,
borax, and possibly saccharin.
4. Drugs which Render the Urine Alkaline. — Some salts of
the metals potassium, sodium, lithium and calcium will do this,
e. g., the carbonates, borates and hydroxides; even the tar-
trates, citrates, malates, lactates, and acetates, since they are
excreted by the kidney as carbonates. Nitric acid is said to
increase the amount of ammonia in the urine, and thus to render
it slightly alkaline. Ammonium salts given internally do not
render the urine alkaline, because they are decomposed in the
body, with the formation of urea; they may even increase the
acidity from the larger amount of nitric acid excreted.
Antilithics are drugs which tend to prevent the decomposition,
in the urinary passages, of the solids of the urine. When the
SUBSTANCES ACTING ON URINARY SYSTEM. 513
secretion is acid, gravel or uric acid calculus is liable to occur
from the crystallization of uric acid, or, more rarely, lime oxa-
late calculus, from the crystallization of lime oxalate. When-
ever a tendency is shown to the formation of either of these
calculi, alkalies or other remedies reputed to prevent this should
be administered. For uric acid the following are chiefly used:
distilled water, potassium salts, lithium salts, magnesium citro-
borate, piperazine, lysidine and lycetol. For lime oxalate, dilute
nitro-hydrochloric acid, carbonated water, and lactic acid (for
digestion). When, on the other hand, the urine undergoes alka-
line decomposition, phosphatic calculi are liable to form from
the crystallization of phosphates. Here the aim must be to
render the secretion acid and aseptic, and benzoic acid, the
benzoates, salicylic acid, the salicylates, as well as urotropin or
other urinary antiseptics, are given for this purpose. Lithon-
triptics are agents which are supposed to promote the solution
of calculi, but as a matter of fact, no means has as yet been
discovered which is capable of dissolving a calculus when once
formed. It is true that alkalies have been credited, owing to
their action in the test-tube, with the power to dissolve uric acid
calculi; but in the body alkalies cannot convert free uric acid
into soluble alkaline urates, but at most into acid urates, which
are found to be almost as insoluble as uric acid itself. Hence,
it is believed, it would be quite impossible to effect in this way
the solution of even very small calculi.
Therapeutics. — The chief use of alkalies in this connection is
to diminish or entirely neutralize acidity of the urine, and thus
prevent as far as possible the precipitation of uric acid. In this
way they tend to prevent increase in the size of a stone already
formed. They are also of service in lessening the irritability
of the urinary passages. In the case of gouty subjects they are
prescribed not only to alkalize the blood, but also to alkalize
the urine, since in such persons the deposition of uric acid in
the urine is a common occurrence. The citrates and acetates
are the best forms in which to give the alkalies, as they are not
apt to interfere with the digestion, and potassium and lithium
34
514 PHARMACOLOGY AND THERAPEUTICS.
citrate and acetate are to be preferred, since these metals form
more soluble urates than sodium. Copious draughts of water,
by diluting the urine, aid in the prevention of calculi, and
natural mineral waters, especially those containing lithium, are
in very general use.
5. Drugs Preventing the Urine from Decomposing. — Urine
retained from any cause in the bladder will undergo alkaline
decomposition, and the same result is likely to occur from the
admixture of pus, as from cystitis or pyelitis, with the urine.
This decomposition of the urine may be prevented by the ad-
ministration of drugs which in their excretion by the urine
render it aseptic. Such are —
(1) Urotropin.
(6) Cubeb.
(2) Benzoic acid.
(7) Oil of Sandal Wood
(3) Salicylic acid.
(8) Saccharin.
(4) Uva Ursi.
(9) Many volatile oils.
(5) Copaiba.
(10) Boric acid.
6. Drugs Altering the Composition of the Urine. — Almost any
drug will do this, either because it is excreted in the urine, or
because it sets up certain changes in the body the products of
which are excreted in the urine; but it will be sufficient to refer
to a few striking examples.
Turpentine, cantharides and salicylic acid in large doses will cause
hematuria, for the reason that they set up inflammation of the kidney.
Potassium chlorate, all nitrites, acetanilide, pyrogallic acid, poisoning
by the mushroom {Helvetia esculenta), and transfusion of blood break
up red blood-corpuscles, and the products when excreted by the urine
render it dark. Large doses of mineral acids, arsenic, naphthol and
naphthalene may occasionally produce the same result.
Phosphorus in large doses causes leucin and tyrosin to appear in the
urine, while the urea is greatly increased.
The saline diuretics increase the solids of the urine.
The chrysophanic acid in rhubarb and senna makes the urine, if it
is acid, a brownish color ; if it is alkaline, a purplish red. Logwood
renders alkaline urine reddish or violet. Santonin colors acid urine
yellow or greenish-yellow, and alkaline urine, reddish. Phenol, naph-
SUBSTANCES ACTING ON URINARY SYSTEM. 5 I 5
thalene, creosote and other preparations of tar, as well as the arbutin
in uva ursi, chimaphila and gaultheria make it dark greenish-brown.
Picric acid makes it a bright yellow, and methyl violet a dark blue.
The urine of persons poisoned with carbonic oxide remains sweet for
months.
Poisoning by carbonic oxide, curare, amyl nitrite, and turpentine, and
sometimes chloroform, camphor, mercury, morphine, hydrocyanic acid,
sulphuric acid, alcohol, lead compounds, and salicylic acid, lead to the
appearance in the urine of a body which like sugar reduces Fehling's
copper solution. In the case of some of these drugs, at least, the urine
does not contain glucose, but glycuronic acid ; for although it re-
duces blue copper solutions, it does not undergo alcoholic fermentation
on the addition of yeast or give the phenyl-hydrazin test. Chloral was
formerly supposed to induce glycosuria, but this has been shown not to
be the case, the reducing agent in the urine being urochloralic acid, and
not sugar. The administration of phloridzin, a glucoside from the
bark of stems and roots of the apple, pear, plum and cherry, which, when
continuously heated with dilute mineral acids, is resolved into glucose
and phloretin, leads to the production of genuine glucose in the urine.
Some drugs impart a peculiar odor to the urine ; for instance, the
smell of violets is produced by turpentine and oil of juniper. The
aromatic odor of cubeb and copaiba can be detected in the urine after
the administration of these substances.
Prolonged poisoning by lead often induces chronic nephritis. This is
usually of the granular type, but in some instances the kidney presents a
mixture of interstitial and parenchymatous disease. In acute mercurial
poisoning, when death does not follow in the course of a few hours,
anuria is not infrequently observed, and this has been found to be due
to renal changes, the most prominent feature of which is necrosis of
the epithelium of the tubules. Fatty degeneration of the renal epi-
thelium may be caused by phosphorus and arsenic.
7. Drugs Acting on the Bladder and Urethra. — Practically,
the only ones of value are sedatives to the urinary tract.
If the urine shows a tendency to decompose, the drugs which prevent
decomposition, and if the urine is excessively acid, alkalies, act as
urinary sedatives. Other sedatives are opium, belladonna, hyoscyamus,
pareira, buchu and uva ursi, which are direct sedatives to the vesical
and urethral mucous membrane.
Urinary sedatives are used very largely in cases of cystitis and
urethritis, whatever the cause may be. Local astringent and antiseptic
injections are also employed.
5 l6 PHARMACOLOGY AND THERAPEUTICS.
A. Diuretics.
WATER.
1. AQUA.— Water.
2. AQUA DESTILLATA.— Distilled Water.
Action of Water.
External.— An indifferent bath (31. i° to 36.60 C— 88° to 980
F.), or one in which there is experienced a sensation of neither
heat or cold, produces no particular effect.
In a healthy individual a cold bath causes at first a feeling
of extreme chilliness, the teeth chatter, and the extremities are
blue and covered with cutis anscrina. This is because the blood
is driven away from the surface, which is consequently left
cold. The abstraction of heat lowers the bodily temperature,
as the calorific centres are not able to produce all the heat re-
quired for the preservation of the normal temperature. Very
shortly, however, reaction sets in; the extremities grow warm,
the pulse grows stronger and more rapid, and the respiration,
which was at first gasping, becomes full and regular. Every
portion of the body now receives a more perfect supply of
blood, and a general feeling of exhilaration is experienced,
which, if the bath is left at this stage, often remains for many
hours. This action is explained by the fact that cold always
contracts the blood-vessels and reflexly stimulates the vital
centres to increased activity. If the bath is unduly prolonged,
the system suffers from the effects of over-stimulation, with
more or less profound depression of the nervous system and
circulation, and consequent interference with functional activity.
The proper duration and temperature of the cold bath differs
very greatly for different individuals. The daily use of a suit-
ably regulated cold bath no doubt diminishes the liability to
catch cold.
Warm baths cause flushing of the skin and have the effect
of accelerating the pulse and respiration. They have a tend-
ency to raise the temperature of the body by imparting heat to
WATER. 5 I 7
it and preventing loss of warmth from it. After the bath pro-
fuse perspiration results, while the excretion of urine is dimin-
ished. Owing to the dilatation of the cutaneous vessels caused
by warm baths, the blood is withdrawn to a considerable extent
from the internal organs, and in consequence of this their func-
tional activity is lessened.
Water is not absorbed into the circulation through the skin
in mammals. It has been ascertained that when it is absorbed
into the red blood-corpuscles outside the body, some obscure
change takes place in the latter, and the haemoglobin diffuses
into the surrounding fluid.
Internal. — Water if swallowed in sufficient quantities washes
out the tissues and increases the flow of urine. Taken habitu-
ally thus, it somewhat augments the excretion of urea, while
the amount of uric acid is said to be diminished. It has been
supposed to have considerable effect in promoting tissue meta-
morphosis, through the increased movement of the lymph flush-
ing out the cells and leading to a more complete removal of
the waste products. It does indeed have some such action, but
this is not as pronounced as is thought by many, as the increase
in the nitrogen and sulphur eliminated in the urine has been
found to amount to only 5 per cent., or less. Lukewarm water,
as is well known, will cause nausea and vomiting, while hot
water, in small amounts frequently repeated, is often, very
useful in controlling irritability of the stomach.
Therapeutics of Water.
External. — Cold baths are used for the subsequent exhila-
rating effects, which may be increased by brisk rubbing with
a rough towel, but persons whose systems do not promptly react
afterward should not resort to them. Cold salt baths, particu-
larly if they are sea baths, are more stimulating than fresh-
water bathing. The use of a cold bath is popularly supposed
to be dangerous to the over-heated, but persons with healthy
circulations find nothing so refreshing and so preventive of
muscular stiffness after severe exercise and sweating: as a brief
5 l8 PHARMACOLOGY AND THERAPEUTICS.
cold plunge- or shower-bath. Cold baths at the present time
are very largely employed in the treatment of febrile diseases,
more particularly typhoid fever. Vogel's statistics of typhoid
at the Military Hospital in Munich, covering a period of fifty
years, show a' reduction of mortality from 20 per cent., under
other methods, to 2.07 per cent, under what is known as the
Brand treatment. The latter consists in the use of water at
about 21.10 C. (700 F.), for fifteen minutes every three or four
hours, when the rectal temperature is at or above 39.40 C.
(1030 F.). In applying the method, the temperature of the
bath is made at first about 29. 40 C. (850 F.), and in each suc-
cessive bath the temperature is lowered 2.80 C. (50 F.), until
18. 30 C. (650 F.) is reached. Sometimes a bath is employed at
a temperature 5.50 C. (io° F.) below that of the patient, and
the water is then cooled by adding cold water or ice until it
falls to a temperature of about 200 C. (68° F.). In these baths
the patient is lowered into the tub by means of a sheet, and on
being lifted back into bed is carefully dried without rubbing
and left covered with a sheet or blanket. Brisk rubbing of the
whole body should be carried out during the bath, and the feet
kept warm. Cold baths are no longer used in the treatment of
typhoid fever with the notion that they simply reduce tempera-
ture. They are useful for the stimulation of the nervous system
which they effect to a greater or less degree, and for the
marked diuresis which they produce, thus, supposedly, favoring
the elimination of toxins by the urine. If for any reason the
use of the cold bath is impracticable or unadvisable, various
substitutes for this may be resorted to, such as sponging,
affusion, or the cold pack. The latter consists of a sheet, four
folds thick, wrung out in cold water and wrapped around the
naked body for five or ten minutes at a time. Affusions were
employed as long ago as 1795 by Currie, and in the form known
as "slush baths" were used with excellent effect among our
troops in the Spanish-American war. Rubbing the surface with
pieces of ice is also sometimes practiced. In pneumonia the
cold bath is occasionally used, when the fever fs high, but cold
WATER. 5 I 9
is more commonly applied by means of powdered ice, which,
confined in rubber tissue, is placed in a flannel bag and bound
to the chest over a layer of lint. Cold baths are also sometimes
of service in entero-colitis and in acute rheumatism with high
fever, and they undoubtedly constitute the best treatment for
any sudden hyperpyrexia. Thus, ice-water baths are of the
greatest possible service in sunstroke, or thermic fever, care
being taken that friction of the skin is at the same time em-
ployed, in order to bring the hot blood to the surface and pre-
vent congestions. Cold water may also be injected into the
bowel in cases where the skin is cold but the central tempera-
ture very high. The application of ice-bags or of the cold
water coil to various parts of the body is used for the purpose
of controlling inflammatory action and sometimes also for the
haemostatic effect of the cold, as in pulmonary haemorrhage, by
its vaso-constricting action.
In nocturnal seminal emissions the submerging of the scro-
tum in a tumbler of cold water, or the dashing or sopping of
cold water against the perineum, scrotum and lumbar region,
is not infrequently found beneficial. A very useful practice in
dysentery is the gentle injection into the bowel of considerable
quantities of cold water, and the use of a moderately forcible
stream of water of varying temperature is highly esteemed by
some physicians in the treatment of a number of affections of
the rectum, anus, and genito-urinary apparatus. Among these
may be mentioned haemorrhoids, internal and external, prolapsus
ani, slight cases of prolapsus recti, pruritus ani and vulvae,
eczema of the margin of the anus, vaginitis, varicocele, chronic
prostatitis, and atonic impotence in the male. In these various
troubles the application is made by means of a bidet, which, it
is advised, should be attached to the water-closet seat habitually
used by the patient. The bidet pipe should be movable by means
of a handle, so that the stream can be directed wherever de-
sired, and it should also have connection with the hot and cold
water-supply of the house.
A cold bath is one the temperature of which is below 21 ° C.
520 PHARMACOLOGY AND THERAPEUTICS.
(yo° F.), and a hot bath one with a temperature above 36.60 C.
(980 F.). Anything between 31. i° and 36.60 C. (88° and
980 F.) is often spoken of as a warm bath, though it is really
indifferent, and should more properly be called tepid. Hot
baths, as they have the effect of liquefying the fatty secretions,
are naturally more cleansing than cold. Like the application
of heat in other forms, they soothe pain, and they are useful
in alleviating muscular and mental fatigue and various in-
flammatory conditions. ' They also serve to relieve muscular
spasm, as well as internal congestion, by withdrawing blood
from the internal organs to the surface, and often prove of
great value in colic, spasmodic stricture of the urethra, laryn-
geal spasm, infantile convulsions, etc. Hot baths and the hot
pack are useful in renal disease and uraemia and in commencing
colds, on account of the free diaphoresis which they induce ; and
after a hot bath the patient should be immediately wrapped in
warm blankets and put to bed. in order to prevent contraction
of the cutaneous blood-vessels and arrest of perspiration. A
hot bath at bedtime is not infrequently of service in insomnia,
and in many asylums for the insane it is customary to give a
bath of the temperature of 400 C. (1040 F.) as a remedy for this
condition. The hot vapor, or Russian, bath is employed for
many of the same purposes as the hot air, or Turkish, bath, and
particularly when the skin or kidneys are inactive, but is not so
generally useful, as no evaporation of perspiration can take
place during the bath. A valuable method for using the hot
vapor bath in a mild form is the "bronchitis tent," which con-
sists of a bed canopy made by sheets, into which the steam
arising from a steam sterilizer is introduced by means of a
tube. While equally efficacious in the first stage of bronchitis
in adults, it is more conveniently employed in the case of chil-
dren on account of the size of the bed.
Localized hot baths act in the same way as general ones, but
are less pronounced in their effects. A hot sitz bath causes dila-
tation of the vessels of the pelvic viscera and a hot foot bath
of proper depth, dilatation of the branches of the femoral and
WATER. 5 2 I
probably of the iliac arteries. Mustard is often added to in-
crease their effect, and both these forms are much used in
amenorrhcea. The sitz bath is more particularly suited to spas-
modic dysmenorrhea, and the foot bath is commonly employed
in the first stage of a cold. In gonorrhoea a hot sitz bath is a
good prophylactic against c-hordee, and steeping the penis in hot
water is a widely used remedy for this painful affection when
it does occur. In spasmodic croup benefit may.be derived from
the application to the neck of a hot compress made from
spongiopiline wet with hot water, or from several layers of
flannel wrung out of water and covered with cotton and oiled
silk. In various painful inflammatory and other affections of
the eyes much relief may be derived from the use of hot water
applied by cotton pledgets, frequently renewed, or allowed to
drop continuously upon the eye from a fountain syringe. Irri-
gation with plain hot water, or with normal saline solution
(see Sodium Chloride) has proved of great service in markedly
lessening tenesmus in acute dysentery. Enteroclysis is now
also employed with advantage in a variety of other conditions,
among which may be mentioned shock, nephritis, especially
acute uraemia, auto-infection from retention of putrid contents
in the intestine, cholera infantum, toxaemia in fevers, particu-
lary typhoid, septic endocarditis and septic conditions generally,
pelvic and genito-urinary inflammations, and haemorrhage in
the rectum or adjacent organs. Such antiseptics or other medi-
caments as seem to be indicated are often added to the irriga-
tion fluid.
Internal. — Water is principally used to wash out the tissues
and for its supposed effect upon tissue metamorphosis and the
excretions. It is of great service in keeping the urine diluted.
By its free use the liability to the formation of gall-stones may
be diminished, in consequence of its effect in increasing the
watery secretion of bile, so that the bile becomes less concen-
trated and flows more freely. The liability to the formation
of gravel or urinary calculi is also lessened, as the crystals com-
posing such calculi are washed out of the urinary tract before
522 PHARMACOLOGY AND THERAPEUTICS.
an opportunity is afforded them of forming in aggregations of
any size, while if they consist of uric acid, the habitual use
of a sufficient quantity of water, as has been mentioned, tends
to diminish the excretion of that substance. When large
amounts of water are taken, pure distilled water should be
used, and it should be drunk for the most part between meals.
One or more glasses of cold water swallowed upon rising has
the effect in some individuals of causing an evacuation of the
bowels. Tepid water, to which mustard is often added, is
very commonly used as an emetic. In a work of this kind the
natural mineral waters employed for baths and internal medic-
inal use can be only incidentally alluded to as their principal
solid ingredients from time to time come under consideration.
For more extended information in regard to them reference
must be had to the special treatises on physical therapeutics.
BROOM.
1. SCOPARIUS. — Scoparius. (Broom.) Dose, 1 gm.; 15 gr.
2. SPARTEINE SULPHAS.— Sparteine Sulphate. Dose, 0.010
gm.; y5 gr.
JJnfRcxal Preparation.
Extractum Scoparii Fluidum (U. S. P., 1890). — Fluidextract
of Scoparius. Dose, 1 to 4 c.c; y4 to 1 fl. dr.
Action of Broom.
External. — None.
Internal. — Nervous System. — Its alkaloid sparteine if given
in poisonous doses causes, in the lower animals, tremblings,
incoordination, increase of reflexes, clonic and tonic convul-
sions, followed by enfeeblement of all the functions, paralysis,
and death from asphyxia.
Respiration. — It paralyzes the respiratory centres, causes
embarrassment of the respiration, and paralyzes the motor
centres of the spinal cord, but has a very feeble influence upon
the muscles; lessening, though not destroying, their excitability.
Circulation. — Under the influence of this alkaloid, it is stated,
there is a very great increase in the size and height of the
BUCHU. 523
cardiac wave. If the dose has been a small one, the pulse is
at first accelerated; after large doses there is a slowing, fol-
lowed by enfeeblement of the heart. The arterial pressure is
not materially changed unless the dose is toxic, when it falls.
Small doses weaken, and large ones paralyze the pneumogas-
tric; upon the vaso-motor system it appears to have no influ-
ence, unless in very large toxic doses, when it may perhaps act
as a paralyzant.
Kidneys. — Broom is of value as a diuretic. Scoparin prob-
ably represents the diuretic principles of the plant.
Therapeutics of Broom.
Broom is a very useful diuretic, which is generally prescribed
in association with other diuretics in cases of dropsy from heart
disease or chronic nephritis. In acute nephritis, or where pul-
monary congestion or inflammation is present, it is contra-
indicated. According to some authorities, sparteine sulphate is
of very great value in producing regularity in cases of irregular
cardiac action. It accelerates the beats when a weak, atonic
state is present, and has the great advantage of acting quickly.
On the whole, it is probably inferior to digitalis in power, but
it is not cumulative, and is a useful remedy in uncompensated
cardiac, especially mitral, disease. In the treatment of the
opium habit it has been employed to stimulate the heart's action
at periods of depression.
BUCHU.
BUCHU.— Buchu (Bucco). Dose, 2 gm.; 30 gr.
Preparation.
Fluidextractum Buchu. — Fluidextract of Buchu. Dose, 2
c.c.; 30 ni.
Action of Buchu.
In moderate doses buchu causes in the stomach a feeling of
warmth, which is often diffused gradually over the body. In
large doses it gives rise to nausea, vomiting, purging and
strangury, with a burning sensation in the epigastric region.
524 PHARMACOLOGY AND THERAPEUTICS.
Buchu stimulates the appetite and digestion, and slightly in-
creases the pulse-rate. Its volatile oil, which is diffused into
the blood, is excreted by the kidneys, the bronchial mucous
membrane, which it stimulates, and probably also by the skin,
as it induces mild diaphoresis. The excretion is chiefly by the
urine, which it renders slightly antiseptic, but, although it is
generally regarded as a diuretic, it does not appear to appre-
ciably increase the renal activity. Under its influence the urine
becomes darker in' color, assumes an aromatic odor, and depos-
its a brownish sediment. After its elimination by the kidneys
it acts as a disinfectant to the urinary tract. The free use of
buchu, if continued for a considerable period, is said to be in-
jurious to the kidney.
Therapeutics of Buchu.
It has been used in atonic dyspepsia, certain cutaneous affec-
tions, dropsy, and chronic rheumatism. It is difficult to see how
it could have any effect in the last of these conditions, and in
dropsy also it probably does no good when given by itself. The
infusion (B. P., 1 to 20, dose 30 to 60 c.c. ; 1 to 2 fl. oz.) con-
tains very little of the volatile oil, but is an excellent vehicle
for saline diuretics. The chief therapeutic use of buchu is in
chronic affections of the mucous membrane of the genito-
urinary tract, and it is a valuable remedy in pyelitis, lithiasis,
cystitis, urethritis, and prostatitis. It is also occasionally pre-
scribed as an expectorant in bronchitis. It is well to note that
the fluidextract, on account of the oil in its composition, is not
readily miscible with water.
UVA URSI.
UVA URSI.— Uva Ursi (Bearberry). Dose, 2 gm.; 30 gr.
Preparation.
Fluidextractum Uvae Ursi. — Fluidextract of Uva Ursi. Dose,
2 c.c; 30 Tn_.
Unofficial Preparations.
Extractum Uvae Ursi (U. S. P., 1890). — Extract of Uva Ursi.
Dose, 0.25 to 1.00 gm.; 5 to 15 gr.
Arbutinum. — Arbutin. Dose, .20 to .30 gm.; 3 to 5 gr.
UVA URSI. 525
Action of Uva Ursi.
Uva ursi is a tonic, astringent and diuretic, and is also re-
puted to have some oxytocic action. In medicinal doses it
promotes the appetite and has a somewhat constipating effect
upon the bowels. Large doses ordinarily occasion vomiting
and purging, but it is stated that these effects may be prevented
by filtering the watery preparations through animal charcoal,
or by administering the glucosides instead of the cruder prep-
arations. Arbutin is decomposed by the action of acids or of
emulsin into glucose and hydroquinone or methylhydroquinone,
and in the body a part of the arbutin appears to undergo this
decomposition. The larger portion of it, however, is found to
be eliminated by the kidneys unchanged, and it has been sug-
gested that the small amount of hydroquinone and methylhydro-
quinone which appears in the urine may perhaps be formed
from arbutin by the bacteria of the intestine, and not by the
activity of the tissues. The diuretic effect of uva ursi seems
to be unquestionably due to the direct action of the drug upon
the renal epithelium. It also has a decidedly anti-putrefactive
effect upon the urine, which was formerly attributed to the
formation of hydroquinone, but which is now believed to be
due to the arbutin itself; which, in addition to exerting a mod-
erate stimulant action on the kidney cells, appears to be some-
what antiseptic. Uva ursi is therefore a mild disinfectant to
the urinary tract. Under its influence the urine often becomes
dark in color, the discoloration becoming more marked when
it is allowed to stand and undergo putrefaction, and this is due
to the hydroquinone, which becomes further oxidized and forms
brownish-green pigments similar to those observed after phenol
and other agents of its class.
Therapeutics of Uva Ursi.
Like buchu, it is used in pyelitis, cystitis, urethritis, etc. It
often serves to relieve incontinence of urine, dysuria and stran-
gury, and the fluidextract is an excellent remedy for the ardor
urinae of acute gonorrhoea. Arbutin has been successfully em-
526 PHARMACOLOGY AND THERAPEUTICS.
ployed in gonorrhoea and also as a diuretic in cardiac dropsy.
Uva ursi is said to have sometimes proved serviceable in uter-
ine haemorrhages.
SABAL.
SABAL.— Sabal. Dose, 1 gm.; 15 gr.
Unofficial Preparation.
Fluidextractum Sabal. — Fluidextract of Sabal. Dose, 2 c.c;
30 Hi.
Action of Sabal.
It is a nutrient, tonic and diuretic, and also has expectorant
and sedative properties. Under its use the digestion is im-
proved and the strength and weight increased, and it likewise
tends to induce sleep. Its volatile oil is excreted mainly by the
mucous membranes, and on these its principal effects are
exerted.
Therapeutics of Sabal.
In general, all catarrhal conditions are improved by sabal,
especially when it is combined with oil of santal. It has been
employed for irritated states of the mucous membrane of the
nose, pharynx, larynx and bronchial tubes. It relieves cough
of various kinds, and is of some service in chronic bronchitis,
laryngeal phthisis, and cardiac asthma. It is also given in cys-
titis and to relieve the vesical distress of prostatic hypertrophy,
and is thought to be more or less effective in functional im-
potence.
JUNIPER.
OLEUM JUNIPER!.— Oil of Juniper. Dose, 0.2 c.c; 3 111 •
Preparations.
1. Spiritus Juniperi. — Spirit of Juniper. Dose, 2 c.c; 30 ni .
2. Spiritus Juniperi Compositus. — Compound Spirit of
Juniper. Dose, 8 c.c; 2 fl. dr.
Action of Oil of Juniper.
Oil of juniper is a stomachic tonic, antiseptic, diaphoretic,
diuretic and aphrodisiac. Its action is practically the same as
PAREIRA. 5 27
that of oil of turpentine, but it is less apt to interfere with the
digestion or to cause hematuria and albuminuria. It is, how-
ever, a powerful renal stimulant and in large doses irritant; so
that from sufficient amounts there may result strangury, pria-
pism, hematuria, suppression of urine, and ursemic convul-
sions. It imparts a violaceous odor to the urine, and will
produce diuresis when inhaled in an atomized solution. Be-
cause of its antiseptic properties it is employed for the preser-
vation of cat-gut.
Therapeutics of Oil of Juniper.
It is a very efficient diuretic, and is largely used, combined
with other less irritant diuretics, in the treatment of dropsies
resulting from cirrhosis of the liver, organic heart disease, and
chronic Bright's disease. As it is a constituent of gin, this, or
the compound spirit of juniper, may be given to patients suffer-
ing from such affections who require alcoholic stimulus. Oil
of juniper may also be used in chronic pyelitis, cystitis, pros-
tatorrhcea, gleet, etc., but it should never be prescribed when
acute nephritis is present. Occasionally it is employed as a
carminative and stomachic.
PAREIRA.
PAREIRA. — Pareira (Pareira Brava). Dose, 2 gm.; 30 gr.
Preparation.
Fluidextractum Pareirae. — Fluidextract of Pareira. Dose, 2
c.c; 30 TH,.
Action of Pareira.
With the exception of its diuretic action, in which it closely
resembles buchu, pareira is not known to have any physiological
effects.
Therapeutics of Pareira.
Like buchu, it is employed in chronic pyelitis, vesical catarrh,
gleet, and other chronic inflammatory affections of the genito-
urinary tract. It was formerly renowned as a lithontriptic.
528 PHARMACOLOGY AND THERAPEUTICS.
PICHI.
FABIANA.— Pichi (not official). Dose, 2 gm.; 30 gr.
Unofficial Preparation.
Fluidextractum Fabianae. — Fluidextract of Fabiana. Dose,
.30 to 2.50 c.c; 5 to 40 n\.
Action of Pichi.
Pichi is a diuretic with properties similar to those of buchu
and uva ursi.
Therapeutics of Pichi.
It is of great value in inflammation of the bladder and
catarrh of the urinary tract. It should not be used in organic
disease. It is best prescribed in combination with an alkali,
as sodium carbonate.
THEOBROMINE.
THEOBROMINE SODIO-SALICYLAS. — Theobromine Sodio-
salicylate (not official). Dose, 1.0 to 20 gm.; 15 to 30 gr.
Action of Theobromine Sodio-Salicylate.
This is a pure diuretic, acting upon the renal epithelium,
without action upon the heart, and it is believed that it does not
irritate the kidneys.
Therapeutics of Theobromine Sodio-Salicylate.
The daily dose is from 4 to 8 gm. (1 to 2 dr.), best admin-
istered in solution with aromatic water. It has been given
with benefit in cases of severe cardiac or hepatic dropsy. It
does not ordinarily cause depression, but in occasional instances
is said to have had an untoward action. This may, however,
have been due to impurities.
APOCYNUM.
APOCYNUM.— Apocynum. (Canadian Hemp.) Dose, 1 gm.; 15 gr.
Preparation.
Fluidextractum Apocyni, — Fluidextract of Apocynum. Dose,
1 c,c.; 15 TT\,
STRONTIUM. 529
Unofficial Preparation.
Infusum Apocyni. — Infusion of Apocynum. Dose, 30 to
60 c.c; 1 to 2 fl. oz.
Action of Apocynum.
When used as an infusion (1 to 16), Canadian hemp is not
only diuretic, but has an action resembling that of strophanthus
and similar drugs. In large doses it is also a hydragogue
cathartic.
Therapeutics of Apocynum.
This is a more valuable medicinal agent than its limited use
would indicate. It frequently produces copious diuresis after
other, and better known, drugs have failed, and the infusion,
especially, has been found beneficial in dropsy.
CORN-SILK.
ZEA.— Zea. (Corn-silk.)
Unofficial Preparations.
Fluidextractum Zeae. — Fluidextract of Zea. Dose, 2 to 8
c.c; y2 to 2 fl. dr.
Infusum Zeae. — Infusion of Zea. Dose, freely.
Action of Corn-Silk.
Corn-silk is a mild but fairly certain diuretic when given in
full doses. It increases the secretion of urine in consequence
of the effect of its resinous acid in stimulating the renal epi-
thelium.
Therapeutics of Corn-Silk.
It is useful in acute and chronic cystitis, in the bladder irri-
tation of uric acid, and for phosphatic gravel. It is possibly,
as well, a cardiac stimulant in the dropsy of heart disease.
It is best administered in the form of an infusion, in boiling
water (1 to 8), taken almost ad libitum.
STRONTIUM.
1. STRONTII LACTAS (U. S. P., 1890; no longer official).—
Strontium Lactate. Dose, 1 to 8 gm.; y4 to 2 dr.
35
530 PHARMACOLOGY AND THERAPEUTICS.
2. STRONTII BROMIDUM. See Bromine.
3. STRONTII IODIDUM. See Iodine.
4. STRONTII SALICYLAS. See Salicylic Acid.
Action of Strontium Lactate.
The strontium salts have been demonstrated to be harmless
to animals and men, and to have a diuretic action. If given
for some time and in large quantities they impair gastric diges-
tion and subsequently the general nutrition. The lactate re-
duces the amount of albumin in albuminuria, and it is claimed
to have a sedative effect on the heart in diseases of the valves
and of the muscular tissue. It also checks fermentation and
putrefaction in the small intestine.
Therapeutics of Strontium Lactate.
The strontium salts improve the appetite and facilitate diges-
tion in gastric affections, and are also used in chronic intestinal
catarrh. The lactate is useful in albuminuria, due to renal
atony, on account of its diuretic properties, but not in uraemia,
nor in interstitial nephritis, nor in the high fever of acute
parenchymatous nephritis. In chronic renal disease due to
scrofula, rheumatism or gout it is of service. It is also thought
to have a decidedly beneficial action in diabetes of hepatic
origin, and in cirrhosis of the liver.
PIPERAZINE.
Unofficial Preparations.
1. Piperazinum. — Piperazine. (Piperazidine. Diethlenedia-
mine. Dispermine.) Dose, .50 to 1 gm.; 8 to 15 gr.
2. Lysidinum. — Lysidine. Dose, 2 to 10 c.c; y2 to 2x/2
fl. dr., daily.
3. Lycetol.— Lycetol. Dose, .90 to 1.80 gm.; 15 to 30 gr.
Action of Piperazine.
Piperazine is believed to increase slightly the amount of urea
in the urine, while the uric acid coefficient is diminished. The
testimony as to its diuretic action is conflicting, but the weight
CANTHARIDES. 53 1
of clinical evidence is in favor of its being a reliable diuretic.
In ordinary doses it does not appear to have arty influence upon
the nervous, circulatory or respiratory systems; nor does it
irritate the gastro-intestinal or the genito-urinary tract.
Therapeutics of Piperazine.
There is much clinical testimony as to the value of this drug
in gout, goutiness (uricacidaemia) and rheumatism. It is here
given in water containing carbon dioxide. It is so highly
hygroscopic that it cannot be administered as pill or powder.
Lysidine, which is a base obtained by the action of sodium
acetate upon ethylene-diamine hydrochlorate, is reputed to
have an even more pronounced effect in uricacidaemia than
piperazine. It is said to have been given in cases of chronic
gout with good results, especially as regards lessening of the
joint-stiffness and reduction in the tophi around the joints.
The dose is 2 to 10 c.c. (J-4-2^ fl. dr.) of the 50 per cent,
alkaline solution, administered in a glassful of carbonated
water.
Lycetol, or dimethyl-piperazine tartrate, has been introduced
for the purpose of combining the action of piperazine with the
alkalizing and diuretic effects of a tartrate. It may be given
in carbonated water or in the form of a lemonade.
CANTHARIDES.
CANTHARIS. — Cantharides. (Spanish Flies. Blister Beetles.)
Preparations.
1. Ceratum Cantharidis. — Cantharides Cerate.
2. Collodium Cantharidatum. — Cantharidal Collodion.
3. Tinctura Cantharidis. — Tincture of Cantharides. Dose,
0.3 c.c; 5 TTL-
Unofficial Preparation.
Potassii Cantharidinatum. — Potassium Cantharidinate. Dose,
.0006 gm.; t±q gr., hypodermatically.
532 pharmacology and therapeutics.
Action of Cantharides.
External. — Cantharides is a powerful irritant, but the irri-
tant action of this and other agents of its class still remains
unexplained. It acts more slowly than most irritants, so that
if a preparation of cantharides is applied to the skin, it will
usually be two or three hours before any appreciable effect is
produced. The first symptom from it is a tingling, burning
pain in the part, which very shortly becomes reddened in con-
sequence of the local vascular dilatation caused. In the course
of three or four hours after the application numerous vesicles
make their appearance, and these soon coalesce, forming one
large blebs (varying in area according to the extent of the
application), which is filled with clear serum. Although the
local action is thus a violent one, it is also very superficial.
Hence, as less of the irritant penetrates into the deeper tissues
than in the case of the volatile oil of mustard, and the process
is so much slower, the vesication is much less painful than
that caused by mustard. If the blister be broken, however, and
the irritant be allowed to come in contact with the unprotected
dermis, severe inflammation with much pain, suppuration and
even sloughing is liable to result. Cantharides is an energetic
counter-irritant, as well as a rubefacient and vesicant, and this
action is probably due to an alteration in the calibre of the
blood-vessels and in the sensory nerves, or their terminations,
reflexly induced by it in the deep-seated organs in the vicinity
of the part to which it is applied.
Cantharidin may be absorbed through the skin and in this
way produce the constitutional effects of the drug.
Internal. — G astro-intestinal Tract. — When taken in sufficient
quantity by the mouth, cantharides produces the same irritant
effect along the alimentary canal, and gastro-enteritis results.
If cantharidin is swallowed in solution, blisters are formed in
the mouth and throat, and deglutition is rendered difficult or
impossible by the excruciating pain and the swelling in the
oesophagus caused by it. There is also intense pain in the
abdomen, and vomiting ensues, followed by purging, with all
CANTHARIDES. 533
the symptoms of shock and collapse. Both the matters vom-
ited and the stools may contain blood. Ulceration of the
stomach and other portions of the alimentary canal have been
observed after death, not only when cantharides has been ad-
ministered by the mouth, but also when the drug has been given
by subcutaneous injection, and it is thought possible that under
these circumstances it is excreted in part by the stomach, and
that these lesions are produced in the act of excretion.
Genito-urinary Tract. — Cantharidin is absorbed from the ali-
mentary canal and also to a less extent from the skin, and will
exert its irritant action elsewhere, especially upon the organs
of excretion. The effect upon the kidneys is seen in diuresis,
and when a larger amount is absorbed, in nephritis, albuminu-
ria, hematuria, glycosuria, and sometimes in total suppression
of urine. The other parts of the urinary tract, the bladder and
urethra, also show the action of the irritant, and strangury,
with a constant desire for micturition, priapism, etc., is reflexly
induced. The vesical tenesmus is extreme, and the patient suf-
fers from severe pain in the loins. The local irritation is apt
to occasion erotic excitement, with seminal emissions in the
male, and there may also be swelling and inflammation of the
external genitals. Sufficient of the active principle may be
absorbed from a cantharides blister to cause marked renal irri-
tation and strangury. The drug is chiefly excreted by the kid-
ney, and the nephritis is the main factor in death from can-
tharidal poisoning.
Nervous System. — While cantharidin, thus absorbed, has no
important action upon the internal organs other than those by
which it is eliminated, when injected into the circulation of
animals this agent is stated to affect the central nervous system
much in the same way as phenol, producing short stimulation,
excitement and increased reflexes, followed by paralytic symp-
toms, coma, etc. It is found, however, that this central action
is not often observed, as it is mostly obscured by the gastro-
enteritis or nephritis.
534 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Cantharides.
External. — Cantharides is of all drugs the most commonly
used as a vesicant and counter-irritant. Blisters may be spread
with cerate of cantharides, or preferably with the cerate of the
extract of cantharides (U. S. P., 1880). The raised cuticle
should not be removed, but simply punctured to allow the
escape of the serum, and the surface should then be dressed
with some bland fat. A very convenient method of blistering
is to paint the desired area with one or two coats of can-
tharidal collodion, and then lay over it a piece of waxed paper.
In using a blistering plaster sodium bicarbonate or a little mor-
phine with powdered camphor may be sprinkled over its sur-
face before it is applied, for the purpose of lessening the danger
of strangury, and with the same end in view the preliminary use
of an alkaline diuretic has been suggested. The tendency to
strangury is also diminished by the free use of diluent drinks.
Blisters are employed to relieve pain, reduce inflammation, and
promote the removal of inflammatory products by absorption.
They are thus of service in a great variety of conditions, al-
though not in such general use as formerly, when heroic meth-
ods of treatment were more in vogue. Only a few of the spe-
cial uses of blisters need be referred to here. They are ap-
plied over the chest in pleuritic effusions (a succession of small
blisters being most efficacious), behind the ear in aural inflam-
mations, on the perineum in obstinate gleet, around the affected
joints in acute rheumatism, at the nape of the neck in severe
headaches, and over the epigastrium for persistent pain in the
stomach, vomiting, etc. They are of great value in neuralgia,
especially if applied close to the emergence of the nerve from
the spinal column, and also in sciatica and neuritis and in sub-
acute joint affections. It has been shown by careful researches
that a distinct relation exists between irritation of an internal
organ and that part of the skin which is supplied by the same
segment of the spinal cord or brain. While these superficial
points are connected with the diseased organ only by means of
nerve-fibres, it appears that a nervous impulse from these
CANTHARIDES. 535
organs does not pass in an indeterminate manner through the
central nervous system, but has a distinct tendency to affect
the superficial areas which are supplied with sensory nerves
from the same segment of the cord. It is therefore argued
that an affection of these superficial areas may affect the cor-
responding internal organ more than the rest of the body, and
that this satisfactorily explains the benefits derived from
counter-irritants. In confirmation of this, attention is called to
the fact that several of the points which were observed to be
affected by internal disease are precisely those points at which
experience has shown irritation to be of most service. Thus,
the application of a blister to the epigastrium has long been
recognized as a means of relieving stomach disorders, while the
old treatment of iritis by means of a blister on the temple may
be justified by the fact that in the researches mentioned an
area of tenderness in this region was found to accompany the
eye-disease. An aura proceeding from an extremity may some-
times be intercepted, and epileptic seizures averted, by encirc-
ling the limb with a strip of blistering-plaster. The moral
impression produced by the use of vesication is not infrequently
very beneficial. Hysterical paralysis is most successfully
treated by encircling the affected extremity with narrow blis-
ters, and hysterical aphonia may sometimes be quickly cured
by a blister over the larynx. If in any case an especially pro-
nounced counter-irritant effect is desired, the blister, after hav-
ing been punctured, may be irritated by the application of an
irritating ointment. Unguentum Sabinae (savin, 8; yellow
wax, 3; benzoated lard, 16) was formerly much used for this
purpose. In blistering with cantharidal preparations the plas-
ter should be removed as soon as the blebs has formed, on
account of the danger of the absorption of cantharidin. When
strangury is produced, relief may be afforded by an enema of
laudanum or by a small hypodermatic injection of morphine.
Among the conditions contra-indicating the use of blisters in
general may be mentioned the acute stage of an inflammation,
scurvy and purpura, pregnancy, infancy and debility. They
536 PHARMACOLOGY AND THERAPEUTICS.
should never be applied to a part on which a patient lies, on
account of the risk of the formation of bed-sores, or to para-
lyzed limbs. Cantharidal blistering is contra-indicated in renal
disease or inflammation of the urinary passages, and here vesica-
tion by ammonia water or chloroform (evaporation being pre-
vented) may be substituted for it. These are rather more rapid
in action, but much more painful than cantharides. By some
it is advised that blisters should not be opened at all, but should
be covered with antiseptic wool, by which means ulceration
and inflammatory complications may be avoided. It is held
also that the removal of the serum is practically equivalent to
a blood-letting of the same amount, and that this is very rarely
desirable. The cuticle raised by a blister may be used for skin-
grafting.
Cantharides is one of the most common and useful remedies
employed in the treatment of loss of hair. Good results may
often be obtained from its use if the alopecia has not progressed
too far, but it is hardly likely to prove of service if the treat-
ment is begun late. It is usually applied in the form of tinc-
ture, largely diluted with alcohol, or as the active constituent
of a pomade. Some such preparation as the following may
also be employed to stimulate the growth of hair: Vinegar of
cantharides (B. P., cantharides, 1; glacial acetic acid, 5;
water), 1; glycerin, 1; spirit of rosemary, 1; water, 10. In
alopecia circumscripta cantharidal collodion, painted over the
bald patches every week or ten days, is occasionally successful.
Internal. — On account of its irritating properties cantharides
is used internally to only a limited extent. It is given in the
form of the tincture, in small doses, principally as a stimulant
to the urinary organs, and among the conditions in which it
has been commended are hematuria, incontinence of urine,
chronic pyelitis, chronic cystitis, irritability of the bladder,
gleet, prostatorrhcea, and spermatorrhoea due to deficient tone
of the seminal vesicles. It is naturally contra-indicated when
any active inflammation is present. Cantharides has some
popular reputation as an emmenagogue, but if it has any influ-
CANTHARIDES. 537
ence at all upon the menstrual function, this is quite insignifi-
cant, and due, no doubt, only to its irritant effect upon the
urinary organs and passages. It is one of the drugs most
relied upon in the treatment of impotence, in which condition
it may prove of service through reflex irritation from the
urethral mucous membrane. Its administration is attended
with considerable danger, however, since efficient doses are apt
to induce nephritis. Several cases of poisoning have been re-
ported from its use as an aphrodisiac, though it is stated that its
aphrodisiac effect is usually more manifest under ordinary or
even small medicinal doses than from immoderate amounts.
Sometimes, but not often, it relieves chordee. Small doses are
sometimes useful in the late stage of acute desquamative nephri-
tis. It has been recommended for diabetes insipidus. Can-
tharidin, in the form of potassium cantharidinate, administered,
has been used as a remedy for pulmonary tuberculosis, and for
lupus. Notwithstanding that cures of both of these diseases
have been claimed, the value of the drug in such conditions is
by no means established.
TOXICOLOGY.
Symptoms. — The effects of toxic doses of cantharides have already-
been described. In cases where lethal amounts have been taken, there
usually result dyspnoea, great frequency of the pulse, and finally col-
lapse and coma, death being sometimes preceded by convulsions. These
fatal effects would appear to be dependent upon suppression of the
urinary functions in consequence of the violent nephritis caused by
the drug. It is one of the substances employed for the purpose of
producing abortion with criminal intent, and it is in cases of this
kind that symptoms of poisoning are most likely to be observed.
Post-Mortem. — There are found swelling and intense hyperemia of
the gastro-intestinal mucous membrane, with ecchymoses and often
ulceration, and the appearances of acute inflammatory action also in
the kidneys, bladder and whole genito-urinary tract.
Treatment. — There is no chemical or physiological antidote to
Cantharides. The stomach should be emptied by emetics (see p. 175),
or washed out by the stomach-pump. Mucilaginous and demulcent
liquids should be freely given. Opium is indicated to relieve the pain
and gastro-enteritis.
538 PHARMACOLOGY AND THERAPEUTICS.
TRITIOUM.
TRITICUM.— Triticum. (Couch-grass.) Dose, 8 gin.; 120 gr.
Preparation.
Fluidextractum Tritici. — Fluidextract of Triticum. Dose, 8
c.c; 2 fl. dr.
Unofficial Preparation.
Infusum Tritici. — Infusion of Triticum. Dose, freely.
Action of Triticum.
Triticum is emollient and demulcent, and has some nutrient
qualities. It has been regarded as a diuretic also, but the in-
crease in the amount of urine noted under its use appears to
be due simply to the water given with it.
Therapeutics of Triticum.
For its soothing and supposed diuretic properties it has been
used in dysuria, irritability of the bladder, chronic cystitis, irri-
table prostate, gleet, and other affections of the genito-urinary
tract. The infusion is a popular fever-drink in Europe.
B. Drugs Preventing the Urine from Decomposing.
UROTROPIN.
HEXAMETHYLENAMINA. — Hexamethylenamine. Hexamethyl-
ene Tetramine. (Urotropin.) Dose, 0.250 gm. (250 milligm.) ; 4 gr.
Action of Urotropin.
Large doses in man, e. g. (io gm. ; 150 gr.), are well borne;
intravenous injections in rabbits and dogs do not increase, but,
rather, slightly lower blood-pressure. Very large doses cause
albuminuria in rabbits and hematuria in dogs. Of most im-
portance is the inhibitory action of this remedy upon micro-
organisms when it is split up into formaldehyde and ammonia,
the former being the active agent. This takes place for the
BENZOIN. 539
most part, after ingestion, in the urine, which is not only of the
proper temperature for the purpose, but also contains uric acid
and acid salts which are efficient. Further, as has been shown,
it will dissolve uric acid at the temperature of the body. Lastly,
it may or may not produce diuresis.
Therapeutics of Urotropin.
This remedy is of especial value in diseases of the urinary
passages. In ammoniacal fermentation of the urine, which is
extremely frequent in the cystitis of prostatic hypertrophy, the
maximum dose given for two or three successive days is effi-
cient in clearing that excretion. Inasmuch as the growth of
the micro-organisms is inhibited, the remedy should be con-
tinued in sufficient amount to maintain this result. In gonor-
rhceal posterior urethritis, cystitis and pyelitis the results are
equally favorable. It may be employed as a prophylactic meas-
ure before operations upon the genito-urinary tract. For the
uric acid diathesis it has been used with good results by most,
with failure by a very few, physicians. Since it is not always
diuretic, other measures should be employed to increase kidney
action. As a so-called lithontriptic some success has been
claimed. For phosphaturia excellent results are reported. In-
asmuch as the specific bacillus of the disease is found in a very
considerable percentage of urines from patients suffering from
typhoid fever, and failure to disinfect this excretion is a source
of danger, urotropin should be administered not only for this
purpose but also in order to avoid the cystitis which sometimes
supervenes in the course of this disease.
BENZOIN.
BENZOINUM.— Benzoin. (Gum Benjamin.) Dose, 1 gm.; 15 gr.
Preparations.
1. Adeps Benzoinatus. — Benzoinated Lard.
2. Tinctura Benzoini. — Tincture of Benzoin. Dose, 1 c.c;
15 TT\.
540 PHARMACOLOGY AND THERAPEUTICS.
3. Tinctura Benzoini Composita. — Compound Tincture of
Benzoin. (Friar's Balsam.) Dose, 2 C.C.; 30 TIT..
ACIDUM BENZOICUM.— Benzoic Acid. Dose, 0.500 gm. (500
milligm.) ; 7y2 gr.
Preparations.
Liquor Antisepticus. — Antiseptic Solution. Dose, 4 c.c; 1
fl. dr.
Ammonii Benzoas. — Ammonium Benzoate. Dose, 1 gm.;
15 gr.
Lithii Benzoas. — Lithium Benzoate. Dose, 1 gm.; 15 gr.
Sodii Benzoas. — Sodium Benzoate. Dose, 1 gm.; 15 gr.
Unofficial Preparations.
Bismuthi Benzoas. — Bismuth Benzoate. Dose, 1 gm-; 15 gr.
Acidum Cinnamicum. — Cinnamic Acid. Dose, .30 to .60
gm.; 5 to 10 gr.
Action of Benzoic Acid.
As benzoic acid, its salts, and benzoin all have practically the
same action, that of benzoic acid only will be here described.
External. — Like salicylic acid, it is irritant to mucous mem-
branes, and its vapors when inhaled are capable of exciting a
catarrhal condition of the bronchial membrane. When ap-
plied in a concentrated form it is also irritant to the skin. In
antiseptic power it appears to be equalj if not superior, to sali-
cylic acid, preventing the growth of many forms of bacteria in
a solution of I in iooo.
Internal. — In the body its action is in many respects very
similar to that of salicylic acid, and, like the latter, it may be
taken in comparatively large quantities without the production
of toxic symptoms. In very large doses it sometimes causes
nausea and vomiting, and in occasional instances the matters
vomited may be tinged with blood. It produces a moderate
acceleration of the pulse, and has some effect in increasing and
disinfecting the bronchial secretion. It is therefore regarded
as an expectorant, and it is thought probable that either the
acid or one of its derivatives is excreted by the bronchial mu-
cous membrane. It is said also to be excreted by the skin,
BENZOIN. 541
and thus stimulate its functional activity, though this has been
denied by some. It differs from salicylic acid in being less
stimulant to the central nervous system, and in man a certain
sedative effect has been observed under it. In dogs it may
give rise to tremors and convulsions, and the following phe-
nomena have also been observed: Ataxia and paresis, followed
successively by complete paralysis of the anterior and posterior
extremities and trunk; fall of temperature; death from as-
phyxia. The pulse and respiration are first accelerated and
then slowed, from a direct action on the heart and on the res-
piratory centre. As the gastric mucous membrane has been
found after death to be eroded and ecchymosed, even when the
acid has been injected subcutaneously or intravenously, it is
believed that benzoic acid has a specific action on this mem-
brane quite apart from its irritant effects when applied locally.
In the dog, as well as in man, vomiting is produced when the
acid is given by the mouth in sufficient quantity. While traces
of benzoic acid have been found in the saliva of dogs after the
administration of the drug, it is thought that it is not excreted
by the salivary glands in man. It no doubt lessens the putre-
faction in the intestinal canal, as some diminution in the double
sulphates and the indican of the urine has been observed after
its administration by the mouth. Benzoic acid and the ben-
zoates, particularly sodium benzoate, appear to have the effect
of somewhat stimulating the functional activity of the liver.
An important feature of the action of benzoic acid is that it
is in great part excreted in the urine as hippuric acid, which is
formed in the body from a combination with glycocoll. Hip-
puric acid is benzoyl-glycocoll (or glycosine), so that a syn-
thetic process takes place, benzoic acid combining with glyco-
coll, and hippuric acid and water being the result —
C6H5 • COOH + H2N • CH2 ■ COOH =
C6H5 • CO ■ HN • CH2 ■ COOH + H20.
It has not as yet been determined from what source the nitro-
gen required for this is derived. Some of the benzoic acid
542 PHARMACOLOGY AND THERAPEUTICS.
escapes in the urine, and the proportion of hippuric acid formed
appears to depend more or less upon the condition of the kid-
neys (in which the synthesis takes place) and of the general
health, as well as upon the amount of benzoic acid ingested.
If hippuric acid is given by the mouth, it is stated that ben-
zoic acid is found in the blood, but that hippuric acid reappears
in the urine. When benzoic acid has been administered to the
mother shortly before delivery, hippuric acid has been observed
in the urine of the new-born infant. It is generally believed
that the hippuric acid formed from benzoic acid in the system
increases the acidity of the urine and renders alkaline uric
acid, while it also tends to disinfect and stimulate the genito-
urinary tract. Most clinicians agree that the acidity of the
urine is increased after benzoic acid, and it is thought probable
that the disappearance of uric acid crystals from the urine
under its influence is due to the conversion of insoluble uric
acid into soluble hippuric acid. It has been asserted by some,
however, as the result of experiment, that sodium benzoate
does not increase the acidity of the urine, and that the mistake
of clinicians has arisen from the fact that in cystitis the urine
has its acidity increased by the drug for the reason that the
ammoniacal fermentation is checked by the benzoic acid. Dur-
ing its excretion by the kidney benzoic acid slightly stimulates
the renal cells, and thus has a mild diuretic effect. After large
doses there has sometimes been found in the urine a reducing
body, which is presumed to be glycuronic acid. By some it is
believed that the reducing property of the urine is always the
result of intoxication, so that unless symptoms of poisoning
are present, no such reducing action will be observed. Phthalic
acid, and possibly succinic acid, may also occasionally appear
in the urine after the administration of benzoic acid. Benzoic
acid is found to increase to a considerable extent the nitrogen
eliminated in the urine, and it would therefore seem, like sali-
cylic acid, to augment the decomposition of the proteids in the
body.
BENZOIN. 543
The action of benzoic acid on the body-temperature is prob-
ably similar to that of salicylic acid.
One of the rarer results of the administration of the drug
is urticaria or an erythematous condition of the skin.
Therapeutics of Benzoic Acid.
External. — On account of its marked antiseptic qualities, as
well as its stimulating effect, the compound tincture of benzoin
is quite largely used as a surgical dressing. It is applied on
lint to wounds and ulcers or other sores, and when injected
into old sinuses it disinfects the tract and promotes healing.
It makes a good application for spongy gums, and is also used
to paint over abrasions and excoriations, as in the case of
tender nipples. Its use in the same way is recommended in
the treatment of chilblains, after the part has been washed with
a 5 per cent, solution of carbolic acid. It sometimes relieves
the itching of urticaria or eczema, and, mixed with an equal
quantity of glycerin, is serviceable for chapped lips and hands,
chapped and fissured nipples, and frost-bite. A solution of
tincture of benzoin in cologne-water is also often successful in
urticaria, and a lotion made with the tincture, and containing
mercuric chloride, may be applied for the removal of freckles
or moth-spots and in pityriasis versicolor and chronic urticaria.
In catarrhal affections of the pharynx and larynx the compound
tincture, more or less diluted, makes an efficient application,
and the hoarseness of singers and public speakers, the result
of undue strain upon the vocal cords, is frequently relieved by
this remedy. Bismuth benzoate (not official), which contains
about 65 per cent, of bismuth, is an efficient dressing for chronic
or sloughing ulcers and for venereal lesions of various kinds,
and is usually dusted on the parts after they have been thor-
oughly bathed with a weak solution of mercuric chloride. Ben-
zoated lard is a favorite basis for ointments the active ingre-
dient of which it is desired to have absorbed, as the benzoin
prevents the decomposition of the lard when melted on the
skin. Where the benzoin causes irritation, as it may near the
544 PHARMACOLOGY AND THERAPEUTICS.
eye, a non-irritant basis which keeps indefinitely may be made
by adding 3 parts of oil of cloves or 2 of oil of gaultheria to
480 parts of lard.
Internal. — Urinary Organs. — The chief value of the benzoic
compounds is no doubt in diseases accompanied by disordered
conditions of the urine. Ammonium and sodium benzoate are
preferable to benzoic acid itself on account of their much
greater solubility, and they may with advantage be combined
with some such sedative as hyoscyamus. Spirit of chloroform
is sometimes employed to cover the taste. In pyelitis or cys-
titis the alkalinity of an ammoniacal urine is promptly dimin-
ished, the hippuric acid which is formed combines with ammo-
nia to form ammonium hippurate, less triple phosphate results
in consequence, and the condition is therefore ameliorated. As
the acidity of the urine is increased by the salts, they may also
be of more or less service in phosphaturia and in vesical cal-
culus. During the presence of fever the transformation of ben-
zoic acid into hippuric acid is much diminished, and in ad-
vanced parenchymatous nephritis and amyloid disease of the
kidney is entirely abolished, the benzoates being excreted as
such. The latter fact goes to confirm the results obtained from
experiments on dogs, showing that this change takes place only
in the kidneys, and probably in the renal cells. In some ani-
mals, however, notably the rabbit and the frog, the kidney is
not the only place of synthesis. In certain cases of chronic
Bright's disease the benzoates may be used with advantage.
They are also sometimes of value in chronic gonorrhoea, in
obstinate irritation of the urethra due to the condition of the
urine, and in incontinence caused by an alkaline urinary reac-
tion.
Pulmonary Organs. — Benzoin and its derivatives, especially
sodium benzoate, were at one time employed to a considerable
extent in phthisis, but have now for the most part been aban-
doned, as it has been found that they have no such effect on
the tubercle bacillus as had been hoped, though they may some-
times be of service when the sputum is fetid. In bronchitis
copaiba. 545
they are of more value, and in this affection, as well as in
laryngitis, much benefit may often be derived from the inhala-
tion of a mixture of compound tincture of benzoin (4 c.c. ; 1
fl. dr.) and water (500 c.c; 1 pint), heated to a temperature
of 6o° C. (1400 F.). The simple or compound tincture is used
also as an ingredient of expectorant mixtures, and is regarded
as more especially beneficial when the mucus is tenacious and
coughed up with difficulty.
Other Uses. — Sodium benzoate has been lauded by some in
the treatment of gout, but its value here is very questionable.
The same is true as regards diphtheria, and it has quite fallen
into disuse in this disease. It has been given as an antipyretic
in pneumonia and in intermittent, typhoid, and other fevers, and
on account of its antiseptic properties in erysipelas and puer-
peral fever and other septic conditions, but without satisfactory
results. In diseases of the alimentary canal the benzoates have
proved of considerable value, though inferior to some other
remedies. They are sometimes efficient in chronic diarrhoea
and dysentery and the intestinal catarrh of children. As he-
patic stimulants they are but little used, and even if the claims
once made for them in this capacity were true, it is now ac-
cepted that the functions of the liver can generally be much
better modified indirectly than by direct action upon the organ.
In acute rheumatism the benzoates appear to have somewhat
the same effects as the salicylates, but are much less reliable.
Cinnamic Acid is thought to resemble benzoic acid in its
pharmacological characters. It is said to increase the leuco-
cytes of the blood and the uric acid of the urine to a marked
degree.
COPAIBA.
COPAIBA. — Copaiba. (Copaiva. Balsam of Copaiba.) Dose, 1
c.c; 15 Til,.
OLEUM COPAIBA.— Oil of Copaiba. Dose, 0.5 c.c; 8 TTL-
Unofficial Preparations.
Massa Copaibae. — Mass of Copaiba. Solidified Copaiba. (U.
S. P., 1890.) Dose, 1.0 to 4.0 gin.; y4 to 1 dr.
36
546 PHARMACOLOGY AND THERAPEUTICS.
Resina Copaibae. — Resin of Copaiba. (U. S. P., 1890.) Dose,
.30 to 1.00 gm.; 5 to 15 gr.
Action of Copaiba.
External. — Copaiba is slightly stimulating to the skin and
mucous membranes, and is also antiseptic.
Internal. — G astro-intestinal Tract. — Its taste is very unpleas-
ant, and it often occasions disagreeable eructations, which taste
of the drug. Its action is like that of other volatile oils, in
ordinary doses causing a pleasant sense of warmth in the stom-
ach, and in large amounts acting as a gastro-intestinal irritant,
with the production of vomiting and purging. Like cubeb
and sandalwood oil, however, it is less irritant to the stomach
than many of the volatile oils, though its prolonged adminis-
tration is apt to give rise to more or less gastric disturbance.
Mucous Membrane. — After entering the circulation it is ex-
creted to a considerable extent by the various mucous mem-
branes, in the process stimulating their action and also having
a disinfectant effect. It is thus a stimulating disinfectant to
the bronchial mucous membrane and that of the genito-urinary
tract, acting especially on the latter. It imparts to the mucous
secretions and breath, as well as to the urine, a peculiar aro-
matic odor.
Skin. — It appears to be eliminated by the skin also, and in
some instances it occasions cutaneous eruptions and annoying
itching. The more common form of effervescence is a coarse
rash, resembling measles, but sometimes there is urticaria,
erythema or a bullous eruption. The cause of these eruptions
is unknown. By some they have been attributed to the irritant
effect of its excretion by the skin; by others to the gastric
disturbance caused by the drug.
Kidneys. — Copaiba is diuretic not only by virtue of its vola-
tile oil, but also because of its resinous acid, which has an
action both upon the bronchial mucous membrane and the kid-
neys. This resin is excreted in the urine, where it may be
precipitated by acids. The precipitate can be readily distin-
copaiba. 547
guished from albumin, as it is evenly distributed through the
fluid and is dissolved by both heat and alcohol. While it might
thus at first be mistaken for albumin, it also leads to confusion
when Trommer's test is employed to detect glucose. As co-
paiba exerts an antiseptic action in the urine, the bladder and
urethra are bathed in an antiseptic, slightly irritant fluid, which
not only tends to retard the growth of microbes, but also to
promote the healing of lesions of the mucous membrane. In
large doses it causes irritation in these parts, with a con-
stant desire to micturate. The act of micturition is attended
with difficulty and pain, and sometimes the pain is so severe
as to lead to complete retention. Large quantities are also irri-
tating to the kidneys, and from this cause may result a dimin-
ished secretion, with blood and albumin in the urine. While
copaiba is excreted partly by the lungs and mucous membranes
and in the milk and other secretions, its main excretion takes
place by the kidneys and in combination with glycuronic acid.
Therapeutics of Copaiba.
External. — Like other terebinthinates, copaiba serves to stim-
ulate, as well as protect, parts to which it is applied. It is
sometimes used as a dressing for chilblains, frost-bite, sore
nipples, anal and other fissures, etc. A mixture of equal parts
of copaiba and rosin cerate has been recommended as an effi-
cient application for indolent ulcers. It has also been used, on
account of its stimulating and antiseptic effects, in chronic
skin diseases, such as psoriasis, lupus and leprosy, and as a
topical application to the urethra or vagina in chronic gonor-
rhoea.
Internal. — Occasionally copaiba is employed as an expector-
ant in bronchitis, especially where the secretion has become
profuse and fetid. In chronic conditions it has the effect of
diminishing, instead of increasing, secretion, and on this ac-
count as well as its disinfectant properties, it may serve a use-
ful purpose. The resin is an efficient diuretic for hepatic
ascites and cardiac dropsy, but should not be used in Bright's
548 PHARMACOLOGY AND THERAPEUTICS.
disease on account of its irritant action upon the kidneys. It
is, however, a very disagreeable remedy to take. The follow-
ing mixture, for one dose, is probably as palatable as any that
can be made: To I gm. (15 gr.) of resin of copaiba, rubbed up
with 1 gm. (15 gr.) of tragacanth and 1.20 c.c. (20 Til) of
alcohol, are added 4 c.c. (1 fl. dr.) of syrup of ginger in 30
c.c. (1 fl. oz.) of water. It is found that after copaiba has
been administered for some time it loses its effect to a consid-
erable degree, so that the diuresis produced by it is less copious
than at first. It was formerly given to a considerable extent
in pyelitis, cystitis, vaginitis, and a variety of other affections,
but at the present time its use is almost entirely restricted to
the treatment of gonorrhoea and gleet. The reasons for this
are its unpleasant taste, the offensive odor which the drug gives
to the breath of those taking it, and its liability to cause dis-
agreeable eructations, to derange the digestion, or to produce
eruptions on the skin. In gonorrhoea it has proved so unde-
niably efficacious, however, that in spite of the objectionable
features attendant .upon its administration, it still holds its place
as a standard remedy in this disease. It is regarded as safe
to begin the use of copaiba in gonorrhoea as soon as the initial
severity of the attack has subsided and the bowels have been
freely opened. It is best administered in capsules, and may
be combined with other agents if desired.
CUBEB.
CUBEBA.— Cubeb. Dose, 1 gm.; 15 gr.
Preparations.
1. Fluidextractum Cubebae. — Fluidextract of Cubeb. Dose, 1
c.c; 15 TTt-
2. Oleoresina Cubebae. — Oleoresin of Cubeb. Dose, 0.500
gm. (500 milligm.); 7V2 gr.
3. Trochisci Cubebae.— Troches of Cubeb.
OLEUM CUBEBA.— Oil of Cubeb. Dose, 0.5 c.c; 8 m..
Unofficial Preparation.
Tinctura Cubebae (U. S. P., 1890).— Tincture of Cubeb.
Dose, 2 to 12 c.c ; y2 to 3 fl. dr.
CUBEB. 549
Action of Cubeb.
External. — By reason of its volatile oil cubeb is irritant and
rubefacient when applied by inunction.
Internal. — Its action is much the same as that of copaiba,
though it is somewhat less irritant. In small doses it is an
aromatic stomachic and carminative, and assists digestion.
Large doses cause marked gastric and sometimes intestinal
irritation, with nausea, vomiting, abdominal pain, and perhaps
purging, while the urine may contain albumin or blood, or
both. It is absorbed, and, like other volatile oils, produces
some cardiac stimulation and also stimulates the functions of
the organs by which it is eliminated. It is excreted by the
kidneys and lungs, and perhaps by the skin, and its chief action
is on the mucous membrane of the genito-urinary tract. This
is not only powerfully stimulated but also disinfected by it, as
the urine containing the drug acts as a stimulant and antiseptic
lotion. It sometimes gives rise to a cutaneous papular or
erythematous eruption, but whether this is due to its excretion
by the skin, as believed by some, or to the gastric disturbance
is as yet undetermined. As cubeb induces considerable irrita-
tion of the kidney, it is a diuretic. Containing, as it does, like
copaiba, a resinous acid, this is considered to aid the effects
of the oil in its action upon the renal epithelium, as well as
upon the bronchial mucous membrane. This resin also is ex-
creted in the urine and is precipitated by the addition of acids.
Therapeutics of Cubeb.
Cubeb is one of the drugs most commonly employed in the
treatment of genito-urinary affections, especially gonorrhoea,
gleet and chronic cystitis. It is considered most valuable in
the acute stage of gonorrhoea. It often relieves functional irri-
tability of the bladder, and sometimes checks nocturnal inconti-
nence of urine. Some patients are peculiarly susceptible to its
effects, and in them even small doses may produce gastric dis-
turbance or vesical irritation, with bloody urine. In the treat-
ment of affections of the respiratory passages it has a well-
550 PHARMACOLOGY AND THERAPEUTICS.
established position. Powdered cubeb, blown into the nostrils
by an insufflator, is employed in chronic nasal catarrh, and is
also sometimes an efficient local application in hay-asthma un-
accompanied with fever and in follicular pharyngitis. The
symptom asthma is often relieved by cubeb cigarettes, and these
are useful also in sensitive hypertrophies of the nose and in
mild bronchitis. The official troches are employed by vocalists
and public speakers, and many popular bronchial troches con-
tain cubeb. It is of considerable service in subacute or chronic
bronchitis, especially when there is a profuse muco-purulent
secretion. It is not much used as a stomachic or cardiac stim-
ulant, on account of its liability to cause digestive disturbance,
but in atonic dyspepsia its carminative effect on the stom-
ach may sometimes be availed of by its cautious employment
in small doses. Cubeb is of decided service in cases of
chronic catarrh of the colon and rectum, with a relaxed condi-
tion of the mucous membrane and of the inferior hemorrhoidal
vessels, whether the affection assumes the form of mucous
dysentery or not. In haemorrhoids it is less efficient than black
pepper.
OIL OF SANTAL.
OLEUM SANTALL— Oil of Santal. (Oil of Sandal Wood.) Dose,
0.5 c.c; 8 ni.
Action of Oil of Santal.
The action of the oil of santal closely resembles that of
copaiba and cubeb, but it is less irritant, as well as more agree-
able to take, than either of the others. Like them, it is a
bronchial and genito-urinary stimulant and disinfectant. Its
absorption and excretion are very rapid, and it appears in the
urine in about half an hour after ingestion by the mouth.
After daily doses of 4 c.c. (60 Ttl) irritation of the alimentary
canal and urethra, with an eruption of small red papules upon
the skin and conjunctiva, have been observed.
OIL OF THYME. 55 I
Therapeutics of Oil of Santal.
It is best administered in capsules, or in an emulsion, and is
much used in gonorrhoea and gleet. One objection to it is its
expensiveness, and on account of its high cost it is frequently
adulterated. The advantage of pure oil of santal over copaiba
and cubeb is that it does not nauseate or disturb digestion, and it
can be given with good results during the inflammatory stages
of gonorrhoea or cystitis. In addition to these affections, it is
of service in pyelitis, urethral haemorrhage, and bronchitis.
Two or three drops on sugar will often be found to relieve the
hacking cough with which there is little expectoration.
MATICO.
MATICO. — Matico. Dose, 4 gin.; 60 gr.
Preparation.
Fluidextractum Matico. — Fluidextract of Matico. Dose, 4
c.c; 1 fl. dr.
Unofficial Preparation.
Oleum Matico. — Oil of Matico. Dose, 0.30 to 1.20 c.c.; 5 to
20 TT1..
Action of Matico.
The volatile oil of matico probably has much the same action
as that of cubeb, influencing chiefly the genito-urinary passages.
Therapeutics of Matico.
It has been given for the same cases as cubeb, but is now
rarely used. The leaves are sometimes placed upon a bleeding
surface. Their numerous hairs promote the clotting of the
blood, and thus they are haemostatic.
OIL OF THYME.
OLEUM THYML— Oil of Thyme. Dose, 0.2 c.c; 3 TT|..
Action of the Oil of Thyme.
Its action is similar to that of copaiba.
552 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of the Oil of Thyme.
The chief use of oil of thyme is as a source of thymol. It
has been employed in the treatment of bronchitis, gonorrhoea,
gleet, leucorrhoea, and vesical catarrh.
SACCHARIN.
BENZOSULPHINIDUM.— Benzosulphinide. Saccharin. (Gluside.)
Dose, 0.200 gm. (200 milligm.) ; 3 gr.
Unofficial Preparation.
Dulcinum. — Dulcin. (Sucrol. Para-phenetol-carbamide.)
Dose, .03 to .12 gm.; y2 to 2 gr., up to a daily maximum of
2 gm.; 30 gr.
Action of Saccharin.
Saccharin is an antiseptic, but almost the only practical use
which is made of it in this capacity is in the surgery of the
bladder. Its principal use is as a sweetening agent. It is not
a food, and is eliminated in the urine and saliva without change.
Therapeutics of Saccharin.
It is quite generally employed as a substitute for sugar when
from any cause, as in diabetes mellitus, this cannot be taken.
It may be used in tablets (for sweetening a cup of tea or coffee
one-quarter to one-half grain is sufficient) or in the form of
soluble saccharin, which is prepared by neutralizing a solu-
tion of sodium bicarbonate with saccharin. It contains about
90 per cent, of saccharin, and is soluble in 15 of water. An
excellent elixir for covering the taste of nauseous medicines
may be prepared as follows: Saccharin, 2; sodium bicarbon-
ate (90 per cent.), 1; alcohol, 5; water, 35 parts. Saccharin
is used as an internal antiseptic in cystitis with ammoniacal
urine, and has been highly commended as a mouth-wash, in
aphthae and a topical agent in ozsena.
Dulcin (para-phenetol-carbamide) is a urea derivative of
phenetidin, the sweetening power of which is about 200 times
that of sugar. It is said not to give rise to the disgust en-
DRUGS ACTING ON THE BODILY HEAT. 553
gendered by saccharin on prolonged use, but it has the disad-
vantage of great insolubility. It is soluble in 800 of water, 55
of boiling water, and 25 of alcohol. It is said that 1 gm. (15
gr.) will usually reduce the temperature in fever one degree
centigrade in about three hours.
Division VII. — Drugs Acting on the Bodily Heat.
A. Antipyretics, or Drugs which decrease the Body Tem-
perature.— With the exception of those which, when given in
sufficient quantity to induce severe collapse may in this way
cause the temperature to fall below normal, there are few drugs
capable of reducing the temperature in health. The term anti-
pyretic is therefore limited to such drugs as have the power of
depressing the body temperature in fever. In health the tem-
perature is maintained at a uniform point through a balance
established between the production of heat (thermogenesis)
and its dissipation (thermolysis) through the skin, lungs and
other organs. The main source of production is the voluntary
and involuntary contraction of the muscles, and the loss of
heat occurs to some extent through the lungs, but chiefly by
means of radiation from the cutaneous blood-vessels and the
evaporation of perspiration. Now if an excessive formation
of heat takes place, as during active muscular exertion, this is
compensated for by an increased output from the skin, through
the dilation of the vessels and by the perspiration. On the
other hand, if there is an increased heat dissipation from ex-
posure to cold, this is offset by an augmented combustion of
the tissues, with the formation of more heat. In order to pre-
serve a balance between the heat producing and heat dissi-
pating agencies there must be present a coordinating mechan-
ism, and there is considerable ground for locating this about
the corpus striatum, in the basilar ganglia of the cerebrum.
Lesions in this part of the brain are usually found to cause a
very marked rise of temperature, and it is stated that in ani-
554 PHARMACOLOGY AND THERAPEUTICS.
mals no shivering is produced by cold after section of the cere-
bral peduncles. The heat regulating function (thermotaxis)
is more or less deranged by various poisons, and especially by
such as are generated in fever. The existence of a heat-regu-
lating centre in the brain, it may be stated, has never as yet
been definitely proved, and some investigators believe that the
vasomotor centre in the medulla oblongata is sufficient to ex-
plain the normal coordination of formation and output. It has
lately been suggested that the thyroid and suprarenal glands,
one of which is thought to be perhaps the main organ of the
body to provide vaso-dilating material, while the other fur-
nishes the chief supply of vaso-constricting material, may play
an important part, by their opposed action, in this alternate
opening and shutting of the blood-vessels. As affording some
support to this view, attention has been called to the fact that
in the babe, which apparently has no heat governor or regula-
tor, since its temperature varies with that of its surroundings,
the thyroid is but imperfectly developed, while the suprarenal
glands have been observed to contain no vaso-constricting
material.
Antipyretics which increase the loss of heat. — Among these
are included all sudorifics and dilators of the cutaneous blood-
vessels. Cold, as in the form of a cold bath, acts by direct
abstraction of caloric. The action of salicylic acid and salicin
in reducing temperature is probably explained by the vascular
dilation caused and the increase in the output of heat. This
is also now believed to be the case with drugs of the class to
which acetanilide, antipyrine and phenacetine belong, so that the
cells of the body grow and change less when removed from the
high temperature to which they were previously exposed.
Some investigators, however, regard the fall in heat formation
as too great to be explained in this way, and infer that these
antipyretics diminish the combustion through some other action,
though not by affecting the tissues directly.
Drugs wJtich probably diminish the production of heat. —
Quinine apparently does this by lessening the metabolism. The
DRUGS ACTING ON THE BODILY HEAT. 555
antipyretic action of digitalis may perhaps be due to its causing
an increased activity of the heat-regulating centre, as has been
shown to be the case with picrotoxin and several other central
nervous stimulants. The fall of temperature produced by anti-
mony has been explained by the slowness of the circulation and
by the general depression and profuse perspiration. The pre-
cise manner in which aconite reduces the temperature is un-
known. A cold bath not only abstracts heat, but if continued
for a time diminishes its formation. Sometimes the removal
of some reflex source of irritation may lower the temperature,
and in this way purgatives occasionally act as antipyretics.
Therapeutics. — Alcohol, spirit of nitrous ether, antimony,
ipecacuanha and opium were formerly in constant use as anti-
pyretics, but at present are not very often given to reduce fever.
Cold is more often employed, either by cold sponging, ice, or a
cold bath. Sponging with hot water will, by the vascular dila-
tation and subsequent sweating it induces, reduce a febrile
temperature.
Of the drugs which are now used for this purpose, acetanilide
and antipyrine are dangerous because of the collapse they may
bring about, while quinine and salicylic acid are rather uncer-
tain, except in ague and rheumatic fever respectively. Anti-
pyrine is a very prompt and certain antipyretic, and, notwith-
standing its dangerousness, it and phenacetine are most in de-
mand. Phenacetine is less powerful, but quite safe, as a rule.
Antipyretics, however, should be rarely given, as in sufficient
doses to reduce the temperature they may cause dangerous
depression. Fever is only a surface indication of the essential
pathological condition, systemic infection, and if the pyrexia is
not excessive, no special action is called for. When this is the
case the external use of cold is generally preferable, since in
addition to its antipyretic effect, it is likely to furnish a needed
stimulus to the nervous system and prove beneficial in other
ways.
B. Drugs which cause a rise of Temperature. — Belladonna
may have this effect. The cause is not definitely known, but it
55^ PHARMACOLOGY AND THERAPEUTICS.
has been attributed to direct action on the heat centres in the
brain. The temperature is generally increased by poisonous
doses of cocaine, also it is thought probable, from some disorder
of the cerebral heat-regulating centres. Picrotoxin, like other
convulsive poisons, may cause a rise of temperature when given
in poisonous amounts.
Tuberculin, various albumoses, and certain animal poisons, such as
that of shell-fish, will cause a rise of temperature. Their mode of action
is unknown.
ANTIPYRETICS.
ACETANILIDUM.— Acetanilide. (Phenylacetamide. Antifebrin.)
Dose, 0.250 gm. (250 milligm.) ; 4 gr.
Preparation.
Pulvis Acetanilidi Compositus. — Compound Acetanilide Pow-
der. Dose, 0.500 gm. (500 milligm.) ; 7V2 gr.
Action of Acetanilide.
External. — It is antiseptic, haemostatic, and slightly sedative.
Internal. — Blood. — Upon the red corpuscles it has the effect
of causing the formation of methsemoglobin, and, in larger
amounts, a disintegration of the corpuscles. The movements
of the leucocytes are also arrested by it. The formation of
methsemoglobin has been found to be much more pronounced
inside than outside the body. The actions on the blood are
decidedly weaker than in the case of phenol and other sim-
ilar agents, but they occasion a peculiar cyanosis, which is
much more intense than that caused by the formation of the
same amount of methaemoglobin by other poisons. It is often
accompanied by dyspncea and acceleration of the pulse, and
lasts for periods ranging from a few hours to several days.
Heart and Vessels. — The heart is at first accelerated and
afterwards slowed, and this is attributed to the direct action
of the drug upon the cardiac muscle. When a considerable
reduction in temperature is caused, this also contributes largely
to the slowing of the organ. The increased rhythm of the heart
leads to a slight rise in the blood-pressure, but this falls as the
pulse becomes slower.
ANTIPYRETICS. 557
Respiration. — This is not usually affected by ordinary doses,
but under poisonous amounts it progressively fails.
Kidneys. — Acetanilide has some diuretic property. Some
observers consider it probable that in large doses it increases
the excretion of uric acid, but others state that in health it has
no effect on the excretion of this substance. After ordinary
doses the urea and total nitrogen of the urine may be slightly
augmented, and in large amounts it causes an increase in these
of from 30 to 35 per cent., so that there is a large increase in
the tissue waste. Acetanilide is rapidly absorbed and rapidly
excreted by the kidneys. It undergoes a partial oxidation, but,
except after very large doses, none of the original body appears
in the urine. Some of it enters into combinations with sul-
phuric and glycuronic acids, and the oxidation products often
give a smoky color to the urine, especially after it has been
exposed to the air for some time. After large doses the color
of the urine may also be darkened in consequence of the pres-
ence of methsemoglobin. After acetanilide, ferric chloride gives
a reddish-brown tinge to the urine.
Skin. — Diaphoresis may be produced in consequence of the
increased cutaneous circulation, and in fever profuse sweating
not infrequently follows its use. Sometimes an erythematous
rash is caused which usually resembles that of measles. Occa-
sionally urticaria occurs, and more rarely eczema and bullae,
while in some instances an oedematous swelling is observed.
Such skin affections, which are less frequently elicited by ace-
tanilide than by antipyrine, may possibly be accompanied by
some febrile reaction.
Temperature. — Acetanilide has little effect upon the normal
temperature, though it may cause a slight elevation unless the
amount administered is sufficient to produce pronounced symp-
toms of collapse. If the temperature is above normal, how-
ever, it has a marked antipyretic effect, often reducing .it to
below normal. It was at one time supposed that acetanilide and
other drugs of- its class diminished the heat production in con-
sequence of lessening the metabolism, in the same way as qui-
55$ PHARMACOLOGY AND THERAPEUTICS.
nine. It is now known, however, that such is not the case, and
it is held that the seat of their action is the base of the cere-
brum. As to the modus operandi of these antipyretics, it is
believed that they effect the reduction of pyrexia through alter-
ations produced in the heat-regulating mechanism which result
in lowering the point at which the temperature is maintained.
Consequently, a great increase in the dissipation of heat must
take place in order to get rid of the warmth that has accumu-
lated in the body, and this augmented output is attained by
dilatation of the cutaneous blood-vessels. Their principal ac-
tion practically, therefore, is by causing an increased heat loss
through this vascular effect, by reason of which a large amount
of blood is exposed to the cold air. It has been shown experi-
mentally that the dilatation of the cutaneous vessels is suffi-
ciently marked to be recorded by the plethysmograph in many
instances, while in others flushing of the skin is observed.
There is also a lessened heat production, but this is found to
be much less important, and is now generally regarded as due
to the fact that, at the lower temperature caused, metabolism
goes on less actively. The decrease in metabolism is really,
then, an effect, and not a cause, of the fall of temperature. The
degree of antipyretic action produced by these drugs is thought
to depend to a great extent on the functional activity present
in the centres, as it is found that there is a difference in the
susceptibility of different fevers to the action of such agents;
high continuous fevers reacting least, and those of an intermit-
tent type being most amenable. Acetanilide, and its group,
therefore, possesses anti-periodic properties, and in malarial
fever the greatest effect is always produced when the action
falls in the period of the natural decline of temperature.
Nervous System. — The action on the central nervous system,
aside from that on the heat-regulating centre, consists m stimu-
lation followed by paralysis, and a narcotic, a convulsant, and
a collapse effect, which pass insensibly into each other, have
been described. Its narcotic action renders acetanilide a power-
ful analgesic, although the narcosis is only slight and not at
ANTIPYRETICS. 559
all comparable to that of the true narcotics, since cerebral ac-
tion may be induced by small doses which do not apparently
influence the mental activity. As the influence of ordinary
doses upon the nerve cells appears to be very slight, it has been
suggested that the action may perhaps be confined to some spe-
cial areas of the brain. The convulsions produced by large
doses are stated to be intermittent in character and preceded
by increased reflex irritability. In the frog the excitability of
the spinal cord may lead to convulsions, but in mammals the
origin of the convulsions is not clearly understood. In general,
they appear to be referable to the cerebrum, but it is thought
possible that in some cases they may not be due to the direct
action of the poison on the brain, but are rather asphyxial in
character and dependent upon the changes in the blood, circu-
lation and respiration. In ordinary poisoning the peripheral
nerves and nerve ends do not seem to be seriously involved,
and in both frogs and mammals the final paralysis is consid-
ered to be undoubtedly central. The convulsive stage is fol-
lowed by unconsciousness, collapse, and total paralysis. The
pulse, at first accelerated, becomes slowed, and the respiration
is dyspnceic and then diminished. The skin is cyanotic and
covered with cold sweat, and sometimes there are vomiting
and dilatation of the pupils. Symptoms of collapse are occa-
sionally produced in susceptible persons by medicinal doses, and
especially if these are large, though death has been known to
occur after only .30 gm. (5 gr.) in one instance. In this, how-
ever, it is possible that the drug may have been impure. In the
milder cases the skin is cool and the pulse rather small and rapid,
but the condition soon passes off. In severe cases the skin is
cold and covered with a clammy sweat, the heart is weak, irreg-
ular, and sometimes fluttering, and the body temperature may
be subnormal. The weakness of the heart is the principal source
of anxiety, and the total failure of the circulation seems to be
the cause of death. These cases of collapse occur more fre-
quently when a rapid fall of temperature has been produced
than under other circumstances, but may be observed in per-
560 PHARMACOLOGY AND THERAPEUTICS.
sons who have had no fever. The collapse sometimes appear-
ing after small doses in fever, it has been suggested, may be
due, not to the drug, but to the reduction of the temperature.
In such cases, it is claimed, there was a pre-existing collapse,
which was masked by the hyperpyrexia, the effects of which
are in certain ways antagonistic to those of collapse. When,
therefore, the stimulus of the high temperature is removed, the
hidden collapse becomes apparent. Notwithstanding its insolu-
bility, acetanilide is said to have been absorbed from wounds in
sufficient amount to produce toxic symptoms.
Untoward Action. — In addition to the collapse and to the
cutaneous eruptions or the cyanosis which occasionally follow
medicinal doses of acetanilide, may be mentioned certain other
untoward effects: digestive disturbances, symptoms resembling
cinchonism, and paroxysms of sneezing. Under prolonged use
of the drug congestion of the liver, spleen and kidneys is said
to occur.
Therapeutics of Acetanilide.
External. — Acetanilide has been used with advantage as a
dusting powder for soft and hard venereal ulcerations, in place
of iodoform, and in the form of an ointment (1 to 24) for
chronic ulcers, eczema, urticaria, erysipelas, and other affec-
tions associated with, considerable irritation. It has also been
employed as an antiseptic for wounds. Too large a surface,
however, should not be dusted over.
Internal. — Pyrexia. — Acetanilide was originally introduced as
a rival to antipyrine on account of its powerful antipyretic
action in fever, and it is still used to some extent for the reduc-
tion of temperature. The opinion is gaming ground, however,
that if the temperature is not very high no attempt should be
made to reduce it, as there is then no danger from this source,
and, moreover, the theory is still held by some that fever is a
defensive measure taken by the organism against the causes of
disease. The principal objection to the use of acetanilide and
other similar drugs is the cardiac depression which they are
liable to induce, and hence in exhausting diseases like the con-
ANTIPYRETICS. 56 1
tinued fevers they may prove distinctly dangerous. By most
physicians of the present day, therefore, it is deemed safer, as
well as preferable in some other respects, to use cold baths or
some of the modifications of the Brand treatment whenever
the temperature reaches such a point that the hyperpyrexia is
dangerous to life. If it is decided to use antipyretics acetani-
lide will often produce a rapid reduction of temperature. The
minimum is reached in about two hours, and the effect may
continue for a considerable time. This action does not persist
after the drug is excreted, however, and hence the administra-
tion must be a continuous one, although if it is given when the
fever is just beginning to rise again, smaller doses are required
than at first. Of the more usual antipyretics, acetanilide pro-
duces probably the strongest collapse effects, and it is found
not to keep the temperature down quite so long as some other
remedies of its class. As it has no direct action upon the intes-
tinal tract, it may be administered by the rectum when this
seems desirable.
Analgesic Action. — Acetanilide is frequently useful in reliev-
ing the pain of neuralgia, sciatica, dysmenorrhoea, locomotor
ataxia, migraine, and various headaches.
Under the name of Antikamnia a substance has been intro-
duced that is probably a mixture of 20 parts of sodium bicar-
bonate, 70 of acetanilide and 10 of caffeine; which is the com-
position of the new official compound acetanilide powder. Since
acetanilide is a cardiac depressant, the addition of caffeine is
advantageous in most instances, though a case of death has
been reported which was attributed to the ingestion of 1.50
gm. ; 24 gr. of this mixture. Antinervine contains acetanilide,
sodium salicylate and potassium bromide.
Ammonol is a proprietary antipyretic and analgesic, claimed
to possess unusual stimulating and expectorant properties in
consequence of the ammonia in its composition. It is believed
to be merely an admixture of acetanilide, 2 parts ; sodium bicar-
bonate, 1 ; and ammonium carbonate, 1 part ; with a minute
quantity of the dye, metanyl-yellow. A similar mixture is in
37
562 PHARMACOLOGY AND THERAPEUTICS.
use at the Philadelphia Hospital, consisting of acetanilide, 5;
sodium bicarbonate, 3; ammonium carbonate, 2.
TOXICOLOGY.
When collapse symptoms are caused by acetanilide the treatment con-
sists in stimulation, as in collapse from other causes. General stimula-
tion is called for by alcohol and ether, given subcutaneously or by the
mouth, or in both ways, and stimulation of the heart by the subcu-
taneous injection of strychnine. Oxygen inhalations may also be of
service, and hot applications should be made to the extremities and body.
ANTIPYRINE.
ANTIPYRINA.— Antipyrine. (Phenazonum, B. P. Phenyldimethyl-
pyrazolon.) Dose, 0.250 gm. (250 milligm.) ; 4 gr.
Unofficial Preparations.
Iodopyrinum. — Iodopyrine. — (Iodantipyrine.) Dose, 0.40 to
2 gm.; 6 to 30 gr.
Migraninum. — Migranine. Dose, 1 gm.; 15 gr.
Pyramidonum. — Pyramidon. (Dimethyl - ami do - antipyrine.)
Dose, 0.25 to 0.50 gm.; 4 to 8 gr.
Salipyrinum. — Salipyrine. (Antipyrin Salicylate.) Dose, 0.40
to 2 gm.; 6 to 30 gr.
Action of Antipyrine.
Antipyrine in small doses may moderately increase arterial
pressure by direct stimulation of the heart; in large doses it is
a cardiac depressant, the final fall of blood-pressure being cer-
tainly due, at least in part, to a direct action upon the heart.
It is mildly antiseptic, and will preserve blood for some days
when added to it so as to form a 2 to 5 per cent, solution. It
is also haemostatic, having the property of coagulating proteids.
Like acetanilide, it is somewhat diuretic, and it is excreted in
great part unchanged in combination with sulphuric acid and
perhaps with glycuronic acid. After antipyrine has been taken
the addition of ferric chloride to the urine gives a red color.
It is a local anaesthetic, but irritation has followed its hypoder-
matic use. It may produce an erythematous or other rash. It
ANTIPYRINE. 563
rapidly reduces an elevated temperature in the same way as
acetanilide. In large doses it is said to produce convulsions;
later, coma and paralysis of motor nerves and muscles.
Therapeutics of Antipyrine.
Antipyrine is given internally as a powerful antipyretic, in
fevers of various kinds. It is also used as a haemostatic in
haemorrhoids and epistaxis. It has been given with some suc-
cess in diabetes. It is largely employed as an anti-neuralgic,
relieving the pains of locomotor ataxia and other nervous affec-
tions, and as an anti-rheumatic. It has been highly recom-
mended in chorea and epilepsy.
Salipyrine is prepared by the action of antipyrine upon sali-
cylic acid in substance. It is a white, coarsely-crystalline pow-
der with a rather sweetish taste, readily soluble in alcohol and
but slightly in water. In chronic articular rheumatism and sci-
atica it may prove of service, but it does not prevent relapses.
It has been successfully used for spasmodic dysmenorrhcea.
Iodopyrine, or iodantipyrine, is supposed to have a hydrogen
atom in the phenyl group of antipyrine replaced by iodine. It
occurs in colorless, prismatic needles, which are tasteless. It
is with difficulty soluble in cold water or alcohol, but readily
in hot. It causes a fall of temperature and considerable dia-
phoresis, but it is doubtful if it has any advantage over anti-
pyrine.
Migranine is a double citrate of antipyrine and caffeine which
is stated to be efficacious in sick headache and neuralgia.
Pyramidon, dimethyl-amido-antipyrine, is a derivative of
antipyrine by a substitution process, which occurs as a yellow-
ish-white crystalline powder, soluble in 10 parts of water. As
compared with antipyrine, with which it has the same general
action, it is less soluble and acts with less promptness, but its
effects are more lasting, and the same results are said to be
produced with about one-third the dose. As an antipyretic it
has been highly praised in the fever of tuberculosis, in acute
articular rheumatism, and in typhoid fever. It is claimed that
564 PHARMACOLOGY AND THERAPEUTICS.
when properly administered it has no deleterious effect upon the
blood or the digestion, and that it exerts a beneficial rather than
an unfavorable action upon the heart. As an analgesic and
anti-neuralgic it has been given with considerable success in
the pains of locomotor ataxia, in migraine, and in intercostal,
trigeminal, and other neuralgias.
TOXICOLOGY.
While antipyrine is somewhat less liable to such action, it occasionally
produces collapse effects in the same way as acetanilide. The treat-
ment of the depression caused by it is the same as in the case of the
latter. Antipyrine has been credited with a considerable number of
deaths, but it is quite likely that most of them have been due to im-
proper dosage.
ACETPHENETIDIN.
ACETPHENETIDINTJM.— -Acetphenetidin. (Phenacetine.) Dose,
0.500 gin. (500 milligm.) ; 7V2 £*-
Action of Acetphenetidin.
Acetphenetidin, or phenacetine, as it has hitherto been
known, has no action externally nor on the gastro-intestinal
tract, and with ordinary doses the blood is unaffected. It
slightly depresses the heart, but does not in ordinary doses
affect the respiration. It is a mild diuretic, and large doses
cause the passage of altered blood. It is a powerful antipyretic,
by increasing heat dissipation and also diminishing heat pro-
duction to some extent. It is likewise a powerful analgesic.
Therapeutics of Acetphenetidin.
It is a valuable remedy for reducing fever, and, because it
depresses the heart but little, it is safer than either antipyrine
or acetanilide. It is, however, very insoluble, and slower and
less powerful than these remedies, though its effects last longer.
Since it possesses a very marked analgesic action, acetpheneti-
din is to be preferred as a remedy for the relief of pain, as in
neuralgia, sciatica, locomotor ataxia, migraine and various
headaches. For this purpose, the dose of .30 gm. (5 gr.) should
LACTOPHENINE. 565
be administered every hour for three or four hours ; when relief
generally results. This drug has been of service in the treat-
ment of epilepsy.
TOXICOLOGY.
Symptoms. — Acetphenetidin sometimes produces severe vomiting,
sweating, feeble and rapid pulse, and collapse. Treatment. — Alcoholic
stimulation. Strychnine hypodermatically. External warmth.
EXALGIN.
Unofficial Preparation.
Exalginum. — Exalgin. (Methyl Acetanilide.) Dose, 0.03 to
0.20 gm.; y2 to 3 gr.
Action of Exalgix.
It has the general action of the antipyretics. In medicinal
doses it rarely causes depression, but large amounts, since they
are capable of causing disintegration of the red blood-corpus-
cles, may prove dangerous.
Therapeutics of Exalgix.
Exalgin is an excellent analgesic, and not infrequently gives
relief when various other drugs have failed. It may be advan-
tageously dissolved in Tinctura Aurantii Dulcis, but is often
given in pill or tablet form. It is used for migraine., sciatica,
the pains of rheumatism, and, of late, for chorea.
TOXICOLOGY.
Several severe cases of poisoning having been reported, the usual dose
should not be exceeded. The symptoms are similar to those of ace-
tanilide.
Treatment. — As for acetanilide. {See p. 562.)
LACTOPHENINE.
Unofficial Preparation.
Lactopheninum. — Lactophenine. (Lactylparaphenetidin.)
Dose, 0.60 to 1 gm.; 10 to 15 gr.
566 PHARMACOLOGY AND THERAPEUTICS.
Action of Lactophenine.
Lactophenine is an analgesic and antithermic. It is usually
better borne than antipyrine. Although it may, in some in-
stances, give rise to sweating, it does not cause collapse nor
cyanosis. It produces a considerable and persistent lowering
of a febrile temperature, but without abundant perspiration, and
its use is not followed by chilly sensations.
Therapeutics of Lactophenine.
It has been administered in articular rheumatism, influenza,
scarlet fever, septicaemia and other infectious diseases. Excel-
lent results have been reported from it in typhoid fever, with
daily doses from 0.50 to 1 gm. (7 to 15 gr.), not only in reduc-
ing the fever, but as a sedative when delirium becomes a promi-
nent symptom.
PHENOCOLL HYDROCHLORIDE.
Unofficial Preparation.
Phenocolli Hydrochloridum. — Phenocoll Hydrochloride. Dose,
0.30 to 2 gm.; 5 to 30 gr.
Action of Phenocoll Hydrochloride.
It is not poisonous to animals, nor does it injuriously affect
the blood. It is a fairly powerful antipyretic, not followed by
collapse or cyanosis; the perspiration is not more marked than
after large doses of antipyrine. It is rapidly excreted by the
urine, to which it gives a brownish color, and it probably in-
creases the excretion of uric acid.
Therapeutics of Phenocoll Hydrochloride.
In addition to its use as an antipyretic it has been employed
as an antineuralgic, while in severe acute articular rheumatism
it has exercised a beneficial action upon the joints when other
remedies have failed. The reports, of which there are now a
considerable number, are favorable to this remedy.
DRUGS ACTING ON THE RESPIRATION. 567
Unofficial Preparation.
Thallinae Sulphas.— Thalline Sulphate. Dose, 0.12 to 0.60
gin.; 2 to 10 gr.
Action of Thalline Sulphate.
This drug was introduced into medicine as an antipyretic,
but it was soon abandoned because of the dangerous collapse,
with marked cyanosis, which it produced. It is rarely given
internally, because it is poisonous to the red blood-corpuscles
and to the nervous system.
Therapeutics of Thalline Sulphate.
Its chief use is as an injection for gonorrhoea, in aqueous
solution ( 1 or 2 to 120), or it can be used in a 2 per cent,
solution in gelatin bougies. In gleet beneficial results have
followed the injection of 1 to 8 aqueous solutions.
Division VIII. — Drugs Acting on the Respiration.
The influences affecting the respiration are so numerous and
varied that it is not always easy to determine the precise mode
of action of any drug which produces an impression upon it.
Thus, the respiratory centre in the medulla (which is subject
to direct or reflex influences from almost all the organs of the
body), the movements of the respiratory muscles, or the circu-
latory mechanism influencing the respiration may be acted
upon; or, again, alterations produced in the blood or in the air
respired may affect the function. In therapeutics, however, the
object is generally to remove the cause of or alleviate respira-
tory difficulty, rather than act upon the respiration itself.
Drugs which produce changes in the blood and circulation have
already been considered, while for the consideration of such
modifications of the temperature, moisture and atmospheric
pressure as are of service reference must be made to works on
general therapeutics. Therefore, the respiratory drugs will
now be treated of under the following heads :
568 PHARMACOLOGY AND THERAPEUTICS.
A. Drugs altering the Composition of the Air inhaled. — In
this come drugs which, when inhaled, have some direct effect
on the respiratory mucous membrane, or the bronchial and
pulmonary contents, and may also have remote effects. Certain
drugs, although they are not employed for their effects on the
respiration, are most conveniently administered by inhalation;
e. g., anaesthetics and amyl nitrite.
Some drugs when inhaled produce very marked irritation of
the bronchial mucous membrane, thus giving rise to vascular
dilatation and augmented secretion, and reflexly causing cough
from stimulation of the sensory nerves of the part.
Such are iodine, bromine, chlorine, senega, ipecacuanha, sulphurous
anhydride, nitric acid fumes, ammonia, and tobacco, as well as cold
dry air. These are rarely used therapeutically as inhalations, and their
inhalation is to be particularly avoided in irritable conditions of the
bronchi.
The drugs which, when inhaled, are soothing to the bron-
chial mucous membrane, but are rarely employed, are —
Hydrocyanic acid. Conium.
Inhalations which are used to stimulate the bronchi, that is
to say, to increase their vascularity, secretion, and muscular
power, are —
(i) Phenol 1 1.20C.C. (4) Tincturaben-
(2) Oil of cajuput I (20 TTt ) . zoini composita,
(3) Oleum pini sylvestris, 2 c.c. (5) Creosote,
(30 TTL). (6) Oil of cubeb.
15 c.c. (fl 3SS)-
The amounts given after each are the quantities that should be added
to 500 c.c. (1 pint) of water at 6o° C. (1400 F.).
Inhalations which are used to disinfect foul secretions from
the bronchial mucous membrane are those of —
(1) Creosote.
(2) Iodoform.
(3) Mild solutions of benzoin.
(4) Phenol.
(5) Sulphurous anhydride.
(6) Oil of juniper.
(7) Oil of cubeb.
(8) Oil of eucalyptus.
DRUGS ACTING ON THE RESPIRATION.
569
Inhalations for relieving spasm of the bronchial tubes are
those of —
(1) Conium.
(2) Stramonium.
(3) Chloroform.
(4) Ether.
(5) Amyl nitrite.
B. Drugs acting on the Respiratory Centre. — If, when in-
jected into the carotid artery, a drug produces a very prompt
effect on respiration, it is concluded that it acts on the respira-
tory centre. In order to determine whether the drug acts on
the centre, or on the vagal terminations in the lung, it is cus-
tomary to divide the vagi and then observe whether it acts in
the same way after, as before, the section.
Drugs which directly stimulate the respiratory centre are —
(1) Strychnine.
(2) Ammonia (very power-
ful).
(3) Apomorphine.
(4) Belladonna.
(5) Stramonium.
(6) Hyoscyamus.
Drugs which depress the respiratory centre are —
(1) Physostigmine (very
(9) Aconite.
powerful).
(10) Veratrine.
(2) Hydrated chloral.
(11) Conium.
(3) Chloroform.
(12) Caffeine.
(4) Ether.
(13) Quinine.
(5) Alcohol.
(14) Ipecacuanha.
(6) Opium.
(15) Antimony salts (very
(7) Hydrocyanic acid.
weak).
(8) Codeine.
Alcohol, ether, chloroform, caffeine, and quinine slightly excite, be-
fore they depress, the respiratory centre.
Therapeutics. — Drugs exciting the respiratory centre may be
given when there is any difficulty in respiration for the purpose
of increasing the force of the respiratory act; at the same time
measures should be employed to remove the cause of the diffi-
5/0 PHARMACOLOGY AND THERAPEUTICS.
culty. They are, naturally, most frequently required in respir-
atory diseases, and especially bronchitis. Ammonia and apo-
morphine are very frequently prescribed for the reason that
they are also powerful expectorants, and belladonna is applica-
ble in cases with excessive bronchial secretion.
Drugs which depress the respiratory centre are very seldom
required for this action; but the centre for the reflex act of
coughing is in the immediate vicinity of the respiratory centre,
and opium, morphine, codeine, heroine, hydrocyanic acid, co-
nium, and ipecacuanha are often very valuable in allaying the
continual hacking cough frequently accompanying disease of
the heart and lungs.
The drugs which relieve cough are very numerous, since this
may be reflexly set up by irritation of so many peripheral parts,
viz., nose, throat, pharynx, ear, teeth, larynx, trachea, bronchi,
lungs, pleura, stomach, and liver; and consequently its success-
ful treatment may depend upon the removal of peripheral irri-
tation in any of them.
C. Drugs affecting the Bronchial Secretion.
(a) Those increasing it:
(i) Apomorphine.
(9) Camphor.
(2) All alkalies,
especially
am-
(10) Benzoin.
monium carbonate
and
(11) Balsam of Peru.
other ammonium salts.
(12) Balsam of Tolu.
(3) Cocillana.
(13) Antimony salts.
(4) Ipecacuanha.
(14) Sulphur.
(5) Senega.
(15) Iodine.
(6) Squill.
(16) Tobacco.
(7) Turpentine.
(17) Pilocarpus.
(8) Terebene.
(18) Many volatile oils
It is probable that volatile oils and substances containing them de-
crease the amount of bronchial secretion as a later effect.
(b) Those decreasing it:
(1) Acids. (3) Stramonium.
(2) Belladonna. (4) Hyoscyamus.
DRUGS ACTING ON THE RESPIRATION. 57 1
Many authorities believe that under some circumstances alkalies de-
crease the secretion.
(c) Those disinfecting it: — Drugs which, when inhaled, act in this
way have already been mentioned. Copaiba, cubeb, eucalyptus, and
many volatile oils are excreted partly by the bronchial mucous mem-
brane, and thus will disinfect the secretion.
Therapeutics. — In bronchitis, remedies which increase the
secretion are used when the latter is so viscid that it adheres
to the tubes and cannot be coughed up; and those which de-
crease it are employed when it is too watery to be easily expec-
torated. The use of the disinfectants is obvious.
D. Drugs relaxing Spasm of the Muscular Coat of the Bron-
chial Tubes, or Antispasmodics. — It is believed that the symp-
tom asthma is due to a spasmodic contraction of the bronchial
tubes, and as —
(1) Stramonium
(2) Belladonna
(3) Hyoscyamus
(4) G-rindelia
(5) Aspidosperma
relieve this symptom, it is concluded that these drugs relax
spasm of the muscular coat of the bronchial tubes. Stramo-
nium is the most powerful. From their analogous action in
other parts of the body, it is probable that the following drugs
act in the same way:
Chloroform, ether, opium, hydrated chloral, cannabis indica, amyl
nitrite, and conium.
Therapeutics. — Stramonium is of great use for relief of the
symptom asthma, and this and the other drugs may be employed
for cases of bronchitis in which spasm of the tubes seems to
result from the inflammation present. Many of these muscu-
lar depressants in all probability depress the nerves at the same
time.
E. Drugs acting on the Vessels of the Bronchi. — These are
the same as have been already described (p. 324) as acting on
the vascular system generally.
572 PHARMACOLOGY AND THERAPEUTICS.
F. Expectorants. — On account of the complexity of the
modes of action of drugs affecting the respiratory system, it is
customary to regard most of them clinically: simply as drugs
which hinder or aid the expectoration of the contents of the
bronchial tubes. Those which aid it are divided into two
groups, named after their action, not on the lungs, but on the
circulation.
i. Stimulating expectorants. — These are stimulants to the circulation
generally. They are —
(i) Acids.
(9) Balsam of Peru.
(2) Ammonium salts.
(10) Turpentine preparations
(3) Cocillana.
(n) Terebene.
(4) Senega.
(12) Oleum Pini Sylvestris.
(5) Squill.
(13) Nux Vomica.
(6) Benzoin.
(14) Sulphur.
(7) Benzoic acid.
(15) Quillaja.
(8) Balsam of Tolu.
2. Depressing expectorants. — These depress the general circulation.
They are —
(1) Alkalies.
(2) Antimony salts.
(3) Ipecacuanha.
(4) Lobelia.
(5) Pilocarpus.
(6) Apomorphine.
(7) Potassium iodide.
Therapeutics. — It is almost impossible to lay down any gen-
eral directions. In any case before us we must consider the
acuteness or the reverse of the disease and whether we wish
to stimulate or to depress the circulation, to increase, to
diminish or to disinfect the expectoration, to stimulate the
respiratory centre, to overcome spasm of the bronchial tubes,
or to allay a hacking cough; and then employ such remedy or
combination of remedies as seems best to meet the indications
present. Warmth to the chest and warm drinks are sedative,
and increase the amount of secretion, while cold and cold drinks
have an opposite effect.
HYDROCYANIC ACID. 573
G. Drugs which in Man sometimes produce Cheyne- Stokes
Breathing. — These are morphine, potassium bromide, and
hydrated chloral. In animals the following, in addition, may do
it: picrotoxin, muscarine, digitalin, strychnine and ammonium
carbonate.
B. Drugs Acting on the Respiratory Centre.
HYDROCYANIC ACID.
POTASSII FERROCYANIDUM.— Potassium Ferrocyanide. (Yel-
low Prussiate of Potash.) Dose, 0.500 gm. (500 milligm.) ; 7V2 gr.
POTASSII CYANIDUM.— Potassium Cyanide. Dose, 0.010 gm.
(10 milligm.) ; y5 gr.
Preparation.
Acidum Hydrocyanicum Dilutum. — Diluted Hydrocyanic
Acid. (Prussic Acid.) Dose, 0.1 c.c; iy2 "HI-
Action of Potassium Cyanide and Diluted Hydrocyanic
Acid.
External. — Hydrocyanic acid is a violent protoplasmic poi-
son, and is toxic to all forms of life. It inhibits fermentation
and putrefaction, and retards the growth of plants and the
movement of animal cells. The diluted acid, when applied to
the unbroken skin, is at first slightly irritating, but, as it
penetrates the epidermis, it soon causes paralysis of the sensory
nerve-endings, and thus has a sedative and anaesthetic effect.
From raw surfaces it is very rapidly absorbed, and toxic effects
may result from this absorption. Potassium cyanide may pos-
sibly give the same results. It also produces a dermatitis on
local application to the epidermis.
Internal. Alimentary Tract. — Hydrocyanic acid is quickly,
and potassium cyanide less rapidly, absorbed by mucous mem-
branes, and on the fauces, oesophagus and stomach the same
sedative and anaesthetic effects are produced as upon the skin.
Blood. — Under the influence of hydrocyanic acid the tissues
are unable to absorb the oxygen brought to them by the blood
cells; in consequence, the oxyhaemoglobin of the blood is not
574 PHARMACOLOGY AND THERAPEUTICS.
reduced in the capillaries, and the venous blood, therefore, has
the same bright red color as the arterial. Lactic acid and sugar,
which are always present when the oxidation of the tissues is
imperfect, are found in the blood in unusually large quantities
during the action of hydrocyanic acid. In the body the acid
does not enter into any combination with the haemoglobin of
the red corpuscles. Blood to which it has been added retains
its red color much longer than ordinary blood, and it is
thought by some observers that the reason for this is that the
acid destroys some oxidizing substance or ferment in the blood.
Whenever hydrocyanic acid and methaemoglobin come in con-
tact, a combination is formed (cyanomethsemoglobin) which is
distingushed from ordinary methsemoglobin by having a bright
red color; and in cases of cyanide poisoning the dependent
parts of the body are often found to present such a tinge in
consequence of this action on the methsemoglobin which they
contain after death. The blackness of the blood which is
observed in the internal organs is believed to be simply the
result of the rapid death, such as is met with after any sudden
death in well-nourished persons; the tissues being still alive
after the stoppage of the circulation, and using up all the
oxygen contained in the blood.
Heart and Circulation. — The circulation is altered mainly
through the action on the central nervous system, but the drug
also acts directly on the heart. The pulse is apt to be slowed
from the primary stimulation of the inhibitory centres, while
the increased activity of the vaso-constrictor centres occasions
a very considerable rise in blood-pressure. This central stimu-
lation is succeeded by paralysis, in consequence of which the
blood-pressure falls very low, but the movements of the heart
generally remain slow, notwithstanding the cessation of the
inhibitory stimulation, since the cardiac muscle is now directly
affected by the depressing action of the drug. It is found that
if very large quantities are injected intravenously or inhaled,
the heart may cease contracting for a few seconds, and then
recommence a slow and feeble beat, which is quickly arrested
HYDROCYANIC ACID. 575
again. This is thought to be due to primary action on the
inhibitory centre, followed by direct paralysis of the heart.
Respiration. — The respiratory changes are caused by primary
stimulation and subsequent paralysis of the medullary centre.
After very large quantities the respiration may cease within
a few seconds. Under the use of smaller doses it is rendered
quicker and deeper at first. It then becomes irregular, subse-
quently grows very slow and deep, and finally ceases.
Nervous System and Muscles. — The central nervous system
is primarily stimulated and then depressed and paralyzed, and
the medulla oblongata and lower portions of the brain are
at first much more profoundly affected than the cerebral cortex,
although the final paralysis apparently includes all parts of
the central axis. When the drug is given in doses small enough
to permit of watching its action, it is found that this com-
mences in the medulla, where the vaso-motor, respiratory,
vagus, vomiting and pupil-dilator centres are all stimulated.
Then unconsciousness results, and after this convulsions, which
in man are believed to be chiefly medullary in origin. Finally,
paralysis of the whole central nervous system ensues, and in-
voluntary evacuations of faeces, urine and semen are frequently
observed. During the convulsions, which are rare in man but
common in animals, there is generally a temporary rise in
blood-pressure, and the respiration is naturally very irregular.
