as iw «i W ^?£$<*: mm mm (<\irv $fl ^>&4"5?< S? 00103071 b ARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NLM001030716 -theido, Md U S Department ol Health. Education. ond Welfare. Public Health Serv.ce Bethesda. Md US Department ol Health, Educot.on, Ml* 33.*iaS H.|OaH £ 3t|q"d ="°,I'M Pu° S uo„o:>np3 ^ipan £ (O mainuodaQC, fl a -pi* 'DpsaHiag *> BDiAjas SI|OaH , t-ethesdo, Md U S Department of Health. Education, ond Welfare. Public Health Ser«.ce Bethesda. Md US Department of Health. Education. Z ond Welfare. Publn oc i!iq"d-3JD)I3M Puo £ uoi|D3np3 'U|; and Welfare, Public Health Service . o f*^\/ ^ ^^^^ o ^^\x s X^^k o ,o luauiuodaQ-S-fl » pw'opsaH1ag £ a^l'ias S'P^H £ >!iqnd ^°fP/v\ P"° £ uo,,o5np3 'H,,oaH % |o .uauiuodaQ S n « pw 'opou.ag £ "!<>«S H,,o3H Bethesda. Md U.S. Department of Hec.llh.Educot.on. ond Welfare, Public Health Ser.,ce Bethesdo. Md U S. Department ol 3||qid'aJD)l3M Puo in uo'iojnpg 4tp.,h ond Welfore. Publ.c Health Se |0 iuauj|Jodaa S 0 % PW 'opsauiag o: aajAja; uipaH ^ ^iq"J' = '°)PM puo a -uouoanpg -uipoH £ jo (uamuodaa'STI <* PW 'op^u.ao, J aJ.*J3S HM°3H * "nnd '3'°II3M puc £ 'u01" "nP3 '4I|0:>H g 2 <( A TEXT-BOOK -/D MATERIA MEDICA, THERAPEUTICS, AND PHARMACOLOGY. BY GEORGE FRANK BUTLER, Ph.G., M.D., Professor of Materia Medica and Clinical Medicine in the College of Physicians and Surgeons, Medical Department of the University of Illinois ; Professor of General Medicine and Diseases of the Digestive System, Chicago Clinical School; Attending Physician to Cook County Hospital; Member of the American Medical Association, Illinois State Medical Society, Chicago Medical Society, Chicago Pathological Society, and Chicago Society of Internal Medicine; Fellow of the Chicago Academy of Medicine, etc. SECOND EDITION, REVISED. Miseris succurrere disco LIBRARY SURGEON GENERAL'S OFFICE SEP.-! 9*1898 PHILADELPHIA : \V. B. SAUNDERS, 925 Walnut Street. 1898. B386ir 1898 Copyright, 1898, By W. B. SAUNDERS. ELECTROTYPED BY WESTCOTT & THOMSON, PHILAOA PRESS OF W. B. SAUNDERS, PHILAOA. TO THE MEDICAL STUDENTS OF THE UNITED STATES, IN THE HOPE THAT IT MAY AID THEM IN ATTAINING A CORRECT KNOWLEDGE OF THE NATURE AND ACTION OF DRUGS AND THE RATIONAL TREATMENT OF DISEASE, THIS WORK IS CORDIALLY INSCRIBED BY PREFACE TO THE SECOND EDITION. It is peculiarly gratifying to the author to be so soon called upon to revise his book on Materia Medica, Therapeutics, and Pharmacology for the second edition, since it is an evidence of the very favorable reception and appreciation of the work by medical teachers, students, and physicians generally. Since the publication of the first edition there have been many advances in pharmacology, rather in the direction of clearing from obscurity the action of old remedies than in marvellous new dis- coveries. In this respect therapeutics has but followed the normal line of the evolution of science. The recent important additions made to the knowledge of the physiological action of drugs principally relate to antipyretics, antiseptics, aconite, and strychnine. These, as well as some minor changes in the pharmacology of a few other drugs, appear in the present edition. Many alterations also have been made in the chapters on diuretics and cathartics. One of the principal innovations is the substitution of a chapter on the Untoward Effects of Drugs for that on Definitions. The tables given summarize all contributions to the subject to date. Serum-therapy and the therapeutics of nuclein have received considerable attention during the past year, and these interesting topics are more fully discussed in the present issue. The author earnestly requests any reader who may discover an error of whatsoever nature in this edition to report the same to him promptly, and hopes that the work as revised will continue to prove of value to the medical profession. GEORGE FRANK BUTLER. 794 West Adams St., Chicago, August, 1898. PREFACE. The present work has been undertaken with the immediate object of supplying the student of medicine with a clear, concise, and practical text-book, adapted for permanent reference no less than for the requirements of the class-room. The arrangement—embodying the synthetic classification of drugs based upon therapeutic affinities—the author believes to be at once the most philosophical and rational, as well as that best calculated to engage the interest of those to whom the academic study of the subject is wont to offer no little perplexity. Should an intelligent and comprehensive understanding of Materia Medica and Therapeutics be facilitated by the author's treatment of the theme, the deductions derived from his experience as a practitioner and instructor will not have been committed to print in vain. Special attention has been given to the Pharmaceutical section, which there is reason to hope will be found exceptionally lucid and complete. It has been deemed advisable, however, in the general work to include in the descriptive enumeration only such drugs as experience has proved to be of unquestionable value and are of standard and authoritative acceptance in general prac- tice. In accordance with this plan, many new and comparatively untried remedies have been omitted, since, while of established efficacy in certain conditions, they are as yet too imperfectly known to warrant association with remedial agents bearing the sanction of exhaustive scrutiny. So, too, a few official drugs have been excluded because they are practically never used or are employed only in isolated instances. It will be observed that "Untoward Action" and "Poisoning" n 12 PREFACE. are treated under separate heads. By the former it is intended to record the effects of medicinal doses in developing certain symp- toms dependent more or less upon individual susceptibility, not necessarily assuming the aggravated form incident to toxic doses, which exert a definite influence regardless of idiosyncrasy. In giving the careful Latin accent and quantity of medicinal nomenclature (Foster), so far as practicable with the prosodial signs employed, the design has been to correct a prevalent dis- regard of proper pronunciation reflecting little credit upon those to whom a knowledge of the subject should be as exact as it is familiar. To the prescription-writer the appropriate Latin genitive, and in a few cases the accusative, will doubtless afford valuable assistance. During the preparation of the work many important text- books, periodicals, etc. have been freely consulted, and from the U. S. Pharmacopoeia chiefly, and from the National Dispensatory, have been adopted almost verbatim the "Origin" and "Description and Properties " of the various drugs under consideration. In reviewing the progress of the present volume the author desires to express his cordial acknowledgments to Prof. Carl S. N. Hallberg, Ph. G., whose exhaustive contribution of " Weights and Measures" and "Pharmaceutical Preparations" cannot fail to lend permanent interest to the work; to Dr. Alfred C. Cotton, Dr. Wm. E. Quine, and Dr. James B. Herrick, for friendly suggestions ; to Dr. D. Lee Shaw, Dr. Fred C. Zapffe, and Dr. Thomas J. Jack- son, for assistance in compilation. To Mr. Storrow Higginson the author's personal thanks are due for his scholarly assistance in the revision of the text. G. F. B. Chicago, III., 794 West Adams St., September, 1896. CONTENTS. PAGE INTRODUCTION .......................... I? PHARMACOLOGY AND GENERAL THERAPEUTICS........21 Classification of Medicines....................24 Administration of Medicines....................29 Untoward Effects of Drugs.................... -.4 Weights and Measures.......................4, PHARMACEUTICAL PREPARATIONS............ . . . . 51 Solutions.............................52 Aquae Medicatae—Medicated Waters.................53 Liquores—Solutions.........................53 Spiritus—Spirits..........................59 Syrupi—Syrups...........................60 Elixiria—Elixirs..........................66 Glycerita—Glycerites........................73 Liquid Mixtures—Internal.....................74 Mistumj—Mixtures.........................74 Emulsa—Emulsions........................78 Extractive Preparations......................Si Infusa—Infusions..........,...............83 Decocta—Decoctions........................84 Aceta—Vinegars..........................84 Vina—Wines...........................84 Tincturae—Tinctures........................86 Extracta Fluida—Fluid Extracts...................92 Extracta—Extracts.........................97 Abstracta—Abstracts........................98 Oleoresiiuv—Oleoresins.......................99 Resina-—Resins..........................100 Solid Mixtures for Internal Use.................101 Pulveres—Powders.........................102 Sales Effervescentes—Effervescent Salts................105 Confectiones—Confections......................106 Trochisci—Troches.........................107 Massac—Masses..........................10S Pilulae—Pills........ .................109 Unofficial Forms of Mixtures of Solids for Internal Use.........114 Preparations for External Use..................115 Linimenta—Liniments........................116 Lotiones—Washes.........................117 Oleata—Oleates..........................118 13 14 CONTENTS. PAGE Olea Infusa—Infused Oils......................"9 Collodia—Collodions........................M9 Unguenta—Ointments........................I2° Cerata—Cerates..........................122 Suppositoria—Suppositories.....................123 Emplastra—Plasters........................124 Chartae—Papers..............,...........126 Poultice or Cataplasm........................127 Fomentations...........................127 Plaster Mull............................127 Bandages, Antiseptic Dressings....................127 Medicated Dressings........................128 Medicated Cottons.........................128 Medicated Gauzes—Carbasa.....................128 Plaster-of-Paris Bandages......................129 CLASS I.—DISEASE MEDICINES................131 Division I.—Restoratives......................131 Group I.—Digestants.......................131 Group II.—Fats and Oils.....................*34 Group III.—Mineral Acids...................137 Group IV.—Vegetable Acids...................148 Group V.—Alkalies.......................151 Group VI.—Mineral Waters...................167 Group VII.—Bitters.......................172 Simple Bitters....................172 Aromatic Bitters...................174 Group VIII.—Hematics......................181 Animal Extracts (Organo-therapy)...............219 Division II.—Alteratives.....................223 Serum-therapy..................271 Division III.—Antiseptics.....................304 Aromatics....................359 CLASS II.—SYMPTOM MEDICINES.............381 Group I.—Antispasmodics.....................381 Group IT.—Antipyretics.....................390 Group III.—Anesthetics.....................398 Group IV.—Hypnotics......................412 Group V.—Narcotics.......................429 Group VI.—Motor Excitants...................466 Group VII.—Motor Depressants.................500 Bromides......................529 Group VIII.—Cardiac Stimulants.................536 Group IX.—Cardiac Sedatives..................578 Group X.—Diaphoretics.....................594 Group XI.—Emetics........................601 Group XII.—Expectorants....................616 Group XIII.—Diuretics......................630 CONTENTS. 15 PAGE Group XIV.—Cathartics.....................658 Laxatives.....................666 Simple Purgatives..................674 Hydragogue Purgatives...............684 Salines.......................688 Drastic Purgatives..................691 Group XV.—Anthelmintics....................695 Group XVI.—Emmenagogues and Ecbolics.............704 Group XVII.—Astringents....................710 Vegetable Astringents................712 Mineral Astringents.................726 TOPICAL REMEDIES. Group XVIII.—Caustics or Escharotics..............756 Group XIX.—Vesicants and Epispastics..............763 Group XX.—Rubefacients.....................771 Group XXI.—Emollients, Demulcents, and Protective Agents . . . 773 PRESCRIPTIONS..........................784 INDEX...............................813 A TEXT-BOOK OF MATERIA MEDICA, THERAPEUTICS, AND PHARMACOLOGY. INTRODUCTION. The history of medicine since the time of' Hippocrates is the record of a more or less continuous series of experimental re- searches, having for their paramount object a precise and compre- hensive knowledge of the nature of disease and the practical application of remedial science. Regarded sensu latiori, the various " schools " which have arisen from time to time are philosophically co-ordinate, their fundamental principles being ref- erable to one dominating thought—the art of healing. It is scarcely practicable here, even were it necessary, to review in detail the separate doctrines which have obtained during the evolution of sectarian therapy. From the earliest ideas promul- gated by the ancient priests of ^Esculapius, through the subse- quent era of Hippocrates, Theophrastus, and the Alexandrian school, influenced by the crude, misguided notions prevailing ere science emerged from its infancy; discernible in the Galenic and other tentative yet memorable systems, in the epoch of Paracelsus and the Monastic Medicine of the Mediaeval period, and in the radical theories of Rasori and Roeschlaub which attended the development of the last, and have left a passing impress upon the present, century,—through all, the gradual acceptance of empiri- cism as a legitimate guide to therapeutic truth is manifest. Yet viewed with reference to their underlying animus, these varied expressions of scientific endeavor distinguishing the past are per- ceptibly linked with the ampler system which has emanated from the more rational methods of modern research. 2 17 18 A TEXT-BOOK OF MATERIA MEDICA The light of inductive reasoning and the marvellous progress in scientific knowledge which characterize the nineteenth century are a living appeal from the idealism of a less enlightened age. The release from tradition—anticipated in the labors of Bichat and others—to which later investigation owes so many signal triumphs has doubtless been profoundly affected by the realistic tendency of modern thought. It is to the startling advancement attained in the natural sciences, however, resulting in a chemical skill and in me- chanical appliances of incomparable value, that we must look for the originating impulse which has inspired the therapeutic know- ledge of the present day. It needs but little reflection to perceive the immeasurable superiority of actual acquirements over the vague, hesitating—though ardent and laborious—methods to which the theory and practice of medicine were so long subservient. We have said that, considered in the larger sense, the history of medicine has been a harmonious rather than an intermittent devel- opment. It is not to be supposed that, in the evolution of so momentous a scheme as the formulation of a remedial system applicable to the extensive catalogue of human ailments, there should not have occurred spasmodic and ill-adjusted theories, crystallizing in many a strange ailtus, which, if ineffectual in retarding the onward sweep of rational progress, has, it may be safely averred, worked incalculable injury to the cause of medical truth. Mesmerism, astrology, spiritualism, even theosophy, how- ever incongruously conjoined, and similar vagaries have not failed to enlist among their votaries many enraptured, even noted, be- lievers ; nor is the mental strabismus with which they are afflicted amenable to any resource of rational treatment. We need, more- over, but contemplate the pitiable hallucinations which urge the pious pilgrimages to Marpingen, Lourdes, and Treves, and the criminal negligence and incredible offence to reason which stultify the so-called " Christian Scientists " (as ironical a misnomer as lan- guage permits), to realize that miraculous cures still hold blighting yet potent sway over the minds of the ignorant and credulous. May not even the assumption of thaumaturgical powers be one day possible with those who arrogate to themselves a knowledge little short of omniscience, and to whose rudimentary intelligence the laws of nature convey no perceptible lesson ? As from the sublime to the ridiculous, so from faith to fanaticism, it is but a step, after all. It is appropriate here to emphasize the unfailing—nay, ever- INTRODUCTION. 