' fc * ?s -. '.'^ii^la^.""..- ii;pn iUs??■• »V.-tft::.-:.5 •■.'. M*:!!!!;" ■■■:::: ■ ii'i'' NLM000867422 T^^ ; ~ &J l \§s' NATIONAL LIBRARY OF MEDICINE NATIONAL IIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE M 1/V ! 3N I 3 10 3W JO ABViail IVNOIIVN ] N I 3 I 0 3 W JO A * V I a II IVNOIIVN IN I 3 10 3 W JO ABV BBI 1 IVNOIIVN 3 NATIONAL IIBRARY OF MEDICINE NATIONAL IIBRARY OF MEDICINE NATIONAL IIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL IIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE N 3NI3IQ3W JO AlViail IVNOIIVN 3 N I 3 I 0 3 V. JO A a V I B I 1 IVNOIIVN 3NI3I03W JO ABVBail IVNOIIVN 3 NATIONAL IIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE N 3NI3I03W JO ABVaail IVNOIIVN 3NI3I03W JO A * V II a I 1 IVNOIIVN 3NI3I03W JO A II V B a II IVNOIIVN 3 NATIONAL IIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL IIBRARY OF MEDICINE A TEXT-BOOK OF PRACTICAL THERAPEUTICS, WITH ESPECIAL REFERENCE TO THE APPLICATION OF REMEDIAL MEASURES TO DISEASE AND THEIR EMPLOYMENT UPON A RATIONAL BASIS. BY HOBART AMORY HARE, M.D., B.Sc, w» ♦ PROFESSOR OF THERAPEUTICS AND MATERIA MEDICA IN THE JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA | PHYSICIAN TO ST. AGNES'S HOSPITAL AND TO THE MEDICAL DISPENSARY OF THE CHILDREN'S HOSPITAL | LAUREATE OF THE ROYAL ACADEMY OF MEDICINE IN BELGIUM, OF THE MEDICAL SOCIETY OF LONDON, ETC. ; SECRETARY OF THE CONVENTION FOR THE REVISION OF THE PHARMACOPOEIA OF 1890. SECOND EDITION, ENLARGED AND THOROUGHLY REVISED. PHILADELPHIA: LEA BROTHERS & CO. 189 1. Entered according to the Act of Congress, in the year 1891, by LEA BROTHERS & CO., in the office of the Librarian of Congress. All rights reserved. DORNAN, PRINTER. H- THIS VOLUME IS DEDICATED TO Dr. J. WILLIAM WHITE, PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF PENNSYLVANIA, AS AN EVIDENCE OF FRIENDSHIP AND ESTEEM, BY THE AUTHOR. PREFACE TO THE SECOND EDITION. The fact that the first edition of this book was exhausted within six months of its publication, and adopted as a text-book in a number of medical schools during that time, has encouraged the author in his efforts to make the work more serviceable than before. A number of new drugs are discussed which have been tried with suf- ficiently good results to warrant their introduction into a text-book and work of reference, and the latest information regarding the more familiar medicaments has been added. The method of employing the rest-cure, and the use of suspension in the treatment of loco- motor ataxia and allied affections are given, and a large number of new prescriptions have been inserted to illustrate still further the best means of applying remedies for the cure of disease. Philadelphia, 222 South Fifteenth Street. May, 1891. PREFACE TO THE FIRST EDITION. The object of this book is to provide the physician or under- graduate student of medicine with a reliable guide in the study of Therapeutics, or the application of remedial measures for the cure of disease. It has been written because, in the belief of the author, most of the text-books on this subject treat of it as if the student was already a skilled physician or experimental pharmacologist. As a consequence, two classes of undergraduate readers exist. One finds that the mixture of science and empiricism is too difficult for him to fathom, and is hopelessly confused; the other simply learns the reme- dies and doses by heart and gives drugs with little idea as to what they are to do. Further than this, the physician is often at a loss to decide when a remedy is indicated, even though his theoretical knowl- edge of the subject be very thorough. Thus, he is told that ammo- nium chloride is a remedy in bronchitis, but the exact stage at which it is to be employed is often not stated; or he knows that digitalis does good in cases of cardiac disease, but fails to recognize the fact that it is only when compensation is lacking that the drug is needed. For this reason Part IV. has been written, not with the object of providing a rigid system for treatiug disease, but rather for the pur- pose of bringing together the best remedies, and of showing how and why they are given. Rational therapeutics at the present day does not consist in a knowledge of doses and the materia medica, but exists as a complex art in which knowledge and its proper application, based on common- sense principles, go hand-in-hand. The treatment of "symptoms as they arise" by the employment of remedies recommended by some eminent authority is a variety of empiricism whose existence has depended largely on the fact that many physicians of the past have viii PREFACE TO THE FIRST EDITION. either been so ignorant as to be led where a writer willed, or so sloth- ful as to be willing to let others think for them. Scientific research has so largely opened up to everyone the possibility of using drugs with a distinct idea of the reason for their employment, that the writer has endeavored to bring together in a readable form the com- bined results of laboratory and bedside experience, thinking the time ripe for such a task. It. is true that several other books give, in a more or less thorough manner, a resume of the physiological action of the drugs of which they treat, but in even the best of them only the most trained student of pharmacology can discover the close rela- tionships which exist between the results reached by the physiologist on the one hand and the clinician on the other. The two parts of the study are usually so divorced by the prolonged mental effort neces- sitated by the arrangement of the text, that the student either ignores the physiological action for the sections on therapeutics, or crams the former to pass an examination required by the teacher whose course he must follow. As a consequence, too many physicians regard pharmacology simply as a species of mental training, or believe it to be a waste of time and energy. No one can think that the writer of this book will ever deny the value of original research or bedside experience, but he does desire to weave science and practice into so close a network that the foundations of experience may be cemented by the mortar of exact knowledge. In some instances, however, science and practice seem to be absolutely opposed, and only future research can explain the apparent contradiction. Throughout this book, in every part where drugs or diseases are considered, the writer has arranged the titles in alphabetical order, according to their English names. This has been done because it is desired to afford the reader a ready-reference book to which he may turn at short notice for desired information, for at present the state of pharmacology is so unsettled that a true classification is impossible. Thus, morphine may be classed by one writer as a nervous sedative by another as a sleep-producer, by a third as a bitter substance and by a fourth as a respiratory depressant. Bromide of potassium can with equal propriety, be called a spinal sedative or a cerebral sedative PREFACE TO THE FIRST EDITION. ix or caffeine be classed as a cerebral stimulant, a circulatory stimulant, or a diuretic. In order to make the book more complete, the preparations of the British Pharmacopoeia have been introduced ; and with the same object in view, a dose-list of drugs, both officinal and unofficinal, has been appended for ready reference. The subject of medical electricity has heretofore commonly fouud a place in most text-books on thera- peutics, but has been advisedly omitted in this instance, since elec- trical therapeutics has outgrown any work save one devoted to that subject alone. For many of the articles on treatment the author wishes to thank friends who have earned prominence in connection with their special- ties. Thus Dr. G. E. de Schweinitz has contributed the articles on the treatment of diseases of the eye; Dr. Edward Martin those on the treatment of venereal diseases and on antisepsis; Dr. Barton C. Hirst those on the treatment of diseases of the puerperal state; and Dr. J. Howard Reeves, the articles on the treatment of diseases of the upper air-passages. All of these articles enhance the value of the book to so great an extent that the author feels sure they will be sought out and read with interest. In addition to the general index, a copious and explanatory index of diseases and remedies has been appended, which will prove sug- gestive and valuable to practitioners, and for which the anthor is in- debted to his friend and student, Mr. J. G. Clark. Philadelphia, 222 South Fifteenth Street. September, 1890. CONTENTS. PART I. page General Therapeutical Considerations.....17-31 PART II. Drugs............33-310 PART III. Remedial Measures other than Drugs.....311-344 Foods for the Sick.........345-350 PART IV. Diseases ............ 351-593 Table of Doses and Remedies.......595-602 Tables of Relative Weights and Measures in the Metric and Apothecaries' Systems . . . . . . . 603-604 Index of Drugs and Remedial Measures .... 605-620 Index of Diseases and Remedies......621-658 PART I. GENERAL THERAPEUTICAL CONSIDERATIONS. Before entering into a study of the action of drugs upon the living body, it is necessary that the student should possess a clear idea of what the word "therapeutics" means, the reason why we resort to drugs, and more important than all, that he should grasp the limi- tations which govern the administration of remedies. Two very foolish and unfounded ideas have recently been put for- ward by certain physicians—one being, that medical therapeutics is useless; and the other, that this branch of medical knowledge is not advancing with so great a stride as is pathology or surgery. The individuals who laugh at the general use of drugs in disease belong to one of two classes: either they have never tried them, or if so have used the drugs ignorautly or wrongly, or else they believe that they are promulgating a new theory, and do not know that the eras of excessive dosage and nihilism are alike relics of the past. No reform has ever attacked a crying evil without becoming excessive and absurd itself, and if successful in accomplishing its object has generally re- sulted not in the mere remedy of the faults it antagonized, but in so complete a reversal of popular opinion as to force its converts into ways as reprehensible as their former habits. Thus, iu exactly the same manner that the excesses of Catholicism resulted in fanatical Puritanism, so did the careless methods of physicians during the past century lay the foundation for the growth of homoeopathy or thera- peutic nihilism. At the present time, although we have much to learn, it can be said that we have benefited by both of these errors, and are in consequence taking a path which may be considered the happy medium. To the majority of the readers of this book, however, the harmful- ness of over-dosing is sufficiently evident, and the cry of " no drugs at all" so absurd that no rebuttal need be offered. The statement that therapeutics is to-day more backward than pathology and surgery is readily answered by a denial; for the thera- peutist is able to treat successfully many diseases of which the pathologist knows nothing, and is obliged to rest his treatment on empiricism simply because he canuot tell how his drugs act if the pathologist cannot tell him what the disease is. Rheumatism is a good example of this very point. 2 18 GENERAL THERAPEUTICAL CONSIDERATIONS. In regard to surgery, everyone must recognize the extraordinary advances made in this branch of medical science, yet comparatively few realize that it is solely by the introduction of drugs that all its triumphs are possible. The definition of the word " therapeutics " in Billings's Dictionary is: "that branch of medical science which treats of the application of remedies to the cure or alleviation of disease," and, practically, the term is universally used to signify the employ- ment of drugs for such purposes. The credit for the introduction of new instruments may or may not be accorded to surgery, but the dis- covery of new drugs must be accorded to therapeutics. We find, then, that ether and chloroform began to revolutionize surgery fifty years ago, and that corrosive sublimate, carbolic acid, and other drugs have revolutionized it once more within the lifetime of everyone who reads this book. Cocaine has changed the entire aspect of eye surgery and other minor operations, and has immediately averted an enormous amount of pain and suffering which the surgeon could not relieve, or at most remove, unless its influence was present. To the accusa- tion of backwardness, the therapeutist can well ask the champion of any other branch of medical science to put forward one discovery which equals antipyrine or acetanilide in power to relieve disease or pain, or which can be applied to so wide a scope of ailments as specifics. In the lauguage of one of the most progressive medical men of to- day in the United States, the man who does not believe in the proper use of drugs for the cure of disease must lack the very keystone of the arch upon which all medical knowledge rests. The ultimate aim and object of all medical thought and effort is the cure or alleviation of disease, and therapeutics is the refined product culled from every department of medical learning. Like every other thing requiring a thorough knowledge of its component parts, it is often much abused by the careless and ignorant, but is a power for good in the trained hand of the properly educated physician. Further than this, therapeutics is the only universally used brauch of medicine, for each and every branch must resort to it, and the most skilful operator who fails to treat his cases medicinally with equal skill will have worse results than he who, though bungling in his surgery, yet uses drugs intelligently after his slashing is finished. Homoeopathy depends upon more than one reason for its existence. If infinitesimal doses are given, the patient is satisfied that he is re- ceiving medicine, and Nature often produces her most rapid cures when left alone. Again, the entire basis of homoeopathic therapeutics rests not upon the study of the causes of disease, but upon the symptoms which constantly present themselves. As a result of this, so many minor symptoms are relieved that the patient's comfort is insured and doubtless in many instances serious disorders are discovered which might otherwise be cast aside or go unseen. No detail should be too small to attract the attention of the physician, and he who exercises care in detail must reap reward in larger measure. MODES OF ADMINISTERING DRUGS. 19 MODES OP ACTION OP DRUGS. Drugs act in two ways, which are sometimes called near and remote, direct and indirect. The near, or direct, action of a drug is that influence which is felt by the exercise of its effects directly upon the tissues with which it comes in contact; the indirect, or remote, influ- ence is that result which comes as a sequence of its primary effect. As an illustration of this we may take the local use of cantharides. The local, near, or direct effect of this is a blister; the remote or indirect effect is the absorption of exudations or the influencing of inflammatory processes. If pilocarpine is used, its direct effect is the sweating which ensues, while its indirect effect is the relief of dropsy. MODES OP ADMINISTERING DRUGS. Drugs may be used to affect the general system in many ways, but practically we employ only six methods, as follows : 1. By the mouth or stomach. 2. By the rectum. 3. By inhalation. 4. By hypodermic injection. 5. By inunction. 6. By the endermic method. By far the most usual manner of administering drugs is by way of the mouth, which is the most natural means of entrance into the body for foreign substauces. Whenever medicines are used in this way, the physician should clearly bear in mind what the medicine is to do after it is swallowed. Thus, if the drug is intended to act directly upon the stomach it should not be given after meals, but a little while before, since the food and gastric juice may afterward so cover the gastric mucous membrane that the medicament cannot act. Thus, in the case of chronic gastric catarrh or gastric ulcer the nitrate of silver which is used should always be given half an hour before meals. On the other hand, if an ulcer or other trouble exist in the small intestine, the pill should be given some time after meals, and if a heavy meal is taken, three or four hours after, since under these circumstances the medicine is swept out into the intestine almost at once, without remaining any time in the stomach, where it may be chemically altered. Very often it is necessary to give a medicine soon after food is taken, in order that it may not act in too powerful or concentrated a manner upon the viscus which receives it. The general rule, however, may be laid down, that all medicines are to be taken after rather than before meals, unless a local gastric effect or very rapid absorption is desired. 20 GENERAL THERAPEUTICAL CONSIDERATIONS. When drugs are given by the rectum, we employ them for three purposes. First, to influence the general system by their absorption ; secondly, to act locally upon any disease which may be present in this particular locality; and, finally, to dislodge substances or parasites which it is desired to bring away. The word " enema " is loosely used to denote all these injections, be their purpose what they may, and is synonymous with " rectal injection " or the more old-fashioned word "clyster." If nourishment is being given the injection is called a "nutrient enema." Sometimes these injections are called "lave- ments." In this mode of administration it is very necessary that the physi- cian should use his medicaments in proper bulk; and it may be laid down as a rule that no more liquid should be iujected than is neces- sary to convey the medicine or food, unless the injection is for the purpose of emptying the bowel of faecal matter or other materials, or it be desired to distend the colon in order to overcome obstruction or to influence chronic colitis. The reason for this lies in the fact that any large bulk of liquid sent into the rectum so stimulates its walls by distention as to cause spasmodic contraction, with expulsion of all the rectal contents, which is just what is needed when fsecal matter is to be removed, but the opposite of what is desired when retention of a remedy or food is necessary for absorption or local action. In rectal catarrh or ulcer, two to four ounces of liquid are usually sufficient in an adult to accomplish any medicinal influence locally or by absorption, while as a laxative enema one to two pints may be employed. In the use of injections we frequently find that the rectum becomes irritable, and promptly resists all efforts to force the entrance of liquids or solids. This is to be avoided by giving the injection so gently that the bowel fails to recognize, as it were, the entrance of liquid, and by introducing a few drops of oil and laudanum in each injection. Suppositories are another means by which we introduce medicines into the bowel, either for local effect, or to act after absorption of their contents upon the general system. When drugs are given by inhalation they are generally employed with the object of affecting the respiratory tract alone, although there are notable exceptions to this in ether, chloroform, nitrous oxide gas, and other volatile substances. Aside from anaesthetics, we find such remedial measures as the inhaling of steam laden with the druo-s employed, the respiring of air loaded with the fumes of the medica- ment, or the inhalation of gases; and last, and most commonly resorted to of all, the atomizing spray, which, if properly made and employed, so minutely divides the liquid containing the medicine that the inspired air carries it to the furthest bronchiole and pulmonary vesicle. As examples of the rules governing the administration of druo-s in this mauner, we find that compound tincture of benzoin may be taken MODES OF ADMINISTERING DRUGS. 21 by inhaling the steam arising from hot water containing it, but cannot be used in a spray because it occludes the fine points of the tubes. In a similar manner we may inhale the smoke of belladonna or tobacco . leaves to relieve asthma, or the fumes of chloride of ammonium for bronchitis in its later stages. Finally, we find that oxygeu is exceed- ingly useful, the gas being readily inhaled with good results in proper eases. The " spray " or atomizer is made in two forms; one form of appa- ratus being worked through the agency of compressed air, the other through the escape of steam from a small boiler. Very few of the compressed-air atomizers throw a spray fine enough to reach the lower parts of the lung, particularly if the air is compressed by the hand. The inhalation of moist air is very useful in bronchitis, and greatlv aids other remedial measures. Steam may be disengaged in a room by means of a kettle of boiling water, or by placing pieces of unslaked lime in a pan of water. Next to the use of drugs by the mouth, by far the most popular method is their administration by means of the hypodermic needle and syringe. The logic of this method rests upon the absorption of all soluble substances from the subcutaneous tissues with great rapidity. Any substance soluble enough or suspeudable enough to pass through a hypodermic needle without forming an obstruction may be employed, provided it is not too irritating and that it is " clean." The proper places to give such injections are the forearm, on the extensor surface,1 the calf of the leg, the buttock, or the broad of the back—in other words, any spot where the tissues are not dense and unyielding. The skin of the part is to be grasped or pinched up with the thumb and forefinger of the left hand and the needle sent well into this raised fold, preferably above the finger and thumb—so that the pressure of the fingers may prevent pain and the too rapid entrance of the medicine into the system. The needle should always penetrate well into the loose connective tissue, so that the liquid injected may find lodgment in the loose and spongy subcutaneous tissues without sepai'ating the skin from its rather close adhesion to the tissues below and to the bloodvessels supplying it, for if separation occurs abscess and a slough may result. The dangers from hypodermic injections are chiefly two. First: The medicine may enter a vein, owing to the penetration of its wall bv the needle, and the entire dose be carried at once, en masse, to the vital centres. Second: The solution used may not be sterile, or the needle may be dirty, and an abscess may result. The first, danger is to be avoided by injecting into spots not well supplied with veins, and the second by thoroughly washing both syringe and needle with water the instant before they are used, pushing a fine wire through the needle, and in some cases by soaking the latter in carbolized oil. The liquid 1 Hypodermic injections into the anterior aspect of the forearm often cause much pain in the hand by irritating temporarily the radial or ulnar nerve. 22 GENERAL THERAPEUTICAL CONSIDERATIONS. injected may be rendered sterile by using freshly boiled water and adding thereto carbolic acid in such proportion that one-half to one drop of carbolic acid is present in each injection. Most hypodermic syringes hold from twenty to thirty minims. Inunctions consist in the rubbing into the skin of medicines gener- ally of an oily or fatty nature, or which assume this character through embodiment with oil or fat. The three substances most commonly used in this way are cod-liver oil, mercurial ointment, and iodine ointment. They should always be applied on some part where the derm is thin and is well supplied with subcutaneous lymphatics, as in the axillse, the groins, or the insides of the thighs. Other sub- stances have been and may be used by inunction ; but as this method is necessarily a disagreeable and dirty one, it is rarely resorted to unless the stomach is disordered, or it is necessary to push the drug into the system by every possible avenue of entrance. The endermic method consists in the use of a blister by means of which the epiderm is raised when little morphine or other alkaloid may be slipped under it aud so absorbed through the true skin. It is a painful method, almost never to be resorted to, which has been entirely supplanted by the hypodermic method of medication. Remedies are administered in a number of forms, but chiefly as follows: Abstracts are dry powdered extracts mixed with sugar of milk until they are twice as strong as the crude drug; only eleven of them are officinal. Aceta, or vinegars, are solutions of drugs in vinegar or acetic acid. There are four in the United States Pharmacopoeia and three in the British. Alkaloids are organic bases, generally occurring in crystalline form and abstracted from crude drugs. They nearly always represent the active principle of the drug. Aqu^e, or waters, are used as vehicles either for the dilution of strong medicines, or for the purpose of carrying minute amounts of flavoring materials. Cataplasms are not officinal in the United States Pharmacopoeia, but are in the British Pharmacopoeia. They are virtually poultices made of linseed-meal or of bread-crumbs. Cerates are ointments containing wax to render them harder than would ordinary fats. Chart.e, or papers, consist of bibulous paper soaked in a solution of the drug which they are meant to carry. Confections are sometimes called electuaries or conserves and are soft pastes which contain the drug mixed with sugar or honey. Decoctions are solutions of drugs made by boiling and then straining while hot. dosage. 23 Elixirs are diluted tinctures rendered pleasant to the taste by the addition of aromatic substances and sugar. Emplastra, or plasters, are made up of adhesive substances placed upon a backing of cloth or leather and designed to adhere to the skin : being so applied for the purpose of holding a medicinal substance in contact with the body, of acting as a protective, or of aiding in the approximation of the edges of a wound. Extracts consist of the soluble parts of plants reduced to a semi-solid or solid condition by evaporation ; the soluble constituents being taken from the plant by water or alcohol. Fluid Extracts are made in the same way as solid extracts, except that they are not so completely evaporated. Glycerita, or glycerins, are solutions of various substances in glycerin; the glycerin being used as a vehicle. Infusions are made by pouring boiling water on the crude drug and allowing it to stand for a short time until the water cools, after which the liquid is strained. Sometimes cold water is employed. Pills are small round masses which, as a general rule, should not weigh more than three grains, in order to avoid their being too bulky. If the material is a heavy one, as much as five grains may be placed in each pill. Suppositories are small masses made into a cone shape and having for their basis cacao butter. They are designed to carry into the rectum certain medicines for absorption into the system or for local action. Tinctures are solutions of the active principles of drugs in alcohol. Triturates are made by adding ten per cent, of the active medi- cine to ninety per cent of milk-sugar. These are then carefully rubbed together until the two are intimately mixed. Troches, or lozenges, are flat, hardened masses designed for hold- ing medicines in the mouth so that they may be slowly dissolved, thereby affecting the local mucous membraue. Ointments consist of the mixture of some kind of fatty substance with the medicine which they are designed to carry. Wines are made in the same way as tinctures; strong white wine being used in the United States, and sherry or orange wine in Great Britain, in place of ordinary alcohol. DOSAGE. There is, unfortunately, no absolutely fixed rule which can be applied to dosage, for several reasons. In the first place, the indi- vidual may not be readily affected by drugs, or the disease process which is present may so antagonize them as to render very large doses necessary. Further than this, the age and sex of a 24 general therapeutical considerations. patient have much to do with the regulation of the proper amount of a drug which we may give. Finally, that curious but common condition of susceptibility to various remedies, that we call idiosyn- crasy, creeps in as an important factor in the decision as to the dose which should be given in each case. By far the nearest approach which wTe can make to absolute accuracy in dosage, is to use drugs according to the weight of the patient, but this method possesses the disadvantages that we cannot always weigh our patients, and that the presence of a large amount of fat or of dropsy will make an unknown quantity in our calculation as to the true weight of the active part of the individual. At present we are accustomed to be governed by a list of doses to be given to all adults within certain limitations, and which are varied sufficiently to permit of great differences in the effects ob- tained. It is in this very point that the success of many a physi- cian chiefly rests; for the use of a dose by "rule of thumb" is as empirical and lacking in thought as is the use of a remedy, not because we have a different action for it to carry out, but because it did someone else good who was suffering from what appears to have been a similar attack. The dose must be varied to fit the case in the same manner that the cut of a coat must be varied to fit each individual. There are a number of rules in regard to the doses which are to be given in treating the diseases of children, the best of which is Young's rule. This is as follows: Add 12 to the age and divide by the age. Thus, if a child is two years old, we have the following formula: 2 + 12= 14 -=-2 = 7; or, one-seventh of the dose for an adult is the dose for a child of two years. This rule is not a law, however, for of narcotics children receive less than this (one-half), and of purgatives or laxatives more than this (two to three times). When drugs are given hypodermically the dose should be generally one-half to one-quarter of that given by the mouth, and if any thought of idiosyncrasy exist the dose should be smaller still at the start if powerful remedies are to be used. By the rectum the dose should be twice the amount given by the mouth, unless the drug be very powerful or capable of very rapid absorption. IDIOSYNCRASY. This is one of the most interesting features of the study of the action of drugs. It is a frequent cause of disappointment to both patient and doctor, and an equally frequent cause of excessive action from what the physician has thought to be a moderate dose. No rule can be laid down for the discovery of idiosyncrasy in a given case, except that females, particularly of the hysterical type, are more subject to it than are males, although certain men often present marked evidences of this tendency. No better illustration of idiosyncrasy can be adduced IDIOSYNCRASY. 25 than the case which here follows, nor than that of a friend of the author, who cannot eat a strawberry without suffering from a violent attack of hives. The first case is that of a woman of thirty years, suffering from severe headache, who received an eighth of a graiu'of the hydrochlorate of pilocarpine, hypodermically, every twenty minutes, till nearly three- fourths of a grain was taken, without any evidence of its action either in salivary flow or sweat. But the tolerance of drugs did not stop here. Twenty drops of tincture of cannabis indica every four hours failing to relieve the pain, half-grain pills of the solid extract were ordered, two of which commonly affect a grown man most markedly. The extract had been proved to be active in other patients. In order to avoid any failure in absorption the pills were each cut in half before they were given, and forthwith administered, one every three hours, without any effect after ten had been taken. Twenty more of the pills from the same manufacturers, but from a different retailer, were now given, one every hour, with the exception of a few irregularities in administration during the night, the entire twenty being swallowed be- tween four o'clock one afternoon and two o'clock on the next afternoon. The thirty pills (15 grains) were taken in less than forty-eight hours without producing a single physiological sign of the slightest character. That the doses were really swallowed would seem to be undoubted, for their administration was carried out by a trained attendant, and their black color forbade their expulsion from the mouth on the bed without attacting attention. The hypodermic injections were given by the author, and as the solution was made as fast as it was used, the patient must certainly have received all of the pilocarpine. As there was daily an afternoon rise of temperature amounting to several degrees, quinine bisulphate was ordered in the dose of fifteen grains, to be given after six powders of one-sixth of a grain of calomel had been taken; this not only failed to control the fever, but also pro- duced no buzzing in the ears. The writer was now inclined to con- sider all the symptoms as hysterical, even including the evening rise of temperature. Twenty-four hours after the last dose of cannabis indica, the attendant gave the patient, without orders, no less than sixty grains of antipyrine in sixteen hours without any physiological symptoms, and, under orders, she took from forty to fifty grains of bisulphate of quinine every day for three days without any signs of cinchouism. Wide experience has taught us, however, that several conditions act fairly constantly in regard to some idiosyncrasies. Certain diseased conditions—such as peritonitis or pain—allow large doses of opium to be given, and in lead-poisoning and paralysis patients may require enormous doses of active purgatives to move the bowels. The climate in which the patient lives, or has been accustomed to live, renders him more or less susceptible to certain remedies. Thus the East Indian runs amuck after eating hasheesh or cannabis indica, 26 general therapeutical considerations. or the Chinaman goes into a delightful dreamland from smoking opium, whereas the Anglo-Saxon experiences no such agreeable sensa- tions, as a general rule. Southerners generally require larger doses of purgatives than Northerners, often because their livers are not as active. The temperament of an individual is also a highly important matter to be considered. It is a notorious fact that phlegmatic dark-skinned persons usually yield to drugs less readily than blondes and nervous persons, more especially in respect to the drugs which act on the nervous system. Nervous light-haired women stand belladonna very badly as a general rule, while children will take large doses often with- out discomfort. Opium is usually badly borne by children. Habit is another important factor governing idiosyncrasy. We all know how rapidly one becomes accustomed to tobacco, and how mor- phine habitues take enormous amounts of their favorite drug without effect. ABSORPTION OP DRUGS. The knowledge of the rapidity with which certain drugs are absorbed from the various surfaces with which they come in contact, is of im- portance in order that we may know when to repeat the dose if the first amount does not produce the desired effect. The rapidity of absorption depends upon a number of factors. If the circulation is active absorption is active, but if it be depressed absorption is slow. Thus, in a person apparently drowned, absorption may not occur at all until the vital functions are restored, and repeated doses given to the patient while unconscious, acting together, in the end poison him. This is often the case in delirium tremens where hypodermic injections of morphine are given, or when the drug is administered by the mouth. In dropsy absorption is peculiarly slow, and the drug may remain in the tissues for days, only to be absorbed with the exudation after severe purgation or profuse diuresis, or tapping. In general dropsies hypodermic medication is nearly always worse than useless. When the stomach or bowel is empty absorption from them is rapid, but when they are full it is very slow. In this fact we find the reason for the popular idea that a glass of whiskey when a man is hungry makes him drunk, whereas twice the quantity after dinner does not do so. Drugs in the stomach or bowel have no influence over the general system unless they are irritants. They only act when taken into the blood or lymphatics. Recent studies show that alcoholic solutions of drugs are more rapidly absorbed than are watery solutions or those made with glycerin or milk. STRENGTH AND RELIABILITY OF DRUGS. 27 DURATION OP ACTION OF DRUGS. The duration of the action of drugs depends partly upon their rapidity of absorption, but chiefly upon the rapidity or slowness of their destruction in the body, or their elimination from it. Thus, volatile substances such as ether, chloroform, and nitrite of amyl, act only for a short time and are quickly eliminated, whereas bromide of potassium and digitalis continue active during many hours, and are slowly elim- inated, as in the case of the former, or oxidized, as in that of the latter. Again, if curare is given hypodermically it will cause paralysis, but if taken by the stomach in moderate amount it will be eliminated by the kidneys as rapidly as it is absorbed, and produce no effects if these organs are active. From studying the rapidity of the elimination of a drug we learn how often to order a dose. Thus, digitalis may be given once, twice, or thrice a day, but carbonate of ammonium every two or three hours. When the physician is not careful in the use of a drug which is eliminated slowly, it may suddenly develop so severe an effect as to cause alarm, owing to the accumulation of the poison in the body. This is called "cumulative action." STRENGTH AND RELIABILITY OF DRUGS. If a census could be made of those who die annually from the use of drugs which are impure or useless from weakness, the writer believes that a most alarming array of figures would be presented. For many years this was unavoidable to a great degree, either because our knowledge of the active principles of drugs and the methods of isolating them was deficient, or because the time consumed in their transportation by sailing vessels or on the backs of natives from the countries in which the natural products yielding the drugs were obtained, permitted deterioration to take place At present these difficulties have been largely overcome. The trained pharmacist is taught how to make an assay for active principles in most of the valuable alkaloidal drugs, and every physician should make careful investigation into the quality of all preparations which he employs. That these remarks are not out of place will be seen by the fact that very recently an intimate friend of the writer bought from five of the leading druggists of Philadelphia 6 ounces of tincture of mix vomica which were stated to have been made according to the directions of the United States Pharmacopoeia. That made by perhaps the leading drug- gist of the five contained twice as much strychnine and brucine as it should, and had twice as much solid residue; or, in other words, a physician prescribing this tincture in full dose would probably have poisoned his patient and reported the case as one of unusual suscepti- 28 GENERAL THERAPEUTICAL CONSIDERATIONS. bility to drugs! On the other hand, the author has recently seen a tincture of nux vomica which contained only a trace of alkaloid, but had much inert solid residue. In neither instance was the druggist a dishonest one, intentionally, but one had used a crude drug which was unusually rich in alkaloids, while the other had purchased nux vomica beans which, by reason of immaturity, bad surroundings, or exposure to weather, were very poor in active principles. All these disadvantages may be avoided if physicians will insist that the druggists who dispense the drugs they order shall either themselves prepare assayed products, or purchase such products from any one of the large manufacturing chemists who put assayed goods on the market. When this is impossible the physician should employ the alkaloids, in pill form, or, if solutions are desirable, the alkaloid may be added to alcohol and water and given by drops, as is the case with any ordinary tincture. Digitalis and veratrum viride are practically the only drugs with which this cannot be done; in the first the action of the drug does not depend upon a single active principle, but upon a large number, and in the second the relative proportions of jervine and veratroidine cannot be well estimated by the physician. H. C. Wood records a case in which opium poisoning occurred in a child who had taken a Dover's powder; the reason being that the amount of opium intended for many doses was in the powder that was dis- pensed, the other constituents not having been properly mixed with the opiate in compounding the prescription. Constant uncertainty is a dangerous element when we are dealing with patients who are desperately ill; and in many cases failure and discouragement may both be avoided if the physician will see to it that the tools with which he works are in good order and capable of doing what he requires of them. A poor drug to the physician is worse than a rusty knife to the surgeon ; for the injury in the one case is unknown, whilst in the other it can be carefully watched and guarded. INDICATIONS AND CONTRA-INDICATIONS. The indication for a drug is any symptom or series of symptoms which we know the drug will relieve without causing at the same time any evil effect to be felt by other parts of the body. A contra- indication is any coexisting state or tendency which will be made so much worse by the drug as to forbid its use. Thus, one might be tempted to give quinine in meningitis for the fever, yet this would be bad therapeutics, since quinine is contra-indicated because it will intensify the meningitis. Cardiac stimidants are contra-indicated in the presence of arterial excitement, and indicated in arterial depression. Cardiac sedatives are indicated in arterial excitement, contra-indi- cated in arterial depression. COMBINATION OF DRUGS FOR JOINT EFFECT. 29 Nervous stimulants are contra-indicated in nervous excitement, indicated in nervous depression. Nervous sedatives are indicated and contra-indicated in a reverse manner to nervous stimulants. Astringents are contra-indicated as a rule in acute inflammations, as most of them are irritants when applied profusely. The exceptions to this rule are the salts of lead and silver, and bismuth subnitrate, all of which are sedative astringents. Tonics are indicated in instances of local or general systemic de- pression, contra-indicated in cases of inflammation or excitation with excessive functional activity. Alteratives are indicated where cell-growth is active to excess, but contra-indicated where tissue break-down is present, or there exists a tendency thereto. Emetics are indicated when we wish to unload the stomach of un- desirable materials, or when we desire to cause an increased flow of bile from the gall-bladder—which is accomplished by the pressure exerted upon this viscus at the time that the abdominal walls and diaphragm contract in retching. When the ducts are mechanically obstructed with a gall-stone emetics are dangerous, as they may cause rupture of the gall-bladder. Sometimes we are able by the use of emetics to rid the lungs and stomach of mucus in bronchitis or gastric catarrh. The contra-indications to emetics are cerebral congestion or men- ingitis, as well as gastritis, gastric ulcer, advanced pregnancy, and hernia. COMBINATION OP DRUGS FOR JOINT EFFECT. The study of the physiological action of drugs has aided us very greatly in improving our therapeutic measures. Thus, we now know that chloral is a heart-depressant and cannot be used in very full doses, or pushed to produce sleep in persistent insomnia, without grave danger; whereas morphine, which also produces sleep but does not depress' the heart, but does depress the respiration, can be combined with it, and the two acting together, each in small dose, produce a heavy sleep, although so little chloral is present that the heart is safe, and so small an amount of morphine is used that the respiration does not suffer. Another example of this is found in certain purgative pills where the purgative agent is assisted by belladonna and nux vomica, the first of which relaxes muscular spasm, while the second acts as a tonic to the alimentary tract, the drugs combining to accomplish one result. Skill in the combination of drugs, not only for increased physio- logical effect but also for the purpose of making their administration pleasant to the taste, has much more to do with professional success 30 GENERAL THERAPEUTICAL CONSIDERATIONS. than is generally supposed. This is particularly so in regard ^ to children, for parents dislike forcing their children to take doses which they themselves regard as horrible, and they are ever ready to believe that as long as a medicine tastes good it is better than one which tastes otherwise. The medical practitioner who prescribes ever so wisely and appro- priately for a patient, but who is utterly regardless as to his combi- nations of drugs so far as taste is concerned, will sooner or later see a more ignorant man take from him that practice which his greater wisdom entitles him to, but which is driven from him by his own errors in this matter. While in some cases there is no alternative but to give a bad dose, in others a little thought and care will often avoid offending the taste of the patient. INCOMPATIBILITY. The chief value of a knowledge of chemistry to a practitioner of medicine is the avoidance of what is known as an " incompatibility," or the placing in one prescription of two or more substances which will undergo chemical interchanges, decompositions, precipitations, or cause the formation of explosive mixtures. It is impossible to detail all the incompatibilities, and only the most dangerous and common possibilities of error can be considered. 1st. An acid should never be combined with an alkali. 2d. An acid should not be added in any quantity to a tincture. The following prescription is an illustration of this : IJ.—Potas. iodidi...... . gij. Acid, nitro-muriatici ..... f^j- Tr. cinchonas comp......q.s. f^iij. M. S.—Use as directed : a teaspoonful. In this ridiculous mixture the acid is incompatible with the iodide of potassium, forming a chloride and setting free iodine, and would also change part of the alcohol in the tincture into an ether. 3d. Alkalies should not be combined with the alkaloids. Thus : 1J.—Strychninae sulph. ...... gr, j. Potas. iodidi ....... Zji. Syr. sareaparillae comp......f^iij. M. S.—Teaspoonful t. d. In this prescription the strychnine would be precipitated by the potassium salt, and the patient would get nearly all the strychnine in the last dose. 4th. Potassium chlorate should not be ordered to be rubbed up with tannic acid or any other organic substance capable of oxidation INCOMPATIBILITY. as it will explode. Permanganate of potassium is subject to the same rule. 5th. Chlorate of potassium and ammonium chloride when mixed together may take fire. 6th. Iron is incompatible with tannic acid, as it forms a tannate of iron, or ink. As all the vegetable astringents contain tannic acid they should none of them be used with iron except chiretta. 7th. Tannic acid should never be added to solutions of alkaloids. 8th. Gum arabic is not to be added to solutions of iron, lead, or the mineral acids. 9th. Alcoholic solutions of camphor and similar resinous substances are incompatible with water. 10th. Fluid extracts are incompatible with water, as the addition of water will precipitate them. 11th. All salts not acid but alkaline in reaction are decomposed by acids. 12th. All salts which are acid are decomposed by alkalies. 13th. All vegetable acid salts are altered by mineral acids and are decomposed by alkalies. 14th. Iodine and the iodides should not be given with alkaloids. 15th. Corrosive sublimate, the salts of lead, iodide of potassium, and nitrate of silver should always be prescribed alone, except in the following instances: (a) Corrosive sublimate may be given with potassium iodide, since it will throw down a soluble precipitate which redissolves and forms a double salt. (6) Nitrate of silver may be used with extract of opium or hyoscy- amus. 16th. Syrup of squill should not.be given with the carbonate of ammonium, as it contains acetic acid. Chloride of ammonium is not incompatible with it. 17th. Cherry-laurel water should not be prescribed with morphine, as it may form the poisonous cyanide of morphine. 18th. Chloral and cyanide of potassium should never be placed in the same prescription, as they will decompose each other, setting free hydrocyanic acid. 19th. Cocaine and borax when added together form an insoluble borate of cocaine. Boric acid and cocaine do not result in this forma- tion. 2lJth. Calomel and antipyrine are said to be incompatible, as are also sweet spirit of nitre and antipyrine. PART II. DRUGS. ACACIA. Acacia, U. 8., Acacice Gummi, B. P., Gum Arabic, or Gum Acacia, is a gummy exudate from the stems and branches of small trees known as Acacia Yereh, Acacia Senegal, and other acacias growing in northern Africa and in Australia. As sold in the stores it consists of irregular semi-transparent lumps, which are either smooth or angular, according to whether the substance has been preserved in the original beads or been broken by handling. Its color is slightly yellow or almost white, both color and transparency depending largely on the amount of the impurities by which it is contaminated. It is devoid of physiological action. Therapeutics.—Acacia is employed in medicine as a local applica- tion to inflamed and irritated mucous membranes, particularly of the upper air-passages, and also in the form of a drink in the same condi- tions. In instances where genilo-urinary irritation exists it is useful as a vehicle for more powerful remedies. Made into a mucilage with flaxseed, to which liquorice may be added, it is largely employed to loosen a hacking cough in children or in adults. The flaxseed should not be boiled, but allowed to stand on a moderately warm part of the " range," and the gum arable solution added with a little lemon-juice for flavoring purposes. Acacia is chiefly used in phar- macy for making pills, emulsions, and similar preparations, and is officinal in the form of the mucilage of acacia {Macilago Acacia?, U. 8. and B. P.); and the syrup of acacia (Syrupus Acacice, U. 8.), the first containing 34 parts of acacia and 66 parts of water, and the second 25 parts of the mucilage to 75 parts of simple syrup. ACETANLLIDE, OR ANTIFEBRIN. This substance, first employed in medicine by Hinsberg and Kast, is a white crystalline material only slightly soluble in water, but com- pletely soluble in alcohol and ether. Applied to the tongue it causes a burning sensation which is not very severe. It has been known to 3 34 DRUGS. chemists for many years, and is made by the action of glacial acetic acid upon aniline, forming in this way acetanilide or phenyl-acetamide. The word antifebrin is a trade-mark, and should be avoided by the profession, since its employment obliges the druggist to use the acetani- lide made by one firm instead of the compound made by chemists, who are able to make the drug as an ordinary chemical compound, and do not charge so high a price as do those holding control over the trade-mark name. Physiological Action.—Acetanilide has been studied experimentally and chemically to a very great extent, and fairly definite outlines of its action have been mapped out. Nervous System.—On the nervous system acetanilide has been found to act as a powerful sedative, the sensory portion of the nerves and spinal cord particularly being quieted. After a poisonous dose general anaesthesia comes on, with total loss of reflex action and with motor and sensory paralysis. The portions of the nervous system involved in these changes are, primarily, the sensory side of the spinal cord and the sensory nerves, the motor apparatus being least affected. The muscles are not influenced by the poison, except indirectly. Circulation.—On the circulation acetanilide has but little direct influence except when used in poisonous doses. Applied to the frog's heart it at first accelerates its beat and increases its force, but soon causes a weakening, ending with arrest in wide diastole. Upon the higher animals it causes, in toxic dose, an immediate fall of arterial pressure with a diminution in the size of the pulse-waves and all the evidences of cardiac and circulatory depression, notwithstanding the fact that death ensues from respiratory failure. The cause of this fall of blood-pressure is a direct depressing action on the heart asso- ciated with failure of the vasomotor system, as asphyxia causes no rise in pressure. In medicinal dose acetanilide causes no circulatory changes of any moment. Sometimes the pulse-rate is increased, sometimes diminished. The tendency is, however, toward depression rather than stimulation of the circulation. Blood.—The action of this drug upon the blood, when used in large doses, is more pronounced than its influence upon any part of the body, causing this tissue to become brownish-red, decreasing its ozonizing and oxygen-carrying power, and, finally, reducing the haemoglobin to methaemoglobin to a very considerable extent. The question as to the influence of acetanilide upon the corpuscles is still somewhat undecided, some observers declaring that these bodies are dis- organized, while others assert that they remain intact. In moderately large poisonous doses it may not affect the corpuscles, but if its use in large amount be maintained for some days, or a very large amount be used at one time, corpuscular destruction certainly occurs free haemo- globin appearing in the urine in its characteristic forms. The normal alkalinity of the blood is decreased, and the urine becomes dark and brownish in color, so that the blood-crystals of Teichmaun may be acetanilide, or antifebrin. 35 found in it. _ In medicinal doses the blood shows no change except in cases where idiosyncrasy is present or the doses are unusually large. Under these circumstances the blood in the arterial system becomes more blue than normal. Respiration.—No effect is produced upon this function bv acetan- ilide when given in moderate doses. When poisonous doses are used the breathing at once becomes rapid and then impaired and labored. Large doses produce death by paralysis of the respiratory centres. The causes of these changes are, primarily, the alterations in the blood, which so influence oxygenation of the tissues as to lead the respiratory centres to greater effort, while at the same time they are beginning to be directly depressed by the drug itself, so that impair- ment of their function is soon manifest. Bokai asserts that the drug paralyzes the peripheral motor nerves, which, if true, brings forward a third factor in the respiratory failure. Temperature.—W7hen given in full medicinal doses, acetanilide lowers the normal bodily temperature or else fails to produce any change. In poisonous doses it produces a decrease in temperature depending on the amount employed, and may produce collapse and rigors. On a fevered temperature it acts as'a powerful and fairly constant antipyretic, lowering the fever by decreasing heat-production and increasing heat-dissipation, heat-production being the function most affected.1 Whether the decrease in heat-production is due to an action on the heat-centres in the nervous system, or upon other causes, is not positively known. Some investigators have claimed that the fall depends upon the partial reduction of the haemoglobin of the blood, whereby less oxygen is carried to the tissues and less combus- tion ensues. This seems doubtful, in view of the fact that the most careful spectroscopic examination of the blood fails to show any such change. That the fall of temperature is not dependent on the sweat produced is proved by the fact that the temperature falls even if enough atropine be given to stop all perspiration. Kidneys, Tissue-waste, and Urine. — Much contradictory evidence exists in regard to the changes which occur in these organs and their excretory products under the influence of acetanilide, but most observers agree that the excretiou of urea is increased, and it is a fact that the more laborious researches which have been undertaken have reached a similar result. (Lepiue, Chittenden and Taylor.) Less uncertainty exists as to its influence on uric acid, which is increased rather than diminished by the drug. After excessively large doses the urine becomes dark from the presence of broken-down blood coloring matter. Elimination.—The drug is eliminated by the kidueys in the form of para-amido-phenol-sulphate. , 1 The conclusions of Evans and of the writer have been severely criticised by H. C. Wood. My reasons for holding to the opinions stated can be found in my Boylston Prize Essay on Antipyretics. Philadelphia, 1891. 36 DRUGS. Antiseptic Action.—The drug possesses some slight antiseptic powers, but they are only exercised when the amount present is quite large. Toxic Changes from Prolonged Use. — Although it has been claimed that no untoward effects result from the prolonged use of acetauilide in large doses, there can be no doubt that this is untrue. Under these circumstances congestions of the liver, kidneys, and spleen occur, and if the doses be poisonous, clots may be found in the cardiac cavities. There may be also a progressive decrease in the number of the red blood-corpuscles. Poisoning.—In man this drug in toxic quantity causes the lips to become blue, the face livid, cyanosed, expressionless or anxious. The forehead and cheeks become covered by beads of sweat, which gradually extend over the rest of the body. The pulse is soft and compressible, but slow and finally very weak. The respirations are slow and shallow. The treatment of a case of poisoning by acetanilide should consist in supporting measures, the use of stimulants, external heat, bella- donna to maintain blood-pressure, strychnine to aid the respiration, and oxygen inhalations if they are necessary to overcome cyanosis. Therapeutics. — The employment of acetanilide in fevers must depend very much upon the exact condition of the patient and the form of his disease. The mere existence of a malady, or of a high temperature, cannot, correctly speaking, be an indication for any particular remedy. The phase of the disease must be recognized, and the question as to whether the fever which is present is harmful must be duly weighed. (See Fever.) In typhoid fever the studies of most clinicians show that though the drug possesses very decided antipyretic power, it often causes great depression and collapse, and in no way influences the duration or general course of the disease. For the same reasons the value of acetanilide in phthisis is doubtful since, although it greatly affects the temperature, it is very apt to cause collapse, profuse sweating, and depression. Thus the writer has seen cases of phthisis where the attempt to control the fever resulted in the manner just stated, and Riese points out, what the author also noted, namely, that in this disease cyanosis is very apt to come on after the use of the drug. In regard to the employment of acetanilide in sthenic fevers it at once becomes evident to the most careless student of medicine that a drug absolutely unsuited to a case of asthenic disease may, on the other hand, agree with a sthenic fever patient very well. In conse- quence of this, we find that the sweating produced by acetanilide is not so marked or troublesome in diseases of a dynamic type, and that in consequence, it more rarely causes collapse. In much the same manner that antipyrine was found, some time after its introduction, to be possessed of pain-relieving power so ACETATE OF POTASSIUM. 37 acetanilide has been discovered to possess similar properties—a dis- covery the credit of which must be given to the French investigator Lepine, who has written upon this subject, at various times, very ex- tensively. Almost every form of nerve pain seems to indicate its em- ployment, and it has been successfully used in the crises of ataxia, the agonizing dartings of gastralgia, and eveu in chorea, with good results. In a corresponding manner Secretau has obtained brilliant effects in cases of sciatica, and Silva has seen the most obstinate headache yield to its influeuce. A large amount of experience has proved it to be of value in epilepsy. The employment of acetauilide in rheumatism may be separated, if desired, into that devoted to the cure of the disease, with the relief of pain, and the reduction of pyrexia. There can be no doubt whatever of the ability of the drug to control the fever of this disease, and the question as to whether it favorably influences the progress of the malady is to be answered very forcibly in the affirmative (see Rheu- matism). The dose for cases of rheumatism should be 4 to 6 grains three times a day. Acetanilide has even been recommended as a haemostatic in epistaxis and hcemoptysis. Untoward Effects are not very common if acetanilide be used with care. The writer has collected a number of cases (thirty-eight) in which unfavorable signs appeared after its use, but untoward action was never seen unless the dose given was excessive for the case which received it. The dose most commonly producing such symptoms was from 3 to 10 grains. In only three instances of the series did death occur, one from heart-clot and two from excessive dosage. No deaths were reported from moderate amounts, although some of the cases were very alarming. Administration.—Acetanilide may be given in doses varying from 2 to 10 grains, the last-named amount being usually far too much. As it is virtually insoluble in water, it should always be administered in wine or spirit, in which it will dissolve, or in capsules or pills. When neuralgias are to be treated, or similar forms of pain are pre- sent, monobromated camphor, in the dose of i a grain, may be combined with acetanilide with advantage. IJ.—Acetanilidi Camphor, monobromati . Ft. in pil. no. x. S.—One every two hours ACETATE OF POTASSIUM. Potassii Acetas, U. S. and B. P., is a neutral white salt of saline taste, readily deliquescent and soluble in water. It was at one time very largely used in the treatment of rheumatism in the " alkaline method," but has been supplanted by the salicylates. The dose . gr. xx. . gr. v. M. 38 DRUGS. should be from 1 to 2 ounces a day. A combination of 10 grains of the iodide of potassium and 30 of the acetate is useful in rheumatism in some instances. In hepatic torpor acetate of potassium is exceedingly useful, and aids in promoting the flow of bile. It has been used in the treatment of the uric acid diathesis, and is supposed to purify the blood by aid- ing in the oxidation of effete material. The dose of potasii acetas is from 20 grains to 2 ounces. ACETATE OF ZINC. Zinci Acetas, U. 8. and B. P., occurs iu the form of white mica- ceous crystals, which are efflorescent and quite soluble in water. It acts as a decided astringent to the skin and mucous membranes, but is less astringent than the sulphate of zinc. It is used as a collyrium in eye diseases, such as conjunctivitis, in the strength of 1 to 2 grains to the ounce. In gonorrhcea it is often employed instead of the ace- tate of lead in injections of the strength of 1 to 20 grains to the ounce of rose-water. The treatment of poisoning by acetate of zinc is that adapted to gastro-enteritis. ACETIC ACID. Acidum Aceticum, U. 8. and B. P., as used in medicine, is a clear liquid made up of 36 per cent, of acetic acid and 64 per cent, of water, and has a sweetish odor. It is obtained from wood by destructive distillation. Therapeutics.—Acetic acid is seldom used internally, except in combination with potassium or sodium. As an escharotic, the glacial or absolute acetic acid (Acidum Aceticum Q-laciale, U. 8. and B. P.) is used ; it is a powerful caustic. It can be applied to warts and other growths, and to old sores where the granulations are profuse and slow to heal. The dilute acid (Acidum Aceticum Dilutum, U. S. and B. P.) is used as a lotion in night-sweats, and to arrest epistaxis and other small haemorrhages. As a lotion to be widely employed it should be diluted one-half. Vinegar or acetic acid (Acidum Aceti- cum, U. 8. and B. P.) has been used internally for the decrease of obesity, but is a harmful and useless remedy, disordering digestion and reducing the patient's strength. In the following mixture acetic acid has been used with success for the removal of vegetations about the external genitals : R-—Acid, salicylic.......„r xxx Acid, acetic.......' f 5i. ' M S.—Apply with a camel's-hair brush. Very little pain is caused by this application. Poisoning.—When over-doses of acetic acid are taken, the treatment ACONITE, OR MONKSHOOD. 39 consists in the use of large doses of milk, alkaline liquids, such as lime-water, soap-water, etc., and the general measures adopted for the treatment of gastro-enteritis. (See Gastro-enteritis.) ACONITE, OR MONKSHOOD. The Aconite of the U. S. P. is derived entirely from the tuberous root of Aconitum Napellus. At one time the leaves were officinal, but are so no longer, and for this reason the term " radix" is not to be employed, as it is a useless distinction. Aconite is indigenous in Germany, France, and Switzerland, and is cultivated as a garden plant all over Europe and America. The root is so strikingly like that of horseradish as to be readily confused with that article of food, but does not emit the pungent fumes of the latter when it is scraped or broken. It is to be remembered, however, that it produces a distinct feeling of heat in the mouth when chewed. The active principle upon which the therapeutical value of aconite would appear to depend is aconitine, but there is reasonable doubt whether this can be relied upon as completely as the fluid prepara- tions of the crude drug; the aconitine of commerce, moreover, varies very much in strength. Physiological Action. Nervous System.—Aconite in medicinal dose depresses the functional activity of the perceptive centres in the brain, the sensory side of the spinal cord, and, finally, the peripheral ends of the sensory nerves. Applied to a mucous membrane, it acts as a local anaesthetic, but is too irritating for use in the eye. On the motor portion of the body it exerts little influence, unless given in poisonous doses, when it paralyzes the motor tract of the spinal cord and the peripheral motor nerves. Circulatory System.—On the heart aconite acts, when given in moderate doses, as a quieter of its movements and force, and lowers blood-pressure and pulse-rate by a direct action on the heart muscle. There is no evidence of its possessing any direct influence on the vaso- motor system. In poisonous dose it causes first a very marked fall in pulse-rate, preceded sometimes by a quickening due to a condition of weakness and abortive cardiac action ; this condition gradually passes into diastolic arrest of the heart-beat, the viscus becoming paralyzed and refusing to respond to stimuli. Respiration.—In moderate doses aconite quiets the respiratory movements slightly, particularly if the breathing is hurried before its use. In poisonous doses it paralyzes the respiratory centres, and so causes death. Temperature.—Aconite acts as a distinct reducer of fever, prob- ably because of increased heat-radiation arising from relaxation of the capillaries and impaired circulation. Kidneys.—In fever aconite usually increases the urinary flow. 40 DRUGS. Poisoning.—When aconite is taken internally in excessive amount it causes tingling of the mucous membranes wherever it touches them, which sensation finally amounts to severe burning. This soon passes away, and is followed by a sense of tingling about the lips and finger-tips, or all over the skin. At the same time the patient feels relaxed the pulse becomes slow and weaker, but later on rapid and running so that it seems a mere trickle under the finger; sweating more or less severe is present, and fainting may ensue. Vomiting may occur, but is rare. The respirations now become slow and shallow, seeming to expand the lung in the smallest possible degree. The face is pallid and anxious. There may be exophthalmus, or the eyes may be sunken and dull. There is excessive pallor. Epileptiform convulsions may be present, due to disorder of the circulation at the base of the brain. Previous to this there may be marked anaesthesia of the skin. The pupils may be normal, or dilated to a wide degree. The sclerotic coat of the eye is pale and pearly-looking. The temperature is very low. Death may be gradual or sudden, the slightest movement of the body which can throw any strain on the heart stopping that organ in diastole. Treatment of Poisoning.—The patient is to be placed in a prone position or on a board, with the feet higher than the head, in order to confine the circulation as far as possible to the vital centres at the base of the brain. Hot bottles or bricks are to be placed about the body for the purpose of maintaining the bodily heat. Emetics are not to be given if the symptoms are severe, as vomiting may cause cardiac arrest, owing to the muscular effort involved, or the stomach may be so depressed that the emetics will not act. If vomiting comes on, let it be into a towel without the patient being allowed to raise the head. The stomach is to be washed out by means of a stomach-pump or a siphon made of rubber tubing. Ether may be given hypoder- mically, and followed by alcohol, and this again by digitalis The ether acts at once and lasts while the alcohol is being absorbed, and the alcohol supports the heart until the digitalis, which is the physio- logical antagonist of aconite, but slow aud prolonged in its effects, asserts itself. If the breathing fails, artificial respiration is to be employed, or if the heart seems about to cease its action, a whiff of the nitrite of amyl may start it going again, but only a few drops of the nitrite should be used, as large amounts depress this organ. Therapeutics.—The employment of aconite in disease is one of the most universally recognized procedures in medicine. It fulfils indi- cations which nothing else can, and lends itself to the control of a large number of morbid processes, its effects being uniformly explain- able by its known physiological action. It is used chiefly for its influ- ence as a cardiac and circulatory quieter, for its effects on the periph- eral sensory nervous system, as in the vomiting of pregnancy, and in those states in which, through inflammation elsewhere, the nervous system needs a sedative which will simultaneously reduce arterial ten- sion. In the early stages of all acute inflammations aconite is of service. ADONIDIN. 41 It may be applied locally over superficial nerves in neuralgia in the form of an ointment (2 grains to 1 drachm, or as the oleate of aconi- tine, 2 grains of the oleate to 100 of sweet oil). It is useful in croup, quinsy, sore-throat, severe colds, bronchitis and asthma due to exposure, in their early stages. In pericarditis it is valuable to allay the inflam- mation and quiet the excited heart, and it is also of great value in the earliest stages of pneumonia. It ought not to be used in adynamic, asthenic affections. Aconite is useless and harmful in prolonged acute diseases, such as scarlet fever, if constantly employed. In nervous palpitation of the heart, and in the palpitation of exces- sive cardiac hypertrophy, it is very valuable. In the epistaxis of full- blooded people, and in the early stages of gonorrhoea and chordee it often affords great relief. Aconite is by far the best circulatory and nervous depressant for children suffering from sthenic fevers, particu- larly of the irritative type. Administration.—As a general rule, small divided doses of the drug in the form of the tincture (Tinctura Aconiti), | to | a drop given every fifteen minutes, will act better than a full dose given at once, unless the condition of the patient requires active treatment. Preparations.—Tincture of aconite (Tinctura Aconiti, U. 8. and B. P.) is used in the dose of 1 to 5 drops in water, and repeated as needed. The extract of aconite (Extractum Aconiti, TJ. 8.) is given in the dose of J to f of a grain, while of the abstract (Abstractum Aconiti, U. S.) 1 grain is used. The fluid extract (Extractum Aconiti Fluidum, TJ. 8.) is given in the dose of 1 to 2 minims. Fleming's tincture ought never to be used. The active principle aconitine is not officinal in the U. 8. P. Its dose is y^- of a grain. The B. P. preparations that are not officinal in the TJ. 8. P. are: aconite leaves (Aconiti Folia), aconitine (Aconitina), aconite ointment (Unguentum Aconitince), and aconite liniment (Linimentum Aconiti). The dose of the extract of aconite (Extractum Aconiti, B. P.), is |- to 1 grain. ADONIDIN. This is a glucoside, derived from Adonis vernalis, a plant in- digenous in Europe and Asia. WTien given to one of the mammalia —the dog, for instance—it causes an increase in heart force and a rise of arterial pressure. In the frog, poisonous amounts arrest the heart in systole. The indications for the use of adonidin are, all conditions of cardiac failure, and particularly has it been recommended in cardiac dropsy. It is much inferior to digitalis and caffeine, but may be employed when these fail, as it sometimes succeeds under such circumstances. The dose of adonidin is |- to \ of a grain three times a day ; or, 4 to 8 parts of the plant—all portions of which are employed—may be added to 180 parts of water, and of this infusion a tablespoonful may be given every four hours. 