Death is due to arrest of the respiratory function, the heart
continuing to beat for a short time. The phenomena of the
action of hydrocyanic acid on the central nervous system, it will
be seen, are very much like those of asphyxia, and it is regarded
as probable that the latter plays an important part in their
production, though the rapidity of their development indicates
that they cannot be attributed entirely to asphyxia. The peri-
pheral nerves and muscles, when suspended in an atmosphere
of hydrocyanic acid, are weakened and eventually paralyzed;
but in the living animal, unless large amounts of the drug are
injected, are found to be not much affected.
Excretion. — Hydrocyanic acid is rapidly decomposed in the
57^ PHARMACOLOGY AND THERAPEUTICS.
body. Part of it combines with sulphur-containing molecules
to form sulphocyanides, and is excreted as such in the urine,
while part undergoes further changes which are as yet un-
known.
Therapeutics of Potassium Cyanide and Diluted Hydro-
cyanic Acid.
External. — Hydrocyanic acid is a valuable antipruritic. The
official preparation should always be well diluted, and lotions
of a strength of about 1 to 48 may be applied, to allay itching
from almost any cause. They should not be employed in any
case where the skin is broken.
Internal. — Hydrocyanic acid may be administered as the
official diluted acid, oil of bitter almond (3 to 14 per cent, of
acid), bitter almond water, cherry laurel water (B. P.), the
fluidextract, infusion and syrup of wild cherry, and as potas-
sium cyanide. Reference should be made to each of these. In
small doses the diluted acid, on account of its sedative and an-
aesthetic effect, is often useful in relieving vomiting or gastric
pain, and in many instances it may be administered most ac-
ceptably in an effervescing draught. Since the effect of the
remedy is transient, it should be given at frequent intervals.
Enteralgia also not infrequently yields promptly to hydrocyanic
acid. It is sometimes employed with advantage to allay cere-
bral irritation and excitement. The giddiness of Meniere's
disease (auditory nerve vertigo) is sometimes benefited by
it, and it may prove useful in relieving the nervous palpita-
tion met with in some cases of organic disease of the heart
and also attacks of palpitation occurring as a symptom of
a nervous condition in patients not affected with cardiac
disease. It has been given in whooping-cough, and is very
serviceable for the nervous cough of mothers which is not
uncommonly observed in those whose children are suffering
from this disease. It is used to a considerable extent as an
ingredient of cough mixtures, on account of its effect in dimin-
ishing reflex excitability by reason of its depressing action on
HYDROCYANIC ACID. 577
the central nervous system, and is especially valuable where
there is a dry, hacking cough, without expectoration. Inhala-
tions of a solution containing about .20 c.c. (3 Til) of diluted
hydrocyanic acid to 250 c.c. (8 fl. oz.) of water, at a tempera-
ture of 48. 8° C. (1200 F.), are sometimes given with benefit in
asthma and the irritative cough of phthisis. The uses of potas-
sium cyanide are similar to those of hydrocyanic acid.
TOXICOLOGY.
The great danger from hydrocyanic acid is the rapidity of its action,
for the lethal dose of the pure acid in man (probably about .06 to .09
gm. (1 to il/2 gr.)) is much larger than that of some of the poi-
sonous alkaloids. After large doses in mammals there may be prac-
tically no symptoms. The animal falls to the ground with a slight
convulsive movement or a scream, and death results in a few seconds
from arrest of the respiration and heart. One drop of the pure acid,
however, when placed inside the eye of even moderately large animals,
has been known to destroy life instantly. In man the symptoms usually
commence in a few seconds after taking a large dose of hydrocyanic
acid. The patient falls insensible, and the eyes will be found fixed,
glassy, and with dilated pupils, the limbs relaxed, the skin cold and
clammy, the pulse so small as to be scarcely perceptible, and the res-
piration slow, deep, and convulsive. Death takes place, as has been
mentioned, from respiratory failure. When the poisonous quantity
taken is smaller, there is at first an acrid, burning taste, which is ac-
companied by increased salivary secretion and followed by numbness
of the mouth and throat. In the stomach there is a feeling of warmth,
followed by nausea and vomiting. Other symptoms are headache, con-
fusion, dyspnoea, slowness of the pulse, and great prostration, while
the pupils are widely dilated and the eyeballs protrude. Soon uncon-
sciousness supervenes, with or without convulsions, and then general
paralysis, with involuntary defecation and micturition.
Post-mortem. — The characteristic odor of hydrocyanic acid is gen-
erally perceptible. The body is livid and the blood very dark. The
heart is soft and flaccid and there is generally considerable congestion
of the gastric mucous membrane. Post-mortem rigidity sets in very
early, and the teeth are clinched, the fingers tightly closed, the toes
strongly flexed, and the eyes prominent and staring.
Treatment. — In cases of poisoning by hydrocyanic acid the fatal re-
sult is usually produced so rapidly that the physician rarely has the
38
57$ PHARMACOLOGY AND THERAPEUTICS.
opportunity of interfering. If life is not already extinct, the utmost
promptitude is called for. The stomach should be washed out imme-
diately, or vomiting should be induced by inserting the finger into
the throat. Should this prove ineffectual, large doses of emetics must
be given, as every moment is precious, and it is found that recovery
is rapid when it has once set in. Atropine has been proposed as an
antidote, but there is no reason to suppose that it will prove of ser-
vice, since it has been shown that it is of no benefit in experiments on
animals. The real element of danger is the stoppage of the heart, for
although the respiration fails before this, respiratory paralysis can
always be more or less successfully counteracted by artificial respiration,
which is usually called for in poisoning by this drug. General stimu-
lants, such as brandy or ether, given subcutaneously, are indicated,
and ammonia, by inhalation, and caffeine may also be of service. Cold
affusions, or alternately hot and cold, may be of assistance. Cobalt chlo-
ride, which has proved valuable in a considerable number of instances, is
believed by some to be the best chemical antagonist. A thirty per cent,
solution of hydrogen dioxide may be employed to wash out the
stomach. Intravenous injections of sodium thiosulphate (producing
theoretically the relatively harmless sulphocyanide) enable animals to
survive an otherwise lethal dose. The following results of experiments
recently made in Australia are of great interest and value: i to 100,000
of potassium cyanide produced in rabbits, within seven minutes, stag-
gering gait and very rapid respirations, followed shortly by labored
breathing. Convulsions of varying intensity always occurred, and at
times appeared within three minutes after introduction of the drug.
Exhaustion followed the spasms, respiration became shallower and
shallower, and the animals died. Hydrogen dioxide, when used sub-
cutaneously, as recommended, in 3 per cent, solution was immediately
broken up, and its effects were nil. A similar result followed its ad-
ministration by the stomach, even when the poison and the supposed
antidote were introduced mixed. While hydrogen dioxide does oxidize
cyanides, its action was found to be too slow to be of therapeutic value.
Twenty-six experiments with cobalt chloride pointed to the fact that
this salt is capable of forming an insoluble cyanide, but that for this
purpose it must be given in excess. The acid of the gastric juice does
not interfere with the reaction. Cobalt chloride itself, however, is not
free from poisonous action, producing severe gastro-enteric symptoms.
These should be carefully guarded against. Ferrous hydrate, when added
to a cyanide salt forms a ferrocyanide almost instantaneously. This is
but slightly poisonous, and its administration would seem to be even
better than the cobalt, in view of the toxic action of the latter. Un-
WILD CHERRY. 579
fortunately, however, the strongly acid contents of the stomach con-
tents greatly hinder the action of the ferrous hydrate, and hence alkalies
must be added to neutralize the free hydrochloric acid. Magnesium
oxide is the best for this purpose. Another drawback is that the ferro-
cyanides are kept in solution with difficulty. As the result of their
investigations the experimenters recommend the following treatment :
Have in readiness in places where cases of cyanide poisoning are likely
to occur the following: 30 c.c. (1 fl. oz.) of a 23 per cent, solution of
ferrous sulphate; 30 c.c. ( 1 fl. oz.) of a 5 per cent, solution of caustic
potash; 1.80 gm. (30 gr.) of powdered magnesium oxide; a metal re-
ceptacle of 500 c.c. (1 pint) capacity; a stomach-tube. The first two
solutions should be kept in air-tight tubes, which can be broken into
the receptacle. When a case of poisoning occurs this is to be done,
the powdered magnesia and 250 c.c. (^ pint) of water added, and the
mixture shaken up and administered. This amount of antidote, it is
stated, will take care of 6.50 gm. (75 gr.) of potassium cyanide. As
cyanide poisoning has become not infrequent among the Australian
miners since the introduction of the cyanides in the extraction of gold,
it is advised that the antidote be kept in all mines where such processes
are employed, in readiness for instant use, since time is the most im-
portant factor in securing a successful result.
WILD CHERRY.
PRUNUS VIRGINIANA.— Wild Cherry. Dose, 2 gm.; 30 gr.
Preparations.
1. Fluidextractum Pruni Virginianse. — Fluidextract of Wild
Cherry. Dose, 2 C.C.; 30 Tl\.-
2. Infusum Pruni Virginianse. — Infusion of Wild Cherry.
Dose, 60 c.c.; 2 fl. oz.
3. Syrupus Pruni Virginianse. — Syrup of Wild Cherry. Dose,
4 c.c.; 1 fl. dr.
Action of Wild Cherry.
Wild cherry is an aromatic bitter tonic. As hydrocyanic
acid is yielded when it is treated with water, its preparations
possess more or less of the sedative action of that agent, and
very large doses have a depressing influence upon the heart.
In common with the apple and some other fruit trees, the root-
bark contains a glucoside, phloridzin, which has the effect of
58O PHARMACOLOGY AND THERAPEUTICS.
producing glycosuria. This differs from the glycosuria met
with in the disease diabetes mellitus in that the sugar of the
blood is not augmented. Hence, it has been pointed out, it is
not attributable to any change in the general metabolism, but
no doubt to some alteration of the renal epithelium, in conse-
quence of which the blood sugar escapes into the urine, instead
of being retained in the system and used as a source of energy.
Therapeutics of Wild Cherry.
It is highly esteemed as a stomachic tonic, and the infusion
is used in atonic dyspepsia and chronic gastric catarrh, as well
as in convalescence from acute diseases and' other debilitated
states of the system. The preparations of wild cherry have
the same effect as hydrocyanic acid in relieving cough, by
diminishing reflex excitability. The drug is sometimes a use-
ful palliative in phthisis, where it may serve not only to alle-
viate the irritative cough, but also as a remedy for cardiac
palpitation and gastric debility. The syrup is very largely
employed as an ingredient of cough mixtures in' general. Used
as a vehicle for tincture of digitalis, it renders the latter less
likely to produce gastric disturbance.
CHERRY LAUREL.
LAUROCERASI FOLIA.— Cherry Laurel Leaves (B. P., not offi-
cial).
Unofficial Preparation.
Aqua Laurocerasi.— Cherry Laurel Water. Dose, 2.0 to 8.00
c.c; y2 to 2 fl. dr.
Action of Cherry Laurel.
Its action is the same as that of diluted hydrocyanic acid.
Therapeutics of Cherry Laurel.
Aqua Laurocerasi, B. P., is made by distillation and stand-
ardized so that its strength is 0.1 per cent, of absolute hydro-
cyanic acid ; dose, 2 to 8 c.c.. ; ^ to 2 fl, dr. Owing to evapora-
APOMORPHINE. 58 1
tion, it is of very varying strength, and as it cannot therefore
be depended upon, and the inequality of its effects may possibly
lead to disastrous results, it is but rarely employed, except it
may be merely as a flavoring agent. As any virtues which it
may possess are due entirely to the hydrocyanic acid contained
in it, it is preferable to use in its stead a definite solution of
this acid or of oil of bitter almonds.
C. Drugs Affecting the Bronchial Secretion.
APOMORPHINE.
APOMORPHINE HYDROCHLORIDUM.— Apomorphine Hydro-
chloride. Dose (expectorant), 0.002 gm. (2 milligm.) ; -£0 gr.;
(emetic), 0.005 gm. (5 milligm.); T^ gr.
Unofficial Preparation.
Apocodeina. — Apocodeine. Dose, 15 to 20 gm.; y4 to y3 gr.,
hypodermatically.
Action of Apomorphine Hydrochloride.
External. — Apomorphine is said to have some anaesthetic
effects on the cornea when a solution is dropped upon it.
Internal. G astro -intestinal Tract. — Apomorphine is the
most powerful emetic known. It is an indirect emetic, because
its action is on the vomiting centre in the medulla, and not a
local one on the stomach. This is apparent from the fact that
vomiting is produced more promptly, and with a smaller dose,
if the drug is administered hypodermatically than when it is
given by the mouth. It is shown even more positively by the
fact that when injected subcutaneously it acts if the blood-
vessels are ligatured in such a way that none of it can reach
the stomach, while it does not act if they are so tied that none
can reach the medulla. Moreover, no emesis is produced if
apomorphine is placed in the stomach after the vessels supply-
ing that organ have been ligatured. Still again, if the medulla
be brushed with apomorphine solution, vomiting follows imme-
diately. The act of vomiting is preceded by nausea, and it is
582 PHARMACOLOGY AND THERAPEUTICS.
found that symptoms of nausea may be elicited by doses of the
drug too small to give rise to vomiting. Under the ordinary
hypodermatic dose the latter usually occurs in man inside of
fifteen minutes. The nausea generally disappears rapidly, but
occasionally persists for some time and may be accompanied
by a repetition of the vomiting. Collapse has been known to
occur, but this is simply a result of the vomiting and not a
direct effect, and it is not usually dangerous. In frogs no
emesis is induced by apomorphine.
Muscles. — Under large amounts the irritability of striped
muscle is much diminished and finally abolished in frogs, but
no such action has been observed in mammals. This weaken-
ing in the contraction of the muscles is quite distinct from the
feeling of weakness accompanying nausea in man. In frogs
a similar action has been demonstrated on the cardiac muscle;
the heart being stopped even after atropine.
Heart and Circulation. — During the act of vomiting there is
an increase of pulse and of blood-pressure. The acceleration
of the pulse, however, as well as the feeling of depression and
muscular weakness present, is simply a result of the emetic
action. Although in a few instances alarming collapse has been
observed, no actual fatality is stated to have occurred from
the use of the drug.
Respiration. — There is an increase of respiration in conse-
quence of the vomiting. If the amount of the drug is suffi-
ciently large, its irritant effects are produced upon the rest of
the central nervous system, as well as the vomiting centre, and
in consequence of this action also the respiration is quickened.
Physiological experiments show that apomorphine produces a
watery discharge from the blood-vessels of the respiratory
mucous membrane, which is found to be paler after the admin-
istration of this remedy, as well as less cedematous. This
effect is produced within a half hour after ingestion, and it is
not in any respect the first stages of emesis. Large doses
eventually depress the respiration.
Nervous System. — Its action on the central nervous system
APOMORPHINE. 583
is shown first and mainly upon the vomiting centre, so that the
only direct effect of small doses is the production of the symp-
toms of emesis. If the drug is administered in large quantities,
and especially to animals incapable of vomiting, like the herbi-
vora, its irritant effects upon the rest of the central nervous
system are seen in the production of marked restlessness, with
circus movements, excitement and terror. The movements
then become less coordinated, and eventually tetanic convul-
sions set in. During the convulsions the respiration, which
was at first greatly accelerated, ceases, while the heart con-
tinues to beat for some time later. In man minute doses are
said to be slightly hypnotic.
Fate in the Body. — Apomorphine is not excreted into the
stomach, like morphine, and it is stated that it has not been
found in the mucous membranes of the air passages. It is
possible that it may be decomposed in the tissues.
Therapeutics of Apomorphine Hydrochloride.
Vomiting Action. — The advantages of apomorphine over
other emetics are that it is certain, prompt and energetic, that
it can be given when emetics exhibited by the stomach would
not act, and that it produces no gastric irritation. It is hence
particularly valuable in cases of poisoning. It is usually ad-
ministered subcutaneously, dissolved in camphor water; 1 in
50. Dose, .25 to .50 c.c. (4 to 8 ^l). This must be prepared
extemporaneously, as it will not keep.
Expectorant Action. — It is, when given by the mouth, a valu-
able expectorant. In an adult .002 gm. (/* gr.), or 4 c.c. (1
dr.) of the syrup (see below) will produce a watery expectora-
tion within the time above stated, and this effect will last from
two to three hours. It is particularly useful in the early stages
of acute bronchitis, in chronic dry bronchitis, in chronic ca-
tarrhal pneumonia, and in old tuberculous patients who are
harassed by an unproductive cough.
Soporific Action. — Recently it has been claimed that when
given hypodermatically at bedtime, in dose just short of pro-
584 PHARMACOLOGY AND THERAPEUTICS.
during emesis, sleep, closely approaching the normal, ensues.
This is not always the case, and its hypnotic action may be
due to contamination with other alkaloids.
The British Pharmaceutical Conference recommends the fol-
lowing Syrup of Apomorphine: Mix Rectified Spirit, 84; with
the same amount of water; dissolve in this Apomorphine Hy-
drochloride, 1 ; add Diluted Hydrochloric Acid, 24 ; and finally
Syrup, 1728 parts. Dose, 2 to 4 c.c. (/2 to 1 fl. dr.). The
drug may also be given as a lozenge.
Apocodeine is formed from codeine in the same way as apo-
morphine from morphine. According to some observers, it
has, when injected subcutaneously, the same action as apomor-
phine, while others state that pure apocodeine is not an emetic,
but a cerebral depressant. It induces free secretion of saliva,
and is used chiefly as an expectorant, particularly in chronic
bronchial affections.
COCILLANA.
Unofficial Preparation.
Cocillana.— Cocillana. Dose, .30 to 1.20 m.; 5 to 20 gr.
Action of Cocillana.
Cocillana acts upon muciparous glands, increasing their ac-
tivity; on the bronchial mucous membrane, causing expectora-
tion; on the intestinal mucous membrane, producing a laxative
effect; it also slightly increases the appetite; it slightly
strengthens the heart beat and the pulse, but does not stimulate
the respiratory centre. The syrup does not act as a laxative,
while the resins are distinctly purgative.
Therapeutics of Cocillana.
Cocillana is of very great value as an expectorant, preferable
to ipecacuanha, in that it does not so readily cause nausea and
a metallic taste in the mouth, while it assists the regular move-
ment of the bowels. If, however, nausea should be produced,
this is very persistent. Its action is fully established in from
three to six hours after administration, and persists at least for
IPECACUANHA. 585
six hours. It can, in many cases, be substituted for apomor-
phine, ammonium carbonate, and many other drugs, classed,
with more or less reason, as expectorants.
IPECACUANHA.
IPECACUANHA. — Ipecac. Dose (expectorant), 0.065 gm. (65
milligm.) ; 1 gr.; (emetic), 1 gm.; 15 gr.
Preparations.
1. Fluidextractum Ipecacuanha. — Fluidextract of Ipecac.
Dose (emetic), 1 C.C.; 15 TTL ; (expectorant), 0.05 C.C.; 1 TTL-
2. Syrupus Ipecacuanha. — Syrup of Ipecac. Dose (expec-
torant), 1 c.c; 15 ul; (emetic), 15 c.c; 4 fl. dr.
3. Vinum Ipecacuanhae. — Wine of Ipecac. Dose, 1 c.c; 15 TTL.
4. Pulvis Ipecacuanha et Opii. — Powder of Ipecac and
Opium. (Dover's Powder.) Dose, 0.500 gm. (500 milligm.) ;
7V2 gr.
5. Tinctura Ipecacuanha et Opii. — Tincture of Ipecac and
Opium. Dose, 0.5 c.c.; 8 n\.
6. Pilula Laxativa Composita. — Compound Laxative Pills.
Dose, 2 pills.
Unofficial Preparations.
Trochisci Ipecacuanha (U. S. P., 1890). — Troches of Ipecac.
Trochisci Morphina et Ipecacuanha (U. S. P., 1890). —
Troches of Morphine and Ipecac.
Action of Ipecacuanha.
External. — Ipecacuanha powder is a powerful irritant to the
skin, producing redness, vesication, and even pustulation and
ulceration, when its application is prolonged. It is also irritant,
naturally, to mucous membranes, and some individuals are so
susceptible to its local action that the opening of a jar of the
drug at a distance of several feet will produce violent sneezing,
irritation of the eyes, coughing, and other unpleasant symptoms.
It possesses some antiseptic properties, being capable of de-
stroying the bacilli of anthrax, though having no offect on the
spores.
Internal. Alimentary Canal. — When taken by the mouth its
586 PHARMACOLOGY AND THERAPEUTICS.
irritant effect is exerted on the mucous membrane of the ali-
mentary canal, and in small doses it is a stomachic; producing
moderate gastric hyperemia and an increased flow of saliva
and gastric juice, and thus aiding digestion. In large doses it
is a powerful emetic. It is still an unsettled question whether
this action is due entirely to the local effect of the emetine on
the stomach, or in part to this and partly to its influence on the
vomiting centre in the medulla. Most of the reliable evidence
at command, however, points to a peripheral gastric, and not
to a central, action. Unlike apomorphine, which is known to
act directly on the centre, ipecacuanha causes vomiting as
quickly and with as small doses when it is given by the mouth
as when administered hypodermatically ; and the fact that
emetine, like many other irritants, has a specific action on the
alimentary canal when injected subcutaneously would seem
to satisfactorily explain the emetic action of the drug when
given by this method. A certain amount of depression is pro-
duced by ipecac, but this is simply a result of the vomiting. If
the dose is sufficiently large, and the most of it is not ejected
in the emesis caused, the irritant effect of the drug is continued
in the intestine, with the production of increased secretion and
purging. It also has a cholagogue action, directly augmenting
the biliary secretion. When injected subcutaneously in animals,
emetine induces nausea, vomiting and catharsis, frequently with
bloody stools, followed by collapse and generally by death
from exhaustion in the course of a few hours. When vomiting
is not produced by large doses given in this manner collapse
still results, and after some weak convulsive movements, the
animal dies of cardiac failure. When the fatal result does not
occur for from eighteen to twenty-four hours, evidences of
gastro-enteritis are often found after death.
Circulation and Nervous System. — When emetine is injected
intravenously the cardiac effects are more pronounced than
when it is given by the mouth or hypodermatically. After
large amounts the central nervous system is acted upon. Para-
lytic symptoms are developed, and among the earliest in mam-
IPECACUANHA. 587
mals is vaso-motor paralysis with fall of blood-pressure. Con-
tributory to the production of the fall is weakening of the
heart's action from the direct effect of the drug upon the
cardiac muscle, and this results in death. In the frog, in
which no vomiting is caused, a slowly advancing central
paralysis is observed, and the heart's movements grow weak
and irregular, and finally cease from paralysis of the cardiac
muscle.
Respiration. — The respiratory movements are but little
affected by moderate doses of ipecac, though as the result of
the vomiting they may be somewhat quickened. The inhala-
tion of the powder causes congestion of the bronchial mucous
membrane, with increased secretion, and excites cough by re-
flex stimulation; and the same effect is produced by the ex-
cretion by this membrane of the drug when it is taken inter-
nally. Animals poisoned by large doses of emetine present
after death more or less hyperemia of the bronchial mucous
membrane and of the lungs, and in some instances, especially
among rabbits, pulmonary oedema is found.
Skin. — Ipecac is in part excreted by the skin, and it acts as
a mild diaphoretic. The cutaneous action resembles that pro-
duced by the application of warmth.
Therapeutics of Ipecacuanha.
External. — Ipecacuanha has been used with success, as an
antiseptic, in cases of anthrax. In the dermatitis caused by
rhus toxicodendron a lotion containing powdered ipecac, 12 gm.
(3 dr.) to 500 c.c. (1 pint) of water, has been recommended,
and for the bites of insects, especially mosquitoes, one com-
posed of 2 gm. (y2 dr.) and 15 c.c. {l/2 fl. oz.) each of alcohol
and ether.
Internal. Alimentary Tract. — Ipecac is quite generally em-
ployed as an emetic. It is contra-indicated in the very feeble,
as it has no property that will serve to mitigate the depressing
effects of the vomiting; nor on account of the slowness of
its action, should it be used in cases where, as in poisoning,
588 PHARMACOLOGY AND THERAPEUTICS.
a prompt evacuation of the stomach is called for. Its chief
use as an emetic is for clearing the passages in diseases of the
respiratory organs, and in infants and young children, par-
ticularly, who cannot cough well, it often acts very happily.
In the domestic treatment of laryngismus stridulus an emetic
dose of the syrup is the most usual remedy. Ipecacuanha is
also of service as an emetic when the stomach is to be relieved
of undigested food, and attacks of acute indigestion, migraine,
and the so-called bilious headache may sometimes be cut short
by the vomiting caused by it. An ipecac emetic was formerly
administered to a considerable extent at the beginning of con-
tinued fevers, the eruptive fevers, erysipelas, and malarial
fever, and some clinicians still advocate this method of treat-
ment in suitable cases, claiming that experience has shown the
good effects of the practice on the subsequent course of the
disease. The indications for its use in cases of this kind are
considered by them to be : a heavily coated tongue, much nausea
with ineffectual efforts to vomit, marked epigastric oppression,
icterus or an icterode hue of the surface, a hot and dry skin,
acid and turbid urine. For emetic purposes a small dose (.03
gm. to y2 gr.) of tartar emetic is sometimes combined with it.
In small doses, such as .25 to .30 c.c. (4 or 5 1U) of the wine
or .015 gm. (J4 gr.) of the powder, ipecac is sometimes used
as a stomachic, and, employed in this way, it may even serve
to check vomiting. It has been known to arrest obstinate
attacks of vomiting which had resisted all other treatment, and
one of the recognized methods of controlling the vomiting of
pregnancy is the administration of .06 to .12 c.c. (1 or 2 ""l)
of the wine in water every half hour. .03 gm. {]/2 gr.), or
more, of ipecacuanha, combined with other cholagogues, has
been found useful in cases of dyspepsia in which there is
functional derangement of the liver, and in gastric ulcer
Dover's powder {see p. 590) is sometimes beneficial. One of
the most important applications of the drug is in the treatment
of dysentery. Epidemic dysentery, especially of malarious
and tropical countries, is the form of the disease to which it
IPECACUANHA. 589
seems best adapted, but it may often be used with advantage
in other varieties also. In the severe attacks of tropical regions
from 1.20 to 4.00 gm. (20 to 60 gr.) are usually given for the
initial dose and about 1.20 gm. (20 gr.) every four., six or eight
hours afterward. It is considered important to establish toler-
ance of the remedy as soon as possible, and subsequent doses
may be retained if the first one is rejected. In order to secure
the retention of these large doses it may be combined with
opium and aromatic powder, or other expedients may be re-
sorted to. Milk is a good vehicle for the administration of
ipecacuanha, and in acute dysentery doses of 1 gm. (15 gr.),
given in milk, are generally fairly well borne. Some authori-
ties advise doses of 2 gm. (30 gr.), without any liquid, at the
onset, the ipecac to be preceded by a sedative dose of opium.
The good effects of the remedy have been attributed by some
to the large amount of tannic acid contained in the root, and
as emetine and cephaeline are much more irritant to the in-
testine than the unaltered drug, a preparation from which
the alkaloids have been removed (Ipecacuanha Deemeti-
nisata, dose .60 to 2.00 gm. ; 10 to 30 gr.) has been used
with advantage, it is claimed, in this disease. On the other
hand, it has been stated that the efficient agent in the treat-
ment of dysentery is the emetine, and those holding this view
deny that the same results are obtained by the use of this
preparation. The deemetinized ipecac is said to have the ad-
vantage of not causing any nausea or vomiting, and if the
claims of its advocates should prove to be well founded, it
would undoubtedly be much preferable on this account. In
chronic dysentery ipecac is by no means so distinctly efficient
as in acute, but in association with other remedies is often
very useful. In catarrhal jaundice and in diarrhoea, especially
when associated with hepatic derangement, it is sometimes of
service. In bowel affections it is often combined with opium
and mercury. It is useful also in the summer complaint of
infants and young children when the stools are of a greenish
color and contain mucus or blood. With it may be associated
bismuth, pepsin, zinc oxide or other remedies, as indicated.
590 PHARMACOLOGY AND THERAPEUTICS.
Respiratory Tract. — It is in very general use as an expec-
torant in the form of the syrup, the wine, and ipecac troches.
It not only increases the secretion of the bronchial mucous
membrane, but also has the effect of rendering it more fluid
and therefore less tenacious; while its property of exciting the
act of coughing often adds to its usefulness. The fluidextract
is considered the most efficient preparation by some practition-
ers. The wine, more or less diluted, in the form of a spray
from a hand atomizer, has sometimes been found of service in
winter cough, chronic bronchitis, emphysema and fibroid phthi-
sis, in allaying the spasmodic vomiting and liquefying the secre-
tions. In children, too, the wine, in doses of from .30 to .60
c.c. (5 to 10 TTL), is apt to be especially beneficial in the chronic
bronchitis which remains after whooping-cough, measles or
influenza, or is associated with chronic tonsillo-pharyngitis or
adenoids. A general tonic treatment should also be maintained
at the same time. In the treatment of acute bronchitis ipe-
cac is usually much more valuable in children than in the case
of adults. Cephaelin seems to possess the expectorant proper-
ties of ipecacuanha.
As a Diaphoretic. — Dover's powder is an excellent anodyne
diaphoretic, and is frequently given, in doses of .60 gm. (10
gr.) in chills and in the early stage of catarrh of the respira-
tory passages and of mild feverish attacks in general. In the
intense suffering which sometimes results from the sudden sup-
pression of menstruation it is often of great service in reliev-
ing pain and promoting diaphoresis. In acute rheumatism and
other diseases where also it is desired to allay pain and at the
same time increase the action of the skin, this powder may be
administered in doses of from .18 to .30 gm. (3 to 5 gr.) every
two, three or four hours, according to circumstances.
As a Hemostatic. — Ipecacuanha has long been regarded as
an internal haemostatic, and it has been employed especially in
haemoptysis, haematemesis and uterine haemorrhage. At the
present time, however, it is much less frequently used as an
anti-haemorrhagic remedy than formerly. In haemoptysis small
SENEGA. 59I
doses, short of producing vomiting, it is stated, serve to reduce
the bleeding by decreasing the pulmonary congestion. Some
writers, on the other hand, advise that in haemorrhages the
drug should be given in frequently repeated doses until vomit-
ing ensues, maintaining that when this effect is produced the
haemorrhage usually ceases.
On account of their irritant properties, neither the prepara-
tions of ipecac nor its alkaloids are suitable for subcutaneous
injection.
SENEGA.
SENEGA. — Senega. Dose, 1 gm.; 15 gr.
Preparations.
1. Fluidextractum Senegae. — Fluidextract of Senega. Dose,
1 c.c; 15 ttl.
2. Syrupus Senegae.— Syrup of Senega. Dose, 4 c.c; 1 fl. dr.
3. Syrupus Scillae Compositus. — Compound Syrup of Squill.
Dose, 2 c.c; 30 Ttl.
Action of Senega.
External. — Senega is irritant to the skin when applied re-
peatedly or rubbed on in the form of ointment, and has a very
marked irritant action on mucous membranes. When the pow-
dered root is inhaled it causes hyperaemia and increased secre-
tion in the respiratory passages, and excites violent sneezing
and coughing.
Internal. Alimentary Canal. — When swallowed, its irritant
effect on the mucous membrane induces increased secretion of
saliva and gastric juice. In large doses it causes not only
salivation, but more or less marked inflammation of the gastro-
intestinal tract, with nausea, vomiting and purging.
Respiration. — Senega is a stimulating expectorant. When
the drug is taken internally, senegin is excreted through the
bronchial mucous membrane, with the result of producing vas-
cular dilatation and augmented secretion and of reflexly excit-
ing cough. It is on the respiratory passages that it appears
to exert its-most important influence.
592 PHARMACOLOGY AND THERAPEUTICS.
Blood and Circulation. — When added to defibrinated blood,
senegin is found to dissolve the red corpuscles and liberate the
haemoglobin and the salts. Even when it is injected into the
blood of living animals this action is observed to some extent,
the plasma containing haemoglobin, while the corpuscles are
considerably diminished in number. In mammals the circula-
tion appears to be comparatively little affected until shortly
before death, when there is a rapid fall of blood-pressure and
the pulse becomes feeble and slow. For a short time after the
respiration fails the heart continues to beat, but its movements
are extremely weak, and it finally stops in diastole, even if arti-
ficial respiration is maintained.
Nervous System and Muscles. — When senegin is injected
into the blood in moderate toxic quantities, the symptoms usu-
ally produced are principally intestinal, and fatal collapse from
the changes in the alimentary canal occurs after the elapse of
several days ; but when large doses are used the central nervous
system is most affected. At first there are violent convulsions,
then paralysis, especially of the respiratory centre, and the
fatal result is very rapid. If the poison is applied directly to
skeletal or cardiac muscle or to nerve trunks, they lose their
irritability at once, and even in dilute solutions muscle con-
tracts more weakly, and eventually is not only paralyzed but
structurally altered.
Kidneys. — Senegin is absorbed with difficulty, and is ex-
creted by the kidney, as well as the bronchial mucous mem-
brane, and also to some extent, it is said, by the skin. In the
process of excretion it irritates the renal epithelium, and the
drug therefore has diuretic properties.
Therapeutics of Senega.
Senega is used now only- as a stimulating expectorant. In
subacute and chronic bronchitis it may prove useful in excit-
ing an increased secretion of mucus and facilitating its expul-
sion from the respiratory passages. It should not be given in
acute conditions on account of its irritant effect on mucous
QUILLAJA. 593
membranes, and for the same reason it is contra-indicated
whenever gastric irritability or intestinal disorder is present.
It is commonly prescribed in combination with other drugs in
expectorant mixtures.
QUILLAJA.
QUILLAJA. — Quillaja. (Panama Bark. Soap Bark.)
Preparations.
Fluidextractum Quillajse. — Fluidextract of Quillaja. Dose,
0.2 c.c; 3 m,.
Tinctura Quillajae. — Tincture of Quillaja.
Unofficial Preparation.
Infusum Quillajae. — Infusion of Quillaja. Dose, 8 to 30 c.c;
2 to 8 fl. dr.
Action of Quillaja.
Quillaja is allied to senega in its properties, but is a much
more powerful irritant, as the principle quillaja-sapotoxin is
stated to be about ten times more poisonous than senegin.
Therapeutics of Quillaja.
On account of its soapy nature, it may be used to aid the
diffusion of oils and other soluble bodies, but the fact that it
contains such a toxic substance as saponin renders it objec-
tionable for emulsifying medicines for internal use. It is em-
ployed chiefly as an ingredient of hair lotions, and hairdressers,
for shampooing, use an aqueous decoction (i to 20), which
makes an excellent lather. An infusion, employed by means
of a roller-bandage saturated with it, makes a good stimulant
application for old ulcers and chronic eczema, and this prepara-
tion is also useful for hyperidrosis and bromidrosis. In chronic
eczema and alopecia circumscripta the tincture, used locally,
may prove of service, and for certain forms of acne the fluid-
extract, mixed with glycerin, has been recommended. The tinc-
ture has been given occasionally as an expectorant, and it is
stated to have proved efficient, especially in cases requiring the
free expectoration of mucus which was accumulating in the
39
594 PHARMACOLOGY AND THERAPEUTICS.
chest. On account of its irritant qualities, however, it should
always be employed with caution.
TEREBENE.
TEREBENUM.— Terebene. Dose, 0.5 c.c; 8 TTL.
Action of Terebene.
Its odor is more pleasant, but in other respects it for the
most part closely resembles oil of turpentine. Like turpentine
and many other volatile oils, it causes irritation of the lungs
in the course of excretion, and therefore increases the bron-
chial secretion. It is likewise diuretic from the irritation of
the kidneys excited in the process of excretion, and by its anti-
septic properties it disinfects both the renal and bronchial
secretions.
Therapeutics of Terebene.
Externally it has been used successfully as a general anti-
septic dressing for wounds, ulcers, burns, etc. It has also been
employed with advantage as a substitute for copaiba and other
similar drugs in the treatment of genito-urinary diseases. In
fermentative dyspepsia it is useful as an antiseptic. Its most
important use is as a stimulating disinfectant expectorant, and
it is highly esteemed in chronic bronchitis, emphysema, winter
cough, and even phthisis. Although it is said to form an in-
soluble compound with sugar, it seems to be efficient when
given on a lump of sugar, which is quite a common method
of administering it. A few drops taken in this way several
times a day will not infrequently cure a slight winter cough.
It may also be given in capsules, in an emulsion, or in a mix-
ture with other expectorants. It is sometimes employed as an
inhalation, in some such way as the following: Pure terebene,
2; magnesium carbonate, i; distilled water, 24; to be used in
water (1 to 128) at a temperature of 6o° C. (1400 F.) in an
apparatus so arranged that air can be drawn through it and
inhaled.
storax. 595
TERPIN HYDRATE.
TERPINI HYDRAS.— Terpin Hydrate. Dose, 0.125 gm. (125
milligm.); 2 gr.
Action of Terpin Hydrate.
Terpin hydrate is an antiseptic, and it is stated that it will
arrest the development of tubercle bacilli. It increases the
secretion of the mucous membrane, and the functional activity
of the kidneys.
Therapeutics of Terpin Hydrate.
It has been given as an antiseptic in acute and chronic bron-
chitis, when the secretion is unusually free, in whooping-cough,
and rarely in the treatment of chronic nephritis, chronic cys-
titis and gonorrhoea.
BALSAM OF TOLU.
BALSAMUM TOLUTANUM.— Balsam of Tolu. Dose, 1 gm.;
15 gr.
Preparations.
1. Syrupus Tolutanus. — Syrup of Tolu. Dose, 16 c.c; 4
fl. dr.
2. Tinctura Tolutana. — Tincture of Tolu. Dose, 2 c.c; 30 Til .
Action of Balsam of Tolu.
In action, as well as in composition, though it contains more
benzoic acid, it resembles the balsam of Peru.
Therapeutics of Balsam of Tolu.
It is used only as an expectorant and, on account of its
grateful taste, to flavor medicines, particularly cough mixtures.
The syrup is almost always prescribed.
STORAX.
STYRAX. — Storax. Dose, 1 gm.; 15 gr.
Unofficial Preparation.
Styronum. — Styrone.
Action of Storax.
Its action is the same as that of the balsams of Tolu and
Peru and of benzoin, and also resembles that of copaiba.
596 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Storax.
Storax is a serviceable application to stimulate and disinfect
ulcers. Mixed with an equal part of olive oil, it is used in
some diseases of the skin requiring slight stimulation, and also
as a parasiticide in scabies and pediculosis. In the form of an
ointment it is recommended for the ulcerations of frost-bite.
Internally it has been employed to some extent in the treat-
ment of gonorrhoea, gleet and catarrhal affections of the genito-
urinary organs. At present its principal internal use is as an
expectorant in the compound tincture of benzoin.
Styrone, a derivative of styracin (chemically, cinnamic or
cinnamylic alcohol), in a solution of 1 to 12 is said to make
an excellent antiseptic dressing. It is a prompt deodorizer of
foul wounds or ulcers, and, being non-poisonous, it may be
injected into cavities, as after the operation of empyema. It
may also be used in a spray for affections of the respiratory
passages.
SANGUINARIA.
SANGUINARIA. — Sanguinaria. (Bloodroot.) Dose, 0.125 gm.
(125 milligm.) ; 2 gr.
Preparations.
1. Fluidextractum Sanguinariae. — Fluidextract of Sangui-
naria. Dose, 0.1 c.c.; iy2 1T\,.
2. Tinctura Sanguinariae. — Tincture of Sanguinaria. Dose, 1
c.c; 15 HI.
Action of Sanguinaria.
Sanguinaria is an acrid emetic with stimulant, and in large
doses, narcotic powers; it is also expectorant and said to be
an emmenagogue.
Therapeutics of Sanguinaria.
It is chiefly used as a stimulating expectorant in chronic
bronchitis or in advanced stages of the acute disease.
PLEURISY ROOT.
Unofficial Preparation.
Asclepias. — Asclepias (U. S. P., 1890). (Pleurisy Root.)
Dose, 2.0 to 8.0 gm.; y2 to 2 dr.
creosote. 597
Unofficial Preparation.
Extractum Asclepiadis Fluidum (U. S. P., 1890). Fluid-
extract of Asclepias. Dose, 2.0 to 8.0 c.c; y2 to 2 fl. dr.
Action of Pleurisy Root.
Pleurisy root possesses diaphoretic, carminative, and expec-
torant properties, without being stimulant.
Therapeutics of Pleurisy Root.
It is used in the disease which gives its name, and in various
pectoral affections.
CREOSOTE.
CREOSOTUM.— Creosote. Dose, 0.2 c.c; 3 TTt-
Preparation.
Aqua Creosoti. — Creosote Water. Dose, 8 c.c; 2 fl. dr.
Unofficial Preparation.
Creosoti Carbonas. — Creosote Carbonate. (Creosotal.) Dose,
1 to 4 c.c; 15 to 60 Til.
Action of Creosote.
The action of creosote, externally and internally, is prac-
tically the same as that of phenol.
Therapeutics of Creosote.
Before the introduction of carbolic acid it was employed ex-
ternally as a mild anaesthetic and a parasiticide, as well as a
stimulating antiseptic, and internally to relieve vomiting and
flatulence. It is really superior to phenol as an antipruritic,
but is not much used on account of its acrid and penetrat-
ing odor. When applied on cotton to the cavity, it is effi-
cient in relieving the aching of a carious tooth, and in the
form of creosote water is valuable as a haemostatic. The most
important use of creosote is as a pulmonary antiseptic, ad-
ministered by the mouth, hypodermatically, or by inhalation.
598 PHARMACOLOGY AND THERAPEUTICS.
In cases of tuberculosis it can be administered in the form of
an emulsion with cod-liver oil and acacia ; or with the hypophos-
phites and cod-liver oil; or with the syrup of wild cherry and
acacia (.12 c.c. of creosote to 4 c.c. (1 fl. dr.) of emulsion in
each case), or in a mixture of glycerin and whiskey. The dose
of creosote should be .03 to .12 c.c. (y2 to 2 HI), given thrice
daily, and increased to 1.20 to 1.50 c.c. (20 to 25 ti\) in the
twenty-four hours, by easy stages. Administered in the form of
enteric pills (which will dissolve only in the intestinal fluids),
a daily dosage of 3 to 3.30 c.c. (45 to 50 ^l) can be reached
without inconvenience. This method is preferable to that
of Sommerbrodt, which consists in the administration of .06 c.c.
(1 ^l) of creosote in 12 c.c. (2ITI) of cod-liver oil, in capsules.
The method of hypodermatic injection in sterilized olive oil
requires a special apparatus, is very tedious, somewhat painful,
and altogether irksome to patient and physician. By inhala-
tion creosote is employed with equal parts of alcohol and spirit
of chloroform, or in alcohol, one part to eight, in a perforated
zinc inhaler, of which 1 c.c. (15 ^l) is placed upon a bit of
cotton and used for fifteen minutes in every hour. If the best
beechwood creosote is employed, no untoward results are likely
to be obtained. If the dose is increased too rapidly there may
occur some nausea, epigastric uneasiness, and even vomiting.
Disturbance of the kidneys has been produced, and the urine
then presents practically the same appearances as after the
ingestion of phenol {see p. 61). The stomach symptoms have
been relieved by the patient's placing himself upon his back,
for half an hour after administration of the remedy. It is
quite likely that the patient acquires a tolerance, for the daily
dose of 20 c.c. (300 Til) has been given for a considerable time,
with benefit, although 3.30 c.c. (50 1U) should be considered as
the maximum daily dose. Creosote is more efficient than either
of its principal constituents, guaiacol or creosol, even if given
in proportionate dose. Creosote should never be given to the
aged.
Creosote carbonate (not official), which contains 92 per cent.
QUAIACOL. 599
of creosote, does not possess the caustic and irritative proper-
ties of the pure creosote, and can be administered in dose of
from i to 4 c.c. (15 to 60 ^l) in a wineglass of sherry after
meals. As it is slowly absorbed, it is probable that it is elimi-
nated for the most part by the bronchial mucous membrane.
Since it does not irritate the gastro-intestinal tract nor the kid-
neys, it is the method of choice in the treatment of pulmonary
tuberculosis. Creosote carbonate is also highly esteemed in the
treatment of pneumonia, and under its use, as in the case of
sodium salicylate, defervescence is much more frequently by
lysis than by crisis, which is ordinarily the rule in this disease.
GUAIACOL.
GUAIACOL. — Guaiacol. (Methyl Pyrocatechin.) Dose, 0.5 C.C.;
8 Til .
Preparation.
Guaiacolis Carbonas. — Guaiacol Carbonate. Dose, 1 gm.;
15 gr.
Unofficial Preparations.
Guaicolis Benzoas. — Guaiacol Benzoate. (Benzosol. Benzoyl
Guaiacol.) Dose, 0.10 to 0.60 gm.; 2 to 10 gr.
Guaiacolis Salicylas. — Guaiacol Salicylate. Dose, 0.30 to
2.00 gm.; 5 to 30 gr.
Action of Guaiacol.
Guaiacol is locally an antiseptic and its general action is
similar to that of creosote, but it is less likely to irritate the
intestinal canal and kidneys.
Therapeutics of Guaiacol.
External. — If painted on the skin over an area of from 10
to 50 sq. cm. (4 to 20 square inches), it is capable of reducing
pyrexia, but it is not used for this purpose on account of the
sweating and collapse which it occasions.
Internal. — Benzosol was introduced as a nearly tasteless com-
bination for the administration of guaiacol. In the digestive
tract it splits up into guaiacol and benzoic acid. As an in-
600 PHARMACOLOGY AND THERAPEUTICS.
testinal disinfectant it has proved to be of service in the treat-
ment of diabetes mellitus. The carbonate and salicylate have
been used as substitutes for guaiacol, and are in many cases
preferable to it. Guaiacol, especially the carbonate, has been
used to a large extent in pulmonary tuberculosis, under the
idea that it has a destructive effect upon the bacilli of the
disease; but there is no absolutely certain evidence that such
is the case. The carbonate has given excellent results in the
treatment of typhoid fever in limiting the decomposition in
the intestines.
INULA.
Unofficial Preparation.
Inula. — Inula (U. S. P., 1890). (Elecampane.) Dose, 1 to
4 gm.; y4 to 1 fl. dr.
Unofficial Preparation.
Heleninum.— Helenin. Dose, .02 to .12 gm.; y3 to 2 gr.
Action of Inula.
Inula is demulcent, tonic and gently stimulant.
Therapeutics of Inula.
It is chiefly used in diseases of the lungs, especially when
the affection is associated with general debility. Recently, some
laboratory experiments have suggested that helenin (its active
principle) may be of value in the treatment of tuberculosis,
since it is believed to be a bactericide.
D. Antispasmodics.
GRINDELIA.
GRINDELIA.— Grindelia. Dose, 2 gm.; 30 gr.
Preparation.
Fluidextractum Grindelise. — Fluidextract of Grindelia. Dose,
2 c.c; 30 TTL-
GRINDELIA. 6oi
Action of Grindelia.
By reason of its volatile oil, grindelia is gently stimulating
to the stomach. In therapeutic doses it appears to have little
or no action on the heart or arteries, but in large quantities it
slows the heart by stimulating the vagi and raises blood-
pressure by stimulating the vaso-motor centre. In these large
doses it may also induce paralysis of the peripheral sensory
nerves, the sensory centres in the spinal cord, and, finally, the
motor centres and nerve-trunks. It is excreted by the bron-
chial mucous membrane, as well as by the kidneys, and at first
slightly increases the secretion of mucus, but afterward dimin-
ishes it. It appears to have a special action in relaxing the
muscular coats of the bronchi, and this is said to be through
depression of the ends of the- motor fibres of the vagus dis-
tributed to the parts and of the reflex centre in the medulla
oblongata. The terminations of the sensory nerves supplying
the bronchial mucous membrane are also said to be depressed.
In the course of its elimination by the kidneys it excites more
or less renal irritation, with increased urinary secretion.
Therapeutics of Grindelia.
In ivy poisoning rapid relief is often afforded by the appli-
cation of cloths dipped in a mixture of the fluidextract with
from 30 to 50 parts of water. Such a mixture may also be
used to allay the pain of herpes zoster and as a lotion for burns
and blisters, as well as an injection in gonorrhoea, gleet, and
vaginitis. One part of the fluidextract to four parts of water
has been employed as a topical dressing in iritis, and diluted
with glycerin or water this preparation makes a good appli-
cation for chronic or irritable ulcers. On account of its prop-
erty of relaxing the bronchial muscles, grindelia is one of the
remedies most commonly resorted to for the relief of the symp-
tom asthma, and two or three doses of 1.20 c.c. (20 ni) of the
fluidextract given every twenty minutes in milk (which pre-
vents the precipitation of the resin) will often prove effica-
cious in arresting the paroxysms. Between the attacks this
602 PHARMACOLOGY AND THERAPEUTICS.
dose should be taken three times a day. Grindelia may also
be combined advantageously with other asthmatic remedies,
such as lobelia and belladonna. Sometimes during the parox-
ysms it is administered by inhalation. Grindelia leaves steeped
in a saturated solution of nitre and dried are smoked in
a pipe or burned on a plate, so that the patient may inhale the
fumes as they rise. The leaves prepared in this way, and with
or without the addition of tobacco, lobelia, stramonium, etc.,
may also be rolled into cigarettes and smoked. Cough by imi-
tation and habit, whooping-cough, and the spasmodic difficulty
of breathing which accompanies various pulmonary and cardiac
diseases, hay-asthma, etc., are not infrequently helped by grin-
delia. It is often of service in subacute bronchitis, chronic
bronchitis (especially of the aged), emphysema and bronchor-
rhoea, and is usually prescribed in association with other expec-
torants. Grindelia is also a remedy of some value in the treat-
ment of chronic pyelitis, chronic cystitis and other diseases of
the urinary tract, all along which, in consequence of the excre-
tion by the kidneys, the local application of the oleo-resin takes
place. The bitter taste of the drug is perhaps best covered by
spirit of chloroform.
ASPIDOSPERMA.
Unofficial Preparations.
Aspidosperma. — Aspidosperma (U. S. P., 1890). (Quebracho.
Iron Wood.) Dose, 0.30 to 2.00 gm.; 5 to 30 gr.
Fluidextractum Aspidospermatis. — Fluidextract of Aspido-
sperma. Dose, 0.30 to 2.00 c.c; 5 to 30 HI.
Aspidosperminum. — Aspidospermine. Dose, 0.015 to 0.03
gm.; y4 to y2 gr.
Action of Aspidosperma.
None of the alkaloids fully represent the drug. In the lower
animals large doses of the bark produce motor paralysis, with
dyspnoea and finally death from asphyxia. The breathing early
becomes slower, but deeper; the blood-pressure is not affected
ERIODICTYON. 603
until late. There is reason to believe that the relief of dysp-
noea, which is obtained clinically, is caused by its increasing the
power of the blood to take up oxygen.
Therapeutics of Aspidosperma.
It is a bitter which may aid the appetite, and is a valuable
remedy when the respiration is embarrassed by emphysema,
chronic bronchitis, or chronic pneumonia; even uraemic asthma
is benefited by it. It is not of benefit in dyspnoea of cardiac
origin. The commercial aspidospermine, which is an impure
mixture of all the alkaloids, and therefore represents their com-
bined action, may be given in place of the drug itself.
PULSATILLA.
Unofficial Preparations.
Pulsatilla.— Pulsatilla (U. S. P., 1890). Dose, 0.05 to 0.30
gm.; 1 to 5 gr.
Fluidextractum Pulsatilla. — Fluidextract of Pulsatilla. Dose,
.06 to .30 c.c; 1 to 5 HI.
Action of Pulsatilla.
It is said to be very nearly the equivalent of senega, and also
to paralyze the heart and respiratory centres.
Therapeutics of Pulsatilla.
It has been used for the treatment of the symptom asthma,
convulsive coughs, and ordinary bronchitis. Pulsatilla is a
favorite remedy for dysmenorrhoea in its various forms, ob-
structive excepted. The fluidextract has been highly recom-
mended for orchitis and epididymitis.
ERIODICTYON.
ERIODICTYON. — Eriodictyon. (Yerba Santa. Mountain Balm.)
Dose, 1 gm.; 15 gr.
Preparation.
Fluidextractum Eriodictyi. — Fluidextract of Eriodictyon.
Dose, 1 c.c; 15 irt.
604 PHARMACOLOGY AND THERAPEUTICS.
Action of Eriodictyon.
Eriodictyon has long been used in California as a bitter tonic,
and as a stimulating expectorant.
Therapeutics of Eriodictyon.
It has been found useful in chronic bronchitis, and as it
appears to have something of the anti-spasmodic action of
grindelia, it is sometimes combined with that drug. In asth-
matic attacks it has also been employed by smoking. It is an
excellent vehicle for quinine, concealing its bitter taste.
CHESTNUT.
Unofficial Preparations.
Castanea.— Castanea (U. S. P., 1890). (Chestnut.) Dose, 2
to 8 gm.; V2 to 2 dr.
Fluidextractum Castaneae. — Fluidextract of Castanea. Dose,
2 to 8 c.c; V2 to 2 fl. dr.
Action of Chestnut Leaves.
Chestnut leaves are mildly sedative.
Therapeutics of Chestnut Leaves.
They are used in whooping-cough, because they are supposed
to possess anti-spasmodic and expectorant properties.
OXYGEN.
Unofficial Preparation.
Oxygenium. — Oxygen.
Action of Oxygen.
The first effect of the inhalation of oxygen in the pure state
(not as air) is a sensation of warmth in the respiratory pass-
ages. The appetite is increased, and a feeling of mental ex-
hilaration and a disposition to greater bodily activity are pro-
OXYGEN. 605
duced. The pulse is generally quickened, but may be reduced
in frequency. It has been shown that the administration of
oxygen in from 40 to 90 litres (ioj4 to 2^/2 gallons) per day,
given in two doses and mixed with a determinate quantity of
air, energizes to some extent the nutritive functions, increases
the appetite, slightly elevates the temperature, stimulates the
cardiac movements, and augments the body-weight. These
effects are chiefly attributable to the action on the blood; the
red corpuscles being increased in number and stimulated to
greater organic activity. The capacity of the blood for the
absorption of oxygen, however, is limited, as the oxygen forms
a definite chemical compound with haemoglobin, and as soon as
the latter is saturated, the blood will not take up any further
amount. With the normal amount of oxygen in the air, the
normal rapidity of the circulation, and the normal extent of
lung surface, the blood is almost, but not completely, saturated,
and it is this small difference between the possible and actual
saturation which seems to be sufficient to cause some stimula-
tion to the formation of red corpuscles. In disease the case
is often very different, and when the absorption of oxygen is
in any way impeded the blood passes through the pulmonary
circulation before it has time to absorb all the oxygen it is
capable of absorbing. There is, therefore, a very evident indi-
cation for an artificial supply of the gas for the more complete
oxygenation of the blood.
Therapeutics of Oxygen.
Oxygen inhalations are used in cardiac disease, pneumonia,
pulmonary oedema, emphysema, convulsions, chloroform nar-
cosis, asphyxia from toxic gases, and in various other condi-
tions characterized by great lividity or by dyspnoea due to
causes interfering with the oxygenation of the blood. Even
though they should fail to avert a fatal issue, they often greatly
relieve the distress of the patient, and in many instances they
are of material assistance in tiding over a temporary risk of
death. In various chronic conditions, as anaemia, albuminuria,
606 PHARMACOLOGY AND THERAPEUTICS.
glycosuria and different forms of sub-oxidation, the persistent
use of oxygen has given excellent results. There seems to be
satisfactory evidence that it is beneficial in some cases of phthi-
sis, especially those in which emaciation, dyspeptic symptoms,
etc., have occurred without marked change in the condition
of the lungs. When cavities have formed and hectic fever has
set in, oxygen can be of service simply as a palliative of dysp-
noea. In the administration of this remedy the gas should be
allowed to issue in a gentle stream, and it is advisable that the
inhaler should not be held too near the patient. The ordinary
inhaling mouth-piece may often be replaced with advantage by
a glass funnel three or four inches in diameter, and the latter
should be held, an inch or so away, over the nose and mouth
of the patient. Small doses of oxygen at frequent intervals
are usually best.
Division IX. — Drugs acting on the Digestive Apparatus.
A. Drugs acting on the Teeth. — For cleaning the teeth pow-
ders are commonly used, but soaps and liquid dentifrices are
occasionally employed. Chalk, which acts mechanically, con-
stitutes the basis of most tooth powders, and charcoal, which,
however, may abrade the enamel, is also sometimes used for its
mechanical effect. In order to prevent the decomposition of
food lodged between the teeth, antiseptics, such as quinine,
borax and phenol, are often used as ingredients of tooth-pow-
ders. Astringents such as krameria are employed when the
gums are inclined to bleed. As iron is apt to blacken the teeth
and mineral acids and alum are injurious to them, it is advisa-
ble that these drugs should not be used as gargles for long
periods and that when prescribed internally they should be
taken through a glass tube.
For the relief of toothache local anodynes such as creosote
or pure carbolic acid may be employed on absorbent cotton,
which is inserted into the cavity of the carious tooth. There
is some danger of damage to the dental pulp, and to prevent
DRUGS ACTING ON DIGESTIVE APPARATUS. 607
injury to the gums and mouth a pledget of unmedicated cotton
should be placed over the carbolized cotton.
B. Drugs acting on the Salivary Glands. — Drugs which in-
crease the amount of saliva are called Sialogogues; those which
diminish it, Anti-sialogogues. The saliva is derived from the
secretion of the parotid, submaxillary and sublingual glands
and the muciparous glandules of the buccal cavity, and the
secretions produced by these different glands vary somewhat
in their physical properties, especially in the degree of their
viscidity. The function of the submaxillary gland and the
influences affecting it have been especially studied in the
dog, and from these researches it is known that the gland
is largely under the control of the chorda tympani nerve,
some of whose fibres are of a vaso-dilator character, and
thus secondarily influence the glandular secretion, while others
affect the latter directly. This nerve, which has its centre in
the medulla, may be reflexly excited by stimulation of various
nerves, and particularly the gastric branches of the vagus and
the lingual and buccal terminations of the glosso-pharyngeal
and gustatory nerves. The gland has also a nerve-supply from
branches of the cervical sympathetic trunk, and these are vaso-
constrictor in character. The secretion of saliva in the normal
animal appears to occur only when impulses reach the gland
cells through the chorda tympani or through the cervical sym-
pathetic fibres. The positively known modes of action of sia-
logogues and anti-sialogogues will alone be mentioned here.
1. Sialogogues acting either on the secretory cells or upon
the terminations of the nerves in them. — Of these, pilocarpus
has been the most carefully investigated, and it has been shown
that it acts on the terminations of the secretory nerves — the
minute fibrils which ramify between the epithelial cells and
perhaps even enter them. It is found that its action is not at
all interfered with by section of all the nerves supplying the
maxillary gland; also that it acts when injected directly into
the gland but is prevented from entering the general circula-
tion. When pilocarpus has been administered, the effect which
608 PHARMACOLOGY AND THERAPEUTICS.
stimulation of the chorda tympani or of the sympathetic pro-
duces is only such as can be readily explained by the vascular
effects.
Sialogogues falling under this heading are —
(0 Pilocarpus. (4) Mercury.
(2) Muscarine. (5) Nicotine.
(3) Iodine compounds. (6) Physostigmine.
The last two probably act also by stimulating the centre in the medulla,
for section of the chorda tympani decidedly lessens the secretion
caused by them. Physostigmine soon ceases to cause an increase of the
secretion, for it tightly contracts the vessels of the gland.
2. Sialogogues acting reiiexly by stimulating the peripheral
ends of afferent nerves. — Of these there are two important
varieties :
(a) Those stimulating the gustatory and glosso-pharyngeal nerves in
the mouth :
(1) All Acids and
(2) Acid salts.
(3) Chloroform.
(4) Alcohol.
(5) Ether.
(6) All pungent substances, as
mustard, ginger, etc.
(b) Those stimulating the vagus in the stomach:
Most emetics, especially Antimony and Ipecacuanha.
3. Anti-sialogogues acting either on the secreting cells or the
terminations of the nerves in them. — Of these atropine has
been most studied, and that it acts directly on the gland is
shown by the fact that it prevents any increase of salivary
secretion on stimulation of the chorda, although the vessels
dilate as usual. It appears to act on the terminations of nerve
fibres in the gland cells, but this action is limited to certain
definite terminations, since the sympathetic secretory nerve
fibres are not paralyzed, and it has been ascertained that not all
the fibres of the chorda tympani are acted upon. Atropine
DRUGS ACTING ON DIGESTIVE APPARATUS. 609
would seem, then, to select the terminations of the secretory
fibres for paralysis, and to leave all others unaffected.
Anti-sialogogues falling under this heading are —
(1) Belladonna, 1 (3) Stramonium, and
(2) Hyoscyamus, (4) Nicotine in excess.
4. Anti-sialogogues acting reflexly by depressing the peri-
pheral ends of afferent nerves. — Such are alkalies, opium, and
any substances allaying irritation of the mouth. Part of the
effect of opium is due to its depressing action on the medullary
centre.
Therapeutics. — A deficiency in the amount of saliva secreted
is a prominent feature of belladonna poisoning, and it is also
sometimes a disease in itself, being then probably of nervous
origin. It is most commonly met -with in fevers, the mouth
becoming extremely dry and the patient suffering from thirst.
Remedies which relieve this febrile thirst and impart a sensa-
tion of coolness are known as Refrigerants. In fever, acid
drinks, such as lemonade, and beverages containing carbon
dioxide gas are of service as sialogogues. For the condition
known as " dry mouth " pilocarpus has been employed, and this
is also useful in relieving the dryness caused by belladonna or
atropine. Excessive salivary secretion is seldom met with ex-
cept as a symptom of poisoning by such drugs as mercury,
iodine and pilocarpus. In some forms of indigestion the saliva
acquires a very disagreeable taste, or perhaps the secretion may
become diminished, but here the correction of the difficulty is
to be sought in the improvement of the digestion.
C. Drugs acting on the Stomach. — In the present state of our
knowledge it is not possible to speak with accuracy of the
special action of many of the drugs affecting the stomach, and
it will therefore serve the most useful purpose to divide this
class of drugs into those affecting the secretion of gastric juice
as a whole, the secreted contents, the vessels, nerves, and move-
ments of the stomach, and, lastly, those which are emetics.
1. Drugs increasing the amount of gastric juice secreted.—
These are usually called Stomachics, and they include a large
40
6io
PHARMACOLOGY AND THERAPEUTICS.
variety of agents. The secretion of gastric juice is reflexly
augmented by all bitter and aromatic substances (which like-
wise increase the appetite), as well as by stimulants to the
mouth. Indeed, the smell and taste of food constitute the most
powerful stimulant to gastric secretion, and substances of
agreeable flavor cause a marked increase in it by reflexes from
the mouth and nose. The simple presence of food in the
stomach also tends to promote the flow. The aromatics appear,
like other volatile oils, to cause an irritation, hyperemia and in-
creased secretion and peristalsis, with consequent improvement
in digestion and absorption. It is thought probable, though this
has not been proved, that bitters also cause an irritation, lead-
ing reflexly to the same results. Their effects are, however,
no doubt largely due to their acrid taste, which is very lasting.
(a) The drugs which increase the flow of gastric juice are — ■
(i) Aromatics.
(2) Bitters.
(3) All alkalies (especially potas-
sium and sodium bicarbon-
ates, and Spiritus Ammonise
Aromaticus).
(4) Alcohol.
(5) Ether.
(6) Chloroform.
(7) Magnesium oxide.
(8) Magnesium carbonate.
(9) Pungent substances (pep-
per, mustard, horse-radish).
Therapeutics. — Stomachics are extensively employed to fa-
vorably modify the digestive process in various functional
disorders.
2. Drugs decreasing the amount of gastric juice secreted.
(1) Mineral acids.
(2) Acetic acid.
(3) Many of those in the last list
if given in large doses, e. g.,
alcohol, ether and chloro-
form.
Therapeutics. — These drugs, it may be stated, are never
given for this purpose. It should be noted here that acids and
alkalies have opposite effects as regards the gastric juice and
DRUGS ACTING ON DIGESTIVE APPARATUS. 6 1 I
the saliva. While acids diminish the secretion of the gastric
juice, which is acid, they increase that of the saliva, which is
alkaline; alkalies, on the other hand, diminish the secretion of
the alkaline saliva, but increase that of the acid gastric juice.
3. Drugs altering the composition of the gastric contents. —
The reaction of the gastric contents may, of course, be modi-
fied by acids and alkalies. In cases of dyspepsia believed to
be due to a deficient secretion of hydrochloric acid, diluted
mineral acids are often prescribed, and they should be taken
about two hours after eating, so as not to interfere with the
secretion of the natural acid. If, on the other hand, there
appears to be an excess of acid in the stomach, alkalies are
ordered at meal-times, and sodium bicarbonate is the one gen-
erally selected. When it is thought that the secretion of pepsin
is at fault, pepsin is administered, and it is customary to pre-
scribe it with diluted hydrochloric acid. In order to prevent
fermentation and putrefaction in the stomach, antiseptics are
sometimes employed, but their field of usefulness is compara-
tively limited, since doses large enough to accomplish the de-
sired purpose are liable to prove injurious to the patient. • In
all varieties of indigestion it should be borne in mind that it
is of much greater importance to remove the primary cause
of the trouble than to endeavor to modify the composition of
the gastric contents.
Drugs which have been used for this purpose are —
(1) Phenol. (9) Bismuth salicylate.
(2) Iodoform.
(3) Boric acid.
(4) Creosote.
(5) Eucalyptus.
(6) Thymol.
(7) Resorcinol.
(8) Salicin.
(10) Phenyl salicylate (salol).
(11) Sodium thiosulphate.
(12) Sodium phenosulphonate.
(13) Sulphurous anhydride.
(14) Naphthol.
(15) Charcoal.
Charcoal has been considered by many to be useless when it
is moist, but it has been shown that when moist it is capable
6l2 PHARMACOLOGY AND THERAPEUTICS.
of absorbing the gases from decomposing matter almost as
readily as when in the dry state.
4. Drugs which dilate the vessels of the stomach. — The vas-
cularity of the stomach is very readily affected. Thus, me-
chanical irritation, such as results from the presence of food,
and particularly peptones, causes a considerable dilatation of
the vessels. Such increased vascularity, if not excessive, is
advantageous, since it tends to promote absorption, as well as
gastric secretion.
The substances which increase the vascularity of the stomach
are, all stomachics (except alkalies), diluted mineral acids, the
drugs. which have been already enumerated as irritants gener-
ally, and squill, digitalis, colchicum, senega, copaiba, gamboge,
guaiacum, and veratrine. Most of these, however, produce,
even in small doses, too powerful an irritant effect to be of
service in this regard, and practically the only class of drugs
much employed to increase gastric vascularity is the stomach-
ics. Even these may induce gastritis, if used to excess, as is
constantly seen in the case of alcoholics.
Gastro-intestinal irritants. — It will be found that in the de-
scription of the action of drugs a large number are designated
as gastro-intestinal irritants. Caustic potash and mineral acids
such as nitric and sulphuric acids are very powerful agents of
this class, and the reader is referred to the sections on these
drugs for a narration of the local and general symptoms pro-
duced. There is naturally a great variation in the severity of
the effects of different gastro-intestinal irritants, and it is
worthy of note that many of them have no action on the mouth.
5. Drugs which contract the gastric vessels. — These have
already been mentioned as being generally astringent. As they
are much more frequently employed for intestinal disorders
than for those of the stomach, their detailed consideration is
deferred to the section on drugs acting on the intestines.
6. Drugs acting on the nerves of the stomach. — The terminal
branches of the right and left pneumogastric nerves, which
supply the stomach, are markedly affected by all powerful gas-
DRUGS ACTING ON DIGESTIVE APPARATUS. 613
trie irritants, with the causation of severe pain; while drugs
which are only mildly irritant to the stomach give rise merely to
a sensation of warmth, which is often agreeable, rather than
otherwise. It is, of course, never desirable to produce gastric
pain.
(6) Gastric Sedatives. — These drugs are the same as those
which are local sedatives to other parts of the body. Those
most used for the stomach are —
(1) Bismuth subcarbonate.
(2) Bismuth subnitrate.
(3) Bismuth salicylate.
(4) Opium.
(5) Hydrocyanic acid.
(6) Carbon dioxide.
(7) Ice.
(8) Belladonna.
(9) Hyoscyamus.
(10) Stramonium.
They are most commonly employed in the various painful
forms of dyspepsia, and all of them, with the possible exception
of stramonium, are in constant use.
7. Drugs acting on the movements of the stomach. — As it
has been observed that the movements of the stomach increase
proportionately with an increased acidity of the gastric contents,
it would appear that anything which causes an increase of
acidity will tend to produce more pronounced movements. In
addition, stomachics seem to promote the movements, while
strychnine has been thought to directly stimulate the unstriped
muscle of the gastric wall. Many authorities, however, believe
that the latter has no such specific action, but affects the diges-
tion merely in the same way as the simple bitters. Under this
class of drugs we have, then, mineral acids, stomachics, and nux
vomica, and as an adequate amount of gastric movement is
essential to the digestive process, they are of great value in
the treatment of dyspepsia.
Carminatives. — This term is usually applied to substances
which promote the expulsion of gas from the stomach and in-
testine by increasing peristalsis, stimulating the circulation,
and perhaps relaxing the two orifices of the stomach. Many
6 14 PHARMACOLOGY AND THERAPEUTICS.
of them are also antiseptics. The most efficient carminatives
are —
(i) Stomachics generally, espe-
cially—
(2) Aromatics,
(3) Bitters,
(4) Pungent substances,
(5) Asafetida,
(6) Ammoniac,
(7) Valerian,
(8) Camphor and
(9) Volatile oils.
8. Emetics. — The act of vomiting is a reflex one, and is con-
trolled by a nerve centre in the medulla which is situated near
and closely related to the respiratory centre. This may re-
spond to afferent impulses reaching it from many organs, as
the cerebrum (through the special senses), the various parts
of the alimentary canal, the gall bladder, the genito-urinary
tract, etc. Disturbance of the mechanism of equilibrium, as
in vertigo and seasickness, is also a common cause of vomiting.
Numerous drugs which, by their action on special organs, are
capable of reflexly stimulating the centre might be included
among emetics, but it is customary to limit this designation to
those which produce vomiting either by acting on the stomach
or on the medullary centre. The first class are sometimes
calley direct emetics, and the second, indirect emetics, but as
certain authors use these terms in just the opposite way, making
the direct emetics those which act on the centre, it will be
more satisfactory to divide emetics into gastric, or local, and
central, or general. The following experiments have been
employed to determine the mode of action of the different
emetics :
1. If when the drug has been injected directly into the cir-
culation (preferably into the carotid artery, on account of its
nearness to the medulla), it is found that vomiting results very
promptly, it is concluded that the action is on the centre. If,
however, a considerable time elapses between the injection and
the production of vomiting, the conclusion is reached that the
action is on the stomach and that the drug must have been
excreted into this organ before vomiting could be caused.
2. If the smallest amount of the drug which is capable of
DRUGS ACTING ON DIGESTIVE APPARATUS. 6 1 5
causing vomiting when injected into the circulation is larger
than is required when it is introduced directly into the stomach,
it is concluded that the primary action is on the stomach and
that such vomiting as follows its injection into the circulation
is due to the fact that a portion of the drug has been excreted
into the stomach.
3. If when the stomach has been replaced by a bladder no
vomiting results from its injection into the circulation, it is
concluded that the drug acts on the stomach; but if vomiting
takes place under these circumstances, the inference is that the
action is on the centre, the vomiting being caused by the con-
traction of the abdominal muscles.
4. If, when the drug has been introduced into the stomach,
a long time elapses before vomiting is produced, it is concluded
that the action is on the centre, the delay being due to the time
required for the absorption of the drug.
It has been found, however, that such experiments are not
altogether reliable, since some emetics act both locally and cen-
trally, and, moreover, some of them, in the course of their cir-
culation through the blood, probably act on some of the numer-
ous organs from which impulses are transmitted to the vomit-
ing centre.
The following are the emetics most commonly used
Emetics acting on the stomach:
(1) Yellow mercuric subsul-
phate.
(2) Alum.
(3) Ammonium carbonate.
(4) Copper sulphate.
(5) Zinc sulphate.
(6) Sodium chloride.
(7) Ipecacuanha.
(8) Mustard.
(9) Warm water.
Ipecacuanha has' often been classed among emetics which act on the
centre, but it has been demonstrated that emetine, like many other irri-
tants when injected subcutaneously, has a specific action on the alimen-
tary canal, and, according to the best authorities, almost all the facts
brought forward as evidence of the supposed central action of the drug
have now been disproved.
6l6 PHARMACOLOGY AND THERAPEUTICS.
Emetics acting on the medullary centre,
(i) Apomorphine.
(2) Tartar emetic.
(3) Senega.
(4) Squill.
Apomorphine and tartar emetic are very powerful, and much
more depressant than the ordinary local emetics. Tartar
emetic, however, acts partly on the stomach, and by many it
is believed that the vomiting caused by it is mainly due to
gastric irritation.
Therapeutics. — Emetics are employed for three purposes :
(1) To evacuate the stomach. This is a very important indi-
cation in most cases of poisoning. In many instances, however,
washing out the stomach is preferable to the use of an emetic.
Emetics sometimes aid the expulsion of foreign bodies which
have become impacted in the fauces or oesophagus. When with
a distended stomach there is a feeling of nausea, and also in
certain cases of sick headache, the emptying of the stomach
may afford relief. Emetics were formerly employed in a great
variety of conditions in which their use is now obsolete. (2)
To expel the contents of the air-passages. Thus, an emetic
often aids the expulsion of a foreign body lodged in the larynx.
This class of drugs is especially useful in infants and young
children, who cannot expectorate well, to clear the air-pas-
sages in bronchitis, laryngitis, diphtheria, etc. (3) To pro-
duce nausea. The dose for this purpose is usually about one-
tenth of the emetic dose. The nauseant stage is employed
principally in the treatment of catarrhal conditions and coughs,
and it is indicated when the mucous secretion is deficient or
thick and tenacious. The milder emetics should be chosen, as
the nauseant stage is to be prolonged without the production
of actual vomiting.
On account of the straining induced by the vomiting, emetics
are as a rule contra-indicated in cases of aneurism, hernia, peri-
tonitis, prolapse of the uterus or rectum, and where there is a
tendency to haemorrhage.
9. Anti-emetics. — The causes of vomiting being so numerous,
the number of agents which may serve as anti-emetics is also
DRUGS ACTING OX DIGESTIVE APPARATUS. 6l/
very large ; but. as in the case of emetics., only those substances
will be considered which act either on the stomach or on the
vomiting centre.
Anti-emetics acting on the stomach. — These are all those sub-
stances which have been already enumerated as having a seda-
tive influence on the gastric nerves (see p. 613).
Also some drugs which occasionally appear to have a specific local
action in arresting vomiting ; such are :
(1) Cocaine. 8 Phenol. ->
(2) Cerium oxalate. (9) Chloroform.
(3) Menthol. (10) Creosote. In
(4) Wine of ipecac. 1 In (n) Ether. -small
S Tincture of iodine. Lminute (12) Silver nitrate. doses.
(6) Arsenic trioxide. j doses. (13) The phenosul-
- Alcohol. phonates.
.
Anti-emetics acting centrally —
: Opium. (6) Amyl nitrite.
I 2 Ammonium, (7) Nitroglycerin.
3 Potassium, and (8) Diluted hydrocyanic acid.
(4) Sodium bromides. (9) Alcohol.
(5) Hydrated chloral.
It will be noticed that some drugs fall under both headings.
Therapeutics. — The really efficient way to treat vomiting is
to remove the cause, but. of course., this is not always possible.
These drugs are. indeed, only palliative, and all are quite uncer-
tain. Sometimes, however, one will be successful in controll-
ing vomiting where a number of others have failed. Perhaps
the most trustworthy anti-emetics are ice. diluted hydrocyanic
acid, carbon dioxide, bismuth salts, morphine and menthol.
D. Drugs Acting on the Intestines. — Owing to various circum-
stances, among which may be mentioned the lack of accurate
knowledge regarding both intestinal physiology and pathology
and the fact that many drugs are altered in composition by the
time they reach this portion of the alimentary tract, it is as yet
6l8 PHARMACOLOGY AND THERAPEUTICS.
impossible to classify the drugs acting on the intestines upon a
physiological basis. We have, in fact, only three important
divisions : purgatives, antiseptics and astringents.
One of the methods of experimentation which has been used
to determine the mode of action of purgatives is as follows:
The intestine is cut across in two places a short distance apart;
the isolated part, still attached to the mesentery, is sewed up at
one end; the other, the open end, is attached to the abdominal
wall, thus giving a test-tube-like piece of intestine in which
drugs can be placed. The parts of the bowel on either side of
the excised piece are then sewed together, so that the whole in-
testine is the same as before, with the exception of being a little
shorter. The results of this method not having proved very
satisfactory, another was devised, which seems more trust-
worthy. Four ligatures are put around the intestine at equal
distances apart, so that three pieces are shut off from the rest
of the intestine and from each other, each of the same length.
With a fine syringe the drug to be experimented upon is in-
jected into the middle piece, and the whole returned into the
abdominal cavity. In a few hours the animal is killed, and the
state of the interior of the middle piece is contrasted with that
of the pieces on either side of it. Before these experiments there
had been much discussion as to whether some purgatives did
not act only by increasing the action of the muscular coat, and
others only by stimulating the secretions ; but from such experi-
ments it appears that probably the majority act in both ways,
some very slightly on the secretion and powerfully on the mus-
cle, and others slightly on the muscle and powerfully on the
secretion. We will first consider intestinal purgatives, then
intestinal antiseptics, and finally intestinal astringents.
(C) Purgatives are divided into the following classes:
Laxatives. — These are substances which slightly increase the
action of the bowels, chiefly by stimulating their muscular coat.
They are —
(i) Whole meal bread.
(2) Honey.
(3) Treacle.
(4) Most fruits, especially^
DRUGS ACTING ON DIGESTIVE APPARATUS. 6 1
(5) Tamarind,
(10) Cassia fistula.
(6) Fig,
(11) Sulphur.
(7) Prune, and
(12) Magnesium oxide
(8) Stewed apples.
(magnesia).
(9) Manna.
(13) Olive oil.
(14) Castor oil (small doses).
Most of these are well known domestic remedies, and many
of them are habitually used as articles of diet by persons in-
clined to constipation. Ergot, physostigma, nux vomica, bella-
donna, hyoscyamus, and stramonium are also laxatives, but are
not used except under medical orders. Nux vomica is thought
to increase the tone of the intestine, and is frequently prescribed
in association with purgatives. In small doses belladonna in-
creases peristaltic movements, for the reason that it paralyzes
the inhibitory fibres of the splanchnics. In moderate doses,
however, it completely arrests peristalsis, and it is largely given
for this purpose, especially in combination with opium. Hyos-
cyamus has a similar action, and in small doses is frequently
combined with the stronger purgatives in order to counteract
the irregular contractions they induce, and thus prevent griping.
Ergot and physostigma are almost never employed for their
laxative effect. Ergot, however, so often produces diarrhoea
that its purgative action should be kept in mind.
Simple Purgatives. — These are somewhat more powerful in
their action than laxatives; promoting peristalsis and also in-
creasing intestinal secretion. Some of the laxatives, as castor
oil and magnesia, when given in large doses act as simple
purgatives.
The simple purgatives are —
(1) Aloes.
(2) Rhubarb.
(3) Frangula.
(4) Cascara sagrada.
(s) Senna.
(6) Oxgall.
All of these are constantly prescribed, and each has its spe-
cial indications, which will be pointed out when their several
actions are described.
620 PHARMACOLOGY AND THERAPEUTICS.
Drastic Purgatives, often called Cathartics. — These cause
markedly increased secretion and peristaltic movements, and in
large doses severe irritation of the intestine, characterized by
excessive secretion of mucus, pronounced vascular dilatation —
possibly haemorrhage — and profuse loose stools. This condi-
tion is attended with intense abdominal pain and tends to pro-
duce collapse. It is customary to prescribe hyoscyamus or bel-
ladonna with these drugs on account of the irregular peristalsis
and severe griping pain which would otherwise be induced.
The drastic purgatives are as follows :
(i) Calomel.
(2) Podophyllum.
(3) Leptandra.
(4) Aloes.
(5) Jalap.
(6) Scammony.
(7) Gamboge.
(8) Oil of turpentine.
(9) Colocynth.
(10) Elaterium.
(11) Croton oil.
The most powerful are placed last. Some, as jalap, elaterium and
scammony, are often called hydragogue, because of the large amount of
secretion they excite.
Therapeutics. — These drugs are very useful in severe consti-
pation, and are also frequently given for the purpose of with-
drawing fluid from the body in consequence of the watery
evacuations they occasion. Thus, for instance, jalap is in con-
stant use to fulfill this indication in Bright's disease.
Saline Purgatives. — The action of these is obscure. They
differ from the vegetable purgatives in not inducing intestinal
irritation, unless when given in very large quantities. They
are absorbed from the intestine very slowly, probably because
they fail to penetrate into the cells, just as the salts of the heavy
metals fail to penetrate the red blood-corpuscles. There being
a distinct affinity between the intestinal epithelium and sodium
chloride, but only a much weaker one between it and the saline
cathartics, the latter do not permeate it. It seems certain that
these cathartics very greatly increase the secretion of intestinal
fluid, and hinder its reabsorption, so that a large amount of it
DRUGS ACTING OX DIGESTIVE APPARATUS. 621
accumulates in the intestine. Secretion goes on till the fluid in
the intestine has become a 5 or 6 per cent, solution of the drug,
so that if a very concentrated solution is given, much intestinal
fluid is secreted. This tends to excite peristalsis mechanically,
and, in addition, a salt stimulation results from the withdrawal
of liquid and salts from the cells, as well as from the slight
absorption of the salt itself; consequently there are produced
an increased quantity and number of stools of fluid consistency.
It has been denied that catharsis results if the salts are in-
jected into the blood, but in medical practice it has been re-
peatedly demonstrated that magnesium sulphate, administered
hypodermatically, purges. It is possible that other salines may
act similarly. The saline purgatives are —
(1) Potassium and sodium tar- (5) Sodium tartrate.
trate. (6) Sodium citro-tartrate.
(2) Potassium bitartrate. (7) Sodium citrate.
(3) Potassium sulphate.
(4) Sodium sulphate.
(8) Sodium phosphate.
(9) Magnesium sulphate and
other salts.
Therapeutics. — These are very largely used as habitual pur-
gatives and such salts constitute the essential ingredient of the
various cathartic mineral waters, such as Hunyadi Janos,
Apenta, Pullna, Friedrichshall, /Esculap, Rubinat, Villacabras,
etc. The most efficient way of using them is to add some hot
water to the required dose of the salt or mineral water in a
tumbler and slowly sip it in the morning.
Cholagogue purgatives will be considered under the heading
of Drugs Acting on the Liver.
Enemata. — Any fluid preparation, injected into the rectum
is called an enema. It is customary to give purgatives in this
way when there is danger of their exciting nausea or when, in
consequence of peritonitis or of obstruction, ulceration or other
affection of the intestines, it is unadvisable to administer them
by the mouth. Castor oil, olive oil. soap, aloes and magnesium
sulphate are among the substances most commonly employed
62 2 PHARMACOLOGY AND THERAPEUTICS.
for purgative enemata, enough of the vehicle selected for the
injection being used to make an enema of at least 350 c.c.
(}i pint). Such large enemata act mainly by distending the
bowel and thus exciting peristalsis, though the soap or other
agent employed no doubt has an irritating effect in addition.
Attention has recently been drawn, however, to the use of pur-
gatives by enema with only 4 to 12 c.c. (1 to 3 teaspoonfuls)
of fluid. With the small enema, of course, there is no distention,
and the movement is produced solely by the irritant action of
the drug that is given in it. It is found that colocynthine
(.01 to .03 gm.; { to/2 gr.), aloin (.4 to .5 gm. ; 7 to 8 gr.),
and cathartinic acid (.6 gm. ; 10 gr.), dissolved in glycerin, will
cause purgation in periods varying from half an hour to twelve
hours. Colocynthine acts the most promptly and efficiently,
the other two being certain in their effects only when the con-
stipation present is of moderate degree. The action of the
purgatives is attributed to absorption from the rectum. A
teaspoonful (4 c.c.) of glycerin injected into the rectum, or the
same amount given as a suppository, often promptly opens the
bowels.
(d) Intestinal Antiseptics. — These are believed to check fer-
mentation and putrefaction in the intestines and are —
chlo-
(1) Naphthol.
(7) Creosote.
(2) Bismuth naphtholate.
(8) Corrosive mercuric
(3) Naphthalene.
ride.
(4) Bismuth salicylate.
(9) Oil of turpentine.
(5) Phenyl salicylate.
(10) Silver nitrate.
(6) Chlorine.
Naphthol has been shown to destroy micro-organisms in situ.
Bismuth naphtholate has not the irritating properties of naph-
thol, but appears to be equally effective. When pure, naphtha-
lene is not absorbed, it does not cause toxic symptoms, nor is
there any change in the urine. Phenyl salicylate, a combina-
tion of salicylic and carbolic acids, decomposes only in an alka-
line solution, and this is useful for action in the small intestine,
DRUGS ACTING ON DIGESTIVE APPARATUS. 623
Chlorine water has been used for the disinfection of the intes-
tine in typhoid fever. Creosote is valuable if administered in
the form of enteric pills, which are soluble only in the intestinal
fluids. Corrosive mercuric chloride is too poisonous for use,
save in exceptional cases. Brilliant success has been achieved
with oil of turpentine in the treatment of typhoid fever. Silver
nitrate has a limited use as an antiseptic, in its local application
to dysenteric ulcerations within reach in the rectum and sig-
moid flexure. The intelligent use of the foregoing drugs has
greatly improved the success of the treatment of the various
forms of enteritis, diarrhoea, colitis, dysentery and typhoid
fever.
Intestinal Astringents. — These may be described under the
following heads :
Astringents acting on the vessels of the intestine. — These are
the same as those acting on vessels generally. Those employed
for their action on the intestine are —
(1) Lead salts. (3) Alum.
(2) Dilute solutions of silver! (4) Diluted sulphuric acid.
salts.
Astringents coagulating albuminous fluids and thus constrict-
ing the vessels: —
(1) Tannic acid, and all sub-
stances containing it, as —
(2) Krameria,
(3) Kino,
(4) Haematoxylon,
(5) Cinnamon,
(6) Gambir, and
(7) Eucalyptus gum.
(8) Lead salts,
(9) Silver salts,
(10) Zinc salts,
(11) Bismuth salts,
(12) Copper salts, and especially
(13) Ferric salts.
Astringents diminishing the amount of intestinal fluid se-
creted :
(1) Opium. (3) Lead salts.
(2) Coto. (4) Calcium salts.
The precise action of these is obscure, but it is probable that
operate in the way indicated.
they
624 PHARMACOLOGY AND THERAPEUTICS.
Astringents diminishing the contractions of the muscular coat
of the intestines:
(1) Opium.
(2) Belladonna.
(3) Hyoscyamus.
(4) Stramonium.
(5) Lead salts.
(6) Lime.
(7) Bismuth salts.
Therapeutics. — The most important point in the treatment of
diarrhoea is to remove the cause, if possible. Not uncommonly
the cause is the presence of irritating matters in the intestine,
and a mild purgative, such as castor oil or rhubarb, is indicated
to remove them. In many instances a certain amount of en-
teritis appears to be present in diarrhoea, and remedies serving
to constrict the dilated vessels and to diminish intestinal move-
ments and secretion are called for. Hence, it is often advan-
tageous to combine two or more astringents. Opium has long
been recognized as an agent of very great value in diarrhceal
diseases, and is a very frequent ingredient in prescriptions em-
ployed for them. In such troubles, however, it must be remem-
bered that drugs constitute only a small part of the treatment.
It is. essential that the diet should be very carefully regulated,
and if the case is at all severe, absolute rest and attention to
keeping the patient warm are called for. If there is a per-
sistent cause, as tubercular ulceration, palliation of the symp-
toms is generally all that can be looked for.
E. Drugs Acting on the Liver. — The liver has several distinct
functions; viz.: (a) to secrete bile; (b) to form and store up
glycogen; (c) to form urea; (d) to excrete substances absorbed
from the intestine; and (e) to destroy poisonous substances
absorbed from the intestine.
1. Drugs Influencing the Secretion of Bile. — Because an in-
creased amount appears in the faeces it does not necessarily
follow that more bile is secreted. Thus, it may be that the
gall bladder and ducts have been thoroughly emptied, or that
the bile which has been poured into the duodenum has been
DRUGS ACTING ON DIGESTIVE APPARATUS.
625
swept along quickly before reabsorption, which is ordinarily
rapid, has had time to take place. Drugs which increase the
amount of bile actually secreted are called direct cholagogues.
They are also sometimes spoken of as hepatic stimulants, but
this is an unsatisfactory designation on account of the liver's
having so many different functions. Drugs which simply lead
to a larger amount of bile being found in the faeces, without
any additional secretion, are called indirect cholagogues.
Direct Cholagogues. — These have been studied in fasting,
curarized dogs. A cannula having been inserted into the bile-
duct, in order to conduct the fluid outside the body, the amount
of bile secreted before and after the administration of the drug
under experiment is noted. A fasting state is essential because
food itself causes a considerable increase in the biliary flow.
Direct cholagogues (the most powerful being placed first) are-
(1) Euonymus.
(11) Ipecacuanha. •
(2) Sodium benzoate.
(12) Diluted nitric acid.
(3) Sodium salicylate.
(13) Diluted nitrohydrochloric
(4) Podophyllin.
acid.
(5) Iridin.
(14) Colocynth.
(6) Leptandra,
(15) Colchicum.
(7) Corrosive mercuric chlo-
(16) Potassium sulphate.
ride.
(17) Rhubarb.
(8) Sodium sulphate.
(18) Jalap.
(9) Sodium phosphate.
(19) Scammony.
(10) Aloes.
(20) Diluted arsenic trioxide.
There are individual differences among direct cholagogues. Some
increase the fluidity of the bile, while others have the opposite effect.
Euonymin, sodium benzoate, sodium salicylate, Harrogate old sulphur
spring, and Carlsbad water, all markedly increase both the total quan-
tity and the solids. Podophyllin and iridin, on the other hand, increase
the solids without affecting the quantity.
Indirect Cholagogues. — These appear to stimulate the upper
part of the jejunum and the lower part of the duodenum, thus
sweeping the bile on before there is time for it to be re-
absorbed.
626 PHARMACOLOGY AND THERAPEUTICS.
They are — (1) Mercury; (2) most Cathartic purgatives, especially
Calomel.
Therapeutics. — Cholagogues are used for cases of digestive
derangement in which hepatic disorder seems to be the cause
of the trouble, and in order to secure the excretion of the bile,
as well as the secretion of a proper amount, it is often advanta-
geous to combine direct and indirect cholagogues. Bile being
a stimulant to peristalsis, all cholagogues naturally have a pur-
gative action. In cases of dyspepsia in which the liver is at
fault careful attention to the diet is a matter of importance, and
active exercise, such as horseback riding, rowing, etc., is of
service in promoting the expulsion of bile from the gall-bladder
and ducts.
Anti-Cholagogues. — These decrease the quantity of the bile
secreted, and are sometimes called hepatic depressants. Calo-
mel, castor oil, gamboge, magnesium sulphate, opium and lead
acetate have something of this effect, but it is not sufficiently
pronounced to interfere with the therapeutic actions for which
they are employed.
2. Drugs modifying the glycogenic function of the liver. — We
will here refer to those drugs which cause sugar to appear in
the urine, and to those drugs which diminish the glycogenic
function of the liver.
Drugs causing Sugar to appear in the Urine. — Until re-
cently it was assumed that all these drugs acted on the liver,
probably by increasing the amount of sugar made from the
hepatic store of glycogen; but now we have reasons for think-
ing that sometimes the pancreas may be the organ at fault in
diabetes, for its excision causes sugar to appear in the urine,
and other symptoms of diabetes; also it has been suggested
that perhaps some perversion of processes going on in muscles
may cause diabetes. Therefore it is rash to assume that all
drugs causing sugar to appear in the urine (glycosuria) must
act on the liver. What little can be stated as to the mode of
action of these drugs will be given when each individual drug
is considered.
CALUMBA. 62J
The drugs stated to cause glycosuria have already been mentioned
(see p. 515).
' Depressants of the Glycogenic Function. — Phosphorus, arsenic,
and antimony diminish and may even arrest the formation of gly-
cogen by the liver ; they also cause fatty degeneration of the organ. In
many instances of diabetes opium, morphine and codeine have a
marked effect in diminishing the quantity, of sugar in the urine.
3. Drugs modifying the formation of urea by the liver. — The
quantity of urea excreted by the urine is increased by phos-
phorus, arsenic, antimony, ammonium chloride, and iron. Phos-
phorus may also lead to the appearance in the urine of leucin
and tyrosin. There is some evidence that this drug causes an
increase of the urea through its action on the liver, for in phos-
phorus poisoning that organ undergoes extreme fatty degenera-
tion, and jaundice supervenes. Whether the other drugs act
through the liver is uncertain, but antimony and arsenic, like
phosphorus, are capable of producing general fatty degenera-
tion. Very large doses of all these substances are required to
increase the amount of urea in the urine, and they are not
employed therapeutically for this purpose.
Opium, colchicum, alcohol and quinine are among the drugs
stated to increase the quantity of urea excreted.
C. Drugs Acting on the Stomach.
(a) Stomachics.
CALUMBA.
CALUMBA.— Calumba. (Columbo.) Dose, 2 gm.; 30 gr.
Preparations.
1. Fluidextractum Calumbae. — Fluidextract of Calumba.
Dose, 2 c.c; 30 ni .
2. Tinctura Calumbae. — Tincture of Calumba. Dose, 4 c.c;
1 fl. dr.
Action of Calumba.
External. — Calumba is slightly antiseptic and disinfectant.
Internal. Mouth. — Calumba is a typical simple bitter. It
628 PHARMACOLOGY AND THERAPEUTICS.
irritates the terminations of the gustatory nerves in the papillae
and mucous membrane of the tongue, increasing the appetite
and reflexly stimulating the salivary and gastric secretions.
The reflex action of bitters has recently been particularly stud-
ied. In these experimental researches there was employed Pav-
low's method of sham feeding in a dog in which oesophagotomy
had been performed and a gastric fistula also established. The
bitter substances, therefore, did not pass into the stomach, and
the reflex effects of their presence in the mouth could be accu-
rately judged. It was found that if a little wad of wool soaked
in tincture of gentian was put into the mouth immediately
before food was administered, a marked stimulant effect upon
gastric secretion resulted; but if the bitter was used fifteen to
thirty minutes before the meal it was quite inefficacious. It is
concluded, therefore, that these substances have the power of
rendering gustatory sensations more acute and of exercising a
temporary stimulant effect upon gastric secretion; for this pur-
pose they should be given in small doses and in the form of
tinctures (.60 to 1.20 c.c. ; 10 to 20 drops).
G astro -intestinal Tract. — The gastric nerves are probably
stimulated, and a sort of artificial hunger produced. The diges-
tion is improved, as there is vascular dilatation, and the secre-
tion of gastric juice is increased by this, as well as by the
arrival in the stomach of an increased amount of alkaline
saliva; while the gastric movements also appear to be some-
what augmented. The stronger bitters have some tendency to
increase intestinal peristalsis and act on the bowels. The secre-
tions of the pancreas and the bile are unaffected by any of them.
They are more or less antiputrefactive, and, by removing mor-
bid states of the intestinal mucous membrane, they favor assim-
ilation. Too large doses are apt to interfere with digestion,
and their long-continued use induces gastric catarrh and con-
sequent indigestion. Calumba is rapidly absorbed. Like some
other bitters, it is feebly anthelmintic.
Blood and Circulation. — The leucocytes of the blood are
markedly augmented, which may possibly assist in the absorp-
tion of food, and the red corpuscles are also stated to be in-
CALUMBA. 629
creased. Calumbin, when injected intravenously, has the effect
of increasing the blood-pressure by stimulation of the vasomotor
centre.
Berberine, an alkaloid found in calumba and many other vege-
table drugs, is, in large doses, an irritant which gives rise to
a yellow discoloration of the intestines and urine. It is never
fatal when given by the mouth, but when injected subcutane-
ously or intravenously it causes convulsions and paralysis, and
death is likely to result by asphyxia from failure of the respi-
ratory centre.
Therapeutics of Calumba.
Calumba and other simple bitters are used with good effect
in atonic dyspepsia, and are often of material service in cases
of anaemia and weakness, and in convalescence from acute dis-
eases. In general, they may be said to be most advantageous
in debilitated conditions in which the stomach participates in a
feebleness of all the various organs. Calumba is the mildest
agent of its class, and may be used with safety in many in-
stances when other bitters would be too irritating. The tinc-
ture in doses of a few drops and the infusion in 4 c.c. (1 fl. dr.)
doses are occasionally used for the relief of the vomiting of
pregnancy and of seasickness. In diarrhoea due to relaxation
of the mucous membrane (without the presence of any inflam-
mation), and in the relaxation of the bowels following acute
affections of the intestines, the tincture may often be employed
with benefit. In such cases it is sometimes combined with the
tincture of deodorized opium. To permanently cure a disposi-
tion to the accumulation of flatus in the intestines an infusion*
is highly recommended which is made with calumba, ginger,
senna and boiling water. Thread worms may be treated by the
rectal injection (the patient being in the knee-chest position)
of 240 c.c. (J/2 pint) of the infusion (B. P.), which is made
with calumba, 1 ; cold water (to avoid extracting the starch), 20.
The use of bitters ought to be combined, whenever possible,
with measures designed to relieve the cause of the dyspepsia.
They should not be given in too concentrated form, nor em-
63O PHARMACOLOGY AND THERAPEUTICS.
ployed for too long a time continuously. They are contra-
indicated in acute and subacute inflammation of the stomach, or
when the secretion of gastric juice is diminished as the result
of organic disease. Neither should they be prescribed as stom-
achics during the continuance of acute febrile diseases. Should
the appetite remain good, although the digestion is impaired, it
will usually indicate that the indigestion is intestinal, and rem-
edies other than the bitters are called for.
GENTIAN.
GENTIANA. — Gentian. Dose, 1 gm.; 15 gr.
Preparations.
1. Extractum Gentianae. — Extract of Gentian. Dose, 0.250
gm. (250 milligm.) ; 4 gr.
2. Fluidextractum Gentianae. — Fluidextract of Gentian. Dose,
1 c.c.; 15 TTl.
3. Tinctura Gentianae Composita. — Compound Tincture of
Gentian. Dose, 4 C.C.; 1 fl. dr.
Action of Gentian.
Gentian has the same action as calumba and other simple
bitters.
Therapeutics of Gentian.
It is given in the same kinds of cases as the other drugs of
its class, and, on account of its more agreeable flavor, it is
perhaps more widely used than any of the rest. The compound
tincture is esteemed an excellent vehicle for the administration
of codliver oil, the digestion and assimilation of which it serves
to promote. For potassium iodide the compound infusion (B.
P. : Gentian, 8 ; dried bitter orange peel, 3 ; cardamom, 1 ; alco-
hol— 45 per cent. — 80) is a good vehicle in cases where its tonic
effects would be useful.
QUASSIA.
QUASSIA.— Quassia. Dose, 0.5 gm.; 7y2 gr.
CALAMUS. 63 I
Preparations.
1. Extractum Quassiae. — Extract of Quassia. Dose, 0.065 gm.
(65 milligm.) ; 1 gr.
2. Fluidextr actum Quassiae. — Fluidextract of Quassia. Dose,
0.5 c.c; 8 m..
3. Tinctura Quassiae. — Tincture of Quassia. Dose, 2 c.c;
30 TTl .
Action of Quassia.
Quassia is an aromatic bitter stomachic, which has the same
action as calumba and gentian. In doses of .12 gm. (2 gr.)
quassin is said in many individuals to produce burning in the
throat and stomach, discomfort, headache, nausea and vom-
iting.
Therapeutics of Quassia.
As it contains no tannic acid, quassia is often prescribed with
iron. On account of its intense bitterness it is objectionable
to some patients, but it is a very useful remedy in the class of
cases in which these bitters are given. It is regarded as espe-
cially serviceable in the dyspepsia of inebriates, and whenever
there are much relaxation and digestive torpor it is apt to be
efficient as a stomachic tonic. A goblet turned out of quassia-
wood may be used, by allowing water to stand in it for a num-
ber of hours, for making an extemporaneous infusion of the
drug. The infusions of quassia, gentian and calumba are fre-
quently employed as vehicles for the administration of acids or
alkalies, according to the requirements of the case, in gastric
indigestion. 250 c.c. (y2 pint) of the infusion (1 to 100 of cold
water to avoid extraction of too much of the bitter principle),
injected into the rectum, with the patient in the knee-chest posi-
tion, may be used with advantage against thread-worms.
CALAMUS.
CALAMUS. — Calamus. (Sweet Flag.) Dose, 1 gm.; 15 gr.
Preparation.
Fluidextractum Calami. — Fluidextract of Calamus. Dose, 1
c.c; 15 TTL.
632 PHARMACOLOGY AND THERAPEUTICS.
Action of Calamus.
Sweet flag is a simple bitter and feeble aromatic.
Therapeutics of Calamus.
It is used with advantage in pain or uneasiness in the stom-
ach or bowels arising from flatulence, or as an adjuvant to
purgative medicines.
BARBERRY.
. BERBERIS.— Berberis. (Barberry.) Dose, 2 gm.; 30 gr.
Preparation.
Fluidextractum Berberidis. — Fluidextract of Berberis. Dose,
2 c.c; 30 Hi.
Action of Barberry.
It is in moderate doses a stomachic tonic, and somewhat
astringent. It is also credited with alterative qualities. In
large amounts it is a gastro-intestinal irritant.
Therapeutics of Barberry.
Locally it has been used in conjunctivitis, and internally in
a variety of chronic conditions for its alterative effect.
CASCARILLA.
Unofficial Preparations.
Cascarilla.— Cascarilla (U. S. P., 1890). Dose, 0.60 to 2
gm.; 10 to 30 gr.
Infusum Cascarillse. — Infusion of Cascarilla. Dose, 30 c.c;
1 11. oz.
Tinctura Cascarillae. — Tincture of Cascarilla. Dose, 2 to 8
c.c; y2 to 2 fl. dr.
Action of Cascarilla.
Cascarilla has astringent properties, on account of its tannic
acid, and, because of its bitter principle cascarillin, it improves
the appetite and digestion like calumba, while the volatile oil
CUSPARIA. 633
in its composition gives it an increased stomachic and carmina-
tive effect. It is an agreeable aromatic tonic, without unpleas-
ant bitterness. Large doses are somewhat irritant.
Therapeutics of Cascarilla.
Its medicinal uses are similar to those of calumba. It is some-
what difficult to dispense, as the infusion (1 to 20) quickly de-
composes unless the tincture (1 to 15) is added to it, and acids
precipitate the resin from the tincture.
CHIRATA.
CHIRATA.— Chirata. (Chiretta.) Dose, 1 gin.; 15 gr.
Preparation.
Fluidextractum Cbiratse. — Fluidextract of Chirata. Dose, 1
c.c; 15 1TL-
Unofficial Preparation.
Tinctura Chiratae (U. S. P., 1890). — Tincture of Chirata.
Dose, 2 to 8 c.c; y2 to 2 fl. dr.
Action of Chirata.
Chirata is a simple bitter, like calumba.
Therapeutics of Chirata.
It has the same uses as calumba and gentian, and in India,
where it is more frequently employed than elsewhere, it is
given considerably as a substitute for cinchona. It diminishes
flatulency and acidity, and is thought to be especially service-
able in the dyspepsia of gouty subjects. As it contains no tan-
nic acid, it can be prescribed in combination with the iron salts.
CUSPARIA.
Unofficial Preparation.
Cusparise Cortex.— Cusparia Bark. (Angustura Bark.) Dose,
.60 to 2.40 gm.; 10 to 40 gr.
634 PHARMACOLOGY AND THERAPEUTICS.
Action of Cusparia.
Cusparia bark is an aromatic bitter. It has been supposed
to possess valuable antiperiodic properties, but there seems no
more reason to ascribe such action to it than to the simple
bitters. In large quantities it is a gastro-intestinal irritant.
Therapeutics of Cusparia.
It is a stimulant to digestion, and in order to prevent its
causing nausea it is often combined with aromatics. It is given
in large doses as an antiperiodic in South America, and it is
said to be peculiarly efficacious in bilious diarrhoeas and trop-
ical dysentery. It is used for the manufacture of Angustura
Bitters.
SERPENTARIA.
SERPENTARIA.— Serpentaria. (Virginia Snakeroot.) Dose, 1
gm.; 15 gr.
Preparations.
1. Fluidextractum Serpentariae. — Fluidextract of Serpentaria.
Dose, 1 c.c.; 15 n\.
2. Tinctura Serpentariae. — Tincture of Serpentaria. Dose, 4
c.c; 1 fl. dr.
Action of Serpentaria.
Serpentaria is an astringent bitter and stimulating expector-
ant. In large doses it causes nausea, vomiting, colic, flatulence
and rectal tenesmus, with frequent, but not watery stools. The
irritant action appears to produce gas rather than fluid. It is
slightly diuretic and diaphoretic.
Therapeutics of Serpentaria.
It was formerly regarded as an antidote to snake poison, but
is without value in this capacity, and a number of other virtues
have been attributed to it which it quite likely does not possess.
It may be employed as a bitter stomachic, and is of consider-
able utility as a stimulant expectorant in capillary bronchitis
and in pneumonia of low grade, when ammonium carbonate is
combined with it. It is seldom administered alone.
CANELLA. 63 5
DANDELION.
TARAXACUM.— Taraxacum. (Dandelion.) Dose, 8 gm.; 120 gr.
Preparations.
1. Extractum Taraxaci. — Extract of Taraxacum. Dose, 1
gm.; 15 gr.
2. Fluidextractum Taraxaci. — Fluidextract of Taraxacum.
Dose, 8 c.c; 2 fl. dr.
Action of Dandelion.
Dandelion is a simple bitter, promoting appetite and diges-
tion. For a long time it was supposed to have some action in
increasing the secretion of bile, but it has been shown that this
idea has no foundation in fact. It is a mild laxative, however,
and as such may, by reflex stimulation, have some effect in tend-
ing to evacuate the gall bladder. The vulgar name by which
dandelion is known both in England and France suggests that
it may be diuretic.
Therapeutics of Dandelion.
It is not nearly as frequently employed now as formerly, but
is still occasionally prescribed as a laxative in catarrhal jaun-
dice, in ascites from hepatic disease, and in some forms of dys-
pepsia. By German physicians particularly it has been given
in combination with ammonium chloride. Its practical utility
as a diuretic seems to be very limited.
CANELLA.
Unofficial Preparation.
Canellae Cortex. — Canella Bark. Dose, 1 to 4 gm.; 15 to
60 gr.
Action of Canella.
Canella is an aromatic bitter stomachic.
Therapeutics of Canella.
It is not much used. When it is prescribed, it is almost in-
variably in association with other bitters or, for its tonic action,
with purgatives which tend to debilitate.
636 PHARMACOLOGY AND THERAPEUTICS.
BAEL FRUIT.
Unofficial Preparation.
Belae Fructus. — Bael Fruit. Dose, 1 to 2 gm.; 15 to 30 gr.
Action of Bael Fruit.
Very little is known in regard to the principles or action of
bael fruit, but it is thought that it may perhaps have some effect
as a bitter; it appears to be slightly astringent.
Therapeutics of Bael Fruit.
In India bael fruit, although it contains very little tannic acid,
is a very popular remedy for diarrhoea and dysentery, especially
when unattended by fever. Various preparations of it are
employed, particularly a decoction boiled down until the water
containing the fresh fruit is reduced to one-quarter its original
quantity, and sometimes the fruit is eaten in its natural state.
The imported bael fruit is probably of no therapeutic value.
CLOVES.
CARYOPHYLLUS.— Cloves. Dose, 0.250 gm. (250 milligm.) ;
4 gr.
OLEUM CARYOPHYLLL— Oil of Cloves. Dose, 0.2 c.c; 3 m..
EUGENOL.— Eugenol. Dose, 0.2 c.c; 3 Til.
Unofficial Preparations.
Infusum Caryophylli. — Infusion of Cloves. Dose, 15 to 30
c.c; y2 to 1 fl. oz.
Eugenol Acetamidum. — Eugenol Acetamide.
Action of Cloves and Oil of Cloves.
External. — Oil of cloves has antiseptic and parasiticidal
properties. Rubbed into the skin, or applied to mucous mem-
branes, it is rubefacient and irritant, producing hyperemia, and
the burning sensation to which it at first gives rise is followed
by anaesthesia of the part. The action on the skin is mainly
one of sensory irritation.
CLOVES. 637
Internal. Mouth. — In the mouth the effects just mentioned
are naturally produced, and, in addition, the nerves of taste and
smell are stimulated and the salivary glands excited to increased
secretion.
Stomach. — Oil of cloves is preeminently stomachic and car-
minative, and its gastric effects constitute the most important
part of its action. It has the characteristic action of the vola-
tile oils, appearing to induce dilatation of the blood-vessels, to
stimulate the secretion of the gastric glands, and to accelerate
the movements of the stomach, in consequence of which there
is more or less eructation of gas. The oil also acts as an anti-
septic here, as elsewhere, and it thus no doubt hinders the de-
velopment of yeasts and other organisms. As soon as it reaches
the stomach a grateful sensation of warmth is experienced, and
its whole action in the organ tends to increase appetite and
digestion. By the stimulation of the gastric nerves the heart
is reflexly stimulated to a certain extent, and the rate and force
of the heart are consequently moderately increased.
Intestine. — Similar effects are believed to be produced in the
intestine, though it is not positively known whether the peri-
staltic movements of the latter are increased by the volatile
oils. At all events, flatulence and distention are relieved, an
effect which may be due in part at least to the antiseptic action.
It is well known that the colic caused by some of the more pow-
erful purgatives is much diminished by the administration with
them of oil of cloves and other volatile oils. It has been shown
that the intestine, like the stomach, absorbs more rapidly in the
presence of small quantities of these oils. Oil of cloves, like
others of its class, is capable when given in sufficient quantity
of exciting gastro-enteritis.
Excretion. — Oil of cloves is absorbed from the intestine, and
in the course of its excretion exerts more or less irritant action
on the kidneys and respiratory passages, the secretions of which
it tends to disinfect.
Eugenol has the same general action as the oil of cloves, of%
which it is one of the chief constituents.
638 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Cloves and Oil of Cloves.
External. — The expensiveness of oil of cloves is an objection
to its free or frequent use. On account of its local anaesthetic
action it is sometimes employed as an external application for
neuralgias. It is more or less used in combination with other
rubefacients, counter-irritants and antiseptics. It is of service,
in an ointment made with lanolin, in some cases of eczema,
and in lupus vulgaris its repeated application is said to cause
separation of the epithelium and retrocession of the nodules.
As a parasiticide it has been used for pediculosis. It is one
of the remedies most commonly resorted to for the relief of the
pain of carious teeth, and is an important constituent of many
" toothache drops." It is sometimes employed to give a pleas-
ant odor to liniments.
Internal. — In cooking, cloves are largely used for seasoning.
The oil or infusion (B. P., 1 to 40) may be given as a stom-
achic or as a carminative for the relief of gastric or intestinal
pain, and the oil is sometimes combined with preparations of
scammony, of castor oil, and of colocynth, to prevent griping.
Its aromatic qualities render it an agreeable adjuvant to other
remedies besides purgatives, and in minute doses it has been
successfully given for severe vomiting. In gastric fermenta-
tion the following combination has proved quite efficient: .06
c.c. (1 1TL) each of the oils of cloves, cinnamon and peppermint,
with .06 c.c. (1 ni) of creosote, administered three times a day
in a soft capsule containing about ^6 c.c. (6 ^l) of olive oil.
Eugenol acetamide, a crystalline substance obtained from
eugenol-acetic-ethyl-ester by treating with a strong solution of
ammonia, has been used in dentistry and minor surgery. It is
said to be not only an active antiseptic, but a powerful local
anaesthetic, analogous to cocaine in its action.
ALLSPICE.
PIMENTA. — Pimenta. (Allspice.) Dose, 1 gm.; 15 gr.
OLEUM PIMENTO.— Oil of Pimenta. Dose, 0.2 c.c; 3 m,.
NUTMEG AND MACE. 639
Action of Allspice.
The same as that of cloves and oil of cloves.
Therapeutics of Allspice.
The uses, as well as the action, are the same as those of cloves
and oil of cloves.
NUTMEG AND MACE.
MYRISTICA. — Nutmeg. Dose, 0.500 gm. (500 milligm.) ; 7Y2 gr.
Preparations.
Pulvis Aromaticus. — Aromatic Powder. Dose, 1 gm.; 15 gr.
Fluidextractum Aromaticum. — Aromatic Fluidextract. Dose,
1 c.c.; 15 m,.
OLEUM MYRISTIOdE.— Oil of Nutmeg. Dose, 0.2 c.c; 3 HI.
