;i;i;V>. M I fflin ; lis ---dim. :I i'i ••*;.rs*«Jf; 4401372�7643�4 DDDflb7M7 NLM000867477 a^.XLJVy^ J> When called to guide a patient through an illness the physician should be constantly a watchman, and a therapeutist only when neces- sity arises. A TEXT-BOOK 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, »> » PROFESSOR OF THERAPEUTICS AND MATERIA MEDICA IN THE JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA; PHYSICIAN TO THE JEFFERSON MEDICAL COLLEGE HOSPITAL; LAUREATE OF THE ROYAL ACADEMY OF MEDICINE IN BELGIUM, OF THE MEDICAL SOCIETY OF LONDON ; CORRESPONDING FELLOW OF THE SOCIEDAD ESPANOLA DE HIGIENE OF MADRID; MEMBER OF THE ASSOCIATION OF AMERICAN PHYSICIANS; AUTHOR OF " A TEXT-BOOK OF PRACTICAL DIAGNOSIS," ETC. SEVENTH EDITION, ENLARGED, THOROUGHLY REVISED AND LARGELY RE-WRITTEN. LIBRARY SURGEON GENERAES OFFICE $EP.-1'M898 /C 3 3 *j LEA BROTHERS & CO, PHILADELPHIA AND NEW YORK 1898. V R v\v\ -4 M Entered according to Act of Congress, in the year 1898, by LEA BROTHERS & CO., in the Office of the Librarian of Congress. All rights reserved. WESTCOTT & THOMSON, ELECTROTYPERS, PMILADA. THIS VOLUME IS DEDICATED TO Dr. J. WILLIAM WHITE, PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OP PENNSYLVjI AS AN EVIDENCE OF FRIENDSHIP AND ESTEEM, BY THE AUTHOR PREFACE TO THE SEVENTH EDITION. The continued favor shown by students and practitioners of medi- cine toward this book, once again exhausting a large edition in about nine months, has naturally given its author great pleasure. because this favor indicates that it brings to their hands information which proves valuable in actual practice. In the preface to the last edition the author stated that every endeavor had been made by re- writing the text and carefully preparing new articles to keep the book abreast of the times and as useful as before. Equal attention has been given to the present issue, and in addition a number of illus- trations designed to elucidate descriptions of technique or thera- peutic results have been inserted. The opportunity has been embraced to make the text conform, not onlv as it has done to the Pharmacopoeia of the United States, but also to the British Pharmacopoeia of June, 1898. By these constant endeavors to maintain the object for which the book was written it is hoped that it may remain popular with medical readers. 222 S. Fifteenth St. August, 1898. PREFACE TO THE SIXTH EDITION. Although the number of copies printed of the fifth edition of this work was almost three times as great as was the case with earlier editions, they have been rapidly exhausted and the author has been called upon within two years to prepare the manuscript for the sixth edition. The original object of the book was to present the physi- cian and student with a well-digested and concise, yet practically use- ful, statement of the best methods of treating disease. It was written for the reason that the author appreciated as a practitioner and teacher that many of the works upon this subject contain a vast amount of information so compiled as to be almost useless because the reader is forced to discover for himself what is worthy of his confidence. For this reason remedies which are so rarely employed as to be curiosities are not discussed in this volume, and the space so saved is utilized in rendering rational the application of well-tried remedies both new and old. Many books after appearing in several editions lose a large part of their original value because the statements that have been added are so confused with the original text that its conciseness is destroyed. Recognizing this fact, the author has rewritten a very considerable portion of the present edition in order to render the statements in the text clear and concise. He has also endeavored so to arrange the work that it can be readily used in conjunction with his Text-book of Practical Diagnosis. As this volume is not intended as a year-book for the record of all things in therapeutics, only those measures which have proved useful and reliable in therapeutics are included. For this reason nothing is said of the use of serum in the treatment of many infectious processes in which it has proved itself of little or no avail, for instance in strep- tococcus infection or tuberculosis, or in croupous pneumonia. Philadelphia, 222 South Fifteenth Street, September, 1897. ,i 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 were 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 know- ledge 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 treating 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 11 12 PREFACE TO THE FIRST EDITION. depended largely on the fact that many physicians of the past have 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 every one 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 PREFACE TO THE FIRST EDITION. 13 with equal propriety be called a spinal sedative or a cerebral seda- tive, or caffeine be classed as a cerebral stimulant, a circulatory stim- ulant, 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 official and unofficial, has been appended for ready reference. The subject of medical elec- tricity has heretofore commonly found a place in most text-books on therapeutics, but has been advisedly omitted in this instance, since electrical 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 author is indebted to his friend and student, Mr. J. G. Clark. Philadelphia, 222 South Fifteenth Street. Sept., 1890. CONTENTS. PART I. PAGE General Therapeutical Considerations.......... 17 PART II. Drugs.............................. 43 PART III. Remedial Measures other than Drugs..........391 Foods for the Sick......................446 PART IV. Diseases.............................453 Table of Doses of Medicines.................697 Tables of Relative Weights and Measures in the Metric and Apothecaries' Systems................713 Index of Drugs and Remedial Measures..........715 Index of Diseases and Remedies...............733 15 PART I. GENERAL THERAPEUTICAL CONSIDERATIONS. Before entering into a study of the action of drugs upon a 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 limita- tions 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 Avith 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 ignorantly or wrongly, or else they believe that they are promulgating a new theory, and do not know that the eras of excessive dosage and of 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 resulted not in the mere remedy of the faults it antago- nized, but in so complete a reversal of popular opinion as to force its converts into ways as reprehensible as their former habits. Thus, in 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 therapeutic 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 are pathology and surgery is readily answered by a denial; for the thera- peutist is able to treat successfully many diseases of which the pathol- ogist knows nothing, and is obliged to rest his treatment on empiri- cism simply because he cannot 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 17 18 GENERAL THERAPEUTICAL CONSIDERATIONS. In regard to surgcrv. every one 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 posssble. The definition of the word u 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 almost universally used to signify the employment of drugs for such purposes. The credit for the intro- duction of new instruments may or may not be accorded to surgery, but the discovery of new drugs must be accorded to therapeutics. \\ e 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 Avithin the lifetime of every one 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, and certainly could not remove, in the absence of its influence. To the accusation of backwardness the therapeutist can well reply by asking the champion of any other branch of medical science to put forward one discovery which equals antipyrine or ace- tanilide in power to relieve disease or pain, and last, but by no means least, those triumphs of modern therapeutics, the use of thyroid gland for niyxoedema and antitoxin for diphtheria, are to be remembered. The man who does not believe in the proper use of remedies for the cure of disease lacks the very keystone of the arch upon which all medical investigation 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 branch 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 bunglino- in his surgery, yet uses drugs intelligently after his slashing is finished. Homoeopathy depends upon more than one reason for its exist- ence. If infinitesimal doses are given, the patient is satisfied that he is receiving medicine, and Nature often produces her most rapid cures when left alone. Again, the entire basis of homoeopathic thera- peutics rests not upon the study of the causes of diseases, 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 ensured, and doubtless in many instances serious disorders are dis- covered 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 The first duty of the physician when called to a case of illness is to reach a diagnosis as to the cause of the ailment, and not until he has formed a definite idea as to the condition which confronts him should he prescribe any medicinal agent. In certain cases where the symptoms are severe or indicative of immediate danger it may be necessary to give relief by the use of temporary remedies, not only to prevent death, but to remove symptoms which, because of their severity, mask the case so that a diagnosis is impossible. Thus a patient may be found in collapse or in a state of syncope. The cause of this state may be obscure, but the pulse, heart-sounds, and respiratory action may indicate the need of immediate stimula- tion. In another instance agonizing pain, as that due to a crisis in locomotor ataxia, or renal or hepatic colic, may require a hypodermic injection of morphine as soon as the physician assures himself that the pain complained of is genuine. In other instances the case may be so obscure that several days of careful study may be necessary, and during this time palliative remedies may be required. Before ordering a drug or method of treatment the physician should have a clear conception of what he is trying to accomplish. No remedy should be given unless there is a distinct indication for its use. The old-fashioned " shotgun " prescription, containing many ingredi- ents, one or more of which might hit the mark, should be supplanted by the small-calibre rifle-ball sent with directness at the condition to be relieved. Having decided upon the remedy indicated, the physi- cian must next determine the dose required. This latter decision is almost as important as the first, for very often an error in dosage will cause failure of the remedy. A large part of the therapeutic skill of the physician consists in fitting the dose to the needs of his patient. 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, influence is that result which comes as a sequence of its primary effect. As an illustration of this we may take the local use of can- tharides. The local, near, or direct effect of this is a blister; the remote or indirect effect is the absorption of exudations or the influ- encing of inflammatory processes. If pilocarpine is used, its direct effect is the sweating which ensues, while its indirect effect is the relief of dropsy through the removal of exudation by the increased action of the skin, salivary glands, and kidneys. MODES OP ADMINISTERING DRUGS. Drugs may be administered for the purpose of affecting the gen- eral system in many ways, but practically we employ only six methods, as follows: 20 GENERAL THERAPEUTICAL CONSIDERATIONS. 1. Bv the mouth or stomach 2. o •J. Bv Bv hypodermic injection ; inhalation ; ■4. r,V the rectum; 5. B'v inunction; 6. By fumigation ; 7. By the endermic method. By far the most usual manner of administering drugs is by way of the mouth, which is the natural means of entrance into the body for foreign substances. 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 some time before, since the food and gastric juice may afterward so cover the gastric mucous membrane that the medicament cannot act upon it. Thus, in a case of chronic gastric catarrh or gastric ulcer, the nitrate of silver which is used should always be given half an hour or 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 or upon the general system by reason of its rapid absorp- tion in concentrated form. 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. 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 suspendable 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 alwavs penetrate well into the loose connective tissue, so that the liquid injected may find lodgment in the loose and spongy subcutaneous tissues without separating the skin from its rather close adhesion to 1 Hypodermic injections into the anterior aspect of the forearm often cause much pain in the hand by irritating temporarily the Lrancl.es of the radial or ulnar nerves! MODES OF ADMINISTERING DRUGS. 21 the tissues below or from the blood-vessels supplying it, for if sepa- ration occurs abscess and a slough may result. Fig. 1. Method of giving a hypodermic injection. The skin having been sterilized, the skin of the part into which the injection is to be given is to be raised by grasping it between the thumb and fingers of the left hand and the needle is then pushed into the base of this fold, as shown in the illustration. The injection may be made toward the body if it is preferred. The dangers from hypodermic injections are chiefly two. First: The needle may enter a Arein, and the entire dose be carried at once, en masse, to the vital centres. Second: The solution or needle used may not be sterile, and an abscess results. The first danger is to be avoided by injecting into spots not well supplied Avith veins, and the second by thoroughly Avashing both syringe and needle Avith sterile Avater 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 solution injected should be prepared by using freshly boiled Avater and adding thereto carbolic acid in such proportion that one-half to one drop of carbolic acid is present in each injection. It is claimed by some that this use of carbolic acid seriously hinders absorption, and in cases of urgency it should not be used. A third danger supposed to exist by some persons, but probably more feared than need be, is the injection of air into a vein Avith the medicament. It is Avell to see that all air is expelled from the syringe before making the injection. Most hypodermic syringes hold from tAventy to thirty minims. When drugs are given by the rectum, we employ them for three purposes : First, to influence the general system by their absorption; 22 GENERAL THERAPEUTICAL CONS/DERATIONS. secondly, to act locally upon any disease Avhich may be present in this particular locality or in the colon ; and, finally, to dislodge substances or parasites Avhich it is desired to bring away. The Avord "enema" is loosely used to denote all these injections, be their purpose what they may, and is synonymous Avith " rectal injection " or the more old-fashioned Avord* "clyster." If nourishment is being given, the injection is called a "nutrient enema." Sometimes these injections are called "lavements." 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 doAvn as a rule that no more liquid should be injected than is neces- sary to convey the medicine or food, unless the injection is for the purpose of emptying the bowel of fsecal matter or other materials, or it be desired to distend the boAvel in order to overcome obstruction, or to influence the colon by drugs, The reason for this lies in the fact that any large bulk of liquid sent into the rectum so stimulates its Avails by distention as to cause spasmodic contraction, with expulsion of all the rectal contents, Avhich is just what is needed Avhen fiocal matter is to be removed, but the opposite of Avhat 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, Avhile as a laxative enema one to tAvo pints may be employed. In the use of injections Ave 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 boAvel fails to recognize, as it were, the entrance of liquid, and by introducing a few drops of oil and laudanum in each injection. A large amount of distress often follows the gradual accumu- lation of fsecal masses in the colon Avhich are not passed with the daily movement of the lower howel. These can readily be removed by large injections of warm water or by the use of medi- cated liquids. A very important use of injections by the rectum is in the treat- ment of the various causes of intestinal obstruction. Here the great- est caution should be exercised that the injection be made with all possible gentleness, and slowly, the liquid being allowed to dribble into the bowel rather than to force its way. It is dangerous to use a greater pressure than is given by a fountain syringe at the height of two or three feet, as rupture of the peritoneal coat of the bowel may occur. Y\ here a large quantity of water is used it should be care- fully warmed to 100° or a little more, and it is well to add salt to it so that it will represent the normal saline strength of blood-serum' namely, seven-tenths of one per cent. (For use of injections in special diseases see Part IV., and for Enteroclysis Part III) 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. MODES OF ADMINISTERING DRUGS. 23 When drugs are given by inhalation they are generally employed Avith 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, Ave find such remedial measures adopted as the inhaling of steam laden Avith the drugs employed, the respiring of air loaded Avith the fumes of the medicament, or the inhalation of gases, and last, and most commonly resorted to of all, the use of 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 farthest bronchiole and pulmonary vesicle. Atomized sprays have also been found to possess great penetrating power in the treatment of inflammations under the skin or mucous membranes, as, for example, boils and carbuncles. As an example of the rules governing the administration of drugs in this manner Ave find that compound tincture of benzoin may be taken by inhaling the steam arising from hot water containing it, but can- not be used in a spray because it occludes the fine points of the atom- izing tubes. In a similar manner Ave may inhale the smoke of bella- donna or tobacco-leaves to relieve asthma, or the fumes of chloride of ammonium for bronchitis in its later stages. Fumigation Avith mercury, the sublimed vapor being inhaled, is also useful. Finally, we find that oxygen is sometimes very useful, the gas being readily inhaled, with good results in proper cases. The " spray " or atomizer is made in two forms—one form of appa- ratus being Avorked 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 deeper parts of the lungs, particularly if the air is compressed by the hand; but all instrument-makers noAv sell vaporizers or nebulizers Avhich so minutely divide the liquid medicament that it enters the deeper parts of the lungs very readily. The inhalation of moist air is very useful in bronchitis, and greatly aids other remedial measures. Steam may be disengaged in a room by means of a kettle of boiling Avater or by placing pieces of unslaked lime in a pan of water. Inunctions consist in the rubbing into the skin of medicines gen- erally of an oily or fatty nature, or Avhich assume this character through embodiment with oil or fat. The three substances most com- monly used in this Avay are cod-liver oil, mercurial ointment, and iodine ointment. They should always be applied on some part where the derm is thin and Avell supplied with subcutaneous lymphatics, as in the axillae, 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 24 GENERAL THERAPEUTICAL CONSIDERATIONS. which the epiderm is raised, when a little morphine or other alkaloid may be slipped under it and so absorbed through the true skin. It is a painful method, almost never to be resorted to, having been entirely supplanted by the hypodermic method of medication. Drugs are also sometimes caused to enter the body through the skin by placing them in plasters or poultices, or by the electrical process called cataphoresis. (Part III.) Remedies are administered in a number of forms, but chiefly as follows: Abstracts are dry poAvdered extracts mixed Avith sugar of milk until they are tAvice as strong as the crude drug. Abstracts are no longer official in the United States Pharmacopoeia. Aceta, or vinegars, are solutions of drugs in vinegar or acetic acid. There are two in the United States Pharmacopoeia (Acetum ()pii and Acetum Scilhe) and three in the British. Alkaloids are organic bases, forming salts Avith acid radicals, gen- erally occurring in crystalline form and abstracted from crude drugs. They nearly always represent the active principle of the drug. Aqu.e, or Avaters. are used as vehicles either for the dilution of strong medicines or for the purpose of carrying minute amounts of flavoring materials. Cataplasais are not official in the United States Pharmacopoeia. They are virtually poultices made of linseed-meal or of bread-crumbs. Cerates are ointments containing Avax to render them harder than Avould ordinary fats. Charts, 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 Avhich contain the drug mixed Avith sugar or honey. Dix'octions are solutions of drugs made by boiling and then strain- ing Avhile hot. 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 Avith the body, of acting as a protective, or of aidino- 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 Avater or alcohol. Fluid Extracts are made in the same Avay 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 alloAving it to stand for a short time until the water cools, after Avhich the liquid is strained. Sometimes cold Avater is employed. Pills are small round masses which, as a general rule, should not MODES OF ADMINISTERING DRUGS. 25 Aveigh more than three grains, in order to avoid too great bulk. If the material is a heavy one, as much as five grains may be placed in each pill. Pills may be Avithout covering or coated Avith sugar or gelatin to preserve them and prevent the patient from tasting their contents. Sugar-coated pills must always be fresh and the sugar- coating pure. Gelatin is the best coating for pills. Many pills are fraudulently coated with varnish and are insoluble. 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. Tablets.—Under this name manufacturing pharmacists and others prepare compressed pills or lozenges, generally of small size, the mass being made to adhere by means of its being subjected to great pres- sure by special machinery. Smaller tablets are used for carrying powerful drugs for hypodermic use. These, hoAvever, are often only lightly pressed, so as to render them easily soluble. Tinctures are solutions of the active principles of drugs in alcohol. Triturates are made by adding 10 per cent, of the active medi- cine to 90 per cent, of milk-sugar. These are then carefully rubbed together until the tAvo are intimately mixed, and are very valuable in the administration of medicines to adults or to children. 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 membrane Ointments, or unguents, consist of the mixture of some kind of fattv substance Avith the medicine which they are designed to carry. Wines are made in the same Avay as tinctures—strong Avhite wine being used in the United States, and sherry or orange Avine 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 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 suscep- tibility to various remedies, that we call idiosyncrasy, 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 we 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 can- not 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 26 GENERA L THERA PE UTIC. 1L ('ONSIDERA TIONS. be given to all adults Avithin certain limitations, and Avhich are varied sufficiently to permit of great differences in the effects obtained. It is in this" verv point that the success of many a physician chiefly rests ; for the "use of a dose by 'l rule of thumb " is as empirical and lacking in thought as is use of a remedy, not because we have a defi- nite action for it to carry out, but beeause it did some one else good Avho Avas suffering from Avhat 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 approximate rules in regard to the doses Avhich are to be given in treating the diseases of children, the best of Avhich is Young's rule. This is as folloAvs: Add 12 to the age and divide bv the age. Thus, if a child is tAvo years old, Ave have the folloAving 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 laAv, hoAvever, for of narcotics children should receive less than this (one-half), and of purgatives or laxatives more than this (two or three times). Closely connected with the question of dosage is that of hoAV drugs shall be ordered; that is, whether we shall employ the apothecaries' Acetum lobeliae..... Acetum opii....... Acetum sanguinariae . . . Acid, acetic........ Acid, acetic, dilute .... Acid, carbolic....... Acid, hydrobromic. . . . Acid, hydrochloric. . . . Acid, hydrochloric, dil. . Acid, nitric........ Acid, nitric, dilute .... Acid, nitrohydroohloric. . Acid, nitrohydrochloric. di lute.......... Acid, phosphoric..... Acid, sulphuric...... Acid, sulphuric, dilute . . , Acid, sulphuric, aromatic. Aqua ammoniae...... Aqua destillata...... Liquor potass, arsen..... Oleum anisi........ Oleum amygdalae amar. . Oleum cari......... Oleum chenopodii..... Oleum carophylli..... Oleum cinnamomi..... Oleum crotonis....... Oleum cubebse ...... Oleum gaultheriae..... Oleum hedeomse...... Oleum lavandulae..... Oleum monardae...... Oleum menthse pip..... Oleum menthae viridis . . . Oleum myristicae...... Oleum origani......, Oleum pimentae...... Oleum rosmarini...... Oleum sassafras...... Dropped from sa 91 55 99 82 66 no Dl 65 70 60 57 96 70 51 62 82 66 124 63 60 81 87 74 92 58 54 62 54 43 62 160 152 172 57 47 60 97 94 144 45 41 54 64 61 58 61 77 76 73 112 102 77 75 108 84 133 94 75 129 98 75 133 77 73 112 84 62 104 86 80 120 93 93 136 95 83 130 105 78 133 82 76 125 88 73 132 95 81 132 98 83 128 91 83 133 102 86 133 92 88 133 83 77 142 Oleum tanaccti .... Oleum terebinthinae. . Spiritus ammon. ar. . . Spiritus camphorse . . Spiritus aether, comp. . Spiritus aether, nitr. . . Spiritus menthse pip. . Syrupus scillae comp. . Tinctura aconiti . . . Tinctura asafcetidae . . Tinctura belladonnae . Tinctura benzoini co. . Tinctura cannabis ind. Tinctura cantharidis . Tinctura capsici.... Tinctura colchici . . . Tinctura digitalis . . . Tinctura ferri chlor. . Tinctura hyoscyami . Tinctura ignati'ae . . . Tinctura iodi..... Tinctura kino . ... Tinctura krameriae . . Tinctura lavand. co. . Tinctura lobeliae . . . Tinctura myrrhae . . . Tinctura nucis vomicae Tinctura opii..... Tinctura opii eamph. . Tinctura opii deodor. . Tinctura rhei..... Tinctura sanguinariae . Tinctura stramonii . . Tinctura tolutani . . . Tinctura veratri virid. Arinum aloes..... Vinum colchici rad. . '. Vinum colchici sem. . Vinum ergotae..... Vinum opii . . 110 103 108 98 120 88 98 106 120 102 94 98 121 118 116 86 114 108 114 112 112 116 117 97 110 100 112 98 94 109 98 110 100 120 108 71 92 86 148 96 87 102 85 81 81 120 97 88 91 83 97 100 96 86 79 95 105 92 136 142 139 140 140 144 143 122 164 145 128 146 98 136 143 124 145 139 147 140 144 148 150 141 138 145 148 143 135 141 144 134 120 156 152 94 95 105 122 102 ABSORPTION OF DRUGS. 27 weights or the metric system of Aveights and measures. There is no doubt that the latter are far preferable from a scientific point of vieAv, and they are generally used in all civilized countries save England and America. Even here, however, their use is daily increasing. Whether we use the old or the neAv system, however, we should always take pains when ordering small amounts of liquids to write for minims rather than drops, for the size of a drop varies with the particular liquid with which we are dealing and the character of the mouth of the vessel containing it. This is well shoAvn in the table on page 26, compiled by Kinsey and originally published in the American Journal of Pharmacy. 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 tAvice the amount given by the mouth, unless the drug be very poAverful or capable of very rapid absorption. ABSORPTION OF DRUGS. The knoAvledge of the rapidity with Avhich certain drugs are absorbed from the various surfaces with Avhich they come in contact is of importance in order that Ave 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 droAvned, 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 injec- tions 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 Avith the exu- dation after severe purgation or profuse diuresis, or tapping. In general dropsies hypodermic medication is nearly always worse than useless. When the stomach or boAvel is empty absorption from either is rapid, but when thev 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, Avhereas 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 gly- cerin or milk. . When the stomach is depressed and its powers of absorption im- paired, the addition of some irritant or stimulant, such as capsicum, will often aid in the absorption of an important drug. 28 GENERAL THERAPEUTICAL CONSIDERATIONS. DURATION OF 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. I bus, 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 eliminated, as in the ease 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 rapidiy as it is absorbed, and produce no effects if these organs are active. From studying the rapidity of the elimination of a drug Ave learn hoAv often to order a dose. Thus, digitalis may be given once, tAvice, or thrice a day, but carbonate of ammonium every tAvo or three hours. AY hen 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, OAving to the accumulation of the poison in the body. This is called "cumulative action." COMBINATION OF 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 com- bined Avith it, and the tAvo acting together, each in small dose, pro- duce 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 respira- tion 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 Avhich relaxes muscular spasm, Avhile 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 phvsio- logical effect, but also for the purpose of making their administration pleasant to the taste, has much more to do with professional success 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 othenvise. The medical practitioner Avho prescribes ever so wisely and appro- priately for a patient, but who is utterly regardless as to his combina- tions 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 STRENGTH AND RELIABILITY OF DRUGS. 29 wisdom entitles him to, but Avhich is driven from him by his oavu 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. 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 Aveakness, the writer believes that a most alarming array of figures Avould be presented. For many years this Avas unavoidable to a great degree, either because our knowledge of the active principles of drugs and the methods of isolating them Avas 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 Avere obtained, permitted deterioration to take place. At present these difficulties have been largely overcome. The trained pharmacist is taught how to make an essay for active principles in most of the valu- able alkaloidal drugs, and every physician should make careful inves- tigation into the quality of all preparations Avhich 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 lead- ing druggists of Philadelphia six ounces of tincture of nux vomica which Avere stated to have been made according to the directions of the United States Pharmacopoeia. That made by perhaps the leading druggist of the five contained twice as much strychnine and brucine as it should, and had tAvice as much solid residue; or, in other words, a phvsician prescribing this tincture in full dose Avould probably have poisoned his patient and reported the case as one of unusual suscepti- bility to drugs ! On the other hand, the author has recently seen a tincture of nux vomica Avhich 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 Avhich was unusually rich in alkaloids, Avhile the other had purchased nux vomica beans Avhich, by reason of immaturity, bad surroundings, or exposure to Aveather, were very poor in active principles. All these disadvantages may be avoided if physicians will insist that the drug- gists Avho dispense the drugs they order shall either themselves pre- pare 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 ordi- nary tincture. Digitalis and veratrum viride are practically the only drugs Avith Avhich 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. AYood records a case in Avhich opium poisoning occurred in a child who had 30 GENERAL THERAPEUTICAL CONSIDERATIONS. taken a Dover's powder: the reason being that the amount of opium intended for many doses Avas in the powder that Avas dispensed, 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 Avith patients who are desperately ill; and in many cases failure and discouragement may both be avoided if the physician Avill see to it that the tools with Avhich he Avorks are in good order and capable of doing Avhat he requires of them. A poor drug to the physician is Avorse than a rusty knife to the surgeon ; for the injury in the one case is unknoAvn, whilst in the other it can be carefully Avatched and guarded. 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 Avhat 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 than the case which here folloAvs, nor than that of a friend of the author who cannot eat a straAvberry without suffering from a violent attack of hives. The first case is that of a Avoman of thirty years, suffering from severe headache, who received an eighth of a grain of the hydro- chlorate of pilocarpine, hypodermically, every tAventy minutes, until 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. TAventy drops of tincture of cannabis indica every four hours failing to relieve the pain, half-grain pills of the solid extract Avere ordered, two of Avhich commonly affect a grown man most markedly. The extract had been proved to be active to other patients. In order to avoid any failure in absorption the pills Avere 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 between four o'clock one afternoon and two o'clock in the next afternoon. The thirty pills (fifteen grains) were taken in less than forty-eight hours without producing a single physio- logical 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 attracting attention Ihe hypodermic injections were given by the author, and, as the solu- tion was used as fast as it was made, the patient must certainly have received all of the pilocarpine. J IDIOSYNCRASY. 31 As there was daily an afternoon rise of temperature amounting to several degrees, quinine bisulphate Avas ordered in the dose of fifteen grains, to be given after six poAvders of one-sixth of a grain of calomel had been taken ; this not only failed to control the fever, but also produced no buzzing in the ears. The writer was now inclined to consider all the symptoms as hysterical, even including the evening rise of temperature. TAventy-four hours after the last dose of cannabis indica the attend- ant gave the patient, Avithout orders, no less than sixty grains of anti- pyrin 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 cinchonism. AYide experience has taught us, however, that several conditions act fairly constantly in regard to some idiosyncrasies. Certain dis- eased 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 Avhich 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, or the Chinaman goes into a delightful dreamland from smoking opium, Avhereas the Anglo-Saxon experiences no such agreeable sen- sations, 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 blonds and nervous persons, more especially in respect to' the drugs Avhich act on the ner- vous system. Nervous light-haired women stand belladonna very badly as a general rule, while children will take large doses often without discomfort. Opium is usually badly borne by children. Habit is another important factor governing idiosyncrasy. We all knoAv hoAV rapidly one becomes accustomed to tobacco, and hoAV mor- phine habitues take enormous amounts of their favorite drug without effect. INDICATIONS AND CONTRAINDICATIONS AND DEFINITIONS. The indication for a drug is any symptom or series of symptoms which Ave know the drug will relieve without causing at the same time an 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 contraindicated because it will intensify the meningitis. 32 GENERAL THERAPEUTICAL CONSIDERATIONS. Ahm-tificients form a class of drugs which, as such, ought never to be employed. If pregnancy is to be interfered with, the interruption should be produced bv instrumental means, and then only after con- sultation with another practitioner to get his views and protect one's self from possible legal difficulties. Alteratives are indicated where cell-growth is active to excess, but contraindicated where tissue break-down is present, or there exists a tendency thereto. Anesthetics are drugs used to produce lack of sensation. 1 hey are either local or general. Many of the local anaesthetics produce loss of sensation through benumbing the parts by the cold they pro- duce. Cocaine is an example of a local anaesthetic which causes anaesthesia by a direct paralyzant action on the peripheral sensory nerves. The general anesthetics are taken by inhalation and act upon the higher centres in the brain. An aphrodisiacs are remedies used to diminish sexual desire. Antacids are employed in cases where, as a result of morbid^ pro- cesses, lactic and butyric acids, or even hydrochloric acid, are found in abnormal quantities in the stomach. Anthelmintics are those remedies which are used for the purpose of removing intestinal Avorms. Antiarthritics is the name given those drugs which are employed for the purpose of relieving inflammations occurring in joints, Avhether these be in an acute or chronic condition of disease. Antihydroties are used to prevent excessive sweating, either when it is local or general. Camphoric acid is probably the best general antihydrotic. Antiperiodics is a term applied to drugs or remedies employed for the prevention or cure of malarial poisoning. They are so named because they tend to break up the periodicity of the attacks, which periodicity is a characteristic of such diseases. Antiphlogistics are remedies employed to prevent the progress of inflammatory processes. They are nearly all contraindicated in the presence of tissues possessing an impaired vitality through previous conditions of disease. Aphrodisiacs are remedies used to increase sexual desire and power. Astringents are employed for the purpose of contracting or con- stringing tissues. They act either by coagulation of albumin, by pre- cipitating albumin, or by making the tissues more dense by con- centration. Theoretically, all astringents should be non-irritatinc, but practically they possess irritant properties, and are, in conse- quence, contraindicated in the presence of very acute inflammations as a rule. Three of the mineral astringents, hoAvever, possess marked sedative properties in addition to their astringent power, and cap therefore be used freely in acute inflammations when locally applied They are nitrate of silver, subacetate or acetate of lead, and the sub carbonate or subnitrate of bismuth. Bitters are remedies designed to increase the activity of the mucous membrane of the gastro-intestinal canal by increasing its INDICATIONS, CONTRAINDICATIONS, AND DEFINITIONS. 33 tone. They may be divided into simple bitters and complex bitters. The first depend upon their bitterness solely for their activity; the second class is well represented by quinine or strychnine, both of which are exceedingly bitter, but, in addition to their local effect on the gastro-intestinal mucous membrane, act as stimulants to other por- tions of the organism. A good example of a simple bitter is columbo. Many bitters contain so much tannic acid that they are not generally useful, and for this reason very few can be used with preparations of iron, since a tannate of iron Avould be formed. Cardiac sedatives are drugs Avhich decrease the force of the heart, and, as a class, the amount of blood expelled at each beat of the ven- tricles. They are indicated in arterial excitement, contraindicated in arterial depression. Cardiac stimulants are drugs Avhich increase the force of the heart, thereby increasing the quantity of blood expelled from the ventricles. This may be accomplished by an increase in the rapidity of the beats or by a greater output of blood at each contraction, the diastole being sufficiently prolonged to admit of the ventricles being well filled. They are contraindicated in the presence of arterial excitement, and indicated in arterial depression. Carminatives are remedies given for the purpose of expelling flatus, particularly if there is reason to believe that the " Avind " has accu- mulated because of intestinal torpidity. Many of the carminatives are necessarily possessed of irritant properties, and are therefore con- traindicated in the presence of flatulence due to intestinal atony aris- ing from inflammation. The best carminative is spiritus getheris com- positus, or Hoffmann's Anodyne. Cathartics.—These are drugs employed when a positive and decided action of the boAvels is desired. They occupy a position betAveen the purges and the drastics. (See Purges and Drastics.) A good example of a cathartic is senna Avhen given in full dose. Cholagoyues are used to exert a stimulant influence over the flow of bile. Nitro-hydrochloric acid and mercury bichloride are perhaps the best types of pure cholagogues, while podophyllum and calomel represent the class of cholagogues which increase intestinal peristalsis in addition to stimulating the flow of bile. Cholagogues are, as a rule, contraindicated in the presence of acute inflammation of the gall- bladder or liver. Counter-irritants are remedies used to produce irritation at a spot distant from a painful or inflamed area, in order to relieve the diseased parts by reflex action exerted through the nervous system upon the painful nerve or disordered capillary netAvork. Demulcents are substances used to protect any exposed parts of the body from irritation. Diaphoretics produce an increased secretion from the sAyeat-glands. They may be considered as internal and external. The internal are represented by pilocarpine, which stimulates the sweat-glands them- selves ; the external are represented by the Turkish and Russian baths, which, by increasing bodily heat, cause a profuse sweat by reflex action. 3 34 GENERAL THERAPEUTICAL CONSIDERATIONS. Diuretics are used to increase the flow of urine from the kidneys. They act by stimulating the renal epithelium to greater activity, thereby increasing the excretion of both the watery and solid con- stituents of the urine; or they simply increase the watery constituents by increased blood-pressure in the kidney. It is to be remembered that the vegetable salts of potassium and the lithium salts inciease the solids in the urine, not by stimulating the secreting epithelium of the kidney, but by uniting Avith insoluble material in the system, forming soluble compounds Avhich are then readily eliminated. (See Eliminators.) They are indicated in con- ditions of renal inactivity due either to functional or organic causes. Irritating diuretics, such as cantharides, for example, are contraindi- cated in acute nephritis. Such a diuretic is only to be used where the kidneys are inactive through atony or prolonged chronic or sub- acute disease. Eliminators are drugs Avhich, by forming soluble compounds Avith insoluble substances in the body, render them capable of being ex- creted by the excretory organs, such as the skin, kidneys, and boAvels. Emetics are drugs used to produce vomiting. They act centrally Avhen, as is the case Avith apomorphine, they stimulate the vomiting centre, peripherally Avhen they irritate the Avails of the stomach. They are indicated Avhen we Avish to unload the stomach of unde- sirable materials, or Avhen Ave desire to cause an increased Aoav of bile from the gall-bladder, which is accomplished by the pressure exerted upon this viscus Avhen the abdominal Avails and diaphragm contract in retching. AAThen the ducts are mechanically obstructed by 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 contraindications to emetics are cerebral congestion or menin- gitis, gastritis, gastric ulcer, advanced pregnancy, and hernia. Emmenagogues are remedies used to produce or increase the men- strual flow. They are of tAvo classes—direct and indirect. The direct are all of them irritants, and are seldom of much value; the indirect are used to overcome the morbid condition underlying the menstrual disorder, and are therefore more rational. Thus iron and arsenic may be used in amenorrhoea due to anaemia Avith beneficial result. Expectorants are employed when it is desirable to promote secretion or to get rid of secretion in the bronchial tubes. Thus, in the early stages of an acute bronchitis the mucous membrane is hypersemic and swollen, but dry and irritable. Ipecac and citrate of potassium form at this time a sedative expectorant mixture, which, while allay- ing irritation, promotes secretion, and so relieves the engorged area On the other hand, after the acute stage is passed, there may be so much atony of the mucous glands that the secretion is either too scanty or too viscid to be coughed up. Stimulant expectorants, such as chloride of ammonium, eucalyptus, and terebene, are now to be employed. These latter drugs are contraindicated in the acute inflam INCOMPA TIBILITY. 35 matory stage of the disease, as they would simply stimulate the irri- tated mucous membrane to greater irritation. Hypnotics are drugs used to produce sleep. They may be divided into those which produce sleep and relieve pain, and those which have no analgesic poAver. The latter are therefore not to be employed in sleeplessness due to pain, and the former are contraindicated* when pain is absent. Thus, chloral produces sleep if it be ordinary func- tional insomnia; but if the sleeplessness is due to pain, opium is the drug to be employed. Chloral, in ordinary doses, is the purest hyp- notic that we have. Mydriatics are drugs which produce dilatation of the pupil or mydriasis. Conditions of the eye associated with increased intra- ocular tension are contraindications to mydriatics, as a rule. Myotics are drugs which cause contraction of the pupil or myosis. They are best represented by eserine. Nervous sedatives are indicated and contraindicated in a reverse manner to nervous stimulants. Nervous stimulants are contraindicated in nervous excitement, indi- cated in nervous depression. Oxytoxics are drugs which increase the expulsive power of the uterine muscular tissues. Revulsives are remedies used to produce increased activity of the general system or parts thereof through reflex influences—that is, they cause a determination of blood to one part, thereby relieving an engorged area. Thus, in cerebral congestion or effusion a vigorous purgative or cathartic may give relief by exercising a derivative effect. RevulsiAres are closely allied to counter-irritants. Roborants are drugs or measures devoted to the repair and build- ing up of tissues in the body, and comprise both foods and drugs. Roborant treatment also includes hygienic surroundings, fresh air, light and healthful employment. Tonics are used to increase vital activity. They are indicated in instances of local or general systemic depression, contraindicated in cases of inflammation or excitation with excessive functional activity. (See Bitters.) Vasomotor depressants are drugs which decrease arterial pressure by an action on the vasomotor nervous system rather than by an action on the heart. They act by relaxing the blood-vessels. Vasomotor stimulants are drugs which increase arterial pressure by an action on the vasomotor system, thereby producing contraction of the blood-vessels. INCOMPATIBILITY. The chief value of a knowledge of chemistry or pharmacy 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 Avhich will undergo chemical interchanges, decompositions, precipitations, or cause the formation of explosive mixtures. It is 36 GENERAL THERAPEUTICAL CONSIDERATIONS. impossible to detail all the incompatibilities, and only the most dan- gerous 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: R.—Potassii iodidi •• .............51*!' Acidi nitro-muriatici.............J.3J:. M Tr. cinchona? comp............9- s- t^uj.—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 : R.—Strychninse sulph..............Sr/.3- Potassii iodidi..............3'J;. Syr. sarsaparilke comp............^".1- •™" 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, as it will explode. Permanganate of potassium is subject to the same rule. 5th. Chlorate of potassium and ammonium chloride Avhen 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 and columbo. 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 Avith Avater. 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 Avhich 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 folloAving instances: (a) Corrosive sublimate may be given with potassium iodide, since it will throAv down a precipitate which redissolves and forms a double salt. (b) Nitrate of silver may be used Avith extract of opium or hyos- cyamus. 16th. Syrup of squill should not be given Avith the carbonate of CLASSIFICATION OF DRUGS. 37 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 formation. 20th. Calomel and antipyrin are incompatible, as are also sweet spirit of nitre and antipyrin. 21st. AYaters cannot be used in preparing saturated solutions of drugs, as they are already loaded Avith the volatile substance. 22d. Pepsin and pancreatin should not be used together, since the former can only act in an acid and the latter in an alkaline medium, and the pancreatin is destroyed by the acid gastric digestive process. Further, one ferment may digest the other. CLASSIFICATION OF DRUGS. In order that the student may gain a definite idea as to the various actions of different remedies the following list of drugs is appended, Avhich is of necessity somewhat arbitrary, and is not intended to be exhaustive, for many remedies might be placed in several classes. The endeavor has been made to place the best or most powerful drug of each class first in the list. It is to be remembered that a strict physiological classification is impossible. I. Alteratives. 1. Mercury. 2. The iodides of potassium dium. and so- 3. Iodine. 4. Iodoform. 5. Iodol. 6. Arsenic. 7. s. Cod-liver oil. Colchicum. 9. Ichthyol. 10. Taraxacum. 11. Mezereum. 12. Nuclein. II. Anesthetics. 1. Ether. 2. Nitrons oxide gas. 3. Chloroform. 4. Cocaine. 5. Eucaine. 6. Bromide of ethyl. 7. Chloride of ethyl and methyl. 8. Pental. 9. Bromoform. 10. Carbolic acid. 11. Antipyrin. 12. Menthol. III. Antacids. 1. Ammonia. 2. Sodium and its salts. 3. Liquor potassa. 4. Magnesia. 5. Lime. IV. Anthelmintics. Those that are used against the round- worm are— 1. Santonica. 2. Spigelia. 3. Chenopodium. 4. Azedarach. 5. Santoninate of sodium. Those used against the tape-worm are— 1. Pelletierine. 2. Aspidium. 3. Pepo. 4. Pomegranate. 5. Brayera. 6. Kamala. 7. Turpentine. 8. Chloroform. 38 GENERAL THERAPEUTICAL CONSIDERATIONS. Those used against the seat-worm, or oxyuris vermicularis, are— 1. Quassia. 2. Turpentine. 3. Tannic acid. 4. Chloride of sodium. 5. Vinegar. V. Antiseptics. (See also Disinfect- ants. ) 1. Corrosive sublimate in weak so- lutions. 2. Carbolic acid in weak solutions. 3. Peroxide of hydrogen. 4. Creolin. 5. Lysol. 6. Boric acid. 7. Permanganate of potassium. 8. Salicylic acid. 9. Sulphate of iron. VI. Antipeuiodics or Antimalarials. 1. Cinchona. 2. Eucalyptus. 3. Warburg's tincture. 4. Arsenic. 5. Methylene blue. VII. Antipyretics. 1. Antipyrin. 2. Acetanilid or antifebrin. 3. Phenacetin. 4. Guaiacol. 5. Phenocoll. 6. Quinine. 7. Salicylic acid. 8. Thallin. 9. Carbolic acid. 10. Kairin. VIII. Antispasmodics. 1. Amyl nitrite. 2. Chloral. 3. Bromides. 4. Opium. 5. Belladonna. 6. Camphor. 7. Hoffmann's anodyne. 8. Asafoetida. 9. Musk. 10. Valerian. 11. Monobromated camphor. 12. Amber. 13. Cimicifuga. 14. Hops. IX. Astringents. Vegetable : 1. Tannic acid. 2. Hsematoxylon. 3. Kino. 4. Catechu. 5. Khatany or krameria. 6. Rhus glabra. 7. Geranium. S. White oak. 9. Black oak. 10. Gallic acid. 11. Rosa centifolia. 12. Rosa gallica. All of these depend chiefly upon tannic acid for their active principle. Mineral : 1. Sulphuric acid. 2. Alum. 3. Lead. 4. Nitrate of silver. 5. Nitric acid. 6. Sulphate of copper. 7. Bismuth. 8. Sulphate of zinc. X. Cardiac Sedatives. 1. Aconite. 2. Veratrum viride and albumen. 3. Antimony. 4. Hydrocyanic acid. 5. Veratrum sabadilla. XI. Cardiac Stimulants. 1. Digitalis. 2. Strophanthus. 3. Ammonia. 4. Ether. 5. Alcohol. 6. Caffeine. 7. Nux vomica. 8. Ignatia. 9. Adonis vernaiis. 10. Convallaria majalis. 11. Sparteine. 12. Amyl nitrite (momentarily). 13. Opium. XII. Counter-irritants. Those counter-irritants that blister are called epispastics. They are— 1. Cantharides. 2. Thapsia. 3. Ammonia or chloroform when under a watch-glass. Those that redden or produce local hyperemia of the skin are — 1. Mustard. 2. Capsicum. 3. Turpentine. 4. Ammonia. 5. Chloroform. 6. Burgundy pitch. 7. Canada pitch. 8. Most of the spices. Under the name of Escharotics are grouped a number of substances capable of acting as destructive agents upon the soft tissues of the body. They are— 1. Chromic acid. 2. Nitric, acid. CLASSIFICATION OF DRUGS. 39 3. Sulphuric acid. 4. Nitrate of mercury (solution). 5. Bromine. 6. Caustic potash. 7. Caustic soda. 8. Burnt alum. 9. Arsenous acid. 10. Chloride of zinc. 11. Vienna paste. 12. Canquoin's paste. XIII. Diaphoretics. The only ones that we know as direct stimulants to the glands are— 1. Pilocarpus or jaborandi. 2. Warburg's tincture. The others are— 3. Hot dry and hot moist baths. 4. Dover's powder. 5. Alcohol (particularly when hot). 6. Nitrous ether. XIV. Digestants. 1. Pancreatin. 2. Pepsin. 3. Hydrochloric acid. 4. Diastase. 5. Papain. XV. Disinfectants. 1. Corrosive sublimate. 2. Chlorine or chlorinated lime. 3. Formaldehyde. 4. Carbolic acid. 5. Chloride of zinc. XVI. Diuretics. Those that increase both the solids and liquid constituents are probably— 1. Caffeine. 2. Squill. 3. Cantharides. 4. Buchu. 5. Vegetable salts of potassium. 6. Lithium. 7. Juniper. 8. Turpentine. 9. TJva ursi. 10. Chimaphila. 11. Cubebs. 12. Pareira brava. 13. Blatta. Those which increase the watery con- stituents of the urine without in- creasing the solids proportionately are— 1. Digitalis. 2. Nitrous ether. XVII. Eliminatives. 1. The iodides. 2. The salicylates. 3. The vegetable salts of potassium and the purgatives. 4. The lithium salts. 5. Jaborandi. 6. Colchicum (probably). XVIII. Emmenagogues. The direct emmenagogues are— 1. Apiol. 2. Binoxide of manganese. 3. Permanganate of potassium. 4. Cantharides. 5. Aloes. 6. Myrrh. 7. Rue. 8. Savine. 9. Tansy. 10. Pennyroyal. 11. Guaiac. The indirect are— 1. Iron. 2. Arsenic. 3. Copper. 4. Tonics in general. XIX. Emetics. The direct are represented by— 1. Apomorphine. 2. Ipecac (which is both centric and peripheral). 3. Tartar emetic (which is both centric and peripheral). The peripheral are— 1. Sulphate of zinc. 2. Mustard. 3. Alum. 4. Sulphate of copper. 5. Turpeth mineral. XX. Expectorants. Sedative: 1. Citrate or acetate of potassium. 2. Ipecac. 3. Antimony. 4. Lobelia. Those which act as stimulating expec- torants are— 1. Ammonium chloride. 2. Apomorphine. 3. Creasote. 4. Eucalyptus. 5. Tar. 6. Terebene. 7. Terpine hydrate. 8. Oil of sandal-wood. 9. Sulphur. 10. Grindelia robusta. 11. Garlic. 12. Squill. 40 GENERAL THERAPEUTICAL CONSIDERATIONS. Besides these we have nux vomica, which increases expectoration by stimu- lating the nervous system to coughing, and thus expels the mucus. Opium and the bromides depress the nervous system and allay cough, and so decrease expecto- ration. XXI. Hypnotics. 1. Chloral. 2. Bromides of potassium, sodium, etc. 3. Opium. 4. Sulphonal. 5. Trional. 6. Tetronal. 7. Paraldehyde. 8. Chloralose. 9. Chloralamide. 10. Hypnal. 11. Hyoscine (in mania). 12. Duboisine (in mania). 13. Cannabis indica (in large dose). XXII. Nervous Sedatives. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. Chloral. Opium (in full doses). The bromides and hydrobromic acid. Chloroform. Amyl nitrite. Nitrites of potassium and sodium, and nitroglycerin. Ether. Bromide of ethyl. Nitrous oxide. Bromoform. Belladonna. Antipyrin. Acetanilid. Phenacetin. Calabar bean. Hydrocyanic acid. Lobelia. Conium. Cannabis indica. Sulphonal. Croton chloral. Paraldehyde. Camphor. Monobromated camphor. Asafoetida. Amber. Hoffmann's anodyne. Cimicifuga. Musk. Valerian. Humulus. Castor. Hypnal. Tobacco. XXIII. Nervous Stimulants. 1. Nux vomica. 2. Ignatia. 3. Coca. 4. Kola. 5. Caffeine. XXIV. Oxytocics. 1. Ergot. 2. Cotton-root. 3. Ustilago maydis. And indirect when in labor: 1. Quinine. 2. Kola. XXV. Purgatives. Laxatives: 1. Cascara sagrada. 2. Sulphur. 3. Rhubarb. 4. Frangula. 5. Cassia fistula. 6. Euonymus. 7. Magnesia. 8. Manna. 9. Fruits. Cathartics (mineral): 1. Magnesium sulphate. 2. Magnesium citrate. 3. Sodium phosphate. 4. Potassium and sodium tartrate. 5. Sodium sulphate. 6. Mercury. Cathartics (vegetable): 1. Castor oil. 2. Senna. 3. Aloes. 4. Podophyllin. Cathartics (hydragogue): 1. Elaterium. 2. Jalap. 3. Colocynth. 4. Croton oil. 5. Gamboge. 6. Scammony. 7. The saline purgatives, if con- centrated solutions are used. XXVI. Tonics. 1. Cinchona. 2. Nux vomica. 3. Calumba. 4. Arsenic. 5. Phosphorus. 6. Mercury (in minute doses). 7. Copper. 8. Iron. 9. Hydrochloric acid. 10. Nitro-hydrochloric acid. 11. Nitric acid. 12. Phosphoric acid. 13. Condurango. 14. The vegetable bitters in general. CLASSIFICATION OF DRUGS. 41 XXVIL Vasomotor Depressants. 1. Amyl nitrite. 2. Nitroglycerin and other nitrites. 3. Veratrum viride. 4. Antimony. 5. Aconite. 6. Veratrum album. 7. Veratrum sabadilla. 8. Alcohol (in excessive doses). 9. Jaborandi. XXVIII. Vasomotor Stimulants. 1. Belladonna. 2. Hyoscyamus. 3. Digitalis. 4. Nux vomica. 5. Ergot. 6. Stramonium. 7. Caffeine. 8. Convallaria. 9. Suprarenal gland. PART II. DRUGS. ACACIA. Acacia, U. S., Acacice Gummi, B. P., Gum Arabic or Gum Acacia, is a gummy exudate from the stems and branches of small trees known as Acacia Senegal, and other acacias growing in Northern Africa and in Australia. As sold in the stores it consists of irregular semi- transparent lumps, Avhich are either smooth or angular, according to whether the substance has been preserved in the original beads or broken by handling. Its color is slightly yellow or almost white, both color and transparency depending largely on the amount of the impurities by Avhich 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 Avhen dissolved in water in the form of a drink when the same conditions exist in the mucous membranes of the alimentary canal and genito-urinary tract. In all these states it is useful as a vehicle for more powerful remedies. Made into a mucilage Avith flaxseed, to Avhich 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 Avarm part of the "range," and the gum-arabic solution added with a little lemon-juice for flavoring purposes. Acacia is chiefly used in pharmacy for making pills, emulsions, and similar preparations, and is official in the form of the mucilage of acacia {Mucilago Acacice, U. S. and B. P.) and the syrup of acacia (Syrupus Acacice, U. S.), the first containing 340 grms. of acacia and water enough to make 1000 grms., and the sec- ond 25 c.c. of the mucilage to 75 c.c. of syrup. ACETANILID, or ANTIFEBRIN. Acetanilidum, U. S. and B. P., Avas first employed in medicine by Cahn and Hepp, and is a white crystalline material only slightly sol- uble in water, but completely soluble in alcohol and ether. Applied to the tongue, it causes a burning sensation Avhich is very slight. It has been known to chemists for many years, and is made by the action of glacial acetic acid upon aniline, forming acetanilid or phenyl-aceta- mide. The word antifebrin is a registered name, and should be avoided 43 44 DRUGS. by the profession, since its employment obliges the druggist to use the acetanilid made by one firm instead of the compound made by other chemists, who are able to make the drug as an ordinary chemical com- pound, and do not charge so high a price as do those holding control over the registered name. Physiological Action.—Acetanilid has been studied experimentally and clinically to a very great extent, and fairly definite outlines of its action have been mapped out. Nervous System.—On the nervous system acetanilid has been found to act as a sedative, the sensory portion of the nerves and spinal cord particularly being quieted. After a poisonous dose general anaes- thesia 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. Circulatiox.—On the circulation acetanilid has but little direct influence except Avhen used in poisonous doses. Applied to the frog's heart, it at first accelerates its beat and increases its force, but soon causes a Aveakening, ending Avith arrest in wide diastole. Upon the higher animals it causes, in toxic dose, an immediate fall of arterial pressure Avith 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 Avith failure of the vasomotor system, as asphyxia causes no rise in pressure. In medicinal dose acetanilid 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 methsemoglobin to a very considerable extent. The question as to the influence of acetanilid upon the corpuscles is still someAvhat undecided, some observers declaring that these bodies are disorganized, Avhile others assert that they remain intact. In mod- erately 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 haemoglobin 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 Teichmann may be found in it. In ordinary medicinal doses the blood shows no change except in cases Avhere 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 by acetan- ACETANILID, OR ANTIFEBRIN. 45 ilid 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, Avhile 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.—When given in full medicinal doses, acetanilid 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, loAvering the fever by decreasing heat-production arid 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 knoAvn. 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 vieAV of the fact that the most careful spectroscopic examination of the blood fails to show any such change from the use of medicinal doses. That the fall of temperature is not dependent on the sweat produced is proved by the fact that the tem- perature falls even if enough atropine be given to stop all perspiration. Kidneys, Tissue-waste, and Urine.—Much contradictory evi- dence exists in regard to the changes which occur in these organs and their excretory products under the influence of acetanilid, but most observers agree that the excretion of urea is increased, and it is a fact that the more laborious researches which have been undertaken have reached a similar result (Lepine, Chittenden, and Taylor). Less uncertainty exists as to its influence on the elimination of uric acid, which is increased rather than diminished by the drug. After exces- sively large doses the urine becomes dark from the presence of broken- doAvn blood-coloring matter. Elimination.—The drug is eliminated by the kidneys as para- amido-phenol sulphate, and is entirely passed out of the body in about tAventy-four hours. . , , Antiseptic Action.—The drug possesses antiseptic powers, but they are only exercised when the amount present is quite large, (bee ThToxiecUChanges from Prolonged Use.—Although it has been claimed that no untoward effects result from the prolonged use of acetanilid in large doses, there can be no doubt that this is untrue. Under these circumstances congestion of the liver, kidneys, and spleen occurs, and if the dose be poisonous, clots may be found in the cardiac cavities. i Wood has criticized this statement. My reasons for holding to the opinions stated befoundf?n my Boylston Prize Essay of Harvard University on Antipyretics. can 46 DRUGS. 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 Aveak. The respirations become slow and shalloAv. Poisoning has occurred rarely from its external use. The treatment of a case of poisoning by acetanilid 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 combat cyanosis. Therapeutics.—The employment of acetanilid 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 rem- edy. The phase of the disease must be recognized, and the question as to Avhether the fever Avhich is present is harmful must be duly Aveighed. (See Treatment of Fever, Part IV.) In typhoid fever the studies of most clinicians shoAV that though the drug possesses very decided antipyretic power, it often causes great depression and collapse, and in no way influences the duration or gen- eral course of the disease. For the same reasons the value of acetanilid in phthisis is doubt- ful, since, although it greatly affects the temperature, it is very apt to cause collapse, profuse sweating, and depression. Thus the writer has repeatedly seen cases of phthisis in Avhich the attempt to control the fever resulted in the manner just stated, and lliese points out, what the author has 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 acetanilid in sthenic fevers, it at once becomes evident 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 consequence of this, we find that the sweating produced by acetanilid is not so marked or troublesome in diseases of a dynamic type, and that, in consequence, it more rarely causes collapse; but even in this class of cases, and particularly in both varieties of pneumonia, the use of acetanilid is rarely advisable. Indeed the anti- pyretic use of this and similar compounds is yearly becoming less if cold can be used in their stead. In much the same manner that antipyrin was found, some time after its introduction, to be possessed of pain-relieving power, so ace- tanilid has been discovered to possess similar properties—a discovery the credit of which must be given to the French investigator Lepine. Almost every form of nerve-pain seems to indicate its employment. It has been successfuly used in the crises of ataxia, the agonizing dartings of gastralgia, in cases of sciatica, and severe headaches often yield to its influence. A large amount of experience has proved it to be of value in epilepsy. The employment of acetanilid in acute rheumatism may be separated, ACETANILID, OR ANTIFEBRIN. 47 if desired, into that devoted to the cure of the disease, Avith the relief of pain and the reduction of pyrexia. There can be no doubt what- ever of the ability of the drug to control the fever of this disease. and the question as to Avhether it favorably influences the severity of the malady is to be answered very forcibly in the affirmative. (See Rheumatism, Part IV.) The dose for cases of rheumatism should be 4 (0.2) to 6 grains (0.5) three times a day. In subacute rheumatism of the muscular type acetanilid will often give great relief. Acetanilid is of great value in the treatment of chancroids when used in dry powder, and it is useful in the antiseptic dressing of wounds. In many cases of obstinate vomiting, particularly that following surgical operations when an anaesthetic has been used, acetanilid is a useful drug. The drug is usually best given in the dose of 1 grain every half hour until 6 grains are taken; and the following prescrip- tion may be used in compressed tablet, pill, or powder, preferably the latter, in order to increase the sedative effect on the stomach and steady the heart: R.—Acetanilidi................gr. vj. Caffein. citrat...............gr. iij. Camphor, monobromati..........gr. vj.—M. Ft. in pil. vel chart. No. vi. S.—Wash down with a little water or else dissolve powder in a drachm of brandy; pour over cracked ice, and give it from a spoon. Acetanilid has even been recommended when applied locally as a haemostatic in epistaxis, and has been given internally Avith asserted advantage in hosmoptysis. Acetanilid very distinctly increases the susceptibility of a patient to cold, and for this reason it should not be used for the relief of neur- algic or other pain before leaving the house in cold weather if it can be avoided. Untoward effects are not very common if acetanilid be used with care. The writer has collected a number of cases (thirty-eight) in Avhich unfavorable signs appeared after its use, but untoward action Avas never seen unless the dose given was excessive for the case Avhich received it. The dose most commonly producing such symptoms was from 3 (0.15) to 10 grains (0.65). In only three instances of the series did death occur—one from heart-clot and two from excessive dosage. No deaths Avere reported from moderate amounts, although some of the cases were very alarming. Very rarely symptoms of poisoning by acetanilid, such as are described on p" 46, follow its now general use as a dusting powder over wounds and other breaks in the skin. Administration.—Acetanilid may be given in doses varying from 2 (0.1) to 10 grains (0.65), 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. The antipyretic effect begins to be felt about one hour after the drug is taken. When neuralgias are to be treated or similar forms of pain are present, monobromated camphor, in the dose of | a grain, may be combined with acetanilid with advantage. 48 DRUGS. R.—Acetanilidi..............gr. xx (1.3). Camphor, inonobromati........gr. v (0.3.)—M. Ft. in pil. No. x. S.—One every two hours. This pill is not to be used if there is reason to believe that marked renal congestion or irritation is present. ACETATE OF POTASSIUM. Potassii Acetas, U. S. and B. P., is a neutral Avhite 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," as when it enters the blood it is changed into an alkaline carbonate. It has, however, been supplanted by the salicylates in the treatment of most cases of rheumatism. The dose should be from 1 to 2 ounces (32.0-64.0) a day. A combination of 10 grains (0.65) of the iodide of potassium and 30 grains (2.0) 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 as well as that of the urine. It has been used in the treatment of the uric-acid diathesis, and acts powerfully in rendering an acid urine alkaline. At one time it Avas supposed to purify the blood by aiding in the oxidation of effete material. The dose of potassii acetas is from 20 grains to 2 ounces (1.3-64.0), but the latter dose is only employed Avhen a purgative effect is desired. ACETIC ACID. Aeidum Aceticum, V. S. 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. Acetum, or Vinegar, is practically a dilute acetic acid. Therapeutics.—Acetic acid is seldom used internally. As a pow- erful escharotic the glacial or absolute acetic acid {Aeidum Aceticum Gflaciale, U. S. and B. P.) is used. 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 {Aeidum Aceticum Dilutum, U. S. and B. P.) is used as a lotion in night-sweats and to arrest ejnstaxis and other small haemorrhages. As a lotion to be widely employed it should be diluted one-half. Vinegar, or dilute acetic acid, has been used internally for the decrease of obesity, but is a harmful and useless remedy, disordering digestion and reducing the patient's strength. Sometimes inhalation of vinegar fumes from a cloth saturated Avith this liquid will control vomiting. In the following mixture acetic acid has been used with success for the removal of vegetations about the external genitals: R.—Acid, salicylic.............gr. xxx (2.0*1. Acid, acetic..............f^j (32.0).—M. S.—Apply with a camel's-hair brush. Very little pain is caused by this application. ACONITE. 49 Poisoning.—When over-doses of acetic acid are taken the treat- ment 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, Part IV.) Contraindications.—Nursing mothers should not take freely of vinegar, as it may produce a troublesome diarrhoea in the nursling. 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 official, 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 Avhen it is scraped or broken. It is to be remembered, how- ever, 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 preparations of the crude drug; the aconitine of commerce, moreover, varies very much in strength, because some of it is amorphous and impure, Avhile other samples are very pure and crystalline. Further than this, even the crystalline form is exceedingly variable. In addition to aconitine, Dunstan asserts that there are tAvo amorphous alkaloids—namely, aco- nine and napelline—and this investigator believes that there is a fourth alkaloid closely allied to napelline. Physiological Action.—When aconite is placed on the tongue it produces a sensation of tingling and burning Avhich extends over the pharyngeal surface and into the stomach if the drug is SAvallowed. This is due to its primary irritant and secondary benumbing action on the sensory nerve-endings of the mucous membrane. It sometimes causes a sensation of constriction in the fauces. Aconite is rapidly absorbed and destroyed by oxidation or eliminated. Nervous System.—In full medicinal dose aconite depresses the functional activity of the perceptive centres in the brain, the sensory side of the spinal cord, but chiefly depresses the peripheral ends of the sensory nerves. Applied to a mucous membrane, it acts as a local an- aesthetic, but is too irritating for this use in the eye. On the motor portion of the body it exerts little influence unless given in large, poisonous doses, Avhen it paralyzes the motor tract of the spinal cord and the peripheral motor nerves. Circulatory System.—When aconite is given in moderate medi- cinal dose it exercises no marked change on any part of the organism save the circulation, which becomes somewhat slower by stimulation of the vagus centres and by the drug acting as a sedative to the heart- muscle itself. The arterial pressure is slightly decreased by these doses, 4 50 DRUGS. chiefly by the decrease in cardiac force. If large doses are used, the pulse'becoines still more feeble and sIoav, and the arterial pressure falls from depression of the vaso-motor centre. When a poisonous dose is given it causes first a very marked fall in pulse-rate and arterial pres- sure, preceded sometimes by a quickening due to a condition of weak- ness and abortive cardiac action: this condition gradually passes into diastolic arrest of the heart, 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. In poison- ous 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. Absorption and Elimination.—Aconite is rapidly absorbed and destroyed by oxidation, so that its effects do not last for any length of time. The effect of aconite Avhen given in a large medicinal dose lasts for about three hours. It usually increases the urinary flow. Poisoning.—When aconite is taken internally in excessive amount it causes tingling of the mucous membranes wherever it touches them, Avhich 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 at first becomes weak and sIoav, but later on rapid and run- ning, so that it seems a mere trickle under the finger; sweating more or less marked is present, and fainting may ensue. Vomiting may occur, but is rare. The respirations noAV become sIoav and shalloAv, seeming to expand the lung to the smallest possible extent consistent Avith life. The face is pallid and anxious. Consciousness is preserved unless lost through an attack of syncope. There may be exophthalmus, or the eyes may be sunken and dull. The sclerotic coat of the eye is pale and pearly-looking. There is -excessive pallor. Clonic convulsions of unknoAvn origin sometimes occur. There may be marked anaes- thesia of the skin. The pupils may be normal, contracted, or di- lated to a Avide degree. The temperature of the body is very low. Death may be gradual or sudden, the slightest movement of the body Avhich 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 on a bed or board, Avith 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 failure, owing to the muscular effort involved, or the stomach mav be so depressed that the emetics w ill not act. If vomiting comes on, it should be into a towel, the patient not being allowed to raise his 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 hypodermically, and followed by alcohol, and this again by digitalis. The ether acts at ACONITE, OR MONKSHOOD. 51 once, and lasts while the alcohol is being absorbed, and the alcohol sup- ports the heart until the digitalis, Avhich is the physiological antagonist of aconite, but slow and prolonged in its effects, asserts itself. Atropine, because of its stimulating effect on the vaso-motor system, may also be used. 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. Full hypodermic doses of strychnine, such as -^ to y1^ (0.003-0.006) of a grain, may be given to stimulate the respiration and heart. Untoward Effects.—Aconite may cause in susceptible persons a vesicular, or even a pustular, eruption, or instead intense itching of the skin may be developed. Therapeutics.—The employment of aconite in disease is one of the most universally recognized procedures in medicine. It fulfils indi- cations Avhich nothing else can, and lends itself to the control of a large number of morbid processes, its effects being uniformly explain- able by its knoAvn physiological action. It is used chiefly for its influence as a cardiac and circulatory sedative, for its effects on the peripheral sensory nervous system, as in the vomiting of pregnancy, and in those states in which, through inflammation elsewhere, the nervous system needs a sedative Avhich Avill simultaneously reduce arterial tension. In the early stages of all acute inflammations aco- nite is of service. It may be applied locally over superficial nerves in neuralgia in the form of an ointment (2 grains [0.1] to 1 drachm [4.0], or as the oleate of aconitine, 2 grains [0.1] of the oleate to 100 [6.0] of sweet oil). In the earlier stages of gonorrhoea aconite in small doses frequently repeated is a most valuable remedy, and later in the disease tends to prevent chordee by its influence on the nervous centres. It is useful in croup, quinsy, sore throat, severe colds, bronchitis, and asthma due to exposure, in their early stages. When suppression of menstruation follows an exposure to cold, this drug, given Avith a hot drink and a hot sitz bath, will often restore the normal Aoav. In pericarditis it is valuable to allay the inflammation and quiet the excited heart, and it is also of great value in the earliest stages of sthenic pneumonia if great arterial excitement is present. Aconite is by far the best circulatory and nervous sedative for children suffering from sthenic fevers, particularly of the irritative type. It ought not to be used in adynamic, asthenic affections. Aconite is use- less and harmful in prolonged acute diseases, such as scarlet fever, if constantly employed. In persons who suffer from asthma which is preceded by coryza aconite does good if given in the earliest stages. In nervous palpitation of the heart and in the palpitation of exces- sive cardiac hypertrophy aconite is very valuable. In many cases of this character where there is not only hypertrophy, but irregular inner- vation, the use of a prescription containing aconite and digitalis proves of service, for the minute doses of digitalis stimulate the vagus nerves, and the aconite not only steadies the heart, but also counteracts the stimulant effect of the digitalis on the heart muscle: 52 DRUGS. R.—Tine, aconit..............f.^s (2.0). Tine, digital..............*!#» (2-°)- Tine. belladonna?...........fj5.i (4-°)- Tine, gentian, comp.......q. s. ad f^nj (00.0).—M. S.—Teaspoonful every six hours. In the epistaxis of full-blooded people aconite often affords great relief. Full doses of Duquesnel's crystalline aconitine are of value in some cases of obstinate neuralgia. This crystalline salt is about 4 times stronger than the amorphous variety. Administration.—As a general rule, small divided doses of the drug in the form of the tincture, \ to % a drop (0.015-0.03) given every fifteen minutes, will act better than a full dose given at once, unless the condition of the patient requires very active treatment. Preparations.—Tincture of aconite (Tinctura Aconiti, U. S. and B. P.) is used in the dose of 1 to 5 drops (0.06-0.3) in Avater, re- peated every hour if needed so often. A very useful way of employ- ing it is in the form of tablet triturates. The extract of aconite (Extractum Aconiti, IT. S.) is given in the dose of T to f of a grain (0.015-0.045), Avhile of the abstract (which is no longer official) 1 grain (0.05) is used. The fluid extract (Extractum Aconiti Fluidum, U. S.) is given in the dose of 1 to 2 minims (0.05-0.1). Fleming's tincture ought never to be used. The active principle aconitine is not official in the U. S. P. Its dose is ^hf to tto °f a grain (0.0003- 0.0006), but it ought never to be used internally. The B. P. prepa- rations that are not official in the U. S. P. are : aconitine (Aconitin a), aconite ointment (Unguentum Aconitince), and aconite liniment (Linimentuni Aconiti). ADONIS VERNALIS. From Adonis vernalis, a plant indigenous in Europe and Asia, is derived a glucoside, Adonidin. When 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 diastole. The indications for the use of adonis are all conditions of cardiac failure, particularly the presence of cardiac dropsy. It is much infe- rior to digitalis and caffeine, but may be employed when these fail, as it sometimes succeeds under such circumstances. Within the last few years adonis vernalis and bromides have been combined in the treat- ment of epilepsy Avith asserted success. The dose of adonidin is ^ to £ of a grain (0.008-0.016) 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 table- spoonful (16.0) may be given every four hours. A GARICIN—ALCOHOL. 53 AGARICIN. Agaric, or Touchwood, or Punk, has been used in the Southern United States very largely in the dose of 5 grains (0.3) every few hours in the treatment of the night-sweats of phthisis; and agaricin, the alcoholic extract of the drug, has been used with very extraordi- nary results, under these circumstances, by certain German and English physicians, in the dose of from l'to 2 grains (0.05-0.1) every five hours. Its physiological action is unknown, but it is sup- posed to act upon the nerve-filaments in the sweat-glands. The writer has employed it frequently in varying dose, and has never seen any decrease Avhatever produced by it in the sweats of phthisis, although he has Avatched it most closely, expecting to see great relief folloAv its use. Sometimes agaricin causes nausea and diarrhoea. ALCOHOL. Ethyl Alcohol (Alcohol Ethylicunx) 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 official in four forms—namely, as Alcohol, U. $., containing 91 per cent, by weight of the spirit and 9 per cent, of Avater; Alcohol Absolutum, U. S. and B. P., containing not more than 1 per cent, by weight of Avater; Alcohol Deodoratum, containing 92.5 per cent, by Aveight of alcohol; and Alcohol Dilutum, U. S., or dilute alcohol, 41 per cent, by weight spirit and the remainder water. The drug is generally given in the form of whiskey or brandy, and when the Avord alcohol is used in the saying, " Give the patient alco- hol," one of these tAvo liquids is always meant unless it is otherwise stated. Physiological Action.—Neratous System.—Alcohol acts first as a powerful excitant, and afterAvard, when given in very full dose, as a most active depressant and paralyzant of the nervous system. Locally applied in small amounts to the peripheral nerves, it excites them at first and paralyses them afterward. By the primary stimulation of the brain it increases the rapidity, but not the depth, of thought, and it increases the reflex activity of the spinal cord, the muscles, and the nerves. In large doses it produces lack of co-ordination by depression of the brain and loAver nervous system, the loss of co-ordi- nation being due largely to impairment of sensation, so that the power of touch and the muscle sense is interfered with. This makes a drunken man fail to recognize the angles or uneven surfaces of sur- rounding objects, and the impaired mental power and disordered judg- ment, 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 loAver animals, it stimulates the heart-muscle and increases the rapidity as Avell as the force of its beat. According to Dogiel, the increase in rate is partly due to stimulation of the accelerator nerves, 54 DRUGS. but Castillo denies any such influence. Wood teaches that the effect of alcohol is not through any action upon these nerves, but upon the heart itself, and is probably correct in his belief. Along Avith the stim- ulation 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 system. Respiration.—Respiration is stimulated by small doses of alco- hol 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 poAver, 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 body's oxidizing poAver 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 ferments retards or inhibits digestion, but in the stomach, on the other hand, when used in moderation, it assists the process; for by reason of its irritant and stimulating properties it induces the secretion of an excess of the digestive juice. When exces- sive amounts are ingested it disorders digestion by inhibitino- the action of the digestive ferments. Therapeutics.—The employment of alcohol in disease can here be only briefly alluded to, special mention of its indications beino- named when the diseases in which it is used are discussed. (See Part IV.) 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 stim- ulant in low fevers and prolonged wasting diseases, in old ao-e and in convalescence from acute disease. In both croupous and catarrhal pneumonia alcohol is useful, and particularly is this true Avhen these affections occur in children. (See Pneumonia, Part IV.) Some additional conditions, to state them specifically, in Avhich alcohol is indicated are fainting, snaJce-bite, surgical shock, and chronic ALCOHOL. 55 pneumonia in its later stages, and excessive wasting due to prolonged suppuration. It is also useful in poisoning by depressant drugs, such as aconite or antimony. Alcohol should never be given in the presence of circulatory excite- ment, but Avhenever the circulation fails during the progress of an acute disease it is useful. In the pneumonia of children, whether it be croupous or catarrhal, brandy or Avhiskey is very useful in the dose of 5 to 60 drops (0.3-4.0) every tAvo hours in a little water or milk. (See Administration.) In exhausting fevers, such as typhoid or typhus, alcohol finds its true usefulness. While it is Avell to give alcohol in many cases of enteric fever 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 Aveak and the patient seems to be sinking, or the appe- tite is failing and adynamia is a pressing symptom, alcohol is indi- cated ; 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. Sometimes ordinary Avhiskey or brandy Avill in severe typhoid fever disorder the stomach. The physician should then em- ploy an old brandy or Avine Avhich has acquired an aroma Avhich is called a "bouquet." In persistent vomiting small doses of good brandy poured on cracked ice will often do much good. Alcohol is not only of service internally, but it is also useful exter- nally as a wash or evaporating lotion over bruises, inflamed joints, and ivounds of a contused character. It acts as a cooling and anti- septic dressing. It is also useful for washing the skin of invalids, and "salt and whiskey" applied by rubbing is a good mixture to stimu- late the skin of unhealthy persons. Acute Poisoning.—In advanced poisoning by alcohol, Avith coma and total relaxation, external heat and hypodermic injections of digi- talis and strychnine are indicated if the heart or respiration seems to be failing. Belladonna should be administered to stimulate the vaso- motor system if the skin is relaxed and clammy, and counter-irrita- tion to the back of the neck is to be employed if any brain symptoms are 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, Avhen emollient sub- stances should be used to quiet the irritation. If persistent vomiting comes on, it must be quieted by the patient swalloAving 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 j-alap or elaterium (40 grains (2.8) of jalap powder or ^ of a grain (0.01) of elaterium should be employed); or full doses of calomel followed by a saline may be given if milder effects are sought. For the morning vomiting of drunkards FoAvler's solution of arsenic is often a valuable remedy. In view of the frequency Avith Avhich alcoholic and opium poison- ing are confused, the folloAving table is appended, which will be found 56 DRUGS. 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. Kespiration and pulse slow and full. rapid, and finally feeble. 3. Face may be pallid. 3. Face suffused and cyanosed. 4. Skin cool, perbaps moist. 4. Skin warmer than in alcoholic poi- soning. 5. Pulse rapid, at first strong, then 5. Pulse slow, strong, and full till late weak. in poisoning. There is scarcely r«ny difference as to consciousness in the two conditions. In medico-legal cases the urine should be saved in hermetically sealed vessels for examination. 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 lowered. 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 palsy. 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 blood-vessel. Chronic Poisoning, or the Alcohol Habit.—Chronic poisoning by alcohol results in very characteristic changes in the tissues. As the liver receives the alcohol from the stomach diluted only by the portal blood, it is often affected very early, and cirrhosis of this organ comes on with its accompanying gastric and nutritional symptoms. Mental disturbances are common, and neuritis may develop in its painful forms or produce paralysis or symptoms resembling locomotor ataxia.1 The treatment of chronic alcoholic poisoning may be carried out in two ways: First, by the isolation of the patient and the complete withdrawal of the drug at once; secondly, by a better plan, a gradual tapering-off in the daily amount of the spirit. In either instance isolation must be abso- lute, 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 reAvarded by finding hidden whiskey- bottles. The depression of the patient when recovering from alcohol- ism 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 and nutritious preparation under these circumstances. In the treatment of the atonic stomach of drunkards nothing does so well as the following pill: 1 See author's work on Diagnosis, Lea Brothers & Co., 1896. ALCOHOL. 57 R.—Oleoresin. capsici............n\x(0.65). Olei caryophylli............Tt^x (0.65). Hydrarg.chlor. mit...........gr. xx (1.3). Aloe Socotrinse.............gr. xl (2.65).—M. Ft. in pil. No. xx. S.—One three times a day after or before meals. If this pill fails to move the boAvels, a saline purgative should be used. The following are the principal points in the differential diagnosis of Chronic Alcoholism and the General 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 alco- 5. Tremors made worse by alcohol. hoi. 6. Mental symptoms temporarily re- 6. Mental state made worse by alcohol. moved, or at any rate improved, by al- cohol. 7. Tremors occur chiefly in the morn- 7. Tremors not confined to the morn- ing, ing. 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 Avhiskey are generally used as rapidly- acting stimulants. They should be exhibited in the form best adapted to the work they are intended to perform. If the action must be instantaneous, as in a case of fainting, they should be employed hot and concentrated, so that the stomach has not to Avarm the liquid before absorption. They are to be used hypodermically if 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 eggnog, the latter being the "heavier " of the two so far as diges- tion is concerned. In fevers of a typhoid type the dose of Avhiskey or brandy should be for an adult from 1 to 4 tablespoonfuls every three or four hours. More than a pint in twenty-four hours is rarely re- quired, but this amount often does great good and is not excessive. When brandy or whiskey is given to children, the following rules as to dosage may be used as indicating the approximate proper dose: 5 to 10 drops every four hours for a child of 1 month old; 10 to 20 drops for a child of 2 months old; 20 to 30 drops for a child of 3 months old ; 30 to 40 drops for a child over 3 months old ; 60 drops for a child over 4 months old. In some cases, however, it is Avell to use half these doses every two hours. In all cases the liquor should be diluted with hot or cool water. Wine-whey is very light and useful. Mulled wine and champagne are particularly useful in the treatment of irri- table stomach. (See Foods for the Sick.) Champagne when used as a medicinal stimulant should always be as devoid of sugar as possible —that is, what is knoAvn as " extra dry." Gin is rarely employed as 58 DRUGS. a stimulant, except when the kidneys are torpid. Stout and porter are of value in wasting diseases, in convalescence from acute diseases, and for nursing women. Contraindications.—All states of cerebral excitement, unless due to exhaustion, acute inflammations, the alcoholic habit, apoplexy, meningitis, acute nephritis, aneurysm, and advanced atheroma, con- traindfcate the use of alcohol, as does also the history of the alcoholic habit. The official preparations of alcohol are as follows : Whiskey (Spiritus Frumenti, U. S.) should be at least three years old, and be made, in America, from rye for medicinal purposes. Brandy (Spiritus ViniGallici, U. S. 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) is used solely as a lotion and perfume. Red Wine (Vinum Rubrum, U. S.) is made from grapes not deprived of their skins. White Wine (Vinum Album,) is the fermented juice of grapes the skins of Avhich have been removed. Dilute Alcohol (Alcohol Dilutum, U. S.), deodorized alcohol (Alcohol Dendoratum, U. S.), pure alcohol (Alcohol, U. S.), and absolute alcohol (Alcohol Absolutum) are also official. The unofficial 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 U. S. Pharmacopoeia are virtually identical therapeutically.) When diuresis is required and atony of the kidneys is present, without inflammation, 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) 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 Xerieuni) has about 30 per cent, of alcohol in it. It is not official in the U. S. P. Beer is made by a slow fermentation, while ale is made by a more rapid fermentation at a higher heat. Most of the beer in America contains about 4-6 per cent, of alcohol. Porter resembles the other malt liquors closely, except that it contains more solids, due to a scorching of the grain by a high heat. The B. P. preparations that are not official in the U. S. P. are rectified spirit (Spiritus Rcetificatus), sherry ( Vinum Xcricum), and Mistura Spiritus Vini Gallici, which is a useful, pleasant, and nutri- tious 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—ALLSPICE—ALMONDS. 59 ALLIUM. Garlic, or Allium Sativum, U. S., is a stimulant to digestion, OAving to the volatile oil it contains, which by its someAvhat irritating proper- ties excites the gastric mucous membrane to increased secretion. In persistent colds, Avhere the bronchial tubes are particularly affected, a garlic poultice, made by pounding the bulbs in a mortar, is a very efficient though disagreeable 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 or 2 drops (0.05-0.1). It ought not to be given dur- ing the febrile stage, as it is stimulating. If the skin in any case is too delicate to permit of the use of pounded garlic alone, it may be mixed Avith equal parts of bran, and a regular poultice or plaster made thereof. Employed in this form, allium is useful if applied over the spine or feet in the treatment of the cerebral and spinal con- vulsions of infants; placed over the belly in cases of gastro-intestinal catarrh, it acts almost as Avell as a spice poultice. Allium-juice has also been used, in the dose of 2 to 5 drops (0.1-0.3) to relieve ner- vous vomiting. The dose of the syrup (Syrupus Allii, U. S) for a child is 1 drachm (4.0), but 4 drachms (16.0) may be given to an adult. ALLSPICE. Allspice, or Pimenta (U. S. and B. P.), is the nearly ripe fruit of Pimenta officinalis, a tree of the West Indies. It contains an official volatile oil (Oleum Pimentcc, U. S. 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 1 to 5 drops (0.06-0.3). Aqua Pimento? (B. P.) is given in the dose of 1 to 2 ounces (32.0-64.0). ALMONDS. Almonds are official in the form of the bitter almonds (Amygdalus Amara, U. S. and B. P.) and the sweet almonds (Amygdalus Dulcis, U. S. and B. P.). Bitter almonds develop hydrocyanic acid in the presence of Avater, by the reaction betAveen the amygdalin and water in the presence of the emulsin contained in them; this is not the case Avith sweet almonds. Sweet almonds, Avhen 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 60 DR UGS. strained, an emollient and soothing drink is formed, which is very useful in irritations of the stomach anil intestines and of the air-pas- sages and pharynx. The expressed or fixed 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 Amygdala? Amarce, U. S.) which is exceedingly poisonous, owing to the prussic acid which it contains, and it is said that one drop Avill 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 gonorrhoea, as they diminish the burning on urination. Almond emulsions, Avhen locally applied, are supposed to be of value for the removal of freckles and sunburn. The preparations of sweet almonds are: an emulsion (Emulsum Amygdala?, U. S. and B. P.), dose 1 to 2 ounces (32.0-64.0); a syrup (Syrupus Amygdala?, U. S.), dose 2 drachms to 2 ounces (8.0- 64.0); a compound poAvder (J'ulvis Amygdala? Compositus, B. P.), given in the dose of 1 to 2 drachms (4.0-8.0); and the oil (Oleum Amygdala? Expressum, U. S. and B. P.), the dose of Avhich is 1 to 4 drachms (4.0-16.0) Aqua Amygdala? Amarce (U. S.) is prepared from the oil of bitter almonds. The dose is 30 to 60 drops (2.0-4.0). ALOES. Aloes, or Aloe of the U. S. P., is derived from Aloe Perryi, or Aloe vera. In the U. S. P. of 1890 the first is called Socotrine aloes (Aloe Soeotrina, U. S.), the second Barbadoes aloes (Aloe Barbaden- sis, U. S., B. P.). Aloes is the inspissated or dried juice of the leaves of the plant. It is also probably derived from several other species. Aloes contains an active principle known as aloin (Aloinum, U. S.), which is a crystalline substance. As aloin is generally sold it is^ however, an amorphous poAvder 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 Aoav 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 very 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 Avithout inducing purgation, probably because four drachms were not enough to affect the bovvels. Aloes has been used endermically, and Avhen so employed ALOES. 61 is said to act thoroughly. It is eliminated by the milk of nursing Avomen, and Avill 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 Avill be Avatery; but if the dose be more moderate (2 to 3 grains), the stools Avill be thick and pultaceous. Therapeutics.—Aloes should be used only Avhen 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 subacute or chronic constipation, but it is distinctly harmful if continued for any length of time, as it seems to produce atony of the boAvel. Owing to its bit- ter properties it acts as a tonic to the stomach, and is often given Avith iron to promote the absorption of this metal by stimulating 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 Aveight and fulness in the region of the rectum after the evacuation, and the writer has seen severe rectal catarrh produced in this Avay. If given alone it is very apt to produce griping, and it ought always to be combined with other drugs whose tendency is to prevent intestinal spasm. In cases of haemorrhoids occurring in persons suffering from gen- eral muscular relaxation and atony, aloes is said to do great good, but its use under these circumstances is by no means universal or generally accepted as correct. For weak, anaemic persons leading sedentary lives it may be combined with tonics to relieve the consti- pation so often a pressing symptom in these cases. In amenorrhoea dependent upon atony of the sexual system, or anaemia, or constipa- tion, it is thought to have a specific emmenagogue influence. Locally applied 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 bed-sores. The glycerole of aloes is to be made by evaporating four to eight parts of tincture of aloes and gradually adding thirty parts of glycerin. Contraindications.—Constipation occurring in plethoric persons should not be treated by aloes, and it should not be used if any irritation or catarrh of the intestine is present. Pregnant women should use aloes most carefully, lest abortion be produced, and if hepatic congestion or inflammation is present it ought not to be used. Fever is said to contraindicate the use of aloes, as does also rectal pn f o i»rn Administration.—Aloes is generally given in a pill, combined with spices and belladonna. (See Constipation, Part IV.) The dose should be about 1 to 5 grains (0.06-0.3) as a laxative, and 10 grains (0.6) as a purge. The Aloe Purificata, U. S. P.. should always be used. The official preparations most commonly employed are the pill of aloes (Pilulce Aloes, U. S. and B. P.), 2 grains (0.12) each of aloes and soap; the pill of aloes and myrrh (Piluhe Aloes et Myrrhce, U. S. and B. P.), 2 grains (0.12) of each constituent; the pill of aloes and mastich (Pilulce Aloes et Mastiches, U. S.), 2 grains (0.12) of aloes, 62 DRUGS. or the "Lady Webster dinner pill;" the pill of aloes and iron (Pilulce Aloes et Ferri, U. S. and B. P.), 1 grain (0.06) of aloes and 1 grain (0.06) of dried sulphate of iron; and the pill of aloes and asafoetida (Pilulce Aloes et Asafeetidce, U. S. and B. P.), containing 4 grains (0.26) of aloes, asafoetida, and soap. The dose of all these is one or tA\'o pills. Aloes is also official as Extractum Aloes Aquo- sum, dose 1 to 2 grains (0.06-0.12). The liquid preparations are the tincture (Tinctura Aloes, U. S. and B. P.), dose 1 to 3 fluidrachms (4.0-12.0); the tincture of aloes and myrrh (Tinctura Aloes et Myrrhce, U. S.),1 dose 1 to 2 fluidrachms (4.0-8.0). The B. P. preparations, besides those given, are the Decoctum Aloes Compositum, dose I to 2 ounces (16.0-64.0); and the Extractum Aloes Barbadensis,, the dose of Avhich is 2 to 6 grains (0.1-0.3). ALUM. Alum (Alumen, U. S. and B. P.) is the sulphate of aluminum and potassium in the V. S. P., but in the B. P. both it and the sulphate of aluminum and ammonium crystallized from a Avatery solution are official. At present much of the alum of commerce is made in the manu- facture of coal-gas for illuminating purposes, and it is therefore very cheap. It occurs in the form of octahedral crystals, and has an astrin- gent taste and acid reaction. After the crystals are exposed to the air for some time they become covered Avith a Avhite coating. Physiological Action.—When alum is brought in contact with ?- 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 blood-vessels and capillaries. Large amounts given for any length of time seem to increase secre- tion. Poisoning.—Very large amounts are necessary to produce death. As much as tAvo ounces will not kill a sickly dog. This is largely due to the fact that the vomiting and purging rid the animal of the drug, for if vomiting is prevented 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 Avater__1.3- 32.0) on a SAvab will be found very useful. It Avould be of much service in this condition Avere it not that it posseses a destructive action on the teeth. In hemorrhage, Avhen the leaking blood-vessels can be directly reached, alum is a remarkable hemostatic, aiding in the arrest of the bleeding in three Avays—namely, by coagulating the albumin, by con- stringing the parts, and by crystallizing Avhen applied in large amounts on lint, and thereby affording a surface Avhich is rouo-h and aids coao-u- 1 Sometimes called Elixir Proprietatis. AMBER. 63 lation. In hemorrhage after tooth-extraction its application is a very useful treatment. Dissolved in water or alcohol, 2 grains to the ounce (0.1 to 32.0), it makes an exceedingly efficient application for sponging in night-sweats or localized sweating of the feet or hands. In haemop- tysis a fine spray of a strong solution of alum, 20 grains to the ounce (1.3-32.0), may be employed, the necessity of the spray being made very fine being constantly borne in mind. This method may also be resorted to in bronchorrhoea or chronic bronchitis Avith excessive secre- tion, and in chronic catarrh of the pharynx and larynx. In mercurial pt gal-ism 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 for pruritus vulva?. As a vaginal wash for excessive leucorrhaa, in the strength of from 10 to 20 grains to the ounce (0.65-1.3 to 32.0) 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 be deeply inserted into the depressed follicles or applied to the SAvollen surface of the gland. In ingrowing 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 toAvard a cure. Dried alum (Alumen Exsiccatum, U. S. and B. P.) is useful as a dressing for old ulcers and sores, and has been highly recommended as an application "or swollen gums Avhere they press upon and override a tooth, particularly at the back of the jaw. The possibility of its exercising an evil effect on the teeth should not be forgotten Avhen this treatment is resorted to. Internally, alum has been used in diabetes, gastralgia, and dysen- tery of an acute and chronic type. In lead colic it seems to be of value in conjunction Avith morphine to allay the pain. At one time alum Avas largely employed in membranous croup in emetic dose for the dislodging of.the membrane and for the astringent effect exer- cised as it Avas swalloAved and expelled. The emetic dose of poAvdered alum is a heaping teaspoonful for a child or a tablespoonful for an adult. Alum mav be used as an antidote in acute lead-poisoning, as it is a soluble sulphate and also an emetic. Glycerinum Aluminis (1 to 5) is official in the B. P., and is used as a local astringent application. AMBER. Succinum is derived from a fossil resin found in Prussia and Bohemia, and is used in the form of the oil (Oleum Succini), which is volatile, quite irritant, and obtained by destructive distillation 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, and 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 1 to 3 parts of olive oil applied to the back and front of the chest is of service. 64 DRUGS. In adults suffering from acute laryngitis with an extension of the inflammation into the bronchial tubes full doses of sodium bromide given internally, with this proportion of amber oil and olive oil rubbed into the neck and chest, are very useful. The dose internally is 2 to 6 minims (0.1-0.3) given in emulsion. AMMONIA (NH3). Ammonia is a gas of a very acrid, burning taste and sensation, capable of producing death very rapidly, when inhaled, by inflam- mation 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 Avith the tissues of the body it acts as a most powerful irritant, causing a red- dening of the parts, folloAved, if the exposure be long enough, by local death and sloughing. If it be inhaled as a gas, it may produce rapid death by spasm or oedema of the glottis, and if a strong solution of it is sAvallowed, the same accident may occur. After more moderate inhalations severe bronchitis or pulmonary oedema may develop. Nervous 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 con- vulsive movements had their origin in the brain. The drug in moder- ate 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, but if the drug be in very weak solu- tion, it seems to increase its functional activity. Circulation.—Upon the circulation ammonia acts as a powerful but fleeting stimulant, increasing the pulse-rate, pulse-force, and arterial pressure. The cause of the increased pulse-rate depends upon stimula- tion of the accelerator nerves of the heart and of the heart itself, while the increase in force is due to the same cause, for Ringer and Sainsbury found the strength of the ventricles much increased. The rise of arte- rial pressure is due to the increased amount of blood pumped into the arteries by the stimulated heart, and probably by a stimulant action on the vaso-motor 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 vasomotor centre, it probably increases the functional activity of both. If by means of intravenous injection the ammonia reaches the heart in large amount in concentrated form, this organ ceases to 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, the respiratory movements AMMONIA. 65 becoming not only more full, but more rapid. If the drug is inhaled in small amounts or SAvallowed, the same action is seen in a less degree, the changes both in breathing and circulation being partly due under such circumstances to a reflex irritation transmitted along the sensory nerves. Elimination.—Ammonia Avhen 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 four distinct purposes in medicine—namely, as a circulatory and respiratory stimulant, as a counter-irritant, and as an antacid. The indications for the use of ammonia in the first class of cases are all forms of sudden cardiac failure wThere there is no time or opportunity to use the more stable and slowly-acting drugs. These emergencies 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 Avhere rapid cardiac stim- ulation is needed. It is claimed, without great justification, that ammo- nia will aid in preventing heart-clot or thrombosis in cases of severe hemorrhage and in pneumonia. In the most 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. Ringer has found that the drug has the extraordinary power of causing a heart stopped or depressed by chloroform to return to its beating. In prolonged diseases the employment of ammonia is not particularly advisable, owing to its fugacious action, although it is largely used, for the frequent 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. In gastric acidity due to fermentation, with the development of abnormal acids, ammonia is the most active remedy we can employ, but is not to be given if acute irritation of the stomach exists. Locally applied, strong ammonia-Avater 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 Avith great relief, to the spot stung by insects. The waters of ammonia are used exter- nally in 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 (2.0-4.0), Avell 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 Ammonia? For- tior, IT. S.; Liquor Ammonia? Fortis, B. P.), containing 28 per cent. by weight of the gas, and the weaker water (Aqua Ammonia?, XT. S. ; "> 66 DRUGS. Liquor Ammonia?, B. P.), which should contain about 10 per cent. by weight of the gas. The spirit of ammonia (Spiritus Ammomae, U. S)\ given in the dose of 30 to 60 minims (2.0-4.0) in water, and the aromatic spirit of ammonia (Spirit™ Ammonice Aromaticus, U. S and B. P.) in the dose of 25 to 60 minims (1.5-4.0) m water. The latter preparation is composed of carbonate of ammonium, the oils of nutmeg, lemon, and lavender, with alcohol and ammonia-water. Spiritus Ammonia? Faetidus (B. P.) contains asafoetida and is used in place of the aromatic spirit. Ammonia liniment (Linimentum Am- monia?, U. S. and B. P.) is used over tender joints and muscles. AMMONIAC. Ammoniac (Ammoniacum, U. S. and B. P.) is a resinous gum obtained from Dorema Ammoniacum, and is used very little in 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 (0.65-2.0) in pills in cases of chronic bronchitis devoid of any active inflammatory process. It is official in the form of the plaster of ammoniac and mercury (Em- plastrum Ammoniaci cum Hydrargyro, U. S. and B. P.), which is used as a stimulant over enlarged glands. Finally, there is the emul- sion of ammoniac (Emulsion Ammoniaci, U. S. and B. P.), used in chronic bronchitis in the dose of a tablespoonful (16.0). AMMONIUM (NH4). The following salts of ammonium are official, 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 Ammonii Acetatis, IT. S. and B. P.), dose 1 to 2 fluidrachms (4.0-8.0), for the purpose of acting as an antacid in gastric indigestion, and also as a mild diaphoretic which is inferior to sweet spirit of nitre. Benzoate of Ammonium. Benzoate of Ammonium (Ammonii Benzoas, IT. S. and B. P.) is employed chiefly for its diuretic influences, which depend entirely upon the benzoic acid present in the compound. It should be kept in well-stoppered bottles. As benzoic acid is eliminated as hippuric acid and ammonia as nitric acid, this drug may be employed in 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 are dissolved by this acidulation. The dose is 10 to 30 grains (0.6-2.0), Avhich should be dissolved in water or, better, administered in cachets or capsules. AMMONIUM. 67 Bromide of Ammonium. Bromide of Ammonium (Ammonii Bromidum, U. S. and B. P.) is really a crystalline salt, but is generally found in commerce as a white granular poAvder, which, Avhen exposed to the atmosphere, becomes slightly yelloAvish. It is readily dissolved in Avater. 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 swalloAved, 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 pro- duces in frogs total loss of reflex activity, preceded, it is said, in some cases by tetanic convulsions, although no such motor disturbances may take place. In a series of studies undertaken by the writer to deter- mine the exact effect of the drug it Avas found that the spinal cord Avas depressed, both on its motor and sensory sides, Avhile the nerves and muscles escaped. These results are in accord with those of other investigators, Avho 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 in small doses, but as a cardiac paralyzant if a large amount comes in contact writh the heart. In medicinal dose it is distinctly stimulant to the circulation, but not sufficiently so to render it valuable as a circulatory stimulant, to the exclusion of other more poAverful preparations. 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 gen- eral system than the latter drug. It is, however, more 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, and may be com- bined Avith it in some cases Avith success. (See article on Epilepsy, Part IV.) According to DaCosta, the drug is of very distinct value in rheumatism in the dose of 60 to 80 grains (4.0-5.3) a day, Avell diluted Avith water, although its manner of action in this disease is not known. The usual dose is 10 to 30 grains (0.65-2.0). It is incompatible with spirit of nitrous ether. Carbonate of Ammonium. Carbonate of Ammonium (Ammonii Carbonas, IT. S. and B. P.) undoubtedly has an action exactly like that of the liquid preparations of ammonia, and is used either alone or Avith the chloride in the treatment of bronchitis, particularly Avhen this disease occurs in babies and young children. It is also largely employed by surgeons in the treatment of children after a surgical operation to overcome the respiratory and circulatory depression produced by the anaesthetic. 68 DR UGS. The dose is 2 to 10 grains (0.1-0.65) in syrup of acacia and Avater. It is a rapidly-acting cardiac and respiratory stimulant. R. Ammonii carbonat...........gr. xlviij (3.0). fSviup. acacia? ............f ^j (32.0). Aquae dest............q. s. ad f.^iij (96.0).—M. S.—Teaspoonful (4.0) every two hours for a child of three or four years. Chloride of Ammonium. The Chloride or Muriate of Ammonium (Ammonii Chloridum, IT. S. 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 consideration of its use in diseases of the lungs can be found in the articles on Pneu- monia and Bronchitis. Chloride-of-ammonium fumes can be obtained from a few grains of the drug heated in an iron spoon over a gas-jet or by means of a set of three wash-bottles. In one of these is placed stronger water of ammonia, in the other muriatic acid. Each of these is connected with a third bottle by means of glass tubing, this bottle being partly filled with Avater, through Avhich the fumes in passing become purified and form the fumes of chloride of ammonium. The drug may also be used in a spray from an atomizer. 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 hospitals and elsewhere Avhere the author has charge. The dose is 2 to 15 grains (0.1-1.0), preferably given with liquorice and water to mask the taste. R. Ammonii chloridi............^jj (8.0). Extract glycyrrhiz. fl...........fjj (32.0). Aqua>dest.............q. s. ad f |iij (96.6).—M. 8— Teaspoonful (4.0) t. d. after meals for a child of five to ten years. The chloride of ammonium may, however, be given in compressed pills, provided a large draught of water or milk is taken simulta- neously to protect the stomach. (See article on Bronchitis for other prescriptions.) Gillespie asserts that 10 grains (0.65) of chloride of ammonium given half an hour before meals gives extraordinary relief in painful dyspepsia due to hyperacidity of the stomach. Iodide of Ammonium. Iodide of Ammonium (Ammonii lodidum, U. S.) should be kept in dark, well-stoppered bottles, and if deeply colored should not be dispensed. It may be employed in the dose of 2 to 5 o-rains (0.1-0.3) in all cases where the iodide of potassium is indicated, and seems to AMYL NITRITE. 69 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 (2.0) of the salt to the ounce (32.0) of glycerin, particularly if struma is the cause of the enlargement. The application is to be made once a day Avith a SAvab or camel's- hair brush. It is necessary that this solution be not exposed to the air or it Avill undergo decomposition. Valerianate of Ammonium. Valerianate of Ammonium (Ammonii Valerianas, IT. S.) is the salt of ammonium commonly used in the nervous unrest of pregnant or hysterical Avomen, or at the menopause in the peculiar nervous dis- orders apt to occur at that period. In poisonous doses it paralyzes the spinal cord in the loAver animals. It is usually given in the form of the elixir of valerianate of ammonium, the dose of Avhich is a tea- spoonful to a dessertspoonful, or it is combined Avith the bromides, under Avhich circumstances it is much more efficacious. The dose of the salt itself is 10 to 15 grains (0.65-1.0). The sulphate of ammonium is never used in medicine. The phos- phate of ammonium is employed in rheumatism in the dose of 10 to 20 grains (0.65-1.3). It is no longer official. The B. P. preparations besides those already given are: Sulphide of Ammonium, Oxalate of Ammonium, Liquor Ammonii Citratis, dose 2 to 6 fluidrachms (8.0-24.0). AMYL NITRITE. Amyl Nitrite (Amyl Nitris, U. S. 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 amyhc alco- hol, and is not to be confounded with nitrate of amyl, which has a different physiological action and is never used medicinally. Nitrite of amvl should be protected from light, heat, and fire. 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 forci- bly, and the respiration becomes gasping- % Nervous System.—Nitrite of amyl acts as the most rapid of all the nervous depressants and sedatives known, except prussic acid. 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 bv 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 70 DRUGS. 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 depres- sion of the vasomotor centres and the muscular coats of the blood- vessels. 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 methsemoglobin. Urine and Elimination.—The urine sometimes contains sugar after the use of the nitrite of amyl, and there is increased diuresis. The drug is eliminated very rapidly from the body by the lungs and kidneys. 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 vascular dilatation also greatly tends to aid in 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, provided the attack is accompanied by high arterial tension. It may be used in puerperal eclampsia, but it is a dangerous remedy, because of its relaxation of the uterus and the consequent danger of post- partum hemorrhage. In dysmenorrhea Avith uterine spasm it often gives great relief. Nitrite of amyl has been used in cases of sea-sick- ness as a prophylactic and cure with considerable success. In cardiac failure from fright or anaesthetics amyl nitrite is often of great value in single Avhiffs. If it does not act at once under these circumstancs, 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 hypodermic- ally, as the respiratory cramp prevents its inhalation. Administration.—The drug may be given by placing three to five drops on a handkerchief and inhaling the fumes, or it may be dropped on sugar and taken by the mouth in the same quantity. 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 physician should warn the patient that the effect of the drug is sudden and alarming, and in nervous cases should direct that the inhalations be made gently, as a very full inhalation may produce unpleasant sensations of cardiac failure. The best way for patients to use the drug is to have it in pearls of glass, each holding 3 minims (0.15). One or more of these may A NTHRA ROBIN—A N TIM ON Y. 71 be crushed in the handkerchief and 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 fin- gers. These are, of course, to be avoided. ANTHRAROBIN. Anthrarobin, Avhich Avas originally discovered by Liebermann, seems to possess equal value Avith its relative chrysarobin, and to be capable of acting as efficaciously as this substance in the treatment of skin diseases. It is a yelloAvish poAvder, tolerably stable in a dry atmosphere, not soluble in acids or Avater, but readily soluble in dilute alkaline solution or alcohol, at first making a solution of a brown color, Avhich, 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 Avith good results in a 10 to 20 per cent, solu- tion in the various forms of tonsurans as a Avash. 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 chrysarobin, 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 Avashing. According to most authorities, it is best to keep the drug in alco- holic solution, and, if the bottle is Avell corked, such a mixture remains good for a Aveek. ANTIMONY. Antimony itself is rarely used in medicine, oAving to its insolubil- itv, but is generally employed as the tartrate of antimony and potas- sium, or Tartar Emetic {Autimonii et Pothyllum, B. P.) are the unex- panded flowers of the Eugenia aromatica, 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 Carophylli, U. S. and B. P.), which is yellow Avhen fresh, but very dark-colored when old. Therapeutics.—Cloves or their oil are used in medicine for the pur- pose of acting as a carminative. They are also employed as a stimu- lant and tonic to the stomach to prevent griping during an attack of diarrhoea, or that caused by purgatives, to act as a flavoring agent, as a counter-irritant, and, finally, as a parasiticide and local anasthctic. The oil of cloves possesses great power for good in many cases of pulmonary tuberculosis, partly by its germicidal influence upon the bacillus. It should be given in the dose of 5 minims (0.3) in capsules after food three or four times a day, and a hypodermic injection of ster- ilized sweet oil, containing in each dose of 30 drops (2.0) 5 minims (0.3) of the oil of cloves, should be administered once a day. The in- jection should be given into the subcutaneous tissues of the flank or abdomen, and is painful, but the decrease in the cough and expectora- tion amply repays the patient for the pain. Like all volatile oils, this oil is an efficient local application for pediculus pubis and similar parasites, and it may be used in toothache because of its anaesthetic powers, if placed on a pledget of cotton in COCA AND COCAINE. 165 the cavity of a tooth. In the treatment of myalgia or muscular rheu- matism oil of cloves is often placed in a liniment 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 h to 1 drop (0.03-0.06) of the oil in a little water will some- times control excessive vomiting. In addition to the oil the B. P. has an official infusion, Infusum Caryophylli, the dose of which is 1 to 2 fluidounces (32.0-64.0). COCA AND COCAINE. Erythroxylon Coca is official in the U. S. and B. P. as Coca, but in the U. S. P. of 18S0 it was known as Erythroxylon. Cocaine (B. P.) (Cocaince Hydrochlor as, U. S.) is the alkaloid derived from Ery- throxylon C>ca. a shrub of Peru and Bolivia. When cocaine is heated with hydrochloric acid it is split up into several substances, amongst Others a base called ecgonine, Avhich has entirely different poAvers from cocaine, and is perhaps responsible for some of the evil effects which have resulted from poorly prepared cocaine. It is to be distinctly understood that Erythroxylon Coca is not the same as chocolate or Theobroma Cacao. 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. When locally applied to a mucous membrane, cocaine causes a blanching followed by marked congestion. Nervous System.—The dominant action of cocaine, when locally applied to the peripheral sensory nerves, is to paralyze them. When taken internally it stimulates the brain to an extraordinary degree, but exercises 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, hoAvever, very feeble. If the dose be a poisonous one, convulsions of cerebral origin ensue, and are both clonic and tetanic in type. The sensory nerves are paralyzed by enormous doses both A\hen the drug is directly applied and when it is taken internally. Upon the muscles, Avhen taken internally, Mosso has proved the drug to be a direct stimulant, and it is particularly active after star- vation or fatigue. Muscular poAver is increased temporarily by cocaine. 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 poAverful respiratory stimulant, producing in large dose a great increase in the rapidity of the respira- tory movements, but in poisonous dose it kills by failure of respira- tion associated with exhaustion from the accompanying convulsions. Temperature.—Cocaine raises bodily temperature to a very extraordinary degree if given in overdose, this rise being due to an 166 DRUGS. increase of heat-production (lleichert). In moderate or medicinal 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.—OAving to its powerful action as a local anaesthetic, cocaine has been used largely in diseases of the eye, and it is particularly effi- cacious in this organ because of the delicacy of the conjunctiva, Avhich it can readily penetrate and so paralyze the peripheral nerve-endings. The anaesthesia comes on in from one to five minutes after the use of the drug, according to the strength of the solution used. It is accom- panied by very marked dilatation of the pupil, which Roller asserts is due to the fact that the drug constricts the blood-vessels of the iris and leaves the muscular fibres untouched. Ophthalmologists, however, gen- erally assert that it stimulates the peripheral ends of the sympathetic nerve. It is important to remember that this dilatation, unlike that produced by mydriatics, such as atropine, is not accompanied by paral- ysis of accommodation. The drug does not cause a forcible mydriasis, and is never used for the prevention of adhesions in iritis unless com- bined with atropine. Therapeutics.—Cocaine hydrochlorate (Cocaines Hydrochlor as, U. S. and B. P.) is used as an anaesthetic in the eye in the dose of from 3 to 5 or more drops of 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 in the eye are all operations of a painful character, be they what they may, and it can also be used for the relief of pain Avhen an acute inflammation or foreign body is caus- ing suffering. The folloAving formula will be found useful in these states: R.—Cocainse hydrochlor. . . •......gr. viij (0.53). Acid, boric..............gr. vij (0.46). Aquae dest..............fgj (32.0).—M. S.—Use with a dropper in the eye every half hour until relieved. Cases of keratitis are recorded in Avhich cocaine has produced per- manent corneal opacities, and it may cause dryness and roughening of the corneal epithelium even in the normal eye. Cocaine is often used in 2 per cent, solution upon cracked nipples just before nursing to relieve pain. The drug must be carefully washed off before the baby is put to the breast. It is asserted, however, by Guenel and Desamaux that this treatment may permanently stop the flow of milk. 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 COCA AND COCAINE. 167 exceedingly disagreeable, the congestion looking more angry and being more painful than before, and the experience of the Avriter indicates that it Avill only act in a curative manner if applied before the capillaries become relaxed or paralyzed by the severity of the inflammatory process. In coryza and hay fever a poAvder consisting of cocaine, morphine, and bismuth in the proportion of 1 part each of the tAvo alkaloids and 5 parts of the bismuth will often be of ser- vice if snuffed up into the nostrils. If cocaine be applied to a large nerve-trunk, amputation of the tributary limb may be performed Avith- out.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 in cases requiring amputation of the fingers or in cases of minor surgery Avhere 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, solu- tion injected into the part, a ligature about the base of the digit being used to prevent hemorrhage and the systemic absorption of the drug. After the operation is concluded slight hemorrhage should be alloAved to occur, to sweep out the drug and thereby avoid systemic medi- cation. Not more than ^ grain of cocaine should be injected. Under the name of " infiltration anaesthesia " Schleich has introduced a method of destroying sensation in localized areas which often gives good results for minor operations. He injects into the skin, as super- ficially as possible, a sufficient amount of a solution of common salt, cocaine, and morphine to produce local oedema, and thereby pressure on the nerve-filaments, which are also depressed by the cold liquid coming in contact with them. He also believes that the local anaemia so caused aids in destroying sensation. The injection is given so gently that a sort of Avheal or cedematous spot is produced Avhere the incision is to be made. As soon as this spot is developed the needle is inserted into its margin and carried under the skin farther, and the injection is repeated. In this way the line of an extensive incision can be anaesthetized progressively. If deep incisions are necessary, the injec- tions are given into the deeper tissues as well. The injections must ahvays be made into the healthy skin, as if it is diseased a slough may result. Schleich asserts that similar injections under the periosteum permit of operations on the bones. The anaesthesia will last tAventy-six minutes. The solution is of three strengths, as follows: Solution. I. II. III. Cocaine hydrochloride . . . gr. iv (0.2). gr. ij (0.1). gr. £ (0.01). Morphine hydrochloride . . gr. } (0.025). gr. \ (0.025). gr. TV (0.005). Sodium chloride .....gr- iv (0.2). gr. iv (0.2). gr. iv (0.2). Sterilized distilled water. . . f|iv (120.0). fjiv (120.0). fgiv (120.0). To each of these solutions 3 drops of a 5 per cent, solution of carbolic acid is added. The second solution is the one commonly used. The first is commonly employed Avhere acute inflammation is present, and the third where repeated injections are necessary. It is Avorth remembering that cocaine is soluble in fats, whereas its salts are not. Cocaine itself should therefore be used in anaesthetic salves. 168 DRUGS. Internally, cocaine or the fluid extract of coca may be used as a supportive and stimulant in Ioav fevers, and in cases Avhere great physical and mental strain is to be borne. Thorington has found cocaine of very great value as a stimulant and anti-emetic in yellow fever. In the vomiting of pregnancy and other forms of excessive emesis it is of great service by depressing the gastric sensory nerves and thereby decreasing the irritability of the stomach. Cocaine 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." The dose of the fluid extract (Extractum Coco? Fluidum, U. S. and B. P.) is from £ to 2 drachms (2.0-8.0); that of cocaine, from J to \ grain (0.015-0.03). The other B. P. preparations are Lamellae Cocaines, each disk containing y^ grain (0.0006) of cocaine hydro- chloride and Unguentum Cocaines and Injectio Cocaines Hypodermica. The cocaine habit is a condition unfortunately often met Avith since the introduction of the drug into therapeutics. It is often combined Avith the morphine habit, and sometimes is employed as a substitute for that morbid state. The symptoms of the cocaine habit consist of marked loss of flesh, disorders of the circulatory system, mental fail- ure and delusions, sometimes resembling those of chronic alcoholism. Often hallucinations come on which are generally of a disagreeable type. The habit is difficult to cure, for relapses are frequent. The sudden withdraAval of cocaine from a patient may result in profound collapse. According to Magnan, a pathognomonic symptom of chronic or subacute cocaine-intoxication is a sensation of a crawling Avorm or bug under the skin. Untoward Effects.—Sometimes loss of speech, Mindless, nausea and vomiting, syncope, and unconsciousness have followed the internal use or local application of cocaine. Eplileptiform convulsions have also been noted, Avhile the circulation and respiration have been disordered in every possible manner. In many of these cases the urine passed after the poisoning is copious, very limpid, and contains albumin. Curi- ously enough, a large number of cases of severe poisoning have folloAved the injection of cocaine into the urethra previous to some operation for the relief of chronic gonorrhoea or stricture. The hypodermic injection of cocaine as a stimulant sometimes causes vomiting. The treatment of the poisoning consists in the use of ammonia, coffee, strychnine, or ether and alcohol if the symptoms are those of depression. If they are convulsive in type, then the treatment to be instituted is identical with that of strychnine-poisoning (Avhich see). Out of 250 cases of accidental poisoning arising from the medicinal use of the drug, 13 proved fatal. CODEINE. Codeina, U. S. and B. P., is an alkaloid derived from opium, and is often contaminated by morphine. The sulphate of codeine is gen- erally used, as it is more soluble than codeine itself. In the B. P. codeine phosphate (Codeines Phosphas) is official. COD-LIVER OIL. 169 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). It does not arrest secretion in the respiratory and intestinal tract, as does morphine, and therefore is less apt to cause constipation. Therapeutics.—Codeine has been highly recommended in France as a nervous quietant, and in this country in nervous cough or in cases Avhere the cough is excessive in bronchitis and phthisis. In diabetes mellitus some clinicians have found it of the greatest value, Avhile others have been disappointed in its use. It should, however, ahvays be tried in this disease, in the hope that it may exercise a favorable effect. When given for cough it should be used in the dose of from ^ to 2 grains (0.03—0.12) three or four times a day ; gen- erally placed in the syrup of Avild-cherry bark. When given for diabetes the dose should be much larger, beginning at 1 or 2 grains (0.05-0.1), and rapidly increasing to 20 or 30 grains (1.3-2.0) or more, given three times daily. The B. P. recognizes a syrup (Syrupus Codeinae) given in the dose of 1 to 2 drachms (4.0-8.0). • COD-LIVER OIL. Oleum Morrhuce, U. S. and_B. P., sometimes called Oleum Jecoris Aselli, is a fixed oil obtained from the fresh livers of the Oadus Morrhua, 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. Although the paler oils are gen- erally 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, and sulphuric 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 definite alterative poAvers, and the oil seems peculiarly adapted to digestion and absorption, for cod-liver oil passes through animal membranes very readily, probably OAving 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 influ- ence the blood directly, for clinical observation shows that anaemic persons become healthy-looking under its use, and Cutler and Brad- ford have found that this apparent improvement 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 cod-liver oil is more readily oxidized than any other oil. * The belief among physicians that the effects of cod-liver oil are dependent upon some peculiar combination of substances has shoAvn 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, Avho seems to have isolated a crystalline substance con- 170 DRUGS. taining phosphorus, iodine, and bromine : 3 to 5 grains of this prepa- ration are said to represent 1 drachm of the pure oil, and it is certainly of value as a medicament in most of the states in Avhich Ave use the oil itself. In "colds" which "hang on" and are not readily gotten rid of morrhuol is best given in capsule or pill. This substance is put on the market in gelatin-coated pills or capsules. Therapeutics.—Cod-liver oil is useful in persons who have no tuber- cular lesion in the lung or other tissues, but have mucous membranes Avhich are readily susceptible to disease. This state has been called the pre-tubercular stage of phthisis. Cod-liver oil possesses no curative power in cases of well-developed or rapid phthisis, and its admin- istration in many cases only serves to nauseate the patient or to pro- duce an oil}7 diarrhoea through failure of digestion. It does good in the early part of the disease in that it acts as a food peculiarly suited to a Avasting malady, and its mild alterative effects are also of value. It does not act 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 existence not only upon scrofulosis, but also upon anaemia, often yield to its use. In enlargement of the lymphatic glands, where they are not undergoing 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 sIoav formation characterized by no active change, but represented by cold abscess or old sores. If the suppurative process is chronic, the oil does good by aiding in maintain- ing the patient's nutrition. In cases of strumous ophthalmia cod-liver oil is of great service. 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 feAv grains of bile-salts, consisting of glycocholate and taurocholate of sodium, be added to each drachm of oil, it will be very ready absorbed from the skin when applied by rubbing.1 In sciatica and lumbago and in neuralgia cod-liver oil is of service. In emphysema of the lungs it is said to be of great value, and certain writers commend its use in gout, although others have asserted that it is of no value. Sometimes old persons, Avhose digestion is not disordered and Avho have no organic brain disease, complain of giddiness. The best treatment for this condition, in many instances, is cod-liver oil with small doses of quinine, or if these fail Avine 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 1 These salts may be bought, or made as follows: To about 300 cc. 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 tauro- cholate and glycocholate of sodium. Having carefully removed these salts from the paper, they are ready for use. COD-LIVER OIL. 171 persistence, be readily overcome, so that finally the patient may not object to the remedy, 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 Avhich may be dropped into a teaspoon 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 Avithout the oil touch- ing the sides of the glass, it will not be tasted. The first gulps must be large enough to include the oil. The oil may be taken on a full stomach, but as a general rule it is best digested if taken about two or three hours after meals, Avhen the gastric contents are about to be passed into the small boAvel, Avhere the oil is digested; and if it be im- mediately folloAved by a little pancreatin, its digestion will be much aided. Other modes of ingestion consist in the placing of the oil in whiskey or brandy, in the manner which has been described Avith milk, and this method possesses the advantage that the alcohol by its stimu- lating effect aids very distinctly in the digestion 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 (0.03-0.06) 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 Avith good results. CheAV- ing a piece of smoked herring before and after taking the oil is of value to disguise the taste in some cases. The oil is readily taken in soft cap- sules holding from \ to 1 drachm (1.0—4.0). Very feAv people are unable to swalloAv such capsules if these are first made slippery by dipping them in water. 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 feAv 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 instead. Often a simple bitter, such as a des- sertspoonful (8.0) of compound tincture of cardamom, taken in Avater immediately after the oil is SAvallowed, aids in its digestion. 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. A very useful preparation is the egg-emulsion made by one large manufacturing concern, as it contains no acacia and 40 per cent, of the oil. One of the preparations Avidely advertised in the street-cars of Philadelphia as "tasteless " has been shoAvn to contain no oil at all. 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 and makes it possible to put more oil into the emulsion. Oil devoid of smell is probably devoid of medi- 172 DRUGS cinal value, as all the peculiar properties have been "purified" out of it. Quite recently it has been suggested that cod-liver oil be given by the rectum, a full dose of pancreatin being mixed with it to increase its assimilability. Sometimes creosote is placed in this injection in 5- to 10-drop(0.35-0.65) doses. COFFEE. (See Caffeine.) COLCHICUM. Colchicum is the corm (Colchici Cormus, B. P.; Colchici Radix, U. S.) and seed (Colchici Semen, U. S. ; Colchici Semina, B. P.) of the Colchicum Autumnale, or Meadow Saffron, a plant of Europe, containing an alkaloid, colchicine, which may be still further changed into colchiceine. While the drug is official 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 skin. Taken internally in overdose, it also irritates 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 tem- perature, only producing changes in these parts when given in poi- sonous doses. In full doses it greatly increases the flow of bile, and may cause bilious vomiting and purging. 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 in man certainly has much to do with the usual fatal result. Therapeutics.—The employment of colchicum in medicine centres around its use in gout and similar states, such as chronic rheumatism. Indeed, it is almost a specific in acute gout, provided that it be pushed until it causes slight griping or laxity of the bowels. Colchicum does not seem to possess any marked beneficial effect in preventing attacks. Indeed, while it relieves one attack it often seems to hasten the onset of the next. In acute gout it is usually well to unload the bowels by a small dose of compound extract of colocynth, with some hyoscyamus added to it to stop griping. Thus R.—Ext. colocynth. comp. ...... gr. x vel xx (0.65-1.3). Ext. hyoscyami........gr. ij (0.12).—M. Ft. in pil No. iv. S.—One as soon as threatened by an attack. This pill is particularly needed if constipation be present and the belly is hard. If the abdomen is soft, it should not be given. After this has acted colchicum may be given. Thirty to 40 drops (2.0- 2.65) of the wine of the root should be given, and 20 drops more in COLLODION. 173 twelve hours. In some cases of subacute or chronic gout or chronic rheumatism iodide of potassium should be used in conjunction Avith the colchicum. The folloAving may be ordered : E.—Potassii iodidi..........gss vel 7,) (2.0 vel 4.0). Vini colchici radicis.......fgiss (6.0). Vini alb...........q. s. fgiij (90.0).—M. S.—Tablespoonful (15.0) three times a day after meals ; shake well. The use of colchicum in such doses as to cause severe purgation or emesis is dangerous, and ought not to be resorted to. Colchicine can be used successfully against gout in the dose of y^- to -£$ (0.0006- 0.001) of a grain. Poisoning.—The symptoms of poisoning by colchicum are nausea, griping, agony in the belly, purging folloAved by the passing of thick mucus, with great and increasing tenesmus, profuse salivation, col- lapse, and death from exhaustion and gastro-enteritis. Bloody purg- ing is almost never seen. The poisoning is one of the most painful, sIoav, 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 Avashed out by the administration of emetics and the use of 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 Avine of the root (Vinum Col- chici Radicis, U. S.) in the dose of 10 to 20 drops (0.6-1.2), although if a marked effect is required 30 drops (2.0) may be used. The extract (Extractum Colchici Radiids, XI. S.) is given in the dose of 2 to 3 grains (0.12-0.2), and the fluid extract (Extractum Colchici Radicis Fluidum, U. S.) in the dose of 2 to 4 minims (0.1-0.3). Of the seeds, the tincture (Tinctura Colchici Seminis, U. S. and B. P.) is given in 30- to 90-minim (2.0-6.0) doses; the wine (Vinum Colchici Seminis, U. S.) in the same amounts; and the fluid extract (Extractum Colchici Seminis Fluidum, U. S.) in the dose of 2 to 5 drops (0.1-0.3). The B. P. preparations, in addition to those given, are Vinum Colchici, dose 10 to 30 minims (0.0-2.0): Extractum Colchici, dose \ to 1 grain (0.015-0.05); and Extractum Colchici Aceticum, dose i to 2 grains (0.03-0.13). Colchicine is given in pill in the dose of y^-g- to ■£$ grain (0.0006- 0.001). COLLODION. Collodium, U. S. and B. P., is a solution of gun-cotton or pyrox- ylon 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 174 DRUGS. wounds and abrasions and for rendering small dressings Avaterproof. A difficulty in its use consists in the contraction Avhich takes place as it dries, which draws and puckers the part sufficiently to cause not only discomfort, but acute pain. It should be applied Avith a camel's-hair brush over the part affected. In 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 alloAved to become inspissated. By this treatment and by the frequent application of a coat or two the local 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 Avith 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 iodine, equal parts, will often remove the pain, although at first the suffering may be increased by this treatment. Flexible Collodion. Flexible Collodion (Collodium Flexile, U. S. and B. P.) is made hy adding Canada turpentine 5 parts and castor oil 3 parts to ordi- nary collodion. It does not contract or become hard, and is gener- ally to be preferred to ordinary collodion in the dressing of wounds. Styptic Collodion. Styptic Collodion (Collodium Stypticum, U. S.) contains tannic acid, and is employed to control small hemorrhages. It is seldom used, and its employment is a dirty way of controlling bleeding. Cantharidal Collodion. Cantharidal Collodion (Collodium Cantharidatum, U. 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. COLOCYNTH. Colocynthis, U. 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 is ever used in medicine. Colocynth causes large watery evacuations, and may, in very large dose, produce fatal gastro-enteritis. It is official 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 and for the relief of serous effusions this drug is generally given in the form of the compound extract of CONDURANGO—CONIUM. 175 colocynth (Extractum Colocynthidis Composition, U. S. and B. P.), Avhich contains 160 grms. of colocynth, 500 grms. of purified aloes, 140 grms. of the resin of seammony, 60 grms. of cardamom, and 140 grms. of soap. In the dose of 5 to 20 grains (0.3-1.3) this acts as a poAverful watery purge useful in dropsy. The extract (Extractum Colocynthidis, U. S.) is given Avith other drugs in the dose of 2 to 5 grains (0.13-0.3) as a purge. The following is a useful form in which to administer it: &.—Extract, colocynth...........gr. xxx (2.0). Extract, belladonna?.........gr. ij (0.1). Extract, nucis vomicae........gr. ij (0.1).—M. Ft. in pil. Xo. x. S.—One each morning. Colocynth is one of the principal ingredients in compound cathartic pills (Pilulce Catharticae Composites, U. S.) Each pill contains: com- pound extract of colocynth, IJ grains (0.09); extract of jalap and calomel, of each 1 grain (0.06); gamboge, J grain (0.015). This pill is not to be used constantly, as it eventually makes the bowels more constipated than before. The 17. S. P. of 1890 also orders a pill (Pilules Catharticae Vegetabiles, XT. S.) Avhich contains compound extract of colocynth, extract of hyoscyamus, extract of jalap, extract of leptandra, resin of podophyllin, and oil of peppermint. This is given in the dose of 1 to 2 pills. The preparations of the B. P. not official in the U. S. P. are: Pilula Colocynthidis Composite/, composed of colocynth-pulp, aloes, seammony, sulphate of potassium, and oil of cloves, dose 5 to 10 grains (0.3—0.65); Pilula Colocynthidis et Hyoscyami, dose 5 to 10 grains (0.3-0.65). CONDURANGO. Condurango is the bark of Condurango Blanco, a tree of Colombia, South America. It Avas introduced into medicine in 1873 as a cure of gastric cancer, and at one time had a favorable reputation. We noAV knoAV that, so far as the morbid growth is concerned, its action is valueless, but there is no doubt that it diminishes the severity of the symptoms in many cases by exercising a sedative effect on the gastric mucous membrane. It also tends to relieve the accompanying gastric catarrh through its action as a stomachic. The bark is never employed as the bark, but in the form of the fluid extract, dose 1 to 2 drachms (4.0-8.0), or the wine, dose J to 1 ounce (15.0-30.0). Sometimes it is given in the form of a decoction made by adding 1 part of the bark to 8 parts of Avater, Avhich is given in the dose of 1 tablespoonful (2.0) three times a day. Often it is Avise to add to the prescription a little hydrochloric acid to take the place of the natural acid of the stomach, Avhich is usually lacking in such cases. CONIUM. Conium (U. S.) is the leaves and fruit of the Conium maculatum. The plant groAvs in Europe and the United States, and contains a 176 DRUGS. resin knoAvn as coniine. This drug is official in the B. P. as hemlock- leaves (Conii Fcdia) and hemlock-fruit (Conii Fructus). Physiological Action.—Conium in full medicinal dose produces a feeling of relaxation and loss of muscular power, and if the dose be very large it causes giddiness, staggering, and disordered vision, Avith failure of the circulation. Nervous System.—Conium depresses the motor nerves, and, if the dose be extraordinarily large, the sensory nerves. Upon the spinal cord it exerts a feeble depressing influence, but has no posi- tive effect, Avhile the fact that consciousness continues almost up to death shows that the intellectual portion of the cerebrum escapes its influence. Circulation.—The action of the drug upon the circulation is depressant. It causes at first a fall of arterial pressure, then, if the dose be large, a rise, due to the asphyxia caused by nervo-muscular failure of the respiratory apparatus. Finally, a constant fall of pressure takes place. Respiration is depressed, because of the paralytic 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 proto- plasm, but only prevents the impulses which are sent out from mani- festing themselves in movements of the muscles. The poAvdered leaves or other preparations may be smeared over poultices to relieve the pain of ulcers and cancers, and they certainly do good in such instances. Administration.—The dose of the alcoholic extract (Extraction Conii, U. S.) is from ^ to 1 grain (0.03-0.06), and of the fluid extract (Extractum Conii Fluidum, U S.) 2 to 6 drops (0.1-0.3). The dose of the tincture (Tinctura Conii, B. P.) is 10 to 30 drops (0.65— 2.0). Coniine is a liquid alkaloid Avhich should never be used. The dose would be about -^ of a grain (0.001). The dose of the hydro- bromide of coniine is said by Helbing to be ^ to J a grain (0.01-0.03). The preparation in the B. P. made from the leaves is Succus Conii, dose 30 minims to 2 fluidrachms (2.0-8.0) or more. Yapor Conii consists of the juice of hemlock (Succus Conii) ^ ounce (16.0), liquor potassa 1 drachm (4.0), and distilled Avater 1 ounce (32.0). 20 drops (1.2) 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 given at first and the amount gradually increased. Poisoning.—A prominent symptom of poisoning by conium is drop- ping of the eyelids (ptosis), due to paralysis of the oculo-motor nerves, CONVALLARIA—COPAIBA. 177 and staggering and inability to walk. Its treatment consists in the use of strychnine as a respiratory and nervous stimulant, the employ- ment of external heat, and the use of cardiac stimulants if the circu- lation fails. The stomach is to be emptied by emetics or the stomach- pump before the antidotes are used. CONVALLARIA. This drug is derived from the rhizome and root-stalk of Conval- laria majalis. It is employed in medicine as a cardiac tonic to fulfil the indications Avhich direct us in the use of digitalis. While by no means so valuable a drug as foxglove, it sometimes acts better in an individual case than the older remedy. The heart is not greatly sloAved by it, but the drug is particularly useful in cases of arhyth- mia and "cardiac hurry."' The dose of the fluid extract (Extractum Convallarics Fluidum, U. S.) is from 4 to 8 drops (0.2-0.5) three times a day. The tinc- ture (Tinctura Convallarics) is given in the dose of 5 to 20 minims (0.3-1.3). Convallamarin is a glucoside of convallaria which has been used in the dose of % a grain (0.03) three times a day. Some clinicians think it ought to be given but once a day on account of a danger of cumulative action. COPAIBA. The Copaiba of the U. S. P. and B. P. is really the balsam or the oleoresin of Copaifera Langsdorffi, and is a clear, transparent liquid of oily consistency, of a pale-yellow color and a peculiar odor. From it is distilled an oil (Oleum Copaibae, U. S. and B. P.) which is of little value. As copaiba is an oleoresin, the term " oleoresin of copaiba " is often used to distinguish it from the oil. 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 gonorrhoea. In cases suffering from chronic urethritis with anaemia and debility the folloAving prescription is useful: R.—Oleoresinae copaibae...........3j (4.0). Oleoresina? cubebae...........gtt. iv (0.2). Ferri et ammonii citratis........gr. xx (1.3).—M. Ft. in capsulis No. x. S.—One t. d. after meals. Copaiba is employed in subacute and chronic bronchitis as an expect- orant. In the treatment of subacute pyelitis, cystitis, and dysentery it is of value. In dropsy due to slow renal changes it will often be of service. Administration.—Copaiba itself is given in the dose of 5 to 20 minims (0.3-1.3) in capsule or in emulsion. The oil of copaiba 12 178 DR UGS. (Oleum Copaibae, U. S. and B. P.) is given in capsule or emulsion, preferably in the former, in the dose of 10 to 20 minims (0.65-1.3) tAvo to four times a day- Sometimes it is dropped on sugar and so administered. 3Iassa Copaiba>,U. S., is made by rubbing up copaiba with magnesium, but this is a useless and clumsy way of using it in the pill form. The drug is eliminated in the urine, and gives the test for albumin with nitric acid. In some cases it causes urticaria, which soon disappears on theAvith- drawal of the drug. COPPER. Cuprum is never used in the form of the metal itself, but chiefly as the sulphate, Avhich appears in commerce as a blue, clear, some- what efflorescent salt. It is soluble in 4 parts of cold Avater, 2 of boiling water, but is not soluble in alcohol. Physiological Action.—Copper sulphate, Avhen locally applied to a mucous membrane, acts as a powerful astringent, or on the surface of an ulcer as a mild and superficial caustic. Upon the nervous system in cats it acts as a depressant poison when given hypodermically, finally causing death from respiratory failure. When given in over- dose by the stomach it causes death by violent gastro-enteritis and exhaustion. The symptoms do not generally come on for an hour, and consist in burning pain in the stomach, a copperish or metallic 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 an epileptiform character are present, and constant and profuse salivation is not infrequent. After death fatty degene- ration 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, Avhich is the yellow prus- siate of potassium, and the administration of emollient or demulcent substances, such as sweet oil and Avhite of eggs, followed instantly by emetics or the stomach-pump. If emesis and purgation are already active, emetics are of course contraindicated, and counter-irritation is to be employed over the stomach and intestines in the shape of a mustard plaster of moderate strength, and opium given to allay irrita- tion and relieve pain. Chronic copper poisoning is almost never seen, and, although the metal is widely used for coloring canned green vegetables, it seems to be harmless when ingested in such small amounts. Therapeutics.—Sulphate of copper (Cupri Sulphas, U. S. and B. P.), in the dose of 5 to 7 grains (0.3-0.4) may be used as a rap- idly-acting emetic which only acts upon the stomach, not the vomit- ing 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 CREOSOTE. 179 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 poi- soning, Avhen it acts as the chemical antidote. Even here its use must be most cautious, for Thornton has proved in the Laboratory of Experimental Therapeutics of the Jefferson Medical College that an antidotal dose of copper sulphate given to a dog poisoned with phos- phorus may produce death before the phosphorus can cause a lethal result. In pill form it is sometimes given in diarrhoeas depending upon ulceration of the bowels, The dose should be J to 1 grain (0.015—0.06) combined with opium. In some states of the body, particularly in skin diseases of the dry type and in persons Avith tubercular tendencies, copper seems to act like arsenic, and may be used in minute doses of y1^ of a grain (0.006) or less three times a day Avhere arsenic is not Avell borne. In small doses it is said to be a direct stimulant to the tissues, and to increase the firmness of the flesh and strength of the normal man. Very recently strong claims for copper as a remedy for ancemia have been put forward, particularly if it is employed as the arsenite of copper, Avhen the action of the arsenic and copper together produces a good effect. Locally applied, sulphate of copper is useful, in the solid form or in poAvder, 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 draAvn over the diseased spot; or a Aveak solution of 1 to 3 grains (0.06-0.18) to the ounce (32.0) of water may be dropped into the eye in subacute con- junctivitis. In relaxed sore throat, as a gargle, in the strength of 4 grains (6.2) to the ounce, it is often of service. CREOSOTE. Creosote (Creosotum, U. S. and B. P), as employed in medicine, should ahvays be derived from the destructive distillation of beech- wood and be designated " beechwood creosote." Much of that sold is derived from coal-tar, and is far less useful. Chemically, creosote is almost identical with carbolic acid. Clinically, it is very different. BeechAvood creosote should be of a reddish-amber hue and about as thick as olive oil. Its physiological action is almost identical with that of carbolic acid, and in poisoning by creosote the same antidotes as are employed in carbolic-acid poisoning—namely, soluble sulphates —should be used, as has been proved in experiments by the author. Creosote contains 60 per cent, of guaiacol and 40 of cresol, not creosol. Guaiacol is sometimes used in place of creosote in the dose of 1 to 2 minims (0.06-0.13). (See Guaiacol.) Creosote is a powerful anti- septic. According to the studies of Imbert, creosote is eliminated chiefly by the kidneys in the form of guaiacol sulphate and creosol sulphate of potassium. Elimination does not go on very rapidly, for this 180 DRUGS. investigator did not find it completed for about twenty-eight hours. A small amount of the drug is eliminated by the lungs. Therapeutics.—During the past few years creosote 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 creosote may be placed in 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 subacute inflammation of the bronchi. The beginning dose when the drug is given internally is 2 to 5 drops (0.1—0.35). Creosote is useless, so far as producing a cure is concerned, if tuberculosis is more than incipient, and ought not to be employed if it disorders the stomach. The drug is contraindicated in phthisis if fever or haemoptysis be present, but in those patients who have little fever and a rather slow development of the disease creosote often proves of very considerable advantage. The most favorable subjects for its employment are those in whom there is, in addition to parenchymatous changes in the lungs, marked bronchial catarrh, with a profuse secre- tion of mucus. In such cases the following prescription may be used: &.—Creosoti (beechwood)..........f ^iij (12.0). Tinct. gentian, comp...........f %] (32.0). Spt. vini rectificati...........f ^viij (256.0). Vini Xerici ..............Oij (1 litre).—M. S.—A tablespoonful in a wineglassful (16.0: 64.0) of water three times a day. Unless the patient is fastidious, the creosote may be dropped into half a glass of milk and taken in this three times a day. Often as much as a drachm can be given by gradually producing tolerance through ascending doses; and it is worthy of note that in most in- stances large doses are required if satisfactory results are to be obtained. Inhalations of the drug often give relief in the advanced stages of phthisis, and decrease the cough, allay the laryngeal dryness, and aid expectoration. When creosote is given hypodermically in phthisis, it should be given in the folloAving formula: R— Creosoti................f^ij (8.0). Olei amygdal. dulcis..........f^ij (8.0).—M. S—10 minims (0.65) to be injected deeply into tissues'below the scapula. This method is not to be employed except in rare cases. In the treatment of subacute laryngitis a fine spray of 1 to 2 minims (0.05-0.1) of creosote, 4 grains (0.2) of menthol, and 1 ounce (32.0) of alboline is of service used several times a day, or a mixture composed of creosote 10 minims (0.65), chloroform spirit 10 minims (0.65), and alcohol 20 minims (1.3) may be placed on an inhaler and inhaled. Creosote is a very valuable remedy in cases of indigestion with fermentative changes in the gastric contents when these arise from the CREOSOTE CARBONATE—CREOLIN. 181 deficient digestion of meats or the use of SAveets, Avhen given in the dose of h to 2 minims (0.03 to 0.1) after meals, preferably in tablet or capsule. Applied on a pledget of cotton to the cavity of a tooth, creosote often relieves toothache by virtue of its anesthetic influence over peripheral sensory nerves. Sometimes creosote is given in pancreatized cod-liver oil by enema, from 5 to 15 drops being so given to children with pul- monary or peritoneal tuberculosis. While ordinary medicinal doses of creosote rarely cause disagree- able symptoms, except some disorder of the stomach or bowels when it is pushed in full doses, the physician avIio is ordering large amounts should be always on the lookout for toxic symptoms. These consist in vertigo, headache, and a tendency to stupor, and the urine may become smoky in appearance, as in carbolic-acid poisoning. If any of these signs of overdosing appear, the drug must be reduced in dose or stopped altogether. The preparations of creosote are Acpia Creosoti, U. S. and B. P., given in the dose of 1 to 3 fluidrachms (4.0-12.0); 3Iistura Creosoti, B. P., dose 1 to 2 fluidounces (32.0-64.0); Unguentum Creosoti, B. P., for local application. CREOSOTE CARBONATE. Creosote carbonate, sometimes called " Creosotal," is a combination of creosote Avith carbonic acid. Over 90 per cent, of creosote car- bonate is said to be creosote. It is a thick, oily fluid of an amber color, Avith but little taste or odor. It is insoluble in water, alcohol, and glycerin, but is soluble in 95 per cent, alcohol, in ether, chloroform, and in cod-liver and olive oils. It is said to be less irritating to the stomach than creosote. The drug is dissolved and absorbed chiefly in the intestine. The dose of creosote carbonate is identical with that of creosote itself, and it is used for the same purposes. It is best given in capsules in olive oil. (See Guaiacol Carbonate.) CREOLIN. Creolin is a liquid cresol, a coal-tar product, possessing marked antiseptic but comparatively slight poisonous properties. In appear- ance it is a dark-brown fluid, and is derived from soft coal. It is of the consistency of syrup. When 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 wash for the hands, and for vaginal irrigation. It cannot be used as a solution in which to place instruments, as it makes so opaque a mixture Avith water as to prevent their being seen Avhen lying at the bottom of the dish. When used as a vaginal douche it should be employed in the strength of 2 per cent. One of its properties which is of value is that it forms a slippery coating over the maternal parts during parturition. In the treatment of cystitis in the female, Parvin highly recommends it as a vesical Avash in the strength of a 1 per cent. 182 DRUGS. solution, or, after the bladder becomes accustomed to its use, in a 2 per cent, solution. According to Kretzschmar and others, a solution of 1 to 500, used Avith a syringe, is useful in otorrhoea, 1 to 100 in nasal ulcers, and 1 to 1000 as a nasal douche in rhinitis Avhen there is much discharge Avith the formation of crusts. Creolin has also been used as an injection in the proportion of 5 parts in 1000 of Avater for dysentery and entero-colitis with success. In the eye Alt has used with good results a 1 to 2 per cent, solution in the treatment of blepharitis, keratitis, and phlyctenular ophthalmia. CROTON CHLORAL. Croton Chloral, or Butyl Chloral Hydras, B. P., has a physio- logical action closely allied to chloral itself, but possesses more anal- gesic power and is very much less depressant to the heart and circu- lation. The dose for the production of sleep is the same as chloral, 5 to 20 grains (0.3-1.3) in syrup. Therapeutics.—Croton chloral is preferable to chloral in sleepless- ness due to pain. In facial neuralgia and migraine it is exceedingly efficacious, par- ticularly if the fifth nerve be involved. In headaches due to eye- strain, and in those associated Avith 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 (0.2-0.3) every two hours till the pain is relieved or sleep comes on, or it may he given in solution or syrup of acacia and Avater, or water and glycerin. It has been used in as large a dose as 60 grains (4.0), but 20 to 30 grains (0.65-2.0) ought to be the maximum dose as a general rule. CROTON OIL. Croton oil (Oleum Tiglii, U. S. ; Oleum Crotonis, B. P.) is an exceedingly 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. 1 drop (0.06), placed on the tongue Avith 5 drops (0.35) of sweet oil, acts as a violent Avatery purge, and, owing to the smallness of its dose, it is frequently employed to revulse the uncon- scious, as in cerebral congestion. In delirium it is used for the same purpose, and 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 (0.06) 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 counter-irritant it is sometimes applied over a ten- der nerve or to the chest in the treatment of bronchitis, in the pro- CUBEBS—CUSSO. 183 portion of half-and-half Avith SAveet oil. Thus applied, it may be absorbed and cause purging. The treatment of poisoning by croton oil is identical Avith that of gastro-enteritis. (See Gastro-enteritis.) Linimentum Crotonis is a preparation of the B. P. Avhich is employed as a counter-irritant liniment for sprains and in muscular rheumatism. CUBEBS. Cubebs (Cubeba, U. S. and B. P.) are the unripe fruit of Piper Cubeba, a plant of Java. They consist in wrinkled or rough black bodies about the size of small peas, and have an aromatic pungent taste.. They contain a volatile oil, cubebic acid, and cubebin. The drug should not be kept in poAvdered form, as it loses its poAvers, but should be poAvdered as needed. Overdoses of cubebs cause gastro- intestinal and genito-urinary inflammation. Therapeutics.—Cubebs are used in the advanced stages of gonor- rhoea AA'here 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. In the treatment of chronic or subacute bronchitis the oleoresin of cubebs is very useful in some cases (see Bronchitis), and in the form of cubeb cigarettes the drug is much used as a remedy for hoarseness due to subacute laryngitis. Administration.—Cubebs may be given in poAvder in the dose of 10 to 60 grains (0.65-4.0), in the fluid extract (Extractum Cubebce Fluidum, U. S.) 10 to 30 drops (0.65-2.0), and in the form of the tincture (Tinctura Cubebce, U. S. and B. P.) in the dose of 10 drops to ^ an ounce (0.05 : 16.0). The dose of the oleoresin (Oleoresina Cubebce, U. S.) is 2 to 20 drops (0.1-1.3) three times a day, and it may be given in capsules or emulsion. The troches of cubebs (Trochisei Cubebce, U. S.) are used for the relief of pharync/itis of a chronic type. The dose of the oil (Oleum Cubebce, U. S. and B. P.) is 5 to 20 minims (0.3-1.3). cusso. Cusso, U. S. and B. P., sometimes called Kousso, is derived from Bray era Anthelmintica, a plant of Abyssinia. In the U. S. P. of 1880 it Avas called Bravera. It contains a volatile oil, tannic acid, and koosin or taeniin. The drug is used against the tape-worm, and is most valuable as a vermifuge, also possessing the advantage of safety. It should be used in an infusion (Infusum Brayera) in the dose' of ^ an ounce (10.0) of the powdered flowers to a pint (500 cc.) of Avater, and be taken in the morning on an empty stomach. (See Worms.) Koosin may be used in the dose of 20 to 40 grains (1.3-2.5) in capsule. The fluid extract (Extractum Cusso Fluidum) is 184 DRUGS. given in the dose of | an ounce (16.0). It has been said that the drug is apt to cause abortion in pregnant Avomen, but this is not known to be a fact. CYANIDE OF POTASSIUM. Cyanide of Potassium (Potassii Cyanidum, U. S.) is used in the same way and for the same purpose as hydrocyanic acid. (See Hydrocyanic Acid.) The dose is TV to T\ of a grain (0.006). The following prescriptions maybe used in cases suffering from bronchitis or phthisis accompanied with excessive cough: R.—Potassii cyanid....... Morphinse sulph...... Acid, sulph. arom..... Syr. pruni virginianse . . . S — Teaspoonful (4.0) three times a day . • . . gr. ij (0.1). . • • - gr.j (0.05). ... fsij (8.0). . q. s. ad f ^iij (96.0).—M. Or as folloAvs: R .—Potassii cyanid............gr-. ij (0.1). Ammon. chloridi..........31} (8.0). Acid, hydrochlor. dil.........f£j (4-0)- .. Elix. calisava-........q. s. ad f 311J (96.0).—M. S.—Teaspoonful (4.0) three or four times a day. DERMATOL. (See Bismuth Subgallate.) DIASTASE. The word diastase is applied to substances found in certain of the digestive juices of the animal body and present in processes connected with grain when fermented, as, for example, in the manufacture of al- coholic beverages. Whatever diastase may be in one sense, we recog- nize that it belongs to the same class of enzymes as pepsin and the like, and it has the power of converting starch into sugar. Many preparations of malt contain some diastatic power, but there is only one preparation of diastase, which possesses no other property save that of aiding the digestion of the starches—namely, one prepared origin- ally by a Japanese investigator, Takamine, and called from his name " Taka-diastase." It is used to relieve cases of indigestion of the starchy foods in the dose of 2 to 5 grains after meals, in tablets or capsules or in a solution. DIGITALIS. Digitalis, U. S., is the leaves of Digitalis purpurea, or foxglove, of the second year's growth. The leaves are official in the B. P. as Digi- DIGITALIS. 185 talis Folia. It contains a number of substances, no single one of Avhich acts as do preparations of the crude drug. In other Avords, all these compounds must act together to be therapeutically active. Among the substances so far isolated from digitalis by chemists may be named digitalin, digitalein, digitoxin, digitin, and digitonin. Several of these are simply compounds of the others. Digitalin, so called, occurs in tAvo forms, amorphous and crystalline. The crystalline digi- talin (French) is largely digitoxin, while the amorphous is composed of digitonin, digitalein, and digitalin. A pure digitalin has been isolated Avhich can now be obtained from Merck. Digitoxin and pure digitalin are the tAvo most active principles yet found. None of these substances should be used in medicine to take the place of digitalis. We have already pointed out in the early part of this volume the necessity of employing reliable drugs. In the instance of digitalis this is particularly important, because the cases in Avhich it is used are often serious, and because digitalis varies greatly in strength. As a rule, the Avild digitalis is stronger than the cultivated, and the English or German digitalis is better than the American. The prep- arations of digitalis should therefore be obtained from a first-rate manufacturing pharmacist after they have been physiologicallv tested. Physiological Action.—Digitalis is apt to irritate mucous membranes Avhich are already slightly out of order, and for this reason should not be given by the mouth in cases of gastritis and allied states if it can be avoided. Neratous System.—The action of digitalis upon the nervous sys- tem is only manifested when poisonous doses are used. Small toxic doses decrease reflex activity by stimulating Setschenow's reflex inhib- itory centres in the medulla, and finally by depressing the spinal cord. Convulsions are sometimes seen as a result of the action of decomposi- tion products of digitalis—namely, toxiresin and digitalresin. Finally, the motor nerve-trunks themselves are depressed and the muscles are paralyzed. Circulation.—Upon the circulatory system digitalis exerts its chief influence. In moderate or medicinal amounts it increases the pulse- force and arterial pressure, slows the pulse, and increases the size of the pulse-wave. The increase of pulse-force is due to a stimulating influ- ence exercised upon the cardiac ganglia and the muscular fibres of the heart; the rise of arterial pressure is caused by the increase in pulse- force and pulse-volume, and by a stimulation of the vasomotor centre and the muscular coats of the blood-vessels, 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 peripheral ends of the vagus verves. The increase in the volume of the pulse is due to this influence on the vagi, for, the pneumogastric nerves being stimu- lated, 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 Avave of blood through the aorta than is normally sent out. This is important to remember Avhen using the drug in heart disease and other states. While we do not knoAv that the vagi are the trophic nerves of 186 DRUGS. the heart, we have a large amount of evidence in favor of such a vieAv, and it has long been thought that digitalis ay as not only a heart stimulant, but a heart tonic. If the trophic nerves of the heart are stimulated by digitalis, it becomes evident that it is a doubly useful remedy.1 (See the article on '• Heart Disease " in Part IV. of this volume for a further explanation of the influence of digitalis in improving the nutrition of the heart muscle.) When very full medicinal doses of digitalis are given, or when poison- ous doses are ingested, the action of the heart becomes exceedingly irregular, hobbling, and dicrotic. (See Poisoning.) What the cause of this irregularity is we do not knoAv. It is certainly not due to Aveak- ness, for the cardiac beats, Avhen they occur, are in themselves more forcible than in health. The probable explanation of this peculiar cardiac irregularity lies in a disturbance of the co-ordinating apparatus of the various parts of the heart muscle. By this the author does not refer to the so-called co-ordinating centre of Kronecker and Schmey, which probably does not exist, but to the changes which may take place in the so-called "contraction wave," which is found to begin in the normal heart at the great veins and passes from them through the auricular walls to the Avails of the ventricles. It has been found by Wooldridge and by Tigerstedt that if the auricle and ventricles be separated by a ligature or clamp, they still continue beating, but no longer do so synchronously, or, in other Avords, the centres of each set of Walls act independently of the others. The irregular action of the heart under digitalis is probably dependent upon a disassociation of these centres; and this theory is still further substantiated by the experiments of Roy and Adami, Avho have proved that independent contraction of the various parts of the heart can be produced by stim- ulation of the peripheral end of the cut vagus, a part of the nerve which is stimulated by digitalis in the large doses Avhich Ave have been considering. In man Ave frequently see this irregular pulse replaced by an exceedingly rapid pulse, A\diich is shuttle-like in character; and whether the pulse be irregular or rapid, the arterial pressure is always low, OAving, first, to the imperfect action of the heart, and, second, to a depression of the vasomotor centres and the muscular coats of the blood-vessels. The rapid pulse, when it occurs, is probably due to a depression of the peripheral ends of the vagus nerves. In the frog digitalis causes, Avhen given in full doses, systolic arrest of the heart, but in man the arrest is in diastole. If a patient Avho has taken a poisonous dose be suddenly raised up, he may drop dead, OAving to the disturbance of the contraction-Avave in the heart produced by the erect posture. Under these circumstances the heart beats so abortively that the circulation fails. Respiration.—Digitalis has almost no effect on this function unless the amount be poisonous, Avhen respiration is slowed. Temperature.—Upon the normal bodily temperature digitalis has little or no effect in medicinal dose. In poisonous dose it lowers tem- 1 In a recent study by the author he found that when digitalis is given continu- ously for a long period of time there results cardiac hypertrophy independent of any valvular lesion. See Therapeutic Gazette, December, 1S(J7. DIGITALIS. 187 perature. In fever the drug seems to cause a slight fall Avith some con- stancy, but it can rarely be used for any antipyretic influence. High temperatures prevent digitalis from slowing the pulse, because, as proved by Brunton and Cash, fever depresses the vagus centres in the medulla, and also in all probability, Avhen the temperature is very high, the peripheral ends of the vagus. This is an important point to be remembered in the therapeutic use of this drug. Kidneys, Tissue-avaste, 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 floAV produced by digitalis in cases of cardiac dropsy depends upon the removal of congestion of the kidneys and the increased arterial pres- sure and improved circulation brought about by the drug. It is important to remember that digitalis, if given in overdose, may cause a spasm of the blood-vessels of the kidney, and so cause suppres- sion of urine. This is usually folloAved by the development of cumula- tive effects. Upon tissue-Avaste digitalis seems to have little effect, but 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. We do not knoAV 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, folloAved by the hobbling, dicrotic, shuttle-like pulse-beats, and the angry, tumultuous cardiac beat against the chest-wall, afford a combination of symptoms characteristic of the over-action of digitalis. The pulse may be full and slow when the patient is lying doAvn, but at once becomes irregular on his sitting up. Often when the patient has by error received too much of the drug the finger can scarcely note any pulse at the wrist, yet the ear Avhen placed over the heart shoAvs it to be beating wildly, as though it would break out of the chest. It is important that the Aveak pulse at the wrist be not taken as the only guide as to the state of the patient for this very reason, and the physician should always auscult the prsecor- dium before reaching an opinion as to the action of digitalis. As the poisoning progresses vomiting may come on, exophthalmus occurs, and a peculiar blue pearliness of the sclerotic coat of the eye is seen. Consciousness is generally preserved nearly to the last. Death from digitalis poisoning 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 chem- ical antidote; emetics and the stomach-pump are to be used, the former only when the drug has not yet been absorbed, for if the heart is much affected emetics are dangerous. External heat is to be applied, par- ticularly about the abdomen ; the maintenance of a horizontal posi- tion must be insisted upon for several days after active symptoms have passed by, for sudden death on sitting up has occurred. The use of tincture of aconite, as the physiological antidote, is resorted to. Therapeutics.—Much unfortunate misunderstanding concerning the action of digitalis has arisen, and, Avhile some call it a circulatory stim- 188 DRUGS. ulant, others think it a circulatory depressant. The first class base their belief on the signs of increased 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 car- diac stimulant, and not a depressant. The quieting of irritability by it is the quietness produced by the drink of Avhiskey or coffee taken by the pugilist before he enters the ring, to steady his nerves and 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 Avhere the con- dition is one in Avhich the heart fails to do its proper amount of Avork. If simple hypertrophy or excessive compensatory hypertrophy exists, it is harmful. It is of less value in 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, although in the second stage of this lesion, Avhen the mitral orifice and valve are beginning to be affected, it is often very useful. In some instances of mitral regurgitation the drug does harm by overdistending the auricle through ventricular stimulation, which results in an increase in the regurgitant Aoav, and we can never tell before trying it Avhich cases will be so affected. In cases Avhere the heart is irritable, palpi- tation present, and indigestion not the cause of the trouble, digitalis is of service. (See Heart Disease.)1 It is also useful in cardiac dila-' tatiou and asthenia—that condition Avhich DaCosta calls a tired heart. In the second stage of pneumonia if the heart is laboring and un- able to do its work properly, digitalis is often invaluable (see Pneu- monia), and as a heart tonic during the course of 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, in which 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 is most useful when the kidneys are congested and the circulation is sluggish from cardiac feebleness. When the renal structure is diseased other drugs should take its place, or it should be combined Avith more active renal remedies, such as squill or caffeine, or in very chronic cases of kidney trouble with compound spirit of juniper. Untoward Effects.—Digitalis sometimes causes nausea and indigestion by irritating the stomach. In children it is very apt to produce marked irregularity of the pulse. When it is given in full doses the patient should always be made to remain in bed and not alloAved to sit up sud- denly, as syncope may occur. It is particularly important that this rule be enforced if the patient desires to empty his bladder, for cases are on record in which a patient has risen suddenly, emptied the bladder, and fainted or even died in syncope. 1 It is absolutely necessary for the student to turn to the article on Heart Disease and to read it carefully in order to understand the action of digitalis in disease. DIGITALIS. 189 In some cases a cumulative action occurs Avhich consists in the failure of the drug to appreciably influence the circulation for some days, only to exert all its poAver suddenly and produce symptoms of poisoning. This is particularly apt to occur Avhen 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 AvithdraAval of pres- sure 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 inactive. Such an accident also sometimes occurs Avhen a fever ends by crisis and digitalis has been given. It also takes place whenever full doses are given so frequently as to be in excess of elimi- nation, for the drug is sloAvly eliminated, and so rapidly accumulates in the body. Cumulative action is often preceded by a scanty passage of urine. A decrease in the quantity of the urine Avhen digitalis is being used should cause the physician to stop its administration or be most cautious in its continuance. Contraindications.—In cases of marked atheroma of the blood-ves- sels, in aneurism and apoplexy digitalis is a dangerous drug, because it raises arterial pressure, and it is because of this effect that it is harmful in the presence of arterial excitement. In fatty degeneration of the heart the remaining healthy muscular fibres of this organ are, it is true, stimulated by the drug, but at the same time it also increases arterial tension to such an extent as to increase the labor of the failing heart. Administration.—The official preparations of digitalis are the tinc- ture (Tinctura Digitalis, U. S. and B. P.), dose 10 to 20 drops (0.65- 1.3); the infusion (Infusion Digitalis, U. S. and B. P.), 1 teaspoon- ful to 4 teaspoonfuls (4.0-16.0); the fluid extract (Extraction Digi- talis Fluidum, U. S.), dose 1 to 2 drops (0.05-0.1); the extract (Extraction Digitalis, U. S.), ^ of a grain (0.015); and the powdered digitalis leaves (Digitalis Folia, B. P.), dose 1 to 4 grains (0.05-0.2), generally given in a pill. Some choice should be exercised in the use of the various prepa- rations made from digitalis leaves, because the different active ingre- dients of the drug possess different solubilities and exert different effects on the circulation. Thus digitalin, digitoxin, and digitalein all act a3 poAverful stimulants to the heart muscle. Digitalin also stimulates the vagus peripherally and centrically. All three of these raise arterial pressure by stimulating the vasomotor system periph- erally and centrically. Digitonin, on the other hand, does not stim- ulate the heart muscle, but rather depresses it. It also depresses the vagus and thereby somewhat antagonizes the digitalin,1 digitoxin, and digitalein. If Ave now turn to a consideration of the solubilities of these prin- ciples, Ave can readily explain the different effects produced by the infusion and tincture or fluid extract. Digitonin is soluble in Avater, as is digitalein; but digitalin is only slightly soluble and digitoxin is 1 By digitalin reference is made to that prepared by Merck, and sometimes called the digitalin of Schmiedeberg, and not the amorphous form of Homolle or the crystalline digitalin of Nativelle. 