42 DRUGS. AGARICIN. Agaric, or Touchwood, or Punk, has been used in the southern United States very largely in the dose of 5 grains every few hours in the treatment of the night-sweats of phthisis; and agaricm, the alcoholic extract of the drug, has been used with very extraordinary results, under these circumstances, by certain German and English physicians, in the dose of from 1 to 2 grains every five hours. Its physiological action is unknown, but it is supposed to act upon the nerve filaments iu the sweat-glands. The writer has employed it fre- quently in varying dose, and has never seen any decrease whatever produced by it in the sweats of phthisis, although he has watched it most closely, expecting to see great relief follow its use. ALCOHOL. Ethyl alcohol (Alcohol Ethylicum, B. P.) is the only alcohol used in medicine. Some of the other alcohols are exceedingly poisonous. Amylic alcohol is fusel oil. Alcohol is a liquid derived from the fermentation of starches or sugars in the presence of heat. It is officinal in two forms—namely, as Alcohol, TJ. 8., containing 91 per cent, of the spirit and 9 per cent. water, and Alcohol Dilutum, TJ. S., or dilute alcohol, 45.5 per cent. spirit and the remainder water. The drug is generally given in the form of whiskey or brandy, and when the word alcohol is used iu the saying " Give the patient alcohol," one of these two liquids is always meant unless it is otherwise stated. Physiological Action. Nervous System.—Alcohol acts firs tas a powerful excitant and afterward as a most active depressant and paral- yzant of the nervous system. Locally applied in small amounts to the peripheral nerves it excites them at first and paralyzes them after- ward. By the primary stimulation of the brain it increases the rapid- ity, but not the depth, of thought, while it increases the reflex activity of the spinal cord, the muscles, and the nerves. In large doses it produces lack of coordination by depression of the brain and lower nervous system, the loss of coordination being due largely to sensory paralysis, so that the power of touch is interfered with. This makes a drunken man fail to recognize the surfaces of obstructions, and the impaired mental power and disordered judgment combined with the badly acting motor and sensory pathways, cause him to stumble and fall. Circulatory System.—When alcohol is ingested either by man or the lower animals, it stimulates the heart muscle and increases the rapidity as well as the force of its beat. According to Doo-iel, the increase in rate is partly due to stimulation of the accelerator nerves but Castillo denies any such influence. Wood teaches that the ALCOHOL. 43 effect of alcohol is not through any action upon these nerves, and is undoubtedly correct in his belief. Along with the stimulation of the heart a rise of arterial pressure ensues, largely due to increased heart action and partly to vasomotor stimulation. In very large toxic doses alcohol depresses and finally paralyzes the heart and vasomotor system as well as the nervous svstem. Respiration.—Respiration is stimulated by small doses of alcohol and decreased by large ones. Temperature.—Alcohol at no time increases to any extent the actual number of heat units in the body. It produces a sensation of warmth and warms the extremities by causing the heart to pump hot blood from the centre of the body to the cold parts. If it be used in excess the temperature rapidly falls, owing primarily to the increase of heat-radiation produced by the excessive distribution of heat just named, and secondarily by the depression of vital power which is caused by a too rapid destruction of the tissues of the body in the effort induced by the drug. Calorimetrical studies show that, while more heat may be created under its influence, so much heat is dissi- pated that the temperature nevertheless falls. Bodily Metabolism.—The quantity of carbonic acid given off by the body, under the use of alcohol, is in most instances increased ; but it may be decreased. The effect on the absorption of oxygen is not known. Some observers have noted an increase, some a decrease of such absorption, and some no change at all, when alcohol is taken. Upon the giving off of nitrogenous substances it acts as a decided depressant, which seems to prove that it inhibits rapid tissue changes, and is a conservator of vital power. It adds force, but not tissue, to the body. Elimination.—Alcohol is largely " burnt up " in the body, but when taken in excess of the latter's oxidizing power, it is eliminated by the breath, and by the skin, kidneys, and intestines. Digestion.—Alcohol added in any amount to food in a test-tube containing digestive fluids retards or inhibits digestion, but in the stomach, on the other hand, it assists the process; for, by reason of its irritant and stimulating properties, it induces the secretion of an excess of the digestive juice. Therapeutics.—The employment of alcohol in disease can here be only briefly alluded to, special mention of its indications being named where the diseases in which it is used are discussed. Its chief uses are as a rapidly acting stimulant in all forms of cardiac failure due to shock or to poisons, and as a systemic support and stimulant iu low fevers and prolonged wasting diseases, in old age, and in convalescence from acute disease. Some of the conditions, to state them specifically, in which alcohol is indicated, are fainting, snake-bite, surgical shock, acute, subacute and chronic pneumonia in its later stages, and excessive wasting, due to prolonged suppuration. Alcohol should never be given in sthenic fevers unless some com- 44 drugs. plication, such as syncope or pneumonia, comes on. The reason it is contra-indicated is that in sthenic fevers the circulation is already sufficiently excited, and generally acting in excess of the needs of the system. In exhausting fevers, such as typhoid or typhus, alcohol finds its true usefulness. While it is well to give alcohol in many cases from the beginning to the end of the attack, for the double purpose of aiding digestion and of supporting the system, its administration should not be a mere matter of routine, but should be based upon clear ideas of the indications it is calculated to fulfil. If the pulse is weak and the patient seems to be sinking, or the appetite is failing and adynamia is a pressing symptom, alcohol is indicated ; but if the pulse is good, and the passage of the patient through his illness is not a stormy one, alcohol should be excluded from the sick-room. In phthisis, in neu- ralgia, and in similar states dependent upon depression of the system, care must be taken to prevent the setting up of a "habit." Alcohol is very useful as a local application to ulcers and wounds, as it acts as an antiseptic and stimulant, and when combined with salt forms a useful liniment in cases of debility and atony of the skin and subcutaneous tissues. Acute Poisoning.—In advanced poisoning by alcohol, with coma and total relaxation, external heat and hypodermic injections of digi- talis and strychnine are indicated, if the heart or respiration seems failing. Belladonna should be administered to stimulate the vaso- motor system if the skin is relaxed and clammy, and counter-irritation to the back of the neck is to be employed if any brain symptoms seem pressing. The after-treatment consists in the use of substances stimulating to the stomach, such as ammonia, spirit of Mindererus, and spices, unless there is gastric inflammation, when emollient substances should be used to quiet the irritation. If persistent vomiting comes on, it must be quieted by the patient swallowing pieces of ice, by aconite, cocaine, or minute doses of ipecac. Counter-irritation should be applied over the belly. If the emunctories are not acting freely, thorough purgation by jalap or elaterium (40 grains of jalap powder or ^ of a grain of elaterium) should be employed; or calomel followed by a saline may be given, if milder effects are sought. In view of the frequency with which alcoholic and opium poisoning are confused, the following table is appended, which will be found of value in making a differential diagnosis as to the condition of the patient: Alcoholism and Opium Poisoning. Alcoholism. Opium Poisoning. 1. Pupils normal or dilated. 1. Pupils contracted. 2. Respiration nearly normal. Pulse 2. Respiration and pulse slow and full rapid, and finally feeble. 3. Face suffused and cyanosed. 3. Face may be pallid. 4. Skin warmer than in alcoholic 4. Skm cool, perhaps moist. poisoning. Note.—The urine is always to be saved for medico-legal examination. There is scarcely any difference as to consciousness in the two conditions. ALCOHOL. 45 Acute Alcoholism and Apoplexy. Alcoholism. Apoplexy. 1. Pulse rapid, compressible, and weak. 1. Pulse apt to be strong and slow. 2. Skin moist, or relaxed and cool. 2. Skin hot or dry. 3. Bodily temperature lower. 3. Bodily temperature raised. 4. Pupils equally contracted or dilated; 4. Pupils unequal. generally dilated. 5. No hemiplegia. 5. Hemiplegia; one side tossed, the other remaining motionless. 6. Breathing not so stertorous, nor so 6. Respiration stertorous; the lips being one-sided in lips. inflated on one side on expiration. 7. No facial palsy. 7. Facial palsv. 8. Unconsciousness may not be com- 8. Unconsciousness complete. plete. The smell of alcohol in the breath is no guide, as acute alcoholism may have caused the rupture of a cerebral bloodvessel. Chronic Poisoning.—The treatment of this condition may be car- ried out iu two ways : First, by the isolation of the patient and the complete withdrawal of the drug at once; secondly, and what is better, a gradual tapering-off in the daily amount of the spirit. In either instance isolation must be absolute, and all smuggling of alcohol to or by the patient prevented. The attendants must be absolutely trustworthy. Careful scrutiny of bed-clothes and closets will often be rewarded by finding hidden bottles. The depression of the patient when recovering from alcoholism must be met by the use of nutritious broths highly seasoned, in order to stimulate the stomach, by easily digested or predigested foods, and by small doses of morphine or coca if the patient be very weak and need such a stimulus. Koumyss is an exceedingly valuable preparation uuder these circumstances. In the treatment of the atonic stomach of drunkards nothing does so well as the following pill: 1J.—Oleoresin. capsici ......tf[ x. Olei caryophylli.......HI x. Hydrarg. ehlor. mit.......gr. xx. Aloes Socotrin........gr. xl. M. Ft. in pil. no. xx. S.—One three times a day after or before meals. (See Capsicum.) Chronic alcoholism may produce cirrhosis of the liver, with the resulting symptoms, notably ascites. The following are the principal points in the differential diagnosis ot Alcoholism and the G-eneral Paralysis of the Insane. Alcoholism. Paretic Dementia. 1. Attacks shorter, and more widely 1. Attacks more prolonged. separated by intervals of sanity. 2. Delirium may be of any character. 2. Delirium of grandeur more marked and defined. 3. Visions more characteristic, and are 3. Visions often not evil, but pleasant. evil. 4. Tremors confined to head and arms. 4. Tremors more diffused. 5. Tremors removed by dose of alcohol. 5. Tremors made worse by alcohol. 6. Mental symptoms temporarily re- 6. Mental state made worse by alcohol. moved, or at any rate improved, by alcohol. 7. Tremors occur chiefly in the morn- 7. Tremors not confined to the morn- ing, ing. 46 DRUGS. There is danger of pneumonia from failure of the right side of the heart in subacute and chronic alcoholism, and the physician should always be on the lookout for this complication. Administration.—Brandy and whiskey are generally used as rapidly acting stimulants. They should "be exhibited in the form best adopted to the work they are intended to perform. If the action must be instantaneous, as in a case of fainting, they should be em- ployed hot and concentrated, so that the stomach has not to warm the liquid before absorption. They are to be used hypodermically if a still more rapid action is required. If administered to aid digestion and support the system, then they should always be given with the food—never alone, and never concentrated. They may be given as milk-punch or as egg-nog, the latter being the " heavier" of the two so far as digestion is concerned. Wine-whey is very light and useful. Mulled wine and champagne are particularly useful in the treatment of irritable stomach. The latter should always be as devoid of sugar as possible—that is, what is known as " extra dry." Gin is rarely employed as a stimulant, except when given to young children, or to adults, when the kidneys are torpid. Stout and porter are of value in wasting diseases, in convalescence from acute diseases, and for nursing women. Lager beer contains too little alcohol to be used as a distinct stimulant, but may be used in moderation to aid diges- tion, or ale may be employed instead. Clarets are useful aids to digestion, and port is also of value in these cases. Contra-indications.—All states of cerebral excitement, acute inflam- mations, the alcoholic habit, apoplexy, meningitis, acute nephritis, aneurism, and advanced atheroma contra-indicate the use of alcohol. The officinal preparations of alcohol are as follows : Whiskey (Spiritus Frumenti, TJ. 8.) should be at least three years old, and be made, in America, from rye for medicinal purposes. Brandy (Spiritus Vini Gfallici, TJ. 8. and B. P.) is obtained by the distillation of fermented grapes or fruits, and should be from three to five years old before use. Cologne Water (Spiritus Odoratus, TJ. 8.) is used solely as a lotion and perfume. Red Wine (Vinum Rubrum, TJ 8.) is made from grapes not de- prived of their skins. White WTine (Vinum Album, TJ. S.) is the fermented juice of grapes the skins of which have been removed. Dilute (Alcohol Dilutum, TJ. S.), and pure alcohol (Alcohol, TJ. 8.), are also officinal. The unofficinal preparations are : Rum, which is made from the fermentation of molasses, and con- tains about 40 to 45 per cent, of alcohol. Gin is made from rye or barley, with the addition of juniper berries and hops. (Good gin and the Spiritus Juniperi Compositus of the TJ. S. Pharmacopoeia are virtually identical therapeutically). When diuresis is required and atony of the kidneys is present v^ithout in- ALMONDS. 47 flammation, gin is a useful medicament, provided that a stimulant is indicated. Gin is one of the alcoholic drinks most apt to produce cirrhosis of the liver. Port Wine (Vinum Portense, TJ. 8. and B. P.) is a fermented wine to which pure spirit is added to increase its strength. It is one of the strongest table wines, and is useful as a stimulant in convalescence. Sherry (Vinum Xericum, B. P.) has about 30 per cent, of alcohol in it. It is not officinal in the U. 8 P. Beer is made by a slow fermentation, while Ale is made by a more rapid fermentation at a higher heat. Porter resembles the other malt liquors closely, except that it con- tains more solids, due to a scorching of the grain by a high heat. The B. P. preparations that are not officinal in the TJ. 8. P. are rectified spirit (Spiritus Rectificatus), proof spirit (Spiritus Tenuior), sherry ( Vinum Xericum), amylic alcohol (Alcohol Amylicum), and Mistura Spiritus Vini Galliei, which is a useful, pleasant and nutritive stimulant made by beating up the yolks of two eggs with half an ounce of sugar and then adding four ounces each of brandy and cinnamon-water. This is sometimes called " egg-flip." ALLIUM. Garlic is a stimulant to digestion, owing to the volatile oil it con- tains, which, by its somewhat irritating qualities, excites the gastric mucous membrane to increased secretion In persistent colds, where the bronchial tubes are particularly affected, a garlic poultice, made by pounding the bulbs in a mortar, is a very efficient, though disagree- able, remedy. In the treatment of children with colds, garlic may be used boiled in milk, and the liquid given as a drink, warm or cold, or the oil of garlic may be given in emulsion in the dose of 1 to 2 drops. If the skin in any case is too delicate to permit of the use of pounded garlic alone, it may be mixed with equal parts of bran, and a regular poultice or plaster made thereof. Employed in this form, allium is useful if applied over the spine in the treatment of the spinal convul- sions of infants; placed over the belly in cases of gastro-intestinal catarrh, it acts almost as well as a spice poultice. The dose of the syrup (Syrupus Alii, TJ. X.) is 1 to 4 drachms. ALMONDS. Almonds are officinal in the form of the bitter almonds (Amygdala Amara, TJ. S. and B. P.), and the sweet almonds (Amygdala JDulei*, TJ. 8. and B. P.). Bitter almonds develop hydrocyanic acid in the presence of water, by the combination of the amygdalin and emulsin contained in them; this is not the case with sweet almonds. 48 DRUGS. Sweet almonds, when rubbed up in a mortar with water form a pleasant-tasting emulsion of an agreeable odor, that is very useful as a vehicle for remedies having a disagreeable taste. Almond bread has been proposed as a food for diabetics, owing to its containing virtually no starch; but it is requisite that the oils and saccharine constituents of the almond shall first be removed. (See Foods for the Sick.) When half an ounce of sweet almonds are rubbed up with thirty grains of gum arabic and two drachms of sugar, to which is added gradually a half-pint of distilled water, the mixture being then strained, an emollient and soothing drink is formed which is very useful in irritations of the stomach and intestines, and of the air- passages and pharynx. The expressed or essential oil of almonds is a useful demulcent, and has been recommended in the cough of phthisis, given in the dose of a few drops in emulsion. Bitter almonds give off an oil (Oleum Amygdalce Amarce, TJ. 8.) which is exceedingly poisonous, owing to the prussic acid which it contains, and it is said that one drop will kill a cat, while seventeen drops have killed a man. Bitter almonds are used to allay irritable coughs and similar states, but are not frequently employed, because other drugs are less danger- ous, more stable, and more active as remedial agents. The emulsion of bitter almonds is made as is that of sweet almonds, and may be used in teaspoonful doses for the same purposes, and as a vehicle in cough mixtures. Both emulsions are useful as vehicles in the treatment of gonorrhoza, to diminish the burning on urination. Almond emulsions, when locally applied, are supposed to be of value for the removal of freckles and sunburn. The preparations of sweet almonds are: a mixture (Mistura Amyg- dalce, TJ. 8. and B. P.), dose 1 to 2 ounces; a syrup (Syrupus Amyg- dalce, TJ. S.), dose 2 drachms to 2 ounces; a compound powder (Pulvis Amygdalce Compositus, B. P.), given in the dose of 1 to 2 drachms; and the oil (Oleum Amygdalce Expressum, TJ. S. and B. P.), the dose of which is 1 to 4 drachms. Aqua Amygdalce Amarce (B. P.) is pre- pared from the oil of bitter almonds. ALLSPICE. Allspice, or Pimenta (TJ. 8. and B. P.), is the nearly ripe fruit of Eugenia Pimenta, a tree of the West Indies. It contains an officinal volatile oil (Oleum Pimentce, TJ. 8. and B. P.), used for flavoring pur- poses, as a constituent of spice plasters, in diarrhoea mixtures, or as a carminative. It will also prevent the griping of purgative medicines. The dose of the oil is one to five drops. Aqua Pimentce (B. P.) is given in the dose of 1 to 2 ounces. ALOES. 49 ALOES. Aloes, or Aloe of the U. S. P., is derived solely from the Aloe Soco- trina, while that of the B. P. is obtained not only from Socotrine aloes, but also from Barbadoes aloes (Aloe Barbadensis, B.P.). It is the inspissated or dried juice of the leaves of the plant, but the actual species from which the drug is derived is uncertain. It is probably derived from several species. Aloes contains an active principle known as alo'in, which is a crystalline substance. As alo'in is gener- ally sold, it is, however, an amorphous powder of extremely bitter taste. ^ Physiological Action.—Locally applied to the tongue, aloes is a bitter of rather a persistent taste. According to the studies of Ruther- ford, the drug increases very considerably the flow of bile in the dog, but in man it cannot in any sense be regarded as a medicament for the production of an increased biliary flow. Rutherford's doses given to the dog amounted to as much as sixty grains, equal to three or four drachms in man. In the lower animals and in man aloes acts verv slowly, requiring many hours for its influence to be distinctly felt, unless the dose be toxic in amount. As much as four drachms of aloes have been injected into the veins of a horse without inducing purgation, probably because four drachms were not enough to affect the bowels. Aloes has been used endermically, and when so em- ployed is said to act thoroughly. It is eliminated by the milk of nursing women, and will cause purgation in an infant put to the breast of a patient taking it. If the doses be quite large (10 to 20 grains), the passages will be watery; but if the dose be more moder- ate (2 to 3 grains), the stools will be more thick and pultaceous. Therapeutics.—Aloes should be used only when a somewhat slow stimulant to peristaltic movement is desired, and never where the object of the physician is to relieve congestions by depletion through the intestine. It is a favorite remedy in cases of subacide or chronic constipation, but is distinctly harmful if continued constantly for anv length of time, as it seems to produce atony of the bowel. Owing to its bitter properties it acts as a tonic to the stomach, and is often given with iron to promote the absorption of this metal by stimulat- ing the liver and by preventing any constipation which might be produced by the chalybeate. When taken in a large enough dose to produce a copious passage, aloes nearly always produces a feeling of weight and fulness iu the region of the rectum after the evacuatiou, and the writer has seen severe rectal catarrh produced in this way. If given alone it is very apt to produce griping, and it ought always to be combined with other drugs whose tendency it is to prevent intestinal spasm. In cases of hcemorrhoids occurring in persons suffering from general muscular relaxation and atony, aloes is said to do great good, but its use under these circumstances is by no means universal or 4 50 DRUGS. generally accepted as correct. For weak, anaemic persons, leading sed- entary lives, it may be combined with tonics to relieve the constipation so often a pressing symptom in these cases. In amenorrhea depen- dent upon atony of the sexual system, or anaemia, or constipation, it is thought to have a specific emmenagogue influence. Locally ap- plied in the form of the glycerole of aloes, it has been employed in the healing of old or new fissures of mucous membranes, and even in bedsores. The glycerole of aloes is to be made by evaporating four to eight quarts of tincture of aloes and gradually adding thirty parts of glycerin. Contra-indications.—Constipation occurring in plethoric persons should not be treated by aloes, and it should not be used if any irri- tation or catarrh of the intestine is present. Administration.—Aloes is generally given in a pill, combined with spices and belladonna (see Constipation). The dose should be about 1 to 5 grains as a laxative, and 10 grains as a purge. The Aloe Puri- ficata, TJ. S. P., should always be used. The officinal preparations most commonly employed are the pill of aloes (Pilulce Aloes, TJ. 8. and B. P.), two grains each of aloes and soap; the pill of aloes and myrrh (Pilulce Aloes et Myrrhce, TJ. 8. and B. P.), two grains of each constituent; the pill of aloes and mastisch (Pilulce Aloes et Mastiches, TJ. 8., two grains of aloes), or the " Lady Webster dinner pill; " the pill of aloes and iron (Pilulce Aloes et Ferri, TJ. S. and B. P.), one grain of aloes and one of dried sulphate of iron; and the pill of aloes and asafcetida (Pilulce Aloes et Asafcetidce, TJ S. and B. P.), contain- ing four grains of aloes, asafcetida, and soap. The dose of all these is 1 to 2 pills. The liquid preparations are the tincture (Tinctura Aloes, TJ. S., and B. P.), dose 1 to 3 fluidrachms; the tincture of aloes and myrrh (Tinctura Aloes et Myrrhce, TJ. 8.), dose 1 to 2 fluidrachms ;x and the wine of aloes (Vinum Aloes, TJ. 8. and B. P.), containing cardamoms and ginger, the dose of which is J to 1 drachm, or even 2 drachms. The B. P. preparations, besides those given, are Alo'in, dose J to 2 grains; the Decoctum Aloes Compositum, dose, ^ to 2 ounces; and the extract, Extractum Aloes Socotrince and the Extractum Aloes Barbadensis, the dose of each of which is 2 to 6 grains. Enema Aloes, given in the dose of 10 ounces, is composed of aloes 40 grains, carbonate of potassium 15 grains, and mucilage of starch 10 fluidounces. ALUM. Alum (Alumen, TJ. 8. and B. P.) is the sulphate of aluminium and potassium, or of aluminium and ammonium, crystallized from a watery solution. At present all the alum of commerce is made in the manufacture of coal gas for illuminating purposes, and it is 1 Sometimes called Elixir Proprietatis. ALUM. 51 therefore very cheap. It occurs in the form of octahedral crystals, and has an astringent taste and acid reaction. After the crystals are exposed to the air for some time they become covered with a white coating. Physiological Action.—When alum is brought in contact with a mucous membrane it produces whitening, constriction, and puckering of the part, and applied to the skin thickens and toughens it by means of its astringent action. In either case it decreases secretion and causes contraction of the local bloodvessels and capillaries. Large amounts given for any time seem to increase secretion. Very large amounts are necessary to produce death. As much as two ounces will not kill a sickly dog. This is largely due to the fact that the vomit- ing and purging rids the animal of the drug, for if vomiting is pre- vented death rapidly ensues from gastro-enteritis. Injected into the blood, alum produces embolism and thrombosis. Therapeutics.—Alum is used at present in a number of diseases, chiefly as a local application. In cases of ordinary sore-throat appli- cations of a strong solution (20 grains to the ounce of water) on a swab will be found very useful. It is a valuable gargle iu this con- dition, but ought not to be used because of its destructive action on the teeth. In hemorrhage, when the leaking bloodvessels can be directly reached, alum is a remarkable haemostatic, aiding in the arrest of the bleeding in three ways, namely, by coagulating the albumin, by constringing the parts, and by crystallizing when applied in large amounts on lint, and thereby affording a surface which is rough and aids coagulation. In haemorrhage after tooth-extraction its application is a very useful treatment. Dissolved in water, or alcohol, it makes an exceedingly efficient application for sponging in night-sweats or localized sweating of the feet or hands. In conjuncti- vitis as a lotion alum may be employed in a solution of 1 to 3 grains to the ounce of water for a child, or in the form of alum curd, made by adding powdered alum to milk or white of egg until a curd is formed, which is then applied to the eye every few hours or oftener. This is often useful in ecchymosis of the eyelid, or "black-eye," to pre- vent much exudation and discoloration. In cases where granular con- junctivitis occurs, the use of the alum crystal or stick is sometimes very useful, the lid being lifted and the alum passed lightly over it. In hcemoptysis a fine spray of a strong solution of alum, 20 grains to the ounce, may be employed, the necessity of the spray being made verv fine being constantly borne in mind. This method may also be resorted to in bronchorrhcea or chronic bronchitis with excessive secre- tion, and in chronic catarrh of the pharynx and larynx. In mercurial ptyalism the drug may be used on a swab. Bathing the parts affected with an alum solution is said to be an efficient remedy in chilblains, and even in pruritus vulvce. As a vaginal wash for excessive leucor- rhcea, in the strength of from 10 to 20 grains to the ounce of water alum is of value. Some observers claim good results from its use in diphtheria and tonsillitis. In follicular tonsillitis the alum-stick may 52 DRUGS. be deeply inserted into the depressed follicles or applied to the swollen surface of the gland. Burnt Alum (Alum Exsiccatum, TJ. S. and B. P.) is useful as a dressing for old ulcers and sores, and has been highly recommended as an application for swollen gums where they press and override a tooth, particularly at the back of the jaw. In ingrowmy toe-nail with granulations, a piece of twisted absorbent cotton soaked in strong alum solution and inserted under the edge of the nail, will in most instances do a great deal toward a cure. Internally, alum has been used in diabetes, gastralgia, and dysentery of an acute and chronic type. In lead-colic it seems to be of value in conjunction with morphine to allay the pain. In some forms of constipation it is said to be quite valuable if given in large dose. At one time alum was largely employed in membranous croup in emetic dose for the dislodging of the membrane aud for the astringent effect exercised as it was swallowed and expelled. Alum may be used as an antidote in acute lead-poisoning, as it is a soluble sulphate and also an emetic. The emetic dose of powdered alum is a heaping teaspoonful to a child or a tablespoonful to an adult. Gflycerinum Aluminis (1 to 5) is officinal in the B. P., and is used as a local astringent application. AMBER. Succinum is derived from a fossil resin found iu Prussia and Bohe- mia, and is officinal in the form of the oil (Oleum Succini,'TJ. 8.), which is volatile, quite irritant, and obtained by destructive distilla- tion from the deposits named. Therapeutics.—Oil of Amber is one of the best remedies for per- sistent hiccough that we have. It is very useful as a counter-irritant over rheumatic joints, aud has been used in asthma, whooping-cough, and hysteria with good results. In the bronchitis of infants, with nervous disturbance, oil of amber in the proportion of one to three parts of olive oil applied to the back aud front of the chest is of service. The dose internally is 2 to 6 minims in emulsion. AMMONIA. Ammonia is a gas of a very acrid, burning taste and sensation, capable of producing death very rapidly, when inhaled, by inflamma- tion of the air-passages and the spasm of the glottis which ensues. It is made in large amounts in the manufacture of coal gas. Physiological Action.—When ammonia comes in contact with the tissues of the body it acts as a most powerful irritaut, causing a red- dening of the parts, followed, if the exposure be long enough, by A M M O NIA . 53 death and sloughing. If it be inhaled as a gas it may produce instant death by spasm or oedema of the glottis, or if a strong solution of it is swallowed the same accident will occur. After more moderate inhalations severe bronchitis or pulmonary oedema may take place. Xervous System.—If ammonia be injected into the blood of animals violent convulsions at once ensue which are largely tetanic in type and depend upon a spinal action of the drug, since they are not stopped by division of the spinal cord, as they would be if the convulsive movements had their origin in the brain. The drug in moderate amounts acts as a spinal excitant, increasing reflex action and all the evidences of spinal activity. If applied directly to a nerve, either motor or sensory, it paralyzes it, or if the drug be in very weak solution it seems to increase its functional activity. Circulation.—Upon the circulation ammonia acts as a very powerful but fleeting stimulant, increasing to a very great extent the pulse-rate, pulse force, and arterial pressure. The cause of the increased pulse-rate depends upon stimulation of the accelerator nerves of the heart, and of the heart itself, while the increased force is due to the same cause, for Ringer and Sainsbury found the strength of the ven- tricles much increased. The rise of arterial pressure is due to the increased amount of blood pumped into the arteries by the stimulated heart, and probably by an action on the vasomotor centre, although it is stated by some authorities that this is not so. As the drug acts as a stimulant on the respiratory centre, which is very near the vaso- motor centre, it probably increases the functional activity of both. If by means of intravenous injection the ammonia reaches the heart in large amount, this organ ceases its beat at once, owing to paralysis of its muscular walls. The Blood.—In moderate amounts the drug has no effect on the blood, but when injected in poisonous quantities it causes the blood to fail to take up the oxygen, according to Feltz and Ritter. Respiration.—The injection of ammonia in moderate quantities into the blood causes an acceleration of the rate of respiration due to a stimulation of the respiratory centre, so that the respiratory move- ments not only become more full, but more rapid. If the drug is inhaled in small amounts the same action is seen in a less degree, and the changes both in breathing aud circulation are partly due under such circumstances to a reflex irritation transmitted along the sensory nerves. Elimination.—Ammonia when taken into the body is so extremely fleeting in its action that the question as to its escape from the system is of interest. If large amounts are taken, it is partly given off by the breath, but more of it is burnt up in the system, and, according to Bence Jones, eliminated as nitric acid by reason of its being oxidized in the body. Some think that it is in part excreted as urea. Therapeutics.—Ammonia is employed for three distinct purposes in medicine, namely : as a circulatory and respiratory stimulant, as a counter-irritant, and as an antacid. 54 DRUGS. The indications for the use of ammonia in the first class of cases are all forms of sudden cardiac failure, where there is no time or oppor- tunity to use the more stable and slowly-acting drugs. These instances occur in snake poisoning, in syncope from fright or other shock, or indigestion, in sudden cardiac failure during the course of fevers and in pneumonia, and in all cases where rapid cardiac stimulation is needed. In these pressing cases it should be injected directly into the vein of the leg so as to act more quickly. If put into the subcutaneous tissues it is almost certain to make a slough, and if injected into a vein of the arm it may reach the heart in too concentrated form and cause cardiac depression. Riuger has found that the drug has the extra- ordinary power of causing a heart stopped or depressed by chloroform to return to its beating. In gastric acidity due to fermentation, with the development of abnormal acids, it is the most active remedy we can employ, but is not to be given if acute irritation of the stomach exists. In prolonged diseases the employment of ammonia is not particu- larly advisable, owing to its fugacious action, although it is largely used, and the constant administration necessarily required is apt to produce gastric disorder. Some persons claim that ammonia is useful as a sedative in drunkenness, but this is doubtful. Locally applied, strong ammonia water may be used to produce a blister by placing a few drops on the skin under an inverted watch- glass. Ammonia water may also be applied, often with great relief, to the spots stung by insects. The waters of ammonia are used externally iu stimulating liniments, and hypodermically when the drug is so given. The stronger water ought not to be employed for the latter purpose. The aromatic spirit is generally used internally in the dose of ^ drachm to 1 drachm, well diluted. This is also the dose of the ordinary spirit. Administration.—Ammonia is never employed in medicine as pure ammonia, but in the form of the stronger water (Aqua Ammonice For- tior, TJ. S; Liquor Ammonice Fortior, B. P.) and the weaker water (Aqua Ammonice, TJ. 8. ; Liquor Ammonice, B. P.). The spirits of ammonia (Spiritus Ammonice, TJ. S.), are given in the dose of 30 to 60 minims in water; and the aromatic spirit of ammonia (Spiritus Ammo- nice Aromaticus, TJ. S. aud B P.), in the dose of 25 to 60 minims in water. Spiritus Ammonice Fcetidus and Linimentum Ammonice are both officinal in the B. P. AMMONIUM. The following salts of ammonium are officinal, and are used for various purposes. Acetate of Ammonium. Acetate of Ammonium is used in medicine in the form of the spirit of Mindererus (Liquor Ammonice Acetatis, TJ. S. and B. P.), dose 1 to 2 fluidrachms, for the purpose of acting as an antacid in gastric indi- gestion. A M M O N I U M . 55 Benzoate of Ammonium. Benzoate of Ammonium (Ammonii Benzoas, TJ. 8. and B. P.) is employed chiefly for its diuretic influences, which depend entirely upon the benzoic acid present in the compound. As benzoic acid is eliminated as hippuric acid, and ammonia as nitric acid, this drug may be employed iu cases where the physician desires to make the urine decidedly acid ; as, for example, in patients suffering from catarrh of the bladder when the urine is loaded with phosphates, which may be dissolved by this acidulation. The dose is 10 to 30 grains. Bromide of Ammonium. Bromide of Ammonium (Ammonii Bromidum, U. 8. and B. P.) is really a crystalline salt, but is generally found in commerce as a white, granular powder which, when exposed to the atmosphere, becomes slightly yellowish. It is readily dissolved in water. Physiological Action.—Applied to the mucous membrane of the mouth the bromide of ammonium produces a salty taste, is markedly pungent, and dissolves readily in the oral secretions. If large amounts are swallowed it causes burning pain in the belly and evidences of gastro-enteritis. Nervous System.—The action of this drug upon this part of the body is its most important effect. Given to the lower animals it produces iu frogs total loss of reflex activity, preceded, it is said, in some cases by tetanic convulsions, although no such motor disturb- ance may take place. Iu a series of studies undertaken by the writer to determine the exact effect of the drug, it was found that the spinal cord was depressed, both on its motor and sensory sides, while the nerves and muscles escaped. These results are in accord with those of other investigators who also found that the nerves are unaffected. On the cerebral cortex it acts as a very distinct sedative. Circulation.—Upon the circulation bromide of ammonium acts as a stimulant iu small doses, but as a cardiac paralyzant if a large amount comes in contact with the heart. Iu medicinal dose it is distinctly stimulant to the circulation. Therapeutics.—The bromide of ammonium may be used in nearly every instance where bromide of potassium may be employed, and possesses the distinct advantage of being less depressant to the general system than the latter drug. It is, however, no less apt to disorder the stomach even if given in moderate doses. In epilepsy it would seem to be of as much value as the potassium salt, aud may be com- bined with it in some cases with success. (See article on Epilepsy.) According to Da Costa, the drug is of very distinct value in rheuma- tism in the dose of 60 to 80 grains a day well diluted, although its manner of action in this disease is not known. The dose is 10 to 30 grains It is incompatible with spirit of nitrous ether. 56 DRUGS. Carbonate of Ammonium. Carbonate of Ammonium (Ammonii Carbonas, TJ. 8. and B. P.) undoubtedly has an action exactly like that of the liquid prepara- tions of ammonia, and is used either alone or with the chloride iu the treatment of bronchitis, particularly wheu this disease occurs in babies and young children. It is also largely employed by surgeons in the treatment of children after surgical operations. The dose is 2 to 10 grains in syrup of acacia. It is a rapidly-acting cardiac and respira- tory stimulant. Chloride of Ammonium. The Chloride or Muriate of Ammonium (Ammonii Chloridum, TJ. 8. and B. P.) has an entirely different action and therapeutic use from the rest of this group. It possesses almost no influence over the heart and respiration, but does exercise a very stimulant effect on mucous membranes, increasing the secretion of mucus. The consider- ation of its use in diseases of the lungs can be found in the articles on Pneumonia and Bronchitis. It has been employed in intermittent fever, but has gone out of use, and has also been used in neuralgias of the ovarian type, by Goodell and others. In the treatment of chronic torpor of the liver and subacute hepatitis, and even in cirrhosis and hepatic abscess, it has been thought of value. Many clinicians have found it useful in the treatment of the gastric and intestinal catarrhs of children of a very subacute type, and it is the routine treatment for all such cases which come under observation at the Children's Depart- ment of the University of Pennsylvania and elsewhere where the author has charge. The dose is 2 to 15 grains, preferably given with liquorice and water to mask the taste. (See Bronchitis for prescrip- tions.) Iodide of Ammonium. Iodide of Ammonium (Ammonii Iodidum, TJ. S.) may be employed in the dose of 2 to 3 grains in all cases where the iodide of potassium is indicated, and seems to possess alterative influences equal to those of that salt. It has been recommended as a local application in cases of enlarged tonsils in the form of a solution of 30 grains of the salt to the ounce of glycerin, particularly if struma is the cause of the enlargement. The application is to be made once a day with a swab or camel's-hair brush. It is necessary that this solution be not exposed to the air or it will undergo decomposition. Valerianate of Ammonium. Valerianate of Ammonium (Ammonii Valerianas, TJ. S.) is the salt of ammonium commonly used in the nervous unrest of pregnant or hysterical women, or at the menopause in the peculiar nervous dis- AMYL NITRITE. 57 orders apt to occur at that period. In poisonous doses it paralyzes the spinal cord in the lower animals. It is usually given in the form of the elixir of the valerianate of ammonium, the dose of which is a teaspoonful to a dessertspoonful, or it is combined with the bromides, under which circumstances it is much more efficacious. The dose of the salt itself is 10 to 15 grains. The sulphate of ammonium (Ammonii Sulphas, TJ. S.) is never used in medicine. The phosphate of ammonium (Ammonii Phosphas, TJ. S. and B. P.) is employed in rheumatism in the dose of 10 to 20 grains. The B. P. preparations besides those given are: Sulphide of Am- monium, Oxalate of Ammonium, Liquor Ammonii Citratis, dose 2 to 6 fluidrachms, Liquor Ammonii Citratis Fortior, dose 30 minims to 2 fluidrachms, Liquor Ammonii Acetatis Fortior, dose 25 to 75 minims. AMMONIAC. Ammoniac (Ammoniacum, TJ. 8. and B. P.) is a resinous gum obtained from Dorema Ammoniacum and is used very little iu medi- cine at the present time. Internally and externally it produces some irritation when brought in contact with the tissues and may be used internally in the dose of 10 to 30 grains in pills in cases of chronic bronchitis devoid of any true inflammatory process. It is officinal in the form of the plaster of ammoniac (Emplastrum Ammoniaci, TJ. S. and B. P.), which is used as a stimulant over enlarged glands and joints, and as the plaster of ammoniac and mercury (Emplastrum Ammoniaci cum Hydrargyro, TJ. S. and B. P.) which is used for the same purpose. Finally there is the mixture of ammoniac (Ilistura Ammoniaci, TJ. S. and B. P.) used in chronic bronchitis, in the dose of a tablespoouful. AMYL NITRITE. Amyl Nitrite (Amyl Nitris, TJ. 8. and B. P.) is a very volatile, somewhat oily, liquid possessing a peculiar penetrating pear-like odor. It is made by the action of nitric and nitrous acids upon amylic alco- hol, and is not to be confounded with nitrate of amyl, which has a different physiological action and is never used medicinally. Physiological Action.—When swallowed or inhaled the drug pro- duces staggering, fulness in the head, roaring in the ears, duskiness of the face, and finally utter muscular relaxation, so that the animal or man falls to the ground. The heart beats very rapidly and forcibly and the respirations become gasping. Nervous System.—Nitrite of amyl acts as the most rapid of all the nervous depressants and sedatives known except prussic acid. 58 DRUGS. Experiments show that its dominant action is on the motor side of the spinal cord. The motor cortex of the brain and the motor nerves are only affected by large amounts. Upon the nervous apparatus of sensation nitrite of amyl has no effect in medicinal amounts and can never be used to relieve pain unless it be due to spasm or to angina pectoris. The muscles are depressed by toxic amounts. Circulation.—When nitrite of amyl is used the pulse becomes exceedingly rapid, while the arterial tension progressively falls. The increase in pulse-rate is due to depression of the centric inhibitory apparatus of the heart and to the sudden relaxation of the blood- vessels, by reason of which, the resistance being taken away, the heart beats faster. The fall of arterial pressure is due to a depression of the vasomotor centres and the muscular coats of the bloodvessels. In very small amounts the drug stimulates the heart muscle (Reichert), but its dominant action is that of a depressant. The Blood.—In medicinal dose this drug produces a chocolate color of the arterial blood, due to the change of oxyhemoglobin into methaemoglobiu. Urine and Elimination.—The urine very frequently contains sugar after the use of the nitrite of amyl, and there is increased diure- sis. The drug is eliminated very rapidly from the body by the lungs and kidneys. Iu the urine it is formed into a nitrate if nitrite of potassium be employed. Temperature.—If the nitrite of amyl be employed for any length of time a most remarkable fall in bodily temperature ensues, which is probably due to diminished oxidation, but possibly to some effect on the heat centres governing heat production and dissipation. The vas- cular dilatation also greatly tends to aid iu the fall of bodily heat produced by the drug. Therapeutics.—Nitrite of amyl is used to relax general or local muscular spasms, for the relaxation of the spasm of epilepsy and for aborting an on-coming fit, for the prevention and subjugation of strych- nine convulsions and tetanus, and for the relief of angina pectoris. It may be used in puerperal eclampsia, but it is a daugerous remedy because of its relaxation of the uterus aud the consequent danger of post-partum haemorrhage. In dysmenorrhcea with uterine spasm it often gives great relief. In cardiac failure from fright or anaesthetics amyl nitrite is often of great value in single whiffs. If it does not act at once under these circumstances it is worse than useless to push it. It has also been found of value in whooping-cough, laryngismus stridulus, asthma, spasmodic croup, and infantile convulsions. In migraine with local vasomotor spasm and true hemianopsia it is very useful. In strychnine poisoning and tetanus it must be used between the spasms or else given hypodermically, as the respiratory cramp prevents its inhalation. Administration.—The drug is usually given by placing three to five drops on a handkerchief and iuhaling the fumes, or it may be dropped on sugar and taken by the mouth in the same quautity. antimony. 59 It is important to remember the fact that the effects of the drug are more severe for a moment after its use than during its inhalation. The best way for patients to use the drug is to have it in pearls of glass, each holding 3 minims. One or more of these may be crushed in the handkerchief aud the fumes inhaled. Some of the pearls made by careless manufacturers are of such thick, strong glass that they are difficult to break, and if broken are apt to cut the fingers. These are, of course, to be avoided. ANTHRAROBIN. Anthrarobin, which was originally discovered by Liebermanu, seems to possess equal value with its relative chrysarobin, and to be capable of acting as efficaciously as this substance in the treatment of skin diseases. It is a yellowish powder, tolerably stable in a dry atmosphere, not soluble in acids or water, but readily soluble in dilute alkaline solution or alcohol, at first making a solution of a brown color, which, as oxygen is taken up, passes to a green and finally to a violet. Therapeutically, anthrarobin has been employed by Rosenthal and by Behrend, and more recently Kobner has recorded his experience with it, employing it with good results in a 10 to 20 per cent, solu- tion in the various forms of tonsurans as a wash. Rosenthal has used it in psoriasis and pityriasis versicolor and herpes, and Behrend asserts that it is often better in its effects upon the skin than chrys- arobin, as it produces less inflammation and only discolors the skin slightly. It also possesses the additional value of making so slight a stain on the linen that it can be removed by washing. According to most authorities, it is best to keep the drug in alco- holic solution, and, if the bottle is well corked, such a mixture remains good for a week. ANTIMONY. Antimony itself, or its oxide, is rarely used in medicine, owing to its insolubility, but is generally employed as the tartrate of antimony and potassium, or Tartar Emetic (Antimonii et Potassii Tartras, TJ. 8.; Antimonium Tartaratum, B. P.), or in the form of the sulphide (Anti- monii Sulphidum, U. S.); purified sulphide (Antimonii Sulphidum Purification, U 8.; Antimonium Nigrum Purification, B. P.); aud sulphurated antimony (Antimonium Sulphuratum, V. 8. and B. P.). The last three drugs are so rarely employed and are such unreliable and useless preparations that they will probably be dropped in the present revision of the Pharmacopa'ia. 60 DRUGS. Tartar Emetic. Tartar Emetic (Antimonii et Potassii Tartras, TJ. 8.; Antimonium Tartaratum, B. P.) is made by boiling the oxide of antimony with bitartrate of potassium and water. Although it is really crystalline it is generally sold as a fine powder, owing to these crystals being easily pulverized. It is insoluble in absolute alcohol, but is soluble in ordiuary water, and still more so in boiling water. In dilute alcohol it is partly soluble. Owing to its chemical constitution tartar emetic should never be given with either acids or alkalies, and all drugs containing tannic acid are also incompatible with it, owing to the fact that an insoluble tannate is rapidly formed which is absorbed very slowly if at all. So complete is the insolubility of the compound so formed that tannic acid is the best antidote to the drug that we possess. Physiological Action.—Tartar emetic, when applied to mucous membranes, produces a burning sensation, and upon the skin it may readily cause a large amount of irritation if the part be delicate. If kept in contact with a mucous membrane very distinct inflammatory changes occur, and if it be applied to the skin for any length of time, redness, followed by acne of a pustular character, appears, which finally ends in ulceration aud sloughing if the use of the drug is persisted in. Under these circumstances the vitality of the parts seems interferred with, and, as a result, healing takes place very slowly indeed. Nervous System.—Antimony is a depressant to the sensory side of the spinal cord and a paralyzant to all the spinal centres, motor and sensory, in poisonous dose. It is stated that sensation to heat and acids is lost before the ordinary sense of touch is destroyed. The convulsions which some- times ensue after poisonous doses in the lower animals are due to anaemia of the brain brought on by the circulatory depression. Ringer and Murrell have proved antimony to be a motor-nerve and muscle poison. Circulation.—The chief influence of antimony is exerted upon the circulation. In small doses it lowers the pulse-rate by a direct depression of the heart-muscle and simultaneously decreases arterial tension by an action upon the peripheral portions of the vasomotor system in the walls of the bloodvessels, but the vasomotor influences may be in part centric, aud this question must be considered as sub judice. The fall of arterial pressure is also due to failure of heart force. With the lowering of the pulse-rate there is nearly always a corresponding decrease in cardiac power. When poisonous doses are employed death ensues after great circu- latory aud respiratory depression, as will be seen below. The heart is found relaxed and flabby and utterly dead to all stimuli, although if the dose has not been very excessive and digitalis is freely employed the heart may be made to beat again; this is true at least iu the frog. A N TI M O N Y . 61 The drug in poisonous doses is thought to depress the peripheral ends of the vagus nerves. Respiration.—The drug has little or no effect upon respiration except when given in lethal doses. Under these circumstances death is produced in three ways, all of them acting together. Primarily, the respiratory centre in the medulla is depressed, and the governing nerves of breathing, the pneumogastrics, are also rendered inactive; secondarily, the cardiac failure readily causes pulmonary congestion ; and, thirdly, the drug causes such an outpouring of liquid and mucus into the bronchial tubes that the patient is drowned in his own sputum, which he is too weak to expel. Stomach and Intestines.—Antimony in toxic doses is a powerful irritant to these portions of the body. In full medicinal amounts it acts as a slow but powerful emetic, producing much nausea. The vomiting is due to an action on the vomiting-centre in the medulla and to a direct action on the stomach itself. The drug is, therefore, a centric and peripheral emetic. Very full doses produce watery purging attended with some griping and tenesmus. Elimination.—Antimony escapes from the body in all the secre- tions, but largely by the bowels. The latter method of escape seems chiefly to follow poisonous doses, aud Wood believes with others that purging is an effort at elimination. Poisoning.—Wlien toxic doses of tartar emetic are taken the pulse at first becomes slightly weaker and slower, the skin becomes moist and relaxed, a general sense of relaxation comes on, and simultaneously a sensation of severe nausea and gastric distress appears. Following this condition violent vomiting asserts itself. The ejected mass consists of the contents of the stomach, mucus, bile, and watery fluids, and perhaps blood. Purging appears almost as early as the vomiting, and consists first of the contents of the intestines, then mucus, then bile, and, very rarely, of blood. These signs may rapidly pass away and the characteristic peculiar " rice-water " stools1 appear. The general condition of the patient is now most serious. The face is pinched, livid, and covered with a cold sweat. The pulse is rapid and shuttle-like—to aud fro—or lost at the wrist; the arterial tension is almost nil. The respirations are faint aud fluttering, and so shallow as hardlv to be seen or heard. Cramps in the calves of the legs attack the patient, due to the abstraction of water from the tissues by the violent purging, and the temperature falls lower and lower as death approaches. The general condition is such that all the signs point to Asiatic cholera, and antimonial poisoning cannot be separated from this disease without a history of the case or a chemical analysis of the secretions, which ought always to be preserved.2 1 A " rice-water " stool is one which, on standing in a glass, separates into two layers, the lower white and flocculent, the upper watery and almost clear. s This is probably as good a place as will occur to state that the secretions and excre- tions of a person dying of any poison should be placed in a chemically-clean jar capable 62 DRUGS. The treatment of antimonial poisoning consists in the internal administration of large amounts of tannic acid, in the use of the stomach-pump, and in the maintenance of an absolutely prone position. The patient should vomit into towels and not raise the head from the ground; the head, indeed, should generally be placed lower than the heels. External heat, alcohol, and digitalis should be thoroughly used, and opium should be employed hypodermically to allay pain and irritation, unless the respirations are too feeble. Fatty degeneration of the tissues may occur after acute poisoning. Therapeutics.—Tartar emetic is employed for at least five separate purposes, the most usual of which is as a circulatory quieter and seda- tive. The indications for antimony as a circulatory depressant are not so generally recognized at present as they were at one time, ou account of the introduction of other drugs. Suffice it to state that all states of sthenic inflammation with a bounding pulse, high fever, and symptoms showing the patient to be possessed of robust constitution, permit of its use, while all asthenic conditions most emphatically contra-indicate its employment. In the treatment of colds, to break forming diseases, and to allay inflammation, it is given in moderate dose. It is useful in sthenic bronchitis as an expectorant. Under these circumstances it may be given in emetic dose; or, if emesis is not desirable, minute amounts given hourly are of value, such as -gVj of a grain every hour, or a teaspoonful of a solution of 1 grain to a half-pint every hour may be used. This is a particularly useful method in children, as the solution is tasteless, and it does not produce nausea and vomiting. In the acute catarrh of children which affects the stomach and entire alimentary canal and is associated with little fever, the use of the drug is extremely valuable, and often aborts an attack in the same dose as just described. As an emetic antimony is slow but forcible, and it ought not to be used in poisoning owing to its slowness. Before the introduction of anaesthetics, emetic doses were employed to relax the muscles in reducing dislocations and fractures. Tartar emetic is harmful if irritation of the stomach is present or if kidney lesions are active, aud if one good-sized emetic dose is not suffi- cient to produce vomiting, it should not be repeated, but some other emetic or the stomach-pump be used, lest antimonial poisoning com- plicate the case. This dose must be large enough to be effective or none at all should be giveu. If this rule is disobeyed systemic changes come on with undesirable severity in those cases where emesis fails to occur. As a counter-irritant antimony is employed in the form of an oint- ment whenever a very slowly acting and prolonged counter-irritation is to be maintained, as in epilepsy or similar chronic states, and in old enlargements of the joints. of being sealed tight. The same rule of cleanliness applies to the jars holding organs at the post-mortem. The jars should be ready, and no intermediate vessel used. They should be sealed at once, and kept so until claimed by the authorities. ANTIPYRINE. 63 Antimony acts well as a diaphoretic, but its use is unnecessary owing to its disagreeable effects, such as nausea and intestinal disturbance, and because other, more pleasant, drugs act equally well. Administration.—The dose of tartar emetic, when there is an excited circulation, is 2V to ^ of a grain every three hours until au effect is obtained. As an emetic the dose is J to 1 grain. The wine of antimony (Vinum Antimonii, TJ. 8. ; Vinum Antimoniale, B. P.) contains only two grains of tartar emetic to each ounce, a\id may be used in the dose of ^ to 1 teaspoonful, or, as an emetic, in the dose of 1 to 2 teaspoon- fuls. The compound pill of autimony (Pilulce Antimonii Compositce, TJ. 8.) is used as an alterative, and contains sulphurated antimony \ a grain, calomel J a grain, guaiac 1 grain, aud tragacanth ; the dose is 1 to 3 pills. The ointment of antimony (TJnguentum Antimonii Tartarati, B. P.) is used externally as a counter-irritant spread on a rag or piece of lint. Antimonial powder (Pulvis Antimonialis, TJ. 8. and B. P.) or James's powder, contains oxide of antimony and phosphate of calcium, and is given occasionally as an antipyretic in the treatment of rheumatism and fever in the dose of 3 to 10 grains; it is best given in a pill. The compound syrup of squill (Syrnpus Scillw Compositus, TJ S.), otherwise known as " Coxe's Hive Syrup," contains three-fourths of a grain of tartar emetic to the ounce. The dose is 20 to 30 drops for an adult as a sedative, or from this amount to 1 drachm to a child as au emetic. Liquor Antimonii ChloHdi, B. P., is not officinal in this country, and in England is rarely used, as an escharotic. ANTIPYRINE. Antipyrine is a derivative of coal tar, its chemical name being dimethyloxyquinizine. In appearance it is a white powder of a some- what bitter taste and is very soluble in water, less so in ether, alcohol, and chloroform. The process by which it is made is patented. When antipyrine is given to a man in full medicinal amount it causes a buzzing and tightness of the head not unlike that produced by quinine. The bodily temperature, if normal, is depressed a frac- tion of a degree, but no other symptoms are manifested. If the dose be quite large some blueness of the lips and finger-nails appears, chilly sensations are experienced, and finally a profuse sweat breaks out over the entire body, which is more severe if fever has previously existed. Large doses sometimes cause nausea and vomiting. Physiological Action. Nervous System.—When a poisonous dose of antipyrine is given to one of the lower auimals, relaxation, utter loss of reflex action, and total inability to move come on at once and death ensues. Somewhat smaller doses produce exceedingly severe tetanic and epileptiform convulsions, but consciousness seems to be preserved. It has been proved that the chief cause of the 64 DRUGS. convulsion is an action of the drug on the brain.1 Very large toxic doses, therefore, decrease reflex action and smaller ones increase it, though medicinal amounts certainly lessen reflex activity to a notable degree. The cause of this failure of reflexes is depression of the sensory nerves and the receptive centres of the spinal cord. Medici- nal amounts must, therefore, be regarded as very distinct nervous sedatives, acting much more actively on the nerves of sensation than on those of motion. Circulation.—The studies of a very large number of pharma- cologists prove most conclusively that antipyrine has no effect on the circulation of the lower animals in moderate doses, unless these be so frequently repeated that cumulative effects ensue. Many reliable clinical observers have asserted that the drug depresses the circula- tion in man in some cases, and antipyrine is certainly not a cardiac stimulant. Large, poisonous doses lower blood-pressure, unless con- vulsions are present, when the pressure is raised. The action of the drug on the circulation is nevertheless a very unimportant part of its power, aud in most cases is not to be considered in the treatment of disease. In many of the cases where vascular depression and collapse have followed its use it has been employed in excessive amounts, or the fall in bodily temperature has caused the untoward symptoms. (See Fever and its Treatment.) Blood.—No spectroscopic changes in the blood follow the use of medicinal doses of antipyrine iu the ordinary individual, but in poisonous amounts it produces methaemoglobin. If the doses be toxic, or idiosyncrasy exists, cyanosis may come on. That the blood is not destroyed by small amounts is proved by the absence of haematin in the urine of persons taking the drug. The corpuscles suffer no changes except in very pronounced poisoning, when they are said to become crenated and shrivelled. Respiration.—When antipyrine is given in lethal doses death results from failure of the respiratory centre. Ordinary doses have no effect on this function, but large ones make the breathing more rapid. Temperature.—In normal men and animals antipyrine in medici- nal d.ose may be considered as without effect so far as bodily tempera- ture is concerned. In fevered animals it has been found to lower temperature by decreasing heat production and increasing heat dissi- pation. That it does not do this by an action on the blood seems proved by the fact that the blood is not affected by medicinal amounts. The sweating does not cause the fall, since it takes place when no sweating occurs. It may, therefore, be considered that the drug directly affects the nervous heat-mechanism of the body. Kidneys, Tissue-waste, and Urine.—A very large number of studies made upon man and the lower animals by competent investi- gators have brought about very considerable advances in our knowl- 1 See author's Boylston Prize Essay on Antipyretics. Philadelphia, 1891. ANTIPYRINE. 65 edge of the influence of antipyrine upon tissue-waste. It is useless to burden this volume with a discussion of their methods and results, which may be found in my Essay on Antipyretics; suffice it to say that while all observers are not agreed as to the effects produced, the deductions apparently to be drawn are that the drug diminishes the quantity of the urine excreted, and also decreases the elimination of the results of nitrogenous tissue metamorphosis—or, in other words, is a conservator of the tissues of the body. Elimination.—The elimination of antipyrine goes on verv rapidly indeed, and begins almost at once after its ingestion. Maragliano states that it appears in the urine in three hours after it is taken, so that at the fourth hour elimination is at its height, although it continues for twenty-four or perhaps thirty-six hours. According to Pavlinow, part of the antipyrine ingested is eliminated by the salivary glands. Toxic Effects from Prolonged Use.—After chronic poisoning by antipyrine a post-mortem examination shows intense engorgement of the brain and meninges, with a serous exudate into the cerebral ventricles. The lungs are highly congested, the spleen is small and shrivelled, aud the kidneys are filled with blood and slightly inflamed. The liver is not much affected, but the blood-corpuscles are greatly decreased in number. Poisoning.—The treatment of poisoning by antipyrine consists in the administration of stimulants, the maintenance of bodily heat, the use of atropine to restore the tone of the vascular system, and if cyanosis is alarming the employment of oxygen inhalations. Antiseptic Power.—Antipyrine exerts a very distinct antiseptic action in small amounts, delays all forms of fermentation, and pre- vents the growth of germs when it is present in large quantity. Therapeutics.—Antipyrine is employed in medicine for two great purposes—namely, for the reduction of fever and the relief of pain, but its employment as an antipyretic is now entirely surpassed by its use as an analgesic. As an antipyretic, antipyrine should be given in a few large doses rather than frequent small ones, as a general rule, since if the fever is of any severity the latter method of administering it will have no effect. On the other hand, too large doses may depress the tem- perature to a point below normal, and induce collapse. In the article on Fevers the conditions are indicated in which the drug is best em- ployed, these being the sthenic fevers, as a rule, or instances where excessive outbursts of fever necessitate prompt reduction of tempera- ture. Under these conditions, autipyrine is the best adjunct to the cold pack. In excessively high temperature in pneumonia it is of great value, and in scarlet fever and smallpox is of service in some instances. In pneumonia, as a rule, the condition of the patient indi- cates at first cardiac depressants rather than antipyretics. In phthisis antipyrine generally increases the sweating, produces oppression, and either fails to act at all or produces collapse by producing too 66 DRUGS. great an effect. In sunstroke it frequently fails to influence the tern- perature. Be the fever what it may, provided it be associated with any dis eased process, antipyrine is absolutely useless so far as any influence over the course of the disease itself is concerned. It is a remedy to be used in the treatment of symptoms, not in the removal of the cause of the fever. As an aualgesic antipyrine is the peer of opium. Although the latter drug will relieve all forms of pain if it be pushed, it possesses many disadvantages not found in antipyrine. In deep-seated pains due to disease of the organs of the body, iu inflammations and similar disturbances, antipyrine is useless. In neuralgic affections of all kinds it finds its sphere, particularly if the disorder be rheumatic, gouty, or due to nervous depression. Under the latter circumstances it is best combined with caffeine and a little bromide of potassium (see Neuralgia). In rheumatism it will give relief in a fairly large number of cases, not only relieving the pain and fever, if they be present, but also actually modifying the disease. It seems, how- ever, to increase sweating in acute articular rheumatism. In gout it is stated to have a specific curative effect upon the disease, over and above the relief of the pain. Its use in dysmenorrhea has been recommended, but its beneficial influence in such cases is doubtful. At one time it was thought that its use would relieve the pains of labor entirely, but this has, unfortunately, proved untrue. It may, however, be tried when the suffering is very severe in the dose of 15 grains. In the severe lancinating or darting pains of locomotor ataxia, and in the laryngeal and gastric crises complicating this disease, anti- pyrine is an invaluable and reliable remedy. Curiously enough it seems to affect acute attacks of pain in posterior sclerosis, but fails to control the slighter pains and muscular twitchings sometimes seen in this disease and in myelitis. Some clinicians have used antipyrine with asserted great success in diabetes mellitus. Antipyrine may be used hypodermically in the case of a hypersensitive nerve as a local anaesthetic. The anaesthesia produced by it lasts for several days, but the pain immediately after the injection is excruciating. Antipyrine is a very useful remedy in epilepsy. In malarial diseases antipyrine certainly exercises no antiperiodic influence, although it controls the febrile paroxysms to a great extent. Yet, while this is the opinion of the majority of those who have used it, it cannot be said that every observer has reached similar conclu- sions. Potter reports cases where the results obtained from its use were most satisfactory, particularly in the intermittent form of mala- rial poisoning. One cannot help "thinking that frequently where anti- pyrine has been reported as acting as an antiperiodic, it has simply lowered the fever and so seemed to affect the disease. Untoward Effects.—Aside from the results of poisonous doses a large number of cases present slight cyanosis or duskiness of the hands antipyrine. 67 and of the face about the nose and lips; the fingers may be cold and clammy, and the feet are often very cold; sweating is a very common symptom of the untoward influence of antipyrine, and pricking or tingling of the skin is not uncommonly seen. By far the largest number of these cases, however, suffer from disorders associated with the skin, and erythematous patches may be seen everywhere, more particularly on the hands and feet, and about the face, arms, and chest. Occasionally pemphigus-like spots appear, and often large bullae have been noted as present. Elsewhere are published the statistics, collected from medical literature, of 121 cases of untoward effects exercised by antipyrine.1 An analysis of these shows that females were much more frequently affected than males, and that the most susceptible age was decidedly that of full adult life—namely, from thirty to forty years, in both sexes. The dose causing these effects was most com- monly a moderate one—from 10 to 15 grains, or even from 4 to 10 grains. This fact holds good with regard to both sexes. The time of onset of the symptoms varied somewhat, according to whether the drug was given in one excessive dose or in frequently repeated medicinal doses. In many instances, the appearance of the symptoms was sudden rather than gradual. As a rule the duration of the symptoms did not exceed one to three hours, three days being the longest time mentioned. It is interesting to note, however, that of all these cases only six proved fatal, and in these there was ample cause for death aside from any effect of the drug. We can rest assured, therefore, in ordinary cases of disease, that patients exhibiting untoward effects of antipyrine are not in any acute danger, although the symptoms may be temporarily most alarming. Typhoid fever seems, according to the statistics collected by the writer, to be the disease in which this unexpected influence manifests itself most fre- quently, but this may be due to the fact that it is so common a malady, and is so frequently treated by means of antipyretics. Administration.—Owing to the solubility of antipyrine, it is most readily given in a little water in a wineglass or spoon. If its slight taste is disliked, it may be dissolved in any one of the aromatic waters, or in svrup of bitter orange peel, or some similar vehicle. Most per- sons prefer to take it with water. The amount which may be given at a dose is 5 to 20 grains, 5 grains being perhaps the best dose in most cases. Incompatibles.—When added to sweet spirit of nitre, antipyrine in the course of a few moments produces a blue, changing to a dark- green, color, owing to the formation of iso-nitroso-antipyrine, which is not poisonous, but when in the form of a dry powder is readily oxi- dized on exposure to slight heat. If this color is not formed the spirit of nitre lacks its nitrous ether and is worthless, so that we have not only another incompatibility to remember, but a new means of testing the therapeutic value of all samples of sweet spirit of nitre 1 See author's Essay on Antipyretics. Philadelphia, 1891. 68 DRUGS. which may be dispensed by druggists. Calomel aud antipyrine have also been found to be incompatible. APIOL. Apiol is a yellowish, oily liquid with a specific gravity greater than water, an acid taste, and curious odor. It is derived from common parsley, or Petroselinum. So far as is known to the author, no careful study of its physiological action has ever been made, but two French observers, Joret and Horaolle, state that in overdose it causes ringing in the ears, intoxication, and severe frontal headache. Therapeutics.