Unofficial Preparations.
Spiritus Myristicae. — Spirit of Nutmeg, U. S. P., 1890.
(Essence of Nutmeg.) Dose, 0.06 to 0.18 C.C.; 1 to 3 TTj,.
Oleum Myristicae Expressum. — Expressed Oil of Nutmeg.
Dose, 0.10 to 0.30 gm.; 2 to 5 gr.
Macis. — Mace (U. S. P., 1890). Dose, 0.30 to 1.20 gm.; 5
to 20 gr.
Action of Nutmeg and Mace.
Oil of nutmeg has the same action as that of other aromatic
oils. Its effects after absorption appear to render it more toxic
than most volatile oils. In addition to its aromatic and carmina-
tive qualities, it is possessed of considerable narcotic power, and,
injected into the circulation of the dog, it has been found to
produce profound sleep, with slowing of the circulation, and,
if the dose is sufficiently large, loss of reflex activity.
Therapeutics of Nutmeg and Mace.
The expressed oil of nutmeg may be rubbed on the skin as
a rubefacient in rheumatism, neuralgia and paralysis, and in
plasters it is used as a sweet-smelling stimulant. For mild
64O PHARMACOLOGY AND THERAPEUTICS.
cases of ringworm a liniment composed of one part of the oil
to three of olive oil may be employed as an elegant antipara-
siticide. In itching and painful haemorrhoids the following oint-
ment affords relief: Powdered nutmeg, 8; tannic acid, 4; pe-
trolatum, 31. Nutmeg and mace are much used in cooking, as
their volatile oil renders them agreeable stomachics. In medi-
cine powdered or grated nutmeg, or the volatile oil, is given as
a carminative and anodyne for the relief of nausea or colic
and, combined with other remedies, of diarrhoea. The narcotic
properties of the drug make it of service at times in the treat-
ment of delirium tremens.
CINNAMON.
CINNAMOMUM SAIGONICUM.— Saigon Cinnamon. Dose, 0.250
gm. (250 milligm.) ; 4 gr.
Preparations.
1. Pulvis Aromaticus. — Aromatic Powder. Dose, 1 gm.;
15 gr.
2. Tinctura Cinnamomi. — Tincture of Cinnamon. Dose, 2
c.c; 30 tt\..
3. Fluidextractum Aromaticum. — Aromatic Fluidextract.
Dose, 1 c.c; 15 Trt.
CINNAMOMUM ZEYLANICUM.— Ceylon Cinnamon. Dose, 0.250
gm. (250 milligm.) ; 4 gr.
OLEUM CINNAMOMI.— Oil of Cinnamon. Oil of Cassia. Dose,
0.05 c.c; 1 TTt-
Preparations.
1. Aqua Cinnamomi. — Cinnamon Water. Dose, 16 cc; 4
fl. dr.
2. Spiritus Cinnamomi. — Spirit of Cinnamon. Dose, 2 c.c;
30 1TL.
CINNALDEHYDUM.— Cinnamic Aldehyde. Dose, 0.05 C.C. J 1 1TL-
UnofUcial Preparation.
Cinnamomum Cassia (U. S. P., 1890). — Cassia Cinnamon.
(Cassia Bark.) Dose, 0.250 gm.; 4 gr.
HORSE RADISH. 64 1
Action of Cinnamon.
Oil of cinnamon has the same action as other aromatic oils.
The bark, on account of its tannic acid, has considerable astrin-
gent property.
Therapeutics of Cinnamon.
Finely powdered cinnamon is sometimes of service in arrest-
ing nausea and vomiting, and in doses of 4 to 6 gm. (60 to 90
gr.), night and morning, is said to be efficient in acute dysen-
tery. Cinnamon is much used as an ingredient of carminative
and astringent powders and mixtures, and is also combined with
purgatives to prevent griping. On account of its tannic acid
it is incompatible with iron preparations. It has been claimed
that in large doses it is of value in the palliative treatment of
carcinoma of various internal organs. Spirit of Cinnamon,
although in full strength very irritant, has been utilized, when
dissolved in retinol, as a surgical dressing, and it has consid-
erable antiseptic value. For counter-irritation, especially in
children, a spice plaster made by placing Aromatic Powder
between two layers of flannel and moistening it with hot whis-
key or other form of alcohol, is sometimes employed. Spice
plasters may also be obtained already prepared for use. Oil of
cinnamon dissolved in one of the liquid petroleum preparations
has been recommended as an injection in gonorrhoea.
HORSE-RADISH.
Unofficial Preparation.
Armoracia. — Horse-Radish. Dose, 1.20 to 2 gm.; 20 to 30 gr.
Action of Horse-Radish.
The action of horse-radish is similar to that of mustard. It
especially stimulates the secretion of urine.
Therapeutics of Horse-Radish.
It may be employed as a rubefacient and counter-irritant.
As a condiment it is used particularly with meats and raw
42
642 PHARMACOLOGY AND THERAPEUTICS.
oysters. It is occasionally given in dropsy attended with en-
feebled digestion and general debility, and the addition of grated
horse-radish to cider renders it actively diuretic. The com-
pound spirit (B. P., scraped horse-radish root, 10; bitter orange
peel, 10; nutmeg, 1; alcohol, 192; water, 196; dose, 4 to 8 c.c;
1 to 2 fl. dr.) is used for flavoring and as a carminative.
SUMBUL.
SUMBUL.— Sumbul. (Musk Root.) Dose, 2 gm.; 30 gr.
Preparations.
1. Extractum Sumbul. — Extract of Sumbul. Dose, 0.250 gm.
(250 milligm.) ; 4 gr.
2. Fluidextractum Sumbul. — Fluidextract of Sumbul. Dose,
2 c.c; 30 HI.
Unofficial Preparation.
Tinctura Sumbul (U. S. P., 1890). — Tincture of Sumbul.
Dose, 4 to 16 c.c; 1 to 4 fl. dr.
Action of Sumbul.
Little is known positively of the effects of sumbul on the
system, but its action appears to resemble that of the volatile
oils in general, and it is usually classed with the substances
having malodorous oils, such as asafetida and valerian. It is
stomachic and carminative, and is regarded more particularly
as an antispasmodic and nerve tonic. It stimulates appetite,
improves digestion, and allays irregular nerve action. It is
said to directly influence the cerebro-spinal nerve centres, and
thus control spasm, restlessness and incoordination of movement
dependent upon disturbances of their circulation. Its resinous
and volatile constituents, it is believed, are excreted by the
mucous surfaces of the kidney and air-passages; stimulating
their vessels and controlling excessive secretions.
Therapeutics of Sumbul.
Sumbul may be given for its carminative effects in colic and
flatulence. It is thought to be especially beneficial in depressed
LAVENDER. 643
or excitable conditions of the nervous system, and among the
affections in which it has been recommended are neuralgia,
facial, ovarian or sciatic, occurring in hysterical subjects, hys-
teria in general, chlorosis, neurotic migraine, functional de-
rangement of the heart, alcoholic and other insomnia, chorea,
catarrhal and spasmodic conditions of the respiratory and
genito-urinary tracts, nervous dyspepsia, neurasthenia, and the
unrest of nervous females. It is usually associated with such
other remedies as may be indicated by the condition present.
In Russia it is highly esteemed as a stimulant in atonic dyspep-
sia, asthenic diarrhoea, dysentery and typhoid fever.
LAVENDER.
OLEUM LAVANDULA FLORUM.— Oil of Lavender Flowers.
Dose, 0.2 c.c; 3 n\,.
Preparations.
1. Spiritus Lavandulae. — Spirit of Lavender. Dose, 2 c.c;
30 TIL
2. Tinctura Lavandulae Composita. — Compound Tincture of
Lavender. Dose, 2 C.C.; 30 1T1 .
Unofficial Preparations.
Aqua Lavandulae. — Lavender Water.
Oleum Lavandulae.— Oil of Lavender. Dose, .06 to .30 c.c;
1 to 5 n\.
Action of Oil of Lavender Flowers.
This has the same action as oil of cloves and other aromatic
volatile oils.
Therapeutics of Oil of Lavender Flowers.
In nervous headache a few drops of the oil are sometimes
rubbed upon the temples. Its principal external use is as an
agreeable stimulating ingredient of liniments and ointments,
and the compound tincture is largely employed to color the
Lotion Rubra {see p. 426) and other red lotions. The com-
644 PHARMACOLOGY AND THERAPEUTICS.
pound tincture, which is a very palatable carminative and gas-
tric stimulant, is in constant use in the treatment of nausea,
flatulence, gastralgia, etc., and as an adjuvant or corrigent of
other medicines. In hysterical and other nervous conditions it
is a pleasant antispasmodic, and it is used as a stimulant in
fainting. As a tranquilizing remedy in various disturbed states
of the system it is not infrequently combined with Hoffman's
anodyne (Spiritus ^Etheris Compositus), which it renders less
disagreeable to take. To calm nervous headache the oil may
be used internally as well as externally. Lavender water, which
is an alcoholic solution of the oil with other volatile substances,
is a well-known perfume and deodorant.
Oil of Lavender (B. P.) is usually distilled from the flowers
and flower-stems conjointly, and consequently is inferior in
quality to that obtained from the flowers exclusively.
BERGAMOT.
Unofficial Preparation.
Oleum Bergamottae (U. S. P., 1890). — Oil of Bergamot.
Action of Oil of Bergamot.
Oil of bergamot has the same action as other aromatic vola-
tile oils.
Therapeutics of Oil of Bergamot.
Although possessing the carminative and stimulant properties
of other similar oils, it is employed chiefly, if not exclusively,
as a perfume.
' PEPPERMINT.
MENTHA PIPERITA.— Peppermint. Dose, 4 gm.; 60 gr.
OLEUM MENTHA PIPERITA.— Oil of Peppermint. Dose, 0.2
c.c; 3 n\.
Preparations.
1. Aqua Menthae Piperitae. — Peppermint Water. Dose, 16
c.c; 4 fl. dr.
2. Spiritus Menthse Piperitae. — Spirit of Peppermint. (Es-
sence of Peppermint.) Dose, 2 CCS. J 30 n\.
LAVENDER. 645
Unofficial Preparations.
Infusum Menthae Piperitae. — Infusion of Peppermint. Dose,
freely.
Trochisci Menthae Piperitae (U. S. P., 1890). — Troches of
Peppermint. Dose, freely.
Action of Peppermint.
Oil of peppermint has the action of volatile oils in general.
The feeling of coolness and numbness which sometimes attends
the external application of these agents is particularly marked
in the case of oil of peppermint, on account of the menthol in
its composition. Like many other volatile oils, especially those
containing a considerable amount of terpene, it is actively
antiseptic.
Therapeutics of Peppermint.
External. — Oil of peppermint is in common use as the " pep-
permint test " for defective plumbing. The menthol in it ren-
ders its external application of value in many cases of neural-
gia. The surface painted over with it should be covered with
oiled silk to prevent evaporation. Similar applications may be
made for the relief of myalgia and various rheumatic and
gouty pains. Peppermint water, with the addition of 4'to 8 gm.
(1 to 2 dr.) of borax to each 500 c.c. (1 pint), is useful in
pruritus of the genitals.
Internal. — Peppermint is very largely employed as an efficient
stomachic and carminative (often in association with sodium
bicarbonate), and also as a flavoring agent. An infusion
("peppermint tea"), generally made with about a tablespoon-
ful of the herb to one or two cupfuls of water, is a popular
household remedy to induce perspiration or promote diuresis in
fevers or chills, as well as to relieve attacks of colic. For the
latter purpose the spirit, in hot water, is more effective, and it
is especially well suited to children. Peppermint water is in
very general use as a component of carminative mixtures for
infants. The inhalation of the oil, vaporized by means of hot
water, is reported to have been of material service in a number
I
646 PHARMACOLOGY AND THERAPEUTICS.
of cases of pulmonary tuberculosis. The troches are sometimes
useful in relieving nausea, as well as flatulence and pain.
SPEARMINT.
MENTHA VIRIDIS.— Spearmint. Dose, 4 gm.; 60 gr.
OLEUM MENTHA VIRIDIS.— Oil of Spearmint. Dose, 0.2 C.C.;
3 m,.
Preparation.
1. Aqua Menthae Viridis.— Spearmint Water. Dose, 16 c.c;
4 fl. dr.
2. Spiritus Mentha Viridis. — Spirit of Spearmint. (Es-
sence of Spearmint.) Dose, 2 C.C.; 30 nT..
Action of Spearmint.
It has the same action as peppermint, but its effects are less
pronounced.
Therapeutics of Spearmint.
The therapeutic applications of spearmint are the same as
those of peppermint, but its oil is not so agreeable as oil of
peppermint. The preparations of spearmint are in less gen-
eral use than those of peppermint.
ANISE AND STAR-ANISE.
ANISTJM.— Anise. Dose, 0.500 gm. (500 milligm.) ; 7V2 gr.
OLEUM ANISL— Oil of Anise. Dose, 0.2 c.c; 3 Ifl,.
Preparations.
1. Aqua Anisi. — Anise Water. Dose, 16 c.c; 4 fl. dr.
2. Spiritus Anisi. — Spirit of Anise. Dose, 4 c.c; 1 fl. dr.
Unofficial Preparations.
Illicium (U. S. P., 1890).— Illicium. (Star-Anise.) Dose, 0.30
to 2.00 gm.; 5 to 30 gr.
CORIANDER. 647
Oleum Illicii. — Oil of Star- Anise. Dose, .06 to .30 c.c; 1
to 5 TT\.
Action of Anise.
The action of oil of anise is the same as that of aromatic oils
generally. Although anise imparts a peculiar taste to the milk
of nursing women, it apparently does not augment the secre-
tion, as is supposed by some. Anisic acid (which is formed
from anethol, the main constituent of the oil, by the action of
chromic and nitric acids) and sodium anisate are antiseptic
and are also said to be antipyretic.
Therapeutics of Anise.
Anise is the pleasantest carminative for infants and young
children, and the seeds are used in many culinary products as a
condiment which tends to increase their digestibility. It prob-
ably has some slight efficacy as an expectorant, and it is em-
ployed to a considerable extent as an agreeable component of
cough mixtures. It is also much used as a general flavoring
agent.
Action of Star-Anise.
Star-anise owes its properties entirely or chiefly to its vola-
tile oil, the action of which is the same as that of oil of anise.
Therapeutics of Star-Anise.
Its seeds and oil have been used externally to relieve local
pains, such as colic, rheumatism, earache, etc., and internally in
the treatment of flatulent colic and bronchitis.
CORIANDER.
CORIANDRUM.— Coriander. Dose, 0.500 gm. (500 milligm.) ;
7y2 gr.
OLEUM CORIANDRL— Oil of Coriander. Dose, 0.2 c.c; 3 Vf\,.
Action of Coriander.
Oil of coriander has the same action as other aromatic vola-
tile oils.
648 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Coriander.
Coriander is employed in confectionery and to promote the
digestion of certain kinds of pastry. In medicine it is used
almost entirely for flavoring purposes, for disguising the taste
of senna and rhubarb, and for preventing the griping of these
and other purgatives.
FENNEL.
FCENICULUM.— Fennel. Dose, 1 m.; 15 gr.
OLEUM FCENICULL— Oil of Fennel. Dose, 0.2 c.c.; 3 HI.
Preparation.
Aqua Foeniculi. — Fennel Water. Dose, 16.0 c.c; 4 fl. dr.
Unofficial Preparation.
Infusum Foeniculi. — Infusion of Fennel. Dose, freely.
Action of Fennel.
Oil of fennel has the same action as that of anise and other
similar oils. It has been supposed to have the effect of increas-
ing the secretion of milk, urine, perspiration and bronchial
mucus, and also to act as an emmenagogue.
Therapeutics of Fennel.
, As. one of the most grateful of the various aromatics, fennel
is employed to quite a large extent as a stomachic and carmina-
tive, and as a corrective against the griping effects of purga-
tives. It is still sometimes used in hot infusion, as an adju-
vant, in the treatment of amenorrhcea dependent on uterine con-
gestion and for re-establishing the mammary secretion when
suppressed. The infusion (not official, 4 gm. ; 1 dr. to 250 c.c;
y2 pint of water) is given as an enema to infants for the
expulsion of flatus.
CARAWAY.
CARUM. — Caraway. Dose, 1 gm.; 15 gr.
OLEUM CARL— Oil of Caraway. Dose, 0.2 c.c; 3 TTt.
ELDER. 649
Action of Caraway.
The action of oil of caraway is the same as that of other
aromatic volatile oils.
Therapeutics of Caraway.
Caraway is used chiefly as a flavoring agent and a carmina-
tive for flatulent colic, especially in infants. The seeds are often
baked in cakes, which thus receive a pleasant aromatic taste
and have the effect of stimulating the digestive organs.
DILL.
Unofficial Preparation.
Anethum.— Dill. Dose, 0.60 to 2.00 gm.; 10 to 30 gr.
Action of Dill.
The same as that of anise and caraway.
Therapeutics of Dill.
It is not much used in this country, but may be employed for
the relief of flatulent colic and hiccough due to gastric indiges-
tion. In England, dill water (B. P.; dill fruit, 1; water, 10;
dose, 30 to 60 c.c. ; 1 to 2 fl. oz.) is a common carminative for
children, and it is also sometimes given to cover the taste of
sodium salts.
ELDER.
Unofficial Preparations.
Sambucus (U. S. P., 1890). — Sambucus. (Elder.) Dose, 2 to
4 gm.; 1/2 to 1 dr.
Decoctum Sambuci. — Decoction of Sambucus. Dose, freely.
Action of Sambucus.
Elder flowers are gently stimulant and diaphoretic. The in-
ner bark of the elder is a hydragogue cathartic and in large
doses emetic.
Therapeutics of Sambucus.
The flowers are considerably used for flavoring purposes.
Elder-flower water (B. P. — 1 in 1) makes a good vehicle for
65O PHARMACOLOGY AND THERAPEUTICS.
collyria and lotions. The berries are edible, and jam or con-
serve made from them is somewhat laxative. A decoction of
the fresh inner bark is said to be strongly diuretic and to have
been used with good effect in acute nephritis.
PENNYROYAL.
HEDEOMA. — Hedeoma. (Pennyroyal.) Dose, 8 gm.; 120 gr.
OLEUM HEDEOM^E.— Oil of Hedeoma. Dose, 0.2 c.c.; 3 m_.
Action of Pennyroyal.
Pennyroyal is a gentle aromatic stimulant.
Therapeutics of Pennyroyal.
It may be given in flatulent colic and sick stomach. The oil
is in common use locally applied as a remedy for mosquito
bites.
WORMWOOD.
Unofficial Preparations.
Absinthium (U. S. P., 1890). — Absinthium. (Wormwood.)
Dose, 0.50 to 2.40 gm.; 8 to 40 gr.
Infusum Absinthii. — Infusion of Wormwood. Dose, 30 to 60
c.c; 1 to 2 fl. oz.
Action of Wormwood.
In medicinal doses wormwood is a digestive stimulant. Ab-
sinthol differs from many of the volatile oils in the profound
effect which, when given in sufficient amount, it has upon the
central nervous system, the result of which is seen in a marked
increase in the reflexes. It gives rise to epileptiform convul-
sions, and in these, other parts of the central axis are involved
as well as the cerebrum, which is mainly responsible for them.
It is found that the continued use of absinthe produces various
nervous symptoms, morning nausea and vomiting, and a ten-
dency to such epileptiform convulsions.
CHAMOMILE. 65 I
Therapeutics of Wormwood.
Wormwood is used in an infusion as an aromatic tonic in
atony of the stomach or intestines. The volatile oil has been
employed as a local anaesthetic for rheumatic and other pains
and internally in the form of a liqueur, as a narcotic stimulant
in cerebral exhaustion.
CHAMOMILE.
ANTHBMIS. — Anthemis. (Chamomile.) Dose, 2 gm.; 30 gr.
Unofficial Preparations.
Infusum Anthemidis. — Infusion of Anthemis. Dose, 30 to
60 c.c; 1 to 2 fl. oz.; as an emetic, 150 to 300 c.c; 5 to 10 fl. oz.
Oleum Anthemidis. — Oil of Anthemis. Dose, .06 to .25 c.c;
1 to 4 TTt.
Action of Chamomile.
Chamomile has the general action of the aromatic volatile
oils. Its oil is said to have the power of reducing reflex excita-
bility in frogs, even after its excitation by strychnine or
brucine.
Therapeutics of Chamomile.
External. — A poultice made with chamomile flowers is a
popular domestic remedy, but it has no special advantages over
other kinds of cataplasms. The oil, on account of its sedative
action, has been recommended as a serviceable addition to fatty
preparations for various inflammations of the skin. Combined
with other remedies in ointments, it may be used in erysipelas,
erythema, acute eczema, seborrhcea, etc.
Internal. — Chamomile is more or less used as a stomachic
and carminative. The infusion acts as an emetic when given
in doses of considerable size. In smaller doses it is aro-
matic and carminative, and favors diuresis and the action of the
skin. It is a popular household remedy for colds, dyspepsia
and intestinal disorders. The oil has some effect in checking
reflex cough, and may prove useful in spasmodic asthma. It
is believed that it should be of service in poisoning by strych-
652 PHARMACOLOGY AND THERAPEUTICS.
nine, on account of its depressant action upon the reflex excita-
bility of the spinal cord.
GERMAN CHAMOMILE.
MATRICARIA.— Matricaria. (German Chamomile.) Dose, 16
gm.; 240 gr.
Action and Therapeutics of Matricaria.
These are identical with those of chamomile.
GARLIC.
Unofficial Preparations.
Allium (U. S. P., 1890). — Garlic. Dose, 1.0 to 2.0 gm.; 15 to
30 gr.
Syrupus Allii. — Syrup of Garlic. Dose, 4.0 to 16.0 c.c; 1 to
4 fl. dr.
Action of Garlic.
The effects of garlic are those of a general stimulant, quick-
ening the circulation, exciting the nervous system, and promot-
ing expectoration.
Therapeutics of Garlic.
It is beneficial in impaired digestion and in chronic affections
of the respiratory organs in which symptoms of inflammation
have subsided and a relaxed state of the vessels remains.
SAGE.
SALVIA.— Salvia. (Sage.) Dose, 2 gm.; 30 gr.
Unofficial Preparation.
Infusum Salviae. — Infusion of Salvia. Dose, 30 to 60 C.C.;
1 to 2 fl. oz.
Action of Sage.
Sage has the action of volatile oils generally and is also
astringent in consequence of its tannic acid. The oil has been
shown to occasion epileptiform convulsions in dogs.
ROSE. "653
Therapeutics of Sage.
While used chiefly as a condiment, it is said to be beneficial
in checking the perspiration of hectic fever. Infusion of sage
(1-4) is employed as a gargle and an astringent wash for the
mouth or nasal passages. The compound sage-gargle is made
as follows: Sage, 30; alum, 15; clarified honey, 60; boiling
water, 500. Sage is sometimes combined with other remedies
as an injection for urethritis or cystitis.
ROSE.
ROSA GALLICA.— Red Rose.
Preparations.
1. Confectio Rosae. — Confection of Rose.
2. Fluidextractum Rosse. — Fluidextract of Rose. Dose, 2
c.c; 30 TTj..
3. Mel Rosae. — Honey of Rose. Dose, 4 C.C.; 1 fl. dr.
4. Syrupus Rosas.— Syrup of Rose.
OLEUM ROS^:.— Oil of Rose. (Attar of Rose.)
Preparations.
1. Aqua Rosae Fortior. — Stronger Rose Water. Dose, 8 c.c;
2 fl. dr.
2. Aqua Rosae. — Rose Water. Dose, 16 c.c; 4 fl. dr.
3. Unguentum Aquae Rosae. — Ointment of Rose Water.
Unofficial Preparation.
Rosa Centifolia (U. S. P., 1890).— Pale Rose.
Action of Rose.
Preparations of rose are somewhat astringent, but have not
much other action.
Therapeutics of Rose.
The confection is a good base for pills, and the water an
agreeable excipient for collyria, lotions and urethral injections.
The ointment of rose water is a favorite soothing application
for the skin, The infusion (B. P., not official : Dried petals, 2;
654' PHARMACOLOGY AND THERAPEUTICS.
diluted sulphuric acid, i; water, 80), which is slightly astrin-
gent, constitutes an acceptable gargle and wash for inflamed or
ulcerated conditions of the throat and mouth. Given inter-
nally it offers a pleasant method of administering sulphuric
acid.
ORANGE.
AURANTII AMARI CORTEX.— Bitter Orange Peel. Dose, 1
gm.; 15 gr.
Preparations.
1. Fluidextractum Aurantii Amari. — Fluidextract of Bitter
Orange Peel. Dose, 1 c.c; 15 TT\.
2. Tinctura Aurantii Amari. — Tincture of Bitter Orange
Peel. Dose, 4 c.c; 1 fl. dr.
Unofficial Preparations.
Tinctura Aurantii Recentis Corticis. — Tincture of Fresh
Orange Peel. Dose, 4 c.c.; 1 fl. dr.
AURANTII DULCIS CORTEX.— Sweet Orange Peel. Dose, 1
gm.; 15 gr.
Preparation.
Tinctura Aurantii Dulcis. — Tincture of Sweet Orange Peel.
Dose, 4 c.c; 1 fl. dr.
Syrupus Aurantii. — Syrup of Orange.
OLEUM AURANTII CORTICIS.— Oil of Orange Peel. Dose, 0.2
c.c; 3 TTt.
Preparations.
1. Spiritus Aurantii Compositus. — Compound Spirit of
Orange.
2. Elixir Aromaticum. — Aromatic Elixir.
3. Elixir Adjuvans. — Adjuvant Elixir.
Unofficial Preparation.
Spiritus Aurantii (U. S. P., 1890). — Spirit of Orange. Dose,
2 c.c; 30 TTL-
Preparations of the Volatile Oil of Fresh Orange Flowers.
Unofficial Preparation.
1. Aqua Aurantii Florum Fortior. — Stronger Orange Flower
Water. (Triple Orange Flower Water.) Dose, 8 C.C.; 2 fl. dr.
LEMON. 655
2. Aqua Aurantii Florum.— Orange Flower Water. Dose, 16
c.c; 4 fl. dr.
3. Syrupus Aurantii Florum. — Syrup of Orange Flowers.
Unofficial Preparation.
Oleum Aurantii Florum (U. S. P., 1890). — Oil of Orange
Flowers. (Oil of Neroli.)
Action of Orange.
Orange is slightly bitter and aromatic, stomachic and tonic.
Its oil has the action of other volatile oils. In large amounts
it is a gastro-intestinal irritant and may give rise to convul-
sions. Persons much exposed to its fumes are liable to skin
eruptions and various nervous disorders.
Therapeutics of Orange.
The preparations of the orange are used extensively for fla-
voring purposes. The aromatic and adjuvant elixirs are excel-
lent flavoring agents and vehicles for liquid medicines.
LEMON.
LIMONIS CORTEX.— Lemon Peel.
Preparation.
Tinctura Limonis Corticis. — Tincture of Lemon Peel.
OLEUM LIMONIS.— Oil of Lemon. Dose, 0.2 c.c.; 3 m..
Unofficial Preparation.
Spiritus Limonis (U. S. P., 1890). — Spirit of Lemon. (Es-
sence of Lemon.) Dose, 2 c.c; 30 TT\.
LIMONIS SUCCTJS.— Lemon Juice. Dose, 30 c.c; 1 fl. oz.
Action of Lemon.
The same as that of orange.
Therapeutics of Lemon.
The preparations of the lemon, like those of the orange, are
employed as flavoring agents. The oil may be applied exter-
nally as a rubefacient, but is seldom used for this purpose.
656 PHARMACOLOGY AND THERAPEUTICS.
Action of Lemon Juice.
Lemon juice, which contains a considerable amount of free
citric acid, has the same action as this acid (see pp. 331 and
342).
Therapeutics of Lemon Juice.
Lemon juice, in the form of lemonade and various effer-
vescing mixtures, relieves thirst and makes an otherwise re-
freshing beverage. Hot lemonade, to which whiskey or gin
is often added, is useful as a diaphoretic in commencing colds.
Lemon juice is also largely employed for flavoring flaxseed tea
and the mildly nutritive drinks given in fevers. Its most im-
portant medicinal use is in the prophylaxis and treatment of
scurvy, in which lemon and lime juice may almost be consid-
ered specifics. Orange juice is also efficient. The beneficial
effect appears to be due, not to the citric acid, but to some
unknown property of the fruit juices. 90 to 120 c.c. (3 to 4
fl. oz.) should be taken daily. A somewhat larger amount is
said to have afforded marked relief in certain cases of rheu-
matism, both chronic and acute. Lemon juice is one of the
popular remedies in this disease, though not very much reliance
is probably to be placed upon it. Its local application is effi-
cient in arresting post-partum haemorrhage. For this purpose
a gashed lemon should be carried up into .the uterine cavity and
squeezed, when vigorous contractions will be excited in the
same manner as by squeezing in the uterus a rag saturated with
vinegar. Lemon juice is applied to the integument to relieve
pruritus and to remove sunburn, freckles, moth-spots, and ink-
stains. For sunburn an excellent lotion is made of equal parts
of lemon juice and glycerin, with the addition of some bismuth
subnitrate.
PEPPER.
PIPER.— Pepper. (Black Pepper.) Dose, 0.500 gm. (500
milligm.); 7V2 gr.
Preparation.
Oleoresina Piperis. — Oleoresin of Pepper. Dose, 0.030 gm.
(30 milligm.) ; y2 gr.
PIPERINA.—Piperine. Dose, 0.200 gm. (200 milligm.) ; 3 gr,
PYRETHRUM. 657
Action of Pepper.
By reason of its volatile oil, pepper has much the same action
as cloves. In the course of its excretion it acts as a disinfect-
ant and stimulant to the genito-urinary tract, and it is reputed
to be feebly antiperiodic and antipyretic.
Therapeutics of Pepper.
In the form of ointment pepper is efficient in tinea capitis.
It is occasionally employed for counter-irritation, as a substi-
tute for mustard, and, in washes and gargles, for relaxed con-
ditions of the gums and throat. It is universally used as a
condiment, and its chief medical application is to stimulate the
stomach and correct flatulence. Pepper lozenges, or the con-
fection (B. P., Pepper, 2; carroway, 3; honey, 15. Synonym,
Ward's paste), are sometimes given for the relief of ulcers of
the rectum, anal fistulae and fissures, haemorrhoids, gleet and
leucorrhcea. In malarial fevers the oleoresins of both black
pepper and capsicum have sometimes proved of service as adju-
vants to other remedies. Piperine has been used in cholera as
a stimulant, local and general, and in low conditions of the
system from various causes other than gastro-intestinal inflam-
mation.
PYRETHRUM.
PYRETHRUM.— Pyrethrum. (Pellitory.) Dose, 2 gm.; 30 gr.
Preparation.
Tinctura Pyrethri. — Tincture of Pyrethrum.
Action of Pyrethrum.
Pyrethrum is an irritant sialogogue. When chewed it has a
prickly, pungent effect upon the mouth, tongue and fauces, and
excites a free secretion of saliva and buccal mucus. It is a
rubefacient and when inhaled into the nostrils causes sneezing.
Internally it has the characteristic action of the volatile oils,
and when taken in considerable quantities may cause gastro-
enteritis, with bloody stools, and more or less stupor. In a
43
658 PHARMACOLOGY AND THERAPEUTICS.
child 2^/2 years old tetanoid convulsions were also produced
by it.
Therapeutics of' Pyrethrum.
It is chewed as a masticatory in paralysis of the tongue, and
when in other conditions an increased flow of saliva is desired.
In neuralgic, rheumatic, or other painful affections of the
tongue or teeth it may also be chewed or held in the mouth, as
the burning sensation to which it at first gives use is followed
by one of numbness; the stimulation of the nerves of the parts
which it causes being succeeded by depression and a blunted
sensibility. For the aching of a carious tooth a few drops of
the tincture may be introduced into the cavity on cotton wool.
Properly diluted, it makes an efficient lotion for scorbutic and
other forms of sore mouth and gargle for relaxed uvula. Pyre-
thrum is sometimes used as an ingredient of tooth-powders. Its
sialogogue action has been found of service in the removal of
iodine from the system in cases of chronic poisoning by that
drug. The powder has been recommended as a sternutatory in
chronic catarrh of the frontal sinuses. Persian insect powder
consists of the flowers of the chrysanthemum (or pyrethrum)
roseum, a variety of pellitory growing in Asia.
CAPSICUM.
CAPSICUM. — Capsicum. (Cayenne Pepper. Guinea Pepper.)
Dose, 0.065 gm. (65 milligm.) ; 1 gr.
Preparations.
1. Fluidextractum Capsici. — Fluidextract of Capsicum. Dose,
0.05 c.c; 1 TTL.
2. Oleoresina Capsici. — Oleoresin of Capsicum. Dose, 0.030
gm. (30 milligm.) ; y2 gr.
3. Tinctura Capsici. — Tincture of Capsicum. Dose, 0.5 c.c;
8 rc\,.
4. Emplastrum Capsici. — Capsicum Plaster.
5. Pilulae Podophylli, Belladonnae et Capsici. — Pills of
Podophyllum, Belladonna and Capsicum. Dose, 1 pill.
CAPSICUM. 659
Action of Capsicum.
Although it contains no volatile oil, the action of capsicum
is like that of the volatile oils generally. It is a powerful local
irritant, its oleoresin when applied to the skin producing in a
short time intense pain and redness, and eventually destroying
the cuticle. In the alimentary canal it acts in a similar way.
In the stomach, in small doses, it occasions a feeling of warmth,
excites hyperemia, and stimulates the muscular coat and the
secretions, while large doses give rise to gastro-enteritis, which
after a time is accompanied by strangury and other evidences
of irritation of the genito-urinary tract. Aphrodisiac effects
have sometimes been noted. It is chiefly eliminated by the
kidneys, and moderate amounts increase the flow of urine. It
is a powerful stimulant to the heart, and thus increases the
strength and frequency of the pulse.
Therapeutics of Capsicum;
External. — The tincture of capsicum, like that of cantharides,
has been used to stimulate the scalp in the various forms of
alopecia, and it is frequently employed as a domestic remedy
for toothache and chilblains. The diluted tincture, or an infu-
sion, makes a serviceable gargle in scarlet fever and for relaxed
uvula, pharyngitis, and other throat affections. In tonsillitis
the tincture, with an equal quantity of glycerin, may be topically
applied by means of a swab. The tincture is used in making
up rubefacient liniments, and capsicum ointment (B. P.) is also
employed as a counter-irritant (Capsicum, 6; spermaceti, 3;
olive oil, 22). This resembles Smedley's paste. A strong tinc-
ture of capsicum-pods, mixed with an equal quantity of muci-
lage of gum arabic, has been recommended in chilblains (when
the surface is unbroken), discolored bruises, chronic rheumatic
pains, etc. The preparation is brushed two or three times upon
tissue paper, which is then applied to the affected surface.
Capsicum plaster is quite extensively used as a rubefacient and
counter-irritant.
660 PHARMACOLOGY AND THERAPEUTICS.
Internal. — Capsicum is much used as a condiment. In medi-
cine it is an excellent remedy for flatulent colic and for cases
of atony of the stomach due to general debility, errors in diet,
and subacute and chronic alcoholism. In acute alcoholism it
should be given with caution, if at all, as there is likely to be
present more or less gastric irritation, which may be aggra-
vated by the drug. After a few days it may usually be given
with advantage, as it serves to increase the appetite and diges-
tive power, and by its stimulating effect and the hot sensation
to which it gives rise it often satisfies, at least to some degree,
the craving for liquor. In these cases the tincture may be
administered every four or five hours in doses of .30 to .60 c.c.
(5 to 10 ni), or the oleoresin in a pill containing .03 to .06 gm.
(^ to 1 gr.). In delirium tremens capsicum is often valuable
in quieting restlessness and inducing sleep. It should here be
given in a dose of about 2 gm. (30 gr.), which may be admin-
istered in an animal broth or made into a bolus with syrup or
honey. Tincture of capsicum has been resorted to in the treat-
ment of the opium, as well as the alcohol, habit. Capsicum
tends to check albuminuria, and is therefore sometimes of ser-
vice in chronic parenchymatous nephritis. It may also prove
beneficial in functional torpidity of the kidney, but it is never
admissible in acute renal inflammation. In chronic pyelitis,
chronic cystitis, and prostatorrhcea it is of some value, though
not as efficient as cubeb. Good results may often be obtained
from it in functional impotence and in spermatorrhoea from
deficient tone. The oleoresin is the best preparation for use in
these genito-urinary affections. Capsicum has been given as
a diffusible stimulant in low fevers, but is more useful in the
anorexia and impaired digestion of convalescence.
GINGER.
ZINGIBER.— Ginger. Dose, 1 gm.; 15 gr.
Preparations.
1. Fluidextractum Zingifoeris. — Fluidextract of Ginger.
Dose, 1 c.c; 15 IT],.
CARDAMOM. - 66 I
2. Oleoresina Zingiberis. — Oleoresin of Ginger. Dose, 0.030
gm. (30 milligm.) ; y2 gr.
3. Tinctura Zingiberis. — Tincture of Ginger. Dose, 2 c.c;
30 tti.
4. Syrupus Zingiberis. — Syrup of Ginger. Dose, 16 c.c;
4 fl. dr.
5. Pulvis Aromaticus. — Aromatic Powder. Dose, 1 gm.; 15
gr.
6. Fluidextractum Aromaticum. — Aromatic Fluidextract.
Dose, 1 c.c; 15 1TI.
Unofficial Preparation.
Trochisci Zingiberis (U. S. P., 1890). — Troches of Ginger.
Dose, freely.
Action of Ginger.
Ginger has the same action as that of other substances con-
taining aromatic volatile oils.
Therapeutics of Ginger.
It is much used as a stomachic, carminative, and flavoring
agent. It is a favorite domestic remedy for colic, and, given
in hot water, is also frequently employed as a sudorific and
stimulant in the pain due to acute suppression of the menses.
It is administered in association with various other remedies
in the treatment of atonic dyspepsia, especially in elderly per-
sons, and is useful in flatulence and some forms of diarrhoea.
It may be given with salines to disguise their taste, and the
oleoresin is a useful addition to purgative pills to prevent
griping.
CARDAMOM.
CARDAMOMTJM. — Cardamom. Dose, 1 gm.; 15 gr.
Preparations.
1. Tinctura Cardamomi. — Tincture of Cardamom. Dose, 4
c.c; 1 fl. dr.
2. Tinctura Cardamomi Composita.— Compound Tincture of
Cardamom. Dose, 4 c.c.; 1 fl. dr.
662 PHARMACOLOGY AND THERAPEUTICS.
3. Pulvis Aromaticus. — Aromatic Powder. Dose, 1 gm.; 15
gr.
4. Fluidextractum Aromaticum. — Aromatic Fluidextract.
Dose, 1 c.c; 15 n\,.
Action of Cardamom.
Cardamom is carminative and stomachic, acting, by reason
of its volatile oil, like cloves or pepper.
Therapeutics of Cardamom.
As the compound tincture has a bright red color, due to its
cochineal, and an agreeable aromatic taste, it is frequently
employed as a coloring and flavoring agent. It is a customary
addition to mixtures given for the relief of flatulent colic, and,
mixed simply with sweetened hot water, is also a favorite rem-
edy for such affections. The Tinctura Carminativa of the
British Pharmaceutical Conference is likewise an excellent
flavoring carminative. (Cardamom, 6; tincture of ginger, 6;
oil of cinnamon, oil of cloves, oil of caraway, of each, i ; recti-
fied spirit to 96. Dose, .12 to .60 c.c; 2 to 10 HI.) Cardamom
makes one of the best flavoring additions to saline solutions or
mixtures, and when combined with purgatives is very efficient
in correcting flatulence and griping.
PEPSIN.
PEPSINXJM.— Pepsin. Dose, 0.250 gm. (250 milligm.) ; 4 gr.
Unofficial Preparation.
Pepsinum Saccharatum (U. S. P., 1890). — Saccharated Pep-
sin. Dose, 1 gm.; 15 gr.
Action of Pepsin.
The only action of pepsin, which is a normal constituent of
the gastric juice, appears to be on the digestive system. In the
presence of hydrochloric acid it digests the proteid elements of
the food, converting them into albumoses, and finally into pep-
tones. In alkaline solution it is not only inert, but is rapidly
decomposed.
PEPSIN. 663
Therapeutics of Pepsin.
Pepsin is usually prescribed on the hypothesis that in cer-
tain conditions the stomach does not secrete a sufficient quan-
tity of it. It has been questioned, however, whether this is true
in even a small proportion of the cases in which this ferment
is given, since the gastric juice is found to be almost always
capable of digesting proteids if it is acid in reaction. In a
number of forms of dyspepsia, while the acid secretion is defi-
cient, pepsin is generally present in quantity, since it will digest
proteids outside the body as soon as it becomes acid in reaction.
Consequently, pepsin would seem to be indicated only in those
instances in which the gastric contents acidulated with hydro-
chloric acid fail to perform their digestive work. Pepsin may
be used as an aid to stomach digestion in those in whom from
old age, continued illness, or other cause, the secretion of gas-
tric juice is inadequate. It has been found to be more certain
in its effects in the impaired digestion of infants than of adults,
and this has been attributed by some, who hold that the ordi-
nary quantities given to adults are entirely too small, to the
fact that to young children it is administered in proportionately
much larger doses. When it is prescribed together with alka-
line carbonates, any effects produced are due entirely to the lat-
ter, the pepsin being decomposed in the presence of alkalies.
It is naturally of no service in promoting the digestion of fatty
or carbohydrate foods. Unless obtained from an absolutely
reliable source, pepsin should be tested before giving it to a
patient, as many of the specimens sold are quite inert. It
should be administered, in a powder, pill or tablet, immediately
after meals, and followed in about half an hour with a suitable
dose of hydrochloric acid. One of the applications now made
of pepsin is the predigestion by it of albuminous food, which
may then be given either by the mouth or the rectum, and as
morbid processes which interfere with digestion may be going
on in the stomach, this method is not infrequently preferable to
using the ferment in the ordinary way. As a rule, however,
pancreatin is found to be of more service for purposes of pre-
664 PHARMACOLOGY AND THERAPEUTICS.
digestion than pepsin. The rectum, as is well known, has only-
very feeble digestive powers, and consequently nutrient ene-
mata or suppositories should always be predigested. In the use
of predigested foods, either by the mouth or rectum, much dis-
cretion should be employed, and except in case of absolute
necessity the method should not be maintained for a very long
period continuously, as there is some danger that the digestive
functions of the stomach, from lack of use, may become inca-
pable of action.
Meat may be peptonized in the following manner: Reduce
to a fine pulp 450 gm. (1 pound) of lean meat, add six times
its weight of water containing 0.2 per cent, of hydrochloric
acid and 8 gm. (120 gr.) of pepsin, and digest at 480 C. (1200
F.) in a porcelain digester for five or six hours, with frequent
stirring; neutralize with sodium carbonate, boil and filter;
evaporate the filtrate on a water-bath until it is of the con-
sistency of a soft extract. Peptonized meat suppositories are
often very serviceable. To make one suppository 2 gm. (30
gr.) of the above extract is mixed with 2.40 gm. (40 gr.) of
oil of theobroma, and shaped in a conical mould.
PANCREATIN.
PANCREATINUM.— Pancreatin. (Zymine.) Dose, 0.500 gm. (500
milligm.); 7y2 gr.
Unofficial Preparation.
Trypsinum. — Trypsin.
Action of Pancreatin.
Pancreatin, in the presence of alkalies, has the power of
digesting albuminoids and all proteid substances, which are
changed to peptones, of converting starch into sugar, and, when
not over twenty-four hours old, of emulsionizing fats. It co-
agulates and then peptonizes milk, and will also peptonize gruel,
oysters and many other articles of diet. It is incapable of act-
ing in an acid medium, or in a temperature above 6o° C.
(1400 R).
VALERIAN. 665
Therapeutics of Pancreatin.
It is used as an artificial agent to assist the digestion of in-
valids and of old persons, or those prostrated by fever or ex-
haustion. Also by means of it food may be partially or
wholly digested previous to administration. It should be used
in combination with an alkali, as sodium bicarbonate, in the
proportion of 1 to 4. Nutritive enemata should be thoroughly
pancreatized. If pancreatin be administered two hours after
meals it will assist intestinal digestion, and it is especially indi-
cated in those conditions in which starch and fat are imper-
fectly digested. It should be preceded by full doses of sodium
bicarbonate, or other alkali, to insure an alkaline reaction in
the contents of the stomach. It is sometimes of service in the
vomiting of pregnancy or of hysteria. In diphtheria a spray
of trypsin (the proteolytic ferment of pancreatin) or of pan-
creatin solution has been used with considerable success for
the purpose of dissolving the false membrane and promoting
its expulsion. Pancreatin has also been employed in the blad-
der, like pepsin, to dissolve blood-clots resulting from haemor-
rhage.
VALERIAN.
VALERIANA.— Valerian. Dose, 2 gm.; 30 gr.
Preparations.
1. Fluidextractum Valerianae. — Fluidextract of Valerian.
Dose, 2 c.c; 30 n\..
2. Tinctura Valerianae. — Tincture of Valerian. Dose, 4 c.c;
1 fl. dr.
3. Tinctura Valerianae Ammoniata. — Ammoniated Tincture
of Valerian. Dose, 2 c.c; 30 m,.
AMMONII VALERAS.— Ammonium Valerate. Dose, 0.500 gm.
(500 milligm.) ; 7V2 gr.
ZINCI VALERAS.— Zinc Valerate. Dose, 0.125 gm. (125 mil-
ligm.) ; 2 gr.
Unofficial Preparations of Valerian.
Ferri Valerianas (U. S. P., 1890). — Ferric Valerianate.
(Ferric Valerate.) Dose, 0.05 to 0.15 gm.; 1 to 3 gr.
666 PHARMACOLOGY AND THERAPEUTICS.
Quininse Valerianas (U. S. P., 1890). — Quinine Valerianate.
(Quinine Valerate.) Dose, 0.05 to 2.00 gm.; 1 to 30 gr.
Sodii Valerias. — Sodium Valerate. Dose, 0.05 to .30 gm.; 1
to 5 gr.
Oleum Valerianae. — Oil of Valerian. Dose, .12 to .30 c.c;
2 to 5 HI.
Action of Valerian and the Valerates.
Neither valerianic acid nor ammonium, ferric, sodium, qui-
nine or zinc valerates are known to have any physiological
action, although their extensive use warrants the belief that
they are valuable remedies. Valerian itself acts in virtue of
its volatile oil, which has the same properties as other volatile
oils. Valerian is therefore an irritant when applied externally,
causing redness, itching and warmth by reason of the local
dilatation of vessels which it induces. Internally it stimulates
the mouth (leading to a reflex secretion of saliva) and the
gastro-intestinal tract. It causes increased appetite and in the
stomach a sense of warmth and comfort, with reflex stimula-
tion of the heart and nervous system. The slight irritation
produces hyperemia of the mucous membrane, with some in-
crease of secretion, and the movements of the stomach are
accelerated. Similar effects are observed in the intestine.
While nervous effects are produced reflexly by the local action,
sufficient doses affect the central nervous system independently
of such local action. There is a preliminary stimulation fol-
lowed by a depression of the nerve-cells, and the higher divi-
sions of the central axis are more markedly acted upon than
the lower. Excretion takes place principally by the lungs and
kidneys, and in the course of this action some irritation and
increased secretion may be induced in these organs. The heart
is stimulated indirectly, but does not seem to be affected except
in this indirect manner. It has been found that in cases of
poisoning by the volatile oil the collapse and shock may alter
the cardiac contractions, but direct effects on the cardiac mus-
cle, it is stated, have not been shown to be produced, unless
when enormous quantities are injected intravenously. Under
CYPRIPEDIUM. 66?
large doses by the mouth nausea, hiccough, eructations of the
drug, vomiting and diarrhoea may be caused.
Therapeutics of Valerian and the Valerates.
Valerian in various forms is much used as a carminative for
the relief of flatulence, especially in hysterical conditions. Any
feeling of fullness after meals is removed, and this is often
accompanied by the eructation of quantities of gas. Though
the oil is not official, it is more efficient as a carminative than
the valerates. It is most conveniently administered suspended
in mucilage with cinnamon water. The tincture and fluid-
extract also usually promptly relieve the flatulence of the
hysterical and hypochondriacal. Preparations of valerian are
likewise serviceable as reflex stimulants in syncope, palpi-
tation, etc., and their chief therapeutic use is in the treat-
ment of nervousness, hysteria and hysterical disorders gen-
erally. In these ammonium valerate is preferred by many.
In neuralgic conditions they sometimes prove of value, ai d
again fail to give relief. As a rule, the best preparation here
is zinc valerate, which has also been employed with some suc-
cess in nervous affections such as chorea and epilepsy. In
both forms of diabetes the fluidextract has been used tempor-
arily with advantage. It serves to diminish the amount of
urinary water, and in the saccharine variety to lessen the ex-
cretion of sugar. It has no curative effect, however, for as
soon as the remedy is discontinued all benefit from it ceases.
CYPRIPEDIUM.
CYPRIPEDIUM.— Cypripedium. (Ladies' Slipper.) Dose, 1 gm.;
15 gr.
Preparation.
Fluidextractum Cypripedii. — Fluidextract of Cypripedium.
Dose, 1 c.c; 15 TTt.
Action of Cypripedium.
Cypripedium is a gentle, nervous stimulant, resembling vale-
rian in its action.
668 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Cypripedium.
It has been used for nervous diseases, epilepsy, hypochon-
driasis and neuralgia, but is not a very reliable remedy.
ASAFETIDA.
ASAFCETIDA.— Asafetida. Dose, 0.250 gm. (250 milligm.) ; 4 gr.
Preparations.
1. Emulsum Asafoetidas. — Emulsion of Asafetida. (Mistura
Asafoetidae. Milk of Asafetida.) Dose, 16 C.C.; 4 fl. dr.
2. Pilulae Asafoetidae. — Pills of Asafetida. Dose, 2 pills.
3. Tinctura Asafoetidae. — Tincture of Asafetida. Dose, 1
c.c; 15 nr.
Unofficial Preparation.
Pilulae Aloes et Asafoetidae. — Pills of Aloes and Asafetida.
Dose, 1 to 5 pills.
Action of Asafetida.
Owing to its containing allyl sulphide, asafetida is extremely
unpleasant to the taste. Its action is due entirely to its vola-
tile oil, the external and internal effects of which are those of
the volatile oils in general. On the intestine it has a specially
marked stimulant action, expelling flatus and producing an
efficient carminative effect. Large doses may cause nausea and
vomiting, though the action of the drug varies greatly in dif-
ferent individuals. A series of experiments showed that in a
number of persons headache and giddiness, with some aphro-
disiac effect, were produced by 1.20 gm. (20 gr.), while others
took as much as 15 gm. (l/2 oz.) with no other result than
offensive eructations and foul-smelling faeces. It often has a
powerful stimulant and antispasmodic effect upon the nervous
system, and there is reason to believe that in hysterical sub-
jects this is in part at least due to the mental influence result-
ing from the odor and taste of the drug. In some women an
emmenagogue effect has been noticed from it. It is excreted
by the lungs, skin and kidneys, and is found to act like other
volatile oils in increasing and disinfecting the secretions.
asafetida. 669
Therapeutics of Asafetida.
Extraordinary as this may seem, asafetida is used in India
as a condiment, but it is a fact also that valerian was formerly
employed in England as a perfume. Were it not for its un-
pleasant characteristics, and especially the extremely disagree-
able eructations to which it gives rise, asafetida might prove
very useful as a stomachic tonic in atonic dyspepsia accom-
panied by torpor of the bowel. It is contained in small amount
in some of the popular sauces. The emulsion was long held
in high repute in the flatulent colic of infants, and is still used
to some extent, though most practitioners prefer to give reme-
dies less obnoxious to the attendants, if not to the little patients
themselves. Asafetida is especially serviceable in the flatu-
lence of neurotic subjects, expelling the flatus, promoting intes-
tinal secretion and digestion, and relaxing the bowels; and it
is commonly very well borne by this class of individuals. The
pill of aloes and asafetida is a favorite form of administering
the drug, particularly when there is constipation associated with
amenorrhcea, and an asafetida enema (1 to 64 of water) is also
used to relieve flatus. Partly on account of its reflex stimulat-
ing effect, and partly on account of the moral effect of its
offensive odor and taste, this remedy is not infrequently em-
ployed to control hysterical, emotional and other mental dis-
turbances, and for this purpose it is sometimes combined with
valerian. Although asafetida, in the course of its excretion,
would serve a useful purpose in disinfecting the urine and the
expectoration, its disagreeableness ordinarily prevents its use
for these purposes. Still, it is occasionally employed in sub-
acute bronchitis and bronchorrhcea (especially in old people),
the cough succeeding the paroxysmal stage of pertussis (which
is often maintained by habit), and the sympathetic cough of
mothers whose children are suffering from whooping-cough ;
all of which conditions are found to be greatly benefited by it.
This remedy is of service in the convulsions of children from
reflex irritation, though it is useless in those depending upon
cerebral or renal disease ; and may also be given with advantage
67O PHARMACOLOGY AND THERAPEUTICS.
in chorea, particularly in young girls about the period of
puberty and when the affection is associated with menstrual
difficulty. The chronic scaly eruptions (eczema, etc.), espe-
cially when the skin is dry and harsh, are said to be much im-
proved by the persistent use of the drug, but few patients, it
may well be imagined, would be willing to submit to such a
course of treatment. One of the ways of treating cases of
malingering is to make the patient take, three times a day, an
effervescing draught containing a few drops of the tinctures
of asafetida and valerian; the effervescence causing the un-
pleasant taste of the medicines to recur in the mouth for some
time after they have been swallowed.
AMMONIAC.
Unofficial Preparations.
Ammoniacum (U. S. P., 1890). — Ammoniac. Dose, 0.30 to
2 gm.; 5 to 30 gr.
Emplastrum Ammoniaci cum Hydrargyro (U. S. P., 1890).
— Ammoniac Plaster with Mercury.
Emulsum Ammoniaci. — Emulsion of Ammoniac (U. S. P.,
1890). — Dose, 15 to 30 c.c; y2 t0 1 fl« oz-
Action of Ammoniac.
Externally and internally the action of ammoniac is that of
volatile oils. On the skin its irritant effect, which is usually
mild, sometimes gives rise to a papular eruption. It is a stimu-
lating expectorant and a laxative. Its action is very similar
to that of asafetida, but while the drug is free from the objec-
tionable features of the latter, its effects are considerably less
powerful.
Therapeutics of Ammoniac.
The plaster is employed as a stimulant alterative and resol-
vent in glandular enlargements and indolent swellings, espe-
cially of the joints and periosteum, and is sometimes useful for
small patches of very chronic skin diseases. The principal use
of ammoniac internally is as an expectorant. Being excreted
MYRRH. 67I
by the bronchial mucous membrane, it increases and disinfects
the secretion of the latter, and this makes it a useful remedy in
chronic bronchitis with offensive expectoration. It is largely
employed for old people, in whom the bronchitis is often accom-
panied by emphysema, and its beneficial effect is increased by
combining ammonium carbonate or chloride with it.
GALBANUM.
Unofficial Preparation.
Galbanum. — Galbanum. Dose, 0.30 to 1.20 gm.; 5 to 20 gr.
Action of Galbanum.
It is stimulant, expectorant and antispasmodic, like other sub-
stances containing a volatile oil. Its effects, in general, are
similar to those of asafetida and ammoniacum, with one or the
other of which it has usually been prescribed. Applied to the
cutaneous surface, it occasions a papular eruption, and, if the
true skin is exposed, causes it to ulcerate.
Therapeutics of Galbanum.
It has been used as a carminative, expectorant and emmena-
gogue and as an alterant in chronic rheumatism. At the pres-
ent time it is very rarely employed internally, its principal
use being as an ingredient of stimulating or resolvent plasters
for indolent swellings. The following is a good formula for
such a plaster : Galbanum, 1 ; ammoniacum, 1 ; yellow wax, 1 ;
lead plaster, 8.
MYRRH.
MYRRHA.— Myrrh. Dose, 0.500 gm. (500 milligm.) ; 7y2 gr.
Preparations.
1. Tinctura Myrrhae. — Tincture of Myrrh. Dose, 1 c.c;
15 TTL-
2. Tinctura Aloes et Myrrhae. — Tincture of Aloes and
Myrrh. Dose, 2 C.C.; 30 TTt.
672 PHARMACOLOGY AND THERAPEUTICS.
3. Pilulae Aloes et Myrrhae. — Pills of Aloes and Myrrh.
Dose, 2 pills.
4. Mistura Ferri Composita. — Compound Iron Mixture.
Dose, 16 c.c; 4 fl. dr.
Action of Myrrh.
External. — Locally applied it is mildly irritant to the skin
and stimulant and disinfectant to mucous membranes and ulcer-
ated surfaces.
Internal. — Its internal, as well as its external, effects are due
to its volatile oil. In moderate doses it is carminative, stimu-
lant and tonic, and in large doses a gastro-intestinal irritant,
exciting vomiting and purging. It is excreted by mucous mem-
branes, especially the bronchial and the genito-urinary, and it
is believed to increase the number of leucocytes in the blood.
It has expectorant qualities and is also reputed to be a stimu-
lant to the ovarian and uterine functions.
Therapeutics of Myrrh.
External. — The tincture is sometimes used for the removal
of freckles, and a lotion or ointment containing myrrh may be
applied as a stimulant and antiseptic dressing to indolent or
unhealthy ulcers. In cases of eczema requiring moderate
stimulation an ointment made by heating together myrrh with
wax and oils has been found useful. The undiluted tincture
may be applied to ulcerated gums, aphthous patches, and re-
laxed uvula. Diffused in water (1 to 16), with the addition
of a little carbolic acid or thymol, the tincture is a good mouth-
wash for spongy gums, for mercurial ptyalism, or for wounds
after operations upon the mouth, and may also be used as a
gargle in pharyngitis, etc. As a mouth-wash it is very com-
monly associated with borax, as in the following formula:
Myrrh, 1; Cologne water, 16; borax, 1; water, 3; syrup, 3.
Myrrh has long been employed as an ingredient of dentifrices.
Internal. — Its internal administration is considered of ser-
vice in checking excessive discharges: bronchorrhcea, leucor-
BISMUTH. 673
rhoea, cystitis, etc. It has some vogue as a disinfectant expec-
torant for chronic bronchitis, and under the name of myrrholin
a concentrated solution of one part of myrrh in one part of
oil, conjoined with creosote, has been given in capsules in pul-
monary tuberculosis. It has also been brought forward as a
remedy for diphtheria, in which it is administered internally
and likewise applied locally to the pharynx. In laryngeal diph-
theria frequent inhalations are advised of from 8 to 15 c.c. (2
to 4 fl. dr.) of a 2 per cent, mixture of myrrh. Myrrh is fre-
quently prescribed with purgatives on account of its carmina-
tive and stomachic properties, and, in combination with other
remedies, is more or less employed in atonic dyspepsia and gas-
tralgia. It is considered more especially useful in such condi-
tions when they are associated with flatulence, mucous evacua-
tions, constipation, and the presence of nervous disorders of a
hysterical or hypochondriacal character. Here it may profit-
ably be combined with vegetable bitters and iron. The com-
pound iron mixture, in which myrrh is one of the chief con-
stituents, is quite extensively used in amenorrhcea connected
with anaemia and general torpor of the system. It has been
doubted by some whether myrrh really has any effect on the
menstrual function, its apparent value in amenorrhcea being due,
it is alleged, to the iron, aloes, or other drugs usually combined
with it. It has remained in use as an emmenagogue, however,
for a very long time, and in this capacity still seems to retain
the confidence of the profession.
(b) Gastric Sedatives.
BISMUTH.
1. BISMTJTHT CITRAS.— Bismuth Citrate. Dose, 0.125 gm. (125
milligm.) ; 2 gr.
2. BISMUTHI ET AMMONII CITRAS.— Bismuth and Ammo-
nium Citrate. Dose, 0.125 gm. (125 milligm.) ; 2 gr.
3. BISMUTHI SUBCARBONAS.— Bismuth Subcarbonate. Dose,
0.500 gm. (500 milligm.) ; 7% gr.
4. BISMUTHI SUBGALLAS.— Bismuth Subgallate. (Dermatol.)
Dose, 0.250 gm. (250 milligm.); 4 gr.
44
674 PHARMACOLOGY AND THERAPEUTICS.
5. BISMUTHI SUBNITRAS.— Bismuth Subnitrate. Dose, 0.500
gm. (500 milligm.); 7y2 gr.
6. BISMUTHI SUBSALICYLAS.— Bismuth Subsalicylate. Dose,
0.250 gm. (250 milligm.); 4 gr.
Unofficial Preparations.
Bismuthi Naphtholas. — Bismuth Naphtholate. (Beta-Naph-
thol Bismuth.) Dose, .30 to 2.00 gm.; 5 to 30 gr.
Bismuthi Oxidum. — Bismuth Oxide. Dose, .30 to 1.20 gm.;
5 to 20 gr.
Bismuthi Oxyiodidum. — Bismuth Oxyiodide. (Red Bismuth
Oxyiodide. Bismuth Subiodide.) Dose, .30 to .60 m.; 5 to
10 gr.
Bismuthi Phenolas. — Bismuth Phenolate. (Phenol-Bismuth.)
Dose, .30 to 2.00 gm.; 5 to 30 gr.
Bismuthi Tetra-iodophenol-phthaleinas. — Bismuth Tetra-
iodophenol-phthaleinate. (Eudoxin.) Dose, .30 to .50 gm.; 5
to 8 gr.
Bismuthi Tribromophenolas. — Bismuth Tribromophenolate.
(Tribromophenol-Bismuth. Xeroform.) Dose, .30 to 2.00 gm.;
5 to 30 gr.
Action of Bismuth Salts.
External. — Bismuth salts have no action on the unbroken
skin. On raw surfaces they are antiseptic and mildly astrin-
gent. When dusted on such a surface they form a protecting
coat over it. Used in this way their value, as in the case of
iodoform, probably depends not so much on their germicidal
action as on their absorption of the fluids of the part, which
renders the surface less favorable for the growth of bacteria.
Internal. — When injected in large quantities directly into the
circulation, bismuth salts produce, like arsenic, a relaxation of
the walls of the capillaries, and it is believed that they have a
direct action on the central nervous system and depress the
vasomotor centre in the medulla. There is also a depressant
action on the cardiac muscle, and from both these influences
the blood-pressure falls rapidly. Late in the poisoning the
heart is often found to stop entirely for some time, and then
suddenly resume its action. The respiration is at first quick-
BISMUTH. 675
ened, and violent convulsions, both clonic and tonic, follow at
short intervals, during which the movements are feeble and
incoordinated. In some animals the respiration ceases before
the heart, and in others the reverse of this is noted. The in-
jection of smaller quantities is followed by more chronic effects,
which resemble those met with in cases of poisoning in the
human subject. In man medicinal doses of the insoluble salts,
although maintained for a long period, produce very few appre-
ciable symptoms. Any action which they may have in increas-
ing peristalsis and the secretion of mucus in the stomach is
probably simply that which would be caused by the presence
of any heavy powder. In the intestine they are said to have
some effect in augmenting the leucocytes of the blood, and
they are apt to induce more or less constipation. The stools
are blackened, a result which is generally supposed to be due
to the formation in the large intestine of bismuth sulphide, but
which is attributed by some to the reduction of bismuth in the
bowel. Occasionally a purplish line makes its appearance on
the gums. As long as bismuth was employed only internally,
no serious effects were produced by its insoluble salts, as it is
now known that certain cases of poisoning formerly ascribed
to them were in reality due to the arsenic, lead or antimony
with which they were contaminated. Since their use was ex-
tended to the treatment of wounds and abraded surfaces, how-
ever, several instances of dangerous intoxication have been
observed, though the patients have generally recovered when
the bismuth dressing was removed. Among the symptoms
which have been noted may be mentioned black spots, or even
gangrene, in the mouth and fauces, swelling of the gums, tongue
and throat, increased flow of saliva, dysphagia, nausea, vomit-
ing, diarrhoea and albuminuria. As much less bismuth is used
for external applications than is often given by the mouth, it
would appear either that the drug is more readily absorbed
from raw surfaces than from mucous membranes or else that
what is absorbed from the alimentary canal is prevented by
the liver from reaching the general circulation. In animals in
676 PHARMACOLOGY AND THERAPEUTICS.
which chronic poisoning is induced by the intravenous or sub-
cutaneous injection of moderate amounts of bismuth salts there
are caused salivation, ulcerative stomatitis, gastro-intestinal
irritation, muscular weakness and incoordination, and usually
tetanic convulsions at intervals, while the urine contains albu-
min and casts. The blood-pressure is low, as a result of the
intestinal disturbance and general collapse, and complete paraly-
sis eventually results. Post-mortem there are found ulcera-
tions of the mouth and gums and of the large intestine, and
inflammation and necrosis of the kidneys. There is also an
intense black pigmentation of the upper part of the large intes-
tine, which is limited very exactly by the ileo-csecal valve and
which extends throughout the thickness of the bowel-wall.
This is caused by the depositing of bismuth sulphide on the
mucous membrane and in the capillary vessels and lymph
spaces, and the ulceration found is no doubt due to the em-
bolism which results from this precipitation in the vessels.
Bismuth is excreted all along the alimentary canal, but par-
ticularly in the large intestine, and also by the urine and pos-
sibly by the milk; and is stored in considerable amount in the
liver. In therapeutic doses bismuth salts, especially the naph-
tholate act as antiseptics, and it is believed that the benefit
derived from them is also due to some extent to their ridding
the intestinal canal of hydrogen sulphide, in consequence of
the avidity of bismuth for this irritant compound.
Therapeutics of Bismuth Salts.
External. — Bismuth salts are useful as dusting powders for
ulcers and excoriated surfaces and as a dressing for wounds,
when not too large. For such purposes the tribromophenolate
and subgallate, the latter also known as dermatol, are preferable.
The subnitrate and subcarbonate are also employed to some
extent. In acne, vesicular eczema, intertrigo and the erythema
of infants one of these salts may be lightly dusted over the
surface. Bismuth compounds are also used in ointments, and
the following will be found serviceable; Bismuth oxide (official
BISMUTH. 677
in B. P.), i part, and oleic acid, 8 parts, stirred in with 3 parts
of white wax liquefied by heat, and with 9 parts of soft paraffin.
By some the red oxyiodide is preferred to iodoform as an anti-
septic for wounds and sores, and also for ointments for skin dis-
eases, and it is recommended as an excellent application to
chancre, chancroids, open buboes, ulcers, unhealthy wounds,
and phlegmonous erysipelas. The subnitrate, snuffed into the
nostrils, is sometimes employed in coryza and simple ozaena and
as a tropical application in aphthous or nursing sore mouth,
mercurial ptyalism, chronic conjunctivitis and granular lids.
An ointment composed of bismuth subnitrate, boric acid, lanolin
and olive oil has been found especially suited to the treatment
of burns in children. The subnitrate, suspended in mucilage,
may be used as an injection for gonorrhoea or leucorrhGea. It
may also be applied in the form of soluble bougies and supposi-
tories, and preparations of this kind are of service for ulcers
of the rectum.
Internal. — Bismuth salts are used internally chiefly for their
local action upon the alimentary tract, as they form a protec-
tive coating over the irritated or inflamed surfaces and keep
them from coming in contact, and also exert an astringent,
sedative and antiseptic influence. The ones perhaps most fre-
quently prescribed are the subnitrate and subcarbonate, which
are safer and also appear to be more efficient than the soluble
salts. The latter when absorbed are likely to act as irritant
poisons, and for this reason should not be used. The insoluble
compounds are best given suspended in mucilage, which should
be made with tragacanth, for when acacia is used a compact
mass is formed at the bottom of the bottle. However they may
effect these results, bismuth preparations are very efficacious in
relieving gastric pain, whether due to organic disease, such as
scirrhus, or to less serious causes, and also not infrequently in
checking vomiting of whatever origin. They are said not to
be beneficial in the gastralgia of chlorosis and hypochondriasis,
nor in that produced by habitual constipation. In the latter
condition they are naturally contra-indicated on account of
678 PHARMACOLOGY AND THERAPEUTICS.
their astringent effects. They are of great service in both
acute and chronic gastritis, and also in gastric ulcer, where
they not only alleviate the pain but contribute to the cure of
the condition. In these painful affections their good effects
are increased by having morphine combined with them.
Sodium bicarbonate also often enhances their effects as gas-
tric sedatives, but it should not be prescribed in a mixture with
bismuth subcarbonate, as the formation of carbon dioxide is
likely to result. Bismuth salts are also useful in the treatment
of diarrhoea of various kinds. They are generally most effi-
cient when given in large doses, and this is especially true in
that of tuberculosis and in chronic diarrhoea. For internal use
the phenolate and naphtholate are preferable to the inorganic
salts. The subsalicylate is also a very useful preparation. It
probably passes through the stomach unchanged to be broken
up in the small intestine where it acts as an unirritating anti-
septic. It has been proved to be a valuable remedy in the
treatment of diarrhoeas, typhoid fever, and catarrhs of the ali-
mentary tract. Reliable observations in Asiatic cholera prove
that the tribromophenolate (xeroform) is a valuable intestinal
antiseptic. Bismuth subgallate was formerly much employed in
the treatment of gastro-intestinal indigestion, but has been
largely supplanted by the more efficient naphtholate and tribro-
mophenolate.
Eudoxin (not official) is bismuth tetra-iodophenol-phthalein-
ate, and occurs as a tasteless, odorless, reddish-yellow, insoluble
powder. This is decomposed in the intestines, and is claimed
to be a germicide. It is certainly known that iodine is liber-
ated. It is employed as an intestinal antiseptic.
TOXICOLOGY.
When applied in large quantity to an exterior wounded surface suffi-
cient bismuth may be absorbed to produce poisoning. This may also
occur if glycerin is used to form an emulsion for injection into closed
cavities (abscesses, joint-disease).
Symptoms. — These are acute stomatitis with a peculiar blackish dis-
coloration of the mucous membrane, generally upon the borders of
CERIUM. 679
the teeth and extending over the whole mouth, ulceration of the mucous
membrane, intestinal catarrh, pain and diarrhoea. Even desquamative
nephritis may be set up.
Treatment. — Use demulcents.
CERIUM.
CERII OXALAS. — Cerium Oxalate. (Cerous Oxalate.) Dose,
0.065 gm. (65 milligm.) ; 1 gr.
Action of Cerium Oxalate.
Very little is known of the effects of cerium oxalate, but
when injected into the circulation it is said to produce gastro-
intestinal irritation, .with vomiting and diarrhoea and hyper-
emia and ecchymoses of the mucous membranes, and also con-
gestion or inflammation of the kidneys. It seems to be ab-
sorbed with difficulty from the stomach and bowel.
Therapeutics of Cerium Oxalate.
It is used empirically as an anti-emetic, and especially for
the vomiting from pregnancy, seasickness and other conditions
in which gastric irritation is not the primary cause. It is not
known how it acts in controlling emesis, but it is thought prob-
able that its effects are local and similar to those of bismuth
subnitrate. The dose above given is often exceeded; 2 gm.
(30 gr.) have been frequently given with good results. Cerium
oxalate appears to have some action as a sedative to the gastric
mucous membrane, and so may allay the pain of gastralgia or
prove beneficial in dyspepsia occasioned by deranged innerva-
tion. In cases of cough (no doubt of reflex origin) associated
with vomiting, it is sometimes of great service, and it has even
been recommended for controlling excessive cough in phthisis
or chronic bronchitis. In chronic diarrhoea it may be used in
the place of bismuth. It has been thought to be of service in
nervous dysmenorrhoea and such other nervous disorders as
chorea and epilepsy, but it is difficult to see how this can be
the case, and probably little reliance can be placed on it in this
class of affections.
68o PHARMACOLOGY AND THERAPEUTICS.
D. Drugs Acting on the Intestines.
(c) Purgatives.
HONEY.
MEL. — Honey. Dose, 4 c.c; 1 fl. dr.
Preparations.
Mel Depuratum (Mel Despumatum, U. S. P., 1890). — Clari-
fied Honey. Dose, 4 c.c; 1 fl. dr.
Mel Rosae. — Honey of Rose. Dose, 4 c.c; 1 fl. dr.
Action of Honey.
Honey is demulcent, nutritive and slightly laxative. Gener-
ally it constitutes an agreeable article of diet. In some indi-
viduals, however, it causes pyrosis, flatulence and colic, and in
others an eruption of urticaria.
Therapeutics of Honey.
Honey is useful in relieving dryness of the mouth and facili-
tating swallowing, and oxymel (clarified honey, 8; acetic acid,
1; water, 1) is a pleasant addition to gargles or vehicle for
astringents or expectorants. Honey is sometimes a sufficient
laxative for the constipation of children.
TAMARIND.
TAMARINDTJS.— Tamarind. Dose, 16 gm.; 240 gr.
Unofficial Preparation.
Infusum Tamarindi. — Infusion of Tamarind. Dose, freely.
Action of Tamarind.
Tamarind is nutritive, laxative and refrigerant.
Therapeutics of Tamarind.
It may be given to fever patients or convalescents in infu-
sion or in the form of tamarind whey (1 part of tamarind to
30 of milk) as an acid, cooling, slightly purgative 'drink. As a
MANNA. 68 1
laxative it is often prescribed in association with other reme-
dies, but in the case of children it may be given alone, spread
upon bread and butter.
FIG.
FICUS.— Fig.
Action of Fig.
Fig is a pleasant and mildly purgative article of diet. The
mucilaginous and saccharine constituents of the fresh fruit give
it a laxative action. This effect in dried fig is largely due to
the indigestible skins and seeds, which act mechanically in
stimulating intestinal paralysis, but also have some tendency to
create flatulence.
Therapeutics of Fig.
It may be used as a dessert to correct slight constipation, and
confection of senna, in which fig is contained, is a very ser-
viceable laxative for children. Split open and heated, fig may
be employed, particularly in the mouth for gum-boils, etc., to
fulfill the indications of a poultice. Poultices made with the
dried fruit and milk have sometimes been found by surgeons
to neutralize the most persistent fetor of cancerous and other
ulcers.
PRUNE.
PRUNUM.— Prune.
Action of Prune.
Prune is demulcent, nutritive and slightly laxative.
Therapeutics of Prune.
It may be eaten, either raw or stewed, as an article of diet
in cases of slight constipation. It is used as a corrective for
senna in the confection. In " medicated prune " senna or podo-
phyllin is added to give a more pronounced purgative effect.
MANNA.
MANNA.— Manna. Dose, 16 gm.; 240 gr.
682 PHARMACOLOGY AND THERAPEUTICS.
Action of Manna.
Manna is aperient when taken in considerable quantities.
Therapeutics of Manna.
Manna is given as a mild laxative to children. It dissolves
easily in milk, and is pleasant to the taste.
CASSIA FISTULA.
CASSIA FISTULA.— Cassia Fistula. (Purging Cassia.) Dose, 4
gm.; 60 gr.
Preparation.
Confectio Sennae. — Confection of Senna. Dose, 4 gm.; 60 gr.
Action of Cassia Fistula.
Cassia-pulp is laxative in doses of 4 to 8 gm. (1 to 2 dr.), and
in quantities sufficient to purge causes nausea, flatulence and
griping.
Therapeutics of Cassia Fistula.
The pulp is administered as one of the ingredients of con-
fection of senna, and in this country is rarely ever prescribed
in any other form.
CASTOR OIL.
OLEUM RICINL— Castor Oil. Dose, 16 c.c; 4 ft. dr.
Unofficial Preparation.
Fluidextractum Ricini Foliorum. — Fluidextract of Ricinus
Leaves. Dose, 2 to 8 c.c.; y2 to 2 fl- dr-
Action of Castor Oil.
External. — Castor oil, like other bland fixed oils, is protec-
tive and sedative when applied to the skin and mucous mem-
branes.
Internal. G astro -intestinal Tract. — The so-called unpleasant
taste of castor oil is mostly due to the smell, and if the nose is
held when the oil is swallowed loses most of its objectionable-
CASTOR OIL. 683
ness. It is non-irritant to the stomach, upoji which it produces
no effects. When it reaches the intestine, however, it is de-
composed by the digestive juices, and the ricinoleates thus
formed are irritant and cause purgation. Castor oil may be
taken in very large quantities without producing any other
effect than that of a simple laxative. The seeds of the Ricinus
communis contain an intensely poisonous toxalbumin, Ricin,
which was at one time supposed to be the active principle of
the oil, but it is now known that the latter is entirely free from
this substance, and that its action is solely due to the ricinoleic
acid of which it is the glyceride. A similar but less poisonous
toxalbumin is found in the seeds of the Croton Tiglium, but
does not enter into the composition of croton oil itself. It
takes about five hours for castor oil to operate, the stools from
it being soft, but not liquid, and it does not usually cause grip-
ing. Even when rubbed into the skin, it is capable of acting
on the bowels, and also when thrown into the rectum. It is
absorbed from the intestine and disappears in the tissues like
ordinary oils. A single dose is not followed by constipation,
but this is very apt to result from the habitual use of the drug.
The symptoms of poisoning by castor beans are violent abdom-
inal pain, vomiting and purging, with collapse, and in fatal
cases evidences of some severe gastro-enteritis have been found
post mortem.
Mammary Glands. — The leaves of Ricinus communis when
applied to the breasts have some reputation as a galactagogue.
Therapeutics of Castor Oil.
On account of the mildness of its action, castor oil is one of
the most useful drugs we have in cases where it is desired sim-
ply to evacuate the alimentary canal. For instance, it is well
adapted for getting rid of undigested food that is causing diar-
rhoea. When irritating substances or hardened faeces are to be
removed from the intestines it is the most efficient purgative
compatible with safety. Formerly it was advised, as a routine
practice, to give a dose of castor oil early on the morning of
684 PHARMACOLOGY AND THERAPEUTICS.
the third day after parturition, for the purpose of modifying
the severity of the so-called milk-fever. Since the general in-
troduction of the thermometer into practice, however, and the
better understanding of the causes of febrile temperatures in
the puerperal state, the existence of a distinct milk-fever refer-
able to functional disturbance in the breasts during the period
in question has been found to be an entirely exceptional occur-
rence. Still, although the administration of this particular
laxative at this time has largely fallen into disuse, the canonical
practice of opening the patient's bowels on the third day is of
unquestionable utility, for the reason that very few women
escape from an accumulation of faecal matter during the last
weeks of pregnancy, which is often very great and which cre-
ates a predisposition to puerperal affections. In some an ordi-
nary injection of soap and olive oil in water suffices to procure
an adequate evacuation ; in others, compound liquorice powder,
compound rhubarb pill, or a dose of some cathartic mineral
water. In obstinate cases a calomel purge may be called for.
A very favorite post-partum combination is a pill composed of
compound extract of colocynth, extract of hyoscyamus, pow-
dered socotrine aloes, and extract of nux vomica, with a small
quantity of podophyllin and ipecacuanha. By some of the best
obstetricians castor oil is now given only in cases of severe
colic, in which it is sometimes found advisable to combine with
it a small dose of laudanum. When inflamed haemorrhoids,
fissures of the anus or surgical operations on the pelvic viscera
require the use of a certain, but mild and unirritating, laxative,
castor oil should be selected. It is often very useful in the
temporary constipation of children, as well as in diarrhoea in
young subjects induced and maintained by undigested food or
irritating secretions. In the latter condition the oil may be
followed with advantage by an opiate or an enema containing
laudanum, and in some forms of diarrhoea, both in adults and
children, a small quantity of laudanum is frequently adminis-
tered with it. In the dysentery of children and the sporadic
dysentery of adults, especially after the more acute febrile
CASTOR OIL. 685
symptoms have subsided, an emulsion of castor oil made with
mucilage of acacia (to which laudanum or paregoric may be
added if the symptoms are severe), is generally of great
service. It may also prove valuable in the entero-colitis of
infants and young children. In these cases the amount of oil
in each dose should be quite small. Except in the case of
aspidium (see Aspidium), castor oil is a good purgative to give
before and after the use of anthelmintics. It is not suited for
cases of chronic constipation. As an enema it does not appear
to possess any advantages over olive oil. One part of castor
thoroughly mixed with five parts of warm olive oil may be used
for a mild injection.
As most persons object to taking castor oil by itself, it is
generally necessary to disguise its taste in some way. It may
be given in soft capsules, which can be obtained of any desired
size. If for any reason these are objectionable, it is best ad-
ministered in the beverage known as sarsaparilla. Lemon
juice or coffee conceals the taste to some extent, and the fol-
lowing is recommended as a good way in which to take it:
The oil is added to 4 c.c. (1 fl. dr.) of peppermint water, and
then a little brandy added till the oil neither sinks nor floats.
If the inside and rim of the glass are moistened with the vehicle,
the oil, which should, if possible, be between two layers of the
vehicle, is scarcely tasted. In the same way it may be taken in
the froth of ale or beer. In the B. P. a mixture is official
which is composed of castor oil, 6; mucilage of acacia, 3;
orange-flower water, 2, and cinnamon water, 5, and various
other more or less palatable mixtures have been recommended.
The extemporaneous dose prepared at the soda-water fountain
is preferred by many persons. Castor oil with balsam of Peru
(see Balsam of Peru) makes an excellent surgical dressing
which is applicable for burns, wounds, abscesses, and many
other conditions, and the oil is occasionally used as a basis for
ointments for the treatment of alopecia. A drop of the oil in
the eye will often relieve the irritation caused by a foreign
body or by granular lids. A poultice made of the leaves of
686 PHARMACOLOGY AND THERAPEUTICS.
the castor-oil plant may be applied to the breasts to promote
the secretion of milk, and a fluidextract of the leaves (not offi-
cial), taken three or four times a day and also locally applied,
is likewise supposed to have some effect in increasing this.
(b) Simple Purgatives.
ALOES.
ALOE (Aloe Barbadensis, Aloe Socotrina, U: S. P., 1890). — Aloes.
Dose, 0.250 gm. (250 milligm.) ; 4 gr.
Preparations.
1. Aloe Purificata. — Purified Aloes. Dose, 0.250 gm. (250
milligm.); 4 gr.
2. Extractum Aloes. — Extract of Aloes. Dose, 0.125 gm.
(125 milligm.); 2 gr.
3. Pilulae Aloes. — Pills of Aloes. Dose, 2 pills.
4. Pilulae Aloes et Ferri. — Pills of Aloes and Iron. Dose, 2
pills.
5. Pilulse Aloes et Mastiches. — Pills of Aloes and Mastic.
(Lady Webster's pill.) Dose, 2 pills.
6. Pilulae Aloes et Myrrhae. — Pills of Aloes and Myrrh.
Dose, 2 pills.
7. Tinctura Aloes. — Tincture of Aloes. Dose, 2 c.c; 30 TTt-
8. Tinctura Aloes et Myrrhae. — Tincture of Aloes and
Myrrh. Dose, 2 C.C.; 30 TTt.
Unofficial Preparation.
Pilulae Aloes et Asafcetidae. — Pills of Aloes and Asafetida.
Dose, 1 to 5 pills.
ALOINUM.— Aloin. Dose, 0.065 gm. (65 milligm.); 1 gr.
Preparation.
Pilulae Laxativae Compositae. — Compound Laxative Pills.
Dose, 2 pills.
Action of Aloes.
External. — Aloes has no action on the unbroken skin, but is
thought to be slightly stimulating to denuded surfaces. Pow-
dered aloes, dusted upon an abrasion, blister or ulcer, is capable
ALOES. 68?
of being absorbed and producing the characteristic internal
effects of the drug.
Internal. Gastro-intestinal Tract. — Like other substances
having a strong bitter taste, aloes, in small doses, acts as a
stomachic. It is a slowly acting but efficient cathartic. Its
main action is shown in the stimulation of the large intestine,
particularly the rectum, and the result of this is chiefly muscular
contraction, though some increase of secretion is also produced
by it. The presence of bile in the intestine is necessary to elicit
its full effects, and it is believed itself to cause some increased
secretion of bile, as indicated by the dark character of the
passages from it. If given alone it usually causes a consider-
able amount of griping pain. Aloin is regarded as less certain
in its purgative action than aloes, and there can be little ques-
tion, it is thought, that the crystalline aloin itself is inactive
in the bowel, but is there changed under certain conditions to
an amorphous compound which has irritant effects. It is
stated, however, that a warm solution of aloin will produce
purgation if injected subcutaneously.
Pelvic Organs. — Aloes produce a comparatively marked con-
gestion of the pelvic organs, and is therefore regarded as an
emmenagogue.
Excretion. — It is readily absorbed, and is eliminated through
the bowels and kidneys, and also in the milk. It is quite likely
that the habitual use of the drug will result in irritation of the
kidney.
Therapeutics of Aloes.
As it usually requires from twelve to fifteen hours, or more,
to act on the bowels, it is customary to administer it compara-
tively early in the evening in order to secure a movement from
it in convenient season on the following morning. On account
of the griping which it is apt to cause if employed alone, it is
usually associated with carminatives or other agents calculated
to promote greater regularity of peristaltic contraction. A
small amount of extract of hyoscyamus or extract of bella-
donna generally answers very well. The bitter principles of
688 PHARMACOLOGY AND THERAPEUTICS.
aloes are of service in aiding digestion, and a very good dinner
pill is composed of .06 gm. (1 gr.) of extract of aloes and .015
gm. (14 gr.) of extract of mix vomica. If the faeces are hard,
.03 gm. (y2 gr.) of powdered ipecacuanha should be added.
Such a pill, with the addition of .06 or .12 gm. (1 to 2 gr.) of
ferrous sulphate is often very useful in anaemia. For cases of
chronic constipation, especially in children and also in persons
of middle age, many of which are due to an imperfect contrac-
tion of the muscular coat of the large intestine, aloes is an
excellent purgative. If given in moderate doses, it has the
advantage of not producing subsequent constipation, and, in
addition, of seldom requiring an increase in the dose. Simple
jaundice, of an atonic kind, and jaundice, or at least a bilious
state, in which the tongue is coated, the breath foul, the abdo-
men tumid, and the colon impacted, may usually be successfully
treated with this remedy. The constipation of hypochondriasis
and melancholia also is best overcome by the use of aloes, and,
with the removal of the impacted faeces, there is not infre-
quently an improvement in the mental state. In cerebral dis-
orders when purgatives are indicated for their derivative effect,
this is the one commonly selected. In cases of hysteria, with
anaemia and constipation, the pills of aloes and asafetida, which
have also a carminative effect, may be given. Combined with
iron and asafetida or myrrh, aloes is used to a considerable
extent in the treatment of amenorrhoea, whether associated
with chlorosis or not. It is generally prescribed on account of
its tendency to induce hyperaemia of the pelvic organs, but it
seems quite possible that the relief by it of the constipation
which is so commonly present in these cases is largely, if not
chiefly, responsible for the improvement which frequently takes
place under its use. It is often stated that aloes is contra-
indicated in cases of menorrhagia. This is no doubt true as
regards full-blooded subjects, but when this condition occurs in
the debilitated and relaxed, it is sometimes relieved by the drug.
As to the risk of employing it in pregnancy, lest the fullness
of the uterine vessels induced by it may lead to abortion, which
RHUBARB.
689
has also been suggested by writers, it would appear doubtful
whether the danger from aloes in this respect is greater than
that from any other active cathartic. The presence of haemor-
rhoids has been regarded as another contra-indication, but if
a patient suffers from haemorrhoids which are not inflamed,
aloes can be safely administered, and even with marked benefit
if they are due to a relaxed rectal mucous membrane. In gon-
orrhoea aloes has been used both internally and by injection,
after the acute inflammation has subsided. The following
enema may be given for ascarides : Aloes, 8; potassium carbon-
ate, 3; mucilage of starch, 960. As the purgative principle of
aloes is excreted to some extent in the milk, the drug should be
avoided or given with great caution in the case of nursing
women, on account of the danger of its causing diarrhoea in the
infant.
RHUBARB.
RHEUM.— Rhubarb. Dose, 1 gm.; 15 gr.
Preparations.
1. Extractum Rhei. — Extract of Rhubarb. Dose, 0.250 gm.
(250 milligm.); 4 gr.
2. Fluidextractum Rhei. — Fluidextract of Rhubarb. Dose,
1 c.c; 15 n\.
3. Pilulae Rhei Composite. — Compound Pills of Rhubarb.
Dose, 2 pills.
4. Pulvis Rhei Compositus. — Compound Powder of Rhu-
barb. Dose, 2 gm.; 30 gr.
5. Syrupus Rhei. — Syrup of Rhubarb. Dose, 8 c.c; 2 fl. dr.
6. Syrupus Rhei Aromaticus.— Aromatic Syrup of Rhubarb.
(Spiced Syrup of Rhubarb.) Dose, 8 C.C.; 2 fl. dr.
7. Tinctura Rhei. — Tincture of Rhubarb. Dose, 4 C.C.; 1
fl. dr.
8. Tinctura Rhei Aromatica. — Aromatic Tincture of Rhu-
barb. Dose, 2 c.c; 30 TT\.
9. Mistura Rhei et Sodse. — Mixture of Rhubarb and Soda.
Dose, 4 c.c: 1 fl. dr.
45
69O PHARMACOLOGY AND THERAPEUTICS.
Unofficial Preparations.
Pilulae Rhei (U. S. P., 1890).— Pills of Rhubarb. Dose, 3 to
5 pills.
Tinctura Rhei Dulcis (U. S. P., 1890).— Sweet Tincture of
Rhubarb. Dose, 15 to 30 c.c; y2 to 1 fl. oz.
Action of Rhubarb.
External. — Rhubarb is never used for external application.
If it were so applied, it would probably give rise to a mild irri-
tation in consequence of its chrysarobin, which by itself excites
inflammation of the skin.
Internal. Alimentary Canal. — In the mouth, rhubarb slightly
increases the salivary secretion. In moderate doses it is sto-
machic, by reason of its bitter resins, increasing gastric secre-
tion, peristalsis, vascularity and absorption, and thus promoting
digestion. In larger doses it has a purgative action, producing
in from four to eight hours, generally with some griping, *a
soft, though not watery, evacuation which is of a yellowish-
brown color, due to the chrysarobin. The purgative properties
of the drug have been attributed to the chrysarobin, although,
chrysophanic acid, which it yields, is stated not to cause purga-
tion, on account of its rapid absorption. Rhubarb has some
effect in increasing the biliary secretion, but its cholagogue
action is not sufficiently marked to entirely explain its pur-
gative properties. It probably also increases the excretion
of bile by accelerating its passage through the intestine and
preventing its reabsorption. Rhubarb, as well as podophyllin
and resin of jalap, is said to require the presence of bile
in the intestine as a necessary condition for its operation,
so that in its absence these drugs may be either altogether
inactive or much less energetic than usual. It is often stated
that rhubarb affects chiefly the muscular coat of the intestine,
and thus purges by increasing peristalsis, but no satisfactory
proof of this has apparently been educed. The purgative action
is succeeded by constipation, due, no doubt, to the astringent
effect of the rheotannic acid. This is presumably absorbed
quickly and subsequently excreted back into the bowel, for were
RHUBARB.
69I
it not thus soon absorbed it would be swept away in the evacua-
tions and would have no opportunity of producing its astrin-
gent action.
Kidneys. — Rhubarb has the effect of slightly increasing the
amount of urine. The excretion of chrysophanic acid gives a
yellowish color to this fluid, and also to the milk of nursing
women. Rhubarb urine may be distinguished from that of
jaundice by its becoming purplish-red on the addition of an
alkali.
Skin. — The skin may also assume a yellowish tinge from the
presence of chrysophanic acid, and in rare instances cutaneous
eruptions of different kinds are produced.
Therapeutics of Rhubarb.
Rhubarb is an excellent purgative for the indigestion of chil-
dren, whether attended by diarrhoea or not, as it efficiently
clears the intestinal canal of undigested food and irritating
secretions, and its stomachic and after-astringent effects often
serve a very useful purpose. A very satisfactory stomachic
for young children consists of equal parts of powdered rhubarb
and sodium bicarbonate (which conceals the taste of the rhu-
barb), with the addition of some powdered gentian; or, if pre-
ferred, the same remedies may be associated in a liquid mixture.
The aromatic syrup combined with an alkali is especially ser-
viceable in the summer complaints of children when the stools
are greenish and mucous. Rhubarb is much used in diarrhoea,
with intestinal weakness or relaxation, to unload the bowels of
acrid secretions. In small doses, the tincture is a good sto-
machic tonic in dyspepsia with deficient biliary and intestinal
secretions. On account of the griping which it is apt to occa-
sion, rhubarb should rarely be prescribed alone, though in habit-
ual constipation some individuals find benefit from chewing the
root. Notwithstanding its astringent property, rhubarb is
largely used as an habitual laxative, as it not only does not
impair, but improves the appetite and digestion. It is adapted
to those of relaxed habit, and should not be given in a high
692 PHARMACOLOGY AND THERAPEUTICS.
sthentic state of the system, with hyperemia of the mucous
membrane, or when depletion is necessary. For the treatment
of constipation, however, it has the disadvantage of requiring
to be frequently repeated, its astringent after-effect being in
many cases a decided objection. The compound rhubarb pill
is a mild and efficient preparation for moving the bowels. It
is often combined with calomel to act upon the so-called torpid
liver, as in Quain's pill, which is calomel, .06 gm. (1 gr.) with
compound rhubarb pill; .20 gm. (3 gr.).
BUTTERNUT.
Unofficial Preparations.
Juglans (U. S. P., 1890). — Juglans. (Butternut.) Dose, 4
to 8 gm.; 1 to 2 dr.
Extractum Juglandis (U. S. P., 1890). — Extract of Juglans.
Dose, 0.30 to 2.00 gm.; 5 to 30 gr.
Action of Butternut.
Butternut is a mild cathartic, and resembling rhubarb in the
property of evacuating, without debilitating, the alimentary
canal.
Therapeutics of Butternut.
Butternut has some reputation in dysentery and in chronic
constipation. It was much employed during the war of the
Revolution.
CASCARA SAGRADA.
RHAMNUS PURSHTANA.— Cascara Sagrada. (Sacred Bark.)
Dose, 1 gm.; 15 gr.
Preparations.
1. Extractum Rhamni Purshianae. — Extract of Cascara Sa
grada. Dose, 0.250 gm. (250 milligm.) ; 4 gr.
2. Fluidextractum Rhamni Purshianse. — Fluidextract of
Cascara Sagrada. Dose, 1 C.C.; 15 hi,.
3. Fluidextractum Rhamni Purshianse Aromaticum. — Aro-
matic Fluidextract of Cascara Sagrada. Dose, 1 C.C.; 15 m\.
CASCARA SAGRADA. 693
Action of Cascara Sagrada.
The fresh bark is emetic, but after it has been kept for about
two years this action is lost. Cascara sagrada is a simple, but
efficient, purgative, which does not occasion much griping. Its
action resembles that of buckthorn, but it is more powerful
and certain in its operation. One of the advantages of this
drug is that it overcomes constipation without purging, and
consequently without weakening, and the stomachic properties
which it derives from its bitter principle add to its value by
improving the appetite and digestion.
Therapeutics of Cascara Sagrada.
Although introduced only a few years ago, cascara sagrada
has established itself as a favorite and reliable remedy in habit-
ual constipation. It should not be employed as a purgative
when a powerful impression is required. It does not operate
hurriedly or urgently, like many purgatives which produce
watery stools, and is best suited to cases of simple constipation,
or of torpor of the colon without associated disease. It may
be given for the relief of catarrhal jaundice, as well as of
haemorrhoids and affections of the pelvic organs, and is often
very useful in cases of dyspepsia accompanied by constipation.
A special virtue of cascara sagrada is that in its continued use
gradually increasing doses are unnecessary. As the condition
improves the daily quantity may be reduced, and a considerable
number of cases of chronic constipation are eventually cured
by the drug. As the fluidextract is very bitter, it is advisable
that its taste should be covered by aromatics, liquorice or sal
volatile, or it may be administered in chloroform water. The
aromatic syrup (B. P., liquid extract of cascara, 8; tincture
of orange, 2 ; alcohol — 90 per cent. — 1 ; cinnamon water, 3 ;
syrup, 6) also conceals the taste satisfactorily. The liquid
extract is made with alcohol (90 per cent.) and water. A
preparation known as Tinctura Laxativa, consisting of equal
parts of fluidextract of cascara sagrada, aromatic spirit of
ammonia, spirit of chloroform, tincture of belladonna leaves,
694 PHARMACOLOGY AND THERAPEUTICS.
and tincture of nux vomica, is miscible in water and constitutes
a pleasant simple purge which is highly recommended in habit-
ual constipation. The dose is 1.20 to 4 c.c. (20 to 60 ill).
The official aromatic fluidextract is an excellent preparation,
and some of the unofficial preparations now made, such as
" Cascara Cordial," are very palatable, and seem to be quite
efficient as laxatives. The drug is also sold in various pills and
tablets. The preparations of cascara sagrada have to some
extent supplanted the compound liquorice powder, which was
formerly in very general use.
SENNA.
SENNA.— Senna. Dose, 4 gm.; 60 gr.
Preparations.
1. Confectio Sennse. — Confection of Senna. Dose, 4 gm.;
60 gr.
2. Fluidextractum Sennas. — Fluidextract of Senna. Dose, 2
c.c; 30 hi..
3. Infusum Sennae Compositum. — Compound Infusion of
Senna. (Black Draught.) Dose, 120 C.C.; 4 fl. OZ.
4. Pulvis Glycyrrhizae Compositus. — Compound Powder of
Glycyrrhiza. (Compound Liquorice Powder.) Dose, 4 gm.;
60 gr.
5. Syrupus Sennae. — Syrup of Senna. Dose, 4 c.c; 1 fl. dr.
Action of Senna.
External. — None.
Internal. — Senna is one of the class of drugs, including rhu-
barb, aloes, frangula and cascara sagrada, which are known as
the anthracene purgatives, because they owe their activity to
the presence of certain irritant anthracene (C14H10) compounds.
Only a few of the latter have as yet been isolated. Senna dif-
fers from rhubarb in the absence of any astringent property,
and its use is not followed by constipation. It is somewhat
more liable to induce griping and nausea than rhubarb, but its
tendency to gripe may be almost abolished, without greatly
SENNA. 695
reducing its activity, by first exhausting it with strong alcohol.
Generally five or six hours elapse between its administration
and the first action of the bowels, and the stools resulting from
it are watery and of a pale yellow color. Senna has little or
no action on the secretion of bile. The cathartic acid in it is
supposed to stimulate the muscular coat of the intestine, espe-
cially the colon, occasioning some hyperemia, and, in conse-
quence, the contents of the small intestine are hurried through
the lower bowel, so that some undigested food may appear in
the motions. Some observers state that senna acts directly as
a stimulant upon the mucous membranes, and so produces a
local peristalsis as it is moved along. It will cause purgation,
however, if it is injected into the circulation, and this is prob-
ably because cathartic acid is excreted into the bowel. While
this acid is by far the most important purgative principle of
senna, there is reason to suppose that there are other substances
in it which also have such action. Some constituents of the
drug are absorbed and the chrysophan (chrysarobin) may
cause discoloration of the urine, staining it carmine if that fluid
is alkaline, or yellow if it is acid. The purgative properties of
the drug may be imparted to the milk of nursing women, and
therefore senna should be used with caution in this class of
patients.
Therapeutics of Senna.
The most active preparation is an extemporaneous infusion,
which should not, however, be boiled very long. It soon under-
goes decomposition if left to itself, but this may be prevented
by adding nitre to it (1 to 480). Senna is a safe and reliable
purgative for cases of simple constipation, but is usually com-
bined with other remedies. As it acts largely upon the colon,
it is serviceable in slight cases of faecal accumulation. It is
useful to complement the action of duodenal purgatives, and
an illustration of this is seen in the old prescription of a blue
pill at night and black draught in the morning. As the com-
pound infusion of senna is a very disagreeable mixture, how-
ever, the compound liquorice powder is preferable to it. The
696 PHARMACOLOGY AND THERAPEUTICS.
latter preparation is still used to a considerable extent in habit-
ual constipation, especially among children, and in the consti-
pation of pregnancy. In pregnant women and other patients
when cascara sagrada alone will not move the bowels, senna is
sometimes combined with it with good effect. Confection of
senna is also a very satisfactory preparation for children, and
especially in the form of Tamar Indien, in which it is coated
with sugar or chocolate and which is readily taken by them.
In the case of children manna is often combined with senna,
and an excellent laxative mixture consists of fluidextract of
senna, manna and magnesium carbonate, with syrup of ginger
and water. Coffee has been recommended for masking the
disagreeable taste of senna. 8 gm. (2 dr.) of senna and 4 gm.
(1 dr.) of coffee may be infused in 90 c.c. (3 fl. oz.) each of
hot milk and boiling water, and the whole drunk after twelve
hours.
FRANGULA.
FRANGULA.— Frangula. (Buckthorn.) Dose, 1 gm.; 15 gr.
Preparation.
Fluidextractum Frangulae. — Fluidextract of Frangula. Dose,
1 c.c; 15 ttl.
Action of Frangula.
The fresh bark is a violent gastro-intestinal irritant, but that
which has been kept a year is a mild purgative, acting like senna.
Therapeutics of Frangula.
It is suitable for children, and for use in chronic constipation.
OXGALL.
Fel Bovis. — Oxgall. (Fel Tauri.)
Preparation.
Fel Bovis Purificatum.— Purified Oxgall. Dose, 0.500 gm.
(500 milligm.); 7V2 gr.
EUONYMUS. 697
Action of Oxgall.
Oxgall when added to albuminous solutions delays their de-
composition. It aids in the absorption of fats. If given by the
mouth it is mostly absorbed from the intestine and acts as a
cholagogue.
Therapeutics of Oxgall.
Oxgall has been used as a cholagogue purgative, not infre-
quently associated with aloes. Although theoretically of value
in replacing deficient biliary secretion, it has the great disad-
vantage of disturbing the gastric digestion, and on this account
is not now very much employed. It may be found useful, how-
ever, when given as an enema in cases of impacted faeces in
which there is not sufficient room in the rectum for a bulky
injection. For this purpose 30 to 60 gm. (1 to 2 fl. oz.) of
oxgall in 500 c.c. (1 pint) of water should be used. It is claimed
that bile has some antitoxic power with reference to the poi-
sons produced by pathogenic micro-organisms, and oxgall has
sometimes been used as an antiseptic in typhoid fever and in
intestinal fermentation.
(c) Drastic purgatives.
EUONYMUS.
EUONYMUS.— Euonymus. (Wahoo. Spindle Tree.) Dose, 0.500
gm. (500 milligm.); 7l/2 gr.
Preparations.
Extractum Euonymi. — Extract of Euonymus. (Euonymin.)
Dose, 0.125 gm. (125 milligm.); 2 gr.
Fluidextractum Euonymi. — Fluidextract of Euonymus.
Dose, 0.5 c.c.; 8 HI.
Action of Euonymus.
In small doses euonymus is a gastric stimulant, promoting
appetite and digestion. In both moderate and large doses it is
also regarded as an hepatic stimulant, increasing the biliary
secretion, while in the latter amounts it is distinctly irritant
698 PHARMACOLOGY AND THERAPEUTICS.
to the intestine and is an energetic purgative. It owes its
activity to its euonymin, a substance which has the same
action on the heart as digitalis. The drug is also said to have
slight diuretic and expectorant effects. Beyond its tonic and
purgative properties it probably has no special virtue.
Therapeutics of Euonymus.
It has been chiefly employed in cases of constipation asso-
ciated with impaired functional derangement of the liver, and
is often combined with calomel. In dyspepsia its administra-
tion two or three times a week is sometimes attended with good
results.
IRIS.
Unofficial Preparations.
Iris (U. S. P., 1890).— Iris. (Blue Flag.) Dose, 0.60 to
2.00 gm.; 10 to 30 gr.
Extractum Iridis (U. S. P., 1890). — Extract of Iris. Dose,
0.05 to 0.015 gm.; 1 to 3 gr.
Extractum Iridis Fluidum (U. S. P., 1890). — Fluidextract of
Iris. Dose, 0.60 to 2 c.c; 10 to 30 TT\.
Iridinum. — Iridin. (Irisin.) Dose, 0.05 to 0.30 gm.; 1 to
5 gr.
Action of Iris.
Iris is a cholagogue and hydragogue cathartic. Like euony-
mus, it is stimulant to the intestinal glands, but it is more
powerfully purgative than that drug, and is also more apt to
create gastric disturbance. As in the case of other cathartics
of its class, moderate quantities do not appear to induce griping
so frequently as some of the anthracene purges. It is credited
with some diuretic action.
Therapeutics of Iris.
It may be used in dropsy, for the purpose of causing diuresis
as well as purgation, and it has been found an efficient cathar-
tic in malarial and catarrhal jaundice and bilious remittent
fever. It is also said to exert a specific influence in enlarge-
PODOPHYLLUM. 699
ment of the thyroid gland. It is a common practice to com-
bine iridin, which has a cholagogue action, with euonymin,
calomel, podophyllin or similar purgatives.
CELANDINE.
Unofficial Preparation.
Chelidonium (U. S. P., 1890). — Chelidonium. (Celandine.)
Dose, 1.0 to 4.0 gm.; 15 to 60 gr.
Action of Celandine.
Celandine apparently possesses a stimulating effect upon the
hepatic secretions. It is a somewhat irregularly acting purga-
tive, giving rise to watery motions, but at the same time to
griping pains.
Therapeutics of Celandine.
It has been found useful in jaundice, and it constituted the
chief ingredient in the old Decoctum ad Ictericos of the Edin-
burgh Pharmacopoeia.
PODOPHYLLUM.
PODOPHYLLUM.— Podophyllum. (May Apple. Mandrake.) Dose,
0.500 gm. (500 milligm.) ; 7y2 gr.
Preparations.
1. Fluidextractum Podophylli. — Fluidextract of Podophylli.
Dose, 0.5 c.c; 8 TH..
2. Resina Podophylli. — Resin of Podophyllum. (Podo-
phyllin.) Dose, (purgative) 0.015 gm. (15 milligm.); y4 gr.;
(laxative) 0.005 gm. (5 milligm.); T\ gr.
3. Pilulae Podophylli, Belladonnse et Capsici. — Pills of Podo-
phyllum, Belladonna and Capsicum. Dose, 1 pill.
4. Pilulae Catharticae Vegetables. — Vegetable Cathartic
Pills. Dose, 2 pills.
Unofficial Preparation.
Extractum Podophylli (U. S. P., 1890). — Extract of Podo-
phyllum. Dose, .10 to .60 gm.; 2 to 10 gr.
/OO PHARMACOLOGY AND THERAPEUTICS.
Action of Podophyllum.
External. — Podophyllum is irritant to the skin and mucous
membranes and from denuded surfaces it may be absorbed and
produce a purgative effect.
Internal. G 'astro-intestinal Tract. — Podophyllin is a drastic
purgative. Large doses cause marked gastro-intestinal irrita-
tion, and have been known to prove fatal from acute inflamma-
tion of the bowel. Medicinal doses occasion considerable colic
and in some instances nausea. Podophyllin is like aloes in the
slowness of its action, catharsis rarely occurring earlier than
ten or twelve hours after its administration, and sometimes not
for twenty to twenty-four hours. The watery passages which
it produces are stained dark by the presence of bile. In small
doses podophyllin probably increases the secretion of that fluid
— at all events, under its action there is an augmentation of the
solids in it. When it is given in purgative doses the quantity
of bile is said not to be increased, though more of it is emptied
from the gall bladder into the intestine. Podophyllin would
thus seem to act both as a direct and indirect cholagogue. An
old name for this drug is Vegetable Mercury. Both podophyl-
lin and podophyllotoxin cause purgation when injected subcu-
taneously, and this is probably because after absorption they
are excreted into the bowel, since they have been detected in
the faeces when administered in this way. Podophyllotoxin
occasions the formation of methaemoglobin in the red corpuscles
when added to blood outside the body, and when thrown into
the circulation in large amount gives rise to glomerular nephri-
tis and haemorrhages into various organs. While it has a de-
pressant effect upon the central nervous system, this is thought
to be indirect, and due to the shock and haemorrhage resulting
from its severe intestinal action.
Therapeutics of Podophyllum.
As podophyllum is believed to act especially on the liver, it
is quite largely employed in constipation with hepatic derange-
ment, and particularly in so-called bilious attacks. In conges-
LEPTANDRA. JO I
tion of the portal circulation, in catarrhal and malarial jaun-
dice, and in ascites it generally acts with great efficiency, and
haemorrhoids of recent formation which bleed in consequence
of stasis in the portal circulation may sometimes be cured by
a brisk podophyllum cathartic. Habitual constipation due to
inactivity of the muscular coat of the intestine may also be
cured by the nightly use of a small dose of podophyllin com-
bined with belladonna. The resin has been recommended for
infants one or two months old who have hard, stony stools, .12
c.c. (2 HI), or more, of a solution of .06 gm. (1 gr.) of podo-
phyllin in 4 c.c. (1 fl. dr.) of alcohol being used on sugar once
or twice a day. It should not be given in association with
promptly acting purgatives, as in that case it will be carried
through the bowel before it has had time to produce its effects.
It may often be advantageously combined with belladonna, nux
vomica, or with hyoscyamus to prevent griping. The only
preparation that should be employed is the resin (podophyllin),
and this is almost universally administered in pill form.
LEPTANDRA.
LEPTANDRA. — Leptandra. (Culver's Root.) Dose, 1 gm.; 15 gr.
Preparations.
1. Extractum Leptandrse. — Extract of Leptandra. Dose,
0.250 gm. (250 milligm.) ; 4 gr.
2. Fluidextractum Leptandrae. — Fluidextract of Leptandra.
Dose, 1 c.c; 15 TIL
3. Pilulae Catharticse Vegetabiles. — Vegetable Cathartic
Pills. Dose, 2 pills.
Action of Leptandra.
Recent leptandra root acts as a violent cathartic, and some-
times as an emetic. It is an excellent cholagogue, owing its
activity to leptandrin, and appears to have a special influ-
ence upon the muciparous follicles of the intestine.
702 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Leptandra.
It acts very advantageously in cases of duodenal indigestion
and chronic constipation.
SCAMMONY.
SCAMMONIUM.— Scammony. Dose, 0.250 gm. (250 milligm.) ;
4 gr.
Preparation.
Resina Scammonii. — Resin of Scammony. Dose, 0.200 gm.
(200 milligm.); 3 gr.
Action of Scammony.
Scammony, which consists very largely of jalapin, is a hydra-
gogue cathartic of rapid and energetic action. It has no effect
until it enters the duodenum, and the presence of bile appears
to be essential for its activity. With the aid of the bile it pow-
erfully stimulates the intestinal glands to increased secretion,
and incidentally causes more or less hyperemia of the bowel
and stimulation of its muscular coat. In about four hours after
its administration a profuse watery evacuation occurs, and its
action is attended with considerable griping. In over-doses it
is likely to cause violent gastro-enteritis. No purgative effect
is produced when it is injected subcutaneously or intravenously.
Therapeutics of Scammony.
As it is a prompt and efficient cathartic, scammony may be
used in cases of obstinate constipation and impaction of faeces.
On account of its violent properties, however, it is usually best
to combine with it some carminative or less active purgative.
It is often serviceable in the treatment of dropsical effusions
and of cerebral affections, and is well adapted for severe cases
of mania and hypochondriasis. For dropsy the compound
jalap powder is more commonly employed, but when this fails
to act recourse may be had to scammony or the compound
scammony powder of the B. P. (scammony resin, ioo; jalap,
75; ginger, 25). The latter preparation is also used as a vermi-
JALAP. 703
fuge. Scammony is efficient in clearing mucus from the intes-
tines, and is anthelmintic against both round-worms and tape-
worms. For children, however, this remedy is unnecessarily
severe in the treatment of worms. Where active purgation is
required in children, calomel and scammony may be given
triturated with sugar of milk, or scammony may be adminis-
tered rubbed up with milk or with syrup of rhubarb.
JALAP.
JALAPA. — Jalap. Dose, 1 gm.; 15 gr.
Preparations.
1. Pulvis Jalapse Compositus. — Compound powder of Jalap.
Dose, 2 gm.; 30 gr.
2. Resina Jalapae. — Resin of Jalap. Dose, 0.125 gm. (125
milligm.); 2 gr.
3. Pilulse Catharticae Composite. — Compound Cathartic
Pills. Dose, 2 pills.
4. Pilulse Catharticae Vegetables. — Vegetable Cathartic
Pills. Dose, 2 pills.
Unofficial Preparation.
Extractum Jalapae (U. S. P., 1890). — Extract of Jalap.
Dose, .12 to .50 gm.; 2 to 8 gr.
Action of Jalap.
External. — It causes pain and irritation when applied to the
nostrils in fine powder.
Internal. — The action of jalap is very much the same as that
of scammony, but it is somewhat less powerful and produces
rather less colic, while it promotes even greater intestinal
secretion. It has also been credited by some observers with
diuretic properties. Jalapin administered by the mouth cannot
be detected in the faeces or urine, and is therefore supposed to
undergo complete or partial oxidation in the body.
704 • PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Jalap.