190 DRUGS. scarcely at all soluble in water. As a result, the use of the infusion in a case of heart disease Avould not give the patient the same degree of cardiac poAver as the use of the tincture, for not only Avould the most poAverful stimulant of all to the heart, vasomotor system, and vagi—namely, digitalin—be present in small amount, but in addi- tion the large proportion of digitonin would antidote it. On the other hand, digitonin is sparingly soluble in alcohol, while digitalin and digitalein are readily soluble in it, digitoxin being slightly so. It would seem, therefore, that in the presence of a failing heart and circulation the tincture and the fluid extract are the preparations greatly to be preferred to the infusion, because they contain large amounts of the active stimulant ingredients. The reason that the infusion acts efficiently as a diuretic in some cases probably depends upon the fact that as it does not contain so much digitalin it is less apt to cause spasm of the renal vessels; but if the heart is feeble and there is renal stasis, the tincture is probably the better preparation to overcome this state, because it both aids the heart and by contracting the renal vessels overcomes the stasis. The use of digitalin is inadvisable, unless we are sure that we get that made according to the process of Schmiedeberg, for the other digitalins usually sold are very uncertain. The infusion is far more apt to disorder the stomach than the fluid extract or tincture, because of the irritating digitonin. The dose of digitalin, Avhich ought not to be used as a substitute for digitalis, is ^ of a grain (0.001). When digitalis cannot be swallowed it can be given hypodermi- cally in the form of the tincture, or its absorption can be brought about by the use of a poultice made by placing some digitalis leaves in a small bag and steeping it in hot Avater. The bag is then placed over the loins. This treatment must be cautiously employed to avoid poisoning. DIURETIN. (See SODIO-SALICYLATE OF THEOBROMINE.) DUBOISINE. Duboisine is the alkaloid of the leaves of Duboisia myoporoides, a plant of Australia. The crude drug is little used in medicine, but duboisine sulphate is used as a mydriatic under the same conditions as is atropine, and more largely still as a hypnotic in insanity, inter- changeably with hyoscine. The dose of duboisine sulphate hypodermi- cally as a hypnotic is -^ to -^ of a grain (0.0008-0.001). The clinical experience so far adduced would seem to indicate that it tends to de- crease urinary secretion and to disorder the digestion, producing at the same time a soapy taste in the mouth, Avith excessive dryness of the mucous membranes. Rarely it causes profuse salivation or SAveating in those who have an idiosyncracy to its use. In a large number of insane and hysterical cases De Montyel found its use was folloAved by vom- iting of part of the food, but the patients seemed to have no nausea. EL A TERIUM—ERGOT. 191 The sulphate has been used with much asserted success in the treat- ment of paralysis agitans. Usually the dose by the mouth for this pur- pose has been y^- of a grain three times a day. Cividati and Gianelli .assert that duboisine is useful in epilepsy, particularly in its psychic forms. ELATERIUM. Elaterium, B. P., is a sediment obtained from the juice of the Ecballium Elaterium, or squirting cucumber. It appears in small, easily-broken, thin, grayish-green flakes, and has a bitter taste. Ela- terium is not official in the U. S. P., but its active principle, elaterin (Elaterinum, U S. and B. P.), is official. Notwithstanding this fact, the crude drug is largely used. Physiological Action.—Elaterium is a very decided irritant to all mucous membranes, and even to the fingers of those Avho handle it. Its chief effect Avhen taken internally by man is to cause profuse Avatery stools, but for some unknoAvn reason it rarely acts upon animals in this manner. Therapeutics.—This drug is the best hydragogue purge which Ave have, causing very large Avatery passages, but not producing much pain Avhen 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 or general anasarca. It ought never to be used in cases of marked exhaustion, and may be advantageously folloAved, soon after it acts, by alcoholic stimulants. In uraemia with dropsy it is thought to aid in the elimination of the ursemic poison by the boAvel. In cerebral congestions or effusions the drug will often be of service by depleting the diseased vessels. In poisoning by elaterium the symptoms are those of violent gas- tro-enteritis, and must be treated accordingly. (See Gastro-enteritis.) Administration.—The dose of elaterium is £ of a grain (0.01), given in a freshly-made pill. Elaterin is best given in the dose of from -^5- to -^ of a grain (0.002-0.004), as folloAvs: R.—Elaterini.............gr. iv (0.2). Alcoholis..............f giv (128.0).—M. Dissolve by gentle heat. S.—Half a drachm contains ^ grain (0.004), or one full dose. The official preparation of elaterin, the active principle of elate- rium, is Tr it u ratio Elaterini, U. S. (elaterin 1, sugar of milk 9), given in the dose of \ to 1 grain (0.03-0.06). The Pulvis Elaterini Compositus, B. P. (elaterin 1, sugar of milk 39), is given in the dose of 1 to 5 grains (0.05-0.35). ERGOT. Ergota, U. 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. 192 DRUGS. 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 ergotin is not an isolated principle, but a combina-. tion of principles. Kobert teaches that there are three principles— namely, ergotinic acid, cornutine, and sphacelinic acid—and that cor- nutine is a true alkaloid. Further, that it is upon this cornutine and sphacelinic acid that the chief activity of the drug depends. Tanret, on the other hand, denies the existence of cornutine as an alkaloid. Physiological Action.—Nervous System.—Upon the nervous sys- tem ergot exercises little, if any, effect. Circulation.—Ergot when injected into the circulation causes a primary fall of arterial pressure, folloAved by a rise. The dominant action is represented in 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 the direct contact 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. When given in medicinal doses by the stomach the drug causes a rise of arterial pressure, probably by an action on the vasomotor centre and the muscu- lar coats of the blood-vessels. Uterus and Unstriped Muscular Fibre.—It has been com- monly taught that the contractions of the uterus produced by medicinal doses of ergot arise from the stimulating influence of this drug upon the muscular fibres of this organ ; and while this is probably the case, it is also a fact, as shown by the careful studies of Hemmeter, that the drug causes uterine contractions by stimulating the centres in the lumbar portion of the spinal cord Avhich control this viscus. On the uterus ergot in full medicinal dose exerts its influence—not increasing the normal pains of labor, but causing a tetanic, tonic, unyielding uterine spasm Avhich drives all before it. In very small doses it may assist the normal contractions Avithout causing them to become tetanic. Ergot acts as a stimulant to all unstriped muscular fibres. Acute Poisoning.—The symptoms of overdosing from ergot, Avhen the effects are slowly produced, are sometimes great hunger or craving of food, at other times nausea and vomiting. If the poisoning is quite severe, there are great restlessness, headache, delirium, and coldness of the surface of the body. 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. In the first of these forms it is not very un- common for cataract to develop, and it is stated that the spasms are due to the influence of one of the principles of ergot—namely, cornu- tine. Therapeutics.—Ergot is given to parturient Avomen for the preven- tion or arrest of post-partum hemorrhages. For the prevention it should be given to the woman by the mouth just as the head of the child is ERGOT. 193 about to slip over the perineum, and not before. When administered to stop a hemorrhage already flowing, the doses should be large, as much as 1 to 2 drachms (4.0-8.0) of the fluid extract or 2 Avineglass- fuls (64.0) of the Avine of ergot. The drug should produce its effects in about fifteen minutes, and may be repeated every fifteen minutes till it acts. The action lasts about half an hour. Ergot should never be given in the early stages of labor, but this rule may, under certain con- ditions, be modified. If uterine inertia comes on in the course of a nor- mal labor, and quinine cannot be used for any reason, a small dose of ergot may be employed. These small ddses do not cause a constant tetanic uterine contraction, but simply bring on the "to-and-fro" move- ments. By small doses the writer means from 5 to 20 drops (0.35- 1.3) of the fluid extract. Caution must be used even with these doses. If the birth-canal is obstructed, ergot should never be employed, and, unless the os uteri is Avell dilated, should not be given in any dose. In post-partum hemorrhage of a severe character it may be Avell to give a solution of the aqueous extract of ergot hypodermically. The extract should be rubbed Avith 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.1 When ergot is given care should be taken that the uterine cavity is clear of all clots or placental fragments, lest the closure of the os uteri under the influence of the drug imprison these harmful materials. According to many obstetricians, Avhose results have been confirmed by a number of special studies, ergot in moderate doses very distinctly aids in overcoming subinvolution of the uterus. In hemorrhages from the lungs and kidneys or other unapproach- able parts ergot is thought by some to be very useful when given by the mouth, but it is probable that it rarely achieves any real good. Particularly is this the case in pulmonary hemorrhage, since the vaso- motor system practically does not exist in the pulmonary vessels, and the increased pressure caused by the ergot in the general systemic cir- culation may increase the pulmonary leakage. The truth is, that in pul- monary hemorrhage very little real good can be obtained by internal medication. In epistaxis, menorrhagia, and metrorrhagia, and in some cases of night-sweats, ergot is of service. In hypostatic, pulmonary, and other congestions it is useful, particularly if employed with digitalis. In dysenteries with bloody stools and in serous diarrhoea ergot some- times does good. Some persons suffer from vertigo associated with hypersesthesia of the scalp and headache. Relief can often be obtained in such cases by the use of 20 drops (1.3) of the fluid extract of ergot and 5 to 10 grains (0.35-0.65) 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 1 Under the name of " Ergot Aseptic," there is dispensed in sealed and sterile glass bulbs a concentrated preparation of ergot for hypodermic use. Each bulb holds one dose, and the drug is drawn directly from it into the syringe. 13 194 DRUGS. where the groAvths are just beneath the mucous membrane. By the contractions of the uterine muscular fibres the blood-supply of the growth is decreased, the recurring hemorrhages cease, and the tumor is finally expelled, having really sloughed out of its bed. This method is far inferior to the knife, and very painful and prolonged. Large growths cannot be so treated. Ergot is sometimes useful in the treatment of bleeding hemorrhoids, and it has been given with success in diabetes insipidus, when it is well to combine with it the bromide of sodium. Administration.—Ergot is official in the U. S. P. as the fluid extract (Extractum ErgotaeFluidum), dose ■£ to 1 drachm (2.0-4.0); the solid extract (Extractum Ergotae, B. P.), dose 5 to 20 grains (0.35-1.3); and the Avine ( Vinum Ergotae), dose 2 to 4 drachms (8.0-16.0). Bon- jean's ergotin is made by a special process, and it or the solid extract can be given hypodermically in the manner already described. The B. P. preparations are Extractum Ergotae Liquidum, dose 10 to 30 minims (0.65-2.0); and Infusum Ergotcs, 1 to 2 fluidounces (32.0- 64.0). Ergotin (Ergotinum) is given in the dose of 2 to 5 grains (0.1- 0.35). Injectio Ergotinae Hypodermica, B. P., is given in the dose of 3 to 10 minims (0.15-0.65), by subcutaneous injection. The B. P. also recognizes an ammoniated tincture of ergot. ERIGERON, or FLEABANE. Oil of Erigeron (Oleum Erigerontis, U. S.) is a yellowish volatile oil of a peculiar, not bad, taste, closely resembling turpentine, which is distilled from the fresh, flowering herb of Erigeron canadense. It is by far the best medicinal remedy which Ave have for the treatment of pas- sive uterine oozing, or a "show," as it is sometimes called. In epistaxis and other hemorrhages of moderate degree it is quite useful. In some instances it is used in place of copaiba and cubebs in the later stages of gonorrhoea. It is best given in capsule or on sugar in the dose of 10 to 30 drops (0.65-2.0) after meals, or oftener if needed. ETHER. Sulphuric ether is official as JEther, U. S. and B. P., but in the Pharmacopoeia of 1880 Avas called ^eEther Fortior. Pure Ether (JEther Purificatus, B. P.) is free from alcohol and Avater. 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 or official ether contains about 96 per cent, of ethyl oxide and only 4 per cent, of alcohol, Avith water. Both preparations boil Avhen held in a test-tube if a piece of broken glass is added to the liquid. The stronger ether boils much more vigorously than the Aveaker under these circumstances. ETHER. 195 *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 fire in the room should be above the patient, not beloAv him. No flame should be held nearer to the ether than five feet. Physiological Action.—The action of ether on the animal organism is very rapid and powerful, but temporary. Except for the rapidity of its effects it is very much like that of alcohol. When applied to the skin, it causes intense cold by its evaporation, and may be used in the form of a spray to benumb or locally freeze a part. Upon mucous membranes ether as a liquid or in vapor acts as an irritant, and causes, when its vapor is first inhaled, great irritation of the fauces and respiratory tract, so that temporary arrest of respiration is not uncommon. The face becomes suffused and red and the conjunc- tiva injected. OAving to these conditions the patient often is restless or or struggles to get his face away from the vapor, but a stage of quiet soon succeeds this primary stage of struggling. During this period of quiet the breathing is generally full and deep and the pulse rapid but strong, Avhile the ocular reflexes are at its beginning intact. Following this stage a second period of struggling comes on, in Avhich the patient may become absolutely uncontrollable 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, according to his temperament. If the drug is now pushed, a condition of total anaesthesia is soon 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 pre- vent any operative procedures. (See Therapeutics, below.) It is not proper to push the drug till the muscular relaxation amounts to complete flaccidity, as this endangers the respiration. Nervous System.—In producing its effects, ether acts first on the brain, then on the sensory tracts of the spinal cord, then on the motor tracts, then on the sensory side of the medulla oblongata, and finally upon the motor side of the medulla, and thereby produces death from respiratory failure if given to excess. Upon the nerve-trunks it exerts no effect unless it is directly applied to them. Ether does not produce anaesthesia by influencing the blood, coagulating the protoplasm of the nervous system, or by any other destructive 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 rapidly act- ing cardiac stimulants Avhich Ave possess, and is correspondingly fleeting in its effects. It increases the pulse-rate and force by stimulating the heart and the arterial pressure by increasing the activity of the vaso- motor centres. In overdoses it acts as a cardiac depressant, but only Avhen the amount is very large. Upon the blood J. Chalmers DaCosta has shoAvn that ether, when given by inhalation, decreases the haemo- globin and the number of the red corpuscles, particularly in those persons Avho are already somewhat anaemic. 196 DRUGS. Respiration.—As already stated, 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, Avhich causes a reflex spasm of the glottis, and not to irritation of the peripheral vagi in the lungs. This is only partly true, for the author has proved that section of the vagus nerves prevents this occurrence, so that both the vagal and tri- geminal irritations are responsible for the arrest. Upon the respiratory centre ether acts as a powerful stimulant Avhen used in 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. 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 abso- lutely devoid of all dangerous effects.1 Sometimes, Avhen the drug is pushed too strongly, deep cyanosis Avith pulsation of the jugular veins shows deficient oxygenation of the blood and cardiac distention. In other, 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 heart lesions have been present, and have been found at the autopsy. Rarely the rise of arterial pressure Avhich it pro- duces has caused apoplexy. In patients under ether the movement of the diaphragm is an exceedingly interesting study, for before the condition known as sur- gical anaesthesia is developed, while there is still some rigidity and the throat reflex is not completely abolished, the contractions of the diaphragm are frequently so violent that unless the laryngeal open- ing be absolutely free the intercostal spaces are depressed and the abdominal contents thrust violently downward and outAvard. Just so soon, however, as the chin is pulled fonvard and a free access of air is allowed, the abdominal displacement, though it is still present, is not so great, 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 alloAvs the chest on expansion to aspirate the abdominal viscera upAvard, as is shoAvn by the retraction of the belly- walls at a time Avhen they should normally expand Avith the thorax in inspiration. This observation Avould 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. These facts give us, therefore, a danger-signal during the adminis- tration of ether, and the integrity of the diaphragmatic function, as 1 The mortality due to etherization is about 1 in 20,000 cases. ETHER. 197 represented by the movement of the belly-walls, should be as care- fully observed as are the thoracic excursions, the character of the pulse, or the condition of the pupil. The rule may therefore be laid doAvn that Avhen the diaphragm ceases to act anaesthesia has been carried to its extreme legitimate limit, and that the use of an anaes- thetic after this time must be carried on Avith 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 Avill, in the vast majority of cases, be denoted by a failure on the part of the diaphragm primarily, Avith 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 iTappui, the chest remains motionless, the loAver jaw is dropped, and the scene is closed by a few gasps in Avhich the muscles of the neck may be the chief factors. The treatment of accidents during etherization consists in the withdraAval of the ether, the use of artificial respiration, and the placing of the body, if the face is pale, head doAvnward. 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, more rarely, an intravenous injection of ammonia, Avhich is more dangerous, but better than the others in a pressing emergency 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 depressed by ether, the employment of still more of the drug simply makes matters worse. The cases in which such a line of treat- ment is folloAved by good results are those in Avhich the failure of res- piration is not due to a saturation of the body with ether, but to asphyxia produced by mechanical interference Avith free breathing, as, for example, the presence of mucus in the air-passages or a too close application of the toAvel to the face. In such cases the hypodermic injection of ether causes so much local pain and irritation as reflexly to call up respiratory 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 physiologically and chemically to ether. Frictions, hot appli- cations, and artificial respiration should be practised. (See article on Asphyxia.) The diaphragm being the most important muscle of respiration, the physician should seek to stimulate it by resorting to Laborde's rhythmic traction of the tongue, Avhich consists in rhythmically drawing this organ outward and upAvard from the mouth ten to fourteen times a minute. As ether is at hand, it may be dashed on the chest and abdomen to 1 As consciousness is not necessary to the carrying out of a reflex action, this is perfectly possible and probable. 198 DR UGS. cause inspiration by reflex action ; in lieu of cold Avater, Avhich Avets the clothes and does not evaporate rapidly. In some cases great nausea and vomiting folloAvs the use of ether. This can generally be prevented by the avoidance of food before the operation (see Therapeutics), and by the administration of cracked ice and small doses of aconite or brandy after tbe operation. (See Vomit- ing.) This condition may also be avoided in many cases by giving oxygen gas with the anaesthetic. (See Oxygen, Important.) Severe bronchitis may occur in invalids and children after the inhalation of ether, and in many cases this is due more to the exposure than the drug. Total or partial anuria may develop after etherization, partic- ularly after abdominal operations; and this is a very dangerous symp- tom. It has, however, been proved both experimentally and clinically that ether is not capable, in the ordinary patient, of producing renal disorder of any moment unless the kidneys are already diseased. Weir asserts that ether is not dangerous even in those Avith moderately dis- eased kidneys. The use of ether in diabetic patients is very danger- ous ; the patient often never regains consciousness after its use. Not uncommonly after the use of ether in the case of an old person or a child the bronchial tubes so fill with mucus that there is danger of the patient drowning in his owji secretions. Full doses of atropine, which check secretion, given hypodermically, are useful at such times. Therapeutics.—Ether is used chiefly as an anaesthetic by means of inhalation. The method consists in forming a cone out of a tOAvel 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 Avay is to hold the cone at some dis- tance from the face, and gradually bring 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 concen- trated a form as possible, Avhereas Avhen 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 Avhich it will set up. To prevent this a thin piece of muslin Avet Avith Avater Avill be found of service if placed over the eyes. A large number of ether-inhalers are employed in preference to the towel, of Avhich the best is probably that knoAvn as the " Allis Inhaler." When ether is to be given no food ought to be alloAved the patient for twelve hours preceding its use, except a little milk or tea an hour or tAvo before the operation, in order to avoid vomiting during and after this procedure. The patient should not be alloAved to retain any tobacco or false teeth in the mouth, as either may slip into the larynx and cause death while the anaesthetic is being given. Under the name of the A. C. E. mixture there is used a com- pound of alcohol, chloroform, and ether, Avhich is properly but rarely used in America. (See Chloroform for Schleich's mixtures.) Ether may be used as a local anaesthetic in an atomizer spray, OAving ETHYL BROMIDE. 199 to the cold produced by its evaporation Avhen it strikes the skin. Thus it is particularly useful in cases Avhere thoracentesis or paracentesis abdominis is to be performed, and also in cases of superficial neur- algia, 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 efficient remedy. In cases of collapse ether given by means of the hypodermic needle or by the stomach is of great service, particularly Avhen cardiac action is very feeble, and it will give relief by inhalation in some of these cases more rapidly than the nitrite of amyl. In hiccough a few inhalations of ether Avill often stop the spas- modic movements, and other local muscular spasms can be relieved in this Avay. Large doses of ether given by the mouth or hypodermically have been highly recommended in the treatment of uraemia. They are most serviceable in the forms in Avhich cardiac and respiratory com- plications are marked. Ether may be used by inhalation to produce muscular relax- ation when the surgeon desires to reduce a strangulated hernia by taxis. In cases where cod-liver oil cannot be digested ether may be given in 20-drop (1.30) doses in ice-water or capsule, either Avith the oil, or some minutes after it is taken, to aid in its digestion and absorption. Internal Administration.—When used internally, ether should be given in ice-cold Avater, or, better still, in capsules, in the dose of 30 drops to J an ounce (2.0:16.0). If cold Avater is not used to dilute it, so great is the irritation of the fauces produced by the fumes of the drug that deglutition is impossible. Contraindications.—Ether should not be used by inhalation in bron- chitis or acute nephritis, because of its irritant properties; in perito- nitis or gastritis, because it is apt to induce vomiting; in aneurism or in the presence of marked vascular atheroma, because it may rupture a blood-vessel by raising arterial pressure; nor in diabetes. ETHYL BROMIDE. Bromide of Ethyl is obtained by distilling a mixture of alcohol, sulphuric acid, and bromide of potassium, and is a colorless fluid of neutral reaction, having a pleasant odor resembling chloroform. It evaporates Avith great rapidity, and any sample Avhich does not do this is to be discarded. Poured on the hand, it should leave no fatty feeling. It should be remembered that the drug is decomposed by sunlight and when in contact with pure air. In the presence of lamp- light the fumes form bromal hydrate and bromine. The drug should be kept in dark-glass bottles. The physician should distinctly sepa- rate in his mind bromide of ethyl from bromide of ethylene. The latter is a chemical product possessing very dangerous properties, and should never be used in medicine. There is reason to believe that 200 DRUGS. unfavorable symptoms follow the use of bromide of ethyl only Avhen the drug is impure or is improperly used. Physiological Action.—According to the studies of Thornton and Meixell in the Laboratory of the Jefferson Medical College, the domi- nant action of the bromide of ethyl is on the respiratory, not on the circulatory, system. This effect is depressant, but only seen after excessive doses. The blood-pressure falls under its influence to a slight degree, and the pulse is slowed through an influence probably exercised on the inhibitory nervous mechanism of the heart. Therapeutics.—Bromide of ethyl is a useful anaesthetic for short operations, such as opening boils or abscesses, or for the relief of the pain in other brief surgical procedures. Originally introduced into general use in this country by Levis, it has been found unsuited to major surgical cases, because if continued for a long time it seriously depresses the respiration. Bromide of ethyl has been found of the greatest value by Montgomery of Philadelphia as an anaesthetic in labor and for minor gynecological operations in office practice. He finds that the patient may be allowed to inhale the drug from a Haw- ley inhaler, for as soon as she has had enough to produce anaesthesia the inhaler drops from her hand. The patient is also more obedient to the physician's directions, because of the fleeting influence of the drug, than Avhen chloroform or ether is taken, and it is not so apt to cause post-partum hemorrhage through uterine relaxation. A very great advantage possessed by bromide of ethyl is the rapidity of its action. A feAv whiffs are generally all that is needed to cause anaesthesia. It rarely produces disagreeable effects. Cases of sudden death under its use are, hoAvever, on record, and in some instances nervous tAvitchings, and even tetanic spasms, have been known to folloAv its employment. These tetanic symptoms are, how- ever, fleeting and generally of little importance. Nausea and vomit- ing rarely folloAv its employment, but it is apt to leave an unpleasant garlic-like taste in the mouth, and a similar odor of the breath is frequently noted for several days after its use. Administration.—Bromide of ethyl should be administered for but a brief period, but when taken should be inhaled freely. It cannot be given carelessly with good effect. If a good sample is employed, 45 minims to 3 drachms (3.0-12.0) is a sufficient amount to induce anaesthesia. This quantity should be used at once, instead of added to the inhaler drop by drop, as in the case of chloroform, and the cloth or inhaler should be held close to the mouth and nose, instead of at a little .distance, as is often necessary with other anaesthetics. ETHYL IODIDE. This is a colorless, non-inflammable liquid, which really should be called hydriodic ethyl. Ethyl iodide 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 disagreeable to most persons. E UCAINE HYDR 0 CHL OR A TE. 201 Physiological Action.—Very little is known of the general physio- logical action of iodide of ethyl, and the drug Avould be a good one for laboratory investigation. It does not produce anesthesia except in very large amounts. Therapeutics.—Iodide of ethyl is used in medicine entirely by inhalation for the treatment of subacute or chronic catarrh of the air- passages and for the purpose of rapidly impressing the system Avith iodine for alterative purposes, for 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 is supposed to cause free secretion and to prevent abnormal thickening of the mucus and dilatation of the air-passages. For this reason iodide of ethyl is sup- posed to be of service in asthma and its resulting emphysema. Very recently BartholoAv has recommended this drug in the treatment of pneumonia. It is said by that Avriter to be particularly useful in the later stages of this disease, to aid in producing resolution, but the author has never seen it produce much effect. Administration.—10 to 20 drops (0.65-1.3) may be placed upon a handkerchief and inhaled, or a small vial filled Avith the drug may be held in the hand under the nostrils. Under these circumstances the heat of the hand sets free the necessary amount of vapor. EUCAINE HYDROCHLORATE. Eucaine hydrochlorate is a synthetic substance having a chemical formula closely resembling that of cocaine. The drug is noAv mar- keted as a substitute for cocaine, it being claimed that it does not affect the heart as does the latter drug. Eucaine does not cause a primary contraction of the blood-vessels when locally applied, as does cocaine, but a hyperaemia of the parts affected. Tavo forms of eucaine are used, eucaine "A" and eucaine "B;" the first for ordinary local anaesthesia, and the second for use in ophthalmic and genito-urinary surgery, as it is said to be less irritating. Used by the process for producing infiltration anaesthesia (see Cocaine), it causes considerable pain before acting as an anaesthetic. In ophthalmic practice it is employed in 2 per cent, solution, and to ordinary mucous membranes in 10 per cent, solution—that is, from 10 to 48 grains to the ounce of Avater. One advantage of eucaine is that it forms a permanent solution with water in 10 per cent, solution. Further, eucaine solu- tions can be boiled before they are used without causing decomposi- tion of the drug. Eucaine hydrochlorate possesses a distinct disadvantage in its inability to cause primary contraction of the blood-vessels Avhen locally applied, and this effect of cocaine is often most valuable to overcome local engorgement. Further, it causes severe smarting pain when dropped in*o the eye. Eucaine is also capable of pro- ducing internal effects resembling those due to overdoses of cocaine, and these must be treated by the use of strong coffee, alcohol, digi- talis, and strychnine. If the case is pressing ether, ammonia, and nitroglycerin may be used as rapidly acting stimulants. 202 DRUGS. EUCALYPTUS. Eucalyptus, U. S., is the leaves of the Eucalyptus globulus, or blue- gum tree, a native of Australia, but grown at present all over the world. Its chief medicinal constituent is the oil of eucalyptus (Oleum Eucalypti, U. aS'.), from which is derived Eucalyptol,U. S., Avhich is a camphorous body obtained by redistillation Avith caustic potash or chloride of calcium. The oil of eucalyptus and eucalyptol are used for the same purposes, but the latter is the refined product of the former. Physiological Action.—Locally applied, the oil is a decided irritant. 10 to 20 drops (0.65-1.3) 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 sen- sation in the lower limbs may occur. If death takes place, it is due to respiratory failure. The drug is eliminated by the skin, kidneys, boAvels, 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, nor 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), since in its elimination by the lungs it acts locally upon the inflamed mucous membrane, and it may be used in the subacute forms of gonorrhoea in the same manner. The following pre- scription will ansAver: R.—Olei eucalypti.............f^j (4.0). Olei amygdalae dulc...........f^j (4.0).—M. Ft. in capsule 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. Eucalyptol, U. S., is obtained from oil of eucalytus, and is largely employed by rhinologists and others in lotions and other nasal appli- cations It may be used in solutions of fatty oils, but is insoluble in water, although it is soluble in alcohol and ether. Administration.—The fluid extract (Extraction Eucalypti Fluidum, U. S.) is given in the dose of 10 drops to 2 drachms (8.0), the oil (Oleum Eucalypti, U. S. and B. P.) in the dose of 5 drops (0.35). The dose of eucalyptol is 5 grains (0.35) in capsule. Trochisei Eucalypti and Unguentum Eucalypti are official in the B. P., but are seldom used. EUONYMUS. Euonymus, U. S., or Wahoo, is the bark of Euonymus Atropurpu- reus, a native plant of the United States. It contains an active prin- E UP A TORIUM—E UR OPHEN. 203 ciple, Euonymin, B. P. As a laxative its action is very sIoav and moderate, but it is thought to act particularly on the liver, and may be used Avhen mild hepatic torpor is present. Administration.—The dose of the solid extract (Extractum Euonymi, U. S., Extraction Euonymi Siccum) is 3 to 10 grains (0.15-0.65). Of euonymin the dose is J to 1 grain (0.03-0.05). EUPATORIUM. Eupatorium, U. S., Thoroughwort or Boneset, is the leaves of the Eupatorium perfoliatum, an American plant which is very laro-ely used as a simple bitter tonic and diaphoretic in household medicine. The drug is generally given in hot infusion in cases of arrested men- struation due to cold or in the chill of a remittent or intermittent fever, and also for anorexia and debility. Its taste is very disagreeable, and in the dose of a pint (500 cc.) of the cold infusion it has been used as an emetic. The fluid extract (Extractum Eupatorii Fluidum, U. S.) is given in the dose of 30 drops to 1 drachm (2.0-4.0). 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 groAvs profusely as a weed by the wayside. Physiological Action.—In toxic doses the drug kills small ani- mals by failure of the respiration and circulation, these tAvo vital functions being greatly affected by doses which exert no great influ- ence 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 Avithout reserve. As yet we do not know the form of asthma Avhich is most relieved by its use, and its employment is purely empirical. It has also been highly praised in the treatment of chronic bronchitis and emphysema. Administration.—Euphorbia pilulifera is best given in the form of the fluid extract in the dose of 30 drops to 1 drachm (2.0-4.0). The decoction is made by adding a " handful of stalks Avith the leaves on them to 2 quarts (2 litres) of boiling water, and boiling doAvn to IJ quarts (IJ litres)." Of this decoction the dose is a small wineglass- ful (64.0) three times a day. (See Asthma.) EUROPHEN. Europhen is the result of the action of iodine on isobutylorthocre- Bol in the presence of an alkali, and appears as a fine yellow poAvder, 204 DRUGS. soluble in alcohol, ether, chloroform, and oils, but insoluble in water. Introduced because it Avas hoped that it might prove a useful substi- tute for iodoform, its usefulness is still undecided, owing to the short time that it has been before the profession. One advantage claimed for it is that it parts Avith its iodine very sloAvly, and so is not apt to produce toxic symptoms as rapidly as does iodoform. For this very reason, however, it lacks the remedial power of the older drug, except in those instances in Avhich a drying powder is needed which will keep the wound pure by making it too dry to be favorable to the groAvth of germs. When such an action is desired, europhen pos- sesses the additional advantage of being five times as bulky as iodo- form. In the treatment of tuberculous groAvths europhen has already proved itself very inferior to iodoform. OAving to its stability, it fails to part with its iodine except in the presence of moisture, and is use- less in dry skin diseases. It has been found useful in scrofuloderm, ulcer of the legs, and lupus. Europhen may be employed externally in a salve of the strength of from 5 to 10 per cent., or with olive oil or lanolin. It can also be added to flexile collodion. The drug does not possess the odor of iodoform, but experience Avill probably prove it to be more irritating than the latter drug. The internal dose is 1 to 3 grains (0.05-0.15) in cases of syphilis. Europhen is incompat- ible Avith metallic oxides and the preparations of mercury, and also with the starch and zinc paste largely used by dermatologists. EXALGINE. This substance is really methyl-acetanilid, and closely resembles acetanilid or antifebrin in its effects. It is given for the same pur- poses as is acetanilid and antipyrine—namely, for the relief of pain in locomotor ataxia and other nervous affections—but never as an antipyretic. When used, exalgine should be given night and morn- ing as a rule, so that the doses shall not be near together. The beginning dose should be from 2 to 4 grains (0.1-0.2), and not more than 15 grains (1.0) should be given in twenty-four hours. It is stated by those who have used the drug that fever contraindicates its employment. The following prescriptions will be found applicable: R.—Exalgini..............gr. xxx (2.0). Tincturse auraut. dulcis.......f^ij (8.0).—M. Ft. in sol. et adde Syr. aurantii............f^ss (16.0). Aquae menth. piperit.....q. s. ad fjiv (128.0).—M. S.—A tablespoonful night and morning. Or, R.—Exalgini........ .....gr. xxx (2.0). Spt. frumenti ...........f§ss (16.0)—M. Ft. in sol. et adde Syr. simplicis...........f?j (32.0). Aquae dest..........q. s. ad f|iv (128.0).—M. S.—Tablespoonful night and morning. FLAXSEED. 205 FLAXSEED. Flaxseed or Linseed (Linum, U. S. and B. P.) is the seed of Linum usitatissimum, or flax from Avhich linen is made; it is official in the B. P. as Lini Semina. These seeds contain an oil and a mucilage, the first of which is largely used in the arts, and the second is sometimes em- ployed in medicine. The oil (Oleum Lini, U. S. 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 flax- seed tea. This is prepared by mixing together 3 drachms (12.0) of flaxseed, not ground, 30 grains (2.0) of extract of liquorice, 10 ounces (320.0) of boiling water, and allowing the mixture to stand one to four hours in a Avarm place. If the mixture is boiled, the oil is set free and makes the dose disagreeable. This infusion may noAv 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 (4.0-8.0) 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 (64.0), and is said to be of service Avhen so given in the treatment of hemorrhoids. Flaxseed meal (Lini Farina) is employed universally Avhen moist- ened as a useful poultice. Under the name of Carron oil an emulsion of lime-water and lin- seed oil, equal parts, is the standard application for limited or exten- sive burns. FORMIC ALDEHYDE (FORMALDEHYDE). Formic aldehyde is a gaseous body difficult of application because of its physical characteristics, but nevertheless possessing very great power as a disinfectant or germicide. It is prepared by subjecting methyl alcohol to oxidation, and almost every instrument-maker has a device whereby this gas may be generated, and the room formerly occu- pied by a sick person thereby disinfected far more efficaciously than can be accomplished by burning sulphur. The doors and windows of the room should be tightly shut during the process of disinfection and for several hours after the formaldehyde generator is exhausted. As the gas is exceedingly irritating to the eyes and respiratory passages, no one should attempt to enter the room. After the disinfection is completed the room should be aired for some hours, or, if it must be used at once, it may be rendered capable of habitation by spraying a 20 per cent. solution of ammonia to neutralize the acid atmosphere. The great ad- vantage of formaldehyde for these purposes is the fact that it permeates every nook and cranny, and yet does no injury to colored fabrics, as does chlorine gas under similar circumstances. Such generators as have been named can be had for about four dollars. A solution of formic aldehyde in the strength of 40 per cent, has been Avidelv used of late for disinfectant and antiseptic purposes. For 206 DR UGS. all these purposes it is usually diluted still further by the addition of water. A 1 per cent, solution is usually quite active enough for sur- gical antisepsis, and is far less poisonous than is the bichloride of mer- cury. A similar percentage, or a little stronger, may be used to pre- serve pathological specimens, and it is stated that in the proportion of 1 to 32,000 it will preserve milk for several days. Taken internally in small amounts, it does not possess any toxic properties. Concentrated undiluted formaldehyde solution may be used for the purpose of cauterizing syphilitic sores. The safety, efficiency, and cheapness of formaldehyde gas as a dis- infectant, and of the solution, render this agent a most valuable one. GALLIC ACID. Acidum G-allicum (U. S. and B. P.) is usually prepared from tannic acid. It occurs in nearly colorless, long, needle-like crystals, which are soluble in 100 parts of cold Avater, 41 parts of alcohol, and 3 parts of boiling Avater. Physiological Action.—Gallic acid is an astringent, but not a coag- ulator of blood. Locally applied in bleeding, it is useless, but given internally in hemorrhages which cannot be acted upon by the direct locally application of tannic acid, it is useful as a haemostatic because it contracts the blood-vessels. It is eliminated from the body by the kidneys as gallic acid. Therapeutics.—Gallic acid may be used with some success in hema- turia, haemoptysis, colliquative sweats, and in chronic bronchitis Avith 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 upon a relaxed, atonic state of the kid- neys and in acute or chronic diarrhoea gallic acid may be used with advantage, lu 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. A very useful application to external hemorrhoids is equal parts of stramonium ointment and gallic acid. Administration.—Gallic acid is given in the dose of 2 to 40 grains (0.1-2.6) in pill or solution. It ought never to be used with any salt of iron, as it is chemically incompatible. The preparation used locally is the Unguentum Acidi Gallici. Nut-gall. Nut-galls (Galla, U. S. and B. P.) are the small excrescences found upon the oak (Quercus lusitanica) formed by the ova of the fly Cynips Galla tinctorice. Their sole value depends upon the tannic acid contained in them, and they are official in the form of the tinc- ture (Tinctura Gallce, U. S.), dose h to 2 fluidrachms (2.0-8.0), and the ointment (Unguentum Gallce, TJ. S. and B. P.). Unguentum Gallce cum Opio is official in the B. P., and is used as an astringent and sedative ointment. GA ULTHERIA—GELSEMIUM. 207 GAULTHERIA. Wintergreen, or Gaultheria procumbens, is an American ever- green containing a volatile oil. The oil possesses a peculiar, exceed- ingly penetrating odor and a warm aromatic taste. It is about 96 per cent, salicylate of methyl. Salicylate of Methyl (Methyl Sali- cylatis, U. S.) is an artificial product made official in the last revision of the U. S. P. Physiological Action.—OAving to the large amount of salicylate of methyl contained in the oil, its physiological action is almost identical with that of salicylic acid. Therapeutics.—Aside from its use as a flavoring substance, oil of gaultheria is largely used in place of the ordinary salicylates in all forms of rheumatism. The oil (Oleum Gaultheria, U S.) 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 (7.0) a day, but if 60 drops (4.0) three times a day do no good, push- ing it further is practically useless. Very few patients can take more than 30 drops a day. Very recently Lannois and Limousin of Lyons has highly recom- mended the application of this oil to acute and chronic rheumatic joints. The oil is placed on lint, and then the lint is wrapped around the part affected, evaporation being prevented by applying a gutta-percha cover- ing. They assert that this treatment gives rapid relief, although they admit that after it the skin may desquamate. The spirit of gaultheria (Spiritus Gaultheriae, U. S.) is given in the dose of 10 to 20 minims (0.65-1.3). GELSEMIUM. Gelsemium, U. S. and B. P., or Yellow Jasmine, as used in med- icine 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, act- ing particularly on the heart. It paralyzes the vagus and loAvers blood pressure. Respiration.—Gelsemium kills by paralyzing the respiratory cen- tres (Sanderson, Ringer, and Murrell). Temperature.—In overdose the drug lowers bodily heat very markedly. Eye.—Gelsemium is a mydriatic of considerable power, causing, when dropped into the eye, wide dilatation of the pupil, a result due to paralysis of the oculo-motor nerve peripherally. 208 DRUGS. Therapeutics.—Gelsemium is used in headache and migraine depend- ing 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 mus- cular spasm, such as seen in torticollis or wry-neck, and in spasmodic dysmenorrhoea, 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 gelsemine as equal to atropine in effect, but much more transient in its influence. He uses a solution of 8 grains of gelsemine to the ounce (0.5: 32.0) of water, instilled, drop by drop, into the eye every fifteen minutes for one hour, and then every half-hour for two hours. Poisoning.—The most prominent symptoms of gelsemium poison- ing are ptosis and dropping of the jaw. These are preceded by a sensation of languor, a desire to lie doAvn, relaxation, and muscular Aveakness. 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 Avet and cold, the face pinched and anxious, the voice is lost in aphonia, and death ensues from centric respiratory failure and an almost simultaneous cardiac arrest. Sensation 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 and digitalis, the application of external heat, and the employment of atropine and 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, U. S.) is given in the dose of 5 to 10 minims (0.35-0.65), and the tincture (Tinctura Gelsemii, U. S. and B. P.) 10 to 20 drops (0.65-1.3). In some parts of the United States physicians largely employ a very strong unofficial tincture of gelsemium, the dose of Avhich is 1 to 2 drops. Gelsemine may be used in the dose of -^ of a grain (0.001). GENTIAN. Gentiana, U. S., is the root of the Gentiana lutea, or Yellow Gentian, a European plant. It contains gentianine and gentisic acid, and has a bitter taste. This drug is official in the B. P. as Gentiance Radix. Therapeutics.—Gentian is one of the most efficacious bitter tonics that we possess. In the anorexia following acute diseases and in gout and malarial poisoning with dyspepsia it is of service. Combined with bicarbonate of sodium, it is of great service in the treatment of the subacute gastric and intestinal catarrh of children. GERA NIUM—GINGER. 209 Administration.—The compound tincture (Tinctura Gentiance Com- posita, U. S. and B. P.) is given in the dose of 1 drachm to a wine- glassful (4.0-64.0), the fluid extract (Extraction Gentiance Fluidum, U. S.) in the dose of 30 drops to 1 drachm (2.0-4.0), and the solid extract (Extraction Gentiana, U. S. and B. P.) in the dose of 1 to 8 grains (0.05-0.40). Infusion Gentiance Composition, B. P., is given in the dose of 1 to 2 fluidounces (32.0-64.0). The compound tincture and compound 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. dil........f 3j vel f gij (4.0-8.0). Tr. nucis vomicae...........f ^j (4.0). Tr. cardamomi comp..........f ?ij ((54.0). Tr. gentiana? comp.......q. s. ad f|iv (128.0).—M. S.—Teaspoonful (4.0) in water after meals. GERANIUM. Geranium, U. S., is the rhizome of Geranium maculatum. It contains tannic and gallic acids, and is useful as an astringent in cases of serous diarrhoea. It is not the common red geranium seen in flower-gardens. In infantile diarrhoea 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 tasteless. The dose of the drug itself is 20 to 60 grains (1.3^- 4.0), and that of the fluid extract (Extractum Geranii Fluidumy U. S.) i to 1 fluidrachm (2.0-4.0). GINGER. Zingiber, U. S. and B. P., is the rhizome of Zingiber officinale, a plant of Hindostan, 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 cramps due to suppres- sion from exposure to cold. Ginger is often combined with purgative medicines to stop griping and for its pleasant flavor. Of itself it is decidedly constipating, and Avhen used in diarrhoea mixtures is of value other than as a flavoring addition to the prescription. Administration.—The fluid extract (Extractum Zingiberis Fluidum, U. S.) is given in the dose of 10 to 30 drops (0.65-2.0), well diluted; the tincture (Tinctura Zingiberis, U. S. and B. P.), dose 20 drops to 2 drachms (1.3—8.0); the syrup (Syrupus Zingiberis, U. S. and B. P.), dose 30 drops to 2 drachms (2.0-8.0); the oleoresin (Oleoresina Zingiberis, U. S.), dose ^ to 1 drop (0.03-0.05), well diluted or in pill; and the troches (Trochisei Zingiberis, U. S.) used as stimulants* to salivary secretion. 14 210 DR UGS. GLANDULAR TREATMENT. Within the past ten years physiological investigations haAre indi- cated that several glands in the body not only secrete substances in the body-cavities, but also pour out into the blood- or lymph-vessels ferments or substances Avhich perform definite physiological functions in the system. Disease of these glands perverts these functions, and secondary disorders follow. Acting upon the discoveries just named, some persons have attempted to show that nearly all of the organs of the body, be they glands or not, possess these functions, until they have reached a rccluctio ad absurdum. On the other hand, some of the glands are now used, Avhen derived from the loAver animals, for definite therapeutic purposes, such as the thyroid gland, for example. The use of this gland will be found discussed under its own beading, but unimportant glands in therapy, or those in regard to Avhich doubt exists, are included under the general heading here given. The employment of testicular juice, or the dried gland itself, has been practically abandoned, but the juice of the ovary seems to possess poAverful effects. According to Ferri and Bestion, it is capable of caus- ing death when given in overdose, and males are far more susceptible to it than females. So, too, females before and after the menstrual period of life are more susceptible than females during the child- bearing period. Given to dogs in overdose the ovary causes erections Avith ejaculations of semen, and, if the dose is large, death Avith haem- orrhages into the spinal cord. It has been used to combat the symp- toms following double oophorectomy, and those common to the meno- pause and also for aphrodisiac purposes. On the ground that chlorosis is due to a faulty internal secretion of the ovary, it has been given in this condition Avith asserted good results, and also in osteomalacia, neurasthenia, and hysteria. The dose is from 2 to 4 grains (0.10- 0.20) a day. The suprarenal gland will be found discussed under its OAvn head- ing. The use of cerebral and spinal extracts has proved futile, as has also the use of bone-marrow in pernicious anemia. The pancreas has been used in pancreatic diabetes, but its value is in doubt. The liver has been given in the dose of 3 ounces (90.0) of fresh gland a day to combat the delirium of cirrhosis, Avith asserted good results (Carnot), and has also done good in alcoholic cirrhosis Avith icterus, in that the haemorrhages Avere arrested, the delirium ceased, and the patient gen- erally improved. The same treatment has been tried in diabetes. It is difficult to see hoAV it can do good. While glandular therapeutics gives promise of aiding us greatly in the treatment of disease, and Avhile for this reason the cautious phy- sician should not oppose resort to the use of glandular extracts, he should, nevertheless, always study the physiological function of the gland to be employed in order that he may reach a clear idea of its remedial possibilities. The extraordinary effects of some glands do not prove that all animal extracts are of value, nor does the failure of others indicate that all are useless. GL YCERIN 211 GLYCERIN. Glycerinum, U. S. and B. P., is a liquid obtained by the decom- position and distillation of fats. It possesses great poAver in absorb- ing water and of dissolving many substances. Even if pure it irri- tates the skin of susceptible persons when applied locally by its absorp- tion of Avater, and often causes a slight rash. Physiological Action.—Injected into the circulation in large amounts, glycerin causes convulsions, which are due to its hygroscopic poAver. 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. Other clinicians, hoAvever, disagree Avith him and use it con- stantly for this purpose Avith asserted advantage. Therapeutics.—Glycerin may be employed as a sAveetening agent in the food of diabetics and in cases Avhere sugar cannot be used. It has also been given as a laxative in 1- or 2-drachm (4.0-8.0) doses by the mouth, and in enema—1 to 1 drachms (4.0-16.0) Avith or without equal parts of Avater. In some cases it may be used in suppository in the official Suppositoria Glycerini, U. S. and B. P. This latter method i< very successful in chronic constipation. Its continued use by suppository may, hoAvever, result in rectal irritation. t As an antiseptic it is used for preserving specimens and for keep- ing alkaloids in solution for hypodermic use. In acute coryza, applied by a spray or brush to the nostrils, it is sometimes of service; for this purpose it should be diluted four or five times Avith Avater. If used on the skin, it should be diluted one- half AA'ith Avater. In cases of impacted cerumen in the external audi- tory canal glycerin is often of service in softening the mass. The uses of glycerin, other than those mentioned, are many. In the proportion of equal parts of glycerin and Avater it makes a very useful mouthwash for the sore and dry mouth of typhoid fever and for the removal of sordes. The same Avash, Avith lemon-juice added to it, is very agreeable and will relieve the dry, glazed tongue of advanced phthisis. OAving to the fact that glycerin is hygroscopic, it may be used as a depletant on a pledget of cotton in congestion of the uterine cervix, the tampon being reneAved daily. (See Boric Acid and Boroglyceride.) For the prevention of bed-sores Ringer recommends the daily Avash- ing and rubbing of the part likely to be affected, followed by the application of glycerin, and a draAV-sheet placed smoothly against the patient to protect the bedding. Glycerin and Avhiskey is a favorite household remedy for colds and coughs, but is not very useful. Glycerite of starch (Glycerinum Amyli, U. S. and B. P.) is used as a protective over superficial irri- tations of the skin. Glycerite of yolk of egg ((ilyceritum Vitelli, U. S.) is used in making emulsions. A very useful ointment for the application of medicinal substances 212 DR UGS. to the skin may be made by mixing constantly in the presence of heat 1 part of potato starch and 15 parts of pure glycerin. The result is a clear, transparent, jelly-like substance Avhich does not decompose, and has the advantage of holding the medicament Avhich it carries in solution rather than by mechanical suspension. The B. P. preparations of glycerin are as follows: Glycerinum Acidi Carboliei, Glycerinum Acidi Taunici, Glycerinum Aluminis, Glycerinum Acidi Borici, Glycerinum Plumbi Subacetatis, Glycerinum Tragacanthae, and Glycerinum Boracis. GOLD. Gold itself is not official in the U. S. Pharmacopoeia, 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, U. S.). The dose of this substance is 2V to ^ of a grain (0.003- 0.006) once, twice, or thrice a day. The author has not found it of much value. Gold has also been strongly recommended for indiges- tion with epigastric pain after eating Avhen looseness of the boAvels is present, and it is said to act as a poAverful sexual stimulant and to be of service in impotence dependent upon inability to obtain an erection or Avhen 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, U. S., 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 spinal cord, and finally the motor centres and nerve-trunks. It slows the heart by stimulating the vagi, and raises blood-pressure by stimu- lating the vasomotor centre. Therapeutics.—Grindelia robusta 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 (1.3-4.0) of the fluid extract (Extractum Grindeliae Fluidum, U. S.), or by inhaling the fumes of burning grindelia-leaves, Avhich 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 Avith Avater it forms one of the best lotions that we have for the relief of the dermatitis produced by poi- son ivy or Rhus Toxicodendron. Administration.—The only preparation Avhich is official is the fluid extract (Extraction Grindeliae Fluidum, U. S.), dose 20 to 60 drops (1.3-4.0). G UAIAC—G UAI A COL. 213 GUAIAC. Lignum Vitro, or Guaiacum officinale, a West Indian tree, is used in medicine in tAvo forms—namely, as guaiac Avood (Guaiaci Lignum, U. S. and B. P.), Avhich is in raspings and enters into the compound syrup of sarsaparilla, and guaiac resin (Guaiaci Resina, U. S. and B. P.), or guaiac, Avhich is soluble in alcohol, ether, and chloroform, but is insoluble in Avater. Therapeutics.—Guaiac has been largely used in syphilis, but is noAv 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 Avill often abort the disease. In rheumatism it has been largely used. The ammoniated 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, and the sali- cylates may alAvays be used in its place. Administration.—The tincture (Tinctura Guaiaci, U. S.) is given in the dose of 5 to 60 drops (0.35-4.0), and the ammoniated tincture (Tinctura Guaiaci Ammoniata, U. S. and B. P.) is used in the same dose, preferably in milk. Mistura Guaiaci, B. P., is given in the dose of 1 to 2 fluidounces (32.0-64.0). Trochisei Guaiaci are official in the B. P. GUAIACOL. Guaiacol is a liquid constituting from 60 to 90 per cent, of creo- sote. It is obtained by the distillation of beechwood creosote, fol- loAved by a complicated process Avhich it is not necessary to describe. In other cases guaiacol is obtained from beechwood creosote by pre- cipitation Avith barium hydrate. Much of the " absolute guaiacol " of commerce is impure. Chemically pure guaiacol, obtained by the process last named, is a light-colored fluid of an agreeable odor and soluble in Avater in the proportion of 1 to 85 (Helbing). It is easily soluble in alcohol and ether. Therapeutics.—Guaiacol has been largely used by some practition- ers, chiefly in Europe, for the treatment of tuberculosis as a substitute for creosote, because it is the principal ingredient of that drug. (See Creosote.) It Avas thought by Guttmann, Sommerbrodt, and others that the good effect of creosote Avas due to its destructive action on the bacillus, or that it so improved digestion as to increase the resist- ance of the patient to the spread of the disease. Recently, Hoelscher and Seifert have asserted that guaiacol and creosote produce their good effects by forming compounds Avith the toxines or poisonous albuminoids formed by the bacilli, Avhich are then eliminated from the body. The same rules gOArern the use of guaiacol as govern the employment of creosote. It is best given Avith brandy, wine, or other alcoholic drink, or in capsules Avith cod-liver or SAveet oil. 5 or 10 drops (0.35-0.65) of guaiacol may be added to a pitcher of hot water 214 DR UGS. and the vapor inhaled three or four times a day in cases of subacute and chronic bronchitis. The dose by the stomach is 5 to 20 minims (0.35-1.5). Recent clinical observations prove conclusively that guaiacol pos- sesses poAverful antipyretic influences. As pointed out by Sciolla in 1893, guaiacol Avhen painted on the skin of a febrile patient causes a pronounced fall of temperature, Avhich begins soon after the applica- tion is made, but is not fully accomplished for from tAvo to three hours. The application may be made to the skin of the abdomen, thighs, or chest, about 30 to 40 drops (2,0-2.6) being used with a brush. When a full effect is required, it is Avell to place an imper- meable dressing over the part painted to prevent evaporation and aid absorption. These applications may be resorted to as often as is necessary for the reduction of the fever, and, although the fall of temperature is sometimes very rapid and very great—as much as 7° F. in tAvo hours—DaCosta has never seen serious nervous or car- diac symptoms produced, but other observers have noted such unto- ward results. The temperature is very apt to speedily rise after the reduction, and this rise is often preceded by a chill. These appli- cations cannot supplant the cold bath, although they undoubtedly do reduce the temperature. The true sphere of usefulness to be assigned to guaiacol as an antipyretic seems to be that of a less valuable therapeutic measure than the bath, and one equally poAver- ful and about as dangerous as are the antipyretic drugs of coal-tar derivation. When used externally in the fever of tuberculosis its action is very satisfactory, but the presence of cavities contraindicates its use, it is said. The studies of Stolzenberg shoAV that if frequently and constantly used guaiacol produces in febrile patients a tendency toward depression. Thayer finds that great SAveating and depression generally folloAv its external use in fevers. Probably future reports will develop the fact that in cases of renal irritation guaiacol will prove harmful. Guaiacol has been used by painting it on the affected part in the treatment of superficial neuralgias, and in deep-seated nerve-pains, as in sciatica, it has been given hypodermically in the dose of 2 minims in 10 minims of spirit of chloroform deeply into the neighborhood of the painful nerve. If guaiacol is placed upon the skin by means of a small compress, which has been wet with it and bound tightly to the part, local anaes- thesia is rapidly developed, but if it is left in place too long, it may be absorbed in sufficient amount to cause depression or a fall of tem- perature. Belfield highly recommends painting the scrotum Avith guaiacol 15 minims (1.0) and glycerin 45 minims (3.0) for orchitis. A serious objection to the external use of guaiacol is its disagree- able odor. GUAIACOL CARBONATE—HAMAMELIS. 215 GUAIACOL CARBONATE. Carbonate of guaiacol is a white, crystalline powder, consisting of 91 per cent, of pure guaiacol and 9 per cent, of carbonic acid. This poAvder is insoluble in Avater, neutral in reaction, and is said to be Avith- out any irritating effect on the stomach. Taken by the healthy indi- vidual, it is decomposed into guaiacol and carbonic acid in the boAvel, but not in the stomach, and it is used for this reason, as salol is, as an intestinal antiseptic in the various forms of fermentative diarrhoea and typhoid fever. The drug is said to be sloAvly absorbed, but after ab- sorption is rapidly eliminated. Its therapeutic applications in tuber- culosis are practically identical Avith those of pure guaiacol, save that it is more readily borne by the stomach than the latter drug. Guaiacol carbonate may be given in capsule or pill, or it may be given in dry poAvder on the tongue in the dose of 2 to 10 grains (0.10-0.65). Usually in typhoid fever the dose is about 2 grains (0.10) every three hours, and in tuberculosis of the lungs 5 grains (0.35) three times a day. PLEMATOXYLON. Hcematoxylon, U. S., Hcematoxyli Lignum, B. P., or LogAvood, is the heart-wood of Hcematoxylon campechianum, a tree of the Amer- ican tropics. It contains an alkaloid, haematoxylin. Therapeutics.—Haematoxylon is a mild astringent, very useful in serous diarrhoeas and in the diarrhoeas of young children, as children do not dislike it, owing to its agreeable taste. (See article on Diar- rhoea.). As it colors the stools and urine red, the nurse should be warned lest she be alarmed at the sight of Avhat looks like blood on the diaper after the drug is given to infants. If the urine is alka- line, the color may be violet or red. In leucorrhoea its internal use is of service. The extract (Extractum Haematoxyli, U. S.) is given in the dose of 8 to 30 grains (0.6-2.0), and Decoctum Hcematoxyli, B. P., in the dose of 1 to 2 fluidounces (32.0-64.0). An unofficial fluid extract is often to be found in the shops. The dose of this is \ to 2 fluidrachms (2.0-8.0). (See article on Diarrhoea.) HAMAMELIS. Hamamelis, II. S., Witch-hazel, or Hamamelis virginiana, is a plant of the United States, devoid of any true active principle, but possessing extraordinary remedial power. Therapeutics.—Hamamelis is to be employed in relaxed sore throat resulting in congestion and hyperemia upon exposure or where mild catarrhal states are present. Similarly, we employ it in an atomizer, after attacks of acute coryza, to tone up the nasal mucous membrane. The strength of the solution should be 20 to 60 minims (1.3-4.0) of the distilled extract to the ounce (32.0) of water. Hamamelis when taken internally is often wonderfully successful in the treatment of uterine oozing from small blood-vessels, seems to do good even in hosmatemesis 216 DR UGS. and haemoptysis, and Avill sometimes arrest hcematuria when all other remedies fail. Applied by means of cloths to leg ulcers, it acts very thoroughly and rapidly relieves the angry-looking skin surrounding the ulcer. 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 bleeding and the so-called blind piles. (See Hemorrhoids.) Administration.—The one official preparation in the U. S. P. is the fluid extract (Extractum Hamamelidis Fluidum, U. S.; Liquid urn. B. P.), dose 5 to 20 drops (0.35-1.30). The dose of the distilled extract, which is not official and is a perfectly clear liquid, is from 30 drops to 1 drachm (2.0-4.0), and this is much the best preparation for internal and external use. Unfortunately, the preparations of the drug vary very much both in odor and efficacy. Some of the pro- prietary preparations of witch-hazel are more active than those ordi- narily dispensed in the drug-store. This is due to greater care in their preparation, and to the fact that they are sold in original packages Avithout exposure to the air. The B. P. recognizes a solu- tion, Liquor Hamamelidis. HOFFMANN'S ANODYNE. Spiritus JRtlieris Compositus, U. S. and B. P., consists of alco- hol, ether, and the heavy oil of Avine. The writer has experimentally studied very thoroughly the action of the last-named ingredient, and finds: First. That the belief in heavy oil of Avine 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 Avhich there are linked together three drugs of undoubted power, each one of Avhich 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 Ioav. That large doses of the heavy oil of Avine are in no Avay possessed of toxic effects is proved by the fact that 30 cc. 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, and it possesses but little taste other than that caused by the presence of an oily sub- stance. Therapeutics.—Hoffmann's anodyne is the best carminative that we possess for general use, and is one of the best remedies for singultus or hiccough. These effects are accomplished probably in tAvo ways: The alcohol and ether act as irritants or stimulants to the intestine, and free peristalsis results, while the heavy oil of wine acts, perhaps, HOMA TROPINE—HONEY. 21'I as a nervous sedative. In angina pectoris this drug is often the best remedy Ave have, and in the cardiac palpitation of tobacco heart or that arising from indigestion it is very useful. In the nausea and depression seen after excessive smoking, Hoff- mann's anodyne should ahvays be given in capsules or in cold water, preferably ice-cold, in order to prevent too rapid volatilization of the ether and consequent difficulty in SAvalloAving the liquid. The dose is 1 to 2 drachms (U 0-8.0) to an adult. HOMATROPINE. Homatropine is an artificial alkaloid obtained by prolonged and gentle heating of a solution of equivalent quantities of tropine1 and toluic acid in hydrochloric acid. The hydrobromate of homatropine (Homatropinae Hydrobromidum, B. P.) is a crystallizable salt of hom- atropine soluble in 10 parts of distilled water. The B. P. recognizes discs of homatropine. 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 Avith retinal-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 hom- atropine is far removed, even Avhen repeated instillations have been made, and its temporary action upon the pulse causes no inconvenience to the patient. Slight hyperaemia of the conjunctiva almost invaria- bly follow its use, but true conjunctivitis, if it occurs at all, must be excessively rare. According to the studies of Dr. de SchAveinitz 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 thirty-six to forty-eight hours, that of hyoscyamine eight to nine days, and that of atropine ten to tAvelve days. For the pro- duction of ordinary mydriasis the drug should be used in solution of the strength of 4 grains (0.20) to the ounce (32.0) of distilled Avater, which is to be dropped into the eye every five or ten minutes. As the drug is expensive, only a feAv drachms of the solution of the strength named should be ordered for a patient. HONEY. Honey, or Mel, U. S., is the saccharine fluid deposited in combs by the honey-bee, or Apis mellifica. It is used to cover the taste of disagreeable medicines. When it is abstracted from a particular 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 Avhich it is gathered. This accident occurs commonly 1 Tropine is a product obtained by splitting up atropine into tropine and tropic acid. 218 DRUGS. in those parts of the country Avhere the bees have had access to moun- tain laurel and similar plants. Therapeutics.—Honey is used as a vehicle 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 membrane, 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, to Avhich a small proportion of glycerin is added, is knoAvn as Mel Despumatum, U. S., and Mel De- puration, B. P. There are also a honey of roses (Mel Rosce, U. S.) and a confection (Confectio Rosce, U. S.), used as vehicles for other drugs. 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 Avhen water is added to it. The nitrous acid is, hoAvever, more efficacious than nitric acid in the serous or choleraic diarrhoeas Avhich it is used to combat. The formula is as follows: R.—Acidi nitrosi.............f^j (4.0). Aquae camphora?...........f^viij (256.0). Et adde Tinct. opii.............gtt. xl (2.65).—M. S.—One-fourth of this in water every three or four hours. HOPS. Humulus, U. S., is the strobiles of ordinary hops, or Humulus Lupulus. These contain a liquid volatile alkaloid, lupuline, and a bitter principle, lupulinic acid. Hops are knoAvn under the name of Lupulus in the B. P. Much confusion has arisen in regard to the preparations of this drug, partly because Humulus is the official name in the U S. P. and Lupulus in the B. P. This confusion has been increased by the fact that the alkaloid of hops is called lupuline, while the poAvder Avhich is found on the strobiles is called lupulin. Those preparations in the U. S. P. having the Avord " humulus " in their name are made from the hops themselves, those Avith kk lupulin" in their name from the powder of the strobiles. Therapeutics.—Hops are used as antispasmodics and nervous seda- tives in cases of hysteria and nervousness. In priapism, vesical irrita- bility, 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 poAvdered strobiles in the mass, and employed in this way they are a favorite home remedy for local pain- ful inflammations. Hops have been used in the form of a hop pillow in nervous insomnia, but the soporific influence is largely imaginary HYDRASTIS. 219 or depends on the fumes of the alcohol Avith Avhich the pilloAV is moistened. Administration.—The tincture (Tinctura Humuli,U. S.) is given in the dose of £ to 3 ounces (16.0-9(5.0). Lupulin (Lupidinum, U S. and B. P.), Avhich is the powder found on the strobiles of hops, is given in the dose of 2 to 5 grains (0.1-0.35) or more; the oleoresin of lupulin (Oleoresina Lupulini, U S.) is given in dose of 10 to 40 drops (0.65-2.65) in capsules; and the fluid extract (Extraction Lupu- lini Fluidum, U. S.), in the dose of 30 to 120 drops (2.0-8.0). The preparations of the B. P. are the infusion (Infusum Lupuli), dose 1 to 2 fluidounces (32.G-64 0); and the tincture (Tinctura Lupuli), dose *- to 2 fluidrachms (2.0-8.0). HYDRASTIS. Hydrastis, U. S. and B. P., is the rhizome of the Hydrastis cana- densis, containing tAvo alkaloids, knoAvn as hydrastme and berberine, and, perhaps, xanthopuccin. Physiological Action.—In poisonous doses hydrastis may cause con- vulsions folloAved 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, Avhen injected into the jugular vein, causes a primary fall of arterial pressure, succeeded by a decided rise, and the studies of Cerna 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 folloAving 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 leucorrhoea dependent upon a relaxed state of the vagina, and in chronic nasal inflammations and irritations it Avill be found useful. Tincture of hydrastis is said to possess a distinct antimalarial influence. One of the best remedial measures that we have in the later stages of gonorrhoea, Avhen the acute period has passed, is the local and internal use of hydrastis. If it is used as an injection, 5 grains (0.3) of the commercial hydrastine to each ounce (32.0) of water should be employed tAvice 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; \ to 1 drachm of the fluid extract may also be added to a pint of water and used as a wash in vaginal gonorrhoea and leucorrhcsa. In chronic dyspepsia hydrastis seems to act as an antiseptic and as a curative agent upon the mucous membranes of the stomach. Administration.—The fluid extract (Extractum Hydrastis Fluidum, U. S. ; Liquidum, B. P.) may be given in the dose of 5 to 30 drops (0.30-2.0), Avhile the dose of the tincture (Tinctura Hydrastis, U. S. 220 DRUGS. and B. P.) is from 30 drops to 2 drachms (2.0-8.0). The Glyceritum Hydrastis, U. S., is used as a healing application to mucous membranes. Much doubt exists as to the dose of hydrastine. This arises from the fact that two forms of it are sold. The most commonly seen is a dark-brown mass Avhich is very impure, and contains berberine and other substances. Its dose is 3 to 10 grains (0.15-0.65). The pure hydrastine, as made by Merck, is given in the dose of \ to % grain (0.016-0.03). Hydrastinine hydrochlorate, an artificial alkaloid of hydrastine, has become official in the U. S. P. of 1890. HYDROBROMIC ACID. (See Bromides.) HYDROCHLORIC ACID. Acidum Hydrochloricum (U. S. and B. P.) is a clear, colorless liquid, possessing an acid odor and taste, devoid of astringency, but in concentrated form decidedly caustic. It should be kept in dark- colored bottles. In the strength of two-tenths of 1 per cent, it is normally present in the gastric juice, and aids the pepsin in the con- version of proteids into peptones and in the formation of pepsin from pepsinogen. Therapeutics.—Hydrochloric acid is a much overrated remedy in dyspepsia. With new methods of studying gastric secretions we have learned that proper dieting and the use of lavage will do great good in ordinary dyspepsias, and this acid now finds comparatively rare and far more rational uses. These are its employments: to aid digestion dur- ing and after fevers, when this acid is apt to be absent from the gastric juice, particularly in typhoid fevers. In cases of gastric cancer, when this acid is always absent from the gastric secretion, and in the sick stomach following an alcoholic debauch, it is of great service. In some cases of chronic gastric catarrh in which there is atrophy of the gastric tubules, it should be used freely. The dose of the dilute acid (Acidum Hydrochloricum Dilution, U. S. and B. P.) is 5 to 10 drops (0.36-1.3). This acid is combined Avith nitric acid to form dilute nitro-hydro- chloric acid (Acidum Nitro-hydrochloricum Dilution, U. S. and B. P.), the dose of which is 10 to 30 minims (0.65-2.0); also the pure acid (Acidum Nitro-hydrochloricum, U. S.), dose 1 to 5 minims (0.05-0.35). Hydrochloric acid causes, Avhen taken in poisonous doses, violent gastro-enteritis and corrosion of the gastric Avails, and its action should be combated by alkalies, soap, oils, and white of egg, and the use of opium to relieve pain and irritation. HYDROCYANIC ACID. Hydrocyanic or Prussic Acid is a transparent, colorless, very volatile liquid, giving rise to vertigo Avhen inhaled in minute amounts and capable of producing death if the fumes be concentrated. If the HYDROCYANIC ACID. 221 bottle containing the pure drug be opened, it should be done Avhere there is sufficient draught betAveen AvindoAvs to prevent any contamina- tion of the atmosphere of the room by the acid. Pure hydrocyanic acid is never used in medicine ; the form employed is the dilute acid (Acidum Hydrocyanieum Dilutum, U. 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) of the lethal poisons, only being approached by carbolic acid and nitrobenzole in the violence of its effects. Owing to its volatility, it is absorbed Avith great rapidity, and acts upon the respiratory centre and the heart, being eliminated almost immediately afterward. Because of its fleeting character, the survival of a patient twenty or thirty min- utes after the ingestion of a poisonous dose is a favorable sign for his recovery. 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 vital parts are killed at once if much of it is present. Poisoning.—When a lethal dose of hydrocyanic acid is taken, death either comes at once, so that the person drops dead to the floor Avith a gasp, is for a moment convulsed, the face cyanotic, the eyes Avide open, Avith 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 large enough to result in immediate death. In the first of these stages there are difficult respiration, sIoav cardiac action, and disturbed cerebration. In the second stage, which is convulsive, we find wild cries, dilated pupils, unconsciousness, vomiting, spasmodic urination and defecation, erections of the penis, and ejaculations of semen. In the third stage there are asphyxia, collapse, and paralysis, ending 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 Avhen 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 Avide-staring eye, the clinched teeth covered Avith froth, and the livid, cyanosed face. If the body be opened, the odor of hydro- cyanic acid is marked, but this rapidly passes away, owing to the vol- atility of the drug. The only poisoning producing symptoms resembling those Avhich have just been described is that produced by nitrobenzole or essence of mirbane, which has a someAvhat similar odor, but which is, however, 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, Avhere, OAving to a hypersesthesia of the mucous mem- branes, the taking of food produces discomfort. In irritable coughs, due to tickling in the throat and bronchi, it is very extensively used, and 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 moment, and that a dose every ten or fifteen minutes is necessary to produce any 222 DRUGS. real effect. However this may be in theory, practically the acid cer- tainly does aid in relieving cough. In these states the folloAving pre- scription Avill be found of service: R.—Acid, hydrocyan. dil..........ffij (4.0). Syrup, pruni virg...........f Jiij (96.0).—M. S.—Teaspoonful (4.0) every four or five hours to an adult. In enteralgia or neuralgia of the intestines dilute prussic acid is often a very useful remedy. Externally, the drug is useful in pruritus and other forms of itch- ing skin diseases, and the folloAving formula will be found of service in pruritus vulvae: R.—Hydrarg. chlor. corros.........gr. jss (0.09). Acid, hydrocyanic, dil.........fgj J4.0). Aqua? amygdal. amarae........fjvj (192.0).—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 (0.05-0.35). In certain forms of irritable cough inhala- tions of the vapor (Vapor Acidi Hydrocyanic!) are recommended; this is prepared by adding 10 to 15 minims (0 65-1.0) of the diluted acid to 1 fluidrachm (4 0) of Avater, Avhich is then placed in a suitable apparatus, from Avhich is inhaled the vapor that arises. HYDROGEN PEROXIDE. Peroxide of Hydrogen is a clear, odorless, syrupy fluid of a specific gravity of 1.452, possessing a harsh, bitter taste. It is readily soluble in Avater, and its chemical formula is H202. Pure peroxide of hydrogen is never used in medicine, but in solutions of varying strength. The ordinary solution, as found in the shops and that noAv official (Aqua Hydrogenii Dioxidi, U. S., Liquor Hydrogenii Peroxidi, B. P.), is about 3 per cent., or, as it is gen- erally called, a 10-volume solution. This term, " 10 volumes," sig- nifies that it can yield 10 volumes of available oxygen; and it is upon this yield of oxygen that its activity depends. The specific gravity of this official solution is 1.006 to 1.012 at 59°. The reaction is acid, but this is due to a small amount of acid added to the solution to preserve it. The official solution of peroxide of hydrogen, Avhile the most stable that can be prepared, is nevertheless readily deterio- rated by exposure to heat, sunlight, or prolonged shaking. If placed in an absolutely clean, smooth glass vessel, it may be concentrated for immediate use by exposing it to a temperature of 140° F.; but exposure to a temperature above this point may result in its decompo- sition with explosive violence. Practically, this means of concentra- tion is not convenient for the practitioner, and the ordinary official solution fulfils all ordinary requirements unless it has deteriorated by age. The great difficulty in the use of the solution of the peroxide is its liability to undergo change and become practically Avorthless. Wallian states that as a rough test for the value of a given solution a HYOSCYAMUS. 223 few crystals of permanganate of potassium may be placed in a test- tube, and 1 or 2 drachms (4.0-8.0) of the solution added. The vio- lence of the resulting effervescence is in direct ratio to its value as a remedial agent. Therapeutics.—The most valuable use of the peroxide-of-hydrogen solution in medicine is in the treatment of diphtheria. So far as Ave knoAV, it is the best application for the destruction and removal of the false membrane. There is no injury to the normal tissues, nor is there the danger of poisoning Avhich sometimes folloAvs the use of such drugs as carbolic acid. Applied to the false membrane, there is at once an active effervescence Avith some local tingling of the part. The mem- brane can afterward be removed in shreds. The solution should be applied by means of a SAvab or spray, but if the latter is used a glass atomizer must be employed, as the peroxide is decomposed by coming in contact with metals. In the treatment of abscess-cavities, tubercular or septic in cha- racter, the peroxide of hydrogen is a very valuable application, and its use will often decide the presence of pus, since Avhen it meets Avith this material active effervescence ensues. Similarly, it is a valuable preparation for cleansing ulcers and malignant groAvths Avhich have ulcerated. The employment of the peroxide internally, with the idea that it will yield oxygen to the body in cases where this gas is lack- ing, is futile. Even if the oxygen entered the blood, the amount disengaged from a possible dose Avould be too small to be of any value. It is stated that the application of this liquid to the spot suffering from a hornet's sting will give instant relief. Where the peroxide is used as a gargle it may produce pain through its attacking cavities in the teeth or the metallic substances Avith Avhich they are filled. Taken internally, the peroxide of hydrogen is not poisonous. The internal dose of the Aqua Hydrogenii Dioxidi of the U. S. P. is from 1 to 4 drachms (4.0—16.0), Avell diluted with Avater, and taken from a porcelain, not a metal, cup or spoon. It possesses no distinct value in internal medication. HYOSCYAMUS. Hyoscyamus, U. S., 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 tAvo alkaloids—one known as hyos- cyamine, the other as hyoscine. The first has practically the same physiological action as atropine, save that it is much more sedative in its effects on the nervous system. (See Belladonna.) The second is quite different in its influence over the body. The only marked differ- ence in the action of hyoscyamine and atropine is in the mydriasis pro- duced by each. While that of atropine lasts, in man, from tAvelve to fourteen days, hyoscyamine generally remains for only seven to nine days. Sometimes the development of mydriasis is preceded by violent pain in the eye due to a cramp of the ciliary muscle. If so, the drug 224 DR UGS. must be pushed to overcome the spasm. The strength of the solution to be used is 2 grains (0.1) to the ounce (32.0). 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, Avherever local spaxm or arterial relaxation exists or where pain is due to spasm. It has been particularly recommended in nervous cough, in whooping cough, and 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 official in four forms and as hyoscyamine sulphate and hydrobromate. The dose of the tincture (Tinctura Hyoscyami, U. S. and B. P.) is 30 drops to 1 drachm (2.0-4.0); the alcoholic extract (Extractum Hyoscyami, U. S., and Viride, B. P.), dose 1 to 3 grains (0.05-0.15); the alkaloid (Hyoscya- mince Sulphas, U. S. and B. P., vel Hydrobromas, U S.), dose ■£$ to z\ of a grain (0.001-0.0015); and the fluid extract (Extractum Hyoscyami Fluidum, U. S.), dose 5 to 30 drops (0.35-2.0). The B. P. prepa- ration, besides those given, is the juice (Succus Hyoscyami), dose 30 minims to 1 fluidrachm (2.0-4.0). Hyoscine. This is one of the alkaloids derived from hyoscyamus, and is a powerful nervous sedative in some cases. Much if not all the so-called hyoscine of the stores is in reality scopolamine, derived from Scopolia atropoides. Physiological Action.—Hyoscine quiets the cerebrum and produces deep sleep in a certain class of patients. In the loAver animals or in man it may cause sleep or Avild delirium. It causes loss of reflex action in overdose, Avhich is due to paralysis of the spinal cord and not of the nerve-trunks. Upon 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 circu- latory effect is a minor one. In cases where hyoscine has acted in excess, or where an overdose has been given, pilocarpine may be used as a physiological antidote in full doses if the heart is sound. Therapeutics.—Hyoscine is of value as a hypnotic in a very lim- ited class of cases, but in this class generally acts most favorably. These cases consist of those who, from acute mania, alcoholic mania, hysteria, or similar cause, suffer from insomnia, and perhaps use vio- lent struggles against proper control or refuse to SAvallow or retain food. The drug may be given to such persons, hypodermically, in the dose of y^-g- to -^5- of a grain (0.0006), or by the mouth in the dose of -^ to -^- of a grain (0.0008). The fact that it possesses no taste and is small in bulk renders it readily employed. In some. HYPNA L—ICHTHYOL. 225 persons 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 patients are not quieted by the drug, but pace up and doAvn in a semi-sane condition until its action wears off. In the opinion of the Avriter the applicability of the drug is very limited indeed, and untoward effects are common. Hyoscine is certainly of great value in spermatorrhoea and noc- turnal emissions. The drug is contraindicated 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 Avill produce asthma rather than relieve it. The breathing in some persons may become under its influence croupy or rasping. Hyoscine is an uncertain remedy in nervous affections, sometimes acting very well, at others producing very alarming symptoms in cerebration, circulation, and respiration. Hyoscine is official in the form of Hyoscine Hydrobromate (Hyos- cince Hydrobromas, U. S.) and in the B. P. as Hyoscine Hydrobro- mide (Hyoscinae Hydrobromidi). HYPNAL. The chemical name of this substance is monochloral-antipyrine, and it is, as its name indicates, a compound of chloral and antipyrine. There is also a dichloral-antipyrine, which contains more chloral. The compound is employed in treating those patients who suffer from pain and insomnia 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, and the disadvantages of that medicament are often so prominent as to prevent its use. In cough arising from bronchitis or phthisis, and causing by its con- stancy loss of sleep, and in neuralgic insomnia, hypnal will be found of service. The dose is from 5 to 20 grains (0.35-1.3), best given with simple syrup and Avater or Avith syrup of orange-peel, or it may be used as follows : R.—Hvpnal...............gr. xv (1.0). Chartreuse.............fgj (4-°)- Distilled water..........fgss (16.0).—M. S.—The entire amount to be taken in one dose. ICHTHYOL. The substance sold in the shops and employed in medicine under the name of ichthyol is really a salt formed by the bibasic acid, ichthyo-sulphuric or sulpho-ichthyolic acid with ammonium. In other 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. 15 226 DRUGS. words, it is ammonium ichthyol, which is a semi-solid substance. The ichthyo-sulphuric acid itself is derived from a crude oil, Avhich in turn is obtained by destructive distillation from a deposit of fossil fish found in the Tyrol Mountains. When combined Avith sodium, forming sodium ichthyol, a more solid substance man ammonium ichthyol is formed, which can be employed if it is desired to use the drug in pill form. Both the ammonium and sodium ichthyol contain about 10 per cent. of sulphur, and it is largely upon this that their therapeutic activity depends. They are both soluble in water, and have a dark-brown, tarry appearance. Their disagreeable odor depends upon an inseparable volatile oil. Therapeutics.—Ichthyol is without doubt one of the most remark- able substances introduced for medicinal purposes within the last few years, both because of its curious origin and its therapeutic value in a large variety of ailments. In the author's hands it has proved most efficacious in the treatment of the inflamed areas in acute articular rheumatism. When used in this disease an ointment composed as fol- Ioavs is to be smeared over the inflamed part, and then spread on lint, which is Avrapped about the limb. This usually relieves the pain and tenderness of the part to a great extent. The same application, accom- panied by rubbing or applying massage to the joint, is of value for the pain and stiffness met with after the acute manifestation of the disease has passed by : R—Ichthyol.........3ij (8.0). 01. citronellse.......gtt. xv vel xxx (1.0-2.0). Adipis..........gj (32.0).—M. Sometimes the quantity of ichthyol in this prescription can be in- creased to three or four drachms Avith advantage. The same prescrip- tion is also the best external treatment of erysipelas that we have. The skin should be carefully and gently Avashed, and then anointed with the ointment and covered by lint smeared with this ointment. If the disease be in the skin of the face, holes are to be cut in the lint for the mouth, nose, and eyes. Ichthyol is also a very useful drug in the treatment of chronic skin diseases associated Avith atony and induration of the deeper layers of the skin, such as acne, eczema, and even lupus- and keloid in their chronic stages. It is always better to use ichthyol in ointment form, but some practitioners have employed it by painting it on in watery solution with a camel's-hair brush. In frost-bites, chilblains, and in burns it is of service, and Agnew has recommended it highly when rubbed into lymphatic enlargements. Ichthyol has proved remarkably efficacious in removing peri-uterine and other pel- vic exudations when used as a salve or in a vaginal suppository. For acute sprains, and for the removal of the SAvelling folloAving such injuries, its influence is extraordinary if it be Avell rubbed into the part affected. In severe cases of cracked nipples, with much induration, an oint- ment of ichthyol, 1 drachm to 4 (4.0-16.0) of lanolin, will prove of value, but it must be Aviped off before each nursing or the child will not take the breast. Often the odor remains and prevents nursing. IODIDE OF POTASSIUM. 227 The dose of ichthyol internally is 1 to 10 grains (0.05-0.65), given in pill. IODIDES OF AMMONIUM AND ETHYL. (See Ammonium Iodide and Ethyl Iodide.) IODIDE OP POTASSIUM. The physiological effects of iodide of potassium (Potassii Iodidum, U. S. and B. P.) are entirely comparable to those of iodine itself (see Iodine), but it is employed for someAvhat different purposes, is less irritant, more readily given, and perhaps more readily absorbed. When it is given in very large doses or for a long period of time, the fact that the potassium base is a depressant poison is to be remembered, and it is well to use iodide of sodium instead. Physiological Action.—Circulation.—Upon this part of the sys- tem Avhen in health 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), but if atheroma of the blood-vessels be present with high arterial tension in association Avith it, iodide of potassium acts as a valu- able remedy in reducing the vascular spasm. It therefore lowers arte- rial pressure. Absorption and Elimination.—Iodide of potassium is very rapidly absorbed and eliminated, appearing in the urine, according to Doux, in thirteen minutes after it is ingested, and the daily amount excreted equals about 80 per cent, of the dose taken. Some of the drug tends to accumulate in the body. It is evident, therefore, that in the use of iodide of potassium Ave should give it freely and fre- quently at first until the residual amount has reached its limit, Avhen smaller doses may be given, and given less frequently, for the purpose of maintaining the iodine influence. That is to say, the drug should be given up to the point of tolerance, whatever that may be, and then a smaller dose will be sufficient to maintain its influence by replacing the albuminoid compounds of iodine as they are sloAvly eliminated. On the other hand, if the iodide is being given for the purpose of elimi- nating some poison, as lead, for example, here the dose cannot be greatly decreased, because in addition to the ordinary quantity eliminated a portion is passed out as a double soluble iodide of lead. This theoretical deduction seems to find support in the fact that after the syphilographer reaches the full effect of the drug he often cuts the dose doAvn to Avhat he calls the "tonic dose," and so maintains the constant alterative effect Avithout disordering the functions of the body. If he does not do this, the drug accumulates and causes chronic iodine cachexia, a state Avhich it is important to avoid in grave diseases, like syphilis, which depend for their relief so largely on the maintenance of great vitality in the patient. All traces of the iodine in the urine disappear four or five days after the last dose is administered (Elhers). 228 DRUGS. Therapeutics.—The medicinal uses 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. This resistance does not always prove the presence of syphilis, nor does the absence of this resistance prove the absence of this disease. Persons having hereditary asthma, gout, rheumatism, or some similar diathetic malady often resist the iodide, and, on the other hand, some syphilitics are affected with " iodism " after very small doses. In treating syphilis the drug should be used in the dose of 10 grains (0.65) three times a day, and this amount gradually increased a grain a day until symp- toms of " iodism " occur. The quantity borne often amounts to from 100 to 200 grains (6.0-13.0) a day, and as much as 400 grains may be taken by some persons. 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 sarsaparilla. To a tablespoonful of the latter the patient is to add the iodide solution, beginning with 10 drops (0.65) three times a day, and increasing a drop every twenty-four hours. The iodide acts more slowly as an antisyphilitic than does mercury. In tertiary syphilis the iodide is invaluable. In nervous syphilis, be its manifestations what they may, iodide of potassium is the standard remedy, only being supplanted by mercury when it is necessary to break down a growth Avhose existence is a daily menace to the patient's life, as, for example, a brain tumor which causes pressure near vital areas. It is not of value in sclerotic post-syphilitic changes nor in locomotor ataxia due to syphilis, except in the earliest stages. 2. Metallic Poisoning.—OAving to the fact that iodide of potas- sium forms double soluble salts Avith all the metals in the tissues in chronic poisoning, thereby aiding in their elimination, it should ahvays be employed in chronic lead, zinc, arsenic, or mercurial poisoning. 3. Antirheumatic.—Iodide of potassium is best suited, not to the acute sthenic stages of rheumatism, Avhen the joints are very hot and painful, but to the secondary or subacute periods, when the joints are large and the case "hangs on"—noAv better, noAV worse. It acts best, under these circumstances, if combined with Avine of colchicum- root. (See Rheumatism.) It is also to be tried in sciatica, lumbago, and rheumatic neuralgia, and it may be employed in chronic pleurisy, pericarditis, and hydrocephalus to cause absorption of the fluids. In these conditions, however, it often fails and cannot be relied upon. IODIDE OF POTASSIUM. 229 In aneurism, particularly that of the aorta, the drug often does good, but its value rests largely upon the cause of the disease. If it is due to syphilis, the aneurism may yield very rapidly to the drug, and the pain, sAvelling, and pulsation gradually decrease. In asthma iodide of potassium is valuable if the disease is of the pure bronchial type, but it ought not to be employed if the cause is associated with gastric irritation or indigestion, as it makes the condi- tion of the stomach worse. In bronchitis and intestinal catarrh where the condition of the mucous membranes is semi-chronic, and not relieved by chloride of ammonium, 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 (0.15-0.30) three times a day, for small doses tend to increase secretion far more than large ones, Avhich often seem to decrease it. In pulmonary emphysema iodide of potassium is often of great value. In chronic interstitial nephritis small doses (5 grains (0.35) t. i. d.) ar3 thought by some to check the disease, but it is to be remembered th.it the drug may produce untoward symptoms if the kidneys do not eliminate it, so that, if used at all, it must be given Avith great care. If the drug is Avell borne in chronic parenchymatous nephritis, it will cause an extraordinary increase in the urinary Aoav, and will relieve very rapidly any dropsy which may be present. In bronchocele the employment of iodide of potassium internally and tincture of iodine externally is the best treatment Ave can use, and in acute coryza, or " cold in the head," 10 grains (0.65) taken at the beginning of the trouble Avill often abort the attack. In hepatic cirrhosis, in its early stages, the iodide often does good, and in arteriosclerosis or atheroma of the blood-vessels it is of great service. Thus in the latter conditions a combination of iodide of sodium or potassium Avith a little digitalis will relieve vascular spasm and support a feeble heart. 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 othenvise, external paintings Avith 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 contraindicated in phthisis, except in the fibroid form and in those cases Avhich are dependent upon syphilis as an underlying dys- crasia, as they aid in the breaking down of the lung. Untoward Effects.—In some persons, after the use of the iodide, coryza comes on, so that the edges of the lids become reddened and the nose runs constantly; and it is a curious fact that small doses are more apt to produce such a result than large ones. This is fol- lowed, 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 diges- tion and gastric irritability come on. The acne can nearly ahvays be prevented by giving arsenic at the same time with the iodide. In 230 DRUGS. some cases petechial rashes break out on the legs, while in others great mental and physical depression appears, so that listlessness or melan- cholia may develop. Sometimes iodide of potassium causes diarrhoea. In persons susceptible to iodide of potassium care should be exer- cised when it is first administered lest sudden and dangerous oedema of the glottis occur. Eisner has reported a case in Avhich death due to this cause followed the administration of 30 grains of the iodide of potassium. Multiple hemorrhages from the skin and mucous membrane occurred. If bullae or blebs folloAv the use of the iodides or other rashes appear, it is said that atropine Avill afford relief. Sometimes the iodide of ammonium or iodide of sodium Avill be borne when the iodide of potassium will not. Administration.—The iodide of potassium, owing to its exceed- ingly disagreeable taste, should be given Avith the compound syrup of sarsaparilla, extract of liquorice, or in milk. Large amounts of these vehicles are to be used. A good way to give it is to add the drug to one of the liquid pepsins, and then to add this to Avarm milk, as in the directions for the preparations of junket given in Part III. The curd completely covers the taste of the drug. The dose usually varies from 5 to 60 grains (0.35-4.0) three times a day, according to the condition of the patient. It is best given an hour after meals, so that it will not disorder digestion by irritating the stomach or interfere with the gastric juice. 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 folloAv it, in order to prevent the drug from coming in contact Avith the stomach in concentrated form. The preparations of the iodide of potassium are—Unguentum Potassii Iodidi, U. S. and B. P., and the liniment (Linimentum Potassii Iodidi cum Sapone, B. P.). The former should always be freshly prepared. IODIDE OP SODIUM. Sodii Iodidum, U. S. and B. P., is used in the same doses and for the same purposes as the iodide of potassium, and is less irritant than the latter salt, as well as less depressant to the general system. IODINE. Iodum, U. S. and B. P., is a non-metallic element found largely in seaweed and 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 unknoAvn. 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-Se'e believed it to be- a stimulant to the nutritive processes of the body and to the IODINE. 231 circulatory system, and he Avas certainly correct in regard to the influ- ence it exercises over nutrition. Absorption and Elimination.—The drug is rapidly absorbed, escapes from the body chiefly through the kidneys, the skin, the sali- vary glands, and it even appears in the milk of nursing women to such an extent that the nursing infant may be affected by iodism and suffer from gastro-intestinal disturbance in consequence of ingesting it. Poisoning.—The symptoms of acute poisoning by iodine are those of acute gastro-enteritis, such as 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, Avith markedly increased salivation. The pulse becomes rapid, running, and feeble, the face deathly pale, total arrest of urinary secretion takes place through renal irritation, and death occurs by failure of respira- tion, Avhich is accompanied by loss of all vital poAver. If the poisoning is not severe enough to cause death at once, a fatal result is. nevertheless, reached after a feAv days by reason of a widespread fatty degeneration of the tissues which iodine often produces. 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, and atropine or strychnine for the purpose of maintaining the strength of the circulatory and respiratory systems. Untoward Effects.—Under the. name of "iodism" the profession recognizes a state of the body brought on by the prolonged and excessive use of iodine in any of its forms. The earliest notable signs of this state are a peculiar metallic taste in the mouth, par- ticularly before breakfast, slight tenderness of the teeth and gums, increase of salivary secretion, a little morning nausea and a lack of appetite for breakfast, and perhaps some coryza or evidence of gastric irritation. Acne rosacea often comes on very early during the use of full doses of iodine. If the drug is continued, all these symptoms become more marked and the coryza becomes intense. Headache under the frontal bone and sore throat often appear, and the pustu- lar and bleb-like changes in the skin go on to active suppuration. Sometimes large boils appear or purpura haeinorrhagica comes on. Slight catarrhal fever may develop. In other cases the nervous system chiefly suffers. TAvitchings of muscles, neuralgic pains in the trunk and extremities, and Avasting 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 extreme cases. Soullier asserts that albuminuria may be developed in children after tincture of iodine is applied to the skin by reason of its absorption and irritation of the kidneys. Therapeutics.—In all cases where the system is in a state of chronic perverted functional activity, as in those diseases associated with disorder of the processes of nutrition, and often included under 232 DRUGS. 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 rem- edies Ave 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 in rapid phthisis, because it tends to disintegrate the tissues, and this is precisely Avhat the dis- ease is doing. In the exceedingly chronic form of pulmonary disease known as fibroid phthisis iodine may be used. When inhaled in fumes it may be of service as a stimulant to the mucous membranes, but is never of value in phthisis so far as combating the true pathological change is concerned. In countries where exophthalmic goitre is very prevalent iodine ranks as a most efficient but a dangerous remedy. In cystic or vascular enlargement of the thyroid gland it is valueless, but in simple hypertrophy of the gland iodine is of great value. To accom- plish the best results it must be injected by means of a hypodermic needle into the gland. The usual dose is 10 to 15 drops (0.65-1.0) every second or third day till twenty or more injections have been used. Meltzer states that while this treatment is sometimes efficacious, it is not by any means devoid of danger, for at least thirty deaths have resulted from it. 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 ancemia exists the syrup of the iodide of iron should be given internally. The other uses of iodine externally are many and important. As a sIoav counter-irritant, Avhich does not produce pain if properly em- ployed, it is particularly useful in children, and may be employed in one to three coats, and no more, applied by means of a camel's-hair brush. The proper way to use the tincture of iodine as a local counter-irri- tant 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 effective coat, it will cause agonizing burn- ing pain, Avhich 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 lotion for its removal is one of iodide of potassium, which should be folloAved by a starch poultice. A good rule to follow is never to cause pain by the use of, iodine, as the drug acts equally well if applied in such a way as to avoid suffering. Iodine in the form of the tincture is applied as a counter-irritant paint to the skin of the chest in pleurisy, both to abort an attack and to aid in absorption of the fluid after it is passed out into the chest. In harassing irritative cough it may be painted over the supraclavicular 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 applica- tion of iodine causes increased SAvelling for some days. This should not cause alarm, for ultimately the swelling decreases very greatly, and IODINE. 233 the cases in Avhich this occurs are generally the best from a prognostic point of view. In the course of phthisis every noAv 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 groAvth, and even over its surface, Avith the object of retarding its spread. In chilblains an application of iodine ointment gives the greatest relief if diluted one-half Avith lard, and its use is probably the most efficacious measure at our disposal. In certain individuals Avho have "pains in the chest" iodine ointment may do good if rubbed in over the affected spot. As has been pointed out by others, iodine does good if muscular tenderness is present, Avhile it fails if pleuro- dynia or intercostal neuralgia is the cause of the suffering. The lat- ter 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 Avith 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 on, and Stille' recommends for this dis- order 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 (0.05 : 32.0), 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 Ave have. The sac should first be emptied by the use of a trocar and canula, and the iodine alone or mixed with glycerin injected Avith 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 or other anaesthetic. In white swellings and ovarian tumors as much as 10 ounces (320.0) of the tincture may be injected, but it is to be remembered that certain dangerous symptoms may arise. After the injection of tincture of iodine into the pleural cavity in hydrothorax symptoms of poisoning have come on in some cases, the most common complication being con- vulsions. These are epileptiform in character and are folloAved by coma or collapse. In empyema a solution of iodine 6 grains (0.37), iodide of potas- sium 6 grains (0.37), and Avater 1 pint (500 cc), may be used daily as an irrigating fluid Avith good results; but this practice is not entirely devoid of danger, as too much of the iodine may be absorbed or the irritation produced in the chest by its injection may cause reflex and severe nervous symptoms. Iodoform is better. The tincture of iodine may be used, according to Ringer, as an inhalation Avith signal benefit in the folloAving three instances: 1. In the chronic forms of phthisis (fibroid lung). When the expectoration is abundant and Avhen the cough is troublesome, its inhalation, used both night and morning, Avill generally lessen the expectoration and allay the cough. 234 DRUGS. 2. In children six to ten years of age, Avho after meals, or, inde- pendently of them, on exposure to cold, are seized Avith hoarseness, a hoarse, holloAv cough and some wheezing at the chest. This affection, involving the larynx, trachea, and larger bronchial tubes, and often proving very obstinate, is apt to return and to persist a considerable time. 3. Some persons suffer with itching of the nose, of the inner canthus 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, Avith 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, and effectual plan of inhalation : Heat Avell a jug capable of holding about 2 pints, by rinsing with boiling water, then partly fill Avith boiling water, into Avhich pour 20 to 30 drops (1.3-2.0) of the tincture of iodine, then direct the patient to put his face over the mouth of the jug and breathe the iodized steam, covering the head to prevent the escape of the vapor. This inhalation should be used night and morn- ing 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 in the head. In some cases of acute coryza much relief may be obtained by sniff- ing the fumes of tincture of iodine from a bottle, as in the use of "smelling salts." The heat of the hand is sufficient to disengage the vapor in proper quantity. Administration.—Iodine is never used in solid form, and it has been taught that the tincture (Tinctura Iodi, U. S. and B. P.) should not be given internally, on the ground that it is precipitated in the stomach. Whether 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 (0.35-0.65), well diluted. Under the name of Lugol's solution (Liquor Iodi Compositus, U. S.) iodine is frequently used internally; the dose is 5 to 10 drops (0.35- 0.65), in water. Unguentum Iodi, U. S. 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 Avith lard. This ointment should ahvays be freshly made. Contraindications.—Iodine is contraindicated in renal diseases, except in small doses, during the progress of acute inflammation, and whenever tissues are rapidly undergoing degenerative changes. IODOFORM. Iodoform (Iodoformurn, U S. and B. P.) occurs in small saffron- colored crystals Avhich possess a poAverful characteristic, penetrating IODOFORM. 235 odor and strong taste. It is soluble in alcohol, ether, chloroform, benzol, and in fixed and volatile oils, but is insoluble in water. Physiological Action.—The effects of iodoform upon the circulation, respiration, and other vital functions are very slight when the drug is used as a surgical dressing in ordinary amounts or Avhen it is given by the mouth in average doses. It acts as an anaesthetic upon mucous membranes, and produces those changes Avhich Ave are Avont, for Avant of a better term, to call "alterative," in the tissues with which it comes in contact. Iodoform is eliminated in the urine as iodine or as alkaline iodides, chiefly iodide of sodium. The drug also escapes by the saliva. Poisoning.—If applied to an absorbing surface in susceptible indi- viduals, iodoform may cause general systemic poisoning. This poison- ing may be mild, in Avhich case Ave have a general feeling of malaise, with nausea and the perception of various odors which are in reality not present. There may be headache and vomiting. If the system is still more impressed by the drug, these symptoms are followed by cerebral excitement, insomnia, loss of memory, loss of appetite, and a rapid pulse. In very grave cases convulsive movements and maniacal delir- ium, alternating with coma, may be the dominant symptoms. The pulse is small and rapid, and there is often retention of urine or hema- turia. Loebisch asserts that the mental excitement cannot be quieted by narcotics. If death occurs, the heart and respiration fail simultane- ously. In addition to the fatty degeneration Avhich such poisoning pro- duces in all the vital organs, there is sometimes found an ©edematous condition of the pia mater or a loAv-grade leptomeningitis. These symptoms seem to occur more commonly in the aged. In the graver cases the onset of the poisoning is apt to be sudden, though from tAventy-four hours to several days usually elapse between the appli- cation of the drug and the onset of the symptoms of poisoning. Treatment of the poisoning by iodoform consists, according to Soui- lier, in the administration of bicarbonate of sodium to unite Avith the iodine and so aid in its elimination ; the use of alcoholic stimulants to support the system ; the employment of diuretics, and wrapping the patient in hot blankets to encourage free SAveating, so relieving the kidneys. Kocher advises saline transfusion in such cases. Untoward Effects.—It is not to be forgotten that iodoform when applied as a dressing may produce less violent symptoms than those just described, and capable, because of their aberrant character, of seriously misleading the physician. Thus a scarlatinal rash may develop with fever, malaise, and nervous disturbances. Therapeutics.—Iodoform is used chiefly as a surgical dressing. It is antiseptic, but not germicidal. Germs may be found in poAvdered iodoform, and will even grow in it. When used locally, the drug does good by absorbing the liquids of the Avound, and thereby removing the nidus for germ-growth, and when applied to large moist surfaces gives off free iodine and acts as Avell as a protective. There can be no doubt that iodoform when applied to a wound does good, not by destroying the bacteria directly or indirectly, but by inducing chemical changes in their toxines. 236 DRUGS. In syphilitic sores the following dressing ay ill be found of great service: Iodoform, 20 grains (1.3); oil of eucalyptus, | fluidounce (16.0); or a powder of iodoform h an ounce (16.0), camphor 75 grains (5.0), and essence of roses 2 drops (0.1), may be employed. In eczema, Avith tingling and itching, the folloAving application will give relief (Ringer) : H.—Iodoformi.............gr. iv (0.2). Olei eucalypti............f%j (4.0). Petrolati..............%] (32.0).—M. S.—Apply locally. Internally, iodoform is used in tertiary syphilis in all its forms in the dose of from 1 to 5 grains (0.05-0.35). Bartholow recommends it most highly in catarrhal jaundice and in the early stages of hepatic cirrhosis ; indeed, he thinks its persistent use in small dose will cure the latter affection. The influence of iodoform upon the tubercle bacillus is very great, and it is now largely used in the treatment of tubercular disease of the joints and pleurae. The pus is allowed to escape under antiseptic pre- cautions ; the cavity is washed out Avith warm boric-acid or carbolic-acid solutions of low strength, and from 1 to 6 drachms (4.0-24.0) of an emulsion of iodoform and sterilized sweet oil are injected and alloAved to remain. The strength of the iodoform-and-oil emulsion should usually be 10 per cent. Should the abscess-cavity fail to heal after these injections have been repeated every feAv days for some time, it must be reopened, scraped, and injected again or packed with iodoform gauze. The iodoform also promotes healing through its alterative influ- ence, Avhich aids in the absorption of the inflammatory exudate. Should tubercular glands be present, injections maybe made into them even if pus has not formed. Used by means of a powder-blower, iodoform will often relieve the hoarseness and discomfort of laryngeal phthisis, but it must be pulver- ized most minutely. Sometimes a spray may be used, which should consist of spirits of turpentine and sweet oil, half-and-half, and contain 2 grains (0.10) of iodoform to each ounce (32.0). This mixture may also be used in chronic 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 (2.0) of a 1 :100 solution of iodoform in oil of sweet almonds, but this treatment has not generally found favor, in this country at least. For fissure of the anus and irritated hemorrhoids 5 grains (0.35) of iodoform in a suppository may be placed in the rectum, and after it has remained there a few minutes defecation may he had Avithout pain. The pain following operations on the female perineum may also be much relieved in this manner. In the tenesmus of cholera infantum an injec- tion of 1 ounce (32.0) of sweet oil with 5 grains (0.35) of iodoform will give great relief if used after or before enteroclysis. Administration.—The ointment of iodoform ( Unguentum Iodoformi, U. S. and B. P.) is useful Avhen applied over foetid sores. It should always be freshly made. The drug itself may be given in 1- to 5-grain IODOL—IPECA CUA NHA. 237 (0.05-0.35) doses three times a day. The suppositories (Suppositoria Iodoformi) are official in the B. P. ; each one contains 3 grains (0.15) of iodoform. IODOL. This is a dark, dirty-yelloAvish-looking poAvder, soluble in alcohol, ether, and oils, but only slightly so in Avater. Its uses in medicine are identical Avith those of iodoform, and it possesses the advantage of being not so penetrating in odor as the latter drug. In tubercular laryngitis the poAvder may be bloAvn into the larynx Avithout disagreeable results and with a favorable effect on the dis- eased process. Cerna has found iodol of very great service in dia- betes when given internally, in the dose of from 2 to 6 grains (0.1- 0.3) three times a day, and it is said to be of value in tertiary syph- ilis 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. Ingalls recommends the following prescription in cases of eczema or abrasions of the upper lip and nostrils: R—Acid, carbolic............ttVvj (0.3). 01. rosse..............V(\y (0.3). Iodol................gr. xxv (1.65). Lanolin..............§ss (16.0).—M. IPECACUANHA. Ipecacuanha, U. S. 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, ipe- cac acts as an irritant, and if applied for a long period to the skin produces vesicles and irritation. Yery minute doses have little notice- able 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. The drug acts as a depres- sant to the spinal cord (Pecholier), and it also depresses the heart if given in large doses and retained by the stomach. Ipecac is elimi- nated by the kidneys, the gastro-intestinal mucous membrane, and the skin (Binz). If emetine is given in lethal dose to one of the lower animals, death is due to failure of respiration. Therapeutics.—Ipecac is used as an emetic where a fairly rapid action is required. It is particularly useful in cases where the stom- ach 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 bronchitis often causes digestive disorders, by reason of the mucus coughed up from the lungs being at once swallowed instead of spit 238 DRUGS. 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, 2 to 3 drachms (8.0-12.0). Often if the dose be not large enough to produce emesis it will purge the child and remove the mucus by the boAvel. In obstinate vomiting small doses of ipecac "will act as a most suc- cessful cure, provided that the vomiting is due not to inflammation and excitement, but to depression. The irritant effect of the ipecac stimulates the depressed stomach up to a normal tone. The proper dose of ipecac for this purpose is J to J a grain (0.016-0.03) or less every half-hour until five or six doses are taken. In some cases of the vomiting of pregnancy it is very useful, in others it utterly fails. 1 drop of the Avine or -^ to \ grain of the poAV- dered ipecac, repeated for six or seven doses, 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 are small amounts of arsenic or hydrochloric acid. Ipecac is also said to possess marked oxytocic properties, similar to quinine, Avhen given in small doses, 10 to 15 drops (0.65-1.0), of the wine every tAvo or three hours. In true acute dysentery ipecac is the best remedy we possess. When the passages are large and bloody and the disease is malignant, as it occurs in the tropics, ipecac should be given in the folloAving manner : The powdered ipecac is to be administered in the dose of 60 grains (4.0) at once to produce vomiting. After vomiting has taken place small doses of 3 grains (0.2) 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. Vomiting is to be controlled with opium, and stimulants are to be freely used to avoid great depression. In choleraic diarrhoeas and cholera morbus ipecac is often of great service in the dose of 3 grains (0.2) every tAvo hours. No less a per- son than the great Trousseau asserted that ipecac Avas a haemostatic, and it is said to be a most effective remedy in haemoptysis in small doses. 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 Avith citrate of potassium. (See Bronchitis). Ringer and Murrell have found that inhaling ipecac spray is very useful in chronic winter cough or bronchitis, particularly Avhen there is present shortness of breath. The pure wine may be used in a spray apparatus or be diluted one-half Avith Avater. While the throat may seem temporarily Avorse, the shortness of breath rapidly decreases and a great improvement takes place in the cough. In order to pre- vent the Avine Avhich collects in the mouth from being SAvallowed, and nausea and vomiting thereby induced, the patient should be directed to rinse his mouth thoroughly every few minutes. The inhalation should not last at first over three or four minutes, and, until it is IRON. 239 knoAvn hoAv Avell the patient will bear the application, the wine should be diluted tAvice or thrice Avith Avater and alcohol, equal parts. It is stated that poAvdered ipecac made into a paste and smeared on the skin will greatly relieve the pain and SAvelling produced by the stings of bees. Administration.—The syrup (Syrupus Ipecacuanha, U. S.) is given in the dose of ^ to 1 drachm (2.0-4.0) as an expectorant, or in the same dose as an emetic to an infant. The wine ( Vinum Ipecacuanha, B. P.) is given in the same dose as the syrup, and the fluid extract (Extraction Ipecacuanha? Fluidum, U. S. ; Extractum Ipecacuanha Liquidum, B. P.) in the dose of 30 drops (2.0) as an emetic to an adult. The troches (Trochisei Ipecacuanha, U. S. and B. P.) con- tain l of a grain (0.016) each. Trochisei Morphines et Ipecacuanha?, U. S. and B. P., each of Avhich contains -^ of a grain (0.002) of mor- phine and ^ of a grain (0.006) of ipecac, are used in sore throat, dis- solved in the mouth. Dover's poAvder (Pulvis Ipecacuanha? et Opii, U. S.; Pulvis Ipecacuanhcs Compositus, B. P.) is g;ven in the dose of 5 to 15 grains (0.35-1.0). It contains 1 grain (0.05) of opium, 1 grain (0.05) of ipecac, and 8 grains (0.5) of sugar of milk. (See Opium.) Emetine may be given in the dose of y1^ to -|- grain (0.006-0.012) as an emetic, but is very rarely so employed. The British preparations are the pill of ipecac and squill (Pilula Ipecacuanfue cum Scilla, B. P.) Avhich is given in the dose of 5 to 10 grains (0.35-0.65) and the vinegar of ipecac (Acetum Ipecacuanha?, B. P.), Avhich is given in the dose of 5 to 30 drops (0.3-2.6) as expec- torants. IRON. Iron (Ferrum, U. S. and B. P.) is a metal Avhich is used both as a medicine and a food—a food because it forms part of the body Avhen taken into the organism and is used by the system in the making of blood. The number of its official salts and compounds is far in excess of the needs of practical physicians, and half the preparations are 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 an increase in the number of red blood-corpuscles, and plethora, or an increase in the quantity and quality of the blood. Much discussion has arisen as to Avhether iron Avhen given as a drug in the form of one of the inorganic salts is absorbed. One theory has been that only the organic iron of the food is absorbed, and that metallic iron Avhen given freely allows this absorption to go on both by stimulating the bowel and by enter- ing into combination Avith the sulphuretted hydrogen in the intestine, thus permitting the organic iron to escape into the system. That both forms of iron are absorbed and eliminated is now certain. (For a discussion of some of these views see article on Anaemia.) If, however, iron is given in excessive doses, much of it remains unabsorbed, is changed into the sulphide of iron in the bowels, and escapes with the faeces. Careful studies have shoAvn that the iron, Avhen once absorbed, 240 DRUGS. escapes from the body very slowly, and that its pathAvay of escape is not by the bile or in the urine, but by the walls of the intestine which excrete it, so that it may be recovered from 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-manufacture or simply supplies the glands Avith blood-making material we do not know, but the latter is probably the correct view. Iron causes oxidation to go on more rapidly by reason of its peculiar power of converting oxygen into ozone, and in this manner acts as a stimulant to nutrition and bodily activity. The preparations of iron consist in the soluble and insoluble salts or forms. Of these the insoluble are better than the soluble, because nearly all the soluble salts of iron are precipitated by the gastric juice and have to be sIoavIv redissolved. Nearly all iron preparations are capable of acting as more or less poweful astringents, and so are apt to cause constipation and to disorder digestion if given in large doses. The most astringent of all of these preparations are Monsel's salt (the Ferri Subsulphas, U. S., B. P.) and the sulphate (Ferri Sulphas, U. S. and B. P.) Closely following these in astringency are the am- monio-ferric alum, (Ferri et Ammonii Sulphas, U. S.) and the chloride of iron (Ferri Chloridum). The least astringent preparations are Quevenne's iron, or iron by hydrogen (Ferrum Redactum, U. S. and B. P.), and carbonate of iron (Ferri Carbonas Saccharatus, I . S. and B. P.), and Basham's Mixture (Liquor Ferri et Ammonii Acetatis, U S.), and the citrates, tartrates, and the lactate and phosphate of iron. Therapeutics.—The chief indications for the administration of iron are those forms of anaemia (see Anaemia) characterized by a decrease in the normal quantity of haemoglobin in the blood as determined by the haemoglobinometer, as, for example, chlorosis, and its chief contraindica- tion is plethora. When used in small dose (^ to |- grain—0.016-0.03), it is quite as efficacious as in large amounts, and less apt to disorder the stomach, but the doses given in this article are the classical ones usually prescribed by physicians. 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 elimination 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 every preparation possesses some peculiarity, the use of each will be considered separately. Ammonio-ferric Alum. Ammonio-ferric Alum (Ferri et Ammonii Sulphas, U. S.) is often given in cases in atonic leucorrhaea associated with chlorotic tendencies in the dose of 2 to 5 grains (0.1-0.35). It is quite astringent, and should not be given in cases of gastric irritability, as it is not suited to such a condition. IRON. 241 Aromatic Mixture of Iron. The Aromatic Mixture of Iron (Mistura Ferri Aromatica) con- tains so little iron that it should not be administered in cases where a very marked chalybeate influence is desired; it is, however, a useful tonic for cases of debility and slight ancemia following long illnesses, given in the dose of 1 to 2 fluidounces (32.0-64.0) after meals. Aro- matic mixture of iron contains cinchona-bark, calumba, cloves, iron, compound tincture of cardamoms, tincture of orange-peel, and pepper- mint-water. Arsenate of Iron. Arsenate of Iron (Ferri Arsenas, B. P.) is used in the dose of tV to tV gram in anaemic subjects who are suffering from the dry, scaly forms of skin disease Avhich indicate the use of arsenic. (See Arsenic.) It is also of value in the anaemia of chronic diarrhoea, as both iron and arsenic are useful, not only for the anaemia, but for the control of the intestinal disorder. Basham's Mixture. Under the name of Basham's Mixture (Liquor Ferri et Ammonii Acetatis, U. S.) a very useful and elegant preparation of iron is employed. It is particularly useful in the anaemia of Bright's dis- ease, and it acts as a diuretic and diaphoretic. It is made up as follows: Tincture of chloride of iron.........2 parts. Dilute acetic acid..............3 " Spirit of Mindererus............ 20 " Elixir of orange..............10 " Svrup..................15 " Water...................50 " The dose is from 1 to 8 drachms (4.0-32.0), well diluted. Bromide of Iron. Bromide of Iron (Ferri Bromidum) is said by DaCosta to be use- ful in anaemia, Avhen this state is associated Avith chorea, in the dose of 5 to 20 grains (0.35-1.3) given in syrup. In other nervous dis- eases accompanied by anaemia and insomnia the syrup of the bromide of iron (Syrupus Ferri Bromidi) is useful in the dose of J to 1 fluid- drachm (2.0—4.0), but its sedative properties are not sufficiently marked to render it of much value in overcoming true insomnia unless it is fortified by one of the other bromides. Carbonate of Iron. The Carbonate of Iron (Ferri Carbonas Saccharatus, U. S. and B. P.) is very slightly astringent, and may be used in pill form under the name of Pilule/' Ferri Carbonatis, U. S., sometimes called '• Bland's pill," or in Griffith's pill, AAThich also contains myrrh. The 16 242 DRUGS. dose is about 3 grains (0.15), and this preparation of iron is largely used for the treatment of amenorrhea dependent upon anaemia. Under the name of Mistura Ferri Composita, II. S., or Griffith's mixture, and B. P., we have a liquid preparation used for the same purposes as the pills just named, in the dose of 1 to 2 tablespoonfuls (16.0-32.0). Massa Ferri Carbonatis, U. S., sometimes called Vallet's mass, is given in pills in the dose of from 1 to 10 grains (0.05-0.65). Chloride of Iron. Tincture of the Chloride of Iron (Tinctura Ferri Chloridi, U. S.), often called Tincture of the Muriate of Iron, is one of the best and most useful preparations of iron that Ave 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 been taught, since hydrochloric ether is not present, and. is hard to prepare except there is 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, U. S.) is 1 to 3 grains (0.06-0.18). Tincture of the chloride of iron is considered a specific in erysipelas, and should be given in very full dose and frequently repeated if it is to be of any service. (See Ery- sipelas.) 10 drops (0.65), Avell diluted, every hour is not too much if the stomach of the patient does not rebel. In chronic Bright's disease it is of value and decreases the albuminuria. In anaemia it is useful, and owing to its acid is a doubly effective tonic. In cases of slight anaemia in Avhich very great arterial pressure exists Dr. Mitchell uses a purely milk diet, and an ounce of an old tincture of iron in the twenty-four hours. While he recognizes the fact that iron prepa- rations are generally supposed to raise blood-pressure, he asserts that iu this instance the blood-pressure is loAvered. The dose of Liquor Ferri Chloridi, U. S., is 4 to 10 drops (0.2-0.65). It is rarely used internally, but chiefly as an astringent of great poAver. Liquor Ferri Chloridi is identical Avith Liquor Ferri Perchloridi, B. P. Tinctura Ferri Perchloridi, B. P., is used internally in the dose of 10 to 20 minims (0.65-1.3). 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- irritation over the neck, are most useful. When used internally it should be well diluted Avith Avater and taken through a glass tube to protect the teeth. The strong solution of perchloride of iron (Liquor Ferri Perchloridi Fcrtis, B. P.) is a powerful styptic. Citrates and Tartrates of Iron. The four citrates of iron are soluble in Avater and very useful for this reason, because they are readily added to liquid prescriptions, and IRON. 243 they are also of value because they are very slightly irritant and astrin- gent and do not disorder the alimentary canal. Ferri Citras, U. S., and Ferri et Ammonii Citras, XT. S. and B. P., occur in garnet-red scales and are given in the dose of 5 grains (0.35). The solution of the citrate of iron (Liquor Ferri Citratis, U. S.) is given in the dose of 10 minims (0.65). The Ferri et Quininae Citras, B. P., and the Ferri et Strychnince Citras, U. S., and B. P., are given in the dose of 5 to 15 grains (0.35-1.0) and 1 to 3 grains (0.05-0.15), respectively. The new official Ferri et Quinince Citras Solubilis, U. S., is given in the dose of 1 to 2 grains (0.05-0.10). Besides these citrates there are three tartrates—(Ferri et Ammonii Tartras, U. S., and Ferri et Potassii Tartras, U. S., and Ferrum Tar- taratum, B. P., all given in the dose of 5 grains (0.35). Dialyzed Iron. Dialyzed iron (Ferrum Dialysatum) is a very feeble preparation of iron, lacking in astringency, easily precipitated from the solution in Avhich it occurs, but largely used in ancemia by some practitioners. The dose is 10 to 20 drops (0.35-1.3) in Avater three times a day. Sometimes river-water, if it contains much inorganic or organic matter, will precipitate it. OAving to the instability of dialyzed iron, it may be used without any further preparation as an antidote to arsenic. Hydrated Sesquioxide of Iron. Hydrated Sesquioxide of Iron (Ferri Oxidum Hydration, U. 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- nesia. The resulting precipitate is the antidote, and the supernatant liquid is to be poured off. If ammonia is used, the precipitate must be Avashed Avith Avater 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. Magnesia is an antidote in itself, and should be preferred under all circumstances. The antidote should be given in excess, and as much as a pint of the iron solution should be precipitated. The magnesia should be freely added, as too much of it cannot be given. The official antidote to arsenic is Ferri Oxidum Hydratum cum Magnesia, U. S. In the Prussian Pharmacopoeia this is knoAvn as the Antidotum Arscnici. (See Arsenic, Poisoning by, for official method of preparing antidote.) Iodide of Iron. The Syrup of the Iodide of Iron (Syrupus Ferri Iodidi, U. S. and B. P.) is a transparent liquid of a SAveet, iron-like taste. It should contain no free iodine, and if it strikes a blue color with starch should 244 DRUGS. be discarded. It is largely used in ancemia 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 (0.1-0.15), Avell diluted, and to an adult 30 to 40 drops (2.0-2.65) in water, to be taken through a glass tube to protect the teeth. The saccharated iodide of iron (Ferri Iodidum Saccharatum, U. S.) is used in place of the syrup in the dose of 2 to 5 grains (0.1-0.3). The official pills (Pilula Ferri Iodidi, U. S.) each contain l of a grain (0.01) of reduced iron and | of a grain (0.075) of iodine, and are given in the dose of one to three pills. Lactate of Iron. The Lactate of Iron (Ferri Lactas, U. S.) is soluble in 48 parts of Avater, and is given in the dose of 5 grains (0.35). It is used for the same purposes as the other preparations of iron. Lactate of iron is one of the ingredients of SyrupusHypophosphitum cumFerro, U. S., the dose of which is J to 1 fluidrachm (2.0-4.0). Ferri Subsulphas, or Monsel's Salt. Monsel's Solution (Liquor Ferri Subsulphatis, U. S.), sometimes wrongly called the Solution of the Persulphate of Iron, is one of the most powerful styptics or haemostatics that we have. It is never to be employed where a hemorrhage is to be attacked through the circu- lation, but only when the solution can come in direct contact with the bleeding spot. The objection to its use is the hard, black, and dirty clot which it forms on coming in contact with the blood. In haemop- tysis Monsel's solution should be used in fine spray consisting of from 10 to 60 drops (0.65-4.0) 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 cervix uteri, the pure solu- tion should be used, locally applied. In nose-bleed Monsel's solution may be employed diluted one-half or pure, but its use is not to be commended, because of the hard, black clot which is formed and the uncomfortable sensations and pain produced in the nasal chambers. Plugging the nostrils, and if need be the posterior nares, with pledgets of cotton is generally sufficiently efficacious. For the intestinal hemorrhage occurring during or after typhoid fever Monsel's solution has been given, but ought not to be so employed, as it is decomposed in the stomach before it reaches the intestine. In its stead Monsel's salt (Ferri Subsulphas, U. S.) should be given in pills of 3 grains (0.15) each, the pills being made hard enough to escape into the intestine before the stomach breaks them doAvn. One, two, or three pills may be given and repeated in an hour in pressing cases. Haematemesis due to bleeding in the stomach may be treated by 3-drop (0.15) doses of the solution in a little water. It must be remembered, hoAvever, that the drug is irritating. In tonsillitis and pharyngitis a most efficient application is pure IRON. 245 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) is given in the dose of 2 to 3 grains (0.1-0.15). It possesses no advantages peculiar to itself. Phosphates of Iron. There are two phosphates of iron—Ferri Phosphas Solubilis, U. S. and B. P., and Ferri Pyrophosphas Solubilis, U S. Phosphate of iron itself is very insoluble and is rarely used. The official forms are, however, quite soluble, and useful in the dose of 2 to 5 grains (0.1-0.35). Syrupus Ferri Phosphatus, B. P., is given in the dose of 1 fluidrachm (4.0). Phosphate of iron is one of the ingredients of the syrup of iron, quinine, and strychnine (Syrupus Ferri, Quininae et Strychninae Phosphatum, U. S. ; Syrupus Ferri Phosphatum cum Quinina et Strychnino, B. P.), Avhich is given in the dose of 1 fluidrachm (4.0). Reduced Iron. Quevenne's Iron (Ferrum Reductum, U. S. and 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 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 (Trochisei Ferri Redacti, B. P.), each lozenge containing 1 grain (0.05) 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, U. S. and B. P.) is used inter- nally in the dose of 5 grains (0.35) in pill form in chronic diarrhoea. Externally, in a solution of the strength of 5 to 25 grains to the ounce (0.35-1.65 : 32.0), it is used as an astringent lotion. Two other forms of the sulphate are also employed—namely, the dried (Ferri Sulphas Exsiccatus, U. S~ and B. P.) and the granulated (Ferri Sulphas Granulatus, U. S.), each of which is given in the dose of 3 grains (0.18). Valerianate of Iron. Valerianate of Iron (Ferri Valerianas, U. S.) is sometimes useful in hysteria with anaemia, given in the dose of 1 grain (0.06) or more. 246 DRUGS. Wines of Iron. The Bitter Wine of Iron (Vinum Ferri Am arum, U. S.) is useful as a bitter tonic in anaemia in both children and adults, and may be ad- vantageously accompanied with cod-liver oil. It is given in a dose of 1 to 2 fluidrachms (4.0-8.0) or more. This Avine is composed of soluble citrate of iron and quinine, tincture of sweet orange-peel, syrup, and stronger Avhite wine. Wine of the Citrate of Iron, or Vinum Ferri Citratis, U. S. and B. P., is composed of the citrate of iron and ammonium, tincture of sweet orange-peel, syrup, and stronger Avhite wine. The dose is identi- cal with that of the bitter wine, and it is used for the same purposes. The plaster of iron (Emplastrum Ferri), official in the U. S., is prepared from the hydrated oxide of iron. The following preparation of iron is also official: Liquor Ferri Acctatis, U. S. and B. P., dose 15 minims to 1 fluidrachm (1.0-4.0). 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 been brought on by the iron, and will be relieved if mild laxa- tive or purges are used. The state of the bowels should always be inquired into when iron is being used, and laxatives given Avhenever constipation is present and iron is being administered. In rheumatic and gouty persons frontal headaches are a common symptom Avhen iron is given, and purgatives will not generally give relief. Garrod and Haig have shown that iron decreases the elimination of uric acid, Avhich may account for the production of headache in the case of rheumatic patients under its influence. Sometimes salts of iron produce vesical irritation and a constant desire to urinate, causing mucus to form in abnormal amount in the bladder. In children its use may result in nocturnal incontinence of urine. JALAP. Jalap (Jalapa, U. S. and B. P.) is the root of Ipomoea Jalapa, 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 U. 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 tasteless- ness is a useful active cathartic in children if given in the proper dose —namely, 1 to 2 grains (0.05-0.10) in h an ounce of syrup of rhubarb. Combined Avith calomel, it is preferred to all other purges by some practitioners, particularly if the liver is torpid. JEQ UIRITY—J UNIPER. 247 Administration.—Jalap may be given in the form of the compound powder (Pulvis Jalapa? Compositus, U. S. and B. P.), dose 15 to 40 grains (1.0-2.65), Avhich is composed of 35 parts of jalap and 65 parts of bitartrate of potassium ; and the resin (Resina Jalapae, U. S. and B. P.), dose for an adult 2 to 4 grains (0.1-0.2). 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 J to J a grain (0.016-0.03). The tincture (Tinctura Jalapa, B. P.) is given in the dose of J to 1 fluidrachm (2.0-4.0); the extract (Extractum Jalapa-, U. S. and B. P.) is used in the dose of 5 to 15 grains (0.35-1.0). JEQUIRITY. This is a plant knoAvn as Abrus precatorius, the seeds of Avhich are poisonous Avhen applied to a wound. An active principle, abrin, is composed of paraglobulin and a-phytalbumose, which closely resem- ble snake-venom in their action. Jequirity is never used internally in medicine in this country. An infusion of the powdered seeds, made by adding J a drachm to an ounce (2.0 : 32.0) of water at 140° F. may be painted with a brush on the inside of the eyelids in cases of chronic granular conjunctivitis, in order to produce an acute diph- theritic inflammation which will so change the chronic process present as to permit of a cure. If an excessive action is developed, it may be controlled by hot compresses made of very dilute solutions of cor- rosive sublimate. The solution of the drug undergoes decomposition Avith great rapidity, and should be freshly prepared each time it is used, or 4 to 8 grains (0.2-0.5) of boric acid should be added to preserve it. The drug is a poAverful cardiac depressant poison Avhen injected into the circulation. Whether the seeds produce poisoning Avhen swallowed is doubtful, some asserting that they cause gastro-enteritis, others that they are harmless. Probably much depends on the activity of diges- tion at the time of ingestion. JUNIPER. Juniper us is the fruit or berry of Juniperus communis, an ever- green of Northern Europe and America. It contains a volatile oil and an 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 stimulating, exciting diuretic. It escapes from the body by the kidneys. Therapeutics.—Juniper is valuable as a stimulant to the genito- urinary tract whenever 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 Avith albuminuria. Used after an 248 DRUGS. attack of acute Bright's disease Avhen reaction has set in and the secre- ting 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 con- dition corresponds to that just described, juniper is also useful. In old persons a sensation of weight across the lumbar region is often quickly 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, U. S.), composed of the oils of juniper, caraway, and fennel, combined with alcohol and water, in the dose of 1 to 4 drachms (4.0-16.0). Gin is virtually identical with the compound spirit. The infusion of juniper is made by add- ing an ounce (32.0) of the berries to a pint (J a litre) of boiling Avater and alloAving it to stand in a warm place for an hour. The entire quantity is to be taken in twenty-four hours, and the infusion is often combined with acetate of potassium or an ounce (32.0) of the bitar- trate of potassium in the treatment of dropsy. The spirit (Spiritus Juniperi, U. S. and B. P.) is given in the dose of 30 minims to 1 drachm (2.0-4.0). The oil (Oleum Juniperi, U. S. and B. P.) is used in the dose of 1 to 4 minims (0.06-0.3). KAMALA. Kamala, U. S., or Rottlera, as it is sometimes called, is the glands and hairs from the capsules of Mallotus philippiensis, a plant of Abyssinia, India, China, and Australia. It contains an active principle, rottlerin, which is not official. Given in the dose of 1 to 2 drachms (4.0-8.0), kamala acts as a drastic and as a remedy for tape-worm, and is sometimes used for the removal of the ascaris lumbricoides. It should be administered in syrup in which is placed some hyoscyamus to prevent griping, and the dose is to be repeated in eight hours if no effect is produced. (See Worms.) KAOLIN. Kaolin (B. P.) is a soft Avhite powder, a decomposition-product of mineral deposits containing feldspar. It is used externally as a dust- ing poAvder in eczema. 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 astringent in the treatment of serous diarrhoea. It is official in the form of the tincture (Tinctura Kino, U. S. and B. P.), and is given in the dose of 1 fluidrachm (4.0). Kino may be used as a gargle in sore throat and for relaxation of the uvula. Under the name of Com- pound Powder of Kino (Pulvis Kino Compositus, B. P.) an efficient and pleasant antidiarrhaea powder is used. This powder is not official KOLA—LEAD. 249 in the U. S. P. The formula for each powder is 15 grains (1.0) of powdered kino, 4 (0.2) of powdered cinnamon, and 1 (0.05) of pow- dered opium. KOLA. This drug is the nut of Kola acuminata, a tree groAving in certain parts of Africa. The nut depends for its chief medicinal activity upon the caffeine Avhich it contains. In addition to this alkaloid it contains some theobromine and kolatannic acid, Avhich latter ingredi- ent may explain the good results Avhich have folloAved the use of kola in cases of diarrhoea. Physiological Action.—The physiological action of kola is, as far as we knoAv, nearly identical Avith its near relatives coffee and coca. Therapeutics.—In cases of feeble heart associated Avith general debil- ity kola often proves a valuable stimulant to the heart and general sys- tem, as Avell as to the kidneys. It has also been used Avith asserted success in sea-sickness and to sober drunken persons, although the latter poAver is to be doubted. Its use will sometimes relieve sick and neuralgic headache. Recently a large number of semi-proprietary articles have been introduced to the laity Avith the statement that they increase muscular strength. Except for their temporary stimulating power they are useless for this purpose. The drug is, however, of value in cases of uterine inertia during labor in the dose of 30 drops (2.0) of the fluid extract. Administration.—Kola is not official. It may be given in the form of the fluid extract (Extraction Kola? Fluidum), dose 10 to 30 minims (0.65-2.0), or in an elixir. LANOLIN. Lanolin, Avhich is practically the Adeps Lanae Hydrosus of the U. S. and B. P., is a fat derived from the wool of the common sheep, and is a whitish substance of peculiar stability, very difficult of saponification, and incapable of becoming rancid. Unna states that ointments of acids, hydrogen peroxide, and other substances may be made by it. One great objection to lanolin is its stickiness, Avhich is avoided by adding one-third of vaseline. Lanolin is supposed to possess very remarkable penetrating poAvers when applied to the skin in cases where much infiltration is present, particularly if it is com- bined with resorcin or some similar medicament. In itself it has little curative poAver, and is but little better than lard, suet, or any common fat as a basis for ointments. In 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 Avhich are employed. It is not official as lead itself. 250 DRUGS. Physiological Action.—Lead, in one of its soluble salts, if applied to a mucous membrane, by reason of its astringent effect, produces a blanching which is particularly noticeable Avhere the redness of inflam- mation has previously been present. It has little effect Avhen given in a single dose, except by an indirect influence over the circulation, nervous system, or respiration. (For a description of the effects of lead in overdoses see "Poisoning," below.) The most irritant and poisonous of the soluble salts is the nitrate, the next the subacetate, and the least poisonous of the soluble salts is the acetate. The insoluble salts rarely cause acute poisoning, but frequently produce chronic plumbism. Acute Poisoning.—When the acetate of lead is taken in poisonous amounts, it produces a sweet metallic taste in the mouth, folloAved by pain in the epigastrium and the vomiting of Avhite, milky-looking liquids or white curds mixed with food. The white color is due to the presence of chloride of lead formed by the acid of the gastric juice. The pain rapidly increases in severity, and diarrhoea due to gastro- enteritis may be set up, or, in other cases, obstinate constipation is present. The passages are generally black, this color 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 Aveak and compressible. 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 occur in acute poisoning, but this is rarely if ever seen. If coma comes on in the course of acute lead poisoning, death is almost certain. The treatment consists in the use of the chemical antidote, a sol- uble 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 Avill Avash out the intestinal canal. Hot applications should be applied to the belly and feet, and the pain and irritation which are present should be 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 occurrence of rare, anomalous symptoms in a given case should at once bring to the mind of the physician the thought of lead poisoning or syphilis. Chronic poisoning occurs in painters, manufacturers of lead salts, and every one Avho is largely throAvn in contact with the metal in the arts. It occurs from the use of hair-dyes containing the acetate of lead, from drinking water which has passed through neAV lead pipe, and even from the biting of silk threads loaded with lead to increase their weight. Chromate of lead has been used to color sponge-cake Avhen eggs were thought too dear, and has killed many persons. Millers LEAD. 251 Avho have filled the holes in grindstones Avith lead have caused Avide- spread epidemics of Avhat has been called "dry cholera," and many persons have suffered from lead poisoning from eating apple-butter kept in jars glazed Avith lead. One of the most prominent, but by no means the most constant, symptoms of chronic plumbism is bilateral Avrist-drop, due to palsy of the extensor muscles of the forearm. The short extensor of the thumb generally escapes the drug's influence, as does also the supi- nator longus. Sometimes internal squint arises from paralysis of the external rectus muscles by the lead. Another very common symptom is colic centering around the umbilicus and radiating through the belly and loins. Obstinate constipation often accompanies these symptoms, and the faeces, Avhen passed, are white and clay-colored, OAving to a deficient secretion of bile. During an attack of lead colic the arterial tension is increased very markedly, the tongue is coated and whitish, and the bowels are obsti- nately confined. If these early warnings are disregarded and the exposure to the lead is continued, cerebral symptoms may come on, the result of encephalopathia saturnina, or saturnine cerebritis. Saturnine epi- lepsy is not very rare. If convulsions come on, death generally ensues. The convulsions in some cases are not due to a cerebral effect of the lead, but to uraemia due to the renal changes Avhich 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 chronic lead poisoning. If a patient with chronic lead poisoning have a urine with a persistent Ioav 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 atro- phied, and finally changed into fibrous cords. Anterior poliomyelitis may be present, but true locomotor ataxia is rarely caused. If ataxic symptoms exist, they are most probably dependent on pseudo-tabes produced by a plumbic multiple neuritis, and can be separated from true tabes dorsalis by the absence of several of the important true tabetic symptoms—such as slow onset, the Argyll-Robertson pupil, etc. —while the presence of marked Avasting and loss of poAver, with ten- derness over the nerve-trunks, points to neuritis. In some cases trophic changes in the joints ensue, and plumbic gout is not rarely seen, or even lead arthralgia, with deposits of urates in the joints. This condition is due to the fact, pointed out by Gar- rod and Haig, that lead forms insoluble salts Avith uric acid. Lead escapes from the body in the urine, the faeces, and all the secretions. It is chiefly eliminated by the liver in the bile. 252 DRUGS. 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 2-grain doses, the others in full amounts. In many cases purges fail to move the boAvels of a person suffering from chronic lead poisoning, and succeed only when morphine is given to overcome the intestinal inhibition produced by the irritation caused by the lead. In the cerebral inflammation of lead-poisoning a blister to the back of the neck, revulsives, and a pilocarpine SAveat 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 (0.65-1.3) three times a day. If progressive paralysis is present, Wood 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 in the same mixture as 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 employed, and, if not, the galvanic current should be used. Curiously enough, partial voluntary power sometimes returns before the muscles will react at all to electricity. It is said that baths of sulphuret of potassium do good in chronic plumbism, 5 or 6 ounces (160.0) of the salt to each bath, which is to be given in a Avooden tub. The patient should afterwards be well soaped, then thoroughly rinsed off, and rubbed down with a rough toAvel. As the salts of lead are used for different purposes, the therapeu- tics of each one Avill be taken up separately. Acetate of Lead. Acetate of Lead (Plumbi Acetas, U. 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 employed, in the following pill in the treatment of serous diarrhoea : B.—Plumbi acetat............gr. xl (2.65). Pulv. opii.............gr. x (0.65). Camphorae.............gr. xl (2.65).—M. Ft. in pil. No. xx. S.—One every four hours. This pill may also be given in cases of dysentery. The acetate of lead in proportion of 1-8 grains (0.06-0.5) to the ounce of water may be used as an injection for gonorrhoea. Lead acetate is also a useful application for the dermatitis produced LEAD. 253 by poison ivy, as this drug precipitates the sticky, non-volatile oil of Rhus toxicodendron, recently studied by Pfaff. The acetate of lead should be dissolved in alcohol in the proportion of half a grain to the ounce (0.03-30.0) and used as a wash. After this the inflamed parts should be treated by cooling applications, but ointments are not to be used, as they dissolve the poisonous oil and spread the irritation. Administration.—The B. P. recognizes the following preparations of lead acetate: Pilula Plumbi cum Opio, dose 3 to 5 grains (0.1- 0.3); Suppositoria Plumbi Composita, each suppository containing 1 grain (0;06) of opium to 3 grains (0.18) of lead acetate; and an oint- ment (Unguentum Plumbi Acetatis). Carbonate of Lead. Carbonate of Lead (Plumbi Carbonas, U. S. and B. P.), or White Lead, is insoluble, and is used as a coating or dressing for burns, scalds, or ulcers Avhen rubbed up with linseed or other oil, or in the form of the ointment (Unguentum Plumbi Carbonatis, U. S. and B. P.). If a Avide surface is covered with this ointment, it may cause lead poisoning by absorption. Carbonate of lead may be used in the treatment of sunburn in the following prescription: E.—Plumbi carbonat.............gj (4.0). Pulv. amyli..............zj (4.0). Unguent, aquae rosse...........Ij (32.0). Olei olivse...............fgij (8.0).—M. S.—Apply to the inflamed skin. Iodide of Lead. Iodide of Lead (Plumbi lodidum, U. S. and B. P.) is occasion- ally employed in medicine; the dose is ^ to 2 grains (0.03-0.1). Emplastrum Plumbi Iodidi, P. B., and Unguentum Plumbi Iodidi, U. S. and B. P., are useful as external astringent and alterative applications, but are rarely used. Liquor Plumbi Subacetatis. Liquor Plumbi Subacetatis, U. S. and B. P., or Goulard's Extract, is a colorless liquid, much used externally, Avhen diluted Avith lauda- num, for sprains, bruises, and local inflammations, under the name of "lead-water and laudanum." " L. and L.," as it is often called in the hospitals, is a useful application in the dermatitis produced by poison ivy. 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 official liquor is also official in a dilute solution (Liquor Plumbi Subacetatis Dilutus, U. S. and B. P.), and as such is too weak for ordinary use, although it is commonly employed. The strong solution should be used in the strength of from 1 to 4 ounces (32.0-128.0) to the pint (500 cc.) of water. This solution should never be employed if the skin is broken, 254 DRUGS. 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 the solution just named and applied to an inflamed finger, a felon can often be aborted in the early stages. The official dilute solution is useful as a lotion in eczema which itches and tingles and is not dry in character. It should be applied once or twice a day, and it is well to follow the application of lead Avith a Aveak sulphur bath or alkaline wash. (See Eczema.) Lead-Avater is also useful in pruritus pudendi. The cerate (dera- tion Plumbi Subacetatis, U. S.), the liniment (Linimentuni Plumbi Subacetatis), and the glycerin (Glycerinum lJlumbi Subacetatis, B. P.) may be used for the same purposes as the Goulard's extract. Litharge. Litharge (Plumbi Oxidum, U. S. and B. P.) is used for the prep- aration of lead plaster (Emplastrum Plumbi, U. S. and B. P.), some- times called " Diachylon," and this is in turn employed for the manu- facture of resin plaster (Emplastrum Rcsinae, U. S. and B. P.). It is also used in the preparation of the solution of subacetate of lead. Hebra recommended for sweating of the feet an application of equal parts of lead plaster and linseed oil, applied on linen and Avrapped around the feet every third day. Nitrate of Lead. Nitrate of Lead (Plumbi Nitras, U. S.) is never used internally, but as a poAvder, in the treatment of cases of onychia maligna and in the formation of Ledoyen's disinfecting solution. The latter dis- colors 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 Veronica virginica is the rhizome and rootlet, from Avhich are made the official extract of leptandra (Extrac- tum Leptandra, U. S.) and the fluid extract (Extractum Leptandra? Fluidum, U. S.). The dose of the former is from 1 to 8 grains (0.06-0.5) and of the fluid extract 5 to 40 minims (0.3-2.6). 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 Vignal, who found that it possesses a mod- erate influence in increasing the flow of bile. In overdose it causes violent purging. Therapeutics.—In the official preparations of leptandra, which are not as active as is the fresh drug, Ave 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 LIP A NIN—L1Q UORICE. 255 intestinal type sometimes called "duodenal atony." (See also Podo- phyllin.) The folloAving pill is a good method of using the drug in these cases: R— Ext. chirata.'.............gr. xx (1.3). Ext. leptandra............gr. xx (1.3).—M. Ft. in pil. No. x. S.—One pill after each meal. Under the name of leptandrin we have an impure resin which is given in the dose of 2 to 5 grains (0.1-0.3). 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 (4.0) which may be increased to 4 drachms (16.0). This mixture has been found of value in most of the wasting diseases in which cod-liver oil is em- ployed, and in the opinion of von Mering its efficacy is greatly increased if the hypophosphites of lime and sodium are used at the same time in the dose of 10 grains (0.65) three times a day. Iodine or one of its compounds may also be given if it is desired to exert an alterative influence. LIQUORICE. Liquorice (Glycyrrhiza, U. S. ; Glycyrrhizae 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 Avater to form a vehicle for other drugs, particularly if they have a disagreeable taste. The powdered solid extract is a very mild and useful laxative. Administration.—The solid extract (Extractum Glycyrrhiza?, U. S. and B. P.) is used in a dose anywhere from 5 to 120 grains (0.35- 8.0). The pure extract (Extractum Glycyrrhizae Purum, U. S.) is used in the same quantities as the ordinary extract. The fluid extract (Extractum Glycyrrhizae Fluidum, U S.) or the liquid extract (Extrac- tum Glycyrrhiza Liquidum, B. P.) is used in 1- to 2-drachm (4.0-8.0) doses. Under the name of BroAvn Mixture or " Compound Liquorice Mixture " a very efficient expectorant solution is official (Mistura Glycyrrhizae Composita, U. S.), Avhich contains as its most important ingredients 12 parts of paregoric, 6 parts of Avine of antimony, and 3 parts of sweet spirit of nitre. The dose of Brown Mixture is 1 to 4 drachms (4.0-16.0). Pulvis Glycyrrhiza? Compositus, U. S. and B. P., or compound licorice poAvder, contains, according to the U. S. P., 18 per cent, of senna, 23.6 per cent, of liquorice, 4 per cent, of oil of fennel, 8 per cent, of washed sulphur, and 50 per cent, of sugar. Ac- 256 DRUGS. cording 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 (4.0-16.0). It is largely used as an efficient laxative after childbirth and in cases Avhich suffer from constipation chiefly due to the inactivity consequent upon being in bed. The troches (Trochisei Glycyrrhizae et Opii, U. S. and B. P.) contain 2V grain (0.003) of opium and 2 grains (0.1) of extract of liquorice. Finally we have Glycyrrhizinum Ammoniatum, U. S., Avhich is the sweet principle of liquorice rendered soluble and easily tasted by the addition of ammonia. The dose of this preparation is 5 to 15 grains (0.3-1.0). LIQUOR POTASSA. Liquor Potasses, U. S. and B. -P., is a solution of potassa contain- ing 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 cases of ingroiving toe-nail it is often used to soften the nail prior to packing Avith cotton or partial evulsion. Its dose is 5 to 30 drops (0.35-2.0) well diluted with Avater. 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 Ave have the carbonate (Lithii Carbonas, U. S. and B. P.), dose 2 to 10 grains (0.1-0.65), the citrate (Lithii Citras, U. S. and B. P.), dose 5 to 20 grains (0.3-1.3), and the effervescent citrate (Lithii Citras Effervescens, U. S. and B. P.), dose 1 to 4 drachms (4.0-16.0). In the second class Ave find the benzoate (Lithii Benzoas, U. S.), dose 5 to 30 grains (0.3-2.0); Lithii Bromidum, U. S., dose 10 to 40 grains (0.65-2.65), and Lithii Salicylas, U. S., dose 10 to 30 grains (0.65-2.0). 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 untrue, though they are used when it is desired to render the urine alkaline. Haig has pointed out that although lithia forms salts with uric acid in the test-tube, in the body it has a greater affinity for the acid sodium phos- phate in the blood, and practically leaves the uric acid to itself. This is an important point, since it proves that the large amount of Avater generally taken with lithia has more to do with relieving gout than has the lithia. The 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 LOBELIA. 257 (3 3) of the carbonate, 90 grains (6.0) of crystallized citric acid, and warm distilled water 1 fluidounce (32.0). 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 upon a gouty taint remarkable results are often obtained from the use of the citrate or carbonate of lithium and arsenic. The dose should be ~-fa of a grain (0.002) of arsenite of sodium and 10 grains (0.65) of the lithium salt three times a day. It is worthy of note that in some cases citrate of lithium will dis- order the stomach and produce vomiting. (For the use of other salts of lithium see the articles on the Bro- mides, Salicylic Acid, and Benzoic Acid.) (See also article on Mineral Springs.) LOBELIA. Lobelia, U. S. and B. P., is the leaves and tops of Lobelia inflata, a common Aveed of the United States. It contains an alkaloid, lobe- line, and lobelic acid. Physiological Action.—When taken in overdose lobelia causes eme- sis. intense prostration, a feeble pulse, pale skin, livid face, muscular relaxation, and a cold SAveat. 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, the latter change being due to the asphyxia Avhich 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 Aromiting, to give alcohol and ammonia to support the heart, and the use of external heat. Therapeutics.—Lobelia is used chiefly as an antiasthmatic, and has been equally praised and condemned by eminent authorities. The reason for this lies in the fact that it is generally useless in asthma unless given in almost poisonous dose. Wood teaches that it should rarely if ever be used, because of its poisonous effects even in doses medicinally active, while Sydney Ringer says that the drug is erro- neously thought to be dangerous. In 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 Avith cardiac disease, lobelia should never be employed. The drug should be taken in the dose of \ a drachm (2.0) to 1 drachm (4.0) of the tincture at the first sign of an attack, or in 10-drop (0.65) doses every fifteen minutes until distinct nausea occurs or relief is obtained. If the heart is feeble, its use is contraindicated. In atonic constipation with great dryness of the faeces 10 drops (0.65) of the tincture of lobelia at bed-time are often of service, particularly if it is combined Avith cascara sagrada. (See Cascara Sagrada.) Administration.—Lobelia is given in the form of the tincture (Tinc- 17 258 DRUGS. tura Lobelice, U. S.), in the dose of 10 to 30 drops (0.65-2.0), or 1 to 2 drachms (4.0-8.0) as an emetic. The vinegar {Acetum Lobeliae) is no longer official, but is given in the dose of 20 to 30 drops (1.65- 2.0), and the fluid extract (Extractum Lobelice Fluidum, U. S.) in the dose of 1 to 5 drops (0.05-0.35), or as an emetic in the dose of 15 drops (1.0). 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 (32.0) to the pint (| litre) of Avater. The preparation of the B. P. is Tinctura Lobelice jEtherca, dose 10 to 30 minims (0.65-2.0). LYCOPODIUM. Lycopodium, U. S., is a pale-yelloAv poAvder derived from Lyeo- 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. LYSOL. This is a preparation made by dissolving in fat and saponifying with alcohol that part of tar oil which boils betAveen 190° and 200° C, and is a brownish, clear, oily fluid, smelling some\vhat like creo- sote. It is used for the same antiseptic purposes as creolin (see Creo- lin), but possesses the advantage .of forming a clear, soapy fluid Avhen mixed with water, in which instruments can be seen. If small instru- ments are used, the solution is so soapy that it renders them too slippery for ready use. Those who have used lysol claim that it does not affect the skin of the operator's hands except to render it soft and flexible. Experiment shows it to be possessed of marked antiseptic poAver, and it is far less poisonous than carbolic acid. Used upon mucous mem- branes, a solution of lysol should not be stronger than 2 per cent. MAGNESIA. Magnesia is the oxide of magnesium, made by exposing the car- bonate of magnesium to a red heat. It is used in the form of the light magnesia (Magnesia Levis) as a dusting powder. The troches (Trochisei Magnesia?) each contain 3 grains (0.015). Magnesia is an antidote to arsenic, and Avhen employed to precip- itate a soluble preparation of iron it forms the Antidotum Arsenici (Ferri Oxidum Hydration cum Magnesia, U. S.). 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." Magnesia is of little value in internal medicine except as a feeble antacid. Magnesia and the carbonate of magnesium may be used interchangeably. MAGNESIUM. 259 MAGNESIUM. Magnesium is a metal never used as such, but ahvays in the form of one of its salts, Avhich are the sulphate, citrate, carbonate, and sulphite. The sulphite is a natural salt found in sea-water and in caves or in the Avater coming from the latter. The citrate and car- bonate are derived from the sulphate. The carbonate is insoluble in Avater and alcohol. The others are soluble. Magnesium Carbonate. The Carbonate of Magnesium (Magnesii Carbonas, U. S.) is official in the form of the heavy and light poAvder (Magnesii Carbonas Pon- derosus vel Levis, B. P.), and these two substances do not differ in respect to their effects. The light magnesium is never given internally, because of its bulk, but it is used as a dusting powder in intertrigo, and in the form of white cubes rubbed on the skin to prevent ex- cessive perspiration and as a cosmetic. The heavy magnesium 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 stom- ach or intestines contain much acid from fermentative changes, these acids may, however, unite 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 (0.3-4.0). It should not be used constantly, as there is danger that it will accumulate in the intestines. Liquor Magnesii Carbonatis, B. P., is given in the dose of 1 to 2 ounces (32.0-64.0) as a laxative. Magnesium Citrate. The Citrate of Magnesium (Magnesii Citras) is a much more irri- tating purge than the sulphate, but it is more agreeable to the taste. It is official in tAvo forms, one of which is the solution (Liquor Mag- nesii Citratis, U. S.), which is effervescent and should never be used unless freshly prepared. It is made by adding bicarbonate of potas- sium to a syrupy solution of the citrate of magnesium containing an excess of acid, and corking the bottle tightly, the cork being tied doAvn Avith a strong cord. Care should be taken that the bottle is a strong one, as the development of large amounts of carbonic acid gas may burst it if it be weak. The dose is half to one bottle, Avhich contains about 12 ounces (360 cc). It is too irritating to be used Avhere inflammation of the alimentary canal exists, but is useful in the treatment of sick and bilious headache. The Granulated Citrate (Magnesii Citras Effervescens, U. S.) is less agreeable to take than the solution just named. It should be dissolved in Avater, about 1 to 3 drachms (15.0-45.0) of the salt being used in each dose, and SAvallowed Avhile the solution is effervescing. It must be kept in bottles tightly corked. 260 DRUGS. Magnesium Sulphate. Sulphate of Magnesium (Magnesii Sulphas, U. S. and B. P.) is a Avhite granular poAvder of neutral reaction and salty taste, and is sol- uble in water. It is generally knoAvn as "salts," although in some parts of the country this term 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 Avater from the intestinal blood-vessels. All strong saline solutions above the strength of 7 per 1000 abstract liquids from the tissues Avhen brought in contact Avith them. The recollection of these facts readily makes clear the mode of action of magnesium sulphate. Whenever a thorough pur- gative action is required—that is, Avhere 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 as of high a percentage as possible. Magnesium sulphate may be given by enema with the double purpose of unloading the boAvels and acting as a depletant. The best mixture for this purpose seems to be that of Watkins—namely, 2 ounces (64.0) of magnesium, 1 ounce (32.0) of glycerin, and 4 ounces (128.0) of Avater. In cases of dropsy the use of concentrated solutions is particularly necessary if free watery evacuations are desired, and from 1 to 2 ounces should be given before breakfast or on an empty stomach in as little water as will dissolve the salt. (See Dropsy.) Generally it is better to give this quantity divided into small doses every fifteen minutes till it is all taken. In enteritis and peritonitis the use of magnesium is widely recog- nized as a proper measure for its depletant effects, and it is claimed to be better than ipecac in the treatment of tropical dysentery. When used for the latter purpose it should be given in drachm (4.0) doses of a saturated solution Avith 10 to 15 drops (0.65-1.0) of aromatic sulphuric acid every tAvo hours. The sulphate is not irritating, and may be given freely Avhen inflammation exists. (See Peritonitis.) It forms a large part of most of the natural purgative Avaters. MANGANESE. Manganum, or Manganese, is official in the U. S. Pharmacopoeia in the form of the black oxide (Mangani Dioxidion) and the sul- phate (Mangani Sulphas). T,he first of these, under the name binoxide of manganese, has been highly praised in conenorrhaea dependent upon functional disturbance and anaemia. The dose is 3 to 5 grains (0.15-0.3) three times a day, in pill form, and the drug should be taken for a feAv 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 (0.05-0.1) . MANNA. Manna, U. S., is the concrete saccharine exudation of Fraxinus Ornus, a tree of Europe. It occurs in roundish masses of varying MA TRICARIA—MERCUR Y. 261 size, looking somewhat like a gray-colored gum arabic. It has a sweet taste and odor. Sometimes the taste is a little bitter. Therapeutics.—Manna 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 (4.0-8.0) of the SAveet variety of manna may be dissolved in the milk of each bottle. When given to older children or adults, manna is ahvays combined Avith other more power- ful drugs, chiefly to cover their taste. It may be combined Avith advantage with rhubarb and senna, and it enters into the official Infusion Senna? Composition, U. S., the dose of Avhich is from 1 to 4 fluidounces (3.20-64.0). MATRICARIA. Matricaria, U. S., German Chamomile, consists in the flower-heads of Matricaria Chamomilla, a European plant, possessing mild bitter tonic properties Avhen given 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 (32JM34.0: J litre) it has been largely used as a diaphoretic, and, in small doses, to prevent colic in teething children. MENTHOL. (See Peppermint.) MERCURY. Hydrargyrum, U. S. 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 Avhen 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 some- times called ptyalism. If the use of the drug is persisted in, all these symptoms groAv Avorse. 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 doAvn and decomposition of the tissues the patient dies. The blood is affected, and becomes very thin, fluid, and poor in its corpus- cular elements. These symptoms ensue on the use of mercury in continued doses, and rarely folloAv exposure to the drug in the pro- cesses of the arts. In the arts—as, for instance, in the making of 262 DRUGS. looking-glasses—workmen are often affected by various trains of symptoms varying very Avidely in their course. In some cases the nervous system becomes chiefly affected. Tremors of all sorts arise, paralysis agitans is developed and degenerations in the spinal cord ensue; but it is worthy of note that the ocular muscles are rarely involved in mercurial tremor, Avhile in disseminated sclerosis nystagmus is not rare. Similarly the tremors of mercurial poisoning often affect the head and neck alone, while in paralysis agitans this is rarely the case. Chorea often comes on in chronic mercurial poisoning, and the occurrence of choreic movements in an adult should cause inquiry as to any possible exposure to mercury. In other cases brownish discolor- ation of the skin, resembling Addison's disease, appears. Blindness, deafness, sensory disturbances, such as hypersesthesia and anaesthesia, may be developed, and localized Avasting of muscles or groups of muscles may assert itself. In still other cases the blood becomes impoverished and mercurial cachexia is developed. . It is Avorthy of note that children under three years are rarely sali- vated by the use of mercury, but this is no reason for using this drug carelessly in this class of cases, since the other changes in the organ- ism nevertheless occur. Absorption and Elimination.—The rapidity of absorption and elimination of mercury depends to a very great extent on the variety of it Avhich is given. The drug in some forms is so insoluble that very great delay in its elimination must often ensue because it is sloAvly absorbed. Several opinions are held as to the form in Avhich mercury is absorbed. It is usually taught in France that the theory of Miahl is correct; this is that the mercurial preparations are transformed in the stomach and intestine into the bichloride, which in turn unites Avith the sodium chloride in the blood and circulates as a double chloride of mercury and sodium. In Ger- many it is taught that it forms an albuminate of mercury and so circulates (Henoch's theory), or that it forms a chloro-albuminate (Voit's theory). All these theories as to its absorption are open to grave criticism. As to the elimination of mercury, it is known to escape by every excretion of the body—the urine, feces, sweat, tears, milk, and saliva. After a single dose the drug begins to be eliminated in about two hours according to Byasson, and is entirely gotten rid of in tAventy-four hours. If, hoAvever, the doses are per- sisted in, it gradually accumulates in the body and is so slowly elimi- nated as to remain for almost indefinite periods of time, and is found deposited in all the organs. In other words, the doses of mercury ordinarily given are always large enough to produce cumulative effects. Thus while Balzer and Klumpke agree Avith Byasson as to the rapidity of elimination of a single dose, they find from an experi- mental study that the amount of mercury which can be eliminated by the kidneys for many weeks Avhen the body is saturated with the drug is only one-sixteenth of a grain a day. It is evident, therefore, that after a full mercurial effect is produced it is Avell to decrease, as do most syphilographers, the dose of mercury and give only enough to maintain the effect. It is also evident that the plan of using MERCURY. 263 iodide of potassium every noAV and again to aid in the elimination of the residual mercury is advisable. 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 germ- icide ; 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. As an Antisyphilitic.—In syphilis mercury is to be given, not because the patient shows symptoms of this or that stage of the dis- ease, but because the conditions present call for its employment. Many writers have insisted that it ought only to be employed in the second- ary stages, and, Avhile this is, as a general rule, correct, certain condi- tions may call for it at any time. (See Syphilis.) Of all the preparations of mercury used in the treatment of syphilis, the protoiodide is the most popular, and deservedly so. (See article on Syphilis.) Mercury is often administered by means of fumigations or inhala- tions both for the removal of local and general syphilitic disorders. The best apparatus for either purpose is one devised by Bumstead, and it is both simple and inexpensive. It consists of a sheet-iron cup so bent that the bottom of the vessel, instead of being flat, projects up- ward into the centre of the cup, thereby forming a raised centre with a little ditch about it. The top of this projection is flattened, and on its apex is placed the calomel AAhich is to be sublimed. The sur- rounding ditch is then filled with hot water, and the cup placed over an alcohol flame, Avhich disengages the vapor of the calomel and water. When inhalations are used the face should be held some six or eight inches aAvay from the cup to permit the fumes to pass through the air. Under these circumstances the quantity of calomel used should not exceed 4 or 5 grains (0.3), and the mouth should be rinsed out to prevent mercurial stomatitis unless a local action on the buccal mucous membrane is desired. Not more than eight or ten inspira- tions should be taken at one sitting. If general fumigations are to be practised, the patient places the lamp and cup with 30 grains (2.0) of calomel on it under a chair, on which he sits Avrapped in a heavy blanket, (See Fig. 2.) We believe that the ultimate conclusion of the profession in regard to the hypodermic injection of mercurials in syphilis will certainly be identical Avith that governing its use of quinine in malarial fever. There can be no doubt that a certain number of instances do arise in which, by reason of severe infection, susceptibility of the patient, or inability to take mercury by the ordinary means, hypodermic injec- tions are absolutely necessary. In the same way that we give qui- nine by the mouth, the rectum, and hypodermically in pernicious malarial fever, so do Ave give mercury by the mouth, by inunctions, by sublimation, and by the hypodermic needle in malignant syphilis. The reasons for believing that hypodermic injections of mercurials 264 DR UGS. are not to be resorted to as a routine treatment of syphilis are several. In the first place, all forms of hypodermic medication possess disad- Fig. 2. A patient prepared for the vise of mercurial Mililimations. A blanket having been pinned tightly around the neck after the patient is stripped, the fumigator shown at his feet i.s placed under his chair and the calomel placed on the central disc, as shown in the illus- tration. Water is in the little ditch around it and an alcohol lamp under it. The patient should be given a full, warm bath beforehand to cleanse and prepare the skin for absorption. vantages not possessed by the use of drugs by the mouth. There is ahvays some danger of entering a vein, of producing an abscess, or of causing local pain. When mercurials are so employed, the danger of abscess, of pain, or of milder inflammatory manifestations is greatly increased, and the presence of an indurated spot Avhere the hypodermic injection has been given proves that it is not the simplest form of medication in syphilis. Of the mercurial preparations Avhich are best administered hypodermically in syphilis, the tAvo which sur- pass all others are undoubtedly the bichloride of mercury, in the dose of J- grain, dissolved in 10 or 15 drops of distilled water, every second or third day, or gray oil (Oleum Cinereum), Avhich Avas first introduced into medicine by Lang of Vienna. (See Gray Oil, under Mercury.) MERCURY. 265 In all cases the injection should be given slowly and deeply into some portion of the body in Avhich the tissues are loose, as the buttock or the broad of the back, and the skin of the part Avhere the injection is to be made should be carefully washed and sterilized by green soap and alcohol. The intravenous injection of bichloride of mercury has been proved so dangerous as to be properly considered unjustifiable. As a Purge.