—Originally introduced to combat malarial fevers, because of a fancied resemblance in its toxic action to quinine, apiol has at last found its true level as a remedy in amenorrhea, given in the dose of 2 to 8 minims three times a day for a week before the proper date for menstruation. It should be given, if possible, in capsules owing to its bad taste. It is said not to possess any abortive influences, although it is often taken with this object in view. Apiol is imported from France iu capsules containing a little less than 3 minims. APOMORPHINE. Apomorphine is an artificial alkaloid obtained by the action of hydrochloric acid upon morphine in a sealed tube to which is applied a high heat. It is a whitish or gray powder, made up of minute crys- tals, which rapidly undergo decomposition when exposed to the air. The drug should be kept in dark bottles well stoppered. A very important point to remember is that old solutions rapidly decompose, and, if employed, may produce poisonous symptoms. The drug ought to be dissolved freshly each time it is used. Physiological Action.—One of the best studies of this drug is that of Reichert, who found that in poisonous doses it produces convul- sions, and finally paralysis which is chiefly spinal in origin. Nervous System.—On the nervous centres in the brain apomor- phine acts as a stimulant, but the convulsions produced by poisonous doses are probably spinal. The motor and sensory nerves are finally paralyzed, and even the muscles become poisoned and incapable of contraction. Circulation.—Apomorphine increases the rapidity and force of the pulse and raises arterial pressure, when given in moderate amounts, by stimulation of the accelerator uerves and the vasomotor centre. In large doses it acts as a circulatory depressant. Respiration.—After ordinary amounts no changes in respiration occur, but after poisonous doses the breathing becomes rapid aud irregular. ARNICA. 69 Vomiting.—Vomiting is produced by a direct action of the drug upon the vomiting centre in the medulla, and not by an action on the stomach. Apomorphine is, therefore, a typical centric emetic. Therapeutics.—Apomorphine is useful in nearly all cases where an emetic may be employed. In poisoning from other drugs, particu- larly depressants and narcotics, we have little knowledge of its safety, but, uuless the stupor or circulatory changes are very profound, the drug may be used with care. In subacute and chronic catarrh of the stomach and air-passages it may be useful in getting rid of the mucus by emesis, and it is a useful remedy in acute bronchitis when it is neces- sary to quiet irritation, or when the secretion which has been poured out is very scanty. Administration.—The drug when used as an emetic should always be given hypodermically and the solution be freshly prepared. The emetic dose is about ^of a grain, but as much as ^ may be used in strong patients. The expectorant dose is ^ to -^V of a grain by the mouth. No nausea is usually felt. The drug nearly always acts badly in children, and it is better not to use it in this class of patients. The salt used is Apomorphine Hydrochloras, TJ. 8. and B. P. An injection (Injectio Apomorphince Hypodermica—2 grains dissolved in 100 minims of camphor-water) is officinal in the B. P. ARISTOL. Aristol is a compound of iodine and thymol, which has been intro- duced into medicine for the purpose of substituting iodoform. Ex- periments and practical clinical experience have shown that it can be used in all instances where iodoform can be applied externally, and it is said to possess the advantage of being almost entirely harmless to man, although it is a powerful antiseptic. Its odor is also very slight. As a dressing for the ulcers of tertiary syphilis it seems to act with remarkable success, producing cicatrizatiou with greater rapidity than does iodoform, and it has also been found of value in the treat- ment of ljipus. Aristol may be used in the place of chrysarobin or pyrogallic acid in the treatment of psoriasis. It is best employed in this disease in the form of an ointment in the strength of J to 1 drachm to the ounce of vaseline. ARNICA. Arnica is a medicine derived from Arnica montana, a native plant of the Western United States and Europe. It holds a very high posi- tion in domestic medicine as a local and internal remedy in sprains and bruises, and in the treatment of passive hemorrhages, amenor- rhea, and similar states. Two parts of the plant are officinal, the 70 DRUGS. arnica flowers (Amice Flores, TJ. 8.) and the root (Arnicce Radix, TJ. 8., Amice Rhizoma, B. P.) Physiological Action.—When arnica is applied to a delicate skin it produces burning and irritation, aud even extensive skin lesions. Ac- cording to the studies of the author it slows the pulse, raises the blood-pressure slightly, and stimulates the vagus nerves. Toxic doses produce a rapid pulse from paralysis of these nerves.1 Administration.—Arnica is rarely given internally. If it is so used the dose of the tincture (Tinctura Amice Radicis, TJ. 8.) is 15 to 30 drops, and the same amount of the tincture of the flowers (Tinctura Amice Florum, TJ. S.) may be employed. The solid (Extractum Arniae Radicis, TJ. S.) and the fluid extract of the root (Extractum Amice Radicis Fluidum) are also officinal. The dose of these prep- arations is 3 to 5 grains and 5 to 10 minims respectively. The plaster (Etnplastrum Amice, TJ. 8.) is very useful for external applications. The tincture is the preparation usually applied to sprains and bruises, and the alcohol contained therein accomplishes a large part of the good achieved. The only British preparation is the tincture (Tinctura Amice), which is given in the dose of 30 minims to 1 drachm. ARSENIC. Arsenic (Arsenicum) itself is never employed in medicine, but it is used in the form of arsenious acid or the arseniates of sodium, potas- sium, or copper. Arsenious acid is derived from arsenic-bearing ores by roasting them in a reverberatory furnace, when it rises in the form of a vapor which adheres to the walls of the furnace, requiring a second sublimation owing to the first deposit being quite impure. It is soluble in water, is without odor, and when heated gives off the smell of garlic. Physiological Action.—The changes produced in man by poisonous doses will be found considered under the heading of Poisoning, and the writer will now confine himself to a study of the effects of medi- cinal amounts. Applied to the normal skin arsenious acid produces no change of any moment whatever, but if the surface be broken or a wound or sore exist its action is very powerful, and it destroys the tissues to a considerable extent. For this reason it has been employed as a caustic by " quacks " and to some extent by regular physicians, the latter using it to remove warts, condylomata, and similar growths, while the former have employed it chiefly as a " cancer cure," asserting that it would take the disease " out by the roots.'' Nervous System.—When small amounts of arsenic are given to animals, particularly those of the lower types, as represented by the frog, 1 See Boston Medical and Surgical Journal, 1888. arsenic. 71 reflex action is lost long before, or more rarely at the same time that voluntary movement is put aside, and, finally, all sensation to pain produced by heat aud pinching totally ceases. It is, therefore, quite evident that the sensory nervous apparatus is affected, and experiments have proved that the sensory tract of the spinal cord is at fault. Ultimately, however, the motor system also fails and complete motor palsy ensues. Arsenic in poisonous amount acts as a depressant poison to all protoplasm with which it may come in contact. (Ringer aud Murrell.) In medicinal amounts the drug acts as a nervous excitant and as a stimulant to the trophic nervous apparatus. Circulation.—In moderate amounts arsenic has little or no in- fluence upou the circulation. Large doses cause marked decrease in the force and frequency of the pulse accompanied by a decided fall in arterial pressure, and in these amounts it is to be regarded as a distinct cardiac depressant which depresses all the heart's component parts, such as the ganglia, muscle, and nerves. The fall of the arterial pressure is due to vasomotor depression with relaxation of the general bloodvessels, more especially those of the abdominal cavity. Accord- ing to Lesser, small doses cause it to act as a cardiac stimulant, in- creasing pulse-rate. Arsenic is absorbed by the bloodvessels. Respiration.—In small amounts arsenic very distinctly stimulates the respiratory centre, and Lesser asserts that small doses stimulate the peripheral euds of the vagi iu the lungs, but that in toxic quantities arsenic acts as a powerful respiratory depressant. Elimination.—Arsenic escapes from the body chiefly by the kid- neys and bowels. In poisoning, the purging which is produced carries off much of the drug, but after medicinal amounts some traces of it may be found in the saliva aud in the milk of nursing women. The writer has seen colic produced in infants taking milk at the breasts of women who were receiving large doses of Fowler's solution. Tissue-waste.—According to Chittenden and Cummins, arsenic in medicinal amount distinctly decreases tissue-changes. Large doses, however, greatly increase nitrogenous metamorphosis. Therapeutics.—Arsenic is used in chorea, in which it is almost a specific, acting in an unknown manner. Small doses should be given at first and later on its dose should be rapidly increased, as patients soon get accustomed to the drug. As a tonic combined with iron it is invaluable in malarial anemia and cachexia. In atony of the mucous membranes it is exceedingly useful, and in ordinary anemia and debility, combined with a simple bitter tonic, it is invaluable. In malaria it acts as a prophylactic, as a cure, and as an aid to conva- lescence. Next to quinine it is the best antiperiodic that we have. When the attacks of intermittent fever are far apart, arsenic is useful between the paroxysms as an antiperiodic, quinine being withheld for use during the attack itself. In ordinary neuralgia, due to eye-strain or debility, it is very useful, and in gastralgia it is of great service. The author desires to speak particularly of the employment of arsenic for the improvement of depraved mucous membranes, particularly in 72 DRUGS. those persons who have not true tuberculosis but phthisical tendencies —that is, individuals who continually have colds in the head, chest, or elsewhere. The prolonged use of arsenic for mouths at a time will often cure these cases. No drug is so universally abused as is arsenic in the treatment of skin disease; it should never be employed in " wet" skin diseases— that is, those associated with much proliferation of new cells and the exudation of serum and other liquids. Its field of usefulness is in the dry, scaly skin affections. Where the skin is affected in its lower layers arsenic is useless and should be used only where the epiderm is diseased (Duhring). In psoriasis arsenic at first makes the skin more red and seemingly worse, but this passes off and the disease gets well. This is important to remember, as otherwise the drug may be stopped just at the wrong time. Pemphigus, lichen, and lepra all yield to its influence in most instances. In the treatment of diabetes and pruritus vulve the drug is said to be of value when given internally. In gouty diabetes the use of the carbonate of lithium and the arseniate of sodium is often of great service. In asthma, particularly where the mucous membranes are at fault, arsenic is one of the best remedies that we have, either given internally or smoked in arsenic cigarettes, which are to be made as follows •} Y^.—Belladonnas foliorum Hyoscyam. foliorum Stramonii foliorum Extract, opii Tabaci Aquae . Ft. sol. et adde gr. xcvj. gr. xlv. gr. xlv. gr. iv. gr. lxxx. Oj. M. Potas. nitrat........gr. clx. Potas. arsenit........gr. cccxx. M, Bibulous paper is to be wetted with this compound, and after drying is to be rolled up and smoked in a cigarette. A more simple procedure is to wet bibulous paper in a solution of arsenite of potassium of the strength of fifteen grains to the ounce. In chronic rheumatism arsenic is very valuable in certain cases, but often fails to be of service. In coryza, in cancrum oris, severe sore- throat, and chronic nasal catarrh it is to be employed internally, and in some cases of hay-fever undoubtedly affords relief. The use of arsenic in all stages of phthisis often gives the most surprising results. In gastric cancer and ulcer, given in small amounts frequently repeated, arsenic will often do good by relieving the pain and checking the vomiting. It may be tried in the vomiting of pregnancy with some chance of success. In atonic dyspepsia associated with chronic diarrhea, and with evidences of dysentery, arsenic is of service, and in small 1 See Philadelphia Hospital Pharmacopoeia. arsenic. 73 amounts it is very valuable in frequently repeated doses (T^ of a grain every hour), in all forms of serous diarrhea. For gastric atony or torpidity the following prescription is useful, but if irritation of the stomach is present it should not be employed : R.—Liq. potas. arsenit. Tr. nuc. vomicae Aquae .... S.—Teaspoonful t. d. in water after meals In old persons whose feet become swollen aud hot after prolonged standing and who have shortness of breath on exertion, arsenic does good. Locally applied to warts aud other growths of the skin for several days in the form of Liquor Arsenicalis (B. P.), or Liquor Acidi Arsen- iosi, or of Fowler's solution, it causes the growth to drop off or to become very much loosened. Where the growth is very hard and horny its surface should be softened by the application of liquor potassa before the arsenical liquor is applied. The same plan may be used for corns, and salicylic acid is employed in a similar manner, but is not so efficient. Where large growths with wide surfaces are to be attacked the physician must use arsenic most boldly or not at all. The danger of absorption is only escaped when the drug is used so generously as to destroy the tissues before they can carry on any absorption of the poison. Marsden recommended the use of one ounce each of arsenious acid and powdered gum acacia to five drachms of water as an application to epitheliomatous growths. Administration.—Children generally bear more arsenic than adults, . proportionately, and Ringer states that boys bear less than girls. The drug should generally be administered after meals, as it is apt to irritate the stomach if given when this viscus is empty. Whenever a patient is given arsenic he should be cautioned to watch for any puffiness about the eyes, particularly in the morning on arising, and for slight laxity of the bowels and griping. These are signs that the drug should be stopped for a day or more. The swelling under the eyes may spread if the use of the drug is persisted in, and finally amount to general anasarca. This is due at first to a cellulitis, and afterward to a true effusion. The officinal preparations are arsenious acid (Acidum Arseniosum, TJ. S. and B. P.), the dose of which is ^ to 2V of a grain, the solution of the arsenite of potassium (Liquor Potassii Arsenitis, TJ. 8. ; Liquor Arsenicalis, B. P.), or Fowler's solution, the dose of which at first is from 1 to 5 drops in water; the solution of arseniate of sodium (Liquor Sodii Arseniatis, TJ. 8. and B. P.), the dose of which is 1 to 5 drops, and the solution of arsenious acid (Liquor Acidi Arseniosi, TJ. 8. ; Liquor Arsenici Hydrochloricus, B. P.), the dose of which is 1 to 5 drops. This is more irritating to the stomach than the other preparations. The iodide of arsenic enters into Donovan's solution (Liquor Arsenii et Hydrargyri Iodidi, TJ. 8. and B. P.), the dose of q. s. f3ra. f3j- M. 74 DRUGS. which is 1 to 3 drops well diluted. Iodide of arseuic (Arsenii Iodidum, TJ. S. and B. P.) is given in TVj grain doses, and arseniate of sodium (Sodii Arsenias, TJ. S. and B. P.), in the dose of ^ to T\ of a grain. Acute Poisoning.—Arsenic is a gastro-intestinal irritant, producing, when taken in poisonous dose, violent vomiting and purging, with great pain in the oesophagus, stomach, and entire belly. The passages are finally watery and resemble " rice-water" stools, but are to be separated from those of cholera and antimonial poisoning by the presence of blood aud, if necessary, by chemical analysis. The mucous membrane is stripped off the bowel and in the passages appears in shreds. Very commonly about the third day, if the patient survive so long, an intermission in the attack appears, which will only be followed by a return of all the symptoms, so that the physician must not give a favorable prognosis. In this symptom (remission) arsenical poisoning resembles phosphorus poisoning and yellow fever. Death generally occurs about the fourth or sixth day, and on or about the third day a peculiar skin eruption appears which may be of any character. In rare cases sudden pain, collapse, and death may take place after the ingestion of the poison. Widespread multiple neuritis may be brought on. A typical change always present in acute poisoning when it lasts for any length of time is fatty degeneration of all the tissues. Treatment of Acute Poisoning.—Besides washing out the stomach by the stomach-pump, applying external heat aud stimulants, the proper antidotes should be at once employed, and the only ones of any value are the freshly-precipitated hydrated sesquioxide of iron and magnesium.' The first is to be prepared by the precipitation of iron from one of its fluid preparations by the use of an alkali. Ammonia added to the tincture of the chloride of iron is efficacious, but the pre- cipitate has to be repeatedly washed to rid it of an excess of this irri- tant. Magnesium is a better precipitant because it not only precipi- tates the iron but is an antidote itself. Monsel's solution and the so- called dialyzed iron may be employed in place of the-tincture, but the Monsel's salt is too irritating and the dialyzed iron is so readily pre- cipitated that it needs no alkali, but may be given pure. Magnesium is a useful antidote when used alone. Under the name Fcrri Oxidum Hydratum cum Magnesia the TJ. 8. P. recognizes an antidote for arsenic; this is often called the " anti- dotum arsenici.^ After the use of the antidote opium should be used to allay irritation and pain, and large draughts of water be given to flush the kidneys and dilute the poison. In the later stages the danger from arsenical poisoning arises from the changes produced in vital organs. Chronic Poisoning by arsenic shows itself in great irritation of the air-passages, in diseases of the kidneys,in pigmentation of the skin, and in nervous symptoms due to inflammations of the nervous tissues in different parts of the system, such as patches of anaesthesia and loca - ized loss of motor power. These anaesthetic areas are generally con- fined to the extremities, and extend only to the first or the second ASAFCETIDA. 75 joint above. Arsenic often produces asthma in those exposed to it by reason of the irritation it causes in the bronchial tubes. Chronic poisoning is to be treated by withdrawal from the exposure, and the use of iodide of potassium to aid in the elimination of the arsenic. The other symptoms are to be treated by the application of electricity, tonics, out-of-door life, and such measures as will improve the general condition of the patient. ASAFCETIDA. Asafetida, TJ. S. and B. P., is a gum obtained by making an inci- sion into the root of the Ferula Narthex. It occurs in irregular masses of a dark yellow or reddish color which become still more red if exposed to the light aud air. Asafcetida in tears is a term applied to the drug when it appears in the shape of drops or pearls, and is a form seldom seen. Its odor is penetrating and strong, and resembles that of garlic. When taken internally it causes a sensation of warmth and acts as a stimulant and carminative in the alimentary canal. Therapeutics.—Asafcetida is used in medicine as a carminative which will particularly affect the lower bowel, and is useful in the intestinal indigestion of old persons when associated with flatulence, and in the flatulent colic of children. By way of rectal injections it is of value in the tympanites of children and in that of adults during typhoid fever. It is also used as a stimulating expectorant in the later stages of bronchitis. In the nervous irritability of children it is often of service. Administration.—Asafcetida is given in pills of asafcetida (Pilule Asafelide, TJ. 8.), of which two or three may be taken, each one containing 3 grains; the mixture or milk of asafcetida (Mistura Asa- fetide, TJ. S.), the dose of which is ^ to 1 ounce; and the tincture (Tinctura Asafetide, TJ. S. and B. P.), \ to 1 fluidrachm. The sup- positories contain what is equal to 40 drops of the tincture; and the plaster of asafcetida (Emplastrum Asafetide, TJ. 8.) is used where a faint counter-irritant and antispasmodic is needed. WThen intestinal indigestion and flatulence occurs in old people the following pill is of service: JJ.—Extracti nucis vomicae.....gr. v. Extracti physostigmatis.....gr. iij. Asafcetida?.......gr. xl. M. Ft. in pil. no. xx. S.—One night and morning. The B. P. preparations not officinal in the TJ. S. P. are Enema Asafelidce and Pilula Asafetide Composita, composed of asafcetida, galbanum, and myrrh, dose 5 to 15 grains. 76 DRUGS. ASPIDIUM. Aspidium, TJ. 8., Filix Mas, B. P., or Male Fern, is employed in medicine as a taeniacide or remedy against the tape-worm, and is a very efficient and valuable drug under such circumstances, being, perhaps, the most reliable of all the vermifuges except pelletierin. When employed the directions and precautions given in the article on Worms must be strictly followed. Administration.—Male fern is rarely, if ever, used at present in its crude form, being employed most commonly in this country in the form of the oleoresin (Oleoresina Aspidii, TJ. S.), dose J to 1 fluidrachm iu capsules, or as follows : R.-Oleoresin. aspidii j.....aa ly Tmct. vanillae J l Pulv. acacias....... 3ss. Aq. destillat........fgj. M. S.—Take entire amount after fasting, and follow in two hours by a full dose of castor- oil or sulphate of magnesium. The dose of the liquid extract (Extractum Filicis Liquidum) of the B. P. is 15 minims to 1 fluidrachm. AZEDARACH. Azedarach, TJ. 8., is the bark of the Melia Azedarach, or Pride of China, as it is sometimes called. It is found in Syria, Persia, the north of India, and in the southern United States. The drug has little toxic power, aud children may eat of it largely without ill effect. If very large amounts are used gastro-intestinal inflammation occurs. It is employed as a remedy against the round- worm, and should be given in decoction made by boiling 2 ounces of the drug in a pint and a half of water until there only remains a pint of liquid. Of this from 1 to 2 tablespoonfuls are to be giveu a child, and repeated every two hours until the bowels are opened. It has also been used as a fluid extract prepared by the ordinary means with alcohol, to which some white sugar should be added. The dose of this extract is a teaspoonful, and is not to be repeated. The decoction is the best form in which to use the drug. BARIUM CHLORIDE. One of the most recent and one of the best evidences of the value of the study of the action of drugs upon the lower animals is given us by this substance. It will be remembered that Brunton aud Ringer, of London ; Robert and Bary, of Dorpat; and Bartholow and the writer in America, have at various times published, during BELLADONNA. 77 the last few years, studies concerning the effect of barium on the cir- culatory apparatus of the frog, dog, and man, and all of them are in accord in the statement that it slows the heart very greatly, steadies its rhythm, and, at the same time, increases the ^volume of blood thrown out of the ventricle. They have also found that barium in- creases blood-pressure, and Robert has, by a series of careful experi- ments, concluded that it brings about this change by au action on the muscular coats of the bloodvessels. If large doses are used iu the lower animals, the heart suffers sys- tolic arrest from over-stimulation, and the strongest irritation of the vagus nerves fails to relax the systolic contraction. Still more inter- esting is the statement that this failure of the vagi to inhibit the heart is not the result of paralysis of these nerves, but is simply due to the excess of cardiac contractile power. The slowing of the pulse is not due to inhibitory influence, but depends solely upon the stimulation of the heart muscle, although it would seem probable that the vaso- motor stimulation, by increasing the arterial resistance, may be at least a factor in the reduction of the pulse-rate. At one time, in the dog, after large doses, there is a period of increase of pulse-rate which is asserted to be due to stimulation of the accelerator nerves. In most works on chemistry barium is stated to be an irritant poison, but to produce such evidences of its presence the dose given must be extremely large, and many times greater than any amount useful for medicinal purposes. Therapeutics.—Barium chloride may be used in all forms of car diac disease in which failure of the heart muscle is present. In the treatment of varicose veins it is said to be of value, both when given internally and applied locally over the distended vessels. A point worthy of remark is the character of the pulse-wave pro- duced. While its volume is increased it does not give that sensation of tenseness to the finger that does digitalis, and the pulse-wave seems to be very considerably prolonged; a fact that the sphygmo- graph also records. Administration.—The solution of barium chloride to be used in- ternally should have the strength of 5 grains to the ounce of water, and of this 1 or 2 teaspoonfuls is to be given three times a day. BELLADONNA. Belladonna is botanically known as Atropa Belladonna, and is officinal in the form of the root (Belladonne Radix, TJ. 8. and B. P.), and leaves (Belladonne Folia, TJ. S. and B. P.). It belongs to a very large class of plants which all have a similar physiological action. Belladonna contains an active principle in the form of an alkaloid, known as atropine (Atropina, TJ. 8. and B. P.), which is insoluble in water. The sulphate of atropine (Atropince Sulphas, TJ. 8. and B. P.) is soluble. 78 DRUGS. Physiological Effects. — In man, full medicinal doses produce flushing of the face, redness and dryness of the fauces, dilated pupils, sometimes an erythematous rash over the skiu, rarely diplopia and delirium. If the dose be still larger the delirium becomes very marked and is wild and talkative. The pulse is rapid and wiry. The rash which appears resembles that of scarlet fever, but lacks the punctations. The skin may desquamate after several days if the rash is severe. In children belladonna is usually borne very well indeed, and opium very badly. When belladonna asserts itself in children the respiration is quickened, the eyes become bright and the cheeks red, but lines of pallor reach from the malar bones to the corners of the mouth, giving the face a curious expression. Nervous System.—Belladonna acts as a powerful excitant of the brain and spinal cord. When very large doses are given, paralysis of tiie spinal cord comes on, which is followed by tetanic spasms and finally by recovery. The primary loss of power is due to paralysis of the entire cord, and the second state, of convulsions, to the escape of the motor and sensory pathways from the paralysis before the inhibitory centres recover. As a result any peripheral irritation causes violent explosions of motor power.1 Even in large medicinal dose belladonna may be con- sidered as a depressant to the motor nerves and as a quieter to sensory nerve-filaments. On voluntary muscles the drug has no effect, but upon unstriped muscles it acts as a depressant and antispasmodic. It distinctly lessens reflex action. Circulation.—Belladonna quickens the pulse by depression of the peripheral vagi and by stimulating the cardiac muscle. It pro- duces a rise of arterial pressure by stimulating the vasomotor centre and by the increased heart action which it causes. In poisonous doses it causes a fall of arterial pressure due to centric vasomotor palsy, and depression of the muscular coats of the bloodvessels, but not to cardiac depression, as has been generally taught, for Reichert has proved that the drug is not a heart depressant unless the dose is simply over- whelming. Sometimes when belladonna is given the pulse becomes slow, but in these cases the slowing is due to temporary stimulation of the peripheral vagi or to momentary depression of the cardiac motor ganglia. Respiration.—Atropine is a stimulant to the respiratory centre in ordinary amounts, but recent careful studies show that its high reputation as a respiratory stimulaut is not based either on clinical or experimental experience. In many cases it fails to increase the respiration at all, and it is certainly inferior to coffee and strychnine 1 If a homely simile, found useful by the writer in teaching, may be used, the inhibi- tory centres may be represented by a schoolmaster, and the motor and sensory centres by two boys. The escape of chloroform in the room paralyzes them all, but, finally the boys recover before tbeir master and go off as truants (convulsions); at last the master (inhibitory centres) recovers, and order, or health, is restored. BELLADONNA. 79 in the treatment of opium poisoning. In large doses it is a depressant and paralyzant to respiration, and produces death from respiratory failure due to paralysis of the motor nerves supplying the respiratory muscles, and probably by depressing the respiratory centres. Abdominal Contents.—Belladonna increases peristalsis by de- pressing the peripheral ends of the inhibitory fibres of the splanchnic nerves and by diminishing any tendency to spasm on the part of the muscular coats of the intestine. Action on Secretion.—The drug decreases all the secretions of the body except the urine, which is sometimes increased in amount under its use. The decrease of secretion is due to paralysis of the peripheral nerve-filaments supplying the secretory cells of the glands. Bodily Heat.—When belladonna is used in large amounts there is nearly always a rise of temperature, which in children may amount to one or two degrees. In advanced poisoning the temperature rapidly falls. Elimination.—Atropine is eliminated by the kidneys and bowels and is partly destroyed in the liver. In a suspected case of poisoning the urine of the patient may be dropped in the eye of an animal, and, if atropine or belladonna has been taken, mydriasis will result. Eye.—On the eye belladonna produces dilatatiou of the pupil by stimulating peripherally the sympathetic nerve fibres of the iris and paralyzing the ocular motor fibres. It generally increases intra-ocular tension. Treatment of Poisoning.—Poisoning by belladonna is to be treated by the application of external heat if the patient goes into collapse and the use of strychnine if respiration fails. Opium may be employed in carefully graded doses as the physiological antagonist, but large doses are of doubtful service, particularly if the respirations are not in a satisfactory state. Therapeutics.—Belladonna is used to allay excessive secretion, to act as an antispasmodic, and to influence the circulatory apparatus when local inflammations are beginning, particularly in secretory glands. Belladonna is of value in neuralgias and in the pains due to irritated peripheral nerves. To check secretion in night-sweats it is the best remedy we have, and it is useful in excessive idiopathic ptyalism, as seen in children, or in that due to mercurialization. In bromidrosis of the feet and other localized sweatings it is useful, and may be employed locally or taken internally for their cure. It is the best drug we have for checking the secretion of milk in an inflamed breast, and under these circumstances it is best to smear it over the gland in an ointment. Belladonna may be used in serous diarrhea, as it checks the disorder by stimulation of the splanchnic vasomotor filaments of the intestinal bloodvessels, which being inactive permit a transudation of liquid into the bowel. Trousseau recommended as a local remedy 1 to 2 grains of the ex- tract of belladonna with 6 to 8 grains of tannic acid in leucorrhea dependent upon disease of the uterine cervix. This should be placed 80 DRUGS. on a pledget of cotton and applied to the affected part daily, being allowed to remain all day. Ringer states that if pain is also present in these cases the following injection is of value : R.—Sodii bicarbonatis......3j- Tr. belladonnae......f 3ij- Aquae dest......q. s. ad Oj. M. This is to be injected into the vagina, the woman first being placed on her back with her buttocks raised, so that the drug may bathe the uterine cervix for some minutes. As an antispasmodic, atropine is to be used in torticollis, injected directly into the muscle itself, so as to act on its motor nerve fibres, and it may be given in spasm of the intestine with cramps and griping, while in cramps in the legs and body, either as a local application by means of liniments, or when employed internally, it is of service. In asthma of the spasmodic type, belladonna is a sovereign remedy, particularly if it be combined with morphine. It may be used both as a prophylactic and as a cure during the attack. The belladonna leaves may be smoked by rolling them into a cigarette or putting them into a pipe. This drug is used in whooping-cough at all ages and in all stages, but it has generally to be given in large ■ amounts in this disease to do any good. In spasm of the sphincter ani, either that which is idiopathic or due to fissure, belladonna in the form of an ointment or suppository is of value. In spasm of the urethra and bladder the drug may be used internally and externally, and in the former state the ointment should be smeared along the under surface of the penis, every night. This treatment is also useful in chordee. In the colic resulting from the passage of hepatic and renalcalculi belladonna in full dose will nearly always give relief. Where urinary incontinence depends upon spasm of the bladder bella- donna should be used (see Urinary Incontinence). In dysmenorrhea in nervous women with spasm of the cervix uteri it is of very great value applied as an ointment or in a vaginal suppository, or when given by the mouth. For the nervous cough of children and adults belladonna is one of the best remedies we have. In constipation it does good by depressing the inhibitory nerves of the intestine. It is also of value in laryngismus stridulus and in hiccough. In spasms from peripheral irri- tations belladonna is of value. In iritis atropine is used to dilate the pupil and prevent adhesions. The solution to be dropped into the eye should contain 1 to 4 grains of atropine sulphate to the ounce of water. When employed to act on the circulation it is to be used in shock and collapse from injury, or in the course of severe disease (see Shock). During the progress of a case of pneumonia, typhoid fever, or other severe disease, belladonna should be kept in the house and administered freely if collapse or vasomotor relaxation suddenly asserts itself. In mastitis, or inflammation of the breast, even where pus is beginning to be formed, belladonna, if pushed, will give surprisingly good results BELLADONNA. 81 if given internally and applied locally. In sore-throat, when the pharynx is hot and dry and has a sensation of rawness, while the local capillaries appear injected and red, belladonna is often of the greatest service if given in full dose, aborting the " cold." In exophthalmic goitre belladonna is thought to act by stimulating the sympathetic nerves, and certainly gives relief in some cases. For the relief of local nerve pains it is of value, and probably acts by quieting the irri- tated nerve. It should be applied in these cases in the form of an ointment or plaster and be well rubbed into the part affected. In headache occurring in young persons, often due to over-work, with pain in the eyeballs and forehead and a sensation as if the orbits were too small for the eyeballs, belladonna is of service. In intercostal neuralgia or pleurodynia belladonna plasters may be applied to the spot where the pain is felt, with relief. Use of Atropine in Poisoning.—Atropine acts as an antidote in cases where poisonous mushrooms have been eaten, and is a physio- logical antidote to opium, Calabar bean or physostigma, and jaborandi. In opium poisoning it acts as an antidote in all parts of the body except the eye, and in jaborandi poisoning the same fact holds true. In opium poisoning the drug should not be given after the respirations rise to ten from three or four per minute, as too much of the drug may be given aud atropine poisoning may come on and complicate the case. The con- dition of the pupil is not a guide as to the effect of atropine in opium poisouing, because opium acts centrically and atropine acts peripherally on the nerves governing the iris. Atropine should be used in aconite, antimony, and hydrocyanic acid poisoning, for its influence on the vasomotor system, the respiratory centre, and the heart, and for the purpose of maintaining the bodily heat, the dissipation of which it retards by preventing vasomotor palsy and consequent dilatation of the peripheral bloodvessels. It should be borne in mind that atropine is not the very best single antagonist to opium, and that it should always be largely replaced by caffeiue and strychnine. Administration.—The dose of the sulphate of atropine (Atropine Sulphas, TJ. 8. and B. P.), is T-^- to -^ of a grain. The alcoholic extract (Extractum Belladonne Alcoholicum, TJ. S. and B. P.) is given in ^ to 4/ grain doses, and the tincture (Tinctura Belladonne, TJ. 8. and B. P. in the dose of 5 to 15 minims. The fluid extract (Ex- tractum Belladonne Fluidum, TJ. 8.) is given in 1 to 2 minim doses, while the extract of the B. P. is given in \ to 1 minim doses. Ab- stractum Belladonne, TJ. S., is given in the dose of 1 grain, and Succus Belladonne, B. P., is given in 5 to 15 minim doses. The preparations of the B. P. not officinal in the TJ. 8. P. are Liquor Atropince Sulphatis, given in the dose of 1 to 6 minims, Lamelle Atropine, each of which contains 5^6o of a grain of atropine, aud TJnguentum Atropine. Belladonna liniment (Linimentum Belladonne, TJ. S. and B. P.), Belladonna plaster (Emplastrum Belladonna', TJ. S. and B. P.), and the ointment (TJnguentum Belladonne, TJ. S. and B. P.) are for external application. e 82 DRUGS. Recent experiments show that belladonna decreases gastric secretion very considerably in some persons. It is better, therefore, not to administer'it just before or immediately after a meal. BENZOATE OF BISMUTH. This is a preparation which has been highly recommended in Germany, and to some extent in this country within the last few months, in the treatment of chancroid. Under its influence the sore heals up with great rapidity and leaves a comparatively small cicatrix. It may also be used iu the treatment of all specific sores and for the dressing of indolent or sloughing ulcers. Benzoate of bismuth, when properly applied, should be preceded by a careful washing of the diseased surface with a very weak bichloride solution, after which the bismuth is to be sprinkled over the wouud and the entire surface covered with cotton, which should be held in place by an adhesive strip. The only disadvantage in this dressing lies in the fact that it has to be changed once or twice iu every twenty-four hours Im- mediately after it is applied it may produce some tingling or burning, but this is never very severe. BENZOIN AND BENZOIC ACID. Benzoin (Benzoinum, TJ. 8. and B. P.) is a resinous balsam derived from the Styrax Benzoin, which is a native of Sumatra, Borneo, and Java. Benzoic acid is obtained by the sublimation of gum benzoin, and it is benzoic acid which is generally used in medicine. Physiological Action.—Locally applied in concentrated form ben- zoic acid is an irritant, and taken internally in excessive amount it causes a sensation of warmth and burning. It is eliminated as hip puric acid, and increases the quantity of the acids in the urine. On the lower forms of life it acts as an antiseptic and germicide. Therapeutics.—Benzoic acid is useful in the treatment of chronic cystitis with alkaline urine which is loaded with phosphates, and, com- bined with cannabis indica, acts well in the later stages of gonorrhoea. Senator states that in the dose of 2 or 3 drachms a day it is a specific in acute rheumatism, and thinks it equal to salicylic acid. When these doses are to be used the benzoate of sodium should be employed, owing to its solubility. In acute laryngitis accompanied by great hoarseness the inhalation of steam laden with compound tincture of benzoin is of the greatest service. A tablespoonful of this tincture should be placed in a pitcher of boiling water, the face held over the liquid, and a towel throwu over the head of the patient to retain the steam. The drug cannot be used in an atomizer, as it clogs the "tips." Taken internally it is useful in chronic bronchitis. BISMUTH. 83- Administration. — The dose of benzoic acid (Acidum Benzoicum, U. 8. and B. P.) is usually 10 to 40 grains, but a drachm may be given in capsule. The gum itself is never used. The tincture (Tinctura Benzoini, U. S.) is given in 30 minim to 1 drachm doses, and the compound tincture (Tinctura Benzoini Composite, U. S. and B. P.) is composed of benzoin, aloes, storax, balsam of Tolu, and alcohol, the dose of it being 1 to 2 fluidrachms. The preparations officinal in the B. P. but not in the TJ. S. P. are the troches (Trochisci Acidi Benzoici and TJnguentum Cetacei). Adeps Benzoinaius (U. S. aud B. P.), or benzoated lard, is simply a non-rancid basis for many ointments, notably that of zinc. BICARBONATE OF POTASSIUM. This salt (Potassii Bicarbonas, TJ. 8. and B. P.) is used for the same purposes as the citrate and acetate of potassium, and as it is much less agreeable in taste should not be employed when they can be obtained. The dose of potassii bicarbonas is 5 to 40 grains, or even as much as 2 drachms may be given if well diluted with water. BICARBONATE OF SODIUM. • Bicarbonate of Sodium (Sodii Bicarbonas, TJ. 8. and B. P.) is a salt largely used as an antacid in gastric fermentation, and in sick head- aches arising from this condition. Combined with calomel in powder it certainly adds to its efficiency in increasing biliary flow, as all alkalies of this class liquefy and thin the bile. The drug has been widely employed in the treatment of rheumatism, and is found to be of great service in allaying pain and soreness in the joints when used iu a lotion made by dissolving it in water and applying it to the part on lint or rags. In acidity of the stomach the following effervescing powder is useful: Bicarbonate of sodium (Sodii Bicarbonas), 30 grains in one paper, and, in the other, 20 grains of tartaric acid (Acidum Tartarieum). These are each dissolved in half a tumbler of water, added to one another, and swallowed during effervescence. BISMUTH. Bismuth (Bismuthum, B. P.) is used in medicine as the subcarbonate (Bismuthi Subcarbonos, TJ. 8.), the subnitrate (Bismidhi Subnitras, TJ. 8. and B. P.), the citrate (Bismuthi Citras, TJ. S. and B. P.), and the bismuth and ammonium citrate (Bismuthi et Ammonii CitraSj TJ. S. and B. P.). The first and second are identical in their dose (5 to 20 grains) and action, and may be employed interchangeably. The third and fourth are more astringent and more irritating than 84 DRUGS. the other two, and must be given in a smaller dose, which is 2 to 4 grains. Many years ago the drug was supposed to be capable of producing gastro-enteritis in large doses, but this was due to a con- tamination by arsenic. Bismuth may produce chronic poisoning after prolonged use on wounds or when internally administered. The symptoms under these circumstances are the formation of black sloughs in the mouth and gastro-intestinal tract, desquamative neph- ritis, and albuminuria. The preparations of the B. P. not officinal in the TJ. 8. P. are the Liquor Bismuthi et Ammonii Citras, dose J to 1 fluidrachm, and the troches (Trochisci Bismuthi), 2 grains in each. Bismuthi Carbonas, B. P., is the same as the subcarbonate of the U. S. P. Therapeutics.—Bismuth is used as an astringent in large doses to cover the surface of inflamed mucous membranes and so to allay irrita- tion. It is useful in irritative vomiting for this reason, and in diarrhea of a similar type in which the stools are serous. If the passages are mucous, castor oil should precede bismuth in order to rid the ali- mentary canal of the secretion already poured out. It is very useful when combined with carbolic acid in serous diarrhea, given in cap- sules containing 5 grains of bismuth subnitrate aud 1 drop of carbolic acid (Wood). It is also to be used as a slow and feeble antacid. The Bismuthi et Ammonii Citras is very astringent, and should be used in chronic serous diarrheas in the dose of 5 grains every two or three hours. The other preparations of bismuth are insoluble, and they should not be given in water, but this preparation is soluble, and may be given in solution. Bismuth is of service in dyspepsia when lactic and butyric acid fermentation is present with excessive belching, and may be employed in gastralgia and gastric ulcer and gastritis as a sedative and astringent. The salt of bismuth and ammonium citrate must never be employed if acute inflammation exists. When the salts of bismuth are used for any length of time they cause the odor of garlic to appear iu the breath, which is due to the presence of an exceedingly slight trace of tellurium in the bismuth. The stools are apt to become black, and the tongue, if furred, may also be black about the centre when bismuth is used. Where there is chapping of the hands or cheeks from exposure to cold or wet, the folio wing prescription is useful: R.—Bismuthi subnitratis Zinci oleatis Lycopodii . S.—Apply to the parts t. d. BISMUTH SALICYLATE. (See Salicylate of Bismuth.) 5iij- 3ij. M. BORAX AND BORACIC ACID. 85 BITARTRATE OF POTASSIUM. Potassii Bitartras, TJ. 8., Potassii Tartras Adda, B. P., is some- times called " cream of tartar," or acid tartrate of potassium. It is a white gritty powder which may occur in rhombic crystals. Owing to its stability it has been thought that it escaped from the body without oxidation, and so to differ from the other potassium salts formed from vegetable acids. This is probably incorrect. Therapeutics.—The bitartrate of potassium is the most diuretic of the potassium salts, and is used iu chronic nephritis with gin or com- pound infusion of juniper, when it is very useful in removing dropsy. One ounce of the salt is added to a pint of the infusion of jumper berries, and the entire quantity taken in divided doses in twenty-four hours. In acute renal disease the drug should be used without the juniper. In large doses (half an ounce) it acts as a watery purge, but is rarely so used. Where the urine is thick coid alkaline bitartrate of potassium is a useful remedy to render it acid and make it clear and normal in hue. BORAX AND BORACIC ACID. Borax, or Sodii Boras (TJ. S. and B. P.), is made by the action of boracic or boric acid upon sodium. It,is soluble in twelve times its weight of water. Both borax and boracic acid have been supposed to act as efficient germicides in strong solutions, but this has been proved incorrect. They are antiseptics, however, even when in weak solutions. In the form of a lotion boracic acid has been used as a remedy for ery- sipelas with a good deal of success, and it may be similarly employed in bums and scalds. Borax may also be used as a wash in diphtheria and in aphthous stomatitis, cancrum oris, and gangrenous stomatitis. Internally borax has been used in epilepsy, and may be tried with some slight hope of a good result. In the treatment of pruritus ani and vulvce, and in bromidrosis and fetid sweating it is of great value when used as a wash. Strong solutions locally applied are useful in tinea tonsurans and tinea circinata. Boracic acid may be given in- ternally in cystitis to render the urine acid, and is useful in the removal of freckles when applied as a wash to the skin. It is one of the most commonly used substances in eye-washes, either alone or with cocaine. When used with cocaine or other drugs it is employed to prevent the destruction of the alkaloid or glucoside, as the case may be, by the growth of mould. The following formula may be employed : R.—Cocain. hydrochlor......gr. iv vel viij. Acid, boracic.......gr. x vel xx. Aquae destillat.......f5ij. M. S.—To be used in conjunctivitis and similar states. 86 DRUGS. Boroglyceride is a liquid made by the addition of boracic acid to glycerin in the presence of heat. It is soluble in water. Locally it is used as an antiseptic, and as a vehicle for carbolic acid, chrysarobin, and the vegetable alkaloids in the treatment of skin diseases and in diseases of the eye, such as purulent ophthalmia. The following makes a very elegant application for the skin of the face and hands : R.—Acid, boric.........3j- Ceree albae........3j. Paraffini ....... ^i.j- 01. amygdalae dulc.......3ij. M. S.—To be thoroughly mixed and applied night and morning. Potter recommends the following in uric acid diathesis when there is a tendency to the formation of stone: R.—Magnesii carbonatis . . . . ■ • 3j. Acid, citrici ....... 3y- Sodii biborat. ....... 3>j- Aquae bullientis.......f ^viij. M. S.—A tablespoonful t. d. Or, JJ.—Acid, boric..........3j- Potassi bitartrat........3iy- Aquae........q. s. f ,^x. M. S.—Heat together to dryness, and give 20 grains in water, well diluted, t. d. Borated lint is made by dipping lint into a boiling, saturated solu- tion of boracic acid or borax. It makes a simple, inexpensive anti- septic surgical dressing, and contains nearly one-half its weight of the drug. Grlycerinum Boracis, B. P., and Mel Boracis, B. P., are not officinal in the TJ. 8. P., but are used as local applications for chapped hands and small sores. BRAYERA. Brayera, TJ. 8., Cusso, B. P., sometimes called Kousso, is derived from Brayera Anthelmintica, a plant of Abyssinia. It contains a vola- tile oil, tannic acid, and koosin or taeniin. The drug is used against the tapeworm and is most valuable as a vermifuge, also possessing the advantage of safety. It should be used in an infusion (Infusum Brayere) in the dose of \ an ounce of the powdered flowers to a pint of water, and be taken in the morning on an empty stomach (See Worms.) Koosin may be used in the dose of 20 to 40 grains in capsule. The fluid extract (Extractum Brayere Fluidum) is given in the dose of J au ounce. It has been said that the drug is apt to cause abortion iu pregnant women, but this is not known to be a fact. Infusum Cusso, B. P., is given in the dose of 4 to 8 fluidounces. BROMIDES. 87 BROMIDES. Bromides of potassium, sodium, lithium, calcium, nickel and ammonium, and hydrobromic acid. Bromide of Potassium. Bromide of potassium (Potassii Bromidum, TJ. 8. and B. P.) is the most commonly used and important member of the group above named, and will, therefore, be spoken of before the others. It is prepared by precipitating freshly-made bromide of iron with pure carbonate of potassium, or by a process more readily carried out and recommended by the B. P. It occurs in colorless transparent crystals which are stable in dry air, but absorb moisture in a damp atmosphere. It is very soluble in water, but less so in alcohol. This bromide has a salty taste, aud is distinctly irritant to mucous membranes if locally applied in concentrated form. Physiological Action.—Bromide of potassium has an action upon the animal economy which is clearly defined, and closely followed by all the other bromide salts, so that what is said in this place concerning its effects may be taken as representing the whole class of bromides, except in the instances where slight differences exist, which will be pointed out under the various names of the respective salts. Nervous System.—The bromide of potassium acts as a distinct depressant to the motor and intellectual portions of the cortex cerebri. It slows the development of thought and decreases the excitability and power of the motor cells of the brain. (Albertoni.) Upon the spinal cord it acts as a marked sedative, affecting chiefly the sensory tracts, and causing thereby loss of reflex action and a decrease in the ability of the animal to recognize pain. It also depresses to a less extent the motor pathways in the cord. Motion is maintained after sensations to pain and reflexes are lost. The drug depresses the peripheral parts of the sensory nerves, and, iu very large doses, the motor nerves and muscles are similarly involved. Circulation.—If the drug be injected in ordinary dose into the jugular vein it causes at once a fall of arterial pressure and pulse-rate. These changes are due to a direct action of the bromine and the potassium upon the heart. When given to man in therapeutic doses by the mouth its circulatory effect is so slight as not to be worthy of consideration. Respiration.—Bromide of potassium is a depressant to the respir- atory centre in toxic dose. In medicinal dose it does not affect the breathing except when the amounts given are large and the drug persistently administered, when the breathing becomes slower. Temperature.—No effect upon this function is noted, unless the dose be enormous; when such a dose is given the bodily heat is pro- gressively diminished, the fall of temperature being probably due to 88 DRUGS. the circulatory and nervous depression produced, associated with the general failure in vital power. Elimination.—The drug escapes unchanged very slowly with all the secretions, and is found in the sweat, urine, tears, semen, milk, and faeces. Tissue-waste is decreased. Therapeutics.—From what has been already said it is evident that bromide of potassium is a remedy to be devoted almost entirely to the treatment of diseases of the nervous system, and its uses are, therefore, as various as the manifestations of perversion of nervous action can be various. In a word, it may be said that bromide of potassium is to be used wherever over-excitement of nervous protoplasm is present, but never where nervous symptoms are due to depression. In epilepsy, which, to the best of our knowledge, is due to explosive impulses arising in the cerebral cortex, it is the best drug we have, and in all forms of minor spasm, due to heightened reflex activity, it is of service. In spasmodic contractions, in the treatment of hysterical females, in nervous startings and alarm at sudden noises in adults and children, and in the nervous symptoms accompanying pregnancy and the menopause, it will be found of great value. The following pre- scription is recommended very highly by Goodell, and will be found of service in these states : ]J.—Ammonii bromidi.......,5ij- Potassii bromidi.......3'v- Spts. ammon. aromat.......f 3VJ- Aquae camphorae.....q. s. ad f §vj. M. S —A dessertspoonful to a tablespoonful every four hours. In headaches due to uterine trouble the pain is often felt at the top of the skull or at the back of the neck near the occiput. The cause of this trouble will sometimes be found to be in the cervix uteri, and relief under these circumstanees can only be obtained when the uterus is treated and the bromides administered. In convulsions in children aud adults, combined with chloral, bro- mides are most efficient, aud are sometimes of service in incontinence of urine due to vesical spasm. In seminal emissions due to a morbid excitability of the centres in the spinal cord, bromide of potassium is one of the best remedies we have, and in satyriasis and nymphomania it is of great service. In cases where undue irritability of the pharynx and larynx prevents examination of these parts, one or two full doses will render an exami- nation easy of performance by decreasing the local reflex activity. This is a useful point to be remembered in relation to the treatment of pharyngeal and laryngeal disease. The bromides are found to be of service in the laryngeal crises of locomotor ataxia, the explanation of this fact being as follows : The adductor centre of the larynx is situated in the brain, and the abductor centre in the spinal cord. The first closes the larynx, the second opens it, and in health they maintain a patulous tube by their oppo- BROMIDES. 89 sition. In disease the spinal centre (the abductor or opener) fails, and the adductor iu the brain being unopposed, produces closure of the tube with disastrous results. The bromide, by quieting reflex action, as well as depressing the adductor centre in the cerebral cortex, prevents this accident. In whooping-cough with much mucous exudation the drug is rarely of benefit and had better not be used. In laryngismus stridulus or any form of spasm depending upon local irritation, the local trouble must, of course, be removed if possible. In teething the drug may be used to decrease reflex irritation and prevent convulsions, and it will decrease the night-screaming of children—which is often due to bad dreams—to a very extraordinary degree, even if the dose be quite small. As a soporific for the insane, aud in the insomnia of the over- worked and that of nervous women, the bromide of potassium is of great service. It may also be employed with good results iu chronic alcoholism and morphiomania. In migraine and neuralgia due to eye- strain or other nerve strain, combined with caffeine the bromide is almost a specific. The caffeine seems to stimulate the depressed nerve up to the normal level, and the bromide to deaden the perception of the pain. The following is a most valuable remedy in migraine and even in sick headache. It ought not to be used in bilious headache, which will be made worse by it: J£.—Antipyrinae.......gr. xxv. Caffeinae citratis...... gr. x. Potassii bromidi . . ' . . . . gr. xxv. M. Ft. in chart no. v. S.—One powder as needed. In the treatment of dysmenorrhea and menorrhagia, particularly in young subjects, the bromides are also of service (see Dr. Goodell's pre- scription, p. 88). When the flow is too great at such a period the drug should be begun a week before the expected epoch, and kept up in the dose of 5 to 10 grains night and morning. In cases where the epochs follow one another too closely the drug should be used con- tinuously. After an apparent cure ensues the bromide should be used for a few periods to avoid a relapse. For sea-sickness the bromides are the best prophylactics we possess, and should be used in the dose of 5 to 10 grains three times a day for several days before the patient sails in order to quiet the vomiting centre. After sea-sickness begins they should not be given in ordinary solution, but in an effervescing draught made as follows : I£.—Acid, citric........otf. Aquae dest........ . f 51V. M. Ft. sol. I£.—Potassii bromidi......oj. Potassii bicarbonatis......oj. Aquae dest........f.5'v- ^L Ft. sol. S.—A tablespoonful of each of these solutions should be added to one another and taken during effervescence. 90 DRUGS. This prescription will also be found of value in the persistent vom- iting of pregnancy and in that following prolonged etherization, or other states. If the vomiting is excessive the dose ought to be reduced to 2 teaspoonfuls of each solution and be given every half hour until half of each mixture is taken or the patient is relieved. In cases where this will not act, rectal injections of the following will be found of value : JJ.—Potassii bromidi . Tinct. opii deodorat Aquae amyli S.—To be injected gently into the empty rectum and retained as long as possible. This method is the most reliable plan that can be followed. Bromide of potassium may be used to prevent the symptoms of cinchonism after quinine aud salicylic acid, and it is said to prevent the nausea and depression so apt to follow the use of opium. Administration.—The dose of bromide of potassium is from 5 to 60 grains a day. Use of Bromides in Poisoning.—Bromides are useful in all con- vulsive attacks consequent upon the ingestion of poisons, except those due to cardiac sedatives which alter the circulation at the base of the brain ; and they may be used to allay any nervous symptoms which are of an excited nature, to prevent excessive vomiting, to produce sleep, and to quiet delirium, and even to allay pain. Effects of Prolonged Use.—After the drug has been used for some time acne appears about the face and extends over the entire body, the breath becomes foetid, the patient dull, expressionless, and heavy, remaining buried in sleep during nearly every hour of the day. During this time he can be aroused, but at once falls to sleep again. The walk becomes weak and feeble, the movements slow and painfully prolonged. Taste is lost and hearing is benumbed, while the intel- lectual faculties of the brain are almost blank. Loss of sexual power is an early symptom. The acne may be put aside by the use of arsenic, and where bromides are used to any extent in women this drug should always be given simultaneously to prevent the eruption. As Fowler's solution is compatible with the bromide in solution, it is the best form of arsenic to employ. Bromide of Ammonium. Bromide of Ammonium (Ammonii Bromidum, TJ. 8. and B. P.). This salt is far more stimulating than the bromide of potassium, and it is certainly much more irritating. The dose is the same as the potas- sium salt—5 to 60 grains a day. Combined with autipyrine it is useful in epilepsy. Da Costa has recommended it highly in rheuma- tism in large doses well diluted, but the author has never seen it do any good in such cases. gr. xxx. gtt. xxx. fgvj. M. BROMIDES. 91 Bromide of Calcium'. Calcium Bromide (Calcii Bromidum, TJ. S.) was introduced into medicine as a nervous sedative and hypnotic, and was thought at one time to be an efficient substitute for the bromide of potassium. Its action on the nervous system is virtually identical with that of the potassium salt, aud it has been found to be far less irritant aud depres- sant than the latter. For some uuknown reason it has never won the confidence of the profession, but it may be given with very good results in the dose of from 30 to 90 grains a day, or even more in cases which are not readily affected by bromides. It is employed especially in hysteria and epilepsy, and iu all the conditions in which the other bromide salts are indicated. It is sometimes of value combined with the potassium salt, since under such circumstances better results are often gained than if a single salt is employed. Bromide of Gold. The bromide of gold has been employed in epilepsy by a number of clinicians with great success in the dose of from ^ to J grain three times a day in pills. Physiological studies have proved that the drug is a direct sedative to the motor cells in the cortex cerebri. Bromide of Lithium. Bromide of Lithium (Lithii Bromidum, TJ. 8.). This salt is much weaker than the other salts, aud may be given in larger dose. Dr. S. Weir Alitchell states that it is of value in epilepsy after the potas- sium salt fails. The dose is 30 to 90 grains a day. Bromide of Nickel. This is a green salt quite irritant to the stomach. The author has made an experimental study of the bromide of nickel and found it prac- tically identical with the bromide of potassium in physiological action. It should be given well diluted, or in an effervescing draught, as it is apt to disorder the stomach if used in concentrated solution. The efferves- cing form of the drug is made by mixing the salt with bicarbonate of sodium and tartaric acid, moistening with alcohol, passing the moist powder through a sieve, aud then drying it in a warm closet. Bromide of Sodium. Bromide of Sodium (Sodii Bromidum, TJ. S. and B. P.)._ This salt is to be used in every instance where bromide of potassium can be employed. Its dose is the same, although it is asserted to be a little 92 DRUGS. weaker physiologically, grain for grain, than the potassium salt, It is far less apt to disorder the stomach, and is not so generally depres- sant as is the bromide of potassium. Hydrobromic Acid. Hydrobromic Acid is an extremely irritant preparation, but is thought to be less apt to cause acne and other untoward effects than the other bromides. It is only to be used in the form of the officinal dilute acid (Acidum Hydrobromicum Dilutum, TJ. 8. and B. P.) and to be given in the dose of from one drachm to half an ounce well diluted with sweetened water. It is highly recommended by De Schweinitz and others for headaches due to eye-strain in nervous women. BROMINE. Bromine (£7. 8. and B. P.) is a dark-red liquid of an excessively puugent odor like that of chlorine, possessing very extraordinary power as a caustic when applied to the tissues of the body. It is the most severe caustic we possess, and penetrates very deeply. It may be applied in hospital gangrene and other large sloughs, by means of a glass rod. BRYONIA, OR BRYONY. This is a remedy very largely used by irregular physicians but which nevertheless possesses very great power aud often relieves con- ditions which are obstinately persistent under other treatment It is the root of Bryonia Alba or Bryonia Dioica ( TJ. S.); the only officinal preparation is the tincture (Tinctura Bryonice, TJ. S.). The dose of the powdered root as a drastic is 10 to 40 grains. Physiological Action.—In overdoses bryonia acts as a hydragogue cathartic and gastro-intestiual irritant. On serous membranes it ex- ercises an irritant influence and may produce symptoms of meningitis when given in poisonous doses. In moderate doses bryonia may cause some flushing of the face and neck and headache in susceptible persons. The drug needs studying from a physiological point of view. Therapeutics.—Although one of the oldest of remedies, bryonia has been given a new impetus by the homoeopaths, who employ it in a number of affections. In the treatment of dyspepsia depending upon gastric and intestinal atony or the abuse of alcohol or other similar causes, bryonia often gives relief. Its influence is exerted through the irritant effects it produces, for by this means it stimulates or spurs the atonic digestive glands to increased activity. For this reason it has been found to be particularly useful in children who suffer from constipation resulting from insufficient secretion on the part of the intestinal glands. When the passages are dry and friable aud BUCHU. 93 resemble those of a dog in character, bryonia is certainly of great value. The drug has been praised as a remedy in the treatment of rheumatism and in pleurisy, but little is recorded as to its real value in these diseases. It is probably always more effective when the febrile stages of these affections have passed by. Thus in pleurisy it is useless during the acute, forming stage, but prevents the pouring out of effu- sions, and if they be already poured out causes their absorption. Administration.—The dose of the tincture of bryonia is from 1 to 5 fluidrachms, but the so-called mother tincture of the homoeopaths is perhaps the best preparation for ordinary use. The dose just given is a laxative dose. The proper amount to be used in the treatment of a case of dyspepsia is from 5 to 60 drops unless the mucous membranes are very torpid, when this quantity may be increased. In pleurisy with effusion drastic doses may be needed. BUCHU. Buchu (TJ. S.) is derived from Barosma Betulina, a plant of Africa. It contains a volatile oil, which is probably the active principle, and a bitter extractive. It is officinal, under the name of Buchu Folia, in the B. P. Therapeutics.—Buchu is used as a diuretic when it is desired to affect the mucous membranes of the genito-urinary tract which are chronically diseased, and particularly when these parts are below their normal tone. It does not increase the urinary flow to any great extent, but acts on the genito-urinary passages as a stimulant. It is useful iu pyelitis, cystitis, and vesical irritation of a chronic type. The following prescription is useful: JJ.—Potassii citratis.......3\v. Spt. chloroformi.......f^iij. Tinct. digitalis.......f£j. Infusi buchu.......f.lviij- M. S.—Two tablespoonfuls 3 times a day. If the urine is continually highly acid, muddy, laden with salts, and productive of incontinence by reason of the vesical irritation which it produces, buchu in the form of the fluid extract, in the dose of a teaspoonful three times a day, combined with an equal amount of sweet spirit of nitre, will be of great service. For a child the dose should be about ten to thirty minims. If the vesical irritation is acute buchu is contra-indicated. Administration.—The fluid extract (Extractum Buchu Fluidum, TJ. S.) is the only officinal preparation, and it should be always well diluted before it is given, in the dose, to an adult, of 1 drachm three times a day. The infusion is not officinal, but is made by adding one ounce of the leaves to a pint of water. The dose of this is a table- spoonful to two tablespoonfuls. The officinal B. P. preparations are 94 DRUGS. the infusion (Infusum Buchu), dose 1 to 4 fluidouuces, and the tincture (Tinctura Buchu), dose 1 to 2 fluidrachms. CAFFEINE. Caffeine (Caffeina, TJ. 8. and B. P.) is an alkaloid derived from the berries of Cafifea Arabica, which also contain, upon roasting, an empyreumatic oil. Caffeine is usually employed in medicine as the citrate, and is soluble iu 75 parts of water.1 Physiological Action.—On the nervous system caffeine acts as a rapidly acting stimulant, exerting its chief influence on the brain and spinal cord. By its cerebral effect it causes increased rapidity of thought, and by its influence on the spinal cord it increases reflex activity, and for this reason is said to make people " nervous." It is important to remember that it has no effect on brain protoplasm except to stimulate it, aud that ultimately a brain driven along by caffeine breaks down by the concentration of its energy for the time being in one effort. In the frog in poisonous doses it causes tetanic convulsions by an action on the spinal cord, and if applied directly to a muscle, causes it to contract spastically. It does not affect the motor nerves. Circulation.—Caffeine has been supposed to increase the pulse- rate and blood-pressure by stimulating the heart muscle, but from recent studies in this country and abroad it would seem probable that these changes are indirectly produced and due solely to its stimulating action on the nervous system. Clinically, it certainly seems to raise the blood-pressure in almost every instance where it is used. Kidneys, Tissue-waste, and Elimination.—Caffeine increases diuresis by a direct stimulation of the secretory epithelium of the kidney, and therefore increases the amount of solids as well as of the liquids in the urine. Upon tissue-waste the drug acts as a depressant, and is therefore a conservator of the tissues. It is burnt up in the body. The empyreumatic oil, of which there is about one teaspoonful in each well-made breakfast cup of coffee, has no physiological effects. It is probably the cause of the " biliousness " sometimes produced by the habitual use of coffee, due to the faulty digestion of this oil, which is also apt to disorder the digestion if taken alone. Therapeutics.—Caffeine is a valuable cardiac stimulant and tonic as well as a renal stimulant. It acts equally well in cardiac and renal dropsies for this reason, and is an invaluable remedy in such cases. In acute Bright's disease it is contra-indicated, because all stimulants are contra-indicated iu acute inflammations. In opium poisoning, 1 Theine, derived from tea, caffeine, the active principle of coffee, and the alkaloid of guarana from South America, are chemically identical. Much of the caffeine of commerce is really theine, although it is claimed that pure theine has a very different physiological action. calcium. 95 owiug to its stimulant effect on the respiratory centre, it is very valuable. Under these circumstances it may be given iu the form of strong black coffee, which will aid in keeping the patient awake and also add heat to the body, which is often very cold. A cup of strong black coffee is often useful in the treatment of a paroxysm of asthma. In headache due to nerve-strain, caffeine combined with antipyrine and one of the bromides is of the greatest service (see Neuralgia). So useful is caffeine in cases of cardiac disease that it has largely sup- planted digitalis in the hands of some practitioners. Caffeine Citras, TJ. S. and B. P., cannot be used hypodermically, owing to its decomposition in the presence of water. The following solution may, however, be used hypodermically : Salicylate of sodium, 30 parts; caffeine, 40 parts ; and distilled water, 60 parts; or, in other instances, the following preparation, recommended by Huchard, may be employed: Benzoate of sodium, 45 grains; caffeine, 30 grains; distilled water, 1J drachms. This mixture is to be heated and 10 drops given at a dose. CAJUPUT OIL. Oil of Cajuput (Oleum Cajuputi, TJ. 8. and B. P.) is a volatile oil distilled from Melaleuca Cajuputi, a tree of the Molucca Islands. It is a stimulant, and in large amounts an irritant, to mucous mem- branes, but acts as an efficient carminative and parasiticide in moderate amounts. As a remedy for tinea tonsurans and pediculi it should be applied pure to the part affected. Cajuput oil is capable of irritating the skin. In diarrhea of a serous type it is of value in the dose of 10 to 20 drops (see Diarrhoea). Spiritus Cajuputi is officinal in the B. P.; dose, J to 1 fluidrachm. CALCIUM. Calcium is officinal in a number of forms, and is to be distinctly separated in the mind of the student from calx or lime, which is an oxide of calcium. It is never employed as calcium, but as one of its salts. These are as follows : Bromide of calcium (Calcii Bromidum, TJ. 8.), precipitated carbonate of calcium (Calcii Carbonas Precipitatus, V. 8., Calcii Carbonas Precipitata, B. P.), chloride of calcium (Calcii Chloridum, TJ. 8. and B. P.), hypophosphite of calcium (Calcii Hypo- phosphis, TJ. 8. and B. P.), and as precipitated phosphate of calcium (Calcii Phosphas Precipitatus, TJ. 8., Calcii Phosphas Precipitata, B. P.). Calcium sulphate is not officinal. All salts of calcium are incompatible with acids. The precipitated carbonate of calcium is used iu the treatment of serous diarrhea, as an antacid and as a local protective in cases of chappjed skin or intertrigo, particularly in young children. When given internally the dose is from 10 to 30 grains, but by far the best 96 DRUGS. method for its administration is iu the employment of chalk mixture (Mistura Qretee, TJ. 8. and B. P.), which contains about 30 grains of the chalk to each ounce of liquid. The dose of this mixture is from a teaspoonful for a young child to an ounce for an adult. _ In the treatment of cases of diarrhea chalk mixture is best given in com- bination with tincture of kino or the compound tincture of catechu and paregoric, in some such form as follows : R.