Jalap is occasionally employed for severe constipation, and
an old prescription consists of equal parts of powdered jalap
and calomel, well triturated. The dose is from .30 to .60 gm. ;
5 to 10 gr. This is known as Rush's thunderbolt. Curiously
enough, it does not gripe. The principal use of jalap is in the
treatment of all forms of dropsy, and particularly that from
Bright's disease. For this purpose the compound powder,
which produces abundant watery evacuations, is commonly
employed, and while the diuresis which also is frequently ob-
served after its administration may possibly be due in a small
measure to the effect upon the kidney of the jalap itself, the
action of the potassium bitartrate and the relief of the engorge-
ment of renal vessels resulting from the drain of fluid from the
intestinal vessels would seem to be important factors in the
augmentation of the urine. In order to enhance the diuretic
effect, some clinicians are in the habit of prescribing an addi-
tional amount of the potassium salt with each dose of compound
jalap powder. For renal dropsy, and to avert the dangers of
uraemia, it is customary to aid and supplement the action of the
powder by the more or less frequent use of vapor baths. Jalap
should not be employed for too long a time continuously, since
it may occasion a form of gastro-enteritis and, in addition, may
favor cardiac weakness. It is sometimes given in the begin-
ning of inflammations and fevers or other acute diseases where
an efficient cathartic is required, and is also found of service
in various forms of cerebral congestion. The clrug is natur-
ally contra-indicated in all inflammatory states of the alimen-
tary canal, and large doses of it should not be given if the
intestinal mucous membrane is liable to inflame easily.
GAMBOGE.
CAMBOGIA. — Gamboge. Dose, 0.125 gm. (125 milligm.) ; 2 gr.
Preparation.
Pilulae Catharticae Composite. — Compound Cathartic Pills.
Dose, 2 pills.
COLOCYNTH. fO$
Action of Gamboge.
Gamboge belongs to the class of drastic or hydragogue ca-
thartics, and is violent in its action, causing marked irritation
of the alimentary canal, energetic peristalsis, with considerable
griping, and greatly augmented intestinal secretion. It owes its
activity to gambogic acid, which, however, is insoluble, and
seldom acts unless it is accompanied with the inert bodies of
the crude drug. Most of it escapes unaltered in the stools, but
some is absorbed, and small and repeated doses are slightly
diuretic. It colors the urine yellow.
Therapeutics of Gamboge.
As its action is somewhat uncertain, and is so violent and
apt to cause severe colic when it does take place, gamboge is
not often prescribed, except as the official pill into which it
enters (Pilulse Catharticae Compositse). Even the gum-resin,
on account of its solubility, is irritant to the stomach, so that
the drug should always be used in pill form. It should also
always be administered in combination with other remedies.
It is quite an efficient anthelmintic, and is occasionally given
with other agents of this class.
COLOCYNTH.
COLOCYNTHIS.— Colocynth. (Bitter Apple. Bitter Gourd. Bitter
Cucumber.) Dose, 0.065 gm. (65 milligm.) ; 1 gr.
Preparations.
1. Extractum Colocynthidis. — Extract of Colocynth. Dose,
0.030 gm. (30 milligm.) ; y2 S1-
2. Extractum Colocynthidis Compositum.— Compound Ex-
tract of Colocynth. Dose, 0.500 gm. (500 milligm.) ; iy2 £?•
3. Pilulae Catharticae Composite. — Compound Cathartic
Pills. Dose, 2 pills.
4. Pilulae Catharticae Vegetabiles. — Vegetable Cathartic
Pills. Dose, 2 pills,
46
706 PHARMACOLOGY AND THERAPEUTICS.
Unofficial Preparations.
Tinctura Colocynthidis. — Tincture of Colocynth. Dose, .12
to 4.00 c.c; 2 TTL to 1 fl. dr.
Citrullinum.— Citrullin. Dose, .01 to .30 gin.; y6 to 5 gr.
Colocynthinum.— Colcynthin. Dose, .01 to .30 gm.; y6 to
5 gr.
Action of Colocynth.
External. — Colocynthin is irritant to mucous membranes,
especially those of the eye, nose and throat.
Internal. — The action of colocynth varies in accordance with
the amount given and the mode of administration. In small
doses it acts as a simple bitter, increasing appetite and gastric
secretion. In larger doses it is a powerful intestinal stimulant,
augmenting the biliary and intestinal secretions, and accelerat-
ing the movements of both the large and small intestine. It
occasions considerable griping pain, but the amount of colic
does not seem to be entirely dependent upon the quantity taken,
as even small doses may be followed by much discomfort if
the drug is given alone. It produces abundant watery passages,
and if the dose is excessive may set up enteritis, with bloody
stools. Toxic symptoms are not infrequently met with from
the use of colocynth, as it is one of the drugs commonly em-
ployed for the purpose of producing abortion. It appears to
have a distinct diuretic action, for colocynthin is stated to excite
renal irritation or inflammation when it is given either hypo-
dermatically or by the mouth, and even when the powder is
inhaled during its manufacture. This glucoside not only
purges when swallowed, but also when administered subcu-
taneously or by intravenous injection, a result probably due to
its excretion into the intestine, though it has been suggested
that this and some of the other purgative principles may have
a specific action quite apart from their irritant effects. Ap-
plied to the skin of the abdomen, colocynth causes intestinal
pain and some purgation,
COLOCYNTH. JOJ
Therapeutics of Colocynth.
Colocynth is perhaps the most generally useful of the drastic
cathartics, but it is of great importance that it should be admin-
istered in carefully regulated doses and properly combined with
other remedies. On account of the griping to which it gives
rise it should never be given by itself, but a proper mode of em-
ployment renders its effects almost comparable to those of sim-
ple purgatives. The violence of its action may be moderated to
a considerable degree by its administration with aromatic sub-
stances or with intestinal sedatives such as belladonna or hyos-
cyamus, as in the colocynth and hyoscyamus pill (B. P.: Com-
pound colocynth pill, 2 ; extract of hyoscyamus, 1 ) . Compound
colocynth pill consists of colocynth pulp, 1 ; Barbadoes aloes,
2 ; resin of scammony, 2 ; potassium sulphate, l/± \ oil of cloves,
Y^ ; water, q. s. The compound extract is a safe, effective, and
not unpleasant preparation for the relief of constipation, and
the compound cathartic pill is also a very serviceable combina-
tion. This pill is sometimes made extemporaneously with podo-
phyllin in the place of calomel. Some prefer the official veg-
etable cathartic pill. For some cases of habitual constipation
the compound extract of colocynth, combined with the ex-
tracts of belladonna and physostigma, seems to answer very
well. In cerebral congestion the preparations of colocynth
are employed for their revulsive effect. Hypochondriasis and
melancholia, when associated with sluggishness of the large
intestine and faecal accumulations, are benefited by colocynth,
as by other hydragogue cathartics. Notwithstanding its diur-
etic action, even in the condition of health, colocynth is not so
generally serviceable in the treatment of dropsy as jalap, al-
though it is more or less used. Minute doses of a tincture of
colocynth (not official) have proved efficient, it is said, in colic,
sciatica, ovarian and other neuralgias, and for relieving the
pain of glaucoma. Like other remedies of its class, colocynth
is contra-indicated in inflammatory states of the intestinal canal.
It is often stated that colocynth is unsafe during the existence
of pregnancy, but there seems to be no good reason for this
708 PHARMACOLOGY AND THERAPEUTICS.
assertion, provided the remedy be administered with due cau-
tion. Some of the most eminent obstetricians are in the habit
of prescribing it when required, often with hyoscyamus and
nux vomica. Colocynth in combination with colchicum is found
in some popular remedies for gout.
Both citrullin and colocynthin are occasionally used in medi-
cine, particularly in the form of suppositories or enemata. The
former is stated to be of value in hernia when strangulation is
threatened. Colocynthin, in doses of .01 to .03 gm. (-J to T/z
gr.), dissolved in glycerin and administered in a small enema
consisting of not more than from one to three teaspoonfuls of
the fluid, has been found to be a very reliable purgative, acting
in from half an hour to two hours. Its action is attributed to
absorption from the rectum.
ELATERIN.
Unofficial Preparation.
Elaterium (B. P.). — Elaterium. Dose, .005 to .03 gm.; T\
to 14 gr.
ELATERINUM.— Elaterin. Dose, 0.005 gm. (5 milligm.) ; T\ gr.
Preparation.
Trituratio Elaterini. — Trituration of Elaterin. Dose, 0=030
gm. (30 milligm.); y2 gr.
Action of Elaterin.
External. — Elaterium is a marked local irritant. It is stated
to cause ulcerations upon the fingers of those who handle the
fruit and prepare the drug for the market.
Internal. — The action of elaterin closely resembles that of
colocynth, but is much more energetic, and it is regarded as
the most powerful hydragogue cathartic known. The drain of
fluid which it induces even in medicinal doses is so profuse
that its use is commonly attended with considerable exhaustion
and prostration. When externally applied, it is said, as well
ELATERIN. 7O9
as when it is injected into the circulation, it also produces a
purgative effect. If given in properly regulated amount, it
occasions comparatively little pain or irritation, notwithstand-
ing the very free catharsis caused. In small doses by the
mouth it increases the secretion of saliva and promotes appe-
tite.
Therapeutics of Elaterin.
On account of the violence of its action, elaterin is not
adapted to cases of ordinary constipation. It is the most effi-
cient of the hydragogue cathartics in general dropsy or in
ascites, and while there appears to be no authority for the
claim that it is capable of increasing the intestinal elimination
of urea, its practical value in uraemia has been demonstrated
by clinical experience. The great drawback to its use is the
depression resulting from it, and hence great care should be
exercised not to administer it in too large doses, and also to
support the strength of the patient by appropriate measures
when it is employed. Almost always it may be advantageously
followed by alcoholic stimulants. It ought never to be given
in cases of marked exhaustion, and its injudicious use in the
later stages of dropsical affections may induce fatal collapse.
It should always be given with the greatest caution, if at all, in
disease of the heart, but under proper restrictions it may be
employed for the effusion in pericarditis, as well as in pleurisy.
In cerebral congestions or effusions and in other affections of
the brain it is valuable as a derivative. Elaterin has been em-
ployed in various diseases for the purpose of depletion, but to
accomplish this the salines are usually preferable. Especially
is this the case if there is present any gastro-intestinal irrita-
tion or inflammation, in all instances of which, it need scarcely
be said, elaterin is contra-indicated. Clutterbuck's elaterium,
the dose of which is .008 gm. (l/g gr.) has been used, because
of the confidence reposed in its reliability, to a considerable
extent in uraemia and puerperal eclampsia.
7 TO PHARMACOLOGY AND THERAPEUTICS.
BRYONIA.
Unofficial Preparations.
Bryonia (U. S. P., 1890).— Bryonia. (Bryony.) Dose, 0.60
to 4.00 gm.; 10 to 60 gr.
Tinctura Bryoniae (U. S. P., 1890). — Tincture of Bryonia.
Dose, 8.0 to 15.0 c.c; 2 to 4 fl. dr.
Action of Bryonia.
Bryonia is an active hydragogue cathartic.
Therapeutics of Bryonia.
It was formerly much employed, but has been superseded by
jalap.
CROTON OIL.
OLEUM TIGLIL— Croton Oil. Dose, 0.05 c.c; 1 ni.
Action of Croton Oil.
External. — Croton oil is an irritant of extraordinary power.
A single drop applied to the skin causes pain, hyperemia and
prompt vesication. The vesicles thus formed rapidly undergo
pustulation, while the surrounding tissue becomes inflamed and
cedematous. The pustules may be umbilicated, but differ from
variolous pustules in that they vary greatly in their size. It
has now been determined that the subcutaneous injection of
croton oil, provided that it contains free acid, is capable of
causing the formation of pus without the presence of microbes,
which was formerly thought by many to be necessary for such
action.
Internal. — On the mucous membrane of the mouth, fauces,
oesophagus and stomach croton oil exerts its irritant action, as
upon the skin, but it is found that if the free acid in it is
removed, this irritant effect will be prevented, while the oil
will simply cause purgation in consequence of its saponifica-
tion by the intestinal juices. Under these circumstances it is
quite bland, and can only be distinguished from castor oil by
its more energetic purgative action. Ordinarily croton oil is
CROTON OIL. 711
such a powerful irritant poison that except in the smallest doses
it produces marked gastro-enteritis, with nausea and vomiting,
severe abdominal pain, violent purging, with bloody stools, col-
lapse and death. A drop of it will cause considerable colic and
in the course of one or two hours an evacuation of the bowels.
This is likely to be followed by others, the passages becoming
more and more fluid. At the same time there are produced
hyperemia of the gastro-intestinal tract, increase of secretion,
and probably increased peristalsis. Whether the latter is due
simply to the irritation or to some action of the drug exerted
after absorption is undetermined, but the other effects are at-
tributable to the local action of the oil. As to what becomes of
croton oil in the body nothing is known with positiveness, but
it is thought probable that part of it is excreted into the large
intestine. Applied to the skin, the oil may cause free purga-
tion. The toxalbumin, Crotin, which is found in the Croton
Tiglium, but which does not pass into the oil, resembles that
of the castor oil bean (Ricin), but is considerably less poi-
sonous.
Therapeutics of Croton Oil.
External. — Croton oil was formerly employed to produce
counter-irritation, especially in diseases of the chest and of the
joints, but is not often used for this purpose now, at least in
an undiluted state, as in many instances permanent cicatrices
are left as the result of the suppuration caused. Corson's paint
is a 5 to 10 per cent, solution of croton oil in ether, to which
a small quantity of tincture of iodine is added to color it ; while
the liniment of the B. P. consists of 15 per cent, of the oil in
equal parts of alcohol and oil of cajuput. .30 c.c. (15 ^l) of
this liniment in 30 c.c. (1 fl. oz.) of olive oil may be used as a
stimulant application in alopecia. In very obstinate cases of
ringworm, which have resisted other remedies, croton oil is
sometimes applied to a spot about the size of a dime. It should
never be used for such purposes in delicate children.
Internal. — The chief advantages of croton oil are its rapid
action as a drastic cathartic and the smallness of the dose
712 PHARMACOLOGY AND THERAPEUTICS.
required. It is therefore of great value for patients who are
unconscious or maniacal, and it is used to a considerable ex-
tent in cerebral apoplexy, uraemia and puerperal eclampsia. As
a revulsive in cerebral congestion it may be of service by in-
creasing vascular dilatation in the bowel, and thus lowering the
intra-cranial blood-pressure. By some authorities it is consid-
ered the one cathartic to employ when it is desired to revulse
by the intestines. It is unsuitable for the treatment of dropsy
or of other conditions requiring frequency of administration,
as the action may be followed by considerable irritation. In
obstinate constipation when there is no organic intestinal ob-
struction a dose of croton oil often acts very happily. Thus,
it is appropriate in cases of faecal impaction, without inflamma-
tory symptoms, and the constipation due to lead poisoning may
not infrequently be overcome by it after less energetic cathar-
tics have failed. It is contra-indicated in all very feeble per-
sons, in pregnant women, and in patients suffering from haemor-
rhoids, peritonitis, or affections of the stomach or bowels. As
a rule, it should be avoided in children, but occasionally it may
be called for in them. As washing with alcohol removes the
acidity without impairing the purgative effect of the oil, a prep-
aration so treated is the best for this class of subjects, and it
may be administered rubbed up with sugar of milk. The un-
pleasant effects of croton oil may be modified by combining it
with other remedies, as the compound extract of colocynth and
extract of belladonna, and if in any exceptional case there should
seem to be sufficient reasons for giving it continuously for a
short period, it would certainly be advisable to employ it in this
way. The treatment of poisoning by croton oil is the same as
that for gastro-enteritis from other causes. Fortunately, when
an over-dose is swallowed, vomiting is usually very promptly ex-
cited, and hence very large quantities have been taken without
producing a fatal result. In case free emesis has not been
caused by the drug the first step in the treatment would of
course be to evacuate the stomach.
COLCHICUM. 713
COLCHICUM.
COLCHICI CORMUS (Colchici Radix, U. S. P., 1890).— Colchicum
Corm. Dose, 0.250 gm. (250 milligm.) ; 4 gr.
Preparation.
Extractum Colchici Cormi. — Extract of Colchicum Corm.
Dose, 0.065 gm. (65 milligm.); 1 gr.
COLCHICI SEMEN.— Colchicum Seed. Dose, 0.200 gm. (200 mil-
ligm.) ; 3 gr.
Preparations.
1. Fluidextractum Colchici Seminis. — Fluidextract of Col-
chicum Seed. Dose, 0.2 C.C.; 3 TT\,.
2. Tinctura Colchici Seminis. — Tincture of Colchicum
Seed. Dose, 2 c.c; 30 TT\.-
3. Vinum Colchici Seminis. — Wine of Colchicum Seed.
Dose, 2 c.c; 30 TO,.
COLCHICINA.— Colchicine. Dose, 0.0005 gm. (0.5 milligm.);
T28 S1,
Unofficial Preparations of Colchicum.
Extractum Colchicis Radicis Fluidum (U. S. P., 1890). —
Fluidextract of Colchicum Root. Dose, .12 to .50 C.C.; 2 to 8 Vl\,.
Vinum Colchici Radicis (U. S. P., 1890). — Wine of Colchicum
Root. Dose, 0.30 to 1 c.c; 5 to 15 TT\.
Colchicine Salicylas. — Colchicine Salicylate. (Colchisal.)
Dose, 0.0006 gm.; T^ gr.
Action of Colchicum.
External. — Colchicum is a decided local irritant, causing red-
ness and smarting when applied to the skin, while the dust,
when inhaled, excites sneezing and conjunctival hyperemia,
with a burning sensation in the mouth and throat.
Internal. Gastro-intestinal Tract. — In the great majority of
instances moderate doses of colchicum give rise to no appre-
ciable effect. In some individuals, however, there is produced
after a time a feeling of malaise, with discomfort in the stom-
ach and bowels, followed by some nausea and diarrhcea. It
may also have the effect of slightly increasing the biliary secre-
714 PHARMACOLOGY AND THERAPEUTICS.
tion. In large amounts it causes salivation and nausea, with
violent vomiting and purging, and afterwards a condition of
depression, apathy and collapse; and the same effects are pro-
duced by the intravenous injection of colchicine. Several
hours elapse after the administration of the drug before these
symptoms are elicited, and the reason for this is stated to be
that it is not the colchicine itself which produces them, but an
oxidation product, oxydicolchicine, which is formed from it in
the mammalian organism. In man, at least, it would appear
that the gastro-intestinal irritation is not altogether an inflam-
matory action, since the intestine may appear quite normal
after death, and there is seldom more than a simple catarrh of
the duodenum. When ecchymoses, etc., have been found, they
have been ascribed to the mechanical effects of the extremely
energetic peristalsis occasioned. The explanation of the symp-
toms which has been offered is that there appears to be an
increased irritability of the intestinal tract, so that normal im-
pulses, which ordinarily keep up a moderate peristalsis, now
produce a very violent one. In mammalian animals poisoned
with colchicine, however, it is stated that the alimentary canal
presents all the appearances of acute gastro-enteritis ; so that
this explanation would seem somewhat inadequate. The
amount of the drug ingested appears to have little influence on
the duration of the preliminary stage of quiescence.
Circulation and Respiration. — In animals the heart's action
and blood-pressure remain unaffected, and while in man the
pulse may become small, rapid and thready, this is no doubt
simply the result of the collapse. The respiration is found to
be slow, though deep and full at first. Later it becomes shal-
low, and death is due to failure of the respiratory centre, the
heart continuing to beat for some time afterward.
Nervous System and Muscles. — The action on the central
nervous system is almost purely depressant, but it is believed
that the nervous symptoms caused are probably secondary to
the effect upon the abdominal organs, rather than due to any
direct central action. In the case of mammalian animals poi-
COLCHICUM. 715
«
soned with colchicine when the collapse sets in the movements
are found to become slow and difficult, more especially in the
posterior extremities, which are eventually rendered completely
motionless. The paralysis then extends upwards until the
movements of the fore limbs and respiratory muscles are in-
volved, when death occurs from asphyxia. In man the con-
sciousness and intelligence as a rule remain unimpaired, though
there is generally some giddiness. In exceptional instances
there is more or less confusion, and even delirium may precede
the collapse. In the frog colchicine is said to have little or no
effect, but if the solution be exposed for some time to the air,
so that oxydicolchicine is formed, it is found to cause a pro-
longation of the muscular contraction similar to that seen after
veratrine, and eventually a tetanus resembling that due to
strychnine. This oxidation product does not seem to be capa-
ble of formation within the frog's system, as in that of a warm-
blooded animal.
Kidneys. — In some instances the urine is slightly increased,
while in others complete anuria, lasting for many hours, is pro-
duced. According to the latest and most reliable researches,
it has been found that small quantities of colchicine increase
the amount, and both the urea and uric acid, as well as the
fluid, while under larger doses the fluid is diminished, the urea
and uric acid being less affected than with the smaller ones.
In animals, it is stated, bloody urine sometimes results from
the colchicine.
Therapeutics of Colchicum.
Colchicum has long been used empirically in the treatment
of gout, but it is not now as universally employed in this dis-
ease as formerly. Authorities differ as to its value, and some
physicians have denied that it has any beneficial effect. It has
been shown, as has been mentioned, that it increases the elim-
ination of uric acid, but unfortunately for the explanation of
its remedial action on rational grounds, it seems now to be
established that gout is not due to a deficient excretion of this
agent. As the pathology of the disease, therefore, remains
yi6 PHARMACOLOGY AND THERAPEUTICS.
entirely uncertain, it can only, like other medicines, be used in
its treatment in a purely empirical manner; but it appears to
be a fact that in a considerable proportion of cases, at least,
its administration is attended with more or less decided benefit.
In these, if given in suitable quantities during the attack, it
markedly relieves the pain, while in smaller doses between the
attacks it seems to lessen their severity. In certain instances
also where headache, neuralgia, dyspepsia, neuritis, eczema,
conjunctivitis, bronchitis and various other ailments recur in
gouty subjects, it is found useful. According to some who
consider the drug almost a specific in acute gout, provided that
it be pushed until it causes a slight griping or laxity of the
bowels, it is the opinion that it not only does not have any
marked effect in preventing attacks, but that it often seems to
hasten their onset. The active principle, colchicine, is believed
by some to be more successful in gout than any form of the
crude drug. The preparation known as colchicine salicylate
is a solution of colchicine in oil of wintergreen. Colchicum is
used to some extent in the treatment of chronic rheumatism
and so-called rheumatic gout, or rheumatoid arthritis, and here,
as well as in subacute or chronic gout, it is advised that it
should be given in conjunction with potassium iodide. In gout
the commencement of the treatment with a purgative is usually
advisable, and it is also a common practice to administer col-
chicum with magnesium sulphate or carbonate. A well-known
formula is: Extract of colchicum corm, calomel, powdered aloes,
powdered ipecacuanha, of each .06 gm. (1 gr.), with .015 to
.03 gm. (34 to y2 gr.) of extract of nux vomica. The seed is
said to be less active than the corm. To elderly persons and
to those whose circulatory apparatus is feeble it is advised
that colchicum should be administered with caution, or not at
all. Moreover, some individuals exhibit an intolerance of even
very small doses, which quickly produce intestinal irritation or
cardiac depression. It is found that the paroxysms of gout may
often be suppressed by large purgative doses, but experience
has shown that this use of the drug is dangerous, as such sup-
PHYTOLACCA. 7 I J
pression is liable to be followed by serious internal disease, ap-
parently due to a transfer of the gouty affection.
TOXICOLOGY.
In the treatment of colchicum-poisoning an emetic and a cathartic
should be administered at once, if the stomach and bowels have not
been freely evacuated. Large quantities of warm water may also be
given to aid in these operations and to act on the kidneys. Tannic
acid is a chemical antidote, forming an insoluble tannate with the alka-
loid, and though experiments upon animals have shown that it is
not to be relied upon, it should be thoroughly tried in large amount.
Otherwise the treatment must be symptomatic. Opium is usually re-
quired to relieve the pain and check vomiting and diarrhoea, and
stimulants to counteract depression.
PHYTOLACCA.
PHYTOLACCA (Phytolacca Radix, U. S. P., 1890).— Phytolacca.
(Poke Root.) Dose, (emetic) 1 gm.; 15 gr.; (alterative) 0.125 gin.
(125 milligm.) ; 2 gr.
Preparation.
Fluidextr actum Phytolaccae. — Fluidextract of Phytolacca.
Dose, (emetic) 1 C.C.; 15 Til; (alterative) 0.1 C.C.; V/2 TTV.
Unofficial Preparation.
Phytolaccae Fructus (U. S. P., 1890). — Phytolacca Fruit.
(Poke Berry.) Dose, 0.05 to 0.30 gm.; 1 to 5 gr.
Action of Phytolacca.
Phytolacca is an emeto-cathartic, acting slowly and causing
considerable depression. In large doses it possesses also some
narcotic properties.
Therapeutics of Phytolacca.
Phytolacca is used as a laxative and alterative. Recently a
preparation made from the berries has been used to reduce adi-
pose tissue.
7l8 PHARMACOLOGY AND THERAPEUTICS.
(d) Intestinal Antiseptics.
BETANAPHTHOL.
BETANAPHTHOL (Naphtol, U. S. P., 1890).— Betanaphthol.
Dose, 0.250 gm. (250 milligm.) ; 4 gr.
Unofficial Preparations.
Hydronaphthol. — Hydronaphthol. Dose, .12 to .18 gm.; 2
to 3 gr.
Naphthol Camphoratum. Camphorated Naphthol.
Action of Betanaphthol.
This substance is antiseptic and irritant. In animals, in
large doses, it causes symptoms similar to those of phenol
poisoning, except that the convulsions are less pronounced,
and in the dog are not observed at all. In solution or in vapor
it is irritant to mucous membranes, and in the course of excre-
tion it induces pain in the bladder and urethra, with strangury,
and hyperemia and swelling of the mucous membrane. Either
when injected subcutaneously or absorbed from the alimentary
canal in sufficient quantity it excites acute nephritis, with albu-
minuria and hemoglobinuria. In man some nephritis is said
to have been caused from its external application.
Therapeutics of Betanaphthol.
Betanaphthol was first introduced as an antiseptic in der-
matological practice and used, in a 10 per cent, ointment, in
scabies, ringworm and psoriasis; it is, however, irritating in
eczema. It is a remedy of great value in obtaining intestinal
antisepsis, bacteriological investigations showing that it de-
stroys certain micro-organisms in situ when administered to the
extent of 2.70 gm. (40 gr.) a day. As it is more or less irri-
tating to the stomach it should be administered in keratin-
coated pills when its action is desired in the intestine only. It is
useful in flatulent dyspepsia, chronic gastric or intestinal ca-
tarrh, and dilatation of the stomach. Good results have also
been reported from its employment in typhoid fever, tubercu-
lous ulceration of the bowels, scarlatina, diphtheria and erysipe-
ASAPROL. 719
las. Fatal inflammation of the kidneys has resulted in some
instances where it has been used in large quantities.
Hydronaphthol (not official) occurs in glistening, micaceous
scales and is sparingly soluble in water, but freely soluble in
alcohol, ether, chloroform, glycerin and oils. It has been rec-
ommended for antiseptic purposes generally, and it is beneficial
as an external application in many skin diseases. It has been
shown, however, to exist only as an impure form of beta-
naphthol.
Camphorated Naphthol (not official), which is prepared by
carefully heating one part of naphthol with two of camphor, is
a homogeneous, oily fluid which is insoluble in water and read-
ily decomposes on exposure to light and air. It is used as a
parenchymatous injection, either undiluted or in olive oil, in
doses of .12 to .30 c.c. (2 to 5 1*1). It is reported to have been
extensively employed in the irrigation of joints, bony cavities,
tendinous sheaths, cold abscesses in the pleural and uterine
cavities, and in tuberculosis of the bladder; all of which parts
seemed to bear the undiluted fluid well. It has also been sub-
cutaneously injected, with alleged good results, in tuberculous
adenitis and tuberculosis of the testis. It is considered by some
practitioners to be superior to all other remedies for prevent-
ing suppuration in acute tonsillitis.
ASAPROL.
Unofficial Preparation.
Asaprol. — Asaprol. (Calcium betanaphthol alpha-monosui-
phonate.) Dose, 1 to 4 gm.; 15 to 60 gr.
Action of Asaprol.
Asaprol is a useful, soluble and safe antiseptic.
Therapeutics of Asaprol.
It is valuable in epidemic influenza, relieving the pain and
reducing the fever, not giving rise to prostration or inter-
720 PHARMACOLOGY AND THERAPEUTICS.
ference with the heart or respiration. In atonic dyspepsia,
when fermentation alternates with acid eructations, it has
achieved brilliant results. Since it is not irritating to the ali-
mentary mucous membranes, it can advantageously replace
betanaphthol. In chronic rheumatism it will relieve the pain of
an acute exacerbation. In acute rheumatism, although it does
not present the disadvantages of the salicylates, it is not so use-
ful, nor so uniformly successful. It has also been employed
in typhoid fever.
NAPHTHALENE.
NAPHTHALENTJM (Naphtalinum, U. S. P., 1890).— Naphthalene.
(Naphthalin.) Dose, 0.125 gm. (125 milligm. ) ; 2 gr.
Action of Naphthalene.
Naphthalene is antiseptic, antifermentative, disinfectant and
deodorant. Since it is not absorbed by the system, it acts only
upon the mucous membrane of the bowels.
Therapeutics of Naphthalene.
It is a true intestinal antiseptic, and is of great value in
dysentery and in catarrhal, typhoid and tuberculous diarrhoea,
where it markedly lessens or entirely abolishes the foetor of the
movements. It has also been used as a vermifuge (dose, .20
to .40 gm. ; 3 to 6 gr.). Success in the treatment of dysentery
usually requires a daily dose of from 4 to 8 gm: (1 to 2 dr.),
best administered in starch wafers with oil of bergamot.
Externally, naphthalene is a useful antiseptic for ulcers, can-
cers and pus cavities, and can be employed in watery emulsion,
in alcoholic solution, or in a dry form. In ointments, in which
it is sometimes combined with calomel, it has been used with
advantage for chancres, chancroids, syphilitic ulcers, sloughing
wounds, psoriasis and chronic eczema. Naphthalene is well
suited for the disinfection of urinals, since it is so sparingly
soluble and very cheap. It is also in common use for preserv-
ing furs and woollen goods from moths.
SALICYLIC ACID. J2\
RESORCINOL.
Resorcinol (Resorcinum, U. S. P., 1890). — Resorcinol. (Resorcin.)
Dose, 0.125 gm. (125 milligm.) ; 2 gr.
Action of Resorcinol.
Resorcinol was originally introduced as an antipyretic, but
is now seldom employed for this purpose, as the necessarily
large doses are too depressant to the heart. It is powerfully
antiseptic. Dark-colored urine, often described as smoky, is
sometimes seen after large doses.
Therapeutics of Resorcinol.
A solution of resorcinol in glycerin, 1 to 4, is a good appli-
cation for removing epidermic scales in chronic skin diseases
and also the scales in seborrhcea sicca of the scalp; here it
doubtless inhibits the action of the bacteria which may be the
cause of dandruff. A lotion of resorcinol, 1 ; ether, 1 ; castor
oil, 1; eau de Cologne, 10; alcohol (90 per cent.), 35, may be
used both for dandruff and alopecia. A 5 per cent, solution
of resorcinol is an excellent antiseptic injection for the bladder
in cystitis. This remedy is of great value in fermentative dys-
pepsia when administered, well diluted, one hour after the in-
gestion of food.
SALICYLIC ACID.
SALICINTJM.— Salicin. Dose, 1 gm.; 15 gr.
ACIDUM SALICYLICUM.— Salicylic Acid. Dose, 0.500 gm.;
7V2 gr.
SODII SALICYLAS.— Sodium Salicylate. Dose, 1 gm.; 15 gr.
LITHII SALICYLAS.— Lithium Salicylate. Dose, 1 gm.; 15 gr.
AMMONTE SALICYLAS.— Ammonium Salicylate. Dose, 0.250 gm.
(250 milligm.); 4 gr.
STRONTII SALICYLAS.— Strontium Salicylate. Dose, 1 gm.;
15 gr.
Unofficial Preparation.
Aspirinum. — Aspirin. (Acetyl Salicylic Acid.) Dose, 0.30 to
4 gm.; 5 to 60 gr.
7
722 PHARMACOLOGY AND THERAPEUTICS.
Action of Salicin, Salicylic Acid, and of Sodium, Lithium,
Ammonium and Strontium Salicylates.
External. — Salicylic acid is somewhat more powerfully anti-
septic than phenol, but its salts are less strongly antisep-
tic. Salicin, it is stated, has no antiseptic properties unless
decomposed into its constituents. Applied to the skin, salicylic
acid has the effect of softening the epidermis and also of dimin-
ishing perspiration. It is irritant to mucous membranes and
abraded surfaces, and its continued application in concentrated
form may have some destructive action on the tissues. When
inhaled or applied to the fauces, it excites sneezing and cough-
ing.
Internal. Alimentary Tract. — When swallowed in powder
salicylic acid causes irritation, and sometimes soreness, of the
mouth and throat. In the stomach it is also irritant, and is
apt to cause pain, nausea and vomiting, with more or less con-
gestion. In some instances even erosion of the mucous mem-
brane is produced. In dilute solution, however, it has no such
effect. Salicin is a bitter tonic, instead of an irritant to the
stomach, though after absorption its action is similar to that
of the acid. The sodium and lithium salts are also much less
irritating than salicylic acid. In the body salicin, when given
by the mouth, is decomposed into glucose and saligenin
(C7H802), and this process no doubt takes place in the intes-
tine, for when it is injected into the circulation it is chiefly
excreted unchanged. Saligenin is further decomposed into
salicylic acid, salicylous acid or salicylic aldehyde (C7H60,),
and salicyluric acid (HC9H8N04).
Liver. — Salicylic acid and the salicylates increase the biliary
secretion, through some specific action, it is thought, on the
liver cells, and they are probably the strongest cholagogues
known. Both the amount of bile and the solids are augmented,
and in one case of biliary fistula it was found that the concen-
tration of the secretion was increased, the solids being aug-
mented in greater proportion than the fluid. In dogs, however,
SALICYLIC ACID. 723
the bile is stated to become more liquid, and to contain less than
the usual amount of solid constituents.
Heart and Circulation. — In animals small doses intrave-,
nously injected have the effect of accelerating the heart, prob-
ably from a direct action on the cardiac muscle, while the
blood-pressure is increased from stimulation of the vasocon-
strictor centre in the medulla. Very large doses produce weak-
ness and slowness of the heart, which becomes dilated, and a
fall in the blood-pressure. The lowered pressure is due prin-
cipally to the cardiac action of the drug, and to a less extent,
it may be, to depression of the vaso-constrictor centre. It has
been shown by sphygmographic tracings that in man full doses
of sodium salicylate (5 gm. — yy gr. — in two doses of 2.5 gm. —
38^ gr. each, given in water with an interval of one hour
between the doses) possess rather a raising than a lowering
action upon the intra-arterial blood-pressure and the frequency
of the pulse. In febrile cases, some of which were rheumatic,
the continued use of the drug in doses of 2 to 4.5 gm. (30 to
7° &r-) Per diem did not produce any appreciable depression.
The depressing effect of salicylates upon the heart which has
sometimes been observed clinically may, it is thought likely.
have been due to impurities in the drug, since it has been shown
that orthocreosotic acid is a powerful cardiac poison, and that
artificial salicylic acid and its sodium salt, containing creosotic
acids, were fatal to rabbits, while much larger doses of the
pure acid had no injurious effects.
Blood. — It is now known that salicylic acid, which is readily
absorbed, exists in the blood as the salicylates of the alkalies.
By some observers it has been found to be taken up from the
blood by the synovial membranes and rapidly excreted into the
cavities of the joints. If this is the case, it would thus be
capable of exercising a specific action in acute rheumatism.
The number of leucocytes in the blood is increased.
Respiration. — In man, acceleration of the respiration and
dyspnoea are occasionally observed, and such results have been
attributed to a central action. In animals the respiration is
724 PHARMACOLOGY AND THERAPEUTICS.
first quickened to some extent, and then slowed; showing prob-
ably that the respiratory centre is at first stimulated and then
depressed. Very large doses eventually paralyze the respira-
tion, and death is apparently due to this cause, the heart con-
tinuing to beat for some time afterwards.
Temperature. — Medicinal doses have no influence on the nor-
mal temperature. Very large quantities, by producing a col-
lapse-like condition, may bring about some reduction in it. In
fever patients, however, a distinctly antipyretic action is often
observed, though the fall in temperature is usually smaller and
of shorter duration than that caused by drugs of the acetanilide
series. This action has been attributed to dilatation of the
cutaneous vessels and an increase in the output of heat. Sali-
cylic acid and salicin are antiperiodic.
Skin. — It has been shown by plethysmographic measurements
that the vessels of the skin are dilated by salicylic acid in the
same way as by the antipyretics, and this action is supposed
to be due to excitation of the vaso-dilator centres in the medulla
which control the cutaneous areas. Probably the reason that
such dilatation does not cause any reduction of the normal tem-
perature is that it is counter-balanced by an increased heat
formation. In some individuals skin eruptions of various
character (possibly due in great measure to the dilation of the
cutaneous vessels) are observed, but they occur less frequently
than under the use of the antipyretics. The perspiration which
so often follows the administration of salicylic acid and its salts
is due, it is thought, rather to increased activity of the sweat
centres than to the vascular dilation.
Nervous System. — Except in cases where a special idiosyn-
crasy is present, the effects of salicylic acid on the central ner-
vous system are unimportant. In animals no marked depres-
sion appears to be produced except in the medulla oblongata.
It is true that convulsions sometimes make their appearance
before death, but they are believed to be due to the asphyxia
caused rather than to any direct effect of the drug. In the
medulla there is apparently at first a stimulation and subse-
SALICYLIC ACID. 725
quently a depression of the respiratory, the vaso-constrictor,
and, probably, the vaso-dilator centres.
Kidneys. — Salicylic acid has a moderate diuretic action, prob-
ably increasing the urinary secretion by its irritating effect on
the renal epithelium. The increased formation of urea may
also be a factor in the diuresis. Nephritis, with albuminuria and
hematuria, has occasionally been observed. An increase of 10 to
12 per cent, in the nitrogen and sulphur of the urine is caused by
salicylic acid, indicating a considerably augmented decomposition
of the proteids of the body. There is also a very marked in-
crease in the excretion of uric acid, different observers esti-
mating this at from 30 to 100 per cent. Salicylic acid first
appears in the urine in from ten to thirty minutes after inges-
tion. It is excreted by the kidneys to some extent unchanged,
but for the most part in combination with glycocoll. The com-
pound thus formed, salicyluric acid, is analogous to hippuric
acid. It reduces Fehling's solution, and has been mistaken for
sugar. The color of the urine is often dark or' greenish in
consequence of the presence of pyrocatechin or indican, or
both. The urine of persons taking salicylic acid gives a purple
tint with ferric chloride. Under the use of salicylic prepara-
tions the normal acidity of the urine is increased, and alkaline
urine may become acid. It acts as an antiseptic to the mucous
membrane of the urinary tract, and will remain undecomposed
for a considerable time after it has been passed.
Salicylic acid does not appear to be excreted by the stomach,
but it has been found in the milk, bile and perspiration.
Salicylism. — In some individuals a train of symptoms ana-
logous to those of cinchonism, and designated as salicylism, is
produced by the use of salicylic preparations. The skin rashes
have already been referred to. Perhaps the most frequent of
the manifestations is deafness, generally with tinnitus aurium,
and these disorders of hearing, as in the case of quinine, have
been shown to depend upon congestion of the tympanum, in
which ecchymoses and even inflammation may be found. Such
symptoms, it is well to note, may be relieved by the administra-
726 PHARMACOLOGY AND THERAPEUTICS.
tion of a small amount of alcoholic stimulant fifteen minutes
before each dose. The eye may also be affected; so that there
may be dimness of vision, sometimes amounting to total blind-
ness, in consequence, it is supposed, of constriction of the ocular
vessels. Headache, with a sense of fullness, is also a common
symptom, and this is very often associated with epistaxis. In
some instances haemorrhages from the retina, mouth, intestine,
kidney, or uterus likewise occur. Abortion has been repeat-
edly observed under salicylate treatment, but, as in the case
of quinine, it is considered an open question whether this was
due to the remedy or the disease. If the administration of
the drug is continued, the disturbances of the circulation of the
brain may produce violent delirium. Nausea and vomiting
occur, and the pulse and respiration gradually become de-
pressed. That some at least of these untoward symptoms, as
well as others which are occasionally met with, may be due to
impurities present in artificial salicylic acid seems probable.
Therapeutics of Salicin, Salicylic Acid, and of Sodium,
Lithium and Strontium Salicylates.
External. — For external applications salicylic acid has the
advantages of being odorless and comparatively free from the
danger of toxic symptoms following absorption. The ointment
(official in B. P., 1 part of the acid to 9 of hard, and 18 of soft
paraffin) may be used when an antiseptic and stimulating un-
guent is called for. Other useful preparations are a collodion
composed of salicylic acid, 1, flexible collodion, 8; a glycerin
containing 10 per cent, of salicylic acid; and a plaster, also 10
per cent. Strong applications of salicylic acid are very ser-
viceable for removing excess of epidermis, as in warts or corns,
because it softens epithelium. The acid has a peculiar action
upon the epidermis, and especially upon the corneous layer;
the horny cells are softened, gradually loosened, and separated
from the corium without any inflammatory reaction. What is
known as "green solution," consisting of salicylic acid, 11;
extract of cannabis indica, 2; flexible collodion, 87 parts, is
SALICYLIC ACID. 727
often used for corns, but the tincture of hemp is of no special
advantage and makes an unsightly stain. Strong applications
of the acid are also employed for the destruction of such
growths as lupus nodules. Salicylic acid may be combined with
chalk as a dentifrice, and with chalk, talc, starch, cornmeal or
rice flour for checking profuse or fetid perspiration of the feet
and axillae and also the night-sweats of phthisis. This acid is
the principal ingredient in Thiersch's solution (see p. 87),
and a small amount of it is often added to Thompson's fluid
(see p. 87). In gangrene or sloughing ulcer it may be ap-
plied either in full strength or diluted, as seems advisable.
Dressings may be saturated with an alcoholic solution and
dried. Aqueous solutions, made by means of alcohol, act as a
local anodyne, when applied in thrush and catarrhal stomatitis,
allaying the burning pain of the erosions left after the vesicles
have ruptured. Salicylic acid is used to a considerable extent
in cutaneous diseases. On account of its germicidal activity
it is efficacious in tinea circinata, and a solution of it in collo-
dion is said to be a serviceable application for scabies, after the
skin has been cleansed by a hot alkaline bath. An ointment con-
taining it may be used to remove freckles, and for the treatment
of chronic eczema, lupus erythematosus of the face and eyelids,
and ulcerated lupus vulgaris. To relieve the smarting and itch-
ing of urticaria the following powder has been recommended:
Salicylic acid, 5; zinc oxide, 15; powdered starch, 30 parts.
Internal. — In many cases of rheumatic fever salicylic acid
seems to act as a specific. Under its influence the temperature
is rapidly reduced and the swelling and pain in the joints dimin-
ished, and it apparently has some effect in preventing the car-
diac complications so frequently met with in this disease. In
order to avoid gastric disturbance it should be administered
well diluted. Sodium salicylate is frequently given on account
of its greater solubility, in preference to the acid itself. When
this preparation is used, care should be taken that it is made
either from natural salicylic acid or from artificial acid known
to be free from impurities. In a well-marked attack of the
728 PHARMACOLOGY AND THERAPEUTICS.
disease it is customary to give 1.20 gm. (20 gr.) every two to
three hours for the first day, or longer if there is not a satis-
factory abatement in the symptoms. When this has been ac-
complished, the remedy, in the same dose, should be given
three times a day, and continued for about ten days after the
fever and pain have gone. Salicin, which is usually very well
borne and is thought to be less depressant, is less certain in its
effects, as its therapeutic activity probably depends upon its
conversion into salicylic acid, and this process has been found
to be a slow and imperfect one. The salicylic preparations
are sometimes of service in chronic as well as acute rheuma-
tism. They are of no benefit in rheumatoid arthritis. In gout
their value is questionable, some authorities advocating their
employment and others believing them to be entirely inefficient.
If given at all in this disease, very large doses seem to be
required, and even then no effect may be produced. For the
glycosuria of patients affected with gout or goutiness they are
distinctly useful. In many cases of migraine and sciatica the
salicylates are of incontestible service, and their efficacy in such
affections is explained by the action of these remedies in elim-
inating uric acid. So far as they limit intestinal fermentation
they are also beneficial in diabetes. Except in the case of rheu-
matic fever they are not employed as antipyretics, as in other
febrile conditions the temperature can be more efficiently re-
duced, when this is desirable, by other means. In cases of
alkaline urine and cystitis salicylic acid has sometimes been
resorted to to alkalize the urine, but there are better remedies
for this purpose. In the treatment of cholelithiasis, sodium
salicylate, in association with sodium benzoate, has been found
very useful for the conditions which tend to cause intestinal
catarrh and thus lead to catarrh of the biliary passages. Sali-
cin, which, like other bitters, promotes appetite and digestion,
may be employed as a stomachic in atonic dyspepsia. It has
also been found useful in preventing the fermentations which
take place in the food in cases of gastro-intestinal catarrh, and
as a remedy for the chronic diarrhoea of children.
SALICYLIC ACID. 729
Aspirin (not official) is acetyl salicylic acid, which occurs as
a white, insoluble, crystalline powder, or in needles, of an agree-
able taste. In an alkaline fluid it breaks up and sets free sali-
cylic acid. It has been employed for acute polyarticular rheu-
matism in the same doses as sodium salicylate, over which it is
believed to possess the advantage of not deranging digestion.
OLEUM BETULA. (Oleum Betulae Volatile, U. S. P., 1890.) —
Oil of Betula. (Oil of Sweet Birch.) Dose, 1 C.C.; 15 TTL .
OLEUM GAULTHERIA.— Oil of Gaultheria. (Oil of Winter-
green.) Dose, 1 c.c; 15 TT\.
Preparation.
Spiritus Gaultheriae.— Spirit of Gaultheria. Dose, 2 c.c;
30 TT\.
METHYLIS SALICYLAS.— Methyl Salicylate. Dose, 1 C.C.;
15 T\. .
Preparation.
Cataplasma Kaolini. — Cataplasm of Kaolin.
Action of Oil of Betula, Oil of Wixtergreex and Methyl
Salicylate.
The action of these substances is the same as that of salicylic
acid. When taken in moderate quantities, they are, like that
acid, broken up and eliminated as salicyluric acid. It is as-
serted that methyl salicylate, which is an ester, formed syn-
thetically, can be produced of more uniform quality and is more
certain and definite in its action than either of the natural oils.
Therapeutics of Oil of Betula, Oil of Wixtergreex axd
Methyl Salicylate.
The uses of these drugs are the same as of salicylic acid, and
they possess the additional advantage that they are not liable
to contamination with impurities such as ortho- and para-
creosotic acids ; the former of which is a powerful cardiac de-
pressant, and both of which are found in the artificial salicylic
acid.
730 PHARMACOLOGY AND THERAPEUTICS.
PHENYLIS SALICYLAS (Salol, U. S. P., 1890). Phenyl Salicy-
late. Dose, 0.500 gm. (500 milligm.) ; 7y2 gr.
Unofficial Preparation.
Salol Camphoratum. — Camphorated Salol. (Salol Camphor.)
Action of Phenyl Salicylate.
Phenyl Salicylate, or Salol, is an antiseptic, germicide and
antipyretic. It has little or no local action in the mouth or
stomach, but in the intestine is decomposed by the fat-splitting
ferment of the pancreatic juice into phenol, about 36, and sali-
cylic acid 64, per cent. It is thought that under certain con-
ditions some decomposition also takes place in the stomach.
The two constituents, thus set free, are absorbed and produce
their characteristic effects on the system. It is not generally
toxic in therapeutic doses, but its too free use may give rise to
the symptoms of carbolic acid poisoning. In moderate quanti-
ties it sometimes produces the disturbances of hearing observed
under salicylic acid, without any evidences of carbolic intoxi-
cation.
Therapeutics of Phenyl Salicylate.
External. — As an antiseptic for external use it has probably
been overrated, as it is stated to be active only when decom-
posed by the microbes which it is designed to destroy. It has
been used, mixed with talc (1 to 5), as a dusting powder, and
as a dressing for wounds, burns and ulcers, as well as for ery-
sipelas, impetigo, pustular eczema, and other cutaneous affec-
tions. A camphorated salol is recommended in the treatment
of suppurative otitis.
Internal. — In rheumatic fever it is used to some extent as a
substitute for salicylic acid. Although somewhat slower in
action, it has the advantage of being tasteless and of producing
no gastric irritation. Occasionally, however, the considerable
amount of phenol freed by its decomposition has induced
troublesome symptoms. Since the decomposition of salol takes
place in alkaline fluids, it has been used as an intestinal anti-
SALOPHEN. 731
septic in acute diarrhoea, catarrh of the bile-ducts, dysen-
tery, cholera and other diseases; also in affections of the urin-
ary tract. For the last the following may be used : Salol, 1 ;
almond oil, 2 ; powdered acacia, 1 ; syrup, 2 ; water, 24. The
emulsion should be made in a warm mortar with water at 65.5 °
C. (1500 F.). It is a remedy of very great value in the treat-
ment of typhoid fever, for by the active disinfection of the con-
tents of the intestine and of the ulcerations, it favors their
healing and prevents reinfection, thus lowering temperature and
diminishing the liability to relapse and to permanent damage to
tissues. This is the logical treatment, because it destroys the
cause of the symptoms at their point of origin. On account of
the large proportion of phenol which it contains salol is more
dangerous than the corresponding amount of salicylic acid, and
it is especially to be used with great caution if the kidneys are
diseased. Sometimes, in fever, on account of the lessened alka-
linity of the intestinal contents, it is not decomposed into its
constituents, and for that reason becomes very much less effec-
tive. In this case an alkali should be administered at the same
time. Salol has proved efficient in the so-called bilious form
of sick headache and in some varieties of neuralgia, and is
highly praised in the treatment of epidemic influenza.
Unofficial Preparation.
Salophenum. — Salophen (Acetylparamidophenol Salicylate).
Dose, .30 to 1 m.; 5 to 15 gr.
Action of Salophen.
Salophen is regarded as possessing the medicinal virtues of
salol, while at the same time free from its toxic qualities. In
a warm alkaline solution it is broken up into salicylic acid and
acetylparamidophenol, the latter being harmless. It is decom-
posed in the intestines, even when given hypodermatically.
Therapeutics of Salophen.
It is used as a substitute for salicylic acid in acute rheuma-
tism, and as an intestinal antiseptic. It is probably quite as
732 PHARMACOLOGY AND THERAPEUTICS.
efficient, and much safer than salol. The fact that it is taste-
less renders it easy of administration.
Division X. — Drugs acting on the Nervous and Muscular
Systems.
A. Drugs acting on the Muscles. — While many facts of inter-
est have been ascertained in regard to this class of drugs, they
have no practical bearing on therapeutics. Brunton's classifi-
cation, founded on that of Kobert, is as follows:
Class I. Irritability of muscle unaffected ; total amount of work it
can do diminished. — The following produce this effect : Apomorphine,
delphine, saponin, copper, zinc, and cadmium, and in large doses, anti-
mony, arsenic, platinum, and iron.
Class II. Both the irritability and the capacity for work diminished.
— The following produce this effect : Potassium, lithium, ammonium,
quinine, alcohol, hydrated chloral, and chloroform.
Class III. Diminish the capacity for work, and make the excitability
very irregular. — Lead, emetine, and cocaine.
Class IV. Alter the form of the muscle curve. — Veratrine, digitalis,
squill, and barium, strontium and calcium salts.
Class V. Increases the excitability. — Physostigmine.
Class VI. Increase the capacity for work. — Caffeine and theobromine.
Small doses of strychnine and veratrine shorten the latent period ;
large doses lengthen it.
Dilute alkalies diminish the extensibility ; dilute acids increase it.
B. Drugs acting on the Peripheral Endings of Motor Nerves.
— Curare is the typical drug of this class. While many of the
others have a special action on the motor nerve terminations in
common with curare, in the greater number of them this action
is more or less over-shadowed by other effects. With curare,
however, the action is so widely distributed that it may be
looked upon as a peculiar expression of fatigue and as a sign
of injury to these endings. In experiments upon animals it
can be shown by a process of exclusion that curare paralyzes
the peripheral endings of motor nerves alone, the sensory
nerves and the muscle-fibres being unaffected.
DRUGS ACTING ON NERVES AND MUSCLES. 733
Drugs paralyzing the termination of the motor nerves in muscle:
(1) Curare.
(2) Conium.
(3) Belladonna (atropine).
(4) Stramonium.
(5) Hyoscyamus.
(6) Scopola.
(7) Saponin.
(8) Sparteine.
(9) Amyl nitrite.
(12) Camphor.
(13) Lobeline.
(14) Nicotine.
(15) Methyl-brucine.
(16) Methyl-cinchonine.
(17) Methyl-codeine.
(18) Methyl-morphine.
(19) Methyl-quinine.
(20) Methyl-nicotine.
(10) Diluted hydrocyanic acid. (21) Methyl-strychnine, and
(11) Cocaine. many others.
Curare and conium are by far the most important, but this action is
not made use of in medicine.
Drugs stimulating the termination of motor nerves in muscle:
(1) Aconite.
(2) Nicotine.
(3) Pilocarpine.
(4) Pyridine.
(5) Strychnine (slightly).
It is possible that some of the beneficial action of strychnine in cer-
tain cases may be due to its slight action on motor nerves, but other-
wise these drugs are not employed for this action.
C. Drugs acting on the Peripheral Endings of Sensory-
Nerves (other than those of special sense). — As it is very diffi-
cult to secure any satisfactory data regarding sensation from
animals, our knowledge of the action of this group is neces-
sarily derived almost entirely from observations on man.
Drugs which Stimulate the Termination of Sensory Nerves.
— These are the same as those already enumerated (p. 325)
as acting locally on vessels. When topically applied they give
rise to pain, and in the case of most of them the cause of the
pain is the local inflammation they set up.
Therapeutics. — It is for their action on the blood-vessels that
local irritants are principally used, but they are not infrequently
employed also for their counter-irritant effects. By their ap-
plication to the skin it is probable that changes are induced in
734 PHARMACOLOGY AND THERAPEUTICS.
the calibre of the vessels and in the sensory nerves of internal
organs, so that deep-seated pain is thereby relieved. The heart
and respiration are also reflexly stimulated by peripheral exci-
tation of nerves, and hence counter-irritation is made use of to
rouse persons who have fainted or became unconscious from
opium poisoning, etc. It is essential that the action should be
a prompt one, and the application of the faradic current is quite
commonly employed as an external stimulus in such cases.
Drugs which Depress the Terminations of Sensory Nerves. —
Of these there are two kinds: those which simply relieve pain,
or local anodynes; and those which diminish sensibility, or
local anaesthetics.
Local Anodynes. — These have no action unless pain be present. They
(i) Aconite.
(2) Phenol.
(3) Menthol.
(4) Diluted hydrocyanic acid.
(5) Veratrine.
(6) Ether. ^v These must
(7) Alcohol. I be allowed to
(8) Chloroform. ] evaporate.
(9) Hydrated chloral.
(10) Belladonna.
(11) Stramonium.
(12) Hyoscyamus.
(13) Scopola.
(14) Opium.
(15) Sodium bicarbonate.
(16) Zinc oxide.
In the above list the most powerful are placed first. The local
anodyne action of opium has been disputed, and it is probable that
many substances not included in this list which have been regarded as
local anodynes have little if any claim to this designation. Cold is an
effective local anodyne because of its depressant effect on sensibility,
and so likewise is warmth, which relieves pain by diminishing tension,
in consequence of the vaso-dilation which it primarily induces.
Therapeutics. — Local anodynes, it may readily be supposed,
are called for in a great variety of conditions, and while often
of service as adjuvants to internal treatment, they are espe-
cially useful in those affections in which it is not possible to
remove the cause of the pain or irritation present.
Local Anaesthetics. — These are cocaine, eucaine, holocaine, ortho-
form, phenol, and extreme cold, whether produced by ice or by
DRUGS ACTING ON NERVES AND MUSCLES. 735
the evaporation of ethyl chloride, methyl chloride, or ether. As re-
gards the performance of operations, the ether spray has the disad-
vantage of stiffening the parts so that it is only useful for a single incision
as for opening furuncles. Upon a damp day it is ineffectual. Ethyl chlo-
ride sprayed from tubes by the heat of the hand is the best method and
the one most frequently employed at present. Eucaine and cocaine,
which produce a high degree of local insensibility, are largely employed.
D. Drugs Acting on the Trunks of Nerves. — These, if taken
for a considerable period, give rise to chronic neuritis, with
much augmentation of the areolar tissue and also fatty degen-
eration of the nerve-fibres. During the earlier stages of the
inflammation much pain and tingling are experienced, but later
these are replaced by numbness and diminished sensation as
the function of the nerves becomes more and more depressed,
and finally paralysis, often accompanied by trophic lesions, re-
sults. These actions are of pathological, rather than pharma-
cological, interest, and will be found fully described in works
on medicine.
The drugs producing peripheral neuritis are —
(1) Lead.
(2) Mercury.
(3) Arsenic.
(4) Alcohol.
E. Drugs Acting on the Spinal Cord. — After the administra-
tion of certain drugs it is found that a slight peripheral stimu-
lus will produce such marked reflex action that convulsions will
result. When this is due to stimulation of the spinal cord, it
is determined in the following way: If the cord is cut across
and convulsions are still caused by such slight stimulus, it is
evident that these cannot be of cerebral origin, since in that
case they would not take place below the point of section. On
the other hand, if the drug does not cause convulsions when
previously to its injection into the circulation the vessels of the
cord have been ligatured, it is inferred that its action is not
on the muscles or nerves. Other experiments going to show
that the action is on the cord are the following: If when the
drug is injected into vessels by which it reaches the cord
73^
PHARMACOLOGY AND THERAPEUTICS.
quickly, convulsions appear sooner than when it is injected into
other vessels; if convulsions do not occur when the cord is
destroyed ; if when the destruction of the cord is gradually pro-
duced by pushing a wire down the vertebral canal, the convul-
sions cease from above downward as the destruction proceeds.
(i) The drugs increasing the irritability of the anterior cornua are —
(i) Strychnine.
(2) Brucine.
(3) Ammonia.
(4) Thebaine.
(5) Chloroform.
(6) Ether.
(7) Ergot.
(8) Opium.
(The last four only slightly, and early in their action.)
Therapeutics. — Strychnine is at times useful for paralysis
resulting from diseases of the spinal cord, but with this excep-
tion it is rare that affections of the cord are benefited by stimu-
lation of the anterior cornua.
(2) Drugs which depress the activity of the anterior cornua:
(1) Physostigmine.
(15) Lithium salts.
(2) Gelsemium.
(16) Antimony salts.
(3) Muscarine.
(17) Arsenical salts.
(4) Bromides.
(18) Camphor.
(5) Alcohol.
(19) Amyl nitrite.
(6) Chloroform.
(20) Sodium nitrite.
(7) Ether.
(21) Hydrated chloral
(8) Ergot.
(22) Phenol.
(9) Opium.
(23) Apomorphine.
(10) Mercury.
(24) Veratrine.
(11) Zinc salts.
(25) Turpentine.
(12) Silver salts.
(26) Saponin.
(13) Sodium salts.
(27) Emetine.
(14) Potassium salts.
(28) Colchicum.
Of these, apomorphine, alcohol, chloroform, ether, arsenic, camphor,
morphine, phenol, hydrated chloral, nicotine, and veratrine first excite
slightly before depressing.
DRUGS ACTING OX NERVES AND MUSCLES. 737
Therapeutics. — So far as their action on the spinal cord is
concerned, these drugs are of very little practical utility. Phys-
ostigmine, which is by far the most powerful, has been tried to
a considerable extent in tetanus and other diseases accompanied
by convulsions, but with little benefit.
F. Drugs Acting on the Brain. — The action of these can by
no means be so distinctly localized as that of drugs acting on
the spinal cord and nerves. Drugs acting on the brain illus-
trate two very important general laws :
(1) The law of dissolution, which, when stated as it applies
in pharmacology, is as follows : When a drug affects functions
progressively, those first affected are the highest in develop-
ment ; that is to say, they are the last acquired by the individual
and the last to appear in the species. The next affected are
those next to highest, and so on; till finally the lowest of all
from an evolutionary point of view, that is to say, the functions
of respiration and circulation, are affected. This law is well
exemplified in the case of alcohol, under the influence of which
the first functions to be disordered are those of the intellect,
especially the highest, such as judgment and reason; then follow
disorders of movement, and finally death from failure of respi-
ration and circulation.
(2) When a drug in moderate doses excites a function, in
large doses it often paralyzes it. Cerebral stimulants may thus
also be hypnotics.
Drugs Acting on the Motor Centres of the Brain. — To inves-
tigate these, the motor area of the cortex is exposed by trephin-
ing. One method is to note, before and after the administration
of the drug, the strength of the electric current which it is neces-
sary to apply to this area to produce corresponding movements.
Another is to observe the strength of current necessary to elicit
a movement and then to allow the wound made by the trephine
to close; after which the drug is regularly administered to the
animal for several weeks. The opposite motor area is then ex-
posed, and the strength of the current required for the same
purpose is noted.
48
738
PHARMACOLOGY AND THERAPEUTICS.
It has been found that the following diminish the activity of the
motor area.
(i) Alcohol.
(2) Anaesthetics.
(3) Hydrated chloral.
(4) Potassium bromide.
(5) Sodium bromide.
(6) Ammonium bromide.
It is on account of this action that bromides are largely em-
ployed in epilepsy and other convulsive affections.
Drugs exciting the motor cells of the cortex are —
(1) Atropine.
(2) Absinthium.
(3) Strychnine.
(4) Physostigmine.
They are not used in medicine for this purpose.
(1) General Cerebral Stimulants. — Experiments on animals
are of no value in determining the effects of these. In the
human subject they produce general excitation of the mental
faculties, and this is not infrequently followed by confusion,
incoherence and delirium, the character of the latter varying to
some extent with the particular drug employed. In many in-
stances the stimulation is soon replaced by a paralyzing in-
fluence.
Such drugs are —
(1) Belladonna.
(11) Guarana.
(2) Stramonium.
(12) Coca.
(3) Hyoscyamus.
(13) Cannabis Indica
(4) Scopola.
(14) Lupulin.
(5) Alcohol.
(15) Opium.
(6) Chloroform.
(16) Camphor.
(7) Ether.
(17) Santonin.
(8) Nitrous oxide.
(18) Quinine.
(9) Coffee.
(19) Salicylic acid.
(10) Tea.
(20) Tobacco.
Therapeutics. — These are of the greatest importance in their
therapeutic applications, and many of the drugs are taken habit-
ually as cerebral stimulants in various parts of the world.
DRUGS ACTING OX NERVES AXD MUSCLES. 739
(2) General Cerebral Depressants. — These are commonly
divided into three classes : Hypnotics or Soporifics. Narcotics
and Anaesthetics.
Hypnotics or Soporifics are drugs which produce sleep,
closely resembling, if not identical with, natural sleep. It is
known that during sleep the brain is anaemic, and it is probable
that the anaemia is the cause of sleep. It may be that the action
of some hypnotics is due to their inducing cerebral anaemia.
The hypnotics are —
(1) Opium. (10) Paraldehyde.
(2) Morphine. (n) Alcohol.
(3) Hydrated chloral. (12) Hyoscine.
(4) Chloralamide. (13) Scopolamine.
(5) Butyl-chloral hydrate. (14) Cannabis Indica.
(6) Bromides. (15) Urethane.
(7) Trional. (16) Lupulin.
(8) Peilotine. (17) Lactucarium.
(9) Sulphonal.
Therapeutics. — In all cases of insomnia the underlying condi-
tion should be carefully looked into and removed if possible.
These drugs should be resorted to with the greatest reluctance
on account of the danger of habituation. Chloral, if used with
great caution, peilotine, paraldehyde, trional. and choralamine
are perhaps the most satisfactory, but the use of hypnotics
is apt to be greatly abused. It is well to remember that sleep
may often be induced by causing dilatation of the vessels of
other parts of the body than the brain. Thus,, a warm bath or
a full meal tends to promote sleep.
Narcotics are substances which not only produce sleep, but
also in large doses depress the functions of respiration and cir-
culation. Many of them fall also under the head of general
anaesthetics; others are. in smaller doses, hypnotics. All must
be given in considerable doses.
740 PHARMACOLOGY AND THERAPEUTICS.
The following is a list of them.
(i) General Anaesthetics. i (6) Hyoscyamus.
(2) Opium. (7) Scopola.
(3) Hydrated chloral. (8) Alcohol.
(4) Belladonna. (9) Cannabis Indica.
(5) Stramonium. (10) Lupulin.
Therapeutics. — They are of great value in .diminishing mor-
bidly acute perception, relieving pain, allaying irritation, ner-
vous excitability, and spasm, inducing sfeep, and regulating the
vital functions by rest. For instance, opium and belladonna are
sometimes of much service in cardiac disease.
General Anesthetics. — These are drugs which lead to a
total loss of consciousness, so that pain is no longer felt, while
at the same time reflex action is abolished. They illustrate
admirably the law of dissolution, and also the fact that, after
excitement, paralysis often succeeds. The various stages of
their action will be described under Chloroform and Ether.
There are individual differences in the different anaesthetics,
and different individuals are sometimes differently affected by
the same anaesthetic.
(3) The general anaesthetics are-
(1) Chloroform.
(2) Ether.
(3) Nitrous oxide.'
(4) Pental.
(5) Ethyl bromide.
(6) Many other substitution
products derived from
alcohols and ethers.
Therapeutics. — Anaesthetics are given to cause unconscious-
ness, so that pain may not be experienced during operations, to
relax muscles in cases of dislocations, abdominal examinations,
phantom tumors, etc., to relieve severe pain, such as that of
parturition, biliary and renal colic, and to control convulsions,
as in tetanus and hydrophobia.
The chief dangers of anesthetics are — 1. Death from shock.
This usually takes place before the patient is fully under the
influence of the anaesthetic; reflex action being not yet quite
DRUGS ACTING ON NERVES AND MUSCLES. 74 1
abolished, the heart is stopped reflexly in consequence of the
peripheral stimulus of the operation. Such a deplorable result
may generally be avoided by taking care that the patient is fully
under the influence of the anaesthetic before the operation is
begun.
2. Death from paralysis of respiration. This may be due to
various circumstances. Thus, too much of the anaesthetic may
have been given, the patient may be suffering from some disease
of the lungs which renders respiration difficult, or the operation
may demand a posture which interferes with the breathing. It
is not usually a very grave danger, as warning is afforded by the
lividity of the surface. Changing the posture and the with-
drawal of the anaesthetic are often all that is required to restore
the patient, but artificial respiration, with the head thrown back
and the tongue pulled forward, may be called for, and in some
instances it is necessary to maintain this for hours.
3. Cardiac failure may occur if the vapor is too concentrated.
Gradual heart-failure is always preceded by respiratory changes,
but cardiac arrest may occur suddenly and without warning.
The patient all at once grows pale, and the pulse stops. In such
a case the anaesthetic should be discontinued, the patient should
be placed in the inverted posture, and artificial respiration main-
tained as before. The heart may be stimulated by large rectal
injections of hot normal saline solution or of coffee, if at hand,
by the inhalation of amyl nitrite, by the plunging of electric
needles into the heart or, better, by making a series of forcible
compressions of the chest over the heart; also, if the reflexes
are not abolished, by flicking the chest over the heart with hot
towels and placing hot compresses over it. Giving brandy sub-
cutaneously is to but add the effect of one poison to that of an-
other. The application of the faradic current over the cardiac
region is also objectionable.
4. Vomited matter or, if the operation is about the mouth,
blood, may suffocate the patient. No food should be taken for
some time before the operation, and if the patient is sick at the
742 PHARMACOLOGY AND THERAPEUTICS.
stomach, he should be turned on his side. In operations about
the mouth special precautions are required.
G. Drugs Acting on the Eye.
i. Drugs Acting on the Pupil. — If when a drug having the
property of dilating or contracting the pupil is applied locally
to one eye, it acts promptly and powerfully, and only upon the
eye into which it is dropped, it is evident that its action must
be local. So also when it acts on an excised eye. Again, if
the drug will act when thrown into the eye after all the vessels
going to the eye are ligatured, but will not act when thrown into
the general circulation, its action is shown to be local. On the
other hand, if after being dropped into one eye it acts but feebly
and after some time upon both eyes, it is to be inferred that its
action is a central one. So, if all the vessels of the eye are
ligatured, and the drug will not act if dropped in the eye, al-
though it would do so if thrown into the general circulation, it
is proved to act centrally. If such a drug acts when locally
applied, the inference is that its action is due to the fact that
some of it has been absorbed.
As to the manner in which a centrally-acting drug exerts its
influence, it has been shown that it may act either upon the
muscular fibres of the iris, upon the terminations of the third,
or motor oculi, nerve in these fibres, or upon the terminations
of the cervical sympathetic in them. Stimulation of the third
nerve causes the pupil to contract and stimulation of the cer-
vical sympathetic causes it to dilate; while section of these
nerves produces just the opposite effects. If, when the pupil is
dilated by the local action of a drug, stimulation of the third
nerve will not cause contraction, notwithstanding the muscular
fibres are responsive to mechanical stimulation, it shows that the
terminations of the third nerve are paralyzed. If, on the other
hand, the pupil is contracted by the drug, and although respon-
sive to mechanical stimulation, will not dilate after section of
the third nerve, it shows that the terminations of this nerve
are stimulated. If a drug, locally applied, causes dilatation of
the pupil, but not to the same extent as is caused by stimulation
DRUGS ACTING ON NERVES AND MUSCLES. 743
of the sympathetic, it is shown that its whole effect is not due
to stimulation of the sympathetic; and if the muscle remains
locally irritable, there must be paralysis of the terminations of
the third nerve. In a similar way the actions on the sympa-
thetic may be determined. It has been found, however, that
many drugs act both on the third nerve and on the sympathetic,
and in the following list they are classified under their main
actions :
Mydriatics (dilate the pupil) —
A. Paralyze the termination of the third nerve.
(6) Gelsemine.
(1) Atropine.
(2) Homatropine.
(3) Daturine.
(4) Hyoscyamine.
(5) Coniine.
(7) Muscarine.
(8) Hydrocyanic Acid.
(9) Aconite.
(10) Amyl nitrate.
prob-
ably.
B. Stimulate the terminations of the sympathetic. — Cocaine.
C. Act centrally. — Anaesthetics (late in their action).
Myotics (contract the pupil).
A. Stimulate the terminations of the third nerve. — Pilocarpine, and
nicotine (probably).
B. Stimulate the muscle. — Physostigmine.
C. Act centrally. — Anaesthetics (early in their action) and Opium.
Therapeutics. — Dilators of the pupils, especially atropine and
homatropine, are used to dilate the pupil for ophthalmoscopic
examination, and to prevent or break down adhesions of the
iris. Contractors of the pupil, especially physostigmine, are
used to overcome the effects of atropine, to prevent or break
down adhesions of the iris, and to prevent too much light enter-
ing the eye in painful diseases of the organ.
2. Drugs Acting on the Ciliary Muscle. — The following
drugs impair or paralyze accommodation:
(1) Atropine.
(2) Daturine.
(3) Hyoscyamine.
(4) Homatropine.
(5) Cocaine.
(6) Physostigmine.
(7) Pilocarpine.
(8) Gelsemine.
(9) Coniine.
744 PHARMACOLOGY AND THERAPEUTICS.
Intra-ocular tension is increased by atropine (large doses),
hyoscyamine, and daturine. It is decreased by cocaine, hyos-
cine, and physostigmine.
Gelsemine paralyzes the external ocular muscles, especially
the levator palpebral and the external rectus, by its action on
the terminal nerve filaments.
Cocaine, by stimulating the unstriped fibres in the orbital
membrane and the eyelids, causes the eye to protrude. Coniine,
when given in large doses, produces ptosis.
The capacity for seeing blue is increased by strychnine. San-
tonin causes first violet, then yellow vision.
H. Drugs Acting on the Ear. — Very little is known of the
action of drugs upon the organ of hearing. Some substances,
such as quinine and salicylic acid, cause ringing and buzzing in
the ears, and sometimes deafness.
I. Drugs Acting on the Sympathetic System. — The principal
points in regard to the actions of drugs on the sympathetic sys-
tem have already been touched upon in discussing their actions
upon blood-vessels. In regard to nicotine, it is a curious cir-
cumstance that if a large dose of it is administered, or if the
substance be locally applied to the superior cervical ganglion,
stimulation of the nerve below the ganglion fails to produce its
characteristic effects, although these still result from stimulation
of the nerve above the ganglion.
B. Drugs Acting on the Peripheral Endings of Motor
Nerves.
CURARE.
Unofficial Preparation.
Curara. — Curare, (Wourara. Ourari. Urari. Wourali.)
gr.
Action of Curare.
The characteristic effects of curare are paralysis of the nerve
endings in striped muscles and, later, paralysis of the nerve end-
conium. 745
ings around sympathetic ganglia. Under very large doses there
is induced a direct depression of the irritability of the muscle
substance. In some instances tetanic convulsions, from an
action on the central nervous system, are caused before the
characteristic curare action makes its appearance, but under
ordinary conditions, and especially if the amount given is only
moderately large, these are masked by the paralysis of the
nerve endings. When curare is applied directly to the spinal
cord, it gives rise to typical strychnine convulsions. It is elim-
inated chiefly in the urine, but some of it appears also in the
faeces. The urine of a curarized animal will poison another
one, and this may be repeated to several animals.
Therapeutics of Curare.
It has been used, by hypodermatic injection, with a limited
measure of success in tetanus. It has also been tried in hydro-
phobia, and recoveries have been reported from its employment
in two alleged cases of this disease. In epilepsy some observers
have found it beneficial, and it has been experimented with in
the treatment of various other nervous affections. In practice
it has proved unsuccessful as an antidote in strychnine poi-
soning.
CONIUM.
CONIUM.— Conium. (Spotted Hemlock.) Dose, 0.200 gm. (200
milligm.) ; 3 gr.
Preparation.
Fluidextractum Conii. — Fluidextract of Conium. Dose, 0.2
c.c; 3 n\.
Unofficial Preparations.
Extractum Conii (U. S. P., 1890). — Extract of Conium.
Dose, 0.02 to 0.05 gm.; y3 to 1 gr.
Succus Conii. — Juice of Conium (B. P.). Dose, 4 to 8 c.c;
1 to 2 fl. dr.
Coniina.— Coniine. Dose, 0.003 to 0.01 c.c; fa to 1 n\,.
746 PHARMACOLOGY AND THERAPEUTICS.
Action of Conium.
External. — It has no action on the unbroken skin. When
applied to bruised surfaces it has been alleged to exert some-
thing of an anaesthetic influence, but, in view of the manner of
action of the drug, very large doses being required to produce
a depressant effect upon the sensory nerves, this seems im-
probable.
Internal. G astro-intestinal Tract. — Coniine, even when in-
jected directly into the circulation, causes nausea and frequently
vomiting at an early stage of its action, and this effect is no
doubt due to a medullary influence. The nausea is accom-
panied by profuse salivation and sometimes by perspiration.
Large doses by the mouth may produce some diarrhoea, as well
as vomiting.
Circulation. — The cardiac action is not marked. As the in-
hibitory mechanism is stimulated, the pulse is usually rather
slow and weak. Sometimes, however, paralysis of the ganglia
on the inhibitory nerve may cause its acceleration. A consid-
erable, though transient, increase in the arterial tension which
is observed has been attributed to a stimulation of the gangli-
onic apparatus situated in the course of the vaso-constrictor
nerves.
Respiration. — The respiration is at first quickened and deep-
ened, but later becomes slow and labored, and then weak and
irregular. It finally ceases while the heart is still strong, and
the asphyxia is believed by the majority of recent investigators
to be due to paralysis of the nerve endings in the diaphragm.
Many, however, consider that the respiratory centre in the
medulla is paralyzed before these terminations.
Nervous System. — In the frog the chief effect is a paralysis
of the motor nerve terminations, such as is caused by curare,
but it is thought probable that while in frogs the symptoms are
all due to the action on the nerve endings, in mammals, in
whom this paralysis is much less marked, some of the phenom-
ena observed are due to central stimulation and to subsequent
paralysis of the respiratory centre. On the nerve terminations
conium. 747
in ganglia coniine acts in the same way as curare. It is found
that after large doses of the drug, the inhibitory impulses, owing
to paralysis of the ganglionic apparatus, no longer reach the
heart, and that stimulation of the vagus nerve has no effect on
the pulse-rate. Weak convulsive movements are often observed
before death, but they are due simply to the asphyxia.
In the earlier stages of the intoxication, twitchings and tre-
mors may occur. While coniine has been supposed to have a
narcotic depressing action on the central nervous system, this
is by no means a characteristic feature of its effects. Languor
and drowsiness are observed, but the latter does not pass into
actual sleep. In both man and animals consciousness is gen-
erally retained until immediately before the cessation of respira-
tion, and in most cases the intelligence remains clear to the end,
as in the case of Socrates.
In man the main symptoms relate to the motor, system, and
these are very characteristic. Under poisonous doses there is
an ascending paralysis, beginning with the lower extremities
and finally reaching the tongue, so that the patient may be un-
able to speak, though his intellect remains unimpaired. This
ascending paralysis has been ascribed to a lowered conductivity
of the spinal cord to impulses coming from the brain, the path
being blocked at first only to those impulses which have a long
distance to traverse. The sensory, as well as the motor, nerves
are depressed.
Eye. — In coniine poisoning the pupils are generally somewhat
dilated, and ptosis also occurs, indicating that the dilatation is
due to oculo-motor paralysis. In many instances imperfect
vision, from paralysis of accommodation, is noted.
Excretion. — Coniine is excreted in the urine, and very rap-
idly, so that its action passes off quite soon even when a con-
siderable quantity has been taken.
Therapeutics of Conium.
External. — Hemlock leaves, in the form of poultices and oint-
ments, have been applied to painful swellings and ulcers, but
74-8 PHARMACOLOGY AND THERAPEUTICS.
are of doubtful benefit. Conium applications for the relief of
myalgia or rheumatic pains are quite useless.
Internal. — Conium has fallen into almost complete disuse, and
one reason for this is the unreliability of its preparations, which
may contain no coniine whatever. This substance is very vola-
tile and unstable, and light and air render it inert. Succus
Conii (B. P., the expressed juice of the leaves and young
branches, to which 25 per cent, of alcohol is added) is generally
considered the most reliable preparation of the drug, but it is
stated that ounces of it have been taken without producing any
effects. Conium has been employed in spasmodic affections, as
chorea, paralysis agitans, tetanus, epilepsy, whooping-cough,
asthmatic attacks and laryngismus stridulus, and also in mani-
acal and hysterical excitement. It has little value except in
spasms due to irritation of a nerve-trunk, when it may perhaps
be of service. In those of cortical or spinal origin other reme-
dies should certainly be employed, as the physiological action of
the drug shows that it has really very little quieting effect upon
the central nervous system, but only prevents the impulses which
are sent out from manifesting themselves in movements of the
muscles.
TOXICOLOGY.
Attention has already been called to the languor and drowsiness and
to the eye-symptoms in cases of poisoning. The other phenomena have
been so accurately described by Plato in his account of the death of
Socrates, who was probably given the expressed juice of the root, that
his words may be taken as a fair representation of the ordinary symp-
toms : " He went about, and as he noticed that his thighs became heavy,
he lay down on his back, as the man directed. The latter — the one who
had given him the poison — touched him from time to time, and examined
his feet and thighs. Then he pressed his foot strongly, and asked
whether he could feel it ; he answered, No. Then he tried the knees,
and so went higher and higher, and showed us how he gradually became
cold and stiff. Then he touched him once more, and said that when it
came to the heart he would be dead. Now almost everything from
the abdomen down was cold." The mental powers of the sage re-
mained unimpaired until near the end. Post-mortem. — No distinctive
lesions are found, but only the usual indications of death from asphyxia,
such as engorgement of the organs with venous blood.
tobacco. 749
Treatment. — Emetics (see p. 175) should be administered and the
stomach washed out. Then tannic acid should be given freely, and
the stomach again washed out. Strychnine, as a respiratory stimulant,
and other stimulants, by hypodermatic injection, are called for. Warmth
should be applied to the surface and artificial respiration resorted to.
TOBACCO.
Unofficial Preparations.
Tabacum (U. S. P., 1890).— Tobacco.
Nicotinae Salicylas. — Nicotine Salicylate. (Eudermol.)
Pyridina. — Pyridine. Dose, .40 to 1.50 c.c; 6 to 25 TTL daily.
Action of Tobacco.
External. — Nicotine is powerfully antiseptic. It is absorbed
from the unbroken skin, as well as from abraded surfaces and
mucous membranes.
Internal. — The action of tobacco is due to nicotine, which is.
one of the most fatal and rapid poisons known. Very large
doses may cause death within a few seconds.
Gastro-intestinal Tract. — Even in very small doses (.009 gm. ;
-i gr.) nicotine, by its stimulation of the ganglia, causes in-
creased salivary secretion. It produces irritation of the fauces
and a burning sensation in the mouth, oesophagus and stomach,
with extreme nausea. The sensation of heat spreads from the
epigastric region all over the body. Nicotine is a violent
gastro-intestinal irritant, and vomiting and purging quickly set
in. The drug causes contraction of the muscular coats of the
hollow viscera, and this is chiefly a peripheral effect, but is also
due in part to stimulation of ganglia within the walls. Thus,
the stomach is thrown into contraction, and powerful and spas-
modic movement of the intestine occurs, with repeated evacua-
tion of its contents. A special feature of the action is the
profound collapse which attends these effects.
Circulation. — The heart appears to be at first slowed in con-
sequence of stimulation both of the vagus centre and the vagus
ganglia. Very soon, however, its action becomes markedly ac-
750 PHARMACOLOGY AND THERAPEUTICS.
celerated and irregular, from paralysis of the ganglia, which
obstructs the passage of the inhibitory impulses from above. If
the dose of the alkaloid is sufficiently large, however, no slow-
ing is caused, as immediate paralysis of the ganglia then results,
without any primary stimulation. In addition, nicotine has
some direct action on the cardiac muscle, which apparently is
first stimulated and then depressed. A rise in blood-pressure is
produced partly by the quickened action of the heart and partly
by vaso-constriction from stimulation of the constrictor ganglia.
This stimulation also is succeeded by depression, and in con-
sequence of this, as well as the enfeebling action on the heart,
the blood-pressure falls. Owing to the increased irritability of
the cardiac muscle caused by the drug, the heart may continue
to beat for a considerable time after death. Nicotine produces
disintegration of the red corpuscles in freshly-drawn blood, but
is not found to have this effect upon living blood, although the
spectrum of haemoglobin is said to be altered by it.
Respiration. — The respiratory centre in the medulla is first
stimulated, then depressed, and finally paralyzed. As a result
of the stimulation, the respiratory movements are accelerated
and deepened; later they become slow, shallow and irregular,
and death occurs from asphyxia. During the convulsions
caused by the alkaloid they are completely arrested. Before
the effects of central stimulation of the respiration become evi-
dent, however, it has been observed that the breathing is tem-
porarily shallow and at the same time rapid, with some defi-
ciency of the expiratory movements, and this is believed to be
due to an irritation of the pulmonary branches of the pneumo-
gastric.
Nervous System. — When very large doses prove almost in-
stantaneously fatal, the symptoms are those of sudden paralysis
of the central nervous system, including the respiratory centre.
In these exceptional instances no convulsions are observed.
The regular action of the drug is a stimulation, followed by
depression, of the whole cerebro-spinal axis, from above down-
ward. The effect of considerable amounts on the cerebrum is
TOBACCO. 751
to cause evanescent excitement, with violent headache, which
is quickly succeeded by a comatose condition. In the medulla
oblongata nicotine affects particularly the respiratory, vagus,
vaso-constrictor and convulsive centres, while the salivation and
vomiting caused by it are probably also partly of medullary
origin. Its action on the spinal cord is shown by increased
excitability, tremors and heightening of the reflexes. Convul-
sions also are observed, but as these are clonic instead of tonic
in type, and are found to be much weaker after division of the
cord immediately below the medulla than in the intact animal,
it is concluded that they have their seat in the medulla and hind
brain rather than in the cord. The peripheral actions are essen-
tially the same as those of pilocarpine, with the exception that
the stimulation is shorter and under large doses entirely absent,
while the depression is much more marked. Nicotine causes a
stimulation, and subsequently more lasting paralysis, of sympa-
thetic ganglia in all situations. In the skeletal muscles there
are produced fibrillary twitchings, which are succeeded by
complete paralysis of the nerve endings, as in the case of curare.
Ultimately, therefore, the function of the motor nerves is abol-
ished, and as a result of this there is intense muscular weakness.
Unstriped Muscle. — As has been mentioned, the stomach is
powerfully contracted. This contraction extends throughout
the intestine, and eventually results in a tetanic condition
which for a time arrests peristalsis, though afterwards the wave
contractions recur with increased vigor. Similar contraction
occurs in the uterus and bladder. In consequence of the latter
being thrown into this tetanic contraction, the urine is expelled
very soon after the injection of nicotine, and on this account,
no doubt, the impression has obtained that the drug augments
the renal secretion. Apparently, however, it has no diuretic
action.
Eye. — The influence of nicotine on the pupil differs in differ-
ent animals, and it is supposed that the varying effects are prob-
ably due to the amount of stimulation relatively exerted upon
the ciliary and the superior cervical ganglia in different in-
752 PHARMACOLOGY AND THERAPEUTICS.
stances. In acute poisoning in man the pupil is generally first
contracted and then dilated.
Secretion. — Reference has already been made to the increased
secretion of saliva. The seat of action is the ganglionic appa-
ratus of the secretory nerves, and there is at first stimulation
and later, depression; so that the secretion is eventually much
lessened or suppressed from paralysis of the apparatus. If the
dose is sufficiently large, the saliva is diminished at once. The
other secretory glands appear to be affected in the same way ;
the secretions of the sweat, lachrymal and bronchial mucous
glands being increased and afterwards diminished. The secre-
tion of bile and urine does not seem to be so dependent upon
nervous influences, and it has not been shown that these secre-
tions are affected by nicotine.
Excretion. — Nicotine is eliminated by the kidneys, and, to a
less extent, probably by the lungs. It has also been detected
in the sweat and saliva. It is believed that that which is ab-
sorbed from the stomach and intestine usually loses much of its
toxic activity during its passage through the liver.
Therapeutics of Tobacco.
An excellent poultice for epididymitis is made of fine-cut
tobacco and flax-seed. In non-smokers tobacco is useful to
relieve the symptom asthma, and for this purpose it is often
mixed with stramonium, belladonna, etc., and the smoke inhaled.
Pulverized tobacco, or snuff, has been employed for arresting
stubborn paroxysms of hiccough, a pinch being drawn into the
nostrils by a strong inspiration. Enemata made from the leaves
were formerly used sometimes for purgative purposes and also
to relax muscular spasm and so facilitate the reduction of dis-
locations, herniae, etc. The objects for which tobacco was at
one time employed, however, can now be accomplished more
efficiently and safely by anaesthetics and other agents.
Nicotine salicylate (eudermol), in the form of an ointment
(i per cent), is said to be efficacious in the treatment of scabies
and to possess the adavntage of not staining the linen, as well
tobacco. 753
as being odorless. Pyridine which is found in tobacco, but com-
mercially is obtained from other sources, when administered by
inhalation will frequently relieve the paroxysms of asthma.
For this purpose 4 c.c. (1 fl. dr.) is generally placed in a
dish, so that it may slowly evaporate. Its persistent and abom-
inable odor is a great obstacle to its use.
Tobacco smoking is often indulged in on the supposed ground
that it aids digestion and that after breakfast it promotes the
daily movement of the bowels. It appears in many instances,
particularly in persons who lead sedentary lives, to stimulate
the mental powers and induce a feeling of serenity. Many indi-
viduals use tobacco to a moderate extent for many years with
impunity, but its excessive use not infrequently leads to more
or less serious disorders. One of the most common effects is
a catarrhal condition of the throat and upper parts of the respi-
ratory passages. The tongue is also irritated, especially when
the smoke is concentrated on one point, as in pipe-smoking, and
it has been thought that this constant local irritation may favor
the development of cancerous disease in the tongue or lip.
Other effects liable to be produced are dyspepsia and want of
appetite, with consequent loss of flesh, palpitation and irregu-
larity of the heart, vertigo, depression, neuralgia, insomnia,
muscular weakness, and various ocular disturbances. Atrophy
of the optic nerve may eventually result, and chronic nicotine
intoxication is said to favor arterio-sclerosis. The use of to-
bacco in those who are unaccustomed to it almost invariably
causes nausea and vomiting attended by depression, which may
even amount to collapse. The records of the senior classes of
Yale University for eight years showed that those who used no
tobacco were 20 per cent, taller, 25 per cent, heavier, and had
66 per cent, more lung capacity than the smokers.
TOXICOLOGY.
The symptoms are those which we would expect from the physiological
action of nicotine. Thus, there are marked nausea, vomiting and purg-
ing, accompanied or followed by profound collapse, with coldness and
clamminess of the surface, icy extremities, a weak and rapid pulse, great
49
754 PHARMACOLOGY AND THERAPEUTICS.
dyspnoea, and extreme muscular weakness. There is usually partial loss
of consciousness, and convulsions are often observed. Notwithstanding
the extreme toxicity of nicotine, in animals as well as man a certain
tolerance may be acquired. Post-mortem. — When the poison is taken
by the mouth there may be more or less hyperemia of the gastric and
intestinal mucous membrane, since nicotine is sufficiently alkaline to be
somewhat caustic ; but the appearances are not characteristic. The odor
may furnish a valuable indication.
Treatment. — Tannic acid followed by emetics (see p. 175). Strych-
nine is the true physiological antidote. Alcohol and ammonia stimu-
late the heart. The recumbent position must be maintained. Artificial
respiration may be necessary.
LOBELIA.
LOBELIA.— Lobelia. (Indian Tobacco.) Dose, 0.5 gin.; 7V2 gr.
Preparations.
1. Fluidextractum Lobeliae. — Fluidextract of Lobelia. Dose,
0.5 c.c; 8 TH,.
2. Tinctura Lobelia. — Tincture of Lobelia. Dose, (expecto-
rant) 1 C.C.; 15 TTt; (emetic) 4 C.C.; 1 fl. dr.
Unofficial Preparation.
Infusum Lobelia. — Infusion of Lobelia. Dose, 15 to 30 c.c;
y2 to 1 fl. oz.
Action of Lobelia.
External. — Lobelia is absorbed through the skin, but has no
local action on it. The local application of lobeline to the eye
is followed by contraction of the pupil, though in general poi-
soning by it dilatation has been observed.
Internal. G astro -intestinal Tract. — Lobelia is a powerful
gastro-intestinal irritant. Ordinarily, however, it produces
violent vomiting without any action on the bowels, as most of
it is expelled by the emesis, which is attended by extreme pros-
tration. When the vomiting is insufficient to get rid of the
LOBELIA. 755
poison it causes active purging, and the collapse condition is
marked. When injected into animals lobeline induces vomit-
ing and salivation, these effects being ascribed to stimulation
of the medullary centres.
Circulation. — In consequence of its action on the inhibitory-
apparatus of the heart, the pulse-rate is slowed at first, but after-
wards is more or less accelerated. The blood-pressure, at first
diminished, is afterwards increased beyond the normal. As a
result of vomiting, however, marked variations in the rate of
the heart and in the arterial tension are apt to be observed. In
the collapse resulting from the gastro-intestinal irritation caused
by lobelia the pulse is naturally small and weak.
Respiration. — Small doses stimulate and large doses paralyze
the respiratory centre, while the vagus terminations in the mus-
cular coat of the bronchi or in ganglia in the lungs are also
paralyzed by lobeline. The respiratory movements may at first
be much increased in rate and force. Later they become dysp-
nceic and asphyxia supervenes, death occurring from respira-
tory failure.
Nervous System. — When injected into mammals lobeline in-
duces increased reflex irritability, as well as accelerated respira-
tion. The same is true as regards frogs, so that it is inferred
that in both it causes primary stimulation of the spinal cord
and of the medulla oblongata. Only in the frog, however, does
there appear to be any action on the higher divisions of the
nervous system. They are depressed in frogs and in them the
terminations of the motor nerves are paralyzed in the same
manner as by curare. In man and warm-blooded animals gen-
erally coma and convulsions may be observed after poisonous
amounts, but they would seem to be simply a result of the as-
phyxia. By some, however, these effects are regarded as due
to a direct action on the higher cerebral centres.
Excretion. — Lobelia is apparently excreted by the kidneys
and to some extent by the skin, and it is credited with a diuretic
and diaphoretic action.
7 $6 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Lobelia.
External. — As an external application tincture of lobelia, with
an equal quantity of glycerin, is a most useful remedy for the
relief of pain in acute epididymitis. An infusion (i to 16) may
be used for the dermatitis of poison ivy.
Internal. — As it has the effect of relaxing bronchial muscle,
the chief use of lobelia is for the relief of the symptom asthma.
4 c.c. (i fl. dr.) of the tincture may be given until nausea is
induced, and as soon as this appears it should be discontinued.
The administration of .6 c.c. (io HI) every ten minutes, if begun
early, often shortens the paroxysm. Lobelia is also employed
to some extent as an expectorant in bronchitis, and especially
when the latter is characterized by a spasmodic element. It is
often combined with other antispasmodics and expectorants.
In both bronchitis and asthmatic attacks its good effects are no
doubt largely due to the free secretion of mucus which is pro-
duced by its nauseant action. It is, relatively, better borne by
children than by adults. It was formerly prescribed as an
emetic and also as a purgative, but it is now regarded by most
as too depressing to be used for these purposes, while its action
as a purgative is very uncertain. In very small doses, how-
ever (.06 to .12 c.c; 1 to 2 Til every hour, or .6 c.c; 10 in. at
bed-time), the tincture is still recommended by some writers
as useful in promoting peristalsis and intestinal secretion in
cases of habitual constipation, dependent upon atony of the
muscular layer and deficient secretion of the bowel, where
there is an impacted caecum, but no inflammatory action has
supervened. An infusion of lobelia has sometimes succeeded
in relieving strangulated hernia, intussusception and faecal im-
paction, and is regarded as safer than tobacco.
C. Drugs Acting on the Peripheral Endings of Sensory
Nerves.
MENTHOL.
MENTHOL.— Menthol. Dose, 0.065 gm. (65 milligm.) ; 1 gr.
MENTHOL. 757
Action of Menthol.
Menthol is antiseptic and locally anaesthetic, producing a
sensation of coldness wherever it is applied. The blood-vessels
of the part are, however, dilated, and instead of there being a
fall of temperature, the skin temperature is higher there than
elsewhere. The drug is generally regarded as exerting a pecu-
liar stimulating effect upon the nerves conveying the sense of
cold, but this has been denied by some authorities, who assert
that it acts only on the terminations of the nerves of common
sensation or pain. The feeling of coldness is associated with
more or less prickling, and later there follows some heat and
burning. Like camphor, menthol stimulates the central ner-
vous system, and its general effects are practically identical,
except that the convulsions to which it gives rise are much less
severe. It is excreted in combination with glycuronic acid.
Therapeutics of Menthol.
Menthol, externally applied, will often relieve neuralgic pains,
provided they are of superficial and peripheral origin. The
solid menthol, in the form of a pencil or cone, is sometimes
employed for this purpose, and sometimes it is used in alcoholic
solution, or in a solution of oleic acid (i to 2.4) made by heat.
A menthol plaster is composed of menthol, 3 ; yellow wax, 1 ;
rosin, 15; and an excellent liniment, of menthol, 3; chloroform,
4; olive oil, 9. Rubbed up with an equal part of camphor,
chloral or pure phenol, and placed in the cavity, it promptly
cures the aching of a carious tooth. It has considerable
power in controlling superficial inflammations, and in an
ethereal solution of from 10 to 50 per cent, may be applied two
or three times a day for the purpose of aborting boils, car-
buncles, cutaneous abscesses, etc. An excellent combination
for inflamed joints, whether the inflammation is rheumatic or
gonorrhceal, is a mixture of menthol, thymol and hydrated
chloral (each 8 gm. ; 2 dr.), rubbed up together until liquefied,
and to which are added morphine sulphate, .13 gm. (2 gr.) and
atropine sulphate, .008 gm. (^ gr.), or cocaine hydrochloride,
758 PHARMACOLOGY AND THERAPEUTICS.
.06 gm. (1 gr.). Or, a solution of menthol, thymol and chloral
in ether or chloroform may be painted over the inflamed part.
These combinations are also applicable in local neuralgias.
Menthol is very useful for allaying itching, and is employed in
solutions (to which other drugs may be added, if called for), in
such affections as pruritus ani, urticaria, eczema and herpes
zoster. In laryngeal and tracheal tuberculosis great relief is
afforded by a 20 per cent, solution in olive oil, introduced into
the larynx with a syringe or spray, and followed by inhalations
of the same from boiling water or by means of a respirator.
A pigment of 1 to 4 of the oil may also be employed for paint-
ing the larynx. In bronchiectasis the injection twice daily of
4 c.c. (1 fl. dr.) of a mixture composed of menthol, 10; guaiacol,
2; olive oil, 88, has been followed by marked improvement.
Inhalations of menthol (volatilized in a tea-pot by the addition
of hot water) have sometimes proved successful in relieving
the symptom asthma. It has also been used by inhalation in
hay fever and diphtheria. In solution, or rubbed up with sugar
(5 to 10 per cent.), it may be applied by means of a large cam-
el's hair brush as a disinfectant and anodyne for the throat in
diphtheria, scarlet fever, tonsillitis, pharyngitis, etc. A 10 per
cent, alcoholic solution, applied on cotton wool, is preferred by
some. Menthol is now used to a considerable extent topically
in diseases of the ear and nose. In the nasal form of hay fever
a mixture of menthol and ammonium carbonate has been found
to make a very efficient smelling-salt. Internally menthol has
been used in small doses (.006 gm. ; -J^ gr.) to relieve nausea
and vomiting. In doses of .10 gm. (i*/2 gr.), in capsules with
olive oil (six or eight being taken daily), it has been given as
an intestinal antiseptic. It is also said to have been used with
advantage, by means of the stomach-tube, in cases of atonic
dyspepsia. The stomach is first washed out and then a 1-5 per
cent, solution of menthol in liquid petroleum is blown through
the tube. In spasmodic cough, asthma and hiccough its inter-
nal administration is sometimes of service.
coca. 759
COCA.
COCA. — Coca. (Erythroxylon. Cuca.) Dose, 2 gm.; 30 gr.
Preparations.
Fluidextractum Cocae. — Fluidextract of Coca. Dose, 2 c.c;
30 Til.
Vinum Cocae. — Wine of Coca. Dose, 16 c.c; 4 fl. dr.
Cocaina. — Cocaine. Dose, 0.030 gm. (30 milligm.) ; y2 gr.
Oleatum Cocainae. — Oleate of Cocaine.
Cocainae Hydrochloridum. — Cocaine Hydrochloride. Dose,
0.030 gm. (30 milligm.) ; y2 Sr-
Unofficial Preparation.
Trochiscus Krameriae et Cocainae (B. P.). — Krameria and
Cocaine Lozenge. Dose, 1 lozenge.
Action of Coca.
External. — Cocaine has little or no action on the unbroken
skin, but upon mucous membranes or the subcutaneous tissue
it produces complete local anaesthesia. At first, owing to the
contraction of the vessels caused, the surface to which it is
applied becomes somewhat blanched, but later there is hyper-
emia with increased redness of the part, in consequence of
secondary vascular dilation. A 5 to 10 per cent, solution of
the hydrochloride will paralyze the sensory nerves, but to pro-
duce this effect on motor nerves requires a much stronger dose.
The local application of cocaine to the tongue abolishes the
sense of taste, and to the nose, that of smell. This alkaloid is a
typical protoplasmic poison, and its effects as a local anaesthetic
are no doubt attributable to its destructive action on the proto-
plasm of the end organs.
Internal. G astro -intestinal Tract. — In South America from
time immemorial the natives have chewed coca leaves to relieve
hunger and fatigue. On account of its anaesthetic effect on the
gastric mucous membrane cocaine deadens the sensation of
hunger, and tends to allay irritability of the stomach, but the
760 PHARMACOLOGY AND THERAPEUTICS.
drug is not an aliment, and if no food is taken, rapid emaciation
occurs under its use. In exceptional instances vomiting is
caused when poisonous quantities are swallowed. According
to some observers intestinal peristalsis is markedly increased by
moderate doses, while after large doses this increase is followed
by great sluggishness, deepening into paralysis.
Circulation. — The pulse-rate is lessened by very small doses,
in consequence of stimulation of the vagus centre, but increased
by large doses, which depress the vagus. Usually, but not, it
is said, invariably, the heart is eventually slowed, apparently
from a direct depressant action on the cardiac muscle. Cocaine
constricts the arterioles, mainly from stimulation of the vaso-
constrictor centre, and in the earlier stages of the poisoning
the vessels are much contracted. This, together with the in-
creased rate of the heart, leads to a marked rise in the blood-
pressure. Later the pressure falls, probably from peripheral
action.
Respiration. — The respiratory centre in the medulla is at first
stimulated and then depressed. Consequently, the respiration
is primarily accelerated, but as the depression comes on, the
amount of air inspired gradually becomes diminished, and the
breathing grows slow, weak and irregular. Cheyne-Stokes
respiration is frequently present, and death occurs from as-
phyxia.
Nervous System. Cerebrum. — The first effect is a stimula-
tion of the higher parts of the brain, such as is caused by caf-
feine. In animals there is increased movement, which is per-
fectly coordinated, and in man wakefulness and mental exhilara-
tion. All observers agree that cocaine has remarkable potency
in increasing muscular power and removing fatigue. If the
quantity taken is sufficiently large, the stimulation is followed
by depression, which is often first shown in choreic movements,
from derangement of the coordinating functions. The animal
moves in a circle, the symptoms resembling the forced move-
ments often seen in affections of the cerebellum. Narcosis
ensues, and this is succeeded by convulsions, the seat of which
COCA. 761
has not been determined, but is supposed to be in some portion
of the hind brain. If the paralysis is rapid, it is found that
the convulsive stage may be absent.
Medulla Oblongata. — The medulla is early affected, and the
various centres are first stimulated and then depressed.
Spinal Cord. — The cord, too, is at first stimulated, as is shown
by exaggeration of the reflexes, and very large doses may cause
convulsions, of spinal origin, resembling those due to strych-
nine. It will thus be seen that the action of cocaine on the
central nervous system consists in a descending stimulation,
followed by depression, which successively progresses from the
cerebrum to the spinal cord. In some cases, however, it is to
be noted, the stage of stimulation is very short or altogether
absent, and it has also been observed that the two stages are
not definitely divided, so that one part of the cerebrum may
show depression while another is still excited. With small
doses the cerebrum chiefly is affected.
Eye. — Cocaine, applied to the eye, causes local anaesthesia and
pallor of the conjunctiva and iris, from vascular constriction.
When it is applied to the conjunctiva, in considerable quantity
and for some time, and also when it is administered system-
ically, ocular phenomena are produced which are the same as
those caused by stimulation of the cervical sympathetic. It is
therefore considered that cocaine has a special action on the
centres or terminations of this nerve, and there is reason to be-
lieve that the stimulation to which it gives rise really affects
both. Mydriasis is caused, though the iris still reacts to light,
and the accommodation is impaired. The intra-ocular ten-
sion is somewhat reduced, and the palpebral aperture is
widened. The dilatation of the pupil differs from that due to
atropine as regards the persistence of the reaction to light and in
being less complete. The mydriasis is also more readily over-
come by pilocarpine and muscarine than that caused by atro-
pine. Either strong or weak cocaine solutions when fre-
quently applied desiccate the corneal epithelium.
Temperature. — Under large doses of cocaine the temperature
762 PHARMACOLOGY AND THERAPEUTICS.
rises, and this has been ascribed to a stimulation of the thermo-
genetic centre in the brain. In poisoning in animals it has
been observed that the higher the temperature, the more readily
are convulsions produced and the more severe their character.
Excretion. — Cocaine is eliminated in the urine and probably
also excreted into the intestine. The quantity of urine appears
to be sometimes increased and sometimes diminished. In some
instances the injection of the drug has been followed by com-
plete anuria lasting for several hours. In view of the variations
noted, it has been suggested that the action is not a direct one
on the kidney, but is caused merely through the changes in the
calibre of the vessels. The effects on the vasomotor centre,
an early stimulation and later paralysis, would account for such
variations. The other secretions beside the urinary seem to be
rather diminished than increased. Cocaine has some anaphro-
disiac effect.
Therapeutics of Coca.
External. — A 5 to 10 per cent, solution of cocaine hydrochlo-
ride may be injected subcutaneously as a local anaesthetic for the
performance of small operations. In the infiltration method
of Schleich three solutions are employed: cocaine hydrochlo-
ride, 0.2 (strong) ; 0.1 (normal) ; or 0.01 (weak) ; morphine
hydrochloride, 0.025; sodium chloride, 0.2; sterilized distilled
water or saturated boric acid solution to 100. These are in-
jected into the substance of the skin, forming wheals. This
method requires less of the drug than when it is used subcu-
taneously. Yet it should be borne in mind that the anaesthetic
properties of the two weaker solutions depend largely upon the
mechanical anaesthesia produced by injection of water, the anal-
gesic effect of which had been previously pointed out. Solu-
tions of cocaine hydrochloride, topically applied, are used for
operations on the mouth, throat, teeth (4 per cent.), eye (1 to
4 per cent.), ear, vagina, urethra and rectum (4 to 10 per cent.).
Congestive urethral stricture may be temporarily relieved by it
so that instruments may be passed, but it should be employed
with great care in urethral operations. It is used on mucous
COCA. 763
membranes for the relief of pain in various conditions, and also
for the abatement of inflammation. It is of service in painful
ulcers, fissures, etc., and in pruritus of the vulva and anus, and
is also used as an application to the nasal passages in coryza and
hay fever. In the latter affections a powder consisting of co-
caine, 1 ; morphine, 1 ; bismuth subnitrate, 5, may be snuffed
into the nostrils. Ointments, bougies, and suppositories, usually
containing 2 to 5 per cent, of cocaine, which mixes better than
the hydrochloride, are very useful. A 15 per cent, solution has
been injected into the gums for tooth extraction, but is hardly
to be commended. Ophthalmic surgeons employ it very largely
to produce local anaesthesia of the eye. If inflammation is pres-
ent, however, anaesthesia is produced with great difficulty.
A solution is useful for painting or spraying on the throat
previous to laryngeal examinations. Lozenges of the hydro-
chloride, containing .003 gm. ( J^gr.) in each, are valuable for
painful sore throat. Often in addition each lozenge contains
.06 gm. (1 gr.) of extract of krameria.
Internal. — Cocaine, because of its effect in depressing the gas-
tric sensory nerves, is sometimes employed to relieve vomiting
in pregnancy, seasickness and other conditions. It or the fluid-
extract of coca may be given, as a supportive and stimulant in
low fevers, and in cases where great physical and mental
strain is to be borne. The preparations of coca, especially the
wine, are much used as stomachic tonics, and in the debility
of convalescence from acute diseases. Some clinicians have
found cocaine a remedy of the highest value in chorea, and
state that paralysis agitans, alcoholic tremors, and senile tremb-
ling are more favorably affected by it than by any other drug.
Medullary Anasthesia. — Within the last few years it has been
proposed to obtain surgical anaesthesia by injection of from
-jlj- to^- gr. ; .006 to .012 gm. into the arachnoid space. Puncture
is made between the third and fourth lumbar interspace of the
spine with a specially prepared needle, as for diagnostic pur-
poses. A few drops of the spinal fluid is allowed to escape
and the solution is injected. Anaesthesia supervenes, gradually
764 PHARMACOLOGY AND THERAPEUTICS.
extending from the feet upwards, and may reach to the chest or
even higher ; this persists for a variable time, but generally suffi-
cient for the performance of surgical operations. This method
of anaesthesia does not interfere with labor further than abol-
ishing its pain. Strict asepsis must be observed. Beyond some
nausea, vomiting and headache, after-effects are not usually
noticed. Several deaths have now been reported as due to the
procedure, however, so that it seems hardly likely that it will
supplant ether or chloroform narcosis, or that it can be per-
formed without too great risk when contra-indications exist to
either.
TOXICOLOGY.
Symptoms. — Acute poisoning in quite a large number of instances has
followed the injection of cocaine into the urethra previous to some
operation, and sometimes occurs from the injection of the drug under
the gums or skin. Otherwise it is not often met with. The symptoms
vary in different individuals, but usually the patient at first becomes more
or less excited, restless and garrulous. The pulse and respiration are
quickened, the pupils dilated, and there are present dryness of the throat,
headache, vertigo and confusion. There may be exaggeration of the
reflexes, and tremors and slight convulsive movements are apt to occur.
Later, powerful tonic or clonic convulsions may come on. The heart
becomes turbulent in its action, and the respiration, which soon grows
dyspnoeic in character, may be arrested during a convulsion. In other
cases no actual convulsions may be met with, while fainting and collapse
rapidly supervene. The patient suffers from profound cardiac and res-
piratory depression, with tremors, and the skin is cold, cyanotic and
clammy. Death may take place from gradual failure of the respira-
tion, and if the patient survives he may suffer for months from tremors
and other nervous symptoms. Out of 250 cases of accidental poisoning
from the medicinal use of cocaine, 13 proved fatal.
Chronic poisoning, or cocamania, is not infrequently seen. The victim
of the cocaine habit rapidly loses flesh and sometimes suffers from faint-
ing fits. Among the phenomena characterizing the condition are dis-
orders of the circulatory system, insomnia, mental failure, and delusions
not unlike those of chronic alcoholism. Visual and other hallucinations,
generally of a disagreeable type, are often present, and one symptom
which is regarded as pathognomonic of subacute or chronic intoxication
with this drug is a sensation of crawling worms or insects, "cocaine
ALPHA-EUCAINE HYDROCHLORIDE. 765
bugs," under or on the skin. Sometimes there is delirium or acute
mania. The central nervous system seems to undergo degeneration like
that observed in chronic morphine poisoning. Cocaine habitues are by
no means infrequently met with. The moral degradation is fully equal
to that of opium-eaters. Cocaine, which is usually taken by hypoder-
matic injection in these cases, is often employed in association with
morphine, and the habit is sometimes acquired by those making use of
this drug to break themselves of the morphine habit.
Treatment. — Acute poisoning. If the drug has been taken by the
mouth the stomach should first be evacuated by washing out or by the
use of apomorphine. The treatment is mainly one of stimulation, and
strychnine is especially indicated as a respiratory stimulant. Artificial
respiration may also be called for. Amyl nitrite may be of service if
the blood-pressure is high, and small quantities of chloroform or ether,
by inhalation, may be required for the convulsive attacks.
Chronic poisoning. — The habit is difficult to cure, as relapses are
frequent. The most important point in the treatment is the withdrawal
of the drug, though the sudden stopping of it may bring on profound
collapse. There is little chance of a successful result unless the patient
is confined for a considerable time in an asylum or sanitarium.
Unofficial Preparations.
Alpha-Eucainae Hydrochloridum. — Alpha-eucaine hydrochlo-
ride. (Eucaine Hydrochloride. Eucaine. Alpha-eucaine hydro-
chlorate.)
Beta-Eucainae Hydrochloridum. — Beta-eucaine hydrochlo-
ride. (Beta-eucaine hydrochlorate.) •
Action of Eucaine Hydrochloride.
The general action of eucaine, both in cold and warm-blooded
animals, consists in a marked excitation of the entire central
nervous system, followed by paralysis; in toxic doses going on
to death. Small doses administered to mice and rabbits cause
increased reflex excitability, and increased but weakened respi-
ratory movements. Medium doses in rabbits cause repeated
tonic and clonic convulsions. The animals lie senseless on their
sides, with dyspnoea, opisthotonos, and finally paresis of the
posterior limbs. These phenomena are still more marked when
large toxic doses are administered; the convulsions return con-
766 PHARMACOLOGY AND THERAPEUTICS.
tinuously, and affect all the muscles of the body. The animals
finally die when the paralysis reaches the respiratory muscles.
When the dose is not a fatal one, the convulsions gradually
cease, the increased reflex excitability disappears, and the pare-
sis of the hind limbs slowly improves. The effect on the cen-
tral nervous system is therefore at first excitant, and later, in
toxic doses, paralyzing. The paralysis is a central one, for if
the sciatic nerve of a frog poisoned with eucaine is exposed,
and its peripheral end irritated with the induced current, the
limb reacts in a normal manner. As regards its action on the
heart and the blood-vessels, the subcutaneous and intravenous
injection of small and medium doses slows the heart on the
average from twenty to thirty beats per minute, but without
otherwise modifying the beats, or increasing the blood-pressure.
This effect on the pulse is caused by the excitation of the cen-
tral vagus ; for section of the vagi causes an immediate increase
of the pulse to the normal and above it, together with an in-
crease of the blood pressure. Death occurs from paralysis of
the respiratory centres, for the heart continues to beat for some
time thereafter. It is claimed that eucaine solutions possess
moderate antibacterial powers.