19 increasing—importance of therapeutics in its relation to the wel- fare of mankind. Especially imperative is this obligation in an epoch of unprecedented achievement in every department of science which contributes to the perfection of the healing art, in which general advancement medicine has borne no inconspicuous a role. The rapid advance of experimental philosophy, however, applied to medical treatment, culminating in bacteriological discoveries of signal value to mankind, and the remarkable triumphs attending the development of operative surgery, have inevitably tended to disparage the equally noble and far more widely cultivated field of therapeutic science. This result is the more deplorable since it creates in the minds of the young and inexperienced an impression of contrast and divergence in departments of study naturally and indissolubly correlated. It is scarcely surprising that the marvels of the laboratory and the splendid achievements of the arena should possess for the tyro an entrancing interest. Yet it is to be borne in mind that the most brilliant triumphs of diagnostic and surgical skill might prove futile as the means of arresting disease were they not supplemented by the course of treatment which constitutes therapy. It must be confessed that medical art has too often been dis- credited by professional incompetence, and consequent failure to effect the cure that with the laity is wont to form, however ignor- antly, the only criterion of ability. In America especially—where from defective laws the widest latitude is given to incapacity and imposture—the lack of proper academical training is frequently the cause of serious consequences in practice, little calculated to enhance the popular confidence and esteem. It therefore behooves the student of medicine to master thoroughly the details of the remedial art, become practically conversant with physiological conditions and the manifold phenomena of morbid anatomy, and so familiarize himself with the varying indications of disease that in the presence of whatever malady, his diagnosis and treatment may command respect—not only from the laity, but, what is of far more consequence to him, from the profession. It is almost superfluous to lay stress upon pharmaceutical know- ledge as a powerful weapon in the armament of the medical prac- titioner. Yet no branch of therapeutic science has, perhaps, been more neglected than a practical acquaintance with the nature and uses of Materia Medica, their origin, potency, and characteristic value, as well as their physiological action, and the incompatible 20 A TEXT-BOOK OF MATERIA MEDICA. and synergistic agents upon which their efficacy often largely depends. Thanks to careful and competent training among pharmacists, the skilful preparation and dispensing of drugs relieve the physi- cian of much responsibility; yet he should be keenly sensible of the fact that the larger share of public confidence is reposed in him, and by diligent study of the subject endeavor to command the minutiae of pharmacology, holding himself morally accountable for errors quite possible in the druggist's dispensary. It may not be irrelevant to add that in all medical procedure a sympathetic yet perfectly controlled nature, ready tact, and sterling common sense are cardinal requisites to professional triumph, it being gene- rally true, as was long since observed by Hufeland, that " success- ful treatment requires only one-third science and two-thirds savoir faireT Finally, the author would counsel the utmost seriousness in the pursuit of a calling which might aptly be termed " Christian Science"—the power to alleviate human suffering by means of curative agents with which the laboratory of nature has been mercifully stored. There can be no loftier, more practical mani- festation of love to men than is exemplified in the benignant effort to assuage the ills to which mortality is heir; nor can any devotion be more privileged and inspiring than that which softens the shock of disease, illumines the darkness of mental and physical distress, and from the debris of misfortune, vice, and heredity creates anew the image of divine perfection. It is this uplifting, consecrated zeal, akin to veneration for medical science, which has endeared to the world the masters of the profession—of which the same wise Hufeland said: " To him who fails to make a religion of the heal- ing art it is the most cheerless, wearisome, and thankless labor upon earth; indeed, in him it must become the greatest frivolity and a sin." And for those—and they are many—to whom the material, possibly mercenary, aspect of their task appeals unduly it is enough to cite in rebuke the elevated maxim of Stigelius : Non omnia quae suscipimus lucrum spectant. [ Thurnbergii Dissertationes.~\ PHARMACOLOGY AND GENERAL THERAPEUTICS. Remedies.—In a comprehensive sense every means of counter- acting, curing, or mitigating disease or bodily disorder may be termed a remedy or remedial agent. The mode of treatment may be preventive, reparative, or restorative; but the agents employed by the physician are properly called remedies. Although their number is wellnigh as great as the multifarious causes of disease, the chief classes of remedies are comparatively few, and may be grouped mainly under the following heads: Prophylactic, whereby attention is directed to the immediate environment of the patient, with a view to secure proper sanita- tion and outward conditions more favorable to recovery sug- gested by hygienic laws. Sanitary, when hygienic treatment is combined, as it now usually is, with medical remedies, constituting what is known as regimen, including proper ventilation, temperature, diet, bathing, and exercise. Imponderable, as when the forces of light, heat, cold, and elec- tricity or magnetism are brought into requisition by the aid of science. Mechanical, pertaining to certain surgical methods and remedial applications, or a course of physical training, including the peculiar yet often efficacious treatment known as massage. Pharmaceutical, including a very large and varied class of remedies which, from their established curative properties and their signal importance to the physician (medicus), are technically termed medicines. They are designed to preserve or restore the health of the animal organism, promote recovery in cases of injury or disease, and, in short, perform every office proper to a palliative or remedial agent. Physiology is the study of the functions of the different organs of the animal body under normal conditions. Pharmacology is, strictly speaking, the study of the functions 21 2 2 A TEXT-BOOK OF MATERIA MEDICA. of the different organs of the animal body rendered abnormal by drugs. Materia Medica deals especially with the sources from which drugs are derived, their chemical and physical properties, their constituent elements, and their general function as substances or agencies in the practice of medicine. Pharmacy is restricted to the analysis and determination of drugs, and the science of preparing and dispensing medicines in the forms in which they are best administered. Pathology is the study of the animal body rendered abnormal by disease. Therapeutics (from the Greek word meaning to attend, to serve) is the study of the diseased body under the influence of remedial agents and the science and practice of selecting and applying remedies for sickness and disease, and necessarily includes the proper care and treatment of invalids. " The ultimate aim of all medical research," it has been truly said, " is the treatment and prevention of disease." This constitutes the primary object of the therapeutist. In its amplest signification therapeutics embraces all that relates to the science and art of healing, and the application not only of medicines, but of every remedial agent likely to accomplish this paramount motive of the physician's labor. Under the general term of therapeutics, therefore, are included the action of natural forces, the varied resources of Materia Medica, and the contingent considerations of climate, food, clothing, etc., grouped under two principal divisions : Natural Therapeutics, being, as the term implies, a curative method dependent upon the laws of nature rather than the sub- sidiary arts of man. Applied Therapeutics, including the scientific application of palliative or remedial agents having no counterpart in the living organism, designed, through the art of medicinal administration, to assist nature in the process of restoring health. This division con- stitutes more properly the study of therapeutics and the domain of professional practice. Empirical Therapeutics implies the application of remedies to which experience has ascribed certain specific properties irre- spective of systematic value. It is not based upon scientific research, but rather upon formulae established by the accumula- tion of isolated facts—empiricism—and practical observation, apart PHARMACOLOGY AND GENERAL THERAPEUTICS. 23 from theoretical reasoning and the relations of physiological phenomena as revealed by modern methods of investigation. Were it possible to extend indefinitely the list of remedial agents so as to embrace the entire field of therapeutic knowledge, the empirical method might attain the dignity of an exact science. Such, however, is the complexity arising from the manifold, often contradictory, impressions drawn from human experience that for the evolution of a systematic scheme of therapeutics the empirical system must of necessity prove inadequate. Rational Therapeutics is based upon the use of medicines in accordance with a scientific knowledge of pathology and the physi- ological effects of remedial agents. Here nothing is left to chance, and the nostrums of the older system have but little weight com- pared with the methods of careful and intelligent diagnosis and a skilful administration of remedies suggested by well-known and accepted indications of disease. Every department of medical sci- ence has been illumined by the light of modern research, and the chemical and physical properties of Materia Medica submitted to severe and competent analysis, that Rational Therapeutics may establish a system through which the errors and uncertainty of empiricism may be supplanted by a more stable and philosophical method, and the chances of inaccuracy minimized. Through the college curriculum and the medium of professional intercourse, afforded by personal comparison of opinions and by innumerable publications throughout the world, the results of scientific experi- mentation are becoming widely diffused and the scope of serious investigation constantly enlarged. In connection with this subject it may be well to call the atten- tion of the student to the technical signification of the following terms: Pharmacopoeia {pharmakon, drug ; poiein, to make), a book com- piled by the government, or, as in the United States, a National Committee on Revision, and published by authority, establishing standards for the identification, purity, strength, and quality, and giving directions for the purification, valuation, preparation, com- pounding, and preservation of drugs, chemicals, and medicinal sub- stances. The United States Pharmacopoeia is revised decennially, the present (nth) edition having been adopted Jan. 1, 1894. Official—Officinal.—Unnecessary confusion prevails concerning the precise import of these terms. They are readily understood by reference to the Latin originals from which they are derived. 24 A TEXT-BOOK OF MATERIA MEDICA Official drugs are those which bear the stamp of professional— i. e. official—sanction (Lat. officium, authority). They are prac- tically ordered by the Pharmacopoeia to be kept in all druggists' shops, the formulae being supplied by the work revised in decennial conventions. Officinal drugs are those prepared or kept by the druggist upon his own responsibility, bearing only the authority of the shop (Lat. officina, a shop). Such preparations are often included in works on Materia Medica, and, together with those emanating from other individual formulae, are marked " unofficial." The term " unofficinal," it will be seen, is a solecism; and it fol- lows, moreover, that there are many preparations which are in pharmacy officinal, but not official, and that a pharmacopceial formula cannot possibly be officinal, although, speaking generally, all official drugs are officinal in that they are kept or prepared in the druggist's shop. Dispensatory.—This is a compilation of and commentary on one or more pharmacopoeias, enlarging the authoritative but re- stricted pharmacopceial formulae by including the medical and physical history of the various substances, with directions regard- ing dosage, together with observations on their physiological action and therapeutics. It also contains information concerning drugs not accepted by pharmacopceial authority, yet which are of occa- sional use or interest. The Dispensatory is in effect a private pub- lication and unofficial, in this respect differing essentially from a pharmacopoeia. There are in the United States various works of this character, the United States and National Dispensatories being commonly in use. CLASSIFICATION OF MEDICINES. The classification of drugs and remedial agents is a theme regarding which the many writers upon and teachers of medicine have shown a wider diversity of opinion, perhaps, than upon the physiological action and medical uses of individual remedies. The fact that therapeutics is far from being an exact science, and the rapid advance in our knowledge of normal physiological processes, of pathological conditions, and the systematic action of drugs, are sufficient explanation of the ever-changing judgments of our best observers concerning the action of certain medicinal agents under given conditions. CLASSIFICATION OF MEDICINES. 