—The employment of mercury as a purge or laxative having a special action on the liver is constantly resorted to. The tAvo preparations used are blue mass and calomel, but the latter is more active. They both cause soft or watery stools, according to the dose in which they 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 Avhether mercury affects the liver, and Avhether the peculiar greenish or brownish-yellow stools produced by it are due to the presence of bile or mercury. If there is one point firmly fixed in the mind of the average practitioner of medicine, it is that the mild chloride of mercury increases the quantity of bile in the intestine. If such a believer is questioned as to whether this increased amount of biliary fluid is due to a true increase in secretion or simply to an increase in the flow of bile from the gall-bladder, he will either state that he is unable to answer the question or that he believes that it is an increased secretion. Practically, the position of the profession in general in regard to the purgative influence of calomel is that the drug exercises a stim- ulating effect upon the biliary gland. Careful experimentation upon the loAver animals by several competent observers, and careful studies made by physiological chemists, fail, however, to give us very much light upon this subject. It is held by some that calomel never acts as calomel, but is converted by the hydrochloric acid of the gastric juice into corrosive sublimate, and that this drug then stimulates the liver to increased activity. On the other hand, the best chemical investigations shoAV positively that the feeble acidity of the gastric juice and the temperature to which the calomel is exposed are not favorable to the conversion of a sufficient quantity of calomel into corrosive sublimate to account for any hepatic influence. Thus it Avas found by Rutherford and Vignal, in their well-knoAvn series of studies upon the influence of drugs upon the secretion of bile, that if 5 grains of calomel are subjected, at 100° F., for seA^enteen hours to the action of normal gastric juice, not more than -^ of a grain of mercuric chloride is produced. As calomel does not remain in the human stomach for more than a night at the utmost, and generally but a very feAv hours, it is not likely that as much as ^- of a grain of mercuric chloride is produced from the moderately large dose of 5 grains. In contradiction of this. Bucheim, Winkler, and others assert that no conA'ersion Avhatever takes place at the temperature of the body, and Jaennel's later studies support this \TieAv. The other theory as to the change Avhich takes place in calomel prior to its action upon the liver is that it escapes into the intestine, 266 DRUGS. where it is decomposed and the gray oxide of mercury precipitated, which may, however, be held in solution by any fatty materials, Avhich, being mixed Avith alkaline liquids, practically form soaps. It is thought by Wood and others that this is the more probable result, particularly in view of the fact that calomel acts more like blue mass than cor- rosive sublimate. Further than this, these opinions are confirmed by the fact, Avith Avhich all of us are familiar, that the hepatic influence of calomel is much more positively asserted if at the same time small doses of the bicarbonate of sodium are administered. Under these circumstances the bicarbonate of sodium naturally diminishes, to some extent at least, the acidity of the gastric contents, and also directly or indirectly tends to increase the alkalinity of the contents of the duodenum. As if to increase the complexity of the problem, the studies of Rutherford and Vignal seem to prove conclusively that in the dog, at least, mercuric chloride has a direct stimulant effect upon the hepatic cells; whereas, calomel, AA^hile producing purgation by increas- ing the secretion of the intestinal glands, in no way increases the true secretion of bile; and this Avould seem to indicate that, after all, the influence of calomel upon the liver is due to a very minute portion of it being changed into corrosive sublimate. Probably the truth of the matter is, that Ave have as yet no definite scientific explanation of hoAv calomel really does act. It may be that the solution of the problem lies in the hepatic influence exercised by the presence of minute quan- tities of corrosive sublimate, and the purgative effect produced by that portion of the calomel which has not been converted into the strong chloride of mercury. This is rendered the more likely in view of the fact that the corrosive sublimate has been found a feeble intestinal stimulant, Avhile the calomel has been found to produce active purga- tion in dogs, Avithout producing an increase in hiliary flow, when the drug has been introduced into the duodenum. It has been suggested, too, that calomel itself may stimulate the bile-expelling mechanism, Avhile the minute portion of corrosive sub- limate increases the secretion of the liquid; and, again, that by means of the purgative effect that it produces certain substances Avhich have been in the intestine are immediately removed, and, as a consequence, a depressant influence upon the hepatic cells no longer exists. While, at first sight, the argument seems a forcible one that a vast clinical experience in regard to calomel is far superior to any series of experiments on dogs, it is only just to remember that in the entire series of remedies supposed to produce an hepatic effect calomel is the only one which failed to influence the liver of the dog as the others influenced the liver of man. Quite a number of physicians have studied the effect of the various so-called cholagogue drugs upon the Aoav of bile in human beings who have had biliary fistula. The most recent and perhaps the best study is that of Pfaff and Balch upon a woman with a biliary fistula. Calomel and the bichloride of mercury seemed invariably in her case to decrease rather than increase the biliary Aoav. Ox-gall was the only drug which did increase it. MERCURY. 267 This subject also is of interest to the practical physician in rela- tion to the administration of calomel in compressed tablets or other preparations Avhen mixed Avith Avhat might be called excipients. Under these circumstances, if one of the excipients is bicarbonate of sodium, the tablet almost ahvays undergoes a change and becomes of a gray color. Those Avho have used pills or tablets of calomel Avhich have been kept for a long period of time seem to be universally in accord with the statement that they have lost the hepatic effect Avhich a recently-prepared powder ahvays possesses. Thus it has been fre- quently found that no biliary Aoav occurs under the use of stale tab- lets. Avhereas free bilious purging folloAvs the administration of freshly- prepared poAvders. Calomel and blue mass are largely used in the condition known as biliousness, and undoubtedly give relief. (See Biliousness.) If the tongue is heaA'ily coated, the breath foul, the conjunctiva a little icte- roid, and headache is present, either of them should be employed. In remittent malarial feArer the use of small repeated doses of calomel Avill often bring relief from the vomiting, and it should ahvays be gh^en in the treatment of malarial disease before quinine is used if a thorough action of the antiperiodic is required. As a Disinfectant.—The disinfectant and germicidal power of bichloride of mercury and of the biniodide is very Avell established by clinical experience and experimental investigation. The strength of the bichloride in solution 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 unit- ing Avith the albumin of the tissues to form an insoluble and useless albuminate. The same is true of the use of mercury biniodide. As an Antiphlogistic.—The antiphlogistic or anti-inflammatory action of mercury is very marked indeed, but its employment is abso- lutely limited under these circumstances to one variety of inflamma- tion—namely, the sthenic or dynamic form. In inflammation arising during the course of some exhausting disease mercury is not only con- traindicated, 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 and large in quantity. It is in the first case that mercury should be used to prevent the fibrinous exudate or to make it serous. In the second instance it will do harm by increas- ing the exudation. When mercury is given as an antiphlogistic, opium is often combined with it to relieve the pain and irritation and to prevent purging. In meningitis arising from head injuries this is a routine treatment, and may be carried out by the use of poAvders containing \ grain (0.015) 268 DRUGS. of calomel and \ grain (0.015) of powdered opium every hour till 1 or 1| grains (0.05-0.07) 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 given in full dose. The bichloride may be used in small doses in place of the calomel, and does not, of course, produce the same tend- ency to laxity of the boAvels. On the other hand, it often seems to be less efficacious. Mercury in myocarditis and pericarditis is also of service, and cer- tainly exerts distinct prophylactic power in the early stages of diphtheria and membranous croup. (See Diphtheria.) One of the best ways to employ any of the various forms of mer- cury is in the form of triturates, Avhich may be prepared by triturating 10 parts of the drug with 90 parts of milk-sugar. The minute sub- division of the medicament aids in its efficiency, because of its more ready absorption. Leaving the general subject of mercury, we may noAV consider each individual preparation. Ammoniated Mercury. White Precipitate, or Ammoniated Mercury of the strength of 10 per cent, with lard (Hydrargyrum Ammoniatum, U. S. and B. P.), is used in an ointment (Unguentum Hydrargyri Ammoniati, U. S. and B. P.) in various skin affections, when a stimulating application is needed, as, for example, in psoriasis and chronic dry eczema. It is also sometimes employed as a parasiticide in cases of tinea. The official ointment should generally be diluted with lard, as it is far too strong and will often induce a dermatitis if used undiluted. In ozaena, Avhether syphilitic or not, Trousseau has recommended the employment of the following powder as a snuff: R.—Hydrargyri ammoniati........gr. iv (0.2). Pulv. sacchar. alb...........fss (16.0).—M. S.—To be used as a snuff, after thoroughly blowing the nose. The red precipitate may be used instead of the white. The treat- ment removes the stench and may cure the complaint. It may, hoAV- ever, irritate the mucous membrane, in which case it should be used in the strength of 2 grains to the J ounce (0.1 : 16.0). It is never used internally. Bichloride of Mercury. The Bichloride of Mercury, or Corrosive Sublimate (Hydrargyrum Chloridum Corrosivum, U. S.; Hydrargyri Perchloridum, B. P.), as it is called, is an exceedingly poisonous and irritating substance Avhen taken internally in concentrated form. Taken internally, it causes violent pain in the stomach, vomiting, purging of mucus, blood, and the contents of the intestine, collapse, syncope, and death. If taken in poisonous amount, the patient should be made to swallow large quantities of the antidote, white of egg, the MERCURY. 269 stomach should be washed out Avith the stomach-pump, heat should be 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 stric- tures, sloughs, destruction of the peptic glands, and ulcerations. The bichloride of mercury is an exceedingly useful preparation of mercury for hypodermic injection in syphilis, and is better than calomel for this purpose. About ^ grain (0.012) may be injected deeply and gently into the cellular tissues every tAvo or three days. When the injections are made the greatest possible cleanliness should be obtained. The needle should be aseptic and the hands of the operator Avell disinfected. The best place for the injection is in the gluteal region or betAveen the shoulder-blades. Mercury bichloride, aside from its antiseptic use (see Antiseptics), is of great value Avhen given internally, not only in syphilis, but in other states not associated with any such depraved condition, as in chronic Bright's disease. In diphtheria it may be used to prevent fibrinous exudation as readily as calomel (see Diphtheria), and in ton- sillitis, Avhere the inflammation is severe, it is often used with great service. In small amounts—that is, in -^ to -fa of a grain (0.0015-0.0017) three times a day—the bichloride is one of the best remedies Avhich Ave possess for the treatment of anaemia depending upon a deficient num- ber of blood-cells. If the anaemia is syphilitic in origin, it is, of course, peculiarly useful. Bichloride of mercury is of value in minute doses of ■5-^-0- to -fa of a grain (0.0003) for the ill-smelling green stools of summer diarrhoeas in adults and children, and it has been recommended that a solution be made of J a grain (0.03) in 5 ounces (160.0) of water, and a tea- spoonful given every hour until relief is obtained. The water used in making the solution should be distilled, and it may be well to add to it a little tartaric acid to prevent precipitation of the bichloride by organic matter which may have gotten into the Avater. This treat- ment is particularly useful in mucous diarrhoea in Avhich blood and mucus are thoroughly mixed. Patients in the dispensaries often speak of these passages as containing "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 diarrhoea of adults the same treatment may be resorted to, using 2 teaspoonfuls of the solution instead of 1. It is hardly necessary to add that the greatest care must be bestowed upon 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 \ an ounce (16.0) of corrosive sublimate and 1 ounce (32.0) of chloride of ammonium may be added to a Avarm bath, Avhich should be taken 270 DR UGS. every feAv days. J a grain (0.03) of the bichloride of mercury in 6 ounces (192.0) 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 (0,1) of bichloride to the ounce (32.0) of water may be sopped on the part three times a day. A solution of perchloride of mercury (Liquor Hydrargyri Perchloridi) is official in the B. P.: it is prepared by adding -^ grain (0.03) of the perchloride of mercury to 1 ounce (32.0) of Avater, with ^ grain (0.03) of ammonium chloride to hold it in solu- tion. (For the antiseptic uses of the bichloride of mercury see Antiseptics and Disinfectants.) Biniodide of Mercury. Mercury Biniodide (Hydrargyri Iodidum Rubrum, U. S. and B.P.) is a bright-red poAvder, possessing irritating powers equal to or above those of the bichloride, and causing symptoms, Avhen taken in over- dose, closely resembling those produced by the latter drug. OAving to the formation of the salt, it is thought to be particularly useful in the later stages of syphilis. The dose is -^ to ^ of a grain (0.003- 0.006). (See Syphilis.) An ointment (Unguentum 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 than the bichloride, but recent researches have proved that this is not a fact. Black Wash. Black Wash (Lotio Hydrargyri Nigra, B. P.) is made bv adding 1 drachm of calomel to a pint (4.0: J litre) of lime-water. It is used as a stimulant application for Avashing syphilitic sores and wounds and in various forms of eczema. Blue Mass. Blue Mass (Massa Hydrargyri, U. S. ; 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 (0.02) of mercury, and it may be given in the dose of from J to 20 grains (0.03-1.3) for the same laxathTe purposes for Avhich we use calomel. Blue mass is rarely used to produce systemic effects. Calomel. Calomel (Hydrcn-gyri Chloridum Mite,U. S. ; Hydrargyri Subehlo- ridum, B. P.), or the Mild Chloride of Mercury, is an insoluble salt Avhich is, nevertheless, freely absorbed. Calomel Avhen used as a iaxative purge should be given in the dose of \ to | grain (0.01-0.03) every half-hour or every fifteen minutes until 1 or 2 grains (0.05-0.1) are taken, as it "will act as efficiently in this Avay as if 10 grains (0.65) are given at one dose, and there is no dan- MERCURY. 271 ger of producing ptvalism. The reason that small doses are as efficient as large ones lies in the fact that only the calomel Avhich is changed into the gray oxide is active, and, as the amount of alkaline juice in 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 is added to calomel poAvders, to aid the intes- tinal juice in the reduction 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 ahvays be used if large doses of the mercurial are employed, to avoid possible mercurialization. Mercury in the form of calomel is very largely used hypodermic- ally, being held in solution by a mucilage, or, better still, by fluid cosmoline. Best of all, hoAvever, is the employment of chloride of sodium in Avater Avith the calomel, in the proportion of 5 parts each to 50 parts of Avater. 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 gan- grene, has folloAved its employment in this way. (See also Salicylate of Mercury and Bichloride 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 a favor- able change in the number and character of the stools appears. Cal- omel is not to be used if great asthenia complicates the disease. In children Avho seem constantly " under the weather " and never quite Avell, Avho have flatulence, foetid breath, and ill-smelling, pasty stools, calomel often gives great relief in the dose of -^ of a grain (0.003) 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 conges- tion | of a grain (0.01) of calomel every half-hour until 1 grain (0.06) is taken will often bring relief. Calomel is generally prescribed in conjunction vvith sugar of milk, white sugar, or bicarbonate of sodium, Avhich 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, calomel is often placed on the tongue in children, but for this class of patients white sugar is to be used in small quantity, as the other vehicles are less agreeable. The most agreeable form of administration is by means of triturates. It is important to remember that calomel, Avhen used as an anti- syphilitic, produces salivation very much earlier than the other mer- curials. Sometimes calomel is of value Avhen dusted into the eye in cases of phlyctenular conjunctivitis which are strumous. This practice must not be resorted to if iodine or iodides are being taken inter- nally, as the iodine is eliminated by the tears and forms a compound which burns the conjuncthra. A very important use of calomel, and one which has been brought 272 DRUGS. forward very recently as neAv, but Avhich is really many years old, is its employment in dropsy as a diuretic, either alone or combined Avith squills or digitalis, or with opium to prevent purging. The dose is small, about 1 grain (0.05) thrice a day, and if a diuretic influence does not assert itself in forty-eight hours it should not be continued. Hoav calomel acts to produce the increased urinary flow under these circumstances Ave do not knoAv. Some suppose that it aids the absorp- tion of liquid from dropsical tissues, and so increases urinary secre- tion ; others think that it stimulates the renal epithelium to greater activity. The latter seems the least probable of the two, but neither theory has been proved correct, although experimentation supports the vieAv first named. The full urinary effect of the drug is not felt till the second or third day of its use, and speedily passes away, par- ticularly as purging is often induced very early. Still another use of calomel is in typhoid fever, in Avhich disease it has been highly recommended in small repeated doses, particularly if constipation is present. In the opinion of the author this is disadvantageous as a routine measure and entirely uncalled for. although in the very early stages of the disease, Avhen the bowels are confined and the tongue coated, a dose of 1 grain (0.05) in fourths Avith a little bicarbonate of sodium is useful. Sydney Ringer has called attention to the fact that in constipa- tion or in " biliousness " podophyllin does more good than calomel, provided 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 efficient. 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 depression following acute diseases, and when the tongue is covered by a thick yelloAv coat it is the remedy for the gastro-intestinal tor- por ahvays present. While purgative doses of calomel certainly are of value, the use of freshly-prepared nitro-muriatic acid is, however, 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 Avay, but in other cases it will seem to increase the nausea and bring on vomiting. This is true of both adults and children, and it is impossible to tell beforehand which -will occur. Ringer asserts that in a peculiar form of vomiting occurring in very young children, Avhich comes on immediately after the food is SAvalloAved, 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 Avill often give relief Avhen all other remedies fail. It should not be resorted to until some evidences of Avasting occur, as this action of the stomach in many children only rids that organ of that part of the milk Avhich is in excess, and is a purely physiological regurgitation. The calomel may be given in the dose of ^ of a grain (0.005) every hour, or, if preferred, gray powder in the dose of |- of a grain (0.02) every hour for three doses is equally efficient in these cases. Calomel in a fine poAvder Avill often remove syphilitic condylomata MERCURY. 273 if dusted over them for some time, and an ointment made of 1 drachm (1.0) of calomel to 1 ounce (32.0) of lard is very useful in pruritus. Calomel ointment (Unguentum 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 : R.—Hydrarg. chlor. mit..........gr. xl (2.65). Magnesiae carbonatis.........gr. xl (2.65). Unguent, aquae rosae.........*j (30.0).—M. Gray Oil. Gray Oil is prepared as folloAvs: 2 drachms (8.0) of lanolin is rubbed up Avith enough chloroform to emulsify it. The rubbing process is continued until most of the chloroform is evaporated, and while the mixture is still in a fluid state metallic mercury, in double the amount of lanolin, 1 drachms (16.0) is added and the tritu- ration continued. By this means an ointment of mercury is left Avhich equals 2 parts of mercury and 1 of lanolin. This is some- times called Strong Gray Ointment. For hypodermic injection 3 parts of this gray ointment are added to 1 part of olive oil, or it may be still further diluted by adding olive oil in the proportion of half- and-half. Of this mixture 1 to 2 minims (0.05-0.1) may be injected every second or third day. With some practitioners this preparation is considered much better than any other for hypodermic use in syphilis. Mercury with Chalk. Mercury Avith Chalk (Hydrargyrum cum Creta, U. S. and B. P.), or Gray PoAvder, is slightly purgative, but is chiefly employed in the treatment of infantile syphilis, as it will not freely purge. It is com- posed of 38 parts of mercury, 12 parts of sugar of milk, and 50 parts of prepared chalk. The dose is 1 to 10 grains (0.06-0.65). Chil- dren suffering from syphilitic marasmus seem fairly to fatten on it. This preparation is also of service in the syphilis of adults, and may be employed Avhenever the laxative effect of mercury is not desired. In the treatment of infantile diarrhoea Avith Avatery, colorless stools containing undigested food gray poAvder in small doses is often very useful. Mercury Ointment. The Ointment of Mercury, Mercurial Ointment (Unguentum Hydrargyri, U. S. and B. P.), sometimes called Blue Ointment, is made by rubbing up mercury with suet and lard until the mercury is extinguished, or, in other words, until the globules of mercury cannot be seen Avith a magnifying power of ten diameters. 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 Avell be taken by the mouth. In syphilis Avhere a mercurial effect is to be reached the ointment in small amounts is 274 DRUGS. 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, and 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 applications, places the drug on spots Avhere 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 in producing the impression upon the system, and the wearing of an undershirt saturated with the ointment after a few days' Avear is a very valuable, though somewhat dirty, method of producing mercu- rialization. The ointment of mercury is sometimes rubbed into the skin over enlarged glands. LTnder the name of Oleate of Mercury (Oleatum Hydrargyri, U. S.; Hydrargyri Oleas, B. P.), a very efficient and more agreeable application than the ointment is used in the same manner or still further diluted Avith lard. It is made from the yelloAV oxide of mercury. (See Oxides of Mercury.) For pediculus 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 folloAving 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 insects, 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 ointment is probably more active than the mercurial oxide." Linimentum Hydrargyri, B. P., and Emplastrum Hydrargyri, U. S. and B. P., are used for the same purposes as is the ointment of mercury. The plaster is made Avith olive oil, resin, and lead plas- ter instead of ordinary suet or lard. Nitrate of Mercury. The Solution of Mercuric Nitrate (Liquor Hydrargyri Nitratis, U. S. and B. P.), Acid Nitrate of Mercury, is an exceedingly active, penetrating 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 Avith advantage in lupus until the surface of the growth is level Avith the skin. The surrounding parts should be protected by lard or oil. As this treatment is very painful, the spot may be first cocainized and afterward covered Avith flexible collodion. MERCURY. 275 Citrine Ointment (Unguentum Hydrargyri Nitratis, U. S. and B. P.) is used as a stimulating application in cases of chronic skin diseases of the scalp and trunk. It is too strong for ordinary use, and should be diluted one-half or less Avith lard according to the stim- ulating effect required; the dilute ointment is official in the B. P. as Unguentum Hydrargyri Nitratis Dilution. Oxides of Mercury. The Yellow and Red Oxide of Mercury (Hydrargyri Oxidum Flavian, U. S. and B. P. and Hydrargyri Oxidum Iiubrum), U. S. and B. P..), Red Precipitate, are used largely as a dressing for syph- ilitic sores Avhen diluted about one-half with chalk or other powder. If used pure, they are someAvhat caustic. From the vcIIoav oxide is made the Oleate of Mercury (Oleatum Hydrargyri, U. S.), which is used for the same purpose as ordinary mercurial ointment. In intestinal and gastric indigestion, Avith foul belching and very ill-smelling stools Avhich are due to intestinal sepsis, the yellow oxide is sometimes given in the dose of g^ to ■£$ of a grain (0.001-0.0012) in a triturate. Red Precipitate Ointment ( Unguentum Hydrargyri Oxidi Rubri, U. S. and B. P.) and the Ointment of the YelloAv Oxide (Unguentum Hydrargyri Oxidi Flavi, U. S. and B. P.) are largely used, diluted one-half with lard, for chronic scaly skin affections, in obstinate con- junctivitis, and in granular lids and styes. (See Styes.) They should ahvays be freshly prepared. Protiodide of Mercury. Mercury Protiodide (Hydrargyri Iodidum Flavum, U. S.) is much more mild than the biniodide, and is given for exactly the same pur- poses. It is very useful in chronic Bright's disease. It is to be remembered as the best mercurial preparation for ordinary cases of syphilis. The dose is -^ to + of a grain (0.01-0.016) three times a day. Salicylate of Mercury. Salicylate of Mercury is a drug which has come into quite general use since the introduction of the hypodermic method of administer- ing mercury in syphilis. It is to be suspended in paraffin oil in the proportion of 22 grains (1.5) of the salicylate of mercury to 3 drachms (12.0) of the oil, and before it is used the bottle must be Avell shaken in order that the insoluble mercury may not remain at the bottom. It is of great importance that the needle and syringe shall be thoroughly cleansed after each injection, as the insoluble drug readily clogs the opening of the instrument. At first 1 minim (0.05) of the mixture just named should be injected deeply into the gluteal region every fourth day, and this may be increased to every second day if no systemic evidences of the action of the drug appear. 276 DR UGS. Yellow Sulphate of Mercury, Hydrargyri Subsulphas Flavus, U. S., 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 Avriter Avould recommend great care in its use. The dose for a tAvo-year-old child is 2 to 5 grains (0.1-0.35), repeated in fifteen minutes if necessary. If as much as 5 grains (0.35) has been given, and emesis does not folloAv, other emetics or the stomach-pump must be used to pre- vent gastro-intestinal irritation. Yellow Wash. YelloAv Wash (Lotio Hydrargyri Flava, B. P.) is made by adding 30 grains (2.0) of corrosive sublimate to a pint (± litre) of lime-Avater. It is used for the same purposes as the black wash already mentioned, but is much more stimulating in its influence. Incompatibles.—Bichloride of mercury should never be given with any other substance except iodide of potassium and chloride of ammo- nium, 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 redissolved and the resulting mixture is highly alterative. Calomel should never be given with iodides or bromides, and hydro- chloric acid may convert it into the bichloride if the acid is present in any amount. It is also incompatible Avith antipyrin. METHYL BLUE. Methyl Blue or Methyl Violet is an aniline dye often sold under the name of Pyoktanin. When used medicinally, it must be perfectly pure and deprived of its usual contaminating matter, arsenic, Avhich if present causes local irritation of the part to Avhich it is applied. Pyok- tanin was introduced to professional notice under this name by Still- ing as an antiseptic, but careful study has proved it to be of very feeble poAver over the growth of germs. In all conditions of the eye in Avhich antiseptic lotions are indicated pyoktanin has been stated to be of value, but elseAvhere in surgery it is practically useless as an antiseptic. Even in the eye it possesses, according to de Sclnvcinitz, a very limited range of usefulness, being no better than the older antiseptics, except in diseases of the lachrymal apparatus. The fact that pyoktanin stains everything it touches is a great disadvantage in its use. It may be tried in blepharitis, eczema of the eyelids, con- junctivitis, both simple and phlyctenular, and in the treatment of corneal ulcer. When so employed it should be applied in the strength of 1 to 1000 of water. It should be remembered that any pure aniline dye may be used in place of pyoktanin. Thus some physicians have used yellow pyok- tanin or auramine. Methyl blue and similar aniline substances are largely employed by some persons in the treatment of malignant neoplasms. The solution METHYL CHLORIDE—METHYLENE BLUE. 277 (1 to 500 of Avater) should be filtered through hot asbestos to render it sterile, and every antiseptic precaution carefully adhered to in giving the injection. The dose is J to 3 drachms (2.0-12.0) of this solution every other day or every third day, and the injection is to be given either into the groAvth itself if it is large, or just at the side, in the healthy tissues, if it is small. Too much should not be injected into one spot, lest it cause a slough. This treatment does not cure the disease. It relieves pain and so quiets the patient, and in rare cases stops the groAvth of the tumor. If the groAvth sloughs, complete anti- septic dressing is necessary. An antiseptic pyoktanin-ganze dressing should ahvays be used Avhile the treatment is going on. METHYL CHLORIDE. Methyl Chloride is a colorless gas, easily liquefied under pressure, with an odor resembling that of ether and chloroform, used to produce local anaesthesia, which it does by absorbing a large amount of heat on passing from the liquid to the volatile state as it strikes the skin. It is usually kept in a small flask Avhich has its end fused into a fine point. This is broken off, and the heat of the hand volatilizes the drug, Avhich is then forced out of the flask in a fine spray. The nozzle should be held ten to tAvelve inches from the part to be frozen. The skin of the part to be anaesthetized should be Avashed with soap and ether to remove all fatty substances before the spray is used. Under these circumstances the skin becomes pale in a few seconds, and afterward perfectly Avhite and parchment-like in appearance. Local anaesthesia is noAV complete, and minor surgical operations, such as opening boils or abscesses, can be performed without pain. The spray should not be continued more than tAvo to four minutes, as local death of the tissues may result. A great advantage of the spray of methyl over that of ether is its slight inflammability and rapidity of action. Methyl chloride is to be distinctly separated from methyl- ene chloride. The first is monochlormethane, the second dichlorme- thane. METHYLENE BLUE. Methylene Blue is to be distinctly separated in the mind of the student from methyl blue, Avhich is practically what is knoAvn by the trade name "Pyoktanin." Methylene blue has been employed in the treatment of malignant growths and in malarial fevers with asserted success, although its suc- cessful use in the first group of cases is decidedly problematical. When used in the treatment of sarcoma and cancer, from ^ to 2 grains (0.03- 0.12) in Avatery solution are injected daily or on alternate days directly into the groAvth. The neoplasm, it is said, ceases to groAV, shrinks, and comes aAvay, leaving a fairly healthy sloughing surface. This treat- ment is so uncertain that it should only be tried in inoperable cases. In malarial fever of the intermittent type methylene blue seems to possess very distinct curative poAvers. It is not so powerful as quinine by any means, but has its chief sphere of usefulness in patients Avho cannot take quinine or Avhere (juinine has been tried 278 DRUGS. unsuccessfully. This antimalarial influence is due to its destruction of the plasmodium malarice, but its administration must begin from seven to ten hours before the expected intermittent paroxysm and be continued after the attacks have ceased and for some little time after the physician fails to find the micro-organism in the blood, as relapses are common. Particularly good results seem to follow the use of methylene blue in children suffering from malaria. Untoward symptoms from its use are not common, but Avhen they do occur con- sist in slight vertigo, nausea, and some strangury. The urine is ahvays blue from the elimination of the drug through the kidneys. Recently Levy has employed methylene blue in the dose of from 1 to 2 grains (0.05-0.1) four times a day in the treatment of migraine. It is to be given in capsule Avith kola. He states that as much as 15 grains (1.0) may be given in a day Avith safety. Methylene blue has been highly commended by Horwitz in the treatment of the earlier stages of gonorrhoea, as it shortens the course of the disease. He suggests the folloAving formula: Methylene blue........... 2 grains. Oil of sandalwood..........3 " Oleo-resin of copaiba.........3 " Oil of cinnamon..........1 minim. To be made in one capsule, three of which are to be taken each day. The ordinary dose in the treatment of malaria is 2 to 4 grains (0.1-0.2) every four hours to adults, or 1 to 2 grains (0.05-0.1) to children of five years, preferably given in capsule. METHYLENE CHLORIDE. Methylene Chloride is made from chloroform or by the action of chlorine on marsh-gas, and is a colorless liquid resembling chloroform in odor. It is readily decomposed by light, which process may be hindered by the addition of a little absolute alcohol. Therapeutics.—It is employed as an anaesthetic in a manner like chloroform, and was introduced as a safe substitute for that drug, but it is of doubtful safety and is little used. It has been used as a spray for the production of local anaesthesia. As stated under Methyl Chloride, it is not to be confounded with that drug. In England, under the name of methylene chloride or methylene, a mixture of ethyl ether and methylene chloride has been widely em- ployed. This preparation is, of course, to be distinguished from true methylene chloride. The amount of this mixture used to produce anaesthesia is 1 to 2 drachms (1.0-8.0) for minor and 3 to 6 drachms (12.0-24.0) for major operations. The term "methylene chloride" has also been applied to a mixture of chloroform and methyl chloride, MEZEREUM. Mezereum, U. S. (Mezerei Cortex, B. P.), is the bark of Daphne Mczereum, a plant of Asia, Europe, and'Great Britain. It is sup- posed by some to be possessed of extraordinary alterative power, but M USE—MUST A RD. 279 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 distinctly irritant, and in overdose causes all the symp- toms of gastro-enteritis. Mezereum is so irritant as to have been used externally as a counter-irritant in the form of the ointment (Unguentum Mezerei). It enters into the compound syrup, fluid extract, and decoction of sarsaparilla. The official preparation of mezereum is the fluid extract (Extractum Mezerei Fluidum, U. S.) used as an external irritant. MUSK. Musk (3Ioschus, U. S. and B. P.) is obtained from the preputial follicles of the Moschus moschiferus or musk deer of Thibet, and is a substance possessing the most remarkable penetrating poAvers, 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 tAventy-five cents a grain it is probably Avorth- less or impure. Therapeutics.—For some unknown reason musk acts as a diffusible stimulant and supports the system. It^is also an antispasmodic and nervous sedative. In all low fevers Avhere 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-Avater should be employed. The dose should be 5 to 10 grains (0.35-0.65). This drug is of value where either 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 poAver and the expense is a needless one. Musk is one of the best remedies in obstinate hiccough. The dose of the tincture (Tinctura Moschi, U. S.) is 30 drops to 1 drachm (2.0-4.0), and of musk itself 5 to 10 grains (0.35-0.65). MUSTARD. Mustard is official in the form of Sinapis alba, U. S., and Sin- apis Alba? Semina, B. P., or white mustard, derived from the seeds of Brassica alba, and Sinapis nigra, U. S., and Sinapis Nigra? Semina, B. P., or black mustard, derived from the seeds of Brassica nigra. Both of these contain an irritant oil (Oleum Sinapis Volatile, U. S.) 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 2 table- spoonsful 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 in excess. Its internal use is contraindicated during the existence of acute gastritis and all states of gastro-intestinal irritation. When used as a counter-irritant mustard is applied to relieve the pain of colic due to flatulence and acute inflammation of the thoracic and abdominal viscera, that due to muscular rheumatism, inflamed 280 DRUGS. joints, and neuralgia, and it may be applied at the nape of the neck in cases of lieadache and cerebral congestion. When applied to the skin of an ordinary individual, it will produce a bad burn if left on more than a feAv minutes, and it should be mixed Avith Avheat flour in the proportion of half-and-half Avhen used upon persons having tender skins. Children generally will not stand more than one-fourth mus- tard. The plaster should be made with warm Avater or vinegar, or a little brandy may be used. The scald or burn produced by mustard is peculiar in its slowness 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 applying 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 sometimes given in the treatment of the atonic stomach of drunkards in the dose of \ to \ a drop (0.016-0.03). Charta Sinapis, U. S. and B. P., or mustard-papers, are sometimes called sinapisma, and these afford a ready means of applying this counter-irritant. They are generally very strong, and one or tAvo layers of thin and moistened linen should be placed betAveen the skin and the sinapism to prevent too great an action. (See Counter-irritation.) The compound liniment (Linimentum Sinapis Compositum, U. S. ; Linimentum Sina- pis, B. P.) is composed of the oil of mustard, castor oil, extract of mezereum, and alcohol. The mezereum is omitted in the British prepa- ration, which is twice as strong as the U. S. P. preparation in mustard oil. MYRRH. Myrrha, U. S. and B. P., is a gum-resin obtained from Com- miphora 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 amenorrhoea due to functional inactivity or ancemia, " 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 Avith a small brush or by the end of the finger to spongy or tender gums. In leucorrhoea depending upon uterine trouble and in chronic cystitis myrrh is often of service. Sometimes it enters into expec- torant mixtures given in the later stages of bronchitis. The dose of the tincture (Tinctura Myrrha, XT. S. and B. P.) is 10 to 30 drops (0.65-2.0). It also enters into the composition of Pilula' Aloes et Myrrha, U. S. and B. P., dose tAvo to five pills, and Tinctura Aloes et Myrrha?, U. S., the dose of Avhich is 1 to 2 fluidrachms (4.0- 8.0). NAPHTHALIN, or NAPHTALENE. Naphthalinum, U S., is a coal-tar derivative occurring in color- less mica-like crystals, possessing a peculiar smell, and soluble in NAPHTOL—NITRATE OF POTASSIUM. 281 alcohol to some slight extent. Helbing states that naphthalin when pure is colorless and Avithout action on moist litmus-paper. It should also dissolve in concentrated sulphuric acid Avithout color Avhen gently warmed. After it is taken for some time, or even after the first dose, the patient will state that Avhen he belches the gas has the smell and taste of burning rubber. The drug possesses distinct antiseptic poAver, and for this reason has been employed in certain gastric and intestinal diseases asso- ciated Avith fermentative changes or dependent upon ulceration and organic lesions. In foetid diarrhoea it may be given as a deodorant and cure. When given to children, as in summer clianduva, the dose should De "g"to i grain (0.01-0.015) every two or four hours, but adults may take as much as 5 to 10 grains (0.35-0.65). More than this will dis- order the stomach. The drug should be given in poAvder, with sugar, or in capsule. It has not been as widely employed as Avas expected Avhen it first came before the profession, and certainly often fails to do good. In cats and rabbits naphthalin, Avhen administered continuously for a considerable period of time, produces cataract. NAPHTOL. Naphtol (U. S. and B. P.) is often called Beta-naphtol. It is used for precisely the same purposes as naphthalin internally, and is generally artificially prepared from naphthalin. It is also used in antiseptic dressings. The dose is 2 to 5 grains (0.15-0.3). NITRATE OP POTASSIUM. Nitre (Potassii Nitras, U. S. 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 Avhen taken in overdose symptoms of violent o-astro-enteritis. While 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 rheuma- tism, the dose should be 1 ounce (32.0) in a pint (I litre) of barley- Avater or svrup of acacia and water, to be taken in divided doses of a tablespoonful every three hours. Nitrate-of-potassium papers (Charta Potassii Nitratis, U. 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 bv asthmatics, or burned in a pan and the fumes arising from them 282 DRUGS. inhaled. Their efficacy may be increased in cases where the respira- tory mucous membrane is irritable by dipping them in compound tinc- ture of benzoin and exposing to the air long enough to dry. They should then be protected from the air until used. The paper should be moderately thin bibulous paper. NITRATE OP SILVER. Nitrate of Silver (Argenti Nitras, U. S. and B. P.) is a heavy crystalline salt of silver readily soluble in its oavii Aveight of water. " It is official as the pure nitrate (Argenti Nitras, U. S. and B. P.) and as the sticks or fused rolls (Argenti Nitras Fusus, U. S.), or lunar caustic. The latter are never used in medicine internally, only the crystals being employed. Applied to the tissues of the body or other substances, nitrate of silver causes a brown and finally a black stain, Avhich is due to the formation of an oxide of silver. Physiological Action.—Nitrate of silver is one of the feAv astrin- gent substances which are applicable to inflamed mucous membranes, as it is, with lead, bismuth, and zinc, one of the few drugs of this 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 in its effects, as the drug coagulates the albumin Avith Avhich 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 in the belly, Avith vomiting and purging, comes on. At the same time evidences of widespread gas- tro-enteritis develop. The abdominal walls are knotted and hard, and perhaps scaphoid. The face is anxious and livid and covered Avith a sweat. When the vomiting occurs the ejecta are seen to be brown or blackish, or even white and curdy. The lips are stained Avhite, but they rapidly become brown, then black. In some cases the nervous symptoms are severe and convulsions Avith delirium may occur. The convulsions are epileptiform. 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 irri- tant. The bodily heat must be maintained. Chronic Poisoning.—This is a form of poisoning quite frequently Been. The most prominent symptom is the pale slate-blue color of the skin, which causes the individual to be most livid, and death-like in appearance. NITRATE OF SILVER. 283 Argyria, as chronic silver poisoning is called, is caused by the continued 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 inner part of the lips. The treatment of argyria is not hopeful so far as the color of the skin is concerned, but the discoloration may be slightly modified in some cases 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 Ave possess if combined with extract of hyoscyamus or opium and given in pill form. In chronic gastric catarrh and gastritis nitrate of silver is very useful when the patient is troubled Avith sour eructations or Avhen vomiting occurs after meals. When used in these states it should be given i"1 -jU to 4^-grain (0.01- 0.16) doses, half to one hour before each meal, in order that the stomach may be exposed 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 stom- ach without being chemically changed. In ulceration of the caecum and rectum and in acute and chronic dysentery the disease may be at- tacked by rectal or colonic injections of nitrate of silver. If the caecum is involved, the solution must be given in large quantity in order to reach the part affected, but if the rectum is diseased, the amount of liquid injected should not exceed 4 ounces, the boAvel in either case being washed out beforehand by Avarm Avater to rid it of faeces. Soap and water and salt and Avater must not be used for this purpose, as the soap or salt 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 (4.0 : 1500 cc.) of water in caecal trouble, and 3 grains (0.18) to each 4 ounces (128.0) in rectal trouble. If the latter con- dition is very obstinate and chronic, the strength may be raised to 5 grains (0.3) to each 4 ounces (128.0). Whenever nitrate-of-silver injections are used in this way, a solu- tion of salt and Avater 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 Avith 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 noAv 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 (0.01- 0.015) 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 small-pox if on the fourth or fifth day the vesicles are punctured by a needle dipped in a solution of nitrate 284 DRUGS. of silver in the strength of 20 grains (1.3) to the ounce (32.0) of water. Others simply paint the skin over the eruption Avitli a solution of 5 to 10 grains (0.35-0.65) to the ounce, claiming that this method is equally effective and prevents inflammation and sup- puration. 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.) In 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. In all inflammations of the pharynx, larynx, fauces, and 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 relieAre this, and if it is employed in the strength of 60 grains (4.0) to the ounce (32.0) of Avater, 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 \ to 2 grains (0.03-0.1) to the ounce (32.0) of Avater may do good service. In ivhooping 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 gonorrhoea an injection of nitrate of silver of the strength of gr. I (0.025) to 3 ounces (90.0) is very useful. In uterine ulceration and in leucorrhoea Avhen the cervix is boggy and tender, the application of the solid nitrate-of-silver stick is of service. Its use is often folloAved by headache about the vertex, and this in turn is to be relieved by 10-grain (0.65) doses of the bromides. In pruritus pudendi vel ani and vulva a solution of 4 to 6 grains (0.25-0.40) to the ounce (32.0) should be painted Avith a camel's-hair brush over the parts to relieve the itching. The application is to be made from tAvo to four times a day. Bed-sores may be aborted if, as soon as the skin reddens, a solu- tion of nitrate of silver of the strength of 20 grains (1.3) to the ounce (32.0) is applied with a brush to the part. This measure fails in paralytics. Boih which begin in a small limited papule Avith 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 nitrate of silver in stick form or in solution is largely and success- fully employed. (See Conjunctivitis.) NITRIC ACID. 285 When it is desired to remove nitrate-of-silver stains, they should be washed with a solution made of cyanide of potassium 2J drachms (10.0), iodine 15 grains (1.0), and water 3 ounces (96.0); or dissolve 15 grains (1.0) corrosive sublimate in 7 ounces (200.0) of boiled water, add about 45 grains (3.0) of cooking salt (a scant teaspoonful) just before using, lay the stained materials in it for about five minutes, and then Avash them tAvo or three times. Administration.—The dose of nitrate of silver is \ to 4 of a grain (0.01-0.015) in pill form. Mitigated caustic, or diluted nitrate of silver (Argenti Nitras Dilutus, U. S. ; Argenti Nitras Mitigatus, B. P.), is composed of equal parts of nitrate of silver and potassium nitrate, and is used as a mild caustic. The drug Avhen given continuously should be discontinued for tAvo weeks at the end of the eighth week, as it is so slowly eliminated as to accumulate in the body and cause argyria, but Lewin and Soullier as- sert that the smallest aggregate amount on record which has produced argyria is 1 ounce. NITRIC ACID. Nitric Acid (Acidum Nitricum, U S. and B. P.), the strongest and most corrosive of the mineral acids used in medicine, is a clear liquid, becoming slightly yellow with age. It should be kept in dark, glass-stoppered bottles. Physiological Action.—Nitric acid acts, Avhen in pure form, upon the tissues of the body as a poAverful caustic. Applied to the mucous membranes, Avell diluted, it acts as an irritant or astringent, and when taken internally it exerts a stimulating influence over the secretory glands of the stomach and small intestines. It does not tend to relax the bowels, as does nitro-hydrochloric acid. Continued for a long period of time in small doses, it is said to cause some salivation and looseness of the teeth. Nitric acid coagulates albumin. Poisoning.—When nitric acid is taken in concentrated form it pro- duces a Avidespread gastro-enteritis, great pain in the mouth, oesoph- agus, and abdomen, and finally death, from the inflammation induced or from collapse. If the patient survives the acute stages, he may die from secondary changes in the stomach and boAvels, such as stric- ture or destruction of the peptic tubules. The stain made by the acid about the mouth and clothes is deep lemon-yellow. Renal irritation is often a severe symptom, and the passages from the boAvels and the urine may be bloody. The antidotes are any alkali of a mild type, as magnesium, chalk, or whiteAvash from the walls of the room, the use of oils and opium to relieve irritation, and the proper maintenance of bodily heat. Therapeutics.—Nitric acid is used externally in medicine as a caustic for chancres and chancroids, the surrounding tissues being protected by oils or ointments. It may also be used on ivarts, in cases of gangrene to destroy the tissues, and on phagedenic ulcers. Whenever the acid is to be applied for such purposes, a solution of soap and water should be at hand to neutralize its effects as soon as it has acted deeply enough. Nitric 286 DRUGS. acid is also used externally in a dilute form, 5 to 30 drops (0.35-0.65) to the ounce, as a stimulant and astringent to indolent ulcers. Internally, nitric acid is used as a tonic and astringent. In the oxalic-acid diathesis when oxaluria is present, nitric acid will give relief Avhen nitro-muriatic acid cannot be obtained, although the latter is far preferable. When small ulcers exist in the mouth or stomatitis is present, 3 drops (0.25) of nitric acid at a dose, in water, will often be of service, but it should be taken through a tube to protect the teeth. In gastric indigestion in which, soon after a meal, sour food regurgitates into the mouth, a feAv drops of nitric acid will often give relief. In intestinal dyspepsia coming on some hours after meals, and in which not only discomfort but pain may be felt in the hypochon- drium, nitric acid Avith some simple bitter tonic is most efficient, and it will often cure the green diarrhoea of children, particularly in the summer, bringing about these changes not only by its astringent poAver, but also by its stimulating effect on the intestinal glands. Combined Avith some good pepsin, it will gi\e relief in the chronic diarrhoea of children associated Avith lientery, and in Avhich the stools may be pasty or watery and at the same time ill-smelling. Ringer recommends the employment of nitric acid in the treat- ment of piles. The strong acid should be used, and simply touched to one or two points, not SAvept over the Avhole surface. The pain is very slight, or none at all may be felt. A slough results, and finally comes away, leaving a cicatrix which as it contracts diminishes the size of the pile. The same author also states that a lotion of dilute nitric acid in the proportion of ^ to 1 drachm (2.0-4.0) to a pint (500 cc.) of water is of service in bleeding hemorrhoids, arresting the bleeding, con- stringing the parts, and relieving the sensation of Aveight and fulness so often a pressing symptom. The dose of dilute nitric acid (Acidum Nitricum Dilutum, U. S. and B. P.) is 3 to 15 drops (0.25-1.0), well diluted, and taken through a tube to protect the teeth. NITRITE OF POTASSIUM. Nitrite of Potassium is a salt used largely in modern medicine to take the place of nitrite of amyl, but it possesses greater stability, and is, therefore, more permanent in its effects. It is used for the relief of angina pectoris or heart-pang, in the treatment of gastralgia, and even in epilepsy. The dose is from 3 to 5 grains (0.25-0.3), although much larger doses have been employed. These larger doses are, how- ever, not devoid of danger. Nitrite of potassium is eliminated by the lungs and by the kidneys as a nitrate. (See Nitro-glycerin.) Cobalto-nitrite of Potassium. This preparation has been suggested and tried successfully as a sub- stitute for the nitrite of potassium. As it is a more stable compound, NITR O-GL YCERIN. 287 it is less rapidly broken up in the system, and so exercises a more pro- longed influence. For this reason it does not act so vigorously or suddenly, Avhich is a great advantage in some cases. Its use is iden- tical Avith that of the rest of the nitrite group. The dose of cobalto- nitrite of potassium is ^ grain (0.03) every three hours. NITRO-GLYCERIN. Nitro-glycerin, sometimes called trinitrin or glonoin, is a com- pound Avhich, in its pure state, is used largely as an explosive, but it is employed in medicine in a dilute form as a useful drug in those instances Avhere a someAvhat rapid and poAverful effect is to be exer- cised over the vascular system. Its physiological action is identical AATith that of the other nitrites, such as the amyl nitrite (Avhich see), except that it is not so fugacious as the latter, nor so persistent in its effects as the nitrites of sodium and potassium. The dose is 1 to 2 drops (0.06-0.12) of a 1 per cent, solution in a little Avater or in a pill, and no more than this may be employed at one dose unless the patient takes the remedy for a considerable period of time, when as much as 60 drops may be administered. Often good results are obtained only by giving ascending doses. It is noteAvorthy that patients rapidly become immune to the drug, and Reading has recorded a case in Avhich, after a year of treatment, 1 drachm (4.0) of a 10 per cent, solution was taken daily with good effect. D. D. SteAvart has also reported similar cases. The drug is largely em- ployed in angina pectoris (see Part IV.), and sometimes in epilepsy and chorea and in gastralgia. DaCosta and others have highly commended this drug in the treatment of chronic parenchymatous nephritis, as it very distinctly decreases the escape of albumin from the kidneys. In interstitial nephritis, with cardiac disturbance re- sulting from the renal changes, in Avhich there is a marked increase in arterial pressure, so that auscultation reveals at the second right costal cartilage an accentuated second sound due to the forcible closure of the aortic leaflets, nitro-glycerin often produces a good effect by reducing the pressure and relieving the heart of strain. It is Avhen attacks of angina pectoris seem to be accompanied or pre- ceded by marked vascular spasm, that nitro-glycerin is chiefly indi- cated. In cases of asthma dependent upon engorgement of the mucous membranes of the bronchial tubes it is very serviceable. Humphreys asserts that nitro-glycerin is a most valuable drug in vomiting of all kinds, except that of pregnancy and peritonitis. The solution used in medicine is too Aveak to be explosive. Tablets of nitro-glycerin (Tabello? Trinitrini, B. P.) each contain -^ of a grain (0.0006)." The U. S. P. of 1890 has introduced a Spiritus Glonoini, Avhich is an alcoholic solution of glonoin. It should be kept in tightly- stoppered tins, never in glass, and be stored in a cool place, aAvay from heat. Its explosiveness is in direct ratio to the evaporation of its alcohol. The dose of the spirit is the same as that of the Avatery solution—namely, 1 to 2 drops (0.05-0.1). The watery solution is not explosive. 288 DR UGS. NITRO-HYDROCHLORIC ACID. Nitro-hydrochloric Acid (Acidum Nitro-hydrochloricum, U. S.) is a liquid giving off a distinct odor, and possessed of a very caustic poAver, staining the tissues of the body a light yelloAv. It is official in the form of the dilute acid (Aridurn Nitro-hydrochloricum Dilution, U. S. and B. P.), in Avhich form it is useless except as an ordinary acid. When we Avish to use the acid for its OAvn peculiar effects, the official dilute acid ought ahvays to be supplanted by the freshly-mixed strong acid and be of an orange color. If this cannot be obtained, the physi- cian should prepare the compound for himself by adding 4 parts of medicinally pure nitric acid to 16 parts of hydrochloric acid, and allowing the mixture to stand in an open bottle until the fumes are no longer given off in excess, Avhen it must be tightly corked and kept in a dark place. This acid ought to be freshly prepared every feAv days. Poisoning.—The symptoms caused by poisonous doses are those of violent gastro-enteritis with vomiting and purging of bloody materials. Death may occur from perforation of the alimentary canal, from inflam- mation of the abdominal viscera, and from destruction of the peptic tubules or constrictions of the oesophagus or bowel. The treatment consists in the use of alkalies, such as magnesium, lime, AvhiteAvash, soap, and oils, with opium to allay irritation. The use of external heat to prevent collapse is also to be resorted to. Therapeutics.—Nitro-hydrochloric acid is an invaluable remedy in many cases of indigestion arising either in the stomach or bowels, as it acts as a tonic and stimulant to secretion. Upon the biliary flow its action is quite marked, and it may even cause bilious purging if administered in full doses for some days. It is therefore largely used in hepatic torpor, either acute or chronic, and in the early stages of hepatic cirrhosis should always be resorted to. In the chronic hepatitis of hot climates it is exceedingly useful, but it is not to be employed in acute sthenic hepatitis, as it is a stimulant to the liver, which, under these conditions, needs quieting. When used in chronic hepatitis it should be given in full dose and pushed to its physiological limit, as evidenced by the bilious purging produced or by signs of gastro-intes- tinal irritation. A useful additional means for obtaining the beneficial effects of this acid is to use it by means of the foot-bath or general bath. As used by Johnson in India, the acid for this bath is prepared by slowly and carefully adding together 2 parts of nitric acid, 3 parts of hydro- chloric acid, and after tAventy minutes mixing carefully Avith these dis- tilled Avater 5 parts. For the general bath (in a wooden tub) take 5 pailfuls of water, 64 fluidounces (2 litres +) of the acid mixture, and enough boiling Avater to raise the temperature to 98°. Keep the patient in the bath tAventy minutes. Then rub him thoroughly with warm towels and place him in a dry, ay arm bed. For the foot-bath add 6 ounces (180.0) of the acid to 2 gallons (7 litres) of water at 98°, and bathe the thighs and calves of the legs for tAventy minutes Avith a sponge Avet with the mixture. This is a very useful treatment, NITROUS ON IDE. 289 according to Stille, for cases of alcoholic hepatic torpor. If in either case the skin becomes irritated less acid is to be used. In ordinary so-called biliousness, Avhich is not biliousness, but intestinal indigestion, this acid is often of great service. (See Indi- gestion and Biliousness.) It is also of value in dysenteric diarrhaa where the dysentery rests upon defective secretory action on the part of the glands A\hich pour out the proper fluids for digestion. Another very important action of nitrohydrochloric acid is the re- medial influence it exerts in cases suffering from oxaluria, particularly if this be associated Avith melancholia or great depression of spirits. Administration.—The strong freshly-mixed acid should be given to the adult in the dose of 1 to 3 drops (0.05-0.18) three times a day, Avell diluted, and taken through a tube, after meals. If the patient is intelligent, he should be ordered h ounce (16.0) of the pure acid and told hoAv to drop it. If he is not, the physician must order it partly or entirely diluted in the prescription, and in so small an amount that it may be reneAved before it loses any of its power. Warning should be given of its effects on any clothes Avith Avhich it may come in contact, and care should be taken that the bottle is held some dis- tance aAvay from the face Avhen the cork is AvithdraAvn, as the acid, if it is fresh, may spurt out and burn the eyes and face. NITROUS OXIDE. Nitrous oxide or nitrogen monoxide is sometimes called protoxide of nitrogen or "laughing gas." Its power of relieving pain was first recognized by Sir Humphrey Davy about one hundred years ago. As Avith ether, so Avith nitrous oxide, its first use as a surgical anses- thetic was by an American, Horace Wells, a dentist. This gas is obtained by a complicated process which requires the use of such cumbersome apparatus that its manufacture is out of the question for the ordinary practitioner of medicine, Avhile the fact that several large firms prepare the gas and sell it in cylinders ready for use renders its preparation on a small scale unnecessary. The gas is devoid of odor, but possesses a slightly SAveet taste. It may be kept in gase- ous form or liquefied and alloAved to become gaseous as it is used. Physiological Action.—OAving to the symptoms sometimes produced in patients inhaling this gas. it has received the popular name of "laughing gas," but a condition of hilarity is rarely seen Avhen the inhalations are full and deep, and only comes on in the majority of cases Avhere the gas is taken in small amounts or very sloAvly. When used properly, the patient is directed to take long, deep inspirations from the tube placed in the mouth, the nose being held so that the nos- trils are closed. Under these circumstances the face becomes for a moment flushed, then of a deadly pallor, and finally the jaAV drops if the effect is very great. At this time anaesthesia is complete and the operation is to be rapidly performed. Owing to the fact that Avhen pure it is devoid of irritant properties, this gas can be used Avhen ether and chloroform are contraindicated. According to the most recent studies upon the action of this gas 19 290 DRUGS. (Kemp), it has no direct effect on the heart and vasomotor system, but indirectly it causes a rise of arterial pressure by the slight asphyxia Avhich is produced. The anaesthesia may be due in part to the non-oxygenation of the blood during the time the gas is in this fluid, but the gas produces anaesthesia aside from any such influence by a direct action on the cerebral cortex. It is a curious fact that the conjunctival reflex is often preserved after general anaesthesia is present. It has been thought that the use of this drug produces temporary glycosuria, but recent studies render this doubtful, to say the least. Where permanent glycosuria has been produced some injury to the vascular system in the region of the diabetic centre in the floor of the fourth ventricle has in all probability occurred. The gas ought not to be given to those Avho are advanced in years or have atheromatous blood-vessels, since the rise of arterial pressure conse- quent upon the asphyxia may rupture a cerebral blood-vessel and thereby cause an apoplexy. Nitrous oxide gas when inhaled very rarely produces any disagreeable after-effects, save a little light- headed sensation or dizziness for a feAv hours. Therapeutics.—Nitrous oxide is a useful anaesthetic in all minor operations, such as opening an abscess, boil, or felon, or even ampu- tating a thumb. It possesses two disadvantages, the first of AA'hich is its brevity of action; the other, the difficulty in carrying it about from place to place. It possesses a great advantage in almost abso- lute safety, very feAv deaths having been caused by it directly. It is the safest of all anaesthetics, not even excepting cocaine, Avhich latter drug has largely supplanted the gas for many minor surgical opera- tions. When teeth are to be extracted, a plug or cork is placed be- tAveen the jaAvs before the gas is given, to keep them apart, and the cork should ahvays be attached to a string, so that if it slips into the back part of the mouth it may be AvithdraAvn before it chokes the patient. Oxygen gas may be combined with nitrous oxide gas Avith as great advantage as Avith the vapor of ether or chloroform, although its use may delay to a slight extent the development of anaesthesia. The fol- loAving classes of persons, according to HeAvitt, do better with the mix- ture of oxygen and nitrous oxide than Avith the nitrous oxide alone: 1. Children (av!io with nitrous oxide alone are liable to inconvenient jactitation); 2. Anaemic and debilitated patients, Avho, like children, quickly exhibit muscular contractions, and, in addition to this, remain but a very short time under the influence of nitrous oxide alone ; 3. Any one Avho has previously exhibited great susceptibility to nitrous oxide per se (such patients are difficult subjects to manage in dental practice because of the short period of available anaesthesia); 4. Patients who, under nitrous oxide alone, have experienced highly unpleasant sensations ; 5. Patients very advanced in years ; 6. Patients with very large tonsils; 7. Patients suffering from heart or lung affections. NUCLEIN. The animal body has several methods of protecting itself from the attacks of infecting micro-organisms. One of these is by phagocytosis, NUTMEG. 291 or the devouring of the germs by the cells of the body ; the other is by the protective or germicidal influence of the blood-serum. It has been proved that the latter poAver depends upon the presence in the blood of certain proteid-like bodies rich in phosphorus. Avhich can also be derived from cell-nuclei and other sources, such as yeast-cells and many animal tissues. Nuclein is a Aveakly acid body composed of nucleic acid and some form of proteid matter, and it not only increases the germicidal power of the blood-serum Avhen it is given to man or one of the loAver animals, but in addition it causes a great increase of leu- cocytosis, Avhich of course aids in phagocytosis and probably results in the production of still more nuclein from the leucocytes. Nuclein, as placed upon the market, is manufactured, as a rule, from yeast. It is prepared in many different ay ays and much of it is unreli- able and possesses none of the characteristics of true nuclein. Very recently Chittenden of Yale University has analyzed the various nu- clein preparations on the market; and he finds a preparation called "nuclein standard" to contain no phosphorus, and, as phosphorus is a prominent constituent of nuclein, he says it " seems obvious that the solution contains no nuclein." " Protonuclein," another preparation of this character, contained 1.25 per cent, of phosphorus, and therefore contains in all probability nuclein, and the improved nuclein solution of Parke, Davis & Co., which is a 1 per cent, solution of pure nucleinic acid from yeast, contained 6 per cent, of phosphorus, " Avhich Avould imply the presence of even more than 1 per cent, of such a nucleic acid" (Chittenden). 1$ is evident, therefore, that this preparation of nuclein is a good one to use in testing this neAv method of treatment. Therapeutics.—Nuclein is used Avith asserted great success in the treatment of the ordinary forms of pulmonary tuberculosis and for septicaemia. Theoretically it should prove useful in combating any infectious process. Administration.—The proper way to use the nuclein solution just named is to give 10 to 6') minims (0.65-4.0) hypodermically once, twice, or thrice a day with careful antiseptic precautions, or to give a teaspoonful (4.0) in a Avineglassful of Avater on an empty stomach thrice during the day and at bed-time. Contraindications.—The nucleins should not be given for a long period of time to gouty persons ; these patients usually have uric-acid troubles under their use, as nuclein is an antecedent of uric acid. NUTMEG. Myristica, U. S. 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 diarrhoea. The oil (Oleum Myris- ticce, U. S. and B. P.) is given in the dose of 1 to 3 drops (0.05- 0 15). The spirit or essence (Spiritus Myristicce, U. S.) is used in the dose of 1 to 2 fluidrachms (4.0-8.0). 292 DRUGS. Several cases of poisoning by nutmeg are reported, the most recent by Dr. Reading of Woodbury, N. J. The symptoms closely resemble those produced by excessive doses of cannabis indica. NUX VOMICA. Nux Vomica ( U. S. and B. P.) is the seeds or beans of the Strych- nos Nux-vomica, an East Indian tree. It contains two alkaloids, strychnine and brucine, and depends largely for its medicinal poAver on the former. For this reason the statements made in regard to the physiological action of strychnine may practically be considered as applicable to the entire drug. Physiological Action.—When strychnine is given to man or the loAver animals in full medicinal dose it increases reflex activity, res- piratory rate, pulse-force, arterial pressure, the acuity of vision and hearing, and causes general systemic irritation or excitement. Nervous System.—On the nervous system strychnine exerts-its chief influence. It excites the spinal cord in its motor tracts, and probably increases the receptive activity of the sensory centres. It also has some slight influence in increasing the conductive power of the motor and sensory nerves. In overdose strychnine produces spinal or tetanic convulsions by an action exerted on the spinal cord. When enormous doses are given intravenously, total paralysis, resembling that caused by curare, precedes the convulsions, and if artificial respiration is not used the animal dies from failure of respiration. If death takes place from the effects of the drug, the motor nerves are found to be depressed, partly as the result of the poisonous action of the strychnine, and partly as the result of the exhaustion of the nerve-trunks by the con- vulsing impulses Avhich they have carried. Circulation.—Nux vomica increases the force of the pulse-beat and the pulse-rate by a stimulation of the heart-muscle and its gan- glia, while the rise of arterial pressure Avhich it causes is due to stimulation of the vasomotor centre. If very poisonous doses are injected intravenously, a fall of arterial pressure occurs instead of a rise, Avhich is due to vasomotor depression and paralysis. Respiration.—Strychnine is one of the most constant and poAv- erful stimulants to the respiratory centre that Ave have, and it not only increases the rate, but the respiratory capacity. Temperature.—Ordinary doses have no effect upon temperature, but poisonous doses may raise it by reason of the convulsions. Elimination.—Strychnine is eliminated from the body by the kidneys as strychnine and strychnic acid. Most of it is oxidized and destroyed by the liver. Poisoning.—When a poisonous dose of strychnine is taken, it acts either suddenly or gradually. If suddenly, the man or animal may be, without any premonition, thrown several feet and becomes rigid by contraction of his muscles. If the onset is gradual, some stiffness at the back of the neck and uneasy startings may precede the general nerve-storm. The convul- NUX VOMICA. 293 sions are tetanic, or, in other words, tonic, and the body is throAvn into opisthotonos; that is, resting on the head and heels at each con- vulsion. Sometimes the trunk is tAvisted sideAvise or the flexion of the body is forward (emprosthotonos). The eyes are open and fixed, the corners of the mouth draAvn back into risus sardonicus, and respiration during a severe convulsion is impossible, OAving to the respiratory muscles being in a state of tetanic rigidity. The slightest noise, draught of air, or touch may cause a convul- sion or convulsion after convulsion, because the sensory impulse, reaching the spinal cord, causes a spasmodic motor impulse to be sent out to the muscles. The convulsions are not absolutely continuous, but periods of utter or partial relaxation occur, during Avhich the patient breathes easily. The cramp-like contractions of the muscles are exceedingly painful, and the patient either dies of cramp asphyxia—that is, through fail- ure of respiration because his chest-muscles are locked in spasm— or, much more rarely, from exhaustion. Reichert has shown that it requires five hundred times the ordinary fatal dose of strychnine to cause death in animals if artificial respiration is properly maintained. Treatment of Poisoning.—The attendant should give at once, if no symptoms have yet appeared, inhalations of nitrite of amyl, and mean- while employ the stomach-pump, using the nitrite to prevent any con- vulsive tendencies during the operation. Draughts of water contain- ing tannic acid, as the chemical antidote, are to be administered, and after the stomach is washed out 60 grains (4.0) of bromide of potas- sium and 20 grains (1.3) of chloral in solution are to be given. These are the physiological antidotes, for the bromide of potassium depresses the sensory tracts of the spinal cord, and the chloral depresses the motor tracts. If the convulsions prevent swalloAA'ing, the patient must be chloroformed with care, and the physiological antidotes given in starch-Avater by the rectum, muscular relaxation being maintained by the anaesthetic until the drugs are absorbed. Ether cannot be used as a relaxant, as it is too irritant and too sIoav. Nitrite of amyl is a physiological antidote, but it is useless if a complete convulsive attack is present, as it cannot be inhaled if the chest is immovable. Neither can any other relaxant, such as chloroform, be used under these circumstances. These drugs should be gently given betAveen the paroxysms. If relaxation does not occur, the nitrite of amyl should be injected hypodermically. While a light touch may produce a spasm, a firm, hard grasp of the limb often relieves the pain of the cramp. Sensation and con- sciousness are preserved in strychnine poisoning unless the asphyxia destroys them. Differential Diagnosis.—The convulsions of strychnine poisoning do not resemble epilepsy, because they are so distinctly tonic and never clonic. From tetanus strychnine poisoning is to be separated by the fact that in tetanus the locking of the jaAvs comes first, Avhile in strychnine poisoning it comes last. The convulsions of tetanus rarely, if ever, completely relax, Avhile those of strychnine do have 294 DRUGS. periods of relaxation. There is a different history in each case—in one perhaps of an injury, as of a nail run into the foot; in the other, of a dose of poison having been swallowed. The differential diagnosis of strychnine poisoning from hysterical convulsions is more difficult. The convulsions are rarely so persist- ently tonic in hysteria, and the peculiar expression of the hysterical face is often seen in such cases. The history of the patient, if obtain- able, will throAv much light on the case and aid very materially in the separation of the two conditions, Avhile the peculiar variations in cutaneous sensibility, such as areas of hyperaesthesia and anaesthesia, which are so characteristic of hysteria, may render the diagnosis pos- sible. As the treatment of all these states is virtually identical, the employment of the measures just suggested may be resorted to in each instance, and the diagnosis made afterward. Therapeutics.—Nux vomica, or its chief alkaloid strychnine, is used for several purposes in medicine. Owing to its bitter character- istics it may be employed as a simple bitter tonic or as one especially influencing the nervous system. It may also be used as a respiratory, cardiac, and ocular stimulant. In cases of functional nervous atony, or depression, strychnine does good, but in organic disease, if used during the period of acute inflammation, as after an apoplexy or in acute infantile palsy, it is distinctly harmful. Some persons Avho have suffered from apoplexy can never take the drug Avithout a spasm coming on in the paralyzed part or parts. In acute or subacute neuritis strychnine ought never to be used in any Avay Avhatever, as the nerves are already inflamed, and are not to be still further irritated by the employment of nervous excit- ants. In progressive lead palsy large doses of strychnine should be constantly used to stop the progress of the disease, iodide of potassium also being employed to cause the elimination of the lead. In amaurosis dependent upon the excessive use of tobacco or alco- hol strychnine is almost a specific, and in eye-strain resulting from insufficiency of the ocular muscles it does great good, curing the insuf- ficiency and improving the general condition of the muscles. Accord- ing to de Schweinitz, the patient should use ascending doses of the tincture of nux vomica, beginning with 3 drops (0.15) three times a day, and increase the amount 2 drops (0.1) a day until distinct physiological effects are produced. Sometimes 60 drops (4.0) may be taken in twenty- four hours after tolerance is reached. In pneumonia and all other acute diseases in which sudden collapse is liable to occur strychnine is of the greatest service at the time of need. Often it will pull the patient out of a sinking attack which seems certain to end in death. It should be used freely by the hypo- dermic needle, and is often aided in producing its good effects by the addition of -^ to y^y grain (0.0004-0.0006) of atropine to each injec- tion. (See Pneumonia and Shock.) There is no drug known which is so antidotal to the effects of over- doses of chloroform as is strychnine. In cases of sudden accident, Avith arrest of the heart or respiration during the use of this anaesthetic the OPIUM. 295 physician should give hypodermic injections of y1^- grain (0.006) of strychnine as a powerful, rapidly-acting cardiac and respiratory stimu- lant, Avhich dose may be repeated1 in ten minutes if no effect is produced. Strychnine is a very valuable remedy in surgical shock, and is a better antidote to opium than is belladonna. In dyspnoea from any cause, such as that of old persons suffering from winter cough or bronchorrhoea, in emphysema, phthisis, and in shortness of breath, strychnine is of service, and it is a valuable drug for the treatment of opium-poisoning, because it preserves the reflexes and stimulates the respiratory centre. In atony of the bowels strychnine is of service, and it is to be added to purgative pills to avoid their depressing after-effect on the intestines. In cases in Avhich a lesion exists in the brain, strychnine may be used to keep up the nutrition of a limb Avhich is paralyzed; but if the palsy be due to disease of the trophic cells in the spinal cord, it does little good except to stimulate the remaining cells to greater effort. According to Ringer, sick headaches, due to errors in diet and without much nausea, can be put aside for the day by the use of 1 drop (0.05) of the tincture of nux vomica in a teaspoonful (4.0) of water every five or ten minutes until 10 drops (0.65) are taken. Strychnine possesses no curative properties in chronic alcoholism. Owing to its poAverful stimulant properties it may temporarily brace the nervous system, but its prolonged use is dangerous. It should only be employed to combat great depression of the system. Untoward Effects.—Care should be exercised in giving strychnine to children, as they are more susceptible to the drug than are adults. The proper beginning dose of strychnine by the mouth for a child of five or six years is not more than y-^j- grain (0.0006). In some cases of exhausting disease the prolonged use of full doses of strychnine may produce a talkative delirium Avith great peevishness, and, if the drug is continued, this condition may pass into a state of temporary insanity. Brunton asserts that nux vomica may induce malarial chills in those predisposed to them. He also asserts that strychnine acts more power- fully Avhen given by the rectum than by the mouth. This is doubtful. Administration.—The extract of nux vomica (Extraction Nucis Vomica, U. S. and B. P.) is given in the dose of -^ to y of a grain (0.01-0.016); the fluid extract (Extraction Nucis Vomicae Fluidum, U. S.; Extractum Nucis Vomicae Licpiidum, B. P.), in the dose of 1 to 5 drops (0.05-0.3); the tincture (Tinctura Nucis Vomicce, U. S. and B. P.), in the dose of 5 to 30 drops (0.3-2.0). Strychnines Sulphas, U S. and B. P., and Strychnine Hydrochloride (B. P.) are given hypodermically in the dose of ^ to ^lT of a grain (0.002-0.003), and by the mouth in the same amounts. In cases of severe surgical shock as much as y grain (0.016) may be used hypodermically. OPIUM. Opium (U. S. and B. P.) is the juice or milky exudation appear- ing on the surface of the unripe capsules of white poppy or Papaver somniferum, a native plant of Asia, now groAvn in many other parts of the Avorld. 296 DRUGS. Good opium, according to the U. S. P., should contain at least 9 per cent, of crystalline morphine, but the poAvdered opium (Pulvis Opii. U. S.) should contain not less than 13 or more than 15 per cent, of morphine. The chemical composition of this drug is very complex, no less than seventeen alkaloids having been obtained from it, the most important of which are morphine, codeine, narcotine, thebaine, narceine, papaver- ine, pseudomorphine, and laudanine. It also contains meconic acid and meconine. Physiological Action.—The action of opium upon man and the lower animals varies Avith the degree of intelligence or cerebral development. It quiets the brain and excites the spinal cord. Nervous System.—The dominant action of opium upon man is to produce nervous sedation in small doses and sleep Avhen given in larger amounts. Sometimes, hoAvever, in persons who are accustomed to its use, it produces a state of restless insomnia or quiet, wakeful apathy. When given to frogs it often produces tetanic convulsions, OAving to its primary stimulant effect on the spinal cord. In dogs it increases the reflexes and produces droAvsiness, and in man sleep. If, however, the patient be a member of one of the lower races or a young child, the spinal irritation may be as manifest as the cerebral sedation. If large doses are given, sleep is produced in all animals, and both the brain and spinal cord are depressed. The sensory nerves are also markedly benumbed, and the motor nerves may finally be rendered inactive. Circulation.—Small therapeutic doses of opium have no effect upon the circulation, but large ones slow the pulse, increase its force, and slightly raise arterial pressure. The sloAving of the pulse depends upon stimulation of the pneumo- gastric nerves peripherally and centrically ; the increase in pulse-force rests upon the stimulation of the heart-muscle and its ganglia: the rise of pressure is due chiefly to the increased heart-action. After poisonous doses the pulse becomes rapid and feeble, due to depression of the vasomotor centre and the heart, and the gradually increasing asphyxia. Respiration.—In very minute doses opium is a feeble stimulant, or at least not a depressant, to the function of respiration. In over- dose it is one of the most powerful paralyzants of the respiratory cen- tres in the medulla oblongata, causing death by this action. Temperature.—The bodily temperature is raised slightly by full doses and lowered by poisonous amounts of opium. Tissue-waste.—Opium acts as a preventive to tissue-waste, decreas- ing the elimination of urea and other results of nitrogenous break-doAvn. Elimination.—The drug escapes from the body, if given in excess, as morphine, by Avay of the intestines and kidneys, but most of it is destroyed by oxidation in the liver and tissues. Experiments made by Alt and Tauber show that morphine is chiefly eliminated by the stomach, and that if this viscus is frequently washed out during a case of poisoning, recovery is much aided, as by this means reabsorption is prevented. Pupil.—Opium contracts the pupils by a centric stimulation of OPIUM. 297 the oculo-motor nerves, and perhaps by depression of the sympathetic fibres. Stomach, Intestines, and Secretion.—Opium depresses the motor activity of the stomach and intestines and produces constipa- tion. It does this by stimulating the splanchnic inhibitory fibres of the intestine and thereby preventing peristalsis. In very large doses it increases peristalsis by paralyzing these fibres. Opium checks every secretion in the body except that of the skin. Acute Poisoning.—When opium is taken by man in overdose it causes droAvsiness, deep sleep, full breathing,* a sIoav, full pulse, a Avarm, dry skin, contracted pupils, and pleasant—or, more commonly, in the Anglo-Saxon race, disagreeable—dreams or no dreams at all. Preceding this period there may be a brief one during Avhich the person feels self-satisfied and contented. The duration of this agree- able sensation only lasts a short time, and if the dose is large does not occur or at once passes off. It has been called the first stage, while the more marked symptoms just described have been grouped into a so-called second stage. During the sleep of the second stage the patient can be roused by shouting in his ear or by violent shaking, but sinks back into slumber at once on being left alone. The face is suffused and reddened, and may be finally distinctly cyanotic. Many of the symptoms resemble those of congestion of the brain. The breathing may be puffing and stertorous. When the patient is aAvakened he breathes more rapidly, and for this reason the duskiness of the face disappears and the normal hue returns. Death never occurs in the second stage of opium poisoning from the poison alone, but if a complicating disease is present death may take place at this time. The third or fatal stage emerges from the second by a process so gradual that no abrupt line of separation can be noted. The face becomes at first more cyanotic, then pale and livid; the respirations, Avhiph have been eight to ten to the minute, are noAV only four or five, and finally such prolonged pauses occur that all hope of another res- piration is lost by the attendant. While the sIoav breathing is at first deep, it now rapidly becomes shalloAv, and muscular relaxation is present to the greatest degree. The skin, previously dry, is wet with the sweat of death, the patient is so deeply narcotized that nothing can arouse him, and he dies from respiratory failure, although the heart ceases almost simultaneously from the asphyxia. The pupils do not dilate in the third stage, except in the relaxation of death. Treatment of Acute Poisoning.—After employing the usual methods resorted to for the purpose of unloading the stomach, and after giving permanganate of potassium or tannic acid, preferably the former, as the chemical antidote, the patient should receive one or two cups of strong black coffee, hot and concentrated. The heat in the liquid is useful in maintaining bodily temperature, and the caf- feine stimulates the respiratory centre and keeps the man awake. Coffee should be used even before any symptoms come on, in order to 298 DR UGS. put them off if possible. If strychnine is at hand and the respirations are becoming very slow, -Jj- to yL- of a grain (0.003-0.006) should be given hypodermically. Strychnine is much better than atropine as an antidote to opium, and should be given hypodermically in full dose, repeated frequently enough to keep the nervous system of the patient active and respiration intact. The pupil is no guide as to the action'of atropine in opium poisoning, as the action of these tAvo drugs (opium and atropine) on the eye is not directly antagonistic. Alcoholic stimulants may be called for, and ammonia as a cardiac and respiratory stimulant may be resorted to. In the third stage heat should be applied to the trunk and extrem- ities. Much emphasis has been placed on keeping the patient awake, and it has been thought that the cause of death was the deep sleep. This is not so. The man must be kept aAvake in order that he will supplement the efforts of his depressed respiratory centres by volun- tary breathing. If he sleeps, he forgets to breathe, and sleep means death for this reason, and not because sleep in itself produces death. Besides the use of the hot strong coffee, the patient may be kept aAvake by lashing him Avith SAvitches or by keeping him Avalking up and doAvn between tAvo attendants. Both of these measures are rep- rehensible if anything better can be done—the first method because it covers the patient Avith cuts and bruises, the second because it may aid in the production of death by exhaustion. If an ordinary med- ical faradic battery is at hand, the full force of the current may be allowed to come in contact with the skin from two small poles wet with salt water, or, better still, the dry or wire electric brush should be SAvept over the body Avhile the negative pole is held in the hand of the patient or pressed against his skin. This causes the most exqui- site pain in the normal individual, but if the brush is kept moving will not cause any bruises or discoloration. (See Asphyxia.) Arti- ficial respiration may be resorted to. As already pointed out Avhen discussing the elimination of opium, the dose is eliminated into the stomach from the blood-vessels and then reabsorbed. Frequent Avashing out of the stomach is therefore advis- able in treating cases of poisoning. Chronic Poisoning.—Morphine or opium Avhen taken constantly generates a habit. The person—or morphine-habhue, as he is some- times called—depends for a comfortable existence on the drug, and day by day increases his dose until the most extraordinary amounts are taken by the stomach or by means of the hypodermic needle. If the drug is withheld, a train of symptoms typifying depression or exhaustion ensues. The pulse is scarcely to be felt, horrible mental depression and melancholia come on, the miserable man or woman wrings his or her hands, and begs, screams, hoAvls, or yells for mor- phine, only to break doAvn and cry on being refused the customary dose. Diarrhoea of a serous type and most violent in character, with cramps in the muscles, may assert itself, and must be controlled by astringents and an active line of treatment as far as possible free from opium. (See Diarrhoea.) OPIUM. 299 A characteristic symptom of chronic opium-eating is the develop- ment of the most clever lying in previously truthful persons. In the same breath that the patient begs the physician to cure him, he will lie to obtain the drug in a surreptitious manner, and may even have the drug in his mouth at the moment he speaks. It A\:ill often be found hidden in the seams of the clothing in small packages, and the nurse must be absolutely reliable, above bribery, and forever on the watch lest the drug be obtained by smuggling. Any sudden improve- ment on the part of the patient should be placed to the credit of more morphine, not to professional skill. Treatment.—The best way to treat such cases is to " taper off" the daily dose, and to decrease by a sixth or a fourth the total cus- tomary amount in each tAventy-four hours. The sudden complete withdrawal of the drug is an unnecessarily severe measure, and its withdraAval in a sloAver manner than that named is simply prolonging the treatment beyond reasonable limits. Cocaine has been used to tide over the crisis after the AvithdraAval of morphine, but too fre- quently the patient passes from opium to the cocaine, and finally to the alcohol habit, all of which are equally bad. If the circulation flags, digitalis and strychnine may be given and the remaining symp- toms treated as common sense indicates. Sometimes paregoric is taken in excess, and the writer has seen and treated a case in Avhich over a pint of paregoric Avas taken every day. When a mother is an opium-eater, the new-born child often suffers from collapse on the second or third day after its birth, owing to the lack of its customary dose of opium. Therapeutics.—Opium is used for the relief of five great conditions, Avhich will be spoken ^f seriatim, the minor uses of the drug being considered afterward. These are pain, insomnia, inflammation and irritation, over-secretion, and systemic strain. Pain.—Opium is the best remedy that Ave possess for the relief of all forms of pain, except in those instances Avhen neuralgia exists, Avhen antipyrin and its fellow-compounds exceed it in medicinal value because they have no marked after-effects. It is to be remembered, hoAvever, that no drug has yet been discovered Avhich equals its pain- relieving poAver in this or any other painful affection. In one form of pain opium is not to be employed—namely, that arising from cerebral congestion and cerebritis, for it is distinctly contraindicated in these affections, as it makes them Avorse. In acute or traumatic meningitis, however, opium is of great service, either alone or combined with mercury in sthenic cases. In the treatment of cases of renal and hepatic colic associated Avith spasm, and in dysmenorrhea, bella- donna and opium given together will relieve the spasm and pain, and yet so counteract each other elseAvhere in the body as to be devoid of marked effect upon other organs. Usually in these severely painful affections it is best to give morphine and atropine hypodermically. Persons suffering from pain will ahvays bear very much larger amounts of opium than painless individuals. For the relief of violent pain physicians of experience usually employ morphine hypodermically as the most rapid and effective 300 DR UGS. means of giving relief. If this is not possible, the morphine should be given by the mouth in a little hot Avater with or Avithout Avhiskey or brandy added to it; or deodorized tincture of opium may be given in the same manner. If neither the hypodermic needle nor the draught can be resorted to, then the drug is best given in the form of the fluid extract, or tincture, by the rectum, being first mixed with some Avarm starch-Avater. If the pain is chiefly in the pelvic viscera, the rectal administration of the drug is always advisable by injection or by suppository. When the pain is due to violent sciatica or to muscular spasm it is best relieved by injecting the morphine directly into the subcutaneous tissues over the affected part. In other instances local pain due to superficial inflammation may be relieved by compresses Avet Avith laudanum and lead-water. To patients Avho are prone to frequent attacks of pain opium must be given with the greatest caution, as the "opium-habit" is easily produced. Insomnia.—Opium, while capable of producing sleep in almost every case in Avhich it is given, save in those persons who by reason of idiosyncrasy are made wakeful by it, is only to be used in those instances Avhere the sleeplessness is due to pain. If constantly used for the relief of insomnia or pain, the opium habit is rapidly contracted, and for this reason the use of this drug should be alternated with chloral, cannabis indica, and other soporific drugs. In some cases chloral and morphine, Avhen given in small doses in combination, will so act upon the brain as to produce sleep. Thus, in the following prescription, the dose of both active ingredi- ents is much smaller than would be needed if either one was used alone, yet the result sought by their use—namely, sleep—is readily produced: R.—Morphinse sulph.............gr- ij (0.10). Chloralis...............3j (4.0). Syrupi................ffl (32.0). Aqwe dest.............q. s. f^'ij (64.0).—M. S.—Dessertspoonful (8.0) at nine P. m., and, if needed, again at ten or eleven o'clock. In the insomnia of typhoid fever opium may be used, particularly during convalescence, but it must be employed most carefully, and it is far better to give the patient cold affusions preceded by a hot bath to equalize the circulation and produce sleep. (See Heat and Cold, Part XI.) Inflammation and Irritation.—Opium seems to possess some influence over inflammation which Ave cannot explain, and both small and large doses are particularly valuable in inflammation of serous membranes, such as peritonitis, meningitis, and pericarditis. In peritonitis opium has been thought to be very useful, but grave doubts are noAv entertained as to its value. (See the article on Peri- tonitis in Part IV.) It allays the nen^ous excitement and cough following haemoptysis, and the intense unrest caused by itching skin diseases, as, for example, the irritation of small-pox. OPIUM. 301 Sometimes intense irritation or inflammation produces so great an effect upon unstriped muscular fibres as to cause spasm or paralysis, as in retention of urine, cystitis, or the constipation folloAving inflammation of the boAvels due to the ingestion of irritating foods; under these cir- cumstances the employment of opium is indicated, and is usually very successful. In irritative coughs morphine given in syrup of Avild-cherry bark does good in the dose of yL to -fa of a grain (0.005). Opium is often used, or its alkaloid morphine, to allay nervous excitement and cough in cases of hamoptysis. In some cases of irritable cough, due to a tickling sensation in the larynx much relief can be had by inhaling the steam arising from a cup of boiling water in which has been placed a drachm or tAvo of pare- goric. Whenever a cough is in excess—that is, greater than is necessary to free the lung from mucus—morphine may be given in small doses. If the lungs contain more rales after its use than before, its use must be stopped, as the increase in the number of rales indicates an increase in the accumulation of mucus. In the treatment of strangury due to cystitis, and in rectal inflam- mation, provided they are not acute, and after operation on the pelvic organs, suppositories of the strength of T or l of a grain (0.016-0.03) of the watery extract of opium are very useful. In excessive vomit- ing from any cause, except it be from a previous dose of opium, an enema of deodorized laudanum 30 drops (2.0) and starch-Avater 4 ounces (128.0), with 20 grains (1.3) of bromide of sodium, will be found of value. (See Vomiting, Part IV.) In muscular rheumatism and similar states, and when a "cold" has been taken, opium in the form of Dover's powder in the dose of 5 to 10 grains (0.31-0.65) will often produce a cure, particularly if employed in combination with hot drinks and a hot foot-bath. Cam- phor can often be added to the Dover's poAvder Avith advantage. (See Coryza, Part IV.) For sprains and bruises lead-water-and-laudanum is one of the best applications. (See Article on Lead.) If the skin is broken, the lau- danum may be used alone to relieve pain, and, by its alcohol, will act as an antiseptic. Opium is also a useful drug in the treatment of inter- nal and external burns to relieve the pain and irritation. Over-secretion.—In serous diarrhoea, diabetes insipidus, and mel- litus, and in the treatment of over-secretion on the part of all secre- ting surfaces except the skin, opium may be used. It is said to decrease the amount of urine before decreasing the amount of the sugar in diabetes. However this may be, the employ- ment of opium or morphine or codeine in diabetes is a very valuable form of treatment. The doses should be rapidly increased, as the effect is only obtained by ascending amounts, and diabetic patients seem peculiarly immune to the nervous influence of this drug and its alkaloids. Morphine is, therapeutically, the more powerful of the tAvo alkaloids, but crude opium is more poAverful for good in this affection than either. None of them, probably, cure the disease, but so modify it as to make life bearable and happy, for the sugar is 302 DR UGS. decreased in many cases and the sense of excessive hunger, thirst, and nervous irritability is put aside. Itching of the skin is also re- lieved in this class of patients by its use. (See Plate, and also article on Diabetes, Part IV.) Opium should not be used to arrest an attack of mucous diarrhoea until after the mucus Avhich is already present in the boAvel has been swept out of the intestinal canal by a dose of castor oil or magnesium sulphate. Minute doses of -^ to ^ of a grain (0.001) of morphine given hypodermically Avill sometimes check summer diarrhoea in chil- dren at once. (See article on Diarrhoea.) Morphine is used to relieve pain rather than opium, because it does not cause so much constipation, but opium is better to check diarrhoea. Paregoric is particularly useful in diarrhoea because it contains a volatile oil and camphor. Systemic Strain.—In prolonged strain upon the system, as in great physical or nervous effort, or more frequently in old age to smooth out the cares of the remaining years of life and decrease worry, opium is useful, but its use in young persons is most dangerous, as it is almost certain to produce the opium habit. In asthenic fevers opium is thought to be supportive, but its use is apt to cause so many other conditions, such as constipation, anorexia, or mental depression, that alcohol is much better for this purpose. In very advanced phthisis it is often justifiable to give enough opium to keep the patient free from pain and discomfort for the remaining hours of his life, but care must be taken that the dose does not interfere with his breathing and so hasten death. In heart disease, particularly of the mitral valves, the patient can often breathe easily only Avhen aAvake, starting up Avhen he falls asleep and gasping for breath. It is stated by some Avriters that morphine Avill relieve this state and permit sleep, but that it will not be of service in aortic disease. While this may be partly true, the drug Avill often give great relief in all forms of cardiac dyspnoea, and ought ahvays to be tried Avith caution, although it is contraindi- cated if the heart has undergone fatty degeneration. Care should be taken that the first dose is small, as in some instances it increases the discomfort. The relief obtained is supposed to be due to cardiac stim- ulation by the drug, and, Avhile this is no doubt correct, the other car- diac stimulants, such as digitalis, will often fail Avhen morphine suc- ceeds. The presence of cyanosis and lividity is said to be no con- traindication to the hypodermic use of morphine under these circum- stances, provided the dose is not unreasonably large. The drug should be given hypodermically for this purpose. Opium and morphine, particularly the latter, have been freely given to produce quiet in patients Avith urgemic convulsions. The practice is a dangerous one and should not be resorted to as a rule, as the impaired state of the kidneys prevents the proper elimination of the drug. Administration.—Recent studies upon the action of opium and its alkaloids show that it acts in an inhibitory manner upon gastric diges- tion and absorption, decreasing the amount of hydrochloric acid in Powdered Opium l j- i i; T T J. I .L A, I h f t T t I h Sugar

U -i'j HlpHIII T I I 20 'i it TTrrrtm- j Ttt Tit ! 27 •l 1U T ttliv I | rj til 28 , i 1 2'.) J. in. riiill ■ylJlrmllll Opium st ) >ped| 28|l ; imp > . I I ''• TnJ f I I 30 ''> i ■ rrHr dpi J n| jbej un-Uj30't M •'•II I _ 31tttl : i ' 1 June 1 1 _"i;iiTrrT)" M \ ■ 6 ll Tr" |i 5t 1 « 1 3 1 1 !'.' Ill It lit Chart showing the effect of opium in a case of diabetes mellitus. On the day of admission the patient was placed on a full house diet. The quantity of urine and fluid ingested at once in- creased. He then was placed on a restricted diet which caused a fall in the urine and fluids ingested but no decrease in sugar. Opium was now given and the sugar fell at once (see green line). Later on the house diet was resumed but the opium held the sugar in cheek. Note how the fluids increased on the 28th of May and how they fell when the opium was renewed and in- creased. The chart shows how the restricted diet governed the urinary flow and how the opium was needed to control the mellituria. 33BO b fii rrtjjxqb 1o Jostle erfJ pniworia JiBriO noiaarrnbe to' \rfih ertj nO Tanjilism; asJedsib to 9riT .isih ssuod ltut b no bspsiq sew ineUeq sriJ -ni 99n.o..-*s beiaeqni biult bns *&oHu to YJi-*ni3IJP bsJoHJasT b no beoslq eew n9ril 9tH .JbseBeio abiufi briB 9rii°uj scti ni list s bagXiBO rfoiriw Jaifo ssw rnuiqO .TBgna ni eaBaaoeb on tud baisapni n99ig ssa) 9Dfloie Ilalisrjije 9ifi bna n9vig won Jud b9ntuasT sbw l9ib eapofl srii no iiedfaJj .(Isnil wori ©JoH .>l99rto ni TBDPa 9rfJ Jbif9ri muiqo 9riJ wori briB '^sM ioTrDSS^ertt nq bea&eioni sbinlt srij -ni bnB b9W9n9T ;3Bw muiqb 9riJ ne>riw Il9l y&ri\i b9ioinJ89i sriJi wori aworie JnBriDi 9riT .b9369To • ; : : ' I ; j 9riJ wori 'bnax wolt y^611^1^ @rD; b^msvog ttaib .BinuliWorn 9rtjr tonJnoo ol b9b99ff asw mPiqo OPIUM. 303 the gastric juice. For this reason, unless there is an excess of acid present in the stomach, it is well not to give opium or morphine at meal-times, but some time after. Opium itself is used in the form of the powder (Pulvis Opii, U. S.) in the dose of from ^ to 1 grain (0.016—0.05). The solid preparations are the deodorized opium (Opium Deodoratum, U. S.), which is de- prived of its narcotine, dose \ to 1 grain (0.03-0.05); the pills of opium (Pilula Opii, U. S.), each containing 1 grain (0.05); and the watery extract (Extraction Opii, U. S. and B. P.), dose \ to | a grain (0.010—0.03). Of the liquid preparations we have paregoric (Tinctura Opii Camphor at a, U. S.; Tinctura Cetmpli<>ra> Composita, B. P.), dose 1 drachm to 2 tablespoonfuls (4.0-82.0); laudanum (Tinctura Opii, U. S. and B. P.), dose 10 to 30 drops (0.65-2.0) ; the deodo- rized tincture (Tinctura Opii Deodorati, U. S.), dose 10 to 30 drops (0.65-2.0); the Vinum opii, XT. S., or, as it is sometimes called, SvdenhanTs Laudanum—dose 10 to 30 drops (0.65-2.0); and Acetum Opii, U. S.. or Black Drop, dose 10 to 30 drops (0.65-2.0). As all the liquid preparations of opium are of 10 per cent, strength, except paregoric, which is about 2 grains to the ounce, the dose of all of them except paregoric is identical. This is a fact to be remembered by students. Under the name of Dover's Powder (Pulvis Ipecacuanha et Opii, U. S.) a powder containing 1 grain (0.05) of powdered opium, 1 grain (0.05) of powdered ipecac, and 8 grains (0.50) of sugar of milk is largely used. This is more efficacious if separated into fifths and taken in di- vided doses. The tincture of ipecac and opium (Tinctura Ipecacuanha? et Opii, U. S.) is given in the dose of 4 to 15 minims (0.8-1.0). The preparations of opium official in the B. P., other than those already named, are Extraction Opii Liquidum, dose 4 to 20 min- ims (0".3-1.3); Pulvis Opii Compositus, composed of opium, pepper, ginger, carawav-fruit, and tragacanth, dose 2 to 5 grains (0.1-0.35); Tinctura Opii Ammoniata, dose \ to 1 drachm (2.0-4.0). Pilula Saponis Composita, B. P., is purely a preparation of opium. It is sometimes necessary to give this drug to patients without their knowl- edge, and it may be prescribed in this way, the patient not learning from the prescription the nature of the medicine. The B. P. also recognizes a liniment (Linimentum Opii) and a plaster (Emplastrum Opii) for local application. Untoward Effects.—-When opium is given to some persons it pro- duces for some hours marked wakefulness followed by sleep, and in many patients produces after its primary influence great nausea, and sometimes vomiting. The mental depression may be simply over- whelming, and the very fact of having to drag out existence is a curse. By far the most effective mode of preventing these very distressing effects of opium or its derivatives is to administer with this drug about 2^- grain of nitroglycerin. ()ne of the chief causes, however, of the nausea produced by the use of opium or morphine is the change in the body of morphine into oxy-dimorphine, which is eliminated into the stomach and there reabsorbed, and then induces these secondary effects. It is also a fact that these symptoms can be largely done away with by 304 DRUGS. the use of 20 grains (1.3) of bromide of potassium, which must be taken at the same time as the opiate, and by employing the preparations of opium largely devoid of narcotine, such as the deodorized tincture or deodorized opium itself. Whenever it is possible these preparations should be used to the exclusion of the others. Haig is responsible for the assertion that, as opium frees the blood of uric acid by causing its retention in the tissues of the body, the pleasant effects are so produced, and that, the retention being cumulative, no sooner does the effect of the opiate pass off than the uric acid is set free in the blood, and as a result depression ensues. He states that if salicylates are given with the opium the retention does not occur, and the unpleasant sequelae are much modified or prevented. After the untoward symptoms come on coffee and stimulants may be used with advantage to overcome them. In some persons the use of opium is followed by the development of an erythematous rash which may go on to desquamation. Children bear opium badly, and some children are very much more susceptible than others to its influence. One-eighth grain of morphine has caused death in an adult when given hypodermically, probably because it entered a vein. Sometimes the drug causes collapse, or in other cases an eruption upon the skin of the body. The use of repeated doses of morphine for several days often sets up obstinate vomiting, due probably to the change of the drug into oxy- dimorphine or apomorphine. Codeine. (See p. 168.) Morphine. Morphina, U. S. and B. P., is the chief alkaloid of opium, but owing to its insolubility is rarely used, being generally given in the form of the sulphate. Sulphate of Morphine (Morphines Sulphas, U . *S'.) is given in the dose of -^ to ^ grain (0.008-0.03), either by the mouth or hypo- dermically. Besides the sulphate of morphine we have the acetate (Morpliina Acetas, U S. and B. P.), the muriate (Mor/diince Hy- droehloras, U. S. and B. P.), and the tartrate (Morphines Tartras. B. P.), all given in the dose of l to \ grain (0.008-0.03). In the U. S. Pharmacopoeia of 1870 a solution of morphine was official, dose 1 to 2 drachms (4.0-8.0), but it is no longer official and should not be called for. Magendies solution of morphine is sixteen times as strong as this liquor just named (16 grains to the ounce), and is not official. The words "Liquor Morphinse Sulphatis " will often cause Magendie's solution to be dispensed in New York State, and care should be taken that poisoning does not result. Pulvis Morphines Compositus, U. S., or Tully's Powder, is given in the dose of 10 grains (0.65). It contains sulphate of morphine, camphor, licorice, and precipitated calcium carbonate. It is used to break up forming colds and as a nervous sedative. Troches of morphine and ipecac ON-GALL— OXIDE OF ZINC. 305 (Trochisei Morphines et Ipecacuanha?, U. S.) are given one or two at a time for irritation of the pharynx. The following additional preparations of morphine are official in the B. P.: Liquor Morphines Hydrochloridi, Liquor Morphines Tartratis, dose 10 to 40 minims (0.65-2.65) ; Tinctura Chloroformi et Morphines Composita, dose 5 to 10 minims (0.35-0.65); Suppositoria Morphines, each suppository containing \ grain (0.015) of morphine; Trochisei Morphines and Trochisei Morphines et Ipecacuanha?, each lozenge con- taining -.^ of a grain (0.002) of morphine, dose 1 to 4. Liquor Mor- phin a grain (0.00006) of physostigmine. The dose of both salts of eserine is T7nr—sir 0I> a grain (0.0006-0.0008.) PICRIC ACID. Picric Acid or Trinitrophenol occurs in light-yelloAV scales or needles without odor, and is chiefly used in the arts as dye. Its uses in medicine are very limited. Recently it has been found exceed- ingly efficacious in solution in the treatment of burns and scalds. This solution is made as follows: R.—Acid, picric.............gr. lxxv (5.0). Alcohol..............t"3iiss (75.0). Aquae destillata;..........Oij (1000 c.c).—M. After the burn is cleansed of dirt and charred clothing, strips of ster- ilized gauze are soaked in this solution and applied to the part. Over this is placed a pad of dry absorbent cotton Avhich is fastened by a light bandage. The dressing rapidly dries, and may be left in place for several days. It is then moistened with the solution so as to soften it, is removed, and then a fresh dressing is applied for a Aveek. All blis- ters should be pricked. This dressing relieves pain, stops suppuration, and leaves a smooth cicatrix. PILOCARPUS. Pilocarpus, U. S. (Jaborandi Folia, B. P.), is derived from the South American tree, Pilocarpus Selloanus or Pilocarpus Jaborandi. It contains t\vo alkaloids, known as pilocarpine and jaborine, a volatile oil, and other minor constituents. The alkaloid pilocarpine is non- crystallizable and occurs as a soft mass, but the salts of pilocarpine are crystallizable. Jaborine is never used in medicine, and has an effect antagonistic to pilocarpine, or like atropine. Physiological Action.—When jaborandi is taken in medicinal dose by a healthy man, it causes a deep flushing of the face and neck, fol- lowed by the outbreak of a profuse SAveat, Avhich, though beginning in these regions, rapidly spreads over the entire body. Accompany- ing the sweat, the salivation is often exceedingly profuse, so that saliva dribbles from the mouth. Nausea frequently comes on, and severe vomiting may appear in susceptible persons either during or after the SAveating. On the contrary, some individuals are singularly insusceptible to the influence of pilocarpus, and this is particularly so, 324 DRUGS. according to Ringer, Avith children, Avho will often take as much as 60 grains (4.0) of the crude drug before they perspire. Some adults also refuse to yield to its influence.1 The sweat lasts from three to five hours. Nervous System.—Moderate doses have no effect on this part of the body, but poisonous amounts cause in the frog tetanic reflex con- vulsions, and finally paralysis, the latter being due to depression of the muscles and spinal centres. The motor and sensory nerves in man are not affected. Medicinal doses in man exercise no effect over the nerves. Circulation.—In large doses there is no doubt that jaborandi acts as a cardiac depressant rather than as a stimulant, and, Avhile there may be no evidence of an experimental character pointing to such a conclusion, the fact exists in practical medicine. The drug causes in the loAver animals a slow pulse and increased arterial pres- sure, in moderate quantities, the first change being due to an action on the inhibitory centres in the heart or on the peripheral vagi. Ringer, on the other hand, has proved that it slows the beat of the ventricles in the frog Avhen they are separated from these centres, and believes that the drug acts directly on the motor centres of the heart-muscle and the muscle itself. In man the drug does not slow the pulse, but quickens it very markedly, often as much as forty to fifty beats per minute. The rise of arterial pressure seen in the animal is often replaced by a fall of pressure in man, and, though the pulse in ani- mals is generally made stronger from its use, in man it is generally made weaker. Stomach.—Jaborandi sometimes produces nausea and vomiting by irritating the stomach and perhaps the vomiting centre. Temperature.—Jaborandi lowers bodily temperature to a con- siderable degree, probably by the dilatation of the peripheral capil- laries and the profuse sweat which it produces. This fall is some- times preceded by a brief rise. Kidneys and Tissue-waste.—Upon the kidneys jaborandi acts very slightly or very strongly, according to the dose that is given. Large doses, Avhich produce a profuse sweat, naturally decrease the urinary secretion, and small ones undoubtedly increase it. Upon the tissue-changes in the body under pilocarpine no researches have been made, but it is an undoubted fact that in disease the excretion of urea is largely increased under the influence of this drug. Eye.—Jaborandi contracts the pupil by stimulating the peripheral ends of the oculo-motor nerve in the iris. Skin and Secretion.—The amount of sweat caused by the drug in man may equal as much as a pint, and it is generally first acid, from the secretions of the sebaceous glands, then neutral, and finally alka- line. The sweating is not primarily due to vasomotor palsy, but to stimulation of the ends of the nerves supplying the glands and of the sweat-glands themselves. The sweat usually lasts about two to three 1 The writer has reported a case (see Idiosyncrasy) where a woman of thirty years received f of a grain of the muriate of pilocarpine hypodermically in half an hour without any effect. PILOCARPUS. 325 hours. Sometimes excessive salivary secretion supplants that of the skin. Pilocarpine increases the gastric, salivary, and lachrymal secretions, as Avell as that of the skin and kidneys. It also seems to have con- siderable influence over the secretion of milk. Therapeutics.—Jaborandi, or, better still, its alkaloid, pilocarpine, is of some value for the relief of dropsy of the renal type. In that due to cardiac disease it is generally too depressing, and the author knoAvs of a case in which a fatal result speedily followed its use under these circumstances. It may be used to abort an attack or paroxysm of malarial fever, but because of its depressant influence should never be employed in asthenic fevers, such as typhoid fever. In pleurisy Avith effusion it may be used, but more efficient remedies are elaterium, or salines given in concentrated form and at the proper time of the day. (See Magnesium Sulphate and Dropsy.) Better than all these "is thoracentesis. Spaulding and de SchAveinitz have both recommended very highly the hypodermic use of pilocarpine in the dose of y^- to ^ grain (0.005-0.006) a day for opacities of the vitreous humor of the eye. The fluid extract of jaborandi may be employed, but is apt to nauseate the patient. Diaphoresis should not be produced. Because of its myotic influence on the pupil pilocarpine is of very great value in the treatment of all conditions of the eye associated with increased intraocular pressure. It is so good a myotic as to be rapidly supplant- ing eserine for this purpose with some clinicians. The strength of pilo- carpine solution for this purpose is 1 to 4 grains (0.06-0.25) to the ounce (30.0). It should be dropped into the eye, 1 or 2 drops at a time, every hour until the patient is relieved. Pilocarpine is also use- ful as an ocular tonic to relieve eye-pain after excessive use of the eyes, in the strength of y^g- grain (0.006), to the ounce (30.0). A few drops of this solution may be dropped into the eye three times a day. This solution should have a little boric acid (4 grains) added to it to prevent fungus groAvth. (See Asthenopia.) Clinical reports show that pilo- carpine in small doses is a very good remedy in tobacco and alcoholic amblyopia. MitkoAvski has tried pilocarpine in catarrhal jaundice of a persistent type Avith gieat benefit, in the hypodermic dose of | grain (0.01) every other day for three weeks. In uraemic poisoning pilocarpine is theoreti- cally the most efficient and rapidly acting remedy that we have, and when used in Bright's disease it may be of value in several Avays—first, by removing the strain on the kidneys ; second, by eliminating the urgemic poison; and third, by decreasing the inflammatory condition in the kidneys by lowering the blood-pressure, which, it will be remembered, is the more constant effect of the drug in man. Care should ahvays be used in the use of the drug lest cardiac depression ensue, and alcohol or strychnine may often be used Avith advantage to guard against this accident. The general consensus of opinion is that in the nephritis of middle years or advanced life Avith cardiac changes it is contraindicated. The author never uses it in chronic renal disease of the parenchyma. In the urgemic convulsions of pregnancy pilocarpine, while theoretically useful, has been proved by experience to do more harm than good 326 DR UGS. through its depressing influences, although the drug in small doses cer- tainly increases renal activity. The hypodermic dose of pilocarpine as a renal stimulant should be about ^ to 2V of a grain (0.002-0.003). In some forms of profuse sweating, such as come on at night in cases of general debility, pilocarpine, if given hypodermically or by the mouth about two hours before the sweat in the dose of -^ of a grain (0.003), is often useful even where atropine fails. The good effect is produced by stimulating the sweat-glands and so overcoming their atony. DaCosta, Salinger, and Barr have highly recommended the hypo- dermic injection of pilocarpine in erysipelas as a preventive and cura- tive measure in the early stages of this disease, and their reports are so encouraging as to warrant a careful trial of the method. The proper dose is \ grain (0.01) every three hours until free sweating ensues. After this is accomplished the doses may be repeated every four or six hours. The author would fear that such active treatment might seriously affect the strength of the patient unless stimulants were also used. In cases of obstinate aural vertigo a most efficient treatment is the hypodermic use of pilocarpine every few days in sufficient dose to pro- duce some salivation. The patient has to lie down or go to bed after the dose is given. Pilocarpine certainly has a decided effect in encouraging the growth of hair, and applied locally will often do good in partial baldness. If too much pilocarpine is used, it is apt to cause the development of small pustules about the hair-follicles. BartholoAv recommends the following application for baldness: R.—Extract, pilocarpi fluid.........f Sj (32.0). Tincturse cantharidis.........f j^ss (16.0). Liniment, saponis...........f SJss (48.0).—M. The author has found the following prescription peculiarly effica- cious in falling of the hair : R.—Extract, pilocarpi fluid..........f ^j (4.0). Tr. capsici..............f^j (32.0). Tr. cantharidis............f ^ss (2.0). 01. ricini...............f ^j (4.0). Alcohol.............q. s. f'giv (128.0).—M. S.—Apply with friction in spots to the scalp, night and morning. Antagonisms of Jaborandi.—Jaborandi is a physiological antidote to atropine and to agaricin. Four times the dose of pilocarpine must be used to equal a dose of atropine. Vomiting produced by pilocarpus is to be antagonized by morphine. Untoward Effects.—Dimness of vision, vomiting, and sudden col- lapse, swelling of the salivary glands and tonsils, hiccough and strang- ling are sometimes met with after using pilocarpus. Sometimes bloody leucorrhoea is seen. The vomiting can usually be prevented by full doses of chlorodyne. Administration.—The dose of jaborandi is 40 grains (2.65), used in the form of the powdered leaves in infusion. The fluid extract PIPERAZINE. 327 (Extractum Pilocarpi Fluidum, U. S., Extractum Jaborandi Liqui- dum, B. P.) should be used in the dose of 30 drops to 1 drachm (2.0-4.0). Pilocarpine is far superior to jaborandi, in that it does not so often produce nausea and vomiting. It is used in the form of the hydrochlorate (Pilocarpines Hydrochloras, U. S.), in the dose of from |- to -}^ of a grain (0.008-0.03) hypodermically, or y to |- of a grain (0.015-0.03) by the mouth. The additional preparations of the B. P. are—the tincture (Tinc- tura Jaborandi), dose \ to e\ fluidounce (8.0-16.0); and the nitrate of pilocarpine (Pilocarpines Nitras). -fa to ^ grain (0.003-0.03). PIPERAZINE. This is a substance, the chemical formula of Avhich is C4HI0N2, which has been recently introduced into medicine for the treating of the uric-acid diathesis. It is not stable, and Avhen exposed to the air attracts wTater and carbonic acid. Aqueous solutions are decidedly alkaline, but do not have any distinct taste. Piperazine is peculiar in its power to dissolve uric acid, dissolving twelve times as much as will carbonate of lithium, while it is also entirely soluble in water, which lithium is not. When taken into the body the drug is partly oxidized and partly eliminated unchanged. Theoretically, piperazine, when taken into the body, forms Avith uric acid a urate of piperazine. which is soluble and readily eliminated. Experiments have been made to determine this point with very satis- factory results, but repeated clinical observation has shoAvn that the administration of the drug causes an increase in the amount of urea in the urine with a decrease in the uric acid, indicating that under its influence oxidation is more complete. Therapeutics.—Piperazine is used for the purpose of preventing the formation of renal and Aresical calculi in the uric-acid diathesis, and also in cases where the excess of uric acid in the urine tends to pro- duce irritation of the bladder. Similarly, its action has been found of value in treating Aresical irritation due to this cause by Avashing out the bladder Avith a solution of piperazine of the strength of 1 per cent. Piperazine has also been injected into uric-acid deposits about the body or applied to the broken-doAvn surfaces of these deposits in 1 per cent, solution, but the author has not been favorably impressed with this method, and Avould advise against its use—first, because it does little if any good, and, second, because the method is painful and apt to cause sloughs by interfering Avith nutrition of the skin, Avhich is already lacking in health. The dose of piperazine is 15 grains (1.0) in tAventy-four hours. It is best given by dissolving this amount of the drug in 1 pint (^ litre) of Avater, and directing the patient to take a Avineglassful of the solu- tion frequently through the day. OAving to the effect upon the drug of exposure to air, it cannot be given in pill or poAvders, and should be freshly mixed each day. The writer has failed to obtain any results from the use of this drug in his practice. 328 DRUGS. Stewart has noted, as untoward effects of full doses of piperazine, tremors, hallucinations, and clonic spasms. PISCIDIA ERYTHRINA. Piscidia Erythrina is a drug which is stated to possess marked nar- cotic and pain-relieving properties. It is sometimes called Jamaica dogwood. Its poAvers as a soporific and analgesic do not compare with those of opium, but it is stated to be devoid of the unpleasant after-effects of the latter drug. Further studies concerning its effects on the animal economy are needed. According to Dr. Isaac Ott and Dr. Nagle, the drug has little or no effect on the motor and sensory nerves, and its dominant effect on the circulation is to increase arterial pressure through stimulation of the vasomotor system. The indica- tions which have been met best by piscidia are dysmenorrhaea due to irregular flow and spasm of the uterine cervix and fundus, to allay nervous irritability, and to relieve pain or insomnia due to pain. Administration.—The dose of the fluid extract of piscidia erythrina is ^ to 2 drachms (2.0-8.0); of the solid extract, 2 to 10 grains (0.1- 0.65). The alkaloid piscidine is not known to represent all the prop- erties of the drug, and is not used in medicine. PITCH. Pix is a resinous exudation derived from several species of pines, firs, and spruces, and is, in one of its forms, obtained by the evapora- tion of wood-tar. It is used for various purposes, according to its derivation. Burgundy Pitch (Pix Burgundica, U. S. and B. P.) is derived from Norway spruce, or Abies excelsa, a plant of Europe and Asia. It softens and melts at the temperature of the body and is use- ful for plasters. In muscular rheumatism and in chronic bronchitis pitch is a mild and fairly useful local remedy for external use. In the form of the plaster (Emplastrum Picis, B. P., Burgundica?, U. S.) and in the form of Avarming plaster (Emplastrum Picis Canthari- datum, U. S.) it is employed for the relief of deep-seated sprain* and bruises, and acts as a mild counter-irritant, Avhich mav blister a tender skin. Canada Pitch (Pix Canadensis) is obtained from the hemlock spruce of Canada and the United States, and is used for the same purposes as Burgundy pitch. The Canada-pitch plaster (Emplastrum Picis Canadensis) is employed for the same conditions as the plaster of Burgundy pitch. Tar. Under the name of Pix Liquida, U. S. and B. P., or Tar, we have an empyreumatic oleoresin obtained by destructive distillation from Pinus palustris and other varieties of pine. It is a thick, dark oil, slightly soluble in water and soluble in alcohol, oils, and solutions of potassa and soda. By distillation of tar Ave obtain oil of tar (Oleum PITCH. 329 Picis Liquidce, U. S.), Avhich is sometimes used for bronchitis by inha- lations from an atomizer, but is not a particularly use application. It should be diluted with some other oil or with fluid cosmoline. Tar itself is used in subacute and chronic bronchitis in 2-grain (0.1) pills and as a remedy for gastro-intestinal catarrh. Externally, it is used in psori- asis and other skin diseases needing stimulation. For the relief of obstinate diarrhoea Wood has highly recommended a mixture of tar made as follows : Add a pint of tar to a gallon of lime-Avater, and allow this solution to stand one week, stirring it every few hours. Decant the clear liquid and percolate it through powdered wild-cherry bark, allowing 1 ounce of the bark to be present for each pint passed through it. The dose is a wineglassful (30.0). In chronic bronchitis tar-water is largely used, as a popular rem- edy, in Europe and England. Tar-water is made by shaking 1 part of tar Avith 4 parts of Avater several times during tAventy-four hours, decanting, and filtering. The dose is from 1 to 2 pints (^-1 litre) a dav as a drink. It at first increases the expectoration, but finally decreases it. Syrup of Tar (Syrupus Picis Liquidce, U. S.) is simply sweet- ened tar-water. In skin diseases of the dry, scaly sort, such as psoriasis, tar oint- ment (Unguentum Picis Liquidce, U. S. and B. P.), equal parts of tar and suet, is very useful if frequently applied, or the following may be used: R.—Sulphur.praecipitat. \ aa ^vi (24.0). Picis liquid* j ' o j \ / Saponisviridis"^..........aa 5ij (64.0). Adipis J OJ Pulv. cretse..............-?iv (16.0). If the skin is tender, this prescription should be diluted with lard. Sometimes children will suffer from a persistent dry chronic eczema which resists all treatment; the following may then be employed with advantage: R.—Picis liquid. ■_.............3SS (2-0)- Sulphur, praecip..............?ss (2.0). Unguent, zinc, oxidi..........§j (32.0). S.—Apply night and morning. Tar should not be used on the face, as it will stain the skin. Wine of Tar (Vinum Picis) is made by adding together tar 1 pint, glycerin, Avhite Avine, and honey, of each | a pint, dilute acetic acid 1 ounce, and 3 quarts of boiling Avater, and shaking constantly at a temperature of 160° F. for several hours. It is then set aside to stand for some days and repeatedly filtered or strained through muslin. The dose is 1 to 4 ounces (32.0-128.0). It may be used instead of tar-Avater or tar-syrup. 330 DRUGS. PODOPHYLLUM. Podophyllum, U. S. (Podophylli Rhizoma, B. P.), May Apple or Mandrake, is the rhizome and small roots of Podophyllum peltatum, a plant of the United States and Canada. Podophyllum contains a resin, podophyllin. Therapeutics.—Podophyllum is the sloAvest-acting purge official in the Pharmacopoeia. In small doses it is laxative, but is purgative and almost drastic in larger amounts. In overdose it may produce gastro- enteritis. The drug particularly excites the flow of bile, and is used as a cholagogue. It is best given Avhen the stools are dark in color, calomel being indicated Avhen they are light. The author has found the follow- ing prescription useful in cases of intestinal flatulence and indigestion with constipation : R.—Podophyllin Euonymin Leptandrin Ext. chiratae Creasotse Ft. in pil. No. xx . gr. v (0.26). . gr. v (0.26). . gr. v (0.26). . gr. xlv (2.8). . gr. x (0.65).—M. In children one or tAvo months old who have hard, stony stools, podo- phyllin is a good remedy. The dose should be given by dissolving a grain of the resin in a drachm of alcohol and using 2 drops or more of this on sugar once or twice a day. In children who suffer from summer diarrhoea, in Avhich the passages consist almost entirely of Avater, which have a peculiar musty smell or a mouse odor, podophyllin in the dose of fa to fa of a grain (0.001-0.0012), repeated every feAv hours, is of service, seeming to control the passages and make them normal. This treatment Avill often succeed Avhen all else fails. This statement is also true in regard to the chronic diarrhoeas of adults, though the drug should be given in somewhat larger amounts in such cases. Podophyllin will also check vomiting in these doses in some instances, provided that the stomach is depressed and the liver is tor- pid. It should not be employed if the vomiting is due to irritation or inflammation of the stomach. Administration.—Podophyllum is used in the form of the extract (Extractum Podophylli, XI. S.), dose 1 to 5 grains (0.05-0.35); the fluid extract (Extractum Podophylli Fluidum, U. S.), dose 2 to 20 drops (0.1-1.3); and, more commonly than all, as the Resina Podo- phylli, U. S. and P. B., or podophyllin, Avhich is the best preparation. The dose of this preparation is from -^to fa of a grain (0.003-0.006) as a feeble laxative, and from y1^ to J a grain (0.006-0.03) as a purge. The tincture of the resin (Tinctura Podophylli, B. P.) is given in the dose of 15 minims to 1 drachm (1.0-4.0). POMEGRANATE. Although G-ranatum (U. S.) is official, it is almost never used in America in its crude form. It contains an alkaloid knoAvn as pelle- POTASSIUM BICARBONATE. 331 tierine, this alkaloid being a colorless liquid, soluble in 20 parts of Avater and readily miscible Avith ether, chloroform, and alcohol. When acids are added to it, it forms crystalline salts, of which four are used —namely, the tannate, the sulphate, the hydrobromate, and the hydro- chloride. The first is most commonly employed, and is a velloAvish powder possessing an astringent taste. It is soluble in 700 parts of water and 80 of alcohol. Its physiological action needs further inves- tigation, but the drug in poisonous amounts paralyzes the peripheral ends of the motor nerves in a manner closely resembling the action of curare. Sensibility is preserved. The loss of poAver is chiefly mani- fested in the loAver limbs, in which at first there may be cramps. Tnere may also be nausea and vomiting. Therapeutics.—Originally, pomegranate Avas largely used in the form of the rind of the fruit in decoction as a vegetable astringent, but this practice has ceased because of its disagreeable taste and effect upon the stomach. The ailments Avhich Avere supposed to indicate its em- ployment Avere serous diarrhoea and profuse SAveats. In some tropical countries the bark of the root is used as a vermifuge, and it is very efficient in removing the tape-worm. It is said that the bark of the root of the wild shrub is much more efficacious than that of the cul- tivated and more handsome plant. To be efficacious the dose of the decoction of the bark must be large. The drug is prepared by soak- ing 2 ounces (64.0) of the bark in 2 pints (1 litre) of Avater for twenty-four hours and then boiling doAvn to a pint (J litre). A Avine- glassful (32.0) of this is the dose Avhich is generally given, and it may be repeated every hour until the Avhole amount is taken. The objec- tion to this line of treatment is that it is unnecessarily severe, often purging and vomiting the patient excessively. The nausea produced is often great. Should purging fail to appear, it is necessary to give castor oil or other purge to dislodge the worm, and it is always neces- sary to starve the patient for tAvelve hours before the remedy is tried. The dose of pelletierine is 3 to 5 grains (0.25-0.35), and the tan- nate is the salt always employed. Practically, the only pelletierine used is that of Tanret, and his preparation is a syrupy solution in each bottle of Avhich is one dose of the drug. As large doses as 20 grains (1-3) of pelletierine have been used, but as very serious paralytic symptoms have ensued after the inges- tion of 5 grains by a susceptible Avoman, not more than this amount should be given. When pelletierine is used it should ahvays be fol- loAved in tAvo hours by a purge. Those wrho have used it most place great reliance on it. The B. P. contains one official preparation of pomegranate— namely, the Decoctum Gfranati Corticis, the dose of Avhich is 1 to 2 fluidounces (32.0-64.0). POTASSIUM BICARBONATE. This salt (Potassii Bicarbonas, U. S. 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 Avhen they can 332 DR UGS be obtained. From the bicarbonate of potassium are made several very useful preparations: the liquor potassii eitratis, by adding 120 grains (S.0) to 90 grains (6.0) of citric acid and 10 ounces (320.0) of water; the neutral mixture, by adding to 1 pint (500.0) of lemon-juice enough of the potassium salt to neutralize it. The dose of potassii bicarbonas is 5 to 40 grains (0.3-2.6), or even as much as 2 drachms (8.0) may be given if well diluted Avith Avater. POTASSIUM BROMIDE. (See Bromide of Potassium.) POTASSIUM CARBONATE. Carbonate of Potassium (Potassii Carbonas, U. S. and B. P.). This salt is never used in medicine, except to prepare other salts, as it is disagreeable to the taste and is an irritant. (See Potassium Citrate.) POTASSIUM CITRATE. Citrate of Potassium (Potassii Citras, U. S. and B. P.) is a white, granular, deliquescent salt, almost neutral in reaction and very solu- ble in water. It is by far the most agreeable of all the salts of potas- sium 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 (1.4) every four hours, and in urinary incontinence due to acid and concentrated urine the dose should be equally large. Under the name of neutral mixture (Mistura Potassii Citratis), made by adding to 1 pint (^ litre) of lemon-juice enough bicarbonate of potassium to neutralize it, Ave have a useful febrifuge drink in fevers, particularly those of childhood. The dose is ^ to 1 ounce (10.0-32.0) every few hours. Liquor Potassii Citratis, U. S., is made in the same manner as is the neutral mixture, except that citric acid is substituted for the lemon-juice (citric acid 6 grm., potassium bicarbonate 8 grm., and water 100 cc). The neutral mixture is the better preparation of the two, but more expensive. A very refreshing and agreeable Avay of prescribing this drug is in the form of "effervescing draught," made by mixing two solutions Avhich are prepared as folloAvs: 1. Lemon-juice and water, equal parts, enough to make 4 ounces (128 gm.). 2. Bicarbonate of potassium 1 drachm (4.0) and water 3 ounces (96.0). These solutions are to be mixed in the quantities desired, and taken Avhile efferves- cing. If lemon-juice is not at hand, a solution of citric acid of the strength of 2 drachms (8.0) to 4 ounces (128.0) of Avater should be employed in its stead. Under the name of Potassii Citras Effervescens the U. S. P. of 1890 calls for an official poAvder possessing the advantages of the mixture just named. POT A SSIUM IODIDE— Q UA SSI A. 333 POTASSIUM IODIDE. (See Iodide of Potassium.) PRUNUS VIRGINIANA. Primus Virginiana, U. S. and B. P.—Wild Cherry, as it is incor- rectly called—is the bark of Primus serotina, a large tree of the United States and Canada. It contains two substances, knoAvn as emulsin and amygdalin, Avhich when they come together in water form hydrocyanic acid. Therapeutics.—Wild-cherry bark is largely used as a domestic tonic, and in the form of a syrup as a vehicle for cough mixtures. It has been supposed that the hydrocyanic acid present allays the cough, but this is doubtful, as the acid is very fleeting in its effect and present in very small quantity. Administration.—As a tonic it is used in the form of the infusion (Infusum Pruni Virginiana, U. S.), dose J to 1 ounce (16.0-32.0), and the fluid extract (Extractum Pruni Virginianae Fluidum, U. S.), dose 30 drops to 1 drachm (2.0-4.0). The syrup (Syrupus Pruni Virginiana, U. S. and B. P.) is given in the dose of 1 to 4 drachms (4.0-16.0). The B. P. also contains a tincture (Tincturce Pruni Virginiana) given in the dose of 1 to 2 drachms (4.0-8.0). PYROGALLOL. Pyrogallol,U. S., sometimes called Pyrogallic Acid, is a triatomic phenol obtained by dry distillation of gallic acid, and should be kept in dark, well-stoppered bottles. It occurs in light Avhite scales or crys- tals, has no odor, but a bitter taste. If exposed to the light, it becomes dark. It is soluble in 2J parts of water, and readily so in ether and alcohol. Therapeutics.—Pyrogallol is used in parasitic skin diseases, in ointment, in the strength of 30 to 100 grains (2.0—7.0) to the ounce (32.0). The stronger ointments exercise a mild caustic effect. It may be employed in place of chrysarobin in psoriasis- Unfortu- nately, it stains the skin a deep broAvn. PYOKTANIN. (See Methyl Blue.) QUASSIA. Quassia, U. S. (Quas*ice Lignum, B. P.), is the Avood of Picrcsna excelsa, a large tree of Jamaica and other islands of the West Indian 334 DR UGS. group. It contains an active principle, named quassin, which is intensely bitter and an irritant to mucous membranes. Quassia is a simple bitter tonic which has been used very largely in domestic medicine and by the medical profession. It is very efficient as a tonic, is supposed to be particularly useful in the anorexia folloAv- ing malarial fevers, and has even been thought to possess antiperiodic poAver. In simple dyspepsia with eructations after meals, not due to gastritis, it is very serviceable. In the treatment of seat-worms (Oxyuris vermicularis), or thread- worms, as they are often called, injections of the infusion of quassia are the most efficacious and useful remedial measures we possess, and are also very harmless to the patient. The boAvel should be well Avashed out by soap and Avater, and J pint to a pint of an infusion, made by adding 1 or 2 ounces (32.0-64.0) of quassia chips to a pint (| litre) of Avater, should be injected and retained for some minutes. A feAv such injections will invariably kill the parasites, provided the boAvel is first well washed out with soap and water and enough fluid be injected to reach high up into the rectum. Administration.—The tincture (Tinctura Quassia, U. S. and B. P.) is given in the dose of \ a drachm to 1 drachm (2.0-4.0), the fluid extract (Extractum Quassia? Fluidum, U. S.) \-a drachm (2.0), and the extract (Extractum Quassics, U. S.) 1 to 3 grains (0.05-0.15). The infusion (Infusum Quassics, B. P.) is given in the dose of | to 2 ounces (16.0-64.0), and is made by macerating 1 drachm (4.0) of quassia Avith 10 ounces (320.0) of water, and alloAving it to stand twenty-four hours or more. QUERCUS ALBA. Quercus Alba, U. S., or White Oak, in infusion- is used as an astringent injection in oonorrhoea and vaginitis in the female, where a large amount of fluid is necessarily employed. It is also used in prolapse of the rectum, in hemorrhoids, in leucorrhaea, and as a gargle in sore throat. It stains the clothing very slightly. Quercus Tinctoria is equally efficient, but is seldom used, because it stains the clothes very badly. Either may be used in infusion of the strength of 1 ounce to the pint (32.0 : | litre). In the form of the powdered bark it is often used as an astringent poultice to freely running sores to check the discharge. RESIN, or ROSIN. Resina, U. S. and B. P., is Resin or Rosin, the mass left after the distillation of turpentine, and enters largely into plasters, cerates, and similar preparations. Its burning fumes when inhaled are said to be of value in cases of chronic bronchitis. Ceratum Resinae, U. S., is used in chilblains and superficial scalds, and Emplastrum Besina, U. S. and B. P., is adhesive plaster. Unguentum Resinae is a B. P. preparation used for the same purposes as the plaster or cerate. RESORCIN. 335 RESORCIN. Resorcin, U. S. (metadioxybenzoD, is the wefa-compound of the group of which hydrochinone is the para- and pyrocatechin the ortho-, and occurs in clear crystals of a slightly reddish hue. It is quite soluble in water, alcohol, and ether. Physiological Action.—Resorcin is an irritant to mucous mem- branes, and when taken internally in poisonous doses causes deafness, giddiness, salivation, profuse SAveat, unconsciousness, and clonic con- vulsions. The heart of the dog under its influence is at first slowed by vagal stimulation, and then becomes very rapid from vagal palsy. Therapeutics.—Resorcin has been found of service as a remedy for whooping cough, given in the dose of 10 drops (0.65) of a 2 per cent. solution or used in a spray of the same strength, the latter being the better method of using the drug. Resorcin has also been employed in a spray in 2 per cent, solution in hay fever with remarkably good effects. It has been used as an antipyretic, but is not serviceable and has little poAver over strong fevers. The chief use of resorcin is in skin affections of a subacute or chronic character, such as eczema wTith much induration, and in psori- asis. In these states an ointment of the following character, well applied, is of service: R.—Eesorcin...............gj (4.0). Zinci oxidi..............sjj (4.0). TJng. aquae rosse ... ......3x (40.0).—M. S.—Apply to the part affected twice a day. After mixing the ointment heat it until the resorcin crystals melt, to prevent any irritation of the skin. Resorcin is also of service in Aveak solution in allaying itching of the skin due to erythematous eczema. For this purpose it should be used in watery solutions of about 10 to 15 grains to the ounce, and a little salt added to aid in its absorption by the skin. This should be dabbed, not rubbed, on the part: R.—Kesorcin.............gr. xv (1.0). Glycerin.............TTLx (0.65). Liquor caleis...........fjj (30.0).—M. In slowly spreading epithelioma of the face the following plaster, recommended by Hartzell, is useful : R.—Kesorcin............gr. lxxii (5.0). Cerse flav. et pulv. resinae.....3Jss. (6.0) 01. olivae........ . . . q. s.—Al. V\ ithin the last few years resorcin has been employed with good results in the treatment of gastric ulcer in the dose of 2 to 4 grains (0.1-0.2) before each meal in pill or capsule. It is supposed to act by reason of its analgesic, antiseptic, and haemostatic poAver. 336 DRUGS. RHIGOLENE. This is a product of petroleum obtained by repeated redistillation until the liquid resulting from this process boils at 64.4° F. It evaporates more rapidly than any other known liquid, except cymo- gene, which boils at 32° F., and is used in a spray for the production of localized numbness or freezing before minor painful operations, such as the use of the actual cautery. RHUBARB. Rheum, U. S. (Rhei Radix, B. P.), is the root of Rheum offici- nale, a plant of Thibet, but Avhich is cultivated in America and else- Avhere. It is also derived from China, and this variety is known as Chinese rhubarb. Several alkaloids are contained in it, all of Avhich are unimportant and never used alone, except chrysophanic acid. Physiological Action.—According to the studies of Prevost and Binet, rhubarb acts inconstantly upon the Aoav of bile, sometimes increasing it, sometimes having no effect, but, on the other hand, according to those of Rutherford and Vignal, it never fails to stimu- late biliary secretion. Owing to the astringent properties possessed by rhubarb, it does not purge excessively, and improves the appetite, digestion, and intestinal tone. Therapeutics.—Whenever it is desired simply to unload the bowels without affecting the general system rhubarb may be employed. In other words, it is useful in simple constipation. In children a state is very commonly seen in which constipation is replaced by diarrhoea if any ordinary laxative is employed, and in these instances rhubarb is the best remedy, as it is astringent and prevents any after-effects beyond those directly produced by the dose. In the summer diarrhoea of children, when the stools are green, rhubarb is often used to empty the bowels of fermentative products before direct treatment is instituted. Rhubarb, because of its chrysophan, may stain alkaline urine car- mine or acid urine yellow7. Administration.—The preparations of rhubarb are unnecessarily numerous. Rhubarb itself may be given in the dose of 20 grains (1.3) in powder, and small pieces of the root are habitually chewed by some persons for the relief of constipation. Extractum Rhei, U. S. and B. P., is given in the dose of 5 to 10 grains (0.35-0.65) in pills. Pilulae Rhei, U. S., of which each pill contains 3 grains (0.25) of rhubarb, is given in the dose of one to three pills (0.05-0.25); and Pilulae Rhei Compositus, U. S. and B. P., which contain 2 grains (0.1) of rhubarb and IJ (0.09) of aloes, are given in the same dose. Pul- vis Rhei Compositus, XI. S. and B. P., contains rhubarb, magnesia, and ginger, and is given in the dose of 20 to 40 grains (1.3-2.6); Ex- tractum Rhei Fluidum, U. S., is given in the dose of 20 to 30 minims (1.3-2.0). Syrupus Rhei, U. S. and B. P., is given in the dose of 1 drachm (4.0) to a babe, and 4 drachms (16.0) to an adult, although rarely used for older persons. Syrupus Rhei Aromaticus, U S., is given in the same dose and to the same class of cases. Tinctura RHUS AROMATICA—ROSA CENTIFOLIA. 337 Rhei, U. S.. is used in the dose of 1 to 2 drachms (4.0-8.0), Tinc- tura Rhei Aromatica, U. S., is used in the dose of £ to 1 drachm (2.0-4.0), and Tinctura Rhei Dulcis, U S., 2 to 3 drachms (8.0-12.0). The aromatic spirit is commonly employed for children, and the com- pound pills for adults. Infusion Rhei, B. P., is given in the dose of 1 to 2 ounces (32.0-64.0), and 3Iistura Rhei et Soda, U. S., in the dose of 2 drachms to 3 ounces (8.0-96.0). RHUS AROMATICA. Sweet Sumac is unofficial, but has been so largely used of late that it deserves notice. In hesmaturia, menorrhagia, diabetes insip- idus, and in urinary incontinence in children depending upon vesical atony it has been highly praised. In the latter affection a sufficient amount of experience has been acquired to show that it really is of benefit. Rhus aromatica should be used in the form of the fluid extract, derived from the bark of the roots according to the general directions in the Pharmacopoeia for making fluid extracts. The dose as a remedy for urinary incontinence is 15 drops (1.0) of this preparation. Adults may take from 15 to 60 drops (1.0-4.0). The drug is best given Avith glycerin and Avater. RHUS GLABRA. Rhus Gflabra, U. S., Smooth Sumac, is the fruit of Rhus glabra, and contains tannic and malic acids as its chief constituents of me- dicinal value. In the fluid extract (Extractum Rhois Gflabra? Fluidum, U. S.) Ave have an official preparation Avhich is very efficient as a gargle for sore throat AA'hen diluted with glycerin and Avater or prepared according to the formula given under Chlorate of Potassium. ROCHELLE SALT. Potassi et Sodii Tartras, U. S. (Soda Tartarata, B. P.), is largely used as a saline cathartic in the dose of \ an ounce (16.0), and is preferred by many patients to Epsom salts because its taste is not so disagreeable. It is, hoAvever, more irritating. Rochelle salt is the purgative constituent of Seidlitz powder. ROSA CENTIFOLIA. Rosa Centifolia, U. S., Pale Rose, possesses almost no medicinal value, but is mentioned because its official preparations are largely used by the laity and physicians. Aqua Rosa, U. S. and B. P., is used as a diluent or solvent for preparations, such as astringents, Avhich are to be employed locallv, as in injections for gonorrhoea. It may also be used internally for these purposes. Unguentum Aqucs Rosce, U. S. and B. P., is " cold 22 338 DRUGS. cream," and is largely used as an emollient application to small burns, sores, cuts, scratches, and chapped hands and lips. It is much improved if a little glycerin and benzoic acid are added to keep it sweet in warm Aveather. ROSA GALLICA. Rosa G-allica, U. S. (Rosae Gallica? Pctala, B. P.), Red Rose, con- tains more gallic and tannic acids than pale rose, and is astringent. From it are prepared the Extractum Rosae Fluidum, U. S., dose 5 drops to 2 drachms (0.35-8.0), used to flavor other extracts, and the Confectio Rosae, U. S. and B. P., Avhich is used as a basis for pills. Mel Rosae, U. S., or honey of rose, is employed as a local application or as a vehicle for gargles, and the Syrupus Rosae, U. S. and B. P., dose 1 to 2 drachms (4.0-8.0), as a flavoring substance. The acid infusion (Inflexion Rosce Acidum, B. P.) is given in the dose of 1 to 2 ounces (32.0-64.0). RUBUS ID^EUS, or RASPBERRY. Rubus Idaeus, U. S., or Raspberry, is used for the preparation of a syrup (Syrupus Rubi Idaei, U. S.) which is employed very largely as an elegant vehicle or flavoring mixture. The leaves are often used in domestic medicine in a decoction or infusion for the cure of diar- rhoea when an astringent is needed. RUE. Ruta graveolens is the source from Avhich we derive the Oil of Rue. Physiological Action.—Locally applied, rue is an irritant, produ- cing vesication, and if taken internally in large amount gastro-enteritis, Avhich may be very severe. It is eliminated by the lungs, kidneys, and skin, and its odor is easily noticed in all these secretions. If the dose be poisonous, vomiting, great pain in the belly, and epileptiform convulsions come on, but death has rarely occurred. Therapeutics.—Rue has been used as an abortifacient, but with great danger to the mother. Its action is most uncertain even Avhen poisonous doses are employed. It has been given in colic as a car- minative, and seems to be really valuable in atonic menorrhagia and metrorrhagia. Given in capsule, oil of rue has been employed for the removal of lumbricoid or round-worms, but ought not to be so used. The dose of the oil is 3 to 6 drops (0.25-0.40). SACCHARIN. Saccharin is a compound first prepared by Fahlberg under the direction of Professor Remsen of Johns Hopkins University. It is SALICYLIC ACID. 339 a remarkably sweet substance, two hundred and twenty times stronger than sugar in SAveetening power, and is used largely to SAveeten glucose and in confections. It escapes from the body unchanged, and has been used in place of sugar in cases of diabetes and gout to sweeten coffee, food, or medicine. The dose is indefinite, but it is to be noted that a very feAv grains will SAveeten a very large bulk of material. As 1 grain (0.06) is equivalent to about 1 teaspoonful (16.0) of sugar, less than 1 grain is the quantity usually given. It is commonly sold in small tablets con- taining half a grain each (0.03). Physiological Action.—Upon the circulation and similar vital func- tions saccharin has no effect, but Pliigge has proved it to retard the action of all the digestive ferments, and to be in consequence harmful to diabetics Avhose digestion is impaired. SALICYLIC ACID. Salicylic Acid (Acidum Salieylicum, U. S. and B. P.) occurs in fine white crystals or in fine Avhite powder. It has a sweet yet acrid taste, and is derived from carbolic acid by treating it Avith caustic soda and carbonic acid at a moderate heat. Sometimes it is derived from plants in Avhich it exists in combination, although the artificial acid is chiefly used. If the crystals are pinkish in hue, the acid should not be used, as it is probably impure. It is soluble in 500 parts of water and 4 parts of alcohol. Physiological Action.—On mucous membranes salicylic acid acts as an irritant. (See Poisoning.) Nervous System.—Upon the nervous system salicylic acid exerts comparatively slight effects in medicinal doses, causing buzzing in the ears, decrease of the reflexes, and finally producing, in overdose, epi- leptiform convulsions by an action on the brain. Circulation.—Upon the circulation the effects of salicylic acid are not very marked in medicinal dose. It undoubtedly has a depress- ant rather than a stimulant effect, but the depression is very slight. It is sufficient, hoAvever, to make the use of the drug in cases of feeble circulation Avorthy of thought and care. Respiration.—Salicylic acid stimulates the pulmonary vagi and respiratory centre, but if the dose be poisonous death is due to respi- ratory failure. Temperature.—The effect of salicylic acid on temperature has been studied by the author with a good deal of care. The drug acts as a distinct antipyretic upon fevered states, and is a slight depress- ant of normal bodily heat. The studies of Gedl, Fiirbringer, and See also shoAV this, and those of DaneAvsky point to it. In the experi- ments of North upon man, after and during exercise, the antipyretic effects Avere marked. According to the author's studies, the drug loAvers fever by diminishing heat-production and increasing heat-dis- sipation, but this is by no means positively decided as a fact. Absorption and Elimination.—Salicylic acid is absorbed from 340 DRUGS. the stomach as a salicylate of sodium, and so circulates in the blood. It is eliminated by the kidneys and by all the secretions. In the urine it appears as salicyluric acid. According to Kolbe, after a dose of 1 ounce (30.0) elimination does not commence for three hours, but Fleischer found the drug in the urine in one and a half hours. Usually, however, it is far more rapidly eliminated, and, as pointed out by Soullier, after a dose of 15 grains (1.0) it appears in the urine in ten to twenty minutes and after 30 grains (2.0) in five minutes. The elimination continues for a period of from thirty-three to fifty-six hours. (Weill). The urine after large doses is dark olive-green, and this change in color is due to the presence of indican and pyrocatechin, which are formed by the action of the pancreatic juices upon the drug in the intestine. The presence of salicyluric acid in the urine is to be discovered by the addition of a solution of the chloride of iron to that fluid, which causes the appearance of a violet color. Poisoning.—Salicylic acid when taken in excessive dose causes profuse sweating, roaring in the ears, dimness of vision, headache, partial or total deafness, and a decided fall in temperature. The pulse becomes Aveak and relaxed, and finally ptosis, strabismus, and general paralysis ensue. The urine and faeces are passed involun- tarily, and the urine is olive-green in color. The respirations at first are quickened and deepened, but finally become shallow and feeble, death ensuing from respiratory failure. If the dose is sufficiently large, the blood is involved and the cor- puscles rapidly break down. Therapeutics.—Salicylic acid, owing to its close resemblance to quinine, was first introduced as an antiperiodic and antipyretic, but soon Avas found to be of an inferior value in these states and of super- lative value in rheumatism. At present it is rarely if ever used for either of the former purposes, but is largely employed as a standard remedy for the latter trouble. The value of salicylic acid in rheumatism limits itself solely to the relief of pain and the cure of the malady without preventing the complications incident to its course. That is to say, the changes in the joints or heart in rheumatism are only of less frequency after the use of salicylic acid because the drug shortens the disease, and not because it prevents these changes by a direct influence ; this is also true of rheumatic hyperpyrexia, Avhere salicylic acid is of service in shortening the attack, though it often fails to control the tempera- ture to any great extent. In acute rheumatism 15 to 20 grains (1.0- 1.3) should be given every four hours until marked physiological symptoms occur. Another method is to give 30 or 40 grains at 7 and 9 P. M., with a copious draught of milk, so that the main effects will be produced during sleep. It is to be remembered, however, that in many cases the salicylates are of no value whatever, merely producing sweats and headaches, and it is also worthy of note that nothing else does these cases much good, as they seem bound to run a given course before the patient recovers. If a cure does take place, relapses are very common indeed, and the drug should always be continued for several days after all symptoms cease. In gonorrhoeal rheumatism salicylic SALICYLIC ACID. 341 acid is of little value until the gonorrhoea is cured, Avhen the rheuma- tism also ceases, Avhether Ave give salicylates or not. In rheumatoid arthritis it is entirely valueless. The question as to the value of the salicylates in cases of gout is one open for debate. Some physicians regard it as useful, others as useless. Thus DuckAvorth states that in his experience and that of his friends the salicylates do not compare Avith colchicum. On the other hand, See, Jaccoud, and Haig find them useful. If they are of any value it is only Avhen the dose is very large, and even then their usefulness seems to be doubtful. In subacute rheumatism citrate of potassium and sodium may be used in place of salicylic acid in the dose of 30 to 60 grains (2.0-4.0), and these salts are to be taken just before going to bed. In lumbago, sciatica, and similar states salicylic acid is a very useful remedy. While it is not as good as antipyrin in neuralgia, it is of great service in the migraine of rheumatic persons, often entirely curing the disease. Haig has proved that the salicylic compounds all aid in the excretion of uric acid, and thinks they relieve rheumatism in this manner. Brunton has highly recommended the use of the salicylates with the bromides in the nervous irritability of gouty or lithgemic persons. Salicylic acid has been largely used for the removal of pleural effu- sion if the effusion be serous. Dock believes that the duration of treatment is less Avith the salicylates than by the use of diuretics, alteratives, or purgatives, but the author has not reached good results from this plan of treatment. The dose should be from 1 to 2 drachms (4.0-8.0) daily. Doses larger than this are not necessary. How sali- cylic acid does good in pleural effusion we do not know, for its diuretic properties are not sufficiently great to drain away the liquid by this means. In quinsy or true toiisillitis the drug is a specific, particularly when rheumatism is the cause. It will generally prevent suppuration, shorten the attack, and relieve the pain and swelling. The doses should be small, say 3 grains (0.25) at each dose, and given hourly. In stomatitis, after the blisters have broken, the burning and pain are often intense, and a mouth-Avash of salicylic acid in the proportion of 1 to 250 of water is useful. Ringer recommends the use of the folloAving sahre in pruritus of the anus and vulva: R— Acid, salicylic..............^ij (8.0). 01. theobromse............^v (20.0). Cetacese................3iij (12.0). 01. myristicae.............f^iss (6.0).—M. In the treatment of corns there is probably no better application than lint soaked in a solution of salicylic acid, or the use of the fol- lowing formula: R— Acid, salicylic..............gr. xxx (2.0). Ext. cannab. indicse.........gr. v. (0.35). Collodii...........m.....f^ss (16.0).—M. S.—Apply with a brush until a good coat is formed. A useful salve for the soreness following horseback or bicycle riding is one composed as folloAvs: 342 DRUGS. R— Acid, salicyl...............gr. x. (0.65). Adip. benzoinat.............£j (32.0).—M. S.—Apply to the sore part. A solution of salicylate of sodium or of bicarbonate of sodium, applied on lint to inflamed rheumatic joints, often gives great relief. Smearing an ointment of salicylic acid over the joints not only pro- duces good effects locally, but by absorption of the drug influences the disease. (See Rheumatism, Part IV.) In gastric dilatation or catarrh, where vomiting occurs and the matters vomited contain sarcinae, salicylic acid Avill be found of ser- vice, and Bartholow thinks it of value in paroxysmal gastralgia. In adults suffering from ascaris lumbricoides, or round-worms, salicylic acid may be used in the dose of 8 grains (0.6) every hour till 40 grains (2.65) are taken. This treatment should be followed by the use of a purge. For thread- or seat-Avorms the folloAving injection will be found of service : R.—Acid, salicylic.............^ss (2.0). Sodii borat................^ss (2.0). Aquae................Oj (500.0).—M. S.—Warm, and inject into the bowels. For a child reduce this one-half in all its parts. In bromidrosis of the feet (excessive sweating Avith foetor) salicylic acid may be dusted over the parts, or the following poAvder used: R.—Acidi salicylic. 1 __ _ ,.,„„, Pulv. amyl. } • • • • •.....aa ^ss (16.0).—M. S.—Apply to the feet. In eczema of the face and hands, where the eczema is of the wet or weeping variety, salicylic acid, locally applied, is often of great service. R .—Acidi salicylic..........gr. v vel x (0.3-0.65). Pulv. amyli..........sjij (8.0). Pulv. zinci oxid.........zij (8.0). Petrolati...........|ss (16.0).—M. S.—Apply locally. If the eczematous process is subacute and needs stimulation, the salicylic acid may be increased to 20 or 30 grains (1.3-2.0). Contraindications to the use of the salicylates are meningeal in- flammation or congestion, middle-ear disease, albuminuria, inactivity of the kidneys, particularly as occurring in pregnancy, and Bright's disease. Antiseptic Use.—Salicylic acid is employed as an antiseptic in the treatment of wounds as a local remedy and as a dressing, but should not be applied over too large an area, as it may be absorbed and pro- duce constitutional symptoms. As an application to small burns a mixture of 1 drachm (4.0) of salicylic acid to 8 ounces (256.0) of olive oil is of service. In the treatment of soft chancres and venereal sores salicylic acid has been largely used by some practitioners either as a salve or as a dusting-powder, as follows: SALICYLIC ACID. 343 R.—Acid, salicylic............gr.xx (1.3). Alcohol...............gtt. xlv (3.0). Adipis benzoinat...........gij (64.0).__M. R— Acid, salicylic............gr. xv (1.0). Pulv. amyli vel cretse........gij (8.0).__M. Salicylic acid may be added to urine to prevent its decomposition, but will sometimes cause the tests for sugar to appear. Patients taking salicylic acid often notice that the urine is odorless after standing, and that it will remain fresh for many days because of the salicylic acid present in it. It may cause the reaction of sugar in the urine in Trommer's test. Untoward Effects.—Salicylic acid, as already stated, may produce headache and roaring sounds in the ears. In persons with middle-ear disease it is contraindicated unless urgently called for, as it often makes the deafness permanently worse. Sometimes erythema or acne folloAVS its employment, and blindness and retinal hemorrhages have been found to occur. Striimpell asserts that delirium of an active character sometimes appears after full doses of salicylic acid, which delirium is usually happy in its type, and is seen most commonly in young girls. Sometimes full doses produce visions Avhich may be seen only Avhen the eyelids are closed. It Avould be impossible to enumerate all the untoAvard effects Avhich have been noted, but it is worthy of remark that very few deaths have taken place.1 Binz thinks that full doses of salicylic acid may produce abortion in Avomen who already have a tendency to abort, and Vineberg thinks that menorrhagia and metror- rhagia are caused by it. Administration.—Salicylic acidhasanauseous,disagreeable taste and is irritant to the stomach. It should be given in a solution of glycerin and Avater, or its taste may be covered by the use of syrup of bitter orange-peel or syrup of ginger. The folloAving formulae may be used: R.—Acid, salicylic.............ijij (8.0). Tinct. lavanduhe comp.........fgiv (16.0). Glycerini...............fSss (16.0). Aqua;.....■.......q. s. ad f gviij (256.0)—M. S.—A tablespoonful (16.0) every two hours. Or, R— Acid, salicylic............^ij (8.0). Glycerini..............f^ss (16.0). Syrup, aurantii...........fliv (128.0). Aquae........... q. s. ad fgviij (256.0).—M. S.—A tablespoonful (16.0) every two hours. Salicylic acid may be used in pill or capsule, but is irritant to the stomach in so concentrated a form ; it must be taken with much Avater, and should follow rather than precede meals. If buzzing in the ears produced by this acid is annoying, bromide of sodium in the dose of 20 grains (1.3) will generally give relief. Salicylic-acid ointment (Unguentum Acidi Salicylici, B. P.) is a useful preparation for external application in chronic, deep-seated skin diseases. 1 See author's Boylston Prize Essay of Harvard University on Antipyretics. 344 DRUGS. Salicylate of Methyl. (See Gaultheria.) Salicylate of Sodium. Salicylate of Sodium (Sodii Salicylas, U. S. and B. P.) is a less irritant and somewhat less disagreeable preparation than salicylic acid. Its internal action, use, and doses are the same as those of the acid. It may be given by dissolving it in milk, and then adding ren- net to produce a curd, which covers the taste and protects the stomach. Other salicylates are largely used by some persons. Salicylate of lithium is supposed by some physicians to be of more value than the other salts. SALOL. In appearance, Salol, U. S. and B. P., is a Avhite crystalline poAvder, faintly aromatic and almost Avithout taste. It is not soluble in Avater, but is in alcohol, and an alcoholic solution forms an imper- fect emulsion Avhen mixed with Avater. Salol is also slightly soluble in copaiba, in the oils of sandahvood and of turpentine, and in mineral oils. This solubility is very useful in prescribing it with these remedies in certain diseases of the genito-urinary apparatus. (See Gonorrhoea.) Salol is a compound of 60 parts of salicylic acid and 40 of car- bolic acid, and is decomposed by the pancreatic juice into these two substances. For this reason overdoses are capable of producing symp- toms of carbolic-acid poisoning. Thus 20 grains of salol (1-3) taken five times a day will cause a man to take 40 grains (2.65) of carbolic acid, which is almost a poisonous dose. Hesselbach has proved that salol is very apt to affect the kidneys unfavorably, and rightly believes it to be contraindicated in all cases of renal inflammation of an acute type. It is worthy of note that the drug rarely produces untoward effects, although at one time a number of observers accused it of frequently doing so. Salol is used for the same purposes as salicylic acid in the treatment of rheumatism when the stomach is irritated so that it cannot bear the latter drug, and it often acts well in these cases, as it is dissolved in the small intestine. A dose often used is 10 grains (0.65) an hour, but this is too much, as a rule, and may produce dangerous symptoms. Salol is also useful in muscular rheumatism and neuralgia due to exposure. In pharyngitis 5 grains (0.3) of salol, given three times daily, is a valuable part of the treatment of the affection, and in per- sons subject to chronic sore throat due to the uric-acid diathesis this treatment will often produce extraordinary results. It is of the great- est use in duodenal catarrh and catarrhal jaundice. In the treatment of gonorrhoea in all its stages salol may be employed by the mouth, as in its elimination it sterilizes the urine SALOPHEN—SANDAL-WOOD OIL. 345 and tends to disinfect or sterilize the urethra at each act of mic- turition. (See Gonorrhoea.) Salol is of very great value in cases of intestinal indigestion and fermentation, and is sometimes used in cases of mild or pernicious auismia when it is thought that the development of decomposition pro- ducts is their cause. (See Anaemia.) In diarrhoea dependent upon such causes salol is one of the best remedies Ave have, since it renders the intestinal canal antiseptic, and so removes the cause of the disorder, instead of locking the putrid material in the boAvel, as does opium. In cholera morbus the writer's friend, Dr. Fussell of Philadelphia, has found the folloAving very useful: R.—Salol . . . ._...........5i/40). Bismuth, subnitrat..........,"ij (8.0). Misturse cretfe........q. s. adf^iij (96.0).—M. S.—Two teaspoonfuls (8.0) every two hours. Wide experience with the drug in the treatment of cholera during recent epidemics has proved it to be one of the best remedies we can employ in the treatment of this disease. Salol may be given in wafers, capsules, or pills. SALOPHEN. Salophen has been introduced into medicine as a substitute for salol, and is said to possess the advantage of being far less poisonous than salol, because in this case the phenol of the salol is replaced by a compound of phenol Avhich is innocuous. Experiments on ani- mals seem to indicate that these theoretical advantages are present in fact. Like salol,. salophen is broken up in the intestine by the juices there present, and the result is salicylic acid and acetylparamidophenol. Salophen contains about 10 per cent, less salicylic acid than does salol (51 per cent.), and appears in the form of thin, white laminse nearly insoluble in water. It is tasteless. Therapeutics.—For the therapeutics of salophen the reader is referred to the article on Salol, as the indications for both drugs are identical, save that salophen can probably be used when salol cannot be employed. The dose of salophen is from 5 to 20 grains (0.35-1.3) three times a day. It can be very effectually combined with phen- acetin in the treatment of neuralgia. In subacute rheumatic affec- tions it is certainly very useful. SANDAL-WOOD OIL. Sandal-Avood Oil (Oleum Santali, U. S. and B. P.) is derived from the Avood of Santalum album, a tree of India, and has a hot, burning taste. The odor is very pleasant, and the oil has been used as a per- fume. In overdose the oil is capable of producing great irritation of the genito-urinary passages. Therapeutics.—The oil of sandal-wood is much used by genito- 346 DRUGS. urinary surgeons in chronic gonorrhoea and gleet for the purpose of stimulating depraved mucous membranes to proper action, and in chronic cystitis to act as a tonic to the bladder. In the subacute or later stages of bronchitis, Avhen the expectora- tion is thick and ropy and the cold is not readily "thrown off," the oil of sandal-wood is efficacious. Dr. Daggett strongly recommends its use in cases of asthma associated with marked catarrhal symptoms, and in the excessive cough following influenza it is of great value. In all cases it should be given in capsules in the dose of 5 to 20 drops (0.35-1.3), 5 drops (0.35) being generally sufficient, although drug- gists generally keep it in 10-minim (0.65) capsules. Oil of sandal- Avood may irritate the stomach, but it is not so apt to do so as are cubebs or copaiba. SANGUINARIA. Sanguinaria, U. S., or Blood-root, is the rhizome of Sanguinaria canadensis, and has been largely used in medicine, but is a danger- ous remedy, possessing more power for harm than good. Its chief alkaloid is sanguinarine. Poisoning.—Sanguinarine in poisonous dose causes vomiting, purg- ing, profuse salivation, and finally tonic convulsions which are spinal in origin. Death is due to respiratory failure, but the circulation is much decreased in force and frequency. Therapeutics.—The employment of sanguinaria in chronic bron- chitis is about the only purpose for which it is now employed to any extent. As an emetic in croup it has been largely used, but is too irritant and depressant, and ought not to be so employed. According to Bartholow, the drug acts as an hepatic stimulant, and is of service in gastro-intestinal catarrh with jaundice. Administration.—The dose of the fluid extract (Extractum San- guinariae Fluidum, U. S.) is 1 to 5 drops (0.05-0.35) as an expec- torant, or 10 to 30 drops (1.0-2.0) as an emetic. If the drug does not cause vomiting after an emetic dose, it must not be allowed to remain in the stomach, as it is poisonous. The tincture (Tinctura San- guinaria, U. S.) is the best preparation to use, and may be given in 20- to 30-drop doses as an expectorant, and 1 to 3 drachms (4.0-12.0) as an emetic. The vinegar (Acetum Sanguinariae) is no longer official, but is given in the dose of 10 to 30 drops (0.65—2.0), and as an emetic in the dose of 2 to 4 drachms (8.0-16.0). SANTONIN. Santoninum, U. S. and B. P., is a neutral principle derived from Levant Worm-seed or Santonica, Avhich is the unexpanded flower- heads of Artemisia pauciflora, a plant of Asia Minor and Turkestan. Santonin is soluble in alcohol and chloroform, but less so in water. Santoninic acid is formed by warming santonin Avith alkalies, and Hesse has found that santonin is an anhydride of santoninic acid. Santoninic acid is more soluble than santonin. SANTONIN. 347 Poisoning.—Santonin causes, Avhen taken in overdose, muscular tremors, convulsive movements, unconsciousness, and sometimes epi- leptiform convulsions. One of the most common symptoms of the poisoning is chroma- topsia or xanthopsia, during the existence of which all objects look yellow. This is due to the staining of the humors of the eye by the drug. This may go on to total blindness or pass aAvay in a few days. If the vision is not yelloAv, it may be green. The urine is also stained—first yellow, then saffron, and finally purple-red, or is bloody-looking. This is not due to the presence of blood, but to the drug. Poisonous doses of the drug do not cause gastro-enteritis. Therapeutics.—Santonin is used for the removal of the round-worm, and is very efficacious. It has no influence on the tape-worm. It should be given in the manner of all vermifuges (see Worms)— namely, at a time when the alimentary canal is empty. Santonin is said to have a distinct influence over vision, increasing, in me- dicinal amount, its acuity Avhenever the optic nerve is at fault. In urinary incontinence santonin will often produce a cure after all other remedies fail. Santoninate of sodium (Sodii Santoninas) is a useless, harmful preparation, never to be employed except for the benefit of the eye when vision fails through disease of the optic nerve. Introduced into medicine because of its solubility, it is absorbed into the system, which is just Avhat is least desired in an anthelmintic, Avhich should seek the Avorm in the bowel, not by entering the blood. In eye affec- tions the dose may be from 2 to 8 grains (0.1-0.6) a day, according to the age of the adult. Santonin may also be given in the dose of 1 to 2 grains (0.05-0.1) to an adult in capsules or wafers. The crystals should be used, not the powdered santonin. If the boAvels are not opened Avithin ten hours after the drug is used, a saline purge should be given, preceded preferably by a 2- or 3-grain (0.1-0.15) dose of calomel, taken half an hour before, as the flow of bile caused by the mercurial is partic- ularly useful in making the Avorm let go its hold. Untoward Effects.—In addition to the curious effects already named santonin may cause urinary incontinence even in medicinal dose. Administration.—Santonin is best given in the form of a troche or lozenge (Trochisei Santonini, U. S. and B. P.), but it is to be dis- tinctly borne in mind, and written on the prescription, that the Trochisei Sodii Santoninatis of the U. S. P. of 1880 are not to be sold to the patient. The troches of santonin itself are now official in the U. S. P., but if the physician prefers to write for troches, they can be made as follows: R.—Santonini............... g£.v(0-3)- Pulv. sacchari alb............3nJ y}.2-0'- , Pulv. acaciae..............gr. vnj (0.5). Misce bene, et adde Acaciae mucilag.............gtt- xvj (1.0). Aquae.................I- s- Ft. in troches No. x. S.—One or two lozenges, as directed. 348 DRUGS. SARSAPARILLA. Sarsaparilla, U.S., is the root of Smilax officinalis, Smilax medica, and other species of Smilax, growing chiefly in Central America. It is knoAvn in the B. P. as Sarscs Radix. The drug is devoid of any physiological action, yet seems to possess some power over the general condition of the system. Thus while sarsaparilla seems utterly with- out effect in the hands of most physicians when given alone, it often seems to do good and to increase the effects of other drugs when com- bined with them, so that some cases of syphilis which are of an obsti- nate character will yield to iodide of potassium and sarsaparilla Avhen the iodide alone fails. Sarsaparilla is largely used in domestic med- icine as a " blood-purifier," and is a prominent constituent of many patent medicines. It is useless for such purposes. Administration.—Sarsaparilla is most commonly given in the form of the compound syrup (Syrupus Sarsaparilla Compositum, U. S.), composed of sarsaparilla, sassafras, guaiacum-wood, liquorice, pale rose, gaultheria, anise, and senna, dose 1 to 4 fluidrachms (4.0-16.0). (See Iodide of Potassium.) The other official preparations of the U S. P. are the compound decoction (Decoctum Sarsaparillce Com- positum), composed of the same principal ingredients as the compound syrup, except that anise, senna, pale rose, and mezereum are omitted, dose 4 to 6 fluidrachms (16.0-24.0); the compound fluid extract (Extractum Sarsaparilla? Fluidum Compositum), similar to the syrup in composition, dose ^ to 1 fluidrachm (2.0-4.0); and the fluid extract (Extractum Sarsaparilla? Fluidum), dose J to 1 fluidrachm (2.0-4.0). The B. P. preparation is a liquid extract (Extractum Sarscs Liquidum), dose ^ to 4 fluidrachms (2.0-16.0). SAVINE. Sabina, U. S., is the tops of the Juniperus Sabina, an evergreen shrub of Northern Europe, Asia, and America. It contains an official volatile oil (Oleum Sabinae, XL S.). Locally applied, it is more of a counter-irritant than is turpentine, and if SAvallowed in poisonous amount causes nausea, vomiting, gastro-enteritis, uncon- sciousness, suppression of urine, and death. If the individual be a pregnant female, abortion takes place as death approaches, but very rarely before this time. Profuse flooding nearly alAvays accompanies the act. Therapeutics.—The oil, taken in the dose of 5 to 10 drops (0.35-0.65), repeated every three or four hours, acts as a poAverful stimulant to the uterus and ovaries, causing hyperaemia and aiding in the production of menstruation in cases of amenorrhaa. It may also be employed Avith advantage in some cases of menorrhagia. The drug is best given in emulsion or capsule. The fluid extract (Ex- tractum Sabinae Fluidum, U. S.) is given in the dose of 5 to 15 minims (0.35-1.0.) SCA MM ONY—SCOPOLA MINE. 349 SCAMMONY. Scammonium, U. S., Scanimonia Radix, B. P., is a resinous exu- date from the root of Convolvulus Scanimonia, groAving in Asia Minor and Syria. Its active principle is sometimes called jalapin. Therapeutics.—Seammony is an irritant, drastic, hydragogue puro-e, which causes a good deal of griping and exerts a cholagogue effect. If an inflammatory condition of the bowels is present its use is contra- indicated. The ingestion of poisonous doses is to be followed by treatment suitable for gastro-enteritis. Seammony is given in the dose of 2 to 5 grains (0.1-0.35), ahvays in combination Avith some other similar drug—as, for example, colocynth. Seammony forms part of the com- pound extract of colocynth (Extraction Colocynthidis Composition, U. S.), the dose of which is 1 to 3 grains (0.05-0.15) as a lax- ative or 5 to 20 grains (0.35-1.3) as a purge. The resin (Resina Scammonii, U S.) is given in the dose of 3 to 8 grains (0.15- 0.6). The B. P. preparations of seammony are Pilula Scam- monii Composita, dose 5 grains (0.35); and Pulvis Scammonii Com- positus, dose 10 to 20 grains (0.65-1.3). The last two preparations are composed of seammony, ginger, and jalap. SCOPOLAMINE. Scopolamine is an alkaloid derived from Scopolamia atropoides, a plant of Southern Europe, Avhich possesses medicinal powers closely resembling those of belladonna and its sister drugs. Its physiological action is very closely allied to that of hyoscine, one of the alkaloids of hyoscyamus, and, as stated in the article on Hyoscine, it is probable that much so-called hyoscine is scopolamine. Therapeutics.—Scopolamine is used in medicine chiefly by ophthal- mic surgeons, and in the eye is far less irritating than either of the alkaloids of hyoscyamus or atropine. Indeed, it may be considered as being distinctly sedative in plastic iritis. Its effects are not, however, so lasting as are those of atropine. The use of -j|-q of a grain dropped into the eye in one dose produces a mydriasis in eighteen minutes and ciliary paralysis in twenty-three minutes. This mydriasis lasts about seventy-two hours, and the ciliary paralysis about ninety-six hours (Oliver). It finds its greatest usefulness in the early stages of iritis, when a rapidly-acting and efficient sedative mydriatic is demanded. Scopolamine is best used for this purpose in the strength of fa of 1 per cent. (1: 500) in Avater. This solution may be dropped into the eye every twenty minutes till one hour has elapsed. As this use of the drug is slightly painful it is well to place a few drops of cocaine solution in the eye before each instillation of scopolamine. Internally scopolamine acts as a fairly poAverful soporific in nervous insomnia, and in the sleeplessness of mania, and even when dropped into the eye its general systemic effect is soporific. 350 DR UGS. Scopolamine itself is rarely employed, the hydrobromate of scopola- mine being preferable. It also occurs as the hydriodate and hydro- chlorate. The dose of these salts of scopolamine varies from ^^ to fa of a grain (0.0003-0.001) by the hypodermic needle or the mouth. SCOPARIUS AND SPARTEINE. Scoparius, U. S. (Seopari Cacumina, B. P.), or Broom, is the tops of the Cytisus Scoparius. It contains scoparin and sparteine, the first being a crystalline principle and the second a liquid alkaloid. The second (sparteine) is the alkaloid used in medicine in the form of a sulphate (Sparteines Sulphas, U. S.), Avhich is a crystalline salt readily soluble in Avater. Physiological Action.—As scoparius depends for its medicinal value almost entirely upon sparteine, Avhat is here said applies to both the crude drug and the alkaloid. Nervous System.—Sparteine acts on the nervous system very decidedly if given in large dose, depressing the brain and spinal cord, chiefly in its motor tracts, thereby causing a decrease of reflex action and motor power, ending in complete paralysis. These changes occur both in man and in the lower animals. The heart is said to be stopped in systole. Circulation.—Upon the circulation sparteine acts as a stimulant. It quickens the pulse-rate in moderate doses, and also raises arterial pressure. The force of the contraction of the ventricles is also increased. In very large poisonous doses the drug acts as a circulatory depressant. Respiration.—Upon this function in small amounts sparteine has no effect, but poisonous doses kill by paralysis of the respiratory centre. Poisoning.—The symptoms of poisoning consist in trembling and inco-ordination of movement, and clonic and tonic convulsions, fol- lowed by a second stage of depression of the nervous system and general enfeeblement. Therapeutics.