—Tr. kino.........f o.j: Tr. catechu comp........f.T'j- Mistura creta;.....q. s. ad f,5vj. M. S.—A dessertspoonful every three hours till diarrhoea ceases. It is to be remembered that the chalk mixture acts very slightly as an astringent, and chiefly as an antacid and mechanical agent in the alimentary canal. Precipitated carbonate of calcium is the slowest antacid which we possess, and for this reason is the remedy to be employed in acidity of the intestines, as it passes through the stomach to a very great extent unchanged. (For the varieties of diarrhoea in which it is to be used see article on Diarrhoea.) As an external application it is used in sweating of the feet and hands, and sometimes as a dry dressing to ulcers. It may also be used over burns. Calcium chloride, when taken internally in any amount, acts as an intense gastro-intestinal irritant, and may produce death by this means. It is to be distinctly separated from the chlorinate or chloride of lime, with which it is sometimes confused, for the latter is nothing more than hydrate of lime or slaked lime, containing 25 per cent, of chlo- rine, while chloride of calcium is a hard, vitreous, friable substance, giving off no odor of chlorine and utterly different in its use, action, and appearance. Chloride of calcium is used in medicine by some physicians in the treatment of scrofulous enlargements of glands iu the neck and else- where, and is even said to cause calcification and encysting of tuber- cular nodules. In cases where deficient bone-formation is evident it often does good, but the other salts of lime, such as the hypophos- phites, are better. In cases where boils mature slowly, a poultice made by adding a solution of chloride of lime to the mass may be used to hasten suppuration. The dose is 5 to 30 grains, best given in a solu- tion made by adding water in the proportion of a drachm to each 5 grains of the drug. The hypophosphite of calcium and the precipitated phosphate of calcium are used for the treatment of scrofulosis or strumous states and allied conditions such as rachitis, generally in the form of the Syrupus Hypophosphitum, TJ. S., and the Syrupus Calcii Lactophosphatis, TJ. S. The large amount of phosphate of calcium in the bones and tissues renders it a useful drug when the body is starved of its proper proportions of salts, and its use has been found, in animals, to cause a great increase in bony growth, not only in the earthv but also in the CALUMBA. 97 animal constituents of the osseous tissues. The hypophosphite has a similar effect. In rickets and in fractures where the bone is slow is uniting, and in some cases of phthisis aud scrofula, the lactophosphates and hypo- phosphites are of service. In dental caries, particularly that occur- ring in nursing women, and in the anemia of this class of patients, they are useful. In genei-al debility and nervous prostration they are often of great value, and may be even used with benefit in chronic and atonic diseases of the skin and mucous membranes. In cases of hepatic torpor they may be employed with advantage. The lactophosphates are better than the hypophosphites, as the latter are probably changed into phosphates in the stomach as soon as they enter this viscus. The only advantage which they possess over phosphorus in certain diseases, particularly of the bony system, is that they afford an easy method of administration, and also that they contain calcium. The dose of either of these two drugs is 10 to 30 grains three times a day, or, of the syrups just named, a teaspoon- ful to a tablespoonful. The difference between these salts aud phos- phorus, both in therapeutical effect and physiological action, is to be clearly borne in mind. The lactophosphates and hypophosphites are simply convenient modes of administering lime, potassium or other substances, while phosphorus acts as a stimulant to bone growth and not by its deposition in the boue. Phosphoric acid does not act any more like phosphorus than does sulphuric acid act like sulphur. Sulphate of calcium is not to be confounded with sulphide of cal- ' cium, or to speak more correctly, calx sulphurata. The latter remedy, which was first used by Sidney Ringer, is a very useful preparation in the treatment of boils, both as as remedy to hurry on the "point- ing" of the boil and to prevent the formation of others. The dose of calcium sulphide or calx sulphurata is ^ to 4/ grain. (See Boils and Calx.) Prepared chalk (Creta Preparata, TJ. 8. and B. P.) is given in the dose of 20 to 60 grains. Other preparations are compound chalk powder (Pulvis Ct^ete Compositus, TJ. 8.), dose 10 to 60 grains, and troches of chalk (Trochisci Crete, U.S.). Preparations officinal in the B. P., but not in the TJ. S. P., are aromatic powder of chalk (Pulvis Creta: Aromaticus), dose 10 to 60 grains, and Pulvis Crete Aromaticus cum Opio, dose 10 to 60 grains. CALUMBA. Calumba, Columbo, or Columba, is the root of the Cocculus Pal- matus, a climbing plant of Mozambique. Its taste is bitter, and its odor is slightly aromatic. Two alkaloids are found in it, berberine and columbine, aud a third substance known as columbic acid. Calumba is one of the purest bitters known. Therapeutics.—Calumba is one of the best simple tonics which 98 DRUGS. can be used, owing to its lack of astringent effect and to its favorable action on mucous membranes. In cases of gastro-intcstinal atony, particularly that following fevers and similar states, calumba will be found of service, and it is a valu- able remedy in the convalescent stages of summer complaint and serous diarrheas. The following prescription of Dr. George B. Wood is very useful in these states when they are associated with flatulence: $.—Calumbse pulv........3SS' Zingiber, pulv........$ss. Sennae fol......... 3>j. Aq. bullientis........Qj. M. Ft. in infusium. S.—A wineglassful t. d. Administration.—The fluid extract (Extractum Ccdumbce Fluid ion, TJ. S.) is given in the dose of 15 to 60 minims; the tincture (Tinctura Calumbe, TJ. 8.), dose 1 to 4 fluidrachms. The dose of the extract (Extractum Calumbe, B. P.) is 2 to 10 grains ; the infusion (Infu- sum Calumbe, B. P.) 1 to 2 fluidouuces, and the tincture (Tinctura Calumbe, B. P.) J to 2 fluidrachms. CALX. Calx, or Lime, or Oxide of Calcium, is an alkaline earth which is incompatible with acids, ammoniacal and metallic bases, borates, alka- line carbonates, and astringent vegetable infusions. Therapeutics.—Lime is used for the purpose of acting as an escha- rotic, particularly on old ulcers and on hairy growths. It is never given internally, except in the form of the hydrate or slaked lime. As an escharotic application lime is used in the officinal caustic Potassa cum Calce. When given internally it should always be used as Liquor Ccdcis, TJ. 8. and B. P., or lime-water, and under these circumstances it acts as an antacid, as an aid to the digestion of milk by preventing too rapid and solid coagulation of the casein, and by exciting an increased gastric secretion. It is also feebly astringent. Given to infants and nursing women it is probably utilized in the body in the formation of bone. It is also of value in diabetes, in the uric acid diathesis, and in the excessive nausea and vomiting very often seen in adults and children. Teaspoonful doses of milk and lime-water, equal parts, will often be retained when nothing else will remain in the stomach. The dose of lime-water is a teaspoonful to 1 ounce or even 2 ounces. Externally applied, lime-water is of value in tinea capitis and similar states, and it is the best application in burns, when it is to be mixed with equal parts of linseed or olive oil, forming the Linimentum Calcis, U. 8. and B. P., or carron oil. As a local application in mem- branous croup and diphtheria, lime-water has a high reputation and is believed to dissolve the membrane. It may be used as a spray or by means of a swab. CAMPHOR. 99 Liquor Calcis, or lime-water, is to be made by adding a piece of unslaked lime as large as a walnut to 2 quarts of boiled and filtered water in an earthen jar; after stirring it thoroughly allow it to settle, and pour off the clear liquid into a bottle. More water may then be added to the lime until it is all used. Sulphurated lime (Calx Sulphurata, TJ. S. aud B. P.) is useful to check inflammation and hasten suppuration; the dose is -^ of a grain. Where sulphide of calcium is not obtainable and successive crops of boils constantly appear, it is often possible to relieve the patient by baking egg-shells in an oven, powdering them, and then letting the patient eat 1 drachm or more of the powder each day. The prepa- rations of the B. P. that are not officinal in the TJ. 8. are the saccha- rated solution of lime (Liquor Calcis Saccharatus), dose 15 to 60 minims, and slaked lime (Calcii Hydras) used in different prepara- tions. CAMPHOR. Camphor (Camphora, TJ. 8. and B. P.) is derived from the Cin- nomomum or Taurus Camphora, which grows chiefly in China and Japan. The camphor used in the drug stores is in reality refined camphor, and is so obtained by repeated sublimation. It is a volatile, irritant gum or resin, producing a burning taste and possessing a peculiar odor, soluble in one thousand parts of cold water and in one part of strong alcohol. Camphor is so volatile that if allowed to remain exposed to the air for any length of time it rapidly loses its bulk and eventually disappears. It is an exceedingly combustible substance, burning with a flame and much smoke. It may be white or pinkish in color. Physiological Action.—If taken in large amount camphor produces epileptiform convulsions preceded by vertigo, roaring in the ears, and delirium. The pulse soon becomes rapid, feeble, and running, and the skin livid, cold, and covered with sweat. Great heat and burning may be felt in the belly, and if the poisoning be slow, evidences of gastro- intestinal and renal inflammation ensue. In small doses it acts as a stimulant and adds a sensation of warmth to the stomach, while the pulse may become more rapid and stronger under its influeuce. At the same time there is a sedation of the nervous system and a general feeling of contentment. In large medicinal dose camphor is thought by some to act as a sexual stimulant and by others as a sexual sedative. The stimulant effect is probably only produced by doses large enough to produce irritation of the genito-urinary tract. The convulsions fol- lowing poisonous doses are cerebral in origin, and the drug, although largely destroyed in the body, is eliminated by the kidneys as campho- glycurie acid and escapes by the breath and perspiration. Therapeutics. Internal Use.—Camphor is employed for the pur- pose of acting as a nervous sedative and antispasmodic in the treatment of nervous women and children, and as a carminative in persons who suffer 100 DRUGS. from intestinal flatulence. It is of value in nervous dysmenorrhea and headache, and is best combined with one of the new analgesics, such as antipyrine and acetanilide given in pill form. As it is virtually a volatile oil, so far as its physiological action is concerned, it will be found useful in cholera morbus and all forms of serous diarrhea, but never in mucous diarrhoea (see Diarrhoea).. In chordee, combined with bromides and similar depressants to the spinal cord, camphor is of great service in some cases, particularly late in the disease. In adynamic fevers it has been used as a diffusible stimulant by Graves and others with great success. In hiccough it is of great service, and in cardiac palpitation due to functional irritability it is found to be of value. In capillary bronchitis and catarrh of the air-passages it will be found useful in old or atonic cases. It is also of value as a mouth-wash iu persons who have foetid breath. External Use.—Externally camphor may be used as a stimulant to indolent sores, and as a useful addition in small amount to the pre- cipitated carbonate of calcium as a dusting powder in intertrigo. In the form of a liniment camphor is used over inflamed joints from sprains or rheumatism, and in myalgia and neuralgia to relieve the pain and stiffness. Camphor may be inhaled or taken internally in cases of cold in the head with great relief and a decided influence in aborting the attack. After the attack is in full force it is useless, but used early it will decrease the frontal headache and the sneezing and running at the nose. In coryza from unknown causes with much lachrymation and incessaut sneezing, camphor will be found of benefit. It may be snuffed up the nostril in a fine powder, or powdered camphor may be put iu boiling water and the fumes inhaled. The spirit may also be inhaled from a handkerchief. Camphorated alcohol, spirit of camphor, is a useful application for abortive purposes when used over boils, in their formative stage, if repeated two or three times a day, for a few moments at a time. Fol- lowing these applications the skin should be dried, and camphorated oil applied. Ringer and Tilt both recommend that Eau de Cologne, saturated with camphor, be rubbed into the head in the drowsiness and headache of the menopause, and a lotion of equal parts of aqua am- monia and spirit of camphor dabbed on the painful or hyperaesthesic spots at the top of the head, so commonly felt at the change of life or during menstruation, will be found to give relief. Administration.—Camphor is used internally in the form of the camphor water (Aqua Camphore, TJ. 8. and B. P.), dose J to 2 fluid- ounces ; the spirit of camphor (Spiritus Camphore, TJ. S. and B. P.), dose \ a fluidrachm, or in the form of the camphor itself, in pill, in the dose of 1 to 3 grains in each pill. The best preparation for internal use is the spirit, or the camphor itself may be given in pill form. For external use we have, officinal, the Camphor Liniment (Lini- mentum Camphore, TJ. 8. and B. P.), and the Soap Liniment, or Lini- mentum Saponis, TJ. S. and B. P., which is the mildest of the two. \ CAMPHORIC ACID. 101 Ceratum Camphore is also officinal. A compound tincture of camphor (Tinctura Camphore Composite)), composed of opium, benzoic acid, camphor, and oil of anise, is officinal in the B. P., dose 15 minims to 1 fluidrachm. Linimentum Camphore Compositum, B. P., is com- posed of camphor, rectified spirit, and stronger ammonia. CAMPHOR MONOBROMATE. Monobromate of Camphor (Camphora Monobromata, TJ. 8.). This drug is made by heating together in a sealed tube camphor and bro- mine. It occurs in colorless crystals or scales, and has a mild taste resembling camphor. It is almost entirely insoluble in water, but freely soluble in alcohol, ether, aud chloroform. Physiological Action.—Monobromate of camphor possesses powers partaking of the bromides and of camphor. In the frog it causes loss of reflex action, motor palsy and death by respiratory failure, and in warm-blooded animals violent convulsions, Cheyne-Stokes respira- tions, muscular tremblings and weakness. The pulse is at first more rapid than normal, then slow and weak, death coming in coma or during the convulsions. Therapeutics.—Monobromated camphor will generally be found most useful in combination with other drugs in pain due to disease, such as lumbago, or that due to nervous disturbances. If used in hystericcd females it will often produce sleep, and is of value to those who are addicted to the camphor-habit, as it acts as a hypnotic and warms the stomach. Like camphor itself, it is a gastric irritant, and should not be employed where gastritis exists. It has been used in spermatorrhea with great success, and in delirium tremens has been found of benefit in cases where the gastric mucous membrane is de- pressed and the nervous twitchings are troublesome. In whooping- cough it may be tried, and it has even been used in chorea, epilepsy, and petit mat. Administration.—It should never be used hypodermically, as it is too irritating, but administered in the dose of 5 grains three times a day in pill or in an emulsion made by dissolving it in six times its weight of expressed oil of almonds and then forming an emulsion with gum arabic and water in the usual manner. CAMPHORIC ACID. Camphoric Acid is made by the oxidation of camphor through the influence of acids, and has been used in the night-sweats of phthisis with considerable success. In a large number of cases suffering from night-sweats the author has found this drug to act very favorably in- deed where other remedies failed. It may be resorted to in the dose of from 20 to 30 grains taken an hour or two before the sweat is expected. In very obstinate cases as 102 DRUGS. much as 60 grains should be given, but under these circumstances it should be used in two separate doses of 30 grains each, two hours apart, in order to avoid irritating the stomach. It is best given in capsule,'as it is insoluble in water. In other instances camphoric acid may be given in the following formula : JJ.—Acid, camphoric........ q'w. Alcohol........f.^'j- Mucilag. acaciae • . . . . . . f^iij. Syr. aurantii corticis.....q.s. fjvj. M. S.—Dessertspoonful to a tablespoonful one hour before sweat is expected. CANNABIS INDICA. Indian Hemp (Cannabis Indica, TJ. S. and B. P.) is the flowering tops of Cannabis Saliva. It is to be distinctly separated from the so-called American, Americau-Indian or Canada hemp, or Apocynum Cannabinum, which is au intense irritant and drastic. Physiological Action.—Given in full dose to man this drug causes exhilaration, and periods of constant laughter arising from the slightest cause, the person seeming convulsed with merriment; in other cases the sensations are disagreeable, and even death may seem imminent to the deranged mind. Often the sensation of very full breathing comes on, and the patient thinks he is about to burst with the inflation of his lungs. After this deep sleep appears, lasting for many hours, even as much as fourteen or fifteen, without any intervals of wake- fulness. If the dose be very large the respirations are slowed very considerably, but no death from the use of cannabis indica by man is on record, and enormous amounts have been given to the lower ani- mals without causing a lethal effect.1 Applied to mucous membrane it acts as a very severe irritant and then as a local ausesthetic, but the primary effect is so powerful as to prevent its local use for the relief of pain. One of the most constant and pressing symptoms in poisoning in man is the marked sensation of prolongation of time, so that minutes seem like hours, and, in addition to this, a peculiar separation of the mental powers occurs during which both hemispheres of the brain seem to think differently on the same subject. Therapeutics. — Cannabis indica is one of the best adjuncts to cough mixtures that we possess, as it quiets the tickling in the throat and yet does not constipate or depress the system as does morphine. In advanced phthisis it is justifiable to constantly keep the patient in a state of euthanasia by its use. For the relief of pain, particularly that depending on nerve disturbance, it is very valuable. Before the introduction of antipyrine and its congeners, tincture of gelsemium 1 The author has injected as much as 5 drachms of a fluid extract, active in the dose of 10 minims to man, into the jugular vein of a small dog without producing death for many hours. V CANNABIS INDICA. 103 and the tincture or extract of cannabis indica were our best remedies in migraine. The gelsemium under such circumstances should be given in full dose, 20 drops of the tincture, and be followed by 10 to 20 drops of the fluid extract of cannabis indica—it being known that the sample about to be used is active. In true migraine with hemianopsia this treatment is often most effectual in aborting the attack. The prevention of further attacks is to be attained by the use of smaller amounts of the cannabis indica during the intervals; the gelsemium only being used at the onset of the symptoms. In paralysis agitans cannabis indica may be used to quiet the tremors, and in spasm of the bladder, due to cystitis or nervousness, it often gives great relief. In sexual impotence, not dependent upon organic disease, it is said to be of value combined with strychnine, or nux vomica, and ergot. When a patient suffers from sleeplessness which is due in part to pain and in part to nervousness, the following pre- scription may be given : R—Chloralis j Sodii bromidi J Ext belladonnae fl. . Ext. cannabis indicse fl Syr. acaciae S.—Tablespoonful at a dose. In headaches at the menopause cannabis indica is useful, and, if the headaches are associated with constipation, iron and aloes should be given simultaneously, particularly if anaemia is present. Where headaches are due to eye-strain a very useful prescription, according to De Schweintz, is as follows : R.—Tr. nucis vomicae ...... foij. Tr. cannabis indicae......foij' M. S.—Fifteen drops in water twice or thrice a day. In whooping-cough and asthma cannabis indica sometimes proves of service. In uterine subinvolution, chronic inflammation and irritation cannabis indica is of great value, and it has been found of service iu metrorrhagia and nervous and spasmodic dysmenorrhea. Not only does it relieve the pain, but it seems to act favorably upon the muscular fibres of the uterus. In acute aud chronic Bright's disease cannabis indica often allays the painful sensations over the renal region, aud has been recom- mended by some writers in the cases in which bloody urine is present. In gonorrhea it is said to decrease the discharge aud prevent chordee, aud it has supplanted the use of copaiba aud cubebs in some practi- tioners' hands. It should not be used in the early stages of gonor- rhoea, but in the later or subacute stages. There is some foundation for the belief that in small doses it acts as a sexual stimulant. The advantages possessed by it are its lack of constipative power, and the fact that it does not cause after-depression and nausea, its happy effect in most cases, and an increase rather than a decrease of the appetite under its influence. »a- 3j- • f3j. • f3j. 104 DRUGS. Administration.—The employment of this most valuable remedy is handicapped by its frequent lack of power—a fault which is largely dependent upon its preparation. The drug as prepared by Parke, Davis & Co. and the solid extract of McKesson & Robbins have proved efficacious in the author's hands for a number of years. The physi- cian should always employ some preparation known by him to be active by personal trial before condemning the drug as a failure in a given case. The dose of the solid extract (Extractum Cannabis Indice, TJ. 8. and B. P.) is from \ to \ grain, that of the fluid extract (Extractum Can- nabis Indice Fluidum, TJ. 8.) from 4 to 20 minims, aud that of the tincture (Tinctura Ccmnabis Indice, TJ. 8. and B. P.) from 15 minims to 1 drachm. CANTHARIS. Cantharis (TJ. S. and B. P.), or "Spanish Fly," is really a beetle known as the Cantharis vesicatoria, and as such appears with iri- descent coverings or wing-sheaths of a bluish or greenish hue. They come chiefly from Spain, Italy and Sicily, and from the southern parts of Russia. Those from Russia are supposed to be the best. According to Leidy, the vesicating substance is in the blood, the eggs, and the secretions of the generative apparatus. The blistering sub- stance contains cantharidin as an active principle, but cantharidin is not medicinally employed. Physiological Action.—The ingestion of a moderate dose of can- tharides produces only slight stimulation of the genito-urinary system, particularly the kidneys and urinary tracts. Large amounts produce great pain in the lumbar region, burning in the bladder and entire urethra, priapism, agonizing vesical tenesmus, widespread acute ne- phritis, bloody urine, which is scanty at first and finally suppressed, with great irritation of the external openings of the genito-urinary apparatus. The inflammatory changes which are produced may cause sloughing of the penis or of the labia in the female. Violent gastro-enteritis is nearly always a pressing condition. A diagnostic sign of cantharidal poisoning, where the beetles have been swallowed, is the appearance of pieces of the iridescent wings and coats in the vomit. Thirst is always a prominent symptom of poisoning by cantharides. Therapeutics.—Cantharides are employed internally and externally. When given by the mouth the tincture is used as a uterine stimulant, to affect the uterine mucous membrane and relieve amenorrhea in cases where atony and depression are the cause of the suppression. Some persons teach that the tincture of cantharides is a valuable remedy in small doses in the second stage of acute desquamative nephritis, but in the instances where the writer has seen it used it has made matters much worse although it is supposed to decrease the quan- tity of the albumin and blood. In the later stages, where the kidneys CANTHARIS. 105 are relaxed and torpid or where albuminuria comes on on the slightest exertion, cantharides in the dose of one drop of the tincture three times a day are of great service. Iu cases of chronic nephritis, particularly where alcoholism is the cause of the disease and the kidneys are inactive, cantharidal tincture is very useful. In pyelitis and in chronic cystitis it is of service, and it has been recommended very highly in drop doses in irritability of the bladder in women aud children. In these cases the bladder must not be inflamed, but irritable from depression. The use of cantharides is of value in incontinence of urine of a minor degree, as that occurring in some elderly or nervous females when coughing, sneezing or laughing, aud will often prove of service after many years of suffering. In chordee in the dose of one drop twice or thrice daily it is of service. For impotence depending upon sexual excess Ringer asserts that the use of 10 to 20 drops of the tincture of cantharides with full doses of the tincture of the chloride of iron aud nux vomica will often re- lieve the patient aud enable him to beget children. The drug has no true aphrodisiac influence except in toxic dose. In gleet of a very chronic type and in prostatorrhea it is of service. Dermatologists have used cantharides internally as a remedy in psoriasis, eczema, lichen and prurigo, with asserted great success. The dose should be so small as not to irritate the stomach. Externally cantharides are used in the production of vesication for the purpose of withdrawing water from a small area, or as a counter- irritant of some severity in cases of deep-seated inflammations (see Counter-irritation). Care should be taken that a sufficient amount of the drug is not absorbed to cause strangury and renal irritation. In renal congestions and inflammations the use of cantharides as a counter-irritant is often contra-indicated for this reason. In the pro- portion of one drop of the tincture of cantharides to forty of water it is said to be a very good application for biums, but how it acts is not known. Administration.—The dose of the tincture (Tinctura Cantharidis, TJ. S. and B. P.) is from 1 to 20 drops, and it is the only preparation used internally. The cerate (Ceratmn Cantharidis, TJ. 8.) is used, spread upon a rag, to produce a blister, and the cerate of the extract (Ceratum Extracti Cantharidis, TJ. 8.), is used for the same purposes and in the same manner. The Cantharidal Collodion (Collodium cum Cantharide, TJ. 8.) is a method of applying the blister which is most cleanly, but there is more danger of absorption of the irritant if it is used. The collodion acts as a protective to the part, The papers of cantharides (Charta Cantharidis, TJ. 8. and B. P.)are used as blisters, but are weak in action. The liniment of cantharides (Linimentum Cantharidin TJ. 8., Liquor Epispasticus, B. P.) is employed as a counter-irritant. " Warming plaster " (Emplastrum Picis cum Cantharide, TJ. 8.) is a mild counter-irritant to be employed where a blister is thought to be too severe. The preparations of the B. P., other than those named, 106 DRUGS. are Acetum Cantharidis, Charta Epispastica, Emplastrum Calefaciens, Emplastrum Cantharidis, aud TJnguentum Cantharidis. CAPSICUM. Capsicum, TJ. 8., Capsici Fructus, B. P.), or Cayenne Pepper, is the fruit of Capsicum Fastigiatum, a native of tropical Africa aud of Central America. It occurs in long ovoid pods which, when ripe, are scarlet red and possess a very hot, burning taste. The active principle is capsicin, which is a dark, reddish liquid, or, iu other words, is a volatile alkaloid. Physiological Action—Locally applied to the skin or mucous mem- branes capsicum causes great redness, and, finally, in the case of mucous membranes, vesication. The alkaloid will also produce these changes in the skin. When used internally for any length of time in excess capsicum will cause a chronic or subacute gastritis with pain and dis- comfort over the liver and stomach. If single large doses are used renal irritation aud inflammation ensue with strangury and high- colored urine. Taken internally, capsicum is said to act as a circu- latory stimulant. Therapeutics.—In cases of atony of the stomach due to general debility, errors in diet, aud alcoholism of the chronic type, capsicum is one of the best remedies we have. In cases of acute alcoholism the gastric mucous membrane is often too much irritated to permit of its use, but after the lapse of some days it may be found of benefit to increase the appetite. As a remedy for subacute alcoholism it is quite useful, since by its stimulating effect aud hot sensation it often satisfies, at least to some degree, the craving for liquor. Under these circum- stances it should be used in the dose of 5 to 10 drops of the tincture every four or five hours, or as the oleoresin in pill in the dose of J to 1 grain. The following prescription has been found of great service in the wards under the writer's charge at St. Agnes's Hospital in these cases : ]J.—Tr. capsici .... Tr. opii deodorat. Spt aether, nitrosi Spt. lavandulae . S.—Dessertspoonful every four or five hours. In the flatulent colic of old persons and young adults capsicum will be found not only to act as a carminative but also to prevent the develop- ment of the gas. In loir fevers it has been used as a diffusible stimulant, but it is of doubtful value. It is rather in the anorexia of convalescence that capsicum acts most favorably. In chronic nephritis it is of consid- erable service and it teuds to check albuminuria, but it is only to be used in the chronic forms and stages of renal disease or in the treatment of functional torpidity of the kidney. The tincture is to be given under these circumstances in the dose of 20 drops or less, but iu some cases . foil S3. • foij- . foiv. q. s. ad f 5iv. M. CARBOLIC ACID. 107 which are very chronic, as much as 40 drops may be used. Iu sore- throat and simple tonsillitis the tincture of capsicum aud glycerin, half aud half, are very useful as a local application applied by means of a swab. The same preparation may be used as a gargle for relaxed uvula aud sore-throat. Applied externally capsicum acts as a counter-irri- tant, producing redness of the skin, but not a blister in the ordinary individual. It is one of the best moderate counter-irritants which can be used, and it may be employed by saturating blottiug-paper, time and time again, in the tincture of capsicum, allowing it to dry between each dip. This paper should finally be placed when warm and wet over the part and held closely to the skin by a compress. Capsicum plaster (Emplastrum Capsici, TJ. S.) is useful in lumbago, rheumatism, and in headache when applied to the nape of the neck. The tincture is sometimes painted over chilblains which are unbroken. The fol- lowing method given by Ringer, from Rheims, is very efficacious in this annoying affection : "Make a strong tincture of capsicum pods by steeping them for several days in a warm place, in twice their weight of rectified spirits of wine. Dissolve gum arabic in wrater to about the consistence of treacle. Add to this an equal quantity of the tincture, stirring together with a small brush, or a large camel's-hair pencil, until they are well incorporated. The mixture will be cloudy aud opaque. Take sheets of silk or tissue-paper; give them, with the brush, a coat of the mix- ture ; let them dry, and then give another. Let that dry, aud if the surface is shining, there is enough of the peppered gum ; if not, give a third coat. This paper should be applied in the same way as court- plaster, to chilblains that are not broken aud burns that are not blis- tered, and it will speedily relieve the itching and pain. It acts like a charm and effects a rapid cure. The same is true of discolored bruises. It likewise allays rheumatic pains in the joints." The dose of capsicum is 1 to 2 grains iu powder, on food or in pill. The dose of the tincture of capsicum (Tinctura Capsici, TJ. S. and B. P.) is 10 to 30 drops, and of the oleoresin (Oleoresina Capsici, TJ. 8.), I to \ grain. The dose of the fluid extract (Extractum Capsici Fluidum, TJ. S.) is 1 to 3 miuims. The plaster (Emplastrum Capsici, U. 8) is useful for external applications. CARBOLIC ACID. Carbolic Acid (Acidum Carbolicum, TJ. 8. and B. P.) is also known as Phenol, Phenylic Alcohol, and Phenic Acid. Not only is it an acid, but in addition it is an alcohol of the peculiar group known as the phenols, which are derived from coal tar by a process of distilla- tion. It has a peculiar characteristic odor, and varies iu color according to its method of preparation aud purity. It is soluble in 20 per cent. of water, but is liquefied by the addition of 6 per cent, of water. 108 DRUGS. If the crystals be exposed to the air they undergo liquefaction, and in consequence the purest carbolic acid is usually prescribed in drop doses rather than in grains. It is soluble, iu alcohol, ether, chloro- form, glycerin, and most oils. It unites with alkaline bases to form salts, carbolates, but these are very readily decomposed by the feeblest acids, such as carbonic acid. Physiological Action.—Locally applied, carbolic acid produces at first a burning over the skin, accompanied by a diffuse reddening of the surface. If the solution be very strong the part at once becomes temporarily painful, then bleached and numb, so that tactile sensi- bility is destroyed. Applied to mucous membranes it causes similar changes, but to a more marked degree, and may even act as a mode- rately severe caustic of a superficial type. Owing to the local coagu- lation of albumin produced by it, it cannot penetrate very deeply. Nervous System.—Carbolic acid acts as a depressant and para- lyzant to the peripheral sensory nerves when locally applied. Upou the higher centres in the brain the acid produces a coudition of de- pression and stupor. The convulsions which sometimes occur after toxic doses are spinal iu origin, as they occur after section of the spinal cord. The motor nerves escape almost untouched, as do also the muscles. Circulation.—Upon the circulation in the higher animals the drug exercises a distinct depressant influence, stopping the heart in diastole in lethal dose and paralyzing the vasomotor centre even be- fore the cardiac muscle is affected. These changes follow only lethal doses. Small medicinal doses have no effect of any moment upon the circulation. Respiration.—After large doses the breathing becomes more rapid and full. These changes, according to Salkowski and others, are due to stimulation of the respiratory centres and the peripheral vagi. Lethal doses almost invariably kill by failure of respiration due to depression of the centres. Temperature.—Carbolic acid acts as a depressant to normal bodily temperature even in medicinal dose, and also decreases the bodily heat in fever. It lowers fever by diminishing heat production and increasing heat dissipation. (Hare.) Kidneys and Elimination.—In overdose the kidneys may be- come so irritated that total urinary suppression may occur. Carbolic acid when taken in large quantity causes the urine to become brown- ish-black. This discoloration is due to an oxidized educt which is not yet isolated. The drug is eliminated as a sulphocarbolate of sodium and potassium and as glyco-uronic acid and hydrochinon. Part of the carbolic acid is burnt up in the body. It is to be distinctly understood that the dark urine of carbolic- acid poisoning is not due to the presence of blood or any of its educts. Poisoning, Prolonged and Acute.—As the changes produced in the tissues of the body by acute and chronic poisoning by carbolic acid are identical, they may be considered together. carbolic acid. 109 Carbolic acid is one of the most rapidly acting poisons known to man, notwithstanding the fact that few people seem to recognize it as such. If a large, lethal dose be swallowed by a man he may drop dead from its effects within a few feet of the spot where he stood when drinking it, or may perhaps live a few hours. In cases where death has occurred suddenly from the acid, the cause has been failure of respiration. If the patient does not die at once all the evidences of gastro-enteritis come on. Violent vomiting aud purging may ensue, and burning pain in the entire abdomen is a prominent symptom. The skin is wet with sweat, the face pinched aud anxious. Collapse, with a thready, imperceptible pulse and extreme dyspnoea may be present. The mouth and lips may not smell of the drug, but the mucous membrane will be seen to be corrugated and stained black if impure acid has been taken, or be whitish if the pure drug has been used. The eschar on the mucous membraue is a peculiar one, aud is pathognomonic of the poison, having a white centre surrounded by a reddened and inflamed zone, the centre sometimes becoming dark-brown or black. The post-mortem will show these spots in the oesophagus and stomach, aud even in the intestines. All the internal organs, as the brain, kidneys, liver, and spleen, will be found filled with dark grumous blood, and on opening the body the strong odor of the acid will be perceived. A peculiar croupous exudate is sometimes found iu the bronchial tubes, and fatty degeneration of a more or less widespread type often follows carbolic acid poisoning. A large number of cases are on record iu which carbolic-acid poi- soning has been produced by its absorption from surgical dressings. One of the earliest signs of such an accident is a darkened, smoky urine and a slight nervous unrest or cerebral disturbance. Very often pain in the lumbar region indicates kidney strain and irritation. The dressings should, of course, at once be removed. Treatment of Poisoning.—The chemical antidote to carbolic acid is any soluble sulphate, such as Epsom or Glauber salts, which form insoluble sulpho-carbolates. As these salts follow the acid into the bloodvessels and tissues to unite with it, the mere fact that hours have elapsed since the poison has been taken does not invalidate the pro- priety of using these sulphates. The further treatment consists in the administration of warm mucilaginous drinks, hot applications to the extremities, the ingestion of cardiac and respiratory stimulants, such as digitalis and strychnine, and counter-irritation over the abdomen. Emetics and the stomach-pump should be used if possible, but the former are generally useless because of the state of the stomach. Therapeutics.—internally carbolic acid is little used, but, never- theless, has a very favorable effect in certain states. In nervous vomiting, or in that due to gastric irritation, the drug does good in | to 2 drop doses by depressiug the sensory nerves in the stomach. In diarrhea depending upon fermentation, from 2 to 4 drops of the 110 DRUGS. acid do great good, particularly if combined with 10 to 20 grains of bismuth administered in powder or capsule. In gangrene aud tuberculosis of the lung a spray of the acid iu water in the strength of 5 to 15 drops to the ounce may do some good and at least stop the cough and relieve the irritation and tickling in the throat1 Creasote is, however, generally preferred in these con- ditions at the present time. Externally the acid is very largely employed as an antiseptic lotion, and in solutions in which to place instruments while operating. The solutions for this purpose should be in the proportion of 1 of acid to 20 of water (see Antiseptics). Carbolic acid is rarely used directly over wounds in dressings at present, unless the dressing be one of carbolized oil. Other drugs have supplanted it. The use of the carbolized spray over wounds has been found to do more harm than good, and it ought never to be employed. In diphtheria, ulcerated sore-throat, and even in ordinary stomatitis, carbolic acid will be found of value when used in a spray or mouth- wash, and in ordinary sore-throat, in the strength of 1 part to 100 of water, it will be found, when applied on a swab or by a gargle, to relieve the pain aud inflammation. In the treatment of burns car- bolized sweet-oil in the proportion of 1 drachm of the acid to each 6 ounces makes one of the best dressings that can be used. By means of the local anaesthesia produced by the acid, minor operations, such as eversion of the toe-nail or opening a felon, may be performed bv soak- ing the part for ten minutes iu a solution of 30 parts to 100 and applying the pure acid by meaus of a brush to the line of the incision. Carbolic acid may be used as a lotion in the itching of jaundice in the proportion of 10 grains of the acid to 2 drachms of glycerin and 2 drachms of water. In enlarged glands which have not yet gone on to suppuration, intra-glandular injections with a hypodermic needle are of value in a large number of cases, the solution used being no weaker or stronger than 2 per cent.; 5 to 10 minims of this solution is sufficient for each gland. In the treatment of buboes 10 minims of a solution of 8 grains to the ounce may be injected into the swelling, the skin being first benumbed by au ether spray. This is a most successful treatment. The same treatment may be applied in chronic synovitis and repeated every three days, and boils and carbuncles may also be so treated with great success if the measure be used early enough to abort the trouble. In the form of an ointment carbolic acid may be used in the strength of 10 minims to the ounce of simple cerate, particularly in cases of subacute eczema where there is a great amount of weeping and itching. As a disinfectant carbolic acid ranks among the poorest; 1 to 2 per cent, solutions, however, kill most spores and germs. i The spray must be a very fine one, or it will not carry the drug far enough down into the lungs to do any good. CARBON: CHARCOAL. Ill Administration.—Carbolic acid ointment (TJnguentum Acidi Car- bolici, TJ. 8. and _B. P.) is the only officinal preparation of carbolic acid in the TJ. 8. P. In the B. P. the following preparations are officinal: Acidum Carbolicum Liquefaction, given in the dose of 1 to 2 minims; Grlycerinum Acidi Carbolici, aud Suppositoria Acidi Carbolici cum Sopone, each suppository containing 1 grain of carbolic acid. CARBON: CHARCOAL. Carbo Ligni, U. S. and B. P., or Charcoal, is prepared by the exposure of soft wood to a red heat, air being prevented from coming in contact with the wood during the process. Charcoal when used for medicinal purposes should be a black, brittle, somewhat shiny, porous substance, devoid of taste and odor, and completely insoluble in water. Owing to its power of absorbing a very large amount of certain gases, it is of value in medicine in states where these gases abound. Therapeutics. — Charcoal is used externally as an application to old sores or sloughs to act as a deodorant and antiseptic. This is ac- complished by the absorption of any liquids which may be present, thereby depriving germs of a nidus, and by its distinct oxidizing power. It may be applied in the form of a dry powder or in a poultice, which is, however, so uncleanly that other antiseptic dressings are better. The poultice (Cataplasma Carbonis, B. P.), if used, should be made in the following manner : Take of powdered wood-charcoal ^ ounce, bread-crumbs 2 ounces, linseed meal 1J ounces, and add boiling water 10 fluidounces. Macerate the bread-crumbs and meal for ten minutes over the fire, and then stir in the charcoal to the extent of half the amount just named. Spread out the poultice and sprinkle the remain- ing half of the charcoal over its surface, and apply to the part affected while hot. Internally, charcoal is used in powder in mauy conditions, and acts very well indeed in cases of so-called " sour stomach^ from which eructations of gas or sour liquids take place. The following prescription will also be found useful in the atonic or subacute gastric catarrh of persons who are careless in eating and who have much belching : IJ.—Oleoresin. capsici Pancreatinae Pulv. zingiberis . Pulv. carbon, ligni Ft. in pil. no. xx. S. —One or two t. d As ordinary charcoal is not always obtainable, it may be substituted by pieces of very thin toast burnt to a state of charcoal, through and through. A few of these pieces will, when eaten, often stop all the symptoms mentioned. If the attack is very severe and vomiting eventually ensues, the ejecta will commonly be found to be odorless and not sour, and the stools will also be almost odorless, though black. . gtt. x vel xx, . gr. xx. . gr. xl. . gr. xl. M. 112 'drugs. Iu fermentative and acid diarrheas in children and adults this method of treatment is often of value. When charcoal is used iu any condi- tion associated with irritation of the mucous membranes of the gastro- intestinal tract it should always be very finely pulverized. As a filter for impure water, charcoal, in mass or in powder, is one of the most satisfactory substances we have. CARBON BISULPHIDE. Carbonei Bisulphidum, TJ. 8., is a clear, colorless, highly refractive liquid, having a strong characteristic odor, a sharp aromatic taste, and a neutral reaction. Poisoning.—The symptoms of poisoning by bisulphide of carbon consist in headache and nervous excitement resembling in many respects the symptoms of belladonna poisoning, particularly iu the volubility of the patient and the evidences of hysterical tendencies. Prolonged exposure to the fumes of this drug causes great cachexia and pallor, accompanied by muscular weakness and failure of intel- lectual power. Sometimes convulsions of an epileptiform character come on. The treatment of poisoning by bisulphide of carbon consists in quieting the nervous system if convulsive disorders are present, the use of bromide of potassium and chloral, and in supporting the cir- culatory system if any evidences of its failure manifest themselves. Circulatory depression is not, however, a common condition except in very advanced poisoning. Therapeutics.—Bisulphide of carbon has been used in medicine externally over enlarged lymphatic glands. The application is made by placing the liquid in a bottle of such a size that the mouth of the vessel is large enough to cover the diseased area. Iu the bottle should be placed a sponge large enough to contain a fluidrachm of the drug, aud the skin over the gland should be well moistened with water. The vapor derived from the drug uuder these circumstances is an active agent in promoting a cure. Bisulphide of carbon has also been used in a similar manner in the treatment of neuralgia. CARBONATE OF POTASSIUM. Carbonate of Potassium (Potassii Carbonas, TJ S. aud B. P.). This salt is never used in medicine, except to prepare other salts, as it is disagreeable to the taste aud is an irritant (see Potassium Citrate). CARBONATE OF ZINC. Precipitated Carbonate of Zinc (Zinci Carbonas Precipitatus, TJ. 8., Zinci Carbonas, B. P.) is used as a protective, rather astringent powder, CARDAMOM. 113 over surfaces covered by weeping eczema and similar moist discharges. It may be employed to fulfil all the indications commonly treated by the oxide of zinc. It is very largely used, not as the precipitated car- bonate, but as the impure carbonate, under the name of calamine. The following prescription is useful for eczema : IJ.—Calaminaa........3j. Ung. zinci oxidi.......3yij- M. S.—Apply to the eczematous spot. CASCARA SAGRADA. Cascara Sagrada is the bark of the Rhamnus Purshiana, a plant growing in California. It is sometimes called California buckthorn, to distinguish it from ordinary buckthorn, or Rhamnus Frangula, which it closely resembles in many ways, and which may be used as a substitute for cascara sagrada in some cases. Therapeutics.—Cascara sagrada ought never to be used as a purge, but only as a laxative. It is by far the best remedy we have when employed simply to empty the bowel of fsecal matter in cases of con- stipation, since it not only performs this function without intestinal disturbance, but simultaneously acts as a tonic to the intestine, and so prevents the constipation which usually follows the use of all other drugs of its class. Though unofficinal it is most commonly employed in this country in the form of the fluid extract (Extractum Cascare Sagrade Liquidum, B. P.) in the dose of from 10 to 20 drops at night, or morning and night. If 20 drops fail to act, 30 drops may be used, but if larger doses are required other drugs should be employed, as fluidrachm doses have been known to produce irritation of the bowel, with enteritis or intestinal catarrh. The objection to cascara sagrada is its bitter taste, which may be partially overcome by the additional use of the Syrupus Aurantii, in the proportion of 1 part of the cascara extract to 2 parts of the syrup of orange peel. Some of the preparations of this drug are now made in an almost tasteless form, such as " Cascara Cordial," or the non-bitter fluid ex- tract, made by a prominent firm in this country. The solid extract (Extractum Cascare Sagrade) is officinal in the B. P., and given in the dose of 2 to 8 grains in pill. CARDAMOM. Cardamom (Cardamomum, TJ. S.) is the fruit of Elettaria Carda- momum, and is a bitter tonic possessing some aromatic properties. It is useful in cases of atony of the stomach and small intestine, particularly if combined with some other bitter, such as gentian, and a mineral acid. Cardamom is officinal in the B. P. as Cardamomi Semina. 8 114 DRUGS. If the intestine is atonic and secretion is deficient, the following prescription will be found of value: I£.—Acid, nitric, dil........fo"j. Tr. cardamomi comp......q. s. f Jvj. M. S.—Dessertspoonful after each meal.1 Administration.—The officinal preparations of cardamoms are the tincture of cardamoms (Tinctura Cardamomi, TJ. S.), dose 1 to 3 drachms; and the compound tincture (Tinctura Cardamomi Composita, TJ. 8. aud B. P.), which is to be given in the same dose as the tincture. This tincture also contains cochineal, cinnamon, caraway, and glycerin. Cardamom is also a constituent of the officinal aromatic powder (Pulvis Aromaticus, TJ. tS.). CASSIA FISTULA. Cassia Fistula, TJ. 8., is the fruit of Cassia Fistula, or Purging Cassia, as it is sometimes called, and occurs in long, dark-brown pods containing a dark pulp in each segment. This pulp is the useful part of the drug, and is officinal in the B. P. as Cassie Pulpa. Cassia Fistula ought never to be used alone, as it is too apt to cause pain and griping, but it is officinally present in the Confection of Senna (Con- fectio Senne, TJ. S. and B. P.), and may be given in the dose of J drachm to 1 drachm as a laxative, or as much as \ ounce may be used if a purgative effect is desired. CASTOR OIL. Castor Oil (Oleum Ricini, TJ. 8. and B. P.) is a fixed oil, derived by expression from the beans of Ricinus Communis, a plant of the United States and elsewhere, but originally derived from India. It contains an acrid substance, ricinoleic acid. Physiological Action.—The manner in which castor oil purges is somewhat in doubt, but its activity probably depends upon the presence of the acid just named and the fact that it is an oil. As is well known, oils, such as olive oil, for example, if given in any quantity tend to move the bowels, and the ricinoleic acid, which is somewhat acrid, stimulates the small and large gut, and so develops peristaltic movement. According to some writers, this acid is not set free until the oil is attacked by the pancreatic juice. That this acid possesses purgative properties of itself seems proved by the fact that the oil will purge when it is rubbed in by the skin, and that nursing 1 While the rule that an acid is incompatible with a tincture is not recognized in this mixture, the quantities of acid and alcohol are so disproportionate that ether in any amount is not developed. CASTOR OIL. 115 mothers on taking the oil eliminate the acid in the milk to such an extent that the suckling is purged. According to the studies of Rutherford and Vignal, the oil has no effect over biliary secretion other than that violent purgation indirectly increases the flow, and the researches of Hess have shown that the oil acts more rapidly in the small than in the large gut, and only produces peristalsis by coming in contact with the mucous membrane. Therapeutics.—Castor oil is the blandest and most unirritating purge we have with the exception of the sulphate of magnesium, which is depletant and much more rapid in its effects. While the Epsom salt will act in one-half to one hour if the stomach is empty, castor oil will generally act in four hours, or perhaps five. Its action is so regular that it can almost be used as a timepiece. Castor oil is used whenever irritant materials, such as bad food, putrid flesh, or decaying or green vegetables have been eaten, even if the inflammation set up after them is very active. If hard bodies, such as broken cherry-stones, have been swallowed, castor oil is a far better purge than sulphate of magnesium, as it is more gentle and lubricates the gut, thereby preventing scraping and irritation. Where mucus has accumulated in the bowel in children, and must be gotten rid of before other treatment is resorted to, castor oil should be used. Previous to parturition it has been largely used to relieve the bowels of fsecal matter, and is said by old practitioners to make the labor easier than if any other purge is used. It is also employed in the constipation following acute diseases, and in that occurring in infants and children. The disadvantages of castor oil lie in its taste, the fact that it is oily, that it tends to produce haemorrhoids if used constantly, and finally that its frequent use, or even a single dose, is generally fol- lowed by more obstinate constipation than before, so that the dose must be rapidly increased in size to be effective. This is one of the reasons why it is useful in irritative diarrhoeas. The effect of castor oil is very much increased if a little bicarbonate of sodium is given with it. Administration.—Castor oil is very much more agreeable to the taste if pure than if poorly prepared. It is also true that too great purity, so far as taste is concerned, renders it less active. The methods directed for taking castor oil are as various as the tastes of individuals. Its odor may be covered by a drop or two of the oil of bitter almonds, but emulsions of the oil are not of any service, save to interfere with its efficiency. Some take the oil in the foam of beer or porter, others in syrup of sarsaparilla and soda- Mater, and still others in milk or cream. A good way to take it is to eat one or two strong so-called cream peppermint drops, or even the crystalline peppermint drops, swallow the oil from a spoon which is to be placed well back in the mouth, and immediately eat several other peppermints. This plan is improved by using the oil in milk or water, so that the liquid carries the oil down into the oesophagus without 116 DRUGS. its touching the mucous membranes. It may also be taken in highly seasoned beef-tea. Ringer recommends the following : J ounce of oil, fresh syrup of acacia 3 drachms, and distilled water 5 drachms, flavored with a little oil of lemon or peppermint. Wood advises that it be mixed with glycerin, equal parts, to which is added a drop or two of oil of gaultheria or oil of cinnamon. The dose for an infant is 1 to 2 teaspoonfuls, and for an adult J ounce to 1 ounce. Owing to the fact that the oil will very frequently produce griping, a few drops of laudanum should be added to it, or tincture of bella- donna may be used. If these cannot be employed, a drop of the oil of cinnamon is equally useful for this purpose. CATECHU. Catechu (TJ. 8.) is derived as an extract from Acacia Catechu. The catechu of the TJ. 8. P. is true catechu ; that of the B. P. is in reality an extract of gambier, being derived from the leaves and shoots of Uncaria Gambier. Catechu depends for its medicinal use upon the astringent properties which it possesses. Beyond this power it has no particular value. It is of a dark-red color, has a somewhat sweetish taste, aud is in- soluble, like most extracts, iu water. Therapeutics.—Like all the vegetable astringents catechu is used as a remedy for diarrhea, particularly that of the serous type, or that in which the stools are of too fluid a consistency. If large amounts of mucus in the passages show a catarrhal state of the bowel, the mucus should be displaced by a purge of castor oil or sulphate of magnesium before the astringent is used. Catechu may or may not be combined with opium in cases of diar- rhoea, but the following prescription will be found of service in many instances: For an adult: IJ.—Tinct. catechu composit...... f 5jj. Tinct. opii camphoratae......f^ij- Mist, cretae........f?ii. M. S.—Dessertspoonful every four hours till relieved. To be shaken before using. In cases of sore-throat, where the secretion is excessive and the in- flammation subacute, catechu may be used as a gargle. In cases of spongy gums catechu is sometimes useful as a mouth- wash. If the powdered catechu is used internally the dose is 2 to 30 grains. The dose of the Compound Tincture of Catechu (Tinctura Catechu Composita, TJ. S.) is 1 to 2 fluidrachms. Its only constituent besides the catechu is cinnamon. The Troches of Catechu (Trochisci Catechu, TJ. S. and B. P.) are to be employed in sore-throat and are to be held in the mouth. They are not generally used. CERIUM OXALATE. 117 The officinal preparations of the B. P. besides the ones given are : Infusum Catechu, given in the dose of 1 to 1J fluidouuces; the tinc- ture (Tinctura Catechu), dose 1 to 2 fluidrachms, and a compound pow- der (Pulvis Catechu Compositus), composed of catechu, kino, and rhatany, the dose of which is 20 to 40 grains. CAUSTIC POTASH. Caustic Potash (Potassa, TJ. 8., Potassa Caustica, B. P.) is a very deliquescent hard white solid, possessing great caustic power, and used in medicine for the purpose of burning away growths or exuberant ulcers. A piece of the drug should be placed on the skin by means of a pair of forceps, when it will at once soften down and burn the tissues until it can reach no further. The surrounding skin should be protected by wax, suet or oils, and a piece of adhesive plaster with a hole for the growth should first be applied to prevent auy action on the surrounding healthy tissues. The burn produced by caustic pot- ash is very painful, and cauterization through its influence should not be practised if it can be avoided. When the caustic has acted suffi- ciently it is to be washed off with vinegar or other dilute acid. Vienna paste (Potassa cum Calce, TJ. 8.) is used for the same purpose as is caustic potash. CAUSTIC SODA. Caustic Soda (Soda, TJ. S., Soda Caustica, B. P.) is milder than caustic potash, and its action is more readily controlled. It should be used in the same way and for the same purposes as is caustic potash, and the surrounding skin ought to be protected by adhesive plaster and oil or ointment. The soda must be kept in well-stoppered bottles made of hard strong glass. The only officinal preparation of caustic soda in the TJ. S. P. is Liquor Sodce, or solution of soda. CERIUM OXALATE. Cerium oxalate (Cerii Oxalas, TJ. S. and B. P.) is a white granular powder, permanent when exposed to the air, odorless and tasteless, and insoluble in water and alcohol, but freely so in hydrochloric acid. Therapeutics.—It is used instead of bismuth in the treatment of the vomiting of pregnancy or that due to uterine disorders and dis- placements, and in some cases of gastric acidity. The dose is from 2 to 5 grains given in pill form every 4 or 5 hours. 118 DRUGS. CHENOPODIUM. Chenopodium (TJ. S.) is the fruit of the Chenopodium Ambrosioides or Afnerican wormseed. The seeds contain a volatile oil and have a distinct and rather disagreeable aromatic odor. These seeds rubbed up into a powder form with a syrup an electuary which is a most efficient remedy against the ascaris lumbricoides or round-worm as it occurs in children. The dose of the powdered seeds is from 10 to 30 grains. The better way of using chenopodium is in the form of the oil (Oleum Chenopodii, TJ. S.) in the dose of 10 drops to a child of five years, either on sugar or in au emulsion made of gum acacia. If the patient is old enough capsules may be used. The general dietetic measures adopted for the removal of worms should be insisted upon before the drug is given. (See article on Worms.) CHIMAPHILA. Chimaphila (TJ. 8.), or Pipsissewa, is the leaves of Chimaphila TJmbellata, an evergreen found in America, Europe and Asia. Therapeutics.—Pipsissewa is a drug employed in atonic renal con- ditions, particularly of the functional type, as a stimulating diuretic which will bring into activity the secreting structure of the kidney and the mucous membranes of the genito-urinary tract. It is also a tonic to the stomach. For this reason it is often placed iu mixtures given to dropsical patients if debility and anorexia are preseut. In the treatment of ulcers of the skin due to struma it is said to be of service, and it probably has some slight alterative power. The drug may be used in the form of a decoction, which is not officinal, in the dose of 1 to 3 fluidounces, and as the fluid extract (Extractum Chima- phile Fluidum, TJ. S.) in the dose of J to 1 drachm. CHIRETTA. Chiretta (Chirata, TJ. 8. and B. P.), is the plant Ophelia Chirata, which is a native of India. It is a bitter tonic, possessing a very distinct influence over the liver, and, unlike many bitter tonics, is devoid of tannic acid. For this reason it may be used with prepara- tions of iron. Chiretta may be given in all cases of indigestion and loss of appetite, particularly where the liver is torpid or if any tend- ency to constipation is present, although it is not directly laxative. When given in powder the dose is 20 grains; the dose of the fluid extract (Extractum Chirate Fluidum, TJ. S.) is 30 drops to 1 drachm, while that of the tincture (Tinctura Chirate, TJ. 8. and B. P.) is 1 to 4 drachms. . The unofficinal solid extract may be given in pill iu the CHLORAL. 119 dose of 2 to 4 grains. The dose of the infusion (Infusum Chirate, B. P.) is a wineglassful. CHLORAL. Although the name Chloral is applied to the substance used in medi- cine, chloral proper is never so employed, hydrate of chloral (Chloral Hydras, B. P., Chloral, TJ. S.) being the real preparation. Chloral hydrate is a white, crystalline body, but is often sold in irregular broken masses, which are generally impure. Physiological Action.—When chloral is applied to a mucous mem- brane it causes distinct reddening and burning pain, and finally acute inflammation. It is, therefore, a local irritant. Chloral acts in the body as chloral, and is not broken up into formic acid and chloro- form, as was taught at one time. Nervous System.—In medicinal and toxic dose chloral produces sleep by quieting the intellectual centres in the brain, at the same time depressing the motor tract of the spinal cord and the motor nerves. In medicinal amounts it does not decrease sensation, but iu toxic dose it does do so. Very often hyperesthesia results from small doses. Reflex action is decreased by its influence on the motor portions of the spinal cord. Circulation.—A dose of 10 to 20 grains, in the adult, rarely causes any circulatory changes, but larger amounts produce a fall of arterial pressure and a slow, feeble, or sometimes a rapid running pulse due to a direct depression of the heart muscle, for chloral is a cardiac depressant. After death from chloral the blood may be found dark and grumous- looking, with the corpuscles brokeu down, but these changes occur only after very large doses. Respiration.—In moderate amounts no respiratory effect is felt, but in toxic doses the breathing becomes slower and slower, and more and more shallow, until it stops in death. AY hen death is caused by chloral it is due to respiratory failure, with an almost simultaneous arrest of the heart. Temperature.—Chloral tends to lower bodily heat, and in large doses produces a very marked fall of temperature, which does much toward causing death. Brunton has found that rabbits will survive very large doses of the drug if external heat is supplied to them. The fall of temperature is, at least in part, due to the failure of the circu- lation aud vasomotor dilatation. Kidneys, Tissue-waste, and Elimination.—Chloral is elimi- nated by the kidneys in the form of uro-chloralic acid, and, if given in excess, as chloral. Large amounts irritate these organs and may pro- duce bloody urine, owing to the nephritis which is set up as the drug passes through the renal structures. After chloral is ingested the urine of a patient will often give Fehling's test for sugar. 120 drugs. Poisoning.—AA^hen a poisonous dose of chloral is taken by man the person soon falls asleep and sinks into a deep coma. The respirations become at first slow and labored, then shallow and feeble. The pulse, at first perhaps a little slowed, soon becomes rapid, thready, and shuttle- like, and is finally lost at the wrist. The face is white and livid, the forehead and the hands covered with a cold sweat, and the pupils, which are at first contracted, soon become widely dilated. Absolute muscular relaxation is present, and it is impossible to arouse the patient. Treatment of Poisoning.—The physician should apply external heat, and use emetics in the early stages, or if the case is seen too late for emetics to act because of systemic depression he should use the stomach- pump. This latter means of removing the drug from the stomach is more reliable, and safer, because the production of vomiting may result in efforts which will strain the heart. Strychnine should be given in full dose, Jg- to TV of a grain, to stimulate respiration, or atropine may be used for the same purpose. The heart is to be supported by 10- drop doses of tincture of digitalis given hypodermically every twenty minutes until some effect is noted ; and as the digitalis is rather slow in its action, it may be preceded by ether and ammonia or brandy or whiskey. The patient must not raise the head to vomit, and the head should be placed on a lower level than the heels to keep the blood in the brain. In chronic poisoning the patient suffers from weakness, mental aud physical, with sudden flushings due to vasomotor disorder, from pal- pitation of the heart, and finally from petechial eruptions, ulcerations and sloughs. Therapeutics.—Chloral is the purest hypnotic that we have, and may therefore be used where simple nervous insomnia is present, but not where sleeplessness is due to pain. Under such circumstances it is to be employed in the combination of 10 grains of chloral with -g- of a grain of morphine, as a much more powerful hypnotic effect is pro- duced by the combined action of the two drugs than by the use of either one of them alone. In tetanus and strychnine poisoning chloral is the best remedy we have, as it depresses the motor tract of the spinal cord. In such a case it should be given iu 20-grain doses combined with 60 grains of bromide of potassium. If the convulsion prevents deglutition, or is brought on by swallowing, the remedy should be used by the rectum, and if the spasm expels it from the rectum the patient should be chlo- roformed long enough to allow the injection to be given and absorbed. The same remedies in small doses are to be used in infantile convul- sions and in infantile colic in the dose of J grain to 1 grain of chloral to 2 grains of bromide of potassium or sodium in a teaspoonful of peppermint-water. In chorea, paralysis agitans and delirium tremens chloral is of great service, but must be given cautiously in the latter condition for fear it may depress the heart, which is already diseased by alcoholic excess. Cases are on record where chloral has caused CROTON CHLORAL. 121 sudden death from cardiac failure in the persons of alcoholics who were suffering from fatty heart. Chloral has been used for the relief of labor pains, but is rarely so employed, and is not a good remedy. If much rigidity of the os uteri exists chloral may be used with advantage to relax the spasm. The dose given should be 15 grains. In uremic convulsions it has been highly extolled, but if any acute renal trouble is present it must not be used. In puerperal convidsions not dependent upon nephritis, 20 to 30 grains of the drug may be given, and repeated in one or two hours. Hiccough, nocturnal epilepsy and whooping-cough are all indications for its use, but in asthma it rarely does good, and if pushed is danger- ous to the heart. As an antiseptic, chloral possesses a good deal of power, but is sel- dom used except to prevent the decomposition of urine and to assure the maintenance of purity iu urinals used by paralytics, as in these cases the urine is generally heavy and ill-smelling. Untoward Effects.—Chloral sometimes causes nausea, purging and vomiting, by reason of its irritant action, and sudden cardiac failure in heart disease has resulted from 20 grains or less. Administration.—Chloral is best given in syrup of acacia, simple syrup, or water, and it should be always well diluted. The syrup of chloral (Syrupus Chloral, B. P.) is given in the dose of 1 fluidrachm. The following prescription is useful in insomnia : R.—Chloralis........3j. Potassii bromidi . . . . . 3'j- Syr. pruni virginiana?.....f^j. Aqua?..... . . q. s. fgiij. M. S.—Dessertspoonful at night. CROTON CHLORAL. Croton Chloral, or Butyl Chloral Hydras, B. P., has a physiological action closely allied to chloral itself, but possesses more analgesic power and is very much less depressant to the heart and circulation. The dose for the production of sleep is the same as chloral, 5 to 20 grains in syrup. Therapeutics.—Croton chloral is infinitely preferable to chloral in sleeplessness due to pain. In facial neuralgia and migraine it is exceedingly efficacious, par- ticularly if the fifth nerve be involved. Iu headaches due to eye- strain, and in those associated with sick stomach, but not due to gastric indigestion or nervous debility, croton chloral is of service. Curiously enough it is valueless in toothache, but does good in the neuralgia due to decayed teeth. Administration.—Croton chloral should be used in pill form in the dose of 3 to 5 grains every two hours till the pain is relieved or sleep 122 DRUGS. comes on, or it may be given in solution or syrup of acacia and water, or water and glycerin. It has been used in as large a dose as 60 grains, but 20 to 30 grains ought to be the maximum dose as a general rule. CHLORALAMIDE. Chloralamide is a compound very recently introduced into medicine, formed by the addition of formamide to anhydrate of chloral, and is a colorless crystalline substance, soluble in 9 parts of water and 1J parts of alcohol. Its taste is slightly bitter, but not biting, and it keeps well in watery solution without decomposition. Its physiological action is closely allied to that of chloral, except that it is not quite so depressing to the circulation. Upon the nervous system it acts chiefly upon the brain and spinal cord, and produces sleep, a result to be expected, since both chloral and formamide are hypnotics. It is said not to irritate the stomach and kidneys, but it probably is only less irritant than chloral. Therapeutics.—Chloralamide may be employed in medicine when- ever chloral may be used. It is decidedly a nervous sedative, and in the wakefulness of nervous insomnia is very useful. Sleep generally ensues about thirty to forty-five minutes after it is taken. According to most of the reports published so far, the drug relieves pain as well as produces sleep, and is, therefore, distinct in its action from chloral. In neuralgia it is very useful, and it has been found of value in the pains of tabes dorsalis. The dose is 10 to 30 grains, which may be repeated in three or four hours, although the sleep generally lasts five to eight hours. The following formula may be used for its administration : R.—Chloralamide.......gr. xl. Acid, hydrochlorici dil. ..... gtt. v. Syrup, simplicis...... . f.^ij. Aquae dest........f ^ij. M. S.—Take in two doses in a little water. CHLORATE OF POTASSIUM. Chlorate of Potassium (Potassii Chloras, TJ. 8. and B. P.) is a salt of potassium differing entirely in physiological action from all the other potassium salts, and, with the exception of the cyanide of potas- sium, is certainly the most poisonous. Not only is it, when locally applied, an irritant to mucous membranes, but when it is absorbed into the blood it causes changes of a serious character in this fluid, and pro- duces acute nephritis if given in overdose. Physiological Action.—It has been thought by some that chlorate of potassium gives up a large ainouut of oxygen to the body, and for this reason that it would be of value in cases of slow asphyxia, such as result CHLORATE OF POTASSIUM. 