25 It follows that from time to time, as appears in reviewing the literature of the subject, different writers, in their attempt to keep pace with the advancement of knowledge, have devised various systems of classification. In earlier days, when the therapeutist culled from the fields his simples for the cure of disease, there was naturally created a strong tendency toward a botanical classification. So far was the system pushed that in certain so-called schools of medicine the authority of Scripture was invoked, it being proclaimed as an axiom that " the leaves of the tree were for the healing of the nations " (Rev. xxii. 2). This eclecticism, strange as it may seem to-day, was the outgrowth of the Thompsonian or Botanical system of therapeutics. On the other hand, as an evolution of the old alchemic school, an attempt was made to found a classification by explaining the remedial action of all medicines upon a purely chemical basis. With the advent of more modern methods of study, applied to the physiological action of drugs upon the animal economy, came the physiological classification, in which the effects of remedial agents were explained upon rational grounds. It is hardly necessary to state that coexistent with these various endeavors to attain a philosophical method of classification, com- plicating them and perplexing their votaries, the dominating prin- ciple of empiricism held universal sway, setting at defiance in many instances the cardinal maxims of rational therapeutics, the rational therapeutist even to-day welcoming as a last resort the cruder, though often efficient, empirical method. Some authors, perceiving the inutility of the older systems, have contented themselves with a mere alphabetical arrangement of medicinal agents, regardless of their origin, natural affinities, mode of preparation, and physiological action. With due respect for the many able and worthy efforts at classification recorded in the history of modern therapeutics, the author believes that the main object of classifying medicinal reme- dies—viz. to facilitate the retention of a vast number of valuable yet isolated facts—is best accomplished by grouping them along the lines of greatest practical utility. Remembering that the medical student of to-day is animated by an earnest effort to fit himself for the noblest sphere of usefulness —knowledge applied to the relief of human suffering—the author holds that the most philosophical, as well as practical, synthesis and comparison of remedial agents, based upon manifest physical 26 A TEXT-BOOK OF MATERIA MEDICA. and physiological relationships, will afford to the pupil the widest grasp, from a therapeutical standpoint. With the object of aiding the student, in accordance with this con- viction the author has endeavored in this work to give emphasis to a therapeutical classification, claiming for it no especial originality,1 but assured that the method he has selected is alike the most judi- cious and the one best calculated to respond to the demands of daily, practical utility. The thoughtful and logical student of medicine must realize that there are two great classes of remedial agents : i. Those used in cases which cannot be relieved by a single dose of any remedy, but require repeated and prolonged admin- istration. 2. Those employed in cases which are susceptible of immediate relief by the exhibition of a single dose. The remedies employed for the cure of the first class of cases have been appropriately styled Disease- or Organic-Medicines—an unscientific term, perhaps, yet useful to convey the intended idea, since they remove the cause of the departure from normal physio- logical action in the living organism—i. e. perversion of functional integrity, or morbid conditions. Upon reflection it will be seen that remedial agents in the second class are, by the nature of the case, designed for the relief of some manifestation or change in the system or in its functions indicating the character, locality, severity, etc. of a morbid process—a symp- tom of disease. The remedies in this class, therefore, are termed Symptom- or Functional-Medicines, partly because of their specific virtue in relieving symptoms, partly from the fact that they produce certain manifestations characteristic of themselves. Disease-Medicines are usually administered for the relief or cure of chronic diseases. Symptom-Medicines are employed to relieve symptoms of, or prevent complications in, acute diseases—not for the cure of the disease itself. The classes named might be subdivided ad infinitum, yet it has seemed advisable to the author, for the sake of simplicity, to divide only the first class, Disease-Medicines, including the remedial agents employed therein, under three general heads, Restoratives, Altera- tives, and Antiseptics. It is obvious to every reflecting physician that a class of reme- dies act as such by supplying some deficiency in the animal organ- ism, the agent in such cases being either itself the substance 1 This classification is adapted from one formerly used by Prof. William N. Thomp- son of New York. CLASSIFICATION OF MEDICINES. 2J lacking, or its analogue, or by its presence restoring the deficient element or secretion. Iron or fats, for instance, act in certain forms of anemia in which these ingredients are wanting in the red blood- corpuscles; phosphorus or the earthy salts behave similarly in conditions where the tissues are deficient in these necessary constit- uents; and bitters, though not natural ingredients of the system, act upon the gastro-intestinal mucous membrane, stimulating the glands to secrete a larger quantity of normal digestive fluid. In view of the physiological action of the remedies pertaining to this division, the term Restoratives so aptly expresses their general character that no apology is needed for its adoption. The second division, Alteratives, can be administered without injurious results only in diseased conditions, in which the particular remedy combats in a specific and occult manner the prime etiologi- cal factor of the pathological derangement. These medicines act properly only upon diseased organisms, their peculiar effect never being obtained by the exhibition of a single dose, but only after prolonged administration. They are unnatural to the system, and are more or less poisonous. Functional medicines are also un- natural to the system, but they are given only to relieve symptoms of disease, not for the disease itself; whereas Alteratives relieve the symptoms by removing the cause of the disease. The latter nor- mally produce no symptoms, the patient being unaware of their action save by a recognition of his gradually improved condition. Should, in fact, symptoms occur, they should serve as a warning that the remedy is not indicated or that the dose is unsuitable. To elucidate this principle, the use of morphine to allay the pain of gout may be cited. A single dose is usually sufficient, yet it is not curative; while colchicum acts as an alterative through its well-known specific and eliminative properties, and by continued treatment cures the disease. Again, caffeine may be employed to relieve anemic neuralgia, yet it may require hemic restoratives to alleviate the morbid condition producing the symptoms. A genuine alterative seems to have the property of antagonizing some disease. For instance, A and B are put under a prolonged course of mercury: A is salivated beyond recognition, while B's health improves—simply for the reason that B had syphilis, which A had not. At present the number of remedies which we are compelled to relegate to this class, Alteratives, for want of accu- rate knowledge regarding their modus operandi, is quite limited. The second great class of agents to which the name Symptom- 2R A TEXT-BOOK OF MATERIA MEDICA Medicines is applied embraces all medicinal substances which, being introduced into the system, may produce by a single dose abrupt or serious disturbances of function. From the earliest his- tory of medicine they have offered a tempting field to the thera- peutist, because of the absolute certainty of their action in allaying symptoms or producing manifestations peculiar to themselves. It is perhaps superfluous to add that, owing to their extreme activity, the greater number of therapeutic errors may be ascribed to'their use. To the young practitioner the charm of therapeutics lies in that class of agents which produce immediate and tangible results. These are obtained most readily by the remedies affording instant relief of prominent symptoms of disease, such as pain, pyrexia, insomnia, etc. Yet the author is here constrained to add a word of caution to the amateur therapeutist, reminding him that, in the maturer knowledge derived from subsequent experience, he will have Less to regret should he confine his study and practice to physiological medication—that is, to the examination and adminis- tration of legitimate restoratives and alteratives—rather than yield to the allurements presented by the energetic action of a large number of agents classed among Symptom-Medicines. The members of this class of remedies have been variously divided and subdivided by different writers on therapeutics. Antiseptics are classed among Disease-Medicines on account of their property of restoring to their normal condition the tissues, fluids, and secretions of the body by destroying the germs or micro-organisms which by their presence excite pathological processes. This great class, Antiseptics, embraces some of our most important neurotics. Most of them are antipyretic, and many of them possess analgesic and hypnotic properties. Instance, chloral, a powerful antiseptic, hypnotic, antipyretic, and circulatory depressant. Con- sidered only as an antiseptic, it would be classed as a Disease- Medicine ; clinically, however, it is used more as a hypnotic, and therefore in this work it is ranked as a Symptom-Medicine—a neurotic in the subdivision of Hypnotics. Drugs, in fact, exhibit so many different actions that an arbitrary line of demarcation between them is practically impossible, the author merely desiring to assign a given remedy to the class to which its chief therapeutic uses would naturally attribute it. The principal use of opium, as we know, is to relieve pain. It ADMINISTRATION OF MEDICINES. 29 is the typical narcotic, yet it possesses astringent and hypnotic properties, and could therefore not inaptly be classed as an astrin- gent or hypnotic. It is already a question whether antipyrine should not be ranked in the division of Analgesics rather than Antipyretics, since, while formerly it was used almost exclusively for the reduction of tem- perature, we now know it to possess marked anodyne properties ; so that it is actually doubtful which is its more important use—to lower temperature or to relieve pain. These few illustrations serve to show how varied are the actions of drugs, and how their several divisions overlap one another. Thus, the last division of Disease-Medicines, Antiseptics, imme- diately precedes the first group of Symptom-Medicines, Antispas- modics, so closely are they allied, the last-named class possessing properties similar to those of that interesting division of Antisep- tics—the Aromatics. The next group, Antipyretics, is logically followed by Anes- thetics, and this in turn by Hypnotics, Narcotics, etc., each group being succeeded by the one most closely resembling it in physio- logical and therapeutic action. The last group comprises the Astringents, classed under Symptom-Medicines, these agents occu- pying the borderland between external and internal medicines. Caustics, the first group under topical remedies, naturally follow Astringents, since they differ from the latter drugs only in degree perhaps, as is well shown in sulphuric acid, which when diluted is an astringent, but undiluted an active caustic. A thoughtful study of drugs as classified in this work will, it is hoped, enable the student to become more familiar with the com- parative value of the various remedial agents than were possible had the author chosen an alphabetical arrangement, associating remedies having no possible relationship either in their actions or their medical uses. ADMINISTRATION OF MEDICINES. External Method of Application.—In order to utilize the absorptive power of the cutaneous surface for therapeutic pur- poses various methods have been adopted. The simplest of these, though by no means the most successful, is by Inunction, which consists in an outward application of the 30 A TEXT-BOOK OF MA TERIA MEDICA. medicinal agent, without abrasion of the cutis, and compulsory absorption through the process of " rubbing in." The horny epidermis, however, presents an effectual barrier to the absorption of many drugs, and the Endermic Method has been found more active. This plan con- sists in producing, by means of a blister, a raw surface, which readily absorbs the medicinal agent—morphine, strychnine, atro- pine, quinine, etc.—with highly marked effect. The process is somewhat painful and necessarily slow in action, being now almost wholly superseded by the Hypodermic Method.—This consists in injecting the drug into the subcutaneous tissues by means of the hypodermic needle and syringe. Since absorption by the tissues takes place readily, it will be seen that this method of application is far more efficacious than those previously mentioned. Not all drugs, it is to be observed, are available for administration by the hypodermic process of injection. The eminent success attending the operation, however, renders it of signal value to the physician. Parenchymatous Method.—This is a more heroic means of injection, by which the drug is deposited in the corporeal tissues. It is said to afford temporary relief in sciatica, but for various reasons is highly objectionable, chiefly because of the excruciating pain consequent to the operation. Intravenous Injection may be resorted to in desperate cases : its dangers are obvious, however, and, save for the purpose of trans- fusion after severe hemorrhage, it can seldom be attempted with impunity. Internal Administration.—The most obvious, and by far the most useful, method of internal administration is by the mouth; yet care and discretion are to be used even in so ordinary a process, and the physician should consider thoughtfully the time, consequent effects, and chemical changes, that the drug may produce the most beneficial results. Inlialation is in many respects of the first importance as a method of internal administration. Its great facility in practice and its unquestionable efficiency—as in the case of anesthetics__ render it readily available and highly beneficial, although the method has attained as yet only a limited use in therapeutics beyond a resort to it in pulmonary diseases. Enemata.—A different class of administrative operations consists in injections into the rectum, which injections may be purgative ADMINISTRATION OF MEDICINES. 31 anodyne, nutrient, emollient, astringent, anthelmintic, etc. For speedy and efficient cleansing of the large intestine the purgative enema is of incomparable value, care being taken that the quantity of the injection be sufficient, that it be passed up as far as possible, and that it remain as long as the patient is able to retain it. Absorbable enemata are usually small in quantity; they have proved useful in certain cases of diarrhea and dysentery, and are serviceable when the act of swallowing is precluded by affections of the esophagus or in cases where the stomach requires complete rest. The rectum, however, possessing no digestive capacity, the injection should consist of the simplest materials and contain pepsin and acid or pancreatic fluid. Another mode of securing beneficial results from internal admin- istration through the absorptive properties of the intestine is by means of suppositories, readily introduced within the sphincter ani and dissolving at the temperature of the body. Dosage.