PRESENTED

TO

THE UNIVERSITY OF TORONTO

MANUALS

FOE

TUDENTS OF MEDICINE.

MATERIA MEDICA

AND

m

THERAPEUTICS :

to tlje National treatment of giscasc.

y^

J° MITCHELL BRUCE,

i /i

M.A. ABERD., M.D. LOND.,

FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS ;
PHYSICIAN AND LECTURER ON MATERIA MEDICA AND THERAPEUTICS,

CHARING CROSS HOSPITAL;
ASSISTANT PHYSICIAN TO THE HOSPITAL FOR CONSUMPTION, BROMPTON.

CASSELL & COMPANY, LIMITED:

LONIiOX, PARIS <£• NEW YOliK.

[ALL RIGHTS RESERVED.]
1S34.

Co
RICHARD QUAIN, M.D., F.R.S.,

CHAIRMAN OF THE PHARMACOPCEIA COMMITTEE OF THE GENERAL

MEDICAL COUNCIL,

ETC., ETC.

THIS \VOKK IS DEDICATED,
IX ADMIRATION OF A LIFE SPENT IN THE INTERESTS OF

MEDICINE AND THE MEDICAL PROFESSION,
AND IN GRATEFUL ACKNOWLEDGMENT OF CONSTANT-
PERSONAL KINDNESS
DVRING A VALUED FRIENDSHIP OP
MANY YEARS.

PEEFACE.

THIS book is chiefly therapeutical in its scope, and
is intended to be a rational guide to the student
and practitioner of medicine in the treatment of
disease. At the same time the MATERIA MEDICA has
not been sacrificed. On the contrary, it will be found
to be set forth in detail by the adoption of a natural
and concise arrangement, which presents the subject
in such a form that it can be quickly appreciated
and easily remembered. The author attaches im-
portance to the plan which he has adopted in the
description of the Special Therapeutics, and which con-
sists in systematically tracing the physiological action
and uses of the different drugs in their j
through the body, from their first contact \\itli it
locally until they are eliminated in the si-i-ivtion.
In the part of the manual devoted to General '!
peutics he lias further departed from the ordinary

viii PREFACE.

arrangement, by discussing the actions and uses of
remedies, not under the headings of artificial groups,
but of the physiological systems of the body —
digestion, respiration, etc., so as to conduct the stu-
dent from facts with which he is familiar to the great
principles of treatment. In using the book, the first
year's student is recommended to confine his attention
to the Materia Medica proper ; and under the action
and uses of the drugs, to read only the words printed
in thick type.

The author gratefully acknowledges the valuable
assistance which he has received in the prepa-
ration of 'the work from his friends Dr. Quain,
Dr. Lauder Brunton, and Dr. Frederick Roberts ;
from his brother, Dr. William Bruce of Dingwall :
from Mr. Woodhouse Braine, who kindly sketched
the section on the use of anaesthetics ; and espe-
cially from his friend and former class-assistant,
Mr. A. C. N. Goldney, who has relieved him of
much labour by superintending the pharmaceutical
portions, drawing up lists, and compiling the index.

The many standard treatises on Materia Medica
and Therapeutics in this and other countries have

PREFACE. ix

been freely consulted, especially Nothnagel and Ross-
bach's " Arzneimittellehre," Husemann's "Arznei-
mittellehre," the works of Wood and Bartholow, and
the useful volumes of Squire and Martindule.

CONTENTS.

PAOB

INTRODUCTION 1

PART I.— THE INCTRGANIC MATERIA MEDICA :

GROUP 1. THE ALKALIES AND ALKALINE EARTHS . 27

„ 2. THE METALS 57

3. THE METALLOIDS 95

4. THE ACIDS 1-4

5. WATER 132

,, 6. THE CARBOHYDRATES AND OTHER CARBON-
COMPOUNDS 134

PART II.— THE ORGANIC MATERIA MEDICA :

GROUP 1. THE VEGETABLE KINGDOM . . . 17-')

„ 2. THE ANIMAL KINGDOM . . . .373

SYNOPTICAL TABLES 386

PART III.— GENERAL TIIERAPEUT1

CHAPTER I. INTRODUCTION : THE FOUNDATIONS OF

RATIONAL TREATMENT . . .392
„ II. DIGESTION,— THE MOUTH . . .397

„ III. DIGESTION. — THE STOMACH . . . in";

„ IV. EMETICS AND VOMITING . . . 415

„ V. DIGESTION.— THE DUODI-NTM . . 420
„ VI. THE INTESTINE ....

„ VII. THE LIVEH 439

„ VIII. THE BLOOD 44<»

„ IX. METABOLISM.— Tin. ACTION or Yi

— ALTERATIVES ...

xii CONTENTS.

CHAPTER X. THE CIRCULATORY SYSTEM . . . 463
„ XI. THE KESPIRATORY SYSTEM . . .478

„ XII. THE NERVOUS SYSTEM .... 492

„ XIII. THE KIDNEY 509

„ XIV. THE BODY HEAT AND ITS REGULATION :

THE SKIN 520

„ XV. THERAPEUTICAL PROCESSES CONNECTED

WITH THE SURFACE OF THE BODY . 529

APPENDIX :

SUBSTANCES WHICH ACT ON THE PUPIL . . . 538
SUBSTANCES WHICH ACT UPON THE GENERATIVE
ORGANS . 538

INDEX . 539

MATERIA MEDICA
THERAPEUTICS.

INTRODUCTION.

MATERIA MEDICA AND THERAPEUTICS relate to the
use of drugs in the treatment of disease. The place
which these subjects occupy in the Medical Sciences
lies, therefore, between Chemistry, Botany, Anatomy,
and Physiology on the one hand, and Medicine and
Surgery on the other hand ; whilst they stand side by
side with Pathology, the other stepping-stone from
the more purely scientific to the more strictly practical
portions of professional education. The student will
now be able to turn to account his acquaintance with
chemistry and biology, and to appreciate the fact that
these sciences are the true foundations of all profes-
sional knowledge ; and when he has reached the end
of the volume he may anticipate with some confidence
a personal introduction to the treatment of disease.

Let us consider what subjects are comprised under
the title, u Materia Medica and Therapeutics."

Ittateria medica. — This term is applied to the)
materials or substances used in medicine, their nriiws,
sources, physical characters, and chemical properties
the preparations made from them, and the doses in.
which they may be given.

Therapeutics relates to the treatment of di>
the word signifying healing, from Oepanevw, I <iff>'i«t\
heal, or treat. It includes, therefore, all that ivlat«'s
B— 8

2 MATER i A MEDIC A AND THERAPEUTICS.

to the science and art of healing, not merely by the
application of the materia medica to the treatment of
disease, but by the use of remedial measures of every
kind, including diet, climate, baths, clothing, nursing,
and the numerous other means which may be com-
bined to restore health, not the least important being
surgical treatment, or surgical therapeutics. This
definition is manifestly far too comprehensive for
our present purpose, which is concerned only with
medicinal therapeutics, i.e. the uses of the materia
medica. When this subject is discussed under the
head of each article of the materia medica, as it comes
before us in natural order, it is known by the name
of the special therapeutics of that article. Materia
medica and special therapeutics will constitute the
first part of the work.

When the numerous and complex facts of special
therapeutics are collected and examined, certain great
principles may be educed from them, unfortunately
still very far from being perfect, but sufficient to fur-
nish the ground-work for a science of general thera-
peutics. This portion of our subject will be con-
sidered in the concluding part of the work.

Certain other terms, variously related to the pre-
ceding, must here be defined :

Pharmacodynamics (^dp^atcov, a -drug, and

8ura/U9, power) is a convenient name for that part

of our subject which relates to the action of drugs

> upon the healthy individual, that is, the physiological

action of drugs. In the first part of this work the

: term " action " will simply be used to express the

same meaning.

Pharmacology (^dpfiaKov, a drug, that is, either
a medicine or a poison) is a term which has been
employed in two senses. With the older writers in this
country it is the science that relates to the chemical
and physiological properties of drugs, their selection

THE PHARMACOPOEIA. 3

and preparation, the extraction of their active prin-
ciples, and the combination of these with others.
More recently pharmacology has come to be used in a I
wider sense, and to include the whole subject of ma-!
teria medica and therapeutics, for which it is a short \
and convenient term.

Pharmacy is the name applied to the art which |
corresponds with the science of pharmacology, the art I
of making the preparations indicated or ordered by I
the pharmacologist, and of dispensing the combinations'
prescribed by the therapeutist. In such a work as'
the present, the details of pharmacy must be mainly
omitted. They have to be learned practically in the
dispensary or pharmaceutical laboratory, not by rote
from a book.

The .Pliarmacopcria. — The number of drugs
used from time immemorial is enormous, and compara-
tively few are now believed to be really useful, To
separate the valuable materice medicce from those sup-
posed to be worthless, books have been published from
time to time by the governments or medical authori-
ties of different countries, which furnish an authorita-
tive list of the drugs generally recognised and used by
the profession, and the preparations made from them,
which have thus become "officinal" or official. These
books are known as pharmacopoeias (<f)dp/j,afcov, a
drug, and iroiew, / make). In this country we have
the British Pharmacopoeia, which provides us with a
tolerably accurate list of the drugs and preparations
in use at the time of its publication. But as pharma-
cology is a rapidly-advancing science, especially from
the direction of chemistry and pharmacodynamics, and
as opinion is very unsettled on the subject of thera-
peutics, the pharmacopoeias of different countries diti«r
greatly ; and the pharmacopoeia of any given country
neither is accepted at the time of its publican^t
perfect in itself and to be followed : s an article of

4 MATER/A MEDIC A AND THERAPEUTICS.

faith, nor remains a correct representation of profes-
sional opinion for any great length of time. It is,
however, an invaluable medium of communication
between the physician and the pharmaceutical chemist,
whom it furnishes with formulae for a great variety
of preparations of definite composition, and an im-
mense amount of information respecting drugs which
is necessary in combining these, or in devising fresh
preparations.

Plan of the Materia Medica. — In the Pharma-
copeia the materise medicae and their preparations
are arranged alphabetically for convenience of refer-
ence, but in a systematic treatise they must be dis-
cussed in natural order.

The following plan will be adopted in these
pages :

PART I. — THE INORGANIC MATERIA MEDICA.

Group 1. Alkalies and Alkaline Earths.
„ 2. Metals.
„ 3. Metalloids.
„ 4. Acids.
„ 5. Water.
„ 6. Carbohydrates and other Carbon Compounds.

PART II. — THE ORGANIC MATERIA MEDICA.

Group 1. The Vegetable Kingdom.
„ 2. The Animal Kingdom.

Each article will be discussed under several distinct
and definite headings, which are as follows : The
names of the drug, in Latin and in English, its chemical
formula, if any, and the definition of its nature ; its
source ; its characters ; its composition ; its doses ;
and the preparations made from it.

A genera] reference must here be made to each of
these headings.

Names, nature, and sources of drugs. — These
are sufficiently indicated by the above plan in the case

, NATURE, AND SOURCES OF DRUGS. 5

of the inorganic materia medica. It includes many
of the chemical elements, and a great variety of com-
pounds of the same.

Vegetable drugs are derived from entire plants,
including fungi and lichens, stems (woods), green tops
and twigs, roots and rhizomes, barks and leaves, buds,
flowers, parts of flowers and flowering tops, fruits and
seeds ; and various vegetable products, including fixed
and volatile oils, resins, oleo-resins, balsams, gums,
gum-resins, inspissated juices and secretions. The
animal materia medica includes entire animals, portions
of animals, and products yielded either during life or
after death.

The methods for obtaining the drugs will generally
be given, and must be learned by the student, who
should repeat for himself as many as possible of the
easier processes. Most of these are already familiar to
him in chemistry, such as solution, filtration, evapora-
tion, crystallisation, precipitation, decantation, subli-
mation, distillation, destructive distillation, digestion,
and washing. A few specially pharmaceutical pro-
cesses will, however, require to be defined :

Pulverisation, the powdering of drugs, is done on
a large scale in powerful drug-mills. On a small scale
it may be done by simple trituration (triturare, to
pound), or powdering in the dry state ; by levigation
(levigare, to make smooth or fine), or rubbing down
with the aid of a little fluid, the resulting paste bcin^
afterwards dried; or by mediate pulveriwt >'<>/>, in
which some very hard substance or medium is mixed
with the drug, in order to break up its sukstamv
thoroughly. Powdered drugs necessarily require
sifting.

Elutriation (elutriare, from eluere, to wash out)
consists in diffusing an insoluble powder in water,
allowing only the heavier part to settle, and decanting
the fluid; allowing this again to settle for a longer

6 MATER i A MEDIC A AND THERAPEUTICS.

time, so as to deposit a second or finer size of powder,
and again decanting ; and repeating the operation
indefinitely until an extreme degree of fineness has
been reached.

Lixiviation (lix, a lye) is a process of washing an
ash or crude mixture of solids, for the purpose of dis-
solving out the constituents in the form of a lye, or
water impregnated with salts.

Maceration and Percolation are described under
Tincturce (page 15).

Characters. — This part of the description must be
studied practically. Using the Manual as his guide,
the student must examine specimens of drugs, and
note respecting each article its general appearance to
the eye, whether liquid, solid, crystalline, etc.; its colour,
its weight, its smell, and its taste (if non-poisonous).
If convenient, his examination of the drug should
follow the pharmacopoeial account farther, and include
the determination of its reaction ; of its solubility in
water, alcohol, ether, oils, etc. ; and of the effects of
heat on its volatility, fusibility, etc. Other important
chemical properties, bearing on its pharmaceutical
applications, may have to be studied, especially its
incompatibility with other drugs, which prevents their
combination in preparations. Along with the charac-
ters, in many instances, certain tests are given, which
introduce the student to the subject of

Impurities, and the methods of distinguishing
substances so like each other as to be very readily
confounded. Impurities may be the result of the
imperfect selection, preservation, or preparation of
drugs, including chemical decomposition of every
kind ; or of fraudulent adulteration. Similarity is,
of course, a matter of accident, but may give rise to
serious error.

The tests of purity applied to inorganic drugs
are mainly such as are familiar to the student of

IMPURITIES IN DRUGS.

chemistry ; and to avoid constant repetition, the most

common of them will be

represented here once for

all :

Impurity.

Detected ly.

'Water.

Bibulous paper ; dampness ;

loss of weight by heat.

Organic matter.

Colour.

Sulphuric acid.

White precipitate with

BaCL,.

1. Impurities

Hydrochloric

White precipitate with

derived

acid.

AgN03.

from the

Phosphoric

Yellow precipitate with

sources of
the drug, or

acid.

AgN03, soluble in HN03
and in NH4HO.

formed in "

Carbonic acid.

Precipitate with lime-water;

the process

effervesces with acids.

of manufac-

Sulphurous

Zinc and HC1 yield HjjS.

ture and

acid.

imperfectly
removed.

Nitric acid.

H2S04 andFeS04 give abrown
ring between the two fluids.

Lime.

White precipitate with

oxalate of ammonia or with

CO2.

^Arsenic.

Yellow precipitate with H2S.

(Metals, es-
from theJ pecially lead
apparatus] iron> and
used. L c°PPer'

Precipitates with (NH4)2S, or
H2S; and special U

Volumetric test

Non-volatility ; insolubility

in HNO3.
Various tests.
Blue colour with iodine.
Evaporation ; quantitative

test.

In the case of organic drugs, impurities are chiefly
to be detected by careful physical examination and
special quantitative tests.

Composition. — The composition of the inorganic
drugs is expressed by their name and formula. On

3. Insufficient \

strength. J

-Various colored

4. Fraudulent
adultera- •
tions.

earths.
Cheap salts.
Starch.
Sugar.

8 MATERIA MEDIC A AND THERAPEUTICS.

the other hand, the organic drugs are frequently
highly complex, the chief proximate principles being
the following : Fixed oils, volatile oils, resins, oleo-
resins, gums, gum-resins, balsams, pectin, alkaloids,
acids, neutral substances, glucosides, starch, sugar,
cellulose, albuminous substances, ferments, colouring
matter, salts, and extractives. Some of these demand
general consideration.

Fixed oils are extracted by expression (if possible,
without the aid of heat) from the seeds or fruits of
plants, or from animal tissues. They are composed of
oleate, with palmitate and stearate of glyceryl ; that
is, are compounds of fatty acids (oleic, palmitic, and
stearic, as well as of other, less common) with the
radical glyceryl, C3H5. With caustic alkalies or
metallic oxides, they form soaps, the metal displacing
the glyceryl, which is hydrated, and becomes glycerine,
C3H53HO.

Volatile Oils; JZesins ; Oleo-resins ; Balsams. —
Volatile oils are obtained by distillation from entire
plants, flowers, fruits, or seeds. Most of them are
colourless when pure, and highly aromatic. They
consist of a liquid hydrocarbon or elceopten, generally
isomeric or identical with terpene, the hydrocarbon of
oil of turpentine, C10H]6 ; and of an oxydised hydro-
carbon, usually a solid body, or stearopten, like
camphor, C10H16O. A few volatile oils contain sul-
phur and nitrogen. Further oxydation converts a
portion of volatile oils into resins, solid, brittle, non-
volatile bodies, and thus gives rise to oleo-resins,
which can be broken up into their two constituents
i by distillation. Resins or oleo-resins yielding benzoic
lor cinnamic acids are called balsams.

Gums are exudations from the stems of plants.
They consist of two rather complex carbohydrates,
arabin, CI2H2,On, and bassorin, C^H^On,, which play
the part of acid radicals, and exist in gums as salts of

PREPARATIONS. 9

magnesium and potassium. Arabin is soluble in
water; bassorin is not soluble, but swells into a
gelatinoid mass. Pectin, vegetable jelly, C^E^jO.^,
4EL,O, occurs in a few medicinal plants, and, like the
mucilage yielded by several others, is allied to gum.
Gum-resins are natural or artificial exudations from
plants, containing various proportions of gums and
resins, or more frequently of gums, resins, and volatile
oils.

Alkaloids are - active principles formed within
plants, which resemble alkalies in turning red litmus-
paper blue, and form salts with acids. As a rule,
they are crystalline solids, rarely liquids; sparingly
soluble in water, but readily in alcohol, the solution
being intensely bitter.

Organic acids of great variety exist in plants,
combined with the inorganic bases, such as potash and
lime, with alkaloids, or possibly free.

Neutral substances are a very large and mixed
group, including the carbohydrates, such as starch,
sugars, gums, etc. ; albuminous bodies, which occa-
sionally act as ferments ; a few bitter principles ; and

Glucosides are chiefly neutral bodies, capable of
being decomposed in the presence of water into
glucose and a second substance, different in each
instance.

The remaining constituents of organic drugs do
not call for special notice.

Dose. — The Pharmacopoeia suggests the limits
within which the different substances and their pre-
parations may be safely given to an adult,
must be carefully learned. The principles of dosage
will be presently discussed.

Preparations. — The list of preparations made
from the drug, with the principal ingredients, strength,
and doses of each, will conclude the account of its

io MATER i A MEDIC A AND THERAPEUTICS.

pharmacy. This subject demands special considera-
tion here.

Most of the materise medicse possess such
characters that it is absolutely necessary to pre-
pare them for administration. Thus, if we take,
as examples, Sulphur, one of the elements ; Potassii
lodidum, a crystalline salt ; Chloroformum, a liquid
compound of chlorine and formyl ; Colocynthidis
Pulpa, the dried pulp of a fruit; Jalapa, a tuber;
and Cantharis, a dried beetle ; it is manifest that
few of these can be brought into useful contact
with the body in their native form. Preparations
must be made from them, and for several reasons we
must have a variety of preparations. First, as we
have just seen, substances are very various ; secondly,
a substance may contain several active principles,
soluble in different media, which it may or may not
be desirable to extract together or separately ; thirdly,
we constantly wish to obtain combinations of drugs,
so as to increase, diminish, or otherwise modify the
action of each, or to obtain combined action ; fourthly,
we must provide for variety of administration or
application, externally or internally, to act on a part
or to enter the blood by any of the methods of ex-
hibition to be presently described ; and we must be
ready to meet the tastes and fancies of patients witli
respect to pills, powders, etc., as well as the necessities
of circumstances.

The following is a list of the different kinds of
preparations in the British Pharmacopoeia. A com-
plete list of each will be found in the synoptical tables
at the end of the volume.

Aceta, Vinegars, are extractive solutions in acetic
acid (not vinegar).

Aquae, Waters, are very weak simple solutions of
volatile oils in distilled water, obtained by distilling
the vegetable products or the volatile oil. Aqua

PR EPA RA TIONS. 1 1

Camphorae is a solution without distillation. Aqua]
Chloroformi is the only aqua not made from an oil.

Cataplasmata, Poultices, are familiar external
applications. They generally contain linseed meal aa
their basis.

Chartae, Papers, consist of cartridge paper coated
with an active compound much like a plaster.

Confectiones, Confections, conserves, or electuaries,
are soft pasty-looking preparations, in which drugs,
generally dry, are" incorporated with syrup, sugar, or
honey.

Decocta, Decoctions, are made by boiling vegetablej
substances in water from five to twenty minutes. All*
decoctions are simple, except that of aloes and one
of the decoctions of sarsa.

Emplastra, Plasters, are external applications
which adhere when applied to the body, and produce
either a local or a general effect. The basis in all is a
compound of fatty substances (resin, wax, lead, soap,
etc.), and is intended to be spread on linen, leather, or
other material.

Enema ta, Enemas, injections, clysters, are liquid
preparations for injection per rectum. The basis is
generally mucilage of starch or water.

Essentiae, Essences, are solutions of volatile oils in
four parts of rectified spirit, i.e. are ten times the
strength of the ordinary spirits.

Extracta, Extracts, are preparations obtained by
evaporating either the expressed juice of fresh plants,
or the soluble parts of dried drugs. They are, there-
fore, of several kinds :

1. Green extracts. — The juice pressed from the
bruised plant is heated to 130°, to coagulate the green
colouring matter, which is strained off and reserved.
The fluid is next heated to 200°, to coagulate the albu-
men, which is separated by filtration and rejected. The
filtrate is now evaporated at H0° to a syrup, the green

12 MATER i A MEDIC A AND THERAPEUTICS.

colouring matter returned, and the whole evaporated
'down to the required consistence. Ex. : Extractum
Aconiti.

2. Fresh extracts are prepared like green extracts,
but there being no colouring matter, the juice is heated
at once to 212° Fahr. to coagulate the albumen, filtered,
and evaporated at 160°. Ex.: Extractum Taraxaci.

3. Aqueous extracts are prepared from drugs by
the action of cold, hot, or boiling water on dry drugs,
and subsequent evaporation to a proper consistence.
Ex. : Extractum Calurnbse, Extractum Gentianse.

4. Alcoholic extracts are prepared by the action
of rectified spirit, rectified spirit and water, or proof
spirit on dry drugs, and evaporation to a proper con-
sistence. Ex. : Extractum Physostigmatis.

5. Ethereal extracts are prepared in various ways ;
viz. (a) By percolating with ether and evaporating the
product : Extractum Filicis Liquidum. (6) By making
an alcoholic extract, macerating this in ether, and
evaporating : Extractum Mezerei JEthereum. (c) By
washing the drug free from oil, by percolation with
ether, before making an aqueous or alcoholic extract :
Extractum Ergotse Liquidum.

6. Acetic extract. — The only extract of this kind,
Extractum Colchici Aceticum, is made like a fresh
extract, but acetic acid is added to the crushed conns
before expression, and evaporation is arrested whilst
the mass is soft

7. Liquid extracts are prepared by macerating
the drug in water, evaporating to form a concentrated
solution, and adding a little spirit to prevent decom-
position. Ex. : Extractum Pareirse Liquidum. The
process is modified in the case of ergot and filix mas,
as described under ethereal extracts.

The consistence of extracts varies much. Some
are liquid ; four are solid, viz. those of aloes
(2), hsematoxylum, and krarneria ; five are soft, viz.

PR EPA RA TIONS. \ -

the acetic extract of colchicum, and the extracts of
cannabis indica, mezereon, mix vomica, and physo-
stigma; the rest are of the consistence suitable for
forming pills.

G-lycerina, Glycerines, are solutions of substances
in glycerine. They are suitable either for further
solution or for application locally, o

Infusa, Infusions, are obtained by steeping vege-
table substances in water, generally near the boiling
point. The infusions of calumba and quassia are made
with cold water ; those of chiretta and cusparia with
water at 120° Fahr. Those of orange and gentian are
compound ; that of roses contains acid.

Injectio Hypodermica, Hypodermic Injection, is a
strong aqueous solution of an active drug for admini-
stration with a syringe and needle under the skin.

Linimenta, Liniments, or embrocations, are prepara-
tions suitable for application by rubbing, anointing, or
painting. All liniments contain either camphor, oil,
or soap.

Liquores, Solutions proper, consist of substances
other than volatile oils dissolved in water; but the
preparations of many are complicated, solution being
assisted by spirit, acids, ether, lime, other salts, or
carbonic acid as in the effervescing liquores.

Lotiones, Lotions, or washes, are solutions or
mixtures for external use by washing or on lint.
The British Pharmacopoeia contains but two lotions,
Lotio Hydrargyri Elava, and Lotio Hydrargyri Nigra.

Mellita, Honeys, are fluid preparations containing
a large proportion of honey.

Misturse, Mixtures, are made by rubbing up
various substances in water, the product being not
a solution, but a mixture only. The insoluble sub-
stances are generally suspended in the water by
means of gum, spirit, or milk. They are frequently
compound.

14 MATER i A MEDIC A AND THERAPEUTICS.

Mucilagines, Mucilages, are solutions of colloid
substances in water.

Oleum, an Oil, is a solution in a fixed oil. Ex. :
Oleum Phosphoratum.

Pilulse, Pills, are soft easily divisible masses,
variously composed of extracts or substances naturally
tenacious, with suitable " excipients," such as treacle,
confection of roses, or powdered liquorice. They are
almost all complex. The substances best adapted for
giving in pill form are such as are not conveniently
given in fluid form, or those intended to act slowly.

Pulveres, Powders, are compounds of dry sub-
stances reduced to powder and intimately mixed.

Spiritus, Spirits, are either simple or complex.
Simple spirits are solutions of colourless substances or
oils in rectified spirit, the latter of the strength of 1
in 50. Ex. : Spiritus Chloroformi, Spiritus Cajuputi.
Complex spirits are prepared in a special manner;
e.g. Spiritus ^theris Nitrosi.

Succi, Juices, are the expressed juices of the fresh
plants, to which one-third of their volume of spirit
has been added to preserve them. Limonis Succus,
Rhamni Succus, and Mori Succus, are not preparations,
but natural products.

Suppositoria, Suppositories, are solid conical
bodies, composed of active ingredients and various
mixtures of fats and wax, or starch and soap, adapted
for introduction into the rectum, where they are
intended to melt.

Syrupi, Syrups, are fluid preparations containing
a large amount of sugar.

Tinctures, Tinctures, are solutions in spirit, either
alone or combined with other solvents. They may be
grouped according to (1) the solvent, (2) the process, or
(3) the ingredients.

1. Solvents. — Rectified spirit is chiefly used when
the substances contain resin or volatile oil, as in cannabis

PREPARA TIONS. 1 5

inclica. Proof spirit is adapted when the substances
are partly soluble in water, partly in spirit, as in most
tinctures. Ammonia is employed in the ammoniated
tinctures of opium, valerian, quinine, and guaiacum ;
spirit of ether in Tinctura Lobelise ^therea; and
tincture of orange in Tinctura Quinine.

2. Processes. — (a) Simple solution or mixture.
Ex. : Tinctura Ferri Perchloridi. (b) Maceration.
Macerate the drug in the spirit for seven days ; press,
if necessary ; strain ; and add sufficient spirit to make
one pint. Ex. : Tinctura Opii. (c) Percolation. Pour
the spirit on the drug packed in a percolator, and add
spirit slowly until one pint is collected. Ex. : Tinctura
Zingiberis Fortior. (d) Maceration and percolation.
Macerate the drug for forty-eight hours in part of the
spirit ; then percolate, adding more spirit as required ;
press, filter the products, mix the liquids, and add
spirit to one pint. Ex. : Tinctura Digitalis.

3. Ingredients. — Tinctures are either simple, or
compound, i.e. contain more than one active substance.
Ex : Tinctura Benzoini Composita.

Trochisci, Lozenges, are dried tablets of sugar,
gum, mucilage, water, and one or more active ingre-
dients, uniformly divided or previously dissolved.

Unguenta, Ointments, are mixtures of active
substances with lard, benzoated lard, suet, wax, or oil,
variously combined ; or with simple ointment. The
ingredients are either thoroughly mixed or melted
together.

Vapores, Inhalations, are preparations admini-
stered in the form of vapour or gas, disengaged on the
union of the ingredients.

Vina, Wines, are solutions of drugs citln-r in
sherry (ex. : Vinura Ipecacuanha?), or in orange wine
(ex. : Vinum Quinise).

The following kinds of preparations are in rominnu
use, but are not ordered in the British Pharmacopoeia:

1 6 MATER r A MEDIC A AND THERAPEUTICS.

Collyria, Eye-washes.

Gargarismata, Gargles, liquid preparations for
application to the fauces.

Linctus, Linctuses, thin confections to be slowly
swallowed in small doses to affect the throat.

Pessi, Pessaries, a small variety of suppositories
for administration per vaginam.

Weights and Pleasures: Signs and Symbols.

The weights of the British Pharmacopoeia are the
grain, granum; the ounce, uncia ; and the pound,
librum; with their conventional symbols, gr., 3, and
lb., respectively.

The apothecaries' scale runs thus :

1 grain — granum, gr. i. ;

437'5 grains = 1 ounce =z uncia, Jj. ;

16 ounces = 1 pound = librum, Ib.i.

It is very common, however, although not officinal,
to employ a weight between the grain and the ounce,
for the sake of convenience, called the drachm, 3, to
signify 60 grains; not. let it be observed, the ^th
part of an ounce, as in the fluid measures.

A 20 -grain weight, called the scruple, 9, was
formerly in general use, but is now mostly discarded.

Measures. — The measures of the British Pharma-
copoeia and their symbols are the minim, minimum,
min., or mj the fluid drachm, drachma fluida, fl.dr.,
or /5 ) the nuid ounce, uncia fluida, fl.oz., or f^ ;
the pint, octarium, O ; and the gallon, congius, C.

The scale is :

1 minim =. min.j., m_ j.

60 minims = 1 fluid drachm, fl.dr.j.,/3j.

8 fluid drachms — 1 fluid ounce, fl.oz.j.,/jj.
20 fluid ounces rr 1 pint, 0 i.

8 pints — 1 gallon, C j.

WEIGHTS AND MEASURES. 17

Relations of Weights to Measures.—

minim is the measure of 0-91 grain of water.

fluid drachm „ „ 54-68 „ „

fluid ounce ,, ,, 1 ounce, or 437'5 grains of water.

pint ,. „ 1-25 Ibs., or 8750-0 „ „

gallon „ „ 10 Ibs., or 70000-0 „ „

Metrical system. — The metrical or decimal system
of weights and measures, which is officinal on the
continent of Europe, may possibly come to be adopted
in this country, as being in many respects preferable
to the other :

11 milligramme = the thousandth part of 1 gramme = O'(m grm.

1 centigramme = the hundredth „ „ = O'Ol ,,

1 decigramme = the tenth „ ,, = O'l ,,

1 gramme = weight of 1 cubic centimetre of water at 4°C.

1 decagramme = ten grammes = lO'O grin.

1 hectogramme = one hundred grammes = lOO'O „

1 kilogramme = one thousand ,, = lOOO'O ,,

t" (\ millilitre — 1 cub. centim.= the measure of 1 grm. of water.

\ 1 centilitre = 10 „ „ 10 „

HOI decilitre = 100 „ „ 100 „

£ (l litre = 1000 = „ 1000 „ (1 kilo.)

Relation of the weights of the British Pharma-
copoeia to the metrical weights.—

1 pound — 453-5925 grammes.
1 ounce — 28-3495 „
1 grain = 0-0648 „

and conversely :

1 milligramme = 0-015432 grain.

1 centigramme — 0-15432 „

1 decigramme rr 1-5432 ,,

1 gramme — 15-432 „

1 kilogramme = 2 Ibs. 3 oz., 119-8 gr. = 15432-348 gr.

Relation of the measures of the two systems to
each other. —

1 gallon == 4-543487 litres.

1 pint = 0-567936 „ = 567'936 c. centim.

1 fluid ounce =0-028396 „ = 28-396
C— 8

i8 MATER i A MEDIC A AND THERAPEUTICS.

1 fluid drachm = 0*003549 litre — 3v549 c. centim.
1 minim = 0-000059 „ = 0-059 „

and conversely :

1 cubic centimetre — 1-5-432 gi^ain measures.

1 litre = 1 pint 15 oz. 2 drs. 11 min. — 15432-348 „

Domestic measures. — A teaspoonful is a con-
venient but not quite accurate measure of 1 fluid
drachm ; a dessert-spoonful, of 2 fluid drachms ; a
table-spoonful, of half a fluid ounce ; a wineglassful,
of 1 J to 2 fluid ounces ; a teacupful, of 5 fluid ounces ;
a breakfastcupful, of 8 fluid ounces ; a tumblerful,
of 10 to 12 fluid ounces. Wherever accuracy is
desired, a graduated measure glass must be used.
Some " drops " being twice as large as others, it is
specially dangerous to order drops of powerful reme-
dies for children.

Action and uses of drugs. — The preceding
subjects complete the information furnished by the
Pharmacopoeia ; but the student must next make him-
self acquainted with the action and uses of each drug,
that is, its pharmacodynamical and therapeutical rela-
tions. In the following pages this portion of the
subject will be discussed under four distinct heads,
according to the order in which the drug affects the
different parts of the body. These are as follows :

1. Immediate local action. — When a medicine is
applied to an exposed surface, it may produce some
effect or " act upon " it. This may occur either exter-
nally, i.e. on the skin or exposed mucous surfaces, such
as the conjunctiva, anterior nares, vagina, etc. ; or inter-
nally— on the alimentary canal, especially the stomach
and intestines, including the rectum. Some drugs
have no further action.

2. Action in or on the blood. — The great majority
of active remedies are absorbed into the blood, and
enter into the composition of its plasma, much less

PRESCRl 19

frequently of the red or white corpuscles ; that is,
have an effect in it, but little or no effect on it. The
student must carefully note the fact, that very few
medicines produce their characteristic effect by acting
upon the blood.

3. Specific action. — Leaving the circulation, drugs
enter the tissues and organs, alter the anatomical
and physiological state of one or more of them, and
are then said to have a specific action upon these.
In most instances this is the characteristic and most
important part of the action of the drug.

4. Remote local action. — Medicinal substances,
having passed through the tissues, are finally cast out
of the body by the excreting organs, whether in the
same form as they were admitted, or as the products of
decomposition in the system. The kidneys are the great
channel of escape for drugs; the lungs ("breath"),
skin, bowels, mouth, mammary gland, and all mucous
surfaces and wounds, to a less extent. Whilst thus
passing through the excreting organs, the active prin-
ciples of drugs frequently exert a further or remote
local effect upon them, not infrequently resembling
their immediate local influence.

Prescribing. — When the practitioner desires to
employ drugs for the purposes of treatment, he turns
to his knowledge of the action and uses of the materia
medica, selects his remedies, and proceeds to order one
or more of them, according to a recognised form or
formula, which is called a prescription. This is a very
difficult proceeding when first attempted, being nothing
less than a serious and probably sudden practical test
of one's acquaintance with an enormous subject. The
beginner should know, therefore, what points are spe-
cially to be kept before him under these circumstances.
Briefly, they may be said to be the following :

1. Selection of the remedy. — This is, of co
the first and fundamental proceeding of all. It is

20 MATER r A ME DIG A AND THERAPEUTICS.

intended to be the rational result of as accurate a
knowledge as can be gained of the disease which has
to be remedied, and of the means at our command of
doing so. How this choice is to be made will be
discussed under General Therapeutics in the third
part of the work.

Idiosyncrasy. — Before finally deciding, however,
on certain drugs, idiosyncracy must not be forgotten ;
that is, the peculiar susceptibility of some individuals
to the action of particular medicines, such as opium,
mercury, quinine, essential oils, and ipecacuanha. In
almost every instance such idiosyncrasy means in-
creased susceptibility ; unpleasant or even dangerous
results following an ordinary or even minute dose.
It is well, therefore, before ordering such drugs, to
enquire whether the patient has taken them pre-
viously, and if not, to use them cautiously at first.

2. Selection of the preparation. — The drug
having been selected, the particular preparation of it
will be selected in accordance with the considerations
discussed under the head of varieties of preparations.
The Pharmacopoeia affords abundant choice, according
to the channel by which it is to be administered.
This naturally leads us to consider the

MODES OF ADMINISTRATION OF DRUGS.

(a) By the skin, or mucous membrane continuous
with the skin, whether simply applied or rubbed in (lini-
ment, ointment) ; painted on (pigment) ; worn on the
skin (as a plaster) ; applied in a state of fine division
by fumigation, with or without sweating ; used as a
gargle, injection, or wash ; or insufflated on to a part.
The effect desired is usually local only, but it may be
general, many drugs being absorbed by the skin.

(6) By the mouth, to act locally on the alimentary
canal, and to be absorbed from it, especially from the
stomach.

MODES OF ADMINISTERING DRUGS. 21

(c) By the rectum, (or vagina in the female), in
the form of enema or injection (fluid), or of a supposi-
tory (solid). Sometimes drugs cannot be administered
by the mouth, either on account of some physical
obstacle, repugnance on the part of the patient, or
irritability of the stomach ; or to spare the strength
generally, and the stomach especially, in conditions of
exhaustion. Again, the action desired may be a local
one on the rectum and pelvic organs, e.g. to relieve
pain, destroy worms, or soften retained faeces.

(d) By injection under the skin — subcutaneous
or hypodermic injection, or into the tissues — inter-
stitial injection : excellent methods of admitting some
remedies into the system with certainty and despatch,
and in small bulk.

(e) By application to wounds or diseased sur-
faces, as lotions, poultices, gargles, injections, colly ria ;
or by the endermic method, i.e. by being sprinkled on
a blistered surface.

(/) By inhalation, the substances being some-
times volatile, and intended either to enter the blood
through the pulmonary capillaries, e.g. chloroform, or
to act directly on the parts to which they gain access in
the form of smoke, e.g. cigarettes, powders, etc. ; some-
times medicated watery vapours, such as Vapor Conii.

(g) By intravenous injection, very rarely practised
in man.

3. The Dose. — The Pharmacopoeia indicates the
limits of ordinary doses, the minimum being the
smallest useful dose which it may be wise to begin
with, and the maximum being the largest usually
given without special reason and caution. Experience
alone can teach the practitioner how far he may
safely and wisely depart from these limits, to which
he is in no wise tied by law. Several modifying
circumstances which are to be taken into account
with respect to doses must here be carefully noted,

22 MATERIA MEDIC A AND THERAPEUTICS.

(a) Many drugs have different actions in different
doses, which must be arranged accordingly ; e.g. anti-
monium tartaratum, alcohol, opium, and rhubarb.

(b) The dose must vary with the age of the
patient, children getting but a fraction of a dose for
an adult. A convenient method of calculating the
doses for children under twelve, is to divide the age in
years by the age in years + 12, and to use the result
as the proper fraction of an adult dose. Thus, for a
child of four years the dose will be . 4, , = ^ = \ of an

• 4 + 12 lo 4

adult dose ; for a child of twelve, j2Ti2 = S = 2 •
Above twelve, and under twenty-one, the dose must
lie between J and a full dose. Delicate persons and
patients exhausted by disease resemble children in
bearing but small doses.

(c) In particular diseases the ordinary dose may
have to be modified. In disease of the kidneys,
where excretion is diminished, drugs which are dis-
charged by this channel, such as morphia, are retained
in the blood for a longer time, i.e. in larger quantity at
any given time after administration, and symptoms of
poisoning very readily supervene. Quite a different
matter is the effect of a disease in neutralising the
effect of a drug given to combat it. Thus, large doses
of morphia will be tolerated in severe pain, because
the action of the morphia is spent in overcoming the
pain. The periods of menstruation, pregnancy, and
lactation also require to be considered in prescribing.

4. Frequency. — Medicines are ordered to be taken
one or more times, according to the desired end.
Thus purgatives are generally taken in a single dose ;
an emetic is to be taken once, and repeated only in
case vomiting is not induced ; whilst tonics are
generally ordered three times a day continuously.

5. Duration. — The period for which a drug may be
given depends entirely on a variety of circumstances

PRESCRIBING. 23

which need not be discussed here. We must refer,
however, to accumulation, toleration, custom, and
babit. When a drug is allowed to enter the system
at short intervals, for a sufficient period, more rapidly
than it can be excreted, a time will obviously come
when it will have accumulated so much in the tissues
as to produce its effects in a marked degree. Powerful
drugs, e.g. strychnia and digitalis, may thus begin
to act as poisons after having been given in the same
doses with benefit Jor weeks. On the other hand,
certain drugs lose their effect when given for a length
of time, from some cause still obscure, e.g. opium.
The dose must then be steadily increased, toleration
being said to be established by custom. If a patient
become dependent on a drug, crave for it, and indulge
in it to an unfortunate or even vicious extent, he is said
to have developed a habit for that drug, such as the
opium and alcohol habits or the habitual use of enemata.

6. Time. — The times of the day or night at which
the doses must be taken are of the first importance ; and
speaking generally, it may be said that every advantage
must be taken in this respect of the natural tendency
which it is desired to assist or stimulate by the drug.
Thus, drugs which induce sleep are naturally given at
bedtime ; alkaline stomachics before meals ; saline
purgatives early in the morning. The time required
by the drug to act must also be calculated, especially
in the case of the different purgatives.

7. Combinations : Chemical and Physiological
Incompatibles. — In most instances more than one
drug has to be given at the same time, and the prac-
titioner finds that he must combine them in a single
prescription, whether, for instance, pill, powder,
or liniment. Successful combination is at once the
most important and difficult part of the art of
prescribing. Whilst it affords the prescriber an op-
portunity of applying the whole of his knowledge of

24 MATER r A ME DIG A AND THERAPEUTICS.

drugs and their action, it cannot be accomplished
without a thorough acquaintance with the physical,
chemical, and physiological properties of the ingredients
of the proposed compound. The mere appearance,
taste, and flavour of a mixture are important points
to be considered in ordering it. The chemical reactions
which may occur between the constituents must be
constantly kept in view. The prescriber may either
intend the constituents to remain chemically unchanged,
or arrange for the decomposition of one or more of
them, and the production of a new substance. Drugs
which decompose each other are said to be chemically
incompatible in the widest sense ; but the use of the
term is commonly restricted to instances in which the
result is an unexpected, inelegant, useless, or dangerous
compound. Thus, if it be desired to give a patient
chlorate of potash and hydrochloric acid, we say that
the undiluted acid is incompatible with the salt,
because chlorine is produced by their combination ;
but if it be intended to order a fresh solution of
chlorine in water, and the decomposition is deliberately
planned, the combination would not be considered in-
compatible. A list of incompatibles will be found
under the " characters " of the principal drugs.

The prime consideration, however, will be the phy-
siological effect of the combination. This is very diffe-
rent in different cases. Each of the constituents may
be intended to produce an effect different from the
others ; or to have the same effect ; or one or more
ingredients may be introduced to modify the action of
the principal, that is, to correct some unpleasant,
dangerous, or otherwise undesirable influence which
it happens to possess, in addition to the influence which
we wish to secure. Such correctives are necessarily
physiological antagonists, and appear, therefore, to be
physiological incompatibles ; but it is for this very
reason that they are to be combined, because whilst

THE PRESCRIPTION. 25

they neutralise the action of each other in certain
directions, they are left mutually free to affect other
parts of the system. Thus, calomel combined with
opium prevents it from causing constipation, whilst it
does not interfere with its action on the brain ; and
the opium, in turn, prevents the calomel from purging
the patient, whilst it allows the mercurial to act as
an alterative. Most purgative pills contain correctives
or carminatives, which moderate the violence of peri-
stalsis and prevent -pain.

8. The Prescription. — A prescription consists of
five parts : The superscription, consisting of a single
sign, R, an abbreviation for recipe, "take"; the inscrip-
tion, or body of the prescription, containing the names
and quantities of the drugs ordered ; the subscription,
or directions to the dispenser ; the signature, or direc-
tions to the patient, headed by Signa ; and, lastly,
the patient's name, the date, and the prescriber's name
or initials. In what may be called a classical pre-
scription, it was customary to arrange the constituents
of the inscription under four heads, viz. the basis,
or active drug proper ; the adjuvant, or substance
intended to assist, and especially to hasten, the action
of the basis ; the corrective, to limit or otherwise
modify the same (commonly a carminative) ; and the
vehicle, or excipient, to bring the whole into a con-
venient, pleasant form for administration.

To take an example :

Superscription. R

'Ferri et Ammoniae Citratis, gr.v. (basis).

Liquoris Ammoniae Fortioris min.jss. (ad-
Inscription. • j»r

Spiritus Mvristicae, min.vj. (correct h;].

Infusi Calurnbse, ad ^i. (vehicle or excipunt}.
Subscription. Misce. Mitte doses tales viij .

•<>•>-. Signa — Two tablespoon fuls twice a day.

Patient's name. Practitioner's name

Date. or initials.

26 MATER i A MEDIC A AND THERAPEUTICS.

It will be seen that the first three parts of the
prescription are in Latin ; the signature or directions
to the patient in English. The names of the drugs or
preparations are in the genitive case, the quantities
standing in the accusative case, governed by recipe :

Recipe, Spiritus Myristicce, minima sex.

Take, of Spirit of Nutmeg, six minims.

A few abbreviations and signs are allowed, viz. :
R for recipe; m., misce; S.t signa; ad., ana (ava), of
eachjjft, fiat, make; q.s., quantum sufficit, a suffi-
ciency ; ad, up to, to amount to (the full phrase being
quantum sufficit ad); c., cum, with; no., numerus,
number; p.r.n., pro re nata. as required, occasionally;
rep., repetatur, let it be repeated ; ss.,Js., semi, or semis,
a half.

The names of drugs must always be written in
full wherever there can .be the smallest possibility of
error. It is not only inelegant, but dangerous, to use
such abbreviations as Add. Hydroc. DiL, and Hyd.
Cldor.

The various weights and measures are expressed
by characters and figures, very rarely by words, placed
distinctly at the end of the line occupied by the name
of each ingredient; but if two or more consecutive
ingredients are ordered in equal quantity, it is usual,
instead of repeating this each time, to write it only
once after the last of them, preceded by the sign ad, of
each.

ZC/CCOTX7

j9c£t*^.£«.

THE

INOEGANIC MATEEIA MEDICA.
GROUP I.

THE ALKALIES AND ALKALINE EARTHS.

OF the alkalies and alkaline earths, potassium, sodium,
ammonium, lithium, calcium, magnesium, and barium
are used in medicine. These, together with their many
salts, alone constitute a large proportion of the inor-
ganic materia medica. Whilst each of them is so
important as to require separate consideration, many
facts connected with their action and uses are common
to the whole group, and much that is said under
the head of Potassium, the first of the series, will not
require to be repeated under the others.

POTASSIUM. K. 39.

The salts and preparations of potassium are most
conveniently discussed in the following order :

1. Potassae Carbonais. — Carbonate of Potash,
K2C03, with about 16 per cent, of water of crystallisation.

Source. — Obtained from wood ashes by lixiviation, evapo-L
ration, and crystallisation.

Characters. — A white crystalline, very deliquescent powder,
of caustic alkaline taste. 20 gr. neutralise 17 gr. of citric
acid, or 18 gr. of tartaric acid.

Impurities. — Sulphates and chlorides.
.—lQ to 30 gr.

28 MATER i A MEDIC A AND THERAPEUTICS.

From PotasscB Carbonas are made :

a. Potassse Eicarbonas. — Bicarbonate of Potash.

KHCOg.

Source. — Made from a solution of the Carbonate in
distilled water, by passing a stream of carbonic acid gas
through it, and purifying the crystals which form.

Characters. — Colourless right rhombic prisms, not
deliquescent; of a saline, feebly alkaline taste; not cor-
rosive. 20 gr. neutralise 14 gr. of citric acid, or 15 gr. of
tartaric acid.

Dose.— 10 to 40 gr.

Preparation.

Liquor Potassae Effervescens. Potash Water.
— Potasspe Bicarbonas, 30 gr.; Water, 1 pint. Dis-
solve, and pass into the "solution as much C02 as
it will contain under a pressure of 7 atmospheres.

Dose. — Ad libitum.

j. Liquor Potassse. — Solution of Potash, KHO,
(5'84 per cent.) in water.

Source. — Made from a solution of the Carbonate,
by boiling with Slaked Lime and purifying. K2C03 +
CaO,H20 = 2KHO + CaC03.

Characters. — A clear alkaline fluid.

Impurities. — Lime, carbonates, sulphates, and chlo-
rides.

Dose. — 15 to 60 min.

From Liquor Potassce are made :

a, Potassa Caustica.— Caustic potash. KHO.

Source. — Made from Liquor Potassae by evapo-
ration.

Characters. — White pencils, hard but very
deliquescent, alkaline and corrosive.

Impurities. — The same as of the liquor.

From Potassa Caustica is made :

Potassss Permanganas. — Permanganate
of potash. KMnO4. See Manganesium.

Source. — Prepared from a mixture of caustic
potash, chlorate of potash, and black oxide of
manganese, by semi-fusing ; then boiling, neutra-
• lising with dilute sulphuric acid, and purifying.
(1) KClOo + 6KHO + 3Mn02 = 3K.,MnO4 +
KC1 + 3H00. (2) Boiling: 3K2MnO4 +
2H20 = 2KMn04 + 4KHO -f Mn02.

POTASSIUM. 29

Characters. — Dark-purple slender prisms,
inodorous, with a sweet astringent taste. Solu-
ble in 16 parts of cold water. Should be pre-
scribed in simple solution.

Impurities. — Sulphate of potash and oxide
of manganese; detected by less solubility in
water and volumetric test.

Dose. — 1 to 2 gr.

Preparation.

Liquor Potassae Permanganatis. — 4 gr. in
1 fl.oz. of distilled _ water. Dose, 2 to i tl.

j3. Potassii lodidum. — Iodide of Potassium
KI.

Source. — Obtained by dissolving Iodine in
Liquor Potassae, and evaporating — 6KHO+3I2=:5KI
+ KI03 + 3H20 ; then mixing the residue with
wood charcoal, fusing, dissolving, and purifying, to
convert the iodate, which was formed with the
iodide, into iodide — 2KI03 -f 60 = 2KI + 6CO.

Characters. — Colourless opaque cubical crystals,
with some odour of iodine, a saline taste, and feebly
alkaline reaction; strikes blue with preparations
containing starch on addition of chlorine.

Impurities. — Iodate; detected by blue colour
with tartaric acid and starch. Free iodine ; by starch.
And the impurities of the liquor.

Dose. — 2 to 10 gr., or more.

For Preparations, see lodum.

y. Potassii Bromidum. — Bromide of Potas-
sium. K±5r.

Source. — Obtained from Liquor Potassae, Bro-
mine, and Charcoal, by the same process as the
iodide.

Characters. — Colourless cubic crystals, without
odour, and of a pungent saline taste. Does not
strike blue with preparations containing starch,
unless it contain iodide as impurity.

Dose.— o to 30 gr.

e. Potassae Citras.— Citrate of Potash. K3C6HS07.

Source.— Made by neutralising a solution of Citrici
Acid with Carbonate of Potash, and evaporating. 3K0CO3
+ 2C6H5O7, H3 = 2K3C6H507 + 3H2O + aCO^

30 MATER i A MEDIC A AND THERAPEUTICS.

Characters. — A white deliquescent powder, of saline,
feebly acid taste.

Dose. — 20 toJJOjjr.

d. Potassee AcetaSj. — Acetate of Potash. KC2H302.
Source. — Made by dissolving Carbonate of Potash in

Acetic Acid, evaporating, and fusing the residue. K2C03
+ 2(HC2H302) = 2(KC2H302) + H20 4- CO2.

Characters. — White foliaceous satiny masses, very
deliquescent ; neutral. The peculiar appearance of this
salt is due to crystallisation after fusion.

Impurities. — The carbonate ; detected by being in-
soluble in spirit. Excess of acid ; giving acid reaction.
Metallic impurities.

Dose. — 10 to 60 gr.

Potassce Acetas is used in preparing :

T^ncturaJFerri AcetaJig. See Ferrum.

e. Potassae Chloras.— Chlorate of Potash. KC103.

Sotirce. — Made by passing Chlorine gas into a mix-
ture of Carbonate of Potash and Slaked Lime (i.e. caustic
potash), boiling, evaporating, and separating the chloride
of potassium by re-crystallisation. 6KHO + 6C1 =
KC103 + 5KC1 + 3H20.

Characters. — Colourless rhomboidal crystalline
plates, with a cool, sharp, saline taste. Explodes when
rubbed with sulphur. Soluble in 16 parts of cold water.

Impurities. — Chloride of calcium, and lime.

Dose.— 10 to 30 gr.

Preparation.
Trochisci Potassse Chloratia, — o gr. in each.

_/. Potassa Soilphnrata. — Sulphurated Potash.

Source. — Made by fusing together Carbonate of
Potash and Sublimed Sulphur.

Characters. — Solid greenish masses, liver-brown
when recently broken, alkaline and acrid to the taste ; a
mixture of sulphide, sulphate, sulphite, and hyposulphite.

Dose. — 3 to 8 gr.

Preparation.
Unguentum Potassae Sulphuratae. — 1 in 15J.

2. Potassse Tartras Acida.— Acid Tartrate of
Potash, Bitartrate of Potash, Cream of Tartar. KHC4H406.
|j Source. — Prepared from argol, the deposit in wine-casks.

:

0-0

4-tXJUUA.. <"-* \JA

POTASSIL'M. 31

Characters. — A white gritty powder, or fragments of <•
of a pleasant acid taste ; not deliquescent. Soluble in 200 parts
of cold water.

Dose. — 20 to 60 gr. as a diuretic and refrigerant ; 2 to 81
dr. as a purgative.

Acid Tartrate of Potash is an important ingredient of :

^Confectio Sulphuris (1 in 9) ; and^Pulvis Jalapael
Compositus (9 in 15). It is also used in preparing!
various other drugs.

from this salt is derived :

Potassse Tartras.— Tartrate of Potash. K2C4H4Or

Source. — Made by adding Acid Tartrate of Potash]
to a solution of Carbonate of Potash, and crystallising. I
2KHC4H406 + K2C03 = 2K2C4H406 + C02 + H20.

Characters. — Small colourless deliquescent prisms.
10 parts are dissolved in 8 parts of water.

Impurities. — Acid tartrate; detected by insolubility.
Carbonates ; by quantitative test.

Dose. — 20 to 60 gr. as a diuretic and antacid ; 2 to |
4 dr. as a purgative.

3. Potassae IVitras. — Nitrate of Potash, N
Saltpetre^ KN03.

>'ce.— Found native, and purified by crystallisation, m

Characters. — Striated colourless prisms, of a peculiar saline
taste. Solubility, 1 in 4 of water.

Dose.— 10 to 30 gr.

From Potassa Nitras is made :

otassse Sulphas. — Sulphate of Potash. E^SCv
ource. — Prepared from Nitrate of Potash and Sul-V
phuric Acid, which yield the acid sulphate — KN03 -{-
H2S04 = KHS04 + HN03; then addin- • of

Potash— 2KHS04 + K2C03 = 2K2S04 + H,O +

Characters. — Colourless hard six - sided pi i
terminated by six-sided pyramids. Solubility, 1 in 10
of water; not soluble in spirit.

Impurities. — Other sulphates, and chlorides.

Dose. — 15 to tiu -r.

Potassa Sulphas is contained in :

Pulvis IpecacuanhaB Compositus. — 8 in 10 ;j
Pilula Colocyiithidis Composite; and Pilula Colo- 1
cynthidis cum llyoscyamo.

Po

So

32 MATER i A MEDIC A AND THERAPEUTICS.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Potash, in the form of potassa caustica, is a
powerful irritant and caustic, absorbing water from the
part to which it is applied, and converting it into a moist,
grey slough. It is used to destroy morbid growths, to
form issues, and to stimulate ulcers. Solutions of liquor
potassae or the carbonates neutralise caustic acids on the skin.
Hot dilute solutions relieve the pains of rheumatism and gout
when used as local baths or fomentations to the affected joints.
Weak compounds of potash with oli ve oil constitute soft soaps,
which also have antacid and cleansing properties.

i Internally. — Potash and its salts have an alkaline action,
and are employed as antidotes to the caustic acids ; but the use
of the carbonates for this purpose ought, if possible, to be
avoided, on account of the great development of carbonic acid.
In the mouth, potash checks for a moment the secretion of
saliva. Eeaching the stomach, it partly neutralises the contents ;
and liquor potassae effervescens will relieve acidity due to excess
of gastric juice, or to the decomposition attending indigestion.
Of much greater importance is the stomachic action of potash
given shortly before meals, when, as a dilute alkali, it is a
natural stimulant to the gastric follicles, increasing the flow of

»the juice, and is a sedative to the nerves. Liquor potassae and
bicarbonate may be used for this purpose in dyspepsia, especially
when there is much pain and tendency to sickness, or when
the further action of potash on the system is desired, as in
gouty, rheumatic, and calculous subjects ; but soda is more
commonly employed. Large doses of the bicarbonate are apt
to irritate the stomach.

Some valuable saline purgatives belong to the potash
group, notably the acid tartrate, tartrate, and sulphate. The
rationale of the action of saline purgatives is -discussed in

.Part III. In dropsy from any cause, especially ascites from

'liver disease, the acid tartrate, in the form of Pulvis Jalapas
Compositus, of an electuary with honey, or of a lemonade, may
be used to remove the water by the bowels, its hydragogue
effect being assisted by its action as a diuretic.

2. ACTION ON THE BLOOD AND ITS USES.

Potash is freely absorbed into the blood in the form of
^ salts, and there acts both on the plasma and red corpuscles,
increasing the natural alkalinity of the former, and improv-
ing the quality and increasing the number of the latter when

-YI-I /« t -

01 * ±^, .-,

POTASSIUM. 33

judiciously combined with iron. As an alkaliniser of the
plasma, although exceedingly transitory in its action, being
very rapidly excreted, potash is a valuable remedy in gout, where
it combines with the excess of uric acid in the blood and facili-
tates its excretion. The carbonates, citrates, and tartrates of
potash in various forms, and the waters of such spas as Baden-
Baden, Wiesbaden, Vichy, Carlsbad, and Aix-la-Chapelle, which
contain definite though small quantities of potassium salts, are
extensively used for the treatment of acute and chronic gout.
The salts of the vegetable acids, or the effervescing carbonates,
are the best preparations for prolonged use. In acute rheu-
matism the bicarbonate, citrate, tartrate, and acetate are suc-
cessfully employed to increase the alkalinity of the blood. For
restoration of the red corpuscles in anaemia by the increase of
their potash element, the carbonate is the best haematinic,
either as contained in the Mistura Ferri Composita, or given asi
a pill with sulphate of iron (Blaud's Pill).

An indirect action of potash on the blood must here be
carefully noted. We shall see hereafter that citric, tartaric,
and acetic acids, given internally, are partially oxydised in
the blood. The completeness of the combustion, and of the
important influences which the change exerts on the blood and
kidneys, depends upon the combination of the vegetable acid
with an alkali. Citric acid, e.g., is excreted mostly unchanged
in the urine, but citrate of potash is entirely, or almost entirely,
thrown out as the carbonate.

3. SPECIFIC ACTION AND L'SES.

Potash depresses the muscular, nervous, and cardiac
tissues ; and the point of interest in this connection is, that
when given for other purposes it must be used with caution.
The danger of " potash poisoning " is, however, exaggerated,
for the drug passes so quickly through the system, that it
cannot well produce a deleterious effect on the tissues, unless
given for a very long time, or in disease of the excreting
organs, especially the kidneys. Excessive single doses are
generally rejected at once by vomiting.

4. REMOTE LOCAL ACTION AND USES.

Potash is excreted almost entirely by the kidneys ; to a
much less extent by the skin, respiratory passages, stomach,
liver, biliary passages, and bowels. Inoth.rwunls.it passes
out in the fluids of all the secretory surfaces, and in doing so
it stimulates the cells to increased activity.

The diuretic effect of several potash salts, referable to thoir
influence upon the renal epithelium, is the most important of
D— 8

34 MATER i A MEDIC A AND THERAPEUTICS.

jail; and the acetate, acid tartrate, citrate and tartrate, car-
bonate, bicarbonate, and sulphate are used for this purpose in
11 10 order named. These saline diuretics are given chiefly in
renal dropsy, where it is desirable to increase the functional
activity of the renal epithelium, and thus the secretion both of
•water and urea, whilst the vessels remain undisturbed. They
are also suitable diuretics in feverish conditions. In cardiac
dropsy they are less beneficial, as they diminish rather than
increase the force of the circulation ; but in an occasional full
dose they are useful adjuvants, even in this condition, to other
classes of diuretics, such as digitalis and scoparium, to wash
out the tubules. Nitrate of potash is a powerful diuretic, be-
longing partly to a different class, the local vascular stimu-
lants. It is more suitably employed as a diuretic in feverish
conditions, and to remove inflammatory effusions into the
pleura and pericardium, and must be given with caution in
renal disease.

« As alkalinisers of the urine, the carbonate, bicarbonate, and
the vegetable salts of potash are extensively used in uric acid
gravel, acute and chronic gout, and acute rheumatism, the latter
being preferred because less irritant. In uric acid calculus
of the kidney or bladder, these salts have been successfully
employed to cause actual solution of the concretions.

The diaphoretic effect of potash salts is not marked, the
citrate and the nitrate alone being used for this purpose, and
that only in mild feverish attacks.

The bronchial secretions may be increased and rendered
less tenacious in inflammation and dry catarrh of the tubes by
the potash salts, which are thus saline expectorants, the iodide
in particular being useful for this purpose.

Gastric catarrh, especially in gouty subjects, is benefited
by the milder salts of potash beyond their immediate local
effect ; but the mineral waters which appear to act in this way,
such as those of Vals, Vichy, and Carlsbad, owe their efficiency
much more to soda. The same remarks apply to catarrh of the
biliary passages and tendency to gall-stones.

The action of potash on the intestinal glands constitutes
it a remote as well as an immediate purgative.

ACTION AND USES OF THE DIFFERENT SALTS OF POTASH.

On reviewing what has been said respecting potash, we
find that the chief actions and uses of its different salts may
thus be briefly represented : Potassa Caustica — caustic. Liquor
Potasses — antacid and stomachic. Potassa Bicarbonas, Carbonas,
and Citras — antacid stomachics, alkalinisers of blood and urine,
mild diuretics, very mild diaphoretics, saline expectorants,

SODIUM. 35

biliary stimulants. Potassa Tartras, Tartras Acida, and Acetas
— the same, but more powerful diuretics; also saline purga-
tives. Potasses Sulphas — chiefly purgative. Potasses Nitras
— excreted unchanged in the urine ; is a double diuretic, and
probably in this way only a mild febrifuge. Potassa
Chloras — excreted unchanged in all the secretions, inclu-
ding the saliva ; and is much used in inflamed, ulcerative,
and aphthous states of the mouth. The remaining salts of
potassium contain, in combination with the alkali, an element
or acid possessing such distinctly specific actions that the total
effect is but in a minor degree referable to the potash. Such
are the arsenite, bromide, iodide, and permanganate, and sul-
phurated potash. These will, therefore, be discussed under
the head of their other constituents.

SODIUM. Na. 23.

The following are the officinal salts and prepara-
tions of sodium, arranged according to their source :

1. Sodae Carbonas.— Carbonate of Soda. Na2C03,
10H20.

Source. — Made from the ashes of marine plants, or fromi
chloride of sodium by chemical decomposition.

Characters, — Transparent colourless laminar rhombic
crystals, efflorescent, with a harsh alkaline taste, and alkaline
reaction. 20 gr. neutralise 9'7 gr. of citric acid, or 10£ gr. of
tartaric acid.

Impurities. — Sulphates and chlorides.

Dose. — 5 to 30 gr.

From Soda Carbonas are made :

a. Sodse Carbonas Exsiccata. — Dried Carbonate of
Soda. Na2C03. A dry white powder, made from Car-
bonate of Soda by drying. 53 gr. = 143 gr. of tha
crystallised salt. Dose, 3 •

b Sodss Bicarbona.8. — Bicarbonate of Soda.
NaHC03.

Source. — Prepared from a mixture of the Carbonate j
and Dried Carbonate by passing a >d-, am of oarbonio(
acid gas through them; Na.,C03 + ILjO + C02 =
2(NaHC03).

Characters. — A white powder, or small opaque
irregular scales, of a not unpleasant saline taste. 20
gr. neutralise 16'7 gr. of ritrir acid, or 17'8 gr. of tar-
taric acid. 1 part soluble in 10 of \\

36 MATERIA MEDIC A AND THERAPEUTICS.

Impurities. — Carbonate and its impurities.
Dose.— 10 to 60 gr.

Preparations.

a. Liquor Sodse Effervescens. — Soda "Water.
Made like potash, water. 30 gr. in 1 pint. Dose,
Ad libitum.

£. Trochischi Sodaa Bicarbonatls, — 5 gr. in
each. Dose, 1 to 6. ,',, .

7. Sodse Citro-Tartras Effervescens. — Eff er-
vescent Citro-tartrate of Soda. White granules,
deliquescent; made by heating the Bicarbonate
with Citric and Tartaric acids, stirring assiduously.
Dose, 60 to 120 gr.

c. Liquor Sodse. — Solution of Soda. NaHO (4-1
per cent.) in water.

Source. — Prepared by boiling a solution of Carbonate
of Soda with Slaked Lime. Na2C03 + CaH202 = 2NaHO
+ CaCO3.

Characters. — A colourless alkaline liquid.

Impurities. — Lime, carbonates, sulphates, chlorides.

Dose. — (Rarely given) 10 min. to 1 il.dr.

from Liquor Soda are made :

a. Soda Caustica.— Caustic Soda. NaHO.

Source. — Made by boiling down Liquor Sodae.

Characters. — Hard greyish -white fragments,
slightly deliquescent, very alkaline.

Impurities. — Same as of liquor.

fi. Sodae Yalerianas,. See Valerians Radix.

d. Sodse Acetas.— Acetate of Soda. NaC2H3Oa.
3H30.

Source. — Made by acting on Carbonate of Soda by
Acetic Acid.

Characters. — Transparent colourless crystals. Used
} only to make ferri arsenias, ferri phosphas, and syrupus
\ ferri phosphatis.

e. Soda Tartarata. — Tartarated Soda. NaK.
C4H406.4H20. Tartrate of soda and potash. Rochelle
salt.

Source. — Prepared by boiling Acid Tartrate of Potash
in a solution of Carbonate of Soda, and crystallising ;
NaaC03 + 2KHC4H4O6 = 2NaK.C4H4O6 4- H,O +C0<2.

Characters. — Colourless transparent right rhombic

37

prisms, tasting like common salt. Solubility, 1 in 2 of
water.

Impurities. — Acid tartrate of potash.

Dose. — i to ^ oz.

/. Sodse Sulphas. — Sulphate of Soda. Glauber's
salj. Na^SO^lOHaO.

"~ Source. — Prepared by adding Carbonate of Soda to|
the acid sulphate left in the manufacture of hydrochloric*
acid. Na2C03 + 2NaHS04 = 2NasS04 + C02 + H20.

Characters. — Colourless transparent oblique rhom-
bic prisms, efflorescent, with a bitter salt taste. 1 part
soluble in 3 of Water.

Impurities. — Salts of ammonium and iron.

Dose. — ^ to 1 oz. £>

g. Soda Phosphas.— Phosphate of Soda. NaJIP04.
~~

Source. — Prepared by adding a solution of Carbonate
of Soda to the acid product of the action of sulphuric
acid on bone-ash, and crystallising. (1) Ca32P04 -f
2H2S04 = CaH42P04 + 2CaS04. (2) CaH42P04 -f
Na.,CO3 = Na2HP04 + CaHP04 + H20 + C02.

Characters. — Colourless transparent rhombic prisms,
efflorescent, tasting like common salt. 1 part soluble in
5 of water. Used to make ferri phosphas and syrupus
ferri phosphatis.

Impurity. — Phosphate of lime.

Dose. — £_tp_l_qz. ^

h. SodsB Hvpophosphis.— H^T>ophosphite of Soda.
NaPH202.

Source. — Prepared by adding Carbonate of Soda to a
solution of Hypophosphite of Lime, and evaporating the
solution. Ca2PH202 + Na^COg = 2NaPH202 + CaC03.

Characters. — A" white granular deliquescent salt,
with a bitter nauseous taste. 1 part soluble in 2 of
water.

Dose. — 5 to 10 gr.

i. Sodaa ^r^fipiaq. — Arseniate of Soda. Na.,HAs(X.
7H20.

Source. — Prepared by fusing Carbonate of Soda and
Nitrate of Soda with Arsenious Acid, dissolving out and
crystallising.

Characters. — Colourless transparent prisms. 1 part
soluble in 2 of water.
to i gr.

38 MATER i A MEDIC A AND THERAPEUTICS.

Preparation.

^ Arsenia

water. Dose. 5 to 1 0" min.

Liquor Soda) Arseniatis. — 4 gr. dried to 1 oz.
r. Dose,

J. Sodse Chloratse Liquor. — Solution of Chlorinated
Soda.

(Source. — Made by passing a stream of Chlorine gas
through a solution of Carbonate of Soda.

Characters. — A colourless liquid, with an odour of
chlorine and an astringent taste ; alkaline. A mixed
solution of hypochlorite of soda, chloride of sodium, and
carbonate of soda.

Dose.— 10 to 20 min.

Preparation.
Cataplasma Soda? Chloratae.

2. Sodii Chloridum.— Chloride of Sodium. Com-
mon salt. NaCl.

Source. — Native.

Characters. — Small white crystalline grains, or transparent
cubic crystals, free from moisture, with purely saline taste.
1 part soluble in 2f parts of water.

Dose. — 10 to 240 gr.