Therapeutics of Eucaine Hydrochloride.
Eucaine is used in from 1 to 5 or even 10 per cent, solutions
for the same purposes as is cocaine. The anaesthesia comes on
somewhat more slowly, with solutions of the same strength is
about equal to, and its effects last about the same time as with
the latter drug. It possesses the disadvantage of causing hyper-
emia of mucous membranes, and in 2 per cent, solution may
irritate the conjunctiva. A 1 per cent, solution, however, does
not cause any disturbance. It is preferable to cocaine in that
its aqueous solutions are permanent and can be sterilized by
heat without decomposition. It does not cause mydriasis nor
disturbance of accommodation, nor does it dry the corneal epi-
thelium, and further it is relatively safer, so far as circulation
and respiration are concerned, than cocaine.
HOLOCAINE. j6j
Beta-Eucaine. — In order to avoid the burning sensations, pain
and hyperemia to which eucaine may give rise, a substance
known as Benzoylvinyldiacetonalkamin hydrochloride, named
Beta-eucaine (hydrochloride), a compound closely related chem-
ically to eucaine, has been recommended. Its chemical and
physiological properties, with the above exceptions, are the
same. It is safe, being three and three-quarters less toxic than
cocaine, does not affect the heart, and is unirritating. It does
not produce, when employed in the eye, mydriasis, corneal le-
sions, nor disturbances of accommodation. It can be sterilized
by boiling without deterioration ; its solutions are permanent
and do not decompose when kept. Its field is the same as that
of cocaine, and it can be employed for the various operations
upon the eye, nose, ears, genito-urinary tract, in minor surgery
and dentistry, and for infiltration anaesthesia. For medullary
anaesthesia, while the after-effects seem no greater than with
cocaine, the analgesia is not so uniform nor lasting. Its ease
and certainty of sterilization by boiling are in its favor, and
some operators are strong advocates of it. It is employed in
from y2 to 4 per cent, (saturated) aqueous solution, but of the
latter not more than 2 c.c. (30 HI) should be employed at one
time, although for a prolonged operation five times this quan-
tity may be employed.
Unofficial Preparation.
Holocaina. — Holocaine. (Holocaine hydrochloride. Para-
diethoxyethenyl-diphenyl-amidine-hydrochloride.)
Action of Holocaine.
It is a local anaesthetic, and paralyzes the sensory nerves of
the cornea and mucous surfaces even more powerfully than
cocaine. It does not produce any necrosis, and has no effect
upon the blood-vessels. It should not be used hypodermatically,
as it is said to be about five times as toxic as cocaine. Even
small doses cause in both frogs and warm-blooded animals con-
vulsions which appear to be of cerebral origin. It is a muscle
?68 PHARMACOLOGY AND THERAPEUTICS.
poison, a I per cent, solution rapidly killing voluntary and
cardiac muscles in the frog, and it also exerts a curare-like
influence on the motor nerves. It is powerfully antiseptic: a
i per cent, solution has not only an inhibitory effect upon pus
organisms, but destroys them when they are exposed to its
action for a certain length of time.
Therapeutics of Holocaine.
It is used as a local anaesthetic for the same purposes as
cocaine; while it has some advantages over the latter, it is
necessary that its application should be renewed in from ten to
fifteen minutes. It is largely employed in ophthalmic practice,
where its peculiar value lies in the rapidity of its action and
the fact that it leaves the pupil, accommodation and intra-ocular
tension quite unaffected. Its germicidal power is a further
advantage, and it has a very beneficial effect on septic ulcers
of the cornea. Holocaine is widely used also in affections of
the nose, throat and ear and in operative procedures upon these
parts, and no toxic effects appear to have been observed from
its use as a local anaesthetic. A I per cent, solution is gener-
ally employed, and it should be prepared in porcelain (not in
glass), as this salt is very sensitive to alkalies, and even the
small amount of alkali dissolved out of the glass on boiling a
solution of it in a test-tube is sufficient to decompose it.
Unofficial Preparation.
Orthoformum. — Orthoform. (Methyl-para-amido-meta-oxyben-
zoate.) Dose, 0.30 to 0.60 gm.; 5 to 10 gr.
Action of Orthoform.
It has a similar action on the sensory nerve terminations to
cocaine, but as its chemical composition is entirely different
from the latter, this is the only point in which it resembles it
in its effects. The anaesthetic quality of orthoform is appa-
rently due to its being an aromatic derivative. The special
feature of its anaesthetic influence is its long continuance. An-
ORTHOFORM. 769
sesthesia is caused for many hours, or perhaps even for days,
by a single application of the powder to abraded surfaces, and
the reason for this is that the drug becomes dissolved only very
slowly, and hence remains in contact with the part for a long
time. Occasionally it has been known to produce a necrosis.
It is found, however, that it is unable to penetrate mucous mem-
brane like cocaine, and on this account it produces its anaes-
thetic effect only when it comes into actual contact with ex-
posed nerve-ends. Therefore on sound skin or mucous mem-
brane it has no influence, and is consequently unfit for ordi-
nary use as a surgical anaesthetic. On account of its very
slight solubility, and because it is also excreted very rapidly,
it is practically non-toxic. Its insolubility renders its subcu-
taneous use difficult, but it is stated that if it is artificially
brought into solution and then injected, it is no less dangerous
than cocaine. Apparently on account of its insolubility, it has
very little influence on the system, whether applied to abraded
surfaces or taken by the mouth, even in very large amounts.
Therapeutics of Orthoform.
It is commonly applied as a dusting powder or in ointments.
In burns, ulcers, abscesses, etc., where it can reach nerve ter-
minations, it is very efficient in relieving pain, and also exerts
a healing influence similar to that of iodoform ; but in affections
of the nose or throat it has very little effect unless ulceration
be present. In ulcerative disease of the larynx if a spray con-
sisting of a solution of 0.30 gm. (5 gr.) of orthoform in 3
c.c. (50 ^1) each of alcohol and water is made use of, a pro-
tective coating is deposited on the parts. Or, an emulsion of
1 part orthoform to 4 parts olive oil may be applied to the
larynx. Insufflation of the powder is also frequently employed
in diseased conditions of the throat and nose. For many pur-
poses the saturated solution of orthoform in collodion is most
effective. Orthoform has been used with much success in gyn-
aecological and genito-urinary practice, as well as dentistry, and,
administered by the mouth, it is very efficient in controlling the
50
770 PHARMACOLOGY AND THERAPEUTICS.
pain of ulcer or cancer of the stomach. It is of no service,
however, in relieving headache or neuralgic conditions. It is
sometimes employed hypodermatically to produce local anaes-
thesia for surgical operations, it being found that after violent
shaking in water it is divided into such small particles that they
can be injected with a somewhat large needle. The pain caused
by the passage into the tissues may be obviated by a prelim-
inary injection of a small quantity of cocaine. Orthoform
when applied to ulcers has been known to produce sloughing
similar to that caused by pure carbolic acid, and on the skin to
cause redness and irritation and even a decided pruritic erup-
tion. In rare instances it is stated to have given rise to an
erythema complicated with vesicles and to gangrenous erup-
tions.
^ETHYLIS CHLOKIDUM.— Ethyl chloride. (Mono-chlor-ethane.
Hydrochloric ether.)
Unofficial Preparation.
Methylis chloridum. — Methyl chloride (Mono-chlor-methane.)
Two substances used to produce local anaesthesia may be
here considered: Ethyl chloride and methyl chloride.
Ethyl chloride is an inflammable liquid which is even more
volatile than ether, entering into ebullition at 12.50 C. (550 F.),
and producing intense cold by its evaporation. It is used for
the production of local anaesthesia and to relieve the pain of
neuralgia, etc. It is supplied in hermetically sealed glass tubes
having a pointed extremity, and when the end is broken off
and the tube held in the hand, it escapes in a fine stream which
is directed upon the part it is desired to affect. The skin should
first be cleansed of all fat by the use of soap, followed by wash-
ing with ether. More recently ethyl chloride has been used
with considerable success as a general anaesthetic for short
operations and as an anaesthetic preliminary to ether or chloro-
form in longer operations. It acts very promptly, and is pref-
erably employed with a special inhaler. It is claimed to be as
safe as nitrous oxide gas.
TONGA. 771
Methyl chloride is also extremely volatile, producing local
anaesthesia through the cold resulting from its evaporation. It
is used for the same purposes as ethyl chloride. One objection
to the use of both these substances, as well as of ether, for the
production of local anaesthesia, is that the intense cold caused
is sometimes as painful as the operation itself would be without
any anaesthetic.
Unofficial Preparation.
Ouabainum. — Ouabain. Dose, .00013 gm.; jfa gr.
Action of Ouabain.
Ouabain paralyzes cardiac muscle by direct action, and when
given hypodermatically is an emetic. It is a local anaesthetic,
and is stated to have ten times the power of cocaine in this
regard.
Uses of Ouabain.
It has been recommended as a local anaesthetic and also for
the treatment of all stages of whooping-cough in doses of .00006
gm. (y-oVoS1"-) ^or children. As it is a very powerful drug,
.001 gm. (^ig-gr.), when taken into the blood, being sufficient to
kill a man, it should be used with extreme caution.
TONGA.
Unofficial Preparations.
Tonga.— Tonga. Dose, 1 to 4 gm.; y4 to 1 dr.
Fluidextractum Tongas.— Fluidextract of Tonga. Dose, 1 to
4 c.c; 14 to 1 fl. dr.
Action of Tonga.
Very little is known of the action of this drug. In large
doses it is purgative.
Therapeutics of Tonga.
Tonga as a fluidextract, dose, 1 to 4 c.c. {]/A to 1 fl. dr.),
undoubtedly relieves some cases of intractable neuralgia. Com-
772 PHARMACOLOGY AND THERAPEUTICS.
bined with salicylates it is of great value for the treatment of
so-called muscular rheumatism.
E. Drugs Acting on the Spinal Cord.
i. Drugs increasing the irritability of the anteria cornua.
NUX VOMICA.
NUX VOMICA.— Nux Vomica. (Poison Nut. Dog Button.) Dose,
0.125 gni. (125 milligm.); 2 gr.
Preparations.
i. Extractum Nucis Vomicae. — Extract of Nux Vomica.
Dose, 0.015 gm. (15 milligm.) ; y4 gr.
2. Fluidextractum Nucis Vomicae. — Fluidextract of Nux
Vomica. Dose, 0.05 c.c; 1 TT\.
3. Tinctura Nucis Vomicae. — Tincture of Nux Vomica. Dose,
0.6 c.c; 10 Til.
STRYCHNINA.— Strychnine. Dose, 0.001 gm. (1 milligm.) ; ^ gr.
Preparations.
1. Elixir Ferri, Quininae et Strychninae Phosphatum. — Elixir
of Iron, Quinine and Strychnine Phosphates. Dose, 4 C.C.;
1 fl. dr.
2. Glyceritum Ferri, Quininae et Strychninae Phosphatum. —
Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, 1
C.C.; 15 fll.
3. Syrupus Ferri, Quininae et Strychninae Phosphatum. —
Syrup of Iron, Quinine and Strychnine Phosphates. Dose, 4 C.C.;
1 fl. dr.
4. Pilulae Laxativae Compositae. — Compound Laxative Pills.
Dose, 2 pills.
5. Syrupus Hypophosphitum Compositus. — Compound Syrup
of Hypophosphites. Dose, 8 C.c; 2 fl. dr.
STRYCHNINE NITRAS.— Strychnine Nitrate. Dose, 0.001 gm.
(1 milligm.) ; ^ gr.
nux vomica. 773
STRYCHNINE SULPHAS.— Strychnine Sulphate. Dose, 0.001
gm. (1 milligm.) ; ^T gr.
Unofficial Preparation.
Brucina. — Brucine.
Action of Nux Vomica and Strychnine.
External. — Strychnine is a very powerful antiseptic, and
when injected subcutaneously in concentrated solution it is irri-
tating to the tissues. Brucine is a weak local anaesthetic.
Internal. Gastro-intestinal Tract. — Xux vomica is a sto-
machic bitter, increasing the appetite, aiding the digestion, and
acting generally like other agents of this class. In the intes-
tine it is directly stimulating to the muscular coat of the bowel.
Hence it promotes peristalsis and has a purgative action.
Strychnine is believed to be absorbed mainly from the intestine.
Circulation. — Strychnine, by stimulating the vaso-motor cen-
tre, produces constriction of the arterioles, thereby causing a
rise of blood-pressure, which is augmented by the increased
peripheral resistance arising from the general activity of the
muscles. The result is that the force of the heart is increased
and the diastole lengthened. The pulse is also slowed by the
stimulation of the vagus centre in the medulla. The direct ac-
tion on the heart is probably less marked than has been gener-
ally supposed. In experiments upon the excised mammalian
heart it has been found that a small dose slows the heart and
increases its force, while somewhat larger doses cause a slight
acceleration, also with increased force. It is thought likely,
however, that these effects are not sufficiently marked to be of
therapeutic importance. Very large doses cause cardiac mus-
cular paralysis. During the convulsions caused by the alkaloid
the blood-pressure is raised to an extreme height, partly by the
action on the vaso-motor centre and partly, it may be. in con-
sequence of the blood being pressed out of the abdominal or-
gans and the muscles by their violent contraction. Immediately
after a convulsion the blood-pressure falls. The vascular con-
774 PHARMACOLOGY AND THERAPEUTICS.
striction, it would seem, affects chiefly the internal vessels,
while, as a result probably of stimulation of vaso-dilator areas
in the medulla, those of the skin and possibly of the muscles
are dilated; consequently there is an afflux of blood to the ex-
tremities and cutaneous surface. The heart is found to beat
long after the respiration has failed, and if artificial respiration
be maintained, may continue to do so for an indefinite period.
Blood that is mixed with strychnine and shaken with air con-
tains more oxygen and less carbon dioxide than ordinary blood,
but there is no reason to suppose that strychnine, at least in
ordinary doses, increases the oxidizing power of living blood.
Respiration. — The respiratory centre in the medulla is stimu-
lated directly and also reflexly by reason of the increased mus-
cular activity. The respiratory movements are consequently
accelerated and strengthened. As the muscles of respiration
participate in the general convulsive seizures, however, they
ultimately become completely exhausted, and death by asphyxia
may occur suddenly after a spasm. In other instances the fatal
result is due to gradual paralysis of the respiratory centre.
Between the convulsions the breathing is usually fairly regular,
but during their presence it is arrested by the violent contrac-
tion of the diaphragm and the other respiratory muscles.
Nervous System and Muscles. — The cerebrum is believed to
be somewhat affected by strychnine, though to a less extent
than the lower divisions of the central axis. In man the intel-
lect and consciousness remain unaffected, but the special senses
are rendered more acute, and the majority of investigators
maintain that the irritability of the motor parts of the cortex
is distinctly increased, except during a convulsion. In the
medulla oblongata there is produced an active stimulation, fol-
lowed by paralysis, of the respiratory, vaso-motor and vagus
centres. While the stimulation of the vagus causes slowing of
the pulse, this effect is more or less offset by the influence of
the convulsions, since great muscular activity always tends to
accelerate the heart. The clinical evidence is in favor of the
cardiac centre's being strongly influenced. Strychnine in small
nux vomica. 775
amounts increases the tone of the medulla, augmenting the im-
pulses which the medullary centres are constantly receiving.
Consequently, the increased activity of the higher reflex areas
may diminish or inhibit the irritability of the cord, so that the
reflex response from the latter may be rendered more marked
by the removal of the cerebrum and medulla oblongata. The
most marked effect of toxic amounts of strychnine is an in-
creased reflex irritability of the spinal cord, which is shown
most conspicuously by the production of tetanus. After a short
period of augmented reflex excitability, severe spasms occur, in
which there are sudden and violent contractions of all the mus-
cles of the body, the stronger extensor muscles generally pre-
vailing against the flexors. In the intervals (lasting only a
few minutes) between the convulsions there is complete relaxa-
tion. Mammals usually die after the first few spasms, but in
frogs, in which respiration can be dispensed with for long
periods, the alternations of convulsions and the quiescent state
may continue for hours or days. That these spasms are of
spinal origin is shown by the fact that they are at least as well
marked (if not more violent), both in mammals and frogs,
when the brain has been destroyed or severed below the medulla
oblongata, while destruction of the spinal cord stops them en-
tirely. Muscle and motor nerve endings may be excluded by
section of the nerve-trunk, which stops the convulsions : while
sensory nerve endings may be excluded by ligating a leg, with
the exception of the nerve, and then injecting strychnine. The
leg will be seen to take part in the convulsions, although its
sensory terminations are excluded from the poison. The con-
vulsions take place if the posterior nerve-roots are cut. provided
the proximal end is stimulated and if a probe be slowly passed
down the spinal canal of an animal convulsed by strychnine,
the spasms of the muscles will successively cease from above
downward. Furthermore, the convulsions are not only spinal,
but reflex; so that they will not occur unless some stimulus
from without reaches the cord. After the convulsive action
has been established the spasms may seem to occur without any
Jj6 PHARMACOLOGY AND THERAPEUTICS.
such stimulus, but this is not the case, for they may be induced
by a very insignificant stimulation, as for instance, a slight
contraction of a muscle. The conduction power of the cord
must be enormously exaggerated by strychnine, since general
convulsions follow upon a peripheral stimulation so slight as
to be even imperceptible. Strychnine convulsions are abolished
by curare, for the latter has the effect of blocking impulses
from the cord to the muscles. The exact location of the action
of strychnine in the spinal cord has not as yet been determined.
In the present state of our knowledge it may be said that the
drug removes resistances which normally oppose the passage
of impulses somewhere between the point at which the centri-
petal fibres enter the cord and the motor cells, but does not
apparently act upon the motor cells of the anterior horn, nor
upon those of the posterior root ganglion. It is consequently
regarded as most probable that it affects chiefly some cells in-
tercalated between these structures. Strychnine does not seem
to have any direct action on the voluntary muscles. While
very small quantities have the effect of increasing their tone,
this is attributable to action on the spinal cord and not on the
muscle fibres. Neither muscles nor afferent nerves are af-
fected by the largest doses of the poison. Under large quanti-
ties the motor nerve endings are paralyzed by the direct action
of the drug, but this effect is probably only to be observed in
certain species of frogs, in which these terminations are para-
lyzed before the central nervous system. In mammals central
paralysis destroys life before paralysis of the nerve endings is
induced, though towards the end of a case of poisoning their
functional activity is said to be depressed.
Special Senses. — Mention has been made of the influence of
strychnine in increasing the acuteness of the special senses.
This effect is produced by small doses, and is believed to be
probably a cerebral action, although it is contended by some
that it is due to alterations in the peripheral organs. While the
acuteness of the hearing and the sense of smell is apparently
increased, the effect of the drug is most decidedly shown in the
NUX VOMICA. "/J?
sense of touch, the delicacy of which is markedly augmented,
and in the vision. The field of the latter is widened, especially
for blue, and differences can be recognized between shades of
color which ordinarily seem identical ; while in certain condi-
tions of amblyopia light is said to be rendered much more
distinct.
Metabolism. — In consequence of the violent contractions of
the muscles throughout the body, there is naturally an increased
oxidation, and the amount of oxygen absorbed and of carbon
dioxide excreted by the lungs shows a corresponding augmen-
tation. This increased excretion of carbon dioxide is found,
however, to occur, though to a less extent, even when the skele-
tal muscles have been curarized, and it is concluded, therefore,
that it is due in part to the contraction of the muscular coats
of the blood-vessels and possibly to the increased metabolism
of the central nervous system. There is an increased produc-
tion of heat in consequence of the increased oxidation of the
tissues, but this is offset, to a varying degree in different ani-
mals, by an augmented skin dissipation. While, however, the
internal temperature may be even slightly lower than normal,
the cutaneous temperature generally shows a considerable rise
on account of the afflux of blood to the surface.
Elimination. — Strychnine, which is rapidly absorbed, is ex-
creted in part unchanged, principally in the urine, but also in
the saliva, sweat and bile. The excretion, although it com-
mences promptly, is very prolonged, usually continuing for a
week or more. Part of the strychnine is destroyed, probably
through oxidation, in the tissues. The characteristic symptoms
of the poison are found to be very much less marked when the
animal is placed in an atmosphere of oxygen, and it is also
stated that if the dose (though large enough to prove fatal
under ordinary circumstances) is injected into the leg of the
animal, but prevented from reaching the circulation for an
hour, it has absolutely no effect. Strychnine is said to be re-
tained for a long time in the liver and central nervous system.
The action of Brucine, while in general similar to that of
yy8 PHARMACOLOGY AND THERAPEUTICS.
the more powerful alkaloid, is distinguished from the action
of strychnine in showing a greater tendency to produce paraly-
sis of the central nervous system and a more marked curare-
like action. A 5 to 10 per cent, solution of chemically pure
brucine is stated to produce rapid loss of sensibility when ap-
plied to the buccal mucous membrane in man, while a 20 per
cent, solution is capable of exciting a decided local anaesthetic
effect when applied to the skin.
Therapeutics of Nux Vomica and Strychnine.
External. — On account of its very pronounced toxic charac-
ter, strychnine is never employed for antiseptic purposes.
Internal. G astro -intestinal Tract. — Tincture of nux vomica
is an admirable stomachic bitter, and is especially useful in
cases where impairment of digestion is due to enfeeblement of
the general system. 1.20 c.c. (20 ^l) of it in a wineglass of
hot water will frequently at once check gastro-intestinal fer-
mentation. Nux vomica may often be combined with good
effect with diluted hydrochloric acid and some such bitter as
gentian or cinchona. In the gastric catarrh and morning vom-
iting of drunkards it is considered as next in value to arsenic.
It may be given advantageously with mineral acids. In cases
of constipation in which the contractile power of the muscular
coat of the intestine is feeble, in consequence, like the impaired
digestion referred to, of general weakness of the system, it is
of great service in promoting peristalsis by its action on the
intestinal muscle. In instances of this kind it is commonly
associated, in pill or otherwise, with remedies especially appro-
priate to the special condition of the patient, as, for instance,
with preparations of iron in cases of anaemia. It has sometimes
proved useful in epidemic dysentery, and in some epidemics
of cholera strychnine, combined with opium and mineral acids,
has appeared to ward off the stage of collapse. Nux vomica
has been advised in a variety of indefinite conditions of depres-
sion and general want of tone, in which it is difficult to say
whether the results are to be ascribed to its effect in improving
nux vomica. 779
the appetite and digestion or in increasing the activity of the
spinal cord and medulla.
Circulation. — Nux vomica and strychnine are useful as car-
diac stimulants, especially in cases of disease of the heart in
which digitalis is contra-indicated. They are sometimes com-
bined with other cardiac stimulants, such as caffeine. In in-
stances of urgent danger from failure of the heart's action in
the course of chronic cardiac disease and other affections the
prompt use of strychnine by hypodermatic injection not infre-
quently proves of the greatest service.
Respiration. — Strychnine is an excellent respiratory as well
as cardiac stimulant. It may be given with expectorants when
there is an abundant mucous secretion and little effort is made
for its expulsion, but is contra-indicated in dry constant cough
with small expectoration. It is especially valuable when in
bronchitis and other thoracic diseases the respiration has be-
come weak and shallow. In pneumonia it is extremely useful
when death is imminent from dilatation of the right heart. In
this condition it should be administered hypodermatically and
at frequent intervals. In many cases of poisoning also, espe-
cially by agents tending to cause failure of the respiration, its
employment in judicious doses by this method serves a useful
purpose on account of its pronounced stimulating action upon
the respiratory centre in the medulla. Strychnine has been
recommended in the night-sweats of phthisis, on the supposi-
tion that these are due to imperfect respiration during sleep.
Nervous System. — In nervous diseases strychnine has been
used to quite a large extent, and often without proper discrim-
ination. Consequently, the results obtained have not always
been of a satisfactory character. On account of its action on
the central nervous system, it is prescribed in different forms
of paralysis, and some restitution of function, or, it may be,
some retardation of the disease, may attend its use in many of
them. It is found that the cases in which it is of the most
benefit are those in which there is present no appreciable or no
well-marked central anatomical lesion, as in hysterical, neuras-
78O PHARMACOLOGY AND THERAPEUTICS.
thenic, diphtheritic and syphilitic paralyses, and in paralysis
due to such poisons as lead and arsenic. Little is to be ex-
pected from it when sclerosis exists, and in paralysis resulting
from cerebral apoplexy it may possibly prove injurious in con-
sequence of the congestion of the brain and tendency to recur-
rence of the haemorrhage caused by its action in increasing the
blood-pressure. It may, however, be sometimes given with ad-
vantage in hemiplegia when sufficient time has elapsed to per-
mit repair of the damage done by the extravasation, and is of
most service when the paralyzed members are completely re-
laxed. When the paralysis has existed so long that the muscles
have undergone fatty degeneration it is quite useless. Strych-
nine is always contra-indicated in paralytic cases when head-
ache, vertigo and tinnitus aurium are present. It sometimes
proves useful in the nocturnal enuresis of children, as well as
of incontinence of urine in adults, and this has been attributed
to the increased tone of the sphincters resulting from aug-
mented excitability of the spinal cord. Apparently on account
of the action of the cord, it has also been used as an emmena-
gogue and as an aphrodisiac in impotence. Combined with the
fluidextract of ergot, tincture of nux vomica has been recom-
mended as a remedy for post-partum haemorrhage, and the neu-
ralgic form of dysmenorrhcea may sometimes be cured by nux
vomica given between the menstrual periods.
Brucine, in 5 per cent, solution, has been found to give great
relief as a local application in inflammations about the external
ear, and in stronger solution in the itching of chronic pruritus.
TOXICOLOGY.
Symptoms. — The time of the appearance of the symptoms will depend
largely upon individual differences and upon the manner of introduction.
If the poison is taken by the mouth, the promptness of its action will be
affected by the condition of the stomach, whether empty or full, and by
the nature of the food, if any is present. If subcutaneous injection has
been employed, the time will be affected somewhat by the place of
introduction. Strychnine will act more rapidly than tincture of nux
vomica, and both of these more quickly than pills. The symptoms do
NUX VOMICA. /S I
not often develop in less than fifteen minutes, and are not generally
delayed beyond half an hour, but have been known not to appear for
nearly two hours. If the dose is within therapeutic limits and yet
sufficient to produce an ontoward effect, the first symptom is likely to be
a feeling of uneasiness with a heightened reflex irritability, and this
may be followed by muscular twitching in some part of the body.
When a large dose has been taken, with or without a preliminary sense
of impending suffocation convulsive movements begin, which have
the effect mechanically, of causing the patient to cry out or shriek, and
they are very quickly followed by the characteristic spasms, which now
set in with great violence. These are at first clonic and then tonic.
Opisthotonos results from the extensor muscles overcoming the flexors,
and the feet are curved inward. The spasms then again become clonic,
and soon an intermission ensues. Suddenly the convulsions start up
again, and there is thus an alternation of the convulsive attacks and
remissions. During the latter there is complete muscular relaxation
and general depression in the place of stimulation. With each succes-
sive attack the symptoms increase in violence. The patient often rests
on his head and feet, the remainder of his body being arched above the
bed or floor. The face becomes livid and the eyeballs staring, while
the chest and abdomen are stiff as boards. The contractions of the
facial muscles occasion risus sardonicus, the patient grinning in a
ghastly manner, but those of the jaw are not affected till towards the
last. This aids in distinguishing strychnine poisoning from tetanus,
in which the muscles of the jaw are implicated very early. Other
diagnostic marks of tetanus, as contrasted with it, are the slower
development of the symptoms and the continuous muscular rigidity ;
for while between the paroxysmal exacerbations there is some diminu-
tion of this, there is never complete relaxation, as in strychnine poison-
ing. During the attack (in strychnine poisoning) the pulse is very
rapid, and the sight, hearing and sense of touch become abnormally
acute. The patient is entirely conscious, and usually suffers excruciating
pain, though in exceptional instances the asphyxia produces more or less
anaesthetic effect. The interference with circulation and the pressure
on the abdominal viscera, aided by the stimulation of the medullary
centres, may give rise to vomiting and purging. The respiration during
the attack is at first labored and dyspnceic, and then is temporarily ar-
rested by the spasmodic contraction of the diaphragm. Foaming at the
mouth may occur in consequence of the interference with respiration,
and the asphyxia resulting from the latter induces cyanosis, dilatation of
the pupils, and eventually coma. In the intermission the patient lies
782 PHARMACOLOGY AND THERAPEUTICS.
exhausted, and covered with a cold sweat. The slightest noise or touch,
or even a bright light, is likely to bring on a convulsive seizure, which
may jerk the patient out of bed. The number of seizures varies in
different instances, but three or four are usually fatal ; the patient suc-
cumbing to asphyxia and exhaustion. The smallest dose of strychnine
known to have proved lethal is .03 gm. (Y2 gr.). Post-mortem. As in
other conditions characterized by violent convulsions, there is early and
often persistent rigor mortis. The appearances are those due to
asphyxia and the convulsions : venous engorgement of the internal
organs and, generally, hyperemia of the central nervous system, with
small haemorrhages. Quite rarely there is also hyperemia of the
mucous membrane of the gastro-intestinal tract.
Treatment. — Give emetics (p. 175), particularly apomorphine hydro-
chloride hypodermatically, or wash out the stomach if the patient is
seen early enough for the passing of the tube not to cause spasm.
Lavage may be practised with solution of potassium permanganate, as
in cases of opium poisoning, but it is not so effective here. If very
violent convulsions are already present, evacuation of the stomach, as
a rule, should be avoided, as either emetics or the stomach-pump will
have the effect of starting the spasms. Both potassium permanganate
and iodine are chemical antidotes, and when one of these is employed,
it is not so necessary to empty the stomach. When a fatal dose has been
taken, however, the chances are that neither evacuation or any chemical
antidote will be of service, for by the time the physician can arrive
sufficient of the poison will probably have been absorbed to render
both useless. Chloroform is the best physiological and most practical
antidote, and it has the special advantage that its action can be very
largely controlled. Chloral may be useful, and is often advised, but
is open to the objection that with it there is always the risk that its para-
lytic effects may coincide with those of the strychnine, and thus increase
the patient's danger. Both chloral and morphine are antidotal to strych-
nine as regards the effect on the cerebrum, but this is of little importance,
while morphine may only add to the gravity of the symptoms by in-
creasing the reflex excitability of the spinal cord and by its depressing
effect on the respiration. Although calabar bean and gelsemium are
theoretically more perfect physiological antagonists, since both depress
the anterior cornua, they are practically of very little value in strychnine
poisoning. Other measures which have been recommended are the
administration of large doses of potassium bromide per rectum and the
use of amyl nitrite inhalations. If the case is seen early, the employ-
ment of tannin in large quantities may be of service, as the insoluble
CALABAR BEAN. 783
tannate is formed in the stomach. This should be gotten rid of, how-
ever, as soon as possible, as it becomes broken up by the action of the
gastric juice, and the strychnine is then rapidly absorbed. It is claimed
as a result of animal experiments that the application of external heat
decreases the mortality. Artificial respiration, as well as the inhalation
of oxygen, should usually be begun early.
2. Drugs which depress the activity of the anterior cornua.
CALABAR BEAN.
PHYSOSTIGMA.— Physostigma. (Calabar Bean.) Dose, 0.100.
gm. (100 milligm.) ; iy2 gr.
Preparations.
1. Extractum Physostigmatis. — Extract of Physostigma.
Dose, 0.008 gm. (8 milligm.); y8 gr.
2. Tinctura Physostigmatis. — Tincture of Physostigma.
Dose, 1 c.c; 15 n\.
PHYSOSTIGMINE SALICYLAS. — Physostigmine Salicylate.
(Eserine Salicylate.) Dose, 0.001 gm. (1 milligm.) ; i gr.
PHYSOSTIGMINE SULPHAS.— Physostigmine Sulphate. (Eser-
ine Sulphate.) Dose, 0.001 gm. (1 milligm.); ^ gr.
Action of Calabar Bean.
External. — A strong solution of physostigmine is said to have
the effect of slightly diminishing the functional activity of mo-
tor and sensory nerves, while, applied to the conjunctiva, it
causes contraction of the pupil, myopia, dimness of vision, and
other symptoms.
Internal. Alimentary Tract. — Physostigmine has the effect
of increasing the secretions of the glands, especially the sali-
vary, mucous, lachrymal, sweat, and pancreatic, and this is due
to its stimulating action on the terminations of the secretory
nerves in the gland-cells. It thus acts on the same point as
atropine, but in an exactly opposite manner. After the drug
has been absorbed, therefore, there is usually an augmented
flow of saliva, but the secretion may be inhibited or soon
checked by the contraction of the arterioles caused, and the
784 PHARMACOLOGY AND THERAPEUTICS.
consequent insufficient nutrition of the gland cells. In the
stomach and intestine it induces a marked increase in peristal-
sis, in consequence, it is believed, of its action on the nerve end-
ings in the muscular coats of these viscera, and consequently,
if the dose is not too small, vomiting and purging are caused.
The powerful contractions to which it gives rise are of the same
general character as those produced by pilocarpine and mus-
carine, but it is found to differ from them in causing these
movements after small quantities of atropine, while larger doses
of atropine again stop the contractions set up by physostigmine.
The peristaltic movements culminate in a tetanic contraction
of the muscular walls, which prevents the passage onward of
the contents of the viscera.
Unstriped Muscle. — On unstriped muscle in many parts of
the body physostigmine has the same action as in the gastro-
intestinal tract. It thus probably induces contraction not only
of the iris, but of the bronchial tubes, spleen, uterus, ureters,
and the gall and urinary bladders. It is also said by some to
affect the arterioles in the same way, but proof is lacking that
it causes contraction of their muscular coats by stimulating the
vasomotor terminations in them.
Circulation. — In consequence of the violent contractions of
the stomach and intestine, which expel the blood from a very
large area, and also in part, it is supposed, of a stimulation of
the vasomotor centre in the medulla, there is a considerable
rise in the blood-pressure. The contraction of the cardiac mus-
cle is strengthened in frogs. This is denied as regards mam-
mals, but some reliable investigators claim to have demonstrated
it in experiments on dogs. However this may be, the pulse is
slowed by physostigmine, and this is believed to be due to its
direct action on the heart muscle rather than to any inhibitory
interference, since slowing occurs even after large amounts of
atropine. The amplitude of the cardiac movements, whether
due to a strengthening of the contractions or to the slow
rhythm, is afterwards diminished, and in the frog large doses
cause arrest of the heart in systole. The rise in blood-pressure
CALABAR BEAN. 785
is also succeeded by a fall, and this is ascribed to paralysis of
the vaso-motor centre. If large quantities of the alkaloid are
injected, there is an immediate fall in the blood-pressure, and
this is accompanied by a further slowing of the pulse. In the
frog physostigmine, by reason of its effect in increasing the
irritability of the cardiac muscle, is capable of starting a heart
which has been stopped by muscarine.
Respiration. — The respiration, which is at first quickened and
strengthened, soon becomes retarded and dyspnceic, and death,
which is due to paralysis of the respiratory centre, takes place
from asphyxia. The primary acceleration may be due in part
to stimulation of the sensory terminations in the lungs and
partly to central stimulation. The subsequent dyspncea is no
doubt owing in some measure to spasm of the bronchial mus-
cles, as well as to depression of the respiratory centre in the
medulla.
Nervous System. — It is not known positively whether or not
any general stimulation of the central nervous system is caused
by physostigmine, but the primary quickening of the respira-
tion, as well as the changes in the blood-pressure, points
strongly towards this. As regards the cortex, it is still unde-
termined whether the collapse met with in severe poisoning is
preceded by a stage of slight stimulation. There is no question
as to the drug's causing central depression. Whether this be-
gins in the spinal cord and medulla, and only spreads to the
cerebrum after large doses, is unknown, and some observers
hold that the higher centres are depressed earlier than the lower
ones. In man, however, at least, the consciousness remains
unimpaired after the respiration and muscular power have be-
come seriously affected ; indicating that some of the higher
cerebral areas preserve their functions after others have been
weakened. In the medulla, as has been mentioned, the respira-
tory and vaso-motor centres eventually become paralyzed. Re-
flex activity is inhibited in consequence of depression of the
anterior cornua of the spinal cord, as may be seen when phy-
sostigmine is applied directly to the cord. At first such activ-
5i
786 PHARMACOLOGY AND THERAPEUTICS.
ity is slightly increased, but this is the result of irritation, such
as may be caused by almost any substance, and there soon suc-
ceeds a total abolition of reflex excitability. Subsequently
there is paralysis of the posterior portion of the cord also, with
diminution of cutaneous sensibility.
Muscles and Nerves. — In mammals muscular twitchings are
caused by large amounts of physostigmine, and constitute one
of the most characteristic features of the poisoning. They are
also observed in frogs, but much more rarely. In some in-
stances they are so pronounced in warm-blooded animals as to
simulate convulsions, but are distinguished from the latter in
not involving the whole of a muscle at one time. This phenom-
enon is probably attributable to the action on the motor nerve
terminations, though some hold that it is due to direct action
on the muscle.
Eye. — Although the application of a solution of physostig-
mine to the conjunctiva always causes the pupil to contract to
its smallest diameter, this effect is not invariably observed in
systemic poisoning. In man, however, some contraction is gen-
erally produced. Such a variation points to its being due to
changes in the local mechanism, and there is every reason to
suppose that it is caused by a stimulation of the ends of the
motor fibres in the sphincter, such as is seen in unstriped mus-
cle elsewhere. The action of physostigmine on the eye resem-
bles that of muscarine, except that it antagonizes atropine much
more completely. By its effect on the motor nerve termina-
tions in the ciliary muscle it causes spasm of accommodation, in
addition to the contraction of the pupil from its influence on
the iris, and in consequence of the myosis there results a
diminution of intra-ocular pressure. Associated with these
phenomena, especially when they are decidedly pronounced,
there are apt to occur some twitching of the lids, dimness of
vision, and supra-orbital pain.
Excretion. — Physostigmine is readily absorbed and is elim-
inated chiefly in the urine, though traces of it have been found
in the bile and saliva. The action of the alkaloid is much more
CALABAR BEAN. 787
constant than that of calabar bean itself, and this may be be-
cause the effects of the other active principles in the crude drug
interfere to some extent with those of the physostigmine.
Therapeutics of Calabar Bean.
Unstriped Muscle. — Calabar bean has been used to a limited
extent in affections in which its property of stimulating invol-
untary muscle may be availed of. It has a certain value in
atony of the bladder and intestines and in catarrh of the bow-
els, and is sometimes given in purgative pills to stimulate the
muscular layer of the intestine. Combined with nux vomica,
it has been employed with advantage in gastric and intestinal
dilatation. It has been especially recommended for the trouble-
some flatulence of women at the time of the menopause, which
is ordinarily associated with a paretic state of the muscular coat
of the bowel, and it is stated that with the relief afforded to
the flatulence there usually comes relief to the headache, ver-
tigo and morbid fancies so often attending it. In chronic bron-
chitis with deficient power of expectoration, bronchial asthma.
and emphysema it may be of service in promoting the expul-
sion of mucus by its influence over the muscular fibres in the
bronchial tubes.
Central Nervous System. — Calabar bean has been quite
largely employed in the treatment of tetanus, but as a consider-
able number of cases of this disease show a tendency to spon-
taneous recovery, it is difficult to determine its real value.
About one-half the cases in which it has been used are said to
have been reported cured, and it is possible that this proportion
might have been larger if sufficient attention had been paid to
the quality of the drug employed and to the mode of administra-
tion. It has been advised by competent authority always to
commence the treatment by a subcutaneous injection and to
repeat such injection until the system is decidedly affected:
then to administer the remedy by the mouth in doses three
times as large as those employed hypodermatically. Instead
of the bean, it is better to employ physostigmine sulphate.
788 PHARMACOLOGY AND THERAPEUTICS.
Doses of .002 gm. (^i_gr.) may be given hypodermatically and
frequently repeated, the condition of the patient in the mean-
while being watched with great care. This remedy has been
resorted to in trismus neonatorum and other spasms, but with
only moderately good results. It has also been extensively
tried in epilepsy and chorea, but in most cases has proved of
little service and in others has seemed positively deleterious.
Physostigmine has been given as an antidote for strychnine
poisoning.
Eye. — A solution of physostigmine salicylate (i or 2, to
water, 480) is dropped in the eye to break up adhesions of the
iris, to diminish intra-ocular tension, and to prevent prolapse of
the iris after wounds, or ulcers of the cornea. It is also em-
ployed in glaucoma, in paralysis of the iris and ciliary muscles,
and to prevent the entrance of light into the eye in photophobia.
It is useful when for any reason it is desired to rapidly over-
come atropine mydriasis, but as it is less powerful than atro-
pine, a larger amount will be required for this purpose than it
took of atropine to produce the contraction of the pupil.
ANTAGONISM.
It will be observed that in its action on the pupil and on involuntary
muscle generally, on secretion, on the heart, and on respiration, physos-
tigmine is antagonistic to atropine. In its action on the spinal cord and
respiratory centre it is antagonistic to strychnine.
GELSEMIUM.
GELSEMIUM.— Gelsemium. (Yellow Jasmine.) Dose, 0.065 (65
milligm.) ; 1 gr.
Preparations.
Fluidextractum Gelsemii. — Fluidextract of Gelsemium. Dose,
0.05 c.c; 1 TT1.
Tinctura Gelsemii. — Tincture of Gelsemium. Dose, 0.5 c.c;
8 m-
Unofficial Preparation.
Gelseminae Hydrochloridum. — Gelsemine Hydrochloride.
(Gelsemine Hydrochlorate.) Dose, 0.0003 gm.; ^0 S1-
GELSEMIUM. 789
Action of Gelsemium.
External. — If a solution of gelsemium or either of its alka-
loids is dropped into the eye, it causes momentary smarting and
hyperemia of the conjunctiva together with rapid dilatation of
the pupil and paralysis of accommodation.
Internal. — The action of gelsemium is essentially the same
as that of gelseminine, which is much the more powerful of its
two alkaloids. It usually has no effect on the alimentary tract,
though in poisoning by it attempts at vomiting are observed in
some animals.
Circulation. — Almost the only appreciable effect it has upon
the circulation is to induce paralysis of the inhibitory mechan-
ism of the heart. Very little change is observed in the blood-
pressure in animals, even after large amounts, if artificial res-
piration is maintained after the failure of the natural respira-
tion.
Respiration. — Gelsemium powerfully depresses the respira-
tion, and when taken in toxic doses causes death by asphyxia.
The failure of the respiration is probably due to paralysis of
the respiratory centre, though it seems likely that partial pa-
ralysis of the nerve endings in the respiratory muscles may be
a contributory cause. Before death the temperature falls, and
the skin is covered with a cold sweat.
Nervous System and Muscles. — The action of gelseminine in
general resembles in some respects that of coniine, but it differs
from the latter in not causing any increase in arterial tension
and in having a more depressant action on the central nervous
system. The respiratory centre in the medulla oblongata, as
has been mentioned, is apparently paralyzed. The higher cere-
bral functions and the sense of pain remain unimpaired until
just before death. Gelseminine in poisonous amounts causes
loss of coordinating power and extreme muscular weakness,
with marked tremor when any movement is attempted. The
animal falls to the ground and is presently unable to raise even
its head, while the tremors, which are ascribed to the action on
790 PHARMACOLOGY AND THERAPEUTICS.
the nerve terminations, as in the respiratory muscles, become
still more pronounced. The muscles, while not being com-
pletely paralyzed, are incapable of a continued contraction, in
consequence of the failure of the nerve endings to transmit
enough impulses for the purpose, and the interruptions of the
contractions no doubt furnish the explanation of the tremor.
Reflex excitability for the most part remains unaltered. In the
frog the injection of gelseminine produces feebleness and slow-
ness of movement, followed by a partial paralysis of the motor
nerve endings in striated muscle. If the dose is sufficiently
large, the animal is found to lie perfectly motionless and unre-
sponsive to any form of stimulation, just as if poisoned by
curare. It is stated that the contractions of the heart are unaf-
fected by stimulation of the vagus, apparently because the gan-
glionic connections along the course of the inhibitory fibres are
paralyzed by gelseminine in the same way as by nicotine, while,
on the other hand, the terminations of the inhibitory fibres in
the cardiac muscle seem to retain their function, since musca-
rine continues to weaken and slow the heart, as under ordinary
conditions.
Gelsemine is entirely devoid of action on mammals, but in
the frog has an action similar to that of strychnine, increasing
the reflex excitability of the spinal cord and inducing tonic
spasms, and in large quantities paralyzing the motor nerve end-
ings in muscle.
Eye. — The effects of the local application of gelsemium have
already been referred to. The mydriasis is less complete and
less persistent than that occasioned by atropine, but is thought
to be due to the same cause, paralysis of the terminations of
the motor oculi nerve. In general poisoning by it marked
dilatation of the pupil does not occur until quite late. Distur-
bance of vision, followed by diplopia and ptosis is not infre-
quently observed after gelsemium, and these effects have been
attributed to paralysis of the ocular muscles.
MUSCARINE. 791
Therapeutics of Gelsemium.
At one time gelsemium was employed as a circulatory de-
pressant, but is not now used in this way, since its other effects
are so harmful. Nor is it any longer prescribed for convulsive
diseases, as tetanus, whooping-cough, chorea, etc., as it was
found not to do any good. It is often successfully used for
neuralgia and migraine, though how it acts is quite uncertain.
For these the tincture may be given, or the following combina-
tion: Gelsemine hydrochloride, .0003 gm. (-^J^gr.) and butyl
chloral hydrate, 20 gm. (3 gr.), made into a pill with mucilage.
One pill should be given every two hours until the pain is re-
lieved. Gelsemium seems to be especially efficacious in neural-
gia of the facial branches of the trigeminus. It is occasionally
used locally to dilate the pupil and paralyze accommodation,
and it has the advantage that its influence passes off rapidly.
A convenient method of applying it is in gelatin discs, each con-
taining .00013 gm. (-5-J-0 gr.) of gelsemine hydrochloride. Gel-
semium has been employed with success in the treatment of
some cases of eczema and pruritus. It is advised that .18 to
.60 c.c. (3 to 10 HI) of the tincture should be taken every two
or three hours until some of the characteristic effects of the
drug appear. The tincture has also been used in Meniere's
disease, in doses of 0.60 c.c. (10 Tit) three times a day, and to
arrest attacks of bilious colic, in doses of 0.30 c.c. (5 TU) every
quarter of an hour. Gelsemium has sometimes proved of ser-
vice in torticollis, rigid os in labor, after-pains, spasmodic dys-
menorrhea, haemoptysis, laryngismus stridulus, asthma and
whooping-cough, and as an antispasmodic in coughs in general.
MUSCARINE.
Unofficial Preparation.
Muscarina.— Muscarine. Dose, 0.008 to 0.12 c.c; y8 to 2 TH..
Action of Muscarine.
Muscarine in its action somewhat resembles calabar bean
and pilocarpine, and it is antagonistic to atropine. It produces
792 PHARMACOLOGY AND THERAPEUTICS.
free salivation, abundant perspiration, diminution of the force
and frequency of the pulse, dyspnoea, paralysis and finally death.
The pupil is contracted; dilating, however, before death. The
cardiac diastole is prolonged, owing to action upon the inhibitory
nerves. The muscles of the intestines and bladder are mark-
edly contracted. The abdominal secretions are increased.
Therapeutics of Muscarine.
Although it has been but little employed in medicine, musca-
rine is likely to be useful in intestinal torpor, duodenal catarrh,
and in inflammatory effusions and exudations. As it produces
contraction of pulmonary capillaries, it is indicated in pulmo-
nary haemorrhage and incipient pulmonary congestion.
BROMINE.
BROMUM.— Bromine.
Preparations.
i. Potassii Bromidum. — Potassium Bromide. Dose, 1 gm.;
15 gr.
2. Sodii Bromidum. — Sodium Bromide. Dose, 1 gm.; 15 gr.
3. Ammonii Bromidum. — Ammonium Bromide. Dose, 1 gm.;
15 gr.
4. Lithii Bromidum. — Lithium Bromide. Dose, 1 gm.;
15 gr.
5. Calcii Bromidum. — Calcium Bromide. Dose, 1 gm.; 15 gr.
6. Zinci Bromidum. — Zinc Bromide. Pose, 0.125 gm. (125
milligm.) ; 2 gr.
7. Strontii Bromidum. — Strontium Bromide. Dose, 1 gm.
15 gr.
Unofficial Preparations.
Rubidii Bromidum. — Rubidium Bromide. Dose, 0.30 to 4
gm.; 5 to 60 gr.
Rubidii et Ammonii Bromidum. — Rubidium and Ammonium
Bromide." Dose, 0.30 to 4 gm.; 5 to 60 gr.
BROMINE. 793
Action of Bromine.
Bromine closely resembles chlorine in its effects on the
system.
Therapeutics of Bromine.
It is at present very little used in medicine. Locally it has
been employed with success as a caustic in hospital gangrene,
chancre and carcinoma uteri, but its escharotic action is at-
tended with great pain. The vapor of bromine with alcohol
(i to 64) is sometimes used for inhalation in coryza and hay-
asthma.
Action of the Bromides.
External. — Potassium, sodium and other bromides, locally
applied in solution, are slightly sedative to mucous membranes,
lessening the reflex excitability, especially of the pharynx.
Internal. Alimentary Canal. — Administered in bulk or con-
centrated solution, they induce salivation and thirst, and if the
amount is large, gastric irritation with nausea and vomiting.
Occasionally diarrhoea is caused by concentrated solutions
reaching the intestine. These irritating effects are probably
due for the most part to the withdrawal of fluid from the
mucous membranes, as in the case of sodium chloride, and are
not observed when the bromides are given in dilute solution.
It has also been pointed out that bromides may disorder the
stomach by so decreasing reflex action that the proper secre-
tion of gastric juice and the digestive process do not take place
with sufficient rapidity, and that for similar reasons they may
cause constipation.
Nervous System. — They have a direct effect upon the central
nervous system, that of the potassium salt being most marked
because with it the bromide action is supplemented by the de-
pressant action of the base. The action consists in a depres-
sion rather than an abolition of function. In man the bromides
induce a diminution of mental activity in general, but this is
affected in some respects more than others. Thus, the percep-
tion is but little impaired, while the appreciation apparently
794 PHARMACOLOGY AND THERAPEUTICS.
becomes decidedly defective, so that while stimuli reach the
brain much as usual, they do not seem to be adequately appre-
hended. External objects are perceived, but arouse no interest
in the patient, and frequently this state of apathy passes into
drowsiness and sleep. The sleep, however, is never very deep
and is not refreshing, while for several hours after waking the
patient is apt to be more or less affected with mental confusion.
Before slumber comes on there are observed fatigue, lassi-
tude, disinclination for exertion, and often muscular weakness.
There is also a marked diminution in reflex activity. Thus,
the irritation of the mucous membranes of the genito-urinary
tract is less liable to set up reflex movements, tickling of the
fauces does not induce nausea, and after very large doses the
conjunctiva may sometimes be touched without causing wink-
ing. In some instances the general cutaneous sensibility is also
diminished, and after large doses there may be more or less
complete anaesthesia, which extends to the skin. In addition
to the ordinary reflexes, some special functions, as the respira-
tion and the sexual instinct, are depressed. The depression of
the spinal reflexes caused by the bromides renders them antag-
onistic to strychnine, so that in bromidized animals this alka-
loid induces convulsions only when given in much larger
amount than is ordinarily required for this purpose. As re-
gards the motor areas of the cerebral cortex, it is found that a
stimulation of the areas which, under the conditions of the
experiment ordinarily give rise to general epileptiform convul-
sions, will, after the administration of bromide, be confined to
the area directly stimulated. It would appear, therefore, that
the whole cerebrum, as well as the spinal cord, is powerfully
depressed by the bromides. In man, at least, the depression,
beginning with the higher functions of the brain, takes place
in regular order from above downwards, in the reverse order
of the physiological development of the functions; the action,
as in the case of many other drugs, following out the Law of
Dissolution (see p. 737).
BROMINE. 795
Circulation. — Large doses of potassium bromide have a de-
pressant action on the heart, an effect which is due to the potas-
sium ion. If the amount is sufficiently great, diastolic arrest
may be caused in animals. Sodium bromide has little or no
depressing influence, while the ammonium salt is slightly stimu-
lating to the heart. After the bromides there is often found a
contraction of the blood-vessels of the pia mater, and this con-
dition has been supposed to produce cardiac depression, but it
seems probable that this anaemia of the brain is analogous to
that observed in sleep, and is a result, rather than the cause,
of the depression.
Respiration. — The respiration is more or less depressed by
large doses. Under toxic amounts the breathing grows pro-
gressively slower and shallower, probably from depression of
the respiratory centre. Asphyxia is the usual cause of death
in animals, although if the potassium salt is employed in any
large amount, fatal cardiac paralysis may be induced by the
poisonous action of the potassium on the heart muscle. After
a small toxic dose the frog's heart has been observed to con-
tinue beating long after the failure of the respiration.
Temperature. — In animals toxic doses not infrequently pro-
duce some fall of temperature, and this is regarded as being
due to the lessened movement.
Sexual Organs. — Bromides have a distinct anaphrodisiac
influence. Whether the depression of the sexual instinct
which has been mentioned is due to the action on the cerebral
cortex or on the spinal cord has not been determined. A fail-
ure of sexual vigor almost invariably results from the long-
continued administration of the bromides.
Metabolism. — Under large doses there is a marked diminu-
tion in the amount of carbon dioxide exhaled. The quantity
of urine is increased, particularly after the use of the lithium
salt. The nitrogenous metabolism is not apparently affected,
but the sulphur in the urine is increased, while quite commonly
the phosphates are materially reduced.
Excretion. — The bromides, which are rapidly absorbed by
yg6 PHARMACOLOGY AND THERAPEUTICS.
the mucous membranes, are eliminated mainly by the kidneys,
but to a small extent also in the perspiration and milk. There
is probably some excretion likewise by the bronchial and intes-
tinal mucous membrane. The disagreeable odor sometimes
noticed in the breath in chronic poisoning has been supposed
to be due to the elimination by the lungs of bromine or some
of its volatile organic compounds. The hydrobromic acid
secreted into the stomach in bromism is thought to be all reab-
sorbed in the intestines. Some of the bromide is rapidly elim-
inated, as it can be detected in the urine a few minutes after
injection, but the great mass of the drug is found to be excreted
only very slowly. Therefore, under its continued administra-
tion there is an accumulation in the system, though it has been
shown that the proportion excreted increases with the increase
of the salt in the blood until an equilibrium is established,
exactly as much bromine appearing in the urine as is absorbed
from the stomach. After the discontinuation of the drug the
excretion still goes on, and it has been detected in the urine for
as long as sixty-five days later. The slow excretion of bro-
mides is regarded as affording support to the theory that the
bromine enters into combinations in the body, and it is thought
probable that it may to some extent take the place of chlorine
in the combinations of the latter, especially as the excretion of
chloride is increased. The administration of sodium chloride,
it is said, accelerates the excretion of the bromine, and ameli-
orates the symptoms of bromism.
Comparative Action of the Bromides. — Certain of the differ-
ences between the various salts have already been incidentally
referred to, but a little further attention may be given to the
subject. None of the bromides has any action on nerve and
muscle unless applied directly to the excised structures. The
effects of potassium and sodium salts differ chiefly in the ab-
sence of any changes in the heart or in the muscles when ex-
posed to the solution of sodium bromide. Potassium bromide
is also more depressant to the central nervous system on ac-
count of the influence of the potassium ion. Under large doses
BROMINE. 797
of ammonium bromide the convulsive action characteristic of
ammonium has been observed in animals. The depressant
action of lithium bromide is probably next to that of the potas-
sium salt, and it is said by some even to exceed the latter in
this respect. It is the richest in bromine, containing 92 per
cent., and though it has not been so largely used as the others,
is thought to have the most pronounced hypnotic influence of
any. It is asserted that the strontium and calcium salts cause
less disturbance of the .digestion than the others, but they are
apt to be absorbed more slowly by the intestine than those of
the alkalies. Zinc bromide, if the dose is sufficiently large, may
act as an irritant poison.
Bromism. — The name bromism has been given to chronic
poisoning by the bromides. It is to be noted that hydrobromic
acid (see p. 801), although containing a larger proportion of
bromine, rarely gives rise to this condition. Usually the first
symptom is an eruption of papular acne, which appears chiefly
upon the face and back. In severe cases the papules pustulate
and then the pustules may coalesce, forming small abscesses
and eventually ulcers. In other instances the rash produced
resembles eczema, and in still others there is erythema or a
brown discoloration of the skin. A coated tongue and disor-
dered digestion are constant symptoms. There is not infre-
quently some coryza, with or without an increased secretion
from the bronchial mucous membrane, and sometimes a
mild conjunctivitis. These various effects are regarded as due
to a local irritant action, due in part to the salt action of the
bromide salt and in part to the decomposition of the bromide,
with liberation of bromic acid and bromine, by the free acids
in different situations: as hydrochloric acid in the stomach,
carbon dioxide in the air passages, and the acid secretions of
the sebaceous glands in the skin. This action is said to be
favored by insufficiency of the kidney and to be more readily
induced in old age. From the influence of the drug on the
nervous system the general cutaneous sensibility and the sen-
sitiveness of the faucial mucous membrane are distinctly re-
798 PHARMACOLOGY AND THERAPEUTICS.
duced, while the sexual appetite also becomes markedly dimin-
ished. The patient is indisposed to make any exertion and is
easily fatigued, while his gait is uncertain and every movement
may be attended by tremor. The mental phenomena observed
are of the nature of continuations and exaggerations of the
effects of a single dose. The intellect is dulled and the memory
especially is affected. The patient takes little or no notice of
what is going on around him, he speaks slowly and stammers,
and is apt to mispronounce ordinary words or miss several
words out of a sentence. The mental condition induces a stu-
pid and apathetic expression of countenance, while the eyes
become heavy and lustreless. Occasionally maniacal excite-
ment, mental confusion, and even delirium are observed after
continued use of moderate doses, particularly of the potassium
salt. Those who take bromides habitually generally find them-
selves unable to sleep without them, and as a gradual increase
of the dose is required to produce sleep, the effects on the sys-
tem are usually disastrous. In addition to suffering from the
special evils of bromism, the patient, on account of his lowered
resistance, is rendered more liable to contract disease of any
kind, and not infrequently the immediate cause of death is an
attack of pneumonia or bronchitis. Notwithstanding the grav-
ity of the symptoms in bromism, after the withdrawal of the
drug they generally disappear soon after there no longer re-
mains any bromine in the system.
Therapeutics of the Bromides.
External. — Before the days of local anaesthetics it was cus-
tomary to paint the pharynx with a bromide solution in order
to diminish the sensibility of the throat before making a laryn-
geal examination. Finely powdered potassium bromide is
stimulant to chronic ulcers, and is said to be advantageous in
epithelioma. With 5 parts of glycerin, it has been used as a
soothing application for painful haemorrhoids and fissures of the
anus, and in solution (.60 to 1.20 gm. ; 10 to 20 gr. to 30 c.c. ;
1 fl. oz. of water) for the relief of paraesthesia.
BROMINE. 799
Internal. — As would be inferred from their physiological
action, the bromides are of great service in various nervous dis-
eases for the relief of which a depressant effect is required.
They are the most valuable remedies at our command in the
treatment of epilepsy, their good effects being probably due to
their influence in reducing the excitability of the cortical motor
areas. When pushed in a suitable manner, they sometimes
prove curative, and though this happy result is by no means
always to be looked for, they are in most instances of great
service in diminishing both the frequency and severity of the
attacks. Consequently, they may be said to be indicated in
every case of the disease, and their use should be abandoned
only after a thorough trial has demonstrated their inefficiency.
As a rule, they are more successful in cases of grand mal than
of petit mal, and in cases in which the seizures occur in the
daytime rather than in those where they are exclusively noc-
turnal. Experience seems to show that rubidium and ammo-
nium bromide (in doses of 2 gm. ; 30 gr.) is the most serviceable
in some instances, but the potassium salt is the one in most
general use and considered the most efficient by many. There
are special circumstances, however, in which some one of . the
various other bromides possesses certain advantages and may
succeed when the potassium salt has failed. Sometimes the
combination of the three bromides, potassium, sodium and am-
monium, acts better than any one of the salts alone. Bella-
donna often increases the efficiency of bromides in petit mal.
As the bromides when applicable in epilepsy must be admin-
istered for an indefinite period, every effort should be made to
minimize their objectionable effects upon the system. Thus, it
is often advisable to intermit the remedy from time to time, or
to change from one bromide to another. To counteract the
depression, the bromide is sometimes given in infusion of ca-
lumba or digitalis, or strychnine is given hypodermatically at
the same time. It has been claimed by some that most of the
ill effects of the bromides may be avoided by giving them in
combination with intestinal antiseptics, such as sodium sali-
800 PHARMACOLOGY AND THERAPEUTICS.
cylate and naphthol; while others have observed that taking
strong coffee with the meals hinders the development of bro-
mism. For the prevention or amelioration of acne, arsenic is
the best remedy. When the convulsive attacks have ceased to
make their appearance, it is advised that a single dose of 4 gm.
(1 dr.) of bromide should be taken daily at bedtime for a year,
and after that on alternate nights for at least a year longer.
It is better that the remedy should not be discontinued alto-
gether for fully three years. As hypnotics and for quieting
nervousness and hysteria the bromides are often extremely use-
ful, but their too long continued employment should be avoided
on account of the risk of the patient's becoming an habitue of
the drug. They are especially useful in the wakefulness of
fatigue, worry and cerebral over-work. In various forms of
convulsions both in adults and children they are efficient, par-
ticularly when combined with hydrated chloral. This combina-
tion may be useful also in delirium tremens. Here the dose of
bromide should be very large, often as much as 4 gm. (1 dr.),
and it is of more service in the preliminary stage of wakeful-
ness and excitement than after the delirium is fully developed.
Other affections in which bromides may be employed are laryn-
gismus stridulus, the night-screaming of children, migraine,
neuralgia, dysmenorrhea and menorrhagia, particularly in
young subjects, seminal emissions, satyriasis and nymphomania.
In migraine and neuralgia the combination with caffeine is
often very efficient. The bromides have been considerably used
in the treatment of whooping-cough, but cannot be said to have
proved of much value. They are of service in the laryngeal
crises of locomotor ataxia and, in full doses, in acute laryn-
gitis. In cases where irritability of the pharynx and larynx
interfere with a satisfactory examination of these parts, the
trouble may be obviated by the administration of one or two
full doses. They are the best prophylactics which have as yet
been discovered for seasickness, and should usually be em-
ployed in doses of about .60 gm. (10 gr.) three times a day for
a number of days before sailing, though a larger amount will
BROMINE. 8oi
sometimes be required. After seasickness has commenced,
they should be given in small doses, frequently repeated, in an
effervescing draught made by mixing a solution of citric acid
with one containing the bromide and potassium bicarbonate.
They may also be used in the same way in the vomiting of
pregnancy, the vomiting following etherization, and other per-
sistent forms of vomiting which are not due to primary gastric
disturbance. In cases where this method proves inefficient, the
bromide may be given with the tincture of deodorized opium in
a small enema of starch water. The bromides have also been
employed to prevent the nausea and depression resulting from
opium, as well as for the symptoms of cinchonism and salicyl-
ism. They are of service in the abdominal neuroses, such as
cholera infantum when it is due, not to defective alimentation
or other local trouble in the gastro-intestinal tract, but to an
irritable state of the nervous system. In some varieties of
functional disease of the heart they are of decided benefit.
Lithium bromide has been prescribed in various gouty and rheu-
matic conditions, and potassium bromide is recommended as an
eliminating agent, combined with potassium iodide, in mercurial,
copper and lead poisoning. In a considerable number of cases
potassium bromide has proved successful in the treatment of
tetanus. Not less than 15 gm. (J/2 oz.) should be given in the
day, and hydrated chloral should be used as an hypnotic at
night. This bromide, in full doses, is also of value as an anti-
dote for strychnine poisoning.
ACIDUM HYDROBROMICUM DILUTUM.— Diluted Hydrobromic
Acid. Dose, 4 c.c; 1 fl. dr.
Action of Hydrobromic Acid.
Hydrobromic acid appears to have the characteristic bromide
action after absorption, but it also has the local action of an
acid; which makes it more irritant than the bromides. While
pleasanter to take than the latter, it is, therefore, more apt to
create gastric disturbance.
52
802 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Hydrobromic Acid.
It was introduced as a substitute for the bromides, but it
failed to fulfill the expectations of its usefulness, and is now
very rarely employed for the same purposes. It has some re-
pute in preventing the untoward symptoms of quinine, of which
drug it is an excellent solvent. Thus, it is said to give prompt
relief in the annoying tinnitus aurium occasioned by it, though
it often fails in relieving tinnitus from other causes. It has
been highly recommended for headaches due to eye-strain, espe-
cially in nervous women.
F. Drugs Acting on the Brain,
i. General cerebral stimulants.
BELLADONNA.
BELLADONNA FOLIA.— Belladonna Leaves. (Deadly Night-
shade.) Dose, 0.065 gm. (65 milligm.) ; 1 gr.
Preparations.
i. Extractum Belladonnae Foliorum (Extractum Belladonna
Foliorum Alcoholicum, U. S. P., 1890). — Extract of Belladonna
Leaves. Dose, 0.010 gm. (10 milligm.); y6 gr.
2. Pilulae Podophylli, Belladonnae et Capsici. — Pills of Podo-
phyllum, Belladonna and Capsicum. Dose, 1 pill.
3. Pilulae Laxativae Compositae. — Compound Laxative Pills.
Dose, 2 pills.
4. Tinctura Belladonnae Foliorum. — Tincture of Belladonna
Leaves. Dose, 0.5 C.C.; 8 TT\,.
5. Unguentum Belladonnae. — Belladonna Ointment.
6. Emplastrum Belladonnae. — Belladonna Plaster.
BELLADONNA RADIX.— Belladonna Root. Dose, 0.045 gm. (45
milligm.); % gr.
Preparations.
1. Fluidextractum Belladonnae Radicis. — Fluidextract of
Belladonna Root. Dose, 0.05 C.C.; 1 Til.
2. Linimentum Belladonnae. — Belladonna Liniment.
BELLADONNA. 803
ATROPINA.— Atropine. Dose, 0.0004 gm. (0.4 milligm.) ; yi¥ gr.
Preparation.
Oleatum Atropinae. — Oleate of Atropine.
ATROPINE SULPHAS.— Atropine Sulphate. Dose, 0.0004 gm.
(0.4 milligm.) ; T^ gr.
Unofficial Preparation.
Atropinae Santonas. — Atropine Santonate. Dose, 0.06 (1 ni )
of a solution of 0.01 gm. (y6 gr.) in 20 gm. (300 gr.) of water is
sufficient to dilate the pupil.
Action of Belladonna.
The action of belladonna is due to the atropine in it.
External. — Atropine by itself is not absorbed by the unbroken
skin, but when rubbed in with absorbable substances, such as
alcohol, glycerin, camphor, animal fats, etc., or when applied to
abraded surfaces or mucous membranes, it has a well-marked
local action and is also capable of producing systemic effects.
Its chief local effect is a paralyzation of the sensory nerve ter-
minations, so that it acts as an anaesthetic and anodyne, and
it also depresses the motor nerve terminations, though less
markedly, and tends to inhibit secretion. On the peripheral
vessels it has first a constricting and then a dilating influence.
Applied to the conjunctiva, it is a typical mydriatic.
Internal. Blood. — Atropine is rapidly absorbed into the
blood, and it is stated to diminish the number of leucocytes.
Nervous System. — The main action of atropine is on the
nervous system, and most of its effects in the organism are due
to its influence upon the various portions of this. The action
extends from the hemispheres downward, and in the medulla
oblongata the drug first stimulates and then depresses the three
principal centres. Its dominant and characteristic action is a
depression of the terminations of most varieties of nerves.
Secretory Nerves. — On the activity of the peripheral termina-
tions of all the secretory nerves in the body, it has, so far as
804 PHARMACOLOGY AND THERAPEUTICS.
known, a distinctly depressant effect. The secretions are not,
however, all affected to the same extent, since with some of
them the nervous influence is not so important as in the case
of others. The secretion of saliva is entirely dependent upon
the integrity of the nervous connection, and hence may be
entirely arrested by atropine. Thus, in an animal under the
influence of the drug, stimulation of the chorda tympani, which
is the secretory nerve of the submaxillary gland, no longer
causes an increased flow of saliva, as is the case under ordi-
nary circumstances, and it has been shown by experiments ex-
cluding the participation of the ganglia and gland cells that the
action is on the nerve endings. Furthermore, it has been shown
that no paralysis results of the vaso-dilator fibres which move
along with the secretory fibres of the chorda tympani, the secre-
tory fibres alone being selected by the atropine for its attack.
In the same way the secretory nerve terminations in the other
salivary glands and the buccal mucous glands are paralyzed,
and as the normal impulses are thus prevented from reaching
the gland cells, the mouth becomes dry. Even small doses of
atropine will cause a considerable amount of dryness. From
the same cause the secretion of the glands of the throat, nose
and respiratory passages is stopped, and as a result there are
produced hoarseness of the voice, thirst and difficulty of swal-
lowing. The skin likewise becomes dry from the paralysis of
the terminations of the nerves in the sudoriparous glands.
While atropine diminishes the secretion of milk by the same
process, it does not check its flow entirely, as the mammary
gland has been found to continue to secrete after all its nerves
have been severed. The solids of the milk are thought to be
augmented rather than diminished. Recent investigations have
shown that by its action in paralyzing the terminations of the
secretory fibres of the pneumogastric nerve in the stomach,,
atropine diminishes or may even entirely arrest the secretion
of gastric juice. The pancreatic secretion, although it is not
entirely dependent on nervous impulses, is similarly affected;
so that after atropine the increased secretion which ordinarily
BELLADONNA. 805
occurs upon the entrance of food or of acid into the intestine
does not take place, while stimulation of the pneumogastric,
which ordinarily increases it, has no effect. The bile is also
said to be diminished, and it would seem probable that the in-
testinal secretions are affected likewise. Some diminution in
the urine, as well as an alteration in the proportion between
its nitrogenous constituents, has been observed after atropine,
but it is unknown how far such results may be due to its action
on the kidney and how far to its effect on other organs. The
amount of the urinary flow, as is well known, is largely de-
pendent on the secretion of sweat. The flow of lymph is not
affected by atropine, and from this fact it is inferred that this
is not controlled by nerves in the same way as the true secre-
tions.
Sensory Nerves. — The effect of atropine when locally applied
in paralyzing the terminations of the sensory nerves has already
been mentioned. The same local anodyne action is not ob-
served from its internal administration, although some recent
investigators have claimed that the sensory terminations are
first stimulated and then paralyzed by the drug. It is said,
however, that the frog may be rendered less sensitive to cuta-
neous irritation if poisoned with atropine.
Involuntary Muscles and their Nerves. — The innervation of
all unstriped muscle seems to be depressed or paralyzed by
atropine. Hence the movements of the stomach, intestine,
bladder, uterus, spleen, bronchial muscle, thoracic duct, and of
the pupil and oesophagus (except in animals in which these
consist of striped muscle) are more or less diminished by it.
In the intestine not only is normal peristalsis lessened, but that
which is caused by direct nerve stimulation, as by electricity
or drugs such as muscarine and pilocarpine's promptly arrested
by atropine. Immediately after the injection of the atropine
there usually occurs an increase in the intestinal movements.
This might be cited as proof that it causes a preliminary stimu-
lation of the nerve terminations, but may also be explained by
the inhibitory endings being paralyzed earlier than the motor.
806 PHARMACOLOGY AND THERAPEUTICS.
Ordinarily the movements, although they become diminished,
are not finally arrested, since the intestinal muscle, like the other
involuntary muscles, is capable of maintaining a regular move-
ment independently of nervous impulses from without. It is
thus found that any irritating substance will cause peristalsis
after atropine, and that the action of purgative drugs is not in-
terfered with by it. It is a common practice to give belladonna
in association with purgatives for the purpose of preventing
griping, and the generally accepted explanation of this result is
that the local contractions of the intestinal wall which are sup-
posed to give rise to the griping are due to nervous influence,
and hence disappear under the action of the drug. Very large
quantities of atropine are said to paralyze the muscle of the in-
testinal wall, but this, it has been pointed out, could scarcely
occur except under special conditions, as paralysis of the res-
piratory centre would undoubtedly -precede it.
Voluntary Muscles and their Nerves. — Atropine has no direct
action on the voluntary muscles. In the frog the terminations
of the motor nerves are paralyzed by very large amounts, but it
is said that this result has not been elicited in mammals by
ordinary methods of experimental investigation.
The Eye and its Nerves. — Whether atropine be dropped into
the eye or given by the mouth, it has the effect of widely dilat-
ing the pupil. This is due to paralysis of the terminations of
the motor oculi nerve in the sphincter muscle. It is found that
the paralysis is limited to the periphery, and that the muscle
is not acted on is shown by the fact that it reacts to electrical
stimulation. The pupil dilates because the elastic fibres of the
iris have an opportunity to act. That the action is local is
shown by its remaining confined to the eye, and even to that
side of the eye to which atropine is directly applied, and also
by the fact that it can be produced on the excised eye of a frog
and even on the isolated iris. There is also a loss in the power
of accommodation, and this is caused by paralysis of the motor
oculi terminations in the ciliary muscle. In consequence of it,
near objects are no longer seen clearly. In addition, there is
BELLADONNA. 807
increase of intra-ocular tension, such as usually accompanies
dilatation of the pupil, and this is supposed to be probably due
to the dilatation. The dilatation is found to be not quite maxi-
mal, since it is generally increased, though but slightly, by
stimulation of the cervical sympathetic trunk. In birds and
reptiles atropine has no action on the iris, which in them con-
tains striped instead of unstriped muscle.
The Heart and its Nerves. — The inhibitory terminations of
the vagus in the heart are paralyzed by atropine. Consequently
the heart-beat is accelerated, and stimulation of the vagus does
not produce any change in it. In man the amount of accelera-
tion produced varies considerably with the age of the subject,
the vagus being most active in middle life. In the new-born
infant there is no quickening of the heart, but up to about 30
the acceleration increases with the age, and from this point on
lessens again. In its main action on the heart atropine is there-
fore directly antagonistic to muscarine, which has the effect of
stimulating the cardiac terminal filaments of the vagus. A
second effect on the heart is often said to be a slight stimula-
tion of the cardiac muscle by small doses, but there is reason
to believe that the drug really has no such action. Large
amounts undoubtedly weaken and depress the muscle, and may
cause arrest in diastole. Furthermore, atropine has some stimu-
lating influence on the cardiac centres in the medulla oblongata.
This action, however, is for the most part overshadowed by
the peripheral effects, though it may induce a preliminary slow-
ing of the pulse. The circulation always persists after the
cessation of respiration, and its failure is therefore not the
cause of death in atropine poisoning.
Vaso-motor System and its Nerves. — Atropine causes a con-
siderable rise in blood-pressure, an effect which is due in part
to the acceleration of the heart-beat, and largely also to stimu-
lation of the vaso-constrictor centre in the medulla oblongata,
since it is much less marked after division of the spinal cord.
This central stimulation has the effect of causing a contraction
of the abdominal arterioles, which is accompanied by a dila-
808 PHARMACOLOGY AND THERAPEUTICS.
tion of the arterioles of the skin and probably also, it is thought,
of the brain, from excitation of the vaso-dilator centre. Hence
there results a movement of blood from the abdomen towards
the periphery; but as the dilation of the cutaneous vessels can-
not altogether counteract the constriction of the abdominal
ones, a rise in blood-pressure is induced. The dilatation of the
surface vessels is most marked in the region of the head and
neck, where it causes a pronounced flushing of the skin. In
many instances there is observed a rash like that of scarlet
fever, and the hyperemia may be so intense as to lead to des-
quamation. That it is due to central action is shown by the
fact that it is prevented by section of the cervical sympathetic
trunk. The increased arterial tension is maintained for some
time after small doses, but large amounts soon bring about a
fall in the blood-pressure by this action on the muscle fibre of
the heart. Under toxic doses the pressure falls very low from
paralysis of the vaso-motor centre and arterial muscles, as
well as of the cardiac muscle. The spinal vaso-motor centres
are acted on in the same way as the medullary.
Respiration and its Nerves. — The respiration is often slow
at first, not, as was formerly supposed, from paralysis of the
sensory peripheral filaments of the vagus in the lungs, but from
some central action the precise nature of which has not as yet
been explained. Soon, however, in consequence of stimulation
of the respiratory centre in the medulla, the breathing becomes
quicker and also probably deeper, and the amount of air in-
spired per minute is found to be considerably increased. Under
large amounts of atropine the centre is rapidly depressed. The
respiration grows shallower and slower, and in fatal cases
death results from failure of this function. Not infrequently
the breathing is interrupted by convulsive movements, and in
many instances is then never resumed. Both the afferent and
efferent terminations of the vagus in the lungs are paralyzed
by atropine, and not only is the bronchial muscle relaxed, but
the secretions, which are diminished in quantity, are now less
BELLADONNA. 809
irritating in consequence of the depression of the afferent fila-
ments. In this way the drug has the effect of lessening cough.
Central Nervous System. — The action on the central nervous
system consists of a true stimulation, followed by depression,
and if the amount is sufficient, paralysis. While caffeine affects
chiefly the higher divisions of the central axis, and strychnine
the lower, the seat of the influence of atropine may be said in
a general way to be intermediate as regards these. In the case
of caffeine the highest functions of the cerebrum, the psychical,
are involved first of all, but atropine acts principally on the
motor divisions of the brain. It is likely to cause restlessness,
vertigo, garrulity, incoherence of speech, staggering gait, chore-
oid movements, uncontrollable laughter or weeping, a busy
delirium, and mania. In the subsequent paralytic stage, drow-
siness, coma, and finally convulsions may occur, the latter
largely from asphyxia. In the poisoning the medulla and spinal
cord are involved, but in the cord the action is very much
weaker than that of strychnine and appears much later. In the
frog much the same effects are found to be produced by atro-
pine as by the latter drug, because, the higher parts of the
central nervous system being less developed than in mammals,
the first symptoms observed are those arising from the cord.
Young animals can bear much larger quantities of atropine or
belladonna than older ones, and it has been suggested that the
explanation of this is because the brain is less highly developed
and the cerebral symptoms are therefore elicited less easily. It
is also a fact that in the human subject children are much less
susceptible to the influence of the drug than adults.
Temperature. — Atropine often causes a rise of temperature,
which may amount to 2° C. (40 F.) or more. This has been
attributed to a direct action on the cerebral heat centres, though
it cannot be said that proof of such action is positively estab-
lished, and seems to be independent of the blood-pressure and
the diminished respiration, as well as of the convulsions. While
the dissipation of heat is increased, probably because the flush-
8lO PHARMACOLOGY AND THERAPEUTICS.
ing of the skin leads to a greater loss by radiation, the heat
production is apparently increased to a still greater extent.
Elimination. — Atropine is excreted principally by the kidneys,
but also passes into the milk and into the fcetal circulation. In
herbivorous animals particularly it is excreted very rapidly in
the urine. They exhibit a much greater tolerance of the drug
than the carnivora or man, and this probably accounts largely
for the difference. Rabbits, it is found, may be fed for weeks
exclusively on belladonna leaves without presenting any symp-
toms of poisoning. Pigeons are also very insusceptible to the
action of the drug. The uric acid of the urine is said to be
diminished by it.
Therapeutics of Belladonna.
Externally. — Belladonna, and sometimes atropine, is used
locally to relieve pain of all kinds, to check sweating and the
secretion of milk, and to relax spasm, while atropine is em-
ployed to a considerable extent in ophthalmological practice.
For neuralgia, myalgia, lumbago, acute inflammations, and
chronic rheumatism and other painful affections of the joints
belladonna is often applied in the form of liniment, ointment
or plaster. It is also used in a great variety of combinations.
A very good one is Chloroformum Belladonnas (Brit. Pharm.
Conference), in which the root is extracted with ammonia and
chloroform, and it should be diluted with a little olive oil. An-
other is a preparation made by rubbing the extract of bella-
donna leaves, 4, with boiling water, 1, and then gradually
adding glycerin, 12. For severe local pain atropine is some-
times combined with aconitine or other alkaloids. To re-
lieve the pain of herpes zoster, and of irritable or malignant
ulcers, cocaine hydrochloride, .30 gm. (5 gr.) with belladonna
ointment, 30 gm. (1 oz.), may be of service. Belladonna is also
useful in painful haemorrhoids and fissure of the anus, to check
the suppurative process in furuncle, abscess and carbuncle, and
to promote the resolution of enlarged glands. The plaster is
an excellent application to relieve the chest-pains of phthisis
BELLADONNA. 511
or to allay irritability of an over-excited heart. For inter-
costal neuralgia or pleurodynia, strapping the chest with bella-
donna plaster is usually the most efficient way of applying the
drug. In the form of the plaster or ointment it is much used
as an antigalactagogue. A more elegant method is to envelop
the breast in lint wet with a solution of atropine in rose-water,
.24 gm. (4 gr.) to 30 c.c. (1 fl. oz.). The liniment, applied
several times a day, is of great service in restraining excessive
local sweating, and a lotion or ointment containing belladonna
may be successfully employed in pruritus, urticaria and chronic
eczema attended with much itching. In rigidity of the cervix
uteri in the first stage of labor an old practice is to smear the
os with extract of belladonna, but it is of very doubtful utility.
A suppository containing the extract, alone or in association
with opium, has been recommended in dysmenorrhea dependent
upon spasm of the cervix. It has been asserted that oleate of
atropine makes a suppository of much more uniform composi-
tion than when -extract of belladonna is employed. A solution
of atropine in chloroform or in equal parts of chloroform and
alcohol (.30 gm. ; 5 gr. of the alkaloid to 30 gm. ; 1 oz. of men-
struum), applied to the epigastrium on a piece of lint, will some-
times relieve obstinate vomiting, cerebral or reflex, such as that
of pregnancy, seasickness, etc. In ophthalmological practice
atropine is used to dilate the pupil and relax the accommoda-
tion in order to facilitate examination of the eye and determine
its refraction, and also to destroy adhesions and to prevent con-
traction of the iris or its protrusion through an ulcer of the cor-
nea. The solutions of atropine for such purposes, as well as for
hypodermatic injection, should be freshly prepared and steril-
ized each time, in order to avoid the development of penicillium
in the liquid. Atropine sulphate is the salt commonly selected
for dilating the pupil, and some such solution as the following
may be employed : Atropine sulphate, 4 ; boric acid, 5 ; in water to
480. Some oculists prefer atropine santonate, and some advo-
cate the use of atropine sulphate and duboisine sulphate, with
cocaine hydrobromide ; claiming that by this combination of al-
8l2 PHARMACOLOGY AND THERAPEUTICS.
kaloids the same effects may be obtained with smaller doses.
Atropine must not be used if the patient is suffering from glau-
coma. In certain individuals even perfectly neutral solutions
are very irritant, giving rise to what is known as atropine
conjunctivitis, and the alkaloid also acts as an irritant in some
cases of iritis, particularly those occurring in rheumatic pa-
tients with posterior adhesions. When belladonna is applied
in the ointment or other form to open surfaces, the pupils and
throat of the patient should always be carefully watched.
Atropine sulphate is employed locally to a limited extent in
diseases of the ear.
Internal. — Belladonna or atropine is given to check saliva-
tion from the use of mercury or other drugs and the excessive
ptyalism sometimes met with in children and pregnant women.
It is one of the best remedies known for the night-sweats of
phthisis, and for checking this and other objectionable forms
of sweating atropine sulphate (.006 gm. ; Tfa gr.) may be in-
jected hypodermatically, or .06 to .12 c.c. (1 or 2 "ni) of a solu-
tion of atropine sulphate in camphor water (1 to 100) given
by the mouth. For bromidrosis of the feet and other localized
sweatings also the drug may be used internally, as well as exter-
nally. It has been employed in serous diarrhoea on the ground
that it tends to check this by stimulating the splanchnic vaso-
motor filaments of the intestinal blood-vessels, the inactivity of
which permits a transudation of liquid into the bowel. It is
also given to overcome constipation and colic, and the ex-
tract of belladonna leaves is a frequent constituent of purga-
tive pills. In appendicitis or peritonitis this extract is some-
times administered in frequently repeated doses in a pill with
opium, for the purpose of paralyzing intestinal movements and
thus assisting the action of the latter drug. In intestinal ob-
struction the propriety of administering atropine has given rise
to much discussion. It is only in the paralytic or spastic forms
that internal treatment would seem to be useful, and in the for-
mer small doses of atropine and in the latter large ones may
be of service. In gastralgia, as well as the pain accompanying
BELLADONNA. 8 I 3
gastric ulcer, and in pyrosis, chronic gastric catarrh, and irri-
tative dyspepsia, atropine often affords marked relief, and in
cases of this kind it may usually be combined advantageously
with small doses of zinc sulphate. Administered with dilute
hydrochloric acid, it is useful in heart-burn, water-brash, etc.
It may also be of service in the vomiting of pregnancy and
other reflex varieties of vomiting when given by the mouth, as
well as when applied to the epigastrium. Sometimes it seems
to be more efficient if used in suppository. Sick-headache due
to or accompanied by spasm of the arterioles (as indicated by
pallor of the face, vertigo and tinnitus anrium), is frequently
relieved by belladonna. It is also of service in the headache
of young persons, often due to over-work, in which there is
pain in the eyeballs and forehead, with a sensation commonly
described as a feeling that the orbits are too small for the eye-
balls. This drug is a valuable remedy in many cardiac affec-
tions. Thus, as it accelerates the heart's pulsations without
diminishing their force, it may be employed whenever it is
desired to completely empty the ventricles. Its greatest service,
however, is in relieving cardiac pain and distress. Here it may
be applied over the precordial region, as mentioned, or given
internally, usually as the tincture of the leaves. It is also use-
ful in the treatment- of shock and collapse from injury or in
the course of disease, and in pneumonia particularly it should be
resorted to when after the crisis there is great relaxation of the
vascular system and heart stimulants are found to be ineffective.
Here the administration of atropine or belladonna will dry a
moist skin and by increasing the vaso-motor tone often pro-
duce marked improvement. In caseous pneumonia the drug, it
is claimed, has a distinctly curative effect. Given in full dose,
it will not infrequently abort colds in which the pharynx is hot
and dry and has a feeling of rawness, while the local capillaries
appear injected and red. It is also of much benefit in acute
coryza. In whooping-cough (where it should be given freely)
and other spasmodic affections of the respiratory passages it
has long been esteemed one of the most reliable remedies. For
8 14 PHARMACOLOGY AND THERAPEUTICS.
the symptom asthma it is of most service when combined with
opium, and it may be given both during the attacks and as a
prophylactic in the interval. Belladonna leaves rolled into
cigarettes or put into a pipe are often smoked by asthmatics,
but the most effective way of administering the drug here is
the hypodermatic injection of atropine. In bronchitis with a
tendency to paroxysmal spasm the tincture of the leaves is
frequently associated with other remedies. The following is
a very satisfactory mixture : Tincture of belladonna leaves, 3 ;
vinegar of squill, 5 ; syrup of tolu, 10; glycerin, to 60 parts. For
the nervous cough of both children and adults belladonna is an
excellent remedy. It is also useful in laryngismus stridulus
and in hiccough. Atropine has been used with good effect in
the aphonia caused by fatigue of the vocal cords and likewise
in hysterical aphonia. The utility of belladonna, when applied
to the breasts, for " drying up " the milk has already been men-
tioned. It is also of great service, employed both locally and
internally, in cases of mastitis, and even when the formation
of pus has already commenced it will often check the inflam-
matory process if used in sufficient amount. Belladonna is
probably the most efficient remedy we have for the nocturnal
enuresis of children, and is also valuable in urinary inconti-
nence in adults when this depends upon vesical spasm. It re-
lieves enuresis because it has an anodyne effect upon the cen-
tres in the cord, and, when excreted in the urine, anaesthetizes
the neck of the bladder. It is also sometimes useful in the
treatment of nocturnal seminal emissions. Its property of re-
laxing the spasm of involuntary muscle is well shown in the
relief which it affords in the acutely painful vesical spasm which
accompanies urinary calculus, cystitis and prostatitis. Here it
may be employed in the form of a suppository or applied to the
perineum in ointment or plaster, or it may be used both inter-
nally and externally. In urethral spasm and in chordee it may
be given internally, and the ointment may be smeared along the
under surface of the penis. By its action in relaxing spasm
belladonna will also often give relief in the colic resulting from
BELLADONNA. 8 I 5
the passage of hepatic and renal calculi. On account of the
similarity of the symptoms of atropinism with those of scarlet
fever, belladonna has been vaunted as a prophylactic against
this disease, but abundant experience has shown that the drug
is absolutely valueless in this regard. It may, however, prove
useful in relieving some of the symptoms of scarlatina, and is
thought to be indicated when during the stage of eruption the
pulse is feeble, the system much depressed, and the rash im-
perfectly developed. As ammonium carbonate is often pre-
scribed in this condition of affairs, it must not be forgotten that
these two remedies are chemically incompatible, and should not
therefore be used together. Belladonna appears to have a posi-
tive curative effect in erysipelas. It is of most service in the
idiopathic form of the disease, especially the facial variety, and
not so well suited to traumatic erysipelas. Clinical observa-
tions go to show that in typhoid and typhus fever it is some-
times indicated, and may prove very beneficial when there is
much low, muttering delirium, subsultus and stupor.
Although in the healthy individual this drug tends to induce
wakefulness and busy delirium, yet in certain morbid states of
the brain it appears to have a hypnotic action, and it is consid-
ered to be indicated in cases of mental disorder in which there
are found a low state of the blood-pressure, deficient intra-
cranial circulation, and a contracted pupil, with prostration and
insomnia. Thus, a hypodermatic injection of atropine may
overcome the insomnia of delirium tremens in cases where there
are coma — vigil, great restlessness, and feeble heart-action, with
coldness of the surface, blue skin, and a clammy sweat. Bella-
donna was formerly employed to a considerable extent in epi-
lepsy, but its use in that disease has now been almost entirely
abandoned, though it is still claimed by some that while in gen-
eral it is vastly inferior in efficacy to the bromides, yet good
results may sometimes be obtained from it in nocturnal epilepsy
and petit mal, and in the case of pale, delicate and anaemic sub-
jects, with cold extremities, cyanosis, and weak heart. The sub-
cutaneous use of atropine in neuralgia is of recognized value. It
8l6 PHARMACOLOGY AND THERAPEUTICS.
has been found particularly efficient in tic douloureux and sciat-
ica, and to secure the best results it is advised that deep injec-
tions of the largest doses compatible with the safety of the
patient should be made in the vicinity of the affected nerve-
trunk. Atropine is also very highly recommended in peri-
uterine and dysmenorrhoeal neuralgia. In traumatic neuralgias
it is practically worthless. In the treatment of neuralgia in
general it is inferior to morphine, while its systemic effects are
usually much more disagreeable than those of the latter. It
should be resorted to more particularly in the case of patients
who show an idiosyncrasy against morphine.
TOXICOLOGY.
Symptoms. — The most characteristic early symptoms of belladonna
poisoning are dryness of the mouth and throat, dysphagia, and dilatation
of the pupil, with dimness of vision. The skin is dry and the scarlati-
nous rash may or may not be present. The conjunctivae are injected
and the face is flushed, while the pulse is very markedly quickened and
the temperature more or less elevated. There is often nausea, and
sometimes vomiting. There may be purging, but this is not ordinarily
observed. Frequently the urine is voided at an early period, and after
that there is a constant desire to micturate without the ability to do
so. It has been suggested that the preliminary contraction of the
bladder is analogous to that of the intestine, and the subsequent inability
to empty it to the diminution of the peristalsis. The patient staggers
like a drunken man when he attempts to walk, and excitement passing
into delirium is a prominent feature. The cerebral symptoms have al-
ready been sufficiently detailed. Convulsions are rare. The respiratory
movements, which at first are slow and full, become quicker and
shallower, from the depression of the medullary centre. The breathing
grows dyspnoeic in character, and death at length takes place from
respiratory failure. A fatal ending, however, is comparatively infre-
quent. If the patient should survive, it sometimes happens that he has
no recollection of his illness. Post-mortem. There is nothing character-
istic about the appearances, which are simply those met with in
asphyxia from any cause, the result of venous engorgement of the
various internal organs.
Treatment. — Quite commonly the prognosis is favorable, as there is
usually ample time for a successful treatment. The stomach should
HOMATROPINE HYDROBROMIDE. 817
be washed out or evacuated with emetics (see p. 175). The general
symptoms are best treated by the hypodermatic injection of pilocarpine
and the delirium by the application of an ice-cap to the head. Chloro-
form or ether may be used to control spasms. In the stage of depression
stimulants should be given subcutaneously and strong coffee by the
rectum. Warmth must be applied to the surface and extremities, and
artificial respiration may be called for. The effects on the eye may be
counteracted by the local application of physostigmine, as well as by
pilocarpine.
ANTAGONISM.
The antagonism between atropine and morphine is discussed on page
864. Morphine might, on theoretical grounds, be administered in the
early stages of atropine poisoning, but its action on the respiratory
centre renders its use dangerous in severe cases, for the stimulation
caused by atropine soon passes into depression, and the effects of the
two drugs would therefore supplement each other. As a sialogogue,
diaphoretic and myotic, pilocarpine completely antagonizes the action of
atropine on the secretory nerve endings in the salivary and sudoriparous
glands and the terminal filaments of the motor oculi nerve in the iris
and ciliary muscle. Contraction of the pupil and spasm of the ciliary
muscle are also induced by physostigmine, which in like manner stimu-
lates the motor oculi terminations, and it is furthermore antagonistic to
atropine in that it at once has a depressant action on the respiratory
centre.
HOMATROPINE HYDROBROMIDUM.— Homatropine Hydro-
bromide. Dose, 0.0005 gm. (0.5 milligm.) ; Tlj gr.
Action of Homatropine Hydrobromide.
Its action appears to be much the same as that of atropine,
but it is less poisonous and its mydriatic effects, while more
rapidly produced, are somewhat less complete. It also has the
effect of slowing, instead of accelerating, the action of the
heart.
Therapeutics of Homatropine Hydrobromide.
It is largely employed for the purpose of dilating the pupil
in ophthalmic practice, and it has the advantage over atropine
that the mydriasis passes off in about one-quarter of the time.
It is therefore better adapted for diagnostic purposes, while
53
8l8 PHARMACOLOGY AND THERAPEUTICS.
atropine is preferable when it is desired to keep the pupil dilated
for some time, as in the treatment of iritis. It may be used in
solution, i to 120 of distilled water. Sometimes a solution in
castor oil is employed, as being less liable to be washed out by
the tears, but this may produce some irritation.
Unofficial Preparation.
Duboisinae Sulphas. — Duboisine Sulphate.
Action of Duboisine.
The action of duboisine is practically the same as that of
atropine.
Therapeutics of Duboisine.
It is principally employed in ophthalmic practice, and its
advantages over atropine are its more rapid action, the shorter
duration of its mydriatic effects, and the slight degree of con-
junctival irritation produced by it. Discs containing .000013
gm. (-g-oVoS1*-) are used to dilate the pupil. It has been given
with alleged good results in puerperal mania, the mental excita-
bility of the insane, paralysis agitans, and the morphine habit.
It has also been used in place of atropine in the night-sweats
of phthisis, respiratory neuroses, cardiac failure, and other
conditions.
STRAMONIUM.
STRAMONIUM (Stramonii Folia, U. S. P., 1890).— Stramonium.
(Thorn Apple. Jamestown Weed.) Dose, 0.065 gm. (65 milligm.) ;
1 gr.
Preparations.
1. Fluidextractum Stramonii (Extractum Stramonii Seminis,
U. S. P., 1890). — Fluidextract of Stramonium. Dose, 0.05 C.C.;
im.
2. Extractum Stramonii. — Extract of Stramonium. Dose,
0.010 gm. (10 milligm.) ; i gr.
3. Tinctura Stramonii. — Tincture of Stramonium. Dose, 0.5
c.c; 8 TTL.
4. Unguentum Stramonii. — Stramonium Ointment.
STRAMONIUM. 819
Unofficial Preparation.
Stramonii Semen (U. S. P., 1890). — Stramonium Seed. Dose,
0.05 to 0.15 gm.; 1 to 3 gr.
Action of Stramonium.
The physiological action of stramonium is practically the
same as that of belladonna, though it is asserted that in poison-
ing by it irregularity of the heart's action is more marked. It
also appears to relax the bronchial muscle more completely than
belladonna. It is generally regarded as more toxic than the
latter, and accidental poisoning by it, especially among children,
is quite common.
Therapeutics of Stramonium.
Stramonium might, apparently, be employed for all the vari-
ous purposes of belladonna, but it is not very often used except
to relieve the spasm of the bronchial tubes in cases where this
produces the symptom asthma. Here it is of very great value.
It may be given internally, but most commonly the fumes from
the burning leaves are inhaled from cigarettes or otherwise,
and the drug is more beneficial when used in this way. The
following powder, when burned, is often very efficient in giving
relief: Powdered leaves of Datura Stramonium, Datura Tatula
(not official), Cannabis Indica, and Lobelia Inflata, of each, 12;
nitre in powder, 16; oil of eucalyptus, I. Mix thoroughly.
Himrod's, Bliss's and other " cures " for asthma are of similar
composition. Stramonium leaves are sometimes applied locally
in poultices or fomentations for their anodyne effect, and the
ointment is more or less used for irritable or malignant ulcers,
haemorrhoids, fissures and other painful affections, especially
around the anus.
HYOSCYAMTJS.
HYOSCYAMUS.— Hyoscyamus. (Henbane.) Dose, 0.500 gm. (500
milligm.) ; 7y2 gr.
Preparations.
1. Extractum Hyoscyami. — Extract of Hyoscyamus. Dose,
0.065 gm. (65 milligm.); 1 gr.
820 PHARMACOLOGY AND THERAPEUTICS.
2. Fluidextr actum Hyoscyami. — Fluidextract of Hyoscyamus.
Dose 0.2 c.c.; 3 IT]..
3. Tinctura Hyoscyami. — Tincture of Hyoscyamus. Dose,
1 c.c; 15 m_.
HYOSCINE HYDROBROMIDUM. — Hyoscine Hydrobromide.
Dose, 0.0005 gm. (0.5 milligm.) ; ^gr.
HYOSCYAMINE SULPHAS. — Hyoscyamine Sulphate. Dose,
0.0005 gm. (0.5 milligm.) ; T^ gr.
HYOSCYAMINE HYDROBROMIDUM.— Hyoscyaminse Hydro-
bromidum. Hyoscyamine Hydrobromide. Dose, 0.0005 gm. (0.5
milligm.) ; T|¥ gr.
SCOPOLAMINE HYDROBROMIDUM. — Scopolamine Hydro-
bromide. Dose, 0.0005 gm. (0.5 milligm.) ;T|¥ gr.
Action of Hyoscyamus.
As may be inferred from the alkaloidal composition of the
drug, the action of hyoscyamus is very similar to that of bella-
donna and stramonium. There are some particulars, however,
in which it differs, though the difference is really one of degree
rather than of kind. Thus, under atropine the primary stimu-
lation of the central nervous system is usually very marked,
while with hyoscyamus (an effect due to the influence of both
its alkaloids) the stage of stimulation is much shorter, or may
apparently be entirely absent. By its depressant action it may
therefore produce drowsiness and sleep without any preliminary
exaltation. Both hyoscyamine and hyoscine, as a rule, are
powerful hypnotics, and the sleep caused by them very closely
resembles natural sleep. It is to be noted, however, that in
some instances this is preceded by a stage of excitement, with
confusion and garrulous delirium, as in the case of atropine,
while occasionally the hypnotic effect is almost or altogether
absent. In fact, they may have the opposite effect and cause
insomnia. Hyoscine is even more depressant to the brain than
hyoscyamine, and very small amounts are usually sufficient to
induce sleep. As a rule, no confusion is complained of on
awaking, but dryness of the throat and thirst are said to be
HYOSCYAMUS. 821
often present. As regards the peripheral action, while induc-
ing the same effects, it is believed that hyoscyamine acts some-
what more powerfully on the heart, intestine, pupil and sweat-
glands than atropine, while hyoscine appears to have a still
stronger action on the peripheral nerve terminations than hyos-
cyamine, and in man produces no distinct quickening of the
pulse. Hyoscine is generally said to produce mydriasis and
loss of accommodation more quickly than atropine, but for a
shorter period, and according to some observers it acts five
times more strongly on the pupil than that alkaloid. Scopola-
mine is chemically identical with hyoscine.
Therapeutics of Hyoscyamus.
The preparations of hyoscyamus are weaker than the corre-
sponding ones of belladonna, and accordingly must be used in
larger doses. In general, the drug might be employed to ful-
fill any of the indications for which belladonna is used, but in
practice it is almost exclusively given for two special purposes.
As the peripheral action of its alkaloids is more powerful than
that of atropine, it has more effect in preventing local con-
tractions of the intestine depending upon nervous stimulation,
and thus obviating griping, and hence it is very largely given
with purgatives on this account. In the same way, it has a
more marked sedative action on the urinary unstriped muscle
than belladonna, and accordingly it is also much used to relieve
vesical spasm in the same class of affections in which, as we
have seen, belladonna is of service. It is very commonly pre-
scribed with other urinary sedatives, such as buchu, uva ursi,
or benzoic acid if the urine be alkaline.
Hyoscyamine and hyoscine (scopolamine) are very power-
ful alkaloids and should always be administered with great
caution, especially as the activity of different specimens varies.
Hyoscine is the less dangerous of the two. Both are used as
hypnotics to a considerable extent, and especially in hospitals
for the insane. They often act very satisfactorily in cases of
mania, delirium tremens, hysteria, etc., and may also be given
822 PHARMACOLOGY AND THERAPEUTICS.
for the delirium of fevers and for severe insomnia. Hyoscine
is the one more commonly used; it is generally given by hypo-
dermatic injection and is often combined with morphine. Some
patients, it is found, are not quieted by the drug, but pace up
and down in a semi-insane condition till its action has worn
off. It is considered of great value in spermatorrhoea and sem-
inal emissions. A certain degree of tolerance is produced by
it, - so that it is necessary to increase the dose from time to
time in any case where its use is continued for some time.
These alkaloids have been employed in chorea, paralysis agi-
tans, locomotor ataxia, and a variety of other nervous affec-
tions, but apparently without permanent benefit. Hyoscyamine
often temporarily controls very efficiently the tremor of paraly-
sis agitans, and it is at times very useful in the treatment of
the morphine habit, though it should not be given habitually in
these cases. It is used to some extent in ophthalmic practice.
SCOPOLA.
SCOPOLA.— Scopola. Dose, 0.045 gm. (45 milligm.) ; % gr.
Preparations.
i. Extractum Scopolae. — Extract of Scopola. Dose, 0.010 gm.
(10 milligm.) ; * gr.
2. Fluidextractum Scopolae. — Fluidextract of Scopola. Dose,
0.05 c.c; 1 n\.
SCOPOLAMINE HYDROBROMIDUM. — Scopolamine Hydro-
bromide. Dose, 0.0005 gm. (0.5 milligm.) ; T^ f gr.
Action of Scopola.
Scopola is a mydriatic, analgesic and hypnotic. Its action
appears to be identical with that of belladonna in kind, though
differing somewhat in degree. Thus, scopola is to some extent
more depressant to the spinal cord and is decidedly more toxic.
Like belladonna, it has been found to raise the blood-pressure,
paralyze the vagus terminations, and primarily stimulate the
respiratory centre, while in lethal amounts it causes death by
SCOPOLA. 823
asphyxia. In the frog it is stated to be a paralyzant to the
spinal cord and to Setschenow's centre, and, when brought in
direct contact with a motor nerve, to lessen its function. From
the fact that, as mentioned, scopola is slightly more depressant
to the cord and is also considerably more toxic than belladonna,
it is believed that the dominant alkaloids of the two drugs are
probably not identical. As regards effects upon the eye, sco-
pola acts much more promptly, but for a shorter time, in dilat-
ing the pupil and slightly increasing the tension of the globe,
while the systemic effects are more pronounced than from bella-
donna. The general conclusions which have been derived from
a series of recent researches by a number of different investi-
gators are as follows: While scopola is more depressing and
toxic than belladonna, yet when administered externally it
shows almost no tendency toward absorption to the extent of
producing systemic effects. When it is absorbed, however, it
acts locally with promptness and energy. As regards the eye, it
effects are more rapid and less prolonged. In all the other ways
experimented with it acts more efficiently, with the exception of
the matter of plasters, where it is slightly less efficient than
belladonna. Scopola exhibits a distinct superiority over bella-
donna root in its greater uniformity of alkaloidal percentages.
The predominating alkaloid of scopola is hyoscyamine in an
almost pure condition.
Therapeutics of Scopola.
Scopola has been employed for a number of the same pur-
poses as belladonna. It is to be noted, however, that while
belladonna is active, scopola is nearly inert, when used by in-
unction either in the form of the pure fluidextract or in lini-
ment. It is apparently more efficient than belladonna when
used as a solid extract to dry the milk in breasts after wean-
ing. It is advised that the drug should not be given when renal
disease is present, nor in advanced age. Scopolamine hydro-
chloride is employed, in solutions of from TL to J per cent, in
824 PHARMACOLOGY AND THERAPEUTICS.
eye practice and by hypodermatic injection in hospitals for the
insane.
ALCOHOL.
i. ALCOHOL.— Alcohol. (Ethylic Alcohol. Spirit of Wine.)
Preparation.
Alcohol Dilutum. — Diluted Alcohol. (Proof Spirit.)
2. ALCOHOL ABSOLUTUM.— Absolute Alcohol.
3. SPIRITUS VINI GALLICL— Brandy.
4. SPIRITUS FRUMENTL— Whiskey.
5. VINUM ALBUM.— White Wine.
6. VINUM RUBRUM.— Red Wine.
Unofficial Preparation.
Alcohol Deodoratum (U. S. P., 1890). — Deodorized Alcohol.
Action of Alcohol.
External. — Alcohol is antiseptic and disinfectant, but it has
comparatively little bactericidal action at the temperature of
the body. 50 to 70 per cent, alcohol is said to be more destruc-
tive to germs than either stronger or weaker solutions. Curi-
ously enough, it has been pointed out that many substances
which are antiseptic when dissolved in water lose much of this
property when dissolved in alcohol, and it seems to be an estab-
lished fact that the presence of alcoholism, whether acute or
chronic, actually predisposes to bacterial infection. This is a
matter of common observation in the human subject, and has
been demonstrated repeatedly in experiments on animals, whose
power of resistance is diminished by alcoholization. Alcohol
is both refrigerant and rubefacient, and is also astringent, an-
hydrotic and slightly anaesthetic. Applied to the skin, it quickly
evaporates ; thereby cooling the surface, with the effect of tem-
porarily constricting the superficial vessels and checking the
secretion of the sweat-glands. If, however, evaporation is pre-
vented, as by covering the spot with a watch-glass or piece of
ALCOHOL. 825
rubber, or by rubbing the application in, the alcohol (which has
the property of extracting water from all tissues) promptly
absorbs moisture from the skin, and thus has the effect of hard-
ening it. Having passed through the epidermis, it exerts an
irritant action, similar to that of the volatile oils, which pro-
duces a dilatation of the vessels and redness, itching and a sen-
sation of heat in the part. It also causes a temporary pre-
cipitation of albumins. Upon ulcers and abraded surfaces the
irritant action is much more marked. The albumin is coagu-
lated and there is first an astringent and afterwards a corrosive
effect, until the alcohol becomes diluted by the fluids of the
wound.
Internal. Mouth. — Upon the mucous membrane of the mouth
and pharynx concentrated solutions cause effects similar to
those on the skin when evaporation is prevented, but there is
more of a burning sensation produced, and at once also there
results, from reflex action, an increased flow of saliva and pos-
sibly a quickening of the pulse. Then follows a slight local
anaesthesia, and if the alcohol is held in the mouth for some
time, the mucous membrane becomes whitish and opaque, from
coagulation of albumin and abstraction of water from the tis-
sues. This soon disappears, as resolution of the albumin
occurs.
G astro -intestinal Tract. — In the stomach also a burning sen-
sation is produced by concentrated solutions, and large quanti-
ties give rise to so much local irritation that nausea and vomit-
ing are caused. In animals it has been demonstrated that alco-
hol, when given in moderate amount, induces, by its irritant
action on the walls of the stomach, an increased cell activity,
a more active circulation, and a more rapid secretion of both
acid and solids of the gastric juice; also that gastric peristalsis
is augmented and the absorption of fluids from the stomach and
intestine much accelerated. In man the same effects have been
observed in cases of gastric fistula, and it has generally been
found by experimenters that the digestion is promoted. In
some instances, however, in which observations on the dura-
826 PHARMACOLOGY AND THERAPEUTICS.
tion of gastric digestion with and without alcohol were made,
it was found that the process was retarded, instead of being
accelerated, by this agent. To explain this discrepancy it has
been suggested that the effect must vary in different individ-
uals, and that it is not unlikely that the taste has some influence
on the result; so that in those who enjoy the taste of alcohol
it induces a more rapid secretion and an improved digestion,
while in those to whom it is disagreeable, the secretion is in-
hibited. In general, it may be said that alcohol in moderate
amounts tends to favor the process of digestion through an
increased secretion of gastric juice, increased gastric move-
ment, and increased absorption. With a percentage above 15,
these are found to be counteracted by the lessened ferment
action; so that the actual result will depend upon which of
these two — the beneficial irritant or the deleterious anti-ferment
action — predominates. Small amounts of weak alcohol taken
at meals, it would seem, therefore, can scarcely have a bad
effect upon digestion, and may be of service in promoting it.
The primary effect of the irritation of the gastric mucous mem-
brane is to sharpen the appetite, and this explains the quite
common custom of taking a little alcohol just before meals.
Furthermore, the local anaesthetic effect of alcohol may at
times prove useful in relieving gastric pain. Alcohol is unique
in one respect, no other known substance, it is said, having this
effect: it causes the gastric glands to secrete when it is intro-
duced into the small intestine or even into the rectum. It would
seem, therefore, that it may act generally throughout the whole
intestinal canal, to stimulate the flow of the gastric juice. In
addition, alcohol by promoting the latter, indirectly promotes
the pancreatic secretion also, since it has been shown that the
chief stimulus to the flow of pancreatic juice is the action of
the hydrochloric acid of the gastric juice upon the wall of the
duodenum. The injection of a single dose of alcohol in concen-
trated form, as pure brandy, is immediately followed by pro-
nounced reflex effects. Thus, the action of the heart is accel-
erated and increased in force, the blood-vessels generally, and
ALCOHOL. 827
particularly those of the skin, become dilated, giving rise to a
feeling of warmth throughout the body, and the blood-pressure
rises. The respiration is also quickened. These reflex effects,
which are not produced by dilute forms of alcohol, such as
beer, are well shown in the immediate restoration of a faint-
ing person by a dose of brandy. They are quickly followed by
the action on the circulation of the alcohol after its absorption
into the blood. The repeated use of large amounts of alcohol
leads to persistent congestion of the mucous membrane, and, if
long continued, to chronic gastritis. The activity of the gas-
tric juice is soon impaired and afterwards lost, the gastric
glands atrophy, an excessive amount of mucus is secreted, and
the permanent dyspepsia of drunkards results. In the intes-
tines alcohol ordinarily has a slightly astringent effect. In
drunkards, however, there usually results a catarrhal enteritis,
as well as gastritis.
Metabolism. — About 90 per cent, of the alcohol absorbed from
the alimentary tract is found to undergo combustion. In doing
so it gives up energy to the body, and is therefore to be con-
sidered as a food, though the mere fact of its transmission of
energy does not constitute it an advisable food in all conditions.
Alcohol ceases to be a food when it is ingested in such large
amounts that it cannot be completely oxidized. In this in-
stance the excess is likely to be harmful. Taken in addition
to the ordinary food, alcohol is either itself transformed into
tissue, or undergoes oxidation in the place of some substance
which in turn is utilized to build up the body. It has been
shown that alcoholized animals lay on more fat than others
receiving the same food without alcohol, and it is a familiar
fact that in the human subject habitual drinkers evince a
marked tendency to obesity. It is evident, therefore, that to
some extent, at least, alcohol acts as a substitute for fats and
carbohydrates in the food. While, however, it is well known
that these principles can without any injurious effect be sub-
stituted for a certain amount of the nitrogenous food required
by the system, it is as yet an undetermined question how far al-
828 PHARMACOLOGY AND THERAPEUTICS.
cohol, although undergoing combustion in the tissues and leading
to the deposition of fat, is able to replace the fats and .carbo-
hydrates in their relation to nitrogenous metabolism. As far
as can be judged, it would seem that while alcohol really tends
to prevent the waste of fats and carbohydrates, it is probably
of less value than the latter in economizing nitrogenous waste;
so that if alcohol is used as a food it should be associated with
a diet rich in albuminous matter. Under these circumstances it
is believed to be capable of replacing to some extent the ordinary
food-stuffs. The only way in which alcohol, in moderate
amounts, is supposed to have any action on the tissues is as a
food, since the oxidation of the tissues, as measured by the
absorption of oxygen and exhalation of carbon dioxide, is af-
fected only in the same way as by any other food. When
excessive quantities of alcohol are taken, the combustion of the
tissues is first greatly augmented by the violent movements
characterizing the stage of excitement, but later it becomes
reduced from the lessening of the rri'uscular movements in con-
sequence of the stupor and depression induced. Naturally, fats
are saved from combustion by the oxidation of alcohol by the
tissues, and it is thought possible that in the case of some other
bodies also, as benzene, the energy which would ordinarily be
expended in their oxidation, is diverted to that of the alcohol.