—The term dose implies the quantity of a medicinal agent which under certain conditions it is advisable to administer, many considerations entering into the question, to be weighed by the features of the individual case. Dosage may be regarded as perhaps the most vulnerable point in therapeutic science, yet one upon which the art of healing almost wholly depends. Since Heller in 1755 enunciated his philosophical maxims touching the rational method of testing the therapeutic effects of drugs, eminent clinicians have sought to solve the mysteries attend- ing the action of various remedies whose modus operandi remains to this day obscure. Indeed, so great is the diversity of operation pertaining to the commonest remedies, conditioned by the character and circumstances of the case, as well as the amount and quality of the drug, that it is next to impossible to predicate the precise effects of agents whose physiological properties are theoretically and even practically established. The ordinary adult dose of opium, for instance, is I gr. (0.06 Gm.); yet in certain diseases, such as peritonitis, ten times that amount may be required to relieve the pain. The doses given in many text-books differ materially from those prescribed in actual practice, being in- tended to express only the average quantities to be admin- istered, the exact amounts varying with the conditions of the particular case. These conditions may be classed under the heads of age, sex, temperament, idiosyncrasy, habit, state of the system, temperature of the body, time of administration, intervals 32 A TEXT-BOOK OF MATERIA MEDICA. between doses, cumulative action of the drug, and the contingent considerations of diet, climate, race, etc.—oftentimes a complicated problem even to the most skilful therapeutist. A few suggestions regarding the leading characteristics of dosage, as limited by these various circumstances, may be of value to the student. The influence exercised by Age is indubitable, as a rule the young requiring smaller doses than adults, the aged being least susceptible to therapeutic impressions. With regard to children several mathematical formulae have been devised, none of which, however, has proved infallible—least of all those based upon adult dosage, itself subject to no little uncertainty. Nor can deductions as to the efficacy of a given dose be drawn from the action of drugs with which the agent is naturally asso- ciated. A single drop of laudanum has been known to pro- duce the death of an infant, whereas large doses of belladonna, conium, arsenic, and mercury have been taken with comparative impunity. The most convenient rule (Young's) adds 12 to the child's age and divides by the age to get a denominator of a fraction whose numerator is i, this fraction representing the proportion between adult and infant doses. Thus, for a child three years old 3+12 ------- = 5, or ^, the dose being one-fifth of that given to an adult. Temperament acts as an important agent in modifying the effect of medicinal remedies, phlegmatic subjects readily tolerating cer- tain medicines, such as opium, which those of nervous temperament are unable to bear. Stimuli act upon sanguineous patients forcibly, yet upon others their influence may be either tardy or ineffectual. The condition is one which discloses a wide field of inquiry, the mental, moral, and physical tendencies of the individual being involved in the practical administration of medicines. Closely allied to the foregoing is the question of Idiosyncrasy, the constitutional peculiarity which exerts a subtle influence, scarcely understood, as potent as it is obscure. Its characteristics cannot be formulated, but must be studied with the aid of experience—an odor, a taste, a casual or fixed impression, or hereditary instinct often determining their existence and manifestation. In tempera- ment and idiosyncrasy, indeed, the psychological rather than the physiological side of therapeutics is developed, requiring for its treatment a professional acumen not always at command. The influence of Habit is to diminish the susceptibility of the ADMINISTRATION OF MEDICINES. 33 organism to impressions which under normal conditions would be speedy and effectual. Only by gradually increasing the quantity of the dose can results be obtained which in ordinary circumstances require few exhibitions. Thus, patients accustomed to the use of alcoholic stimulants accept heroic doses of alcohol with little or no indication of effects quickly perceptible in temperate subjects. Bodily condition obviously affects the action of remedial agents. It is well established that in severe pain opium may be adminis- tered in quantities which in a healthy organism would produce untoward, perhaps fatal, results. The salivation occasionally caused by mercury is seldom apparent in febrile conditions. Yet in cases where sensibility is diminished great care is necessary to avoid the deleterious effects of over-stimulation or excessive dosage. Respecting Sex, although it is generally admitted that females require smaller doses than males, the exceptions to the rule are so numerous as almost to vitiate the accepted theory. The Time of Administration is closely connected with the Form of the Remedy given, as a rule remedies being withheld immedi- ately before and after meals. The practice, however, is subject to modifications, certain drugs acting best on an empty stomach, and others, such as local irritants, being more safely diffused when the stomach is full, in which case by mingling with the food they are not brought into irritating contact with the intestinal mucous membranes. With regard to Intervals betzveen Doses it may be said, in brief, that they are to be determined by the special features of the case, the character and potency of the drug, and the degree of tolerance and assimilation evidenced by the patient. Every remedial agent, under normal conditions, produces a specific and definite action, the system by absorption and elimination limiting the period of its efficacy in cases of prolonged treatment, so that the drug is evi- dently to be renewed in order to secure perfect results. Failure to continue treatment has frequently proved disastrous, even fatal, to the patient, and it should be borne in mind that, in the absence of contraindications or untoward effects, a primary object of dosage is to create and maintain an impression upon the morbid system. Knowledge of therapeutic action and a thorough understanding of pathological conditions can best determine the interval requisite to attain the most beneficial effect of successive dosage. Other considerations—by some therapeutists held to be of minor, by others of paramount, importance—affect the vital question 31 A TEXT-BOOK OF MATERIA MEDICA of dosage. The emotions, for example, play an interesting part in the toleration or rejection of remedial agents. Strangely enough, too, the imaginative faculty is often a cause of idiosyncrasy, numer- ous instances being adduced by reputable authorities wherein either positive or fancied ills were affected through the agency of spurious remedies—bread-pills, deceptive concoctions, and the like —the ethical aspect of therapeutics being here left to the conscience of the physician. UNTOWARD EFFECTS OF DRUGS. Drugs given a specified patient, a victim of acquired or in- herited defect, will produce in that patient unexpected results dif- fering from their usual action. These results, which should not be classified with typically poisonous effects or with those of pro- longed use, may not appear in many cases, and do not correspond, as a rule, with the admittedly poisonous symptoms. They have been termed in Germany " nebenwirkungen," in France " incon- venients therapeutiques," and among the English-speaking nations " untoward effects " and " bye-effects." The following summary has been made of these from those tabulated by Drs. W. L. Baum, and J. G. Kiernan of Chicago, Lewin of Berlin, Germany, and Mul- heron of Detroit, Mich. Untoward effects are of great interest from a medico-legal standpoint. Even physicians are but too apt to refer them to defects or impurities in the drug dispensed. They are seemingly multiform in character, and yet they can readily be ranged under a few general laws. The primary and secondary effects, which are often opposite in nature, the organs chiefly affected by the ordinary action of the drug, the method of drug-excretion, all play a part in what may be called general constitutional untoward effects, as con- trasted with the untoward manifestations due to temporary and evanescent conditions, which last, however, also range themselves in a regulated fashion. Prediction may be made with considerable accuracy as to the untoward effects of any drug on learning its action and all the factors cited. An antipyretic will have as untoward effects, skin- eruption because it is excreted through the skin, because the skin through its pores regulates temperature, and hence is under control of the central nervous system regulating temperature, and, finally, because the skin is in close connection from an early period with UNTOWARD EFFECTS OF DRUGS. 35 the nervous system. For the same reason profuse, debilitating perspiration often results. Since control of the temperature cannot be effected without control of the vasomotor system regulating the blood-supply, heart-failure, collapse, and palpitation may result, together with certain eye- and ear-symptoms. If the drug be one which tends to cause slight brain vasomotor disturbance, such as results from what is known as a tonic action, then delirium, blindness, and deafness of a temporary character are produced. Temperature in the human subject is regulated by the three systems of nerves : thermotaxic or heat-regulating, thermo- excitory or heat-increasing, and thermo-inhibitory or heat-decreas- ing. As a more or less exact balance is kept by these centers, undue action of any of them constitutes a morbid state. If the thermo-in- hibitory centers be too much stimulated, they may lose their control: hence in certain individuals temperature rises after an antipyretic. Hahnemann, an individual with a neurotic constitution, had an easily upset temperature-regulator, whence his experiments on him- self with cinchona resulted in this phenomenon, which has since been observed by Denk and others from quinine and cinchona preparations. The action on the heart may, by its influence on the kidney-circulation, cause kidney- and bladder-symptoms even to the extent of albumin in the urine. If the antipyretic be excreted through the kidneys, albuminuria is especially likely to present itself as an untoward result. Alteratives and purgatives produce hemorrhages from the mucous membranes and swelling of those of the organs of special sense, beside skin-eruptions. Hypnotics through their action on the central nervous system produce exces- sive perspiration, skin-eruptions, vertigo, and heart-collapse. Astrin- gents cause diarrhea and bloody intestinal discharges. Diaphoretics cause pains at certain points from over-stimulation. Pilocarpine causes at times pain in the penis; as there often occur in certain persons excessive secretion and plugged sebaceous glands around its head, the pain and other resultant symptoms simulate chancre. In classifying tonics and alteratives together in the first table the influences of the trophic nervous system, evident in the constitu- tional changes produced by diseases like typhoid fever, must be taken into account. Alterative drugs have much the same con- stitutional effects, according to the theory of their action now coming into general acceptance. It will be observed from the annexed tables (see pages 36-41) that the most potent tonics and alteratives are most fertile in Table I.—Alteratives and Tonics. General, Fever, gastralgia, nau- sea, bulimia, saliva- tion, profuse sweating, diarrhea, purpura. Nausea. Nausea. Nausea, gastralgia, like guaiac. Fever. Fever, nausea. Fever, salivation, epis- taxis. Fever, profuse sweating. Bulimia, gastralgia, car- diac disorder, hemop- tysis, dyspnea, fever, epistaxis, nausea. Hemoptysis, hematcme- sis, nausea, gastral- gia, fever, diarrhea, constipation. Fever, gastralgia, diar- rhea, constipation, bulimia. Nausea. Fever, nausea, bulimia, hemoptysis, profuse sweating, dyspnea. Profuse perspiration, bulimia, hemoptysis. Nausea, gastralgia, bu- limia, profuse sweat. Bkain and Cord. Vertigo, ataxic symp- toms, local anesthe- Vcrtigo. Vertigo. Like guaiac. Vertigo, contractions. Vertigo. Vertigo, emotional exal- tation, aphrodisia. Vertigo, ataxic symp- toms, neuralgia. Aphrodisia, ataxic symp- toms, vertigo, delir- ium. Vertigo, ataxic symp- toms, insomnia. Insomnia, ataxic symp- toms, insanity, local sensory troubles. Vertigo, contractions. Delirium, insanity, atax- ic symptoms, local sensory troubles, ver- tigo. Vertigo, delirium, insan- ity, ataxic symptoms, local sensory troubles. Vertigo, ataxic symp- toms. Eye, Ear, and Throat. Eyelid edema, glottis edema, catarrh, am- blyopia, tinnitus. Tinnitus. Like guaiac. Conjunctivitis, tinnitus. Eyelid edema, tinnitus. Tinnitus. Glottis edema, tinnitus. Amblyopia, catarrh, glottis edema, eyelid edema, diplopia, tin- nitus, salivation. Eyelid edema, glottis edema, amblyopia, tinnitus. Eyelid edema, ambly- opia, tinnitus, glottis edema. Tinnitus. Amblyopia, photopho- bia, deafness, tinnitus. Dim sight, deafness, tin- nitus. Glottis edema, tinnitus. Skin. Vesicles, pustules, pap- ules, erythema, urti- caria, purpura. Pruritus. Vesicles. Vesicles. Erythema. Erythema, papules. Erythema, papules. Vesicles. Erythema, vesicles, pap- ules, pustules, purpu- ric eruptions, urti- caria. Vesicles, purpuric erup- tion, pustules. Like iodides and qui- nine, tongue ulcera- tion, salivation. Papules. Simulates scarlet fever, vesicles, papules, pus- tules, erythema, urti- caria, purpura. Vesicles, pustules, pruri- tus, gangrene, pur- pura. Eczema. Liver, Kidneys, and Bladder. Dvsuria, icterus, hema- turia, glycosuria, cys- titis, albuminuria. Albuminuria. Cystitis, strangury. Dysuria. Cystitis. Cystitis. Cystitis, strangury. Dysuria, cystitis, glyco- suria, albuminuria. Hematuria, albuminu- ria, glycosuria, icterus. Dysuria, cystitis, hema- turia, glycosuria. Dysuria. Hematuria, cystitis, al- buminuria, glycosuria, icterus. Cystitis, glycosuria, ic- terus. Cystitis, strangury. Strychnine Turpentine Fever, dyspnea. Fever, nausea. Vertigo, ataxic symp- toms, local sensory troubles. I Vertigo, drowsiness, [ Tinnitus stupor. Conjunctivitis, photo- Erythema, pruritus. phobia, tinnitus. Vesicles, erythema. Albuminuria, ria, cystitis. glycosu- Albuminuria, cystitis, strangury, hematuria. Acetanilid or Antife- brin. Aconite Amyl Nitrite Antikamni.i Antipyrin . Arnica . . Atropine . Belladonna Bromides . Caffeine Camphor . Table II.