123 from pneumonia or phthisis. It has even been recommended to persons crossing high mountains where the rarity of the air produced dis- agreeable effects, but nothing is more absurd than the belief that it gives up oxygen to the body. Chlorate of potassium does give off oxygen when treated with very high heat, but not at the temperature of the body. Nearly all of it escapes from the body unchanged. When overdoses of the chlorate are taken, it produces sickness of the stomach, headache, pain in the loius aud belly, dyspnoea, cyanosis, heart failure, and great weakness. The blood is dark and chocolate- looking, this change being due to the production of methsemoglobin. The blood-corpuscles are crenated and broken down, and the liver, kidneys, spleen, and intestines are found softened and filled with broken-down aud disorganized blood. Therapeutics.—Chlorate of potassium is useful iu stomatitis, or in mercurial sore-mouth, as a mouth-wash, or, when given internally, in the following mixture: R.—Potassii chlorat........gr. xlviij. Tr. myrrh........f 3"ss. Elixir calisayae......q. s. f§iij. M. S.—Teaspoonful every five hours; or use as a mouth-wash. Owing to the fact that the drug is eliminated by the saliva to a great extent, the mucous membranes affected by stomatitis are con- stantly bathed by a solution of the chlorate when it is taken by the stomach. If any irritation of the stomach or kidneys exist, the medicament must be used on a swab aud none of it swallowed. In diphtheria chlorate of potassium is very commonly employed, but its use is exceedingly dangerous. Death in many cases of diphtheria is due to the renal irritation present, or, in other words, to an acute nephritis, aud this drug simply increases the inflammatory process. If the chlorate of potassium is employed iu diphtheria it should be used in solution and applied by means of a swab. (See Diphtheria.) In anginose sore-throat chlorate of potassium is a useful gargle, and Wood recommends the use of a solution made by adding 1 ounce of sumach berries, \ ounce of chlorate of potassium, and 1 pint of boil- ing water to each other and allowing them to simmer for a few hours, when the mixture should be strained, cooled, aud used as a gargle. The following is equally serviceable : R.—Potasii chlorat........oj. Ext. rhus. glabrae fl.......foss- Ai[uae dest.......q.s. f ^iij. M. S.—To be added to an equal quantity of water in a glass and used as a gargle every two hours. This prescription makes au abominable-looking pharmaceutical preparation, but an exceedingly useful one. In acute rectal catarrh with mucous diarrhea and tenesmus, a solu- tion of chlorate of potassium in water, 20 grains to the ounce, injected into the bowel, will often produce a cure after one or two injections. 124 DRUGS. Not more than 4 ounces should be used, and it ought to be retained for twenty minutes. In the treatment of hemorrhoids a few drops of laudanum added to this solution will be found of great service. The troches (Trochisci Potassii Chloratis, TJ. 8. and B. P.) are given in the dose of 1 to 6, each lozenge containing 5 grains. CHLORIDE OF SODIUM. Chloride of Sodium (Sodii Chloridum, TJ. S. and B. P.), or common Salt, is a useful drug and food, aiding in maintaining the alkalinity of the blood and tissues, and in the formation of gastric juice, being changed by the lactic acid of the stomach into lactate of sodium, thereby setting free hydrochloric acid, which acts not only by aiding digestion but in the production of pepsin from the pepsinogen of the gastric tubules. The dose is 10 to 20 grains. CHLORIDE OF ZINC. Chloride of Zinc (Zinci Chloridum, TJ. S. and B. P.) is a white, crystalline, deliquescent powder, of caustic taste and acid reaction, possessing considerable disinfectant power. It has been used as an eye-wash in the strength of 1 to 2 grains to the ounce, but is rarely so employed at present. The same solution may be used as an injec- tion in the second stage of gonorrhoea. Under the name of Liquor Zinci Chloridi, TJ. S. aud B. P., is prepared a strong solution of the salt for disinfectant purposes of the strength of about 50 per cent. Numerous experiments with the proprietary "chlorides" show them to be possessed of very slight disinfectant power but to be strongly antiseptic. CHLORINATED LIME. Chlorinated Lime (Calx Chlorata, TJ. 8., Calx Chlorinata, B. P.), is the hydrate of lime containing 25 per cent, of chlorine, provided it is of officinal strength. It is an exceedingly irritant substance, be- , cause of the chlorine which it contains, and is never used internally. Much of the chlorinated lime sold is useless, containing too little or no free chlorine. Good chlorinated lime should be so laden with the gas that the face cannot be held near it without the eye being severely irritated. Unless the chlorine is present the substance is of no value, for its employmeut as a disinfectant depends upon the action of this gas, the lime being merely used as a vehicle and oxidizer, the gas by itself being difficult of application. Uses.—As a disinfectant for privies, drains, and sinks, chlorinated lime is one of the best, if not the best, we possess. A few pounds of it may be added every week to the contents of a privy vault with CHLOROFORM. 125 great advantage, and a solution of it may be used in all bed-pans and urinals. AYhen the passages of a patient having typhoid fever are to be received in a bed-pan, a chlorinated lime solution should be placed in the receptacle beforehand, so that the fsecal matter or urine will fall at once into a disinfecting fluid. The solution should be of the strength of 1 pound to 2 gallons. As it is one of the most powerful deodorizers, chlorinated lime should be placed liberally about decay- ing animals, and, in exhuming corpses, sheets wrung out in a solution made as above will be found of service to destroy the stench, if wrapped about the body. Water which has become foetid by stagnation may be rendered drinkable by adding 1 to 2 ounces of the chlorinated lime to every 65 gallons, and standing the solution aside for some hours until pre- cipitation and exposure to the air have gone on for some time. It should be remembered that the chlorine fumes will bleach many dyed goods. The placing of chlorinated lime in saucers about sinks and closets is useless, as the amount of chlorine liberated is very slight as com- pared to the volume of air in the room. Where the chlorine is present in a sufficiently concentrated form to kill germs it will also kill the occupant of the chamber. A deodorant effect may be obtained, but a bad smell, if it exists, even when overcome by a greater one, is not really gotten rid of. The officinal preparations of the B. P. are, Liquor Calcis Chlorinate and Vapor Chlori. CHLORODYNE. Chlorodyne is a preparation used to a very large extent by the English for the treatment of serous diarheas or cramps in the stomach. Even in England its constitution varies considerably, but the formula most commonly used is as follows: R.—Morphinae hydrochlor......gr. viij. Aquse dest.........f Sss- Heat together, and as soon as the morphine is dissolved and the liquid cooled, add Acid, hydrochlor. dil. Chloroformi . Tr. cannab. indicae Acid, hydrocyanic, dil. Alcoholis 01. menth. piperit. Oleoresinae capsici f3"ss. fffr rrixij. t 5ss. ir\xij. mi- m. S.—5 to 15 drops for an adult, in water. More than this quantity is dangerous. CHLOROFORM. Chloroform was originally discovered by Guthrie, of Sackett's Harbor, New York, but first brought into medicinal use by Simpson, 126 DRUGS. of Edinburgh. It is a clear liquid of an exceedingly hot, burning, sweetish taste, of a rather agreeable odor, and is very volatile in the presence of ordinary air. There are two kinds of chloroform, the purified (Chloroformum Puriflcatum, TJ. S.) and the commercial chloroform (Chloroformum Venale, TJ. 8., Chloroformum, B. P.). According to a number of recent studies chloroform vapor in the presence of artificial light undergoes certain changes which result in the development of noxious and irritating fumes consisting princi- pally of hydrochloric acid. Physiological Action.—Locally applied to the skin, chloroform may produce some tingling and burning, even if evaporation be uot inter- fered with. If it be confined under a watch-glass on the skin it will cause a blister and act as a counter-irritant. When inhaled, chloroform produces a sensation of warmth in the mouth and throat, a feeling of relaxation, and finally unconsciousness. The respirations are at first full and deep, but soon become more rapid aud shallow. The pulse may be somewhat stronger and fuller for a short interval, but soon fails in strength and becomes more rapid. The irritation produced in the air-passages by its inhalation is very slight, and no primary arrest of respiration ensues, as is generally seen after ether is first given. The pupils are at first slightly dilated, but are contracted during anaesthesia. If the pupils dilate during the use of chloroform, after the contraction just named, danger is imminent, and death may suddenly occur. In some persons the first effects of chloro- form are violent struggles, and there is danger in trying to overcome these struggles by pushing the drug very rapidly. This is particularly apt to be the case in athletes and drunkards. Total muscular relaxa- tion should never be caused by the drug. Nervous System.—Chloroform first affects the brain, then the sensory part of the spinal cord, then the motor tract of the cord, then the sensory paths of the medulla oblongata, and finally the motor portion of the medulla, thereby producing death from failure of re- spiration unless the heart has already succumbed to the drug. On the sensory and motor nerves, when locally applied, it acts as an irritant and anaesthetic. Upon these trunks, when taken by inhalation, it has little effect. Circulation. — Chloroform may, during the first few moments of its inhalation, have a slight stimulant effect on the circulation, but its dominant effect is depressant, and it is in overdose a powerful cardiac poison, first dilating and then absolutely paralyzing the con- tractility of the heart muscle. It generally kills by heart-paralysis. McWilliams has found that dilatation of the heart occurs to an appreciable extent, even if the chloroform is gently administered and mixed with an abundance of air. Both sides of the heart are equally affected and the dilatation of the heart causes failure of the circulation before the cardiac movements entirely cease. CHLOROFORM. 127 Blood.—Upon the blood in the body chloroform has little or no effect when it is inhaled. Shaken with chloroform in a bowl outside the body the blood becomes scarlet in hue. Respiration.—Iu small amount chloroform may not be a respir- atory depressant, but iu full dose it certainly acts as such. Death from chloroform may be from either respiratory or cardiac failure, often from both.1 Temperature.—Chloroform when taken by inhalation distinctly lowers the bodily temperature, probably by aiding in the dissipation of heat and by its action on the nervous mechanism of heat production. Elimination takes place by the lungs and by the kidneys, and goes on very rapidly owing to the great volatility of the drug. If large amounts are eliminated by the kidneys, these organs are apt to become irritated and inflamed. Antiseptic Power.—Salkowski has investigated, after Koch's me- thods, the degree to which chloroform-water acts upon microorgan- isms. He has also used chloroform for some years to prevent urine from decomposing before he had time to examine it. Chloroform prevents all fermentations which depend upon the growth of micro- organisms—e. g. alcoholic fermentation, ammoniacal fermentation of urine, conversion of hippuric acid by fermentation into benzoic acid and glycocol, lactic acid fermentation, and the putrefaction of albu- mins—but it has no action on those processes caused by unorganized ferments, as ptyalin, pepsin, etc. Chloroform-water may be used to prepare solutions for subcuta- neous injections and be given internally in diseases of the digestive organs depending on the presence of microorganisms—among others, cholera. Possibly the benefit that many patients derive from stomachic mixtures which contain chloroform-water is due to its destructive action on various microorganisms. Salkowski gave a dog 200 cubic centimetres (about 6\ ounces) of chloroform-water with its food for four days without producing any ill effect, so that in the treatment of a disease like cholera large quautities of chloroform-water might be given. It may also be employed as a mouth-wash.2 Untoward Effects.—Sometimes during the administration of chloro- form the heart or respiration suddenly cease to act, and in some cases this change is preceded by a peculiar shade or cloud which passes over the face of the patient. Death often comes suddenly and without any warning. If' untoward effects appear the anaesthetic must be at once withdrawn and artificial respiration resorted to.3 Injections of 1 For a lengthy criticism and series of experiments proving an error in the conclu- sions of the Hyderabad Chloroform Commission, see paper by Wood and Hare, Medical News, Feb. 22, 1890, also one by McWilliams, British Medical Journal, Oct. 25, 1890, and one by J. C. Reeve, Medical News, vol. lvii., 1890. 2 Chloroform-water is to be made by adding 1 fluidrachm of chloroform to 25 ounces of distilled water. The mixture is then put in a well-stoppered bottle and shaken thoroughly until the chloroform is dissolved in the water. The dose is generally i to 2 ounces. s While few text-books give any specific directions concerning the practical application of the methods which are to be employed in such emergencies, those that do so force the 128 DRUGS. ether and hot brandy should be given beneath the skin, and the poles of a battery with a rapidly interrupted current swept over the body, but not held over the phrenic nerve and diaphragm. The patient must be held head downward, so that the blood will flow to the brain, and external heat should be applied. Atropine, strychnine, and digitalis may be used to stimulate the heart aud respiration. The measures adopted for resuscitation should not be stopped for at least one hour, as persons have recovered as long as this after an acci- dent from chloroform. Therapeutics.—The first and most important use of chloroform is as an anaesthetic, and at this point we come to a question which has been for many years a matter of contention between different sections of the medical profession, namely, as to whether its use is very dangerous. In the southern and western parts of the United States chloroform is nearly always used, but in the eastern and northern portions it is rarely employed. Southerners certainly seem to take chloroform better than northerners or those living on the Atlantic coast. It is impossible to go into a general discussion of the question here; suffice it to state that even the most enthusiastic supporters of the use of chloroform confess that it is a more dangerous drug than ether, if carelessly used, aud while the advantages of chloroform are many, this one great dis- advantage overshadows them all. The advantages are—its more agreeable odor and the fact that it does not irritate the air-passages, owing to the small amount necessary to cause anaesthesia, the fact that it is less apt to be followed by nausea and vomiting, the rapidity of its action, and the small bulk which has to be carried by the surgeon. Its disadvantages are—the possibility of its killing the patient by sud- den cardiac or respiratory paralysis from which there is no relief, and the powerfully depressing influence which it exercises over the respira- tory centres. Owing to these facts these rules may be followed in regard to chloroform and ether : 1. Chloroform may be used whenever a large number of persons are to be rapidly anaesthetized so that the surgeon may pass on to others and save a majority of lives, even if the drug endangers a few, as on the battle-field where only a small bulk of anaesthetics can be carried. 2. Its employment is indicated in cases of Bright's disease requir- ing the surgeon's attention, owing to the fact that anaesthesia may be physician to a procedure at once dangerous and impractical; for the directions usually given are, to place the positive pole of the battery on the phrenic nerve as it crosses the anterior scalene muscle at the root of the neck, the negative pole being pressed against the lower margin of the ribs. A rapidly interrupted current is now to be used with the purpose of causing contraction of the diaphragm by the direct action of the electricity upon the nerve. Even theoretically this is a possible source of danger, and practically the writer has proved danger to be ever-present under such treatment. The cardiac in- hibitory nerves run so closely to the phrenic fibres, and respond so readily to electrical stimulation, that it is hard to imagine how they can escape stimulation if a current be used of sufficient strength to excite the phrenic nerves near by. By practical experiment the writer has proved that inhibition of the heart may not only be possibly brought about by this method, but that it is nearly impossible to avoid such an effect if the phrenics are to be reached at all. CHLOROFORM. 129 obtained with so little chloroform that the kidneys are not irritated, whereas ether, because of the large quantity necessarily used, would irritate these organs. Quantity for quantity, ether is, of course, the less irritant of the two. 3. In cases of aneurism, or great atheroma of the bloodvessels, where the shock of an operation without anaesthesia would be a greater danger than the use of an anaesthetic, chloroform is to be employed, since the greater struggles caused by ether and the stimulating effect which it has on the circulation aud blood-pressure might cause vascular rupture. 4. Iu children or adults who already have bronchitis, or who are known to bear ether badly, or, in other words, have an idiosyncrasy to that drug, chloroform may be employed. 5. Persous who struggle violently and who are robust and strong are in greater danger from the use of chloroform thau the sickly and weak, probably because the struggles strain the heart and tend to dilate its walls. Above all things it is necessary to remember the fact that a person having taken chloroform twenty times before does not show he is not in danger on taking it the twenty-first time, and it is also to be borne in mind that many of the sudden deaths from chloroform have occurred during the first inhalation of the drug, before consciousness has been lost, and, therefore, when an accident was least expected. AYhen chloroform is given it should be poured to the amount of a teaspoonful upon a folded napkin or towel, and the cloth should then be held about three to six inches from the mouth and nose, so that the vapor may be thoroughly mixed with air in the proportion of 95 per cent, of air to 5 of vapor. The administration must be gradual, as "pushing" the anaesthetic is daugerous. The quantity of chloroform administered can only be imperfectly determined by measuring the amount thrown on the " inhaler," for during ordinary breathing one quantity is taken, and in exaggerated breathing much more is respired. Increased respiration should be a signal to withdraw the drug rather than to push it. Chloroform inhalations have been recommended in excessive chorea and in puerperal convulsions, and are, of course, of great service iu the reduction of hernia, owing to the muscular relaxation produced. Sometimes a few whiffs will put a nervous patient to sleep. For some unknown reason parturient women seem able to take chloroform with more safety thau men or women under ordinary circumstances. Chloroform, when taken internally by the mouth, causes a sensation of warmth in the stomach and a hot, burning taste about the lips and buccal mucous membrane. In overdose it can and has produced death when taken in this manner. Although rarely used in internal medicine, chloroform in the form of the spirit of chloroform (Spiritus Chloro- formi), is useful in cough mixtures, which are given to persons having an irritative cough, and in cases where, through nervousness or other 9 130 DRUGS. cause, tickling in the throat or bronchial tubes keeps the patient con- tinually in a state of unrest. (See Bronchitis.) In severe whooping-cough a few drops may be poured on the hand of the attendant and held before the child's face. While the child may at first dislike the odor of the drug the relief given soon teaches the patient its value, and he will ask for it when he feels the attacks coming on. In gastric or intestinal flatulence 1 or 2 drops of pure chloroform, or 10 to 20 drops of the spirit of chloroform, will often give relief. In the treatment of serous diarrhea when combined with astringents and opium the spirit of chloroform is most useful, provided that the irritating cause is first removed. In renal or hepatic colic a few in- halations, not sufficient to disturb consciousness, will not only give temporary but permanent relief. Hypodermic injections of 10 to 15 drops, reaching down to a painful sciatic nerve, have been recom- mended by Bartholow. Rubbed on the chest in the form of chloro- form liniment this drug will sometimes prevent asthmatic attacks, but it ought to be most carefully inhaled in this disease, because of the strained condition of the right side of the heart. In drachm doses chloroform has been used as a remedy for tapeworm, but ought never to be so employed. When placed in liniments of a stimulating character chloroform is a very useful application over muscles affected by soreness and stiff- ness, as in lumbago and gout, and these liniments may also be used in neuralgias for their local anaesthetic effect. Administration.—The officinal preparations of chloroform are a liniment (Linimentum Chloroformi, TJ. 8. and B. P.), a spirit (Spiritus Chloroformi, TJ. S. and B. P.), the dose of which is 20 minims to 1 fluidrachm; and a mixture (Mistura Chloroformi, TJ. 8.), composed of chloroform, camphor, yolk of egg, and water, given in the dose of 2 to 4 fluidrachms. The B. P. recognizes, besides those given, the fol- lowing preparations : Aqua Chloroformi, given in the dose of ^ to 2 fluidouuces; Tinctura Chloroformi Composita, composed of rectified spirit, chloroform, and cardamoms, dose 20 to 60 minims; and Tinc- tura Chloroformi et Morphine, dose 5 to 10 minims. CHROMIC ACID. Chromic Acid (Acidum Chromicum, TJ. 8. and B. P.) is not a true acid, but au auhydrate, and occurs in the form of brilliant red crystals which are deliquescent and possess a sour, metallic taste. It should never be mixed with sweet spirit of nitre, strong alcohol, or glycerin, as under those circumstances it may explode. Therapeutics.—Chromic acid is used solely as a caustic for the removal and destruction of growths on the skin or mucous membranes. The liquid, resulting from its deliquescence on exposure to the air, CIMICIFUGA. 131 may be employed by means of a glass rod, if a very severe action is needed. Dr. J. Wm. White has recorded a death from the application of this acid to a large number of condylomata about the buttocks and vulva. AAliere the drug has been swallowed the patient should be treated for gastro-enteritis, and dilute alkalies and lime-water be used, as well as emetics and demulcent drinks. If a superficial action is desired, a solution containing 100 grains to the ounce of water is sufficient, and for small warts and similar growths this will be found strong enough. Liquor Acidi Chromici, B. P., is composed of 1 part acid to 3 of water. CHRYSAROBIN. Chrysarobin (Chrysarobinum, TJ. S. and B. P.) is a mixture of the proximate principles derived from a powder found in the wood of the tree Andira Araroba, which was originally used for medicinal pur- poses in Brazil. In the East Indies it is called "Goa powder.'' Chrysarobin is misnamed chrysophanic acid, and is a yellow, tasteless powder, soluble in solutions of alkalies, acids, and ether. Therapeutics.—Chrysarobin is given internally in the dose of \ of a grain in psoriasis and parasitic diseases of the skin, but more com- monly is employed externally in the form of the officinal ointment (TJnguentum Chrysarobini, TJ. S. and B. P.), which is too strong for direct use, and should be mixed with 4 or 5 parts of benzoated lard before application to the skin. As the drug stains the skin a dark- brown it ought not to be used on the face, although the discoloration may be removed by a weak solution of chlorinated lime. In psoriasis the following may be employed : R.—Chrysarobini.......3j. f^ff'l 1 . . . . aaq.s.adft.sol. Alcoholis j ^ Collodii........fgiij. M. S.—Apply to the part affected, with a brush, after a bath. CIMICIFUGA. Oimicifuga (TJ. S.). This drug is derived from Cimifuga Race- mosa, otherwise known as black cohosh or black snake-root. It con- tains a resin and a volatile oil, upon which its medicinal powers are supposed to depend. The fluid extract and tincture should always be freshly prepared from the fresh crude drug. It is officinal in the B. P. as Cimicifuge Rhizoma. Physiological Action.—In large doses cimicifuga paralyzes the sen- sory side of the spinal cord, and in consequence lowers reflex activity. It has no effect on the nerves and muscles. On the circulation the 132 DRUGS. drug acts by depressing the heart and vasomotor system. Death is due to respiratory arrest. In small dose it is a cardiac stimulant. In overdose it nearly always produces frontal headache. Therapeutics.—Cimicifuga is, after arsenic, the best remedy we have for chorea, particularly if the patient is otherwise in good health, but it should be used with careful attention to the bowels and often be accompauied by iron. In chronic bronchitis it is asserted to be of value, and in rheumatism of a subacute or chronic type cimicifuga sometimes gives relief. Cimicifuga has been highly praised in the treatment of neuralgia, particularly of the ovarian type, and in amenorrhea, subinvolution, and, tenderness of the womb. To women who state that they cannot step off a step without paining or hurting the uterus or ovaries, cimici- fuga often gives relief. Some writers assert that it is an efficient and active heart tonic in cases of fatty and irritable heart when digitalis fails. There can be no doubt that it is a powerful uterine stimulant, and it ought not to be used during pregnancy for fear of abortion. By reason of this power it may be employed instead of ergot during labor, and is better in some cases, because it produces normal, not tonic, contractions. In the treatment of headache, arising from over- straining of the eyes in study, cimicifuga is said to do good. The drug is officinal in the form of the fluid extract (Extractum Cimicifuge Fluidum, TJ. S. and B. P.), the dose of which is 10 to 30 drops, or even 1 drachm, and the tincture (Tinctura Cimicifuge, TJ. S. and B. P.), the dose of which is 1 to 2 drachms. CINCHONA. Cinchona, TJ. S., is a name applied to the bark of all the trees be- longing to the genus Cinchona, provided they contain as much as 2 per cent, of the alkaloid quinine. The same barks are included under the name of Cinchona Cortex in the B. P. There are thirty-one species of this genus, but only a comparatively small number can be included in the list of 2 per cent, of obtainable alkaloid. These are the Cinchona Calisaya, or Cinchona Flava, TJ. 8., which contains the most quinine, the Cinchona Coudominea, Cinchona Micrantha, Cin- chona Succiruba, or Cinchona Rubra, TJ. 8., Cinchona Rubra Cortex, B. P., and Cinchona Pitayensis. The first is called yellow bark, the second pale bark, the fourth red bark. The alkaloids of the quinine series derived from these barks are quinine or quinina, quinidine or quinidina, and quinicine, which is an artificial alkaloid. Of the cin- chonine series we have cinchonine (Cinchonina, TJ. S.), cinchonidine (Cinchonidine Sulphas, TJ. 8. and B. P.), and cinchonicine, which last is also an artificial alkaloid. Besides these alkaloids we have present kinic and kinovic acids and other inert and useless substances. As quinina is the most important of the group, and as its physio- CINCHONA. 133 logical action is virtually identical with the rest, whatever is said here- after in this article refers to quinine unless it is otherwise stated. Physiological Action.—AYheu quinine is taken in overdose it causes ringing in the ears, dizziness, disorders of taste and smell, disturbance of vision in some cases, and fulness in the head. Deafness often comes on, and is generally, with the roaring in the ears, the most pressing symptom. Headache is not uncommon. Nervous System.—Upon the cerebrum quinine acts as a stimu- lant, and, finally, as a congestant, if given in excessive dose. If poi- sonous doses are used intense cerebral congestion ensues, aud, finally, unconsciousness comes on. On the spinal cord the drug first causes a decrease in reflex action by stimulating Setschenow's reflex inhibitory centre, and, finally, by depressing the spinal cord and nerves. The latter changes only occur after poisonous doses. Circulation.—If quinine, even in small amount, be injected into the jugular vein of a dog, so that it goes in concentrated form to the heart, cardiac paralysis will result. If this does not occur the drug decreases pulse-force, rate, and arterial pressure. In minute doses the drug acts as a general stimulant to the entire body and so supports the circulation. Blood.—The blood after poisonous doses is more coagulable than normal, but in medicinal amouuts no such effect is produced. The movement of the white blood-cells through the walls of the capillaries in inflamed areas is checked by large doses of quinine, and medicinal amounts increase the number of the red blood-corpuscles very mate- rially. It is said that quinine prevents the oxygen-bearing powers of the corpuscles, but this probably does not occur from medicinal doses. Respiration.—Upon respiration quinine acts as a slight stimu- lant in small doses, but as a marked depressant in poisonous amounts, death being most commonly due to failure of respiration if it be taken by the stomach. Temperature.—Quinine lowers bodily temperature in health very little if at all, and in fevered states its influence is governed by the cause of the fever. Thus iu malarial fevers quinine is a very power- ful antipyretic. In fever before crisis quiuine is of little service, but in that after crisis it causes a rapid fall As an antiseptic quinine has considerable power. Quinine is absorbed from the stomach, not from the intestine, and it is precipitated by the alkaline juices of the bowel. Kidneys, Elimination, and Tissue-waste.—Quinine escapes from the body chiefly through the kidneys, although much of it is destroyed by oxidation in the liver and tissues. In the urine it is found as quinine and as dihydroxyl quinine. Upon tissue-waste quinine acts as a depressant and decreases the elimination of nitrogenous materials. Poisoning and Untoward Effects.—Poisoning so seldom occurs as the result of the ingestion of overdoses of quinine that untoward effects is 134 DRUGS. the best term with which to qualify the disagreeable symptoms which sometimes come on in persons having an idiosyncrasy to the drug, and who are in reality poisoned by small doses. In these cases sudden, complete, but temporary blindness is often met with. In other in- stances complete deafness asserts itself, due to congestion of the middle ear, while skin eruptions, generally of the nature of erythema, are not rarely seen. After lethal doses haemorrhage into the middle ear may be found, and severe epistaxis may ensue after so small a dose as 4 grains. The buzzing in the ears can generally be put aside by 10 grains of bromide of sodium or a little ergot. Therapeutics.—This drug is employed iu medicine to fulfil four great offices, although its influence in other directions is hardly less powerful. These are as an anti-periodic or anti-malarial, as an anti- pyretic, as a tonic possessing peculiar virtues, and as a stimulant to the parturient uterus. In malarial fever quinine is the best remedy we have, as a prophy- lactic and cure, and it should be given in doses which are indicated by the state of the patient. (See Malarial Fever.) It should always be preceded by a purge having an hepatic action, if this is possible. This fact is particularly important in bilious or remittent fever. The drug should be given in hourly doses or in one or two large doses in such a way that its influence is fully felt, not at the time of the expected paroxysm, but about an hour or thirty minutes before that time. If the paroxysm is near at hand the drug should be given in solution, bitter though it be, in acidulated water. As a prophylactic against malaria the dose of quinine should be 2 to 4 grains, or more, three times a day. In malarial cachexia or haemorrhagic malarial fever, quinine often does more harm than good. In pernicious malarial fever quinine should be given by the mouth, by the rectum and hypodermically, as much as 60 to 70 grains being used at a dose. Iu brow ague or malarial neuralgia quinine often acts most usefully, and this is also true in some cases of ordinary nerve-pain not dependent upon a specific disease. For the reduction of the pyrexia of typhus or typhoid fever, quinine will be found inferior to the new antipyretics, even when given in very large dose, and ought to be used very rarely. It will seldom cause a fall of temperature before crisis or lysis, but will aid in the fall very actively after these changes have occurred. As a tonic quinine is not only a simple bitter, but also seems to have a direct effect in increasing the number of the red blood-corpus- cles. The tonic dose should be 1 to 2 graius three times a day. In parturient women the drug undoubtedly aids in the expulsion of the child by stimulating the uterine contractions, either by a direct influence over the uterus, or by supporting the system. Its use is particularly indicated in cases where the pains have ceased because of exhaustion from prolonged labor. The dose should be 10 to 20 grains dissolved in water in order that immediate absorption may occur. Quinine will not of itself cause abortion. CINCHONA. 135 In the lobar pneumonia of children quinine should be used in sup- positories in the dose of 2 grains three times a dav. In cases where prolonged mental or physical strain is to be undergone, quinine in the dose of 2 to 4 grains will often prevent exhaustion and support the system. Used in solution in the form of a spray by the atomizer, quinine is of undoubted service in whooping-cough, and will often prevent the spread of the disease to other children if they be subjected to its use. The solution should contain from 1 to 2 grains to the ounce and be employed every few hours. It is well to remember that quinine is not tasted by the tip of the tongue, but is tasted by the back portion. The tip of the atomizer should therefore be carried well back of the root of this organ and a 1 per cent, solution of cocaiue painted over the dorsum of the tongue in cases where the disagreeable taste of the quinine is objected to very strongly. The same solution of quinine used, by means of an atomizer, in colds in the head and in foetid sore- throat is often of service. A very much more agreeable method of pursuing this treatment in whooping-cough is to give the patient the so-called quinine chocolates, which are made of 1 grain of tannate of quinine and chocolate. They do not taste of quinine at all, if well made. Several prominent drug firms manufacture these chocolates. One or two may be allowed to dissolve in the child's mouth three times a day. Administration.—Quinine ought never to be given in solution if it can be avoided, because of its disagreeable taste. In adults and children it should be used preferably in small capsules and in pills, which may be gelatin- or sugar-coated. Care should be taken that the gelatin is thin and the sugar not hardened by age, for if the pill escapes into the intestine the quinine is precipitated aud not absorbed. If the case is that of a child too young to take a pill, the drug may be given in the following manner without tasting very disagreeably: J£.—Quinina? sulph.......gr xvj. Ext. glycyrrhiz.......3j- ' Syrupi aurantii cort. vel syrupi zingiberis vel verba santi.......f^U- M. S.—A teaspoonful t. d. for a child of three. In some cases quinine chocolates may be used, but unless they are well made the after-taste of quinine is well marked. When they are used the tannate of quinine should always be placed iu them. In other cases quinine may be used in the suppository in the dose of 2 to 3 grains, care being taken that irritation of the rectum does not ensue. For hypodermic use the bisulphate of quinine (Quinine Bisulphas, TJ. 8. and B. P.) should be most commonly used, as it is soluble in about 8 parts of water. To its solution should be added a little tartaric acid to prevent precipitation of the drug in the alkaline juices of the connective tissues before it can be absorbed. The tartaric acid should be present in the proportion of about 1 grain to each 5 grains of the quinine. The hydrobromate of quinine (Quinine Hydrobromas, U.S.), 136 DRUGS. the solubility of which is about 1 to 16 of water, may also be used hypodermically, as may also the bimuriate of quinine and urea, which, however, is scarcely more than half as strong in quinine as the other salts. The hydrochlorate of quinine is also a useful salt for hypo- dermic use. It may be employed in the following manner: ]J.—Quinina? hydrochlorat......gr. vii. Glycerini 1.......-,.-, f 3ss- Aquae dest. J ^ M. S.—Warm solution before using it and do not add acid. g.—Quininae hydrochlorat......gr. xv. Alcohol........TTlxv. Aquae dest........f 3jss. M. S.—Add a few drops of hydrochloric acid to complete the solution before using. In Italy Baccelli has resorted to the intravenous injection of quinine in pressing cases. He employs the following solution for this pur- pose : I£.—Quinina? hydrochlorat......gr. xv. Sodii chloridi........gr. xij. Aquae dest........f Sijss. M. S.—This should be injected, after distilled water is added to it, into a vein of the leg rather than into a vein of the arm, to avoid too great an effect on the heart. Valerianate of quinine (Quinine Valerianas, TJ. 8.) is given in 1 to 2 grain doses, and the hydrochlorate (Quinine Hydrochloras, TJ. 8. and B. P.) in the dose of 1 to 10 grains. The alkaloids of cinchona other than quinine which are commonly used in medicine are cinchoni- dine, cinchonine, quinidine, and chinoidium. Cullen, Sinkler, and de Brun have all found the sulphate of cinchonidine very useful in malaria, and it is less bitter and more soluble than is quinine. Sinkler states that it does not produce the severe head symptoms caused by quinine. The dose of quinidine sulphate (Quinidine Sulphas, TJ. S.) is about twice that of quinine, as is also that of cinchonine sulphate (Cincho- nine Sidphas, TJ. S. and B. P.) and cinchonidine sulphate (Cinchoni- dina Sulphas, TJ. 8. and B. P.). The tannate of quinine is a salt not so bitter as the other salts, and is weaker in relative alkaloidal strength. One grain of the tannate equals about one-fourth of a grain of pure alkaloid. The bisulphate equals about two-thirds and the sulphate three-quarters of a grain of the pure alkaloid. The liquid preparations of cinchona are the infusion (Infusum Cin- chone, TJ. 8.), dose a wineglassful; the tincture (Tinctura Cinchone, TJ. S. and B. P.), one to two teaspoonfuls; aud the compound tinc- ture (Tinctura Cinchone Composita, TJ. S. and B. P.), a teaspoonful to a tablespoonful. The last is a most efficient and elegant bitter tonic in debility and convalescence from low fevers It is too weak to be used in malarial poisoning. The other liquid preparation is the fluid extract (Extractum Cinchone Fluidum, TJ. 8.), dose 5 to 15 drops. A solid extract (Extractum Cinchone, TJ. S.) is also officinal in the dose of 5 to 10 grains. The B. P. preparations not officinal CITRATE OF POTASSIUM. 137 in the V. 8. P. are as follows : Decoction Cinchone, dose 1 to 2 fluid- ounces ; Extractum Cinchone Liquidum, dose 5 to 10 minims; Infu- sum Cinchone Acidum, dose 1 to 2 fluidounces; Tinctura Quinine Ammoniata, dose | to 2 fluidrachms; Vinum Quinine, dose J to 1 fluidounce. Contra-indications.—Quinine is contra-indicated in gastritis, cyst- itis, meningitis, epilepsy, cerebritis, middle-ear disease, and in those cases which have an idiosyncrasy to its action. CINNAMON. Cinnamon (Cinnamomum, TJ. 8., Cinnamomum Cortex, B. P.) is the inner bark of the Cinnamomum Zeylanicum, a native of Ceylon, or of the species indigenous to China. It coutains a volatile oil and tannic acid. In overdose the oil acts as a soporific, aud kills by failure of respiration. Therapeutics.—Cinnamon is used, as are all the drugs of its class, for flavoring, as a carminative, and as an intestinal stimulant in serous diarrheas. It has the peculiar power of acting as a haemostatic in uterine hemorrhage where the flow is oozing and not active, thereby differing from the other volatile oils, with the exception of that of erigeron. Administration.—The dose of the oil (Oleum Cinnamomi, TJ. 8. and B. P.) is 1 to 5 drops; of the water (Aqua Cinnamomi, TJ. 8. and B. P.) a wineglassful or less ; of the spirit (Spiritus Cinnamomi, TJ. 8. and B. P.) 5 to 30 drops ; of the tincture (Tinctura Cinnamomi, TJ. S. and B. P.) J to 1 drachm. Under the name of Pulvus Aromaticus, TJ. 8. (Pulvus Cinnamomi Compositus, B. P.), a carminative powder, consisting of cinnamon 35 parts, nutmegs 15 parts, cardamoms 15 parts, and ginger 35 parts, is officinal. It is useful in the treatment of the flatulence of adults and children. The latter should take about 10 grains at a dose, an adult 30 grains. CITRATE OF POTASSIUM. Citrate of Potassium (Potassii Citras, TJ. 8. and B. P.) is a white, granular, deliquescent salt, almost neutral in reaction and very soluble in water. It is by far the most agreeable of all the salts of potassium to the taste. In the early stages of bronchitis it is of the greatest value when combined with ipecac (see Bronchitis), and it is also use- ful as an alkaline diuretic. In bronchitis the dose should be 20 grains every four hours, aud in urinary incontinence due to acid and concen- trated urine the dose should be equally large. Under the name of neutral mixture (Mistura Potassii Citratis, TJ. S.), made by adding to 1 pint of lemon-juice enough bicarbonate of potassium to neutralize it, we have a useful febrifuge drink in fevers, 138 DRUGS. particularly those of childhood. The dose is £ to 1 ounce every few hours. Liquor potassii citratis, TJ. 8., is made in the same manuer as is the neutral mixture, except that citric acid is substituted for the lemon- juice (citric acid 720 grains, potassium bicarbonate 960 grains, and water 24 ounces). Neutral mixture is the better preparation of the two, but more ex- pensive. A very refreshing and agreeable way of prescribing this drug is in the form of " effervescing draught," made by mixing two solutions which are prepared as follows: 1. Lemon-juice aud water, equal parts, enough to make 4 ounces. 2. Bicarbonate of potassium 1 drachm, and water 3 ounces. These solutions are to be mixed in the quantities desired and taken while effervescing. If lemon juice is not at hand, a solution of citric acid of the strength of 2 drachms to 4 ounces of water should be employed in its stead. CITRIC ACID. Citric Acid (Acidum Citricum, TJ. 8. and B. P.) is chemically identical with the acid of the lemon, but has not identical influences over the body with lemon-juice. Not only does the. lemon owe its acidity to this acid, but most of the other edible fruits, such as strawberries and raspberries, depend upon its presence for their acidity. Therapeutics.—Citric acid is used in scurvy or scorbutus as a pro- phylactic and cure. For some unknown reason pure lemon-juice seems to benefit these cases more than citric acid itself, and it is, there- fore, to be preferred to the latter whenever it can be had. In order to keep lemon-juice from decomposition on long voyages, it should be boiled, and poured while hot into bottles until it nearly reaches to the cork; the remaining space is then filled with a thin layer of sweet oil and the bottle corked and stood upright. Under these circumstances the juice may be kept indefinitely. In some cases lemon-juice or lemonade will cause indigestion aud a sensation of weight in the stomach, particularly is this the case with the sick. This is due to the presence of soluble irritant albuminoids, which should be precipitated by boiling the lemonade, decanting the solution on cooling, and leaving the precipitate to be thrown away. If the supernatant liquid is cooled and properly sweetened it is almost as agreeable as the fresh juice aud devoid of irritant power. In rheumatism, either acute or chronic, lemon-juice may be em- ployed in the dose of 1 to 2 ounces four times a day, well diluted, or 2 drachms of citric acid may be given. It is also of value in hepatic inactivity and catarrhal jaundice. (See Citrate of Potassium.) The preparations containing citric acid are Syrupus Acidi Citrici, TJ. S., Succus Limonis, B. P., and Syrupus Ldmonis, B. P. COCA AND COCAINE. 139 CLOVES. Cloves (Caryophyllus, TJ. S., Caryophyllum, B. P.) are the unex- panded flowers of the Eugenia Caryophyllata, a plant of the East and West Indies. They possess an aromatic odor and the pungent taste of a typical spice. They contain a volatile oil (Oleum Caryophylli, TJ. 8. aud B. P.), which is yellow when fresh but very dark colored when old. Therapeutics.—Cloves, or their oil, are used iu medicine for the purpose of acting as a carminative. They are also employed as a stimulant and tonic to the stomach to prevent griping during an attack of diarrhea or that caused by purgatives, to act as a flavoring agent, as a counter-irritant, and, finally, as a parasiticide and local ancesthetic. Like all volatile oils, this oil is an efficient local application for pediculis pubis and similar parasites, and it may be used in toothache because of its anaesthetic powers if placed on a pledget of cotton in the cavity of a tooth. In the treatment of myalgia or muscular rheu- matism oil of cloves is often placed in the liniment used, for its counter- irritant effect. In overdose it acts as a soporific and kills by failure of respiration and the production of marked gastro-enteritis. Minute doses of J to 1 drop of the oil in a little water will sometimes control excessive vomiting. In addition to the oil the B. P. has an officinal infusion, Infusum Caryophylli, the dose of which is 1 to 2 fluidounces. COCA AND COCAINE. Cocaine is the alkaloid derived from Erythroxylon Coca, a shrub of Peru and Bolivia. A second alkaloid, known as Ecgonine, has entirely different powers. It is to be distinctly understood that Erythroxylon Coca is not the same as chocolate, or Theobroma Cacao. Erythroxylon Coca is officinal in the B. P. as Coca and in the U. S. P. as Erythroxylon. Physiological Action.—Coca and its alkaloid cocaine, when taken internally, produce a sense of exhilaration and pleasure. Often the amount of muscular and mental power is temporarily increased under their influence. AVhen locally applied to a mucous membrane cocaine causes a blanching followed by marked congestion. Nervous System.—The dominant action of cocaine, when locally applied, is to paralyze the peripheral sensory nerves. When taken internally it stimulates the brain to an extraordinary degree, but exer- cises no effect upon the sensory nerves. Sometimes its internal use produces a decrease of sensation which Mosso believes to be due to an influence on the spinal cord. This effect is, however, very feeble. If the dose be a poisonous one, convulsions of cerebral origin ensue, and are clonic in type. 140 DRUGS. The sensory nerves are paralyzed by enormous doses, both when the drug is directly applied or when it is taken internally. Upon the muscles, when taken internally, Mosso has proved the drug to be a direct stimulant, and it is particularly active after starva- tion or fatigue. Circulation.—Cocaine acts as a stimulant to the heart and cir- culation in moderate amounts, but its effects are not marked except in poisonous dose. Respiration.—The drug acts as a powerful respiratory stimulant, producing in large dose a great increase in the rapidity of the respi- ratory movements. Temperature.—Cocaine raises bodily temperature to a very ex- traordinary degree if given in overdose, this rise being due to an increase of heat-production. (Reichert.) In moderate amounts it has no effect. Kidneys, Elimination, and Tissue-waste.—The drug is elimi- nated by the kidneys, but is chiefly destroyed by oxidation in the body. The quantity of urine passed is increased under its influence, and the nitrogenous elements eliminated in this fluid are a little diminished. Eye.—Owing to its powerful action as a local anaesthetic, cocaine has been used largely iu diseases of the eye. The anaesthesia comes on in from one to five minutes after the use of the drug, according to the strength of the solution used, and is accompanied by very marked dilatation of the pupil. It is important to remember that this dilata- tion, unlike that produced by mydriatics such as atropine, does not paralyze accommodation. The dilatation of the pupil is due to a peripheral stimulation of the sympathetic nerve. The drug does not cause a forcible mydriasis, and is never used for the prevention of adhesions in iritis. Therapeutics.—Cocaine hydrochlorate (Cocaine Hydrochloras, B.P.) is used as an anaesthetic in the eye in the dose of from 3 to 5 or more drops of from a 1 to a 4 per cent, solution. The strength of 2 and 3 per cent, is perhaps most commonly employed. The conditions indicating its use are all operations upon the eye of a painful character, be they what they may, and it is also to be used for the relief of pain when an acute inflammation or foreign body is causing suffering. The following formula will be found useful in these states : R.—Cocain. hydrochlor.......gr. viij. Acid, boric. ........ gr. vii. Aquae dest.........f =j. m. S.—Use with a dropper in the eye every hour until relieved. Cases are recorded in which cocaine has caused permanent corneal opacities. AArhere enucleation of the eyeball is to be practised the drug should be replaced by general anaesthetics, but cocaine may be used if it is injected deeply around the eyeball. codeine. 141 Owing to the density of the mucous membranes of the vagina and rectum, cocaine has little effect upon them unless used in 10 per cent. solution and profusely applied. In the mouth cocaine may be used in cases of stomatitis where a spot is to be cauterized, in pharyngitis and in soreness and tenderness of the gums. While it gives much temporary relief in pharyngitis the subsequent effects are often ex- ceedingly disagreeable, the congestion looking more angry and being more painful thau before, aud the experience of the writer indicates that it will only act in a curative manner if applied before the capil- laries become relaxed or paralyzed by the severity of the inflamma- tory process. In coryza and hay fever a powder consisting of cocaine, morphine, and bismuth in the proportion of one part each of the two alkaloids and five parts of the bismuth will often be of service if snuffed up into the nostrils. If cocaine be applied to a large nerve- trunk, amputation of the tributary limb may be performed without pain, but so large an amount of the drug must be used that there is great danger of poisoning the patient. Cocaine is generally used at present in the place of ether iu cases requiring amputation of the fingers, or in cases of minor surgery where the drug can be confined to the part injured. A tight cord should be bound around the base of the finger and a 4 to 8 per cent, solution injected into the part, a ligature about the base of the digit being used to prevent haemorrhage and the systemic absorption of the drug. Internally, cocaine or the fluid extract of coca may be used as a supportive and stimulant in low fevers, and in cases where great physical and mental strain is to be borne. It is undoubtedly of service in the opium habit, but if largely used soon changes the patient from a case of morphiomania to a " coca fiend." In the vomiting of pregnancy and other forms of excessive emesis it is of great service by depressing the sensory nerves and thereby decreasing the irritability of the stomach. The dose of the fluid extract (Extractum Erythroxyli Fluidum, TJ. 8.) is from J to 2 drachms. That of cocaine from £ to J graiu. The B. P. preparations are Extractum Coce Liquidum, dose, \ to 2 fluidrachms, and Lamelle Cocaine, each disc containing y^- grain of cocaine hydrochlorate. Untoward Effects.—Sometimes loss of speech, blindness, nausea and vomiting, syncope and unconsciousness, have followed the internal use or local application of cocaine. Epileptiform convulsions have also been noted, while the circulation and respiration have been disordered in every possible manner. Curiously enough a large number of cases of severe poisoning have followed the injection of cocaine into the urethra previous to some operation for the relief of chronic gonor- rhoea or stricture. CODEINE. Codeina, TJ. S. and B. P., is au alkaloid prepared from opium, and is often contaminated by morphine. Its physiological action is very 142 DRUGS. closely allied to that of its sister alkaloid—morphine—but it is very much less powerful. Physiological Action.—Codeine resembles morphine very decidedly in its physiological action, the chief difference being that it possesses less narcotizing power, but in large amount more readily produces tetanus and final paralysis of the peripheral motor nerves in the lower animals. (Dott and Stockman.) Therapeutics.—Codeine has been highly recommended in France as a nervous quietant, and in this country in nervous cough, or in cases where the cough is excessive in bronchitis and phthisis. In diabetes mellitus some clinicians have found it of the greatest value, while others have been disappointed in its use. It should, however, always be tried in this disease iu the hope that it may exercise a favorable effect. When given for cough it should be used in the dose of from J to 2 grains, generally placed in the syrup of wild- cherry bark. COD-LIVER OIL. Oleum Morrhue, TJ. 8. and B. P., is a fixed oil obtained from the fresh livers of the G-adus Morrhue or cod fish. There are several species of cod from which the oil is obtained other than the one named, but this is the chief source of supply. The oil is pale or dark, according to its degree of freedom from foreign materials. Al- though the paler oils are generally prescribed, there can be little doubt that the darker ones are more medicinally active. The most prominent inorganic constituents of the oil are iodine, bromine, sul- phuric and phosphoric acids. It also contains more or less of the biliary salts. Physiological Action.—Cod-liver oil depends on a number of sub- stances for its peculiar effect. The iodine certainly exerts certain alterative powers and the oil seems peculiarly adapted to digestion and absorption, for cod-liver oil passes through animal membranes very readily, probably owing to the biliary salts contained in it. It aids in the maintenance of bodily temperature by its oxidation and causes a deposit of fat in the tissues. The oil also seems to influence the blood directly, for clinical observation shows that anaemic persons become healthy-looking under its use, and Cutler and Bradford have found that this is a physiological fact by the use of Malassez's blood- cell counting apparatus, the red corpuscles being always increased. It has been proved by experiment that this oil is more readily oxidized than any other. The belief among physicians that the effects of cod-liver oil are dependent upon some peculiar combination of substances has shown itself in the attempts of physiological chemists to isolate the combina- tion. One of the best results reached is the so-called " Morrhuol" of Chapoteau, who seems to have isolated a crystalline substance con- taining phosphorus, iodine, and bromine. Three to five grains of this cod-liver oil. 143 preparation are said to represent one drachm of the pure oil, and it is certainly of value as a medicament in most of the states in which we use the oil itself. Iu " colds" which "hang on" aud are not readily gotten rid of, morrhuol is best given in capsule or pill. This sub- stance is put on the market in gelatin-coated pills or capsules. Therapeutics.—Cod-liver oil is useful iu persons who have no tuber- cular lesion in the lungs or other tissues, but have mucous membranes which are readily susceptible to disease. This state has been called the p re-tubercular stage of phthisis. Cod-liver oil possesses no curative power in cases of well-developed phthisis, and its administration in many cases only serves to nauseate and distress the patient or to pro- duce an oily diarrhoea through failure of digestion. It may be used in the early part of the disease as a food but not as a cure. In chronic rheumatism the drug is often of great service, particularly if the disease is largely muscular. Strumous skin lesions depending for their exist- ence not only upon scrofulosis but also upon anemia often yield to its use. In enlargement of the lymphatic glands, where they are not under- going acute active suppuration, cod-liver oil does good. This is a statement requiring explanation. By acute active suppuration is meant the early formation of pus or the molecular death of" the parts— not the slow formation characterized by no active change but repre- sented by cold-abscess, or old sores. If the discharge is chronic the oil does good. In strumous ophthalmia cod-liver oil is of great ser- vice. In advanced syphilis cod-liver oil is most useful, and in the early stages of rickets it ought always to be employed. In marasmus, when used by inunction or taken internally, if the stomach will stand it, it is one of the best drugs we have. If a few grains of bile-salts, consisting of glycocholate and tanrocholate of sodium, be added to each drachm of oil it will be very readily absorbed from the skin.1 In sciatica and lumbago and iu neuralgia cod-liver oil is of service. In emphysema of the lungs it is said to be of great value, aud certain writers commend its use in gout, although others have asserted that it is of no value. Sometimes old persons whose digestion is not dis- ordered and who have no organic brain disease, complain of giddiness. The best treatment for this condition, in many instances, is cod-liver oil with doses of quinine; or, if these fail, wine of ergot and one of the bromides may be used. Administration.—Owing to its disagreeable taste and smell most patients rebel against taking cod-liver oil, but this can, with a little persistence, be readily overcome, so that finally the patient may not 1 These salts may be bought, or made as follows: To about 300 c.c. of ox-gall is added nearly thrice that quantity of ordinary alcohol, and the flask shaken thoroughly. All the mucus is now precipitated and the supernatant fluid is filtered. To the filtrate is added a large excess of sulphuric ether, and after a time a plaster-like mass forms at the bottom of the vessel, which slowly becomes crystalline. These crystals are now placed on a filter paper and washed with a mixture made up of ether and alcohol, equal parts. The filter paper is dried and the substances then seen are the taurocholate and glyco- cholate of sodium. Having carefully removed these salts from the paper they are ready for use. 144 DRUGS. only not object to its use but actually like it. This is particularly true of young children. The secret of reaching this much-to-be-desired state lies in the use at first of doses which may be dropped into a tea- spoon and the spoon then gently submerged in a glass of milk. The oil floats off into the milk in a globule in the centre of the tumbler, and if the milk be rapidly gulped down without the oil touching the sides of the glass it will not be tasted. The first gulps must be large enough to include the oil. The dose should always be taken on a full stomach, and if it be followed in five or ten minutes by a little pan- creatin its digestibility will be much increased. Other modes of ingestion consist in the placing of the oil in whiskey or brandy, in the manner which has been described with milk, and this method possesses the advantage that the alcohol aids very distinctly in the absorption of the oil. Sometimes a pinch of salt placed in the mouth before and after the oil is taken aids in covering its taste and in its digestion. (See Indigestion.) Oil of eucalyptus in the proportion of 1 to 100 of the cod-liver oil will cover the latter's taste, but many dislike the eucalyptus more than the cod-liver oil. The addition of an equal quantity of glycerin, with ^ to 1 drop of the oil of bitter almonds, to each dose is often of service. Syrup of bitter orange-peel is one of the best covers to its taste. Tomato ketchup has also been used with good results. Chewing a piece of smoked herring before and after taking the oil is of value to disguise the taste in some cases. Cod-liver oil is most readily digested when given in single nightly doses after supper, or after a light meal just before going to bed. After a few days it may be given after dinner, and in the course of a week after breakfast. If the patient is once nauseated by overdoses it is almost impossible to make the stomach retain the oil. If it cannot be digested a drachm of ether aids in its absorption, or a drink of whiskey or brandy may be used iustead. A large number of preparations of cod-liver oil are on the market in emulsion, pancreatized and purified till they are nearly tasteless. Many of the permanent or perfect emulsions contain more Iceland moss or acacia than oil. The pancreatized emulsions are the best if the oil is really present in sufficient quantity to do good, as the very fact of its being artificially digested adds to its value aud the possi- bility of putting more oil into the emulsion. Oil devoid of smell is probably devoid of medicinal value, as all the peculiar properties have been " purified " out of it, Cod-liver oil may be used iu capsules with great success by patients who can swallow large boluses. COFFEE. (See Caffeine.) COLCHICUM. Colchicum is the corm (Colchici Cormus, B. P.; Colchici Radix, TJ. S.) aud seed (Colchici Semen, TJ. 8.; Colchici Semina, B. P.) COLCHICUM. 145 of the Colchicum Aidumnale, a plant of Europe, containing an alka- loid, colchicine, which may be still further changed into colchiceine. AVhile the drug is officinal in the form of the seeds and root the former are rarely employed. Physiological Action.—Colchicum is a very powerful drug, and when locally applied is an irritant to the gastro-intestinal mucous membrane. According to the studies of one of the writer's students—Dr. Ferrer Y. Leon—the drug has little or no effect when given in mod- erate dose on the nervous system, circulation, respiration or tempera- ture, only producing changes in these parts when given in poisouous doses. Jacobi asserts that death is produced by respiratory failure, the heart continuing to beat for many minutes after respiration ceases. The violent gastro-enteritis which is present in colchicum poisoning certainly has much to do with the fatal result in man. Therapeutics.—The employment of colchicum in medicine centres around its use in gout and similar states, such as chronic rheumatism or rheumatoid arthritis. Indeed it is almost a specific in acute gout, provided that it be pushed until it causes slight griping or laxity of the bowels. Care must be exercised under these circumstances that "retrocedent gout" does not occur, owing to the manifestations of the disease leaving the toe and going to the internal viscera. In some cases iodide of potassium should be used in conjunction with the colchicum. This is particularly the case in subacute or chronic cases. The use of colchicum in such doses as to cause severe purgation or emesis is dangerous, and ought not to be resorted to. Poisoning.—The symptoms of poisoning by colchicum are nausea, griping, agony in the belly, purging followed by the passing of thick mucus with great and increasing tenesmus, profuse salivation, collapse, and death from exhaustion and gastro-enteritis. Bloody purging is almost never seen. The poisoning is one of the most painful, slow, and hopeless poisonings known, and a man taking as much as an ounce of the wine of the root or the seed is almost inevitably doomed to a terrible death. Tannic acid may be used as a partial chemical antidote, and the stomach washed out with emetics and the stomach- pump. Opium is to be used to relieve the pain and irritation, and oils are to be given to soothe the inflamed mucous membrane. If collapse comes on, external heat and stimulants are to be used, and atropine may prove of service under these circumstances. /Administration.—Colchicum ought never to be used in substance, but should be employed in the form of wine of the root (Vinum Col- chici Radicis, TJ. 8.) in the dose of 10 to 20 drops, although if a marked effect is required 30 drops may be used. The extract (Ex- tractum Colchici Radicis, TJ. 8.) is given in the dose of 2 to 5 drops, and the fluid extract (Extractum Colchici Radicis Fluidum, TJ. 8.) in the dose of 2 to 4 minims. Of the seeds the tincture (Tinctura Colchici Seminis, TJ. 8. and B. P.) is given in 30 to 90 minim doses; the wine (Vinum Colchici 10 146 DRUGS. Seminis, TJ. S.) in the same amounts, and the fluid extract (Ex- tractum Colchici Seminis Fluidum, TJ. S.) iu the dose of 2 to 5 drops. The B. P. preparations besides those given are Vinum Colchici, dose 10 to 30 minims; Extractum Colchici, dose ^ to 2 grains; and Ex- tractum Colchici Aceticum, dose J to 2 grains. COLLODION. Collodium, TJ. 8. and B P., is a solution of gun-cotton in alcohol and ether, and is a clear, syrup-like fluid, smelling strongly of ether. Therapeutics.—Collodion is used as an air-tight dressing for small wounds and abrasions, and for rendering small dressings waterproof. A difficulty in its use consists in the contraction which takes place as it dries, drawing and puckering the part sufficiently to cause not only discomfort but acute pain. It should be applied with a camel's-hair brush over the part affected. Iu boils when they are beginning in a small pustule or papule with an inflamed zone, collodion painted over the spot will generally abort the disease. If the boil has burst, this treatment is useless, but if it has not the pus should not be liberated, but allowed to become in- spissated. By this treatment and by the frequent application of a coat or two, the trouble eventually disappears. Of course, this rule only applies to certain cases, and if pain is caused by the retention of the pus it must be evacuated with antiseptic precautions. In smallpox the flexible collodion may be used to prevent pitting. In gouty inflammations of the joints an application of collodion mixed with iodiue, equal parts, will ofteu remove the pain, although at first the suffering may be increased by this treatment. Flexible Collodion. Flexible Collodion (Collodium Flexile, TJ. 8. and B. P.) is made by adding turpentine 5 parts and castor oil 3 parts to ordinary collodion. It does not contract or become hard, and is generally to be preferred to ordinary collodion in the dressing of wounds. Styptic Collodion. Styptic Collodion (Collodium Stypticum, TJ. S.) contains tannic acid, and is employed to control small hemorrhages. It is seldom used, and is a dirty way of controlling bleeding. Cantharidal Collodion. Cantharidal Collodion (Collodium cum Cantharide, TJ. S.) has been referred to under the head of Cantharides. Collodium Vesicans, B. P., is identical with this preparation, and is used for the same purpose. CONIUM. 147 COLOCYNTH. Colocynthis, TJ. S., is the fruit of the Citrullus Colocynthis, a plant at present largely grown in all parts of the world. It contains an alkaloid, colocynthine, and a resin. Neither of these are ever used in medicine. Colocynth causes large watery evacuations, and may, in very large dose, produce fatal gastro-enteritis. It is officinal in the B. P. as Colocynthidis Pulpa. Therapeutics.—Colocynth is never used alone, but always in com- bination with other drugs of its class as a hydragogue cathartic. In cases of chronic dropsy or for serous effusions it is generally given in the form of the compound extract of colocynth (Extractum Colo- cynthidis Compositum, TJ. S. and B. P.), which contains 16 parts of colocynth, 50 parts of purified aloes, 14 parts of the resin of scam- mony, 6 parts of cardamom, and 4 parts of soap. In the dose of 5 to 20 grains this acts as a powerful watery purge. The extract (Extrac- tum Colocynthidis, TJ. 8.) is given with other drugs in the dose of 2 to 5 grains as a purge. The following is a useful form in which to ad- minister it. R.—Extract, colocynth. comp. Extract, belladonnas . Extract, nucis vomicae Ft. in pil. no. x. S.—One in the morning Colocynth is one of the principal ingredients in compound cathartic pills (Pilulce Calhartice Composite, TJ. 8.). Each pill contains : com- pound extract of colocynth, 1^ grains; abstract of jalap and calomel, of each 1 grain ; gamboge, \ grain. The preparations of the B. P. not officinal in the TJ. 8. P. are : Pilula Colocynthidis Composita, composed of colocynth pulp, aloes, scammony, sulphate of potassium, and oil of cloves, dose 5 to 10 grains, and Pilula Colocynthidis et Hyoscyami, dose 5 to 10 grains. CONIUM. Conium (TJ. S.) is the leaves and fruit of the Conium Maculatum. The plant grows in Europe and the United States, and contains a resin known as coniine. This drug is officinal in the B. P. as hemlock leaves (Conii Folia) and hemlock fruit (Conii Fructus). Physiological Action.—AVhen conium is taken in very full dose it causes weakness and a sense of relaxation, giddiness, staggering, and disordered vision, with failure of the circulation. Nervous System.—Conium causes paralysis of the motor nerves, and, if the dose be extraordinarily large, depression of the sensory nerves. Upon the spinal cord it exerts a feeble, depressing influence, but has no positive effect, while the fact that consciousness continues almost up to death shows that the cerebrum escapes its influence. . gr. xxx. . gr. ij. M. 148 DRUGS. Circulation.—The action of the drug upon the circulation is depressant. It causes at first a fall of arterial pressure, then a rise, due to the asphyxia caused by nervo-muscular failure of the respira- tory apparatus. Finally a constant fall of pressure takes place. Respiration is depressed because of the influence of the drug on the nerve-trunks supplying the respiratory muscles. Therapeutics.—Conium holds an unimportant place in the drug-list of to-day. It has little value except in spasms due to irritation of a nerve- trunk, when it may be of service. In spasms of cortical or spinal origin other drugs should be used, as it is evident that conium has really no effect in quieting the central nervous protoplasm, but only prevents the impulses which are sent out from manifesting themselves in movements of the muscles. The powdered leaves or other prepa- rations may be smeared over poultices to relieve the pain of ulcers and cancers, and it certainly does good in such instances. Administration.—The dose of the abstract (Abstractum Conii, TJ. S.) is from J to 3 grains, that of the alcoholic extract (Extractum Conii Alcoholicum, TJ. S.) is from \ to 1 grain, and of fluid extract (Ex- tractum Conii Fluidum, TJ. 8.) 2 to 6 drops. The dose of the tincture (Tinctura Conii, TJ. 8. and B. P.) is 10 to 30 drops. Coniine is a liquid alkaloid which should never be used. The dose would be about ■gVj of a grain. The preparatious in the B. P. made from the leaves are: Cataplasma Conii, for external use; Extractum Conii, dose 2 to 6 grains or more; Succus Conii, dose 30 minims to 2 fluidrachms or more; Vapor Conii, for inhalations; and Pilula Conii Composita, com- posed of extract of hemlock and ipecac, dose 5 to 10 grains. Vapor Conii consists of the juice of hemlock (succus conii) J ounce, liquor potassa 1 drachm and distilled water 1 ounce. Twenty drops of this mixture are placed in hot water in an inhaler and so employed for the relief of irritative coughs or spasmodic asthma. It is to be remembered that the variability of the drug, so far as power is concerned, is very great—so great as to make it unreliable. For this reason a small dose should be giveu at first and the amount gradually increased. Poisoning.—A prominent symptom of poisoning by conium is dropping of the eyelids (ptosis), due to paralysis of the oculo-motor nerves, and staggering and inability to walk. Its treatment consists in the use of strychnine as a respiratory and nervous stimulant, the employment of external heat, and the use of cardiac stimulants if the circulation fails. The stomach is to be emptied by emetics or the stomach-pump before the antidotes are used. COPAIBA. The Copaiba of the TJ. S. P. and B. P. is really the balsam of copaiba or the oleoresin of copaiba, and is a clear, transparent liquid of oily consistency, of a pale yellow color and a peculiar odor. COPPER. 149 Therapeutics.—Copaiba is used for the purpose of stimulating the mucous membranes of the genito-urinary tract, particularly when they are depressed after a period of inflammation, as in the later stages of gonorrhea. In cases suffering from chronic urethritis, anaemia, and debility the following pill is useful: R.—Oleoresinae copaibae......3j- Oleoresinse cubebi......gtt. iv. Ferri et ammonii citratis......gr. xx. M. S.—Ft. in capsule no. x. One t. d. after meals. Copaiba is employed in subacute and chronic bronchitis as an ex- pectorant. In the treatment of pyelitis, cystitis, aud dysentery it is of value. In dropsy due to slow renal changes it will often be of service. Administration.—The oil of copaiba (Oleum Copaibe, TJ. 8. and B. P.) is given in capsule or emulsion, preferably in the former, in the dose of 10 to 20 minims two to four times a day. Sometimes it is dropped on sugar and so administered. Massa Copaiba, TJ. 8., is made by rubbing up the oleoresin with magnesium, but this is a use- less and clumsy way of using it in the pill form. The drug is eliminated iu the urine, and gives the test for albumin with nitric acid. In some cases it causes urticaria, which soon ceases on the with- drawal of the drug. COPPER. Cuprum is never used iu the form of the metal itself, but as the sulphate, which appears in commerce as a blue, clear, somewhat efflor- escent salt. It is soluble in four parts of cold water, two of boiling water, but is not soluble iu alcohol. Physiological Action.