The observations on the effect of alcohol in moderate doses on
nutrition have led to the following conclusions : ( I ) With a
diet on which the individual gains in weight, the addition of
alcohol lowers the rate of increase; (2) when added to a diet
on which the weight remained constant, it tends to cause a loss
of weight; (3) with insufficient diet, it lessens the loss of
weight, or may even cause a gain.
Blood and Circulation. — On the leucocytes of the blood it
has the effect of first augmenting and then reducing the amoe-
boid movements; while as regards the red corpuscles it inter-
feres with the ready yielding up of its oxygen by the oxyhemo-
globin, and thus tends to retard oxidation in the tissues. The
reflex effects of alcohol on the circulation have been referred
ALCOHOL. 829
to in connection with its influence on the alimentary tract. Its
action on the circulation after absorption has been the subject
of much controversy. There is always a quickening of the
heart during the excitement of alcoholic intoxication, but there
is reason to believe that this is due to the increased muscular
movement, rather than to any direct action on the heart. It
has been shown that in normal cases the pulse-rate is unaf-
fected by alcohol, provided that no excitement be produced by
the environment, and this also remains unaltered in animals,
unless a very large amount of alcohol is administered. In that
case there are induced weakening of the auricular systole and
afterwards of the ventricular, with distention of both cavities
and slowing. It has been pointed out that these effects are
similar to those caused by ether and chloroform, though the
influence on the heart is very much less marked than in the
case of these drugs. Whatever action alcohol has as regards
the heart appears to be on the cardiac muscle. While it has
been claimed that it increases the force of the contraction,
proof, of this is lacking, and, on the contrary, experiments on
animals have indicated that the first effect of alcohol on the
heart is diminished efficiency and weakness of the contractions.
In alcoholic intoxication one of the most noticeable features
relating to the circulation is the flushing of the cutaneous sur-
face. This can be attributed only to dilatation of the vessels
of the skin, but it is undetermined whether such dilatation is
the result of stimulation of the dilator centres or paresis of the
vaso-constrictors. This action apparently has very little effect
on the general blood-pressure. A marked fall in this is caused
by very large amounts of alcohol, which weaken the muscular
tissue of the heart and depress the vaso-constrictor centres ; but
no such effect is to be expected from medicinal doses. In fever
the heart is frequently slowed by the administration of alcohol,
and the results of study of its influence on the circulation would
seem to indicate that this is due to its effect in diminishing
cerebral excitement, rather than to any direct action on the
heart. In shock, whatever improvement in the circulation may
83O PHARMACOLOGY AND THERAPEUTICS.
follow the use of alcohol is to be attributed to the reflex influ-
ence from its local irritant action which has already been men-
tioned. It would appear that the reputation which alcohol has
long enjoyed as a cardiac stimulant is not altogether supported
by fact; but, at the same time, there can be no question that it
is often of value in circulatory disorders for this reason, if for
no other, that by its cerebral action it tends to lessen anxiety
and other mental symptoms.
Respiration. — While experimenters now agree as to the main
facts in the action of alcohol on the respiratory function, the
interpretation of these is still a matter of dispute. During the
excitement of alcoholic intoxication the respiration is usually
quickened, and this may be due simply to the increased mus-
cular activity rather than to a stimulation of the respiratory
centre in the medulla. Such excitement is not induced by
therapeutic doses, but the evidence at command goes to show
that without this the amount of air inhaled is generally in-
creased by alcohol, and such increase has even been noted in
some cases where a well-marked narcotic effect was present.
At present it is impossible to say whether the augmentation of
the air inhaled is due to direct action on the respiratory centre
or to reflexes arising from the stomach, to both of which agen-
cies it has been attributed by different observers. This is a
question of practical importance in cases in which the respira-
tion is insufficient, and not one of merely theoretical interest;
for, it has been pointed out, if the augmented respiration is
caused only by the local action in the stomach, this indicates
that much of the surplus oxygen is used in doing the work of
absorbing the alcohol, and that the rest of the body profits to
a correspondingly small extent from the increased aeration.
On the other hand, if the air inspired is augmented in a greater
ratio than the products of the increased activity of the alimen-
tary tract, as is the case when the respiratory centre is directly
stimulated, the advantage to the organism is correspondingly
great. On the whole, it would seem that while the use of
alcohol as a respiratory stimulant is not actually supported by
ALCOHOL. 83I
experimental investigation, it is nevertheless not to be entirely
condemned.
Nervous System. — Alcohol is very generally regarded as a
central nervous stimulant, which first excites and then depresses
the cerebral and other cells. It should be stated, however, that
the majority of experimental observers lean to the view that
the stimulation is apparent rather than real. Their explana-
tion of the cerebral excitement caused by alcohol is that it is
due, not to the augmented vitality of the nerve cells, but to a
loss of the associations which ordinarily retard the expression
of mental activity. Their argument against the stimulant ac-
tion of alcohol is based on the narrow limits to which this is
confined. While it is true that all the central nervous stimu-
lants act on some particular part, in small doses, it is found
that when larger amounts are employed, the stimulant action
spreads over a wider area of the central nervous system and
gives rise to the symptoms characteristic of stimulation of that
area. Alcohol, they claim, appears to have only a depressant
action on the nervous tissues, except in the human cerebrum;
though it is true that the exceptional development of the human
brain might permit of a departure which is without analogy
with other forms of poisoning. The conclusion arrived at by
them is that the investigations thus far made point strongly to
the correctness of the theory that alcohol really acts as a nar-
cotic. The acceptation of this theory, they hold, is by no means
equivalent to condemning the therapeutic use of alcohol for its
effects on the brain, but, on the contrary, it is maintained that
the narcotic or depressant action of alcohol, far from being in
conflict with its clinical use, supplies a definite and logical ex-
planation of the improvement noted in a large number of in-
stances where the effect of alcohol in allaying the subjective
symptoms, relieving the nervous strain, and promoting the rest
and comfort of the patient is not surpassed by that of any other
drug. Accordingly, it would seem a question whether the re-
sults aimed at by the clinician when he prescribes alcohol have
not been misnamed stimulation, and are not in reality narcotic
832 PHARMACOLOGY AND THERAPEUTICS.
in their nature, and hence in entire agreement with the experi-
mental results. The clinician, it is suggested, in applying the
term stimulant to alcohol, uses the word in quite a different
sense from that in which it is understood by the experimental
observer — his meaning is less definite, and he wishes to indi-
cate only the improvement often noted in the general condi-
tion, without considering whether this is due to an augmenta-
tion or a retardation of the mental processes. The view gen-
erally accepted in the medical profession is that alcohol is a
powerful nervous as well as cardiac stimulant, and that the
increased functional activity which it induces, especially in the
nervous system, is followed by a period of diminished activity
or depression ; furthermore, that alcohol, like many other drugs,
acts on the higher functions first, so that the stimulation and
the subsequent depression proceed in a descending scale from
the highest or least firmly fixed function to the lowest or most
firmly fixed, in accordance with the Law of Dissolution (see
p. 737). In the highest centres the special effect produced by
alcohol appears to depend on the nature of their activity in the
individual. In many individuals moderate amounts increase
the facility of speech and in exceptional instances the brilliancy
of thought. It must be acknowledged, however, that some of
the highest functions of the brain are thrown out of action by
doses of the drug which induce the. phase of exhilaration.
Thus, while a person may show greater brilliancy in conversa-
tion and generosity of sentiment, he is apt to lack that con-
sideration for his own position or that of others which he ordi-
narily manifests, and to lose his self-control and self-restraint,
his sense of responsibility and his power of discrimination.
Such results would be explained, according to the stimulant
theory, by the brief period during which the activity of the
highest centres is augmented; so that the power of judgment
becomes abolished very early, while the imagination, the emo-
tions, and the power of speech are still in increased activity.
These various functions then successively fail in the order
named, and after them the muscular movements, commencing
ALCOHOL. 833
with the more delicate, become first incoordinated and then
paralyzed. If the quantity of alcohol taken is sufficiently large,
the reflex activity of the spinal cord next becomes abolished,
and the bladder and bowels are evacuated involuntarily. The
comparative immunity from injuries in falling, etc., which is
often noted in drunken people, is believed to be due to the
depression of the reflex centres of the cord, since the heart
and respiration, on account of the general central depression,
are not affected reflexly by them. After the spinal centres, the
respiratory centre in the medulla fails, and finally the heart
may be paralyzed and death result. A fatal issue of the poison-
ing, however, is exceptional, and generally recovery takes place
after a prolonged sleep. This is deep and torpid, passing into
total unconsciousness, with slow and stertorous breathing, while
the face, which has hitherto been flushed, grows pale or cyan-
otic. If unconsciousness continues for more than ten or twelve
hours, it is said that a fatal result is almost certain to occur.
It has been conclusively shown that regiments supplied with
alcoholic liquors are less capable of long marches and suffer
more from fatigue than others without them, and, in addition,
that the capacity for forms of work in which more mental
activity is required than by marching soldiers is lessened by
alcohol. Thus, when even a small quantity of alcohol is al-
lowed, typesetters do a less amount of work and make a larger
number of errors than when they are not supplied with it,
while students exhibit a diminished capacity for mental work
and less ability to keep the attention concentrated. The ten-
dency toward sexual excess frequently observed after alcohol
is not due to any influence upon the generative organs them-
selves, but to the loss of control from the cerebral action of
the drug.
Temperature. — Small doses of alcohol have no effect on the
body-temperature, although, in consequence of the dilatation of
the gastric and cutaneous blood-vessels induced, they cause a
sense of warmth both internally and on the surface. Moderate
amounts (30 to 90 c,cr ; 1 to 3 fl. oz.) cause a fall of .5° C,
54
834 PHARMACOLOGY AND THERAPEUTICS.
and this without causing intoxication. The reduction of tem-
perature is believed to be due chiefly to a loss of heat from
the dilatation of the cutaneous vessels. This is usually accom-
panied by a feeling of warmth, and a thermometer applied to the
skin may actually show a rise of several degrees, in consequence
of more warm blood flowing through the vessels. If much
excitement and movement are caused by the drug, the increased
heat resulting may counterbalance the augmented output; so
that there may be no fall in the temperature, and in some cases
even an elevation may be observed. Narcotic doses generally
cause a fall amounting to from 30 to 50 C, which is due to the
lessened movements during unconsciousness and may last for
a considerable time. During exposure to cold a more marked
reduction of temperature than under ordinary conditions ap-
pears to be caused by alcohol, in consequence, perhaps, of its
rendering the heat-regulating mechanism less sensitive. Alco-
hol is, therefore, very unsuitable for a person who has to be
exposed to severe cold. Besides, it causes drowsiness, and in
this way dangerous results and even death may occur from a
free indulgence in liquor under these circumstances.
Skin. — Alcohol is a mild diaphoretic, the action of the sweat-
glands being augmented by the dilatation of the cutaneous ves-
sels and also possibly by some direct influence on the glands.
Kidneys. — Alcohol has some diuretic influence, but it is un-
known whether this is due at all to a direct action on the
kidney. Some of the spirituous liquors, such as gin, induce
free diuresis, but this is owing to the other constituents rather
than the alcohol.
Excretion. — The small percentage of alcohol which is not
oxidized in the tissues is excreted unchanged, principally by
the lungs and kidneys and to a very much less extent in the.
sweat and milk. The exact amount thus eliminated varies with
the quantity taken. If the amount ingested is very large, about:
0.3 per cent, escapes in the milk, but if moderate, none. The
popular notion that an infant may become intoxicated or acquire
a taste for spirituous liquors from the alcohol absorbed in the
ALCOHOL. 835
milk of a drunken mother or wet-nurse is without any founda-
tion in fact. Both the amount and quality of the milk are said
to be unaffected by the administration .of alcohol. When me-
dicinal doses are taken, it is found that the quantity excreted
through the lungs amounts to 5l/2 to 61/- per cent., and through
the kidneys at most to 1 to 2~/2 per cent., while none is elim-
inated by the skin. Alcohol has been demonstrated in the blood
for twenty-four hours after intra-venous injection of large
quantities.
Tolerance is produced by the continued use of alcohol, and
hence it is necessary to prescribe much larger doses in the case
of habitual drinkers than for other persons.
Therapeutics of Alcohol.
External. — Alcohol is used as an evaporating lotion for
sprains, bruises and local inflammations generally. A common
form is the Lotio Spiritus, which is found in many hospital
pharmacopoeias, and which consists of 4 parts of rectified spirit
to 1 of water. This is applied to the affected part upon a single
layer of lint or cotton, and allowed to evaporate. Diluted alco-
hol, 3, with lead-water, 1, to which some morphine acetate may
be added if the pain is severe, is also employed in the same
way. Headaches are often relieved by the refrigerant and an-
aesthetic effect of alcohol when used in the form of bay rum
or eau de Cologne to bathe the forehead, and spirit lotions, in
consequence of their effect in constricting the cutaneous blood-
vessels, may be of service in checking undue sweating. Brandy
or ordinary alcohol is a good application for hardening the
skin to prevent cracking of the nipples in nursing women and
also for the prevention of bed-sores. Its efficiency for this
purpose may be increased by the addition of a little alum. The
rubefacient property of alcohol may be availed of for promoting
the absorption of inflammatory products, or for the relief of
pain in such affections as myalgia and chronic rheumatism, by
rubbing it in the skin in the form of Linimentum Saponis and
other liniments into which it enters. Hot applications of alco-
836 PHARMACOLOGY AND THERAPEUTICS.
hol also alleviate pain, and a favorite method for securing re-
lief in facial neuralgia, toothache, and various other painful
conditions is the use of a flannel hop-bag which has been
dipped in hot whiskey. A little brandy held in the mouth will
also frequently relieve toothache. Properly diluted, alcohol
may be employed as an astringent and antiseptic gargle or
mouth-wash in pharyngitis, stomatitis, scurvy, salivation, etc.
Port wine is very commonly used for this purpose. Concen-
trated alcoholic preparations are of service in the treatment
of frost-bite, ulcers, loss of hair, freckles, and certain vegetable
parasitic diseases. Alcohol dressings have been found valuable
in tuberculous lesions and to relieve the pain of herpes zoster,
and the local application of alcohol is said to be an effective
abortive measure in- herpes.
Internal. — Used with careful discrimination, alcohol is one
of the most valuable remedies we possess. It is not to be
recommended in acute dyspepsia, as it is then apt to be irri-
tant to the gastric mucous membrane, but given before or with
the meals it is in many instances of service in sharpening the
appetite and improving the digestion, especially in the seden-
tary, aged and feeble, and in cases of exhaustion from acute
disease or over-work, where the stomach is naturally affected by
the general condition. Sometimes it is best administered after
eating. On account of its anaesthetic effect, alcohol, as has
been mentioned, may relieve gastric pain, and it is also some-
times useful in allaying nausea and vomiting, particularly when
given in the form of champagne or of brandy in small doses
with pounded ice or effervescent mineral waters. When in
delirium tremens nothing is retained on the stomach, so that
the patient's life may be endangered on account of the lack of
nutriment, a little brandy and ice will sometimes settle the
stomach, and thus enable it to receive and digest the food so
urgently needed. In cholera infantum and in other diarrhceal
affections, in adults as well as children, brandy is at times very
useful, and port wine is also employed in diarrhoeas. Alcohol
may relieve intestinal as well as gastric colic, but gin and hot
ALCOHOL. 837
water has too often been relied upon by old nurses in the flatu-
lence of infants and young children when proper attention to
the feeding would have prevented the indigestion. Alcohol is
of immense advantage in many cases of febrile disease, where
during critical periods it sustains the vital powers by supple-
menting the insufficient quantity of nutriment which the sys-
tem is capable of appropriating; at the same time stimulat-
ing the digestion, and thus enabling the patient to dispose of
an increased amount of food. It is advisable under these cir-
cumstances, therefore, that it should be given with milk, broth,
eggs or other suitable aliment. It is by no means adapted for
all cases of fever, and hence its effects should always be very
carefully watched. If under its use the pulse becomes stronger
and fuller, the tongue and skin less dry, the respiration less
embarrassed, the delirium and subsultus less marked, and the
patient grows more tranquil and disposed to sleep naturally,
we may know that the drug is doing good. Although it is not
given as an antipyretic, in cases in which it thus acts bene-
ficially it will usually be found that the temperature is more or
less reduced by it. On the other hand, if the fever rises and
the other effects produced are the opposite of those just men-
tioned, the alcohol is doing harm and should be discontinued.
While it is often given when it is quite unnecessary, there are
many instances in which it is of inestimable value in such affec-
tions as typhoid and typhus fevers, pneumonia, small-pox,
cholera and diphtheria, and also in gangrene, pyaemia, septi-
caemia, etc. It is also of the highest usefulness to arouse and
support the flagging powers in sudden depression of the sys-
tem, and may be given by the mouth, by the rectum, hypoder-
matically, or applied to the external surface with friction. It
is thus resorted to in shock, syncope, severe haemorrhage, and
poisoning by tobacco, digitalis, antimony, conium, chloroform,
ether, etc. In snake-bite and poisoning by carbolic acid it may
not only serve to tide the system over until the poison is elim-
inated, but also to directly antagonize the latter in the blood,
and it therefore constitutes the best antidote in these cases.
838 PHARMACOLOGY AND THERAPEUTICS.
The beneficial effect of the reflex stimulating action of alcohol
on the circulation is well shown in cases of fainting or collapse
from cold or other cause, where a single dose of strong spirits
often promptly revives the patient. Alcohol may be said to be
indicated in general whenever adynamia is a pressing symptom,
and should then always be employed, tentatively at least, unless
there are special circumstances present which render its admin-
istration unadvisable. In acute disease frequently, and more
rarely in chronic conditions, it is given with excellent effect in
quantities which in health would cause intoxication and alto-
gether disastrous results. The case is recorded by an eminent
clinician of a young woman suffering from pulmonary tuber-
culosis who took one pint of whiskey daily for nearly two years
and who finally recovered from the disease. In many instances
of tuberculosis and other wasting diseases it is a remedy of the
greatest service, lessening tissue-waste, promoting constructive
metamorphosis, favoring the deposition of fat, and in general
tending to retard the progress of the disease. The narcotic
effect of alcohol on the nervous system may be employed to
relieve pain, to promote sleep, and to quiet delirium, but except
in the case of acute disease it should be resorted to for these
purposes with the greatest possible discriminating judgment, on
account of the patient's moral welfare. When given as a di-
uretic, it is usually in the form of gin, in which its effect is
greatly augmented by the juniper contained in this liquor. Al-
though but little alcohol is excreted by the kidneys, its abuse,
particularly in the form of ardent spirits, is one of the recog-
nized causes of chronic Bright's disease. In all inflammations
of the urethra it seems to be irritating, and in the treatment of
gonorrhoea is always interdicted to the patient. Beer is re-
garded as particularly harmful. Among the other contraindi-
cations for the use of alcohol may be mentioned acute nephri-
tis, all states of cerebral excitement, unless due to exhaustion,
apoplexy, meningitis, aneurism, advanced atheroma, and the
alcoholic habit. For its diaphoretic effect, a glass of hot spirits
and water, taken at bedtime, is frequently employed to break
ALCOHOL. 839
up an incipient cold. In malarious regions it is a common
practice to take whiskey with quinine as a prophylactic against
intermittent fever.
TOXICOLOGY.
Very large quantities of alcohol are capable of causing instantaneous
death by reflex arrest of the heart, but such a result is rare. Commonly
they induce a torpid sleep which gradually deepens into a condition like
that seen in chloroform anaesthesia, and which may end in death, usually
from respiratory failure. In some fatal cases convulsions have pre-
ceded death. When the patient is first seen in the advanced stage of
deep coma, the absolute diagnosis of acute alcoholic poisoning cannot be
made out.
Chronic Poisoning. — Among the more common results of chronic
poisoning by the drug are chronic gastritis, cirrhosis of the liver,
delirium tremens and mania. A great variety of other serious diseases
have been attributed to its effects, among which may be mentioned
gout, peripheral neuritis, pachymeningitis, organic heart disease, and
chronic nephritis. There are, in fact, but few organs and tissues not in
some way changed in chronic alcoholism, and its results, from their
frequency and importance, have come to claim the attention of syste-
matic writers on the practice of medicine. Changes met with. It need
only be said here that the changes met with have been classified under
two groups, sclerosis and steatosis. While these anatomical alterations
are developing, the exterior of the body assumes characteristic appear-
ances. The subject may either be pale and flabby, but fat, with a
heavy and imbecile expression, or have a dusky red or purplish, pimply
and bloated skin, with bulging under the eyes, yellow and injected con-
junctivas, and blue and swollen lips. Alcoholics are especially liable to
contract pneumonia, tuberculosis and other infectious diseases, and when
attacked by them show less powers of resistance than most other per-
sons. They are also bad subjects for surgical operations. It is possible,
however, that some of the bad effects resulting from the use of alcoholic
drinks may be due to other substances than alcohol contained in them.
Unofficial Preparation.
Alcohol Amylicum.— Amylic Alcohol. (Fusel Oil.)
Action of Amylic Alcohol.
This substance is present in small quantity in most forms of
spirits, especially when these are freshly distilled. It has a
84O PHARMACOLOGY AND THERAPEUTICS.
more violent acute action and more pronounced after-effects
than ethylic alcohol.
Therapeutics of Amylic Alcohol.
Fusel oil is a poison, and is not used in medicine. The manu-
facturers of cinchona alkaloids employ it as a solvent; formerly
it was required for the preparation of valeric acid.
CANNABIS INDICA.
CANNABIS INDICA. — Indian Cannabis. (Indian Hemp.) Dose,
0.065 gm. (65 milligm.) ; 1 gr.
Preparations.
1. Extractum Cannabis Indicae. — Extract of Indian Cannabis.
Dose, 0.010 gm. (10 milligm.) ; £ gr.
2. Fluidextractum Cannabis Indicae. — Fluidextract of Indian
Cannabis. Dose, 0.05 c.c; 1 Hi.
3. Tinctura Cannabis Indicae. — Tincture of Indian Cannabis.
Dose, 0.6 c.c; 10 ni.
Action of Cannabis Indica.
External. — None.
Internal. — The action of cannabis indica seems to have many
features in common with that of opium, and even more closely
resembles the action of anhalonium (see Pellotine, p. 877). Its
principal influence is on the cerebrum, and it is regarded as per-
haps the most powerful stimulant of the psychic functions
known. It is largely employed for this purpose in the Orient
(often in the form of haschisch) , and its moderate use does not
appear to be attended by any injurious effects. When taken to
excess, it leads to tremor and loss of appetite and strength, and
sometimes to mania and dementia. In some cases convulsive at-
tacks have been observed, and among the natives of India cata-
lepsy is said to occasionally occur. If the drug were generally
used by Caucasians, it is thought that the effects would probably
CANNABIS INDICA. 84 1
be more serious than is usual among Orientals. Death from
acute poisoning is stated to be extremely rare, and recovery has
taken place after enormous doses. At the same time, experi-
ments on dogs have shown that it undoubtedly presents some
danger. In the influence of cannabis indica upon the nervous
system depression is mixed with the stimulation in a manner
similar to that which is occasionally seen in the case of morphine.
Within a short time after taking it the patient experiences the
most pleasurable emotions. Everything seems to amuse him,
and he becomes hilarious and indulges in actions which he may
know to be ridiculous but which he cannot restrain. Double
consciousness is now well marked; in fact the ego may become
a severe critic of the alter ego. In the exuberance of his spir-
its he feels on the best possible, and even affectionate, terms
with everyone about him. He passes in^o a dreamy, semi-
conscious state, in which, while the judgment is practically lost,
the imagination runs riot. All his ideas are on a grand and
magnificent scale; time and space seem to be indefinitely ex-
tended. He may say brilliant or witty things, but there is little
continuity in his thought, which changes rapidly from one sub-
ject to another. Delightful visions pass before him in an end-
less phantasmagoria. True hallucinations are sometimes present
and sometimes not. The general sensibility is much dimin-
ished, and this effect may deepen into complete anaesthesia.
The pupil is usually somewhat dilated. As the system becomes
more profoundly influenced by the drug the dreams alternate
with periods of consciousness, and eventually there results a
tranquil sleep. From this the patient usually awakens without
any feeling of depression, but refreshed and with an acute sense
of hunger. Occasionally, in the midst of the pleasurable
thoughts there is experienced a feeling of impending danger or
other disagreeable sensation, and in some instances melancholia
precedes the stage of sleep. In the Caucasian race the primary
stage of exaltation may be quite short, and is sometimes alto-
gether absent, deep sleep coming on after a preliminary feeling
of heaviness and drowsiness, with noises in the ears and numb-
842 PHARMACOLOGY AND THERAPEUTICS.
ness of the extremities. It is a well recognized fact, however,
that the effects of cannabis indica may vary greatly in different
persons. This difference of action is due largely to individual
peculiarities and also in part, no doubt, to the varying strength
of the preparations of the drug. In man the heart is generally
accelerated when cannabis indica is inhaled. In animals it is
said that its intravenous injection slows the heart, partly through
inhibitory stimulation and partly through direct action on the
cardiac muscle, and that this action on the heart is the cause
of death after poisonous quantities. In them the general effects
appear to resemble those met with in man and also to present
the same marked variations. There is sometimes observed a
stage of exaltation with increased movement, and this is fol-
lowed by depression and sleep. In dogs and cats vomiting is
a not infrequent symptom. In frogs the reflex excitability is
found to be first augmented and then depressed. While the
habitual use of the drug in large amount may lead to grave
psychic disturbances, it does not appear to cause constipation
and the same disturbance of digestion and nutrition as opium.
Some writers, however, assert that while a single dose does not
usually produce constipation, and may even have a slightly
laxative effect, after long continued administration there is a
tendency to constipation both in man and in dogs. Dryness of
the mouth, thirst, nausea, vomiting and strangury are untoward
effects occasionally seen.
Therapeutics of Cannabis Indica.
While the physiological effects of this agent constitute a
very interesting study, it is not of any great therapeutic im-
portance, since almost any indication that it might be supposed
to fulfill can be more satisfactorily and certainly met by other
remedies. As a cerebral depressant it has been employed in
a considerable number of affections, and in many of them it has
been entirely abandoned. As a hypnotic it is unreliable, and,
according to some authors, it produces sleep in only about 50
per cent, of the cases. In many instances there is excitement
OPIUM. 843
without sleep. It might be used, however, in certain instances
in which opium is contra-indicated, and also as a substitute for
opium in some mental diseases. As an analgesic it is some-
times of service. It has been given with advantage in cases
of migraine and neuralgia, although it not infrequently fails to
afford relief. In biliary colic it also sometimes proves success-
ful. Cannabis indica enters into the composition of the pro-
prietary medicine known as chlorodyne {see p. 888) and vari-
ous other similar preparations which are more or less used as
anodynes and hypnotics and are sometimes of great service in
bowel troubles. When prescribing the tincture, the resin from
which is precipitated by the addition of water, it is necessary
to employ mucilage to suspend it, while the taste is usually
covered with spirit of chloroform.
2. General cerebral depressants.
OPIUM.
OPIUM.— Opium. Dose, 0.100 gm. (100 milligm.) ; V/2 gr.
OPII PUL VIS.— Powdered Opium. Dose, 0.065 gm. (65 milligm.) ;
1 gr.
Preparations.
1. Extractum Opii. — Extract of Opium. Dose, 0.030 gm.
(30 milligm.) ; i/2 gr.
2. Emplastrum Opii. — Opium Plaster.
3. Trochisci Glycyrrhizae et Opii. — Troches of Glycyrrhiza
and Opium.
4. Vinum Opii. — Wine of Opium. Dose, 0.5 c.c; 8 TTL.
5. Pilulae Opii. — Pills of Opium. Dose, 1 pill.
6. Purvis Ipecacuanha et Opii. — Powder of Ipecac and
Opium. (Dover's Powder.) Dose, 0.500 gm. (500 milligm.);
71/2 gr.
7. Acetum Opii. — Vinegar of Opium. (Black Drop.) Dose,
0.5 c.c; 8 TTL.
8. Tinctura Opii. — Tincture of Opium. (Laudanum.) Dose,
0.5 c.c; 8 ni.
844 PHARMACOLOGY AND THERAPEUTICS.
9. Tinctura Opii Camphorata. — Camphorated Tincture of
Opium. (Paragoric.) Dose, 8 C.C.; 2 fl. dr.
10. Tinctura Ipecacuanhae et Opii. — Tincture of Ipecac and
Opium. Dose, 0.5 c.c; 8 T\{.
OPIUM GRANULATUM.— Granulated Opium. Dose, 0.065 gm.
(65 milligm.); 1 gr.
Preparations.
1. Opium Deodoratum. — Deodorized Opium. Dose, 0.065 gm.
(65 milligm.); 1 gr.
2. Tinctura Opii Deodorati. — Tincture of Deodorized Opium.
Dose, 0.5 c.c; 8 7H,.
MORPHINA.— Morphine. Dose, 0.012 gm. (12 milligm.); $ gr.
MORPHINE HYDROCHLORIDUM.— Morphine Hydrochloride.
Dose, 0.015 gm. (15 milligm.) ; y4 gr.
MORPHINE ACETAS.— Morphine Acetate. Dose, 0.015 gm. (15
milligm.); y4 gr.
MORPHINE SULPHAS.— Morphine Sulphate. Dose, 0.015 gm.
(15 milligm.) ; y4 gr.
Preparation.
Pulvis Morphinae Compositus. — Compound Powder of Mor-
phine. Dose, 0.500 gm.; 7y2 gr.
Unofficial Preparations.
Trochisci Morphinae et Ipecacuanhae (U. S. P., 1890). —
Troches of Morphine and Ipecac. Dose, 1 to 5 troches.
Liquor Morphinae Bimeconatis. — Solution of Morphine
Bimeconate. Dose, .30 to 2.50 c.c; 5 to 40 nl.
Acidum Meconicum. — Meconic Acid.
Pilula Ipecacuanhae cum Scilla. — Pill of Ipecacuanha with
Squill. Dose, .30 to .60 gm.; 5 to 10 gr.
Tinctura Chloroformi et Morphinae Composita. — Compound
Tincture of Chloroform and Morphine. Dose, .30 to .60 C.C. J
5 to 10 TTL-
Tinctura Opii Ammoniata. — Ammoniated Tincture of Opium.
Dose, 2 to 4 c.c; y2 to 1 fl. dr.
OPIUM. 845
Heroina. — Heroine. (Morphine Diacetic Ester.) Dose, .003
to .012 gm.; ^ to i gr.
Heroinae Hydrochloridum. — Heroine Hydrochloride. Dose,
.003 to .012 gm.; & to I gr.
Dionina. — Dionine. (Morphine Mono-ethyl Ester Hydrochlo-
rate.) Dose, .01 to .015 gm.; 1 to i gr.
Peronina. — Peronine. (Morphine Benzylic Ester Hydrochlo-
rate.) Dose, .0004 gm.; yi^ gr.
Action of Opium.
The effects of opium being due almost entirely to its mor-
phine, the action and therapeutics of the two may be studied
together. Codeine and some other alkaloids are considered a
little later on (see pp. 865 and 866). Meconic acid appears to
be nearly free from physiological properties.
External. — Though locally it has been said to possess feeble
analgesic properties, opium probably has no action when applied
to the unbroken skin ; but from mucous membranes and raw sur-
faces it is absorbed, and it then exerts a marked anodyne in-
fluence. The latter, however, is due to the central action of
the drug, as the sensory nerve endings appear to be in no way
affected by it.
Internal. Secretions. — Most of the secretions are diminished
by opium. The sweat, however, appears to be increased in
consequence of dilatation of the cutaneous blood-vessels.
Opium tends to check the secretion of saliva, but when nausea
is caused, both the saliva and sweat are often markedly in-
creased in consequence of this condition, rather than from any
direct effect of the drug itself. It is noted also that in the
last stages of opium poisoning the perspiration is sometimes
profuse, but this is simply a result of the asphyxia. It is not
known precisely what effect the drug has upon the bile or the
pancreatic secretion. The urine is scarcely affected by it,
though, in consequence of the absence of sphincter reflex, re-
tention in the bladder not infrequently occurs. So far as
known, all the other secretions are diminished.
846 PHARMACOLOGY AND THERAPEUTICS.
Alimentary Canal. — Unless the dose is very small, dryness
of the mouth and a feeling of thirst are promptly caused.
Whether administered by the mouth or not, opium tends to
produce nausea and vomiting and to impair the digestion. The
nausea and vomiting would seem to be probably due in part to
peripheral and in part to central action. When morphine is
given by subcutaneous injection, it is quickly excreted into the
stomach, and yet the great rapidity with which vomiting fol-
lows its administration in this way in dogs (in which this
symptom is more constantly produced than in the human sub-
ject) points to an action on the medullary centre. Small quan-
tities of opium lessen the sensation of hunger, and this is be-
lieved to be probably due rather to central action than to a
local influence on the stomach. Because of the lessened per-
ception of hunger and the gastric derangement, the appetite is
diminished. In man and certain animals opium causes diminu-
tion of intestinal peristalsis and constipation, in consequence,
probably, of some peripheral action. Not only does it tend to
check the movement of the bowels, but it abolishes or mitigates
abdominal pain when present. Very large doses cause violent
peristalsis and diarrhoea in the dog, cat and, according to some
observers, the rabbit.
Circulation. — Small doses have little or no effect upon the
heart and circulation. With either large or small doses, how-
ever, there may be some quickening of the pulse at first, in con-
sequence of nausea. Large amounts cause slowing of the heart
through primary stimulation of the vagus centre in the medulla,
as well as by an action on the cardiac motor ganglia. At the
same time, from some obscure central action, the cutaneous
vessels dilate. This gives rise to a full pulse and to a sensa-
tion of warmth in the skin, which may be followed by itching
or discomfort, but has little influence on the general blood-
pressure. The latter generally remains high, and the circula-
tion is only greatly depressed quite late in the poisoning. While
such depression is dependent to a considerable extent on vaso-
motor paralysis, it is no doubt largely secondary to respiratory
OPIUM. 847
failure. The heart finally stops in diastole, but death is rarely
due to the effects of the poison on this organ or its nervous
apparatus.
Respiration. — The respiration is slowed and at first deepened,
but the increased depth is not sufficient to counterbalance the
slowness of the breathing, so that the air inspired per minute
is reduced. Later the respirations become not only shallow
but irregular, and may assume the Cheyne-Stokes type. Pa-
ralysis of the respiratory centre, to which opium acts as a
direct poison, is the ordinary cause of death. The bronchial
mucus, like the secretions in general, is diminished by opium.
Nervous System. Brain. — The action on the cerebrum con-
sists for the most part of a depression of the higher functions.
In man, owing to the greater development of the brain, the
narcotic effect of the drug is much more pronounced than in
other animals. The depression is usually preceded by a stage
of excitement, characterized by restlessness and increased men-
tal activity, the length of which varies greatly in different indi-
viduals; but in some instances this appears to be entirely lack-
ing. As a rule, it is found that the period of excitation can be
maintained for a considerably longer time by the administration
of small doses at frequent intervals, while under the effect of
a single large dose it is short or absent, and deep sleep very
soon comes on. During this first stage the imagination is often
stimulated, the fancy has free play, and the creative powers are
augmented, while the attention, judgment, coordination of the
brain, and reasoning faculties are less keen than ordinarily.
In exceptional instances, however, the intellectual power and
mental vigor are increased. The general effect seems to be
that of a series of stimulations and depressions going on at the
same time, but whether these successively involve the same or
different centres is unknown. Different parts of the brain
appear to be affected in different degrees and at different inter-
vals of time, so that, as held by some, these act in a dissociated
manner and more or less independently of each other. It is
well recognized that the symptoms are greatly influenced by
848 PHARMACOLOGY AND THERAPEUTICS.
individual susceptibility and by race, and among Oriental peo-
ples the stage of excitement is generally much more prolonged
than in Europeans. The motor areas of the brain are affected
much more markedly in some animals than in man, and dogs,
in which there is often noted a paralysis of the hind legs, are
said to always exhibit a clumsiness in their voluntary move-
ments which closely resembles that observed after ablation of
these areas. In man it is often difficult to detect any evidence
of stimulation of the cerebral motor centres, but the depres-
sion of these is never so pronounced as that of the intellectual
faculties. It is true that the patient, in consequence of the
debility and muscular weakness present, seeks a recumbent
posture, but he can be walked about if he is supported. He feels
in a most contented frame of mind, and sooner or later sinks
into a sleep which is generally filled with dreams, often of the
most fantastical character, though in some individuals it is en-
tirely free from dreams. If the dose is large, the slumber is
more apt to be dreamless. If it is not a poisonous one, the
patient can be easily aroused, but under toxic amounts he soon
sinks into complete coma. Opium is not only a powerful hyp-
notic, but the most perfect analgesic known. The dose required
in any given case to annul pain naturally depends largely upon
the severity of it. After small doses of the drug patients gener-
ally awake refreshed, though not infrequently there is a little
languor, dryness of the throat, headache, and possibly nausea.
In some instances the headache is quite severe and accompanied
by nausea, vomiting and depression.
Medulla Oblongata and Spinal Cord. — The principal effect
in the medulla is the profound depression of the respiratory
centre. The other centres are much less affected, and in cases
of fatal poisoning this is paralyzed before the centres of car-
diac inhibition* and vaso-constriction are depressed to any
marked extent. There is, however, a distinct depression of the
vomiting centre, so that, although vomiting may perhaps be at
first induced by its transient irritation, emetics do not act well
in opium poisoning. In man the spinal cord is but little af-^
OPIUM. 849
fected except by large amounts. Mostly there is depression of
its conducting and reflex functions, but in a few instances, after
large doses, there have been observed increase of reflex excita-
bility and twitchings or convulsions of spinal origin. In some
of the higher animals there may be evidences of a similar action
on the cord, but for the most part in mammals, after poisonous
doses, the failure of the respiration closes the course of the
intoxication. In the cold-blooded animals, however, there is
found to follow a further development of excessive reflex irri-
tability, which may pass into tetanic spasm. In the frog this
reflex action is first diminished to a slight extent, and then
increased to the same degree as by strychnine. In man opium
sometimes has an aphrodisiac influence, and this has been at-
tributed in part to stimulation of the cord and in part to the
effect on the imagination.
Nerves and Muscles. — Except when given in enormous doses,
the drug has no effect upon the peripheral muscles and nerves.
Even when directly applied to the nerve, it has been found to
have little influence on its irritability. Practically, therefore,
opium has no action upon nerve fibres or endings. While in
the frog the subcutaneous injection of large amounts of mor-
phine may diminish the power of the end-organs to transmit
impulses, this is not the case in mammals. In them the sensi-
bility of the skin is lessened by an injection, but this appears
to be a result of central action, since no more effect is produced
at the point of application than elsewhere. In its general effect
upon the nervous system opium affords a good example of the
law of dissolution (see p. 737).
Pupil. — One of the characteristic effects of the drug is con-
traction of the pupil, and this is undoubtedly a central and not
a peripheral action, since it does not occur after local applica-
tion, nor after division of the nerve-trunks going to the iris.
It is at once overcome by the application of atropine to the
conjunctiva. After large doses of opium the pupil is reduced
to the size of a pin-head, but in fatal poisoning it often becomes
widely dilated shortly before death, as a result of the asphyxia.
55
85O PHARMACOLOGY AND THERAPEUTICS.
In birds, which are not much more tolerant of morphine, when
given subcutaneously, than most mammalian animals, the pupil
remains unaffected. In animals in which the drug causes move-
ment and excitement, such as the cat tribe, it is widely dilated,
while in some other animals, such as dogs and rabbits, it is
affected in much the same way as in man.
Temperature. — Sometimes opium causes a slight preliminary
rise of temperature. In most instances it occasions an incon-
siderable fall, which is probably attributable to the lessened
movement, as well as the dilatation of the cutaneous blood-
vessels. Experiments on animals indicate that the heat centre
in the brain is rendered less sensitive by the drug.
Skin. — As has been seen, opium causes some increased secre-
tion of sweat, though its diaphoretic property is not usually very
marked. As the effects of the drug are passing off, redness and
itching of the skin are sometimes observed, and in susceptible
individuals the erythema may lead to exanthemata, such as an
eruption of small red spots resembling roseola.
Metabolism. — The metabolism is ordinarily lessened as a
result of the quiet condition of the subject caused by the drug,
so that the excretion of carbon dioxide is diminished in conse-
quence of the depression; but in animals like the cat, in which
great excitement is caused, its output is increased from the
augmented muscular movement. There is also a lessened ex-
cretion of nitrogen. In consequence of the impairment of res-
piration, there may be an increase in the lactic acid of the
blood and urine, and glycosuria may be present, while glycogen
may disappear from the liver. In patients suffering from dia-
betes the amount of sugar in the urine is diminished. Tran-
sient albuminuria may occur after opium, and it has been sug-
gested that this may possibly be due to vaso-motor changes
affecting the circulation of the kidney. In chronic morphinism
also there is diminished metabolism, but this is probably attrib-
utable for the most part to the derangement of digestion.
Excretion. — Opium is excreted chiefly by the digestive tract,
in the salivary, gastric and intestinal secretions, and is found
OPIUM. 85I
in large amount in the faeces. As morphine has been detected
in the stomach in 2T/2 minutes after the subcutaneous injection
of .03 gm. (J/2 gr.), there appears no question that the drug
is capable of reabsorption from the gastro-intestinal tract.
Traces of the drug have been found in the urine, but only after
large doses. It is thought that a certain amount of it may
perhaps undergo partial oxidation in the tissues, since oxida-
tion products, such as oxydimorphine, have been observed in
the urine. It is also excreted to some extent in the milk of
nursing women, so that it may cause morphinism in the child.
The substances which produce the characteristic odor of opium
are excreted largely by the urine and less freely by the breath,
sweat and milk.
Peculiarities. — Reference has already been made to the
marked differences in the effects of opium in different indi-
viduals. In some instances, instead of having a soothing in-
fluence and putting the patient to sleep, it produces sleepless-
ness and excitement, which may amount to delirium. In others
it causes marked nausea and vomiting, gastric pain, and indi-
gestion, often with very severe headache. Some of these bad
effects may very likely be due to the varying composition of
the drug, but certain individuals present such a pronounced
idiosyncrasy against opium that it cannot be administered to
them in any form without very unpleasant results. Children
are much more susceptible to its influence than adults, so that
it must always be given to them with great caution, and women
are, as a rule, more easily affected by it than men. Among the
other untoward effects of opium may be mentioned diarrhoea,
dyspnoea, aphrodisia, fever and hyperidrosis. Its effect in some-
times causing skin eruptions has been previously mentioned.
The tolerance of the drug by the system is remarkable, so that
persons who use it habitually are soon able to take enormous
quantities with impunity, so far as any immediate danger to
life is concerned. The explanation of the tolerance is believed
to be the increased power of the organism to destroy the poison.
Differences in Action between Opium and Morphine. — A
852 PHARMACOLOGY AND THERAPEUTICS.
number of differences have been noted in the effects of mor-
phine and opium. These are as follows: (1) Morphine is
absorbed more rapidly, and hence acts more quickly. It is
therefore especially adapted for subcutaneous injection, and,
administered in this way, it produces its effects with great
promptness. (2) Opium is more apt to interfere with the
digestion, although it is claimed by some that it causes less
nausea than morphine. (3) Opium is more liable to cause con-
stipation. This is both on account of the greater local action
of crude drugs as compared with alkaloids, and because it re-
mains in the intestine for a longer time than morphine. Con-
sequently, it produces a more pronounced effect there than else-
where in the economy, and this fact is availed of in the treat-
ment of many abdominal diseases. (4) Opium has greater
diaphoretic properties. (5) Morphine is more certain, as well
as more rapid, in its anodyne and hypnotic effects. (6) Mor-
phine is less convulsant. (7) Opium is thought to have a
stronger effect in reducing the sugar in the urine when glyco-
suria is present. (8) Opium affects the bladder sphincter less.
(9) Morphine causes more pruritus. (10) Morphine is ex-
creted more readily.
Therapeutics of Opium.
External. — Local applications of opium to relieve pain have
long been in common use and are still often employed, but as
it has been clearly shown that the drug has no effect on sen-
sory nerve terminations, the practice must be regarded as sim-
ply a concession to a deeply-rooted popular sentiment, which
has been handed down from the past. The apparent good
results obtained are no doubt due for the most part to the
absorption of the drug from wounds or mucous surfaces.
When it is applied to the unbroken skin, there is either no
benefit, or else such relief as is afforded is attributable to adven-
titious circumstances. Thus, it must be due to the heat, and
not to the opium, when hot fomentations or poultices sprinkled
with laudanum (a very common application) are employed.
OPIUM. 853
So, while Linimentum Opii (B. P., tincture of opium and soap
liniment, equal parts), rubbed into the skin, may be of service
in chronic rheumatism, neuralgia, etc., it is probably the fric-
tion that is the principal factor in relieving the pain. The most
popular form of this external use is the lead and opium wash,
and the probable explanation of its undoubted efficacy in
sprains, contusions and other painful conditions is to be found
in the non-irritating covering furnished by the lead precipitate
and the astringent action of the lead itself. The ointment of
nutgall and opium (B. P., powdered opium, 2; gall ointment,
27) is much used to relieve the pain of haemorrhoids and anal
fissures. The warm decoction of the white poppy is used in
England as an anodyne fomentation. Poppy capsules (Papav-
eris Capsular, B. P.) are obtained from the Papaver somnif-
erum, which is cultivated in England. A ten per cent, decoc-
tion made from these contains but a small and uncertain amount
of opium, and its beneficial effects, if any, are doubtless due
to its warmth.
Internal. G astro -intestinal Tract. — Morphine, which is here
preferable to opium, is of much value in relieving the pain of
organic disease of the stomach (ulcer and cancer), as well as
of irritative dyspepsia. It may be given in solution (morphine,
1; water, 480; dose, 4 c.c. ; 1 fl. dr.), and it is also much used
in combination with bismuth, zinc and silver salts in painful
stomach diseases. Opium is often of great service in acute
gastritis, and it is advised that it should always be given in
liquid form, preferably as the Tinctura Opii Deodorati. Many
forms of vomiting, whether of peripheral or reflex origin, are
checked by morphine, and it is likely to prove useful after the
stomach has been emptied in cases of vomiting caused by irri-
tant matters. In colic, and especially lead colic, it often re-
lieves the pain without increasing the constipation; while
allaying the spasm of the intestine, it does not appear to entirely
stop its peristalsis. In diarrhceal diseases opium is of the
greatest possible value, but it must be used with discrimination
and judgment. In acute diarrhoea due to irritating kinds of
854 PHARMACOLOGY AND THERAPEUTICS.
food and in mucous diarrhoea it is advisable that before using
it the bowel should be cleared by a purgative. When the evacu-
ations are watery, it may be combined with advantage with lead
acetate or a mineral acid. In acute dysentery it is generally
most efficacious after the preliminary administration of mag-
nesium sulphate or other saline. It is frequently given by the
rectum either in an enema with starch or milk or in supposi-
tory. In chronic dysentery it is the most reliable remedy, and
may be employed in association with the salts of zinc, silver,
copper or arsenic. In malarial dysentery, particularly, Patna
opium, which contains over 6 per cent, of anarcotine, an anti-
periodic, is especially indicated in combination with arsenic.
In cholera morbus the hypodermatic injection of morphine is
of great service, but in cholera infantum any form of opium
must be used with great caution on account of the danger of
producing narcosis. In cholera it is useless in the stage of
collapse, but may prove of benefit in the preliminary diarrhoea,
and it is an important ingredient of the various so-called cholera
mixtures. In intestinal colic and abdominal pain of whatever
origin opium generally affords relief, and it is largely used in
the treatment of peritonitis and other inflammations and after
operations or wounds of the abdomen. In severe abdominal
cases it has been customary to push the drug to decided narco-
sis, without paying any attention to the constipation caused,
but the more recent and better practice is to keep the bowels
slightly open by the use of salines. When the full-dose opium
treatment is employed in peritonitis, so that the paralyzing of
the intestinal movements prevents the peritoneal surfaces from
rubbing against each other, extensive adhesions are quite likely
to result. As mercury is regarded by many as of special value
in modifying inflammations of the serous membranes, particu-
larly if combined with opium, it is a common practice to give
calomel along with the opium, at least for a time. The follow-
ing general caution has been suggested as one of great prac-
tical importance: As a rule, opium does harm in all gastro-
intestinal affections in which there is a deficiency in the proper
OPIUM. 855
secretion, or a suspension of the functions, of the liver and
kidneys. At the same time, the hypodermatic injection of mor-
phine, by the action of the drug in relaxing spasm, is invaluable
for the relief of the agonizing pain accompanying the passage
of biliary and renal calculi, and is also of service in control-
ling the vomiting which is often present.
Heart. — It is quite probable that in small doses administered
hypodermatically morphine is a cardiac stimulant. At all
events, it often acts very happily in the pain and distress caused
by disease of the heart, and its cautious subcutaneous injection
may be tried in all forms of cardiac dyspnoea. It is especially
indicated in those cases in which the patient, while perhaps
able to breathe quite easily when awake, suffers from marked
distress as soon as he falls asleep. Opium or morphine given
by the mouth are usually much less efficient in affording relief
in heart-trouble than morphine administered in this manner.
The pain of aortic aneurism and intra-thoracic growths, like
pain in general, is relieved by morphine. It is quite customary
to give the drug in association with small doses of atropine, as
it is found that its analgesic effect is rather increased than
diminished thereby, while the sleep resulting is less disturbed
and more nearly approaches normal sleep. In addition, the
atropine serves to counteract some of the depressing effects
upon the heart and respiration and also to largely prevent sub-
sequent headache, vertigo and nausea, as well as constipation.
It has been shown that in the use of chloroform for anaesthetic
purposes a hypodermatic injection of morphine just before the
inhalation begins prolongs the stage of narcosis with a less
quantity of chloroform, diminishes the danger of cardiac paraly-
sis, and tends to prevent the after-nausea and depression. The
same is true as regards other anaesthetics, and especially in the
case of persons addicted to alcoholic stimulants and of excep-
tionally neurotic patients does the preliminary morphine injec-
tion render the anaesthetization safer and favorably affect the
stage of recovery.
856 PHARMACOLOGY AND THERAPEUTICS.
Vessels. — Although not acting directly upon the vessels or
blood, opium is most valuable as an internal haemostatic. This
effect is largely in consequence of the quietude secured by it,
which allows the blood to coagulate in ruptured vessels. When,
as is frequently the case, the haemorrhage is attended by marked
restlessness, the drug is absolutely indicated because of its
sedative effect both on mind and body. It is especially effica-
cious in gastric and intestinal haemorrhage, where its influence
in diminishing peristalsis is of material service, and also in
pulmonary haemorrhage. In haematemesis and haemoptysis the
benefit derived from it is in no small measure due to its con-
trolling of vomiting and coughing, both of which are apt to
bring on fresh bleeding. A very good preparation to use is
the Pilula Plumbi Cum Opio (B. P., powdered opium, 1; lead
acetate, 6; dose, .12 to .25 gm. ; 2 to 4 gr.). Hypodermatic
injections of morphine are preferred by some, and when these
are used they should be repeated at regular intervals as long
as further haemorrhage or the risk of it continues.
Respiration. — Opium, on account of its depressant effect upon
the medullary centre, must be given with caution in respiratory
diseases, but in well selected cases it is of marked benefit. An
incipient catarrh may often be aborted by a full dose of Dover's
powder. In bronchitis with excessive secretion very small
amounts of opium may be sufficient to diminish its amount, as
well as allay cough. If, however, the secretion is scanty and
tenacious and expectoration difficult, opium may aggravate
rather than relieve the condition. In pleurisy and pneumonia
it is often of great service in controlling cough and relieving
pain, but the tendency to asphyxia in serious diseases attended
with cough must always be borne in mind. Opium should
therefore never be used in the last stages of pneumonia and
bronchitis. By its antispasmodic properties it is frequently
efficient in arresting the symptom asthma, but its use here is
objectionable on account of the danger of inducing the opium
habit. It is a very frequent and useful ingredient of expec-
torant mixtures, and among the preparations commonly em-
OPIUM. 857
ployed in the treatment of cough are paregoric, Dover's powder,
compound liquorice mixture, the ammoniated tincture (B. P.),
the pills of ipecacuanha and squill (B. P.) the compound mor-
phine powder, and the compound tincture of chloroform and
morphine (B. P.). Codeine is preferable to all other prepara-
tions and alkaloids of opium for relief of cough in pulmonary
diseases. Heroine is also very much used for this purpose at
the present day. To relieve the pain of tubercular or other
organic disease of the larynx an insufflation may be used con-
sisting of morphine acetate, .06 gm. (1 gr.) and .30 gm. (5 gr.)
of starch, with or without .06 gm. (1 gr.) of iodoform or
boric acid. As the morphine produces its action only after
absorption, however, other agents have a more prompt and
efficient local anaesthetic effect. The intra-laryngeal applica-
tion of menthol and orthoform constitutes one of the best means
of affording relief in these cases.
Nervous System. — Opium is unrivalled in its influence in
relieving pain from whatever source and in inducing sleep when
insomnia is due to pain. For these purposes the hypodermatic
injection of morphine is usually preferred, as acting more
promptly and certainly and less liable to cause nausea- or diges-
tive disturbances than opium or morphine given by the mouth,
and atropine sulphate is often added to the solution in-
jected for the purpose of minimizing as far as possible any
ill-effects of the morphine salt. Morphine is of great value
in relieving the after-pains of labor, and may be of ser-
vice in spasm of the bladder sphincter and spasmodic stricture
of the urethra by its action in relaxing the muscular contrac-
tion. It is manifestly impossible to more than hint at the al-
most unnumbered applications of opium or morphine as an
analgesic and hypnotic, but it is obvious that its use should as
a rule be restricted to acute or rarely recurring conditions, on
account of the very great danger of the patient's contracting
the opium habit. For the relief of pain and insomnia in in-
curable diseases, however, the judicious employment of the
drug for an indefinite period is entirely justifiable. Enormous
858 PHARMACOLOGY AND THERAPEUTICS.
doses are often borne by patients suffering from very severe
pain without the development of any indications of poisoning.
Morphine is sometimes an efficient sedative in delirium tremens
and other forms of mania, but not infrequently such large quan-
tities are required as to render it an unsafe remedy. In acute
mania small doses are said to be the most efficient if the arterial
tension is low, but if the pulse is quick and the blood-pressure
high, the full effect of the drug is necessary. Large hypoder-
matic doses require the utmost circumspection, especially in
obese and aged subjects. In delirium tremens chloral is usually
a more satisfactory hypnotic than morphine. In melancholia
excellent results have been claimed from the use of opium in
small or stimulant doses, and here the best form for its admin-
istration is the tincture. There is reason to believe that the
hypodermatic injection of morphine is of great value in many
cases of puerperal eclampsia, and its use appears to be growing
in favor. It has also been advocated for the relief of ursemic
convulsions when due to acute nephritis, whether puerperal or
not, on the ground that it tends to arrest muscular spasms by
counteracting the effect of the poison on the nerve-centres, to
establish profuse diaphoresis, and to facilitate the action of
cathartics and diuretics. In hysteria it is not as efficient as
various other remedies, and is especially objectionable from
the risk of its inducing the opium habit. In arachnitis, pachy-
meningitis and basilar meningitis opiates in small doses seem
to accomplish more than other remedies, and the hypodermatic
injection of morphine in quantities sufficient to relieve the
pain and rigidity is considered of value in the earlier
stages of cerebro-spinal meningitis. When effusion has taken
place and stupor and coma supervene, opiates are no
longer of use. In conditions of increased excitability, such as
tetanus, strychnine poisoning, and epilepsy, opium has been
found on the whole to be harmful rather than beneficial. Still,
in a large number of affections it is one of the most efficient
of all remedies for relieving spasm, and its admirable action
in this capacity has been incidentally referred to in several
OPIUM. 859
classes of cases. It may be mentioned here that severe hic-
cough is very commonly arrested by a hypodermatic injection
of morphine. As opiates are as completely absorbed from the
rectum (if the latter be thoroughly cleared) as from the stom-
ach, it is often advantageous to administer them in enemata or
suppositories. Since the absorption is slower, however, the dose
should be twice or possibly three times as large as when they
are given by the mouth. In surgical practice opium has always
been widely used to prevent or mitigate shock, as well as to
relieve pain and check or alleviate inflammation. Its uses in
surgery can only be briefly referred to in passing, but there
seems to be no question that it not only relieves existing
shock, but is a potent factor in the prevention of secondary
shock. It is the first remedy called for when pain or haemorrhage
is present, and the hypodermatic injection of morphine is strongly
indicated in shock following injury, especially if an operation
is required. It is an inestimable boon in severe burns, and it
is particularly indicated in fractures, where it not only allays
the immediate pain, but brings about muscular relaxation and
relieves many distressing symptoms. It is not uncommon now
to hear surgeons decrying the use of opium under almost any
circumstances, but while its careless and unscientific employ-
ment has brought this powerful therapeutic agent into more
or less disrepute, there can be no doubt that it will still con-
tinue to occupy the highest position in the estimation of those
who use it judiciously,
Kidneys. — It is probable that the feeling which has existed
against the use of opium when Bright's disease is present has
been due to the idea that the impaired state of the kidneys pre-
vents the proper elimination of the drug; but since it has been
conclusively shown that only the faintest traces, if any, are nor-
mally excreted by these organs, it would seem, from a theoret-
ical point of view at all events, that there is less risk in its
employment in this class of cases than has generally been sup-
posed. As a matter of fact, however, several instances of
chronic nephritis are on record in which death was apparently
860 PHARMACOLOGY AND THERAPEUTICS.
caused by quite small doses of opium. It is the part of pru-
dence, therefore, to use it with great caution in cases of chronic
Bright's disease. Still, ample justification is afforded for its
judicious employment, notwithstanding the apparent risk, by
the marked relief which often attends the hypodermatic injec-
tion of small amounts of morphine in the uraemic dyspnoea,
uraemic insomnia, and cardiac dyspnoea so likely to be met with
in the course of this affection. Its employment in uraemic con-
vulsions has already been referred to as limited to cases due
to acute nephritis.
Skin. — Dover's powder is of considerable utility as a dia-
phoretic. It is commonly given in acute muscular rheumatism,
and at the onset of " colds " and febrile attacks of various
kinds, and will often effect a cure, particularly if its action is
aided by hot drinks and a hot foot-bath.
Metabolism. — Opium and its derivatives are acknowledged to -
have a favorable effect in many cases of diabetes, not only
materially diminishing the amount of sugar in the urine, but
also often causing an amelioration in the general condition of
the patient. Codeine is undoubtedly the most serviceable form
in which to employ the drug in this disease. Opium has ap-
parently a beneficial influence, the precise nature of which is
not very clear, in all sorts of inflammations, and it is thought
to be particularly efficacious in those of the serous membranes.
Heroine (not official) is morphine diacetic ester, which as a
hydrochloride is freely soluble in water and alcohol. It gen-
erally produces no disagreeable symptoms, beyond headache,
and is stated not to give rise to habituation. A more extended
knowledge of the drug, however, would seem to indicate that
the latter assertion is not entirely correct. It occasionally pro-
duces violent and uncontrollable vomiting. Since it diminishes
the sensitiveness of the respiratory centres to an excess of car-
bon dioxide in the blood, it is useful in some forms of dysp-
noea. It is of great value in quieting cough.
Dionine (not official) is morphine mono-ethyl ester hydro-
chlorate, which is readily soluble in water. It is somewhat
opium. 861
hypnotic, and like heroine is useful to allay cough. It is said
to check night sweats.
Peronine (not official) is morphine benzylic ester hydro-
chlorate, soluble in water. This is .hypnotic, producing sound
sleep without previous excitement, and is useful in allaying the
cough of pulmonary tuberculosis, chronic bronchitis and pertus-
sis.
TOXICOLOGY.
Acute . Poisoning. — The symptoms usually appear in from ten
minutes to one hour after opium has been taken by the mouth. As
might be expected from the effects of the drug upon the central nervous
system, they are those of profound narcotism. Drowsiness may or may
not be preceded by some slight excitation, and as a rule it supervenes
very quickly. The drowsiness passes into sleep, from which the patient
may be roused, but soon this deepens into stupor and eventually into
complete coma, in which reflex excitability is abolished and no stimula-
tion of any kind has the slightest effect. A characteristic phenomenon is
the extreme contraction of the pupils. The countenance, at first flushed,
becomes pale and then cyanotic, while the lips are livid. The general
surface is cold, and as the poisoning advances becomes bathed with
prespiration. In the earlier stages the pulse is apt to be full, slow and
laboring : later it becomes so weak as to be almost imperceptible. The
breathing gradually grows slower and more stertorous, as well as irregu-
lar. The limbs are relaxed, but death, which, as mentioned, is due to
respiratory failure, may possibly be preceded by asphyxial convulsions.
The fatal result may occur in from two to ten hours. Even when coma
and convulsions have developed, recovery is possible, and in that case
the coma passes into a condition of slumber which not infrequently lasts
for from twenty-four to thirty-six hours. The patient is then apt to
suffer from much nausea, headache and nervousness.
Diagnosis of Poisoning by Opium. — (i) From Alcoholic Poisoning. —
This is often very difficult, especially when the patient has taken alcoholic
stimulus, and it is important that a correct history of the case should be
obtained, if possible. Points of difference are that in opium poisoning
the pupils are more minutely contracted and the patient can be roused
with less difficulty. The breath usually has a characteristic odor after
opium (though not after morphine), but this may be obscured by the
smell of alcohol if this has been taken. An examination of the urine
may perhaps be of service in determining the true condition present.
(2) From Cerebral Hemorrhage. — If the pupils are unequally dilated,
862 PHARMACOLOGY AND THERAPEUTICS.
cerebral haemorrhage is present. If such haemorrhage has its site in the
pons Varolii, the resultant contraction of the pupils may render the
differential diagnosis very difficult, and local paralysis should be care-
fully looked for. When hemiplegia is present, the recognition of cere-
bral haemorrhage is easy. With a small haemorrhage, and especially in
the pons, the temperature may be elevated, while with a large one, this
is lowered for the first few hours, though it may rise afterwards. (3)
From Phenol Poisoning. — While here there may be coma and con-
traction of the pupils, the characteristic odor of the acid is present
and its caustic effects may be observed upon the mucous membrane of
the mouth. The urine is dark and smoky, and gives little of no pre-
cipitate with barium chloride. (4) From Chloroform and Ether Poison-
ing.— The smell of the breath and of the matters vomited will be a
sufficient indication that the coma is due to one of these drugs." (5)
From Uremia. — In uraemia the presence of albuminuria, even if no
other sign of Bright's disease can be detected, will show the nature of
the case. The odor of the breath is also characteristic in uraemia. (6)
From Diabetic Coma. — Here the odor of the breath is likewise character-
istic, and sugar will be found in the urine. (7) From the Comatose
Stage of an Epileptic or other Fit. — In this condition the lividity of the
face does not become progressively more marked, and the pupils are as
a rule dilated. The history of the case, if obtainable, is also of service.
Post-mortem. — The appearances are simply those characteristic of
asphyxia. If death is due to opium, and not its alkaloids, the odor of
the drug may be detected. The condition of the pupils varies in
different instances. The gastric mucous membrane is sometimes found
to be reddened.
Treatment. — The stomach should be washed out, not merely once, but
repeatedly and at short intervals, because the morphine which has been
absorbed is excreted into the stomach. On this account the evacuation
of the latter is called for whether the drug has been taken subcutaneously
or not. Prompt emetics {see p. 175) should also be given, and especially
apomorphine hydrochloride hypodermatically. If narcosis has already
set in, however, the action of emetics may be materially interfered with.
Potassium permanganate, well diluted, has been successfully used in an
amount equal to that of the alkaloid ingested ; it almost immediately
destroys the latter, through its chemical action. It is claimed that it
can act upon the poison when in the blood, so that a hypodermatic injec-
tion of it even for some hours after its ingestion * may afford relief.
This has been denied, however, and it would seem probable that it is
efficient only on that part of the poison present in the stomach. The
OPIUM. 863
reports have been so generally favorable that potassium permanganate
should be used immediately. It has been recommended that atropine
sulphate (.003 gm. ; ^ gr.) should be given hypodermatically, or tincture
of belladonna (2 c.c. ; 30 TTL) by the mouth, and repeated every fifteen
minutes ; but great caution must be exercised with the use of this anti-
dote— if, indeed, it should be employed at all. Instances of recovery
from opium poisoning followed by death from the belladonna or atropine
given as an antidote have been observed. Some advise that .006 gm.
(yL gr.) of atropine sulphate should be given as soon as possible, and
not repeated. Caffeine, especially in the form of strong, black, hot
coffee, is one of the best antidotes, and given in this way the tannin is
also useful. Coffee may be administered by the mouth, and an enema
of it (500 c.c. ; 1 pint) should also be given. Every effort should be
made to rouse the patient and keep him awake, especially by walking
him about, as the constant movement contributes to the better tone of
the medullary centre. Flapping with a towel, pinching, etc., may also be
restored to, as well as such general reflex stimulants as the application
of the faradic current, cold affusions, the inhalation of ammonia, and
the hypodermatic injection of ether. The patient should be kept warm,
and artificial respiration may be called for. Oxygen or amyl nitrite
inhalations are sometimes of service. The treatment must be kept up
for several hours, of necessary.
Chronic Opium Poisoning. — Chronic poisoning is, unfortunately,
quite common, opium (usually in the form of laudanum or pills) being
taken habitually by the mouth, or morphine by hypodermatic injection.
The effects of the prolonged use of the drug, mental, moral and physical,
are most deplorable. The symptoms, however, are more or less indefi-
nite, and some individuals appear to continue the habit for many years
with comparative immunity. Usually the patient loses weight, becomes
anaemic, and suffers from loss of appetite and indigestion. The bowels
may be continuously constipated, or constipation may alternate with
diarrhoea. The pupils are contracted, the skin and tongue dry, and the
nails brittle, while the hair turns prematurely gray and falls out. The
heart is apt to be irregular, and muscular tremors and unsteadiness of
gait are often observed. The patient is nervous, lacking in energy and
will-power, and entirely unfit for work of any kind. He is utterly un-
trustworthy in his statements, and becomes lost to all sense of honor
and uprightness ; lying in the most bare-faced manner and even com-
mitting theft, if necessary, in his endeavors to obtain the drug. Sexual
impotence is a common result, and melancholia and dementia may
eventually supervene, especially when morphine is used. In morphine
864 PHARMACOLOGY AND THERAPEUTICS.
habitues the arm, leg, or front of the body will usually be found to be
scarred with marks of the needle. The craving for the drug is so
intense that the patient suffers agonies when temporarily deprived of it,
and it becomes necessary for him to increase the dose from time to time
in order to secure the desired effect. The daily quantity of morphine
used is thus often exceedingly large. The practice of opium smoking,
the method of employment in vogue among Oriental peoples, appears
to be less harmful in its results than the prolonged use of opium by the
mouth or morphine by subcutaneous injection.
Treatment. — The treatment of chronic poisoning is attended with
immense difficulties, especially on account of the degraded moral con-
dition of the habitue, and is very often unsuccessful in effecting a cure.
As a rule, the patient should be isolated, and watched with the greatest
vigilance to prevent his securing the drug surreptitiously. The morphine
must not be withdrawn suddenly, as this is likely to be attended by
collapse and aggravated mental disturbance, but the dose should be
gradually diminished until it is deemed judicious to stop it altogether.
There is no known drug which seems to have any curative effect, and
the results of substituting agents such as cocaine for morphine have
always proved disastrous. No reliance can be placed upon any of the
advertised cures for the morphine habit ; most contain morphine and
the remainder are useless. The patient on entering an institution for
his cure must be most thoroughly and carefully searched so that he
shall not be possessed of a supply sufficient to keep him comfortable
during his treatment.
Atropine. — Atropine {see p. 803) is a valuable antidote to morphine,
especially from the fact that it powerfully stimulates the respiratory
centre, and also because it tends to antagonize the depressing effects
of this drug upon the cerebrum and upon intestinal peristalsis. At
the same time, as mentioned above, the danger of substituting bella-
donna for opium poisoning must always be borne in mind. While
appearing to be antagonistic in some other respects, this is really not
the case. Thus, although it arrests perspiration and dilates the pupil,
it produces these effects by its action on the peripheral nerve termina-
tions, while the opposite effects caused by morphine are due to action
on the central nervous system. Still, it is found that in giving
morphine by hypodermatic injection, certain of its disadvantages,
such as indigestion, constipation and cardiac depression may be pre-
vented or rendered less marked by combining atropine sulphate (.0004 to
.0006 gm. ; Ti^ to T^gr.) with each dose.
CODEINE. 865
CODEINA.— Codeine. (Methyl Morphine.) Dose, 0.030 gm. (30
milligm.); y2 gr.
CODEINJE PHOSPHAS.— Codeine Phosphate. Dose, 0.030 gm.
(30 milligm.) ; y2 gr.
CODEINE SULPHAS.— Codeine Sulphate. Dose, 0.030 gm. (30
milligm.); y2 gr.
Action of Codeine.
Codeine is much less toxic than morphine, which it some-
what resembles in the general character of its action. While it
is powerfully analgesic, however, its hypnotic influence is quite
limited. Small doses induce light sleep, but somewhat larger
ones are apt to cause restlessness and more or less exaggera-
tion in the reflex excitability. It is much less depressant to
the higher cerebral centres than morphine, and has a decidedly
stimulating effect upon the spinal cord, as well as the medulla
and lower parts of the brain. Owing, it is believed, to its
action on the cord, tetanic spasm is sometimes caused by
large doses. In man it is much less constipating than mor-
phine or opium, and in animals not infrequently has a purga-
tive action. It has comparatively little effect in slowing the
respiration, and, though the pupil is slightly contracted while
the sleep it causes lasts, dilation is observed when the excite-
ment stage follows.
Therapeutics of Codeine.
In diabetes it is frequently used for reducing the amount of
sugar in the urine, which it does more effectually than opium
itself. For this purpose it is usually given as a pill or in a
syrup. It is, as mentioned, very efficient in relieving cough
of all kinds, and is an excellent substitute for morphine as an
ingredient of expectorant mixtures. It is also very useful for
allaying ovarian pain and as an analgesic generally, and is
especially esteemed in cases where, as often happens in malig-
nant disease, an anodyne effect is required to be maintained
more or less continuously.
56
866 PHARMACOLOGY AND THERAPEUTICS.
The other more important alkaloids of opium are the fol-
lowing:
Papaverine. — This is regarded as occupying a position mid-
way between morphine and codeine as regards its action on
the central nervous system, but it is very much less powerful
than either. After large quantities some tetanic spasm may
be produced by its action on the spinal cord, and, by a direct
action on the cardiac muscle, the rhythm of the heart is
slowed by it.
Anarcotine (known also as narcotine) is even less depres-
sant than codeine, and reflex stimulation characterizes its action.
It is an antiperiodic and valuable in the prevention as well as
the treatment of malarial fever.
Thebaine (paramorphine), rather than a depressant, has a
stimulating character, which appears to be identical with,
though much feebler than that of strychnine. It has been found
to increase peristalsis in the intestine.
HYDRATED CHLORAL.
CHLORALUM HYDRATUM.— Hydrated Chloral. (Chloral U. S.
P., 1890.) Dose, 1 gm.; 15 gr.
Unofficial Preparations.
Hypnalum. — Hypnal. (Antipyrine Monochloral.) Dose, 1
gm.; 15 gr.
Hypnonum. — Hypnone. (Phenyl-methyl-acetone.) Dose, 0.30
to 0.60 c.c; 5 to 10 TTt.
Somnalum. — Somnal. (Ethylirtes Chloral-urethane.) Dose, 1
to 4 c.c; y4 to 1 fl. dr.
Action of Hydrated Chloral.
External. — Like chloroform, chloral has marked antiseptic
properties. Locally, it is irritant, and at the same time anaes-
thetic. Applied to the unbroken skin in concentrated solution
it causes redness and sometimes vesication. On raw surfaces
HYDRATED CHLORAL. 867
it has a decided corrosive action, and when injected subcuta-
neously is liable to excite considerable irritation.
Internal. Alimentary Canal. — Unless well diluted, it is irri-
tant to the gastro-intestinal mucous membrane, and is there-
fore apt to occasion nausea, vomiting and purging.
Blood. — Chloral was first introduced as a hypnotic under the
supposition that it was decomposed in the blood and chloroform
liberated, but it is now known that it circulates unchanged,
since no chloroform is found in the blood or expired air, and
the drug itself is present in the urine both in a free state and
in combination with glycuronic acid.
Circulation. — Large amounts, by depressing the vaso-motor
centre in the medulla and by direct action on the cardiac muscle,
have the effect of slowing and weakening the heart and of
producing a fall of blood-pressure. It is thought probable also
that the action of the drug on the muscular walls of the vessels
has some influence in reducing the arterial tension. The same
alterations in the heart are produced as by chloroform, the
auricular contractions becoming weak before the ventricular,
and some dilatation occurring in both cavities. In fatal poison-
ing the heart is arrested in diastole. In consequence of the
vaso-motor paralysis, there results a marked dilatation of the
cutaneous blood-vessels, and this may give rise to eruptions on
the skin. Moderate doses usually have little effect on the pulse
or blood-pressure, though these may possibly be transiently
raised. Sometimes, however, even small amounts have a dis-
tinctly depressing effect upon the heart.
Respiration. — Under large doses the respiratory movements
become more and more slow and shallow from the depressing
action of the drug on the medullary centre, which may be aided
by the extreme weakness of the heart. In fatal cases death
usually occurs from paralysis of the respiratory centre, though
sometimes, as in the case of chloroform, it is due to paralysis
of the weakened heart. With moderate doses the respiration
becomes slower and weaker, but scarcely more so than in nat-
ural sleep, in which the excitability of the respiratory centre and
868 PHARMACOLOGY AND THERAPEUTICS.
the volume of the inspired air appear to be very much the same
as after small amounts of chloral. '
Central Nervous System. — Chloral is the purest hypnotic we
possess. It has the effect of depressing and eventually com-
pletely paralyzing the central nervous system. Under its influ-
ence there is a successive depression, first of the brain, then of
the spinal cord, and finally of the medulla oblongata. With
small doses, therefore, it is often possible to confine the action
of the drug entirely to the cerebrum, with the result of pro-
ducing a sleep closely resembling ordinary sleep. Under some-
what larger quantities the sleep is more profound, and there is
a depression of the spinal reflexes, while under still larger
amounts the depression extends to the medullary centres, which
are finally paralyzed. Chloral differs from morphine in ap-
parently having no specific action on the analgesic areas of the
brain ; so that acute pain is apt to prevent sleep after it. While
a powerful hypnotic, it is not, therefore, an analgesic. It has
also less influence on the sensibility of the skin than morphine,
though very large doses cause anaesthesia. The pupil is al-
ways contracted under chloral. The irritability of the motor
areas of the cerebral cortex is reduced by it, and they finally
fail to respond to the strongest electrical stimulation. The
spinal reflexes become paralyzed before the failure of the res-
piration. In the frog it has been observed that the depression
of the reflex irritability may be preceded by a temporary in-
crease, but this is believed to be probably due rather to the
remote effects of the local irritation than to the direct action
of the drug on the cord. Chloral appears to have no action
on muscle or nerve when taken internally or injected into the
circulation, but when applied to an exposed nerve it is found first
to irritate and then paralyze it, and, when injected directly into
the artery of a muscle, to produce immediate rigor. After the
sleep caused by it the patient usually awakes refreshed, and free
from headache or other disagreeable symptoms, though occa-
sionally nausea and discomfort are felt.
Temperature. — Chloral causes a considerable reduction in the
HYDRATED CHLORAL. 869
temperature, and this is largely due to the diminished heat pro-
duction from the lessened muscular activity. Another factor,
no doubt, is the increased output from the dilatation of the
cutaneous vessels, and it is possible also that the irritability of
the heat-regulating centres in the brain may be diminished.
Skin. — Chloral habitues often present peculiar purplish
blotches upon the face.
Metabolism. — There appears to be an increased destruction
of proteids, with a more or less incomplete oxidation of waste
products. The acidity of the urine is found to be much in-
creased by the presence of urochloralic acid (a combination of
chloral and glycuronic acid), and the alterations in the metab-
olism are attributed to the excessive production of this acid
in the tissues. It is to be noted also that less oxygen is ab-
sorbed and less carbon dioxide given off in consequence of the
lessened muscular movement.
Excretion. — It is excreted mainly by the kidneys as chloral
and more largely as urochloralic acid. Part of it, however,
is thrown into the stomach, and to this circumstance may pos-
sibly be due, it is thought, the gastric irritation which, as men-
tioned, is in some instances experienced on awaking from the
sleep caused by chloral.
Therapeutics of Hydrated Chloral.
External. — Chloral is used to some extent as a rubefacient
and counter-irritant, as well as an antiseptic, but it is more
expensive than many other equally effective remedies. As a
wash or dressing for suppurating wounds, cancer of the uterus,
foul ulcers, etc., it may be applied in a solution of the strength
of .30 to .60 gm. (5 to 10 gr.) to 30 c.c. (1 fl. oz.), and for
bromidrosis or hyperidrosis in solutions of from 2 to 5 per
cent. A 1 per cent, solution has been found efficient as an
injection in gonorrhoea, and a 10 per cent, solution as an injec-
tion (into the sac) for hydrocele. The same may be injected
into the neighborhood of varicose veins, with the effect of caus-
ing gradual coagulation of the blood and contraction of the
87O PHARMACOLOGY AND THERAPEUTICS.
vessels. The injection per rectum of from 1 to 1.60 gm. (15
to 25 gr.) of chloral, properly diluted, has been used as a
remedy for haemoptysis. The continued application of a solu-
tion of 4 gm. (1 fl. dr.) in 16 c.c. (4 fl. dr.) each, of glycerin
and water, has been recommended as a successful treatment for
furuncle. Chloral solutions (about 5 per cent.) may be applied
to parasitic skin diseases, such as tinea versicolor, and used to
allay itching in eczema, prurigo, etc. The powdered drug in-
corporated in ointments is also of service in relieving the itch-
ing of cutaneous affections. In urticaria the following lotion
has been employed : Chloral, 5 ; boric acid, 30 ; distilled water,
180 parts. In combination with other remedies it is used as
a local anodyne and counter-irritant in neuralgia, pleurodynia,
lumbago and other painful affections. An excellent prepara-
tion of this kind is composed of equal parts of chloral, camphor
and menthol, rubbed up together to form a liquid. It may be
applied to aching teeth and also to the larynx to relieve pain.
It is also an effective preparation for rubbing into the legs to
relieve painful cramps in the calves.
Internal. — Chloral has the advantages of being a promptly-
acting and certain hypnotic. It is far from being a safe one,
however; it depresses the heart and respiration so markedly
that the prescriber should be always upon his guard. It does
not relieve the distress and cough of disease of the heart and
lungs, and must naturally be given, if at all, with special cau-
tion when these organs are affected. It had better be avoided
for the most part, also, when stomach or bowel troubles are
present, as it is very liable to increase the irritation of these
parts. In the insomnia of fevers it is often of great service
in the early stages, but as the disease progresses, the weakness
of the heart may contra-indicate its use. As has been stated,
it is of no value in producing sleep in cases in which insomnia
is due to pain from any cause. It has been used as a cerebral
depressant in puerperal convulsions, delirium tremens, and
mania, but very large doses are usually required, and the effects
of the drug must be watched with great care. Cases are re-
HYDRATED CHLORAL. 8/ I
corded in which it has caused sudden death in alcoholics with
fatty heart. In threatened delirium tremens, however, sleep
may sometimes be induced by quite moderate doses in associa-
tion with potassium or sodium bromide. It is of special value
in sleeplessness from mental over-work, worry, etc.. and in other
forms of nervous insomnia. A very important use of chloral
is in midwifery; here it has been designated the medicinal for-
ceps. Frequently after rest has been obtained by this drug
labor proceeds vigorously and is rapidly terminated. It has
been employed with more or less success in incontinence of
urine, tetanus, and poisoning by strychnine, physostigma and
picrotoxin. If on account of spasm the patient is unable to
swallow, it may be administered by the rectum. It is especially
indicated in tetanus and strychnine poisoning because it de-
presses the motor tract of the spinal cord. It is a safer remedy
for children than for adults, and is often prescribed for infan-
tile convulsions, chorea, laryngismus stridulus, whooping-
cough, and other spasmodic affections. It sometimes acts very
happily in controlling or alleviating the paroxysms of whoop-
ing-cough. Chloral is of considerable value in seasickness,
and may sometimes be efficacious in the morning sickness of
pregnancy, especially in cases in which there is much dizziness,
faintness, and repugnance to food, with but little vomiting.
Should the odor of the drug tend to excite nausea, it may be
given by the rectum. Administered in this way it has been
advised for other forms of nausea and vomiting of reflex origin,
such as occur in uterine fibroids and various other conditions.
Notwithstanding the theoretical objections to the use of the
drug in gastro-intestinal disorders, in severe cholera morbus,
with symptoms of collapse, and in true cholera the hypoder-
matic injection of chloral is considered by some the most effec-
tive treatment that we have, and especially when morphine is
employed with it. A favorite vehicle for the administration of
chloral is syrup of tolu, and its unpleasant taste can be con-
cealed by giving it in bottled " lemon soda."
Hypnal is a compound of chloral with antipyrine made by
872 PHARMACOLOGY AND THERAPEUTICS.
mixing their solutions, and is obtained in crystalline form. It
was proposed as a hypnotic, more certain than chloral, nearly
free from taste, entirely free from irritating effect upon the
mucous membranes, and having distinct analgesic effects. It
has been but little used.
Hypnone, while not a very powerful hypnotic, is said to be
especially useful in the insomnia of alcoholism. In moderate
doses it is ordinarily devoid of danger, its only unpleasant
result being a disagreeable odor left on the breath. In very
large doses it has induced coma, followed by cardiac and res-
piratory paralysis.
Somnal is regarded as a fairly satisfactory hypnotic, but,
like other agents of its class, it will not always produce the
desired effect.
TOXICOLOGY.
Acute Poisoning. — The symptoms of poisoning, as might naturally
be supposed from the physiological action of the drug, closely resemble
those of opium. Thus, there is profound coma, with weak and slow
respiration and pulse and lividity of the surface. There is complete
muscular relaxation, the reflexes are abolished, and the pupils contracted.
The temperature is depressed, and the skin cold and clammy. The
action of the heart is irregular as well as weak, and before death may
become rapid. The pulse should always be carefully watched whenever
chloral has been administered. It frequently happens that symptoms
of failing heart come on unexpectedly even after small doses.
Treatment. — The stomach should be evacuated by the stomach tube.
Emetics (see p. 175) may be employed, but are of less value on account
of the depressing action of the drug on the medullary centres. Artificial
warmth must be supplied by means of hot bottles and blankets, and the
temperature maintained also by friction and massage. Somnolence is to
be resisted by injecting strong coffee into the rectum and by such
measures as flagellation, douches, flapping with wet towels, and shout-
ing at the patient. On account of the cardiac depression, the patient
should not be forced to take active exercise, such as brisk walking. The
inhalation of amyl nitrite may be employed to stimulate the heart, and
strychnine or caffeine subcutaneously injected to stimulate the respira-
tion. Artificial respiration may also be called for.
Chronic Poisoning. — The chloral habit is very easily acquired by
persons who have used the drug in ordinary doses for even a short
BUTYL-CHLORAL HYDRATE. 873
time continuously for the relief of insomnia or other purpose, and, once
established, it produces serious results and is very difficult to break up.
The patient suffers from digestive disturbances, marked physical and
mental weakness, with sudden flushings due to vaso-motor derangement,
from palpitation of the heart, and from erythematous eruptions, gener-
ally of a purplish color, especially found on the face. In some instances
there are bed-sores, ulcerations and sloughs. Dyspnoea, dependent upon
the cardiac and respiratory depression and the general cachexia, is a
prominent symptom. Sleep can be secured only by the accustomed
hypnotic, and an over-dose may at any time result in collapse and
death, since by reason of the cumulative effects of the poison in the
system the vital functions are greatly impaired and elimination may be
rendered impossible. It is to be noted also that the sudden withdrawal
of the drug may lead to symptoms resembling those of delirium tremens,
and as fatty degeneration of the heart is likely to be present, such a
development is sometimes attended with the gravest danger.
Unofficial Preparation.
Butyl-CMoral Hydras (B. P.).— Butyl-Chloral Hydrate.
(Croton Chloral Hydrate.) Dose, 0.30 to 1.20 gm.; 5 to 20 gr.
Action of Butyl-Chloral Hydrate.
The action of butyl-chloral hydrate is apparently identical
with that of chloral. It has been claimed that it is much less
depressant to the heart and circulation; also that it possesses
more analgesic power than chloral and that it has a specific
anaesthetic action on the nerves of the face and head. These
statements, however, have been denied by writers of high
authority, who assert that such claims have been disproved by
the results of experimental research.
Therapeutics of Butyl-Chloral Hydrate.
Whether the drug has the specific analgesic action alleged
or not, there is some clinical evidence going to indicate that
it may be preferable to chloral in insomnia due to pain. On
the whole, however, it has failed to sustain itself, and is less
used now than formerly. Some have found it very efficacious
in facial neuralgia and migraine, particularly when the fifth
874 PHARMACOLOGY AND THERAPEUTICS.
nerve is involved, but in the experience of others, if it has
afforded any relief in tic douloureux and similar painful states,
the effect has been only temporary. It has been recommended
in the headache and neuralgia associated with carious teeth, in
headache of pregnancy, in neurasthenic headaches and those
due to eye-s.train, and also in dysmenorrhea and sciatica.
CHLORALFORMAMIDUM.— Chloralformamide. (Chloralamide.)
Dose, 1 gm.; 15 gr.
Action of Chloralformamide.
This compound appears to have the cerebral action of chloral,
without its depressing effects upon the circulation; the latter
being counteracted by the stimulating influence of the forma-
mide. In poisonous doses only does it produce any noteworthy
depression. It is also less liable to produce gastric irritation
than chloral, but would seem to be somewhat slower and less
certain in its hypnotic effect. Chloral is formed by its decom-
position in the body, and fatty degeneration is said to have been
observed after its prolonged administration. Cutaneous erup-
tions are sometimes produced by it.
Therapeutics of Chloralformamide.
Chloralformamide may be employed in all cases in which
chloral is indicated. It usually induces calm, refreshing sleep
without any unpleasant after-effects, but in some instances
causes confusion, dizziness and headache. It is generally re-
garded as of no more service than chloral in insomnia due to
pain, but some claim that it has a distinct anodyne effect, and
that it is useful in neuralgia and in the pains of tabes dorsalis.
It has been given with good results in some cases of nocturnal
epilepsy and also in chorea. There seems to be no question
that it is better borne than chloral when cardiac weakness is
present, and it has sometimes been found to give relief in asth-
matic symptoms due to heart trouble. If given for sleepless-
ness at night in the form of capsule or powder, it is advisable,
on account of the slowness with which it is absorbed, that the
CHLORATONE. 875
dose should be administered rather early. Perhaps the best
way to give it is dissolved in a little alcohol. 1.20 gm. (20
gr.), or more, may be dissolved in a sufficient quantity of
brandy, and then water added at a temperature not above 54.40
C. (1300 F.). It may also be administered very satisfactorily
in a watery solution with syrup and a little dilute hydrochloric
acid. 60 c.c. (10 TTL) of aromatic sulphuric acid added to 30 c.c.
(1 fl. oz.) of water will generally dissolve 2 gm. (30 gr.) of
chloralformamide, but not always, as some specimens of the
drug are very insoluble. It may be given by the rectum as well
as the mouth. Remarkable results have been obtained in seasick-
ness from the use of chloralformamide in association with potas-
sium bromide. In order to secure the best effect it is advised
that the patient should take a cholagogue for two days before
sailing. As soon as he gets on board the ship he should take 2
gm. (30 gr.) of each drug on an empty stomach, and at once
go to bed and sleep. This combination may be of service in
acute mania and other forms of insanity, and has been used in
a proprietary medicine known as " chlorobrom." In using
chloralformamide continuously it is not necessary to increase
the dose, and with it there appears to be less danger of the
patient's becoming an habitue of the drug than in the case of
chloral.
Unofficial Preparation.
Chloretonum. — Chloretone. (Trichlor-tertiary. Butyl Alcohol.
Acetone-Chloroform.) Dose, 0.30 to 1.20 gm.; 5 to 20 gr.
Action of Chloretone.
Without markedly influencing respiration or blood-pressure
it produces anaesthesia and sleep. The hypnotic effect is ob-
tained by the use of smaller amounts than are required in the
case of chloral. It directly affects sensory nerves, and so may
be used as a local anaesthetic. After excessive doses of it
dogs may sleep for several days, finally succumbing from
asphyxia. Since neither acetone nor chloroform are found
in the expired air or the urine, and the chlorides are increased
in the latter, it is probably broken up in the body.
8y6 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Chloretone.
In one per cent, solution it may be applied as a local anaes-
thetic to ulcers and infected wounds. Internally, its chief use
is as a hypnotic which is both safe and generally efficient. In
moderate -doses it promptly relieves irritability of the stomach.
Unofficial Preparation.
Anhydrogluco-Chloralum. — Anhydrogluco-Chloral. (Chlo-
ralose.) Dose, 0.10 to 0.25 gm.; 2 to 4 gr.
Action of Chloralose.
Chloralose will produce sound sleep in which sensibility is
not lost, although the reflex activities are greater than usual.
By its excitation of the spinal cord the reflexes may be increased
until convulsions resembling those of strychnine result. The
sleep is caused by its depressant action on the functions of the
brain, and the awakening is without unpleasant effects. Unless
very large doses are given the heart and respiration are not
acted upon.
Therapeutics of Chloralose.
Chloralose on account of its bitter taste is best given in cap-
sules. .60 gm. (10 gr.) have produced profound unconscious-
ness, so that caution should be exercised in prescribing it. This
drug has been known to produce diplopia, muscular tremors,
and other unpleasant results, and if a habit is induced by its
constant use, it is said that its hypnotic influence is diminished,
while the untoward effects are more likely to be marked. In
nervous and tuberculous patients it may possibly give rise to
tetanic or cataleptic symptoms, with disturbance of the mental
faculties.
Unofficial Preparation.
Bromalum, CBr3COH.— Bromal. Dose, 0.12 to 0.24 gm.; 2 to
4 gr.
Action of Bromal.
It resembles chloral in its chemical properties, like it exist-
ing as an oily colorless liquid, or, when united with water or
PELLOTINE. 877
alcohol, as a crystalline hydrate or alcoholate. It is prepared
by slowly adding from 3 to 4 parts of bromine to refrigerated
alcohol; the mixture being distilled after fifteen or twenty
hours of contact. It depresses the heart like chloral, but is
much more poisonous. In several respects, however, it differs
from chloral in its action. In animals it causes at first rest-
lessness and excitement and afterwards stupor, which is often
accompanied by dyspnoea, and terminates in respiratory failure
or in convulsions. There are marked contraction of the pupil
and profuse salivation.
Therapeutics of Bromal.
.18 gm. (3 gr.) administered at bedtime are said to have
produced sleep or relieved pain, but the drug appears to be
distinctly dangerous, and scarcely deserves a place in medicine.
Unofficial Preparation.
Amyleni Hydras.— Amylene Hydrate. (Dimethylethyl-carbi-
nol. Tertiary Amylic Alcohol.) Dose, 2 to 4 C.C.; y2 to 1 fl. dr.
Action of Amylene Hydrate.
Amylene hydrate is a hypnotic, about midway in power be-
tween chloral and paraldehyde, and having a pleasanter taste
than the latter. The sleep is generally natural, and the awaken-
ing prompt and complete. It is a safe hypnotic, having but little
action upon the heart or respiration, and it appears also to have
anodyne properties.
Therapeutics of Amylene Hydrate.
It can be administered in wine, raspberry syrup, or simply
in water. It has been given hypodermatically, with one-half
its volume of alcohol. After continued use it is apt to dis-
agree with the stomach.
Unofficial Preparation.
Pellotinum. — Pellotine (an alkaloid of Anhalonium). Dose,
0.03 to 0.06 gm.; y2 to 1 gr. (hypodermatically).
8y8 PHARMACOLOGY AND THERAPEUTICS.
Action of Pellotine.
In frogs slight narcosis follows its injection in from ten to
fifteen minutes. The reflexes are somewhat diminished. After
twenty to thirty minutes there appears a distinct increase
of reflex irritability, followed by spasms, resembling strychnine
poisoning. If large doses are administered this condition may
pass into one of complete paralysis. In man the pulse rate is
slightly diminished, and drowsiness and sleep supervene. It
apparently has no effect on the secretions. The drug is prob-
ably excreted by the kidneys.
Therapeutics of Pellotine.
Pellotine has been recently introduced as a hypnotic which,
because it is unirritating, can be used hypodermatically. With
the slight slowing of the pulse, it induces a feeling of weariness,
weight of eyelids and limbs, and disinclination to mental and
bodily exertion, and a quiet sleep follows. The awakening is
easy and usually without untoward symptoms. In full doses,
with the patient in an upright position it may give rise to
vertigo. It is somewhat analgesic, as well as hypnotic, and
has afforded relief to the pains of locomotor ataxia and
peripheral neuritis.
SULPHONMETHANE.
SULPHONMETHANUM. — Sulphonmethane. (Diethyl sulphonedi-
methylmethane. Sulphonal.) Dose, 1 gm.; 15 gr.
Action of Sulphonmethane.
Sulphonmethane, or Sulphonal, while a less efficient hypnotic
than chloral, is also less dangerous, as it has no depressing
cardiac action. It does not affect the heart directly, though it
may cause a slight quickening of the pulse through its depres-
sant effect upon the inhibitory centre. Through its action on
the central nervous system it also has some influence in dimin-
ishing metabolism. Its excretion appears to be slower than its
absorption, so that there is a tendency to a cumulative action,
SULPHONMETHANE. 879
This may lead to gastritis, renal disease, and certain changes
in the blood which are not very clearly understood. In conse-
quence of the latter there is a characteristic discoloration of
the urine, due to the presence in it of a reddish-brown pigment,
haematoporphyrin, which is an iron-free product of the decom-
position of hsematoglobin. This is found to occur chiefly in
anaemic women, and is accompanied by constipation, vomiting
and gastric pain, weakness and ataxia, confusion and partial
paralysis, while eventually there may result suppression of the
urine or collapse and death. Several fatal cases of poisoning
by this drug have been reported from small doses continued for
long periods. Sulphonal does not often lead to a habit, but
cases of this are sometimes met with. Though its continued
use may not induce the very grave results mentioned, it may
be attended by severe functional disturbances. Persons taking
it regularly for a considerable time are liable to suffer from
mental, moral and muscular weakness, indigestion, impaired
nutrition, and persistent cutaneous eruptions. The untoward
effects of the drug can usually be avoided by intermitting its
administration from time to time. It is thought to have some
deleterious action on the heart when used for long periods,
and is found to be a much less certain hypnotic in cases of
cardiac disease than in other conditions. Very large quanti-
ties of sulphonal have been taken without fatal results, and in
fact without any more serious consequences than prolonged
unconsciousness. An enormous single dose, however, has been
known to cause paralysis of the sphincters, anuria, a fall of
temperature, and, late in the case, depression of respiration.
Very large amounts are said to produce convulsive movements
in animals. The drug is largely decomposed in the body, and
excreted in the urine as ethylsulphonic acid, but a small portion
escapes unchanged. Sulphonal has little or no effect in reliev-
ing pain. As its absorption is very slow on account of its
insolubility, sleep is somewhat late in following its administra-
tion, and not infrequently more or less drowsiness and depres-
sion are experienced the next day.
880 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Sulphonmethane.
Sulphonal is used exclusively to produce sleep. It is prefer-
ably administered in hot water, but on account of their con-
venient form, it is often given in wafers or tablets. These
should be taken at least an hour and a half before the time
when sleep is desired.
SULPHONETHYLMETHANE.
SULPHONETHYLMETHANUM.— Sulphonethylmethane. ( Diethyl
sulphonmethylethylmethane. Trional.) Dose, 1 gm.; 15 gr.
Unofficial Preparation.
Tetronalum. — Tetronal. (Diethyl sulphondiethylmethane.)
Dose, 1 to 2.40 gm.; 15 to 40 gr.
Action of Trional.
Sulphonethylmethane, or Trional, is a prompt hypnotic, with-
out cumulative action, and it has no injurious or unpleasant
after-effects. Apparently the patients do not become habitu-
ated to its use.
Therapeutics of Sulphonethylmethane.
As it is more soluble, quickly absorbed and active, trional is
generally preferred to sulphonal. It has been used as a hyp-
notic and sedative for the insane; for narcotic habitues, so far
as is known, it is a safe remedy. It is important that the daily
action of the bowels be secured, an alkaline water be given
daily, and weekly intermissions be insisted upon; otherwise it
may give rise to disagreeable after-effects. It but rarely pro-
duces hsematoporphyrinuria. As in the case of sulphonal,
multiple neuritis may very rarely follow the prolonged admin-
istration of small doses of trional.
Tetronal is of similar chemical composition, containing four
instead of three ethyl groups, and is used for the same pur-
poses, but in somewhat larger dose.
VERONAL. 50 1
VERONAL.
Unofficial Preparation.
Veronalum. — Veronal. Dose, 0.5 to 1.5 gm.; iy2 to 22y2 gr.
in hot liquids.
Action of Veronal.
External. — None.
Internal. Alimentary Canal. — It does not usually cause nau-
sea, vomiting or any gastric disturbance.
Blood. — It probably has no effect upon the blood, for no blood
pigments appear in the urine.
Circulation. — It does not influence arterial tension, nor does
it have any effect upon the pulse rate.
Skin. — A slight antipyrine-like rash, has been observed in a
few instances, accompanied by itching.
Respiration. — There is no effect.
Temperature. — This is slightly lowered two or three hours
after a moderate dose has been taken.
Brain. — Sleep generally ensues within an hour after the in-
jection of the drug and is likely to last from four to ten hours.
The awakening may be accompanied by some torpor.
Spinal Cord. — There is a possible analgesic action.
Excretion. — The urine usually remains normal, free from
albumin, sugar, and blood pigment. In very rare instances
the drug causes hsemato-porphyrinuria. The nitrogen excre-
tion is diminished.
Therapeutics of Veronal.
The remedy is useful in the treatment of insomnia of
varied causation. It is especially useful in the simple in-
somnia and sleeplessness of neurasthenic or hysterical origin.
In conditions of excitement the maximum dose should be em-
ployed. Since it is without action upon the circulation or
respiration it may be administered to patients suffering from
cardiac or pulmonary diseases. As it does not increase the
nitrogenous output of the kidneys it can be safely given to
i
882 PHARMACOLOGY AND THERAPEUTICS.
debilitated individuals, and for considerable periods of time,
as well as in febrile conditions and wasting disorders. As it is
safe for continued use, reasonably sure in its results, possesses
comparative freedom from habituation, and produces a sleep
approaching the normal, it is a valuable addition to the avail-
able hypnotics. The perspiration of pulmonary tuberculosis, it
may be noted, is sometimes diminished by evening doses of
the drug.
Untoward Symptoms. — These occur but infrequently and are
the exanthem already mentioned, loss of appetite, nausea, vom-
iting, diarrhoea, headache, vertigo, and rarely torpor lasting
through the following day. Cumulation is not to be anticipated.
TOXICOLOGY.
Symptoms. — In a single instance febrile reaction for six or eight days,
dryness of the mouth, burning sensation in the throat, a morbilliform
exanthem on the face, extending to the chest and arms, becoming con-
fluent, followed by a vesicular and bullous eruption upon the buccal
and pharyngeal mucous membranes, conjunctivitis, and pain in the ears,
has been observed.
Treatment. — Interruption of the treatment, or alternation with hyp-
notics of other series, administration of the alkaline mineral waters, with
the securing of a daily movement of the bowels, will obviate these symp-
toms.
PARALDEHYDE.
PARALDEHYDUM.— Paraldehyde. Dose, 2 C.C.; 30 Til.
Action of Paraldehyde.
External. — It is antiseptic and antifermentative.
Internal. — Paraldehyde is a prompt, powerful and safe hyp-
notic. The system is usually very tolerant of it, and it may
be continued and found useful for long periods. In animals,
in which it acts in the same manner as upon man, it depresses
the higher nervous centres first; later it diminishes the re-
flexes, and finally there is a marked effect on the spinal cord.
The anterior cornua are paralyzed, and there are abolition of
reflex action, paralysis and anaesthesia. Fatal results from it
PARALDEHYDE. 883
are rare, but enormous quantities may cause death by para-
lyzing the respiratory centre in the medulla. Its action on the
heart is similar to that of sulphonal, causing a slight accelera-
tion of the pulse by its depressant effect upon the inhibitory
centre. It often produces gastric irritation and an increased
flow of urine. It is chiefly excreted by the kidneys, but in part
also by the lungs, and the odor of the drug may be detected in
the breath for some time after its hypnotic effect has passed
off. An erythematous rash is sometimes caused, and its pro-
longed use is said to have induced gastric catarrh and ulcers
about the nose. Diarrhcea has also been observed. Instances
of the paraldehyde habit have been occasionally reported.
There is great emaciation, cardiac weakness, unsteady gait,
mental confusion and agitation, with hallucinations of sight
and hearing and unpleasant delusions. Restraint for several
months is necessary for cure.
Therapeutics of Paraldehyde.
Unlike chloral, paraldehyde may be given with safety in cases
of cardiac disease. The principal objection to the drug is its
disagreeable and burning taste, and hence it is usually admin-
istered in capsules. If not given in this way, syrup and tinc-
ture of orange peel (with at least 60 c.c. ; 2 fl. oz. of water,
so as to insure the dissolving of the paraldehyde) may be em-
ployed to conceal the taste, or the drug may be administered
in glycerin, in a 25 per cent, solution, which renders it more
palatable. The large dose required is also a disadvantage. If
paraldehyde is to be of service, it usually produces sleep in from
fifteen to thirty minutes, and this is placid, dreamless and re-
freshing. No lassitude or depression is experienced the follow-
ing day, and the appetite often improves under its use. It is
useful in most cases of simple sleeplessness, but is found to
be of little service if there is any active pain, or if there is
cause for worry and anxiety. To patients with gastric irrita-
bility and in cases where there are convulsions it may be given
by the rectum. Paraldehyde is principally used in institutions
884 PHARMACOLOGY AND THERAPEUTICS.
for the insane. It has been found valuable in all forms of
mania, including the delirious mania due to alcohol or epilepsy.
In cases of melancholia it may induce sleep, but is often dis-
appointing. It is useful in mental excitement associated with
chorea, and in many cases of senile excitement, with marked
restlessness, it has been pronounced the best remedy. It has
a certain value in convulsive diseases, and has proved of ser-
vice in some cases of epilepsy, chorea and strychnine poisoning.
It sometimes relieves the symptom asthma and the paroxysms
of whooping-cough, but on account of its disagreeable taste and
pungent odor it is not well suited for children. As an expec-
torant, as well as an antispasmodic, it seems to be useful in the
treatment of cough in general. It is said to have been effica-
cious in some cases of polyuria.
ETHYL CARBAMATE.
-ffiTHYLIS CARBAMAS. — Ethyl Carbamate. (Urethane. Ethyl
Ure thane.) Dose, 1 gm.; 15 gr.
Action of Ethyl Carbamate.
Urethane is a hypnotic, and is believed to induce a calm,
natural sleep without any disagreeable after-effects.
Therapeutics of Ethyl Carbamate.
It was employed more frequently formerly than at present,
as it so often proves disappointing. In some instances it ap-
pears to act as an almost ideal hypnotic, but, unfortunately,
there are many cases in which it has no effect. It is most
successful in those in which there is no pain and where the sleep
is wanting rather from habit than from any uneasy feeling or
from worry. It has been found beneficial in children and in
some cases of sleeplessness following fevers or the result of
alcoholic excess; also in some instances where other more
powerful drugs, such as chloral, have been taken for some time
and where the patient feels that he must have sedatives to help
HOPS. 885
him to sleep. It does not appear to be of much service among
the insane.
HOPS.
HUMULUS.— Hops. Dose, 2 gm.; 30 gr.
LUPULINUM.— Lupulin. Dose, 0.500 gm. (500 milligm.) ; iy2 gr.
Preparations.
1. Fluidextractum Lupulini. — Fluidextract of Lupulin. Dose,
0.5 c.c.; 8 Til.
2. Oleoresina Lupulini. — Oleoresin of Lupulin. Dose, 0.200
gm. (200 milligm.) ; 3 gr.
Unofficial Preparation.
Tinctura Humuli (U. S. P., 1890). — Tincture of Hops. Dose,
4.0 to 8.0 c.c; 1 to' 2 fl. dr.
Action of Hops.
Like other volatile oils, its constituent, valerol, which to a
slight extent also reflexly excites the circulation, is stomachic
and carminative. ' The bitter principle likewise adds to the
stomachic properties of the drug. Hops have an undoubted
sedative and hypnotic influence, which is supposed to be prob-
ably due to the volatile oil, but it is not very marked, and ap-
pears to be subject to considerable variations. Lupulinic acid,
when injected as a neutral salt into the blood, has been found
to cause first stimulation and then paralysis of the medullary
centres, but to have very little effect when given by the mouth,
even in large doses.
Therapeutics of Hops.
Hops are used medicinally chiefly in the form of bitter ale,
which derives from them its peculiar flavor and taste, as well
as a certain degree of its heavy, soporific effect. Ale, stout,
or good beer may sometimes serve to improve the appetite and
digestion and to secure sleep, and such effects are naturally
increased by the alcohol contained in them. Hops may some-
886 PHARMACOLOGY AND THERAPEUTICS.
times be employed with advantage in atonic dyspepsia, flatulent
colic and mild diarrhoeas. Lupulin has been used in nervous
tremors, wakefulness and the delirium of drunkards. Equal
parts of fluidextract of lupulin and tincture of capsicum con-
stitute an excellent substitute for alcoholic stimulants when it
is desired to break off the use of the latter, and this combina-
tion is also very useful for the wakefulness and excitement
preceding a threatened attack of delirium tremens. Lupulin is
supposed to have some value as an anaphrodisiac, and it is
sometimes of service in spermatorrhoea. The oleoresin is here
regarded as the best preparation. It has been recommended
for chordee, but appears to have very little effect in this con-
dition. A hop pillow often seems to have a soothing and
soporific influence, but this result is doubtless to a great extent
the effect of imagination and the association of ideas. So, hop
poultices are used for their alleged anodyne action, but any
benefit derived from them is to be attributed simply to the heat
and moisture.
LACTUCARIUM.
LACTUCARIUM. — Lactucarium. (Lettuce.) Dose, 1 gm.; 15 gr.
Preparations.
1. Tinctura Lactucarii. — Tincture of Lactucarium. Dose, 2
c.c; 30 TH..
2. Syrupus Lactucarii. — Syrup of Lactucarium. Dose, 8 c.c;
2 fl. dr.
Action of Lactucarium.
Lactucarium has been credited with mild hypnotic powers.
Fresh lettuce is said to contain traces of hyoscyamine, in addi-
tion to lactucin, and since classic times has been known as tend-
ing to induce slumber. Large doses of the green extract may
cause mental derangement, and will dilate the pupil.
Therapeutics of Lactucarium.
It is quite unreliable as a hypnotic, but in some instances
appears to have a quieting and soporific effect. It may be
METHYLENE BLUE. 887
tried as a substitute for opium and its alkaloids when these dis-
agree. The syrup is sometimes added to cough mixtures as a
sedative, especially for children, and has also been employed to
allay nervous irritability and as a substitute for the soothing
syrups containing opium. Aubergier's syrup of lactucarium
(not official) has the reputation of being active and uniform
in strength.
METHYLENE BLUE.
METHYLTHIONIN-ffi HYDROCHLORIDUM. — Methylthionine
Hydrochloride. Methylene Blue. Dose, 0.250 gin. (250 milligm.) ;
4 gr.
Action of Methylene Blue.
Methylene blue (not to be confounded with methyl blue) has
been introduced into medicine as an antiseptic. It also possesses
anodyne and diuretic properties. It imparts a blue color to
nerve substance and a like color to the urine.
Therapeutics of Methylene Blue.
It has been used for rheumatism of the joints and muscles,
migraine, sciatica and other neuralgias; also for alcoholic neu-
ritis and the pains of locomotor ataxia. It would seem to be
a remedy of some value for quieting patients suffering from
incurable mental disease in which excitement is a prominent
symptom. In a number of cases of mania and paretic demen-
tia it produced a calmative effect which did not resemble the
action of hypnotic drugs, but seemed rather a natural quietude.
Lately it has been given for intermittent fevers, but the reports
show that it possesses no advantage over quinine except its
tastelessness. It may be substituted for quinine if the latter
cannot be taken or has been unsuccessfully used. Recent reports
indicate that even when given internally, it causes gonococci to
rapidly disappear from the urine in specific urethritis. As to
its effects upon inoperable neoplasms when injected into them
clinical reports differ widely. It may produce irritation at the
888 PHARMACOLOGY AND THERAPEUTICS.
neck of the bladder, which about 2 gm. (30 gr.) of powdered
nutmeg is said to relieve.
(3) General Anaesthetics.
CHLOROFORM.
CHLOROFORMUM.— Chloroform. (Trichloromethane.) Dose, 0.3
c.c; 5 m,.
Preparations.
1. Aqua Chloroformi. — Chloroform Water. Dose, 16 c.c;
4fl. dr.
2. Emulsum Chloroformi. — Emulsion of Chloroform. Dose,
8 c.c; 2 fl. dr.
3. Linimentum Chloroformi. — Chloroform Liniment.
4. Spiritus Chloroformi. — Spirit of Chloroform. (Chloric
Ether.) Dose, 2 c.c; 30 ul.
Unofficial Preparation.
Tinctura Chloroformi et Morphinae Composita (B. P.). —
Compound Tincture of Chloroform and Morphine. Dose, .30 to
1 C.C.; 5 to 15 Til. (This preparation is an imitation of the
proprietary remedy known as Chlorodyne. Among its principal
ingredients are chloroform, tincture of cannabis indica, tincture
of capsicum, and morphine hydrochloride.)
Action of Chloroform.
External. — The local action of chloroform quite resembles
that of alcohol, but is more energetic. It is also more power-
fully antiseptic. Chloroform is a protoplasmic poison of great
intensity, and no living substance is capable of withstanding its
lethal effect if exposed to its concentrated vapor for a sufficient
time. Its evaporation on the skin has a refrigerant effect, and
hence causes contraction of the blood-vessels and anaesthesia at
the point of application. If, however, the vapor is confined, or
if chloroform is rubbed into the skin, it has the effect of causing
heat and redness, with dilatation of the local vessels; and the
irritation may be sufficient to produce vesication. While when
CHLOROFORM. 889
locally applied it is more irritant to mucous membranes than
ether, yet when inhaled it is less irritant than the latter to the
respiratory tract.
Internal. Alimentary Tract. — In the mouth it causes, in con-
centrated form, a burning sensation and pain, followed by anaes-
thesia, and increased secretion of saliva and mucus by reflex
excitation of the glands. In the stomach and intestine it is
also markedly irritant, often causing violent gastro-enteritis.
In small doses its action is very much like that of the volatile
oils, producing in the stomach a sense of warmth and comfort
and inducing increased peristalsis. Absorption, it is believed,
takes place more rapidly than in the case of the volatile oils. In
the intestine it may perhaps have a slightly astringent effect.
Blood. — Chloroform is absorbed into the blood from the
gastro-intestinal tract, and, if administered by inhalation, from
the lungs, and after absorption is thought to form a loose com-
bination with the cholesterin and lecithin in the blood, perhaps
in the red corpuscles.
Nervous System. — The effects of the drug, when inhaled, are
commonly divided into three stages. It must be borne in mind,
however, that there are no sharply denned dividing lines be-
tween them, and that they are simply different degrees of the
same action. For convenience of study they may be named
the stimulant, the anaesthetic, and the paralytic.
First Stage. — There is a more or less marked preliminary
feeling of asphyxia, but with this exception, the sensations are
rather pleasant than otherwise. There is a sense of warmth
experienced first about the face and head, but afterwards ex-
tending throughout the body, while the imagination is tem-
porarily excited. The patient's comfort, however, may be dis-
turbed by the local effects, such as pricking and smarting of
the nose, throat and conjunctiva, accompanied by increased
secretion of saliva, mucus and tears. Vomiting may possibly
occur, but is rare at this period. The mind becomes confused
from the irregular stimulation of the higher cerebral functions,
but this stimulation is only evanescent, and the patient soon be-
89O PHARMACOLOGY AND THERAPEUTICS.
gins to lose consciousness. Hallucinations are apt to be present,
and the special senses are disturbed, so that he experiences un-
usual sensations of light and ringing, hissing and roaring in the
ears. There is formication and a feeling of stiffness in the
muscles and of inability to move the limbs. He loses his
self-control, and gives way to manifestations which vary with
his character — loud talking, laughing, singing, weeping, swear-
ing, etc. The general sensibility becomes blunted, but is not
abolished. With the depression of the higher functions comes
on excitation of the lower motor functions, and the patient
now often begins to struggle violently. He will kick, fight and
throw his arms and legs about to such an extent that it is diffi-
cult to restrain him. These motor phenomena vary greatly in
different individuals, and in some instances, especially in chil-
dren, are entirely absent. Occasionally, and particularly in
hysterical subjects, convulsions are observed. In this stage
usually the pupils are somewhat dilated, the skin warm and
moist, the face flushed or cyanotic, the pulse accelerated, and
the apex-beat augmented. The respiration is generally slightly
quickened, but may be more or less irregular, at first in conse-
quence of the sensation of asphyxia and later from the
struggling.