—Xeuroties, Xarcotics, Antipyretics, and Hypnotics. General. Lungs aud Heart. Bkain and Cord. Cardiac failure, lung edema, cyanosis, fe- ver, pallor, hyperidro- sis, nausea, diarrhea. Nausea, diarrhea, sali- vation, hyperidrosis, collapse, cyanosis. Like glonoin. Like acetanilid. Like acetanilid. Tenesmus, bradycardia, diarrhea, collapse. Like belladonna. Diarrhea, nausea, vom- iting, collapse, hyperi- drosis, fever, cardiac pain, dysphagia, dysp- nea. Collapse, cardiac failure, lung edema, gastral- gia, vomiting, aphro- disia, amenorrhea, pneumonia. Anesthesia, hyperes- thesia, vertigo, delir- ium, stupor, ataxia. Vertigo, anesthesia, paresthesia, hyperes- thesia. Like glonoin. Like acetanilid. Like acetanilid. Stupor, vertigo, head- ache. Like belladonna. Delirium, insanity, stu- por, vertigo, ataxia. Delirium, insanity, stu- por, ataxia, convul- sions, anesthesia, hy- peresthesia. Eye, Ear, and Throat. Skin. Amblyopia, xerostoma, throat constriction, tinnitus, pupil irregu- larity, conjunctivitis. Amblyopia, tinnitus, xerostoma. Like glonoin. Like acetanilid. Like acetanilid. Xerostoma, amblyopia, throat irritability. Like belladonna. Amblyopia, lachryma- I Erythema, vesicles, pap- tion, xerostoma, tin- ules, purpura, pruri- nitus. tus. Erythema, vesicles, pap- ules. Erythema, urticaria. Like glonoin. Like acetanilid. Like acetanilid. Erythema, urticaria, papules, pruritus. Like belladonna. Liver. Kidnhys, and ijladukk. Bradycardia. ! Delirium, insanity. Diarrhea, collapse, aph- Delirium, insanity, stu- rodisia, hyperidrosis, | por, hyperesthesia, vomiting. headache. Throat anesthesia, co- ryza, laryngismus stridulus, conjunctivi- tis, amblyopia, my- opia, diplopia, fetid breath. Diplopia. Xerostoma, coryza, am- blyopia, tinnitus. Acne, papules, vesicles, urticaria, erythema, pruritus. Erythema, vesicles. Erythema, vesicles. Icterus, dysuria, cystitis, albuminuria, glycosu- ria. Icterus, polyuria. Like glonoin. Like acetanilid. Like acetanilid, cystal- gia. Cystalgia, dysuria. Like belladonna. Cystalgia, dysuria, poly- uria. Dysuria, cystalgia, ic- terus, polyuria, glyco- suria. Dysuria. Dysuria, polyuria, cys- talgia, strangury. Table II.—Neurotics, Narcotics, Antipyretics, and Hypnotics (Continued) Cannabis Indica Chloralamid Chloralose . . Chloral Hydrate Chloroform Cocaine Codeine Conium Digitalis Duboisine Ergot . . Ether . Exalgin . . Gelsemium Glonoin Gr.NRKAl Luni.s and Heart. Aphrodisia, vomiting, diarrhea, amenor- rhea. Like chloral. Like chloral. Dyspnea, lung edema, heart-failure, fever, diarrhea, hyperidro- sis, bradycardia. Fever, collapse, aphro- disia, diarrhea, hy- peridrosis. Anaphrodisia, collapse, diarrhea, constipa- tion, nausea, fever, amenorrhea, tenes- mus. See Opium. Nausea, vomiting, bra- dycardia. Cardiac failure, dysp- nea, dysphagia, nau- sea. See Belladonna. Nausea, vomiting, gas- tralgia, bradycardia, fever, cyanosis. Pallor, cyanosis. Like phenacetin. Dyspnea, coryza. Dyspnea, coryza. Brain and Cord. Vertigo, delirium, in- sanity, ataxia. Like chloral. Like chloral. Vertigo, ataxia, stupor, delirium, convulsions, analgesia, anesthesia, hyperesthesia. Vertigo,delirium, ataxia. Vertigo, ataxia, hyper- esthesia, delirium, in- sanity. Ataxia, stupor, hyper- esthesia. Headache, vertigo, stu- por, insanity, ataxia. Convulsions, vertigo, ataxia, hyperesthesia, delirium, insanity. Vertigo, delirium. Like phenacetin. Vertigo. Vertigo, ataxia, analge- sia. Eye, Ear, and Throat. Amblyopia, tinnitus. Like chloral. Like chloral. Epiglottis edema, am- blyopia, photophobia, conjunctivitis, cho- roiditis, tinnitus. Amblyopia, like chloral. Like opium. Amblyopia. Amblyopia. Amblyopia, tinnitus, photophobia. Salivation, laryngismus stridulus, amblyopia, tinnitus. Like phenacetin. Amblyopia. Amblyopia. Skin. Erythema, vesicles. Like chloral. Like chloral. Erythema, acne, purpu- ra, papules, urticaria, pruritus. Like chloral. Like opium. Erythema. Erythema. Erythema, papules, urti- caria. Erythema, urticaria. Like phenacetin. Erythema. Erythema. C*> 00 Liver, Kidneys, and Bladder. Dysuria, cystalgia. u. Like chloral. 8 < Like chloral. Icterus, dysuria, stran- gury, glycosuria, al- buminuria. Like chloral. Icterus, strangury, dys- ^1 uria, polyuria. >, 0. N C*1 Dysuria, polyuria. >! s Dvsuna, polyuria, stran- a. gury, glycosuria. k ^> C*i Icterus,glycosuria, b strangury. Icterus, glycosuria. Like phenacetin. Strangury, icterus. Strangury glycosuria. Holocrine Homatropine Hydracetin . Hyoscyamus, Hyoscyamine, Hyoscine, Kryofine . . Methylal..... Methacetin .... Monobromacetanilid Musk Opium, Morphine, Codeine, Paraldehyde Pental . . Phenacetin Phenocol . . Physostigma Phytolacca . Pulsatilla . . Scopolamine Serosin . . . Stramonium Sulphonal . . Like belladonna. Like belladonna. Fever, nausea, cardiac irritability, dyspnea, nausea. Like hydracetin. Dyspnea, coryza, hy- peridrosis. Like kryofine. Hyperidrosis, like hy- dracetin. Fever, syncope, hyperi- drosis, cyanosis. Nausea, aphrodisia, fe- Nausea, diarrhea, gas- tralgia, dyspnea, aphrodisia, fever, hy- peridrosis. Like opium, cyanosis, gastralgia. Like ether. Fever, collapse, dysp- nea, hyperidrosis, cyanosis. Like phenacetin. Nausea, gastralgia, vom- iting. Like physostigma. Coryza, dyspnea, car- diac irritability. Like belladonna. Like methacetin. Like belladonna. Like methacetin. Like belladonna. Like belladonna. Vertigo, delirium, ataxia, numbness. Like hydracetin. Like hydracetin, except as to delirium. Like hydracetin, stupor. Like hydracetin. Vertigo, stupor, head- ache, numbness, hy- peresthesia. Like monobromacetani- lid. Vertigo, stupor, convul- sions, insanity, head- ache, paresthesia. ' Like opium. Like ether. Vertigo, ataxia, stupor, hyperesthesia. Like phenacetin. Vertigo, mastalgia lirium, ataxia. Like physostigma. Orchialgia, mastalgia Like belladonna. Like methacetin. Like belladonna. Like methacetin. de- Like belladonna. j Like belladonna. Like belladonna. | Like belladonna. Pupil immobility, am- Erythema, purpura. blyopia, conjunctivitis, throat irritability. Like belladonna. Like belladonna Strangury, hematuria. Like hydracetin. Amblyopia. Diplopia, amblyopia. Amblyopia, diplopia. Amblyopia. Throat irritability, am- blyopia. Throat irritability, am- blyopia, yellow vision, accommodation spasm. Like opium. Like ether. Amblyopia, tinnitus, di- plopia. Like phenacetin. Tinnitus, amblyopia. Like physostigmin. Amblyopia, eye-pain, tinnitus. Like belladonna. Like phenacetin. Like belladonna. Like methacetin, Erythema, papules, and Icterus, bladder-itrit. pustules. Erythema. Erythema, urticaria. Erythema. Erythema. Erythema. Erythema, vesicles, pap- ules, purpura, pruri- tus, urticaria. Like opium. Like ether. Erythema, urticaria. Like phenacetin. Pruritus, erythema, urti- caria. Like physostigmin. Erythema. Like belladonna. Like phenacetin. Like belladonna. Like methacetin. bility. Polyuria, dysuria. Polyuria, bladder irrita- bility. Like methylal. Like methylal. Dysuria. Dysuria, glycosuria, ic- terus. Like opium. Like ether. Dysuria, glycosuria, ic- terus. Like phenacetin. Dysuria, icterus. Dysuria. Dysuria, polyuria. Like belladonna. Like phenacetin. Like belladonna. Like methacetin. Table II.—Nan ■oties, Narcotics, Antipyretics, and Hyp notics (Continued). Liver, Kidneys, and Bladder. O Tetronal, ) Trional, j General. Lungs and Heart. Like methacetin. Brain and Cord. Like methacetin. Eye, Ear, and Throat. Skin. Like methacetin. Like methacetin. i Like methacetin. k Valerian..... Nausea, diarrhea, aphro- Paresthesia, vertigo, de- Throat constriction, tin- Pruritus, erythema, pap- Dysuria, polyuria. disia, enteralgia, gas- lirium. nitus, amblyopia. ules. 3 ** Veratrum..... n aigia. Collapse, dyspnea, car- Paresthesia, hyperes- Xerostoma, amblyopia. Pruritus, petechia?. Dysuria. diac pain, enteralgia, thesia, vertigo, con- to gastralgia. vulsions, delirium. Tab le III.—Anthelmintics, Cathartics, Diaphoretics, Diuretics, Emetics, and Expectorants. Aloes....... General. Lungs and Heart. Vomiting, tenesmus. Brain and Cord. Eye, Ear, and Throat. Skin. Liver, Kidneys, and Bladder Hematuria. O ^ Ataxia, vertigo. Amblyopia. Erythema, urticaria. > Ammonium Chloride Nausea, diarrhea. Ataxia, vertigo. Amblyopia. Erythema. Polyuria. Buckthorn .... Fever, diarrhea. Ataxia, vertigo. Amblyopia, tinnitus. Erythema. ', Icterus, polyuria. ^ Caseara...... Like buckthorn. Like buckthorn. Like buckthorn. Like buckthorn. Like buckthorn. t»! Castor Oil..... Vomiting, fever. Like buckthorn. Like buckthorn. Like buckthorn. Icterus. >3 Colocvnth..... Like castor oil. Like buckthorn. Like buckthorn. Pruritus, erythema. Icterus. >, Copaiba...... Fever, dyspnea, gastral- Vertigo, ataxia, spastic Amblyopia, photopho- Roseola, urticaria, ery- . Cystitis, nephritis, dysu ~- gia, nausea, aphro- palsy. bia, conjunctivitis, thema, pruritus, penis ria. ► disia. pharyngitis, tinnitus. ulcers. 5 Croton Oil .... Nausea. Vertigo. Amblyopia, conjuncti-vitis. Erythema. Icterus, cystitis, nephri-tis. Cubebs . . See Copaiba. r5 See Coloiynth. See Colocvnth. See Coloeynth J, tiratiola..... Aphrodisia, vomiting. See Colocvnth. Ipecac ...... Diarrhea. Vertigo. Amblyopia, tinnitus, sali-vation. Pruritus, erythema. Dysuria. See Colocvnth. Vertigo, ataxia, penis- Amblyopia, tinnitus. Erythema, pruritus. Uterus, dysuria, poly- I.iborandi..... Nausea, collapse, fever, lung edema. tip pain. uria. T'Lip.......' See Colocvnth. Male Fern .... Nausea, fever. Vertigo, ataxia. Amblyopia, tinnitus. Erythema, roseola. Dysuria, cystalgia. Podophyllum . . . See Colocvnth. Pomegranate . . . Nausea, diarrhea. Vertigo, ataxia. Amblyopia, tinnitus. Erythema. Polyuria. Pot. Chlorate . . . Nausea, diarrhea, fever. Vertigo, delirium,ataxia. Amblyopia, coryza, epis-taxis. Roseola, erythema. Nephritis, icterus, cyst-itis, dysuria. Rhubarb..... Nausea, vomiting, con- Vertigo, ataxia. Amblyopia, coryza, tin- Roseola, macules, ery- Hematuria, dysuria. stipation, penis hem- nitus. thema, urticaria. orrhage. Vertigo, delirium, ataxia. Amblyopia, deafness, tinnitus. Macules, erythema. Dysuria, cystitis. Nausea, diarrhea, gas- Vertigo, ataxia, insanity, Amblyopia, photopho- Erythema, urticaria. Icterus, dysuria. tralgia, amenorrhea. delirium. bia, yellow vision, tin-nitus. Senega ...... Nausea, diarrhea, gas-tralgia. Vertigo. Amblyopia. Erythema. Dysuria. 1 ,ike senega. Like senega. Xerostoma, amblyopia, coryza, tinnitus. Erythema. Dysuria, hematuria. Tartar Emetic . . . Nausea, cyanosis, col- Vertigo. Amblyopia, conjuncti- Roseola, papules. Nephritis, cystitis, dys- lapse. vitis. uria. s b On b -(^ 42 A TEXT-BOOK OF MATERIA MEDICA. untoward effects. This is naturally to be expected. A drug of pftcnt physiological action must of necessity try more severely inherited and acquired deficiencies of constitution than an inert drug. Too excessive strain on inhibitions weakened by acquired or inherited taint gives an undue sway to inhibited centers. Un- toward effects of drugs may hence be conditioned on pre-existing affections of the inhibitory apparatus of the system. One influence which, together with hereditary or acquired defect, plays a part in determining untoward results is what the Germans call the " etiologic moment." This is excellently illustrated in the neurotics, which display such decidedly variable untoward effects. In many neuroses nerve-strain of the elimi- native and assimilative organs has produced toxins and other products; some of these naturally add to the effects of a given neurotic drug, or direct these in some special channel or inhibit certain effects, thereby giving others undue play. This may con- stitute, as Lewin has shown, a disposition that is but temporary, which disposition may have its foundation either in a greater abundance in the system of bio-chemical substances, which cause an unusually prompt solution or action of the medicines intro- duced, or which may unite with them to form injurious com- pounds ; or it may be conditional on pre-existing pathologic changes in the inhibitory apparatus of the system. The tables given on pages 36-41, covering all the departments of the materia medica, will give a better idea of these untoward effects than any detailed description. WEIGHTS AND MEASURES. The history of Weights and Measures affords a striking example of the incongruity resulting from the absence of a uniform standard of stable value to science, and must be regarded as the strongest argument in favor of the Metric, or Decimal, System. An idea of the confusion prevailing under the old methods may be gained from an examination of their comparative units, by which we find that a pint is not a pound, an ounce not equal to a fluid- ounce, a drachm not equivalent to a fluidrachm, and a minim not commensurate with a grain. It was not until 1836 that the Secre- tary of the U. S. Treasury was directed by Congress to furnish each State in the Union with a complete set of revised standards, includ- WEIGHTS AND MEASURES. 43 ing the troy pound of 5760 grains, from which the Apothecaries', or Troy, weight is derived, the latter term at present being applied only to the system used in weighing precious metals. For commercial purposes the following Weights and Measures are employed: Avoirdupois Weights: the Pound divided into 16 Ounces. Liquid Measures: the "Wine Measure," of which the U. S. Gallon represents a volume of 231 cubic inches; each cubic inch of water at the maximum density (40 C.) being equivalent to 252.892 grains, the weight of a Gallon being therefore 58,418 grains. The Gallon is divided into 8 Pints (octarius), and the Pint is divided into 16 Fluidounces, each containing 8 Fluidrachms, or 480 Minims, the Fluidrachm containing 60 Minims. The signs used to designate these units are—Tit, denoting minim or minims; f3, fluidrachm or fluidrachms; and f 5, fluidounce or fluidounces. Apothecaries' (Wine) Measure. 20 grains (gr. granuni) = 1 scruple 9 (scrupulum). 60 grains, or 3 scruples = I drachm 3 {drachma). 480 grains, or 8 drachms = 1 ounce 3 (uncia). 5,760 grains, or 12 ounces = 1 pound lb (libra). Apothecaries' (Troy) Weight. 60 minims (Tit) = I fluidrachm f£. 480 minims, or 8 fluidrachms = 1 fluidounce f3. 7,680 minims, or 16 fluidounces = 1 pint O (octarius). 61,440 minims, or 8 pints = 1 gallon C (congius). This lack of uniformity in the units and the denominations of the three systems of weights and measures is exemplified in the subjoined table. While the two weight systems have a unit in common, the grain, there is no correlation in the higher denomina- tions, ounces and pounds. The desirability of adopting a fixed standard, applicable in all cases where great accuracy in weights and measures is requisite, has been frequently emphasized by writers on therapeutics. As we have premised, the present diffi- culty forms a cogent argument in favor of the metric system, as wisely adopted in the U. S. Pharmacopoeia. A remarkable dis- parity is shown in the liquid measures, in which there is no unit in common : a minim is not a grain, nor " a pint a pound the world around." 