Sodii Chloridum is used in malting :

Acidum Hydrochloricurn, Hydrargyri Perchlori-
dum, and Hydrargyri Subchloridurn.

3. Sodae Nitras.— Nitrate of Soda. NaN08.
/Source. — Native ; purified by crystallisation from water.
Characters. — Colourless obtuse rhombohedral crystals,

with a cooling saline taste.

Impurities. — Sulphates and chlorides.
Sodce Nitras is used in making :
Sodse Arsenias.

4. Sodse Biboras. — Biborate of Soda. Borax.
Na2B407.10H20.

Source. — Native.

Characters. — Transparent colourless crystals, slightly
efflorescent, weakly alkaline. 1 part soluble in 22 parts of
cold water, or in 1 part of glycerine.

.— 5jto_40jgr.

Preparations.

a. Glycerinium Boracis. — 1 to 4.
b Mel Boracis. — 1 in 8.

fa

SODIUM. 39

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally, soda possesses an action similar to that of
potash, but is much less frequently used as a caustic. Solutions
of the carbonates may be employed to neutralise caustic acids ;
in eczema and itching disorders of the skin ; and in extensive
burns. Soda compounds with olive oil constitute hard soap.

Internally, — Soda closely resembles potash in its action on
the alimentary canal, but is more powerful because much less
diffusible, i.e. more slowly absorbed. It is antacid to the
contents of the stomach, relieving acidity due to indigestion, in
the form either of the bicarbonates, soda-water, the officinal
lozenges, or as a mixture with sal- volatile and an essential oil,
such as peppermint, given after meals. As a stomachic, stimu-
lating the flow of the gastric juice, bicarbonate of soda is more
commonly given than the other alkalies, in doses of gr. 8 to
gr. 15, shortly before meals. Part of the salt at the same time
becomes converted into the chloride, which assists the digestion
of albumen. The alkali also liquefies tenacious mucus, and
thus prevents decomposition, the juice reaching the food more
freely. Common salt is a safe and available emetic.

The salts of soda, being much less diffusible than those of
potash, pass on into the small intestine. Here the sulphate and
phosphate of soda and tartarated soda (Rochelle salt) act as
saline purgatives. The sulphate, which is a constituent of
several natural purgative waters, including Carlsbad, Friedrichs-
hall, Hunyadi Janos, and Bilin, is the most powerful of these,
producing an abundant watery evacuation. It is used as a hydra-
gogue in dropsies, especially in ascites from liver disease, in
congestion of the portal system, and as a habitual purgative.
The phosphate is a milder, but sufficiently active, purgative, less
unpleasant to the palate ; it is often given to children. Soda
tartarata, the purgative basis of the Seidlitz powder, is familiar
as a milder intestinal stimulant, of use in completing the effect
of purgative pills. The chloride is an anthelmintic.

2. ACTION ON THE BLOOD AND ITS USES.

The salts of soda are slowly absorbed into the blood, and
slowly excreted from it, remaining in it chiefly as the bicar-
bonate and phosphate. Taken, as they constantly an', in food,
these salts are the chief sources of the natural alkalinity of the
liquor sanguinis, which may be increased "by their medicinal
exhibition as well as by the tartratc, Ilochelle salt, and even
the sulphate. This effect of soda as an alkaliniser of the

40 MATERIA MEDIC A AND THERAPEUTICS.

blood is taken advantage of in the cases referred to under
potash, namely, gout and rheumatism, only less frequently;
for although soda is less depressing, as we shall see, than
potash, and more easily borne on the stomach, the slowness
of its entrance into the blood, and its tendency to pass off by
the bowels when the dose is increased, more than counteract
these advantages. When a prolonged and moderate alkaline
influence is desired, especially in dyspepsia with a tendency
to constipation, soda is manifestly to be preferred.

3. SPECIFIC ACTION.

In medicinal doses, the salts of soda have no specific in-
fluence on any organ. This circumstance, which at first
sight appears incredible, is due to the fact that the whole
organism is saturated with soda, which participates in many
of the ordinary tissue changes ; that soda is admitted
in large quantities by the food (especially vegetables and
fruits) ; and that the moderate amount contained in medicinal
doses does not appreciably affect metabolism. In this respect
soda differs remarkably from potash, and is therefore said to
produce none of the depressing effects of that drug. As we
have just seen, advantage is taken of this negative action of
soda in its therapeutical applications.

4. REMOTE LOCAL ACTION AND USES.

Soda is excreted by all the mucous surfaces, by the kidneys,
by the liver, and possibly by the skin ; and in passing through
the various epithelial structures, it increases their activity,
whilst it modifies the amount, composition, and reaction of
their secretions. The action of the different salts naturally
varies to a considerable extent, some affecting one organ more,
some another. The sulphate and the phosphate of soda are, as
we have seen, hydragogue purgatives by virtue of their imme-
diate local action ; but they are also stimulants of the intestinal
glands, and are constantly being absorbed and excreted, re-
absorbed and re-excreted, in their course along the bowel. (See
Part III.) Both are also true hepatic stimulants or direct
cholagogues '•> the phosphate more so than the sulphate. The
value of these salts in hepatic and intestinal disorders, which
has been already referred to, is therefore partly referable to
their effect in increasing the bile. Soda tartarata has a similar
but feebler action.

On the kidneys soda acts less powerfully as a diuretic than
potash, increasing the water and the solid constituents, and
diminishing or neutralising the acidity of the urine. The bi-
carbonate is the most useful salt of soda for this purpose ; the

SODIUM. 4 1

acetate and nitrate, whilst also diuretic, are so inferior to the
acetate and nitrate of potash, that they are very seldom em-
ployed. The tartarated soda may he usefully comhined with other
alkalinisers of the urine, as in the ordinary Seidlitz powder ;
and the effervescing citro-tartrate of soda is a convt-riii-nt
modification of much the same drugs. The use of these
alkalinisers of the urine has been explained already.

The secretions of the bronchi are increased hy soda ; that is,
the sputa "become more abundant and more liquid, and are more
easily expelled hy cough. The bicarbonate and the chloride
are specially expectorant, and are indicated in the early stages
of bronchitis, and in recurrent slight bronchial catarrh, when
secretion is deficient and cough harassing. The effects of soda
on the stomach, blood, and urine add much to its usefulness in
such cases. The stimulant effect of soda salts on ciliary action
may also account in part for its expectorant action.

"When a comprehensive view is taken of the action and uses
of the salts of soda — locally in the alimentary canal, in the
blood, in the tissues, and in the organs and passages where it is
excreted from the body, it is found to be peculiarly indicated
iu a condition of system which may be called the " gouty," the
" rheumatic," " acidity," or " chronic derangement of the
liver," and which is specially characterised, amongst other
symptoms, by catarrhs, or discharges from the mucous mem-
branes, interfering with the functions of the part ; by imperfect
biliary activity and constipation ; and by scanty, high-coloured,
very acid urine. In such a condition great benefit may be de-
rived from a course of alkaline waters. If the stomach be the
principal seat of catarrh, i.e. if chronic indigestion be urgent,
the more purely carbonated alkaline waters should be selected,
such as those of Vichy, Bilin, and Ems. If the derangement
chiefly involve the liver and intestines, the sulphated and salt
(NaCl) waters will be more suitable, such as Carlsbad, i
gen, Wiesbaden, and Marienbad. For chronic catarrh of the
bladder and urinary passages, Ems, Vichy, Wildungen, and
Carlsbad are indicated.

5. ACTION AND USES OF THE DIFFERENT SODA SALTS.

The action and uses of the preparations of soda may l>o
summarised as follows, and the special action of some of the salts
particularly noticed : Soda Caustica and Liquor 8od<e are for
external use, but very rarely employed. Soda Carbonas and
Eicarbonas (the former rarely, the latter almost invariably used)
possess the action and uses of soda in general upon all parts.
Soda Citro-tartras is like the carbonates, but milder.

42 MATER i A MEDIC A AND THERAPEUTICS.

Tartarata is like the carbonates, but purgative ; and more rapidly
and distinctly diuretic and alkalinising, by virtue of the potash
it contains. Sodce *Acetas and Sodas Nitras are used pharmaceu-
tically only. Sodce Sulphas and Sodce Phosphas are chiefly hydra-
gogue purgatives and cholagogues, the former acting more on
the bowels, the latter more on the liver. Sodii Chloridum is
in large doses a free and safe emetic ; an anthelmintic as enema ;
it possesses otherwise the ordinary action of soda, and is greatly
used for this purpose as the waters of Homburg, "Wiesbaden,
Kissingen, and Baden-Baden, and as sea-water. The remaining
salts of soda possess peculiar properties by virtue of their second
constituent, and are described elsewhere — Sodce Arsenias under
Arsenic ; Sodce Chloratce Liquor, under Chlorine ; Sodce Hypo-
phosphis under Phosphorus ; Sodae Biboras under Acidum
Boricum ; Sodce Valerianas under Valerianse Radix.

AMMONIUM. NH4. 18.

The following are the officinal salts and prepara-
tions of ammonium, arranged according to their source :

1. A III ill Oil i 8 Chloridum. — Chloride of Ammonium.
Muriate of Ammonia. Sal Ammoniac. NH4C1.

Source. — Made by neutralising Ammoniacal Gas Liquor
with Hydrochloric Acid, and evaporating. NH4HO -j- HC1 =
NH4C1 + H20.

Characters. — Colourless translucent fibrous masses, inodor-
ous and tough. Solubility, 1 in 4 of water ; soluble in spirit.

Impurities. — Iron and lead.

TJase. — 5 to 20 yr.

from Ammonii Chloridum are made :

a. Liquor Ammonige Fortior. — Strong solution of
Ammonia. NH3 (32-5 per cent.yin water.

Source. — Made by heating Chloride of . Ammonium
with Slaked Lime, and collecting the gaseous product in
water. 2NH4C1 + CaH2O2 = 2NH3 + CaCl2 + 2H20.

Characters. — A colourless liquid with a very pungent
characteristic odour, and strong alkaline reaction.

Impurities. — Ammonium chloride, sulphide, and
sulphate ; lime, and metals. Detected by usual tests.

Preparations.

a. Linimentum Camphorae Composituni. — Com-
pound Liniment of Camphor. Strong solution of
Ammonia, Camphor, Rectified Spirit, and Oil of
Lavender ; 1 in 4i.

AMMONIUM. 43

0. Liquor Ammoniae Citratis. — Solution of
Citrate of Ammonia. 3XII4.0(iH-O7 dissolved in
water. Made by adding Strong Solution of Am-
monia to a solution of Citric Acid.

Dose. — ? to fi fl.dr.

y. Spiritns Ammonias Ammaticus. — Aromatic
Spirit of Ammonia. Sal-volatile. Made by distil-
ling a mixture of Strong Solution of Ammonia,
Carbonate of Ammonia, Volatile Oil of Nutmeg,
Oil of Lemon, Spirit, and Water.

Dose.— -j to 1 fl.dr.

Spiritns Ammonia Aromaticus is used in pre-
paring Tinctura Guaiaei Ammoniata,
Tinctura Yaleriamv Ammoniata.

S. Spiritus Ammonige Fcetidus, — Fetid Spirit'
of Ammonia. Made by adding Strong Solution of
Ammonia to an extract made from Assafcetida
macerated in spirit.

to 1 11. dr.

* pre-
i, andl

e. Tinctura Opii Ammoniata. See Opium.
From Liquor Ammonite Fortior are made :

£. Ammonise Phosphas. — Phosphate of Ammo-
nia. (NH4),HPO4.

Source.— Made by adding Strong Solution of
Ammonia to Diluted Phosphoric Acid, evaporating
and crystallising.

Characters. — Transparent colourless prisms, be-
coming opaque by exposure. Solubility, 1 in 2 of
water.

Dose.— b to 20 gr.

77. Liquor Ammonia. — Solution of Ammonia.
NH3 (10 jior cent.) dissolved in water.

.. .- M;ul<> by mixing one part of Strong
Solution of Ammonia with two parts of Distilled
Water.

. — 10 to 20 min. diluted.

I't'tparation.

Linimontum Ammoniae. — Liniment of Am-
Solution of Ammonia, 1 ; Olive Oil, 3.

From Liquor Ammonia arc made :

i. Ammonia? UteTlKQMr — Benzoate of Am-
monia. NH4.C7H5O.,.

44 MATERIA MEDICA AND THERAPEUTICS.

Source. — Made by dissolving Benzoic Acid
in Solution of Ammonia, evaporating, and crys-
tallising.

Characters. — Colourless laminar crystals,
with a characteristic odour. Solubility, 1 ia 5
of water.

Dose.— 10 to 20 gr.

ii. Ammonia Nitras. — Nitrate of Am-
monia. NH4N03.

Source. — Made by neutralising Diluted
Nitric Acid with Solution of Ammonia (or Car-
bonate of Ammonia), crystallising, and fusing.

Characters. — A white deliquescent salt, in
confused crystalline masses, with a bitter acrid
taste.

Used only for making nitrous oxide gas
(N20).

&_. Ammonia? Carbonas. — Carbonate of Ammonia.
N4H16C308.

Source. — Made by subliming a mixture of Chloride
of Ammonium (or Sulphate of Ammonia), with Carbonate
of Lime. 6NH4C1 + 3CaC03 = N4H16C308 + 3CaCl2 +
2NH3 + H20.

Characters. — Translucent crystalline masses, volatile
and pungent to the nose ; alkaline. Solubility, 1 in 4 of
water. 20 gr. neutralise 23£ gr. citric acid, or 25| gr.
tartaric acid; 15 gr. neutralise 17 gr. citric acid, or
one tablespoonful of lemon juice.

Impurities. — Sulphates and chlorides.

Dose. — 3 to 10 gr.

From A.minoni(E Carbonas are made :

«. Spiritus Ammonias Aromaticus. See page 43.

ff. Liquor Ammonias Acetatis. — Solution of
Acetate of Ammonia. NH4.C2H3O2 dissolved in
water.

Source. — Made by neutralising Carbonate of
Ammonia by Acetic Acid, and adding water.

Dose.— 2 to 6 fl.dr.

IAmmonii Chloridum is used in making Liquor
Hydrargyri Perchloridi.

2. Aiiiiiioilii Broinidum.— Bromide of Ammo-
nium. NH4Br.

Characters. — Colourless crystals, which become slightly

AMMONIUM. 45

yellow by exposure to the air, and have a pungent saline
taste. Solubility, 1 in 1^ of water.

Impurities. — Iodides ; free bromine. Detected by colour.

Dose. — 2 to 20 gr.

ACTION" AND USES.

1. IMMEDIATE LOCAL ACTION AND USES.

Externally applied, ammonia is a stimulant to the nerves
and other structures, causing a sensation of pain and burning,
and reddening the part by dilating the vessels. If the appli-
cation be prolonged and the vapour confined, blistering may
result ; but dilute preparations produce only a rubefucu-nt
effect and a sense of heat. It is used in the form of liniment to
stimulate the circulation in a part, either for the purpose of in-
creasing the local nutrition (for instance, in stiffness or other
chronic conditions of joints), or as a counter-irritant (see Part
III.) in diseases of deeper parts, e.g. on the surface of the chest
in bronchitis. Ammonia is not to be used as a caustic ; and
vesication by it is better avoided. In serpent's bite, the appli-
cation of ammonia to the wound has occasionally saved life.

Internally. — Admitted into the nose, ammonia itself, or the
vapour of the carbonate ("smelling salts"), is a powerful
general stimulant, instantly causing a pungent sensation,
sneezing and other disturbances of the respiration, acceleration
of the pulse, and watery secretion from the parts including
the conjunctiva. It is accordingly used as a means of resus-
citating consciousness, the action of the heart, and respiration,
in cases of failure of the circulation, such as fainting, or of
asphyxia.

In the stomach, ammonia produces the same effects as on
the skin. A full dose (30 gr. of the carlxm.itr well diluted) is
an emetic, which is best used in croup and bronchitis. Smaller
doses cause a sense of warmth at the epigastrium, and act as
carminatives, sal-volatile being chiefly used for this purpose.
In common with soda and potash, it has an antacid effect on
the contents of the stomach, and may be given after meals in
dyspepsia. Like these, also, it acts as a natural stimulant to
the gastric juice before meals, and sal- volatile is therefore a
common ingredient of alkaline stomachic mixtures. On the
bowels, ammonia appears to have no local action.

2. ACTION ON THE BLOOD, AND ITS I

Ammonia is absorbed into the blood, and is there fixed ; in-
creasing, possibly, the alkalinity of the plasma, and diminishing

46 MATERIA MEDIC A AND THERAPEUTICS.

the tendency to coagulation. The phosphate is believed to
be useful in gout, by keeping uric acid in solution.

3. SPECIFIC ACTION AND USES.

Although its specific action is still imperfectly known, am-
monia certainly appears to stimulate the central nervous system
generally, the respiratory centre, and the heart ; that is, to be a
general stimulant. It is much given in neuralgia (as the
chloride), and in exhausted states of the vital powers, especially
if respiration and circulation threaten to fail, as in typhoid
fever complicated with pneumonia, in the bronchitis of old or
weakly subjects, and in ordinary acute pneumonia with increas-
ing feebleness of the heart. In this way also it is useful in
serpent's bite, and is given internally in water, or hypodermi-
cally (10 to 20 minims) whilst it is applied to the wound. The
phosphate directly increases the amount of bile, etc. ; chloride of
ammonium decidedly increases the production of urea, partly,
at least, by its own decomposition in the liver.

4. REMOTE LOCAL ACTION, AND USES.

Ammonia is excreted by the kidneys and mucous mem-
branes, especially the respiratory tract ; not, however, as am-
monia, but as some other nitrogen compound. Thus, instead
of diminishing, it actually increases the acidity of the urine,
whilst the amount of urea and uric acid also rises, as well as
the volume of the secretion. The chloride of ammonium pos-
sesses these important powers most fully, the acetate less fully.
They are employed as diuretics in dropsies and feverish states
of the system.

The bronchial secretion is distinctly increased, and ren-
dered more liquid and easily raised, by the carbonate and
chloride of ammonium. These salts prove of great service
as expectorants in the treatment of bronchitis when the
secretion is scanty and thick, or the patient feeble ; the
accompanying stimulation of the respiratory centre increasing
the coughing or expectorant power, whilst the heart is also
sustained.

The mucous secretion of the stomach is affected by ammonia
as by the other alkalies, and the chloride is sometimes used in
chronic dyspepsia. Ammonia remotely stimulates the intes-
tines, and will cause diarrhoea if given in large doses.

On the skin the acetate of ammonia acts as a well-marked
remote stimulant, and as the Liquor is one of our most common
diaphoretics. The chloride also possesses the same property,
but to a less degree.

LITHIUM. 4 7

6. ACTION AND USES OF THE DIFFERENT SALTS OF AMMONIA.

These maybe thus summarised : Liquor Ammoniac Fortior
and Liquor Ammonia are used as stimulants and vesicants, the
former externally only. Ammonia Carbonas — a volatile stimu-
lant, emetic, and double expectorant (through the nerves and
secretions). Ammonii Chloridum — a local refrigerant, a gastric,
intestinal, and hepatic stimulant, nervous stimulant, diuretic
double expectorant, and diaphoretic (hence called an " altera-
tive"). Liquor Ammonia A cctatis^ diaphoretic and diuretic
(febrifuge), and nervous stimulant. Liquor Ammonia Citratis

— diuretic and diaphoretic. Spiritus Ammonia Aromaticus

— agreeable and powerful carminative, antacid, and general
stimulant. Ammonia Phosphas — direct cholagogue, possibly
an alkaliniser of the blood. Spiritus Ammonia Fcetidus. (See
Assafcetida.) Ammonia Benzoas. (See Benzoin.} Ammonii
Bromidum. (See Bromum.}

LITHIUM. L. 7.
Only two salts of this metal are officinal :

Carlxmas* — Carbonate of Lithia. L2C03.

Characters. — A white powder, or minute crystalline grains ;
alkaline. Solubility, 1 in 100 of water.

Impurities. — Lime, alumina; detected by lime-water.
Deficiency of lithia ; detected by weight of residue.

Dose. — 3 to 6 gr., in 3 or 4 oz. of aerated water.

Preparation.

a. Liquor Lithias Efforvescens. — Effervescing Solu-
tion of Lithia. Lithia Water. Made like Potash

10 gr. to 1 pint. Dose, 5 to 10 ti.oz.
From Lithia Carbonas is made :

b. Lithia Citraa. — Citrate of Lithia. LjC.H.,0...
Source. — Made by dissolving Carbonate of Lithia in

a solution of Citric Acid, and evaporating.

Characters. — A white amorphous deliquescent
powder. Solubility, 1 in 2£ of water. Dose, 5 to 10 gr.

ACTION AND 1
1. IMMEDIATE LOCAL ACTION.

.E.rttr»ft??>/, lithia may be used as a t'tum-ntation in |
Internal/i/, lithium has doubtless an antacid action on the

48 MATERIA MEDICA AND THERAPEUTICS.

alimentary canal very similar to that of potash, but it is not
used for this purpose directly.

2. ACTION ON THE BLOOD, AND ITS USES.

Lithium enters the "blood, and behaves there much like
potash, increasing its alkalinity, and combining with such
acid bodies as uric acid, for which it has a powerful affinity,
(1 part of a solution of the carbonate of lithia, at 38° C., dis-
solving four parts of the acid). It is extensively used in gout, to
hold this substance in solution, and thus prevent acute attacks
by fresh deposit in the tissues.

3. SPECIFIC ACTION AND USES.

In this respect also lithia closely resembles potash, being a
cardiac and nervo-muscular depressant, if given in large doses
or for a length of time ; but the risk of lithia poisoning is too
small to be allowed to interfere with the exhibition of the drug
in suitable cases.

4. REMOTE LOCAL ACTION AND USES.

Lithium is rapidly excreted by the kidneys, and prob-
ably by the mucous membranes. It is a powerful diuretic in
passing through the renal epithelium ; and whilst increasing
the volume of water, it diminishes its acidity, and holds in
solution even an excess of uric acid. It is accordingly used as
a valuable remedy in gout, as it hastens the excretion of the
products which it dissolves in the blood ; and in acid lithiasis
or gravel, where it prevents the deposit of salts in the kidney
and urinary passages.

Both of the salts of lithia may be used, the only important
difference between them being with respect to their solubility,
which is very marked.

CALCIUM. Ca. 40. LIME.

Creta or chalk is naturally discussed along with
calcium or lime, of which it is the carbonate.

The various preparations of lime may be repre-
sented as follows, according to their source.

1. Creta.— Chalk. CaC03 (impure). Native.
From Creta are made :

a. Greta Praeparata. — Prepared Chalk. CaC03
(nearly pure).

<rr^csr~L, A*4^W CtJLfije^b^

wf.

c$C6^o^/L£

<& t^/JL"

N, •- <— '_'.. /

CALCIUM. 49

Source. — Made from Chalk by elutriation and sub-
sequent drying.

Characters. — A white amorphous powder, insoluble
in water ; incompatible with all acids and sulphates.

Impurities. — Alumina and oxide of iron.

Dose. — 10 to 60 gr.

Preparations.

a. Mistura Gretas. — Chalk Mixture. Prepared
Chalk, Gum Acacia, Syrup, and Cinnamon Water.
1 in 32. Dose, 1 to 2 fl.oz.

£. Pulvis Cretee Aromaticus. — Aromatic Pow-
der of Chalk. Prepared Chalk, Cinnamon, Nutmeg,
Saffron, Cloves, Cardamoms, and Sugar. 1 in 4.
Dose, 1?4BP gr.

From Pulvis Crette Aromaticus is made :

i. Pulvis Cretge Aromaticus mm
Aromatic Powder of Chalk and Opium. 39 parts
of Aromatic Chalk Powder, mixed thoroughly
with 1 part of Opium in powder. 1 of opium in
40. Dose, 10 to 40 gr.

y. Hydrargyrum cum Creta. — Mercury with
Chalk. Mercury, 1 ; Prepared Chalk, 2. Dose, 3
to 8 gr.

b. Calx. — Lime. CaO (with some impurities).
Source. — Made by calcining Chalk. CaCO« = CaO
+ C02.

Characters. — Compact whitish masses.

From Calx is made :

a. Calcis Hydras.— Slaked Lime. Hydrate
of Lime. CaH2O2 (with some impurities).

Source. — Made by slaking Lime with distilled
water. CaO + H20 = CaH2O2.

Characters. — A white powder, strongly alkaline.
Soluble in 900 parts of water. Incompatible with
vegetable and mineral acids, alkaline and metallic
salts, and tartar emetic.

Preparations.

i. Liquor Calcis. — Solution of Lime. Lime
Water! Made by shaking up Slaked Lime in
Distilled Water, and decanting after the excess
E-8

50 MATER r A MEDIC A AND THERAPEUTICS.

has subsided. \ gr. of lime in 1 fl.oz. Dose,
2 to 4 oz.

From Liquor Calcis is prepared :

Linimentum Calcis. — Liniment of

Lime. Solution of Lime and Olive Oil,

equal parts mixed.

Liquor Calcis is also used in preparing

Lotio Hydrargyri Flava, Lotio Hydrargyri

Nigra, and Argenti Oxidum.

ii. Liquor Calcis Saccharatus.— Saccha-
rated Solution of Lime. Made by digesting
Slaked Lime with Sugar and Water, and strain-
ing. 7' 11 grains of lime in 1 fl. ounce. Dose,
15 to 60 min,

From Calcis Hydras ar» madf :

iii. Calx Chlorata. — Chlorinated Lime.
" Chloride of Lime." CaCl202,CaCl2.

Source. — Made by passing Chlorine gas
over Slaked Lime. 2CaH202+2CLj=CaCl2O2,
CaCl2 + 2H20. PartiaUy soluble in water,
bleaches and disinfects.

Impurities. — Deficiency in chlorine; de-
tected by volumetric test.

Characters. — A dull white powder, with a
feeble odour of chlorine.

Preparations.

(1) Liquor Calcis Chloratae. — Solution
of Chlorinated Lime. 1 pound to 1 gallon
of Water; mixed, agitated, and strained.
See Chlorum.

(2) Vapor Chlori. Inhalation of
Chlorine. Chlorinated Lime, moistened
with cold water, to disengage chlorine.
See Chlorum.

Calx chlorata is also employed in pre-
paration of Chloroform. See Chloroformum.

iv. Calcis Hypophosphis. — Hypophosphite
of Lime] Ca2PH2O2.

Source. — Made by heating Slaked Lime and
Water with Phosphorus, purifying the liquid,
and crystallising. 3CaH202 + P8 -f 6H20 =
3(Ca2PH202) + 2PH..

Characters. — White pearly crystals, with

CALCIUM. 51

a nauseous taste. Soluble in 6 parts of cold
water ; insoluble in spirit.
Dose.— 5 to 10 gr.

Calcis Hypophosphis is used to make :
(1) Sodas Hypophosphis. — See Soda.

c. Calcii Chloridum. — Chloride of Calcium. CaC^.

Source. — Made by neutralising Hydrochloric Acid
with Chalk, and evaporating to dryness. CaC03-|-
2HCl=CaCl2+C02+H20.

Characters. — White, very deliquescent masses ; solu-
bility, 1 in 2 of water.

Impurities. — Carbonates, salts of alumina, and iron ;
Hypochlorites, detected by evolving Cl with HC1.

Dose. — 10 to 20 gr.

Calcii Chloridum is used to make :

a. Calcis Carbonas Prsecipitata. — Precipitated
carbonate of lime. CaC03.

Source. — Made by mixing boiling solutions
of Chloride of Calcium and Carbonate of Soda, and
washing the precipitate. CaCLj+ Na2C03=CaC03+
2NaCl.

Characters. — A white crystalline powder, in-
soluble in water. Dose, 10 to 60 gr.

Calcis Carbonas Precipitata is contained in Tro-J
chisci Bismuthi (4 gr. in each).

2. Calcis Phosphas.— Phosphate of lime. Ca^PCy

Source. — Made by (1) dissolving Bone-ash in Hydrochloric
acid ; and (2) adding Solution of Ammonia, and washing and
drying the precipitate. (1) Caa2PO4 + 4HC1 = CaH42P04 +
2CaCL ; (2) CaH42P04 + 2CaCl2 + 4NH4HO = Caj2P04 +
4NH4C1 + 4H20.

Characters. — A light white amorphous powder, insoluble
in water.

Dose.— 10 to 20 gr.

Calcis Phosphas is contained in :

Pulvis Antimoiiialis (2 parts in 3). See Antimonium. \

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND M

Externally. — Lime in the form of the hydrate is caustic,
like the alkalies, but its action is more localised, so that it may

52 MATERIA MEDICA AND THERAPEUTICS.

be combined with, fused potash to form a convenient caustic,
potass a cum calce, Vienna paste, for ordinary use. Dusted on
the skin as chalk, or applied in lime-water, it is astringent and
desiccative (drying), and is used to promote the healing of
burns, eczema, and ulcers. The linimentum calcis is a valuable
application to burns.

Internally. — The local effect of lime is antacid, like the
alkalies and magnesia, combined with an astringency peculiar
to itself. Tn the mouth, chalk is used as an antacid and phy-
sical dentifrice. Admitted into the stomach and intestines, as
lime-water or the carbonate, lime unites with the free acids
of the contents, and acts upon the structures of the gastric
wall. It is accordingly useful in acid dyspepsia, with heart-
burn, given after food, e.g. as the bismuth lozenge. Lime-
water prevents the gastric juice from curdling milk in
large lumps, and is extensively given to artificially-reared
infants, the liquor calcis saccharatus being an excellent form
when dilution of the food is injurious. Its power of combi-
nation with acids also makes time a valuable antidote for
poisoning by the mineral acids, oxalic acid, and chloride of
zinc, and one which is always available in the form of wall-
plaster ; it must be freely given. The action of lime on the
glands of the stomach appears to be depressant, and it is,
therefore, not suited for administration before meals. Lime-
water is, indeed, a general gastric sedative of some value,
arresting some kinds of vomiting, especially in the acid dys-
pepsia of infants, and in pregnancy.

But little of the alkaline effect of lime or chalk can re-
main in the bowels beyond what has been exerted on the chyme.
The astringent action of these familiar drugs in diarrhoea may
be in part due to their antacid property, in part to an
obscure sedative effect on the intestinal glands (?and vessels),
which diminishes the excretion of water into the bowel.
The lime salts can be traced along the whole length of the
canal, and most of their bulk is finally expelled unabsorbed.
Lime and chalk thus come to be two of our most valuable
astringents in diarrhoea, either alone or with aromatics, opium,
or vegetable astringents, as in the officinal preparations.

Lime-water is also employed locally as an enema for killing
the thread- worm, and as a vaginal injection in leucorrhoea.

2. ACTION ON THE BLOOD.

Lime enters the circulation in very small quantities
only, and appears in the serum as the phosphate. It probably
increases the alkalinity somewhat, but no special use is made
of it for this purpose.

Ctu

~*-L

MAGNESIUM. 53

3. SPECIFIC ACTION AND USES.

The important part played by lime as a constituent of boned
has suggested its " use as a specific remedy in rickets,
fractures, and other lesions of these structures ; and the phos-
phates and lime-water are extensively used for the two former
conditions. The phosphate and the chloride have been recom-
mended in scrofulous diseases of glands and phthisis, to pro-
mote absorption, or possibly to induce calcification ; and appa-
rently with some reason. None of the calcareous mineral
however, are of much service in this respect.

4. KEMOTE LOCAL ACTION AND USES.

The greater part of lime or its salts being expelled by the
bowel, little remains to be excreted by the kidney, so that their
diuretic and alkaline effects are not marked. Their most
useful form for influencing the urine is Bath or Wildungen
water.

5. ACTION AND USES OP THE DIFFERENT SALTS OF LIME.

Greta in its various forms and combinations — Liquor Calcis
and Liquor Calcis Saccharatus — possesses the general effects and
uses of lime. Calcii Chloridum is a gastric sedative, but is also
a specific in scrofulous enlargement of glands ; and is used in
testing. Calcis Phosphas is a specific in bone diseases and
scrofula. Calx Chlorata and its derivates are media for supplying
chlorine, and used accordingly. Calcis Hypophosphis is employed
as a specific in tuberculosis and other wasting diseases. In the
remaining preparations the action of the lime or chalk is com-
paratively insignificant, as, e.g., in the three preparations of
mercury, of which they are ingredients, and in antimonial
powder.

MAGNESIUM. Mg. 24.

The following are the officinal salts and prepara-
tions of magnesium, arranged according to their
source :

JflsigiicslaB Sulphas. — Sulphate of Magnesia.

Epsom Suit. MgiSU..7ina

Source. — Native.

Characters. — Minute colourless rhombic prisms, with a
bitter taste. Solubility, 10 in 13 parts of cold water. Incom-
patible with alkaline carbonates, lime- water, acetate of It-uJ,
uuJ nitrate of silver.

54 MATER i A MEDIC A AND THERAPEUTICS.

Impurities. — Lime, iron, and general impurities.
Dose. — 60 gr. to £ oz.

Preparations.

a. Enema Magnesia? Sulphatis. — 1 oz., in 1 oz. of
Olive Oil, and 15 oz. of Mucilage of Starch; for one
enema.

b. Mistura Sennas Composita. — 1 oz. in 5 fl.oz.
See Senna.

from Magnesice Sulphas are also made :

c. Magnesias Carbonas. — Carbonate of Magnesia
(heavy). (MgC03)3.Mg0.5H20.

Source. — Made by mixing boiling solutions of Sul-
phate of Magnesia and Carbonate of Soda, evaporating,
purifying, and drying. 4MgS04 -f 4Na2C03 + H20 =
3MgC03,Mg2HO + 4Na2S04 + C02.

Characters. — A white granular powder, insoluble in
water.

Impurities. — Lime, sulphates, metals.
Jjose. — 10 to 60 gr.

Preparations.

a. Liquor Magnesise Carbonatis. — Solution of
Carbonate of Magnesia. "Fluid Magnesia."
MgC03 -f H2C03 or MgH22C03, in solution.

Source. — Made by passing an excess of Carbonic
Acid gas through a mixture of Carbonate of Magnesia
(freshly prepared) and water. 1 fl.oz. contains 13
gr. of carbonate.

Characters. — A clear fluid, sometimes effer-
vescing slightly.

Dose.— 1 to 2 fl.oz.

ft. Trochisci Bismuthi. — 2£ gr. in each.

from Magnesia Carbonas is made :

Magnesia. — Magnesia (heavy). Magnesia
Ponderosa. MgO.

Source. — Made by heating Carbonate of
Magnesia in a crucible to expel the carbonic
acid.

Characters.— A. white powder, compara-
tively insoluble in water (1 part in 5,412 cold
water, 1 in 36,000 hot water).

Impurities. — Those of the carbonates.

Uose.—W to 60 gr.

d. Magnesise Carbonas Levist — Light Carbonate of
Magnesia. (MgC03)3.MgO.5H2O.

MAGNESIUM. 55

Source.— Made like magnesiae carbonas, but with
cold dilute solutions instead of hot.

Characters. — A very light white powder, proving
microscopically to be partly amorphous, partly pris-
matic crystals. Soluble in 2,493 parts of cold water,
or in 9,000 parts of hot water ; 3^- times the bulk of the
heavy carbonate.

Dose. — 10 to 60 gr.

From Magnesia Carbonas Levis is made :

Magnesias Levis. — Light Magnesia. MgO.

Soiu-ce. — Made by heating Light Carbonate of
Magnesia jn a crucible to expel the carbonic acid.

Characters. — A bulky white powder, 3J times
the bulk of heavy magnesia.

Dose. — 10 to 60 gr.

Magnesia Carbonis Levis is contained in Pulvis
Rhei Compositus (6 parts in 9).

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally, magnesia has no action, and is not used.

Internally, magnesia is a valuable means of decomposing the
contents of the stomach and intestines under various circum-
stances. The base and carbonates form comparatively insoluble
or innocuous compounds with the mineral acids, oxalic acid,
mercuric, arsenical, and cupric salts ; in large quantities they
prevent the absorption of alkaloids by rendering the contents
of the stomach alkaline ; whilst the sulphate precipitates inso-
luble sulphates of lead and baryta. Magnesia or its salts may
therefore be employed as antidotes in cases of poisoning by
any of these substances, the oxide being preferred to the car-
bonate, so as to prevent the evolution of carbonic acid, and
care being taken to give it very freely.

By a similar process of decomposition, magnesia neutralises
normal or excessive acidity in the stomach and bowels, and is
itself converted into the chloride, lactate, and bicarbonate, this
reaction removing irritant acid, and forming salts of magnesia,
which have a stimulant or purgative action on the intestine.
The carbonate is similarly decomposed, yielding carbonic acid,
which exerts its specific action on the stomach. Both sub-
stances are therefore employed as local alkaline remedies in
acidity of the stomach (heartburn, pyrosis, etc.), given with sal-
volatile, after meals, a further laxative effect on the intestine
being intended.

56 MATERIA MEDIC A AND THERAPEUTICS.

The chloride, bicarbonate, or lactate formed in the sto-
mach, and the sulphate of magnesia directly given, having
reached the intestine, are very slowly absorbed, and if in
sufficient quantity, produce very marked local effects as saline
purgatives, the sulphate being hydragogue in its action. The
result is the free evacuation of a quantity of water by the
bowel, and with it the whole, or almost the whole, of the mag-
nesia. Sulphate of magnesia (Epsom salt) is our most common
saline purgative, used in the form of Mistura SennaB Composita
(black draught), of a simple solution in sulphuric acid and
water with some carminative, and of several of the popular
aperient waters, such as Friedrichshall, Piillna, Hunyadi
Janos, of all of which it is an important constituent. Sulphate
of magnesia is regarded as a mild, painless, non-nauseating
purgative, less rapid in its action than the soda salt, to be
used for completing the effect of purgative pills, for congestion
of the portal system, for chronic constipation as an habitual
laxative in combination with other salts in the above-named
waters, and for feverish attacks with loaded bowels.

Magnesia and the carbonates, when used as purgatives, are
chiefly given to children in diarrhoea with foul acid stools, very
frequently in the form of Pulvis Ehei Composita (Gregory's
Powder). In small doses, neither salt has any purgative action
on the bowel, but enters the blood.

2. ACTION ON THE BLOOD AND ITS USES.

Entering the circulation as the chloride or lactate, magnesia
increases the natural alkalinity of the plasma, of which it is a
normal constituent, and helps to hold in solution any acid
which may be in excess. It will therefore be useful in gout,
lithiasis, and possibly in chronic rheumatism, to assist the more
powerful alkalinisers of the blood with which it is combined in
the waters of Ems, Baden-Baden, Aix-les-Bains, Carlsbad, etc.

3. SPECIFIC ACTION AND USES.

Magnesia taken medicinally does not exert any appreciable
effect upon the tissues or nutrition generally. Although an
important constituent of bone, it cannot be said to be of any
value in rickets or other diseases in which the osseous tissue is
deficient in solid matter.

4. REMOTE LOCAL ACTION.

When magnesia does not purge, it is excreted chiefly by
the kidneys, rendering the urine more abundant and less acid,
and dissolving uric acid. Its diuretic and alkalinising effects
contribute to the value of magnesia waters in gout and gravel.

ALUMINIUM.

BARIUM. Ba. 137.
Barium is chiefly used in testing.

Chloride of Barium, BaCl2.2H2O.
Characters. — Colourless translucent tables.
Dose. — £ to 2 gr.

Solution of Chloride of Barium, 1 in 10.

57

ACTION AND USES.

Baryta greatly disturbs the blood pressure, and the
chloride has accordingly been recommended in aneurism.

GROUP II.
THE METALS.

ALUMINIUM. Al. 27-5.
Only one salt of this metal is used in medicine.

Alumen.— Alum. NH4A1(S04)2.12H20. A sulphate
of ammonia and alumina, crystallised from solution in water.

Characters. — Colourless transparent octahedra, with an
acid, sweetish, astringent taste. Solubility, 1 in 12 of cold, and
in *th parts of boiling water. Incompatible with alkalies, liine,
barytas, lead, tartrates, and tannic acid, mercury, and iron.

Impurity. — Sulphate of Iron.

Lose. — 10 to 20_gr.

From Alumen is made :

Alumen Exsiccatum. — Dried Alum.

Source. — Made by heating alum up to 400° till
aqueous vapours cease to be disengaged, and powdering.

Characters. — An opaque white bulky powd<
spongy masses. Has lost 47 per cent, by heating ; diili-
cult of solution in water, but unites readily with it.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally.— Alum is astringent, an effect which is fully
discussed under Plumbum. The dried alum absorbs water, and

58 MATER i A MEDIC A AND THERAPEUTICS.

is somewhat caustic if the skin be broken, for instance, over
ulcers. It is used to destroy weak exuberant granulations.

Internally. — The local action of alum is appreciated in the
mouth as an " astringent taste,'' and in the throat as," dryness,"
the mucous secretions of the parts being coagulated, and the
membrane constringed, especially if the parts be inflamed and
swollen. Alum is therefore a remedy for sore throat, in the
form of gargles or sprays, variously combined with other sub-
stances.

A similar effect is produced on the mucous membrane of
the stomach and intestines, dyspepsia and constipation being
the result ; in large doses it is an emetic, irritant, and purga-
tive. A teaspoonful mixed with syrup is an excellent vomit in
croup. As an injection in discharges from the vagina, uterus,
and urethra, it is in constant use ; and also as a wash for the
eyes.

2. ACTION IN THE BLOOD.

Alum is absorbed into the blood, probably as an albumi-
nate.

3. SPECIFIC ACTION AND USES.

This salt is believed to possess astringent properties when
it reaches the tissues, arresting haemorrhage and chronic in-
flammatory discharges from the mucous membranes ; and is
used in the treatment of haemoptysis, epistaxis, gleet, diarrhoea,
and even whooping cough. Much of this is doubtful.

4. REMOTE LOCAL ACTION AND TSES.

Alum is excreted by the kidneys, and may arrest haemor-
rhage from these organs. Part of the salt may also escape
by the skin, as it proves useful in some cases of excessive
sweating.

PLUMBUM. Pb. 207. LEAD.
Lead is one of the most powerful and useful of
metallic drugs.

1. Pliimbi Oxidmii. — Oxide of Lead. Litharge. PbO.
Characters. — Heavy scales of a pale brick-red colour. So-
luble in diluted nitric and acetic acids.

Impurities. — Copper, iron, and carbonates ; detected by
ordinary tests.

Preparations.

Emplastrum Plumbi. — Lead Plaster. 1 in 2| of
Olive Oil and 1 of Water.

PLUMBUM. 59

Plumbi Oxidum or its Emplastrum is also con-
tained in Emplastra Ferri, Galbaui, Hydrargyri, Resinse,
Cerati Saponis, and Saponis.

From Plumbi Oxidum is made :

Plumbi Acetas.— Acetate of Lead. "Sugar of
Lead." Pb(C2H302)2.3H20.

Source. —Made by dissolving Oxide of Lead in Acetic
Acid and Water, and crystallising. PbO + 2C3H402 =
Pb(C2H3O2)2 + H,0.

Characters. — White spongy-looking masses of inter-
laced acicular. crystals, slightly efflorescent, having an
acetous odour and a sweet astringent taste. Solubility,
10 in 2o of water.

Incompatibles. — Hard water, mineral acids and salts,
vegetable acids, alkalies, lime-water, iodide of potas-
sium, all vegetable astringents, preparations of opium,
albuminous liquids.

Impurity. — Carbonate ; detected by turbidity of
aqueous solution.

Dose. — 1 to 4 gr.

Preparations.

a. Pilula Plumbi cum Opio. — Acetate of Lead,
6 ; Opium, 1 ; Confection of Roses, 1. A 4-gr. pill
contains 3 gr. of plumbi acetas, and £ gr. of opium.

Dose. — 3 to 5 gr.

b. Suppositoria Plumbi Composita.- — Each 15-
gr. suppository contains 3 gr. of acetate of lead,
and 1 gr. of opium.

c. Unguentum Plumbi Acetatis. — 12 gr. to 1
oz. benzoated lard.

d. Liquor Plumbi Subacetatis. — " Goulard
extract." Pb.,C4H605, dissolved in water.

Source. — Made by boiling acetate of lead and
oxide of lead in water.

Characters. — A dense, clear, colourless liquid,
with a sweet astringent taste and alkaline n-action.

From Liquor Plumbi Subacetatis are prepared :

a. Liquor Plumbi Subacetatis Dilutus. —
" Goulard Water." Solution of Subacetato of
lead, 1 ; Rectified spirit, 1 ; Water, 78.

|8. Unguentum Plumbi Subacetatis Com-
positum.— 1 in 5f.

60 MATERIA MEDIC A AND THERAPEUTICS.

2. PlumM Carbouas.— Carbonate of Lead. " White
Lead." PbC03.

Characters. — A heavy white powder. Insoluble in water.
Impurities. — Lime ; sulphate of lead.

Preparation.
TJnguentum Plumbi Carbonatis. — 1 in 8.

3. PlumM Nitras.— Nitrate of Lead.^ Pb(N03)2.
Source. — Made by dissolving lead in boiling nitric acid

slightly diluted, and crystallising out.

Characters. — Colourless octahedral nearly opaque crystals.

from Plumbi Nitras is made :

Plumbi lodidum. — Iodide of Lead. PbI2.

Source. — Made by mixing solutions of Nitrate of
Lead and Iodide of Potassium. Pb2(N03) + 2KI =
PbI2 -f 2KNO3.

Characters. — A bright yellow powder or crystalline
scales.

Preparations.

a. Emplastrum Plumbi lodidi. — 1 in 9.

b. Unguentum Plumbi lodidi. — 1 in 8.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Lead is said not to be absorbed by the un-
broken skin ; yet the dilute solution of the subacetate (Goulard
water) is of unquestionable value in the treatment of contu-
sions and superficial inflammations, such as erysipelas, and is
extensively used in these conditions. In the same form, or
as the ointment of the subacetate, it relieves itching ; a
symptom, the cause and pathological nature of which are still
obscure. Lead may be absorbed when applied in the form of
ointment, probably by decomposition ; and the specific effects
to be presently described may arise in this way. Lead salts
act readily upon wounds, ulcers, and exposed mucous mem-
branes : (1) precipitating the albuminous fluids which cover
their surface, or are flowing from them as a discharge ; (2) co-
agulating the protoplasm of the young cells of the superficial
layers ; and (3) contracting the small arteries and veins of the
part, thus diminishing or even arresting the circulation within
them, and preventing the escape of the plasma and blood-cells
through their walls ; whilst (4) the nerves are probably also

dj

PLUMBUM. 61

depressed. These effects are called, as a whole, astringent,
antiphlogistic, and sedative. The solutions of the subacetate
are much employed as applications to ulcers, as injections
for chronic inflammatory discharges from the vagina, urethra,
ulcers, ear, etc., and as a collyriumfor the conjunctiva ; or the
carbonate may be dusted upon ulcers, or used as ointment.
The strong solution of the subacetato is a powerful irritant,
causing pain and reaction, and is rarely used undiluted. The
nitrate is stimulant or even caustic, and is applied to syphilitic
onychia and chapped nipples. The iodide, in the form of the
unguentum, may be rubbed into enlarged joints, glandular
swellings and nodes, its absorptive effect being chiefly referable
to the iodine.

Internally. — The local action of lead is first appreciated in
the mouth as a peculiar " astringent taste," with a sharp sweet-
ncss in the case of the acetate. On the mucous membrane of
the throat it acts as already described, coagulating the mucus,
producing an astringent effect on the cells and vessels of
the part, and causing a sensation of dryness. If inflammation
be present it is rapidly controlled ; and the subacetate, either
painted on in the form of the strong solution, or as a gargle
formed of the weak solution, is an efficacious remedy for ton-
sillitis.

The local action of lead on the stomach and intestine
corresponds with what has been described : it diminishes the
secretions, contracts the vessels, and arrests or retards the
peristaltic movements; whilst it is itself converted into an
albuminate by the fluids which it encounters. The acetate is
accordingly given with or without opium to arrest haematemesis ;
and it is one of the most certain drugs in the treatment of
obstinate diarrhoea, especially if ulceration be present, and
hemorrhage threatening, as in typhoid fever (where it may be
advantageously combined with opium), and in tuberculosis of
the bowels.

2. ACTION IN THE BLOOD.

Lead enters the blood as albuminate, but passes very
rapidly through it, and cannot be found in it even after l,np>
doses. If lead be given for some time, the blood becomes more
watery, and the red corpuscles fewer in number.

3. SPECIFIC ACTION.

All the tissues take up lead freely from the blood, and
retain it obstinately as albuminate, the central nervous
being the important seat of its deposit, whilst it is even more
abundant in the kidneys and liver as the channels of its escape,

62 MATERIA MEDIC A AND THERAPEUTICS.

and in the bones from the sluggishness of their metabolism.
Thus combined with the active cells of the body, lead after a
time sets up a series of phenomena known as "plumbism."
These are pathological, not physiological, effects, and may be
briefly said to take the form of dyspepsia, constipation, and
colic ; a full, tense, and infrequent pulse, with increased cardiac
action ; disturbances of the urinary flow ; neuralgic pains ;
tremors, followed by paralysis of the muscles, chiefly affecting
the extensors of the wrist ; anaemia and emaciation.

These symptoms and the results obtained by experiments
on animals have been variously interpreted. Some authorities
refer them to an irritant action of lead on the involuntary
muscular fibres of the stomach, bowels, blood-vessels, similar
to its astringent local effects, whence muscular contrac-
tions, painful spasms, narrowing of the vessels, and finally
paralysis, and other phenomena from exhaustion. Other phar-
macologists contend that lead acts primarily on the central
nervous system and nerves, and secondarily only on the mus-
cles, vessels, etc. Its remarkable effect in raising the blood
pressure has been referred to irritation of the splanchnics, and
consequent narrowing of the abdominal vessels ; that is, to in-
creased peripheral resistance. The increased blood pressure is
the cause of the infrequent powerful cardiac action, and to some
extent of the urinary disturbances.

4. SPECIFIC USES.

The specific action of lead is turned to many important
uses. As a powerful haemostatic it is used in bleeding from
the stomach and bowel, as we have said, and also from the
lungs, opium being advantageously combined with it to
ensure mental and bodily rest (Pilula Plumbi cum Opio, or
acetate of lead and acetate of morphia with acetic acid). Its
use in diarrhoea is also partly referable to its specific action.

5. REMOTE LOCAL ACTION AND USES.

Lead is slowly excreted in the bile, urine, skin, and milk.
In the bowel, the portion that has been excreted by the liver
is reabsorbed, is again excreted, and finally escapes in the faeces
as the black sulphide. In passing through the kidneys, lead
diminishes the excretion of uric acid. It is used as a haemo-
static in renal hemorrhage, in bronchorrhoca, and in profuse
sweating.

6. ACTION* AND USES OF THE DIFFERENT SALTS OF LEAD.

The special action and uses of the different preparations
of lead are as follows: The Acetate is the only salt given

ARGENTUM. 63

internally. The solutions of the Subacetate are the only liquid
preparations of the metal, and are used externally as lotions,
injections, collyria, etc., as well as in the form of the ointment.
The Oxide is made into Emplastrum plumhi, the basis of almost
all plasters. The Nitrate is used as a local stimulant or eschar-
otic, as described ; and pharmaceutically to obtain the Iodide.
The latter possesses, as already described, absorptive powers by
virtue of the iodine, an effect which the lead probably promotes,
Plumbi Carbonas is applied, either as the powder or as an
ointment, for astringent purposes, to ulcers and inflamed
surfaces.

ARGENTUM. 108. SILVER.

Two salts of this metal are officinal, the nitrate
and the oxide.

Argciitiiiii Purificatum. — Refined Silver. Pure
Metallic Silver.

Impurities. — Lead and copper.

From Argentum is made :

Argenti Nitras. — Nitrate of Silver. AgN03. Lunar
Caustic.

Source. — Made by dissolving Silver in Diluted Nitric
Acid.

Characters. — Colourless tabular right rhombic prisms,
or white cylindrical rods. Solubility, 100 gr. in 50 min.
of water.

Impurities. — Other nitrates ; detected by evapora-
tion of nitrate after precipitation with HC1.

Dose.— % to £ gr.

From Argenti Nitras is made :

Argenti Qxidum. — Oxide of Silver. Ae:.,O.

Source. — Made by precipitating a solution of
Nitrate of Silver with Lime- Water— 2A-N< )., +
Ca2HO = Ag20 + Ca2NO3 + H20.

Characters. — An olive-brown powder ; insoluble}
in water. Incompatible with creasote, with whicU
it forms an explosive substance.

Impurities. — Metallic silver, evolving gas with
nitric acid.

Lose.—\ to 2 gr.

64 MATERIA MEDIC A AND THERAPEUTICS.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — In the form of the solid pencil, nitrate of
silver is a caustic causing destruction, with deep staining of
the superficial layers, acute pain, inflammation of the deeper
layers, separation of the part as a slough, and then rapid heal-
ing. Unlike potash, its effects are limited to the area of appli-
cation. On this account it is the best caustic for ordinary use,
to destroy the affected part in bites of dogs, serpents, and other
venomous animals, in post-mortem wounds and chancres, or to
remove small growths. Solutions of the nitrate, when applied
to the broken skin or a mucous membrane, exert much the
same action as lead, but in a greater degree : precipitating the
albumins and the chlorides of the plasma or secretions ; coagu-
lating the protoplasm of the young cells of the part ; causing
active contraction of the arteries, veins, and capillaries; and
very rapidly coagulating the blood both within and without
them. Nitrate of silver is therefore the best local antiphlo-
gistic known, controlling the exudation, growth, and vascular
disturbance of the inflammatory process. It is employed to
touch callous and weak ulcers, including bed-sores ; to control
local inflammations in accessible parts; and, as an injection, to
wash inflamed surfaces, for example, the urethra, vagina, os
uteri, bladder, and conjunctiva. A weak solution is used to
harden the skin in threatening bed-sores. Solid caustic is an
excellent haemostatic on bleeding from leech-bites.

Internally. — In the mouth, silver causes a nauseous astrin-
gent metallic taste. Meeting with chlorides and albuminous
fluids, it combines with these, and acts upon the surface of
the mucous membrane as it does upon the skin. It is a useful
remedy in inflammation of the tonsils and pharynx, whether
applied in the solid form as an antiphlogistic in acute
cases, or in solution as an astringent in relaxed, chronic
states.

Reaching the stomach, nitrate of silver is decomposed by
the hydrochloric acid and mucus, and cannot act as an irritant
upon the mucous membrane unless given in poisonous doses.
Its use in ulcers of the stomach must therefore be ques-
tioned. When given for ulceration of the bowels, it is admini-
stered per rectum.

2. ACTION IN THE BLOOD.

Silver enters the blood either as albuminate, or is absorbed
as the pure metal by the intestinal epithelium and lacteals,

- FvC

CUPRUM. 65

after the manner of fat. It has no appreciable effect on the
blood.

3. SPECIFIC ACTION AND USES.

Silver becomes locked up in all the connective tissues of the
body, in the metallic f orm, staining exposed parts a dusky black
brown, incapable of removal. It probably, therefore, remains
inert within the body; but some authorities believe that it
affects the nervous tissues, and recommend it in epilepsy,
chorea, and locomotor ataxy. The permanent unsightly dis-
coloration of the skin, which comes on after its use for several
months, is a serious objection to its employment.

4. REMOTE LOCAL ACTION.

As we have just seen, silver once admitted to the tissues is
not excreted. A certain amount has, however, been found in
the urine ; and a proportion always passes through the bowels
unabsorbed, appearing on the faeces as sulphide. No use is
made of these facts.

5. ACTION AND USES OF THE DIFFERENT SALTS OF SILVER.

The Nitrate is almost invariably used both externally and
internally. The Oxide is less irritant, and is chiefly given in-
ternally in the form of pill.

CUPRUM. 63-5. COPPER.

The sulphate is the only salt of copper employed
medicinally, although other compounds, as well as the
metal itself, are introduced into the Pharmacopoeia as
tests.

1. Cupri Sulphas.— Sulphate of Copper. C
5H2<T~

Source. — Made by heating Sulphuric Acid with Copper, dis-
solving the soluble product, evaporating and crystallising.

Characters. — A blue crystalline salt in oblique prisms.
Solubility, 1 in 3 of water.

Impurity. — Iron.

Lose. — As an astringent or tonic, J to 2 gr. ; as an emetic,
6 to 10 gr.

From Cupri SidpJias is prcpand :

Jrkilphate of Copper. Anhydrous. CuSO4. — A yel-
lowish-white powder made by heating sulphate of copper
to 400° Fahr. Used in testing.
F— 8

66 MATERIA MEDIC A AND THERAPEUTICS.

Copper wire is used for preparing Spiritus -ZEtheris Nitrosi.

2. Subacetate of Copper of Commerce. Verdigris. (Erugo.
(C.2H302)2Cu,CuO. In powder, or masses of very minute
crystals of a bluish-green colour. Used in chemical testing.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION.

Externally. — The action of copper differs but little from
that of silver and zinc. It does "not affect the unbroken skin,
nor is it absorbed by it into the blood. Applied freely to
wounds, ulcers, or the delicate surface of exposed mucous
membranes, such as the conjunctiva, the sulphate or " blue-
stone " is caustic, and is in frequent requisition to destroy warts,
chancres and poisoned wounds, and for similar purposes. A
swift and slight application of the crystal, or its solution in
water, acts so far like nitrate of silver — precipitating the dis-
charges from a mucous or ulcerated surface ; coagulating the
superficial layers ; thus contracting the blood-vessels and arrest-
ing discharge. It is used as a stimulant to ulcers ; and a solu-
tion of 2 to 5 gr. to the oz. may be used as an astringent
lotion, or injected into the vagina, rectum, or urethra.

Internally. — The local action of copper on the mouth, be-
yond its astringent metallic taste, corresponds with that just
described. If long administered, it may cause a greenish dis-
coloration of the bases of the teeth (not of the gums) from
direct combination with decomposing products there.

Sulphate of copper, in large doses (10 gr.), is not entirely
converted into an albuminate in the stomach, but acts on the
mucous membrane as an irritant, and causes vomiting. It is a
rapid direct emetic, and is suited for administration when the
stomach is to be surely and speedily emptied of a narcotic
poison, such as opium, or the air-passages evacuated of mucus
or false membrane, as in bronchitis and diphtheria, after ipeca-
cuanha has failed. It causes less depression and subsequent
nausea than tartar emetic. If sulphate of, copper fail to vomit,
it must be evacuated by some other means, otherwise dangerous
inflammation may result.

Lastly, copper sulphate is a valuable antidote to phos-
phorus, as it is reduced by the metalloid, the copper being
deposited upon the phosphorus and rendering it inert. In
cases of poisoning by phosphorus, 3 gr. of blue-stone should be
given in water every few minutes, until vomiting occurs, where-
upon a free saline purgative is to be administered.

Wu/\

ZlNCUM. 67

In the intestines copper is an astringent in small quantities,
an irritant purgative in larger quantities. Small doses, com-
bined usually with opium, are given for some kinds of diarrhoea.

2. ACTION IN THE BLOOD.

Given in small doses, copper is absorbed into the blood ; but
•we neither know any effect that it produces here, nor use it in
this connection.

3. SPECIFIC ACTION AND USES.

The specific action of copper on the tissues is most difficult
to evoke, as anyone can testify who has watched a large number
of persons working in brass and copper. It is said to weaken the
voluntary muscles and heart, and to affect the nutrition of the
central nervous system ; whence it was formerly used in con-
vulsions and spasmodic diseases, including epilepsy, chorea, and
hysteria. This treatment is now almost obsolete. It is be-
lieved by some to be a specific astringent to the uterus.

4. REMOTE LOCAL ACTION.

Copper is chiefly excreted by the liver, that is, leaves the
body with the bile and faeces ; part is discharged in the urine,
and part by the saliva. No special advantage is taken of its
elimination by these channels.

ZINCUM. ZINC. 65.

Zi ti mill Oramilatum. — Made by pouring fused
zinc into cold water.

From Zincum Granulatum are made :

a. Zinci Ch}oridum. — Chloride of Zinc. ZnCLj.

Source. — Made by dissolving Zinc in Diluted Hydro-
chloric Acid, and evaporating ; Chlorine Water and Car-
bonate of Zinc being used in the process, to precipitate
iron or tin present as impurities.

Characters. — Colourless rods or tablets, very de-
liquescent, and caustic. Solubility, 10 in 4 of water,
freely in rectified spirit and ether.

Impurities. — Sulphates, iron, and calcium.

J>. Liquor Zinci Chloridi.

Source. — Made as above, without evaporation.
Characters. — Colourless. Used externally only.

c. Zinci Sulphas.— Sulphate of Zinc. ZnSO4,7 H < >.
Source. — Made from Zinc and Sulphuric Acid, like
the Chloride, with the same precautions.

68 MATERIA MEDIC A AND THERAPEUTICS.

Characters. — Colourless prisms, with a metallic
styptic taste.

Impurities. — Iron, lead, copper, arsenic.

Dose. — 1 to 3 gr. as a tonic ; 10 to 30 gr. as an emetic.

From Zinci Sulphas are made :

a. Zinci Carbonas. — Carbonate of Zinc.
ZnC03(ZnO)23H2O. "Calamine.' '

Source. — Made by decomposing a solution of
Sulphate of Zinc with a solution of Carbonate of
Soda. (1) ZnSO4 + Na2C03 = ZnC03 -f Na2S04.
(2) 3ZnC03 + 3H20 = ZnC032(ZnO),3H20 + 2C02.

Characters. — A white, tasteless, inodorous
powder, insoluble in water ; an impure carbonate.

Impurities. — Sulphates, chlorides, copper.

From Zinci Carbonas are made :

(i) Zinci Qxidum.— Oxide of Zinc. ZnO.

Source. — Made by heating the Carbonate.

Characters. — A soft, nearly white, tasteless,
and inodorous powder, insoluble in water.

Impurities. — The carbonate; effervescing
with acids. And its impurities.

Dose. — 2 to 10 gr.

Preparation.

TJnguentum Zinci Oxidi, — 80 gr. to
1 oz. Benzoated Lard.

fii) Zinci Acetas. — Acetate of Zinc.
Zn(C2H302)2.2H2O.

Source. — Made by dissolving Carbonate of
Zinc in Acetic Acid and Water, and crystal-
lising. ZnC03,2Zn0.3H20 + 6C2H402 =
3(Zn2C2H3O2) + 6H20 + C02.

Characters. — Thin colourless crystalline
plates, of a pearly lustre, with sharp, unpleasant
taste. Solubility, 10 in 25 of water.

Impurities. — Those of the carbonate.

Dose.— 1 to 2 gr. as tonic ; 10 to 20 gr. as
an emetic.

Zinci Carbonas is also used in making Zinci
Chloridum and Zinci Sulphas.

B. Zinci Valerianas, — Valerianate of Zinc.

Zn(C5H9O2)2.

Source. — Made by mixing solutions of Sulphate
of Zinc and Valerianate of Soda, and crystallising.

.

#u .

ZlNCUM. 69

Characters. — Brilliant white, pearly, tabular
crystals, with an odour of valerianic acid, and a
metallic taste. Solubility, 1 in 120 of water ; 1 in
60 of spirit.

Impurities. — Sulphate and butyrate of zinc.

Dose. — 1 to 3 gr.

Non-officinal Preparations of Zinc.

Calamina Praeparata. — Calamine. Impure
Oxide of Zinc, obtained by calcining native Car-
bonate of Zinc, and reducing it to an impalpable
powder. A greyish or flesh-coloured powder.

Oleate of Zinc. — Made by heating Oxide
of Zinc with Olcic Acid. 1 to 8.

Incompatible* of Zinc Salts in general.

Alkalies and their carbonates, lime-water, acetate of lead,!
nitrate of silver, astiingent vegetable infusions or decoctions,)
and milk.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — The salts of zinc closely resemble in their
action the salts of lead, silver, and copper, being caustic in their
stronger forms, astringent or antiphlogistic in their weaker
forms. Zinc presents every degree of this action, according to
the salt employed, that is probably according to the solubility
and diffusion-power of the particular combination of the mfltaL
Thus the chloride, which is highly deliquescent, penetrates tho
tissues, and is a powerful escharotic, causing destruction of the
part, with severe pain, separation of a slough, and subsequent
healing. It is employed to destroy morbid growths, oUronio
ulcers, and gangrenous parts, in the form of a paste or of solid
arrows made with plaster of Paris or flour, or as a strong
solution. The sulphate and acetate have less affinity for water,
and are much less powerful than the chloride. AVhen applied
to the broken skin, an ulcer, or an exposed mucous surface, they
precipitate the albuminous juices or secretions, coagulate tin-
protoplasm of the upper layers of growing cells, and indirectly
cause contraction of the vessels, though less than silver and
lead. The sulphate of zinc is the most common of all applica-
tions for healing ulcers and wounds, limiting the amount of
discharge, checking excessive or " weak " growth, and modify-
ing the intensity of the inflammatory process with which tho

70 MATERIA MEDICA AND THERAPEUTICS.

healing is associated. A solution of this salt is the basis of the
ordinary .'.'red lotion" of many hospital pharmacopoeias; and
other weak solutions of the same may be employed as
a wash or injection for the eyes, urethra, vagina, and other
accessible mucous tracts. The oxide and carbonate of zinc,
and calamine, act locally as mild astringents in inflamed con-
ditions of the superficial layers of the skin, such as eczema,
controlling exudation and hypersemia, and protecting the parts
from the air. Being insoluble in water, they are applied in the
form either of powder or of the ointment.

Internally, the local action of zinc corresponds. It is but
little used in the mouth or throat, but its effect on the stomach
as a local irritant furnishes us with the most familiar of our
direct emetics. Sulphate of zinc, in doses of 20 grains, causes
rapid and complete vomiting, attended by less immediate de-
pression and less subsequent nausea than antimony and
ipecacuan. It is much employed in narcotic poisoning ; more
rarely in croup, diphtheria, and phthisis, to clear the air pas-
sages ; or even to empty the stomach in painful dyspepsia. The
oxide on reaching the stomach is dissolved, and acts like the
soluble salts of zinc.

In the intestine the irritant action of zinc is continued, if
it be given in large doses, but this effect is never desired thera-
peutically. On the contrary, the oxide, in sufficient doses to
relieve a moderate superficial catarrh, is often a very efficacious
astringent in the treatment of diarrhcea in children.

2. ACTION IN THE BLOOD.

Zinc readily enters the circulation, but nothing is known
respecting its influence on the plasma or corpuscles which can
be turned to therapeutical account.

3. SPECIFIC ACTION AND USES.

The action of zinc upon the tissues has been learned chiefly
from its effect in certain diseased conditions in man, and is but
imperfectly understood. It appears to bo a depressant to the
nervous and muscular systems, and has been employed with un-
questionable success in epilepsy, chorea, and whooping cough,
all of which are characterised by nervo -muscular excitement.
Observations on animals, in which the irritability of the volun-
tary and cardiac muscles is found to be decidedly reduced by
zinc, confirm this experience.

4. REMOTE LOCAL ACTION AND USES.

The kidneys and mammary gland, and probably the mucous
surfaces and skin, are the channels of elimination of zinc. It

CADMIUM. 71

is possible that the metal exerts a second or remote astringent
effect on these parts as it is leaving the system ; for the sul-
phate and oxide appear to have the power of arresting chronic
discharges from remote mucous passages, such as the uterus and
vagina, even when given internally ; and it is certain that the
oxide diminishes the perspirations of phthisis in some instances.

5. ACTIONS AND USES OF THE DIFFERENT SALTS OF ZINC.

These have heen sufficiently indicated in the preceding
description. The Chloride stands alone as a powerful escharotic,
never to be given internally ; it possesses also disinfectant pro-
perties, as the Liquor Zinci Chloridi, which is used to mop out
very foul wounds, and very extensively to wash infected rooms,
flush drains, etc. The Sulphate and Acetate closely resemble
each other in their action, but the acetate is little used. The
Oxide and Carbonate are similarly allied to each other, the
former being generally employed. Zinci Valerianas probably
acts as a zinc salt only, the valerianic acid appearing to be
inert. See Valeriance Radix.

CADMIUM. CADMIUM. Cd. 112.

Cadniii lodidtim. — Iodide of Cadmium. CdI2.

Source. — Made by direct combination of Iodine and Cad-
mium in the presence of Water.

Characters. — Flat white micaceous crystals, of a pearly
lustre. Solubility, 1 in 1^ of water.

Impurity. — Zinc, and general impurities.

Preparation.
Unguentum Cadmii lodidi. — 1 in 8.

ACTION AND USES.

Cadmium closely resembles zinc in its action, both locally
and specifically, but is even more irritant, and is not given
internally. The iodide, in the form of the ointment or in
aqueous solution, is applied as a local stimulant to enlarged
joints and glands, to promote absorption, instead of the iodide
of lead which stains the skin yellow.

CERIUM. Ce. 92.

Only one salt of this metal is officinal.

Cerii Oxalas.— Oxalate of Cerium. CeC3043H20.

72 MATERIA MEDIC A AND THERAPEUTICS.

Source. — Made by precipitating a solution of Oxalate of
Ammonia with a soluble salt of Cerium.

Characters. — A white granular powder ; insoluble in
water.

Impurities. — Alumina; detected by its solution in potash
giving precipitate with NH4C1. Other oxalates, the ash of
which gives effervescence with boiling HC1.

Dose.— I to 2 gr.

ACTION AND USES.

Nothing is definitely known about the physiological action
of cerium. It is given with benefit in vomiting, acid dyspepsia,
and heartburn, especially when they occur in pregTiancy ; and
has been credited with good effects in chronic nervous diseases
such as epilepsy and chorea.

v FERRUM. IRON. Fe = 56.

Wrought-iron in the form of wire or nails free
from oxide. Iron wire No. 35.

Preparations.

1. Mistura Ferri Aromatica. — Iron Wire, 2,
Pale Cinchona Bark, 4 ; Calumba, 2 ; Cloves, 1 ; Compound
Tincture of Cardamoms, 12; Tincture of Orange Peel, 2 ; and
Peppermint Water, 50.

Dose. — 1 to 2 fl.oz.

2. VJBiUlii Ferri. — Iron wire digested in Sherry, 1 in 20
Dose. — 1 to 4 fl.dr.

From Ferrum are also made :

3. Ferri Sulphas.— Sulphate of Iron. FeS04.7H2O.
Source. — Made by dissolving Iron Wire in Sulphuric Acid

and Water, and crystallising.