—Sparteine has been recommended in all states of the heart in Avhich digitalis is of service, and it is sometimes useful in those fairly frequent cases where digitalis fails. In cardiac arhyth- mia or palpitation it is thought to be of great service by those Avho have used it most. Clark found it of value in Graves's disease and in nearly every circulatory abnormality, but in the judgment of the author of this book sparteine is not a very useful drug—one only to be turned to as a last resource after more generally knoAvn remedies fail; or, in other Avords, it is not a remedy to be used as a " stand- by " in the manner in Avhich digitalis is employed. While some clinicians have found sparteine of value, many of them have not. In the few cases in which it has been used by the writer it entirely failed to be of service, perhaps because the cases were des- perate and the drug was tried after all the other remedies had failed. The dose is as variable as its action. Some state it to be fa of a grain SEIDLITZ PO WDER—SENEGA. 351 (0.003), Avhile still others recommend 2 to 4 grains (0.1-0.2). A small dose should be used at first, and rapidly increased until some effects ensue. To get the best effects it should be given every tAvo hours in the dose of J of a grain. The drug should be given in watery solu- tion. Potts claims to have found sparteine of value in the treatment of tremor, as in paralysis agitans, in the dose of \ to J grain (0.015- 0.025) three times a day. Scoparius itself is used in decoction, made by adding J an ounce (16.0) of the broom-tops to a pint (\ litre) of water, and boiling them doAvn to a J pint (250 cc). Of this, an ounce should be taken every three hours. This decoction is one of the most efficient diuretics in cardiac dropsy. An official fluid extract (Extraction Scoparii Fluidum, U. S.) is given in the dose of 30 drops (2.0). The official prepara- tions of the B. P. are an infusion (Infusum Scoparii), and the juice (Succus Scoparii), dose 1 to 2 drachms (4.0-8.0). SEIDLITZ POWDER. Under the official name of Pulvis Eff'ervescens Compositus the U. S. P. recognizes a purgative powder (Pulvis Soda? Tartarata Effervescens, B. P.) made by taking the bitartrate of sodium and potassium, or Rochelle salt, 120 grains, and bicarbonate of sodium 40 grains, which are Avrapped in blue paper, and 35 grains of tartaric acid placed in a Avhite paper. The contents of each paper are dissolved in a little water—half a tumblerful—and the tAvo solutions added to one another and swallowed during effervescence. As much as two poAvders may be used, but this is generally too large an amount unless full purgation is needed. In sick stomach associated Avith constipation, Avhen a Avhole poAvder cannot be retained, the tAvo poAvders should be divided into fourths, and a fourth added to a fourth dissolved in a half-wineglass- ful of water and taken every fifteen minutes until the entire powder is ingested. This will often settle the stomach and produce purgation. SENEGA. Senega, U. S. (Senega? Radix, B. P.), is the root of Polygala Senega, a small plant of the United States, containing a principle knoAvn as polygalic acid and senegin. Therapeutics.—Senega is used in medicine as a stimulating expec- torant in the subacute and chronic forms of bronchitis. It has also been employed as a diuretic in cardiac dropsy or that due to renal disease. In cardiac disease it should not be used, and indeed it is rarely employed at present except in combination with other drugs in expectorant mixtures. Administration.—Senega is used in the form of the fluid extract (Extractum Senega? Fluidum, U. S.), dose 10 to 20 drops (0.65-1.3), and the syrup (Syrupus Senega?, XI. S.), dose 1 to 2 drachms (4.0- 352 DRUGS. 8.0). It is also used in Coxe's HiA-e Syrup. The official preparations of the B. P. are—a tincture (Tinctura Senega?), dose 1 to 2 drachms (4.0-8.0), and an infusion (Infusum Senegcs), dose 1 to 2 ounces (32.0-64.0). SENNA. Senna, U. S., is the most drastic of the laxative purges used for the relief of constipation. It is the leaflets of Cassia acutifolia and Cassia angustifolia, and contains a very acrid irritant purgative princi- ple knoAvn as cathartic acid. Senna is official in the B. P. as Senna Indica and Alexandrina. Physiological Action.—Senna acts as a purge, producing copious stools, often with a great deal of griping if it is used alone. Accord- ing to Rutherford and Yignal, it acts very materially in increasing the flow of bile, but it is seldom, if ever, used in medicine as a chola- gogue, although, according to Prevost and Binet, cathartic acid has an influence over biliary secretion. Hess has found that the drug acts directly as a stimulant upon the mucous membranes, and so pro- duces a local peristalsis as it is moved along. It is also knoAvn that the drug is eliminated in the milk, and for this reason care should be taken in giving the drug to nursing mothers, as it will purge the nursling. Administration.—Senna is generally combined with other drugs for the relief of constipation, but may be used alone. If this is done, the fluid extract (Extractum Sennae Fluidum, U. S.) may be employed in the dose of 1 to 2 drachms (4.0-8.0) to a child or 4 drachms (16.0) to an adult. It is, however, always better to give children the more agreeable confection (Confectio Sennae, U. S. and B. P.) in the dose of J drachm (2.0) to a child or 1 to 2 drachms (4.0-8.0) to an adult. As the confection is apt to cause gastric dis- order if used continuously because of the sugar contained in it, its use is limited to a certain class of cases. In the treatment of the constipation of pregnancy senna is thought to be very useful. In these cases and in others when cascara sagrada alone will not move the bowels, senna may be prescribed as follows: E.—Ext. sennae fluid.............f|ij (60.0). Ext. cascaraesagradae fl...........f'^j (30.0).—M. S.—Teaspoonful (4.0) at night, or night and morning. Should this produce griping \ to 1 minim (0.025-0.05) of fluid extract of belladonna may be added to each dose. Under the name of Black Draught a mixture of senna, manna, and sulphate of magnesium has been largely used (Infusum Senna? Composition, U. S.) in the dose of 4 ounces (128.0). It is an active hydragogue purge. The syrup (Syrupus Sennae, U. S. and B. P.) is given in the dose of 1 \o 4 drachms (4.0-16.0). One of the best ways to use senna is in the compound liquorice powder (Pulvis G-lycyrrhiza? Compositus, U. S. and B. P.), Avhich is SERPENTARIA—SILICATE OF POTASSIUM OR SODIUM. 353 a good laxative in the dose of 20 to 30 grains (1.3-2.0). Compound liquorice poAvder is composed of senna, liquorice, oil of fennel, avashed sulphur, and sugar. Infusion Sen nee, B. P., is given in the dose of 1 to 2 ounces (32.0-64.0); Mistura Seniles Composita, B. P., in the dose of 1 to 2 ounces (32.0-64.0), and Tinctura Sennae Composita, B. P., in the dose of 1 to 4 drachms (4.0-16.0). Senna, because of its chrysophan, may stain the urine carmine if that fluid is alkaline, or yelloAv if it is acid. No alarm should be felt if the color appears in this secretion. Often it is necessary to Avarn the parents of a child of the possibility of such an occurrence, in order to prevent any fright on the part of the mother, who othenvise might think that haematuria Avas present. SERPENTARIA. Serpentaria, U. S. (Serpentaria Rhizoma, B. P.), or Virginia Snakeroot, is the rhizome and rootlets of Aristolochia Serpentaria and Aristolochia reticulata, plants of the Southern United States. It contains an active principle, aristolochin, which is never used in medicine. Therapeutics.—OAving to the rather pleasant, Avarm taste of ser- pentaria, and the fact that it stimulates secretion, it is used largely as a vehicle for other more potent remedies. It has tonic properties, and in consequence has been largely used in the treatment of atonic dyspepsia and indigestion. It is even said to be a sexual stimulant, but this is doubtful, to say the least. In overdose it is an irritant, and will cause vomiting and purging if large amounts are taken. Administration.—Serpentaria is given in the form of the fluid extract (Extractum Serpentaria? Fluidum, U. S.) in the dose of 10 to 40 drops (0.65-1.3), and the tincture (Tinctura Serpentaria?, U. S. and B. P.) in the dose of \ to 2 drachms (2.0-8.0). It also enters into Huxham's Tincture of Cinchona (Tinctura Cinchona? Composita, U. S. and B. P.). Infusum Serpentaria?, B. P., is given in the dose of 1 to 2 ounces (32.0-64.0). SILICATE OF POTASSIUM OR SODIUM. Soluble Glass, or Silicate of Potassium or Sodium, occurs as a clear syrupy fluid, and is not official. It is used as a splint in the dressing of fractures and sprains, as it rapidly becomes hard and immovable Avhen painted over the bandages. Silicate of potassium or sodium may be universally substituted for plaster of Paris. The silicate of sodium is official as Liquor Sodii Silicatis, U. S. P. 23 354 DRUGS. SOAP. Sapo, U. S. (Sapo Durus, B. P.), is prepared from any alkali and fixed oil, although soda and olive oil are most frequently employed in the manufacture of the soaps Avhich are used medicinally. Castile soap, if good, is the best representative of a pure soap that wTe have. Soap may be cut into the form of a suppository and used to pro- voke movements of the bowel in young children Avho are suffering from constipation by placing it just inside the anus, having previously dipped it into water one instant to make it slippery. It may also be used as an enema, dissolved in Avarm Avater, or a mixture knoAvn in Philadelphia as the " House Mixture " may be employed in the case of an adult. This consists of a mixture of water, soft-soap, and molasses in Ararying proportions, and if flatulence is present turpentine and olive oil are added to it. The preparation is as efficient as it is cheap and dirty. Soap is also used as an antidote to many poisons and as an aid to emetics. Green Soap (Sapo Mollis, U. S. and B. P.) is not generally green, but brown. It is a soft soap made by the use of potash and olive oil, and is largely used by dermatologists in the treatment of eczema and similar skin diseases Avhere a detergent, stimulating application is needed. It is sometimes called "German soft soap," to separate it from the ordinary soft soap, or the common sapo mollis, of this coun- try, which is an impure substance often made of rancid fats, contain- ing a large excess of alkali and never used except for scouring pur- poses. Green soap is not commonly employed as green soap, but in the liniment (Linimentum Saponis Mollis, U. S.), which is to be thoroughly rubbed into the part Avhen used medicinally, Avell Avashed off, and afterward simple cerate or some other soothing salve applied. Soap Liniment (Linimentum Saponis, U. S. and B. P.), or Opo- deldoc, as it is called in domestic medicine, is largely used for rubbing stiff muscles and sprains. It is generally employed to carry more active external remedies, such as opium or aconite. R.—Tinct. aconiti *| Tinct. belladonnae >-........aa f^ij (8.0). Tinct. opii J Liniment, saponis ......q. s. ad f^vj (192.0).—M. Soap Plaster (Emplastrum Saponis, U. S.) is used as a thick, heavy protective for bed-sores or where bed-sores are feared. It is also used as a support about sprained joints. SODIO-SALICYLATE OP THEOBROMINE. This compound, knoAvn as diuretin (or sodio-theobromine-salicy- late), derives its name from the extraordinary power Avhich it is said to possess of producing a great increase in the urinary flow from the kidneys. This poAver depends entirely upon the theobromine, which is a crystallizable, bitter, and volatile alkaloid, closely allied to caf- SODIUM. 355 feine and xanthine, and derived from the seeds ot Theobroma Cacao, or the source of ordinary chocolate. OAving to the insolubility of theo- bromine, it has been found necessary to combine it Avith sodium salicy- late, as under these conditions it is readily absorbed. The diuretic properties of this alkaloid Avere first discovered during a series of experiments made by Schroder in Strasburg in 1889, who found that the diuresis produced in man and the lower animals was very marked. A large number of clinical trials in Europe and America have confirmed his observations, but there are a number of cases in Avhich it signally fails, particularly in chronic Bright's disease. Theobromine does not have so stimulating an effect on the heart as does its relative caffeine, so that the circulatory effect, Avhile showing a stimulant rather than a depressing tendency, is very slight. It slightly increases muscular power, but its peculiar affinity for the renal structures surpasses all its other activities. As the action of the drug depends upon its ability to stimulate the secreting epithelium of the kidney, the physician should remember that in cases of advanced renal disease, where the secreting structures are almost entirely destroyed, no result can be expected from its administration; but it is probable that the drug is useful in almost all conditions of dropsy, whether due to renal inactivity or cardiac disease, and is harmless to the patient even if the diuretic effect does not ensue. The only contraindication to the use of theobromine or diuretin is the presence of acute nephritis, Avhen, of course, sedatives rather than stimulants are needed. So far as the writer is aware, no study as to the proportion of solids and liquids in the urine under the influence of this drug have been made, but the fact that it stimulates the epithelium or secreting structures of the kidney would indicate that the solids are increased. As diuretin only contains from 30 to 50 per cent, of theobromine, it has to be given in very large amounts, as much as 1 to 2 drachms (4.0-8.0) in tAventy-four hours, preferably in divided doses of from 10 to 20 grains (0.65-1.3) in capsule or in warm Avater. The former method is the better, as the taste of the drug is disagreeable and soapy. It must not be exposed to the air, as it undergoes decomposition. In all the cases in which the Avriter has tried sodio-salicylate of theobromine he has failed to see any effect produced, and, while he has no confidence in the drug, he mentions it because others claim to have obtained good results from its use. SODIUM. Sodium is a metallic element, the salts of which are usually white and colorless. It is not used in medicine, but many of its salts are employed. While potassium acts as a depressant to the body, sodium seems to exert comparatively little effect upon the animal economy. The salts vary in their poAver Avith the acid forming them. (See Ben- zoate of Sodium, Chloride of Sodium, Salicylate of Sodium, etc.) 356 DRUGS. Acetate of Sodium (Sodii Acetas, U S. and B. P.) is rarely if ever used in medicine as a substitute for acetate of potassium. The dose is 20 to 40 grains (1.3-2.65) three times a clay. SODIUM BICARBONATE. Bicarbonate of Sodium (Sodii Bicarbonas, U. S. and B. I*.) is largely used as an antacid in gastric fermentation and in sick head- aches arising from this condition. Combined Avith calomel in poAvder, it certainly adds to its efficiency in increasing biliary Aoav, as all alka- lies 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 Avhen used in a lotion made by dissolving it in Avater and applying it to the part on lint or rags. In acidity of the stomach the folloAving effervescing poAvder is useful: Bicarbonate of sodium (Sodii Bicarbonas), 30 grains (2.0) in one paper, and in the other 10 grains (0.7) of tartaric acid (Acidum Tartaricum). These are each dissolved in half a tumbler of water, added to one another, and SAvalloAved during effervescence. SODIUM CHLORIDE. Chloride of Sodium (Sodii Chloridum, U. S. and B. P.), or Com- mon Salt, is a useful drug and food, aiding in maintaining the alka- linity of the blood and tissues and in the formation of gastric juice, beino- 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 pep- sinogen of the gastric tubules. The dose is 10 to 20 grains (0.65-1.3). SODIUM ETHYL ATE. Sodium Ethylate is a Avhitish poAvder, decomposed in the presence of Avater into alcohol and caustic soda, but soluble in absolute alcohol Avithout decomposition. Sodium ethylate is employed in medicine as a depilatory—that is, for the purpose of removing hairy growths. To accomplish this pur- pose it is necessary that the growth be clipped close to the skin, and that the drug be dissolved in absolute alcohol and applied OArer the roots of the hair Avith a glass rod. Soon after this application a crust forms, which should not be detached for two or three Aveeks, but Avhich, on its removal at the end of this time, generally shows that all the roots of the hair have been destroyed. If not, the operation may be repeated as soon as the skin is in a condition to bear it. To prevent pain, a 5 per cent. solution of cocaine may be used hypodermically at the spot to be cauterized. It is worthy of remembrance that moles and small birth- marks, or naevi, may be relieved by a similar application. SODIUM HYPOSULPHITE—SOLANUM CAROLINENSE. 357 SODIUM HYPOSULPHITE. Hyposulphite of Sodium, or Thiosulphite of Sodium, occurs in large, transparent, colorless plates Avhich effloresce Avhen exposed to the air. It has slight alkaline reaction, is soluble in about equal parts of Avater, but insoluble in alcohol. Therapeutics.—Hyposulphite of sodium is used in the proportion of 1 drachm (4.0) to the ounce (32.0) of water or lard in the treat- ment of parasitic skin diseases, particularly those due to the tri- cophyton fungus, such as pityriasis versicolor. It is also very useful, locally applied, in poisoning from poison ivy, and in cases of pruritus due to other causes, in the strength of ^ a drachm (2.0) to the ounce (32.0) of Avater. In malarial hcematuria hyposulphite of sodium is often given with advantage in the dose of from 10 to 30 grains (0.65- 2.0) every four hours. How it acts in this condition we do not know. SODIUM SULPHATE. Sodii Sulphas, U. S. and B. P., or Glauber's salt, is one of the most irritant of the saline purges, rarely used in medicine for human beings, but largely employed by veterinarians. The purgative dose for man is half an ounce to an ounce (16.0-32.0). If any intestinal inflam- mation is present, it is contraindicated. It produces large watery stools, with a good deal of griping. Sulphate of sodium is a promi- nent constituent of Carlsbad water, Hunyadi Janos, Hunvadi Arpad, and similar Avaters. (For an explanation of the action of salines in producing purgation, see Magnesium Sulphate.) Reverdin has recently claimed that small doses of 2 grains (0.1) of sulphate of sodium every hour are of great value in controlling capil- lary hemorrhages and for graver hemorrhages. It must be given by the mouth or intravenously. If given hypodermically he asserts it is useless. SOLANUM CAROLINENSE. Solanum Carolinense, or Horse Nettle, is a Ioav perennial plant of the natural order Solanaceae, a native of the South-eastern United States. According to some studies made by Thornton the drug depresses the cerebrum, but excites the spinal cord. It has been introduced into medicine for the purpose of relieving epilepsy, particularly Avhen the disease occurs in childhood. In a limited employment of the drug the Avriter has found it very serviceable in diminishing the frequency and severity of the attacks. The beginning dose of the fluid extract is 15 to 60 minims (1.0-4.0) three times a day, but it can be increased to as much as a drachm at a dose Avith advantage. 358 DRUGS. SOMNAL. Somnal is stated to be ethylated chloral-urethan, and seems to possess marked hypnotic power. It is a clear, colorless liquid of a hot, burning taste, resembling SAveet spirit of nitre. The dose is 20 to 40 drops (1.3-2.6) in liquorice-water or syrup of raspberry, and the sleep produced by it is said to last seven to eight hours. No very definite reports have yet been made concerning it, but in a number of cases in which the writer has used it it has acted very well, although drowsiness is usually present on the next day. SOZOIODOL. Sozoiodol is an antiseptic preparation first made and employed by one of our own countrymen in San Francisco, but at that time the preparation of it was so imperfectly carried out that foreign matters made it too irritating for general use, and it was discarded, only to be better prepared and more Avidely used in Germany some years later. Therapeutics.—Sozoiodol has been found of value as an antiseptic and disinfectant in the treatment of wounds Avhich are in an unhealthy state, and for acute stomatitis and pharyngeal catarrh it may be employed locally in the form of a 5 per cent, watery solution. It has also been found useful in acute purulent conjunctivitis and in oph- thalmia neonatorum, in the proportion of 2 parts of sozoiodol to 30 parts of water. In urethritis of a specific type we may employ the preparation knoAvn as zinc-sozoiodol in a 2 per cent, solution with advantage, and this compound is also of value in mild and malignant vaginitis if preceded by pyroligneous acetic acid or nitrate of silver, applied by means of a speculum. In the treatment of gynaecological cases, particularly in catarrh of the cervix uteri, Nitschman uses sozoiodol in the form of a poAvder applied by means of a tampon with good results, and it would seem to be worthy of trial in many other states of the mucous membranes than those just named. SPIGELIA. Spigelia, U. S., Pinkroot, is the root and rhizome of Spigelia marilandica, or Carolina Pink, a plant of the Southern United States. Poisoning.—Almost immediately after the ingestion of a poisonous dose of spigelia the animal has short and quick expiratory move- ments, amounting almost to a cough. Soon after the pupils become widely dilated, the eyeball is turned inward, and at the same time the orbit becomes fixed in this position, so that the eye cannot follow any object, such as a pencil, Avhen it is moved from side to SQUILL. 359 side. Constant retching, Avith no result, noAv comes on, the animal standing and apparently suffering from no sensory or motor palsy. There is no change in gait. Soon after this marked exophthalmia is developed. The retching, having lasted about five minutes., now passes off, and at this time signs of muscular weakness and lack of co-ordination appear, the walk becoming staggering both in the fore and hind legs. The respirations noAV become very rapid, resembling those of a dog after a long run on a hot day. The tongue hangs from the mouth and is dry and red, and the nose is hot and no longer moist. Muscular power is progressively lost, so that the dog fre- quently falls Avhen endeavoring to Avalk, but sensation does not seem to be affected. About this period the animal lies doAvn and passes into a deep sleep, Avhich, in turn, soon changes into coma, and death folloAvs Avithout any movement being made, evidently from a general failure of vital force. The respirations, as death approaches, become slow, and are finally extinguished simultaneously with cardiac arrest. The palsy is spinal in origin, the motor and sensory nerve-trunks and the muscles escaping the paralysis. Therapeutics.—Spigelia is one of the most efficient remedies in the treatment of round-worms, and is not dangerous Avhen given with care. When employed for the removal of worms the usual precaution should be taken in regard to the ingestion of food (see article on Worms), and the drug should be folloAved by a purge to swreep out the Avorm while it is narcotized. The purge should be one which is rapid in its action, such as the sulphate of magnesium. Administration.—The dose of spigelia in the form of the fluid extract (Extractum Spigelics Fluidum, U. S.) is 2 drachms (8.0); that of the unofficial fluid extract of spigelia and senna (Extraction Spigelia et Sen nee Fluidum) is J to 1 drachm (2.0-4.0) for a child of two years of age; J an ounce (16.0) is the dose for an adult. The addition of fluid extract of senna makes the drug more efficient, and the mixture is generally not disliked by children. It is to be remem- bered that this latter mixture is no longer official. SQUILL. Scilia, U. S. and B. P., is the sliced bulb of Urginea maritima, a plant of the countries bordering on the Mediterranean. It con- tains scillin, scillipicrin, and scillitoxin, all of which possess poison- ous properties and none of which are used in medicine alone, except by a few persons. Poisoning.—In poisonous doses squill produces vomiting, purging, dulness, stupor, intermittent palsy, convulsions, and death in ten to twenty hours. These symptoms are preceded by a great fall in tem- perature. The urine is suppressed or bloody and acute nephritis is produced. Gastro-enteritis may be marked. Therapeutics.— Squill is largely used as a stimulant or irritant diuretic, not to affect the renal epithelium directly and promote secre- tion, but rather to tone up and excite to normal effort a kidney depressed by disease, as in very chronic Bright s disease or renal con- 360 DRUGS. gestion from cardiac trouble. In cardiac dropsy, combined Avith digi- talis, squill is a standard and much-used remedy, and is undoubtedly of value in aiding in the absorption of effusions in the pericardium, pleura, and abdomen. Squill is usually given in dropsy, in pill form, as folloAvs: R.—Pulv. scilhe..............gr. x (0.65). Pulv. digital, fol............£j (1.3).—M. Ft. in pil. No. x. S.—One t. d. after meals. The employment of squill in bronchitis, although largely resorted to, is not a very good practice, since its irritant action on the kidneys and stomach may cause trouble. The period for its administration is in the beginning of the second stage, Avhen secretion is scanty or so excessive as to need proper stimulation of the mucous membranes to bring on a healthy action. Sometimes Coxe's Hive Syrup is used, either as an emetic in drachm doses every ten minutes until it acts, or as an expectorant in the dose of 30 drops to 1 drachm (2.0-4.0) for an adult. As it contains antimony, it should be given Avith care. Administration.—The fluid extract (Extractum Scillae Fluidum, U. S.) is given in the dose of 1 to 5 drops (0.05-0.3); the tincture (Tinctura? Scillae, U S. and B. P.) in the dose of 5 to 30 drops (0.3-2.0); the vinegar of squill (Acetum Scillcs, U. S. and B. P.) in the dose of 10 drops to J drachm (0.65-2.0). The compound syrup (Syrupus Scillae Compositus, U. S.), or Coxe's Hive Syrup, is com- posed of squill, tartrate of antimony and potassium, precipitated phos-= phate of calcium, alcohol, sugar, and Avater, and is given in the dose of 20 drops (1.3) as a sedative to an adult and 1 drachm (4.0) as an emetic to a child. The folloAving prescription will be found useful in bronchitis in its subacute stages in a child of one to five years: R.—Vini ipecac. . . . ,..........f£j (4.0). Tincturae scillae............f^ij (8.0). Svr. tolutan..............f .^v (20.0). Aqu?e................fgj (32.0).—M. S.—Teaspoonful (4.0) every three or four hours. The plain syrup (Syrupus Scillae, U. S. and B. P.) is given in the dose of J to 1 drachm (2.0-4.0), the honey (Oxymel Scillcs, B. P.) in the dose of \ to 1 drachm (2.0-4.0), and the compound pill (Pilulce Scillae Composita, B. P.) in the dose of 5 to 10 grains (0.3-0.65). STARCH. Amylum, U. S. and B. P., is Avheat starch, but good corn starch is usually employed by many persons. In very fine poAvder starch is used as a dusting powder in intertrigo or chafing. Its more import- ant uses are, hoAvever, its employment in the form of starch-Avater for carrying drugs into the rectum, and in the form of a poultice for cases of skin disease where it is desired to remove crusts. STILLINGIA—STRAMONIUM. 361 Starch-water is made by boiling starch in the proportion of 2 table- spoonfuls to 1 pint of Avater, which is then boiled to paste and diluted by the addition of warm water to the consistency of syrup. Starch- Avater is not only useful as a vehicle for drugs given by the rectum, but as a sedative injection in proctitis and rectal irritation. The starch poultice is made by boiling the starch to a pasty con- sistence or adding enough boiling Avater to a paste made by rubbing cold water and starch together to produce a gelatinous mass. 30 grains (2.0) of boric acid to the ounce (32.0) render it antiseptic. STILLINGIA. Stillingia, U. S., Queen's Root, is the root of Stillingia sylvatica, a plant of the United States, the active principle of Avhich is stil- lingin. Physiological Action.—There can be no doubt that this drug acts in tAvo ways : first, by its immediate effects on the system, and second, by its more sloAvly-shoAvn alterative influences. In overdose it causes bilious purging, increased heart-action, and active secretion from the bronchial mucous membrane. Therapeutics.—Stillingia is highly recommended in habitual con- stipation, as it increases intestinal secretion, and it is even said to act as a specific in hemorrhoids dependent largely for their existence upon hepatic engorgement and intestinal atony. Bartholow recommends the following prescription under these cir- cumstances : R.—Extract, stillingiae fluid.........f^v (20.0). Tincturae belladonnae ~| Tincturae nucis vomicae >-.... aa f %j (4.0).—M. Tincturae physostigmatis J S.—20 drops (1.3) in water t. d. before meals. Tincture of aloes may also be added to this prescription if consti- pation is present. In syphilis of an obstinate and rapid type stillingia should be used as an aid to other drugs. In pasty-looking, white, " putty-faced " children, who are anaemic or strumous, and who never have any appetite, or are subject to mid- dle-ear trouble and general debility, stillingia is of value. It should be used, under these circumstances, for some time. The only official preparation is the fluid extract (Extraction Stillingice Fluidum, U. S.), Avhich should always be made of the fresh root, the dose of Avhich is 10 to 60 drops (0.65-4.0). STRAMONIUM. Jamestown Weed, or Datura Stramonium, is official in the form of the leaves (Stramonii Folia, U. S.) and the seeds (Stramonii Semen, U. S. and B. P.). It contains an alkaloid knoAvn as daturine, Avhich is physiologically identical Avith atropine. 362 DRUGS. Physiological Action.—(See Belladonna.) Therapeutics.—The uses of stramonium are identical Avith those of belladonna. Administration.—The extract (Extractum Stramonii, B. P., Sem- inis, U. S.) is used in the dose of | to \ grain (0.01-0.03), the fluid extract (Extractum Stramonii Seminis Fluidum, U. S.) in the dose of 1 to 5 drops (0.05-0.35), and the tincture (Tinctura Stramonii, U. S. and B. P.) in the dose of 5 to 30 drops (0.3-2.0). It should be remembered that this tincture is nearly tAvice as strong as the tincture prepared according to the U. S. P. of 1880. The ointment (Unguentum Stramonii, U. S.) is used for the same purposes as is belladonna ointment. The dose of daturine is y^ to fa of a grain (0.0005-0.0008). STRONTIUM. This substance has lately been introduced into medicine in the form of the bromide (Strontii Bromidum, U. S.), lactate (Strontii Lactas, U. S.), iodide (Strontii lodidum, U. S.), salicylate, and phosphate, largely through the studies of Laborde, Sde, Paul, and others. The bromide of strontium is used for precisely the same effects as are the other bromides, but it is claimed that, as the strontium has a distinct nutritive influence over the system, the well-knoAvn disadvantages of the potassium salt are avoided. The dose of bromide of strontium is from 30 to 60 grains (2.0-4.0). In addition to the ordinary effect of bromides, See found the bromide of strontium to be very useful in overcoming attacks of gastric indigestion associated Avith pain in the stomach and hyperacidity; and the author has confirmed this state- ment. The lactate of strontium seems to be indicated chiefly in cases of albuminuria due to renal atony. It does not increase urinary flow, and is contraindicated in' the presence of the uraemia and the high fever of acute parenchymatous nephritis. In chronic parenchyma- tous nephritis, such as is due to rheumatism or gout, it is of value. Unfortunately, as soon as the lactate of strontium is AvithdraAvn the albuminuria is apt to recur. The dose of the lactate of strontium is 60 to 100 grains (4.0-7.0) a day. The salicylate of strontium is a valuable preparation, because it is not so disagreeable to the taste as the corresponding salt of sodium; and, more important still, it is far less apt to disorder the stomach than salicylic acid itself or any of its other salts. The author has found it for these reasons very useful in acute articular rheumatism, when the progress of the patient Avas delayed by the inability of his stomach to retain the ordinary anti-rheumatic remedies. The salicylate of strontium is best given in capsules or cachets, and should ahvays be followed by a draught of milk or Avater to prevent its coming in contact with the stomach in too concentrated form. The dose is, for all practical purposes, identical Avith that of the salicylate of sodium. Strontium possesses no toxic poAver Avhatever, and overdoses are not STR OPHANTH US—S UGAR. 363 folloAved by any bad consequences. If the strontium is contaminated by barium, serious effects are produced. The Avriter has often been much disappointed in the use of the lactate of strontium in albuminuria, but others of Avide experience seem to regard it as very constant in pro- ducing good results. STROPHANTHUS. Strophanthus, U. S., Strophanthi Semina, B. P., is an African plant (Strophanthus hispidus), from the seed of which the natives make kombe' arroAv-poison. There are many varieties of Strophanthus. The active principle is strophanthin, from Avhich is derived strophanthidin. It has been claimed that strophanthus contains a local ansesthetic prin- ciple, but Dr. de SchAveinitz and the author found it to be possessed of this poAver only in dogs and not in man. Therapeutics.—Strophanthus may be used in all forms of cardiac disease to supplant digitalis, but it is not its equal. From the cases of cardiac disease seen frequently by the writer he has reached the conclusion that digitalis gives relief to patients under the age of tAvelve years in a much smaller proportion of cases than it does in adults, and that, though the stomach is no more frequently disordered, increased dyspnoea, nervous irritability, and cyanosis often folloAv its use. On the other hand, strophanthus generally gives good results in this class of cases. As every one knowTs, there are a certain number of cases wThere digitalis seems to do harm in adults, the explanation being that under such circumstances the ventricle is so overstimulated that the auricle cannot empty itself thorough^, and becomes congested in consequence. Strophanthus acts exceedingly Avell in those instances where digitalis fails, and this is particularly true in children. It will relieve cardiac dropsy by its action on the heart, but does not possess marked diuretic properties. Untoward Effects.—Strophanthus Avhen given in full dose frequently causes diarrhoea. Administration.—Strophanthus is given in the form of the tincture (Tinctura Strophanthi, U S. and B. P.) in the dose of 3 to 6 drops (0.2-0.35) three times a day. The extract of strophanthus (Ex- traction Strophanthi) is now official in the B. P. The dose is ¥ of a grain (0.016). Strophanthin may be given hypodermically in the dose of -fan to fa of a grain (0.0006-0.0012). Its effects when so used are said to last a Aveek, but this statement can scarcely be correct. SUGAR. Saccharum, U. S. (Saccharum Purification, B. P.), is the refined juice of Saccharum pfficinarum, or Sugar-cane, or the juice obtained from the Sugar-beet. It is an antiputrefactive, but not an antifer- mentative. Mixed Avith iron preparations, it prevents oxidation. As 364 DRUGS. it is a hydrocarbon, it is a nutrient and a developer of adipose tissue, or, in other words, is a food. Its use is contraindicated in obesity, during the existence of fermentative changes in the stomach and intestine, and in diabetes mellitus. SUGAR OP MILK. Saccharum Lactis, U. S. and B. P., is derived from the whey of coav's milk by evaporation, in the proportion of about 5 per cent., and is then purified by re-crystallization. It has little sweetening poAver compared to cane-sugar and possesses a peculiar insipid taste. It is, hoAvever, less apt to ferment and is better for infants than is cane- sugar. Milk-sugar is largely used in triturations, because by its hardness it aids in the subdivision of the medicament. It is also used to increase the bulk of small powders where such drugs as podophyllin and calomel are prescribed. Recent studies, both scientific and clinical, have shown lactose to be possessed of very great diuretic power Avhen given in full doses. The advantage claimed for lactose as a diuretic is its direct action on the kidney and the slight effect exercised upon the rest of the organism. It is, therefore, in renal dropsy or renal inactivity that this substance is particularly indicated. The dose of lactose in cases of dropsy should be as great as from 2 to 4 drachms (8.0-16.0), given daily, dissolved in a quart (1 litre) of water. It has been found that the lactose acts best in those cases in which there is no albuminuria. These recent studies are of interest in vieAV of the well-knoAvn clin- ical fact that the addition of lactose to the milk of bottle-fed babies ahvays causes profuse diuresis. SULPHOCARBOLATES OP SODIUM AND ZINC. The sulphocarbolates of zinc and sodium are largely employed by some practitioners as mild antiseptic local stimulants, either in pow- der or in solution, on ulcers and sores. Much more commonly they are given internally for the production of gastro-intestinal antisepsis Avhen there is diarrhoea with foetid, ill-smelling stools, as in the bowel disorders of hot Aveather in children or adults or in the course of typhoid fever. How much good they do in the latter disease, so far as the disease itself is concerned, is uncertain, but they undoubtedly render the stools less foul and tend to check the diarrhoea. The sul- phocarbolate of zinc is the better of the tAvo for these purposes. The dose is 2 to 3 grains (0.1-0.15) in pill four or five times a day. The sulphocarbolates are probably eliminated from the body unchanged. SULPHONAL. 365 SULPHONAL. Sulphonal, B. P., is a synthetically prepared substance first manu- factured in Germany by Baumann, and possesses the chemical name of diethyl-sulphon-dimethyl-methane. It is a colorless, odorless, solid substance, soluble in 100 parts of cold and 18 to 20 parts of hot water, and is readily soluble in alcohol and ether. The drug is not affected by any of the ordinary acids, and is very stable. Physiological Action.—Several quite interesting researches upon this comparatively neAv hypnotic have been carried out recently. Smith of London has studied its action on the activity of tissue-change, and also attempted to determine the changes in the drug during its pas- sage through the body. Without taking up space Avith a full consid- eration of his method of experimentation, Ave find that his conclusions may be summed up as folloAvs : In moderate doses the drug is com- pletely changed during its passage through the body into a sulphur- etted organic substance, and the elimination of sulphuric acid is not increased by taking sulphonal. Dr. Smith does not give us the exact nature of the substance derived from sulphonal. Another paper upon the physiological action of sulphonal has been published by Dr. Wil- liam F. Shick of Easton, Pa., Avho has found, by a series of experi- ments, first, that sulphonal Avhen given by the stomach acts very sIoavIv, on account of its insolubility, but that subcutaneouslv in Avarru solution it is much more active. The drug was also found to produce a general relaxation of the muscles, and a staggering gait after its hypnotic poAver had passed by. The spectroscope failed to shoAV any changes in the blood. The motor nerves Avere not affected. Shick believes that the action of the drug is exerted upon the higher nerve-centres. He also found a decreased reflex activity, and believes this lessening to be due to stimulation of Setschenow's reflex inhibi- tory centre. On the circulation the drug Avas found to have but little poAver. When sent directly into the blood there Avas produced a slight decrease in arterial pressure, folloAved very soon after by an increase. Upon the respiration the drug Avas found to act as a depressant Avhen given in full doses. Therapeutics.—Sulphonal finds its place in medicine as a somni- facient or hypnotic, valuable Avhen functional nervous insomnia is present, useless Avhere advanced disease, such as cardiac trouble, is responsible for the wakefulness. In insanity it often produces sleep, and is of great service in the various mental disturbances character- ized by lack of sleep and often affecting persons of unsound mind. Sulphonal may be defined very briefly by any one Avho has largely used it or Avatched the reports made of its progress. This definition is that the drug does possess sleep-producing poAver of moderate amount—not equal to chloral, but greater than that of paraldehyde— and that it will sometimes succeed Avhere the other hypnotics fail. Administration.—Sulphonal being virtually insoluble in cold Avater, it may be given in large capsules or in mucilage of acacia, so as to be held in suspension until SAvallowed. The insolubility and bulki- 366 DRUGS. ness of the drug render its use difficult. It is best given in hot Avater (about 6 ounces), as suggested by SteAvart. This makes a solution, and as soon as the liquid is cool enough to be SAvalloAved it should be taken before precipitation occurs as the result of cooling. Sulphonal should be used several hours—say two or three—before the patient retires. If taken late at night, the patient frequently fails to get to sleep until the morning hours, and is heavy and drowsy all the next day. This difficulty is partly avoided by the use of a hot solution, but even then is apt to arise. The dose is 20 to 40 grains (1.3-2.6). It is Avise not to use sulphonal continuously for more than a hV\v days. Untoward Effects.—When sulphonal is taken in full dose for long periods of time, great sleepiness and Aveariness, Avith an unsteady gait, develop, Avhich may go on to paralysis of the loAver extremities if the use of the drug is persisted in. In some cases the paralysis is progressive, and in others hyperesthesia and abnormal sensations develop. In all such cases there is great disturbance of digestion with scanty secretion of urine, Avhich contains an unusual substance, giving this secretion the color of port Avine (hsematoporphyrinuria). Sulphonal often produces heaviness and a staggering gait the day after it is taken. There are numbers of cases of death on record from acute and chronic poisoning by sulphonal. In both classes of cases the death was by respiratory failure preceded by deep unconsciousness. SULPHUR. Sulphur is a non-metallic element official in three forms in the U. S. P.—namely, as Sulphur Sublimation, U. S. and B. P., or sub- limed or flowers of sulphur; Sulphur Praecipitatum, U. S. and B. P., or precipitated sulphur; and Sulphur Lotum, U. S., or Avashed sulphur. Much confusion exists among students as to the differences betAveen these various forms of sulphur. Sulphur itself is an element Avhich is prepared for medicinal uses by being heated and sublimed (Sulphur Sublimation), or flowers of sulphur. Sulphur lotum, or Avashed sul- phur, is prepared in order to get rid of sulphuric acid and other con- taminating substances, and is made from sublimed sulphur. Sulphur precipitatum is also made from sublimed sulphur, and is more bland and minutely subdivided. Some believe it differs from sublimed sulphur in its therapeutic properties by reason of a small amount of Avater supposed to be present. It is sometimes called milk of sulphur. When sulphur is prescribed for internal use the sublimed sulphur is generally designated. Physiological Action.—Sulphur has little physiological influence over the general system. When taken internally it causes a soft, mushy stool of a yelloAv color with a strong odor of hvdrogen sul- phide. The drug acts particularly on the skin and mucous membranes. The juices of the intestines break up some of it into sulphuretted hydrogen and sulphides. Therapeutics.—Sulphur is used as a mild laxative, never as a purge. In stricture of the bowels the soft stools produced by it will SULPHUR. 367 often slip by the obstruction, and it is worthy of note that sulphur Avill sometimes overcome constipation Avhen nothing else will give relief. It is particularly valuable in the treatment of constipation where there are hemorrhoids, and in chronic rheumatism and sciatica it is thought by some to effect a cure. Sulphur is of great service in the treatment of chronic bronchial affections, but for some curious reason its use has become almost obso- lete. The so-called Bergeon's method of treating phthisis by rectal injections of carbonic acid gas loaded Avith sulphuretted hydrogen Avas simply a revival of a custom of our great-grandfathers, who often used sulphur-Avaters by the mouth in the treatment of catarrhs or other disorders of mucous membranes. Bergeon took the trouble to go to the rectum to accomplish Avhat Avas done tAvo hundred years ago by the mouth, and the only novel part of his method Avas his filthy way of using the remedy. Graves recommended 5 to 10 grains (0.35- 0.65) of sulphur three times a day Avherever bronchial secretion was excessive, and found that it rid the lungs of mucus and relieved the cough. The external use of sulphur is very much more important than its internal use, in so far as regards affections of the skin. Of itself, the drug exercises little effect over the cuticle Avhen used in poAvdered form, but combination with an ointment makes it at once active. Even irritations of the skin may ensue from its constant use in concen- trated form. In scabies, or itch, sulphur ointment ( Unguentum Sulphuris, U. S. and B. P.) is the best remedy Ave have. The female parasite burrows under the epiderm and deposits the OAra as she moves about, Avhile the male does not burroAv, but stays on the surface. The ointment will kill him, as he is readily attacked, but the female is protected by her burroAA'ing propensities. To get at her and the ova the burroAvs must be opened, and this may be accomplished by a thorough soaking of the body Avith soap and A\Tater, thereby softening the epiderm covering the parasite, Avhich can then readily be removed by rubbing the patient with a rough toAvel. The toAvel should be boiled at once to prevent its conveying the parasite to others. The ointment, if noAv applied, relieves the patient almost at once. It is important that the skin be Avell softened and rubbed, in order to keep open every burroAv. The ointment should be alloAved to remain on the part all night and be used for three or four nights consecutively. Young Avomen often suffer from acne, particularly about the men- strual epoch, the skin also becoming at this time salloAV and muddy. Ringer recommends the following lotion as one which is very success- ful in promoting a cure : R.—Sulphuris sublimati.........3J (4.0). Glycerini .............f.^i (4.0). Aquserosfp...... .......fgviij (256.0).—M. S.—Apply as a wash once or twice daily. Administration.—Sulphur is given in the dose of 10 to 20 grains (0.65-1.3) three times a day as an alterative, and from 1 to 2 368 DRUGS. drachms (4.0-8.0) at night as a laxative, Avith a little molasses to form a paste. A confection (Confectio Sulphuris) is official in the B. P., dose 10 grains to 2 drachms (0.65-8.0). Sulphide of Calcium. (See Calcium, Calx, and Sulphides.) SULPHURIC ACID. Acidum Sulphuricum, U. S. and B. P., Sulphuric Acid, or Oil of Vitriol, is a powerful irritant and escharotic, rapidly dehydrating and carbonizing the tissues, causing them to become black. It is the most astringent of the medicinal mineral acids, and Avhen absorbed it unites Avith bases to form sulphates, and is so eliminated by the kidneys, the lower boAvel, and the skin. It coagulates albumin. Poisoning.—The symptoms produced by poisonous doses are those of a gastro-intestinal inflammation of the most severe type, or the patient may drop to the floor almost at once, OAving to collapse dependent upon perforation of the Avails of the oesophagus or stomach by the acid and its consequent escape into the peritoneal cavity. If the patient lives to the fourth day, the parotid glands may become SAvollen as the result of stenosis of the salivary ducts of Steno, and violent inflammation of the kidneys may appear from the passage of the drug through these organs in the process of elimination. If par- tial recovery takes place, the patient often dies from inanition due to the formation of strictures in the alimentary canal or to destruction of the peptic tubules. The stain about the mouth is black, and if any of the acid is spilt on the clothes the characteristic burn is to be seen. The treatment consists in the use of alkalies, such as chalk, mag- nesium, AvhiteAvash off the Avails, and soap. Opium and oils are to be given to allay irritation, and external heat is to be applied. Therapeutics.—Sulphuric acid is sometimes employed as a caustic to venereal sores, warts, and slowly-healing ulcers, but is most com- monly used internally, as it fulfils several pressing indications. As a remedy for serous diarrhoea, particularly if combined with some vegetable astringent, it is unsurpassed, and its use in cholera deserves great attention. (See Diarrhoea.) In the Philadelphia Hospital dur- ing an epidemic of cholera some years since every case which received sulphuric acid improved or failed to be attacked, whereas those who did not receive it were either very ill or died. The proper way to use the drug as a prophylactic during cholera epidemics is in the form of "sulphuric-acid lemonade," made so that each wineglassful of Avater contains 5 drops (0.35) of the aromatic sulphuric acid. The same solution may be used in acute lead poison- ing in order to form an insoluble sulphate of lead, and may be taken by artisans exposed to chronic lead poisoning as a prophylactic for the same purpose. SUMBUL-SUPRARENAL GLAND. 369 As sulphuric acid is eliminated by the skin, it is often useful in the night-sweats of phthisis combined Avith belladonna or morphine. Administration.—The dose of the dilute acid (Acidum Sulphuricum Dilution, U. S. and B. P.) is 10 to 20 drops (0.65-1.3), and of the aromatic acid (Acidum Sulphuricum Aromaticum, U. S. and B. P.) 5 to 20 drops (0.35-1.3). The latter is the best preparation for gen- eral use. It contains ginger and oil of cinnamon. Both should be thoroughly diluted before they are administered. SUMBUL. Sionbul, U. S., is the root of Ferula Sumbul, a large plant of Northern Asia. The dose of the root (Sumbul Radix, B. P.) is 10 to 40 grains (0.65-2.65). On the nervous system sumbul acts as an efficient nerve tonic, and was very largely employed by Goodell in cases of nervous exhaustion and in the unrest of nervous females. It is official in the tincture (Tinctura Sumbul, U. S. and B. P.), dose 1 to 4 drachms (4.0-16.0). Goodell used the following formula: R.—Extract, sumbul............gr. xx (1.3). Ferri sulph. exsiccat..........gr. xx (1.3). Asafoetidae............gr. x (0.65). Acid, arsenosi............gr. J (0.03).—M. Ft. in pil. Xo. xx. S.—One t. d. after meals. To be of any value the drug must be fresh, and care must be taken that the crude drug from which it is made is a good sample. SUPRARENAL GLAND. The use of thyroid and other glands for medicinal purposes has led to the employment of the adrenal gland, or its extract, in the treatment of disease in which this gland is found so disorganized as to be unable to carry out its function of internal secretion—as, for example, in Addi- son's disease. An extract from these glands possesses a very distinct physiological action, which consists chiefly in a great rise of arterial pressure, produced by stimulation of the muscular coats of the blood- vessels ; but Avhile it causes such positive effects in ordinary doses, overdoses do not seem to possess markedly toxic influences. Locally applied a sterile 4 per cent, watery solution of the gland is useful in abnormal vascularities of the conjunctiva, as in trachoma, and for the purpose of contracting dilated capillaries, as in hypertrophy of the turbinated bodies. It increases the effects of cocaine in this respect. Because of this effect, and also because suprarenal extract increases muscular tone generally, the extract may be employed in cases of relax- ation of the vasomotor system, in neurasthenia, in cardiac feebleness, and perhaps in cases of purpura. It has been used with asserted great success in the treatment of diabetes insipidus. Suprarenal extract is 24 370 DRUGS. also said by some to be of value in cases of anamia of the pernicious type with enlargement of the liver and spleen. Usually when suprarenal gland is used the effect is produced very slowly. It is best given by the stomach, and neither the acid nor the pepsin have any effect upon it. Careful investigation shows beyond a doubt that the powdered gland, dried in vacuo, and given in tablet in the dose of 3 to 5 grains (0.18-0.30), three times a day, is the most efficacious preparation. SWEET SPIRIT OP NITRE. Sweet Spirit of Nitre (Spiritus ^Etheris Nitrosi, U. S. and B. P.), or Spirit of Nitrous Ether, is a mixture of alcohol, water, and ethyl nitrite. It is upon this last constituent that most of its value as a remedial agent depends. The drug Avhen sold by pharmacists or others Avho are not very careful to keep fresh preparations is no better than alcohol and Avater alone, since the ethyl nitrite readily escapes, and deterioration at once takes place. Until recently the profession have had no ready means of protecting themselves from such poor preparations, but at present we know that all that is necessary to dis- cover this absence is to add a grain or two of antipyrin to a J ounce or less of the spirit. If the ethyl nitrite be present, a purple color fol- lowed by a green precipitate Avill be formed. This green precipitate is iso-nitroso-antipyrin, which is not in the least poisonous. Physiological Action.—Sweet spirit of nitre is a sedative to the cir- culatory and nervous system and a diaphoretic and diuretic, accord- ing to the manner in Avhich it is administered. If given in very full doses, it rapidly produces the cyanosis cha- racteristic of the full effects of any one of the nitrites. (See Amyl Nitrite.) Therapeutics.—There is probably no drug so Avidely employed by the laity as a household remedy Avhich is so potent for good, and yet so harmless, if Avrongly used, as is this one. Physicians often place less reliance upon it than it deserves, and in nearly every instance where it fails it is either not indicated or the nitrite has escaped and left it poAverless. In incontinence of urine in children the combination which follows is very useful in certain cases. (See Incontinence of Urine.) In these instances the urine will be found high-colored and concentrated, and therefore capable of irritating the bladder and genito-urinary tract: R.—Potassii citratis...........^j to .^ij (4.0-8.0). Spt. setheris nitrosi.........f^ss (16.0). Aquae...........q. s. ad f^iv (ll'X.O).—M. S.—Dessertspoonful (8.0) every five hours until the urine becomes clear. As soon as the urine is clear, belladonna may be used, the citrate of potassium and spirit of nitre being continued or not as the case demands. Where the spinal centres are depressed and there is gen- eral atony of the system, it may be Avell to substitute the folloAving pill for the belladonna: TAMARINDS—TANNIC ACID. 371 R.—Acid, arsenosi............gr. 4 (0.016). Extract, nucis vomicae........gr. ij (0.1). Quininae sulphatis..........gr. xx (1.3).—M. Ft. in pil. No. xx. S.—One pill t. d. after meals. The diuretic action of SAveet spirit of nitre is best obtained by using the drug in ice-cold Avater and keeping the patient lightly cov- ered and cool. On the other hand, if a diaphoretic influence is desired, it may be given simultaneously with Avarra lemonade, and the patient should be Avell blanketed. This last action of sweet spirit of nitre has made it a remedy of common use in treating acute colds in adults and children, and in setting aside the fever of these condi- tions in the latter class as Avell. SAveet spirit of nitre is a distinct antispasmodic, and can be well employed where slight nervous excitement accompanies fevers or in other states associated Avith irritation in infancy. The dose for an adult is from 20 drops to 1 drachm (1.3-4.0), and for a child of one year 5 to 10 drops (0.35-0.65). It should always be given in cool Avater to the latter class of patients. TAMARINDS. Tamarindus, U. S. and B. P., is the preserved pulp of Tamarindus indica, a tree of the West Indies. The taste is a peculiar mixture of bitter and SAveet. As a laxative it exerts little power over that of any ordinary fruits, such as apples, but it enters into the confection of senna (Confectio Sennae, U. S. and B. P.). Patients often find tamarinds a very agreeable laxative Avhen they are taken before going to bed or eaten as a confection after meals. TANNIC ACID. This acid Avhen pure is an uncrystallizable, Avhite or yellowish- Avhite poAvder Avithout bitter taste and Arery soluble in Avater or glyce- rin. It is not so soluble in alcohol and ether. It is the chief active principle of vegetable astringents, and occupies the relative position of an alkaloid to a crude drug, so far as the active portion of these vegetable astringents is concerned. Tannic acid is derived from nut- gall. Physiological Action.—Tannic acid when brought in contact with any of the tissues of the body constringes them and decreases their vascularity for a time, by causing contraction of their blood-vessels. For these reasons it stops secretion and condenses parts of the body Avhich are relaxed and feeble. Mixed Avith blood, it forms a clot with great rapidity through coagulation of the albumin. Tannic acid is absorbed as gallic acid and eliminated as such, only acting as tannic acid before absorption. This is important to remember, since we learn from this that tannic acid is to be used to check hemorrhage 372 DRUGS. only Avhere the drug can be brought in direct contact Avith the bleed- ing point. If a hemorrhage is to be reached through the circulation, as in renal bleeding, gallic acid is to be given, as it is absorbed at once without change. Therapeutics.—Tannic acid is used in medicine to control hemor- rhage, and to act as an astringent to relaxed tissues, as in diarrhoea of the atonic or serous type, or in localized or general sweating. It is also of service for the purposes of toughening mucous membranes or parts of the skin Avhich are exposed to much rubbing, as in the case of the nipples of a primipara, or Avhere the feet become mace- rated and sore or SAveat profusely on exercise being taken. In the treatment of haemoptysis tannic acid may be dissolved in water in the proportion of 5 to 10 grains (0.35-0.65) to the ounce (32.0) and used in a fine spray delivered from an atomizer. Glycerite of tannin is made by adding 2 ounces (64.0) of tannic acid to a -| pint (250 cc.) of glycerin, and mixing at a gentle heat until solution occurs. It is use- ful as an application to sloiv ulcers and depressed mucous membranes, as after an attack of stomatitis. In hemorrhoids of the bleeding type tannic acid suppositories are often very useful, and cotton saturated with tannic-acid solution is often used as a packing in vaginal leu- corrhoea. Administration.—The dose of tannic acid is 2 to 10 grains (0.1- 0.65), best given in pill. The official preparations are—the troches (Trochisei Acidi Tannici, U. S.), each containing 1 grain of tannin; the Grlycerition Acidi Tannici, U. S.; Collodium Stypticum, U. S.; and an ointment (Unguentum Acidi Tannici, U. S.). The B. P. preparations are—(Ilyceritum Acidi Tannici; Suppositoria Acidi Tannici, each containing 3 grains (0.15); and Trochisei Acidi Tan- nici, of Avhich each contains ^ grain (0.03) of the acid. TANSY. Tansy (Tanaeetum, U. S.). The leaves and tops of Tan acetum vulgare yield a volatile oil (Oleum Tanaceti) Avhich possesses eni- menagogue poAvers and has been largely used as a uterine stimulant. It is also used as an anthelmintic. In poisonous dose it causes epileptiform convulsions in some cases, and deep coma, Avith death from respiratory failure. The dose of the oil as an emmenagogue is 1 to 3 drops (0.05- 0.15). In domestic medicine tansy tea, made by adding 1 ounce (32.0) of the leaves or tops to 1 pint (h litre) of Avater, and given in the dose of 1 to 2 ounces (32.0-64.0), is largely employed as a remedy for amenorrhea. TAR. (See p. 328.) TARAXACUM—TEREBENE. 373 TARAXACUM. Taraxacum, U. S., Dandelion, is a very old remedy for hepatic torpor and the dyspepsia resulting therefrom. It should be prepared from the fresh leaves or roots, as the dried, stale plant is inert. From disregard of this fact much disappointment has arisen. OAving to its being bitter it acts as a tonic. The extract (Extractum Taraxaei, U. S. and B. P.), dose 5 to 30 grains (0.35-2.0), and the fluid extract (Extractum Taraxaei Fluidum, U. S.), dose 1 to 3 drachms (4.0-12.0), are the only official preparations. Succus Taraxaei, B. P., is given in the dose of 1 to 2 drachms (4.0-8.0). TARTARIC ACID. Acidum Tartar icum. U. S. and B. P., is derived from crude potassium bitartrate, and is much less poAverful than acetic acid, but capable of producing very severe gastro-enteritis if taken in overdose and in concentrated form. It is rarely used alone, and is most com- monly employed to act upon sodium or potassium bicarbonate to form effervescent drinks. (See Seidlitz PoAvder and Effervescing Draughts.) The dose is 5 to 20 grains (0.35-1.3). When tartaric acid is taken in poisonous dose, lime-water, alkalies, and magnesium are the antidotes, and opium is to be given to allay irritation. If necessary, emetics are to be used. TEREBENE. Terebenum, U. S. and B. P., is a liquid substance, clear, color- less, insoluble in Avater, having a peculiar odor like that of neAv pine sawdust, and is made by the action of sulphuric acid upon oil of turpentine, which is then distilled at about 160° F. Therapeutics.—Terebene is a very useful stimulating expectorant, to be used in the late stages of acute or in chronic bronchitis to liquefy and get rid of the mucus Avhich is clogging the bronchial tubes. The drug may be given by way of the stomach or by inhalation. A useful mixture in the later stages of bronchitis Avhen the mucus is very thick and tenacious is one composed of equal parts of terebene, iodide of ethyl, and chloroform, placed on a sponge and held some tAvo or three inches from the face. It has also been employed in genito-urinary inflammations of a subacute or chronic form in place of oil of sandal- Avood or copaiba as a stimulant. In fermentative dyspepsia, it is of service as an antiseptic. The drug should ahvays be given in cap- sules in the dose of 5 to 10 minims (0.35-0.65), or by dropping it on sugar in the same amount. This dose may be repeated every three hours. Unfortunately, terebene is very apt to irritate the stomach or to produce diarrhoea, and it sometimes irritates the kidneys. 374 DRUGS. TERPINE HYDRATE. Terpine Hydrate (Terpini Hydras, U. S.) is prepared by a certain process, unnecessary to explain, from a mixture of pure oil of tur- pentine, alcohol, and nitric acid. In this manner large, colorless crys- tals, without odor and with a faint taste, are formed, and in this form the drug appears on the market. Terpine hydrate is soluble in 250 parts of cold, 32 parts of boiling water, and in 10 parts of alcohol. In ether it requires 100 parts for its solution, and in chloroform 200 parts. Therapeutics.—Terpine hydrate is used for the purpose of increas- ing secretion from the bronchial mucous membrane, and is a useful remedy in subacute or chronic bronchitis to rid the tubes of mucus. The drug has also been satisfactorily employed in the treatment of hay fever when given in full doses. The remedy, Avhile only useful in a limited number of conditions, certainly seems to be very useful in the variety of diseases named. The dose as generally given is 2 to 3 grains (0.1-0.15), but it may given in the dose of 15 to 20 grains (1.0-1.3) three times a day in hay fever. Terpine hydrate may be prescribed in pills, capsules, and in alcoholic solution flavored with some of the aromatic Avaters and Avith the addition of a little syrup. Thus: R.—Terpin. hydrat...........gr. lxxv (5.0). Spt. vini gallici...........f^ij (60.0). Syrup, lactucarii, Syrup, tolutan............aa fgiij (90.0).—M. S.—1 to 2 dessertspoonfuls (0.8-15.0) three or four times a day. Or we may prescribe— R.—Terpin. hydrat..... Acid, benzoic..... Codeinae....... Ft. in pil. No. xx. S.—1 pill three or four times a day TERPINOL. Terpinol is derived from terpine hydrate by boiling the latter with dilute mineral acids. Terpinol occurs as an oily substance smelling like hyacinths. It is almost insoluble in water, but dissolves readily in ether and alcohol. It is used for precisely the same purposes as terpine hydrate, in the dose of 8 to 20 grains (0.5-1.3), in capsules or pills. This dose may be given tAvice or thrice a day. The drug may irritate the stomach and kidneys when given in overdose. THAPSIA. Thapsia garganica is an umbelliferous plant of South-eastern Europe, employed for the purpose of producing a blister. It is gen- gr. xl (2.65). gr. xl (2.65). gr. v (0.3).—M. THIOL—THIOSINAMINE. 375 erally used under these circumstances in the form of a plaster. The resin, obtained from the bark of the root, is the form in which it appears in medicine. When applied continuously it produces great irritation, and finally sloughs appear. THIOL. Thiol is a substance introduced into medicine as a substitute for ichthyol, as the latter drug possesses the disadvantage of having a disagreeable odor. It is derived from broAvn-colored paraffin or gas oils by a complicated process. The product obtained is evaporated in vacuo to a thin extract called Thiolum Liquidum, or still further to dry- ness, or Thiolum Sieeum. The liquid thiol occurs as a thin broAvnish- black neutral fluid, smelling somewhat like birch oil. It is slightly soluble in alcohol and ether, but quite soluble in Avater, forming a clear mixture, Avhich is rendered more perfect by the addition of glycerin. Thiol sicca may appear in lustrous scales. Therapeutics.—The question Avhich arises at once in regard to thiol is, whether the fact that thiol is practically an artificial ichthyol necessarily indicates that it can be used as a substitute for that sub- stance ? While it is true that they are both sulphur compounds, it is also true that ichthyol possesses very extraordinary powers not met Avith in any other form of sulphur compound previously known. Thiol has been used largely by skilful observers in diseases of the skin in moist eczema, scrofulosis of the skin, and in syphilides with asserted good results. In cases of moist eczema the thiol is used, after first wash- ing the part Avith an antiseptic solution, if it is dusted over the skin in the form of poAvder. Bidder has treated the disease by using com- presses Avet with thiol in 10 per cent, solution. AVhile it is claimed that thiol will relieve exudations about joints and elseAvhere in as effective a manner as ichthyol, sufficient evidence as to this point is not yet before us. Thiol is much cheaper than ichthyol. THIOSINAMINE. Thiosinamine is a preparation derived from volatile oil of horse- radish, or more commonly from the volatile oil of mustard seed, by the addition of alcohol and ammonia water and exposing it to heat. Under these conditions crystals of thiosinamine are deposited in prisms which are soluble in 2 parts of Avarm Avater, and in alcohol or ether. A solu- tion of it should not redden litmus paper. This substance is used in medicine for the cure of lupus ■ in scars, and keloid, and it has been used with asserted success in malignant growths. In a case of keloid the drug in 10 per cent, solution in absolute alcohol may be injected directly into the part affected in the dose of 10 to 20 minims (0.65-1.3) every third or fourth day. The part receiving the injection usually becomes congested and swollen and dark in hue. There is often a great increase in the urine, and per- 376 DR UGS. haps nausea and vomiting, and great pain where the injection is given. In cases of lupus it may be injected locally or at a distant spot, and produces a reaction like that caused by tuberculin. The drug may also be given internally in the dose of 4 to 6 grains (0.2-0.4) once a day. THYMOL. Thymol, U. S. and B. P., is derived from the oil of thyme and other volatile oils, and occurs in large crystals. It is almost insoluble in Avater, but is freely soluble in fats and oils. Thymol is irritant. but antiseptic and disinfectant, and has been employed in tvphoid fever as an intestinal antiseptic by Henry and others. Under these conditions it should be used in gelatin-coated pill, and a 'glass of water or milk taken to avoid the burning sensation. In the treat- ment of stomatitis or tenderness of the gums after mercurialization the folloAving mouth-Avash may be used: R.—Thymol..............gr. x (0.65). Sodii boratis............gr. xv (1.0). Aqua-...............fjij (64.0).—M. S.—Place a teaspoonful (4.0) of this in J a tumblerful of water and use as a gargle. Thymol has been used for dressing Avounds, but is too costly. In summer Aveather it cannot be employed, because of its poAver of attract- ing flies, Avhich make the patient's life miserable. The dose is \ to 2 grains (0.03-0.1), in capsule or in Avafer, and it is better to folloAv its use by a glass of milk to prevent the drug from irritating the stomach. In typhoid fever as much as 30 grains (2.0) in tAventy-four hours may be given as an intestinal antiseptic. If very large amounts (100 grains [7.0]) are taken in a day, poi- soning may result, but as much as this must be used before danger is present. Thymol Iodide. This compound of iodine and thymol, sometimes called aristol, but more correctly dithymol diiodide, has been introduced into medicine for the purpose of substituting iodoform. It does not possess the unpleasant odor of iodoform, and it is stated to be less apt to produce poisoning bv absorption. A great deal of contradictory- experience has accumulated as to its exact value, but the result 'of a careful examination of clinical reports is that in some respects it is a better drug than iodoform and in others not so good. Tichhoff and Neisser state that Avhen taken internally thymol iodide is incapable of causing toxjemia, but this can only be true Avhen moderately large doses are given. Upon cocci and bacilli thymol iodide has "less power than iodoform. In regard to the poAver of this drug in healing wounds or sores, the decision has been reached that Avhenever secretion is free it is contraindicated, as the thymol seems to increase moisture. On the other hand, in those instances where in disease of the skin or mucous membrane an undue dryness is present the effect produced is THYMUS GLAND—THYROID GLAND. 377 often favorable. Upon lupus little effect is produced unless the sur- face is first curetted. Finely-powdered thymol iodide has been found of very unusual value in the treatment of interstitial keratitis by de SchAveinitz and Wallace Avhen dusted into the eye each da}\ In an ointment of ^ to 1 drachm to the ounce of lard (2.0-4.0 : 32.0) thy- mol iodide may be used in psoriasis, but it is not as useful as is chrysarobin in this affection. THYMUS GLAND. The Thymus Gland has been used quite largely in certain diseases on the same principle as that governing the use of the thyroid, namely, that this gland possesses the function of internal secretion and will therefore benefit certain systemic conditions hi persons in whom the thymus Avas atrophied too early in life. Others have used it as a sub- stitute for the thyroid, intentionally or by mistake. Its chief use has been in the treatment of goitre (not exophthalmic). It does not produce any disagreeable effects as does the thyroid. Usually the beginning dose is half an ounce (15.0) administered sev- eral times a Aveek. This dose is soon increased to an ounce (30.0) once a week. In this country Parke, Davis & Co. prepare thymus gland in tablets and capsules ready for use, and this is the best form in which to prescribe it. THYROID GLAND. The Thyroid Gland has been introduced into therapeutics within the last few years for the purpose of relieving certain disturbances of nutrition of Avhich the most characteristic are myxcedema and cretin- ism. The results obtained from its use in these states are extraordi- nary, and it is to be regarded as a specific. Its use is based upon the fact that in cases of myxoedema the thyroid gland is usually found atrophied, and on the discovery by Reverdin, Kocher, Schiff, Fuhr, Horsley, Crede', Zesas and others, that extirpation of this gland pro- duces myxoedema or a train of symptoms practically identical Avith it. Soon after these studies had been verified it Avas suggested that myxoe- dema might be cured if it Avere possible to transplant part or all of the thyroid gland of one of the loAver animals to the body of the patient affected, with the hope that this healthy glandular tissue would become vascularized and exercise its beneficent influence on the disease process. This method has been attempted again and again, nearly ahvays with good results, Avhich, hoAvever, have been only temporary because the transplanted gland has not become well vascularized and has been gradually absorbed. When this operation is attempted the gland of the sheep is chosen, because it most closely resembles that of man and its removal from the sheep causes in that animal symptoms very like those seen in a man suffering from disease or absence of the thyroid gland. The animal is killed by a blow or by shooting, an incision is at once made, under absolute antisepsis, and one lobe of the gland is rapidly clis- 378 DRUGS. sected out and placed in a Avarni, sterile glass jar in Avhich it is con- veyed to the surgeon, Avho stands ready to make an incision into the subcutaneous tissues of the trunk just beloAv the breasts. The lobe is split in tAvo and one-half placed in each incision and the wounds are closed and treated like any ordinary surgical wound. Only normal sterile saline solution should be used in the Avound. If good results persist after six months the gland has become vascularized and the operation does not have to be repeated; but if a return of the symptoms comes on in three months, a new graft will have to be made. The objections to this method are so numerous that Murray admin- istered thyroid gland by the mouth and its extract hypodermically, with great success, and he has been folloAved by many others. The gland itself may be eaten in the dose of from one-eighth to one Avhole lobe each day, but the latter is far too large a dose in most cases. As it is disagreeable to take it raw, it may be very lightly fried or broiled or even boiled before it is eaten; but these processes diminish its activity. In other cases the gland maybe minced and spread on bread Avith anchovy sauce. If fresh thyroid cannot be had daily, a glycerin extract may be used. The minced gland is covered by an equal Aveight of pure glycerin, and then after soaking for twenty-four hours is placed in a cloth and firmly squeezed for some time to extract the glycerin laden Avith the active ingredients of the gland. This will keep for a lon<* time, and may be given daily in the dose of 3 to 15 drops. It is° hoAvever, far better for the physician to employ the desiccated thyroids in powdered form or made into a tablet or placed in a capsule than to use the crude preparation just named. A number of firms in this country and abroad prepare the gland and market it in this form, and even prepare an extract. Thus the extract of thyroid gland prepared by Parke, Davis & Co. is of such a strength that 1 grain equals 10 grains of the crude gland or one-sixth of a desiccated thyroid. The dose of this is half a grain three times a day, Avhich dose is gradually increased as the patient becomes accustomed to it. It is-probably better, however, to use the desiccated powdered thyroid itself, and Meltzer states that Parke, Davis et Company's preparations have given better results than those of other firms, and none of the disagreeable untoAvard symptoms which will be named in a moment. Tavo grains of Parke, Davis & Company's powder are equal to 5 grains of the fresh gland, the ordinary sheep's thyroid weighing about 24 grains. When the remedy is first employed we usually employ about 1 grain of P. D. & Co.'s powdered gland, which is gradually increased a grain a day until about 6 grains a day are reached, Avhen a halt is made and the effect of this dose watched for some days. If the patient does not manifest symptoms of overdose on the one hand or fail to improve on the other, then the dose may be further gradually increased. No more than lo grains of the dried gland should be given each day, and this quantity should be divided into several doses. Thyroid gland has been used very largely in the treatment of cre- tinism with success only second to that attained in the therapy of TRICHLORACETIC ACID—TRIKRESOL. 379 myxoedema, and wTith asserted success in excessive obesity and psori- asis. The rapid growth of cretins under thyroid gland therapy may lead to bending of the bones, and care should be taken that too much exercise on the feet is prevented. In the author's experience its effects are inconstant in obesity. It benefits some patients and is useless in others. It has also been asserted that thyroid therapy is useful in the treatment of exophthalmic goitre, but this is quite posi- tively contradicted. Indeed, it is claimed by some that this disease is made worse by its use. Probably it will be found that true exoph- thalmic goitre is not benefited, but it may be proved that when simple hypertrophy of the connective tissue of the thyroid produces the enlargement it is useful. Thyreoiodine and Iodothyrine have been introduced as representing the therapeutic activity of the crude gland; but Avhile they possess some action, they cannot be so used Avith the expectation of such good re- sults as Avhen the desiccated thyroid itself is resorted to. In the B. P. the dried gland is official. Untoward Effects.—Overdoses of thyroid produce violent headache, feeble action of the heart, and sometimes diarrhoea and vomiting. Should any of these symptoms come on they are an indication for the complete stoppage of the use of the drug for some days, and a return to its use must be gradual. These symptoms can be avoided by cau- tious dosing and by keeping the patient in bed for some days after the treatment is inaugurated. A vegetable diet will also aid the treatment. After marked improvement or apparent cure has been effected by the treatment, it is necessary for the patient to continue using thyroid extract indefinitely, for if it is stopped the myxoedema returns. The remedy may be given in minute daily doses or in full doses for several days at the end of every three weeks or a month. Though the latter plan is the more disagreeable it is asserted to possess a greater thera- peutic and preventive value. TRICHLORACETIC ACID. Trichloracetic Acid is a compound of chlorine and acetic acid occurring in deliquescent crystals and used as a rapid, active eschar- otic upon venereal and other warts. A peculiarity in its effect is that it produces a dry scab which speedily falls off, leaving a healing surface beneath. It is also claimed that its action is not followed by secondary inflammation and pain. It is used by applying a crystal to the wart or other growth. TRIKRESOL. Trikresol consists in a combination of ortho-, meta-, and paracresol, bodies allied to creolin and carbolic acid. Trikresol appears in com- merce as a white liquid, smelling someAvhat like creosote, and soluble 380 DRUGS. in water in the proportion of about 2\ per cent. It forms a clear solution, and does not benumb the skin as does carbolic acid. It is also much less irritant and less poisonous than carbolic acid or bichlo- ride of mercury. Therapeutics.—Trikresol is used as an antiseptic in surgery in 1 per cent, solutions. In the strength of 1 : 500 to 1: 1000 it may be employed as an antiseptic collyrium in ophthalmic practice, in Avhich field it has proved very useful. TRIONAL AND TETRONAL. These two substances are very closely related to sulphonal, and are practically identical Avith that drug in their effects on the general system. They occur in shining, odorless, colorless plates with a very faint taste. Trional and tetronal are used for the relief of insomnia of a functional type, and the sleep produced by these ordinarily comes on in about tAventy to thirty minutes after the drug is taken, and lasts five to six hours. The dose is 15 to 30 grains (1.0-2.0). Doses larger than 15 to 30 grains should never be given continuously, and it is ahvays a good plan after the drug has been given for five or six con- secutive days to stop its use for tAvo or three days. It is Avell to order for the patient Avho is taking trional, if there is any tendency to con- stipation, one of the saline purgatives daily. Trional and tetronal are slightly soluble in water and very soluble in alcohol. Advantages in their use are lack of disagreeable taste and the absence of symptoms of circulatory depression. The best Avay to administer trional or tetronal is in hot broth or tea or whiskey. It is wise to gradually decrease the dose if the drug is taken night after night. Tetronal is more expensive than trional, but sometimes suc- ceeds when trional fails. Both of these drugs are apt to make the patient very droAvsy the day after their ingestion. When trional is taken in full dose for several Aveeks, it pro- duces very distinct alterations in the blood, which are manifested by hsematoporphyrinuria—a state in Avhich the urine is dark red or almost black. The drug should be stopped at once Avhen the urine begins to be red and saline purgatives must be used freely. TURPENTINE. Terebinthina, U. S., occurs in two forms—namely, as turpentine derived from the ordinary yelloAv pine (Pinus palustris) and other varieties of pine, and as Canada turpentine (Terebinthina Canadensis, U. S.) derived from Abies balsamea, or silver fir, or species of cone- bearing trees other than Pinus palustris. The turpentine derived from the latter sources is sometimes called "Balm of Gilead." Much confusion often exists in students' minds as to the difference betAveen oil of turpentine (Oleum Terebinthina?, U. S. and B. P.) and spirit of turpentine, both of Avhich are the same substance under a different name. This oil is not, hoAvever, the same thing as " tur- TURPENTINE. 381 pentine," for the oil is distilled from turpentine. The distilled oil is a thin, clear fluid having a peculiar odor and taste, and is irritant to the skin and mucous membranes. It is exceedingly inflammable, should never be placed near a light, and if added to any strong min- eral acid takes fire. When turpentine is spoken of in this book or in medicine gen- erally, the doubly distilled oil of turpentine (Oleum Terebinthina? Rectificatum, U S.) is what is meant unless the contrary is stated. Physiological Action.—Turpentine when taken internally produces a sense of Avarmth in the stomach, a quickened pulse, a Avarm skin, and slightly accelerated breathing. In overdose it may cause intoxi- cation. Upon the circulation it produces a very slight rise of arterial pressure, increased pulse-rate, and increased heart-force. On the nervous system the drug, in large amounts, causes loss of sensation before it affects voluntary motion. The drug is eliminated by the kidneys and lungs, and gives the odor of violets to the urine. Poisonous doses cause strangury, bloody urine, renal inflammation, and cyanosis, Avith dilated pupils and gastro-enteritis. In persons with an idiosyncrasy to this drug, erythematous, papular or vesicular eruptions may follow its external or internal use. Therapeutics.—External Use.—Turpentine is used as a local application for the purpose of producing counter-irritation over any area where deep-seated inflammation exists. Under these circum- stances it is almost ahvays used in the form of a stupe, made as fol- lows : Place a tin cup containing the turpentine in a vessel containing hot water, so that the turpentine may be Avarmed without coming near a flame. Dip a piece of flannel into very hot water and wring it out in a twisted towel, and when it is so dry that no water drips from it, dip it into the hot turpentine and Avring it out again to free it from any excess of the drug. The cloth, while hot, should be applied, and allowed to remain until discomfort ensues, when it should be with- drawn, as it will blister the skin if left on too long. Children and adults suffering from bronchitis may be rubbed on the chest Avith tur- pentine with much relief, but in the former class of patients it should be diluted with sweet oil, half and half, or even tAvo-thirds of oil. Internal Use.—Turpentine is used internally as a stimulant of a diffusible type in the course of the exhausting fevers, particularly if any flatulence exists or if any ulceration of the bowels is present. In typhoid fever turpentine stupes, turpentine enemata, and the administration of the drug by the mouth are the best ways to over- come tympanites. At the end of the second Aveek, Avhen the tongue is red, dry, cracked, and brown, the teeth covered with sordes, and tympany is well marked, turpentine may be used in emulsion in the dose of 5 to 10 drops (0.3-0.65) three times a day. Again, in con- valescence from typhoid fever, when diarrhoea is persistent and relapses are constant and due to an unhealed state of Peyer's patches, turpen- tine is the remedy par excellence. In intestinal and other passive hemorrhages such as menorrhagia or hcematuria, the drug is often of service. 382 DRUGS. Used against the tape-ivorm, turpentine is given in the dose of ^ an ounce to 1 ounce (16.0-32.0), mixed Avith an equal amount of castor oil. This treatment is a somewhat dangerous practice, but is efficient. In chronic and Avell-advanced kidney disease very large doses of poAver- ful diuretics are often required to stimulate the kidneys sufficiently to cause urinary Aoav, and turpentine may be used under these cir- cumstances. Turpentine is contraindicated in the presence of any acute inflam- mation of the gastro-intestinal tract and in acute nephritis. In lumbago the dose of 20 drops (1.3) is said to be very useful, and many have found the vapor of turpentine of value in bronchitis of a subacute or chronic type Avhen inhaled from boiling water. In gleet it is given by the mouth to stimulate the genito-urinary tract. Turpen- tine should be tried in the treatment of purpura hemorrhagica, as it has been found of value. Administration.—Turpentine may be given for the relief of flatu- lence by placing 5 drops (0.3) on a piece of sugar, or in emulsion made by using acacia and a flavoring substance, as folloAvs: R.—01. cinnamomi...........gtt. xx (1.3). 01. terebinthinse..........f^iv (16.0). Mucil. acncise.........q. s. ad f^iv (128.0).—M. S.—A teaspoonful (4.0) every four hours in typhoid fever. A more agreeable preparation, not to be used in typhoid fever, is that recommended by BartholoAv, as folloAvs : R.—Olei terebinthinse..........fcj (4.0). Olei amygdal. expres.........f^ss (16.0). Tincturae opii...........f£jj (8.0). Mucil. acacias............f^v (20.0). Aquae lauro-cerasi..........f|ss (16.0).—M. S.—A teaspoonful (4.0) every four hours for tympanites. When used as an enema the folloAvino- is useful: R.—Olei terebinthinse..........f^j (32.0). Olei olivae.............f5jss (48.0). Camphorae.............gr. xx (1.3). Mucil. acacise ...........f^ss (16.0).' • • AqU8e...............f3x (320.0).—M. S— To be injected as an enema for the relief of tympanites and to aid in the removal of hardened faces. Stir thoroughly before using. The Liniment of Turpentine (Linimentum Terebinthinee, U. S. and B. P.) is largely used as a stimulating application to sprains and enlarged joints. The following preparation is also official in the B. P.: Linimentum Terebinthina?. Aceticum. Turpentine applied with a brush to the part affected is of service in ringworm. The ointment of turpentine is used as a counter-irritant and stimu- lant to the part to Avhich it is applied. The liniment acts in the same Avay when applied to sprains and bruises. UVA URSI—VALERIANIC ACID. 383 UVA URSI. XTva Ursi, U. S., Bearberry, is the leaves of Arctostaphylos Uva ursi, a Avidely-distributed evergreen shrub. The drug is knoAvn in the B. P. as Uses Ursi Folia. Its active principle is arbutin, some- times called ursin. Therapeutics.—Uva ursi is employed in medicine as a wreak, astrin- gent diuretic, possessing alterative poAver over the genito-urinary appa- ratus. It is used in pyelitis, cystitis, and in chronic gonorrhoea or gleet. When taken in overdose it escapes from the body as hydro- chinone, making the urine dark-colored or black. Administration.—Arbutin itself is often used in the dose of 3 to 5 grains (0.15-0.35). The dose of the extract (Extractum Uvcs Ursi, U. S.) is 1 to 4 grains (0.05-0.2), of the fluid extract (Extractum Uvee Ursi Fluidum, U. S.) is 2 to 4 drachms (8.0-16.0) three times a day. An infusion (Tnfusum Uvcs Usi) is official in the B. P., dose 1 to 2 ounces (32.0-64.0). VALERIAN. Valerian (Valeriana, U. S.) is the rhizome and rootlet of Vale- riana officinalis, a plant of Europe, but cultivated in America. It is official in the B. P. as Valerianae Rhizoma. Its active principle is apparently a volatile oil (Oleum Valeriana). It also contains valerianic acid. Physiological Action.—Valerian is a very feeble depressant to the nervous system, tending to produce nervous rest. In cats it excites sexual activity to a great degree, probably from its odor. When very large doses are given to man, it causes a sense of Avarmth in the stomach, a slightly quickened pulse, and sometimes nausea and vomit- ing. Still larger amounts produce purging and mental hebetude^ Therapeutics.—Valerian is used alone or in combination Avith other drugs to quiet nervous females and to relieve nervousness and insom- nia. In hysteria it is often very serviceable, and combined Avith morphine is much used in the treatment of delirium tremens. Administration.—The fluid extract (Extractum Valeriana? Fluidum, U. S.), is given in the dose of 1 fluidrachm (4.0), and the ammoniated tincture (Tinctura Valerianae Ammoniata, 17. S. and B. P.), in the dose of 1 to 3 drachms (4.0-12.0). These are the best preparations for ordinary use. The infusion, which is not official, is given in the dose of a Avineglassful, Avhile that of the simple tincture (Tinctura Valeri- anae, XT. S.) is 1 to 3 drachms (4.0-12.0). The dose of the oil (Oleum Valerianic) is 2 to 4 drops (0.05-0.2). VALERIANIC ACID. Acidum Valerianicum is an oily, colorless liquid of a strong odor and burning taste, but is not employed in medicine except in the form 384 DRUGS. of its salts, such as the valerianate of zinc, iron, quinine, or ammo- nium, all of Avhich are employed, partly for their sedative effects and partly for their influence as tonics. The dose of Zinci Valerianas is J to 3 grains (0.03-0.15), that of Quinince Valerianas, U. S., 1 to 3 grains (0.05-0.15), of Ferri Valerianas 2 to 10 grains (0.1-0.65), and of Ammonii Valerianas 2 to 10 grains (0.1-0.65). Under the name of "the pill of the three valerianates " Goodell recommends the following in nervousness and hysteria: R.—Quininae valerianat. "\ Ferri valerianat. >....... aa 9j (1.3).—M. Ammon. valerianat. J Ft. in pil. No. xx. S.—One or two three times a day. VERATRINA. Veratrina, U. S. and B. P., is an alkaloid derived from the seeds of Asagroea officinalis, and occurs in a grayish powder, which, if it enters the nose, produces violent sneezing which lasts for hours. Physiological Action.—Nervous System.—Veratrine has little effect on the cerebrum, but it excites the spinal cord and the volun- tary muscles, thereby giving rise to tetanic or tonic convulsions, Avhich are never clonic or epileptoid. The dominant action of the drug is paralytic, and the nervous symptoms just named soon give place to paralysis. The muscles lose their contractile poAver and the nervous centres are depressed. Circulation.—In poisonous dose the heart is sloAved by the drug, greatly Aveakened, and finally stopped in diastole, and is found after death to be soft and flabby. In smaller doses it at first sIoavs the pulse by stimulating the peripheral inhibitory nerves and the centres in the. medulla, but later these parts are paralyzed. It first stimulates the vasomotor centre, then paralyzes it. Respiration.—The drug kills by failure of respiration, due t Potassii carbonatis j ••••«*■ 3" {°-v)- Syrupi..............q. s.—M. Ft. in pil. No. xlviii. S.—One to three pills three times a day, after meals. Although it is perfectly true that we have almost no knowledge of the manner in which alteratives act in instances of disease where, through morbid functional activity, enlarged glands or growths appear, it is evident that_ they must act upon the trophic nerves or directly upon the nourishment of the affected parts. One thing we do know, how- ever, and that is that small doses of most of the so-called alterative drugs act as very distinct stimulants to the development of normal structures, and in no instance do we find this more typically represented than in the effect which they exert upon the blood. Quite a number of years ago Keyes of New York emphasized the value of minute doses of mercury bichloride in syphilitic and other anaemias, and abundant clinical observation has certainly confirmed his vieAVS. The dose of bichloride of mercury in anaemia should be about -^ of a grain (0.0016). Not only will minute doses of the bichloride of mercury act ANAL FISSURE. 465 in this way, but small amounts of calomel or mercury itself will have such an effect. Inunctions of very small amounts of mercurial ointment once a day or every other day, in adults and in children, will increase the fulness and redness of the cheeks and lips and the number of the corpuscles, the piece of ointment used being no larger than the half of a very small pea. This treatment will be found of service in cases not necessarily dependent upon specific taint or scrofula. The marked increase in the nutrition of children of a syphilitic taint Avho are suf- fering from marasmus under the internal use of gray powder and such inunction is most extraordinary. Arsenic is also of value in anaemic conditions, and may be em- ployed in relatively larger doses than mercury bichloride. Many clin- icians have shoAvn the value of this drug in anaemia. Any one of the preparations of arsenic may be employed, and should the anaemia be pernicious in its type, or should it depend upon the disease leukaemia or pseudo-leukaemia, the arsenic must be pushed in ascending doses until marked evidences of its general effects are manifested. Most of the drug, under these circumstances, is in excess, and is cast off in the urine and faeces unused and wasted, straining and irritating the emunctories of the body during its passage through them. Arsenic is of particular merit in those forms of anaemia in Avhich the blood-cells are lacking in number rather than in haemoglobin. Arsenite of copper is also a remedy of very considerable value under these circumstances in the dose of from j^-q to ^ of a grain (0.0006-0.003) three times a day. Bullock's blood, fresh or dried and redissolved, may be used by the rectum in the treatment of anaemia in those cases where iron fails, and a change of air and diet may often produce a cure which no drug can bring about. Diet is an important part of the treatment of anaemia. The food should be good, Avell flavored, and varied, as Avell as easy of digestion. It should contain, as far as possible, the remedies needed by the sys- tem, such as bone salts, iron, and alkalies, and its ingestion should be accompanied by some red Avine, such as port. At present Ave are forced to conclude that pathology has not found out the real cause of these troublesome cases, and that until physiology can put its finger upon the most intricate mechanism of blood-making with a positive, clear statement of its function and the physiological chemistry of the manufacture of haemoglobin, Ave must remain satisfied to resort to the remedies Avhich experience or common sense tells us will be of value to our patients. ANAL FISSURE. This is one of the most painful affections to which man is subject, and requires intelligent treatment, generally by surgical means if the result is to be curative, although great relief can be obtained by the use of drugs. 30 466 DISEASES. The most painful and annoying feature of the lesion is the violence of the pain on defecation, which is so severe that any emptying of the bowel is impossible except on rare occasions, when the pain is concen- trated in one effort. To relieve this pain and enable the patient to have a fairly com- fortable stool, nothing is so good as an iodoform suppository containing 2 to 10 grains (0.1-0.65) of the drug. Iodoform being a local anaes- thetic, the passage takes place almost without the patient's knoAvledge. If much spasm of the sphincter is present, extract of belladonna, I grain (0.015), may be added to each suppository. For the cure of the fissure a drop of strong carbolic acid may be applied to the spot, and a lotion of tannic acid, glycerin, and water used if hemorrhoids are also present. Ringer highly recommends the application to the fissure, by means of a brush, of a solution of bromide of potassium, IJ drachms to 1 ounce (0.0 : 32.0) of glycerin. In order that the passages may be soft and yet the patient not be purged, sulphur may be given in the dose of 20 to 40 grains (1.3-2.6) every night, or, if this cannot be used, castor oil may be administered. The best Avay to give the sulphur is by combining it with poAvdered cinnamon or aromatic poAvder. Sometimes relief is obtained by the use of flexile collodion painted over the fissure. ANEURISM. The treatment of aneurism by drugs is, unfortunately, not very suc- cessful, but is at least Avorthy of trial in all cases. Vascular disease resulting in such a lesion depends upon so many causes Avhich may modify the treatment that the history of the case should be carefully considered. The most common causes are syphilis and traumatism, and very often injury is superimposed upon one of the systemic taints. Whatever the cause of the disease may be, iodide of potassium is par excellence the remedy most apt to do good, and it Avill nearly ahvays give relief, even if it does not cure. The doses should be large, 10 to 20 grains (0.65-1.3) three times a day if the patient Avill bear them, and the prognosis under this treatment is far more favorable if the cause be syphilis than if the disease be idiopathic or traumatic. For successful treatment the recumbent position must be insisted upon, the patient being kept quiet in bed, changing his position as little as possible and confining himself to the most simple and easily digested diet, Avith entire avoidance of all stimulating substances either in the way of food or drink. Often it is best to adhere to an absolute milk diet. If the heart is excitable and irregular in its action, the vascular system irritable, and a high arterial tension is present, the circulation must be quieted by small doses of veratrum viride, say 1 or 2 drops (0.05-0.1) twice or thrice a day, but digitalis is not to be employed, since it increases the strain upon the aneurismal sac, although it does quiet the irregular heart beat. Aconite may also be used Avith care, but it is inferior to veratrum viride. If the pain be very great —and it often is severe, particularly at night—opium is indicated and ANGINA PECTORIS. 41)7 sleeplessness should be allayed, not by full doses of morphine, but by morphine and chloral: or,' better still, croton-chloral should be so ordered that the patient receives | grain (0.075) of morphine and 10 grains (0.65) of croton chloral in pill at bed-time. All attempts to cure aneurism by the use of other drugs, unless syphilis indicates mercury, are useless Avhen the lesion is thoracic or abdominal, and Avhen it occurs in the extremities, as in popliteal aneurism, pressure or surgical meas- ures are to be resorted to as the chief means of cure. If dyspnoea is marked in thoracic aneurism, slight inhalations or " Avhiffs " of chlo- roform are sometimes useful. The author has recently performed the operation of introducing gold Avire and using electrolysis in thoracic aneurism, with great bene- fit to the patient. ANGINA PECTORIS. The exact pathological changes existing in angina pectoris are by no means clearly understood, but Avithout doubt many cases are due to spasm of the blood-vessels. Avhich results in distention of the left side of the heart, which organ is already dilated or enfeebled by disease. Often, too, the coronary arteries have undergone degenerative changes, thereby increasing the cardiac debility. Remedies which ordinarily relieve pain act too sloAvly or too feebly to be of service in angina pec- toris, and even if successful would only relieve the symptom without removing the cause. The indication in the great majority of cases is to relax the vascular spasm, thus relieving the overburdened heart. As first pointed out by Brunton, the nitrites possess this poAver, and to him belongs the credit of first applying this class of drugs to this ailment. All the nitrites are useful, but the nitrite of amyl and nitroglycerin are the best remedies for the attack itself, and the nitrite of potassium or sodium for the intervening periods or Avhere the paroxysm is prolonged. The reason for this lies in the fact that the sodium and potassium compounds are more stable than the other tAvo compounds, are more sloAvly broken up in the body, and therefore more prolonged in their effects. In an attack a feAv drops of the nitrite of amyl should be given by inhalation from a handkerchief, or the nitroglycerin can be used in the dose of 1 drop of a 1 per cent, solution by the mouth. The dose of the sodium and potassium nitrites is 3 grains (0.15) three times a day, but all these drugs are useless unless the arterial ten- sion is high and the heart throbbing or irregular in its exercise of poAver. If vascular relaxation is present, they should be supplanted by stim- ulants, such as alcohol, in full dose, in Avarm Avater. Digitalis tincture in the dose of 10 drops (0.65) may be given hypodermically during the attack to stimulate the heart if it is Aveak, and betAveen the attacks to improve its condition. The Avriter has found 20-grain (1.3) doses of antipyrin of great service in some cases. Ether given hypodermically is often of service, but Hoffman's anodyne may be used instead of ether by the mouth or hypodermically Avith better results. 468 DISEASES. If the nitrite does not relieve the pain, or if it cannot be used because of some contraindication, morphine must be given hypoder- mically in the dose of ± to * grain (0.016-0.03), but it should never be given by the mouth under these circumstances, as its absorption will be too slow and its effects will come on after the pain has ceased. The cure of the patient rests upon the elimination of all causes which can possibly produce a nerve-storm from cardiac irritability, and in the administration of arsenic in full dose for long periods of time Phos- phorus is another remedy which is of undoubted value, and should always be tried in the dose of Th> grain (0.0006) three times a day The following is a valuable prescription for use between the attacks: R.—Tine, digital.............^^^lviij (3.0). Tine, strophanthi........Tt\,xlvnj (3.0). Nitroglycerin! (1 per cent.).....n\,xxiv (1.6). Tine, cardamomi........q- s. fgiij (96.0).—M. g—Teaspoonful (4.0) three times a day. The diet should be moderate and easy of digestion, and salads, lobster, and similar articles of food avoided. If the patient is in- clined to take exercise of a violent character he must be restrained, but on the other hand some exercise must be insisted on if it is possible. Tonics, fresh air, freedom from mental worry and avoidance of exposure and cold are also necessary, and running for a car, or per- forming any act calculated to suddenly increase arterial pressure and cardiac Avork, is to be avoided. In that form of angina pectoris occurring in nervous females, some- times called pseudo-angina pectoris, 1 drachm of ether in ice-A\ater or capsule will often abort the attack, or if the paroxysm is caused by dyspepsia and if the stomach be overloaded, the sufferer may be relieved by the stomach-pump. Between the attacks aconite tincture in the doses of 2 to 3 minims (0.1-0.15) three times a day is useful. ANOREXIA. Anexoria, or lack of appetite, is only a symptom of disease, gen- erally associated Avith debility or other systemic disorder, such as fever or many exhausting diseases. It is best treated by a careful, Avell-cooked, and daintily-prepared diet, the use of the bitter tonics, such as gentian, cardamoms, and the mineral acids, or by the use of one of the following prescrip- tions : R.—Acid, arsenosi............gr. \ (0.03). Extract, nucis vomica........gr. iv (0.3). Quininae sulph............gr- xx (1.3).—M. Ft. in pil. No. xx. S.—One t. d. after meals. Or, R.—Acid, hvdrochlorici dil.........f^ss (16.0). Tinct. cinchona' comp.........f^vj (192.0).—M. S—Dessertspoonful (8.0) three times a day, after meals, Avell diluted with water. APOPLEXY. 469 (For the use of other bitter tonics see Calumba, Quassia, Chamo- mile, Cardamom, and Nux Vomica. None of these drugs are suit- able if there is any acute irritation or inflammation of the stomach or intestines. (See Indigestion.) APOPLEXY. When a person suffers from a stroke of apoplexy, the chief aim of the physician must be to loAver the blood-pressure if it be high, and so to decrease the intracranial hemorrhage, and, as the blood-pressure is nearly ahvays excessive under these circumstances, its reduction may be considered as a routine treatment if the patient is seen very soon after the onset of the attack. If the person be full-blooded, copious venesection is to be employed upon any one of the veins in the arm on its anterior surface. (See Venesection.) At least 1 pint (500 cc.) of blood should be AvithdraAvn and the condition of the pulse carefully noted. If bleeding is impossible, veratrum viride or aconite must be used to lower blood-pressure, the latter in full dose, 5 drops (0.35) of the tincture. Hot mustard plasters must be applied to the feet, or a hot mustard foot-bath be used if this is practicable. Ice in an ice-bag or wrapped in a towel may be applied to the head. If vomiting comes on care must be taken that the stertorous breathing does not draAV into the lungs particles of the half-ejected food. Sometimes croton oil, 1 drop (0.05), placed on the tongue Avith 5 drops of SAveet oil, may cause a depletant catharsis Avhich "will relieve cerebral engorgement, or ^ grain (0.01) of elaterium may be used. The head must be kept high and the feet low down. These are the methods to be used immediately after the rupture of the blood-vessel. The object to be sought, after the "stroke" has occurred and the hemorrhage has ceased, is the removal of the extravasated blood, the restoration of function in the paralyzed parts, and the prevention of secondary lesions consequent upon inflammation of the brain as a result of the injury to its substance. If the patient survives the attack, no drugs should be used save arterial sedatives for one or two days, until the clot in the ruptured vessel has become firmly fixed, unless symptoms of meningitis arise, Avhen these drugs must be pushed if the pulse is tense, and opium and calomel administered in small antiphlogistic doses, I grain (0.016) of each every four hours. Meningitis and cerebritis rarely occur if the veratrum viride or aconite is properly used. After the clot has firmly formed and has plugged the blood-vessel, we may proceed to take measures for the absorption of the exudate, the chief measure consisting in the use of iodide of potassium in as large doses as the patient will bear without the produc- tion of iodism. This drug should not be resorted to until several days, or even tAvo or three weeks, have elapsed after the attack. Mercury in small doses may also be given. In order that the muscles of the extremities may not waste and become powerless from disuse, passive exercise, rubbing, and, if pos- sible, massage, must be resorted to. Electricity may be applied to them in the form of the sloAvly-interrupted current, and strychnine 470 DISEASES. may be used hypodermically or by the mouth as a stimulant to the trophic centres in the spinal cord. None of these measures are to be employed if any inflammation exists in the brain, as they will increase the cerebral disorder, and at least three Aveeks should elapse after the attack before they are resorted to. (See Strychnine.) Electricity applied to the head to remove the lesion is useless, as the current does not go through the brain, but around the skull by means of the scalp. A very careful diet is to be maintained. Meats are to be used very sparingly, the boAvels maintained in perfect regularity, and no Avines are to be taken nor any stimulants used, lest they cause a second rupture of the Aveakened vessel in the brain. Apoplexy must be carefully differentiated from acute alcoholism and opium poisoning, Avhich it much resembles. (See Alcohol.) If respiration fails, nothing can be done with much advantage, but belladonna or strychnine may be given hypodermically. The use of electricity to stimulate the phrenic nerve and diaphragm Avhen respi- ration fails is a remnant of senseless medical practice, and is partic- ularly useless in apoplexy. (See Asphyxia.) Above all things, stimulants are contraindicated during the acute attack, even though the pulse fails, as they increase the hemorrhage into the brain. APPENDICITIS. It is to be remembered that many cases AA'hich years ago would have been called idiopathic peritonitis are noAv recognized as arising primarily from inflammation of the appendix vermiformis. For this reason it is incumbent upon every physician Avho is called to see a case of severe abdominal pain Avith symptoms of peritonitis or appendi- citis to carefully examine into the condition of the appendix. No routine treatment for appendicitis can be followed, as each case pos- sesses distinct individuality. There are many surgeons, holding ex- treme views, Avho assert that the mere presence of appendicular inflammation for a feAv hours renders an extirpation of this organ necessarv. On the other hand, there are doubtless many cases in which the physician postpones consultation with a surgeon until it is too late to save the patient. All cases of appendicitis may be divided into three classes:- First, those which are fulminating or gangrenous, and almost invariably result in death Avhether treated medically or surgi- cally ; second, those which need surgical interference; and third, those which undoubtedly get well, some of them permanently so, under proper medical treatment. With the first class Ave shall not deal, for obvious reasons. In all cases of acute appendicitis of the third class which Ave have named the method to be followed is briefly as follows: The patient is to be put to bed and absolute rest on the back insisted upon. He must not rise to the sitting posture even for defe- cation or urination. An ice-bag is to be placed over the appendix, or, if this cannot be done, leeches may be applied in this region. The ASPHYXIA. 471 bowels may be moved by half to one ounce of magnesium sulphate or citrate of magnesium in its official solution, but it is far better to unload the colon by rectal injections. After the bowels have been moved, sufficiently large doses of opium or morphine are to be given to relieve pain and act as an antiphlogistic. The doses should be of such size as to " take the edge off the pain," but they must not stupefy the patient, so that he fails to give clear ansAvers to questions. If in spite of this treatment there is persistent tenderness in the right iliac region, with increase in the area of dulness on percussion over the appendix, and a sense of deep-seated tension exists, then a surgeon should be 'at once called in—not, necessarily, to operate, but to decide as to the advis- ability of an operation, and to perform it if it is considered a Avise pro- cedure. Generally, it is best to postpone surgical interference in mild cases until after the acute attack is over, but this preference is to be waived in pressing cases, when there is rigidity of the belly and great pain. In the second class of cases which Ave have named the treatment is too largely surgical to be considered in a book devoted only to medical therapeutics. It is unnecessary to give a purgative before the opera- tion, unless Ave think the boAvel contains undigested food, since the caput coli never contains faeces in any quantity, and furthermore, in those fairly severe cases which demand operation at once the possibility of perforation of the appendix, Avith escape of the contents of the boAvel into the peritoneal cavity, is always to be remembered, for if perfora- tion has occurred the purgative will force the faeces out through the patulous appendix. Instead of a milk diet, the patient should receive a diet of broths or beef-tea, since the casein in the milk is apt to cause fermentation and the formation of gas in large amounts in the intestine, thereby causing distressing tympanites. If attacks of appendicitis are recurrent, the appendix should be removed in an interval of quiescence. (See Article on Peritonitis.) ASPHYXIA. When practising artificial respiration in cases of asphyxia Sylves- ter's method should ahvays be employed. This consists of laying the patient on some hard, flat surface, kneeling above his head, and then, after grasping the arms at the elboAvs, bringing them upAvard and outward, so that they folloAv the plane on Avhich the body is extended. This movement causes expansion of the chest, or inspiration. After a moment's pause the arms are lifted up and brought toward one another, and then, Avhile still approximated, pushed doAvn to their original position upon the floating ribs, upon Avhich they are pressed. This last movement drives out the air from the chest, or causes expi- ration. These movements should be at the rate of from sixteen to tAventy per minute, about that of normal respiration, and be persisted in for at least forty-five minutes, even though the case seems hope- less, as cases have recovered after as long a period of apparent death as an hour. While these movements are being carried on, the patulous- ness of the upper air-passages is to be maintained. 472 DISEASES. In some researches made by Dr. Martin and the wTriter the folloAv- ing rules regarding the position of the head, neck, epiglottis, and tongue were formulated: The fingers are passed behind the angles of the lower jaAv and the latter is pressed forward; this elevates the epiglottis and the base of the tongue about a quarter of an inch from the post-pharyngeal wall. Extending the head and pushing it for- Avard so that the neck makes an angle of forty-five degrees Avith the plane of the table draws the base of the tongue and the hyoid bone far forAvard, this motion being at the same time imparted to the epi- glottis, so that the latter stands upright and is separated from the posterior Avail of the pharynx by an internal of about an inch. By tightly closing the jaAv the antero-posterior space is still further increased. The epiglottis may prevent free entrance of air to the lungs, even though the tongue is pulled forward. Any means Avhich accom- plishes the anterior projection of the hyoid bone immediately and infallibly raises the epiglottis and the base of the tongue, and the hyoid bone may be made to project anteriorly by direct pressure upon its cornua, by direct pressure or traction applied to the tongue far back behind the anterior half arches of the palate, and by the action of gravity in the abdominal decubitus, or by extension of the head upon the neck, although flexion of the neck Avith extension of the head upon the neck does aAvay with the epiglottis as an obstruct- ing factor as completely as any other posture. A very useful method in treating asphyxia is Laborde's method by rhythmic traction of the tongue. The tongue is grasped Avith forceps and pulled Avell forward and upward from ten to fourteen times a minute until voluntary respirations occur. The sensory nerves of the tongue carry impulses to the phrenic centre, Avhich in turn causes the diaphragm to contract. A very large number of recoveries from apparent death as a result of its use renders this method most worthy of trial. The absurdity of the application of the rapidly-interrupted electric current to the phrenic nerve is not alone dependent upon the points Ave have named. (See Ether.) It has recently been proved by careful ob- servation on the part of Dr. Martin and the author that the application of the electrode over the phrenic nerve in the neck may cause cardiac arrest through diffusion of the current to the vagus nerve, and GrisAVold reached conclusions of an identical character in 1885. If electricity is used, it should be employed solely as a peripheral irritant, with the object of arousing the patient, as Avould a dash of cold water. ASTHENOPIA. Asthenopia, or Aveak sight, depends upon exhaustion of the power of accommodation in cases of refractive error, usually hvpermetropia, or upon insufficiency of the external ocular muscles. The former is sometimes called accommodative asthenopia, and the latter muscular asthenopia. The treatment of these conditions requires the prescrib- ing of the proper pair of glasses, combined, if necessary, Avith prisms ASTHMA. 473 and Avith systematic exercise of the ocular muscles. Locally, a weak solution of the sulphate of eserine or pilocarpine acts as a stimulant to the ciliary muscle, and good results folloAv the internal use of large doses of the tincture of nux vomica or strychnine. R.—Eserina? sulph............gr. ■& (0.002). Aq. destill.............fgj (32.0)— M. S.—2 drops (0.1) night and morning. Or, R— Pilocarpin. nitrat..........gr. ^ (0.003). Aq. destill.............f3J (32.0).—M. S.—2 drops (0.1) night and morning. Another form of asthenopia is termed neurasthenic asthenopia or retinal anaesthesia, and presents a number of eye-symptoms in con- nection Avith a general depression or debilitated state of the nervous system, the eye itself, hoAvever, being a healthy organ. The chief symptoms are fluctuation in visual acuity, rapid disappearance of objects looked at, contraction of the field of vision, imperfect retinal images, often associated with dread of light. The mere prescription of glasses in these cases to correct any refractive error is not suf- ficient. Much relief will often be obtained if hot compresses at 110° F. be made to the closed eyelids for five minutes at a time. The patient requires the same general treatment that Avould be applied to any neurasthenic case. All the functions of the body must be care- fully examined into and placed in as normal a condition as circum- stances will allow. Especially valuable are rest, massage, salt baths, and full doses of strychnine, together with iron if there be anaemia. ASTHMA. Asthma is one of the most difficult diseases to successfully treat that the physician has to deal Avith. The disease in all its forms depends upon interference with the free entrance and exit of the air to and from the lungs, and this is generally, if not always, dependent upon a spasm of the muscular fibres in the walls of the bronchial tubes, although it has been asserted to be due to a sudden SAvelling or hyperaemia of the bronchial mucous membrane. Both of these states are probably present in varying degree in all cases The spasm has been proved by Longet, Williams, Romberg, Paul Bert, Bierner, and more recently by Sandmann, to be due to a neurosis of the pneumogastric or vagus nerve, Avhile the swelling of the mucous membrane has been seen by Stoerk and others. This has formed two schools of teaching concerning the pathology of this disease, when a little attention to the physiology of the subject would at least show that no difference need exist, the vagus nerves governing not only the muscular fibres, but also the blood-vessels of the bronchial tubes. The discovery of Michaclson that injury of the recurrent laryngeal nerves causes catarrhal inflammation of the bronchial tubes, particularly those of the upper lobes, renders the analogy between 474 DISEASES. acute asthma and laryngeal spasm which has been spoken of by many Avriters still more interesting. One other step remains for a thorough understanding of the man- ner in Avhich the disease is produced. Gastric, dyspeptic, or intestinal asthma arises from indigestion, as its name implies, and is caused by the irritation of the afferent filaments of the vagus in the Avails of the stomach and intestine, thereby causing reflexly a contraction and hyperaemia of the bronchial tubes. In a similar reflex manner hyper- trophies of portions of the nasal chambers or abnormal conditions of the nasal mucous membranes in general may result in an asthmatic attack. Having obtained some idea of the cause of an attack, let us turn to the treatment of the affection. By far the most serviceable remedy in asthma is belladonna, Avhich, as has been pointed out Avhen that drug was studied (see Belladonna), exercises in medicinal dose a decided sedative and depressing influ- ence on the peripheral filaments of the vagus nerves, not only so far as the heart is concerned, but also, through the pulmonary fibres, upon bronchial secretion, which is ahvays diminished by the drug, probably by this vagal influence. It is evident, therefore, that the use of belladonna or atropine, although originally employed in an empirical manner, rests upon a rational basis, and as the physiological action of stramonium, hyoscy- amus, and similar members of this group is nearly identical with belladonna, their influence for good is also explained. The experi- ments of Ott prove that lobelia is a peripheral pneumogastric de- pressant, and those of Rosenthal and the author likewise showed that tobacco has a similar effect. The same is also true of nitrite of amyl and the other nitrites, which also relax unstriped muscular fibre. We have before us, therefore, a list of the most efficacious and best antiasthmatics, all of them being depressant to the periph- eral vagi. The other remedies commonly employed are chloroform by inhala- tion, which relaxes the spasm of muscular fibre by its local influence, and morphine, wdiich acts as a nervous sedative, prevents reflex irri- tation, and quiets the patient, acting at the same time as a heart stim- ulant and unloading the engorged cardiac cavities. The relief obtained by the inhalation of the fumes of nitrate of potassium, See asserts, depends upon the formation of the protoxide of nitrogen and carbonic acid gas, Avhich act as local anaesthetics. ' The practical treatment of an attack of asthma consists in the use of morphine hypodermically in the dose of j- to % grain (0.01-0.015), alone or in combination Avith atropine. Cigarettes made of paper soaked in a solution of nitrate of potassium and belladonna may be smoked (see formula under Belladonna), or they may be made in the folloAving manner: R.—Foliorum belladonna?........gr. vj (0.36). Foliorum hyoscyami........gr. iij (0.2). Foliorum stramonii........gr. iij (0.2). Extracti opii ...........gr. } (0.015). Aquas lauro-cerasi.........q. s.—M. ASTHMA. 475 These various leaves are broken up like commercial tobacco, and moistened by adding the cherry-laurel water, which should contain the opium. Finally, a whole leaf soaked in the same fluid is used as a cover, or a piece of cigarette paper may be employed in the same manner. In some cases a very useful treatment is the smoking of nitre- paper cigarettes, which are prepared, before rolling, not only by soak- ing the paper in a solution of nitrate of potassium (see Nitrate of Potassium), but also by dipping them, after drying them, in tincture of belladonna or stramonium, and allowing the alcohol to evaporate from the paper while it is hung in the air. A remedy very recently brought forward in this country for the relief and cure of asthma is euphorbia pilulifera, the fluid extract of which may be given in the dose of i to 1 drachm (2.0-4.0) once, twice, or thrice a day. (See Euphorbia Pilulifera.) The author finds the following formula very useful in asthma: R.—Sodii iodidi............gr. ij (0.1). Potas. bromidi...... . . . gr. ij (0.1). Ext. euphorbia? piluliferse fl.....rnjij (0.15). Xitroglycerini..........gr. ,i_ (0.0003). Tr. lobelia?...........Trtij (0.1).—M. Ft. in tabel. vel capsul. No. i. S.—From 1 to 4 three times a day. It will be seen that each ingredient of this pill has a different action. The action of iodides in asthma is Avell known, as is also that of the bromides. The euphorbia pilulifera has been found useful in asthma empirically. The nitroglycerin depresses the peripheral ends of the vagus nerves, and acts as a stimulant to the heart Avhen engorged Avith blood by removing the inhibitory action of the vagus and relieving the blood-vessels elseAvhere. The tincture of lobelia acts as a depressant to the vagus also. A valuable prescription for asthmatics, to take between the attacks, particularly in those cases Avhich have cardiac symptoms, is the one calling for digitalis, strophanthus, and nitroglycerin in the article on Angina Pectoris. Sometimes a strong cup of coffee taken at the beginning of a paroxysm will abort it. The use of amyl nitrite by inhalation, 3 to 6 drops (0.15-0.4) on a handkerchief, is inAraluable in many cases, and it rarely fails to relieve the spasm. Owing to the engorgement of the heart consequent upon the embarrassment of respiration, this nitrite must be used Avith care, and in one or tAvo instances it has proved dangerous by causing cardiac failure. Sometimes tobacco may be smoked, and it is particularly efficacious in those Avho are not accustomed to its constant use. Lobelia Avhen employed should be used in full emetic dose (1 drachm [4.0]) in the form of the tincture if an attack is imminent. If an attack is feared, 10 drops (0.65) of the tincture every four hours may be given if the heart is in good condition. A treatment of asthma which is very successful Avhen it arises from 476 DISEASES. nasal disorder consists in the application to the nasal cavities, at the onset of the attack, of the following solution by means of a brush or spray: R— Cocain. hydrochlorat.........gr. xv (1.0). Aqua? destillat. .......q. s. ad f^iv (16.0)—M. S.—Apply as directed. If this solution is thoroughly applied and the other directions given are carried out, very rapid relief will often be obtained. Unfor- tunately, we cannot readily separate those cases Avhich are due to nasal disease and those produced by other causes, and in consequence this treatment Avhen tried for the first time in a given case is purely experimental. The curative treatment of asthma to a very large extent rests upon the use of iodide of potassium, and in the careful regulation of the diet and bowels, particularly if the trouble seems to be dependent upon indigestion. As the attacks are generally nocturnal, the even- ing meal should be taken early, be light and easily digested, and tea and coffee should be avoided at this time. The patient should avoid dusty streets and live in the open air as much as possible, and a damp atmosphere is usually preferable to a dry one, provided it is not too cold. This rule is subject to many variations, and each case will be found to be a laAv unto itself. Each patient must try different climates until the proper one is found. Arsenic may be used, particularly if the mucous membranes are below par, and a dose of bromide of potas- sium or sodium, 30 grains (2.0) half an hour before retiring to bed, may be of service. Grindelia robusta is largely used as a prophylactic in the dose of 10 to 30 minims (0.65-2.0) of the fluid extract three times a day. Lobe- lia may also be used in the form of the tincture, 10 drops (0.65) three times daily. The use of compressed and rarefied air is sometimes of service. Inhalations of oxygen are valuable if the cyanosis is extreme. In many cases the greatest relief will be given by the use of the bronchitis tent. (See Bronchitis.) In those cases in which the presence of nasal polypi or other irrita- tions of the air-passages is the provoking cause of the attacks those causes must be removed before a cure can be attained. In other instances arsenical Avail-papers are the cause of the trouble. In all cases of asthma the physician should from time to time examine the urine and the heart. BED-SORES. Bed-sores depend upon disturbances of nutrition resulting from pressure exercised in such a manner that the local circulation is inter- fered Avith at a time Avhen the vitality of all of the tissues is depressed by disease or injury. In most instances the part involved becomes chafed by creases in the sheets, by crumbs of food, or by moisture from the discharges of the rectum and bladder. BILIOUSNESS. 477 The chief thing to be done is to prevent the trouble by careful nursing and cleanliness, Avhich must be supplemented by measures devoted to the hardening and improving of the skin covering the parts Avhere the sores are apt to appear, as over the buttocks and sacrum. To permit of a good supply of blood, the patient should be turned on one side or the other every hV\v hours and the skin of the part Avhich has been pressed upon rubbed thoroughly Avith a dry toAvel to cause a healthy transudation and absorption of the nutritive juices. Salt and whiskey, 2 drachms (8.0) to the pint (500.0), may be rubbed over the skin, and tincture of catechu or the dilute solution of the subacetate of lead applied to harden it. If this is not used, a mixture of alum and spirit of camphor is useful, made by adding 1 ounce (30.0) of pow- dered alum to the Avhites of 4 eggs and mixing this Avith 2 ounces (64.0) of the camphorated spirit. Where the skin is very red and angry- looking, but still intact, a solution of nitrate of silver of the strength of 20 grains to 1 ounce (1.3 : 32.0) is to be thoroughly painted over the spot. All these remedies act in hardening the skin through their astringency, or by acting as sedative astringents to the inflamed capil- laries of the part. When a bed-sore is developed measures must be taken for its cure and the prevention of its spread. With this object in vieAV the body must not rest on the part affected if this can possibly be avoided, and in order that the sore may be protected and the pressure equalized, a large piece of soap-plaster, Avith its edges deeply incised to make them pliable, should be applied after the sore has been thoroughly Avashed out by means of a SAvab or syringe filled Avith a 1 : 5000 solution of bichloride of mercury, and afterAvard dusted Avith iodoform. Some- times large squares of lint heavily covered with zinc ointment are ser- viceable in lieu of the soap-plaster. If the sores spread and burrow through the parts, the sinuses should be freely opened and irrigated with peroxide of hydrogen, all dead tissues being cut away to avoid sepsis. Nitrate of silver in the strength of 20 grains to ounce (1.3 : 32.0) may also be used locally as the patient recovers if the ulcers seem sluggish. A smooth slip-sheet should ahvays be placed under the buttocks. If possible, supportive measures and an increased amount of predigested food should be given if the sloughs are large. The internal use of iron is particularly valuable in the form of the tincture of the chloride in full doses (say 20 drops [1.3]) every four hours. BILIOUSNESS. This is a term used to designate a state Avhich presents different symptoms in different cases, but always includes languor, headache, or dizziness, perhaps some yelloAving of the skin and conjunctiva, and a general sense of atony, mental depression, and discomfort. It depends not upon an excessive secretion of bile, but upon some perversion of the functions of the liver or the retention of bile in the bile-ducts. Further than this, most of the symptoms do not depend directly upon 478 DISEASES. the changes in the bile, but upon failure of proper digestion in the stomach and intestine, coupled with the development of irritative decom- position-products of various kinds. The stomach, intestine, liver, pan- creas, and their juices all form a complex interwoven chain of function in Avhich if one link breaks the entire chain becomes disturbed. The entrance into the stomach of certain food-stuffs which are either ill prepared or improper for gastric digestion rapidly causes the develop- ment of active fermentation, wdth the formation of lactic and butyric acids, which irritate the gastric mucous membrane, and thereby bring' about a faulty gastric secretion of mucus, which makes still further trouble. By the same means the circulation of the stomach is dis- turbed and becomes abnormal, and the intestine, liver, and pancreas receive reflex irritation to AA'hich they are not normally exposed. Further than this, the irritated stomach fails to convert its contents into pep- tones and the general features of chyme, and too early or too late drives out into the duodenum a mass of semi-digested and fermenting material utterly unfit for intestinal digestion and absorption, thereby disordering the functions of these parts still further at a time when they are not prepared for the reception of any food. The secretion poured out by the different glands varies from the normal; the alka- line juices are not able to overcome the normal acid of the gastric juice plus the lactic and butyric acids; and finally the reaction of the intestine becomes acid instead of alkaline, with resulting irrita- tion and secretion of morbid juices and mucus. The trouble when existing in the stomach gives rise to headache and discomfort, a bad taste in the mouth, and perhaps pain, and is followed by fever, lan- guor, jaundice, and flatulence when the intestine is affected. The cause of these symptoms rests upon the fact that, while gastric juice and bile are antiseptic, pancreatic juice mixed with food undergoes rapid decomposition, with the development of products of decomposi- tion, such as skatol and indol and a large number of poisonous alka- loids. Normally, these are not allowed to form, owing to the pres- ence of antiseptic bile, Avhich also hurries on the absorption of the .food; but if the bile is retained in its ducts, its secretion is impaired and its constitution altered by the disorder of the liver which results reflexly from the gastric and intestinal irritation. Unfortunately, the complication does not cease at this point, for the liver in health has other functions to fulfil, one of the most important of which is the arrest and destruction of all poisons of an organic character which come to it from the stomach and bowel. Not only are decomposition- products destroyed by it, but all the vegetable alkaloids are rendered innocuous if present in ordinary amounts.1 The disorder of hepatic function, therefore, permits the entrance into the general circulation of these substances, which are very various as regards their powers and effects. Thus, Brunton has pointed out that one of these com- pounds closely resembles curare, in that it poisons the peripheral ends of the motor nerves, and thereby is at least partly responsible for the muscular relaxation and languor often seen in patients suffering from B1'% dtu!lie? of Schiff' Lailtenbach, and many others, including Ludwie and ocnmidt-Mulheim. 8 BILIOUSNESS. 479 so-called "biliousness." Other substances act as do digitalis, atro- pine, muscarine, and picrotoxin, and the number of these various compounds is infinite.1 It is impossible to give space to a further consideration of these poisons, but Avhat has been said shoAvs clearly that "biliousness" only expresses a state in Avhich absorption of the bile is not the sole cause of the symptoms, but that other poisons are at Avork. The methods of treating biliousness are therefore not to be considered as depending upon some regular routine, but upon a study of the case and its symptoms. Very frequently, after several days of minor discomfort, the disorder culminates in a severe sick headache, after Avhich vomiting comes on and relief is obtained almost at once. Such patients can generally be relieved in the very first part of their discomfort by emetic doses of ipecac or apomorphine, 30 to 60 grains (2.0-4.0) of the former, or 3*5 grain (0.004) of the latter hypodermically. The manner in Avhich this treatment does good is very eAddent. It compresses the liver and expels inspissated bile by the compression exercised by the abdom- inal walls and diaphragm in the effort of vomiting, and thoroughly excites to normal secretion the torpid glands of the stomach and intestine. The vomiting also rids the stomach of the fermenting masses and bacteria contained in them, and renders the alimentary canal more pure. This purity may be increased betAveen the paroxysms of vomiting by draughts of warm water or Avater containing a feAv grains of bicarbo- nate of sodium or salicylic acid. When it becomes evident that an attack is about to begin—that is, Avhen constipation, slight droAvsiness, or languor after meals shoAvs the tendency present—one of tAvo drugs should be used, either podo- phyllin if the stools be dark, or calomel if they be light-colored: ^ grain (0.01) of the former to an adult is generally enough, or 1 grain (0.05) of calomel divided into six poAvders, one of Avhich is to be taken every fifteen minutes, is a good dose, to be folloAved in four hours by a saline. If the attack is sudden in its onset, no time is allowed for these hepatic stimulants, and a saline should be used in a good-sized dose at once, not because it causes a flow of bile, but because it SAveeps the poisonous matters out of the gut before com- plete absorption can occur, and aids in restoring the normal intestinal alkalinity. The prevention of "biliousness" depends upon the maintenance of a normal, easily digested diet, upon the formation and excretion of normal bile, and the prevention of fermentation and decomposition in the alimentary tract. The term " normal diet " is a very elastic one, and varies Avith each case. While certain forms of food are generally considered good or bad, easy of digestion or difficult of assimilation, it nevertheless remains a fact that many of the simplest foods are capable of acting as poisons in susceptible persons. A large number of persons cannot take milk 1 See the researches of Schweringer, Zuelzer and Sonnerscheim, Bence Jones, Dupre, Korch and Fassbender, Brieger, Schmiedeberg, and Harnach. 480 DISEASES. or eggs because their digestion of these substances is faulty, and the writer is cognizant of one case where lobster salad can be eaten at bed- time without discomfort, while an egg at breakfast will cause a severe headache or pain in the belly. Rules as to diet must not be " iron- clad," but based on observation. By far the best means of maintaining hepatic activity in cases where this organ is torpid is horseback exercise, particularly if the exercise is taken on a trotting horse, as the jolting of the liver keeps the chain of digestive functions active and prevents the secretions from becoming clogged. Along Avith this exercise massage of the hypochondrium and belly-Avails is useful, and the movement of stoop- ing over, bending from side to side, and bending backAvard with the feet close together, is of value. Coffee is often the cause of bilious- ness because of its oil. The use of pure, dark orange-colored, undiluted nitromuriatic acid in these cases in the dose of 3 drops three times a day in half a tumblerful of water is invaluable, and the fluid extract of stillingia in the dose of 20 drops (1.3) is of service, as is also the solid extract of euonymus in the dose of 3 grains (0.15). 5-grain (0.35) doses of extract of chirata in pill are also useful in hepatic atony of a mild type. R.—Ext. chirata?. Podophyllin . Euonymin . Leptandrin . Creosoti . . Ft. in pil. No. xx S.—One pill every night The knoAvledge of the action of many of the poisonous materials formed in the alimentary canal renders it possible for us to relieve the patient by other means than those Avhich may be generally resorted to when the attack is present. Thus, if the pupils are dilated, the skin hot and dry, the eyesight dim, and the pulse rapid, the alkaloid pro- ducing these signs of atropine poisoning may be antagonized by opium in small dose, or if the pulse be slow and full, the arterial tension high, and there is throbbing in the head with frontal headache, the alkaloid representing digitalis may be antidoted by the use of aconite. If nervousness and irritation are present, the bromides and chloral may be used. For some unknown reason the use of caffeine in the headaches of biliousness nearly ahvays makes them worse, particularly if the head- ache is due to over-indulgence in coffee. If the face is flushed, a mustard plaster or cup to the nape of the neck may be used, and a hot foot-bath is often of service. In cases where the bilious attacks are associated Avith catarrh of the stomach, intestines, or bile-ducts, chloride of ammonium, in 5- grain (0.3) doses, three times a day, is very useful, as is also the protiodide of mercury, Avhen triturated Avith sugar of milk, in the dose of -g^ to ^ of a grain (0.001-0.0015) three times a day. Fre- quently the use of salol or salophen in 10-grain (0.65) doses, three gr. xl (3.0). gr. iv. (0.2). gr. viij (0.5). gr. viij (0.5). gr. x (0.65).—M. BLEPHARITIS—BOILS. 481 times a day, does much good in these cases, acting as an intestinal antiseptic. (See Salol.) BLEPHARITIS. Blepharitis is divided clinically into an ulcerative and non-ulcera- tive A^ariety. ^ The indication of prime importance in the treatment of this affection is the removal of the scabs and crusts before the application of the local remedies. This may be accomplished by the use of alkaline solutions, bicarbonate of sodium or biborate of sodium (8 grains to the ounce [0.6 : 32.0]), or a 5 per cent, solution of chloral, as recommended by Gradle. The salves that have met with the great- est success are Pagenstecher's ointment (yellow oxide of mercury, 1 grain [0.05], vaseline 1 drachm [4.0]), dilute citrine ointment, pyro- gallic-acid ointment, or a 3 per cent, milk-of-sulphur ointment, to which resorcin may be added. The latter application is useful in the squamous variety alone. In the ulcerated form, if the crusts are tenacious, these, as well as the stunted cilia, must be removed with forceps, and yellow-oxide-of-mercury salve or some similar application applied. Excellent results folloAv touching the crater-like abscesses which exist in edges of the lid with nitrate of silver. If there is an accompanying conjunctivitis, a boric-acid solution is suitable, while under any circumstances obstruction of the lachrymal duct —a frequent accompaniment of the disease—must be removed, and the nasal passages explored for any chronic inflammatory condi- tion. The relation between this disease and the presence of refrac- tive errors demands the correction of the later, should these exist, before a hope for cure may be entertained. BOILS. Boils are dependent upon an impoverished state of the system, or, more rarely, on some local trouble situated in the skin, as in the persons of oil- or paraffin-workers. Their constitutional treatment rests upon the use of fresh air, cod- liver oil, iron, arsenic, phosphate of sodium, and, if any boils are present at the time, the use of the sulphurate of calcium in the dose of -^ grain (0.006) every five hours. The sulphurate of calcium hastens the maturation of boils and prevents the formation of new ones, but is useless, according to its original user, Dr. Ringer, in the boils which appear during the course of some cases of diabetes. The local treatment of boils may be divided into the abortive and curative methods. The abortive method consists in painting the inflamed spot, Avhen the trouble first begins, with a solution of gun- cotton (collodion), and renewing the coat hour after hour until a heavy contractile covering is formed. If pus forms under this, it may be absorbed, but if this does not occur, then the boil must be opened under antiseptic precautions and properly dressed. A strong solution of nitrate of silver is also very useful at the very beginning of the 31 482 DISEASES. formation of a boil if painted over the part in the strength of 20 grains to the ounce (1.3 : 32.0). The other local applications consist in the use of the extract of opium or belladonna over the part to relieve pain and decrease the inflammation. Poultices may also be used to relieve the sensation of tenseness and mature the boil, and should contain SAveet oil and laudanum. Ringer recommends the application of alcohol and camphor over the skin in the early stages. After the skin is wiped dry it is to be smeared Avith camphorated oil. Stehvagon uses the following: R.—Ichthyol.................3J/4-0)- Emplast. plumbi............3ij (8.0). Emplast. resina?.............SU (8-0).—M. S.—Apply to the part. He also approves of the injection of a feAv minims of a 5 per cent. solution of carbolic acid into the apex of the boil if its formation is assured. BREASTS (INFLAMED). Lactation should at once cease and the milk be removed by the aid of massage and the breast-pump. A bandage exercising pressure is now applied and an ice-bag placed over it. This is only useful in those cases in which the glands are the part affected. When the connective tissue is involved lead-water and laudanum should be applied, and saline purgatives used. Belladonna ointment may be smeared over the breast with advantage in both forms to check secretion and allay inflammation. As soon as pus has formed it should be set free by an incision in the line of the ducts. If it be deeply situated, it should be opened by an incision close to the chest and the pockets opened by a grooved director or dressing-forceps and packed with gauze. In the early stages of the inflammation, if the circulation is bound- ing, it should be thoroughly impressed by aconite or veratrum viride. BRONCHITIS (ACUTE AND CHRONIC). In the early stages of bronchitis there is ahvays present a very distinct hypersemia, followed by a true inflammation of the mucous membrane lining the bronchial tubes. When these changes are con- fined to the larger bronchi, the term " bronchitis " is employed, but when the minute bronchioles are imraded, the disease is knoAvn as "capillary bronchitis." In the article on Pneumonia and elseAvhere in this book the Avriter has spoken of the various stages of inflamma- tion, the measures indicated under such circumstances, and has de- scribed the action of the various drugs. In many cases the phy- sician only sees the patient Avhen the second stage of his disease is present, but if the individual presents himself at once, the folloAving history and physical signs Avill indicate the treatment to be employed: After exposure, more or less severe, to Avet, dampness, or dry cold, a sensation of oppression comes on, associated Avith a feeling of " tight- BRONCHITIS. 483 ness across the chest" or a sensation as if a bolus of food Avas under the sternum. Aching and pain may then be traced over the lines of the bronchial tubes, Avhile the dry, hacking cough increases the dis- comfort and seems to strain the tubes till each one can be outlined on the chest-Avail by the patient. The cough, Avhen it occurs, is vir- tually unproductive, and often hurts the larynx and throat. On mak- ing a physical examination by auscultation there Avill be found over the posterior aspect of the chest, betAveen the shoulder-blades, sounds of bronchial breathing, Avhich are rougher than normal, and due to the air passing over an inflamed, swollen, and roughened mucous membrane. This bronchial roughening may be sufficient to cause a harsh inspiratory sound over the entire chest, and the expiratory sounds may be heard a little louder than usual. No other changes from the normal can be noted, but isolated spots of discomfort may be pointed out by the patient where aches, "catches," or "kinks" seem to be present in a previously normal tube. Percussion, palpation, and inspection show nothing more of note. Some fever may be present. The patient should receive a hot foot-bath, take a glass of hot lem- onade Avith a little Avhiskey in it, and go to bed at once, in order that by inducing a profuse perspiration he may relieve the bronchial con- gestion. Often a dose of Dover's poAvder is useful in hearty adults to aid in causing perspiration. In children the chest should be Avell rubbed wTith camphor liniment and a little tincture of aconite be given in water with sweet spirit of nitre every hour, as folloAvs : R.—Tinct. aconit.............^Lviij (0.6). Spt. aether, nitros...........f ^ij (8.0). Aquae.............q. s. ad f ,Sj (32.0).—M. S.—A teaspoonful (4.0) to a child or a dessertspoonful (8.0) to an adult in water every hour. In many adults 5 to 10 grains (0.30-0.65) of DoA^er's powder Avith a hot drink is better. If the attack is not aborted, while the first stage is still present, before secretion is established, resort should be had to ipecac and to citrate or acetate of potassium, which act as sedatives to the inflamed mucous membranes and aid in the formation of secretion, moistening the inflamed surfaces and thereby overcoming the dryness and irritation. These potassium salts also act as febrifuges, and should be used in full doses, as much as 40 grains to 1 drachm (2.0-4.0) in a day, in addi- tion to the aconite already recommended. The folloAving prescription illustrates their employment: R.—Syrupi ipecac..........f& vel f^iij (4.0-12.0). Potassii citratis.........^iv (16.0). Aqua destillat......q.s. ad fgvj (192.0).—M. S.—Dessertspoonful (8.0) every four hours for a child of five years. Or, R.—Syrupi ipecac.............f.|ij (64.0). Succi limonis............f^j (32.0). Potassii carbonatis..........3iv (16.0). Spirit, aether, nitrosi........fjj (32.0). Aqua? destillat..........q.s. ad f^vj (192.0).—M. S.—Dessertspoonful (8.0) every four hours for an adult. This mixture should not be corked for some time after it is made. 484 DISEASES. For a child this prescription should be reduced just one half in each part Avith the exception of the water. In some cases, particularly if the patient be a child, large doses of the citrate or other salt of potassium exert a depressing influence and have to be decreased. Counter-irritation may be applied to the chest m the shape ot a mustard or spice plaster. If the soreness of the bronchial tubes is not relieved by this means, inhalations of steam arising from boiling water may be practised, either through a cone, one end of which covers the top of a pitcher and the other end of which covers the mouth and nose of the patient, or by covering the head and pitcher with a towel. The usefulness of this method may be much increased by the addition of 1 tablespoonful of compound tincture of benzoin to each pint of In young children, particularly in the first stage of bronchitis and in the later stages, the use of the so-called "bronchitis tent" is of Fig. 10. great value. It consists of a canopy raised over the bed a sufficient distance to alloAv of the circulation of plenty of air. Through one side of this canopy passes a tube leading from an Arnold steam sterilizer, under which is an alcohol lamp to keep the temperature of the water sufficiently high. (Fig. 10.) By this means the air breathed by the patient is so saturated Avith moisture that the mucous membrane BRONCHITIS. 485 lining the air-passages is soothed and quieted. In order that the full benefit of this measure be understood, it must be remembered that a mucous membrane in the early stages of inflammation is ahvays dry and red, lacking its normal moisture, and that the upper air-passages fail to catch upon their surfaces, by reason of their dryness, particles of dust, and do not moisten the air before it reaches the lungs. Again, it will be remembered that the bronchial mucous membrane is covered with ciliated epithelium, Avhich, by the constant, upward, wavy motion of its cilia, urges out of the lungs all impurities. Dryness of the surface at once stops this ciliated movement, Avith unfavorable results. The employment of the "bronchitis tent " is equally useful in adults, but less readily employed, OAving to the size of the bed. Having considered the treatment of the first stage of bronchitis, Ave pass to that of the second. The condition of the mucous mem- branes is noAv quite different from that Avhich Ave have just been speaking of. In the place of an absolute lack of secretion we have a profusion of cast-off epithelial cells, a large amount of mucus, and more or less liquid poured out upon the Avails of the bronchial tubes. forming obstructions everyAvhere to the ready passage of air. The secretion is apt to be more or less viscid, ropy, and, Avhen it is coughed up after considerable effort, appears in lumps, particularly in the morning. This state is one in Avhich the excitement of inflammation is folloAved by local depression and an effort on the part of the tissues to rid themselves of the congestion and of the useless epithelial forma- tions. The physical signs on listening to the chest are noAv found to consist in a large number of loose rales Avhich are distinctly Avet and moist. Later they become markedly liquid and bubbling, and so large as to cause gurgling on inspiration and expiration. Sometimes they are musical or squeaking. Generally the latter signs do not come on until the case is far advanced, and, if a cure is soon to be reached, they only last a feAv days or hours, as the mucus is so loose as to be easily coughed up and the lung readily cleared. The object of the physician is to use remedies Avhich Avill stim- ulate the bronchial tubes and increase the volume of liquid poured out. For this purpose the bronchitis tent may of course be employed, but the drugs to be used internally are ammonium, chiefly the chlo- ride, and the pitches and turpentines, such as terebene, pyridine,1 or even turpentine itself. In the majority of instances an ammonium mixture will be the best and most serviceable prescription, in one of the folloAving forms: R.—Ammonii chloridi.........,~ij (8.0). Ext. glvcvrrhiz. fluid........."ij 8.0). Aqua? destillat........q. s. ad f^iij (96.0).—M. S.—Teaspoonful (4.0) everv four hours. Or, R.—Ammonii chloridi...........^ij (8.0). Mist, glycyrrhiz. comp........f^iij (96.0).—M. S.—The same dose. 1 Pyridine, not pyrodine, is used by placing 1 fluidrachm (4.0) on a hot shovel or saucepan in a small room, the patient breathing the fumes, which are carried to him by the air of the apartment. 486 DISEASES. The disadvantage of the latter prescription is the presence of anti- mony in the compound liquorice mixture, Avhich is contraindicated if debility exists. If the cough is troublesome, a little morphine or belladonna may be added, or the following be used, particularly if any signs of car- diac failure appear: R.—Ammonii chloridi . . . ......3J (4.0). Ammonii carbonatis.........3J (4.0). Ammonii bromidi..........3J (4-0). Extract, glycyrrhiz. fluid.......£iv (16.0). Aqua? destillat............fgyj (192.0).—M. S.—Dessertspoonful (8.0) every four hours. In this prescription the first constituent acts particularly on the air-passages, the second cumulates the heart and respiration, and the third allays the cough, while the liquorice covers the salty taste of the ammonium. R.—Codein...............gr. ij vel iv (0.-0.2). Ammon. chlorid...........Xi (4.0). Ext. glycyrrhiz. fl..........f|j (32.0). Aqua?............q. s. ad fgij (64.0).—M. S.—Teaspoonful (4.0) every two hours in water. An oro-nasal respirator, with the sponge saturated with equal parts of terebene, iodide of ethyl, and chloroform, may be worn in order to allay cough and loosen the mucus. If the administration of the chloride of ammonium does not aid in the expulsion and liquefaction of the secretion and rid the lungs rap- idly of the mucus, the use of terebene in 5- or 10-minim (0.35-0.65) capsules may be resorted to Avith great success. If capsules cannot be supplied, terebene may be made into an emulsion with acacia or trag- acanth and given in this way. Sometimes terebene will irritate the kidneys and produce a sense of weight across the loins; if this occurs its use should be stopped. In other cases it will disorder the stomach or cause diarrhoea. These effects are not, however, commonly seen. Terpine hydrate in 10-grain (0.65) doses may be used three times a day, or terpinol in the dose of 8 to 10 grains (0.5-0.65) in capsules or pills. Certain of the volatile oils and resins are also of value at this time, notably the oleoresin of cubebs and copaiba, Avhich, however, pos- sess the disadvantage of disordering the stomach. The oil of eucalyp- tus is also of great value, and may be given in capsule or emulsion in the dose of from 1 to 5 drops (0.05-0.35) every five hours. The oil of sandalwood in the dose of 5 to 10 minims (0.35-0.65) is very valuable, and is not so apt to disorder the stomach, boAvels, and kidneys as are some of the other remedies named. While the proper use of these remedies usually brings about the results desired, in others a stage of profuse secretion comes on which in its treatment is identical Avith that seen in chronic bronchitis, chronic "winter cough," and emphysema, so these diseases will therefore be considered together. In old persons suffering from dilated bronchial tubes, from emphy- BRONCHITIS. 487 sema, and from chronic bronchitis there is constantly poured into the air-passages so free a secretion that persistent coughing is necessary to rid the lung of enough of the mucus and liquid to enable the man to breathe. Any excess of this exudation droAvns him in his OAvn secre- tions, and the constant obstruction to the ready flow of air and blood in the lung soon produces dilatation and weakness of the right side of the heart. The same condition in a more acute form sometimes asserts itself in young children and in adults. In children it some- times comes on so suddenly as to be knoAvn as " acute suffocathe catarrh," Avhile in older persons it appears Avith sufficient severity to make the condition of the patient most serious. Of the treatment of the latter state the writer will speak at once. The objects desired are to rid the lung of the liquid secretions, to prevent the outpouring of more exudations, and to support the patient until the crisis is past. Where the exudations rapidly fill the lung, nothing is better in the strong child or adult than an active emetic, such as apomorphine, hypodermically, in the dose of y1^- grain (0.006) to an adult or ■£$ to a child, Avhich is not to be repeated; if this dose fails to act in ten minutes, ipecac may be used instead in the form of the powder, a small teaspoonful for a man or 5 to 10 grains (0.35- 0.65) for a child, or, if the powder be not at hand, a Avineglassful (32.0) of the wine or syrup of ipecac to an adult or tAvo teaspoonfuls (8.0) to a child may be given. Digitalis should be administered to support the heart, and strychnine be employed in full dose to stimulate the respira- tory centre and excite the nervous system, which is generally depressed by the increasing carbonic acid in the blood. For the same purpose caffeine or strong coffee may be used. Oxygen may be inhaled, and to stop the profuse secretion atropine may be used by the mouth or hypo- dermically. If death seems at hand, hot and cold dashes of water may revive the patient sufficiently to keep up respiration until voluntary efforts are made by the patient. Sometimes letting the patient hang his head over the side of the bed when he coughs may aid in the ex- pulsion of the liquid. The treatment of the more moderate condition of excessive secre- tion in the bronchitis of old persons, which is more sIoav in its prog- ress, but which may end as fatally as similar attacks in the young, is someAvhat similar to that just given. Injurious results are often produced by the physician failing to recognize that the secretion is suf- ficiently liquid, and that ammonium and such expectorants are not only useless, but harmful, because they increase the quantity of these liquids. Under these circumstances a. fine spray of a solution of tan- nic acid of the strength of from 2 to 30 grains (0.1-2.0) to the ounce may be used, or of alum solution from a feAv grains to saturation. Monsel's solution should be employed in the dose of 10 to 15 drops (0.65-1.0) to the ounce (32.0) of water, or acetate of lead may be used in the strength of from 1 to 15 grains to the ounce (0.05-1.0 : 32.0). Belladonna, Avhich checks secretion, stimulates the respiratory centre, and is for this reason a doubly useful remedy. Strychnine is, however, the best of remedies to help the patient get rid of the sputum. It should be given in the dose of ^ grain (0.006) or more three times a day. 488 DISEASES. The use of remedies designed to allay the cough in these cases is absolutely unjustifiable, as it results in the retention of the profuse secretion. The question as to Avhether the cough is excessive or not must depend on the ability of the lung to rid itself of the secretions in its bronchial tubes. BURNS AND SCALDS. The treatment of burns and scalds is both internal and external, the first being devoted to the quieting of the nervous system after the injury, the relief of pain, and the treatment of shock, and the second to the care of the injured surfaces. Immediately.upon being called to a case of burn it is the duty of the physician to determine how badly shocked the patient is, Avhat the condition of the pulse may be, and A\hether or not the lungs and air-passages are involved. After these mental notes he should give a hypodermic injection of ^ to | grain (0.016-0.03) of morphine and ^ of atropine (0.001), and then roll the entire body in a large quilt to maintain the bodily heat Avhile the sufferer is being transferred to the hospital or the house to which he belongs. In some cases the shock is so great that the pulse flags at once, the temperature falls, and collapse ensues. Stimulants hypodermically, external heat, and warm drinks of water and Avhiskey are indicated, folloAved by -^ grain (0.003) of strychnine and 5 minims (0.3) of tincture of digitalis if the circulation does not respond to the less powerful stimulants. A very useful treatment under these circum- stances is to immerse the patient in a bath of warm water, hot enough to maintain the bodily temperature. Often while in this bath the burned cuticle is easily removed with but little pain, and the protection from the air decreases-dermal irritation. If time and circumstances permit, the dressings should be applied before moving the patient, but this is rarely possible. By far the best dressing is lint wrung out of a mixture of picric acid. (See Picric Acid, Part II.) Another useful application is linseed oil and lime-Avater, equal parts, or, if desired, the oil may be rendered antiseptic by the addition thereto of 1 part of carbolic acid to 20 parts of oil. This mixture is also of service in that it acts as a feeble local anesthetic. The cloths should be renewed every twelve or tAventy-four hours, as may be needed, or they may be substituted by lint wrung out of a saturated Avatery solution of boric acid. A useful ointment for severe burns is composed of: R.—Iodoform..............gr. xv (1.0). Antipyrin.............gr. lxxv (5.0). Acid, boric.............gr. ]xxv (5.0). Vaselin..............gij (60.0).—M. If the burn is not very diffuse, a solution of the tincture of can- tharides, 1 part to 40, upon a rag, is said to relieve pain and aid in healing, but if the burned surface be extensive this treatment cannot be resorted to, owing to possible irritation of the kidneys, which are CHANCROID. 489 already overtaxed by the interference with the functions of the skin. In comparatively small burns a saturated solution of carbonate of sodium (washing soda) often does great good in relieving the pain. This relief may depend on the solvent power of this salt over albuminous deposits, formed by the heat, which irritate the peripheral nerves. Sometimes the addition of antipyrin to this solution is of advantage, and the following may be used for superficial and limited burns: R.—Acid, boric.............^iij (12.0). Antipyrin..............5iss (6.0). Aqua? purificat............f 5viij (250 cc).—M. A very important point in the subsequent treatment of burns is the remembrance of the close relationship existing betAveen the internal organs, particularly the duodenum and the kidneys, and the cuticle. When Ave recollect that we trv to influence internal congestions—such as pulmonary congestion—for example—by the application of irrita- tion to the skin of the chest, we see at once that a Avidespread and severe burn is practically a huge counter-irritant and must reflexly affect the viscera. Again, the skin, being prevented from exhaling impurities, forces the kidneys to do the work, and if the kidneys fail under the strain death results. Whenever the urine is high-colored and cloudy the citrate of potassium should be freely given, 20 grains (1.3) in Avater three times a day, combined with 30 drops (2.0) of sweet spirit of nitre, care being taken that the depressant effect of the potassium is counter- balanced by stimulants. In dressing very severe burns the use of a general anesthetic such as chloroform is proper, but it must be used with caution. CHANCROID. The chancroid is a contagious, non-specific ulcer, which has no defi- nite period of incubation, is distinctly inflammatory in type, and is usually multiple. It is further distinguished from the primary sore of syphilis by the fact that it is auto-inoculable, is not followed by secon- dary eruptions, and, if it involves the lymphatics at all, produces a monoganglionic unilateral SAvelling which frequently attains a consider- able size and suppurates. Chancroid, being a purely local affection, would seem to require nothing beyond local treatment: this is true of the uncomplicated sore, but where phagedena or serpiginous ulceration sets in, the question of constitutional treatment is of paramount importance. The treatment of uncomplicated chancroid is as simple as it is efficient. One thorough cauterization converts the sore into a healthy ulcer, the cicatrization of which is quickly and surely accomplished. As the most efficient means of thoroughly destroying the chancroidal ulcerations the actual cautery is chiefly commended. This is, how- ever, objectionable to patients. Sulphuric or nitric acid will be found equally serviceable. The pain of these applications may be greatly lessened by the previous employment of a 20 per cent, solution of 490 DISEASES. cocaine. When the surface involved is large the patient should be etherized. The cardinal point in the cauterization of chancoids is to reach and destroy all the diseased area. Each pocket and sinus must be thoroughly acted upon, otherAvise it remains as a focus for reinfec- tion. A convenient way of both destroying the chancroid and pro- viding for the after-dressing is offered in the application of Ricord's paste. This is made by adding to finely powdered charcoal enough strong sulphuric acid to form a paste of about the consistency of castor oil. This is then applied to every portion of the ulcer. The acid shortly dries out, leaving a dressing of charcoal, Avhich in a few days drops off, exposing a healthy, nearly healed, granulated surface. Where nitric acid is applied the subsequent dressing consists, pre- ferably, in the application of dusting poAvders, iodoform being the best. There has been a tendency of late years to substitute for this treat- ment one less radical, more acceptable to the patient, and in many cases almost equally satisfactory in results. It is certainly true that many of the chancroids as found in persons of robust health show little tendency to spread beyond comparatively narrow limits, and are amenable to mild treatment. It must be remembered, however, that, as long as the smallest portion of such an ulcer remains unhealed it may at any time take on all the features of a virulent ulceration. Moreover, the patient is constantly exposed to the risks of a chan- croidal bubo—a complication so troublesome that the possibility of its development constitutes the strongest argument against palliative treatment. Where the ulceration is entirely superficial, constituting the erosive form of chancroid, iodoform, dusted over the surface of the carefully cleansed granulations, offers the best form of palliative treatment. As a cleansing and stimulating wash to precede the application of the iodoform 1 drachm (4.0) of nitric acid to the pint (500 cc.) of water is most satisfactory. The objection to iodoform lies in its disagree- able and penetrating odor. To prevent this, great care should be exercised in applying the powder to see that none is distributed else- where than upon the sore. The odor can also be disguised to some extent by thoroughly mixing with the iodoform a small quantity of one of the essential oils, such as oil of peppermint or attar of roses, using not over 5 minims (0.35) to 1 drachm (4.0) of the powder. There is no dusting powder which can entirely take the place of iodoform, yet when the objections to the use of the latter are insu- perable aristol or iodol may be substituted, or a mixture of 1 drachm (4.0) of zinc oxide and 3 drachms (12.0) of subnitrate of bismuth, or equal parts of calomel and bismuth. Where the discharge is profuse, poAvdered tannin may be combined with the dusting powder in the proportion of 1 part to 4. In the ordinary uncomplicated chancroid these dry dressings are greatly to be preferred to wet applications: Avhen, hoAvever, the sore is attacked by a high grade of inflammation and becomes indurated, prolonged immersion of the part involved or of the whole body in hot water may be followed by the application of dressings kept constantly CHOLERA, ASIATIC. 491 Avet Avith the dilute nitric-acid lotion, as given above, or with Aveak carbolic solution, 5 grains to the ounce (0.35 : 32.0) of Avater, or Avith lead-Avater and laudanum. Where the chancroid assumes the phagedenic tvpe. extending Avith great rapidity and causing extensive sloughing and destruction of tissue, free cauterization either Avith the hot iron or by means of nitric acid should be instituted immediately, every portion of the ulcerating surface being thoroughly destroyed. This should be folloAved by prolonged hot sitz-baths or general ay arm baths, the patient remaining in the water for days at a time if necessary, and, if practicable, eating and sleeping Avith the body still immersed. If this is not possible, baths of from two to four hours' duration should be given tAvo or three times daily. After cauterization, pow- dered iodoform is the best local application in phagedenic cases. In addition the patient may be given full doses of opium, and should receive a tonic and supporting treatment. Should the chancroid assume the serpiginous type, sIoavIv extend- ing in spite of treatment, till in the course of months or years large areas are destroyed by the process, the Avarm bath, continued night and day for Aveeks at a time, together with thorough cauterization of the entire diseased surface Avith the hot iron, represents the most satisfactory method of treatment. The chancroidal bubo is best avoided by prompt and thorough cauterization of the sore: Avhen it occurs, hoAvever, it should be first treated by rest, pressure, and counter-irritation, since it may be a simple inflammatory adenitis, and Avith care may not run on to sup- puration. Iodine may be painted around the SAvollen area, the patient should be put to bed, and a compress, together Avith a spica bandage of the groin, should be applied, or this may be substituted by a hot bag placed upon the inflamed gland. At the first sign of suppura- tion the bubo should be opened freely, should be Avashed out Avith bichloride solution, 1 : 1000, peroxide of hydrogen half strength, or chloride of zinc 40 grains to the ounce (2.65 : 32.0) of Avater, and should be packed with iodoform gauze. If the bubo takes on phag- edenic action, it should be treated precisely as the phagedenic chan- croid. CHOLERA, ASIATIC. The treatment of this exceedingly dangerous disease is prophy- lactic, curative, and convalescent. The first measures consist of strict quarantine, both public and private, the avoidance of all Avater for culinary purposes which has not been boiled at least an hour and cooled in a place devoid of germs, and the employment of those foods Avhich, Avhile preserving the normal bodily health, in no way predispose to intestinal dis- turbances, as do some of the fruits, as melons and grapes. If these things are attended to, little remains to be done; but it is Ayorthy of remark that sulphuric acid is a drug Avhich is harmless in itself, yet apparently one Avhich is possessed of distinct prophylactic poAver in this disease. 492 DISEASES. Dividing the disease into three stages, we find as the earliest symp- tom some disturbance of peristaltic movement, Avith or Avithout pain, or in other instances the patient is attacked Avith a sudden flux of the intestinal contents. If there is a history of the ingestion of bad or indigestible food, there is no doubt Avhatever that this foreign material must be gotten rid of by the use of castor oil or sulphate of magnesium, the latter being the best, because it is more rapid and less apt to cause griping. No purgative should be given unless the history of the ingestion of bad food is most direct and clear. When the attack is sudden in its onset, as is usual, the question arises, Shall Ave resort to opium by the mouth ? The ansAver, aftei having carefully considered the statements of a large number of authors, is that Ave should not use opium by the mouth or hypo- dermically except in cases where the pain or cramps are so excessive as to absolutely require the drug. In other Avords, it is to be given for the pain, not for the diarrhoea. Should opium be used, it is infinitely better to employ it by the rectum in the manner to be described later, and if it is necessary to use it by the mouth, only the deodorized opium or the deodorized laudanum should be em- ployed, since these preparations are less apt to cause nausea than their fellows. Camphor, on the other hand, seems to be universally regarded as a most useful drug, tending at once to stop diarrhoea and relieve the pain and cramps from the beginning to the end of the attack. Whether camphor exercises any germicidal effect on the cholera bacillus Ave do not know. Certain it is that volatile oils all possess distinct antiseptic powers. Aside from any such influence, camphor is useful as a general systemic stimulant, and has been proved by wide clinical observation to have a very extraordinary power in the control of all forms of serous diarrhoea, particularly true cholera. The spirit of camphor has proved most effective in cholera epidemics. Frequently the use of camphor so controlled the diarrhoea and stimulated the torpid kidneys that anuria was set aside in twenty-four hours. Under these conditions camphor wine has been found to be very useful; it is to be made by adding 75 grains of finely-powdered camphor to a quart bottle of strong red wine, to which is also added gum arabic and alcohol. The camphor is first dissolved in the alcohol, and then thoroughly mixed with the wine. The dose of this mixture is a teaspoonful, in peppermint tea, every hour to a child of six years, for an older child a dessertspoonful, and for an adult a wineglassful. Those who first used this mixture were wiser than they thought, for the recent studies of Pick have shown that both red and white Avine are distinctly inhibitory to the growth of the spirillum of cholera, probably because of the tannic or other acid which they contain, as well as the alcohol. A remedy, the use of which is based on very rational grounds, is salol, and probably the neAver drug salophen, Avhich, theoretically, is much better than the former, because it is less poisonous. According to the interesting studies of LoAventhal, salol seems to be peculiarly antagonistic to the bacillus of Koch. This investigator added to a 50-gramme alkaline solution of pancreatic juice 10 grammes of salol, CHOLERA, ASIATIC. 493 and to this mixture 3 centimetres of a good bouillon culture of the bacillus. Examinations in from forty-eight hours to a Aveek shoAved this to be absolutely sterile. It Avas further proved that the salol was inactive until broken up into its component parts—phenol and sali- cylic acid. Hueppe also asserts that the use of salol prevents the development of anuria. The use of a remedy originally proposed by Dr. R. G. Curtin has been proved by recent study to be eminently rational. This remedy is sulphuric acid. This drug not only is acid, and so deleterious to the bacillus, but, in addition, is astringent, and is probably elimi- nated as a sulphate by the lower boAvel. As is Avell known, ordinary cholera morbus yields readily to its influence. In addition to the treatment already given, which may be used in the second as Avell as in the first stages, Ave have measures which must be resorted to for the relief of the dominant symptoms which mani- fest themselves as the disease progresses. The symptoms noAv to be combated are vomiting, excessive purg- ing, cramps in the extremities, and, as the result of these, exhaustion, collapse, and the advent of the algid stage. By far the best results obtained by any one line of therapeutics at this time certainly fol- Ioavs the employment of salol and camphor by the mouth, with entero- clysis and the use of hot baths; or, if these are not possible, hypo- dermoclysis and the employment of a hot-water bed; or, finally, hot bottles and bricks, for the patient largely dies of cold and of internal congestion of thickened blood, the circulation of which the heart and vasomotor system are unable to control. Atropine and strychnine are very useful, but ether is better than either, given subcutaneously or by the mouth, as a diffusible stimulant. Very extraordinary results are said by Italian observers to follow the rectal injection of a solution of common salt in the proportion of 1 drachm to the pint (4.0 : 500 cc.) of warm water. In other instances the use of tannic acid in the strength of from 1 to 8 drachms to the pint (4.0-32.0 : 500 cc.) of water has proved very satisfactory. The amount used at each injection should be about 2 quarts (2 litres) and the injection made as gently as possible in order to urge the fluid high into the bowel. The inflow tube should be a soft female catheter, and the overflow tube twice as large as the inflow tube. The tubes are to be inserted side by side after thorough oil- ing. The injection may be used every two hours and continued till the outfloAv is clear. This is done to wash out poisonous materials and to supply liquid to the system. A solution much stronger or Aveaker than that named is dangerous, for similar reasons to those given under the head of Dropsy and Saline Purgatives. (See, also, Enteroclysis, Part III.) Another useful measure is hypodermoclysis, or the passage of a solution similar to that just named into the subcutaneous tissues of the thigh or belly-Avail. (See Hypodermoclysis, Part III.) If done sIoavIv these injections are absorbed readily and supply liquid to the depleted blood-vessels. (See article on Diarrhoea.) 494 DISEASES. CHOLERA INFANTUM. Cholera Infantum is a term often applied to all the forms of active serous diarrhoea afflicting children in the summer months, Avhether its cause be exposure to high heat, the use of bad food, or both. The treatment by the use of drugs is identical in all forms of serous diar- rhoea in children as far as the purging is concerned, but the cause requires great care in its discovery and skill in its removal if that be possible. In cities, where the heat is often great, the air damp and impure, and the food not always fresh, cholera infantum often appears as a form of thermic fever or heat-exhaustion, or, in other Avords, as sun- stroke. Often in these cases the temperature in the rectum will be found febrile, while that of the axilla is below normal, and, as pyrexia does harm to the internal organs, the internal temperature must be lowered by cool drinks, by administering pieces of ice, and the irriga- tion of the boAvel, which will be described in a moment. The diarrhoea in such cases is dependent upon a relaxation of the blood-vessel walls in the intestine by reason of the influence of the high heat upon the splanch- nic nerves, and to irritant matters derived from food and resulting from defective secretion of the digestive juices. If the thermometer placed high up in the rectum shows a subnormal temperature, heat-exhaustion is present, not thermic fever, and the treatment is reversed. Hot drinks are to be used, external heat applied, and friction of the limbs resorted to, or the child may be put in a hot bath at a temperature of 105° F., its temperature being carefully watched lest it rise suddenly to a point above the normal. Avoidance of milk and the use of a few drops of beef-juice for tAventy-four hours is the best order as to diet. If vomiting is active and collapse is threatened, a drop or tAvo of good brandy should be used in each teaspoonful of food, and the value of atropine as a vasomotor stimulant is not to be forgotten. There is another form of cholera infantum Avhich is not due to a high atmospheric temperature alone, but more commonly to the inges- tion of irritant foods or foods unsuited to a child, obtained by the pa- tient surreptitiously or through the ignorance of the parents. If there is such a history and the probable cause is discovered by reason of some of the masses of undigested food having been passed, a purgative dose of castor oil (1 to 2 teaspoonfuls [4.0-8.0] to a child of two years), with 20 drops (1.3) of paregoric, should be used to sweep out the offend- ing materials and allay irritation, and be followed at once by the treat- ment which will be spoken of in a moment. Care, of course, should be taken to maintain the bodily heat, or lower it if it is above the normal, and a watch must be kept upon the pulse and breathing to note any changes requiring stimulants. There is still another class of cases. The physician will be called to see a child Avith the same history of having taken indiges- tible food or of there being curds in the stools. Careful examination Avill show that there is much bearing doAvn, or in other cases a simple running off of the liquid from the boAvel almost Avithout effort. Very CHOLERA INFANTUM. 495 soon, indeed, the passages become entirely colorless, except for a speck or tAvo of green, Avhich shoAvs the presence of the peculiar micro- organism which produces this color. The diapers have a peculiar mousy odor, and are characteristic; that is, they seem to be only wet and odoriferous, and contain no solid matter. If closely exam- ined, they will be seen to be soiled by a small amount of a whitish substance, looking like a paste made of Avater and fine chalk. Such a passage bodes ill for the child unless treatment is instituted. The physician should order, at once, ■£§ grain (0.003) of podophyllin for a child of six months, to be taken in two doses, half an hour apart, in 20 drops of brandy Avith a little Avater. Tavo hours after this the dose should be repeated, and again in tAvo hours more if necessary. By the end of the fourth hour there will be generally seen in the move- ments of the bowrels a trace of color, and this will gradually become more marked if the case is to haAre a favorable termination. As soon as the movements have changed from the pasty-white motions named to those having a bilious color, then, and not till then, are astringents to be employed. If they are used before this, the diarrhoea may become less for a feAv hours, but the child absorbs poisons from its alimentary canal and rapidly goes into collapse. The rationale of this treatment rests upon the fact that OAving to the disease every gland connected with the alimentary canal has become inactive. It is absolutely necessary to bring about glandular activity, and podophyllin, in the experience of the author, is the best remedy for this purpose. During the period that the podophyllin is acting it is Avell to apply a spice plaster to the belly or to immerse the child for short intervals in a hot bath to preserve its bodily temperature. In practically every case of cholera infantum it is of the utmost importance to stop milk-feeding absolutely for a few days. Nothing in the way of food may be given except Valentine's or expressed beef- juice, 10 drops (0.65) every two hours with a little cold water until all curds and undigested food are removed. After these measures have been resorted to, and the chief object— namely, a colored stool, not green—obtained, if the diarrhoea continues it must be stopped gradually. The medicinal treatment should consist in the use of a mixture such as the following for a child of a year or eighteen months: R— Acid, sulph. aromat..........gtt. xxx (2.0). Tr. opii camphorat..........f^jij (12.0). Elixir, curacoa?..........CJU (8.0). Aqua? cinnamomi......q. s. ad fgiij (96.0).—M. S—Teaspoonful (4.0) in a little water every two hours. Or, • N R— Acid, sulph. aromat..........gtt. xxx (2.0). 01. carvophylli...........1\viij (0.5). Tr. opii camphorat..........f;5J (4-0). _ Spirit, chloroformi.........gtt- xlvnj (3.0). Syr. zingiberis........q.s. ad fgnj (96.0).—M. S.—Teaspoonful (4.0) every two hours. If preferred, the tincture of kino or compound tincture of catechu may be substituted for the oil of cloves or the spirit of chloroform, 496 DISEASES. or, again, the fluid extract of hcematoxylon may be taken in the place of either of these. Where the vomiting is very severe and incessant, the purging pro- fuse, but free from undigested curds, a rectal injection of starch-water, 2 ounces (64.0), containing 10 drops (0.65) of laudanum, is to be em- ployed, and at the same time | of a grain (0.01) of gray powder (hydrargyrum cum creta) given every hour if the podophyllin is not Avell retained. The gray powder may in turn be substituted by ^ of a grain (0.005) doses of calomel. Very minute doses of arsenic given by means of the following solution are often of service in check- ing the vomiting and purging, and should be resorted to if necessary: R.—Liq. potassii arsenitis.......gtt. j vel ij (0.1). Aqua? cinnamomi........fjj (32.0).—M. g. —Teaspoonful (4.0) every fifteen minutes until four teaspoonfuls (16.0) are taken. In some cases the remedies named above only stop the diarrhoea for the time being, and it returns as soon as they are withdrawn. In such a case the following is of value to restore the lost tone of the parts involved: R— Resina? podophylli........gr. J (0.03). Liq. potass, arsenit.........gtt. iij vel vj (0.18). Liquor caleis..........f^iij (96.0).—M. S— Teaspoonful (4.0) every five hours. Shake well before using. Or a poAvder may be used: R.