Second Stage. — The inhalation being maintained, the move-
ments cease and the muscles become relaxed. In consequence
of this relaxation, the face, which is now pale, assumes a calm
and death-like appearance. The smooth muscles are not usu-
ally affected, but there is sometimes a relaxation of the sphinc-
ters. There is paralysis of the motor reflex centres of the
cord, as well as paralysis of the brain and depression of the
medullary centres. Consciousness, sensation and most reflexes
are abolished, and one of the last reflexes to disappear is the
corneal. The pupils are contracted and do not respond to light,
and the patient lies in a deep sleep. Snoring is apt to be pro-
duced from the falling back of the tongue. The respiration
becomes regular, but slower and shallower than before the
inhalation was commenced. The pulse is generally somewhat
CHLOROFORM. 89 1
slow and weak, but regular, and the blood-pressure falls on
account of the depression of the vaso-motor centre. Vomiting
is a frequent occurrence, and dilatation of the pupil and in-
creased pallor are generally indications of its approach. The
body temperature invariably sinks in consequence of the less-
ened muscular activity and to a less extent of the increased
heat loss, and in prolonged anaesthesia the fall may be as much
as 30 to 50 C. When the inhalation is discontinued, the patient
again passes through a stage of excitement, which is generally
much less violent but may be more prolonged than before.
Usually in recovering from the anaesthesia he falls into a sleep
which lasts several hours, but not infrequently there are dizzi-
ness, nausea and vomiting for a considerable time.
Third Stage. — The characteristic feature of this stage, which
must be carefully guarded against, is progressive paralysis of
the medulla. The surface is cold and covered with a clammy
sweat, and the pupils become widely dilated, though at the last
they may be either dilated or contracted. The faeces and urine
are often passed involuntarily. The respiration grows irregu-
lar, stertorous and labored. The pulse, now also irregular,
becomes more and more slow and feeble, the blood-pressure
falls to zero, and the heart, weakened and dilated, is finally
arrested in diastole.
There has been much discussion as to the cause of death in
chloroform anaesthesia, and in 1889 the Nizam of Hyderabad
appointed a special commission to investigate the question.
After experimenting on over six hundred animals the commis-
sion arrived at the conclusion that death is always due to arrest
of the respiration. The criticism has been made that the altera-
tions in the circulation produced by chloroform were not prop-
erly appreciated by these investigators, or, at all events, were
not sufficiently emphasized in their report, and in the United
States it has generally been believed that death is from depres-
sion of the heart. It may be stated that it is now generally
accepted that the fatal effect of chloroform, as seen in its use
as an anaesthetic in surgery, is due chiefly and in most instances
892 PHARMACOLOGY AND THERAPEUTICS.
to its action upon the circulatory system, and especially upon
the heart itself. There seems to be no doubt of the fact that
in general the mode of administration really determines the
manner of its lethal action. Thus, a percentage of chloroform
vapor so low as to be practically incapable of causing sudden
death will, if the administration is maintained, finally bring
about a fatal result from over-narcosis, and under these cir-
cumstances it is almost invariably the case that death is due
to failure of the respiration from paralysis of the respiratory
centre in the medulla. Experiment has demonstrated that un-
der the inhalation of very dilute chloroform the respiration
always ceases several minutes before the heart, which continues
to beat quite strongly for a short time and then grows rapidly
weaker, and that as the concentration of the vapor is increased,
the interval between the failure of the respiration and of the
heart becomes shorter. When air saturated with chloroform
vapor is inhaled, the interval between the two is so brief as to
be inappreciable. The pulse, indeed, may be so weak as to be
no longer perceptible before the respiration ceases, but if the
movements of the heart be registered directly, it is usually
found beating as long as the respiratory movements are car-
ried on. From a practical point of view, it has been pointed
out, it is of comparatively little importance whether there are
a few fluttering beats of the heart after the last inspiration or
not; the all-important question is whether the heart has been
so injured as to be unable to carry on the circulation. Clinical
experience has shown that it is the sudden administration of
a high percentage of chloroform vapor which is responsible
for most of the fatalities from this drug, and it is through its
direct action on the heart that death is then caused. The car-
diac muscle becomes paralyzed and more or less suddenly fails
to be effective in maintaining the circulation, so that the blood-
pressure falls rapidly. The heart is now incapable of empty-
ing itself, and, the organ becoming distended with blood, its
muscle, after a few slight fibrillar contractions, confined to
the ventricular bases, finally stops acting. In some instances
CHLOROFORM. 893
in dogs, however, the heart has been found flabby and empty.
The action of the respiratory system during this time must be
regarded as for the most part secondary to the state of the
circulation. When the blood-pressure has fallen considerably,
the medullary centres become anaemic and the respiration fails.
When the respiratory movements cease, the lesser, or pulmonic,
circulation fails in consequence, and this embarrasses the heart
still further, precipitating its distention and complete paralysis.
Not only is the heart in a condition of paralytic distention, but
the great vessels of the chest and abdomen are also distended
with blood. In fact the vaso-motor paralysis of the vessels in
the splanchnic system must always be taken into consideration
in determining the factors which bring about a fatal issue.
In its action on the central nervous system, as has been
seen, chloroform affords an excellent illustration of the law of
dissolution (see p. 737). Thus, the paralysis caused by it
commences with the highest cerebral functions, those of self-
control, and passes progressively downwards through the lower
intra-cranial divisions. The spinal cord is affected before the
medullary centres, which are the last portions of the cerebro-
spinal axis to become paralyzed. In the recovery from chloro-
form also the law of dissolution is illustrated, the lowest func-
tions, such as muscular tone, being the first to reappear. The
muscles and nerves are not affected by chloroform when in-
haled.
Metabolism. — A marked resemblance has been noted between
the effects of chloroform on the metabolism and those of phos-
phorus, and in both cases the formation of acid in excess in
the tissues has been assigned as the cause of these effects.
After the administration of chloroform either by inhalation or
by the mouth both nitrogen and sulphur elimination is consid-
erably augmented, indicating, it is believed, an increased de-
struction of nitrogenous bodies in the tissues. The sugar of
the blood has been found to be increased, and the glycogen of
the liver diminished, or entirely absent. This is stated to be
due to a specific action on the liver cells, which form glycogen
894 PHARMACOLOGY AND THERAPEUTICS.
into sugar much more rapidly than usual. Fatty degeneration
of various organs, especially the liver, heart and kidneys, have
been observed after the repeated administration of chloroform,
and even after a single inhalation in some instances. If this
process attains a certain degree of development it is found that
it may lead to failure of the heart, but otherwise the tissues
recover in a few days. Atrophic cirrhosis of the liver has been
produced by the drug when given in small quantities for several
months. Similar but less marked effects have been observed in
the kidneys, spleen and lungs, and they are regarded as the
result of a preliminary fatty degeneration of the parenchyma-
tous cells. In addition to its action on the central nervous
system, it must therefore be recognized that chloroform pro-
duces marked changes in the processes of life and the nutrition
of the different organs.
Excretion. — Chloroform is excreted mainly by the lungs, but
in small quantities may also escape in the urine, perspiration
and milk. Some of the chloroform inhaled seems to undergo
combustion in the body, and an increased acidity of the urine
is attributed to hydrochloric acid formed by the combustion.
Therapeutics of Chloroform.
External. — The local application of chloroform has been
found useful in a variety of conditions. In severe neuralgias
its deep injection in the vicinity of the affected nerve is a valu-
able resource. The official liniment is employed to relieve the
pain of neuralgia, myalgia and chronic rheumatism and to re-
duce chronic inflammations. Chloroform is also often used in
liniments in association with camphor, tincture of aconite, or
opium preparations. The following is highly recommended as
a local anaesthetic: Chloroform, 12 c.c. (3 fl. dr.); camphor,
2 gm. (30 gr.) ; tincture of aconite, 12 c.c. (3 fl. dr.) ; tincture
of capsicum, 4 c.c. (1 fl. dr.) ; tincture of pyrethrum, oil of
cloves, each 2 c.c. (J4 A- dr.). The camphor is first dissolved
in the chloroform, and the oil of cloves and the tinctures are
then added. For overcoming rigidity of the perineum in labor
CHLOROFORM. 895
the following application has been found useful: Chloroform,
1 ; ether, 1 ; Cologne water, 8. The following combination has
been recommended as an efficient anaesthetic spray for the per-
formance of minor surgical operations: Chloroform, 37; men-
thol, 4; ether, 56. An aching tooth may often be relieved by
plugging it with cotton saturated with chloroform. Chloro-
form is a good haemostatic, and applied upon lint or absorbent
cotton, may be used to arrest superficial bleeding. The solution
of gutta percha in chloroform has been employed as a protec-
tive in small-pox and erysipelas, and has also been found use-
ful in the treatment of fissured nipple, superficial burns, furun-
cles, psoriasis and herpes zoster. A lotion containing chloro-
form may be of service in urticaria. In irritable ulcer of the
rectum and itching about the anus an ointment, such as that
of zinc oxide, to which chloroform has been added in the pro-
portion of 4 c.c. (1 fl. dr.) to 30 gm. (1 oz.), often affords great
relief. Chloroform is an excellent antiseptic to preserve urine
in transportation. .20 c.c. (3 Til) to 120 c.c. (4 fl. oz.) of urine
is sufficient. The chloroform should be allowed to evaporate
before testing the urine.
Internal. — As chloroform disguises the taste of many nau-
seous drugs, it is in common use for this purpose. Aqua
Chloroformi is frequently employed as a vehicle and Spiritus
Chloroformi as a flavoring agent. Like alcohol, the gastric
effects of which are similar, chloroform is useful in some forms
of dyspepsia, and in small doses it is sometimes given as a car-
diac stimulant. Chloroform water, or a few drops of chloro-
form taken upon sugar or in water, will often relieve vomiting
when not due to inflammations of the stomach. Small doses
of it, however, may prove of service for the vomiting and pain
of gastric ulcer, especially when given in association with bis-
muth preparations. The spirit of chloroform is used to arrest
hiccough and also to relieve restlessness and irritating cough
in pneumonia, pleurisy and bronchitis. A small quantity of it
is a serviceable addition to expectorant mixtures when a neu-
rotic element is present. 2 c.c. {]/2 fl. dr.), with an equal quan-
896 PHARMACOLOGY AND THERAPEUTICS.
tity of tincture of capsicum, in water, every half hour, hour,
or two hours, has proved a very valuable hypnotic in delirium
tremens with symptoms of depression and adynamia. The
spirit of chloroform is sometimes given with advantage in com-
bination with astringents and opium in diarrhcea, and is con-
sidered especially useful in cholera morbus. In the treatment
of true cholera no single remedy has been found more effica-
cious than the empirical preparation known as chlorodyne (see
p. 888). The following, taken as a draught, is said to be suc-
cessful in the treatment of tape-worm: Chloroform, 4 c.c. (1
fl. dr.) ; croton oil, .06 c.c. (1 "HI) ; glycerin, 30 c.c. (1 fl. oz.).
Somnolence, so prolonged as to become serious, may, however,
follow the administration of this prescription.
Inhalation. — The inhalation of chloroform for anaesthetic
purposes is principally employed for surgical operations, in
biliary and renal colic, and in parturition. For painful de-
livery but a small quantity is required, as it is given, not to
produce unconsciousness, but merely to blunt the sensibility,
and it is a matter of common observation that chloroform inhal-
ation is borne better by women in labor than by any other class
of subjects. Other purposes for which its inhalation is used
are the relaxation of muscular spasm, as for the reduction of
dislocations and hernias, and to relax the muscles for diagnostic
reasons, as for making a thorough examination of fractures or
of the abdomen, for the detection of malingering, etc. Finally,
it is used for the relaxation of spasm in the convulsions of
tetanus, hydrophobia and other affections. In certain anaes-
thetic mixtures, which contain both ether and chloroform, the
object is to obtain the anaesthetic effects of both these agents
without the cardiac and respiratory depression of either. The
best known of these is the A. C. E., which consists of 1 part
alcohol (sp. gr. .838), 2 parts of chloroform (sp. gr. 1.497), and
3 parts of ether (sp. gr. .735). It is claimed that all of its
three constituents volatilize from it at an equal rate, but as
this has been found not to be the case (the ether evaporating
first, the chloroform next, and the alcohol last), the advantages
I
CHLOROFORM. 897
of the mixture would seem to be doubtful. While the A. C. E.
enjoys considerable popularity in England, it has never been
much liked in the United States.
In the administration of chloroform careful attention must
be paid to a number of points:
1. The ansesthetizer must be skilled and give his attention
exclusively to the production and maintenance of narcosis.
2. False teeth should be removed from the patient's mouth,
to prevent the possibility of their falling into the throat and
choking him.
3. No undigested food should be in the stomach; the patient
should be fasting for at least four hours, if possible. If vomit-
ing occurs, his head should be placed in such a position that no
food can get into the larynx.
4. The clothing must be loose enough to allow perfect free-
dom of respiration.
5. The head should be a little raised and the lower jaw held
up, in order to prevent the tongue from falling back over the
larynx.
6. The chloroform must be pure.
7. It should be given in such a way that the vapor may be
thoroughly mixed with air in the proportion of about 5 to 95.
8. The administration must be gradual, as " pushing " the
anaesthetic is dangerous.
9. The respiration should be watched with extreme care, as
it appears to be a fact that gradual cardiac failure never takes
place without producing respiratory changes from the first. A
sudden cardiac arrest, as sometimes occurs in fatty heart, will
not give warning either by the pulse or respiration. Unless,
therefore, it is possible to have an extra assistant to watch the
pulse, it seems advisable to neglect this, since a slighting of
both objects in view is too often the result of dividing the
attention.
10. The operation should never be commenced until the stage
of muscular relaxation has set in, when reflex action is to a
large extent abolished. From neglect of this precaution many
58
898 PHARMACOLOGY AND THERAPEUTICS.
lives have been lost, the heart being reflexly stopped by the
stimulus of the knife; and it is a fact that most of the deaths
from chloroform have occurred during slight operations, in
consequence of the mistaken notion that because an operation
is trivial it may be begun early.
11. In operations about the mouth care must be taken to pre-
vent the entrance of blood into the air-passages.
12. The anaesthetic must be administered with special care in
the old and in all cases where pulmonary disease is present or
where the heart is feeble from any cause. It is contra-indi-
cated in fatty heart.
13. Special care is also called for when the operation neces-
sitates awkward positions, and particularly those (such as the
lateral position) in which the respiration is more or less inter-
fered with.
14. In consequence of the reduction of temperature caused by
chloroform, the warmth of the patient must be seen to.
15. Chloroform should never be administered without a hypo-
dermatic syringe, in good order, being at hand. Amyl nitrite,
ether and ammonia should be in readiness.
16. Inasmuch as substances irritating to the lungs may be
produced when the vapor of chloroform comes in contact with
a naked flame (in the presence of which chloroform is decom-
posed), good ventilation should be insisted upon when gas
light must be employed.
Should any signs of respiratory failure occur, artificial respi-
ration must at once be commenced, the tongue being pulled
forward by forceps to facilitate the ingress of air. The most
efficient means of performing artificial respiration is the use
of the Hoyt pump, each full stroke of the piston of which
forces into the lungs, through an intubation tube inserted in
the larynx, an amount of air corresponding with the normal
inspiration. Other measures which may be employed are the
flicking of the face and abdomen with wet towels, the adminis-
tration of amyl nitrite by inhalation, and the hypodermatic in-
jection of strychnine or ether. Brandy, or alcohol in other
CHLOROFORM. 899
form, should not be given. Galvanization over the cardiac
area has been recommended, but it is probable that this is harm-
ful rather than beneficial. The heart may be stimulated by
large rectal injections of hot normal saline solution, or of hot
decoctions of coffee, if at hand. One of the most efficient
means of maintaining or restoring the action of the heart and
the respiration is the Maas process. This consists of the ap-
plication of a series of compressions of the chest over the heart
sufficiently forcible to create an artificial carotid pulse, the com-
pressions being made at the rate of 120 per minute. The object
in view is to create an artificial circulation which may free the
heart from distention and chloroformed blood, and raise the
arterial tension so that the respiratory centre may be supplied
with blood. If symptoms of improvement do not appear at
once, the patient should be inverted, and this procedure is
facilitated by hooking the knees over the table. It is claimed
by some that inversion only adds to the danger, but there is a
vast amount of clinical evidence going to show that it is of
practical benefit, numerous instances being on record in which
it was undoubtedly the means of saving the patient's life. The
measures just mentioned should be maintained for hours, if
necessary; but if in spite of them the heart utterly ceases to
pulsate and the respiration completely fails, as a last resort
the chest should be opened and cardiac massage practiced by
the Kemp-Gardner method, artificial respiration at the same
time being maintained and the prolonged infusion of hot normal
saline solution employed.
In spite of all care in administration and the observance of
all precautions, one death takes place in about three thousand
administrations. A painstaking series of experiments, how-
ever, has afforded ground for the belief that chloroform is safe
for the majority of cases, provided it be given by one skilled
in its use, and who not only knows how to give it, but to detect
signs of danger. The respiration should be especially watched,
because, as has been mentioned, so soon as enough chloroform
is used to endanger the circulation, the respiration will show
900 PHARMACOLOGY AND THERAPEUTICS.
some abnormality. In the healthy animal death is due to res-
piratory failure, accompanied by circulatory depression. The
latter itself may be severe enough to cause death, even if arti-
ficial respiration be skillfully used. In most of the cases in a
series of careful experiments on dogs respiratory failure oc-
curred first, followed by heart failure. In several instances,
however, heart and respiration failed -synchronously, and in one
the heart stopped as if it had been stabbed. Chloroform may be
chosen in hot climates ; when a large number of persons are to
be anaesthetized; in Bright's disease; in aneurism; in marked
atheroma of blood-vessels; in children or adults who already
have bronchitis; and in persons who struggle violently.
In 1901 a special committee was appointed by the British
Medical Association to investigate chloroform in its therapeutic
uses, the ultimate aim of the research being to determine the
minimum dose of chloroform capable of producing adequate
anaesthesia without endangering life. The first report of the
committee was made in the summer of 1902 and the final report
in that of 1903. In regard to the point whether the ordinary
methods of administering chloroform are trustworthy and safe,
the conclusion was reached that it is absolutely necessary to
regulate the dosage of the drug, and that an apparatus is emi-
nently desirable which will on the one hand permit the admin-
istration of a definite dose capable of securing anaesthesia and
on the other not endanger life. Furthermore, that safety de-
pends upon dosage, that is, the proper percentage to be mixed
with air. Concentration has been shown to be fatal, whereas it
is maintained that a vapor below 2 per cent, is wholly safe, and
that in most patients as low as 1 per cent, will maintain anaes-
thesia. A further step was to determine with scientific accu-
racy what the physical effects of various percentages were.
Working with the isolated mammalian heart, the investigators
found, among other points, that heart muscle takes up chloro-
form from fluid circulating in the coronary vessels and that its
lethal effects vary according to the fluid used. In diluted blood,
for example, the chloroform gives less effect than in saline solu-
CHLOROFORM. 9OI
tion. With the increase of chloroform in the circulating fluid,
more is taken up by the heart muscle, until finally toxic effects
result. With weaker doses an equilibrium appears to be estab-
lished between the chloroform-containing fluid and the heart
muscle, so that at last no further effect upon the muscle mani-
fests itself, in spite of the continued flow of the chloroform
fluid. It was found that under toxic doses the ventricle is
paralyzed in its action before the auricle. The experiments go
to show the extreme importance of restricting the dosage of
chloroform to relatively weak percentages, and that the size
of the dose circulating in fluid through the heart is the im-
portant element, rather than the length of time during which
it circulates. Higher concentrations than 2 per cent, should be
looked upon as potentially dangerous, since their tendency is,
other things being equal, to paralyze the heart muscle. The
prolongation of the anaesthesia with a dilution under this per-
centage is not to be regarded as dangerous, although naturally
individual susceptibility must be taken into account, and, as
usual, arguments drawn from animals cannot be forthwith and
without modification applied to man. It will be observed that
these experiments in a measure controvert the idea that chloro-
form has a cumulative effect upon the heart. As they were
made upon the isolated heart, they would appear to leave unas-
sailed the position that the use of low percentages, if continued
sufficiently long, may bring about a fatal result by inducing
paralysis of the respiratory centre.
ETHER.
-SJTHER.— Ether. (Sulphuric Ether. Ethylic Ether. Ethyl Oxide.)
Dose, 1 c.c; 15 TO,.
Preparations.
1. Oleum uEthereum. — Ethereal Oil.
2. Spiritus Athens. — Spirit of Ether. Dose, 4 c.c; 1 fl. dr.
3. Spiritus ^Etheris Compositus. — Compound Spirit of Ether.
(Hoffmann's Anodyne.) Dose, 4 C.C.; 1 fl. dr.
g02 PHARMACOLOGY AND THERAPEUTICS.
Action of Ether.
External. — By its rapid evaporation when applied to the skin,
ether produces a sensation of cold, and the part becomes
blanched from the resulting contraction of the blood-vessels.
When it is used in the form of a spray, this action is intensified,
and marked local anaesthesia is caused. If, however, evapora-
tion is prevented, or the ether is rubbed in, an irritant effect is
produced, though less pronounced than in the case of alcohol
or chloroform.
Internal. — In the mouth and stomach its effects are similar
to those of alcohol and chloroform. It is a very prompt car-
minative, causing increased secretion of the glands and dilata-
tion of the gastric vessels. By reflex action it also at once
stimulates the heart, increasing the force and frequency of the
pulse and raising the blood-pressure, and at the same time
excites respiration. It is absorbed rapidly and is not only a
quickly acting diffusible stimulant, but also an anti-spasmodic.
Nervous System. — The action on the central nervous system
in general resembles that of chloroform, but in some important
particulars there is a difference. The respects in which the
two differ, when given for anaesthetic purposes, are somewhat
as follows:
i. Chloroform acts 36 to 48 times as powerfully as ether in
paralyzing the heart. The pulse is not nearly so much affected
by ether as by chloroform; while it may be somewhat slower
than usual, it is full and strong.
2. Chloroform is 3 to 3^2 times as depressant as ether to the
medullary centres and the rest of the central nervous system.
3. Anaesthesia is produced with greater difficulty, more
slowly, and often less powerfully with ether than with chloro-
form; consequently, the stage of excitement is usually more
marked and prolonged, and naturally attended with more
struggling.
4. It is necessary to give the ether in much more concen-
trated form in order to produce narcosis — about 70 per cent,
of ethereal vapor to 30 per cent, of air.
ETHER. 9O3
5. Consequently, it is much more difficult to administer than
chloroform.
6. Also it produces more irritation of the respiratory pass-
ages.
7. Ether is much more likely to irritate the kidneys.
8. Chloroform is much more agreeable to inhale. Its odor
and taste are sweet and pleasant, and it causes less irritation
and less feeling of suffocation.
9. Ether is eliminated more slowly, and the odor therefore
lingers about the person for some time.
10. On account of its inflammability, ether is dangerous in
the vicinity of a naked flame or where the actual cautery is
to be used. When artificial light, other than the incandescent
electric, must be employed, the lamp should always be adjusted
above the patient, since the ether vapor is heavier than air.
Kidneys. — From experimental researches it appears that in
the dog, at least, ether anaesthesia has for some as yet unex-
plained reason a specific action upon the kidney, consisting of
a constriction of the arterioles of the organ. This is entirely
independent of any change in the general arterial circulation,
since it is found from the carotid tracings that the blood-
pressure is raised from the beginning. The vascular contrac-
tion in the kidney has a damaging effect upon the renal secre-
tory cells, similar to that which follows clamping the renal
artery; the kidney shrinks in bulk, and as the etherization
progresses to deep narcosis there is a diminished secretion of
urine, marked albuminuria, hematuria, and, finally, suppression.
It would seem probable that in man a corresponding action is
elicited.
Excretion. — So far as known, ether appears to be excreted
only by the lungs.
Therapeutics of Ether.
External. — The pouring of ether on the scalp sometimes
promptly arrests headache. An ether spray may be used in
superficial neuralgia, where the benumbing of the nerve some-
9O4 PHARMACOLOGY AND THERAPEUTICS.
times effects a permanent cure. It is also employed at times
to produce local anaesthesia (by the cold resulting from the
evaporation of the ether), for small operations, and it is par-
ticularly useful where thoracentesis or paracentesis abdominis
is to be performed, or a simple incision made. As a rule, how-
ever, the hardness of the tissues caused by it is a serious ob-
jection as regards operations, while the subsequent reaction is
liable to produce considerable tingling and pain, as well as
oozing of blood from the wound. In any case where such local
anaesthesia is used, the cold produced should not be intense
enough to actually freeze the tissues, as this is apt to render
the healing slow. Since it dissolves fat from the skin, ether may
also be employed as a detergent before operations, the part to
be operated on being washed with it after soap has been used.
Ether being a good solvent of the active principles of many
drugs and also of sebaceous matter, it has been strongly recom-
mended as a menstruum for various remedies to be applied to
the skin. The ether-spray has sometimes been successfully
used in strangulated hernia, and its application to the spine has
been followed by good results in some cases of chorea.
Internal. Stomach. — Ether is very useful in colic and some
forms of dyspepsia. Small doses of Hoffmann's anodyne, which
may be administered in camphor water, are efficient in expel-
ling flatus from the stomach and are often of service in gastral-
gia and sick headache. A few drops of ether, added to cod-
liver oil, render it more tolerable to the stomach and facilitate
its digestion and absorption, probably by increasing the secre-
tion of pancreatic juice.
Heart. — On account of the rapidity of its action, ether is a
cardiac stimulant of great value, and it is frequently employed
in fainting, palpitation and heart-failure. According to cir-
cumstances, it may be given either by the mouth or by hypo-
dermatic injection. The dose for the latter purpose is 0.60 to
1 c.c. (10 to 15 HI). It is also a useful anti-spasmodic in
asthmatic attacks.
ETHER. 905
Inhalation. — Ether is administered as a general anaesthetic
for the same purposes as chloroform. On account of its greater
safety, it is more commonly used in the United States. Some
accidents with chloroform are no doubt due to carelessness, on
account of the great facility with which it can be administered,
but granting this, there can be no question that chloroform, as
might be supposed from the points in which its action differs
from that of ether, is the more dangerous agent of the two.
From the published statistics it would appear that the imme-
diate mortality with chloroform is from three to five times as
great as with ether. The difference in the concentration re-
quired to produce anaesthesia and that which will cause serious
impairment of the heart's action, or which will stop the respira-
tion, is very much smaller in the case of the one than of -the
other. Hence the preference should be given to ether except
when this is specifically contra-indicated, as in bronchitis,
nephritis, etc. From clinical observation, as well as experi-
mental research, it is clear that ether has a special tendency
to produce kidney trouble, and as a rule, therefore, it had bet-
ter be avoided when renal disease is present, and particularly
when with this there is a tendency to pulmonary oedema. If
employed at all, it should be administered with the greatest
caution to those suffering from the various forms of acute or
chronic kidney disease, or renal insufficiency from any cause.
Both ether and chloroform have been shown to be highly dan-
gerous in cases of diabetes. Much attention has of late been
directed to fatalities occurring as sequelae of surgical anaesthe-
sia : in the case of chloroform more particularly in consequence
of fatty degeneration of the heart and kidneys or of diabetic
coma, and in that of ether from uraemia and from bronchitis,
pneumonia and pulmonary oedema, especially in the subjects of
nephritis. In a considerable number of instances death from pul-
monary oedema with bronchial effusion and aspiration pneumonia
has occurred in the course of a few days after etherization. It
is claimed by many that these post-anaesthesia deaths are decid-
edly more frequent after ether than after chloroform, and, in
g06 PHARMACOLOGY AND THERAPEUTICS.
fact, that their number is large enough to bring the total mor-
tality from ether, immediate and secondary, quite up to or even
beyond that of chloroform. Some surgeons, it may be stated,
who formerly used ether almost exclusively, believing that if
a fair estimate were made the fatal uraemias and pneumonias
depending on ether, if properly credited to it, would reverse
the record as it stands at present, are now chiefly employing
chloroform. As it is very difficult, however, to distinguish
between the results of the anaesthetic and the ordinary forms
of disease, no very reliable statistics are as yet available in
regard to the point at issue. The practice is now quite common
of commencing ether anaesthesia with the preliminary inhala-
tion of nitrous oxide gas, and in this way the disagreeableness
of ether to the patient may be largely obviated and a more
rapid and satisfactory narcosis secured. For the nausea and
vomiting sometimes caused by ether the administration of I
gm. (15 gr.) of sodium bromide has been recommended.
AETHER ACETICUS.— Acetic Ether. (Ethyl Acetate.) Dose, 1
c.c; 15 TTt.
Action of Acetic Ether.
It resembles ether in its carminative, stimulant and anti-
spasmodic properties, but as it is less volatile, its action is
less prompt and more prolonged, and it is more irritating to
the skin. While its inhalation will produce general anaesthesia,
its effect in this respect is too slow for practical purposes.
Therapeutics of Acetic Ether.
On account of its agreeable odor and taste it is combined
with other carminatives as a stimulant and antispasmodic. It
is employed as an ingredient of Cologne water, and is some-
times applied externally with friction, as a resolvent and for
the relief of rheumatic and other pains. The inhalation of its
vapor allays laryngeal and bronchial irritation, and may also
be found useful in nervous cough.
ETHYL BROMIDE. 9O7
Unofficial Preparation.
jEthylis Bromidum. — Ethyl Bromide. (yEther Bromatus.
Hydrobromic Ether.)
Action of Ethyl Bromide.
Ethyl Bromide was introduced to the profession in 1880 as
the most agreeable and rapid anaesthetic.
Therapeutics of Ethyl Bromide.
Several fatal cases having been reported, its use was aban-
doned. Recently, however, the inhalation of ethyl bromide,
when pure, has been recommended in doses of from 12 c.c. ; 3
fl. dr. (child of two years), to 24 c.c; 6 fl. dr. (adult), for
surgical anaesthesia. The following precautions should be ob-
served: Food, even a glass of milk, is absolutely forbidden on
the day of operation. A mask is to be employed, and this
should perfectly cover the mouth and nose, so that no air is
allowed to enter. The entire dose should be given at once.
When narcosis is complete, the mask should be removed, and
under no consideration be re-applied. The administration must
not be prolonged over one minute. Sleep is obtained in from
twenty to thirty seconds, and lasts from two to three minutes,
sometimes longer. The contra-indications to its use are dan-
gerous lesions of heart, lungs, or kidneys.
Somnoform, which is a mixture of ethyl bromide, 5 parts;
ethyl chloride, 60 parts ; and methyl chloride, 35 parts, has been
highly recommended as an anaesthetic for small operations,
though a number of surgeons have failed to find that it pos-
sesses advantages over the ordinary anaesthetics in use. It has
now been tried to a considerable extent, especially in dentistry,
as a substitute for nitrous oxide. It acts promptly, and if it
is inhaled for from fifty seconds to two minutes does not give
rise to nausea and vomiting or other unpleasant results. It is
said to induce complete relaxation of the muscles, without
cyanosis. A mask should be employed for the inhalation. A
single dose of somnoform is 5 gm. (75 gr.), and this is supplied
PHARMACOLOGY AND THERAPEUTICS.
in a graduated glass. In prolonged operations it is necessary
to repeat the dose several times. Mixed anaesthetics are much
more commonly resorted to in England and on the Continent
than in America.
PENTAL.
Unofficial Preparation.
Pentalum. — Pental. (Trimethylethyhene.)
Action of Pental.
Pental is an anaesthetic, the equal of nitrous oxide in rapidity
of action and perhaps safety, but superior to it in its more pro-
longed action and in having no unpleasant after-effects. Even
when insensibility to pain is reached, consciousness is retained
sufficiently to respond to commands. The stage of exhilaration
is seldom present. The drug does not lose its effect by repeated
inhalations. It differs from chloroform in that it acts more
promptly, and has no evil after-effects ; from ethyl bromide, in
that it is somewhat slower in its action, but is more lasting in
its effects, and can be prolonged as may be necessary; from
nitrous oxide, in its freedom from unpleasant effects.
Therapeutics of Pental.
It may be used for short operations, but it is not absolutely
safe, as was at one time claimed.
Division XL — Drugs Acting on the Organs of Generation.
A. Aphrodisiacs. — These are substances which increase sex-
ual desire and power. They are supposed to act by stimulating,
directly or reflexly, either the cerebral or spinal genital centre.
The latter has been located in the lumbar portion of the cord,
and irritation of it induces erection. It is conceivable that it
may be excited by afferent impulses conveyed to it from various
parts of the parts, but especially from the cerebrum and the
genital organs. Its activity appears to be largely dependent
DRUGS ACTING OX ORGANS OF GENERATION. 909
upon the condition of the general health, and hence tonics and
all measures promoting the bodily nutrition may act as indirect
aphrodisiacs.
The following drugs are known as aphrodisiacs ; their mode of action
in this regard is not very clearly understood.
(1) Strychnine.
(2) Cantharides.
(3) Alcohol.
(4) Cannabis Indica.
(5) Camphor.
(6) Phosphorus.
(7) Damiana.
Strychnine probably acts by raising the tone of the spinal
centres, cantharides. camphor and damiana through reflex irri-
tation from the urethral mucous membrane, alcohol and can-
nabis indica by their effect on the imagination, and phosphorus
by improving the general condition, especially in chronic ner-
vous exhaustion.
B. Anaphrodisiacs. — These are remedies employed to dimin-
ish sexual desire. They are supposed to act by decreasing the
local circulation, by lessening the excitability of the nerves of
the genital organs, or by depressing the genital centres. Most
of them, it may be said, are probably effective by diminishing
or removing some source of irritation which is reflexly pro-
ducing an aphrodisiac effect.
Drugs used as anaphrodisiacs are —
(1) Bromides. (5) Hyoscyamus.
(2) Potassium iodide. (6) Stramonium.
(3) Opium. (7) Digitalis.
(1) Belladonna. (8) Purgatives.
Local applications of ice, or cold baths, are sometimes of
service as anaphrodisiacs.
C. Ecbolics or Oxytocics are remedies which during or im-
mediately after parturition increase uterine action.
9io
PHARMACOLOGY AND THERAPEUTICS.
They are —
(1) Ergot.
(2) Cotton root bark.
(3) Hydrastis.
(4) Caulophyllum.
(5) Savin.
(6) Rue.
(7) Cimicifuga.
(8) Quinine.
(9) Powerful purgatives.
Of these ergot is by far the most important. Occasionally some of
these drugs will act upon the gravid uterus to produce abortion before
parturition has begun. Most of them have been used for this purpose
with criminal intent.
D. Emmenagogues are substances used to increase the men-
strual flow. Diminution of the menstrual flow is a symptom
of quite a large number of conditions ; so that the various drugs
which are beneficial in any of these are indirect emmenagogues.
Certain substances, however, appear to have a special action in
increasing the menstrual flow. They are —
(1) All Ecbolics.
(2) Manganese salts.
(3) Asafetida.
(4) Apiol.
(5) Myrrh.
(6) Guaiac.
(7) Cantharides.
(8) Borax.
(9) Tansy.
Among the many indirect emmenagogues the commoner are purga-
tives, iron, cod-liver oil, and strychnine, which act by improving the
general health. Hot foot- or hip-baths, especially if mustard be added,
often aid the onset of menstruation.
E. Substances which depress Uterine Action. — These are em-
ployed to diminish or abolish the contractions of the gravid
uterus.
They are —
(1) Bromides.
(2) Opium.
(3) Hydrated chloral.
(4) Viburnum.
(5) Cannabis Indica.
(6) Chloroform.
(7) Antimony and potassium
tartrate.
PHOSPHORUS. 9I I
F. Drugs acting on the Secretion of Milk.
Galactagogues are drugs which increase the secretion of
milk. The most prominent are:
Pilocarpus, Leaves of Ricinus communis, and Alcohol. — Of these
pilocarpus is the most powerful, but its effects soon pass off. The
leaves of the castor-oil plant are used, applied as a poultice, while a
decoction or the fiuidextract of them is given internally at the same
time. Alcohol has but a feeble effect, although the malt liquors have
considerable reputation as galactagogues. The secretion is very depend-
ent on the condition of the system at large ; so that the best means of
securing an abundant flow of milk is to maintain the general health.
Antigalactagogues are drugs which decrease the secretion of
milk.
Belladonna, either given internally or applied locally, is usually
efficient for this purpose, by paralyzing the nerves of the mammary
gland.
The following drugs are excreted by the milk, and are therefore
taken in by the nursing child : — Oil of anise, oil of dill, garlic, oil of
turpentine, oil of copaiba, and probably all volatile oils, sulphur, rhu-
barb, senna, jalap, scammony, castor oil, opium, iodine, indigo, anti-
mony, arsenic, bismuth, iron, lead, mercury, zinc and potassium iodide.
It is evident, therefore, that these remedies must be administered with
care to the mother ; for example, copaiba or turpentine will make the
milk so unpleasant that the child will not take it. Such of the above
list as are purgatives, when given to the mother, may cause diarrhoea
in the child. Opium should not be given in large doses to the mother.
On the other hand, mercury, arsenic, and potassium iodide may be
administered to the child by being given to her.
A. Aphrodisiacs.
PHOSPHORUS.
PHOSPHORUS.— Phosphorus. Dose, 0.Q005 gm. (0.5 milligm.);
Preparation.
Pilulae Phosphori. — Pills of Phosphorus. Dose, 1 pill.
Unofficial Preparations.
Spiritus Phosphori (U. S. P., 1890). — Spirit of Phosphorus.
(Tincture of Phosphorus.) Dose, .50 to 2.50 c.c; 8 to 40 TT\,.
912 PHARMACOLOGY AND THERAPEUTICS.
Oleum Phosphoratum (U. S. P., 1890). — Phosphorated Oil.
Dose, 0.05 to 0.30 c.c; 1 to 5 Hi.
Elixir Phosphori (U. S. P., 1890). — Elixir of Phosphorus.
Dose, 2.0 to 10 c.c.; y2 to 2l/2 fl. dr.
Action of Phosphorus.
Phosphorus has a specific action on bones, and especially
those of young animals which are still growing. Under the
influence of . minute quantities the cancellous tissue tends to
become compact, and there is a deposition of true bone of nor-
mal composition. This effect is attributed to the phosphorus
acting as an irritant or stimulant to the bone-forming cells, and
arsenic also appears to produce it to some extent. Small doses
of phosphorus generally increase the number of red blood-
corpuscles in man. Unless taken in a state of fine division or
dissolved in oil, it is absorbed with difficulty, because of its
insolubility in the fluids of the body and of its slow volatiliza-
tion. The great mass of it, if finely divided, is absorbed un-
changed and exists in the blood as phosphorus, and its action
is due to this element rather than to its compounds. But little
is known of its fate in the body. It is thought that a portion
may perhaps be oxidized to phosphoric acid, and some of it is
stated to be eliminated by the lungs, while some is excreted in
the urine in obscure organic combinations. Phosphorus dimin-
ishes tissue waste, decreasing the elimination of urea and of
carbon dioxide. As it is found as a necessary element in the
nervous system, its action is that of a stimulant to its growth.
Further details of its action are given under Toxicology.
Therapeutics of Phosphorus.
The best known liquid preparation is Thompson's solution :
Phosphorus, 1; absolute alcohol, 300; glycerin, 720; and spirit
of peppermint, 40; dose, 1.20 to 4 c.c. (.J to 1 fl. dr.). Phos-
phorus is especially indicated in osteomalacia, in rickets, and
in cases of ununited fracture. Without doubt it promotes
calcareous deposit in the healing of fractures. It is of value
PHOSPHORUS. 913
in convalescence from exhausting diseases, in nervous exhaus-
tion, in neuralgia when dependent upon debility, in alcoholism,
in sexual exhaustion, and in various suppurative affections.
TOXICOLOGY.
Acute Poisoning. — As phosphorus is quite accessible in the form
of matches or vermin paste, poisoning by it, either accidental or suici-
dal, is not uncommon.
Symptoms. — For some hours no effect is observed. Then there is a
burning pain in the abdomen, with nausea. The vomit has the char-
acteristic garlicky odor of phosphorus and is luminous if heated with
sulphuric acid. There is more or less general depression, and this
may amount to fatal collapse. Usually, however, the patient recovers
from these effects and appears to be quite well for two, three or four
days, when he again begins to suffer from vomiting, and the vomited
matter is often bloody. There are also abdominal pain, distention and
tenderness, and sometimes diarrhoea, and the stools may contain blood.
With these symptoms there occurs jaundice, which soon becomes very
marked, and the area of liver dullness is increased in consequence of
fatty changes occasioned in that organ. The emesis, abdominal pain,
and diarrhoea are explained by the same cause, the epithelial cells of
the stomach and intestine undergoing fatty degeneration. There is
considerable muscular weakness and pain, together with a small and
quick pulse and general prostration. Slight fever is sometimes ob-
served, but the temperature is often lowered in the later stages,
though the patient usually complains of intense thirst. There is likely
to be a garlicky odor to the breath. Haemorrhages may occur in many
different situations, and the immediate cause of these is fatty degener-
ation of the muscular coat of the smaller arteries throughout the body.
The urine also may contain blood, as well as bile, leucin and tyrosin
crystals, albumin, and an abnormal amount of ammonia. Peptone is
sometimes excreted, and the phosphates and sulphates are apt to
be increased from the augmented tissue-waste. The chlorides are much
diminished, in consequence of the patient's taking little or no food.
Sarcolactic acid appears in considerable quantity in the urine, and is
sometimes accompanied by some sugar. The acid is regarded as diag-
nostic of phosphorus poisoning. This condition lasts from five to eight
days, when the patient usually dies of heart failure, as a result of fatty
degeneration of the cardiac muscle from the direct action of the poison
upon it. Towards the last convulsions and coma may occur, and these
59
9I4 PHARMACOLOGY AND THERAPEUTICS.
are regarded as a result of disordered metabolism, rather than due to
any direct influence on the central nervous system. Even when the
symptoms are very severe, however, recovery is possible. With phos-
phorus burns none of the symptoms of phosphorus poisoning are pre-
sented.
Post-mortem. — As might be supposed from the above description,
wide-extended fatty degeneration is a prominent feature of the post-
mortem findings, and in this respect phosphorus resembles arsenic, anti-
mony and chloroform. This pathological change is most marked in the
liver, but numerous fat globules are observed in the cells of many other
organs, notably the kidneys and the gastric and intestinal glands, and also
in the muscle fibres of the heart, stomach, intestines, smaller arteries,
and often of the skeletal muscles. As to whether this fat is formed by
the degeneration of the protoplasm of the cells in which it is found,
or whether it is carried from other parts of the body and simply de-
posited in these cells, is as yet undetermined, but the weight of evidence
appears to be decidedly in favor of the latter view. Another char-
acteristic feature is the appearance of numerous haemorrhages and
ecchymoses. In addition to the fatty degeneration of the muscular
coats of the arteries referred to, it is probable that the absence of
clotting in the blood, due to the changes in the intestine and liver,
which interfere with the formation of fibrin, is a factor in the causation
of these. It has been noted that if the patient lives long enough,
there may be a diminution in the size of the liver, and altogether the
effects of phosphorus poisoning present a considerable resemblance to
those of acute yellow atrophy of this organ.
Treatment. — As phosphorus is absorbed from the alimentary canal
comparatively slowly, an attempt should be made in the early stages to
remove it by emetics or the washing out of the stomach and by purges.
Afterwards the object is to oxidize the phosphorus. Formerly copper
sulphate was much lauded as an antidote, but recent researches appear
to prove that it is itself a dangerous poison. Experiments on dogs
have shown that old oil of turpentine, which contains oxygen, if ad-
ministered before the poison is absorbed, is an antidote. Ordinary oil
of turpentine, however, is worse than useless, for as phosphorus is
soluble in oils, we simply aid in its absorption by giving any oily or
fatty substances. It is stated that only old, ozonized French oil of
turpentine is really antidotal in its influence. Repeated and free in-
halations of oxygen have been used, and this suggests that hydrogen
dioxide may be efficacious when given by the mouth. Potassium per-
manganate has also been advised for the purpose of oxidizing the
PHOSPHORUS. 915
phosphorus. In the secondary stage alkalies are recommended in order
to neutralize the excess of sarcolactic acid formed in the tissues.
Chronic Poisoning. — From the fact that the red or non-poisonous
phosphorus is now generally employed in match factories, chronic
poisoning, which was formerly frequently met with in those who worked
among phosphorus fumes, has become a very rare occurrence. Such
poisoning manifests itself in gastro-intestinal irritation and a peculiar
necrosis of the jaws. The latter, which usually has its starting-point
in carious teeth, begins with salivation and suppurative ulceration of
the gums ; after which there results a profound periostitis, involving
the whole jaw. The lower jaw is more often affected. Phosphorus
necrosis must be treated surgically on the same principles as other
necroses. The diseased bone readily becomes the seat of tuberculous
deposit, and sufferers from phosphorus necrosis not infrequently die
from general tuberculosis.
1. CALCII HYPOPHOSPHIS.— Calcium Hypophosphite. Dose,
0.500 gm. (500 milligm.) ; 7V2 gr.
2. SODII HYPOPHOSPHIS.— Sodium Hypophosphite. Dose, 1
gm.; 15 gr.
3. POTASSII HYPOPHOSPHIS. —Potassium Hypophosphite.
Dose, 0.500 gm. (500 milligm.); iy2 gr.
4. FERRI HYPOPHOSPHIS.— Ferric Hypophosphite. Dose, 0.200
gm. (200 milligm.); 3 gr.
5. MANGANI HYPOPHOSPHIS. — Manganese Hypophosphite.
Dose, 0.200 gm. (200 milligm.) ; 3 gr.
6. ACIDUM HYPOPHOSPHOROSUM.— Hypophosphorous Acid.
7. ACIDUM HYPOPHOSPHOROSUM DILUTUM.— Diluted Hy-
pophosphorous Acid. Dose, 0.5 c.c; 8 Tr\,.
Preparations.
1. Syrupus Hypophosphitum. — Syrup of Hypophosphites.
Dose, 8 c.c; 2 fl. dr.
2. Syrupus Hypophosphitum Compositus. — Compound Syrup
of Hypophosphites. Dose, 8 C.C.; 2 fl. dr.
3. Emulsum Olei Morrhuae cum Hypophosphitibus. — Emul-
sion of Cod Liver Oil with Hypophosphites. Dose, 8 C.C.;
2 fl. dr.
gi6 PHARMACOLOGY AND THERAPEUTICS.
Unofficial Preparation.
Sympus Hypophosphitum cum Ferro (U. S. P., 1890). —
Syrup of Hypophosphites with Iron. Dose, 4 to 8 C.C.; 1 to 2
fl. dr.
Zinci Phosphidum (U. S. P., 1890).— Zinc Phosphide. Dose,
0.006 to 0.02 gm.; ^ to 1 gr.
Action of Ferric, Calcium, Sodium, Potassium and Man-
ganese Hypophosphites.
The hypophosphites were introduced under the supposition
that they exert some special influence on nutrition. Practically
the whole of the hypophosphite administered can be recovered
from the urine, showing that they are not oxidized to phos-
phates in the tissues, as was formerly believed to be the case.
So far as investigations regarding their effects on nutrition has
gone, no evidence has been furnished, according to the best
authorities, that they have any further action than the other
indifferent salts, such as the chlorides. The chief effect of
ferric hypophosphite is regarded as undoubtedly due to its me-
tallic iron.
Therapeutics of Ferric, Calcium, Sodium, Potassium and
Manganese Hypophosphites.
Notwithstanding the unsatisfactory experimental evidence of
their value, these drugs are extensively used in cachectic con-
ditions, especially tuberculosis, and are the basis of a large
number of proprietary preparations.
Following Churchill, they should be of chemical purity, neu-
tral in reaction; the presence of free alkali or alkaline carbon-
ates quickly giving rise to an atonic dyspepsia. The official
syrups of the hypophosphites are faulty in that each salt
has a peculiar property, for the final result is due to the
hypophosphite and its beneficial effect upon nutrition. In the
early stages of phthisis (infiltration) the sodium salt should be
administered and the sodium salt alone ; if excavation is present
the calcium salt is indicated, and that alone, provided that it
CALCIUM HYPOPHOSPHITE. 917
does not too suddenly check expectoration; when the sodium
salt should be resumed.
The potassium salt is a valuable expectorant in chronic bron-
chitis; but it has a very limited usefulness in phthisis. The
hypophosphites, when administered intelligently, will improve
nutrition and relieve some of the symptoms of phthisis. If
administered in too large doses, or simultaneously with other
remedies, as arsenic, stimulants, strychnine, or cod-liver oil,
they are likely to produce headaches and dyspepsia, and fail
to cause improvement. The objection to the official syrups,
namely, the use of the salts in combination, applies to nearly
all of the proprietary preparations, most of which contain im-
pure salts, contain a low percentage of hypophosphites, and
are not scientific combinations. The syrup of hypophosphites
with iron is valuable as a reconstructive. Zinc phosphide is
believed to have the same physiological and therapeutical effects
as phosphorus.
Unofficial Preparations.
Calcii Glycerophosphas. — Calcium Glycerophosphate. Dose,
0.30 to 1 gm.; 5 to 15 gr.
Sodii Glycerophosphas. — Sodium Glycerophosphate. Dose,
0.6 to 2 C.C.; 10 to 30 TTt, usually hypodermatically.
Action of the Glycerophosphates.
The administration of these substances has been found to
increase the solids of the urine, the urea, the carbon dioxide
and sulphur oxidation coefficient, the chlorides, sulphates, lime,
magnesia and potash, with but little effect on uric acid. They
improve the nutrition of all organs, but more particularly that
of the nervous system. Potassium, Lithium, Iron and Mag-
nesium Glycerophosphates (none of them official) are also
prepared.
Therapeutics of the Glycerophosphates.
Inasmuch as the urine of neurasthenics contains relatively
large amounts of incompletely oxidized phosphorus, especially
91 8 PHARMACOLOGY AND THERAPEUTICS.
in the form of glycerophosphoric acid, the effort was made to
replace this loss by the introduction of phosphorus into the
organism in a form approaching, as nearly as is possible, that
in which it exists in the nervous system. The indications for
the glycerophosphates are conditions of nerve depression. If
given subcutaneously they are at least as efficacious as testicular
fluid (q. v.), which owes its activity to its contained organic
phosphates, and possess the advantage of more accurate dosage.
They are useful in various neuralgias, as sciatica, tic doulou-
reux, Addison's disease, and in the symptom-complex, known as
neurasthenia. Chlorosis, albuminuria, phosphaturia and anaemia
(the latter by the iron salt) have been benefited. In diabetes the
general condition improves and the amount of sugar may dimin-
ish. In various diseases of the bones, such as rachitis, osteo-
malacia and tuberculous affections, the lime and magnesium salts
are indicated, though, as has been stated, the value of lime salts
in these has been seriously disputed {see p. 217). The reme-
dies should not be expected to rejuvenate senility, but are use-
ful, even if slowly acting, adjuncts to the systemic treatment
of an impaired nervous system.
DAMIANA.
Unofficial Preparations.
Damiana. — Damiana. Dose, 15 to 30 gm.; y2 to 1 oz.
Fluidextractum Damianae. — Fluidextract of Damiana. Dose,
2 c.c; y2 fl. dr.
Action of Damiana.
Damiana has enjoyed considerable reputation as a remedy
for sexual atony. Some observers believe it to be only tonic.
Therapeutics of Damiana.
It is best administered as a fluidextract, in the dose of 2
c.c. {J/2 A. dr.), and in conjunction with remedies of this class
of established worth.
ERGOT. 9 1 9
C. Ecbolics.
ERGOT.
ERGOTA.— Ergot. (Ergot of Rye.) Dose, 2 gin.; 30 gr.
Preparations.
1. Extractum Ergotae. — Extract of Ergot. (Ergotin.)
Dose, 0.250 gm. (250 milligm.) ; 4 gr.
2. Fluidextractum Ergotae. — Fluidextract of Ergot. Dose,
2 c.c; 30 m..
3. Vinum Ergotae. — Wine of Ergot. Dose, 8 c.c; 2 fl. dr
Action of Ergot.
The effects of cornutine are quite distinct, in some respects
at least, from those of the other constituents of ergot. Like
picrotoxin, it produces a stimulation of the medulla oblongata,
followed by paralysis. A rise in blood-pressure results from
the stimulation of the vaso-constrictor centre. While the other
medullary centres, the salivary, vagus, vomiting, respiratory,
etc., are acted upon to some extent, the stimulating influence
is most conspicuously shown in the production of convulsions,
which are chiefly clonic in character. In the frog it acts, like
veratrine, directly on the fibres of skeletal muscle, thus produc-
ing an alteration in the contraction of the muscles; but, unlike
veratrine, it has no action on the heart. Under its influence
contractions of a peristaltic nature have been observed in the
stomach and intestine and also in the uterus, whether pregnant
or not. The action of sphacelic acid consists in a constriction
of unstriped muscle, especially of the blood-vessels, and a pri-
mary depression, resulting in paralysis of the central nervous
system. The latter is usually the cause of death when it is
given in fatal amount. The muscular constriction is apparently
dependent on both a central and peripheral influence, and is
shown most conspicuously in a tonic spasm of the arterioles,
leading to a rise of blood-pressure. In man, the pig, and the
chicken, but not in other animals, the contraction produced in
920 PHARMACOLOGY AND THERAPEUTICS.
some of the arterioles is so extreme and prolonged that a hya-
line formation in the lumen and walls of the vessels takes place
which effectually obstructs the circulation after the muscular
coats have relaxed, and gangrene results. This is a typical
action of sphacelic acid, and it is not met with to nearly the
same extent in the case of any other known agent. It is ob-
served in the greatest perfection in the comb of the cock, in
consequence of the special arrangement of the blood-vessels in
this structure. In all animals the acid causes contraction of
the pregnant uterus, peristaltic under moderate doses and often
tetanic when the quantity is large. From this sketch of the
chief effects of these two substances the action of ergot itself
may, it is hoped, be more clearly understood.
External. — Upon the skin ergot has no appreciable action,
but upon mucous membranes it has somewhat of an astringent
and haemostatic effect.
Internal. G astro -intestinal Tract. — Digestion is much im-
paired in consequence of the disturbance caused in the circula-
tion, and vomiting is common, partly in consequence of the
disturbed circulation and partly from the action of the cornu-
tine on the medullary centre. Increased peristalsis of the in-
testine is induced by the stimulation of its muscular walls, and
diarrhcea frequently results in chronic poisoning. The intes-
tinal vessels are constricted, partly in consequence of the con-
traction of their own muscular coats and in part from that of
the muscular fibres of the bowel.
Circulation- — A high blood-pressure is indicated by a hard
and small pulse, which is usually slow also. The rise in blood-
pressure may for a time be concealed by the slowness of the
heart, but it is always very marked, and is one of the charac-
teristic effects of ergot. It is dependent upon a general con-
traction of the arteries, which appears to be due in part to
action on the vaso-motor centres and in part to direct action
on the muscular coats of the vessels. Because it constricts the
arterioles ergot is haemostatic. Very large doses may paralyze
the vaso-motor centres, with the effect of causing a fall of
ERGOT. 92 1
blood-pressure from vascular dilatation and cardiac depression.
If ergot is taken continuously for a considerable time gangrene
in various situations is apt to result from the vascular contrac-
tion and stasis of the blood stream, with coagulation and hya-
line thrombosis. This is a prominent feature of chronic poison-
ing, which is known as ergotism, and it was frequently met
with in former times among the lower classes of Europe, who
after poor harvests especially were obliged to use bread con-
taining ergot.
Nervous System. — Besides the gangrenous form of chronic
ergot poisoning, the other principal form is the convulsive.
The differences in the several varieties of ergotism are ex-
plained by the different actions of the constituents of the drug
and by the fact that they may act partly on the blood-vessels
and in part directly on the central nervous system. In some
epidemics both the gangrenous and convulsive forms have been
present, but, as a rule, one has been much more prevalent than
the other. In convulsive or spasmodic ergotism there are at
first formication, itching and tingling of the surface, followed
by numbness and local anaesthesia. Not infrequently anaesthe-
sia and hyperesthesia are found at the same time in different
parts, or even in the same part. These manifestations com-
mence in the hands and feet, and then spread over the whole
body. This disturbance of sensation even affects the alimen-
tary canal, so that there may be present at once both voracious
hunger and loss of appetite. At the same time there are much
weakness and depression, often with severe headache and gid-
diness, as well as central disturbances of the special senses,
such as dimness of vision and impairment of the hearing.
There may follow convulsions, usually clonic in character and
often epileptiform, and these have as sequelae contractures in
the limbs and sometimes in the trunk muscles. The disease
was immediately fatal in a large proportion of cases in earlier
times, and when recovery took place it was apt to be followed
by more or less loss of intellectual power, and in some instances
by complete dementia.
922 PHARMACOLOGY AND THERAPEUTICS.
Uterus. — One of the most prominent features of the action
of ergot is its property of exciting contractions in the pregnant
uterus. Whether the ecbolic effects of ergot are due to its
action on the uterus itself or on the nervous centres is still
an unsettled question. Its action upon the unimpregnated
uterus appears to be the same in kind, but less marked in de-
gree, and of much less constant occurrence.
The saliva, perspiration, urine and milk are diminished by-
ergot, and this is supposed to be due to the general vascular
contraction caused by it.
Therapeutics of Ergot.
Ergot is chiefly used for the purpose of insuring tonic con-
traction of the uterus after parturition, and thus guard against
the occurrence of post-partum haemorrhage. In case severe
haemorrhage is threatened, it is advisable, in order to obtain a
more prompt effect, to administer it hypodermatically. The
modern practice is to forbid the use of ergot until after the
expulsion of the placenta. The only possible exception to this
restriction is during the second stage of labor in cases where
it may seem to be indicated as a prophylactic against post-
partum haemorrhage. Even under these circumstances it should
never be given if there be the slightest mechanical obstacle to
delivery, or if the fcetal head be high up in the pelvic canal.
That ergot is justifiable in only very exceptional instances is
illustrated by the fact that out of twenty-seven cases recorded
by one obstetrical authority in which it was employed during
the second stage on account of inertia uteri, spontaneous de-
livery occurred in only seven. If the remedy is made use of
at this period of labor, it is essential that the foetal heart should
be carefully watched, so that in case of threatened asphyxia
instrumental delivery may be promptly resorted to. One great
objection to the use of ergot before delivery is that the uterine
contractions induced by it are likely to become more and more
severe and prolonged, so that ultimately the continued pressure
may endanger the life of the child, while if serious mechanical
ERGOT. 923
obstruction is present, even rupture of the uterus may be
caused. If employed before the membranes have ruptured, it
may prevent the further dilatation of the os uteri and deprive
the foetus of its blood supply through the constriction of the
uterine vessels. When given, as has been a very common prac-
tice, at the time of the passage of the child's head, it is likely
to produce its effect prematurely, and thus to give rise to hour-
glass contraction and interfere with the expulsion of the
placenta.
Ergot enjoys some reputation as an internal haemostatic, and
in addition to uterine haemorrhage, it has been employed in
epistaxis, haemoptysis, haematemesis and renal and intestinal
haemorrhage. While some authorities regard it with much
favor, it is certainly by no means uniformly successful, and the
marked increase of blood-pressure which it causes may prove
a serious objection to its use. In all cases where it is given
it is of great importance that the preparation should be a reli-
able one, and that a sufficient quantity should be exhibited.
Thus, if the fluidextract is selected, it is advised that in urgent
cases 4 to 8 c.c. (1 to 2 fl. dr.) should be given every half-hour
or hour. Ergot is often combined with ipecacuanha or astrin-
gents in these cases. The special indication for its use in
haemorrhage is regarded as a want of tonicity of the vessels.
WThere an especially prompt effect is required it should be
administered subcutaneously, and this method is often prefer-
able in haematemesis on account of the irritability of the stom-
ach. With suitable means for improving the quality of the
blood, it is regarded by some as very serviceable in the haemor-
rhagic diathesis, but it is not to be relied upon alone. In aneur-
isms, and especially those beyond the reach of surgical treat-
ment, ergot may prove distinctly valuable. By its action in
slowing the heart and causing such contraction of the arterioles
as to induce a marked increase of blood-pressure, the coagula-
tion of the blood in the aneurismal sac is promoted. In small
aneurisms of the peripheral main arterial trunks it is thought
possible that it may effect a cure by means of the contraction
924 PHARMACOLOGY AND THERAPEUTICS.
resulting from its direct action on the unstriped muscular fibres
in the affected portion of the vessel. It is also recommended
in miliary aneurisms of the intra-cranial arterioles, giving rise
to such symptoms as vertigo, epistaxis, headache and tinnitus
aurium; likewise when there is a sluggish and partially ob-
structed state of the intra-cranial veins, usually due to chronic
arteritis and accompanied by hebetude, dizziness, epistaxis, etc.
In certain forms of mental disease, such as recurrent mania,
chronic mania with lucid intervals, and epileptic mania, when
associated with cerebral hyperemia, ergot has been found use-
ful, and in epidemic cerebro-spinal meningitis it is claimed as
one of the remedies from which the best results are to be ex-
pected. Much success is also claimed for it, when given in
large doses, in congestion of the spinal cord and meninges
and in acute myelitis, as well as in the congestive form of
migraine. Other conditions in which it has proved of service
are acute conjunctivitis and blepharitis, congestive dysmenor-
rhea, amenorrhea dependent on plethora, incontinence of urine
caused by a paretic or paralytic state of the bladder sphincter,
and some forms of spermatorrhoea. It has also been used to
check the night-sweats of phthisis and as an antigalactagogue.
It is sometimes beneficial in uterine fibroids and polypi, and
good results have been obtained from the long-continued use
of ergotin in chronic metritis. Ergotin, especially when com-
bined with opium and nux vomica, has been found highly use-
ful in persistent chronic diarrhoea.
Ergot is employed to some extent in topical applications.
Oil of ergot (not official) is serviceable in seborrhcea, loss of
hair, and sycosis. Ergotin, in combination with various other
remedies, has been used in ointments for fissures of the nose,
mouth and anus, haemorrhoids, acne rosacea, boils, etc.
Not infrequently it is desirable to use the fluidextract of
ergot in combination with ferric chloride. The inky mixture
which results, by reason of the tannic acid contained in the
ergot, may be clarified by the addition of a little citric acid,
and chloroform water is a good flavoring agent for it.
HYDRASTIS. 925
COTTON ROOT BARK.
GOSSYPII CORTEX (Gossypii Radicis Cortex, U. S. P., 1890).—
Cotton Root Bark. Dose, 2 m.; 30 gr.
Unofficial Preparation.
Extractum Gossypii Radicis Fluidum (U. S. P., 1890). —
Fluidextract of Cotton Root Bark. — Dose, 1 to 4 C.C.; 14 to 1
fl. dr.
Action of Cotton Root Bark.
Cotton Root Bark has the same action as ergot, and is an
emmenagogue and an abortifacient.
Therapeutics of Cotton Root Bark.
It is used as a uterine haemostatic in the treatment of menor-
rhagia and metrorrhagia from various causes, and particularly
from uterine fibroids.
HYDRASTIS.
HYDRASTIS.— Hydrastis. (Gold Seal.) Dose, 2 gm.; 30 gr.
Preparations.
1. Fluidextractum Hydrastis.— *Fluidextract of Hydrastis.
Dose, 2 c.c; 30 VS\..
2. Tinctura Hydrastis. — Tincture of Hydrastis. Dose, 4
c.c; 1 fi. dr.
3. Glyceritum Hydrastis. — Glycerite of Hydrastis. Dose,
2 c.c; 30 TTL-
HYDRASTINA.— Hydrastine. Dose, 0.010 gm. (10 milligm.) ;
1ST'
HYDRASTININ^E HYDROCHLORIDUM.— Hydrastinine Hydro-
chloride. Dose, 0.030 gm. (30 milligm.); y2 Sr-
Action of Hydrastis.
Hydrastis is a stomachic tonic, and the large amount of
berberine in its composition would seem to give it a place among
926 PHARMACOLOGY AND THERAPEUTICS.
the simple bitters. In moderate doses it promotes appetite and
digestion, increasing the gastro-intestinal secretions and the flow
of bile. Its general action is due principally to the alkaloid hy-
drastine. This primarily stimulates the centres of the medulla
oblongata, causing slowing of the heart, increased arterial ten-
sion, and a quickening of the respiration. The rise in blood-
pressure is due to constriction of the arterioles. Under larger
amounts there is a stimulation of the spinal cord similar to that
caused by strychnine and causing clonic convulsions, followed
by tonic convulsions and tetanus. Furthermore, it weakens and
paralyzes muscle, an action which is confined to the heart in
warm-blooded animals, but affects the muscles generally in the
frog. In consequence of the cardiac depression the blood-
pressure falls, and eventually both the medulla and cord are
paralyzed, death occurring from failure of the respiration.
The constriction of the arterioles is not due, apparently, to any
direct action on the walls of the vessels, but rather to the
stimulation of the vaso-motor centre. There seems to be no
very satisfactory ground for the assertion, made by some writ-
ers, that hydrastis produces contraction of the uterus, from
action on the muscle. The drug has decided antiperiodic prop-
erties. The behaviour of hydrastine towards oxidizing sub-
stances has led to the supposition that this alkaloid is changed
into hydrastinine in the body, but this is disproved by the fact
that it is excreted unchanged in the urine. Hydrastinine has
been found to cause a much greater constriction of the periph-
eral vessels, as well as less depression of the heart, than hydras-
tine. It is also stated to differ from the latter in producing no
marked disturbance of the centres of motion except when given
in enormous doses, which paralyze the nervous system.
Therapeutics of Hydrastis.
External. — Hydrastis is much used empirically for subacute
and chronic inflammations of the mucous membranes. It may
be that the benefit derived from it is due in great measure to
HYDRASTIS. 927
its action in causing the contraction of dilated blood-vessels.
The various preparations, diluted with water, may be employed
as injections in gonorrhoea, vaginitis, leucorrhoea, otorrhcea,
and nasal catarrh, and as lotions for syphilitic mouth-lesions,
mercurial or aphthous stomatitis, follicular pharyngitis, fissured
nipples, hyperidrosis, acne, seborrhcea, and various other con-
ditions. A mixture of equal parts of the fluidextracts of hy-
drastis and ergot has been used as a local application in fissure
or prolapse of the anus, ulcerations of the rectum,, haemorrhoids,
and ulcerations or erosions of the os uteri. In the form of
ointments hydrastine and hydrastinine hydrochloride may be
used for unhealthy ulcers, sloughing sores, chancroids, etc.
Internal. — Hydrastis is very useful in gastric catarrh, espe-
cially when induced by chronic alcoholism, and, combined with
other appropriate remedies, often proves of service in intes-
tinal indigestion and various forms of dyspepsia. In chronic
catarrh of the intestine, even when ulceration has occurred, it
may prove of great service, and it is especially esteemed in
duodenal catarrh accompanied by catarrh of the gall-ducts and
jaundice. It is employed to a considerable extent in uterine
disorders such as menorrhagia and dysmenorrhcea, and also to
check the growth of uterine tumors. For the arrest of haemor-
rhage hydrastinine hydrochloride is to be preferred, but while
this is valuable in other uterine haemorrhages, it has little or
no effect in post-partum haemorrhage, so that it would seem
highly probable that hydrastis has no action on the uterine
muscle. On account of its marked action in constricting the
arterioles in general, hydrastinine should prove of service in
haemorrhages other than uterine. As an antiperiodic, hydras-
tis, while much inferior, ranks next in value to quinine. In
chronic malarial cachexia it may be given with iron prepara-
tions. Hydrastinine has been suggested in epilepsy on the
ground that it has some effect in diminishing the irritability of
the motor areas of the brain.
928 PHARMACOLOGY AND THERAPEUTICS.
CAULOPHYLLUM.
Unofficial Preparation.
Caulophyllum (U. S. P., 1890).— Caulophyllum. (Blue
Cohosh. Squaw Root.) Dose, 0.30 to 2 gm.; 5 to 30 gr.
Action of Caulophyllum.
But little is known positively of the effects of this drug, but
it is regarded as sedative, antispasmodic and oxytocic.
Therapeutics of Caulophyllum.
Caulophyllum is used to increase the force of uterine con-
tractions ; it has been employed as a remedy for deficient labor-
pains, and is believed to be useful in dysmenorrhea.
SAVIN.
SABINA.— Savin. Dose, 0.5 gm.; 7V2 gr.
Preparation.
Fluidextractum Sabinse. — Fluidextract of Savin. Dose, 0.3
c.c; 5 tt\.
OLEUM SABIN^E.— Oil of Savin. Dose, 0.05 c.c; 1 m,.
Action of Savin.
Oil of savin has the same action as oil of turpentine, but it
is more marked. Thus externally it causes great redness, pain,
vesication, and even pustulation. Internally it may produce
severe gastro-intestinal irritation, with vomiting, abdominal
pain and purging. In its excretion through the kidney and the
mucous membranes of the genito-urinary tract it severely irri-
tates them; thus hematuria, scanty urine, and pain on micturi-
tion may follow its use. The point in which the action of oil
of savin differs from that of the oil of turpentine is that it
powerfully irritates the ovaries and uterus, causing hyperemia
of these organs and accelerating menstruation. It also induces
contractions of the pregnant uterus, and therefore it is an
ecbolic.
CIMICIFUGA. 929
Therapeutics of Savin.
A cerate made from the fluidextract, I, in rosin cerate, 4,
has been used as a powerful irritant and counter-irritant, and
internally savin may be given as an emmenagogue; but, on the
whole, its use is to be discouraged, as it is so liable to cause
serious gastro-enteritis. It has often been administered as an
ecbolic with criminal intent, but it is rarely used in medicine.
RUE.
Unofficial Preparation.
Oleum Eutae.— Oil of Rue. Dose, .06 to .25 c.c; 1 to 4 HI.
Action of Oil of Rue.
External. — Oil of rue is irritant and vesicant.
Internal. — In large doses it is a powerful gastro-intestinal
irritant. It is eliminated in, and may be recognized by its odor
in the urine, breath and perspiration. It is irritant to the kid-
neys, ovaries and uterus, and excites the menstrual flow. In all
points its action resembles that of savin.
Therapeutics of Oil of Rue.
From its stimulating action on the uterus rue has been used
for amenorrhcea and also as an abortifacient, and fatal cases
of poisoning by it, from gastro-intestinal irritation, have been
recorded. It is very rarely given as a medicine.
CIMICIFUGA.
CIMICIFUGA.— Cimicifuga. (Black Snakeroot. Black Cohosh.)
Dose, 1 gm.; 15 gr.
Preparations.
1. Fluidextractum Cimicifuga. — Fluidextract of Cimicifuga.
Dose, 1 c.c; 15 Hi.
2. Extractum Cimicifuga. — Extract of Cimicifuga. Dose,
0.250 gm. (250 milligm.) ; 4 gr.
3. Tinctura Cimicifuga. — Tincture of Cimicifuga. Dose, 4
c.c; 1 fl. dr.
60
930 PHARMACOLOGY AND THERAPEUTICS.
Action of Cimicifuga.
Cimicifuga is an astringent bitter and to some extent a car-
diac stimulant, slowing the action of the heart, but increasing
its force. Its action in this respect is not important. In large
doses it depresses the heart and vaso-motor system. In frogs
it paralyzes the sensory side of the spinal cord, producing com-
plete anaesthesia, with loss of reflex activity, at a time when
voluntary movement is still preserved. The respiration is de-
pressed and finally arrested. Cimicifuga is said to cause uter-
ine contractions.
Therapeutics of Cimicifuga.
It has been employed in a great variety of conditions.
Among them may be mentioned dyspepsia, fatty and irritable
heart, dysmenorrhcea, amenorrhcea, subinvolution, rheumatism,
neuralgia, chronic bronchitis, and especially chorea. That it
is of very much benefit beyond that accomplished by a simple
bitter is open to question. It has been asserted that it some-
times promptly cures urticaria of nervous origin after the
failure of other treatment.
D. Emmenagogues.
MANGANESE.
MANGANI DIOXIDUM PR^CIPITATUM.— Precipitated Man-
ganese Dioxide. (Black Manganese Oxide.) Dose, 0.250 gm. (250
milligm.) ; 4 gr.
MANGANI SULPHAS.— Manganese Sulphate. Dose, 0.250 gm.
(250 milligm.) ; 4 gr.
Action of Manganese Dioxide.
When given by the mouth the salts of manganese exercise
an effect only in so far as they are dissolved in the secretions.
In large amounts they cause gastro-intestinal irritation, and in
smaller doses have some astringent action. When given by
subcutaneous or subvenous injection they cause descending
APIGL. 93 I
paralysis of the brain and spinal cord in frogs, and may give
rise to epileptiform convulsions in mammals. These salts, and
especially the dioxide, are thought by many to have a specific
influence upon the uterus.
Therapeutics of Manganese Dioxide.
It has been used empirically as an emmenagogue and is prob-
ably the most certain of all when administered in maximum
dose.
Action of Manganese Sulphate.
Like the dioxide, manganese sulphate in small doses has a
somewhat astringent effect, but larger amounts (2 to 4 gm. ;
30 to 60 gr.) cause vomiting and purging, in consequence of
the local irritation of the stomach and intestine. As in the case
of iron, only a very minute quantity is absorbed from the ali-
mentary canal, and no constitutional symptoms 'have been ob-
served from its prolonged administration by the mouth to
animals.
Therapeutics of Manganese Sulphate.
It has been used as a cholagogue purgative, but on account
of its irritating properties it is a very unsafe remedy. Its
action upon the uterus is much less pronounced than that of
the dioxide.
APIOL.
Unofficial Preparation.
Apiolum. — Apiol. (Parsley.) Dose, 0.60 to 1 C.C.; 10 to
15 TTl.
Action of Apiol.
Apiol in large doses acts as a cerebral and circulatory stim-
ulant. It is also believed to have a special action on the uterine
circulation.
Therapeutics of Apiol.
It is useful in amenorrhcea, scanty menstruation, and dys-
menorrhcea when administered immediately before the expected
932 PHARMACOLOGY AND THERAPEUTICS.
period in cases in which these conditions are due to a want of
ovarian activity; that is, where direct emmenagogues are
required.
TANSY.
Unofficial Preparation.
Tanacetum (U. S. P., 1890). — Dose, 1 to 4 gm.; 14 to 1 dr.
Action of Tansy.
Tansy possesses the properties of an aromatic bitter, and is
an irritant narcotic.
Therapeutics of Tansy.
It has been used as an abortifacient, but is dangerous in
large doses, several fatal cases having been recorded.
E. Substances which Depress Uterine Action.
VIBURNUM.
VIBURNUM PRUNIFOLIUM.— Viburnum Prunifolium. (Black
Haw.) Dose, 2 gm.; 30 gr.
Preparation.
Fluidextractum Viburni Prunifolii. — Fluidextract of Vibur-
num Prunifolium. Dose, 2 C.C.; 30 til.
VIBURNUM OPULUS. — Viburnum Opulus. (Cramp Bark.)
Dose, 2 gm.; 30 gr.
Preparation.
Fluidextractum Viburni Opuli. — Fluidextract of Viburnum
Opulus. Dose, 2 c.c.; 30 n\.
Action of Viburnum.
Viburnum is believed to be an antispasmodic, diuretic and
tonic.
Therapeutics of Viburnum.
It is especially used in the nervous diseases of pregnancy and
to prevent miscarriage. It has considerable reputation as a
ANTITOXINS AND SERUMS. 933
remedy for spasmodic dysmenorrhcea, in the treatment of after-
pains, and in menorrhagia. This remedy has been in extensive
use for more than twenty-five years and is undoubtedly of
value.
Division XII. — Antitoxins and Serums.
Antitoxins and serums have been classed by some among
alterative remedies, and there is a certain amount of reasonable-
ness in this designation; but their manner of action and the
methods by which they are administered are so different from
those of ordinary alteratives that it seems preferable to give
them in a division by themselves. To the class of substances
(believed to be of albuminous nature) produced in the animal
organism by pathogenic germs which is deleterious to the ani-
mals themselves the name toxin has been given, while to a
different class of substances, also albuminous and also produced
by the same germs, but which is inimical to the bacteria, the
name antitoxin has been assigned. The toxin acts both as a
local and systemic poison, and by its hostile influence upon the
bacteria the antitoxin tends to counteract both of these effects.
The precise modus operandi is as yet unknown, but it is thought
probable that the antitoxin affects the protoplasm in such a way
as to render it capable of resisting the action of the toxin. It
is to be noted, however, that the antitoxin has been demon-
strated not to be a germicide, and thus capable of killing the
pathogenic organism; so that there is still considerable mystery
as to just how it produces the beneficial effects observed from
it. The antitoxins are:
(1) Diphtheria Antitoxin. (2) Tetanus Antitoxin.
The most important one is diphtheria antitoxin.
Serums, other than antitoxins or nutrient serums, are attenuated
cultures made from pathogenic germs, and often called vaccines, the
administration of which is designed to confer immunity from the spe-
cial disease represented by the germs from which the cultures are
made. Among the serums which have been employed are the follow-
ing:
934
PHARMACOLOGY AND THERAPEUTICS.
(1) Antistreptococcic Serum.
(2) Antipneumococcic Serum.
(3) Antivenomous Serum.
(4) Antiplague Serum.
(5) Anticholera Serum.
(6) Antityphoid Serum.
For the sake of convenience Nutrient Serum, which is supposed to
replace the blood serum, and also Hydrophobia Antidote, although it
is neither an antitoxin nor a serum, are considered in this Division.
SERUM ANTIDIPHTHERICUM.— Antidiphtheritic Serum. Diph-
theria Antitoxin. Dose, 3000 units. Immunizing dose for well per-
sons, 500 units.
Action of Diphtheria Antitoxin.
Antitoxin serum has a favorable effect upon all the symp-
toms of diphtheria and also a marked influence in preventing
the occurrence of sudden heart-failure which constitutes one of
the great dangers of the disease. The temperature, however,
is less affected than the other symptoms. Statistics collected
from reliable sources afford overwhelming evidence as to the
value of antitoxin in reducing the mortality from diphtheria.
They also show that the frequency of laryngeal diphtheria is
diminished by its use, and that the mortality of patients upon
whom intubation or tracheotomy has been practiced is likewise
diminished. Furthermore, the time during which the tube must
be worn is decreased. After the serum has been employed, it
is found that although the bacilli continue to be present, the
formation of membranous exudation ceases, and that which is
already present rapidly disappears. Consequently, if antitoxin
be used early, the membrane rarely extends from the fauces
into the larynx. It is not until twenty-four hours after injec-
tion, however, that the maximum effect of the antitoxin is ob-
served. It is stated that the frequency of the occurrence of
post-diphtheritic paralysis is not diminished, although the per-
centage of recoveries in cases with paralysis is slightly in-
creased.
The use of the antitoxin is sometimes attended with untoward
effects, but as a rule these are of very little importance. That
they are not due to the antitoxin itself, but to something else
ANTIDIPHTHERITIC SERUM. 935
in the serum, seems to be shown by the fact that they may
result from the injection of the simple serum of animals. The
most common of these is a rash, usually erythematous in charac-
ter, but sometimes resembling measles or urticaria, and another
is pain and swelling in the joints. Somewhat rarely there have
been observed an irregular temperature range and consecutively
emaciation and death; evidently pointing toward an acquired
septicaemia. Further, in a few cases an early fatal result has
been reported. It has been shown that in a fatal issue nephritis
is the cause of death in a majority of instances, and clinically
hemorrhagic nephritis is by no means rare.
Therapeutics of Diphtheria Antitoxin.
As the mortality of the disease when antitoxin is used in-
creases in proportion to the lateness of its employment, it is
evident that the administration should be commenced at the
earliest possible moment. It is the safest plan to give antitoxin
on a clinical diagnosis, without waiting for a bacteriological
culture. Inasmuch as this remedy militates solely against the
infection of the Klebs-Loeffler bacillus and clinically most cases
of diphtheria are cases of mixed infection, the usual local anti-
septic and general supporting measures must not be omitted.
The danger of antitoxin lies in the horse-serum, for, many years
before antitoxin was made, the results of injection of an alien
serum had been pointed out. Concentrated serums then should
be preferred in that they give the largest amount of antitoxin
with the smallest amount of serum. In cases of moderate
severity it is recommended that a dose of 5000 units (10 c.c.
of serum containing 500 units per c.c.) should be given at once.
A second injection may not be required, but if the symptoms
demand it, the dose should be repeated two or three times at
intervals of twelve hours. In severe cases, or in those treated
late, the dose should be 8,000 to 10,000 units. If no ameliora-
tion of the condition is observed within two or three days, the
further continuance of the treatment appears to be useless.
The injections are usually made, with a specially devised
936 PHARMACOLOGY AND THERAPEUTICS.
syringe, between the shoulders or on the side of the abdomen,
and should be given under strict aseptic precautions.
So far as prophylaxis is concerned, the question is still sub
judice. Many failures are reported, and, indeed, instances of
reinfection have occurred even after suitable doses of antitoxin
have been used during a previous attack.
Unofficial Preparation.
Serum Antitetanicum. — Antitetanus Serum. Tetanus Anti-
toxin. Dose, 10 to 20 c.c; 2y2 to 5 fl. dr.
Action of Tetanus Antitoxin.
While diphtheria is recognized by the local inflammation long
before the nerves and heart have become affected, tetanus is
first recognized only when the poison has gained access to the
central nervous system. The hypothesis has been advanced
that the toxin of the bacillus tetanus has a chemical affinity for
nerve-tissue, and enters into chemical combination with and
destroys such tissue, and that the convulsions result from the
changes thus brought about in the nerve centres. Furthermore,
that the antitoxin, having no such chemical affinity, is capable
of neutralizing only the toxin that may still remain in the cir-
culation, and naturally cannot have any effect on the destruc-
tive lesions already present in the centres. While tetanus
serum possesses antitoxic, it has no antibacterial properties.
Therapeutics of Tetanus Antitoxin.
In view of the extreme gravity of the disease, in acute and
rapidly developing cases it would seem advisable to employ the
serum freely at the earliest possible moment in every case of
tetanus. The injections may be repeated every six or twelve
hours at first, and afterwards at longer intervals if there is
evidence of improvement. In some instances the antitoxin has
been injected directly into the brain, after trephining the skull,
and in others into the spinal cord, and this is preferable in
severe cases. In any case of injury in which there appears to
ANTIDIPHTHERITIC SERUM. 937
be a likelihood of the development of tetanus the use of the
serum as a prophylactic is advisable.
It is a well-known fact that tetanus toxin has proved far less
successful than diphtheria antitoxin, and quite recent investiga-
tions have presented an explanation of the difficulties met with
in the use of this serum. In these it was found that not only
is the tetanus toxin carried to the central nervous system along
the motor nerves, but also that the toxin gains entrance to the
nerves through the motor end-plates, that it does not reach the
central nervous system by any other route than the nerves, that
tetanic rigidity is altogether a result of central irritation, and
that the latent period between the injection of toxin (in ex-
periments on animals) and the onset of tetanic symptoms is
almost altogether due to the time required for the toxin to
pass along the motor nerves to the cord or brain. Further-
more, it was found that tetanus antitoxin is not carried along
the nerves, and has practically no action except upon that toxin
which has not yet entered into the motor axis cylinders. Other
recent experiments also go to show that the toxin is absorbed
only by the motor nerves; the antitoxin only by the circulation
and lymph. This peculiar mechanism, now demonstrated for
the first time, brings the tetanus toxin in concentrated form
upon the susceptible cells along the motor axis cylinders, and it
furthermore places the toxin at an early period (and some time
before the onset of symptoms) beyond the reach of the anti-
toxin. From these researches the following practical lessons
have been drawn : ( I ) Subcutaneous, intravenous and subdural
injections of antitoxin are of no value as measures to relieve
tetanus when the symptoms have once appeared. (2) Injec-
tions of antitoxin, especially near the injected wound, will effec-
tually bind any toxin present in the system: i. e., toxin before
it has been picked up by the motor end-plates. (3) It is prob-
able that injections of antitoxin directly into the motor nerve
leading from the infected wound, or even into the segment of
the cord reached by this nerve, will have some influence upon
the toxin.
93 8 PHARMACOLOGY AND THERAPEUTICS.
Unofficial Preparation.
Serum Antistreptococcicum. — Antistreptococcic Serum.
Dose, 10 to 20 c.c; 2y2 to 5 fl. dr.
Action of Antistreptococcic Serum.
Antistreptococcic serum has been used to a limited extent
for some time, but it labors under the great disadvantage that
different cultivations of apparently the same streptococcus show
such variance that serum which is bactericidal to one cultiva-
tion may not be so to another.
Therapeutics of Antistreptococcic Serum.
It has been employed in various diseases in which infection
is largely attributed to the streptococcus, such as erysipelas,
malignant endocarditis, otitis media, thrombosis of the lateral
sinus, and puerperal and surgical septicaemia; and trial may be
made of it in any affection attended with the presence of strep-
tococci. While the results are not infrequently disappointing,
successful cases have been recorded in the disorders mentioned,
and also cases of scarlet fever in which it has apparently proved
useful in shortening the course of the disease and in prevent-
ing serious complications and sequelae, such as otitis media and
other suppurative processes, due to this microbe. It has per-
haps been found of most service in erysipelas and puerperal
septicaemia, and it is recently reported to have been used suc-
cessfully in grave cases of scarlet fever and in inflammatory
rheumatism. With an increased knowledge of its appropriate
application there seems every reason to believe that the serum
will prove a valuable addition to our therapeutic resources.
The chief beneficial effects observed from its use are a fall in
temperature and a general improvement in the patient's con-
dition. In many acute cases such effects have been noted after
each injection. In acute cases the serum may be administered
two or three times a day, and in chronic cases once daily.
ANTIDIPHTHERITIC SERUM. 939
Unofficial Preparation.
Serum Antipneumococcicum. — Antipneumococcic Serum.
Dose, 10 to 20 c.c; 2y2 to 5 fl- dr«
Action of Anti-Pneumococcic Serum.
This serum is antibacterial, but does not appear to possess
antitoxic properties. As in the case of antistreptococcic serum,
there are serious difficulties in its practical application. Pneu-
mococci, when derived from various sources, differ from one
another in virulence and in cultural characteristics; hence a
serum which proves protective in some instances may be of no
value in others. Consequently, the results thus far obtained
have not been very satisfactory.
Therapeutics of Anti-Pneumococcic Serum.
The serum is injected subcutaneously, and it is advised that
the doses should be given twice a day until the temperature has
subsided and the patient is convalescent. It is thought possible
that it may be of more advantage in some other pneumococcal
affections (such, for example, as infective endocarditis) than
in pneumonia itself.
Unofficial Preparation.
Serum Antivenenosum. — Antivenomous Serum. (Anti-
venene.) Dose, 10 to 30 c.c; 2y2 to 8 fl. dr.
Action of Antivenomous Serum.
This serum is protective in animals when employed before,
at the same time, or shortly after inoculation with snake poison.
The immunity conferred by it, however, is found not to last
longer than six days. Up to a certain period after inoculation
the serum is protective, even though symptoms of poisoning
may have manifested themselves; but after that no amount of
it, however large, can prevent a fatal result.
940 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Antivenomous Serum.
The serum should be administered as soon as possible after
the snake bite. It may be given subcutaneously, but, on account
of the greater rapidity of absorption, it is preferable to inject
it into a vein, due aseptic precautions being taken. The results
of this treatment thus far recorded leave no doubt of its ex-
treme value. In a number of instances recovery from the bites
of venomous snakes has taken place even after well-marked
symptoms of poisoning had made their appearance.
Unofficial Preparation.
Serum Antipestilens. — Anti-plague Serum. Dose, 10 to 20
c.c; 2y2 to 5 fl. dr.
Action of Anti-Plague Serum.
Anti-plague serum is antibacterial. If, as is said to be the
case, it also possesses antitoxic properties, these seem to vary
with the method of preparation, and are certainly less pro-
nounced than the antibacterial. The prophylactic vaccine (in-
oculation) contains the toxins derived from the bodies of the
bacteria and also those produced in or diffused into the sur-
rounding medium, which are stated to be so modified as to be
almost entirely nonpathogenic to susceptible animals. From
three to five hours after inoculation there is a marked rise of
temperature, with pain and swelling at the site of inoculation.
While the temperature subsides in from twenty-four to thirty-
six hours, the latter symptoms continue for several days.
Therapeutics of Anti-Plague Serum.
The anti-plague serum, which is injected subcutaneously,
should be administered as early as possible. Two or three doses
should be given the first day, and one dose daily afterwards.
The results thus far obtained with this serum have not been
very encouraging. While in some cases it appears to do good,
in others it has no effect. Such protection as is afforded by it
ANTICHOLERA SERUM. 94 1
has been found to last for only a few days, so that it is avail-
able as a prophylactic only under special circumstances.
The prophylactic vaccine should be injected, with strict asep-
tic precautions, into the subcutaneous tissue, preferably by the
arm. It is stated that if the temperature does not rise as high as
38.80 C. (1020 F.) in several individuals, the prophylactic is
not up to the standard potency, and increased doses must be
given. From an extensive use of this vaccine, particularly in
India, its efficacy against plague appears to be clearly estab-
lished, and it is believed that still more favorable results will
be obtained when better methods of standardizing the prophy-
lactic have been obtained and further improvements made in
the method of preparation.
Unofficial Preparation.
Serum Anticholeraicum. — Anticholera Serum. Dose, 10 to
20 c.c; 2y2 to 5 fl. dr.
Action of Anti-Cholera Serum.
This serum is antibacterial, but not antitoxic; it is said to
protect against the living vibrios but not against their toxins.
Two prophylactic vaccines have been used, one consisting of
an emulsion in sterile broth of a fresh agar cultivation of viru-
lent vibrios, and the other of an emulsion in sterile broth made
from attenuated vibrios. They must be administered immedi-
ately after being made. One vaccine (inoculation) is used five
days, or more, after the other, and they are injected into the
subcutaneous tissue of the abdomen under strict aseptic pre-
cautions. There is a moderate, but brief, febrile reaction after
the first vaccination, and a less marked one after the second.
Therapeutics of Anti-Cholera Serum.
As the serum has no antitoxic properties and as the disease
runs such a rapid course, this serum does not appear to have
any value in the treatment of cholera. On the other hand,
942 PHARMACOLOGY AND THERAPEUTICS.
prophylactic vaccination (inoculation) affords considerable
protection against the disease. The statistics of its employ-
ment in India, however, go to show that while it undoubtedly
diminishes the actual number of deaths from cholera, this is
due to the smaller number of individuals attacked, in conse-
quence of its prophylactic agency, and not to a decrease in the
case mortality. It appears, therefore, that if a vaccinated per-
son contracts the disease, he has no better chance of recovery
than an unvaccinated one. The dose is stated to be an eighth
part of an emulsion made in sterile broth from the whole of
an agar cultivation which has been incubated for twenty-four
hours at a temperature of 350 C. (950 F.).
Recent investigations have shown that in many instances, at
least, of the severe summer diarrhoea of infants and young
children the infection is due to the bacillus of dysentery (Shi-
ga's bacillus), and a serum against this has been prepared.
Although but a very limited trial of this has as yet been made,
the results obtained with it are stated to have been such as to
lead to the hope that much may be expected from this method
of treatment in the future. It has also been proposed to use
an attenuated serum for prophylaxis against dysentery in per-
sons exposed to the disease, as in the case of troops in tropical
climates. It has been found feasible to protect small animals,
like guinea pigs, against the bacillus. Such inoculation is at-
tended with no danger whatever, but whether it is really effec-
tive as an immunizing agent can only be determined after
extended trial and observation.
Unofficial Preparation.
Serum Antityphoideum. — Antityphoid Serum.
Action of Anti-Typhoid Serum.
The inoculation of dead typhoid bacilli, for prophylactic pur-
poses, is made, with strict aseptic precautions, into the subcu-
taneous tissue of the abdomen. It is followed in three or four
hours by local inflammatory reaction and by pyrexia which
NUTRIENT SERUM. 943
usually subsides within twelve hours. The average tempera-
ture observed is about 38.80 C. (1020 F.).
Therapeutics of Anti-Typhoid Serum.
It is advisable that the injection should be made in the even-
ing, so that the patient may go to bed as soon as the symptoms
make their appearance. In order to secure the best chance of
success the inoculation may be repeated in a week. At present
no definite conclusions can be reached as to the immunizing
power of this method, but the inoculation appears to exercise
a pronounced influence on the system, since it renders the blood
serum capable of agglutinating typhoid bacilli. The dose of the
strongest vaccine prepared is about 5 c.c. (8 ni) and of the
weakest, 1.5 c.c. (25 til).
As to the treatment of typhoid with anti-typhoid serum, there
is as yet no reliable evidence that the procedure is of value.
Cases thus treated have from time to time been reported, but
the fact that the serum employed, so far as known, was not
standardized renders it impossible to judge of results.
Unofficial Preparation.
Serum Nutriens. — Nutrient Serum. Dose, 30 to 120 c.c;
1 to 4 fl. oz.
Action of Nutrient Serum.
At the time of the first introduction of diphtheria antitoxin
a very large amount of the serum had to be injected, on account
of its diluteness; as much as 320 c.c. (10 fl. oz.) being used in
two days for a child of five years. As the employment of such
quantities was found to be attended by no bad results, the idea
was suggested that serum might be injected subcutaneously as
a food, and a series of experimental researches in animals was
accordingly instituted for the purpose of determining, as far as
possible, the practical utility of this procedure. The results of
these were as follows: The injection of small quantities of
serum, by increasing the katabolism of the body, induces an
944 PHARMACOLOGY AND THERAPEUTICS.
increase of urinary nitrogen, and a loss of weight, but when
large quantities are employed, the loss from the increased kata-
bolism caused is more than offset by the utilization of the serum
as a food. It was thus found that in animals which were de-
prived of all other means of sustenance life was prolonged for
a very considerable period by the subcutaneous injection of
serum in sufficient quantity. Furthermore, it was ascertained
that if the serum be heated to 650 C. (1490 F.), this has the
effect of destroying the bodies which produce increased nitrog-
enous katabolism and also those which give rise to certain un-
toward effects when the serum of one animal is injected into
another of a different species. At the same time, the nutritive
value of the serum remains unimpaired. These results have
therefore been made use of in the human subject.
Therapeutics of Nutrient Serum.
A horse-serum or sheep-serum, heated to the proper tempera-
ture, may be injected in a variety of conditions: as after grave
abdominal operations when it is impossible or inadvisable to
feed the patient by the mouth or rectum, in the vomiting some-
times met with in post-diphtheritic paralysis, or in certain cases
of gastric ulcer, typhoid fever, infantile diarrhoea, etc. The
dose for an infant is 30 to 40 c.c. (8 to 10 fl. dr.), for a child,
60 to 80 c.c. (16 to 20 fl. dr.), and for an adult 100 to 120 c.c.
(3 to 4 fl. oz.), and these doses may be repeated as required.
Where the daily administration of the serum is called for, the
injection should be made each time in a different part of the
body in order to avoid undue local irritation. Goat serum or
lymph has been employed to improve the general nutrition in
many chronic diseases with some benefit. The exaggerated
claims formerly made for it, however, have not been substan-
tiated.
Unofficial Preparation.
Antidotum Rabiis. — Hydrophobia Antidote.
ORGANIC EXTRACTS. 945
Action of Hydrophobia Antidote.
It has of late years been the practice when a person has been
bitten by a dog supposed to be rabid to inoculate him on suc-
cessive days with rabbits' spinal cords of progressively increas-
ing virulence, and it has been claimed that if this treatment is
begun soon after the bite, hydrophobia does not usually de-
velop. The spinal cords employed are taken from rabbits
which have been inoculated with rabies. For inoculating the
human subject emulsions of dried cords are employed, and the
virulence of the injection depends on the shorter or longer time
for which the cord used has been allowed to dry.
Therapeutics of Hydrophobia Antidote.
The reports of the use of this suggest that some of the
deaths after treatment may be due to it rather than to the bite.
Inasmuch as the incubation period of hydrophobia is so ex-
tremely variable, the pathological findings so inconstant and
the symptoms so diverse, there is much reason for doubting the
existence of the disease in man. At least, the majority of al-
leged cases have been shown to have been those of various
diseases (tetanus, septicaemia, hysteria). For this reason the
antidote possesses but little interest save to those who are inter-
ested in spreading hydrophobia-phobia.
Division XIII. — Organic Extracts.
The glands of the body, it is thought, are more or less inter-
changeable in their functions; so that if one is unable to do its
work, another seems to assume extra activity. It is now a
recognized fact that the blood is continuously supplied by cer-
tain glands with substances which are essential to the welfare
of the system; so that a lack of these induces very serious re-
sults. It has been demonstrated also that the bad effects fol-
lowing the excision of the glands can be successfully obviated
by the administration of the gland substance. The use of ex-
tracts of the glands of the body, known as animal extracts or
61
946 PHARMACOLOGY AND THERAPEUTICS.
organic extracts, now has a legitimate place in medicine. They
are usually active when given by the mouth, as well as by sub-
cutaneous or intravenous injection, and thus present a marked
contrast to the antitoxins, which, being proteid substances, are
destroyed in the stomach. The chief object of the therapeutic
employment of the organic extracts has hitherto been to supply
a deficiency of the normal secretion, but at present their field
of usefulness is becoming more and more extended, as their
pharmacological action becomes more definitely understood and
their practical therapeutic value is demonstrated in various
pathological conditions. It seems altogether probable that the
further developments in the subject of organo-therapy will be
of great interest and utility. The organic extracts most in use
are:
(1) Thyroid Extract.
(2) Suprarenal Extract.
(3) Thymus Extract.
(4) Pituitary Extract.
(5) Mammary Extract.
(6) Ovarian Extract.
(7) Testicular Extract.
(8) Brain Extract.
(9) Splenic Extract.
These substances might, with better reason than the anti-toxins and
serums, be classified with the alteratives, but inasmuch as each one
has a definite, aside from a general, action they are properly considered
separately. The extract which is of the greatest practical importance
is the thyroid, and next to that comes the suprarenal.
GLANDULE THYROIDEiE SICCJE.— Desiccated Thyroid Glands.
(Thyroid Extract.) Dose, 0.250 gm. (250 milligm.) ; 4 gr.
Unofficial Preparations.
Liquor Glandularum Thyroidearum. — Solution of Thyroid
Glands. (Solution of Thyroid.) Dose, .30 to 1.00 c.c; 5 to
15 HI.
Iodothyrinum. — Iodothyrin. (Thyroiodin.) Dose, .06 to .30
gm.; 1 to 5 gr.
Action of Thyroid Gland.
Circulation. — The thyroid gland is thought to be probably
the main organ of the body to furnish vaso-dilating material.
DESICCATED THYROID GLANDS. 947
and the administration of its substance has the effect of dilat-
ing the peripheral blood-vessels and reducing arterial tension.
Consequently, the cutaneous surface becomes flushed and moist,
and the cardiac action is more or less depressed. Unless its
use is continued for a considerable time it has only a slight
action on the heart muscle, but small doses increase and large
doses diminish its force. The pulse-rate is quite constantly
accelerated. Injections of thyroid extract into the circulation
have been found to cause a fall in blood-pressure of relatively
short duration. The only effect of ordinary doses observed on
the blood is an augmentation of lymphocytes.
Alimentary Canal. — Loss of appetite and diarrhoea are quite
frequently caused by large amounts and occasionally by small
doses.
Nervous System. — Thyroid is a cerebral stimulant, capable
of causing wakefulness, acuteness and rapidity of thought, and
general brain activity. Given to excess, it produces headache,
nervousness, restlessness, insomnia, palpitation, hot flushes,
sweating, increased irritability of the reflexes, tremors of the
extremities, and even convulsions.
Kidneys. — The quantity of urine is uniformly increased.
This effect has been thought by some to be due to some specific
action on the kidney, or to the changes in the circulation, but
it may possibly result simply from the augmented excretion of
urea and other urinary elements. In some instances sugar is
found in the urine.
Metabolism. — A greatly increased oxidation is induced, both
nitrogenous and non-nitrogenous bodies being rapidly used up.
On this account there is an increased excretion of urea, uric
acid, and xanthin bases in the urine and of carbon dioxide by
the lungs. It is found that the first effects are upon fat, the
proteids not being acted upon until this has been reduced to a
certain minimum. These tissue changes result in a rise of
temperature and a loss of body weight.
Excretion. — The elimination of the active constituents of
thyroid gland takes place, so far as known, entirely through
the kidneys.
948 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Thyroid Gland.
In man and the monkey one of the constant and characteris-
tic effects of removal of the thyroid gland is a myxcedematous
condition. At an early period there is an abundance of mucus
and later there occurs a marked hyperplasia of connective tis-
sue, embryonic in character. The skin is hard, rough and dry,
because there is no secretion, and the hair loses its vitality and
falls out. Among the other changes observed are, abdominal
vaso-dilation, fatty and colloidal degeneration of the liver and
kidneys, and hyaline degeneration of the arterial walls. All
of these phenomena may be made to disappear by feeding thy-
roid. It is also a well known fact that atrophy of the thyroid
gland always accompanies myxcedema, and it has been found
that if patients suffering from this affection are treated with
sheep's thyroid, all the symptoms disappear, usually in about
six weeks. For the treatment of myxcedema the solution is
preferable to the powder, as the latter is liable to decomposi-
tion. .30 c.c. (5 TTi) may be given three times a day in water,
and the dose gradually increased to .60 c.c. (10 1*1). After the
symptoms have all disappeared it will be necessary, in order
to prevent a recurrence, that the patient should take the latter
dose about twice a week for the rest of his life. Compressed
tablets of the powder are very convenient to take, and are used
to a considerable extent. Goitre may sometimes be favorably
affected by thyroid, and the variety in which it is most bene-
ficial is that known as the hyperplastic follicular. Complete
disappearance is exceptional, but as a rule considerable de-
crease takes place, especially in the young. As recurrence is
otherwise almost certain, the remedy must be continued indefi-
nitely. In exophthalmic goitre it generally seems to be injuri-
ous, rather than beneficial. In sporadic cretinism excellent
results are often obtained with it, and the brain symptoms share
in the general relief afforded. Poorly developed young chil-
dren are often benefited by it. In a few instances of imbecility
in children, of tetany, and of climacteric insanity much im-
provement is reported to have been caused by it. In cases of
SUPRARENAL GLAND. 949
arterio-sclerosis where nitroglycerin in small doses is of value
to reduce such disturbances from high tension as dizziness,
sleeplessness and headache, thyroid has been found of marked
benefit. It must be used with some caution in persons suffer-
ing from organic disease of the heart. It has been observed
in feeding thyroid for other purposes that not infrequently
menorrhagia is produced, and it is asserted that in delayed
menstruation, with or without anaemia, no drug is as efficient
in causing normal menstruation as thyroid extract, given in
.20 gm. (3 gr.) doses thrice daily. It has been given with
success in chronic eczema and some other skin diseases, but the
effects are by no means always permanent. This remedy has
been advised and considerably employed in the treatment of
obesity, but as it is not as efficient as some other means, and as
its continued use in these cases is not unattended with danger,
it is not to be commended.
Iodothyrin, a substance isolated from thyroid which possesses
all the physiological properties of the gland extract, is now
used to a considerable extent. A milk-sugar triturate of this
is given in daily dose of 1 to 2 gm. (15 to 30 gr.).
Poisoning. — A condition somewhat resembling exophthalmic
goitre in its symptoms, though without exophthalmos or in-
crease in the size of the thyroid, and known as Thyroidism,
may be induced by over-doses. Very large doses taken for a
long time make patients thin; and also produce degeneration
of the cardiac muscle, so that permanent disability may result.
Surgeons are especially liable to make this error.
SUPRARENAL GLAND.
GLANDULE SUPRARENALES SICC^.— Desiccated Suprarenal
Glands. (Suprarenal Extract.) Dose, 0.250 gm. (250 milligm.) ; 4 gr.
Unofficial Preparation.
Adrenalinum. — Adrenalin.
950 PHARMACOLOGY AND THERAPEUTICS.
Action of Suprarenal Gland.
The principal effects of suprarenal gland, as demonstrated
by experiment, are to increase the tone of all muscular tissue,
mainly if not entirely by direct action, to constrict the small
arteries through its action on the vaso-motor centre, and to
raise blood-pressure more than any other known substance.
Its action on the circulation is thus exactly the opposite of
thyroid. The rise in blood-pressure is immediate, but it is to
be noted that this effect is very brief, lasting less than a min-
ute, and that it is not elicited at all when the administration
is by the stomach. Suprarenal is a strong cardiac stimulant.
The pulse-rate is slowed from stimulation of the pneumogastric
centre in the medulla oblongata, and the heart muscle is affected
in the same way as by digitalis, its systole being much strength-
ened and its diastole being often rendered less complete. The
heart becomes more and more slowed, and is finally arrested in
systole. The cardiac stimulation is not produced for some
time after the constriction of the vessels. Additional actions
of this substance are a depression of the respiratory centre,
which may result in respiratory failure and death, and a dimin-
ution of peristalsis through peripheral action on the nervous
mechanism. Its action on the muscles strongly resembles that
of veratrine.
Certain unfavorable clinical results have been noticed to be
coincident with the use of suprarenal solutions, and have been
attributed to their effect. These doubtful results are stated to
be: haemorrhage, reactionary symptoms, swelling and localized
areas of oedema, retarded healing, sloughing, and unhealthy
condition of wounds. Hence, with a view to determine the
effect of suprarenal preparations on living protoplasm, a series
of experiments was recently undertaken, and the main results
of these, with the deductions, drawn from them, have been
given as follows :
It seems fair to conclude that solutions in the strength of
o.ooi interfere with the phenomena of clotting of blood in
some of the cold-blooded animals (asteria and limulus), but
SUPRARENAL GLAND. 95 I
that in other animals there is no change. If these results can
be applied to warm-blooded animals we may assume that the
active principle of suprarenal gland has no effect upon the
coagulation phenomenon, and that the danger of secondary
haemorrhage from softening of the clot is not increased by
its use.
In the egg of the arbacia (sea-urchin) strong adrenalin solu-
tions may kill the protoplasm, while weaker solutions have a
marked and regular effect in preventing the cell-division and
development of the egg. At a certain stage in the cell-division
the protoplasm is changed, so that it never develops further.
From these effects on the sea-urchin's egg it seems fair to
assume that the same effects may be active in the human indi-
vidual, since the properties of protoplasm are much the same
wherever it is found. If this be true, then we may assert that
suprarenal preparations have a marked effect on cell-division
of healing tissue and upon the proliferation of cells constitut-
ing granulation tissue. It may also be assumed that these solu-
tions will have an effect depending on the strength of the solu-
tion, as well as the duration of the exposure, and that it is
possible to kill cells or to prevent their activity, or retard cell-
division. In this connection it should be remarked that other
substances, especially alkaloids (atropine and aconitine), seem
to act similarly. As it was also shown that the rate of pro-
gression of the moving ciliated ovum was much slower in cases
that were developed in weak solutions, it would appear that the
vitality of the protoplasm is weakened by suprarenal solutions.
The cilia of the aronicula larvae are affected only by stronger
solutions than are necessary to paralyze muscle movement. By
these the ciliated movement is markedly retarded. In inter-
preting these results we again see a clear line of demarcation
drawn between the strength of solutions; these slight differ-
ences show a potentiality which we would not suspect.
It would seem that the cilia on the gill of the salt-water clam
are more resistant to the effect than those of the arbacia or
aronicula, and this we might expect in an adult animal. When
952 PHARMACOLOGY AND THERAPEUTICS.
the oesophageal membranes of a frog are placed in a solution
of o.oooi the immediate effect is to produce a slowing in the
ciliated movement. These cilia are also more resistant to the
effect of this solution than the arbacia or aronicula, and it has
not been found possible to entirely check the action of the cilia
with solutions of o.ooi.
Experiments on the hearts of turtles and frogs show that
suprarenal solutions are powerful muscle stimulants.
In the medusa the suprarenal alkaloid is a powerful stimu-
lant to contraction, and it affects the contractile tissue in a
most characteristic and marked way. It was found that this
animal reacted best in a solution of the strength of 0.0005.
There is therefore warrant for asserting that, at least in the
lower animals studied in these experiments, suprarenal prepa-
rations have a most marked influence in interfering with the
power of cell-division, the development of protoplasm, and the
movement of cilia, and also in stimulating contractile tissue.
Therapeutics of Suprarenal Gland.
It may be used as a local vaso-constrictor in minor surgery.
On account of this property it may be applied to inflamed tis-
sues so that these may be rendered anaesthetic by cocaine. For
topical application, a filtered, freshly-made aqueous solution
should be employed. It may be sterilized by heat without de-
stroying its active principle. All antiseptics, used as preserva-
tives, are disappointing. The active principle has been iso-
lated by Abel, who proposed the name epinephrin for it. Its
salts produce an exceedingly powerful effect on blood-pressure.
The gastric contents, it is found, have no effect upon the ex-
tract. For internal treatment it is well to commence with .06
gm. (1 gr.) of the powder, three times a day, and progressively
increase the dose. It should be given dry on the tongue and
swallowed without water. It should never be given hypoder-
matically on account of the collapse which it causes when ad-
ministered in this way. It is of great value in the treatment of
" hay-fever," given internally and also applied locally. It is
THYMUS EXTRACT. 953
useful in the treatment of acute and chronic bronchitis, bron-
chial asthma, congestion and oedema of the lungs, haemoptysis,
and oedema of the glottis. It may be cautiously used in dis-
eases of the heart, which, as has been stated, it stimulates from
direct action on the heart muscle. Suprarenal has been used to
a considerable extent in the treatment of Addison's disease, but
without much benefit. It might perhaps be of service if it
could be brought into the blood directly, but its intravenous
injection would be quite unjustifiable in this affection. In
shock it has been proposed to inject a solution of one of the
suprarenal preparations drop by drop into a vein, timing the
rapidity of the injections by the behaviour of the pulse.
Adrenalin is the name proposed by Takamine for a sub-
stance which he has isolated from the suprarenal gland. This
is employed in a i per mille solution as a local astringent.
Unofficial Preparation.
Extractum Thymiamum. — Thymus Extract. Dose, .20 to
.30 gm.; 3 to 5 gr.
Action of Thymus Extract.
As the thymus gland atrophies in childhood and disappears
after puberty, it is probable that it performs some important
function in the development and growth of the young child.
From the fact that it is so active during the period of greatest
bone growth of the body, it has been inferred that it is con-
cerned in the formation of bone salts; and a comparison of
the salts found in the gland with those distributed in the
bones lends color to this view. The thymus contains a larger
amount of nuclein, and hence of phosphorus, than any other
of the glands, and thymus extract is believed to be a recon-
structive. It has some coagulant action on blood, and in
this connection the statement which has been made that the
thymus gland has been found absent in cases of haemophilia is
of interest. In dogs, after injections of the watery extract
into the circulation, there have been observed lowering of the
954 PHARMACOLOGY AND THERAPEUTICS.
blood-pressure with acceleration of the heart's action, and this
fall was not prevented by section of the vagi or by paralyzing
them with atropine. It is thought probable that, as in case
of thyroid extract, this effect is due to the organic extractive
and mineral salts present, and not to any active principle.
With large injections toxic effects have been produced, espe-
cially in young animals; the phenomena observed being agita-
tion, intense dyspnoea, collapse, and finally death. In the study
of the effects of extirpation of this gland, it has been shown
that in many animals the thymus is not essential to life. Some
experimenters have found no bad effects whatever resulting,
while others have observed extreme voracity with emaciation
for some time after the removal; the animals after one or two
months recovering their normal condition. It is stated that as
a result of the operation there have been noted an increase of
the leucocytes and a diminution of the red corpuscles of the
blood, and that nutritional changes have been the more marked
the younger the animal. Among the morbid conditions in
which a persistent and sometimes a large thymus has been
observed are exophthalmic goitre, acromegaly, acute leucocy-
thaemia and, more rarely, simple goitre.
Therapeutics of Thymus Extract.