Characters. — Pale green rhombic prisms, with a styptic
taste. Solubility, 1 in 1 \ of water ; insoluble in spirit.

Impurities. — Persalts, giving sediment in aqueous solution.
Copper, precipitated by H2S.
Dose. — 1 to 5 gr.

Preparations.
From Ferri Sulphas are made :

a. Ferri Sulphas Exsiccata. FeSo4.H20.— A dirty
white powder, made by heating the Sulphate.
9.— £ to 3 gr.

'•

PER RUM. 73

6. Ferri Carbonas Saccharata.— 37 per cent, of
Carbonate of Iron, FeC03, mixed with Peroxide of Iron
and Sugar.

Source. — Made by precipitating a solution of Sulphate
of Iron with Carbonate of Ammonia, and rubbing with
Sugar. (1) FeS04 + (NH4)«CO3 = FeC034- (NH4)0S04.
(2) 3FeC03 + O = FeC03 -f Fe.203 -f 200^ The sugar
prevents oxydation.

Characters. — Grey -brown lumps, with a sweet chaly-
beate taste.

Impurities. — Sulphate of ammonia and oxide of iron.

Dose. — 54;o 20 gr.

Preparation.

Pilula Ferri Carbonatis. — 1 to 1 of Confectio
Rosse.

Dose. — 5 to 10 gr.

^ e. Mistura Ferri Composita.— " Griffiths' Mixture."
Sulphate of Iron, 25 gr. ; Carbonate of Potash, 30 gr. ;
Myrrh, 60 gr. ; Sugar, 60 gr. ; Spirit of Nutmeg, 4 fl.dr. ;
Rose Water, 9 fl.oz. Dose, 1 to 2 fl.oz.

d. Ferri Arsenias. — Arseniate of Iron. Fe3As208.

Source. — Made by precipitating a mixed solution of
Arseniate and Acetate of Soda with Sulphate of Iron;
and washing. 3FeS04 -f 2Na2As04 + 2NaC2H3Oa =
FegAsjjOg + SNasSC^ + 2C2H4O2.

Characters. — A green amorphous powder, tasteless
(but not to be tasted), insoluble in water.

Impurities. — Sulphates, and general impurities.

Dose. — ^ to 2 gr. in pill.

e. Ferri Phosphas. — Phosphate of Iron. Fe^'

Source. — Made by precipitating a mixed solution
of Phosphate and Acetate of So<la with Snip!.
Iron. 3FeS04 + 2Na2HP04 + 2Nu< ' .11 ,«>..
3Xa.,S04 + 2C2H4Oa.

Characters. — A slate-blue amorphous powder, in-
soluble in water.

Impurity. — Arsenic; detected by Reinsch'.-

Dose. — 5 to 10 gr.

/. Ferri Persulphatis Liquor.

Source. — Made by boiling nitric acid and v
with a hot solution of sulpha!.' <>f ii"n in sulphur;"'
and water. eiFeSOJ + 3(HaS04) + 21INO, = 3(F.

74 MATERIA MEDIC A AND THERAPEUTICS.

-f- 4H20 + 2NO. Introduced only for making several
preparations.

Characters. — Dark brown, inodorous and astringent.

From Liquor Ferri Persulphatis are made :

a, Ferri Oxidum Magneticum. — Magnetic Oxide
of Iron. Fe3O4, with some peroxides.

Sources. — Made by precipitating a solution of
the Proto- and Persulphates of Iron with a Solution
of Soda, and drying. (1) FeS04 + Fe.23S04 +
8NaHO = Fe2HO + Fe26HO -f 4Na2S04. (2)
Fe2HO -I- Fe26HO = Fe3O4.4H20.

Characters. — A brownish-black tasteless powder.

Impurity. — Metallic iron; detected by effer-
vescing with HC1.

Dose. — 5 to 10 gr.

B. Ferri Peroxidum HumitJnTn, — Moist Per-
oxide of Iron. Fe2.6HO.

Source. — Made by precipitating Solution of
Persulphate of Iron with Solution of Soda. Fe23S04
+ 6NaHO = Fe26HO + 3Na2S04.

Characters. — A soft reddish-brown mass.

Impurities. — Ferrous hydrate. Ferric oxy-
hydrate ; insoluble in cold HC1.

Dose. — 5 to £ oz.

From Ferri Peroxidum Humidum is made :

Ferri Peroxidum Hydratum. — Hydrated
Peroxide of Iron. Fe2022HO. Made by drying
the Moist Peroxide. A reddish-brown powder,
without taste. Dose, 5 to 30 gr.
Impurities. — Ferrous hydrate.

Preparation.

Empla strum Ferri. — "Emplastrum
Eoborans." 1 in 11.

From Ferri Peroxidum Hydratum is
made :

Ferrum Bedactum. — Reduced
Iron. Metallic iron, with a variable
amount of Magnetic Oxide.

Source. — Made by passing dry
Hydrogen over the Hydrated Peroxide.

Characters. — A fine greyish-black
powder.

FERR UM. 7 5

Impurity. — Excess of oxide; de-
tected volumetrically.
Lose. — 1 to 5 gr.

Preparation.

Tr o ehisci Ferri Redact!. —
1 gr^in each.

•y. Ferri et -Ammonias Citras. — Citrate of Iron
find Ammonia,

Source. — Made by dissolving Hydrated Peroxide
of Iron (freshly prepared from the Solution of the
Persulphate by Ammonia) in a hot solution of Citric
Acid, neutralising with Ammonia, and evaporating.

Characters. — Deep red scales, deliquescent;
slightly sweet and astringent in taste. Solubility,
10 in o of water, almost insoluble in rectified spirit.

Impurities. — Tartrates ; giving crystalline pre-
cipitate with acetic acid. Alkaline salts; detected
in ash.

j)ose. — 5 to 10 gr.

Preparation.

-</ Vinum Ferri Citratis. — 1 gr. in 1 fl.dr. of
orange wine. Dose, 1 to 4 fl.dr.

5. Ferri et Quinia Citras. — Citrate of Iron and
Quinia.

Source. — Made like Ferri et Ammoniae Citras,
freshly precipitated Quinia being also dissolved in
the Citric Acid solution.

Characters. — Greenish-yellow scales, deliques-
cent, bitter and chalybeate in taste. Solubility, 2
in 1 of water. 6 gr. contain 1 grain of quinia.

Impurities. — Alkaline salts ; detected in :ish.
Other alkaloids instead of quinia; insoluble in ether
when precipitated by NH4IIO.

Dose. — b to 10 gr.

f, Feirum Tartaratmn. — Tartarated Iron.

Source. — Made like Fern et Ammonite Citrns
with Acid Tartrate of Potash instead of Citric A. -i.l.

Characters. — Garnet scales. Solubility, 1 in 4 of
water ; sparingly in spirit.

Impurities. — Ammonia ; evolved by boiling with
liquor sodae. Ferrous salts.

Dose. — o to 10 gr.

76 MATER i A MEDIC A AND THERAPEUTICS.

C Tinctura Ferri Acetatis. — Tincture of
Acetate of Iron.

Source. — Made by adding Acetate of Potash and
Eectified Spirit to the Solution of the Persulphate,
and filtering. Fe23S04 + 6KC2H302 = Fe^C^C^
-f- 3K2S04.

Characters. — A deep brown liquid,

J)ose. — 5 to 30 min.

4. Ferri Sulphas Oraiiulata. — Granulated Sul-
phate of Iron. FeS04.7H2O.

Source. — Made by pouring a solution of Iron "Wire in
Diluted Sulphuric Acid into Eectified Spirit, stirring the mix-
ture ; and drying.

Characters.— Small, pale green granular crystals. Solu-
bility, 1 in 1| of water, insoluble in spirit.
"impurities.— Same as of Ferri Sulphas.
Dose. — 1 to 5 gr.

Preparation.

Syrupiis Ferri Phosphatis. — 1 gr. of Ferri Phos-
phas in 1 fl.dr.

Source. — Made by precipitating a solution of Granu-
lated Sulphate of Iron with a mixed solution o"f Phos-
phate and Acetate of Soda, dissolving the precipitate
in Diluted Phosphoric Acid, and adding Sugar.

Characters. — Colourless, becoming brown. 1 fl.dr.
contains 1 gr. of Ferri Phosphas (Fe3Pa08).
Dose. — 1 to 4 fl.dr.

5. Ferri lodidiim. — Iodide of Iron. FeI2.
Source. — Made by boiling Iron Wire and Iodine in Water,

and evaporating.

Characters. — Crystalline, green with a tinge of brown,
inodorous, deliquescent. Consists of iron, 1 ; iodine, 4£ ; water,
lj. Solubility, 1 in 1 of water.

Dose. — 1 to 5 gr.

6» Pilula. Ferri lodidi. — Made by mixing a solution
of Iron Wire and Iodine in Water, with Sugar and Liquorice.
1 in 3£. Dose, 3 to 8 gr.

7. Svriipus Ferri lodidi. — Made by mixing a
solution of Iron Wire and Iodine in Water with Syrup. Colour-
less. 4-3 gr. in 1 fl.dr. Dose, 20 to 60 min.

S. Ferri IVrchloridi. Liquor Fortior. —

Strong Solution of Perchloride of Iron.

OU-O^,

PER RUM. 77

Source. — Made by adding Hydrochloric Acid and Nitric Acid
to a hot solution of Iron Wire in Hydrochloric Acid and Water
(1) Fe + 2HC1 = Fed, + H2. (2) 6FeCL + 6HC1 + 2HN03
= 3Fe2016 + 4H20 + 2NO.

Characters. — An orange-brown liquid, consisting of per-
chloride of iron, Fe2Cl6, in solution in water. Not given in-
ternally.

Impurities. — Ferrous salts.

Preparations.

a. Liquor Ferri Perchloridi. — Pale brown. 1 to 3
of water. Dose, 10 to 30 min.

h. Tinfitura Ferri Perchloridi. — Light brown. 1
to 3 of spirit. flose^ 10 to 30 min.

9. Liiauor Ferri Pernitratis.— Solution of Per-
nitrate of Iron.

Source. — Made by dissolving Iron Wire in Diluted Nitric
Acid.

Characters. — A clear reddish-brown liquid, slightly acid
and astringent to the taste ; consisting of pernitrate of iron,
Fe26N03, in solution in water.

Impurities. — Ferrous salts.

Dose.— 10 to 40 min.

Incompatibilities of Preparations of Iron in General.

Alkalies and their carbonates, lime-water, carbonate of lime,
magnesia, and its carbonate, give green precipitates with
proto-salts, brown with persalts. Tannic and gallic acids give
a deep blue-black with persalts. Preparations of iron there-
fore tinge infusion of chiretta and hops, and change to brown
or black those of chamomile, cusparia, gentian, orange, cas-
caiilla, cloves, digitalis, cinchona, and all astringent infusions;
but they can be given in infusion of quassia or calumba.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND T'SES.

Externally. — A solution of iron has a coiTiiiratin.ur and
astringent effect upon the broken skin and mucous si;
coagulating the albuminous tissues and plasma, and const ring-
ing or condensing the elements. The blood-vessels are thus
closed or diminished in size, not actively, 1ml by compression
from without; the circulation through them is dimii
hemorrhage, if present, is arrested ; and the abnormal escape

78 MATERIA MEDIC A AND THERAPEUTICS.

of plasma and leucocytes, which characterises chronic inflam-
mation or catarrh, is checked. Solutions of the ferric salts are
therefore used as haamostatics to arrest hemorrhage from
accessible parts, such as leech-bites, the nose, and uterus ; less
extensively in chronic discharges from the vagina, rectum, and
nose, as astringents. Injected into the rectum, they destroy
worms. Iron is not absorbed by the unbroken skin.

Internally. — The constringent effect of iron is appreciated
in the mouth as a " styptic taste." Beyond this, the local
action corresponds with that just described externally. Various
iron solutions are usefully applied, either as gargles or with the
brush, in some forms of chronic sore throat.

In the stomach all the salts of iron, whatever their nature,
are converted into the chloride, and do not combine with the
acid albuminates, like some of the other metals. Deficiency of
hydrochloric acid or of food, or excess of iron, thus decomposes
the gastric juice, and allows the iron to act upon the mucous
membrane as an astringent and irritant. Iron is thus directly
unfavourable to digestion ; and in this connection we must
carefully note (1) that iron may disorder the digestion even in
healthy subjects ; (2) that it must not be given for disease
until the gastric functions have been so far restored ; (3) that it
is well to begin then with the mildest preparations ; and (4) that
it must be given after meals. Iron is a valuable antidote in
arsenical poisoning, the humid peroxide (Fe26HO) forming with
arsenious acid an almost insoluble compound (As203 -j- 2(Fe2
6HO) = Fe.jAs.208 + Fe2HO + 5H20). Abundance of the
iron should be given, and the compound should be quickly
expelled by a smart purge of sulphate of magnesia or soda.
The solutions of the persalts are used to arrest haemorrhage
from the stomach. In the duodenum iron is converted into an
alkaline albuminate, and thus absorbed. The further effect of
iron on the bowel is a remote one, to be presently described.

2. ACTION ON THE BLOOD, AND ITS USES.

The action of iron on the blood is almost unique of its kind:
first, because its specific action is exerted, not upon the plasma,
but upon the red corpuscle, and on this alone, not on any
other tissue or organ ; secondly, because this action appears to
be nothing more than the combination of the iron as one of the
constituent elements of the corpuscle with the others. In the
case of no other metal can we speak so definitely of its modus
operandi.

Iron enters the circulation along the whole length of the
alimentary canal as the chloride and alkaline albuminate, and
quickly unites with the corpuscles, as it cannot be found in the

^£
\90L*~*~4 /•'

FERRUM. 79

plasma. Tt combines with the haemoglobin, and as such alone
exists in the blood. In normal blood a " course " of iron in-
creases the richness of the blood ; whilst in anaemia the rapidity
of the growth of corpuscles and of the rise in value of the
haemoglobin, as estimated day by day with the haemoglobin-
ometer and haemacytometer, is remarkable. Iron is accordingly
used as a hsematinic in an endless variety of conditions in which
haemoglobin is deficient, such as simple anaemia, scrofula,
amenorrhcea, cardiac disease, syphilis, malarial cachexia, and con-
valescence from acute disease. The cautions already given re-
specting digestion must be faithfully respected, to secure its
haematinic action over a length of time. Iron is an important
constituent of many well-known mineral waters, the most
important being those of Spa, Tarasp, Kissingen, Kreut-
znach, Pyrmont, and St. Moritz on the Continent ; Harrogate,
Moffat, and Strathpeffer in this country ; and the Rawley
Springs, Sweet Chalybeate, and Bedford, in the United States.

3. SPECIFIC ACTION AND USES.

Iron has no specific action on the organs apart from the
blood ; and the tonic effect which it produces so satisfac-
torily, appears to be entirely referable to its action on the blood.
Abundance of oxygen is essential for every bodily and mental
function ; and the feeling of " tone," vigour, and mental fitness
varies with the degree of oxygenation of the blood, i.e. with the
quality of the blood as regards haemoglobin. Nervous, mus-
cular, and cardiac debility are thus removed by iron, and even
digestion is restored by this gastric irritant, if it can be success-
fully introduced into the blood. The temperature is said to be
slightly raised by iron, showing increased oxydation. Iron has
also a specific effect in erysipelas, diphtheria, and other adynamie
diseases, which cannot be perfectly explained. Fever is gene-
rally held to contraindicate the use of iron ; and the same may
be said of phthisis, except as mild forms in chronic cases.

4. REMOTE LOCAL ACTION AND USES.

Iron is excreted by almost every possible channel. As it is
absorbed, so a portion of it is excreted, along the whole Irn.irth
of the intestine, and colours the faeces black (sulphide). Only
a small amount escapes in the urine, saliva, sweat, the milk in
women, the pancreatic juice, and by the various mucous sur-
faces. Whilst passing out of the system, iron produces a
second or remote effect of an astringent kind. As regards the
bowels, the clinical applications of this action are most impor-
tant. Thus most of the salts of iron cause constipation unless

8o MATERIA MEDICA AND THERAPEUTICS.

combined with a purgative, such as the sulphates of magnesia
and soda, or aloes ; no good can be derived from iron until the
bowels have been thoroughly relieved, and are acting regularly ;
and certain salts, such as the perchloride and pernitrate, which
are more astringent to the intestines than others, may some-
times be employed to check chronic diarrhoea and dysentery, and
to arrest haemorrhage from the bowel in typhoid fever. The
remote astringent action of iron is increased from the fact that
it is also excreted by the liver, and passes down with the bile.
The urine falls somewhat in volume, but the urea and other
solids, as well as the acidity, are increased. Haemorrhage from
the kidney or bladder is arrested by iron, which is also beneficial
in some cases of Bright's disease.

I Iron similarly reduces the secretion of milk in nursing
f women. The remote effect of iron on the mucous surfaces
renders it a valuable haemostatic in recurrent passive bleedings
from the nose, uterus, and respiratory passages. As a remote
astringent, it is invaluable in chronic discharges from the same
and allied parts, especially in leucorrhoea.

5. ACTIONS AND USES OF THE DIFFERENT PREPARATIONS OF IRON.

Large as is the number of the preparations of iron, they
and their special actions may be easily remembered if classified
as follows :

1. Iron, its Oxides and Carbonates. — This group com-
prises Ferrum Redactum, MisturaFerri Aromatica, Vinum Ferri,
Ferri Carbonas Saccharata, Mistura Ferri Composita, Ferri Per-
oxidum Hydratum, and Ferri Peroxidum Magneticum. These
preparations possess the haematinic action of iron with but little
astringency, and are accordingly selected to restore the blood,
when the patient has a tendency to dyspepsia and constipation.
They are the principal forms of iron used in the routine
treatment of anaemia, amenorrhcea, and chlorosis in young
women. Let it be observed that these solid preparations form
the soluble compounds in the stomach, for absorption into the
blood, as readily as do the fluid preparations belonging to the
second class. The Mistura Ferri Composita, although a prepara-
tion of the protosulphate, contains the carbonate and peroxide,
and is a favourite and valuable preparation for anaemia with
amenorrhcea ; the iron acting as a haematinic, the potash also
building up the red corpuscle (the salts of which are almost en-
tirely potassium compounds), and the myrrh possibly increasing
the production of leucocytes for conversion into the red, as well
as stimulating the uterus. Ferrum Redactum, the Saccharated
Carbonate and the Hydrated and Magnetic Oxides, although
bulky powders, are easily taken. Vinum Ferri is an agreeable

FEKR i MA 8 1

preparation largely prescribed for children. The Aromatic
Mixture, containing cinchona and aromatic bitters, is a valuable
stomachic tonic and haematinic.

2. Compounds of Iron with the Mineral Acids.— Ferri
Sulphas in its various forms, Liquor Ferri Perchloridi and its
preparations, and Liquor Ferri Pernitratis, are comprised in this
group, which are characterised by their corrugating and as-
tringent action. They are, therefore, chosen in all the external
and internal applications of iron for local purposes, especially as
haemostatics. The strong solution of the perchloride is injected
into the uterus in post partum haemorrhage in the form of a
watery solution (1 part to 3) with the best results. Cotton
wool or lint soaked in the same solution is used for plugging
deep wounds, the cavities of the nose, mouth, etc., in haemorr-
hage ; but the action of the iron on the surfaces of wounds, and
the extensive coagulation which it sets up in the veins, are both
objections to its employment, unless the bleeding cannot other-
wise be arrested. Internally these astringent preparations may
be given in haemorrhage from the stomach or bowels, kidneys
or bladder; but not, as a rule, in haemoptysis. As haematinics,
the tincture or liquor of the perchloride and the pernitrate, well
diluted, are much given to convalescents after the appetite has
been restored, and to persons who require a tonic, as well as in
passive haemorrhages and chronic inflammatory discharges, such
as leucorrhcea. In ordering this class of iron salts, we must care-
fully observe the various precautions already mentioned in
connection with digestion. Protosulphate is well borne in the
form of pill (Blaud).

3. Compounds of Iron with Vegetable Acids. — These are
the Ferri et Ammonias Citras, Ferrum Tartaratum, and Tinctura
Ferri Acetatis. They are at once the weakest, the blandest, and
the least constipating preparations of iron, and are therefore
employed when only small quantities of the metal have to be
given over a length of time as a tonic, or to commence a course
of haematinics when the alimentary canal cannot tolerate the
stronger preparations. They make but little impression upon
the more severe forms of anaemia. They can be given with
alkalies.

4. Compounds of Iron with other active bodies.— Iron is
combined in the Pharmacopoeia with iodine — Ferri lodidum ;
with arsenic acid — Ferri Arsenias ; with phosphoric acid — Ferri
Phosphas. ; and with quinine — Ferri et Quiniae Citras. Speaking
generally, it may be said that in these preparations the iron is
intended to relieve anaemia, or to act as a tonic in the sense we
have described, whilst the other constituent is specifically
influencing the diseased condition on which the anaemia or

G— 8

82 MATER i A MEDIC A AND THERAPEUTICS.

debility depends. Thus the iodide of iron is employed in
syphilis and scrofula ; the arseniate in chronic diseases of the
skin, liver, etc., with a gouty, rheumatic, or malarial taint ; the
phosphate in diseases of the hones, such as rickets ; and the
compound with quinine in malarial cachexia, where it may
rapidly restore the blood corpuscles. But all the preparations
of this group, and especially the last, are also used as ordinary
tonics, according to circumstances.

The Solution of the Persulphate of Iron is introduced solely
as a source of several other preparations. Ferri Peroxidum
Humidum is the best form as an antidote to arsenic, the rationale
of which has been already explained.

MANGANESIUM. Mn. MANGANESE.

The only salt of this metal in the Pharmacopoeia
is the black oxide ; but permanganate of potash,
which is derived from it, is best discussed under this
head.

Manganesii Oxidum NigYiim. — Black Oxide
of Manganese. Mn02. A heavy black powder.

From Hanganesn Oxidum Nigrum is made :

Potassse Permanganas.— Permanganate of Potash.
KMn04.

Source. — Made by (1) evaporating a mixture of Black
Oxide of Manganese, Chlorate of Potash, and Caustic
Potash in water, pulverising the residue, heating it to red-
ness, cooling and piilverising; then (2) boiling in Water,
neutralising with Diluted Sulphuric Acid, and e vaporati ng.
(1) 3Mn02 + KC103 + 6KHO = 3K2Mn04 + KC1 -f
3H2O ; a manganate being formed. (2) 3K2Mn04 -j-
2H20 = 2KMn04 + 4KHO -f Mn02 ; the manganate
becoming permanganate by boiling.

Characters. — Dark purple, slender prisms, in-
odorous, with a sweet astringent taste, yielding an
intense purple solution when moistened. Solubility, 1
in 16 of water. Is very rapidly deoxydised in the pre-
sence of organic matter into hydrated peroxide of manga-
nese, losing its purple colour for a brown.

Impurities. — Sulphate of potash, and black oxide of
manganese ; detected by being less soluble in water, and
by volumetric test.

Dose. — 1 to 2 gr.

MANGANESIUM. 83

Preparation.

Liquor Potassao Pennanganatis. — 4 gr. to 1
fl.oz. Dose, 2 to 4 fl.dr.

Mancjanesii Oxidum Nigrum is also used in making Liquor
Chlori and Hydrargyri Perchloridum.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally.— Permanganate of potash is an irritant or even
escharotic in the pure state, stimulant in the form of the
solution, and has a healing effect upon scars and wounds. The
principal applications, however, are independent of its physio-
logical action on the human tissues, and due to its influence as
an antiseptic, disinfectant, and deodorant, that is, to its action
on the processes and products of sepsis, fermentation, and
decomposition. By its power of giving up oxygen freely, the
permanganate either destroys the ferment or organism on which
these processes depend, or forms chemical compounds with
the materials on which they flourish (the tissues, plasma,
pus, etc.), incapable of decomposition: it is thus an antiseptic.
By similarly oxydising the products of decomposition already
begun, it so alters their chemical properties as to deodorise and
decolorise them, and possibly destroys also the power of
further infection which such products generally possess : it is
thus u disinfectant. Permanganate of potash may therefore be
: s a dressing for foul ulcers ; but other substances,
possessing special advantages, are generally preferred for this
purpose.

Internally. — This salt is employed as a mouth- wash in foul
condition of the teeth and mouth, as a garglo in putrid sore-
throat, and as an injection in infective and foul discharges,
such as gonorrhoea, vaginitis, ozoena, and cancer of the uterus.

2. ACTION IN THE BLOOD, SPECIFIC ACTION, AND REMOTE
LOCAL ACTION.

Nothing is definitely known of the action of permanganic
acid on the blood, tissues, or organs of excretion. It isditlicult
to believe that any portion of the salt escapes decomposition
before absorption, unless given in poisonous doses; and the
oxide of manganese, into which it is converted, is believed \<>
be inert. The internal administration of the potash salt for
some sxipposed effect on infective fevers or iratmr. nous pro-
cesses must therefore be useless. It has recently been used as
an emmenagogue in amenorrhoea.

84 MATER i A MEDIC A AND THERAPEUTICS.

By far the most important application of permanganate of
potash is as a disinfectant and deodorant, apart from the human
body : to disinfect stools and foul discharges after removal from
the patient ; to wash utensils ; and to flush water-closets, etc.
Its great advantages are, that it is rapid and complete in its
action ; odourless and non-poisonous in solutions of ordinary
strength ; and that it shows by change of colour whether it is
acting or exhausted. The principal disadvantage connected
with it is its expense.

vHYDKARGYRUM. Hg. 200. MERCURY.

This metal is of the first therapeutical importance,
and a large number of salts and other preparations are
made from it.

Hydrargyrum. — Mercury. Hg.
Characters.— A fluid metal, brilliantly lustrous.
Impurities. — Lead, tin, etc. ; detected by being non-volatile.

Preparations.

a. Hydrargrymn cum Greta. — 1, with 2 of Chalk.
Dose, 3 to 8 gr.

b. Emplastrum Hydrargyri.— 1 in 3.

c. Emplastrum Ammoniac! cum Hydrargyro. —
1 in IT

d. Pihila Hvdrargvri.— " Blue Pill." 1 in 3, with
Confection of Roses and Liquorice. Dose, 3 to 8 gr.

e. Ungriflnfaim Hydrargyri. — " Blue Ointment."
Nearly 1 in 2.

From Unguentum Hydrargyri are prepared:

a. Linimentum Hydrargyri. — 1 of Ointment, to
1 of Liquor Ammonias, and 1 of Linimentum Cam-
phor 83.

j8. Unguentum Hydrargyri Compositum. —
6, with 7J Olive Oil, Wax, and Camphor.

•y. Suppositoria Hydrargyri. — 5 gr. of oint-
ment in each.

From Hydrargyrum are made :

f. Ijvdrargyri Oxidum Rubruin. — Red Oxide of
MercuryvTigO .

Source. — Made by triturating together and heating

HYDRARGYR UM. 8 5

Mercury, and Mercuric Pernitrate obtained by dissolving
Mercury inNitric Acid. (1) 3Hg + 8HN03=3(Hg'2N< >,)
-f 2NO + 4H20. (2) Hg2N03 -f Hg = 2HgO -f 2N02.

Characters. — An orange-red powder, insoluble in
water.

Impurities. — Red lead and brick-dust ; detected by
being non- volatile. Nitrate of mercury; by yielding
nitrous vapours by heat.

Dose. — £ to 1 gr.

Preparation.

Unguentum Hydrargyri Qxidi Rubri. — " Red
Precipitate Ointment." 1 in 8.

g. Hydrargyri lodidum Viride. — Green Iodide of
Mercury. Hgl.

Source. — Made by rubbing together Mercury and
Iodine in the presence of Rectified (Spirit.

Characters. — A dull green powder, insoluble in water.

Impurity. — Biniodide of mercury, found by long
keeping ; detected by being soluble in ether.

Dose. — 1 to 3 gr^

h. Hydrargyri Sulphas. — Sulphate of Mercury.
HgS04.

Source. — Made by dissolving Mercury in hot Sul-
phuric Acid, and drying.

Characters. — A white, heavy, crystalline powder.
Used only to prepare calomel and corrosive sublimate.

From Hydrargyri Sulphas are made :

a. Hvdrargyri Subchloridum. — Subchloride of
Mercury. Calomel. HgCl.

Source. — Made by subliming a mixture of Sul-
phate of Mercury, Mercury, and Chloride of Sodium ;
and washing with boiling water. (1) HgSO4 -+•
Hg - Hg2S04. (2) Hg2S04 + 2Nad = 2HgCl +

Characters. — A dull white, heavy, nearly taste-
less powder, insoluble in water and spirit.

Incompatible with iodide of potassium, nitro-
hydrochloric acid, hydrocyanic acid, solutions of
lime, potash, and soda.

Impurities. — Perchloride of mercury ; detected
by being soluble in warm ether. Other chlorides;
non-volatile.

Dose. — £ to 5 gr.

86 MATER i A MEDIC A AND THERAPEUTICS.

Preparations.

i. Lotio Hydrargyri Nigra . — Black Wash.
Calomel, 30 gr. ; Lime Water, 10 fl.oz.

ii. Pilula Hydrargyri Subchloridi Com-
S/ posita. — Plummer's Pill. Calomel, 1; Sulphur-
ated Antimony, 1 ; Guaiacum Resin, 2 ; Castor
Oil, 1. Dose, 5 to 10 gr.

iii. Unguentum Hydrargyri Subchloridi.
~

B. Hvdrargyri Perchlpridum. — Perchloride of

Mercury. " Corrosive sublimate." HgCl.,.

Source. — Made by subliming a mixture of Sul-

phate of Mercury, Chloride of Sodium, and Black

Oxide of Manganese. HgSO4 -f 2NaCl = HgCl2 +

, Na2S04. The manganese simply prevents the f or-

Imation of calomel.

Characters. — Heavy colourless masses of pris-
matic crystals. Solubility, 1 in 20 of water.

Incompatible with alkalies and their carbonates,
lime-water, tartar emetic, nitrate of silver, acetate
of lead, albumen, iodide of potassium, soaps, decoc-
tion of bark.

Impurities. — Fixed salts ; detected by not vola-
tilising.

Dose.—^ to i gr.

Preparation*.

i. Liquor Hydrargyri Ferchloridi. — J gr.
in 1 fl.oz. (r^ gr. in 1 fl.dr.). Dose, 30 to 120
min.

ii. Lotio Hydrargyri Flava. — " Yellow
Wash." Corrosive Sublimate, 18 gr. ; Lime
Water, 10 fl.oz.

From Hydrargyri PerchJoridwn are made :

iii. Hydr-argyri lodidum Rubrum. — Red

Iodide of Mercury. HgI2.

Source. — Made by mixing hot solutions of
Perchloride of Mercury, and Iodide of Polas-
sium, and purifying the precipitate. HgCL +
2KI = Hgl, + 2KC1.

Characters. — A vermilion crystalline pow-
der. Soluble feebly in water, freely in ether.

Jin purities. — As in the perchloride.

Dose. — ^ to j gr.

HYDRARGYR UM. 8 7

Preparation.

TJnguentum Hydrargyri lodidi Rubri. —

] in 28.

iv. Hydrargyrum Ammoniatmn. — Am-
moniated Mercury. " White Precipitate."
NH2HgCl.

Source. — Made by precipitating a solution
of Perchloride of Mercury with Solution of
Ammonia. HgCL, + 2NH4HO = NH2HgCl +

NH4C1 + 2H,0.

'Characters. — An opaque white powder, in-
soluble in water, spirit, and ether.

Impurities. — As in the perchloride.

Preparation.

IJnguentum Hydrargyri Ammoniati. —
1 in ?L

v. Hydrargyri Oxidum FlavTim. — Yellow
Oxide of Mercury. HgO.

Source. — Made by precipitating a solution
of Perchloride of Mercury with a Solution of
Soda.

Characters. — A yellow powder.

Impurities. — As in the perchloride.

i. Liquor Hydrargyri Nitratis Acidus.— Nitrate
of Mercury, Hg2NO3, in solution in nitric acid.

Source. — Made by dissolving Mercury in Nitric Acid
and Water.

Characters. — A colourless, strongly-acid liquid.

Impurity. — Subnitrate of mercury; detected by
giving precipitate when dropped into diluted hydrochloric
acid.

j. Unguentum Hydrargyri Nitratis. — Citrinn
Ointment. Made by adding Lard melted in Olive Oil
to a solution of Mercury in Nitric Acid.

Non-officinal Preparations o

Qlcate of Merciiyy. — Made by dissolving •"> to 20 per
cent, of Yellow Oxide of Mercury inOlrie A<-M.

Donovan's Solution. — Solution of Hydriodate of
Mercury and Arsenic. Dose, 10 to 30 min.

88 MATERIA MEDIC A AND THERAPEUTICS.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Mercury in the form of the acid solution of
the nitrate is a powerful caustic, employed to destroy growths
on the skin, such as lupus^ "but must be used with caution.
The perchloride applied in weak solutions is not absorbed, but
acts destructively on organisms on or in the skin, such as those
of ringworm. Stronger solutions cause inflammation of the
skin, and concentrated solutions are caustic ; but neither effect
is surgically employed. A weak solution (gr. \ to the oz.) is
used as a disinfectant and stimulant to ulcers, acting like
other metallic salts (see pages 60 and 64), at the same time
being absorbed, and producing the specific effects of the metal.
Mercury itself, and most of the other preparations, cause little
or no irritation of the skin, unless rubbed into it for some time.

The various methods of administering mercury locally must
here be noticed.

(1) In the form of the ointment, metallic mercury may be
applied by inunction, i.e. rubbed into a soft part of the skin.
Thus applied, mercury undoubtedly enters the blood ; but it
has been contended that the metal is not admitted by the skin,
but through the lungs, in the form of the vapour arising from
the heated body smeared with the ointment, or even in small
particles by the mouth. Fortunately, the question is of no
practical importance, the fact remaining that the system can be
quickly brought under the influence of mercury by inunction.
The non-officinal oleate painted on the skin quickly conveys the
metal into the system.

(2) The subchloride (calomel) may be administered by
fumigation. The vapour of calomel, rising from a vessel heated
by a lamp, is conducted to a part or to the whole of the surface
of the body of the patient, and there allowed to settle as a fine
deposit of the salt. The effect is increased by simultaneous
diaphoresis, induced either by the vapour of water or by such a
drug as jaborandi. 20 gr. of calomel may thus be fumigated,
during a sitting of twenty minutes. The same doubt exists as to
the precise way in which the calomel thus applied enters the
blood.

(3) As a bath of dilute solutions of the perchloride, say 3 dr.
to 30 gallons of water, with 1 dr. of hydrochloric acid.

(4) Mercurials may be dusted on to the raw surface of a
blistered portion of the skin, or soft syphilitic growths (con-
dylomata) — the endermic method, when it is rapidly absorbed.

• .i <-»•*> .

-4-C^

HYDRARGYRUM. 89

(5) Solutions of the perchloride (albuminates or peptonates)
may be injected hypodermically — a powerful method, but apt to
produce sores.

(6) The vapour of mercurials may be inhaled, as we have
seen ; but this method is rarely employed intentionally.

(7) Mercury may be given per rectum, as the officinal sup-
positories.

The action of mercury admitted to a part of the body by
any of these channels is usually more than local, the specific
effects of the drug, presently to be described, being shortly
developed. At the same time, the local effect will be more
marked : skin diseases will be healed, condylomata removed,
and indurations and chronic inflammatory processes reduced in
connection with the bones or joints.

Internally. — The local action of mercury is the same as
externally, according to the nature and strength of the prepara-
tion employed. Very dilute solutions of the perchloride (4 gr.
to 10 fl.oz., with 8 min. of hydrochloric acid) may be used as a
gargle or wash for syphilitic ulcers of the tongue and gums.g
All the salts of mercury act upon the mouth, gums, and salivary
glands, causing salivation ; but this effect is due to their excre-
tion, not to their immediate influence on the parts, and will be
described later.

In the stomach, mercurials combine with the chloride of
sodium of the secretions, and, whatever their original form, are
converted into a double chloride of sodium and mercury, which
further unites with the albuminous juices, to form a complex
molecule of mercury, sodium, chlorine, and albumen. This
compound, although precipitated at first, is soluble in an excess
either of chloride of sodium or of albumen; exists in the
stomach, therefore, in solution ; and is readily diffusible and
easily absorbed. It is not specially irritant in moderate quan-
tities, and none of the salts of mercury given in medicinal doses
produce vomiting like zinc and copper ; indeed, Dr. Ringer lias
shown that calomel in TVgr. doses, or Hydrargyrum cum Greta
in ^-gr. doses, given every two or three hours, arrests some forms
of vomiting in children. In large or concentrated doses, how-
ever, mercurials are irritant or corrosive to the stomach, and
must be given with caufion, after meals.

The irritant effect of mercurials continues in the duodenum,
naturally taking the form of purgation. The perchloride is
never employed to produce this effect, but divided mercury in
the form of the Pilula Hydrargyri and Hydrargyrum cum Greta,
and Calomel, are common purgatives. The action of mercurials
as purgatives is a purely local one, none of the metal li«-ini*
absorbed, but the whole expelled in the fieces. The exact

90 MATERIA MEDICA AND THERAPEUTICS.

nature of this action is, however, obscure. Probably the intes-
tinal glands are chiefly stimulated to increased secretion, and
the mucous membrane irritated to such a degree as to produce
a moderate increase of watery exudation from its vessels into
the bowel, peristalsis becoming more brisk at the same time.
The result is a thorough evacuation of the contents of the
small intestine as a large, loose, but not watery, stool, charged
with bile, which has been hurried out directly from the duo-
denum, and not allowed to re-enter the portal circulation by
absorption from the lower bowel, as it normally does. Thus
mercurials, especially calomel, increase the amount of bile
evacuated without increasing the amount secreted ; that is,
are indirect cholagogues by being duodenal purgatives. The
manner in which indirect cholagogue action stimulates the liver
to further secretion is discussed in Part III. The purgative
action of mercurials is greatly assisted by a subsequent saline,
such as Seidlitz powder, or the Mistura Sennae Composita. The
class of diseases in which mercurials are selected as purgatives
chiefly include cases of congestion of the portal system and
liver, especially those referable to secondary indigestion from
free living or gout ; cases of constipation attended by irritable
stomach, or actual ulceration of the stomach or bowels ; very
rarely cases of habitual constipation, except at long intervals,
to enable gentle laxative measures to act more freely; and
occasionally diarrhoaa, when it is distinctly referable to biliary
derangement, or the presence of an irritant in the bowel, as in
children.

2. ACTION ON THE BLOOD AND ITS USES.

As we have seen, mercury enters the blood freely through
the broken or unbroken skin. From the bowel but a small
part of a medicinal dose is absorbed, the rest passing off in the
faeces as the sulphide, unless combined with opium, which
delays its progress through the intestine. The complex mole-
cule which mercury forms in the stomach and intestines is
decomposed on entering the blood by combination with oxygen
and albumen, an oxyalbuminate of mercury being the result,
and apparently the same compound is formed when the metal
enters by other channels.

No direct effect on the blood can be attributed to mercury ;
but impairment of nutrition generally, including digestion,
attends its excessive use, and induces impoverishment, both of
Ilic ]>lasma and the corpuscles, indirectly referable to the drug.
The blood under these circumstances is more watery and coagu-
lates less firmly, and nutrition may be further disordered in
consequence, with the production of low forms of inflammation

HYDRARGYRUM. 91

an 1 ulceration. But it is to be clearly understood that this
is not in any sense a specific effect of mercury, and that the in-
fluence of mercury upon inflammatory products and syphilitic
growths, to be presently described, is not exerted through
tlie blood, but upon the tissues themselves. The impoverishing
effect of this drug upon the blood must be constantly kept in
mind, and the quality of the blood sustained by abundance of
food, and the strictest attention to digestion.

3. SPECIFIC ACTION.

Mercury quickjy leaves the blood and enters the tissues,
where it is apt to remain almost indefinitely, being excreted
with comparative slowness, especially when the kidneys are
diseased. It has been found in every organ of the body, most
abundantly in the liver. It is a remarkable fact, however,
that no definite anatomical change has ever been demonstrated
in the viscera, such as the vessels, liver, or nervous system,
even in cases of chronic poisoning by this metal ; mercury in
this respect again differing from lead, silver, antimony, and
arsenic. Whilst, therefore, the specific action of mercury is
unquestionable, its mode of action is still obscure, and
numerous theories have been proposed to account for it, which
need not be fully discussed here. The most probable explana-
tion of the effects of mercury upon nutrition may be said to be
that in some way or other it interferes with the growth or life
of germinal cells, and that it has therefore an alterative in-
fluence on certain processes, such as inflammation and syphilis,
which are characterised by a growth of small young cells.
Possibly, it may have a destructive influence on certain ferments
and organisms connected with physiological and pathological
metabolism, one of these being the organism of syphilis.

Whatever may be the explanation of its action, mercury
produces a train of symptoms, when given for a considerable
period in moderate doses, known as " hydrargyrisui," which
chiefly take the form of debility ; nervous phenomena, including
muscular tremors and paralysis, pains, and mental disturbance ;
cardiac depression ; ulceration of the skin, mouth and in
membranes; salivation, dyspepsia, and diarrhea. Tin- tem-
perature is not directly raised, nor the i-xeivtioiis in
that there is no positive evidence of increased metabolism as
an effect of mercury.

4. SPECIFIC USES.

The uses of mercury as a specific remedy bear no definite
relation to these effects, which have been mentioned chiefly

92 MATER i A MEDIC A AND THERAPEUTICS.

that they may be recognised and arrested. The principal
application of the drug is as an " alterative " in syphilis, a
disease attended by the growth of cells around the small
vessels, and the development of these into nodes, gummata,
various eruptions, etc. Mercury has a powerful influence in
controlling the severity of this disease. Its employment may
be commenced with various local applications to the primary
sore, and regular internal doses of the solution of the per-
chloride, calomel, grey powder, or some of the other prepara-
tions, until salivation threatens. It is generally (not
universally) believed that the secondary stage is rendered less
severe, or is even entirely prevented by this means. The drug
must be continued during the appearance of secondary symp-
toms ; but, as a rule, it is better omitted in the tertiary stage.
The particular preparation employed varies with the experience
of the practitioner. Quinine and opium are useful means of
support to be combined with mercury in a course of the metal,
and we must repeat that, unless the appetite and digestion
continue good, its use must be interrupted.

The other use of mercurials as alterative remedies is in
internal inflammations, especially inflammation of serous
membranes, such as peritonitis, pericarditis, pleurisy, menin-
gitis, and orchitis. This line of treatment, once universal in
England, is now almost obsolete, excepting, perhaps, in peri-
tonitis of a subacute or chronic kind, in which, as in most
instances where it is used as an antiphlogistic, mercury is
combined with opium. Possibly some of the benefit thus
attending mercurialisation in inflammation, and which was
formerly referred to a " resolvent " action on the fibrin of exu-
dations, is due to its purgative and indirect cholagogue effects.

5. REMOTE LOCAL ACTION AND USES.

Mercury passes out of the system in all the secretions — the
saliva, sweat, milk, urine, and bile, probably as an albuminate,
and stimulates many of the glands en route. It is in this way,
as we have seen, a powerful sialagogue, causing swelling of
the salivary glands and a profuse flow of the secretions of the

v mouth. This effect is important only because it is to be
avoided. The diaphoretic effect of mercury is comparatively
insignificant. Whilst it does not increase of itself the volume

\oi urine, it assists to a marked degree such diuretics as
digitalis and scilla ; but it must not be given in kidney disease, as
it acts injuriously on the diseased tubules, and readily produces
its debilitating effects when the renal function is impaired. In
the faeces mercury leaves the body as the sulphide, being de-
rived, first, from that considerable portion of the dose which is

i'^T. 93

not absorbed ; and, secondly, from the portion excreted by the
liver (in the bile), and by the pancreas and intestinal glands.
It will thus be seen that but little use is made of the remote
local action of mercury.

6. ACTION AND USES OF THE DIFFERENT PREPARATIONS OF
MERCURY.

The preparations of mercury, although so numerous, can
be readily remembered, and their special actions understood,
when they are classified as follows :

1. Metallic Mercury and preparations containing it.

2. The Perchloride of Mercury and its preparations.

3. The Subchloride of Mercury and its preparations.

4. The Oxides, Iodides, the Ammoniated Mercury, and their
preparations, a complex group, the action and uses of which
closely correspond either with those of the perchloride or with
those of the subchloride.

5. Acid Nitrate of Mercury and the Ointment corresponding.
1. Metallic Mercury and its preparations. — These may

be employed in all the classes of cases for which mercurials are
adapted. The metal itself is never given internally, except in
the finely-divided form in which it exists in Pilula Hydrargyri
and Hydrargyrum cum Greta. The blue pill is chiefly used
as a purgative and indirect cholagogue, but is also given in sy-
philis, in small doses combined with opium and quinine, and in
combination with digitalis and scilla as a diuretic (the famous
" Guy's pill)." Hydrargyrum cum Cret&, or " grey powder,"
is a favourite purgative for children, and also a convenient pre-
paration for a course of mercury in syphilis. Unguent \\ m
Hydrargyri, or " blue ointment," is the usual means of admini-
stering the metal by inunction in syphilis. A portion as large
as a pea or hazel nut is rubbed daily into a soft part of the skin,
such as the inside of the thigh, or smeared on flannel, and ap-
plied round the loins, the gums being carefully wati-hrd.
This is a very sure and tolerably safe, but very dirty method,
which is chiefly employed with infants. The non-officinal oleate,!^
painted on, is a great improvement in this respect. Mercurial
ointment may also be smeared over inflamed parts, such as tho
testis, and is used as a parasiticide. The Liniment of ML-ivury
(the ointment in a liquid form) is chiefly employed as an anti-
phlogistic, being soaked on lint and applied to the attWtrd
l>;irt, e.g. the joints or the abdomen in subacute peritonitis,
The same use may be made of the plasters, and of the compound
ointment, " Scott's dressing." The suppository may be used in
syphilis or to kill ascarides.

94 MATERIA MEDICA AND THERAPEUTICS.

2. Pel-chloride of Mercury. — This is the most powerful o!
all mercurials. It is one of the most active of antiseptics, being
100 times as strong as carbolic acid, and may be used to dis-
infect foul ulcers, especially of syphilitic origin, a certain
amount of caustic and stimulant effect being secured at the
same time. It must be cautiously employed. It is also used
to destroy the fungus of ringworm. Internally, as the Liquor
(a weak solution) , it is given in syphilis only, never as a purga-
tive. In this form, the perchloride is by no means an irritant
preparation of mercury, but rather the reverse. Lotio Hy-
drargyri Flava, " yellow wash," containing the yellow oxide, is
applied to syphilitic sores.

3. Subchloride of Mercury. — Calomel resembles metallic
mercury in being used externally and internally, as a purgative,
alterative, and antisyphilitic remedy. Externally it is applied
to syphilitic sores and chronic inflammatory growths as calomel
dust, by fumigation, as the unguentum, and as the black wash.
Internally calomel is a valuable purgative, with the powerful
action as an indirect cholagogue and hepatic stimulant already
described. The compound calomel pill (Plummer's pill) is in
much repute as a hepatic stimulant and alterative, with little or
no directly purgative effect, given every night or every other
night for a week at a time, in gout and loaded conditions of the
system consequent on free living. Calomel, combined with
opium, was the favourite mercurial employed by the last
generation of surgeons and physicians in the treatment of
inflammation, to which we have already referred. In syphilis
the same combination is still employed with success.

4. The Oxides, Iodides, and Ammonio-Chloride of Mercury.
— These substances, although forming a convenient group,
belong, as regard their action and uses, partly to the second and
partly to the third group above. Thus the following closely
resemble the perchloride, viz. llydraryyri < >xidum Flavum, Hy-
dra r^yri Oxidum Rubrum, Hydrargyri lodidum Rubrum, and
Hydrargyrum Ammoniatum. The first two are almost exclu-
sively used in syphilis, and externally, cliiclly according to the
opinion and custom of the practitioner. The " white precipitate"
ointment is useful as a parasiticide, and as a stimulant applica-
tion to chronic inflammatory eruptions of almost any kind in
ehildrt >n. Along with the Subchloride is to be classed Hydrargyri
lodidum Yiride, which is much used in syphilis by some sur-
geons. Donovan's Solution is valuable in obstinate syphilides.
The student will not forget that the Lotio Hydrargyri Flava
really contains the yellow oxide, and the Lotio Hydrargyri
Niin'a, the black oxide, although they are reckoned as pre-
parations of the perchloride and Subchloride respectively.

'

ARSENICUM. 95

5. Liquor Hydrargyri Nitratis Acidus, and the Ointment
of the Nitrate. — These are not usnl in syphilis; but the former
is used as a caustic in lupus and other limited growths and
ulcers of the skin ; while the ointment is of value as a stimulant
in cases of chronic skin disease, and is applied to the edges of
the eyelids in chronic inflammation and ulceration of the hair
follicles.

Precautions in the use of mercurials. — Mercury must not j
be given as an alterative, antiphlogistic, or antisyphilitic
remedy in persons with anaemia or debility, unless these are
distinctly referable to syphilis, and even then it must be em-»
ployed with caution. Tuberculosis and kidney disease also}
centra-indicate the use of mercury ; and certain individuals will
occasionally be met with in whom even small doses of calomel
or blue pill quickly induce hydrargyrism by a kind of idio-
syncrasy. In every instance the patient must be carefully
nourished, as we have said. On the contrary, children — even
infants — bear mercury very well, although the prolonged ad-
ministration of the metal to them appears to produce a peculiar
change in the permanent teeth when they appear, which is
extremely unsightly ("mercurial teeth " of Hutchinson).

GROUP III.

THE METALLOIDS.

«/AKSENICUM. ARSENIC. As. 73.

Acidiiiii ArseilJQSUlll, — Arsenious Acid. \Vhito
Arsenic. As^g.

•'•<?. — An anhydrous acid, obtained by roasting Arsenical
Ores, and purified by sublimation.

Characters. — A heavy white powder, or stratified opaque
Solubility, 1 in 100 of cold water ; 1 in 20 of boiling
water. Incompatibles : Salts of iron; magnesia, lim> -
aiid astringent m;r

LnjtK) itifs. — Limr salts ; detected by non-volatility.

Lose. — fa to ^ gr. in solution.

Preparations.

a. Liquor Arsenicalis.— " Fowler's Solution.'*
Source. — Made by dissolving Arsenious Acid and
Carbonate of Potash in Wat.T, and culuurin.u1 with Com-
pound Tincture of La vender. 4 gr. in 1 ll.oz.

96 MATER i A MEDIC A AND THERAPEUTICS.

Characters. — A reddish liquid, alkaline to test-paper,
with the odour of lavender.
Dose. — 2 to 8 min.

b. Liquor Arsenic! Hydrochloricus. — Hydrochloric
Solution of Arsenic.

Source. — Made by boiling Arsenious Acid with Hy-
drochloric Acid and Water. No decomposition occurs.
4 gr. in 1 fl.oz.

Characters. — Colourless, with an acid reaction.

Dose. — 2 to 8 min.

From Acidum Arseniosum is made :

c. Sodse Arsenias. — Arseniate of Soda. Na2
HAs04.7H20.

Source. — Made by fusing Arsenious Acid with Ni-
trate and Carbonate of Soda, boiling the products in
Water, and crystallising. (1) As203 -f 2Na2N03 +
Na2C03 = Na4As2Or -f N203 + C02. (2) Na4As207 +

Characters. — Colourless transparent prisms. Solu-
bility, 1 in 2 of water. The solution is alkaline.
Dose. — tV to £ gr.

Preparation.

Liquor Sodae Arseniatis. — 4 gr. in 1 fl.oz.
Dose. — 5 to 10 min.

From Arseniate of Soda is made :
Ferri Arsenias. See Ferrum.

Non-officinal Preparation of Arsenic :
Donovan's Solution. Solution of Hydriodate of
Arsenic and Mercury. Dose, 10 to 30 min.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Arsenious acid is a powerful irritant and
caustic. It is used occasionally to destroy lupus, epithelioma,
and other superficial or limited new growths, in the form of
"paste," composed of Arsenious Acid (1), Charcoal (l),RedSul-
phuret of Mercury (4), and Water. In the form of a dilute
ointment, it is employed in psoriasis to remove the scaly
growth. Arsenic must be used locally with great care, as it is
absorbed by the broken skin, ulcers, and mucous membranes,
unless sufficient inflammation be set up to throw it off.

*j

. 97

Internally. — The local corrosive action of arsenic may be
employed in caries of the teeth to destroy the painful pulp before
stopping, a paste composed of 2 parts of arsenious acid, 1 part
of sulphate of morphia, and a sufficiency of creasote to make a
stiff compound, being placed in the cavity.

Reaching the stomach in medicinal doses, the preparations
of arsenic do not combine with the albuminous contents like
mercury, but remain unchanged. They thus act upon the
mucous membrane, stimulating the nerves and vessels, causing
a sense of heat and hunger, and increasing the gastric function.
In these small doses arsenic is employed with advantage in
some cases of gastrjc dyspepsia, and a similar effect on the
duodenum makes it of some value in lienteric diarrhoea. If the
dose be increased, the stimulant action passes readily into
irritation of the stomach attended by pain, sickness, and
diarrho?a from intestinal excitement. These symptoms are to
be remembered only that they may be avoided, or arrested if
they should arise.

2. ACTION ON THE BLOOD AND ITS USES.

Arsenic enters the blood and combines with the corpuscles,
not with the serum, as an albuminate ; if in excess, it reduces
the number of the blood cells, as well as their oxygenating
power. It has been used with success in some forms of anaemia ;
but less frequently in idiopathic cases than where the corpuscles
and plasma have suffered from failure of nutrition elsewhere
(symptomatic anaemia), as in tuberculosis, malaria, gout, and
rheumatism. Alone or combined with iron, it has sometimes
an excellent effect in restoring the blood in such cases.

3. SPECIFIC ACTION AND USES.

Arsenic enters all the organs and tissues, but is not known
to combine with their albuminous constituents; it remains in
them for a short time only ; and is quickly excreted. During
this period, however, it distinctly influences metabolism. It
first reaches the liver, and diminishes the amount of glycogen
in it, so that it may be occasionally, but by no means often,
used with success in diabetes. In the other organs it interferes
similarly with metabolism, apparently (like phosphorus) through
the oxygenating process. An increased amount of nitrogenous
waste appears in the urine; the temperature rises; and the
excessive fatty product of the albuminous decomposition remains
unexcreted, constituting fatty degeneration. Short of this
effect, arsenic produces a wholesome increase of the metabolism,
or vital activity of all the organs, and is therefore given as a
general tonic, and as a valuable alterative in such classes of
H-8

98 MATERIA MEDICA AND THERAPEUTICS.

disturbed nutrition as gout and chronic rheumatism. It is
possible that arsenic affects the life processes of other living
particles in the body besides the tissue elements, namely, the
organisms of certain diseases. Thus it is, next to quinine, the
most successful medicinal agent in the treatment of chronic
malaria, brow-ague, and other varieties of neuralgia due to the
same cause, and malarial cachexia ; and is also used with advan-
tage in hay-fever. li; sometimes also dispels lymphomatous
tumours. Beyond a safe amount, arsenic produces a series of
nutritive disorders in the tissues, characterised chiefly by de-
bility and nervous disturbances, known as " chronic arsenical
poisoning," which need not be detailed here.

Next to nutrition generally, the nervous system appears to
be most influenced by arsenic, which is found abundantly in
the grey matter of the cord in poisoning by this metal. Here
it acts by diminishing the sensibility and reflex irritability of
the centres, as well as of the motor nerves and muscles. Pre-
parations of arsenic are useful in chorea, various forms of
neuralgia, and spasmodic asthma, especially when malaria or
anaemia, or both, may happen to be associated with the neurosis.
Like phosphorus, arsenic is said to cause increase of the com-
pact tissue of bone at the expense of the medullary tissue, but
it is not specially used to produce this effect. In large doses it
has a depressing effect on the respiration, circulation, and tem-
perature.

4. REMOTE LOCAL ACTION AND USES.

Arsenic is excreted chiefly in the urine in the form of
arsenious acid; also by the liver and skin. It is not known
to affect the kidney specially, but is sometimes used in chronic
Bright's disease. The liver, as we have seen, is modified
in its activity; and part of the value of arsenic in chronic
gout, gravel, and skin diseases, may be referable to its action on
the greatest metabolic organ in the body. Either thus indirectly,
or directly, its effect on the skin is so remarkable, that it
is the most valuable of all internal remedies for certain erup-
tions obviously connected with disordered nutrition, such as
psoriasis, chronic eczema, acne, and pemphigus, whilst it aggra-
vates such diseases as erythema multiforme. Donovan's Solu-
tion is used in syphilides.

5. METHODS OF ADMINISTERING ARSENIC, AND PRECAUTIONS

IN ITS USE.

Arsenical preparations should always be given immediately
at the end of meals, unless their gastric effect be desired, which
is rarely the case ; and they ought not to come in contact

•tour.

PHOSPHOR i ~s. 9 9

with the exposed mucous memhrane. For the same reason they
must not be given as alteratives if dyspepsia be present.
Epigastric f ulness, pain, and tenderness, a sense of constriction
in the throat, irritation or soreness of the conjunctiva, and
especially vomiting, ought to suggest a diminution or suspension
of the drug. Children bear arsenic with comparative ease,
whilst old subjects are said to bear it badly. A combination of
iron with arsenic (for example, Vinum Ferri with Liquor Ar-
senicalis) is one of the best of haematinics and tonics, probably
because the iron affords a supply of oxygen sufficient to carry
to a complete termination the increased metabolism produced by
the arsenic.

v PHOSPHORUS. P. 31.
A non-metaffic element obtained from bones.

Source. — Prepared from Phosphoric Acid or Superphosphate
of Lime (obtained by acting on bone-ash by oil of vitriol), by
distillation with Charcoal.

Characters. — A semi-transparent, almost colourless, wax-
like solid, when fresh ; luminous in the dark, ignites in the air ;
insoluble in water, soluble in ether, oils, and naphtha, entirely
soluble in boiling oil of turpentine and bisulphide of carbon.

Preparations.

a. Oleum Phosphoratum. — Phosphorated Oil.
Made by dissolving Phosphorus in Almond Oil at 180°
Fahr. 1 in 160. Dose, ojo 10 min.

b. Pilula Phosphor!. — Phosphorus, Balsam of Tolu,
and Yellow Wax. Apt to pass through the bowels
unchanged. Dose, 3 to 6 gr. = -fa to ^ gr. of phos-
phorus.

Phosphorus is also used in preparing Acidum Phos-
phoricum Dilutum, and Calcis Hypophosphis. See
Calcium.

ACTION AND USES.

Phosphorus has a powerful action on the body, and one
which has been proved by elaborate investigations on animals
to be of the most interesting kind to the physiologist. As a
poison phosphorus is also of great importance. Unfortunately,
however, it cannot be said to be of much value to the thera-
peutist, as it has disappointed most attempts to turn it to
practical account in the treatment of disease.

ioo MATER i A ME DIG A AND THERAPEUTICS.

1. IMMEDIATE LOCAL ACTION.

Externally and internally phosphorus acts as a powerful
local irritant and caustic, and is never given to produce this
effect. For the same reason the drug must not be ordered
in the solid form, but carefully mixed with oil or fat.

2. ACTION ON THE BLOOD AND ITS USES.

Phosphorus enters the blood, and may be found in it un-
changed. Here it is partly oxydised into phosphorus or phos-
phoric acid at the expense of the oxygen of the red corpuscles,
and is therefore said to have a "reducing" action on the (oxy-)
haemoglobin or "blood." The small dose sufficient to cause
death will not reduce any considerable number of the corpuscles,
and the specific effects to be presently described cannot there-
fore be accounted for by interference with the oxygenating
function of the blood.

Phosphorus has been employed in leukaemia and lymph-
adenoma, but on the whole with disappointing results.

3. SPECIFIC ACTION AND USES.

In the tissues phosphorus may be traced as the uncombined
element — another proof that its oxydation in the blood is
incomplete. Its effect on metabolism, when given in large
doses, is most distinct and definite : it increases the nitrogenous
products, including urea, tyrosin, and leucin; reduces the
glycogen of the liver to nil; raises the temperature, diminishes
the excretion of carbonic acid, and the volume of oxygen ab-
sorbed ; and leads to fatty degeneration of epithelial, glandular,
and muscular protoplasm throughout the body. No doubt these
alterative effects are essentially associated with each other;
phosphorus, whilst increasing metabolism, so influencing it as to
diminish oxydation, and thus to arrest the process at the first
stage, where proteids are converted into urea and oil, instead of
allowing it to proceed to the second or final stage, where the
oil is further oxydised into carbonic acid and water. Hence all
the results just enumerated ; whilst the soluble products (urea,
etc.) are excreted, the insoluble products (oils or fats) are re-
tained in the tissues, constituting fatty degeneration.

The uses to which phosphorus has been put as a specific
remedy do not obviously depend upon these effects upon nutri-
tion. It has been given in nervous disorders, such as neuralgia ;
in adynamic conditions, such as typhoid fever ; in some
kinds of skin diseases, including pemphigus ; and as an
aphrodisiac. It is difficult to understand how any of these
morbid states can be benefited by a substance which diminishes

-1-^-« v -C^4i^^*

-

•<--. • -. —

A NTIMONIUM. I O I

oxydation; and, indeed, the empirical use of phosphorus has
recently been in a great measure abandoned.

In very small doses over a considerable length of time,
phosphorus affects the structure of bones, converting the spongy
portion into firm, compact substance, without in any way alter-
ing its composition chemically. It has therefore been recom-
mended in cases of rickets and ununited fracture; but in
rickets, at least, is far inferior to other medicinal measures, if of
service in any way.

The hypophosphites have recently been much employed in
cases of nervous and general debility and chronic lung disease,
and act, according to some authorities, in the same manner as
free phosphorus, without being irritant. As the hypophosphites
are probably converted into phosphates in the stomach, they
may be expected to stimulate the liver and bowels, and to affect
the growth and healing of bones, lymphatic glands, and adenoid
tissue, including tubercle.

4. REMOTE LOCAL ACTION.

Phosphorus is excreted by the kidneys as phosphorus and
phosphorous acid, not as phosphates ; but is not employed in
this connection.

ANTIMONIUM. Sb. 122. ANTIMONY.

The inetal itself (Stibium) is not officinal, all the
preparations being derived from " black antimony,"
Antimonium Nigrum, as follows :

A lit i ill Oil i II Bit > i gruni.— Black Antimony. Native
Sulphide of Antimony. 80283.

Source. — Purified from siliceous matter by fusion, and
powdered.

Characters. — A metallic-looking powder, of a steel-grey
colour.

Impurity. — Silica ; insoluble in boiling HC1.

Nut given medicinally.

From Antimonium Nigrum,

a. Antimonium Sulphuratum. — Sulphurated Anti-
mony. Sulphide of Antimony, Sb.,S.,, with a small and
variable amount of Oxide of Antimony, Sb2O3.

>•"•. Made by (1) boiling Black Antimony with
Solution of Soda, and (2) precipitating with Diluted Sul-
phuric Acid. (1) 2Sb3S3 -f GNaHO = 2^<i3SbS3 + Sb.,0,

102 MATER i A ME DIG A AND THERAPEUTICS.

+ 3H20. (2) 2Na.3SbS3 + 3H2S04 = Sb2S3 + 3Xu.,S< )4
- 4- 3H~2S.

Characters. — An orange-red powder, without odour,
and with a slight taste, insoluble in water.

Impurities. — General ; detected volumetrically.
Dose. — 1 to 5 gr.

.; Antimonium Stdphuratum is an important in-
\gredient of Pilula Hydrargyri Subchloridi Com-
jposita. 1 in 5. (See Mercury.}

b. Liquor Antimonii Chloridi. — Solution of Chloride
of Antimony, SbCl3, in Hydrochloric Acid. " Butter of.
^Antimony."

Source. — Made by dissolving Black Antimony in
Hydrochloric Acid. Sb2S3 + 6HC1 = 2SbCl3 + 3H2S.

Characters. — A heavy yellowish-red liquid, giving a
white precipitate with water.

From Liquor Antimonii Chloridi is made :

Antimonii Oxidum. — Oxide of Antimony.
Sb203.

Source. — Made by (1) precipitating Oxychloride
of Antimony, by pouring the Solution of the Chlo-
ride into Water; washing; and (2) adding Carbonate
of Soda Solution. (1) 12SbCl3 + 15H20 = 2SbCl3
6Sb203 4- 30HC1. (2) 2SbCl35Sb203 + 3Na2C03
— eSb^Oj 4- 6NaCl 4- 3C02.

Characters. — A greyish- white powder, in-
soluble in water.

Impurities. — Higher oxides, insoluble when
boiled with acid tartrate of potash.

Dose. — 1 to 4 gr.

Preparation.
Pulvis Antlmonialis — ^James's Powder.' '

1, with 2 of Phosphate of Lime. Dose, 3 to

10 gr.

From Antimonii Oxidum is made :

Anthnonium Tartaratum. — Tartarated
Antimony. Tartar Emetic. KSbC4H4O7.H20.
Source. — Made by boiling Oxide of Anti-
mony with Acid Tartrate of Potash, and crystal-
lising. 2KHC4U406 + Sb203 = 2KSbC4H407
-J-H20.

Characters. — Colourless transparent crys-
tals, exhibiting triangular facets. Solubility,
1 in 20 of cold water ; 1 in 2 of boiling water.

QWC r

L<

• *-* Jti

Clvo7

ANTIMONIUM. 103

Incompatible*. — Gallic andtannic acids, most
astringent infusions, alkalies, lead salts.

Jnijmrities. — Cream of tartar, and iron ;
detected volumetrically, and by solubility.

Dose. — As a diaphoretic, ^ to £ gr. ; as an
emetic, 1 to 2 gr.

Preparations.

(1) Unguentum Antimonii Tartarati.
—1 to 4.

(2) Vinnm Antimoniale. — 2 gr. in 1
fl.oz. Dose, 5 min. to 1 fl.dr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Antimony, in the form of the Liquor Anti-
monii Chloridi, is a escharotic, employed chiefly in veterinary
practice, occasionally by the surgeon as an application to
poisoned, foul, or malignant surfaces. Tartarated Antimony
applied to the skin, either in aqueous solution or as the officinal
ointment (half a drachm at a time, repeated), causes a pustular
eruption, and was once used as a counter-irritant in diseases
of the lungs, joints, or meninges. Antimony is freely absorbed
from the broken skin, and from mucous surfaces.

Internally, the local effect is equally irritant. In doses
of 1 to 3 grains tartarated antimony is an emetic, whence its
popular name. The effect is partly direct — due, that is, to the
irritant action of the drug upon the walls of the stomach ; partly
indirect, from immediate stimulation of the vomiting centre in
the medulla. Further, its direct effect on the stomach is
produced not only when the salt is admitted to it by the mouth,
but when it reaches the stomach by the blood, that is, when it
is being excreted by the gastric mucosa. Thus, whilst tartar
emetic induces vomiting most quickly when swallowed, it is not
speedy and evanescent in its effects, but induces both previous
and subsequent nausea and depression. It is not suited, there-
fore, for use in cases of poisoning, where rapid evacuation is of
the first importance, or where there is much general depression ;
but is useful in the first stage of acute inflammatory dJ
with sthenic fever, in strong healthy subjects. It is especially
indicated in respiratory affections, such as laryngitis and bron-
chitis, where its remote effects as an expectorant are valuable ;
or to clear the air-passages in the same diseases or in whooping
cough.

104 MATERIA MEDIC A AND THERAPEUTICS.

In smaller continued doses the local action of tartarated
antimony on the stomach and bowels is apt to produce loss of
appetite, nausea, pain, and diarrhoea.

2. ACTION IN THE BLOOD.

Antimony enters the blood either from within or from
without, but does not appear to combine with the albumen of
the plasma. No special action or use has to be mentioned under
this head.

3. SPECIFIC ACTION AND USES.

Having reached the tissues and organs, antimony clings to
them with some tenacity, and may be found in them months
after its administration. Here it sets up a series of important
changes, attended by phenomena referable to the general nutri-
tion of the body, the circulation, respiration, and nervous and
muscular systems ; besides the effects to be afterwards described
as referable to its excretion.

The effect of antimony on metabolism closely resembles that
of phosphorus and arsenic, to the account of which the student
is referred. Briefly the principal results are fatty degeneration
of the organs and increase of the nitrogenous products,
oxygenation being comparatively deficient. Upon this altera-
tive effect depends in part the value of antimony in gout,
chronic skin disease, etc., to be afterwards described. The
heart is depressed from the first by tartarated antimony. Even
in small doses it reduces the strength, and very soon the fre-
quency of the pulse, which tends to become irregular, and
fainting may occur ; the whole being referable to a direct action
upon the nervo-muscular substance of the heart. Antimony is
thus a powerful circulatory depressant. The respiratory move-
ments are also weakened and disturbed by this drug, which
causes shortness of inspiration and lengthening of expiration,
manifestly a degree of the same disturbance which culminates
in vomiting, and allied to the process of expectoration. The
nervous system is markedly depressed by antimony, in part
directly, in part indirectly through the circulation, the effect
of a moderate dose being to produce a sense of languor, inapti-
tude for mental exertion, lowness, and sleepiness. Tartarated
antimony has accordingly been used as a sedative in the
delirium and insomnia of fevers, such as typhus, and acute
alcoholism (delirium tremens), combined with opium in various
proportions.

The muscular system is so powerfully depressed by antimony
that, before the introduction of chloroform, it was employed to
produce muscular relaxation in the reduction of hernias and

ANTIMONIUM.

I05

dislocations. Nauseating and emetic doses cause great weak-
ness of the voluntary movements, inability to stand, occasional
tremors, and aching of the muscles. It is still given as an
antispasmodic, to relax the cervix uteri in some classes of
difficult labour, and in combination with purgative medicines
to prevent or remove spasm of the bowel.