—Resina? podophylli . . Pulv. ipecac..... Sacchar. lact..... Ft. in chart. No. x. S.—One powder every five hours A very important, never-to be-forgotten measure in cholera infan- tum is the use of counter-irritation over the belly by means of a mus- tard plaster (1 part mustard flour to 4 of wheat flour) or by a spice plaster. The plaster should be renewed as often as it cools, and kept on continuously if the skin will stand it. A remedial measure carried out with great success in cities in the treatment of cholera infantum is the use of irrigation of the boAvels, or rather Avashing out of the colon. This is accomplished by the use of the solution named in the articles on Cholera and Enteroclysis. The infloAv tube should be of soft rubber, like a female catheter. The outflow tube should be larger, in order to carry off flakes of food or mucus. They may be inserted side by side after being oiled. The pressure used should be by a fountain-syringe raised not more than three feet above the buttocks, and the outfloAv should be clear and unobstructed. The irrigation may be resorted to every hour or two and continued until clear fluid Aoavs aAvay. The solution should, of course, not to be too cold or too hot—say 100° F. (See article on Diarrhoea.) gr. \ (0.016). gr. j (0.06). gr. xx (1.3).—M. CHOLERA MORBUS—CHOREA. 497 CHOLERA MORBUS. This acute, painful, rapidly-exhausting disease arises from expo- sure to cold, the ingestion of poisonous or irritating foods, exposure to excessive heat, and a number of similar causes. In reality, it may be regarded in one instance as a gastro-enter- itis, and in another as an acute serous diarrhoea associated with much pain of a griping, rending character. Nothing compares to counter- irritation for the purpose of affording relief. A large mustard or capsicum draft should be placed over the abdomen and allowed to remain as long as it can be borne. If the patient knows that he has taken irritant foods, castor oil Avith 15 to 20 drops (1.0-1.3) of laud- anum added to it, to preA'ent griping, should be employed to SAveep out the offending masses before any other remedies are used, and be folloAved by an antidiarrhoea mixture, such as here follows : R.—Acid, sulph. aromat........f.^ij vel f^iv (8.0-16.0). Extract. ha?matoxylon fluid. . . . ,~ii (8.0). Spt. chloroformi........f='ss (16.0). Syr. zingiberis......q. s. ad f^iij (96.0).—M. S.—Teaspoonful (4.0) every two hours. If the pain is very severe, the patient should be given morphine (gr. 4;) and atropine (gr. y^) hypodermically. (See article on Diarrhoea and Cholera Asiatica.) CHLOROSIS. (See Anaemia.) CHOREA. St. Vitus's Dance is a nervous affection, generally occurring in children, yielding to treatment quite readily in some cases, and in others remaining persistently severe, and even becoming worse, under the physician's care. The disease is always to be treated by the removal of all sources of reflex irritation, such as worms, a long prepuce if it is irritated by retained urine or smegma, or other trouble of this character, and in the avoidance of punishment or severe rebuke on the part of the attend- ants. This advice is given not because chorea is produced by such irri- tating conditions, but because they tend to impair the nervous tone of the patient. Except in that form of the disease closely associated Avith or dependent upon rheumatism, the profession universally employ arsenic in one of its forms as a specific remedy. (Jenerally FoAvler's solution is used, and, unless the parents are intelligent enough to drop medicine carefully from a bottle or dropper, the physician should order a 3- ounce mixture (96.0) Avith 48 drops (3.1) of FoAvler's solution, so that each teaspoonful will contain 2 drops of the drug. Very frequently, to be effective, arsenic must be used in ascending doses, increased 1 drop (0.05) a day, and in consequence the dilution just spoken of has 32 498 DISEASES. to be avoided and the importance of care in measurement urged upon the patient's relatives. Whenever arsenic is used the physician should instruct the attend- ants to stop administering the drug if any puffiness under the eyes is seen in the morning on arising from bed, or if any pain in the bowels ensues, as these symptoms show that the full medicinal action of the drug is being felt. When arsenic fails, cimicifuga in the dose of 20 to 30 drops (1.3- 2.0) of a fresh fluid extract to a child of ten years may be used as the next best remedy. Where the disease is associated with rheumatism, near or remote, the salicylates or iodides may be of value, and should be thoroughly tried. In some cases of chorea the muscular jerkings are so severe that sleep is impossible, and the patient has to be held in bed and the bed- covers tied down. These cases will often obtain a quiet night by the use of the hot pack at bed-time. (See Heat.) The child should be placed in a blanket previously dipped in water as hot as1 can be borne by the patient and thoroughly wrapped up in another (dry) blanket to retain the heat, and then be allowed to sweat. Care must be taken that a heat-stroke does not result, and, if sAveating does not come on and oppression ensues, the blanket must be removed. The sheets should be ironed to have them warmed for the patient when he is returned to bed, and it is often better to let him sleep between dry blankets. The efficacy of this treatment is increased by the use of a dose of bromide of sodium or potassium and a little chloral, as follows: R.—Chloralis..............#j (8.0). Sodii bromid.............Jss (16.0). Aqua? dest...........q. s. ad fgiij (96.0).—M. S.—A teaspoonful (4.0) in water every five hours for three doses. COLIC (HEPATIC). This exceedingly painful condition, due to the passage of a gall-stone through the bile-duct, is always associated with faintness and nausea. The object of the physician must be to relieve this pain, not only by the use of anodynes, but also by aiding in the escape of the stone into the bowel. To relieve the pain a hypodermic injection of mor- phine J to J grain (0.015-0.03), accompanied by y^- grain (0.0006) of atropine, is indicated. The morphine not only decreases the pain, but allays spasm, and the atropine relaxes the spasm of the muscular coats of the ducts and allows the stone to pass through the relaxed passage-way. Hot applications, such as turpentine stupes, may be used over the liver, but relaxation is not to be obtained by the use of nauseating emetics, as the retching or vomiting may rupture the dis- tended gall-bladder. Severe rubbing should not be used for the same reason. Quite recently the use of olive or cotton-seed oil has been largely resorted to in this affection, and, while we are not sure of the means by which it acts, the studies of Rosenberg and others point to the chang- COLIC, HEPATIC. 499 ing of the oil into glycerin and fatty acids, the first of Avhich liquefies and increases the Aoav of bile. Often the large dose of oil causes nausea, and this by producing general relaxation may aid in the escape of the stone. The oil is used during the attack of pain, and must be SAvalloAved in the dose of half a pint at least; smaller quantities do not suffice. Its action may be aided and its retention in the stomach promoted by the addition of a drachm of ether to each dose. Shortly after the oil is SAvallowed sudden relief often occurs, due to the escape of the stone into the boAvel. The stools should then be carefully Avatched for gall-stones, but care should be taken that the lumps of soap Avhich are passed, made from the oil by the alkaline juices in the intestines, are not mistaken for true biliary calculi. If the pain does not yield to morphine, chloroform or ether may be inhaled for the relaxation of the spasm and the relief of pain. In the endeavor to render our treatment of a patient Avith gall-stones rational, we naturally study the causes Avhich induce their formation and the manner in Avhich we can expel those stones which have formed before the case has come under proper care or in spite of any preven- tive measures Avhich Ave may have attempted. Unfortunately, we are met at the very beginning of our study by the fact that the physiologist and pathologist have not as yet discovered the exact characteristics of the general systemic conditions Avhich underlie their formation; but, on the other hand, experimental and clinical studies have developed a number of facts Avhich are of great value to us. Thus, Ave now know that there are a number of local causes Avhich distinctly predispose to the formation of gall-stone, and that these causes are very commonly found in that very class in which the systemic tendency to Stone-forma- tion is most marked. In the first place, a catarrhal state of the biliary passages favors the formation of gall-stone by providing an excess of mucin, with the aid of Avhich the stone may be built; secondly, this catarrhal state is commonly associated Avith, or produces of itself, a diminished alkalinity of the bile, Avhereby the cholesterin becomes more readily precipitated, and at the same time, it Avould appear, causes the deposition of an abnormal amount of lime salts, brought from else- where in the body and passed out through the mucous membrane. This latter fact seems proved by the circumstance that bile itself con- tains very little lime, and that more lime is found in stones lying against markedly catarrhal mucous membranes than in stones not so situated. So far, then, we have a simple pathological process providing no less than three ingredients of stone-formation—namely, mucin, cholesterin, and stearate, or some other salt of lime. There are still two other im- portant factors at work—namely, the systemic state, gouty or otherwise, which tends to stone-formation, and the stasis of the bile in its ducts, because the catarrhal process in the mucous membrane blocks its pas- sage toward the bowel. Recognizing these etiological factors, it now becomes our duty to oppose them, and Ave have the following indications to fulfil: 1. By causing a free secretion of bile to produce a rapid flow of fluid which shall be normally liquid and probably normal in its constituents. 2. By the use of alkalies to antagonize the development of acid tenden- 500 DISEASES. cies and to aid in the solution of mucus. 3. By regulating the diet prevent those hepatic and systemic disorders which tend to the forma- tion of stone. 4. As catarrhal states are often due to or aided by bacterial infection, to produce intestinal asepsis as far as possible. The normal secretion and Aoav of bile is best brought about by exer- cise of a gentle and Avisely-directed nature, taken continually and evenly, and particularly those forms of exercise which call into play the abdom- inal muscles and diaphragm or cause hepatic movements. The chief and best of these is horseback riding, or, if the patient is too feeble for this, massage should be resorted to, the hypochondrium being Avell but gently kneaded and rubbed daily for a considerable period of time. If the liver seems very torpid, calomel in small divided doses of a fraction of a grain may be given several times a Aveek, or nitro-muriatic acid may be more rarely used. In other instances, where there is reason to believe that the flow is sluggish and the bile not sufficiently alkaline, that catarrh and putrefactive tendencies are present, the administration of benzoate of sodium, or salicylate of sodium, in 10- or 20-grain doses, Avill result in increasing the flow% increasing the alkalinity, overcoming the catarrh, and then to arrest intestinal putrefaction. If the catarrhal process is very marked, chloride of ammonium will act even more satis- factorily. This treatment seems especially valuable Avhen the stones that are passed are very dark in color, indicating that much pigment and little cholesterin is present. In respect to the use of alkalies, the patient should drink freely of those mineral waters Avhich will provide alkaline substances, such as Contrexeville, Vichy, and Kronenquelle, and it is useful in many such cases to relieve any tendency to constipation or duodenal catarrh by the administration of hot Carlsbad water before breakfast daily. In the matter of regulating the diet, all rich or fatty foods are to be prohibited. Meat should be used in moderation, prefer- ably white meats, and green vegetables largely eaten. The catarrhal condition, associated Avith marked bacterial infection, as may be evidenced by some febrile movement, is best controlled by the use of turpentine, chloroform, and ether, given internally, and accompanied by the application externally of hot poultices to the hepatic area. These poultices may or may not be fortified by mustard, and Avhen removed should be replaced by a warm pad to prevent any chilling of the surface of the body. Of the internal remedies just named, turpentine is the most useful, since it liquefies mucus, aids the flow of bile, and is thought by some physicians to cause the expulsion of the stone by stimulating the Avails of the ducts, and that it dissolves the stone. Further than this, its continual use seems to prevent the formation of stone. Ralfe states that it is best given as folloAvs : R.—01. terebinthina?...........rr^v (0.35). Syrup, acacia?............fgss (15.0) Sodii sulph. carbolat. . . ......gr. xx (1.35). Spt. a?theris composit.........Tt^xv (1.0). Aqua? mentha? piperitne......q. s. f§j (32.0).—M. S.—To be taken twice or thrice a day. We Avould prefer adding compound spirit of lavender instead of pep- CON J UNCTIVITIS. 501 permint-water. If this mixture cannot be retained by the stomach, the turpentine may be given in capsule, and folloAved by a draught of milk. Finally, a most important factor in the prevention of gall-stone formation in susceptible persons is the avoidance of exposure and Avet, and, if possible, a residence in a sunny climate during Avinter months. CONJUNCTIVITIS. Simple Conjunctivitis, sometimes called catarrhal, acute, or muco- purulent ophthalmia, is characterized by congestion of the conjunctiva, loss of transparency of the palpebral portion, and some dread of light, Avith a discharge sufficient only to glue the lids in the morning or free and muco-purulent. In the milder stages the use of a boric-acid lotion (10 grains to the ounce [0.65 : 32.0]) is suitable, and the lids should be frequently washed Avith neutral soap and Avater; if there be much muco-purulent discharge, the lid should be everted and an application made of a solution of nitrate of silver (from 2 to 5 grains to the ounce [0.1-0.35 : 32.0]). If the discharge becomes great, bichloride of mercury, 1 : 10,000, may be employed Avith advantage, and the nitrate- of-silver solution increased to 10 grains to the ounce (0.65: 32.0), the excess being neutralized with a solution of salt or Avashed aAvay Avith tepid Avater. Much inflammatory reaction in this disease may be alle- viated by iced compresses. Patients suffering from catarrhal conjunc- tivitis should be protected from tobacco-smoke, bright light, dust, or any mechanical irritant. At.opine usually is unnecessary unless a corneal ulcer complicates the affection. The patient may wear smoked glasses, but under no circumstances must the eyes be bandaged or have poultices applied to them. Domestic medication of this sort may change a simple ophthalmia into a serious and purulent inflammation. Topi- cal medications other than those mentioned are biborate of sodium (gr. iv-viij to the ounce), alum (4 to 8 grains to the ounce [0.3-0.5 : 32.0]), sulphate of zinc (1 to 2 grains to the ounce [0.05-0.1: 32.0]), Avhich may be suitably combined Avith boric acid, creolin, 1 per cent. solution, peroxide of hydrogen, and formaldehyde, 1-6000. During the subsidence of the inflammation, and if it shows any tendency to become chronic, the application of an alum crystal or a solution of tannin and glycerin (10 grains to the ounce [0.65: 32.0]) is suitable. It should be remembered that muco-purulent ophthalmia may become epidemic in crowded institutions, and great care should be taken to isolate cases. One soiled toAvel may be the source of infection to a great number of children. Constitutional treatment ordinarily is not required, but proper hygiene, fresh air, good food, the intelligent use of laxatives, tonic doses of quinine, and Avhatever treatment is indi- cated by any associated condition, are useful. The associated condi- tions most commonly are nasal catarrh, bronchitis, a general cold, eczema of the face, and the exanthemata. Burns of the Conjunctiva.—Immediately after the accident all foreign particles should be removed or neutralized with a weak acid or alkaline solution if a liquid caustic or acid solution has entered the eye; then a feAv drops of cod-liver oil may be instilled and atro- 502 DISEASES. pine employed (suitably incorporated with liquid vaseline) to prevent iritis. The chief danger lies in the formation of severe corneal inflammation and symblepharon; the latter may sometimes be pre- vented by daily breaking up the granulation-tissue or by the insertion of a piece of gold-beater's skin betAveen the inner surface of the lids and the eyeball. The associated conjunctivitis and keratitis require treatment differing in no Avay from that described in the idiopathic forms of these affections. Purulent Conjunctivitis, Avhich is commonly seen in the adult in the form of gonorrhoeal ophthalmia and in the infant as ophthalmia neonatorum, is produced in both varieties by the introduction into the eye of a specific virus from either the urethra or the vagina. The chief danger of the disorder is destruction of the vitality of the cornea and loss of sight. The most important indication is to pre- vent this danger by reducing the amount of SAvelling of the lids and conjunctiva and the profuse discharge, Avhich are the characteristics of the disease. These indications are met best in the folloAving man- ner : Hourly cleansing of the eyes Avith an antiseptic solution, pref- erably bichloride of mercury (1: 8000), formaldehyde 1—3000, or a saturated solution of boric acid. During the acute inflammatory stage, and before the discharge is profuse, astringents and cauterants must not be applied. When this stage has arrived and the conjunctiva is profusely covered Avith discharge, the lids should be carefully everted once a day, wiped clean of every particle of pus, and carefully touched with a solution of nitrate of silver (10 to 20 grains to the ounce [0.65 : 32.0]), and the excess neutralized with a few drops of a solu- tion of common table salt. In the early stages iced compresses wrung out of carbolized water and frequently changed will help to reduce the reaction, or these compresses may be made by placing squares of lint upon a block of ice and thus securing intense cold. If the vitality of the cornea is threatened, it is advisable, in many instances, to substitute for the cold applications hot compresses of a temperature of 110° F. These may be applied for from ten to twenty minutes every two or four hours, according to the exigencies of the case. The appearance of ulceration in the cornea calls for the use of atropine or eserine. Atropine Avas formerly employed almost exclusively ; in recent times great success has followed the adoption of eserine. This is especially applicable if the ulceration should form in the periphery of the cornea. In adults high reaction and violent inflammation may be alleviated by the use of leeches to the temple. Bleeding of any sort is not applicable to newborn infants. Other applications Avhich have met with favor at the hands of various surgeons are solutions of sul- phocarbolic acid, sulphate of alum, sulphate of zinc, nitrate of silver, creolin (1 per cent.) and iodoform ointment. Peroxide of hydrogen is a good cleansing agent, but healing does not progress as favorably under its influence as Avith bichloride of mercury and nitrate of silver. Solutions of permanganate of potassium and aqua chlorini have many advocates. Mules has recommended a treatment Avith alcohol and corrosive sublimate. The preventive method of treating ophthalmia neonatorum that has obtained the happiest results is that instituted by CON J UNCTIVITIS. 503 Crede—namely, the dropping of a 2 per cent, solution of nitrate of silver into the eyes of the neAvborn infant. If one eye alone is attacked in gonorrhoeal ophthalmia, the other should be protected by covering it Avith Buller's shield, Avhich consists of a Avatch-glass fixed in a square of plaster, Avhich is carefully applied so that the crystal comes directly in front of the eye, and the plaster covers the sur- rounding area. Chronic Conjunctivitis may result from an antecedent acute inflam- mation of the conjunctiva or exist as an idiopathic affection, especially in elderly people, in whom it sometimes becomes a troublesome symp- tom, especially if complicating cataract. The characteristic lesions are roughness of the papillae of the conjunctiva, swelling of the caruncle, and soreness of the angles of the eyelids. There are no granulations, although the disease is sometimes inaccurately spoken of as granular lids. A soothing Avash is indicated (10 grains of boric acid to the ounce [0.65 : 32.0] of wrater), to Avhich may be added 2 grains (0.1) of cocaine, provided the cornea is not ulcerated, and for Avhich a similar boric-acid lotion Avith 4 grains (0.3) of salt to the ounce (32.0) may be substituted. A very suitable local application is lapis divinus (sul- phate of copper 1 part, alum 1 part, nitrate of potassium 1 part, fused together, and camphor equal to one-fiftieth of the Avhole added. The mass is run into sticks, and the application made to the everted lips, or 1 grain (0.05) of the same preparation to the ounce (32.0) of Avater may be dropped into the eye). Other useful applica- tions are tannin and glycerin (10 grains to the ounce [0.65 : 32.0]), yelloAV-oxide of mercury salve, and alum crystal. If refractive error exist, this should be corrected. It is to be remembered that chronic conjunctivitis distinctly contraindicates any operative interference in the eye, as, for instance, cataract extraction. Lachrymal Conjunctivitis is a name given to a chronic form of inflammation of the conjunctiva, associated with obstruction in the lachrymal duct, and characterized by a tear-soaked appearance of the eye, small pustules at the roots of the lashes, and a gummy discharge along the palpebral margin. This can be cured only by relief of the stricture of the nasal duct Avhich causes it, but may be alleviated Avith the same remedies recommended in the treatment of chronic conjunc- tivitis. Good results are reported from the use of pyoktanin. Follicular Conjunctivitis—a disease sometimes mistaken for granular lids, but having a distinct clinical difference, inasmuch as the swollen follicles are absorbed Avithout the production of cicatricial changes in the conjunctiva—requires for its local treatment Aveak astringents and antiseptic lotions, and the application to the swollen follicles of an ointment of sulphate of copper (gr. J to the drachm [0.025 : 4.0]), dusting in calomel either alone or Avith equal parts of subnitrate of bismuth, or iodoform or aristol used in the same Avay. If the disease is stubborn, the SAvollen follicles should be crushed with forceps. This disease, or one analogous to it, is sometimes produced by the prolonged instillation of atropine, and less frequently by eserine and cocaine. If this is its cause, the drug must be suspended and the surface painted Avith an alum crystal. 504 DISEASES. Granular Conjunctivitis.—This disease may be divided into acute and chronic granulations. In the former astringents and caustics are inadvisable, the eyes requiring Aveak antiseptic solutions like boric acid or salicylic acid and the instillation of atropine. Leeches to the temple Avill aid in reducing the inflammatory reaction. In the chronic disease the object of treatment is to bring about absorption of the granulations which are its characteristic lesion, not by an application so caustic as to destroy the mucous membrane around them, but of sufficient vigor to produce healthy reaction. The following applica- tions comprise those which have been employed Avith the greatest success: 10-grain (0.65) solution of nitrate of silver if there is dis- charge, applied once a day with neutralization of the excess ; sulphate of copper in the form of a crystal, carefully applied to the everted lids and the retrotarsal folds; glycerole of tannin (tannic acid grs. 30 [2.0], glycerin 1 oz. [32.0]), best applied Avith a cotton applicator; boroglyceride from 20 to 50 per cent, according to the vigor of the granulations. Strong solutions of corrosive sub- limate are employed in the folloAving manner: Solutions of the strength of 1 : 300 or 1 : 500 are painted on the everted lids every second day, the pain of the application being alleviated by the pre- vious instillation of cocaine, while three times daily the eyes are irrigated thoroughly with a solution of the mercury salt, 1 : 7000. Among the many other applications which may be used in this disease the folloAving may be mentioned : liquor potassa, beta-naphthol, iodo- form or aristol in powder or salve, an ointment of the yellow oxide of mercury, calomel, and hydrastin. The surgical means which are employed to destroy the granulations are scarification of the con- junctiva, an inadvisable method; excision of the granulations, use- ful if these exist in isolated groups; crushing the granulations with specially devised forceps, a method often followed by satisfactory results; scarification, followed by a vigorous brushing of the affected tissue with a brush containing short bristles, previously dipped in » strong (1:500) solution of corrosive sublimate (Grattage); electrolysis; and excision of the fornix conjunctiva. In long-standing cases asso- ciated Avith inveterate pannus De Wecker has proposed the use of an infusion of jequirity (3 per cent.). This produces an intense mem- branous conjunctivitis, which must be treated by iced compresses or similar measures to reduce its reaction, but when it has subsided the pannus is often relieved. This method has not been employed in recent times to the extent that it was practised when first introduced. Diphtheritic Conjunctivitis is rare in this country, but on the con- tinent of Europe occasionally occurs as an epidemic. It may appear alone or in association with diphtheria of the throat and nose. The initial subjective symptoms are those of purulent ophthalmia; the characteristic objective symptoms, a board-like infiltration of the lids with a deposit of gray membrane upon the palpebral conjunctiva. More than in any other eye disease destructive inflammation of the cornea is threatened. In the early stages the eye should be fre- quently cleansed Avith boric-acid or bichloride-of-mercury solutions, and atropine instilled, while hot compresses help to maintain the CONSTIPATION. 505 nutrition of the cornea more perfectly than the cold compresses which were formerly recommended for antiphlogistic purposes. TAveedie has highly recommended a solution of quinine (3 grains to the ounce [0.25 : 32.0]); Burgomaster, insufflation of floAvers of sulphur; Avhile in France the local application of lemon-juice or citric-acid ointment has been endorsed; GalezoAvski uses oil of cade (1 : 10). In the early stages all caustics are contraindicated; after absorption of the membrane and re-establishment of the discharge the cautious use of nitrate of silver in the manner described under Purulent Ophthalmia may be employed. The constitutional measures for diphtheria are necessary and the best treatment is the employment of injections of diphtheria antitoxin. Chemosis of the Conjunctiva, in Avhich this membrane is infiltrated with serum, is usually a symptom of other ocular disorders, and sub- sides Avith the general treatment directed to their relief. Good results may follow nicking the swollen tissue Avith a pair of scissors, the application of a warm, moist compress, and the use of astringents, especially alum. Hemorrhage beneath the Conjunctiva (subconjunctival ecchymosis) may follow an injury, occur during a paroxysm of Avhooping cough, and occasionally, in elderly people, may appear spontaneously. No treatment materially hastens the absorption of the blood, unless it be massage of the globe through the closed lid; any associated conjunc- tival irritation may call for a boric-acid and cocaine Avash. Xerosis of the Conjunctiva, depending upon a cicatricial metamor- phosis and the absence of normal moisture, is seen after long-standing inflammations (granular lids, diphtheria, pemphigus), and is incur- able. The affection may be relieved by the local use of glycerin, almond oil, emulsion of cod-liver oil, or the use of Aveak alkaline solutions. Transplantation of the rabbit's conjunctiva has been tried without success. CONSTIPATION. This troublesome state depends on a number of causes, the most common of which is the following of a sedentary life totally devoid of the exercise intended to keep the intestinal and hepatic secretions in an active state. Another frequent cause is simple laziness, which causes the patient to resist the call of the bowel for evacuation until this part of the body becomes indolent and atonic, while modesty often causes constipation in females, because a woman prefers to suf- fer rather than go to a closet which may be somewhat publicly sit- uated. In other instances constipation seems to be hereditary, and to depend upon deficient nerve-supply or muscular weakness and lack of secretion in the loAver boAvel, or upon hepatic torpor. Whatever the causes are, they should be sought for, and, if pos- sible, removed, the physician not being content to order purgatives, which, while they may give temporary relief, soon lose their poAver. Further than this,"it must be remembered that hygienic measures 506 DISEASES. ahvays take first place in the method of treatment, and, if possible, drugs should occupy a very secondary role. Particular attention should be paid to diet, and the physiology of peristalsis must be well borne in mind. It has been proved by a large number of studies, both in the nor- mal intestine and by the use of purgatives, that peristalsis is almost entirely a reflex action depending for its existence upon the integrity of the nervous plexuses in the intestinal Avails—namely, those of Auerbach and Meissner—the first of Avhich are situated between the longitudinal and circular muscular fibres Avhich they supply, the latter existing in the submucosa and supplying the walls of the villi, the glands of Lieberkiihn, and the small arteries and venules. It has also been found that the vagus nerve, when stimulated reflexly or directly, increases peristalsis, and that moderate stimula- tion of the splanchnic nerves decreases it.1 It at once becomes evi- dent that any decrease in the normal activity of these nerves and nerve-centres must speedily result in constipation, and the costive condition consequent upon hepatic torpor is due to the fact that the intestinal walls do not receive the proper stimulation from the bile to set in motion a reflex peristaltic Avave the result of Avhich will be evacuation. This fact rests upon the results of direct experiments, which prove the bile to be primarily an intestinal stimulant, antisep- tic, and promoter of secretion. Other series of experiments have shown that the circulation of the blood through the intestines greatly influences peristalsis, and disor- ders in the blood-supply readily bring on intestinal disorder. The deductions to be drawn from these facts are many. In the first place, it is evident that the maintenance of an active, normal circulation of blood in the abdomen and a free pouring out of bile from the liver and gall-bladder are necessary to a healthy peristalsis; and Ave find that, aside from drugs, Ave have a number' of remedial measures which are to be resorted to according to the means of the patient. By far the best of these is horseback exercise for at least an hour a day or every other day, which by the motion actively stirs up and excites the abdominal viscera as no other measure can do. If for any reason horseback exercise is impossible, then abdominal mas- sage, carried out by a capable "rubber," is to be tried, the hands fol- lowing more particularly the course of the ascending, transverse, and descending colon, the kneading movements being also applied to the hypochondriac regions. If neither of these measures can be used, then the patient must resort to those gymnastic movements Avhich involve the abdominal muscles, either by the use of dumb-bells or pulleys, such as are sold under the name of "home gymnasiums," or by bending the body forward, backward, and laterally, with the fists pressed into the hypogastrium. At the same time that these measures are directed the diet of the patient must be so regulated that the food shall contain a large amount 1 Some persons believe that Meissner's plexus receives impulses from the walls of the intestine and transmits them to the motor plexus of Auerbach, which then sets in motion peristalsis. CONSTIPATION. 507 of residue—that is, after digestion enough of the husk of the grain or enough vegetable fibre must be left free in the intestines to form a stimulus to the intestinal Avail as it slips over the mucous membrane. If a meat diet is largely used, so little residue is left after digestion that constipation ensues, but if vegetables are largely eaten the reverse is the case. No better evidence of this can be adduced than the hard, clay-like passages of the dog and the soft passages of the coav. Very often a plateful of cracked Avheat (Avheaten grits) eaten at breakfast each morning, or the use of bran bread, will relieve a chronic tendency to constipation. In these cases milk as a prominent article of diet is to be avoided above all things, since it is almost entirely assimilated and leaves no residue, though it supplants other foods. Green or canned corn is of great service. Fruits do good in constipation in one of tAvo ways—they either contain residual materials or sufficient vegetable acid salts to be laxative. Figs, by reason of their many small seeds, Avhich scrape the mucous membrane during peristalsis, are particularly valuable, and apples, prunes, dates, and tamarinds are all useful. It must be remembered that strawberries, raspberries, and blackberries are generally constipating rather than purgative. In regard to drink, nothing is so good as a glass of cold Avater taken on arising in the morning or just before breakfast, or, if the cold cannot be borne, then a glass of as hot water as can be SAvallowed with comfort may be substituted. Coffee is constipating to most per- sons, largely because of its empyreumatic oil, and tea has the same tendency because of its tannic acid. Brandy, as every one knows, is distinctly constipating, and whiskey possesses so little poAver to the contrary as to be deAroid of influence in either direction. Beers differ in their properties, some of them increasing and some of them decreas- ing intestinal activity. The patient suffering from constipation should go to stool regularly after breakfast every day even if the attempt is abortive, and so train the bowel to having a movement at this time. The use of drugs for the relief of constipation is capable of division into two parts : first, the employment of remedies to unload the bowel, Avhich has become filled; second, the use of drugs Avhich will so influ- ence the intestines as to cause evacuation and produce normal activity, or, in other words, drugs which Avill cure the tendency instead of giving temporary relief. Of the first class Ave find the various pur- gative salts, jalap, colocynth, senna, mercury, castor oil, and rhu- barb ; of the second class, aloes, cascara sagrada, manna, tamarinds, rhamnus frangula (buckthorn), phosphate of sodium, and small doses of podophyllin. The physician should bear in mind that defecation is a normal physiological act Avhich must be continued all through life, and it is almost as foolish to stimulate the bowel continuously to peristalsis as to perpetually employ heart stimulants or respiratory excitants. Although they are habitually employed by many persons in daily doses, the purgative salts are exceedingly harmful in such instances, rapidly losing their power and decreasing the patient's strength by the abstraction of liquids and salts from the blood. They often pro- 508 DISEASES. duce aneemia when constantly used. These salines are to be employed simply to unload the bowel when an excess of faecal matter has accu- mulated or when irritant materials are to be swept out of the aliment- ary canal. In some cases of pelvic congestion associated Avith con- stipation magnesium sulphate may be given by enema in the propor- tion of 2 ounces (64.0) of the salt, 1 ounce (32.0) of glycerin, and 4 ounces (128.0) of water. In some rare instances, where great pleth- ora exists, a course of Hunyadi water. Friedrichshall or Carlsbad waters is of service, but these instances are rare indeed in America. Jalap, colocynth, and senna are not to be used constantly, as they are too active and the reaction from their effects causes constipation. Rhubarb is commonly used, but is of its class peculiarly unfitted to its task. Although it purges, it is distinctly astringent, and is there- fore more constipating in the end than if no drug had been used. Mercury is exceedingly harmful if used continuously as a purge, and is the cause of much ill-health, of bad teeth, and of digestive troubles. Castor oil is notorious for its tendency to cause ultimate constipation. Of the curative class of laxatives none compare to cascara sagrada, particularly in the form of the aromatic fluid extract or cascara cor- dial. Originally, this drug as prepared was very bitter, but it is now made almost tasteless by certain manufacturers. This is the only drug AA'hich alone moves the boAvels and at the same time tends to make future passages more easy and regular; the dose is 10 to 40 drops (0.65-2.65) of the fluid extract or 1 to 6 drachms (4.0-24.0) of the cordial. There is almost no griping produced by it. For the regula- tion of the bowels of young children, particularly if the case have a tendency to rickets, phosphate of sodium in the dose of 5 to 10 grains (0.35-0.65) in milk is the best laxative, and the same salt may be used in 30- to 60-grain (2.0-4.0) doses in adults. Manna is to be classed as a laxative, but even it sometimes makes the intestinal torpidity ultimately much worse. The two remaining drugs of this class, aloes and podophyllin, should always be used in combination with other non- purgative drugs, as is seen in the folloAving formula: R.—Aloes socotrina?........gr. xx vel xl (1.3-2.65). Extract, nucis vomica?.....gr- iv (0.3). Extract, physostig.......gr. iij (0.25). Extract, belladonna?......gr. iv (0.3).—M. Ft. in pil. No. xx. S.—One pill at night or night and morning. 0r' R.—Resina? podophylli . Extract, nucis vomica? Extract, physostig. Extract, belladonna? . Ft. in pil. No. xx. S.—One night and morning. The object of using several of these drugs is seen at a glance. We have already learned that nearly all purgatives tend to produce griping. The nux vomica acts as a bitter tonic and stimulant, and prevents subsequent atony of the mucous membrane, as Avell as increases reflex action, and consequently improves peristalsis-; the physostigma is a tonic to the unstriped muscular fibre and gives it strength; the gr. ij vel iv (0.1-0.3). gr. iv (0.3). gr. iij (0.25). gr. iv. (0.3).—M. CORNS. 501) belladonna aids peristalsis by depressing the inhibitory fibres of the splanchnic nerves, by allaying spasm, and by decreasing griping. In using these drugs, aloes and podophyllin, Ave should remember that aloes is sIoav and acts particularly on the loAver boAvel, and that podo- phyllin acts chiefly on the upper boAvel and is the sloAvest purge in the list of purges. In obstinate constipation Ave are sometimes forced to resort to the compound cathartic pill of the U. S. P., or its modified form knoAvn as the " Pilula cathartica vegetabilis " (see Colocynth). After the boAvels have been Avell emptied by this pill Ave can often regulate them by cas- cara sagrada Avith or Avithout other laxatives, and by prescribing a proper diet and exercise. In the flatulence of old persons associated Avith constipation a little asafoetida or capsicum should be added to the pill of aloes just named. In some instances constipation arises from reflex irritation or from ovarian or bladder trouble or from chronic lead poisoning. This form of constipation may resist all purgatives and yield to opium or to tobacco, Avhich quiets reflex action. Tobacco depresses the inhibitory nerves of the gut, and devotees of the " Aveed " often use it as a lax- ative. The employment of enemata as a routine practice is to be discour- aged. In cases Avhere it is necessary to use them for temporary relief and to get rid of flatulence, a little soap, common -salt, or a few drops of turpentine may be added to the wrater. Recently the injection of glycerin (1 to 2 ounces [32.0-64.0]) has been largely resorted to, either pure or diluted one-half, and this method has been improved upon by the use of glycerin suppositories containing many drops of the drug. Glvcerin acts in these cases as an irritant to the mucous membrane, and causes secretion by this means and by its abstraction of Avater from the tissues by reason of its hygroscopic poAvers. It is capable, hoAvever, of causing a good deal of rectal irritation in some persons. CORNS. These troublesome formations are best treated by the use of sali- cylic acid, the following formula being applied night and morning for several days, after which the part should be well soaked in hot Avater, Avhen the entire corn Avill readily come away, or in some cases several attempts will be necessary : R— Acid, salicylic............gr. xxx (2.0). Extract, cannab. indica?.......gr. x (0.65). Collodii....._.........f gss (16.0).—M. S.—Apply with a camel's-hair brush. The same acid may be used in alcohol, and lactic acid in the same proportion is often of service. In the so-called "soft corns," Avith much inflammation, the foot 510 DISEASES. should be washed and dried, and a saturated solution of nitrate of silver, 60 grains (4.(1) to 2 drachms (8.0), applied to the part every four or five days. v CORYZA (ACUTE). The treatment of coryza of the acute variety, the form which most frequently presents itself to the physician for relief, is followed in many instances by such marked amelioration of the symptoms and shortening of the attack as to encourage medical interference. It must be remembered, however, that the duration of the condition before the patient presents himself has much to do Avith the progno- sis, for if the tissues of the nasal chambers have become boggy and swollen with exudation recovery must be more prolonged than if rem- edies are applied in the early stages of the catarrhal process. The treatment locally consists in the following measures for relief: By means of a medicine-dropper or an atomizer a few minims of a 4 per cent, solution of cocaine are dropped into the nostrils, the patient's head being Avell tipped back. After the peculiar constringing influ- ence of the cocaine has shrunken the congested mucous membrane, so that the patient can draw air through the nostrils, the nasal cham- bers should be Avashed clean of mucus by means of the following lotion in an atomizer: R.—Sodii chloridi............gr. xv (1.0). Acid, boric..............gr. x (0.65). Sodii borat..............gr. x (0.65). Aqua? dest..............fgiij (96.0).—M. The parts being thoroughly cleansed, a fine spray of the following should be used as antiseptic, sedative, anaesthetic, and protective: R.—Menthol.............gr. viij (0.5). Camphor.............gr. v (0.3). Albolene.............f£j (32.0).—M. In this prescription the menthol exerts an ansesthetic effect, and pro- longs the constriction of the parts produced by the cocaine, so avoid- ing the secondary capillary dilatation due to that drug. The camphor exercises its well-knoAvn soothing influence, and the albolene protects the membrane from dust and irritants. If the congestion has a tend- ency to return, it is well to use a solution of antipyrin, 2 to 4 grains to the ounce (0.1-1.2 : 32.0) of Avater, as a spray to prolong still further the effect of the cocaine. The albolene spray should folloAv, not pre- cede, the antipyrin, as the oil Avould prevent the antipyrin from acting. Under no circumstances should the antipyrin be used without the cocaine preceding it, as the pain is too severe. The internal treatment consists in the very beginning of the attack in the use of the formula for this purpose composed of belladonna, camphor, and quinine, and recommended in the article on Camphor. A hot foot-bath, Avith mustard in it, and the taking of a hot drink, such as lemonade with whiskey in it, on going to bed, are useful. Often 20 or 30 drops (1.3-2.0) of sweet spirit of nitre added to this drink CROUP, SPASMODIC. 511 will increase its diaphoretic effect. In other cases, particularly in strong, hearty men, 5 to 10 grains (0.3-0.65) of Dover's powder at bed-time will be better. This line of treatment is of little value after secretion has been fairly established, and in its place supportive meas- ures are indicated. Small tonic doses of quinine, 2 to 4 grains (0.1- 0.2) three times daily, sometimes combined Avith the use of 5 to 10 grains (0.3-0.65) of chloride of ammonium, as prescribed in the article on Bronchitis, are useful. Where much headache is present full doses of the bromide of potassium or sodium are to be given, and the spray treatment already named is to be persisted in while the attack lasts. CROUP. (See Diphtheria.) CROUP (SPASMODIC). As this is a spasm of the glottis depending for its causation upon catarrh of the mucous membrane of the larynx, and as it is due most commonly to some reflex irritation, such as dentition, indigestible food, or sudden atmospheric changes, the treatment is both prophy- lactic and curative. Prophylaxis consists in the avoidance of cold, the use of a simple diet, particularly at the evening meal, the render- ing of the air of the bedroom moist by means of steam or at least by the avoidance of dust-laden, furnace-heated air, and by the removal of dental irritation and nasal hypertrophies, which make the child a "mouth-breather." Small doses of the bromides, chloral, belladonna, or opium may be resorted to at bed-time. A very useful prescription for this purpose is that Avhich folloAvs: R.—Sodii bromidi............£j (4.0). Syrupi lactucarii.........i%'\} (64.0).—M. S.—Teaspoonful to a dessertspoonful (4.0-8.0) on going to bed, and once or twice dur- ing the night if needed. When the attack is present a cold cloth should be wrapped about the neck and the child placed at once in a hot bath, the air of the room being moistened by the steam escaping from a kettle of boiling water or by pouring Avater upon unslaked lime. If the paroxysm is very severe, a few whiffs of amyl nitrite may be employed, or anti- monial wine in the dose of 2 drachms (8.0) may be used to cause vom- iting. It is also useful to disseminate the fumes of menthol through the air of the room by heating some crystals in an iron spoon. If the fumes are strong enough to produce a distinct odor, they are present in sufficient amount. The drugs first named do good by decreasing reflex excitability, while the emetics indirectly relax the spasm by the nausea and depression which they produce. 512 DISEASES. CYSTITIS (ACUTE). If, by reason of exposure to cold, injury, the introduction of for- eign bodies, such as dirty catheters, or the presence of gonorrhoea or other disease due to a septic poison, an acute inflammation of the bladder ensues, it is accompanied by a sensation of Aveight and ves- ical fulness, by pain, tenesmus, and inability to retain the urine. Sometimes the last-named condition may be reversed and retention of the urine be present. If the general system responds to the local inflammation, as evi- denced by increased arterial excitement and fever, aconite in full doses of the tincture should be used, and it should be combined with small amounts of sweet spirit of nitre and citrate of potassium, as follows: R.—Tinct. aconiti.............f^j (4.0). Spirit. a?ther. nitrosi..........f.3j (32.0). Liquor potassii citratis.....q. s. ad f^vj (192.0)—M. S.—Dessertspoonful (8.0) every four hours until all fever ceases and ihe pulse is quiet. At the same time a hot compress should be applied over the blad- der, but it should not contain turpentine or any irritant substance Avhich may be absorbed from the skin and when eliminated by the kidneys irritate the bladder-walls. Leeches may be placed upon the perineum or cups applied to the region of the sacrum. In some cases belladonna may be used with or without aconite in the dose of 5 to 10 drops (0.65) of the tincture three times a day, and it is worthy of note that this drug is particularly serviceable in the cystitis due to cold; 5 drops of liquor potassa every four hours may be substituted for the citrate of potassium, or the acetate of potassium may be used. If there is much pain and bearing-doAvn, an enema of 30 drops (2.0) of laudanum in 2 ounces (64.0) of starch-Avater may be employed, or the opium may be given in suppository. Sometimes a belladonna suppository is of more service, and an iodoform suppository will often relieve the pain by its local anaes- thetic effects. Hot enemata, without any drugs, are often valuable as a means of relief, and a hot sitz-bath is very efficacious. Can- nabis indica, if an active preparation can be had, is better than opium to relieve the pain, since it seems to affect the bladder favorably. The other curative measures are hygienic, and consist in the main- tenance of the recumbent posture, absolute physical and mental rest, the avoidance of all foods Avhich are stimulating, as rare meats and highly-seasoned dishes, and abstinence from all varieties of alcoholic beverages. Should the inflammation be severe enough to become purulent, the physician should order salol in the dose of 10 grains (0.65) three times a day. This drug, being broken up in the boAvel into carbolic acid and salicylic acid, is so eliminated that it renders the urine anti- septic. Laxatives are to be employed Avith persistence if the boAvels are CYSTITIS, CHRONIC. 513 confined, and salines in the early stages are generally better than vegetable purges. Quinine should not be used against the fever, as it is contraindi- cated, OAving to its irritant effects upon the bladder. CYSTITIS (CHRONIC). The treatment of chronic cystitis is entirely different from that of the acute form, and consists in the use of remedies which will stim- ulate the diseased mucous membrane, cause a normal secretion of mucus, and so influence the urine that the mucus already formed will be passed out and the fluid rendered alkaline or acid, as may be desired. When the secretion of mucus in large amount is persistent, the urine should be rendered alkaline by the use of liquor potassa or the citrate. The bitartrate of potassium, unlike the other vegetable salts of potassium, such as the acetate or bicarbonate, is eliminated as the bitartrate of potassium, and, as it is acid, cannot be employed. We acidify the urine Avhen it is necessary to dissolve the phosphates and to prevent deposits in the bladder and elsewhere. The tAvo best drugs for this purpose are boric acid in the dose of 5 to 10 grains (0.35- 0.65) or benzoic acid in the same amount. Both of these may be given in pill form, made by adding a little glycerin. The rule may be laid doAvn that if the urine is high-colored and is strongly acid, alkalies are useful; Avhereas if it is light in color, but loaded with phosphates, the acids named should be employed. Salol may be given to prevent de- composition of the urine. One of the best measures for the relief of chronic cystitis is to irri- gate the bladder daily Avith pure Avarm water or Avater containing bichlo- ride of mercury in the proportion of 1 : 10,000, as this washes away all mucus and uric-acid deposits and prevents irritation. Solutions of nitrate of silver have been used with great success Avhere the urine is muco-purulent, and Thompson recommends the use of a solution of the strength of 1 grain to 4 ounces (0.05 : 128.0) of water, gradually increased to 2 grains to the ounce (0.1 : 32.0). Others, such as Gard- ner, Richardson, and Potter, recommend the use of stronger solutions, 5 grains to the ounce (0.35 : 32.0) of water, claiming that while these amounts may produce serious effects in some instances, they are very efficacious in obstinate cases. The physician should have at hand a solution of common salt, Avhich he should inject into the bladder at once if the effect of the silver solution is too painful or seems excessive. This treatment is only suited to the most chronic cases. The remaining remedies which are employed internally in chronic cystitis are those Avhich are directed to the improvement of the mucous membrane of the bladder, and consist of buchu in the form of the fluid extract in the dose of J to 1 drachm (2.0-4.0), well diluted; arbutin or ursin, 3 to 5 grains (0.25-0.35); or the fluid extract of uva ursi. dose 30 drops to 1 drachm (2.0-4.0). All of these are better fitted for the treatment of subacute than chronic cystitis, as they are, not sufficiently active for the chronic forms. 33 514 DISEASES. In cystitis of a very chronic type, Avith great vesical atony, strych- nine is of service, and drop-doses of tincture of cantharides do great good. Turpentine may also be used Avith advantage in 5- to 20-drop (0.3-1.3) doses, as may also the oils of eucalyptus, sandalAvood, cubebs, and copaiba. All these measures are suitable for the treatment of cystitis in the male and female, but it is to be noted that injections into the female bladder are made much more readily than into that of the male, because of the shortness of the female urethra. In either case the operation is best performed by attaching a small funnel to a soft-rubber catheter and filling the bladder by raising the funnel when full of Avater above the patient's belly. Creolin has been highly recommended by Parvin in the strength of from 1 to 2 per cent. Avith water. The irrigation is to be performed every twenty-four hours. DIABETES INSIPIDUS. Diabetes insipidus exists simply as a profuse urinary flow dependent upon some disorder of the innervation of the kidney or upon atony or relaxation of this organ. Its treatment consists in the use of astringents and tonics, and in some cases in the employment of opium or bella- donna, particularly if the over-secretion rests upon nervous irritability. Gallic acid may be used in 20-grain (1.3) poAvders three times a day, and the fluid extract or Avine of ergot is often of service given in the dose of 30 drops to a drachm (2.0-4.0) of the former or a wineglassful (32.0) of the latter. As tonics the sulphate of iron and strychnine are indicated. DIABETES MELLITUS. In the treatment of this affection it should be remembered that it is the result of disordered function, and is not a disease in itself, but a symptom of several disease-processes. For this reason a remedy which succeeds in one case may fail in another. The treatment of diabetes mellitus is dietetic and medicinal. The diet-list should consist largely of meat, particularly of meat with fat attached to it, as the fat, to some extent, takes the place of starch in the nutrition of the body. The avoidance of starches of all kinds and the use of dry wines or those containing little or no sugar are to be insisted upon. Beers and malt liquors must be forbidden. According to some authorities, the patient should be placed in bed and put on a purely milk diet, generally of skimmed milk, although buttermilk is better than any other form, OAving to its lactic acid and lack of sugar. Koumyss for the same reason is very valuable. The chief aim of the patient must be to avoid all substances which can be readily converted into sugar by the organism. The following list of foods and drinks may be taken, and the second list forbidden :l 1 It is worthy of note that certain persons having a slight glycosuria without serious injury, waste under a limited diet, and require ordinary fare to support the body plus the diabetic drain. DIABETES MELLITUS. 515 Meats of all kinds (except liver), eggs, fish, cheese, butter, and cream; oyster-plant, asparagus (?), tomatoes, almonds, pecan nuts, butternuts, Avalnuts, and cocoanuts; string-beans, beet tops, radishes, mushrooms, lettuce and Avater-cress, cauliflower, spinach, and onions. Celery and cucumbers may also be permitted. Of the foods and drinks to be avoided, Ave have all forms of sugar, all forms of starch, such as ordinary flour, cornmeal, arrowroot, sago, tapioca, oatmeal, barley, carrots, beets, parsnips, pie-plant, peas and beans, chestnuts, and most of the fresh fruits, cider, beers, champagne, SAveet Avines, and honey. The treatment of diabetes by drugs is varied by the condition of the patient, the cause of his disease, and the quantity of sugar in the urine. While the drugs most commonly employed are used in many instances Avithout any knoAvledge of hoAv they act, and have each of them a set of Avarm supporters among prominent authorities, much of the treatment must depend upon Avhether or not a rheumatic or gouty taint is the cause of the trouble, or whether it is due to high living, little exercise, producing a plethoric, congested, overloaded system. In the first class of cases iodide of potassium and the salicylates will be most serviceable; in the second class, a restricted diet, moderate exer- cise, and purgation to relieve engorgement of the hepatic and gastric veins may be needed. In the cases of gouty diabetes, where relief does not follow the use of the iodides and colchicum, resort must be had to arsenic and lithium citrate or carbonate, a combination pecu- liarly adapted to such a condition, according to several authorities. Indeed, arsenic is a sheet-anchor Avith many practitioners in all forms of diabetes, and should be given in fairly large, constantly-repeated doses for a long time. A very much larger body of medical men rely on opium or one of its alkaloids, such at morphine or codeine. The former is used in the dose of \ to \ grain (0.015-0.03) three times a day; the latter, 1 to 5 grains (0.05-0.3) three times a day, and the writer has found them very useful. The morphine is by far the most powerful for good. Patients who are diabetic must take large ascend- ing doses of opiates, which they bear very well. The chloride of gold and sodium (A^ grain [0.006]) has been highly recommended by Bar- tholow, and ergot by Wood and DaCosta. In cases depending upon rheumatism the use of salicylic acid is often of great value, the dose being 10 to 15 grains (0.65-1.0) three times a day. In cases of diabetes in which diet will control the disease the best clinicians insist that drugs should be avoided, for Avhen opium or any of its alkaloids are used it is necessary to give rapidly-increasing doses, which finally become enormous, as much as 7 grains (0.6) of morphine a day being taken by some persons. Once having begun the use of drugs in severe cases, it is very dangerous to stop them, for clinical experience has shown that many of these patients Avaste rapidly and generally break doAvn when this is done. In regard to the time of day at which to give the morphine or codeine, they are gen- erally given about one hour after meals. Under these circumstances the drugs seem to decrease diuresis more than if the dose precedes the meal; further than this, the stomach is not disordered. In some 516 DISEASES. cases results Avill be obtained from opium Avhen its individual alka- loids fail. Careful observation of the patient should be carried out to determine the proper beginning and subsequent doses, and if at first the opiates fail to give relief, discouragement should not be felt. Jambul is a remedy Avhich has been widely used by clinicians for the relief of diabetes with such varying results that its position in therapeutics is uncertain. This is probably because it is effective in one form of diabetes and not in another, and we are unable to make the clinical distinction. Jambul is used in powder or the powder is placed in capsules or pills. The dose is 5 to 30 grains (0.3-2.0) once to thrice daily, and gradually increased. As much as an ounce (32.0) has been given in tAventy-four hours. This medicament is said to be advantageously combined Avith a pure meat diet in diabetic cases. The excessive thirst of diabetes can be best allayed by the use of acidulated water or alkaline waters containing non-purgative salts. It is useless to cut off the water-supply, to the production of great suffering, but the patient should use moderation in drinking so far as possible. The wasting coming on in diabetes is to be treated by careful diet, rest, and the supply of all the food which the patient can digest. In many instances the amount of aliment ingested is extra- ordinarily large, while in others digestion is so impaired that food cannot be taken. If cachexia comes on, iron, strychnine, bitter tonics, and the lacto- phosphates of lime and sodium are to be used to support the circulatory and nervous systems. Tea and coffee and all forms of food needing sAveetening may be rendered palatable by the use of saccharin or of glycerin. The former passes through the body unchanged; the latter increases the glycogen in the liver, but checks the formation of sugar (Ransom). Unfortunately, Ave have no positive knoAvledge as to the minute and innermost causes of diabetes, and in consequence cannot ex- plain the manner in which opium, codeine, or other drugs produce relief. Diabetic coma is a most dangerous complication of this disease, and should be treated as actively as our knowledge of its cause per- mits. It is thought by some that the symptoms are entirely dependent upon the presence in the blood of oxybutyric acid, and that hypo- dermoclysis or the intravenous injection of normal saline solution (7 : 1000) should be resorted to. Stadelman insists upon the employ- ment intravenously of 150 cc. of normal salt solution to which 7.2 gm. of sodium carbonate and 4.6 gm. of sodium bicarbonate have been added. The injection is continued until the urine is alkaline. Unfortunately, the statistics of this method of treatment are not good so far as permanent recovery is concerned, but some form of transfusion should be used. (See Transfusion.) Hypodermic injections of ether should be resorted to to support the heart. DIARRHCEA AND DYSENTERY. 517 DIARRHCEA AND DYSENTERY.1 Diarrhoea is a term loosely applied, perfectly correctly, to all forms of intestinal disturbance accompanied by the passage of liquid stools, and its meaning, "to run through," expresses the state it repre- sents. The treatment of each form of diarrhoea depends upon its cause, and no case can be intelligently treated in Avhich the physician fails to recognize this aspect of the case. Diarrhoea is but a symptom, not a disease, and must be regarded solely as an evidence of intestinal disorder. While the same drugs are prescribed in many forms of the trouble, we may divide cases of diarrhoea into four classes, as follows: (a) Those in which the laxity is due to a catarrh, acute or chronic, of the intestinal mucous membranes, causing the passages to contain mucus; (b) those where, owing to disordered innervation, a profuse outpouring of liquid takes place from the blood-vessels into the intestinal lumen; (c) those in which, OAving to disease, the glands fail to prepare juices to digest the food properly ; and, finally (d) those cases Avhere ulceration causes irritation and bloody purging. The treatment of the catarrhal form first named consists primarily in the regulation of the diet, Avhich should be made up chiefly of milk, boiled or predigested, or of milk whey, and in the administration of castor oil or other mild purge, such as sulphate of magnesium, to SAveep out fermenting food and mucus. Enough laudanum should accompany this oil to prevent griping, and it is Avell to add bicarbon- ate of sodium, grains 20 to 30 (1.3-2.0) to the dose, both to aid the action of the oil and to render the boAvel alkaline in reaction (normal) instead of acid, as caused by the fermentation abnormally present. A mustard plaster or other counter-irritant should be applied to the abdomen. Often in the milder forms of mucous diarrhoea this is all that is needed, but more frequently it must be followed by the use of tonics and astringents, such as nitrate of silver and hyoscyamus, in the following pill: R.—Argenti nitratis...........gr. ij (0.1). Extract, hyoscyami.........gr. v (0.3).—M. Ft. in pil. No. x. S.—One three times a day. Or, R.—Plumbi acetatis...........gr. ij (0.1). Extract, opii............gr. ij (0.1).—M. Ft. in pil. No. x. S.—One three times a day. If these stop the diarrhoea, yet there still seems to be a tendency for it to return or atony is present, we should use a pill containing the extract of chiretta or employ nitromuriatic acid, or, better still, dilute nitric acid and compound tincture of cardamoms, because the con- 1 The articles on Cholera, Cholera Morbus, and Cholera Infantum should be care-> fully read in connection with this article. 518 DISEASES. stant tendency to relapse indicates a deficient secretive action on the part of the intestinal glands, which these remedies are prone to improve: R— Acid, nitric, dil...........f5J.(4-°h Tr. cardamomi comp.........foij (64.0>. Tr. gentian, comp..........i'sij (64.0).—M. S.—Dessertspoonful (8.0) every four hours. If the catarrhal state is persistent, no remedy compares to the chloride of ammonium, dose 5 grains (0.3) every four hours in liquorice and water. Where the catarrhal state is exceedingly chronic and obstinate it is well to employ 3- to 5-grain (0.15-0.3) doses of potas- sium iodide. If the pills already named do not control the diarrhoea, and the discharges are so profuse as to weaken the patient very greatly, the following prescription may be used to check the movements, but not to stop them completely : R.—Acid, sulph. aromat.........f^jss (6.0). Spt. chloroformi..........f.^ij (8.0). Tr. opii camphorat.........f.^ij (64.0). Syr. zingiberis........q. s. ad fjiv (128.0).—M. S.—Dessertspoonful (8.0) every two hours. Or, R.—Tr. kino..............f.^j (32.0). Tr. catechu comp..........f^j (32.0). Misturae creta?...........f^iij (96.0). Aquae cinnamomi......q. s. ad f^vj (192.0).—M. S.—Shake well before using. Tablespoonful (16.0) every three hours. In many cases where the condition of mucous diarrhoea becomes chronic it is necessary to resort to enteroclysis (Part III.) and the treatment needed in cases of chronic intestinal catarrh. (See Diar- rhoea, Chronic.) In the second form of diarrhoea named—that in which serous or watery purging is present—the treatment is radically different. In these cases the blood-vessels of the gut are relaxed and leaking, and must be contracted and made Avater-tight. This dilatation may result from fear ("nervous diarrhoea"), from exposure to cold, or from exhaustion, extreme heat, and irritant food. If from irritant foods, they are generally swept out in the first flush of liquid. The measures to be adopted consist in those directed to the con- traction of the dilated and relaxed blood-vessels and the restoration of the proper nerve-supply to the parts. As the splanchnic nerves are the vasomotor nerves of the intestine as well as the inhibitory nerves of peristalsis, it is evident that Ave must use drugs Avhich will cause stimulation of these fibres, and the chief of these is found to be opium, which diminishes intestinal peri- stalsis and secretion by just such an influence. In the same way small doses of volatile oils are of service, and camphor and spirit of chloroform may be used. As there is relaxation, astringents are indi- cated ; and as sulphuric acid is not only astringent, but eliminated by the lower bowel, it is peculiarly serviceable. We find, therefore, that the following prescription fulfils every indication: DIARRHCEA AND DYSENTERY. 519 R.—Acid, sulph. aromat.........f^ss (16.0). Olei cajuputi...........gtt. xl (2.65). Ext. ha?matoxyli fl........fgij (8.0). Spt. chloroformi.........fzj (4.0"). Syr. zingiberis.......q. s. ad fgiij (96.0).—M. S.—Teaspoonful (4.0) in water every two or three hours. If desired, kino or catechu may be used in lieu of the hsematoxylon, or the oil of cloves substituted for that of cajuput. Camphor or pare- goric may also supplant these drugs. In some instances these attacks appear to depend upon hepatic disorder, and the only cure, aside from partial relief, is to be obtained by the use of 2 to 6 grains (0.1-0.35) of mercury with chalk (hydrar- gyrum cum creta) or calomel, ghren in i to J grain (0.01-0.03) doses. What is said of intestinal disorder from lack of secretion under the head- ing of Cholera Infantum applies very forcibly to these cases, and diar- rhoea may persist for Aveeks, or only temporarily be held in check by the most poAverful drugs, until the physician thoroughly flushes the intestine Avith bile by the use of podophyllin and calomel. Wood has highly recommended the use of a bismuth powder con- taining a drop or two of carbolic acid. For the purpose of establishing intestinal antisepsis, carbolic acid may be used, and naphthalin, thymol, and other drugs of this class have been employed, particularly salicylic acid. None of them com- pare Avith carbolic acid, however, which should be used in 1-drop (0.05) doses on bismuth or in Avater. When the carbolic acid is given to a child, it is best prescribed in such a way that in each teaspoonful a half-drop is present. This teaspoonful of liquid should be placed in a tablespoonful of wTater. In other cases sulphocarbolate of zinc in the dose of from 1 to 4 grains (0.05-0.2) in powder or capsule is beneficial. Salol combined Avith chalk mixture may also be advan- tageously used. (See prescriptions under Salol.) Sometimes a good-sized, brisk purgative dose of calomel followed by a saline does good in these cases if they are strong enough to permit of its use. The regulation of the diet, Avhich should consist in sterilized milk or koumyss, the former being predigested, is of the greatest import- ance. Should the patient be a bottle-fed baby, the proportions of the milk, water, and cream placed in the bottle should be varied until a mixture is formed Avhich is exactly fitted to the digestion of the case. The after-treatment consists in the use of tonics and a carefully regulated diet, Avhich should be largely composed of milk and milk foods. The third class of cases consists chiefly of children who pass foetid, " mousy "-smelling stools in summer diarrhoea, Avith green, spinach-like masses of semi-digested food or distinct lientery. They may be due to deficient glandular action in any part of the alimentary canal, and are often cured by the use of pepsin and hydrochloric acid to aid the gastric processes. In other instances the duodenum is at fault, and should be stimulated by small doses of nitromuriatic acid, or by podo- phyllin in the dose of -^ to ^ of a grain (0.001-0.0015), Avith a little 520 DISEASES. milk-sugar, or given in alcoholic solution. Similarly, ipecac in poAv- dered form may be used in the dose of £ to £ a grain (0.015-0.03) three times a day. In the case of children who are often sufferers from rickets, phosphate of sodium, lime salts, and common salt should be freely given. (See Cholera Infantum.) The fourth type, generally knoAvn as dysentery, is due in some cases to hepatic trouble, in others to the drinking of impure water, and in the third place to exposure to heat and the use of bad food. It is in most cases a very obstinate form of diarrhoea, requiring much skill and patience for its cure. In the chronic forms deep ulcers may exist; even in the milder cases a high inflammation is often present. In those cases which are due to exposure to heat and hepatic trouble there are two remedies Avhich are far above all others in value and should always be resorted to. The first of these is sulphate of magnesium with sulphuric acid ; the second is calomel. The magnesia should be used in a special manner to be effective (see Magnesium Sulphate), and the calomel should be used in full purgative amounts, but is contraindicated if much Aveakness is present. If the passages are slimy and bloody, ■%$-$ of a grain (0.0003) of bichloride of mercury every hour or two is of service, and if much blood is present high rectal injections of the distilled extract of hama- melis and Avater half and half are of value. In some forms of dys- entery due to acute inflammation large enemata of iced water are of the greatest value. The water should be ice-cold, and at least a quart injected by hydrostatic pressure. This method can only be used in strong persons, and is very useful in that it also aids in reducing any fever which may be present. The folloAving mixture may be injected into the bowel in place of cold water in feeble cases: R.—Sodii boratis........, . . . ^j (4.0). Tinct. benzoin............fgj (4.0). Spt. camphora?...........ffj (32.0). Aque? ferventis...........Oij (1 litre).—M. If the ulcers are very old and chronic, nitrate-of-silver injections of the strength of 10 to 20 grains (0.65-1.3) to the pint (500 cc.) of water may be employed in large bulk, a salt solution being at hand for the destruction of the silver salt if the local action Avhich ensues is too severe. Recently the injection of Avater or medicaments into the boAvel for the purpose of influencing the intestinal Avail has given way in the hands of prominent physicians to irrigation by means of an inlet and outlet tube. The inlet tube should be attached to a fountain syringe, and the outlet tube be long enough to reach to a vessel by the side of the bed and of sufficient calibre to carry off flaky mucus. In manv cases of dysentery of a mild form rectal irrigation will suffice, but if the entire colon is involved larger injections are necessary. The irrigation should be continued until the returning fluid becomes perfectly clean and free from foreign particles. If the bowel move- ments are very frequent, the injections may be made every three hours. Probably the best solution to employ for irrigation Avhere DIARRHCEA, CHRONIC. 521 much mucus and pus is present is one composed of bichloride of mercury, 1 : 5000. When this is used, a pure Avater injection or one of 1 : 30,000 should folloAv it, in order to prevent absorption of the mercury into the system. If for any reason the effect of the bichlor- ide is feared, boric acid may be used in "the proportion of 1 drachm (4.0) to the pint (500 cc), or 15 grains (1.0) of sulphocarbolate of zinc added to 1 quart (1 litre) of hot water be injected. If the dys- entery is due to the amoeba coli large rectal injections of a solution of quinine in the proportion of 1 to 3000 should be used, as this drug destroys that organism. (See Enteroclysis in Part III.) Tannic acid is an intestinal antiseptic, and can be employed in the strength of 1 drachm to the pint (4.0 : 500 cc.) for irrigation purposes. DIARRHCEA (CHRONIC).1 This is one of the most obstinate conditions Avhich the physician is called upon to treat. It may be due to nervous irritability of the bowels, so that the entrance of food or drink sets up an excessive peristalsis which so hurries the food and drink through the alimentary canal that digestion and absorption are only partly performed. Chronic diarrhoea may also be due to chronic intestinal catarrh, to ulcerations of the small or large intestine, as after typhoid fever, or to rectal dis- ease, wThich reflexly causes hyperperistalsis. Fissure of the anus often causes persistent diarrhoea by reflex irritation. In those cases due to hyperperistalsis an advantage is often gained by directing the patient to take as little liquid as possible, particularly at meals, and to avoid coffee or other stimulants to reflex activity. Highly-seasoned foods are also to be avoided. Meats should be preferred to vegetables, and an absolute peptonized milk diet may be ordered, the milk being given in tablespoonfuls every feAv minutes, rather than in large amounts, at meal-times if the patient will remain in bed. Counter-irritation, con- stant and as severe as the patient can stand, should be used over the abdomen. Suppositories and rectal injections seldom benefit this class of cases, but a pill composed as follows may be useful: R.—Argent, nitrat.........gr. iv (0.2). Ext. hyoscvam........gr. x vel xxx (0.65-2.0). Ext. opii *..........gr. ij vel iv (0.1-0.2).—M. Ft. in pil. No. xx. S.—One one hour before a meal. In other instances some of the astringent prescriptions given under the article on Diarrhoea are better than the above. In the cases due to ulcers of the rectum injections of nitrate of silver 2 grains to the ounce (0.1 : 32.0) are of value, particularly if followed by a 5- or 10- grain iodoform suppository. Operative procedure against anal fissure will often cure a diarrhoea due to this cause. The cases due to intes- tinal catarrh are benefited by the use of full doses (5 to 20 grains [0.3-1.3]) of bicarbonate of sodium by the mouth and the use of 1 Eead with this article those on Diarrhoea and Dysentery and Enteroclysis. 522 DISEASES. iodoform suppositories, Avhich not only relieve the rectal irritation nearly always present, but exercise the peculiar effects of iodine upon the catarrhal process. In cases of so-called morning diarrhoea absti- nence from liquids before going to bed the night before and a very dry and small breakfast are to be strongly recommended, with rest in bed during the morning hours. Rockbridge Alum Avater, Avhich contains iron and alum, is useful in cases of diarrhoea writh anaemia. DIPHTHERIA AND MEMBRANOUS CROUP. Diphtheria is at first a distinctly local disease, the membrane in the throat forming a nidus from Avhich the entire body ultimately becomes poisoned by the micro-organism peculiar to the malady. While it is true that in some cases of membranous pharyngitis or laryngitis the true Klebs-Loeffler bacillus cannot be found, it is a fact that all cases should be treated identically as if they were true diphtheria. The best local application to the throat is peroxide of hydrogen. A cotton swab should be soaked with the undiluted 10 or 15-volume solution and pressed against the mucous membrane which is diseased, or, if this cannot be done, a spray, from a glass atomizer, of the strength of 1: 4 of water may be employed. The effect is often extraordinary. After a few applications the false membrane appears to exist only in disor- ganized shreds. If the nasal chambers become affected, a solution of ordinary salt (7:1000) should be used in a spray or by means of a fountain syringe.. The child is placed with its hips on the lap of one nurse and its head on the lap betAveen the knees of another, the dress of the nurse being protected by a rubber sheet, and the nasal cavities irrigated. The position of the child should be on its side, not on its back, and the face should be turned doAvn sufficiently to allow the liquid to freely escape, the child breathing through its mouth. The applications should be made as frequently as the membrane forms. Mercury is very useful in full doses in diphtheria in sthenic per- sons, and the bichloride may be given by the mouth in doses of ^ grain (0.0013) every hour until the stools are loose or signs of ptyal- ism appear. Tincture of the chloride of iron, quinine, and strych- nine are of service to keep the kidneys active, to stimulate the heart and respiration, and to support the vital forces. The dose of the tincture of iron may be as much as 2 drops (0.1) every hour to a child of four years. The food of a child during an attack of diphtheria should be plentiful and consist of pancreatized and sterilized milk. It is best to use throat applications before giving the food, in order to avoid vomiting. A method of using turpentine by inhalation is highly recommended by J. Lewis Smith. The following prescription is placed in Avater in the proportion of 2 tablespoonfuls (32.0) to a quart (1 litre), and this mixture is then placed on a gas or oil stove in a broad open vessel and allowed to boil constantly. The air of the sick-room is soon laden with the vapor, Avhich is not offensive. The prescription is as follows: DIPHTHERIA AND MEMBRANOUS CROUP. 523 Spt. terebinthina?.......... fgviij (256.0).—M. S.—Use as directed. Label: Poison if taken internally. In other cases there is no doubt that calomel by sublimation does great good. The child is placed in a bronchitis tent and from 3 to 5 grammes of calomel are placed in a sublimator and vaporized into the air the child breathes. When the glands of the neck threaten to suppurate, ice-bags should be applied to the throat and pieces of ice held constantly in the mouth, while the tincture of iron is pushed in as full amounts as possible. If suffocation is imminent, inhalations of oxygen are to be used and atropine or strychnine employed, but tracheotomy or intubation is usu- ally the safer plan of treatment. Chlorate of potassium must never be given internally, as the kid- neys are already severely inflamed, and this drug is not only useless when so given, but is in addition a renal irritant. Although the author has been criticised for this last statement, he is convinced of its truth; and that he is not in error is proved by the fact that no less eminent authorities than H. C. Wood and J. LeAvis Smith agree Avith him. Antitoxin Treatment.—This treatment supplants all others in effi- cacy and usefulness, and should displace all other plans of treatment Avhen it can be used, except the local applications. Of all the extra- ordinary advances made in pathology and therapeutics, the introduction and proof of the value of antitoxin in cases of diphtheria is perhaps most worthy of note. (For the study of Antitoxin itself see Antitoxin in Part III.) There are several facts in connection with the use of the diphtheritic antitoxin which should be borne in mind. The syringe for injecting it should have a glass barrel in order that any foreign bodies or air-bubbles can be seen and removed before the injection is given. The packing of the piston should be made of asbestos or rubber, since it is practically impossible to sterilize leather or other packing, and the different parts of the syringe should be easily disjointed in order to permit thorough cleansing and sterilizing. Immediately before and after the use of the syringe the needle should be removed and the cap taken off so that the sterilizing fluid may readily enter the syringe and needle, and then they should be placed in warm water Avhich is brought to the boiling- point. By this gradual heating we avoid the breaking of the glass barrel. It is best to employ one of the syringes made for the purpose noAv being described. The injection is to be given slowly during a period of several minutes into any part of the body -which has loose subcutaneous tissues, such as the broad of the back, the side of the abdomen, or the outside of the thigh. The skin at the place of injection should be thoroughly sterilized beforehand, and after the injection the fluid should be alloAved to diffuse itself and not be spread by rubbing. The following are the recommendations as to the manner of using diphtheria antitoxin made by the American Pediatric Society: " Dosage.—For a child over tAvo years old the dosage of antitoxin should be, in all laryngeal cases with stenosis and in all other severe 524 DISEASES. cases, 1500 to 2000 units for the first injection, to be repeated in from eighteen to tAventy-four hours if there is no improvement; a third dose after a similar interval if necessary. For severe cases in children under two years, and for mild cases over that age, the initial dose should be 1000 units, to be repeated as above if necessary; a second dose is not usually required. The dosage should ahvays be estimated in antitoxin units, and not in the amount of serum. "Quality of Antitoxin.—The most concentrated strength of an ab- solutely reliable preparation. " time of Administration.—Antitoxin should be administered as early as possible on a clinical diagnosis, not waiting for a bacteriological culture. However late the first observation is made, an injection should be given unless the progress of the case is favorable and satis- factory." The dose of antitoxin serum is to be judged by its knoAvn strength or power of conferring immunity and by the severity of the disease and the susceptibility of the patient. At present the common dose of the ordinary antitoxin serum of Parke, Davis & Co. is 1 to 5 cubic centi- metres. It has been urged against serums containing over 250 units per c.cm. that their use is apt to be followed by untoward effects such as skin eruptions and local irritations. On the other hand, if the Aveaker serums are employed such large amounts have to be given that very considerable swelling of the area in which the injection is given is pro- duced, and of course a large amount ot valuable time is lost before the whole dose is absorbed; whereas if serums containing high immu- nizing poAver are employed the small dose is quickly absorbed. In pressing cases of nasal or laryngeal diphtheria the stronger serums are indicated, Avhereas in the more moderate cases the lower grades of strength may be used. The general trend of professional opinion the world over is strongly in favor of the use of antitoxin in diphtheria. So far there have been published an immense number of reports and statistics concerning its use. Of these, two in particular are so exhaustive as to be conclusive. One gives the statistics of the mortality of diphtheria Avith and without an- titoxin in hospital practice, the other the results in private practice. Thus in hospitals Welch shows that out of 7166 cases treated with anti- toxin only 17.3 per cent, died, Avhereas under the old treatment it is calculated that 42.1 per cent, would have died. Again, in Paris dur- ing one epidemic 300 cases were treated with serum Avith a mortality of 26 per cent., while in another hospital in which no serum Avas employed the mortality dnring the same period Avas 60 per cent. In another in- stance, that of Baginsky, the mortality of one epidemic, which Avas 15.6 per cent, during the use of antitoxin, increased to 48.4 when no antitoxin could be had. The report as to the results in private practice, compiled by the American Pasdiatric Society in 1896, shows that in 5794 cases the mortality Avas only 12.3 per cent., although 218 cases were moribund when the antitoxin was used or died within tAventy-four hours there- after. The statistics also show that the frequency of laryngeal diph- DROPSY. 525 theria is decreased by the use of antitoxin, and that the mortality of cases Avhich have been intubated or tracheotomized is decreased by its use. Again the use of the serum decreases the time in AA'hich the tube must be retained in the throat. The collective report made by the same society in 1897 sIioaa-s that the percentage of recoveries in laryngeal diphtheria is now 73 per cent. as against 27 per cent, before antitoxin Avas used. When the antitoxin is given general improvement usually takes place in tAventy-four to forty-eight hours, and the temperature falls. The spread of the membrane is arrested and its separation soon begins. The chief gain from its use is to be obtained very early in the dis- ease, for after degenerative changes have taken place in the heart and kidneys the damage is done. The dose should be repeated every six to tAvelve hours in severe cases and doubled in amount in very malig- nant cases or in those with deeply seated cervical induration. In conclusion, the author cannot too strongly urge upon the reader the vital importance of using antitoxic serum early and freely. The reports in Avhich it has been condemned are imperfect and unreliable. Every patient Avho apparently suffers from the disease should receive this remedy, so potent for good and so lacking in harmful qualities even when given to non-diphtheritic persons, and the physician who can obtain the serum and does not use it is not doing the best thing for his patients. Although the use of antitoxin for immunizing purposes Avhere per- sons have been exposed to infection has been resorted to, it is not practised by the general body of the profession to the extent that it should be. The use of 500 normal antitoxin units will usually pro- duce immunity for three or four Aveeks. Full doses of antitoxin of the higher potencies sometimes give rise to pains in the joints or to an erythematous eruption, which are Avithout danger and need not excite alarm. The only new local application which promises much is that of Loeffler. He directs that the mucous membrane shall be carefully wiped off by a pledget of cotton, and after this is done that a second pledget dipped in the following solution shall be pressed against the diseased area for ten seconds at three-hour intervals: Menthol 2J drachms (10 grammes) dissolved in 9 drachms (36 cc.) of toluol, to Avhich is added 1 drachm (4 cc.) of liquor ferri chloridi and abso- lute alcohol 2 ounces (60 cc). This solution, if kept in a dark glass bottle, well stoppered, will last for months. The author would prefer to use peroxide of hydrogen in all cases. The local use of iodine, carbolic acid, and similar irritating and poisonous substances is not justifiable. DROPSY. Dropsy is to be regarded as a symptom (not as a disease in itself) which may arise from many causes, such as cardiac, pulmonary, or renal diseases, or depend upon obstruction, from various causes, to the 526 DISEASES. normal Aoav of the blood and lymph through the vessels and tissues. Its existence is dependent upon so many causes of a still more indirect nature that it is almost impossible to notice all of them, but the fol- loAving consideration of the subject will at least make clear some of the reasons for its occurrence and indicate the means which are to be taken for its relief. At the very start we are confronted by facts Avhich seem para- doxical, but which are in reality quite reconcilable. These are, that low arterial pressure predisposes to dropsy, and that high venous pressure does likewise, or, in other Avords, that the cause of exudation on one side of the circulation is its prevention on the other. The explanation of these statements lies in a thorough under- standing of the physics of the circulatory system and its anatomical structure. It will be remembered that dropsical exudation takes place from the capillaries, and that the integrity of the walls of the blood-vessels and lymphatics depends upon normal nutrition, or, in other Avords, upon a proper blood-supply. As a consequence, dropsy may be clue to poorly-nourished vessels as much as to any other cause. Further than this, a wratery state of the blood permits abnor- mal exudation. The force exercised upon the column of blood as it is driven out by the heart into the aorta may be considered as the chief support of the capillary circulation, so that if the heart be Aveak the pressure falls in the arteries, and in consequence the rapidity of flow is decreased in the capillaries, Avhile, on the other hand, an increased cardiac activity hastens the capillary circulation. As the arterial pressure and force depend not only upon the heart-force, but also upon the tonicity of the arteries which carry the blood-stream, it becomes evident that dilated arteries must loAver blood-pressure even if the heart be strong, although practically the heart and vasomotor system generally fail or increase in tone together. We find, there- fore, that a weak heart or a relaxed artery tends to cause stagnation of the blood in the capillaries, and, having found that such stagna- tion is productive of exudation, it is not hard to discover Avhy Ioav arterial pressure is a cause of dropsy. Having shown this to be true, let us turn to an explanation of the fact that a high pressure in the veins is productive of the same changes. Here the normal pressure is almost nothing, being much less than in the arteries, and considerably less than in the capillaries. The result of this is, that in health the blood Aoavs rapidly from the high pressure of the artery to the low pressure of the vein, and passes through the small veins under a gradually decreasing pressure until it reaches the heart. Any obstruction to this venous flow must increase the venous pressure, and, the venous pressure being in- creased, the rapidity of flow through the capillaries must be decreased. The whole subject may be made more clear by the following example : Supposing that tAvo iron tubes are connected at one end by several lines of rubber tubes (the capillaries), and that water is floAving into the first tube, or the artery, under a pressure Avhich is represented by DROPSY. 527 the figure 100, Avhile the resistance to the Aoav in the second tube, the vein, is represented by the figure 0. It at once becomes evident that the rapidity of the Aoav through the connecting rubber tubes will be very great, Avhereas if the pressure in the first or arterial tube is decreased to 50, the rapidity is decreased to one-half, or if the pressure in the second tube be increased to 50 instead of remaining at 0, the same changes will occur; in either instance capillary flow is lessened and exudation is caused. This is the pathology of dropsy, and, having understood it, let us proceed to discover the causes of dropsy in various diseases. In cardiac disease it is due to a Aveak heart being unable to supply the arteries Avith enough blood to maintain the normal pressure, or to a damming-up of blood in the venous system as the result of the imperfect emptying of the cardiac cavities. In the first instance low arterial pressure produces dropsy ; in the second, high venous pressure has a similar effect.1 In renal troubles the dropsy depends more upon the lack of proper nutritive processes in the capillary Avails and upon changes in the blood-pressure than upon other causes. If the kidney is diseased, it may not be able to eliminate the proper quantity of liquids, Avhich accumulate and finally escape into the tissues, while the same failure in renal function causes disease of the blood-paths themselves, and often produces cardiac complications. Hepatic troubles cause dropsy by producing pressure upon the large blood-vessels going to the liver, and, in consequence, the exudation is generally confined to the loAver limbs and abdomen. If the hepatic trouble be severe, some failure in the nutrition of the blood-vessels and changes in the quality of the blood may ensue. Pulmonary disease rarely causes dropsy unless the venous pressure is greatly increased and productive of cardiac dilatation, or, as in phthisis, where the changes in the nutrition of the body involve the blood-vessel Avails and the blood. Having spoken of these causes of dropsy, it remains for us to con- sider its treatment, which may be divided into two parts—namely, that directed to its removal after the liquid is poured out, and its relief or cure by direct attention to its causes. The means for the removal of the fluid are suitable to all cases, be the cause what it may, unless the dropsy be of renal origin. Whenever an accumulation of liquid takes place in the tissues, drugs or measures must be resorted to Avhich will cause the emunctories of the body to get rid of it. In ascites, in particular, we may employ elaterium in the dose of ^ of a grain (0.01), or elaterin in the dose of 2V 0I* a g'^in (0.003), placed in the mouth and washed down by a little water, or, if this is not used, the compound jalap poAvder may be resorted to in the dose of 20 to 30 grains (1.3-2.0), and to it may be added, to increase its efficiency, 10 grains (0.65) more of bitartrate of potassium than the official poAvder contains. These two remedies are particularly ser- viceable in renal dropsies, since the elaterium is supposed to aid in 1 For an explanation of these changes in the action of the muscle, valves, and car- diac action in heart disease see the article on Heart Disease. 528 DISEASES. the elimination of urea by the bowel, Avhile the cream of tartar in the jalap poAvder increases the action of the kidneys. The cream of tartar is not to be employed in cases of acute nephritis. Compound extract of colocynth may be employed in the dose of 2 to 6 grains (0.1-0.3), according to the state and idiosyncrasy of the patient. All these remedies relieve dropsy by causing so great an outpour- ing of liquid from the blood-vessels of the intestine that the liquids in the tissues are taken up by the depleted blood-vessels to replace the loss through the action of the purgative. In other Avords, these purgatives render the alkalinity of the blood greater by concentra- tion, and absorption of fluid occurs by reason of the following physio- logical and physical facts: As is well known to every physiologist, the passage through a blood-vessel of a salt solution of less than y7^- of 1 per cent, causes an abstraction of salts from the surrounding tissues by the circulating fluid, in order that the amount of salts in the vessels and tissues may be identical. At the same time the tissues become infiltrated Avith liquid. On the other hand, if the solution be stronger than the normal, the liquid leaves the tissues to enter the vessels, and the tissues in consequence shrink. When salines are given to relieve dropsy, they must be admin- istered in concentrated or saturated solution and on an empty stom- ach, total abstinence from the drinking of Avater being insisted upon until they have fully acted, for the reasons given in the last para- graph. For this reason they should be given an hour or so before breakfast. If these directions are not followed, this method of treat- ment is useless. The other means which we possess for the removal of dropsy are by Avay of the kidneys and skin. If the kidneys are hopelessly dis- eased, that pathway is almost useless, but if they are only passive or partly inactive, diuretics may be used to stimulate their secreting structure and to increase the leakage of liquid through them by increasing blood-pressure. Such patients should be placed almost entirely on a milk diet, and many of them will greatly improve under the use of buttermilk to the exclusion of other nourishment. If this cannot be taken, sugar of milk may be employed as an active diuretic. (See Sugar of Milk.) Often the kidney will be found inactive, because, owing to conges- tion from cardiac trouble, it cannot act. Under these circumstances digitalis, in 5- or 10-drop (0.35-0.65) doses of the tincture, given three times a day, will be of value, and its efficacy will be increased by the addition of 1 drop (0.05) of the tincture of cantharides if the renal lesion is exceedingly chronic or mere torpidity exists. Digitalis and squill, in pill form, as follows, may be used: R — Pulv. digital, fol...........gr. xx (1.3). Pulv. scilla?............gr. xx (1.3).—M. Ft. in pil. No. xx. S.— One every five hours. D YSENTER Y—D YSMENORRHCEA. 529 Or digitalis and calomel may be employed in pill form in renal and cardiac dropsies. Caffeine is also a useful diuretic, particularly in torpidity of the kidney, as it stimulates the secretory epithelium, thus eliminating urea and other effete matters, and increases the passage of liquids by the increased blood-pressure Avhich it produces. That a large amount of liquid may be gotten rid of through the skin under the influence of heat is Avell known. (See Heat.) In addition to external heat we may use pilocarpine by the mouth or hypodermically in localized dropsies, to produce absorption and con- sequent elimination of liquid by SAveating. No drug should ever be given hypodermically in dropsy of a general character, as it will not be absorbed from the Avater-soaked tissues with any rapidity, if at all. The chief means of relief to be resorted to in cases of ascites is tap- ping. Efforts to remove effusions in the peritoneal cavity by medicinal measures are rarely folloAved by success. In reality, tapping is far less heroic treatment than purgation, and the old theory that it is dan- gerous has been completely disproved. It has been found that tap- ping not only removes the fluid, but may in some unknown manner produce a permanent cure after from one to twenty or more operations. In performing tapping the patient is to be placed in a sitting or semi- recumbent position, and directed to evacuate his bladder, so that there will be no danger of this viscus being injured by the trocar. The skin of the abdomen in the middle line one or two inches below the umbilicus is next benumbed by salt and ice held against it. The physician then takes a trocar and canula, at least four inches long, and pushes it through the abdominal Avail until by the decrease in resistance he knoAvs its point has entered the abdominal cavity. It is well to have a broad abdominal bandage placed around the belly, so that an assistant by pulling on its ends may support the belly-Avails when relaxed by the escape of the effusion. As a rule, not more than one-half or three-fourths of the liquid should be removed at one sit- ting, as its entire removal may be folloAved by collapse. The value of iodide of potassium in cases of ascites is not to be forgotten, but it must be given cautiously if renal disease is present. Where the tenseness of the skin in the lower extremities causes danger of local sloughs, some authors recommend small punctures for the escape of the liquid, the limbs being encased in sterilized absorb- ent cotton to absorb the liquid. (See Acupuncture.) DYSENTERY. (See Diarrhoea.) DYSMENORRHCEA. The existence of dysmenorrhoea depends upon so many conditions that the treatment employed in one case is seldom productive of suc- cess in the next. This is not the place for a consideration of the 34 530 DISEASES. surgical measures adopted for the cure of this symptom, and only the medical treatment will be spoken of. When dysmenorrhoea results from the taking of a cold, and is accompanied by uterine congestion and irritability, the folloAving measures are particularly valuable, and may do good in many cases depending upon other causes: The patient should take a hot sitz- bath, and immediately get into bed as soon as the buttocks are dried, being Avell covered Avhile in the tub and afterAvard by a blanket. A turpentine stupe is now to be used (see Turpentine), and 10 grains (0.65) of Dover's poAvder to be administered, unless some idiosyncrasy toward opium is knoAvn to exist, Avhen a half or a fourth of this amount may be employed. Often Avhen the attack is accompanied by constipation a purgative dose of Epsom salts or aloes is of service in the congestive forms of the disorder. If the pain is persistent and severe, a belladonna suppository, of | grain of the extract, may be inserted into the rectum, or in other cases belladonna ointment smeared over the os uteri will be found of service. The latter method is generally impracticable and is rarely resorted to. Very commonly belladonna tincture, by the mouth, is of service in relaxing the spasm of the cervix and of the uterine fundus. Some practitioners resort to the use of opium at each epoch, and keep the patient partially narcotized until menstruation is passed. This is unjustifiable and born of ignorance and bad practice, since the physician is simply dodging the trouble and predisposing the patient to future attacks by reason of the constipation and the result- ing habit which is almost sure to appear after the repeated employ- ment of opiates. When the dysmenorrhoea is due to obstruction of the cervical canal by organic changes or flexions, these conditions must, of course, be relieved before a cure can be expected, and the medical treatment can be directed only to the alleviation of the pain. Divulsions or slow or rapid cervical dilatation should be carried out by the use of instru- ments or tents. In neuralgic dysmenorrhoea, dependent rather upon nervous dis- order accompanying menstruation than upon menstruation itself, measures directed to the improvement of the nervous system and the nutrition of the patient are necessary. (See Cimicifuga.) These cases generally occur in nervous, anaemic women run doAvn by excessive dancing or other gayety or by the bearing and care of a large family of children. A course of strychnine or quinine and iron in small doses is often beneficial in these cases, and horseback exercise between the men- strual periods, out-of-door life, and avoidance of excessive dancing and exhausting exercise are to be ordered. Sometimes bathing the loins with alternate dashes of hot and cold water may do good in atonic patients. Cannabis indica and gelsemium are often of great sendee, both as cures and alleviators of the pain, and antipyrin, acetanilid, and similar drugs may be resorted to Avhile the attack lasts, if it be neuralgic. D YSPEPSIA - D YSPNCEA. 531 When the pain seems to be greater than the patient can bear, enough ether or bromide of ethyl should be given by the physician, by means of inhalation, to produce the primary stages of anaesthesia, but chloroform is not advisable, as the patient, if taught its value by the doctor, may resort to this dangerous drug without advice and die from an overdose. DYSPEPSIA. (See Indigestion.) DYSPNCEA. Shortness of breath, or dyspnoea, arises from cardiac weakness, abnormal innervation resulting in cardiac palpitation, from the accu- mulation of fluids in the chest, from the involvement of the lungs by any disease-process in such a Avay that respiration becomes impaired, or it is produced by indigestion, or, finally, by the encroachment on the lungs or chest-Avails of tumors and groAvths. Each of these states must be removed to effect a cure, but it is only of the relief of the symptoms that Ave will speak. In old persons ayIio suffer from dyspnoea the result of bronchor- rhcea, where a large amount of liquid fills the bronchial tubes and shortness of breath folloAvs exertion, strychnine is the best remedy that Ave have. Its value depends upon its powerful influence over the respiratory centres, on aa hich it acts as a stimulant; and as these cases very commonly also have dilatation of the right side of the heart, Avith consequent cardiac enfeeblement, strychnine is of addi- tional service through its influence upon the circulation. These per- sons are not to be given opium or its alkaloids or any sedative drugs, as such medicines, while giving temporary relief from cough, only serve to depress the respiratory apparatus and cause an accumulation of liquid mucus in the chest as a result of the prevention of cough and lack of expectoration. The cases in Avhich opium or morphine do good are those in which, through nervousness or functional nervous disorder, the respiratory cycle is imperfect, and, above all, in those instances Avhere dyspnoea occurs as the result of cardiac disease. In these cases the attacks of oppression and suffocation can often be entirely set aside by the use of | to ^ grain (0.008-0.015) of mor- phine, given every night or at night and morning. If these doses fail, larger ones may be cautiously used. Hyoscine, instead of causing sleep, nearly ahvays makes these cases worse. Sometimes a little carbonate of ammonium is useful as a respira- tory and cardiac stimulant in cases of dyspnoea. Dry cupping applied over the back of the chest may also be ser- viceable when shortness of breath from cardiac or pulmonary trouble is present. In cases of dyspnoea due to emphysema and pulmonary inflamma- tion of a chronic type, or in those persons Avho take cold on the 532 DISEASES. slightest exposure, particularly after attacks of asthma, arsenic is useful if continuously employed. If pleural effusion be present, relief of a positive and lasting nature can only be obtained through aspiration, or, in other words, by the operation known as thoracentesis. EARACHE. Earache may arise from a great number of causes, all of which are, practically speaking, inflammatory. The pain may be the result of acute or chronic inflammation of the middle ear, with a serous or purulent exudate, or to furunculosis of the external auditory canal. In other cases an eczema of this part is very painful. The treatment of the acute earache is systemic and local, the former being based on the general rules governing the management of inflammatory processes, the latter by the area involved and the cause of the trouble. In the general treatment several leeches may be placed in front of or behind the ear, and heat in a dry form is to be applied to the head on the side affected, by means of a hot bottle or water-bag. Poultices, oil and laudanum, and similar applications are not to be resorted to, as they may ultimately cause trouble and do not always produce even tempo- rary relief, but tincture of belladonna and tincture of opium in equal parts may be dropped in the ear in the dose of 5 to 10 drops when necessary. A very efficient means of relieving the pain is to irrigate the ear with a normal salt solution, as hot as can be borne, every hour or two. Cardiac sedatives are indicated, but quinine is distinctly contrain- dicated, as it tends to cause aural inflammation. If a cold in the head is present, and with it acute myringitis, it is important to establish a free opening through the nostrils, particularly if the middle ear is also involved, in order to clear the orifice of the Eustachian tube. This is to be accomplished by dropping into each nostril 1 to 3 drops (0.05-0.15) of a 4 per cent, solution of cocaine, and, as soon as the engorged mucous membrane is anaesthetic and shrunken, to use an atomizer with a fine spray attachment and the following solution: R.—Acid, boric.............gr. x (0.65). Sodii chlorid............gr. xij (0.8). Sodii borat.............gr. x (0.65). Aq. rosa?..........q. s. ad fgiij (96.0).—M. S.—Use as a spray. This should be folloAved by a spray of menthol and albolene, 3 grains to the ounce (0.15 : 32.0), in order that the menthol may prolong the effect of the cocaine and prevent secondary congestion. This is now to be followed by inflation of the Eustachian tube with a Politzer's air-bag. Only in most obstinately painful cases of acute middle-ear catarrh is paracentesis of the drum to be attempted. Should true septic otitis media develop and drainage of the middle ear become impos- sible through blocking of the Eustachian tube, then the doctor must ECZEMA. 533 very gently irrigate the external auditory canal Avith as hot Avater as can be borne, and render it entirely aseptic by insufflations of boric- acid powder. These injections should be frequently practised, and if the pain persists and the tympanic membrane is bulging, para- centesis must be performed in the most bulging part of the loAver quadrant. After the paracentesis needle is Avithdrawn the discharge should be allowed to Aoav freely. The canal is then to be well irrigated Avith hot carbolized Avater (1 to 50), and as the discharge is constant a piece of sterilized cotton inserted and removed as often as it becomes soiled. In the case of eczema of the ear hot irrigation, folloAved by the ap- plication of powrdered iodoform, is perhaps the best application for tem- porary treatment. In furunculosis of the ear hot irrigation and free incision, Avith an iodoform dressing, are also useful. When foreign bodies cause the pain, they are best removed by repeated and gentle syringing with hot Avater. Forceps are danger- ous instruments in the hands of a novice treating the ear. In earache due to neuralgia a SAvab wet Avith chloroform may be applied to the skin in front of and behind the ear. ECZEMA. This is probably the most common form of skin disease which the physician is called upon to treat, with the exception of acne. Dermatologists divide it into many forms and stages, but in this book a consideration of its forms is out of place, and only the treat- ment for its stages is proper. In the first place, it may be stated that the treatment is a quad- ruple one—namely, dietetic, hygienic, external, and internal. In regard to diet, the patient should be told to avoid salt foods, such as salt fish or pork and corned beef; greasy foods, such as bacon and fried dishes; pastry and cheese. Only moderate amounts of wine and beer can be taken, and foods difficult of digestion are to be stricken off the bill of fare. In the way of hygienic measures, fresh air, the avoidance of seden- tary habits, horseback exercise, or walking are to be recommended. External treatment is the most important of the two measures in Avhich drugs are employed, and its course is perhaps best described by taking a case of ordinary eczema as an example and treating it through its entire course. In the early stages of an acute eczema, when the process is very active and the erythematous reddening of the beginning of the dis- ease is merging into the formation of vesicles or pustules, Avith the formation of large scabs, no application is better than oxide-of-zinc ointment, thoroughly applied night and morning. If the eczema be situated upon the scalp, the hair must be invariably clipped short or shaved off in such a Avay as to prevent the gluing of the hair into a mat by reason of the discharge. The ointment may be smeared over the part or applied on a piece of lint in a thick layer. Nearly ahvays 534 DISEASES. the ointment should be used in conjunction with black Avash (calomel 1 drachm [4.0], lime-water 1 pint [500.0]), Avhich should be applied twice a day, just before the zinc ointment is resorted to, by means of a SAvab or a sop, and alloAved to dry. In other cases the poAvdered oxide of zinc is dusted over the part if the discharge is very watery and profuse, or the following ointment, recommended by McCall Anderson, is very efficacious: R.—Bismuth, oxidi............gj (32.0). Acid, oleic, pur............Sviij (256.0). Cera? alba?..........'. . . . Jiij (96.0). Petrolati..............gix (288.0). Olei rosa?..............rt^v (0.3).—M. Ft. in unguent. S.—Apply to the part affected. As the quantities of this prescription are large, they may be reduced one-half for use in limited eczema. Where the proliferation of cells and the secretion are very profuse it may become necessary to remove the crusts before the local rem- edies can reach the skin, and for this purpose poultices may be used; or, if the disease be on the face, the parts should be anointed with olive oil, containing 1 or 2 drops of carbolic acid to the ounce (0.05- 0.1 : 32.0), to soften the crusts, which are readily removed in a half-hour by the use of a little castile soap and Avater. The soap is not to be used if the inflammatory action is very angry-looking. Whenever itching is an annoying factor, the parts should be protected by lint smeared Avith some simple ointment, which may be carbolized both for its antiseptic and local anaesthetic effect. English and Amer- ican dermatologists use what is known as liquor carbonis detergens very largely in the acute stages of eczema as Avell as in other skin diseases. It should not be used pure, but diluted in such a way that for each 4 ounces (128.0) of water 2 drachms (8.0) of the pure liquor are present. Liquor carbonis detergens is made by taking 9 ounces (288.0) of tincture of soap-bark (quillaia-bark) and 4 ounces (128.0) of coal-tar, mixing and allowing them to digest for eight days, after which the mixture is filtered and used. When the disease has passed from the acute, active inflammation of the first stage to the subacute form of the second stage of its exist- ence, applications of a mildly stimulant character are necessary. Before this the physician has endeavored to soothe the parts; now they must be excited to normal activity. For this purpose resorcin in the proportion of 2 to 30 grains to the ounce (0.1-2.0 : 32.0) of lard, according to the severity and induration of the lesion in the skin, should be used. Stehvagon recommends the folloAving: R.—Unguent, picis liq..........gj (4.0). Unguent, zinci oxidi ........jjvij (28.0).—M. S.—Apply to the parts. Where the disease is chronic and very persistent, but sluggish or atonic in its course, still more powerful remedies are necessary, such as salicylic acid, tar, or tincture of green soap used with hot Avater EMISSIONS. 535 until the skin beneath is bared, dressing this by means of zinc oint- ment or resorcin ointment, 2 to 10 grains to the ounce (0.1-0.65 : 32.0), spread on a cloth. The salicylic acid should be used in the proportion of 30 to 60 grains to the ounce (2.0-4.0 : 32.0) of lard, Avhile the tar is used in the form of the pure official tar ointment. In seborrhoeic eczema, Avhere the secretion is greasy and dry, and folloAved, if Avrongly treated, by oozing and the pouring out of serum and the formation of cells which form crusts, the following prescrip- tion is of value: R.—Resorcin...........gr. x vel xx (0.65-1.3). Unguent, zinci oxidi J o J \ ■ )• Petrolati . -........,$ss (1G.0).—M. S.—To be applied after removing the scabs by the use of a lotion composed of 1 part of bay rum and 3 parts of water. The internal treatment is directed to the cure of any disordered function Avhich is present, such as dyspepsia (see Indigestion), hepatic torpor, general debility, anaemia, scrofulosis, inanition, constipation, gouty diathesis, or renal insufficiency. The gastric disorder is to be relieved by the use of hydrochloric acid and pepsin; the hepatic tor- por by mercury, podophyllin, or, better still, by freshly-prepared undiluted nitro-hydrochloric acid added to Avater; the debility by tonics, such as cinchona, cod-liver oil, strychnine, and bitters; the anaemia by iron, and, if scrofulosis exists, by the syrup of the iodide of iron. Constipation is to be cured by the use of proper foods and laxatives, and the gouty tendency counteracted by the employment of lithium citrate and colchicum or potassium iodide. If the kidneys are at fault because of torpidity, the diuretic potassium salts, such as the citrate, are indicated. Arsenic is never to be used, except in those instances where the skin is very dry, and where, by improving digestion and through its alterative poAver, it does good. In the chronic forms of dry eczema or those depending upon some atonic state of the trophic nerves of the skin, arsenic is of great value in the form of FoAvler's solution, or arsenous acid may be given. EMISSIONS. Seminal emissions occur as the result of sexual abuse, whereby a condition of hyperexcitation of the nervous cells in the spinal cord and the nerves of the genitalia is developed, or they are due to peripheral or centric irritations, AA'hich reflexly irritate the genitalia or the nerves, and to a number of other similar causes. These emis- sions also occur with some periodicity in normal males who are con- tinent and chaste, and under these circumstances are not to be inter- fered Avith by treatment, unless the emissions become excessive. The former types are, hoAvever, proper for medical treatment, and their cure consists in the avoidance of unchaste literature and lasciv- ious thoughts during the Avaking hours, and the use of such spinal and cerebral sedatives that the centres governing the ejaculations of semen 536 DISEASES. may be calmed, and so quiet a sleep produced that erotic dreams are avoided. The patient should sleep on a hard hair mattress, not be too heavily covered, and should avoid sleeping on his back, as this causes an undue blood-supply to the spinal centres, and consequent stimula- tion and ejaculations. Sometimes hard bodies, such as spools, are tied around the loins, so that lying on the back will cause so much discom- fort that the patient aAvakes and turns on his side. The drugs to be used are bromide of potassium or sodium in 20-grain (1.3) doses at bed- time, or chloral may be taken in the same amount. Hyoscine is cer- tainly of value in the dose of T-j^- grain (0.0006). Sometimes a Avarm sitz-bath or general bath before going to bed is of service. In other cases, Avhere atony is the cause of the trouble, the physician should recommend cold sponging of the perineum and loins night and morning. In the cases in Avhich emissions come on as the result of continence, and become excessive, the remedies just named are to be tried, but really do not effect any permanent cure unless used until sexual power is seriously depressed, so that it has been the custom of many physi- cians to recommend "marriage," Avhich the patient may interpret in its legitimate light or not as he pleases. It is worthy of note that all irritations of the urinary bladder and other parts of the genito-urinary system should be removed, and it is often of value to administer citrate of potassium in 20-grain (1.3) doses, in water, three times a day, to render the urine non-irritating and alkaline. Stimulating foods and drinks are to be interdicted, and condiments, such as pepper and mustard, avoided. Sometimes, when the emissions are caused by genital atony, strych- nine and arsenic are of very great service if given in full dose. In many of these cases it is the duty of the physician to treat the moral state of his patient as Avell as to give medicines. Many per- sons, believing that emissions are always an evidence of disease, read books on such subjects Avhich are sold by quacks and soon find their Avay to the hands of these persons, or sensibly consult a regular physi- cian. Half the treatment in these instances consists in assuring the patient that he has nothing to worry about, and in making him feel that the physician is his friend and worthy of all confidence and complete belief. ENDOCARDITIS. Endocarditis occurs sometimes as a single manifestation of disease; sometimes as a symptom, Avith many others, of some general tendency produced by a diathesis, such as gout and rheumatism or syphilis. Further than this, it may be acute, subacute, or chronic, and each one of its forms must be differently treated. It is hardly necessary to state that any diathetic taint should be treated by antirheumatic or antilithic remedies, such as the iodides. The iodides are not, hoAvever, indicated if any rapid changes of a degenerative type are at Avork. In acute sthenic endocarditis, associated with great vascular disturb- EPILEPSY. 537 ance and much cardiac embarrassment or irregularity, there is no rem- edy so useful in the early stages as full doses of tincture of aconite, 2 to 3 drops (0.1-0.15), given every hour until the physiological symptoms of its influence are felt, or, in its place, Avith equal efficacy may be em- ployed the tincture of veratrum viride (2 to 3 drops [0.1-0.15]). At the same time calomel and opium may be used, the calomel for its anti- phlogistic influence, and the opium to control the purgative tendencies of the mercurial. Thus Ave may use \ grain (0.015) of calomel every two hours and -^ grain (0.006) of morphine. Leeches should be placed over the praecordium in a goodly number, and if these are not obtainable wet cups are to be employed. In most cases it is better to apply an ice- bag over the heart. This depletion is only of service Avhen the disease is seen early enough to alloAv us to limit the inflammatory process. As the disease progresses, if the physician fails to stop it, it will be found that the heart becomes someAvhat labored in its action, irregular, and Aveak, and that its rhythm is seriously interfered Avith. At this time digitalis is of use in stimulating the depressed cardiac muscle and increasing its reflex activity, also steadying it through the pneumo- gastric irritation Avhich it produces. Aconite and other depressants are contraindicated at this time. Absolute rest upon the back is to be insisted upon, and it is recommended, in those cases Avhere deposits of a calcareous nature are likely to occur in the valve, that the citrate or acetate of potassium be given or that citrate of lithium be employed. If the disease becomes ulcerative, supporting treatment, consisting chiefly in the use of good food and the tincture of the chloride of iron is of great value if the dose which is given is large. EPILEPSY. The disease knoAvn as epilepsy is probably the most disheartening condition as to treatment that the physician has to deal Avith, since it often resists the influences of all the standard remedies, and drives the practitioner from drug to drug in the hope of finding one Avhich will be at least alleviating in its effects. For this reason the author has in this article included many of the drugs which are rarely used, as Avell as those generally recognized as useful in its treatment, in order that the physician may try every remedy of any possible value. Tt should be borne in mind that the treatment of epilepsy is as various as the disease is variable in its forms and phases, and should, in nearly all cases, resolve itself into tAvo or perhaps three divisions, consisting in the removal of any exciting cause, in the checking of the convulsive tendency already set up, and in the prevention of any further attacks by suitable drugs or other measures of relief. The treatment is governed largely by the cause, and is medicinal or operative according to the etiological factors at Avork. In simple idiopathic epilepsy medicinal means must be folloAved, Avhile in a case resulting from traumatism the depressed bone, abscess, or tumor must be removed, and in those due to reflex irritation the peripheral source of trouble must be sought out and relieved. 538 DISEASES. So far as drugs are concerned, the most valuable remedy in use for the relief of epilepsy is bromide of potassium, although other forms of bromide salts are to be mentioned later on. This drug, hoAvever, is not a '' cure-all," even in epilepsy, and reports are constantly made of cases Avhere it has failed ; but many cases prove that the remedy is undoubtedly responsible for a cure when it is pushed in a suitable manner, and in the vast majority of instances the seizures are so decreased, both in violence and fre- quency, that its use may be said to be indicated in every case of the disease. In a very small minority, hoAA'ever, it signally fails, and in a still smaller number of cases it is useless unless combined with some other drug Avhose poAver alone is very slight. Nevertheless, it is to be laid doAvn as a rule that the bromide treatment of epilepsy is, par excellence, the treatment to be employed on every occasion. There is no other drug knoAvn Avhich can be relied upon so absolutely, or Avhich is so poAverful in its action and devoid of marked toxic effect unless given in enormous doses. The doses to be used vary with the salt employed to a considerable extent, and depend upon the character of the disease and the tem- perament and physique of the patient. The greater the duration of the disease, the greater is the difficulty in effecting a cure, and the length of time Avhich the man has been epileptic should therefore be most carefully reckoned before the treatment begins. Further than this, the frequency and severity of the attacks are to be looked into, and these points are really more important than the actual duration of the ailment; since if a man has only one fit every six months for twenty years his condition is far less serious than if he has a history of three or four fits a day for one year. Again, the character of the attack, as to its violence, may be the most important fact to be re- garded, for if it is violent enough to endanger life, remedies must be pushed even beyond the point of tolerance. The writer has heard a very celebrated physician cause much amusement among his auditors by detailing an instance of an epileptic Avho Avas getting Avell, and would have recovered if he had not died. His explanation Avas, that the man Avas syphilitic, and was receiving moderate doses of iodide and bromide of potassium, Avhich Avere sloAvly benefiting him, and Avould have cured him had not a single severe fit produced death in the mean Avhile. Another point to be considered is the condition of the digestion, Avhich the bromide of potassium is peculiarly liable to disorder, and Avhich is sometimes so disturbed as to necessitate the administration of the drug by the rectum in serious cases. Females generally require smaller doses than males, and children of both sexes do not require as large quantities as adults. The dose to be used in the beginning of the treatment in moderate cases is about 10 grains (0.65) thrice a day ; and while this may seem a very small quantity, it Avill be found that it can be rapidly increased in amount Avithout causing the gastric distress produced by the sudden use of larger doses. Each day an additional 10 grains may be added, until at the EPILEPSY. 539 end of a week the patient is taking 80 grains (5.3) in each twenty- four hours. There are very feAv cases Avhich will not become com- pletely saturated with the drug if this is done, and there are very feAv in Avhich a more rapid arrival at bromism is needed. If, hoAvever, the patient has become able to stand large amounts by the prolonged use of the drug, the amount given is not to be governed by grains, but by physiological effects, and it may be pushed to any amount Avhich is borne Avithout distress. In chronic epilepsy, too, Avith regularly recurring fits, the greatest good is obtained by pushing the drug in ascending doses for one Aveek, and then for the succeeding Aveek only enough is given to preserve the general effects of the medicament. By doing this the stomach gets a rest and the appetite is not greatly interfered Avith. Where the attacks occur only every two Aveeks, this is a particularly useful method for obvious reasons. As regards the time of day Avhen the drug is to be taken, there can be no doubt. Some Avriters have directed that it shall ahvays be taken before meals, but this is entirely lacking in advantage and decidedly fruitful of harm. Medicines Avhich are given Avith the object of affecting the general system should be taken after meals, not before, and it is only Avhen a local gastric effect is desired that Ave use them on an empty stomach, particularly Avhen the substance is as irritant and depressing as potassium. If taken after meals the appetite is not decreased, but there are few Avho can take a dose of 10 or 20 grains (0.65-1.3) of bromide of potas- sium before breakfast Avithout suffering from indigestion. It has been held by some that the drug should be taken in minute doses, fre- quently repeated, in order to keep the patient constantly under its influence. This is an example of therapeutic ignorance, because bromides are sloA\4y eliminated, and this frequent administration pos- sesses the disadvantages of being inconvenient, annoying, and apt to disorder the stomach. In this connection it is not to be forgotten that the use of full doses of the bromides, particularly in epileptics of an ad\ranced type, sometimes causes maniacal outbursts in place of the epileptic attacks. In other instances the patients become morose and homicidal. (See article by author in Therapeutic Gazette, June, 1897.) Cases are on record in Avhich the persistent use of large doses of the bromides has resulted in bronchitis Avith profuse and dangerous exuda- tion, causing suffocative bronchitis. If the attacks have a distinct periodicity or can be foretold for as much as two hours beforehand, the remedy may be taken in a large dose only at this time, and but a feAv grains given in the intervals; and if the attacks are severe, no one should hesitate to use large doses by the mouth and by the rectum on the day of the attack. A very important point to be borne in mind is that the drug often seems to have produced a complete cure, and this ■ results in careless- ness in the regularity of administration. The patient should be impressed by the fact that every day passed Avithout a fit is a step forAvard, and that every fit carries him many steps backAvard. He should also be made to use the drug, in moderation, for at least three years after all fits have ceased, and to watch after that time for the 540 DISEASES. slightest sign of their return. The quantity taken each day should be gradually decreased, not suddenly stopped short. It is true also that if a recurrence of the fits takes place they yield to treatment very much more slowly than before. Before passing on to the discussion of the other bromides, and the conditions produced by the excessive use of all of them, Ave may place our use of these compounds in epilepsy on a scientific footing. It is now generally recognized that the seizures knoAvn as epilepsy arise from the cells in the cerebral cortex, and there can be no doubt that the bromides act very powerfully upon the cerebrum in the higher animals, decreasing the irritability of the motor centres in these regions to a very great extent. Not only is this pointed to by clinical facts, but the well-known researches of Albertoni prove that such is their action beyond all doubt. This investigator found that the administration of a single dose of the bromide of potassium so lessened the excitability of the motor cells in the cortex cerebri that much stronger stimulation Avas necessary in order to cause response in the limbs than Avas normal, and that it ay as difficult to produce epileptic attacks by means of the electrical stimulation of the motor areas, even when currents very much stronger than those Avhich com- monly produce such a result were used. He also found that this lessened irritability was increased still further if the drug was given for several days beforehand in such doses as thoroughly to impress the organism. It is therefore evident that the bromides act directly on the cortical areas, calming the tendency to explosions of nerve- force. There is one more point to Avhich attention must be called, and that is the fact that when the bromides are taken for any length of time they produce bromism, which in its moderate or severe forms produces a mental condition very closely allied to that seen in old, chronic epi- leptics. This condition of the mind should never be overlooked, and the ordinary mental changes of epilepsy are greatly increased by its constant and careless administration. (See Bromide of Potassium.) The bromide salts of gold, iron, sodium, lithium, nickel, and ammonium have all been used in epilepsy with good results, but, except in certain instances, they fail to act as well as that of potas- sium, unless given in larger doses. There are several circumstances, however, under which each one possesses marked advantages, and may suceed where potassium has failed. In all cases of epilepsy complicated with anaemia the bromide of iron should be employed, but where there is plethora it will generally increase the disease or do no good. When it acts after potassium fails the iron is of value, because of its tonic and nutritive effect. Bromide of sodium, Avhile somewhat less powerful than potassium, is not by any means so apt to disorder the stomach, and is preferable in some cases on this account. It possesses no other advantages. The bromide of lithium has been highly recommended in intract- able cases by Weir Mitchell, who even states that it may be given in one-half the dose of the potassium salt Avith equally good effects. The bromide of nickel cures some cases Avhere all other remedies EPILEPSY. 541 fail, but this occurrence is rare. In a series of physiological experi- ments made by the Avriter some years since he found it virtually iden- tical Avith the potassium salt in its action, and it is useful in about the same doses and cases as is bromide of potassium. The bromide of ammonium is very irritant and disorders the stomach quite readily. It ought always to be used, when used at all, Avith some other drugs, the ammonium salt only acting as an adjuvant. Several clinicians have tried hydrobromic acid, but it is very much more apt to derange digestion and to produce vomiting than any of the salts. The dose of the dilute acid is h to 3 drachms (2.0-12.0) in a tumblerful of SAveetened Avater. The bromate of potassium has been used by Mitchell in doses of not more than 5 to 10 grains (0.3-0.65) Avith good results, but is more dangerous and scarcely of greater value. There can be no doubt that in some instances Avhat is knoAvn as the mixed treatment is successful Avhen all else fails. This consists must commonly of a prescription in Avhich the bromides of potassium, sodium, and ammonium take part. Why this combination acts better than any one of the salts alone no one knoAvs, but it is certainly a clinical fact. Bechterew has recommended the joint use of the bromides with adonis vernalis in epilepsy as folloAvs: R.—Potassii bromidi..........giij (12.0). Infus. adonis vernal.......f^vj (180.0). Aqua? destillat........q. s. f §vj (180.0).—M. S.—A dessertspoonful three times a day. Sometimes codeine is combined with this prescription. Within the last feAv years it has been claimed by Flechsig that the use of opium for a long period of time is useful in the treatment of epilepsy. He gives the opium in ascending doses during a period of six Aveeks, beginning Avith \ grain (0.018) three times a day and going as high as 5 grains (0.33) three times a day. This method de- creases the frequency and severity of the fits for several months in *ouie cases, but does not cause a cure. It succeeds best in old cases and is not useful in recent ones. In still other cases digitalis, Avhen used along Avith one of the bro- mides, seems to produce favorable results. Indeed, digitalis has for years been used alone in epilepsy Avith fairly good results, and should ahvays be used in obstinate cases. In petit mal, where bromide of potassium Avhen used alone so often fails, it is useful, and several English Avriters, notably GoAvers, assert that its best effects are in cases of nocturnal epilepsy. Why this should be the case no one knoAvs, and it Avould seem doubtful whether it does any more good in nocturnal attacks than in others. Another combination very much employed and lauded is bromide of potassium Avith belladonna, the mydriatic being almost useless alone, but of great antiquity in its use in epilepsy. Like the mix- ture of digitalis and bromide, it succeeds very frequently in petit mal, 542 DISEASES. and, indeed, seems to be much more successful than the digitalis, but its mode of action is exceedingly doubtful. As the drug acts even more poAverfully upon the nervous system than upon the circulatory apparatus, it has been thought that its influence for good depended upon this effect, but the experiments of Seppilli contradict this belief, for he found that if atropine Avas given to an animal the surface of the cortex cerebri responded more readily than is normal to electrical stimulation. At one time it Avas held that belladonna acted on the spinal cord and peripheral nerves under such circumstances, but it should be remembered that Ave noAv knoAv that atropine is only of value in relax- ing spasm Avhen given in full dose, oftentimes hypodermically, and that Albertoni has made a series of experiments to determine Avhether it irritates the motor centres of the cortex. In his hands repeated small doses or one large dose in no Avay retarded the convulsions com- monly produced by stimulation of the brain. Both these investigators are therefore in accord. Under these circumstances it affects rather the motor nerve-endings than the central nervous apparatus. As long ago as the early part of this century cannabis indica came into notice in the treatment of epilepsy, and it is probably of greater value alone than when combined with any other drug, unless it be with the bromides. Although it is at present rarely so used, the author believes, from his OAvn studies, that it is of value, for he found that it distinctly lessens reflex action and acts poAverfully upon the higher nervous centres in the brain. Its use and value in migraine are undeniably of the greatest importance, and epilepsy and migraine are often very closely allied. Nitrate of silver ay as brought into use long before the value of more recent drugs was known. Every one is agreed that it is Avith- out powrer for good, save Avhen it is used constantly for a long time. As the drug is eliminated very slowly, it rapidly accumulates in the body, and argyria soon comes on. It may be used, after all else fails, in doses of ^ to \ grain (0.01-0.15) thrice a day after meals, the mucous membrane of the inside of the lips and the conjunctiva being carefully Avatched for the early signs of chronic silver poisoning. We certainly have no knoAvledge as to its influence on the nervous sys- tem; and if it acts at all, it must be by some alterative influences rather than by any other means. Nitroglycerin is to be employed in the treatment of petit mal, rather than haul mal, in the dose of 1 drop (0.05) of a 1 per cent. solution, once, tAvice, or three times a day. Our knoAvledge of its effects, so far as its curative influences are concerned, is very slight, but it seems to benefit some cases. Its action is very fleeting, and it influences the brain very little, except it be taken just before an attack is expected or Avhen the cardiac action is defective. Its great lethal poAver should never be forgotton. The use of the nitrite of amyl is not for the purpose of directly curing the disease, but of Avarding off impending attacks, the warn- ing of Avhich is given by an aura of sIoav progression. It increases the severity of petit mal, but in epileptics Avho have a prolonged aura EPILEPSY. 543 Ave may use nitrite-of-amyl pearls, which consist in small glass beads containing a few drops of the drug. As the aura comes on the patient should break one of these in his handkerchief and inhale the drug, thereby putting aside the attack. The influence Avhich the drug exerts upon the brain is secondary rather than primary, and is probably dependent on its action on the blood or circulation. Its influence on the spinal cord and nerves is much more marked and direct, and it is most certainly a very powerful spinal depressant. As its influence over unstriated muscular fibre is very great, it affects the vasomotor system very powerfully ; and those Avho think epilepsy is due to a vasomotor spasm at the base of the brain point to the effects of this drug as a proof of their hypothesis. Such reasoning is not, hoAvever, necessarily correct. Nitrite of amyl puts aside an attack by a sudden shock to the nerve-centres, which diverts them, so to speak, from their intended discharge, very much as a ligature around the arm stops an aura. When Ave remember that the drug acts instantly and converts nearly all the oxygenating blood of the body into a non- oxygen-carrying fluid by reason of the methaemoglobin produced, the sudden change in the cerebral nutrition and state is easily understood. In the treatment of the '" status epilepticus " nitrite of amyl is of great value in stopping the seizures, and may be used under these circumstances in heroic amounts, applied to the nostrils at intervals. During the presence of the tonic spasm, if it be severe enough to stop respiration, it should be remembered that if the drug is not inhaled it is absolutely Avorthless. It is only Avhen respiration is being carried on that it can enter the lungs and do its Avork. Another valued method in treating the status epilepticus is free bloodletting. The nitrite of ammonium or of sodium should be used internally to sup- plement the nitrite of amyl. The use of anaesthetics during an attack of epilepsy is virtually useless, and in some cases dangerous, for ether is too slow in its effects, and may, by its irritant vapors, increase the tendency to laryngeal spasm or cause lung complications. Further than this, if uraemia is the cause of the fit—and this fact is unknoAvn in every case until the individual is carefully examined—the ether may increase the inflam- mation of the kidneys Arery seriously. Chloroform, though it acts much more rapidly, may cause sudden cardiac failure, and both drugs may increase the post-convulsive coma very greatly. In " status epilepticus " they may be used, as in such cases the convulsions must be stopped at all hazards, but the prefer- ence should be ahvays for amyl nitrite. The iodide of potassium is entirely useless in epilepsy unless the disease is due to syphilis, Avhen it is of the greatest service. Indeed, the bromide and all other drugs should be set aside while this one is pushed to the utmost. As is well knoAvn, syphilitics usually bear the drug extremely well, and the author knoAvs of one instance Avhere no less than 800 grains (53.0) Avere taken every tAventy-four hours, Avith rapid improvement as a result. This point is strongly insisted upon bv all therapeutists and syphilographers, notably among whom stands Fournier. 544 DISEASES. Where the convulsions are due to the presence of a gumma, the iodide of potassium is, however, too slow in its action, and should be associated with mercury in order to break doAvn the groAvth Avithout delay, lest a seizure cause death by glottic closure, producing asphyxia or some similar accident. Chloral hydrate is a remedy Avhich has been only partly tried in epilepsy, and its usefulness is not as yet determined. It possesses the marked disadvantage, as compared with the bromides, of being a very fatal poison, which is an important fact to be borne in mind by the physician Avhen giving it to a patient Avhose mind is already Aveak- ened by the disease or naturally stupid, and ayIio may forget and take too much. Its physiological action indicates much more fully that it may be of value than does that of many other much more lauded rem- edies, since it exerts its chief influence on the motor pathAvays of the spinal cord and quiets the motor portion of the cerebral cortex, and also produces sleep. Seppilli has proved this by direct experimenta- tion after the method employed by Albertoni. Its use, combined Avith one of the bromides, is often accompanied by the most desirable results, and it should be tried at all times unless some cardiac complication forbids it. It may disorder the stomach, and should, like the bromides, always be given Avell diluted and after meals. Of the more recent remedies, acetanilid certainly stands in the foremost rank, and bids fair in some instances to rival the bromides. Professor Germain-See, the author, and some others have reported cases wdrich obtained very marked relief from it, and more recent investigators have done likeAvise. The drug will be found to exert its chief benefits in chronic epilepsy. At least, if a child Avas brought to the author with a beginning epilepsy he Avould use the bromides, but, if the disease Avas chronic, acetanilid. Antipyrin has been recommended by Lemoine in certain forms of epilepsy, but is condemned in many cases. In those Avho suffer from menstrual epilepsy, so called, or in those in Avhom the attack is pro- duced reflexly by the presence of intestinal parasites, the drug does good. Lemoine also found it very useful in those cases which are asso- ciated with migraine. In these cases the results were better than with the bromides, but in the idiopathic simple varieties it Avas use- less. Mairet and Combemale have used the drug in the epileptiform mania with satisfactory results. In the epilepsy of childhood Solanum Carolinense in the form of the fluid extract, in the dose of 2 to 15 minims (0.1-1 cc), is a useful drug. The value of the treatment of epilepsy by borax has not received very wide recognition. Perhaps the most thorough studies of its effects have been those of GoAvers in England and Folsom in America. It would seem that some cases which are obstinate under ordinary treat- ment are benefited by borax, but it is certainly not to be commonly employed. The dose generally given is about 15 grains (1.0). (See Borax.) In children suffering from frequently recurring epileptic attacks the presence of worms should always be looked for, and when they EPISTAXIS. 545 are found they should be expelled as rapidly as possible. If they are the oxyuris vermicularis (seat-worms), the best remedy by far is the injection of a strong infusion of quassia of such a strength that there are 2 ounces (64.0) of quassia to each pint (500 cc.) of water. In girls, Avhere the removal of the Avorms from the rectum is not folloAved by relief, a careful examination of the vagina should be made, and quassia employed in somewhat weaker solution, as very commonly intense inflammation is there present, produced by migra- tory movements of rectal parasites. If the quassia is unobtainable in any case, a saturated solution of chloride of sodium may be employed. A very important point, AA'hich is constantly brought before the physician Avho is treating epilepsy, is that of diet. Nearly every patient Avho suffers from this disease inquires what he shall eat. Very feAv researches of a thorough character have ever been carried out on a large scale to determine the things Avhich may or may not be in- gested. Of course, nearly every one of us knoAvs from our personal experience that red meats are hurtful, particularly in children. Curi- ously enough, the influence of diet in one research covering a number of cases of chronic epilepsy seemed to be of little moment. Thus, Merson examined 24 such cases, putting 12 of them on a purely vege- table, and 12 on a purely nitrogenous, diet. The result, after this study had been continued for two months, was that the vegetarians had had a feAv less fits than the others, but the difference Avas so slight as to be of almost no Aveight in determining the question. Some authors at the present day believe this opinion as to the harmfulness of meats to be erroneous, and Gowers is one of them. EPISTAXIS. Nose-bleed depends upon many causes, the chief of which are traumatisms, plethora, and the presence of ulcerations in the nasal chambers. It also occurs as one of the prodromata of typhoid fever. Probably plethora is the most frequent cause of nose-bleed, and in most instances it is an attempt on the part of the system to rid itself of an excess of blood. Under these circumstances epistaxis is not dangerous, nor is it proper to arrest it unless it becomes exces- sive. When it is excessive or must be controlled for any reason, the measures to be adopted are both medicinal and non-medicinal. If the person is full-blooded and strong, full doses of tincture of aconite or A-eratrum viride are useful, say 2 to 4 drops (0.1-0.2) of one of them, followed in a half-hour by a smaller dose, if necessary. The value of these drugs depends upon their power of lowering blood- pressure, and in consequence decreasing the leakage from the break in the Avail of the blood-vessel. Some physicians have recommended ipecac in full nauseating doses to relax the arterial system. PoAvdered alum, pure or half and half with starch, or alum in solution, may be snuffed up the nostril, and tannic acid, in poAvder or in solution, may be used with advantage. If this does not control the hemorrhage, an atomized spray of Monsel's solution, in the strength of 30 drops to 4 35 546 DISEASES. ounces (2.0:128.0) of water, may be of service. Ergot in the form of the fluid extract in the dose of 1 drachm (4.0) may be given, or its Avine in the dose of a Avineglassful (32.0) employed. Sometimes, Avhen the oozing is slow, doses of turpentine, oil of erigeron, or hamamelis, taken internally, do good. All these remedies act as styptics Avhen locally applied, by causing coagulation of the fibrin and the formation of a clot, Avhile the inter- nal remedies produce local contraction of the blood-vessels in the con- gested area. The non-medicinal measures to be employed if the bleeding is severe consist in plugging the anterior nares with pledgets of cotton or pieces of lint soaked in vinegar. If this does not control the hemorrhage, the posterior nares may also be closed by plugs, and compression of the facial artery of the same side as the bleeding nos- tril be made upon the superior maxilla near the nose, thus decreasing the blood-supply. The head must be kept raised, and the patient must not bend over a basin or Avear a tight collar. A piece of bacon fat cut to fit and placed in the nostril may stop epistaxis which has resisted all other measures. As a household remedy vinegar may be injected into the nostrils, or lemon-juice may be employed in the same Avay. Sometimes, if the patient raises one or both hands high above the head, the hemorrhage ceases. This is due to the fact that the easiest pathAvay for most of the blood is straight up the brachial arteries rather than through the tortuous vessels of the face. A hot foot- bath, by dilating the veins of the lower extremities, draws away the blood from the face and is a useful measure. In other cases a hot- Avater bag applied over the dorsal vertebrae is efficacious, and some- times cold when so used is of service. A piece of ice pressed against the nose may prevent further hemorrhage by causing localized anaemia. Where the nasal hemorrhage results from traumatism with fracture of the bones, and great loss of blood ensues, ligation of the bleeding vessel or its supplying vessel should be performed if possible. ERYSIPELAS. This disease is now generally recognized as dependent for its existence upon a germ. The streptococcus of erysipelas is practi- cally identical with that of pus, and the disease is at first a distinctly local one. The changes Avhich have come forward in its treatment are chiefly the local measures, Avhile those methods which have been used internally for many years have suffered no alteration. Whether or not erysipelas is a local or systemic disease has little to do with the proper treatment. In any case it is an inflammation, and as such it must be treated. In its early manifestations and where some uncertainty may exist as to its true character aconite or vera- trum viride may be used in sthenic cases in Avhich the nervous and circulatory systems give evidence of reflex irritation and the pulse is EXHAUSTION AND DEPRESSION. 547 hard and full. These remedies are contraindicated if any tendency to Aveakness exists. DaCosta has recommended, and others have car- ried out Avith success, the practice of using pilocarpine in sweating dose (\ to -^ grain hypodermically) in these early stages. (See Pilo- carpus.) As Avith aconite and veratrum viride, it is to be remembered that this use of pilocarpine is not to be resorted to if debility exists. The internal treatment of erysipelas par excellence is the plentiful use of the tincture of the chloride of iron—20 to 30 drops (1.3-2.0), or even 40 drops (2.65), four times a day. The diet should be reg- ulated and the boAvels kept in good order, while any excessive febrile movement is to be treated by the use of antipyretic drugs, such as antipyrin, or, better still, by cold bathing. Where the patient passes into the typhoid state supportive measures must be used and alcoholic stimulants added to the food, which should be predigested or prepared so as to be readily absorbed. During convalescence the use of tonics, both in the form of iron and of bitters, is particularly indicated if the recovery of strength is sIoav. The local treatment of erysipelas is very varied, but in the majority of cases resort may be had to but one method. By far the best dressing for the general run of cases of erysipelas is a modification of that of Von Nussbaum, Avhich the author has tried in a great number of cases Avith success. The skin of the part involved is carefully cleansed Avith Castile soap of the purest form, and then it is Avashed off by a 1:1000 solution of bichloride of mercury. The skin is dried Avith a soft towel, and a thick coating of ichthyol Avith vaseline or lanolin applied, the strength of this ointment being half and half. Over this is placed antiseptic gauze or sterilized absorbent cotton, and adhesive strips or a bandage is used to keep the dressing in place. Sometimes the ointment alone may be applied if the area is small. Under this treatment the results are often extraordinary in all stages of the malady. Where ichthyol is not obtainable, a thick coat of Avhite-lead paint, as it is sold in cans before it is mixed with any thinning substance, will be found of service in an emergency. The plan recommended by Higginbottom, of applying nitrate of silver, is sometimes successful. It consists in the use of a solution of the strength of 80 grains to 4 drachms (5.3 : 16.0) of distilled Avater, which is thoroughly applied Avith a camel's-hair brush over the entire inflamed area and for a little space beyond. The application must be made tAvice or thrice to secure a good coating. This treat- ment will often arrest the inflammation and prevent its spread, but !ias caused sloughing. EXHAUSTION AND DEPRESSION. While the treatment of both these conditions is almost identical in some respects, it is, nevertheless, important that a clear idea of the difference between the tAvo be clearly understood, if for no other reason than that the physician may recognize that exhaustion is a far more serious state than depression. It also requires more careful 548 DISEASES. treatment. The man who is depressed retains in his body all the vital forces necessary for the maintenance of life, but they are tem- porarily in abeyance from some cause. As soon as the incubus is taken aAvay the system at once asserts itself and recovery takes place. This is not the case with a man suffering from exhaustion. In this patient every particle of his strength is sapped and lost. The man depressed is the giant lying unconscious from a blow on the head; the man exhausted is the same giant after a long attack of typhoid or other fever of a similar nature. The treatment of depression is stim- ulation ; of exhaustion, not only stimulation, but feeding and protec- tion from exposure. FEET SWOLLEN, TENDER, OR SWEATING. These comparatively simple yet annoying conditions are often brought before the physician for relief, and patients suffering from them will frequently be more grateful for skilful treatment than in the event of recovery from a severe illness. Swelling of the feet occurs chiefly in two classes of cases, excepting, of course, in dropsy, which makes a third class. The two classes named are old persons taking too little or too much exercise, and who may have gouty or rheumatic tendencies, and those who by constant standing or walking cause congestion of the lower extremities, chiefly by fatigue, or by wearing bad shoes, or by running over uneven ground, causing bruising. Where the swelling takes place in the first class, small doses of arsenic, in the dose of -^ to ^ grain (0.001-0.0015), often do good, and careful examination should be made of the cir- culatory, renal, and respiratory apparatus to discover any weak points, such as vascular relaxation or tendencies to varicosities. The dis- tilled or fluid extract of hamamelis is often of service in the dose of \ to 1 drachm (2.0-4.0) of the former and 10 to 20 drops (0.65-1.3) of the latter preparation. In some cases absolute rest of the feet will be necessary before a cure is reached. Where the feet are tender the most common cause is bruising from too thin soles on the shoes, too tight shoes, and from abrasions or skin disease. More commonly than all they become sore from excessive sweating and resulting maceration. The treatment of sweating and tender feet is, of course, the removal of the cause and the use of remedies designed to toughen and harden the skin of the parts. Probably the best application for this purpose is a solution of salicylic acid and borax, half and half, in Avater and glycerin, rubbed over the feet night and morning. If the SAveating is very severe, clean stockings should be Avorn each day, the stockings being previously soaked in a strong solution of borax and dried. The following prescription affords a useful poAvder : R.—Pulv. acidi salicylici......gr. xx vel xl (1.3-2.65). Pulv. acidi borici.......%\] (8.0). Pulv. amyli......q. s. ad ly (32.0).—M. S.—Tobe dusted over the feet night and morning, after washing and thoroughly dry- ing them. FEVER, AND ITS TREATMENT. 549 Sometimes the use of cotton instead of Avoollen stockings may aid in the cure. FEVER, AND ITS TREATMENT. (For the Treatment of each Fever, see its Title.) At the present time the medical profession are almost universally of the opinion that fever is a disorder of calorification dependent upon nervous action, said nervous action being the result of various causes, such as the presence of poisonous materials in the blood or of perverted functional activity of heat-centres. The first may be rep- resented by the fever of any infectious disease ; the second, by the so- called hysterical hyperpyrexia. Turning from the general question of fever to those methods and drugs which combat it the rule of practice should be to control all fevers by the use of cold sponging or bathing and resort to antipyretic drugs as little as possible. The value of a drug Avhich can decrease high temperature by influ- encing heat-production alone cannot be over-estimated, and Avhile sev- eral drugs seem to influence this part of the heat apparatus more than that portion connected Avith the dissipation of heat, we have no sub- stance which is distinctly and solely capable of exercising an inhib- itory power over the development of heat in the body. For practical purposes we may therefore divide antipyretics into three great classes: First, the substances Avhich allay or prevent fever by inhibiting its production; second, the drugs AA'hich possess the power of decreasing bodily temperature by increasing the dissipation and decreasing the production of heat; and third, the compounds Avhich allay fever, not by stopping the manufacture of heat-units, but by so increasing the exhalation of heat that the loss is greater than the manufacture. The first and last of these three classes are directly opposed to one another. The second class is half-Avay between, and it is to this class that most of our antipyretic drugs belong. The first is the ideal; the second is the one we have to be content Avith ; the third is the one used by our forefathers. The objection to the use of all antipyretic drugs is that they de- press the patient and decrease his power of resisting disease. Before Ave consider the uses of these drugs in fevers it is necessary to define Avhat Ave mean by hyperpyrexia. As given by most writers upon the subject of fever, this term is applied to any state in which the temperature reaches 106° or 107° F., but the presence of a high temperature alone does not constitute the sole indication for treatment, the physician being governed by the state of the patient Avho is labor- ing under the malady. A temperature of 106° F. in a young healthy man suffering from an attack of some disease of short duration does not mean very great danger, but a temperature of 103° day in and day out in typhoid fever does mean danger, and must be carefully attended to. The question is one not of actual degrees Fahrenheit, but rather as to Avhether the temperature present is doing any harm. Turning to the drugs Avhich are divided into classes named from 550 DISEASES. their physiological effects, we may, in view of our present knowledge, place them as follows: First, those Avhich decrease heat-production alone are not knoAvn. Second, those which act both on dissipation and pro- duction are antipyrin, acetanilid, carbolic acid, salicylic acid, similar substances, and quinine. In this class, also, should be placed cold bathing, Avhich probably decreases heat-production as Avell as increases heat-dissipation. Third, those drugs which only dissipate heat, as far as we know—namely, the great group of cardiac sedatives and their allies. No one is more sensible of the fact than the Avriter that this arrangement of the subject is partly artificial, but in the present state of our knowledge it is probably the best Ave can do. Though a number of writers have claimed that certain antipyretic remedies of equal poAver act Avith different results in different diseases. the writer has never been able to see any such distinction, and Ave must be guided rather by experience as to the value of some particular antipyretic in all diseases than by any other rule. All observers are not in accord, hoAvever, as to the best one of this class. While phe- nacetin has been spoken of very highlv by some authorities, the writer has heard it equally condemned by others, and, although Ringer prefers antipyrin, Mitchell Bruce relies chiefly on acetanilid. In America many persons prefer acetanilid. It may be said that we have only tAvo measures for the relief of fever which are reliable and have stood the test of time. These are the employment of antipyrin and acetanilid, and the use of cold. The drugs just named are to be used very rarely, but the beneficent effects of the use of cold are extraordinary, and it should be constantly employed if the fever is high. (For the mode of using antipyrin and acetanilid see pp. 47 and 77, and for the use of cold see p. 402.) A very important question arises as to the A^alue of cold bathing in private practice. There can be no doubt of its acting well under these circumstances if carefully carried out, and it is certainly much the best remedy for fever where trained nurses are on hand to admin- ister it; but Avhere only members of the family are in care of the sick man, and where the doctor can be on hand only once in twenty- four hours, it is manifestly difficult to resort to it. Nevertheless, the friends of the patient, if they are intelligent, can easily be taught hoAv to use cold sponging Avith friction, and good results, far superior to those due to antipyretic drugs, are thus obtained. The reasons for this are discussed further on. The water should be as cold as is neces- sary to reduce the fever satisfactorily in tAventy minutes of sponging. and reaction must be produced by friction applied to the skin. This reaction is more important than the reduction of the fever. (See Cold in Fevers. Part III.) (For the use of guaiacol externally in fever, see article on Guaiacol.) Sthenic Fevers. The application of antipyretics to the febrile temperatures occur- ring in sthenic cases has an entirely different purpose from their employment in a prolonged low fever of the adynamic type. There can be little doubt that in the sudden excessive outbursts of febrile FEVER, AND ITS TREATMENT. 551 temperature in a child from functional disorder, but Avith no acute disease underlying it, antipyretics may be of value. But the wise phy- sician Avill ahvays endeaAor to avoid their use if possible. Fever is not, as a rule, a very harmful process unless it is continued for a lone period or is exceptionally high. Indeed, as pointed out elsewhere, it may even be beneficial. Antipyretic drugs decrease oxidation, proba- bly interfere Avith ordinary protective natural efforts against disease, and place upon the eliminating organs the task of excretion. In acute illnesses, Avhere the use of cold is impossible, these remedies mav be giAren. The fever in such cases cannot be prolonged enough to neces- sitate the use of antipyretics day in and day out for Aveeks at a time, and there is, for this reason, less danger of the patient being injured by their influence. In scarlet fever the use of such drugs should be most carefully watched, because the kidneys are in danger and the disturbances accompanying the fever may last along time. If in any case it is decided to give antipyretic drugs, they should never be pushed to the point at Avhich even moderate cyanosis de- velops, and if they do not control the fever in moderately full dose they should be discarded and resort to cold bathing insisted upon. In thermic fever, or sunstroke, the employment of antipyretics is often useless. The excessively rapid upAvard rush of the temperature responds in no way to drugs, and there are cases on record in which the use of antipyrin has utterly failed of good result. Thus, in one case reported by Singer a man suffering from thermic fever, with a temper- ature of 108 degrees, received 50 grains (3.3) of antipyrin hypodermi- cally at 6 p. m. ; at 7 P. m. he received 10 grains (0.65) more under the skin; at 8 p. m. 20 grains (1.3) more; and at 9.30 another 20 grains (1.3) were used without effect. In other words, 100 grains (Q.Q) in three hours and a half proved useless. In children suffering from excessive heat during summer weather antipyrin seems to be very use- ful, and has been highly recommended by Demme. It must be used with caution lest collapse be induced, and the author much prefers the use of cool sponging or baths Avith friction. Asthenic Fevers. (Fevers of a Typhoid Type.) In the opinion of the author, antipyretics should play a secondary role in the reduction of the pyrexia of the typhoid state, our main reliance being upon cold applications, the antipyretics being rarely used as an adjunct to the cold pack or bath. Aside from the fact that he has found such an opinion well founded in a large number of typhoid-fever cases, logical reasoning endorses its correctness. Even if antipyretics Avere perfectly innocuous, their constant use in fever Avould but give the already overstrained kidneys the task of their excretion, Avhile the stomac,h, sufficiently disturbed by necessary medi- cines and illness, has enough to do Avithout the addition of another load. Further than this, Ave know that these drugs are not per- fectly harmless, and Ave also knoAv that they act on the protoplasm of the body, and in consequence must gradually lose their poAver, 552 DISEASES. Avhich is not the case with the cold pack. The Avriter is sure that in typhoid and other Ioav fevers of the continued type antipyretics should be given only when the cold pack cannot be used, or at the end of the cold application to prevent the temperature from bounding upAvard after its depression. (For Brand's treatment, see Cold.) Further than this, fever a\ ill sometimes resist all doses of antipyretics Ave can give or all that it is safe to give, but no fever can resist the cold bath. In diseases of a more chronic type, particularly in those represented by phthisis, antipyretics are of doubtful value, owing to the increased sweating which is apt to be produced, and unless the patient seems to be particularly robust they should not be employed except in the smallest effectual doses and with great caution. FRECKLES AND CHLOASMA. The removal of freckles is readily accomplished, but their return is inevitable if any exposure to the sun or wind occurs. One of the best applications for their removal is a solution of corrosive sublimate, in water, varying in strength from 1 to 4 grains to the ounce (0.05- 0.2 : 32.0), and applied night and morning until the skin shows that it is irritated, when the lotion must be stopped for some days, after which its use may be begun again. A very efficient and much less dangerous remedy to leave about the room in which children are allowed to play is a saturated solution of boric acid in water, applied in the same manner as is the solution of bichloride of mercury. Another remedy is lactic acid, 10 grains to a drachm (0.65 : 4.0) of Avater, used in the same manner as the solution of the bichloride of mercury. The following prescription is recommended by Unna: R.—Bismuth oxidi 1 .. .„ ., Pulv. amyli |........aa gr. xxx (2.0). Kaolini............^j (4.0). Glycerini............fsjij (8.0). Aquae rosae........q.s. ad f£ij (64.0).— M. S.—Paint on spots and allow to dry, washing the drug off before each new appli- cation. Or the following may be used R.—Zinci oxidi .... Hydrarg. ammoniati 01. theobromae . . 01. ricini..... Essent. rosae. . . . S.—Apply night and morning, gr. iij (0.2). gr. iss (0.08). f^ijss (10.0). fSijss (10.0). gtt. x (0.65).—M. GASTRALGIA.1 The treatment of gastralgia may be divided into two parts—that directed to the relief of the attack when it is present, and that de- voted to the prevention of other attacks. During the acute stage hot applications and drinks, aromatic and locally stimulating warm 1 See article written by author in Keating's Cyclopasdia of Diseases of Children vol. in. J ' GASTRALGIA. 553 infusions, a few drops of chloroform, or brandy or Avhiskey hot and concentrated, or 30 or 40 drops (2.0-2.65) of laudanum may be used. Counter-irritation often does good, and in some cases, particularly if a suspicion of an hysterical element exists, a vigorous revulsive may act with surprising success. Emesis and purgation are sometimes indicated, since in the early attacks the cause of the pain may be suspected to be the presence of indigestible food. The treatment required in the intervals betAveen the attacks must vary Avith the cause and with the general condition of health. A careful search must be made for the real cause of the trouble, and when found it must be removed or palliated by appropriate measures. The diet should be carefully regulated, and all the hygienic details of the patient's life be critically studied and directed. The avoidance of improper food, the abandonment of tea, coffee, and tobacco, the prescription of proper dress, exercise, or change of residence, ma/be folloAved by marked improvement in general health and by a cessa- tion of the attacks of gastralgia. In regard to remedies it may be premised that all depressing drugs must be avoided, as well as all purgatives Avhich would Aveaken the digestion. Any marked disturbance of digestion should be corrected; and this may require the use of pepsin or of some tonic remedies, such as are suggested in the article on Indigestion. The chief reliance is, however, to be placed upon the administration of arsenic and iron immediately after meals, in proper form and doses. Thus, we may direct, R.—Liquor potassii arsenitis........f^j (4.0). Yini ferri amari.........q. s. ad fJiv (128.0).—M. S.—From 30 to 60 minims (2.0-4.0) in water after meals, three times daily, for a child of six years, or twice this quantity for an adult. Or, R.—Tinctura? ferri chloridi.........f|j (32.0). Acidi hvdrochlorici diluti 1 -- ez nsm ht T. - •■,. • >.....aa f^ss (16.0).—M. Liquor acidi arsenosi j o \ / S.—From 4 to 20 drops (0.2-1.3) in water after meals, three times daily. Occasionally eAren better results are secured by the use of cod-liver oil in emulsion with the hypophosphites. The solution of bromide of strontium (Paraf-Javal) is a valuable one in gastralgia in the dose of a tablespoonful (16.0) three times a day. It is well, in cases where the pain is very severe, to combine Avith the above a powder of bismuth subnitrate and saccharated pepsin, given about an hour or an hour and a half after meals. Consti- pation, should it exist, must be overcome by proper diet, massage, enemata, or by suppositories of gluten or glycerin or soap. If the use of bismuth favors the continuance of constipation too decidedly, small doses of cyanide of potassium, dilute hydrocyanic acid, or chloroform may be substituted at the same hours. In cases Avhere a highly neurotic state exists, it may be necessary to alternate all other treatment with the bromides or with the preparations of valerian, or the following prescription may be used: 554 DISEASES. R.—Acid, hydrocyanic, dil.........f,~j (4.0). Ext. cannab. indicae fl.........f.^j (4.0). Tr. hyoscyam............t'oj (4.0). Spt. chloroformi..........f^ij (8.0).—M. S.—30 minims (2.0) t. d. in water for an adult. GASTRIC CATARRH (ACUTE). By far the most important point in the treatment of acute gastric catarrh is the regulation of the diet, and the following abstract from the article written by the author for the third volume of Keating's Cyclopaedia of Diseases of Children embodies so thoroughly the ideas which the writer desires to express that he has inserted it here: The dietetics may be divided into two parts—first, the regulation of the food during convalescence or during the attack, and, second, the cha- racter of the food to be used during the interval folloAving one attack and preceding the next. Total abstinence from food in the acute stages of the attack, and absolute bodilv and mental quietude, are advisable. There are several reasons for this. In the first place, the juices of the stomach are in an abnormal state and unfit to act properly if the % stomach receive more food. Secondly, the mucous membrane of the stomach is already hypersemic from the inflamma- tion, and, as the normal viscus becomes physiologically hyperaemic on the ingestion of food, Ave would add to the congestion of the blood- vessels did Ave allow more nourishment to enter the stomach. Last of all, the excess of the mucus and lactic and butyric acids present ren- ders any new food impure before it can be assimilated, and so pro- longs the trouble. As the attack passes off small amounts of food may be given Avhich should be of a kind readily digested and not likely to become easily decomposed or rendered acrid by the mucus in the stomach. Milk with a large percentage of lime-Avater is to be used, since the alkali not only prevents a too firm coagulation, but also decreases the secretion and acid reaction of the mucus. The thirst is often excessive, although anorexia is complete, and small pieces of ice may be administered for its relief. Commonly it will be found that the patient rapidly improves up to a certain point, then stops improving or relapses. This is sometimes due to an accumulation of mucus, Avhich when mixed with food causes it to undergo fermentation. If marked evidences of the presence of this secretion are given, a mild and gently-acting emetic may be employed to dislodge the fermenting mass. In other instances the relapses depend upon a tendency to a condition of atony, which can only be overcome by prolonged and careful treatment adapted to the improvement of the general health. Sodium bicarbonate Avith compound infusion or compound tincture of gentian may be used during convalescence, and small sips of effer- vescing draughts are useful. If constipation exists and vomiting for- bids the use of the ordinary purgatives, a Seidlitz poAvder divided into fourths or fifths, and taken in this way every fifteen minutes or half-hour, will settle the stomach, move the bowels, and often carry away mucus. GASTRIC CATARRH, CHRONIC. 555 If there is much epigastric distress, a spice poultice is often of service. Sweets and starches are to be rigidly denied the patient. If anae- mia exists, iron may be used, but this is rarely needed. The abdomen should be carefully protected Avith flannel, and draughts and unsanitary surroundings avoided. The use of pepsin and of hydrochloric acid is to be much more carefully resorted to than has heretofore been the custom. As a rule, we are apt to forget that pepsin acts largely by catalysis, and that it is not secreted as pepsin, but as pepsinogen, a substance which is changed into pepsin in the presence of an acid. For this reason hydrochloric acid should be employed after inflammation has passed away, and pepsin given in large or small quantity according as there is reason to believe this ferment to be in normal* or abnormal amount. Common Salt (sodium chloride) is often beneficial, and should be ahvays used, in moderation, with the food. GASTRIC CATARRH (CHRONIC). Chronic gastric catarrh is a condition of the stomach commonly seen in this country in a more or less Avell developed form. It is often asso- ciated Avith much indigestion and the eructation of sour liquids, or even with active vomiting. The secretions of the stomach are nearly ahvays abnormal, and fermentative changes are constantly present in the gas- tric contents. Lavage is almost ahvays to be resorted to for its relief. (See Part III. for Lavage.) By far the best treatment for this condition is the use of counter- irritation over the epigastrium, the close regulation of the diet, and the use, internally, of nitrate of silver and extract of hyoscyamus, and, if great hyperacidity exists, the administration of the subnitrate of bismuth. Often, howeA^er, the better remedy is bicarbonate of sodium in the dose of 5 to 20 grains. In many instances the patient will be greatly benefited by the use of a Seidlitz poAvder or Carlsbad salt! or Saratoga Carlsbad water before breakfast each morning, as this washes out the stomach, dissolves the mucus, and unloads the mucous membrane of its congestion, at the same time overcoming any engorge- ment of the liver. Constipation is nearly ahvays present, and should be removed by appropriate drugs, such as cascara sagrada, of which the best preparation is the fluid extract, rendered free from bitter taste by certain large manufacturers in this country, such as Parke, Davis & Company, or in the form of cascara sagrada cordial. All fats, rich foods, strong meats, ham, bacon, or fried things are to be avoided, and only light broths, koumyss, or matzoon resorted to if the case be an obstinate or severe one. A nitrate-of-silver pill should be used half an hour before each meal, and be prescribed as follows: 1 Artificial Carlsbad salt may be ordered, composed of 8 ounces of sodium sulphate, \ an ounce of sodium chloride, and 1 ounce of sodium carbonate. The dose varies from 2 drachms to \ an ounce (8.0-16.0). 556 DISEASES. R.—Argenti nitratis...........gr. iv (0.2). Extract, hyoscyami.........gr. x (0.65).—M. Ft. in pil. No. xx. S.—One, half to one hour before each meal. In cases in which the chronic inflammatory process has gone on to atrophy of the tubules the use of hydrochloric acid is often of great value. GASTRIC DILATATION.1 The treatment of dilatation of the stomach may be divided into two varieties—the first consisting of the methods of cure which are directed against the diseased state of the gastric Avails themselves; the second, of those methods by which abnormal changes in the food and the gastric contents and secretions are combated, thereby allow- ing reparative changes to take place. As is Avell known, dilatation of the stomach may be dependent upon some constitutional or some local cause. If the cause be rickets, it is evident that the nutri- tion of the bony system and of the system in general is to be im- proved, and that remedies devoted to this object are to be given, such as cod-liver oil by inunctions, or, if the digestive apparatus will bear it, the oil may be given by the stomach. Lactophosphate of lime, phosphate of sodium, or iron, often in the form of the syrup of the iodide, should be used if any signs of struma are present. Good foods possessing large amounts of salts, yet easy of digestion, are under these circumstances particularly desirable, and by far the larger part of the treatment should be directed to the dietetics of the case. Of this the writer will speak farther on. There are several means to be employed for the relief of gastric dilatation other than those Avhich can be called medicinal, so far as drugs are concerned. These consist, first, in efforts to evacuate the stomach and to cleanse it (see Lavage, Part III.); secondly, in attempts by these and other means to prevent its distention by the gases which arise or by the accumulation of ingesta which takes place; thirdly, in the regulation of the diet so as to avoid causes which have a tendency to increase the disorder. Dilatation of the stomach is so difficult to cure that very satis- factory results are not to be looked forAvard to; nevertheless, the nutrition and the general state of heath are to be carefully con- sidered. The treatment of dilatation to be first considered is dietetic. There can be no doubt that one of the chief reasons for the emaciation Avhich comes on is the failure on the part of the stomach to digest and assimilate nourishment. In addition to this, the intestine is really the place for absorption of food to take place, and the delay of the food in the stomach virtually makes the chyme unfit for the function of the small intestine. The foods to be given are, of course, to be in the highest degree 1 See article by author in Keating's Cyclopaedia of Diseases of Children, vol. iii. GASTRIC ULCER. 557 capable of ready assimilation, and should be confined, especially in severe cases, to the materials Avhich we can readily predigest by the employment of the digestive ferments noAv so largely sold. Carefully- skimmed milk is A^aluable, aside from its inherent usefulness, in that it lacks the fats, which can be utilized only in the intestines, and Avhich simply break doAvn and decompose if kept in the stomach. Oyster broth, carefully freed from any oily matters in cooking and thoroughly pancreatized, is to be given. Ordinary whey obtained from milk by means of rennet is useful. Rectal alimentation to some degree is always useful, and EAvald of Berlin suggests the folloAving nutrient enema: Beat up two eggs with a tablespoonful of cold water; to this add a little starch, boiled in half a cupful of a 20 per cent, solution of grape-sugar and a wine- glassful of red Avine. The solution is to be Avell mixed at a tempera- ture not high enough to coagulate the albumin, and injected as high up into the boAvel as possible. For a child this mixture should be somewhat less in quantity than that given for the adult, particularly as to the wine. An exceedingly important part of the dietetic treatment of gastric dilatation consists in the constant bearing in mind of the fact that the tendency of food is to accumulate, and the avoidance of the pernicious habit of adding solids or liquids to the quantity of ingesta still remain- ing from a previous meal. If the child is old enough, all the remains of previous feedings should be removed by lavage before anything more is given, since otherAvise the SAveet food is at once contaminated by the liquids Avhich it meets in the stomach. The medicinal treatment of gastric ectasy is, unfortunately, very limited, so far as the stomach itself is concerned, and, indeed, we doubt whether any direct medication can ever be of much value unless in the form of disinfectant substances, such as we have spoken of when speaking of lavage, and these only prevent decomposition of the food and do not effect a cure. In a case of marked gastric dilatation Ave should, nevertheless, alwavs resort to the bitter tonics, such as gentian or calumba, and for the improvement of the muscular coats of the viscus should employ the tincture or extract of physostigma in the dose of 5 to 10 drops (0.3-0.65) or \ to J grain (0.005-0.01), respectively. In the case of a child under the author's care a very extraordinary improvement fol- loAved the use of this drug and the careful fulfilling of all the direc- tions just given except the lavage, which was not employed. Another remedial measure Avhich has been comparatively recently introduced is the faradization of the gastric walls by an internal and external electrode made for this purpose by electricians. GASTRIC ULCER. In the treatment of gastric ulcer three points must be borne in mind as being essential. These are, rest for the stomach as far as possible, rest for the patient, and the maintenance of the gen- 558 DISEASES. eral health. The first of these points involves a consideration of diet. If in any case the stomach is very irritable, it is best to place the patient in bed and nourish her for from tAvo to eight days by means of enemata. Probably the best form of nourishment for this purpose is a mixture recommended by Dreschfeld, and consisting of 2 raAV eggs Avith 2 ounces (64.0) of beef-tea and a little brandy, Avhich may amount to 1 ounce (32.0) if the patient really needs stimulants. It may be Avell to place a little pepsin in this injection to peptonize the proteids, but if this is done the alcohol must be left out, as it Avill interfere with the activity of the pepsin. Pancreatin may also be used with adArantage in some cases in the amount of 5 or 10 grains (0.35-0.65) in each injection. For the relief of thirst, which may be excessive if rectal alimentation is resorted to, the patient should hold in the mouth small pieces of ice or drink moderate quantities of barley- or rice-Avater. After this treatment has been used for some days, small quantities of food may be given by the mouth, such as a little peptonized milk or a little Avarm milk with lime-water in the proportion of half and half, or 1 part lime-Avater to 2 of milk. After this thin arrow-root or gruel may be given in moderate quantitj'. It is better to give the food in small amount every two hours than in larger quantity three times a day. The increase in rations, both as to variety and amount, should be most gradual, the physician extend- ing the dieting over at least six weeks, of Avhich the first two had best be spent in bed. It is Avell to use massage and electricity under these circumstances to presenre nutrition, as in the rest cure. (See Rest Cure.) Beef-tea and soups had better be avoided during the early stages of the treatment, as they will irritate the stomach. Soft-boiled eggs, tender chicken or game, and minced lamb may be finally given. Cheese, coffee, tea, beer, and ale are to be avoided, as are all hot drinks. Fresh green vegetables may be used in moderation, but fresh bread and unripe fruit must be carefully avoided. When milk is taken it should he Avarmed. The presence of gastric pain indicates that the diet must be cut down in quantity and the nutrition main- tained solely by rectal injection. The drug treatment of these cases is both palliative as to pain and curative. For the pain counter-irritation of a more or less severe and constant type should be applied to the epigastrium, either as a spice or mustard plaster or by means of a hot-Avater bag. The counter- irritation should be as continuous as possible. Sodium bicarbonate and the subnitrate and subcarbonate of bismuth are also of service in the dose of 20 grains (1.3) each, and to these may be added from A- to \ of a grain (0.003-0.015) of morphine hydrochlorate or 1 grain (0.05) of codeine These may be given thrice daily if necessary. Onlv the smallest dose of morphine necessary to relieve the pam should be employed. By far the best treatment for the pain and for the ulcer itself is the folloAving pill: R.