44 A TEXT-BOOK OF MATERIA MEDICA. Table of Apothecaries' Weight and U. S. Liquid Measure, showing the equivalents of the various denominations (by reading from the left-hand column and referring to headings), the weight equivalent of liquid measures being for water at 15° C: Symbol. Minim. Granum. Scru-pulus. Drach-ma. Fluid-drachma. Av. ounce. Fluid-uncia. Uncia. Av. Libra. pound. Octa-rius. 7,680 Con-gius. m- I °-95 57 60 480 61,440 gr- O.95 1 20 60 57 437-5 456 480 5,760 7,000 7,300 58,400 3 20 1 3 24 288 350 5 63 60 3 1 111 S 96 *'6i 15 60 57 it 1 l\ 8 *i 100 nog 128 1024 av. oz. 437-5 7ij 7? I 1A 0.9115 «3j ' 16 '<>* fl. 3 480 456 8 « 1 16 128 S 4S0 24 8 'A 1 12 1 14.58 lb. 5,76o 288 96 1 1 1.215 lb. av. 7,000 35° 1 i6J 16 H-sa 0.823 1 . . O. 7,680 7,292 128 16 I 8 Cong. 61,440 Drachm 1,024 Fluid- 128 » 1 Scru- Av. Fluid- Apoth. or Tr. oz. Apoth. ^v orTr.- pound. pound.' Gal- ple. drachm, oz. ounce. lon. THE METRIC SYSTEM. The Metric System of Weights and Measures, destined to sup- plant all others, originated with Prince de Talleyrand, bishop of Autun, in 1790. Its almost universal adoption by civilized nations, its legality, though not compulsion, in England and the United States, and its adoption by the U. S. Pharmacopoeia of 1890, require that it should be understood alike by the physician and the druggist. Save in the English-speaking world it is the only system used for governmental, statistical, and scientific purposes, and in the arts and manufactures its value has long since been recognized. Its extreme simplicity, its uniformity, and its facility of computation render it far superior to any other system of Weights and Measures, and it is highly probable that in the near future it will prevail in the transactions of every-day life, as it has already acquired international importance, and is in fact referred to as the International System. The starting-point is the unit of length, the meter (metre), which is the 4 ororoVo 0 0 Part of tne earth's circumference around the poles.1 From this apparently irrelevant measure of length the unit of 1 In 1806, Francois Arago and Biot were commissioned by the French government to complete the meridional measurements interrupted in 1804. The object of their survey was to determine, with as great nicety as possible, the ten-millionth part of a quadrant of the meridian passing through Paris, which had been chosen by the National Convention as the standard unit of length, and named the metre. It being impossible to measure from the poles, an arc of the meridian, equalling a quadrant, from Dunkirk to Barcelona was selected, and from their known difference of latitude the entire length of the arc was deducted. WEIGHTS AND MEASURES. 45 capacity, or volume, the liter, was established, it being the cube of T\r of a meter. With equal simplicity and clearness, from the meter was derived the unit of weight, the gramme, which is the weight of that quantity of pure water at the maximum density, 40 C. (39.20 F.), which will fill the cube of T^ part of a meter1 (cubic centimeter). The Metric is also known as the Decimal System, because its multiples and subdivisions are obtained by ten (Lat. decern). The prefixes denoting multiplication are of Greek derivation, and are usually spelled with a capital letter: Deka 10, Hecto 100, Kilo IOOO, Myria 10,000. Division of the units is indicated by Latin pre- fixes, not capitalized : deci -^, centi y^-, milli y^Q. To distinguish readily one process from the other the word GILD has been aptly suggested as a mnemonic : GILD. Greek increases, Latin decreases. It may be observed that, strangely enough, while we still oppose the general adoption of the Metric System, our enumeration is decimal. We count from one to ten, and begin a new, yet similar, series of another ten units, and so on indefinitely,. We compute money in dollars, dimes, cents, and mills, decimally, and our record of time—years, decades, centuries—is in harmony with decimal arithmetic. Even the provision of the Federal Constitution declaring that a national census be taken every ten years is pertinent as a sugges- tion of decimal convenience; and in the period prescribed for the State censuses, every five years, one-half of ten, there is no great deviation from the same principle of utility. Contrary to a prevalent opinion, the Metric System is easily mastered. A perfect acquaintance with the metric tables is, nat- urally, indispensable, and the abbreviations for the different weights and measures should be thoroughly at command. For the rest, the system is simply that of arithmetical decimals, requiring chiefly a correct use of the decimal point. Only a tyro would read .065 six and five-tenths hundredths instead of sixty-five thousandths ; so Gm. .065 would never be read by one acquainted with decimals 1 The unit of surface measure, the are, the square of ten meters, and the unit of the solid measure, the stere, having the capacity of a cubic meter, need not claim the atten- tion of the physician or the practical pharmacist. 46 A TEXT-BOOK OF MATERIA MEDICA. six centigrammes and five milligrammes, but sixty-five milli- grammes. Metric Table of Lengths. IO millimeters 10 centimeters 10 decimeters 10 Meters 10 Dekameters 10 Hectometers 10 Kilometers make i centimeter. I decimeter. i Meter. i Dekameter. i Hectometer. i Kilometer. i Myriameter. Abbreviations for the different divisions and multiples of the Meter are herewith given, together with their equivalents in inches, showing that the written system depends wholly upon the place of the decimal point, the figures remaining unchanged. It may be noted that the first abbreviations cited are those commonly in use, although in certain cases the second are preferable: Metric Table of Linear Measure. i millimeter is written I mm., or M .001, equal in inches to .039370432, approx. Jz. .39370432, " 0.4. 3.9370432, " 4. 39.370432, " 40. 393.70432 3937.0432 " 39370.432 " 393704-32 1 centimeter 1 decimeter I Meter 1 Dekameter I Hectometer 1 Kilometer I Myriameter I cm., " M .01, I dm., " M.I, iM, " M 1., 1 Dm., " M 10., I Hm., " M 100., I Km., " M 1000., 1 Mm.," M 10000., The term micromillimeter, one-thousandth of a millimeter (0.000001), is used, especially in microscopy, the abbreviations being mmm., mic, mkm., or the Greek letter //. Metric Table of Capacities. 10 milliliters make 1 centiliter. 10 centiliters 10 deciliters 10 Liters 10 Dekaliters 10 Hectoliters 10 Kiloliters 1 deciliter. 1 Liter. 1 Dekaliter. 1 Hectoliter. 1 Kiloliter. 1 Myrialiter. Abbreviations for the different divisions and multiples of the Liter, with their corresponding equivalents in minims or ounces are as follows: WEIGHTS AND MEASURES. 47 i milliliter is wri I centiliter I deciliter I Liter i Decaliter i Hectoliter I Kiloliter I Myrialiter ten I Cc.l or L .001, equal in minims to I cl. I dl. i L. i Dl. i HI. i Kl. I Ml. L .01, L .1, L 1., L 10., " L 100., " L 1000., " L 10000., " " fl. ounces 16.23 162.3 1623. 33-8i4 338-14 338i-4 338i4- 338140. Metric Table of Weights. 10 milligrammes make 1 centigramme. 10 centigrammes 10 decigrammes 10 Grammes 20 Dekagrammes 10 Hectogrammes 10 Kilogrammes 1 decigramme. 1 Gramme. 1 Dekagramme. 1 Hectogramme. 1 Kilogramme. 1 Myriagramme. Abbreviations for the different divisions and multiples of the Gramme, with their corresponding equivalents in grains, are as follows: 1 milligramme is written 1 mg., or Gm. .001, equal in grains to (^?) .015432 (£) -15432 1-5432 I5-432 154-32 1543-2 15432-3 1543234 1 centigramme " 1 eg., " Gm. .01, 1 decigramme " 1 dg., " Gm. 1, 1 Gramme " 1 Gm., " Gm. I-, 1 Dekagramme " 1 Dg., " Gm. 10., 1 Hectogramme " 1 Hg., " Gm. 100., 1 Kilogramme " 1 Kg., " Gm. 1000., I Myriagramme " 1 Mg., "Gm. 10000. METHOD OF CONVERTING METRIC WEIGHTS, MEASURES, AND LENGTHS INTO THOSE IN COMMON USE, AND VICE VERSA. Approximate Table of Weights. 1 grain = 0.65 Gm. (65 milligrammes). lSh grains — 1. Gm. 1 drachm = 3.9 Gm. 1 troy ounce = 31.1 Gm. Approximate Table of Capacities. 1 minim = .06 Cc. 16 minims = 1. Cc. 1 fluidrachm = 3.75 Cc. 1 fluidounce = 30. Cc. 1 This is designated by Cc. instead of Ml, and in practice only cubic centimeters and Liters are employed. 48 A TEXT-BOOK OF MATERIA MEDICA Approximate Table of Lengths. I inch .025 M. (25 millimeters). 40 inches =1. M. Weights. To Convert Grains into the Corresponding Metric Eqidvalcnts.— It has been seen that 1 grain is equal to Gm. .065. In order, then, to convert grains or fractions of a grain into the corresponding metric quantity, we have simply to multiply the number of grains by .065. 2 grains = 2 X .065, or .130 Gm. 60 grains = 60 x .065, " 3.9 Gm. \ grain = ^ of .065, " .0325, Gm. yi^ grain = yfg- of .065, " .00065 Gm., etc. To Convert Metric Quantities into their Equivalent in Grains.— Instead of multiplying as above, divide, using the same number, .065, as a divisor. Gm. .130 .130 -5- .065, or 2 grains. Gm. 3.9 = 3.9 -5- .065, " 60 grains. Gm. .0325 = .0325 -*■ .065, " .5 grain. Gm. .00065 = .00065 -*- .065, " .01 grain. It follows that to convert Apothecaries' drachms into Grammes we multiply the number of drachms by 3.9, the number of Grammes in 1 drachm ; and to convert Grammes into Apothecaries' drachms we divide the number of Grammes by 3.9. The same rule applies to the conversion of Apothecaries' ounces into Grammes and Grammes into ounces, the multiplier and divisor being 31.1, the number of Grammes in 1 ounce. Volumes. To convert minims into the corresponding metric equivalents, multiply the number or fractions of minims by .06, this being the equivalent in Cc. of 1 minim; and to convert the metric quantities into the corresponding equivalents in minims, divide the metric quantity by .06. To convert fluidrachms into Cc, multiply the number of drachms by 3.75, the number of Cc. in 1 fluidrachm; and to convert Cc. into fluidrachms, divide the number of Cc by 3.75. To convert fluidounces into Cc, multiply the number of ounces by 30. Cc, the equivalent of 1 fluidounce; and to convert Cc. into fluidounces, divide the number of Cc. by 30. WEIGHTS AND MEASURES. 49 For convenience of ready reference and to facilitate computa- tion the following tables are subjoined: Table of Metric Equivalents of Grains, Drachms, Minims, and Fluidrachms. 3 Grains. 1 Milligrams, mg. O.65 Centigrams, eg. O.065 Decigrams, dcg. O.O065 Grammes, Gm. Minims. Cubic centi-meters, Cc . 5 O.OO065 1 77 O.85 O.085 O.O085 O.OO085 1 ST I. O.l O.OI O.OOI 1 5ff i-3 O.I3 O.OI3 O.OOI3 1 57 2-5 O.25 O.O25 O.OO25 t1* 6.5 O.65 O.065 O.O065 1 13. i-3 O.I3 O.OI3 i 16. 1.6 O.16 O.OI6 \ 32. 3-2 O.32 O.O32 I 65- 6-5 O.65 O.065 I O.06 2 13- i-3 0.13 2 0.12 3 20. 2. 0.2 3 O.I8 4 25- 2-5 O.25 4 O.24 5 30. 3- °-3 5 °-3 7i 5°- 5- 0.5 8 o.5 io 65. 6-5 0.65 10 0.6 15 100. 10. 1. 16 1. 20 13- i-3 20 1.25 3° 20. 2. 32 2. 3J 60 40. 4- 60 3-75 f& 100 65- 6-5 100 6. 3'J 120 80. 8. 120 7-5 f^ij '5° 100. 10. 150 9- 3»J 180 200 12. 13- 180 200 11.25 12. *3"j 3iv 240 16. 240 15- f^iv 3V 300 20. 300 18. f^v 3VJ 360 400 24. 26. 360 400 22.5 24. *3VJ 3viJ 420 450 28. 3°- 420 45o 26.25 27. f^vij 5J 480 32- 480 3°- f3J Equivalents. Various methods have been proposed for adapting the metric weights to our apothecaries' weights used in prescription writing without entailing calculations in fractions. The method of taking 32 Grammes as equivalent to one troy ounce, and 30 Cc, or fluid Grammes, as equal to one fluidounce, seems to be the least objec- tionable. These equivalents are shown in the following: 32 Gm. = I ounce ; 32 30 Cc. = I fluidounce ; 30 4. Gm. = 1 drachm. 3.75 Cc. = 1 fluidrachm. The exact metric equivalent of I grain is obtained by dividing the unit by the Gramme equivalent in grains; thus, 1. 0.0648 Gramme (or 6\ centigrammes). 4 15432 = 50 A TEXT-BOOK OF MATERIA MEDICA. The metric equivalents of all the other denominations may be obtained by multiplying the grain equivalent by the number of grains in one drachm ; the number of drachms in a troy ounce, etc. The following exact Gramme equivalents are thus obtained: I grain. i drachm. I ounce av. i ounce troy. i It) troy. I lb av. 0.0648 3.888 28.349 3iio3 373-250 453-592 To convert avoirdupois or troy into metric weights, the equiva- lent of the Gramme in grains—15.432—should be remembered, as it serves the purpose of a basis for obtaining the equivalent of all the higher denominations. Table of Metric Equivalents of Ounces (Apoth., Av., and Fluid) in Grammes and Cubic Centimeters. Ounces, 3 Grs. Grammes, Fluidounces, Cubic centimeters, Exact Apoth., Gm. or G. '3 Cm. or Cc. equivalents. 1 31 1 30 29-57 2 62 2 60 59-15 3 93 3 90 88.72 3 IO3 100 3-38 IOO 4 124 4 120 H8.3 5 155 5 150 147-87 6 186 6 180 177-44 7 217 7 2IO 207.01 8 248 8 240 236-59 8 18 250 8-45 250 9 280 9 270 266.16 10 3" 10 300 295-73 11 342 11 330 325-31 I ft) 12 373 12 1 pt. 16 '7 A 360 480 500 354-88 Av. Ounces. Grs. 453-6 473-18 I ft) 16 17 278 500. 20 600 591-47 20 566.8 24 720 709.77 24 680. 2 pt. 32 960 946-35 28 793-2 34 A IOOO 2 ft) 32 907.25 3Pt. 48 1440 1419. 35 120 1000. 4 Pt- 64 1920 1892.71 3 K> 48 1360. 68 A 2000 4 ft) 64 1814.5 5 pt- 80 24OO 2365-9 70 24O 2000. 100 3000 2957-37 5R> 80 100 2268 2835 1 gal. 128 3840 378543 10 ft) 160 4536 It will be noted that in the Pharmacopoeia of 1890 the Gramme (Gm.) and the Cubic Centimeter (Cc) are the only metrical terms used. The reason of this is simply that these two terms express sufficiently the quantities ordinarily handled, the remaining ones being excluded to avoid confusion, Grammes and Cubic Centi- meters standing as perfect equivalents of ordinary weights and measures, as the foregoing tables indicate. PHARMACEUTICAL PREPARATIONS. 51 PHARMACEUTICAL PREPARATIONS. Preparations made by the pharmacist are called pharmaceutical preparations. Nearly one-half of the articles of the United States Pharmacopoeia are pharmaceutical; formulas being given for their preparation, they are intended to be made in the pharmacy. A still greater number are unofficial, being chiefly such as are made according to the formulas or prescriptions of eminent medical practitioners and teachers. Such of the latter as have attained general use and proved of value have been incorporated in the National Formulary, a work published under the direction of the American Pharmaceutical Association. The importance of having a uniform standard for the prepara- tion and strength of this class of medicines has long been recog- nized, instead of the variation in strength and product inseparable from a number of manufactures with the consequent multiplicity in processes and formulas. These preparations of the National For- mulary, designated N. F., are included in this work, following the official preparations (U. S. P.) of the classes to which they belong. The pharmaceutical preparations may be divided as follows : I. Solutions. II. Liquid Mixtures—Internal. III. Extractive Preparations—Liquid and Solid. IV. Mixtures of Solids—Internal. V. Mixtures for External Use—Liquids and Solids. These groups are each divided into a number of Classes, each class having a distinct Latin title by which its members, or indi- vidual preparations, are officially designated and alphabetically arranged in the U. S. P. In addition to the Latin and English titles, each class is also known by an English name, besides various synonyms. There are altogether 34 of these Classes official, besides a number unofficial. Official number. I. The Solutions are divided, according to the charac- ter of the solvent, into— Aqueous: Aquae—Waters.......... 19 Liquores—Liquors (solutions proper)..... 24 Alcoholic: Spiritus—Spirits.......... 25 Elixiria—Elixirs.............. 2 Vina—Wines (by solution)......... 3 52 A TEXT-BOOK" OF MATERIA MEDICA. Official number. Saccharine: Syrupi—Syrups......... 