4. REMOTE LOCAL ACTION AND USES.

Antimony leaves the system by all the mucous surfaces,
the liver, kidneys, and skin ; so that it may cause inflammation,
salivation, and pustulation of the mouth, oesophagus, and
stomach when administered by the skin. In being excreted by
the stomach, it produces there, as we have seen, a remote emetic
effect. Its excretion in the bile constitutes it a hepatic stimu-
lant, sulphurated antimony, either as Plummer's pill or alone,
being much esteemed as a cholagogue, especially in gout and
loaded conditions of the liver. In passing through the kidneys,
it has a slight diuretic action. In doses of ^ to £ gr., it stimu-
lates the skin, acting as a diaphoretic, of service, as we shall
see, in feverish conditions. Its internal use occasionally de-
velops the characteristic pustular eruption, which suggests it as
a remedy for certain forms of chronic skin disease. Antimonial
wine is a familiar sedative expectorant, apparently from the
excretion of the drug by the respiratory surfaces, given with
great advantage in the first stage of acute bronchitis in strong
subjects, less frequently in acute pneumonia.

5. USES OF THE COMBINED ACTIONS OF ANTIMONY.

When the various effects of antimony thus detailed are
reviewed together, it is found to be a powerful general depres-
sant, oxygenation being impaired, nervo - muscular activity
reduced, the heart weakened, and the waste of the body in-
creased through all the channels of excretion, and by loss of
heat. When a full dose (1 to 3 gr.) is given, and vomiting
induced, this general depression may threaten to pass into
collapse, with pallor and coldness of the surface, ami marked
fall of the body temperature. On this account tartarated anti-
mony may sometimes be employed with benefit as an anti-
pyretic or febrifuge at the commencement of acute febrile,
attacks in sound robust subjects, more especially bronchitis,
where the attendant increase of the bronchial secretion will be
serviceable, and the possible emesis by no means contra-indi-
cated. Great caution must, however, be exercised in prescribing
this powerful depressant, and the best method of admin >
it is in very small doses in water every fifteen or thirty minutes.

io6 MATERIA MEDIC A AND THERAPEUTICS.

until the skin becomes moist and cool, when it may be
stopped.

The unquestionable value of Plummer's Pill would appear
to be partly referable in the same way to the action of anti-
mony not only on nutrition, but on the various organs of
elimination, including the skin and the kidneys.

BISMUTHUM. BISMUTH. Bi. 210.

A crystalline metal; as met with in commerce it
is generally impure.

From Bismuthum is made :

Bismuthum PurincatunL — Purified Bismuth.

Source. — Made by heating Bismuth with Nitrate of
Potash.

Characters. — A crystalline metal of a greyish-white
colour, with a roseate tinge.

Impurity. — Copper ; giving coloured reactions.

From Bismuthum Purificatum are made :

a. Bismuth! Subnitras. — Subnitrate of Bis-
muth. White Bismuth. BiON03H2O.

Source. — Made (1) by dissolving Purified Bis-
muth in Nitric Acid ; and (2) pouring the product into
Water. (1) Bi2 + 8HN03 = 2(Bi3N03) + 2NO 4-
4H20. (2) Bi3N03 + H20 == BiON03 + 2HNO3.

Characters. — A heavy white powder, in minute
crystalline scales ; insoluble in water.

Impurities. — Carbonate of lead; giving pre-
cipitate with H2S04 when dissolved in HN03;
arsenic ; and chlorides.

Dose.—b to 20 gr.

Preparation.
i. Trochisci Bismuthi. — 2 gr. Subnitrate

of Bismuth in each, Carbonate of Lime, and

the usual ingredients of a lozenge. Dose, I to 6.

from Bismuthi Subnitras is made :

ii. Bismuthi Oxidum. — Oxide of Bismuth.

Bi203.

Source. — Made by boiling Subnitrate of

Bismuth in Solution of Soda.

Characters. — A dull lemon-yellow powder ;

insoluble in water, soluble in nitric acid mixed

with half its volume of water.

BISMUTH UM. 107

Impurities. — As of the subnitrate.
Dose. — 5 to 15 gr.

/3. Liquor Bisnmthi et Ammonia Citratis.

Source. — Made by dissolving Purified Bismuth
in Diluted Nitric Acid, adding Citric Acid, and re-
dissolving the precipitate with Ammonia, as it forms.

Characters. — A colourless solution, with a sa-
line and slightly metallic taste ; neutral or slightly
alkaline to test-paper ; mixes with water without
change. 1 fl.dr. contains 3 gr. of oxide of bismuth.
1 fl.dr.

•y. Bismuth! Carbonas. — Carbonate of Bismuth.
2(Bi2C05)H20 ; an oxycarbonate.

Source. — Made by (1) dissolving Purified Bis-
muth in Nitric Acid and Water; and (2) precipitating
by a solution of Carbonate of Ammonia. (1) Bi2 -}-
8HNO, = 2(Bi3N03) + 2NO + 4H20. (2)
4(Bi3N03) + 3(N4H16C308) = 2Bi2C05 + 7C02 +
I L JN JdL » JN (Jo.

Characters. — A white powder, insoluble in
water ; soluble with effervescence in nitric acid.

Impurities. — The subnitrate, and its impurities.

Dose.— 5 to 20 gr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally applied in the form of powder or ointment,
bismuth acts only physically on the unbroken skin, protecting
it from the irritation of cold and dirt. If the surface
be inflamed, as in chapped hands, chapped nipples, irritable
ulcers, and eczema, it is a mild sedative and astringent, sooth-
ing and drying up the part. Accessible mucous membranes are
similarly affected by bismuth, when in a condition of catarrh :
thus it is used with success as a "snuff" for nasal catarrh; as an
injection in gonorrhoea and leucorrhoea ; and in irritability of
the cervix uteri as a pessary. Bismuth is not known to be
absorbed from the surface.

Internally, the local action and uses of the subnitrate of
bismuth constitute all, or nearly all, that is definitely known
ing it as a remedy. In the stom.-irh it is insoluble, and
exerts the same sedative and astringent action as on the skin,
whether by affecting the nerves and local circulation, or by its
mechanical properties, that is, by coating and protecting the

io8 MATERIA MEDIC A AND THERAPEUTICS.

mucous surface. Little or no good is to be expected from less
than 20 gr. doses of the subnitrate to an adult, and these may be
trebled with perfect safety. Bismuth is extensively used in this
country in the treatment of pain and vomiting due to catarrh
or organic disease of the stomach, such as the gastric catarrh
that follows a surfeit of food or alcoholic excess, recurrent
gastric ulcer, and cancer; also in some cases of so-called
nervous or reflex vomiting, as in pregnancy and hysteria, where
a true catarrh is often present. Bismuth may be given alone
in such conditions, but is better combined, on the one hand,
with alkalies, such as bicarbonate of soda, if there be much
actual catarrh ; or, on the other hand, with opium, if pain be
the chief symptom. A combination of the subnitrate of bis-
muth and a variable number of grains of Pulvis Ipecacuanhae
Compositus is almost a specific for the pain and vomiting of
ulcer and malignant disease.

The astringent and sedative influence of bismuth on the
intestines constitutes it a valuable remedy for diarrhoea in deli-
cate persons, such as children, phthisical subjects, and those
who have been exhausted by other causes. In lienteric
diarrhoea, probably referable to duodenal catarrh, it is some-
times invaluable. But in the intestines, as in the stomach, the
addition of opium, in however small quantity almost, greatly
assists its action, and in persistent cases of diarrhoea is absolutely
necessary. The same combination with Dover's powder gives
excellent results. Bismuth subnitrate is partly converted into
the sulphide in the bowel, which imparts a characteristic leaden-
grey colour to the fteces.

2. ACTION IN THE BLOOD.

Neither the insoluble nor the soluble (but weak) prepara-
tions of bismuth enter the blood in any quantity. Still, the
metal has been detected, both here and in the tissues.

3. SPECIFIC ACTION.

Bismuth finds its way, but very slowly, through all the
organs and tissues ; but no specific effect can be traced to its
presence, even when it is given in doses of several drachms.
The so-called effects of bismuth, of the older authorities,
were certainly caused by arsenic combined with it as an im-
purity.

4. REMOTE LOCAL ACTION.

Bismuth has been found in the urine, and it is said, in the
milk. No use is made of its remote influence, if any such

exist.

CHLORUM. 109

CHLORUM. CHLORINE. Cl. 35-5.

Although not contained in the Pharmacopoeia as
the pure gas under its own name, chlorine is furnished
by several important preparations, as follows :

ff. Liquor Chlori. — Solution of Chlorine. Chlorine
gas dissolved in Water.

Source. — Made by heating Hydrochloric Acid in
water with Black Oxide of Manganese, passing the gaa
into Water, and shaking till it is absorbed.

Characters. — A yellowish - green liquid smelling
strongly of chlorine.

Impurities. — Salts, not volatile ; deficient Cl, detected
volumetrically by hyposulphite of soda.

In compatibles. — Salts of lead and silver.

Dose. — 10 to 20 min. in water.

b. Calx Chlorata, — See page 50.

g. Liquor Calcis Chloratse. — See page 50.

B. Vapor Chlori.- — Chlorinated Lime and Water.
— See page 50.

c. Liquor Sodas Chlorata. — See page 38.

a. Cataplasma Sodae Chloratse. — See page 38.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND TT8E8.

Externally, the action and uses of chlorine depend upon the
great affinity which it possesses for hydrogen, and its consequent
power to decompose compounds in which hydrogen forms part
of the molecule, such as ammonia, sulphuretted hydrogen, sul-
phide of ammonium, and water. The properties of the body on
which it acts (chemical, vital, or both) are completely altered ;
whilst nascent oxygen is set free, and chlorine further com-
bines with the remaining elements of the broken-down mole-
cule. Thus it is a powerful irritant to the skin, «
redness, vesication, even sloughing, and coagulating the albu-
minates of the part. For the same reason chlorine is the most
powerful of all disinfectants, deodorisers, and decolorisers, its
activity as a disinfectant greatly exceeding that of carbolic acid,
and even corrosive sublimate. As a stimulant and disinfec-
tant, chlorine water, or the solutions of chlorinated lime or of

no MATER i A MEDIC A AND THERAPEUTICS.

chlorinated soda, may be applied to foul ulcers, dissection and '
poisoned wounds, diphtheritic surfaces ; or used in contagious
ophthalmia, ozoena, and other foul discharges from surfaces or
cavities. Of much more extensive application is the disinfec-
tant action of chlorinated lime and its preparations, apart from
the body : to purify rooms, wash infected clothes, flush drains,
and throw upon the stools of typhoid fever and cholera before
they are disposed of.

Internally, chlorine exerts the same local action upon the
parts with which it comes in contact ; and is employed as a
wash or gargle, to disinfect and stimulate foul ulcers of the
mouth, tongue, and throat, especially in diphtheria.

In the stomach chlorine in dilute solutions becomes con-
verted into hydrochloric acid and chlorides, and loses all
further effect upon the body as the uncombined element.

Inhaled as the vapour, chlorine causes local irritation of the
respiratory passages, with distressing pain in the throat and
chest, spasm, cough, lachrymation, sneezing, and headache. It
cannot be recommended in this form or for this purpose.

2. ACTION IN THE BLOOD, SPECIFIC ACTION, AND REMOTE
LOCAL ACTION.

It is doubtful whether chlorine enters the circulation or
reaches the tissues, uncombined ; more probably it is entirely con-
verted into chlorides. From the analogy of its powerfully dis-
infectant and bleaching properties apart from the body, it has
been given, as an " alterative and stimulant," in typhus,
typhoid fever, small-pox, and other "putrescent " diseases, as
well as in chronic dysentery, and liver disease of a malarial
origin. There is little evidence in favour of continuing its use
in these cases.

IODTJM. IODINE. I. 127.

Under this head will be discussed both Iodine and
Iodide of Potassium, the form in which the element
is generally administered internally. Reference will
also be made to the other officinal iodides.

lodum.— Iodine. I.

Source. — A non-metallic element, obtained principally from
Kelp, the ashes of sea- weed.

Characters. — Laminar crystals of a dark colour and lustre,
and peculiar odour. Solubility, 1 in 7,000 of water, 1 in 12 of
rectified spirit, 1 in 4 of ether, sparingly in glycerine, freely

L 5"

S. }

Ill

in a solution of iodide of potassium or chloride of sodium.
Seldom given as pure iodine.

Impurities. — Iodide of cyanogen ; subliming as colourless
pungent prisms. Iron; not volatile. Water; as moisture.
Deficient iodine ; detected by hyposulphite of soda.

Incompatible^ . — Ammonia, metallic salts, mineral acids,
vegetable alkaloids.

Preparation^.

a. Linimentum lodi.- — Iodine, 5 ; Iodide of Potas-
sium, 2 ; Camphor, 1 ; Spirit, 40.

b. Liquor lodi. — Iodine, 20 gr. ; Iodide of Potas-
sium, 30 gr. ;* Water, 1 oz.

c. Tinctura lodi.— Iodine, i ; Iodide of Potassium, \ ;
Spirit, 20. Dose, 5_to 20 min.^

From Tinctura lodi is prepared :

Vapor lodi. — Tincture of Iodine, 1 fl.dr. ;
Water, 1 fl.oz.

d. Unguentum lodi. — Iodine, 32 gr. ; Iodide of Po-
tassium, 32 gr. ; Spirit, 1 fl.dr. ; Lard, 2 oz.

From lodum is made :

Potassii lodidum. — See Potassium, for source
and HJiaracters. Dose, 2 to 10 gr. or more.

Preparations.

a. Linimentum Potassii lodidi cum Sapone. —
Iodide of Potassium, 1^; Hard Soap, 1£; Glycerine,
1; Oil of Lemon, | ; Water, 10.

^.Unguentum Potass ii lodidi. — Iodide of
Potassium, 64 gr. ; Carbonate of Potash, 4 gr. ;
Water, 1 fl.dr. ; Lard, 1 oz.

y. Also all preparations of lodum.

Iodine is also used in the production o/the In
of Cadmium, Ferrum, Hydrargyrum (2), Plumbum,
and Sulphur.

Solutions of Iodine may be decolorised by Hypo-
sulphite of Soda.

ACTION AND USES.

1. IMMEDIATE LOCAL ACTIOX AND V-

Externally applied, iodine is a powerful irritant and vesi-
cant, decomposing organic molecules, and entering into loose

ii2 MATERIA MEDIC A AND THERAPEUTICS.

chemical combination with the albuminous constituents of the
parts. At the same time it stains the epidermis of a deep brown,
causes considerable pain ; and is absorbed into the blood, partly
by the skin and partly by the air of respiration in the form of
vapour. It is also a powerful antiseptic and disinfectant.

The tincture, liniment, and ointment of iodine are exten-
sively used as stimulants and disinfectants to foul, callous ulcers,
much like nitrate of silver ; as vegetable parasiticides in ring-
worm ; and as counter-irritants in subacute or chronic inflam-
mation of joints, periosteum, lymphatic glands, the pleura, and
the lungs. In these instances the chief effect is doubtless
stimulation, but a certain amount of the iodine is absorbed, and
acts specifically, as will be presently described. Iodine in
solution is injected into cysts, goitres, hydrocele, etc., with
much success.

Iodide of potassium applied to the unbroken skin is neither
irritant nor capable of being absorbed, unless decomposed by
the sweat. It is readily taken up from the exposed mucous
membranes. How much specific value can be attached to the
iodide liniment is doubtful.

Internally, the local action of free iodine is also irritant,
and it is successfully applied to the gums in periosteal tooth-
ache. Inhaled into the respiratory passages, it gives rise to
cough, sneezing, severe pain over the frontal sinuses, distress-
ing pains in the chest, and dyspnoea. Combinations of iodine
with creasote and various soothing volatile substances, such
as chloroform and ether, have lately come into repute as
continuous inhalations in the so-called " antiseptic " treatment
of phthisis, bronchitis, and other forms of chronic lung disease.

In the stomach and bowels, although it is gradually con-
verted into the iodide or iodate of sodium, the irritant effects of
free iodine are continued, with abdominal pain, sickness, and
diarrhoea as the result. The iodides of potassium and sodium
have rarely this effect, and it is only in the form of a salt that
iodine is now administered internally. Iodide of potassium is
also decomposed in the stomach, the sodium salt and albu-
minate being formed from it.

2. ACTION ON THE BLOOD.

Iodine is freely absorbed into the blood from mucous siir-
faces, and the sodium iodide quickly enters from the alimentary
canal. In the blood the element is at first combined with
sodium; but this salt appears to be decomposed, the iodine
for a time set free, some of the red corpuscles broken down (if
the amount of iodine be large), and bloody effusions and bloody
urine make their appearance. Such results are to be carefully

_
eft €-itnJUl o<-o

WUL£

' '

«»>->^V-A>l_^ «-<3 ,

lODUM. 113

avoided in practice ; and, as far as we know, less degrees of
the same cannot be usefully applied to therapeutical purposes,
unless the tendency to coagulation of the blood be somewhat
increased by it.

3. SPECIFIC ACTION AND USES.

The iodide of sodium and albuminous compounds pass from
the blood into the tissues with remarkable rapidity, and may be
found in all of them, especially the excreting organs and
lymphatic glands, whilst they appear very scantily in the
nervous centres. Almost as quickly the iodine leaves the
tissues ; and in thus passing rapidly through the protoplasm of
the body, and sharing in its metabolism by combining (probably
very loosely) with the albuminous molecules, it no doubt
accelerates tissue change. As no increase of urea accompanies
this effect, nor bodily wasting, the iodine must either spare the
liver (which is the chief source of urea), or accelerate the meta-
bolism of the plasma, rather than of the tissue elements them-
selves. (See Metabolism, Part III.) However this may be, the
following are the principal directions in which iodine affects
nutrition, and their applications :

(1) The lymphatic glands are reduced in size by iodine,
which is extensively used for scrofulous and other chronic
enlargements of the glands, whether applied locally as iodine,
or internally as the iodides.

(2) Certain poisons, which have intimately associated them-
selves with the albuminous structures, are disengaged from this
combination by iodine. Lead and mercury may be swept out
of the tissues by iodide of potassium administered for plumbism
and hydrargyrism respectively. The principal application,
however, of iodine is in the treatment of syphilis. Either the
poison of this disease is thus eliminated from the system, or
iodine hastens the life and disappearance of the small-celled
growth by which syphilis is characterised. It is specially
valuable in the tertiary forms of syphilis, when mercury cannot
be longer given with advantage ; and nodes and other super-
ficial enlargements, gummata in the viscera, and certain forms
of skin disease may be very successfully treated by the potas-
sium salt. The same precautions must be observed with respect
to the general health, and especially the preservation of diges-
tion in a course of iodide, as were laid down under the
head of mercury.

(3) In subacute and chronic inflammations of various kinds,
such as exudations or effusions in connection with the joints
and serous cavities, and some forms of pulmonary consolidation,
iodide of potassium may promote absorption by stimulating the

1—8

ii4 MATER i A MEDIC A AND THERAPEUTICS.

local nutrition. The local application of iodine " paint " is
combined in such cases.

(4) Scrofula is benefited by iodine, especially when it affects
the lymphatic glands, enlargements of which are treated by the
liniment, by the ointments of the iodides of lead or cadmium, or
by interstitial injections (rarely) ; internally by iodide of iron,
or iodine mineral waters, such as the water of Woodhall. On
the contrary, phthisis is rarely benefited by iodides, unless there
be a syphilitic taint present.

(5) In chronic rheumatism, when debility is not a promi-
nent symptom, in gonorrhoeal rheumatism, and in the arthritis of
syphilis, the iodide may be beneficial. In chronic arthritic
gout it is probably useless, or even prejudicial.

The nervous system, respiratory centre, heart and vessels,
and the body temperature are all unaffected by iodine ; and the
depressing effect on these of large doses of iodide of potassium
is believed to be caused by the potassium. The remarkably
useful effect of potassium in relieving or curing aneurism is due
to the reduction of the blood pressure by the alkali, the coagu-
lating effect of iodine on the blood, and the specific effect of
iodine on the chronic inflammatory changes (often syphilitic) in
the wall of the artery which have led to the dilatation.

4. REMOTE LOCAL ACTION AND USES.

Iodine is rapidly excreted, appearing in the urine, the
mucous secretions generally, and specially in those of the air-
passages, the perspiration, saliva, bile, and milk. Part of the
sodium salt which reaches the excreting organs is thrown out
unchanged, part is decomposed, and iodine is again set free to
exert its local action remotely.

The diuretic effect of iodide of potassium is not marked
unless large doses be given, and probably depends upon the
alkali, not on the iodine. The latter may, however, have an
alterative action upon the kidney, and the iodide may therefore
be used in some forms of chronic Bright's disease, combined
with other remedies.

The excretion of iodine by the mucous membrane of the
jvspiratory tract is of most interest to the therapeutist. In
c. riain siihjc.'ts, and probably when iodide oi potassium contains
free iodine as an impurity, its exhibition produces a series of
-ing symptoms known as " iodism," consisting of coryza,
the watery discharge from the nose being sometimes profuse ;
sneezing ; intense pain of a bursting character over the frontal
sinuses, commonly called " headache; '' swelling and redness of
th'- irums, hard and soft palate and fauces, foulness of the

lODUM. 115

tongue, and increase of the mucus of the mouth ; cough and
frothy expectoration, and a sense of heat and rawness in the
trachea and chest. The phenomena of irritation of the respira-
tory mucosa hy the out-going iodine are therefore identical
•with those produced hy the immediate action of iodine hy
inhalation, hut in a minor degree. When the secretion is
deficient, the mucous membrane of the bronchi swollen and
dry, and cough useless and painful, iodide of potassium is thus
a valuable expectorant, quickly inducing a flow of thin mucus,
by establishing secretion, or by liquefying tenacious mucus
which may be plugging or irritating the bronchi. It is,
further, an indirect antispasmodic, given with great benefit in
asthma and emphysema. The iodide of ethyl (n on- officinal)
inhaled as vapour may rapidly relieve the spasm of asthma.
Iodide of potassium is sometimes given in other respiratory
diseases, e.g. in pneumonia, if the consolidation threaten to
persist.

In escaping by the skin the liberated iodine produces in
certain individuals peculiar eruptions, generally papular or
slightly vesicular, rarely purpuric. The value of the drug in
tertiary syphilitic diseases of the skin no doubt depends partly
on this influence.

6. ACTION AND USES OF THE SEVERAL PREPARATIONS CON-
TAINING IODINE.

1. Cadmii lodidum : TJnguentum Cadmii lodidi. — The
ointment only is employed, and combines the stimulant effects
of the two elements. It is rubbed into the skin over enlarged
glands, stiff joints, etc. See Cadmium.

2. Ferri lodidum : Pilula Ferri lodidi and Syrupus Ferri
lodidi combine the action of the two important elements, and
are especially indicated and extensively employed when iodine
has to be administered for a length of time to anaemic sub-
jects. This is the form in which iodine is usually given in
scrofula, the syrup being a favourite remedy for strumous
children.

3. Hydrarfjyri lodidum Rubrum possesses chiefly the action
of the per-salts of mercury, and is used accordingly. See
Hydrargyrum.

4. Hydrargyri lodidum Viride is also a mercurial rather
than an iodide in its action, and is employed in syphilis much
like calomel.

5. Sulphur is lodidum is now used externally only, and is
believed to produce the combined effects of the two alteratives.

n6 MATER i A MEDIC A AND THERAPEUTICS.

BROMUM. Br. 80. BROMINE.
A liquid non-metallic element.

Source. — Obtained from Bitter, and from some Saline
Springs.

Characters. — A dark brownish-red very volatile liquid,
with a strong disagreeable odour ; solubility, 1 in 30 of water.

Impurity. — Iodine ; detected by starch test.

Not given internally.

From Bromum are made :

L Ammonii Bromidum. — See d.mmonium. Dose, 5 to
30 gr.

2. Potassii Bromidum. — See Potassium. Dose, 5 to
30 gr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION.

Externally bromine is a powerful irritant and escharotic.
Its local use is confined to the treatment of cancer of the
cervix uteri (1 in 5 parts of rectified spirit). The bromides
have no such irritant action unless in highly concentrated solu-
tion ; nor are they absorbed from the unbroken skin.

Internally, the local action of bromine resembles that of
chlorine, the vapour being intensely irritant, and, indeed,
irrespirable. It is never used in this way.

The bromides taken continuously for a time in full doses,
or applied in strong solution to the throat, are said to reduce
the sensibility of the fauces, so that the reflex movements of
the parts, such as swallowing, vomiting, cough, etc., are not
easily excited; and they may therefore be employed previous to
important examinations or operations in connection with the
larynx, or in excessive irritability of the parts. The bromides
have but little effect of an irritant kind on the stomach or
bowels, so that large doses (20 grains thrice a-day for years)
may be readily borne. The greatest care must always be taken,
however, to preserve the digestion and regularity of the bowels,
in cases where bromides are continuously taken.

2. ACTION IX THE BLOOD.

Bromide of potassium enters the blood unchanged, where
it is probably converted into the sodium salt by double decom-
position with the chloride of sodium. For a moment it may be

tJJA^

BROMUM. 117

free in the "blood, but no special action or therapeutic applica-
tion can be referred to this circumstance.

3. SPECIFIC ACTION AND USES.

The bromides pass through the organs as such or as
bromide of sodium, and have a very definite specific action upon
them, which, speaking generally, is one of depression.

The nervous system is specially affected. Loss of reflex
excitability in connection with all the sentient surfaces of the
body follows the administration of full medicinal doses. This
result is due partly to depression of the peripheral (sensory) ner-
vous filaments, but -chiefly to reduced activity of the nervous
centres in the brain and cord. At the same time the motor
nerves are also soothed, and the muscular power (which we may
conveniently consider along with the nervous), is much
weakened. The phenomena of this general nervo-muscular
depression are as follows, beginning with the highest centres :
(1) The bromides lessen mental activity, readiness to react to
emotional stimuli, and sensibility and irritability of mind gene-
rally, thus inducing a condition of brain favourable to the
advent of sleep. They are thus indirect hypnotics, not acting
like opium and chloral, but so reducing the patient's sensibility
of his surroundings, bodily condition, or circumstances, as to
prevent distraction, and allow natural sleep to intervene. It is
uncertain whether the bromides act upon the nerve cells direct!}',
or upon the cerebral blood-vessels. The soothing and hypnotic
effects of the bromides are very extensively employed in
restlessness and sleeplessness from mental strain, whether
emotional or intellectual, in the acute specific fevers when
similar symptoms are urgent, in acute alcoholism, and in
mania. In the three last conditions a certain amount of chloral
or opium may be advantageously combined with the bromides.
Bromide of lithium, the most active hypnotic of the bromides,^
will sometimes remove the insomnia of gout. The most im-
portant application of the soothing action of the bromides is in
epilepsy, which is now almost exclusively treated with these
salts, unless they be contra-indicated. Hysteria, infantile con-
vulsions, whooping-cough, general "nervousness," hypochon-
driasis, and the low despondent condition so common in women
with uterine irregularities, are also relieved by bromides,
although not with the success obtained in epilepsy.

The great vital centres of the medulla are depressed by
bromides. Respiration becomes slower and is weakened, whence
possibly part of the value of the drug in whooping-cough. The
heart is also slower and weakened in its action ; chiefly, how-
ever, by depression of its nervo-muscular substance, not of the

n8 MATER i A MEDIC A AND THERAPEUTICS.

cardiac centre. Bromides are of much service, therefore, in
nervous disorder of the heart, especially in hysterical, dyspeptic,
and alcoholic subjects. The direct effect of these drugs on the
vessels is unsettled ; as a whole, the tension is reduced.

The spinal centres, and spinal nerves and muscles, are all
depressed by the bromides, the former so much so that the
convulsions of strychnia poisoning cannot be induced, and the
two drugs are so far physiological antagonists. In such a case
and in tetanus the bromides may be given, but are neither
rapid nor powerful enough to be trusted to alone.

The temperature is lowered by bromides, but not to an
extent of much practical value.

The ovarian and uterine functions are quieted, and menor-
rhagia relieved, by the same drugs.

4. REMOTE LOCAL ACTION AND USES.

Tbo bromides appear in the secretions within a few
minutes after their administration, being eliminated by the
kidneys chiefly, by the salivary glands, mammae, skin, and all
mucous surfaces. In passing through these excreting organs, the
bromides break up and set free bromine, which exerts a remote
stimulant effect on the parts. The composition of the urine is
irregularly disordered ; but not in a manner that can be turned
to therapeutical account. The skin is markedly affected, a
characteristic acne-like eruption appearing, or other forms of
skin disease, which are familiar in epileptics consuming large
quantities of the drug. Cough is occasionally set up, and
conjunctivitis may also occur. The interest to the therapeutist
of all these remote effects of the bromides lies in their pre-
vention, if possible, in cases where the drugs have to be steadily
taken for an indefinite time, an end which may sometimes be
secured by combining them with arsenic.

Acidum Hydrobromicum Dilutum. — Diluted Hydrobromic
Acid (U.S.P.). (Not Officinal,} A liquid composed of 10 per cent.
of absolute Hydrobromic Acid, HBr, and 90 per cent, of Water.

Source. — By decomposing Bromide of Potassium by Sul-
phuric Acid, and distiUing. 2KBr + H,S04=2HBr + K2S04.

Characters. — A clear colourless liquid, odourless, with a
strong acid taste and acid reaction.

Dose. — 20 min. to 2 11. dr.

ACTION AND USES.

Hydrobromic acid possesses many of the properties of the
bromides, but is less useful than bromide of potassium. It is

SULPHUR. 119

said to prevent the cerebral symptoms produced by quinine,
which it readily dissolves, and the after-effects of morphia, if
given with these drugs.

SULPHUR SULPHUR. S. 32.

An elementary body found native as virgin sul-
phur, also as sulphides of metals.

Sulphur Silbliiiiafiiiil. — Sublimed Sulphur.

Source. — Prepared from crude or rough sulphur by subli-
mation.

Characters. — A gritty powder, of a fine greenish-yellow
colour, without taste or odour until heated. Insoluble in
water, soluble in oils and turpentine with heat.

Impurities. — Sulphurous and sulphuric acid ; acid to test-
paper. Arsenic, detected by agitating with ammonia, and
evaporating. Earthy matters.

J)ose.—2Q to 60 gr.

Preparations.

a. Confectio Sulphuris. — Sublimed Sulphur, 4 ; Acidj
Tartrate of Potash, 1 ; Syrup of Orange Peel, 4.

Lose. — 60 to .120 gr.

b. Unguentum Sulphuris. — Sublimed Sulphur, 1 ;
Benzoated Lard, 4.

From Sulphur Sublimation are made :

c. Sulphur Praecipitatum. — Precipitated Sulphur,
"Milk of Sulphur."

Source. — Made by (1) boiling Sublimed Sulphur withj
Slaked Lime in water ; (2) precipitating the filtrate
with Diluted Hydrochloric Acid, washing and drying.

(1) 6S2 + SCalLOn = 2CaS-, -f CaS,ll,04 + 2H.0.1

(2) 2CaS6 -|- CaS2H204 + 6HC1 == 6~S2 + 3CaCC +
4H20.

Characters. — A greyish-yellow soft powder, free
from grittincss and smell of SH2.

Impurities. — Sulphate of lime; detected micro-
scopically as crystals. Sulphuretted hydrogen ; detected
by odour.

Lose. — 20 to 60 gr.

d. Potassa Sulphurata.— Sulphurated Potash. See
Potassium.

Preparation.
Unguentum Fotassss Sulphurate. — 1 in 15}.

120 MATER i A MEDIC A AND THERAPEUTICS.

e. Sulphuris lodidum. — Iodide of Sulphur, SI.

Source. — Made by fusing Sublimed Sulphur with
Iodine.

Characters.— Greyish-black crystalline pieces. Solu-
bility, 1 in 60 of glycerine ; insoluble in water.

Preparation.
Unguentum Sulphuris lodidi. — 1 in 15|-.

Sublimed Sulphur is also contained in Emplastrum
Hydrargyri, and Emplastrum Ammoniaci cum Hydrar-

ACTION AND USES.
1. IMMEDIATE LOCAL ACTIOX AND USES.

Externally applied, sulphur has probably no local action of
itself, but is partially converted, by contact with the acid pro-
ducts of the skin, into sulphuretted hydrogen and sulphides,
which are energetic substances. Whether, therefore, rubbed
on as ointment, worn in flannel, distributed over the surface by
fumigation, or given as a natural or artificial bath of " sulphur
waters," it is not sulphur, but its hydrogen compound, which
possesses local therapeutical properties.

Sulphuretted hydrogen, when brought in contact with the
skin in any of the forms just mentioned, is a vascular stimulant
and nervous sedative. It is probably on this account that sulphur
has long been regarded as useful in relieving the pains of
chronic rheumatism ; and as an alterative in certain kinds of
skin disease such as acne, in which the ointment of the Potassa
Sulphurata is especially valuable. The solution of the gas is
also absorbed by the skin, and is extolled (in the form of baths)
in lead and mercury poisoning, syphilis, and chronic enlarge-
ments of joints. The rationale of these effects will be dis-
cussed under the head of its specific action.

Sulphur and sulphurated potash destroy the Acarus scab'iei,
and are used in the treatment of itch.

Internally, sulphur has been locally applied to the throat in
diphtheria, but with disappointing results.

In the stomach it remains unaltered, and passes as such
into the intestines, where it acts as a purgative, possibly by
increasing peristalsis, more probably by stimulating the
glandular structures. Medicinal doses of milk of sulphur, the
Confectio, or the German Pulvis Glycyrrhizae Compositus, are
simple laxatives, producing an easy soft stool with little or
no pain. Sulphur waters, drunk freely at Harrogate, Moffat,

omJLcL-,
c(
u fv

SULPHUR. 121

and Strathpeffer in this country, at Aix-la-Chapelle, Challes,
Aix-les-Bains, and the Pyrenees, on the continent of Europe,
and at the Blue Lick, Alpena, Sharon, and other springs
in the United States, have a similar but more powerful effect,
producing considerable disturbance of the bowels, and de-
pressing the portal circulation. Sulphur and sulphur waters
are extensively used as purgatives in congestion of the
rectum and liver, haemorrhoids, and other diseases of the
great bowel ; and the waters and baths combined are powerful
evacuants and alteratives in plethora, hepatic engorgement, and
gravel.

Sulphur escapes^ in a great measure unabsorbed in the
faeces, partly unchanged, partly as sulphides of hydrogen
and the alkalies which it has encountered in the bowel, the
activity of purgation varying indirectly with the degree of
absorption.

2. ACTION ON THE BLOOD.

The amount of sulphur which enters the blood in the form
of sulphides of hydrogen and the alkalies, under the use of
sulphur or sulphur waters, is usually insignificant. When
inhaled into the circulation, sulphuretted hydrogen is a power-
ful blood-poison, acting both on the red corpuscles and the
serum ; it reduces the oxyhaemoglobin of the former, and
converts the carbonates and phosphates of the latter into
sulphides, sulphites, and sulphates ; but this subject is not of
therapeutical interest.

3. SPECIFIC ACTION AND USES.

The hydrogen and alkaline sulphides pass into the tissues
from the blood, and act chiefly upon the central nervous
system. When in large quantity, they induce rapid failure
of the nerve centres, especially those of respiration and circula-
tion, the subject dying rather of asphyxia than from the
poisonous influence on the blood just described. It is possible
that the headache and nervous depression which attend the use
of sulphur waters in some persons are minor degrees of tin so
effects. It is possible also that sulphur and its compounds,
possessing these powerful influences on the blood and tissues
(which appear to be of the nature of arrest of oxydation), may
modify nutrition to some extent even in medicinal do<
thus possess alterative properties. In chronic rheumatism,
syphilis, gout, and skin disease they have been much pres<ril ..•,!.
from time immemorial, especially at watering places. Sulphi.lo
of calcium has lately been found useful in scrofulous di>
bones.

122 MATERIA MEDIC A AND THERAPEUTICS.

4. REMOTE LOCAL ACTION AND USES.

It is under this head that we find the principal suggestions
for the therapeutical employment of sulphur. The sulphides
which we have traced through the blood and tissues are variously
excreted. By the kidneys they pass out as sulphates, and it
is said that one half of a dose of Sulphur Praecipitatum can he
thus recovered from the urine, but only one-fifth of Sulphur
Sublimatum. If in excess, part is also excreted as sulphides.
No special use is made of these facts. By the skin they escape
as sulphides, giving the characteristic foul odour to the per-
spiration, and somewhat increasing- its amount. Sulphur is
used as a mild cutaneous stimulant and diaphoretic, and has
always been regarded as a valuable internal remedy for many
skin diseases, such as acne, chronic eczema, psoriasis, and
syphilitic eruptions. Drinking the waters and taking the baths
at sulphur springs probably act in this remote local way.
Sulphide of calcium is specially useful in boils. The sulphides
are also excreted by the bronchi and lungs, giving their odour
to the breath ; sulphur was once much used as an expectorant,
especially in chronic bronchitis with abundant expectoration
and gouty or rheumatic associations.

The valuable effect of sulphur waters, taken internally and
used as baths, in cases of chronic rheumatism, gout, skin disease,
plethora, etc., is principally, if not entirely, to be accounted for
by the immediate and remote local action of the sulphides— on
the bowels and portal system, and on the kidneys, skin, and
bronchi respectively. It is an important fact that sulphur is a
purgative alterative.

CARBO. CARBON. C. 12.

Two kinds of carbon are officinal, namely, animal
charcoal and wood charcoal.

I. Car bo Alii mails. — Animal Charcoal. Bone

Black.

Source. — Made by exposing bones to a red heat without the
access of air.

(.'/'trtrttrtrm. — A black powder ; contains only 10 per cent,
of pure carbon, the rest consisting chiefly of phosphate and
carbonate of lime.

Preparation.

Carbo Animalis Purificatus. — Purified Animal
Charcoal. Animal Charcoal from which the salts have
been almost wholly removed.

Source. — Made by digesting Animal Charcoal in

- P-"

CAR BO.

123

Diluted Hydrochloric Acid, washing the undissolved
part, and heating to redness in a closed crucible.

Characters. — A black powder, inodorous, and nearly
tasteless.

Dose. — 20 to 60 gr.

2. Cartoo IJgnl.— Wood Charcoal.
So/tree. — Wood charred by exposure to a red heat without
access of air.

Characters. — Black, brittle, porous masses, without taste or
smell, and retaining the texture of wood ; contains about 2 per
cent, vegetable ash.
Dose. — 20 to 60 gr.

Preparation.

Cataplasma Carbonis.— -Wood Charcoal, Linseed
Meal, Bread Crumb, and boiling Water.

Charcoal is also used pharmaceutically as a decolorising
agent, in the preparation of such drugs as morphia and
atropia.

ACTION AND USES.

Externally. — Charcoal absorbs and condenses many gaseous
bodies and vapours, as oxygen, carbonic acid, etc., and
attracts the colouring, odoriferous, and sapid principles of
many liquid substances, for example, litmus, bitters, wines, and
decomposing liquids in general. It is used as a deodorant and
disinfectant to absorb the foul emanations from cancerous
and other discharges, ulcers, and wounds, being either hung
around the bed in bags, or directly applied in dust, or as the
poultice (a bad form.)

Internally. — Charcoal is locally used as a dentifrice. When
taken into the stomach in sufficient bulk, either pnre, or in the
form of biscuits, it absorbs any gas and acrid products of in< lii^i •*-
tion which may be distending and distressing the organ, and is
useful as a carminative in some forms of flatulent dyspepsia.
Animal charcoal has been recommended by Dr. Garrod as an
antidote in poisoning by opium, nux-vomica, aconite, and other
organic poisons, which it attracts from their solutions in the
stomach, and rein UTS in* rt. It is doubtful, however, whether
the absorptive action of charcoal can be retained in the bowel,
or even in the stomach, after it has been thoroughly brought
in contact with water. In the intestines it may possibly re* lure
flatulence, deodorise the faeces, and thus reduce the r.-tl.-x peri-
staltic movements, and relieve diarrhea.

Charcoal is entirely evacuated by the bowel and is not
absorbed, so that it exerts no specific action on the body.

124 MATER i A MEDIC A AND THERAPEUTICS.
GROUP IV.

THE ACIDS.

The officinal acids may be classified as follows :

1, Inorganic Acids. — Acidum Sulphuricum, A.
Nitricum, A. Hydrochloricum, A. Nitrohydrochloricum Di-
lutum, A. Phosphoricum Dilutum, A. Sulphurosum, A. Arse-
niosum. Of these, Acidum Arseniosum is described under
Arsenic, and Acidum Sulphurosum under its own heading.

2, Organic Acids.— Acidum Aceticum, A. Citricum,
A. Tartaricum, A. Hydrocyanicum Dilutum, A. Carbolicum,
A. Benzoicum, A. Gallicum, and A. Tannicum. Of the organic
acids, the first three only will be discussed here ; the action
and uses of the other substances being but little connected with
their properties as acids.

ACIDUM SULPHURICUM, NITRICUM, HYDROCHLORICUM,
NITROHYDROCHLORICUM DILUTUM, PHOSPHORICUM
DILUTUM, ACETICUM, CITRICUM, AND TARTARICUM.

These substances all possess distinctly acid pro-
perties, that is, they neutralise alkalies, and turn
blue litmus red.

Acidum Sulphuricum.— Sulphuric Acid. H2S04
98 per cent., — 79 per cent. SO3, in water.

Source. — Obtained by the combustion of Sulphur, and oxy-
dation by nitrous fumes.

Characters. — A colourless, oily-looking, intensely acid
liquid.

Impurities. — Nitric acid, lead, and arsenic, organic matter ;
detected by colour.

Preparations.

1. Acidum Sulphuricum Dilutum. — 1 to about 11
of Distilled Water. Dose, 5 to 30 min.

From Acidnm Sulphuriewit Dilutum is prepared :
Infusum ROSJB Acidum. 1 of Diluted Acid in 80.

2. Acidum Sulphuricum Aromaticum. — 1 to about
13 of Spirit, with Cinnamon and Nutmeg. Dose, 5 to 30
min.

3. Many Sulphates and other preparations.

AC ID A. 125

Acidiuil Nitricum.— Nitric Acid. HN03, 70 per
cent, by weight, in Water.

Source. — Prepared from Nitre by distillation with Sulphuric
Acid and "Water.

Characters. — A colourless, intensely acid fuming liquid.

Impurities. — Sulphuric and hydrochloric acids ; mineral
matter; excess of water; peroxide of nitrogen; known by
yellow fumes.

Preparations.

1. Acidum Nitricmn Dilutum. — 1 to fully 4 of Dis-
tilled Water, pose, 10 to 30 min.

2. Acidum Nitrohydrochloricum Dilutum.— 3 to
25 of Distilled Water, with 4 of Acidum Hydrochlo-
ricum. Dose, 5 to 20 min.

3. Many Nitrates and other preparations.

Acidum Hydrochloricum.— Hydrochloric Acid.
HC1, 3T8 per cent, by weight, dissolved in Water.

Source. — Obtained by the action of Sulphuric Acid upon
Chloride of Sodium, and the solution of the resulting fumes.

Characters. — A nearly colourless, very acid liquid, with
pungent odour.

Impurities. — Sulphuric and sulphurous acids, arsenic, and
water ; detected by ordinary tests.

Preparations.

1. Acidum Hydrochloricum Dilutum.— 1 to 2* of
Distilled Water. Dose, 10 to 30 min.

2. Acidum Nitrohvdrochloricuin Dilutum. — 4 to 25
of Distilled Water, with 3 of Acidum Nitricum. Dose, 10
to gO min.

3. Many Chlorides, and other preparations.

Acidum Phosplioricum Dilutum. — Diluted
Phosphoric Acid. H3PO4 dissolved in Water =10 per cent.
P205.

Source. — Made by distilling Phosphorus with Nitric Acid
and Water, heating, and diluting.

Characters. — A colourless sour liquid, with a strongly acid
reaction.

Impurities. — Arsenic and lead ; detected by H.,S. Sulphuric,
nitric, hydrochloric, and pyro- and meta-phosphoric acids; de-
tected by usual tests.

Incompatibles. — Lime-water, calcareous salts, and carbonate
of soda.

126 MATERIA MEDIC A AND THERAPEUTICS.

Dose. — 2QJo 30 min.

Diluted Phosphoric Acid is used in preparing Syrupus Feni
Phosphatis, and Ammoniae Phosphas.

Acidum Aceticum. — Acetic acid. Anhydrous Acetic
Acid, C4H6O3. 28 parts in Water.

Source. — Prepared from Wood by destructive distillation
and purification.

Characters. — A colourless liquid, with, a pungent odour and
strong acid reaction.

Impurities. — Lead, copper; sulphuric, hydrochloric, and
sulphurous acids.

Preparations.

1. Acidum Aceticum Dilution. — 1 volume to 7 of
Water. Dose, 1 to 2 fl.dr.

2. Oxvmel.— Acetic Acid, 1 ; Water, 1 ; Honey, 8.
Dose.— 3 to 6 dr.

Acetic Acid is also used in preparing Acetum Can-
tharidis, Acetum Scillos, Extractum Colchici Aceticum,
Linimentum Terebinthinse Aceticum, Liquor Epispas-
ticus, and many Acetates.

Acid ii in Aceticum Ola dale. — Glacial Acetic
Acid! C4H603, 84 per cent, in Water.

Source. — Made by distillation from Acetate of Soda and
Sulphuric Acid.

Characters. — A colourless acid liquid, with a powerful
acetic odour.

Impurities. — Sulphurous acid ; and water.

Glacial Acetic Acid is u*ed in preparing Acetum
Cantharidis, and Mistura Creasoti.

Acetum. — Vinegar.

Source. — Prepared from Malt and Unmalted Grain by
acetous fermentation.

Characters. — A brown-coloured acid liquid, with a charac-
teristic odour.

Impurity. — Excess of sulphuric acid; detected volumetri-
cally.

Dose. — 1 fl.dr. and upwards.

l">ncgar is used in preparing Emplastrum Cerati
Saponis.

Acidum Citricum.— Citric Acid. H3(C6H507)H20.

ACID A. 1 2 7

Source. — Obtained from the juice of the Lemon ((.'it ran
Zimoniim), or of the Lime (Citrus Limetta], by neutralising it
with Chalk, decomposing the Citrate of Lime thus formed by
Diluted Sulphuric Acid, purifying, and crystallising.

Characters. — Colourless crystals, in the form of right
rhombic prisms. Very soluble in water. 17 gr. in ^ fl.oz. of
water make a solution resembling lemon juice in strength and
acidity, and exactly neutralise 2-5 gr. of Potassae Bicarbonas,
20 gr. of Sodae Bicarbonas, or 15 gr. of Ammoniae Carbonas.

Impurities. — Copper, sulphuric acid, mineral matters.
Tartaric acid, detected by precipitate with acetate of potash.

Dose. — 10 to 30 gr.

Citric Acid is used in preparing! Ferri et Ammoniaa
Citras, Ferri et Quinise Citras, and Vinum Quiniae.

Acidum Tartaricum.— Tartaric Acid. H2(C4H406).

Source. — Obtained from Acid Tartrate of Potash by neutral-
ising its solution with (1) Chalk and (2) Chloride of Calcium,
(3) decomposing the Tartrate of Lime thus formed by Sulphuric
Acid, and purifying. (1) 2KHC4H4Ofi + CaCO3 = CaC4H4O6 +
K2C4H406 + H.p + C02. (2) K.,C4H406 + CaCL2 = CaC4H4O6
+ 2KC1. (3) 2CaC4H406 + 2H,SO4 = 2H,C4H406 + 2CaSO4.

Characters. — Colourless oblique rhombic prisms, with a
strongly acid taste, readily soluble in water. 20 gr. exactly
neutralise 27 gr. of Potassae Bicarbonas, 22 gr. of Sodae Bicar-
bonas, or loiy gr. of Ammoniae Carbonas.

Impurities. — Lead, oxalic acid, lime, mineral matter, acid
tartrate of potash.

Dose. — 10 to 30 gr.

Tartaric Acid is used in preparing Soda9 Citrotartras
Effervescens.

Carbonic Acid. — Although not officinal as such,
carbonic acid gas is extensively used in medicine, being obtained
from Bicarbonates and Carbonates, commonly of Soda, Potash,
or Ammonia, by decomposition with Citric or Tartaric Acid.
The process is known as effervescence. The reaction may be
thus represented :
3(NaHC03) + (C6H50,)H3 = Na^CWW + SCO, + 3(H3O).

- S°d* Citras +<*«+ Water.

ACTIONS AND USES.

1. IMMEDIATE LOCAL ACTION'S AXD T

. — Acids are irritants, and some of them very
powerful corrosives. The strong acids are used as caustics ;

128 MATER i A MEDIC A AND THERAPEUTICS.

nitric acid to destroy chancres ; acetic acid, warts ; sulphuric
acid, some forms of malignant growths. Very dilute watery
solutions, sponged on the skin in fever, cool the surface by
evaporation, and thus act as refrigerants ; whilst watery solu-
tions of sulphuric acid used in this way appear to constringe
the tissues, and diminish the sweating of phthisis.

Internally. — In the dilute form, acids act directly upon the
contents of the alimentary canal, and are used in the treatment
of poisoning by alkalies. In every instance the free acids
quickly unite with bases in the digestive tract, and form neutral
salts. In the mouth they are stimulants and sialagogues :
they relieve thirst, rouse the appetite, and aid digestion by
increasing the flow of saliva and gastric juice, the citrates,
tartrates, and acetates being chiefly used for this purpose as
acid drinks and fruits of great variety, e.g. in fever. In the
stomach hydrochloric acid increases the acidity of the gastric
juice, and is given for this purpose during or after meals, as
a powerful stomachic. Carbonic acid, introduced in effervescing
wines and waters, has a grateful sedative action upon the
gastric nerves ; and in the form of champagne and effervescing
mixtures is a most valuable remedy in the treatment of sickness
with exhaustion. The other acids assist gastric digestion but
to a very small, possibly useless, extent. Reaching the duo-
denum, acids increase the acidity of the chyme and stimulate
the liver, pancreas, and intestinal muscles and glands. Dilute
nitric and nitrohydrochloric acids, given at the end of meals,
are therefore used as cholagogues in intestinal dyspepsia with
hepatic torpidity, especially in tropical cases.

2. ACTIONS ON THE BLOOD AND THEIR USES.

Acids render the blood less alkaline (but never acid, even
in poisonous doses) , by combining with part of the alkali of the
liquor sanguinis. No special use is made of this property.
Phosphoric acid increases the phosphates in the red corpuscles,
and is thus hsematinic. The vegetable acids, when given as
salts of the alkalies, have an important deoxydising effect on
the blood. For example, citrate of potash becomes converted
in the blood into carbonate of potash, carbonic acid, and
water, a portion, however, of the citric acid always remaining
unoxydised (see Potassium], thus : 2(K3C6H507) -f- 018 (in blood)
= 3(K2C03) + 5H20, + 9C02. Citrates, tartrates, and acetates
of potash, soda, ammonia, etc., in the effervescing form, may
therefore be used to set free in the blood the carbonates of the
alkalies, which cannot be so conveniently or safely given in
large doses by the stomach. The vegetable acids have been
used in the treatment of scurvy, apparently with doubtful

'

T>-UC . :-ocxC

<7

Gij<j

ACID A. 129

success ; and in rheumatism, with equally questionable results,
beyond their action on the mouth, skin, and kidneys.

3. SPECIFIC ACTIONS AND USES.

In the tissues and organs each of the acids exhibits a specific
action of its own. Sulphuric Acid is an astringent to the bowels,
skin, and blood-vessels, and is a valuable remedjr for diarrhoea,
profuse sweating, and haemorrhage. Nitric and Nitrohydrochloric
Acids are cholagogue, specifically as well as locally ; e.g. when
administered by means of a foot-bath (8 fl.oz. to one gallon of
water), or of a compress wrung out of the solution and worn
over the hepatic region. Tropical enlargements of the liver
may thus be reduced. The tonic influence of these acids is
probably referable to their stimulating effect upon the gastric
and biliary functions. Hydrochloric Acid enters the tissues as
chlorides, and no specific action or use can therefore be credited
to the small doses which can be given of it. Phosphoric Acid
also poss-sses no further influence on the tissues than that of
increasing pro tanto the amount of phosphates, and possibly
the growth of bones ; and its value in constitutional diseases
is probably due to its action on the red corpuscles, and to the
bases with which it is combined (iron, lime, etc.). As we have
seen, Acetic, Citric, and Tartaric Acids never reach the tissues,
being decomposed in the blood, unless given in large doses.

4. REMOTE LOCAL ACTIONS AND USES.

The acids, having chiefly entered into combination as
neutral salts, or having been decomposed in the blood, produce
remarkably little local action when they are escaping from the
body in the secretions. Sulphuric acid is excreted chiefly by
the kidneys, increasing very slightly the normal amount of
sulphates ; part escapes by the bowels as sulphates ; part by the
skin, this acid being anhidrotic. Phosphoric and Hydrochloric
acids behave similarly. Nitric acid is believed to be partly de-
composed into ammonia, and thus actually to diminish, to a
slight degree, the acidity of the urine. Acetic, Tartaric, and
Citric acids pass out of the body as carbonates, unless in excess,
when they escape unchanged by the kidneys. The important
point to be noted about all these acids, therefore, is, that they
do not, to any considerable or useful extent, increase the
acidity of the urine. It must be observed, however, that all
the acids probably stimulate the kidneys and skin i
by increasing the total amount of salts excreted by them.

Ac i till ill Boriciim. — Boric Acid. Boracic Acid.
B03H3. (Not Officinal, except as a test.}
J—S

130 MATERIA MEDIC A AND THERAPEUTICS.

Source. — SodaB Biboras, by the action of sulphuric acid.

Characters. — In white glittering plates, odourless, with a
slightly bitter taste. A weak acid. Solubility, 1 in 26 of cold
water, 1 in 3 of hot water ; freely in glycerine ; less freely
in spirit.

Dose. — 5 to 30 gr.

Preparations.

1. "Boracic Lint." Lint steeped in a boiling satu-
rated solution, and dried. Contains nearly half its weight
of the acid.

2. Various Ointments and Lotions.

ACTION AND USES.

Externally, boracic acid destroys low organisms, a solution of
1 in 133 arresting the activity of bacteria, and it is thus an anti-
septic, disinfectant, and deodorant. On the tissues it produces
little or no irritation, and is thus peculiarly adapted for use as
a surgical dressing. The lint is now extensively employed in
the antiseptic system; and lotions, warm fomentations made
from a boiling saturated solution, and ointments with paraffin
and vaseline, have almost replaced for the time other applica-
tions to wounds and ulcers. As its action does not extend
beyond the surface to which it is applied, boric acid is never
used for dressing cavities. It relieves itching, in the form of a
powder, ointment, or glycerine. It is a test for Rheum (q.v.) .

Internally, boric acid is a gastro-intestinal irritant in large

Acidum Sulphur o sum.— Sulphurous Acid. Sul-
phurous acid gas, S02, dissolved in water, and constituting 9 -2
per cent, by weight of the solution (rarely contains more than
6 per cent.).

Source. — Made by heating sulphuric acid with charcoal,
and dissolving the gas in water. 4H2S04 -f C2 = 4S02 + 2CO2
-f 4H20.

Characters. — A colourless liquid, with a pungent sulphurous
odour.

Impurities.— Sulphuric acid; mineral matters; excess of
water, detected by volumetric starch and iodine test.

Dose.—^to 1 fl.dr.

Non-officinal Preparations containing Sulphurous ^Acid.
Sodse Sulphis.— Sulphite of Soda. Na2S03,7H20.
Source. — Made by saturating a solution of carbonate of
soda with sulphurous acid gas.

ACID A. 131

Characters. — White efflorescent prisms, with a sulphurous
taste ; feebly alkaline. Soluble in 4 parts of water.
Dose. — 5 to 20 gr.

Sodse Hvposulphia. — Hyposulphite of Soda. Na2H2S204.

Source.— Made by passing Sulphurous Acid gas into a solu-
tion of Carbonate of Soda, with Sulphur. 2Na,2C03 -f S2 +
2S02 + 2H20 = 2(Na2H2S204) + 2C02.

Characters. — Large colourless transparent crystals, odour-
less, with a cool, bitter, sulphurous taste. Soluble in 1^ parts
of water. The solution is an officinal test for I and Cl.

Dose. — 10 to 60 gr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Sulphurous acid is a powerful deoxydising agent. Seizing
on oxygen and water, it decomposes organic bodies, and at the
same time produces upon them the irritant local effects of
sulphuric acid, into which it is converted. It thus destroys
low forms of living matter, including the organisms associated
with fermentation, decomposition, and certain diseases, 1 part
in 666 of water being sufficient for this purpose. Sulphurous
acid is therefore applied to ringworms and foul wounds ; and
some kinds of sore throat are relieved by a spray of the officinal
acid. Morbid fermentation in the stomach attended by the
growth of organisms, such as penicillium and sfircina, may be
quickly arrested by doses of min. 5 to min. 60 of the officinal
acid ; but the non-officinal salts are more convenient forms for
internal use, being decomposed by the acids of the stomach.
Sulphites given in full doses become converted into sulphates,
and act as purgatives.

Sulphurous anhydride, although not officinal, is very
extensively used for fumigating infected rooms and clothing1,
briii'.: probably the most powerful, certain, and convenient of
all disinfectants. Sulphur is burned on a shovel or plate, tho
outlets from the room having been carefully closed, excepting
the door through which retreat is made.

2. ACTION ON THE BLOOD, AND SPECIFIC ACTION AND L'SES.

Sulphites were once supposed to enter the blood an<l \
and to arrest morbid fermentation or fever processes within thnn.
The evidence, however, is to the effect that sulphites are not ab-
sorbed as such, but as sulphates, and the benefit derived from them
in fevers is probably due to the laxative and diuretic effects of the

132 MATERIA MEDIC A AND THERAPEUTICS.

higher salts. The suggested decomposition of hyposulphites
into sulphites and free sulphur, and their consequent alterative
and disinfectant action in phthisis and other diseases, appear
to he equally unreal.

3. REMOTE LOCAL ACTION.

Sulphites are excreted hy the urine and howels in the form
of sulphates.

Acidum Nitrosum.— Nitrous Acid. HN02. (Not

linal.}

This acid is not itself used in medicine, hut the nitrites are
active and valuable drugs. Those in use are nitrite of sodium
and nitrite of amyl, as well as sweet spirit of nitre and nitro-
glycerine. The sodium salt will be noticed here ; the others
under their own heads.

Sodii Nitris.— Nitrite of Sodium. NaN02. (Not Officinal.}

Source. — Made by heating nitrate of soda. 2NaN03— 2Na
N02 + 02.

Characters. — A white granular powder, deliquescent, with a
cool saline taste, very soluble in water.

Impurities. — The nitrate, and caustic soda.

Dose. — 2 to 10 grains.

ACTION AND USES.

Nitrite of sodium acts upon the blood, the heart, and vessels
like nitrite of amyl, only less suddenly and markedly, and for a
much longer period of time. It has been used with success in
heart disease, with recurrent attacks of painful angina ; less
successfully in epilepsy. Its depressant action on the central
nervous system is more marked than that of the amyl compound ;
and it also paralyses the peripheral nerves and the muscles
not only in this way, but through the blood.

GROUP V.

WATER.

AQUA. WATER.

Natural water, the purest that can be obtained,
cleared, if necessary, by filtration, and free from
odour, taste, and visible impurity.

AQUA. 133

From Aqua is made :

Aqua Destillata. — H20. Pure water, obtained by dis-
tillation.

Preparations.

Very numerous throughout the whole Pharma-
copoeia.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally, water acts chiefly as a means of applying heat
or cold to the surface of the body, being readily obtained at
any temperature that may be desired. To produce this effect,
water may be applied in the form of baths of all kinds : Cold,
cool, temperate, tepid, warm, hot, vapour, or variously medi-
cated ; also by sponging, douching, fomenting, etc. These
subjects will be noticed in the third part of the work. Pos-
sessing these properties, water is used externally for purposes
of cleanliness; for either raising or lowering the tempera-
ture of the body ; relieving pain, insomnia, and delirium ; re-
moving spasms or convulsions ; diminishing the circulation in
deep parts by superficial " derivation," as in congestion of the
brain, etc. Water is also used, in a purely local way, as a wash
or dressing to wounds, and as the basis of warm fomentations
in inflammations.

rnally, water is constantly being taken in the form of
food and drink. It relieves thirst, improves digestion and in-'
testinal action when drunk in moderation and at proper times, \
and in a purely physical way may reduce the local or general,
temperature of the body, for instance, as ice slowly su<
sore throat and febrile conditions.

2. ACTION ON THE BLOOD.

Water is quickly incorporated with the circulating plasma, i
Great excess has been known to dissolve part of the red cor-!
puscles, but this is a purely pathological effect.

3. SPECIFIC ACTION AND USES.

Water plays an essential part in tissue life and in the
activity of all the organs. A copious supply of water in
nutrition up to a certain point, especially the deposit of fat,
and is therefore extensively employed in hydro-therapeutics.

4. REMOTE LOCAL ACTION AND USES.

Water is excreted by the kidneys, skin, lungs, bowels —
indeed, necessarily in every secretion. Increase of water in the

134 MATERIA MEDIC A AND THERAPEUTICS.

urine is most readily induced when the skin is kept cool, and
carries with it an excess of urea, phosphoric acid, and chloride
of sodium. Water is thus a diuretic, and in one sense the most
natural measure of the kind*, being indicated when we desire
simply to irrigate or flush the urinif erous tubules and urinary
passages, and wash from them the products of disease, such as
blood, leucocytes, cellular debris, and sediments. Some kinds
of calculi may be dissolved by the steady consumption of dis-
tilled water, which carries away minute traces of the stone,
whilst it prevents fresh accretion on the surface.

As a diaphoretic, water acts best when warm and combined
with external heat. It is the basis of most familiar domestic
measures for relieving feverishness by inducing perspiration,
such as warm drinks of all kinds, and spirituous compounds.

GROUP VI.

THE CARBOHYDRATES AND OTHER CARBON
COMPOUNDS.

ALCOHOL. ALCOHOL. C2H6O.

Besides the following preparations, which are
commonly associated with alcohol, all the Tincturse,
Spiritus, and Essentiae, several of the Liquores,
Linimenta, and Misturae, and a few other compounds
contain it in various proportions.

1. Alcohol.— Absolute Alcohol. C2H60. Used only in
chemical testing.

Source. — Made by shaking rectified spirit with carbonate of
potash ; decanting, and distilling with slaked lime.

Characters. — Colourless, free from empyreumatic odour,
Sp. gr., 0795.

Impurities. — Resins, or oil; detected by turbidity on dilu-
tion. Water; giving blue colour with anhydrous sulphate of
copper.

ft. Spiritus Roetificsitns.— Rectified Spirit. Alco-
hol, C2H60, with 16 per cent, of water.

Source. — Obtained by the distillation of fermented saccharine
fluids.

ALCOHOL. 135

Characters. — Colourless, transparent, with a pleasant odour,
and strong spirituous burning taste. Specific gravity, 0%838.

Impurities. — Water ; tested volumetrically. Amylic alcohol,
beyond a trace ; detected by excessive reduction of AgN03,
Resin or oil ; giving turbidity on dilution with water.

Preparation.

Spiritns Tenuior. — Proof Spirit. Alcohol with
51 per cent, of water. Made by mixing 5 parts of recti-
fied spirit with 3 parts of water. Specific gravity,
0-920.

3. S nil-it US Vim Gallici.— Brandy. Spirit dis-
tilled from French wine.

Characters. — A spirit of a light sherry colour, and peculiar
flavour ; contains about 53 per cent, of alcohol, with some
volatile oil, and cenanthic ether.

Preparation.

Mistura Spiritus Vini Gallici. — " Brandy Mixture,"
"Egg Flip." Brandy and Cinnamon Water, of
each 4 oz. ; Yolks of two Eggs ; Sugar, £ oz. Dose, 1 to
2 fl.oz.

4. \ tmilil Xericiim*— Sherry. A Spanish wine.
Characters. — Pale yellowish brown, containing 17 or 18 per

cent, of alcohol ; with colouring matter, ethereal compounds, acid
tartate of potash, malates, sugar, etc.

Preparations.

The following Vina : Aloes. Antimoniale, Colchici,
Ferri, Ipecacuanhas. Opii. Rhei.

Vinum Aurantii is made by fermentation of a sac-
charine solution; Vinum Feni Citratis and Vinum
Quiniae are made from Vinum Aurantii.

Amount of Alcohol (absolute, by weight] in the various substancet

containing it.
Absolute Alcohol.
Alcohol (U.S.P.), 91 per cent.
Spiritus Rectificatus, 84 per cent.
Alcohol Dilutum (U.S. P.), 45*5 per cent.
Spiritus Tenuior, 49 per cent.

Spiritus Vini Gallici (Brandy), about 39 to 47 per cent.
Spiritus Frumenti (Whisky), about 44 to 50 per cent.
Rum )

Gin £ about 40 to 50 per cent.

Strong Liqueurs j

136 MATERIA MEDIC A AND THERAPEUTICS.

Port, Sherry, and Madeira, about 14 to 17 per cent.
Vinum Album Fortius (U.S.P.), about 11-5 to 14 per cent.
Vinum Album (U.S.P.), about 10 to 12 per cent.
Champagne, about 10 to 13 per cent.
Hock and Claret, about 8 to 11 per cent.
Beer and Cider, about 3, 5, or more per cent.
Koumiss (made from milk), about 1 to 3 per cent.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally, alcohol is an antiseptic and disinfectant, em-
ployed as a constituent of lotions for ulcers and wounds.
Applied to the unbroken skin, and the vapour allowed to escape,
it is a powerful refrigerant, withdrawing heat from the body
by its evaporation. In this form it is used to prevent or allay
inflammations of superficial parts, such as the subcutaneous
tissues, joints, and muscles; blanches the parts by vascular con-
striction ; produces a sense of cold ; and relieves pain, especially
headache, due to vascular dilatation and throbbing. Spirituous
lotions sponged on the skin also diminish the activity of the
sweat-glands, and may be used in excessive perspiration as an
anhidrotic. On the contrary, if the vapour be confined, and
allowed to act upon the tissues underneath, or if the alcohol be
rubbed into the part, it penetrates and hardens the epithelium,
and irritates the nerves and vessels of the cutaneous structures,
causing redness, heat, and pain, followed by local anaesthesia.
In the form of brandy it is rubbed into the skin to prevent bed-
sores, by hardening and disinfecting the epidermis. Spirituous
liniments containing soaps, essential oils, and other stimulants
(e.g. Linimentum Camphors and Linimentum Cam] (horse Compo-
situm), are applied with friction to increase the nutrition of
j arts which are the seat of chronic inflammation, induration,
adhesions, stiffness, and pain, such as the joints and muscles in
chronic rheumatism, periostitis, and paralysis, or to produce a
rubefacient ell'ect on a large area of skin, for instance, of the
client in bronchitis. Alcohol is absorbed by the unbroken
skin.

Internally, the local action of alcohol begins in the mouth
with its characteristic taste and a hot, painful, stimulating effect
on the tongue and mucous membranes. If it be retained in con-
ta'-t with them, the epithelium becomes condensed and whitened,
and the parts beneath anaesthetised. Some forms of toothache
can thus be quickly and completely relieved, the spirit also
acting as a disinfectant in the pulp cavity. Wines and other

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ALCOHOL. 137

wholesome alcoholic liquids consumed during meals have an
action of the first importance on the nerves of the tongue,
palate, and nose. By virtue of their taste, flavour, and bouquet,
they give a relish to food, increase the appetite, and stimu-
late the flow of saliva and the functions of the stomach.

In the stomach the action of alcohol is complex, and of
great importance. (1) Alcohol mixes with the contents of the
stomach ; is partly decomposed into acetic acid ; and precipitates
some of the proteids of the gastric juice : so far it depresses
digestion. (2) It stimulates the mucous membrane, dilating and
filling the vessels wilh blood ; excites and markedly in
the flow of gastric juice ; sharpens the appetite ; and renders
the movements of the viscus more energetic : in these respects
it greatly assists digestion. The total effect of a moderate dose
of alcohol is decidedly to favour gastric digestion, especially in
cases where the nerves, vessels, and glands lack vigour, as in
old age and in the chronic dyspepsia of persors weakened by
acute illness, town life, and anxious sedentary employments.
Herein consists the value of a small amount of wine or whole-
some ale taken with meat meals by such subjects. The danger
lies in excess, which readily destroys the activity of the juice,
and also sets up a secretion of alkaline mucus which greatly
interferes with digestion — a common cause of acute dyspepsia.

(3) The action of alcohol on the gastric wall produces
extensive effects of a reflex kind. The heart is stimulated by
moderate doses, producing a pleasurable rise of pressure and
sense of power. The vessels dilate universally, filling the
active organs with blood, further increasing their activity, the
brain being specially excited, and the skin flushed and warmed
subjectively. If the quantity be large these salutary effects
of alcohol as a diffusible stimulant may pass into depression ;
and the sudden ingestion of a large amount of spirit may prove
rapidly fatal by shock. The reflex results of alcoholic stimu-
lants, if properly applied, add to its value at mcul times,
by increasing the enjoyment of eating, and thus the diirrstivc
power. Certain forms* of pain in the stomach and bowels are
rapidly relieved by the local action of brandy, which also helps
to expel flatus ; and pain, spasm, irregular or feeble action of the
heart, cold feelings of the surface, and low conditions of the
brain are all quickly removed by the same reflex means, before
the alcohol could be absorbed in quantity into the blood.

2. ACTION ON THE BLOOD.

Alcohol enters the blood unchanged, and is distributed by
it to the tissues and organs, a small part only becoming lost in
it as acetic and carbonic acid. The action of alcohol on the

138 MATERIA MEDIC A AND THERAPEUTICS.

corpuscles is still obscure, but it probably binds the oxygen
more firmly to the haemoglobin, so that oxygenation of the
tissues occurs less freely, and therefore less extensively. The
eit'ect of this upon metabolism will now be described.

3. SPECIFIC ACTION.

Alcohol is rapidly taken up by the various organs, chiefly
unchanged. If given in moderate quantity, it is (1) completely
oxydised in its passage through the tissues into carbonic acid and
water, like other carbohydrates, that is, it is a food, or source of
heat and energy. At the same time it produces two other
equally important effects ; for (2) it reduces the activity of
metabolism or the oxydation of the tissues ; and (3) it first
stimulates, and afterwards depresses, the circulatory and
nervous systems, quite independently of its action on tissue-
change. These three effects of alcohol must be discussed
separately.