—Argenti nitratis.......gr. iv (0.2). Extracti hyoscyami.....gr. x vel xx (0.65-1.3).—M. Ft. in pil. Xo. xx. S.—One pill half to one hour before meals. GASTRITIS, ACUTE. 559 For the constipation Avhich is frequently present the patient may receive a dose of Carlsbad salts or phosphate of sodium, or even the sulphate of magnesium. For the relief of vomiting and of hoematemesis absolute abstinence from food, so far as its administration by the mouth is concerned, is to be insisted upon. Nutrition must be maintained, under such cir- cumstances, by the rectum. Small doses of cocaine, ^ grain (0.015), may be given, or cocaine and bismuth subnitrate together if the vom- iting is persistent. Sometimes drop doses of creasote are useful, or carbolic acid may be given in the same dose Avith 20 grains (1.3) of subnitrate of bismuth. One of the best remedies for hsematemesis is oil of turpentine in the dose of 5 to 10 drops (0.35-0.65) four times a day. In other cases good results will often folloAv the use of the solution of the subsulphate of iron (Monsel's solution) in the dose of 3 drops (0.15) every half-hour or by the employment of 3 grains (0.15) of the salt itself in pill. Cold compresses or an ice-bag should be applied to the epigastrium. Should perforation of the stomach occur, the prognosis is most gloomy unless inflammatory processes protect the peritoneal cavity, as often occurs. The tendency to peritonitis should be antagonized by the application of cold to the belly-wall, by the avoidance of food, by perfect physical rest, and by supportive treatment in the way of heat to the limbs and the hypodermic use of ether, brandy, or ammonia. Morphine should also be given freely unless collapse is . too pronounced, as it tends to prevent abdominal pain and inflamma- tion. Operative measures may be resorted to in suitable cases. GASTRITIS (ACUTE). This is generally due to the ingestion of irritant foods or drinks, rarely arising in its true acute form from other causes. The treatment is to be directed entirely to the prevention of the spread of the inflammation and to the relief of that already devel- oped. If the patient is seen soon after the onset of the trouble, the stomach is to be emptied of all irritant substances by means of vom- iting induced by large draughts of warm Avater, or, better still, by the use of the stomach-pump, as the retching may increase the irritation. Mucilaginous drinks are to be given freely, and albuminous materials seem especially useful. Oils and similar protecthe liquids aid in preventing further damage. Opium, to allay pain and the local and systemic irritation, is invaluable. This drug should ahvays be given in liquid form, and the deodorized tincture is the best in this respect, OAving to its freedom from narcotine. Paregoric contains too little opium to be of value, and is irritating because of its volatile oil. If the stomach will not retain drugs, they should be given by the rec- tum. If eAridences of collapse appear, hot applications, atropine, or belladonna should be exhibited. It is important that the heat should be applied over the epigastrium and chest, and a flaxseed poul- tice is the best method of doing this. Practically, the same rules hold good in regard to diet in both acute gastritis and in gastro-enteritis. 560 DISEASES. GASTRO-ENTERITIS. Gastro-enteritis is a condition of inflammation affecting the entire alimentary canal in some instances, and commonly produced by the ingestion of some irritant substance, either in the form of bad food, poisons, or mechanical irritants, such as grape-seeds or cherry-stones. The symptoms accompanying it are exceedingly various, but consist chiefly in pain of a griping character with watery or mucous stools, or, if the inflammation be very severe, absolute and unyielding con- stipation may be present. The nervous symptoms depend upon the degree of irritation and the general nervous tendency of the patient, and if the trouble is very severe he may go on into a condition of shock or collapse. If the irritation is very intense, exfoliation of the mucous mem- brane may take place, the epithelium coming away in shreds. The treatment of gastro-enteritis depends upon its severity and cause. Almost always we first allay the pain and tendency to inflam- mation by the hypodermic use of morphine, and immediately follow this or precede it by an emetic of a non-irritating and rapidly-acting type, such as apomorphine, provided there is reason to believe that the poison or food still remains in whole or in part in the stomach. If the irritant has been taken some time before the physician is called in to see the case, emetics are contraindicated, as by disturbing the abdominal contents they render the inflammation Avorse. Following this, or in place of it if emetics are not useful because the poison has already passed through the pylorus, castor oil in the dose of 2 to 3 tablespoonfuls (32.0-48.0) to an adult may be given to sAveep out the offending materials and lubricate the intestinal walls. In other cases sulphate of magnesium may be used, but not sulphate of sodium or Rochelle salt, as they are both irritant. The sulphate of magnesium is of Aralue, because, in addition to its purgative effect, it also depletes the inflamed bowel. Having gotten rid of all offending materials, opium is to be freely used to allay irritation and control diarrhoea (see Diarrhoea), and hot compresses are to be applied to the belly, or a spice or mustard plaster used instead. Vomiting when it is excessive is to be treated in the manner described under that head. The after-treatment of acute gastro-enteritis is very important, both in respect to food and drugs. The inflammatory process, if severe, will have interfered Avith glandular action to such an extent that starvation from the non-assimi- lation of food may occur. Predigested foods are therefore in many cases indispensable, and a carefully regulated diet is a sine qud non. GLAUCOMA. Glaucoma, or that disease dependent upon an increase of intra- ocular pressure, appears in an acute or a chronic form. The disease in general terms is characterized by halos appearing about the gas-light; periods of obscuration of sight; shrinking of the nasal half of the field of vision ; narrowing of the anterior chamber of the eye; anses- GONORRHOEA. 561 thesia of the cornea; and increased tension of the eyeball. In the "glaucomatous attack," or acute glaucoma, the injection of the eve- ball is intense; the lids swell, there is photophobia, the cornea is steamy, the pupil dilated and motionless, and the vision rapidly destroyed. The case may be mistaken for iritis or acute ophthalmia —a fatal blunder. Iridectomy or an equivalent measure is the only treatment for glaucoma. If for any reason this is delayed, a solution of the sul- phate of eserine, 1 to 2 grains to the ounce (0.05-0.1: 32.0), or pilo- carpine nitrate in tAvice this strength, should be dropped into the eye every tAvo or three hours until relief follows. Atropine must not be employed. Hot compresses, opiates, and leeches are also useful to alleviate the pain if for any reason operation is delayed. GONORRHOEA. The therapeutics of urethritis varies in accordance with whether the disease is acute or chronic, and is very greatly modified by the seat of inflammation—a posterior urethritis, for anatomical and mechanical reasons, not being amenable to the same treatment Avhich will prove successful Avhen the disease invades the penile portion of the urethra. The membranous and prostatic portions of the urethra constitute its posterior part. They are surrounded by layers of powerful mus- cles which keep the canal constantly occluded and Avhich play the part of vesical sphincters. Hence any injection forced into the urethra passes to, but not beyond, its membranous part, and is Avorse than useless if administered Avith the intention of combating inflam- mation of the posterior urethra. It is the rare exception for gonor- rhoea to be confined to the anterior urethra. Usually it extends back, and a common cause of gleet is failure to recognize this fact, and con- sequently the omission of measures calculated to cure the deep inflam- mation. Since the general acceptance of the gonococcus as a specific cause of gonorrhoea the treatment of acute anterior urethritis has been mainly antiseptic, those drugs being chosen Avhich are found to act most poAverfully upon the specific germs, and at the same time pro- duce the least irritant action upon the mucous membrane. Bichloride of mercury, as representing the most powerful germicide knoAvn to medicine, has been used most extensively. The main objection to its action lies in the fact that Avhen employed in efficient strength it is exceedingly irritating. This effect may, to some extent, be avoided by using a large quantity in dilute solution, and one of the most sat- isfactory treatments yet advocated consists in thoroughly and repeat- edly flushing the urethra Avith bichloride lotion, 1 : 20,000 or 1 : 40,000. This may be accomplished by means of a bulbous catheter provided with numerous small apertures opening backAvard just behind the enlarged extremity; immediately after urination the bulb is car- ried to the membranous portion of the urethra; the tube from an irri- 36 562 DISEASES. gator is then attached to the extremity of the catheter, and one or two pints of dilute mercury solution, as hot as can be borne, are injected. This may be repeated once or twice daily. When the urethra is so sensitive that the passage of an instrument is not prac- ticable, a conical nozzle of a size to close the meatus entirely Avhen inserted may be employed for irrigation. After first thoroughly washing the glans and lips of the meatus the nozzle should be inserted and held firmly in place. This ensures the passage of the injection back as far as the membranous portion of the urethra, beyond which it will not pass if the pressure does not exceed that obtained by ele- vating the irrigator two feet above the level of the urethra. When neither of these methods of irrigation can be practised, a syringe Avith a conical nozzle and with a capacity of at least 1 ounce may be employed: this should be used tAvo to six times a day, two syringe- fuls of the dilute lotion being injected immediately after urination. The liquid should be forced in very gently, being allowed to Aoav out by slightly lessening the pressure of the nozzle upon the meatus Avhen the anterior urethra is full. When large injections are attempted by the ordinary small urethral syringe, the frequent application of the latter to the meatus occasions much irritation. It is desirable' that the injection should pass back into the posterior urethra, since this portion of the canal is usually involved in acute inflammation. Copious irrigations inaugurated in the earliest stage of gonorrhoea are frequently successful in producing a complete cure in a few days. Much stronger solutions of mercury are frequently employed, the concentration depending upon the subjective sensations of the patient, and varying from 1: 2000 to 1: 6000. The folloAving prescriptions are among the most efficacious in checking the discharge: R .—Argent, nit..............gr. ss (0.025). Aq.destil..............|iij (96.0).—M. S.—Locally in the subsiding stage. R.—Ext. hydrast (colorless) .......fjiv (16.0). Bismuth, sublact...........gvj (24.0). Glycerin. . ............f^iv (16.6). Aq...............q. s. fgvj (192.0).—M. R.—Zinc, sulph. ~| Acid, carbol. V..........aa gr xij (1.0). Alum. crud. J Aq. destil..............fgvj (192.0).—M. S.—Locally. Dilute if painful. When the gonorrhoea has already assumed a markedly inflamma- tory type, with swelling and oedema of the penis, redness and ever- sion of the meatus, and great sensitiveness of the urethra, no injec- tion should be employed. The penis should be wrapped in cloths kept wet with alcohol and water or lead-Avater and laudanum. With the subsidence of acute inflammatory symptoms and the appearance of copious discharge the injection treatment may be inaugurated. It GONORRHOEA. 563 must be remembered that injections may in themselves prevent the discharge from entirely disappearing. Hence, as the symptoms ame- liorate the injection should be made less frequently, finally being entirely omitted for some days if the discharge seems to continue longer than usual. Internal medication and constitutional treatment are most import- ant in all forms and stages of gonorrhoea. It is almost universally accepted that certain drugs, such as copaiba, cubebs, and oil of san- dahvood, Avhen eliminated through the kidneys, possess the power of inhibiting the growth of the gonococci or of destroying their vitality. Bacteriological research has shown that of this'class of remedies copaiba alone possesses such poAver. To this drug may be added salol, Avhich has been proved by laboratory and clinical tests to exert a powerful germicidal action upon the gonococcus. Clinical experience has shoAvn that oil of sandalwood is of great value in the treatment of acute gonorrhoea. An excellent formula for the administration of balsams is the folloAvinjr: R— 01. santal...............gr. v (0.3). Balsam copaib.............n^v (0.3). 01. cinnamom.............tt\j ^0.05).—M. Encapsulate. These capsules should be taken one hour after meals, from six to twelve being admin- tered. Obstinate chordee may require bromide of potassium and chloral. Of these a drachm of the former must be given at bed-time, and 10 grains of the latter; this may be repeated in the night if painful erections persist. Lupulin in 30-grain (2.0) doses is also endorsed. When practicable, opium or belladonna suppositories, or hypodermic injections into or about the perineum of morphine gr. \ (0.015) and atropine gr. -fa (0.001), will proAre very satisfactory. In all cases the patient should be instructed to rise once during the night and pass his Avater. Ardor urines is usually relieved by the use of demulcent drinks and by the employment of bicarbonate of sodium or citrate of potas- sium in sufficient doses to render the urine but slightly acid. Either of these drugs is conveniently administered in the form of compressed tablets, taken one or two hours after meals in 10-grain (0.65) doses, the quantity being increased, if necessary, until the desired effect is produced on the urine. The instillation into the urethra, by means of an eye-dropper, of a 4 per cent, solution of cocaine a few minutes before urination markedly diminishes the burning. Finally, this symptom may often be relieved by instructing the patient to pass his Avater Avith the penis submerged in a vessel containing Avater as hot as can be borne. Where the inflammation is of a high grade and attended by fever and general malaise, the administration of 2 drops (0.1) of aconite repeated every tAvo or three hours is folloAved by marked relief In regard to the general treatment of a patient suffering from gonorrhoeal urethritis rest in bed is particularly desirable. This, hoAvever, is rarely possible, and the surgeon must be content with 564 DISEASES. enforcing the avoidance of all active exertion and the observance of as much rest of mind and body as is compatible Avith the continuance of the daily routine of business life. While skimmed milk or butter- milk diet is theoretically desirable, the advantages to be gained by it are scarcely sufficient to justify insistence upon such a regimen, especially as it would excite suspicion as to the presence of venereal disease; hence a light diet, consisting mainly of vegetables and fruits, and in quantity about half that usually taken, Avith a minimum amount of meat, should be advised. In addition the patient should be induced to drink liberally of plain water or any of the sparkling mineral Avaters, as by this means the urine is not only rendered bland, but greatly increased in quantity, thus enabling the urethra to be fully flushed from behind many times a day. Flooding of the stomach Avith such large quantities of liquids as to produce dyspepsia is to be carefully avoided. It is scarcely necessary to state that copulation or any form of venereal excitement must be strictly interdicted. Finally, prolonged Avarm baths lasting from half an hour to two hours seem to exert a favorable influence upon local inflammation. Acute posterior urethritis does not usually develop until the dis- ease of the penile portion of the urethra has run a course of two or three Aveeks. During the very acute symptoms local treatment applied to any portion of the urethral canal probably aggravates the condi- tion, and even the internal administration of balsams and antiseptics must be employed with very great caution, their use being suspended at once if the inflammation seems to be aggravated by their employ- ment. Hence, Avhen in the third week of gonorrhoea there is a violent outbreak of inflammation in the membranous and prostatic portions of the urethra, suspension of all active treatment is indicated. The bowels are kept open; the diet is carefully regulated; the urine is rendered bland, unirritating, and antiseptic; continued warm baths are ordered, the painful symptoms being controlled by opium and belladonna, administered either hypodermically or in the form of a suppository. When the acute symptoms subside the quantity of anti- septics taken by the mouth may be increased, balsams may be added, and local treatment may be directed first to the posterior urethra, after the cure of Avhich the anterior urethritis should receive attention. It has been stated already that injections forced into the meatus rarely penetrate beyond the bulbous portion of the urethra; hence to influ- ence the deeper portions of this canal some other method of apply- ing these drugs must be devised. This end is best accomplished by means of Ultzmann's irrigation catheter or other instrument similar in principle. The patient is first instructed to empty the bladder of a portion of its contents; by this means the urethra is flushed out. The catheter is then introduced into the membranous portion of the canal, and by means of a syringe 1 ounce (32.0) of the injection is forced into the membranous and prostatic portions of the urethra. This fluid does not regurgitate along the sides of the catheter, but enters the bladder, and is passed with the urine at the next act of micturition. The injection most employed is the following: Nitrate of silver, grain \ GONORRHOEA. 565 to 1 (0.015-0.05); distilled Avater, §j (32.0); carbolic acid, 1 grain to the ounce. Any of the injections used in anterior urethritis may also be then employed. These injections should be made twice a week. Chronic Gonorrhoea. Chronic gonorrhoea differs from the acute form in the fact that the inflammation is distinctly localized in certain portions of the urethra, and does not invade the Avhole canal Avith uniform intensity; hence, efficient treatment must be directed not to the whole urethra, but to the diseased areas. Foci of chronic urethritis are usuallv found either in the bulbous portion of the urethra or in the membranous or prostatic portion. If the disease is located in the anterior urethra, it will commonly be found to depend upon the existence of a struc- ture of large calibre. The passage of sounds of full size—cutting the meatus if this is necessary for their introduction—will be folloAved by prompt relief in such cases. The sounds should be used not more frequently than tAvice a Aveek, and should be most carefully sterilized before introduction. If after free dilatation the discharge still persists and a large por- tion of the anterior urethra is in a catarrhal condition, as shoAvn by examination of the urine, irrigation of the urethra should be prac- tised. This may be best effected by passing a soft-rubber catheter down to the membranous portion of the urethra, and injecting through it once daily 3 ounces (96.0) of a J-grain-to-the-ounce (0.025 : 32.0) solution of nitrate of silver. When the general catarrhal condition is materially modified, by means of an ordinary hard-rubber endo- scope and a head-mirror, the focus of inflammation may be exposed, and may be treated directly by strong astringent solutions carried in by means of a brush or by absorbent cotton secured to the extrem- ity of a long applicator. Nitrate of silver or sulphate of copper, 20 grains to the ounce (1.3 : 32.0), may be employed. Unna has devised a most successful treatment for obstinate cases of gonorrhoea. He advises coating the sounds Avith the folloAving mixture: R.—Ol.'cocse...............giij (96.0). Cerse flav...............3ss (2.0). Arirent. nitratis............gr. xv (1.0). Balsam. Peruvian...........gss (2.0).—M. This is liquefied in a Avater-bath; the sounds are dipped in it and are then hung up to dry. On being passed the heat of the body melts the coating. The objection to their use lies in the fact that the appli- cation is made to the entire urethra. Practically, however, their employment is often followed by brilliant results. Chronic posterior urethritis must be treated by remedies applied directly to the diseased area. Nitrate of silver is more commonly successful than any other medication. By means of Ultzmann's apparatus 3 or 4 drops (0.25-0.3) of a solution varying in strength from 0.1 per cent, to 5 per cent, may be employed. Finger recommends the folloAving ointment: 566 DISEASES. R.—Argent, nitratis vel cupri sulph.....gr. xv (1.0). Lanolin................5"! (96.0). 01. olivse..............3Jss (6.0).—M. By means of an ordinary catheter—Avhich is first filled, then intro- duced until its eye reaches the prostatic portion of the urethra—a definite quantity of the ointment can be forced into the canal by a graduated rod. In many cases pressure will exert a curative action, causing prompt absorption of inflammatory effusion. To accomplish this result large sounds may be passed into the bladder. Frequently the therapeutic influences of cold, together with pressure, are found beneficial. The best means of combining these tAvo remedies is found in the psychro- phore, an instrument in the shape of a sound, but so arranged that a stream of Avater flows through its interior. It must be borne in mind that chronic gonorrhoea is commonly due to unskilful or not sufficiently prolonged treatment of the acute stages. Not only should the treatment of acute gonorrhtea be continued until the gonococci have entirely vanished, but for fully tAvo Aveeks after the disappearance of all symptoms of inflammation. The same rule holds good in regard to the chronic manifestations of the disease. Only after careful examination of the urine fails to show any sign of inflammatory trouble for at least two weeks should the treatment be suspended; and this should not take place suddenly, but the intervals betAveen the applications be gradually increased in length, the patient being carefully watched in the mean time. Per contra, it must not be forgotten that long-continued irritant treatment may in itself indefinitely prolong a urethral discharge. Hence it is wise to suspend all injections in certain cases, and to examine the discharge carefully, as found in the urine, to determine whether or not the continuance of symptoms is dependent upon this cause. There is a mucous secretion Avhich quite frequently follows gonor- rhoea, but which is in no Avay dependent upon the persistence of this disease. Microscopic examination will at once determine its nature. It is probably most rapidly cured by attention to general hygiene and by tonic and supporting treatment. Complications of Gonorrhoea. Among the many local and general complications Avhich may occur in the course of an acute or subacute gonorrhoea are balanitis, balano- posthitis, prostatitis, and epididymitis. Balanitis and balano-posthitis are treated by perfect cleanliness. The discharge must be thoroughly Avashed out, and the surface must be dried and isolated. The thorough cleansing of the parts is best accomplished by Aveak astringent solutions, such as the chloride of zinc, 4 grains to the ounce (0.2 : 32.0), 1 per cent, boric acid, or 1.5 per cent, carbolic acid; nitrate of silver is particularly valuable, and in the proportion of 1 grain to the ounce (0.05 : 32.0) will be found sufficiently strong for use as a Avash or injection. The superficial GONORRHOEA. 567 ulcerations may be further touched with the solid stick of the nitrate of silver. The prepuce having been retracted and the parts having been thoroughly washed, dusting poAvder, such as tannin or oxide of of zinc, is distributed over the surface of the inflamed parts ; the glans is then covered Avith a thin layer of absorbent cotton and the prepuce draAvn fonvard. This dressing is to be repeated three times daily. If the phimosis is so tight that the prepuce cannot be retracted, cleansing, astringent injections, and Avrapping the penis in one or tAvo thicknesses of gauze or other thin fabric, constantly kept Avet with dilute lead-water, Avill be the treatment indicated. If, in spite of this treatment, inflammatory symptoms become more marked, cir- cumcision is indicated. Prostatitis rarely develops before the second or third Aveek in the course of urethritis. Where the acute symptoms are fairly developed direct local treatment is of little avail. Rest in bed, light diet, care- ful regulation of the bowels, medication to render the urine bland and unirritating, elevation of the pelvis, local depletion by means of leeches applied to the perineum, and the administration of morphine and belladonna, either by means of suppository or by hypodermic injection, represent the general treatment of all inflammatory condi- tions at or about the neck of the bladder. In the great majority of cases prostatitis undergoes prompt resolution, and this is more power- fully influenced by rectal injections than by any other method of treatment. For this purpose a two-Avay rectal tube must be employed, the nozzle of Avhich is directed against the projection of the prostate into the bowel. From 2 to 4 quarts (2 to 4 litres) of water, either very cold or as hot as can be borne, are alloAved to Aoav into the rec- tum by gravity, this arrangement of the tubes allowing the injection to Aoav out as" rapidly as it Aoavs in. This treatment should be re- peated three or four times a day. When, in spite of careful treat- ment and the free use of anodynes and antispasmodics, there is reten- tion of urine, a soft cathether should be passed into the bladder and allowed to remain there. If general and local symptoms denote abscess-formation, the pus should be evacuated by perineal incision as soon as its presence is positively determined upon. It is true that the pus collection usually is spontaneously discharged into the urethra, but this result cannot certainly be depended upon, and, at best, is an unsatisfactory termi- nation of the trouble. When the inflammation runs into a chronic type, the treatment suitable for chronic posterior urethritis is indicated—namely, the use of large cold steel sounds and local applications to the prostatic urethra. In addition rectal injections, by means of the two-way tube, are very efficient in producing a cure. Epididymitis requires rest in bed, cessation of all local treatment directed against the gonorrhoea, the elevation of the pelvis and testi- cles, and the systemic treatment applicable to acute inflammation. The general tendency of this complication of gonorrhoea is toward spontaneous resolution. The testicles may be supported by a hand- kerchief bandage, the base of Avhich is passed beneath the scrotum 568 DISEASES. Avhile the ends and apex are secured in front to a circular band pass- ing about the Avaist. To combat the agonizing pain and hasten the cure punctures have been advised. These, by relieving tension, promptly alleviate the suffering. Ice-bags may also be applied, though it is claimed that as a result of this treatment there remains an obstinate induration of the epididymis. Local applications of the nitrate of silver and of tincture of iodine are also said to act beneficially. Since it is usually impossible for a patient suffering from gonor- rhoeal epididymitis to keep to his bed, a treatment must be devised which will allow him to attend to his business, and at the same time will prevent the inflammation from becoming aggravated. The part must be splinted; if at the same time uniform pressure can be applied the cause of the trouble will be still further favorably modified. These indications are complied with, partially at least, by strapping the injured testicle. For this purpose a number of adhesive resin strips, each half an inch wide and long enough to pass three-fourths around the swelled testicle, are cut. The first strip encircles the scrotum betAveen the affected testicle and the body, tightly imprison- ing the former in a pouch of skin. The succeeding strips are then placed, each overlapping the other in such a manner that the entire pouch is covered in, and a handkerchief bandage, applied as described above, may then be used to elevate the testicle. A better means of securing rest and pressure, and at the same time exerting the resol- vent influences of heat and moisture, is offered in the dressing pro- posed by Horand-Langlebert. The entire scrotum is first enveloped in a thick layer of cotton; over this is placed a piece of rubber-dam sufficiently large to cover in the cotton, and the dressing is completed by an ordinary suspensory, gored at the sides and provided Avith tapes to allow of close fitting. Unless there be decided SAvelling of the spermatic cord, this dressing usually allows the patient to attend to his business, and is followed by as prompt resolution as though con- finement to bed had been insisted upon. When the acute symptoms have disappeared attention must be directed to the removal of infil- tration, which if it persists may be a cause of sterility. This is accomplished by the continuance of heat, moisture, and pressure; by local applications, such as iodine gr. iv (0.25) in lanolin 3j (32.0), or of equal parts of mercury ointment and belladonna ointment, or by ichthyol, Avith lard half and half, and by the internal administration of iodide of potassium, 10 to 20 grains (0.65-1.3) three times daily. Gonorrhoea in the Female. The symptoms of acute gonorrhoea in the female are usually so mild that the attention of the physician is rarely called to the disease until it has reached its chronic form and has invaded the uterus and its appendages. When, however, acute urethritis is found, the treat- ment, both local and general, is conducted on the same principles as when the disease attacks the male urethra. During the most acute stage no local treatment is advisable, but subsequently injections can GOUT. 569 be made Avith the ordinary hard-rubber syringe, not more than a drachm and a half of the liquid being employed at a time. If the urethral discharge persists, the seats of the suppuration are readily found by the endoscope tubes, and treated directly by applications of strong solutions of nitrate of silver or sulphate of copper. The results of treatment are commonly satisfactory. Acute vaginitis is not very frequently observed, excepting in chil- dren and young girls. In addition to the general treatment of inflam- mation, local treatment directed to cleansing thoroughly the inflamed surfaces of discharge and acting upon them by a strong antiseptic lotion will be folloAved by a rapid cure. The patient is instructed to irrigate the vagina three times daily Avith 2 pints (1 litre) of bichlo- ride-of-mercury solution, 1 : 4000, throAvn in by means of a fountain syringe. For this fluid to reach every portion of the diseased mucous membrane it is necessary that the patient should lie upon her back with the hips elevated. Before rising a pledget of absorbent cotton is placed betAveen the labia. During the most acute stage of A^aginitis hot-A\ater injections and prolonged hot sitz-baths are indicated. In addition to the antiseptic irrigations Avhich the patient is directed to make, the physician should every second day insert a speculum and paint every portion of the diseased mucous membrane with nitrate- of-silver solution varying in strength from 4 to 40 grains to the ounce (0.25-2.65 : 32.0). The vagina should then be packed Avith tampons of absorbent cotton, Avhich may be dusted Avith astringent medication. Vulvitis corresponds to balanitis in the male, and is treated in a similar manner. Cleanliness is the most essential point in securing a cure. The parts are thoroughly Avashed Avith Aveak antiseptic lotions, and the abraded mucous surfaces are kept from coming in contact by means of a layer of absorbent cotton or a piece of lint soaked in dilute lead-Avater or other mild astringent solution. GOUT. Gout is a wrord used to signify a series of manifestations occurring chiefly in those Avho have led a lazy, sluggish life and have lived on the fat of the land, and partaken more frequently of alcoholic beverages than of wTater; or it occurs in persons who do not live in this Avay, but whose ancestors will be found to have done so, and to have handed down to them the gouty taint or diathesis; or, once more, in those who have had poor food for a long time. In other words, it is a disorder of nutrition and metabolism. Very feAv Americans have gout in its marked and characteristic forms, OAving to the active life pursued, and to the fact that the inhabitants of the Western hemisphere drink large amounts of Avater, thereby contin- ually dissolving effete matters in the system and Avashing them away. The therapeutic importance of pure water in this state is remark- able, and the so-called lithia waters depend for their value more upon their freedom from salts than their presence. When a patient goes to medicinal springs he simply acts as a sluice-Avay, and by 570 DISEASES. continually drinking water washes out the kidneys and prevents deposits of calcareous matters throughout the body. In a gouty individual the liquids of the body may be said to be so overladen Avith salts that they deposit them Avherever a spot is found Avhich is easy of access, just as Avater laden Avith lime forms a deposit on the sides of its bed Avhen a drought comes on, and dissolves and removes these formations Avhen a freshet takes place. Very often, Avhen such Avaters are not attainable, satisfactory results will be reached by ordi- nary distilled Avater, the insipid taste of Avhich can be overcome by charging it Avith carbonic acid gas. When an acute attack of gout conies on, it is generally situated, as is well knoAvn, in the joint of the big toe or other toes, but it may involve any part of the body, even to the heart and the abdominal viscera. By far the best remedy for the relief of the pain is mor- phine, Avhich should be given hypodermically. At the same time the best remedy for gout that Ave have, colchicum, should be freely given until the patient shoAvs the full effect of the drug, as evidenced by gas- tro-intestinal discomfort or pain and slight laxity of the boAvels. The drug should be used in the form of the Avine of the root, not that of the seeds, in the dose of 20 drops (1.3) at first, and increased by 1 drop (0.05) every four hours until relief is obtained or symptoms of poison- ing appear as noted above. In other instances the method of adminis- tration suggested in the article on Colchicum may be resorted to. The local treatment of gout, Avhen it is active, consists in the appli- cation of a number of remedies. For hospital practice a very useful mixture is made by adding 1 part of bicarbonate of sodium to 9 parts of linseed oil. The joint is then wrapped in a piece of lint soaked Avith this concoction. In other cases collodion may be applied in one or two good coats, not more, with relief, and in still others oil of pep- permint has been recommended. It is to be remembered, hoAvever, that the inflamed joints are not to be treated by depletion through leeches or bleeding, as by this means they ultimately become worse; or, in other words, the treatment of gouty inflamed joints is not iden- tical with that of inflamed joints from other causes. When the pains of acute gout are very severe at night, potassium iodide, in the dose of 15 grains (1.0) at four or five o'clock in the afternoon, will sometimes give relief; this drug should always be combined Avith colchicum if the disease is subacute or chronic. In chronic gout, except during the acute exacerbations of the dis- ease, colchicum is almost useless, but potassium iodide should be pushed to the point of iodism if the trouble be painful. Here diet comes in for a great part of the treatment, and should consist of foods Avhich are not fatty nor rich, but plain and nourishing. Milk and eggs, the white meat of chicken, and fruits cooked without sugar being added are alloAved, tea and coffee being used only in modera- tion. If any Avine is taken, it must be folloAved by copious draughts of pure Avater, and this last article should be used ad libitum. On the other hand, pastries, and, more than all, SAveet wines, are the worst things that such a patient can take, and must be absolutely prohibited. HEADACHE. 571 The insomnia of chronic or subacute gout is best put aside by potassium bromide and chloral, the former drug being the safest and best. ^ Nothing should be done in the neighborhood of gouty joints which will injure the skin, as it is easily disorganized and its injury may lead to erysipelas. Where the deposit around the joints is very great and the normal movements are impossible, relief is often obtained by the application of a solution of citrate or carbonate of lithium, 5 to 10 grains to the ounce (0.35-0.65 : 32.0) of Avater, on lint wound around the parts. Where the skin is broken and will not heal, this treat- ment often permits healing by dissolving the crystals in the Avound which prevent the approximation of the edges and so cause local irri- tation. Iodine ointment or the tincture of iodine is often placed around chronic gouty joints with advantageous results. A standard remedy in subacute or chronic gout is arsenic, and its administration in the form of 3 drops (0.15) of Fowler's solution, Avith either perfectly pure or lithiated water, is always to be resorted to. If anaemia is present, arsenic is particularly indicated, and cod- liver oil and syrup of the iodide of iron are also of value in this state. We find, therefore, in conclusion, that the use of large amounts of pure Avater devoid of salts, and the administration of colchicum, potassium iodide, and arsenic, are the greater points about Avhich the rest of our treatment should centre. In those cases Avhere retrocedent gout comes on the heart must be supported by stimulants, particu- larly by hypodermic injections of ether until the sloAver drugs can act, by heat over the belly, by the use of opium to allay irritation, except Avhen the brain and kidneys are seriously affected, by the use of diuretics and alkaline drinks, and finally by counter-irritation in the shape of a mustard plaster placed over the abdomen or chest as the case may require. HEADACHE. (For Neuralgic Headaches, see Neuralgia ; for Bilious Headache, see Biliousness.) Probably no single source of pain compares in its frequency to headache, chiefly because it is essentially a symptom of many dis- eased processes or functional disturbances, and nothing more. It may arise from eye-strain, from brain disease, from anaemia, from uraemia, from plethora, from nervous breakdown, and from a multi- tude of causes Avhich, if they were all recounted, Avould cover many pages of this book.1 The only forms of headache Avhich will be con- sidered here are those due to congestion or those which arise from fatigue. Congestive headaches, dependent upon an engorgement of the cere- bral vessels Avith blood, are to be treated in a number of Avays, and if any direct cause of congestion can be discovered, this must, of course, 1 See article on Headache in the author's Practical Diagnosis, Lea Brothers & Co. 572 DISEASES. be removed. So far as the direct application of drugs is concerned, Ave find two methods of promoting a cure. The first consists in the use of ergot, which will cause contraction of the dilated vessels; the second, in the employment of vascular sedatives, Avhich will produce arterial depression and so remove congestion. Sometimes one of these methods will succeed where the other fails, and it is almost impossible to tell beforehand which case should have one drug and which another. It is to be remembered that when the congestion is due to vascular relaxation and Aveakness the vascular sedatives are contraindicated. The use of a hot mustard foot-bath is of great value, and a mus- tard plaster or dry cup applied to the nape of the neck is often of service in congestive headaches, while in severe cases an ice-bag applied to the head or leeching behind the ears or on the temples may be re- sorted to. Bleeding often gives relief at once in severe congestive headache. Where headache depends upon fatigue, either general or local, stimulating treatment is necessary. If eye-strain be the cause, full doses of strychnine or nux vomica are of service, but these remedies cannot be used if there is much retinal irritability. In many instances a combination of caffeine, bromide of potassium, and antipyrin is very successful, as follows: R.—Caffeinse citratis...........gr. xl (2.65). Potassii bromidi...........£iv (16.0). Antipyrini,.............3y (8.0).—M. Ft. in chart. No. xx. S.—One powder in water as needed. Sometimes the caffeine makes the headache more acute, and if this occurs only the antipyrin and bromide can be used. (See articles on Antipyrin, Acetanilid, and Phenacetin.) Another useful prescription is— R.—Extract, guarana?.........gr. x vel xx (0.65-1.3). Ext. apii graveol.........gr. x (0.65).—M. Ft. in capsul. vel chart, vel pil. No. x. S.—One every half hour till relieved or three are taken. Sleep is generally a more useful prescription than any drug, and if city life creates so much mental anxiety during the day as to be wearing upon the nervous system or make the patient wakeful at night, business must be put aside and health and recreation sought at a watering-place. Horseback exercise is very useful indeed, and should be resorted to by all who can afford it "if they are sufferers from nervous headaches. A form of headache which is often very severe, sometimes fleeting, sometimes persistent, is that due to gout, and it is to be treated by means quite distinct from those named so far. Some practitioners of Avide experience employ salicylic acid in doses of from 5 to 15 grains (0.3-1.0), while others rely on the iodide or acetate of potassium. In cases where anaemia is present Peabody uses the following pre- HEART DISEASE. 573 scription, which is compatible, Avhereas most of the preparations of iron and salicylic acid are incompatible : R.—Acid, salicylic............gr. xx (1.3). Ferri pyrophosphat.........gr. v (0.3). Sodii phosphatis..........gr. j (0.05). Aqua; dest.............fgss (16.0).—M. S.—This is to be taken every three hours. Cohen has used the folloAving, which is more pleasant to the taste: R.—Sodii salicylatis..........^iv (16.0). Glycerini.............fgij (64.0). 01. gaultherise...........Ti\xx (1.3). Tr. ferri chloridi..........f^iv (16.0). Acid, citrici............gr. x (0.65). Liq. ammonii citratis, B. P.1 . q. s. ad f1$iv (128.0).—M. S.—Dessertspoonful (8.0) in water twice, thrice, or four times a day. Other cases of a gouty headache require colchicum, particularly if the gout be widely distributed in its manifestations, and to these Hamilton ghes— R.—Vini colchici seminis.........f§ss (16.0). Potassii acetatis ~| Potassii iodidi V.....aa f£v (20.0). Tr. cimicifugse racemosaej Aquae............q. s. ad fjiv (128.0).—M. S.—Teaspoonful (4.0) every four hours. HEART DISEASE. (For Treatment of Angina Pectoris see p. 451.) The Avriter classifies all forms of heart disease under this heading advisedly. In valvular disease the profession are beginning to under- stand more and more that the mere destruction or laming of this valve or that has little to do with the treatment, although the ultimate result of the case is somewhat dependent upon these conditions. It matters not whether the leak in a valve be minute or great, provided the heart can still do its work ; the condition of the cardiac muscle is the important factor to be considered. If an irreparable leak exists in a pump which cannot be stopped for repairs, the question is not, Can we cure that leak ? but rather whether we can work the pump with enough force and rapidity to obtain all the water needed for the maintenance of life. Some physicians use heart tonics, such as digitalis, whenever they find a valve diseased, as if to mend the broken valve. Nothing can be more erroneous, for a valve once injured is never re- generated. It should be an invariable rule Avith every physician in examining 1 Liquor ammonii citratis, B. P., is made by adding 5 fluidounces (imperial meas.) of strong solution of citrate of ammonium to 15 fluidounces (imperial meas.) of dis- tilled water. The stronger solution of citrate of ammonium is made by taking 12 ounces (avoirdupois) of citric acid, strong solution of ammonia 11 fluidounces, and adding enough distilled water to make 24 fluidounces (imperial meas.). 574 DISEASES. a patient Avith heart disease to determine Avhether or not the tissues of the body receive their normal blood-supply. If they do not, even though the leak is so small as almost to escape notice, treatment is to be instituted; but, on the other hand, if the murmur heard on auscul- tation is as loud as that of a machine-shop and the tissues are not starved, no remedy is needed. Another very important point in regard to the treatment of cardiac disease in children in the remembrance that the stunting of the body and the sloAvness of groAvth are not merely the result of heart trouble, Avhereby the tissues do not increase in size from lack of nourishment, but occur for a special purpose. Let us suppose that a child of eight or nine years has scarlet fever or rheumatism, Avhich leaves the cardiac valves impaired in function for a fewr days, or hours at least, the question must arise in the heart: " Can I properly fill all the blood- vessels?" If the heart can supply the vessels, the child lives, but is stunted, because Nature is wise enough to understand that the strug- gling heart has all it can do to supply even a stunted frame, and realizes that a rapidly increasing area of blood-vessel surface in a groAv- ing child would exhaust the cardiac muscle. The physician should not permit the parents to worry over this lack of growth, but by the use of gentle gymnastics or tonics, and attention to the care of the general health, he is enabled to improve the cardiac condition. As soon as this organ is strong enough to permit of groAvth, groAvth will take place. In the general treatment of heart disease in persons Avho have until recently had no signs of heart failure the most important thing for the physician to prescribe is rest. A tired heart cannot supply an active body. Having made these preliminary remarks, let us turn to the direct application of drugs to heart disease, the chief drug in the list being, of course, digitalis. The value of digitalis may be said to rest upon a number of influences possessed by it. In the first place, evidence is constantly accumulating to shoAV that digitalis increases the nutrition of the heart-muscle by the stimulating influence which it exerts on the pneumogastric nerve, this nerve having been partly proved to be a trophic nerve of the heart. Aside from any such nervous influence, the heart-muscle receives a greater blood-supply under the use of digi- talis, since both diastole and systole are influenced by the drug, the systole being more complete and the diastole being prolonged and more extensive. Tavo theories concerning the nutrition of the heart-muscle through its blood-supply have been promulgated. One is, that the coronary arteries are filled Avith arterial blood as the heart drives its contents out of the left ventricle into the aorta, or, in other Avords, during systole. The other hypothesis rests upon the belief that the contracting muscle prevents a free circulation of blood through the cardiac blood-vessels, and that the blood is driven into the coronary arteries during diastole by the pressure in the aorta, the aortic valves being closed. The latter vieAv is incorrect so far as the coronary arteries are concerned, HEART DISEASE. 575 for they are filled during ventricular systole, and this systolic con- traction of the muscular fibres urges onward the blood already in the intramural vessels. Nevertheless the complete passage of the blood through the smaller Aressels of the cardiac muscle only takes place as relaxation or diastole occurs. The ground for this belief consists in the observation that a muscle Avhen firmly contracted ahvays presses upon its supplying blood-vessels, and particularly interferes Avith capillary Aoav. The heart of one of the loAver animals, if carefully Avatched after the chest-Avail is removed, will ahvavs be found to become paler during systole and redder during diastole. As the blood everywhere in the body nourishes the tissues, not Avhen in the arteries, but Avhile passing through the capillaries, it Avould seem self- evident that, Avhile the coronary arteries are filled by the systole or contraction of the heart, the nutritive changes and perfect capillary circulation go on during diastole. If these things are true, the increase in cardiac nutrition and groAvth under the action of digitalis is only Avhat one Avould expect, for Ave have learned Avhen studying this drug that it prolongs diastole and increases the force and volume of the systolic wave of blood. In other Avords. digitalis fills the coronary arteries almost to bursting, and so, Avhen diastole occurs, not only floods the cardiac capillaries Avith blood, but prolongs the period during Avhich the interchange betAveen the blood-stream and tissues takes place.1 There is still another way in AA'hich digitalis does good in cardiac disease by reason of its peculiar poAvers. Normally, the heart beats fast or sIoav according to the demands for blood made upon it by the system, and its action is varied by the calls Avhich it receives from the tissues. In heart disease, with failure of compensation OAving to the leaky valves, the tissues are starved, and continually send messages for more nourishment to the cardiac muscle, Avhich finally becomes exhausted by its endeavors to supply their Avants, and beats noAv fast and noAv slow, uncertain Avhat to do. If digitalis is given, the vagi render the cardiac action regular and effective, acting as regulators and directors of its energies, thereby supplying the tissues and using the remaining poAver of the heart to the greatest advantage, in addi- tion to improving its blood-supply by the methods already described. The starving tissues of the body having been satisfied, as Wood has eloquently expressed it, " the angry messengers from the periphery cease their callings, and the heart is at peace and in comfort." From what has been said it becomes evident that this drug, digi- talis, generally does good when the heart is Aveak, and we find for this reason that cardiac dilatation, simple cardiac failure, or heart-failure dependent upon the presence of poisons, all indicate its use. The mechanism of the action of digitalis in the different cardiac valvular lesions still remains to be described, and before doing so the author desires to remind the reader that a patient under the full influ- ence of digitalis ought to maintain the recumbent posture. (See article on Digitalis.) Further, the drug tends to accumulate, and therefore it should be stopped for several days at the end of each Aveek of its use. 1 See article on Digitalis in Part II. of this book. 576 DISEASES. Digitalis should be begun in small doses, which can be gradually increased in size if need be. Taking up the most common condition, that of mitral regurgitation, Ave find that in this disease the blood passes, in its normal flow, from the auricle into the ventricle, and, Avhen the ventricle is filled, that the cardiac muscle contracts on all sides equally. Normally, the mitral valves close the auriculo-ventricular opening and prevent any of the blood from regurgitating back into the auricle, and the greater the pressure the tighter they become. Abnormally, the blood is still pressed upon on all sides as before, and, trying to escape, as do all liquids, from pressure, finds that, OAving to disease of these valves, it can, in part at least, slip back into the auricle from which it came, rather than pass out into the high pressure of the arterial system. The ventricle, therefore, propels blood in two directions—in the Avrong way and in the right way. If the leak is large enough to permit of the regurgitation of a large part of the blood, then death occurs. Digitalis does good in mitral regurgitation, because, by increasing the force of the ventricle, it increases the friction at both the mitral leak and the aortic opening; but, as the aortic opening is a large one and the mitral leak a small one, the greater quantity of blood passes out into the cir- culation. The same fact arises for consideration as before—namely, that it is not the amount of leak, but the amount of supply to take its place, Avhich is the vital question in the case. Sometimes relief does not occur, and the patient is made worse by digitalis, because the leak is increased as much as the normal flow. In mitral obstruction the difficulty is that the blood cannot enter the ventricle Avith sufficient rapidity, and this part of the heart con- tracts before it is well filled. By the prolongation of diastole the blood is given sufficient time to enter and the ventricle is filled, send- ing out into the system a large Avave of blood Avhen it contracts. Further than this, the stimulation of the right ventricle by the digitalis enables this part of the heart to overcome the tendency to congestion which arises from the obstruction on the left side of the heart. Often the right side of the heart must be relieved by vene- section and active purgation. In aortic stenosis there is obstruction to the normal flow of blood out of the heart, and the digitalis is needed to increase the ventric- ular force, so that it may overcome the difficulty. In aortic regurgitation digitalis, by its stimulation of the heart, may cause a sufficient output of force to clear itself of the regurgi- tant Aoav, but in many cases the drug fails, because the prolongation of diastole gives so much more time for the blood to flow backAvard into the dilating ventricle. The cardiac remedies to be used in such cases are strophanthus, in the form of the tincture, dose 3 to 5 drops (0.15-0.3), adonidin, dose i to | grain (0.013-0.025), and sparteine J grain (0.025). These remedies may also be used in the other forms of cardiac disease Avhere digitalis fails. It is important to remember, hoAvever, that some cases of aortic regurgitation do improve, at least temporarily, under digitalis. Physicians often meet with cases of severe cardiac disease in Avhich HEART DISEASE. 577 there are present a laboring heart, distended jugulars, and cyanosis, indicating engorgement of the right ventricle. This is to be relieved by free venesection from the arm, and, after the engorgement is re- moved, by the use of digitalis. In many cases of cardiac disease there is associated Avith the heart lesion general debility and anaemia. These cases should be treated not only by the use of heart tonics, but also by iron, arsenic, simple bitters, and, if constipation is present, by mild purgatives. In cardiac dropsy digitalis and the other heart stimulants do good by raising blood-pressure and pulse-force, and in some instances by stimulating the kidneys to increased efforts at elimination. (See Dropsy.) In these cases, too, the patient will often be greatly bene- fitted if he receive every few days a dose of one of the hydragogue cathartics, wrhich will relieve his dropsy and unload the portal circula- tion. On the other hand, if the heart is feeble and the arterial tension is high, Ave not only have to give nitroglycerin to relax the spasm, but it is best to employ a cardiac tonic Avhich at the same time that it stimu- lates the heart will not raise arterial pressure, as, for example, stro- phanthus, in preference to digitalis, which stimulates the arterial system and increases the tension. In sudden cardiac failure from weakness or poisons the use of ether and ammonia is to be resorted to at once, and these are to be followed by alcohol and digitalis if necessary. The ammonia is a direct heart-stimulant, as are also the alcohol and ether. In cardiac palpitation dependent upon indigestion this condition must be relieved by appropriate digestive remedies; but in that form of palpitation due to o\Ter-exertion or heart-strain digitalis is useful. Iron is to be used if the irritability is due to anaemia. Tea, coffee, tobacco, and excessive venery are to be forbidden. Sometimes nux vomica does good by stimulating the heart and nervous system, and belladonna seems of great value Avhere arhythmia is present. In other cases of arhythmia the patient will be more benefited by the use of cactus grandiflorus and sparteine, and sometimes a prescription of aco- nite and digitalis, as suggested in the article on Aconite. Ringer rec- ommends the use of veratrine ointment over the praecordium in many of these cases. In cases of cardiac dilatation and asthenia digitalis is often very useful; but should the patient be advanced in years and have a ten- dency to arterio-sclerosis Ave should, simultaneously with its use, give nitroglycerin to relieve any arterial spasm which will resist the action of the heart. Very often such patients will suffer from scanty secretion of urine and albuminuria, and will develop cyanotic induration of the kidney. This may be controlled and greatly relieved by the use of full doses of digitalis, say 5 drops of the tincture every four hours Avith 20 grains of bitartrate or citrate of potassium every four hours. The addition of the alkaline diuretic very greatly aids in the diuretic effect of the digitalis in these cases. Sometimes diuresis can only be established after free purgation. In some cases it is best to substi- 37 578 DISEASES. tute for the digitalis either strophanthus or caffeine. Both should be given freely, say 3 grains (0.18) of caffeine or 5 minims (0.35) of the tincture of strophanthus every four hours. (See Nephritis.) Cardiac hypertrophy is rarely seen Avithout some other lesion ac- companying it, but it may occur from prolonged and excessive exer- cise or other cause. It is to be treated by perfect rest and avoidance of excessive exercise, and by the use of moderate amounts of food of a non-stimulating character. Wines and coffee should be forbidden, and small amounts of veratrine ointment or a belladonna plaster may be placed over the praecordium if the action of the heart is very exces- sive. Both palpitation of the heart and cardiac hypertrophy are very favorably influenced in many cases by aconite or veratrum viride. Physicians who are in the habit of seeing young men professionally will constantly have their attention called to a condition of shortness of breath on exertion, palpitation, or violent pulsation of the heart, and in some instances the development of severe symptoms Avhich, at first glance, may seem to be those of true angina pectoris. In many of these youths there will be a history of the excessive use of tobacco, or that they have left college, Avhere they have been indulging in severe ath- letic exercise, such as running or bicycle-racing, and have gone into business, where they lead a most sedentary life. In these cases the condition which exists is comparable to the condition which exists in a steamer whose engines are too strong for her hull. The heart, which has heretofore been supplying the body of an athlete Avith blood, now finds itself too strong for the sedentary individual. There is prob- ably no remedy which will give such good results under these circum- stances as aconite, given in the dose of 1 minim (0.05) of the fluid extract or 2 to 3 minims (0.1-0.15) of the tincture three times a day, partic- ularly if at the same time a good belladonna plaster about four inches square is applied over the praecordium. Many cases of tobacco heart, in which there is arhythmia, with an excessive cardiac impulse over the praecordium, with palpitation on exertion, will be benefited by aconite used in this Avay; hut where the heart seems much depressed, so that the apex-beat is feeble and the first and second sounds are not clearly heard, aconite will seldom, if ever, do good. In that form of functional cardiac disorder due to indigestion aco- nite is not capable of producing the results Avhich are obtained in the cases which we have just mentioned. It may, however, be used as a remedy of value at the same time that the physician is directing his attention to the cause of the trouble—namely, the gastro-intestinal disorder, with the treatment of which this article has nothing to do. Here, again, a condition of cardiac feebleness contraindicates the employment of this drug. Passing to the employment of aconite in cases of true cardiac dis- ease, Ave find that a careful study of a certain number of cases will soon show the physician that this drug is capable of doing more good in some instances than is digitalis. The history of the folloAving case illustrates this point: A man, aged nineteen, was brought to the hospital suffering from aortic obstruction, and as a result of this Avas attacked with dyspnoea on the HEART DISEASE. 579 slightest exertion, marked cardiac arhythmia, Avith palpitation, some giddiness, and a tendency to nose-bleed. He stated that in the early part of the year, and for several years preceding it, he had been a deck-hand on a coastAvise vessel, Avhere he performed hard manual labor, notAvithstanding the condition of cardiac disease Avhich Avas present, and of which he kneAV nothing. During this time he suf- fered from no symptoms indicating cardiac disorder. In other words, compensatory hypertrophy Avas complete. Because of the exposure incident to the work he Avas forced, under the advice of a physician, to earn his living on shore. He Avas unsuccessful in trying to obtain employment, and a prolonged period of muscular inactivity folloAved. As a consequence of this the cardiac hypertrophy, Avhich had hitherto been compensatory, Avas noAv excessive, and he suffered from marked cardiac palpitation, Avith disordered circulation in the extremities, and from a considerable amount of cough. Very early in the study of the case it Avas recognized that these disorders Avere due to the excess of cardiac hypertrophy, and not to failure in compensation, and, as a consequence, that a cardiac depressant was indicated rather than a cardiac stimulant in the shape of digitalis. He Avas given from 1 to 2 minims (0.05-0.1) of the fluid extract of aconite three times a day, and during the continuance of this treatment Avas purposely confined to his bed. At the end of the week so much improvement had taken place in his condition that he Avas alloAved to rise and go about the ward as he wished, and after four Aveeks, the medicine being continued during this period, he Avas so Avell that he was discharged from the hospital, with no other evidence of cardiac disorder than physical examination would show. When aconite is used, rest in bed is essential, in order that the heart may not be excited to great activity by exercise of the limbs, and also because the recumbent posture allows the physician to use larger doses of the drug. An exceedingly useful treatment of valvular disease Avith or with- out excessive cardiac hypertrophy is rest in bed without medication. The results in some cases are extraordinary. Fatty heart occurs in two forms—that in which true fatty degen- eration has taken place in the muscular fibre, and that in Avhich there is a deposit of fat about the heart and between the fibres. Nothing of any importance can be done for the first state, except to relieve arterial tension if it be too high by the use of nitroglycerine or by the iodides. Strophanthus Avith or Avithout nux vomica may be useful to relieve symptoms of cardiac distress. Much can be done for the second form. In neither form is digitalis of much value. If given, it should be combined Avith nux vomica, or nux vomica may be given alone in full doses. The patient suffering from the second form of heart- trouble is nearly always obese, and should abstain from fats and rich foods, from all SAveet wines or malt liquors, from sugars and milk, and, at the same time, take exercise. At first this treatment may cause dyspnoea, but by gradually increasing the severity of the exer- cise great feats can generally be effected in the end, with marked improvement in the cardiac action. (See Obesity.) 580 DISEASES. Heart disease associated with failure of the muscle may not only be treated with drugs, but with other remedial measures, such as gentle, active exercise, passive exercise, and baths, the latter being given with care to avoid too great shock and for the purpose of improving the general circulation. Within the last few years a method has been brought forAvard by Schott, of Nauheim, Germany, Avhich consists in treating patients with feeble hearts by means of movements and baths of water derived from the springs at Nauheim. The movements are so-called resist- ance-movements, the patient sloAvly flexing and straightening his limbs and neck against gentle resistance on the part of an attendant. By this means the circulation of blood and lymph in the tissues is aided Avithout tiring the heart. These resistance-exercises do not, hoAvever, agree Avith all cases. In persons with very feeble hearts massage given gently is far better. The rule should be, never to give enough exercise or massage to cause acceleration of the respiration or marked increase in the action of the heart. Very feeble cases should have the massage first, the exercise next, and the baths last. The bath Avhen made from natural Avater at the Nauheim springs pos- sesses not only the stimulating effect of its natural Avarmth and its sodium chloride, but also contains a large amount of carbonic acid gas, Avhich exercises a poAverful stimulating effect upon the peripheral capillaries, bringing the blood to the surface and equalizing the cir- culation. The patient is gently immersed in a tub of the Avater at about 95° F., and alloAved to remain there about five or ten minutes, according to the seriousness of his disease. If it is grave, the first baths are very short, for if they are prolonged reaction will not take place. The patient is then removed and carefully dried by an attend- ant, and must rest absolutely in a reclining position for at least one hour. At first the bath is used only every tAvo or three days. As the patient gets a little strength the baths are gradually increased in length and frequency, and finally additional mother salt obtained by the evapo- ration of the Avater is added to the natural Avater in the tub. Later on, Avhen still stronger, the patient takes the foam, or "strom" bath, in Avhich the gas is present in such quantities that the water foams. This is, of course, very stimulating and dangerous for a weak patient Avith poor reaction. When the patient recovers enough to use gentle Avalking-exercise this is permitted, the resistance-exercise bein<* employed on days between the baths as a rule. These baths may be prepared artificially and are resorted to in this country, being now installed in several watering-places. The form- ulae for making the baths are as folloAvs in each 40 gallons of Avater at 95° F.: Bath No. 1: sodium chloride, 4 pounds; calcium chloride, 6 ounces. Bath No. 2: sodium chloride, 5 pounds; calcium chloride, 8 ounces. Bath No. 3: sodium chloride, 6 pounds: calcium chloride, 10 ounces. Bath No. 4: sodium chloride, 7 pounds; calcium chloride, 10 HEMORRHAGE. 581 ounces; sodium bicarbonate, ^ pound; HCl (25 per cent.), 12 ounces. Bath No. 5: sodium chloride, 9 pounds; calcium chloride, 11 ounces: sodium bicarbonate, 1 pound; HCl, 1|- pounds. Bath No. 6: sodium chloride, 11 pounds; calcium chloride, 12 ounces ; sodium bicarbonate, 2 pounds; HCl, 3 pounds. The alkali should ahvays be slightly in excess unless a porcelain or paper tub is used. A small bottle containing the hydrochloric acid is submerged at the bottom of the tub, uncorked, and its contents allowed to escape into the Avater, in which effervescence at once occurs, the patient entering the bath at that time. Recently Tyson has used a series of perforated iron tubes placed upon the bottom of the tub under a Avooden rack. These tubes are connected to a large cylinder con- taining carbonic acid gas, Avhich is alloAved to bubble through the Avater, thus supplanting the crude method of producing the gas by the acid just named. The tub should be of Avood. The numbers of the baths are simply numbers for different strengths. Patients may never use them stronger than that repre- sented by the second or third formula. Toward the close of the treatment the temperature may be lowrered to 85° F. These baths are indicated chiefly for feeble hearts, as already stated. Thus, if there be cardiac dilatation resulting from such depressing causes as epidemic influenza, they often prove useful. So, too, in cardiac neuroses and functional disorders dependent upon lack of vasomotor tone they are serviceable. In valvular disease Avith perfect compensation they are not needed, and Avhen compensation is ruptured they are dangerous, OAving to the production of syncope. If the bath acts favorably, the pulse becomes stronger and fuller, the heart's action slower, and the physical signs of cardiac dilatation dis- appear. Congestive engorgement of the liver also passes aAvay. As with all other methods of treatment, the cases submitted to this treatment should be carefully selected, as it has its therapeutic limi- tations. This treatment does not necessarily exclude the use of drugs. A libera] vegetable diet, Avith small amounts of meats, is given. HEMORRHAGE. (Including Menorrhagia, Metrorrhagia, Hamoptysis, Hcematemesis, Intestinal Hemorrhage, Hcematuria, and Post-partum Hemorrhage.) Under this heading the author will consider all forms of hemor- rhage Avhich can be controlled by drugs or measures not directly sur- gical in their scope, with the exception of epistaxis, which has already been spoken of. Whenever a hemorrhage can be arrested by the application of a ligature or by compression, as in a cut of the finger or some similar wound, no styptic should be used. Styptics are employed for the double purpose of constringing the tissues and coagulating the blood, and, in consequence, form coagula which tend to make a nasty septic 582 DISEASES. mass about the wound. In their place the physician should resort to a compress soaked in some antiseptic liquid or filled Avith some disin- fectant powder, and if this fails to control the bleeding, then ligation of the bleeding vessel becomes necessary. Where the bleeding point cannot be reached by direct compression or for ligation, the use of packing and of astringents is advisable, and drugs which are antihemorrhagic should be used by the mouth. As these forms of hemorrhage are generally given separate names, thev will be so considered. In all forms of hemorrhage in Avhich the Aoav has been sufficiently great to endanger the patient's life resort should be had to hypoder- moclysis or to transfusion. (See Hypodermoclysis and Transfusion, Part III.) Menorrhagia is an excessive flow of menstrual blood, either excess- ive in quantity during two or three days or prolonging itself oyer an unusual number of days, Avhile metrorrhagia is a state in Avhich bleeding takes place from the uterus independent of menstruation and at any period of the month, or even after the menopause has occurred. Menorrhagia, or excessive menstruation, is not to be judged by the amount of the flow, but by whether the loss is sufficient to cause decrease of health or to indicate disease. In some cases it is a means of relieving plethora. When the physician decides that something should be done to improve the condition of the patient, when suffering either from menorrhagia or metrorrhagia, it will be necessary for him to find out whether a polypus or other form of uterine disease is directly responsible for the trouble, and in the mean time to employ drugs knoAvn to act favorably upon uterine hemorrhage. The most prominent of these drugs are ergot and oil of erigeron, the first being the more active and the best remedy for active bleeding, the second better for oozing and for cases where there is a continual "show." The fluid extract of ergot may be given in varying dose, from 10 to 60 drops (0.65-4.0), according to the necessities of the case, and the oil of erigeron in capsules in the dose of from 3 to 5 minims (0.15—0.3), or, if capsules cannot be had, the physician must employ the oil in an emulsion made by using syrup of acacia or other similar substance. Where menstruation is irregular and the menorrhagia is almost a metrorrhagia, bromide of potassium or sodium in the dose of 10 grains (0.65) once or twice a day is often very serviceable indeed, and the distilled extract of hamamelis in the dose of 1 drachm (4.0) three times a day is almost as useful. Cannabis indica, if an active sample is obtainable, is also said to be of service, but the Avriter has never used it to any extent. Oil of cinnamon in the dose of J drachm (2.0) is very efficacious in the slow oozing of some cases Avhere erige- ron cannot be used or obtained. Sometimes, where congestion of the pelvic viscera is the cause of the trouble, dry cups over the sacrum give relief. HEMORRHAGE. 583 Hemoptysis, or hemorrhage from the lung, is nearly ahvays due to tubercular ulceration of a small or large blood-vessel, and the life of the patient depends in reality more upon the rapidity with Avhich a clot naturally forms than upon the skill of the physician. Though text-books order atomized solutions to be inhaled and other remedies to be taken by Avay of the lung, in most cases these measures will be found impracticable, simply because the nervousness of the patient and the constant cough will not permit of inhalations to any extent, and even if a full breath is taken, it generally increases the bleeding and coughing. The only occasions on Avhich inhalations of styptics are of service are those in Avhich the hemorrhage is just beginning or so slight as to streak the sputum or to be at least thoroughly mixed with it. The solutions to be so employed must be used in an atomizer which will throAv a fine spray—sufficiently fine to enter the smallest air-tubes with the inspiratory Avave of air. A very good fluid is one made from Monsel's solution, as folloAvs: R.—Liquor, ferri subsulphat.......gtt. xx to xxx (2.0). Aqua? dest........<.....f|iv (128.0).—M. S.—Use in an atomizer every few minutes. Or the following :! R.—Acid, tannic............gr. xx (1.3). Glycerini.............f.^ij (8.0). Aquae dest..........q. s. ad f^iij (96.0).—M. S.—Use in an atomizer. Or, R— Aluminis.............gr. vj (0.4). Aquse dest.............f^iij (96.0).—M. S.—Use in an atomizer. Some clinicians ad\4se that the patient should sAvallow, Avhether the hemorrhage be acute or not, not less than 1 to lh drachms (4.0- 6.0) of the fluid extract of ergot, or a solution made by adding 20 grains of gallic acid to 1 ounce (1.3 : 32.0) of water. Tannic acid given by the stomach is not as good as gallic acid, because it must be absorbed and changed into gallic acid before it can reach the bleeding point through the circulation. On the other hand, the tannic acid, if locally used, is the better, for it constringes the tissues and forms a clot, whereas gallic acid does not coagulate the blood. There is no doubt that of all the internal remedies for hemorrhage from the lungs, aconite is the best. Careful studies sIioav that ergot causes primarily an increased flow of blood to the lung, although its dominant and final action is to cause contraction of the blood-vessels. Hemorrhage from the lung is to be regarded as any other hemorrhage. The object of the physician is not to stimulate the heart and vasomotor system, thereby increasing the leakage from the bleeding vessel, but to lower the arterial pressure to as low a point as is safe. The rule to follow is best stated as follows : If the patient is seen early in the attack, give 1 If the Monsel solution does not stop the hemorrhage, tannic acid will probably fail; but, more important still, the two should not be used together, as the tannate of iron will be formed, which is as black as ink. 584 DISEASES. full doses of aconite to prevent further hemorrhage. If Avhen seen so late that he is too much exsanguinated to use sedatives, place his head lower than the feet and apply Esmarch bandages to the limbs to keep the blood in the vital parts as far as possible. The use of stimu- lants can only increase the hemorrhage by increasing the pumping power of the heart and by dislodging the clot from the eroded blood-vessel. Daremburg and Yeo have employed ice or ice-cold compresses to the scrotum or vulva in such cases, and claim good results from this use of cold. To allay nervous excitement many writers advise that a hypodermic injection of morphine should be used. The author is convinced that it should be used with caution, for morphine is a circulatory stimu- lant, and by increasing the poAver of the heart increases the hemor- rhage. Chloral and the bromides are often better remedies, and should be given by the mouth, or, if vomiting is present, they should be given by the rectum, dissolved in starch-water. (See Chloral and Bromides.) Sometimes the patient can point directly to the spot Avhere he thinks the hemorrhage exists, and under these circumstances a dry cup or a piece of ice placed over this point may prove useful. After an attack of haemoptysis there is great danger in many cases of a traumatic pneumonia being set up by the presence of the extrav- asated blood. This should be combated by the use of a carefully regulated diet, and the reduction of any arterial excitement by small doses of aconite in persons not weakened by advanced disease or bleed- ing. Complete rest in bed is to be insisted on, and no stimulants allowed in food or drink unless the weakness of the patient requires it. Hcsmatemesis.—This depends either upon some injury to the stom- ach or, much more commonly, upon gastric ulcer, cancer, or some other severe form of gastric trouble, and is one of the easier of the so-called " internal hemorrhages " to treat, because by ordering the patient to swallow styptic drugs we can act directly upon the bleeding surface.1 In such a case small pieces of ice should be swallowed frequently, and this may be accompanied by 3 drops (0.15) of Monsel's solution in a half tumblerful of water every fifteen minutes till four doses are taken. Tannic acid may be given instead in the dose of 20 grains to a drachm (1.3-4.0), but the two should never be given at once in the same case. (See foot-note to p. 539.) Monsel's salt may be given in pill in the dose of 2 to 3 grains (0.1-0.15). The acetate of lead is also of value in pill form in the dose of 2 to 3 grains (0.1-0.15) with morphine or opium. Tincture of the chloride of iron, the sul- phate of iron, turpentine, ipecac, ergot, and hamamelis may all be used, the last three particularly in slow or passive hemorrhages. Sometimes nitrate of silver in the dose of I of a grain (0.016) in pill form is of service if the hemorrhage is a slow one. 1 Haematemesis also ensues as a result of swallowing blood which has escaped into the mouth or naso-pharynx, and this symptom is sometimes induced by malingerers in order to further their ends. These forms of haematemesis should, of course, be sep- arated from those dependent upon some lesion in the stomach itself. HEMORRHAGE. 585 Hemorrhage from the bowel is to be treated according to its point of origin. If in the small intestine, as from ulceration of Peyer's patches or other glands, the medicines must be used by the mouth ; if it be from the colon or rectum or from hemorrhoids, medication must be by Avay of the anus. Hemorrhage of the first class is best combated by the applica- tion of a small ice-bag to the belly and by the use of Monsel's salt (ferri subsulphas): 3 grains (0.15) made into a pill should be given every half hour or oftener, the pill being made hard enough to reach the intestine Avithout being dissolved and its contents decomposed in the stomach. Ergot has been resorted to, but is of doubtful value unless used hypodermically (s.ee Ergot) ; but tannic acid may be given with advantage in large amount in solution if the Monsel salt is not obtainable. The other remedies Avhich are of service are sulphuric acid in the dose of 5 to 10 drops (0.3-0.65) in water in acute or passive bleeding, or turpentine given in capsule, or, better still, in emulsion Avith acacia in the dose of 10 drops (0.65) every half-hour, particularly Avhen the hemorrhage is not active. Chloride of calcium is useful (Avhich see). Acetate of lead and camphor in the folloAving pill may be of service in some cases: R.—Plumbi acetatis...........gr. v (0.3). Camphora?.............gr. x (0 65).—M. Ft. in pil. No. v. S.—One pill every hour. Where the hemorrhage is dependent upon ulceration of the colon or rectum injections are to be resorted to. These are both styptic and curative, the styptic injections being particularly useful when the bleeding is to be stopped at once, the others where it is sought to remove the condition producing the trouble. To the first class belong alum, sulphate of copper, Monsel's solu- tion, sulphate of iron, tannic acid, and cold water. In the second Ave find nitrate of silver, the sulphates of copper and of iron, and the chlorate of potassium. The alum solution used should be fairly strong, 10 grains to the ounce (0.65 : 32.0); the copper, 5 grains to the ounce (0.3 : 32.0); the Monsel's salt, 10 grains to the ounce (0.65 : 32.0); or £ to 1 drachm of Monsel's solution to each 2 ounces (64.0) of water. The tannic acid should be used in the strength of 20 grains to the ounce (1.3 : 32.0) of water and glycerin. When chlorate of potassium is used it should be employed in saturated solution in small injections (25 grains to the ounce'[1.65 : 32.0]), or Aveaker if the injection be a large one (10 grains to the ounce [0.65 : 32.0]). These injections should be carefully given, and the success or failure attending the treatment of these states depends as much upon the technique of the operation as upon the injection of the medicinal substance. It should never be forgotten that an injection designed for local medication should be as small in bulk as circumstances will permit. Thus, in inflammation of the rectum the amount of the injected liquid should not be above 4 ounces (128.0) at the utmost, 586 DISEASES. and preferably 2 ounces (64.0) unless the diseased area is high up. An enema is given in bulk so as to cause distention and excite the boAvel to movement, whereas from a medicinal injection no moArement is desired. Again, the apparatus for sending in the fluid ought not to be a "family" or ordinary syringe, but a fountain syringe, the pressure being hydrostatic. This may be dispensed with if the injec- tion be small and only intended for the lower part of the rectum, but it is indispensable if the injection be intended to reach the upper part of the colon. The entrance of the liquid should always be gradual and easy. If resistance is met with, the pressure must be overcome, not by force, but by waiting a moment until it passes off. When the entire colon is to be flooded, at least a gallon of Avarm liquid may be needed. In these cases those drugs Avhich are capable of absorption and the production of poisonous symptoms are not to be used except in small amounts. (See Enteroclysis, Part III.) Where the injection is to reach high up into the boAvel the patient should be put in the lithotomy position with the buttocks eleArated. Sometimes in dysentery the injection of a pint to a quart of ice- cold water has a most favorable effect upon bloody purging. Whenever a medicated injection is to be used for the cure of ulcers which cause hemorrhage, the entire tract which is to be in\raded should be washed out Avith pure water or with a saline or soapy liquid, in order to dislodge mucus and faeces, Avhich prevent the drugs from acting on the boAvel-wall. Hematuria is a condition in which blood appears in the urine, and may be divided into two classes—that in which the blood comes from the kidney or bladder, and that in Avhich it comes from the urethra. In the first class the blood is always Avell mixed Avith the urine, Avhich is changed in color from its decomposition, and appears either through the entire act of urination or just at the end of the act. In those instances in Avhich the blood is in the first part of the stream it arises in the urethra, is nearly pure, and not Avell mixed Avith the urine. If the blood is due to the presence of an acute nephritis, the kidneys need treatment, and for directions as to this point the article on Acute Nephritis should be read : while, if the hemorrhage is due to the presence of a lesion in the bladder, the directions governing the use of turpentine, erigeron, or ergot, as given for Menorrha- gia and Metrorrhagia, should be followed, or if any morbid growth be present it should be removed. Sometimes 10 to*20 grains (0.65- 1.3) of camphor in divided doses are of service, given in pill form, while in others cannabis indica is of value. Gallic acid, in 20-grain (1.3) doses, may be used, and is very val- uable. If the hemorrhage is alarming, injections of astringent washes, such as 2 or 3 grains of alum to the ounce of Avater, should be injected into the bladder. It must be remembered, however, that this simply fills the bladder with clots, which are not readily passed and are liable to become septic. A very useful prescription is— HEMORRHOIDS. 587 R.—Acid, gallic.............3j (4.0). Acid, sulphuric, dil.........f^ij (8.0). Aquae...........q. s. ad fgiij (96.0).—M. S.—Teaspoonful (4.0) in water every four hours. If the hematuria be malarial, quinine has been employed, but in a large number of cases it makes the hematuria worse; and in the Southern United States, Avhere severe malarial poisoning is often seen, physicians ought never to use the drug for malarial hematuria. The value of quinine consists in its ability to prevent further attacks rather than to relieve the result of the attack—namely, the hematuria. Hyposulphite of sodium is a most useful remedy in malarial hematuria in the dose of 5 to 15 grains (0.3-1.0) every five hours. Some prac- titioners use as much as a drachm of hyposulphite of sodium every two hours till purgation takes place, give morphine and atropine hypo- dermically to relieve pain and quiet the stomach, apply cups over the kidneys, and give water to drink so as to freely flush the kidneys. Post-partum hemorrhage is to be controlled by the use of friction and kneading or grasping the dilated uterus through the relaxed ab- dominal wall; by the use of drachm doses of the fluid extract of ergot or a wineglassful of the Avine of ergot; and by the irritation of the uterine Avail by passing the hand, Avhich must be absolutely aseptic, up through the vagina into the uterine cavity. Sometimes ice may be passed up the vagina and into the uterine cavity Avith success in stop- ping the bleeding, and even vinegar and lemon-juice may be tried if the case is a desperate one. In other cases injections of water as hot as can be borne may be resorted to. HEMORRHOIDS. Hemorrhoids are vascular dilatations of capillaries, arteries, or ven- ules situated outside or inside of the sphincter am, or are composed, in the case of what are called external piles, of tags of skin which are more or less vascular and become troublesome Avhen inflamed. The internal pile, if large, is apt to prolapse and to become strangulated by the sphincter muscle. It is covered by mucous membrane, and is sometimes very small or like a mulberry in shape, consisting of a tuft of capillaries, a loop of an arteriole, or of a venule. The capillary or arterial hemorrhoid is apt to be bright red, and to bleed profusely when touched or when scraped by hard faeces. The venous tuft also bleeds, but not so freely, and the blood is not so bright in color. In cases in Avhich the hemorrhoids "come doAvn "—that is, pass out through the anus, so being in danger of becoming stran- gulated—the protruding mass should be washed with cold water, thereby at once cleansing the mass and reducing its congestion, and then gently pushed back with the fingers, which should be well oiled. Care should be taken that an external hemorrhoid is not mistaken for an internal pile, since if an external growth is pushed through the sphincter, it also becomes strangulated. The treatment of internal hemorrhoids is to a great extent iden- 588 DISEASES. tical with that of the external variety. A suppository may be used, made up as follows, if there is a tendency to slight hemorrhage: R.—Acid, gallic.................gr. xx (1.3). Extract, opii............... gr. j (0.05). Extract, belladonna?............gr. ij (0.1). 01. theobroma?...............q. s.—M. Ft. in suppos. No. x. S.—Use one every night, or distilled witch-hazel extract may be injected into the rectum. If the hemorrhage is profuse, the physician should use a speculum, find the bleeding point, and touch it with strong nitric acid, followed by the suppository named above. If this is done, the bowels should be confined for some days, until the spot under the slough made by the acid can heal. If the prolapsed hemorrhoid is inflamed and difficult of reduction, the folloAving ointment of Mathews may be ordered: R.—Cocain. hydrochlor..........gr. xij (0.8). Iodoformi ...... ......gj (4.0). Extract, opii.............gr. xxx (2.0). Petrolati...............i?j (32.0).—M. S.—Use as a salve. If the pile still refuses to be reduced, place the patient in bed and apply hot poultices, and if this fails operation is demanded. The treatment of external piles themselves consists in the mainte- nance of the most rigid cleanliness. Immediately after each move- ment the parts should be thoroughly washed by means of a sponge dipped in cold water, or better still, by the use of the bidet or a nozzle attached to a fountain syringe or to the general Avater-supply. After they are thoroughly cleansed, it is well to bathe them with distilled extract of hamamelis. Often it is Avell to precede the regular morn- ing evacuation by a cold rectal injection of pure water to soften the faeces, but more important still to decrease congestion. If the inflam- mation of the external piles is very acute and profound, the patient should be placed in bed and the cold injections frequently repeated or hot poultices applied to the anus. After the acute stage is passed a lotion of lead-water and laudanum (laudanum fgss to dilute lead- water f ^ij) may be used. The injection of carbolic acid into hemorrhoids is a dangerous practice, but if employed only 1 drop is to be used. In addition to these applications there are important general rules to be observed. The patient's habits should be so arranged that his daily act of defecation is at night before going to bed, rather than in the morn- ing, as under these circumstances the rest in bed relieves congestion and soreness, which the maintenance of the erect posture might make worse. Plethoric persons should not use upholstered chairs for office or lounging purposes, as the heat of the body relaxes the rectal tis- sues. A cane-seated chair is best, or an air-cushion Avith a hollow centre. The liver plays a most important part in relation to hemor- rhoids, and, if it is congested, congestion of the hemorrhoidal veins is very apt to ensue. The connection between the liver and the HEPATITIS. 589 hemorrhoidal plexus is most intimate, since the plexus is formed by the superior hemorrhoidal veins, Avhich are branches of the inferior mesenteric, and the middle and inferior hemorrhoidal veins, which terminate in the internal iliac. The portal venous system is com- posed in part of the inferior mesenteric vein, and any obstruction to venous flow in the liver at once results in engorgement of the hemorrhoidal plexus. (For the surgical treatment of piles reference must be made to surgical works.) HEPATITIS. (Acute and Chronic Hepatitis and Hepatic Abscess.) Inflammation of the liver may be produced by many causes, such as injuries, cold, exposure to high heat (as in the tropics), syphilis, and the presence of any infectious disease or of parasites. It may also arise from alcoholism. The acute form is rarely directly pro- duced by syphilis unless by the presence of some other form of the disease, such as gumma or the absorption of septic materials into the circulation from wounds or sores. The same may be said of the hepa- titis of hot climates, which is generally subacute or chronic. The pain, SAvelling, and general symptoms of the acute form of inflamma- tion of the liver are described thoroughly in the text-books on the practice of medicine. The measures commonly adopted for the relief of the symptoms and the disease itself are of two kinds : the first, medicinal; the second, dietetic. The patient, if the attack be acute or severe, will commonly be found in bed, owing to the pain and fever, but if not he must be placed in bed and kept in a recumbent posture. Over the surface of the right hypochondrium should be placed two cantharidal blisters of the diameter of from one to three inches, or, if this is not possible, a large mustard plaster is to be used. Sometimes hot cloths applied over this area not only give relief, but also aid in the formation of the blister. At the same time, if the boAvels are greatly confined, a saline purgative may be given, and be preceded by 1 grain (0.05) of calomel given in fractional doses. In regard to internal medication, the phy- sician should recollect that hepatitis is, like every inflammation, a local hyperaemia or vascular engorgement, and, in consequence, that aconite in full doses is useful. Veratrum viride may be used, but as it may produce vomiting and disturb the liver, it should rarely be employed. The kidneys may be kept active by spirit of nitrous ether and citrate of potassium, or by any one of the diuretic waters, such as Vichy, in moderate quantities. If the inflammation is not aborted by this treatment, it may go on to hepatic abscess.1 If hepatic abscess develops, the best thing to be 1 Just here it may be well to recall that many cases of hepatic abscess are now known to be due to dysentery, and that the diseased state of the lower bowel may infect the liver. 590 DISEASES done is to aspirate and draAV off the pus. Very frequently the in- flamed organ will form so strong an attachment with the peritoneal coat of the abdominal cavity that a bistoury may be used to free the pus if an aspirator is not at hand. After pus is once formed any con- stitutional evidence of its presence, as by night-SAveats, hectic, or rigors, is a sign for immediate interference Avith the purulent collec- tion by the physician. If amoebic dysentery exists, it must be cured as rapidly as possible by the measures generally employed for this purpose. (See Dysentery.) The diet during the early and later stages of acute hepatitis should be limited to those articles of food Avhich are easily digested and assim- ilated, and rich or greasy dishes are to be excluded. " Strong foods," as meats of all kinds, particularly beef, pork, and mutton, are to be sedulously avoided. All spices in the food must be forbidden, and alcohol utterly tabooed. If koumyss cannot be had, the patient may be fed on peptonized milk or pancreatized oysters. (See Part III.) After the abscess develops the same recommendations are to be fol- loAved, and the diet is to be as supportive as possible, small doses of quinine and iron being used. In the treatment of the subacute or chronic hepatitis of hot climates no remedy compares to freshly-prepared strong nitromuriatic acid, used both externally and internally. The acid should be a deep lemon color, and be mixed with Avater only when about to be taken, in the dose of 3 to 4 drops (0.15-0.2) three times a day. This rem- edy is contraindicated in acute hepatitis, because it acts by stimulating the organ, and Avould only increase the severity of the acute form of the disease if administered at this time. Externally, it is to be used by mixing it Avith Avater and applying it by means of a flannel wrung out in the mixture, or by placing it on spongiopiline in the proportion of from 1 to 3 fluidrachms to the pint (4.0-12.0 : 500 cc.) of warm water and applying it over the liver. If 3 fluidrachms (12.0) irritate the skin too greatly, the smaller quantity should be employed. This applica- tion causes a tingling of the skin and a localized SAveat. The hepatitis due to syphilis generally shows itself as a cirrhosis, and is to be treated by antisyphilitic measures. (See Syphilis.) If ascites develops from cirrhosis, the liquid is to be withdrawn, and frequent aspirations, as often as the liquid returns, have been known to result in apparent cure or arrest of the disease. In all forms of chronic hepatitis iodide of potassium is a useful remedy in the dose of from 5 to 10 grains (0.3-0.65) three times a day, or larger amounts may be used if the disease be due to syphilis. HICCOUGH. This is an affection arising from many causes, depending upon irri- tability of the nerves supplying the diaphragm as a result of gastric irritation, nervousness, uraemia, and as a complication of several exhausting diseases, such, for example, as typhoid fever. The mechanism of its production rests upon the sudden contrac- INCONTINENCE OF URINE. 591 tion or descent of the diaphragm, whereby a vacuum is formed in the chest into which the outside air attempts to rush, but is prevented from doing so by a sudden closure of the glottis, the peculiar sound of the hiccough being thus developed. Generally the symptom stops of itself, but it may become continuous and excessive. The remedies to be employed are used according to the cause of the disorder. If there be gastric or intestinal irritation, the irritating matter must be removed by emetics or purges, and nervous and local sedatives used. A feAv drops of spirit of chloroform do good in many cases, and a little tincture of capsicum may be employed in other instances, say 2 or 3 drops (0.1-0.15) Avell diluted. Children should only have i to 1 drop (0.025-0.05) of the tincture, well diluted. Spirit of camphor, or the tincture of valerian, in the dose of 1 drachm (4.0),may be serviceable, and Hoffmann's anodyne is peculiarly appro- priate in the dose of 1 drachm (4.0) in starch-Avater. In the hiccough of typhoid fever nothing compares to musk, 10 grains (0.65) by the rectum, and, if this cannot be used, oil of amber may be given by the mouth in the dose of 5 to 10 drops (0.3-0.65) in capsule or emul- sion, and followed by a drink of milk to prevent irritation of the stomach. Nitrite of amyl may also be inhaled. Where external remedies are resorted to, ether thrown in a fine spray on the epigastrium may stop an attack. In cases where the affection comes on after meals and is due to indigestion, a course of tonic treatment will often give relief. Thus nux vomica in pill or tincture, accompanied by some dilute mineral acid, such as hydrochloric or nitric, may be employed, or R.—Sodii bicarb.............3J (4.0). Tinct. nucis vom..........f^j (4.0). Tinct. cardamomi......q. s. ad f^iij (96.0).—M. S.—Teaspoonful (4.0) before each meal. If the symptom be uraemic, a hot pack or a hypodermic injection of hydrochlorate of pilocarpine may be found of service, unless contra- indicated by advanced depression and systemic weakness. INCONTINENCE OF URINE. Incontinence of urine may be classified either according to its forms or the methods of its treatment. Four A'arieties may be recognized as occurring separately, although all of them may occur in one case. There are cases where the bladder fails to hold the urine day or night, those in Avhich the incontinence is only nocturnal, and those in Avhich it occurs only upon some ner- vous start or in which the sphincter becomes relaxed from general atony. The first of these occur in children, the last in adult females. A fourth form of incontinence depends upon paralysis arising from centric nervous disorder or from paralysis due to retention and conse- quent paralytic distention. Taking up the consideration of the first forms—namely, those occurring in children, in Avhich the trouble is generally nocturnal— 592 DISEASES. the complete history and the present condition of the case must be discovered. Many of the most obstinate cases will yield when the urine is made constantly clear and mild by the use of alkalies, and others will recover upon the removal of worms from the vagina, which have crawled there from the rectum, or upon circumcision of a redun- dant prepuce, particularly if this be tight and smegma and urine be found back of it in large or small quantity. The cause of the incon- tinence in both these conditions is reflex irritation of the bladder-walls, by irritation at the end of the penis or in the vagina, and the rea- son that alkalies do good is that they render the urine, which is con- centrated and irritating, dilute, alkaline, and mild. Belladonna in these cases is rarely, if ever, curative, and. is at most only palliative, the condition returning as soon as the passing off of the effects of the drug permits the irritation to be felt by the nerves of the bladder. After alkaline diuretics have been used belladonna is, however, very valuable. Where the urine is concentrated and dark in color the following prescription is always useful : R.—Potassii citratis............^ss (2.0). Spt. setheris nitrosi.........f sjj (4.0). Aquae...........q. s. ad fgj (32.0).—M. S.—Dessertspoonful (8.0) every four hours in an equal quantity of water. As the urine becomes clear after several days a few drops of tinc- ture of belladonna may be added to the mixture ; but if a little is not sufficient, it must not be increased, as belladonna Avill not cure the condition, and may make the urine concentrated—a condition directly opposed to that Avhich is wranted. Sometimes these cases are dependent not so much upon vesical irritability as upon weakness of the spinal centres governing the bladder. If this be the case, the urine should first be rendered mild and then remedies should be directed to the improvement of these parts. The folloAving pill or the succeeding solution should be administered: R.—Acid, arsenosi ..........gr \ (0.02). Extract, nucis vomicae.......gr. ij (0.1).—M. Ft. in pil. No. xx. S.—One three times daily after meals for a child of eight or ten years. Or, R.—Liquor potassii arsenitis......gtt. xxiv (1.6). Tinct. nucis vomicae........gtt. xvj (1.0). Aquae...........q. s. ad f|iij (96.0).—M. S.—Teaspoonful (4.0) three times daily after meals for a child of eight or ten years. This mixture is so bitter as to be exceedingly disagreeable, and Fowler's solution may often be used alone in the dose of \ to 1 drop (0.025-0.05), and at the same time strychnine in gelatin- or sugar- coated pill or granule. It must be remembered that this last treatment is only to be employed in chronic cases devoid of all irritation and dependent upon atony. It will not do good if the urine is not previously made clear. Nothing can be more unfortunate in the treatment of these cases than punishment by severe scolding or whipping the child, as they INDIGESTION. 593 never do good, and, the fault being beyond the child's control, the unjust punishment makes him sullen, or through nervousness, aug- mented by such treatment, his trouble becomes worse. In some cases it may be necessary, in order to cure the habit, to let the child drink diuretic Avaters for years. The patient should ahvays be taken up from bed when the parents retire for the night and made to evacuate the bladder. For the incontinence of adult females or males on laughing or sud- den movement nothing compares, from a curative point of view, to drop doses of tincture of cantharides three times a day, the urine being kept flowing freely from the kidneys by means of alkaline diuretics. The treatment of the fourth form of incontinence of urine comes into the province of surgery. The bladder must be relieved by the catheter if the trouble be from retention with distention. If the dis- order is due to paralysis, nothing can be done except to carry out those general measures valuable in such cases—to maintain the urine in as normal a state as possible, to frequently catheterize with an aseptic catheter, and to wash out the bladder every few days or hours, as the case may be, with some Aveak antiseptic fluid, such as the 1:10,000 solution of bichloride of mercury, or 1:100 of carbolic acid, or 1:100 of boric acid. INDIGESTION (GASTRIC AND INTESTINAL). Under the heading " Biliousness " the writer has already described many of the conditions arising out of indigestion, and, this being the case, the consideration of that state knoAvn as dyspepsia or indigestion will only receive attention at this point in so far as its cure is con- cerned, without the relief of the symptoms produced. Lack of gastric digestion depends for its existence upon a very great number of causes, and is always a symptom, not a disease. It occurs during the course of short or prolonged fevers from atony of the gastric Avails and glands, from lack of secretion of the proper character, from hypersecretion of mucus by the mucous glands, and by fermentative changes in the food, or as the result of any one or all of these conditions, and, lastly, because the food is unsuitable to the case, or is of a kind difficult of assimilation, or is readily split up into effete products by the juices of the organ, and these in turn, being absorbed, produce toxic symptoms. Sometimes it is due to organic changes in the abdominal viscera, as carcinoma or ulcer, and sometimes to acute or chronic gastritis. In each of these states the treatment is, of course, different, because widely-separated causative factors must be removed. The indigestion attendant upon the course of fevers can nearly ahvays be avoided by a proper diet and the use of predigested food, such as pancreatized beef-tea, milk, or broths. The necessity of this artificial digestion is the more readily recognized when we recall the investigations of Iloppe-Seyler upon the quality of the gastric juice 38 594 DISEASES. of a patient suffering from typhus fever, for he found that no hydro- chloric acid was present. Uff'elmann has also found in a similar study that the peptone-forming secretion of the stomach ceases entirely during fever. Where indigestion results from the presence of gastric catarrh the remedies applicable to such a state must be resorted to. (See Gastric Catarrh.) The studies made within recent years upon the chemical conditions of the gastric contents have changed our methods of treatment from being empirical to being rational, for Ave now knoAv that disorders of digestion depend on deficient or excessive acidity of the gastric juice, deficient formation of pepsin, deficient motility of the gastric walls, and other less important causes. Before carrying out any line of treatment the physician must therefore decide, if possible, as to the underlying cause of the dyspepsia found in each case, and his decision may be based on well-described subjective symptoms by the patient, or upon this description aided, or it may be replaced, by examination of the stomach-contents after a "test-meal." In those cases in which the dyspeptic symptoms result from imper- fect mastication and insalivation of food it is evident that careful eating rules are to be given the patient, Avith the additional advice, which is equally good in all cases, that exact meal-hours shall be adhered to, since irregularity in meal-hours results in imperfect diges- tion as commonly as irregularity of habit in regard to defecation results in constipation. If the dyspeptic symptoms are due to deficient secretion of gastric juice, particularly if it is found that hydrochloric acid is the chief deficient element, one of two plans presents itself for employment. In many cases it will be found that the administra- tion of small doses of bicarbonate of sodium, 5 to 10 grains (0.3-0.65), before each meal will cause a free secretion of gastric juice, particu- larly if it be given simultaneously Avith bitter substances which act as stimulants to the gastric mucosa. These facts are not based solely on the apparent improvement in the patient, but also upon careful chemical studies of the acidity of the gastric juice by means of the stomach-tube. In mild cases the taking of a glass of Vichy water before each meal serves to provide sufficient sodium to produce good effects. The bitter substances Avhich it is best to employ in cases of deficient acidity of the gastric juice are, among the simple bitters, such drugs as quassia, cascarilla, Colombo, and gentian. Among the peculiar bitters Ave have nux vomica, quinine, rhubarb, and con- durango. These may be employed in the folloAving forms: R.—Sodii bicarbonatis.......gj (4.0). Tinct. nucis vomicae......f^j vel. ij (4.0 vel 8.0). Tinct. gentian, comp. . . q. s. ad fgiij (96.0).—M. S.—Teaspoonful to a desertspoonful (4.0 to 8.0) before meals. If the stomach is lazy and atonic, but Avith no true disease which im- pairs its secreting power, an alkali will, in the majority of cases, prove to be the best drug; but if, on the other hand, there'is deficient gas- tric secretion through atrophy of the gastric tubules or carcinoma of INDIGESTION. 595 the stomach, the use of hydrochloric acid is the better plan. Under these circumstances the following prescription may be ordered: R.—Acid, hydrochloric, dil...... . . f£j (4.0). Ext. condurango fl...........f^j (32.0). Tine, cardamomi comp. . . - . . q. s. ad fgiij (96.0).—M. S.—Dessertspoonful with or after each meal in water. The symptoms manifested by persons needing the treatment first named are variable, but generally of sufficient constancy in type to be fairly pathognomonic. There is generally loss of appetite, some impairment in general health and nutrition, and marked difficulty in digesting food, particularly if it be in solid form. Complaint is usually made of a sensation of Aveight after eating, Avithout any real pain, but indigestion is not complete, owing to the food being finally dis- posed of in the duodenum. Often because of the delay in gastric digestion there is some belching of gas due to fermentation of the food in the presence of Avarmth and moisture, and Avithout the anti- septic influence of the gastric juice. If any food is brought up with the belching, it is unaltered or changed only by fermentation. Examina- tion of the stomach-contents for hydrochloric acid by the phloroglucin- vanillin test Avill speedily confirm the diagnosis of absence of hydro- chloric acid, and this confirmation should be sought for in every case. In the cases of gastric indigestion depending upon hypersecretion of the acid of the juice a line of treatment quite at variance with that just discussed must be instituted. This may be divided into the direct and indirect forms, including the remedies which distinctly decrease gastric secretion and those Avhich antagonize or overcome its acidity after it is poured out from the glands. In the first-class we find both general and local nervous and glanular sedatives, and in the second alkaline drugs. Of the first class we have hyoscyamus, belladonna, and opium from the vegetable kingdom, and the bromides, bismuth, and nitrate of silver from the mineral. Of the second class Ave have massive doses of sodium bicarbonate taken during or after meals, ammo- nia, generally in the form of the aromatic spirit, and magnesia and chalk. As many, if not all, of the cases suffering from hyperacidity are of a nervous temperament, these drugs do good by quieting reflex activity throughout the nervous system connected with digestion, and by a local action on peripheral nerves, or on the glands themselves, diminish secretion. Of particular value for this purpose is hyoscy- amus, Avhich very markedly decreases gastric secretion directly and indirectly, and at the same time relieves gastric pain by its local sedative influence. Taking gastric ulcer as a typical instance of a condition of excessive secretion of hydrochloric acid, it Avill be found that the fol- lowing pill, combined Avith an absolute milk diet or, for the first feAv days, alloAving only rectal alimentation by peptonized food, will be most useful: 596 DISEASES. R.—Argenti nitratis............gr. v (0.3). Extract hyoscyami..........gr. x (0.65).—M- Ft. in pil. No. xx. S.—One pill one hour before taking food. Sometimes in place of this pill it is Avise, particularly if no ulcer exists, to give 10 to 20 grains (0.65-1.5) of bromide of strontium one hour before meals, and in any case Avhere this fails to control excessive secretion of acid full doses of sodium bicarbonate may be given, 20 or 30 grains (1.5 or 2.0) or more, after each meal. The bromide had better be given in solution. If the stomach is very irri- table and there is a tendency to vomiting, a powder composed as folloAvs is often useful: R.—Acid, carbolic, (cryst.) . Bismuthi subnitrat. Ft. in chart. No. xx. S.—One t. i. d. with or before food The symptoms manifested by the patients requiring this treatment are as follows : There is often a constant sense of gnaAving or hollow- ness in the stomach, Avhich is sometimes temporarily allayed by the taking of food. The patient is, as a rule, of a nervous temperament and in a condition of nervous depression due to some exhausting cause. Tenderness and even pain in the epigastrium may be produced by superficial or deep palpation, or the patient may complain that the pressure of his clothes is distressing. If ulcer of the stomach is present, all the characteristic symptoms of that lesion may be found. When belching occurs, there is often vomiting of sour masses or acid eructations or heartburn. Gastralgia more or less severe may also occur. In cases where testing the stomach-contents shoAvs that the exces- sive acidity is not due to hydrochloric acid, but to the acids of fer- mentation, the use of the sedative drugs we have named is of no avail for obvious reasons, but in their place Ave may employ sodium bicar- bonate as a palliative, and antiseptic or antifermentative drugs, such as thymol, creosote, chloral, and sodium hyposulphite, as direct reme- dial agents. Lavage of the stomach should also be resorted to. In still other cases a mixture containing chloral and hyposul- phite of sodium is useful because of its antiseptic influence. (See Chloral.) Often these cases are relieved if all fats, and butter in particu- lar, are excluded from their diet-list. If much gas is developed and a sensation of Aveight in the stom- ach is felt after eating, so that the patient feels as if the food lay undigested in that organ, the following prescription may be used, but is contraindicated if the stomach is tender on deep palpation, or, in other Avords, if acute irritation or inflammation of the stomach is present. It is useful in atonic states of the stomach, and it is surprising how much relief may be afforded by the use in such cases either of this prescrip- tion or of one of the volatile oils, such as oil of cinnamon, given in capsule or pill after meals. .......TT\,XX(1.5). .......gr. cc. (14.0).—M. INDIGESTION. 597 R.—Oleoresin. capsici............TT\jj (0.1). Pepsin, vel pancreatin.....;......gr. xx (1.35). Pulv. zingiberis........ . . . . ur. xx (1.35). Carbo ligni...............gr. xl (2.65). Creosoti................n\,x (0.65).—M. Ft. in pil. No. xx. S.—One after eating. Intestinal indigestion depends upon almost the same causes as does gastric dyspepsia, and is to be treated in much the same manner, chiefly by a careful study and regulation of the patient's diet, and by the use of a number of remedies calculated to supplant to some extent the normal juices by some artificial ferment. These ferments should be given with the meals or the food predigested before it is taken. The pancreatin should be given in full dose (5 to 10 grains [0.3- 0.65]), Avith bicarbonate of sodium, and alkaline mineral Avaters used if the urine is concentrated. (See Biliousness.) Sometimes where intestinal indigestion is present great flatulence comes on, and is an annoying symptom. Very commonly in these cases it Avill be found that the patients think they have heart disease because of the pain they suffer under the praecordium. This pain is due to the accumulation of flatus in the small intestine, or more com- monly to its pressing upAvard at the angle Avhere the transverse colon turns to go doAvn to form the descending colon and sigmoid flexure. Under these circumstances the folloAving prescription will be found of service: R.—Acid, nitric, dil.............fgj (4.0). Tinct. cardamom, comp..........f^vj (192.0).—M. S.—Dessertspoonful (8.0) in water four times a day. In old persons flatulence of the large bowel is frequently found, and is often associated with atony of the muscular coats of the gut. Under these circumstances the folloAving prescriptions will be found of service: R.—Asafoetida;...............gr. xl (2.6). Extract, nucis vomicae.........gr. iv (0.25). Extract, physostigmatis.........gr. iij (0.18). Oleoresin. capsici...........Ti^x (0.65).—M. Ft. in pil. No. xx. S.—One pill three times a day, two hours after meals. Or, R.—Tinct. belladonnas ...........f^ij (8.0). Tinct. physostigmatis .... .....f^j (4.0). Spt. camphorae..........q. s. ad f^iij (96.0).—M. S.—Teaspoonful (4.0) two hours after meals or whenever needed. Where intestinal indigestion results in lientery the treatment becomes entirely changed, except in regard to the use of a predi- gested milk diet, and efforts must be made to increase the secretion of the glands of the intestinal Avail. Often minute doses of mercury bichloride or podophyllin may do this, fa to fa grain (0.001-0.0016) of the first or second, respectively. More commonly, however, the mixture of nitric acid, given above, Avill be the proper treatment, or perhaps the following if the liver is found to be torpid: 598 DISEASES. R.—Acid, nitro-hydrochlor. (not dil.) . . . f^ss vel f^j (2.0-4.0). Infus. gentianae-comp......q. s. ad f^vj (192.0). —M. S.—Dessertspoonful (8.0) every four hours or after meals, in water. Chloroform spirit is often valuable in these cases in the dose of 20 drops (1.3). (See Chloroform.) INFLUENZA. The disease knoAvn as influenza affects various individuals so differently, and presents so many symptoms associated with functional disorder of various organs in the body, that it is almost impossible to do more than consider the remedies Avhich are to be employed in the treatment of the more frequent or more immediate manifestations or complications. Greater in importance than the employment of drugs must be regarded continuous rest, and stimulants are in many cases absolutely essential. In those cases in which the disease is ushered in by a severe chill, accompanied by violent pains in the back, if the patient is seen early enough it may be necessary to employ remedies for the relief of the rigor, Avith the double purpose of improving the patient's general con- dition and preventing internal congestion of vital organs. In the majority of instances, however, the patient will not be seen during this period of the disease, but during the febrile stage, Avhich succeeds that just mentioned. Under these circumstances the author does not believe that it is well for the physician to resort to any of the rem- edies Avhich have been so largely used during the last few years, and which are knoAvn as the " antipyretics " or the derivatives of coal- tar. Although originally introduced for the purpose of reducing febrile temperatures, practical experience has taught us that their sphere of action is very limited under these circumstances, and the author almost never gives antipyrin, phenacetin, or acetanilid Avith the object of reducing fever. Although he does not believe that these remedies are to be used for the reduction of temperature, he has certainly seen very marked relief follow their employment with the object of relieving the severe pain which occurs in the back, limbs, or head. Small doses are usually sufficient to at least reduce the suffering, if not to remove it entirely, but, as cardiac complica- tions are by no means unusual, large doses are contraindicated in most persons. The author prefers to allow the patient to suffer from a moderate degree of pain rather than from the dangers incident to the administration of doses large enough to entirely relieve it, because in his experience these doses have to be very large if they are to be entirely competent as analgesics in influenza. If any of the coal-tar products are used either for the relief of fever or of pain, phenacetin and acetanilid should be chosen. Ex- periments made in America and in Germany on animals have proved that phenacetin is far less toxic in its relations to the heart than is antipyrin or acetanilid, and while it has in a number of instances seemed more apt to produce cyanosis in man than either of the INFLUENZA. 599 other drugs, this cyanosis rarely, if ever, has been associated with any other dangerous symptoms. Indeed, it is quite extraordinary the amount of cyanosis which phenacetin may produce without the respiration becoming greatly disordered, very much less cyanosis Avhen caused by acetanilid or antipyrin being accompanied by much more alarming symptoms. A very favorite combination with prac- titioners Avho have had a large experience is one of salol and phena- cetin. The action of the phenacetin in relieving the pain and in reducing the fever seems to point to it as a rational remedy, but the exact influence of salol under these circumstances is not so clear. Composed, as it is, of 60 per cent, of salicylic acid and 40 per cent. of carbolic acid, it seems to possess a therapeutical power different from that possessed by either of these tAvo constituents alone, for neither carbolic acid nor salicylic acid has much power in the relief of pain Avhen used alone, unless, as in the case of carbolic acid, it is applied directly to the part affected. Perhaps the condition of pain in the lumbar and other muscles during the attack of influenza is in some unknoAvn way associated Avith the condition Avhich we have called "■ rheumatism," and in Avhich salicylic acid does good in an unknoAvn manner. Salicylic acid alone might be equally use- ful if it Avere dissolved in the intestine and did not irritate the stomach. On seeing a case of influenza during the first few hours of the attack the author resorts to those remedies which have been in use by the profession for many years, and, so far as he can learn, it is the custom of other members of the profession to give a mixture composed of tincture of aconite, spirit of nitrous ether, and a solu- tion of citrate of potassium in preference to any other medicine at this time. This mixture possesses the advantage of increasing the action of the skin and kidneys, and of reducing the temperature, of quieting the circulation, and of being readily taken by the patient Avithout danger of disordering the stomach at this time or later on, Avhich is important, as this organ is apt to become irritable. As a general rule, citrate of potassium is given in too small doses, and, unless there are reasons to the contrary, it should be given in the dose of 10 to 15 grains (0.65—1.0) three times a day to an adult. If the fever becomes excessive, so that there is danger of the patient suffering from a true hyperpyrexia, it is better to resort to cold bathing instead of the antipyretics just spoken of. It is true that the patients themselves and the friends of the patients will some- times protest against Avhat they deem an heroic measure, but the author is satisfied that if the cold is used in the proper manner it is devoid of danger to the patient. The majority of physicians do not seem to carry out the treatment of Brand and Liebermeister as it is carried out by its originators. Most of them forego the very import- ant portion of the treatment, which consists in frictions designed to bring the heated blood to the surface, and the author has again and again seen physicians apply cold either by means of a wet sheet, by sponcring, or a cold bath Avithout using any measures which are di- rected against internal congestion. (See Cold and Fever.) 600 DISEASES. Hyperpyrexia in influenza does not seem to possess the same dangers that it does in the course of some other diseases. In the first place, as a general rule, the course of the disease is a brief one, and, although it may leave the patient weak and exhausted, the duration of the febrile portion of the malady does not extend beyond a feAv days. Clinical experience and physiological study have proved that it is not the tem- perature of 105° or 106° F. Avhich is distinctly dangerous, but the continuation of this temperature for many hours which is harmful. Similarly, a patient ill from typhoid fever, having a temperature of 103° for many days, suffers very much more than does a patient who is suffering from pneumonia, and Avho may have for forty-eight hours a temperature of 104.5° or 105°. For these very reasons a tempera- ture of 104.5°or 105° is not particularly alarming in the condition which Ave are considering, unless there are symptoms pointing to the fact that the patient is being injured by an excessive temperature, as may be indicated by somnolence and an exceedingly dry skin as Avell as cerebral symptoms. Of course, if renal trouble, associated with cardiac disease, comes on at this time, methods for the reduction of the temperature must be resorted to. The point to be strongly emphasized is that the mere existence of high temperature is not to be regarded as a condition to be overcome by the use of drugs. It seems to be the general consensus of opinion, both in America and in England, that any measures of a depleting character are dis- tinctly harmful in influenza, even at its earliest stages, and we Avould naturally expect that this would be the conclusion arrived at by phy- sicians who treat their patients rationally. Although influenza is a short-lived disease, there is probably no malady in Avhich the patient goes so quickly into a condition of profound depression, or even exhaus- tion, as in this one. The abstraction of blood from a vein or by the use of cups should not be resorted to, as it will increase the exhaustion. Before the system has a chance to recover from the onset of the attack it will be still further depressed by the therapeutic measures of the physician who is unwise enough to bleed. As the case of influenza progresses a condition of marked depres- sion, or even collapse, very frequently develops. The expression of anxiety on the patient's face is to a physician Avho is accustomed to see it in other diseases a most alarming symptom, and it is not until one has seen it repeatedly in influenza that he is able to give it its exact value. Associated Avith this condition, the skin is frequently covered with a profuse perspiration, and the pulse is very apt to be very rapid, running, feeble, and easily compressed. At first glance the old saying, that " Ave treat the symptoms as they arise," Avould seem to cover to a very large extent the indications Avhich are present at this period ; yet the author's experience, Avhich may differ from that of some of his readers, is that the cardiac stimulant Avhich we are most frequently accustomed to use—namely, digitalis—does not seem to take hold of the circulatory apparatus and to act upon it in the manner which is desired. It may be that the pressing symptoms have made us more anxious and impatient as to the use of any medi- cament, and that we have not had the patience to wait and alloAv such INFLUENZA. 601 a slowly-acting remedy as digitalis to take effect. Be this as it may, the author regards strychnine as infinitely preferable to foxglove when these symptoms appear; and he has been able to prevent their appearance, or at any rate to modify them to a very great extent, by using strychnine in full doses from the first portion of the stage of depression. We believe that, as a general rule, strychnine is given in very much smaller doses than safety requires, and that in many instances it fails to act because the doses are too small to strug- gle Avith the profound condition of exhaustion Avhich is present. In an adult we can see no reason Avhy fa of a grain (0.003) may not be given three or four times in twenty-four hours, and in some cases we have given it every four hours Avithout producing any of the symp- toms of an overdose of strychnine. Divided doses are better than a feAv very large ones. The author knows of no better illustration of the fact that in some conditions we are to give drugs for effect rather than according to customary dose than the employment of strychnine in influenza, and the physician Avho is timorous in the presence of this frequent com- plication, depression, certainly increases the patient's danger. As Avith everything else, the drug should be carefully Avatched, and at the first sign of muscular tAvitchino; or stiffness at the back of the neck its administration should be cut down or discontinued. In many instances Avhere the collapse comes on suddenly the strychnine should be administered hypodermically and followed by full doses by the mouth, in order to keep up the fall effect exercised by the drug upon the nervous and circulatory systems. In some cases it will be found that the blood-paths seem to be so relaxed and atonic that the strychnine is unable to produce a sufficient vascular effect to bring the patient out of his difficulties, and under these circumstances very good results folloAv the combination of belladonna with strychnine, the belladonna being, as we well knoAv, a powerful vasomotor stim- ulant under such circumstances. It also should be given in full doses for effect. As the acute stage of depression passes off the belladonna should be stopped and the strychnine continued alone through con- valescence. It is proper to point out, however, that strychnine is not a drug suitable for the purpose of producing constant stimulation. It is a Avhip to the nervous system, and if used in too large a dose for too long a time the overwhipped system fags out. Alcohol has not seemed to be of much value during the active period of the disease. In milk-punches and eggnogs it is of course useful during convalescence. If delirium comes on, it has not seemed to be a symptom of very serious character either for immediate results or in influencing the prognosis as to the ultimate recovery of the case, and in cases of pneumonia complicating grippe, in which delirium is the prominent symptom, it appears that delirium is not to be regarded in the same light as similar manifestations complicating ordinary pneumonia or other diseases. The delirium may be either talkative or muttering, but does not in the majority of cases require treatment, passing away with the fever and rarely extending into the stage of exhaustion. 602 DISEASES. For the irritative cough steam inhalations, laden in the first stage with benzoin or other innocuous and sedative substances, seem par- ticularly useful. For the bronchitis Avhich is often present it is gen- erally sufficient to administer the ordinary mixtures, containing ipecac and potassium citrate, in the earliest stages, and to follow them by chloride of ammonium and cubebs in the later stages. The author does not think that the compound liquorice mixture containing anti- mony should be given in the second stage of influenza. A complica- tion too apt to occur at this time is oedema of the lung or a Avide- spread bronchitis, Avith a profound exudation Avhich bids fair to droAvn the patient in his own secretions. Antimony is not only a substance depressing to the circulatory and respiratory systems, hut aids very materially in causing the peculiar excess of secretion which has just been spoken of. It may be necessary to use bromides if the cough is excessive, or to replace them by codeine or very small doses of morphine. In many cases still better results will be obtained by a good preparation of cannabis indica, which may be pushed until it relieves the cough with- out in any way endangering the patient's life—a safety Avhich cannot be obtained by the employment of any other of the drugs named. If sleeplessness is so pressing a symptom as to require attention, the bromides may be given, but it will be generally found that the insomnia comes after the attack rather than during it, or in any event it will not require attention until the patient is convalescent. Under these circumstances chloral or chloralamide, or even sulphonal, may be administered, care being taken, of course, in the case of chloral that the cardiac apparatus is in good condition, and in the case of sulphonal that it is administered in a poAvdered form or dissolved in hot water and given four or five hours before the time at Avhich sleep is desired. For the vertigo and dizziness Avhich are sometimes bitterly com- plained of by the patient either during or after the attack, small doses of bromide with ergot or cannabis indica have seemed particularly valuable, probably because they exercise some effect upon the blood- vessels of the brain or its membranes or perhaps upon the blood-ves- sels of the ear. Certain it is that in those cases of tinnitus not asso- ciated with organic change in the aural canals bromides and ergot do more toAvard relieving them than any other medication. In the constipation which is sometimes present in the early stages of influenza it is generally advisable to administer either castor oil or in other cases half an ounce (10.0) of the sulphate of magnesium, or for more fastidious patients the citrate of magnesium. A full purga- tive effect of any of these salines seems to lessen the fever Avhen the bowels are unloaded. Care should be taken that the dose of the purga- tive is not excessively large, as it will weaken the patient as much as Avould bleeding. For the constipation following the attack probably no drug is as efficient as cascara sagrada, combined perhaps Avirh aloin. (See Constipation.) If diarrhoea supplants the constipation, the ordinary astringents, such as aromatic sulphuric acid or heematox- ylon, will be found sufficiently active. (See Diarrhoea.) INSOMNIA. 603 INSOMNIA. Insomnia is a condition complicating many diseases, and arises from such a host of causes that the physician may not be able to discover them for some days after the patient is first seen. As a general rule, a patient consulting a physician with this symptom expects a prescription to be given at once and the cause of the insomnia found out afterward. Under these circumstances the physician may safely employ several drugs according to the information that he has concerning the patient's state. One of the most common remedies is chloral given in the following manner: R.—Chloralis...............^iij (12.0). Syrup.................f#v (16.0). Aquae cinnamomi......q. s. ad fgiij (96.0).— M. S.—Dessertspoonful (8.0) at night. Or, R.—Butyl chloral-hydrat..........£j (4.0). Ft. in pil. No. xii. S.—One, two, or three pills at night, as needed. Where, for any reason, as the presence of a Aveak heart, chloral is contraindicated, resort may be had to the bromide of potassium or sodium, and if the patient is a female these drugs should always be accompanied by a small dose of arsenic, generally in the form of FoAvler's solution, 1 to 3 drops (0.05-0.15) three times a day, in order to avoid all danger of the production of acne. The folloAving pre- scription is useful: R.—Potassii bromid.............^ij (8.0). Liq. potassii arsenit...........f^ss (2.0). Aquae cinnamomi.........q. s. ad f^vj (192.0).—M. S.—One to two dessertspoonfuls (8.0-16.0) at night. In many cases larger amounts of the bromide will be needed. Where the sleeplessness is due to pain, chloral is of little value and bromides are worth but little more. Under these circumstances by resorting to what is known as the " crossed action of drugs," Ave can often obtain a very good effect. Thus morphine and chloral both act on the brain to produce sleep, or, in other words, their action is here crossed, for one relieves pain and the other does not; one kills by failure of the heart in overdose, the other by respiratory failure; as a consequence, large doses of neither can be given alone. The fol- loAving is therefore a useful combination, either Avhere one drug fails or when dangerously large doses of either alone have to be used to obtain the desired result : R.—Morphinae sulphatis.........gr. iv (0.2). Chloralis..............gij (8.0). Syrup................f|ij (60.0). Aquas ■ • • ■........q. s. ad fgiv (128.0).—M. S.—Dessertspoonful (8.0) at night. In cases where insomnia is due to mania hyoscine is said to be very 604 DISEASES. useful, given in the dose of Tfa to fa grain (0.0007) by the mouth or Tl^ to Tfa grain (0.0006) by the hypodermic needle. OAving to its tastelessness the powder may be put on the tongue, and it is best to order a little sugar of milk or white sugar (1 grain) to be added to each dose of hyoscine, in order to give it bulk. Where insomnia folloAvs mental effort avoidance of all cerebral activity should be insisted upon during the evening, and if the feet are cold on going to bed sleep should be induced by relieving the cerebral congestion by a hot foot-bath or the use of a hot-water bag at the feet while cold is applied to the head. In other instances a general hot bath, during Avhich an ice-bag is applied to the head, will produce sleep Avhen drugs fail, and it is to be remembered that in the insomnia of convalescence hydrotherapeutic measures are to be used to the exclu- sion of drugs (see Cold and Heat), for the former cure the condition, Avhile the latter only palliate and may produce a drug-habit. During the last few years a very large number of remedies have been introduced as hypnotics, such as somnal, paraldehyde, chloral- amide, sulphonal, trional, amylene hydrate, hypnal, and others. Not one of these is comparable in therapeutic activity with the older rem- edies. Of these the best, from every point of view, are sulphonal and trional. The dose of sulphonal and trional is 10 to 20 grains (0.05- 1.3) in poAvder, but, as they are large in bulk and hard to SAvallow, they should be used in a prescription made up as follows: R— Sulphonal.............gr. xxx (2.0) Syrupi simplicis..........fjij (8.0). Muoilaginis acacia?.........fgij (8.0). Aquae destillat.........q. s. ad f£j (32.0).—M. S.—Half to all of this at one dose, as may be needed. In other instances sulphonal may be dissolved in very hot Avater, and the solution SAvallowed before it cools sufficiently to permit precipi- tation. Chloralamide may be used in the dose of 15 to 60 grains (1.0-4.0), dissolved in Avine or given in capsule. Paraldehyde is given in the dose of 20 to 60 minims (1.3-4.0). As it is disagreeable in odor and taste, it must be given in capsule, and it is very apt to disorder the stomach. The dose of amylene hydrate is the same as that of paraldehyde. It is a liquid, and, like the rest of the drugs named, Avith the excep- tion of hypnal, has no effect in insomnia from pain. Somnal is used in the dose of 10 to 40 minims (0.65-2.65) with liquorice and Avater, and possesses considerable power. In the treatment of insomnia it should be remembered that if pos- sible those drugs should be used which will quiet the part of the brain which is most active. Thus if the patient tosses much, Ave use bro- mides and chloral as motor depressants. If sensation is active, bro- mides and the hot pack are used to act as sensory quietants. In some cases horseback exercise taken late in the afternoon does good, particularly if the patient follows a sedentary life. Many per- sons who are usually sleepless Avill obtain a refreshing slumber by tak- INTERMITTENT FEIrER. 605 ing a very light and easily-digested meal just before retiring for the night or by eating a cracker or drinking a glass of milk when they awake during the night. INTERMITTENT FEVER. In all forms of intermittent fever, Avhether the attacks are diurnal, quotidian, tertian, or quartan, the best remedy for their prevention is quinine, which should under these circumstances be given ahout two or three hours before the attack is expected, so as to be absorbed and be physiologically active when the paroxysm is due. This precaution is often overlooked, and the dose ordered at the time of the expected attack, with failure as a result. Not only should sufficient time elapse for absorption, but the fact should be remembered that the chill often begins an hour earlier each day, and will be in full sway before the quinine can stop it if the drug be not administered at the proper time. Experience has proved that quinine never acts as favor- ably if constipation is present as when the bowels are lax, and hepatic activity seems particularly necessary for its full effect. To obtain the full influence of the drug it should be preceded, by some four or five hours, by jr to % grain (0.010-0.016) of calomel every fifteen minutes until a grain (0.05) is taken, or by a dose of podophyllin amounting to -fa to |- grain (0.006-0.008). If podophyllin is used, a longer time should be allowed before the antiperiodic is given, because of the sIoav action of this purgative, and if the patient has been rendered unusually insensitive to purgatives, larger doses of both the remedies named must be used; particularly is this true in the South. The dose of quinine varies Avith the exigencies of the case, which in turn generally depend upon the region in which the patient lives or has lived. 10 to 15 grains (0.65-1.0) in one dose are generally sufficient in the Eastern and Northern States, but as much as 20 to 45 (1.3-3.0), or even 60 grains (4.0) may be required in the south- ern parts of the United States and elsewhere. When still larger doses are employed, the drug should be given partly hypodermically and partly by the rectum in suppository or in solution, as well as by the stomach, as this viscus will rarely withstand 60 grains (4.0) of quinine without irritation. (For the best salts for hypodermic use, see article on Cinchona.) If the stomach is irritable, resort to these means of entrance into the body are absolutely necessary and must be entirely relied on. In cases where the attacks are several days apart small doses of quinine of from 3 to 6 grains (0.15-0.3) are to be taken daily between the paroxysms, or, what is better, arsenic may be given in moderate dose for its antiperiodic influence during the intermission. In this manner the quinine acts with full force when most needed. Having considered the prophylaxis of a chill, let us turn to the treatment of the attack itself. It must be remembered that the greater part of the harmful effect of the malarial poison is exerted at this time by the internal congestions and engorgement of the abdom- inal and thoracic organs. The physician should therefore try to pre- 606 DISEASES. vent, as far as possible, too great a rigor, and if stasis results from the chill, overcome it, not by depletants, unless the case is very sthenic, but by stimulants, such as strychnine or digitalis, Avhich will drive out the blood from the congested area. If a full meal has just-been eaten, the stomach should be emptied by an emetic dose of ipecac, 2 drachms (8.0) of the powdered drug to an adult, or by 20 grains (1.3) of sulphate of zinc. It is almost useless to give quinine at this time, as absorption from the stomach and subcutaneous tissues is almost entirely absent. Alcoholic stimu- lants are not to be employed, as clinical experience seems to indicate that they act unfavorably. If the chill is severe enough to endanger the patient's life, meas- ures must be used to control it. Chloroform may be inhaled, and immediately preceded by laudanum by the boAvel or mouth. If the laudanum is given by the mouth, a little ether or chloroform may be added to the dose of the opiate. The opium may be used hypoderm- ically in the form of morphine in the dose of ^ of a grain (0.01) com- bined Avith -g1^- of a grain (0.001) of atropine. In the fevered stage little can be done except to give the patient comfort by cool drinks and cool sponging, or, if the fever becomes excessive, by the use of ice-cold sponging with active friction. These measures have seldom to be used, as the fever is generally too fugitive to need such treatment. The sweating stage needs no particular treatment, unless exhaus- tion is caused by it, Avhen stimulants may be cautiously used as needed, and large draughts of Avater at ordinary temperatures swal- loAved. Many measures have been resorted to to put off a malarial attack, the chief of which is the use of ether or chloroform anesthetization at the time of the expected paroxysm, of nitrite of amyl or of the nitrite of potassium or sodium in 10-grain (0.65) dose for the same purpose. Where the " chill habit " exists and depends largely upon nervousness, it has been broken by misplacing the hands of the clock, and so getting the patient past the time for his attacks without his knowledge. It should be remembered that the use of quinine in malarial fevers is no longer based on empiricism, but upon the fact that the drug exerts a peculiarly lethal influence over the cause of the dis- ease, the l^lasmodium malaria of Marchiafava and Celli, or, as it is sometimes called, the malarial germ of Laveran or the lnematozoon of malaria. It is Avorth remembering that methylene blue possesses antimala- rial properties in the dose of 1 to 4 grains (0.05-0.2). (See Methyl- ene Blue.) IRITIS. Iritis, or inflammation of the iris, as usually encountered is caused either by syphilis, rheumatism, or gout. It may also be traumatic: less frequent causes are gonorrhoea, diabetes, malaria, and tuberculo- IRITIS. 607 sis. Metastatic iritis occurs in pyaemia, relapsing fever, etc. The most marked symptoms are severe brow pain; fine ciliary injection; discoloration of the iris and immobility of the pupil, due to the for- mation of adhesions betAveen the iris and the capsule of the lens. The most important local remedy is atropine, to be used every two hours according to circumstances. If for any reason this is not tolerated, duboisine, scopolamine, or daturine may be substituted. Cocaine increases the mydriatic power of atropine. Pain may be relieved by leeches to the temple and the use of dry heat externally (cotton batting heated over a register will suffice) or hot fomentations—water, chamomile infusion, or laurel-water (1: 15). In traumatic iritis iced compresses are suitable in the early stages, but not in the later periods and not in any other form of iritis. Great care must be taken not to mistake iritis for conjunctivitis on the one hand, and glaucoma for iritis on the other; delayed use of atropine and the employment of astringents on account of the former error, or the instillation of atropine because of the latter, would constitute a serious therapeutical blunder. In serous iritis, or that variety in Avhich there is a hypersecretion of the aqueous humor, AA'hich becomes turbid, and a precipitate of dark spots occurs upon the membrane of Descemet, atropine must be cautiously instilled, OAving to the tend- ency to increased tension. If this occurs, paracentesis of the cornea may be needed, and pilocarpine should be given internally if the vit- reous becomes opaque. Subconjunctival injections of sublimate (2-5 drops of a 1: 2000 solution) are recommended in syphilitic iritis, and, if the inflamma- tion is not too acute, produce good results. Similar injections of physiological salt solution are equally efficacious. In true syphilitic iritis mercury must be pushed to the point of tolerance, but it is not necessary to salivate the patient. Any form of mercury usually employed in secondary syphilis may be used— calomel, blue mass, or protiodide of mercury—but the most efficacious method is by inunction : this is preferable even to hypodermic medi- cation in the opinion of many authors. After the mercurial impres- sion has been made and the pupil is well dilated, potassium iodide, either alone or in combination Avith bichloride of mercury, is indicated. In plastic iritis, appearing six to eight months after the disappear- ance of the secondary symptoms, this latter treatment Ayithout the previous use of mercury has been recommended. Caimichael's plan, consisting in the administration of drachm doses of turpentine, in addition to which the potassium iodide may be given, receives the endorsement of some surgeons and is useful in serous iritis. Rheumatic iritis calls for salicylic acid, oil of gaultheria, and, later, potassium iodide; in the chronic types of the affection Zolli- coffer's mixture is an excellent remedy. Potassium iodide should be administered in gonorrhoeal iritis, and relief occasionally follows a pilocarpine sweat. In all forms of iritis the treatment of the consti- tutional disorder which has occasioned the local inflammation is neces- sary, and if the iritis becomes purulent surgical interference is usually required. In any variety of iritis the intense pain should be alle- 608 DISEASES. viated Avith morphine or other anodyne sufficiently active to secure sleep. During the course of the disease saline laxatives may be administered, and after the subsidence and cessation of the specific treatment a course of iron tonics is an excellent routine practice. KERATITIS. Keratitis is the name applied to the various types of inflammation of the cornea. If this inflammation is associated with a breach in the continuity of the corneal surface, it is termed corneal ulcer, and four characteristic symptoms supply the indications for local treat- ment : (1) photophobia, or dread of light; (2) blepharospasm, or spas- modic contraction of the orbicularis muscle; (3) congestion of the blood-vessels; (4) pain; while any existing dyscrasia or constitutional condition upon which the local disease may depend requires general medication. Interstitial Keratitis. Interstitial keratitis is that form of chronic diffuse inflammation of the cornea characterized by ciliary congestion and a ground-glass appearance of this membrane, most common between the ages of five and fifteen years, and in the vast majority of cases the result of inherited syphilis. No local measure is sufficient, antisyphilitic treat- ment being of paramount importance. During the height of the ciliary congestion warm antiseptic lotions and atropine are indicated, the latter especially to prevent the tendency to iritis. Severe pain may be alleviated by the use of a leech to the temple if the subject be of sufficient age to justify the employment of local bleeding. Various other types of keratitis are described as the result of con- stitutional disturbances, such as gout (Hutchinson), malaria (Kipp, Van Milligen), or any condition of the system associated with great exhaustion, such as irregularities in the menstrual functions, certain forms of pulmonary disorders (true herpes of the cornea, Horner). The local management of these cases does not differ from that Avhich has been described. The coexisting constitutional disturbances must be combated with suitable remedies. Phlyctenular Keratitis. Phlyctenular keratitis appears in the form of small, blister-like bodies, sometimes single, sometimes multiple, frequently situated directly at the corneo-scleral margin, which become yellow, break doAvn, and leave an open ulcer (phlyctenular ulcer), to which runs a leash of injected blood-vessels. The disease is common in children, often follows in the wake of the exanthemata, and is so frequently associated with a strumous diathesis that it Avas formerly called strumous ophthalmia. In the majority of cases there is coexisting nasal disease, especially adenoid vegetations, which is responsible for the frequent relapses of the disorder, even if does not cause it. Congestion may be relieved by frequent irrigation with a Avarm KERATITIS. 609 boric-acid solution. Pain and irritation call for the use of atropine drops (4 grains to the ounce [0.2 : 32.0]), which should be continued until the ulcer is covered with regenerated epithelium, when the process of cicatrization may be hastened by the insertion daily into the conjunctival sac of a small quantity of yellow-oxide-of-mercury salve or dusting it Avith finely-poAvdered calomel, providing the patient is not taking at the same time any form of iodine. During the whole treatment the eyes should be protected by dark glasses and the sub- ject permitted to go out into the open air. All local treatment will prove unsatisfactory unless associated with strict hygiene, carefully regulated diet, and constitutional measures—tonics and alteratives— and the treatment of the naso-pharyngeal lesions. If the photophobia becomes distressing in spite of the other treat- ment, it has been suggested that this may be relieved by the use of cocaine, a practice that by no means commends itself in corneal ulcera- tion, in spite of the temporary relief from the local anaesthesia. Relief of this symptom in many instances follows the use of a douche of cold water on the closed eyelids, or by touching Avith blue-stone the ulcer- ated fissure at the external commissural angle, Avhich is commonly an exciting cause of the spasmodic closure of the lids. Suppurating Keratitis. Suppurating keratitis, or that form of inflammation characterized by the formation of pus in the cornea, may be either diffuse, as, for example, a complication of purulent ophthalmia, or circumscribed, forming an abscess of the cornea. If the pus gathers in the bottom of the anterior chamber, the condition is called hypopyon and the dis- ease hypopyon keratitis. These conditions require prompt treatment— namely, frequent application of hot compresses, which may be advan- tageously composed of slightly carbolized water, and atropine drops. If the abscess forms, the pus should be evacuated by a formal opera- tion, either by dividing the anterior surface or by performing the operation after the manner of Saemisch. In addition to the types of diseases which have been described we have the examples of sloughing or infective ulcers, which are seen under a variety of conditions, and often are directly traceable to an injury. The tendency of all these ulcers is to spread, Avhence one important variety has received the name serpiginous, Avhich is noAv known to be due to Fraenkel's pneumococcus. The mild measures are the use of antiseptic lotions, either boric acid, formalin, or bichlo- ride of mercury, iodoform, hot compresses, and instillations of atropine. Threatened perforation may be averted by a pressure bandage. This is made by placing upon the eye a wad of antiseptic cotton, over Avhich, in figure-of-eight turns, a flannel roller is applied. If in spite of this the process continues, the following measures have met Avith the great- est success: Touching the margin of the ulcer with a strong solu- tion of nitrate of silver, 10 to 20 grains to the ounce (0.65-1.3: 32.0), or tincture of iodine, care being taken that the ulcer alone receives the application; scraping the floor of the ulcer with a small curette 39 610 DISEASES. or spud and dusting upon its surface iodoform; finally—and this, in cases in Avhich the ulceration is not too extensive, is the best method —the use of the actual cautery. In every case of sloughing ulcer the lachrymal passages must be explored for obstruction. Sequelae of Corneal Ulceration. After healing of a corneal ulcer the cicatrix consists of a more or less dense white spot in the cornea (macula). If these scars are thick and white, they are irremediable by local medication and require sur- gical interference for optical relief. If, however, they are diffuse, much good will follow systematic massage of the cornea, aided by the introduction of a small particle of yellow-oxide-of-mercury salve. The massage is performed as follows: A piece of the salve the size of a split pea is introduced beneath the upper lid; upon the closed lid a finger is placed, and regular motions made through the lid over the surface of the cornea—namely, vertical, lateral, and radial motions, the seance being completed by circular movements. The whole should last from one to three minutes. Alleman claims excellent results in dissipating corneal opacities by the use of electricity by connecting a suitably prepared electrode with a battery, the cathode being placed directly on the previously anaesthetized cornea and the anode on the cheek. Subconjunctival injections of physiological salt solution, placed near the corneal margin, have some poAver in causing absorp- tion of corneal nebula. LACHRYMAL ABSCESS. Lachrymal abscess results from suppuration in a chronically dis- tended lachrymal sac, owing to the presence of obstruction in the nasal duct, and exists as a swelling under the skin at the inner can- thus, pressure upon the surface causing an escape of pus through the canaliculi. The treatment is practically confined to surgical inter- ference—that is, division of the canaliculi and washing out the dis- tended sac with antiseptic fluids, and restoring the patulency of the nasal duct by the use of probes as soon as the inflammatory symptoms have subsided, or, if the skin over the seat of the abscess is thinned and rupture is threatened, by free puncture downward and outAvard. In purulent discharge from the lachrymo-nasal duct solutions of formal- dehyde (1: 3000), injected through the passage, favorably modify the unhealthy secretions. Much comfort will ensue from the use of hot compresses over the inflamed area. These may be made in the ordinary Avay, or are still more efficacious if composed of a lead lotion, the ordinary lead-water and laudanum answering the purpose very well. LARYNGITIS (ACUTE). The treatment of acute laryngitis is identical in many respects with that directed against acute inflammatory processes elseAvhere. LARYNGITIS, ACUTE. 611 It may be divided into local, external, and internal methods. The condition of the larynx Avhen acutely inflamed is that of intense hyper- aemia and irritation, and the object of the physician must be to allay this irritability. This is best accomplished by the use of compound tincture of benzoin, Avhich is placed in boiling hot Avater (1 ounce to the pint [32.0: 500 cc.]), and the steam inhaled as it rises from a pitcher or as it passes out of the nozzle of a deep coffee-pot. A better apparatus, if it can be obtained, is a can or wide-mouthed bottle arranged with one long and one short tube like a Wolff bottle, the air being draAvn into the larynx through the short tube. This inhalation should be resorted to six or eight times a day, but the patient must not go out of doors or into a cold room, as the steam relaxes the parts involved and renders them more susceptible to cold. Sometimes advantage is gained by adding to this inhalation 1 grain (0.05) of menthol. If the patient is unable to remain in an equable temperature, then the steam-inhaler should be supplanted by the use by the physician of an Oliver nebu- lizer, and in this atomizer should be placed a mixture as folloAvs: R .—Menthol...............gr. iij (0.15). Albolene...............f^j (32.0).—M. S.—Use as a spray. The patient is directed to gently inhale this vapor, which because of its lightness readily passes deeply into the air-passages, and has the effect of soothing rather than irritating them as does the spray from an atomizer. Rarely in the very acute stages of laryngitis should the physician employ a watery spray to wash the laryngeal mucous membrane, as it is apt to increase the irritation. If any aqueous spray is used, as may be necessary when the irritation has resulted from the inhalation of dust, it may be made up as follows : R.—Sodii chlorid..........gr. xv (1.0). Acid, boric............gr. x (0.65). Sodii borat...........gr. x (0.65). Aquae rosae...........f^iij (96.0).—M. S.—Use as a spray. The external treatment, if the inflammation is exceedingly severe and the patient can be confined to bed, is a mustard plaster or hot application over the larynx, care being taken that the volatile mus- tard does not render the inhaled air irritating to the larynx. A mus- tard foot-bath and a warm drink on going to bed are useful. The internal treatment should consist in opening the bowels with calomel and a saline purgative if constipation is present, and in the adminstration of full doses of aconite and bromide of sodium or potas- sium, as follows: R.—Tine, aconiti..........Tti^xij vel xxiv (1.0-1.6). Sodii bromidi..........5fij (8.0). Syr. lactucarii (Aubergier) .... f:|j (32.0). Aquae..........q. s. ad f^iij (96.0).—M. S.—Dessertspoonful (8.0) every hour for six or eight doses. This prescription may in many cases be continued until convalescence, 612 DISEASES. as it stops cough, quiets the inflamed area, and allays arterial excite- ment. Often it is best to omit the aconite after the first few days. By the second day the patient should be directed to make a heavy application of tincture of iodine over the trachea and episternal notch, as high as is possible Avithout the stain shoAving above the collar. In children and in some adults this is well substituted by oil of amber and sweet oil in the proportion of 1 to 3 parts rubbed on the skin. For the stiffness following the inflammation preparations of coca are very useful, given internally, and tonics to the general system are needed. LEUCORRHCEA. This is a condition—vulgarly known as the " whites "—consisting in a hypersecretion from those glands which pour out their contents into the Aagina or the cervical canal of the uterus, or even into the cavity of this organ. It is a state dependent upon many causes for its existence, the chief of which is a condition of the system Avhen it is " run down " from any cause, with perverted functions of the glands or their sur- roundings. In some persons, who seem perfectly strong and well it would appear to be due to an effort of the system to overcome plethora. The character of the discharge varies Avith almost every case. In some instances it is thick and tenacious, in others so liquid as to trickle down the limbs in a stream and greatly soil the clothing. In most of the latter cases catarrh of the Fallopian tubes or ovarian irri- tation and tenderness will be present. Where the secretion is very thick and tenacious it generally arises from the cervical canal, while that from disorder of the vaginal wall alone, independent of other morbid conditions, may be either thick or thin. The treatment of these forms of leucorrhoea may be divided into two parts—one, that directed to the remedying of the morbid process through the use of drugs by the mouth; the other, by their employ- ment locally. It is needless to state that in that form dependent upon excessive lactation or other exhausting manner of life tonics of an active cha- racter are needed. As a general rule, anaemia will be present, and the following pill will be found of service: R.—Acid, arsenosi...........gr. J (0.016). Ferri redacti............gr. v (0.25). Quininae sulph............9j (1.3).—M. Ft. in pil. No. xx. S.—One pill three times a day, after meals, for an adult. Or, R.—Tr. cinchonae comp..........f^ij (64.0). Tr. gentian, comp.......q. s. ad fgiv (128.0).—M. S.—Dessertspoonful (8.0) three times a day, after meals.1 1 In both these prescriptions the small amount of iron and arsenic given will prob- ably be noted, but this is done advisedly, as iron and arsenic do as much good to the blood in small as in large amounts under most circumstances. (See Iron.J LEUCORRHCEA. 613 Sometimes small doses of the sulphate of iron are better for this purpose, OAving to its astringent properties, but Avhen any prepara- tions of iron are used care must be taken that the bowels are kept active and that the stomach is not disordered. Associated with the use of these internal remedies should be a moderate amount of exer- cise and the avoidance of late hours and rich foods. The local applications Avhich are of value in these states consist in Gounter-irritation and vaginal injections or painting the mucous mem- brane of the parts from Avhich the discharge comes with proper fluids. In the leucorrhoea dependent upon irritation of the ovaries with catarrh of the Fallopian tubes the use of small blisters formed by the employment of cantharidal collodion or a cantharidal plaster over the groin on either side is often accompanied by good results. At the same time the vaginal surfaces surrounding the cervix uteri may be painted Avith a mixture of iodine, carbolic acid, and chloral, such as is used by Dr. Goodell, as folloAvs: R.—Iodi resublimat.........3iv (16.0). Acid, carbol. crystal. "I -- 2. /QO ni Chloralis } • • • • aa §j (32.0). Rub the iodine and chloral in a glass mortar into a powder and add the carbolic acid. S.—Formula. To be used by the physician only. The folloAving pill may also be employed: R.—Hydrarg. chlor. corros......gr. \ (0.03). Ft. in pil. No. xx. S.—One pill three times a day, after meals or a tablet triturate may be used instead of a pill. The remaining treatment of watery leucorrhoea consists in the use of astringent injections. A very cheap astringent injection is made by adding 1 ounce (32.0) of powdered white-oak bark to each pint (500 cc.) of Avater, or tannic acid and glycerin in the proportion of 1 ounce to 2 quarts (32.0 : 2 litres) of warm water. Ringer recom- mends the following: R .—Sodii bicarbonatis........3J (4.0). Tincturae belladonna?......f^ij (8.0). Aquae.............Oj (500 cc.).—M. S.—Cse as a vaginal wash. Where the discharge is foetid a solution of permanganate of potas- sium should be used as an injection in the strength of J drachm to 1 pint (2.0 : 500 cc.) of water. In purulent vaginitis, specific or other- wise, the folloAving injection is serviceable: R.-Creolin.............f^s vel f#j (2.0-8.0). Ext.hydrast.canaden.fi......f^ijss (10.0). Aquae.............fgviij (256.0).—M. S.—Add 2 tablespoonfuls to a pint (32.0: 500 cc.) of hot water, shake thoroughly, and use as an injection. Sometimes a tampon thoroughly saturated with a poAvder of iodo- form and tannic acid, equal parts, and packed around a discharging uterine cervix, is of service. 614 DISEASES. When using vaginal injections in females it is important to remem- ber that they should be in large quantities. Nothing is more antago- nistic to true asepsis than the usual manner in which these applica- tions are made. Generally a pint of the solution is placed in a basin over which the woman squats, and by means of a syringe forces the liquid into the vagina as fast as it runs out, thereby filling the syringe joints with the dissolved secretions, and returning to the vagina as soon as they flow aAvay the impurities which have left it. The only proper Avay to give such an injection is to have the solution in one basin, to the extent of 1 gallon (4 litres), while the patient squats over a second basin, into which the impure liquid may run. A very useful astringent injection may be made by ordering R.—Zinc, sulphat............fzj (4.0). Alumin. sulph...........fzj (40). . Glycerini.............f.jjvj (192.0).—M. S.—A tablespoonful (16.0) to each quart (1 litre) of water. LID ABSCESSES. Lid abscesses are seen more frequently in children than adults, as the result of injury, the sequel of acute illness (epidemic influenza, pulmonary catarrhs, fever, etc.), or from local infection; under the latter circumstance they may assume a gangrenous type. The treat- ment is that for any form of abscess—poultices, preferably in the form of hot compresses, early incisions, antiseptic solutions, and tonics. LUMBAGO. This is a form of myalgia or muscular rheumatism of the muscles of the loins and small of the back, and is frequently the result of lifting heavy weights or it results from other strains. In many cases acupuncture is very useful, particularly if the trouble is bilateral. (See Part III.) Sometimes after the employment of this measure the patient can straighten the back at once and retain that position. In other instances antipyrin or acetanilid, in 5- to 10-grain (0.35-0.65) doses of the former and 2- to 4-grain (0.1-0.2) doses of the latter, are of service, and iodide of potassium and salicylic acid are not to be for- gotten if the condition of the patient does not rapidly improve. Phenacetin and salol are also useful, combined or alone. A large hot poultice applied to the back is often efficacious in obstinate cases. Sometimes the use of a hot foot-bath and a Dover's powder on going to bed will produce a cure, and ironing the back Avith an ordinary hot laundry iron at a proper heat, a piece of neAvspaper or cloth being placed over the skin under the iron, is very efficient. Counter-irrita- tion in the shape of a blister, a mustard plaster, or capsicum draft will often give relief. Where these measures fail the reverse treatment may be tried, such as an ice-bag placed over the loins or an ether spray turned on the part until the skin is greatly blanched. MA LA RIAL FE VER—MELA NCHOLIA. 615 MALARIAL FEVER. (See Intermittent and Remittent Fevers and Pernicious Mala- rial Fever.) MANIA (ACUTE). Space is wanting to consider the thorough and complete treatment of mania as it comes to the neurologist. All that can be done here is to denote temporary measures suitable for cases which are brief in their course. In those cases which occur after confinement and are not supposed to be based upon permanent trouble, cimicifuga racemosa is said to be very useful in the dose of 20 to 30 drops (1.3-2.0) of the fluid extract three times a day. Avhile for the rapid quieting of the patient we may use hyoscine hydrobromate in the dose of y^j- grain (0.0006). In other instances, if the kidneys and heart are healthy, full doses of chloral may be used, and if an active preparation of cannabis indica can be had, at least 1 grain (0.05) of the solid extract or J to 1 drachm (2.0-4.0) of the tincture should be employed. Cannabis indica Avill be found particularly senriceable if 60 grains (4.0) of one of the bromides can be combined with it. Where a patient suffering from mania is so violent that nothing can be done Avith him, he should be held, and an emetic dose of -fa grain (0.005) of apomorphine be given hypodermically to produce vom- iting and so relax the muscular system, or he may be tied or anaesthet- ized sufficiently to enable the physician to administer proper remedies. Sometimes full doses of morphine are needful, and in others a cold douche to the head while the body is in hot water is of service. MELANCHOLIA. This is not the place for the discussion of melancholia of so severe a form as to amount to insanity, since the treatment of this latter state is very various and largely depends upon the skill of trained physi- cians Avho are alienists. There is one form of melancholia, however, which may often be rapidly relieved by a simple measure. It is that dependent upon the condition of the system in Avhich oxaluria is present. Whenever an individual complains of melancholia the urine should be examined, and if any oxalate crystals are found, undiluted, fresh nitromuriatic acid should be given in the dose of 5 drops (0.3) after each'meal in a half-tumblerful or more of Avater. In order to guard against errors in diagnosis it is Avell to remember that pears, tomatoes, rhu- barb, and cabbage all cause oxalates to appear in the urine for a short period after their ingestion. 616 DISEASES. MENINGITIS (ACUTE). Meningitis is to be treated as is any other form of acute inflamma- tion occurring in a sthenic or dynamic individual, and particularly does its treatment correspond to that of the other inflammations of large serous membranes, such as peritonitis or pleurisy. In the early stages the patient should receive sufficiently large doses of aconite or veratrum viride to strongly impress the circulatory system. These drugs have the power of producing such dilatation of the blood-paths throughout the body that the congested or inflamed area is relieved of its excess of blood, because, the pressure being less elsewhere, the blood obeys the law that liquids always try to escape from pressure, and so leaves the meninges of the brain for the vessels of the limbs and trunk. A good-sized blister should always be placed at the nape of the neck as a counter-irritant to prevent effusion. The proper dose of veratrum viride in the form of the tincture is 3 drops (0.15) every hour until the skin becomes moist or nausea is developed.1 The tincture of aconite is also useful in full dose. If great arterial excitement is present, venesection may be practised (see Bleeding), but veratrum viride and aconite are better remedies if they are at hand. Associated with these two drugs we should em- ploy mercury and opium, the first for its antiphlogistic influence, the second for its power in allaying irritation. 4; grain (0.016) of pow- dered opium and J grain (0.03) of calomel may be given every hour until the full effect of the opium or mercury is manifested. In some instances the deodorized tincture of opium (Tinctura opii deodorati) is better than the crude drug, in the dose of 2 to 5 drops (0.1-0.25) every one or two hours. Sometimes belladonna is of great service, and this is particularly the case where the drugs already named are contraindicated because of a condition of weakness or asthenia. In both conditions ergot is of value in allaying the congestion, but its period for exerting a favorable effect is not at the very first part of the attack, but a little later, Avhen the stage of exudation is at hand. During the first acute stage an ice-bag should be applied to the head, both for its local influence and its antipyretic effect, and leeches may be put at the nape of the neck with advantage. As the disease advances and the nervous disorders of the affection become marked, nervous sedatives are required to allay the twitchings, muscular spasms, or convulsions, and for this purpose no drugs are to be com- pared to chloral and the bromides. The doses to be used vary Avith the violence of the symptoms, but it may be stated that the chloral should rarely, if ever, be used in doses above 10 grains (0.65), and the bromides given in the dose of from 5 to 40 grains (0.3-2.65). If coma comes on, a large blister should be applied to the nape of the neck. 1 It is to be remembered that veratrum viride often causes nausea, and even vomit- ing, in susceptible persons, and in consequence it should be carefully given in menin- gitis, lest if vomiting come on the disease be made worse. MIGRAINE-M YA LGIA. 617 Quinine has been recommended in meningitis, but it is absolutely contraindicated, as it predisposes to this condition. It may be em- ployed only in comralescence, and then used most carefully. The treatment of the second stage of meningitis must be neces- sarily supportive, OAving to the reaction consequent upon great ner- vous and arterial excitement. Under these circumstances the use of opium is still indicated, because it allays nervous unrest and supports the system, partly by conserving the tissues and partly by inhibiting the waste of nervous force apt to occur at this time. Alcohol should be given with the food if weakness is present, and a very simple or milk diet insisted upon. MIGRAINE. (See Neuralgia.) MUSCLE VOLITANTES. Muscpe volitantes is the name applied to the dark specks Avhich patients frequently see floating across their fields of vision, especially if the eyes are directed toAvard a bright sky or a white page. Usually they indicate no disease of the vitreous humor, and the ophthalmo- scope fails to detect abnormal changes. They are attributed to tor- pidity of the liver by the laity. Musca? volitantes may indicate eye- strain, and if the refraction is abnormal this should be corrected; a mild course of alteratives is often a useful adjuvant. MYALGIA. Soreness of the muscles either on pressure or on movement may be dependent upon a number of causes, such as strains, bruises, rheu- matic taint, or inflammation due to cold. Here, as in many other states, the treatment is to be divided into the external and the inter- nal methods. Of the internal remedies, the best are the salicylates or the iodide of potassium if rheumatism be at the base of the trouble. On the other hand, if a bruise or cold be the cause the chloride of ammonium will be of service in 10- or 20-grain (0.65-1.3) doses given in a solution Avith extract of liquorice. (For prescription see Bronchitis.) Other remedies which may be tried with a good chance of success are full doses of a good fluid extract of cimicifuga (20 drops to 1 drachm [1.3-4.0]) or the citrate or acetate of potassium in 20-grain (1.3) doses. The local medications are numerous, but only a few can be consid- ered as Avorthy of routine employment. The chief one is iodine, in the form of the pure ointment or diluted one-half with lard if the skin is easily irritated. Another method is to employ a liniment, well rubbed into the skin, made up as folloAvs: 618 DISEASES. R.—Tr. belladonna;...........fj$j (4.0). Tr. aconiti..............f^ij (8.0). Tr. opii...............fgy (S.0). Liniment, saponis.......q. s. ad f^vj (192.0).—M. S.—Poison. To be used externally and only as a liniment. Sometimes chloroform liniment is singularly successful, and poul- tices applied as hot as can be borne and covered by oil-silk and cotton to retain the heat are often of great value. Massage or good rubbing is also a sine qua non for the successful treatment of this state. NASAL CATARRH (ATROPHIC). In atrophic nasal catarrh the nostrils are roomy and the mucous membrane red and shiny. The formation of connective tissue has, to a great degree, obliterated the delicate serous glands, and the dis- charge of mucus, no longer diluted, forms inspissated crusts, Avhich adhere to the mucous membrane of the septum and turbinated bones. Areas of ulcerated or abraded membrane are disclosed upon removal of these adherent crusts. The turbinated bones are gradually absorbed and the secreting surface thereby much reduced. Sometimes the wasting is so great that the posterior Avail of the pharynx is clearly visible from the front. The inspissated secretion may make a cast of the nostril, and as fresh layers form underneath the oldest part is raised until the Avhole interior of the nostril becomes a mass of decomposition, giving rise to an overpowering stench. This form of catarrh causes loss of the sense of smell, and the odor is not recognized by the patient him- self. Ulceration or caries of the bony structure produces an odor even worse than the so-called ozaena. The pharynx suffers from the general wasting, and presents a dry, varnished appearance called pharyngitis sicca, which is rather a symptom of nasal atrophy than a separate disease of the pharynx. The indications are the removal of all accumulations in the nose and naso-pharynx and the healing of abraded or ulcerated surfaces. The early removal of dead bone is imperative, and AA'hat secreting surface remains must be stimulated as far as possible, to compensate, in a measure, for the glands that are hopelessly destroyed. In other Avords, our efforts are directed tOAvard producing a compensatory hyper- trophy of the glandular tissue that remains. Therefore Avith the use of antisepsis we combine alteratives and local stimulation. The nose should be thoroughly cleansed Avith an alkaline Avash— Dobell's solution—Avarmed to inciease its solvent poAver. To relieve the odor increase the amount of carbolic acid or substitute for it eucalyptol and thymol in the Avash. Listerine contains both of these, and may be added to the wash. Its OAvn pungent odor masks some- Avhat the offensive odor. Permanganate of potassium may be used in weak solutions, but it is painful except when sensation is entirelv lost. Peroxide of hydrogen is recommended, but the Avriter has had no experience in using it over such an extensive surface. NASAL CATARRH, CHRONIC. 619 The solutions are best applied by means of an atomizer or post- nasal syringe in the hands of the physician or by snuffing from the hand or cup. The odor, if due to decomposition, is much decreased as soon as the passages are clear. The discharge must never be alloAved to reaccumulate or much time Avill be lost. Ulcerations require local stimulation by a strong solution of nitrate of silver or a superficial application of the flat surface of the gal van o- cautery heated to a dull redness. Necrosed bone should be removed, and it is often found detached in the nostril. Local stimulants should be judiciously combined Avith alteratives. PoAvders of nitrate of silver in starch, varying in strength from 1 to 10 grains to 2\ drachms (0.65-10.0) of the latter, may be blown into the nostrils by means of an insufflator. Cover gently the whole surface Avith a thin layer, and use it only of sufficient strength to be slightly felt. Nitrate of silver, in solution, 1 to 10 grains to 1 fluid- ounce (0.05-0.65 : 32.0), gives better results at other times Avhen applied to the mucous membrane. Avoid over-stimulating, and so exhausting, the glands Avhich it is Avished to strengthen. The use of alteratives may alternate with the silver salt and iodide of potassium, and this may be done by using solutions of iodine and glycerin, as recommended for hypertrophic nasal catarrh. Internally, the physi- cian should employ iodide of potassium to increase nasal secretions and mucous-membrane stimulants and tonics. He should also pay attention to the activity of the skin. NASAL CATARRH (CHRONIC). Chronic nasal catarrh is essentially a disease of civilization, which may occur at any period of life, but more commonly develops from youth to early adult life. Although more prevalent among the upper classes, it is in the loAver ranks that it most frequently reaches its later stages and its worst forms. This does not result from lack of opportunity for treat- ment, but from the ignorance or indifference which this class show to diseases Avhile there is no suffering and no interference with business. Hypertrophic nasal catarrh commonly has its origin in a neglected cold in the head or in a series of colds occurring in rapid succession, keeping the nose in a congested state until the erectile tissue covering the turbinated bones loses in a measure its poAver of contracting, and, decreasing the calibre of the nostrils, becomes a source of permanent obstruction to breathing. As the disease increases there is increased susceptibility to cold. Slight exposure produces a stuffy feeling in the nose. The nostrils may become completely occluded; usually, hoAvever, only one side at a time is obstructed at first, the obstruction showing a tendency to change sides. This change is most noticeable in turning in bed, the loAver side usually stopping, and on changing the position the obstruction is reversed, the clearing being accompanied by a crack- 620 DISEASES. ling sensation. A slight tickling cough and tendency to clear the throat in the mornings may result from irritation of the pharynx or larynx. The first indications for treatment are the reduction of inflamma- tion and restoration of the breathing-space. As the chief function of the nose is respiratory, the re-establish- ment of free nasal respiration, combined Avith the liberal use of anti- septic Avashes, will lessen the inflammation and irritation and produce a healthier state of the secretions. The writer places cleanliness at the head of the list of remedial measures. The alkaline wash recommended on page 510, sprayed into the nose by a hand atomizer or gently snuffed from the palm of the hand or from a small cup, gives good results. The hand warms the solution slightly, but when snuffed from a cup the solution should be artificially warmed. This Avash may be used two or more times a day. The nasal douche should never be used Avhere there is nasal ob- struction, on account of the risk of forcing the solution into the Eustachian tube and causing catarrh of the middle ear. In addition to the antiseptic wash where the mucous membrane is congested and irritable, the treatment recommended for coryza may be instituted for a few days with good results. A solution composed of equal parts of distilled extract of hamamelis and water or a dilute solution of hydrastis may be sprayed into the nose during the acute stage. A little later a spray of ferric alum, 5 grains to the ounce (0.3 : 32.0), may be applied carefully in an atomizer by the physician. It is not advisable to use alum in any considerable strength in the nose, as its continued use is liable to impair the sense of smell. The alterative and absorbent action of iodine makes it a valuable remedy for local application in chronic nasal catarrh. Combine it with glycerin in the strength of 6 or 8 grains to the ounce (0.35 : 32.0), with enough potassium iodide to make a solution. Apply this by means of a piece of absorbent cotton on the end of an applicator, along the floor of the nose, until it reaches the pharynx. It is need- less to say that such an application as this should be made with the utmost gentleness. The cotton should project beyond the probe, and care should be taken to avoid bruising the tissues. After the acute stage has subsided, as shown by the disappearance of the livid color and lessened sensibility, any remaining hypertro- phied tissue should be removed by a snare or the galvano-cautery. NEPHRITIS (ACUTE). The treatment of acute nephritis accompanied by any active inflammatory change requires intelligent care. The pain in the loins, and perhaps the bloody urine, which is scanty and high-colored, febrile disturbance, and the history of exposure or other exciting cause, all form a clinical history typical in its major points. Here, as elsewhere, for the reduction of inflammation circulatory depress- NEPHRITIS, CHRONIC. 