—Copper sulphate, when locally applied to a mucous membrane, acts as a powerful astriugent, or, on the surface of an ulcer, as a mild and superficial caustic. Upou the nervous system in cats it acts as a depressant poison when given hypoder- mically, finally causing death from respiratory failure. When given iu overdose by the stomach it causes death by violent gastro-enteritis aud exhaustion. The symptoms do not generally come on for an hour, aud consist in burning pain in the stomach, a copperish or me- tallic taste in the mouth, followed by vomiting of bluish liquids and glairy mucus. With the vomiting purging comes on, the passages at first containing the contents of the intestine, and finally mucus and blood. Convulsions of au epileptiform character are present, and con- stant and profuse salivation is not infrequent. After death fatty degeneration of the liver and kidneys has been noticed, and it is not at all uncommon for jaundice to appear after the first twenty-four hours, if the patient survives so long. This jaundice is dependent upon changes in the blood. The treatment of the poisoning consists in the primary use of the chemical antidote, which is the yellow prus- siate of potassium, and the administration of emollient or demulcent 150 DRUGS. substances, such as sweet oil and white of eggs, followed instantly by emetics or the stomach-pump. If emesis and purgation are already active, emetics are of course contra-indicated, aud couuter-irritatiou is to be employed over the stomach and intestines in the shape of a mustard plaster of moderate strength, with opium to allay irritation and relieve pain. Chronic copper-poisoning is almost never seen, and although the metal is largely used for coloring canned green vegetables, it seems to be harmless in such small amounts. Therapeutics.—Sulphate of copper (Oupri Sulphas, TJ. 8. aud B. P.), in the dose of 5 to 7 grains, may be used as a rapidly acting emetic which only acts upon the stomach, not the vomiting centre. As it is irritant the emetic dose ought not to be repeated, but if emesis does not occur, the sulphate of zinc or mustard should be used in its stead. Indeed, it may be said of sulphate of copper that it should never be given as an emetic, except in phosphorus poisoning, when it acts as the chemical antidote. In pill form it is sometimes given in diarrheas depending upon ulceration of the bowels. The dose should be J to 1 grain combined with opium. In some states of the body, particularly in skin diseases of the dry type and in persons with tubercular tendencies, copper seems to act like arsenic and may be used in minute doses of T\j of a grain or less three times a day where arsenic is not well borne. In small doses it is said to be a direct stimulant to the tissues aud to increase the firm- ness of the flesh and strength of the normal man. Very recently strong claims for copper as a remedy for anemia have been put forward. Injected into the rectum in the strength of 5 to 20 grains to the ounce the drug will be found of service in those cases of diarrhea arising in the lower bowel and dependent upon ulceration. Locally applied, sulphate of copper is useful, in the solid form or in powder, in the treatment of indolent ulcers. In chronic conjunc- tivitis or in cases of tinea tarsi—that is, tinea on the margin of the eyelids—a crystal of the sulphate may be drawn over the diseased spot; or a weak solution of 1 to 3 grains to the ounce of water may be dropped into the eye in subacute conjunctivitis. In relaxed sore-throat, as a gargle, in the strength of 4 grains to the ounce, it is often of service. Nitrate of copper (Cupri Nitras, B. P.) and acetate of copper (Cupri Acetas, TJ. S.) serve the same purpose as the sulphate. CREOLIN. ^ Creolin is a black fluid derived from soft coal, and is of the con- sistency of syrup. AYhen added to water it forms a white cloud and mixes thoroughly, forming an emulsion up to 12 per cent, of the drug. Therapeutics.—Creolin is used as an antiseptic in the lying-in state, as a ivash for the hands and for vaginal irrigation. It cannot CREASOTE. 151 be used as a solution in which to place instruments, as it makes so opaque a mixture with water as to prevent their being seen at the bottom of the vessel. When used as a vaginal douche it should be employed in the strength of 2 per cent. One property of value is that it forms a slippery coating over the maternal parts during partu- rition. In the treatment of cystitis in the female, Parvin highly recom- mends it as a vesical wash in the strength of a 1 per cent, solution, or, after the bladder becomes accustomed to its use, in a 2 per cent. solution. According to Kretzschmar aud others, a solution of 1 to 500, used with a syringe, is useful in otorrhea; 1 to 100 in nasal ulcers, and 1 to 1000 as a nasal douche in rhinitis, when there is much discharge with the formation of crusts. In the eye, Alt has used a 1 to 2 per cent, solution in the treatment of blepharitis, keratitis, and phlyctenular ophthalmia. CREASOTE. Creasote (Creasotum, TJ. 8. and B. P.), as employed in medicine, should always be derived from the destructive distillation of beech- wood and be designated " beech wood creasote." Much of that sold is derived from coal-tar and is far less useful. Chemically, creasote is almost identical with carbolic acid. It is a powerful antiseptic. Beechwood creasote should be of a reddish amber hue aud about as thick as olive oil. Its physiological action is almost identical with that of carbolic acid, and in poisoning by creasote the same antidotes as are employed in carbolic-acid poisoning, namely, soluble sulphates, should be used.1 (Hare.) Therapeutics.—During the past few years creasote has been largely prescribed in phthisis and chronic bronchitis, and some of the results reached by its use have undoubtedly been of value. It has also been inhaled from sponges with great relief, and even has been injected into the lungs by the trachea or through the chest-wall. (See article on Tuberculosis.) In the treatment of chronic bronchitis, creasote may be placed iu boiling water and inhaled in the steam. Under these circumstances it at least relieves the foetor of the breath, and this method often gives more rapid relief than any other measure in ordi- nary inflammation of the bronchi. The dose when the drug is given internally is 2 to 5 drops. Applied on a pledget of cotton to the cavity of a tooth creasote often relieves toothache. When given in phthisis the following prescription may be used, or the drug may be placed upon a Yeo's inhaler and inhaled in that way: R.—Creasoti (beechwood)......f 3)ij- Tinct. gentian, comp.......^J'... Spts. vini rectificati......f^viij. Vini Xerici.....q. s ad Oij. M. S.—A tablespoonful in a wineglassful of water three times a day. 1 See University Medical Magazine, 1889. 152 DRUGS. Creasote is useless so far as producing a cure is concerned if tuber- culosis is more than incipient, and ought not to be employed if it dis- orders the stomach. The drug is contra-indicated in phthisis if fever or haemoptysis are present, and those patients who have little fever aud a chronic phthisis are the most favorable subjects for its employ- ment. Inhalations of the drug often give relief in the advanced stages of phthisis aud decrease the cough, allay the laryngeal dryness, and aid expectoration. AYhen creasote is given hypodermically in phthisis it should be given in the following formula : R.—Creasoti........f3>j- Olei amygdal. dulcis.....f Jij. M. S.—Ten minims to be injected below the scapula and deeply into tissues. The preparations of creasote are Aqua Creasoti, B. P., given in the dose of 1 to 3 fluidrachms; Mistura Creasoti, B. P., dose 1 to 2 fluid- ounces; TJnguentum Creasoti, B. P., for local application, and Vapor Creasoti, B. P., used by inhalation. CROTON OIL. Croton oil (Oleum Tiglii, TJ. 8., Oleum Crotonis, B. P.) is an ex- ceedingly irritant oil derived from Croton Tiglium, a small tree of India. The oil is pale yellow and of a complex character. Applied to the skin for any length of time it is an intense irritant, producing blisters or pustules. One drop placed on the tongue with 5 drops of sweet oil acts as a violent watery purge, aud, owing to the smallness of its dose, it is frequently employed to revulse the unconscious, as in cerebral congestion. In delirium it is used for the same purpose, aud may be given to maniacs who are suffering from an attack of cerebral congestion or obstinate constipation, owing to the smallness of its dose and rapidity of action. The dose is 1 drop placed on the tongue with sweet oil or given in emulsion or in pill. It ought never to be used when there is any irritation of the stomach or bowels. As a couuter- irritant it is sometimes applied over a tender nerve, or to the chest in the treatment of bronchitis, in the proportion of half-and-half with sweet oil. Thus applied it may be absorbed and cause purging. The treatment of poisoning by croton oil is identical with that of gastro- enteritis. Linimentum Crotonis is a preparation of the B. P. which is employed as a counter-irritant liniment for sprains and in muscular rheumatism. CUBEBS. Cubebs (Cubeba, TJ. S. and B. P.) are the unripe fruit of Cubeba Officinalis, a plant of Java. They consist in wrinkled or rough black bodies, about the size of small peas, and have au aromatic pungent taste. They contain a volatile oil, cubebic acid, and cubebin. The DIGITALIS. 153 drug should not be kept in powdered form, as it loses its powers, but should be powdered as needed. Overdoses of cubebs cause gastro- intestinal and genito-urinary inflammation. Therapeutics.—Cubebs are used iu the advanced stages of gonor- rhea where a tendency to a chronic discharge is present. Some sur- geons have used them in the early stages as an abortive treatment, but this is a bad practice. In cold in the head the powdered berries may be snuffed up the nostril, provided that the stage of secretion is well established. They ought not to be used before this stage. Administration.—Cubebs may be given in powder iu the dose of 10 to 60 graius, in the fluid extract (Extraction Cubebe Fluidum, TJ. S.) 10 to 30 drops, and in the form of the tincture (Tinctura Cubebe, TJ. S. and B. P.) in the dose of 10 drops to | an ounce. The dose of the oleoresin (Oleoresina Cubebe, U. 8. and B. P.) is 2 to 20 drops. The latter may be given in capsules or emulsion. The troches of cubebs (Trochisci Cubebce, TJ. S.) are used for the relief of pharvngitis of a chronic type. The dose of the oil (Oleum Cubebe, U. S. and B. P.) is 5 to 20 minims. CYANIDE OF POTASSIUM. Cyanide of potassium (Potassii Cyanidum, TJ. S. and B. P.) is used iu the same way and for the same purpose as hydrocyanic acid. (See Hydrocyanic Acid.) The dose is T\r to yVj of a grain. The following prescription may be used in cases suffering from bronchitis or phthisis and accompanied with excessive cough : R.—Potassii cyanid.......gr. ij. Morphinas sulph.......&r\j- Acid, sulph. arom. •.....f v5ij- Syr. pruni virg.....q. s-ad f giij. M. S.—Teaspoonful three times a day. Or as follows : R.—Potassii cyanid.......gr- ij. Ammon. chloridi......3ij Acid, hydrochlor. dil......foj- Elix. calisayee.....q. s. ad f ,5 iij. M. S.—Teaspoonful three or four times a day. DIGITALIS. Digitcdis, TJ. S., is obtaiued from the leaves of Digitalis Purpurea, or foxglove of the second year's growth. The leaves are officinal in the B. P. as Digitalis Folia. It contains a number of substances, none of which act as does the crude drug. In other words, all these compounds must act together to be therapeutically active. Among the substances so far isolated from digitalis by chemists may be 154 DRUGS. named digitalin, digitalein, digitoxin, digitin, aud digitonin. Several of these are simply compounds of the others. Digitalein, so-called, occurs in two forms, amorphous aud crystalline. The crystalline digitalin (French) is largely digitoxin while the amorphous is com- posed of digitonin, digitalein and digitalin. A pure digitalin has been isolated, but it is not on the market. Digitoxin and pure digi- talin are the two most active principles yet found. None of these substances should be used in medicine to take the place of digitalis. Physiological Action.—Digitalis is apt to irritate mucous mem- branes which are already slightly out of order, and for this reason should not be given by the mouth in cases of gastritis and allied states. Nervous System.—The action of digitalis upon the nervous sys- tem is only manifested when poisonous doses are used. Small toxic doses decrease reflex action by stimulating Setschenow's reflex inhibi- tory centres in the medulla, and finally by depressing the spinal cord. Convulsions are sometimes seen as a result of the disorder of the cir- culation at the base of the brain, owing to the disturbed and abortive action of the heart. Finally, the motor nerve-trunks themselves are depressed. Circulation.—Upon the circulatory system digitalis exerts its chief influence. In moderate amounts it increases the pulse force and arterial pressure, slows the pulse, and increases the size of the pulse wava The increase of pulse force is due to a stimulating influence exercised upon the cardiac ganglia and the muscular fibres of the heart, the rise of arterial pressure is caused by this increased pulse force and pulse volume, and by a stimulation of the vasomotor centre and the muscular coats of the bloodvessels, whereby a contraction occurs in the walls of the arteries and arterioles. The slow pulse is produced by stimulation of the pneumogastric centre and the periph- eral ends of the vagus nerves. The increase in the volume of the pulse is due to this influence on the vagi, for, the pneumogastric nerves being stimulated, the diastole of the heart is more full and complete and occupies a greater length of time. The result of this delay is that the ventricles become thoroughly distended, and on contracting drive out a much larger wave of blood through the aorta than is nor- mally sent out. This is important to remember when using the drug in heart disease and other states. While we do not know that the vagi are the trophic nerves of the heart, we have a large amount of evidence in favor of such a view, and it has long been thought that digitalis was not only a heart stimulant, but a heart tonic. If the trophic nerves of the heart are stimulated by digitalis it at once be- comes evident that it is a doubly useful remedy. The action of digitalis upon the heart is a double one, in that it creates two opposing forces. By the action on the heart muscle it steadily strives to cause contraction or systole of the ventricles ; by the act-ion on the vagi it equally steadily struggles to produce diastole or dilatation of these cavities. In medicinal dose neither of these DIGITALIS. 155 tendencies gets the upper hand, for both are equally excited, so that now increased systole occurs, now increased diastole. Iu poisoning, on the other hand, or in instances where overdoses have been given, so much stimulation is caused that the heart beats now slow, now fast, now strong, now weak: slow when the vagi overcome systole, fast when systole overcomes the vagi; strong when systole escapes from the inhibitory nerves, weak when the ventricles can scarcely contract because the vagi are holding the ventricles open. In man we frequently see this irregular pulse replaced by an exceed- ingly rapid pulse, which is shuttle-like in character. This is probably due to a depression of the peripheral ends of the vagus nerves. In the frog digitalis nearly always causes, when given in full doses, an arrest of the heart in systole, while in man and the higher animals the arrest is in diastole. If the patient be raised up he may drop dead, owing to the still more active disturbance of the balance of power caused by the calls for blood due to the erect position, and under these circumstances the heart beats so fast that it has not time to get enough blood into it to pump anything out, or so feebly that the dilated ventricles are never emptied. Finally, a fall of arterial pressure eusues, not because the vasomotor system is depressed, but because the heart cannot pump out enough blood to fill the bloodvessels. Respiration.—Digitalis has almost no effect on this function, un- less the amount be poisonous, when respiration is slowed. Temperature.—Upon the normal bodily temperature digitalis has little or no effect in medicinal dose. In poisonous dose it lowers tem- perature. In fever the drug seems to cause a fall of a small amount with some constancy, but it can rarely be used for any antipyretic influence. High temperatures prevent digitalis from acting. Kidneys, Tissue-waste, and Elimination.—Digitalis has almost no effect over the kidney structure itself, and does not to any extent stimulate the renal epithelium. The cause of the increased urinary flow produced in cardiac dropsy depends upon the removal of congestion of the kidneys and the increased arterial pressure brought about by the drug. Upon tissue-waste digitalis seems to have little effect, and there is still some discrepancy in the reports as to the amount of urea cast off under its use, some investigators saying it is increased, others that it is diminished. AYe do not know how the drug is eliminated, as chemists have never been able to find it in the urine. It is probably oxidized in the body. Poisoning.—The slow, full pulse, followed by the hobbling, dicrotic, shuttle-like pulse-beats, and the angry, tumultuous cardiac beat against the chest-wall, affords a combination of symptoms characteristic of the over-action of digitalis. The pulse may be full and slow when the patient is lying down, but at ouce becomes irregular on his sitting up. Often when the patient has by error received too much of the drug 156 DRUGS. the finger can scarcely note any pulse at the wrist, while the ear placed over the heart shows it to be beating wildly, as though it would break out of the chest. It is important that the weak pulse at the wrist be not taken as the only guide as to the state of the patient, for this very reason. As the poisoniug progresses vomiting may come on, exophthalmus occurs, aud a peculiar blue pearliness of the sclerotic coat of the eye is seen. Consciousness is generally preserved nearly to the last. Death may be put off for days, or occur in two hours, or even less. Headache is often a severe symptom. Treatment of Poisoning.—Tannic acid is to be given as a chemi- cal antidote; emetics and the stomach-pump are to be used ; external heat is to be applied, particularly about the abdomen ; the maintenance of a horizontal position must be insisted upon, and the use of tincture of aconite, as the physiological antidote, resorted to. Therapeutics.—Much unfortunate misunderstanding concerning the action of digitalis has arisen, and while some call it a circulatory stimulant, others think it is a circulatory depressant. The first class base their belief on the signs of arterial pressure and cardiac power, the others on the fact that it slows and steadies an irritable, rapidly-acting heart, and they overlook the other signs. Digitalis is a cardiac stimu- lant, and not a depressant. The quieting of irritability by it is the quietness produced by the drink of whiskey or coffee taken by the speaker before mounting the platform or the pugilist before he enters the ring to steady his nerves aud make him firm. If digitalis is used to decrease arterial tension its dose must be dangerously large. (See Physiological Action.) Digitalis is of value in all cases of cardiac disease where the condi- tion is one in which the heart fails to do its proper amount of work. If simple hypertrophy or excessive compensatory hypertrophy exists it is harmful. It is of less value iu aortic regurgitation than in any other lesion, because the prolongation of diastole allows greater oppor- tunity for the blood to fall back into the ventricle. In some instances the drug does harm by over-distending the auricle through ventricular stimulation, and we can never tell before trying it which cases will be so affected. In cases where the heart is irritable, palpitation present, aud indigestion not the cause of the trouble, digitalis is of service. (See Heart Disease.) In the second stage of pneumonia digitalis is invaluable (see Pneu- monia), and in exhausting fevers, in small doses, is of great service. In congestion of the lungs in the typhoid state, it will drive out the blood from the part congested and relieve stasis. In cardiac weakness from collapse, injury, poisoning or shock digi- talis is of service, particularly in aconite poisoning, where it is the physiological antidote. Owing to the slowness of its action it should, however, be preceded by ammonia and alcohol where the need is pressing. In muscarine poisoning digitalis is the antidote. As a diuretic, digitalis may be used where the kidneys are congested elaterium. 157 and the circulation is sluggish. Where the renal structure is dis- eased, other drugs should take its place, or it should be combined with more active renal remedies, such as squill or caffeine, or in very chronic cases with compound spirit of juniper. In some cases a cumulative action occurs which consists in the failure of the drug to appreciably influence the circulation for some days, only to exert all its power suddenly and produce symptoms of poisoning. This is particularly apt to occur where the removal of ascites or dropsy takes place by tapping after the drug has been taken for a long period. It is thought that the sudden withdrawal of press- ure upon the great vascular trunks of the body cavities causes the absorption of the drug with the juices of the tissues where it has remained in inactivity. The coutra-indications to the use of digitalis are atheroma of the bloodvessels of a marked type, aneurism, apoplexy, and any state of arterial excitement. Administration. — The officinal preparations of digitalis are the tincture (T'inctura Digitalis, TJ. 8. and B. P.), dose 10 to 20 drops; the infusion (Infusum Digitalis, TJ. 8. and B. P.), 1 teaspoonful to 4 teaspoonfuls; the fluid extract (Extractum Digitalis Fluidum, TJ. 8.), dose 1 to 2 drops; the abstract (Abstractum Digitalis, TJ. 8), J to 1 grain; the extract (Extractum Digitalis, TJ. 8.), \ of a grain ; and the powdered digitalis leaves (Digitalis Folia, B. P.), dose 1 to 4 grains, generally given in a pill. The tincture is the preparation most com- monly used, aud is most satisfactory, although the infusion has been thought of greater value, without any reason. The dose of digitalin, which ought not to be used, is -^ of a grain. ELATERIUM. Elaterium, B. P., is a sediment obtained from the juice of the Ecbalium Elaterium, or squirting cucumber. It appears in small, easily broken, thin, grayish-green flakes, and has a bitter taste. Elaterium is not officinal in the TJ. 8. P., but its active principle, elaterin (Elaterinum, TJ. S. aud B. P.), is officinal. Notwithstanding this fact, the crude preparation is largely used. Physiological Action.—Elaterium is a very decided irritant to all mucous membranes, and even to the hands of those who handle it. Its chief effect in man is to cause profuse watery stools, but for some unknown reason it rarely acts upon animals in this manner. Therapeutics.—This drug is the best hydrogogue purge which we have, causing very large watery passages, but not producing much pain when used in proper dose. For this reason it is useful in the treatment of local serous effusions, as in pericarditis and pleurisy and in dropsy and ascites. It ought never to be used in cases of marked exhaustion, and may be advantageously followed, soon after it acts, by alcoholic stimulants. In uremia, with dropsy, it is thought to aid in 158 DRUGS. the elimination of the poison by the bowel. In cerebral congestions or effusions the drug will often be of service. In poisoning by elaterium the symptoms are those of violent gastro-enteritis and must be treated accordingly. Administration.—The dose of elaterium is \ of a grain, given in a freshly made pill. Elaterin is best given in the dose of from -^ to ^2 of a grain, as follows : R.—Elaterini.......gr. iv. Alcoholis.......fgiv. M. Dissolve by gentle heat. S.—Half a drachm contains T^ grain, or one full dose. The officinal preparations of elaterin, the active principle of elaterium, are Trituratio Elaterini, TJ. S. (elaterin 1, sugar of milk 9), given in the dose of J to f grain, and Pulvis Elaterini Compositus, B. P. (elaterin 1, sugar of milk 39), dose 1 to 5 grains. ERGOT. Ergota, TJ. S. and B. P., is derived from the spawn or mycelium of the fungus known as Claviceps Purpura, which grows in the flower and replaces the grain in common rye or Secale Cereale. Many so-called active principles have been isolated by chemists, and named ecbolic acid, ergotic acid, sclerotinic acid, and ergotin. None of them represent the entire drug, the nearest in its approach being ergotin, and under these circumstances ergotin is uot an isolated principle, but a combination of principles. Kobert teaches that there are three principles, namely, ergotinic acid, cornutine and spacelinic acid, and that cornutine is a true alkaloid. Tanret on the other hand denies the existence of coroutine as an alkaloid. Physiological Action. Nervous System.—Upon the nervous sys- tem ergot exercises little, if any, effect. In chronic poisoning, due to eating rye-bread contaminated by ergot, we sometimes see what is known as spasmodic ergotism due to disturbances of nervous system. Circulation.—Ergot when injected into the circulation causes a primary fall of arterial pressure, followed by a rise. The dominant action is represented iu the rise. This rise is due to a stimulation of the vasomotor centres, but the primary fall is caused by its direct depressant effect upon the heart muscle, resulting from contact on the part of the drug en masse with the heart. If the dose be very large the fall of pressure is never recovered from, and progressive paralysis of the vasomotor apparatus and heart occurs. Uterus and Unstriped Muscular Fibre.—It is commonly taught that ergot acts as a stimulant to the uterine muscle, and causes contraction of unstriped muscular fibres everywhere, but the careful studies of Hemmeter during the past few months have proved that ERGOT. 159 the drug also causes uterine contractions by stimulating the centres in the lumbar portion of the spinal cord. On the uterus ergot in very full dose exerts its influence—not increasing the normal pains of labor, but causing a tetanic, tonic, unyielding uterine spasm which drives all before it. In very small doses it may assist the normal contractions without causing them to become tetanic. Chronic Poisoning.—Two forms of poisoning, from the prolonged use of ergotized rye-bread, sometimes occur. One is characterized by spasmodic muscular contractions, the other consists in the formation of gangrenous sloughs. Therapeutics.—Ergot is given to parturient women for the pre- vention or cure of post-partum hemorrhages. For the prevention it should be given to the womau by the mouth just as the head of the child is about to slip over the perineum, and not before. When ad- ministered to stop a hemorrhage already flowing the doses should be large, as much as 1 to 2 drachms of the fluid extract or 2 wine-glass- fuls of the wine of ergot. Ergot should never be given in the early stages of labor, but this rule may under certain conditions be modified. If uterine inertia comes on in the course of a normal labor and quinine cannot be used for any reason, small doses of ergot may be employed. These small doses do not cause a constant tetanic uterine contraction, but simply bring on the " to-aud-fro " movements. By small doses the writer means from 5 to 20 drops of the fluid extract. If the canal is obstructed ergot should never be employed, aud unless the os uteri is well dilated should not be given in any dose. In post-partum haemorrhage it may be well to give a solution of the aqueous extract of ergot hypodermically. The extract should be rubbed with the proper amount of water (parts 1 to 5), and filtered through a fine aseptic handkerchief to get rid of foreign bodies before it is injected. In hemorrhages from the lungs and kidneys, or other unapproachable parts, ergot is very useful when given by the mouth. In epistaxis, menorrhagia, and metrorrhagia, and in some cases of night-sweats, it is of service. In hypostatic, pulmonary, and other con- gestions it is useful, particularly if employed with digitalis. In dysenteries with bloody stools and in serous diarrhea ergot some- times does good. Some persons suffer from vertigo associated with hyperaesthesia of the scalp and headache. Relief can often be obtained by the use of 20 drops of the fluid extract of ergot aud 5 to 10 grains of bromide of potassium three times a day. Ergot has been used very largely in the treatment of uterine fibroids as an expulsive remedy and cure. It is only of value in those cases where the growths are just beneath the mucous membrane. By the contractions of the uterine muscular fibres the blood-supply of the growth is decreased, the recurring haemorrhages cease, and the tumor is finally expelled, having really sloughed out of its bed. This method 160 DRUGS. is inferior to the knife, and very painful aud prolonged. Large growths cannot be so treated. Ergot is sometimes useful in the treat- ment of bleeding hemorrhoids, aud it has been given with success in diabetes insipidus. Administration.—Ergot is officinal in the TJ. 8. P. as the fluid extract (Extractum Ergote Fluidum), dose J to 1 drachm; the solid extract (Extractum Ergote), dose 5 to 20 grains; and the wine (Vinum Ergote), dose 2 to 4 drachms. Bonjean's ergotin is made by a special process, but it or the solid extract can be given hypodermically in the manner already described. The B. P. preparations are Extractum Ergote Liquidum, dose 10 to 30 minims; Infusum E-gote, 1 to 2 fluidouuces; Tinctura Ergotce, 10 minmis to 1 fluidrachm. Ergotin Ergotinum, B. P.) is given in the dose of 2 to 5 grains. Injectio Ergo- tina Hypodermica, B. P. (ergotin 1, camphor water 2 parts) is given, in the dose of 3 to 10 minims, by subcutaneous injection. ERIGERON, OR FLEABANE. Oil of Erigeron (Oleum Erigerontis, TJ. S.) is a yellowish, volatile oil of a peculiar, not bad, taste, closely resembling turpentine. It is by far the best remedy which we have for the treatment of passive uterine oozing, or a "show," as it is sometimes called. In epistaxis and other haemorrhages of a subacute type it is quite useful. In some instances it is used in place of copaiba and cubebs in the later stages of gonorrhea. It is best given in capsule or on sugar, in the dose of 10 to 30 drops after meals, or oftener if needed. ETHER. Sulphuric Ether is officinal as JEther, TJ. S. and B. P., and JEther Fortior, TJ. 8. Pure ether (jEther Purus, B. P.) is free from alcohol and water. Ordinary ether is not generally used as an anaesthetic, but for the abstraction of oils and for other pharmaceutical purposes. It is made by the action of sulphuric acid on ethylic alcohol, and is sometimes called in consequence ethyl oxide. Ordinary ether contains about 74 per cent, of ethyl oxide and 16 per cent, of alcohol, with a little water. On the other hand, the stronger ether contains about 94 per cent, of ethyl oxide and only 6 per cent, of alcohol, with water. Both preparations boil when held in a test-tube, if a piece of broken glass is added to the liquid. The stronger ether boils much more vigorously, however, than the weaker under these circumstances. Ether possesses a peculiar penetrating odor, a hot burning taste, and is a colorless, volatile, and very inflammable liquid. For this reason it should never be held near a fire or light, and, as its vapor is heavier than air, any light in the room should be above the patient, not below him. No light should be held nearer than five feet. ETHER. 161 Physiological Action.—The action of ether on the animal organism is very rapid aud powerful, but temporary. Except for the rapidity of its effects it is very much like that of alcohol. AYhen applied to the skin it causes intense cold by its evaporation, aud may be used by means of a spray to benumb or locally freeze a part. Upon mucous membranes ether acts as an irritant, aud causes, when first inhaled, great irritation of the fauces and respiratory tract, so that temporary arrest of respiration is not uncommon. The face be- comes suffused and red and the conjunctiva injected, but a stage of quiet succeeds the primary stage of struggling which arises from the choking sensations. During this period the breathing is generally full and deep and the pulse rapid but strong, while the ocular reflexes are at its beginning intact. Following this stage a second period of struggling comes on, in which the patient may become absolutely un- controllable except by brute force. Yelling, shouting, screaming, cursing or laughing and crying may be prominent symptoms, and the individual is pugilistic, caressing or ill-tempered, as the case may be. If the drug is now pushed a condition of total anaesthesia is attained, and quietude takes the place of the struggles. This is the time for the operation to be carried on, for if it is attempted in the earlier stages the struggles of the second stage prevent any operative pro- cedure (see Therapeutics below). It is not proper to push the mus- cular relaxation to complete flaccidity, as this endangers the respiration. Nervous System.—Ether acts first on the brain, then on the sensory centres of the spinal cord, then on the motor centres, then on the sensory centres of the medulla oblongata, aud, finally, upou the motor centres of the medulla, thereby producing death from respira- tory failure. Upon the nerve-trunks it exerts no effect unless it is directly applied to them. Ether does not act by influencing the blood, coagulating the protagon of the nervous system, or by any other de- structive influence. It simply puts aside, for the time being, the vital functions of the parts affected by it. Circulation.—Ether is one of the most diffusible and rapid cardiac stimulants which we possess, and is correspondingly fleeting in its effects. It increases the pulse-rate and force by stimulating the heart and by increasing the activity of the vasomotor centres. In overdoses it acts as a cardiac depressant, but only when the amount is very large. Respiration.—When ether is first inhaled it often causes an arrest of respiration. According to Kretzschmar, this is due to an irritation of the trifacial nerve, which causes a reflex spasm of the glottis, and not to irritation of the peripheral vagi in the lungs. This is only partly true, for it has been proved* that section of the vagus nerve prevents this occurrence, so that both the vagal and trigeminal irrita- tion are responsible for the arrest. Upon the respiratory centre ether acts as a powerful stimulant in 1 Hare: University Medical Magazine, 1889. 11 162 DRUGS ordinary amounts; in overdose it paralyzes this part of the nervous system. Temperature.—Prolonged etherization lowers the bodily heat very greatly. That of the dog may be lowered some 9° F. in an hour if the drug be pushed, and as great a fall has been known as 4° F. in man (Hare). The fall is partly due to the depression of the nervous system and the chilling of the body and lungs by the evaporation of the drug. Elimination.—Ether escapes from the body by the lungs and kidneys. Untoward Effects.—Ether, while safer than chloroform, is not ab- solutely devoid of all dangerous effects. Sometimes when the drug is pushed too strongly deep cyanosis with pulsation of the jugular veins shows deficient oxidation and cardiac distention. In other and very rare instances sudden cardiac failure has occurred, or total arrest of respiration ensued. In nearly all cases of sudden death from ether grave kidney or other lesions have been present, and have been found at the autopsy. One of the earliest signs of the over-action of ether is the failure of the diaphragmatic movement, followed by that of the lower part of the chest, then of the upper part and then of the cervical muscles. In patients under ether the movement of the diaphragm is an ex- ceedingly interesting study, for before the condition known as surgical anaesthesia is developed, while there is still some rigidity, and the throat reflex is not completely abolished, the contractions of the dia- phragm are frequently so violent that unless the laryngeal opening be absolutely free, the intercostal spaces are depressed and the ab- dominal contents thrust violently downward and outward. Just so soon, however, as the chin is pulled forward and a free access of air is allowed, the abdominal displacement is not so great, though it still remains present, and the chest movement is no longer reversed. As the ether is pushed, the respiration becomes purely thoracic, the dia- phragm no longer taking part in the respiratory cycle, or becoming so relaxed that it allows the chest on expansion to aspirate the abdominal viscera upward, as is shown by the retraction of the belly walls at a time when they should normally expand with the thorax in inspiration. This observation would seem to point to the fact that the primary stimulant action of ether upon the respiratory apparatus is particularly felt by those centres which govern the movements of the diaphragm, and that, as this is the case, these centres later on are the first to feel the paralyzing effect of still larger amounts of the drug. This gives us, therefore, yet another danger-signal during the ad- ministration of the ether, and the integrity of the diaphragmatic function, as represented by the movement of the belly walls, should be as carefully observed as are the thoracic excursions, the character of the pulse, or the condition of the pupil. The rule may therefore be laid down that when the diaphragm ceases to act, anaesthesia has ether. 163 been carried to its extreme legitimate limit, and that the use of an anaesthetic after this time must be carried on with the greatest care and watchfulness. The diaphragm is the first part of the respiratory mechanism to yield to respiratory paralysis. In death from any cause, the progress of failure of respiration wTill, in the vast majority of cases, be denoted by a failure on the part of the diaphragm primarily, with compensa- tory excursions of the chest; and it is also to be noted that as the chest movements fail, the accessory muscles of the neck come into play. These muscles in time cease to act, the hyoidean group lose their point d'appui, the chest remains motionless, the lower jaw is dropped, and the scene is closed by a few gasps in which the muscles of the neck may be the chief factors. The treatment of accidents during etherization consists in the with- drawal of the ether, the use of artificial respiration, and the placing of the body, if the face is pale, head downward. On the other hand, if the face is flushed and cyanotic it indicates respiratory, not cardiac, failure, and this position is not to be resorted to. The physician should also employ hypodermic injections of strychnine, atropine, and digitalis, or an intravenous injection of ammonia, which is better than the others, because it is more rapid in its action. Ether is often given hypodermically under such circumstances, and seems to do good, but its use is a bad practice, as, if the heart or respiration is already de- pressed by ether, the use of still more of the drug simply makes matters worse. The cases in which such a line of treatment is fol- lowed by good results are those in which the failure of respiration is not due to a saturation of the body with ether, but to asphyxia pro- duced by mechanical interference with free breathing, as, for example, the presence of mucus in the air-passages or a too close application of the towel to the face. In such cases the hypodermic injection of ether causes so much local pain and irritation as reflexly to call up respira- tory movements as well as to directly stimulate the respiratory centre to greater effort.1 Alcohol ought not to be used if the other drugs named can be obtained, because alcohol is so nearly allied physiologi- cally and chemically to ether. Frictions, hot applications, and arti- ficial respiration should be practised (see article on Asphyxia). As ether is at hand it may be dashed on the chest and abdomen to cause reflex inspiration in lieu of cold water, which wets the clothes and does not evaporate. (Hare.) Iu some cases great nausea and vomiting follow the use of ether. This can generally be prevented by the proper use of food before the operation (see Therapeutics, on next page), and by the use of cracked ice aud small doses of aconite after the operation. (See Vomiting.) Severe bronchitis may occur in invalids and children after the inhala- tion of ether. 1 As consciousness is not necessary to the carrying out of a reflex action, this is perfectly possible and probable. 161 DRUGS. Therapeutics.—Ether is used chiefly as au anaesthetic by means of inhalation. The method consists in forming a cone out of a towel and a piece of paper and placing a small sponge in its end. Upon this sponge the ether is poured and the large open mouth of the cone is placed over the face. If this be done suddenly the sensation of suffocation is generally so great as to cause fright and struggling, which is inadvisable. The better way is to hold the cone at some dis- tance from the face and gradually briug it nearer as the effects of the ether are felt. After partial anaesthesia is attained the cone should be placed closely over the face and the vapor be pushed in as concentrated a form as possible, whereas when chloroform is used it should be well mixed with a great amount of air. Care should be taken that the ether does not get into the eyes of the patient, either in vapor or liquid form, owing to the irritation which it will set up. To prevent this a thin piece of muslin wet with water will be found of service if placed over the eyes. When ether is to be given, no food ought to be allowed the patient for twelve hours preceding its use, except a little milk or tea an hour or two before the operation, in order to avoid vomiting during aud after this procedure. The patient should not be allowed to retain any tobacco or false teeth in the mouth, as they may slip into the larynx and cause death while the anaesthetic is being given. Locally ether may be used in an atomizer spray as a local anaesthetic owing to the cold produced by its evaporation. This is particularly useful in cases where thoracentesis or paracentesis abdominis is to be performed, and also in cases of superficial neuralgia, where the benumbing of the nerve often effects a permanent cure. Internally, by the stomach, ether is very useful in colic, although for flatulence of adults and children Hoffmann's Anodyne is a more agreeable remedy. In cases of collapse the hypodermic and gastric use of ether make it of great service when cardiac action is very feeble, and it will give relief by inhalation in some of these cases more rap- idly than the nitrite of amyl. In hiccough a few inhalations of ether will often stop the spasmodic movements, and local muscular spasms can be relieved in this way. Ether may be used to produce muscular relaxation when the sur- geon attempts to reduce a strangulated hernia by taxis. In cases where cod-liver oil cannot be digested, ether may be given in 20-drop doses in ice-water or capsule, either with, or some minutes after, the oil is taken, to aid in its digestion and absorption. The time of its use should be that at which discomfort is apt to come on, and not at any stated moment. Administration.—Ether should be given, when used internally, in ice-cold water, or, better still, in capsules, in the dose of 30 drops to | ounce. If cold water is not used, so great is the irritation of the fauces produced by the fumes of the ether that deglutition is im- possible. ethyl iodide. 165 Contra-indications.—Ether should not be used by inhalation in bronchitis, acute nephritis, peritonitis or gastritis, in aneurism, or in the presence of marked vascular atheroma. ETHYL BROMIDE. Ethyl Bromide is a liquid employed as an anaesthetic, but possess- ing so powerful an influence over the heart as to make its employment in prolonged operations exceedingly dangerous. It acts with even greater rapidity than chloroform, producing anaesthesia after the first, second, or third whiff, and rarely causes a preliminary stage of excite- ment. Those who have used it assert that an operation may be begun in from five to twenty seconds after the first inhalation and that the inhalations may then be stopped at once, provided the operation is a minor one, such as the opening of a boil or abscess. It is to be remem- bered, however, that persons addicted to alcohol are particularly sus- ceptible to its lethal influence, and that the employment of the drug throws a large amount of responsibility upon the surgeon. ETHYL IODIDE. This is a colorless, non-inflammable liquid, which really should be called hydriodic ethyl. It must be kept in dark-colored bottles in a dark place to prevent it from undergoing decomposition. It is very volatile and the fumes arising from it are slightly pungent, but not irritating in ordinary amounts. Unfortunately the odor is disagree- able to most persons. Physiological Action.—Very little is known of the general physio- logical action of iodide of ethyl, and the drug would be a good one for laboratory investigation. It does not produce anaesthesia except iu very large amouuts. Therapeutics.—Iodide of ethyl is used in medicine entirely by in- halation for the treatment of subacute or chronic catarrh of the air- passages and for the purpose of rapidly impressing the system with iodine for alterative purposes, as it is the iodine in the remedy which produces the curative effects desired. In catarrhal states of the bron- chial tubes the stimulating effect of the iodine causes free secretion and prevents abnormal thickening of the mucus and dilatation of the air-passages. For this reason iodide of ethyl is of service in asthma and in its resulting emphysema. Very recently Bartholow has recom- mended this drug in the treatment of pneumonia. It is particularly useful in the later stages of this disease, as it aids in producing resolution. Administration.—Ten to twenty drops may be placed upon a hand- kerchief and inhaled, or a small vial filled with the drug may be held 166 DRUGS. in the hand under the nostrils. Under these circumstances the heat of the hand sets free the necessary amount of vapor. EUCALYPTUS. Eucalyptus, TJ. S., is the leaves of the Eucalyptus Globulus or Blue Gum tree, a native of Australia, but grown at present all over the world. Their chief medical constituent is the Oil of Eucalyptus (Oleum Eucalypti, TJ. S.), from which is derived eucalyptol. Physiological Action.—Locally applied the oil is a decided irritant. Ten to twenty drops taken internally cause slight stimulation, fol- lowed by a sense of calm, while larger doses produce disturbed diges- tion and loose, oily-odored stools. The pulse is increased in frequency and force and intense headache may come on. After very large doses there is a fall in pulse force, bodily temperature, and strength of limb and the respirations are decreased. A peculiar loss of sensation in the lower limbs may occur. If death takes place it is due to respiratory failure. The drug is eliminated by the skin, kidneys, bowels and lungs. The urine may have the odor of violets, as it sometimes does after the use of oil of turpentine. The oil of eucalyptus has considerable antiseptic power. Therapeutics.—Eucalyptus is used in malarial fever where quinine cannot be had or be borne by the patient owing to idiosyncrasy. In bronchitis in an emulsion or in capsule it is of great value in the later stages (see Bronchitis), and it may be used in the subacute forms of gonorrhea iu the same manner, since in its elimination by the lungs it acts locally upon the inflamed mucous membrane. The following prescription will answer: R.—Olei eucalypti.......f 3j. Olei amygdalae dulc...... . f 3j. M. Ft. in capsular no. x. S.—One t. d. after meals. Oil of eucalyptus is very useful in some forms of rheumatic head- ache or in headache dependent upon malarial fever. Administration.—The extract (Extractum Eucalypti Fluidum, TJ. 8.) is given in the dose of 10 drops to 2 drachms. The oil (Oleum Eucalypti, TJ. 8. and B. P.) in the dose of 5 drops. TJnguentum Eucalypti is officinal in the B. P., but is seldom used. EUONYMUS. Euonymus, TJ. 8., or AVahoo, is the bark of Euonymus Atropurpureus, a native plant of the United States. It contains an active principle, euonymin. As a laxative its action is very slow and moderate, but it exalgine. 167 is thought to act particularly on the liver, aud may be used when mild hepatic torpor is present. Administration.—The dose of the solid extract (Extractum Eu- onymi, TJ. S.) is 3 to 10 grains. EUPATORIUM. Eupatorium, TJ. S., Thorough wort or Boneset, is the leaves of the Eupatorium Perfoliatum, an American plant which is used as a simple bitter tonic and diaphoretic very largely in household medicine. The drug is generally given iu hot infusion in cases of arrested menstrua- tion due to cold, or in the chill of a remittent or intermittent fever, and also for anorexia aud debility. Its taste is very disagreeable, and in the dose of a pint of the cold infusion it has been used as an emetic. The fluid extract (Extractum Eupatorii Fluidum, TJ. S.) is given in the dose of 30 drops to 1 drachm. EUPHORBIA PILULIFERA. This herb is sometimes called Snake-weed or Cat's-hair, and is a native of Australia and the West Indies, where, like stramonium, it grows profusely as a weed by the wayside. Physiological Action.—In toxic doses the drug kills small animals by failure of the respiration and circulation, these two vital functions being greatly affected by doses which exert no great influence on the rest of the body. In full dose it may cause some gastric irritation. Therapeutics.—Euphorbia pilulifera is one of the latest remedies introduced into medicine for the relief and cure of asthma, in which disease the results obtained, after other remedies fail, are very extra- ordinary if the reports of those who have given it a thorough trial can be accepted without reserve. It has also been highly praised in the treatment of chronic bronchitis aud emphysema. Administration.—Euphorbia pilulifera is best given in the form of the fluid extract in the dose of 30 drops to a drachm. The decoction is made by adding a " handful of stalks with the leaves on them to two quarts of boiling water and boiling down to a quart and a half." Of this decoction the dose is a small wineglassful three times a day. EXALGINE. This substance is really methyl-acetanilide and closely resembles acetanilide or antifebrin in its effects. It is given for the same pur- poses as is acetanilide and antipyrin, namely, for the relief of pain in locomotor ataxia and other nervous affections. When used, exalgine should be given night aud morning as a rule, so that the doses shall 168 DRUGS. not be near together. The beginning dose should be from 2 to 4 grains, and not more than 12 grains should be given in 24 hours. It is stated by those who have used the drug that fever contra-indicates its employment. The following prescriptions wil R.—Exalgini1 . Tincturae aurant. dulcis Ft. in sol. et adde Syr. aurantii Aq. menth. piperit. S.—Tablespoonful night and morning. Or, R.—Exalgini Spt. frumenti Ft. in sol. et adde Syr. simplicis Aquas dest. . S.—Tablespoonful night and morning. FLAXSEED. Flaxseed or Linseed (Linum, TJ. 8.), is the seed of Linum TJsitatissi- mum, or flax from which linen is made; it is officinal in the B. P. as Lina Semina. It contains an oil and a mucilage, the first of which is largely used in the arts, and the second is sometimes employed in medi- cine. The oil (Oleum Lini, TJ. 8. and B. P.) is also used by physicians and pharmacists for various purposes. Therapeutics—Flaxseed acts as a demulcent to inflamed mucous membranes, and is used largely in the treatment of acute cystitis, bronchitis, gastritis, nephritis and similar states in the form of flaxseed- tea. This is prepared by mixing together 3 drachms of flaxseed, not ground, 30 grains of extract of licorice, 10 ounces of boiling water, and allowing the mixture to stand one to four hours in a warm place. If the mixture is boiled the oil is set free and makes the dose dis- agreeable. This infusion may now be made more tasteful and useful by the addition of a little lemon-juice and sugar and by the placing of from 1 to 2 drachms of gum-arabic in the pitcher containing it. If the cough is excessive, a little paregoric may be added. Linseed oil is used sometimes as a laxative in the dose of 2 ounces, and is said to be of service when so given in the treatment of hemorrhoids. Flaxseed meal (Lini Farina, B. P.) is employed universally when moistened as a useful poultice. Under the name of carron oil, an emulsion of lime-water and linseed oil, equal parts, is the standard application for limited or extensive burns. An infusion of linseed (Infusum Lini) and a poultice (Cataplasma Lini) are officinal in the B. P. H be found applicable: gr. xxx. f3ij. M. . . fgas. q. s. ad f giv. M. gr. xxx. fgss. M. q. s. ad f giv. M. GAULTHERIA. 169 GALLIC ACID. Acidum Gallicum (TJ. 8. and B. P.) is prepared from powdered nut-galls by a somewhat complicated and prolonged process. It occurs in nearly colorless, long, needle-like crystals, which are soluble in 100 parts of cold water, 4£ parts of alcohol, and 3 parts of boiling water. Physiological Action.—Gallic acid is an astringent but not a coagu- lator of blood. Locally applied in bleeding it is useless, but given internally in haemorrhages, which cannot be acted upon by the direct local application of tannic acid, it is useful as a haemostatic. It is eliminated from the body by the kidneys, as gallic acid. Therapeutics.—Gallic acid may be used with much success in hemat- uria, hemoptysis, colliquative sweats, and in bronchorrhea with profuse expectoration. Combined with opium it is one of the best remedies in diabetes insipidus, and is even useful in diabetes mellitus. In albuminuria dependent upou a relaxed atonic state of the kidneys and in night-sweats and acute or chronic diarrhea, gallic acid may be used with advantage. In the form of the ointment it is useful in the treatment of psoriasis, and in the cure of ulcers and sores which are actively discharging. Administration.—Gallic acid is given in the dose of 2 to 40 grains in pill or solution. It ought never to be used with any salt of iron, as it is incompatible. The officinal preparations are TJnguentum Acidi Gallici, TJ. S., used locally, and Glycerinum Acidi Gallici, B. P, given in the dose of 10 to 60 minims. Nut-galls (Galla, TJ. S. and B. P.) are the small excrescences found upon the oak (Quercus Infectoria) formed by the ova of the fly Cynips Tinctoria. Their sole value depends upon the tannic acid contained in them, and they are officinal in the form of the tincture (Tinctura Gallce, TJ. S. and B. P.), dose J to 2 fluidrachms; and the ointment (TJnguentum Galle, TJ. 8. and B. P.). TJnguentum Galle cum Opio is officinal in the B. P., and is used as an astringent and sedative ointment. GAULTHERIA. Wintergreen, or Gaultheria Procumbens, is an American evergreen containing a volatile oil. The oil possesses a peculiar, exceedingly penetrating odor and a warm aromatic taste. It is about 90 per cent. salicylate of methyl. Physiological Action.—Owing to the large amount of salicylate of methyl contained in the oil, its physiological action is almost identical with that of salicylic acid. (Wood and Hare.) Therapeutics.—Aside from its use as a flavoring substance, oil of gaultheria is largely used in all forms of rheumatism, and in place of 170 DRUGS. the ordinary salicylates. It does not so commonly disturb the diges- tion of patients as do the salts of salicylic acid or the acid itself. The oil (Oleum Gaultherie, TJ. 8.) is best given in capsules or emulsion, or dropped on a teaspoonful of sugar, three times a day after meals. The dose may be as high as 100 drops a day; if 60 drops three times a day, do no good, pushing it further is practically useless. The spirit of gaultheria (Spiritus Gaultherie, TJ. 8.) is given in the dose of 10 to 20 minims. GELSEMIUM. Gelsemium, TJ. 8. and B. P., or yellow jasmine, as used in medicine, is the rhizome of the Gelsemium Sempervirens, a climbing plant of the southern United States. It contains an alkaloid, gelsemine, and gelseminic acid. Physiological Action. Nervous System.—Gelsemium paralyzes the spinal cord, particularly on its sensory side (?), although the motor side is certainly ultimately depressed. It does not influence the nerves or muscles except those of the head, on which it acts as a paralyzant particularly affecting the motor fibres. Circulation.—Gelsemium is a depressant to the circulation, acting particularly on the heart. Respiration.—Gelsemium kills by paralyzing the respiratory cen- tres. (Sanderson, Ringer, aud Murrell.) Temperature.—In overdose the drug lowers bodily heat very markedly. Eye.—Gelsemium is a mydriatic of considerable powder, causing, when dropped into the eye, wide dilatation of the pupil, a result due to paralysis of the oculo-motor nerve. Therapeutics.—Gelsemium is used in headache and migraine de- pending on nervous troubles or upon eye-strain. It is particularly useful in combination with cannabis indica. (See Cannabis Indica and Migraine.) In malarial fever it is said to be of great service, but this is doubt- ful. In the early stages of pneumonia and pleurisy it has been highly spoken of by Bartholow. Gelsemium has also been found of value in asthma, whooping-cough, laryngismus stridulus, and nervous cough. In localized muscular spasm, such as is seen in torticollis or wry-neck, and in spasmodic dysmenorrhea, it is of considerable service. It ought not to be used if the system is already depressed, but only in sthenic cases. ^ When used as a mydriatic Tweedy recommends it as equal to atro- pine in effect, but much more transient in its influence. He uses a solution of 8 grains of gelsemine to the ounce of water, instilled, drop by drop, into the eye every fifteen minutes for one hour, and then every half-hour for two hours. gentian. 171 Poisoning.—The most prominent symptoms of gelsemium poisoning are ptosis and dropping of the jaw. These are preceded by a sensa- tion of languor, a desire to lie down, relaxation and muscular weak- ness. Gelsemium is apt to cause temporary internal squint owing to its paralyzant action on the sixth pair of cranial nerves. The pulse becomes rapid and feeble, the skin wet and cold, the face pinched and anxious, the voice is lost in aphonia, aud death ensues from centric respiratory failure and an almost simultaneous cardiac arrest. Sensa- tion in man is impaired very late in the poisoning. The treatment of the poisoning consists in the use of cardiac stimu- lants, such as ammonia, digitalis, and atropine, the application of external heat, aud the employment of atropine aud strychnine for the purpose of stimulating the respiratory centre. Emetics and the stomach-pump are, of course, to be employed. Administration.—The fluid extract (Extractum Gelsemii Fluidum, TJ. 8.) is given in the dose of 5 to 10 minims, and the tincture (Tinc- tura Gelsemii, TJ. S. and B. P.) 10 to 20 drops. Gelsemine may be used in the dose of -^ of a grain. Extractum Gelsemii Alcoholicum, B. P., is given in the dose of +/ to J grain. GENTIAN. Gentiana, TJ. S., is the root of the Gentiana Lutea, or yellow gen- tian, a European plant. It contains gentianine and gentisic acid and has a bitter taste. This drug is officinal in the B. P. as Gentiane Radix. Therapeutics.—Gentian is one of the most efficacious bitter tonics that we possess, as well as one of the most elegant. In the anorexia following acute diseases and in gout and malarial poisoning with dys- pepsia it is of service. Combined with bicarbonate of sodium it is of great service in the treatment of the gastric and intestinal catarrh of children. Administration.—The compound tincture (Tinctura Gentiane Com- posita, TJ. S. and B. P.) is given in the dose of a drachm to a wine- glassful, the fluid extract (Extractum Gentiane Fluidum, TJ. S.) in the dose of 30 drops to a drachm, and in the solid extract (Extractum Gentiane, TJ. S. and B. P.) in the dose of 1 to 8 grains. Infusum Gentiane Compositum, B. P., is given in the dose of 1 to 2 fluid- ounces, and the compound tincture (Tinctura Gentiane Compositus) in the dose of \ to 1 fluidrachm. The compound tincture and infusion are composed of gentian, bitter orange peel, and cardamoms. The following prescription is an excellent one for use in convalescence from prolonged fevers : R.—Acid, nitro-hydrochlor. du. Tr. nucis vomicae Tr. cardamomi comp. . Tr. gentiana? comp. S.—Teaspoonful in water after meals. f3jvelf3ij. . • • ffj. • • • f,?ij. . q. s. ad f ^iv. M. 172 DRUGS. GERANIUM. Geranium, TJ. 8., is the rhizome of Geranium Maculatum. It con- tains tannic and gallic acid and is useful in diarrhoea as an astringent. It is not the common red geranium seen in flower gardens. In infantile diarrhea geranium root boiled in milk in the propor- tion of one or two roots to the pint will be found of great service, and is lacking in taste. The dose of the drug itself is 20 to 60 grains, and that of the fluid extract (Extractum Geranii Fluidum, TJ. 8.) J to 1 fluidrachm. GINGER. Zingiber, TJ. S. and B. P., in the rhizome of Zingiber Officinale, a plant of Hindoostan, Jamaica, and other tropical countries. Black ginger is the dried rhizome with its bark, while white ginger has this covering removed. It contains a hot volatile oil and an aromatic resin and is very largely used in domestic medicine as a carminative and stomachic. In the treatment of menstrual cramps it is often given, and is particularly useful in those due to suppression from exposure to cold. With purgative medicines ginger is employed for its flavor and the prevention of griping. Of itself it is decidedly constipating, and when used in diarrhea mixtures is of value other than as a flavoring addition to the prescription. Administration.—The fluid extract (Extractum Zingiberis Fluidum, TJ. S.) is given in the dose of 10 to 30 drops, well diluted. The tincture (Tinctura Zingiberis, TJ. 8. and B. P.), 20 drops to 2 drachms; the syrup (Syrupus Zingiberis, TJ. S. and B. P.) dose 30 drops to 2 drachms; the oleoresin (Oleoresina Zingiberis, TJ. 8.), dose \ to 1 drop, well diluted, or in pill, and the troches (Trochisci Zingiberis, TJ. S.) used as stimulants to salivary secretion. In the B. P. a stronger tincture, Tinctura Zingiberis Fortior, is officinal, dose 5 to 20 minims. GLYCERIN. Glycerinum, TJ. S. and B. P., is a liquid obtained by the decom- position and distillation of fats. It possesses great power of absorb- ing water and of dissolving many substances. Even if pure it irritates the skin of susceptible persons by its absorption of water, and often causes a slight rash. Physiological Action.—Injected into the circulation in large amounts, glycerin causes convulsions, which are due to its hydro- scopic power. According to the clinical researches of Pavy, glycerin increases the polyuria of diabetes almost one-half, and for this reason he thinks it is not to be employed in this class of cases as a substitute for sugar. Again, the experiments of Luchsinger and AAreiss have shown glycerin. 173 that the administration of this substance increases the amount of glycogen in the liver to a very considerable extent; while, on the other hand, the researches of Eckhard aud Luchsinger have also proved that glycerin very frequently tends to prevent glycosuria which has been brought about by puncture of the so-called diabetic centre in the floor of the fourth ventricle, if the drug be given hypo- dermically. Luchsinger, therefore, believed that while glycerin might increase the amount of glycogen, it also prevented its trans- formation into sugar by inhibiting the amylolytic action of the hepatic ferment. Eckhard believes that the hypodermic injection of glycerin produces such radical changes in the blood and general system that no conclusion can be made of the proper influence exerted by it. In an exceedingly useful and interesting paper, both from a physiological and clinical standpoint, Ransom, of London, has recently goue over this Vvork in a satisfactory manner, and has tried, with considerable success, to uuravel the somewhat complex pathology of the disease, as well as the equally complex and opposing statements of investigators as to the influence of glycerin. He poiuts out that one element of fallacy in all these experiments is the fact that glycerin, when given hypodermically, must reach the liver so slowly and in such a diffused state as to be almost powerless, and, in consequence, Ransom introduced the glycerin into the alimentary canal. All the experiments seem to have been made in a most painstaking and careful manner, but as we have no space for their detail, we must pass them by in order to reach the results attained. These are as follows : 1. Certain forms of glycosuria may be checked by glycerin. 2. Glycerin acts more efficiently when introduced into the alimentary canal than when injected subcutaneously. 3. Glycerin checks glycos- uria by inhibiting the formation of sugar in the liver. 4. By this means glycerin increases the quantity of glycogen found in the liver. While these conclusions are not final in proving the value of glycerin under such circumstances, it would seem probable that they are of great value in pointing toward a solution of one of the most complex subjects with which physicians are called upon to deal, and it is to be hoped that Ransom will publish other researches at a future time which will further elucidate this difficult subject. The quantity of glycerin which the writer would recommend to be given clinically is 1 drachm diluted at least one-half with water. Therapeutics.—Glycerin may be employed as a sweetening agent in the food of diabetics and in cases where sugar cannot be used. It has also been given as a laxative, in 1 or 2 drachm doses by the mouth, and in enema—1 to 4 drachms with or without equal parts of water. In some cases it may be used in suppository. This latter method is very successful in chronic constipation. As an antiseptic it is used for preserving specimens, and for keep- ing alkaloids in solutions for hypodermic use. In acute coryza, applied by a spray or brush to the nostrils, it is often of service, and should be diluted for such a purpose four or 174 DRUGS. five times with water. If used on the skin it should be diluted one-half with water. In cases of impacted cerumen in the external auditory canal glycerin is often of service iu softening the mass. The uses of glycerin, other than those mentioned, are many. In the proportion of 1 part of glycerin and 1 of water it makes a very useful mouth-wash in the sore and dry mouth of typhoid fever and for the removal of sordes. The same wash with lemon-juice added to it is very agreeable and will relieve the dry, glazed tongue of advanced phthisis. Owing to the fact that glycerin is hydroscopic, it may be used as a depletant on a pledget of cotton in congestion of the uterine cervix, the tampon being renewed daily. For the prevention of bed-sores Ringer recommends the daily washing and rubbing of the part likely to be affected, followed by the application of glycerin, and a draw-sheet placed smoothly against the patient to protect the bedding. Glycerin and whiskey is a favorite household remedy for colds and coughs, but is not very useful. Glycerite of starch (Glyceritum Amyli, TJ. S. and B. P.), is used as a protective. Glycerite of yolk of egg (Glyceritum Vitelli, TJ. 8.) is used in makiug emulsions. The B. P. preparations of glycerin are as follows : Glycerinum Acidi Carbolici; Glycerinum Acidi Gallici; Glycerinum Acidi Tan- nici; Glycerinum Aluminis; Glycerinum Boracis ; Glycerinum Plumbi Subacetatis, and Glycerinum Tragacanthe. GOLD. Gold is not officinal in the TJ. S. Pharmacopeia in any form, but has been recommended very highly by Bartholow in chronic Bright's disease in the form of the chloride of gold and sodium (Auri et Sodii Chloridum). The dose of this substance is ^ to ^ of a grain once, twice, or thrice a day. Gold has also been strongly recommended for indigestion with epigastric pain after eating when looseness of the bowels is present, and is said to act as a powerful sexual stimulant and to be of service in impotence dependent upon inability to obtain an erection or when there is deficient glandular action. In overdoses the drug causes gastro-enteritis. Magruder has recommended chloride of gold and sodium in the treatment of pertussis. GRINDELIA ROBUSTA. Grindelia, TJ. 8., is an American plant (Grindelia Robusta) con- taining a resin, a volatile oil, and an alkaloid. Physiological Action.—Upon the lower animals and man this drug is not very powerful in its action, but may cause, in large doses, paralysis of the peripheral sensory nerves, the sensory centres in the GURJUN OIL. 175 cord, and finally the motor centres and nerve-trunks. It slows the heart by stimulating the vagi, and raises blood-pressure by stimulating the vasomotor centre. Therapeutics.—This is an exceedingly useful remedy in some cases of asthma, and in bronchitis in its later stages. It may be given in the dose of 20 to 60 drops of the fluid extract (Extractum Grindelie Fluidum), or by inhaling the fumes of burning grindelia leaves which are previously soaked in a solution of nitre, dried, and burned on a plate, or rolled into a cigarette and smoked. In chronic cystitis it stimulates the bladder, and is of great service. By diluting it 1 to 10 with water it forms one of the best lotions that we have for the relief of the dermatitis produced by poison ivy or Rhus loxicodendron. Administration.—The only preparation which is officinal is the fluid extract (Extractum Grindelie Fluidum, TJ. 8.), dose 20 to 60 drops. GUAIAC. Lignum Vitae, or Guaiacum Officinale, a West Indian tree, is used in medicine in two forms—namely, as Guaiac wood (Guaiaci Lignum, TJ. 8. and B. P.), which is in raspings and enters into the compound syrup of sarsaparilla, and Guaiac resin (Guaiac Resina, TJ. S. and B. P.) or Guaiac, which is soluble in alcohol, ether, and chloroform, but insoluble in water. Therapeutics.—Guaiac has been largely used in syphilis, but is now rarely, if ever, so employed. Given in acute tonsillitis in the dose of 30 grains in an emulsion made by the use of white of egg, it will often abort the disease. In rheumatism it has been largely used. The am- moniated tincture of guaiac is sometimes employed in the treatment of sore-throat, particularly if it be rheumatic in type, but is a disagreeable preparation to take into the mouth. Administration.—The tiucture (Tinctura Guaiaci, TJ. S.) is given in the dose of 5 to 60 drops, and the ammoniated tincture (Tinctura Guaiaci Ammoniata, TJ. S. and B. P.) is used in the same dose, pre- ferably in milk. Mistura Guaiaci, B. P., is given in the dose of 1 to IJ fluidouuces. GURJUN OIL. Gurjun Oil, or, as it is sometimes called, Gurjun Balsam, or Wood Oil, is the exudation obtained, by incision and the application of heat, from the bark of an East Indian tree. It is a transparent liquid pos- sessing the consistency of olive oil, of a greenish-gray color when held up to the light. It has an aromatic odor resembling to some extent that of copaiba. It is not, however, so disagreeable. Therapeutics.—Gurjun oil has been found of value in cases of chronic bronchitis where a stimulating expectorant of considerable power was desired, and this is particularly the case if the mucus in the bronchial 176 DRUGS. tubes is very tenacious. The oil has also been found of value in gonorrhea and gleet as a substitute for copaiba and cubebs. Administration.—Gurjun oil is best given in the dose of from 1 to 2 drachms three times a day, combined with spirit of nitrous ether, mucilage of acacia aud cinnamon water, or mixed with extract of malt in the proportion of 2 drachms of the oil to an ounce of the extract. Persons having irritable stomachs may not be able to take this drug. HAMAMELIS. Hamamelis, TJ. 8., Witch-hazel, or Hamamelis Virginica, is a plant of the United States, devoid of any true active principle, but possess- ing extraordinary remedial power. According to the studies of Wood and Marshall it has absolutely no physiological action, yet practically we know it to be a most useful remedy. Therapeutics.—Hamamelis is wouderfully successful in the treat- ment of uterine oozing from small bloodvessels, seems to do good even in hematemesis and hemoptysis, and will sometimes arrest hematuria when all other remedies fail. Applied by means of cloths to leg ulcers it acts very thoroughly and relieves the surrounding angry-looking skin at once. In bleeding from the bladder it may be injected into this viscus daily in the form of the distilled fluid extract. Taken internally and applied locally it is of value in the treatment of bleed- ing and the, so-called, blind piles. Injected into the part affected, or taken internally, hamamelis is of value in persons suffering from varicose veins. Administration.—The one officinal preparation is the fluid extract (Extractum Hamamelidis Fluidum, TJ. 8.), dose 5 to 20 drops. The dose of the distilled extract, which is not officinal, aud is a perfectly clear liquid, is from 30 drops to 1 drachm, and this is much the best preparation for internal aud external use. Unfortunately, the prepa- rations of the drug vary very much both in odor and efficacy. HEMATOXYLON. Hematoxylon, TJ. 8., Hematoxyli Lignum, B. P., or Log-wood, is the heart-wood of Hematoxylon Campechianum, a tree of the Ameri- can tropics. It contains an alkaloid, haematoxylin. Therapeutics.