(1) Alcohol as a food. — It may now be accepted as proved
that, when taken in sufficiently small quantities, alcohol is
oxydised in the tissues ; and that it only passes out of the body
unchanged, through the lungs, kidneys, etc., when so freely
given that excretion occurs before oxydation has had time to
take place. This decomposition of alcohol must necessarily
develop vital force and heat, like the oxydation of sugar, fat,
and albumen. Alcohol belongs to the class of foods which do
not become an integral part of the living cells, or " tissue
proteids," as does much of the albumen, salts, etc., but remain
in the plasma which bathes the cells, are oxydised there, and
constitute their pabulum, the materials which supply the
active elements with much of their energy, the " circulating
proteids," carbohydrates, etc. Thus it happens that alcohol can
for a time sustain life when no food (so-called) is taken, as in
confirmed drunkards, and in some cases of severe illness.
Professor Binz, of Bonn, who has studied this question with
L';v;it industry and success, has calculated how much energy is
contained in :i unnnmr <>!' alcohol, and finds that two ounces of
absolute alcohol yield about the same amount of warmth to
the body as is supplied by an ounce and a half of cod-liver oil.
The uses of alcohol as a food will be presently described along
with its other applications.

(2) Alcohol as a nutritive depressant. — Whilst it is itself
thus oxydised in the tissues, alcohol unquestionably interferes
with the metabolism or oxydation of other substances, especially
(it would appear) saving or sparing the wear and tear of the
" tissue-proteids," or formed protoplasm of the cells. This
has been determined from three facts observed in animals

ALCOHOL. 139

supplied with alcohol ; first, that less oxygen is absorbed ;
secondly, that the temperature falls, and the albuminous
tissues, whilst they do not waste, tend to degenerate into fat,
so that the body as a whole grows fat and gross ; thirdly, and
chiefly, that the amount of urea, uric acid, carbonic acid, and
salts excreted, is decidedly diminished. These are settled
facts ; the explanation of them is more difficult. The inter-
ference of alcohol with the oxygenating function of the red
corpuscle is one obvious cause of impaired metabolism ; another
is the extreme readiness of the alcohol when it reaches the
to seize upon the oxygen which is there, thus robbing as
it were the fixed elements of their necessary share, and arresting
their decomposition af the middle stage of fat. This remark-
able property of alcohol of saving tissue waste is one of the
foundations of its employment in fever, to be presently
discussed.

(3) Alcohol as a stimulant and narcotic. — The circulation in
every part of the body is stimulated by a moderate dose of
alcohol. The rise in the force and frequency of the heart, and
the dilatation of the peripheral blood-vessels, which together
constitute this increased circulatory activity, are both so far
reflex effects from the mucous membrane of the stomach, as
we have already seen ; but they are also in part direct, the
alcohol exciting the nerve-muscular structures of the heart, the
cardiac centre, possibly the vaso-dilator centres in the medulla
and cord, and certainly the nervo-muscular tissue of the middle
coat of the vessels. To these causes of circulatory excitement
must be added the voluntary muscular movements which are
much exaggerated under the influence of alcohol. When
alcohol is taken in large quantities, its stimulant effect passes
into depression, both reflex and direct, and death may result,
in part at least from cardiac failure.

Upon the nervous system, the first effect of alcohol in
moderate quantity is one of stimulation. The nervous centres
are increased in vigour from the highest to the lowest, and in
the same order of sequence. The imagination becomes brilliant,
the feelings are exalted, the intellect is cleared, the will is
strengthened, the senses become more acute, the feeling of
bodily strength and ability is raised, and some of the app- tites
are temporarily excited. The centres of speech, and of muscu-
lar movements generally, are specially exalted, givinir
animated talk and lively gesticulations ; and, thnvwith.
of bien etre, referable to the combined nervous and circulatory
excitement, spreads over the system.

If the dose of alcohol be larger, these phenomena of
stimulation are more pronounced, but very soon give place to

140 MATER i A MEDIC A AND THERAPEUTICS.

depression, which spreads, like the excitement, from the highest
to the lowest centres of the brain and cord. The intellectual,
emotional, and voluntary faculties become first inco-ordinated,
then dull, and finally completely arrested ; the muscles are
first ataxic and next paralysed, so that after an unsteady, stag-
gering gait, the erect posture is impossible ; and the consequent
depression of the respiratory and circulatory centres leads to
stertorous breathing, circulatory failure, and even death.
The effects of alcohol upon the nervous centres are referable
partly to dilatation of the blood-vessels of the brain and cord,
but certainly also to a direct action of the drug upon the nerve
cells.

The action of alcohol on the other bodily functions is
chiefly, if not entirely, indirect. Thus, the muscles are affected
solely through the nervous centres and nerves. Respiration is
first increased, then slowed and weakened, partly through the
special centre, but manifestly also, to a great extent, through
the muscles and the circulation. Death occurs partly by
asphyxia. The bodily temperature is, on the whole, lowered
by alcohol : (1) by increased circulation through the dilated
peripheral vessels; (2) by increased perspiration; (3) by di-
minished metabolism ; and (4) after large non-medicinal doses,
by general depression. The sense of warmth is, on the con-
trary, increased by the flushing of the skin with blood, a condi-
tion which promotes bodily heat and comfort in a warm or
moderately cool atmosphere, but causes rapid refrigeration,
general vital depression, and even death, in low states of the
external temperature.

4. SPECIFIC USES.

The uses to which the complex specific action of alcohol
may be turned are many, and of great importance :

Alcohol is employed in fever, and other acute wasting
diseases, such as delirium tremens, and acute mania. The in-
dications in these conditions are to prevent or to make good
the great waste of tissues associated with the disease ; to sustain
the heart and nervous system, which threaten to fail, as the
frequent pulse and the delirium testify; and to promote the
loss of heat, which is formed in excess, as indicated by the
thermometer, the dry-brown tongue, the sleeplessness, and the
general restlessness of the patient. We have seen that these
ends are all fulfilled to a certain extent by alcohol. When the
symptoms just mentioned appear, brandy or other form of
spirit, and wines of the stronger varieties, are given in a definite
amount per diem, according to the height of the fever, the
state of the pulse and heart sounds, the general strength, tlx>

ALCOHOL. 141

ability to consume food, the previous habits, and the age of the
patient. It must be distinctly understood, however, that alco-
hol is by no means essential in every case of fever ; the very
opposite being the case. In delirium tremens (acute alcohol-
ism), -where food, in the ordinary sense of the word, can often
be given only with the greatest difficulty, the very substance
which, as a stimulant, has caused the disease, must be judiciously
continued as a form of nourishment for a time.

In chronic diseases attended by great debility, want of appe-
tite, and. possibly sickness, such as pulmonary phthisis, alcohol
will also find its place as a true food.

As a stimulant the principal use of alcohol is in connection
with the heart. This, as we have just seen, is an important
part of its action in fever. Of all remedies in threatening death
by cardiac failure (syncope, fainting), spirits are the best, being
at once available, convenient, rapid in their action, and almost
invariably successful, if recovery be possible. For this purpose,
brandy, whisky, etc., should be given either pure or only
slightly diluted, by the stomach, bowel, or even under the skin.
Hardly less valuable is alcohol, given continuously in small
regular doses, in chronic disease of the heart, when natural
hypertrophy fails and dilatation ensues. Wine, rectified spirit,
or various tinctures, may be given in such cases.

In nervous depression alcohol must be ordered with the
greatest hesitation. In melancholia, or in despondency be-
gotten by grief, anxiety, suspense, over- work, excess, and espe-
cially by indulgence in alcohol itself, this drug affords only too
ready relief, as also in neuralgia, hysteria, and allied disorders
and sleeplessness ; and the recommendation of it by the practi-
tioner is frequently abused, being employed as a pretext for
continued intemperance. In such cases the best rule is to
order a definite amount of some weak alcoholic drink, such as
ale or claret, at meal times only ; but even this recommendation
is by no means always safe. Severe pain, such as neuralgia, is
often successfully relieved on the same principle. Some forms
of sleeplessness are readily overcome by warm alcoholic
draughts at bed-time, or malt liquors; but here again great
discrimination is requisite in ordering the remedy.

6. REMOTE LOCAL ACTION AND USES.

Alcohol given in medicinal doses is, as we have seen,
almost entirely oxydised in the system, only 16 percent, passing
out unchanged, chiefly by the lungs, less by the kidn
least by the skin. This amount, however, includes ethereal and
other complex bodies associated with alcohol in win

142 MATER r A MEDIC A AND THERAPEUTICS.

spirits ; and by far the greater part of the alcohol proper is
excreted as carbonic acid and water.

The diuretic effects of spirits, wines, and especially gin and
beer, are well known, and may sometimes be employed in
medicine. The diaphoretic effect of alcohol and its applications
have been already sufficiently discussed under fever.

Circumstances modifying the action and employment of alcohol.
— The different alcoholic fluids act very differently, according
to their strength ; their other constituents, already enumerated ;
the presence of carbonic acid in them (sparkling drinks),
which increases the rapidity of their action on the stomach
and possibly of their absorption ; the degree to which they are
diluted with water ; and the condition of the stomach as regards
the presence of food. The age of the patient, the soundness of
his kidneys and other eliminating organs, his habits as regards
alcohol, and the amount of exercise which he can take,
must also be carefully estimated in ordering the remedy. In
conditions of waste and exhaustion, especially febrile states and
after operations, large quantities (even 1 pint of brandy per
diem) may sometimes be tolerated.

ALCOHOL AMYLICUM. AMYLIC ALCOHOL.

" Fousel Oil," C5H120, with a small proportion of other
spirituous substances.

Source. — Contained in the crude spirit produced by the
fermentation of saccharine solutions with yeast, and separated
in the rectification of such spirit.

Characters. — A colourless oily liquid, with a penetrating
and oppressive odour, and burning taste; specific gravity, -818.
Boils at 270°. Sparingly soluble in water ; freely in spirit and
ether.

Impurities. — Other aethereal substances ; detected by specific
gravity and boiling point.

Preparation.
Sodse Valerianas. — See Valerians Radix, page 272.

USE.

Amylic alcohol is used only to prepare Valerianate of Soda.
CHLORQFORMUM. CHLOROFORM. CHC13.

Terchloride of Formyl.

Source. — Made by (1 and 2) distilling Eectified Spirit with
Chlorinated Lime and Slaked Lime (oxydising and chlorinating
the alcohol) ; washing with Sulphuric Acid ; and redistilling

CHLOROFORMUM. 143

with Slaked Lime and Calcium Chloride. (1) 2C2H60 + 00 -f-
Cli, = 2C,HC130 (chloral) + 6HC1 + 2H20. (2) 2C.,HC130 +
Ca2HO = 2CHCL, 4- Ca2CH02 (formate of lime).

Characters. — A limpid, colourless, heavy, volatile liquid, of
an agreeable ethereal odour and sweet taste. Solubility, 10 in
7 of spirit ; 1 in 200 of water ; freely in olive oil and turpen-
tine. Sp. gr., 1-49.

Impurities. — Hydrocarbons ; detected by green colour with
sulphuric acid. Non- volatile compounds ; detected by residue
and unpleasant odour after evaporation. Alcohol ; detected by
opalescence when dropped into water.

Dose. — 3 to 10 min.

Preparations.

1. Aqua Chloroformi.— 1 in 200 of Water. Dose,
\ to 2 fl.oz.

2. Linimentum Chloroform.!. — 1, with 1 of Camphor
Liniment.

3. Spiritus Chloroformi.—" Chloric Ether." 1 to
19 of spirit. Dose, 10 to 60 min.

4. Tinctura Chloroformi Composita. — 2: Spirit,
8; Compound Tincture of Cardamoms, 10. Dose, 20
to 60 min.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND TJSES.

Externally applied, and allowed to evaporate, chloroform
causes a sense of coldness, and depresses the terminations
of the sensory nerves of the part, thus reducing sensibility or
removing pain. If, on the contrary, the vapour be confined, or
the chloroform rubbed into the skin, it acts as an irritant,
causing redness and even vesication, with a sense of heat and
pain, followed by anaesthesia of the part. A similar effect is
produced on all exposed mucous membranes. As a local anaes-
thetic, chloroform may be applied on lint, covered closely with
a wine-glass (e.g. in temporal headache) ; or in the form of
liniment with various combinations of belladonna and other
anodynes, which are used for the relief of lumbago, neuralgia,
etc. The student must understand, however, that the local
anodyne effect of chloroform bears a very inferior relation to
its rapid and powerful action as a general anaesthetic.

Internal/!/. — When it is given by the mouth, chloroform
produces an intensely hot, sweet taste, which renders it useful

144 MATERIA MEDIC A AND THERAPEUTICS.

in pharmacy to cover the nauseous, hitter, and astringent
characters of many drugs. It may also he used to relieve
toothache. Like alcohol, it causes reflex salivation, and in this
way, as well as hy a carminative action on the stomach, the
compound tincture, spirit, and aqua are useful adjuvants to
stomachic and tonic mixtures, relieving pain, vomiting, and
flatulency. In full doses it may give rise to vomiting, as is
frequently seen after anaesthesia. A few drops of chloroform
inhaled from a sponge or piece of lint (quite apart from its
action and use as a general anaesthetic), rapidly soothe the
respiratory nerves, and may he employed to arrest spasm of
the glottis, asthma, and spasmodic or dry useless cough attend-
ing irritation of the air passages.

2. ACTION IN THE BLOOD.

Chloroform enters the circulation hy the respiratory organs,
stomach, and the unbroken skin, as well as subcutaneously.
Chiefly as chloroform, partly as various products, it mixes with
the blood ; but its action on the living circulating blood is
still obscure.

3. SPECIFIC ACTION AND USES.

Chloroform reaches the tissues very rapidly, especially if
administered in the form of vapour freely mixed with air, as
it always is when given as a general anaesthetic. Its most im-
portant action is exerted upon the central nervous system, and
demands detailed description. The phenomena which it pro-
duces will first be noted ; secondly, an analysis will be made of
these ; thirdly, the uses of chloroform will be enumerated ; and
fourthly, the method of administering the anaesthetic, and
certain necessary precautions will be briefly indicated.

1. Phenomena of chloroform anaesthesia. — a. First stage.
The first effect of the inhalation of chloroform on the nervous
system is powerful stimulation, but almost from the com-
mencement this is accompanied by a certain amount of dis-
order. The first few inspirations seem to rouse the cerebrum
to increased activity, an eifect due to the direct action of the
anaesthetic on the nerve-cells of the convolutions and partly, per-
haps, to vascular disturbance. The highest centres are first and
chiefly excited so that the imagination and f eelings immediately
become exalted, always, however, with some confusion. For
a moment the senses may be quickened, but they are quickly
disordered and depressed : vision, hearing, and touch become
dulled or blurred, and a strange feeling of lightness, freedom,
tingling, or numbness pervades the surface and the extremities.
All these sensations are strictly central, probably convolutional
in origin.

I - u 4K

uC

rv(&-^-'VO r\/v»-O • -*-c <XciA».

CHLOROFORMUM. 1 4 5

At the same moment, or almost immediately after, the
chloroform rouses the spinal or muscular centres, and various
gesticulations and spasmodic or struggling movements may cnsm •.

The medulla oblongata is next affected, the centres of cir-
culation and respiration heing stimulated, so that the pulse and
respiration become more frequent (although the latter is more
shallow), the face flushed, the blood pressure raised. At this
point the skin becomes moist, a red rash in irregular patches
may appear on the neck and chest ; and the pupils may dilate
slightly.

These phenomena vary greatly in different instances, with
the constitution and condition of the nerve-centres, the tem-
perament and habits of the individual, laughing or crying or
noisy struggling being the most prominent feature in many
cases.

b. Second stage. — The second effect of chloroform on the
nerve-centres is depression. The same parts continue to be
affected by the drug, but their functions, instead of being in-
creased or simply disordered, are first diminished, and at last
completely arrested. Consciousness now ceases, with the appear-
ance of heavy sleep. Perception and sensation are annulled :
the patient sees nothing, hears nothing, feels no pain. For the
same reason, reflex excitability is first diminished and then
lost : irritation of any part by tickling or pinching no longer
induces movements of the limbs ; at last, even touching the
cornea causes no reflex rolling of the eye-ball or winking of the
lids.

As the anaesthesia deepens, the reflex and automatic
excitability of the cord and medulla is also diminished, and the
phenomena that ensue affect all the parts supplied by these
centres. The muscular tone is lost, and the voluntary muscles
become paralysed and relaxed. The pupil is semi-contrartrd,
and may dilate on stimulation of afferent nerves. The heart :m<l
respiratory organs are no longer excited, but their centres in
the medulla being now depressed, their action is laboured, the
pulse falling in frequency (a striking change from the previous
ition) and in strength, and the respiratory movements
being slow, heavy, and attended by noise or stertor.

Now is the time for the surgeon to operate,
being complete, whilst the depression of the vital fund ;
still within safe limits. The eifects may be expected to pass off
in a few minutes if the administration be stopped; and
although the amount required to complete the second
varies greatly with the subject and other circumstances, it may
be said that from 1 to 4 fluid drachms will probably ha\
given up to this point.
K— 8

146 MATERIA MEDIC A AND THERAPEUTICS.

c. Third stage. — Beyond the second stage or degree, chloro-
form anaesthesia is highly dangerous, the further action of the
drug being attended by complete loss of all reflex excitability
of the cord and medulla. The sphincters relax, the pupils
are widely dilated and fixed, the globes prominent. The
respiratory centre is no longer irritable, and the movements of
the chest become weaker, irregular, sighing, and finally cease.
The cardiac centre fails, the heart beating irregularly and
feebly, and at last stopping in diastole, both from central and
from, direct nervo-muscular depression. The blood-vessels
dilate, the pressure falls to zero, and the circulation has come
to a standstill. It is obvious that the direct effects of chloro-
form on the respiratory centre are complicated towards the last
by venosity of the blood. Death may occur through the heart,
the respiration, or both together.

2. Analysis of the phenomena of chloroform anaesthesia.
— Chloroform anaesthesia affords us an excellent opportunity of
studying the action of a drug upon the various centres of the
nervous system, from the highest downwards. The first parts
to be stimulated are the cerebral centres with mental functions,
the control of the special senses and consciousness; and these
are the first to be depressed and finally annulled. The lower
cerebral and spinal centres are affected less and somewhat later,
so that a certain degree of excitement of these accompanies the
first cerebral depression ; and the spinal centres being no longer
controlled by the cerebral, irregular excessive movements of
the limbs ensue. As the depression deepens in the spinal
centres, the muscles are paralysed. Lastly, the lowest centres
of all, those of organic life, connected with the heart, vessels,
respiratory organs, and sphincters, situated in the medulla and
cord, yield to the action of chloroform. Although affected from
the first, it is not until the higher parts have become com-
pletely overpowered that the functions of these vital centres are
seriously impaired, and death threatens. It is on account of
the safe order of invasion of the different centres by chloroform
that it has been selected as the proper agent for temporarily
arresting consciousness ; we shall find that many other power-
ful drugs equally depress the nervous system, but in a direc-
tion exactly the reverse.

The peripheral nerves are affected last of all in general
anaesthesia, and it must be repeated that the loss of sensibility
to the knife is due to a central, not a peripheral effect.

The muscles are finally affected directly, as well as through
the nervous system. The pupil is dilated in the first stage,
probably by stimulation of the sympathetic ; and contracted in
the second, and dilated in the third stage, by stimulation and

CHLOROFORMUM. 147

paralysis respectively of the third nerve or its cerebral
The other involuntary muscles are less obviously paralysed,
and the parturient uterus contracts freely in complete anaes-
thesia, with some loss, however, of vigour and regularity.

3. Specific uses of chloroform. — The circumstances under
which chloroform anaesthesia may be employed are the follow-
ing: (1) In operations attended by pain. These need not be
particularised. (2) In operations where muscular action or spasm
has to be overcome : reduction of hernias, dislocations and frac-
tures ; catheterism. (3) In diagnostic manipulations : explora-
tion of the abdomen externally and per rectum. (4) In diseases
attended by excessive pain, especially biliary and renal calculus.
(5) In parturition, in certain subjects and conditions, the
degree of anaesthesia induced being generally slight until the
moment of birth. (6) In spasmodic diseases, such as tetanus,
hydrophobia, uraemia, puerperal convulsions, the status epi-
lepticus, severe chorea, and hiccup.

4. Method of administration, and principal precautions
to be observed in chloroform anaesthesia.— This is a purely
practical subject, to be learned by experience and not in theory.
The student has frequent opportunities of witnessing the ad-
ministration of anaesthetics by skilled persons, and he must
closely and carefully observe every effect of the chloroform upon
the patient. He will do well to interpret every phenomenon as
it arises, such as mental and muscular excitement, the
character of the breathing, the colour of the countenance, and
(if possible) the state of the pulse, into exact physiological
terms, as explained above ; as, for example, stimulation of the
convolutions and cord, interference with the respiratory centre,
etc. He will thus come to appreciate accurately the condition
of the patient at any moment, and be prepared to assist in
administering anaesthetics himself. Many purely j >ract i< al points
will then have to be learned : the selection of suitable cases for
anaesthesia ; the preparation of the patient ; the choice of the
anaesthetic and of an inhaler; the position of the patient ;
the method of watching the face, eyes, pulse and respiration ;
the detection of unfavourable symptoms, and thrir immediate
treatment ; and, finally, the after treatment of the case. All
these and other matters connected with the administration of
anaesthetics can be but briefly referred to in the folio wing para-
graphs :

a. Selection of cases. — Chloroform must be given with great
caution to the aged and infirm, to persons who are sul
attacks of faintness, or known to suffer from fatty degeneration
or dilatation of the heart, to very fat. and very anaemic
persons, to epileptics, to chronic drunkards, to the subjects of

148 MATER i A MEDIC A AND THERAPEUTICS.

extensive disease of the lungs or respiratory passages. Nitrous
oxide gas or ether must be preferred in such subjects, according
to the length of the operation. Valvular disease of the heart
•with compensation suggests special care, but is not a contra-
indication. Operations on the mouth, nose, throat, attended by
possible bleeding into the glottis, demand special precautions,
whether by great expedition, special postures of the patient, or
even previous tracheotomy. It must never be forgotten,
however, that when an operation is absolutely necessary, it can
always be more safely performed with anaesthetics than without
their aid ; and that before the days of ether and chloroform,
many persons died under an operation, from fear, f aintness, and
shock, the danger from which is completely removed or greatly
diminished by anaesthetics.

b. Preparation of the patient. — Insensibility is more rapid
when the stomach is empty. No solid food should therefore be
given for at least six hours before the operation, which should,
if possible, be performed early in the morning' when digestion
has been completed and the anaesthetic is rapidly absorbed. If
the patient feel faint under these circumstances, a small quan-
tity of brandy and water may be given before operation.
Artificial teeth must be removed. The respiration and pulse
should be carefully noted before commencing inhalation.

c. Selection of the anesthetic : purity of the same. — The
anaesthetic agents in general use at the present time are chlo-
roform, bichloride of methylene, ether, and nitrous oxide gas.
Of these, ether and nitrous oxide are unquestionably to be
preferred, unless there be some special reason to the contrary.
The purity of the drug is best insured by purchasing it from
well-established makers, and not by attempting to test it for
oneself ; and the same manufacture should always be used, if
possible. It may be advisable to commence with one anaes-
thetic, and then, as circumstances alter during the operation,
to change it for another.

d. Selection of the apparatus. — This will depend on cir-
cumstances arid on the taste and experience of the administrator.
Whilst elaborate inhalers are used in hospitals, it is satisfactory
to know that the simplest apparatus is equally safe, such as a
handkerchief or towel made into a cone, care being taken that
chloroform vapour is mixed very freely with air, but that with
ether, on the contrary, the atmosphere is excluded as com-
pL't'-ly as possible. A few capsules of nitrite of amyl and a
straight polypus forceps should be ready at hand.

e. Position of the patient. — The administrator must accom-
modate himself to the convenience of the operator, whose eye
and hand must never be interfered with. If possible, the

CilLOROFORMUM. . 149

patient's head should be placed in such a position on the edge
of a pillow that the saliva may flow from the mouth instead of
into the stomach, and that the tongue may not fall back and
produce dyspnoea. It is essential that the patient's chest and
abdomen should not be compressed in the slightest degree by
clothes or by the arms of the assistants, or confined by ban-
dages. The most comfortable position for the patient is on the
side, with one hand and fore-arm beneath the pillow ; and as
a rule it is better to induce insensibility in this position, and
afterwards arrange the patient for the surgeon, than to
senasthetise him in the constrained attitude often required in
operations.

/. Administration.— The confidence of the patient should
first be gained by a few minutes' conversation, whilst he is
reassured as to the result and instructed how to breathe.
When inhalation has commenced, the administrator must not
even for a single instant cease to watch the face, respiration,
and pulse. The degree of insensibility necessary for dif-
ferent cases varies greatly, the least being required for uterine,
the most for rectal operations. The loss of the corneal reflex,
and stertorous breathing, are generally employed as tests of
insensibility, but no single sign can be relied upon. The
smallest possible quantity of the drug should always be given ;
and patients once thoroughly ana?sthetised by ether may be
kept under its influence for many minutes by rebreathins^ the
air of expiration loaded with its vapour mixed with some
fresh air.

g. Complications and unfavourable symptoms. — Vomiting is
generally preceded by pallor of the face or a few deep inspira-
tions. When it occurs, care must be taken that nothing is
dnt\vn into the larynx ; the head should therefore be thrown
forward, and the mouth opened by pressure on the symphysis of
the jaw, or by inserting a pair of forceps between the teeth.
Should vomited matter be inhaled into the respiratory j
and asphyxia threaten, laryngotomy must be immediately P«T-
formed.

Lividity of the face and prolonged deep stertor should be
checked by raising tin- shoulders so that the diaphragm may
1 more easily, and by making the patient hreath.' fivsh air.
The position of the head'is to be ehanp'd until respiration is
more easy; the vessels of the head and neck must be allowed to
empty themselves well and quickly; and the mouth may have
to be opened to its fullest extent, which induces a dt^-p inspi-
ration, the following expiratory effort oi'tm i-lcarinir the larynx
and fauces of tenacious mucus which had been obstructing the
entrance of air.

150 MATERIA MKDICA AND THERAPEUTICS.

Pallor of the face is to be combated by lowering the head
and shoulders ; if severe, by dropping the head over the end of
the table. If this should not succeed, the vapour of nitrite of
amyl should be given.

Shallow breathing, especially if intermittent, should be
anxiously watched; and if it increase, artificial respiration
should be at once resorted to, on no account waiting for the re-
spiration to cease.

h. After-treatment. — Absolute quiet and keeping the eyes
closed often prevent sickness after an operation. The whole
surface of the body being carefully covered to pi-event chill, the
room should be cleared of ether vapour as quickly as possible.
Cough induced by ether is often attended by blood-stained
mucus, which, with these precautions, is of no consequence.
Food should not be given within two hours after the operation,
and for the first twelve hours should be entirely cold, and con-
sist chiefly of soups and jellies, milk being avoided. A tea-
spoonful of burned brandy will often relieve the after-sickness,
when all other measures have failed.

4. REMOTE LOCAL ACTION.

Chloroform is excreted in part, as such, by the kidneys,
lungs, and skin ; part is lost in the system. No use is made
of its remote effects, although small doses given by the mouth
are said to increase all the secretions.

AETHER. ETHER. C4H10O.

A volatile liquid prepared from Alcohol, and containing at
least 92 per cent, pure ether. C4H100.

Source.— Made by (1 and 2) distilling Rectified Spirit with
Sulphuric Acid, purifying with Slaked Lime and Chloride of
Calcium, and redistilling. (1) C2H60 + H.,S04 = C2H6S04
(sulphovinic acid) + H20. (2) C\2H6S04 + C2H60 = C4H100
-f H,S04.

Characters. — A colourless, very volatile liquid, with pecu-
liar strong odour and hot taste. It is entirely dissipated in
vapour when exposed to the air, boils below 105" Fahr., and is
very inflammable. It contains 8 per cent, of spirit. Specific
gravity, 0'735.

Impurities. — Alcohol ; tested by specific gravity.

Dose. — 20 to 60 min.

Preparations.

1. ./Ether Puma. — Pure Ether. Ether free from
alcohol and water.

e»-o- Unou twoCi

*» UCOLe«-«er«l

. ' v/' [v. . !$

i

ALTHER. 151

Source.— Made by shaking ether with water, separat-
ing, purifying by quicklime and chloride of calcium,
and distilling.

Ch a racters.— Specific gravity, 0*720. Boils at 96°
Fahr. Given by inhalation.

Impurities. — Alcohol and water ; detected by specific
gravity.

2. Spiritus JEtheris— Ether. 1 ; Rectified Spirit, 2.
Specific gravity, 0'809. Dose, 30 to 60 min.

From Spiritus ^Etheris is prepared :

rinctura Lobelias ^Etherea, See Lobelia.
Cther- is also used in making Collodion and

Liquor Epispasticus ; and in many pharmaceutical

processes.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — When allowed to evaporate, ether is a powerful
refrigerant and anaesthetic, abstracting heat and depressing
the nerves of the part. It is used in the form of Dr.
Richardson's spray to relieve the internal local pain of
neuralgia, and more frequently to prevent pain in minor sur-
gical operations, the parts being completely frozen in the
course of a few minutes by the spray of pure ether from a
proper apparatus. If the vapour be confined, or the ether
rubbed into the skin, a rubefacient or even vesicant effect is
produced, as with chloroform. The Ethereal Extract of
Mezereon and Liquor Epispasticus are powerful vesicants and
counter-irritants.

Internally. — Ether has a powerfully burning, disagreeable
taste, and causes local irritation and reflex salivation in the
mouth, like chloroform. Reaching the stomach, it acts as a
local stimulant to the blood-vessels, nerves, and m
and is therefore used as a carminative, relieving pain and sick-
ness, and expelling flatulence, especially in :
At the same time, it acts reliexly from the gastric muco.-
the heart and respiratory organs, as a powerful systemic stimu-
lant. It is a very useful ingredient of powerful anti-spasmodic
draughts, as will be presently described. Given with cod-liver
oil, it renders it more palatable to some patients, and more
digestible, possibly by stimulating the pancreas.

2. ACTION ON THE BLOOD.

Ether is absorbed into the blood with remarkable rapidity,
and acts here like chloroform.

152 MATER IA MEDIC A AND THERAPEUTICS.

3. SPECIFIC ACTION AND USES.

The specific action of ether and its employment as an
ansesthetic so closely agree with those of chloroform that the
reader is referred to the description of the latter drug, and the
differences between the two substances only require to be men-
tioned here. These are :

1. Ether must be administered nearly pure, say 70 per cent.
of the vapour with 30 per cent, of air ; whilst but 3 to 4 per
cent, of chloroform is given, with 97 or 96 per cent, of air.

2. With ether the stage of stimulation is more protracted ;
there is more struggling ; and the stage of anaesthesia is shorter
and the degree less profound. Ether is therefore said to be
safer than chloroform.

^3. Ether depresses the heart and vessels less than chloro-
form, the heart continuing to beat after respiration has been
arrested by an excessive dose. The respiratory centre is also
less depressed. For these reasons, also, ether is called a safe
anaesthetic.

4. Ether has a much less pleasant smell than chloroform.

In choosing between ether and chloroform, preference must
be given to the safer anaesthetic, and the use of ether has ac-
cordingly been much revived during the last few years. Under
certain circumstances chloroform is preferable, as in operations
about the mouth, ether causing a profuse secretion of ropy
mucus ; in operations where a light or the cautery might come
into contact with the ether vapour and cause an explosion ; in
operations which must be hastily undertaken and completed ;
and in parturition, where profound anaesthesia is unnecessary.
Infants bear chloroform well, and their delicate respiratory
passages are less irritated by it than by the pungent vapour
of ether.

Given by the stomach in small doses, ether increases the
activity of the circulation and nervous system — partly, as we
have seen, by reflex action from the gastric wall ; and is used
as a powerful and rapidly diffusible stimulant and anti-
spasmodic. It is given largely in cardiac failure, faints,
angina pectoris, palpitation, and depression, being even more
rapid in its effects than alcohol, but more evanescent, and
of course less available in emergencies. Its antispasmodic
powers make it useful in hysterical and epileptic threatenings ;
and in spasmodic cough and asthma it is one of the most
valuable remedies during the seizure.

4. REMOTE LOCAL ACTION AND USES.

Ether is excreted like chloroform, and to a certain extent

.'

NITROUS OXIDE. 153

increases all the secretions, but is not eniplovrd with ti

in view. It is believed by some to diminish the liability to

gall stones, or actually to dissolve concretions already formed.

NITROUS OXIDE. N2O. (Not Officinal)

Nitrous Oxide Gas, Protoxide of Nitrogen, " Laugh-
ing Gas."

Source. — Made by heating Nitrate of Ammonia. NH4N03 =
N20 + 2H20.

Characters. — A colourless inodorous gas. It is provided for
use condensed into a liquid, in strong iron bottles, whence it is
allowed to escape into" a caoutchouc bag.

ACTION AND USES.
1. ACTION ON THE BLOOD AND ITS USES.

Nitrous oxide gas, administered from an inhaler, rapidly
enters the circulation ; is absorbed by the plasma ; converts
the arterial into venous blood, in the course of about sixty
seconds; and thus produces partial asphyxia. It does so
apparently by diminishing the amount of oxygen in combi-
nation with the red corpuscles, without itself uniting with
the haemoglobin, like CO and NO ; in this respect it is an
" indifferent " gas, like N and H, simply taking the place of the
oxygen, if this be completely excluded at the same time, and
exerting of itself no poisonous action upon the corpus, ',
must, therefore, be given pure, i.e. without any admixture of air.
The effect of the incipient asphyxia, and the uso to which it
may be turned, will be described in the next section.

2. SPECIFIC ACTION AND USES.

Nitrous oxide gas not only renders the blood venous, but
simultaneously enters the nervous cent ITS, upon which it a< ;s,
first as a stimulant, and speedily as an anaesthetic. Thus the
gas produces a series of phenomena which can he resolved into
,-illel effects of venosity of the blood or asphyxia, and a
specific influence on the nerve cells of the convolutions.
a few seconds' excitement, the subject for anaesthesia by nit runs
oxide begins to breathe laboriously ; the mind Incomes rapidly
obscured ; and by the end of about sixty seconds .
is lost, the face may be livid and bloated in appearui'e,
respiration becomes stertorous, muscular twitching* occur, the
pulse fails at the wrist, and the whole appearane.> i- alam.
novice. If the inhalation be now interrupt! <;.

154 MATERIA MEDIC A AND THERAPEUTICS.

of consciousness and of natural breathing occurs in thirty to
sixty seconds, with disappearance of all the urgent symptoms.
It is clear that asphyxia is carried into the second stage — that
of respiratory excitement, but not beyond, neither the move-
ments of the chest nor the action of the heart being arrested.
But even if these untoward results should occur, resuscitation
is easy by means of artificial respiration; it is said even after
five minutes in the case of rabbits. No attempt to carry the
asphyxia beyond the second stage is permissible in man.

Nitrous oxide gas is extensively used to produce anaesthesia
during operations lasting but one minute or less, and especially
by dental surgeons during the extraction of teeth, destruction
of the nerve, etc. It must always be given pure, by the
arrangement above described in the hands of a skilled anaesthe-
tist. The moment for operating is best indicated by stertorous
breathing and twitching of the muscles. Persons with dis-
eased vessels, such as the subjects of chronic Bright's disease,
ought not to take this anaesthetic, which produces (like all
asphyxiating agents) a great and sudden rise of the arterial
pressure, likely to cause rupture within the brain.

BICHLORIDE OF ETHIDENE. (Not Officinal)

Source. — Obtained in the manufacture of chloral.

Characters. — A colourless volatile liquid, with the odour
and taste of chloroform. Specific gravity, T20. Readily
soluble in ether, chloroform, and alcohol; with difficulty in
water.

ACTION AND USES.

Bichloride of ethidene is a general ansesthetic, supposed
to occupy a position somewhat between ether and chloroform,
but depressing the heart more than the latter. It is a very safe
anaesthetic in some animals, but, like all its allies, occasionally
causes death in man. About 4 n.dr. in the form of vapour are
required for an adult.

BROMIPUM. BROMIDE OF ETHYL.
HYDROBROMIC ETHER. C2H5Br. (Not Officinal.)

Source. — Made by adding Bromine to a mixture of Phos-
phorus and Absolute Alcohol, and distilling. oCaHgO -f- PBr5
(bromide of phosphorus) = 5Cyi5Br + H3P04 + H20.

Characters. — A colourless liquid with a powerful fragrant
odour, and a hot sweetish taste. Very volatile ; specific gravity,

ETHYLATE OF SODIUM. 155

1'42. Non-inflammable. Readily decomposes, yielding bro-
mine. Freely soluble in alcohol and ether; very sparingly
soluble in water.

Lose.— 10 to 60 min.

ACTION AND USES.

Bromide of ethyl acts as an ansesthetic like chloroform and
ether. For a time it was used in America and England, espe-
"cially in short painful operations, and in ophthalmic practice,
as its action is rapid and evanescent, and sickness rare. More
than one death during or after its administration must account
for its sudden loss of popularity. It has also been given by the
stomach as an antispasmodic, especially in convulsions.

BICHLORIDE OF METHYLENE. CHLORIDE OF

MONO-CHLOR-METHYL. CH2C12(CH2C1.C1).

(Not Officinal)

Source. — Obtained from Chloroform by the action of nascent
Hydrogen, one atom of which replaces one atom of chlorine in
the Chloride of Dichlor- methyl (chloroform), CHC12.C1.

Characters. — A colourless volatile liquid, with an odour
like chloroform. Specific gravity, 1'344. Soluble in water,
ether, and alcohol.

ACTION AND USES.

Bichloride of methylene acts as a general anaesthetic very
much like chloroform. It is said, however, to depress the heart
even more than this substance ; and it is now very seldom used
for general surgery, but is the anaesthetic most frequently
employed in ovariotomy.

ETHYLATE OF SODIUM, SOLUTION OF.
(Not Officinal)

Source. — Made by dissolving metallic Sodium in Absolute
Alcohol.

Characters. — A brownish syrupy liquid.

ACTION AND USES.

Sodium ethylate is a powerful caustic, used to destroy
small accessible tumours, such as

156 MATER i A MEDIC A AND THERAPEUTICS.

SPIRITUS ^THERIS NITROSI. SPIRIT OF

NITROUS ETHER.

"Sweet Spirit of Nitre." A spiritous solution,
containing nitrous ether, ethyl nitrite, CaH5NO2.

Source. — Made by distilling a mixture of Rectified Spirit,
Nitric Acid, Sulphuric Acid, and Copper ; and dissolving the
Distillate in Spirit. C2H6O + HN03 + H2S04 + Cu =
C2H5N02 4- CuS04 -f 2H20. The equation represents the
formation of ethyl nitrite, but the drug also contains acetic
ether, aldehyde, and acetic acid dissolved in spirit.

Characters. — Transparent and nearly colourless, with a
slight tinge of yellow, mobile, of an apple-like odour, and a
sweetish cooling sharp taste ; slightly acid ; inflammable. Sp.
gr., -845.

1 it compatibles. — Iodide of potassium, sulphate of iron,
tincture of guaiacum, gallic and tannic acids. Emulsions are
curdled by its addition.

Impurity. — Excess of acid ; effervescing much with NaHC03.

Dose.—% to 2 fl.dr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

In the stomach spirit of nitrous ether is a diffusible stimu-
lant and carminative, doubtless from the amount of alcohol
which it contains.

2. ACTION ON THE BLOOD.

The nitrite of ethyl appears to produce the same effect on
the red corpuscles as other nitrites, especially diminishing
oxygenation. See AMYL NITRIS.

3. SPECIFIC ACTION AND USES.

Although anaesthetic to a degree, sweet spirit of nitre
chiefly acts upon the circulation like amyl nitrite. It relaxes
the peripheral vessels, and accelerates the heart, but much less
quickly, less completely, and more persistently than the amyl
compounds. Thus it lowers arterial tension, and causes the
phenomena described at page 163, only in a much less degree.
By relaxing the renal vessels it is diuretic, the water alone
being increased ; by dilating the cutaneous vessels, as well as by
perspiration, it increases the loss of heat from the skin. Nitrous
ether is chiefly used as an antipyretic in febrile affections, where
it diminishes the heat production by acting on the blood, and

Ct
c

-

CHLORAL HYDRAS. 157

increases the loss of heat through the skin and kidneys. As a
diuretic it is useful when a free watery flow is desired to wash
out the tubules and passages, and relax spasm in the renal
vessels, as in some cases of Bright's disease with increased
arterial tension. Probably for the same reason it fails as a
diuretic in cardiac dropsy, where the veins demand relief, and
the arterial pressure is already too low. Being a dilator of the
renal vessels, it must not be used in acute inflammatory states
of the kidney. Spirit of nitrous ether may also relieve angina
pectoris, and cardiac pain dependent on a failing and dilating
heart in chronic Bright's disease. Like other nitrites, it has
benefited some cases of dysmenorrhcea and of asthma.

4. REMOTE LOCAL ACTION.

This compound or its constituents are chiefly excreted by
the kidneys and lungs. Its diuretic influence has just been
described.

AETHER ACETICUS. ACETIC ETHER.
C2H,C2H302.

Source. — Made by (1) distilling Kectified Spirit with Acetate
of Soda and Sulphuric Acid ; and (2) separating the ethereal
liquid by means of Chloride of Calcium. (1) NaC2H302 -f
H2S04 + C2H6O = C2H5,C8H302 + NaHS04 + H20.

Characters. — A colourless liquid, with an agreeable ethereal,
somewhat acetous odour, and refreshing taste. Specific gravity,
0'9 1. Neutral. Soluble freely in rectified spirit and ether, and
in about 12 parts of water.

Dose. — 20 to 60 min.

ACTION AND USES.

Acetic ether is a stimulant and antispasmodic, murh like
ether itself, but forms more agreeable coml>in;itn>ns with other
carminatives on account of its pleasant odour and taste.

CHLORAL HYDRAS. HYDRATE OF CHLORAL,
C2HClsO.HaO.

Source. — Made from Chloral by the addition of W;it<T.
Chloral (C2HC130) is itself made by the action of dried Chlorine
upon anhydrous Alcohol, and purifying. Q.H8O + Cl$ =
C2HC130 + 5HC1.

158 MATERIA MEDIC A AND THERAPEUTICS.

Characters. — Colourless crystals, or white crystalline
masses, with a peculiar pungent odour, and a pungent, rather
bitter taste. Readily fused by gentle heat, recrystallising on
cooling to 120°. Solubility, very freely in distilled water,
rectified spirit, and ether ; 1 in 4 of chloroform.

Incompatibles. — All alkalies.

Impurities. — Hydrochloric acid, detected by test-paper;
oily substances, colouring sulphuric acid when dissolved in
chloroform.

Dose. — 5 to 30 gr.

Preparation.
Syrupus Chloral.— 10 gr. in 1 fl.dr. Lose, \ to 2 fl. dr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Applied in weak solution (5 gr. to the ounce of
water), chloral hydrate is antiseptic; concentrated solutions
are irritant, causing vesication. The drug is but little used
externally.

Internally. — In the mouth and stomach it is also irritant
unless freely diluted, a point to be observed. It has no
specially sedative effect on the stomach or bowels like opium,
and therefore causes neither dyspepsia nor constipation.

2. ACTION ON THE BLOOD.

Chloral enters the blood as such, and probably leaves it
for the tissues without decomposition, although Liebreich, who
introduced it into the materia medica, contends that it is
broken up into chloroform and formic acid in the presence
of the sodium salts of the plasma. CoHCl30 -f NaHO —
NaCH02 -f CHC13. The blood undergoes no appreciable
change.

3. SPECIFIC ACTION AND USES.

The action of chloral upon the system so nearly resembles
that of chloroform, and the chemical relations of the two sub-
stances are so close, that Licbreich's theory is at first sight
extremely plausible. Chloral chiefly affects the nervous
system, although one of the principal dangers connected with
its use depends on its direct action on the heart. Given in
moderate doses (20 to 30 gr.), hydrate of chloral, after a very
brief period of excitement, quickly induces drowsiness, followed
by several hours' sound sleep, natural in its characters and
refreshing in its effect ; as a rule, without consequent confusion,
headache, or drowsiness in healthy individuals. Larger doses

CHLORAL HYDRAS. 159

produce deeper and more prolonged sleep, and an appearance
of narcosis, the subject being difficult to rouse even by sharp
stimulation. Thus far chloral manifestly acts upon the convo-
lutions, either directly or through the cerebral circulation, or
both ; and is a pure and powerful hypnotic. The larger doses,
however, enable us to appreciate its action, like that of chloro-
form, on the lower nervous centres. The spinal centres are
depressed, whence diminished reflex excitability and relaxa-
tion of the muscles. The three great medullary centres are
decidedly depressed : respiration becomes slow, irregular, and
shallow ; the heart is weakened (but chiefly in another manner,
as we shall presently find) ; and the vaso-motor centre is
lowered in activity, so that the vessels dilate generally. The
peripheral sensory nerves are not specially affected. Neither
are the motor nerves, or the muscles themselves, directly de-
pressed.

Upon these several effects of chloral depend at once its
value medicinally, and the drawbacks or even dangers which
occasionally attend its employment. It is the most rapid, and
probably the most powerful, whilst the most pure, of all the hyp-
notics, opium not excepted. It is therefore extensively used to
produce sleep and soothe the cerebral hemispheres, in conditions
of excitement, in insomnia from over- work, distress, maniacal
excitement, or despondency, and in the early stages of fevers or
febrile diseases, whilst the heart is still strong. It is especially
valuable in delirium tremens. In the sleeplessness which
attends or is caused by peripheral pain, chloral fails, for an
obvious reason ; or if sleep be secured by a powerful dose, the
patient wakes to suffering as before. To relieve the severe
pain of neuralgia it is totally unfitted.

Chloral has also been given in the delirium of the more
advanced stages of fevers; to relieve the distiess, .l\>i-nnM,
and insomnia of cardiac and renal disease ; and in the cough,
spasm, and breathlessness attending phthisis, bronchitis, and
other respiratory affections. The dangers of the drug in these
conditions have been shown by the fatal results which have
followed its employment; and the cause of them is obvious.
Besides its depressing effect on the medulla, chloral in full
doses acts as an intrinsic cardiac poison, slowing and ent'>
the heart by diminishing the irritability oi : i. and

finally arresting it in ventricular diastole. At the same time
the blood pressure falls by peripheral paralysis of the
walls, as well as from the interference with the vaso-motor
centre, the heart, and the respiration; so that altogether the
circulation tends to become arrested. Thus the relief to be
obtained from chloral in the delirium of fpver where the heart

160 MATER i A MEDIC A AND THERAPEUTICS.

is threatening to fail, and in organic disease of the heart,
lungs, or kidneys, is but temporary, and is purchased at
serious cost ; for this purpose the drug is not to be recom-
mended.

The action of chloral in reducing the excitability of the
grey matter of the cord, and higher motor ganglia, has sug-
gested its use in tetanus, strychnia poisoning, puerperal con-
vulsions, hydrophobia, sea-sickness, and whooping-cough. It
has also been given in some cases of chorea, but here really
as a hypnotic.

The exact effect of chloral on metabolism is unknown. It
reduces temperature, chiefly by increased loss of heat from the
dilated peripheral vessels, but also by diminishing the produc-
tion in the weakened muscles, etc. It must not, however, be
given as an antipyretic in high fever, unless at the commence-
ment, in strong subjects, on account of its depressant action
011 the heart. It has been highly recommended in cholera.

4. REMOTE LOCAL ACTION.

Chloral is excreted by the kidneys partly unchanged, but
chiefly as urochloralic acid producing slight diuresis. Pro-
bably part escapes by the skin also, as a variety of eruptions
may attend its prolonged use.

5. ADVANTAGES AND DISADVANTAGES OF CHLORAL; CAUTIONS J
CONTRA-INDICATIONS.

It will be well to state here succinctly the advantages and
disadvantages of chloral as compared with morphia (opium).
Chloral has the following advantages : It acts quickly as a
hypnotic — even more quickly than morphia subcutaneously, and
more certainly even when morphia has failed. After-effects,
such as headache, depression, and sickness are less common
from chloral. It does not derange the stomach, if freely
diluted ; nor cause constipation, even when given for a long
time. It may be more safely given, in proper doses, to children.

On the other hand, chloral has these disadvantages: It does
not relieve pain, and is thus greatly inferior to opium in most
cases as a hypnotic, and useless as an anodyne. It does not,
like opium, prevent or relieve distress, reflex dyspnoaa, and
cough due to heart and lung disease. Chloral causes excite-
ment instead of quiet, in many cases of mania, hysteria, and
confirmed alcoholism.

Chloral must 1 e given in relatively small doses to children
and delicate persons ; and very rarely, as we have seen, to the
subjects of organic disease of the heart, lungs, and kidneys, or
patients suffering from gout. If it excite instead of soothing

u v\c .

CUjUU^l j . > i - FY O\AfC .

.

BUTYL-CHLORAL HYDRAS. 161

the insane or the confirmed drunkard, it should not be perse-
vered with ; nor if it increases instead of relieving sleepless-
ness in certain individuals, as it does occasionally, apparently
from idiosyncrasy. Lastly, chloral must he prescribed with
great hesitation to persons who suffer from constitutional
debility of the nervous system, expressing itself in hysteria,
despondency, excitability, and innumerable other forms. Such
subjects very readily acquire the " chloral habit," that is, they
consume on their own account regular and ever increasing
quantities of chloral, until the nervous system and general
nutrition fail, the mind is demoralised, and the victims ulti-
mately perish like the drunkard and opium eater.

BUTYL-CHLORAL HYDRAS. HYDRATE OF

BUTYL-CHLORAL. PROTON-CHLORAL. C4H3C13O.

(Not Officinal)

Source. — Made by passing Chlorine gas through Acetic Alde-
hyde, which is converted first into Crotonic Aldehyde, and then
into Croton Chloral.

Characters. — Small brilliant tabular crystals, with a pungent
odour, much like that of chloral hydrate, and an acrid nauseous
taste. Solubility, 1 in 100 of water, freely in spirit, 1 in 4 of
glycerine.

Incompatibles. — As of chloral hydrate.

Dose.— 2 to 15 gr.

ACTION AND USES.

In every important respect the action of butyl-chloral is
nearly allied to that of chloral hydrate, and it will therefore
suffice to indicate the points wherein the two drugs differ.

Butyl-chloral as a hypnotic is less rapid, less certain, and less
powerful than the other, which is generally to be preferred for
this purpose. It is believed that butyl-chloral is less depressant
to the heart, and therefore that it may be given in insomnia
with cardiac weakness where chloral hydrate would be inad-
missible. We must accept this recommendation with <rn-at
caution. The most important effect of butyl-chloral, peculiar!
to itself, is anaesthesia of the region of the trigeminus, I
that is, of the face and part of the scalp, preceding the hypnotism. I
But even this action has been disputed by good author!;
The drug relieves some cases of t ic -douloureux and facial

1 62 MATER i A MEDIC A AND THERAPEUTICS.

neuralgia very quickly ; in some cases it fails. It has been
given in other forms of pain in the face, such as toothache
(locally) ; in neuralgia of the limbs ; and in painful menstrua-
tion.

AMYL NITRIS. NITRITE OF AMYL. C5Hn.N02.

Source. — Produced by heating Nitric Acid with Amy lie
Alcohol, distilling, and purifying the product.

Characters. — An ethereal liquid, of a yellowish colour, and
peculiar pine-apple odour. Sp. gr., '877. Insoluble in water ;
soluble in rectified spirit, ether, and chloroform.

Impurities. — Nitric and hydrocyanic acids.

Dose. — 2 to 5 min., used with caution as inhalation from
a crushed capsule,; or ^ to 1 min. internally, dissolved in recti-
fied spirit.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Applied directly to peripheral nerves and muscles, nitrite of
amyl depresses or paralyses them. It is never so employed in
man. Internally, the drug is seldom given by the mouth,
except in cholera.

2. ACTION ON THE BLOOD.

Nitrite of amyl is almost invariably administered by
inhalation, a few drops being kept ready for use in a glass
capsule (enveloped in cotton wool), which may be broken
between the fingers and thumb when required. The vapour
instantly enters the circulation through the lungs, converts a
certain amount of haemoglobin into methsemoglobin, and thus
interferes with the oxygenating function of the red corpuscles;
the amount of oxygen absorbed (in animals) being quickly
lowered, as well as the excretion of carbonic acid. The blood
of animals killed by nitrite of amyl is of a chocolate colour ;
but the effect of an ordinary inhalation in man is very
transitory.

3. SPECIFIC ACTION AND USES.

Nitrite of amyl almost instantaneously reaches the tissues,
and produces striking phenomena. Two to five drops, inhaled
as directed, immediately produce a sense of fulness and
throbbing in the head ; flushing of the face, neck, and trunk ;
tingling over the surface generally ; dilatation of the pupils,
and disturbance of vision; giddiness and unsteady gait;

ho tv*.

^(JL^ "TOL..,

AMYL NITRIS. 163

increased frequency and force, that is, palpitation, of the heart;
visible pulsation of the carotids ; restlessness and anxiety of
mind. These symptoms quickly disappear, leaving possibly
slight headache. Larger doses aggravate all the phenomena,
but never produce unconsciousness ; mental confusion, intense
bodily depression, coldness of the extremities, and sweats being
the result, followed by severe headache which may last for
hours. Very rarely convulsions occur in man as in some of
the lower animals.

The specific action of nitrite of amyl proves on analysis to
be almost confined to the circulatory system, the other parts
being chiefly involvetl secondarily. Two distinct effects are
produced on the circulation ; the heart is greatly accelerated,
with but little, if any, increase of its force ; the peripheral
vessels are dilated by relaxation of their muscular coat.
Some authorities hold that the cardiac acceleration is due
to depression of the cardiac centre, others to depression of the
vagus in the heart ; some refer the vascular relaxation to the
action of the nitrite on the vasor centre in the medulla, others
to its action on the vaso-motor nerves and muscular walls.
Be this as it may, the fact remains that the blood pressure
falls to a remarkable degree, that is, the resistance to the
discharge of the left ventricle is correspondingly diminished ;
whilst this discharge is accomplished much more frequently
within a given time. In other words, the left ventricle,
under the influence of nitrite of amyl, has at once less work to
accomplish, and more force wherewith to accomplish it ; that
is, is greatly relieved. These considerations led Dr. Lander
Brunton to the employment of the drug in those cases of
the complex class of disease known as angina pectoris, in
which agonising pain in the breast and neighbourhood
is due to distension of the left ventricle, from its inability to
empty itself against the pressure in the aorta, and in which
fatal paralysis of the heart, or even rupture of its walls, is the
result of the unequal effort. Clinical experience has fully con-
firmed the value of amyl nitrite, in cases where spasm of the
arteries is damming the blood back upon the ventricle, tho
channels being instantly opened and the ventricle rapidly
emptied by the double effect of the drug. The pain of
the aneurism of the aorta, and of other forms of cardi;u
and disorder, can often be relieved by amyl, but caution must
be exercised in the first trial. Threatening death from cardiac
paralysis in chloroform anaesthesia, and sea-sickness in which
the blood pressure is greatly disturbed, are sometimes success-
fully treated with amyl. Some cases of epilopsy, accompanied
by spasm of the cerebral vessels and facial pallor, and of

1 6 4 MATERIA MEDIC A AND THERAPEUTICS.

meg-rim or sick'- headache, due to similar spasm in the
trigeminal area, are also benefited hy this drug.

The reflex irritability of the cord is reduced (in animals)
by nitrite of amyl, which has therefore been proposed as a
remedy in poisoning by strychnia. Neither the peripheral
nerves nor the muscles are aif ected when it is given through the
blood. Respiration is disturbed, apparently by the alteration
of the haemoglobin and circulation, not through the nervous
system. The nitrite sometimes affords immediate relief in
asthma, but the dyspnoea may as quickly return. The body
temperature falls, from obvious causes.

4. REMOTE LOCAL ACTIOX.

Nitrite of amyl probably escapes from the body by the
urine, which is decidedly increased in amount, and may contain
sugar. Both of these effects are probably results of local
disturbance of the pressure in the kidneys and liver re-
spectively.

NITRO-GLYCEEJNUM. NITROGLYCERINE.
CaHsNaOg. (Not Officinal)

Source. — Made by dropping Glycerine into a mixture of
Sulphuric and Nitric Acids, washing, and evaporating to a
proper density.

Characters. — An oily liquid, colourless, odourless, with a
sweet pungent taste. Specific gravity, 1'60. Slightly soluble in
water ; freely in fats, oil, alcohol, and ether. Highly explosive,
and, when mixed with infusorial earth, constitutes dynamite.
Never used in the pure state.

Preparation.

Liquor Nitroglycerine., — 1 gr. in 100 min. of rectified spirit.
Dose, $ to 2 min. ; in water, or as a chocolate tablet.

ACTION AND USES.

This powerful substance closely resembles in its action the
nitrites of amyl and soda ; its activity being apparently due to
nitrous acid formed by its decomposition within the body. It
is used for the same class of cases, such as angina pectoris,
chronic heart disease, sea-sickness, and asthma and other spas-
modic disorders.

-.

ACIDUM HYDROCYANICUM DILUTUM. 165

yETHYL IODIDUM. IODIDE OF ETHYL. HYDRIO-
DIG ETHER. C2H5I. (Not Officinal.')

Source. — Made by adding iodine to a mixture of Alcohol
and Phosphorus, distilling, and purifying. 5C2H5HO -f Pl-
(iodide of phosphorus) = 5C2H5I + H3P04 + H20.

Characters. — A colourless volatile liquid, with a peculiar
powerful odour, and a pungent taste. Sp. gr., 1-92. Non-
inflammable. Decomposed by light, yielding iodine. Soluble
in alcohol and ether ; very sparingly soluble in water.

Dose. — 5 to 20 min. Inhaled from a broken capsule.

ACTION AND USES.

Iodide of ethyl acts chiefly by virtue of the iodine ele-
ment, and very slightly, if at all, as an anaesthetic ethyl com-
pound. It introduces iodine very rapidly into the system, and
has been chiefly used to stimulate the respiratory passages, and
thus to act as an antispasmodic in asthma attended by scanty
or tough secretion. In some instances it gives instant relief.

AGIDUM HYDROOYAMGUM DILUTUM.

DILUTED HYDROCYANIC ACID.
" Prussic Acid." Hydrocyanic acid, HCN, dis-
solved in water, and constituting 2 per cent., by weight
of the solution.

Source. — Made by distilling solutions of Ferrocyanide of
Potassium and Sulphuric Acid. 2K4Fe(CN)6 + 6H3S04 =
6HCN + Fe2K2(CN)6 + 6KHSO4.

Characters. — A colourless liquid, with a peculiar penetrating
odour. Sp. gr., 0-997. Faintly acid.

Incompatibles. — Salts of silver, copper, iron, red oxide of
mercury, and sulphides.

Impurities. — Sulphuric and hydrochloric acids.

Dose. — 2 to 8 min,

Preparation.

YlPOr Add* Hydrocyanicji.— 10 min. in 1 fl.dr. cold
water.

Hydrocyanic acid is also contained in Aqua Lauro-
cerasi. See also Amygdala Amara, page 239.

1 66 MATER i A MEDIC A AND THERAPEUTICS.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Applied for a time to the skin, dilute hydro-
cyanic acid causes numbness, directly depressing the sensory
nerves. It is used, largely diluted, to relieve itching, but must
not be employed where the surface is raw from scratching, as
it is readily absorbed by wounds.

Internally, it produces a peculiar mixed sensation on the
mouth and throat, and acts as a sedative to the nerves of the
stomach. It is in common use to relieve pain and arrest
vomiting in painful dyspepsia, ulcer of the stomach, cardialgia,
and reflex or other nervous cases, e.g. in phthisis and
pregnancy. The specific action of the drug on the medulla, to
be presently described, doubtless assists its local effect upon
the gastric nerves in producing these results.

2. ACTION ON THE BLOOD.

Hydrocyanic acid enters the blood very rapidly from all
parts, especially the lungs, and produces an important change
on the red corpuscles. If freely given, it converts the blood of
the veins first into a bright arterial colour, and then into a deep
black, the former change arresting the oxygenating function of
the corpuscles, the latter destroying them. When studied in
drawn blood, these effects are found to be due partly to reduc-
tion of the oxyhaemoglobin, the oxygen being replaced by
cyanogen, forming cyano-haemoglobin ; and partly to union of
the cyanogen with oxyhaemoglobin, making cyano-oxyhaemo-
globin. Thus changed, blood does not give up oxygen to
oxydisable bodies, e.g. the guaiacum reaction cannot be ob-
tained. These effects of hydrocyanic acid on drawn blood
must not be too readily applied to the circulating fluid within
the body, where its action in medicinal doses is chiefly local
and specific.

3. SPECIFIC ACTION AND USES.

Hydrocyanic acid rapidly enters the tissues, and acts
chiefly upon the nervous structures. Considerable doses cause
giddiness, faintness, nausea, a constricted feeling in the
chest, headache, mental confusion, disturbed breathing, slow-
ing of the pulse, and muscular debility. Larger doses aggravate
these symptoms, and produce great dyspnoea and other signs of
nsphyxia; whilst in still larger quantity it is familiar as one of
the most swift and deadly of poisons. Analysis proves that
this drug, whilst depressing all nervous tissues, acts first
and chiefly upon the respiratory centre, which is briefly excited

TlUME THYLAMIN. 1 6 7

and then depressed, leading to weak respirations with long
pauses, dyspnoea, convulsions, and finally death by asphyxia.
Simultaneously, the afferent branches of the respiratory nerves
are depressed, especially if the acid be inhaled ; and reflex
respiratory acts are arrested. The vaso-motor centre is tem-
porarily stimulated, and the blood pressure rises, but it falls
again suddenly and greatly. The cardiac centre is the most
resistant of the three, but it also is depressed, so that the
action of the heart becomes less frequent and powerful.
Although at the same time the nervo-muscular structures of
the heart are depressed, the heart continues to beat in
animals poisoned with prussic acid, after the respiration and
other functions have- ceased. The convolutions are depressed,
causing stupor, ending in unconsciousness ; but this effect may
be secondary to the disturbance of respiration. The cord is
also lowered in activity. The peripheral sensory nerves are but
little affected by the internal use of the drug, compared with
its effect upon them locally. The motor nerves and muscles are
depressed by repeated small doses of dilute hydrocyanic acid,
the influence extending downwards.

The chief specific use of this drug is to allay dry, useless
cough, by its action on the respiratory centre and the afferent
nerves, in phthisis, pertussis, and asthma. In phthisis it also
checks the tendency to cough and vomit induced by food.
As a cardiac sedative, it is employed in the palpitation, pain,
and distress brought on by dyspepsia, where again it fulfils a
double indication. Its general sedative effect on the nervous
s\ >{' in has suggested its use in epilepsy, chorea, hysteria, and
tetanus, but with very doubtful benefit.

4. REMOTE LOCAL ACTION.

The mode of excretion of hydrocyanic acid is still ob-
scure. Probably it escapes in part, as it enters in part, by the
lungs ; and some of it is supposed to be thrown out as formate
of ammonia.

TRIMETHYLAMIN. PROPYLAMIN. (Not Officinal)

An ammonia compound, in which the thre
atoms of hydrogen are replaced by methyl, NC3H9=
N(CH3)3, dissolved in water.

Source. — Obtained from herring brine by distillation. It is
also contained in cod-liver oil and in various plants.

Characters. — Trimethylamin contains 10 to 20 per cent, of
the ammonia compound ; is colourless, with a very disagreeable

1 68 MATERIA MEDICA AND THERAPEUTICS.

smell and taste ; alkaline ; miscible with, water. Propylamin
is another name for impure trimethylamin.
Dose. — 20 to 60 min.

ACTION AND USES.

Externally, trimethylamin is a local irritant. Internally,
it lowers the frequency of the heart, the blood-pressure, and
the temperature. It was for a time believed to be specially
valuable in acute rheumatism, but is now very seldom used.

ACIDUM CARBOLICUM. CARBOLIC ACID,

PHENIC ACID, PHENOL, PHENYLIC ALCOHOL.

C6H5HO.

An acid obtained from coal-tar oil by fractional
distillation and purification.

Characters. — Colourless, acicular crystals ; hygroscopic ;
with a tarry odour and burning taste. Becomes and remains
fluid on addition of 6 per cent, of water. Solubility, 1 in 15
of water, 1 in If olive oil, 3| in 1 of glycerine. It does not
redden blue litmus paper.

Dose. — 1 to 3 gr.

Preparations.

1. Glvcerinum Acidi Carbolic!.— 1 to 4.

2. Suppositoria Acidi Carbolic! cum Sapone. — 1 gr.

in each.

Sodse Sulphocarbolas. — Sulphocarbolate of Soda. NaC5
H6S04H20. (Not Officinal.}

Source. — Sulphocarbolic acid is formed by direct union of
Carbolic and Sulphuric Acids. The Sulphocarbolate of Soda
by neutralising Sulphocarbolic acid with Carbonate of Soda.

Characters. — Whitish odourless lumps of minute colourless
rhombic prisms. Soluble in water.

Dose. — 20 to 60 gr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — The principal action and uses of carbolic acid
in disease depend upon its influence on fermentation and de-
composition, which are intimately associated with many patho-
logical processes. When this influence is studied apart from

4- c*

ACIDUM CARBOLICUM. 169

the body, we find that most organised ferments (fungi, bacteria,
infusoria) are readily deprived of their characteristic powers by
solutions of carbolic acid; whilst chemical ferments, such as
pepsin and ptyalin, are much less readily affected. At the same
time the products of decomposition, which are almost invariably
foul-smelling, are deodorised by the phenol. The exact modus
operandi in all these cases is still unknown, as are also the
nature of the processes, and the relation of organisms to them.
Be the explanation what it may, the power of carbolic acid, or
of any substance which can thus arrest molecular processes
universally at work in physiology and pathology, must be said
to be enormous, both in itself and in its effects.

Carbolic acid is Extensively employed in the antiseptic
method of the treatment of wounds, associated with the name of
its introducer, Sir Joseph Lister. A 5 per cent, solution in
water serves as a spray to cleanse instruments, and to wash the
skin of the part before operation. A 2 J per cent, watery solution
is used to purify sponges and the hands of the operator, and as
a lotion. Dissolved in olive oil (1 to 10, 1 to 20, 1 to 50, or still
weaker), or 1 part of carbolic acid with 7 parts of castor oil
and 8 of almond oil, it is used for lubricating catheters, or as a
special dressing. Carbolic acid gauze consists of unbleached
cotton gauze medicated with half its weight of a mixture of
carbolic acid (1), resin (4), and paraffin (4).

Coming to its physiological action proper on the human
tissues, we find that carbolic acid is a local irritant to the skin,
causing burning pain, anaesthesia, and finally a caustic effect
with formation of a white hard eschar. It may therefore be
applied to poisoned wounds and foul ulcers ; and in dilute
solutions is a stimulating as well as a disinfecting wash to
wounds and discharging mucous surfaces or cavities, in the
form of a lotion, injection, or gargle. It also relieves some
forms of itching and inflammatory skin diseases, and is used
with success in ringworm, where it destroys the vegetable
organisms.

Apart from the body, carbolic acid is extensively used as
a general disinfectant.

Internally. — In the form of vapour, carbolic acid is stimu-
lant and disinfectant, and is used in ulceration of the throat and
lungs (phthisis, dilated bronchi, gangrene, etc.), much impor-
tance having lately been attached to it in the so-called " anjjj-
septic "treatment of phthisis. In the stomach and bowels it is
a powerful irritant poison in largo doses ; in moderate quantity
it arrests fermentative changes in the gtiftrift ft^Utfl11^ in cases
of dilatation of the vis: ; other points may be noted in

this connection j first, that carbolic acid unites with sulphates

i yo MATERIA MEDIC A AND THERAPEUTICS.

to form sulphocarbolates, which suggests the use of soluble
sulphates as antidotes in poisoning "by the drug ; and secondly,
that phenol is a natural product of the intestine or its contents.

2. ACTION OX THE BLOOD.

Carbolic acid is rapidly absorbed from the unbroken skin,
mucosse, wounds, subcutaneous tissues, respiratory passages, and
stomach ; and for a considerable time can be found in the blood
unchanged. Here it steadily disappears, by conversion into
compounds from which it may be again derived ; uniting, for
example, with sulphates, as already described. The blood is
dark and slow to coagulate after poisoning by the drug.

3. SPECIFIC ACTION AND USES.

The action of carbolic acid on the organs is of little in-
terest to the therapeutist. It is found in them chiefly as
phenol-yielding compounds ; and its effects in man are chiefly
those of an irritant poison. The heart first falls and then rises
in frequency, from disturbance of the cardiac centre. The blood
pressure rises at first, returns to the normal, and falls after a
fatal dose. Dyspnoea ensues, also central in origin. Convulsions
occur in the lower animals through the cord, then paralysis and
collapse. The voluntary muscles are not affected by carbolic
acid, but the pupil is contracted. Sensibility is not reduced by
internal administration of the drug. The temperature falls
slightly after medicinal doses, but may rise in cases of dangerous
absorption from dressings. Carbolic acid has been given
internally in fevers, it is said with good results, but is little
used in this country for such a purpose. It may temporarily
relieve diabetes.

4. REMOTE LOCAL ACTION.

Carbolic acid and its products rapidly leave the body, chiefly
by the urine. But little of it can be recovered unchanged, for
(1) part is lost in the system, being probably converted into
oxalates and carbonates ; (2) part appears as sulphocarbolic
acid (C6H5.H.S04) in combination ; (3) part is constituted by
an obscure compound ; and (4) the remainder appears to give
lise to a peculiar olive- green, brown, or grey discoloration of
the urine, which is familiar to surgeons. It is important to
note that this change in the urine bears no definite relation to
the amount of carbolic acid in the blood, or the danger of
poisoning. Fainting and collapse are the principal symptoms
of its excessive absorption from a wound or through the skin,
with or without rise of temperature. Disappearance of the
sulphates from the urine, easily ascertained by ordinary tests, is

CHINOLIN. 171

a sure indication of danger. ATbuminuria is sometimes in-
duced.