32 Mellita—Honeys............. 2 Glycerin : Glycerita—Glycerites........ 6 II. The Liquid Mixtures—Internal: Misturae—Mixtures (proper)........ 4 Emulsa—Emulsions............ 4 III. Extractive Preparations: Liquid: Aqueous : Mucilagines—Mucilages....... 4 Infusa—Infusions............. 4 Decocta—Decoctions........... 2 Acetous : Aceta—Vinegars.......... 2 Vinous: Vina—Wines ........... 5 Alcoholic: Tincturae—Tinctures........ 71 Extracta Fluida—Fluid Extracts....... 89 Solid: Alcoholic: Extracta—Extracts........ 33 Abstracts (unofficial). Resinae—Resins.............. 3 Semi-liquid : Ethereal: Oleoresinae—Oleoresins....... 6 IV. Mixtures of Solids—Internal: Pulveres—Powders............ 9 Tritu ratio—Trituration........... I Sales effervescentes—Salts, effervescent .... 4 Confectiones—Confections......... 2 Trochisci—Troches............ 15 Massae—Masses.............. 3 Pilulae—Pills................ 15 V. Mixtures of Solids—External: Liquid: Linimenta—Liniments....... . 9 Oleata—Oleates.............. 3 Collodia—Collodions.............. 4 Solid: Unguenta—Ointments.......... 23 Cerata—Cerates.............. 6 Suppositoria—Suppositories......... 1 Emplastra—Plasters........... T? Chartae—Papers............ 2 PHARMACEUTICAL PREPARATIONS. AQU.E MEDICATE—MEDICATED WATERS. The Medicated Waters are solutions of volatile substances in Water. They comprise (i) the Aromatic Waters and (2) the Chemical Waters. The Aromatic Waters are made by dissolving the volatile oils of their respective drugs, or distilling the latter with Water; two Waters are saturated solutions of other liquids than volatile oils— viz. Aqua Chloroformi and Aqua Creosoti. The following are official: Contains Cc. in ioo Cc, Aqua or percentage by volume. Amygdalae Amarae.......bitter almond oil 0.1 Anisi................ anise oil 0.2 Aurantii Florum Fortior........saturated Aurantii Florum..........of the above 50. Camphorae..............camphor 0.8 Chloroformi1............chloroform 0.5 Cinnamomi.............cinnamon oil 0.2 Creosoti................creosote 1. Fceniculi...............fennel oil 0.2 Menthae Piperitse.........peppermint oil 0.2 Menthae Viridis...........spearmint oil 0.2 Rosse Fortior.............saturated Rosae...............of the above 50. The Chemical Waters are solutions of gases in Water. The fol- lowing are official: Contains gas, percent- Aqua— age by weight. Ammoniae................NH3 10 Ammoniae Fortior.............NH3 28 Chlori...................Cl 0.4 Hydrogenii Dioxidi (Hydrogen Peroxide) . . . H202 3. LIQUORES—SOLUTIONS. The Solutions (also termed Solutio, -nes, Lat.) are solutions of non-volatile substances in Water. The official Solutions are all solutions of inorganic salts. They are made either by simple solution (dissolving the particular salt in 1 Chloroform Water, aside from its medicinal properties, is an efficient preservative agent, and forms a good solvent in place of water for preparing solutions intended to be kept free from micro-organisms, as, for example, those for hypodermic use. 54 A TEXT-BOOK OF MATERIA MEDICA. Water) or by chemical solution (reacting upon different substances, and obtaining the newly-formed salt in solution in the Water). 1 he following 24 are official: The Arsenic Solutions: these are all of the same strength— viz. 1 per cent.; 10 minims (0.6 Cc.) represent yVj- grain (0.006 Gm.) of arsenic, the usual dose: Percentage Liquor— or Gm. in 100 Cc. Acidi Arsenosi...........acid, arsenous 1. Arseni et Hydrargyri Iodidi.....arsenic iodide 1. (Donovan's Solution). mercuric iodide I. Potassii Arsenitis . . . potas. bicarb. 2 ; acid, arsenous I. (Fowler's Solution) tinct. lavender comp. 3. Sodii Arsenatis..........sodium arsenate 1. The Alkaline Salt Solutions, prepared by saturating an organic acid with an alkaline carbonate or bicarbonate, furnishing an agree- able and refreshing potion (also designated Saturatio, Potio, Lat.) charged with Carbonic Acid Gas. The dose is from 2 to 4 fluid- drachms (8-15 Cc), except Liq. Magnesias Citratis: Liquor— Gm. in 100 Cc. Ammonii Acetatis (Spiritus Mindererus) ammon. carb. 5. acid, acetic, dil. 100. Ferri et Ammonii Acetatis . . . liquor ammon. acet. 20. (Basham's Mixture), acid, acetic, dil. 3.; tr. ferri chlor. 2. elix. arom. 12; glycerin 10; aqua ad 100. Magnesii Citratis . . . magnes. carb. 15.; acid, citric. 30. potas. bicarb. 25.; syrup. acid, citric. 60 Cc; aqua ad 350. Potassii Citratis (Neutral Mixture) . . potass, bicarb. 8. acid, citric. 6.; aqua ad 100. The Iron Solutions, containing ferric salts in the following pro- portions by weight: Gm. in 100, or Liquor— percentage by weight. Ferri Acetatis...........ferric acetate 31. Ferri Chloridi...........ferric chloride 37.8 Ferri Citratis............ferric citrate 42.5 Ferri Nitratis............ferric nitrate 6,2 Ferri Subsulphatis (Monsel's) . . ferric subsulphate 43.7 Ferri Tersulphatis.........ferric sulphate 28.7 PHARMACEUTICAL PREPARATIONS. 55 These are mostly used in producing other Iron preparations and compounds, particularly the Tincture of Ferric Chloride, the Ferric Hydrate (arsenical antidote), and the scaled salts of iron. The Alkali Solutions : Percentage by vol. Liquor— 0r weight. Calcis (Lime Water).......calcium hydrate 0.17 Potassae............potassium hydrate 5. Sodae..............sodium hydrate 5. Sodae Chloratae (Labarraque's)......chlorine 2.6 Lime Water is given as an antacid (10-30 Cc); Labarraque's Solution is used as a powerful disinfectant. The Solutions of Metallic Compounds; all but that of Iodine are used only externally: Percentage by vol. Liquor— or weight. Iodi Compositus (Lugol's Solution) . . potass, iodid. 10. iodine 5. Hydrargyri Nitratis........mercuric nitrate 60. Plumbi Subacetatis........lead subacetate 25. Plumbi Subacetatis Dilutus .... of above solution 3. (Lead Water).......distilled water to 100. Sodii Silicatis...........sodium silicate 50. Zinci Chloridi...........zinc chloride 50. The dose of Liq. Iodi Comp. is 3-10 minims (0.2-0.6 Cc), preferably given in a little milk. Unofficial Liquors of the National Formulary. Liquor— Acidi Phosphorici Compositus (Acid Phosphates). Alum in 1 Acetatis (Alumini Acetici, Ph. Ger.).—Contains 8 per cent, of basic Aluminum Acetate. Alumini Acetico-tartratis.—Contains about 50 per cent. of dry, so-called Aluminum Acetico-tartrate, which may be obtained by evaporating the solution. Auri et Arseni Bromidi.—Ten minims contain ■£% grain (0.002 Gm.) of Tribromide of Gold and -^ grain (0.004 Gm). of Tribromide of Arsenic. Bismuthi.—Each fluidrachm (4 Cc.) represents 1 grain (0.06 Gm.) Bismuth and Ammonium Citrate. Bromi (Smith's Solution of Bromine).—Bromine, 20 per cent; Potassium Bromide, 10 per cent.; Water. A TEXT-BOOK OF MATERIA MEDICA. or— Calcis Sulphurate (Solution of Oxysulphuret of Calcium; Vleminck's Solution or Lotion). Cupri Alkalinus (Fehling's Solution). I. The Copper Solution. Copper Sulphate, pure......grains 505 . . 34.639 Gm.' Distilled Water . . enough to make fluidounces 16 . . 500 Cc. II. The Alkaline Solution. Potassium and Sodium Tartrate . . grains 252 . . 173 Gm. Soda (U. S. P.).........troy ounces 2 . . 60 Gm. Distilled Water . . enough to make fluidounces 16 . . 500 Cc. Keep both solutions, separately, in small well-stoppered vials, in a cool and dark place. For use, mix exactly equal volumes of both solutions by pouring the copper solution into the alkaline solution. Ten Cc. of the mixture prepared by metric weight and measure correspond to 0.05 Gm. of glucose. Of the mix- ture prepared by apothecaries' weight and measure, 210 minims correspond to I grain of glucose. Electropoeicus (Battery-fluid). A. For the Carbon and Zinc Battery.—I. (For ordinary use).—Potassium Bi- chromate, in powder, 6 troy ounces (180 Gm.); Sulphuric Acid, commercial, 6 fluidounces (180 Cc.); Water, cold, 48 fluidounces (1400 Cc).—II. (For use with the galvano-cautery).—Sodium Bichromate, in powder, &y2 troy ounces (185 Gm.); Sulphuric Acid, commercial, 14 fluidounces (420 Cc.); Water, cold, 48 fluidounces (1400 Cc). Pour the Sulphuric Acid upon the powdered Bichromate and stir the mix- ture occasionally during one hour. Then slowly add the Water. Sodium Bi- chromate is more soluble than the Potassium Salt, and also much cheaper. When it cannot be obtained, the Potassium Salt may be substituted for it, weight for weight. B. For the Leclanche Battery.—Ammonium Chloride, 6 troy ounces (180 Gm.); Water, enough to make 20 fluidounces (600 Cc.) ; dissolve the Salt in the Water. Ferri Oxysulphatis (Oxysulphate of Iron). Ferri Protochloridi (Solution of Ferrous Chloride).—Each fluidrachm (4 Cc.) represents about 20 grains (1.3 Gm.) of Protochloride of Iron (ferrous chloride). Hydrargyri et Potassii Iodidi (Solution of Iodide of Mer- cury and Potassium ; Channing's Solution).—Red Mercuric Iodide, 72 grains (5.0 Gm.); Potassium Iodide, 56 grains (3.8 Gm.); in Distilled Water, 16 fluidounces (450 Cc). Hypophosphitlm.—Each fluidrachm (4 Cc) contains 2 grains (0.12 Gm.) of Calcium Hypophosphite, \\ grains (0.75 Gm.) of Sodium Hypophosphite, and 1 grain (0.06 Gm.) of Po- tassium Hypophosphite. Iodi Carbolatus (Boulton's Solution ; " French Mixture ").__ PHARMACEUTICAL PREPARATIONS. 57 Liquor— Comp. Tincture of Iodine, no minims (7 Cc.); Carbolic Acid, 40 grains (3.0 Gm.); Glycerin, 2\ fluidounces (100.0 Cc); in 16 fluidounces (450 Cc). Iodi Causticus (Iodine Caustic; Churchill's Iodine Caustic). —Iodine, 1 troy ounce (31 Gm.); Potassium Iodide, 2 troy ounces (63 Gm.); in Water, 4 fluidounces (120 Cc). Magnesii Bromide—Each fluidounce (30 Cc) contains about 7 grains (0.5 Gm.) of Magnesium Bromide. Morphine Citratis.—Each fluidrachm (4 Cc.) contains 2 grains (0.12 Gm.) of Morphine in the form of citrate. Morphin.e Hypodkrmicus (Magcndie's Solution of Morphine).1 — 16 grains (1 Gm.) Morphine Sulphate to 1 fluidounce (30 Cc). Pancreaticus (Pancreatic Solution).—Each fluidrachm (4 Cc) represents 1 grain (0.06 Gm.) of Pancreatin, effectually pre- served in Glycerin and a little Alcohol. Pepsint Aromaticus.—Each fluidrachm (4 Cc.) represents 1 grain (0.06 Gm.) of Pepsin. Phosphori (Thompson's Solution of Phosphorus).—Each fluid- drachm (4 Cc) contains about ^ grain (0.0025 Gm.) of Phosphorus, preserved in Absolute Alcohol and Glycerin. Picls Alkalinus (Tar, Alkaline). Potass.e Chlorat.e (Solution of Chlorinated Potassa ; Javelle Water).—An effective and popular disinfectant. Potassii Arsknatis et Bromidi (Liquor Arsenii Bromidi; Clemens' Solution).—This solution contains an amount of Arsenic in combination corresponding to about I per cent. of Arsenous Acid. The title " Solution of Bromide of Arsenic " (Liquor Arsenii Bromidi), which is often applied to Clemens' Solution or similar preparation, is a misnomer, since bromide of arsenic cannot exist, as such, in presence of water, but is split up into hydrobromic and arsenous acids. The proportions of the ingre- dients, in the formula above given, have been adjusted as closely as practicable, so as to yield definite compounds—viz. arsenate and bromide of potassium. Saccharini (Solution of Saccharin).—Each fluidrachm repre- sents 4 grains of Saccharin. Intended to be used for sweetening liquids and solids when the use of sugar is objectionable, or when a sweet taste is to be imparted to a liquid without increasing its density. 1 Particular care should be taken in prescribing and dispensing this solution, so that it may not be mistaken for the so-called United States Solution of Morphine (Liquor Morphia; Sulphatis, U. S. P. 1S70. containing only I grain of Sulphate of Morphine in each fluidounce, which is still occasionally used. A TEXT-BOOK OF MATERIA MEDICA. uor— Seriparus (Liquid Rennet). If this liquid is to be used merely for curdling milk, without separating the whey as a distinct layer, it should be added to the milk, previously warmed to a temperature of about 350 C. (950 F.), and the mixture should then be set aside undisturbed until it coagulates. If the whey is to be separated, the Liquid Rennet should be added to the milk while cold, and the mixture heated to about 350 C. (950 F. 1, but not exceeding 400 ('. (1040 F.). One part of the liquid should coagulate between 200 and 300 parts of cows' milk. Liquor Sodii Arsenatis, Pearson.—This Solution contains about jY; per cent, of anhydrous Sodium Arsenate. This preparation should not be confounded with the Liquor Sodii Arsenatis of the U. S. P., which is ten times stronger than the above. Pearson's Solu- tion is official in the French Pharmacopoeia, under the title Solute d'Arse- niate de Soude (or Solution Arsenicale de Pearson). Sodii Boratis Compositus (Dobell's Solution).—Sodium Borate and Sodium Bicarbonate, each 120 grains (8.0 Gm.); Carbolic Acid, 24 grains (1.5 Gm.); Glycerin,1 fluidounce (15 Cc.); in Water, 16 fluidounces (450 Cc). Sodii Carbolatis (Phenol Sodique).—Carbolic Acid, 50 per cent.; Soda, 3 per cent.; in Water. Sodii Citratis.—Saturatio (Potio Riveri, Ph. Ger.).—Citric Acid, 150 grains (10.0 Gm.); Sodium Bicarbonate, 190 grains (12.5 Gm.); in Water, 16 fluidounces (450 Cc). Sodii Citro-tartratis (Effervescing Saline Water).—Sodium Bicarbonate, Tartaric Acid, Citric Acid, Syrup, and Water, in about the same proportions as in Solution of Magnesium Citrate, for which it is a cheaper substitute. Sodii Oleatis (Oleate of Sodium).—Intended to be used in the preparation of oleates. Strychnin.f: Acetatis (Hall's Solution of Strychnine).—Each fluidrachm (4 Cc.) contains \ grain (0.008 Gm.) Strychnine Acetate. The Ph. Br. directs a Liquor Strychninse Hydrochloratis (with synonym, Liquor Strychnia?) which is much stronger, and should not be confounded with the above preparation. It should never be dispensed unless expressly designated. Zinci et Ferri Compositus (Deodorant Solution).—A com- bination of Sulphates of Zinc and Iron, Naphthol, Oil of Thyme, and Hypophosphorous Acid, in Water. Used as a simple deodorant and antiseptic for common domestic use when it is unnecessary or impracticable to employ more powerful agents. PHARMACEUTICAL PREPARATIONS. 59 When a deodorant solution is required for purposes where iron is objection- able—as, for instance, when woven fabrics are to be steeped in it—the follow- ing preparation may be employed : Liquor Zinci et Alumini Compositus, in which the Iron Sulphate is replaced by Aluminum Sulphate. Liquor— Zingiberis (Essence of Ginger).—A 25 per cent, preparation of Ginger for flavoring aqueous mixtures. SPIRITUS— SPIRITS. The Spirits are solutions of volatile substances in Alcohol. They comprise (1) the Natural Spirits; (2) the Aromatic Spirits, or so-called " Essences;" and (3) the Medicinal Spirits. The Natural Spirits are produced by distillation, and include: Spiritus Frumenti (Whiskey), containing Alcohol 50-58 per cent, by volume. Spiritus Vini Gallici (Brandy), containing Alcohol 46-55 per cent, by volume. Spiritus Juniperi Comp. (Gin), containing Alcohol 60-70 per cent, by volume. The Aromatic Spirits are made by dissolving the respective oils or aromatic principles in (deodorized) Alcohol: Cc. in 100 Cc, Spiritus— or percentage by vol. Amygdalae Amarae (water 20) . . bitter almond oil I. Anisi (alcohol deod.)