621 ants are to be resorted to, and aconite is generally most service- able. The patient should be kept quietly in bed and supplied with a milk diet, cups or leeches being used over the loins if the urine is scanty. Blisters are not advisable, as the irritant substances pro- ducing them may be absorbed and cause increased renal irritation. The restlessness will generally be quieted by the aconite ; but if this fails, resort must be had to bromides or small doses of opium, which must be given cautiously, as these drugs are not readily eliminated when the kidneys are diseased. Cannabis indica is thought to be of great service if bloody urine is present, but chloral is generally too irritating to the kidney to justify its employment. The appearance of large amounts of blood in the urine at about the fifth day of the illness is an indication, according to Sydney Ringer, for the use of drop doses of tincture of cantharides, given every few hours. Should the urine be scanty and of high specific gravity, and constipation be present, some calomel, or a purgative dose (i an ounce [16.0]) of sul- phate of magnesium should be used to aid in the elimination of impurities by the bowel. Warm mucilaginous drinks, as flaxseed tea, are of service, and the use of the citrate of potassium and the SAveet spirit of nitre Avith copious draughts of pure water should be resorted to to increase urinary flow and promote the action of'the skin. If dropsy or symptoms of uraemia (see Uraemia, Part IV.) come on, they may be relieved by the use of hydragogue purges, such as elate- rium, which is particularly useful in that it is supposed to aid in the elimination of the urea by the bowel. If vomiting is present, elate- rium ought not to-be used, as it irritates the stomach. Jaborandi or pilocarpine may"be used to SAveat the patient at this time or in the earlier stages with advantage; -| grain (0.008) of the hydrochlorate should be given hypodermically, and repeated in fifteen minutes if no SAveat appears; but it should never be forgotten that when the heart is feeble or the patient very susceptible pilocarpine may produce serious collapse. This can sometimes be guarded against by the simul- taneous use of strychnine in -fa grain (0.003) doses. Hot-air baths are often useful to provoke a sweat. (See Heat, Part III.) The treatment of the later stages consists in the use of stimulants to the kidneys to arouse them from the atony consequent upon the excitement of inflammation. To this end digitalis and squill, or digi- talis and calomel, or caffeine citrate, may be used in small amounts, gradually increased and followed by the compound spirit of juniper or gin as the case progresses. If the renal structure is persistently atonic, \ to 1 drop (0.01—0.05) of the tincture of cantharides at each dose may be used, and, as anaemia is often a prominent symptom, tincture of the chloride of iron, Avhich is both a diuretic and a tonic, should be resorted to. If renal hemorrhage is excessive, gallic acid and ergot are indi- cated to control the bleeding. A milk diet should be rigidly enforced. NEPHRITIS (CHRONIC). The treatment of chronic nephritis is a very different matter, so far as prognosis is concerned, from that of the acute form. It is 622 DISEASES. almost, if not quite, impossible to cure the condition present, and Ave can only improve the state of the kidneys and other organs by care and the use of proper drugs. As Tyson has aptly put it, we must try to arrest the development of the renal lesions and improve the general health, treat the symptoms which are not dependent upon the nephritis, except indirectly, and, last, treat those signs Avhich are due to the nephritis itself. To arrest the disease all alcoholic drinks should be avoided as far as possible, and business cares and worries be cast aside. Great care should be taken to avoid cold, and a warm climate is generally to be recommended to the patient, since sudden changes of temperature tend to produce congestion of the kidneys by the chilling of the skin. The diet and drink are important considerations, and should con- sist largely of milk. Many physicians direct that skimmed milk be used. The author believes" that this advice is not wise, as it deprives the patient of the nutritive fats, Avhich he needs and which are not contraindicated, whereas the proteids of skimmed milk, while the best form of albuminoid food Ave can give, are not advantageous, but have to be used to maintain nutrition. If the cream in the milk dis- agrees with the patient, it may be removed or diluted by effervescent Avater. The treatment suggested so far is applicable to all forms of chronic nephritis, but there are symptoms and complications of both the inter- stitial and parenchymatous forms of the disease Avhich require special treatment. If the urine be scanty in the parenchymatous form, and the heart is feeble, digitalis and caffeine are useful to improve the renal cir- culation and act directly on the kidney. In other cases we may pre- scribe the Avell-knoAvn pill of digitalis, squill, and calomel. These drugs not only increase urinary flow, but also decrease albuminuria in many cases. In still other instances Ave may give the acetate and bitartrate of potassium as diuretics, Avhich are particularly valuable if combined with digitalis in those cases of albuminuria dependent upon failure of the heart muscle; nor should the bichloride and protiodide of mercury be forgotten, as they are very valuable indeed for their alterative influence. These remedies are also of value to relieve the dropsy, and one of the most efficacious forms of treatment is a com- bination of the bitartrate of potassium and juniper-berries, so that 1 ounce (32.0) of* the former is dissolved in 1 pint (500 cc.) of an infu- sion (1 ounce (30.0) to the pint) of the latter and taken in twenty- four hours. A most valuable aid in decreasing the albuminuria is the use of 1 to 3 drops of tincture of cantharides in water three times a day, particularly if the kidney seems torpid and is secreting too little urine. If dropsy develops (see Dropsy), hydragogue purges are useful, such as jalap and elaterium, and hot baths, Turkish or Russian, are to be given, not only to relieve the dropsy, but to so hypertrophy the excretory glands of the skin that they will be able through greater activity to relieve the kidneys. (See Heat.) Very great benefit can often be obtained by the use of nitro- glycerine given in ascending doses beginning with y^ grain (0.0006) three times a day. This decreases the albuminuria, if it is present, NEURALGIA. 623 loAvers arterial tension, and benefits the heart. Copious draughts of pure water should be given, if the urine be scanty, to flush the kidneys if possible and aid SAveating, although copious urination may in many cases be present and troublesome. Another drug of great value in many cases of chronic contracted kidney is iodine in the form of iodide of sodium. This may be given in 10-grain (0.65) doses three times a day Avith great advantage to old persons with well advanced atheromatous changes. The treatment of uraemia, should it be mild or severe, is important, and the reader is referred to the article on that subject (see Uraemia). The various forms of hot baths should also be employed to aid the skin in eliminating poisons and relieving the kidney. The anaemia in both forms of nephritis is to be combated by the use of the tincture of the chloride of iron, or Basham's Mixture (see Iron), and oxygen inhalations, although these agents are most needed in the parenchymatous type. NEURALGIA. Like headache, neuralgia gives rise to most of the suffering expe- rienced by active persons Avho are not sick enough for bed and by those who are confined to bed by other diseases. It affects members of every walk of life, and may be so severe as entirely to incapacitate the most poAverful of men. The causes of neuralgia are very various, but they may be briefly stated to depend chiefly upon malnutrition, over-work, nervous excite- ment with consequent reaction, and to reflex irritation from diseased organs, as in the case of supraorbital neuralgia from eye-strain or ovarian irritation or uterine inflammation. Nerves functionally dis- eased are always more or less active than normal; that is, hyper- excited or hypo-excited, above or beloAv par. In both cases they must be brought back to their normal tone by appropriate remedies, and these consist in nervous excitants and nervous sedatives. To give a nerve already depressed the additional depression of a bromide, or a nerve excited the additional excitement of strychnine, would be absurd. From what has just been said it becomes evident that the physician must always determine the condition of the system of his patient and the causes of. that condition before administering remedies. The treatment of this condition of neuralgia from its curative stand- point may be divided into the use of tonics, nutritives, and palliatives. Where neuralgia is associated with anaemia no hope of permanent relief can be looked for unless iron and arsenic are used until the anaemia is cured, and it is often necessary to combine Avith these drugs the use of cod-liver oil and bitter tonics. These are the cases, too, in Avhich nux vomica and strychnine raise the depressed nerves to increased activity, and so bring relief. Hoav they do this is not known, but we knoAv enough to recognize one or tAvo important facts. Strychnine is certainly a nervous stimulant, and is also a stimulant 624 DISEASES. to the anterior columns of the spinal cord. It probably also acts upon the trophic centres in the anterior cornua of the spinal cord, and by stimulating these centres increases the nutrition of the trib- utary nerve-fibres. It is needless to state that the neuralgias of syphilis and scrofulosis are to be treated by the specific remedies directed to the cure of these affections, while at the same time the various symptoms are carefully controlled by appropriate palliatives. When nervous exhaustion causes neuralgia, phosphorus is a useful remedy, particularly in those cases which are convalescing from acute fevers. Sometimes malarial poisoning produces a violent form of supra- orbital pain knoAvn as "brow ague," which is to be relieved, not by ordinary remedies, but by large doses of quinine. The relief of the states producing neuralgia having been spoken of, it yet remains for us to consider the measures to be adopted for the cure of an attack. Fortunately, the recent advances of thera- peutic study have placed in our hands a large list of drugs not apt to produce a habit after prolonged use, comparatively safe though active, and not of disagreeable taste or evil general effect. By these terms the Avriter refers to antipyrin, acetanilid, and phenacetin, all of which possess Avonderful power in the alleviation of pain dependent upon true nervous involvement. In order to avoid failure in the use of these drugs in the relief of headache, we must always remember that their field of service is that of neuralgic pain, not other pains. Antipyrin is to be used in the dose of 5 to 20 grains (0.3-1.3) for ordinary neuralgia or the pain arising from the crisis of locomotor ataxia, acetanilid in the dose of 3 to 8 grains (0.18-0.5) for the same purposes, and phenacetin in the same amount as acetanilid. Upon these remedies, combined with caffeine and the bromides according to circumstances, we noAv depend, and the following pre- scriptions Avill be found of service : R.—Antipyrini............3j vel ^ij (4.0-8.0). Caffeinse citratis..........gr. xx (1.3).—M. Ft. in chart No. x. S.—One every thirty minutes till relieved. The following may be of use also: R.—Antipyrini......> . . . Potassii bromidi....... Ft. in chart No. x. S.—One every thirty minutes till relieved Or, when the caffeine in the first prescription causes nervousness, R-_^niiP^rini. • :..........33 vel 3ij (4.0-8.0). Oaneinse citratis . ........gr. x (0.65). Potassii bromidi.........^iij (12.0).__M. Ft. in chart No. x. S.—One as above. In any one of these prescriptions acetanilid or phenacetin may be substituted for the antipyrin. 3J vel 3ij (4.0-8.0). 3iij (12.0).—M. NIPPLES, SORE. 625 A very effective remedy in some cases of neuralgia of the fifth nerve is croton chloral in from 5- to 20-grain (0.3-1.3) doses in pills of 5 grains (0.3) each. In some cases of anaemic neuralgia of the head nitrite-of-amyl inhalations have proved useful, probably by reason of the cephalic flushing produced by this drug. A very large number of local applications have been used with success in obstinate neuralgias and other cases not so difficult of cure. Cocaine cannot be applied, as it does not penetrate the skin, but relief can sometimes be obtained by the local use of the oleate of aconitine painted over the spot if it be limited in area. Much of this alkaloid cannot be applied, lest poisoning by absorption occur. Where the nerve is very superficial it can often be treated by cold with great success. This is accomplished by freezing the parts with an ether, chloride of methyl, or rhigolene spray, or by the application of a small package of finely-chopped ice and salt to the part. Within the last feAv years the treatment of neuralgia by kataphoresis (see Part III.) has come into prominence, and consists in the use of some local anaesthetic, such as chloroform, Avhich is applied over the part on a small piece of lint, and a galvanic current used through the pledget Avhich is attached to the positive pole. Under these circumstances the anaesthetic passes through the skin and affects the nerve. A very useful local injection in localized neuralgia is ^ to 4 of a grain (0.016) of morphine, but the danger of beginning the morphine habit is to be remembered Avhen treating chronic cases. Sometimes acupuncture (see Part III.) is of service, and the surgeon may be called upon to stretch the nerve or to do a neurectomv. There still remains to be considered a form of neuralgia generally knoAvn as migraine. This affection is very severe in its manifesta- tions, and is often most obstinate in yielding to treatment. Com- monly it is associated with eye-strain or cerebral disease or other sim- ilar cause, and these must be removed before a cure is entirely effected. The best treatment of most of these attacks is the use of 20 drops (1-3) of the tincture of cannabis indica every hour if a good preparation can be had, or by the use of \ to J grain (0.016-0.30) of the solid extract every two hours, accompanied by 10 to 20 drops (0.65-1.3) of tincture of gelsemium. (See article on Headache.) NIPPLES (SORE). Whenever the nipples become sore, so that it is impossible for the mother to alloAv the child to nurse, a solution of cocaine of the strength of 4 grains to the ounce (0.2 : 32.0) should be applied to the part, and Avashed off carefully just before the child sucks. FolloAving the nursing, a solution of boric acid, of the strength of 20 grains to the ounce (1.3 : 32.0) of water or mucilage of acacia, may be used over the part, the nipple being thoroughly dried beforehand. Where the fissures are deep and sIoav to heal the tip of a stick of silver nitrate may be applied to them with advantage. Some practitioners employ tincture of benzoin over the inflamed part, and glycerite of tannin is 40 626 DISEASES. often of value. Cleanliness, dryness, and care of the breast previous to parturition do much toward preventing the condition. Sometimes it is necessary to use a breast-pump or nipple-shield before a cure can be effected. OBESITY. Whenever an excess of fat accumulates in the body, various dis- comforts, both mental and physical, arise, and in addition the normal functions of all the parts are so disturbed or interfered with that the continuance of health is often impossible. In many cases the deposition of fat about the heart or between its fibres results in serious symptoms; and breathlessness on exertion is produced by the obstruction Avhich is offered to the free movements of the diaphragm by masses of omental fat, aided by the fact that the great Aveight and bulk of the body requires severe muscular effort. It is Avorthy of note, also, that a layer of fat over the body increases the vascular surface very greatly, and in consequence gives the heart the labor of supplying a larger number of blood-vessels. The causes of obesity are numerous. In many families there is an inherited tendency, while in others only certain individuals are affected. These persons are fat because their systems naturally tend to the de- posit of obese materials, in the same Avay that the members of one family have large bones, while those of another have small bones. The etiology of obesity, outside of the causes just named, are very numerous, but the chief one is over-indulgence in food. Just at this point it is not out of place to state exactly what over- indulgence in food means. Every individual is a laAv unto himself in regard to the amount of food Avhich is consumed and ingested. One often sees large, powerful, Aviry men, Avho eat little, sit beside others, not so poAverful or large, Avho eat excessively, and Avho appa- rently do not suffer from indigestion in consequence. Neither of these two groups becomes excessively fat, because one represents a grate which burns its fuel so that there is no Avaste, Avhile the other resem- bles a grate in which there is ahvays a residue of unburnt coal, Avhich is cast out Avith the ashes as effete matter. As different engines of the same build require varying amounts of coal, so do different men assimilate different amounts of food. No stated amount of food can be set down as a man's daily portion until his case is carefully studied, but it is important to remember that the quantity of food is generally in direct ratio to the severity of the toil, and that a man who loafs about a club or "takes life easily " often eats more than a day-laborer—of far richer foods, too—and wonders why he gets stout. In nearly every case of obesity not dependent upon'gross disorder of the trophic nerves over-indulgence in food is the cause. To some this may seem absurd, and the patient will say that he eats just enough to keep him from feeling empty between meals; but this does not alter the case in the least. The proper amount of food for a man is not what his appetite or gastric viscus calls for, but Avhat his svs- OBESITY. 627 tern needs. To this further reference will be made Avhen considering the diet for obesity, found beloAv. The very presence of fat aids in the deposition of it, for, by act- ing as a non-conducting pad all over the body, it prevents the'dissi- pation of heat, and so decreases the combustion of those substances which, Avhen not used for the manufacture of heat, are deposited as fat. Again, Ave nearly ahvays find that obese persons take alcohol Avith their food, thereby increasing the fat in their bodies; for, find- ing that they cannot digest all the substances Avhich greediness makes them SAvalloAv, they take alcohol to stimulate their digestive apparatus to increased efforts and assimilation. Further than this, alcohol adds force to the body, and preserves the tissues by substituting itself for food in the oxidizing processes. We find, therefore, that three great causes are active in producing corpulence in many cases—namely, heredity, over-indulgence in food, and lack of exercise, Avhich is one of the means by Avhich over-indul- gence is produced; i. e. less exercise, less food needed, but often more eaten. The treatment of corpulence rests solely upon the conditions named. In all instances the diet is the important point for the bestoAA-al of care. Reference has already been made to the fact that the needs of the system are the criterion by Avhich Ave judge the amount of food necessary to each case, not the sensations in the stomach. The use of coca by the natives of South America enables them to Avithstand hunger and privation, not because it gives tissue to the body, but because it paralyzes the sensory nerves in the stomach and relieA-es the sensation of hollowness or Aveakness Avhich Ave are accustomed to overcome in this country, in the absence of food, by tightening our belts. Every one who has undergone severe mental or physical labor and missed a regular meal will remember that about the usual hour for the meal his sensation of emptiness may amount to nausea and distress, but the hour once passed he feels as strong as before until by prolonged toil he so exhausts his powers that the system forces him to eat, not so much from hunger as from exhaustion. To under- stand this clearly, we must recollect that the system keeps its shares of force in the same way as a careful speculator keeps his shares of stock—namely, one part in active use for speculation, the other half for'reserve in case of need. In health the stomach begins to "feel hungry" as soon as the speculative shares of force are nearly used, in order to cause the ingestion of more food and to preserve the " sinking fund " intact. It becomes evident, therefore, that the mere presence of hunger is purely a symptom, not an indication of the absolute necessity of food, for, if it Avere, the consumptive Avould be notorious for his appetite, instead of being noteAvorthy for his anorexia. The food of the patient suffering from obesity is to be cut doAvn gradually, and the character of it arranged so that, though its bulk be great, its nutritive properties are small. Beef and other meats are concentrated foods containing much nourishment in a small space, Avhile lettuce, spinach, cabbage, and nearly all vegetables, except 628 DISEASES. roots or tubers, contain a large amount of fibre useless to the body. By the use of a carefully arranged vegetable diet in obesity Ave cut down the actual amount of food absorbed, and by its bulk keep the stomach so busy at sifting the nutritious from the non-nutritious mate- rials that hunger is not felt, because another meal-time is reached almost before the food of the first is assimilated. We find, therefore, that the diet for the reduction of corpulence should consist chiefly of bulky vegetables, but not too exclusively of any one article or set of articles. Heretofore it has been thought that proteids (meats, eggs, etc.) should be used to take the place of all hydrocarbons or carbohydrates (fats, starches, and sugars), but this is not physio- logically correct, as both forms of food are ahvays needed for health, and it has been found that proteids may be converted into fats in the body. The following bill of fare will be found of service in the treatment of obesity: Breakfast: One or two cups of coffee or tea, Avithout milk or sugar, but sweetened Avith a fraction of a grain of saccharin. 3 ounces of toasted or ordinary Avhite bread or 6 ounces of bran bread. Enough butter may be used to make the bread palatable—not more than 1 ounce. Sliced raw tomatoes Avith vinegar or cooked tomatoes without any sugar or fats. This diet may be varied by the use of salt or fresh fish either at breakfast or at dinner. Noon meal (dinner): One soup-plate of bouillon, consomme, Ju- lienne, or other thin soup, or Liebig's or Mosquera's beef jelly, fol- lowed by one piece of the white meat of any form of fowl or a small bird. Sometimes a small piece, the size of one's hand, of rare beef or mut- ton, but no fat, may be alloAved, and this should be accompanied by string-beans, celery, stewed or raAv, spinach, kale, cabbage, beans, asparagus, leeks, and young onions. FolloAving this, lettuce Avith vinegar and a little olive oil (to make a French dressing), a cup of black coffee or one of tea, and a little acid fruit, such as some sour grapes, tamarinds, and sour oranges or lemons, may be taken, and followed by a cigar or cigarette. Supper should consist of one or two soft-boiled eggs, which may also be poached, but not fried, a few ounces of bran bread, some salad and fruit, and perhaps a glass or two of light, dry (not sweet) wine, if the patient is accustomed to its use. Before going to bed, to avoid discomfort from a sensation of hun- ger during the night, the patient may take a meal of panada or soak Graham or bran crackers or biscuits in Avater and flavor the mass with salt and pepper. The reduction of diet is generally best accomplished sloAvly, and should be accompanied by measures devoted to the utilization of the fat present for the support of the body. Thus the patient should not be too heavily clad, either day or night, should resort to exercise, daily becoming more severe, and should not drink freely of water, unless sweating is established sufficiently freely to prevent the accumu- lation of the liquid in the vessels and tissues. Very often a cold bath will, by its dissipation of heat, cause PERICARDITIS. 629 destruction of fat, which will be burnt up in the body in the manu- facture of heat-units to maintain the temperature; and if the patient is not too anaemic and stands this exposure to cold avcII, the bath should be repeated each day or a Turkish bath used instead. The boAvels should be kept active by laxative fruits or purges, but if liquids taken in drink are not eliminated rapidly, saline purges are useful, since, if the blood-vessels are engorged, the circulation in the capillaries is slow and a deposit of fat is apt to result. Where proper exercise is impossible the rest cure, with massage, electricity, passive exertion, and an absolute skimmed-milk diet, may be resorted to, particularly in those persons knoAvn as "fat anaemics," who have not enough red corpuscles in their blood to carry sufficient oxygen to the tissues to complete oxidation. PERICARDITIS. Inflammation of the pericardial sac is a frequent occurrence and requires prompt treatment. If the case be sthenic and is seen early, five to ten leeches should be placed over the praecordium, and at the same time sufficiently large doses of veratrum viride or aconite resorted to to depress the circulation, and by the dilatation of the blood-vessels elseAvhere to draw off the blood from the inflamed area. To prevent the outpouring of a plastic exudate capable of undergoing organiza- tion and forming adhesions, calomel should be given in |-grain (0.03) doses every hour, combined with enough opium to prevent purgation. An ice-bag placed over the praecordium not only relieves the pain, quiets the circulation, and reduces the temperature, but also acts favor- ably in modifying the severity of the inflammation. Where the case passes from the acute stage of inflammation to that in Avhich effusion takes place, the treatment changes at once, and becomes supportive if the system shows signs of failure. The fric- tion-sounds of the first stage are noAv lost, and the heart-sounds may be feeble or muffled in tone by reason of the effusion present. Digi- talis, alcohol, or caffeine may be used if the heart shows signs of fail- ure, but when digitalis is used its influence should be carefully watched, since the employment of this drug produces a very full diastole or dilatation of the ventricles, and these are already cramped for space in which to dilate by reason of the exudate Avhich has entered the pericardial sac. If the effusion is sufficient to endanger life, it should be tapped and aspirated away very gradually. Often it is best to use a long needle attached to a hypodermic syringe in order to be sure that there is fluid. The best place for making the puncture is the fourth or fifth intercostal space, very close to the left edge of the sternum. In other instances, if the patient is strong, it is only nec- essary to administer hydragogue purges, such as jalap (20 grains [1.3] of the compound jalap powder), or elaterium \ grain (0.01), or a saline purgative in concentrated form, before breakfast. Often a blister over the praecordium is of service. Should pus be present, free drainage must be gradually established. 630 DISEASES. PERITONITIS (ACUTE). The views of the best minds in the medical profession concerning the treatment of peritonitis have ehanged radically in the last ten years, chiefly through the advances made in abdominal surgery and bacteriological research. These opportunities for study have shoAvn that peritonitis never arises as a strictly primary condition, but is due in every case to the infection of the peritoneum by micro-organ- isms, benign or malign, Avhich are originally found in the intestines or other portions of the abdominal viscera. Even when peritonitis folloAvs directly upon injury, the actual cause of the pathological process is the escape of micro-organisms through the devitalized wall of the intestine, and the severity of the attacks depends in turn upon the vital resistance of the patient, the degree of infection, and the rapidity Avith which a plastic exudate is thrown out to encapsulate the inflamed area. It is not possible in this short article to discuss the facts now knoAvn in regard to the etiology and pathology of acute peritonitis. Suffice it to state, one of the germs found normally as a benign inhabitant of the intestine becomes at once, on entrance into the peritoneal cavity, malignant and capable of producing rapidly-fatal peritonitis. Nor is actual rupture of the bowel or appendix vermi- formis necessary for this infection, since it has been shown that this germ, the bacillus coli communis, rapidly migrates through the bowel- Avall as soon as it becomes inflamed or congested in all its coats. Streptococci and staphylococci, finding access to this cavity, also produce violent inflammation. It has been found that the perito- neum Avill destroy many infecting germs in the healthy man if its vitality is not impaired, but if it is impaired a mild infection starts up severe inflammation. Having learned, then, that acute peritonitis is always secondary to some local cause or to some general infection, the first thing for the therapeutist to do, being called in to a case of this disease, is to deter- mine what the provoking agent is, in order that his treatment may be directed against the cause rather than the effect. This cause is now knoAvn, in the great majority of cases, to be Appendicitis (which, see), the inflammatory process being spread by infection from this source. In women it is not uncommonly due to more or less obscure pelvic disease, or, again, it may arise from abscess and other severe diseases of the liver, spleen, pancreas, or stomach. Finally, it should never be forgotten that intestinal obstruction is a frequent cause of peritonitis. The physician may rest assured that if he cannot find the provoking cause, it is his OAvn fault, and not that the case is purely idiopathic. HaAung found the cause, treatment is of course to be at once insti- tuted, and is medical or surgical—more commonly the latter than the former, since nearly all the provoking causes of this disease are at most only palliated by medicinal treatment, Avhile they can sometimes be removed by surgical interference. Fortunately for those who can only obtain medicinal treatment, nature does much to aid in produ- PERITONITIS. 631 cing a cure in many cases by limiting the disease through its localiza- tion by Avails of lymph, so that many cases of peritonitis recover with- out active medicinal or surgical care. In the pelvis this localization of the process is very apt to take place unless the infection follow childbirth, AA'hen septic diffuse peritonitis may arise, which is nearly ahvays fatal. If the trouble arise in the appendix vermiformis, this condition may be treated in its early stages by the means suggested in the arti- cle on Appendicitis, but at the very first sign of the spread of the inflammation, or of its becoming locally very severe, or of general sys- temic disturbance, the surgeon must be called in. The difficulty is that in many cases requiring operation, the operation is performed too late through the hesitancy of the patient, his friends, the physician, or even of the operator himself. If the local trouble does not seem to be spreading and the patient's general condition is favorable, ope- ration should be postponed indefinitely or until a state of quiescence is reached, when the prospects of recovery from operative interference are better. If there is reason to believe that an abscess has ruptured into the peritoneal cavity, or if perforation of the bowel is followed by severe general symptoms of widespread peritoneal difficulty, ope- ration should be resorted to at once. In deciding the question, hoAvever, as to Avhether a case of periton- itis requires surgical interference, the physician at the present time is in an unfortunate position. There can be no doubt that there are many records in medicine which prove most conclusively that lives have been saved through operative interference which would have been undoubtedly lost had the surgeon not come to the rescue. On the other hand, there are cases in Avhich a fatal result has followed an operation, and in Avhich the physician has bitterly reproached him- self that he consented to surgical interference, for as he looks back over the case he perceives that the operation has distinctly aided in causing the loss of life. At the present time each case must be decided upon its individual merits, and the physician or surgeon in giving ad\Tice to the family in regard to a Avell-developed case of peri- tonitis should ahvays be careful to let them understand distinctly that the condition of the patient is most alarming, and the chances of life poor whether the treatment be medical or surgical, since in many instances neither form of remedial measure can possibly produce good results. In other words, the relatives should clearly understand that Avhether medicinal measures or surgical procedures are resorted to, the patient has only a fighting chance. The following case illustrates the value of surgical interference in peritonitis: M-----Avas taken ill at twelve midnight, with violent pain in the belly, and was seen by the writer the folloAving evening at eight o'clock. At this time all the physical signs of a widely-diffused peritonitis were present. The belly was hard and board-like, the pulse Avas exceedingly rapid, the respirations fifty-six, and there Avas great pain. Careful physical examination of the belly and a study of the patient's history failed to reveal any cause near or remote for 632 DISEASES. the attack, he having been in perfect health up to the time at which the pain began. After consultation Avith an eminent surgeon it Avas iecided that his condition Avas so pressing that death under medicinal treatment Avas assured, and that, Avhile operative interference offered but a faint chance of success, it Avas the only measure Avhich could be resorted to. Accordingly, at tAvelve o'clock that night, just tAventy- four hours after the pain began, the patient Avas operated upon, the incision being made in the median line for the purpose of exploring the belly, with the hope that an exciting cause for the attack might be found. On opening the belly it was found that acute intestinal obstruction had taken place through the boAvel being twisted over an old inflammatory band. After this obstruction had been reduced the appendix Avas examined, and found to be in a condition of acute in- flammation, and for this reason it Avas removed. It Avas noted that the peritoneal surfaces of the intestines and of the abdominal Avail was intensely hyperaemic and red and lacking in their normal appearance. The operation lasted an hour and a half, and the patient recovered after a desperate struggle for life which lasted for Aveeks, during which time his attendants several times gave up all hope of his re- covery. Had no operation been permitted, death would certainly have resulted from the intestinal obstruction if not from the appendicitis, and had the median incision not been made, but the appendix alone sought for by a lateral incision, the obstruction Avould have been overlooked, and the death recorded as one due to general peritonitis folloAving appendicitis for Avhich an operation had been performed unsuccessfully. On the other hand, the Avriter saAv a case in AA'hich the conditions before operation Avere apparently identical Avith that just named, in which appendicitis and obstruction Avere discovered at the operation, and in which death took place as early or earlier than it would have occurred had operative interference not been resorted to. These two cases are mentioned for the purpose of emphasizing the fact that a definite prognosis as to the results of treatment, either surgical or medicinal, in peritonitis is not possible. Aside from the surgical treatment, which is an absolute essential in many cases of peritonitis, Ave have at hand medicinal methods which are of some value early in the attack and Avhere operation is refused or considered inadvisable. The first of these is the use of opium, given until the pain is partly removed and the respirations decreased to tAvelve or fourteen per minute. The patient should never be so narcotized as to have no pain on abdominal palpation or be unable to answer questions. On the other hand, it should be remembered that cases of peritonitis bear large doses of opium without effect. The dose should be pushed till the desired effect is obtained, and not be measured in grains. Cases are on record in which many hundred grains of opium have been given in a feAv days, with recovery as a result. For many years physicians of repute have regarded mercury as the drug above all others capable of modifying inflammations of serous membranes, particularly if combined with opium. Half-grain doses of calomel may be used every hour for tAventy-four hours. An ice- PERITONITIS, CHRONIC. 633 bag or a turpentine stupe may be put over the the area originating the trouble. If the case is very sthenic, leeches may be used on the belly, but this is not advisable in most cases, as the patient may later need the blood to preserve his strength. Should vomiting be a press- ing symptom, it is best controlled by the use of tAvo grains of ace- tanilid every tAvo or three hours Avith brandy and ice. Medication is best carried out by the hypodermic needle or the rectal injection. The thirst in many cases of peritonitis is excessive, and ought to be relieved by giving small pieces of ice Avith or Avithout a little white of egg poured over it. Even small amounts of water are not to be forbidden, since the vomiting is reflex, and the water alloAvs the vom- iting to take the place of the more exhausting retching. If collapse is threatened, the best remedy is probably the extract of hyoscyamus by the rectum in injection or suppository, since this drug, Avhile it contracts the Aressels and soothes the nervous system, does not tend to produce disagreeable symptoms as does belladonna. The question of the use of purgatives in cases of peritonitis has been much discussed. The writer believes that in cases of perito- nitis folloAving operation, where the operator knows the intestine is intact, saline purgatives, such as teaspoonful doses of a saturated solution of magnesium sulphate every ten or fifteen minutes, may be used in many cases Avith good effects ; but if there is any pos- sibility of the peritonitis being caused by perforation or obstruc- tion, their use is absolutely contraindicated, since if used the con- tents of the gut may be washed into the peritoneal cavity or the obstruction be rendered more complete. The saline purgative not only empties the bowel, but in addition, by the free watery Aoav pro- duced, depletes the inflamed peritoneum. When there seems to be a probability that the pain may be due to the ingestion of bad food, and signs of perforation are absent, purgatives may be used to remove the offending articles. Should the patient be feeble, purgation is contraindicated. The tympanitis, Avhich may be a prominent symptom, may be relieved in some cases by the use of the rectal tube or of injections into the bowel of milk of asafoetida or turpentine emulsion. This book is not the place for the consideration of the surgical procedures to be folloAved, but it may be stated that in septic peri- tonitis in all cases it is a question of operation Avith probable death, or no operation Avith certain death. In obscure cases of general peri- tonitis, Avhere the cause of the disease cannot be found by ordinary methods of diagnosis, the writer believes that exploratory incision should be done, and after the cause is removed the belly-cavity Avell Avashed out Avith hot normal saline solution, and drainage-tube or gauze left in for at least twenty-four hours. PERITONITIS (CHRONIC). Chronic peritonitis is very apt to be circumscribed and to exist in connection Avith chronic appendicular trouble or in females in connec- 634 DISEASES. tion with diseases of the organs of generation. The most diffuse and curable form of the disease is that knoAvn as tubercular peritonitis, in Avhich cures have been safely reached through abdominal incision Avith or Avithout drainage or the dusting in of iodoform. Of all forms of organic disease affecting the abdominal area and of a chronic type, none offer such results to the physician and surgeon as does this, and operation ought ahvays to be advised and urged upon the patient most strenuously. Care should be taken, hoAvever, to separate the subacute or chronic process, termed tubercular peritonitis, from the malignant and acute form called tuberculosis of the peritoneum, which is often only a manifestation of a general infection. PERNICIOUS MALARIAL FEVER. This is one of the most acutely dangerous diseases known to man if it be fully developed, and requires the greatest activity and skill on the part of the physician, who may be called upon to treat a large number of widely varying symptoms, all of a pressing nature, at one and the same time. The chief indication is for the use of quinine in its most soluble forms, in solution and in large doses, which may be given hypodermically or intravenously. (See Cinchona.) As a rule, the use of the drug by the mouth is futile because the state of the stomach is such that absorption Avill not take place, at least till after the attack has done its damage. The hypodermic or intravenous use of the drug is therefore advisable. Given in this manner doses ranging from 10 to 15 grains (0.65-1.5) may be used with safety. If more than this is given intravenously, the dose must be given very slowly, and preferably divided into several smaller doses lest cardiac depression ensue. If the attack be of the hema- turic or hemoglobinuric type, quinine is to be used with the greatest caution, or better not at all. (See Cinchona.) The patient should be treated by the use of 60-grain (4.0) doses of hyposulphite of sodium every tAvo or three hours till the bowels are moved freely. Copious draughts of pure water with, or without lemon-juice added, are to be given to flush the kidneys, and if necessary morphine and atropine are to be given hypodermically to control the retching and vomiting. PLEURITIS, OR PLEURISY. The treatment of this disease in its acute form in its early stages is identical with that of other inflammatory diseases, or, in other Avords, the use of venesection, or, better still, of tincture of veratrum viride or aconite, to bleed the man into his OAvn blood-vessels, is to be resorted to if the patient is seen in the very earliest stages and has a bounding pulse. If the circulation is not bounding, these dru»s should not be used. When the pain from the pleurisy is excessive and the movements PLEURITIS, OR PLEURISY. 635 of respiration greatly increase the discomfort, strapping the chest- wall may be resorted to. This is done for the purpose of immobil- izing the chest. The straps should consist of adhesive plaster, two and a half inches wide, and should be long enough to reach from the middle line of the vertebrae to the sternum or a little beyond its middle line. They should be applied tightly during expiration, slightly overlapping one another at a right angle to the spine, and not in the line of the ribs. (Fig. 11.) The old idea that pleurisy was usually due to cold rather than to an infecting micro-organism led to the enveloping of the chest in poultices. Fig. 11. Showing the overlapping of the adhesive strips in strapping the chest for painful pleurisy. The strips extend too far to the right. These soil the clothing, speedily get cold, and are very uncomfortable. They have been supplanted almost entirely by the cotton jacket, which is much better. It consists of one or tAvo thicknesses of carded cotton basted inside a thin undershirt, as fur is placed in a fur-lined coat. On the outside of the shirt oil-silk should be basted. By using this we envelop the chest in a Avarm poultice, because the heat of the body keeps the cotton at the proper temperature, while the oil-silk, by pre- ventino- evaporation of the moisture exhaled from the skin, soon causes the cotton to be moist as well as Avarm. Even the cotton jacket is losing its popularity, as the fever of the patient makes a hot jacket 636 DISEASES. almost unbearable and it does very little real good. Further, its re- moval is very apt to result in a chill. When the pleurisy has fully developed other lines of treatment are needed. The cardiac sedatives have been stopped as soon as the quiet- ing of the circulation has been accomplished. If the pulse becomes weak and the system is depressed, stimulants in the form of alcohol or digitalis are needed, and special care must be devoted to the condition of the exudation in the pleural space. If the effusion is sufficiently large to cause marked dyspnoea on exertion, or reaches to the third interspace anteriorly, it should be removed by aspiration. When the effusion is not causing dyspnoea, or other evil symptoms by reason of pressure, the physician should allow sufficient time for recovery to occur; as, for example, a week or ten days, during Avhich interval the system will in many cases remove the fluid by natural processes of absorption. If after this time has elapsed the fluid remains, it is Avise to give salicylic acid in the dose of 1 to 2 drachms (4.0-8.0) a day. or saline purges given in the early morning in concentrated form, and finally, if the fluid is not taken up by the vessels after jalap or elaterium is used, resort must be had to aspiration of the liquid. In his OAvn practice the author rarely uses these drugs, but resorts at once to aspiration. They ought never to be employed to such a degree as to Aveaken the patient, and in most cases this is a necessary evil if the purgative is active enough to be at all effective in AvithdraAving liquid from the body-cavities. There is no danger in aspiration, if it is properly performed. The best place to insert the needle is the sixth or seventh interspace in the middle axillary line. Care should be taken that the needle is aseptic; that the skin at the point of puncture is Avell cleansed ; and that the exhaust-pump is Avorking Avell. All the fluid should not be Avithdrawn at one sitting. Often the aa ithdraAval of a portion of it will result in the natural absorption of the quantity Avhich is alloAved to remain in the chest. The physical signs at this time, it will be remembered, con- sist in flatness on percussion over the loAver portions of the chest, Avhich area of flatness generally varies Avith the change in the position of the patient from the erect to the recumbent position, unless the effu- sion is sacculated. Blowing or bronchial breathing at the apex of the lung, when this organ is compressed upAvard by the fluid beneath it, is often heard. If the effusion is on the right side, the apex-beat of the heart is apt to be displaced to the left. If it is on the left side, there is obliteration of Traube's semilunar space, which is a spot at about the level of the sixth and seventh ribs anteriorly beloAv the nipple, where there is usually a tympanitic note on percussion. During this stage of effusion blisters have been largely used in aiding in the absorption of the liquid Avhich is present, but they are not of great service. When used they should be applied in the form known as fly- ing blisters. (See Cantharides, Part II.) It is to be remembered that blisters are, as a rule, contraindicated in the case of children, because of the pain and irritation they produce. If a pleural effusion in the chest of a child is not absorbed by natural processes, it is best to aspirate it. PLEUROD YNIA—PNEUMG NIA. 637 PLEURODYNIA. This condition, being one of intercostal neuralgia, should be treated according to the directions given under the headings of Neuralgia and Counter-irritation. PNEUMONIA. Pneumonia is a term loosely applied to two very different forms of disease—namely, that acute infectious process due to an infection by the micrococcus lanceolatus and called croupous pneumonia, and that form folloAving as a rule some other disease which has exhausted the patient's strength and due in some cases to various forms of infection, namely, catarrhal pneumonia. These tAvo distinct diseases have been confused by the common term pneumonia, and yet are very different conditions as to their pathology and treatment. Croupous Pneumonia. Croupous pneumonia usually attacks the strong and hearty rather than the feeble and exhausted, but both types of cases may be affected. The treatment can be divided, Avhen we study it, into that devoted to the stage of onset, the stage of consolidation, and the stage of ab- sorption of the exudate and convalescence; and it will be governed by the state of the patient's pulse, the sounds of his heart, and his general condition as to strength, as well as the degree of respiratory embarrassment which is present. There can be no routine treatment of croupous pneumonia; each case must be a law to itself, and there is no such thing as the depletant treatment to be advocated on the one hand, or the stimulant treatment to be lauded on the other. Further than this, it must be remembered that as croupous pneumonia is an acute infectious disease the patient may die not from pulmonary consolidation or cardiac distention, but from the malignancy of the infection. One man Avith an entire lung consolidated may have slight evidences of general infection or toxaemia, another with a small area of lung involved may be overwhelmed by toxaemia Avithin a few hours. For this and other reasons we can divide all cases of croupous pneumonia into three gr0UpS—those that are doomed to death by the malignancy of the in- fection, those that are but slightly ill by reason of mild infection, and those who between these two extremes of severity need careful medical aid to accomplish recovery. The first class die do what we will, the second class get well almost without help, the third need all the help possible to survive. It is to this last class that our treatment must be chiefly directed. In the very earliest stages of the disease occurring in a healthy, sthenic individual Avho has been seized with a chill folloAved by fever and a bounding, angry pulse, with marked anxiety and nervous excite- ment, it is proper to freely bleed from a vein in the arm to the extent of a pint (see Part III.), or in its stead to use veratrum viride or aco- nite to relax the systemic blood-vessels and " bleed him into his own vessels" by making it easier for the blood to pass into the general 638 DISEASES. arterial system than into the lung which is inflamed. These sedative drugs also quiet the excited heart and prevent it from pumping so much blood into the engorged lung. A hot foot-bath at this time AA'ill also tend to relieve thoracic congestion. If veratrum viride or aconite are used they should be given in minim doses of the tincture every half-hour till five or ten doses have been used or until the patient's pulse becomes less angry and his skin becomes moist. Veratrum vir- ide is the best drug of the tAvo for adults. If violent pain in the chest is present it is to be relieved by small doses of morphine or Dover's poAvder. This treatment is devoted to an attempt to limit the degree of inflammatory action as far as possible. It may be aided, if it is thought Avise, by Avet cups over the engorged lung. The depressant treatment of croupous pneumonia is, hoAvever, lim- ited in its application to the very beginning of the malady and to those persons who have a bounding circulation. It is absolutely contraindi- cated after consolidation has taken place or if the patient is feeble. Because of the fact that its usefulness is confined to this early stage it cannot be employed in many cases, because the physician is not called till after this stage has passed by. Its use in a case with a feeble pulse or in one who is adynamic or feeble is absolutely contraindi- cated. In the majority of cases the plrysician is called after the consolida- tion has occurred, and he must noAv be a Avatchman all the time and a therapeutist only when treatment is actually needed. Every man who is suffering from pneumonia does not need active treatment. A cer- tain number of cases get Avell Avithout treatment and do so sooner than if meddlesome therapeutics hinders them. The treatment usually neces- sary is to combat fever, if it becomes excessive, to support the heart if it seems feeble or congested, to keep the kidneys in a state of active secretion, and to see that constipation is relieved. In the treatment of the fever the physician should remember that it is not to be regarded as a dangerous symptom unless it rises to 103° and remains at this point for some hours, for in a febrile disease running a short course fever is not only not harmful, but there is reason to believe that when present to a moderate degree it is actually beneficial.1 When the fever does rise to a point above 103° it should be reduced by spong- ing with cold water, active friction being used at the same time. (See Part III., on Cold.) There is absolutely no danger of the patient " taking more cold," although this is generally doubted by the laity. If the fever has a tendency to be excessive and if the heart's action is tumultuous an ice-bag may be placed over the heart, and this will be particularly useful if, as is often the case, there is a tendency to pericar- ditis. If it is desired to apply cold over a greater area of the chest than the praecordium an ice-jacket may be employed, but it possesses the disadvantage of being a wet application, do what Ave will to protect the bedding. This ice-jacket is to be made of cracked ice and sawdust mixed and sewed up tight in an oil-silk covering which is basted to an undershirt to keep its shape. This treatment has been said to greatly 1 See article on "The R61e of Fever in the Modification of Disease," in the Thera- peutic Gazette for February, 1896. PNEUMONIA. 639 reduce the inflammatory process in the lung, but of this there are grave doubts. The use of antipyretic drugs is not good practice. They tend to depress the heart, to relax the blood-vessels, and apparently render the patient more susceptible to his infection. Sponging will generally control the fever if it is properly employed, or, if it fails, then a cold bath may be required if the fever is really very excessive. (See Cold, in Part III.) For the support of the heart we may employ several circulatory stimulants. If the patient is a feeble case Avith lack of vitality and relaxation of his muscles, then alcohol in the form of a good whiskey or brandy given in water after food every three or four hours in the dose of from half an ounce to an ounce is useful. Sometimes more than this must be given, particularly if the patient has been accustomed to the use of the drug. In other cases less is needed. For the laboring heart with almost empt}r arteries no drug compares Avith digitalis, and if the skin is moist or the blood-vessels relaxed, so that the pulse is gaseous, then belladonna should be combined Avith it. The Avriter usually gives 5 drops (0.3) of the tincture of digitalis every eight hours, with 5 drops (0.3) of tincture of belladonna every four hours. (See Digitalis and Belladonna.) If necessary, both of these drugs may be given in larger dose, but usually these doses are sufficient. If the fever is very high the digitalis will have to be supplanted by the alco- holic stimulants or strychnine for a few doses. The question as to whether the patient's pulse is of the proper strength is one of import- ance : very often the quiet pulse of a patient lying in bed will be taken by the inexperienced as an evidence of true cardiac feebleness, Avhen if the physician feels his own pulse he will be surprised to find it no stronger than that of his patient. A feeble apex beat, a feeble second sound at the second right costal cartilage (aortic valve) and an accen- tuated second sound at the second left costal cartilage (pulmonary valve) will reveal the fact that active stimulation is needed, for the Aveak apex beat and the soft second (aortic) sound, show that the heart is feeble and the arterial walls relaxed, and this means a low arterial pressure. Further, the accentuated second sound on the right side indicates pul- monary congestion and a tendency to failure of the right side of the heart from obstruction to the Aoav of blood in the lungs. Should the action of the heart become labored, the jugular veins distended and pulsating, and the radial pulse weak, while the face is cyanotic, then free venesection (Part III.) is to be practised. It will often save an apparently desperate case. Digitalis in the presence of this condition is not rapid enough in its effects. Strychnine should be given in full dose hypodermically, fa-fa of a §rain (0-003-0.006), and with it, if the skin is moist or sweating, y^-g- of a grain of atropine (0.0004), and both these drugs should be repeated in an hour if needed. At the same time it is Avell to give J drachm (2.0) of aro- matic spirit of ammonia every tAvo hours in cold water or 1 drachm (4.0) of Hoffman's anodyne in cold Avater every hour. Oxygen inhala- tions may be used at this time with benefit, particularly if cyanosis is marked. (See Oxygen.) 640 DISEASES. Should crisis come on at this time, active supportant treatment, such as that just described, will be needed. Many patients die in crisis for the Avant of active stimulation. The secretion of the kidneys is best maintained by the use of some alkaline diuretic, such as SAveet spirit of nitre and citrate of potassium, and if necessary a little gin may be given to support the heart and aid in maintaining renal activity. Having detailed this treatment of the second stage, that for the third stage is to be considered. For the thorough understanding of this Ave should remember that this stage consists in the breaking doAvn or resolution of the exudations and in their absorption and expulsion from the chest. At this time the entire diseased area is crowded Avith secretions which have been formed, dead epithelial cells, and all the morbid sub- stances which have accumulated. The local surfaces are depressed by the reaction following upon the excitement of inflammation, and their tone is below par. The object of the physician must be to stimulate these areas so that they may throAv off the old and take on a neAv functional activity, and for this purpose remedies are to be used Avhich will soften deposits and stimulate depressed vesicles and bronchial tubes. By far the most valuable class of drugs to be here employed are those Avhich will increase the secretion from mucous membranes Avithout acting as cardiac depressants. Under the article on Bronchitis the action of these drugs will be found more thoroughly explained, but it Avill suffice to point out, at this time, the method of their administra- tion. First and foremost stands the chloride of ammonium, a drug whose elimination takes place largely through the lungs, and Avhich acts most happily in aiding in the loosening of the cough and secretions. Its only disadvantage is its salty taste, Avhich in many cases renders it disagreeable to the patient, Avhile its irritant properties may disorder the action of the stomach, although if this organ is depressed and atonic this drug often improves its condition. This drug may be given in compressed pills, or, what is far better, in such a mixture as here folloAvs: R.—Ammonii chloridi............gij (8.0). Extract, glycyrrhizae fl..........^ij (8.0). Aqua? dest................tgiij (96.0).—M. S.—Teaspoonful (4.0) in water every four hours during the day. If the cough be in excess of the expectoration—that is, if the cough often fails to bring up phlegm and is due to tickling or irrita- tion—it may be relieved by the addition of a little morphine to this mixture, as follows: R.—Morphinae sulph.........gr. j vel gr. ij (0.05-0.1). Ammonii chloridi.......3ij (8.0). Extract, glycyrrhizae fl......xiv (16.0). Aquas dest...........3yj (192.0).—M. S.—Dessertspoonful (8.0) every four hours. If much more morphine than this is used, it will tend to stop secretion. PRURITUS. 641 When the chloride of ammonium fails to act favorably, the car- bonate may be called into use for its local and circulatory action, and, in addition, the bromide of ammonium may be employed to allay the cough if morphine cannot be used. The following prescription is valuable : R.—Ammonii chloridi............gj (4.0). Ammonii bromidi............^j (4.0). Ammonii carbonat............^j (4.0). Extract, glycyrrhizae fl..........^iij (12.0). Aqua? dest."...............fgvj (192.0).—M. S.—Dessertspoonful (8.0) every four hours. (For other remedies for this stage see Bronchitis.) Nutritious broths, milk, and, if necessary, predigested foods, should be given with the regularity with which medicine would be given from the beginning to the end of the attack. Catarrhal Pneumonia. The main difference in the treatment of Catarrhal Pneumonia in distinction from the treatment of croupous pneumonia lies in the fact that first, last, and all the time the treatment is to be stimulant in its character if any treatment other than rest in bed is resorted to. Catarrhal pneumonia usually arises out of an acute bronchitis or is superimposed upon some exhausting disease which has sapped the vitality. Toward its close expectorants are even more useful than in croupous pneumonia, and every care should be taken that the catarrhal process does not pass by insidious degrees into a hidden tuberculosis. All cases in which recovery is abnormally slow should be suspected of tubercular infection. PRURITUS. Itching of the skin or mucous membranes about the openings of the body is a very common state, and Avhile it may be dependent upon local causes, such as lice or fleas, it more commonly is due to some systemic condition, such as debility, diabetes, gout, or renal disease, or other similar causes. The treatment consists, first, in the removal of the cause, and, next, in the local treatment of the condition. There is generally no redness or eruption, except that due to scratching. Internally, arsenic, quinine, bitter tonics, cod-liver oil, alkaline diuretics, or mineral waters are useful in debilitated cases, and an avoidance of condiments, such as mustard or pepper, is needful if the disease affects the mouth of the urethra or vagina. The local treatment of pruritus consists in the use of lotions, salves, or ointments made up of various constituents, a number of which are capable of acting as local anaesthetics. Very often, bathing the parts with 1 drachm of bicarbonate of sodium or of borax to a pint of cold Avater gives relief temporarily, or the following formulae will be of service: 41 642 DISEASES. R.—Acidi carboliei.........f.5J vel f^ij (4.0-8.0). Aquae dest......_• . . q. s. ad Oj (500 cc.).—M. S.—Apply as a lotion several times a day. Or, R.—Liquor carbon, detergen.1 .... f^ij (8.0). Aquae . ;........q.s. ad Oj (500 cc.).—M. S.—Apply as a lotion. Or an ointment made as follows is serviceable: R.—Acidi carboliei.........gtt. v vel xx (0.3-1.3). Adipis benzoinatus......- ,§j (32.0). Petrolati_...........3J (4.0).—M. S.—Apply as an ointment. In other cases 10 to 20 minims (0.65-1.3) of chloroform may be used in place of the carbolic acid. Cocaine may be painted over the parts, but it should rarely be used in ointment, as fats prevent its acting effectively. It should also be remembered that the anal and vaginal mucous membranes are so thick that strong solutions of cocaine are necessary to produce anaesthesia, and that the effects of cocaine are only temporary. Where the itching is very obstinate the parts may be painted with a solution of nitrate of silver of the strength of 20 grains to the ounce (1.3 : 32.0) of water, cocaine having been previously applied to relieve the pain of the application. (See article on Cold.) Brinton has highly recommended powdered teucrium scordium in the dose of 20 grains (1.3) three times a day. Allingham has used with advantage a piece of ivory shaped like a rubber nipple and provided with a circular shield. This is slipped into the boAvel at night and serves to keep the surfaces apart. PUERPERAL DISEASES. The diseases of the puerperium may be divided into two broad classes—infectious and non-infectious. The first class should be further subdivided into (1) those infectious diseases in Avhich the point of infection has been someAvhere along the parturient tract, and (2) those in Avhich the infecting poison has entered the body by some other channel. Under sub-heading 1 come all those diseased conditions grouped together under the very inadequate generic terms " puerperal fever," "puerperal septicaemia," "puerperal infection," and the like, none of which truly express the condition. If it is necessary in medical nomenclature to have a single term Avhich shall denote infection of the genitalia after delivery, a word should be coined strictly limited in sense to mean the pathological conditions which result from the activity of pathogenic microbes along the Avhole genital tract. This classification is necessary for a clear and sys- tematic description of the treatment of diseases in the puerperal state. 1 For method of preparing this liquor see article on Eczema. PUERPERAL DISEASES. 643 The Treatment of Infection along the Genital Tract after Labor.— By far the most common form of infection along the genital tract after labor is the absorption of ptomaines from the infection and decomposition of membranes, fragments of placenta, or blood Avithin the uterus. This condition Avill be found in more than 75 per cent. of all cases in which infection occurs. Therefore, in any case after labor in Avhich there is fever that cannot be explained by some evi- dent cause independent of the genitalia, it is safe to assume ptomaine poisoning and to act accordingly. The indications are plain: to destroy the microbes, and thus at once stop the manufacture of their poisonous products, and, if necessary, to remove their habitat. The writer's routine application of this principle in practice is as follows: If the temperature after delivery remains over 100° F. for twenty-four hours without evident cause independent of the genitalia, he Avashes out the uterine cavity Avith at least 1 quart (1 litre) either of bichloride-of-mercury solution, 1: 2000, or a 2 per cent, solution of creolin. The former is more convenient in private practice, be- cause the tablets of corrosive sublimate can be easily carried about in one's instrument-bag. To ensure the entrance of the antiseptic fluid to the fundus and its free exit from the cervical canal an intra-uterine catheter is desirable. Of all those upon the market, the best is that known as Fritsch's modification of Bozeman's catheter. If, hoAV- ever, the cervical canal is patulous, as it usually is after labor, a hard-rubber catheter attached to a Davidson's or fountain syringe answers the purpose perfectly. In the majority of cases this treatment will bring the temperature down to normal within twenty-four hours. If fever does not disap- pear within this time or perhaps rises even higher, the second indica- tion must be met. The infected albuminous substance within the uterine cavity must be removed in order to deprive the micro- organisms of their feeding-ground. This is best accomplished by the use of the curette and the placental forceps, care being taken in the employment of the former instrument to guard the uterine wall itself from the slightest injury; for not only can the uterine muscle be per- forated by a curette in clumsy hands, but slight wounds of the uterine substance with this instrument may be enough to inoculate the gen- eral system Avith the germs Avhose activity has been confined before to the uterine cavity. The Avriter's manner of employing this plan of treatment after labor is as follows: The anterior lip of the cervix is seized with a double tenaculum and pulled gently dowmvard; a cleansing uterine douche is then given in order to disinfect the field of operation; next the curette is inserted to the fundus, and the whole interior of the uterus is carefully gone over Avith the instrument, first the fundus and then each of the four sides ; then the curette is turned with the scraping surface upward and Avithdrawn from the cervical canal, a finger in the vagina meet- ing its tip as it emerges in order to help extract any substances which may be caught by and entangled in it- Next the placental forceps is inserted, and an effort made to grasp 644 DISEASES. any material lying loose Avithin the cavity or still attached to the uterine Avails. It is usually best to repeat each of these manj (32.0). Vin. albse . . _......q. s. ad f^iv (128.0).—M. S.—Teaspoonful (4.0), in water or wine, three times a day. Better still, order in ascending doses (1 minim extra each dose) in milk or Avine. Often a 1-drop (0.05) dose three times a day may be increased to 5 drops (0.3) in the same period Avith advantage, and if given in ascending doses the author has frequently had patients take as much as 90 minims (6.0) a day. Sometimes 1 or 2 drops (0.1) in capsules are as useful as the formula just named. (For methods of administra- tion see Creosote; also, see Guaiacol and Creosote Carbonate.) Creosote may also be inhaled in the spray from a steam atomizer or bv means of an inspirator fitted over the nose and mouth and made of perforated zinc Avith a sponge at the edge to hold the drug. A very good method is to Avet the sponge Avith creosote, alcohol, and water, equal parts, or to use the creosote alone if coughing is not too severe. Another useful mixture consists of equal parts of tere- bene, iodide of ethyl, and chloroform. This last mixture is most useful when the secretion is tough and tenacious, and should not be used in the presence of acute irritation due to inflammation. Such inhalers are very cheap, not easily broken, and readily worn. If the cough' in phthisis is excessive, a little spirit of chloroform placed on the sponge of the inhaler will often relieve it, or a mixture of morphine and Avild-cherry bark may be given as follows: R.—Morphina? sulph. ......gr. j vel ij (0.05-0.1). Syr. pruni Virginiana?......f.^iij (96.0).—M. S.—Teaspoonful (4.0) every three hours. Or the following: R.—Spt. chloroformi.........f5ss (15-°)- Morphinse sulph.........gr.j vel ij (0.05-0.1). Syr. pruni Virginiana?......f §iij (96.0).—M. S.—Teaspoonful (4.0) every four hours. In still other cases 2 to 10 minims (0.1-0.65) of a good fluid extract of cannabis indica, or \ to | grain (0.008-0.016) of the solid extract, will act Avith surprising benefit and stop the cough. Very often during the course of phthisis localized spots of pleu- ritic inflammation arise. Without the occurrence of any exposure the patient will remark, " Doctor, I think I have taken a little more cold, and I have a stitch here in the chest." The best treatment is to apply a small blister or to paint the spot with iodine. (For the treatment of Haemoptysis see Hemorrhage.) Laryngeal phthisis, one of the most serious complications of this disease is best prevented by ordering the patient to inhale the steam 684 DISEASES. arising from boiling water which contains corrosive sublimate in the proportion of 1: 10,000. If a proper watch is kept for evidences of a general mercurial effect, and this measure stopped at once when tenderness of the gums appears, no danger exists. Before the inhala- tion takes place a spray of cocaine (4 per cent, solution) should be thoroughly used. . The treatment of laryngeal phthisis itself is various. Ihe best method is that in which lactic acid is used. By the aid of a laryn- geal mirror and a cotton applicator a 10 per cent, solution of lactic acid is applied to the spots which are involved. As this is generally quite painful, cocaine solution should first be used. Gradually the strength of the lactic-acid solution should be increased to 60 per cent. if the weaker solutions do not check the disease. Very valuable results have been obtained by this method. The second method in point of value is that of iodoform insuffla- tions. A powder of iodoform alone is too light for satisfactory pro- pulsion into the larynx, and powdered talc should be added to it m small amount, as may also TV grain (0.004) of morphine to each drachm (4.0) of iodoform. The odor is generally disagreeable to the patient, but if a cocaine spray be first employed and the operator is skilful, very little coughing is produced. As iodoform is a local anesthetic, it relieves the pain in the larynx, acts as an antiseptic and alterative, and is peculiarly obnoxious to the bacillus tuber- culosis. When the night-sweats are very profuse, hypodermic injections of atropine in the dose of ^ to yfg- grain (0.0004-0.0006) are useful in some cases, and the efficiency of* this treatment may be increased by the use of an alum sponge-bath at bedtime. A solution of alum, 10 to 20 grains to the ounce (0.65-1.3 : 32.0), may be sponged over the body, or sulphuric acid may be added to Avater in the proportion of 1 drachm to the pint (4.0 : 500 cc), and used in the same Avay as the alum solution. Camphoric acid in 20- to 30-grain (1.3-2.0) doses is the best rem- edy and is invaluable in treating night-SAveats. Sulphuric acid is often given internally with advantage in these cases of sweating. Small doses of pilocarpine amounting to fa grain (0.003), given from one to tAvo hours before the SAveat is expected, are sometimes potent for good. The means by which this result is brought about are not far to seek. The drug in any dose causes great stim- ulation of the peripheral ends of the nerves supplying the SAveat- glands. In many instances we find excessive secretion dependent upon depression of function, as in a serous diarrhoea or a local SAveat- ing of the feet. These states pass away just as soon as the parts regain their normal tone through proper treatment. The night-SAveats of phthisis are sometimes improved by pilocarpine, because this drug in all doses stimulates the sweat-glands. In large doses this stimula- tion amounts to free diaphoresis; but in the minute doses, such as fa to fa of a grain (0.0016-0.003), the stimulation just balances the de- pression and a normal tone is acquired. While it is true that pilocar- pine and atropine are physiological antagonists, it will be found prac- TYPHOID FEVER. 685 tically beneficial to prescribe small doses of both in such cases as refuse to respond to either one alone, as by their antagonism they prevent over-action on other parts of the body, and both act in harmony in so influencing the sweat-glands as to be of service to the patient. TYPHOID FEVER. Any attempt to revieAv the treatment of the disease known as typhoid fever would be absolutely impossible, OAving to the very numerous theories and practices put forward by various clinicians. What is said under the general heading of Fever and under the con- sideration of cold, Part III., and also under Antipyrin and Acetan- ilid, gives sufficient information as to the treatment of febrile move- ments, and the care of the patient beyond this point in nearly all cases depends upon the severity of the attack. Before going further, however, the writer desires to insist very strongly upon one fact—namely, that a case of typhoid fever is not curable in any degree. No remedy yet found, except it act through the prevention of complications, can shorten its course. We can only guide the patient safely to health Avhen the storm of disease comes on, and Ave cannot stop the storm. Not only should the facts of the last paragraph be carefully borne in mind, but the physician must remember that he is treating an exhausting disease—not a disease Avhich runs a violent course for a feAv days and strands the patient sick and Aveak, but convalescent, upon the shores of health, but one in Avhich, after sapping the strength for weeks, some sudden intercurrent malady or accident may ensue Avhich Avill speedily kill him if every grain of strength is not preserved for the struggle. The physician should always put every case in Avhich there is a suspicion of typhoid fever to bed at once, and keep the patient there till the disease has passed or fails to appear. Every muscular movement unnecessarily made is a Avaste of force, and, in consequence, everything should be done for the patient, and not by him. A bed-pan should always be employed, the patient not being alloAved to sit erect upon a commode. Remembering, too, that a typhoid fever patient is subjected to prolonged Avasting fever and toxaemia for many days, his nutrition should be maintained by the use of a concentrated nourishing diet easy of digestion. In addi- tion to milk he should also receive one or two very slightly boiled eggs each day, arrowroot and perhaps thin corn starch, provided they agree with his digestive powers. If diarrhoea is not present, broths may be given, but it must be recalled that Brieger has shown that typhoid bacilli do not readily reproduce themselves and their poisons in pep- tone and well-digested milk, but do so very actively in meat-broths or jelly which has not been acted upon by the digestive juices. Milk diet is therefore evidently better than a broth diet in typhoid fever, and Ave once more are able to explain an empirical fact by a scientific discovery. Another reason for using liquid instead of solid foods, beyond the difficulty of digesting the latter, is the fact that solids may irritate or perforate the ulcers in the small intestines. 686 DISEASES. Alcohol may be used in all stages as a stimulant, as a giver of force to the system, and as an aid to digestion. A very large part of the profession believe that the mere presence of an abnormally high temperature contraindicates the use of alcohol. Mere high tempera- ture does not do so, hoAvever, and it seems probable that many deaths have resulted from putting into practice such a belief. High tem- perature of a sthenic type, Avith a full, tense, bounding pulse and all the signs of a disease attacking one in the full vigor of life, • of course precludes its use; but in the high temperature of advanced typhoid, with the marked asthenia often present in that stage, alco- hol should be given whenever the heart-sounds are feeble. Under these circumstances the tissues Avhich the man can afford to lose are gone, and much of the vital portion of his system is greatly encroached upon: the alcohol yields force to the body, and is burnt up in great part, keeping the flagging heart pumping the tides of blood through the lungs and systemic circulation, when otherwise the very cardiac depression Avould produce hypostatic congestion, if not more wide- spread circulatory disorder. A no less useful and valuable result obtained by the use of alcohol in the early stages of exhaustive fevers is the part that it plays in aid- ing digestion. The Avriter has elseAvhere defined the difference be- tAveen the influence of alcohol in the artificial digestion of the test- tube and that occurring in the stomach. No one doubts that alcohol added to a small amount of gastric juice in the test-tube retards or prevents its action; but evidence is abundant to prove that the inges- tion of this drug produces by its stimulating and irritant action a very decided increase in the quantity of gastric juice secreted over and above the amount normally present. Aside from experimental evi- dence, every-day experience has taught the gourmand that alcohol, in a fairly concentrated form, enables him to digest an amount of food which under ordinary circumstances would remain unchanged in his stomach. The importance of aiding the flagging powers of the stomach is not generally recognized; but if one remembers the fact that at one time during the course of a severe attack of typhoid an occasion must come when a struggle between the few remaining grains of strength and the disease results in death or in recovery, its importance becomes evident. By the ingestion and digestion of more food early in the attack a larger amount of vital force remains for use at a crisis, and the chances of a recovery, to say the least, are increased. Alcohol may therefore be used all through the ordinary exhausting fevers__ for the purpose in the first stage of aiding digestion, and in the later stages of supporting the system; but the physician ought not to use it as a routine measure in every case without a rational idea of why he does so, nor without a clear idea as to what indication is met by its use. In those cases in which a temporary loss of heart-power is due to hemorrhage or to some sudden severe depression alcohol is one of the remedies to be employed—in a hot and concentrated form. That alcohol may be misused and cause great harm is of course known to every practitioner of medicine. So long as it reduces the TYPHOID FEVER. 687 temperature and loAvers the rate of the pulse, causes a moist skin and tongue, and quiets nervous twitchings, it does good, and only up to this point is it to be employed. If its administration is pushed after this, the tendency to adynamia becomes, under the over-use of the drug, one of dynamia ; the pulse is no longer soft, but comes in angry, bounding beats; the nervous symptoms change from Ioav, weak, mut- tering delirium, with subsultus tendinum, to Avild, incoherent callings and strong tossings to and fro; and by and by, when the influence of the alcohol begins to decrease, and even before this time, the system has put forth the strength of days in a feAv hours, and the man, having no reserve strength, is dead. The treatment Avhich has been used by the author in his Avards at the Jefferson Medical College Hospital has given him results which the application of other methods has failed to give, and is as folloAvs: As soon as the patient enters the house he is Avashed or bathed and placed in bed, and required to remain there. He is assured that the more quietly he lies the more mild and safe will be the course of his attack, and is made to use a bed-pan and urinal, and never alloAved to get up. He receives several small doses of calomel, followed, if the boAvels are not moved, by a mild saline purge, such as a Seidhtz poAvder. He is also given 5 drops (0.3) of dilute hydrochloric acid in a Avineglass (32.0) of Avater every four hours, or, if the boAvels are not active, nitro- muriatic acid is substituted therefor, care being taken to employ 1, 2, or 3 drops of the strong, freshly mixed acid according to the degree of coating of the tongue. The diet is largely a milk diet—namely, a quart to a quart and a half (1 to 1-^ litres) a day, Avith a little salt to flavor it, as already described in the article on Indigestion. In some cases koumyss acts very much better than milk. Sometimes, if vom- iting is threatened, lime-Avater is added, or the milk is peptonized, or beef-tea is temporarily employed. In other instances the milk agrees Avith the patient if it is partly diluted with plain soda Avater or Apol- linaris Avater. Eggs, arroAvroot, corn starch, and curds and Avhey are also alloAved, as already indicated. For the dry and sordes-covered tongue a mouth-Avash of glycerin and Avater, half and half, to Avhich may be added a little lemon-juice, is used, and it is important to keep the mouth constantly cleansed, as by this means swalloAving is not interfered Avith through cracking of the lips, tongue, and buccal mucous membrane, pulmonary infection is avoided, and facial erysipelas and parotitis are prevented. If constipation is very obstinate and continues over tAvo days, an injection is employed, and if this, after being used tAvice, fails to act, a dose of calomel, ^ grain (0.001) every fifteen minutes till a grain has been taken, is prescribed, and, if no movement occurs in tAvelve hours, is folloAved by \ an ounce of sulphate of magnesium, or a tea- spoonful of liquorice poAvder is given. In other cases small doses of cascara sagrada are equally useful. Violent purgatives should never be used for obvious reasons. Rectal injections may be given some hours after the purgative is taken, to aid its action. When diarrhoea becomes troublesome—that is, over three or four passages a day—the following will be of service : 688 DISEASES. R.—Acid, sulph. aromat...........f.5'j (8.0). Extract, hpematoxvli fl.........f^iy (12.0). Svr. zingiberis ............• f.^iij (96.0).—M. g.—Teaspoonful (4.0) in water every hour until relieved. Should the stools be excessively foetid and tympanites be marked guaiacol carbonate may be given as an intestinal antiseptic, or, so soon as any evidence of tympanites or much meteorism comes on, turpentine may be given, as folloAvs: R.—01. terebinthina;...........f.^ij (8.0). Syr. acacia?...........q. s. ad fjiij (96.0).—M. Ft. in emulsio. S.—Teaspoonful (4.0) three times a day. At the same time it is Avell to employ a turpentine stupe over the abdomen. (See Turpentine.) Where the tympanites is excessive it may be relieved by an injection made up as follows: R.—01. terebinthina?............f^J to ij (4.0-8.0). 01. olivaa...............ffiv (128.0). Emul. asafoetidae.........• • Oj (500 cc.).—M. S.—Use as an injection. Shake well before using. In the later stages of typhoid fever, as convalescence is approached, turpentine is often useful, as it causes rapid healing of the intestinal ulcers and stops diarrhoea. Much has been said about the value of purgatives and so-called intestinal antiseptics in typhoid fever, and extravagant claims made for them. Suffice it to state that Avhile they may be indicated in certain cases they are not to be used as a routine plan of treatment, because the skill of the true physician is to give each patient Avhat he needs—not to give all the same treatment. Typhoid fever cannot be aborted ; it can only be modified in the sense that Ave place our patients in the best possible physical state to Avithstand its ravages. A point of importance in the treatment of typhoid fever is to see that the patient receives enough Avater in tAventy-four hours. OAving to his apathy he often does not complain of thirst and the kidneys are not flushed of impurities by fluid. Some perfectly pure water, such as Londonderry Lithia, or Poland water, should be freely given to help eliminate toxic materials through the kidneys. The complications of typhoid fever of the most serious import are hemorrhage from the bowel, pneumonia and pleurisy, and perforation of the boAvel. The hemorrhage from the bowel may be treated as indicated under that heading (Hemorrhage), and the pneumonia or pleurisy should be treated as are these diseases Avhen free from complications; but it is to be remembered that the patient is an asthenic adynamic case Avho must not be bled or depressed, but stimulated. When perforation of the intestine occurs, large doses of morphine should be -riven to relieve pain, prevent collapse, and allay irritation. Warm .ipplica- tions should be used over the belly and doAvn the limbs, and stim- ulants given if needed. Probably in the future surgery Avill add another triumph to its art by devising some fairly safe plan of ope- rative interference in this accident, which, if left alone, is very often URAEMIA. 689 fatal. Personally, the author Avould advise immediate operation unless the patient is very feeble. As stated at the beginning of this article, cold bathing is very important and should always be employed in one of its forms if the fever is high, except in the presence of hemorrhage or perforation. For a number of days after the patient begs hard for solid food it should not be alloAved, for he will ask for it long before he should have it; but if the temperature remains normal after five days, very soft-boiled rice may be given in broth. The soft part of stewed oysters may be used and the patient gradually brought back to an ordinary simple diet. UREMIA. The treatment of this dangerous manifestation of renal disease is often futile, but always to be resorted to with the recollection that wonderful recoveries sometimes occur under judicious management. It matters little Avhether the onset of the symptoms has been gradual or instantaneous : in either event the prime endeavor must be to rid the system of the poison which is threatening life. This can only be accomplished by aiding its elimination through the bowels, skin, and kidneys. The second indication is to support the vital organs until the emunctories have had time to act. Often this second indi- cation Avill be more pressing than the first, and the physician will have to give stimulants at once. The third indication is to arrest any convulsive seizures. The methods to be resorted to for the elimination of the uraemic poison are external and internal, externally the hot pack being resorted to to increase the activity of the skin. (See Heat in Part III.) Internally Ave give elaterium or elaterin in the dose of -jt grain (0.01) or fa grain (0.004), respectively, for the induction of watery purg- ing, which at once aids elimination through the bowel and relieves dropsy if present. The elaterin should be dissolved in a few drops of alcohol or in whiskey. The medication directed to increased action of the skin should consist of small doses, hypodermically—say -|- grain (0.01)—of hydrochlorate of pilocarpine, but this is contraindicated unless the heart is believed to be strong and acting properly. It should be used in conjunction with the hot-pack or hot-air Lath. If dropsy is present, the drug will have to be given by the mouth, as it will not be absorbed from the boggy subcutaneous tissues. Pilo- carpine will also tend to increase the activity of the kidneys, and in addition to this influence on the renal structure we may use caffeine in the dose of 2 grains (0.1) every four hours for three doses, to stimulate the renal epithelium still remaining healthy to greater effort, or if the arterial tension is high we may give nitro-glycerin to lower it and increase urinary flow. Should pulmonary oedema threaten, atropine may be used in full dose with advantage. For the support of the heart and respiratory function we employ strvchnme hypodermically or by the mouth in the dose of fa to fa grain (0.003-0.006), and follow it by the more powerful stimulant digitalis in the form of the tincture in the dose of 20 drops (13). 44 690 DISEASES. The convulsions, if present or threatened, are to be combated by the use of an enema of 20 grains of chloral (1.3) and 60 grains (4.0) of bromide of sodium in 3 ounces (96.0) of starch-water, and the hot pack will also be of value, not only to produce sweating, but for its sedative influence on the venous system. Should the convulsive tend- encies be marked, chloroform inhalations may be employed until the chloral or bromide can be absorbed. According to Peabody and Kinnicutt, urethan is extraordinarily efficacious in uraemic convulsions, and thev advise that the dose be very large, as much as 6 to 7 drachms (24.0-28.0) in twenty-four hours. It is said to lack the irritating properties of chloral, and to be lacking in dangerous effects on the heart. The drug may be given hypodermically or by the rectum, dis- solved in water. Two other remedial measures should be resorted to in cases of ursemia for the relief of all the symptoms—namely, full venesection if the pulse is bounding, and hypodermoclysis. (See Part III.) Vene- section is contraindicated in the feeble. As much as 1 to 2 pints (^ to 1 litre) may be withdrawn in a sthenic case from a vein in the arm. After the bloodletting or during its progress hypodermoclysis may be performed or a saline solution transfused into the vein. (See Trans- fusion.) Often deep insensibility is speedily removed by venesection, which should be regarded as the sheet-anchor of treatment in those cases with a high blood-pressure. The author regards hypodermoclysis and intravenous transfusion of salt-solution as most useful methods of treatment in this state. VITREOUS DISEASES. Vitreous opacities may be either dust-like, flaky, or dense and membranous. They impair vision in proportion to their number and density, and are to be detected with the ophthalmoscope. Patients detect them as floating dark spots in their field of vision, because the opacities cast a shadow upon the retina. If vitreous disease is syphilitic, the usual remedies are indicated. Hypodermic injections of pilocarpine act favorably, and in the earlier stages of the inflam- mations of the retina, choroid, iris, and ciliary body, upon which the opacities depend, leeches should be applied to the temple. Gal- vanism has been recommended. VOMITING. Vomiting is of course a symptom, not a disease, and arises from a large number of causes, some of Avhich are very unimportant, others very serious. The most common cause is probably lack of proper digestion, with all that this implies; that is, gastro-intestinal irrita- tion and perversion of normal function. Additional causes are cer- ebral hemorrhage, tubercular meningitis, cerebritis, uraemia, or dis- eases of the middle lobe of the cerebellum, all of which conditions cause irritation of the vomiting centre.1 1 See Practical Diagnosis, by the author. Lea Brothers & Co., Philadelphia. VOMITING. 691 All these states may be considered as lesions of a centric charac- ter Avhich directly or indirectly cause the vomiting centre to send out impulses. On the other hand, it is Avorthy of note that under certain circumstances vomiting may be reflex and dependent upon irritation of the nerves of the stomach or elseAvhere which convey impulses to the muscles Avhose activity results in vomiting. These conditions are well represented by the vomiting Avhich comes on in incarcerated hernia, or in pregnancy, or in that occurring during the passage of renal or hepatic calculi, or in indigestion. It is important to bear in mind that peripheral vomiting due to disorder of the gastric Avails may be dependent upon tAvo con- ditions. The mucous membrane and its nerves may be over- excitable or they may be depressed. For this reason Ave shall find that two modes of treatment are necessary Avhen this subject is considered below. The mechanism of vomiting consists in the closure of the pyloric sphincter, the contraction of the gastric muscles from the pylorus to the cardia, and at the same time, and more important than these movements, the contraction of the supplementary respiratory and abdominal muscles, Avhich so compress the stomach as to drive out its contents through the open oesophagus. The violence of the muscular contractions in the abdominal Avails is greatest when the stomach is partly empty, and gives rise to the pain and exhaustion accompanying the condition knoAvn as retching. The practical point to be learned from this is that vomiting is ahvays easier Avhen the stomach is full; so if an emetic is given on an empty stomach, as the popular expres- sion runs, a large amount of liquid should precede or accompany it if possible. Dogs vomit easily because of the development of the gas- tric muscles, but they render the effort easier by filling the stomach with air, and so completely fill the viscus that its walls can contract on a resisting mass. Having described the mode and causes of vomiting, it still remains for us to consider its treatment. It is needless to remark that the vomiting of cerebral disease is very intractable, and that very active agents must be used to stop it. Probably the vomiting folloAving etherization is centric, and should be treated, as should all forms of obstinate emesis, by the injection into the rectum of 40 grains (2.65) of sodium or potassium bromide and 20 drops of laudanum in 4 to 8 ounces (128.0-256.0) of water. If this does not stop the vomiting, a second injection may be given one hour after the first. A very valuable remedy in this state is acetanilid given in 1 grain (0.05) doses every half hour in a drachm of brandy with cracked ice (see Acetanilid), and it is well to remember that inhalation of the fumes of vinegar from a cloth wetted with it will often be of service. When vomiting seems to be due to hyperexcitability of the gastric mucous membrane, so that very small amounts of food Avhen SAvallowed are at once rejected, local anaesthetics and depressants are needed, the chief of these being cocaine and aconite. Both of these drugs, how- ever, have disadvantages, because in effective dose their general phys- 692 DISEASES. iological action may be very severe and almost poison the patient. When given to act as antiemetics, these drugs do so by acting as local anaesthetics, or, in other words, by paralyzing the peripheral sensory nerves. Cocaine should be given in the dose of 2 to 3 drops (U.l- 0 15) of a 4 per cent, watery solution every fifteen minutes until 10 drops (0.65) are taken. The aconite should be used in the form of the tincture, the patient being placed flat on the back, so as to with- stand the ensuing cardiac depression with the least inconvenience, and 2 to 5 drops (0.1-0.3) of the tincture given in a little water every thirty minutes until the rapidly weakening pulse forbids its further use. This drug may be resorted to in all forms of vomiting due to irritability of the stomach, but it is contraindicated in cases of debil- ity or weakness. Aconite is generally to be preferred to cocaine. Sometimes a prescription of the following character is of service, the bismuth acting as a coating to the walls of the stomach, protect- ing and soothing them : R.—Bismuthi subnitrat........3"j (12.0). Tr. aconiti..........Til, xx vel xxx (1.3-2.0).—M. Ft. chart. No. x. S.—One powder every half-hour. In other cases of the same type the folloAving is useful, and is to be preferred if, OAving to active fermentation, the vomiting is ex- cessive (the creosote or carbolic acid being a local anaesthetic and antiseptic): R.—Acid, carbolic, vel creosoti (beechwood) . gtt. x vel xx (0.65-1.3). Bismuthi subnitratis.........£iij (12.0).—M. Ft. in chart. No. x. S.—One powder every hour. In other cases 1 drop of tincture of iodine and 1 drop of carbolic acid in a couple of drachms of water will act very Avell. Sometimes pure chloroform in 1- or 2-drop (0.05-0.1) doses, in a little water, does good; and dilute hydrocyanic acid, in the dose of 2 to 6 drops (0.1-0.4) is also of value in like instances, given in a tablespoonful (16.0) of water. In other instances small repeated doses of nitroglycerin do good unless the vomiting complicates peritonitis or pregnancy. Particu- larly is nitroglycerin useful in the nausea Avhich often follows the use of opium, although this symptom is best prevented by its use. The dose used should be about -g-1-^ grain (0.0002). The treatment of a case of vomiting dependent rather upon de- pression and debility of the stomach than upon irritation is directed to the administration of gastric and, it may be, systemic stimulants. The chief of the gastric stimulants is ipecac in small doses, and it it is this employment of a drug generally resorted to for the produc- tion of emesis by physicians Avhich has caused homoeopaths to claim that the regular school obey the laAv of similia similibus curantur and infinitesimal doses. The claim only holds good on its face, for Ave do not use an infinitesimal dose, and obey no laAv, but use common sense. Ipecac is an irritant, even to the skin, and it is partly by its irritant WHOOPING COUGH. 693 effects that it causes vomiting by exciting the stomach to a point over and above its normal condition. In the vomiting depending upon gastric debility and depression small doses of ipecac do good, because they irritate the stomach sufficiently to restore its normal tone Avith- out going to the other extreme of hyperexcitation. Under these cir- cumstances a drop dose of the Avine of ipecac, or J of a grain (0.016) of the poAvdered ipecac, every hour, is of the greatest value, often succeeding after all other remedies have failed. In other instances tincture of nux vomica, given in J- to 1-drop (0.025-0.05) doses, is useful as follows : R.—Tinct. nucis vomica?.......gtt. iv vel viij (0.25-0.5). Aquse cinnamomi........f§j (32.0).—M. S.—Teaspoonful (4.0) every half-hour or hour. In the nausea and vomiting following an alcoholic debauch h to 1 drop (0.025-0.05) of FoAvler's solution every tAvo hours, or before food, often gives relief, and it may be used in some cases in place of the nux vomica and ipecac. Another useful measure for the cure of alcoholic nausea is the use of full doses of hydrochloric acid, 5, 10, or 15 drops (0.3-0.65-1.0) of the dilute acid in half a tumblerful of Avater, repeated every tAvo hours. In all cases of persistent vomiting counter-irritation should be applied over the stomach in the form of a mustard plaster, or, if preferred, an ice-bag may be applied to the nape of the neck, the lumbar spine, or the epigastrium. Sometimes the application of the positive pole of the rapidly interrupted induced or faradic current ap- plied betAveen the sterno-clavicular muscles while the negative is placed on the epigastrium will give relief. The food given in cases of vomiting should be especially prepared. It is ahvays best to use peptonized milk, made by using the pepton- izing materials sold by all the large drug firms of reliability. (See article on Diet, Part III.) Lime-water should ahvays be put in the milk if it is not peptonized; the amount usually employed is per- fectly useless, because of its smallness: at least 2 to 3 tablespoonfuls (32.0-48.0) should be placed in each glass of milk. Another point of importance is the quantity of liquid taken. As fast as the patient vomits he is often fed with glasses full of liquid by Avell-meaning friends. Instead of this, he should have only 1 or 2 teaspoonfuls (4.0-8.0) of milk every hour, half-hour, or fifteen min- utes, for it is better for him to retain a drachm than to take a quart and vomit it. Where vomiting is absolutely persistent enemata previously partly or entirely digested must be resorted to. WHOOPING COUGH. The remedies recommended for this disease are almost as numer- ous as the members of the medical profession, and every one of them is Avorthless so far as a cure is concerned. Probably the very best 694 DISEASES. drug of all in the majority of cases is antipyrin. Given in the dose of i to 3 grains (0.025-0.15) every five hours according to the age of the child, it will nearly always decrease the number of paroxysms, but not the severity of each individual attack. Where the child will submit to it there is little doubt that a solution of quinine applied to the pharynx by means of a very fine spray will be of service in many cases, and it is very useful, Avhen so used, as a prophylactic in other children of the family who it is feared will be attacked by the same disease. The strength of the solution to be employed should be about 1 grain (0.05) to the ounce of water. There is no doubt that carburetted hydrogen as inhaled in the air at gasAvorks is useful as a curative measure in some cases of whooping cough. A very useful remedy in some cases is belladonna in the form of the tincture, in the dose of 2 drops (0.01) twice a day to a child of one or two years. Where great vascular engorgement ensues upon a severe coughing spell vascular sedatives are of service; that is, in those cases in Avhich hemorrhages from the nose, ears, and mouth take place veratrum viride or aconite may be used, unless the disease has already so exhausted the child that stimulants are needed, and cardiac sedatives are contraindicated by the degree of adynamia present. The reason for this lies in the following facts: The vascu- lar tension consequent upon the obstruction of respiration causes a rise of blood-pressure from asphyxia, and the hemorrhages or the conjunctival ecchymoses are due to rupture of the small blood-vessels under the increased strain. By lowering vascular tension we prevent so great a spasm of the blood-vessels and avoid vascular rupture or distention. Where paroxysms come on so rapidly as really to interfere seri- ously wdth respiration, the child should take a Avhiff of chloroform poured over the parent's hand, and so relax the spasm, while in other instances nitrite of amyl is equally serviceable. Only 2 to 3 drops of the nitrite of amyl should be used at a time, and this fact must be impressed upon the parents. Benzine has been found useful in certain cases of whooping cough. It should be lightly sprinkled about the room or on the bed-clothing. In France it has been used internally in the dose of 10 to 15 drops (0.6-1.0) for this affection. This is scarcely to be recommended. Bromoform renders good service in some cases. (See article on Bromoform for prescription.) The vomiting following the cough may be overcome by using such minute amounts of milk as to enable nutrition to go on Avithout at any time overloading the stomach, as, for example, a teaspoonful (4.0) after each paroxysm of cough. Often it will be found possible to modify the severity and frequency of the attacks by keeping the patient under a bronchitis tent or by keeping the air of the room moistened by steam. (See Bronchitis.) WORMS. 695 WORMS. Intestinal parasites may be said to be represented by the Ascaris lumbricoides, or round-worm; the Taenia solium, Tamia media canellata, and the Bothriocephalus latus, or tape-worms ; and, finally, by the Oxyuris vermicularis, sometimes called seat-, pin-, or thread- worm. The round-worm and tape-Avorm are to be attacked by way of the patient's mouth, the seat-Avorm by Avay of the anal opening; but 'before mentioning the drugs to be employed it is necessary to insist upon one or tAvo important points, disregard of which will result in failure in treatment. Whenever a round- or tape-Avorm is to be attacked, the patient must be starved for at least twelve to twenty-four hours, in order that no food in the intestinal tract may protect the worm from the action of the drug. During this time a little milk may be taken, and after a night of fasting, before breakfast, the anthelmintic must be swal- loAved. Further than this, nearly all of these drugs must be folloAved by purges in, order to dislodge the intruder while he is paralyzed and has lost his hold; and in many instances it is Avell to have a basin of salt and Avater ready, so that Avhen a passage occurs a rectal injection may be given to Avash out any segments of the worm which remain behind in the rectum. In the treatment of thread-worms it is necessary to fill the boAvel thoroughly Avith soap and Avater to dislodge the faecal matter and expose the Avorms in the folds of the mucous membrane. The drugs Avhich are used against the round-worm are: Spigelia in the form of the fluid extract, dose 1 drachm (4.0) to a child of two or three years, or 2 drachms (8.0) to an adult, or, better still, the fluid extract of spigelia and senna, dose 2 to 3 drachms (8.0-12.0), given in divided doses, to a child; oil of chenopodium, dose 5 to 20 drops (0.3-1.3) on sugar; santonin, dose \ to J grain (0.016-0.025) to a child, in the form of troche, made by using the crystals, or as much as 2 to 4 grains (0.1-0.2) to an adult. (See Santonin.) Brayera, or kooso, is given for the removal of the tape-worm in the form of an infusion, which is made by adding \ ounce (16.0) of the powdered leaves to 1 pint (500 cc.) of water and mucilage of acacia, one-half of each. This may be taken at one dose, or the fluid extract may be given in the dose of \ ounce (16.0) to an adult. Koosin may be given in 40-grain (2.65) doses in capsule to adults, but it should not be used against worms in pregnant women, as it may cause abortion. Unless the spigelia is used with senna, it should always be followed after from two to four hours by a full dose of castor oil or a saline purgative to sweep out the worm, and the same rule applies to all the drugs mentioned above. The most efficient remedy against the tape-worm is pelletierin, the active principle of pomegranate, dose 3 to 5 grains (0.18-0.26) in capsules; or pepo, or pumpkin-seeds (2 ounces [64.0]), may be resorted to when deprived of their outer coating and rubbed into a 696 DISEASES. paste Avith sugar. Almost, if not quite, as valuable a remedy is male fern, or Filix mas, or, as it is officially called, Aspielium. Used in the form of the oleoresin (Oleoresina Aspidii), in the dose of J to 1 drachm (2.0-4.0) to an adult, it should be followed in three or four hours by a calomel purge, aided by a saline. Either the calomel or the increased amount of bile Avhich is present is apparently peculiarly abhorrent to the tape-worm, and its free excretion should follow the use of all the drugs just named. Aspidium should not be followed by castor or other oils, as they increase the absorbability of the drug, and so tend to develop poisonous symptoms. By far the most useful remedy for seat-Avorms is quassia used by injection. 1 to 2 ounces (32.0-64.0) of poAvdered quassia or quassia chips may be made into a decoction with a pint (500 cc.) of Avater, and half of this injected into the rectum after it has been Avell cleansed with soap and water. The quassia injection should be retained in the bowel for some minutes, and in children this may be accomplished by pressing upon the anal opening the ball of the thumb covered by a pad formed from a small folded towel. If this treatment fails to bring away all the Avorms in three or four trials, either there are none present or the bowel is not thoroughly invaded by the injection. In some cases the worms infest the colon, and large injections sent high up into the bowel are necessary. DOSES OF MEDICINES. dr. = drachm ; fl. dr. ■■ fluidrachm; fl. oz. = fluidounce; gr. min. <= minim ; oz. = ounce. = gram; gm. = gramme; Remedy. Acetanilid....... Acetophenone..... Acetphenetidin..... Acetum lobeliae..... opii......... sanguinariae..... scillae....... Acid, acetic, diluted . . . arsenous....... solution of (Ph. U. S.) benzoic....... boric........ carbolic....... chrysophanic ..... citric ........ fluoric, dilute..... gallic........ hydriodic, dilute . . . hydrobromic, dilute . . hydrochloric..... dilute....... hydrocyanic, dilute . . lactic........ nitric........ dilute....... nitrohydrochloric - • phosphoric, dilute. . . picric....... polygalic....... salicylic....... sulphuric...... aromatic...... dilute....... sulphurous ...... tannic........ tartaric ...... valerianic...... Aconite, abstract of . . . leaves, extract of . . . fluid extract of . . . tincture of..... . root, extract of • • • fluid extract of . . . tincture of..... Aconitine....... Adonidin.....• • Either. See Ether. Dose. Apothecaries' Weights and Measures. 1-8 gr. 5-20 min. 2-5 gr. 15-30 min. 5-10 min. 15-30 min. 10-30 min. 1-2 fl. dr. 6 0~J5 §r- 2-8 min. 5-15 gr. 5-10 gr. |—5 min. 5-20 gr. 10-20 min. 3-15 gr. i- fl. dr. i-2 fl. dr. 2-5 min. 10-20 min. 2-5 min. 1-3 dr. 2-5 min. 10-25 min. 2-5 min. 5-25 min. 1-5 gr. 3-1 gr. 5-15 gr. 2-5 min. 5-20 min. 5-20 min. i-l fl. dr. 2-10 gr. 10-30 gr. 3-4 min. 1-5 min. 10-15 min. tW gr- Metric System. 0.06 0.3 0.12 1.0 0.3 1.0 0.6 4.0 0.001 0.12 0.3 0.3 0.03 0.008 0.3 0.6 0.2 2 2.0 0.12 0.6 o.r; 4.0 0.12 0.6 0.12 0.3 0.06 0.015 0.3 0.12 0.3 0.3 2 0.12 0.6 0.2 0.015 0015 0.06 0.6 0.01 0.03 0.06 0.00015 0.005 -0.5 gm. -1.25 gm. -0.3 gm. -2.0 gm. -0.6 gm. -2.0 gm. -1.8 gm. -8.0 gm. -0.003 gm. -0.5 gm. -1.0 gm. -0.6 gm. -0.06 gm. -0.3 gm. -1.25 gm. -1.2 gm. -1.0 gm. .0 gm. -8.0 gm. i-0.3 gm. i—1.2 gm. -0.3 gm. -12.0 gm. -0.3 gm. -1.5 gm. :-0.3 gm. —1.5 gm. -0.3 gm. 1-O.O6 gm. 1-1 gm. 1-0.3 gm. ;-1.2gm. 1-1.2 gm. -4 gm. 0.6 gm. -2gm. 1-0.25 gm. .-0.03 gm. 1-0.03 gm. i-0.3 gm. i—1.0 gm. -0.016 gm. -0.06 gm. -0.18 gm. ,-0.0002 gm. i-0.01 gm. 697 698 DOSES OF MEDICINES. Remedy. Agaricin.............. Aloes ............ extract of............ and myrrh, tincture of....... tincture of............ watery extract.......... wine of............. Aloin............... Alumen.............. (as emetic)............ Aluminium hydrate......... Ammonia, aromatic spirit...... solution of acetate of....... spirit of............. water of............. Ammoniacum........... mixture............. Ammonium benzoate........ bromide............. carbonate............ chloride............ iodide.............. phosphate............ picrate .............. sulphate............. valerianate............ Amygdala amara, water of...... Amyl nitrite............ by inhalation.......... Amylene hydrate.......... Amylum iodatum.......... Angelica-root, fluid extract...... Angustnra-bark........... Anise, oil of............ spirit of . ............ Anthemis............. extract............. fluid extract........... Antimonial powder......... Antimony oxide.......... oxysulphuret........... and potassium tartrate, as diaphoretic as emetic........... sulphide............. sulphurated........... sulphuret............ wine of ............. Antipyrine............. Antitoxine (for diphtheria)...... Apiol............... Apocynin ... ......... Apocynum cannabinum....... fluid extract of......... Apomorphine hydrochlorate..... Aralia hispida, fluid extract of ... . nudicaulis, fluid extract of..... racemosa, fluid extract of...... spinosa, fluid extract of...... Arbutin............... Areca, fluid extract of......... Argentum and compounds. See Silver. Arnica-flowers, extract of....... Dose. Apothecaries' Weights and Measures. Ti-\ gr- 2-6 gr. 2-6 gr. 1-2 fl. dr. 1-2 fl. dr. £-2 gr. 1-2 fl. dr. 1-3 gr. 5-10 gr. 30 gr.-l dr. 5-15 gr. 30 min.-l fl. dr. 1-2 fl. dr. 5-15 min. 2-6 gr. 10-30 gr. £-1 oz. 10-20 gr. 10-30 gr. 3-10 gr. 5-10 gr. 3-5 gr. 10-20 gr. i-igr- 3-10 gr. 2-8 gr. 1-2 fl. dr. 2-3 min. 3-5 min. 10-30 min. 5-30 gr. 30-60 min. 10-30 gr. 1-5 min. 1-2 fl. dr. i-1 dr. 2-10 gr. 30-60 min. 1-3 gr. 2-3 gr. f-2 gr. t\~\ gr. *-l gr- }-2gr. 1-2 gr. *-2 gr. 10 min.-l fl. dr. 5-15 gr. 5-10 cc. 2-5 gr. 1-2 gr. 10-20 gr. 10-30 min. tV-tV gr- 30-60 min. 30-60 min. 30-60 min. 30-60 min. 1-10 gr. 30-60 min. 2-5 gr- Metric System. 0.005-0.015 gm. 0.1-0.35 gm. 0.1-0.35 gm. 4.0-8.0 gm. 4.0-8.0 gm. 0.03-0.12 gm. 4.0-8.0 gm. 0.06-0.18 gm. 0.3-0.6 gm. 2.0-4.0 gm. 0.3-1.0 gm. 2-4 gm. 4-8 gm. 0.6-1.0 gm. 0.1-0.35 gm. 0.6-2 gm. 16-32 gm. 0.6-1.2 gm. 0.6-2 gm. 0.18-0.6 gm. 0.3-0.6 gm. 0.18-0.3 gm. 0.6-1.2 gm. 0.016-0.03 gm. 0.18-0.6 gm. 0.12-0.48 gm. 4.0-8.0 gm. 0.12-0.18 gm. 0.18-0.3 gm. 0.6-2.0 gm. 0.3-2.0 gm. 2.0-4.0 gm. 0.6-2.0 gm. 0.06-0.3 gm. 4.0-8.0 gm. 2-4 gm. 0.12-0.6 gm. 2.0-4.0 gm. 0.06-0.18 gm. 0.12-0.18 gm. 0.03-0.12 gm. 0.004-0.03 gm. 0.03-0.06 gm. 0.03-0.12 gm. 0.06-0.12 gm. 0.03-0.12 gm. 0.6-4 gm. 0.3-1.0 gm. 0.12-0.3 gm. 0.03-0.12 gm. 0.6-1.2 gm. 0.6-2.0 gm. 0.004-0.006 gm. 2.0-4.0 gm. 2.0-4.0 gm. 2.0-4.0 gm. . 2.0-4.0 gm. 0.06-0.6 gm. 2.0-4.0 gm. 0.12-0.3 gm. DOSES OF MEDICINES. 099 Arnica-flowers, fluid extract of..... root, extract of.......... fluid extract of.......... tincture of............ Aromatic powder........... Arsenate of sodium, solution of..... Arsenic. See Acid, arsenous. bromide.............. iodide............... and mercury iodide, solution of (Dono- van's solution) ......... Arsenite of potassium, solution of (Fowler's solution)............ Asafa?tida .............. mixture of ............. tincture............... Asclepias incarnata, fluid extract of . . . Syriaca, fluid extract of........ tuberosa.............. Aspidium, fluid extract of....... oleo-resin of............ . Aspidosperma, abstract of........ fluid extract of............ Atropine sulphate........... Aurantii cortex, fluid extract of..... Azedarach, fluid extract of....... Balsam of Gurjun........... of Tolu............... Baptisia, extract of........... fluid extract of........... Baptisine............... Belladonna, abstract of......... alcoholic extract of.......... leaves, fluid extract of........ tincture of............ root, extract of........... fluid extract of........... Benzanilide.............. Benzoin, compound tincture of...... tincture of............. Benzol ................ Berberina............... sulphate.............. Berberis aquifolium, fluid extract of . . . vulgaris, fluid extract of....... Bismuth and ammonium, citrate of ... . citrate .............. salicylate............. subcarbonate ............ subnitrate............. tannate.............. valerianate............ Boldo, fluid extract of........ oil of............... tincture of............ Brayera............... fluid extract of. . . . ...... infusion of............ Bromal............... Bromoform............. Brucina.............• • Dose. Apothecaries' Weights and Measures. 5-15 gr. 2-5 gr. 5-15 gr. 10-20 gr. 10-30 gr. 3-5 min. 1-4 min. is j gr- 5-10 min. Metric System. 0.3-1.0 gm. 0.12-0.3 gin. 0.3-1.0 gm. 0.6-1.2 mg. 0.6-2.0 gm. 0.18-0.3 gm. 0.06-0.024 gm. 0.004-0.008 gm. 0.3-0.6 gm. 2-5 min. 0.12-0.3 gm. 5-20 gr. 0.3-1.2 gm. i-1 fl. oz. 15-30 gm. 30 min.-l fl. dr. 2-4 gm. 15-30 min. 1.0-2.0 gm. 15-30 min. 1.0-2.0 gm. 15-30 min. 1.0-2.0 gm. 1-2 fl. dr. 4.0-8.0 gm. 30 min.-l fl. dr. 2.0-4.0 gm. 5-20 gr. 0.3-1.2 gm. 15-30 min. 1.0-2.0 gm. 1___1_ crr 0.0005-0.0015 gm 15 min.-2 fl. dr. 1.0-8.0 gm. 15-60 min. 1.0-4.0 gm. 20-30 min. 1.2-2.0 gm. 10-30 min. 0.6-2.0 gm. 2-10 gr. 0.12-0.6 gm. 10-30 min. 0.6-2.0 gm. 2-5 gr. 0.12-0.3 gm. f-H gr- 0.03-0.1 gm. *-igr- 0.016-0.03 gm. 3-6 min. 0.18-0.36 gm. 10-20 min. 0.6-1.2 gm. 8-?gr- 0.008-0.016 gm. 1-2 min. 0.06-0.12 gm. 1-5 gr. 0.06-0.3 gm. 30 min.-l fl. dr. 2.0-4.0 gm |-1 fl. dr. 2 0-4.0 gm 5-10 min. 0.3-0.6 gm 3-10 gr. 0.18-0.6 gm 3-10 gr. 0.18-0.6 gm 15-30 min. 1.0-2.0 gm 15-30 min. 1.0-2.0 gm 1-10 gr. 0.06-0.6 gm 3-15 gr. 0.18-1.0 gm 5-15 gr. 0.3-1.0 gm 5-20 gr. 0.3-1.2 gm 5-20 gr. 0.3-1.2 gm 5-30 gr. 0.3-2.0 gm 1-3 gr. 0.06-0.18 gm. 5-15 min. 0.3-1.0 gm. 5 min. 0.3 gm. 8 min. 0.5 gm. 2-3 dr. 8.0-12.0 gm. |-1 fl. oz. 15.0-30.0 gm. 4-8 oz. 118.0-236.0 gm. 2-3 gr. 0.12-0.2 gm. 5-10 min. 0.3-0.6 gm. TfWe gr- 0.002-0.004 $ 'm. 700 DOSES OF MEDICINES. Remedy. Bryonia, fluid extract of...... tincture of........... Buchu, fluid extract of....... Buckthorn, fluid extract of..... Cactus grandiflora, fluid extract of . . Caffeine.............. citrate of............ Cajeput, oil of.......... Calamus, fluid extract of...... Calcium benzoate.......- . bromide............ carbonate............ chloride............ hypophosphite.......... iodide............. lactophosphate, syrup of..... phosphate............ sulphide............ Calendula, fluid extract of...... tincture of.......... Calomel. See Mercury, mild chloride of. Calumba, extract of......... fluid extract of.......... tincture of............ Calx chlorata........... sulphurata.......... . Camphor............. bromide............ monobromated.......... spirit of........... water.............. Camphoric acid ......... Cannabin tannate......... Cannabis Americana, fluid extract of . Indica, abstract of....... extract of........... fluid extract of......... tincture of.......... Cantharides............ tincture of........... Capsicum............. fluid extract of.......... oleoresin of........... tincture of........... Caraway, oil of........... Carbon bisulphide......... Cardamom, compound tincture of . . fluid extract of.......... tincture of........... Caryophyllus, oil of........ Cascara sagrada.......... extract of............ fluid extract of.......... Cascarilla............. fluid extract of.......... Cassia fistula, pulp of........ Castanea vesca, fluid extract of. . . . Castor.............. tincture of............ Cataria, fluid extract of....... Catechu.............. Dose. Apothecaries' Weights and Measures. 15 15-60 min. 15-30 min. i-1 fl. dr. 15-30 min. 5-10 min. 2-5 gr. 2-5 gr. 5-20 min. 15-60 min. 10 gr. 10-20 gr. 15-30 gr. 5-10 gr. 10-30 gr. 1-3 gr. 1-2 fl. dr. 15-30 gr. HP- 15-60 min. 15-30 min. 3-10 gr. 15-60 min. 1-4 fl. dr. 2-5 gr. Hgr- 2-10 gr. 2-5 gr. 2-5 gr. 5-30 min. i-2 fl. oz. 15-30 gr. 5-10 gr. 3-15 min. 1-3 gr. Hgr: 3-6 min. 5-20 min. i-1 gr- 2-5 min. 1-2 gr. \-\ min. \-l min. 5-20 min. 1-5 min. \-\ min. 1-2 fl. dr. 15-45 min. 1-2 fl. dr. 1-5 min. 2-8 gr. 2-8 gr. 10-30 min. 20-30 gr. 1-2 fl. dr. 1-2 dr. 4-1 fl. dr. 10-30 gr. 2-4 fl. dr. min.-l fl. dr. 10-30 gr. Metric System. 1.0-4.0 gm. 1.0-2.0 gm. 2.0-4.0 gm. 1.0-2.0 gm. 0.3-0.6 gm. 0.12-0.3 gm. 0.12-0.3 gm. 0.3-1.2 gm. 1.0-4.0 gm. 0.6 gm. 0.6-1.2 gm. 1.0-2.0 gm. 0.3-0.6 gm. 0.6-2.0 gm. 0.06-0.18 gm. 4.0-8.0 gm. 1.0-2.0 gm. 0.012-0.03 gm. 1.0-4.0 gm. 1.0-2.0 gm. -0.6 gm. -4.0 gm. -16.0 gm. -0.3 gm. -0.06'gm. -0.6 gm. -0.3 gm. -0.3 gm. -2.0 gm. -64.0 gm. -2.0 gm. -0.6 gm. -1.0 gm. -0.18 gm. -0.06 gm. -0.36 gm. -1.2 gm. -0.06 gm. -0.3 gm. -0.12 gm. -0.06 gm. -0.06 gm. -1.2 gm. -0.3 gm. -0.06 gm. -8.0 gm. -3.0 gm. -8.0 gm. -0.3 gm. -0.5 gm. -0.5 gm. -2.0 gm. 2.0 gm. -8.0 gm. -8.0 gm. -4.0 gm. -2.0 gm. -16.0 gm. -4.0 gm. -2.0 gm. 0.18 1.0 4.0 0.12 0.016 0.12 0.12 0.12 0.3 16.0 1.0 0.3- 0.18- 0.06- 0.015- 0.18- 0.3- 0.03- 0.12- 0.03 0.03- 0.015- 0.3- 0.06- 0.03- 4.0 1.0- 4.0- 0.06 0.12 0.12- 0.6- 1.2- 4.0- 4.0- 2.0- 0.6- 8.0- 1.0- 0.6- DOSES OF MEDICINES. 701 Catechu, compound tincture of... . fluid extract of.......... Caulophyllin........... Caulophyllum, infusion of...... C;iva-cava........ . . . . Cerium nitrate.......... oxalate............. Chalk, compound powder of..... mixture............. prepared.......... . . Chamomile, oil of......... Charcoal, animal, purified...... Chelidonium majus......... extract of............ fluid extract of.......... Chenopodium, oil of ....... . Cherry-laurel water........ Chimaphila, fluid extract of..... Chinoidin............. Chionanthus, fluid extract of ... . Chiretta, fluid extract of...... tincture of............ Chloral hydrate.......... Chloralamide......... . . Chlorine-water........... Chloroform, mixture of....... purified............. spirit of............. Chrysarobin............ Cimicifuga, fluid extract of..... tincture of............ Cinchona-bark........... aromatic fluid extract of..... compound tincture of....... extract of............ fluid extract of.......... tincture of............ Cinchonia sulphate......... Cinchonidia or Cinchonidine sulphate Cinchonine sulphate........ Cinnamon............. oil of........... . . . spirit of............. tincture of............ Cloves. See Caryophyllus. Coca, fluid extract of ....... leaves of .......... Cocaine............. Cocculus, fluid extract of...... tincture of............ Codeine or Codeia........■ Colchicine............ -Colchicum, acetic extract of ... . root............. extract of.......... fluid extract of........ wine of ........... seed............ fluid extract of....... tincture of.......... wine of........... Dose. Apothecaries' Weights and Measures. 1-2 fl. dr. 10-30 min. t ? gr- 1-2 oz. 10-30 gr. 1-2 gr. 1-2 gr. 10-30 gr. 1-2 fl. oz. 15-30 gr. 5-15 min. 10-30 gr. |-1 dr. 5-10 gr. 15-30 min. 4-8 min. 5-30 min. 1-2 fl. dr. 10-30 gr. 30-60 min. i-1 fl. dr. 15-60 min. 5-20 gr. 15-30 gr. 1-4 fl. dr. 1-4 fl. dr. 5-10 min. 10 min.-l fl. dr. 5-20 gr. 10-30 min. l-l fl. dr. 10 gr.-l dr. 30-60 min. 1-2 fl. dr. 10-30 gr. 10-30 min. 1-2 fl. dr. 10-20 gr. 10-30 gr. 10-30 gr. 5-20 gr. 1-5 min. 5-20 min. 1-2 fl. dr. 20 min.-l fl. dr. i-1 dr. i~l gr- 1-3 min. 2-10 min. 1-2 gr. jins-u gr- l-1 err % 2 gr- 2-5 gr. H gr: 2-5 min. 10-20 min. 2-10 gr. 2-8 min. 10-30 min. 20-40 min. Metric System. 2.0- 8.0 gm. 0.6- 2.0 gm. 0.015- o.oa gm. 16.0- 64.C gm. 0.6- 2.0 gm. 0.06- o.n gm. 0.06- O.li gm. 0.6- 2.0 gm. 32- 64 gm. 1.0- 2.0 gm. 0.3- 1.0 gm. 0.6- 2.0 gm. 2.0- 4.0 gm. 0.3- 0.6 gm. 1.0- 2.0 gm. 0.24-0.5 gm. 0.3- -2.0 gm. 4.0- 8.0 gm. 0.6- -2.0 gm. 2.0- 4.0 gm. 2.0- -4.0 gm. 1.0-4.0 gm. 0.3- -1.2 gm. 1.0- -2.0 gm. 4.0- -15.0 gm. 4.0- -15.0 gm. 0.3- -0.6 gm. 0.6- -4.0 gm. 0.3- -1.2 gm. 0.6- -2.0 gm. 2.0- -4.0 gm. 0.6- -4.0 gm. 2.0-4.0 gm. 4.0- -8.0 gm. 0.6- -2.0 mg. 0.6- -2.0 gm. 8.0- -15.0 gm. 0.6 -1.2 gm. 0.6 -2.0 gm. 0.6 -2.0 gm. 0.3 -1.2 gm. 0.06 -0.3 gm. 0.3 -1.2 gm. 2.0-8.0 gm. 1.2 -4.0 gm. 2.0 -4.0 gm. 0.03 -0.06 gm. 0.06 -0.2 gm. 0.12 -0.6 gm. 0.06-0.12 gm. 0.0012-0.0006 gm 0.015 -0.03 gm. 0.12 -0.3 gm. 0.015 -0.03 gm. 0.12 -0.3 gm. 0.6 -1.2 gm 0.12-0.6 gm 0.12-0.5 gm 0.6 -2.0 gm 1.2-2.4 gm 702 DOSES OF MEDICINES. Colocynth.......... compound extract of..... extract of.......... Colocynthidine........ Colocynthin.......... Condurango, fluid extract of . . . Coniine............ hydrochlorate........ Conium, abstract of....... fluid extract of........ fruit, alcoholic extract of . . . fluid extract of....... tincture of........ leaves, extract of....... fluid extract of....... Convallamarin......... Convallaria, extract of..... fluid extract of........ Copaiba............ oil of............ oleo-resin of......... Copper, acetate........ ammoniated......... sulphate, astringent, tonic . . . emetic....... . . Coptis, fluid extract of..... Corrosive sublimate. See Mercury. Corydalis, fluid extract of ... . Coto............. fluid extract of........ tincture of......... Cotoi'n............ Cotton-root bark. See Gossypium. Creasote............ water............ Creolin............ Croton-chloral hydrate..... Croton oil........... Cubebs ............ fluid extract of........ oil of............ oleoresin of . ........ tincture of . ........ Curare............ Curarin............. Cypripedium......... fluid extract of........ Damiana, fluid extract of ... . tincture........... Daturine ......... Delphinium, fluid extract of . . . Digitaline........... Digitalis, abstract of...... extract of.......... fluid extract of........ infusion of......... powder of leaves of...... tincture of.......... Dioscorea, fluid extract of ... . Dita, fluid extract of...... Dogwood, bark of root..... Dose. Apothecaries' Weights and Measures. 2-8 gr. 5-10 gr. 2-5 gr. tW gr. i-lgr. 10-30 min. 1 - 1 o-r 5152 gr- 1 - 1 or 5J J? gr. 1-2 gr. 5 min. i-1 gr- 1-2 min. 10-20 min. 1-2 gr. 1-3 min. i"2gr. 2-10 min. 15-30 min. 20 min.-l fl. dr. 10-20 min. 2-10 gr. i-igr- i~l gr. iri gr- 5gr. 30-60 min. 15-30 min. 1-2 gr. 5-15 min. 2-10 min. A-i gr- 1-3 min. 1-4 fl. dr. \ gr. 2-10 gr. \-\ min. 10 gr.-l dr. 15-30 min. 10-20 min. 5-20 gr. 1-2 fl. dr. sW gr- ■bsrh gr- 15 gr. 15-30 min. 30 min.-2 fl. dr. 1-3 fl. dr. riWj gr- 1-3 min. ■hr-h gr- 1-2 gr. Hgr: 1-6 min. 2-4 fl. dr. 1-1 gr.. 5-15 min. 15-30 min. 1-4 min. 20-60 gr. Metric System. 0.1: 0.3 0.12 0.005 0.015 0.6 0.001- 0.001- 0.06- 0.03- 0.06- 0.6- 0.06- 0.06- 0.03- 0.12- 1.0- 1.2- 0.6- 0.12- 0.015- 0.01- 0.015- 2.0- -0.5 gm. -0.6 gm. -0.3 gm. -0.01 gm. -0.06 gm. -2.0 gm. -0.002 gm. -0.002 gm. -0.12 gm. 0.3 gm. -0.06 gm. -0.12 gm. -1.2 gm. -0.12 gm. -0.18 gm. -0.12 gm. -0.6 gm. -2.0 gm. 4.0 gm. -1.2 gm. -0.6 gm. 0.03 gm. -0.06 gm. -0.03 gm. 0.3 gm. -4.0 gm. 1.0-2.0 gm. 0.06-0.12 gm. 0.3-1.0 gm. 0.12-0.6 gm. 0.005-0.008 gm. 0.06 4.0 0.12 0.03 0.6 1.0 0.6- 0.3 4.0 0.002- 0.001- 1.0- 2.0- 4.0 0.0006- 0.06- 0.001 0.06 0.01- 0.06- 8.00- 0.03- 0.3- 1.0 0.06- 1.2 -0.18 gm. -15.0 gm. 0.03 gm. -0.6 gm. -0.06 gm. -4.0 gm. -2.0 gm. -1.2 gm. -1.2 gm. -8.0 gm. -0.008 gm. -0.002 gm. 1.0 gm. -2.0 gm. -8.0 gm. -12.0 gm. -0.0012 gm. -0.2 gm. -0.002 gm. 0.12 gm. -0.03 gm. -0.35 gm. -16.00 gm. -0.06 gm. -1.0 gm. -2.0 gm. -0.25 gm. -4.0 gm. DOSES OF MEDICINES. 703 Dogwood, fluid extract of........ Donovan's solution. See Arsenic. Dover's powder............ Dracontium.............. fluid extract of........... Drosera, fluid extract of......... Duboisine............... Dulcamara, extract of. ........ fluid extract of............ Elaterin............... Elaterium............... Emetin, diaphoretic.......... emetic............... Ergot................. extract of.............. fluid extract of............ tincture of............. wine of .............. Ergotin, Bonjean's (purified extract of ergot) Erigeron, oil of............ Eriodictyon, extract of......... fluid extract of............ Erythrophloein............. Erythroxylon. See Coca. Eserine................ Ether, acetic.............. compound spirit of (Hoffman's anodyne) nitrous, spirit of (sweet spirit of nitre) . sulphuric.............. Ethyl bromide............. Eucalyptol............. Eucalyptus, fluid ^extract of....... oil of..... .......... Euonymin............... Euonymus, extract of.......... fluid extract of............ Eupatorium, fluid extract of...... Euphorbia pilulifera, fluid extract of . . . Fel bovis purificatum.......... Ferrum. See Iron. Frangula, fluid extract of........ Galls, aromatic syrup of......... fluid extract of............ tincture of.....,...... Gamboge............... Gaultheria, oil of............ Gelsemium, abstract of......... extract of.............. fluid extract of............ tincture of............. Gentian, compound infusion of...... extract of.............. fluid extract of............ tincture of............. Geranium, fluid extract of........ Ginger, fluid extract of ......... oleo-resin of.......... . . . tincture of.............. Glycyrrhiza. See Licorice. Goa powder.............. Gold bromide............. Dose. Apothecaries' AVeights and Measures. 30-60 min. 5-10 gr. 10-20 gr. i-l fl. dr. 5—10 min. tAo gr- 5-10 gr. i-l fl. dr. 1-1 or So" 2"o gr- xWgr- T2U so gr. W gr- 15-60 gr. 2-10 gr. 15 min.-l fl. dr. i-2 fl. dr. 1-3 fl. dr. 2-8 gr. 5-15 min. 2-5 gr. 15-30 min. iVi gr- 6(T_20 gr- 10-20 min. 30 min. i-l fl. dr. 15-40 min. 15-60 min. 10-15 min. 15-30 min. 5-10 min. 2-5 gr. 1-3 gr. i-l fl. dr. i-l fl. dr. 5-30 min. 3-6 gr. 1-2 fl. dr. 1-2 fl. dr. 1-2 fl. dr. i-2 fl. dr. i-4 gr. 2-10 min. 1-2 gr. 1-1 gr- 2-5 min. 5-10 min. 1-4 fl. dr. 2-3 gr. i-l fl. dr. 1-2 fl. dr. 20-30 min. 10-30 min. 1-3 gr. 15-30 min. 5-20 gr. I-1 or s j gr- Metric System. 2.0-4.0 gm. 0.3-0.6 gm. 0.6-1.2 gm. 2.0-4.0 gm. 0.3-0.6 gm. 0.0006 gm. 0.3-0.6 gm. 2.0-4.0 gm. 0.001-0.003 gm. 0.006-0.015 gm. 0.0005-0.002 gm. 0.008-0.015 gm. 1.0-4.0 gm. 0.12-0.06 gm. 1.0-4.0 gm. 2.0-8.0 gm. 4.0-12.0 gm. 0.12-0.5 gm. 0.3-1.0 gm. 0.12-0.3 gm. 1.0-2.0 gm. 0.004-0.008 gm. 0.001- 0.6- 2.0 1.0 1.0 0.6 1.0 0.3- 0.12 0.06 2.0 2.0 0.3 0.18 -0.003 gm. -1.2 gm. 2.0 gm. -4.0 gm. -2.5 gm. -4.0 gm. -1.0 gm. -2.0 gm. -0.6 gm. -0.3 gm. -0.18 gm. -4.0 gm. -4.0 gm. -2.0 gm. -0.36 gm. 4.0-8. 4.0-8. 4.0-8. 2.0-8. 0.03-0. 0.12-0. 0.06-0. 0.03-0. 0.12-0. 0.3-0, 4.0-8, 0.12-O 2.0-4. 4.0-8, 1.2-2. , 0.6-2 0.06-0 1.0-2 0 gm. 0 gm. 0 gm. 0 gm. 25 gm. 6 gm. 12 gm. 06 gm. 3gm. 6gm. 0 gm. 2 gm. 0 gm. 0 gm. 0 gm. ,0 gm. ,18 gm. ,0 gm. 0.3-1.2 gm. 0.008-0.03 gm. 704 DOSES OF MEDICINES. Remedy. Gold and sodium chloride....... Gossypium-root, fluid extract of bark of . Granati radicis cortex, fluid extract . . . Grindelia, fluid extract of....... Guaiac, ammoniated tincture of ... . resin of......... . . . . tincture of............. Guaiacol.............. Guarana.............. fluid extract of........... (i 11 r j u 11. .See Balsam. Iiii-niatoxyion............ extract of............. fluid extract of........... Hamamelis, fluid extract of...... Hedeoma, oil of........... Helleborein............. Helleborus niger, extract of...... fluid extract of........... tincture of............ Hepatica, fluid extract of....... Hops, extract of........... fluid extract of........... tincture of............ Hydrangea, fluid extract of...... Hydrastine............. Hydrastis, extract of......... fluid extract of........... tincture of............ Hyoscine hydrobromate........ Hyoscyamine sulphate........ Hyoscyamus, abstract of........ alcoholic extract of......... extract of............. fluid extract of flowers....... of seeds ............ tincture of flowers......... of seeds............ Hypnal............... Hypnone.............. Hypophosphites, syrup of....... with iron, syrup of......... Ichthyol .............. Ignatia, abstract of.......... extract of............. fluid extract of........... tincture of............. Iodine, compound solution of..... tincture of............. Iodoform........... Iodol ................ Ipecacuanha, emetic......... expectorant........... abstract of............. fluid extract of, emetic . .'..... syrup of.............. wine of, emetic.......... . expectorant.......... Iridin or Irisin........... Iris, extract of............ fluid extract of......... Dose. Apothecaries' Weights and Measures. i - 1 err TS 2o gr- i-l fl. dr. 1-2 fl. dr. i-l fl. dr. 30-60 min. 10-20 gr. 30-60 min. i-3 gr. 10-30 gr. 10-30 min. 10-20 gr. 10-20 gr. 30-60 min. 30 min.-2 fl. dr. 2-5 min. iVi gr- i-2 gr. _ 5-15 min. 10-15 min. 30-60 min. 3-15 gr. 30-60 min. 1-2 fl. dr. 30-60 min. i-igr- 3-10 gr. 10-30 min. 30-60 min. tsts~sj5 gr- T?W(T gr- 2-3 gr. 1-2 gr. 2-3 gr. 5-15 min. 5 min. 15-30 min. 15-30 min. i-l gr. 1-5 gr. 1 fl. dr. 1 fl. dr. 2-4 gr. 1-3 gr. i-l gr. 1-6 min. 5-15 min. 5 min. 5-15 min. 1-3 gr. i-2 gr. 15-30 gr. i-l gr. 5-30 gr. 15-30 min. i-l fl. dr. 3-6 fl. dr. 5-15 min. 1-5 gr. 1-3 gr. 5-15 min. Metric System. 0.001-0.003 gm. 2.0-4.0 gm. 4.0-8.0 gm. 2.0-4.0 gm. 2.0-4.0 gm. 0.6-1.2 gm. 2.0-4.0 gm. 0.03-0.18 gm. 0.6-2.0 gm. 0.6-2.0 gm. 0.6-1.2 gm. 0.6-1.2 gm. 2.0-4.0 gm. 2.0-8.0 gm. 0.12-0.3 gm. 0.006-0.016 gm. 0.03-0.12 gm. 0.3-1.0 gm. 0.6-1.0 gm. 2.0-4.0 gm. 0.2-1.0 gm. 2.0-4.0 gm. 4.0-8.0 gm. 2.0-4.0 gm. 0.015-0.03 gm. 0.2-0.6 gm. 0.6-2.0 gm. 2.0-4.0 gm. 0.0006-0.001 gm. 0.0005-0.001 gm. 0.12-0.2 gm. 0.06-0.12 gm. 0.12-0.2 gm. 0.3-1.0 gm. 0.3 gm. 1.0-2.0 gm. 1.0-2.0 gm. 0.03-0.06 gm. 0.06-0.3 gm. 4.0 gm. 4.0 gm. 0.1-0.25 gm. 0.06-0.2 gm. 0.015-0.06 gm. 0.06-0.35 gm. 0.3-1.0 gm. 0.3 gm. 0.3-1.0 gm. 0.06-0.2 gm. 0.03-0.12 gm. 1.0-2.0 gm. 0.01-0.06 gm. 0.3-2.0 gm. 1.0-2.0 gm. 2.0-4.0 gm. 12.0-24.0 gm. 0.3-1.0 gm. 0.06-0.3 gm. 0.06-0.18 gm. 0.3-1.0 gm. DOSES OF MEDICINES. 705 Remedy. Iron acetate, tincture of . . and ammonium citrate sulphate ...... tartrate ....... arsenate....... benzoate....... bitter wine of..... bromide........ syrup of....... carbonate, saccharated . chloride....... tincture of..... and cinchonidia citrate . citrate........ compound mixture of . dialyzed........ solution of...... hydrated oxide of . . . hypophosphite..... syrup of....... iodide........ syrup of....... lactate ........ magnetic oxide of . . . malate ........ nitrate, solution .... phosphate. '...... pomate........ and potassium tartrate . pyrophosphate..... and quinia citrate . . . reduced ........ saccharated carbonate of. and strychnine citrate . subcarbonate...... subsulphate...... sulphate....... dried........ valerianate...... wine of the citrate of. . Jaborandi, extract of . . ■ fluid extract of. - . . Jalap.......... abstract of....... compound powder of . . extract of....... alcoholic extract of . . . fluid extract of..... resin of...... . . tincture of...... Juglans, extract of ... . fluid extract of..... Juniperus, fluid extract of. Kairin......... Kamala......... fluid extract of..... Kino . ...... fluid extract of..... tincture of ..... Kola, fluid extract of . . . Koosso. See Brayera 45 Dose. Apothecaries' Weights and Measures. Metric System. 15-30 min. 1.0-2.0 gm. 5-10 gr. 0.3-0.6 gm. 5-10 gr. 0.3-0.6 gm. 5-15 gr. 0.3-1.0 gm. 1-1 OT ?ff sv gr- 0.0015-0.003 gm. 1-5 gr. 0.06-0.3 gm. 1-2 fl. dr. 4.0-8.0 gm. 1-5 gr. 0.06-0.3 gm. 15-60 min. 1.0-4.0 gm. 5-15 gr. 0.3-1.0 gm. 1-3 gr. 0.06-0.18 gm. 10-30 min. 0.6-2.0 gm. 5-10 gr. 0.3-0.6 gm. 5-10 gr. 0.3-0.6 gm. 1-2 fl. oz. 30.0-60.0 gm. 5-15 min. 0.3-1.0 gm. 10-30 min. 0.6-2.0 gm. Tablespoonful doses i n arsenical poisoning 5-10 gr. 0.3-0.6 gm. 1 fl. dr. 4.0 gm. 1-5 gr. 0.06-0.3 gm. 10-30 min. 0.6-2.0 gm. 1-5 gr. 0.06-0.3 gm. 5-10 gr. 0.3-0.6 gm. 5-15 gr. 0.3-1.0 gm. 8-15 min. 0.5-1.0 gm. 1-5 gr. 0.06-0.3 gm. 5-15 gr. 0.3-1.0 gm. 10-30 gr. 0.6-2.0 gm. 2-5 gr. 0.12-0.3 gm. 5-10 gr. 0.3-0.6 gm. 3-6 gr. 0.2-0.4 gm. 5-15 gr. 0.3-1.0 gm. 1-3 gr. 0.06-0.18 gm. 5-30 gr. 0.3-2.0 gm. 1-3 gr. 0.06-0.18 gm. 1-3 gr. 0.06-0.18 gm. i-2 gr. 0.03-0.12 gm. 1-3 gr. 0.06-0.18 gm. i-l fl. dr. 2.0-4.0 gm. 2-5 gr. 0.12-0.3 gm. 10-60 min. 0.6-4.0 gm. 5-30 gr. 0.3-2.0 gm. 5-10 gr. 0.3-0.6 gm. *dr. 2.00 gm. 5-10 gr. 0.3-0.6 gm. 3-6 gr. 0.18-0.35 gm. 15-30 min. 1.0-2.0 gm. 4-8 gr. 0.25-0.5 gm. i-2 fl. dr. 2.0-8.0 gm. 5-20 gr. 0.3-1.2 gm. 1-2 fl. dr. 4.0-8.0 gm. 30-60 min. 2.0-4.0 gm. 2-10 gr. 0.12-0.6 gm. 1-2 dr. 4.0-8.0 gm. 30-60 min. 2.0-4.0 gm. 10-30 gr. 0.6-2.0 gm. 15-30 min. 1.0-2.0 gm. i-2 fl. dr. 2.0-8.0 gm. 10-30 min. 0.65-2.0 gm. 706 DOSES OF MEDICINES. Remedy. Dose. Krameria............... extract of.............. fluid extract of............ syrup of............... tincture of.............. Lactucarium.............. fluid extract of........... syrup of............... Lappa, fluid extract of......... Lead acetate.............. iodide................ Leptandra .............. extract of.............. fluid extract of............ Leptandrin.............. Lime, solution of............ syrup of............... Liquor potassse, sodse, etc. See Potassa, Soda, etc. Liquorice, compound mixture of..... powder of.............. Lithium benzoate........... bromide.............. carbonate.............. citrate ............. salicylate.............. Lobelia, fluid extract of......... tincture of.............. Lupulin............... fluid extract of............ oleoresin of............. tincture of.............. Magnesia............... Magnesium carbonate.......... sulphate.............. sulphite............... Male fern, oleoresin of......... Malt, extract of............ Manganese binoxide.......... sulphate.............. Manna................ Matico................ fluid extract of............ tincture of............. Matricaria, fluid extract of.....' . . Menispermum, fluid extract of..... Menthol............... Mercury with chalk.......... corrosive chloride of......... cyanide....... ...... formamidate (1 per cent, solution) . . . green iodide of............ ss of (blue pill).......... !d chloride of........... ] i iodide of............. deviate.............. tannate............... yellow subsulphate of......... Mezereum, extract of.......... fluid extract of............ Morphine and its salts......... Apothecaries' Weights and Measures. 10-20 gr. 5-15 gr. 20-30 min. 1-4 fl. dr. i-2 fl. dr. 10-15 gr. 10-30 min. 1-3 fl. dr. 30-60 min. i-3 gr. i-3 gr. 20-40 gr. 3-10 gr. 30-60 min. 2-4 gr. 1-4 dr. 15-30 min. 1-4 fl. dr. i-l dr. 5-10 gr. 2-10 gr. 2-10 gr. 2-10 gr. 2-10 gr. 1-5 min. 10-30 min. 5-10 gr. 10-15 min. 2-5 gr. i-2 fl. dr. 10-30 gr. 10 gr.-l dr. 2 dr.-l oz. 10-30 gr. 30 min.-l fl. dr. 1-2 fl. dr. 2-4 gr. 2-10 gr. 1-2 oz. i-2 dr. i-l fl. dr. i-2 fl. dr. 10-30 min. 30-60 min. 2gr. 2-10 gr. sWs gr- A4 gr- 5-15 min. i i „r 6 j gr- 3-10 gr. 1-5 gr. *Ws gr- i-l gr. gr- k-1 gr. i-lgr-. 3-10 min. tW gr- Metric System. 0.6-1.2 gm. 0.3-1.0 gm. 1.2-2.0 gm. 4.0-16.0 gm. 2.0-8.00 gm. 0.6-1.0 gm. 0.6-2.0 gm. 4.0-12.0 gm. 2.0-4.0 gm. 0.03-0.18 gm. 0.03-0.18 gm. 1.2-2.5 gm. 0.18-0.6 gm. 2.0-4.0 gm. 0.12-0.25 gm. 4.0-15.0 gm. 1.0-2.0 gm. 4.0-16.0 gm. 2.0-4.0 gm. 0.3-0.6 gm. 0.12-0.6 gm. 0.12-0.6 gm. 0.12-0.6 gm. 0.12-0.6 gm. 0.06-0.3 gm. 0.6-2.0 gm. 0.3-0.6 gm. 0.6-1.0 gm. 0.12-0.3 gm. 2.0-8.0 gm. 0.6-2.0 gm. 0.6-4.0 gm. 8 0-32.0 gm. 0.6-2.0 gm. 2.0-4.0 gm. 4.0-8.0 gm. 0.12-0.25 gm. 0.12-0.6 gm. 32.0-64.0 gm. 2.0-8.0 gm. 2.0-4.0 gm. 2.0-8.0 gm. 0.6-2.0 gm. 2.0-4.0 gm. 0.12 gm. 0.12-0.6 gm. 0.002-0.004 gm. 0.004-0.008 gm. 0.3-1.0 gm. 0.01-0.03 gm. 0.2-0.6 gm. 0.008-0.3 gm. 0.002-0.004 gm. 0.03-0.06 gm. 0.03-0.06 gm. 0.015-0.06 gm. 0.03-0.06 gm. 0.18-0.6 gm. 0.004-0.03 gm. DOSES OF MEDICINES. 707 Morrhuol............... Musk................ tincture of.............. Myrrh................ tincture of.............. Myrtol .............. Naphthaline.............. Naphthol............... Narceine............... Narcotine............... Nectandra, fluid extract of....... Nitroglycerin (1 per cent, solution). . . . Nux vomica, abstract of......... extract of.............. fluid extract of.........' . . . tincture of . . . . v........ Opium, camphorated tincture of (paregoric) confection of............ extract of.............. powder............... tincture of (laudanum)........ wine of ............... Pancreatin.............. Papaver, extract of........... fluid extract of............ Papayotin............... Paracotoi'n.............. Paraldehyde.............. Pareira................. extract of.............. fluid extract of............ tincture of.......... . . . . Pelletierine sulphate.......... tannate.............. Peppermint, oil of........... spirit of.............. Pepsin, pure.............. liquor of............. saccharated............ Petroselinum, fluid extract of...... Phenacetin.............. Phosphorated oil............ Phosphorus.............. Physostigma, extract of......... fluid extract of........... tincture of............. Physostigmine salicylate........ sulphate.............. Phytolacca, abstract of......... berries, fluid extract of........ root, extract of............ fluid extract of........... tincture of............. Phytolaccin.............. Picrotoxin .............. Pilocarpine and its salts......... Pilocarpus, abstract of......... fluid extract of............ Pimenta, fluid extract of........ Piper methysticum, fluid extract of. . . . nigrum, fluid extract of........ Dose. Apothecaries' Weights and Measures. 1-5 gr. 2-15 gr. 15-60 min. 10-30 gr. 15-30 min. 2-3 gr. 2-10 gr. 2-10 gr. i"i gr- 3gr. 1-4 fl. dr. 1 min. ^1 gr- i-l gr- 1-5 min. 10-20 min. i-2 fl. dr. 10-40 gr. i-i gr- i-lgr-. 5-15 min. 5-15 min. 10-20 gr. i-2 gr. 15-30 min. 1-5 gr. 1-3 gr. 20-60 min. i-l dr. 10-30 gr. i-l fl. dr. 1 fl. dr. 2-5 gr. 1-5 gr. 2-5 min. 30-60 min. 15 gr.-l dr. 2-4 fl. dr. 30 gr.~i oz. 1-2 fl. dr. 2-5 gr. 3-5 min. 1 _ 1 err tss 75 gr- 1__1 err TT 6 gr; 1-3 min. 5-10 min. T^T)—8 o gr- 1 - 1 OT TZo ¥o gr- 5-15 gr. 5-30 min. 1-3 gr. 5-30 min. 10-60 min. 2-3 gr. sWs gr- *W gr- 5-20 gr. 15-60 min. 15-45 min. 15 min.-l fl. dr. 15-45 min. Metric System. 0.06- 0.1- 1.0 0.6- 1.0- 0.12- 0.12- 0.12- 0.01- 4.0- 0.015- 0.008- 0.06- 0.6- 2.0- 0.6- 0.01- 0.015- 0.3- 0.3- 0.6- 0.03- 1.0- 0.06- 0.06- 1.2- 2.0 0.6- 2.0- 0.12- 0.06- 0.12 2.0 1.0 8.0 2.0 4.0 0.12 0.18 0.0006 0.004 0.06 0.3 0.0005- 0.0005 0.3 0.12 0.06 0.3 0.6 0.12 0.001 0.001 0.3 1.0 1.2 1.0 1.0 0.3 gm. -1.0 gm. 4.0 gm. 2.0 gm. -2.0 gm. -0.18 gm. -0.6 gm. -0.6 gm. -0.03 gm. 0.18 gm. -16.0 gm. 0.06 gm. -0.06 gm. -0.03 gm. -0.3 gm. -1.2 gm. -8.0 gm. -2.5 gm. -0.03 gm. -0.06 gm. -1.0 gm. -1.0 gm. -1.2 gm. -0.12 gm. -2.0 gm. -0.3 gm. -0.18 gm. -4.0 gm. -4.0 gm. -2.0 gm. -4.0 gm. 4.0 gm. -0.3 gm. -0.3 gm. -0.3 gm. -4.0 gm. -4.0 gm. -15.0 gm. -16.0 gm. -8.0 gm. -0.3 gm. -0.3 gm. -0.0008 gm. -0.01 gm. -0.18 gm. -0.6 gm. -0.0008 gm. -0^008 gm. -1.00 gm. -2.0 gm. -0.18 gm. -2.0 gm -4.0 gu -0.18 g -0.002 j, ■.. -0.03 gm. -1.2 gm. -4.0 gm. -3.0 gm. -4.0 gm. -3.0 gm. 708 DOSES OF MEDICINES. Piper nigrum, oleoresin of..... Piperine............. Piscidia erythrina, extract of ... . fluid extract of. . ....... powder of........... Podophyllum, abstract of...... resin of............. Pomegranate, bark of........ Poppy. See Papaver. Potassa, solution of (liquor potassae) . Potassium acetate......... bicarbonate . ......... bitartrate........'. . . . bromide............. carbonate............ chlorate............. citrate............. solution of............ cyanide............. ferrocyanide........... hypophosphite.......... iodide............. mixture of the citrate of..... nitrate ............. permanganate......... and sodium tartrate....... sulphate............ sulphide............ sulphite............. tartrate ........ ..... Prinos.............. fluid extract........... Pulsatilla, fluid extract of...... Pyrethrum, tincture of....... Pyridine.............. Pyrodine............. Quassia, extract of......... fluid extract of.......... tincture of........... Quebracho, fluid extract of..... Quercus, fluid extract of....... Quinidine............. Quinine and salts......... arsenate............ Quinoidin............. Resorcin............. Rhamnus catharticus, fluid extract of . Rhubarb............. aromatic syrup of........ tincture of........... compound powder of....... extract of............ fluid extract of.......... and soda, mixture of....... sweet tincture of......... syrup of............. tincture of.......... Avine of............ Rhus, aromatic fluid extract of. . . . glabra (cortex), fluid extract of . . (friictus), fluid extract of . . . . Apothecaries' Metric Weights and Measures System. 1-3 gr. 0.06-0.2 gm. 1-8 gr. 0.06-0.5 gm. 1-2 gr. 0.06-0.12 gm. 10-30 min. 0.6-2.0 gm. 5-15 gr. 0.3-1.0 gm. 1-5 gr. 0.6-0.3 gm. f-i gr. 0.008-0.03 gm. 20-30 gr. 1.2-2.0 gm. 5-20 min. 0.3-1.2 gm. 15 gr.-l dr. 1.0-4.0 gm. 10-40 gr. 0.6-2.5 gm. 1-5 gr. 0.06-0.3 gm. 10 gr.-l dr. 0.6-4.0 gm. 5-30 gr. 0.3-2.0 gm. 5-15 gr. 0.3-1.0 gm. 15-60 gr. 1.0-4.0 gm. 2-4 fl. dr. 8.0-16.0 gm. tV? gr- 0.004-0.008 gm. 10-15 gr. 0.6-1.0 gm. 5-15 gr. 0.3-1.0 gm. 2-15 gr. 0.12-1.0 gm. i fl. oz. 15.0 gm. 5-15 gr. 0.3-1.0 gm. 1-2 gr. 0.06-0.12 gm. i-l oz. 15.0-30 0 gm. 30 gr.-2 dr. 2.0-8.0 gm. 1-10 gr. 0.06-06 gm. 15-30 gr. 1.0-2.0 gm. 1 dr.-l oz. 4.0-32.0 gm. 30 gr.-l dr. 2.0-4.0 gm. 30-60 min. 2.0-4.0 gm. 2-5 min. 0.12-0.3 gm. 10-30 min. 0.6-2.0 gm. 1-3 gr. 0.06-0.18 gm. 1-3 gr. 0.06-0.18 gm. 1-5 gr. 0.06-0 3 gm. 30-60 min. 2.0-4.0 gm i-2 fl. dr. 2.0-8.0 gm. 20-60 min. 1.2-4.0 gm. 30-60 min. 2.0-4.00 gm. 1-30 gr. 0.06-2.0 gm. 1-30 gr. 0.06-2.0 gm. i-l gr. 0.01-0.06 gm. 10-30 gr. 0.6-2.0 gm. 5-10 gr. 0 3-0.6 gm. 30-60 min. 2.0-4.0 gm. 2-30 gr. 0.12-2.0 gm. 1-4 fl. dr. 4.0-16.0 gm. i-l 11. dr. 2.0-4.0 gm. i-l dr. 2.0-4.0 gm. 5-15 gr. 0.3-1.0 gm. 15-40 min. 1.0-2.5 gm. i-l fl. dr. 2.0-4.0 gm. 1-4 fl. dr. 4.0-16.0 gm. 1-4 fl. dr. 4.0-16.0 gm. 1-4 fl. dr. 4.0-16.0 gm. 1-2 fl. dr. 4.0-.S.0 gm. 15-00 min. 1 0-4.0 gm. 30-60 min. 2.0-4.0 gm. 30-60 min. 2.0-4.0 gm. DOSES OF MEDICINES. 709 Rhus toxicodendron........ Roses, fluid extract of........ syrup of............. Rubus, fluid extract of....... Rumex, fluid extract of....... Ruta, fluid extract of........ Sabina, fluid extract of....... Saccharin............. Salicin.............. Salix, fluid extract of........ Salol.............. Salvia, fluid extract of...... . Sambucus, fluid extract of...... Sandal-wood, oil of......... Sanguinaria............ fluid extract of......... tincture of........... Santonica ............. fluid extract of.......... Santonin ............ Sarsaparilla, compound fluid extract of compound syrup of........ fluid extract of.......... Sassafras, fluid extract of...... Savine, oil of........... Seammony............ resin of............. Scoparius, fluid extract of...... Scutellaria, fluid extract of..... Scutellarine............ Senega, abstract of......... fluid extract of.......... syrup of............. Senna.............. compound infusion of....... confection of........... fluid extract of.......... infusion of........... syrup of............. tincture of............ Serpentaria, fluid extract of .... tincture of........... Silver iodide. ......... nitrate............. oxide .............. Simaruba, fluid extract of...... Soda, solution of (liquor sodse) .... Sodium acetate........... arsenate............. benzoate............ bicarbonate........... bisulphite............ borate ............. bromide............. carbonate ............ chlorate ............. citrate............. hypophosphite.......... hyposulphite......... iodide............. nitrite............. Dose. Apothecaries' Metric Weights and Measures. System. 10 min. 0.06-0.4 gm. i-2 fl. dr. 2.0-8.0 gm. 1-2 fl. dr. 4.0-8.0 gm. i-2 fl. dr. 2.0-8.0 gm. 30-60 min. 2.0-4.0 gm. 15-30 min. 1.0-2.0 gm. 5-15 min. 0.3-1.0 gm. i~4 gr- 0.03-0.25 gm. 10-30 gr. 0.6-2.0 gm. i-2 fl. dr. 2.0-8.0 gm. 10-20 gr. 0.6-1.2 gm. i-2 fl. dr. 2.0-8.0 gm. 1-2 fl. dr. 2.0-8.0 gm. 15-20 min. 1.0-1.2 gm. 1-5 gr. 0.06-0.3 gm. 5-10 min. 0.3-0.6 gm. 10-40 min. 0.6-2.5 gm. 10-30 gr. 0.6-2.0 gm. 15-60 min. 1.0-4.0 gm. 1-4 gr. 0.06-0.25 gm. 1-2 fl. dr. 2.0-8.0 gm. 1-4 fl. dr. 4.0-16.0 gm. i-2 fl. dr. 2.0-8.0 gm. i-2 fl. dr. 2.0-8.0 gm. 2-5 min. 0.12-0.3 gm. 5-15 gr. 0.3-1.0 gm. 2-10 gr. 0.12-0.6 gm. i-l fl. dr. 2.0-4.0 gm. 1-2 fl. dr. 4.0-8.0 gm. 1-3 gr. 0.06-0.18 gm. 4-10 gr. 0.25-0.6 gm. 8-15 min. 0.5-1.0 gm. i-2 fl. dr. 2.0-8.0 gm. 10-60 gr. 0.6-4.0 gm. 1-2 oz. 32.0-64.0 gm. 1-2 dr. 4.0-8.0 gm. 1-4 fl. dr. 4.0-15.0 gm. 4 fl. oz. 125.0 gm. 1-4 fl. dr. 4.0-16.0 gm. 2 fl. dr.-l fl. oz. 8.0-30.0 gm. 30 min.-l fl. dr. 2.0-4.0 gm. i-2 fl. dr. 2.0-8.0 gm. i"2 gr. 0.03-0.12 gm. \~\ gr- 0.015-0.03 gm. i-l gr- 0.03-0.06 gm. 15-30 min. 1.0-2.0 gm. 5-20 min. 0.3-1.2 gm. 15 gr.-l dr. 1.0-4.0 gm. ^o"-"io gr- 0.001-0.006 gm. 5-30 gr. 0.3-2.0 gm. 10-30 gr. 0.6-2.0 gm. 10-30 gr. 0.6-2.0 gm. 10-30 gr. 0.6-2.0 gm. 10-30 gr. 0.6-2.0 gm. 10-30 gr. 0.6-2.0 gm. 5-30 gr. 0.3-2.0 gm. 1-10 dr. 4.0-40.0 gm. 5-15 gr. 0.3-1.0 gm. 10-30 gr. 0.6-2.0 gm. 5-20 gr. 0.3-1.2 gm. 1-4 gr. 0.06-0.25 gm. 710 DOSES OF MEDICINES. Remedy. Sodium phosphate...... salicylate......... sulphate.......... sulphite.......... Sparteine sulphate...... Spigelia, fluid extract of. . . . and senna, fluid extract of . . Squill, compound fluid extract of syrup of. . ...... fluid extract of....... syrup of.......... tincture of ....... . Stillingia, fluid extract of . . . Stramonium, extract of . . fluid extract of...... leaves, alcoholic extract of . tincture of....... seeds, extract of...... tincture of........ Strontium bromide...... iodide........... lactate.......... phosphate......... Strophanthus, tincture of . . . Strophantin......... Strychnine and its salts .... Sulphonal.......... Sulphur........... Sumbul, fluid extract of ... . tincture of......... Taraxacum, extract of ... . fluid extract of....... Terebene .......... Terpine hydrate....... Terpinol.......... Thallin, sulphate of...... tartrate of......... Theine........... Thuja, fluid extract of ... . Thymol........... Toxicodendron, fluid extract of Triticum, fluid extract of . . . Turpentine, oil of...... Urethane.......... Ustilago maidis, fluid extract of Uva ursi, fluid extract of . . . Valerian, abstract of..... ammoniated tincture of . . . extract of......... fluid extract of....... oil of -.......... tincture of........ Veratrine.......... Veratrum viride, abstract of . . fluid extract of....... tincture of......... Verbena, fluid extract of . . . Viburnum, fluid extract of . . Vinegar. See Acetum. Wnhoo. See Euonymus. Wild-cherry bark...... Dose. Apothecaries' Metric Weights and Measures. System. 2-10 gr. 0.12-0.6 gm. 10-20 gr. 0.6-1.2 trm. 1-4 dr. 4.0-10.0 gin. 10-30 gr. 0.6-2.0 gm. 3TS gr- 0.002 gm. 15-60 min. 1.0-4.0 gm. i-2 fl. dr. 2.0-8.0 gm. 5-30 min. 0.3-1.8 gm. 15-30 min. 1.0-2.0 gm. 5-30 min. 0.3-1.8 gm. i-l fl. dr. 2.0-4.0 gm. 10-60 min. 0.6-4.0 gm. 15-60 min. 1.0-4.0 gm. i gr. 0.03 gm. 1-4 min. 0.06-0.25 gm. i-i gr- 0.015-0.03 gm. 8-15 min. 0.5-1.0 gm. J-1 OT ¥ 2 gr- 0.015-0.03 gm. 6-15 min. 0;4-1.00 gm. 20-30 gr. 1.2-2.0 gm. 10-20 gr. 0.6-1.2 gm. 20-30 gr. 1.2-2.0 gm. 20-30 gr. 1.2-2.0 gm. 3-8 min. 0.2-0.5 gm. 1 1 or T2o ss gr- 0 0005-0.001 gm. eWe gr- 0.001-0.004 gm. 15-30 gr. 1.0-2.0 gm. 1-3 dr. 4.0-12.0 gm. 15-60 min. 1.0-4.0 gm. 10-30 min. 0.6-2.0 gm. 5-15 gr. 0.3-1.0 gm. i-l fl. dr. 2.0-4.0 gm. 5-10 min. 0 3-0.6 gm. 2-5 gr. 0.12-0.3 gm. ?V gr- 0.003 gm. 1-5 gr. 0.06-0.3 gm. 1-5 gr. 0.06-0.3 gm. 1-2 gr. 0.06-0.12 gm. 10-15 gr. 0.6-1.0 gm. 1-5 gr. 0.06-0.3 gm. 1-5 min. 0.06-0.3 gm. 1-2 fl. dr. 4.0-8.0 gm. 5-30 min. 0.3-2.0 gm. 10-30 gr. 0.6-2.0 gm. 15-60 min. 1.0-4.0 gm. i-l fl. dr. 2.0-4.0 gm. 10-15 gr. 0.6-1.0 gm. i-2 fl. dr. 2.0-8.0 gm. 5-15 gr. 0.3-1.0 gm. i-l fl. dr. 2.0-4.0 gm. 4-5 min. 0.24-0.3 gm i-2 fl. dr. 2.0-8.0 gm. eWo" gr- 0.001-0.003 gm. 1-2 gr. 0.06-0.12 gm. 1-5 min. 0.06-0.3 gm. 3-5 min. 0.18-0.3 gm. 15-60 min. 1.0-4.0 gm. 1-2 fl. dr. 4.0-8.0 gm. -ldr. 2.0-4.0 gm. DOSES OF MEDICINES. 711 Remedy. Wild-cherry bark, fluid extract of . infusion of......... syrup of........... Wintergreen, oil of........ Wormseed, oil of... . • . . . . Xanthoxylum bark, fluid extract of. fruit, fluid extract of...... Zinc acetate........... bromide............ iodide............ oxide ............. phosphide........... sulphate (alterative)...... (emetic)......... syrup of iodide of....... valerianate.......... Zingiber. !*^ee Ginger. Dose. Apothecaries' Weights and Measures. Metric System. 30-60 min. 2.0-4.0 gm. 1-2 fl. oz. 30.0-60.0 gm. 2-4 fl. dr. 8.0-16.0 gm. 1-20 min. 0.06-1.2 gm. 4-8 min. 0.24-0.5 gm. 15-30 min. 1.0-2.0 gm. 15-30 min. 1.0-20 gm. 1-2 gr. i-2 gr. i-3 gr. 2-8 gr. iVtV gr-i-l gr. 10-30 gr. 0.06-0.12 gm. 0.03-0.12 gm. 0.03-0.18 gm. 0.12-0.5 gm. 0.003-0.006 gm. 0.015-0.06 gm. 0.6-2.0 gm. 20-40 min. 1.2-2.5 gm. 1-4 gr. 0.06-0.2 gm. TABLES OF RELATIVE WEIGHTS AND MEASURES IN THE METRIC AND APOTHECARIES' SYSTEMS. (See Oldberg's Manual of Weights and Measures.) Milligrammes in Grains. Milligramme. 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 Grain. — "50~0~ — _L_ — TTO" — T0~T> — l — 3TJ Milligrammes. 1 1.2 1.6 2 3 4 5 6 7 Grain. l — ^o = 3o __ l — TO __ 1 — S(> | Ammoniated mercury, 268 715 716 INDEX OF DRUGS. Ammoniated tincture of ergot, 194 of guaiac, 213 of valeriac, 38G Ammonii acetas, 66 benzoas, 66 bromidum, 67 carbonas, 67 chloridum, 68 iodidum, 68 oxalas, 69 phosphas, 69 sulphas, 69 sulphis, 69 valerianas, 69, 383 Ammonio-ferric aium, 240 Ammonium, 66 Amygdala amara, 59 dulcis, 59 Amygdalin, 333 Arnyl nitrite, 69 Amylic alcohol, 53 Amylum, 360 Anaesthesia by infiltration, 167 Anaesthetics, 32, 37 Anaphrodisiacs, 32 Antacids, 32, 37 Anthelmintics, 32, 37 Anthrarobin, 71 Antiarthritics, 32 Antidotum arsenici, 87, 243, 258 Antifebriu, 43 Antihydrotics, 32 Antimalarials, 38 Antimonial powder, 71, 75 Antimonii et potassii tartras, 71 oxidum, 71 sulphidum, 71 purificatum, 71 Antimonium nigrum purificatum, 71 sulphuratum, 71 tartaratum, 71 Antimony, 71 Antiperiodics, 32, 38 Antiphlogistics, 32 Antipyretics, 38 Antipyrin, 75 Antiseptics, 38, 392 Antispasmodics, 38 Antitoxin, 398 Aphrodisiacs, 32 Apiol, 80 Apolysin, 317 Apomorphinae hydrochloras, 82 Apomorphine, 81 Aqua ammoniae, 65 fortior, 65 amygdalae amarae, 60 camphorae, 118 chloroformi, 154 cinnamomi, 163 creosoti, 181 hydrogenii dioxidi, 222 menthae piperitse, 312 pimenta?, 59 rose, 337 Aqiia\ 21 Arbutin, 383 Argenti et potassii nitras, 285 nitras, 282 dilutus, 285 fusus, 282 Argyria, 283 Aristol, 82, 376 Arnica, 82 flores, 82 radix, 82 rhizoma, 82 Aromatic chalk powder, 114 with opium, 114 mixture of iron, 241 powder, 163 spirit of ammonia, 66 sulphuric acid, 369 syrup of cascara, 130 of rhubarb, 336 tincture of rhubarb, 337 Arsenate of iron. 241 of sodium, 86 Arsenic, 83 Arsenicum, 83 Arseni iodidum, 86 Arsenous acid, 83, 86 Asafetida, 88 Asafoetida, 88 Aspidium, 89 Astringents, 32, 38 Atomization, 23 Atropinae sulphas, 91, 95 Atropine, 91 Auramine, 276 Auri et sodii chloridum, 212 Azedarach, 90 BALM OF GILEAD," 380 Balsam of copaiba, 177 Barbadoes aloes, 60 Barium chloride, 90 Barley-water, 450 Basham's mixture, 241 Bath, Bussian, 425 Turkish, 423 Bearberry, 383 Beechwood creosote, 179 Beef essence, 450 peptonized, 447 -tea, 449 Beer, 58 Belladonna, 91 folia, 91 liniment, 95 ointment, 95 plaster, 95 radix, 91 suppositories, 95 Benzoate of ammonium, 66 of bismuth, 98 of lithium, 256 Benzoated lard, 96 Benzoic acid, 96 Benzoin, 96 Benzoimim, 96 Berberine, 115 Beta-naphthol, 281 Bicarbonate of potassium, 331 of sodium, 356 Bichloride-carbolic acid solution, 394 Bichloride of mercury, 268 as an antiseptic, 392 Biinuriate of quinine and urea, 162 Biniodide of mercury, 270 Binoxide of manganese, 260 Bismuth, 97 INDEX OF DRUGS. 717 Bismuth benzoate, 98 salicylate, 9.8 subgallate, 98 Bismuthi carbonas, 97 citras, 97 et ammonii citras, 97 salicylatis, US subcarbonas, 97 subnitras, 97 Bismuthum, 97 Bisulphate of quiuine, 161 Bitartrate of potassium, 99 Bitter almonds, 59 wine of iron, 246 Bitters, 32 Black cohosh, 155 draught, 352 drop, 303 ginger, 209 mustard, 279 oxide of manganese, 260 pepper, 311 snake-root, 155 wash, 270 Blaud's pill, 241 Bleeding, 444 Blood-root, 346 Blue-mass, 270 ointment, 273 pill, 270 Bone-marrow, 210 Boneset, 203 Bonjean's ergotin, 194 Boric acid, 99, 397 Borate of sodium, 99 Borated lint, 101 Borax, 99 Boroglycerin, 101 Bran bread, 451 Brandy, 58 Brayera. 183 Bromide of ammonium, 67 of calcium, 106, 112 of ethyl, 199 of gold, 106 of iron, 241 of lithium, 106, 256 of nickel, 106 of potassium, 101 of sodium, 107 of strontium, 362 Bromides, 101 Bromine, 107 Bromoform, 107 Bronchitis tents, 484 Broom, 350 Brown mixture, 255 Brucinc, 292 Bryonia, 108 Bryony, 108 Buchu, 109 folia, 109 Burgundy pitch, 328 Butyl-chloral hydras, 182 pACTUS GRANDIFLORUS, 109 \J Caffeina, citrata, 110 effervescens, 110 Caffeine, 110 Cajuput oil, 112 Calabar bean, 321 Calabarine, 321 Calamine, 3s,s Calcii bromidum, 106, 112 carbonas praecipitatus, 112 chloridum, 112 hydras, 116 hypophosphis, 112 phosphas pra?cipitatus, 112 sulphas, 112, 114 Calcium, 112 Calcined magnesia, 258 California buckthorn, 130 Calomel, 270 ointment, 273 Calumba, 114 Calumbine, 115 Calumbo, 114 Calx, 115 chlorata, 141 chlorinata, 141 sulphurata, 116 Camphor, 116 liniment, 118 water, 118 Camphora monobromata, 118 Camphorated alcohol, 118 oil, 117 tincture of opium, 303 Camphoric acid, 119 Canada pitch, 328 Cannabis Indica, 119 Cantharidal cerate, 123 collodion, 123, 174 liniment, 123 paper, 123 Cantharidin, 122 Cantharis, 122 Capsici fructus, 124 Capsicine, 124 Capsicum, 124 fruit, 124 plaster, 125 Carbo ligni, 129 Carbolic acid, 125 as an antiseptic, 393 ointment, 129 Carbon,129 Carbonate of ammonium, 67 of bismuth, 97 of creosote, 181 of guaiacol, 215 of iron, 241 of lead, 253 of lithium, 256 of magnesium, 259 of potassium, 332 of zinc, 388 Cardamom, 130 seed, 130 Cardiac sedatives, 33, 38 stimulants, 33, 38 Carminative powder, 163 Carminatives, 33 Carron oil, 116, 205 Caryophyllus, 164 Cascara cordial, 131 sagrada, 130 Cassia fistula, 131 Cassia? pulpa, 131 Castile soap, 351 Castor oil, 131 Cataplasma carbonis, 129 718 INDEX OF DRUGS. Cataplasms, 24 Catechu, 133 Cathartics, 33 Cat's-hair, 203 Caustic potash, 134 soda, 134 Cayenne pepper, 124 Cerates, 24 Ccratum camphora?, 118 cantharidis, 123 plumbi subacetatis, 254 resina?, 334 Cerebral extracts, 210 Cerii oxalas, 134 Chalk, 114 mixture, 112 Champagne, extra dry, 57 Charcoal, 129 poultice, 129 Charta cantharidis, 123 potassi nitratis, 281 sinapis, 280 Charta?, 24 Chenopodium, 135 Chimaphila, 135 Chinoidinum, 162 Chirata, 135 Chireta, 135 Chloral, 136 hydras, 136 Chloralamide, 138 Chloralose, 139 Chlorate of potassium, 140 Chloride of ammonium, 68 of barium, 90 of calcium, 112 of gold and sodium, 212 of iron, 240, 242 of mercury, corrosive, 268 mild, 270 of sodium, 356 of zinc, 388 as an antiseptic, 397 Chlorinated lime, 141 Chlorine gas, 142 Chlorobrom, 139 Chlorodyne, 142 Chloroform, 142 liniment, 154 water, 154 Chloroformum, 143 purificatum, 143 venale, 143 Cholagogues, 33 Chromic acid, 154 Chrysarobin, 155 ointment, 155 Cimicifuga, 155 racemosa, 155 rhizoma, 155 Cinchona, 156 calisaya, 156 condaminea, 156 cortex, 156 micrantha, 156 pale, 156 pitavcnsis, 156 red,'156 rubra, 156 cortex, 156 succirubra, 156 yellow, 156 Cinchonicine, 156 Cinchonidine, 156, 162 Cinchonidina? sulphas, 162 Cinchonidinum, 162 Cinchonina? sulphas, 162 Cinchonine, 162 Cinnamic acid, 163 Cinnamon, 163 Cinnamon-water, 163 Cinnamomum cortex, 163 Citrate of bismuth, 97 of bismuth and ammonium, 97 of caffeine, 110 of iron, 242 of iron and ammonium, 243 of iron and quinine, 243 of iron and strychnine, 243 of lithium, 256 of magnesium, 259 of potassium, 332 Citric acid, 164 Citrine ointment, 275 Classification of drugs, 37 Climates, 437 Cloves, 164 Clyster, 22 Cobalto-nitrite of potassium, 286 Coca, 165 Cocaina? hydrochloras, 165 Cocaine, 165 Codeine, 168, 296 phosphate, 168 Cod-liver oil, 169 Coffee, 111, 172 Colchicine, 172, 173 Colchicum, 172 corms, 172 radix, 172 seed, 172 Cold as a remedy, 401 bath, 403 cream, 337 pack, 311 Collodion, 173 Collodium, 173 cantharidatum, 123, 174 flexile, 174 stypticum, 174, 372 vesicans, 171 Colocynth, 174 Colocynthidis pulpa, 174 Cologne-water, 58 Columbic acid, 115 Columbo, 114 Combination of drugs for joint effect, 28 Commercial oxide of zinc, 305 Compound cathartic pill, 175 effervescing powder, 351 decoction of aloes, 62 of sarsaparilla, 348 extract of colocynth. 174 fluid extract of sarsajiarilla, 348 infusion of gentian, 209 of senna, 261, 352 liniment of mustard, 280 mixture of iron, 242 of liquorice, 255 of senna, 352 pill of antimony, 75 of asafoetida, 89 of colocynth, 175 of rhubarb, 336 INDEX OF DRUGS. 719 Compound pill of seammony, 349 of soap, 303 of squill, 360 powder of almonds, 60 of catechu, 134 of chalk, 114 of cinnamon, 163 of elaterin, 191 of ipecac, 239 of jalap, 247 of kino, 248 of liquorice, 255, 352 of morphine, 304 of opium, 303 of rhubarb, 336 of seammony, 349 solution of iodine, 234 spirit of ether, 216 of juniper, 248 suppositories of lead, 253 syrup of sarsaparilla, 348 of squill, 75, 360 tincture of benzoin, 96 of camphor, 118 of cardamom, 130 of catechu, 133 of chloroform, 154 of cinchona, 163 of geutiau, 209 Condurango, 175 Confectio piperis, 312 rosa?, 218. 338 senna?, 131, 352, 371 sulphuris, 368 Confections, 24 Conii folia, 176 fructus, 176 Coniine, 176 Conium, 175 Conserves, 24 Contraindications for drugs, 31 Convallamarin, 177 Convallaria, 177 Convolvulin, 246 Copaiba, 177 Copper, 178 Cornutine, 192 Corrosive chloride of mercury, 268 sublimate, 268 Cosmoline, 315 Counter-irritants, 33, 38 Counter-irritation, 412 Coxe's hive-syrup, 75, 352, 360 Cream of tartar, 99 Creolin, 181 as an antiseptic, 396 Creosotal, 181 Creosote, 179 carbonate, 181 Cresol, 179 Creta praeparata, 114 Croton chloral, 182 oil, 182 liniment, 183 Cubeba. 183 Cubebic acid, 183 Cubebin, 183 Cubebs, 183 Cupri sulphas, 178 Cuprum, 178 Cusso, 183 Cvanide of potassium, 184 DANDELION, 373 Daturine, 361 Decoction of azedarach, 90 of chimaphila, 135 Decoctions, 24 Decoctum aloes compositum, 62 granati radicis, 331 ha?matoxyli, 215 sarsa?, 348 compositum, 348 sarsaparillae compositum, 348 scoparii, 351 Definition of therapeutics, 18 Definitions of drugs, 31 Demulcents, 33 Deodorized alcohol, 53, 58 opium, 303 tincture of opium, 303 Dermatol, 98, 184 Diachylon, 254 Dialyzed iron, 253 Diaphoretics, 33, 39 Diastase, 184 Diet for child six to twelve months old, 449 one year old, 449 two years old, 449 seven years old, 448 lists, 448 Diethyl-sulphon-dimethyl-methane, 365 Digestants, 39 Digested gruel, 448 Digitalin, 185, 190 Digitalis, 184 folia, 184, 189 Digitin, 185 Digitoniu, 185 Digitoxin, 185 Dilute acetic acid, 48 alcohol, 53, 58 hydrobromic acid, 107 hydrochloric acid, 220 hydrocyanic acid, 221 nitric acid, 286 nitro-hydrochloric acid, 220 phosphoric acid, 319 solution of subacetate of lead, 253 sulphuric acid, 368 Disinfectants, 39 Disinfection, 416 Diuretics, 34, 39 Diuretin, 354 Dobell's solution, 100 Donovan's solution, 86 Dosage, 25 by the rectum, 27 hypodermic, 27 Double cyanide dressing, 397 Dover's powder, 239, 303 Dried alum, 63 sulphate of iron, 245 Drugs, absorption of, 27 classification of, 37 Drugs, combination of, for J unt effect, 28 duration of action of, 2b indications and contraindications for, 31 modes of action of, 19 of administering, 19 strength and reliability of, 29 Duboisine, 190 Duquesnel's crystalline aconitine, 52 720 INDEX OF DRUGS. ECBOLIC ACID, 192 Ecgonine, 165 Effervescing citrate of caffeine, 110 of lithium, 256 powder, 356 Egg-flip, 58 -nog. 57 Elaterin,' 191 Elaterium, 191 Electuaries, 24 Eliminators, 34, 39 Elixir phosphori, 321 proprietatis, 62 roborans, 163 Elixirs, 24 Emetics, 34, 39 direct, 34, 39 peripheral, 34, 39 Emetine, 237, 239 Emmenagogues, 34, 39 direct, 34, 39 indirect, 34, 39 Emplastra, 24 Emplastrum ammoniaci cum hydrargyro, 66 arnica?, 83 asafoetida?, 89 belladonna?, 95 califaciens, 123 cantharidis, 123 capsici, 125 ferri, 246 hydrargyri, 274 menthol, 313 opii, 303 picis burgundica?, 328 canadensis, 328 cantharidatum, 123, 328 plumbi, 254 iodidi, 253 resina?, 254, 334 saponis, 354 Emulsin, 59, 333 Emulsion of bitter almonds, 60 of sweet almonds, 60 Emulsum ammoniaci, 66 amygdala?, 60 asatcetidae, 88 chloroformi, 154 Endermic medication, 23 Enema, 22 peptonized, 447 Enteroclysis, 419 Ergot, 191 Ergotic acid, 192 Ergotin, 192 Ergotinic acid, 192 Ergotinum, 194 Erigeron, 194 Erythroxylon, 165 Escharotics, 38 Eserine, 321 Ether, 194 Ethyl alcohol, 53 bromide, 199 iodide, 200 Eucaine hydrochlorate, 201 Eucalyptol, 202 Eucalyptus, 202 Euonymin, 203 Euonymus, 202 Eupatorium, 203 Euphorbia pilulifera, 203 Europhen, 203 Exalgine, 204 Expectorants, 34, 39 sedative, 34, 39 stimulating, 34, 39 Extracts, 24 Extractum aconiti, 52 aloes aquosum, 62 barbadensis, 62 arnica? radicis, 82 cannabis indica?, 122 cascara? sagrada?, 131 cimicifuga?, 156 cinchona?, 163 colchici, 173 aceticum, 173 radicis, 173 colocynthidis, 175 compositum, 175, 349 conii, 176 digitalis, 189 ergotae, 194 euonymi, 203 siccum. 203 gentiana?, 209 glycyrrhiza?, 255 purum, 255 haematoxyli, 215 hyoscyami, 224 jalapa?, 247 leptandra?, 254 nucis vomica?, 295 opii, 303 physostigmatis, 322 podophylli, 330 quassia?, 334 rhei, 336 stramonii seminis, 362 strophanthi, 363 taraxaei, 373 uva ursi, 383 Extractum belladonna? foliorum alcoholi- cum, 95 Extractum aconiti fluidum, 52 arnica? radicis fluidum, 82 belladonna? radicis fluidum, 95 buchu fluidum, 109 calumba? fluidum, 115 cannabis indica? fluidum, 122 capsici fluidum, 125 chimaphila? fluidum, 135 chirata? fluidum, 135 cimicifuga? fluidum, 156 cinchonae fluidum, 163 coca? fluidum, 168 colchici radicis fluidum, 173 seminis fluidum, 173 conii fluidum, 176 convallaria? fluidum, 177 cubeba? fluidum, 183 cusso fluidum, 183 digitalis fluidum, 189 ergotae fluidum, 194 eucalypti fluidum, 202 eupatorii fluidum, 203 gelsemii fluidum, 208 gentiana? fluidum, 209 geranii fluidum, 209 glycyrrhiza? fluidum, 255 grindelia? fluidum, 212 hamamelidis fluidum, 216 INDEX OF DRUGS. 721 Extractum hydrastis fluidum, 219 hyoscyami fluidum, 224 ipecacuanha? fluidum, 239 kola? fluidum, 249 leptandra? fluidum, 254 lobelia? fluidum, 258 lupulini fluidum, 219 mezerei fluidum, 279 nucis vomicae fluidum, 295 pareira? fluidum, 310 pilocarpi fluidum, 327 podophylli fluidum, 330 pruni Virginiana? fluidum, 333 quassia? fluidum, 334 rhamni Purshiana? fluidum, 131 rhei fluidum, 336 rhois glabra? fluidum, 337 rosa? fluidum, 338 sabinae fluidum, 348 sanguinarine fluidum, 346 sarsaparilla? fluidum, 348 compositum, 348 scilla? fluidum, 360 scoparii fluidum, 351 senega? fluidum, 351 sennae fluidum, 352 serpentaria? fluidum, 353 spigelia? fluidum, 359 et senna? fluidum, 359 stillingia? fluidum, 361 stramonii seminis fluidum, 362 taraxaei fluidum, 373 uva? ursi fluidum, 383 Valeriana? fluidum, 383 veratri viridis fluidum, 387 zingiberis fluidum, 209 Extractum belladonnae liquidum, 95 cascara? sagrada? liquidum, 130 ergota? liquidum, 194 filicis liquidum, 89 glycyrrhiza? liquidum, 255 hamamelidis liquidum, 216 hydrastis liquidum, 219 ipecacuanha? liquidum, 239 jaborandi liquidum, 327 nucis vomica? liquidum, 295 opii liquidum, 303 pareira? liquidum, 310 sarsa? liquidum, 348 Extractum euonymi siccum, 203 FEL BO VIS, 305 purificatum, 305 bovinum purificatum, 305 Ferri arsenas, 241 bromidum, 241 carbonas saccharatus, 240, 241 chloridum, 240, 242 citras, 242 et ammonii citras, 243 sulphas, 245 tartras, 243 et potassii tartras, 243 et quinina? citras, 243 solubilis, 243 et strychnina? citras, 243 iodidum saccharatum, 244 lactas, 244 oxalas, 245 oxidum hydratum, 243 cum magnesia 87, 243, 258 Ferri phosphas solubilis, 245 pyrophosphas solubilis, 245 subsulphas, 240, 245 sulphas, 240, 245 exsiccatus, 245 granulatus, 245 valerianas, 245, 383 Ferrum, 239 dialysatum, 243 reductum, 240, 245 tartaratum, 243 Ferula fretida, 88 Filix mas, 89 Flaxseed, 205 meal, 205 oil, 205 poultice, 205 tea, 205 Fleabane, 194 Flemming's tincture of aconite, 52 Flexible collodion, 174 Flowers of sulphur, 366 Fluid extracts, 24 Flying blister, 412 Foods for the sick, 446 Foot-bath, 422 Formaldehyde, 205 Formic aldehyde, 205 Fowler's solution, 86 Fusel oil, 53 GALLA, 206 Gallic acid, 206 ointment, 206 Gambier, 133 Garlic, 59 Gaultheria, 207 Gelsemine, 207, 208 Gelseminic acid, 207 Gelsemium, 207 General therapeutical considerations, 17 Gentian, 208 Gentiana? radix, 208 Geranium, 209 German chamomile, 261 soft soap, 354 Germicides, 416 Germs, mode of destroying, 417 Gin, 58 Ginger, 209 Glacial acetic acid, 48 Glandular treatment, 210 Glauber's salt, 357 Glonoin, 287 Glycerin, 211 Glycerins, 24 Glycerinum acidi boricum, 101 carboliei, 212 tannici, 212 aluminis, 63, 212 boracis, 212 pepsini, 314 plumbi subacetatis, 212, 354 tragacanthae, 212 Glycerita, 24 Glyceritum acidi carboliei, 129 tannici, 372 amyli, 211 boroglycerini, 101 hydrastis, 220 vitelli, 211 722 INDEX OF DRUGS. Glycerole of aloes, 61 Glycyrrhiza, 255 Glycyrrhiza? radix, 255 Glycyrrhizinum ammoniatum, 256 Goa powder, 155 Gold, 212 bromide of, 106 Goodell's pill of the three valerianates, 384 sumbul pill, 369 Goulard's extract, 253 Granatum, 330 Granulated citrate of magnesium, 259 Gray oil, 273 powder, 273 Green soap, 354 Griffith's mixture, 242 pills, 241 Grindelia, 212 Guaiac, 213 resin, 213 wood, 213 Guaiaci lignum, 213 resina, 213 Guaiacol, 213 carbonate, 215 Gum acacia, 43 arabic, 43 HCEMATOXYLI LIGNUM, 215 Haematoxylon, 215 Hamamelis, 215 Heat, 422 Heavy magnesium, 259 Hemlock fruit, 176 leaves, 176 Henbane 223 Hoffman's anodyne, 216 Homatropine, hydrobromate, 217 Home modification of Turkish bath, 425 Honey, 217 of borax, 101 of rose, 218, 338 of squill, 360 Hop poultice, 218 Hope's camphor mixture 218 Hops, 218 Horse-nettle, 357 House mixture, 354 Humulus, 218 Husband's magnesia, 258 Huxham's tincture, 163, 353 Hydrargyri chloridum corrosivum, 268 mite, 270 iodidum flavum, 275 rubrum, 270 oxidum flavum, 275 rubrum, 275 perchloridum, 268 subchloridum, 270 subsulphas flavus, 276 Hydrargyrum, 261 ammoniatum, 268 cum creta, 273 Hydrastine, 219, 220 Hydrastinine hydrochlorate, 220 Hydrastis, 219 Hydrate of chloral, 136 of lime, 115 Hydrated oxide of iron with magnesium 87, 243, 258 sesquioxide of iron, 87, 243 Hydrobromate of homatropine, 217 of hyoscine, 225 of hyoscyamine, 224 of quinine, 161 Hydrobromic acid, 107 Hydrobromide of coniine, 176 of hyoscine,. 225 Hydrochlorate of apomorphine, 82 of cocaine, 165 of eucaine, 201 of hydrastinine, 220 of morphine, 304 of pilocarpine, 327 of quinine, 161 Hydrochloric acid, 222 Hydrochloride of phenocoll, 317 Hydrocyanic acid, 220 Hydrogen peroxide, 222 as an antiseptic, 397 Hyoscine, 223, 224 hydrobromate, 225 hydrobromide, 225 Hyoscyami folia, 223 Hyoscyamina? hydrobromas, 224 sulphas, 224 vel hydrobromas, 224 Hyoscyamine, 223 Hyoscyamus leaves, 223 Hypnal, 225 Hypnotics, 35, 40 Hypodermic medication, 20 injection of apomorphine, 82 Hypodermoclysis, 428 Hypophosphite of calcium, 112 of sodium, 357 Hyposulphite of sodium, 357 TCE JACKET, 403 J. poultice, 403 Ichthyol, 225 Idiosyncrasy, 30 Incompatibility, 35 Indian hemp, 119 poke, 385 Indications for drugs, 31 Infiltration anaesthesia, 167 Infusions, 24 Infusum brayera?, 183 buchu,109 calumba?, 115 caryophylli, 165 chirata?, 135 cinchonae, 162 acidum, 163 columba?, 115 digitalis, 189 ergota?, 194 gentiana? compositum, 209 lupuli, 219 pruni Virginiana?, 333 quassia?, 334 rhei, 337 rosa? acidum, 338 scoparii, 350 sennae, 353 compositum, 352 senegae, 352 serpentariae, 353 uvae ursi, 383 Inhalations, 23 Injectio apomorphina? hypodermica, 82 INDEX OF DRUGS. Injectio cocaina? hypodermica, 168 ergotini hypodermica, 194 morphina? hypodermica, 305 Intravenous injection, 430 Inunctions, 23 Iodide of ammonium, 68 of arsenic, 86 of ethyl, 200 of iron, 243 of lead, 253 of potassium, 227 of sodium, 230 of strontium, 362 of thymol, 376 Iodine, 230 ointment, 234 Iodoform, 234 as an antiseptic, 395 ointment, 236 Iodol, 237 Iodothyrine, 379 Iodum,' 230 Ipecac, 237 Ipecacuanha, 237 Iron, 239 by hydrogen, 240 plaster, 246 JABORANDI, 323 0 Jaborine, 323 Jalap, 246 Jalapin, 246 Jamaica dogwood, 328 Jamestown weed, 361 James's powder, 75 Jequirity, 247 Jervine, 385 Joint effects of drugs, 28 Juniper, 247 Juniperiu, 247 Junket, 452 P" AM ALA, 248 IV Kaolin, 248 Kataphoresis, 430 Kermes mineral, 71 Kino, 248 Kola, 249 Koosin, 183 Kousso, 183 Koumyss, 448 Kreolin, 181, 396 LACTATE OF IRON, 244 of strontium, 362 Lactophenin, 317 Lactose, 364 Lady AVefoster dinner pills, 62 Lamella? atropina?, 95 cocaina?, 168 homatropina?, 217 physostigminae, 323 Lanolin, 249 Laudanine, 296 Laudanum, 303 Laughing gas, 289 Lavage, 431 Lavements, 22 Lead, 249 I Lead plaster, 254 Lead-water and laudanum, 253 Leeches, 432 Leeching, 432 Ledoyen's disinfectant solution, 254 Lemon-juice, 164 Leptandra, 254 Leptandrin, 255 Levant wormseed, 346 Light magnesia, 258 Lignum vita?, 213 Lime, 115 water, 116 Lingual traction, 197 Lini fariua, 205 semina, 205 Linimentum aconiti, 52 ammonia?, 66 belladonna?, 95 caleis, 116 camphora? 118 ammoniatum, 118 cantharidis, 123 chloroformi, 154 crotonis, 183 hydrargyri, 274 opii, 303 potassii iodidi cum sapone, 230 plumbi subacetatis, 254 saponis, 118, 354 mollis, 354 sinapis, 280 compositum, 280 terebinthina?, 382 aceticum, 382 Linseed, 205 oil, 205 poultice, 205 Linum, 205 Lipanin, 255 Liquor acidi arsenosi, 86 chromici, 155 ammonia?, 66 fortis, 65 ammonii acetatis, 66 citratis, 69 arseni et hydrargyri iodidi, 86 arsenicalis, 86 atropina? sulphatis, 95 bismuthi et ammonii citratis, 97 caleis, 116 chlorinata?, 142 saccharatus, 114 carbonis detergens, 534 epispasticus, 123 ferri acetatis, 246 et ammonii acetatis, 240, 241 chloridi, 242 citratis, 243 perchloridi, 242 fortior, 242 subsulphatis, 244 tersulphatis, 87 hamamelidis, 216 hydrargyri nitratis, 274 perchloridi, 270 hydrogenii peroxidi, 222 iodi compositus, 234 magnesii carbonatis, 259 citratis, 259 morphina? acetatis, 305 hydrochloratis, 305 724 INDEX OF DRUGS. Liquor morphinae sulphatis, 304 tartarata, 305 pancreaticus, 309 pepsini, 314 plumbi subacetatis, 253 dilutus, 253 potassa?, 256 potassii arsenitis, 86 citratis, 332 permanganatis, 314 soda?, 134 sodii arsenatis, 86 silicatis, 353 zinci chloridi, 389 Liquorice, 255 root, 255 Litharge, 254 Lithia-water, 256 Lithii benzoas, 256 bromidum, 106, 256 carbonas, 256 citras, 256 effervescens, 256 salicylas, 256 Lithium, 256 Liver, 210 Lobelia, 257 Logwood, 215 Lotio hydrargyri flava, 276 nigra, 270 Lozenges, 25 Lugol's solution, 234 Lunar caustic, 282 Lupuline, 218 Lupulinic acid, 218 Lupulus, 218 Lycopodium, 258 Lysol, 258 MAGENDIE'S SOLUTION, 304 Magnesia, 258 levis, 258 ponderosa, 259 Magnesii carbonas, 259 ponderosa vel levis, 259 citras, 259 effervescens, 259 sulphas, 260 Magnesium, 259 Male fern, 89 Mandrake, 330 Manganese, 260 Maugani dioxidum, 260 sulphas, 260 Manganum, 260 Manna, 260 Massa copaiba?, 178 ferri carbonatis, 242 hydrargyri, 270 Matricaria, 261 May apple, 330 Meconic acid, 296 Meconine, 296 Mel, 217 boracis, 101 depuratum, 218 despumatum, 218 rosae, 218 Mentha piperita, 312 Menthol, 312 Mercurial ointment, 273 Mercurial oleate, 274, 275 pills, 270 plaster, 274 Mercury, 261 salicylate, 275 with chalk, 273 Methyl acetanilid, 204 blue, 276 chloride, 277 salicylas, 207 violet, 276 Methylene blue, 277 chloride, 278 mixture, 153 Mezerei cortex, 278 Mezereum, 278 ointment, 279 Mild chloride of mercury, 270 Milk of asafoetida. 88 of sulphur, 366 -punch,57 peptonized, 446 -sugar, 364 Mineral springs, 435 Mint camphor, 312 stearopten, 312 Mistura creosoti, 181 creta?, 112 ferri aromatica, 241 glycyrrhizae composita, 255 guaiaci, 213 potassii citratis, 332 rhei et soda?, 337 sennae composita, 353 spiritus vini gallici, 58 Mitigated caustic, 285 Modes of action of drugs, 19 of administering drugs, 19 Monkshood, 49 Monobromated camphor, 118 Monochloral-antipyrin, 225 Monsel's salt, 240, 244 solution, 244 Morphina? acetas, 304 hydrochloras, 304 sulphas, 304 tartrata, 304 Morphine, 304 Moschus, 279 Mucilage of acacia, 43 Mucilago acacia?, 43 Mulled wine, 57, 452 Muriate of ammonium, 68 of morphine, 304 Musk, 279 Mustard, 279 papers, 280 plaster, 280, 415 Mydriatics, 35 Myotics, 35 Myristica, 291 Myrrh, 280 \TAPHTHALIN, 280 iy Naphthol, 281 Narceine, 296 Narcotine, 296 Nervous sedatives, 35, 40 stimulants, 35, 40 Neutral mixture, 332 Nickel, bromide of, 106 INDEX OF DRUGS. Nitrate of lead, 254 of mercury, 274 of pilocarpine, 327 of potassium, 281 of silver. 282 Nitre, 370 Nitric acid, 285 Nitrite of amyl, 69 of potassium, 286 Nitroglycerin, 287 Nitro-hydrochloric acid, 220, 285 Nitrous oxide, 289 Norwood's tincture of veratrum viride, Nuclein, 290 Nut-gall, 206, 371 Nutmeg, 291 Nux vomica, 292 OIL OF AMBER, 63 of rue, 338 of tar, 328 of vitriol, 368 Ointment of aconitine, 52 of ammoniated mercury, 268 of antimony, 75 of atropine, 95 of belladonna, 95 of calomel, 273 of cantharides, 123 of capsicum, 125 of carbolic acid, 129 of carbonate of lead, 253 of chrysarobin, 155 of cocaine, 168 of creosote, 181 of eucalyptus, 202 of gallic acid, 206 of galls, 206 with opium, 206 of iodide of lead, 253 of potassium, 230 of iodine, 234 of iodoform, 236 of lead acetate, 253 of mercury, 273 of mezereum, 279 of nitrate of mercury, 275 of oxide of zinc, 305 of red iodide of mercury, 275 of resin, 334 of rose-water, 337 of salicylic acid, 343 of stramonium, 362 of sulphur, 367 of tannic acid, 372 of tar, 329 of tartrate of antimony, 75 of veratrine, 384 of yellow oxide of mercury, 275 Ointments, 25 Oleatum hydrargyri, 274, 275 veratrina?, 384 Oleoresina aspidii, 89 capsici, 125 cubeba?, 183 lupulini, 219 piperis, 312 zingiberis, 209 Oleum amygdala? amara?, 60 expressum, 60 cajuputi, 112 387 Oleum caryophylli, 164 chenopodii, 135 cinnamomi, 163 copaiba, 177 crotonis, 182 cubeba?, 183 erigerontis, 194 eucalypti, 202 gaultheria, 207 jecoris aselli, 169 juniperi, 248 lini, 205 mentha? piperita?, 312 morrhua?, 169 myristica?, 291 picis liquida?, 328 pimenta?, 59 phosphoratum, 321 ricini, 131 sabinae, 348 santali, 345 sinapis, 279 volatile, 279 succini, 63 tanaceti, 372 terebinthinae, 380 rectificatum, 381 tiglii, 182 Valerianae, 383 Opium, 295 deodoratum, 303 Opodeldoc, 354 Ovarian juice, 210 Oxalate of ammonium, 69 of cerium, 134 of iron, 245 Ox-gall, 305 Oxide of antimony, 75 of calcium, 115 of lead, 254 of mercury, 275 of zinc, 305 Oxygen, 307 Oxygen-water, 307 Oxymel, 218 scillae, 360 Oxytocics, 35, 40 PALE CINCHONA, 156 rose, 337 Pancreas, 210 Pancreatin, 309 Papain, 310 Papaverine, 296 Papayotin, 310 Papers, 24 Papoid, 310 Paraldehyde, 310 Paregoric, 303 Pareira, 310 Pareira? radix, 310 Parsley, 80 Pearson's solution, 86 Pelletierine, 330 Pental, 311 Pepo, 311 Pepper, 311 Peppermint, 312 Peppermint-water, 312 Pepsin, 313 cordial, 314 726 x INDEX OF DRUGS. Pepsinum saccharatum, 314 Peptonized beef, 447 enema, 448 milk, 444 -punch, 444 oysters, 447 Permanganate of potassium, 314 Peroxide of hydrogen, 222, 397 Petrolatum, 315 liquidum, 315 molle, 315 spissum, 315 Petroselinum, 80 Phenacetin, 315 Phenacetinum, 315 Phenicacid, 125 Phenocoll, 317 hydrochloride, 317 Phenol, 125 Phen ozone, 75 Phenyl-dimethyl-pyrazolon, 75 Phenylic alcohol, 125 Phlebotomy, 444 Phosphate of ammonium, 69 of codeine, 168 of iron, 245 of sodium, 318 of strontium, 362 Phosphide of zinc, 318 Phosphorated oil, 321 Phosphoric acid, 319 Phosphorus, 319 Physostigma, 321 Physostigmatus semen, 321 Physostigmina, 321 Physostigmina? salicylas, 322 sulphas, 322 Physostigmine, 321 Picric acid, 323 Pill of three valerianates, 384 Pills, 24 Pilocarpina? hydrochloras, 327 nitras, 327 Pilocarpine, 323 Pilocarpus, 323 Pilula asafoetidae composita, 89 colocynthidis composita, 175 et hyoscyami, 175 ferri carbonatis, 241 hydrargyri, 270 ipecacuanha? cum scilla, 239 plumbi cum opio, 253 quinina? sulphatis, 161 saponis composita, 303 scammonii composita, 349 scilla? composita, 360 Pilula? aloes, 61 et asafcetida?, 62 et ferri, 62 et mastiches, 61 et myrrha?, 61, 280 antimonii composita?, 75 asafoetidae, 88 catharticae composita?, 175 vegetabiles, 175 ferri iodidi, 244 opii, 303 phosphori, 321 rhei, 336 composita?, 336 Pimenta, 59 Pinkroot, 358 Piper, 311 nigrum, 311 Piperazine, 327 Piperin, 311 Pipsissewa, 135 Piscidia erythrina, 328 Pitch, 328 Pix, 328 burgundica, 328 canadensis, 328 liquida, 328 Plaster of ammoniac with mercury, 66 of arnica, 83 of asafcetida, 89 of belladonna, 95 of Burgundy pitch, 328 of Canada pitch, 328 of cantharides, 123 of capsicum, 125 of iodide of lead, 253 of iron, 246 of lead, 254 of menthol, 313 of mercury, 274 of opium, 303 of resin, 334 of soap, 354 of tar, 328 Plasters, 24 Plumbi acetas, 252 carbonas, 253 iodidum, 253 nitras, 254 oxidum, 254 Plumbum, 249 Plummer's pills, 75 Podophylli rhizoma, 330 Podophyllin, 330 Podophyllum, 330 Poke-root, 385 Pomegranate, 330 Port wine, 58 Porter, 58 Potash papers, 281 Potassa, 134 caustiea, 134 cum calce, 115, 134, 387 Potassii acetas, 48 bicarbonas, 331 bitartras, 99 bromidum, 101 carbonas, 332 chloras, 140 citras, 332 effervescens, 332 cyanidum, 184 iodidum, 227 nitras, 281 permanganas, 314 et sodii tartras, 337 tartras acid a, 99 Potassium nitrite, 286 Precipitated carbonate of calcium, 112 of zinc, 388 phosphate of calcium, 112 sulphur, 366 Prepared chalk, 114 Pride of China, 90 Protiodide of mercury, 275 Protonuclein, 291 Prunus Virginiana, 333 | Prussic acid, 220 INDEX OF DRUGS. Pseudomorphine, 296 Pulvis amygdala? compositus, 60 antimonialis, 71, 75 aromaticus, 130, 163 catechu compositus, 134 cinnamomi compositus, 163 creta? aromaticus, 114 compositus, 114 cum opio, 114 effervescens compositus, 351 elaterini compositus, 191 glycyrrhiza? compositus, 255, 352 ipecacuanha? compositujjf 239 et opii, 239, 303 jalapa? compositus, 247 kino compositus, 248 morphina? compositus, 304 opii, 303 compositus, 303 rhei compositus, 336 scammonii compositus, 349 soda? tartaratae effervescens, 351 Pumpkin-seed, 311 Punch, milk-, 57 Punk, 53 Purging cassia, 131 Purified aloes, 61 ox-gall, 305 sulphide of antimony, 71 Pyoktanin, 376 ~ --. Pyrogallic acid, 333 Pyrogallol, 333 Pyrophosphate of iron, 245 QUASSIA, 333 Quassia? lignum, 333 Queen's root, 361 Quercus alba, 334 Lusitanica, 206 tinctoria, 334 Quevenne's iron, 240, 245 Quicksilver, 261 Quiuicine, 156 Quinidina? sulphas, 162 Quininae bimuriatica carbamas, 162 bisulphas, 161 hydrobromas, 161 hydrochloras, 161 sulphas, 161 valerianas, 161, 384 Quinine, 156 chocolates, 161 RASPBERRY, 338 Rectal medication, 21 Rectified spirit, 58 Red cinchona, 156 iodide of mercury, 270 oxide of mercury, 275 precipitate, 275 ointment, 275 rose, 338 wine, 58 Reduced iron, 240, 245 Reliability and strength of drugs, 29 Remedial measures other than drugs, Remedy, cold as a, 401 Resin, 334 cerate, 334 ointment, 334 | Resin plaster, 254, 334 Resina, 334 jalapa?, 247 podophylli, 330 scammonii, 349 Resorcin, 335 Rest cure, 433 Restorative beef-essence, 450 Revulsives, 35 Rheum, 336 radix, 336 Rhigolene, 336 Rhubarb, 336 Rhus aromatica, 337 glabra, 337 Rice-water, 450 Roborants, 35 Rochelle salt, 337 Rosa centifolia, 337 gallica, 338 gallica? petala, 338 Rose-water, 337 Rosin, 334 Rottlera, 248 Rubus idaeus, 338 Rue, 338 Rules for dosage, 25 Rum, 58 Russian bath, 425 n ABINA, 348 U Saccharated carbonate of ir iodide of iron, 244 pepsin 314 solution of lime, 116 Saccharin, 338 Saccharum, 364 lactis, 364 Sal prunella, 281 Salicylate of bismuth, 98 of lithium, 256 of mercury, 275 of methyl, 207 of physostigmine, 322 of sodium, 344 Salicylic acid, 339 ointment, 343 Salol, 344 Salophen, 345 Salt, 356 Saltpetre, 281 Salts, 260 Sandalwood, 345 oil, 345 Sanguinaria, 346 Santonin, 346 Santoninate of sodium, 347 Santoninic acid, 346 Santoninum, 346 Sapo, 354 duris, 354 mollis, 354 Sarsa? radix, 348 Sarsaparilla, 348 Savine, 348 Scammonium, 349 Seammony, 349 Schleich's fluid, 167 Scilla, 359 Scillin, 359 Sdllipikrin, 359 j Scillitoxin, 359 728 INDEX OF DRUGS. Sclerotinic acid, 192 Scoparii cucumina, 350 Scoparin, 350 Scoparius, 350 Scopolamine, 349 Seidlitz powder, 337, 351 Senega, 351 Senega? radix, 351 Senna, 352 Aiexandrina, 352 Indica, 352 Serpentaria, 353 rhizoma, 353 Sherry, 58 Silicate of potassium, 353 of sodium, 353 Sinapis alba, 279 alba? semina, 279 nigra, 279 nigra? semina, 279 Sinapisma, 280 Slaked lime, 116 Smooth sumach, 337 Snake-weed, 203 Soap, 354 liniment, 118, 354 plaster, 354 Socotrine aloes, 60 Soda, 134 caustiea, 134 tartarata, 351 Sodii acetas, 356 arsenas, 86 bicarbonas, 356 boras, 99 bromidum, 107 chloridum, 356 hyposulphis, 357 iodidum, 230 phosphas, 318 et potassii tartras, 337 salicylas, 344 santoninas, 347 sulphas, 347 Sodio-theobromine salicylate, 354 Sodium, 355 chloride, 356 ethylate, 356 hyposulphite, 357 iodide, 230 sulphate, 357 Soft petrolatum, 315 Solanum Carolinense, 357 Soluble glass, 353 Solution of acetate of ammonium, 66 of iron, 246 of morphine, 304 of ammonia, 66 of arsenate of potassium, 86 of sodium, 86 of arsenous acid, 86 of carbonate of magnesium, 259 of chloride of zinc, 389 of chlorinated lime, 142 of chromic acid, 155 of citrate of ammonium, 69 of bismuth and ammonium, 97 of iron, 243 of potassium, 332 of hydrochlorate of morphine, 305 of iodide of arsenic and mercury, 86 Solution of iodine, 234 of lime, 116 of nitrate of mercury, 274 of pepsin, 314 of perchloride of mercury, 270 of permanganate of potassium, 314 of potassa, 256 of soda, 134 of subacetate of lead, 253 of sulphate of atropine, 95 of morphine, 304 of tersulphate of iron, 87 Somnal, 358 Sozoiodol, 358 Spanish fly, 122 Sparteine, 350 Sphacelinic acid, 192 Spice plaster, 416 Spigelia, 358 Spinal extracts, 210 Spirit of Mindererus, 66 of turpentine, 380 Spiritus astheris compositus, 216 nitrosi, 370 ammoniae, 66 aromaticus, 66 fcetidus, 66 cajuputi, 112 camphorae, 118 chloroformi, 154 cinnamomi, 163 frumenti, 58 gaultheria?, 207 glonoini, 287 juniperi, 248 compositus, 58, 248 menthae piperita?, 312 myristica?, 291 odoratus, 58 phosphori, 321 rectificatus, 58 vini gallici, 58 Springs, mineral, 435 Squill, 359 Squirting cucumber, 191 Starch, 360 poultice, 360 water, 360 Stillingia, 361 Stramonii folia, 361 semen, 361 Stramonium, 361 Strength, relative, of drugs, 29 Stronger water of ammonia, 65 Strontium, 362 bromide, 362 iodide, 362 lactate, 362 phosphate, 362 Strophanthin, 363 Strophanthus, 363 Strychnina? sulphas, 295 Strychnine, 292 hydrochloride, 295 Styptic collodion, 174 Subcarbonate of bismuth, 97 Subgallate of bismuth, 98 Sublimed sulphur, 366 Subnitrate of bismuth, 97 Subsulphate of iron, 240, 244 Succinum, 63 INDEX OF DRUGS. 