Carbolic acid also leaves the "body by the saliva, which is
increased, and it stimulates the flow of sweat although it is
not found in it.

Resorcin. (Not Officinal) — A derivative of car-
bolic acid by various processes.

Characters. — "White tabular lustrous crystals, with a weak
odour like carbolic acid, and a sweetish, somewhat pungeut
taste. Solubility, 1 in 2 of water ; 1 in 20 of olive oil.

Dose. — 5 to 30 gr.~ every two hours, or single doses of 60
gr. at long intervals.

ACTION AND USES.

Externally. — Resorcin is antiseptic and disinfectant, with-
out being irritant, in ordinary solutions (2 to 10 per cent.) It
has been used as a dressing for all kinds of sores and wounds.

Internally. — It passes rapidly through the system, and is
excreted unchanged in the urine by the end of one hour. It
causes diaphoresis, and reduces the temperature and pulse for
a time in conditions of fever ; but has no influence on the normal
body heat. Excessive doses cause trembling, singing in the
ears, deafness, and mental disturbance. It has been used as an
antipyretic in fevers of every kind, and is said to be specially
useful in ague ; but the drug is still on its trial.

Cliiiioliii. C9H7N. (Not Officinal)— A. derivate
of Cinchona Bark, whence its name. Now made synthe-
tically, or by the action of glycerin on nitro-benzol and
aniline, in the presence of a dehydrating agent.

Characters. — A colourless, oily-like, highly refracting
liquid, with a peculiar odour. It forms salts with acids, of
which the tartrate is used, occurring in lustrous crystals, soluble
in water.

Dose. — Of chinolin, 3 to 10 min. ; of the tartrate, 5 to
15 gr.

ACTION AND USES.

Chinolin is antiseptic and disinfectant externally. In-
ternally, it is an antipyretic, like resorcin, and has been used
for the same class of cases.

172

MATERIA MEDICA AND THERAPEUTICS.

Kairin. (Not Officinal.} — A pale-buff powder, with
a disagreeable bitter and somewhat aromatic taste. It
is made from phenol.

Dose. — 5 gr. every hour; or 15 to 20 gr. in single doses.

ACTION AND USES.

Kairin is antiseptic, disinfectant, and especially anti-
pyretic, like the two preceding substances, to which it is closely
allied.

Fuchsine — MAGENTA DYE. (Not Officinal.)—
An aniline product occurring in brilliant beetle-
coloured needles, forming an intense deep-red solution
wich water.

Dose. — \ to 4 gr.

ACTION AND USES.

Fuchsine passes through the blood and tissues, and colours
the urine and faeces. It has been said to reduce the amount of
albumen in some cases of Blight's disease.

Creasotum— CREASOTE. — A product of the dis-
tillation of Wood Tar.

Characters. — A liquid, colourless or with a yellowish tinge,
a strong empyreumatic odour, and burning taste. Soluble,
sparingly in water ; freely in alcohol, ether, and glacial acetic
acid. Sp. gr., 1-071. Coagulates albumen.

Impurity. — Carbolic acid ; detected by becoming solidified
by cooling.

Dose. — 1 to 3 drops, with mucilage or bread crumb.

' fionition. — Creasote is not a simple body, but a variable
compound of Guaiacol, C7Hg02, and Kreasol, CgHioOg.

Preparations.

1. Mistura Creasoti.— Creasote. 16 min. ; glaciai acetic acid,
16 min.; spirit of juniper, 30 min.; syrup, 1 fl.oz. ;
water, 15 fl.oz. Dose, 1 to 2 fl.oz.

2 Unguentum Creasoti. — 1 in 9.

3. Vapor Creasoti.— 12 min. in 8 fl.oz. of boiling water.

GU>_4>3<: •- Uccjutrv-ocM^ - -~A-4-fc<»

lODOFORMUM. I J 3

ACTION AND USES.

The action of creaaote is, practically speaking, the same
as that of carbolic acid, to which the student is referred.
Before the latter came into general use, creasote was not
unfrequently employed for the same purposes internally to
which carbolic acid is now put; hut the uncertainty of its
composition and strength, as a complex product, renders it
inferior to phenol in this respect.

The Unguentum is employed in dry skin diseases. The
Vapor is disinfectant and deodorant in phthisis, chronic bron-
chitis, gangrene, and other diseases of the lungs attended by
foul discharges. A combination of creasote, iodine, and various
volatile substances such as ether, chloroform, and spirit, has
lately become popular as a constant inhalation in phthisis. The
Mistura Creasoti is intended chiefly as a remedy in vomiting,
especially when this is due to pyloric obstruction, dilatation of
the stomach, and the development of fermentation ; but it has
also been recommended in the vomiting of pregnancy, hysteria,
and sea-sickness.

A specific and remote local effect has lately been claimed
for creasote, when given by the stomach, namely, as a dis-
infectant and deodorant in phthisis with antipyretic and healing
properties.

IOPOFORMUM. IODOFORM. CHI3. (Not Officinal.}
Source. — Made by the action of Iodine on a hot solution of

Carbonate of Soda in Diluted Alcohol. C2H6O -f 81 + 3Na2C03

=CHI3 + NaCH02 + 5NaI + 2H20 + 3C02.

Characters. — Small lemon-coloured lustrous crystals, with

a powerful and persistent saffron-like odour, and an unpleasant

sweetish taste. Insoluble in water ; soluble freely in fixed and

volatile oils and ether. It contains more than 90 per cent, of

iodine.

Dose. — £ to 3 gr. or more.

Preparations.

Unguentum lodoformi _(U.S.P.). — 1 to 9 of benzoated lard,
lodoformum Praecipitatum. — An impalpable yellow powder,
lodoform Wool. — Absorbent Cotton Wool, containing 10 per
cent, of iodofonn.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTIOX AND USES.

Iodofonn is an antiseptic and disinfectant, but destroys
organisms less readily than carbolic acid. It is a very powerful

174 MATERIA MEDIC A AND THERAPEUTICS.

deodorant. Applied to the human tissues, it produces little or
no irritation.

lodoform is used to cleanse foul ulcers, especially of vene-
real origin ; and may possibly have a special effect on strumous
ulceration. It has also been extensively applied as an anti-
septic dressing to healing wounds, the best forms being the
wool and the ointment. Sometimes iodoform gauze has been
employed. lodoform bougies for insertion into the urethra and
os uteri have not given satisfaction. A powder of iodoform
diluted with quinine or bismuth is a valuable insufflation in
ozoena and ulcers of the mouth and throat.

2. ACTION ON THE BLOOD, SPECIFIC, AND REMOTE LOCAL ACTION
AND USES.

Iodoform is occasionally absorbed from wounds, causing
sickness and fever, restlessness and delirium in some subjects,
dr< wsiness and collapse in others. Iodine is possibly set
free in the blood, appearing in the urine as iodide of sodium,
lodoform has been used in an endless variety of diseases inter-
nally, but unfortunately with no special benefit.

Petrolatum (TI.S.P.) — PETROLEUM OINTMENT,
VASELINE. (Not Officinal.)

Source. — Obtained from American petroleum by distilling
off the lighter portions and purifying the residue.

Characters. — A yellowish semi-solid fat-like mass, trans-
parent, odourless, tasteless, neutral. Insoluble in water ; freely
soluble in fixed and volatile oils.

ACTION AND USES.

Vaseline cannot become rancid or irritant to the skin, and,
being readily miscible with many active 'substances, such as
the phenol compounds and alkaloids, is indicated as a valuable
basis for ointments instead of lard. Its chief disadvantage is
the low point at which it melts, and its consequent tendency
to spread through the dressings. It is now extensively used.

HP.

THE OEGANIC MATEEIA MEDICA.

GROUP I.
THE VEGETABLE KINGDOM.

Aconiti Folia — ACONITE LEAVES. — The fresh
leaves and flowering tops of Aconitum Napellus.
Gathered when about one-third of the flowers are ex-
panded, from plants cultivated in Britain.

Characters. — Leaves smooth, palmate, divided into five
deeply cut wedge-shaped segments; exciting slowly, when
chewed, a sensation of tingling. Flowers numerous, irregular,
deep blue, in dense racemes.

Aconiti Radix— ACONITE ROOT. — The dried
root of Aconitum Napellus. Imported from Ger-
many. or cultivated in Britain. Collected in the winter
ly spring before the leaves have appeared.

Characters. — Usually from one to three inches long, not
thicker than the finger at the crown, tapering, blackish-brown,
internally whitish. A minute portion, cautiously chewed,
s prolonged tingling and numbness.

iance resembling Aconite Root : Armoracea. (See page 202.)

Composition . — The active constituent of aconite is aeon it ia

"tin, C30H47X07, an amorphous or crystalline alkaloid,

forming salts with acids. The names of pseud-aconitin,

napellin, nepallin, napalm, aconellin, etc., have been given to

other more or less identical active principles obtained from the

same plant or its botanical allies. They are combined with a

ar acid, aconitic acid.

Preparations.
A. Of the Leaves :
L Extractum Aconiti. — A green extract. Dose, 1 to 2 gr.

176 MATER i A MEDIC A AND THERAPEUTICS.

B. Of the Root :

1. Tinctura Aconiti. — 1 in 8 of spirit. DOSP, 5 to 10 min.

2. Linimentum Aconiti. — 1, in 1 of spirit, with -fa camphor.

3. Aconitia^ — An alkaloid obtained from aconite root. Made

(1) by dissolving the alcoholic extract of the powdered
root in water ; (2) Precipitating the impure aconitia by
ammonia ; (3) Extracting the dried precipitate with
ether, dissolving in diluted sulphuric acid, again precipi-
tating with ammonia, and purifying.

Characters. — See Composition. Not given internally.
Preparation.

Unguentum Aconitia3. — 1 in 60.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Applied to the skin, or an exposed mucous
membrane, aconite affects the terminations of the sensory
nerves, causing tingling, followed by numbness, and lowering
the sensibility of touch and temperature. It is, therefore,
used to relieve pain due to disorder of the peripheral nerves,
especially certain forms of neuralgia, and acute and chronic
rheumatism. The aconitia ointment must be employed with
caution.

Internally. — Aconite and aconitia cause an intensely acrid
sensation on the tongue, followed by persistent tingling and
numbness. A sense of warmth, pain, and sickness follow its
admission to the stomach in full doses.

2. ACTION ON THE BLOOD.

Aconitia enters the blood, and thence finds its way to the
tissues.

3. SPECIFIC ACTION AND USES.

Medicinal doses of aconite, taken in close succession,
reduce the frequency, force, and tension of the pulse ; flush
and moisten the skin ; and increase the amount of urine.
Larger doses cause a sense of illness and muscular weakness ;
" creeping," " tingling," " numb " sensations generally, but
especially on' the lips, face, and extremities, ending in
anaesthesia ; and disturbances of vision, hearing, and conscious-
ness. On analysis, it is found that the heart is briefly acceler-
ated, and then reduced in frequency through the nerves; its
force is then reduced, by direct action on the nervo-muscular

.

ACOKITUM. 177

structures; and finally the cardiac action becomes more fre-
quent, irregular, and more and more feeble, tending to cease
-tole. The blood pressure falls continuously, partly from
cardiac, partly from vaso-motor depression. Respiration is
slowed and deepened, with spasmodic irregularity of rhythm,
and finally is arrested after poisonous quantities. The skin
is stimulated, perspiration becoming abundant. The kidneys
are also stimulated, the fluids and solids of the urine being
increased in amount. The temperature falls steadily. The
muscular weakness appears to be primarily due to depression
of the motor-nerve endings; but this condition extends to
the cord. The brain itself is not directly affected, and even
in cases of poisoning by aconite, consciousness is preserved
almost to the end. The sensory nerves are probably paralysed
from their periphery inwards by the internal, as by the
external, administration of the drug.

Such being the specific action of aconite, its use is obviously
indicated in the treatment of two conditions, namely, fever and
pain. The cardio- vascular excitement, the dry skin, the high
temperature, and the scanty secretions of fever, will all be re-
lieved by this drug. For this purpose the tincture is given in
small and closely repeated doses, say 1 minim in water every
15, 20, or 30 minutes, the effect being watched. Acute
tonsillitis, bronchitis, pleurisy, and febrile conditions attending
other local inflammations, have been treated with aconite, the
effect being to control the urgent symptoms, relieve the dis-
tress of the patient, and even to cut short the disease. Some
of the symptoms of scarlatina and measles may be similarly
alleviated. The powerfully depressant action of aconite on the
circulation altogether forbids its use as an antipyretic in
heart disease, and suggests caution in its employment in all

In neuralgia and other painful affections connected with the
nerves and muscles, aconite may be given internally instead of
being locally applied; facial neuralgia with spasm (tic-douloureux}
particularly being relieved by it. In these cases, also, the
tincture should be given in minim doses, repeated three or four
times in an hour, and the effect watched.

4. REMOTE LOCAL ACTION AND USES.

Aconite is probably excreted by the kidneys, and, as we
have already seen, increases the activity of their secretion.
The stimulation of the sweat-glands and the occasional appear-
ance of an eruption suggest that it also leaves the body by the
skin.

M— 8

178 MATER IA MEDIC A AND THERAPEUTICS.

Podoptiylli Radix— PODOPHYLLUM ROOT.—
The dried rhizome of PodophyHum peltatum. Im-
ported from North America.

Characters. — In pieces of variable length, about two lines
thick, mostly wrinkled longitudinally, dark reddish-brown
externally, whitish within, breaking with a short fracture ;
accompanied with pale brown rootlets. Powder yellowish-grey,
sweetish in odour, bitterish, subacrid and nauseous in taste.

Composition. — The active principle of the rhizome is the
resin, which is really a compound of several resinous bodies.

Preparation.
1. Podophvlli Resina. — Resin of Podophyllin.

Source. — Made by extracting with spirit, and precipitating
in acidulated water.

Characters. — A pale greenish-brown, amorphous powder,
sol'ible in rectified spirit and in ammonia.

Dose. — i to 1 gr.

ACTION AND USES.

Externally, podophyllin possesses no local action ; but if
applied to a wound, it enters the blood and exerts its specific
effect as a purgative.

Internally, podophyllin causes a bitter acrid taste, salivation,
irritation of the stomach, nausea, colic, and after ten or twelve
hours a free watery motion. This purgative effect appears to
be due to stimulation both of the muscular coat and of the
glands of the intestine, as well as to increase of the biliary flow.
Podophyllin is used entirely as a purgative. One-grain
doses are given to produce free evacuation of the bowels in
severe constipation or portal congestion. A dose of £ to £
grain may be employed as an ingredient of habitual laxative
pills. It is a useful cholagogue when mercurials are contra-
, indicated. Podophyllin must not be given alone, on account
' of its griping tendency, but combined with a carminative such
i as hyoscyamus, belladonna, or cannabis indica. The compara-
tive slowness of its action must also be remembered.

MAGNOLIACE^B.
Hlicium Anisatum— STAR ANISE. — The oil

distilled in China from the fruit forms part of the
Oil of Aniseed of the Pharmacopoeia. See Oleum
Anisi. N.O. Umbelliferse.

CALUMBA. 179

Actaea Racemosa. Cimicifiiga. (Not Offi-
cinal.} — The rhizome and rootlets of Cimicifuga
racemosa f Actaea racemosa) Black Snake-root or Black
Cohosh. From the United States.

Characters. — Knotted heads, with numerous fine brittle
rootlets ; odour faint ; taste somewhat bitter, astringent, and
acrid, not unlike opium.

Composition. — Cimicifuga contains a volatile oil, two resinsy
tannin. The active principle is still uncertain.

Dose. — 20 to 30 gr..

ACTION AND USES.

In moderate doses black snake-root is bitter; in larger
doses it slows the heart and raises the blood pressure like
digitalis ; finally it is excreted in the urine, and increases the
activity of the skin, kidneys, and generative organs.

Cimicifuga is used as a stomachic ; in diseases of the heart ;
and in rheumatism, bronchitis, uterine disorders and sperma-
torrhoea, in which its remote stimulant action is occasionally
valuable. It has been much lauded in chorea.

MENISPERMACE^E.

CalumbsB Radix— CALUMBA ROOT. — The root,
cut transversely and dried, of Jateorrhiza Calumba
and Miersii. From the forests of eastern Africa,
between Ibo and the Zambesi.

Characters. — Slices, flat, circular, or oval, about two inches
in diameter, and from two to four lines thick, softer and
thinner towards the centre, greyish-yellow, bitter. A decoc-
tion, when cold, is blackened by the solution of iodine.

Composition. — Calumba contains a non- nitrogenous, bitter
principle, calumbin,t C21RK07, crystallising in white needles ;
an alkaloid, berberin, C20H17N04; calumbic acid, C21H2i07; 33
per cent, of starch ; but no tannin.

j)ose. — 5 to 20 gr.

Preparations.

1. Extractum Caluinbse.— Aqueous. 8 in 1. Lose, 2 .to 10 gr.

2. Infusum Calumbae. — 1 in 20 of cold water. Dose, 1 to 2 fl.oz.

3. Tinctura Calumbae.— 1 in 8. Dose, $ to 2 fl.dr.

Calumba is also an ingredient of Mistura Ferri Aromatica.

i8o MATER i A MEDIC A AND THERAPEUTICS.

ACTION AND USES.

Calumba is the first of the large and important group of
hitter suhstances or bitters, which we meet with in the
materia medica, and will therefore he fully discussed as the
type of this class of remedies. Under the head of the other
bitters, such as quassia and gentian, fresh description of their
action and uses will be unnecessary, and reference will simply
be made to the present account. So with the action and uses,
as litters, of the alkaloids (strychnia, quinia, etc.), and the
aromatic bitters, including orange, lemon, cascarilla, etc.

1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Calumba and other bitters are antiseptic and
disinfectant to a degree, arresting decomposition and fermenta-
tion. They are not used for this purpose.

Internally. — Taken into the mouth, bitters, as their name
implies, stimulate the nerves of taste, and thus induce several
general reflex effects, of the first importance in digestion. (1)
The saliva is increased, and therewith its solvent and digestive
influence on the food in the mouth, as well as its stimulant
action on the gastric secretion ; (2) The vessels and g lands of the
stomach are excited through the central nervous system, and
the gastric secretion is thus increased in a second way ; an
effect which is heightened if the bitter be aromatic, and relish
given by the pleasant flavour.

Reaching the stomach, calumba and other bitters stimulate

digestion in a third way, by acting upon the gastric nerves and

causing a sensation closely resembling hunger. This rouses

the appetite, and if food be taken within a few minutes, the

other effects just described afford the means of digesting it.

As in the mouth, the action of bitters in the stomach is greatly

• I by aroma tics (essential oils) and alcohol (contained in

linctmv.s). Jake these substances, bitters also stimulate tbe

local circulation, and produce a remote effect on the heart and

systemic vessels, raising the blood pressure, and thus acting as

•nil tonics." They will also exert a certain controlling

cflcct on any decomposition or fermentation which may be set

up in the stomach. When given in excess, or for a long time,

will manifestly, for every reason, tend to irritate the

stomach and induce indigestion.

Calumlu and bitters in general pass slowly along the
intestines, moderating decomposition, and slightly stimulating
I sis when they contain tannin, which many of them do.
'J h y arc not cholagogue.

PAREIRA. 181

The uses of calumba and other bitters internally depend
on the actions just described. They are of great value as
stomachics, and much employed in rousing gastric digestion in
atonic dyspepsia, where the appetite and the ability to digest
have been diminished or lost, as in anaemia, convalescence from
acute diseases, in persons exhausted by over- work, whether
mental or bodily, and in the subjects of chronic constitutional

>, such as phthisis and syphilis. In such cases, bitter
infusions form the best vehicle for acid or alkaline stomachics,
as the case may require, combined with an aromatic tincture,
which renders the mixture much more agreeable and active.
Their use must not be continued too long without intermission ;
they must not be given in too concentrated a form ; and they
must be employed with caution, or entirely avoided, in cases
of dyspepsia attended by much pain, vomiting, mucous secre-

- well as in organic disease of the stomach. Calumba
is one of the least irritant of all bitter stomachics.

The action of bitters on the bowels no doubt adds to their
value in indigestion, as they remove flatulence and promote

tion. Some forms of diarrhoea are relieved by calumba.
Whether given by the mouth or as enema, bitter infusions are
anthelmintic, preventing and destroying the thread-worm.

2. ACTION ON THE BLOOD, SPECIFIC ACTION, AND REMOTE LOCAL
ACTION.

Whether bitters possess any direct action on the blood
ues beyond those just described, is uncertain. The
indirect effect on the system is manifestly great and of the
first importance therapeutically, as they are the means of intro-
ducing into the blood an increased amount of nutrient mate-
rial. In this way bitters are tonics, invigorating the body
whilst they increase appetite ; a system of treatment which is
Me and striking to invalids and persons enfeebled by
, over-work, or dyspepsia.

ParoiraR Radiv — PAREIRA ROOT. — The dried
root of Cissampelos Pareira. Brazil. T>o vx^^

>. — Cylindrical oval or compressed pieces, entire
or split longitudinally, half an inch to four inches in diameter,
and four inches to four feet in length. Bark greyish-brown,
longitudinally wrinkled, crossed transversely by annular
elevations ; interior woody, yellowish-grey, porous, with well-
marked often incomplete concentric rings and medullary rays.
Taste at tirst sweetish and aromatic, afterwards intensely bitter.

1 82 MATERIA MEDIC A AND THERAPEUTICS.

Composition. — Pareira root contains, amongst other ingre-
dients, an active principle, pelosin, believed to be identical
with beberia.

Incompatibles. — Persalts of iron, salts of lead, and tincture
of iodine.

Preparations.

1. Decoctum Pareirse. — 1 in 13^. Dose, 1 to 2 fl.oz.

2. Extractum Pareirse. — Aqueous. 16 in 1. Dose, 10 to 20 gr.

3. Extractum Pareirse Liquidum. — 1 in 1. Dose, \ to 2 fl.dr.

ACTION AND USES.

The physiological action of Pareira is imperfectly known,
but it is believed to possess mild bitter and laxative effects,
and to be a moderately active diuretic.

Empirically, it is used in inflammatory affections of the
urinary tract, from the pelvis of the kidney downwards, being
held to relieve pain, reduce irritation, and promote healing and
cessation of muco-purulent discharge. The extract is given
along with the decoction to increase its strength ; not alone.

CoccuSus Indicus. (Not Officinal) — The fruit
of Menispermum coccuius,. the Cocculus indicus plant.
From the

Characters. — A small dark brown berry containing a
yellowish reniform seed.

Composition. — The active principle of cocculus is a bitter
neutral substance, picrotoxine. C?H]004, in colourless crystals,
neutral, soluble with difficulty in water. It is united with
menispermic or cocculinic acid, and other principles.

Dose of Picrotoxin. — T-|^ to -fa gr.

ACTION AND USES.

Externally, cocculus or picrotoxin, in the form of a dilute
ointment, very carefully applied to the unbroken surface,
destroys pediculi.

Internally, picrotoxin is a very powerful agent, especially
stimulating the spinal cord and medulla, and causing violent
spasms of the flexors, and intoxication in large doses. It has
been chiefly used in the night- sweating of phthisis, and in
chronic nervous diseases.

OPIUM. '183

PAPAVERACE.E.

Papaveris Capsulae — POPPY CAPSULES. —
The nearly ripe dried capsules of the White Poppy,
Papaver somnifftmm. Cultivated in Britain.

Characters. — Globular, two or three inches in diameter,
crowned by a sessile stellate stigma.

Composition. — Poppy capsules contain a little opium and
•woody fibre ; the seeds a bland oil. See Opium.

Preparations.

1. Decoctum Papaveris. — 1 in 10.

2. Extractum Papaveris. — Aqueous. 3 in 1. Dose, 2 to 5 gr.

3. Syrupus Papaveris. — 1 in nearly 2£. Dose, I fl.dr.

ACTION AND USES.

The action of poppy capsules is the same as that of opium,
but much weaker. The warm decoction is a favourite anodyne
fomentation. The extract and syrup are uncertain remedies, and
opium preparations are in every respect preferable.

Opium — OPIUM. — The juice, inspissated by spon-
taneous evaporation, obtained by incision from the
unripe capsules of the Poppy, Papaver somniferum.
Grown in Asia Minor.

Characters. — Irregular lumps, weighing from four ounces
to two pounds ; enveloped in the remains of poppy leaves, and
irr in -rally covered with the chaffy fruits of a species of rumex ;
when fresh, plastic, tearing with an irregular slightly moist
t 'in 'stunt-brown surface, shining when rubbed smooth with the
finger, having a peculiar odour and bitter taste.

. — This is a modification of the process for making
hydrochlorate of morphia. (See page 186.) 100 gr. of opium
ought to yield at least 6 to 8 gr. of morphia.

Varieties. — There are two varieties of officinal opium,
Smyrna opium, and that of Constantinople. 1. S>ni/rnaf
Turkey, or Levant _ opium is the best. It occurs in irregular
rounded or flattened masses, seldom more than two pounds in
weight, enveloped in poppy leaves, and surrounded with the
fruits or seeds of a species of rumex. Good Smyrna opium
yields about 8 per cent, of morphia. 2. Constantinople opium
is of very uncertain quality, generally inferior to Smyrna. It

184 MATERIA MEDIC A AND THERAPEUTICS.

is found in cakes, either large and irregular, or small and
lenticular, covered with a poppy leaf, and marked with its mid-
rib, but without rumex seeds. It smells much less strongly
than Smyrna opium. Besides the two officinal varieties, there
are found in the market Egyptian opium, in round flattened
cakes of a reddish hue, with vestiges of a leaf ; Persian opium
in sticks or lumps ; Indian opium in balls, enveloped in poppy
leaves, or in cakes ; and French and English varieties.

Impurities (chiefly adulterations). — Opium is often soft
from excess of water, which causes great variation in the
strength. Stones, fruits, leaves, etc., may be detected by
filtering a decoction ; and starch by the iodine test. The
officinal test is intended to ascertain the amount of morphia in
specimens which are pure but of doubtful richness.

Composition. — Opium contains (1) certain alkaloids ; (2) two
neutral substances ; (3) two organic acids ; (4) water, resin, gum,
extractives, odorous principles, and other constituents of plants.
The important components are as follows :

Parts
in 100
Parts.

Constitu-
tion.

Reaction.

Characters.

1. Morphia

5 to 20

C17H19N03

Alkaline

See below.

2. Codeia

up to '6

CisHaNOg

Alkaline

f White octahedra
/ or rhombic prisms.

3. Thebaia or")
Paramorphiaj

up to '3

C19H21N03

Alkaline

C White plates, with
\ acrid styptic
C taste.

4. Opianin ... ^

5. Cryptopia I
6. Metamorphia t

•5tol

C23H25NO5

Alkaline

—

7. Papaveriua )

C20H2iN04

Alkaline

White needles.

C Shining prisms ;

8. Narcotin

4 to 6

C22H23N07

Alkaline

< tasteless, odour-

(. less.

(Fine white

9. Narcein ... ...

upto*02

C^HaNOa

Neutral

•< needles ; odour-

(. less, bitter.

10. Porphyroxin...
11. Laiidanin

~

CseHsaNOs

~

12. Meconin

•08 to -3

CioHio04

Neutral

( White needles ;
( odourless, acrid.

13. Meconic Acid

4to8

C7H407

Acid

( White crystalline
( pearly scales.

14.ThebolacticAcid

—

Probably
Lactic Acid

Acid

—

General chemical characters. Reactions, and Incompatibles. — A
fluid (watery or spirituous) preparation of opium reddens litmus

OPIUM. 185

paper (free meconic acid) ; gives a deep red colour with per-
chloride of iron (meconic . acid) ; precipitates with, acetate and
subacetate of lead, nitrate of silver, zinc, copper, and arsenic
(meconates, sulphates, and colouring matter) ; a precipitate
with tincture of galls or astringent preparations (tannates of
morphia and codeia) ; and "becomes turbid with fixed alkalies,
and the carbonates, alkaline earths, and ammonia (precipitated
morphia and narcotin).
Lose.— i to 2 gr.

Preparations.

1. Emplastrum Opii. — 1 in 10.

2. Extractum Opii. — Aqueous. 2 of opium in 1. Dose, \ to

Igr.

From Extractum Opii are prepared :

a. Extractum Opii Liquidum, — Made by digesting
the Extract in water, and adding spirit. 1 of opium,
i.e. $ of extract, in 10. Dose, 10 to 40 ruin.

b. Trochisci Opii. — ^ gr. of Extract in each. Dose,
I to 2.

c. Vinum Opii. — | of Extract, i.e. 1 of opium, in
10 of Sherry, with Cinnamon and Cloves. Dose, 10 to
40 min.

3. Pilula Plumbi cum Opio. — Opium, 1 ; Acetate of Lead, 6 ;

Confection of Roses, 1. 1 in 8. Dose, 4 to 8 gr.

4. Pilula Saponis Composita. — Opium, 1 ; Hard Soap, 4 ;

water, q.s. 1 in 6. Dose, 3 to 5 gr.

b. Pulvis Opii Compositus. — Opium, 3 ; Black Pepper, 4 ;
Ginger, 10 ; Caraway, 12 ; Tragacanth, 1. 1 in 10.
Dose, 2 to 5 gr.

from Pulvis Opii Compositus is prepared :

a. Confectio Qpii.-L— Compound Powder in Syrup.
1 of opium in 40. Dose, 5 to 20 gr.

6. Pulvia Ipecacuanha Compositus. — Dover's Powder. Opium,

1 ; Ipecacuanha, 1 ; Sulphate of Potash, 8. 1 in 10.
Dose, 5 to 15 gr.

From Dover'' s Powder is prepared :

a. Pilula Ipecacuanha cum Scilla. — Compound
Ipecacuanha Powder, Squill, Ammoniacum, and Treacle.
1 of opium in 23. Dose, 5 to 10 gr.

7. Pulvis Kino Compositus, — Opium, 1 ; Kino, 15 ; Cinnamon,

4- 1 m 20. Dose, 5 to 20 gr.

8. Fulvis Cretse Aromaticus cum Opio.— Opium, 1 ; Aromatic

Chalk Powder, 39. 1 in 40. Dose, 10 to .40.

1 86 MATERIA MEDIC A AND THERAPEUTICS.

9. Suppositoria Plumbi Composita. — Opium, Acetate of Lead,

Benzoated Lard, White Wax, and Oil of Theobroma.
1 gr. in each.

10. Tinctura Opii. — " Laudanum." Opium, 1^; Proof Spirit,

20. 1 gr. in 14ij min, Dose, 5 to 40 min.

From Tinctura Opii are prepared :

a. Enema Opii. — Tincture, ^ fl.dr. ; Mucilage of
Starch, 2 oz. For one enema.

b. Linimentum Opii. — Equal parts of Tincture and
Soap Liniment.

11. Tinctura Opii Ammoniata. — "Scotch. Paregoric." Opium,

Saffron, Benzoic Acid, Oil of Anise, Strong Solution of
Ammonia, and Spirit. 1 in 96. Dose, ^ to 1 fl.dr.

12. Tinctura Camphorse Composita, — Opium, Benzoic Acid,

Camphor, Oil of Anise, Proof Spirit. ^ gr. in 1 fl.dr.
Dose, 15 to 60 min.

13. Unguentum Gallse cum Opio. — Opium and Ointment of

GaTE 1 in 14$.

From Opium is made :
Morphia' Hydrochloras. — Hydrochlorate of morphia.

Source. — Made by (1) precipitating and rejecting the
meconic acid and resins, by adding a solution of chloride
of calcium to a concentrated cold watery infusion of
opium ; (2) evaporating the solution (containing hydro-
chlorates of the alkaloids), pressing to remove colouring
matter, exhausting with boiling water, filtering, and
pressing again; (3) repeating process (2) until solution
is nearly colourless; (4) completing decolorisation by
digesting with charcoal and filtering; (5) precipitating
morphia by ammonia, washing, diffusing in water, dis-
solving in hydrochloric acid and crystallising out.

Characters. — White acicular prisms of silky lustre ;
soluble in water and in spirit.

Incompatibles. — The alkaline carbonates, lime-water,
Baits of lead, iron, copper, mercury, and zinc, liquor
arsenicalis, and all astringent vegetables.

Dose. — ^ to £ gr.

a. Liquor Morphia? Hvdrochloratis.— Solution of Hydrochlorate

of Morphia. 4 gr. in 1 fl.oz. of a mixture of Spirit,
Water, and Diluted Hydrochloric Acid. Dose, 10 to 60
min.

b. Suppositoria Morphia. — I gr. in each.

c. Suppositoria Morphias cum Sapone. — 2 S1"- m eacn-

QO.» nt*CuCs

fwAAAAjuf^ -^

4^4^u

kcu iv

OPIUM. 187

d. Trochisci Morphise.— ^ gr. in each.

e. Trochisci Morphia et Ipecacuanhas. — A gr. with ^ gr.

Ipecacuanha in each.

From Morphia Hydrochloras is made :

Acetas. — Acetate of Morphia. C17Hl9N03.

(J2.H4U2.

Source. — Made by precipitating morphia from a
solution of the hydrochlorate by means of ammonia, dis-
solving in acetic acid and water, and evaporating.

Characters. — A white powder, soluble in water and
in spirit.

Dose.— | to £ gr.

a. Inlectio Morphia Hypodermica. — Hypodermic Injection of
Morphia. 1 gr. acetate in 12 min.. made by freshly pre-
paring the acetate as above, but without evaporating.
Dose, hypodermically, 1 to 6 min.

/3. Liquor Morphias Acetatis. — Solution of Acetate of Morphia.
4 gr. in 1 fl.oz. of Spirit, Water, and Diluted Acetic
Acid. Dose, 10 to 60 min.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Opium is very generally believed to be
anaesthetic and anodyne when applied to the unbroken skin,
and the emplastrum, linimentum, fomentations, and other pre-
parations are used to relieve the pains of neuralgia, lumbago,
abscess, etc. It is doubtful, however, whether morphia can be
absorbed by the unbroken skin, and the benefit derived from
these applications may be referable to the spirit, resins, and heat.
"Wounds, ulcers, and exposed mucous surfaces readily absorb
opium, which is used in painful ulcers, conjunctivitis, and
similar diseases. It is occasionally given by the endermic
method, especially in the epigastric region. Hypodermic in-
jection is a most valuable means of administering morphia,
when a specially rapid or local effect is desired, or when the
stomach is irritable or inaccessible.

Internally. — Opium has a peculiar taste, is quickly ab-
sorbed by the mucous membrane, and exerts an action upon the
mouth, which, although in part specific and in part remote, is
chiefly an immediate local one. A full medicinal dose renders
the mouth dry and the tongue foul, from diminution of the
secretions, with thickness of the voice and some thirst. On
entering the stomach opium may cause sickness, from brief

1 88 MATERIA MEDIC A AND THERAPEUTICS.

irritation of the nerves, but sensibility is quickly reduced,
hunger and pain relieved or removed ; appetite, gastric secre-
tion, and digestive activity diminished; and the afferent im-
pressions which give rise to vomiting arrested, so that direct
emetics will no longer act. Anorexia, nausea, and sickness
may occur as sequelce of the same or larger doses.

These effects of opium on the stomach have a double
bearing in therapeutics. First, they indicate that it has a
constant tendency to derange digestion. Secondly, it is a
powerful means of relieving gastric pain and vomiting, what-
ever their cause, but especially in the acute catarrh which
remains as the effect of irritant food, alcohol, or poison, after
these have been removed ; in ulcer, "chronic," or malignant;
and in reflex sickness, due to disease, irritation, or operation, in
some other part of the abdomen. In chronic dyspeptic pain it
is manifestly contra-indicated.

The action of opium on the intestine is distinctly sedative,
although very brief primary stimulation may sometimes be
recognised. Both the sensible and insensible impressions from
the mucous membrane are diminished or arrested by medicinal
doses. Pain is prevented or relieved, the secretions are less
abundant, and peristalsis is more feeble or arrested ; the total
result being anodyne and astringent. Opium is therefore a
most valuable remedy for unnatural frequency of the bowels,
as in simple diarrhoea, dysentery, the first stage of cholera,
the ulceration of typhoid fever and tuberculosis, and irritant
poisoning. In all such cases, however, it must be employed
with the cautions to be afterwards insisted on, and in most
instances it is best prescribed as an addition to other astrin-
gents such as chalk, lead, and tannic acid in its many forms ;
the amount of opium being a minimum, but still sufficient to
assist the less powerful drugs. It has the further advantage of
relieving abdominal pain. Even infants (see cautions, page 197)
may thus be treated for diarrhoea with the greatest benefit.

Opium is of still greater service in paralysing the bowels
in hernia, intestinal obstruction, peritonitis, and visceral per-
t'oi-itions, ruptures, and wounds. The drug must be freely and
continuously given in such cases, until nature or art can afford
relief.

Given by the rectum, as the enema or suppository, opium
relieves local pain, diarrhoea, dysentery, and spasm of the
rectum or neighbouring parts, sets the pelvic organs at rest
after operations, and prevents irritability of the rectum by
nutrient enemata. The dose of opium by the rectum should be
half as much more as by the mouth. A trace of morphia ia
excreted unabsorbcd in the faeces.

*7
C6C<

J^>

cu.; t- f^L ^>v^<txm

OPIUM. „ 189

2. ACTION ON THE BLOOD.

Morphia enters the circulation less quickly than some
other alkaloids, although the first traces of the drug are
rapidly discovered in the blood. Thus its full action is
comparatively slowly developed, and solid opium continues to
exert local effects even in the colon, portion by portion of the
morphia being absorbed into the vessels. The red corpuscles
are said to be reduced in size indirectly, possibly through
slowing of the circulation and want of oxygen.

3. SPECIFIC ACTION.

After administration morphia may be found in all the
organs, which, probably without exception, are physiologically
affected by it; but its principal action is exerted upon the
nervous system.

The convolutions are first briefly excited, and afterwards
depressed, probably by direct action of the morphia upon the
nerve-cells, not on the cerebral vessels. The stage of opium
excitement transcends even the first stage of alcoholic intoxica-
tion in the exaltation of feelings, the sense of happiness and
comfort, the brilliancy of imagination, and the increase of in-
tellectual power and mental vigour generally, all accompanied
by brightness of expression and manner. But the effect of
opium, even in this stage, is rarely one of pure exaltation, and
in most persons is perhaps never so. There is generally some
perversion of the faculties, and the imagination becomes extra-
vagant, wandering into the land of dreams, of the grotesque,
and the impossible. Depression now supervenes : the various
perceptive and sensory centres in the convolutions are more or
less depressed, according to the dose ; impressions made upon
the afferent nerves, including pain, do not readily affect the
receptive centres ; the subject becomes drowsy, and finally
; and if he momentarily respond to a sharp enquiry or
other forms of stimulation, he quickly relapses into heavy
sopor. If the dose has been excessive, the stage of excitement is
entirely absent, the cerebrum is speedily and profoundly de-
pressed, and no response follows severe forms of stimulation,
such as flagellation : the patient is comatose. These effects of
opium on the brain as a stimulant, hypnotic, anodyne, and
narcotic, are more marked in man and in highly intellrrtu.il
races than in animals and lower races respectively. In cold-
blooded animals they are quite subordinate to the effects of
stimulation of the cord.

The ganglia at the base of the brain are affected by opium,
en using contraction of the pupil, and disturbance of accom-
modation.

1 90 MATERIA MEDIC A AND THERAPEUTICS.

The grey matter of the spinal cord is at first, and briefly,
stimulated by a moderate dose of opium, reflex excitability
being increased, as shown by restlessness in man and convul-
sions in animals. At the stage of cerebral depression, languor
and muscular weakness, of spinal origin, set in, and the sub-
ject lies down; but there is not even then complete loss of
muscular power and irritability ; and even in dangerous poison-
ing by opium the patient can be marched about, if supported on
either side.

Following close upon the convolutions and cord, the great
vital centres in the medulla are markedly affected by opium.
Vomiting is not uncommon as one of the first effects. The
respiratory centre, at first unaffected, is then depressed, the
respiratory movements becoming quiet, superficial, and ir-
regular ; and death by opium poisoning is due to paralysis of
the respiratory centre and arrest of breathing, that is, to
asphyxia. The cardiac centre is more resistant to morphia,
and is first excited so as to increase inhibition (after an
evanescent acceleration) ; but it is soon depressed, and the
pulse rises in frequency. The vascular centre is depressed by
opium, but never to a dangerous extent ; and even in complete
narcosis, when respiration is failing, the blood pressure (pulse)
responds to afferent stimuli. The full action of opium on the
respiration, heart, and vessels will be immediately described.

We shall presently find that the therapeutical value of
the action of opium on the central nervous system lies in the
fact that it depresses the perceptive and sensory centres so
much earlier and more profoundly than the vital centres in
the medulla. Its effect on the pupil, heart, vessels, respira-
tion, and cord are either of little positive value in treatment,
or are altogether unfortunate.

The functions of the sensory nerve terminations are lowered
or arrested by opium, common sensibility being especially re-
duced, so that pain cannot be originated ; but this peripheral
anaesthetic or anodyne effect of morphia given by the mouth is
decidedly secondary, both in time and in degree, to its allied
action on the sentient centres, and to its local effect when
administered by hypodermic or interstitial injection, already
described.

The sensory nerve-trunks are diminished in conductivity by
local injection of morphia, as well as by its internal administra-
tion, thus offering a second interruption to the flow of painful
impressions inwards.

The motor nerves are first briefly excited, and then para-
lysed from the centre outwards. Muscular irritability is never
completely lost.

OPIUM. 191

The action of opium upon the centres of several of the
viscera has been partly described under the previous heads. In
addition to this, it depresses the afferent (including the sensory)
nerves of all organs, and acts upon many of the viscera
directly.

The heart is temporarily accelerated by opium, in part
through the cardiac centre, in part through its intrinsic
ganglia. Thereafter, or with fuller doses, it is slowed by
stimulation of the vagus in the medulla and heart. Finally,
the cardiac vagus is depressed or paralysed; but by this
time the intrinsic ganglia are so depressed that acceleration is
impossible, and the action remains infrequent, whilst very
feeble. Very rarely death occurs by sudden cardiac failure.

The vessels, dilated through the centre, as described, are
not directly influenced by opium, either in their muscular coats,
or in their peripheral nerves.

Whilst the respiratory movements of the chest are im-
paired through the centre, so that they become feeble and tend
to cease, the afferent nerves of breathing — that is, the branches
of the vagus arising in the lungs and passages — are also depressed.
Thus reflexion is dulled or arrested at its very origin, and
dyspnoea! excitement (hyperpnrea) , cough, spasm, and other
reflex respiratory acts are rendered more difficult or altogether
prevented. At the same time, the bronchial secretions are
diminished or inspissated by the action of the drug upon the
glands, and the activity of pulmonary circulation is lowered
with the general blood pressure, and by the weakening of the
respiratory movements. The total effect of opium upon the
respiratory functions is thus powerfully depressant.

The biliary and glycogenic functions of the liver are
affected by morphia, which causes pale stools or even jaundice,
and remarkably diminishes the amount of sugar in diabetes.
Hepatic and general metabolism is reduced in activity, the
amount of urea and probably of carbonic acid excreted being
distinctly diminished. The temperature rises for a time, and
then falls, apparently varying with the blood pressure.

4. SPECIFIC USES.

The hypnotic and anodyne effects of opium constitute it
by far the most valuable drug of its kind, and the most im-
portant article of the whole materia medica. It is constantly
employed to induce sleep, relieve pain, and calm excitement;
this combination of properties giving opium a great superiority
to chloral and other simple hypnotics, on the one hand, and to
aconite, belladonna, quinine, and other direct or indirect ano-
dynes, on the other hand. Speaking broadly, it is used in

192 MATERIA MEDIC A AND THERAPEUTICS.

sleeplessness due to pain ; in the insomnia of exhaustion, over-
work, fever, or insanity ; and in the restlessness and anxiety
of visceral disease ; the quantity, combinations, and time of
administration being carefully arranged. In delirium chloral
is often preferred, especially in delirium tremens ; but opium
is more suitable in the delirium of mania, and in the later
stages of fevers, when the temperature is falling and the
respiration and circulation are not oppressed. It has been
recommended, however, in heat-pyrexia, combined with quinia.

There are but few kinds of pain that cannot be relieved by
opium ; but whether it be wise to administer it in every instance
is another question. The unbearable pains attending the passage
of renal and biliary calculi, the pains of neuralgia, acute rheu-
matism, and cancer ; of fractures, dislocation, and other in-
juries, are a few examples of conditions in which opium is essen-
tial. In all cases when pain is urgent, and its seat accessible,
the hypodermic method should be chosen. In gout it is to be
used only when the pain is excessive, as it tends to aggravate the
cause. In hysterical pain it is less valuable. Other local
visceral pains will be noticed presently. The pain and shock
of operations are constantly treated with a full dose of opium.

No use is made of the action of opium on the iris and
ciliary nerves.

As an an ti spasmodic, opium is less employed for various
reasons, e.g. in epilepsy and other convulsive diseases ; but it
relieves some cases of spasmodic asthma, whooping-cough, and
spasmodic stricture of the urethra.

The violent spasms and pains of certain diseases of the
cord may yield to no other form of treatment than morphia
injected hypodermically.

From its action on the medulla, opium has been recom-
mended as an antidote to belladonna, which is so far its physio-
logical antagonist, as we shall see (page 198) ; but it must
always be used with great caution, and only in the stage of
excitement.

The practical points connected with the vital centres will be
noticed under the heart, vessels, and respiration.

In disease of the heart, opium is of great value to relieve
pain, anxiety, and distress, whilst, as we have seen, it is a
dangerous cardiac depressant. Towards the end of most cases
of cardiac disease, the greatest discrimination is called for as to
when opium may or may not be given. The safe rule is to
trust to other anodynes entirely, such as belladonna, direct and
indirect stimulants, and measures for relieving the circulation;
but it is equally true that in some cases of heart disease un-
jq !• 'likable relief and permanent benefit may be obtained by the

OPIUM. - 193

hypodermic injection of morphia. This subject must be studied
in books on the practice of medicine.

From its soothing effect upon the vessels and circulation
generally, opium is a haemostatic of the first order, but requires
to be used with judgment. In haemoptysis, it is given in small
doses, to relieve cough, to depress the circulation slightly by
slowing and weakening the heart and dilating the vessels, and
to relieve the mind of the anxiety which aggravates the bleed-
ing. In intestinal haemorrhage it is of great value, arresting,
as it also does, the movements of the bowel. It is best given
combined with lead or preparations containing tannic acid.

The soothing influence of opium on the bronchi, lungs, the
afferent nerves, and the centre of respiration, accounts for its
extensive employment in cough, pain, dyspnoea, and other dis-
tressing symptoms in the chest. Its power here is unquestion-
able ; but for this very reason the danger of it is great. Cough
and dyspnoea are frequently beneficial acts, and are not to be
arrested in a routine fashion by sedatives, but, if possible, by
the removal of their cause. When cough is due to some irre-
movable condition, such as growth in the lung or bronchi,
pressure, or a remote (reflex) irritation, or to excessive irrita-
bility of the nerves and centre, opium is indicated, and may be
given with benefit. On the other hand, in cough and respira-
tory distress with abundant secretion, as in the bronchitis of
the old and infirm or of the very young and feeble, opium
leads to retention and inspissation of the products, aggravation
of the cause, and asphyxia, and is on no account to be given.
Between these extremes lies every variety of case in which
opium may suggest itself, e.g. in phthisis and recurrent
bronchial catarrh. The rule here should be on no account to
prescribe opium unless other means have failed, such as the
many expectorants, and attention to food, warmth, etc.; and
that, when given, opium must be ordered in small doses com-
bined with expectorants, such as ammonia and ipecacuanha,
which will prevent dangerous depression of the local nerves
and centres. In acute inflammation of the pleura, or pleuro-
pneumonia, it may be necessary to relieve severe pain in the
chest, harassing cough, sleeplessness, and mental distress by
morphia hypodermically. For asthma, opium must be ordered
with the greatest hesitation, as the opium habit is readily
acquired in this disease. Its employment in haemoptysis has
been already noticed.

With respect to the liver and metabolism, opium is by far the

most powerful drug known in reducing or removing sugar

from the urine in diabetes, and therewith ameliorating the

condition of the patient in most respects. Very large doses of

if— 8

194 MATERIA MEDIC A AND THERAPEUTICS.

solid opium, morphia, or better still, cocleia, may be tolerated
in this disease, their effect on the nervous system being re-
markably absent whilst the diabetes is yielding. Acute
inflammatory and febrile diseases are now less frequently
treated with opium than formerly, when a combination with
calomel was generally used, the opium preventing the purgative
action of the mercurial, and the latter preventing constipation,
whilst both drugs were believed to act specifically on the morbid
process, reducing the local general circulation, alleviating pain
and restlessness, and promoting healing. The combination is,
however, very valuable in syphilis. In the specific fevers,
such as typhoid, opium given with judgment relieves delirium,
as we have seen, checks diarrhoea, and is invaluable in
hsemorrhage, perforation, or peritonitis. With quinia it is
given in some cases of malaria. Phagedsena may call for its
free exhibition.

Opium is employed in obstetrics to prevent abortion, in
some varieties of difficult labour, and to relieve after-pains.

5. REMOTE LOCAL ACTION AND USES.

The excretion of morphia commences quickly, but may not
be completed for forty-eight hours. It passes out of the body
by most of the secretions, especially the urine, where it is found
mainly unchanged. The quantity of urine is diminished ; its
evacuation sometimes disturbed or difficult, from the local
action of morphia on the bladder ; and sugar occasionally
present. These facts, and the probability of the retention and
accumulation of morphia in the system if the action of the
kidneys be deficient, indicate the necessity to give it only with
the greatest caution, in reduced doses, or not at all, in renal
disorder or disease.

Opium in passing through the skin may cause itching,
heat, and sometimes eruptions. The vessels are also dilated, as
we have seen, and the sweat glands decidedly stimulated ; both
being effects of its central, not local, cutaneous action. Thus
opium, especially in the form of Dover's powder, is a valuable dia-
phoretic, and is given with great success as a refrigerant apyretic
in the outset of catarrh, influenza, and mild febrile or rheumatic
attacks caused by cold. Under certain circumstances, Dover's
, powder actually checks the sweating of phthisis, probably by
removing its cause. Being excreted in the milk, opium must
be prescribed with caution to nursing females.

6. ACTION AND USES OF THE PRINCIPAL CONSTITUENTS OF OPIUM.

1. Morphia. — The action of opium depends chiefly on
morphia, and the description just given applies so nearly to the

OPIUM. - 195

pure alkaloid, that only a few points of difference require to
be noticed. These depend upon two principal circumstances :
(1) Opium, being much less soluble than the pharmacopceial
preparations of morphia, is more slowly absorbed, and thus
acts less quickly than morphia, whilst its effects are more
lasting, and its immediate local action on the intestines
decidedly more marked. (2) Several of the constituents of
opium possess more or less convulsant action (thebain, codeia,
narcotin), morphia none (in man) ; the latter has therefore a
somewhat more sedative influence than the entire drug. The
effect of opium on the skin is also less marked in morphia.
Unless there be some special reason to the contrary, morphia
is generally to be preferred to opium in practice, as being of
definite composition (whilst the crude drug is very variable),
more rapid in action, readily administered hypodermically,
whilst the dyspeptic and constipating effects of the drug
are less marked. Opium is to be preferred in intestinal and
abdominal diseases such as diarrhoea, obstruction, peritonitis,
hernia, because it reaches the bowel; in delirium tremens
and mental disorder, because its action is more continued ;
in diabetes, because it contains codeia ; for combinations with
quinine or calomel, and as a diaphoretic, because it prevents pur-
gation and lowers fever ; in astringent enemata, from its action
on the bowel; and for local applications, e.g. to the con-
junctiva, because less irritant than the alkaloid. The relative
strength of opium to morphia is about 20 or 30 to 100, \ or
|tol.

2. Codeia. — This alkaloid appears to excite the cord more
than morphia, and to depress the convolutions less, so that
muscular tremors may follow and exceed the sedative influence.
Codeia, in ^-gr. doses cautiously increased, markedly reduces
the amount of sugar in diabetes, appearing to act as an
alterative to the nervous system, and thus to cure (not simply
relieve) the disease in some instances.

3. Narcotin, which is so large a constituent of opium, is
probably often impure from an admixture of morphia. By
some authorities it is considered to be hypnotic, by others con-
vulsant. It is not used.

4. Narce'in probably acts like morphia, and is not employed
medicinally.

5. Thebain is a convulsant, almost like strychnia, but is not
used.

6. Opianin, cryptopia, metamorphia, and possibly papa-
verina, act like morphia. Porphyroxin and laudanin act like
codeia.

The action of meconic acid is doubtful.

196 MATERIA MEDICA AND THERAPEUTICS

7. APPLICATIONS OF THE VARIOUS PREPARATIONS OF OPIUM.

This subject will be best discussed from the point of view
of the conditions calling for opium.

1. Severe pain, such as colic or neuralgia, is to be treated
with the Hypodermic Injection of Morphia. Failing this, either
of the Solutions of Morphia must be given by the mouth, or a
fluid preparation of opium, such as the Tincture, or Liquid
Extract (about f more active than the tincture). The Enema is
a valuable anodyne in cases of abdominal pain. The Pilula
Saponis Composita also acts rapidly, being more readily soluble
in the stomach than solid opium.

2. Superficial pain may be met by local applications such
as the Plaster, Liniment, or fomentations made with laudanum
or other fluid preparation ; but, as we saw, the value of the drug
itself in all these applications is very doubtful.

3. A,s a hypnotic, the best forms are the Tincture, the Liquid
Extract, the Solution of Morphia, and the Soap and Opium
Pill ; the particular preparation and the dose being regulated
by the degree of sleeplessness and of the pain which may
accompany it. Dover's Powder is an excellent hypnotic in the
restlessness at the commencement of feverish attacks.

4. As a sedative to the stomach, various preparations may be
tried, such as the Solutions of Morphia in effervescing mixtures,
morphia endermically or hypodermically over the epigastrium ;
sometimes solid opium or the Extract in the form of a small
pill. Dover's Powder is of great value in painful ulceration
and acute dyspepsia, combined with bismuth or soda.

5. As a sedative and astringent to the bowels, Laudanum,
either by the mouth or as the Enema, may be given in urgent
cases attended by much pain. When there is less urgency, we
may prescribe one of the powders — Compound Opium Powder,
Chalk and Opium, Kino and Opium, or Dover's Powder.
Acetate of morphia with acetate of lead and acetic acid, or the
Lead and Opium Pill may be demanded in severe diarrhoea,
especially if haemorrhage threaten. Solid opium, alone or
combined with calomel, is the best form of astringent when the
bowel must be paralysed, as in hernia, peritonitis, and
intestinal obstruction.

6 As a sedative to the rectum, bladder, pelvic organs, and
urethra, we possess the various Suppositories of opium and
morphia, and the Enema.

7. Couyh may be relieved by several special preparations,
namely : Tinctura Camphora Composita, Tinctura Opii Ammo-
niata, the three Trochisci, and the Pilula Ipecacuanhae cum
Scilla.

OPIUM. 197

8. Diaphoresis is generally accomplished with Dover's
Powder.

The uses of the other preparations are obvious. The Con-
fection is a pleasant form of the compound powder.

Influences modifying the action and uses of opium. —
Dangers : Cautions. — Age modifies greatly the effects of opium,
children being particularly susceptible of its influence on the
convolutions and medulla. An infant of one year should not be
given more than half a minim of the tincture for an ordinary dose,
and suckling women should be ordered opium with special pre-
cautions. Females are more easily affected than males. Certain
individuals have peculiar idiosyncrasies as regards opium, some
resisting its action, others being excited by it, others again
very readily narcotised ; whilst more frequently some persons
suffer from a species of shock after the hypodermic injection of
morphia, becoming sick, faint, and even alarmingly collapsed.
The effect of habit is extremely marked in opium, the necessary
dose steadily rising, until large quantities may be safely taken.
Disease, especially pain, affords great resistant power to the
action of opium, which appears to expend its action on the
morbid process. The quality of the opium, the particular pre-
paration, and the combinations used, also modify its action. On
the contrary, opium and morphia act more powerfully in the
subjects of kidney disease, as we have already seen. Morphia
and opium are contra-indicated, because dangerous, or are to be
used with special care, in diseases of the respiratory organs, the
heart, and the kidneys ; in congestive conditions and hyper-
aemia of the brain ; and in alcoholic intoxication.

Opium and Belladonna : Combinations and Antagonism
of Morphia and Atropia.— In several respects the action of
morphia is opposed to that of atropia, the important principle
of belladonna. The antagonism between the two substances is
in part real, such as their respective effects on the convolutions,
respiratory centre, and intestines ; in part apparent only.
Thus, the contraction of the pupil caused by morphia occurs
through the basal ganglia; the dilatation caused by atropia is
referable to paralysis of the ciliary branches of the third
nerve. Morphia is a diaphoretic through the centres : atropia
an anhidrotic through the terminal nerves of the glands. Both
depress the heart and reduce the blood pressure, in poisonous
doses. Thus, morphia and atropia are not true antagonists,
but the one may prevent or relieve certain effects of the other,
and may therefore be combined with the other for particular
medicinal purposes, or given in the treatment of poisoning by
the other under particular circumstances. Combinations of
atropia and morphia are now extensively used for hypodermic

198 MATERIA MEDIC A AND THERAPEUTICS.

injection (r^, -5^, or even -fa gr. of sulphate of atropia to 1 gr.
of morphia), to prevent certain unpleasant effects of the latter.
It is found that the immediate sickness and depression, and the
subsequent dyspepsia and constipation, may thus be avoided,
and a more natural sleep induced. The combination is pre-
ferable when morphia is given as a hypnotic or anodyne ; in
conditions of cardiac depression and disease of the lungs ; in
obstruction of the bowels ; and to relieve spasms in general.
The atropia should be avoided in cerebral excitement, especially
mania.

Use as mutual antidotes. — Sulphate of atropia, in doses of
T^O- gr-> mav be injected subcutaneously every quarter of an
hour in opium poisoning, the pulse and respiration being care-
fully watched. Three or four doses may thus be given ; but
the ordinary means of resuscitation, especially artificial respira-
tion, must not be for a moment interrupted.

In poisoning by belladonna, morphia should be given sub-
cutaneously, with the same precautions, in doses of j of a
grain.

Apomorphia. C17H17N02. APOMORPHIA. (Not
Officinal. )

Source. — Made by heating morphia in a closed tube, with
concentrated hydrochloric acid, whereupon the alkaloid loses one
molecule of water— Ci7Hl9N03 = C17H17N02 + H20.

Characters. — A white powder, becoming green on exposure
or in solution, without loss of its properties. Soluble in ether
and alcohol. The hydrochlorate of apomorphia, which is
generally used, occurs as minute greyish crystals, soluble in
water. Solutions should be freshly prepared for use.

l)ose of the hydrochlorates. — ^ to £ gr., by the mouth ;
•fa to tk gr., hypodermically.

ACTION AND USES.

Apomorphia is the most certain of all emetics, acting upon
the vomiting centre, and not on the stomach, i.e. being an
indirect emetic. In from five to twenty minutes it induces
moderate nausea, repeated vomiting, and the disturbances of the
respiratory and circulatory organs, characteristic of this class of
remedies. If the dose have been sufficient, the evacuation of the
stomach is certain and complete. Larger doses cause prostration
and paralysis of the voluntary muscles, depression of the respir-
atory centre, acceleration of the heart, and fall of temperature,
Small doses are expectorant. Apomorphia may be used for the

SIN A PIS. 199

many purposes of emetics in general. Its special advantages
consist in its certainty ; the absence of local irritation of the
stomach ; the readiness with which it can be given hypodermi-
cally, that is, to patients unable to swallow, as a small non-
irritant injection; and the absence of after-effects. Its
expectorant action has been but little employed.

Rkoeados Petala— RED-POPPY PETALS. — The
fresh petals of Papaver Jtlhoeas. From indigenous
plants.

Characters. — Of a scarlet colour and heavy poppy odour.

Composition. — Red poppies contain a large quantity of
colouring matter, readily soluble in water, consisting of two
acids, papaveric and rhceadic acids ; also an alkaloid rhceadin,
C.21H21N06, without narcotic properties. Eed poppies contain
no morphia.

Preparation.

Syrupus Rhoeados. — 1 in 3^. Dose, 1 fl.dr.

ACTION AND USES.
Syrup of red poppies is used as a colouring agent only.

CRUCIFERJ^

Sinapis— MUSTARD. — The seeds of Sinapis Nigra.
and Sinapis Alba ; also the seeds reduced to powder,
mixed.

Characters of the Powder. — Greenish-yellow, of an acrid
bitterish oily pungent taste, scentless when dry, but exhaling
when moist a pungent penetrating peculiar odour, very irritating
to the nostrils and eyes. Impurity. — Starch ; a decoction cooled
should not be made blue by tincture of iodine.

Substances resembling black mustard : Colchicum seeds,
which are larger, lighter, and not quite round.

Composition. — The seeds of sinapis nigra contain : (1) about
35 per cent, of a bland fixed oil. When this has been removed
by expression, and the powdered mustard mixed with water
and distilled, there is obtained (2) the officinal volatile oil, Oleum
Sinapis, C4H5NS. This is a colourless or pale yellow body,
nearly insoluble in water, of intensely penetrating odour,
burning taste, and blistering action on the skin. As the seeds
and powder of the mustard are devoid of these irritant pro-
perties, the oil cannot exist ready formed in them, but is

200 MATER i A MEDIC A AND THERAPEUTICS.

developed by a decomposition of their constituents. On the
addition of water to the black mustard, its most important
principle, potassium myronate or sinigrin (CinH18NKS2010), a
compound of potassium with an acid glucoside, tnyronic acid,
is broken up by another constituent, myrosin, a ferment, into
volatile oil of mustard, potassium sulphate, and sugar, thus :
K,C10H18NS2010 = C4H5NS + KHS04 + C6H1206. Sinapis
alba also contains the fixed oil. It does not, however, yield the
volatile oil, but a substance with allied properties, called sulpho-
cyanate of acrinyl, C8H7NSO, by a similar decomposition of its
constituents, sinalbin, C30H44N2S2016 (in place of potassium
myronate) and myrosin, thus : C30H44N2S2Oj6 = C8H7NSO +
C16H23N05,H2S04 (disulphate of slnapin) -f C6H1206 (glucose).

Preparations.

1. Oleum Sinapis. — The oil distilled with water from the seeds

of Sinapis nigra after the expression of the fixed oil.
Solubility, 1 in 50 of water ; readily in spirit and ether.

From Oleum Sinapis is prepared :

a. Linimentum Sinapis Compositum. — 1 in 41, with
Ethereal Extract of Mezereon, Camphor, Castor Oil,
and Spirit.

2. Cataplasma Sinapis. — Mustard in powder, linseed meal,

and boiling water.

3. Charta Sinapis. — Made with guttapercha solution.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — When applied to a limited area of skin
mustard acts quickly (1) as a rubefacient and nervous stimu-
lant, causing redness, heat, and severe burning pain. (2) This
effect is speedily followed by loss of sensibility in the
part to other impressions, and relief of previous pain. (3) The
prolonged application of the charta or cataplasm causes vesi-
cation by the production of local inflammation. Neighbouring
and deeper parts, and viscera in vascular communication or
intimate nervous relation with the blistered area, may thus
have their circulation relieved. The heart, blood pressure,
respiration, and nervous centres generally are stimulated by
the first application of mustard to the skin ; soothed during the
stage of anaesthesia, and relief of pain ; and depressed in the
third stage, especially if the vesication be severe through

SlNAPIS. . 201

neglect. Applied to the whole or a large part of the surface
of the skin in the form of a bath, mustard dilates the cutaneous
vessels, and thus relieves the hlood pressure in the viscera.

In the form of poultice or paper, mustard is extensively
used as a readily available, convenient, and rapid means of
relieving local pain, stimulating the internal organs, and pro-
ducing counter-irritation, with evanescent and mild alter-
effects. It is applied to relieve the pains of muscular rheu-
matism (lumbago, etc.) ; neuralgia in any part of the body ; the
indefinite pains in the chest in chronic disease of the lungs or
heart ; and colic, gastralgia, and other forms of distress in the
abdomen. As a car dio- vascular and respiratory stimulant,
a large sinapism may be applied to the calves or soles in
syncope, coma, or asphyxia, whether from disease or from
poisoning. The counter-irritant effect of mustard is chiefly
used in inflammation of the throat, larynx, bronchi, lungs,
pleura, and pericardium ; sometimes in abdominal diseases ;
frequently, and with success, in morbid conditions of the
stomach, and persistent vomiting from any cause. Diffused
through a warm bath it is a popular " derivative " in cerebral
congestions, headache, and at the onset of colds and febrile
diseases in children. A mustard sitz bath may stimulate
menstruation if taken at the period.

Internally. — Mustard produces a familiar pungent impres-
sion on the tongue and olfactory organs, a sense of warmth in
the stomach, and an increase of relish and appetite. The cir-
culation in the gastric wall is also stimulated, but it is remark-
able that the effect of mustard on the circulation in the stomach
is much less powerful than that on the skin. In full doses it is
emetic, with a rapid stimulant action, and little subsequent
depression.

Mustard is used internally chiefly as a condiment. As an
emetic, from one to four teaspoonfuls may be given stirred up
with a tumblerful of warm water in cases where other emetics
are not available, or have failed, especially in poisoning by
narcotics such as opium.

2. ACTION ON THE BLOOD, SPECIFIC, AND REMOTE LOCAL ACTION.

The odour of oil of mustard can be detected in the blood.
Its specific action is obscure, and never taken advantage of
medicinally. Part, at least, of oil of mustard is excreted by
the lungs.

Armoracire Radix — HORSERADISH ROOT. — The
fresh root of Cochlearia Armoracia. Cultivated in
Britain.

202 MATER i A ME DIG A AND THERAPEUTICS.

Characters. — A long cylindrical, fleshy root, half an inch to
one inch in diameter, expanding at the crown into several very
short stems. It is internally white, and has a pungent taste
and smell.

Substances resembling Horseradish : Aconite root, which is
short, conical, darker, and causes tingling when chewed.

Composition. — Horseradish yields, along with other con-
stituents, a volatile oil, C4H5Si$r, closely allied to the volatile oil
of black mustard, and formed, like it, by decomposition of a
more complex principle by means of a ferment.

Preparation.

Spiritus ArmoracigB Compositus. — 1 in 8, with orange-peel,
nutmeg, and spirit. Dose, 1 to 2 fl.dr.

ACTION AND USES.

Horseradish has been used in domestic medicine as a
counter-irritant, but is most familiar as a pleasant condiment,
possessing much the same properties as mustard. The compound
spirit is a flavouring and carminative agent.

POLYGALACE^:.

Seoegee Radix — SENEGA ROOT. — The dried root
of Polygala Senega. From North America.

Characters. — A knobby root-stock, with a branched tap-
root, of about the thickness of a quill, twisted and keeled ; bark
yellowish-brown ; sweetish, afterwards pungent, causing saliva-
tion ; interior woody, tasteless, inert.

Substances resembling Senega : Veratrum Viride, Arnica,
Valerian, Serpentary. All have no keel.

Composition. — The active principle of senega is saponin, a
colourless amorphous glucoside, C32H54018, decomposed by
HC1 into a sugar, and sapogenin (C14H2202). Saponin is closely
allied to digitonin, one of the active principles of digitalis.

Preparations.

1. InfiiBum Senegse. — 1 in 20. Dose, 1 to 2 fl.oz.

2. Tinctura Senegse. — 1 in 8. Dose, \ to 2 fl.dr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

y.s ternatty. — Applied to the mucous membrane of the nose
or throat, in the form of powder (snuff), senega is a powerful

•** *> _ ^ji^o

£xX
lc^tU^-Ax^ £t<-#t^r. .

SENEGA. 203

irritant, causing reflex hyperaemia, sneezing, cough, and mucous
flow. These effects are not employed, but are a key to its
remote local action. Solutions of saponin injected under the
skin are violent local irritants and general depressants ; the
heart, vessels, central and peripheral nervous system, and
muscles being dangerously affected.

Internally. — The action of senega on the stomach and
intestines is moderately irritant, large doses causing epigastric
heat, sickness, and diarrhoea ; and medicinal doses deranging
digestion. The absence of severe general symptoms indicates
the difficulty of its absorption by the stomach.

2. ACTION IN THE BLOOD, AND SPECIFIC ACTION.

Saponin passes through the blood to the tissues. Senega
diminishes the frequency of the heart, and probably affects the
circulation much like digitalis, but in a manner which is
more uncertain or at least still obscure.

3. REMOTE LOCAL ACTION AND USES.

Saponin appears to be excreted in part by the bronchial
mucosa, which it stimulates thus remotely as it does when locally
applied. The circulatory, muscular, and nutritive activity of the
tubes is increased ; the mucous secretion rendered more abundant
and watery ; and the efferent nerves stimulated, so that reflex
cough is the result. The total action is said to be expectorant,
the bronchial contents being expelled with greater force, and in
greater volume, i.e. more readily and easily. Senega is in
common use as a stimulant expectorant in the second stage
of acute bronchitis, in chronic bronchitis, and in dilated bronchi,
to liquefy and evacuate the contents of the tubes or cavities, and
stimulate the "weak" surface of the mucous membrane. It is
manifestly contra-indicated in acute bronchitis, phthisis, and
•when the digestion is feeble or deranged. Saponin is probably
excreted in part by the skin and kidneys, both of which it
slightly stimulates, increasing the volume of urine, and its
most important solid constituents.

Krameriae Radix — RHATANY ROOT. — The dried
root of Krameria triandra. Imported from Peru.

Characters. — About an inch in diameter, branches numerous,
long, brownish-red and rough externally, reddish-yellow inter-
nally, strongly astringent, tinging the saliva red.

Composition. — Khatany root contains from 20 to 45 per

204 MATERIA MEDIC A AND THERAPEUTICS.

cent, of rhatania-tannic acid, C^H^C^-p a red amorphous sub-
stance, the watery solutions of which first colour chloride of
iron green and then precipitate it, but are not precipitated by
tartar emetic.