—Haematoxylon is a mild astringent, very useful in serous diarrheas and in the diarrhoeas of young children, as children do not dislike it, owing to its agreeable taste. (See article on Diarrhoea.) As it colors the stools and urine red, the nurse should be warned, lest she be alarmed at the sight of what looks like blood on the diaper after the drug is given to infants. In leucorrhea its internal use is of service. The extract (Extractum Hematoxyli, TJ. 8. and B. P.) is HOFFMAN'S ANODYNE. 177 given in the dose of 8 to 30 grains, and Decoctum Hematoxyli, B. P., in the dose of 1 to 2 fluidounces. An unofficiual fluid extract is often to be found in the shops. The dose of this is J to 1 fluidrachm. HOFFMANN'S ANODYNE. Spiritus JEtheris Compositus, TJ. S. and B. P., consists of alcohol, ether, aud the heavy oil of wine. The writer has experimentally studied very thoroughly the action of the last-named ingredient, and finds: First. That the belief in heavy oil of wine being the quieting agent in Hoffmann's anodyne is fallacious. Second. The calmative effects of this mixture depend largely on the ether, rather than on the oil. Third. It would seem probable that in Hoffmann's anodyne we possess an agent in which there are linked together three drugs of undoubted power, each one of which successively substitutes the other, stimulating the system in the order here named, viz., ether, alcohol, and the heavy oil of wine. On animal temperature, as ascertained by the thermometer in the rectum, the heavy oil of wine exercises no influence, even when the arterial pressure is very low. That large doses of the heavy oil of wine are in no way possessed of toxic effects is proved by the fact that 30 c.c. of the drug given by the mouth to a small dog, weighing twelve pounds, failed to produce any apparent symptoms, except, perhaps, to stimulate him slightly. While the odor of the oil is penetrating it is by no means disagreeable, aud it possesses but little taste other than that of the presence of an oily substance. Therapeutics.—Hoffmann's anodyne is the best carminative that we possess for general use, and it is one of the best remedies for singultus or hiccough. These effects are accomplished probably in two ways: The alcohol and ether act as irritants or stimulants to the gut, and free peristalsis results, while the heavy oil of wine acts, perhaps, as a ner- vous sedative. In angina pectoris this drug is often the best remedy we have, and in the cardiac palpitation of tobacco-heart or that arising from indigestion it is very useful. Iu the nausea aud depression seen after excessive smoking, Hoff- mann's anodyne should always be given in capsules or in cold water, preferably ice-cold, in order to prevent too rapid volatization of the ether and consequent difficulty in swallowing the liquid. The dose is 1 to 2 drachms to an adult. 12 178 DRUGS. HOMATROPINE. Homatropine is an artificial alkaloid obtained by prolonged aud gentle heating of a solution of equivalent quantities of tropine1 aud toluic acid in hydrochloric acid. The hydrobromate of homatropine is a crystalHzable salt of homatropine soluble in 10 parts of distilled water. Hydrobromate of homatropine, properly applied by frequent instil- lations, is a reliable mydriatic for the correction of anomalies of refrac- tion in healthy eyes. Experience is not at hand to determine its value for this purpose in eyes affected with retino-choroidal disturbance. Atropine and hyoscyamine are preferred under such circumstances, for the obvious reason that their prolonged action is desirable as a method of treatment. The danger of systemic disturbance from homa- tropine is far removed, even when repeated instillations have been made, and its temporary action upon the pulse causes no inconvenience to the patient. Slight hyperaemia of the conjunctiva almost invari- ably follows its use, but true conjunctivitis, if it occurs at all, must be excessively rare. According to the studies of Dr. de Schweinitz and the writer, the drug has a physiological action closely allied to that of atropine, from which it is derived. Homatropine mydriasis generally lasts from 36 to 48 hours, that of hyoscyamine 8 to 9 days, and that of atropine 10 to 12 days. For the production of ordinary mydriasis the drug should be used in solution of the strength of 4 grains to the ounce of distilled water, which is to be dropped into the eye every 5 or 10 minutes. HONEY. Honey, or Mel, TJ. S. and B. P., is the saccharine fluid deposited in combs by the honey bee, or Apis Mellifica. It is used to cover the taste of disagreeable medicines. AY hen it is abstracted from a peculiar variety of flowers it frequently has the odor of the flower, and when taken internally may even produce the physiological effects of the plant from which it is gathered. This accident occurs commonly in those parts of the country where the bees have had access to mountain laurel aud similar plants. Therapeutics.—Honey is used as an emollient in gargles and to relieve cough and dryness of the mouth and fauces. When used as a gargle it very distinctly increases the secretion of the mucous mem- brane, and so relieves the congestion. Under the name of Oxymel the B. P. recognizes a mixture of 8 parts of honey, 1 of acetic acid, and 1 of water. This is generally used as a vehicle for more active remedies in gargles, or even for expectorant mixtures. Melted and strained honey is known as Mel Despumatum, 1 Tropine is a product obtained by splitting up atropine into tropine and tropic acid. HYDRASTIS. 179 TJ. S., and Mel Depuratum, B. P. There are also a honey of roses (Mel Rose, TJ. 8.) and a confection (Confectio Rose, TJ. 8.) used as vehicles for other drugs. HOPS. Humulus, TJ. 8., are the strobiles of ordinary hops, or Humulus Lupulus. They contain a liquid volatile alkaloid, lupuline, and a bitter principle, lupulinic acid. Hops are known under the name of Lupulus in the B. P. Therapeutics.—Hops are used as antispasmodics and nervous seda- tives in cases of hysteria and nervousness. In priapism, vesical irri- tability, and renal irritation they are of service. Even in delirium tremens they seem to be of value. For local application a hop poul- tice may be made by placing the powdered strobiles in the mass, and employed in this way they are a favorite home remedy for local pain- fid inflammations. Hops have been used in the form of a hop pillow in nervous insomnia, but the soporific influence is largely imaginary, or depends on the fumes of the alcohol with which the pillow is moistened. Administration.—The tincture (Tinctura Humuli, TJ. 8.) is given in the dose of J to 3 ounces, the alkaloid (Lupulinum, TJ. S. and B. P.), dose 2 to 5 grains or more ; the oleoresin of lupuline (Oleoresina Lupulini, TJ. S.), dose 10 to 40 drops in capsules, and the fluid ex- tract (Extractum Lupulini Fluidum, TJ. 8.), in the dose of 30 to 120 drops. The preparations of the B. P. are the extract (Extractum Lupuli), dose 5 to 10 grains; the infusion (Infusum Lupuli), dose 1 to 2 fluidouuces, and the tincture (Tinctura Lupuli), dose J to 2 fluid- drachms. HOPE'S CAMPHOR MIXTURE. This is a mixture originally made with nitrous acid, but largely used at present with nitric acid, owing to the fact that nitrous acid is changed into nitric acid when water is added to it. The nitrous acid is however, more efficacious than nitric acid in the serous or choleraic diarrheas which it is used to combat. The formula is as follows : JJ.—Acid, nitrosi........^§j'... Aquae camphorse.......f5viij- et adde Tinct. opii........gtt- xl- M- S.— One-fourth of this in water every three or four hours. HYDRASTIS. Hydrastis TJ 8., is the rhizome of the Hydrastis Canadensis, containing two alkaloids, known as hydrastine and berberine, and, perhaps, xanthopuccin. 180 DRUGS. Physiological Action.—In poisonous doses hydrastis may cause con- vulsions followed by paralysis, according to the quantity of berberine or hydrastine present. The latter is more convulsive in its effects than the former. Upon the circulation hydrastine, when injected into the jugular vein, causes a primary fall of arterial pressure succeeded by a decided rise, and the studies of Dr. Cerna, in the laboratory of the University of Pennsylvania, have proved that it is an active poison producing spinal convulsions followed by paralysis. Therapeutics.—Hydrastis is of service in chronic gastro-intestinal catarrh, particularly that following the abuse of alcohol, and may be used as a stomachic and tonic after malarial fever and similar depress- ing diseases. Wherever membranes exist in a condition of lowered tone this drug is indicated. Thus, in catarrhal jaundice of a subacute type, in uterine catarrh, in leucorrhea dependent upon a relaxed state of the vagina, and in chronic nasal inflammations aud irritations it will be found useful. Tincture of hydrastis is said to possess a distinct anti-malarial in- fluence. One of the best remedial measures that we have in the later stages of gonorrhea, when the acute period has passed, is the local and in- ternal use of hydrastis. If it is used as an injection 5 grains of the commercial hydrastine to each ounce of water should be employed twice a day. If this is not used the following infusion will be found of service: Take 1 drachm of the powdered root and add it to 8 ounces of boiling water. Half to one drachm of the fluid extract may also be added to a pint of water and used as a wash in vaginal gonorrhea and leucorrhea. In chronic dyspepsia hydrastis seems to act as an antiseptic and as a curative agent upon the mucous mem- branes of the stomach. Administration.—The fluid extract (Extractum Hydrastis Fluidum, TJ. S.) may be given in the dose of 5 to 30 drops, while the dose of the tincture (Tinctura Hydrastis, TJ. S.) is from 30 drops to 2 drachms. Much doubt exists as to the dose of hydrastine. This arises from the fact that two forms of it are sold. That most commonly seen is a dark-brown mass which is very impure, and contains berberine aud other substances. Its dose is 3 to 10 grains. The pure hydrastine, as made by Merck, is given in the dose of J to \ grain. HYDROCHLORIC ACID. Acidum Hydrochloricum (TJ. 8. and B. P.) is a clear, colorless liquid, possessing an acid odor and taste, devoid of astriugency, but in concentrated form decidedly caustic. In the strength of two- tenths of 1 per cent, it is present normally in the gastric juice and aids the pepsin in the conversion of proteids into peptones, and in the formation of pepsin from pepsinogen. HYDROCYANIC ACID. 181 Therapeutics.—In dyspepsia due to faulty gastric secretion, as in typhoid fever and in gastric indigestion, accompanied with fermenta- tion, this acid is of service. In combination with compound tincture of cardamoms it is of value in intestinal indigestion. (See Indiges- tion.) The acid is best used in the form of the officinal dilute acid (Acidum Hydrochloricum Dilutum, TJ. S. and B. P.), dose 10 to 30 drops in water. In the sick stomach and gastric distress following an alcoholic debauch, 20 drops of the dilute acid in water are often of service. This acid is combined with nitric acid to form dilute nitro-hydro- chloric acid (Acidum Nitro-hydrochloricum Dilutum, TJ. S. and B. P.), the dose of which is 10 to 30 minims; also the pure acid (Acidum Nitro-hydrochloricum, TJ. S.), dose 1 to 5 minims. Hydrochloric acid causes, when taken in poisonous doses, violent gastro-enteritis and corrosion of the gastric walls, and its action should be combated by alkalies, soap, oils, aud white of egg. HYDROCYANIC ACID. Hydrocyanic or Prnssic Acid is a transparent, colorless, very vola- tile liquid, giving rise to vertigo when inhaled in minute amounts and producing death if the fumes be concentrated. If the bottle con- taining the pure drug be opened it should be done where there is sufficient draught between windows to prevent any contamination of the atmosphere of the iron by the acid. Pure hydrocyanic acid is never used in medicine, but it is employed in the form of the dilute acid (Acidum Hydrocyanicum Dilutum, TJ. S. and B. P.), which contains about 2 per cent, of the drug. It must be kept in dark, tightly-stoppered bottles. Physiological Action.—This is one of the most rapid, if not the most rapid, lethal poison known, only being approached by carbolic acid in the violence of its effects. Owing to its volatility it is ab- sorbed with great rapidity, and acts upon the respiratory centre and the heart, being eliminated almost immediately afterward. As a con- sequence, the survival of a patient twenty or thirty minutes after the ingestion of a dose is a favorable sign. The drug is an active paralyzant and exerts a lethal influence over every part of the body. The nervous system, heart, respiration, brain, and all parts are killed at once if much of it is present. Poisoning.—Death either comes at once, so that the person drops dead to the floor with a gasp, is for a moment convulsed, the face cyanotic, the eyes wide open, with the teeth tightly shut, and the lips covered by a bloody froth, or, three stages of poisoning may ensue if the dose has not been very large. In the first of these there is difficult respi- ration, slow cardiac action, and disturbed cerebration. In the second stage, which is convulsive, we find wild cries, dilated pupils, uncon- sciousness, vomiting, spasmodic urination and defaecation, erections of 182 DRUGS. the penis and ejaculations of semen. In the third stage there is asphyxia, collapse and paralysis, euding in death. The blood is found to be dark and venous-looking, but does not give the spectrum bands of cyano-haemoglobin. These bands only appear when the drug is shaken with the blood outside the body. The diagnostic signs of death from prussic acid are the odor on the body, the wide-staring eye, the clinched teeth covered with froth, and the livid, cyanosed face. If the body be opened the odor of hydrocyanic acid is marked, but rapidly passes away. The only poisoning produciug symptoms resembling those which have just been described is that produced by nitrobenzole or essence of mirbane, which has a somewhat similar odor, but which is, how- ever, more permanent, the odor remaining in the opened body for hours. Therapeutics.—Hydrocyanic acid is useful in cases of gastralgia of purely nervous origin, and in some cases of nervous vomiting, and in irritable stomach where, owing to a hyperaesthesia of the mucous membranes, the taking of food produces discomfort. In irritable coughs, due to tickling in the throat and bronchi, it is very extensively used, aud has received high praise by those best qualified to judge. On the other hand it has been claimed that owing to the extreme volatility of the drug it only acts for the mo- ment, and that a dose every ten or fifteen minutes is necessary to produce any real effect. However this may be in theory, practically the acid certainly does relieve cough. Iu these states the following prescription will be found of service : R.—Acid, hydrocyan. dil......f 3j. Morphinse sulph.......gr. ij. Syrup, pruni virg.......f ^iij. M. S.—Teaspoonful every four or five hours to an adult. In enteralgia or neuralgia of the intestines, prussic acid is very useful. Externally the drug is useful in pruritus and other forms of itching skin diseases, and the following formula will be found of service in pruritus vulve: R.—Hydrarg. chlor corros......gr. J. Acid, hydrocyanic, dil......f 3j. Aquae amygdal. amarse.....f §vj. M. S.—Apply to the itching surface with a small rag. The same prescription may also be employed in pruritus without the bichloride, if so desired. The dose of dilute hydrocyanic acid is 1 to 5 drops. In certain forms of irritable cough inhalations of the vapor (Vapor Acidi Hydrocyanici, B. P.) are recommended; it is prepared by adding 10 to 15 minims of the diluted acid to 1 fluid- drachm of water, which is then placed in a suitable apparatus from which is inhaled the vapor that arises. HYOSCINE. 183 HYDROGEN PEROXIDE. (See Oxygen.) HYOSCYAMUS. Hyoscyamus, TJ. 8., or Henbane, is a plant of the northern United States and Europe. The leaves (Hyoscyami Folia, B. P.) only are used, and from them are obtained two alkaloids, one known as hyos- cyamine, the other as hyoscine. The first has the same physiological action as atropine (see Belladonna). The second is quite different in its influence over the body. The only marked difference in the action of hyoscyamine and atropine is in the mydriasis produced by each. While that of atropine lasts, in man, from twelve to fourteen days, hyoscyamine generally remains for only seven to nine days. Owing to the presence of hyoscine in hyoscyamus it is more quieting and depressing to the nervous system than is belladonna. Therapeutics.—Hyoscyamus is used in every condition indicating the employment of belladonna; or, in other words, wherever local spasm, or arterial relaxation exists or where pain is due to spasm. It has been particularly recommended in nervous cough, in whooping- cough, aud in colic, and probably is better in its influences in these states than is belladonna. In combination with nitrate of silver the extract may be used with advantage in chronic gastric catarrh. In urinary incontinence due to irritable bladder it is very serviceable, and particularly is this true of this affection in children and old persons. Administration.—The drug itself is officinal in four forms, and as hyoscyamine sulphate. The dose of the tincture (Tinctura Hyos- cyami, TJ. 8. and B. P.) is 30 drops to 1 drachm; the alcoholic ex- tract (Extractum Hyoscyami Alcoholicum, TJ. 8), dose 1 to 3 grains; the alkaloid (Hyoscyamine Sidphas, TJ. S.), dose -fa to -^ of a grain ; the abstract (Abstractum Hyoscyami, TJ. 8.), dose 2 to 3 grains; and the fluid extract (Extractum Hyoscyami Fluidum, TJ. 8.), dose 5 to 30 drops. The B. P. preparations besides those given are the extract (Extractum Hyoscyami), dose 2 to 5 grains, or more, and the juice (Succus Hyoscyami), dose 30 minims to 1 fluidrachm. Hyoscine. This is one of the alkaloids derived from hyoscyamus and is a powerful nervous depressant. Physiological Action.—Hyoscine quiets the cerebrum aud produces deep sleep in a certain class of patients. In the lower animals, or in man, it may cause sleep or wild delirium. It causes loss of reflex action in overdose, which is due to paralysis of the spinal cord and 184 DRUGS. not of the nerve-trunks. Upou the circulation it has little effect, but it is worthy of note that it does influence the vagus nerves, as does atropine, stimulating them at first, and finally paralyzing them ; although the contrary has been asserted. In any event the circulatory effect is a minor one. Therapeutics.—Hyoscine is of value as a hypnotic in a very limited class of cases, but in this class generally acts most favorably. These cases consists of those who, from acute mania, alcoholic mania, hys- teria, or similar cause, suffer from insomnia, and perhaps use violent struggles against proper control, or refuse to swallow or retain food. The drug may be giveu to such persons hypodermically, in the dose of y^Q- to -^q- of a grain, or by the mouth in the dose of ^ to •^q of a grain. The fact that it possesses no taste, and is small in bulk, renders it ready of employment. In some cases it utterly fails, even in this particular type of cases.1 In delirium tremens it may cause evidences of cerebral congestion and Cheyne-Stokes breathing. Some cases are not quieted by the drug, but pace up and down in semi-sane condition until its action wears off. In the opinion of the writer the applicability of the drug is very limited indeed, and un- toward effects are common. Hyoscine is said to be of great value in spermatorrhea and nocturnal emissions. The drug is contra-indicated in the sore-throat of scarlet fever, as it may cause glottic spasm. In the insomnia of heart disease with nervousness it will cause sleep, but may also produce death by respi- ratory failure or cardiac arrest, and it is to be remembered that the drug will produce asthma rather than relieve it. The breathing, in ordinary cases, may become under its influence croupy or rasping. HYPNAL. The chemical name of this substance is monochloralantipyrine, or monotrichloracetyledimethylphenylpyrazalon, and it is, as its name indicates, a compound of chloral and antipyrine. There is also a dichloralantipyrine, which contains more chloral. The compound is employed in treating those patients who suffer from pain and in- somnia combined, the antipyrine relieving the pain and the chloral producing sleep. Opium is the only drug known which can be relied upon to act in this double manner, aud the disadvantages of this medicament are often so prominent as to prevent its use. In cough arising from bronchitis or phthisis, and causing by its constancy loss of sleep, and in neuralgic insomnia, hypnal will be found of service. 1 The writer has given one-tenth of a grain of Merck's hyoscine in twenty four hours, obtained from two different and reliable stores, without producing sleep, although the respirations were much quickened. IGNATIA. 185 The dose is from 5 to 20 grains, best given with simple syrup and water or with syrup of orange peel, or it may be used as follows : R.—Hypnal........gr. xv. Chartreuse.......f^j. Aqua? dest. ........ f^s's. M. S.—The entire amount to be taken in one dose. ICHTHYOL. Ichthvol is a substance obtained by distillation from a peculiar resinous accumulation found chiefly in the Tyrol, and supposed to be the result of a deposit of extinct fish. Ichthvol occurs as the ichthyo- sulphate of sodium or ammonium. Both of these contain about 10 per cent, of sulphur, and it is largely upon this that their therapeutic activity depends. Therapeutics.—Ichthyol is without doubt one of the most remark- able substances used for medicinal purposes which has appeared in the last decade. In skin diseases it has been most highly recommended on both sides of the Atlantic, and is employed in the form of ichthyol ointment in chronic eczema, acne, urticaria, and even on lupus and keloids. In almost all chronic skin affections it is of the greatest value, and the writer has seen it exert a most favorable influence upon erysipelas both in hospitals and in his private practice. Under these circumstances the ointment should contain about 20 per cent, of ichthyol, or less. Some practitioners recommend that ichthyol be applied in a watery solution of the strength of 1 drachm to the ounce, applied with a camel's-hair brush. Under these circumstances it is necessary to wash the parts with an emollient and water every day, using the greatest gentleness. It has also been found by the writer very efficacious in the pain and swelling accompanying acute rheuma- tism of the joints, both during and after the acute stage of the disease. The strength for this use should be about 30 per cent, of ichthyol to 70 of benzoinated lard. In frost-bites, chilblains, aud in burns it is of service, and Agnew has recommended it highly when rubbed into lymphatic enlargements. For acute sprains, and for the removal of the swelling following such injuries, its influence is extraordinary if it be well rubbed into the part affected. Owing to the disagreeable odor of ichthyol, oil of citronella ought to be added to it, as follows: R.—Ichthyol........3ij. 01. citronellae.....gtt. xv. vel xxx. Adepis........,5j. M. IGNATIA. Ignatia, TJ. 8., or Iguatia bean, is the seed of the Strychnos Ignatia. It contains two alkaloids, strychnine aud brucine, as does nux vomica. 186 DRUGS. Physiological Action.—Its physiological action is identical with that of strychnine or nux vomica. Therapeutics.—(See Nux Vomica.) The abstract of ignatia (Ab- stractum Ignatie, TJ. 8.) is given in the dose of 1 grain; the tincture (Tinctura Ignatie, TJ. S.) in the dose of 10 to 15 minims. IODIDE OF AMMONIUM. Ammonii Iodidum, TJ. S., is used in the same doses and for the same purposes as the iodide of potassium. It is preferred by some practi- tioners to the latter salt when the respiratory or digestive tracts are involved. IODIDE OF ETHYL. (See Ethyl Iodide.) IODIDE OF POTASSIUM. The physiological effects of iodide of potassium (Potassii Iodidum, TJ. S. and B. P.) are entirely comparable to those of iodine itself, but it is employed for somewhat different purposes, is less irritant, more readily given, and perhaps more readily absorbed. Physiological Action. Circulation.—Upon this part of the system iodide of potassium produces effects differing very slightly, if at all, from those caused by potassium itself. Small amounts raise the blood-pressure, and large quantities lower it. (Prevost and Binet.) Elimination.—Iodide of potassium is very rapidly eliminated, appearing, according to Doux, in thirteen minutes after it is ingested in the urine, and the daily amount excreted equals about 90 per cent. of the dose taken. All traces of the iodide in the urine cease 4 or 5 days after the last dose is administered. (Ehlers.) Therapeutics.—The use of iodide of potassium may be divided into three great divisions, each of which is important. It is also employed for many conditions not included in these classes. 1. Syphilis.—The use of iodide of potassium in syphilis is recog- nized as a part of all treatment for its relief. Elsewhere Dr. Martin has, in his excellent article (see Syphilis), treated of this question, and it is only necessary to call attention to the fact that the drug is generally well borne in large amounts by advanced syphilitics, although this is not always the case. The term " therapeutic test" is applied by one eminent teacher to signify a state of the system produced by syphilis in which a diagnosis may be made by the fact that large doses of the iodide are borne without inconvenience. As already intimated, this resistance does not always prove the presence of syphilis, nor does its absence prove the absence of this disease. Persons having heredi- IODIDE OF POTASSIUM. 187 tary asthma, gout, rheumatism, or some similar diathetic malady, often resist the iodide, and some syphilitics are affected with "iodisin" after very small doses. In treating syphilis the drug should be used in the dose of 10 grains three times a day, and this amount gradually in- creased a grain a day until symptoms of "iodism" occur. The quantity borne often amounts to from 100 to 200 grains a day. The best way to use the iodide of potassium is to order for the patient a saturated solution of the drug, which contains in each drop about 1 grain, and at the same time a bottle of the compound syrup of sarsa- parilla. To a tablespoonful of the latter the patient is to add the iodide solution, beginning with 10 drops three times a day and increasing a drop every twenty-four hours. The iodide acts more slowly as an anti-syphilitic than does mercury. In tertiary syphilis the iodide is invaluable. In nervous syphilis, be its manifestations what they may, iodide of potassium is the staudard remedy, only being supplanted by mercury when it is necessary to break down a growth whose existence is a daily menace to the patient's life. 2. Metallic Poisoning.—Owing to the fact that iodide of potas- sium forms double soluble salts with all the metals in the tissues in chronic poisoning, thereby aiding iu their elimination, it should always be employed in chronic lead, zinc, arsenic, or mercurial poisoning. 3. Anti-rheumatic.—Iodide of potassium is best suited, not to the acute sthenic stages of rheumatism when the joints are very hot and painful, but to the secondary or subacute periods when the joints are large and the case " hangs on "—now better, now worse. It acts best, under these circumstances, if combined with wine of colchicum- root (see Rheumatism). It is also to be tried in sciatica, lumbago, and rheumatic neuralgia, and should be employed in chronic pleurisy, peri- carditis, and hydrocephalus, to cause absorption of the fluids. In aneurism, particularly that of the aorta, the drug does good, but its value rests largely upon the cause of the disease. If it is due to.syphilis the aneurism yields very rapidly to the drug. The pain, swelling, and pulsation generally decrease. In asthma iodide of potassium is valuable if the disease is of the bronchial type, but it ought not to be employed if it is gastric. In bronchitis and intestinal catarrh where the condition of the mucous membranes is semi-chronic, and not relieved by chloride of ammo- nium, iodide of potassium should be used. If the bronchitis is chronic and the secretion profuse (bronchorrhoea) iodide of potassium will make it worse. The dose for an adult in all these instances should be about 3 to 5 grains three times a day. In pulmonary emphysema iodide of potassium is ofteu of great value. In chronic nephritis small doses (5 grains t. d.) are thought by some to check the disease, but it is to be remembered that the drug may produce poisoning if the kidneys do not eliminate it, so that, if used at all, it must be with great care. If the drug is well borne it will 188 DRUGS. cause an extraordinary increase in the urinary flow, and will relieve any dropsy which may be present very rapidly indeed. In bronchocele the employment of iodide of potassium internally, and tincture of iodine externally, is the best treatment we can use, aud in acute coryza, or ucold in the head," 10 grains of the iodide taken at the beginning of the trouble will often abort the attack. In hepatic cirrhosis, in its early stages, the iodide often does good, and in arteriosclerosis, or atheroma of the bloodvessels, it is of great service, according to many English, French, and American writers. A very important use of iodide of potassium is for the removal of enlargements of the cervical glands and those occurring in other parts of the body. In enlargements of the spleen, malarial or otherwise, external paintings with iodine and the internal use of the iodide in small doses are of service. In the later stages of pneumonia the iodides are useful to aid in the absorption of any exudates, but they are contra-indicated in phthisis, except in the fibroid form and in those cases dependent upon syphilis, as they aid in the breaking down of the lung. Untoward Effects.—In some persons, after the use of the iodide, coryza with a tearful condition of the eyes comes on, so that the edges of the lids become reddened and the nose runs constantly. This is followed, if the drug is pushed, by the more positive signs of "iodism" spoken of under Iodine. In other cases acne breaks out on the face and disorders of digestion and gastric irritability come on. The acne can nearly always be pre- vented by giving arsenic at the same time with the iodide. In some cases petechial rashes break out on the legs, while in others great mental and physical depression appear, so that listlessness or melan- cholia may develop. Sometimes the iodide of ammonium or iodide of sodium will be borne when the iodide of potassium will not. If bullae or blebs follow the use of the iodides, or other rashes ap- pear, it is said that atropine will afford relief. Administration.—The iodide of potassium, owing to its exceedingly disagreeable taste, should be given with the compound syrup of sarsa- parilla, extract of licorice, or in milk. Large amounts of these vehicles are to be used. The dose varies from 5 to 60 grains, according to the condition of the patient. One of the best ways to take the drug is in capsule, but if this is done a drink of milk or water or other fluid should precede or follow it, in order to prevent the drug from coming in contact with the stomach in concentrated form. The preparations of the iodide of potassium are: TJnguentum Potassii Iodidi, TJ. S. aud B. P., and the liniment (Linimentum Potassii Iodidi cum Sapone, B. P.). IODINE. 189 IODIDE OF SODIUM. Sodii Iodidum, TJ. S. and B. P., is used iu the same doses and for the same purposes as the iodide of potassium. IODINE. Iodum, TJ. 8. and B. P., is a non-metallic element found largely in sea-weed aud in mineral iodates and iodides. It is soluble in ether and alcohol, but slightly so in water, and possesses an acrid burning taste and a neutral reaction. Physiological Action.—The physiological action of iodine, so far as its alterative powers are concerned, is absolutely unknown. Applied to the skin it stains it yellow, brown, or black according to the free- dom of its application, and it acts without pain if the skin is intact. If very large amounts are used it produces vesication. Upon mucous membranes iodine acts as a powerful irritant. Germain-See believes it to be a stimulant to the nutritive processes of the body and to the circulatory system, and he is certainly correct in regard to the influ- ence it exercises over nutrition. Elimination.—The drug escapes chiefly through the kidneys, the skin, the salivary glands, and it even appears in the milk of nursing women. Poisoning.—The symptoms of acute poisoning by iodine are those of acute gastro-euteritis with severe pain in the oesophagus, stomach, and abdomen, accompanied by violent vomiting and purging. An early symptom is the persistent strong metallic taste in the mouth, with markedly increased salivation. The pulse becomes rapid, run- ning and feeble, the face deathly pale, total arrest of urinary secretion takes place through renal irritation, and death occurs by failure of respiration, which is accompanied by loss of all vital power. If the poisoning is not severe enough to cause death at once, a fatal result is, nevertheless, often reached after a few days, by reason of a widespread fatty degeneration of the tissues. The treatment of the poisoning consists in the use of large amounts of starch in any of its forms as the antidote, the employment of emetics and the stomach-pump, the application of heat to the body and extremities, and, finally, the employment of hypodermic injections of alcohol, digitalis, ammonia, and atropine or strychnine for the pur- pose of maintaining the strength of the circulatory and respiratory system. Chronic Poisoning.—Under the name of " iodism " the profession recognizes a state of the body brought on by the prolonged and ex- cessive use of iodine in any of its forms. The earliest signs of this state are shown by a peculiar metallic taste in the mouth, particularly before breakfast, slight tenderness of the teeth and gums, increase of 190 DRUGS. salivary secretion, a little morning nausea and lack of appetite for breakfast, and perhaps some coryza or evidence of gastric irritation. Acne rosacea often comes on very early. If the drug is continued, all these symptoms become more marked and the coryza becomes in- tense. Headache under the frontal bone and sore-throat often appear, and the pustular and bleb-like changes in the skin go on to active suppuration. Sometimes large boils appear, or purpura haemorrhagica comes ou. In other cases the nervous system chiefly suffers. Twitchings of muscles, neuralgic pains in the trunk and extremities, and wasting of the testicles, mammae, and all other tissues occur, as the result of trophic disturbances. Anaemia amounting to an actual cachexia is commonly produced. Loss of vision and paralysis may ensue in ex- treme cases. Therapeutics.—In all cases where the system is iu a state of chronic perverted functional activity, as in those diseases associated with disorder of the processes of nutrition and often included under the single name of scrofulosis, iodine is of service. In enlargement of the lymph-glands it is, in its various forms, one of the best remedies we possess, but it ought not to be employed in those cases where rapid changes are going on in the gland, such as the formation of pus, since under these circumstances it will increase the size of the slough. The drug ought never to be used iu phthisis because it tends to disin- tegrate the tissues, and this is precisely what the disease is doing. In the exceedingly chronic form of pulmonary disease known as fibroid phthisis iodine may be used. AVhen inhaled in fumes it may be of service as a stimulant to the mucous membranes, but is never of value in phthisis otherwise. In countries where exophthalmic goitre is very prevalent iodine ranks as a most efficient remedy. In cystic enlargement of the thyroid gland it is valueless, but in simple hyper- trophy is of great value. In chronic bone disease iodine applied about the affected joint in the form of the ointment diluted one-half with lard, or in the pure tincture, will be found of service, and if anemia exists the syrup of the iodide of iron should be given internally. The other uses of iodine externally ate many and important. As a slow counter-irritant which does not produce pain if properly em- ployed, it is particularly useful in children, and may be employed in 1 to 3 coats, and no more. The proper way of using the tincture is to give one good black coat at one sitting, and not to repeat it until the skin has desquamated and become well renewed. If iodine is applied soon after one good effec- tive coat it will cause agonizing burning pain, which nothing will relieve except the removal of the iodine by the use of cologne-water, alcohol, whiskey, or gin. The application of any of the latter liquids causes such an increase in the pain as to be almost useless after the skin is broken. The best solution for its removal is one of iodide of potassium, which should be followed by a poultice. A good rule to iodine. 191 follow is never to cause pain by the use of iodine, as the drug acts equally well if applied iu such a way as to avoid suffering. Iodine iu the form of the tincture is applied as a counter-irritant paint in pleurisy, both to abort an attack and to aid in absorption of the fluid after it is thrown out into the chest. In harassing irritative cough it may be painted over the supra-clavicular spaces, and it will lessen the secretion in chronic bronchitis if used in this way. In chronic rheumatism affecting the joints and muscles it does good when locally applied. Often in synovitis the local application of iodine causes increased swelling for some days. This should not cause alarm, for ultimately the swelling decreases very greatly, and the cases in which this occurs are generally the best from a prognostic point of view. In the course of phthisis every now and then a " spot" in the chest will become " sore," probably due to a limited area of pleurisy, and, under these circumstances, tincture of iodine locally applied will give relief. In lupus the tincture may be painted around the edges of the growth, and even over its surface, with the object of retarding its spread. In chilblains an application of iodine ointment gives the greatest relief if diluted one-half with lard, and its use is probably the most efficacious measure at our disposal. In certain individuals who have " pains in the chest" iodine ointment may do good if applied over the spot. As has been pointed out by others, iodine does good if muscular tenderness is present, while it fails if pleurodynia or inter- costal neuralgia is the cause of the suffering. The latter troubles should be removed by the use of belladonna. In certain forms of skin diseases, such as tinea tonsurans and circinata, tincture of iodine may be applied with a camel's-hair brush, and even the entire scalp may be painted. A better way is to apply it to different spots each day. When erysipelas is present the tincture may be painted around the edges of the inflammation, in order to prevent its spread. In old persons, or those in middle life, retraction of the gums from the teeth sometimes comes ou, and Stille recommends for this disorder the use, by means of a camel's-hair brush, of a watery solution of iodine of the strength of 1 grain to the ounce, to be followed at once by a thorough rinsing of the mouth with pure water. In hydrocele iodine in the form of the tincture is the best remedy for effecting a permanent cure that we have. The sac should first be emptied by the use of a trocar and canula, and the iodine alone, or with glycerin, injected with a syringe, and then allowed to escape. As the pain is most atrocious, the patient should first be put partly or entirely under the influence of ether. In white swellings and ovarian tumors as much as 10 ounces of the tincture may be injected, but it is to be remembered that certain dan- gerous symptoms may arise. After its use in this way in the chest violent symptoms of poisoning have come on, in some cases the most common complication being convulsions. These are epileptiform in character and are followed by coma or collapse. 192 DRUGS. In empyema a solution of iodine 6 grains, iodide of potassium 6 grains, and water 1 pint, may be used daily as au irrigating fluid with good results. The tincture of iodine may be used, according to Riuger, as au inhalation, with signal benefit in the following four instances: 1. In the chronic forms of phthisis (fibroid lung); when the expec- toration is abundant, and when the cough is troublesome, its inhalation used both night aud morning will generally lessen the expectoration and allay the cough. 2. In children six to ten years of age, who after meals, or inde- pendently of them, on exposure to cold, are seized with hoarseness, a hoarse, hollow cough, and some wheezing at the chest. This affec- tion, involving the larynx, trachea, and larger bronchial tubes, and often proving very obstinate, is apt to return, and to persist a con- siderable time. 3. In some epidemics of diphtheria the inhalation recommended by Dr. Waring-Curran is of value, and consists of 4 grains of iodine and 4 ounces of water. A teaspoonful of this should be added to boiling water, and kept hot by a spirit lamp, whilst the steam is inhaled. As the patient becomes accustomed to the iodine the quantity of the solu- tion may be increased till half au ounce of it is used at each inhalation. It should be repeated many times a day, and each inhalation continued from 8 to 12 minutes. 4. Some persons suffer with itching of the nose, of the inner cauthus of one or both eyes, sneezing, running at the nose of a watery fluid, weeping of the eyes, and severe frontal headaches, and these patients of various ages are greatly troubled, often for many years, with daily attacks of this character lasting, it may be, several hours. Iodine inhaled often removes this affection at once, lessening the headache and discharge from the nostrils. Its effect is most marked in respect to the itching. Ringer generally adopts the following simple, handy, cleanly, aud effectual plan of inhalation: Heat well a jug capable of holding about two pints, by rinsing with boiling water, then partly fill with boiling water, into which pour 20 to 30 drops of the tincture of iodine, then direct the patient to put his face over the mouth of the jug and to breathe the iodized steam, covering the head to prevent the escape of the vapor. This inhalation should be used night and morning for five minutes, or a little longer. Occasionally an excess of iodine will temporarily produce a sensation of soreness in the chest and throat, accompanied with redness of the conjunctiva, running from the nose, and pain iu the head. Administration.—Iodine is never used iu solid form, and it has been taught that the tincture (Tinctura lodi, TJ. 8. and B. P.) should not be given internally, on the ground that it is precipitated in the stomach. AYhether this be true or false, it is a fact that the tincture has recently been largely used in the vomiting of pregnancy with very good results. The dose is 5 to 10 drops, well diluted. Under IODOFORM. 193 the name of Lugol's Solution (Liquor lodi Compositus, TJ. 8) iodine is frequently used internally ; the dose is 5 to 10 drops, in water. Ihe B. P. preparations not officinal in the U. 8. P. are the liniment {Linimentum lodi), the solution (Liquor lodi) and Vapor lodi, which is prepared by adding 1 fluidrachm of iodine to 1 fluidounce of water, which is gently heated, and the rising vapor inhaled. TJnguentum lodi, TJ. 8. and B. P., is used locally over enlarged glands. In the case of children or adults who have delicate skins the ointment should be diluted one-half with lard. Contra-indications.—Iodine is contra-indicated in renal diseases except in small doses, during the progress of acute inflammation, and whenever tissues are rapidly undergoing degenerative changes. IODOFORM. Iodoform (Iodoformum, TJ. 8. and B. P.) occurs in small saffron- colored crystals which possess a powerful characteristic penetrating odor, and strong taste. It is soluble iu alcohol, ether, chloroform, benzol, and in fixed and volatile oils, but is insoluble in water. Physiological Action.—AYhen iodoform is absorbed from the stomach, or from the skin from surgical dressings, it induces a train of serious and curious symptoms. Within half an hour iodine appears in the urine, and the evidences of its action assert themselves in one of two ways. One set of symptoms resembles meningitis. The face is suffused, the pupils contracted, the respiration stertorous, and the pulse slow and full, or rapid. Delirium of the wildest character may ensue so that the patient tears everything within reach. In another ^ class of cases the symptoms resemble those of cerebral congestion in the flushed face, contracted pupils, slow breathing, and low muttering delirium or perfect vocal quiet. Widespread fatty degeneration is found at the autopsy. The resemblance of the symptoms to cerebral congestion or menin- gitis should not mislead the physician into the belief that any head injury is present when a limb has been dressed with iodoform after an accident. _ Locally applied to mucous membranes the drug possesses very dis- tinct anaesthetic power. Therapeutics.—Iodoform is used chiefly as a surgical dressing. It is antiseptic, but not germicidal. Germs may be found in powdered iodoform, and will even grow in it. It does good by absorbing the liquids of the wound, and thereby removing the nidus for germ growth; aud when applied to large moist surfaces gives off free iodine and acts as a protective. In syphilitic sores the following dressing will be found of great service: Iodoform, 20 grains; oil of eucalyptus, \ fluidounce; or, a powder of—Iodoform \ an ounce, camphor 75 grains, and essence of 13 194 DRUGS. roses 2 drops, may be employed. In eczema, with tingling and itch- ing, the following application will give relief (Ringer) : R.—Iodoformi........gr. iv. Olei eucalypti.......f £j. Petrolati........|j. M. S.—Apply locally. Internally, iodoform is used in tertiary syphilis in all its forms, in the dose of from 1 to 5 grains. Bartholow recommends it most highly in catarrhal jaundice and in the early stages of hepatic cir- rhosis; indeed, he thinks its persistent use in small dose will cure this affection. Used by means of a powder-blower it will often relieve the hoarseness and discomfort of laryngeal phthisis. Sometimes a spray may be used, which should consist of spirits of turpentine and sweet oil, half and half, and contain 2 grains of iodoform to each ounce. This mixture may also be used in bronchial catarrh to lessen the cough and foetid discharge. In the early stages of phthisis several clinicians claim to have reached very good results by the daily hypodermic injection into the back of 30 minims of a 1 to 100 solu- tion of iodoform in oil of sweet almonds. In fissure of the anus 5 grains of iodoform in a suppository may be placed in the rectum, aud after it has remained there a few minutes, defaecation may be had without pain. Administration.—The ointment (TJnguentum Iodoformi, TJ. S. and B. P.) is useful when applied over foetid sores. The drug itself may be given in 1 to 5-grain doses three times a day. The suppositories (Suppositoria Iodoformi) are officinal in the B. P.; each one contains 3 grains of iodoform. IODOL. This is a dark, dirty-yellowish-looking powder, soluble in alcohol, ether, and oils, but only slightly so in water. Its uses in medicine are identical with those of iodoform, and it possesses the advantage of being not so penetrating in odor as the latter drug. In tubercular laryngitis the powder may be blown into the larynx without disagreeable results and with a favorable effect on the dis- eased process. Cerna has found iodol of very great service in diabetes when given internally, in the dose of from 2 to 6 grains three times a day and it is said to be of value in tertiary syphilis in the same quantity. A very useful antiseptic dressing for small wounds and abrasions is made by adding 1 part of iodol to 10 parts of ether and 5 of gun- cotton, thereby preparing an iodol collodion. IPECACUANHA. 195 IPECACUANHA. Ipecacuanha, TJ. 8. and B. P., or Ipecac, is the root of Cephaelis Ipecacuanha, a small shrub of Brazil. It contains an alkaloid, eme- tine, and ipecacuanhic acid. Physiological Action.—Locally applied to mucous membranes ipecac acts as an irritant, and if applied for a long period to the skin produces vesicles and irritation. Very minute doses have little noticeable effect, but large ones produce nausea, relaxation, vomiting, free secretion into the bronchial tubes, and a profuse flow of saliva. The emesis is due both to the irritation of the stomach and to an effect upon the vomiting centre in the medulla. If emetine is given in lethal dose death is due to failure of respi- ration. Therapeutics.—Ipecac is used as an emetic where a fairly rapid action is required. It is particularly useful in cases where the stomach of a child is overloaded with food. In cases of poisoning it is hardly active or rapid enough as an emetic and is not as good as mustard or sulphate of zinc. In babies and young children an attack of bron- chitis often causes digestive disorders, by reason of the mucus coughed up from the lungs being at once swallowed instead of spit out of the mouth. In these cases the stomach may be relieved and the state of the lungs improved by the use of an emetic dose of syrup of ipecac. (Dose, 2 to 3 drachms.) In obstinate vomiting small doses will act as a most successful cure, provided that the vomiting is due not to inflammation and excitement, but to depression. The irritant effect of the ipecac stimulates the depressed organ up to a normal tone. In some cases of the vomiting of pregnancy it is very useful, in others it utterly fails. One drop of the wine or one or two grains of the powdered ipecac is all that should be used. In vomiting with flatulence, either ipecac or nux vomica is of service. In the morning vomiting of drunkards, ipecac is of service, but it is not so good a remedy as small amounts of arsenic or hydrochloric acid. In acute true dysentery, ipecac is the best remedy we possess. When the passages are large and bilious and the disease is malignant, as it occurs in the tropics, ipecac should be given in the following manner : The powdered ipecac is to be administered in the dose of 60 grains at once to produce vomiting. After vomiting has taken place, small doses of 3 grains are to be given every hour and continued until a profuse black stool is passed. The passage of this stool is a most favorable prognostic sign, and its non-appearance is equally significant of danger. In choleraic diarrheas aud cholera morbus ipecac is often of great service in the dose of 3 grains every two hours. No less a person than the great Trousseau asserted that ipecac was a hemostatic, and it is said to be the most effective remedy in haemoptysis in small doses. 196 DRUGS. As an expectorant, ipecac is to be used in the early stages of bron- chitis, to act as a sedative to the inflamed mucous membrane and to promote secretion. Under these circumstances it is best combined with citrate of potassium (see Bronchitis). Ringer and Murrell have found that inhaling ipecac spray is very useful in chronic winter cough or bronchitis, particularly when there is shortness of breath present. The pure wine may be used in a spray apparatus, or be diluted one-half with water. While the throat may seem temporarily worse, the shortness of breath rapidly decreases, and a great improvement takes place in the cough. In order to prevent the wine which collects in the mouth from being swallowed, the patient should be directed to rinse his mouth thoroughly every few minutes lest nausea and vomiting be produced. The inhalation should not last at first over three or four minutes, and, until it is known how well the patient will bear the application, the wine should be diluted twice or thrice. Administration.—The syrup (Syrupus Ipecacuanhe, TJ. 8.) is given in the dose of J to 1 drachm as an expectorant, or in the same dose as au emetic to an infant. The wine ( Vinum Ipecacuanhe, TJ. 8. and B. P.) is given in the same dose as the syrup, the fluid extract (Ex- tractum Ipecacuanhe Fluidum, TJ. S.) in the dose of 30 drops as an emetic to an adult, and the troches (Trochisci Ipecacuanhe, TJ. 8. and B. P.), J of a grain each. Trochisci Morphine et Ipecacuanhe, TJ. 8. and B. P., containing -^ of a grain of morphine and -fy of a grain of ipecac, are used in sore-throat, dissolved in the mouth. Dover's powder (Pulvis Ipecacuanhe et Opii, TJ. S., Pulvis Ipecacuanhe Compositus, B. P.) is given in the dose of 5 to 15 grains. Emetine may be given in the dose of -^ to \ grain as an emetic. The pill of ipecac and squill (Pilula Ipecacuanhe cum Scilla, B. P.) is given in the dose of 5 to 10 grains. IRON. Iron (Ferrum, TJ. S. and B. P.) is a metal and a food. A food because it forms part of the body when taken into the organism and is used by the system in the making of blood. The number of its officinal salts and compounds is absurd, and half the list is rarely, if ever, used. Physiological Action.—Iron has little or no effect upon the system when given in a single dose, but repeated doses cause au increase in the number of red blood-corpuscles, aud plethora, or an increase in the quantity and quality of the blood. Iron is eliminated from the system by the liver, and perhaps by the kidneys. If given in excessive doses it is changed into the sulphide in the bowels, and escapes with the faeces. ^ It has been asserted that it is never released from the body, but this is untrue. Whether it acts as a stimulant to blood manu- facture, or simply supplies the glands with blood-making material, iron. 197 we do not know. Iron probably increases the activity of the body to some extent, and thereby causes oxidation to go on more rapidly by reason of its peculiar power of converting oxygen into ozone. The studies of Skvortzoff are interesting in connection with this subject. He found: 1. That iron has no marked influence on nitrogenous meta- morphosis in the healthy body. 2. The ingestion of iron iu daily doses of 0.02 to 0.03 gramme'(0.3 to 0.5 grain) causes a very slight decrease in the assimilation of the nitrogenous portions of the food. 3. After bleeding, the assimilation of nitrogenous substances increases a little, whether iron is used or not; but if iron is used at this time the haemoglobin is rapidly reproduced, and the drug would seem to be of value in restoring the bodily weight. The preparations of iron consist in the soluble and insoluble salts or forms.^ Of these the insoluble are probably better thau the soluble, but this is by no means to be thought a universally recognized fact. Therapeutics.—The chief indication for iron is anemia (see Anaemia), and its contra-indication is plethora. When used in small dose (J to 1 grain), it is quite as efficacions as in large amounts, and less apt to disorder the stomach. In some cases of anaemia of a semi- pernicious type large doses of iron are really needed, probably because the system is deranged in such a manner that an excessive loss or destruction of iron is constantly present. Large doses compensate for this leakage and afford the quantity needed for physiological purposes. It should not be used as a tonic unless some direct indication for its employment is present, and no drug is more abused in this respect than iron. As each of its preparations possesses some peculiarity, the use of each will be considered separately. Ammonio-ferric Alum. Ammonio-ferric Alum (Ferri et Ammonii Sidphas, TJ. 8.) is often given in cases of atonic leucorrhea in the dose of 2 to 5 grains. It is quite astringent. Aromatic Mixture of Iron. The Aromatic Mixture of Iron (Mistura Ferri Aromatica, B. P.) contains so little iron that it should not be administered in cases where a chalybeate influence is desired; it is, however, a useful tonic, given in the dose of 1 to 2 fluidounces. Arseniate of Iron. Arseniate of Iron (Ferri Arsenias, B. P.) is used in the dose of J_ to Jt% grain in anaemic subjects who are suffering from skin diseases. 198 DRUGS. Basham's Mixture. Under the name Basham's Mixture (Mistura Ferri et Ammonii Acetatis, TJ. 8.), a very useful and elegant preparation of iron is em- ployed. It is made up as follows : Tincture of chloride of iron ... 2 parts. Dilute acetic acid.....3 " Spirits of Mindererus . . . . . 20 " Elixir of orange......10 " Syrup ........15 " Water........50 " The dose is from 1 to 8 drachms well diluted, aud it acts as a diuretic, diaphoretic, aud chalybeate. Bromide of Iron. Bromide of Iron (Ferri Bromidum) is said by Da Costa to be useful in anemia, when this state is associated with chorea, in the dose of 5 to 20 grains given in syrup. In other nervous diseases accompanied by anaemia aud insomnia the syrup of the bromide of iron (Syrupus Ferri Bromidi, TJ. S.) is useful in the dose of \ to 1 fluidrachm. Carbonate of Iron. The Carbonate of Iron (Ferri Carbonas Saccharatus, TJ. 8. and B. P.) is very slightly astringent, and may be used in pill form under the name of Pilule Ferri Composite, TJ. S., or in Griffith's pills, which also contain myrrh. The dose is 3 grains, and this preparation of iron may be largely used for the treatment of amenorrhcea dependent upon anaemia. Under the name of Mistura Ferri Composita, TJ. 8. and B. P., we have a liquid preparation used for the same purposes as the pills, in the dose of 1 to 2 tablespoonfuls. Pilula Ferri Carbonatis, B. P., are given in doses amounting to 5 to 20 grains. Chloride of Iron. Tincture of the Chloride of Iron (Tinctura Ferri Chloridi, TJ. S.), often called tincture of the muriate of iron, is one of the best and most useful preparations of iron that we have. It is the most diuretic preparation of iron. This diuretic effect does not depend upon the presence of a muriatic ether, as has heretofore beeu taught, since hydrochloric ether is not present, aud is hard to prepare except there be an excess of chlorine present. According to some researches of Dr. S. Weir Mitchell, the only ether present is nitrous ether, and this is devoid of power and in small quantity. As chloride of iron itself is diuretic, it is probably upon this that the diuresis produced by it depends. The dose of the chloride of iron (Ferri Chloridum, TJ. S.) is 1 to 3 grains. Tincture of the chloride of iron is considered a IRON. 199 specific in erysipelas, and should be given in very full dose and frequently repeated if it is to be of any service. Ten drops every hour is not too much. Iu chronic Bright'8 disease it is of value and decreases the albuminuria. In anemia it is useful, and owing to its acid is a doubly effective tonic. In cases of slight anaemia in which very great arterial pressure exists Dr. Mitchell uses a purely milk diet, and an ounce of an old tincture of iron iu the twenty-four hours. While he recognizes the fact that iron preparations are generally sup- posed to raise blood-pressure, he asserts that iu this instance the blood- pressure is lowered. The dose of Liquor Ferri Chloridi is 4 to 10 drops. It is rarely used internally, but chiefly as an astringent of great power. Liquor Ferri Chloridi is identical with Liquor Ferri Perchloridi, B. P. Tinctura Ferri Perchloridi, B. P., is used inter- nally in the dose of 10 to 20 minims. As a local application tincture of the chloride of iron is useful in diphtheria and membranous croup, and even in tonsillitis. In each of these maladies large doses of the tincture internally with counter-irri- tation over the neck are most useful. AYhen used internally it should be well diluted and taken through a glass tube to protect the teeth. The strong solution of perchloride of iron (Liquor Ferri Perchloridi Fortior, B. P.) is a powerful styptic. Citrates and Tartrates of Iron. The four citrates of iron are soluble in water and very useful for this reason. Ferri Citras, TJ. S., and Ferri et Ammonii Citras, TJ. 8. and B. P., occur in garnet-red scales and are given in the dose of 5 grains. The solution of the citrate of iron (Liquor Ferri Citratis, TJ. 8.) is given in the dose of 10 minims. The Ferri et Quinine Citras, TJ. S. and B. P., and the Ferri et Strychnine Citras, TJ. S. and B. P., are given in the dose of 5 to 15 grains and 1 to 3 grains respectively. The solution of iron and quinine (Liquor Ferri et Quinine Citratis, TJ. S.) is given in the dose of 8 to 15 minims. Beside these citrates there are two tartrates—Ferri et Ammonii Tartras, TJ. 8., and Ferri et Potassii Tartras, TJ. S.; and Ferrum Tar- taratum, B. P., all given in the dose of 5 grains. Dialyzed Iron. Dialyzed Iron (Ferri Dialyzatum) is a very feeble preparation of iron, lacking in astriugency, easily precipitated from the solution in which it occurs; it is largely used in anemia by some practitioners. The dose is 10 to 20 drops iu water three times a day. Sometimes river water, if it contains much inorganic or organic matter, will pre- cipitate it. Owing to the instability of dialyzed iron it may be used without any preparation as au antidote to arsenic. Liquor Ferri Dialyzatus, B. P., is given in the dose of 10 to 30 minims. 200 DRUGS. Hydrated Sesquioxide of Iron. Hydrated Sesquioxide of Iron (Ferri Oxidum Hydratum, TJ. S.) is the antidote to arsenic, but to be efficacious it must be freshly prepared. It is to be made by precipitating any liquid preparation of iron by the addition of an alkali such as ammonia, or by the addition of mag- nesium. If ammonia is used, the precipitate has to be washed with water several times to get rid of the alkali, which will render the antidote too irritant to be swallowed if it is allowed to remain with the precipitate. Magnesium is an antidote in itself and should be preferred under all circumstances. The antidote should be given in excess aud as much as a pint of the iron solution should be precipi- tated. The magnesium should be freely added, as too much of it cannot be given. The officinal antidote to arsenic is Ferri Oxidum cum Magnesio, TJ. 8. In the Prussian Pharmacopoeia this is known as the Antidotum Arsenici. Iodide of Iron. The Syrup of the Iodide of Iron.(Syrupus lerri Iodidi, TJ. 8. and B. P.) is a transparent liquid of a sweet, iron-like taste. It should contain no free iodine, and if it strikes a blue color with starch should be discarded. It is largely used in anaemia associated with scrofulosis and struma, and is useful in the eczema of young children when this is dependent upon lack of vitality or anaemia. The dose to a child of two years is 2 to 3 drops well diluted, and to an adult 30 to 40 drops in water, to be taken through a glass tube to protect the teeth. The saccharated iodide of iron (Ferri Iodidum Saccharatum, TJ. 8.) is used in place of the syrup in the dose of 2 to 5 grains. The officinal pills (Pilula Ferri Iodidi, TJ. S. and B. P.), each contain ^ of a grain of reduced iron and -|- of a grain of iodine, and are given in the dose of 1 to 3 pills. Lactate of Iron. The Lactate of Iron (lerri Lactas, TJ. S.) is soluble in forty-eight parts of water, and is given in the dose of 5 grains. Lactate of iron is one of the ingredients of Syrupus Hypophosphitum cum Ferro, TJ. S., the dose of which is \ to 1 fluidrachm. Monsel's Solution. Monsel's Solution (Liquor Ferri Subsulphatis, U. 8.), sometimes wrongly called persulphate of iron, is one of the most powerful styptics or haemostatics that we have. It is never to be employed where a haemorrhage is to be attacked through the circulation, but only when the solution can come in direct contact with the bleeding spot. IRON. ' 201 The objection to its use is the heavy, black, aud dirty clot which it forms on coming in contact with the blood. In hemoptysis Monsel's Solution should be used in fine spray consisting of from 10 to 60 drops to the ounce of distilled water. In uterine hemorrhage from any cause the dilution may be half-and-half, or if the hemorrhage be from a polypus or the cervex uteri the pure solution should be used, locally applied. In nose-bleed Monsel's Solution may be employed diluted one-half or pure, but it is disagreeable because of the hard, black clot which is formed and the uncomfortable sensations produced in the nasal chambers. Plugging the nostrils with pledgets of cotton is generally sufficiently efficacious. In the intestinal hemorrhage occurring during or after typhoid fever Monsel's Solution has been, but ought not to be, given, as it is decom- posed in the stomach before it reaches the intestine. Monsel's Salt (Ferri Subsulphatis) should be given in pills of 3 grains each, the pills being made hard enough to escape into the intestine before the stomach breaks them down. One, two, or three pills may be given and repeated in an hour. Hematemesis due to bleeding in the stomach should be treated by 3-drop doses of the solution in a little water. In tonsillitis and pharyngitis a most efficient application is pure Monsel's Solution applied by means of a pledget of cotton or camel's- hair brush; or equal parts of the solution and glycerin may be used. This application is often as painful as it is efficient. In diphtheria this method of treatment is often of great service. The antidote to Monsel's Solution is common soap. Oxalate of Iron. Oxalate of Iron (Ferri Oxalas, TJ. 8.) is given iu the dose of 2 to 3 grains. Phosphates of Iron. There are two phosphates of iron, Ferri Phosphas, TJ. 8. and B. P., and Ferri Pyrophosphas, TJ. S. The first of these is insoluble and is rarely used. The second is quite soluble and useful in the dose of 2 to 5 grains. Syrupus Ferri Phosphatis, B. P., is given in the dose of 1 fluidrachm. Phosphate of iron is one of the ingredients of the syrup of iron, quinine, and strychnine (Syrupus Ferri, Quinine et Strychnine Phosphatum, TJ. 8.), and is given in the dose of 1 fluid- drachm. Reduced Iron. Quevenne's Iron (Ferrum Redactum, TJ. 8. aud B. P.) is an iron- gray or reddish powder which is frequently adulterated with lamp- black. If it is pure it should burn in sparks when dropped into a flame, but if lampblack is present this will not occur. It should also yield no sulphuretted hydrogen on adding sulphuric acid to it. It is 202 DRUGS. tasteless, and may be given to children for this reason in pills or gum-drops, or placed inside of small chocolate creams, or in the form of troches (Trochisci Ferri Redacti, B. P.), each lozenge containing 1 grain of the reduced iron. It is used solely in anaemia and is one of the least astringent of the iron preparations. Sulphate of Iron. Sulphate of Iron (Ferri Sulphas, TJ. 8. and B. P.) is used internally in the dose of 5 grains in pill form in chronic diarrhea. Externally, in a solution of the strength of 5 to 25 grains to the ounce, it is used as an astringent lotion. Two other forms of the sulphate are also employed, namely, the dried (Ferri Sulphas Exsiccatus, TJ. 8. and B. P.) and the precipitated (Ferri Sulphas Precipitatis, TJ. S.) or (Ferri Sulphas Granidaia, B. P.), each of which is given in the dose of 3 grains. Valerianate of Iron. Valerianate of Iron (Ferri Valerianas, TJ. S.) is sometimes useful in hysteria with anaemia, given in the dose of 1 grain or more. Wines of Iron. The Bitter Wine of Iron ( Vinum Ferri Amarum, B. P.) is useful in anemia, both in children and adults, and may be advantageously accompanied with cod-liver oil. It is given in a dose of 1 to 2 fluid- drachms or more. This wine is composed of soluble citrate of iron and quinine, tincture of sweet orange-peel, syrup, and stronger white wine. AYine of the Citrate of Iron, or Vinum Ferri Citratis, TJ. 8., is com- posed of the citrate of iron and ammonium, tincture of sweet orange- peel, syrup, and stronger white wine. The dose is identical with that of the bitter wine, and it is used for the same purposes. Hydrated Peroxide of Iron (Ferri Peroxidum Hydratum, B. P.) is used in the dose of 5 to 30 grains. From the last preparation iron plaster (Emplastrum Ferri, B. P.) is made. The plaster of iron officinal in the TJ. S. is prepared from the hydrated oxide of iron. The following preparations of iron are also officinal: Liquor Ferri Acetatis, TJ. 8., dose 15 minims to 1 fluidrachm; Liquor Ferri Acetatis Fortior, B. P., dose 1 to 8 minims; and Basham's Mixture (see page 198). Untoward Effects of Iron.—Iron is apt to cause gastric distress and frontal headache in persons who are susceptible to its use. Even one dose will cause this trouble in some persons. In many instances the frontal headache will be found to be due to the constipation which has JEQUIRITY. 203 been brought on by the iron, and will be relieved if mild laxatives or purges are used. The state of the bowels should always be watched and laxatives given whenever constipation is present and iron is being administered. In rheumatic and gouty persons frontal headaches are a common symptom when iron is given, and purgatives will not gen- erally give relief. Sometimes salts of iron produce vesical irritation and a constant desire to urinate, causing mucus to form in abnormal amount in the bladder. Iu children its use may result in nocturnal incontinence of urine. JALAP. Jalap (Jalapa, TJ. S. and B. P.) is the root of Exogonium Purga, a native of Mexico. It contains two resins, jalapin and convolvulin, neither of which is used in medicine by itself, though both of them enter into the Resin of Jalap of the TJ. S. P. In overdose jalap or its resin causes vomiting and purging, with gastro-enteritis. Therapeutics.—Jalap is used in medicine as a hydragogue purge to relieve dropsy of any origin. It may be used to deplete in cases of general plethora with cerebral congestion, and owing to its tastelessness is a useful cathartic in children if given in the proper dose, namely, 1 to 2 grains in half an ounce of syrup of rhubarb. Combined with calomel it is preferred to all other purges by some practitioners, par- ticularly if the liver is torpid. Administration.—Jalap may be given iu the form of the compound powder (Pulvis Jalape Compositus, TJ. 8. and B. P.), dose 15 to 40 grains; as the abstract (Abstractum Jalape, TJ. S.), dose 5 to 15 grains ; and the resin (Resina Jalapxe, TJ. S. and B. P.), dose for an adult, 2 to 4 grains. Owing to the small size of the dose of the resin and its lack of taste, this preparation is to be preferred for children in the dose of | to | a grain. The tincture (Tinctura Jalape, B. P.) is given in the dose of \ to 1 fluidrachm ; the extract (Extractum Jalape, B. P.) is used iu the dose of 5 to 15 grains. JEQUIRITY. This is a plant known as Abrus Precatorius, the seeds of which are poisonous. Jequirity is never used internally in medicine in this country. In the proportion of 8 grains of the powdered seeds to an ounce of distilled water, jequirity is sometimes dropped into the eye in cases of chronic granular conjunctivitis, in order to produce an acute diphtheritic inflammation which will so change the chronic process present as to permit of a cure. The solution undergoes decomposition with great rapidity, and should be prepared freshly each time it is used, or 4 to 8 grains of boric acid added to preserve it. The drug is a powerful cardiac depressant poison. 204 DRUGS. JUNIPER. Juniperus, TJ. S., is the fruit or berry of Juniperus Communis, an evergreen of Northern Europe and America. It contains a volatile oil and au amorphous principle, juniperin. Physiological Action.—Juniper acts as a gastric stimulant and tonic, as a mild diaphoretic if combined with alcohol, and as a marked stim- ulating, exciting diuretic. It escapes from the body by the kidneys. Therapeutics.—Juniper is valuable as a stimulant to the genito- urinary system wherever it is depressed or chronically diseased, as in chronic pyelitis, nephritis, and chronic catarrh of the bladder. In con- gestion of the kidneys, if not accompanied by active tissue changes, it relieves these organs and does away with albuminuria. Used after an attack of acute Bright's disease, when reaction has set in and the secreting epithelium of the kidney is atonic, it is of value; but care should be taken that all inflammation has passed by or it will make the patient worse. In the later stages of scarlet fever, in which the renal condition corresponds to that just described, juniper is useful In old persons a sensation of weight across the lumbar region is often readily removed by the use of juniper if the kidneys are inactive. Administration.—Juniper is used in the form of the compound spirit (Spiritus Juniperi Compositus, TJ. S.), composed of the oils of juniper, caraway, and fenuel, combined with alcohol and water, in the dose of 1 to 4 drachms. Gin is virtually identical with the compound spirit. The infusion of juniper is made by adding an ounce of the berries to a pint of boiling water and allowing it to stand in a warm place for an' hour. The entire quantity is to be taken in twenty-four hours aud the infusion is often combined with acetate of potassium or an ounce of the bitartrate of potassium in the treatment of dropsy. The spirit (Spiritus Juniperi, TJ. S. and B. P.) is given in the dose of 30 minims to 1 drachm. The oil (Oleum Juniperi, TJ. S. and B. P.) is used in the dose of 1 to 4 minims. KAMALA. Kamala, TJ. S. and B. P., or Rottlera, as it is sometimes called, is the hairs and bristles from the capsules of Rottlera Tinctoria, a plant of Abyssinia, India, and China. It contains an active principle, rottlerin, which is not officinal. Given in the dose of 1 to 2 drachms kamala acts as a drastic and as a remedy for tapeworm. It should be administered in syrup, and repeated in eight hours if no effect is produced. (See Worms.) KINO. Kino is the inspissated juice of the Pterocarpus Marsupium, a tall tree of India. It contains kino-tannic acid and is used as an astrin- LEAD. 205 gent in serous diarrheas. It is officinal in the form of the tincture (Tinctura Kino, TJ. S. and B. P.) and is given in the dose of 1 fluid- drachm. Kino may be used as a gargle in sore-throat and for relax- ation of the uvula. Under the name of compound powder of kino (Pul- vis Kino Compositus, B. P.) an efficient aud pleasant anti-diarrhea powder is used. This powder is not officinal in the TJ. 8. P. The formula for each powder is 15 grains of powdered kino, 4 of powdered cinnamon, aud 1 of powdered opium. KRAMERIA. Krameria, TJ. S., Kramerie Radix, B. P., sometimes called Rha- tany, is the root of Krameria Triandra and Krameria Tomentosa, shrubs of Peru and Xew Granada, and is employed in serous diar- rheas with good effect. The tincture (Tinctura Kramerie, TJ. 8. and B. P.) is given in the dose of 1 drachm, the solid extract (Extractum Kramerie, TJ. S. and B. P.) 5 to 10 grains, the fluid extract (Ex- tractum Kramerie Fluidum, TJ. 8.), dose 10 to 20 drops, and the syrup (Syrupus Kramerie, TJ. S.), dose 1 ounce. The troches (Trochisci Kramerie, TJ. S.) are held in the mouth for the purpose of producing a local astringent effect. An infusion (Infusum Kramerie) is officinal in the B. P., dose 1 to 2 ounces. LANOLIN. Lanolin is a fat derived from the wool of the common sheep and is supposed to possess very remarkable penetrating powers when applied to the skin in cases where much infiltration is present, par- ticularly if it is combined with resorciu or some similar medicament. In itself it has little curative power, and is no better than lard, oil, or any common fat. Iu some cases, which are rare, it will cause irritation of the skin. LEAD. Plumbum, or Lead, is a metal possessing more or less power over the organism according to the salts which are employed. It is not officinal as lead itself. Physiological Action.