It would seem to be indicated in rickets, haemophilia and the
scurvy of children. In the latter affection, as the blood is
evidently inadequately supplied with its requirements, it is
thought likely that it is the thymus gland that cannot get the
salts which it needs; this being the cause of the bleeding and
other symptoms of that condition. Fairly good results have
been reported from its use in goitre, and it is possible that
these may have been due to the fact that in the thymus there
are traces of an iodine-containing compound similar to the iodo-
thyrin of the thyroid. In exophthalmic goitre (Graves' disease)
the results have not been so satisfactory, though many cases
are stated to have improved under its use. One observer, after
an extensive trial of it, concludes that the thymus gland admin-
PITUITARY EXTRACT. 955
istered internally has no specific action in this affection, hav-
ing no direct effect on the goitre, the heart, or the exophthalmos,
though it possibly has some value in improving the general
condition of the patients, and in this way may contribute
towards their recovery. He publishes the results of the
treatment of twenty cases, comparing them with twenty cases
treated in other ways. In pulmonary tuberculosis it has been
found by some to aid the hygienic and medical treatment, its
employment being based on the ground that the earthy salts
of the bones are necessary to permanently encapsulate or heal
tuberculous lung lesions. One clinician reports, however, that
while in five out of six carefully selected cases of apyretic
phthisis an increase in weight occurred during the first weeks
of treatment, the gain was followed by a loss; otherwise there
was no change in the general condition. Thymus has also
been given for haemoptysis. A few cases have been reported
in which it has appeared to do good in chlorosis, and it has
been given with benefit in malnutrition and in defective devel-
opment in children. Thus, it is said to be useful in pseudo-
hypertrophic paralysis, and other conditions in which it has
been recommended are leucocythaemia and idiopathic and per-
nicious anaemia.
Unofficial Preparation.
Extractum Pituitarium. — Pituitary Extract. Dose, .20 to
.30 gm.; 3 to 5 gr.
Action of Pituitary Extract.
The function of the pituitary secretion in the body is some-
what uncertain. Pituitary substance slightly stimulates the
heart and constricts the blood-vessels, but is greatly inferior
to suprarenal in this respect. Other effects which have been
observed after subcutaneous injection in small animals are
quickened respiration and paralysis of the hind limbs. The
pituitary body is thought to be always hypersecreting in the
condition of giantism and is stated to be always diseased in
acromegaly. In cases of the latter when this secretion be-
956 PHARMACOLOGY AND THERAPEUTICS.
comes disturbed there results almost continuous headache,
sometimes excruciating in character.
Therapeutics of Pituitary Extract.
It has been used chiefly in acromegaly, and sometimes with
good results. Of thirteen cases collected in which it was em-
ployed, in seven varying degrees of improvement were re-
corded, in five there was no benefit, and in one the treatment
appeared to make the patient worse. In one case where there
was marked improvement this extract was given in combina-
tion with thyroid. In a number of instances the severe head-
aches accompanying acromegaly have been relieved by the
administration of pituitary extract. It has been proposed to
feed it to young dwarfs.
Unofficial Preparation.
Extractum Mammarium. — Mammary Extract. Dose, .20 to
.30 gm.; 3 to 5 gr.
Action of Mammary Extract.
It is believed to have some influence on the uterus, though its
action is not well understood.
Therapeutics of Mammary Extract.
It has been given with alleged good results in uterine fibroma
and carcinoma, also in menorrhagia, dysmenorrhea and en-
larged, sensitive uterus. In too frequent menstruation, and par-
ticularly in chlorotic girls, there is no remedy which acts so
satisfactorily (delaying the period to the regular time) as mam-
mary extract. It should be given for five or six days before the
expected period.
Unofficial Preparation.
Extractum Ovarianum. — Ovarian Extract. Dose, .20 to .30
gm.; 3 to 5 gr.
TESTICULAR EXTRACT. 957
Action of Ovarian Extract.
But little is known of its pharmacological action. Fresh
ovarian extract is said, when injected into the circulation in
rabbits, to raise the blood-pressure, diminish the heart's action,
and slow the respiration, and when administered to the human
female also to increase the arterial tension. In the castrated
animal it is found to increase oxidation to somewhat above
the normal degree, but on the normal animal it has no such
effect. Its administration does not prevent atrophy of the
uterus after removal of the ovaries.
Therapeutics of Ovarian Extract.
Some time since it was suggested in cases of removal of the
ovaries, and it has been given with more or less success in the
various conditions following the functional loss of these organs,
either through operation or disease. It has been employed
to relieve congestion and ovarian neuralgia, and may be used
when the functions of the ovaries are either partially or wholly
arrested. It is reported to have a decidedly beneficial action
not only upon typical climacteric disturbances, but also upon the
psychical depression and constitutional affections, such as gout
and psoriasis, which may make their appearance at this period.
In five cases of epilepsy which appeared to be connected with
the climacteric or with amenorrhcea much benefit is said to
have been derived from its use. It has been employed in
delayed or scanty menstruation, ordinary amenorrhcea, uterine
fibroids, and exophthalmic goitre.
Unofficial Preparation.
Extractum Testicularium. — Testicular Extract. (Testicular
juice.) Dose, .20 to .30 gm.; 3 to 5 gr.
Action of Testicular Juice.
The theory has been advanced that certain organs supply to
the body a natural ferment which is essential to health. When
this ferment is absent the vital forces degenerate. Under the
95 8 PHARMACOLOGY AND THERAPEUTICS.
use of testicular juice the functions of organic life are per-
formed with new vigor.
Therapeutics of Testicular Juice.
Favorable reports of its use in many hundreds of patients
suffering from organic nervous diseases are on record, but
the claims are so broad that further observations are necessary.
Unofficial Preparation.
Extractum Cerebralum. — Brain Extract. Dose, .20 to .30
gm.; 3 to 5 gr.
Action of Brain Extract.
Febrile reaction, prostration, and in some cases cardiac
weakness, have followed its administration.
Therapeutics of Brain Extract.
It has been made use of for the treatment of various nervous
disorders, and excellent, although not always constant, results
have been claimed.
Unofficial Preparation.
Extractum Splenicum. — Splenic Extract. Dose, .20 to .30
gm.; 3 to 5 gr.
Action of Splenic Extract.
Excision of the spleen, or the serious impairment of its func-
tions by disease, it is stated, is usually followed by marked tis-
sue changes and great susceptibility to alterations of tempera-
ture, especially in malarial subjects. Scarcely anything is
known of the action of splenic extract. According to some ex-
perimenters its subcutaneous injection produces no physiolog-
ical effects, while others have found that in the dog intravenous
injections cause first a prompt fall of blood-pressure, followed
later by a pronounced and continuing rise, which again is suc-
ceeded by a slow return to the normal. It has been found
SPLENIC EXTRACT. 959
that if it is given by the mouth in sufficient amount to produce
effect it is apt to violently disturb the digestion and cause
much pain, nausea and vomiting, and that administered hypo-
dermatically it frequently causes marked local irritation and
sometimes abscesses.
Therapeutics of Splexic Extract.
In various disorders of the blood it has been employed with
the idea of supplying to that fluid some material which may
be required for its healthy condition. It has been pointed out
that the possession of bacteriological power by some secretion
of the spleen is indicated by such facts as the evident incom-
patibility of tuberculosis and malaria and by the enlargement
of the spleen in acute infectious diseases, as though working
against the germs of such affections. Accordingly, it was pro-
posed that the splenic substance of animals immune against
certain of these diseases, such as tuberculosis, malaria and ty-
phoid fever, should be employed as a remedy in them. Splenic
extract has been given with more or less benefit in exophthalmic
goitre, and is stated to have improved the mental, as well as
the general condition, of the patients in some cases of insanity.
Like red bone marrow, it has been tried in leucocythsemia, but
with no great success, and it has been suggested that the reason
for the failure of these remedies is that in this affection both
the bone marrow and the spleen are hypertrophied, not
atrophied.
Red bone marrow, in addition to its use in leucocythsemia, has
been given particularly in pernicious anaemia, and also em-
ployed in the ordinary forms of anaemia and in osteomalacia,
tuberculous joint diseases, etc. The reports as to the results,
however, are conflicting, and as a rule these appear to have
been negative.
Parotid extract has been used to diminish uterine fibroids
and in ovarian disease, and is said by some to be practically spe-
cific in certain forms of dysmenorrhea.
960 PHARMACOLOGY AND THERAPEUTICS.
Division XIV —Drugs Acting on Metabolism.
The action on metabolism of many of the drugs previously
described has already been referred to. As our knowledge of
the normal metabolism of the body is as yet very limited, no
further remarks on this subject need be made except as regards
the individual drugs now to be considered. In this place it
may be well to call attention to two names in common use, viz. :
alterative and tonic.
Alterative is a vague term which cannot be accurately de-
fined. It is often employed to cloak our ignorance of the exact
action of a drug, but in general it is applied to agents which
appear to modify the nutritive processes and thereby cure or
alleviate many diseases of chronic type. They thus favorably
alter morbid processes, as in the case of mercury in syphilis,
but the modus operandi, of which almost nothing is definitely
known, probably varies very greatly in the case of different
drugs.
Tonic. — A tonic has been stated to be a drug which so influ-
ences nutrition as to increase the reconstruction or upbuilding
of the tissue or tissues concerned. While this definition is not
entirely adequate, it is perhaps as satisfactory as any that can
be given.
This division also includes substances used as foods.
IODINE.
IODUM.— Iodine. Dose, 0.005 gm. (5 milligm.) ; T^ gr.
Preparations.
1. Liquor Iodi Compositus. — Compound Solution of Iodine.
(Lugol's Solution.) Dose, 0.2 C.C.; 3 Tl\,.
2. Tinctura Iodi. — Tincture of Iodine. Dose, 0.1 c.c;
iy2 TTL-
3. Unguentum Iodi. — Iodine Ointment.
IODINE. 961
Action of Iodine.
External. — Iodine is an irritant, disinfectant, and parasiti-
cide. The first effect of its application to the skin is a yellow-
ish-brown or dark brown discoloration, which is removable
by alkalies or sodium hyposulphite. It acts more slowly than
most other irritants, but on account of its volatility and because
it precipitates proteids and enters into easily dissociated com-
pounds with them, its action is both penetrating and prolonged.
It produces a sensation of heat and itching, accompanied by
local hyperemia and sometimes by more or less cedematous
swelling. Some exudation of leucocytes takes place, and the
strong absorbent action of iodine has been attributed to this.
Unless used in very concentrated solution or in the solid form,
which may cause vesication or even corrosion, its irritant action
is comparatively mild. By repeated applications, however, it
is possible to secure very pronounced counter-irritation with-
out the production of a deep destruction of tissue. The super-
ficial cuticle is usually destroyed, and the skin afterwards ex-
foliates. As a result of its local application, small quantities
are absorbed. The subcutaneous injection of solutions of it
causes intense pain and irritation. The inhalation of the vapor
of iodine also gives rise to very considerable irritation; excit-
ing sneezing, coughing and some dyspnoea, with smarting,
swelling and increased secretion in the nasal mucous membrane,
conjunctiva, throat and lower respiratory passages.
Internal. — Iodine naturally exerts its local irritant action on
the gastro-intestinal tract, causing pain and vomiting, and
sometimes purging. The drug may be recognized in the vom-
ited matter and in the stools. In minute doses the slight
irritation produced on the mucous membrane of the stomach
may have a somewhat tonic effect, improving the appetite and
digestion, and be followed by a sedative action. In excessive
doses it produces marked irritation of the oesophagus and severe
gastro-enteritis, but death is rarely caused by it. In fatal
cases of poisoning the mucous membrane of the stomach and
intestine has been found tumefied and loosened. The irritation
62
962 PHARMACOLOGY AND THERAPEUTICS.
of the alimentary canal may also prove fatal by inducing col-
lapse and failure of the heart and respiration. In animals
fatty degeneration of the heart, liver and kidneys has some-
times been found. Iodine, in the form of iodides and, it may
be, in a combination with proteids, is rapidly absorbed by the
mucous membranes generally. Its chief effects after absorption
are due to its action on the thyroid gland. The symptoms pro-
duced by its continued administration, such as acceleration of
the pulse and certain nervous phenomena, are much the same
as those caused by large amounts of thyroid extract, and are
thought to be probably due to the excessive production of the
organic compound, iodothyrin. In the thyroid gland iodine
exists normally in the form of this substance, and the adminis-
tration of the drug may lead to an increase in its formation.
Iodine is excreted, in the form of iodides, chiefly by the kid-
neys, but also to some extent in the saliva, perspiration, milk
and bronchial secretion. Free iodine has been detected in the
stomach, and this is believed to probably result from the de-
composition of hydriodic acid excreted into that organ.
Therapeutics of Iodine.
External. — Iodine preparations are much relied upon as irri-
tants, counter-irritants and resolvents. The tincture is one of
the most popular of all external applications. While mild in
its action, a sufficient effect may usually be secured by the repe-
tition of its use. The ointment and compound solution are
also comparatively mild preparations. If a more powerful
effect is desired, the liniment (B. P., 1885, which contains
iodine, 5 ; potassium iodide, 2 ; glycerin, 1 ; alcohol, 40) may
be employed. As it is otherwise liable to cause severe inflam-
mation, it should be painted on the skin quite lightly, and in
case it causes much pain it may be washed off with a solution
of potassium iodide. " Iodine paint " is a tincture twice as
strong as the official tincture. The conditions for which these
and other iodine preparations are used are almost innumerable,
and need not be given in detail. Among them may be men-
IODINE. 963
tioned chronic inflammation of joints, periostitis, ringworms,
enlarged glands, buboes, abscesses, chilblains, pleurisy, and
inflammation or retraction of the gums. For the last-named,
what is known as dental tincture of iodine, consisting of
tincture of iodine, 11, alcohol, 30, is sometimes applied over
a very circumscribed area. This, or the official tincture,
may be painted over a spot of tinea or ringworm, and
the tincture is usually efficacious in tinea versicolor. Other
preparations used for these parasitic affections are iodized
collodion (.75 gm. ; 12 gr. ; iodine, dissolved in ether and
alcohol, to 30 c.c. ; 1 fl. oz. ; of collodion); the liquor (B. P.,
iodine, 10; potassium iodide, 15; water, 200), and Coster's
paste, which consists of iodine dissolved in light oil of wood
tar (1 to 4). Tincture of iodine is sometimes of service in
lupus, and is curative in lentigo and chloasma. Added to salt
water, it forms a useful wash in chronic ozsena. Two prep-
arations of iodine are frequently employed in the treatment of
diseases of women, namely: Churchill's tincture: iodine, 5;
potassium iodide, 1; water, 8; alcohol, 24; and Battey's fluid:
iodine, 2; free carbolic acid, 1. A colorless tincture of iodine
has the advantage of not staining the skin, but is much milder
than the ordinary tincture. In it iodine is dissolved in alcohol
and deodorized by a strong solution of ammonia; but it really
contains no iodine, ammonium iodide and iodate being formed,
and any irritant affect which it may have is due to excess of
ammonia. A colorless iodine ointment is also prepared, in
which the decolorization is effected by means of sodium sul-
phate. Formerly the practice was much in vogue of injecting
tincture of iodine into the sac of hydrocele and into cysts, ab-
scesses, dropsical joints, and the pleural cavity after empyema,
as well as into other cavities, for the relief of various affections,
but other methods of treatment have largely superseded this.
When it is employed, great caution must be observed, as intense
pain and irritation may be caused, which may possibly be fol-
lowed by collapse or by suppuration and gangrene. Fatal sys-
temic poisoning has also been known to result from the injec-
964 PHARMACOLOGY AND THERAPEUTICS.
tion of large quantities of iodine into cysts. The same objec-
tions hold true as regards the parenchymatous injection of the
tincture in hypertrophied tonsil, goitre, glandular tumors, etc.
In some cases of spina bifida a successful result may be ob-
tained by the injection of Morton's fluid, which consists of
iodine, 1 ; potassium iodide, 3 ; glycerin, 48.
Internal. — Among the ignorant classes the idea has long pre-
vailed that seaweed has the effect of reducing obesity, and the
Fucus vesiculosis, or bladderwrack, has been especially esteemed
for this purpose. Consequently, it has been made the basis of
various quack preparations, but any action it may have in this
regard would seem to be due simply to the interference with
nutrition caused by the digestive disturbances arising from the
iodine, chlorine and bromine in its composition. .06 to .12 c.c.
(1 or 2 m.) of tincture of iodine, largely diluted and repeated
from time to time, may sometimes have the effect of arresting
vomiting. Minute doses of the tincture or compound solu-
tion may also be of service in passive intestinal hemorrhage or
diarrhoea from atony of the mucous membrane. Goitre, when
there is present simply a hypertrophy of the gland elements,
may not infrequently be successfully treated by the internal
and external use of iodine. For the internal treatment the
best mode of administration is to give the tincture in small
doses with potassium iodide, freely diluted. Thyroid extract,
however, is much more efficient. Iodine has been thought to
have some curative influence in malarial fevers, but probably
not much reliance is to be placed upon it. To increase its
efficiency it has been advised that phenol should be combined
with it. Thus, .60 to .90 c.c. (10 to 15 R), well diluted, of a
mixture of the tincture with phenol, in the proportion of 8 to
1, may be prescribed three times a day; though, as this dosage
is large, its effects should be carefully watched. A similar com-
bination has sometimes proved of service in typhoid fever:
Tincture of iodine, 2; carbolic acid, 1; dose, .06 to .18 c.c. (1
to 3 m.) three times a day. The compound solution has also
been employed in typhoid. This preparation has obtained re-
POTASSIUM IODIDE. 965
pute as a remedy in scrofulous affections of the skin and of
the lymphatic glands, especially in syphilitic children, and is
stated to be useful in some old syphilitic skin diseases attended
by thickening and scaling. Judiciously employed, iodine prep-
arations are of some value as inhalations. The vapor of the
B. P. (tincture of iodine, 1; water, 8; to be gently heated) is
sometimes prescribed for diseases of the lungs and air-passages,
but it is too irritating. The following method of inhalation
has been found beneficial in acute nasal catarrh, " hay-asthma,"
and chronic bronchitis: Tincture of iodine (.30 to .60 c.c. — 5 to
10 m.) is dropped upon a moistened sponge in a small, wide-
mouthed bottle, which is placed in a vessel of hot water, and
the vapor of the iodine is inhaled with that of the water.
The carbolate (tincture of iodine, 2; carbolic acid, 1) may be
used instead of the simple tincture of iodine. Camphor is also
sometimes inhaled with tincture of iodine. In some cases of
" hay asthma " the local application of the following with a
post-nasal syringe is of advantage: tincture of iodine, 6; car-
bolic acid, 1 ; water, 190. The inhalation of iodine and tur-
pentine has been recommended, as an adjuvant to other meth-
ods of treatment, in laryngeal and pulmonary tuberculosis.
1. POTASSII IODIDUM.— Potassium Iodide. Dose, 0.500 gm.
(500 milligm.) ; iy2 gr.
Preparations.
1. Liquor Iodi Compositus. — Compound Solution of Iodine.
Dose, 0.2 c.c; 3 HI.
2. Acidum Hydriodicum Dilutum. — Diluted Hydriodic Acid.
Dose, 0.5 c.c; 8 n\.
3. Syrupus Acidi Hydriodici. — Syrup of Hydriodic Acid.
Dose, 4 c.c; 1 fl. dr.
4. Unguentum Potassii Iodidi. — Ointment of Potassium
Iodide.
2. SODII IODIDUM.— Sodium Iodide. Dose, 0.500 gm. (500
milligm.); iy2 gr.
966 PHARMACOLOGY AND THERAPEUTICS.
3. AMMONII IODIDUM.— Ammonium Iodide. Dose, 0.250 gm.
(250 milligm.) ; 4 gr.
4. STRONTII IODIDUM.— Strontium Iodide. Dose, 0.500 gm.
(500 milligm.) ; 7V2 gr.
5. ZINCI IODIDUM. — Zinc Iodide. Dose, 0.065 gm. (65
milligm.); 1 gr.
Unofficial Preparation.
Rubidii Iodidum. — Rubidium Iodide. Dose, 0.30 to 1.20
gm.; 5 to 20 gr.
Action of the Iodides.
External. — None. Iodides in watery solution are not ab-
sorbed from the unbroken skin, but are rapidly absorbed from
mucous membranes.
Internal. — The effects produced by the iodides appear to vary
very considerably, not only in different individuals, but also in
the same individual at different times, and their mode of action
is still a matter of great uncertainty. It is recognized, how-
ever, that they are capable of causing two distinct kinds of
effects, one an irritation, in consequence of their salt-action, of
the alimentary canal, manifested by nausea and vomiting and
sometimes by diarrhoea, and the other a series of symptoms to
which the name of iodism has been given. The latter symp-
toms may be elicited by considerably smaller doses than the
gastric irritation, but, as a rule, appear only when the adminis-
tration has been continued for some time, the length of this
period varying greatly in different instances. The size of the
dose naturally has some relation to their onset. When admin-
istered internally the iodides are absorbed unchanged by the
stomach and intestine, and it is found that they make their ap-
pearance in the secretions within a very short time. They are
excreted mainly in the urine, in which they are found as salts;
also to some extent in the saliva and in various other secretions,
as those of the nasal mucous membrane and sebaceous glands,
and in the tears, sweat and milk. By the stomach small amounts
are eliminated as hydriodic acid and sometimes as free iodine.
POTASSIUM IODIDE. 967
No free iodine, however, has been found in the saliva, sweat
or nasal secretion, and it is stated that no iodine can be de-
tected in the breath of animals poisoned with iodides. There
seems to be no question that some of the iodide undergoes de-
composition in the body, and there is strong ground for be-
lieving that the symptoms of iodism are produced by the iodine
thus set free. Support to this view is afforded by the fact that
repeated doses of iodine sometimes cause symptoms resembling
those of iodism, and also by the fact that formerly much the
same therapeutic effects were produced by the internal admin-
istration of iodine which are now obtained with the iodides.
As has been stated, free iodine is excreted into the stomach,
and, furthermore, an organic compound of iodine has been
found in the hair, muscles, heart, etc., after iodide treatment.
Various explanations have been offered regarding the forma-
tion of free iodine from iodides, but as none of the theories
advanced has as yet been positively demonstrated, they need
not be given here. Some of the symptoms are thought to be
probably due to action on the thyroid gland. The urine is gen-
erally increased by the iodides, although so far as known they
have no specific action on the kidneys. On the other hand, the
secretion of milk is diminished. Infants have been known to
suffer with iodism from being nursed by persons under iodide
treatment.
Iodism. — This is induced by all the iodides, and the basic ion
does not appear to be concerned in the effect. Owing to the
fact that iodine is more readily freed from it, ammonium
iodide is said to be more liable than the others to cause iodism.
The symptoms may be divided into two groups. (1) Very
commonly there is catarrh of the respiratory passages, which
commences in the nasal mucous membrane, exciting a profuse
watery discharge, and extends both upward and downward.
Accordingly there is conjunctivitis, and severe headache may
result from the invasion of the frontal sinuses. At the same
time there is much swelling and irritation about the fauces, the
tonsils are liable to become inflamed, and laryngitis or bron-
968 PHARMACOLOGY AND THERAPEUTICS.
chitis may result. (Edema of the larynx, which unless promptly
relieved may prove fatal, occasionally occurs. In animals it
has been shown that the bronchial secretion is increased by
quite small quantities intravenously injected. Usually some-
what later, an eruption may appear upon the skin. This most
commonly consists of erythematous patches, but instead there
may be papules, which sometimes become pustular, and, more
rarely, other forms of cutaneous disease. (Edema of the face
is met with in some instances, and very rarely there is albumin-
uria. Nervous troubles, neuralgia, singing in the ears, con-
vulsive movements, disturbed intellection, and rarely atrophy
of the mammae and testes may be noticed. (2) Iodic cachexia
(which is characterized by rapid emaciation), severe cardiac
palpitation, and ravenous appetite occasionally occur as late
phenomena. The local manifestations of iodism can sometimes-
be prevented by the administration of alkalies, and hence it is
thought that the variation of their extent in different persons,
or in the same person at different times, may perhaps be ex-
plained by a different degree of acidity. Children appear to be
less subject to iodism than adults. A tolerance may be estab-
lished, and not infrequently the symptoms disappear while the
administration is still being maintained. Although the mani-
festations may be very severe, a cessation begins soon after the
treatment is discontinued, and the chewing of pellitory will
hasten the elimination of iodine in the chronic forms. When
iodic cachexia has supervened, however, the symptoms may not
disappear for a considerable time.
Therapeutics of the Iodides.
The iodides were largely substituted for iodine in therapeu-
tics for the reason that they are less irritating to the gastro-
intestinal tract. Potassium iodide is the one in most general
use. The iodides are perhaps more extensively employed than
any other of the salts of the alkalies. The most conspicuous
of their applications is in the treatment of syphilis, in which
their very great value has long been established. It is in the
POTASSIUM IODIDE. 969
third stage of the disease that they produce results which can-
not be accomplished by any other means; often causing the
rapid absorption of nodes, gummata and other deposits. In
order to secure the best effect it is necessary to give very large
doses in many instances, so that 8, 12 or even 16 gm. (2 to 4
dr.) may be taken in a day. In syphilis of the nervous system
large doses are especially called for, and daily amounts of 30
gm. (1 oz.) are not infrequently required in these cases. No
symptoms of iodism are likely to appear until the disease sub-
sides. What is known as the " mixed treatment " is often re-
sorted to in syphilis, and it is believed by the majority of prac-
titioners to be especially effective in the intermediate period,
when the secondary stage is passing into the tertiary. This
consists of the combination of potassium iodide with corrosive
mercuric chloride; as a result red mercuric iodide is formed and
dissolved in the excess of potassium iodide. It has been sug-
gested that in syphilis the iodides may act as a specific poison
(antiseptic) to the unknown cause of the disease, but if this
were so it seems reasonable to suppose that they would be
much more efficacious in the early stages than is the case.
Their remedial action remains in fact as yet unexplained. In
various troubles not directly attributable to syphilis, but occur-
ring in those who have at one time had the disease, iodides are
often beneficial.
While these drugs are of little value in acute rheumatism,
they are relied upon to some extent in chronic rheumatic mani-
festations. Rheumatoid arthritis would seem to be more
amenable to the long-continued use of ferrous iodide than of
the potassium salt, which is more commonly employed for its
relief. In any affection in which the administration of the
iodides must be maintained for a great length of time it will
usually be found advantageous to allow occasional intermis-
sions. In so-called gonorrhceal rheumatism the syrup of hy-
driodic acid is preferable to potassium or other iodide. In sub-
acute catarrh of the duodenum and of the biliary ducts com-
paratively small doses of sodium or ammonium iodide may be
970 PHARMACOLOGY AND THERAPEUTICS.
of service, and it is asserted that the latter, especially when
combined with arsenic, is one of the best remedies for the first
stage of cirrhosis of the liver. Some good results with potas-
sium iodide have been obtained in aneurism, but whether it has
any effect in cases where there is no syphilitic taint seems
doubtful. The iodides are not infrequently useful in promot-
ing the absorption of inflammatory products, as, for instance,
in joint disease, pleurisy and catarrhal and fibrinous pneumo-
nia; and there is reason to believe that their prolonged use in
sufficient dose may be of benefit in arterio-sclerosis, interstitial
nephritis, and amyloid disease of the kidney and other organs.
Simple hypertrophy of the spleen may be cured by the internal
use of the iodides and the external application of iodine paint
or ointment of red mercuric oxide, and ammonium iodide is
often efficacious in removing the enlargements of the spleen
and liver caused by malarial disease. Iodides have long been
employed in the treatment of goitre, but now seem likely to be
entirely supplanted by thyroid extract. Ammonium iodide is
highly esteemed in capillary and in chronic bronchitis, and
potassium iodide is sometimes quite efficacious in relieving the
symptom asthma. For the internal treatment of " hay asthma "
it should be given in full doses, and it may be advantageously
combined with arsenic. The iodides have been recommended
in various cerebral affections, but unless these are of syphi-
litic origin, not much is probably to be expected from their use.
Potassium iodide is occasionally prescribed to diminish the
secretion of milk. This salt is commonly given to promote the
elimination of lead and mercury in cases of chronic poisoning
from these metals, though experiments appear to indicate that
it is not more efficient in this regard than the chloride or bro-
mide. The iodide treatment is sometimes of service in non-
syphilitic skin diseases. It is regarded as especially useful in
actinomycosis and psoriasis. In many of the conditions in
which potassium iodide is employed, particularly when the ad-
ministration is long-continued, it would seem that sodium iodide
should be preferred, as it does not occasion so much depression.
GOLD AND SODIUM. CHLORIDE. 97 1
Rubidium iodide (not official), which, it is asserted, is better
borne than the potassium salt, has been proposed as a substi-
tute for potassium iodide.
Strontium iodide has been recently introduced, and is used
for the same purposes as the other iodides. It is believed that
it is less likely to disturb the stomach, cause acne, and depress
the heart than the remaining iodides. In many instances the
syrup of hydriodic acid can be substituted with advantage for
the iodides. It is not so likely to produce iodism, nor does it
so readily give rise to the " iodide punishment." Its pleasant
taste is grateful to most patients, and it should be admin-
istered, well diluted, one-half hour before meals, or at least
upon an empty stomach. Some of the commercial preparations
are likely to decompose readily, especially when made from
tartaric acid and potassium iodide, and are objectionable from
the amount of syrup which is administered when large doses
are employed.
GOLD.
AURI ET SODII CHLORIDUM.— Gold and Sodium Chloride.
gr.
Action of Gold and Sodium Chloride.
In small doses gold and sodium chloride is supposed to pro-
mote appetite and digestion, to stimulate the functions of the
brain and to be an aphrodisiac. Full doses cause nausea and
vomiting, and finally impair nutrition. The toxic symptoms
resemble those of poisoning by corrosive mercuric chloride.
Therapeutics of Gold and Sodium Chloride.
It is useful in irritative dyspepsia, gastro-duodenal catarrh,
hypochondriasis, and also chronic ovarian irritation and ovari-
tis, as well as in chronic albuminuria, hepatic sclerosis, and
granular kidney, since it prevents hyperplasia of connective
tissue. It is a valuable remedy in the tertiary manifestations
of syphilis, especially of the bones, and presents fewer disad-
vantages than corrosive mercuric chloride.
972 PHARMACOLOGY AND THERAPEUTICS.
GUAIAC.
GUAIACUM (Guaiaci Resina, U. S. P., 1890).— Guaiac. (Gum
Guaiac.) Dose, 1 gm.; 15 gr.
Preparations.
Tinctura Guaiaci.— Tincture of Guaiac. Dose, 4 c.c; 1 fl. dr.
Tinctura Guaiaci Ammoniata. — Ammoniated Tincture of
Guaiac. Dose, 2 c.c; 30 TT1.
Unofficial Preparation.
Guaiaci Lignum (U. S. P., 1890). — Guaiacum Wood.
(Lignum Vitae.) Dose, 1 to 4 gm.; 14 to 1 dr.
Action of Guaiac.
External. — The tincture of guaiac is used for the detection
of blood stains.
Internal. — Guaiacum is diaphoretic, expectorant and laxa-
tive, and in large doses a gastro-intestinal irritant, pro-
ducing vomiting and purging. When it fails to act on the
skin it is apt to cause free diuresis. In moderate amount it
increases the flow of saliva and occasions a feeling of warmth
in the epigastrium, and in its local effects on the stomach and
reflex stimulation of the heart it resembles the volatile oils. It
is thought to probably have a slight antiseptic action as regards
the alimentary canal and the secretions, and when taken in
small doses for some time is said to favorably affect metabolism.
It is also considered to have emmenagogue properties. In some
individuals a skin rash is produced by it.
Therapeutics of Guaiac.
Internal. — Guaiacum is so disagreeable and its therapeutic
value rests on such a slender basis that it is not very often
prescribed. Its effectiveness in many chronic and obscure
complaints, it has been observed, no doubt correctly, is due
partly to its purgative property and partly to its nastiness, a
quality which is highly appreciated by many patients. Prob-
PRICKLY ASH. 973
ably its most useful application is in the treatment of tonsillitis,
where in doses of 2 c.c. [}/& fl. dr.) given in emulsion or yolk of
egg every four hours, it often serves to abort the disease, or at
all events to reduce the inflammation. In chronic sore-throat
it is also sometimes of service, and, it is said, more particularly
in patients who have had syphilis. It is preferably used here
in the form of lozenges (.20 gm. ; 12 gr. of the resin with a fruit
basis). The ammoniated tincture may be employed as a gar-
gle. On account of its purgative properties, guaiac has been
given in habitual constipation. Malt extract is a good vehicle
for it, or it may be prescribed in a pill in combination with
other remedies. It is practically useless in syphilis and chronic
rheumatism, for which it was at one time largely prescribed.
It is thought by some to be of benefit in warding off attacks of
gout. Doses of .75 gm. (12 gr.), taken in wafers and followed
by effervescent lithium citiate, are recommended, and it is ad-
vised that the treatment should be maintained indefinitely. The
mixture of the B. P. (Guaiacum resin, 6; sugar, 6; tragacanth,
1; cinnamon water, 240; dose, 15 to 30 c.c; ^ to 1 fl. oz.) is
said to be a more efficient preparation than the tincture.
PRICKLY ASH.
XANTHOXYLUM.— Xanthoxylum. (Prickly Ash Bark.) Dose,
2 gm.; 30 gr.
Preparation.
Fluidextractum Xanthoxyli.— Fluidextract of Xanthoxylum.
Dose, 2 c.c; 30 nt.
Action of Prickly Ash Bark.
Xanthoxylum has about the same action as guaiac. It pro-
duces, when swallowed, a sensation of heat.
Therapeutics of Prickly Ash Bark.
It enjoys some reputation as a remedy for chronic rheuma-
tism, and has been used in syphilis and chronic hepatic dis-
orders. For patients suffering from chronic syphilis who do
974 PHARMACOLOGY AND THERAPEUTICS.
not tolerate either mercury or the iodides, McDade's formula
may be employed. This is equal parts of the fluidextracts of
sarsaparilla, stillingia, lappa, and phytolacca and of tincture of
xanthoxylum. The dose is from 4 to 15 c.c. ; 1 to 4 fl. dr.,
thrice daily. The bark, used as a masticatory, is a popular
remedy for tooth-ache.
ICHTHYOL.
Unofficial Preparation.
Ichthyol. — Ichthyol. (Ammonium Ichthyol-Sulphonate.)
Dose, 0.60 to 1.20 gm.; 10 to 20 gr.
Action of Ichthyol.
Ichthyol is an active reducing agent. It has some antiseptic
property and it is mildly irritant to the skin, from which a
certain amount of absorption takes place when it is rubbed in.
In large doses it produces gastro-intestinal irritation. It is
excreted by the kidneys and also, it is believed, by the intestine.
Therapeutics of Ichthyol.
It is used chiefly as a local application in skin diseases, espe-
cially chronic eczema and psoriasis. For acne rosacea ichthyol
paste is recommended (starch, 40; moisten with water, 20;
rub in ichthyol, 40, and then a strong solution of albumin, 1 or
more). In erysipelas in which it is thought to be of con-
siderable service, an ointment composed of lanolin and ichthyol
(20 to 50 per cent.) may be applied. Ichthyol has also been
used for ulcers of the leg and for burns, and in the form of a
suppository for chronic prostatitis. Combined with glycerin
(1 to 10) it is employed in gynaecological practice. It has been
advised as an application over inflamed and rheumatic joints,
indurated glands and swellings, as well as for chronic inflam-
mations of the pelvic viscera, and is said to cause the absorp-
tion of inflammatory products. Internally it has been given in
capsules or pills (in dose from .60 to 2 gm. ; 10 to 30 gr.) for
SARSAPARILLA. 975
a variety of chronic affections, including rheumatism, syphilis
and pulmonary disease, but it seems doubtful whether it is of
any practical value. Under the name of Thiol, a mixture of
sulphuretted hydrocarbons has been used as a substitute for
ichthyol, because it is less offensive. It has been applied as an
ointment in vaseline (i to '8).
SARSAPARILLA.
SARSAPARILLA. — Sarsaparilla. Dose, 2 gm.; 30 gr.
Preparations.
1. Fluidextractum Sarsaparillae. — Fluiciextract of Sarsapa-
rilla. Dose, 2 c.c; 30 m,.
2. Fluidextractum Sarsaparillae Compositum. — Compound
Fluidextract of Sarsaparilla. Dose, 2 C.C.; 30 TTL-
3. Syrupus Sarsaparillae Compositus. — Compound Syrup of
Sarsaparilla. Dose, 16 C.C.; 4 fl. dr.
Unofficial Preparation.
Decoctum Sarsaparilla Compositum (U. S. P., 1890). —
Compound Decoction of Sarsaparilla. Dose, 30 to 1.20 C.C.;
1 to 4 fl. oz.
Action of Sarsaparilla.
Sarsaparilla is not known to have any physiological action.
Therapeutics of Sarsaparilla.
It is apparently useful only as a vehicle. On account of its
containing an acrid glucoside similar to saponin it should be
administered with some care, as intestinal ulceration has been
attributed to its prolonged use.
INDIAN SARSAPARILLA.
Unofficial Preparations.
Hemidesmus. — Hemidesmus. (Indian Sarsaparilla.)
Syrupus Hemidesmi. — Syrup of Hemidesmus. Dose, 2 to 4
gy6 PHARMACOLOGY AND THERAPEUTICS.
Action of Indian Sarsaparilla.
Hemidesmus has been described as diaphoretic, diuretic and
alterative, but, like sarsaparilla, it does not appear to have
any distinct physiological action.
Therapeutics of Indian Sarsaparilla.
It has been employed for the same purposes as sarsaparilla,
and in India, where it is chiefly used, the native physicians are
said to give it for the relief of renal troubles. The syrup con-
stitutes a pleasant vehicle for other remedies, and this is prob-
ably the only service that this drug renders.
SASSAFRAS.
SASSAFRAS.— Sassafras. Dose, 8 gm.; 120 gr.
SASSAFRAS MEDULLA.— Sassafras Pith.
Preparation.
Mucilago Sassafras Medullae. — Mucilage of Sassafras Pith.
Dose, 16 c.c.; 4 fl. dr.
OLEUM SASSAFRAS.— Oil of Sassafras. Dose, 0.2 c.c; 3 HI.
SAFROLUM.— Safrol. Dose, 0.3 c.c; 5 IT^
Action of Sassafras.
Sassafras has the action of the volatile oils in general. The
pith is demulcent.
Safrol, which also occurs in the oils of camphor, star-anise,
and cinnamon leaves and in various barks, constitutes about
8o per cent, of the oil of sassafras, and its action is therefore
practically the same as that of the latter.
Therapeutics of Sassafras.
The mucilage is somewhat stimulant in its action, and is
an excellent vehicle. The infusion, made from the bark (not
official), is considered highly efficacious in poison oak eruption,
for which it may be used both internally and locally.
j
DULCAMARA. 977
STILLINGIA.
STILLINGIA.— Stillingia. (Queen's Root.) Dose, 2 C.C.; 30 gr.
Preparation.
Fluidextractum Stillingiae. — Fluidextract of Stillingia.
Dose, 2 c.c; 30 TTL.
Action of Stillingia.
Stillingia is in large doses emetic and cathartic, but in smaller
ones, alterative.
Therapeutics of Stillingia.
It is a valuable remedy in syphilis and in the cutaneous and
hepatic diseases which are benefited by so-called alterative
medicines.
BURDOCK.
LAPPA.— Lappa. (Burdock.) Dose, 2 gin.; 30 gr.
Preparation.
Fluidextractum Lappae. — Fluidextract of Lappa. Dose, 2
c.c; 30 ttl.
Action of Burdock.
Burdock is considered to be a diuretic and a diaphoretic alter-
ative.
Therapeutics of Burdock.
It has been recommended in the treatment of various chronic
skin diseases, especially in psoriasis and acne.
DULCAMARA.
DULCAMARA (U. S. P., 1890).— Dulcamara. (Bittersweet.)
Dose, 4 to 8 gm.; 1 to 2 dr.
Unofficial Preparation.
Extractum Dulcamarse Fluidum (U. S. P., 1890).— Fluid-
extract of Dulcamara. Dose, 4 to 8 c.c; 1 to 2 fl. dr.
63
97 8 PHARMACOLOGY AND THERAPEUTICS.
Action of Dulcamara.
Dulcamara increases the secretions, particularly those of the
kidneys and skin, with some diminution of sensibility. In large
closes it is an acro-narcotic poison.
Therapeutics of Dulcamara.
It has been employed chiefly for cutaneous eruptions, par-
ticularly of a scaly character, but is seldom prescribed.
CHIMAPHILA.
CHIMAPHILA.— Chimaphila. (Pipsissewa.) Dose, 2 C.C.; 30 gr.
Preparation.
Fluidextractum Chimaphilae. — Fluidextract of Chimaphila.
Dose, 2 c.c; 30 Til.
Action of Chimaphila.
This plant is diuretic and diaphoretic.
Therapeutics of Chimaphila.
It is used for rheumatism and nephritic affections.
MARIGOLD.
CALENDULA.— Calendula. (Marigold.) Dose, 1 gm.; 15 gm.
Preparation.
Tinctura Calendulae. — Tincture of Calendula.
Action of Marigold.
Marigold was formerly supposed to be antispasmodic, sudo-
rific and emmenagogue, but now it is believed to have no thera-
peutic value.
Therapeutics of Marigold.
The tincture has been employed topically to promote the heal-
ing process in wounds, burns, ulcers, etc.
RHUS TOXICODENDRON. 979
SCUTELLARIA.
SCUTELLARIA.— Scutellaria. (Skullcap.) Dose, 1 gm.; 15 gr.
Preparation.
Fluidextractum Scutellariae. — Fluidextract of Scutellaria.
Dose, 1 c.c; 15 TT\,.
Unofficial Preparation.
Decoctum Scutellariae. — Decoction of Scutellaria. Dose, 30
to 60 c.c; 1 to 2 fl. oz.
Action of Scutellaria.
Scutellaria has little medicinal effect.
Therapeutics of Scutellaria.
It is used as a nervous sedative; formerly it was given, in
decoction, for epilepsy.
CANADIAN MOONSEED.
Unofficial Preparations.
Menispermum (U. S. P., 1890). — Menispermum. (Canadian
Moonseed.) Dose, 0.30 to 2 gm.; 5 to 30 TTt.
Extractum Menispermi Fluidum (U. S. P., 1890). — Fluid-
extract of Menispermum. Dose, 0.30 to 2 C.C.; 5 to 30 TT\.-
Action of Canadian Moonseed.
The action of menispermum is similar to that of sarsaparilla.
Like sarsaparilla, it is probably inert.
Therapeutics of Canadian Moonseed.
It has some repute in domestic practice as a " blood purifier,"
but is rarely prescribed in medicine.
RHUS TOXICODENDRON.
Unofficial Preparations.
Rhus Toxicodendron (U. S. P., 1890). — Rhus Toxicodendron.
(Poison Ivy.) Dose, 0.05 to 0.30 gm.; 1 to 5 gr.
98O PHARMACOLOGY AND THERAPEUTICS.
Tinctura Rhois Toxicodendri. — Tincture of Rhus Toxicoden-
dron. Dose, .006 to .12 c.c; T\ to 2 Ti\..
Action of Rhus Toxicodendron.
Applied to the skin it produces redness and swelling, with
a vesicular eruption and intense itching, which may spread
rapidly over the surface of the body. The irritation may ex-
tend to the mucous membranes, causing conjunctivitis, pharyn-
gitis, etc. In addition, there may be fever, general rheumatoid
pains, colic, and diarrhcea with bloody stools. Sometimes there
is also hematuria. Similar phenomena are said to result from
its internal administration, but no cases of fatal poisoning have
been observed from it. Some individuals are so susceptible to
its influence that the exhalations from the plant will produce
on them its characteristic effects, while others are not at all
affected by contact with it or even by chewing the leaves. The
effects of the drug are partly due to its volatile active principle,
but also to a fixed oil which it contains, as the dried plant may
also cause poisoning. The eruption produced by it is followed
by desquamation.
Therapeutics of Rhus Toxicodendron.
The tincture of the fresh leaves has been used in paralysis,
nocturnal incontinence of urine, and cutaneous diseases; but
the remedy is dangerous and, probably, a useless one for these
purposes. Largely diluted it has been used as a lotion for
bruises and burns.
COD LIVER OIL.
OLEUM MORRHU^E.— Cod Liver Oil. (Oleum Jecoris Aselli.)
Dose, 16 c.c; 4 fl. dr.
Preparations.
1. Emulsum Olei Morrhuae. — Emulsion of Cod Liver Oil.
Dose, 8 c.c; 2 fl. dr.
2. Emulsum Olei Morrhuae cum Hypophosphitibus.— Emul-
sion of Cod Liver Oil with Hypophosphites. Dose, 8 C.C.; 2 fl. dr.
COD LIVER OIL. 98 I
Action of Cod Liver Oil.
External. — Cod liver oil is emollient to the skin, and when
rubbed in is absorbed from it.
Internal. G astro -intestinal Tract. — Cod liver oil, while often
well borne by the stomach, has, especially in large doses, a
tendency to cause eructation, nausea and sometimes diarrhoea.
It is generally believed that it is more rapidly absorbed from
the intestine than other oils, though the evidence on this point
is not altogether conclusive. Some authorities attribute this
supposed superior absorbability to the free acid in the oil, the
presence of this facilitating saponification and emulsion. While
this explanation might hold good as regards the old dark-
colored oils, the pale oil now generally in use is found to
often contain less free acid than ordinary olive oil. In the
test-tube, at all events, cod liver oil forms an emulsion more
rapidly than other oils.
Tissues. — Cod liver oil reduces the color of a solution of
potassium permanganate more promptly than other oils, show-
ing that it is more readily oxidized. As it is a fat which is readily
absorbed and readily assimilated, its continued ingestion leads
to a marked increase in weight and strength. It is thus a food
of the highest value, and it is especially esteemed for the reason
that many delicate persons who cannot digest ordinary animal
fats are able to take this. In addition, there is some ground for
supposing that cod liver oil, aside from its admirable qualities
as a food, possesses certain peculiar virtues in consequence of
special elements in its composition. Thus, if it is true, as has
been stated, that iodine may occur in the proportion of 1 to
2,000 of the oil, the influence of this remedy is not to be ignored.
Erythema or acne is sometimes caused by cod liver oil.
Therapeutics of Cod Liver Oil.
External. — The external application of cod liver oil by rub-
bing it into the skin is undoubtedly of considerable value in
cases of defective nutrition or wasting disease, both in adults
and children, but the very disagreeable odor of the oil is a
982 PHARMACOLOGY AND THERAPEUTICS.
serious objection to its use. In infants the common practice
has been to apply it simply under the binder, but in order to
prevent the child from smelling so much of the oil the following
method is recommended: The patient is stripped and the oil
applied over the surface of the body, with the manipulations of
massage, before a warm fire; a blanket is wrapped around him
and should be kept on for an hour or two; the excess of oil
is then removed by a warm bath containing a little whiskey or
bay rum. Inunction with cod liver oil has sometimes been
practised in the case of adults suffering from chronic dysen-
tery or scaly skin diseases, and, when other treatment proves
inadequate, it may be resorted to in children affected with
chronic skin diseases, marasmus, scrofula, tuberculosis and
wasting diseases generally. It is regarded as especially ser-
viceable in the coeliac affection of children characterized by
suspension of the function of the pancreas.
Internal. — Cod liver oil is of more value than any other one
remedy in nearly all varieties of tuberculosis. The following
conditions are regarded as contra-indicating its use : Diarrhoea,
whether due to the disease or caused by the oil, severe haemo-
ptysis, vomiting, aggravated dyspepsia, and high temperature.
When none of these is present, it is indicated in convales-
cence from acute disease, especially in children, and in all
chronic diseases attended with malnutrition and loss of flesh.
It was first introduced in medicine for the treatment of chronic
rheumatic affections, and while not now so generally employed
in these as formerly, it may not infrequently prove of service
when they occur under bad hygienic influences in cachectic sub-
jects. It is beneficial in strumous synovitis and in caries and
necrosis of bone, and both its local and internal use has been
commended in rheumatic gout with deposits about the joints.
In diseases of the skin of strumous origin it has been designated
" our sheet-anchor," and there is no question of its utility in
tertiary syphilis, chronic bronchitis, emphysema, and various
chronic affections of the brain and nervous system. It may con-
stitute a very efficient element in the treatment of neuralgia,
COD LIVER OIL. 983
chorea, epilepsy, mercurial tremor, and paralysis agitans, and in
atheroma of the arteries it has been found useful in combating
degenerative changes and preventing failure in the nutrition of
the brain. Here its prolonged administration with phosphates
or hypophosphites is commended. Cod liver oil is invaluable in
the treatment of rickets and the wasting diseases of children,
especially in cases of strumous diathesis, and in these condi-
tions it may often be given with advantage in association with
syrup of ferrous iodide. Many infants and young children
take the undisguised oil with avidity. Older persons, however,
are apt to object to its unpleasant odor and taste. When such
objection is made, the oil may be administered in soft capsules
or in one of the numerous carefully compounded preparations
to be found in the market. Some patients are able to take the
oil by rinsing out the mouth with whiskey or brandy before-
hand, and 6thers by putting a little salt in the mouth after
swallowing it. To render it less unpalatable .60 c.c. (10 Tl)
of pure ether or .06 to .12 c.c. (1 to 2 ni) of oil of peppermint
or cloves may be added to each dose. One part of essential
oil of eucalyptus to 100 parts of pale oil is said to entirely do
away with the odor and taste. A very nutritious combination
in which the taste of the oil is quite well disguised is made by
rubbing together equal parts of cod liver oil and extract of
malt. In this, however, the oil is likely to repeat.' Paresi's
well-known disguise is prepared as follows: To 400 parts of
cod liver oil are added 10 parts of animal charcoal and 20 parts
of ground roasted coffee. The mixture is digested in a water-
bath at a temperature of 500 to 6o° C. (1220 to 1400 F.), and
after standing for three days is filtered and put into well-
stoppered bottles. The oil is also sometimes given in ordinary
black coffee. The most popular way of taking it is in the form
of emulsions, and a great variety of these have been suggested.
The following is advised by the British Pharmaceutical Con-
ference: Cod liver oil 240 c.c. (8 fl. oz.) ; the yolk of two
eggs; tragacanth in powder, 1 gm. (15 gr.) ; elixir of saccharin,
4 c.c. (1 fl. dr.) ; tincture of benzoin, 4 c.c. (1 fl. dr.) ; spirit of
984 PHARMACOLOGY AND THERAPEUTICS.
chloroform, 15 c.c. (4 fl. dr.) ; oil of bitter almonds, .50 c.c.
(8 ni); distilled water to 500 c.c. (16 fl. oz.). The elixir of
saccharin consists of saccharin, 1.50 gm. (24 gr.) ; sodium
bicarbonate, .75 gm. (12 gr.) ; alcohol, 4 c.c. (1 fl. dr.); dis-
tilled water, 28 c.c. (7 fl. dr.). When, as is often the case,
it is desirable to give iron with cod liver oil the following may-
be used: Cod liver oil, 15 c.c. (4 fl. dr.) ; iron and ammonium
citrate, .30 gm. (5 gr.) ; potassium carbonate, .20 gm. (3 gr.) ;
saccharin, .015 gm. (% gr.) ; oil of caraway, .015 c.c. (*4 1TL) ;
water to 30 c.c. (1 fl. oz.). The hypophosphites are also some-
times incorporated in emulsions of the oil. It will be seen that
emulsions of the oil, with and without hypophosphites, are now
official preparations.
EXTRACT OF MEAT.
Unofficial Preparation.
Extraction Carnis. — Extract of Meat.
Action of Extract of Meat.
Extract of meat is a nutrient and a stimulant.
Therapeutics of Extract of Meat.
It is useful in relieving prostration and fatigue. The solu-
tion seasoned with capsicum is valuable in alcoholic excess and
delirium tremens. In infantile bowel disturbances, when milk
must be forbidden, it is often indicated. In phthisis it will fre-
quently sustain the patient ; in the aged it will support life with-
out taxing the digestive powers. The amount to be used should
be regulated by the age and condition of the patient.
MILK.
Unofficial Preparations.
Lac. — Milk.
Lac Humanum Artificiosum. — Artificial Human Milk.
Lac Peptonizatum. — Peptonized Milk.
Kumyss. — Kumyss.
MILK. 985
Action of Artificial Human Milk.
It is designed to produce the effects of human milk, and is
invaluable as a food for infants whose mothers cannot suckle
them.
Therapeutics of Artificial Human Milk.
Many cases of diarrhoea, indigestion and other ailments
can be cured by substituting this milk for the usual milk and
water given to infants. Some manufacturers supply it on
prescriptions designating the amount of milk sugar, fat, pro-
teids and salts, which it should contain, but it is cheaper to
make it at home, and the method of preparing it is easily car-
ried out. When bought it is often sterilized, or pasteurized,
and sold in air-tight bottles. It should be remembered that a
long-continued diet of sterilized milk may, in children, cause
rickets.
Action of Peptonized Milk.
The nutritive value of the peptones has been shown by the
gain in weight observed in animals in whose diet they were
made to replace the ordinary proteids, and the same result is
seen in kittens fed with peptonized milk. The alkaline reac-
tion of peptonized food has the effect of stimulating secretion.
Therapeutics of Peptonized Milk.
It is ordinarily given in any condition in which the stomach
is incapable of digesting unchanged milk. It is also used where
it is desirable, as may be the case in typhoid fever, to avoid the
rapid precipitation of casein in the stomach. Small quantities
of peptonized milk are sometimes of great service in cases of
acute febrile diseases in which vomiting is a troublesome symp-
tom, as also in repeated vomiting from whatever cause. Pep-
tonized milk and other peptonized foods are especially useful in
cases in which there is a marked deficiency of the secretion of
the stomach, as in gastric catarrh, atrophy of the gastric mu-
cous membrane, and advanced cancer of the stomach. Among
the numerous other conditions in which they are of service
986 PHARMACOLOGY AND THERAPEUTICS.
may be mentioned chronic Bright's disease, pulmonary tuber-
culosis, and pernicious anaemia, when the digestive function is
greatly impaired. As a rule, the use of peptonized food should
be resorted to only as a temporary expedient. Milk is often
given by the rectum, and when administered in this way it
should always be peptonized. A nutrient enema which is much
used consists of the yolk of an egg with sufficient milk to make
120 c.c. (4 fl. oz.). The mixture may be peptonized in the same
way as plain milk, and 2 gm. (30 gr.) of common salt should
be added before the injection is made.
Action of Kumyss.
This preparation has the nutritious properties of ordinary
milk, and, as it contains a small quantity of alcohol, is also a
mild stimulant. A large amount of carbon dioxide gas is gen-
erated in kumyss, and great care must therefore be exercised
in opening the bottles containing it.
Therapeutics of Kumyss.
On account of its slightly stimulating quality it is of much
service in convalescence, in phthisis, and in various other de-
pressed conditions. It is also used in gastric ulcer and cancer,
and other diseases of the stomach, and for the same general
purposes as milk. It is usually more agreeable to the patient
than the latter, and is often borne by the stomach when all other
food is vomited. The preparations found in the market are
very good substitutes for the kumyss drunk by the Tartars, who
prepare it by fermenting mares' milk.
Division XV. — Drugs which Have no Marked Therapeutic
Properties.
Many of the drugs here presented are official, although some
have been dismissed from the Pharmacopoeia, and a number of
them are in daily use in the pharmacies. Their interest to the
physician lies chiefly in their employment to make prescriptions
more palatable or sightly.
BALM. 987
VANILLA.
VANILLA.— Vanilla. Dose, 1 gm.; 15 gr.
Preparation.
Tinctura Vanillae. — Tincture of Vanilla.
VANILLINUM.— Vanillin. Dose, 0.030 gm. (30 milligm.) ; 1/2 gr.
Action of Vanilla.
Vanillin has been asserted to be locally irritant and to have
produced in frogs spinal convulsions, followed by paralysis
affecting both the spinal cord and the motor nerves. Vanilla
is probably inert as regards any action on the human system.
There can be little question that the cases of poisoning which
from time to time have been reported from the eating of ice-
cream and other articles flavored with vanilla were due to
ptomaines.
Therapeutics of Vanilla.
Vanilla has been suggested as a remedy in hysteria, but it
is used for the most part simply as a flavoring agent.
RASPBERRY.
Unofficial Preparations.
Rubus Idseus (U. S. P., 1890). — Raspberry.
Syrupus Rubi Idsei (U. S. P., 1890). — Syrup of Raspberry.
Dose, indefinite.
Action of Raspberry.
Raspberry has no medicinal properties.
Therapeutics of Raspberry.
Raspberry syrup is used chiefly as a flavoring agent.
BALM.
Unofficial Preparation.
Melissa (U. S. P., 1890).— Melissa. (Balm.) Dose, 4 to 8
gm.; 1-to 2 dr.
988 PHARMACOLOGY AND THERAPEUTICS.
Action of Balm.
Balm has no appreciable effects upon the system.
Therapeutics of Balm.
It is used as a flavoring agent.
COCHINEAL.
COCCUS.— Cochineal.
Unofficial Preparation.
Tinctura Cocci (B. P.). — Tincture of Cochineal. Dose, 0.30
to 1 c.c; 5 to 15 Tn,.
Action of Cochineal.
It has been supposed by some to possess anodyne properties,
but it probably has no action.
Therapeutics of Cochineal.
Cochineal is used only as a coloring agent. It was formerly
employed in the treatment of whooping-cough (in which it had
a considerable vogue), and of neuralgia.
SAFFRON.
Unofficial Preparations.
Crocus (U. S. P., 1890).— Saffron. Dose, 0.30 to 2 gm.;
5 to 30 gr.
Tinctura Croci (U. S. P., 1890). — Tincture of Saffron. Dose,
4 to 8 c.c; 1 to 2 fl. dr.
Infusum Croci. — Infusion of Saffron. Dose, freely.
Action of Saffron.
Saffron is somewhat aromatic, and is credited with mild anti-
spasmodic and anodyne properties.
SESAME. 989
Therapeutics of Saffron.
Saffron is used to color pharmaceutical preparations. It has
sometimes been given as an emmenagogue. A hot infusion,
known as saffron tea, is a popular remedy in domestic practice
to promote the eruption in measles and other exanthemata.
Any diaphoretic influence that it may have is no doubt due
simply to the hot water.
RED SAUNDERS.
SANTALUM RUBRTJM.— Red Saunders.
Action of Red Saunders.
Red Saunders is of no value medicinally.
Therapeutics of Red Saunders.
It is used only as a coloring agent.
MYRCIA.
Unofficial Preparations.
Oleum Myrcise (U. S. P., 1890).— Oil of Myrcia. (Oil of
Bay.)
SpiritUS Myrcise (U. S. P., 1890). — Spirit of Myrcia. (Bay
Rum.)
Action of Myrcia.
Oil of myrcia has the general action of the volatile oils.
Therapeutics of Myrcia.
Oil of myrcia is used solely as a perfume. Bay rum is used
as a refrigerant lotion.
SESAME.
Unofficial Preparation.
Oleum Sesami (U. S. P., 1890). — Oil of Sesamum. (Sesame
Oil.)
990 PHARMACOLOGY AND THERAPEUTICS.
Action of Oil of Sesamum.
It is emollient and in large doses laxative.
Therapeutics of Oil of Sesamum.
Benne oil is used in preparing hair oil.
WAX.
CERA FLA VA.— Yellow Wax.
CERA ALBA.— White Wax.
Action of Wax.
Wax has no medicinal qualities.
Therapeutics of Wax.
Yellow and white wax are used only as bases for various
plasters, cerates and ointments.
PARAFFIN.
PARAFFINUM.— Paraffin.
Action of Paraffin.
None.
Therapeutics of Paraffin.
It makes a good basis for ointments used for protecting
wounds or sores, but as it is absorbed with difficulty, it is not
suitable for ointments to be applied in cases in which the ab-
sorption of drugs is desired. In recent years subcutaneous in-
jections of paraffin have been largely and successfully employed
for the correction of deformities, especially of the nose.
SUET.
SEVUM PR^PARATUM (Sevum, U. S. P., 1890).— Prepared
Suet.
BENZIN. 991
Action of Suet.
Suet has the action of fats in general.
Therapeutics of Suet.
Suet is used chiefly in cerates.
LYCOPODIUM.
LYCOPODIUM.— Lycopodium. (Vegetable Sulphur.)
Action of Lycopodium.
The plant was formerly regarded as diuretic and antispas-
modic, but it probably has no physiological action. Lycopodium
powder has a pronounced property of absorbing oils and oleo-
resins.
Therapeutics of Lycopodium.
It makes an excellent absorbent and protective powder when
dusted over an excoriated surface, as in the intertrigo of in-
fants. For this purpose it is often mixed with an equal quantity
of powdered starch. It is also used as a basis for insufflations.
As it is powerfully repellent to water, and thus protects hygro-
scopic substances, it is a good basis for pills, and it is exten-
sively employed for facilitating the rolling of the pilular mass
and preventing the adhesion of pills to each other.
BENZIN.
BENZINUM.— Petroleum Benzin.
Preparation.
Benzinum Purification. — Purified Petroleum Benzin.
Action of Benzin.
Large doses give rise to gastro-enteritis, and benzin-poison-
ing may be induced by its inhalation.
Therapeutics of Benzin.
Benzin is used to obtain volatile oils and for depriving pow-
dered drugs of their fixed oil by percolation, as a substitute
992 PHARMACOLOGY AND THERAPEUTICS.
for ether in making oleoresins, and for dissolving fats, resins,
caoutchouc and some of the alkaloids. It has occasionally been
employed externally in the treatment of neuralgia, rheumatic
pains, scabies and prurigo, and internally as a remedy for tape-
worm.
CARBON DISULPHIDE.
CARBONEI DISULPHIDUM.— Carbon Disulphide. (Carbon Bisul-
phide.)
Action of Carbon Disulphide.
Persons exposed to its fumes in the arts are liable to be-
come emaciated and to be affected with headache, vertigo,
nervous excitement, incoordination of movement, and de-
pression of the special senses, with impairment of sensation and
motility. Even insanity is said to sometimes result. Directly
inhaled, it excites violent coughing and produces general an-
aesthesia with marked muscular rigidity. It is a powerful car-
diac depressant, and even in small doses by the mouth it causes
severe nausea and vomiting, with a burning sensation in the
epigastrium, and a weak and rapid action of the heart.
Therapeutics of Carbon Disulphide.
Carbon disulphide is used as a solvent. It is the best solvent
for rubber and similar bodies. It can be freed from its usual
disgusting odor by repeated rectification. In minute doses it
is said to relieve gastralgia and the pain of cancer of the
stomach, as well as nausea and vomiting.
ACETONE.
ACETONUM.— Acetone.
Action of Acetone.
In small amount it is a normal constituent of the blood
and urine, and in certain pathological conditions is found in
larger quantities. It is stated to possess anaesthetic, hypnotic
and anthelmintic properties.
talc. 993
Therapeutics of Acetone.
It has been given in rheumatism and gout, but its principal
use is in pharmacy. It is employed in the preparation of chloro-
form and sulphonal and as a solvent for resins, fats, camphors,
gun-cotton, etc.
MASTIC.
MASTICHE.— Mastic. Dose, 2 gm.; 30 gr.
Preparation.
Pilulae Aloes et Mastiches. — Pills of Aloes and Mastic. Dose,
2 pills.
Action of Mastic.
Mastic is a mild stimulant.
Therapeutics of Mastic.
It is mostly used as a masticatory, for filling decayed teeth,
and for cements and varnishes.
RUBBER.
ELASTICA.— Rubber. (India-rubber. Caoutchouc.)
Action of Rubber.
It is so insoluble that it cannot be absorbed in any form into
the blood. It therefore has no action on the system.
Therapeutics of Rubber.
Rubber is used for making plasters, bougies, pessaries, and
syringes.
TALC.
TALCUM.— Talc.
Preparation.
Talcum Purificatum. — Purified Talc.
Action of Talc.
None.
64
994 PHARMACOLOGY AND THERAPEUTICS.
Therapeutics of Talc.
Purified talc makes an excellent filtering basis, and it is em-
ployed in the manufacture of a large number of official pharma-
ceutical preparations.
DRIED CALCIUM SULPHATE.
CALCII SULPHAS EXSICCATUS.— Dried Calcium Sulphate.
(Dried Gypsum. Plaster of Paris.)
Action of Dried Calcium Sulphate.
Dried calcium sulphate is inert.
Therapeutics of Dried Calcium Sulphate.
Dried calcium sulphate is used for making casts of deformi-
ties and injuries, and for making immovable bandages and ap-
paratus for injuries and diseases when immobilization is neces-
sary.
SODIUM SILICATE.
Unofficial Preparation.
Liquor Sodii Silicatis (U. S. P., 1890). — Solution of Sodium
Silicate.
Action of Sodium Silicate.
None.
Therapeutics of Sodium Silicate.
It is employed on bandages for making immovable dressings ;
it is stronger than starch and lighter than plaster of Paris.
The following drug properly belongs in the Class of General
Anaesthetics, Division X.
BROMOFORM.
RROMOFORMUM.— Bromoform. (Tribromomethane.) Dose, 0.2
c.c; 3 IT]..
BROMOFORM. 995
Action of Bromoform.
Bromoform, an analogue of chloroform, is anaesthetic and
antispasmodic, and also has antiseptic properties. When in-
haled, the narcosis produced by it is shorter than that of ether
or chloroform.
Therapeutics of Bromoform.
It has been employed internally in influenza and spasmodic
cough, and especially in whooping-cough. In the latter it is
a remedy of considerable value, but must be employed with
great caution, as a number of cases of poisoning from its use
have been reported. As a rule, it is better in this affection
to depend upon agents attended with less danger than bromo-
form. On account of its high specific gravity it is likely to
separate from mixtures unless very carefully compounded. It
can be administered as follows: Bromoform, i; alcohol. 8;
glycerin, 48; compound tincture of cardamom, 8. Each fluid
drachm contains the official dose.
NDEX.
In all Latin titles of more than one syllable, the accented syllable is distin-
guished by the sign ' placed after the corresponding vowel.
ABSI NTHIUM, 650
Absorbent cotton, 443
Aca'cia, 463
Accelerating centre, drugs
acting on, 253, 323
A. C. E. mixture, 896
Acetanilide, 556
Acetyl paramidophenol
salicylate, 731
Acetone, 992
Acetone-chloroform, 875
Acetphenetidin, 564
Acetyl paramidophenol
salicylate, 731
salicylic acid, 721
Acid, acetic, 331
acetyl salicylic, 721
arsenous, 234
benzoic, 540
boracic, 83
boric, 83
cacodylic, 234, 245
camphoric, 296
carbolic, 57
cetraric, 473
chromic, 345
cinnamic, 540
citric, 331
chrysophanic, 690,
691
di-iodosalicylic, 78, 83
gallic, 389
hippuric, 541
hydriodic, 965
hydrobromic, 801
hydrochloric, 330
hydrocyanic, 573
hypophosphorous, 915
iodosalicylic, 74, 83
lactic, 331
meconic, 845
Acid, muriatic, 330
nitric, 330
nitrohydrochloric, 330
nitromuriatic, 330
oleic, 450
orthocreosotic, 729
phenic, 57
phosphoric, 330
prussic, 573
salicylic, 721
sphacelic, 919
stearic, 438
sulphuric, 329
sulphurous, 106
tannic, 382
tartaric, 331
trichloracetic, 331
Acids, 329
Aconine, 310
Aconite, 305
preparations of, 305
Aconitine, 305
Actions, pharmacological
and therapeutical, 8
Actol, 418
A'deps, 440
benzoina'tus, 440
la'nse, 438
hydro'sus, 438
Adhesive plaster, 404
Adjuvant elixir, 461
Administration of drugs,
2, 6
Adonidin, 278
Adrenalin, 949, 953
^Esculap, 621
vE'ther, 901
ace'ticus, 906
broma'tus, 907
JEthy'lis bro'midum, 907
ca'rbamas, 884
iEthy'lis chlo'ridum, 770
Air inhaled, drugs alter-
ing composition of, 568
Aix-la-Chapelle, 105
A'lcohol, 824
amylic, 839
ethylic, 824
tertiary amylic, 877
trichlor-tertiary butyl,
875
Aldehyde, cinnamic, 640
formic, 49
A'llium, 652
Allspice, 638
Almond, 465
Aloes, 686
Aloin, 687
Alpha-eucaine hydrochlo-
ride, 765
Alteratives, 960
Althse'a, 475
Alum, 432
ammonia-ferric, 221
Alu'mini hydroxidum, 433
su'lphas, 432
Aluminum salts, 432
Alumnol, 435
Ammonia, solutions of,
194
spirit of, 194
Ammoniac, 670
Ammonium, 194
acetate, 206
benzoate, 540
bromide, 792
carbonate, 201
chloride, 203
ichthyol sulphonate,
974
iodide, 966
muriate, 203
997
INDEX.
Ammonium nitrate, 207
salicylate, 721
valerate, 665
Amy'gdala ama'ra, 465
du'lcis, 465
Amyl colloid, 322
nitrite, 364
Amylene hydrate, 877
A'mylis ni'tris, 364
Amyloform, 49
A'mylum, 476
Anaesthesia, medullary,
763
Anaesthetics, general, 740,
888
local, 734
dangers of, 740
Analgesics, 556, 739
Anaphrodisiacs, 909
Anarcotine, 866
Ane'thum, 649
Angustura bark, 633
Anhalonium, 840, 877
Anhydrotics, 495
Anhydrogluco-chloral, 876
Anise, 646
Anodyne, Hoffmann's, 901
colloid, 316
Anodynes, local, 734
Anthelmintics, 17, 18, 112
A'nthemis, 651
Anthracene purgatives,
694
Anticholagogues, 626
Anticholera serum, 941
Antidiphtheritic serum,
934
Antidote, arsenical, 221,
230
hydrophobia, 944
Anti-emetics, 616
Antifebrin, 556
Antigalactagogues, 911
Antihydrotics, 495
Antikamnia, 561
Antilithics, 512
Antimony, preparations
of, 502
Antinervine, 561
Antiparasitics, 18, 122
Antiperiodics, 18, 128
Antiplague serum, 940
Antipneumococcic serum,
939
Antipyretics, 553, 556
Antipyrene, 562
monochloral, 866
Antiseptic solution, 84
Antiseptics, 14, 19
gastric, 611
internal, 16, 611, 622
intestinal, 622, 718
Antisialogogues, 607, 608
Antispasmodics, 571, 600
Antistreptococcic serum,
938
Antitetanus serum, 936
Antitoxin, diphtheria, 934
tetanus, 936
Antitoxins and serums,
933
Antityphoid serum, 942
nntivenomous serum, 939
Antizymotics, 17
Apenta, 181, 621
Aphrodisiacs, 908, 911
Apiol, 931
Apocodeine, 581, 584
Apo'cynum, 528
Apomorphi'nae hydrochlo'-
ridum, 581
Apomorphine, 581
A'qua, 516
destilla'ta, 516
hydroge'nii dio'xidi,
93
Arbutin, 524
Argentamine, 418
Arge'nti cya'nidum, 414
ni'tras, 414
o'xidum, 414
Argonin, 418
Argyrol, 419
Aristol, 74, 81
Armora'cia, 641
A'rnica, 489
Aromatic elixir, 654
fluidextract, 640
powder, 640
Arrhenal, 247
Arsenic, 234
antidote, 221, 230
preparations of, 234
poisoning, 247
Artificial human milk, 985
oil of wintergreen,
729
Asafetida, 668
Asafrol, 719
Ascle'pias, 596
Ash, prickly, 973
Asparagin, 475
Aspi'dium, 112
Aspidospe'rma, 602
Aspirin, 721, 729
Astringents, 327
intestinal, 623
Atropine, 803
and morphine, 864
Aubergier's syrup, 887
Aura'ntii a'mari co'rtex,
654
du'lcis, co'rtex, 654
Au'ri et so'dii chlo'ridum,
971
BAEL fruit, 636
Baker's ammonia, 201
Baking soda, 177
Balm, 987
Balsam of fir, 356
Friar's, 540
Ba'lsamum Peruvia'num,
no
Toluta'num, 566
Barberry, 632
Barium salts, 381
Bark, Angustura, 633
cassia, 640
cotton root, 925
cramp, 932
Panama, 593
Peruvian, 128
prickly ash, 973
sacred, 692
sassy, 294
soap, 593
Barley, pearl, 459
Basham's mixture, 221,
232
Basilicon ointment, 363
Bassorin, 465
Baths, 516
cold, 516, 517, 519
hot, 516, 520
ice-water, 519
INDEX.
999
Baths, indifferent, 516, 520
tepid, 520
warm, 516, 520
Battey's fluid, 963
Bay rum, 989
Bearberry, 524
Be'lse fruc'tus, 636
Bellado'nna, 802
Benzaconine, 310
Benzaldehyde, 465
Benzin, 991
Benzoin, 539
Benzosol, 599
Benzoyl-guaiacol, 599
Benzosulphinide, 552
Berberine, 629
Be'rberis, 632
Bergamot, 644
Beta-eucaine, 765
Betanaphthol, 718
Be'tula, oil of, 729
Bile, drugs acting on, 624
Bismuth, 673
Bitter apple, 705
Bitters, 610, 627
Bittersweet, 977
Bladder, drugs acting on,
515
Bladderwrack, 964
Blackberry, 400
cohosh, 929
draught, 694
drop, 843
haw, 932
manganese oxide, 930
mustard, 478
pepper, 656
snake root, 929
wash, 21
Blaud's pills, 221
Bleaching powder, 53
Bliss' cvire, 819
Blisters, 534
Blood, drugs acting on,
148
Bloodroot, 596
Blue cohosh, 928
flag, 512
Lick Springs, 105
mass, 19
methylene, 887
ointment, 19
Blue pill, 19
stone, 428
vitriol, 428
Boneset, 508
Borax, 84
Boro-glycerin, glycerite
of, 83
Bougies, 4
Bourboule water, 231, 245
Brain, drugs acting on,
737, 802
extract, 958
Brandy, 824
Bromal, 876
Bromides, 792, 793
comparative action of
the, 796
Bromine, 793
Bromism, 797
Bromoform, 994
Bro'mum, 792
Bronchial secretion, drugs
affecting, 570, 581
vessels, drugs acting
on, 571
spasm, drugs relax-
ing, 57i
Broom, 522
Brown mixture, 461
Brucine, 777, 780
Bryo'nia, 710
Bucco, 523
Buchu, 523
Buckthorn, 696
Burdock, 997
Burgundy pitch, 362
Burnett's fluid, 426
Burton's line, 406
Butternut, 692
Butter of cacao, 444
of zinc, 422
Butyl-chloral hydrate, 873
Byne, 456
CACAO butter, 444
Cacodylic acid, 234,
245
Ca'ctus, 323
Cade, oil of, 361
Caffeine, 282
Cajuput, oil of, 482
Calabar bean, 783
Ca'lamus, 631
Calcium, 214
beta-naphthol alpha-
monosulphonate,7i9
bromide, 792
carbonate, precipitat-
ed, 214
chloride, 219
glycerophosphate, 917
hydroxide, 216
hypophosphite, 915
lacto-phosphate, syrup
of, 218
oxide, 215
phosphate, 218
sulphate, dried, 994
sulphide, crude, 103
Cale'ndula, 978
Calomel, 19
Calu'mba, 627
Calx, 215
chlorina'ta, 53
sulphura'ta, 103
Cambo'gia, 704
Camphor, 296
preparations of, 296
salol, 730
Canada turpentine, 356
Canadian hemp, 528
moonseed, 979
Cane'lla, 635
Ca'nnabis i'ndica, 840
Canquoin's paste, 425
Cantha'rides, 531
Caoutchouc, 993
Ca'psicum, 658
Caraway, 648
Carbamate, ethyl, 884
Ca'rbo, anima'lis, 95
li'gni, 95
Carbolic acid, 57
Carbon disulphide, 992
Cardamom, 661
Cardiac mechanism, drugs
acting on, 249
Carlsbad water, 181
Carminative tincture, 662
Carminatives, 613
Carolina pink, 121
Carron oil, 216, 446
Ca'rum, 648
Caryo'phyllus, 636
ooo
INDEX.
Casca'ra sagra'da, 692
Cascari'lla, 632
Ca'ssia bark, 640
fi'stula, 682
purging, 682
Casta'nea, 604
Castile soap, white, 451
Castor oil, 682
Catapla'sma kaoli'ni, 437
Ca'techu, 393
Cathartic pills, compound,
19
vegetable, 705
Cathartics, 620
Caulophy'llum, 928
Caustic, lunar, 414
mitigated, 414
potash, 152
soda, 174
Vienna, 152
Caustics, 326
Celandine, 699
Ce'ra a'lba, 990
fla'va, 990
Cerate, 440
Cerates, 5
Cerebral depressants, 739,
843
excitants, 738
stimulants, 738
Ce'reus grandiflo'rus, 323
Ce'rium oxalate, 679
Ceta'ceum, 440
Cetra'ria, 473
Chalk, preparations of, 214
Chamomile, 651
German, 652
Champagne, 836
Charcoal, 95
Chaulmoogra oil, 441
Chelido'nium, 699
Chemical constitution and
physiological action, 9
Chenopo'dium, 122
Cherry laurel, 580
wild, 579
Chestnut, 604
Cheyne-Stokes breathing,
drugs which produce,
573
Chima'phila, 978
Chira'ta, 633
Chire'tta, 633
Chloral, 866
Chloralamide, 874
Chloralformamide, 874
Chlora'lum hydra'tum,
866
Chloralose, 876
Chloretone, 875
Chlorinated lime, 53
soda, solution of, 53
Chlorine, 53
compound solution
of, 53
water, 53
Chlorobrom, 975
Chlorodyne, 888
Chloroform, 888
Commission, British
Medical Associa-
tion, 900
Hyderabad, 891
Chlorofo'rmum bellado'n-
nae, 810
Chlorophenol, 57, 67
Chlo'rum, 53
Cholagogues, 625
Cholera serum and inocu-
lation, 941
Cho'ndrus, 474
Chromium trioxide, 345
Chrysophan, 695
Chrysophanic acid, 691
Chrysarobin, 122, 690, 695
Churchill's tincture, 963
Cigarettes, 4
Ciliary muscle, drugs
acting on, 743
Cimici'fuga, 929
Cincho'na, 128
relative action of al-
kaloids of, 139
preparations of, 128
ru'bra, 128
Cinchonism, 138
Cineol, 483
Cinnabar, 21
Cinnaldehy'dum, 640
Cinnamic aldehyde, 640
Cinnamon, 640
Citrine ointment, 20
Citric acid, 331
Citrullin, 707, 708
Clarendon, 215
Claret, 824
Clark's powder, 144
Classification of drugs, 14
Clemens' bromide solu-
tion, 224
Cloves, 636
Clutterbuck's elaterium,
709
Clysters, 4
Co'ca, 759
Cocaine, 759
Cocainization, spinal, 763
Cocamania, 764
Co'ccus, 988
Cochineal, 988
Cocilla'fia, 584
Codeine, 865
Cod liver oil, 950
Coffee, 283, 291
Cohosh, blue, 928
black, 929
Co'la, 293
Colchicine, 716
Co'lchicum, 713
Colchisal, 713, 716
Collodion, 443
Colloid, amyl, 305
mercury, 21
Colloidal silver, 419, 422
Colocynth, 705
Colocynthin, 706, 708
Colophony, 363
Columbian spring, Sara-
toga, 231
Columbo, 627
Condal, 181
Condy's fluid, 92
Coniine, 746
Coni'um, 74s
Contrexe'ville, 215
Convalla'ria, 281
Copa'iba, 545
Copaiva, 545
Copper sulphate, 428
Coriander, 647
Corn-silk, 529
Cornutine, 919
Corrosive sublimate, T9
Corson's paint, 711
Coster's paste, 963
Coto, 402
INDEX.
IOOI
Cotton, 443
root bark, 925
Couch grass, 538
Counter-irritants, 326
Court plaster, 439
Cramp bark, 932
Cream of tartar, 165
Crede's ointment, 419
Creolin, 72
Creosotal, 597, 598
Creosote, 597
Cre'sol, 57, 67
Cre'ta praepara'ta, 214
Cro'cus, 988
Crotin, 711
Croton chloral hydrate,
873
oil, 710
Cubeb, 548
Cu'ca, 759
Cucumber, bitter, 705
Culver's root, 701
Cumulative action, 7
Cu'pri su'lphas, 428
Curare, 744
Curd soap, 451, 455
Cuspa'ria, 533
Cusso, 1 1 5
Cypripe'dium, 667
DAMIA'NA, 918
Dandelion, 635
Deco'ctum ad icte'ricos,
699
Definitions, 2
Deliriants, 738
Delphinine, 125, 126
Demulcents, 328
Deodorants, 17
Depressants, cerebral, 739,
843
Dermatol, 673
Dextroform, 49
Diabetin, 461
Diachylon ointment, 404
plaster, 404
Dialyzed iron, 223
Diaphoretics, 494, 496
Diastase, 456
Diethylsulphonedimethyl-
methane, 878
Diethylsulphonmethyl-
ethyl-methane, 880
Digestants, animal, 662
Digestive apparatus, drugs
acting on, 606
Digitalin, 254
Digita'lis, 253
Digitoxin, 254
Di-iodosalicylic acid, 74,
83
Di-isobutylorthocresol
iodide, 74
Dill, 649
Dimethylethylcarbinol,
877
Dinner pill, 686
Dionine, 844, 860
Diphtheria antitoxin, 934
Direct action, 8
Disinfectants, 14
Dispermine, 530
Dissolution, law of, 737
Diuretics, 509, 516
Diuretin, 528
Dock, yellow, 401.
Dog button, 772
Donovan's solution, 234
Doses, 5
for children, 5
Dover's powder, 843
Droitwich water, 188
Drop chalk, 214
Drugs, modes of adminis-
tration of, 2
Duboisine, 818
Dulcama'ra, 977
Dulcin, 552
Durand's remedy, 354
Dusart's syrup, 233
EAR, drugs acting on,
744
Easton's pill, 232
syrup, 232
Eau de goudron, 360
Ecbolics, 909, 919
Effervescing powder, com-
pound, 143
Egg, 441
Ela'stica, 993
Elaterin, 708
Elaterium, 708
Elder, 649
Elecampane, 600
Electrozone, 54, 56
Elemi, 493
Eli'xir, adjuvant, 461
aromatic, 654
fe'rri, quini'nae et
strychni'nse phos-
pha'tum, 222
pho'sphori, 912
Elm, slippery, 462
Emetics, 614
Emetine, 586
Emmenagogues, 910, 930
Emollients, 328
Empirical therapeutics, 1
Ene'mata, 4, 621
Enteroclysis, 3
Epinephrin, 952
Epson salt, 209
Ergot, 919
oil of, 924
Ergotin, 919
Ergotism, 921
Erigeron, oil of, 357
Eriodi'ctyon, 603
Erythrophlceine, 2q.\
Erythro'phloeum, 294
Erythrol tetranitrate, 379
Erythro'xylon, 759
Escharotics, 326
Eserine, 783
Essence of nutmeg, 639
of peppermint, 644
of spearmint, 646
Ether, 901
acetic, 906
chloric, 883
hydrobromic, 907
nitrous, spirit of, 378
sulphuric, 901
Ethyl acetate, 906
alcohol, 824
bromide, 907
carbamate, 884
chloride, 770
oxide, 901
urethane, 884
Ethylirtes chloral-ure-
thane, 866
Eucaine, 765
1002
INDEX.
Eucalyptol, 483
Eucal'yptus, 483
gum, 401
Eudermol, 749, 752
Eudoxin, 678
Eugenol, 636, 638
Eunatrol, 447
Euonymin, 698
Euo'nymus, 697
Eupato'rium, 508
Europhen, 74, 82
Exalgin, 565
Excretion, rate of, 7
Expectorants, 572, 581
Extracts, organic, 945
Eye, drugs acting on, 742
FABIA'NA, 528
Family pill, 503
Eel bo'vis, 696
Fennel, 648
Ferratin, 223, 233
Ferric hypophosphite, 915
Fe'rrum, 220
Fi'cus, 581
Fig, 681
Fir wood oil, 356
balsam of, 356
Flag, sweet, 631
Flaxseed, 445
Fleabane, oil of, 357
Flitwick water, 231
Flowers of sulphur, 98
Fceni'culum, 648
Formaldehyde, 15, 49
Formalin, 49
Formol, 49
Fowler's solution, 234
Foxglove, 253
Fra'ngula, 696
Frankincense, 364
Franz Joseph, 181
Friedrichshall, 181, 621
Friar's balsam, 540
Fusel oil, 839
GALACTAGOGUES,
9..
Galba'num, 671
Ga'lla, 382
Gallacetophenone, 389
Gambir, 393
Gamboge, 704
Gargari'smata, 4
Gargles, 4
Garlic, 652
Gastric antiseptics, 611
juice, action of drugs
on, 609
sedatives, 613, 673
Gastro-intestinal irritants,
612
Gaulthe'ria, 729
Gelatin, 475 »
Gelsemine, 790
Gelse'mium, 788
Generation, drugs acting
on organs of, 908
Gentian, 630
Gera'nium, 399
Gin, 527
Ginger, 660
Gla'ndulae suprarena'les
si'ccae, 380, 949
thyroide'ae si'ccae, 946
Glauber's salt, 179
Glonoin, spirit of, 374
Gluside, 552
Glutoform, 49
Glutol, 49, 53
Glycerin, 467
Glycerites, 467
Glycerol, 608
Glycerophosphates, 917
Glyceryl trinitrate, 374
Glycoformalin, 49
Glycogelatin, 476
Glycogenic function, 626
Glyconin, 441
Glycosuria, 626
Glycyrrhi'za, 461
Glycyrrhizin, ammoniated,
461
Gold and sodium chloride,
971
Gold seal, 925
Gossy'pii co'rtex, 925
Goulard's cerate, 404
extract, 404
Gourd, bitter, 705
Grana'tum, 115
Gray powder, 19
Green mercurous iodide,
20
Green, Paris, 247
Scheele's, 247
Schweinfurth's, 247
soap, 451
solution, 726
Grinde'lia, 600
Guaiac, 972
Guaiacol, 599
Guara'na, 292
Gum arabic, 463
Benjamin, 539
camphor, 296
guaiac, 972
red, 401
Gun cotton, 443
Guy's pill, 280
(jypsum, dried, 994
H.EMATINICS, 150
indirect, 150
Hacmato'xylon, 396
Haemostatics, 328
Hamame'lis, 397
Habit, 5
Harrogate water, 105
Hartshorn, 201
Haschisch, 840
Heart, drugs acting on,
250, 253
Heat as an antiseptic, 15
bodily, drugs acting
on, 553
increasing, 555
Hedeo'ma, 650
Helenin, 600
Hemide'smus, 975
Hemlock, spotted, 745
Hemp, Indian, 840
Canadian, 528
Henbane, 819
Hepatic stimulants, 625
Heroine, 845, 860
Hexamethylenamine, 538
Himrod's cure, 819
Hive syrup, 279, 502
Hoffman's anodyne, 901
Holocaine, 767
Homatropine hydrobrom-
ide, 817
Honey, 680
Hops, 885
Horehound, 508
INDEX.
IOOl
Horseradish, 641
Hu'mulus, 885
Hunyadi Janos, 181, 621
Hyderabad commission,
891
Hydragogues, 620
Hydra'rgyri cklo'ridum
corrosi'vum, 19
chlo'ridum mi'te, 19
cya'nidum, 20
empla'strum, 19
io'didum fla'vum, 20
io'didum ru'brum, 20
o'xidum fla'vum, 20
o'xidum ru'brum, 20
subsu'lphas fla'vus, 21
Hydrargyrol, 21
Hydra'rgyrum, 19
ammonia'tum, 19
cum cre'ta, 19
Hydrastine, 925
Hydra'stis, 925
Hydrated chloral, 866
Hydriodic acid, 965
Hydrobromic acid, 801
ether, 907
Hydrochloric acid, 330
ether, 770
Hydrocyanic acid, 573
Hydrogen dioxide, solu-
tion of, 93
Hydronaphthol, 718, 719
Hydrophobia antidote, 944
Hydroxide, ferric, 221
potassium, 152
sodium, 174
Hyoscine, 820
Hyoscyamine, 820
Hyoscy'amus, 819
Hypnal, 866, 871
Hypnone, 866, 872
Hypnotics, 739
Hypodermic injections, 2
Hypodermoclysis, 3
Hypophosphites, 916
Hypophosphorus acid, 915
TCE BAGS, 519
A Ice-water baths, 519
Ichthyoco'lla, 439
Ichthyol, 974
Idiosyncrasy, 5
Uli'cium, 646
Imperial drink, 166
Index, 997
India rubber, 993
Indian hemp, 840
tobacco, 754
sarsaparilla, 975
Indirect action, 8
Infusions, intravenous, 2
Inhalations, 4
Injections, 2, 4
Insufflations, 4
Intestinal antiseptics, 622
718
astringents, 623
Intestines, drugs acting
on, 617, 680
Intra-ocular tension, 744
venous injection, 2
I'nula, 600
Inunction, 4
Iodantipyrine, 562
Iodides, 966
Iodine, 74, 960
Iodism, 967
Iodoform, 74
Iodol, 74, 81
Iodopyrine, 562
Iodosalicylic acid, 74, 83
Iodo-tannin, 382
Iodothyrin, 946, 949
Ions, theory of, 10
Ipecac, 585
Ipecacua'nha, 585
Iridin, 699
Iris, 698
Iron, 220
preparations of, 220,
232
Quevenne's, 220
wood, 602
Irritants, 325
gastro-intestinal, 612
Isinglass, 439
Itrol, 418
Ivy, poison, 979
Izal, 72
TABORANDI, 496
J Jaborine, 500
Jalap, 703
Jalapin, 702, 703
James' powder, 503
Jamestown weed, 818
Jarisch's ointment, 392
Jasmine, yellow, 788
Jervine, 316
Jeyes' disinfectant, 74
Ju'glans, 692
Juniper, 526
KAMA'LA, 114
Kaolin, 437
Kemp-Gardner method,
899
Kermes mineral, 503
Ki'no, 395
Kissingen, 181
Kombe poison, 273
Kousso, 1 1 5
Krame'ria, 394
Kumyss, 986
LABARRAQUE'S solu-
tion, 53
La Bourboule, 231, 245
Lac, 984
su'lphuris, 98
Lactic acid, 331
Lactophenine, 565
Lactose, 477
Lactuca'rium, 886
Lactylparaphenetidine, 56 5
Lady Webster's pill, 686
Ladies' slipper, 667
Lanolin, 438
La'pis divi'nus, 429
La'ppa, 977
Lard, 440
Largin, 419
Laudanum, 843
Lauroce'rasus, 580
Lavender, 643
Laxative tincture, 693
pills, compound, 686
Laxatives, 618, 680
Lead poisoning, 411
salts, 403
Lemon, 655
Lenigallol, 389, 392
Lepta'ndra, 701
Lettuce, 886
Levant wormseed, 118
Levico water, 231, 245
ioo4
INDEX.
Levulose, 461
Li'gnum vi'tae, 972
Lily of the valley, 281
Lime, 216
chlorinated, 53
preparations of, 216
sulphurated, 103
Limo'nis co'rtex, 655
su'ccus, 655
Linseed, 445
Li'num, 445
Li'quor antise'pticus, 84
chlo'ri compo'situs, 53
pi'cis carbo'nis, 359
so'dae chlorina'tae, 53
Liquorice, 461
Lister's ointment, 88
Litharge, 403
Lithium, 207
benzoate, 657
bromide, 792
carbonate, 207
citrate, 207
glycerophosphate, 917
salicylate, 721
vanadate, 207
Lithontriptics, 513
Liver, drugs acting on,
624, 626
Llangammarch wells, 382
Lob'elia, 754
Lobeline, 755
Local action, 8
anodynes, 734
anaesthetics, 734
Logwood, 396
London paste, 216
Losophan, 74, 83
Lo'tio fla'va, 21
ni'gra, 21
ru'bra, 426
spi'ritus, 835
Lugol's solution, 960
Lunar caustic, 414
Lupulin, 885
Lycetol, 530
Lycopo'dium, 991
Lysidine, 530
Lysol, 71
M
AAS' PROCESS, 899
Mace, 639
Magnesia, 210
Magnesium, 209
glycerophosphate, 917
salts, 210
Male fern, 112
Malt, 456
Maltose, 457
Mammary extract, 956
Mandrake, 699
Manganese dioxide, 930
hypophosphite, 915
sulphate, 930
Ma'nna, 681
Marienbad, 181
Marigold, 978
Marrow, red bone, 959
Marru'bium, 508
Marsden's paste, 240
Marsh's test, 249
luarshmallow, 475
Mass, blue, 19
of copaiba, 545
of ferrous carbonate,
221
Vallet's, 221
Mastic, 993
Ma'tico, 551
Matrica'ria, 652
May apple, 699
McDade's formula, 974
Meat extract, 984
Medullary anaesthe'sia, 763
Mel, 680
Meli'ssa, 987
Menispe'rmum, 979
Mental influences, 6
Me'ntha piperi'ta, 644
vi'ridis, 646
Menthol, 756
Mercuric ammonium chlo-
ride, 20
chloride, corrosive,
15, 1
cyanide, 20
iodide, red, 20
nitrate, 20
oxide, red, 20
yellow, 20
subsulphate, yellow,
21
sulphide, 21
Mercurol, 21
Mercuro-zinc cyanide, 41
Mercurous chloride, mild,
19
iodide, yellow, 20
tannate, 21
Mercury, 1 9
ammoniated, 19
antiparasitic action
of, 32
colloid, 21
mass of, 19
modes of administra-
' tion of, 42
oleate of, 20
preparations of, 19
in syphilis, 39
vegetable, 700
with chalk, 19
Metabolism, drugs acting
on, 960
Methyl acetanilide, 565
chloride, 770
morphine, 865
salicylate, 729
Methylene blue, 887
Methylthionine hydrochlo-
ride, 887
Mezere'um, 492
Miaouli, oil of, 482
Michel's paste, 332
Milk, 984
artificial human, 985
drugs acting on, 911
drugs excreted by,
911
peptonized, 985
sugar of, 477
Mindererus, spirit of, 206
Modes of administration
of drugs, 2
Monochlor-ethane, 770
methane, 770
Monsel's solution, 220,
228
Moonseed, Canadian, 979
Morphine, 844
benzylic ester hydro-
chlorate, 845
diacetic ester, 845
methyl, 865
monoethyl ester hy-
drochlorate, 845
INDEX.
IOO5
Morton's fluid, 964
Mo'schus, 304
Moss, Iceland, 473
Irish, 474
Motor nerves, drugs act-
ing on, 732
Mountain balm, 603
Muriatic acid, 330
Muscarine, 791
Muscles, drugs acting on,
732
Muscular and nervous
systems, drugs acting
on, 732
Musk, 304
Musk root, 642
Mustard, 478
Mutton suet, 990
Mydriatics, 743
Myotics, 743
My'rcia, 989
Myri'stica, 639
Myrrh, 671
N\NTWICH water, 188
Naphthalene, 720
Naphthol, camphorated,
719
Naphtol, 718
Narcotics, 739
Narcotine, 866
Nasal douches, 4
Ne'bulae, 4
Neroli, oil of, 654
Nerves, drugs acting on,
732, 733
Nervous system, drugs
acting on, 732
Neuritis, drugs causing,
735
Nicotine, 749
salicylate, 752
Night blooming cereus,
323
Nightshade, deadly, 802
Nitre, sweet spirit of, 378
Nitric acid, 330
Nitrites, 364
Nitroglycerin, 374
Nitrohydrochloric acid,
330
Nitromuriatic acid, 330
Nitrous ether, spirit of,
378
Norwood's tincture, 320
Nutgall, 382
Nutmeg, 639
Nutrient serum, 943
Nux vo'mica, 772
OAK, poison, 660
white, 382
Oil of allspice, 638
almond expressed,466
American wormseed,
122
anise, 646
bay, 989
bergamot, 644
betula, 729
bitter almond, 465
cade, 361
cajuput, 482
caraway, 648
Carron, 216, 446
cassia, 640
castor, 682
chamomile, 651
chaulmoogra, 441
cinnamon, 640
cloves, 636
cod liver, 980
copaiba, 545
coriander, 647
cotton seed, 443
croton, 710
cubeb, 548
dill, 649
erigeron, 357
ergot, 924
ethereal, 901
eucalyptus, 483
fennel, 648
firwood, 356
flaxseed, 445
fleabane, 357
fusel, 839
gaultheria, 729
hedeoma, 650
juniper, 526
lard, 440
lavender, 643
flowers, 644
lemon, 655
Oil, linseed, 445
miaouli, 482
mustard, volatile, 478
myrcia, 989
neroli, 654
nutmeg, 639
olive, 447
orange flowers, 654
peel, 654
pennyroyal, 650
peppermint, 644
phosphorated, 912
pimenta, 638
pine, 356
rose, 653
rosemary, 489
rue, 929
santal, 550
sassafras, 976
savin, 928
sesame, 989
spearmint, 646
star-anise, 647
sweet, 605
sweet birch, 729
tar, 358
theobroma, 444
thyme, 551
turpentine, 348
valerian, 666
vitriol, 329
wintergreen, 729
Oleic acid, 450
Olive oil, 447
Opium and its prepara-
tions, 843
and morphine, differ-
ences in action, 851
poisoning, diagnosis
of, 861
Opodeldoc, 451
Orange, 654
Organic extracts, 945
Organisms infecting the
body, diugs acting on
14
Orthoform, 768
Osmosis, 13
Ouabain, 771
Ovarian extract, 956
Oxgall, 696
Oxygen, 604
ioo6
INDEX.
Oxymel, 680
Oxytocics, 909
PACK, cold, 518
hot, 526
Painter's palsy, 407
Pancreatin, 664
Papaverine, 866
Paracotoin, 402
Paraffin, 990
Paraform, 49, 53
Paraldehyde, 882
Paramorphine, 866
Parasiticides, 18, 122
Paregoric, 844
Pare'ira, 527
Paris green, 247
Parish's food, 233
Parsley, 931
Parotid extract, 959
Paste, Coster's, 963
London, 216
Marsden's, 240
Ricord's, 332
Vienna, 216
Pearson's solution, 243
Pelletieri'nse ta'nnas, 116
Pellitory, 657
Pellotine, 877
Pennyroyal, 650
Pental, 908
Pe'po, 117
Pepper, 656
cayenne, 658
Guinea, 658
Peppermint, 644
Pepsin, 662
Peronine, 845, 861
Peru, balsam of, no
Peruvian bark, 128
Pessaries, 4
Petrola'tum, 442
Petroleum benzin, 991
Pharmaco-dynamics, 1
Pharmacognosy, defini-
tion, 1
Pharmacological actions,
8
Pharmacology, definition,
1
Phenacetine, 564
Phenazo'num, 562
Phenocoll hydrochloride,
566
Phenol, 57
Pheno-salyl, 57, 67
Phenosulphonate, sodium,
70
zinc, 70
Phenylacetamide, 556
dimethylpyrazolone,
562
methyl-acetone, 866
salicylate, 730
Phosphorated oil, 912
Phosphoric acid, 330
Pho'sphorus, 91 1
poisoning, 913
Physiological action, 8
Physosti'gma, 783
Physotigmine, 783
Phytolacca, 717
Pichi, 528
Picrotoxin, 126
Pigme'nta, 4
Pills, Blaud's, 221
blue, 19
cathartic, compound,
19
vegetable, 705
chalybeate, 221
ferruginous, 221
Lady Webster, 686
laxative, compound,
686
of podophyllum, bel-
ladonna and capsi-
cum, 699
Trousseau's, 428
Piloca'rpus, 496
Pi'lula plumbi cum opio,
856
tri'um phospha'tum,
232
Pime'nta, 638
Pink root, 121
Pinol, 356
Pi'per, 656
Piperazine, 530
Piperine, 656
Pipsi'ssewa, 978
Pitch, Burgundy, 362
Pituitary extract, 955
Pix H'quida, 357
Pixol, 360
Plague serum and inocu-
lation, 940
Plasma, drugs acting on,
148, 152
Plaster of Paris, 159
Plasters, 5
Piatt's chlorides, 426
Pleurisy root, 496
Plu'mbi ace'tas, 404
ca'rbonas, 404
io'didum, 404
ni'tras, 404
o'xidum, 403
Plummer's pills, 503
Pneumogastric, drugs act-
ing on, 252
Podophyllum, 699
Poison hemlock, 745
ivy, 979
nut, 772
oak, 979
Poisons, 2
Poke berry, 717
root, 717
Pomegranate, 115
Pond's extract, 398
Poppy capsules, 853
Posology, 5
Potash, caustic, 152
yellow prussiate of,
573
Pota'ssa, 152
sulphura'ta, 103
Pota'ssium, 152
acetate, 161
alum, 432
and sodium tartrate,
180
arsenite, solution of,
234
bicarbonate, 159
bichromate, 345
bitartrate, 165
bromide, 792
cantharidinate, 531
carbonate, 1 59
chlorate, 169
citrate, 161
cyanide, 573
dichromate, 345, 347
ferrocyanide, 573
INDEX.
007
Pota'ssium glycerophos-
phate, 917
hydroxide, 152
hypophosphite, 915
iodide, 965
nitrate, 167
oleate, 453
permanganate, 89
salts, action of, 152
sulphate, 165
tartrate, acid, 165
Powder, aromatic, 640
compound effervesc-
ing, 180
Dover's, 843
gray, 19
James', 503
Seidlitz, 180
Precipitate, red, 20
white, 19
Preparations, 7
Primary action, 8
Proof spirit, 824
Protargol, 418
Prune, 681
Pru'nus Virginia'na, 579
Prussiate of potash, yel-
low, 573
Prussic acid, 573
Pullna, 181, 621
Pulsatilla, 603
Pu'lvis acetanili'di com-
po'situs, 556
aroma'ticus, 640
cre'tse compo'situs,
214
effeve'scens compo'si-
tus, 180
glycyrrhi'zse, com-
po'situs, 461
ipecacua'nhae et o'pii,
843
jala'pae compo'situs,
703
morphi'nae compo'si-
tus, 844
rhe'i compo'situs, 639
salicy'licus cum
ta'lco, T2"j
Pumpkin seed, 117
Pupil, drugs acting on,
742
Purgatives, 618, 680
anthracene, 694
drastic, 620
saline, 620
simple, 619, 686
Pustulants, 326
Pyre'thrum, 657
Pyridine, 749, 753
Pyrogallol, 389
Pyroxylin, 443
QUAIN'S pill, 692
Qua'ssia, 630
Quebracho, 602
Queen s root, 977
Que'rcus, 382
Quevenne's iron, 220
Quicksilver, 19
Quilla'ja, 593
Quinine, 128
preparations of, 128
specific action of, 141
RAISINS, 455
Raspberry, 987
Red bone marrow, 959
corpuscles, drugs act-
ing on, 149, 220
cinchona, 128
gum, 401
precipitate, 20
saunders, 989
wine, 824
Refrigerants, 609
Reinsch's test, 249
Remote action, 8
Resi'na, 363
Resorbin, 467
Resorcinol, 721
Respiration, drugs acting
on, 567
Respiratory centre, drugs
acting on, 569, 573
depressants, 569
disinfectants, 568
stimulants, 569
Retinol, 362
Rha'mnus purshia'na, 692
Rhatany, 394
Rhe'um, 689
Rhubarb, 689
Rhus gla'bra, 399
Rhus toxicode'ndron, 979
Richfield Springs, 102, 413
Ricin, 683
Ricord's paste, 332
Rise of temperature, drugs
causing, 555
Risus sardonicus, 781
Rochelle salt, 180
Rose, 653
Rosemary, oil of, 439
Rosin, 363
Rubber, 993
Rubefacients, 325
Rubidium and ammonium
bromide, 792
iodide, 966
Rubinat, 621
Condal, 181, 621
Ru'bus, 400
idae'us, 987
Rue, 929
Rush's thunderbolt, 704
Ru'mex, 401
Rye, ergot of, 919
SA'BAL, 526
Sabi'na, 928
Saccharin, 552
Sa'ccharum, 459
la'ctis, 477
Saffron, 988
Safrol, 976
Sage, 652
Sal alembroth, 41
ammoniac, 203
volatile, 201
Salicin, 721
Salicylism, 725
Saligen, "J22
Saline purgatives, 620
Salipyrine, 562
Salivary glands, drugs
acting on, 607
Salol, 730
camphor, 730
Salophen, 731
Salt action, 183
Epsom, 209
Glauber's, 179
Rochelle, 180
of tartar, 159
Sa'liva, 652
:oo8
INDEX.
Sambu'cus, 649
Sandalwood, oil of, 550
Sanguina'ria, 596
Sanitas, 352
Santal, oil of, 550
Sa'ntalum ru'brum, 989
Santo'nica, 118
Santonin, 118
Sa'po, 451
anima'lis, 455
mo'llis, 453
Sarsapari'lla, 975
Indian, 975
Sa'ssafras, 976
Sassy bark, 294
Saunders, red, 989
Savin, 928
Saw palmetto, 526
Scammony, 702
Scheele's green, 247
Schleich's infiltration
method, 762
Schweinfurth's green, 247
Sci'lla, 279
Scopa'rius, 522
Scopo'la, 822
Scopolamine, 820, 822
Scott's ointment, 35
Scutellaria, 979
Secondary action, 8
Sedatives, gastric, 613, 673
Seidlitz powder, 180
Se'nega, 591
Senegin, 591
Se'nna, 694
Sensory nerves, drugs act-
ing on, 733, 734, 756
Serous cavities, injections
into, 4
Serpenta'ria, 634
Serum, anticholera, 941
antidiphtheric, 934
antiplague, 940
antipneumococcic, 939
antistreptococcic, 938
antitetanus, 936
antityphoid, 942
antivenomous, 939
nutrient, 943
Serums, 933
Sesame, 989
Se'vum prsepara'tum, 990
Sialogogues, 607
Silver salts, 414
Si'napis a'lba, 478
ni'gra, 478
Skin, drugs acting on, 493
Skullcap, 979
Smedley's paste, 659
Snakeroot, black, 929
Virginia, 634
Soap, 451
Soda, 174
baking, 177
caustic, 174
tartarated, 180
Sodium, 174
acetate, 191
arsenate, 234
benzoate, 540
bicarbonate, 177
borate", 84
bromide, 792
cacodylate, 234, 245
carbonate, 176
dried, 176
monohydrated,
176
chlorate, 191
chloride, 144
citrate, 192
ethylate, 192
glycerophosphate, 917
hydroxide, 174
hypophosphite, 915
hyposulphite, 102
>^iodide, 965
nitrate, 190
nitrite, 376
oleate, 447
phenosulphonate, 70
phosphate, 179
pyroborate, 84
pyrophosphate, 192
salicylate, 721
silicate, 994
sulphate, 179
sulphite, 102
sulphocarbolate, 70
thiosulphate, 102
valerate, 666
Soja bean, 456
Soporifics, 739
Somnal, 866, 872
Somnoform, 907
Sozo-iodol, 74, 83
Spanish flies, 531
Sparteine sulphate, 522
Spearmint, 646
Spermace'ti, 440
Spige'lia, 121
Spinal cocainization, 763
cord, drugs acting on,
735, 112
Spindle tree, 697
Sphacelic acid, 919
Spirit of Mindererus, 206
nitrous ether, 378
proof, 824
of wine, 824
Spi'ritus se'theris nitro'si,
378
frume'nti, 824
vi'ni ga'llici, 824
Splenic extract, 958
Sponging, cold, 518
Sprays, 4
Squaw root, 928
Squill, 279
Squire's chemical food,
233
Staphisa'gria, 125
Star-anise, 646
Starch, 476
Stavesacre, 125
Stearates, 438
Stearic acid, 438
Stilli'ngia, 977
Stimulants, cerebral, 738
hepatic, 625
Stomach, drugs acting on,
609, 627
Stomachics, 609, 627
Sto'rax, 595
Stramo'nium, 818
Strangury, 350, 533
Strengthening plaster, 223
Streptococcus antitoxin,
938
Stro'ntium, 529
bromide, 792
iodide, 966
lactate, 529
salicylate, 721
Strophanthin, 272
Stropha'nthus, 272
INDEX.
1009
Strychnine, 772
Styptics, 328
Styrax, 595
Styrone, 596
Sublimate, corrosive, 19
Sucrol, 552
Sucrose, 459
Sudorifics, 494
Suet, prepared, 990
Sugar, 459
drugs causing it in
urine, 626
Sulphonal, 878
Sulphonethylmethane, 880
Sulphonmethane, 878
Su'lphur, 98
iodide, 103
lo'tum, 98
precipitated, 98
sublimed, 98
vegetable, 991
washed, 98
Sumach, 399
Sumbul, 642
Suppositories, 4
Suprarenal extract, 949
Sweet almond, 613
birch, 729
flag, 631
oil, 447
orange peel, 654
spirit of nitre, 378
Sympathetic system, drugs
acting on, 744
Sy'rupus, 459
tri'um phospha'tum,
232
Systemic action, 3
TABA'CUM, 749
Taka-diastase, 456
Talc, 993
Tamar indien, 696
Tamarind, 680
Tanacetum, 932
Tannalbin, 382, 388
Tannigen, 382, 389
Tannin, 382
Tansy, 932
Tar, 357
Tarasp, 181
Ta'raxacum, 635
Tartar, emetic, 502
cream of, 165
Tartaric acid, 266
Tea, 283
Teeth, drugs acting on,
606
Temperature, drugs caus-
ing rise of, 555
drugs decreasing,
553, 556
Terebene, 594
Terebi'nthina, 348
canade'nsis, 356
Terpin hydrate, 595
Testicular extract, 957
Tetanus antitoxin, 936
Tetronal, 880
Thalline sulphate, 567
Thebaine, 866
Theine, 282
Theobro'ma, oil of, 444
Theobromine sodio-salicy-
late, 528
Therapeutic actions, 8
Therapeutics, 1
definition of, 1
general, 1
rational, 1
empirical, 1
experimental, 2
Therapo-dynamics, 1
Thermogenesis, 553
Thermolysis, 553
Thermotaxis, 554
Thiol, 975
Thiersch's solution, 87
Thompson's fluid, 87
solution, 912
Thorn-apple, 818
Thoroughwort, 508
Thus America'num, 364
Thyme, oil of, 551
Thy'mol, 108
iodide, 74, 81
Thymus extract, 953
Thyroid extract, 946
Thyroiodin, 946
Tinctu'ra antiperio'dica,
145
laxati'va, 693
Tobacco, 749
Indian, 754
Tobacco, smoking, 754
Tolu, balsam of, 595
Tonga, 771
Tonic, definition of, 960
Toxicology, definition of,
2
Tragacanth, 464
Tribromomethane, 994
Trichloromethane, 888
Trichlor-tertiary butyl-al-
cohol, 875
Trimethyl amine hydro-
chlorate, 490, 492
Trimethylethylene, 908
Trional, 880
Tri'ticum, 538
Troches, 4
Trousseau's pill, 428
Trunks of nerves, drugs
acting on, 735
Trypsin, 664
Turpentine, 348
Canada, 356
Chian, 348, 356
Turpeth mineral, 21
Typhoid serum and inoc-
ulations, 942
U'LMUS, 462
Ungue'ntum metal-
lo'rum, 426
Urea, drugs acting on,
627
Urethane, 884
ethylated chloral, 866
Urethra, drugs acting on,
5i5
Urinary system, drugs
acting on, 509
sedatives, 575
antiseptics, 574
Urine, composition al-
tered, 514
increased, 509
diminished, 512
rendered acid, 512
alkaline, 512
aseptic, 514
Urotropin, 538
Uterus, drugs acting on,
909, 919
IOIO
INDEX.
Uterine action, substances Vitriol, oil of, 329
which depress, 910, 932 white, 423
U'va u'rsi, 524 Volatile liniment, 194
Wormseed, Levant, 11!
Wormwood, 650
Wourara, 744
VAGUS centre, drugs
acting on, 252, 305
Valerian, 665
Vallet's mass, 221
Vani'lla, 987
Vanillin, 987
Vascular irritants, 325
Vasomotor centre, drugs
acting on, 329
Vaso-constrictors, 327
Vaso-dilators, 325, 329
Vegetable cathartic pills,
705
mercury, 700
sulphur, 991
Veratrine, 316
Vera'trum, 315
Vermicides, 17
Vermifuges, 17
Veronal, 881
Vesicants, 326
Vessels, drugs acting on,
324
Vibu'rnum, 932
Vienna paste, 215
Villacabras, 181, 621
Vi'num a'lbum, 824
ru'brum, 824
Vittell, 215
Vitellus, 441
Vitriol, blue, 428
WAHOO, 697
Warburg's tinc-
ture, 145
Ward's paste, 657
Warming plaster, 362
Wash, black, 21
yellow, 21
Water, 516
distilled, 516
Waukesha, 215
Wax, 990
Weight, 5
Weld's syrup of ferric
chloride, 225
Whiskey, 824
White corpuscles, drugs
acting on, 151
mustard, 478
oak, 382
petrolatum, 442
precipitate, 19
vitriol, 423
wax, 990
wine, 824
Wildungen, 215
Wine, red, 824
white, 824
Wir.tergreen, oil of, 729
Witchhazel, 397
Wool-fat, 438
Wormseed, American, 122
VANTHOXYLUM,
973
YELLOW DOCK, 401
jasmine, 788
mercuric oxide, 20
subsulphate,
21
mercurous iodide, 20
prussiate of potash,
573
wash, 2 1
wax, 990
Ye'rba Sa'nta, 603
ZE'A, 529
Zinc salts, 422
Zi'nci ace'tas, 423
bro'midum, 792
ca'rbonas prsecipita'-
tus, 423
chlo'ridum, 422
io'didum, 966
o'xidum, 423
phenosu'lphonas, 70
pho'sphidum, 916
ste'aras, 423
su'lphas, 423
va'leras, 665
Zi'ncum, 422
Zingiber, 660
6
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