Incompatibles. — Alkalies, lime-water, salts of iron and lead,
gelatine.

Preparations.

1. Extractum Kramerise. — Aqueous. Dose, 5 to 20 gr.

2. Infusum Krameriae. — 1 in 20. Dose, 1 to 2 fl.oz.

3. Fulvis Catechu Compositus. — 1 in 5.

4. Tinctura Kramerise.— 1 in 8. Dose, 1 to 2 fl.dr.

ACTION AND USES.

The preparations of rhatany possess the properties of tannic
acid, and may be employed for the same purposes (see Acidum
Tunnicum, page 337), except that they are obviously of no use
in poisoning by antimony. The drug is not extensively
ordered.

SAPINDACEJE.

Guarana. (Not Officinal.) — The seeds of Paul-
linia sorbilis, reduced to powder after roasting, and
made into a stiff paste with water. From Brazil.

Characters. — Cylindrical rolls of dried paste. Brazilian
cocoa.

Composition. — Guarana contains no less than five per cent,
of cajfein, C8Hi0N402, the alkaloid of the coffee and tea
plants ; united, as in these, with tannic acid, starch, and gum.

Dose. — 15 to 60 gr. in powder, or as infusion.

ACTION AND USES.

The action of guarana closely resembles that of strong tea
or coffee. It is chiefly used in sick headache (megrim). See
Caffein (page 271).

ERYTHROXYLACE^E.

Coca. (Not Officinal.) — The leaves of Erythroxy-
lon Coca. From South America.

Characters. — Leaves two inches long, petiolate, oval,
entire, pointed at the blunt apex, with a slight odour of tea,
and a bitter aromatic taste.

a. •••> ,

an-tx

<Jva to

0

Li NUM. 205

Composition. — Coca leaves contain a yellowish-white crys-
talline bitter alkaloid, coca'in, Ci7H2iN04, which is converted by
heat into a second alkaloid, ecgonin, C9H15N03, benzoic acid,
and methylic alcohol.

Dose. — | to 4 dr. of the leaves ; £ to 1 gr. of cocain.

ACTION AND USES.

Coca is believed to possess stimulant, restorative, or even
nutritive properties, enabling persons who chew the leaf to
undergo great muscular exertion with little or no fatigue.
In animals the alkaloid causes great muscular restlessness or
excitement, and finally convulsions ; the whole brain, medulla,
and cord being powerfully stimulated. The pupils are dilated ;
respiration rises in frequency, is disturbed in rhythm, and
finally ceases. The heart is greatly accelerated by paralysis of
the vagus ; the blood pressure first rises and then falls. The
muscles themselves remain unaffected. The amount of urea
is said to be diminished, as if from diminished metabolism ;
but coca does not prolong the life of starved animals.

This drug has been used to prevent muscular exhaustion ;
in wasting attended with increased formation of urea (azo-
turia) ; in convalescence ; in mental exhaustion ; and in the
opium habit. It has somewhat disappointed expectation.

LINAGES.

L.ini Semiiia — LINSEED. — The seeds of Linura
usitatissimum, Flax. Cultivated in Britain.

Characters. — Small, oval, pointed, flat, with acute edges,
smooth shining brown externally, yellowish- white within, of a
mucilaginous oily taste.

Composition. — The seeds of flax contain a quantity of
mucilage, chiefly in the testa or coat, and from ^ to ^ of their
weight of the officinal fixed oil. This consists chiefly of the
glyceride of linole'ic acid, which has a powerful affinity for
oxygen, and thus becomes resinoid on exposure, constituting
it a " drying oil." The linseed meal, obtained after expression
of the oil, consists chiefly of mucilage, proteids, salts, a little
oil, but neither starch nor sugar.

Preparations.

1. Farina Lini. — Linseed Meal. Linseed ground and deprived
of oil, and the cakes powdered.

206 MATER i A MEDIC A AND THERAPEUTICS.

From Farina Lini is prepared :

a. Cataplasma Lini. — Mix Linseed Meal 4, with toiling

Water 10, and add Olive Oil -5, stirring constantly.

Freshly bruised linseed is better than the meal and

olive oil.
Linseed meal is also used in preparing all Cataplasmata

except Cataplasma Fermenti.

2. Infusum Linu — " Linseed Tea," 1 in 30, with Liquorice.

Dose, ad libitum.

3. Oleum Lini. — Brown. Made by expression without heat.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Linseed meal is used only as the Cataplasma,
which is the poultice universally employed to convey heat and
moisture to parts, and thus affect the nerves, circulation, and
nutrition generally. The oil may be applied to burns, either
pure or mixed with an equal quantity of lime-water, con-
stituting carron oil, a substitute for Linimentum Calcis. It
may also be used as a laxative in the form of enema.

Internally. — Infusum Lini, or " linseed tea," is a familiar
demulcent drink, containing a large quantity of mucilage,
which coats the surface of the pharynx and fauces, and thus
relieves troublesome throat cough, especially when it is com-
bined with a little stimulant lemon.

2. ACTION IN THE BLOOD, SPECIFIC AND REMOTE LOCAL ACTION.

Linseed tea is supposed to have a specific and remote
local effect as a demulcent on the bronchi and urinary passages,
but this is probably referable to the warm water only. It is,
perhaps, slightly diuretic as oil of linseed becomes oxydised
in the system (as it does on exposure to air), and is excreted by
the kidneys as a resinoid body which stimulates these organs.

MALVACEAE.

Oossyimim— COTTON WOOL.— The hairs of the
seed of several species of Gossypium, carded.

Preparations.

pyroxylin. Gun Cotton. — Made by immersing the wool in a
mixttire of sulphuric and nitric acids, washing, draining,
and drying.

A URANTII COR TEX. '207

From Pyroxylin is prepared :

Collodium. — Made by dissolving Pyroxylin, 1 ; in Ether,
36 ; and Rectified Spirit, 12.

From Collodium is prepared :

Collodium Flexile. — Collodium, 48 ; Canada Balsam, 2 ;
and Castor Oil, 1.

Non-officinal Preparation of Gossypium.
Absorbent Cotton "Wool. Cotton wool deprived of its oil
by washing with an alkali.

ACTION AND USES.

The action and uses of cotton wool in medical and surgical
practice are sufficiently familiar. Absorbent cotton is now
much employed.

Pyroxylin is introduced for the purpose of making collodion.

Collodion, when painted on the skin or other exposed part,
instantly dries by evaporation of the ether, forming a fine film.
This film serves as a protective to thin, inflamed, broken, or
incised surfaces, preventing bed-sores, arresting haemorrhage
(as in leech-bites), and closing fissures or punctures made with
aspirateurs or trochars in paracentesis. The flexible collodion
does not contract on drying or readily crack, and is a better
form for most of the above purposes.

ATJRANTIACE2E.

Aurantti Cortex — BITTER-ORANGE PEEL. — The
dried outer part of the rind of the bitter orange,
Citrus Bigaradia. From the ripe fruit imported from
the south of Europe.

Characters. — Thin, of a dark orange colour, nearly free
from the white inner part of the rind, having an aromatic
bitter taste and fragrant odour.

Composition. — Orange peel contains 1 to 2| per cent, of
volatile oil, oleum eorticis aurantii, isomeric with oil of tur-
pentine, C>i0Hl6, and a bitter crystalline principle, anrantiin or
hesperidin.

Preparations.

1. Infusum Aurantii.— 1 in 20. Dose, 1 to 2 fl.oz.

2. Infusum Aurantii Compositum.— 1 in 40. Dose, 1 to

2 fl.oz.

208 MATER i A MEDIC A AND THERAPEUTICS.

3. Tinctura Aurantii.— 1 in 10. Dose, 1 to 2 fl.dr.

from Tinctura Aurantii is prepared:
a. Svrupus Aurantii. — 1 of tincture in 8.
Tinctura ^Aurantii is also an ingredient of Mistura Ferri
Aromatica and Tinctura Quiniae.

4. Vimim Aurantii. — Orange wine made in Britain, and con-

taining 12 per cent, of alcohol.

Vinum Aurantii is used in making Vinum Ferri Citratis
and Vinum Quinise.

Bitter-orange peel is also an ingredient of Spiritus Ar-
moracese Compositus, Tinctura Cinchonas Com-
posita, and Inf usum Gentianae Compositum, Mistura
Gentianae, and Tinctura Gentianae Composita.

Aurantii Fmctus — BITTER ORANGE. — The ripe
fruit of Citrus Bigaradia. Imported from the south
of Europe.

1 Preparation.
Tinctura Aurantii Recentis.— 6 in 20. Dose, 1 to 2 fl.dr.

Aqua Aurantii Floris— ORANGE-FLOWER WATER.
— Water distilled from the flowers of the bitter-orange
tree, Citrus Bigaradia, and of the sweet-orange tree,
Citrus aurantium. Prepared mostly in France.

Characters. — Nearly colourless, fragrant.

Composition. — Orange flowers yield an aromatic volatile

oil, oleum neroli, and a trace of a bitter principle.
Impurities. — Lead derived from the vessels in which it is

imported ; detected by H2S. Dose, | to 1 fl.oz.

Preparation.
Syrupus Aurantii Floris. — Dose, 1 to 2 fl.dr.

ACTION AND USES.

Orange is at once an aromatic and a bitter substance,
and combines the action of these two classes of remedies, as
described under Calumba and Caryophyllum respectively. It is
extensively used as a highly agreeable flavouring agent in
cookery, pharmacy, and the manufacture of liqueurs; and in

LIMONIS Succus. .209

these several ways may be turned to account therapeutically.
It is but feebly bitter.

U in oil is Cortex— LEMON PEEL. — The outer part
of the rind of the fresh fruit of Citrus Limonum.
Lemons are imported from southern Europe.

Composition. — Lemon peel contains the officinal volatile oil,
Oleum Limonis, C10H16 (isomeric with turpentine), and a bitter
principle.

Preparations.

1. Oleum Limonis. — The oil expressed or distilled from the

fresh peel. Pale yellow. Dose, 1 to 4 min.
Oil of Lemon is an ingredient of Linimentum Potassii lodidi
cum Sapone and Spiritus Ammonige Aromaticus.

2. Syrupus Limonis. — 2 in 41, with 20 of Lemon Juice. Dose,

1 to 2 fl.dr.

3. Tinctura Limonis. — 1 in 8. Dose, % to 2 n.dr.

Lemon peel is also contained in Infusum Aurantii Compositum
and Infusum Gentianse Compositum.

ACTION AND USES.

The action and uses of lemon are the same as those of
orange, the only difference of importance being in the flavour.
See Aurantii Cortex.

Li 111 oiii s Succiis— LEMON JUICE. — The freshly
expressed juice of the ripe fruit of Citrus Limonum.

Characters. — A slightly turbid yellowish liquor, with a
sharp acid taste, and grateful odour. Half a fluid ounce (one
table-spoonful) contains 16-25 gr. of Citric Acid, and neutralises
23 gr. nearly of Bicarbonate of Potash, 20 gr. nearly of Bicar-
bonate of Soda, or 13 gr. fully of Carbonate of Ammonia.

Composition. — Lemon juice contains citric acid, both free
and combined with potash and other bases, malic and phosphoric
acids, etc.

Dose.— | to 4 fl.oz.

Preparations.

1. Syrupus Limonis. — See Limonis Cortex.

2. Acidum Citricum, — See Acids, page 126.

0—8

2io MATER r A MEDICA AND THERAPEUTICS.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Lemon juice in the mouth and stomach has the same action
as citric acid, and is used chiefly to relieve thirst and
produce effervescing mixtures and drinks.

2. ACTION ON THE BLOOD, AND SPECIFIC ACTION AND USES.

Lemon juice enters the blood as alkaline citrates, potash
salts, and phosphoric acid. Here the citrates are in part
oxydised into carbonic acid and water. (See Acidum Citricum.)
The potash and phosphoric acid probably act upon the red
corpuscles, of which they are both important constituents.

Lemon juice is used with great success in the prevention
and treatment of scurvy, a disease the exact nature of which
is still obscure, but which is no doubt produced by the want
of the juices of fresh vegetable and animal food. The citric
acid, the potash, and the phosphoric acid have severally been
credited with the beneficial effect by different authorities.
Lemon juice has also been given in acute rheumatism, but is
probably useful only in as far as it conveys alkalies into the
blood and tissues.

3. REMOTE LOCAL ACTION AND USES.

Those, which are of great importance, are fully described
under Citric Acid.

Belae Fructus— BAEL FRUIT. — The dried half-
ripe fruit of .flCgle Marmelos. From Malabar and
Coromandel.

Characters. — Fruit roundish, about the size of a large
orange, with a hard woody rind ; usually imported in dried
slices, or in fragments consisting of portions of the rind and
adherent dried pulp and seeds. Rind about a line and a
half thick, covered with a smooth pale-brown or greyish
epidermis, and internally, as well as the dried pulp, brownish-
orange or cherry-red. The moistened pulp is mucilaginous.

Composition. — Bael is believed to contain a kind of tannio
acid, but has not been thoroughly analysed.

Preparation.
Extraction Belss Liquidum. — 1 in 1. Dose, 1 to 2 fl.dr.

THEOBROMA. .211

ACTION AND USES.

In the fresh state, Indian hael is a pleasant refreshing
fruit, with astringent and refrigerant properties, which render
it valuable in the treatment of diarrhoea and dysentery. As
imported into this country in hard portions of rind and dried
pulp it is probably useless ; but a liquid extract made from the
fresh fruit appears to produce its specific effects. It is seldom
employed out of India.

BYTTNERTAOFJR.

Oleum Theobromae — OIL OF THEOBROMA. —
Synonym : Cacao Butter. A concrete oil obtained by
expression and heat from the ground seeds of Tbeo-
broma cacao, a small tree, a native of Demerara and
Mexico.

Characters. — Of the consistency of tallow ; colour yellowish,
odour resembling that of chocolate ; taste bland and agreeable ;
fracture clean, presenting no appearance of foreign matter.
Does not become rancid from exposure to the air. Melts at
95°. The seeds also contain theobromin. See Caffein, page 270.

Composition. — Oil of theobroma constitutes from 30 to 60
per cent, of the cacao bean. It consists chiefly of stearin with
a little olein.

Preparations.

All the suppositories.

ACTION AND USES.

Cacao butter serves as a vehicle for more active substances
in the form of suppositories. The action of theobromin is the
same as that of caifein. See page 271.

CAMELLIACE^.
Tea. (Not Officinal.)— The dried leaves of Thea

Composition. — Tea contains an alkaloid, thein^
identical with caffein ; a volatile oil, most abundant in green
tea, and tannin. The relations of the alkaloid, as well as
ita

ACTION AND USES,
are described fully under Caffein, page 271.

212 MATERIA MEDIC A AND THERAPEUTICS.

GUTTIFERJE.

Cambogia— GAMBOGE. — A gum-resin obtained
from Garcinia Morella. Imported from

Characters. — Cylindrical pieces, breaking easily with a
smooth conchoidal glistening fracture ; colour tawny, changing
to yellow when it is rubbed with water ; taste acrid.

Dose. — 1 to 4 gr.

Impurity. — Starch; detected by yielding a green colour
with iodine.

Composition. — Gamboge contains about 73 per cent, of a
resinous substance, yambooic acid. C^IL^O^; 25 per cent, of
gum ; and about 2 per cent, of water. Gambogic acid is in-
soluble in water, gives the brilliant yellow colour to the gum-
resin, and forms salts with bases. It is less active than the
gum-resin.

Preparation.

Pilula CambogisB Composita. — Gamboge, 1 ; Barbadoes Aloes,
1 ; Compound Powder of Cinnamon, 1 ; Hard Soap, 2 ;
Syrup, q. s. Dose, 5 to 10 gr.

ACTION AND USES.
' 1. IMMEDIATE LOCAL ACTION AND USES.

Gamboge is an irritant to the stomach and bowels, causing
vomiting in large doses, and in medicinal doses acting as a
hydragogue cathartic not unlike colocynth, without being
cholagogue. It is seldom prescribed alone, and not often as
the compound pill. Such a remedy is indicated in dropsies,
cerebral hyperaemia, and as an anthelmintic (not to children) ;
but other substances have now almost completely displaced it.

2. ACTION IN THE BLOOD, SPECIFIC AND REMOTE LOCAL ACTION
AND USES.

Gambogic acid is chiefly thrown out in the liquid faeces ;
but part is absorbed, passes through the blood and tissues, and
is excreted by the kidneys. These it stimulates, causing an
increased flow of yellow-coloured urine. Its diuretic effect may
add to its value in dropsy.

CANELLACEJE.

Cancllac Albae Cortex— GANELLA ALBA BARK.
—The bark of Canella alba. From the West Indies.

GUAIACUM. 213

Characters. — In quills or broken pieces, hard, of a yellowish-
white or pale-orange colour, somewhat lighter on the internal
surface. It has an aromatic clove-like odour, and an acrid
peppery taste.

Composition. — Canella contains a bitter principle and an
aromatic oil.

Canella Alba is contained in Vinum Ehei. (See Rhei Radix,
page 318.)

ACTION AND USES.

Canella alba is an aromatic bitter stomachic and tonic, like
cascarilla and cinnamon. The action and uses of this class of
remedies is fully described under Calumba Radix, page 181.

Uvae — RAISINS. — The ripe fruit of Yitis vinifera.
the Grape Vine, dried in the sun or with artificial
heat. Imported from Spain.

Composition. — Raisins contain grape sugar, acid tartrate of
potash, other vegetable acids, etc.

Raisins are contained in Tinctura Cardamomi Composita and
Tinctura Sennae.

ACTION AND USES.

Raisins are demulcent, refreshing and nutrient, but are
employed in medicine chiefly as sweetening and flavouring

ZYGOPHYLLACE^.

Ouaiaci L.igimm — GUAIACUM WOOD. — The
wood of Guaiacum officinale. Imported from St.
Domingo and Jamaica, and reduced by the turning
lathe to the form of a coarse powder or small chips.

Guaiaci Lignum is an ingredient of Decoctum Sarsas Com-
positum. (See Sarsce Radix, page 354.)

Guaiaci Resina — GUAIACUM RESIN. — The resin
of Guaiacum officinale. Obtained from the stem by
natural exudation, by incisions, or by heat.

Characters. — In large masses of a brownish or greenish-
brown colour ; fractured surface resinous, translucent at the

214 M.iTKRIA MEDIC A AND THERAPEUTICS.

edges ; with pleasant aromatic odour and burning taste. In-
in watrr; soluble in alcohol, ether, chloroform, and
alkaline fluids. A solution in rectified spirit strikes a clear
1)1 a.- colour when applied to the inner surface of a paring of
raw potato.

i resembling Guaiacum Resin : Myrrh, Scammony,
]>i •n/oiii, Aloes, Resin, which have no green tinge.

nosition. — The chief constituent of guaiacum wood is
the officinal resin, with a crystalline bitter colouring matter,
IT. nn, etc. The resin is itself composed of three resins, guaia-
><-id, CigHaoOg, 70 per cent.; guaiac acid, C6H8O3, re-
sembling benzoic acid; and guaiaretic acid, C^H^O^ 10 per

with an indifferent resin.

J)n'i,>n}>Ktihles. — Mineral acids, spirit of nitrous ether.
Jtose. — 10 to 30 gr.

Preparations.

1 . Mistura Guaiaci.— Guaiacum Resin, 2; Sugar, 2; Gum

Acacia, 1 ; Cinnamon water, 80. Dose, ^ to 2 fl.oz.

2. Tinctura Guaiaci Ammoniata. — 1 in 5 of Aromatic Spirit of

Ammonia. Dose, % to 1 n.dr., with 1 drachm of mucilage
»r yolk of egg.

3. Pilula Hydrargyri Subchloridi Composita.— 1 in 2£. (See

••ruryyruin, page 86.)

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

^ Intern fili'it. guaiacum is a local stimulant, producing sali-
ii'ii, an aerM hot sensation in the throat, warmth in the
epigastrium, inn-ease of the movements and secretions of the
Btomach and bowels, and reflex stimulation of the heart. In
large quantity it is a gastro-intestinal irritant, causing power-
ful vomiting and purging, and the attendant disturbances of

: illy.

i powder frequently relieves sore throat, if given

. to he jilaeed on the tongue, and slowly swal-

>urs. The tincture or non-officinal lozenge is

lens successful, riummer's pill doubtless owes part of its

mil'll;. t to the guaiac resin it contains.

N THE BLOOD, SPECIFIC AND REMOTE LOCAL ACTION
AND USES.

t ion of guaiacum physiologically is still ob-
l stimulant effect on 'the circulation already

'" ;•• La

uu

BUCHU. 215

mentioned, it appears to increase the secretions of the skin and
kidney, and probably stimulates the liver and metabolism
generally. In the form of the ammoniated tincture it is used
in chronic gout and rheumatism, certainly with much success
in some cases. As a constituent of Decoctum Sarsse Com-
posituin, not alone, it is given as an alterative in syphilis.

Buchn Folia — Bunnn LEAVES. — The dried
leaves of : 1. Barosma betulina, Bartling. 2. Barosma
crenulata, Hooker. 3. Barosma serratifolia^ Willd.
Imported from the Cape of Good Hope.

Characters, — Smooth, marked with pellucid dots at the
indentations and apex ; having a powerful odour and a warm
camphoraceous taste. 1. About three-quarters of an inch long,
con :i< rous, obovate, with a recurved truncated apex and sharp
cartilaginous spreading teeth. 2. About an inch long, oval-
lanceolate, obtuse, minutely crenated, five-nerved. 3. From an
inch to an inch and a half long, linear-lanceolate, tapering at
each end, sharply and finely serrated, three-nerved.

Impurities. — Leaves of Emplanum serrulatum (for those of
B. serratifolia) ; have no glands.

Substances resembling Buchu : Senna and Uva Ursi, which
have entire leaves.

Composition. — Buchu contains a volatile oil, in the glands
or " dots," of a yellowish-brown colour, and the source of the
peculiar odour of the leaves ; a camphor, barosma camphor ; a
crude oil ; and other substances of less importance.

J)ose.—2Q to 40 gr.

Preparations.

1. Infusmn Buchu.— 1 in 20. Dose, 1 to 4 oz.

2. Tinctura Buchu.— 1 in 8. Dose, 1 to 4 fi.dr.

ACTION AND USES.

The action and uses of buchu closely resemble those of

Sireira, to the description of which the student is referred.
; is more frequently employed than pareira, its infusion con-
stituting an excellent vehicle for saline diuretics.

Oleum Rutre— OIL OP RUE.— The oil distilled
from the fresh herb of Ruta graveolens.

216 MATERIA MEDIC A AND THERAPEUTICS.

Characters. — Colour pale yellow, odour disagreeable, taste
bitter, acrid.

Composition. — Oil of rue is a mixture of various volatile oils.
Dose. — 2 to 6 min.

ACTION AND USES.

The action of rue is the same as that of savin ; but it is
seldom employed as an emmenagogue. See Sabince Cacumina,
page 351.

Cusparise Cortex— CUSPARI A BARK. ANGUSTURA
BARK. — The bark of Galipea Cusparia. From tropical
South America.

Characters. — In straight pieces, more or less incurved at
the sides, from half a line to a line in thickness, pared away
at the edges ; epidermis mottled, brown, or yellowish-grey ;
inner surface yellowish-brown, flaky ; breaks with a short
fracture ; the taste is bitter and slightly aromatic. The cut
surface examined with a lens usually exhibits numerous white
points or minute lines.

Impurity. — The bark of Strychnos Nux vomica (" false
angustura bark "), which may be distinguished by its inner
surface giving a blood-red colour with nitric acid, whilst true
cusparia bark does not. Cusparia resembles Canella alba, but
is darker and has pared edges.

Incompatibles. — Mineral acids ; perchloride of iron, and
other metallic salts.

Composition. — Cusparia contains a neutral crystalline bitter
principle, cusparin or angusturin, a second bitter substance, an,
aromatic oil, but no tannin.

Dose. — 10 to 40 gr.

Preparation.
Infusum Cusparise. — 1 to 20. Dose, 1 to 2 fl.oz.

ACTION AND USES.

Cusparia belongs to the group of aromatic bitters, the
action and uses of which are fully discussed under Calumba
and Caryophyllum. Like other bitters, it has been credited with
antipyretic and antiperiodic properties, and in its native place
is used instead of cincbona for malarious diseases.

Pilocarpi Folia (Not Officinal).— The leaflets

^~r*

•-

GJU

PlLOCARPUS. .217

of Pilocarpus pennatifolius. Jaborandi. Imported
from Brazil,

Characters. — Leaves dull green, large, pinnate, with 3 to
5 pairs of leaflets and a terminal one. Leaflets coriaceous,
4 to 6 inches long, oblong, lanceolate, emarginate, smooth or
only slightly tomentose, and full of pellucid dots.

Impurities. — Leaves of species of piper ; not pinnate.

Composition. — Jaborandi contains mlocarvin. a liquid colour-
less alkaloid, to which its chief effects are due. It is said to
contain a second (isomeric) alkaloid, jaborin, closely resembling
atropia in its action, and therefore antagonistic to pilocarpin.

Dose. — 5 to 60 gr.

Non-officinal Preparations.

Extract. Dose, 2 to1 10 gr. Fluid Extract. 1 in 1 ; Dose, 10
to 60 min. Infusion. 1 in 20; Dose. 1 to 2 fl.oz. And Tincturef 1
in 2 ; Dose, 5 to 20 min. Also Hydrochlorate and Nitrate of
Pilocarpin ; Dose of either, ^ to ^ gr. by the mouth, ^ to J
gr. hypodermically. The last is most used.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Jaborandi applied to the conjunctiva causes
contraction of the pupil, tension of the apparatus of accommo-
dation and disturbance of vision. The effect commences in
ten minutes, and lasts from 1^ to 24 hours before finally disap-
pearing. It is used in some cases of inflammation of the eye,
such as iritis ; in certain forms of blindness ; and in paralysis of
the muscles. (See Physostigma, page 230.)

Internally, in full doses, it is liable to cause nausea and
vomiting.

2. ACTION ON THE BLOOD.

Pilocarpin enters the blood rapidly and passes thence into
the tissues.

3. SPECIFIC ACTION AND USES.

The striking effects of Jaborandi consist in profuse salivation,
perspiration, disturbances of vision, and circulatory depression,
which last for hours, and leave a sense of drowsiness and de-
bility behind them. Salivation is due to stimulation of the
terminal ends of the chorda tympani in the glands, as well as
of its centre. The flow commences in about five minutes after
a moderate dose, and lasts several hours. It increases with
the dose. It is completely prevented or arrested by atropia.

218 MATERIA MEDIC A AND THERAPEUTICS.

Perspiration is referable to stimulation both of the sudoriparous
nerves and the sweat centres. It follows quickly on the ap-
pearance of the salivation ; is accompanied by flushing of the
skin, and sometimes rigor ; progresses from the head down-
wards ; may be so profuse as to soak the bedclothes ; and lasts
several hours. The body weight necessarily falls, metabolism
is stimulated, and a large quantity of urea is -said to be ex-
creted by the skin. Atropia arrests this diaphoresis. The -milk
is doubtfully increased. The hair grows more actively under a
course of jaborandi. Bronchial and nasal secretions flow more
freely ; even the tears, cerumen, and alimentary secretions are
somewhat increased; but not the bile. The amount of urine
is moderately raised by small doses. The menses are not
affected. The eye is affected specifically, as it is locally.
Respiration is not modified directly by pilocarpin. At first
the heart and pulse are accelerated, but they are afterwards
slowed and weakened; the blood pressure falls temporarily,
then rises, and finally falls. Part of these effects are due to the
action of the drug on the vagus in the heart, and can be
arrested by atropia ; part seem referable to the ganglia. The
temperature rises before, and falls during, the sweating.

Pilocarpin has been tried in every kind of disease, but is
now chiefly given as being a powerful and rapid diaphoretic.
In renal dropsy, especially with uraemia, it may be of much
service, eliminating a quantity of urea ; also in effusions into
the pleura and peritoneum ; rarely in cardiac dropsy, since in
this and every class of case it cannot be safely used if the
heart be already weak. It has also been given in syphilis, and
in a variety of uterine conditions, with various results. Bron-
chial catarrh, asthma, and pertussis are all relieved by the flux
which it establishes. Small doses relieve the thirst of chronic
Bright's disease. In certain dry skin diseases, and certainly
in alopecia (baldness), it may answer well. Very conflicting re-
ports have been published of its value in diphtheria, where it
is said to loosen or detach the false membrane.

SIMARUBACE^E.
Ugnum — QUASSIA WOOD. — The wood

of Picrsena excelsa. From Jamaica.

Characters. — Billets varying in size, seldom thicker than
the thigh. Wood dense, tough, yellowish white, intensely and
purely bitter. Also chips of the same.

Substance resembling quassia : Sassafras, which is aromatic,
and not bitter.

<ir-f<JuO ^O

>/y .

tsJtA-C^

QUASSIA. ,219

Composition. — The active principle of quassia is quassin*
Ci0H1203, a white crystalline, neutral bitter principle. Quassia
contains no tannin.

Preparations.

1. Extractum Quassia. — Aqueous. 48 in 1. Dose, 3 to 5 gr.

2. Infusum Quassiae. — 1 in 80 of cold water. Dose, 1 to 2 fl.oz.

3. Tiactura Quassia.— 1 in 27. Dose, 1 to 2 fl.dr.

ACTION AND USES.

Quassia is a pure or simple bitter, and possesses the various
properties fully described under Calumbce Radix. It is very
extensively used. The special points to be noted respecting
it are : (1) that its preparations contain no tannin, and may be
combined with salts of iron ; (2) that it is entirely devoid of
flavour, and intensely bitter, i.e. less agreeable than gentian
and chiretta ; and (3) that the infusion is an excellent anthel-
mintic enema.

CELASTEACE^E.

Euonymus — WAHOO. (Not Officinal. ) — The bark
of Euonynms atropurpureus.

Characters. — Quilled or curved pieces ; ash-grey with
blackish patches without ; whitish within ; nearly inodorous ;
sweetish, somewhat bitter, and acrid.

Composition. — Euonymus contains euonvmin. an un-
crystallisable intensely bitter principle, various resins, and
o.Jixed oil.

Non-officinal Preparations.
Extractum Euonymi (U. S. P).— Dose, 1 to 5 gr.

jnymin. — An eclectic preparation, consisting of the resins
" fixed oil. Dose, 1 to 5 gr.

ACTION AND USES.

Euonymin is an hepatic stimulant, direct cholagogue,
and mild cathartic ; the latter effect being but little marked
unless other purgatives be combined. It is used in constipa-
tion and hepatic derangements.

Rliamni SIICCMS — BUCKTHORN JUICE. — The re-
cently expressed juice of the ripe berries of common
Buckthorn, Khamnus catharticus. a native of Britain.

220 MATER i A MEDIC A AND THERAPEUTICS.

Characters. — Deep red by reflected, green by transmitted,
light.

Composition. — Buckthorn juice contains an active prin-
ciple, rhamnicin, probably identical with cathartic acid, the
purgative glucoside of senna and rhubarb.

Preparation.
Syrupus Bha-ynT". — Dose, 1 fl.dr.

ACTION AND USES.

Buckthorn is an active cathartic, naturally resembling
senna and rhubarb. It is very seldom employed.

Rhamnus Frangula. (Not Officinal.) —The
bark of the Rhamnus frangula, or Black Alder. Im-
ported from Holland.

Characters. — Quills half a line thick, with a warty greyish-
brown exterior ; nearly inodorous ; taste sweetish bitter.

Composition. — Black Alder contains an active crystalline
principle, emodin, also found in Eheum (see page 317).

Non-officinal Preparations.

A Fluid Extract, and Lozenges.
Dose. — 1 to 4 fl.dr. of the former.

ACTION AND USES.

Rhamnus frangula is a certain and pleasant aperient,
without griping or severe cathartic action, used in chronic con-
stipation, and especially suitable for children.

Rhamnus Purshiana. (Not Officinal) — The
bark of Gascara sagrada, or .Rhamnus purshiana.
From the North Pacific coast.

Composition. — A crystalline and various resinoid bodies
have been obtained from caseara, which requires to be further
investigated.

Non-officinal Preparations.

A Fluid Extract, and a Cordial.

MYRRH A. 221

ACTION AND USES.

Cascara sagrada is a tonic and stomachic in small doses,
aperient in large doses, and cathartic if freely given. It is
useful in the same class of cases as the Rhamnus frangula.

ANACARDIACE^B.

Mastiche — MASTICH. — A resinous exudation ob-
tained by incision from the stem of Pistacia lentiscus.
Produced in the island of Scio.

Characters. — Small irregular yellowish tears, brittle, be-
coming soft and ductile when chewed, having a faint agreeable
odour.

Substances resembling mastich : Acacia, ammoniacum, gal-
banum, which are larger, rougher, and more opaque.

Composition. — Mastich consists of 80 or 90 per cent, of a
resin, mastichic acid, soluble in alcohol ; of a smaller quantity
of another resin, masticin, soluble in ether, but insoluble in
alcohol ; and of a trace of volatile oil.

ACTION AND USES.

Mastich was formerly used much like other oleo-resins, but
its application is now confined to dentistry, where it is em-
ployed as a temporary stopping for carious teeth. A solution
in ether or collodion is applied on cotton wool with oil of cloves
or cinnamon, and remains as a firm plug by evaporation of the
solvent.

AMYRIDACE^E.

Myrrhat — MYRRH. — A gum-resinous exudation
from the stem of Balsamodendron myrrha. Collected
in Arabia Felix and Abyssinia.

Characters. — In irregular- shaped tears or masses varying
much in size, somewhat translucent, of a reddish-yellow or
reddish-brown colour ; fractured surface irregular and some-
what oily ; odour agreeable and aromatic ; taste acrid and
bitter.

Composition. — Myrrh contains about 2 per cent, of an
oxygenated (ethereal oil, Ci0HnO, myrrhol ; a resin, myrrhin, 35
per cent. ; and gum 60 per cent. Myrrh forms a milky- white
emulsion with water, the resin being "suspended by the gum in
solution

222 MATER i A MEDIC A AND THERAPEUTICS.

Impurities. — Every variety of resins and gum-resins : de-
tected by appearance, smell, and taste.

Preparations.

1. Pilula Aloes et Myrrhse. — 1 in 6. (See Aloe Socotrina,

page 357.)

2. Tinctura Myrrhs^ — 1 in 8. Dose, ^ to 1 fl.dr.

Myrrh is also contained in Decoctum Aloes Compositum,
Mistura Ferri Composita, Pilula Assafoetida Composita, and
Pilula Rhei Composita.

ACTION AND USES.
rl. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Myrrh is a stimulant and disinfectant like
other oleo-resins, and is sometimes used as a dressing for ulcers.

Internally. — It exerts a similar effect upon the mouth,
throat, stomach, and bowels. It is much employed as a wash
in spongy gums and ulcerated mouth ; as a gargle in relaxed
throat ; and as a stomachic and adjuvant of purgatives in
dyspepsia, anaemia, and constipation.

2. ACTION ON THE BLOOD AND ITS USES.

Myrrh appears to increase the number of leucocytes in the
blood ; and this fact may in part account for its value along
with iron in anemia.

3. SPECIFIC ACTION.

Nothing definite is known on this subject.

4. REMOTE LOCAL ACTION AND USES.

Like the oleo-resins (see Terebinthina Oleum] myrrh
appears to be excreted by the mucous membranes, especially of
the genito-urinary and respiratory tracts, and stimulates them
during its passage. It is thus an uterine stimulant and em-
menagogue, and is extensively given along with aloes or iron
in the amenorrhoea of girls. As a stimulant and disinfectant
expectorant it is much less used now than formerly in chronic
bronchitis.

Elemi — ELEMI. — A concrete resinous exudation,
the botanical source of which is undetermined, but is
probably Canarium commune. Chiefly imported from
Manilla.

Characters. — A soft unctuous adhesive mass, becoming
harder and more resinous by age ; of a yellowish-white colour ;

L

^-t-

'vG* yULXs ivr-cxAAwK

AAA.'

TRAGACANTHA. -223

with a rather fragrant fennel-like odour ; almost entirely soluble
in rectified spirit.

Substances resembling Elemi : Assafoetidu, Galbanum, Ammo-
niacura, known by smell.

Composition. — Elemi is a mixture of a turpentine and several
resinous bodies.

Preparation.
Unguentum Elemi. — 1 in 5.

ACTION AND USES.

Elemi acts much like resin of turpentine, and is employed
in the ointment as a stimulant and disinfectant to sores and

LEGUMINOS^:.

Tragacantha — TRAGACANTH. — A gummy exu-
dation from the stems of Astragalus verus. and
possibly other species. Collected in Asia Minor.

Characters. — White or yellowish, in broad shell-like
slightly curved plates, tough and elastic, but rendered more
pulverisable by a heat of 120° Fahr. Very sparingly soluble
in cold water ; but swelling into a gelatinous mass, which is
tinged violet by tincture of iodine. After maceration in cold
water, the fluid portion is not precipitated by rectified spirit.

Impurities. — Other gums, and white lead.

Composition. — Tragacanth consists of two gums : bassorin.
33 per cent., comparatively insoluble in water, Ci2H2oOi0, and
unfcrmentable ; a-nd a gum nearly identical with the arabin of
acacia (but precipitated by acetate of lead), 53 percent., soluble
in water. It also contains a little starch.

Preparations.

1. Mucilago Tragacanthae. — 1 in 80. Dose, 1 fl.oz. or more.

2. Pulvis Tragacanthse Composifos.— Tragacanth. 1 ; Gum

Acacia, 1 ; Starch, 1 ; Sugar, 3. Dose, 10 to 60 gr.
Tragapanth is also contained in Pulvis Opii Compositus.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Internally, tragnc-dnth is demulcent. The mucilage may be
used as a vehicle for active substances in linctuses for pharyii-

224 MATERIA MEDIC A AND THERAPEUTICS.

geal cough. Tragacanth is partly converted into sugar by the
stomach; in large quantities it causes indigestion. It is
chiefly employed to suspend resins and heavy powders, such
as bismuth, the simple gum being preferable to the compound
powder, because not fermentable.

2. ACTION ON THE BLOOD, SPECIFIC AND REMOTE LOCAL ACTION.

Tragacanth, like other gums, enters the blood and tissues,
partly unchanged, partly as sugar and other products, and has
a nutritive effect of comparatively low value. It is not used
for this purpose. A remote demulcent effect on the urinary
organs is probably imaginary only.

Olycyrrhizse Radix— LIQUORICE BOOT. — The
root or underground stem, fresh and dried, of Gly-
cyrrhiza glabra. Cultivated in England.

Characters* — In long cylindrical branched pieces, an inch
or less in diameter, tough and pliable ; of a greyish-brown
colour externally, yellow internally ; without odour, of a sweet
mucilaginous and slightly acrid taste. Digested with water, it
yields a solution which gives a precipitate with diluted sul-
phuric acid.

Substances resembling Liquorice Eoot: Pyrethruin and Tarax-
acum, which are not sweet.

Composition. — Liquorice root contains grape-sugar, gly-
cyrrhizin, starch, resin, asparagin, and malic acid. Glycyrrhizin
is a yellow amorphous glucoside, C24H3609, with a strong bitter-
sweet taste and acid reaction, yielding glucose and a very bitter
substance, glycyrretin.

Preparations.

1. Extraction Glycyrrhizse. — Aqueous. Dose, £ to 1 dr.

2. Extractum Glycyrrhiza? Liquidum. — Made as above with

spirit. 2 fl. oz. = 1 oz. of solid extract. Dose, 1 fl. dr.

3. Pulvis Glvcvrrhizae Compositus. — 1, with 1 of Senna and 3

of Sugar. Dose, 30 to 60 gr.

Non-officinal Preparation.

Pulvis Litmiritise Compositus (Ph. Germ, and Euss.).— 1,
with 1 of Senna, £ of Sulphur, \ of Fennel, and 3 of Sugar.
Dose, a tea spoonful.

Liquorice or its preparations are contained in many prepara-
tions throughouc the Pharmacopoeia. It especially covers the
taste of senna, chloride of ammonium, senega, hyoscyamus,
turpentine, and bitter sulphates. The powdered root is a useful
basis for pills.

SCOPARIUM. 22$

ACTION AND USES.

Liquorice is chiefly used for the pharmaceutical purposes
just indicated. It has a pleasant taste and flavour, and in-
creases the flow of saliva and mucus when slowly chewed or
sucked, the increased secretions acting as emollients to the
throat. Liquorice is therefore a popular demulcent, much
ased to relieve sore throat and coughs.

Scoparii Cacumina — BROOM TOPS. — The fresh
and dried tops of Sarothamnus Scoparius. From
indigenous plants.

Characters. — Straight angular dark-green smooth tough
>£ a bitter nauseous taste, and of a peculiar odour when
bruised.

Composition. — Scoparium contains two active principles,
iteoparin and sparteint besides other constituents. Scoparin
C2lH22Oi0, is a yellow crystalline neutral body, said by some to
be a diuretic, by others not so. Spartein, C^H^gNa, is a volatile
icily-looking liquid alkaloid, allied in appearance, composition,
land physiological action to conia. See Conii Fructus, page 250.

Preparations.

1. Decoctum Scoparii. — 1 dried in 20. Dose, 2 to 4 fl.oz.
1 2. Succus Scoparii. — 3 of juice of fresh tops to 1 of spirit.
Dose, 1 to 2 fl.dr.

ACTION AND USES.

Broom has a bitter stomachic and somewhat astringent

tion in moderate doses, but is not used on this account. Its

'•ffect on the system is still obscure, the only fact

v known being that it frequently produces free diuresis.

is believed that the active principles of the plant, either or

th, pass through the blood and tissues, and stimulate the

•ret ing substance of the kidneys during the process of

'). Broom is therefore extensively used in this country

a diuretic in dropsy, especially cardiac dropsy, but is almost

variably combined with other drugs of the same class, such as

ritalis, acetate of potash, etc. It should be avoided in acute

oal dropsy.

Fterocarpi Lignum — RED SANDAL WOOD. —
le wood of Fterocarpus santalinus. From Ceylon.
p— 8

226 MATER i A MEDIC A AND THERAPEUTICS.

Characters. — Dense heavy billets, outwardly dark "brown,
internally variegated with dark 'and lighter red rings, if cut
transversely. Powder "blood-red, of a faint peculiar odour, and
an obscurely astringent taste. Also chips of the same.

Substances resembling Sandal Wood : Logwood, less dense.

Composition. — Red sandal wood contains a blood-red
crystalline principle, santalic acid, or santalin, insoluble in I
water.

Red Sandal Wood is contained in Tinctura Lavandulse Com- $
posita.

USE.

Red sandal wood is used only to give colour to the Compound \
Tincture of Lavender.

Kino — KINO. — The inspissated juice obtained
from incisions made in the trunk of Pterocarpus
Marsupium. Imported from Malabar.

Character s. — In small angular brittle glistening reddish- I
black fragments, translucent and ruby-red on the ecL
inodorous, very astringent. When chewed it tinges the saliva
blood-red.

Composition. — Kino contains 75 percent, of kino-tannic acid,
Ci8Hi808, giving a greenish precipitate with persalts of ir-
brenzcatechin, a derivate of catechin (see Catechu Pallidum, }•
270) ; and kino-red, formed from kino-tannic acid by oxydati

Dose. — 10 to 30 gr.

Preparations.

1. Pulvis Kino Compositus. — Kino, 15 ; opium, 1 ; cinnamon, $

4 (1 of opium in 20). Dose, 5 to 20 gr.

2. Tinctura Kino. — 1 to 10. Dose, % to 2 fl.dr.

Kino is also a constituent of Pulvis Catechu Compositus,
Iin5.

ACTION AND USES.

Kino closely resembles tannic acid in its action, and may
be used for the same purposes. (See page 337.) It is chi'
employed in the form of astringent gargles, and as a con-
stituent of mixtures for diarrhosa.

Balsaniiiiii Peruvianum — BALSAM OF PEEU.
— A balsam obtained from Myroxylon Pereirse. If '
exudes from the trunk of the tree after the bark ha?

IV

^'

BALSAMUM PERUVIANUM. -227

been scorched and removed. From Salvador in
Central America.

Characters. — A reddish-brown or nearly black liquid, trans-
lucent in thin films ; having the consistence of syrup, a
balsamic odour, and an acrid slightly bitter taste ; soluble in
five parts of rectified spirit. Undergoes no diminution in
volume when mixed with water.

Impurity. — Resin, soluble in bisulphide of carbon.

Composition. — Balsam of Peru is a complex substance. The
greater part consist of (1) the volatile oil of Peruvian balsam,
which is itself composed of cinnamin (or cinnamate of benzyl-
ather], Ci6Hi402; styracin (or cinnamate of cinnamic-cether),
Ci8Hl603 ; peruvin (or benzyl-alcohol) , C7H80 ; benzoate of
benzyl aether ; (2) cinnamic and benzoic acids in small quantities ;
and (3) a mixture of resins, probably hydrates of cinnamin. See
Styrax.

Dose. — 10 to 15 minims, made into an emulsion with
mucilage or yolk of egg.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Balsam of Peru possesses the properties of its
several constituents — benzoic acid and its allies and resins,
being an antiseptic and disinfectant, a vascular and nutritive
stimulant, and a nervine sedative. (See Terebinthince Oleum for
a full account, page 344.) Balsams have been used from time
immemorial as applications to wounds and sores, but are now
almost entirely displaced by simpler dressings, such as carbolic
acid and boracic acid. They are still used, however, to cleanse
bed-sores. A more important application of Peruvian balsam is
in certain diseases of the skin, namely, (1) in some chronic in-
flammatory affections (eczema) ; (2) to relieve itching, prurigo,
urticaria, etc., 1 in 8 of vaselin ; (3) in scabies, for which it is
the best of all remedies, killing the acarus, relieving the itching
and inflammation, and disinfecting the parts. The skin should
be thoroughly rubbed with it (1 drachm for the whole body) on
two or more occasions, a warm bath being taken before and after.

Internally. — Balsam of Peru has a mild carminative effect
on the stomach and bowels, like volatile oils.

2. ACTION ON THE BLOOD, SPECIFIC AND REMOTE LOCAL ACTION
AND USES.

The important changes undergone in the blood and tissues
by benzoic and cinnamic acids, and the excretion of these and

228 MATER i A ME DIG A AND THERAPEUTICS.

of aromatic oils by the mucous membranes, kidneys, and skin,
are fully discussed under Benzoin, Styrax, and Terebinthina
Oleum. The constituents of Peruvian balsam appear chiefly to
affect the respiratory organs ; and it may therefore be added to
cough mixtures as an agreeable stimulant and disinfectant
expectorant in chronic bronchitis.

Balsamum Toliitanum— BALSAM OF TOLU.—
A balsam obtained from Myroxylon Toluifera. It
exudes from the trunk of the tree after incisions have
been made into the bark. From New Granada.

Characters. — A reddish-yellow soft and tenacious solid,
becoming hard by keeping, with a fragrant balsamic odour ;
soluble in rectified spirit.

Composition. — Balsam of Tolu contains a turpentine C10Hlfi,
benzoic and cinnamic acids, and various resins.

Dose. — 10 to 20 gr., as an emulsion with mucilage and
sugar.

Preparations.

1. Syrupus Tolutanus. — 1 in 29. Dose, 1 to 2 fl. dr.

2. Tinctura Tolutana.— 1 in 8. Dose, 15 to 30 min.

Balsam of Tolu is also a constituent of Tinctura Benzoin!
Composite.

ACTION AND USES.

These are the same as those of Peruvian balsam, but tolu
is used internally only, and chiefly as a pleasant ingredient of
cough mixtures.

Pliysostigmatis Faba— CALABAR BEAN.— The
seed of Physostigma venenosum. Western Africa.

Characters. — About the size of a very large horse-bean,
with a very firm, hard, brittle shining integument of a
brownish-red, pale chocolate, or ash-grey colour. Irregularly
kidney-shaped, with two flat sides, and a furrow running
longitudinally along its convex margin, ending in an aperture
near one end of the seed. Within the shell is a kernel con-
sisting of two cotyledons, weighing on an average about 46
grains, hard, white, and pulverisable, of a taste like that of the
ordinary edible leguminous seeds, without bitterness, acrimony,
or aromatic flavour. It yields its virtues to alcohol, and im-
perfectly to water.

'^-O <b-0~r

"

^- O .

229

Composition. — Besides the ordinary constituents of beans, the
seed of physostigma contains an active principle, phttsostigmin.
or eserin, C^H^ISLC^, an alkaloid, combining with acids, and
variously obtained as colourless crystals, or an amorphous or
syrupy body.

Dose, in powder. — 1 to 4 gr.

Preparation.

Extractum Physostigmatis.— Spirituous. 45 in 1. Dose,
is to i gr.

1. IMMEDIATE LOCAL ACTION AND USES.

Extract of physostigma or preparations of eserine are
readily absorbed by the conjunctiva, and produce the specific
contraction of the pupil to be presently noticed.

Taken by the mouth, calabar bean in moderate doses
sometimes causes sickness and colic, and in larger doses diarrhoea,
all from increased and irregular peristalsis, apparently of local
origin. The extract is therefore occasionally used in habitual
constipation.

2. ACTION IN THE BLOOD.

Eserin enters the blood unchanged, and passes thence into
the tissues.

3. SPECIFIC ACTION AND USES.

Eserin is found in all the organs. Along with the gastro-
intestinal sjTnptoms first described, moderate doses of the bean
give rise to a sense of weakness, faintness, and shortness of
breath ; larger doses to an aggravation of the same symptoms,
with contraction of the pupil, frontal headache, salivation,
diaphoresis, slowing and weakening of the pulse. These are
short of truly poisonous effects.

On analysis it is found that consciousness is not lost,
though impaired by large doses, showing comparative freedom
of the convolutions. The cord is the part principally affected by
calabar bean, the chief symptoms being of the nature of motor
jura lysis from depression of the anterior cornua, and thus of
reflex irritability also. The respiratory muscles necessarily
fail from this cause. The posterior cornua (sensory portions)
of the cord are paralysed to a degree, so that sensibility is
diminished in the limbs. The motor nerves and muscles are but
slightly affected directly. Occasional twitchings occur, whether
direct or spinal in origin. The sensory nerves are not directly in-
fluenced. The medulla is decidedly affected by physostigma.
Thus the respiratory centre, after brief (probably reflex) stimu-
lation, is depressed, and death occurs chiefly by asphyxia. The

230 MATERIA MEDICA AND THERAPEUTICS.

cardiac centre is first stimulated, so that the heart beats more
powerfully and less frequently ; but at last, or after large doses,
depression ensues. Therewith the intracardiac branches of
the vagus are probably stimulated at first, and the ganglia
paralysed at last. The blood pressure rises with the increased
cardiac action, and falls later on. Whether there is any direct
action of eserin on the vaso-motor apparatus is unsettled.

Contraction of the pupil and spasm of accommodation are
striking and highly important effects of eserin, whether it be
given internally or applied locally. Both phenomena are due
to irritation of the fibres of the third nerve, aud not to central
disturbance as in the contraction caused by opium, or to
paralysis of the sympathetic. These effects are accompanied
by fall of the intraocular tension, and can be removed by
atropia. The salivary secretion is increased through the centre
of the chorda, but ceases after large doses from arrest of the
circulation in the glands.

The specific uses of calabar bean depend on its action on
the cord and the eye. It has been frequently given in tetanus,
and other convulsive diseases referable to irritation or disease
of the spinal centres, and apparently with success, although
many of these cases recover spontaneously, and others resist
the eserin. The alkaloid should be given subcutaneously in doses
of gr. ^<7 to T\ in solution ; or gr. ^ of the extract may be given
subcutaneously, or gr. 1 by the mouth, repeated in two hours,
and follow«d by doses of gr. TV to 5 every few hours. For the
convulsions of strychnia poisoning calabar bean is of little or
no use. Neither is it of much real service in the treatment of
poisoning by atropia or chloral, as was once expected.

In diseases of the eye eserin is now much used. A drop of
a solution of the sulphate (2 gr. to 1 ounce of water) is
applied locally to diminish intraocular pressure in glaucoma,
perforating keratitis, etc. ; in paralysis of the iris and ciliary
muscle, e.g. after diphtheria (^ gr. to 1 ounce) ; to counteract the
effects of belladonna ; or to diminish the entrance of light in
painful diseases of the eye, photophobia, etc.

4. REMOTE LOCAL ACTION.

Eserin is excreted by the liver and salivary glands, but has
never been found in the urine.

Araroba — GOA POWDER. — A concretion from
clefts in the stem of Andira Araroba ( Angeliun Amar-
gosa) imported from Brazil chiefly into India. (Not
ojjicinal.}

ACIDUM CHRYSOPHANICUM. 231

Characters. — A powder or in small pieces of a light yellow
colour, becoming pale-brown by exposure ; mixed with small
pieces of wood.

Composition. — Goa powder contains 80 per cent, of chrys-
arobin, C3oH2607, which is converted into chrysophanic acid,, by
the process presently to be given.

From Goa Powder is prepared :

Acidum Chrysophanicum. — Chrysophanic acid C4iHi004.
Made by exhausting Goa powder with hot Benzol,
filtering, allowing Chrysarobin to crystallise out, dis-
solving this in strong Potash, and decomposing with
a mineral acid. It may also be obtained from
Rhubarb. See Rhei Radix, page 318.

Characters. — A dull orange-yellow powder, or shining
•yellow needles, odourless, with an acrid taste ; insoluble in
water, and spirit ; soluble in hot benzol, oils, and vaseline.

Dose.—& to 2 gr.

Preparation.

tlngnentiim Acidi Ciirysophanici.— Vnguen-
tum Chrysarobini (U.S.P.). 1 in 10 of benzoated lard.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND TJSES.

Externally. — Goa powder or chrysophanic acid destroys
low vegetable organisms in connection with the skin, stains it
yellow, and stimulates it so much as to produce in some in-
stances serious constitutional disturbance. It is a successful
application in some forms of ringworm, and in scaly diseases
of the skin, especially psoriasis.

Internally. — Chrysophanic acid is apt to cause vomiting
and purging.

2. ACTION ON THE BLOOD ; SPECIFIC ACTION ; AND REMOTE
LOCAL ACTION AND USES.

Chrysophanic acid has been given with various degrees of
success in psoriasis, apparently by a remote local action on the
skin.

Senna Alexandrina— ALEXANDRIAN SENNA. —
The leaflets of Cassia lanceolata and Cassia obovata,
imported from Alexandria ; carefully freed from the

232 MATERIA MEDIC A AND THERAPEUTICS.

flowers, pods, and leafstocks of the same, and from the
leaves, flowers, and fruit of Soleiiostemma Argel.

Characters and Tests. — Lanceolate or obovate leaflets, about
an inch long, unequally oblique at the base, brittle, greyish-
green, of a faint peculiar odour, and mucilaginous sweetish
nauseous taste. The unequally oblique base, and freedom from
bitterness, distinguish the senna from the argel leaves, which,
moreover, are thicker and stiff er.

Impurities ; and substances resembling Senna : Soleno-
stemma Argel, Uva Ursi, and Barosma, all equal at the base.

Seima liidica— TINNIVELLY SENNA. — The leaf-
lets of Cassia elongata. From plants cultivated in
Southern India.

Characters. — About two inches long, lanceolate, acute,
unequally oblique at the base, flexible, entire, green, without
any admixture ; odour and taste those of Alexandrian Senna.

Composition. — Senna contains an active principle, cathartig
agid ; a colouring matter closely allied to chrysophanic acid ;
peculiar unfermentable sugar, catharto mannite; other obscure
glucosides, sennapicrin and sennacrol ; and various vegetable
salts. Cathartic acid, a highly important body, is an amorphous
glucoside, C18oHl92N2S082, which forms salts with bases, and
can be broken up in into glucose and cathartogenic acid,

Dose. — 10 to 30 gr. in powder.

Preparations of either kind of Senna :

1. Confectip Senna.— 1 in 11 with Coriander, Figs, Tamarinds,

Cassia Pulp, Prunes, Extract of Liquorice, Sugar and
Water. Lose, 60 to 120 gr.

2. Infusum Sennse.— -1 in 10. Dose, 1 to 2 fl.oz.

From Infusum Senna is prepared :

a. Mistura Senna? Composita.— Infusion of Senna, 145
Tincture of Senna, 2^ ; Sulphate of Magnesia, 4 5
Extract of Liquorice, £ ; Compound Tincture of
Cardamoms, 1£. Dose, 1 to l£ fl.oz.

3. Syrupus Sennae. — 1 in 2. Dose, 1 to 4 fl.dr.

4. Tinctura Senna. — 1 in 8. Dose, 1 to 4 fl.dr.

Senna is also the most important ingredient in Pulvis Glycyr-
Compositum. 2 in 10. See Glycyrrhizee Radix, page 224.

ivJU .

. 233

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Given internally, senna stimulates the muscular coat of the
intestine, apparently by local reflex action, originating in the
mucous surface of the bowel itself; and produces brisk
peristaltic movements and purgation within four or five hours.
The colon is chiefly stimulated, hurrying downwards the fluid
contents received from the ileum, which appear as very thin
copious yellow stools, with excess of soda salts and digestive
products, but no special increase of bile. Full doses cause re-
peated evacuation and griping, but no inflammation of the
mucous surface. The pelvic structures may, however, become
hypersemic, leading to haemorrhoids and the appearance of the
menses. Constipation does not follow the use of senna.

Senna is never given alone, but always with a carminative to
prevent griping, and frequently with other purgatives, as in the
compound mixture. It is one of the most useful of purgatives.
It is very extensively prescribed to complete the effect of mer-
curial and other duodenal purgatives, given several hours
before. It affords at once a rapid and a safe purge at the com-
mencement of febrile attacks in children, in local inflamma-
tions, and in cerebral congestion. As an habitual laxative in the
form of Pulvis Glycyrrhizae Compositus, senna is most valuable
as a simple stimulant of the muscular coat, which neither loses
its effect by use, nor produces subsequent constipation. Com-
bined with bitter and other stomachics, it is useful in atonic
dyspepsia, its laxative effect being increased by acids but
diminished by alkalies.

ACTION IN THE BLOOD, SPECIFIC AND REMOTE LOCAL ACTION.

Cathartic acid and chrysophanic acid enter the blood, pass
through the tissues, and are excreted by the kidneys and mam-
mary gland ; the cathartic acid purging infants at the breast,
tlie chrysophanic acid staining the urine yellow. Senna
purges animals when injected into the veins.

Haematoxyli Lignum— LOGWOOD. — The sliced
heark wood of Hsematoxylum Campechianum. Im-
ported from Campeachy. Honduras, and Jamaica.

Characters. — The logs are externally of a dark colour,
internally they are reddish-brown. The chips have a feeble
agreeable odour, and a sweetish taste. A small portion chewed
imparts to the saliva a dark pink colour.

234 MATER i A MEDIC A AND THERAPEUTICS.

Composition. — Logwood contains tannic acid, and a peculiar
colouring principle, hcematoxylin, Ci0H1406, occurring in colour-
less crystals, which become red on exposure to light, the
solutions undergoing various changes of colour with acids and
alkalies, and coagulating gelatine. The decoction precipitates
perchloride of iron violet blue, acetate of lead and other
metallic salts a beautiful blue. Other less important substances
occur in logwood.

Incompatibles. — Mineral acids, metallic salts, lime-water,
and tartar emetic.

Preparations.

1. Decoctum Hgematoxyli. — 1 in 20. Dose, 1 to 2 fl.oz.

2. Extraction Hsematoxvli. — Aqueous. Dose, 10 to 30 gr.

ACTION AND USES.

Haematoxylum possesses the astringent action of tannic
acid, and may be used in the same class of cases. See Gfalla.

Cassise Pulpa— CASSIA PULP. — The pulp ob-
tained from the pods of the Purging Cassia, Cassia
Fistula. Imported from the East Indies, or recently
extracted from pods imported from the East or West
Indies.

Character? of the pods. — Cylindrical, a foot or more in length,
slightly curved, woody, indehiscent, black, rounded, divided by
septa into colls, each containing a seed and viscid pulp. Of the
pulp : blackish-brown, viscid, sweetish disagreeable taste, and
somewhat sickly in odour, usually containing the seeds and
dissepiments.

Composition. — Cassia pulp contains sugar, pectin, mucilage,
and a purgative principle supposed to be allied to cathartic
acid. See Senna.

Cassia Pulp is contained in Confectio Sennse, about 1 in 8.

ACTION AND USES.

Cassia pulp is a laxative, given only as an ingredient of
Confectio Senme.

Tamarindus— TAMARIND. —The preserved pulp
of the fruit of Tamarindus indica. Imported from the
West Indies.

COPAIBA. ~ 235

Characters and Test. — A brown sweetish subacid pulp
preserved in sugar, containing strong fibres and brown shining
seeds, each enclosed in a membranous coat.

Impurity. — Copper ; a piece of bright iron left in contact
with the pulp for an hour does not exhibit any deposit of
copper.

Composition. — Tamarind contains sugar, gum, tartaric acid,
acid tartrate of potash, citric, acetic, and various aromatic
acids.

Tamarind is contained in Confectio Sennse, about 1 in 8.

ACTION AND USES.

Tamarind acts as a pleasant acid refrigerant and gentle
laxative. For the former purpose it is prepared either as an
infusion or as tamarind whey (1 part of the pulp to 30 parts
warm milk), which is also a mild purgative, like the Confectio
Sennas.

Copaiba — COPAIVA. — The oleo- resin obtained
from incisions made in the trunk of Copaifera rnulti-
juga. and other species of Copaifera. Chiefly from
the valley of the Amazon.

Characters and Tests. — About the consistence of olive oil,
light yellow, transparent, with a peculiar odour, and an acrid
aromatic nauseous taste. Perfectly soluble in an equal volume
of benzol. Is not fluorescent.

Composition. — Copaiba consists of less than 50 per cent of
the officinal volatile oil, and more than 50 per cent of resin. The
oil of copaiva, isomeric with turpentine, Ci0Hl6, is colourless or
pale yellow, with the odour and taste of copaiva. Resin of
Copaiva, C2oH3o02, is a brownish resinous mass, consisting of a
crystallisable resin, copaivic acid, the chief constituent of the oleo-
resin, and a non-crystallisable viscid resin of copaiba, amount-
ing to 1| per cent. The proportion of oil and resin varies
much with the age and exposure of the copaiba.

Impurities. — Turpentine, detected by the odour on heating.
Fixed oils, detected by a greasy ring round the resinous stain
left by copaiva when heated on paper. Copaiva dissolves one-
fourth its weight of carbonate of magnesia by the aid of heat, and
remains transparent ; not so the fixed oil. Gurjun balsam,
which coagulates at 270°.

Dose.— i to 1 fl.dr.

236 MATERIA MEDIC A AND THERAPEUTICS.

Preparation.

Oleum Copaibge. — The oil distilled from Copaiba. Dose, 5
to 20 min., with, mucilage or yolk of egg.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION.

Copaiva produces an acrid nauseous sensation in the mouth,
warmth in the stomach, unpleasant eructations, and gastro-
intestinal irritation like other oleo-resins. Large doses or the
persistent use of the drug leads to dyspepsia, sickness, and
diarrhoea ; and it is contra-indicated in irritable states of the
stomach and bowels.

2. ACTION IN THE BLOOD, AND SPECIFIC ACTION.

The active principles of copaiva are absorbed into the blood,
and pass thence into the tissues. The action of copaiva on the
organs and tissues generally is obscure.

3. REMOTE LOCAL ACTION AND USES.

The volatile oil of copaiba is excreted by the kidneys,
bronchi, and skin, and the resin at least by the kidneys. All
the secretions smell freely of the drug, and the neighbourhood
of the patient is pervaded with a characteristic unpleasant
odour. In thus passing through the eliminating organs, copaiva
stimulates them, altering their secretions and the nutrition of
their cells and vessels. The urine is passed more frequently,
and usually in increased quantity ; but it may be scanty, witn
albumen and blood, pain in the loins, and other symptoms of
renal congestion. The albumen thus passed must be dis-
tinguished from the acid resin of copaiva which may be thrown
down from the urine by nitric acid, and which is dissolved by
heat or alcohol. Carried by the urine into the bladder and
urethra, and possibly also excreted by the mucous membranes
of the same parts, copaiva produces along the whole genito-
urinary tract a stimulant and disinfectant effect. A similar
influence is produced in the bronchi, and the mucous secretion
is increased, and expectoration reflexly excited. The stimu-
lation of the skin (and probably the primary gastro-intestinal
irritation in part) may sometimes cause an eruption, the
" copaiba rash," not unlike that of measles.

The uses of copaiva depend entirely on its remote local
effects, the immediate local effects only suggesting care in its
administration. Its chief application is to the geni to -urinary
organs. The resin is given as a highly useful diuretic in

-Jjto L/-

ACACIA. , 237

hepatic and cardiac dropsy, but must be avoided in the dropsy
attending Blight's disease. It is much to be preferred to
the oleo-resin for this purpose. The latter is chiefly employed
in inflammatory affections of the bladder and urethra, especially
gonorrhoea, when the first acute symptoms have somewhat
subsided. It is best combined with potash and cubebs. Natu-
rally it is less useful in the vaginal gonorrhoea of women.
Copaiba is now seldom used in bronchial affections, on account
of the unpleasant effects attending it ; but in hospital practice
it will sometimes diminish and disinfect the profuse foul pro-
ducts of chronic bronchitis and bronchiectasis when other
means have failed. It is occasionally given in skin diseases.

Acaciae GiiMimi— GUM ACACIA.— A gummy
exudation from the stems of one or more undeter-
mined species of Acacia.

Characters and Tests. — In spheroidal tears, nearly colour-
less, and opaque from numerous minute cracks ; or in fragments
with shining surfaces ; brittle ; bland and mucilaginous in
taste ; insoluble in alcohol, but soluble in water.

Impurities. — Starch; detected by the iodine test. Gum
resins ; detected by smell and taste.

Incompatibles. — Alcohol and sulphuric acid, borax, pe^rsalts
of iron, and subacetate of lead.

Composition. — Gum arabic consists chiefly of arabic acid
or arabin, C3,.H66033, combined with calcium, magnesia, and
potash, and 17 per cent, of water.

Preparations.

Mucilago AcacisB. — Gum, 40 ; Water, 60. Dose, 1 to 4 fl.dr.
Gum Acacia is also contained in Mistura Cretaa, Mistura
Guaiaci, Pulvis Amygdalae Compositus, Pulvis
Tragacanthae Compositus, and in all Trochisci.

ACTION AND USES.

Acacia possesses very similar properties and physiological
effects to those of tragacanth, and is employed for the same
purposes. (See Tragacantha.} An objection to its pharmaceutical
use is its liability to undergo fermentation, and cause indiges-
tion, flatulence, and diarrhoea. Its principal application thera-
peutically is for cough in the form of lozenges and linctuses.

238 MATER i A MEDIC A AND THERAPEUTICS.

Indigo — CSH5NO. A blue pigment prepared
from various species of Indigofera. From India.
Use. — Indigo is employed in chemical testing.

ROSACE2E.

Rosae Gallicae Petala — RED ROSE PETALS. —
The fresh and dried unexpanded petals of Rosa
gallica. From plants cultivated in Britain.

Characters. — Colour fine purplish-red, retained after dry-
ing ; taste bitterish, feebly acid, and astringent ; odour roseate,
developed by drying.

Composition. — Red-rose petals contain an aromatic oil,
tannic and gallic acids, gum, colouring matters, salts, etc.
Oleum roses exists in very small quantity ; it consists of an
aromatic oxygenated eloeoptin, and an odourless solid rose-
camphor.

Preparations.

1. Confectio Rosse Gallicae. — 1 of fresh petals in 4. Dose, 30

to 60 gr.

2. Infusum Rosa Acidum.— 1 of dried petals in 40 of diluted

sulphuric acid and water. Dose, 1 to 2 fl.oz.

3. Syrupus Rosas. — 1 of dried petals in 17j. Dose, 1 to 2

fl.dr.

Rosae Centifoliae Petala — CABBAGE ROSE
PETALS. — The fresh petals, fully expanded, of Rosa
centifolia. From plants cultivated in Britain.

Characters. — Taste sweetish, bitter, and faintly astringent ;
odour roseate ; both readily imparted to water.

Preparation.
Aqua Rossa.— 1 in 1 by distillation. Dose, 1 to 2 fl.oz.

ACTION AND USES.

The preparations of the red and the cabbage rose are
chiefly used as pleasant vehicles. The acid infusion is an
agreeable astringent.

Rosae Caiiiiiae Friictiis- — FRUIT OF THE DOG

AMYGDALA. - 239

ROSE — HIPS. — The ripe fruit of the Dog Rose, Rosa
canina, and other indigenous allied species.

Characters. — An inch or more in length, ovate, scarlet,
smooth, shining ; taste sweet, subacid, pleasant.

Preparation,

Confectio Roaa Caning. — 1 in 3. Dose, 60 gr. or more.
Confectio Rosce Canina is contained in Pilula Quiniaa.

ACTION AND USE.

The confection of hips forms a very useful basis for pills.
Composition. — Hips contain malic and citric acids, free and
combined, tannic acid, sugar, and a trace of volatile oil.

Amygdala Pulcis- — SWEET ALMOND. — The seed
of the sweet almond tree, Amygdalus communis, var.
dulcis. Cultivated about Malaga.

Characters. — Above an inch in length, Lanceolate, acute,
with a clear cinnamon-brown seed-coat, and a bland sweetish
nutty-flavoured kernel. Does not evolve the odour of bitter
almonds when bruised with water.

Impurity. — The bitter almond, which yields an odour of
hydrocyanic acid when bruised with water.

Amygdala Amara — BITTER ALMOND. — The
seed of the bitter almond tree, Amygdalus communis»
var. amara. Brought chiefly from Mogadore.

Characters. — Resembles the sweet almond in appearance,
but is rather broader and shorter ; has a bitter taste, and when
rubbed with a little water emits a characteristic odour.

Composition. — Both varieties of almond yield by expression
about 50 per cent, oijixed oil, Oleum Amygdalae, and albuminous
substances, including emulsin. The bitter variety also yields, by
distillation with water, a volatile oil, Oleum Amygdalae Amara,
Essential Oil of Almonds, not officinal.