—Lead in one of its soluble salts, if applied to a mucous membrane, produces a bleaching which is particularly noticeable where the redness of inflammation has previously existed. It has little effect in single dose except by an indirect influence over the circulation, nervous system, or respiration. For a description of the effects of overdoses see Poisoning by Lead, below. The most irritant and poisonous salt is the nitrate, the next the subacetate, and the least poisonous of the soluble salts is the acetate. 206 DRUGS. Acute Poisoning.—AYhen the acetate of lead is takeu iu poisonous amounts it produces a sweet metallic taste in the mouth, followed by pain in the epigastrium and the vomiting of white, milky-looking liquids or white curds mixed with food. The white color is due to the presence of chloride of lead formed by the action of the gastric juice. The pain continually increases, and diarrhoea due to gastro-enteritis may be set up, or, in other cases, obstinate constipation is present. The passages are generally black, this being due to the presence of the sulphide of lead. At the same time the pulse becomes rapid, tense, and cord-like, but after a time weak and relaxed. The face is anxious and pale, or livid. The thirst is excessive and cramps in the calves of the legs or muscular twitchings may ensue. It is said that the characteristic blue line on the gums may appear in acute poisoning, but this is not based on fact. If coma comes on, death is assured. The treatment consists in the use of the chemical antidote, a soluble sulphate, in large quantity, in the administration of emetics and the use of the stomach-pump if the vomiting produced by the drug is not sufficient to rid the stomach of all the poison. The best soluble sulphates to employ are Epsom and Glauber salts, because they are always at hand, are readily soluble, and, in excess, act as purges, which will wash out the intestinal canal. Hot applications should be applied to the belly and feet, and the pain and irritation which is present relieved by opium. Chronic Poisoning.—Chronic lead-poisoning is rarely produced by the soluble salts of lead, nearly always being due to the insoluble salts. The symptoms of chronic lead-poisoning or plumbism are as various as it is possible to find variety in the signs of disease of every kind. There is no train of symptoms which may not occur, and the occur- rence of rare, anomalous symptoms in a given case should at once bring to the mind the thought of lead-poisoning or syphilis. Chronic poisoning occurs in painters, manufacturers of lead salts, and every one who is largely thrown in contact with the metal in the arts. It occurs from the use of hair-dyes containing the acetate of lead, from drink- ing-water which has passed through new lead pipe, and even from the biting of silk threads loaded with lead to increase their weight. Chro- mate of lead has been used to color sponge-cake, when eggs were thought too dear, and has killed many persons. Millers, who have filled the holes in grindstones with lead, have caused widespread epidemics of what has been called " dry cholera," and many persons have suffered from lead-poisoning on eating apple-butter kept in jars glazed with lead. The most prominent, but by uo means the most constant symptom of chronic plumbism, is bilateral wrist-drop, due to palsy of the extensor muscles of the forearm. The short extensor of the thumb generally escapes the drug's influence. Sometimes internal squint arises from paralysis of the external rectus muscles. Another very LEAD. 207 common symptom is colic centering around the umbilicus and ra- diating through the belly aud loins. Obstiuate constipation often accompanies these symptoms, and the faeces, when passed, are white and clay-colored. During an attack of lead-colic the arterial tension is increased very markedly, the tongue is coated and whitish, and the bowels are obstinately confined. If these early warnings are disregarded and the exposure to the lead is continued, cerebral symptoms come on, the result of encepha- lopathia satumina or saturnine cerebritis. Saturnine epilepsy is not very rare. If convulsions come on death generally ensues. The con- vulsions in some cases are not due to a cerebral effect of the lead, but to uraemia from the renal changes which it has caused. Renal disease is very commonly produced by lead, and it is not uncommon for chronic contracted kidney to be found at the autopsy of a sufferer from lead-poisoning. If a patient with chronic lead- poisoning have a urine with a persistent low specific gravity, the prognosis is grave as evidencing advanced kidney involvement. Asthma, due to the inhalation of lead-dust, is sometimes met with. The most important confirmatory evidence of chronic lead-poisoning is a blue line on the gums just where they join the teeth. Its absence is not a negative sign, however, as poisoned persons cleanly in respect to their mouths often do not have it. Marked cachexia or anaemia is commonly seen in chronic lead-poisoning. After prolonged lead-poisoning the nerve-trunks are found atrophied and finally changed into fibrous cords. Polio-myelitis, anterior or posterior, may be present, and locomotor ataxia is commonly caused. It is said that the locomotor ataxia produced by lead may be dis- tinguished from the idiopathic form by the fact that in lead-poisoning the sphincters are affected, while in the non-toxic variety they escape. In some cases trophic changes iu the joints ensue, and plumbic gout is not rarely seen, or even lead arthralgia with urate of sodium deposits in the joints. Lead escapes from the body in the urine, the faeces, and all the secretions. It is chiefly eliminated by the liver and the bile. Treatment of Chronic Poisoning.—The treatment consists in three classes of remedial measures: 1st, the removal of the cause ; 2d, the removal of the poison in the body ; and, 3d, the treatment of the lesions produced by the poison. In lead-colic hepatic purges, such as jalap and calomel, combined with opium to prevent pain, are indicated, and alum and opium, or morphine, are said to be almost specifics, the alum in two-grain doses, the others in full amounts. In the cerebral inflammation of lead-poisoning a blister to the back of the neck revulsives, and a pilocarpine sweat may be resorted to. To aid in the elimination of the lead, iodide of potassium, which forms double soluble salts in the tissues with the metal, is to be used, 10 to 20 grains three times a day. 208 DRUGS. If progressive paralysis is present AYood insists on the use of large doses of strychnine at the same time that the iodide is given. The strychnine should not, of course, be given with the iodide, as it is incompatible. Electricity should be used as a remedy to restore lost function. If the faradic current makes the muscles contract it should be em- ployed, and, if not, the galvanic should be used. Curiously enough, voluntary power sometimes returns before the muscles will react at all to electricity. It is said that baths of sulphuret of potassium should be used; 5 or 6 ounces of the salt to each bath, which is to be given in a wooden tub. The patient should afterward be well soaped, then thoroughly rinsed off, and rubbed down with a rough towel. As the salts of lead are used for different purposes the therapeutics of each one will be taken up separately. Acetate of Lead. Acetate of Lead (Plumbi Acetas, TJ. S. and B. P.), or sugar of lead, has a sweet, astringent taste, and is soluble in water, although the solution formed is slightly milky in appearance. Therapeutics.—Acetate of lead may be used, and is largely em- ployed, in the following pill in the treatment of serous diarrhea: R.—Plumbi acetat........gr. xl. Pulv. opii........gr. x. Camphora?........gr- xl. M. Ft. in pil. no. xx. S.—One every four hours. This pill may be given in dysentery. Administration.—The B. P. recognizes the following preparations of lead acetate (Pilula Plumbi cum Opio), dose 3 to 5 grains; Sup- positoria Plumbi Composita, each suppository containing 1 grain of opium to 3 grains of lead acetate; and an ointment (TJnguentum Plumbi Acetatis). Carbonate of Lead. Carbonate of Lead (Plumbi Carbonas, TJ. S. and B. P.) is insoluble, and is used as a coating or dressing for burns, scalds, or ulcers, when rubbed up with linseed or other oil, or in the form of the ointment (TJnguentum Plumbi Carbonatis, TJ. S. and B. P.). If a wide surface is covered with this ointment it may cause lead-poisoning by ab- sorption. Carbonate of lead may be used in the treatment of sunburn in the following prescription : IJ.—Plumbi carbonat........3j- Pulv. amyli........3j. Unguent, aquae rosaa . . . . . ^j, Olei olivse........f^ij. M. S.—Apply to the inflamed skin. LEAD. 209 Iodide of Lead. Iodide of Lead (Plumbum Iodidum, TJ. 8. and B. P.) is occasionally employed in medicine; the dose is | to 2 grains. Emplastrum Plumbi Iodidi, B. P., and TJnguentum Plumbi Iodidi, TJ 8. and B. P., are useful as external astringent aud alterative applications. Liquor Plumbi Subacetatis. Liquor Plumbi Subacetatis, TJ. S. and B. P., or Goulard's Extract, is a colorless liquid, much used externally, when diluted, with lauda- num, for sprains, bruises, and local inflammations, under the name of " lead-water and laudanum." The proportion should be 4 parts of the pure lead-water, diluted with 16 parts of water, to 1 of laudanum, but this is varied as the inflammation or pain is the more severe. The officinal liquor is also officinal in a dilute solution (Liquor Plumbi Subacetatis Dihdus, TJ. S. and B. P.), and, as such, is too weak for ordinary use, although it is commonly employed. The strong solution should be used iu the strength of from 1 to 4 ounces to the pint of water. This solution should never be employed if the skin is broken, as absorption may occur, and what is more important still, the drug prevents healing by constringing and whitening the edges of the wound. If some bread-crumbs be saturated with this solution aud applied to an inflamed finger, a felon can be aborted in the early stages. The officinal dilute solution is useful as a lotion in eczema which itches and tingles, and is not dry iu character. It should be applied once or twice a day, and it is well to follow the application of the lead with a weak sulphur bath or alkaline wash. (See Eczema.) Lead-water is also useful in pruritus pudendi, and the acetate of lead may be used as an injection in the dose of 1 to 8 grains to the ounce of water in cases of gonorrhea. The cerate (Ceratum Plumbi Subacetatis, TJ. S.), the liniment (Linimentum Plumbi Subacetatis, TJ. S.), and the glycerin (Glycerinum Plumbi Subacetatis, TJ. S. and B. P.), may be used for the same purposes as the Goulard's extract. Litharge. Litharge (Plumbi Oxidum, TJ. S. aud B. P.) is used for the prepa- ration of lead-plaster (Emplastrum Plumbi, TJ. 8. and B. P.), and this is in turn employed for the manufacture of resin plaster (Emplastrum Resine, TJ. 8. and B. P.). It is also used in the preparation of the solution of subacetate of lead. Hebra recommends for sweating of the feet an application of equal parts of lead-plaster and linseed oil, applied on linen, and wrapped around the feet every third day. 14 210 DRUGS. Nitrate of Lead. Nitrate of Lead (Plumbi Nitras, TJ. S. and B. P.) is never used in- ternally but as a powder in the treatment of cases of onychia maligna, and in the formation of Ledoyen's Disinfecting Solution. The latter discolors the paint in water-closets, dissolves the solder in drain-pipes, and is not a good preparation for general use. LEPTANDRA. The medicinal portion of Leptandra Virginica is the rhizome and rootlet from which are made the officinal extract (Extractum Leptan- dre, TJ. 8.), and the fluid extract (Extractum Leptandre Fluidum, TJ. 8.). The dose of the former is from 1 to 8 grains and of the fluid extract 5 to 40 minims. Physiological Action.—Very few experiments have been made as to the action of this remedy, and the only ones of importance are those of Rutherford and Vigual, who found that it possessed a moderate influence in increasing the flow of bile. In overdose it causes violent purging. Therapeutics.—In the officinal preparations of leptandra, which are not as active as is the fresh drug, we have excellent substitutes for calomel according to many clinicians. Those who have used leptan- dra also believe it to be of the greatest value in the indigestion of the intestinal type sometimes called "duodenal atony." The following pill is a good method of using the drug in these cases : ]J.—Ext. chirettee.......gr. xx. Ext. leptandrae.......gr. xx. M. Ft. in pil. no. x. S.—One pill after each meal. Under the name leptandrin we have an impure resin which is given in the dose of 2 to 5 grains. An alkaloid of doubtful existence is called leptandrine. LIPANIN. Lipanin is an artificially prepared mixture devised by Von Mering as a substitute for cod-liver oil, and consists in 6 parts of oleic acid added to 100 parts of olive oil. The advantages possessed by it are its lack of disagreeable odor and taste, and its ready emulsification and digestibility. The commencing dose is 1 drachm, which may be increased to 4 drachms. This mixture has been found of value in most of the diseases in which cod-liver oil is employed, and in the opinion of the author its efficacy is greatly increased if the hypophos- phites of lime and sodium are used at the same time in the dose of 10 grains three times a day. LITHIUM. 211 LIQUORICE. Liquorice (Glycyrrhiza, TJ. 8. P., Glycyrrhize Radix, B. P.) is the root of Glycyrrhiza Glabra, a plant of Southern Europe and Asia. It is used to increase secretion in the mouth in the form of a solid extract, and when dissolved in water to form a vehicle for other drugs, particularly if they have a disagreeable taste. The powdered solid extract is a very mild laxative and forms the bulk of the officinal compound liquorice powder. Administration.—The solid extract (Extractum Glycyrrhize, TJ. S. and B. P.) is used in a dose anywhere from 5 to.120 grains. The pure extract (Extractum Glycyrrhize Purum, TJ. 8.) is used in the same quantities as the ordinary extract. The fluid extract (Extractum Glycyrrhize Fluidum, TJ. 8.) or the liquid extract (Extractum Glycyr- rhiza1 Liquidum, B. P.) is used in 1 to 2-drachm doses. Under the name of Brown Mixture or " compound liquorice mixture," a very efficient expectorant solution is officinal (Mistura Glycyrrhize Com- posita, TJ. 8.) which contains as its most important ingredients 12 parts of paregoric, 6 parts of wine of antimony, and 3 parts of sweet spirit of nitre. The dose is 1 to 4 drachms. Pulvis Glycyrrhiza Compositus ( TJ. S. and B. P.), or compound liquorice powder, contains, according to the TJ. S. P., 18 parts of senna, 16 of liquorice, 8 of fennel, 8 of washed sulphur, and 50 parts of sugar. According to the B. P. it should contain 2 parts of senna, 2 of liquorice root, 1 of fennel fruit, 1 of sublimed sulphur, and of sugar 6 parts. The dose is 1 to 4 drachms. The Troches (Trochisci Glycyrrhize et Opii, TJ. 8. and B. P.) contain -^V grain of opium and 2 grains of extract of liquorice. Finally we have Glycyrrhizinum Ammoniatum, TJ. S., which is the sweet principle of liquorice rendered soluble and easily tasted by the addition of ammonia. The dose of this prepara- tion is 5 to 15 grains. LITHIUM. Lithium is used in several forms, but its salts may be divided into two classes—those which act as lithium and those which act as the acids forming them. In the first class we have the carbonate (Lithii Carbonas, TJ. 8. and B. P.), dose 2 to 10 grains, and the citrate (Lithii Citras, TJ. 8. and B. P.), dose 5 to 20 grains. In the second class we find the benzoate (Lithii Benzoas, TJ. S.) dose 5 to 30 grains ; Lithii Bromidum, TJ. 8., dose 10 to 40 grains, and Lithii Salicylas, TJ. S., dose 10 to 30 grains. The carbonate and citrate are used in gout and rheumatoid arthritis for the purpose of entering into combination with the uric acid in the body to form soluble urates and prevent deposits in the joints. They have been said to dissolve calculi, but this is doubtful, and they are very useful when it is desired to render the urine alkaline. The 212 DRUGS. carbonate is not soluble in water, and should be given in capsule or freshly-made pill, but the citrate is soluble. The latter may be made from the former by taking 50 grains of the carbonate, 90 grains of crystallized citric acid, and warm distilled water 1 fluidounce. The acid should be dissolved first and the carbonate added to the solution. The solution should then be kept hot until effervescence ceases. In cases of diabetes depending upou a gouty taint remarkable results are often obtained from the use of the citrate or carbonate of lithium and arsenic. The dose should be -^ of a grain of arseuite of sodium and 10 grains of the lithium salt three times a day. For the use of the other salts of lithium, see the articles on the Bromides, Salicylic Acid, and Benzoic Acid. It is worthy of note that in some cases citrate of lithium will dis- order the stomach and produce vomiting. Lithia water, or the prepa- ration of the British Pharmacopoeia, Liquor Lithie Effervescens, is useful in gout in quantities of 5 to 10 ounces at a time. LIQUOR POTASS^. Liquor Potasse, TJ. 8. and B. P., is a solution of potassa containing about 5 per cent, of potassium hydrate, and is a clear, odorless liquid of caustic taste and strongly alkaline reaction. It is used in medicine as an antacid and for the purpose of decreasing the acidity of the urine. In ingrowing toe-nail it is often used to soften the nail, prior to packing with cotton or partial evulsion. Its dose is 5 to 30 drops well diluted with water. LOBELIA. Lobelia, TJ. 8. and B. P., is the leaves and tops of Lobelia Inflata, a common weed of the United States. It contains an alkaloid, lobeline, and lobelic acid. Physiological Action.—When taken in overdose lobelia causes emesis, intense prostration, a feeble pulse, pale skin, livid face, mus- cular relaxation and a cold sweat. Violent purging may be present. It is said to paralyze the motor nerve-trunks, and it causes a fall of arterial pressure, followed by a rise due to the asphyxia which it finally produces. Ultimately it paralyzes the respiratory centre and the peripheral vagi. The treatment of the poisoning is to administer opium to stop irritation and vomiting, to give alcohol and ammonia to support the heart, and in the use of external heat. Therapeutics.—Lobelia is used chiefly as an anti-asthmatic and has been equally greatly praised and condemned by eminent authorities. The reason for this lies in the fact that it is generally useless in asthma MAGNESIUM. 213 unless given in almost poisonous dose. AYood teaches that it should rarely if ever be used, because of its poisonous effects even in doses medicinally active, while Sidney Ringer says that the drug is erro- neously thought to be dangerous. Iu asthma both of the gastric and bronchial form lobelia is undoubtedly of service. In some cases it fails as signally as it succeeds in others. If the asthma is due to or associated with cardiac disease lobelia should never be employed. The drug should be taken in the dose of J a drachm to 1 drachm of the tincture at the first sign of an attack, or in 10-drop doses every fifteen minutes until distinct nausea occurs, or relief is obtained. In atonic constipation, 10 drops of the tincture at bed-time are often of service. Administration.—Lobelia is given in the form of the tincture (Tinctura Lobelie, TJ. S.), in the dose of 10 to 30 drops, or 1 to 2 drachms, as an emetic. The vinegar (Acetum Lobelie, TJ. 8.) is given in the dose of 20 to 30 drops, and the fluid extract (Extractum Lobelie Fluidum, TJ. S.), in the dose of 1 to 5 drops, or, as an emetic, in the dose of 15 drops. In the form of the infusion, lobelia is useful as a lotion in the treat- ment of the dermatitis produced by poison-ivy. The proportion used should be an ounce to the pint of water. The preparations of the B. P. are the Tinctura Lobelice, dose 10 minims to J drachm, and Tinctura Lobelie JEtherea, dose 10 to 30 minims. LYCOPODIUM. Lycopodium, TJ. 8., is a pale yellow powder derived from Lyco- podium Clavatum, a species of moss. It is used by pharmacists as a powder in which to roll pills, and by physicians and nurses to prevent the intertrigo or chapping of the skin of infants and adults. MAGNESIUM. Magnesium is a metal never used as such, but always in the form of one of its salts, which are the sulphate, citrate, carbonate, and sulphite. The sulphite is a natural salt found in sea-water and in caves or in the water coming from the latter. The citrate and carbonate are derived from the sulphate. The carbonate is insoluble in water and alcohol. The others are soluble. It is important that the student should not confuse magnesia and magnesium. The first is the oxide of the second, and is sometimes called calcined magnesia, or " Husband's Magnesia." Therapeutics.—The carbonate of magnesium is officinal in the form of the heavy and light powder (Magnesii Ponderosa, TJ. S. and B. P., and Magnesii, TJ. 8., Magnesii Levis, B. P.). These two substances do not differ in respect to their effects. The light magnesium is never 214 DRUGS. given internally, because of its bulk, but is used as a dusting powder in intertrigo, and in the form of white cubes rubbed on the skin to prevent excessive perspiration and as a cosmetic. The heavy magne- sium is used as an antacid, and is not, as has been thought by some, in any sense a laxative, as it possesses no such power. When the stomach or intestines contain much acid from fermentative changes, these acids may, however, uuite with the magnesium and form a slightly laxative salt. In sick-headaches due to great gastric acidity, carbonate of magne- sium is often of service. The dose of the carbonate is from 5 to 60 grains. It should not be used constantly, as there is danger that it will accumuate in the intestines. The troches (Trochisci Magnesie, TJ. 8.) each contain 3 grains of magnesium oxide, or, in other words, calcined magnesia. Liquor Magnesii Carbonatis, B. P., is given iu the dose of 1 to 2 ounces as a laxative. Magnesium Citrate. The Citrate of Magnesium (Magnesii Citras) is a much more irri- tating purge than the sulphate, but is more agreeable to the taste. It is officinal in two forms, one of which is the solution (Liquor Mag- nesii Citratis, TJ. 8. and B. P.), which is effervescent and should never be used unless freshly prepared. It is made by adding bicarbonate of potassium to a syrupy solution of the citrate of magnesium, con- taining au excess of acid, and corking the bottle tightly, the cork being tied down with a strong; cord. Care should be taken that the bottle is a strong one. The dose is half to one pint. It is too irri- tating to be used where inflammation of the alimentary canal exists, but is useful in the treatment of sick and bilious headache. The Granulated Citrate (Magnesii Citras Granulatus, TJ. S.) is less agreeable to take. It should be dissolved in water, about 1 to 3 drachms of the salt being used iu each dose, and swallowed while the solution is effervescing. It must be kept in bottles tightly corked. Magnesium is an antidote to arsenic, aud when employed to precipitate a soluble preparation of iron it forms the antidotum arsenici (Ferrum Oxidum Hydratum cum Magnesio, TJ. 8.). Magnesium Sulphate. Sulphate of Magnesium (Magnesii Sulphas, TJ. 8. and B. P.) is a white granular powder of neutral reaction, salty taste, and is soluble in water. It is the form generally known by the laity as " salts," although in some parts of the country this also includes the sulphate of sodium. According to the studies of Hay and others, sulphate of magnesium is a purge by reason of its abstraction of water from the intestinal bloodvessels. All strong saline solutions above the strength MANNA. 215 of 7 per thousand abstract liquids from the tissues when brought in contact with them. On the other hand, if a saline solution be less strong than 7 per thousand, it will abstract salts from the tissues and replace them with water. The recollection of these facts readily makes clear the use of magnesium sulphate. AYhenever a thorough purga- tive action is required, that is, where depletion of the intestine or absorption of exudations is to be attained, the magnesium should be given in concentrated form, so as to make its solution of as high a percentage as possible. In cases of dropsy this is particularly necessary, and from one to two ounces should be given before breakfast, or on an empty stomach, in as little water as will dissolve the salt. (See Dropsy.) In enteritis and peritonitis this use of magnesium is widely recog- nized as a proper measure. The sulphate is not irritating and may be given freely when inflammation exists. (See Peritonitis.) It forms a large part of most of the natural purgative waters. The B. P. recognizes an enema, Enema Magnesii Sulphatis, composed of sulphate of magnesium 1 part, olive oil 1 part, starch mucilage 15 parts. MANGANESE. Manganum, or Manganese, is officinal in the form of the black oxide (Mangani Oxidum Nigrum, TJ. S. and B. P)., aud the sulphate (Mangani Sulphas, TJ. S.). The first of these, under the name bin- oxide of manganese, has been highly praised in amenorrhea de- pendent upon functional disturbance and anaemia. The dose is 3 to 5 grains three times a day, in pill form, and the drug should be taken for a few days before the expected or proper date for menstruation. The sulphate is rarely if ever employed, but may be tried in malarial jaundice. The dose is 1 to 2 grains. MANNA. Manna, TJ. 8. and B. P., is the concrete juice of the exudation of Fraxinus Ornus, a tree of Europe. It occurs in small or large roundish masses, looking somewhat like a gray-colored gum arabic. It has a sweet taste and odor. Sometimes the taste is a little bitter. Therapeutics.—Mauna is the most feeble of the laxatives, and causes a slight flatulence in some persons. In children fed by the bottle one of the most frequent disorders is obstinate constipation, and for its relief 1 to 2 drachms of the sweet variety of manna may be dissolved in the milk of each bottle. When given to older children or adults manna is always combined with other more powerful drugs, chiefly to cover their taste. It may be combined with advantage with rhubarb and senna, and it enters into the officinal Infusum Senne Compositum, TJ. 8., the dose of which is from 1 to 4 fluidounces. 216 DRUGS. MATRICARIA. Matricaria, TJ. S., German Chamomile, consists in the flower-heads of Matricaria Chamomilla, a European plant, possessing mild tonic properties in moderate dose. In larger amounts it acts as an emetic and anthelmintic. In the form of an infusion, of the strength of 1 to 2 ounces to the pint, it has been largely used as a diaphoretic, and, in small doses, to prevent colic in teething children. MERCURY. Hydrargyrum, TJ. 8. and B. P., Mercury, or Quicksilver, is a heavy fluid metal of a peculiar color and appearance. As mercury it is used in medicine in the form of the ointment, the plaster, gray powder, and blue mass. Physiological Action.—When mercury is taken into the body in one of its insoluble and mild preparations, it may cause no evidence of its presence until by frequent dosage the system in general begins to feel its influence. The first evidences of this are to be found in the mouth, and consist in tenderness of the teeth when the jaws are firmly and quickly closed, foetid breath, sponginess of the gums, which finally may bleed at the slightest touch, swelling of the tongue, and, most prominent of all, excessive salivation, a condition sometimes called ptyalism. If the use of the drug is persisted in, all these symptoms grow worse. Eczema, and finally sloughs of the chin and chest develop as the result of the constant dribbling of saliva and the direct depressing effect of the drug on the tissues. The teeth drop out, the maxillary bones undergo necrosis, and amid a general melting-down and decomposition of the tissues the patient dies. The blood is affected and becomes very thin, fluid, and poor in its corpuscular elements. These symptoms ensue on the use of mercury in continued doses, and rarely follow exposure to the drug in the processes of the arts. In the arts, as, for instance, in the making of looking-glasses, workmen are often affected by various trains of symptoms varying very widely in their course. In some cases the nervous system becomes chiefly affected. Tremors of all sorts arise, paralysis agitaus is developed with its typical characteristics, and widely different changes and degenerations in the spinal cord ensue. Chorea often comes on in chronic mercurial poisoning, and its occurrence in an adult should cause inquiry as to any possible exposure to mercury. In other cases brownish discoloration of the skin, resembling Addison's disease, appears. Blindness, deaf- ness, sensory disturbances, such as hyperaesthesia and anaesthesia, are developed, and localized wasting of muscles or groups of muscles may assert themselves. In still other cases the blood becomes impoverished and mercurial cachexia is developed. Mercury in all its forms is absorbed, and eliminated by the kidneys, MERCURY. 217 liver, skin and salivary glands. No secretion of the body, even to the semen, fails to carry it out of the system, but it is to be remembered that, although all these parts are actively engaged in its elimination, the drug nevertheless rapidly accumulates in the body. AVinternitz asserts that the drug is excreted with equal rapidity whether given in its soluble or insoluble forms, or, iu other words, that calomel is absorbed and eliminated as rapidly as is corrosive sublimate. The question as to the form in which mercury finds entrance into the system is one of interest and importance. According to certain writers, it is changed into an albuminate and so circulates in the blood, but while this is probably true it is not known to be a fact. It is generally supposed that the bichloride is held in solution as au albuminate of the oxide of mercury united with sodium chloride, but others have asserted that metallic mercury in a state of minute sub- division circulates in the blood; this point, however, cannot be con- sidered settled, and the drug undoubtedly accumulates in all the tissues, more especially in the liver and kidneys. Balzer and Klumpke have made a long series of observations at the Lourcine Hospital, in Paris, on the rapidity of the elimination of mercury by the kidneys during a treatment of long standing. AYhile there are many methods for the estimation of mercury in organic fluids, these investigators throughout adopted that of Witz, as modified by Souchow and Alichaelowsky, which permits of the easy detection of the yoVo °f a graiu m an ounce. After a single dose of mercury the elimination of the drug is rapid aud sometimes complete in twenty- four hours, but if a continuous treatment is interrupted its excretion continues for some time, and Kussmaul and Gorup-Besanez have found it in the liver as much as a year after its administration has been stopped. The amount of mercury that can be readily eliminated for many weeks from the kidneys when the body is saturated is about Y^ of a grain daily. Therapeutics.—The employment of mercury in medicine centres around four great points, viz.: 1st, its value in syphilis and kindred states; 2d, its use as a purge; 3d, its power as an antiseptic and germicide; and 4th, its action as an antiphlogistic ; the first and fourth points are fulfilled by all the mercury salts more or less perfectly, the second only by blue mass and calomel, the third by the bichloride and biniodide of mercury. In syphilis mercury is to be given, not because the patient shows symptoms of the secondary or tertiary type of the disease, but because the conditions present do or do not call for its employment. Many writers have insisted that it ought only to be employed in the second- ary stages, and while this is, as a general rule, correct, certain condi- tions may call for it at any time. (See Syphilis.) The employment of mercury as a purge or laxative having a special action on the liver is constantly resorted to. The two preparations used are blue mass and calomel, but the latter is more active. They both cause soft and watery stools, according to the dose in which they 218 DRUGS. are given, but the blue mass is rarely, if ever, used, except for the production of a laxative effect. Much discussion has arisen as to whether mercury does affect the liver, and whether the peculiar greenish or brownish-yellow stools produced by it are due to the presence of bile or mercury. The experiments of Rutherford, Prevost and Binet, aud others upon the lower animals seem to prove that in these instances, at least, mercury does not increase the biliary flow; but, on the other hand, it is undoubtedly a fact that in man, even so small a dose as ^- of a grain of calomel may produce a bilious-looking passage, and yet it is evident that there cannot be enough mercury present to color a large passage green or yellow. Again, analysis of the stools often fails to find any mercury unless large doses are given. Further thau this, we know clinically that when the stools are clay-like and lacking in biliary coloring-matter mercury will restore the normal state. The conclusion must be reached that, be the results in animals what they may, in man, at least, the drug does increase biliary secretion and flow. Calomel and blue mass are largely used in the condition known as biliousness, and undoubtedly give relief. (See Biliousness.) If the tongue is heavily coated, the breath foul, the conjunctiva a little icte- roid, and headache is present, either of them should be employed. In remittent malarial fever the use of small repeated doses of calomel will often bring relief from the vomiting, and it should always be given in the treatment of malarial disease before quinine is used, if a thorough action of the antiperiodic is required. The disinfectant and germicidal power of bichloride of mercury and of the biniodide are very well established by clinical experience and experimental investigation. The strength of the bichloride in solu- tion for antiseptic purposes may vary from 1 to 2000 to 1 to 20,000 of water, and for disinfectant use from 1 to 500 to 1 to 1000. (See Antiseptics.) In using the bichloride of mercury as an antiseptic it is necessary to add a few grains of tartaric acid to the solution to prevent its uniting with the albumin of the tissues to form an insoluble and useless albuminate. The same is true of the mercury biniodide. The antiphlogistic or anti-inflammatory action of mercury is very marked indeed, but its employment is absolutely limited under these circumstances to one variety of inflammation, namely, the sthenic or dynamic form. In inflammation arising during the course of some exhausting disease mercury is not only contra-indicated, but harmful. Thus, if a man in health is stricken with pleurisy or peritonitis or meningitis, or any acute inflammation of a serous membrane, be the cause what it may, the exudate poured out will probably be fibrinous, and capable of undergoing organization, thereby causing adhesions of the pleural surfaces, of the intestines, or of the meninges of the brain. On the other hand, if a man be taken with pleurisy or meningitis during the course of phthisis or typhoid fever, the exudate will be serous aud large in quantity. It is in the first case that mercury MERCURY. 219 should be used, to prevent the fibrinous exudate or to make it serous. In the second instance it will do harm by increasing the exudation. When given as an antiphlogistic the drug is often combined with opium to relieve the pain and irritation and to prevent purging. In meningitis arising from head injuries this is the routine treatment and may be carried out by the use of powders containing I grain of calomel and +; grain of powdered opium every hour till 1 or IJ grams of each are taken. The simultaneous use of the ice-bag to the head and perfect quiet will often bring relief very rapidly. Mercury is also the best remedy in sthenic endocarditis, and should be giveu iu full dose. The bichloride may be used in small doses iu place of the calomel, and does not, of course, produce the same ten- dency to laxity of the bowels. At the same time it often seems to be less efficacious. Mercury in myocarditis and pci'icarditis is also of service, and certainly exerts distinct prophylactic power in the early stages of diphtheria and membranous croup. (See Diphtheria.) Leaving the general subject of mercury, we may now consider each individual preparation. Ammoniated Mercury. AYhite Precipitate or Ammoniated Mercury (Hydrargyri Ammonia- turn, TJ. 8. and B. P.) is used iu an ointment (TJnguentum Hydrargyri Ammoniati, TJ. S. and B. P.) in various skin affections, and it should generally be diluted with lard. In ozena, whether syphilitic or not, Trousseau has recommended the employment of the following powder as a snuff: }£.—Hydrargyri ammoniati.....gr. iv. Pulv. sac. alb. ......3SS. M. S.—To be used as a snuff, after thoroughly blowing the nose. The Red Precipitate may be used instead of the white. This treatment removes the stench and may cure the complaint. It may, however, irritate the mucous membraue, in which case it should be used in the strength of 2 grains to the \ ounce. Bichloride of Mercury. The Bichloride of Mercury, or Corrosive Sublimate (Hydrargyrum Chloridum Corrosivum, TJ. 8., Hydrargyri Perchloridum, B. P.) as it is called, is au exceedingly poisonous and irritating substance when taken in concentrated form. Taken internally, it causes violeut pain in the stomach, vomiting, purging of mucus, blood, aud the contents of the intestine, collapse, syncope, and death. If taken in poisonous amount the patient should be made to swallow large amounts of the antidote, white of egg, the stomach should be washed out by the stomach-pump, heat should be 220 DRUGS. applied about the body, and the proper stimulants be given if the pulse or respiration fail. If death does not occur at once the patient generally has a protracted convalescence or else dies from the organic changes produced in the gastro-intestinal tract, such as strictures, sloughs, destruction of the peptic glands and ulcerations. Mercury bichloride, aside from its antiseptic use (see Antiseptics), is of great value when given internally, not only in syphilis, but in other states not associated with any such depraved condition. In diphtheria it may be used to prevent fibrinous exudation as readily as calomel (see Diphtheria), and in tonsillitis, where the inflammation is severe, it is often used with great service. When using a solution of bichloride of mercury as an antiseptic, tartaric acid should be added to the solution to prevent the precipita- tion of the mercury in the form of an albuminate. In small amounts, that is in fa to -fa of a grain three times a day, the bichloride is one of the best remedies which we possess for the treatment of anemia, be its cause what it may. Bichloride of mercury is of value in minute doses of -fa to -g-1^ of a grain in the ill-smelling green stools of summer diarrheas in adults and children, and it has been recommended that a solution be made of \ a grain in 5 ounces of water aud a teaspoonful given every hour until relief is obtained. This treatment is particularly useful in mucous diarrhea, in which blood and mucus are thoroughly mixed. Patients in the dispensaries often speak of these passages as contain- ing " corruption," and others think they consist of " lumps of flesh," owing to the masses of blood and mucus. Whether the disease be acute or chronic, the bichloride, used in the way just described, will be found of service. In dysentery and the diarrhea of adults the same treatment may be resorted to, using two teaspoonfuls of the solution instead of one. It is hardly necessary to add that the greatest care must be bestowed upou the diet and clothing. The author has treated a child suffering from persistent diarrhoea for months with varying success, only to succeed when, it being found that the abdomen was exposed to the air, the mother was forced to apply and keep on the child a flannel binder. In some cases in which an obstinate syphiloderm is present, half an ounce of corrosive sublimate and one ounce of chloride of ammonium may be added to a warm bath which should be taken every few days. Half a grain of the bichloride of mercury in six ounces of water is said to be most efficient as an injection in gleet, if used every three or four hours. (See Gonorrhoea.) In all parasitic affections of the skin a solution of 2 grains of bichloride to the ounce of water may be sopped on the part three times a day. A solution of perchloride of mercury (Liquor Hydrargyri Perchloridi) is officinal in the B. P.; it is prepared by adding J grain of the perchloride of mercury to 1 ounce of water, with \ grain of ammonium chloride to hold it in solution. (For the antiseptic uses of the bichloride of mercury, see Antiseptics and Disinfectants.) MERCURY. 221 Biniodide of Mercury. Mercury Biniodide (Hydrargyri Iodidum Rubrum, TJ. 8. and B. P.) is a bright-red powder, possessing irritating powers equal to or above those of the bichloride, and causing symptoms when taken in over- dose closely resembling those produced by the latter drug. Owing to the formation of the salt it is thought to be particularly useful in the later stages of syphilis. The dose is fa to fa of a grain. (See Syphilis.) An ointment^ (TJnguentum Hydrargyri Iodidi Rubri, B. P.) is useful as an application in goitre and obstinate skin diseases. At one time it was thought that biniodide of mercury was a better antiseptic thau the bichloride, but recent researches have proved that this is not a fact. Black Wash. Black AYash (Lotio Hydrargyri Nigra, B. P.) is made by adding 1 drachm of calomel to a pint of lime-water. It is used for washing syphilitic sores and wounds. Blue Mass. Blue Mass (Massa Hydrargyri, TJ. 8., Pilula Hydrargyri, B. P.) is made by rubbing up metallic mercury with liquorice and other excipients, and is often called Blue Pill. Each grain of the mass contains ^ grain of mercury, and it may be given in the dose of from \ to 20 grains, for the same laxative purposes for which we use calomel. Blue Mass is rarely used to produce systemic effects. Calomel. Calomel (Hydrargyri Chloridum Mite, TJ. S., Hydrargyri Subchlor- idum, B. P.), or the Mild Chloride of Mercury, is an insoluble salt which is nevertheless freely absorbed. Some have taught that it enters into the body as a bichloride, being changed into this salt by the acid of the stomach, but practically this does not occur. Calomel on pass- ing into the intestines is changed by the alkaline juices there present into the black or gray oxide of mercury. Calomel when used as a laxative purge should be given in the dose of \ to \ grain every half-hour or every fifteen minutes until 1 or 2 grains are taken, as it will act as efficiently in this way as if 10 grains are given at one dose, and there is no danger of producing ptyalism. The reason that small doses are as efficient as large ones lies in the fact, that only the calomel which is changed into the gray oxide is active, and as the amount of alkaline juice iu the intestine is small, only a minor part of a large dose of calomel acts, the major portion escaping unchanged. This is the reason that bicarbonate of sodium 222 DRUGS. is added to calomel powders, to aid the intestinal juice in the reduc- tion of the salt. If purgation does not occur after a dose of calomel, a saline purge may be given at the end of twenty-four hours, and this must always be used if large doses of the mercurial are employed. Mercury in the form of calomel is very largely used hypodermically, being held in solution by a mucilage, or better still by fluid cosmoline. It should be injected deeply into the tissues, not immediately underneath the skin, the greatest cleanliness being necessary to avoid abscesses. The best place for these injections is in the fold of the buttocks, but sloughing, tetanus, and even gangrene, has followed its employment in this way. (See Salicylate of Mercury.) In dysentery of the acute form calomel and ipecac are the two best remedies. (See Dysentery and Ipecac.) The calomel should be given in small doses repeated every hour or half-hour until some effect in the number and character of the stools appears. Calomel is not to be used if great asthenia complicates the disease. In children who seem constantly "under the weather" aud never quite well, who have flatulence, fetid breath and ill-smelling, pasty stools calomel often gives great relief in the dose of -^- of a grain every half-hour until four doses are taken, this treatment being pursued. every fourth or fifth morning. In jaundice due to exposure to cold and to slight hepatic congestion ^ of a grain of calomel every half-hour until \ a grain is taken will often bring relief. Calomel is generally prescribed in conjunction with sugar of milk, white sugar, or bicarbonate of sodium, which are added to increase the bulk and wieldiness of the powder, and, in the case of the latter ingredient, to increase its activity. Owing to its lack of taste, calo- mel is often placed on the tongue in children, but in this instance white sugar is to be used, in small quantity, as the other vehicles are less agreeable. A very important use of calomel, and one which has been brought forward very recently as new, but which is really many years old, is its employment in dropsy as a diuretic, either alone or combined with squills or digitalis, or with opium to prevent purging. The dose is small, about 1 grain thrice a day, and if a diuretic influence does not assert itself in twenty-four hours it should not be continued. Still another use of calomel is in typhoid fever, in which disease it has been highly recommended in small repeated doses, particularly if constipa- tion is present. In the opinion of the author this is disadvantageous as a routine measure and entirely uncalled-for. Sidney Ringer has called attention to the fact that in constipation or in " biliousness " podophyllin does more good than calomel pro- vided that the stools are dark in color, whereas if the same signs are present but the stools light and clayey in color calomel is more effi- cient. The author has proved the correctness of this assertion so frequently that he is convinced of its truth. Calomel has been recommended in the condition of anorexia and MERCURY. 223 depression following acute diseases, and, when the tongue is covered by a thick yellow coat, it is the remedy for the gastro-intestinal torpor always present, AVhile purgative doses of calomel certainly are of value, the use of red, freshly prepared nitro-muriatic acid is, how- ever, highly preferable to the mercurial salt in many such instances. Calomel is often given in small doses to "settle the stomach." Sometimes it will act in this way, but in other cases it will seem to increase the nausea aud bring on vomiting. This is true of both adults and children, and it is impossible to tell beforehand which will occur. In a peculiar form of vomiting occurring in very young children, which comes on immediately after the food is swallowed, the rejection of milk being forcible and perhaps so sudden that it is not even curdled, and which is not accompanied by much straining, calomel will often give relief when all other remedies fail. It should not be resorted to until some evidences of wasting occur, as this action of the stomach in many children only rids that organ of that part of the milk which is in excess, and is a purely physiological regurgita- tion. The calomel may be given in the dose of -fa of a grain every hour, or if preferred, gray powder in the dose of J of a grain every hour for 3 doses is equally efficient in these cases. Calomel will often remove syphylitic condylomata if dusted over them for some time, and an ointment made of one drachm of calomel to one ounce of lard is very useful in pruritus. Calomel ointment (TJnguentum Hydrargyri Subchloridi, B. P.), is often useful in the treatment of small patches of eczema, or the fol- lowing prescription may be given for its use : !£.—Hydrarg. chlor. mit. ...... gr. xl. Magnesise carbonatis . . . . . . gr. xl. Unguent, aquse rosae......§j. M. Mercury with Chalk. Mercury with Chalk (Hydrargyrum cum Creta, TJ. S. and B. P.), or Gray Powder, is slightly purgative, but is chiefly employed in the treatment of infantile syphilis, as it will not freely purge. The dose is 1 to 10 grains. Children suffering from syphilitic marasmus seem fairly to fatten on it. This preparation is also of service in adults, and may be employed whenever the laxative effect of mercury is not desired. In the treatment of infantile diarrhoea with watery, colorless stools containing undigested food, gray powder in small doses is often very useful. Mercury Ointment. The Ointment of Mercury, Mercurial Ointment (TJnguentum Hy- drargyri, TJ. 8. and B. P.), sometimes called Blue Ointment, is made by rubbing up mercury with suet and lard until it is extinguished— or in other words, until the globules of mercury cannot be seen with a magnifying power of 10 diameters. 224 DRUGS. The ointment of mercury is used externally in certain skin affec- tions, and for the purpose of influencing the general system in cases where the drug cannot well be taken by the mouth. In syphilis where a mercurial effect is to be reached, the ointment in small amounts should be thoroughly rubbed into the skin in various parts of the body, one evening in the left groin, the next in the right groin, the next evening in the left axilla aud the fourth evening in the right axilla, beginning on the fifth evening in the left groin once more. This avoids local irritation of the skin by means of too frequent ap- plications, places the drug on spots where it is readily absorbed, and very rapidly influences the system of the patient In infantile syphilis this method may be employed, or a flannel binder covered with the ointment may be placed about the belly. The clothes should not be changed too frequently, as their saturation with the drug aids iu pro- ducing the impression upon the system, and the wearing of an under- shirt saturated with the oiutment after a few days' wear, is a very valuable, though somewhat dirty, method of producing mercurializa- tion. The oiutment of mercury is sometimes rubbed into the skin over enlarged glands. Under the name of oleate of mercury (Oleatum Hydrargyri, TJ. S. and B. P.) a very efficient and more agreeable ap- plication than the ointment, is used iu the same manner. In pediculis pubis, or in any case where parasites, such as the flea or louse, infest the region of the genitals, or any spot covered by a hairy growth, mercurial ointment may be used as a remedy owing to its lethal influence over these troublesome pests. Care should be taken that it does not cause salivation of the patient, and it must not be allowed to remain on the parts, but be wiped off in the course of an hour or two, or less. The following words from the pen of Dr. Joseph Leidy are sufficiently interesting to demand a place at this juncture : " We may here say that if it is once understood that all iusects, including lice, are destroyed quickly by the application of any fixed or volatile oil, physicians will see there is no necessity of employing remedies of a noxious character to the patient. The fat of mercurial oiutment is probably more active than the mercurial oxide." Nitrate of Mercury. The Solution of Mercuric Nitrate (Liquor Hydrargyri Nitratis, TJ. S. and B. P.), acid nitrate of mercury, is an exceedingly active, pene- trating caustic, so rapid in its effects that it seems to drop through the tissues. It may be employed for the removal of epitheliomata and large warts, and should be applied by means of a glass rod. This treatment may also be resorted to with advantage in lupus until the surface of the growth is level with the skin. The surrounding parts should be protected by lard or oil. As this treatment is very painful, the spot should afterward be covered with flexible collodion. MERCURY. 225 Citrine Ointment (TJnguentum Hydrargyri Nitratis, TJ. 8. and B. P.) is used in chronic skin diseases of the scalp and trunk. It is too strong for ordiuary use aud should be diluted one-half or less with lard according to the stimulating effect required; the dilute oint- ment is officinal in the B. P. as TJnguentum Hydrargyri Nitratis Dilutum. Mercurial suppositories (Suppositoria Hydrargyri, B. P.) are used when a mercurial effect is desired without the danger of interfering with the digestion. Linimentum Hydrargyri, B. P., and Emplastrum Hydrargyri, TJ. S. and B. P., are used for the same purposes as is the ointment of mercury. Oxides of Mercury. The yellow and red Oxide of Mercury (Hydrargyri Oxidum Flavum, TJ. S. and B. P. and Hydrargyri Oxidum Rubrum, TJ. 8. and B. P.), red precipitate, are used largely as a dressing for syphilitic sores when diluted about one-half with chalk or other powder. If used pure they are somewhat caustic. From the yellow oxide is made the Oleate of Mercury (Oleatum Hydrargyri, TJ. 8. and B. P.), which is used for the same purpose as ordinary mercurial ointment. In intestinal and gastric indigestion, with foul belching and very ill-smelling stools which are due to intestinal sepsis, the yellow oxide is sometimes given in the dose of g^ to fa of a grain in trituration. Red Precipitate Ointment (TJnguentum Hydrargyri Oxidi Rubri, TJ. S. and B. P.) and the Ointment of the Yellow Oxide (TJnguentum Hydrargyri Oxidi Flavi, TJ. S) are largely used, diluted one-half with lard in chronic, scaly skin affections, in obstinate conjunctivitis and in granular lids. Protiodide of Mercury. Mercury Protiodide (Hydrargyri Iodidum Viride, TJ. 8.) is much more mild than the biniodide and is given for exactly the same pur- poses. The dose is \ to J of a grain three times a day. Yellow Sulphate of Mercury. Hydrargyri Subsulphas Flavus, TJ. 8., has been used under the name of Turpeth Mineral as an errhine in chronic ophthalmia, and also as a prompt emetic in croup. It is a quick and certain emetic, and, it is claimed, does not produce depression, but the writer would recommend great care iu its use. The dose for a two-year-old child is 2 to 5 grains repeated in fifteen minutes if necessary. Yellow Wash. Yellow Wash (Lotio Hydrargyri Flava, B. P.) is made by adding 30 grains of corrosive sublimate to a pint of lime-water. It is used 15 226 DRUGS. for the same purposes as the black wash, but is much more stimu- lating. Incompatibles.—Bichloride of mercury should never be given with any other substance except iodide of potassium and chloride of am- monium, as it is incompatible with almost every other drug. With the iodide of potassium it may be used because the precipitate formed is at once re-dissolved, and the resulting mixture is highly alterative. Calomel should never be given with iodides or bromides, and hy- drochloric acid may convert it into the bichloride if the acid is present in any amount. One of the best ways to employ mercury is in the form of triturates which may be used by triturating 10 parts of the drug with 90 parts of milk sugar. The minute subdivision of the medicament aids iu its efficiency because of its more ready absorption. METHYL CHLORIDE. Methyl Chloride is a colorless, easily liquefied gas with an odor resembling that of ether and chloroform, used to produce local anaes- thesia. It is usually kept in a siphon or in au ordinary bottle and applied to the skin in a spray, or better still, by means of a cotton tampon saturated with the liquid. Under these circumstances the skin becomes pale in a few seconds, and afterward perfectly white and parchment-like in appearance. Local anaesthesia is now complete, and minor surgical operations, such as opening boils or abscesses, can be performed without pain. MEZEREUM. Mezereum, TJ. S., Mezerei Cortex, B. P., is the bark of Daphne Mezereum, a plant of Asia, Europe, and Great Britain. It is sup- posed by some to be possessed of extraordinary alterative power, but this is certainly a mistake, as its influence in this line is very feeble. It is never used internally except in compound decoction of sarsa- parilla. It is, however, distinctly irritant, and in overdose causes all the symptoms of gastro-enteritis. Mezereum is so irritant as to have been used externally as a counter-irritant in the form of the ointment (TJnguentum Mezerei). It enters into the compound syrup, fluid extract, and decoction of sarsaparilla, but is rarely, if ever, given alone. The officinal preparations of mezereum are the extract (Extractum Mezerei, TJ. S.), the fluid extract (Extractum Mezerei Fluidum, TJ. 8.), and the ethereal extract (Extractum Mezerei JEthereum, B. P.), all of which are used as external irritants. MUSTARD. 227 MUSK. Musk (Moschus, TJ. 8. and B. P.) is obtained from the preputial follicles of the musk deer of Thibet, and is a substance possessing the most remarkable penetrating powers, so far as odor is concerned. Very little of the musk for sale in the shops is pure, and most of it is not musk at all. Its price varies very greatly, but if sold for less than twenty-five cents a grain it is probably worthless or impure. Therapeutics.—For some unknown reason musk acts as a diffusible stimulant and supports the system. It is also an anti-spasmodic and nervous sedative. In all low fevers where the strength of the patient is fast ebbing away, and the nervous symptoms are those of the most advanced depression, rectal injections of musk in starch-water should be employed. The dose should be 5 to 10 grains. This drug is of value, either where nervous excitement or nervous collapse is present, but is not to be employed until it is absolutely needed to carry the patient past a crisis. If frequently employed it loses its power, and the expense is a needless one. Musk is one of the best remedies in obstinate hiccough. The dose of the tincture (Tinctura Moschi, TJ. S.) is 30 drops to 1 drachm, and of musk itself 5 to 10 grains. MUSTARD. Mustard is officinal in the form of Sinapis Alba, TJ. S., Sinapis Albe Semina, B. P., or white mustard, and Sinapis Nigra, TJ. S., and Sinapis Nigre Semine, B. P., or black mustard. Both of these con- tain an irritant oil (Oleum Sinapis Volatile, TJ. 8., Oleum Sinapis, B. P.) as their chief active constituent. Therapeutics.—Mustard is often used in the form of mustard flour as an emetic, when stirred up in water in the proportion of a table- spoonful to a glass of water. It is also employed as a counter-irritant and as a condiment. If given in excessive dose it will cause violent gastritis, and chronic gastritis is often set up by its constant use. _ It is contra-indicated internally during the existence of acute gastritis and all similar states. When used as a counter-irritant it is applied to relieve the pain.of colic, due to flatulence and acute inflammation, in muscular rheumatism and inflamed joints, and for neuralgia, and it may be applied at the nape of the neck in cases of headache and cerebral congestion. When applied to the skin of an ordinary individual it will produce a bad burn if left on more than a few minutes, and it should be mixed with wheat flour in the proportion of half-and-half for tender skins. Children generally will not stand more than one-fourth mustard. The plaster should be made with warm water or vinegar, or a little brandy may be used. Mustard plaster (Cataplasma Sinapis) is officinal in the B. P. The scald or burn produced by mustard is peculiar in its slowness 228 DRUGS. to heal, and in the fact that it is tender and reddened for days. If the burning of the mustard becomes excessive it should be treated by a piece of lint soaked in lime-water and olive oil, half-and-half, or olive oil alone may be used. The oil of mustard is very irritant, and almost epispastic in its effects. It is given in the treatment of the atonic stomach of drunkards in the dose of \ to \ a drop. Charta Sinapis, TJ. 8. and B. P., or mustard papers, are sometimes called sinapisma, and these afford a ready meaus of applying this counter-irritant. They are generally very strong, and should be covered by one or two layers of old and moistened linen to prevent too great an action. (See Counter-irritation.) The compound liniment (Linimentum Sinapis Compositum, TJ. S. and B. P.) is com- posed of the oil of mustard, castor oil, extract of mezereum, and alcohol. MYRRH. Myrrha, TJ. 8. and B. P., is a gum resin obtained from Balsamo- dendron Myrrha, a tree of Arabia. It occurs in dark-colored tears, and contains an active principle, myrrhin. Therapeutics.—Myrrh, in medicinal amount, is a stimulant to the circulation, and to the uterine and the bronchial mucous membranes. In amenorrhea, due to functional inactivity, or anemia, " iron and myrrh " is a standard remedy. The tincture of myrrh, diluted one-half, is useful in ulcerated sore- throat as a gargle, and the pure tincture is sometimes applied with a small brush or by the end of the finger, to spongy or tender gums. In leucorrhea depending upon uterine trouble, and iu chronic cystitis, myrrh is often of service. Sometimes it enters into expectorant mixtures given in the later stages of bronchitis. The dose of the tincture (Tinctura Myrrha, TJ. 8. and B. P.) is 10 to 30 drops. It also enters into the composition of Pilulce Aloes et Myrrhe, TJ. 8. and B. P., dose 2 to 5 pills, and Tinctura Aloes et Myrrhe, TJ. 8. and B. P., the dose of which is 1 to 2 fluidrachms. NAPHTHALIN. Naphthalin is a coal-tar derivative occurring in colorless mica-like crystals, possessing a peculiar smell, and is soluble in alcohol to some slight extent. After it is taken for some time, or even after the first dose, the patient will state that when he belches, the gas has the smell and taste of burning rubber. The drug possesses distinct antiseptic power, and for this reason has been employed in certain gastric aud intestinal diseases, associated with fermentative changes or dependent upon ulceration and organic lesions. In fetid diarrhea it may be given as a deodorant and cure. When given to children, as in summer diarrhea, the dose should be NITRATE OF SILVER. 229 £ to I grain every 2 or 4 hours, but adults may take as much as 5 to 10 grains. More than this will disorder the stomach. The drug should be given in powder, in capsules, or with sugar. It has not been as widely employed as was expected when it first came before the profession, and certainly often fails to do good. NUTMEG. Myristica, TJ. 8. and B. P., or Nutmeg, is the kernel of the seed of Myristica Fragrans, an East and West Indian Plant, Mace being the outside covering of the same. Nutmeg is a soporific and nervous sedative exercising a peculiar influence over the cerebrum. It is also used as a flavoring substance in somnifacient mixtures and is of value in prescriptions for serous diarrhea. The oil (Oleum 3Iyris- ticce, TJ. 8. and B. P.) is given in the dose of 1 to 3 drops. The spirit or essence (Spiritus Myristice, TJ. S. and B. P.) is used in the dose of 1 to 2 fluidrachms. NITRATE OP POTASSIUM. Nitre (Potassii Nitras, TJ. 8. and B. P.), or Saltpetre, occurs in long, needle-like crystals and has a sharp, saline taste. Sal Prunella is saltpetre melted and run into moulds. Next to the chlorate of potassium this is the most poisonous of the potassium salts, and produces when taken in overdose violent symp- toms of gastro-enteritis. AYhile it does not affect the blood it is more irritant than the chlorate. Nitrate of potassium is rarely employed at present, and has been very properly put aside as inferior to the harmless vegetable potas- sium salts (the citrate, acetate, and bitartrate). If used in rheumatism the dose should be 1 ouuce in a pint of barley-water or syrup of acacia and water, to be taken in divided doses of a tablespoonful every three hours. Nitrate of potassium papers (Charta Potassii Nitratis, TJ. S.) are made by dipping unsized paper in a solution of the drug of the strength of 20 parts of the salt to 80 parts of distilled water. They are rolled into cigarettes and smoked by asthmatics or burned in a pan and the fumes arising from them inhaled. NITRATE OF SILVER. Nitrate of Silver (Argenti Nitras, TJ. 8. and B. P.) is a heavy, crystalline salt of silver, readily soluble in its own weight of water. It is officinal as the pure nitrate (Argenti Nitras, TJ. 8. and B. P.) and as the sticks or fused rolls (Argenti Nitras Fusus, TJ. 8) or lunar caustic. The latter are never used in medicine internally, only the 230 DRUGS. crystals being employed. Applied to the tissues of the body or other substances it causes a brown and finally a black stain which is due to the formation of an oxide of silver. Physiological Action.—Nitrate of silver is oue of the few astrin- gent substances which are applicable to inflamed mucous membranes, as it is, with .lead, bismuth, and zinc, the only drug of the class which is not irritant as well as astringent. Locally applied it acts in pure form as a powerful caustic, which is, however, very superficial indeed, as the drug coagulates the albumin with which it comes in contact and thereby forms a coat which protects the tissues beneath. The action of the drug upon the circulation, respiration, and similar vital functions is only partly known and has no relation to its em- ployment in medicine. Nitrate of silver is eliminated from the system very slowly indeed. Poisoning.—Almost immediately after the ingestion of a poisonous dose of nitrate of silver, violent pain iu the belly, with vomiting and purging, comes on. At the same time evidences of widespread gastro- enteritis develop. The abdominal walls are knotted and hard, and perhaps scaphoid. The face is anxious and livid and covered with a sweat. When the vomiting occurs, the ejecta are seen to be brown or blackish or even white and curdy. The lips are stained white, then brown, then black. In some cases the nervous symptoms are severe and convulsions with delirium may occur. The convulsions are epi- leptiform. Death ensues either from gastro-enteritis or from centric respiratory failure accompanied by a profuse exudation of liquid mucus into the bronchial tubes. The treatment consists in the use of common salt, which is the chemical antidote, the employment of opium and oils to allay irrita- tion, and in the ingestion of large draughts of milk and of soap and water for the purpose of diluting the poison and protecting the mucous membranes of the oesophagus and stomach from the action of the irritant. The bodily heat must be maintained. Chronic Poisoning.—This is a form of poisoning quite frequently seen. The most prominent symptom is the pale slate-blue color of the skin which causes the individual to be most livid aud death-like in appearance. Argyria, as chronic silver poisoning is called, is caused by the con- tinued employment of the drug until it is deposited in the tissues. It is then found in every part of the body. The first signs of dis- coloration can generally be seen in a darkening of the conjunctiva over the sclerotic coat of the eye, or in a dark line on the iuuer part of the lips. The treatment of argyria is not hopeful so far as the color of the skin is concerned, but it may be improved by the use of iodide of potassium to aid in the elimination of the poison. Therapeutics.—Internally this salt is used as a cure for gastric ulcer, and it is certainly the best remedy we possess if combined with extract of hyoscyamus or opium in pill form. In chronic gastric NITRATE OF SILVER. 231 catarrh and gastritis nitrate of silver is very useful, when the patient is troubled with sour eructations or when vomiting occurs after meals. When used iu these states it should be given in i to £ grain doses, half to one hour before each meal, in order that the stomach may be ex- posed -to its effects and not be protected by food. In intestinal ulceration the drug has been highly recommended by Dr. Pepper, and under these circumstances should be given in hard or keratin-coated pills in order that it may escape through the stomach without being chemically changed. In ulceration of the cecum and rectum and in acute and chronic dysentery the disease should be attacked by injections of nitrate of silver. If the caecum is involved the solution must be in large quantity in order to reach the part affected, but if the rectum is diseased the amount of liquid injected should not exceed four ounces, the bowel in either case being washed out beforehand by warm water to rid it of faeces. Soap and water and salt and water must not be used for this purpose, as the soap which remains in the bowel will prevent the silver salt from acting. The strength of the solution employed should be 1 drachm to 3 pints of water in caecal trouble, and 3 grains to each four ounces used in rectal trouble. If the latter condition is very obstinate and chronic, the strength may be raised to 5 grains to each four ounces. AYhenever nitrate of silver injections are used in this way a solution of salt and water should be made, ready for use, and injected if the action is too severe, or as soon as it is thought that the drug has acted with sufficient thoroughness. Nitrate of silver is the only remedy of any value in idiopathic anterior and posterior spinal sclerosis, but often fails. Nitrate of silver has been largely used in epilepsy and chorea, but is now seldom so employed, and does little good in most cases. Dr. William Pepper speaks highly of the continual administration of nitrate of silver in pill form in the dose of ■§- to \ grain through the entire attack of typhoid fever, and believes it greatly modifies the severity of the disease. Externally nitrate of silver is used for many purposes, and will often prevent the pitting of smallpox if, on the fourth or fifth day, the vesicles are punctured by a needle dipped in a solution of nitrate of silver in the strength of 20 grains to the ounce of water. Others simply paint the skin over the eruption with a solution of 5 to 10 grains to the ounce, claiming that this method is equally effective and prevents inflammation and suppuration. Higginbottom has highly recommended the use of nitrate of silver over erysipelatous inflammations, but the practice is not often resorted to, and is now supplanted by better measures. (See Erysipelas.) Iu other inflammations of a superficial character nitrate of silver is of great value. Painted in strong solution over the scrotum in the early stages of orchitis or epididymitis it will often relieve the pain and swelling, and felons can sometimes be aborted by its early application over the surface of the finger. 232 DRUGS. In all inflammations of the pharynx, larynx, fauces, aud mouth, solutions of silver nitrate are to be used in varying strength. Some- times after slight exposure to cold or dampness the posterior wall of the pharynx suddenly becomes sore and raw, feeling as if the mucous membrane had been scarified. A solution of nitrate of silver will relieve this, and if it is employed in the strength of 60 grains to the ounce of water the application will be more efficacious and less painful than if weaker solutions are employed. In laryngeal phthisis a spray used from an atomizer in the strength of J to 2 grains to the ounce of water may do good service. In whooping-cough Ringer recommends the use of a spray in the strength given above for the purpose of relieving the cough in its vio- lence and frequency and of obtaining a good night's rest. The appli- cations should be made when the stomach is empty, as they are apt to bring on retching. The end of the atomizer must be within the mouth or the skin of the face will be stained. In the later subacute stages of gonorrhea au injection of nitrate of silver of the strength of 2 to 4 grains to the ounce is very useful. In uterine ulceration and in leucorrhea, when the cervix is boggy and tender, the application of the solid nitrate of silver stick is of ser- vice. Its use is often followed by headache about the vertex, and this in turn is to be relieved by 10-grain doses of the bromides. In pruritus pudendi, ani, and vulvae a solution of 4 to 6 grains to the ounce should be painted with a camel's-hair brush over the parts to relieve the itching. The application is to be made from two to four times a day. Bed-sores may be aborted if, as soon as the skin reddens, a solution of nitrate of silver of the strength of 20 grains to the ounce is applied with a brush to the part. This measure fails in paralytics. Boils which begin in a small limited papule with a surrounding area of inflammation may be aborted by the use of a strong solution of this salt. In granular lids, conjunctivitis, and similar affections about the eye the use of the nitrate of silver in stick form or iu solution is largely and successfully employed. (See Conjunctivitis.) When it is desired to remove nitrate of silver stains they should be washed with a solution made of cyanide of potassium 2J drachms, iodine 15 grains, and water 3 ounces. Administration.—The dose of nitrate of silver is £ to |- of a grain in pill form. Mitigated caustic, or diluted nitrate of silver (Argenti Nitras Dihdus, TJ.