729 Succus belladonnae, 96 conii, 176 hyoscyami, 224 limonis, 164 scoparii, 351 taraxaei, 373 Sugar, 363 of lead, 252 of milk, 364 Sulphate of aluminum, 62 of ammonium, 69 of atropine, 91, 95 of calcium, 112, 114 of cinchonidine, 162 of cinchonine, 162 of copper, 178 of hyoscyamine, 224 of iron, 240, 245 and ammonium, 240 of magnesium, 260 of manganese, 260 of morphine, 304 of physostigmine, 322 of quinidine, 162 of quinine, 161 of sodium, 357 of sparteine, 350 of strychnine, 295 of zinc, 389 Sulphide of ammonium, 69 of antimony, 71 Sulphocarbolate of sodium, 364 of zinc, 364 Sulphonal, 365 Sulphur, 366 lotum, 366 ointment, 367 pra?cipitatum, 366 sublimatum, 366 Sulphurated antimony, 71 lime, 116 Sulphuric acid, 368 Sumach, smooth, 337 sweet, 337 Sumbul, 369 pill, Goodell's, 369 radix, 369 Suppositoria belladonnae, 95 acidi tannici, 372 asafcetida?, 89 glycerinae, 211 iodoformi, 237 morphinae, 305 plumbi composita, 253 Suppositories, 22, 25 Suprarenal gland, 369 Suspension, 440 Swamp hellebore, 385 Sweet almonds, 59 spirit of nitre, 370 sumach, 337 Sydenham's laudanum, 303 Syrupus acacia?, 43 acidi citrici, 164 allii, 59 amygdala?, 60 calci lactophosphatis, 113 chloralis, 138 codeina?, 169 ferri bromidi, 211 iodidi, 243 phosphatis, 245 Syrupus ferri, quininae et strychninae phos- phatum, 245 hypophosphitum, 113 cum ferro, 244 ipecacuanha?, 239 limonis, 164 picis liquids?, 329 pruni Virginiana?, 333 rhei, 336 aromaticus, 336 rosa?, 338 rubi idaei, 338 sarsaparilla? compositus, 348 scillae, 360 compositus, 75, 360 senega?, 351 senna?, 352 zingiberis, 209 TABELL^E TRINITRINI, 287 Tablets, 25 of nitroglycerin, 297 Taeniin, 183 Taka-diastase, 184 Tamarinds, 371 Tamarindus, 371 Tanacetum, 372 Tannate of quinine, 161 Tannic acid, 371 Tansy, 372 tea, 372 Tar, 328 ointment, 329 water, 329 Taraxacum, 373 Tartar emetic, 71 Tartaric acid, 373 Tartrate of antimony and potassium, 71 of iron and ammonium, 243 and potassium, 243 of potassium and sodium, 337 Terebene, 373 Terebinthina, 380 Terpine hydrate, 374 Terpinol, 3<4 Testicular juice, 210 Tetronal, 380 Thapsia, 374 Thebaine, 296 Theine, 110 Theobromine, 249, 354 Therapeutical considerations, general, 17 nihilism, 17 Therapeutics, definition of, 18 Thiol, 375 Thiolum liquidum, 375 siccum, 375 Thiosinamine, 375 Thiosulphite of sodium, 357 Thorough wort, 203 Thymol, 376 iodide, 376 Thymus gland, 377 Thyroid gland, 377 Thyreoidine, 379 Tinctura aconiti, 52 aloes, 62 et myrrha?, 62, 280 arnica?, 83 florum, 82 radicis, 82 730 INDEX OF DRUGS. Tinctura asafcetida?, 89 belladonna? foliorum, 95 benzoini, 96 composita, 96 bryonia?, 108 buchu, 109 calumba?, 115 camphorae composita, 118, 303 cannabis indicae, 122 cantharidis, 123 capsici, 125 cardamomi, 130 composita, 130 catechu, 134 composita, 133 chiratae, 135 chloroformi et morphina?, 154, 305 cimicifugae, 156 cinchonae, 163 composita, 163, 353 cinnamomi, 163 colchici seminis, 173 conii, 176 convallariae, 177 cubebae, 183 digitalis, 189 ferri chloridi, 242 perchloridi, 242 galla?, 206 gelsemii, 208 gentiana? composita, 209 guaiaci, 213 ammoniata, 213 huruuli, 219 hydrastis, 219 hyoscyami, 224 iodi, 234 ipecacuanha? et opii, 303 jaborandi, 327 jalapae, 247 kino, 248 lobeliae, 257 aetherea, 258 lupuli, 219 moschi, 279 myrrhae, 280 nucis vomicae, 295 opii, 303 ammoniata, 303 camphorata, 303 deodorata, 303 physostigmatis, 322 podophylli, 330 pruni Virginiana?, 333 quassia?, 334 quinina? ammoniata, 163 rhei, 337 aromatica, 337 dulcis, 337 sanguinariae, 346 scilla?, 360 senegae, 352 senna?, 353 serpentaria?, 353 stramonii, 362 strophanthi, 363 sumbul, 369 Valerianae. 383 ammoniata, 383 veratri viridis, 386 zingiberis, 209 Tinctures, 25 Tonics, 35, 40 Touchwood, 53 Transfusion, 441 Tribromethane, 107 Trichloracetic acid, 379 Trikresol, 379 Trinitrin, 287 Trinitrophenol, 323 Trional, 380 Triturates, 25 Trituratio elaterini, 19.1 Troches, 25 Trochisei acidi benzoici, 96 carboliei, 129 tannici, 372 bismuthi, 97 catechu, 134 creta?, 114 cubeba, 183 eucalypti, 202 ferri redacti, 245 glycyrrhizae et opii, 256 guaiaci, 213 ipecacuanha?, 239 magnesia?, 258 mentha? piperita?, 312 morphina?, 304, 305 et ipecacuanha?, 305 potassii chloratis, 141 santonini, 347 sodii santoninatus, 347 zingiberis, 209 Tropic acid, 217 Tropine, 217 Tully's powder, 304 Turkish bath, 423 home modification of, 425 Turpentine, 380 liniment, 382 ointment, 382 stupe, 381 Turpeth mineral, 276 NGUENTUM ACIDI CARBOLICl, 129 gallici, 206 salicylici, 343 taunici, 372 aconitina?, 52 antimonii tartarati, 75 aquae rosae, 337 atropinae, 95 belladonna?, 95 cantharidis, 123 capsici, 125 cetacei, 96 chrysarobini, 155 cocaina?, 168 creasoti, 181 eucalypti, 202 galla?, 206 cum opii, 206 hydrargyri, 273 ammoniati, 268 iodidi rubri, 270 nitratis, 275 dilutum, 275 oxidi flavi, 275 rubri, 275 subchloridi, 273 iodi, 334 INDEX OF DRUGS. 731 Unguentum iodoformi, 236 mezerei, 279 petrolei, 315 picis liquidae, 329 plumbi acetatis, 253 carbonatis, 253 iodidi, 253 potassii iodidi, 230 resinae, 334 stramonii, 362 sulphuris, 367 terebinthina?, 382 veratrina?. 384 zinci oxidi, 305 Unna's dressing, 306 Ursin, 383 Uva ursi, 383 Uvae ursi folia, 383 VALERIAN, 383 \ Valeriana? rhizoma, 383 Valerianate of ammonium, 69, 384 of iron, 245. 384 of quinine, 161, 384 of zinc, 384 Valerianic acid, 383 Vallet's mass, 242 Vapor acidi hydrocyanici, 222 chlori, 142 conii, 176 Vaseline, 315 Vasomotor depressants. 35, 41 stimulants, 35, 41 Venesection, 444 Veratri viridis rhizoma, 385 Veratrina, 384 Veratrine ointment, 384 Veratroidine, 385 Veratrum viride, 3S5 Vienna paste, 387 mixture, 153 Vinegar, 48 of lobelia, 258 of opium, 303 of sanguinaria, 346 of squill, 360 Vinegars, 24 Vinum album, 5s antimoniale. 75 antimonii, 75 colchici, 173 radicis, 173 seminis, 173 ergotae, 194 ferri, 246 amarum, 246 citratis, 246 ipecacuanhae, 239 opii, 303 picis, 329 portense, 58 quininae, 163 rubrum, 58 xericum, 58 Virginia snake-root, 353 WAHOO, 202 H AA'arburg's tincture, 387 Warming plaster, 123, 328 Wash, black, 270 yellow, 276 Washed sulphur, 366 A\rater of chloroform, 154 Watered toast, 452 Wet pack, 426 Whiskey, 58 White ginger, 209 lead, 253 mustard, 279 oak, 334 precipitate, 268 ointment, 268 wine, 58 Whytt's tincture, 163 Wild cherry, 333 Wine, 58 of antimony, 75 of citrate of iron, 246 of colchicum-root, 173 of colchicum-seed, 173 of ergot, 194 of iron, 246 bitter, 246 of ipecac, 239 of opium, 303 of tar, 329 whey, 57, 451 Wines, 25 Wintergreen, 207 Witch-hazel, 215 Wormseed, 135 VANTHOPUCCINE, 219 \7ELLOW CINCHONA, 156 1 gentian, 208 iodide of mercury, 275 jasmine, 207 oxide of mercury, 275 prussiate of potassium, 178 pyoktanin, 276 sulphate of mercury, 276 wash, 276 Young's rule for dosage, 26 ZINCI ACETAS, 388 carbonas, 388 praecipitatus, 388 chloridum, 388 oxidum, 305 venale, 305 phosphidum, 318 sulphas, 389 sulpho-carbolas, 364 as an antiseptic, 397 valerianas, 384 Zingiber, 209 INDEX OF DISEASES AND REMEDIES. ABORTION, 453 Cascara sagrada, or compound liquorice powder, as a laxative for associated con- stipation ; if these fail, rhubarb or castor oil, 453 Creolin (2 per cent, solution), should be in- jected after removal of the membranes, or if fever should follow, 455 Curettement, 455 Diet and hygiene, 453 Elaterium, jalap, seammony, strychnine, erigeron, cantharides, contraindicated, unless very necessary, 453 Ergot and quinine, in small doses, with perfect Test for one or two weeks, and antiseptic irrigation as an after-treat- ment, 455 Iodine, applied to the inner surface of uterus, after removal of membranes, as a hemostatic and antiseptic, 455 Opium or morphine, best agents to quiet uterus if abortion threatens, 454 Podophyllin, senna, salines in active doses, and aloes, not to be used if they can be avoided, 453 Quinine, useful in malarial poisoning, as a preventive; in other cases contraindi- cated, 454 Saline purges contraindicated, except in plethoric women, 453 Sponges should not be used as tampons, 454 Tampons of absorbent cotton, dusted with iodoform, followed later by ergot, if abortion is inevitable, 454 Venesection useful in plethoric women to prevent. 454 A'iburnum prunifolium, fluid extract, drachm 1 to 1| (4.0-6.0), taken during pregnancy as a prophylactic, 454 ABSCESS, 455 Aconite or veratrum viride, in full dose, often aborts, 455 Alcohol, given with milk, in cold abscess, 456 Belladonna ointment, locally applied to abort; or tincture, internally, if aconite is not at hand, 455 Calx sulphurata, gr. ^ (0.006) every hour or two, useful to abort or cause absorp- tion, 455 Carbolic acid, minims 5 to 10 (0.3-0.65) of 2 per cent, solution, injected into gland threatening suppuration, 455 Cod-liver oil with hypophosphites, quinine, and iron, useful in cold abscess, 456 Hydrogen peroxide, 10 per cent, solution, to wash out cavity of tubercular or slow abscess, 223, 456 Incision, if pus forms, followed by irriga- tion with carbolic acid (1 : 20) or bichlo- ride solution (1: 5000) and antiseptic dressing, 456 Iodine, locally applied, may abort, 455 Iodoform gauze, packed into cavity, or ethereal solution injected after aspira- tion, and antiseptic dressing, useful in tubercular abscess, 456 Lead-water, applied on bread-crumb poul- tice or lint, in early stage, to abort, 455 Nitrate of silver, gr. 20 to 40 (1.3-3.0) to the ounce, locally applied, may abort, 455 Poultices to assist maturation, 456 Prescriptions for tonics, in cold abscess, 456 ACIDITY. Ammonia, the most active remedy in gas- tric acidity, contraindicated if acute ir- ritation exists, 65 Bicarbonate of sodium, in form of effer- vescing powder, valuable in gastric acidity, 356 Bismuth a slow and feeble antacid, 97 Carbonate of calcium, precipitated, best antacid in intestinal acidity, 112 Cerium oxalate, used in some cases of gas- tric acidity instead of bismuth, 134 Charcoal useful in some cases of " sour stomach," 129 Lime-water. 116 Liquor potassa? useful both for gastric and urinary acidity, 256 Magnesium a useful antacid, 259 ACNE, 457 Calx sulphurata, gr. & to $ (0.006-0.008) in pill, thrice daily, in pustular acne, 116, 457 Carbolic acid touched to pustules, after in- cision, 457 Cod-liver oil, if scrofulosis exists, 457 Fowler's solution often cures and prevents relapse, dose gtt. 1 to 3 (0.05-0.15) thrice daily for a month or two, 457 Green or Castile soap used in face-bath night and morning, followed by brisk rubbing; if irritation ensues, simple cerate or emulsion of bitter almonds will relieve, 457 Ichthyol, 20 parts to 100 of lard, well rubbed in, when induration is great, 226, 457 Mercurial ointment, to relieve induration, 733 734 INDEX OF DISEASES AND REMEDIES. several days intervening between its use and that of sulphur, 457 Phosphorus especially useful in acne indu- rata, 321 Resorcin, gr. 10 to 20 to the ounce (0.65- 1.3:32.0) of lard, when induration is great, 457 Saline purges, followed by cascara sagrada or similar remedy, to regulate bowels, if dependent upon obstinate constipa- tion, 457 Sulphur internally and as a wash or oint- ment for women with disordered men- struation, prescription for, 367, 457 ADDISON'S DISEASE. Suprarenal gland, 369 ADENITIS, 458 Ichthyol, prescription for, 458 Iodine ointment and lard, equal parts, ap- plied by inunction night and morning, or tincture, as a paint, stopping applica- tion on appearance of redness or fluctu- ation, 458 Iron, syrup of the iodide, gtt. 5 to 20 (0.3- 1.45) in children, 458 Lancing preferable to allowing abscess to break, 458 Poultice, when redness or fluctuation ap- pears, 458 Removal of gland by dissection, if enlarge- ment is scrofulous, 458 Tonics, to improve systemic condition, 458 ALBUMINURIA. (See Bright's Disease.) Gallic acid, if due to atony of kidneys, 206 Strontium lactate, if due to renal atony, 362 ALCOHOLISM. (See Poisoning from Alcohol.) ALOPECIA, 458 Chrysarobin, drachm £ to 1 (2.0-4.0) to lan- olin 1 ounce (32.0), 459 Corrosive sublimate, gr. 2 to 5 (0.1-0.3) to rectified spirit 1 drachm (4.0) and oil of turpentine 7 drachms (28.0), 459 Liquor epispasticus painted over bald spot after loose hairs have been depilated, 458 Pilorcarpine, locally applied, often stimu- lates new growth ; too much causes small pustules around follicles; pre- scription for, 326 AMBLYOPIA AND AMAUROSIS, 459 Antipyrin, 460 Bromide of potassium, 460 Cauterization of nape of neck, 459 Correction of optical errors, when arising from congenital trouble or uon-use, 459 Cups, wet and dry, 459 Digitalis in toxic cases, 460 Electricity, constant current, 459 Emmenagogues, if due to menstrual dis- orders, 459 Fly-blister to temple in some cases, 459 Iodide of potassium, 459 Lactate of zinc, 460 Mercury, when due to syphilis, 459 Metallo-therapy, may be tried in hysterical cases, 459 Nitrate of silver, 460 Nitrite of amyl, inhalations, 460 Nitro-glycerin, 460 Nux vomica in ascending doses in tobacco or alcoholic cases, 294 Phosphorus, 460 Pilocarpine, in uraemic, tobacco, or alcohol amaurosis, 325, 459 Salicylates, 460 Stretching the optic nerve, 460 Strychnine, hypodermically, after irrita- tion has subsided, 459, 460 Suspension, and injections of testicular juice, 460 AMENORRHEA, 460 Aloes, as a specific, when dependent upon constipation, atony of sexual system, or anaemia, 61, 461 Apiol, 3 to 10 minims (0.15-0.64) in capsule thrice daily for a week before date of meustruation, 80, 461 Arnica, 82 Binoxide of manganese, gr. 1 to 3 (0.05- 0.15), taken for two weeks before time of menstruation, 260, 461 Cantharides, as a stimulant, if due to atony or depression, 122 Cimicifuga, fluid extract, gtt. 30 (2.0), at the proper time for a flow, 156, 461 Dewees's emmenagogue mixture, 461 Eupatorium, in hot infusion, if due to cold, 203 Goodell's prescription for, 461 Griffith's pills, largely used when depend- ent upon anaemia, 242 Hot sitz-bath, for several nights before period; mustard added often increases its efficacy, 461 Iron and myrrh, a standard remedy if due to atony or anaemia, 2»0, 461 Oil of rue, gtt. 5 (0.3), in capsule, thrice daily, 461 Potassium permanganate, useful, but infe- rior to binoxide of manganese, 314, 461 Salines inferior to aloes if due to constipa- tion, 461 Savine, gtt. 5 (0.3), in capsule, thrice daily, to stimulate uterus, 348, 461 Tansy, gtt. 5 (0.3), in capsule, thrice daily, or in form of tansy tea, 461 ANEMIA, 461 Aromatic mixture of iron, 241 Arsenate of iron in anaemia of chronic diarrhoea, 241 Arsenic, not to exceed gr. ^ (0.004) daily, alone or combined with iron, valuable, 465; very valuable in pernicious and malarial anaemia, 84 Arsenite of copper, 179, 465 Beta-naphthol, when due to intestinal in- digestion, 464 Bitters, simple or aromatic, in conjunction with iron, when stomach and intestines are atonic, 464 Blaud's pill, 464 Bromide of iron, gr. 5 to 20 (0.3-1.3\ in syrup, useful when there is chorea, 241 Bullock's blood, fresh or dried, given by enema when iron fails, 465 Carbonate of iron, 464 INDEX OF DISEASES AND REMEDIES. 735 Chloride of iron, useful because of its tonic properties, 242 Dialyzed iron, 243 Diet and hygiene, 465 Hypophosphites and phosphate of lime, with cod-liver oil, iron, and quinine, when anaemia is due to childbearing and lactation, 114, 464 Iodide of irou, syrup of, largely used in strumous and scrofulous anaemias, 243 Iron, 239, 462 Mercury bichloride or calomel, especially valuable, in syphilitic cases. Inunctions of mercurial Ointment, once a day or every other day, of service in all forms of anaemia, 269, 464 Oxygen inhalations of value, 307 Quevenne's iron, 464 Quinine in malarial cases, and in tonic doses in all other anaemias, 464 Reduced iron, with laxatives and mineral acids for their effects on intestines and liver, in uncomplicated cases, 464 Salol, when due to decomposition products, 464 Sulphate of iron or some other astringent preparatiou in conjunction with mild purges, when tongue is broad, flabby, and white, 464 Suprarenal gland useful in pernicious type, 369 ANAL FISSURE, 465 Carbolic acid, 1 drop (0.05), applied to fis- sure to effect cure; in addition when hemorrhoids are present, a lotion of tannic acid, glycerin, and water, 466 Castor oil, to relieve bowels if sulphur can- not be used, 466 Flexible collodion painted over spot, may relieve, 466 Iodoform suppositories, gr. 2 to 10 (0.1- 0.65), relieve pain of defecation; bella- donna, gr. \ (0.016), to be added when there is spasm of sphincter, 466 Potassium bromide, drachms l£ to the ounce (6.0:32.0) of glycerin, locally ap- plied to fissure by means of a brush, highly recommended, 466 Sulphur, 20 to 40 grains (1.3-2.6), combined with powdered cinnamon or aromatic powder, at night to render passages soft, 466 ANEURYSM, 466 Aconite, inferior to veratrum viride as a cardiac sedative, 466 Chloroform inhalation if dyspnoea is great, 467 Digitalis, contraindicated, 466 Iodide of potassium, in large doses, asso- ciated with restricted diet and rest in bed; more valuable in syphilitic than in other forms of the disease, 229, 466 Morphine, gr. i (0.08), combined with chloral or better with croton chloral, gr. 10 (0.65), in sleeplessness due to pain, 467 Veratrum viride, gtt. 1 to 2 (0.05-0.1), twice or thrice daily if heart is excitable and vascular tension high, 386, 466 ANGINA PECTORIS, 467 Aconite, useful between attacks, 468 Alcohol, instead of nitrites, when there is vascular relaxation, 467 Antipyrin, gr. 20 (1.3), valuable in some cases, 467 Arsenic, in full dose long continued, and elimination of causes of nerve-storm, 468 Cactus grandiflorus, in some cases, 110 Digitalis, when heart is weak, 467 Ether, in 1-drachm (4.0) doses in ice-water or capsule, to nervous females, often aborts, 468 Hoffmann's anodyne, often the best rem- edy, 467, 217 Morphine, gr. \ to \ (0.016-0.03) hypoder- mically, when nitrite of amyl fails to relieve, 468 Nitrite of amyl, inhalation of a few drops from handkerchief during attack, 70, 467 Nitrite of sodium or potassium, gr. 3 (0.15), thrice daily, useless unless arterial ten- sion is high and heart throbbing, 286, 467 Nitro-glycerin, gtt. 1 (0.05) of a 1 per cent. solution during attack, 287, 467 Phosphorus, gr. TJ^ (0.0006), after meals, often of value, 468 Prescription for use between attacks, 468 Stomach-pump may be required when due to overloaded stomach, 468 Tonics combined with careful diet and hy- giene necessary to a cure, 468 ANOREXIA, 468 Calomel, useful when following acute dis- ease ; nitro-muriatic acid, however, gen- erally preferable, 272 Capsicum, in convalescence, acts most fav- orably, 124 Chimaphila, in dropsical patients, as a tonic and diuretic, 135 Eupatorium useful in, 203 Gentian, 208 Prescriptions for tonics, 468 Quassia, especially valuable when follow- ing malarial fever, 334 APOPLEXY, 469 Belladonna, hypodermically, if respiration fail, 470 Croton oil, gtt. 1 (0.05) with sweet oil gtt. 5 (0.3), as a depletant cathartic, 469 Diet, 470 Elaterium, gr. i (0.01), as a depletant cathartic, 469 Ice to the head, 469 Iodide of potassium, in large doses several clays after attack, when clot has firmly formed, to promote absorption, 469 Massage and electricity, applied to muscles to prevent atrophy ; contraindicated if inflammation exist, 469 Mercury, 469 Mustard plaster to feet, or mustard foot- bath and ice to head, keeping head high and feet low, 469 Opium and calomel, gr. \ (0.016) of each every four hours, if meningitis arise, 469 * 736 INDEX OF DISEASES AND REMEDIES. Stimulants contraindicated, 470 Strychnine, hypodermically, if respiration fail; is also useful to stimulate trophic centres in cord, 470 Venesection, if patient is full-blooded, to prevent inflammation and further leak- age, 469 Veratrum viride or aconite, when venesec- tion is impossible, to lower blood-press- ure, 469 APPENDICITIS, 470 Absolute rest necessary, 470 ' Ice-bag or leeches, applied to appendicular region, 470 Magnesium sulphate or citrate, 471 Opiuru or morphine (after the bowels have moved), to relieve pain and act as an antiphlogistic, 471 Surgical treatment, 471 ARTHRITIS. Bicarbonate of sodium, applied to part on lint, to allay pain, 356 Lithium carbonate and citrate, prevent deposit in joints from rheumatoid ar- thritis, 256 Mustard plaster, as a counter-irritant, 279 Veratrine ointment, 384 ASCARIS LUMBRICOIDES. (See Worms.) ASCITES. (See Dropsy.) ASPHYXIA, 471 Ammonia, injected intravenously into leg to stimulate heart and respiration, 65 Artificial respiration. Sylvester's method, 471 Electricity, only to be used as a peripheral irritant to restore respiration, 472 Laborde's lingual traction of great value, 472 Oxygen inhalations, 307 Rules regarding position of patient, 472 ASTHENOPIA, 472 Cannabis indica, in retinal asthenopia, pre- scription for, 121 Eserine or pilocarpine, weak solution, as a stimulant to ciliary muscles, 473 Glasses, combined with prisms if necessary, to correct optical defects, 472 Hot compresses, 473 Massage, rest, salt baths, strychnine, and iron, if due to neurasthenia, 473 Strychnine or tincture of nux vomica in large doses, to stimulate ciliary muscles, 473 ASTHMA, 473 .Aconite, in early stages, 51 Arsenic, internally or smoked in cigarettes, best remedy when mucous membrane is at fault, 85, 476 Belladonna, combined with morphine, very useful, 94, 474 Bromide of potassium or sodium, gr. 30 (2.0), half an hour before retiring, 476 Bronchitis-tent, 476 Chloral, rarely useful; if pushed, danger- ous, 138 Chloroform, inhaled, relaxes spasm ; also useful in form of liniment applied to chest, to abort, 154, 474 Cocaine, applied to nasal cavities, if due to nasal disorders, 476 Coffee, a cup of strong black, during parox- ysm, 111, 475 Compressed and rarefied air, 476 Diet and hygiene, 476 Ethyl iodide, to increase secretions and prevent thickening, 201 Euphorbia pilulifera, \ to 1 drachm (2.0- 4.0) of the fluid extract, 203, 475 Gelsemium, 208 Grindelia, fluid extract of, gtt. 20 to 60 (1.3-4.0), or leaves soaked in nitre smoked as cigarettes, or fumes of burn- ing leaves inhaled, exceedingly useful, 212, 476 Iodide of potassium, useful in bronchial, harmful in gastric type, 229, 476 Lobelia, tincture gtt. 10 (0.65) every four hours, if attack threaten ; in emetic dose if heart be strong, when spasm is present, 257, 474, 475 Morphine, hypodermically, gr. \ to \ (0.01- 0.016), alone or combined with atropine, 474 Nitrate of potassium alone or combined with belladonna, in form of cigarettes or inhalations of fumes, often relieves, 281, 474 Nitrite of amyl, 3 to 6 drops (0.15-0.3) on handkerchief, inhaled with care, re- lieves spasm, 70, 475 Nitro-glycerin, serviceable if bronchial mu- cous membranes are engorged, 287, 475 Oil of amber, 63 Oxygen, inhalations when cyanosis is ex- treme, 476 Physostigma, in bronchial asthma, to aid in expelling mucus, 322 Sandalwood oil, useful in catarrhal cases, 346 Tobacco-smoking often efficacious in pa- tients not accustomed to it, 475 Zinc oxide, prescription for, 307 ATONY. Arsenic, in gastric and intestinal atony, 84 Calumba, valuable in gastro-intestinal atony following fevers, 115 Capsicum, one of the best remedies in gas- tric atony due to debility aud alcohol- ism, 124 Cardamom, with bitter tonics and mineral acid, in gastro-intestinal atony, 130 Chimaphila, useful as a stimulating diu- retic in atonic renal conditions, 135 Hydrastis, indicated in atony of mucous membranes, 219 Leptandra, in duodenal atony, 255 Lime salts, useful in atony of mucous mem- branes, 114 Pepper, in atony of genito-urinary mucous membranes, 311 Physostigma, in intestinal and vesical atony, 322 Strychnine, in intestinal atony, 294 AURAL VERTIGO. Pilocarpine, 326 INDEX OF DISEAS BALANITIS AND BALANO - POSTHITIS, 566 Astringent solutions, to cleanse parts, zinc chloride (gr. 4 to the ounce [0.2:32.0]), boric acid (1 per cent.), carbolic acid (1.5 per cent.); silver nitrate (gr. 1 to the ounce [0.05 : 32.0]) especially valu- able, 566 Lead-water, dilute, as a wet dressing, pre- ceded by astringent washes, in phimo- sis ; if inflammation increase, circum- cise, 567 Silver-nitrate stick, touched to ulcerations, 567 Tannin or zinc oxide, as a dusting powder, after retracting prepuce and cleansing parts, followed by returning prepuce over absorbent cotton, 567 BALDNESS. (See Alopecia.) BED-SORES, 476 Aloes, glycerole of, as a local application, 61 Alum, with spirit of camphor and white of egg, locally applied, to prevent, 477 Catechu, with lead subacetate, locally ap- plied, to harden skin, 477 Glycerin application daily, after washing and rubbing part, to prevent, 211 Incision, followed by irrigation, if sores tend to burrow, 477 Iron, tincture of chloride, gtt. 20 (1.3) every four hours as a tonic, 477 Nitrate of silver (gr. 20 to the ounce [1.3 : 32.0J), painted over threatening part, to abort. If ulcers form and are sluggish, same solution may be used, 284, 477 Salt and whiskey, rubbed over skin to harden it (drachms 2 to the pint [8.0: 500.0]), 477 Soap plaster, applied to sore after washing with bichloride solution (1:5000) and dusting with iodoform, 354, 477 Supportive measures and increased amount of food, if sloughs are large, 477 Zinc ointment, on squares of lint, sometimes used in lieu of soap plaster, 477 BILIOUSNESS, 477 Aconite, antagonizes the poisonous alka- loids which cause slow pulse, high arte- rial tension, etc., 480 Ammonium chloride, gr. 5 (0.3) thrice daily, if associated with catarrh, 480 Bromides and chloral, if nervousness and irritation are present, 480 Calomel, gr. J; (0.01) in powder every fifteen minutes until six are taken, followed in four hours by a saline, if stools be light. 272, 479 Chirata, extract of, gr. 5 (0 3), in hepatic torpor, prescription for, 480 Diet, 479 Euonymus, extract of, gr. 3 (0.15), 480 Horseback riding combined with gym- nastic movements especially valuable, 480 Ipecac, powdered, gr. 30 to 60 (2.0-4.0), or apomorphine, gr. & (0.004) hypoder- mically, may relieve in first stage, 479 ES AND REMEDIES. 737 Leptandra, where liver is torpid, 254 Mustard plaster or cup to nape of neck, if face is flushed; foot-bath also of service, 480 Nitro-muriatic acid, gtt. 3 (0.15), thrice daily in water, of great service, 288, 480 Opium, antagonizes the poisonous alkaloid which causes hot skin, rapid pulse, di- lated pupils, etc., 480 Podophyllin, gr. £ (0.01), if stools be dark, 479 Protiodide of mercury, gr. ^ to ^ (0.001- 0.0016), in trituration, thrice daily, if due to catarrh, 480 Salines, if attack is sudden, to sweep out poisonous matter, 479 Salol or salophen, in 10 gr. (0.65) doses, useful as an intestinal antiseptic, 480 Stillingia, fluid extract of, dose 20 drops (1.3), 480 BLEPHARITIS, 481 Boric-acid lotion when there is accompany- ing conjunctivitis, 481 Chloral, 5 per cent, solution, to remove scabs and crusts, 481 Creolin, 1 to 2 per cent, solution, useful as a wash, 182 Methyl blue, 276 Ointments, dilute citrine, Pagenstecher's (yellow oxide of mercury, 1 gr. [0.05], vaseline, 1 drachm [4.0]), pyrogallic acid, miik of sulphur (3 per cent.), lo- cally applied after removal of crusts, 481 Silver nitrate, touched to crater-like ab- scesses, gives good results, 481 Sodium bicarbonate or biborate solution, gr. 8 to ounce (0.5:32.0), to remove scabs and crusts, 481 BOILS, 481 Atomized sprays useful in, 23 Belladonna, locally applied to relieve pain and inflammation, 482 Calcium sulphurate hastens pointing and prevents formation of new ones; use- less in boils of diabetes, 116, 481 Camphorated alcohol, applied over boils in formative stage, then wiped dry, fol- lowed by camphorated oil, to abort, 118, 482 Carbolic acid, 5 per cent, strength, injected into apex of boil when formation is assured, to abort, 128, 482 Chloride of calcium, added to poultice, hastens maturation, 113 Collodion painted over inflamed spot, to abort, 174: if pus form, it may be ab- sorbed, if not, evacuate by incision, 481 Egg-shells baked and eaten, for successive crops, 116 Opium, locally applied to relieve pain and inflammation, 482 Phosphorus, 321 Poultices, containing sweet oil and lauda- num, to assist maturation, 482 Prescription for ointment, 482 Silver nitrate (gr. 20 to the ounce [1.3: 32.0]), painted over part, may abort, I 284, 481 47 738 INDEX OF DISEASES AND REMEDIES. BREATH, FETID. Camphor, as a mouth-wash, 117 BREASTS (INFLAMED), 482 Aconite or veratrum viride, to depress cir- culation, 466 Belladonna, internally or as an ointment, before and after inflammation, with cold compresses to breast, 93, 482 Breast-pump, if milk continues to form, 48:i Incise as soon as pus forms, 482 Pressure bandage with ice bag, 482 Purges, mild saline, 482 BONE DISEASE. Iodide of iron, syrup of, if anaemia exist, 232 Iodine ointment, diluted one-half, or tinc- ture, locally applied, 232 BROMIDROSIS. Belladonna, 93 Borax of great value, 100 Carbonate of calcium, precipitated, a useful application, 113 Salicylic acid, used as a dusting powder, prescription for, 342 BRONCHITIS, 482 Aconite, alone or combined with sweet spirit of nitre, in initial stage, 51, 483 Amber, oil of, and olive oil (1:3), applied to back and front of chest, in infantile bronchitis, 63 Ammoniac, useful in old forms devoid of inflammation, 66 Ammonium carbonate, alone or with the chloride, especially useful in children ; gr. 2 to 10 (0.1-0.65) in syrup of acacia, 67 Ammonium chloride, in second stage, to stimulate bronchial tubes, prescription for, 485 Apomorphine, gr. TV to \ (0.006-0.015), as an expectorant in subacute stage; if exudation accumulates rapidly, gr. -5*5 to ^ (0.003-0.006), hypodermically, as an emetic, 82, 487 Asafcetida as a stimulating expectorant, 88 Astringent sprays, often of value if secre- tion be excessive; tannic acid (gr. 2 to 4 to the ounce [0.1-0.15:32.0]), alum solution (a few grains to saturation). Monsel's solution (10 to 15 drops to the ounce [0.65-1.0:32.0]), lead acetate (gr. 1 to 5 to the ounce [0.05-0.3 : 32.0]), 487 Belladonna, to check excessive secretion and stimulate respiration, 487 Benzoic acid, 96 Bronchitis tent, 484 Caffeine, or strong coffee, to stimulate res- piration if suffocation threatens, 487 Camphor, in old or atonic cases, 117; lini- ment rubbed on chest, 483 Cimicifuga'in chronic bronchitis, 156 Codeine, recommended when cough is ex- cessive, 169, 486 Creosote, recommended in chronic bron- chitis, 180 Croton oil and sweet oil (half and half), sometimes applied to chest, 182 • Cubebs or copaiba, as expectorants, liable to derange stomach, 177, 183, 486 Digitalis, if heart be feeble, 487 Dover's powder, gr. 5 to 10 (0.30-0.65), with a hot drink, useful in early stage, 483 Ethyl iodide, 5 to 10 drops (0.3-0.65), in- haled from a handkerchief every few hours in the later stages to loosen secre- tions, 201, 486 Eucalyptus oil, valuable in later stages; dose, gtt. 1 to 5 (0.05-0.3), in capsule, every three hours, 202, 486 Euphorbia pilulifera J to 1 drachm (2.0- 4.0) of fluid extract in chronic bronchi- tis, 203 Flaxseed tea, a useful demulcent, 205 Gallic acid for profuse expectoration, 206 Grindelia, very useful in later stages, 212 Guaiacol vapor inhalations very valuable, 214 Hot foot-bath, with drinks of hot lemonade, in early stages, 483 Hypnal for cough, 225 Inhalations of steam from boiling water, to relieve bronchial soreness,when counter- irritation fails, 484 Iodine externally, 232 Iodide of potassium, often useful when ammonium salts fail, contraindicated if secretion is excessive, 229 Iodoform, to lessen cough and fetid dis- charge, 236 Ipecac, to unload stomach, 237; as a seda- tive expectorant, 238 ; to promote secre- tion in first stage, also as an emetic when exudation accumulates rapidly and suffocation threatens, 487 Myrrh, with expectorant mixtures, useful in later stages, 280 Oro-nasal respirator with terebene, iodide of ethyl, and chloroform, 486 Oxygen inhalations, when dyspnoea is great, 307, 487 Potassium citrate with ipecac, to aid in formation of secretion, prescriptions, 332, 483 Potassium cyanide for excessive cough, 184 Pyridine as an inhalant, 485 Resin, inhalations of fumes, 334 Sandalwood oil, in later stages, dose 5 to 10 minims, 346, 486 Sanguinaria, 346 Senega, a stimulating expectorant in sub- acute and chronic stages, 351 Squill, inferior to other drugs as an expec- torant, 360 Strychnine, to stimulate respiration, if suf- focation threatens, 487 Tar, 329 Tartar emetic, as an expectorant, gr. fa (0.001) hourly, or 1 drachm (4.0) of solu- tion (gr. 2 to the pint [0.1:500.0]), or as an emetic in sthenic cases, 74 Terebene, if ammonium chloride fails; dose, 5 to 10 minims (0.3-0.65), in cap- sule or emulsion; must be stopped if kidneys or stomach are irritated ; or used in an inhaler with equal parts of iodide of ethyl and chloroform, 373, INDEX OF DISEASES AND REMEDIES. 739 Terpine hydrate or terpinol useful, 374, 486 Turpentine, inhalations or applied to chest, for children, diluted one-half with sweet oil, 382 Water, hot and cold dashes, if death is imminent from suffocation, 487 BRONCHOCELE. Ointment of biniodide of mercury, useful in, 270 Potassium iodide internally, and tincture of iodine externally, 229 Thymus gland in, 377 BRONCHORRHCEA. Alum, solution gr. 20 to the ounce (1.3 : 32.0) ; applied in fine spray, 63 Gallic acid, 206 BRUISES. Alcohol, as a lotion, very useful, 55 Arnica, 82 Liquor plumbi subacetatis, locally applied ; strength 1 to 4 ounces to the pint (32.0- 128.0 : 500.0); contraindicated, if skin is broken ; also useful as lead-water and laudanum (water 16, lead-water 4, laud- anum 1), 253, 301 Warming plaster, 328 BUBO. Carbolic acid, solution (gr. 8 to the ounce [0.6:32.0]), 10-minim injections, pre- ceded by ether spray, 128 Incision, at first sign of suppuration, fol- lowed by washing with either bichloride solution (1 to 1000), hydrogen peroxide (A strength), or zinc chloride (gr. 40 to the ounce [2.5:32.0]), 495 Iodine, painted around spot, with compress and spica bandage, or hot bag over swelling, 491 BURNS AND SCALDS, 488 Anaesthesia, chloroform in, 489 Antipyrin in solution and ointment, 489 Bath in the treatment of, 488 Boric acid solution, a useful dressing, 100, 489 Calcium carbonate, precipitated, as a dress- ing, 113 Cantharides, tincture of (1:40), locally applied on lint if burn is not diffuse, 488 Carbolized sweet oil, cosmoline, or simple cerate, useful application to counter- irritation burns, 128 Cold cream, as a dressing, 338 Digitalis, in shock, if circulation fails to respond to less powerful stimulants, 488 Hypodermoclysis useful, 430 Ichthyol ointment, 226 Iodoform in ointment with other drugs in severe burns, 488 Lead carbonate, as an ointment, or, with linseed or other oils, as a dressing, 253 Lime-water and linseed oil, equal parts, the best dressing, 205. Carbolic acid is of service, added in proportion of 1 to 20, 488 Morphine and atropine, gr. I to i (0.016- 0.03) of former to gr. fa (0.001) of latter, to allay pain, 488 Picric acid the best dressing, 323, 488 Potassium citrate with sweet spirit of nitre, if urine is high-colored, 488 Poultice, applied to counter-irritation blis- ter, relieves pain ; when blister forms, puncture if large, allow to break if small, and dress with absorbent cotton 416 Salicylic acid, prescription for, 342 Sodium carbonate solution often relieves pain, 489 Stimulants, if shock is severe, 488 Zinc oxide, 305 CANCER (GASTRIC). Arsenic, small doses often repeated, to re- lieve vomiting and pain in gastric can- cer, 85 Condurango, in the dose of 1 drachm (4.0) of the fluid extract, 175 Hydrochloric acid, 220 CANCRUM ORIS. Arsenic internally, 85 Boric acid, as a mouth-wash, 100 CARBUNCLE. Carbolic acid, solution (gr. 8 to the ounce [0.6:32]), hypodermic injections, to abort, 128 Phosphorus, 321 CARIES. Lime salts, especially valuable in dental caries of nursing women, 114 CATARRH OF AIR-PASSAGES. (See Nasal Catarrh.) Alum solution (gr. 20 to the ounce [1.3: 32.0]), applied in flue spray, 63 Arsenic, internally, 84 Camphor, of service in old and atonic cases, 117 Sozoiodol, applied locally in 5 per cent. solution, 358 CATARRH OF BLADDER. Ammonium benzoate, to render urine acid, 66 Juniper, a valuable stimulant in chronic cases, 247 CATARRH OF UTERUS. Hydrastis, 219 Sozoiodol, in powder, applied by tampon, in catarrh of cervix uteri, 358 CEREBRAL DISEASES. Blisters, to nape of neck in cerebritis, 413 Croton oil, in cerebral congestion, 182 Elaterium, in cerebral congestion, 191 Phosphorus, often of service in cerebral softening, 321 Veratrum viride, of greatest value in cere- britis during stage of hyperaemia, after that period harmful, 386 CHANCRE. Nitric acid, used as a caustic, surrounding tissues being protected by oil, 285 740 INDEX OF DISEASES AND REMEDIES. CHANCROID, 489 Acetanilid, used in a dry powder, 47 Actual cautery, the most destructive caus- tic, 489 Benzoate of bismuth, 98 Bismuth and zinc oxide, or calomel and bismuth, are substitutes for iodoform, 490 Carbolic acid, as a wet dressing (gr. 5 to water oz. 1 [0.3:32.0]), 491 Cocaine, 20 per cent, solution to relieve pain of cauterization, 489 Hot sitz-bath or general warm bath, 490 Iodoform, the best dusting-powder after cauterizing, also useful as a palliative treatment, preceded by nitric acid wash (3j to water Oj [4.0:500.0]), in erosive chancroid, 490 Iodol or aristol, as a substitute for iodo- form, 490 Nitric acid, a good caustic, surrounding tissue being protected by oil, 285, 490 Salicylic acid in powder or ointment, 342 Sulphuric acid with charcoal, a good caustic and after dressing, 490 Tannin, combined with dusting-powder (1: 4), if discharge is profuse, 490 CHAPPING. Calcium carbonate, precipitated, as a local protective in intertrigo of infants, 112 Camphor, added to precipitated calcium carbonate, useful in intertrigo, 118 Carbonate of zinc, in infantile forms, pre- scription for, 388 Cold cream, a useful application, 337 Light magnesia, as a dusting-powder in in- tertrigo, 258 Lycopodium, as a dusting-powder, 258 Starch as a dusting-powder in intertrigo, 360 Zinc oxide, in powder form, useful in in- tertrigo, 306 CHILBLAINS. Alum, as a wash, 63 Capsicum, tincture, painted over parts or applied as a paper, prescription for, 125 Ceratum resinae, 334 Ichthyol ointment, 226 Iodine ointment and lard, equal parts, give great relief, 233 CHLOROSIS. (See Anaemia.) CHOLERA (ASIATIC), 491 Camphor in the form of camphorated wine, of the greatest service in controlling cramps, 492 Enemata of warm salt solution (3j to Oj [4.0 to 500.0]), highly recommended by Italian observers, 493 Enteroclysis, associated with hot baths, very valuable, 419 Ether, subcutaneously, as a diffusible stim- ulant, 493 Hypodermoclysis, very useful, 493 Opium, 492 Purgatives, contraindicated, unless bad food has been taken, 492 Quarantine, and strict hygiene, as a pro- phylactic, 491 Salol and salophen, 492 Sulithuric acid, with camphor, to control diarrhoea, 368, 493 Tannic acid, by enemata (3j-viij to Oj [4.0-32.0:500.0]), 493 CHOLERA INFANTUM, 494 Arsenic, to check vomiting, prescription for, 496 Beef-juice, as a food especially valuable, 494 Brandy, if vomiting is active and collapse threatens, a few drops to drachm (4.0) of nourishment, 494 Castor oil, with paregoric to empty bowels and allay irritation, 494 Cold drinks, cracked ice, and antipyretics, if rectal temperature is above normal, 494 Diet,. 494 Enteroclysis, very valuable, 496 Hot drinks, applications and baths if rectal temperature is subnormal, temperature being watched, 494 Iodoform and oil injections to relieve tenes- mus, 236 Irrigation of bowels, 496 Laudanum, gtt. 10 (0.65) and starch-water, oz. 2 (64.0), by enema, and calomel gr. ■fa (0.005) or gray powder gr. \ (0.01) by mouth, to control vomiting and purg- ing, if severe, 496 Mustard or spice plaster, over belly, always useful, 495, 496 Podophyllin, if stools are of peculiar pasty color, 495 Predigested milk or beef-juice, the best food, 495 Prescriptions for, 495 CHOLERA MORBUS, 497 Camphor, 117 Castor oil, with laudanum, to sweep out intestines, before diarrhoea mixture is used, 497 Ipecac, gr. 3 (0.15) every two hours, often of service, 238 Morphine and atropine if pain is severe, 497 Mustard or capsicum plaster, over abdo- men, 497 Prescription for, 497 Salol, prescription for, 345 CHORDEE, 563 Aconite, often relieves, 51 Belladonna internally, and ointment ap- plied to under surface of penis, 94 Bromide of potassium, dr. 1 (4.0), with chloral, gr. x (0.6), at bedtime, repeated during night if necessary, 563 Camphor with bromides, very useful in some cases, 117 Cantharides, gtt. 1 (0.05), thrice daily, 123 Hot sitz-bath and steeping penis in hot water before retiring, relieves, 423 Lupulin, gr. 30, 563 Morphine, gr. \ (0.016), with atropine gr. fa (0.001), hypodermically into peri- neum, to relieve, 563 INDEX OF DISEASES AND REMEDIES. 741 Opium or belladonna suppositories, to re- lieve, 563 CHOREA, 497 Arsenic, in ascending doses ; discontinue if symptoms of poisoning ensue, 84, 497 Bromides with chloral, when there is in- somnia, prescription for, 498 Chloral, 137 Chloroform inhalations when excessive, 150 Cimicifuga alone, or with arsenic, very use- ful, 155, 498 Hot pack, at bedtime if muscular jerkings are severe, 498 Monobromated camphor, 119 Nitro-glycerin, 287 Quinine in full doses, 160 Salicylates or iodides of value, if associated with rheumatism, 498 Silver nitrate, occasionally used, not re- liable, 283 CINCHONISM. Potassium bromide, as a preventive, 105 CIRRHOSIS OF LIVER. (See Hepatic Cirrhosis.) COLDS. (See Coryza.) COLIC. Asafcetida, useful in children, 88 Chloral and bromide, when severe in chil- dren ; prescription for, 137 Ether internally, very useful, 199 Hoffmann's anodyne, 199 Hyoscyamus, 224 Matricaria, infusion, to prevent, in teething children, 261 Mustard plaster, I to k strength if skin is tender, 279 Peppermint in infantile colic, 312 Rue, as a carminative, 338 COLIC (HEPATIC), 498 Belladonna, in full dose, to relax spasm, 94 Benzoate of sodium, 500 Calomel, if liver be very torpid, 500 Chloroform or ether inhalations to relieve pain during spasm, 151, 499 Diet, 500 Hot applications over liver, as a relaxant, 498 Horse-back riding, 500 Morphine, gr. ± to i (0.016-0.03), with atro- pine gr. fa (0.001) hypodermically, to relieve pain, 498 Olive or cotton-seed oil, H pints (750.0), during attack ; ether, drachm 1 (4.0), may be added with advantage, 498 Opium with belladonna, to relieve pain and spasm, 299 Salicylate of sodium, 500 Turpentine, useful in, 500 COLIC (RENAL). Belladonna, in full dose, 94 Chloroform, a few inhalations often relieve, 151 Opium with belladonna relieves spasm and pain, 299 COLLAPSE. Belladonna as a vaso-motor stimulant, 94 Digitalis, 188 Ether, by mouth, inhalation, or hypoder- mically, of great service, 199 CONDYLOMATA. Calomel, as a dusting powder, often re- moves, 272 CONGESTION. Croton oil, as a revulsive in cerebral con- gestion, 182 Digitalis, relieves stasis of congested lung in typhoid state, and congestion of the kidneys, 188 Elaterium, in cerebral congestion, 191 Ergot of service, especially with digitalis, 193 Glycerin, on cotton tampon, as a depletant in uterine congestion, 211 Jalap useful in plethora with cerebral con- gestion, 246 Juniper, often relieves congested kidneys, 247 CONJUNCTIVA (BURNS OF), 501 Atropine incorporated with liquid vaseline instilled into eye, to prevent iritis, 501 Cod-liver oil instilled into eye after re- moval of foreign matter, 501 Gold-beater's skin inserted between lids and eyeball, or breaking up granula- tions, prevents corneal inflammation, 502 Neutralization of foreign matter, if acid or alkaline, 501 CONJUNCTIVA (CHEMOSIS OF), 505 Astringent washes, especially alum, 505 Nicking swollen tissue with scissors, 505 Warm, moist compresses, 505 CONJUNCTIVA (HEMORRHAGE BE- NEATH), 505 Boric-acid or cocaine wash, when conjunc- tival irritation exists, 505 Massage of globe through closed lids, to aid absorption of blood, 505 CONJUNCTIVA (XEROSIS OF), 505 Glycerin, almond oil, cod-liver oil, or weak alkaline washes, 505 CONJUNCTIVITIS (CHRONIC), 503 Acetate of zinc, gr. 1-2 (0.05-0.1) to the ounce (30.0), 388 Boric acid, wash (gr. 10 to the ounce [0.65 : 32.0]), cocaine, gr. 2 (0.1), may be added if there is no corneal ulcer; for this condition salt, gr. 4 to the ounce (0.3: 32.0), may be substituted, 503 Copper crystal, or a solution (gr. 1 to 3 to the ounce [0.05-0.15:32.0]), applied to diseased spot, if subacute, 179 Correction of any refractive error, 503 Lapis divinus, 503 Tannin and glycerin (gr. 10 to the ounce [0.65 : 32.0]),' as an application, 503 Yellow oxide or sulphate of mercury salve, or alum crystal, useful application, 503 ES AND REMEDIES. 742 INDEX OF Zinc oxide, in powder, or the sulphate in the form of a wash, 306 CONJUNCTIVITIS (DIPHTHERITIC), 504 Atropine instilled, 504 Boric-acid or bichloride solution, frequent- ly applied in early stages, 504 Cade, oil of (strength 1 to 10), 505 Citric-acid ointment or lemon-juice, locally applied, 505 Hot compresses, 504 Quinine, solution (gr. 3 to the ounce [0.15: 32.0]), 505 Silver nitrate, same as in purulent con- junctivitis, 505 Sulphur, insufflations, 505 CONJUNCTIVITIS (FOLLICULAR), 503 Alum, crystal, applied locally if due to atropine instillations, 503 Astringent and antiseptic lotions, 503 Calomel, as a dusting-powder, alone or with bismuth, aristol, or iodoform, 503 Copper sulphate, as an ointment (gr. £ to the drachm [0.03 : 4.0]), 503 CONJUNCTIVITIS (GRANULAR), 504 Atropin, instillations, in acute forms, 504 Boric acid or salicylic acid, solution, as a wash in acute forms, 504 Boroglyceride (20 to 50 per cent.), applied to chronic granulations, 504 Copper sulphate, crystal, applied to chronic granulations, 504 Corrosive sublimate solution (1: 200 or 1 : 500), applied every second day in chronic forms, preceded by cocaine; eyes also being irrigated thrice daily with sublimate solution (1: 7000), 504 Crushing granulations, often satisfactory, 504 Excision of granulations when isolated, 504 Glycerole of tannin, applied to chronic granulations, 504 Grattage, 504 Jequirity infusion (3 per cent.) painted on inner side of eyelids, of use, 247, 504 Leeches to temple, to reduce inflammation in acute stage, 504 Liquor potassa?, beta-naphthol, iodoform, aristol in powder or salve, yellow-oxide ointment, calomel, or hydrastin may be tried, 504 Scarification, not advisable, 504 Silver nitrate, stick or solution (gr. 10 to the ounce [0.65 : 32.0]), applied daily, if there is discharge; neutralize excess with salt solution, 284, 504 Yellow oxide of mercury, ointment with lard, equal parts, in chronic types, 275 CONJUNCTIVITIS (LACHRYMAL), 503 Treatment same as for chronic type. CONJUNCTIVITIS (MUCO-PURULENT). Treatment same as for purulent type. CONJUNCTIVITIS (PURULENT), 502 Atropine or eserine, if corneal ulcer ap- pears, 502 Bichloride of mercury (1 : 8000), or boric acid (saturated solution), as a wash, used hourly, 502 Boroglycerin, 101 Hot compress, in lieu of cold, if vitality of cornea is threatened, 502 Iced compress in early stage, to reduce in- flammation, 502 Leeching, useful if inflammation is high, contraindicated in infants, 502 Permanganate of potassium, aqua chlorini, sulphocarbolic acid solution, alum sul- phate, zinc sulphate,creolin (1 percent.), or iodoform ointment may be tried, 502 Peroxide of hydrogen useful as a cleansing agent, 502 Silver nitrate, stick or solution (gr. 10 to the ounce [0.65: 32.0]), touched to lids after they have been cleansed of pus, excess neutralized with salt solution; 2 percent, solution dropped in new-born infant's eyes to prevent, 502, 503 Sozoiodol (2 : 30), 358 CONJUNCTIVITIS (SIMPLE), 501 Alum crystal applied when it tends to be- come chronic, 501 Atropine usually unnecessary unless cor- neal ulcer is present, 501 Boric acid, lotion (gr. 10 to the ounce [0.65: 32.0]), 501 Compresses of ice to allay inflammation, 501 Creolin solution (1 per cent.), 501 Mercury, bicloride solution (1: 10,000), if discharge is great, 501 Peroxide of hydrogen, 501 Poultices and bandages contraindicated, 501 Silver nitrate, solution (gr. 2 to 5 to the ounce [0.1-0.3:32.0]), if there is muco- purulent discharge. If discharge is ex- cessive employ gr. 10 to the ounce (0.65 : 32.0), and neutralize excess with salt solution or wash with tepid water, 501 Smoked glasses, 501 Sodium biborate, gr. 4 to 8 to 5j (0.3 to 0.5:32.0), 501 Tannin and glycerin (gr. 10 to the ounce [0.65:32.0]), or alum crystal if there is a chronic tendency, 501 Zinc oxide, 306 Zinc sulphate solution (gr. 1 to 2 to the ounce [0.05-0.1:32.0], alone or with boric acid, if there is chronic tendency, 389, 501 CONSTIPATION, 505 Aloes, 61; and podophyllin, with other drugs useful for temporary use; pre- scription for, 508 Belladonna, 94 Bryonia, when intestinal secretions are de- ficient, 108 Cascara sagrada, the best curative agent, dose gtt. 10 to 20 (0.05-1.3) of fluid ex- tract or drachm 1 (4.0) to 6 (24.0) of cordial, 130, 508 Castor oil ultimately harmful in all cases, 132, 508 Colocynth, jalap, or senna, not to be used constantly, 508 INDEX OF DISEASES AND REMEDIES. 743 Compound cathartic pill, sometimes neces- sary, 509 Diet, of extreme importance, 506 Enemeta, as a routine treatment, harmful, 509 Glycerin, suppositories or enemata, often used, 211, 509 Gymnastic movements, horseback riding or massage, with regulated diet, 506 Hunyadi, Carlsbad, or Friedrichshall wa- ters, rarely of value in chronic forms, 508 Leptandra, fluid extract of, in intestinal atony,254 Lobelia, in combination with cascara sa- grada, useful in atonic forms, 257 Magnesium sulphate by the mouth or by enema, 260 Manna, as a laxative fruit for adults, or drachms 1 to 2 (4.0-8.0) to bottle of milk, for infants, 261, 508 Mercury, as an habitual purgative harmful, 508 Opium in reflex constipation, 509 Phosphate of sodium, useful in rickety chil- dren, 32 to 4 (0.1-0.2); or adults, 318, 508 Pilula cathartica vegetabilis, may be re- quired, 509 Rhubarb, usually harmful; in some cases in children, useful, 336, 508 Salines, simply to unload bowels, 508 Seidlitz powder. 351 Senna, said to be useful in constipation of pregnancy, particularly if combined with cascara sagrada, 352 Soap suppositories, useful in children, 354 Stillingia, recommended when habitual; prescriptions for, 361 Sulphur, especially valuable if hemorrhoids are present, 367 Tobacco, sometimes used, 509 CONVULSIONS. Allium, as a poultice, over spine or feet in infantile spinal or cerebral convulsions, 59 Amyl nitrite, 70 Chloral with bromide, in infants : also use- ful alone in ura?mic and puerperal con- vulsions, if no acute renal trouble exists, 103, 137, 138 Chloroform, 150 CORNS, 509 Fowler's solution, locally applied, 86 Salicylic acid, the best application, formula for, 341, 509 Silver nitrate solution (gr. 60 to the ounce [4.0:32.0]), applied to soft corns every four or five days, 510 CORYZA, 510 Aconite, useful in early stages, 51 Allium, as a poultice to breast, or in emul- sion or boiled in milk, for children, 59 Arsenic, taken for months, often cures per- sistent colds, 84 Antipyrin, in 2 to 4 per cent, solution as a spray, preceded by a cocaine spray, 78, 510 Belladonna in, 94, 510 Bromides useful in headache, 511 Camphor, as a snuff, or inhalation of spirit, or fumes, when sneezing and lachryma- tion are excessive, 117 Cocaine, a few minims of a 4 per cent, solu- tion dropped into nostril, followed by lotion (see prescription) with atomizer, or cocaine (1 part), morphine (1 part), and bismuth (7 parts) as a snuff, 167, 510 Cubebs, as a snuff during stage of secretion, 183 Glycerin, applied alone by brush or spray, often of service, 211 Hamamelis, useful after acute stage is past, 215 Hot mustard foot-bath with hot draught or Dover's powder, followed by rest in bed, may relieve, 510 Inhalation of tincture of iodine, 234 Iodide of potassium, at beginning will often abort, 229 Menthol, very useful, 313 Prescription for wash, 510 Quinine, internally, combined with chlo- ride of ammonium, useful after secre- tion is established, 511; also useful as a spray, 161 Sweet spirit of nitre, 510 Tartar emetic, 74 COUGH. Acacia, as a mucilaginous drink with flax- seed and liquorice, to loosen hacking cough, 43 Almond, essential oil of, in emulsion, as a demulcent in cough of phthisis, 60 Belladonna, the best remedy in nervous cough,94 Cannabis indica, a useful adjunct to cough mixtures, 120 Chloroform, useful, added to cough mix- tures for irritant cough, 151 Codeine, useful in nervous cough, 169 Flaxseed tea, alone or with paregoric, a useful demulcent in excessive cough, 205 Gelsemium in nervous cough, 208 Honey, 218 Hydrocyanic acid, highly recommended, prescription for, 221, 222 Hyoscyamus in nervous cough, 224 Hypnal, 225 Iodine, as a paint over supraclavicular spaces, in irritative cough, 232 Ipecac, in spray, useful in chronic winter cough, 237 Morphine in wild-cherry syrup, useful in irritative cough and wheu cough is greater than necessary to expel mucus, 301 Paregoric (1 drachm [4.0]) in hot water, from which the steam is inhaled, use- ful in irritative form of cough, 301 Sandalwood oil for excessive cough follow- ing influenza, 346 Syrupus pruni Virginiana?, as a vehicle for cough mixtures, 333 CRAMPS. Belladonna, internally or locally as a lini- ment, 94 Chlorodyne, for stomach cramp, 142 Ginger, especially useful in menstrual 744 INDEX OF DISEASES AND REMEDIES. cramp due to cold, 209. (See Dysmenor- rhoea.) CRETINISM. Thyroid gland very useful, 377 CROUP (MEMBRANOUS). Diphtheria.) (See CROUP (SPASMODIC), 511 Aconite, useful, 51 Amyl nitrite, inhalations, if paroxysm is severe, 70, 511 Antimonial wine, drachm 1, to cause vom- iting if paroxysm is severe, 511 Belladonna, bromides, chloral, or opium in small doses at bedtime, as a preventive, 511 Bromides and lactucarium, 511 Cold cloth around neck, and child placed at once in hot bath, air of room being moistened by steam, 511 Menthol, useful, 511 Prophylactic measures, 511 Sanguinaria, as an emetic, unfavorable, 346 CYSTITIS (ACUTE), 512 Aconite in full dose, with sweet spirit of nitre and potassium citrate if there is fever; prescription for, 512 Belladonna, alone or with aconite, espe- cially useful if due to cold ; dose gtt. 5 to 10 (0.3-0.65) thrice daily, 512 Boric acid, to render urine acid, 100 Cannabis indica, preferable to opium for relieving pain, 120, 512 Copaiba, 177 Creolin, as a vesical wash (1 to 2 per cent. solution) in cystitis of women, 181 Flaxseed tea, as a demulcent, 205 Hot compress over bladder, should not con- tain irritants, 512 Hot sitz-bath and enemata, to relieve bear- ing-down pain, 512 Hygienic measures, 512 Laudanum, gtt. 30 (2.0), to starch-water oz. 2 (64.0), in enema, to relieve bear- ing-down pain, 512 Leeches to perineum or cups to sacrum, 512 Opium, belladonna, or iodoform supposi- tory, to allay bearing-down pain, 301, 512 Quinine, contraindicated, 513 Salines, in early stage to evacuate bowel, 513 Salol, gr. 10 (0.65) thrice daily if inflamma- tion becomes purulent, 512 CYSTITIS (CHRONIC), 513 Arbutin, gr. 3 to 5 (0.15-0.3), or fluid extract of buchu or uva ursi, £ to li drachms (2.0-6.0), to improve vesical mucous membrane when inflammation of sub- acute type, 383, 513 Benzoic or boric acid, gr. 5 to 10 (0.3-0.65) in pill, to render urine alkaline, 100, 513 Buchu, 109, 513 Cantharides, 122 Creolin solution (1 to 2 per cent.) as a vesi- cal douche, 514 Grindelia, as a vesical stimulant, 212 Juniper of value, 247 Mercury, bichloride solution (1: 10,000), as an injection to cleanse bladder, 513 Myrrh often of service, 280 Opium suppositories, gr. i to i (0.016-0.03), very useful, 301 Pareira, 310 Potassium salts, except bitartrate, to ren- der urine alkaline when mucus is ex- cessive, 513 Salol, 513 Sandalwood oil, 346 Silver nitrate, solution (gr. 1 to oz. 4 [0.05 : 128.0] increased gradually to gr. 2 to oz. 1 [0.1:32.0]), as an injection when discharge is muco-purulent, followed by salt solution if pain is severe, 513 Strychnine and cantharides when vesical atony is great, 514 Turpentine, oil of sandalwood, cubeb, or copaiba, useful when vesical atony is great, 514 DEBILITY. Arsenic, with bitter tonics, very useful, 84 Calomel, in debility of children, often re- lieves, 271 Capsicum for gastric atony, 124 Eupatorium, a good tonic, 203 Lime salts, 114 Phosphorus, of service in sexual debility, 321 DELIRIUM TREMENS. Chloral, of great service used cautiously, 137 Croton oil, 182 Hops, 218 Hyoscine, in insomnia 224 Monobromated camphor, when nervous twitching is troublesome, 119 Valerian with morphine, frequently used. 383 DIABETES INSIPIDUS, 514 Arsenic, 85 Belladonna or opium, if due to nervous irritability, 514 Carbonate or citrate of lithium, gr. 10 (0.65), with sodium arsenite, gr. fa (0.002), val- uable in gouty types, 257 Ergot, in combination with bromide of sodium, 194, 514 Gallic acid, alone or with opium, one of the best remedies, 206, 514 Opium, 301 Rhus aromatica, highly recommended, 337 Strychnine and sulphate of iron, as tonics, 514 Suprarenal gland useful in, 369 DIABETES MELLITUS, 514 Acidulated water or non-purgative alkaline water, to allay thirst, 516 Almond bread or bran bread, as a food for diabetics, 59, 451 Alum, 63 Antipyrin, 78, and arsenate of sodium and carbonate of lithium when of eoutv origin, 85 J Carbonate of sodium, by intravenous in- jection in diabetic coma, 516 Chloride of gold and sodium, gr. J* (0 006) recommended, 515 ' ' INDEX OF DISEASES AND REMEDIES. 745 Codeine, in ascending doses, beginning gr. 1 to 5 (0.05-0.25), thrice daily, 169 Colchicum and iodides, in gouty types, 515 Diet, 514 Ergot, highly recommended, 515 Ether, hypodermically, to support heart in diabetic coma, 516 Gallic acid, with opium, one of the best remedies, 206 Glycerin or saccharin, as sweetening agents to replace sugar, 211, 339, 516 Iodol, gr. 2 to 6 (0.1-0.3), thrice daily, rec- ommended, 237 Iron, lacto-phosphates of lime and sodium, strychnine and astringents, if cachexia comes on, 516 Jambul, gr. 5 to 30 (0.3-2.0), once to thrice daily, said to be very useful in some cases, 516 Lime-water, 115 Lithium carbonate or citrate, with arsenic, very useful, if due to gout, 85, 257, 515 Morphine, very useful in ascending doses, 515 Opium, gr. \ to J (0.016-0.03), thrice daily, largely used, 301, 515 Pancreatin, when the disease is due to a lesion of the pancreas, 309 Purgatives, restricted diet, and exercise, if due to high living and sedentary habits, 515 Salicylates and iodide of potassium, if due to rheumatic or gouty taint, 515 Transfusion, in diabetic coma, 516 DIARRH03A, 517 Allspice, 59 Ammonium chloride, gr. 5 (0.3) every four hours, best remedy iu persistent catar- rhal states, 518 Arsenic, 85 Belladonna, may be used in serous types, 93 Bichloride of mercury, gr. ^J^ (0.0003), hourly, if stools be slimy and bloody, 269, 520 Bismuth, with carbolic acid, gtt. 1 or 2 (0.05-0.1) highly recommended in se- rous and summer diarrhoeas, 97, 519 Cajuput, gtt. 10 to 20 (0.65-1 3) in serous forms, 112 Calomel, followed by a saline, useful in sthenic cases of summer diarrhoea, 519 Calumba, in summer and serous diarrhoeas, prescription for, 115 Camphor, useful in serous but never in mucous types, 117, 518 Carbolic acid, especially useful as an intes- tinal antiseptic, 128, 519 Castor oil, with laudanum and sodium bi- carbonate, to unload bowel and render it alkaline, 132, 517 Catechu, alone or with opium, in serous types, prescription for, 133 Chalk mixture, with' kino and catechu, in' serous diarrhoeas, prescription for, 112 Charcoal, useful in acid and fermentative types, 130 Chirata, nitro-muriatic acid, or, better still, nitric acid and cardamoms, in mucous type, prescription for, 517, 518 Chlorate of potassium for acute rectal catarrh with mucous diarrluca, 141 Chlorodyne, largely used in serous types, 142 Chloroform, with astringents and opium, very useful after removal of irritant cause, 151, 518 Cinnamon, as a stimulant in serous types, 163 Cloves, 164 Copper sulphate, gr. \ (0.016) with opium, gr. 1 (0.06) in pill, or in enema, gr. 5 to 20 to the ounce [0.3-1.3 : 32.0]), if due to ulceration, 179 Creolin in entero-colitis, 5 :1000 of water, 182 Diet, for summer diarrhoea, 517, 519 Enteroclysis, when mucous form becomes chronic, 518 Ergot, sometimes useful in serous types, 193 Gallic acid, 206 Geranium, 1 to 2 roots, boiled in pint of milk, of great service in infantile types, 209 Ginger, a good addition to diarrhoea mix- tures, 209 Guaiacol carbonate, in fermentative forms of, 215 Haematoxylon, useful in children, because of agreeable taste, 215 Hope's camphor mixture, in serous and choleraic types, 218 Ipecac, gr. \ to \ (0.016-0.03) thrice daily, useful in summer diarrhoea of children, 238, 520 Kino, formula for, 248, 518 Lead acetate, with opium and camphor in serous types, prescription for, 252, 517 Mercury, with chalk or calomel, in hepatic disorder, 273, 519 Morphine, gr. fa to fa (0.0008-0.0C12) hypo- dermically, often checks summer diar- rhoea in children, 302 Mustard plaster, or other counter-irritants, to abdomen, 517 Naphthalin or naphthol, in fetid and sum- mer diarrhoeas, 281, 519 Nitrate of silver and hyoscyamus, or lead acetate and opium, in mucous diarrhoea, prescription for, 517 Nitro-muriatic acid, or podophyllin, gr. fa to fa (0.0012-0.0016), in summer diar- rhoea, if duodenum is at fault, 289 Nutmeg, useful in serous types, 291 Opium, 301, 518 Pancreatin in lienteric diarrhoea, 309 Pepsin with hydrochloric acid in summer diarrhoea, if gastric digestion is deficient, 519 Phosphate of sodium, lime salts, and com- mon salt in summer types, if rickets is present, 318, 520 Podophyllin, 330 Potassium iodide, gr. 3 to 5 (0.15-0.3), if '" catarrhal state is obstinate, 518 Precipitated carbonate of calcium, in serous diarrhcea, 112 Raspberry-leaves, used in domestic medi- cine, 338 Rhubarl), often useful, preceding direct treatment in summer diarrhoea, 336 740 INDEX OF DISEASES AND REMEDIES. Salol combined with chalk mixture, 519 Sulphate of iron in chronic forms, 245 Sulphocarbolate of zinc, 2 grains (0.1) every three hours ; of service in summer diar- rhoea, 519 Sulphocarbolates, 364 Sulphuric acid, especially valuable in serous types, prescription for, 368, 518, 519 Tannic acid, in atonic or serous types, 372 Tar mixture, highly recommended in ob- stinate types, formula for, 329 Thymol, naphthalin, and especially sali- cylic acid, useful as intestinal antisep- tics, in summer diarrhoea, 519 Zinc oxide, in summer types, prescription for, 307 Zinc sulphate, 2-grain (0.1) pills, especially useful with opium, or podophyllin, gr. fa (0.001), in serous types, 389 DIARRHOZA (CHRONIC), 521 Arsenic, 85 Bismuthi et ammonii citras, in chronic serous types, 97 Diet, 521 Iron sulphate, gr. 5 (0.3) in pill, in chronic types, 245 Nitric acid, with a bitter tonic, useful in green diarrhoea of children, combined with pepsin, 286 Operative procedures when due to lesions of the rectum, 521 Rockbridge alum water, useful when anemia is present, 522 Silver nitrate in pill form, or in other cases rectal injections of this drug, gr. 2 to oz. 1 (0.1: 32.0) followed by iodoform sup- pository, of greatest benefit, 521 Sodium bicarbonate, gr. 5 to 20 (0.3-1.3), and iodoform suppositories, by their combined action, give great relief, 521 DILATATION (GASTRIC AND INTES- TINAL). Physostigma with nux vomica, 322 DIPHTHERIA, 522 Aconite, in early stages, 51 Alum, 63 Antitoxin, of great value; 5 to 10 cubic centimetres should be thrown into the connective tissues of the back. A spe- cial syringe is used for this purpose, and should be perfectly aseptic, 399, 523 Antistreptococcic serum, 400 Calomel by sublimation, of great good in some cases, 523 Carbolic acid (1:100) in the form of spray or gargle, 128 Chlorate of potassium, contraindicated for internal use, because of danger to the kidneys. It may be applied upon a swab,"l41, 523 Corrosive sublimate, gr. fa (0.0012), or calo- mel, gr. £ to \ (0.01-0.015) every hour, unless diarrhoea or ptyalism be pro- duced, 269, 522 Ice-bags to the neck, ice in the mouth and the tincture of the chloride of iron in- ternally, if glandular suppuration threatens, 523 Irrigation of the nasal chambers useful in, 522 Lime-water as spray or application very useful in, 116 Loeffler'sapplication (menthol, dr. 2\ [10.0], dissolved in dr. 9 [36.0] of toluol; add dr. 1 [4.0] of liquor ferri chloridi and absolute alcohol, fl. oz. 2 [60.0]), 525 Milk diet, 522 Monsel's solution, as a topical application, 245 Oxygen inhalations, strychnine, and atro- pine if suffocation is imminent. In- tubation or tracheotomy may be neces- sary, 523 Peroxide of hydrogen is the best local ap- plication. May be applied on a swab or as a spray (1:4), to remove false mem- brane, 223, 522 Potassium permanganate, solution (gr. 20 to the pint [1.3 : 500.0], applied as a swab or gargle, 314 Salt solution (7:1000), as a spray in nasal diphtheria, 522 Tincture of the chloride of iron, 242 Tonics, such as quinine, strychnine, and the chloride of iron, as supportive meas- ures, 522 Turpentine, by inhalation, prescription for, 523 DROPSY, 525 Acupuncture, less favorable than incisions, only to be resorted to after other rem- edies fail, 391, 529 Caffeine, in cardiac or renal dropsy, 111; in torpidity of kidneys, 529 Calomel and digitalis, in renal and cardiac types, 271, 529 Colocynth, compound extract of, gr. 2 to 6 (0.1-0.3), 175, 528 Copaiba, of service in slow renal types, 177 Digitalis, gtt. 5 to 10 (0.3-0.65), with can- tharides, gtt. 1 (0.05), thrice daily, in renal torpidity due to heart trouble, 528 Elaterium, especially useful in renal dropsy, 191, 527 Jalap, compound powder of, gr. 20 to 30 (1.3-2.0), with potassium bitartrate, gr. 10 (0.65), added, especially serviceable in renal dropsy, 246, 527 Magnesium sulphate, in concentrated solu- tion, before breakfast, 260 Milk diet, very useful, 528 Paracentesis abdominis, very useful in as- cites, 529 Pilocarpine, useful in localized and renal dropsy, contraindicated in cardiac types, 325, 529 Potassium iodide, in hepatic cirrhosis and localized effusions, to remove liquid, 529 Scoparius, infusion, may be used, 351 Senega, rarely of value, 351 Squill with digitalis, prescription for, 360, 528 Strophanthus in cardiac dropsy, 363 Sugar of milk, useful as a diuretic, 364. 528 Tapping in ascites, the best method, 529 INDEX OF DISEAS1 DYSENTERY, 517 Alum, internally, 63 Arsenic, 85 Bichloride of mercury, gr. ^ (0.0003), if passages are slimy and bloody, 520 Bichloride of mercury, injections (1: 5000), followed by solution (1: 30,000) to pre- vent toxic effect by absorption, 521 Boric acid, 3j to Oj (4.0:500.0), or sul- phocarbolate of zinc, gr. 15 to 1 quart (1.0 :1000.0), very useful as rectal injec- tion, 521 Calomel, in purgative dose, contraindicated if weakness exists, 271, 520 Continuous irrigation with two-way tube, of great value, 520 Copaiba, 177 Creolin enemata, 182 Ergot, useful in bloody stools, 193 Hamamelis, injections, if much blood is present, 520 Ice-water, injections, if due to inflamma- tion, used only in strong persons, 520 Ipecac, best remedy in acute dysentery, 238, 521 Lead acetate, with opium and camphor, prescription for, 252 Nitro-hydrochloric acid, if due to defective action of secretory glands, 289, 519 Prescription for enema, 520 Quinine injections useful in amoebic dysen- tery, 161, 521 Silver nitrate, rectal injections (gr. 10 to 20 to the pint [0.6-1.3 : 500.0]), if ulcers are chronic; followed by salt solution if action is too severe, 283, 520 Tannic acid (3j [4.0] to water Oj [500.0]), in the form of intestinal irrigation, 521 DYSMENORRHEA, 529 Amyl nitrite, often relieves, 70 Antipyrin or acetanilid, in neuralgic at- tacks ; in other cases of doubtful value, 78, 530 Belladonna, suppository, gr. \ (0.03, of ex- tract, or ointment applied to os; tinc- ture, internally, useful to relax spasm, 94, 530 Camphor with acetanilid, in pill, useful in nervous cases, 117 Cannabis indica and gelsemium, often of service, 121, 530 Cimicifuga in neuralgic form, 530 Epsom salts or aloes, if constipation is present, 530 Ether or bromide of ethyl, 531 Gelsemium in spasmodic forms, 208 Hot sitz-bath, followed by turpentine stupe, and Dover's powder, gr. 10 (0.65), often relieves, 530 Iron, strychnine, and quinine, as tonics, with rest and horseback riding for anae- mic and run-down patients, 530 Opium, to relieve spasm and pain, 299, 530 Piscida erythrina, extract, in the dose of from j to 2 fluidrachms (2.0-8.0), 328 Potassium bromide, 104 Water, cold and hot, alternately dashed over loins in atonic cases, 530 ES AND REMEDIES. 747 DYSPEPSIA. (See Indigestion.) Arsenic, useful in atonic types associated with chronic diarrhoea, 85 Bismuth, when due to acid fermentation, 97 Bismuth subgallate in fermentative dys- pepsia, 99 Gentian, 208 Hydrastis, as an antiseptic and curative agent in chronic types, 219 Hydrochloric acid, if gastric secretion is deficient, 220 Lavage in fermentative dyspepsia, 431, 596 Nitric acid with bitter tonics often relieves intestinal types, 286 Permanganate of potassium, 314 Quassia, useful, if not due to gastritis, 334 Serpentaria, as a tonic in atonic types, 353 Strontium bromide, in painful dyspepsia, 362 Terebene, useful as an antiseptic in fer- mentative dyspepsia, 373 DYSPN02A, 531 Ammonium carbonate, as a respiratory and cardiac stimulant, 531 Arsenic, continuously employed, useful in emphysema and chronic pulmonary in- flammation, 531 Dry cupping over back, when due to car- diac or pulmonary trouble, 531 Hyoscine, contraindicated, 531 Morphine, gr. £ to \ (0.008-0.016), night and morning, often cures when due to ner- vous or cardiac disorders, 302, 531 Opium, if due to nervous disorders, 531 Strychnine, in idiopathic types and when due to bronchorrhcea in old people, 295, 531 Thoracentesis if there is pleural effusion, 532 EAR (DISEASES OF). Bismuth subgallate useful in purulent otitis media, 99 Glycerin, useful to soften impacted ceru- men, 211 Potassium permanganate, solution, useful in purulent otitis media, 314 EARACHE, 532 Cardiac sedatives, 532 Chloroform, on swab, behind and in front of ear in otalgia, 533 Cocaine, gtt. 1 to 3 (0.5-0.15), dropped into nostril, followed by spray if mucous membrane is engorged, 532 Heat, dry, applied to head on affected side, 532 Inflation of Eustachian tube with Politzer's air-bag, 532 Irrigation with normal salt solution hot as can be borne, gives great relief, 532 Leeching behind ear, to relieve pain, 532 Menthol and albolene spray, following co- caine, 532 Poultices, oil, and laudanum, contraindi- cated, 532 Puncture of tympanum, if it bulge, fol- lowed by careful cleansing and insuffla- tion of boric acid, 533 748 INDEX OF DISEASES AND REMEDIES. Tincture of belladonna and of opi dropped into the ear, 532 ECLAMPSIA, 651 Amyl nitrite, dangerous, 70 Chloral and bromide, each 1 drachm (4.0), by rectum, before applying hot pack, 653 Chloroform, pushed-rapidly as possible, at onset of attack, 653 Elaterium, gr. J (0.016), rubbed up with butter, or compound jalap powder and calomel, may be substituted for croton oil, 652 Ether, as an ana?sthetic, contraindicated, 653 Extraction of child rapidly as possible, if attack comes on during labor, 653 Ice-bag to head while in warm pack, 652 Morphine, veratrum viride, and amyl ni- trite, may be held in reserve, to be used if necessary, 653 Pilocarpine, contraindicated, 652 Venesection, hot wet pack, and croton oil, gtt. 2 (0.1), with sweet oil on tongue, to eliminate poison, 652 Veratrum viride in full doses, 386 ECZEMA, 533 Ammoniated mercury in chronic dry form, 268 Arsenic, only when skin is very dry, 85, 535 Bismuth subgallate in weeping eczema, 99 Black wash of value in, 270 Calamine in moist eczema, 388 Cantharis, internally in small doses, 123 Carbolic-acid ointment (minims 10 [0.65] to cerate 1 ounce [32.0]), to prevent itch- ing, 129 Dermatol in weeping eczema, 99 Green soap, 354, 534 Hygienic measures and diet, 533 Ichthvol ointment, highly recommended, 226 Internal treatment, 535 Iron, syrup of iodide, in young children with anaemia and debility, 244 Kaolin as a dusting-powder, 248 Lead, dilute solution of subacetate, a useful lotion, 254 Liquor carbonis detergens, in acute cases, 534 McCall Anderson's ointment, 534 Methyl blue in eczema of the eyelids, 276 Ointments, prescriptions for, 306, 335, 534 Poultices, or olive oil with carbolic acid (gtt. 1 to 2 to the ounce [0.05-0.1: 32.0]), followed by soap and water, necessary in some cases to soften scales, before use of ointment, 534 Prescription of iodol, as an ointment, about nose and lip, 237 Resorcin ointment (gr. 2 to 30 to the ounce [0.1-2.0:32.0]), locally applied in sub- acute types; in chronic form ointment (gr. 2 to 10 to the ounce [0.1-0.65: 32.0]), 335, 534; solution gr. x-xv (0.6-1.0) to f^j (32.0) in itching of erythematous form, 335 Salicylic acid ointment (gr. 30 to 60 [2.0- ,ni | 4.0] to lard 1 ounce [32.0]), in chronic or weeping types, 342, 534 Starch poultice, in crusty eczema, 360 Tar ointment, in chronic forms, 329, 534 Thiol, as a dusting-powder, preceded by an antiseptic wash, especially suited to moist eczema, 375 Unna's dressing, 306 Zinc carbonate, as a protective powder in weeping eczema, 388 Zinc oxide, as a dusting-powder or oint- ment in early stages, applied directly or on lint, generally preceded by black wash, 533 EMISSIONS, 535 Bromide of sodium or potassium, gr. 20 (1.3), at bedtime, valuable in spinal irri- tability, 103, 536 Chloral, gr. 20 (1.3), at bedtime, 536 Cold sponging of perineum and scrotum, 536 Hygienic measures, 536 Hyoscine, gr. yj^ (0.0006, of great value, 225, 536 Monobromated camphor very useful in spermatorrhoea, 119 Potassium citrate, gr. 20 (1.3), thrice daily, to render urine non-irritating, 536 Strychnine and arsenic, in full dose, of great service in genital atony, 536 Warm bath before retiring, often useful, 536 EMPHYSEMA OF LUNGS. Cod-liver oil, useful, 170 Ethyl iodide, 201 Euphorbia pilulifera, 4 to 1 drachm (2.0- 4.0) of the fluid extract, 203 Iodide of potassium, 229 Physostigma. aids in expelling mucus, 322 Strychnine, 295 EMPYEMA. Iodine, gr. 6 (0.4); potassium iodide, gr. 6 (0.4) ; water, 1 pint (500.0), as an irri- gating fluid, used daily, 233 ENDOCARDITIS, 536 Aconite, tincture of, gtt. 2 to 3 (0.1-0.15), hourly, in early stage of acute sthenic types, 537 Antirheumatics, antilithics, or iodides, if due to diathetic taint, 536 Antistreptococcic serum in ulcerative endo- carditis, 401 Calomel, gr. \ (0.016), with morphine, gr. fa (0.006), every two hours, in early _ stages, 268, 537 Digitalis, to strengthen heart in later stages, 537 Ice-bag over praecordium, 537 Iron, tincture of chloride, associated with supportive treatment, in purulent types, Leeches or wet cups, in early stages, to abort, 537 Lithium citrate or acetate, or citrate of potassium, to prevent calcareous deposit in valves, 537 Mercury, in full dose, sthenic cases, 268 Veratrum viride, used for same purposes as aconite, 537 INDEX OF DISEASES AND REMEDIES. 749 ENTERITIS. (See Dysentery and Diar- rhcea.) EPIDIDYMITIS, 567 Guaiacol used locally highly recommended, 214 Heat, moisture, and pressure, in later stages, to relieve induration, 568 Horand-Langlebert's dressing, 568 Ice-bags, 568 Iodide of potassium, gr. 10 to 20 (0.65-1.3), thrice daily, to remove induration, 568 Iodine, painted over scrotum, said to be beneficial, 568 Mercury and belladonna ointments, equal parts, or iodine, gr. 4 (0.25), with lano- lin, ounce 1 (32.0), locally applied, to relieve induration, 568 Punctures, useful to relieve tension and alleviate pain, 568 Rest in bed, elevation of pelvis and testi- cles, cessation of local gonorrhoeal treat- ment and administering treatment for acute inflammation, 568 Silver nitrate, solution, painted over scro- tum, in early stage, may relieve, 281, 568' Strapping and suspending testicle, to re- duce inflammation, 568 EPILEPSY, 537 Acetanilid, 46, 544 Adonis vernalis with bromides have been found useful, 52, 541 Ammonium or sodium nitrite, used to sup- plement amyl nitrite, 543 Amyl nitrite, inhalations, when aura is perceived and also in status epilepticus to relax spasm, 70, 542, 543 Anaesthetics contraindicated in all cases except status epilepticus, when chloro- form may be used to control attack, 543 Antifebrin and antipyrin especially useful in some cases, 78, 544 Belladonna, with bromides, recommended, 541 Bleeding for the status epilepticus, 543 Borax may be used, 100, 544 Bromate of potassium, 541 Bromide of ammonium, should be used with other drugs, 67, 541 of calcium, 106 of gold, 106 of iron, when anaemia is present, 540 of lithium, highly recommended in some cases, 106, 540 of nickel, 540 of potassium, the most reliable, in as- cending dose, 103, 538 of sodium, not so apt to disorder stom- ach, 540 Cannabis indica, 542 Chloral, alone or with bromides, well di- luted, after meals, used with care, 137, 544 Diet, 515 Digitalis, with bromides, useful in some cases, 541 Duboisine, especially in psychic forms, 191 Hydrobromic acid, liable to derange diges- tion, 541 Iodide of potassium, useless except in syphilitics, 543 Mercury, associated with potassium iodide, when due to gumma, 544 Mixed treatment, 541 Monobromated camphor, 119 Nitro-glycerin, useful in some cases of petit mal, 287, 542 Opium with gelsemium, only to be used when other remedies fail; also a pro- longed course of, in ascending doses, useful in old cases, 541 Potassium nitrite, 286 Quassia injections, when due to worms; if not obtainable, sodium chloride solu- tion may be used, 545 Silver nitrate, may be tried when other remedies fail, 283, 542 Solanum carolinense, fluid extract of, 2 to 15 minims (0.1-1.0), thrice daily, in the epilepsy of childhood, 357, 544 Strontium bromide, 362 Tartar emetic ointment, as a counter-irri- tant at back of neck, 74 EPISTAXIS, 545 Acetanilid, used locally, has been recom- mended, 47 Acetic acid, locally applied, to arrest, 48 Aconite or veratrum viride, tincture, gtt. 2 to 4 (0.1-0.2), in sthenic cases, followed in thirty minutes by smaller doses, if necessary, 52, 545 Alum powder, pure or half-and-half with starch, as a snuff, 545 Bacon fat inserted as a plug in nostril, may arrest, 545 Compression of facial artery may be neces- sary, 546 Ergot, turpentine, hamamelis, or oil of erigeron, internally, in slow oozing, 193, 546 Hot foot-bath, or hot- or cold-water bags applied to dorsal vertebra?, may arrest, 546 Ice applied to nose, may arrest, 546 Ipecac, in nauseating doses, recommended, 545 Monsel's solution, in spray (gtt. 30 to 4 ounces [2.0:128.0]), only to be tried when other remedies fail; very dis- agreeable, 545 Oil of erigeron, 194, 546 Plugging anterior and posterior nares, if necessary, with cotton or lint soaked in vinegar, 546 Tannic acid, in powder or solution, snuffed up nostril, 546 Vinegar or lemon-juice injected into nos- tril, 546 EPITHELIOMA. Acid nitrate of mercury, applied to part with glass rod, 274 Arsenous acid and gum acacia (of each 1 ounce [32.0] to water 5 fluidrachms [20.0]), locally applied, 86 Resorcin, in epithelioma of the face, 335 ERYSIPELAS, 546 Alcoholic stimulants if patient passes into typhoid state, 547 750 INDEX OF DISEASES AND REMEDIES. Antipyrin, to control fever, 547 Antistreptococcic serum, 400 Bitters and iron, during convalescence, as tonics, 547 Boric acid, as a lotion, 99 Cold bathing to control excessive fever, 547 Ichthyol ointment and vaseline, half-and- half, locally applied, preceded by wash- ing with castile soap, followed by bi- chloride solution (1:1000), 226, 547 Iodine, tincture, painted around inflamed edges, to arrest, 233 Iron, tincture of chloride, gtt. 20 to 40 (1.3-2.6), thrice daily, best internal treatment, 242, 547 Pilocarpine, gr. \ to & (0.008-0.01), hypo- dermically, contraindicated in debility; also injected around borders of inflam- mation in some cases, to arrest, 326, 547 Silver nitrate, solution (gr. 80 to the i ounce [5.0:16.0]), applied twice or thrice, to arrest, 284, 547 Veratrum viride or aconite, in early stages of sthenic cases, 546 White-lead paint, locally applied, when ichthyol is not at hand, 547 EXHAUSTION AND DEPRESSION, 547 Stimulants, 548 EXOPHTHALMIC GOITRE. Belladonna relieves some cases, 93, 94 Sparteine, 350 FAINTING. Alcohol, 54 FEET (SWOLLEN, TENDER, OR SWEAT- ING), 548 Arsenic, gr. ^to fa (0.001-0.0015), in swell- ing of old persons, 548 Borax, stockings soaked in saturated solu- tion and dried, each day, when sweat- ing is excessive, 548 Carbonate of calcium, precipitated, locally applied to sweating feet, 113 Cotton instead of woollen stockings may aid cure, 549 Hamamelis, distilled or fluid extract, drachm i to 1 (2.0-4.0) of former, or gtt. 10 to 20 (0.65-1.3) of latter, 548 ' Lead plaster and linseed oil, equal parts, applied on linen to feet, every third day, for sweating, 254 Prescription for dusting-powder, 548 Rest, absolute, of feet, may be necessary in swollen feet, 548 Salicylic acid and borax, equal parts, in water and glycerin, best application to sweating and tender feet, 548 FELON. Bread-crumbs saturated with liquor plumbi subacetatis, as a poultice, to abort, 254 Silver nitrate, solution, applied early, to abort, 284 FEVER, 549 Acetanilid, 45, 550 Aconite, the best depressant for sthenic types in children, 51 Alcohol, as a systemic support and stimu- lant in low fevers, 54, 55 Ammonia for sudden cardiac failure in, 65 Antimonial powder as an antipyretic, 75 Antipyretics, useful in most sthenic fevers, often fail in thermic fever, 551 Antipyrin, 77, 550 Brand's method, 410 Camphor a diffusible stimulant in adynamic fevers, 117 Coca a supportive and stimulant in low fevers, 168 Cold applications and baths, 549, 550, 551 Cold packs and baths, in asthenic types to be relied on first; if impracticable, then antipyretics, 551 Digitalis, in small doses, valuable in ex- hausting fevers, 188 Guaiacol, useful in, 214 Hvdrochloric acid an adjuvant to digestion, ' 220 Musk, by rectal injections, valuable in low stages, 279 Neutral mixture, useful, as a febrifuge, es- pecially in children, 332 Phenacetin, 316 FIBROIDS. Ergot, used as an expulsive and curative remedy, 193 FLATULENCE. Aromatic powder, 163 Asafcetida, 88 Camphor, 177 Capsicum, prevents formation of gas, 124 Charcoal, 129 Chloroform, gtt. 1 to 2 (0.05-0.1), or spirit, gtt. 10 to 20 (0.65-1.3), will relieve, 151 Cloves, a useful tonic and stimulant, 164 Ginger, 209 Hoffmann's anodyne, the best carminative, 216 Ipecac, 238 Pepper, 311 Peppermint, 312 Podophyllin with euonymin, leptandra, chirata, and creosote, 330 Potassium permanganate, 314 Turpentine, prescriptions for, 381 FRECKLES AND CHLOASMA, 552 Almonds, emulsion of, supposed to be of value, 60 Boric acid, saturated solution, applied same as corrosive sublimate wash, 100, 552 Corrosive sublimate (gr. 1 to 4 to the ounce [0.05-0.25 : 32.0]), applied night and morning until irritation appears, then stop for some days and again renew, 552 Lactic acid (gr. 10 to the drachm [0.65: 4.0]), applied same as corrosive subli- mate, 552 Prescription for chloasma of pregnancy, Prescriptions for, 552 FURUNCLES. (See Boils.) INDEX OF DISEASES AND REMEDIES. 751 GALACTORRHEA, (550 Antipyrin, gr. 2 V (0.125), thrice daily, said to decrease secretion, 651 Caustic, introduced into uterus, successful in some cases by inducing menstrual flow, 650 Chloral should be tried, 651 Compression of gland with applications of belladonna ointment and potassium iodide internally, usually relieves, 650 Diet, 651 Electricity, generally ineffective, 650 Ergot, long continued, highly recom- mended, 650 Malt, wine-glassful at midday and evening meals, useful addition to diet; pyro- phosphate of iron, gr. 4 (0.3), in addi- tion, if anaemia is present, 651 Warm douches, 650 GANGRENE. Bromine, as an escharotic in hospital gan- grene, 107 Carbolic acid or creosote, spray (gtt. 5 to 10 to the ounce [0.3-0.65 : 32.0]), useful in pulmonary gangrene, 128 Nitric acid, to destroy tissue, 285 GASTRALGIA, 552 Acetanilid, 46 Alum, 63 Arsenic with iron, the most reliable rem- edy, prescription for, 553 Bismuth and pepsin, 1 to li hours after meals, to prevent pain, 97, 553 Bromide of strontium, a valuable remedy, 553 Bromides or valerian, alternated with other treatment if case is neurotic, 553 Cannabis indica, prescription for, 121 Cod-liver oil in emulsion with hypophos- phites, occasionally better than arsenic and iron, 553 Counter-irritation and a vigorous revulsive, especially useful in hysteria, 553 Cyanide of potassium, dilute hydrocyanic acid or chloroform as a substitute for bismuth, if it favors constipation, 553 Diet and hygiene, 553 Emesis and purgation, when due to indi- gestible food, 553 Hot applications, stimulating infusions, chloroform, hot brandy or whiskey or laudanum, gtt. 30 (2.0) to 60 (4.0), dur- ing acute stage, 552 Hydrocyanic acid, useful in nervous types, 221 Massage, enemata, diet, or suppositories of gluten, glycerin, or soap, to overcome constipation, 553 Menthol, 313 Nitro-glycerin, 287 Potassium nitrite, gr. 4 to 5 (0.25-0.3), 286 Salicylic acid, used in paroxysmal forms, 342 Emetic, mild, to dislodge fermenting mass, if present, 554 Flannel to protect abdomen, 555 Ice, to quench thirst, if anorexia is great, 554 Iron, if anaemia exists, 555 Milk, with large percentage of lime-water. 554 Pepsin and hydrochloric acid, 555 Salicylic acid, valuable in vomiting, 342 Salt, in moderation, in food, 555 Seidlitz powder, one fourth of one powder every fifteen minutes, to settle stomach and remove fermenting mucus, 554 Sodium bicarbonate with gentian, useful, 554 Spice poultice to relieve epigastric distress, 555 Tartar emetic, given early, in acute attack of children, may abort, 74 GASTRIC CATARRH (CHRONIC), 555 Apomorphine, as an emetic, to throw off mucus, 81 Arsenic for the vomiting, in hand-fed babies, 85 Bicarbonate of sodium for hyperacidity, 555 Bismuth subnitrate, added to prescription, if hyperacidity exists, 555 Carlsbad salt, Saratoga-Carlsbad water, or Seidlitz powder of great benefit, 555 Cascara sagrada, if constipation exists, 555 Charcoal, prescription for, 129 Diet, such as koumyss, light broths, and matzoon, 555 Hydrochloric acid, if due to atrophy of the gastric tubules, 220, 555 Lavage almost always to be used, 555 Silver nitrate and hyoscyamus, with coun- ter-irritation and regulated diet, 224, 283, 555 GASTRIC DILATATION, 556 Cod-liver oil, by stomach or inunction, if due to rachitis, 556 Diet, 556 Enemas, nutrient, often useful, especially in older children, 557 Faradization of gastric walls recently in- troduced, 557 Gentian and calumba, useful as tonics, 557 Iodide of iron, syrup of, lacto-phosphates of lime, or phosphate of sodium, in stru- mous diathesis, 556 Lavage. 556 Physostigma, tincture, gtt. 5 to 10 (0.3-0.65), or extract, gr. i to i (0.008-0.016), to im- prove muscular coats, 556 GASTRIC ULCER, 557 Arsenic, 85 Bismuth and sodium bicarbonate, as an as- tringent and sedative, and to these may be added morphine or codeine for pain, 97, 558 Carlsbad salts, magnesium sulphate, or so- dium phosphate, for relief of constipa- tion, 559 Cocaine, gr. I (0.016), alone or combined with bismuth, to control vomiting, 559 Cold compresses or an ice-bag applied to. epigastrium in ha?matemesis, 559 GASTRIC CATARRH (ACUTE), 554 Ammonium muriate, useful in subacute forms in children, prescription for, 68 Diet, principal point in treatment, 554 Effervescing draughts, useful in convales- cence, 554 752 INDEX OF DISEASES AND REMEDIES. Counter-irritation, continuous, over belly, to relieve pain, 558 Creosote or carbolic acid, for vomiting, 559 Diet and hygiene, 558 Massage and electricity, 558 Monsel's solution, cold compresses, or tur- pentine, may be given to check heniat- cmesis, 559 Morphine for pain or collapse following perforation, 558, 559 Rectal alimentation, of great service, 559 Resorcin useful in some cases, 335 Rest for the patient and rest for the stom- ach essential, 557 Silver nitrate with hyoscyamus in pill, half to one hour before meals, 558 Spice plaster, useful as a continuous coun- ter-irritant, 558 Stimulants, cardiac, guardedly adminis- tered, external heat and rubbing, in collapse following hemorrhage or per- foration, 559 GASTRITIS (ACUTE), 559 Belladonna or atropine, internally, and flaxseed poultice over epigastrium and chest, if collapse threatens, 559 Bismuth, as an astringent and sedative, 97 Flaxseed tea, a useful demulcent, 205 Mucilaginous drinks and albuminous sub- stances freely given, 559 Oils, to prevent spread of inflammation, 559 Opium, in fluid form, to relieve pain and irritation, 559 Paregoric contraindicated, 559 Warm water, internally, or stomach-pump, to unload stomach at onset, 559 GASTRO-ENTERITIS, 560 Castor oil or magnesium sulphate, to sweep out poison, 560 Morphine, hypodermically, to allay pain, followed or preceded by mild, rapidly acting emetic, if irritating substance re- mains, 560 Opium, with hot applications or plasters to belly, to control irritation and diar- rhoea, 560 Predigested foods, 560 GASTRO-INTESTINAL CATARRH. Carlsbad, Vichy, or other alkaline mineral water of purgative powers, often useful, 436 Diet for seven-year-old child, 448 Garlic, as a poultice to belly almost equal to spice poultice, 59 Gentian with bicarbonate of sodium useful in children, 208 Hydrastis, especially useful if due to alco- holism, 219 Salicylate of bismuth in the presence of fermentation or putrefaction, 98 Sanguinaria, of service if jaundice is pres- ent, 346 Sodium bicarbonate, 10 to 20 grains, 356 Tar, in 2-gr. (0.1) pills, 329 GIDDINESS. Cod-liver oil with quinine, valuable in old age, 170 Ergot and bromides useful, 193 GLANDS (DISEASED). Ammoniac plaster, as a stimulant to en- larged glands, 66 Ammonium iodide and glycerin (gr. 30 to the ounce [2.0 : 32.0]), locally applied to enlarged tonsils, 69 Carbolic acid (2 per cent, solution), injected into glands threatening suppuration, 128 Cod-liver oil, in lymphatic enlargements, 170 Ichthyol ointment, valuable as an inunc- tion in lymphatic enlargements, 226 Iodine, the best remedy for enlargements, 232 Mercury ointment as an inunction in en- larged glands, 274 Potassium iodide for enlargements of the cervical glands, 229 GLAUCOMA, 560 Atropine, contraindicated, 561 Eserine (gr. 1 to 2 to the ounce [0.05-0.1 : 32.0]), or pilocarpine nitrate (gr. 2 to 4 to the ounce [0.1-0.2:32.0]), dropped into eye if operation is delayed, 323, 561 Hot compresses, leeches, and opiates to re- lieve pain, 561 Iridectomy, the only curative treatment, 561 Pilocarpine in, 325, 561 GLEET. Bichloride of mercury, injection (gr. \ to water ounces 6 [0.025:192.0]), every three or four hours, 270 Cantharidal collodion, applied to under surface of penis, or perineum, 413 Cantharidal, 123 Sandalwood oil, 345 Turpentine, internally, 382 Uva ursi, 383 GOITRE. (See Bronchocele.) GONORRHOZA (ACUTE), 561 Aconite, gtt. 2 (0.1), every two or three hours, if inflammation is high, 563 Almond emulsion, diminishes burning on urination, 60 Benzoic acid, with cannabis indica, useful in later stages, 96 Bicarbonate of sodium or potassium citrate, gr. 10 (0.65), after meals, increasing, if necessary; relieves ardor urinse, 563 Cannabis indica, often used in later stages instead of copaiba and cubebs, 121 Carbolic acid injection, 565 Cinnamon oil, by injection or spray, 163 Cocaine, solution (4 percent.), instilled into urethra before urination, diminishes ardor urina?, 563 Copaiba and cubebs, useful, 177, 183, 563 Diet and hygiene, 564 Erigeron oil, occasionally used instead of copaiba and cubebs, 194 Eucalyptus, valuable in subacute stages, 202 8 ' Hot sitz-bath, prolonged, and hot-water in- jections, useful in females, 569 Hydrastis, one of the best remedies, locally INDEX OF DISEASES AND REMEDIES. 753 and internally in later stages; also as a vaginal wash for females, 219 Lead acetate, injection, gr. 1 to 8 to the ounce, (0.05-0.6:32.0), 252 Lead-water and laudanum, or alcohol and water, applied on a cloth to penis, dur- ing inflammation, 562 Mercury bichloride (1: 20,000 or 1: 40,000), in large quantities to flush urethra; in females, 2 pints of solution (1:4000), thrice daily, to irrigate vagina, 561, 569 Opium or belladonna, hypodermically or in suppository, to control pain in posterior urethritis, at same time discontinuing active treatment, and observing strict hygiene and diet, 564 Prescription for administration of balsams, 563 Prescriptions for checking the discharge, 562; for injection for posterior ure- thritis, 564 Quercus alba, injections, useful in females, 334 Salol, 563 Sandalwood oil, 563 Silver nitrate, injections (gr. J to 3 ounces [0.025 : 90.0]), useful in subacute stage; in females, gr. 4 to 60 to the ounce (0.2-4.0 : 32.0), painted over vagina, fol- lowed by astringent cotton tampon, 284, 562 Urinating with penis in hot water, to re- lieve ardor urina?, 563 Warm baths, lasting one-half to two hours, useful in early stage, 564 Zinc acetate, injection, gr. 1 to 20 to ounce (0.05-1.3 : 30.0) of rose-water, 388 Zinc chloride, injection, gr. 1-2 to the ounce (0.05-0.1: 32), occasionally used in second stage, 389 Zinc sozoiodol, 2 per cent, solution, 358 Zinc sulphate, weak solution, as an astrin- gent, 389, 562 GONORRHEA (CHRONIC j, 565 Bichloride of mercury useful in, 270 Copper sulphate or silver nitrate, solution as an application, after dilatation, to focus of inflammation, 565 Dilatation, if stricture exists, 565 Prescriptions for, 565, 566 Pressure and use of cold, often valuable, 566 Sandalwood oil, to stimulate depraved mu- cous membrane, 345 Silver nitrate, solution, if discharge per- sists after dilatation; also in posterior urethritis, 565 Unna's treatment with coated sounds, pre- scription for, 565 Uva ursi, 383 GOUT, 569 Antipyrin, said to have a specific effect, 78 Chloral, in insomnia, 571 Chloroform liniment, applied over affected part, 151 Cod-liver oil, 170, 571 Colchicum, wine of the root, gtt. 20 (1.3), increasing by gtt. 1 (0.05) every four hours, until symptoms are relieved or appear toxic, in acute types, 173, 570 Collodion, not more than one or two coats; also useful with iodine, 174, 570 Colocynth with hyoscyamus, to unload the bowels, prescription for, 175 Diet, 570 Fowler's solution, gtt. 3 (0.15) in water, a standard remedy in subacute and chronic types, 571 Gentian, 208 Hot air, valuable, 413 Iodide of iron, syrup of, and cod-liver oil if anaemia is present, 571 Iodide of potassium, to relieve night pains; also with colchicum, iu chronic gout, 570 Iodine, ointment or tincture, locally ap- plied to chronic gouty joints, 571 Leeches or venesection, contraindicated, 570 Lithium carbonate or citrate (gr. 5 to 10 to the ounce [0.3-0.65 : 32.0]), locally ap- plied to dissolve deposit around joints, 256, 571 Morphine, hypodermically, to relieve acute pain, 570 Peppermint oil, locally applied, 570 Potassium bromide, the best remedy for in- somnia, 571 Potassium permanganate, 314 Salicylates in large dose may be useful in, 341 Sodium bicarbonate and linseed oil (1: 9), locally applied to joints, 570 Stimulants, ether hypodermically, opium except in brain or kidney disturbances; diuretic and alkaline drinks and coun- ter-irritation, in retrocedent gout, 571 Water, distilled or medicinal, in large amounts, 569 GRANULAR LIDS. (See Conjunctivitis, Granular.) GRAVES'S DISEASE. (See Exophthal- mic Goitre.) GRIPING. Allspice or ginger, to prevent griping of purgatives, 59, 209 GROWTHS (PATHOLOGICAL). Acid nitrate of mercury, 274 Caustic potash, or soda, occasionally used to destroy, 134 Chromic acid, as a caustic, to destroy growths on skin or mucous membranes, 154 Injections of tincture of iodine in ovarian tumors, 233 Lime as an escharotic on hairy growths, 115 Methylene blue, 277 Nitric acid, 285 Pyoktanin, 277 Sodium ethylate to remove hairy growths, 356 Thiosinamine has been used with some success in malignant growths, 375 GUMS (DISEASES OF). Burnt alum, useful applied to swollen gums, 63 4S ES AND REMEDIES. 754 INDEX OF Catechu, as a mouth-wash, for spongy gums, 133 Cocaine, locally applied, in soreness and tenderness of gums, 166 Iodine, solution (gr. 1 to the ounce [0.05: 32.0], locally applied, followed by rins- ing mouth, when gums are retracted, 233 Myrrh, tincture, locally applied, to spongy or tender gums, 280 HAY FEVER. Arsenic, 85 Cocaine, with bismuth and morphine, as a snuff, 167 Resorcin, solution, 2 per cent., in spray, 335 Terpine hydrate, in full dose, 374 HEADACHE, 571. Acetanilid, 46 Belladonna, valuable in young people, 95 Bleeding, 572 Caffeine, with antipyrin or sodium bro- mide, in nervous headache, 111, 572 Camphor, with acetanilid or antipyrin, in nervous headache, 117 Cannabis indica, when at menopause or due to retinal asthenopia, 120 Capsicum plaster to nape of neck, 125 Cimicifuga, if due to eye-strain, 156 Colchicum, in gouty headache, 573 Croton chloral, if due to eye-strain or asso- ciated with sick stomach, 182 Cup, to nape of neck, in congestion, 572 Ergot, if due to congestion, 193, 572 Eucalyptus, if headache be rheumatic or malarial, 202 Gelsemium, if due to nervous troubles or eye-strain, 208 Horseback exercise and sleep very useful in obtaining relief from nervous head- ache, 572 Hydrobromic acid, if due to eye-strain in nervous women, 107 Ice-bag, applied to head, or leeches behind ears, in severe cases, 572 Kola, very useful in elixir or tincture for sick and neuralgic headaches, 249 Liquor magnesii citratis, in sick headache, 259 Magnesium carbonate, gr. 5 to 60 (0.3-4.0), in sick headache due to gastric acidity, 259 Mustard foot-bath and plaster to nape of neck, in congestion, 279, 572 Nux vomica, gtt. 1 (0.05) every five or ten minutes till 10 drops (0.65) are taken, in sick headache, 295 Phenacetin, if due to eye-strain or neural- gia, 316 Potassium bromide, 103 Prescriptions for, 572, 573 Salicylic acid or iodide or acetate of potas- sium, if due to gout, 572 Sodium bicarbonate, as an antacid in sick headache, 356 Strychnine or nux vomica, in sick head- aches or if due to eye-strain, 295, 572 HEART DISEASE, 573 Aconite or veratrum viride, often useful in palpitation and hypertrophy, 51, 577, 578 Adonidin, often of service when digitalis fails, 52, 576 Ammonia and ether, followed by digitalis and alcohol, in heart failure, 65, 577 Amyl nitrite, in single whiffs, often relieves cardiac failure, 70 Barium chloride, in heart failure, 91 Baths by Schott's method ; formula for, 580 Belladonna, when arhythmia is present, 577; in palpitation, 93 ; plaster in hyper- trophy, 578 Cactus grandifloris, useful in valvular dis- ease with incompetency, cardiac weak- ness and palpitation, 110, 577 Caffeine, very useful, 111, 578 Camphor in palpitation, 117 Cimicifuga, as a tonic in fatty and irritable heart when digitalis fails, 156 Citrate or bitartrate of potassium with digi- talis when secretion of urine is scanty, 577 Convallaria majalis, in cardiac arhythmia, 177 Diet, exercise, and hygiene, 578, 579, 580 Digestive remedies, in palpitation due to indigestion, 577 Digitalis, to be tried in all heart troubles, except in simple or compensatory hyper- trophy, 188, 574, 576 Hoffman's anodyne, very useful in palpi- tation due to indigestion or tobacco, 217 Hydragogue cathartics for the dropsy and portal engorgement, 577 Iodides to relieve tension in fatty heart, 579 Iron in palpitation due to anaemia, 577 Iron, arsenic, and simple bitters for asso- ciated debility and anosmia, 577 Kola, useful in cases with debility, 249 Nitro-glycerin, when arterial tension is high, 577, 579 Nux vomica, as a stimulant, 577, 579 Opium, if dyspnoea prevents sleep, 302 Potassium bitartrate or citrate with digi- talis for scanty secretion of urine, 577 Rest in bed essential when aconite is used, 579 Sparteine, in arythmia or palpitation, also as a substitute for digitalis, if it fails, 350, 576, 577 Strophanthus, if digitalis fails, 369, 576. 578 Suprarenal gland, 369, 579 Venesection followed by digitalis for over- distended right ventricle, 577 Veratrine ointment, locally in palpitation, 577; in hypertrophy, 578 Veratrum viride, 386 HEMATEMESIS, 584 Ergot, hamamelis, or ipecac, in slow bleed- ing, 584 Ice, cracked, swallowed frequently, accom- panied by Monsel's solution, gtt. 3 (0.15) in a half-tumblerful, of water, every fifteen minutes, 584 Iron, tincture of chloride, or turpentine, internally, 584 Lead acetate with morphine or opium, gr 2 to 3 (0.1-0.15), in pill, 584 Monsel's salt, gr. 2 to 3 (0.1-0.15), in pill. 244, 584 INDEX OF DISEASES AND REMEDIES. 755 Silver nitrate, gr. \ (0.015) in pill, in slow bleeding, 584 Tannic acid, gr. 20 (1.3), to drachm ; must not be given with Monsel's solution, 584 HEMATURIA, 586 Alum, gr. 2 to 3 (0.1-0.15) to water 1 ounce (32.0), injected into bladder, if alarming, 586 Astringent injections, should be used only when bleeding is alarming, 586 Camphor, gr. 10 to 20 (0.6-1.3), in divided doses, iu pill, 586 Cannabis indica, useful in some cases, 586 Ergot, 586 Erigeron, 586 Gallic acid, gr. 20 (1.3), very valuable, 206, 586 Hamamelis, injected daily into bladder, or used internally, 215 Hyposulphite of sodium, 5 to 15 grs. (0.3- 1.0), if due to malaria, 357, 586 Morphine and atropine hypodermically and cups over kidneys in hematuria, 587 Prescription for, 586 Quinine, usually harmful, unless due to malaria, 587 Rhus aromatica, 337 Turpentine, 381. 586 HEMOPHILIA. Calcium chloride, 113 HEMOPTYSIS, 583 Acetanilid, has been recommended, 47 Aconite, to prevent pneumonia following, contraindicated in exhaustion, 584 Alum, solution (gr. 20 to the ounce [1.3: 32.0]), in fine spray, 63 Chloral and bromides, to allay nervous ex- citement, 584 Ergot, fluid extract, 1 to 1\ drachms (4.0- 6.0), internally, 583 Esmarch bandages to limbs when aconite cannot be used because of exsanguina- tion. 584 Gallic acid, gr. 20 to the ounce (1.3: 32.0) of water, when ergot is not at hand, 206, 583 Hamamelis, 215 Ice or dry cup over bleeding spot, 584 Ice or ice-cold compresses to the scrotum or vulva in, 584 Ipecac, in small doses, very effective, 238 Morphine, hypodermically, to allay nervous- ness and cough, 301, 584 Tannic acid, Monsel's solution, or alum, used in spray, as styptics, prescriptions for, 244, 372, 583 HEMORRHAGE, 581 Alum, a useful styptic, applied to bleeding vessel, 62 Antipyrin, 79 Arnica, 82 Cinnamon in uterine hemorrhage, 163 Compress, soaked in antiseptic liquid or filled with antiseptic powder, preferable to styptics, 582 Hamamelis, useful for uterine oozing, and bleeding from the bladder, 215 Hypodermoclysis, 428 ' Ligation preferable to styptics, when appli- cable, 581 Monsel's solution, 244 Oil of erigeron, 194 Packing of astringents, if bleeding point cannot be reached by compression, or for ligation, 582 Sulphate of sodium by the mouth or intra- venously ; useless hypodermically, 357 Tannic acid, 372 Transfusion, 441 HEMORRHAGE (INTESTINAL), 585. (See also Hemorrhage.) Chloride of calcium, 585 Enemas, styptic, for hemorrhage from rec- tum or colon ; alum (gr. 10 to the ounce [0.65:32.0]), copper (gr. 5 to the ounce [0.3:32.0]), Monsel's solution (dr. 1 to 2 ounces [4.0:64.0]), Monsel's salt (gr, 10 to the ounce [0.65 : 32.0], or drachm j [2.0] to water 2 ounces [64.0]), chlorate of potash (gr. 10 to 25 to the ounce [0.6-1.6:32.0]), and tannic acid (gr. 20 to ounce [1.3:32.0]) of glycerin and water, 585 Ergot, 585 Ice, by mouth, and to the belly, and Mon- sel's salt, gr. 3 (0.15), in hard pill, every half-hour or oftener, 585 Ice-water injections in bloody purging of dysentery, 586 Lead acetate and camphor, in pill, of ser- vice in some cases, 585 Monsel's solution not advisable, 244 Sulphuric-acid, gtt. 5 to 10 (0.3-0.65) in water, 585 Tannic acid, when Monsel's salt is not at hand,585 Turpentine, in capsule or emulsion, when bleeding is not active, 381, 585 HEMORRHOIDS, 587 Aloes, 61 Carbolic acid injection dangerous, 588 Cocaine and iodoform ointment, prescrip- tion for, 588 Cold-water injections in the morning, re- lieve congestion and cause easy evacua- tion, 405, 588 Ergot, sometimes useful in bleeding piles, 194 Gallic acid and ointment of stramonium, equal parts, 206 Gallic acid and opium, suppository, pre- scription for, 588 Hamamelis, internally or as a lotion or in- jection, 216, 588 Hygiene and general rules, 588 Iodoform suppository, if ulceration is pres- ent, 236 Lead-water and laudanum lotion after acute stage is passed, 588 Linseed oil, 205 Nitric acid, lightly touched to one or two points, 286, 588 Potassium chlorate, with laudanum, as an injection, 141 Poultice, to effect reduction, 588 Quercus alba, as an astringent wash, 334 Stillingia, prescription for, 361 Sulphur, to produce soft passages, 367 ES AND REMEDIES. 756 INDEX OF Tannic acid, suppositories in bleeding piles, 372 HEPATIC ABSCESS, 589 Active treatment for dysentery, if present, 590 Ammonium muriate, thought to be of value, 68 Aspiration, when pus forms, 589 Diet, 590 Quinine and iron, after abscess develops, 590 HEPATIC CIRRHOSIS. Ammonium chloride, 68 Iodoform, highly recommended, 236 Nitro-muriatic acid, in early stages, 288 Potassium iodide, often useful in early stages, 229 Sodium phosphate very useful, 318 HEPATITIS (ACUTE), 589 Aconite in early stages, 589 Cantharidal blister, small, over right hypo- chondrium ; if impracticable, use mus- tard plaster, 589 Hot cloths, over counter-irritant, may re- lieve pain and aid in formation of blis- ter, 589 Saline purgatives, preceded by calomel, gr. 1 (0.05), in divided doses, if constipation exists, 589 Sweet spirit of nitre with potassium citrate, or diuretic waters, to regulate kidneys, 589 Veratrum viride, 386, 589 HEPATITIS (CHRONIC AND SUBACUTE), 590 Ammonium chloride, useful in subacute forms, 68 Antisyphilitic treatment, if due to syph- ilis, 590 Aspiration, frequently repeated, may effect a cure, 590 Nitro-muriatic acid, internally and exter- nally, most useful remedy, 288, 590 Potassium iodide, useful in all cases, 590 HERNIA. Chloroform or ether inhalations, to relax muscles during reduction, 150, 199 HICCOUGH, 590 Amyl nitrite, 591 Belladonna, 94 Camphor, spirit of, dose 1 drachm (4.0), 117, 591 Capsicum, tincture, gtt. 2 to 3 (0.1-0.15), 591 Chloral, 138 Chloroform, 591 Emetics or purges when gastric or intesti- nal irritation is present, 591 Ether, sprayed on epigastrium, 591 Hoffman's anodyne, especially valuable, 216, 591 Musk, gr. 10 (0.65), given by rectum, valu- able in all cases, especially in typhoid fever, 279. 591 Nux vomica, accompanied by mineral acids, if due to indigestion, 591 Oil of amber, gtt. 5 to 10 (0.3-0.65), in cap- sule, one of the best remedies, 63, 591 Pilocarpine hydrochlorate, hypodermically or hot pack if due to uraemia, 591 Valerian, tincture of, dose 1 drachm (4.0), 591 HYDROCELE. Iodine, injections, after evacuation of the sac, the best curative remedy, 233 HYDROCEPHALUS. Potassium iodide, to cause absorption of fluids, 228 HYSTERIA. Calcium bromide, 106 Hops, as a nervous sedative, 218 Monobromated camphor, to produce sleep, 119 Oil of amber, 63 " Pill of three valerianates," recommended, 384 Potassium bromide, 103 Valerian, 383 Valerianate of ammonium, 69 Valerianate of iron if associated with anaemia, 245 IMPOTENCE. Cannabis indica, with strychnine, nux vomica, or ergot, if no organic trouble exists, prescription for, 120 Cantharis, with nux vomica and iron, may restore sexual power if loss is due to excess, 123 Cold douche to perineum and testicles, in atonic types, 408 Gold, chloride of, and sodium, gr. fa (0.003), 212 INCONTINENCE OF URINE, 591 Alkalies, 592 Antiseptic fluids, to cleanse bladder, in paralysis, 593 Arsenic, with nux vomica, in weakness of spinal centres, prescription for, 592 Belladonna, if due to vesical spasm, 94, 592 Bromides with chloral, if due to vesical spasm, 103 Buchu, with sweet spirit of nitre, valuable in some cases, 109 Cantharides, gtt. 1 (0.05), with alkaline diuretics, thrice daily, in adults, 123, 593 Catheterization, in retention or paralysis, 593 3 Circumcision, if prepuce is redundant, re- lieves some cases, 592 Diuretic waters, used for years, necessary in some cases, 593 Fowler's solution, gtt. i to 1 (0.025-0.05) in chronic types due to atony, 592 Hyoscyamus, if due to irritable bladder, 224 Potassium citrate when due to acidity, 332 Rhus aromatica, in incontinence of chil- dren, due to atony, 337 Santonin, often valuable when other reme- dies fail, 347 Strychnine. 592 INDEX OF DISEASES AND REMEDIES. 757 Sweet spirit of nitre and potassium citrate, if urine is dark and concentrated, pre- scription for, 370, 592 Worms removed from vagina often cure, 592 INDIGESTION (GASTRIC AND INTES- TINAL), 593 Alkalies, before meals in atonic states, dur- ing or after meals when the secretion of acid is excessive, 594, 595 Ammonium chloride, in painful forms, 68 Asafoetida, in indigestion of old age, asso- ciated with flatulence, 88, 597 Bicarbonate of sodium with bitters, 594 Bitter tonics, useful in atony, contraindi- cated in gastric irritation, 594 Bromide of strontium, in excessive secre- tiou, when not due to ulcer, 362, 596 Bryonia, when dependent upon gastric or intestinal atony, 108 Carbolic acid and bismuth, 596 Chirata, if liver is torpid or constipation is present, 135 Chloroform spirit, gtt. xx (1.3), often of great value, 598 Chloral, creosote, sodium hyposulphite, or thymol, with lavage, when fermentation is excessive, 596 Diastase when starchy foods are not di- gested, 184 Diet, 593, 594 Fats, excluded in fermentative types, 596 Gold, chloride of, and sodium, when epi- gastric pain is present, 212 Hydrochloric acid, combined with carda- moms, in atrophy of the gastric tubules, cancer, or intestinal dyspepsia, 596 Hyoscyamus, belladonna, opium, bromides, and bismuth, when there is hyperacid- ity, 595 Lavage, 596 Leptandra, of great value in intestinal types, prescription for, 254 Nitrate of silver, especially where an ulcer is present, 596 Nitro-hydrochloric acid or nitric acid, val- uable in many cases, 286, 288, 597 Ox-gall, 305 Pancreatin, with sodium bicarbonate and alkaline mineral waters, in intestinal types, 597 Papain, 310 Podophyllin or mercury in lientery, 597 Prescription for torpid liver of indigestion, 598 Prescription for flatulence of intestinal in- digestion, 597 Rhubarb, quinine, condurango, and nux vomica, useful tonics, 594 Salol iu intestinal form with fermentation, 345 Serpentaria, as a tonic, 353 Test meal as a means of diagnosis, 594 Volatile oils, prescription for, 597 Yellow oxide of mercury, gr. fa or fa (0.001-0.0012), in trituration, if there is foul belching or ill-smelling stools, 275 INFLAMMATION. Cannabis indica, valuable in chronic types, 121 Cocaine, in acute types, prescription for, 166 Flaxseed for inflamed mucous membranes, 205 Hop poultice, 218 Liquor plumbi subacetatis, useful as a top- ical application, 253 Opium, 300 Sulphurated lime useful to check, 116 Tartar emetic, in sthenic inflammation, 74 Turpentine stupe, 381 Veratrum viride, 386 INFLUENZA, 598 Aconite, sweet spirit of nitre, and citrate of potassium in combination, valuable in early stage, 599 Alcohol, 601 Antipyrin, phenacetin, and acetanilid should only be used in small doses to allay pain, 598 Belladonna, combined with strychnine, if there be vasomotor paresis, 601 Bromides, codeine or morphine, if cough be excessive, 602 Cannabis indica, often valuable if pushed, for irritative cough, 602 Castor oil or magnesium sulphate for con- stipation, 602 Chloral, chloralamide, or sulphonal, for in- somnia, 602 Cold bath, preferable to antipyretics for re- duction of temperature, 599 Cups, contraindicated, 600 Ergot, cannabis indica, with bromides, often relieve vertigo, 600 Monobromated camphor, 119 Phenacetin, 315 Remedies for bronchitis when present, 602 Salol and phenacetin, valuable in combi- nation, to allay irritation and pain, 599 Sandalwood oil, for excessive cough, 346 Steam inhalations, laden with vaporized drugs, for cough, 602 Strychnine, preferable to digitalis if there be tendency to collapse, 601 INSANITY. (See Mania, Acute.) INSOMNIA, 603 Amylene hydrate, useless if due to pain, 604 Bath, cold in cerebral anaemia, hot in ner- vous irritability, 405 Bromide of potassium with Fowler's solu- tion, in nervous females, prescription for, 603 Cannabis indica, prescription for, 120 Chloral, useful if not due to pain, prescrip- tion for, 138, 603 Chloralamide, gr. 15 to 60 (1.0-4.0), in wine or capsule, in nervous insomnia, 139, 604 Chloralose, 2 to 7 grains (0.1-0.5), in cap- sule, 139 Chlorobrom for insomnia of melancholia and acute mania, 139 Croton chloral, preferable to chloral, if due to pain, 182 Duboisine more useful than hyoscine, 190 Hop pillow, 218 ES AND REMEDIES. 758 INDEX OF Hot-water bags to feet and cold to head, or general hot bath, 604 Hyoscine, gr. TJn to fa (0.0006-0.0008), by mouth, or gr. T^ to TJ5 (0.0004-00006,) hypodermically, in mania or hysteria, 224, 603 Hypnal, useful in insomnia due to pain, 225, 604 Morphine with chloral, if due to pain, pre- scription for, 603 Opium, only to be used in pain, 300 Paraldehyde, 310, 604 Potassium bromide, in nervousness and overwork, 104 Scopolamine, if due to nervousness, 349 Somnal, minims 10 to 40 (0.65-2.6), in liquorice and water, 358, 604 Sulphonal, prescription for, may be given in hot water, 365, 604 Tetronal, useful, 380 Trional, in 15-grain (1.0) doses, 380, 604 Valerian, in nervousness, 383 INTERMITTENT FEVER, 605 Alcohol, contraindicated during chill, 606 Anesthetization, has been employed to put off paroxysm, 606 Arsenic, in intervals between attacks, as an antiperiodic, 84, 605 Calomel, gr. £ to i (0.01-0.015), every fif- teen minutes until 1 grain (0.06) is taken, four or five hours before quinine, if constipation is present, 605 Chloroform inhalations, preceded by lauda- num, by mouth or rectum, or morphine, gr. $ (0.01), with atropine, gr. fa (0.001), hypodermically, if death threatens dur- ing chill, 606 Cool drinks and sponging, in fevered stage, cold with friction, 608 Digitalis or strychnine, to relieve internal congestion during chill, 606 Eupatorium useful in, 203 Ipecac or zinc sulphate, as an emetie, if chill follows full meal, 606 Methylene blue, 1 to 4 grains (0.05-0.2), 277,606 Phenocoll, sometimes useful, 318 Podophyllin, gr. fa to & (0.006-0.007), pre- ceding quinine, if constipation is pres- ent, 605 Potassium or sodium nitrite, gr. 10 (0.65), have been employed to put off attack, 605 Quinine, as a prophylactic and antiperiodic, 605 INTERTRIGO. (See Chapping.) INTESTINAL CATARRH. Ammonium chloride, useful in subacute types, 68 Chlorate of potassium, injections (gr. 20 to the ounce [1.3:32.0]), in acute rectal catarrh, 141 Iodide of potassium, if ammonium chlo- ride fails to relieve, 229 Leptandra, fluid extract, dose 20 minims to 1 drachm (1.3-4.0), 254 Salol, 344 INVOLUTION (ANOMALIES OF), 647 Applications of nitric acid and silver ni- trate useful in lacerations, 648 Cannabis Indica, of great value in subinvo- lution, 121 Cimicifuga in subinvolution, 156 Curette in subinvolution due to retention of hypertrophic endometrium, 647 Digitalis in subinvolution due to sluggish circulation, 647 Ergot, quinine, and strychnine, in pill, if due to fibroids, 647 Purgatives, disinfectants, and possibly hot water locally applied, if due to inflam- mation, 647 Removal of placenta, if adherent, 648 IRITIS, 606 Atropine, the best local remedy, 94, 607 Daturine, scopolamine, or duboisine, when atropine cannot be used, 607 Iced compress, in early stage of traumatic iritis, 607 Iodide of potassium, alone or with mer- cury bichloride, following mercurial impression, in syphilitics, 607 Leeches and dry heat or hot fomentations, to relieve pain, 607 Mercury, preferably by inunction, if due to syphilis, 607 Morphine, if pain is severe, 607 Paracentesis, 607 Pilocarpine, internally if vitreous becomes opaque, also in gonorrhoeal types, 607 Salicylic acid or oil of gaultheria, followed later by potassium iodide, in rheumatic iritis, 607 Saline laxatives, during course of disease, followed by iron, after cessation of spe- cific treatment, 608 Scopolamine in early stages of, and in plastic, 349 Subconjunctival injections of sublimate or of salt solution recommended in syph- ilitic iritis, 607 Turpentine accompanied by potassium iodide, in plastic iritis, following sec- ondary syphilis, 607 Zollicoffer's mixture, useful in chronic types, 607 IRRITABILITY. Almonds, as a drink in irritability of in- testines and air-passages, 59 Cantharis, recommended in irritable blad- der of women and children, 123 Cimicifuga, in uterine irritability, 156 Hops, in vesical irritability, 218 Hydrocyanic acid in irritability of the stomach, 221 Hyoscyamus for vesical irritability with incontinence, 224 Petrolatum, as a soothing agent in gastro- intestinal types, 315 Piperazine, in bladder irritation due to ex- cess of uric acid, 327 Potassium bromide, in irritability of phar- ynx, 103 JAUNDICE. Calomel, gr. £ (0.01), every half-hour till gr. £ (0.025) is taken, if due to cold, 271 INDEX OF DISEASES AND REMEDIES. 759 Carbolic acid, gr. 10 (0.65), with water and glycerin, each 2 drachms (8.0), locally applied in itching of jaundice, 128 Citric acid, in catarrhal form, 164 Hydrastis, useful in subacute types, 219 Iodoform, highly recommended, 236 Manganese sulphate, may be tried in ma- larial types, 260 Pilocarpine, useful unless due to malignant disease, 325 Salol, said to be of value, 344 Sodium phosphate, of value, 318 JOINTS (ENLARGED). Tartar emetic ointment, 74 Turpentine liniment, 382 KELOID. Ichthyol ointment, 226 Thiosinamine, 10 per cent, solution in al- cohol, injected into the growth, 375 KERATITIS (INTERSTITIAL), 608 Antiseptic lotions, in marked ciliary con- gestion, 608 Antisyphilitic treatment, if due to syph- ilis, 608 Atropine, in ciliary congestion, to prevent iritis, 608 Leeches, to temple to relieve pain, if pa- tient is not too young for bleeding, 608 Thymol iodide, as a dusting powder, 377 KERATITIS (PHLYCTENULAR), 608 Atropine, to relieve pain, 609 Boric acid, solution to relieve congestion, 608 Cocaine, not advisable in photophobia, 609 Cold-water douche on closed eyelid, to re- lieve photophobia, 609 Creolin, 182 Dark glasses, to protect eyes, 609 Tonics and alteratives, with strict hygiene and regulated diet, associated with local treatment, 609 Yellow oxide of mercury ointment, or cal- omel as a dusting powder, to hasten cica- trization, contraindicated if iodine is being given, 609 KERATITIS (SUPPURATING), 609 Antiseptic lotions, to limit sloughing, 609 Atropine, instilled into eye, to limit sloughing, 609 Cautery, actual, best means of preventing perforation, 610 Curetting floor of ulcer, if perforation threatens, 609 Hot compresses of carbolized water and atropine drops, 609 Massage of cornea and introduction of yellow-oxide ointment to remove scars of ulcers, 610 Pressure bandage, if perforation threatens, 609 Silver-nitrate or tincture of iodine applied to margin of ulcer does good, 609 Subconjunctival injections of salt solution to absorb corneal nebula, 610 LACHRYMAL ABSCESS, 610 Division of canaliculi and washing out sac with antiseptic fluids, and insertion of probes into ducts after inflammation subsides, to restore patulency, 610 Formaldehyde (1: 3000) injected through external opening if there is purulent discharge, 610 Hot compresses, composed of lead-water and laudanum, to relieve pain, 610 Puncture of abscess, if rupture threatens, 610 LARYNGISMUS STRIDULUS. Amyl nitrite, 70 Belladonna, 94 Bromide of potassium, 103 Gelsemium, 208 LARYNGITIS (ACUTE), 610 Aconite, to control fever, 611 Antipyrin, as a spray, 79 Bromides, useful in full doses, 60 to 120 grains (4.0-8.0) a day, 103, 611 Calomel, small and repeated doses, fol- lowed by saline purges, along with hot mustard foot-bath and demulcent drinks, 611 Creosote spray in subacute laryngitis, 180 Cubebs cigarettes, useful for hoarseness of subacute forms, 183 Dover's powder, if necessary, to give rest, 301 Iodine, painted over throat, useful ou third or fourth day, 612 Mustard plaster or hot applications over larynx,611 Oil of amber and olive oil, half and half, well rubbed into the skin of the neck and chest, 64, 612 Prescriptions for sprays, 611 Silver nitrate, 284 Steam inhalations, charged with benzoin ; often advantageous to add menthol, 96, 611 LEPRA. Arsenic, 85 LEUCOCYTHEMIA. Arsenic, very useful in full ascending doses, 84 LEUCORRHOZA, 612 Alum, gr. 10 to 20 to the ounce (0.65-1.3 : 32.0), as a vaginal wash, 63 Ammonio-ferric alum gr. 2 to 5 (0.1-0.25), in atonic types, 240 Belladonna, gr. 1 to 2 (0.05-0.1), with tan- nic acid, gr. 6 to 8 (0.5), applied on cot- ton, in disease of uterine cervix, 93 Cantharidal collodion, applied over groins to produce blister, 613 Goodell's prescription for, 613 Haematoxvlon, used internally, of service, 215 Hot sitz-bath, or vaginal injections of hot water, if due to uterine congestion, 423 Hydrastis, injections, 219 Iron, with tonics, if due to excessive lacta- tion or exhausting life, 612 Myrrh, if due to uterine trouble, 280 Nitrate of silver, when there is cervical ulceration, 284 ES AND REMEDIES. 760 INDEX OF DISEA Potassium permanganate (drachm ' [2.0] to water 1 pint [500.0]), as an injection, if discharge is foetid, 613 Prescriptions for injection, 613, 614 Ringer's prescription for wash, 613 Tampon, saturated with iodoform and tan- nic acid, 372, 613 White-oak bark (ounce 1 [32.0] to water 1 pint [500.0]), or tannic acid and glycerin (ounce 1 [32.0] to 2 quarts [2 litres] of water), as an injection, 334, 613 LICHEN. Arsenic, usually cures, 85 Cantharides, 123 LID ABSCESSES, 614 Treatment, same as for other abscesses, 614 LITHEMIA. (See Gout.) LOCOMOTOR ATAXIA. Acetanilid, 46 Antipyrin, relieves lancinating pains, 78 Exalgine, prescriptions for, 204 Phenacetin, 317 Potassium bromide, to prevent laryngeal crises, 103 Suspension, 440 LUMBAGO, 614 Acupuncture, often relieves, especially if pain is bilateral, 614 Antifebrin, dose gr. 4 to 8 (0.2-0.5), 614 Antipyrin, dose gr. 10 to 20 (0.65-1.3), 614 Chloroform liniment, 151 Cod-liver oil, 170 Foot-bath and Dover's powder, before re- tiring, often relieves, 614 Hot poultice to back often useful, 614 Ice-bag or ether spray to loins, if hot ap- plications fail, 614 Ironing back with laundry iron, skin being protected by cloth or paper, very effi- cient, 614 Monobromated camphor, with other drugs, very useful, 118 Mustard or capsicum plaster or blister over painful spot, may relieve, 614 Phenacetin and salol, of each 5 grains (0.3), 614 Potassium iodide or salicylic acid, if recov- ery is slow, 228. 614 Salicylic acid, useful, 341 Turpentine, gtt. 20 (1.3), said to be useful, 382 LUPUS. Acid nitrate of mercury, 274 Europhen, in ointment or powder, 204 Ichthyol ointment, 226 Iodine, as a paint, to retard spread, 233 Thiosinamine, useful in, 375 MALARIAL FEVER. (See Intermittent and Remittent Fevers.) Antipyrin, 78 Arsenic, as a cure and prophylactic, 84 Calomel, 267 Eucalyptus, instead of quinine, when it cannot be borne, 202 Gelsemium, of doubtful value, 208 Gentian, in malaria associated with dys- pepsia, 208 Hydrastis, said to be antimalarial, 219 Iodine externally and iodide of potassium internally for enlargement of the spleen, 229 Methylene blue, 1-4 grains (0.05-0.2), 277 Phenocoll, useful in some cases, 318 Pilocarpine, may be used to abort, 325 Fiperin has been used with varying suc- cess, 311 Quinine, the best remedy as a prophylactic and a cure, 159 Warburg's tincture, said to excel quinine in pernicious malarial regions, 387 MANIA (ACUTE), 615 Anaesthetics, or apomorphine in emetic dose, to relax muscular system, if pa- tient is very violent, so that other rem- edies may be administered, 615 Bromide of potassium, as a soporific, 104 Cannabis indica, with large dose of bro- mides, particularly serviceable, 615 Chloral, in full doses, if kidneys are healthy, 615 Chloroform for insomnia, 150 Cimicifuga, fluid extract, gtt. 20 to 30 (1.4- 2.0), thrice daily, in cases occurring after confinement not due to permanent causes, 615 Cold douche to head while body is im- mersed in hot water, often of service, 615 Duboisine, for insomnia, 190 Hyoscine hydrobromate, gr. jj^ (0.0006), when necessary to quiet patient quickly, 615 Morphine, in full dose, may be required to quiet patient, 615 Scopolamine as a soporific, 349 Sulphonal as a hypnotic, 365 MARASMUS. Cod-liver oil inunctions, one of the best remedies, 170 MASTITIS. (See Breast, Inflamed.) MELANCHOLIA, 615 Chloroform for insomnia, 150 Nitro-muriatic acid gtt. 5 (0.3), in water after meals, if associated with oxaluria, 289, 615 Phosphorus, useful in some cases due to overwork, 321 MENINGITIS (ACUTE), 616 Aconite or veratrum viride, in early stages to depress circulation, 616 Alcohol, given with food in second stage, if there be asthenia, 617 Belladonna, often useful, especially when opium and calomel are contraindicated, 616 Blister to nape of neck, in early stage, to prevent effusion : also in comatose state, 616 Bromides and chloral, best agents to allay nervous symptoms, 616 Calomel, gr. £ (0.025), with opium gr. i INDEX OF DISEASES AND REMEDIES. 761 (0.012), every half-hour, in early stage, until effect is manifested; the deodor- ized tincture, gtt. 2 to 5 (0.1-0.3), every two hours, or less, preferable to powder of opium in some cases, 267, 616 Ergot, in stage of exudation, 616 Ice-bag to head, in early stage, 616 Leeches to nape of neck, in early stage, 616 Milk diet, in second stage, 617 Opium, useful in second stage, 300, 617 Quinine, contraindicated in acute stage, 617 Venesection in early stage of sthenic cases, if aconite or veratrum viride is not at hand, 616 MENINGITIS (CHRONIC). Phosphorus, 321 MENOPAUSE. Bromide of potassium, in nervous disor- ders, 103 Cannabis indica, alone or with aloes and iron, if anaemia or constipation exist, in headaches of the menopause, 121 Eau de Cologne, saturated with camphor, locally applied in headache or drowsi- ness, 118 Valerianate, of ammonium, in nervous dis- orders, 69 MENORRHAGIA AND METRORRHAGIA, 581 Bromide of potassium or sodium, gr. 10 (0.65) once or twice daily if bleeding is irregular, 104, 582 Cannabis indica, recommended, 121, 582 Cinnamon oil, drachm i (2.0), when erig- eron is not at hand, in oozing flow, 582 Dry cups, over sacrum, if due to conges- tion, 582 Ergot, fluid extract, gtt. 10 to 60 (0.65-4.0), best remedy in active bleeding, 193, 582 Erigeron, oil of, minims 3 to 5 (0.15-0.3), in capsule or emulsion, the best remedy for oozing, 582 Hamamelis, distilled extract, drachm 1 (4.0), thrice daily, in irregular bleeding, 582' Monsel's solution (50 per cent.) full strength locally applied, if due to polypus. 244 Rhus aromatica, highly recommended in menorrhagia, 337 Rue, in atonic menorrhagia, 338 Savine, oil of, gtt. 5 to 10 (0.3-0.65), in cap- sule or emulsion, every three or four hours, as a tonic in menorrhagia, 348 Turpentine, often of value, 381 MIGRAINE, 625 Amyl nitrite, 70 Bromide of potassium, with caffeine, almost a specific, if due to eye-strain, 104 Cannabis indica, tincture, gtt. 20 (1.3\ hourly, or- extract, gr. i to i (0.015-0.0:'. , every two hours, best treatment, 120 625 Croton chloral, very efficient, especially if fifth nerve is involved, 182 Gelsemium, with cannabis indica, to abort, 208, 625 Methylene blue, gr. 1 to 2 (0.06-0.1) in capsule, 278 Phenacetin, 317 Salicylic acid, of great service in rheu- matic types, 341 MILK DEFICIENCY, 650 Electricity, 650 Treatment for intercurrent affection, if due to such cause, 650 MORPHIOMANIA. (See Poisoning from Opium, Chronic.) Bromide of potassium, 104 Phosphorus, of service in sequela? of mor- phiomauia, 321 MUCOUS MEMBRANE (DISEASES OF). Acacia, as a mucilaginous drink in irrita- tion and inflammation of upper air- passages, 43 Bismuth, as an astringent, to inflamed membranes, 97 Flaxseed, as a soothing demulcent, 205 Glycerole of aloes, locally applied to fis- sures, valuable, 61 Opium, suppositories, gr. I (0.015), useful in rectal inflammation, if not an acute catarrh, 301 Pareira, useful in chronic genito-urinary inflammation, 301 Terebene, useful in subacute and chronic genito-urinary inflammation, instead of sandalwood or copaiba, 373 Zinc sulphate, weak solution, as an astrin- gent, 389 MUSOE VOLITANTES, 617 Alteratives and correction of anomalies of refraction, 617 MUSCULAR STIFFNESS. Hot laundry iron passed over part, skin being protected by layers of paper or cloth, often relieves, 423 MYALGIA, 617 Ammonium chloride, if due to cold or bruises, 617 Camphor liniment, 118 Chloroform liniment, 618 Cimicifuga, fluid extract gtt. 20 to 1 drachm (1.3-4.0), 617 Clove oil, added to liniment, as a counter- irritant, 165 Iodide of potassium or salicylates, if due to rheumatism, 617 Iodine ointment, pure or diluted with lard, 617 Massage or good rubbing, very necessary, 618 Potassium acetate or citrate, gr. 20 (1.3), may be tried, 617 Poultices, hot as can be borne, 618 Prescription for liniment, 618 MYXEDEMA. Thyroid gland, or extract of, a specific for, 377 762 INDEX OF DISEASES AND REMEDIES. NASAL CATARRH (ATROPHIC), 618. Dobell's solution, as a cleansing wash; car- bolic acid may be increased, or thymol and eucalyptus substituted for it, to re- lieve odor, 618 Galvano-cautery, or strong silver nitrate solution, if ulcerations are present, 619 Hydrogen peroxide, 618 Iodine and glycerin (gr. 6 to 8 to the ounce [0.4-0.5:32.0]), with potassium iodide sufficient to make solution, valuable, locally applied, 619 Listerine, may be added to Dobell's solu- tion, to relieve odor, 618 Potassium iodide internally, tonics and stimulants to mucous membrane, and attention to activity of skin, 619 Potassium permanganate, useful; painful if sensation is not entirely lost, 618 Removal of necrosed bone, 618 Silver nitrate and starch (gr. 1 to 10 [0.05- 0.65] to drachms 2£ [10.0]), as an insuf- flation powder, or solution (gr. 1 to 10 to the ounce [0.05-0.65:32.0]), better, in some cases, locally applied, 619 NASAL CATARRH (CHRONIC), 619 Arsenic, 85 Camphor, 117 Ferric alum (gr. 5 to the ounce [0.3 : 32.0]), useful, in spray, in later stage, 620 Galvano-cautery or snare, to remove hy- pertrophic tissue remaining after acute stage, 620 Hydrastis, dilute solution or distilled ex- tract of hamamelis and water, equal parts, useful in spray, in acute stage, 620 Iodine and glycerin (gr. 6 to 8 to the ounce [0.4-0.6 : 32.0]), with potassium iodide, sufficient to make solution, locally ap- plied, 620 Prescription for alkaline wash, 510 NAUSEA. (See Vomiting.) Hoffman's anodyne, when due to exces- sive use of tobacco, 217 Hydrocyanic acid, dilute, gtt. 3 (0.18), in water, often useful, 221 Lime-water, 116 NEPHRITIS (ACUTE), 620 Aconite, to depress circulation, 620 Blisters contraindicated, 621 Bromides or opium, given cautiously if aconite fails to quiet restlessness, 621 Caffeine, in later stages, 621 Cannabis indica, if hematuria is present, also to allay pain over kidneys, 121, 621 Cantharides, i drop (0.025) of tincture, about fifth day, when kidneys are atonic, also if hematuria is present, 122, 621 Citrate of potassium and sweet spirit of nitre, to increase flow of urine, 621 Cups or leeches over loins if urine is scanty, 621 Digitalis, with squill or calomel, gradually increased, followed by gin or compound spirit of juniper in later stages, 621 Elaterium, to relieve dropsy, 621 Flaxseed tea, as a demulcent, 205, 621 Gallic acid and ergot, to control excessive hematuria, 621 Hot-air baths, useful to pnovoke sweat, 621 Iron, if anaemia be present, also to decrease albuminuria, 621 Juniper, to re-establish secretion, after in- flammation has subsided, 247, 621 Milk diet, 621 Pilocarpine hydrochlorate, gr. fa to J (0.003-0.008), hypodermically, if urae- mia threatens, repeated in fifteen min- utes if no sweat appears, but guarded by strychnine when the heart is weak, 325, 621 Potassium bitartrate, 99 Sulphate of magnesium, §ss (16.0) or calo- mel to aid in elimination of toxic prod- ucts by bowel, 621 Turkish bath, to aid in eliminating effete products, used with care, 424 NEPHRITIS (CHRONIC), 621 Basham's mixture for anaemia, 241 Bichloride and protiodide of mercury, 269 622 Cannabis indica, to allay pain over kid- neys, also if hematuria is present, 121 Cantharides, particularly useful if due to alcoholism, 122, 622 Capsicum, to check albuminuria, 124 Chloride of gold and sodium has been re- commended in interstitial forms, 212 Chloride of iron if anaemia is present; also to decrease albuminuria, 242, 623 Digitalis and caffeine useful, 622 Elaterium or jalap, to relieve dropsy, 622 Juniper of value, 622 Milk diet, 622 Nitro-glycerin useful in ascending doses in chronic parenchymatous nephritis, 287, 622 Oxygen inhalations, 623 Potassium acetate or bitartrate combined with digitalis or the bitartrate combined with gin or compound infusion of juniper, 99, 622 Potassium iodide, gr. 5 (0.3), thrice daily, used with great care, 229 Sodium iodide of great value in many cases, 623 Squill, 359, 622 Strontium lactate for the relief of albu- minuria, 362 Turkish and Russian baths, relieve dropsy by increasing action of skin, 622 NERVOUSNESS. Bromides, 103 Camphor, as a sedative, 117 Hops, as a sedative, 218 Lime salts, 114 Musk, useful in nervous excitement and collapse; only to be used through crisis, 279 Phosphorus, in nervous debility and ex- haustion, 321 "Pill of three valerianates," highly recom- mended, 384 Rest-cure very useful where nervousness is due to exhaustion, 433 Strychnine, in functional nervous atony or depression, 294 INDEX OF DISEASES AND REMEDIES. 763 suprarenal gland, 369 Sumbul, prescription for, 369 Sweet spirit of nitre, in nervous excitement of fever and other nervous states of in- fancy, 370 Valerian, alone or with other drugs, 383 NEURALGIA, 623 Acetanilid, useful, especially with mono- bromated camphor, 47, 624 Aconite ointment (gr. 2 to the drachm [0.1: 4.0]), or oleate of aconitine (gr. 2 [0.1] to sweet oil 100 [6.0]), useful applied over painful spot, if limited in area, 49, 624 Acupuncture, nerve-stretching, or neurec- tomy necessary in some cases, 624 Ammonium chloride, in ovarian neuralgia, 68 Amyl nitrite, inhalations, when due to anaemia, 625 Antipyrin, very useful, especially in gout, rheumatism, or nervous depression, 78, 624 Belladonna, 95 Bromide of potassium with caffeine, almost a specific, 624 Prescription for, 104, 624 Camphor liniment, locally applied, to re- lieve pain, 118 Chloralamide, 139 Chloroform liniment, as a local anaesthetic, 151 Cimicifuga, especially useful in ovarian tvpes, 156 Cod-liver oil, 170, 623 Croton chloral, gr. 5 to 20 (0.3-1.3), in 5- grain pills, often effective in brow neur- algia, 182, 625 Duquesnel's crystalline aconitine in obsti- nate forms, 52 Freezing parts with ether or rhigolene spray or by small package of ice and salt, 199, 624 Guaiacol used locally, of value in, 214 Hydrocyanic acid, useful in intestinal neur- algia, 222 Iodide of potassium, may be tried in rheu- matic neuralgia, 228 Iron and arsenic, in anaemia; often neces- sary to associate with them bitter tonics and cod-liver oil, 623 Kataphoresis, 431, 624 Menthol, locally, 313 Morphine, gr. 4; to \ (0.013), injected into painful spot, if localized; not advisable in chronic cases, 624 Muriate of ammonium, useful in ovarian types, 68 Mustard plaster, as a counter-irritant, 279 Nux vomica or strychnine, if nerve is de- pressed by anaemia, 623 Peppermint oil, locally applied on cloth over painful spot, 312 Phenacetin, gr. 3 to 8 (0.15-0.6), very use- ful, prescription for, 317, 624 Phenocoll, 318 Phosphorus, if due to nervous exhaustion, 321, 624 Potassium iodide, 228 Prescriptions containing antipyrin with bromides and caffeine, 624 Quinine, if due to malaria, 160, 624 Rest-cure very useful in exhausted patients, 433 Salol, if due to exposure, 344 Specific remedies, if due to scrofulosis or syphilis, (524 Turkish bath, may relieve, if due to rheu- matism or gout, 424 Veratrine ointment, locally applied over neuralgic nerve, 384 NIGHT-SCREAMING. Bromide of potassium, 104 NIGHT-SWEATS. Acetic acid, as a lotion, diluted one-half, 48 Agaricin, of doubtful value, 53 Alum dissolved in water or alcohol, efficient application for sponging, 63 Belladonna, best remedy, 93 Camphoric acid, the best of all remedies, 189 Ergot, 193 Gallic acid, 206 Pilocarpine, gr. fa (0.003) hypodermically, two hours before sweat, often useful, even when atropine fails, 326 Sulphuric acid, with belladonna or mor- phine, often useful, 369 Zinc oxide, prescription for, 306 NIPPLES (SORE), 625 Benzoin, tincture, locally applied, 625 Boric acid (gr. 20 to the ounce [1.3 : 32.0]), or mucilage of acacia, applied after nursing, nipple being dried beforehand, 625 Breast-pump or nipple-shield may be neces- sary to effect cure, 625 Cocaine (gr. 4 to the ounce [0.2:32.0]), ap- plied and washed off before nursing, if breast is very painful, 166, 625 Ichthyol, when indurated, 226 Prophylaxis, 646 Silver-nitrate stick touched to fissure, if deep and slow to heal, 625 Tannin, glycerite of, locally applied, 625 NYMPHOMANIA. Bromide of potassium, of great service, 103 OBESITY, 626 Acetic acid, harmful, 48 Cold bath, 628 Diet, 627 Laxative fruits and purges, to regulate bowels, 629 Massage, passive movements, absolute skimmed-milk diet, and electricity, if exercise is impracticable, 629 Potassium permanganate, 310 Saline purges, 629 Thyroid gland, 379 Turkish bath, 629 OPHTHALMIA. (See Conjunctivitis.) OPIUM HABIT. (See Poisoning from Opium, Chronic.) 764 INDEX OF DISEASES AND REMEDIES. ORCHITIS. (See Epididymitis.) OSTEOMALACIA. Phosphorus, 321 OTORRHCEA. Creolin, solution (1:500), used with syringe, 182 OXALURIA. Nitric acid, 286 Nitro-hydrochloric acid, 289 OZ£NA. Prescription for insufflation powder, 268 PARALYSIS AGITANS. Cannabis indica, to quiet tremors, 120 Chloral, of great service, 137 Duboisine sulphate, of some use, 190 Sparteine, 351 PARASITES. Bichloride of mercury (gr. 2 [0.1] to water oz. I [32.0]), applied thrice daily in para- sitic skin diseases, 270 Cajuput oil, applied pure, will destroy pe- diculi, 112 Chrysarobin gr. £ (0.008), internally, or the ointment, with benzoated lard (1:4 or 5), locally applied, in parasitic skin diseases ; must not be used on face, 155 Hyposulphite of sodium, 1 drachm to the ounce (4.0 : 32.0), for parasitic skin dis- ease, 357 Mercurial ointment, useful to destroy pe- diculus pubis or other parasites, 274 Oil of cloves, 164 Pyrogallol, 30 grains to ounce (2.0:32.0), for parasitic skin disease or psoriasis, 333 Volatile or fixed oils, useful to destroy, 274 PARTURITION. Antipyrin, for pains, of doubtful value, 78 Castor oil, to relieve constipation, 132 Cimicifuga, 156 Quinine, as a stimulant to uterus, 160 PEMPHIGUS. Arsenic, 85 PERICARDITIS, 629 Aconite, to allay inflammation and quiet heart, 51, 629 Alcohol, digitalis, or caffeine, if heart shows signs of failure, 629 Aspiration, gradual, if exudation endangers life, 629 Blister, over pra?cordium, often useful, 629 Calomel, gr. £ (0.025), with opium, hourly to prevent exudation, 629 Elaterium, useful in effusions, 191 Ice-bag over the pra?cordium, very useful, 403, 629 Iodide of potassium, to aid in absorption of fluid, 228 Jalap, compound powder of, gr. 20 (1.3); or elaterium, gr. \ (0.01) ; or saline purga- tive, before breakfast, useful iu sthenic cases, to remove effusion, 629 Leeches, 5 to 10, over praecordium, accom- panied by large dose of veratrum viride in early stages of sthenic cases, (529 Opium, to allay inflammation, 300 PERITONITIS (ACUTE i, 630 Acetanilid, 633 Calomel, \ gr. (0.025) every hour, prefer- ably combined with opium, 2(57, 632 Hyoscyamus, by suppository or injection, in collapse, 633 Ice, with white of egg, for thirst. Vomit- ing does not contraindicate small amounts of water, 633 Ice-bag or turpentine stupe to abdomen ; leeches in sthenic cases, 632 Opium, pushed until pain is relieved, but never to the point of obtunding intelli- gence, 300, 632 Salines, useful in cases following surgical operations, but contraindicated by fee- bleness, perforation, or obstruction, 633 Surgical procedures, often necessary. When diagnosis is obscure or in septic general peritonitis exploratory incision is justi- fied, 631, 633 Rectal tube, milk of asafcetida or turpen- tine injections, in tympanites, 633 Veratrum viride, 386 PERITONITIS (CHRONIC), 633 Incision, with or without drainage and iodoform, useful iu tubercular peri- tonitis, 634 PERNICIOUS MALARIAL FEVER, 634 Hyposulphite of sodium, grs. 60 (4.0) to move the bowels, 634 Morphine and atropine to control retching and vomiting, 634 Quinine, large doses, in solution by mouth, rectum, or hypodermically, 159, 634 PHARYNGITIS. Antipyrin in 4 per cent, spray, 79 Cocaine, gives temporary relief; after- effects bad, 166 Cubebs, troches of, used in chronic types, 183 Monsel's solution, pure or diluted one-half with glycerin, applied on pledgets of cotton or camel's-hair brush, 244 Peroxide of hydrogen, 223 Salol, in 5-gr. (0.3) doses, 344 Silver nitrate solution, iu varying strength, locally applied, 284 PHTHISIS. (See Tuberculosis.) PLEURITIS, or PLEURISY, 634 Aconite or veratrum viride, preferable to venesection, in early stage, 634 Aspiration, when hydragogue purges fail to remove effusion, 636 Calomel, in sthenic cases to prevent exuda- tion, 267 Cantharidal blister, two inches below axilla, aids absorption of effusion, 413, 636 Cotton jacket, 635 INDEX OF DISEASES AND REMEDIES. 765 Digitalis or alcohol, if pulse weakens in second stage, 636 Elaterium or jalap, useful to remove effu- sion, 191, 636 Gelsemium, 208 Ice-poultice or jacket, used with success in sthenic cases, 403 Iodide of potassium, used in chronic stage, to aid absorption, 228 Iodine, locally applied, to abort, and aid absorption of fluid, 232 Pilocarpine, 325 Salicylates, very useful for the removal of effusion, 341, 636 Saline purges, iu second stage, to remove effusion, 636 Strapping chest, if respiratory movements are very painful, 634 Veratrum viride, 386 PLEURODYNIA. (Sue Neuralgia.) PNEUMONIA, 637 Aconite, preferable to veratrum viride, in early stage, in children, 638 Alcohol, inferior to digitalis, as a cardiac stimulant in the second stage in adults, but better than in children, 54, 639 Ammonia useful for adults aud children, 639 Ammonium bromide and carbonate may be used if the chloride fails, 641 Ammonium chloride, as an expectorant in third stage, 640 Antipyrin, of great value, if fever is exces- sive, 77 Belladonna, very useful if there are evi- dences of collapse, 94, 639 Citrate of potassium, to maintain renal activity, 640 Cold bath, sometimes necessary for high fever, 639 Cold sponging for fever, 638 Digitalis, tincture, gtt. 5 (0.3) every four hours, accompanied by belladonna, gtt. 5 (0.3), carefully watched in second stage, 639 Dover's powder for pain at onset, 638 Ethyl iodide, causes resolution, 201 Gelsemium, in early stages, 208 Gin, to maintain renal activity, 640 Hoffman's anodyne, useful, 639 Hot foot-bath, useful at onset, 638 Ice-bag to heart if fever be high and heart tumultuous, 638 Ice-poultice or jacket, highly recommended in first stage of sthenic cases, 403, 638 Iodide of potassium, in later stages to ab- sorb exudates, 229 Morphine, for pain at onset, and for exces- sive cough, (538, 640 Oxygen inhalations, if asphyxia threatens, 3U7, 639 Phosphorus, 321 Prescriptions, containing ammonium chlo- ride, to loosen cough of second stage, 640 Quinine, gr. 2 (0.1), thrice daily, in sup- pository, in lobar pneumonia of children, 160 Strychnine as a respiratory and circulatory stimulant in second stage and as an ad- juvant to digitalis, 639 Sweet spirit of nitre to maintain renal ac- tivity, 640 Venesection, in early stage of sthenic cases, cardiac depressants preferable, and late when heart is laboring and veins dis- tended, 444, 637, 639 Veratrum viride, preferable to aconite, in early stage, in adults, 380, 637 POISONING FROM— Acetanilid. Supportive measures, stimulauts, external heat,belladonna to maintain blood-press- ure, strychnine to counteract respira- tory failure, and oxygen inhalations to overcome cyanosis, 46 Acetate of Zinc. Treatment same as for gastro-enteritis, 560 Acetic Acid. Large amounts of milk, alkaline liquids, and general treatment for gastro-enteri- tis, 49 Aconite. Keep patient in prone position, with feet higher than head, Hot applications; emetics contraindicated ; evacuate stom- ach by siphon or stomach-pump. Ether hypodermically, followed by alcohol, and this by digitalis. Artificial respiration and amyl nitrite, a few whiffs, no more, if heart fails; Atropine ; Strychnine, 50 Alcohol (Acute). External heat, digitalis and strychnine hypodermically, in coma, if heart fails. Belladonna, if skin is relaxed and clammy, and counter-irritation to nape of neck, for brain symptoms. After- treatment, ammonia, spices, spirit of Mindererus; emollients in gastritis. Ice, aconite, hydrochloric acid, or ipecac in minute dose, and counter-irritation for vomiting. Jalap, gr. 40 (2.6), elaterium, gr. £ (0.011), or calomel and salines, as purgatives, 55 Fowler's solution for morning vomiting, 85 Alcohol (Chronic). Withdrawal of drug, at once or gradually. Highly seasoned broths, predigested foods, and morphine or coca, in small dose, if weakness is marked. Capsicum prescriptions (pages 56, 124), 56 Antimony. Large doses of tannic acid, external heat, alcohol, digitalis, and opium hypoder- mically, if respiration is not too feeble. If necessary to use opium, it should be accompanied by strychnine. Prone po- sition, the patient vomiting into towels. Stomach-pump, if vomiting is absent, 73; Atropine, 95 Antipyrin. Maintain bodily heat, stimulants, atropine, 766 INDEX OF DISEASES ANI) REMEDIES. and oxygen inhalations, if cyanosis is alarming, 77 Arsenic (Acute and Chronic;. Stomach-pump, external heat, stimulants, and the chemical antidote, hydrated sesquioxide of iron and magnesia. Mag- nesia also useful by itself. Opium should follow antidote, to allay pain, also large draughts of water to flush kidneys and dilute poison. For chronic poisoning, iodide of potassium, tonics, electricity, and out-of-door life, 87 Belladonna. External heat if collapse intervene, and strychnine to support respiration. The physiological antidote, opium, may be carefully given, 93 Carbolic Acid. Soluble sulphates, as Epsom or Glauber salts, warm mucilaginous drinks, hot applications to extremities, digitalis, strychnine, and counter-irritation over abdomen. Emetics and stomach-pump should be used if possible, 127 Chloral. External heat, emetics in early and stom- ach-pump in later stages. Strychnine or atropine to stimulate respiration. Digitalis, preceded by ether, ammonia, brandy, or whiskey. Prone position, feet being elevated, 136 Chloroform. Artificial respiration, ether and hot brandy hypodermically. Poles of battery with rapidly interrupted current swept over body, not over diaphragm or phrenic nerve. Place patient with head down- ward. Compression of the abdomen and limbs; compression and massage of the praecordium. Atropine, strychnine, and digitalis to stimulate the heart and respiration. Laborde's lingual traction, 147 Cocaine. Ammonia, coffee, strychnine, ether and alcohol. If convulsive in type, treat same as strychnine poisoning, 168 Colchicum. Tannic acid, emetics, and stomach-pump. Opium to relieve pain, and oils. Atro- pine and stimulants if collapse comes on, 173 Conium. Emetics or stomach-pump, strychnine as a nervous and respiratory stimulant, ex- ternal heat and cardiac stimulants, if circulation fails, 176 Copper. Yellow prussiate of potassium, sweet oil, white of egg; followed instantly by emetics or stomach-pump. If emesis or purgation is present, emetics are contra- indicated; instead, mustard plaster over abdomen and opium internally are to be employed, 178 Corrosive Sublimate. Large amounts of white of egg, followed by stomach-pump, external heat, stimu- lants, 268 Croton Oil. Treatment same as for gastro-enteritis, 560 Digitalis. Tannic acid as a chemical antidote, emetics or stomach-pump, external heat to ab- domen and aconite as a physiological antidote. Maintain horizontal position, 187 Elaterium. Treatment same as for gastro-enteritis, 560 Ether. Artificial respiration, lowering head if face is pale; strychnine, atropine, and digi- talis hypodermically, or intravenous in- jection of ammonia to stimulate heart and respiration; frictions and hot ap- plications ; ether dashed on chest and abdomen ; Laborde's method of traction of the tongue, 196 Eucaine. Treatment like that of cocaine intoxica- tion, 168 Gelsemium. Emetics and stomach-pump, digitalis, atro- pine, and ammonia as cardiac stimu- lants ; external heat, strychnine, and atropine for respiratory centre, 208 Iodine. Emetics or stomach-pump, large amounts of starch, hot applications, and hypo- dermic injections of alcohol, ammonia, atropine, digitalis, or strychnine, 231 Iodoform. Sodium bicarbonate to combine with iodine, alcohol, diuretics, and hot blankets; saline transfusion, 235 Lead (Acute). Epsom or Glauber's salts, in large amounts; alum ; emetics or stomach-pump. Hot applications and opium to relieve pain, 250 Lead (Chronic). Jalap and calomel with opium or alum, gr. 2 (0.1), in full dose, valuable in lead colic. Blister to back of neck, revulsives and pilocarpine in cerebral inflamma- tion. Iodide of potassium to eliminate lead. Strychnine in progressive paral- ysis. Electricity and baths of sulphuret of potassium, 250 Mineral Acids. Alkalies, such as magnesium, lime, white- wash, and soap as antidotes ; white of egg, external heat, oils, and opium, to relieve irritation. INDEX OF DISEAS1 Monsel's Solution. Soap, 245 Nitrate of Silver (Acute). Common salt as the chemical antidote, opium and oils to allay irritation ; also large amounts of milk and soap and water ; maintain bodily heat, 282 Nitrate of Silver (Chronic). Iodide of potassium, to aid in eliminating poison, 282 Nux Vomica and its Alkaloids. Inhalations of amyl nitrite, to prevent con- vulsive tendencies, at the same time use stomach-pump. Tannic acid followed by physiological antidotes, potassium bromide, gr. 60 (2.0), with chloral, gr. 20 (1.3). If convulsions prevent swal- lowing, chloroform patient carefully and give antidotes by rectum in starch- water. Amyl nitrite, hypodermically, if relaxation does not occur, 293 Opium (Acute). Emetics, or stomach-pump, tannic acid, black coffee, electricity, and other meas- ures to keep patient awake. Atropine or strychnine, hypodermically, if res- piration fails. Alcohol, ammonia, and external heat. Artificial respiration may be necessary; repeated washing out of stomach. Permanganate of po- tassium, 297 Opium (Chronic). Decrease a sixth or fourth of customary amount each twenty-four hours. Co- caine not advisable as a substitute, as the cocaine-habit may be established. Digitalis and strychnine if heart fails, 298 Phosphorus. Permangauate of potassium, 1 per cent, so- lution, or peroxide of hydrogen. Sul- phate of copper is too poisonous in itself, 320 Physostigma. Atropine as a physiological antidote, ex- ternal heat, and. cardiac and respiratory stimulants, 322 Seammony. Treatment same as for gastro-enteritis, 560 Strychnine. (See Nux Vomica.) Veratum Viride. Prone position, head higher than feet; atropine, strychnine, external heat, and cardiac stimulants, 386 ES AND REMEDIES. 767 Correction of displacement sometimes neces- sary, 648 Drugs have been recommended, but are dangerous as local applications, 649 Enema, of hot water, 1 pint (500.0), after cessation of bleeding, 649 Ergot, as a cure and prophylactic, 193, 587 Ether, hypodermically, if symptoms of shock are manifested, followed by small doses of hot, strong brandy and water, and warm milk, 649 Gauze, preferably iodoform, packed into uterine cavity, 649 Ice used externally and internally, 649 Injections of lemon-juice, vinegar, or hot water, 587, 649 Manipulations of the uterus, 587, 648 Method to pursue when caused by haema- toma, 648 Suture, if due to laceration, 649 PRIAPISM. Hops 218 PROLAPSUS ANI AND RECTI. Injection of cold or hot water, often re- lieves, 405 Quercus alba, infusion, 334 PROSTATITIS, 567 Cold-water injections and perineal douches, 408, 567 Local treatment to prostatic urethra, and use of cold steel sounds in chronic types, 567 Perineal incision, to evacuate pus, if ab- scess forms, 567 Rest in bed, regulation of bowels, leeches to perineum, medication to render urine alkaline, and morphine hypodermically or in suppository, 567 Soft catheter, allowed to remain in blad- der, if retention of urine is persistent, 567 PR0STAT0RRH02A. Cantharides, 123 PRURIGO. Cantharides, 123 PRURITUS, 641 Alum solution in pruritus vulva?, 63 Arsenic, quinine, bitter tonics, cod-liver oil, alkaline diuretics or mineral waters, in debility, and avoidance of condi- ments if mouth of vagina or urethra is affected, 641 Boric acid, 100 Calomel and lard (1 drachm to the ounce [4.0 : 32.0]), locally applied, 273 Carbolic acid, 642 Chloride of calcium, prescription for, 113 Chloroform may be used, 642 Cocaine, relieves temporarily, 642 Cold douche and injections highly recom- mended in pruritus ani and vulva?, 407 Goulard's extract, dilute, useful in pruritus pudendi, 244 Hydrocyanic acid, locally applied, 222 Ivory plug for, 642 Prescriptions for lotions and ointments, 642 POST-PARTUM HEMORRHAGE, 587, 648 Auto-transfusion, or actual transfusion of weak salt solution, necessary in some cases, 649 Beef-tea, i pint (250.0), and morphine, gr. £ (0.01) hypodermically, after reac- tion is established, 649 768 INDEX OF DISEASES AND REMEDIES. Salicylic acid, prescription for, 341 Silver nitrate (gr. 20 to the ounce [1.3 : 32.0]), locally applied, preceded by co- caine, if itching is intense; a 4-to 6- grain (0.2-0.3) solution may relieve itching of pruritus pudendi, ani, and vulvae, 284, 642 Sodium bicarbonate or borax (1 drachm to the pint [4.0 : 500.0]), as a wash, 641 Teucrium scordium, highly recommended by Briuton, 642 PSEUDO-LEUKEMIA. Arsenic internally, and injections of Fow- ler's solution into glands, 84 PSORIASIS. Ammoniated mercury in, 268 Anthrarobin, 71 Aristol, 377 Arsenic, 85 Cantharides, 123 Chrysarobin, gr. £ (0.008) internally, or the ointment with benzoated lard (1 to 4 or 5), locally applied, face excepted ; prescription for application, 155 Gallic acid, ointment, 206 Pyrogallol, 30 grains to ounce (2.0 : 32.0) of lard, 333 Resorcin, prescription for, 335 Tar, locally applied, 329 Thymol iodide, 377 Thyroid gland in, 379 PTYALISM. Alum, applied on swab, in mercurial ptyal- ism, 63 Belladonna, in idiopathic or mercurial types, 93 PUERPERAL DISEASES, 642 (For treatment see special titles.) PUERPERAL FEVER, 643 Antipyretics, best abstained from as long as possible, 644 Antistreptococcic serum nuclein and injec- tions of normal salt solution important adjuvants, 644 Bichloride of mercury (1 : 2000), or creolin (2 per cent.) solutions, as antiseptic in- jections, 642 Boric acid, creolin (2 per cent.), or bichlo- ride (1: 8000), solutions, as injections into bladder, to prevent septic cystitis, 646 Curette or placental forceps, to remove membranes if fever continues after an- tiseptic injections, 643 Epsom salts, concentrated solution, 2 drachms (8.0) every fifteen minutes, if peritonitis develops, 645 Laparotomy occasionally saves life, if sep- tic peritonitis develops, 644 Nutriment in large amounts and alcoholic stimulants, if symptoms of systemic in- vasion arise, 644 Silver nitrate (gr. 40 to 60 to the ounce [2.6-4.0:32.0]), locally applied to un- healthy ulcerated wounds; zinc chlo- ride solution maybe necessary, 645 Veratrum viride, 386 PURPURA HEMORRHAGICA. Suprarenal gland, 369 Turpentine, 382 PYELITIS. Buchu in chronic types, 109 Cantharides, 122 Copaiba, 177 Juniper, as a tonic in chronic types, 247 Pareira, 310 Uva ursi, 383 QUINSY. Aconite, in early stage, 51 Salicylic acid, gr. 3 (0.15), hourly, acts as a specific, especially if due to rheuma- tism, 341 REMITTENT FEVER, 653 Antipyrin, or cold pack, if fever is exces- sive, 654 Eupatorium, 203 Monsel's salt, gallic or tannic acid inter- nally, if intestinal hemorrhage occurs, 654 Morphine, spirit of chloroform, or aconite, in sthenic cases, to control vomiting, 654 Phenocoll, 5 to 8 grains (0.3-0.6), 316 Quinine, gr. 20 to 30 (1.3-2.0), preceded by calomel, gr. 3 to 4 (0.15-0.2); if not re- tained, administer by rectum, or hypo- dermically, with divided doses of Seid- litz powder by mouth, 159, 653 Tonics, potassium salts, to regulate kid- neys, and purgatives, if necessary, dur- ing convalescence, 654 Turpentine stupe, if belly is tender, 653 RETINITIS, 654 Atropine, dark glasses, and later suitable lenses, if due to eye-strain, 654 RHEUMATISM (ACUTE ARTICULAR), 654 Acetanilid, relieves pain and fever, 46, 656 Acetate of potassium, 48 Aconite, or veratrum viride, useful at onset of inflammation in sthenic cases, 655 Alcohol, in depression, 655 Ammonium bromide and phosphate, 67, 69 Antimonial powder as an antipyretic, 75 Antipyrin, gr. 10 to 20 (0.65-1.3), or anti- febrin, gr. 4 to 8 (0.2-0.4), often very valuable, 78, 656 Benzoic acid, drachms 2 to 3, daily, said to be a specific, 96 Bicarbonate or citrate of potassium, gr. 20 to 30 (1.3-2.0), in water, every five hours, in obstinate cases, 658 Bicarbonate of sodium, 356, 655 Blisters over joints, useful after systemic disturbance is past, 659 Caffeine useful to support the heart, 658 Camphor liniment, 118 Capsicum plaster, 125 Cimicifuga, shortens attack and relieves pain in some cases, 156, 658 Colchicum, prescription for, 658 Cold pack, if fever threatens life, 656 Fuller's lotion, applied on hot cloths to joints, 655 INDEX OF DISEASES AND REMEDIES. 769 Guaiac, 213 lee-cold compress, may relieve inflamed joints, 655 Ichthyol, ointment valuable, applied to joints, prescription for, 226, 655 Iodine, ointment or tincture, painted over parts, 659 Lemon- or lime-juice, or citric acid, bene- ficial in nearly all cases, 164, 659 Oil of gaultheria, useful as a substitute for salicylic acid; also used as a local ap- plication to the joints, 207, 656 01. succini, applied locally over joints, 63 Phenacetin. alone or with salol, 317, 658 Phenocoll. 318 Potassium iodide, useful in subacute or ob- stinate types, prescription for, 228, 658 Potassium nitrate, 281 Rhus toxicodendron, especially useful for night pains, 658 Salicylic acid, gr. 20 (1.3) thrice daily; if untoward symptoms arise it must be stopped, 340, 656 Salicylic acid, applied to joints in a salve when stomach is irritable, 342, 655 Salol, useful as a substitute for salicylic acid; dangerous in large doses, 344, 659 Sodium bicarbonate (gr. 20 to the ounce [1.3: 32.0]), to inflamed joints, 655 Splints for fixation of limbs, may relieve greatly, 655 Veratrine ointment, used locally, applied to joints, 659 RHEUMATISM (CHRONIC), 659 Arsenic, useful in some cases, 85 Cimicifuga, sometimes relieves, 156 Citric acid. 164 Cod-liver oil, internally; also useful rubbed into joints, 170, 660 Colchicum, with iodide of potassium, pre- scription for, 173 Hot-air bath, 424 Ichthyol, the best remedy for joints, 660 Iodine, locally applied, 232, 660 Liniments, prescriptions for, 660 Ointments, prescriptions for, 660 Potassium iodide, colchicum, and sarsapa- rilla, usually indicated; see prescrip- tions, 228, 659 Salophen, 345 Sulphur, 367 Turkish or Russian baths, very valuable, 659 Veratrine ointment, gives greatest relief in some cases, prescription for, .'584, 660 RHEUMATISM (MUSCULAR). Burgundy pitch, a mild local remedy, 328 Croton oil liniment, 183 Dover's powder, in conjunction with hot drinks and hot foot-bath, often cures, 301 Mustard, as a counter-irritant, 279 Veratrine ointment, locally applied, 384 RHINITIS. Creolin (1:1000), as a nasal douche, 182 Fluid cosmoline, in spray, 315 Potassium permanganate, solution, in foetid rhinitis, 314 RHUS POISONING. Grindelia, 212 Infusion of lobelia, 258 Lead acetate, 252 Liquor plumbi subacetatis, 253 RICKETS, 661 Arsenite of copper, 661 Cinchona, or strychnine, 661 Cod-liver oil, prescription for, 170, 661 Cool sponging or rubbing with salt and whiskey (1 drachm to the pint [4.0: 500.0]), useful at night, 662 Hypophosphites and lactophosphates useful, 113 Iodide of iron, syrup of, if scrofulous tend- ency or anaemia exists, prescriptions for, 661, 662 Lime salts, phosphorus, zinc phosphate, as bone tonics, 661 Massage and passive movements, 662 Mineral acids, physostigma and simple bitters, as digestive tonics, 661 Nux vomica, rarely given because of bit- terness, 661 Phosphate of lime or sodium gr. 1 to 2 (0.05-0.1), in child's milk, 662 Phosphorus (gr. TJn [0.0006]), in sugar- coated pill, 321, 662 Quinine, cod-liver oil, nux vomica, and iron as general tonics, 661 Sodium and lime salts, useful iu nursing and pregnant women, 662 RINGWORM. (See Tinea Circinata.) SATYRIASIS. Potassium bromide, one of the best rem- edies, 103 SCABIES. Sulphur, the best remedy, 367 SCARLET FEVER, 662 Aconite, harmful if constantly employed, 51 Alcohol, indicated in collapse, 665 Antipyrin or acetanilid, may produce col- lapse in large doses, 77, 664 Antistreptococcic serum, 400 Bromide of sodium, with chloral, useful when convulsion ushers in attack, 664 Carbolic acid (gtt. 2 [0.1] to olive oil oz. 2 [64.0]), benzoated lard, vaseline, cosmo- line, or almond oil, useful, locally ap- plied, to allay itching, 665 Chloral, very useful, prescription for, 663 Chlorate of potassium, locally applied, by spray or swab, in sore throat,-665 Cold sponging, useful; pack must be em- ployed if fever is excessive, 664 Ice applied externally and held in mouth, to prevent swelling of throat, 665 Ice-bag or rubber head-coil to head, if very hot, 665 Juniper, in later stages, if there is renal atony, 248 Potassium citrate and sweet spirit of nitre, prescription for, 664 Quinine, unsuccessful in most cases, 665 Salicylic acid, highly recommended, pre- scription for, 663 49 770 INDEX OF DISEASES AND REMEDIES. Strychnine, iron, simple bitters, quinine or Basham's mixture, in convalescence, 666 Sweating necessary in nephritis, 665 Warm wet pack, useful to bring out rash, 664, 665 Water, pure, such as Vichy or Poland, in large amounts, 664 SCIATICA, 666 Absolute rest of limb in splints very need- ful, 667 Acetanilid and antipyrin, 46, 666 Acupuncture, recommended, 666 Cod-liver oil, of service in obstinate cases, 170, 667 Chloroform, deeply injected over exit of nerve, a favorite remedy, 151, 666 Ether or rhigolene sprayed on part, often effective, 666 Hot water-bags, placed around exit of sciatic nerve, 667 Liniments for rheumatism, may be tried 667 Massage of nerve with glass rod, 666 Morphine, injected over course of nerve 666 Nerve-stretching, 666 Potassium bitartrate or citrate, gr. 40 (2.6), thrice daily, in plenty of water, to reg- ulate kidneys, 666 Potassium iodide, 228 Remedies for rheumatism, often relieve, 667 Salicylic acid, 341 Sulphur, 367 Wet or dry cups, highly beneficial over course of nerve, 666 SCLERITIS, 667 Atropine, boric acid, and hot-water com- presses, in early stage, 667 Eserine, with pilocarpine sweats or cautery, in stubborn episcleritis without iritis, 667 Specific treatment, in syphilitic cases, 667 Yellow-oxide ointment, associated with massage, to subdue infiltration, 667 SCLEROSIS. Antipyrin, 78 Nitrate of silver, 283 SCROFULOSIS, 667 Arsenic or corrosive sublimate useful if anaemia is present, prescriptions for, 667 Calcium chloride, 113 Cod-liver oil, the best remedy, 170, 667 Diet and exercise, 667 Europhen in scrofuloderm, 204 Excision, or scraping gland, and packing with iodoform gauze if other treatment fail, 668 Hypophosphite of calcium, 113 Ichthyol ointment, useful, rubbed into per- sistent enlargements, prescription for 668 Iodine ointment and lard, equal parts, rubbed into glands, stopping at first sign of reddening or fluctuation, 608 Iron, syrup of the iodide, in anaemia, pre- scription for, 213, 667 Lactophosphates, or hypophosphites, with cod-liver oil, useful in young children, 667 Phosphate of sodium or lime, if glands are breaking down, 113, 668 Sulphurate of calcium, if suppuration is active, 668 Thiol, recommended in scrofulous skin dis- eases, 375 SCURVY, 668 Arsenic and iron, of service in most cases, 668 Citric acid, if lemon-juice is not attainable, 163, 668 Diet. 668, 669 Lemon- or lime-juice, particularly indi- cated, 668 SEA-SICKNESS. Bromides, the best prophylactics, 104 Chloralamide and potassium bromide, 139 Nitrite of amy], 70 Kola, 249 SHOCK, 669 Alcohol, 54 Atropine, gr. fa to fa (0.001), hypodermi- cally, with hot applications, very useful in first or second stage, 94, 670 Digitalis, valuable as an adjuvant to atro- pine, 188, 670 Heat, external, very useful, 670 Hypodermoclysis, useful, 670 Strychnine, very valuable, 295 SKIN DISEASES. Arsenate of iron, 241 Arsenic, in dry, scaly types, 85 Bismuth subgallate when there is much secretion, 99 Boro-glycerin, 101 Cod-liver oil, in strumous types, 170 Copper sulphate gr. fa (0.005), thrice daily, if arsenic is not well borne, 179 Corrosive sublimate, oz. ^ (16.0), and am- monium chloride, oz." 1 (32.0), useful, added to bath, in syphiloderm, 269 Hydrocyanic acid, in itching types, pre- scription for, 222 Ichthyol in those forms associated with atony and induration of the deeper layers, 226 Ointment of biniodide and of yellow oxide and lard, in equal parts, useful applica- tion, 270, 275 Petrolatum, as an emollient dressing, 315 Tar and suet, equal parts, locally applied except on face, 329 Unguentum hydrargyri ammoniati. 268 Zinc oxide ointment, 305 SMALLPOX, 670 Aconite, with spirits of nitre and Min- dererus, useful as a fever mixture, 670 Antipyrin or acetanilid, to control head- ache and backache, 77, 670 Brandy and whiskey, if pulse fails, 670, 671 Bromides and chloral, in insomnia; latter must be used carefully, 670 Carbolic acid and sweet'oil (1:100), as an ointment to check irritation, 67l' INDEX OF DISEASES AND REMEDIES. 771 Chlorate of potassium with tincture of myrrh, as a mouth-wash, 671 Disinfection and hygiene necessary, 671 Flexible collodion, glycerite of starch, or simple cerate, locally applied, to prevent itching, 671 Iron, tincture of the chloride, to give strength and act as a specific, 671 Mustard plasters contraindicated, 670 Salicylic acid and vaseline, or cold cream (4 :100), best local application, 671 Silver nitrate, locally applied, to prevent pitting, 283, 671 SORDES. Glycerin and water, equal parts, useful as a month-wash, 211 SORES. Acetic acid, in old sores, 48 Black wash, useful for syphilitic sores, 270 Camphor, locally applied, as a stimulant in indolent sores, 118 Charcoal, applied to old sores, as a deodor- ant and antiseptic, 129 Cold cream, as an emollient dressing, 337 Dried alum a useful dressing, 63 Formaldehyde solution useful for cauter- izing syphilitic sores, 206 Gallic acid, 206 Iodoform, gr. 20 (1.3), with oil of eucalyp- tus, oz. \ (16.0), or iodoform, oz. \ (16.0), camphor, gr. 75 (5.0), and essence of roses, gtt. 2 (0.1), as a dressing for syph- ilitic sores, 236 Petrolatum, as an emollient dressing, 315 Potassium permanganate (gr. 60 to the pint [4.0: 500.0]), as a wash, 314 Quercus alba, powdered, as a poultice, to check discharge, 334 Red or yellow oxide of mercury a good dressing for syphilitic sores, 275 Salicylic acid ointment, 2 per cent., for sores from riding in a saddle, 342 Sulphuric acid, sometimes used as an es- charotic in venereal sores, 368 Zinc-oxide ointment, 305 SORE THROAT. Aconite, in earlv stage, 51 Alum (gr. 20 to the ounce [1.3: 32.0]), lo- cally applied on swab, 62 Arsenic, 85 Belladonna, of greatest service in some cases, 94 Capsicum, tincture of, and glycerin, 124 Carbolic acid (1:100), in spray, in ulcerated types, 128 Catechu, as a gargle or in troches, 133 Copper sulphate (gr. 4 to the ounce [0.2 : 32.0]), often of service in relaxed sore throat, 179 Guaiac, 213 Hamamelis, in relaxed sore throat, 215 Hydrogen peroxide (2 per cent, strength), * in spray, in fcetid types, 223 Kino, as a gargle, 248 Myrrh, tincture of, diluted one half, as a ' gargle in ulcerated types, 280 Potassium chlorate gargle in anginose form, prescription for, 141 Quercus alba, useful as a gargle, 334 Quinine (gr. 1 to 2 to the ounce [0.05-0.1 : 32.0]), in sprav, in foetid sore throat, 160 Rhus glabra, with glycerin and water, use- ful as a gargle, 337 SPASMS. Belladonna, useful in urethral, anal, and vesical spasm, 94 Bromides iu spasmodic contractions, 103 Cannabis indica, useful in vesical spasm, 120 Conium, useful, if due to irritation of nerve-trunk, 176 Ether, inhalation, relieves local spasms, 199 Gelsemium in localized muscular spasms, 208 Hyoscyamus in local spasm or where pain is due to spasm, 224 Nitrite of amyl, of service to relax, 70 SPERMATORRHEA. (See Emissions.) SPRAINS. Arnica, 82 Camphor liniment, 118 Cold applications, useful in sprained ankle, 401 Croton oil liniment, 183 Hot-air bath, 424 Hot bath, very useful in sprained ankle, 422 Ichthyol ointment, well rubbed in, very useful, 226 Lead-water and laudanum, 253, 301 Soap liniment, 354 Soap plaster, used as a support to sprained joints, 354 Soluble glass, 353 Turpentine liniment, 382 Warming plaster, 328 STINGS AND BITES, 671 Ammonia or alkaline liquids, locally ap- plied to neutralize poison, 671 Carbolic acid (1:50 or 100), sponged over part, useful in mosquito-bites, 671 Corrosive sublimate, with flexible collodion (1:1000), painted over part; salicylic acid a useful addition, 671 Hydrogen peroxide applied locally to hor- net's sting, of great value, 223 Ipecac paste for stings of bees, 239 Ligature, or cleansing of wound, at once, to prevent absorption in snake-bite, 671 Potassium permanganate, applied and in- jected around snake-bite, followed by alcohol in full dose, 671 Vinegar, dilute or pure, locally applied, often relieves insect-bites, 671 STOMATITIS, 672 Borax, as a mouth-wash, prescription for, 99, 672 Bromide of potassium or sodium, gr. 1 to 3 (0.05-0.15), thrice daily, when nervous irritability is excessive, 673 Carbolic acid, as a mouth-wash, 128 Cleansing nipples, in breast-fed babies, 672 Cocaine, before cauterization, 166 772 INDEX OF DISEASES AND REMEDIES. Nitrate of silver, stick touched to sore spots when they fail to yield to other treatment, 284, 672 Nitric acid, gtt. 3 (0.15), in water, taken through tube, 286 Nitro-muriatic acid, indicated when he- patic torpor exists, 672 Peroxide of hydrogen, 672 Potassium chlorate, prescription for, 140, 672 Salicylic acid (1 : 250), as a mouth-wash, after blisters have broken, to allay pain, 341 Salines or rhubarb, if constipation exist, 672 Sozoiodol (5 per cent, solution), locally ap- plied, 358 Sweet spirit of nitre, 10 drops (0.65), well diluted, to a one- or two-year-old child, and a warm foot-bath, before retiring, to produce rest, 672 Thymol, prescription for, 376 Tonics and careful diet after the attack, 673 STYES, 673 Boric acid (saturated solution), collodion (ethereal solution), or red or yellow ox- ide of mercury salve (gr. 2 to the ounce [0.1-32.0]), locally applied to abort, 673 Calcium sulphurate, if they tend to return, 673 Hot compresses, to alleviate pain, 673 Incision, as soon as pus forms, 673 Tonics, if general health is poor, 673 SUBINVOLUTION OF UTERUS. (See In- volution, Anomalies of.) SUNBURN. Almonds, in emulsion, 60 Carbonate of lead, prescription for, 253 SUNSTROKE, 673 Antipyretics, almost useless, 77, 674 Hot baths (105° to 110° F.), or hot bottles or bricks, in heat exhaustion, 674 Ice, application to chest, back, and abdo- men, as quickly as possible, in thermic fever, 674 Salicylic acid, quinine, and similar drugs contraindicated, 674 Tonics, during convalescence in heat ex- haustion, 675 Venesection, best treatment, if face be cya- notic and heart laboring, and if menin- gitis threatens, after thermic fever, 674 Veratrum viride may be used if meningi- tis threatens, 674 SYNCOPE. Ammonia, if due to shock or indigestion, 65 SYNOVITIS, Carbolic acid (2 per cent, strength), as an injection in chronic types, 128 Counter-irritation, 413 Iodine, 232 SYPHILIS, 675 Biniodide of mercury, 270 Bismuth and calomel, as a dusting-powder, or bichloride solution (1:2000), locally applied to mucous patches about geni- talia, 677 Calomel, gr. £ (0.011), every two hours, for cephalalgia, 677 Cod-liver oil. useful in advanced cases, 170, 679 Expectant plan of treatment, 676 Formaldehyde solution, useful for cauter- izing sores, 206 Hypodermic injections of mercury, 263, 275, 679 Iodides, followed if necessary by mercury, recommended by some, 228, 675 Iodoform, gr. 1 to 5 (0.05-0.25), internally in tertiary stage, and the ointment ap- plied to ulcers, very useful, 236, 679 Iodol, in tertiary stage, 237 Mercurial ointment, by inunction, 273, 678 Mercury, at beginning of secondary stage, followed later by the iodides, 676 Mercury, by fumigation, general and local, 263, 678 Mercury, with chalk, chiefly employed in infantile syphilis, .273 Mixed treatment, 677 Ointments and washes of mercury, and hot applications, to combat surface erup- tions, 677 Prescription for blue mass and iron, 678 Prescription for potassium iodide and mer- cury, to be used after first eighteen months, 677 Pressure bandage and mercurial inunctions for periostitis, 677 Protiodide of mercury, 275, 676 Salicylate of mercury hypodermically, 275 Sarsaparilla, a useful adjunct to potassium iodide, 348, 680 Shampooing and local application of croton oil, or cantharides, as a lotion, to com- bat alopecia, 677 Silver nitrate, copper sulphate, chromic acid solution (20 per cent.) or acid ni- trate of mercury, locally applied to mu- cous patches, in mouth, 677 Stillingia, used as an aid to other drugs, 361 Thiol, in syphilides, 375 Tonic and general treatment, 679 Vapor baths, hypodermic injections, or in- unctions, useful modes of applying mer- cury if it cannot be taken by mouth, 678 SYSTEMIC STRAIN. Opium, useful in prolonged physical strain, 302 Quinine, gr. 2 to 4 (0.1-0.2), useful to pre- vent exhaustion following physical and mental strain, 160 TABES DORSALIS. (See Locomotor Ataxia.) Chloralamide, prescription for, 139 TAPE-WORM. (See Worms.) INDEX OF DISEASES AND REMEDIES. 773 TEETHING. Bromide of potassium, to prevent convul- sions, 104 TETANUS, 680. (See Poisoning from Strychnine.) Amyl nitrite, to relieve and prevent, 70 Antitoxin, value of, not established, 680 Chloral and bromide of potassium, by mouth or rectum, 138 Fowler's solution, said to be almost specific in some cases, 680 Physostigma, of moderate value, 322 TINEA CAPITIS. Lime-water, locally applied, 115 TINEA CIRCINATA. Borax, strong solution, locally applied, 100 Iodine, applied with camel's-hair brush, 233 Turpentine, useful, applied with a brush, 382 TINEA TARSI. Copper, crystals, or weak solution, applied to diseased eyelid, 179 TINEA TONSURANS. Borax, strong solution, locally applied, 100 Iodine, applied with camel's-hair brush, 233 Oil of cajuput, applied pure, 112 TOE-NAIL (INGROWING). Absorbent cotton, soaked in strong alum solution, and inserted under nail, 63 Liquor potassa?, to soften nail prior to pack- ing with cotton or partial evulsion, 250 TONSILLITIS, 680 Alum stick, deeply applied, 62 Ammonium iodide, for enlarged tonsils, 69 Carbolic acid, solution (1:100), as an anti- septic gargle, 680 Glycerin and tincture of capsicum, equal parts, applied by swab, 124 Guaiac, 213, 680 Hot fomentations and gargles useful in some cases, 680 Hydrogen peroxide (2 per cent, strength), in spray, iu ulcerative types, 223 Ice-bag to throat, 680 Iron, tincture of the chloride, 242, 680 Monsel's solution, pure, applied with cam- el's-hair brush, 244 Nitrate of silver, applied locally, 680 Salicylates, are valuable in rheumatic cases, 34*1, 680 Saline purgative, followed by fever mixture of aconite, sweet spirit of nitre, and po- tassium citrate, 680 Scarification may be of service in early stage, 680 TOOTHACHE. Creosote, applied on cotton, often relieves, 181 Oil of cloves, inserted into cavity on cotton, 164 Oil of peppermint, applied on cotton, 312 TORPOR. Acetate of potassium, in hepatic torpor, 48 Ammonium chloride, in hepatic torpor, 68 Arsenic, in gastric torpor, 85 Citric acid, in hepatic torpor, 164 Euonymus, in mild hepatic torpor, 203 Lactophosphates and hypophosphites, useful in hepatic torpor, 114 Nitro-hydrochloric acid, in torpor of liver, 288 Russian and Turkish baths, useful in tor- pidity of skin and kidneys, 424 Taraxacum, in hepatic torpor, 373 TORTICOLLIS. Belladonna, injected into muscles, 94 Gelsemium, 208 TREMOR. Hyoscine, 225 Sparteine, 351 TUBERCULOSIS, 681 Acetanilid, generally acts unfavorably, 46 Agaricin, of doubtful value in night-sweats, 53 Almonds, essential oil of, recommended in cough, 60 Alum (gr. 10 to 20 to the ounce [0.65-1.3: 32.0]), or sulphuric acid (1 drachm to the pint [4.0:500.0]) useful, sponged over body in night-sweats, 684 Antipyrin, harmful, 77 Arsenic, in phthisis, 85, and in phthisical tendencies, 84 Atropine, gr. fa to fa (0.001), hypodermi- cally, in excessive night-sweats, 68, 684 Blister, small, useful over new pleuritic spots, 683 Camphoric acid, gr. 20 to 30 (1.3-2.0,) in- valuable, 684 Cannabis indica, 120, 683 Carbolic acid (gtt. 5 to 15 to the ounce [0.3- 1.0:32.0]), in spray, 128 Chloride of calcium, 113 Chloroform, spirit of, used by inhaler, often relieves cough, 683 Climatic treatment, 438 Codeine, recommended in excessive cough, 169 Cod-liver oil, rules for its use, 682 Copper in tubercular tendencies, 179 Creosote, internally, in spray or by inhaler, often relieves cough and discomfort; contraindicated if fever and haemopty- sis are present; prescription for, 180, 682 Glycerin and water equal parts, with lem- on-juice, useful as a mouth-wash, 211 Guaiacol, useful in, 213, 214 Hydrogen, peroxide (2 per cent, strength), in fine spray in laryngeal phthisis, 223 Hygienic measures, 682 Hypnal for cough, 225 Inhalations of steam from corrosive subli- mate solution (1:10,000), stopping at first sign of mercurial effects, in laryn- geal phthisis; precede inhalation with cocaine-spray (4 per cent, solution), 683 Iodine, useful, painted over new pleuritic 774 INDEX OF DISEASES AND REMEDIES. spots, also useful in chronic cases as an inhalant, 233, 683 Iodoform with small amount of powdered talc and a little morphine, useful when puffed into the larynx in laryngeal tu- berculosis, 684; also used in spray, 236 Iodoform emulsion (10 per cent.), useful in tubercular abscess, 236 Iodol, of use in tubercular laryngitis, 237 Lactic acid applications (10 to 60 per cent. solution), in laryngeal tuberculosis, using cocaine-spray first to relieve pain, 684 Lactophosphates and hypophosphites, 114 Morphine and wild-cherry bark in cough, prescription for, 683 Nuclein, 291 Oil of cloves, 164 Opium, may be given in last stage, to re- lieve pain and discomfort, 302 Oxygen, inhalations in dyspnoea, 307 Pilocarpine, gr. fa (0.003), one to two hours before sweat, sometimes arrests; if it or atropine fails alone, give them together, 684 Potassium cyanide, in excessive cough, pre- scription for, 184 Silver nitrate (gr. £ to 2 to the ounce [0.03- 0.1:32.0]), in spray, may be tried in laryngeal types, 284 Strychnine, in dyspnoea, 295 Sulphuric acid, internally, may relieve night-sweats, 684 Terebene, iodide of ethyl and chloroform, equal parts, for inhalation, 683 TYPHOID FEVER, 685. (See Fever.) Acetanilid, generally acts unfavorably, 46 Alcohol, useful throughout course of dis- ease, 54, 686 Asafcetida, by rectal injections, in tympa- nites, 88 Belladonna in case of collapse or vasomotor relaxation, 94 Calomel, gr. £ (0.011), every fifteen min- utes, till gr. 1 (0.05) is taken, followed by magnesium sulphate, \ ounce (16.0), if constipation lasts two days, 272, 687 Cascara sagrada for constipation, 687 Enemas, to be tried first, if constipation lasts over two days, 687 Glycerin and water, equal parts, with a little lemon-juice, as a mouth-wash, if sordes are present, 211, 687 Guaiacol, an antipyretic in, 214 Guaiacol carbonate, an intestinal antiseptic of value, 215, 688 Hydrochloric acid, dilute, gtt. 5 (0.3) every few hours, or, if bowels are inactive ni- tro-hydrochloric acid, gtt. 3 (0.15), 220, 687 Lime-water added to milk, if vomiting threatens, 687 Liquorice powder, drachm 1 (4.0) if consti- ' pation lasts over two davs, 687 Milk diet, 685, 687 Morphine in large dose, if perforation oc- curs. 688 Opium for insomnia, 300 Phosphorus, if nervous system is affected 321 Prescription for diarrhoea, 688 Quinine inferior to new antipyretics, 160 Reduction of fever by cold, 401, 410 Rest and diet, 685 Silver nitrate, gr. \Xo\ (0.011-0.015), high- ly recommended, 283 Sulphocarbolate of zinc, useful, 364 Thymol as an intestinal antiseptic, 376 Turpentine, in the form of stupes, enemata, or by mouth, in tympanites, also useful in later stage, to relieve diarrhoea, heal ulcers, and prevent relapse, 381, 688 Venesection, contraindicated, 688 (For remedies for complications—intesti- nal hemorrhage, pneumonia, and pleurisy —see their titles.) ULCERS. Alcohol, a useful local application, 55 Aristol, 376 Benzoate of bismuth, as a dressing for in- dolent or sloughing ulcers, 98 Burnt alum, as a dressing for old ulcers, 63 Caustic potash, as an escharotic for exu- berant ulcers, 134 Chimaphila, said to be of service in stru- mous ulcers, 135 Conium, used locally to relieve pain, 176 Copper, in solid or powder form, locally applied to indolent ulcers, 179 Creolin, solution (1:100), as a douche for nasal ulcers, 182 Dried alum, useful, 63 Europhen, in 10 per cent, ointment, in leg n leers, 204 Gallic-acid ointment, in actively discharg- ing ulcers, 206 Hamamelis. locally applied on a cloth, re- lieves leg ulcers, 216 Hot pack to increase activity of skin, 426 Hydrogen peroxide, a useful application, 223 Lime, as an escharotic in old ulcers, 115 Methyl blue in corneal ulcers, 276 Nitric acid, as a caustic for phagedenic ulcers, or a solution (gtt. 5 to 30 to the ounce [0.3-2.0: 32.0]), locally applied to indolent types, 285 Ointment of lead carbonate as a dressing, 253 Potassium permanganate, (gr. 60 to the pint [4.0 : 500.0]), as an antiseptic wash, 314 Precipitated carbonate of calcium, as a dry dressing, 113 Silver nitrate, in hard pills, for intestinal ulcers, and by injection for rectal and caecal ulcers, 283 Sulphuric acid, sometimes used as an es- charotic in slow ulcers, 368 Unna's dressing, 306 URiEMIA, 689 Atropine useful in pulmonary oedema, 689 Bromides for convulsions, 690 Caffeine useful to stimulate the' kidneys, 689 Chloral and chloroform for convulsions, 690 Elaterium thought to aid elimination of poison by the bowel, 191, 689 Ether given by the mouth or hypodermi- cally, 199 INDEX OF DISEASES AND REMEDIES. Hot pack. 689 Hypodermoclysis, 690 Nitro-glycerin to increase the urinary flow when arterial tension is high, 689 Pilocarpine, a most efficient remedy, 325, 689 Strychnine, followed by digitalis, for heart failure, 689 Transfusion of salt solution of great value, 690 Urethan for convulsions, in large doses, 690 Venesection, very useful, 690 URIC-ACID DIATHESIS. Acetate of potassium, 48 Lime-water, 115 Piperazine in the dose of 15 grains (1.0) a day in 1 pint (500.0) of water, 327 URTICARIA Calcium chloride, to prevent, 113 UTERINE INERTIA. Kola useful, 249 Quinine not of great value, 160 UVULA (RELAXED). Capsicum, tincture of, and glycerin, equal parts, as a gargle. 125 Kino, as a gargle, 248 VARICOCELE. Cold water, applied by bidet, highly recom- mended, 408 VARICOSE VEINS. Barium chloride, internally and locally ap- plied, said to be of value, 91 VITREOUS DISEASES, 690 Antisvphilitic treatment, if due to syphilis, 690 Galvanism, 690 Leeches, in early stage, if due to inflam- mation, 690 Pilocarpine, hypodermically, in opacities, 325, 690 VOMITING, 690 Acetanilid. verv useful, 47, 691 Allium-juice, gtt. 2-5 (0.1-0.3), useful in nervous vomiting, 59 Arsenic in vomiting of pregnancy, and of hand-fed babies, and of drunkards, 85, 693 Bismuth and aconite may be of service, prescription for, 97, 692 Brandy poured on cracked ice very useful, 55, 691 Bromide of potassium, effervescing, 104 Bromide of sodium, with laudanum as a rectal injection, prescription for, 104, 301, 691 Calomel, 272 Carbolic acid or creosote, with bismuth, useful in acidity and fermentation, pre- scription for, 128, 692 Chloroform, gtt. 1 to 2 (0.05-0.1), in water, 692 , ,„. Cloves, oil of, sometimes controls, lbr> Cocaine or aconite, if due to hyperexcita- bility of stomach, 168, 691 Enemas, partially digested, if vomiting is incoercible, 693 Faradism sometimes gives relief, 693 Fowler's solution, gtt. \ to 1 (0.025-0.05), every two hours, useful in nausea fol- lowing debauch, 55, 693 Hydrochloric acid. gtt. 5 to 15 (0.3-1.0), in water, every two hours, in alcoholic nausea, 220,"093 Hydrocyanic acid, dilute, gtt. 2 to 6 (0.1- 0.3),'in water, 221, 692 Ice-bag, to nape of neck, lumbar region, or epigastrium, 693 Iodine and carbolic acid, gtt. 1 (0.05) of each in dr. 2 (8.0) of water, 692 Ipecac, in small doses, if due to gastric de- pression, 238, 692 Lime-water, added to milk, may relieve nausea, 116, 693 Mustard plaster over stomach, useful in all cases, 693 Nitro-glvcerin, very useful in some cases, 287, 692 Nux vomica, if due to gastric depression, prescription for, 693 Peptonized milk, best food, 693 Podophyllin, useful in gastric depression and hepatic torpor, 330 Seidlitz powder, often settles stomach, if due to constipation, 351 Vinegar fumes of service when inhaled, 691 VOMITING OF PREGNANCY. Aconite, as a nervous sedative, 51 Arsenic, may be tried, 85 Bromide of potassium, as an effervescing draught, or with opium by enema, pre- scriptions for, 104 Cerium oxalate, gr. 2 to 5 (0.1-0.25). in pill, every four or five hours, 134 Cocaine, useful to decrease irritability, 168 Iodine, tincture of, largely used of late with good results,. 234 Ipecac wine, gtt. 1 (0.05), or powder, gr. 2 (0.1), useful in some cases, 238 Menthol, very useful, 313 WARTS. Acetic and salicylic acids combined, 48 Chromic acid (gr. 100 to the ounce [6.5: 32.0]), locally applied, to remove, 154 Fowler's solution, locally applied, 86 Glacial acetic acid, useful to remove, 48 ' Nitric acid, as a caustic, 285 Salicylic acid, locally applied, 86 Trichloracetic acid, useful, 379 WHITE SWELLING. Iodine, 233 WHOOPING-COUGH, 693 Aconite or veratrum viride, if vascular en- gorgement is excessive, 694 , Amber, oil of, 63 - Amyl nitrite, when paroxysms interfere with respiration, 70, 694 , Antipvrin, gr. 2 (0.025-0.15), every five hours, probably the best remedy, 78, 693 776 INDEX OF DISEASES AND REMEDIES. Belladonna, tincture of, gtt. J (0.025), thrice daily, to child of one or two years, 94 Benzine, 694 Bromoform, prescription for, 107, 694 Bronchitis tent, to modify severity of at- tacks, 694 Carburetted hydrogen, 694 Chloral, 138 Chloride of gold and sodium has been rec- ommended, 212 Chloroform, a few whiffs, if paroxysms in- terfere with respiration, 151, 694 Gelsemium, 208 Hyoscyamus, probably better than "bella- donna, 224 Milk, in small amounts, may overcome vomiting following paroxysms, 694 Monobromated camphor, 119 Quinine (gr. 1 to the ounce [0.05:32.0]), in spray, useful, also of service in ex- posed children as a prophylactic, 160, 694 Resorcin, gtt. 10 (0.65), of a 2 per cent, so- lution, internally, or, better, in spray, 335 Silver nitrate (gr. J to 1 to the ounce [0.025- 0.05 :32.0]), in spray, used when stom- ach is empty, 284 WORMS, 695 Aspidium, very efficient against tape-worm, prescription for, 89, 695 Azedarach, a useful remedy against round- worms, 90 Brayera, as an infusion, or fluid extract, against round-worms, 694 Calomel, should follow or precede all drugs used for tape-worm, 696 Castor oil, or a saline purgative, should fol- low remedies for round-worms, 695 Chenopodium, oil of, gtt. 5 to 20 (0.3-1.3), on sugar, to remove round-worms, 135, 695 Chloroform, should not be used against tape-worm, 151 Cusso in tape-worm, 183 Kamala, drachms 1 to 2 (4.0-8.0), in syrup, against tape-worms, 248 Koosin, gr. 40 (2.6), to adult, against round- worms, contraindicated in pregnant women, 695 Matricaria, 261 Pelletierine, gr. 1 to 2 (0.05-0.1), in capsule, best remedy against tape-worm, 695 Pepo, ounce 2 (64.0), in confection, against tape-worm, 311, 695 Pomegranate, useful in tape-worm, 331, 695 Quassia injections, preceded by soap and water, most useful remedy against seat- worms, 334, 695, 696 Rue, should not be used against round- worms, 338 Rules for diet preceding taeniacides, 695 Salicylic acid, gr. 8 (0.6), hourly, till gr. 40 (2.6) are taken, against round-worms, or as an injection against seat-worms, prescription for, 342 Santonin, gr. \ to \ (0.016-0.3), in troches, for child, against round-worms, 347, 695 Spigelia, alone, or, better, with senna, to remove round-worms, 359, 695 Turpentine and castor oil, equal parts, effi- cient, but somewhat dangerous, against tape-worm, 382 Zinc oxide, prescription for, 306 WOUNDS. Acetanilid as a dusting powder, 47 Alcohol, very useful in contused wounds, 55 Collodion, as an air-tight dressing for small wounds, 173 Oil of cinnamon, 163 Potassium permanganate (gr. 20 to 60 to the pint [1.3-4.0:500.0]), as an antiseptic wash, 314 Salicylic acid, 342 Sozoiodol, as an antiseptic and disinfectant in diseased wounds, 358 YELLOW FEVER. Cocaine of great value as a stimulant and anti-emetic, 168 Catalogue of Book© PUBLISHED BY Lea Brothers & Company, 706, 708 & 710 Sansom St., Philadelphia. Ill Fifth Ave. (Cor. 18th St.), New York. The books in the annexed list will be sent by mail, post-paid, to any Post-Office in the United States, on receipt of the printed prices. No risks of the mail, however, are assumed either on money or books. Intending purchasers will therefore in most cases find it more convenient to deal with the nearest bookseller. STANDARD MEDICAL PERIODICALS. 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