This Essential Oil of Bitter Almonds, or " Oil of Bitter
Almonds," although not officinal, must be carefully dis-
tinguished from the officinal fixed oil, Oleum Amygdalae, inas-
much as in the crude form generally sold it is highly poisonous,
from admixture with 4 to 8 per cent, of hydrocyanic acid.
Bitter almonds contain neither the volatile oil nor hydrocyanic

240 MATERIA MEDICA AND THERAPEUTICS.

acid until moistened, but 2 to 3 per cent, of a body called
amygdalin^ C^H^NOn, a crystalline glucoside, which, in the
presence of water, and under the fermentive influence of the
emulsin, breaks up into the volatile oil, hydrocyanic acid, and
glucose : C^H^NOu -f 2H20 = C7H60 + HCN + 2C6Hi206.
When purified by separation of the hydrocyanic acid, volatile
oil of bitter almonds is not poisonous, consisting, as it does, of
hydride of benzol (CyHgOH), with benzoic acid (C7H602) as a
product of oxydation by exposure, and other allied substances,
and is used for flavouring sweets. Nitro-benzine, however,
which is sometimes substituted for it, having a very similar
flavour, is decidedly poisonous.

Preparations of the Sweet Almond.

1. Oleum Amygdalae. — Almond Oil. The oil expressed from

bitter and sweet almonds. Pale yellow, nearly in-
odorous or with a nutty odour, and a bland oleaginous
taste. Dose, 2 to 4 fl.dr.

Almond Oil is contained in Unguentum Cetacei, ITnguentum
Simplex (and its preparations), Unguentum Hydrar-
gyri Oxidi Rubri, Unguentum Plumbi Subacetatis
Compositum. It is used in preference to olive oil, as
it makes a whiter ointment.

2. Pulvis Amygdalae Compositus. — 8 to 4 of Sugar, and 1 of

Gum Acacia. Dose, 60 to 120 gr.

Pulvis Amygdalae is used in preparing :
a. Mistura Amygdalae. — 1, with water, 8. Dose, 1 to 2
fl.oz.

ACTION AND USES.

The Sweet Almond is demulcent and nutritive, and has
been ground into a flour for making cakes to be eaten by
diabetic patients, instead of starchy food. The Compound
Powder and Mixture are used only as vehicles for insoluble
powders and demulcent cough medicines.

Almond oil has the same action, and is used for the same
purposes, as olive oil, which, though less agreeable, is more
generally employed as being cheaper. See Oleum Olivce, p. 284.

Prunum— PRUNE. — The dried drupe of the Plum,
Prunus domestica. From southern Europe.

Cusso. .241

Composition. — The prune contains sugar, malic acid, and a
purgative principle.

Prune is contained in Confectio Sennae, 1 in 12£.

ACTION AND USES.

The prune is nutritive, demulcent, and slightly laxative,
It may be ordered as an article of diet in habitual constipation.

L.aurocerasi Folia— OTTF.RP.V-TMTTRTCT. LEAVES.
—The fresh leaves of Primus Laurocerasus. The
Common or Cherry Laurel.

Characters. — Ovate-lanceolate or elliptical, distantly toothed,
furnished with glands at the base, smooth and shining, deep
green, on strong short footstalks ; emitting a ratafia odour when
bruised.

Composition. — Cherry laurel leaves yield by distillation a
variable amount of hydrocyanic etc id, and a volatile oil, by a pro-
cess of decomposition resembling that just described in the
bitter almond. Neither emulsin nor ordinary amygdalin have,
however, been demonstrated in the leaves, but a resinoid body,
which yields with emulsin hydrocyanic acid, and is called
" amorphous ami/adalin."

Preparation.

Aqua Laurocerasi. — 1 in 1 \ by distillation. Incompatibles,
metallic salts. Dose, 5 to 30 min.

ACTION AND USES.

Cherry-laurel water possesses the action of hydrocyanic
acid, and is also a flavouring agent. The strength of the drug
in this very powerful substance is so uncertain that its use
ought to be avoided. See Acidum Hydrocyanicum Dilutum.

Cusso — Kousso. — The flowers and tops of Brayera
anthelmintica. Collected in Abyssinia.

Characters. — Flowers small, reddish brown, on hairy stalks,
outer limb of calyx five-parted, the segments oblong or oblong-
lanceolate, reticulated, with a fragrant odour and a disagreeable
acrid taste.

Composition. — Kousso contains a volatile oil, tannic acid, gum,
Q— 8

242 MATERIA MEDIC A AND THERAPEUTICS.

sugar, and a neutral crystallisable active principle, koussin, or
cossin, C31H38Oi0.
Dose. — ^ to |- oz.

Preparation.

Infusum Cusso.— 1 oz. in 4 fl.oz. boiling water for one dose ;
to be drunk without straining.

ACTION AND USES.

Taken in the large doses necessary, kousso is apt to cause
nausea, vomiting, colic, and slight diarrhoea. Its principal
action is as an anthelmintic, the tape-worms (Tsenia solium,
Taenia mediocanellatat and Bothryocephalus latus) being fea"dily
killed by it. It is used for this purpose only, and rarely in
England. It may or may not require the assistance of a
purgative to expel the dead worm. The powdered flowers,
either in compressed masses or suspended in an aromatic water,
are said to be much more active than the officinal infusion.

MYRTACE^B.

Caryophyllum — CLOVES. — The dried unex-
panded flower buds of Caryophyllus aromaticus.
Cultivated in Penang, Bencoolen, and Amboyna.

Characters. — About six lines long, dark reddish-brown,
plump and heavy, consisting of a nearly cylindrical body
surmounted by four teeth and a globular head, with a strong
fragrant odour, and a bitter spicy pungent taste. It emits oil
when indented with the nail.

Composition. — Cloves contain 20 per cent, of the officinal
oil, tannic acid, and gum. Oil of cloves consists of eugenol
(eugenic acid), C]0Hl2O2, chemically resembling phenol (carbolic
acid), and a turpentine. A crystalline body, eugenin, isomeric
with eugenol, and a neutral body, caryophyllin, isomeric with
camphor, can also be obtained from cloves.

Preparations.

1. Oleum Caryophylli. — Oil of cloves. The oil distilled in

Britain from cloves. Colourless, when recent, becoming
red-brown, with the odour and burning spicy taste of the
clove. It is one of the few volatile oils heavier than
water. Dose, 1 to 4 min.

2. Infusum Caryophylli.— 1 in 40. Dose, 1 to 2 fl.oz.

Cloves and Oil of Cloves are also contained in several pre-
parations of other drugs.

(XAJL-i

Ouuu&a^ v!

cXx<A>JUAX^,

^S (Ao ta- ^Vx f

CARYOPHYLLUM. - 243

ACTION AND USES.

Cloves may be taken as the type of a great group of remedies,
other members of which are orange, lemon, pimenta, cajuput,
carui, dill, peppermint, and many more, which are met with
in our systematic review of medicinal plants. This group is
known as the aromatic essential oils, of complex and
variable chemical" composition, but consisting as a rule of
terpenes, mixed with camphors, resins, fatty and other acids,
and different vegetable constituents. They are closely allied, on
the one hand, to phenol (carbolic acid) and benzoic acid, and on
the other to still more complex vegetable products, the balsams
and gum-resins. Instead of dislocating the various members
of the group of aromatic oils from their proper botanical
position to discuss them together, we will describe their action
and uses once for all under the present head, it being under-
stood that what is said of oil of cloves applies to the other
substances, with insignificant qualifications.

1. IMMEDIATE LOCAL ACTION AND VSES.

Externally, the essential oil of cloves and allied substances
closely resemble turpentine in properties. Thus, whilst preven-
ting or arresting decomposition, they redden and inflame the
skin, and cause for a time smarting pain, which gives place to
local anaesthesia. Oil of cloves and other officinal fragrant oils
are too costly to be used externally, except to scent liniments ; but
the concrete " oils," or solid constituents of the oils, of pepper-
mint, thyme, eucalyptus, myrtle, etc. (stearoptenes), are ex-
cellent antiseptics, local anaesthetics, stimulants and counter-
irritants and turpentine and camphor are common applications
for these purposes. Such aromatic substances might be used to
disinfect foul wounds and ulcers, and promote healing ; to hasten
the removal of chronic inflammatory products by increasing the
local blood-flow, and thus to reduce swelling in or under the
skin, the periosteum, or the joints ; to relieve neuralgic and
rheumatic pains, such as sciatica and lumbago, by dulling the
sensibility of the nerves ; and to act reflexly on deeper parts,
for instance, the lung or heart, when applied to the skin over
them as counter-irritants.

Internally. — In the mouth the aromatic oils of cloves and
its allies act much as they do on the skin. Besides being anti-
septic, they dilate the local vessels (? directly), and thus in-
crease the circulation, heat, and nutrition, and may even cause
inflammation. They irritate the nerves, causing pain associated
with a sense of burning; but depression quickly follows, and
local anaesthesia. Oil of cloves is a valuable "application in

244 MATER i A MEDIC A AND THERAPEUTICS.

toothache from dental caries, acting at once as an anodyne and
disinfectant. At the same time, the nerves of taste and smell
(flavour) are powerfully excited. Several results, of the first
importance in digestion, follow these local changes, namely : (1)
reflex salivation ; (2) reflex flow of mucus ; (3) reflex hyper-
semia of the gastric mucosa, a sense of hunger, and a flow of
gastric juice ; (4) stimulation of the appetite and increase of
relish by the pleasing flavour ; and (5) in a word, increased
desire for, enjoyment of, and digestion of food.

Aromatic oils are accordingly used very extensively in
cookery, where the proper use of them constitutes an important
portion of the culinary art. Those of them which are also
bitter, such as orange, are taken with wines and spirits as
various "aromatic bitters," liqueurs, etc., to rouse or strengthen
appetite and digestion before or during a meal. In pharmacy
they are employed to correct the tastes of nauseous drugs ; and
theiapeutically they are given in dyspepsia and debility along
with most bitters to increase the saliva and gastric juice.

In the stomach, the effect of aromatics on the vessels and
nerves is continued ; and here it is generally described as
carminative. Besides causing an increased flow of juice, by
stimulation of the mouth, these substances are powerful
stomachics in several ways. The vessels of the mucosa are
dilated ; the nerves of the same are first excited (causing a sense
of heat in the epigastrium) and then soothed, thus relieving pain ;
the contents, rf decomposing, as in dyspepsia, are partly disin-
fected. Their reflex influence is equally important. The mus-
cular coat is stimulated, thus increasing the gastric movement,
expelling flatulence, and relieving painful cramps, spasms,
hiccup, and other forms of distress. Distant organs are also
stimulated : the vigour of the heart increased, the blood pressure
raised, and the spinal, medullary, and even cerebral centres
temporarily excited, to the relief of low, hysterical, and
" spasmodic " symptoms, very common in certain classes of
females, as well as of more serious conditions, such as asthma,
cardiac pain, and palpitation. Aromatics are thus general
stimulants and antispasmodics.

In the intestines the aromatic oils may still be found partly
unabsorbed, acting on the same structures as before, increasing
the local functions, stimulating the intestinal movements, and
expelling flatus. They thus relieve or prevent pain or spasm
(colic), and provide us with valuable correctives of the griping
tendencies of many purgatives. The constitution of the most
important compound pills, powders, and laxative draughts
should be studied in this connection, such as Pilula Rhei Com-
posita, Pulvis Jalapae Compositus, and Mistura Sennae Com-

PlMENTA. 245

positus. Caryophyllum is slightly astringent, by virtue of its
tannic acid.

2. ACTION ON THE BLOOD.

The aromatic oils of cloves and its allies enter the blood as
such, and whilst oxydised in part by the red corpuscles, leave
the circulation mainly unchanged. Some of them are known
to increase the number of white corpuscles, possibly by acting
on the lymphatic glands or spleen.

3. SPECIFIC ACTION AND USES.

The aromatic oils are rarely given in sufficient doses to
produce definite specific effects on the tissues and organs. It
may safely be assumed that in the main their action closely
resembles that of turpentine, or that of camphor, respectively,
as the one or the other compound is in excess in the particular
drug. (See these substances.) Speaking generally, they are
stimulant and antispasmodic ; but let it be noted that a great
part of this effect is reflex from the stomach, as described.

4. REMOTE LOCAL ACTION AND USES.

The aromatic oils are excreted by the kidneys, skin, bronchi,
liver, and probably the bowels ; and in passing through these
structures stimulate and disinfect them. This subject is of
the first importance in pharmacology, and will be best discussed
under the head of turpentine, an oil which produces very
marked remote effects. See Terebinthina Oleum, page 346.

Pimenta— PIMENTO. — The dried unripe berries
of the Allspice tree, Eugenia Pimenta. West Indies.

Characters. — Of the size of a small pea, brown, rough,
crowned with the teeth of the calyx, yellowish within, and
containing two dark brown seeds. Odour and taste aromatic,
hot, and peculiar.

Substances resembling Pimenta : Pepper, which has no calyx.

Composition. — Pimento contains chiefly the officinal volatile
oil, identical with oil of cloves.

Preparations.

1. Oleum PimentsB. — The oil distilled from the fruit in

England. Colourless, becoming brown by keeping. Sinks
in water. Dose, 1 to 3 rnin.

2. Aqua Pimenta.— 1 in 11 £, by distillation. Dose, 1 to 2 oz.

Pimenta is also contained in Syrupus Khumni.

246 MATER i A MEDIC A AND THERAPEUTICS.

ACTION AND USES.

The action and uses of pimento are the same as those of the
preparations of cloves, and other aromatics.

Oleum Cajupiiti— OIL OF CAJUPUT. — The Oil
distilled from the leaves of Melaleuca minor. Im-
ported from Batavia and Singapore.

Characters. — Very mobile, transparent, of a fine pale
bluish-green colour. It has a strong agreeable odour, and
a warm aromatic taste, and leaves a sensation of coldness in the
mouth.

Composition. — Oil of Cajuput consists of hydrate of cajupu-
tene (§), isomeric with Borneo camphor, C10Hl80, and a second
oil (J), boiling at a higher temperature.

Impurities. — Copper ; detected by usual tests. Other volatile
oils.

Dose. — 1 to 3 min.

Preparation.
Spiritus Ca.i'uputi. — 1 in 50. Dose, 30 to 60 min.

Oil of Cajuput is also contained in Linimentum Crotonis.
3 in 8.

ACTION AND USES.

Cajuput oil resembles in its action and uses oil of cloves,
just described, but it is more used externally as a stimulant
and counter-irritant.

Eucalypti Folia — EUCALYPTUS LEAVES. (Not
Officinal.} — The dried leaves of Eucalyptus globulus,
the Blue Gum tree of Australia.

Characters. — Grey-green coriaceous leaves, 6 to 12 inches
in length, £ to 1 inch in breadth, ensiform, smooth, entire,
studded with oil glands ; smell, camphoraceous ; taste, bitter
and pungently aromatic.

Composition. — The leaves contain 2*75 to 6 per cent, of an
sethereal oil, eucalyptol, resin, tannin, salts, and colouring matter.
Eucalyptol is a colourless mobile liquid obtained by distillation
from the leaves, with a strong agreeable odour, consisting of
70 per cent, of a terpene, with cymol. It readily changes into
resin, yielding ozone.

EUCALYPTUS. * 247

Dose. — Of the leaves, 5 gr. and upwards ; of the oil, 1 to
5 miu.

Preparations.

Eucalyptus Gauze ; and Eucalyptus Ointment. — 1 of the oil
in 5.

ACTION AND USES.

Externally. — Eucalyptus oil is a powerful antiseptic and
disinfectant. The gauze has almost supplanted carbolic acid
gauze in Lister's process, as it is neither irritant locally, nor
poisonous when absorbed.

Internally. — The action of eucalyptus oil is nearly the same
as that of oil of turpentine, with which it is otherwise so
closely allied. (See Terebinthince Oleum.} It is antipyretic and
antiperiodic to a degree, like quinia, and was once believed to
be of great value in ague, but this is now doubtful. The blue
gum tree is planted in aguish districts to free the soil of
malaria.

The remote local action of eucalyptus is important. It
leaves the system by the kidneys and lungs, giving its odour
to their excretions, and disinfecting these and the mucous sur-
faces. The oil is therefore indicated in pyelitis and cystitis
on the one hand ; and in bronchitis, dilated bronchi, and
asthma on the other hand.

Oranati Radicis Cortex — POMEGRANATE
ROOT BARK. — The dried bark of the root of Punica^
Granatum. Obtained from the south of Europe.

Characters. — In quills or fragments of a greyish-yellow
colour externally, yellow internally, having a short fracture,
little odour, and an astringent slightly bitter taste.

Incompatibles. — Alkalies, lime-water, metallic salts, gela-
tine.

Composition. — Pomegranate root bark contains tannin; a
crystallisable body punicin; a substance resembling mannite
(see Manna), mucilage, etc.

Preparation.
Decoctum Granati Radicis. — 1 in 10. Dose, 1 to 2 fl.oz.

ACTION AND USES.

Pomegranate root bark has an anthelmintic and slightly
irritant action, much like kousso (see Cusso, page 242),

248 MATERIA MEDIC A AND THERAPEUTICS

but is somewhat astringent unless taken in large quantities.
It has long been used in the treatment of the tape -worm,
which is expelled apparently (not actually) dead by a dose of
the decoction, preceded and followed by a purgative.

DIPTEROCARPINE^.

Chaulmoogra Oil.— The oil expressed from
the seeds of Gynocardia odorata. From India.

Characters. — A pale-brownish unctuous solid, with a dis-
agreeable smell and taste.

Composition. — Chaulmoogra oil contains a quantity of
palmitic acid, with three other fatty acids, including gynocardic
acid, the supposed active principle.

Dose. — 2 to 15 gr.

ACTION AND USES.

Chaulmoogra oil is believed to be a local stimulant, and a
nutritive when administered either by inunction or internally.
It was for a time much praised in leprosy, and has been used
for phthisis, lupus, psoriasis, and chronic rheumatism.

CUCURBITACE^E.

Colocynthidis Pulpa— COLOCYNTH PULP. — The
dried decorticated fruit, freed from seeds, of Citrullus
Colocynthis. Imported chiefly from Smyrna. Trieste.
France, and Spain.

Characters. — Light, spongy, white or yellowish-white in
colour, intensely bitter in taste.

Composition. — The active principle of colocynth is a bitter
glucoside colocynthin, C^H^O^, usually amorphous, but crystal-
lisable, and readily soluble in water.

Dose, in powder, 2 to 8 gr.

Preparations.

1. Extraction Colocynthidis Compositum. — Colocynth Pulp, 6;

Extract of Socotrine Aloes, 12 ; Resin of Scammony, 4 ;
Hard Soap, 3 ; Cardamom Seeds, 1 ; Proof Spirit, 160.
Lose, 2 to 5 gr.

2. Pilula Colocynthidis Composita. — Colocynth Pulp, 1 ; Barba-

does Aloes, 2 ; Scammony, ~2 ; Sulphate of Potash, \ ; Oil
of Cloves, £ ; Water, q.s. (about £). Dose, 5 to 10 gr.

C- -•

^iWc *c.

COLOCYNTHIS. ~ 249

3. Pilula Colocynthidis et Hyoscyami. — Made like the com-
pound pill with \ its weight of Extract of Hyoscyamus.
Lose, 5 to 10 gr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Colocynth is a powerful gastro-intestinal stimulant or
irritant, according to the amount, causing speedy large and
watery evacuations of the bowels, attended by griping and
general depression unless its effect be covered by a carminative.
It is one of the most powerful of officinal purgatives, acting as
a hydragogue cathartic at once upon the muscular coat and
intestinal glands and liver, the secretions of which are rendered
abundant and watery.

Colocynth is always used in combination with milder
purgatives and carminatives. The compound pills are exten-
sively employed alone, or with calomel or blue pill, as an
occasional purgative, to produce free evacuation of the bowels,
and relieve the portal system, after free living, bilious derange-
ment, or chronic constipation. It is less suitable as a habitual
purgative. Its hydragogue effect is employed in cerebral
congestion, where rapid " derivation " is required, and in
dropsies, especially ascites, either alone or as the basis of a pill
containing elaterium. Colocynth must be given with caution in
pregnancy, and entirely avoided in delicate or irritable condi-
tions of the stomach and bowels.

2. ACTION IN THE BLOOD ; SPECIFIC AND REMOTE LOCAL ACTION.

Colocynthin may be taken up by the skin, enters the blood,
and is excreted partly by the kidneys, being, according to some,
a diuretic.

Ecbalii Fructus— SQUIRTING CUCUMBER FRUIT.

—The fruit, very nearly ripe, of the Squirting Cucum-
ber, Ecbalium Officinal-urn.

Composition. — Elaterium contains an active neutral prin-
ciple, elaterin, C2oH28O5, occurring in small colourless silky
prisms, odourless, with an intensely bitter acrid taste ; insoluble
in water, soluble in spirit.

Preparation.
Elaterium. — A sediment from the juice of Ecbalium Offici-

250 MATERIA MEDIC A AND THERAPEUTICS.

Source. — Made by pressing the juice from the incised fruit,
straining, filtering, and drying the sediment.

Characters. — In flattened or slightly incurved pieces about 1 line
thick ; light, greenish-grey, friable.

Impurities. — Starch, flour, and chalk ; detected by ordinary
tests.

Dose.— & to £ gr.

from JUlaterium is prepared :

Pulvis Elaterii Compositus.— 1 to 9 of Sugar of Milk.
Dose, ^ to 5 gr.

ACTION AND USES.

Elaterium acts much like colocynth, as a gastro-intestinal
irritant, but is decidedly more violent, being the most powerful
hydragogue purgative which we possess. It produces, even in
doses of ^ to ^ gr., numerous very watery motions, with
griping and considerable depression.

Elaterium is used almost entirely as a hydragogue purgative
in dropsies and uraemia, relieving the venous pressure by free
evacuation of fluid into the bowel. More rarely it is given as a
rapid " derivative " in cerebral cases ; and still more rarely as
an evacuant in obstinate constipation. This drug must be
used with caution, doses of tV grain being given at first, as the
strength in elaterin is uncertain. It must not be ordered in
catarrhal states of the stomach or bowels.

UMBELLIFER^E.

Coiiii Folia — HEMLOCK LEAVES. — The fresh
leaves and young branches of Spotted Hemlock,
Conium maculatum ; also the leaves separated from
the branches and carefully dried ; gathered from
wild British plants when the fruit begins to form.

Characters. — Fresh leaves decompound, smooth, arisingfrom
a smooth stem with dark purple spots ; dried leaves of a full
green colour and characteristic odour. The leaf rubbed with
solution of potash gives out strongly the odour of conia.

Dose, in powder. — 2 to 8 gr.

Conii Fnictus— HEMLOCK FRUIT. — The dried
ripe fruit of Qonium maculatum, Spotted Hemlock.

Characters. — Broadly ovate, compressed laterally; half-
fruit with five waved or crenated ridges. Reduced to powder

CONIUM. 251

and rubbed with solution of potash, they give out strongly the
odour of conia.

Substances resembling Conium Fruit : Caraway, Anise, Dill,
known by presence of vittse.

Composition. — The active principle of conium is a liquid
alkaloid, coniq^ C8H15N. It is strongly alkaline, oily, and
volatile ; and has a peculiarly disagreeable mouse-like odour.
It is readily disengaged from the preparations of the plant by
the addition of alkalies ; and is liable both to conversion into
an inert resinous mass by exposure, and to decomposition by
heat. The preparations of conium, for these and probably other
reasons, are peculiarly uncertain in strength and action. Coniic
acid, and a second alkaloid conhydrin, also exist in hemlock.

Incompatibles. — Caustic alkalies, vegetable acids, and astrin-
gents.

Preparations.

A. Of Conn Folia :

1. Cataplasma Conii. — 1 oz. of the dried leaf powdered in

each.

2. Extraction Conii. — A green extract from fresh leaves. About

30 in 1. Dose, 2 to 6 gr.

From Extract of Conium are prepared :

a. Pilula Conii Composita. — Extract of Hemlock, 5 ;

Ipecacuanha, 1 ; Treacle, q.s. Dose, 5 to 10 gr.

b. Vapor Conii.— Extract of Hemlock, 60 gr. ; Solution

of Potash, 1 fl.dr. ; Water, 10 fl.dr. 20 min. for one
inhalation.

3. Succus Conii.— 3 of the expressed juice of the fresh leaves,

with 1 of Spirit. Dose, 30 to 60 min. (B. Ph.)

B. Of Conii Fructus :

Tinctura Conii. — 1 in 8. Dose, ^ to 1 fl.dr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally applied, as the cataplasm, conium is believed
by many to be anaesthetic and especially to relieve the pain of
cancer, as well as to promote the absorption of tumours. Care-
ful experiment fails to confirm this opinion, the whole of the
sensory nervous system remaining unaffected by the drug, ex-
cept indirectly by poisonous doses.

Internally. — Conium sometimes causes irritation and
vomiting.

252 MATER i A MEDIC A AND THERAPEUTICS.

2. ACTION ON THE BLOOD.

Conia is readily absorbed into the blood, whence it reaches
the tissues.

3. SPECIFIC ACTION AND USES.

Conia is found unchanged in many of the organs after
administration. Moderate doses cause a sense of weight in the
legs and weakness of the knees ; confusion of vision, with
slight drooping of the upper lids, and swollen appearance of the
eyes; giddiness, thickness of speech, and slight dysphagia.
The poisonous effects of the plant are well described in the
classical account of the death of Socrates.

On analysis, the action of conium is found to be as follows.
The convolutions remain intact until asphyxia supervenes. The
corpora striata are said to be depressed. The motor parts of
the cord are but slightly affected, but their reflex excitability
is moderately reduced. The respiratory centre in the medulla
is finally paralysed ; but the cardiac and vascular centres are
not definitely influenced.

The motor nerves are the parts specially attacked by
conium, being paralysed from their extremities upwards,
whence the heaviness and weakness of the limbs. The muscles
themselves remain irritable.

Death occurs in hemlock poisoning by asphyxia due to
paralysis of the respiratory nerves and depression of the respi-
ratory centre.

Conium, although of great interest to the pharmacologist,
is but little used in medicine. It has been recommended, as
large doses of the succus, in spasmodic and convulsive diseases
such as tetanus, chorea, and epilepsy ; in mania with muscular
excitement ; and in asthma, pertussis, and spasmodic affections
of the larynx. The vapour would appear to afford relief in
some of the last-named class of cases. Possibly the compound
pill may allay spasmodic cough. The extract is an adjuvant
vehicle of purgative powders such as calomel.

4. REMOTE LOCAL ACTION.

Conia is excreted unchanged, chiefly in the urine.

Assafoetida — ASSAFGETIDA. — A gum-resin ob-
tained by incision from the living root of Narthex.
Assafoetida. In Afghanistan and the Puniaub.

Characters. — In irregular masses, partly composed of tears,
moist or dry. The colour of a freshly cut or broken piece is
opaque white, but gradually becomes purplish-pink, and

ASSAFCETIDA. 253

ultimately dull yellowish or pinkish -brown. Taste bitter, acrid ;
odour fetid, alliaceous, and persistent. It dissolves almost
entirely in rectified spirit.

Composition. — Assafcetida contains 4 per cent, of a volatile
oil> 65 per cent, of resin, and 25 per cent, of gum. Oil of
assafoetida is probably complex, but consists chiefly of sulphide
of allyl, C6H10S, to which the unpleasant odour is due. The
resin also contains sulphur.

Impurities. — Earthy matter.

Substances resembling Assafoetida : Galbanum, Ammoniacum,
Benzoin ; known by odour.

Dose. — 5 to 20 gr.

Preparations.

1. Enema Assafoetidse. — 30 gr. in 4 fl.oz. of water.

2. Pilula Aloes et Assafcetidse.— 1 in 4. (See Aloes, page 359.)

Dose, 5 to 10 gr.

3. Pilula Assafoetidse Composita. — Syn. : Pilula Galbani Com-

posita. Assafcetida, 2 ; Galbanum, 2 ; Myrrh, 2 ; Treacle,
by weight, 1. Dose. 5 to 10 gr.

4. Spiritus Ammonia Foe tidus. — Assafoetida, 1^ ; Strong Solu-

tion of Ammonia, 2 ; Spirit, 20. Dose, ^ to 1 fl.dr.

5. Tinctura Assafcetidas. — 1 in 8. Dose, % to 1 fl.dr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND L'SES.

Assafcetida possesses the action of other volatile oils and
resin upon the alimentary canal, but differs from them in this
highly important respect, that whilst most of them are
aromatic and pleasant to the palate, it is extremely disagreeable.
The mental effect of this nauseous impression, added to the other
stimulant effects on the mouth and stomach (see Caryophyllum,
page 242), constitute assafeetida a powerful nervine stimulant,
which arrests the emotional disturbance, muscular spasms, and
other morbid nervous disorders of hysteria. It is no longer
used in true epilepsy, chorea, laryngismus, or asthma. The
stimulant action of volatile oils on the bowel (see Terebinthina
page 343) is specially marked and is employed in the
Enema Assafcetidae to expel flatulence, relieve constipation, and
arrest convulsions.

2. ACTION IN THE BLOOD ; SPECIFIC, AND REMOTE LOCAL
ACTION AND VSER.

The volatile oil of assafoetida passes through the blood and
tissues, and is excreted in the urine, sweat, breath, and dis-

254 MATER i A MEDIC A AND THERAPEUTICS.

charge from wounds. Thus remotely it exerts the usual
stimulant action of ethereal oils, and is sometimes given as a
stimulant and disinfectant expectorant in chronic bronchitis.

Cralbaimm— GALBANUM. — A gnm-resin, derived
from an unascertained umbelliferous plant (said to be
Ferula galbaniflua). Imported from India and the
Levant.

Characters. — In irregular tears, about the size of a pea,
usually agglutinated into masses ; of a greenish-yellow colour,
translucent ; having a strong disagreeable odour, and an acrid
bitter taste.

Substances resembling Galbanum : Ammoniacum, Assaf cetida,
Benzoin ; known by odour.

Composition. — Galbanum contains 3 to 6 per cent, of volatile
cil, isomeric with turpentine, Ci0Hl6, gum, and a mixture of
resins, which yield by dry distillation a blue oil, and umbel-
liferon, in colourless, tasteless, odourless, satiny crystals.

Preparations.
Emplastntm Galbani. — 1 in 11.

Galbanum is also an ingredient of Pilula Assaf oetidse Composita.
1 in 3£. See Assafoetida, page 252.

ACTION AND USES.

Galbanum acts and is used much like assafoetida and
ammoniacum, and is always given with either of these sub-
stances.

Ammoniacum— AMMONIACUM. — A gum-resinous
exudation from Porema Ammoniacum. Collected in
Persia and the Punjaub.

Characters. — In tears or masses; the tears from two to
eight lines in diameter, pale cinnamon-brown, breaking with a
smooth shining opaque white surface ; the masses composed of
agglutinated tears ; hard and brittle when cold, but readily
softening with heat. Has a faint odour, and a bitter acrid
nauseous taste. Rubbed with water it forms a nearly white
emulsion.

Substances resembling Ammoniacum : Assafoetida, Galbanum,
Benzoin ; known by odour.

Composition. — Ammoniacum contains about 4 per cent, of a

AMMONIA c UM. 255

volatile oil, 20 per cent, of gum, and 70 per cent, of resin. The
oil does not contain sulphur.
Dose. — 10 to 20 gr.

Preparations.

1 . Emplastrum Amtnoniaci cutn HvdraTfirvro. — About 1 in 14-.

(Sae Hydrargyrum, page 86.)

2. Mistura Ammoniac!. — A milk-like emulsion. 1 in 32 water.

Dose, ^ to 1 fl.oz.

Ammoniacum is also an ingredient of Emplastrum Galbani,
1 in 1 1 ; Pilula Ipecacuanha cum Scilla, 1 in 7 ; and
Piiula Scillae Composita, 1 in 6.

ACTION AND USES.

The action of ammoniacum closely resembles that of the
other aromatics and oleo-resins, "but it is used almost solely for
its remote local effects. In being excreted by the bronchial
mucosa, it stimulates the surface and disinfects the secretions of
the part (see Terebinthina Oleum, page 343) ; and it probably
acts similarly on the skin. It is used as a disinfectant ex-
pectorant in chronic bronchitis with profuse discharge, and as
a constituent of plasters intended to strengthen circulation in
the skin and promote absorption.

Oleum Anisi— OIL OF ANISE. — The oil distilled
in Europe from the fruit of Pimpinella Anisum.
Also the oil distilled in China from the fruit of
Illiciuin anisatum, Star Anise (Magnoliacese.)

Characters of the fruit. — Half fruits with five filiform
equal ridges, the lateral ones being marginal. In each channel
are three or more vittae. Thicker and more ovate than caraway
fruits.

Characters of the oil. — Colourless or pale yellow, with the
familiar odour of anise, and a warm sweetish taste. Concretes
at 60C.

Composition. — Oil of aniseed, anethol, or anise-camphor, is
composed of two isomeric bodies, the fluid (£), and the solid
(|), anethol.

Dose. — 2 to 5 min.

Preparation.

Essentia Anisi.— 1 in 5. Dose, 10 to 20 min.

Oil of Anise is also contained in Tinctura Camphor® Com-
posita, and Tinctura Opii Ammoniata.

256 MATER i A ME DIG A AND THERAPEUTICS.

ACTION AND USES.

The action and uses of anise are those of the aromatic oils
in general. It is believed, however, to possess specially stimu-
lant action on the bronchial mucosa, like ammoniacum, probably
because excreted in part by it. It is therefore a favourite
flavouring agent for cough mixtures.

Coriaudri Fructiis — CORIANDER FRUIT. — The
dried ripe fruit of Coriandrum sativum. Cultivated
in Britain.

Characters. — Globular, nearly as large as white pepper,
beaked, finely ribbed, yellowish-brown; has an agreeable
aromatic odour and flavour.

Composition. — The principal constituents of coriander are
an abundant fatty oil, and a small quantity of aromatic oils, one
of which is isomeric with Borneo camphor, Ci0H180. See
Camphora.

Preparation.

Oleum Coriandri.— Obtained by distillation. Yellowish,
with the odour of coriander. Dose, 2 to 5 min.

Coriander Fruit and Oil are also contained in a variety of
preparations of more important drugs.

ACTION AND USES.

The action and uses of coriander do not differ from those
of the aromatic substances just described. Its flavour specially
covers the taste of senna and rhubarb.

Freniciili Fructus— FENNEL FRUIT. — The fruit
of Foeniculum dulce. Imported from Malta.

Characters. — About three lines long and one line broad ;
elliptical, slightly curved, beaked, having eight pale-brown
linal ribs, the two lateral being double ; taste and odour
aromatic,

Xxlistnncrs rescnillinfl Fennel : Conium, Caraway, Anise.
Ff -Mm -1 is larger than Conium, and has eight ribs and often
.Ik.

/>osition.— Fennel contains an ethereal volatile oil, appa-
rently identical with anethol (see Oleum Anisi, page 255 ;) united

CARNI FRUCTUS. .257

with a terpene. It is of a light yellow colour, with the
peculiar odour of the fruit.

Preparation.
— 1 in 10 by distillation. Dose, 1 to 2 fl.oz.

ACTION AND USES.

Fennel has the same action, and is used for the same pur-
poses as other aromatic substances.

Canii Fructus— CARAWAY FRUIT. — The dried
fruit of Camm Carui. Cultivated in England and
Germany.

Characters. — Fruit usually separating into two parts, which
are about two lines long, curved, tapering at each end, brown,
with five paler longitudinal ridges ; having an agreeable aromatic
odour and spicy taste.

Substances resembling Caraway : Conium, Fennel. Caraway
has small ridges and a spicy taste.

Composition. — Volatile oil of caraway, the active constituent
of the fruit, is a mixture of caruen, C10Hl6, isomeric with tur-
pentine, and cartel, CloHuO, isomeric with thymol.

Preparations.

1. Aaua Carui, — 1 in 10. Dose, 1 to 2 fl.oz.

2. Oleum Carui — Obtained by distillation. Pale yellow, with

aromatic odour and spicy taste. Dose, 2 to 5 min.

Caraway Fruit and Oil are also contained in many prepara-
tions of other drugs.

ACTION AND USES.

Caraway acts like other aromatic substances, as described
under Caryophyllum. It is extensively used as a flavouring and
carminative agent.

Anethi Fructiis— DILL FRUIT. — The fruit of
Anethum graveolens. Cultivated in England, or im-
ported from middle and southern Europe.

Characters. — Oval, flat, about a line and a half in length,
with a pale membranous margin. Odour aromatic ; taste
warm, somewhat bitter.
R— 8

258 MATERIA MEDICA AND THERAPEUTICS.

Substances resembling Dill : Conium, Anise, Fennel, Cara-
way. Dill is winged.

Composition. — Dill contains the officinal volatile oil, which is
pale yellow, with a pungent odour, and an acrid sweetish taste.

Preparations.

1. Aqua Anethi. — 1 in 10. Dose, 1 to 2 fl.oz.

2. Oleum Anethi. — Obtained by distillation. Dose, 2 to 5 min.

ACTION AND USES.

The same as of other substances containing aromatic vola-
tile oils. It is often given as a carminative to infants.

Siiiiilmi Radix — SUMBUL ROOT. — The dried
transverse sections of the root of a plant the botanical
history of which is unknown. Imported from Russia,
and also from India.

Characters. — The pieces are nearly round, from 2^ inches to 5
inches in diameter, and from £ to 1| inches in thickness. They
are covered on the outer edge with a dusky brown rough bark,
frequently beset -with short bristly fibres. The interior is
porous, and consists of irregular, easily separated fibres. It
has a strong odour, resembling that of musk. The taste is at
first sweetish, becoming after a time bitterish and balsamic.
That brought from India differs from the Eussian, being closer
in texture, more dense and firm, and of a reddish tint.

Composition. — Sumbul contains a small quantity of volatile
oil, 9 per cent, of a soft resin with its characteristic odour, and
a crystalline substance, sumbulic acid.

Preparation.
Tinctura Sumbul. — 1 in 8. Dose, 15 to 30 min.

ACTION AND USES.

Sumbul is a stimulant, like the aromatic oils in general,
and specially resembles valerian and musk. It is used in the
same class of cases as these drugs, to the account of which the
reader is referred.

CAPRIFOLIACE^B.

Samtouci Flores — ELDER FLOWERS. — The fresh
flowers of Sambuciis nigra. From indigenous plants.

CINCHONA. - 259

Characters. — Flowers small, white, fragrant, in cymes.
Composition. — Elder flowers contain a trace of volatile oil,
a resin, and baldrianic (valerianic) acid, C5H1002.

Preparation.
Aqua Sambuci. — 1 in 1, by distillation. Dose, 1 to 2 fl.oz.

ACTION AND USES.

Elder flowers are chiefly used for flavouring purposes, but
probably possess mild diaphoretic and diuretic properties.

CINCHONACE^B.

Cinchonas Flavae Cortex— YELLOW-CINCHONA
BARK. — The bark of Cinchona Calisaya. Collected in
Bolivia and southern Peru.

Characters. — In flat pieces, uncoated or deprived of the
periderm, rarely in coated quills, from six to eighteen inches
long, one to three inches wide, and two to four lines thick,
compact and heavy ; outer surface brown, marked by broad
shallow irregular longitudinal depressions; inner surface
tawny-yellow, fibrous ; transverse fracture shortly and finely
fibrous. Powder cinnamon-brown, somewhat aromatic, persis-
tently bitter.

Cinchonas Pallidec Cortex— PALE - CINCHONA
BARK. — The bark of Cinchona Gondaminea. B.C.,
vars. Chahuarguera Pavon, and crispa Tafalla.
From Loxa.

Characters. — From half a line to a line thick, in single or
double quills, from 6 to 15 inches long, 2 to 8 lines in diameter,
brittle, easily splitting longitudinally, and breaking with a
short transverse fracture ; outer surface brown and wrinkled, or
grey and speckled with adherent lichens, with or without numer-
ous transverse cracks ; inner surface bright orange or cinnamon-
brown ; powder pale brown, slightly bitter, very astringent.

Cinchona; Rubrae Cortex — R ED-CINCHONA
BARK. —The bark of Cinchona succirubra. Collected
on the western slopes of Chimborazo.

Characters. — In flat or incurved pieces, less frequently in
quills, coated with the periderm, varying in length from a few

260 MATERIA MEDIC A AND THERAPEUTICS.

inches to two feet, from one to three inches wide, and two to
six lines thick, compact and heavy; outer surface brown or
reddish-brown, rarely white from adherent lichens, rugged or
wrinkled longitudinally, frequently warty, and crossed by deep
transverse cracks ; inner surface redder ; fractured surface often
approaching to brick-red ; transverse fracture finely fibrous ;
powder red-brown ; taste bitter and astringent.

€1 11 eh on a L.ancifoliae Cortex — LANCE-
LEAVED CINCHONA BARK. — The bark of Cinchona
lancifolia, Mutis. Spongy or orange Carthagena
bark.

Characters. — Either in quills of various size with brownish
epidermis, and whitish crustaceous and foliaceous lichens,
extremely fibrous, moderately bitter ; or as curved pieces, of an
orange or red colour, with an extremely fibrous liber, of stringy
fracture, very slightly bitter.

Composition. — Cinchona bark contains (1) four alkaloids,
namely : quinia, cinchonia, quinidia, and cinchonidia ; (2) two
peculiar acids : kinic and kinovic acids ; (3) a variety of tannic
acid, called cincho-tannic acid; (4) cinchona red; and (5) an
aromatic volatile oil.

1. The alkaloids of cinchona. — a. Quinia, C2oH24N202,
occurs (as the hydrate) in white acicular crystals, inodorous,
very bitter ; reacting like an alkali, and forming neutral and
acid salts with acids ; presenting fluorescence in dilute solutions
of the sulphate ; and turning the plane of polarisation to the
left. An amorphous form of quinia is found after crystallisation
of the sulphate from the mother-liquors, and from quinoidia,
which appears to be a compound of the alkaloids with resin and
colouring matters.

b. Cinchonia. C20H24N20, consists of colourless prisms,
inodorous, and bitter ; f orms salts with acids ; but possesses no
fluorescence in solution ; and deflects the plane of polarisation to
the right.

c. Quinidia^ C2oH24N202, i.e. isomeric with quinia, closely
resembles quinia, but crystallises in prisms, and deflects the
plane of polarisation to the right.

d. Cinchonidia. C2()H24N20, i.e. isomeric with cinchonia,
resembles that alkaloid, but yields fluorescent solutions, and
left-handed polarisation.

As a rule quinia is most abiindant in yellow bark, cinchonia
in pale bark, and the red bark contains a considerable pro-
portion of each. Quinidia is specially abundant in the bai'l:
of lancifolia. More exactly, yellow bark yields 2'5 to 3'8 per

CINCHONA. 261

cent, of quinia; pale bark, 0*7 to 1-4 per cent, of alkaloids,
chiefly cinchonia or quinidia with a little quinia ; the best red
bark, 2'6 per cent, of quinia, and 1-5 per cent, of cinchonia.

2 and 3. The acids of cinchona. — a. Kinic or q//i//i
CyH^Og, occurs in large colourless prisms, soluble in water.
In the bark it is probably combined with the alkaloids, and is
found also in the coffee-bean, the Vaccinium myrtillus, and
other plants. It is closely allied to benzoic acid, and appears
in the urine as hippuric acid. See Benzoinum, page 281.

b. Kinovic _acid^ C^H^gO^, " kinova bitter," is a white
amorphous body, insoluble in water. It appears to be a
product, with glucose, of kinovin, a glucoside.

c. Cincho-tannic acid, the astringent principle and soluble
red-colouring matter of the bark, amounts to 1 to 3 per cent.
It is a yellow hygroscopic body, and differs from ordinary
tannic acid in striking green with persalts of iron, and in being
very readily oxydised, one of the products being

4. Cinchona red, a reddish-brown substance without taste
or smell, nearly insoluble in water.

5. The volatile oil, obtained by distillation, has the odour
of the bark.

Impurities. — Inferior barks are detected by the absence of
the true characters of the officinal barks, and by a quantitative
test. This consists in (1) boiling 100 gr. of the bark in water
acidulated with' HC1, macerating, and percolating ; (2) precipi-
tating the colouring matter with solution of subacetate of lead ;
(3) adding caustic potash to the filtrate, until the precipitate
first formed is nearly redissolved ; (4) agitating with ether, and
evaporating the resulting solution. This should yield not less
than 2 gr. of quinia from yellow bark ; 2 gr. of alkaloids from
red bark ; and £ gr. of alkaloids from pale bark. The
yellow bark is adulterated with elm, larch, and Winter's barks,
known by absence of bitter taste ; the pale bark with
cascarilla, which is whiter ; the red bark with red sandal wood,
logwood, and larch barks, which are all devoid of a bitter
taste.

Incompatibles. — Ammonia, lime-water, metallic salts, and
gelatine. May be combined with mineral acids.

Dose of any of the barks.— 15 gr. as a tonic; 1 to 2 dr. in
ague.

Preparations.

A. Of the Tellow Bark :

1. Decoctum Cinchona Flavse. — 1 in 16. Dose, 1 to 2 fl.oz.
'L gxtractum Cinchona FlavsB Liquidum. — 4 in 1. Dose, 10
to 30 min.

262 MATERIA MEDIC A AND THERAPEUTICS.

3. Infusum Cinchonse Flavse. — 1 in 20. Dose, 1 to 2 fl.oz.

4. Tinctura Cinchona Flavae.— 1 in 5. Dose, % to 2 fl.dr.

5. Quinise Sulphas.

B. O/ £A<? -P#& -Bar& (Cinchona Pallida] :

1. Tinctura Cinchona? Composita.— Pale Bark, Bitter-Orange
Peel, Serpentary, Saffron, Cochineal, and Proof Spirit.
1 in 10. Dose, % to 2 fl.dr.

c. Of the Red £ark there are no officinal preparations.
D. Of the Lance-leaved Cinchona Bark : Quiniae Sulphas.

ACTION AND USES.

The action and uses of the Cinchona harks will he described
along with those of Quinia, their most important active prin-
ciple.

Sulphas — SULPHATE OF QUINIA. (C^

H24N2O2)2H2S04.7H20.— The sulphate of an alkaloid,
prepared from yellow Cinchona bark, and from, the
bark of Cinchona lancifolia, Mutis.

Source. — Made hy (1) exhausting the bark with Diluted
Hydrochloric Acid ; (2) precipitating the Quinia with Solution of
Soda; (3) dissolving this in Diluted Sulphuric Acid; and (4)
crystallising out.

Characters. — Filiform silky snow-white crystals, with an
intensely bitter taste. Solubility, 1 in 576 of water : 60 gr.
require 60 min. of diluted sulphuric, or 100 min. of diluted phos-
phoric acid ; and 66 gr. require 60 min. of diluted nitric acid
for solution in two ounces of distilled water. 12 gr. = 1 oz.
of good bark.

Impurities. — Sulphates of the other cinchona alkaloids, and
of lime, chalk, magnesia ; starch, boracic acid, etc. ; detected by
the quantitative test given above. Salicin; which gives blood-
red with sulphuric acid.

Incompatible*. — Alkalies and their carbonates, astringent
infusions. Nitric acid alone makes a clear mixture with sul-
phate of quinia.

Dose. — 1 to 5 gr. as a tonic ; larger doses as an antipyretic
and antiperiodic.

Preparations.

1. Ferri et Quiniss Citras.— 16 in 100. Dose, 5 to 10 gr.

2. Pilula Quinise. — 1 with £ of Confection of Hips. Dose, 2 to

10 gr.

^ ^ ^xnsv-»~«.

CXu^j-'v.^.
CUu

QUINIA. 263

3. Tinctura Quiniaa.— 1 in 60. Lose, 1 to 1£ fl.dr.

4. Tinctura Quiniaa Ammoniata.— 1 in 60 of Solution of Am-

monia and Proof Spirit. Lose, £ to 2 fl.dr.

5. Vimim Quiniaa. — 1 in 480 of Orange Wine, with Citric Acid.

Lose, % to 1 fl.oz.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Quinia arrests some kinds of fermentation and
decomposition, and might be used as a local antiseptic and
disinfectant to wounds and ulcers, but for its cost. A solution I
of 2 gr. to 1 fl.oz., applied as a spray to the nose, relieves hayj
asthma. A solution of 4 gr. to 1 fl.oz. (with a minimum of
diluted sulphuric acid) is recommended as a constant application
in diptheritic conjunctivitis, or to wash out a foul bladder.

Internally. — Quinia is freely absorbed by the mucous
membranes, and may be given either by the mouth, rectum,
or subcutaneously. In the mouth, stomach, and intestine, it
acts as a powerful bitter, possessing all the important in-
fluence on the secretions of the digestive tract described
under Calumba. The stomachic effect of quinia is obtained
from small doses, ^ to 2 grains, and must be kept entirely
distinct from the specific effects to be presently described,
otherwise confusion as to the action and value of this impor-
tant drug will be the result. In small doses, like all other
bitters, it improves the appetite and digestion, stimulates the
heart and circulation, increases the sense of comfort and bien
tire produced by a meal; and its continued use will thus
increase the bodily strength, that is, will be tonic in its effects.
Quinia is extensively used for this purpose, especially during
convalescence, in debilitated subjects, and in patients taking
depressing or alterative remedies such as mercury. Largei
doses (10 to 30 gr. or more), have the opposite effect, interfer-
ing with digestion, and so causing depression.

In the stomach quinia or its sulphate becomes the chloride,
a soluble and diffusible salt, which readily enters the blood.
Little or none escapes unabsorbed in the faeces.

2. ACTION ON THE BLOOD, AND ITS USES.

Quinia or its chloride may be found in the blood within a
few minutes of its administration. Here the alkaloid produces
several definite effects, namely : (1) It binds the oxygen more
firmly to the haemoglobin, so that oxygenation is less easy and
less active. (2) It causes enlargement of the individual red

264 MATERIA MEDIC A AND THERAPEUTICS.

corpuscles. (3) It paralyses the leucocytes, when given in
large doses, thus checking diapedesis ; and reduces the number of
visible leucocytes very greatly (to one-fourth). In blood freshly
drawn, it (4) retards the formation of acid (through loss of oxy-
gen and increase of carbonic acid) which naturally occurs in
blood removed from the vessels, as well as (5) the ozonising
power of blood, e.g. on guaiacum and turpentine. Altogether,
quinia manifestly interferes with oxygenatiOn, the giving up
of oxygen by the red corpuscles to oxydisable bodies, and with
the function of the white corpuscle. The outcome of these
effects will be presently considered.

3. SPECIFIC ACTION.

Quinia passes through the tissues without decomposition,
quickly making its appearance in them, but not being com-
pletely excreted for several days. The maximum effect of
large doses is produced in about five hours. If therefore the
full specific effect be desired, a single large dose (15 to 30 gr.)
must be given, and this may have to be repeated once or twice
within the hour ; small doses given over a length of time do not
sufficiently accumulate.

The obvious phenomena produced by a full dose (15 to 30 gr.)
of quinia are not by any means its most important effect. It
acts most strikingly upon the nervous centres, and causes
confusion of the mental faculties, noises in the ears and deaf-
ness, disorders of vision, headache, giddiness, vomiting, and
possibly prostration from involvement of the cord and circula-
tion. Of infinitely greater interest and importance are certain
concomitant effects of quinia which require careful investigation
for their discovery. These effects may be arranged thus :

(1) Quinia lowers the body temperature very moderately
in the healthy subject ; very markedly in the pyrexia of many
acute specific fevers. It appears to be difficult to lower the
normal temperature by drugs, as compensating mechanisms are
probably brought into play ; but the rise of temperature and
the perspiration normally produced by muscular exercise are
prevented by quinia. In malarial fevers, typhoid, acute
pneumonia, and some forms of hectic and other periodic fevers,
the defervescent effect of quinia is unquestionable.

(2) Quinia reduces the amount of nitrogenous excretions,
i.e. urea and uric acid, and probably also of carbonic acid, as
determined both in healthy and in fevered animals, and in man.

These two sets of effects taken together point to a powerful
action of quinia in reducing the metabolism of the body, of
which heat and the excretions are the two most measurable
products. This conclusion is supported by other facts, observed

QUINIA. 265

out of the body, viz. : That (3) a solution of albumen cannot
be converted into peptones in an atmosphere of ozone if
quinia be present. (4) Healthy pus and fresh vegetable juices
lose their ozonising power if mixed with quinia. (5) Phos-
phorescent infusoria (rapidly oxydating protoplasmic masses)
lose their phosphorescence in the presence of quinia. (6) Fungi
absorb oxygen less readily, and many forms of f ermentation are
arrested, in the presence of quinia. These facts indicate that
quinia so combines with living cellular protoplasm as to render it
less able to incorporate oxygen, and more resistant of vital
change (metabolism). Now we have already seen that the
oxygen actually in the corpuscles is bound more firmly to them
by quinia. We may therefore conclude that the effect of quinia
in the body is to check metabolism by interfering with oxygena-
tion, with the oxydation of protoplasm generally, and with the
associated action of ferments. Thus the fall of temperature
produced by quinia is due to diminished production of heat in
the body, not to increased loss of heat ; it is effected through
the tissues, not through the heat-regulating centre ; and the
fever-causing (pyrogenic) processes themselves (probably allied
to fermentations) are also controlled by the drug, which affects
their organic causes, whether living organisms or complex
chemical substances.

An action such as this upon the processes of nutrition,
though it might escape the notice of an ignorant observer, is
more " powerful " even than the action of morphia upon a
highly sensitive nervous mechanism such as the convolutions.

Turning to the other systems, we find that whilst small
doses of quinia accelerate the heart and raise the pressure, as we
saw when considering the stomachic effect, full doses slow and
weaken the heart and lower the pressure. These effects are due
to direct depression of the cardiac ganglia and muscle, and of
the vessel walls and their centre, not of the cardiac centre.
Respiration is accelerated by medium doses, depressed by large
doses ; and death, should it occur, is referable to respiratory and
cardiac failure. The spleen is reduced in size, and hardened.

4. SPECIFIC USES.

The uses of quinia, which have been mainly establishe<l In-
experience, are in accord with these physiological results. Its
specific action may be taken advantage of in the following

1. Malaria is remarkably benefited by quinia, which is an
antiperiodic or direct specific, whether given to persons exposed
to the morbid influence as a prophylactic measure, or to the
subjects of ague. It acts best in fresh cases, the first dose of

266 MATERIA MEDIC A AND THERAPEUTICS.

10 gr. being given at any time with relation to the attack, and
similar doses repeated five hours before the time of the next
paroxysm. AH forms of malarial fever are benefited by quinia,
as well as many diseases and disorders of malarial origin, such
as neuralgia, hepatic disturbances, etc. The functions of the
liver must be maintained during this treatment of ague, and
the quinia may be combined with morphia if its effects are
not well marked.

2. Febrile conditions in general are relieved by the antipyre-
tic effect of quinia, for instance, acute pneumonia, typhoid fever,
puerperal fever, and septicaemia, the exanthemata, and acute
rheumatism; but generally in ' very different degrees, so that
its value is denied in some or all of them. To be of use the
quinia must be very freely given (10 to 20 grains) as single
doses when the temperature reaches a definite height, say 104°
Fahr. Even if apyrexia do not follow, the drug may be of
much benefit. In hectic fever quinia is rarely of much service ;
and in purely symptomatic fever, of still less use.

3. In splenic enlargement of malarial origin quinia is given
with success, and in some cases of leukaematous hypertrophy.

4. In painful nervous affections, especially headache and
face-ache, the effect of quinia is well marked. Some of these
cases are malarial (brow ague) ; but ordinary facial neuralgia
and toothache will frequently yield to it. Yet quinia pos-
sesses no direct action on peripheral nerves.

5. The tonic action of quinia has been already referred to.
This is also due in part to its removal of fever, and thus of
restlessness, sleeplessness, and want of appetite. It further
modifies the processes of " secondary digestion " in the liver,
and may relieve hepatic disorder due to free living, especially
in persons who have resided in the tropics.

5. REMOTE LOCAL ACTION AND USES.

Quinia is excreted chiefly in the urine, as the amorphous
alkaloid; partly as resinoid and crystalline derivates. In
passing through the urinary organs it is slightly diuretic, and
occasionally irritates the passages. It also escapes by the skin,
diminishing the perspiration, and very rarely causing an
itching eruption, which resembles scarlatina or measles. All
the mucous secretions, the milk, and pathological fluids may
also contain quinia.

ACTION AND USES OF THE CINCHONA BARKS.

The cinchona barks contain but a small percentage of
alkaloids, and are far too bulky for use as antiperiodics and
antipyretics if quinia can be obtained. They are there-

f C

IPECACUANHA. 267

fore given only as bitter stomachics and tonics. The
amount of tannin contained in them indicates that they
may be used when an astringent effect is also desired, either
locally, as in passive diarrhoea, or remotely, as in sweating,
chronic mucous discharges, and purulent formations ; and
avoided in constipation, dyspepsia, or irritability of the bowels.
The red bark is especially astringent.

Cinchonia, and other non-officinal alkaloids and products of
bark, may be employed as substitutes for quinia, their action
being very similar. Cinchonia is from \ to $ as powerful as
quinia.

Ipecacuanha- — IPECACUANHA. — The dried root
of Cephae'lis Ipecacuanha. Imported from Brazil.

Characters. — In pieces three or four inches long, about the
size of a small quill, contorted and irregularly annulated.
Colour, brown of various shades. It consists of two parts, the
cortical or active portion, which is brittle, and a slender tough
white woody centre. Powder pale brown, with a faint
nauseous odour, and a somewhat acrid and bitter taste.

Impurities . — (1) Hemidesmus, which is cracked, but not
annulated ; (2) Almond meal (in powdered ipecacuanha), de-
tected by odour of prussic acid when moistened.

Composition. — Ipecacuanha contains from ^ to 1 per cent, of
enietin, which is its active principle ; ipecacuanhic or cephaelic
acid ; starch, gum, etc. JEmetin, C2oH3oN05, is a crystalline
alkaloid, white, becoming yellow, odourless, bitter, compara-
tively insoluble in water, forming salts with acids which are
readily dissolved in ordinary media.

Dose. — As an expectorant, £ to 2 gr. ; as an emetic, 15 to
30 gr.

Preparations.

1. Pulvis Ipecacuanha Cpmpositus. "Dover's Powder." —

Ipecacuanha, 1 ; Opium, 1 ; Sulphate of Potash, 8. A
light fawn-coloured powder. Dose, 5 to 10 gr.

from Dover* '« Powder is prepared :

Pilula Ipecacuanhas cum Scill|. — Compound Powder
of Ipecacuanha, 3 ; Squill, 1 ; Ammoniacum, 1 ; Treacle,
q.s. Dose, 5 to 10 gr.

2. Pilula Conii Composita. — 1 in 6. See Conii Folia.

3. Trochisci Ipecacuanhas. — ^ gr. in each. Dose, 1 to 3.

4. Trochisci Morphias *>t Tpf>rnp.^anha.— Ipecacuanha, £, gr. ;

Hydrochlorate of Morphia, -fa gr. in each. See Opium ,

page 1£>7.

268 MATERIA MEDIC A AND THERAPEUTICS.

5. Vimun Ipecacuanhse. — 1 in 20 of Sherry. Dose, 5 to 40 min.
as an expectorant ; as an emetic, 3 to 6 dr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Externally. — Ipecacuanha powder is irritant, and even
pustulant, but is never used to produce this effect. Exposed
mucous membranes are similarly affected by it. If taken as
snuff it causes irritation of the nerves, sneezing, and reflex
mucous secretion ; and the same effect follows its application in
smoke or spray to the pharynx, larynx, or lower air-passages ;
in some persons it excites asthma. In the form of a spray of
the diluted vinum, or inhaled as the smoke of the burning
powder, it is used to relieve cough due to dryness or deficient
secretion of the throat and air passages.

Internally. — Reaching the stomach, ipecacuanha in very
small doses (gr. |) is a gastric stimulant doubtless increasing
the local circulation and secretion. It is therefore a useful
addition to bitter stomachic and tonic mixtures, and will even
arrest vomiting due to certain obscure conditions of the gastric
nerves. The compound powder is of the greatest value in
ulceration of the stomach, and some forms of dyspeptic vomiting.
In larger doses (15 to 30 gr.) it acts as an emetic, partly by a
direct effect upon the stomach, and partly by exciting the
vomiting centre in the medulla (indirect emesis). This im-
portant subject will be discussed under the heading of the
specific action.

In the intestines, ipecacuanha is still a stimulant, increasing
the flow of mucus ; and in large doses an irritant. A remark-
able tolerance of the drug is, however, readily established in
many persons suffering from dysentery, in which disease
ipecacuanha has the power of arresting the inflammatory action
in the bowel, checking the liquid and bloody evacuations, and
often effects a complete cure. For this purpose enormous doses
(30 to 90 gr.) are given, or large doses frequently repeated
(20 gr. every two hours).

2. ACTION IN THE BLOOD.

Emetin passes through the blood, from the alimentary canal
to the tissues, but is not positively known to affect it.

3. SPECIFIC ACTION AND USES.

Ipecacuanha (emetin) acts on the vomiting centre in the
medulla, i.e. is an indirect emetic, this effect being added to

^fl-^l m-c ci .

'-u<^/ir>— cx^.

IPECACUANHA. 269

the direct (gastric) action already mentioned. The ord::
doses (15 to 30 gr. of the powdered root, 3 to 6 fl.dr. of the
vinum for adults) produce free evacuation of the stomach, and
respiratory passages in 20 to 30 minutes, the dose often having
to be repeated in 15 minutes, and the vomiting act probably
occurring but once. But little nausea precedes, and moderate
depression follows, the emesis. The circulation and respiration
are disturbed and finally depressed by ipecacuanha, chiefly
through the vomiting.

This drug is suitable as an emetic in cases -where the
necessity for evacuation of the stomach is not very urgent, and
the subject is likely to be benefited by moderate but injured by
great depression. It must not be given, therefore, in poisoning
by alkaloids, such as morphia, but to children and weakly
subjects in cases where the after effects of the drug will be also
useful. It thus occupies a position amongst emetics between
sulphate of zinc or copper and tartar emetic. Ipecacuanha may
be used to empty the stomach in the early stages of sthenic
fevers (less commonly than before) ; in cramp, whooping-
cough, and the bronchitis of children, to expel membranes or
mucous products from the air passages ; and in acute dyspepsia
with biliousness and heat of skin.

The skin is stimulated to increased secretion by ipecacuanha,
which is used as a diaphoretic, especially combined with opium
(Dover's Powder), in common colds, sore throat, and mild
rheumatic attacks.

4. REMOTE LOCAL ACTION AND '

Emetin is excreted by the various mucous membranes,
including those of the bronchi, the stomach, and bowels, and by
the liver. On the bronchi it produces the same remote as
immediate local action, namely, stimulation of the nerves,
reflex cough, increased secretion, and, in large doses, even in-
flammation of the mucous membrane and lungs. Ipecacuanha
is thus an expectorant, increasing at once the expiL
and the amount, that is, the liquidity, of tho sputa. It is the
most generally used of all this class of m>
in acute and chronic bronchitis, in phthisis, and in most cases
of cough when the phlegm is scanty and tough. Important
advantages of ipecacuanha are, that, if taken in excess, it causes
sickness, which is often beneficial in the bronchitis of child:
and that as a diaphoretic and moderate depressant of the
circulation, i.e. a sedative expectorant, it controls the fever at
the same time.

Acting remotely on the liver, this drug is a direct chola-
gogue, increasing the secretion of bile ; and has long been a

270 MATERIA MEDIC A AND THERAPEUTICS.

favourite constituent of some purgative pills and aperient
draughts for chronic biliousness and gouty dyspepsia.

Catechu Pailidum — PALE CATECHU. — An ex-
tract of the leaves and young shoots of Uncaria
Gambir, Prepared at Singapore and in other places
in the Eastern Archipelago.

Characters. — In cubes, about an inch in diameter, externally
brown, internally ochrey-yellow or pale brick-red, breaking
easily with a dull earthy fracture. Taste bitter, very astringent,
and mucilaginous, succeeded by slight sweetness. Entirely
soluble in boiling water. The decoction when cool is not
rendered blue by iodine.

Composition. — Catechu chiefly contains a crystalline bitter
substance, catechin or catechuic acid, CjsH^Og, probably itself
inactive ; and catechu-tannic acid, the active principle, isomeric
with it, and into which it is rapidly converted by boiling or by
the action of saliva, with the development of a red colour.
Both catechuic and catechu-tannic acids give a green precipitate
with persalts of iron.

Incompatible*. — The alkalies, metallic salts, and gelatine.

Dose. — 10 to 30 gr.

Preparations.

1. Infusum Catechu. — 1 in 27. Dose, 1 to 2 fl.oz.

2. Pulvis Catechu Compositus.— Catechu. 4 : Kino, 2; Ehatany,

2 ; Cinnamon, 1 ; Nutmeg, 1. Dose, 20 to 40 gr.

3. Tinctura Catechu.— 1 in 8. Dose, £ to 2 fl.dr.

4. Trochisci Catechu. — 1 gr. in each. Dose, 1 to 6.

ACTION AND USES.

Catechu acts like tannic acid, and is used for the same
purposes. It is a favourite astringent application to sore
throat in the form of the lozenge, and the compound powder
and tincture are very commonly prescribed for diarrhoea.

Caffein. (Not Officinal] — An alkaloid obtained
from Coffea arabica, the coffee plant ; from Thea
sinensis, the tea plant (nat. ord,, Camelliaceae) ; from
Ilex paraguay ensis, Mate, or Paraguay Tea (nat. ord.,
Aquifoliacse) ; and from Guarana. (See page 211.)

Characters. — Caffein, C8HlnN2O4, occurs in fine long silky
white prisms, soluble in water, with a bitter taste. It is a

CAFFEIN.

- 271

feeble base. Tea contains 1 to 4 per cent, of caffein ; coffee,
0-2 to 0-8 : mate, 1-2 ; guarana, 5 per cent. It is closely allied
to theobromin, C7H6N402, being, in fact, methyl-theobromin,
C7H9(CH3)N402, which can be made synthetically.

Incompatible*. — Tannic acid, iodide of potassium, and salts
of mercury.

Dose. — 1 to 5 gr., or more.

Preparation.
Citrate of Caffein, in white needles. Dose, 1 to 5 gr.

ACTION AND USES.
1. IMMEDIATE LOCAL ACTION AND USES.

Coffee stimulates most of the digestive glands, being sialn-
gogue, stomachic and slightly laxative. So far it is diete-
tically wholesome.

2. ACTION IN THE BLOOD, AND SPECIFIC ACTION AND USES.

Caffein is absorbed into the circulation unchanged; and
acts chiefly upon the central nervous system. The cerebrum
is first stimulated, causing the clearness of intellect, the re-
moval of languor, and the sleeplessness, familiar after a cup of
strong coffee. Larger doses cause a species of narcotism ; but
there are great differences in this and other respects according
to the individual and other circumstances. In the 1< > \\-IT
animals the spinal centres are simultaneously affected to such ;i
degree that tetanic convulsions may occur, not unliko tlms-.
C;MISC<I by strychnia; but in man these effects on the lower
centres are quite subsidiary. The sensory and motor peri-
pheral nerves are not certainly affected. The muscle curve
is altered in character, and muscular contraction seems more
easily executed. The heart is first accelerated — another
familiar effect of a full cup of coffee ; it is then slowed
and weakened. The blood pressure first rises and then falls.
Respiration is temporarily increased, then depressed ; an :
occurs in this way. Metabolism is probably somewhat in-
creased, and the temperature raised. In all these respects
habit markedly reduces the influence of coffee.

Coffee and caffein may be used as a nervine stimulant and
restorative in ordinary conditions of fatigue. .M
qucntly relieved by either. Large doses must be avoided.

3. REMOTE LOCAL ACTION AND USES.

Caffein is excreted unchanged in the bile and urino, thr
latter presenting the characteristic odour of th'

272 MATER i A MEDIC A AND THERAPEUTICS.

In passing through the kidney, it appears to stimulate
the cells, at least in some subjects, and acts as a diuretic.
Citrate of caffein is thus a powerful, hut somewhat uncertain,
remedy in dropsy, whether cardiac or hepatic. It is best
given after, and then along with, a stimulant diuretic, such as
digitalis ; for a short time ; and in moderate doses.

YALERIAKACE.E.

Valerianae Radix — VALERIAN ROOT.
dried root of Yaleriana officinalis. From
indigenous to and also cultivated in Bri
Collected in autumn, wild plants being preferred.

Characters. — A short yellowish- white rhizome, with nume-
rous fibrous roots about two or three inches long ; of a bitter
taste, and a penetrating odour, agreeable in the recent root,
becoming fetid by keeping ; yielding volatile oil and valerianic
acid when distilled with water.

Substances resembling Valerian : Serpentary, Arnica, Vera-
trum Viride, known by odour.

Composition. — The active principles of valerian are a volatile
oil and valerianic acid. The oil consists of a terpen valerene,
Ci0Hl6, and an oxygenated oil, baldrian camphor, Ci2H2oO.
Valerianic acid, C5H1002, occurs in a large number of other
plants, and in cod-liver oil ; and can be derived from fousel oil
(amylic alcohol, or valeryl-aldehyd), C5H120, by oxydation. It
is a colourless oily fluid, with a powerful odour and acid
burning taste ; soluble in 30 parts of water, and freely in
alcohol and ether.

Dose, in powder. — 10 to 30 gr.

Preparations.

A. Of Valerian Hoot :

1. Infusum Valerianse. — 1 in 36. Dose, 1 to 2 fl.oz.

2. Tinctura Valerianse.— 1 in 8 of Proof Spirit. Dose, 1 to 2

fl.dr.

3. Tinctura Valerians? Ammoniata. — 1 in 8 of Aromatic

Spirit of Ammonia. Dose, ^ to 1 fl.dr.

B. Containing Valerianic A.cid :

SodsB Valerianas.— Valerianate of Soda. NaC5H902.

Source. — Made by (1) distilling Amylic Alcohol with Sul-
phuric Acid and Bichromate of Potash; (2) saturating the
distillate with Liquor Sodae, evaporating, liquefying, and

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