........anise oil 10. Aurantii " ........orange oil 5. Aurantii Comp. (alcohol deod.) .... orange oil 20. oils, anise 0.5, coriander 2; lemon oil 5. Camphorae..............camphor 10. Cinnamomi............cinnamon oil 10. Gaultheriae . ..........wintergreen oil 5. Juniperi..............juniper oil 5. Lavandulae (alcohol deod.).....lavender oil 5. Limonis...........lemon peel 5 ; oil 5. Menthae Piperitae.....peppermint herb 1; oil 10. Menthae Viridis . . . • . . spearmint herb I; oil 10. Myrciae (Bay Rum).....water 38; oil of bay 0.8 oils, orange, pimenta, each 0.05 Myristicae..........nutmeg (vol.) oil 5. These are chiefly used for flavoring purposes; some are used fx> A TEXT-BOOK OF MATERIA MEDICA medicinally as aromatic stimulants and carminatives in doses of from 15-30 minims (1-2 Cc.); Spiritus Amygdalae Amarae con- tains Hydrocyanic Acid, and is never used internally except in very small quantities as a flavor. The Medicinal Spirits are made by solutions of the medicinal substance in Alcohol. The following are official: Cc in JOO CCj Spiritus— or percentage by vol. iEtheris............ether (C2H5)20 32.5 yEtheris Comp. (Hoffmann's Anodyne) . ethereal oil 2.5 ether 32.5 By weight. Athens Nitrosi (Sweet Spirit of Nitre) . ethyl nitrite 4. Ammoniae............ammonia gas 10. Ammoniae Aromaticus . . water 14; ammonia water 9. ammonia carb. 3.4 oils, lavender, nutmeg, each 0.1 ; lemon oil 1. Chloroformi...........chloroform 6. Glonoini.............nitroglycerin I. Phosphori.....absolute alcohol, phosphorus 0.12 The dose of these Spirits is from 30 to 60 minims (2 to 4 Cc.; about 75 to 150 "drops"), except the Ammonia Spirit, used only in the preparation of Liniments (externally), and that of Phosphorus, which is for the preparation of the EJixir. Unofficial Spirits of the Actional Formulary. Spiritus— Acidi Formici (Spirit of Ants, Ph. Ger.).—A solution of 3 per cent, of Formic Acid in Water and Alcohol. Ophthalmicus (Alcoholic Eye-wash).—A solution of 10 min- ims (0.6 Cc.) Oil of Lavender and 30 minims (2 Cc.) Oil of Rosemary, in Alcohol 1 fluidounce (30 Cc). Saponatus (Spirit of Soap). Sinapis (Spirit of Mustard, Ph. Ger.).—A solution of 2\ per cent, of Volatile Oil of Mustard in Alcohol. SYRUPI—SYRUPS. Syrups are nearly saturated Solutions of Sugar in Water, in which aromatic or medicinal substances are dissolved. The official Syrup, Syrupus, contains 65 per cent, by weight, 85 per cent, by volume, of Sugar (about 7 pounds, average, in PHARMACEUTICAL PREPARATIONS. 6l I gallon) : with a smaller proportion of Sugar the syrup undergoes fermentation (spoils). The " Medicated Syrups " contain less sugar, owing to the solu- tion of the medicinal substances, which usually reduce the solubility of the sugar in the liquid from which the syrup is prepared. Syrups should be kept in a cool place, in cork-stoppered bottles, in order to preserve them. The thirty-two official Syrups are made by different methods : by solution, or mixing the medicinal substance with the syrup; by dissolving the Sugar in the medicinal solution; by extraction from the drug; and by chemical reaction and solution. They may be divided into (i) the aromatic or adjuvant syrups, and (2) the medicinal syrups, comprising [a) those made from extractive drugs, including alteratives, astringents, cathartics, and expectorants, and {b) those made from chemicals, either by simple solution or by chemical reaction and solution, including the hypo- phosphites, iron, and other tonics. The Aromatic or Adjuvant Syrups are mostly used as additions to, or vehicles of, liquid mixtures containing Bromides, Iodides, Phosphates, or similar salts of disagreeable saline taste, desirable to disguise. The following are official: „ . „ & Cc. in 100 Cc, Syrupus— or percentage by vol. Acaciae............mucilage acacia 25. Acidi Citrici......spir. lemon, 1 ; acid, citric I. Althaeae.............marshmallow 5. Amygdalae . . (bitter almond 4, sweet almond 14) 18. orange flower water 10. Aurantii......orange, fresh exterior rind 5. Aurantii Florum......orange flower water 50. Rubi Idaei........raspberry juice (fresh) 40. Tolutanus.............tolu balsam 1. Zingiberis........fluid extract of ginger 3. The Extractive Syrups are often made by mixing the Fluid Extract of the respective drugs with Syrup. Tinctures and Fluid Extracts of resinous drugs often precipitate when mixed with Syrups and aqueous solutions. In order to fur- nish clear mixtures it is therefore sometimes necessary to mix the extractive preparation with Water, clarify the mixture by filtration, and dissolve the sugar in the filtered liquid. 62 A TEXT-BOOK OF MATERIA MEDICA The following are official: Gm 0t p^g Syrupus— "' IO° Cc- Allii.............vinegar of garlic 20. Ipecacuanhae..........fl. ext. ipecac 7. Krameriae...........fl. ext. rhatany 45. Lactucarii.........tinct. lactucarium 10. Picis Liquidae.......... glycerite, tar 7.5 Pruni Virginianae.........wild cherry 15. Rhei............. fl. ext. rhubarb 10. Rhei Aromaticus......tinct. rhubarb,arom. 15. Rosae............fl. ext. red rose 12.5 Rubi .........fl. ext. blackberry bark 25. Sarsaparillae Comp.......fl. ext. sarsaparilla 20. fl. ext. glycyrrh., senna, each 1.5 oils, sassafras, anise, gaultheria, each 0.01 Scillae............vinegar of squill 45. Scillae Comp.....fl. exts. squill, senega, each 8. (Coxe's Hive Syrup) . . antimony and potass, tart. 0.2 Senegae............fl. ext. senega 20. Sennae.........oil coriander 0.5 ; senna 25. The dose of the Syrups of Ipecac, Squill, Squill Comp., and Senega as an expectorant is from 5-30 minims (0.5-2 Cc.); as emetic, from 1-2 fluidrachms (4-8 Cc). The Chemical Syrups are an elegant class of preparations in which the taste of the medicinal agents is greatly modified. They do not keep well unless put up in small bottles completely filled, ready for dispensing. Except the Syrup of Iodide of Iron, which is best preserved in bottles exposed to light, they should be kept in a cool and dark place. The dose is from 1 to 2 teaspoonfuls (4 to 8 Cc), except of the Syrup of Iodide of Iron, the ordinary dose of which is 10 drops, nearly equivalent to 10 minims (0.6 Cc). The Syrup of Iron, Quinine, and Strychnine Phosphates (Easton's Syrup, Ph. Br.) is almost identical with the well-known unofficial Elixir of that name. It contains -^ grain of Strychnine in 80 min- ims (1 mg. in 5 Cc); the formula of the U. S. P. 1880 yielding a Syrup nearly three times as strong, care should be observed that the preparations of the two formulas be not accidentally confused with each other. A somewhat similar preparation is the Syrupus Hypophosphitum Compositus of the X. F. PHARMACEUTICAL PREPARATIONS. 63 The following are official: ° Percentage, Gm. or Cc. Syrupus— i„ /00. Acidi Hydriodici.....acid, hydriodic, by weight 1. Calcii Lactophosphat;s . . . calcium lactophosphate 1. Calcis..........lime (calcium saccharate) 1. Ferri Iodidi.......ferrous iodide, by weight 10. Grains Percent- in 1 fluid- age by drachm (4 Cc). vol. Ferri, Quininae et Strychninae Phosphatum: ferric phosphate, soluble 1^ 2. quinine sulphate 2 3. strychnine -g^ 0.02 acid, phosphoric 3 4.8 Hypophosphitum . . . calcium hypophosphite 3 4.5 potassium and sodium hypophosphites, each 1 1.5 spirit lemon 0.5 ; acid hypophos. dil. 0.2 Hypophosphitum cum Ferro . . ferrous lactate 1. with potass, citrate 1, in syrup hypophosph. Unofficial Syrups of the National Formulary. Unless otherwise stated, the dose is 1 to 2 fluidrachms or tea- spoonfuls (4-8 Cc). Syrupus— Act;e/e Compositus (Cimicifuga or Black Cohosh).—Contain- ing 2\ grains (o. 15) each of Cimicifuga and Wild Cherry, \\ grains (0.07) Glycyrrhiza and Senega, and f grain (0.04) Ipecac in each fluidrachm (4 Cc). Asari Compositus (Canada Snake Root). —Each fluidrachm (4 Cc.) represents 3^- grains (0.2) of Asarum. Calcii Chlorhydrophosphatis (Chlorhydrophosphate of Lime).—Each fluidrachm (4 Cc.) contains 1 grain (0.06) of Calcium Phosphate. Calcii et Sodii Hypophosphitum (Hypophosphite of Lime and Soda).—Each fluidrachm (4 Cc.) contains 2 grains (0.13), each, of Hypophosphites of Calcium and Sodium. Calcii Hypophosphitis (Hypophosphite of Lime).—Each fluidrachm (4 Cc.) contains 2 grains (0.13) of Calcium Hypo- phosphite. Calcii Iodidi (Iodide of Calcium).—Each fluidrachm (4 Cc.) contains about 5 grains (0.3) of Calcium Iodide. H A TEXT-BOOK OF MATERIA MEDICA. Syrupus— Calcii Lactophosphatis cum Ferro (Lactophosphate of Lime with Iron).—Each fluidrachm (4 Cc.) contains 1 grain (0.03) of Lactate of Iron and about \ grain (0.015) of Calcium Lactate (or about f grain (0.02) of so-called Lacto- phosphate of Calcium). Chondri Compositus (Irish Moss).—Containing 1 grain (0.06) each of Squill and Senega, T\«- grain (0.004) each of Ipecac and Irish Moss, and 1^ minims (0.1) Tincture Opium Camph. to each fluidrachm (4 Cc). Cinnamomi (Cinnamon, Ph. Ger.).—Chiefly used for flavoring. Codeine.—Containing | grain (0.03) Codeine Sulphate in each fluidrachm (4 Cc). The Syrup of the French Codex is about one-fourth this strength. Coffee (Coffee).—Containing 15 grains (1.) of the choicest Coffee (Java and Mocha) in fluidrachm (4 Cc.); an elegant vehicle for Quinine and addition to nauseous mixtures. Eriodictyi Aromaticus (Yerba Santa; Syrupus Corrigens). —Chiefly intended as a vehicle for disguising the taste of Quinine and other bitter substances. Ferri Arsenatis.—Each fluidrachm (4 Cc.) contains about ■g\j grain (0.001) of Arsenate of Iron (ferric). Ferri Bromidi (U. S. P., '80).—Containing 10 per cent, of Ferrous Bromide. Ferri Citro-iodidi (Tasteless Syrup of Iodide of Iron).— Each fluidrachm (4 Cc.) contains an amount of Iron corre- sponding to about 3.6 grains (0.25) of Ferric Iodide. The official Syrupus Ferri Iodidi contains about 8 grains (0.5) of Ferrous Iodide (Protiodide of Iron) in each fluidrachm (4 Cc). Ferri et Mangant Iodidi (Iodide of Iron and Manganese).— Each fluidrachm (4 Cc.) contains 6 grains (0.4) of Iodide of Iron (ferrous) and 3 grains (0.2) of Iodide of Manganese. Ferri Hypophosphitis (Hypophosphite of Iron).—Each fluid- drachm (4 Cc.) contains 1 grain (0.06) of Hypophosphite of Iron (ferric). Ferri Lactophosphatis (Lactophosphate of Iron).—Each fluidrachm (4 Cc.) contains 1 grain (0.06) of Lactate of Iron, or about i| grains (0.1) of so-called Lactophosphate of Iron. Ferri Protochloridi (Ferrous Chloride).—PLach fluidrachm PHARMACEUTICAL PREPARATIONS. 65 Syrupus— (4 Cc.) contains about 1 grain (0.06) of Protochloride of Iron. Ferri Saccharati Solubilis (Soluble Saccharated Iron; Saccharated Oxide of Iron, Ph. Ger.).—Each 75 minims (5 Cc.) represents approximately 1 grain (0.06) of Metallic Iron, or 3 grains (0.2) of Oxide of Iron. Glycyrrhiz.e (Liquorice).—Each fluidrachm (4 Cc.) repre- sents 30 grains (2.) of Glycyrrhiza. Hypophosphitum Compositus.—Each fluidrachm (4 Cc.) con- tains 2 grains (0.12) of Calcium Hypophosphite, I grain (0.06), each, of the Hypophosphites of Potassium and Sodium, \ grain (0.008), each, of the Hypophosphites of Iron and Manganese, -^ grain (0.004) °f Quinine Hydro- chlorate, and 1^ minims (0.01) of Tincture of Nux Vomica. This Syrup should not be confounded with the official Syrupus Hypo- phosphitum (Syrup of the Hypophosphites : Calcium, Sodium, and Potassium). It is intended to replace a well-known proprietary article, for which it has been found by many physicians to be a satisfactory substitute. It is uniform in com- position and more stable and elegant than the patent article. Ipecacuanha: et Opii (Syrup of Dover's Powder).—Each fluidrachm (4 Cc.) represents 5 grains (0.3) of Dover's Pow- der, or \ grain (0.03), each, of Ipecac and Opium. Mann.e (Syrup of Manna, Ph. Ger.). Morphine Compositus.—A preparation sometimes dispensed as Jackson's Pectoral Syrup, but, as it differs in essential particulars, the N. F. recommends that this preparation be dispensed only when expressly designated under this title. Each fluidrachm (4 Cc.) contains \ grain (0.008) Ipecac, 5 grains (0.3) Senega, I grain (0.06) Rhubarb, and -^ grain (0.002) Morphine, with Oil of Sassafras. Morphin.-e Sulphatis (Syrup of Morphine).—Each fluid- drachm (4 Cc.) contains \ grain (0.008) of Sulphate of Morphine. Papaveris (Poppy, Ph. Br.; Diacodii, Ph. Ger.).—Similar to the preceding, but considerably weaker. Pectoralis (Jackson's Pectoral Syrup).—Each fluidrachm (4 Cc.) contains ■£% grain (0.OO2), each, of Morphine and Oil of Sassafras. Piiosi'iiatum Compositus (Chemical P"ood).—Each fluidrachm (4 Cc.) contains about 2 grains (0.12) of Phosphate of 5 66 A TEXT-BOOK OF MATERIA MEDICA Syrupus— Calcium, i grain (0.06), each, of the Phosphates of Iron and Ammonium, and smaller quantities of the Phosphates of Potassium and Sodium. Pini Strobi Compositus (White Pine Compound).—A com- bination of White Pine, Wild Cherry, Spikenard, San- guinaria, Chloroform, and Morphine, -fa grain (0.002) in a fluidrachm. Rhamnt Cathartic.*: (Buckthorn Berries; Syrupus Spinas Cervinae, Ph. Ger.). Rubi Aromaticus (Blackberry, Aromatic).—A combination of Rubus, Cinnamon, Nutmeg, Cloves, and Allspice. Sanguinary (Bloodroot).—Each fluidrachm (4 Cc.) repre- sents 13 grains (0.8) of Sanguinaria. Senn.e Aromaticus (Senna, Aromatic).—Each fluidrachm (4 Cc.) represents /§ grains (0.5) of Senna, 3 grains (0.2) of Jalap, and 1 grain (0.06) of Rhubarb, with aromatics. Senn/E Compositus (Senna, Compound).—Each fluidrachm (4 Cc.) represents 8 grains (0.5) of Senna, 2 grains (0.12), each, of Rhubarb and Frangula. Sodii Hypophosphitis.—Each fluidrachm (4 Cc.) contains 2 grains (o. 12) of Sodium Hypophosphite. Stillingia; Compositus.—Each fluidrachm (4 Cc.) represents 15 minims (1 Cc.) of Compound Fluid Extract of Stillingia. Oxymel ScilL/E (Oxymel of Squill, Ph. Br.).—A preparation of Honey containing about 5 grains (.32 Gm.) of Squill in each fluidrachm (4 Cc). ELIXIRIA—ELIXIRS. Elixirs are a class of elegant preparations similar to wines or cordials, composed of Water, Sugar, Alcohol, and Aromatics. The medicinal substances are usually in such proportion that an ordinaiy dose may be contained in one or two teaspoonfuls (4 to 8 Cc.) of the elixir. There are but two Elixirs official: Aromatic Elixir, which serves as a vehicle, and one medicinal, Elixir of Phosphorus. Elixir Aromaticum.....spirit of orange, comp. 12 Cc. mix with.....alcohol, deodorized, to make 250 Cc. to this solution add in several portions, agitating after each addition..........syrup 375 Cc. and in the same manner.........water 375 Cc. PHARMACEUTICAL PREPARATIONS. 67 mix the liquid with precipitated calcium phosphate 15 Gm. and filter, adding . . water 3 ; alcohol 1 ; to make 1000 Cc. This illustrates the method by which Elixirs are made. The medicinal ingredients are dissolved in the Water, or Alcohol, as indicated by their solubilities, before mixing the Alcoholic Solution of Oils with the Saccharine Solution. Elixir Phosphori: glyc. 55 ; anise oil 0.2; sp. phosph. 21 Cc. mix by agitation ; then add . aromatic elixir, to 100 Cc. This Klixir contains of phosphorus 25 mg. in 100 Cc, or -^ grain (1 mg.) in 1 fluidrachm (4 Cc), the ordinaiy dose. Some Salts and Fluid Extracts may be dissolved in or mixed with the Elixir itself. For example : Potassii Bromidi.............. 10. Elixir Aromatici...........q. s. ad 100. Cc This contains 15 grains (1 Gm.) in 2\ fluidrachms (10 Cc), 6 grains in I fluidrachm or teaspoonful. Elixirs of the National Formulary. The value of pleasant vehicles to mask or modify the taste of bitter and nauseous drugs is recognized by every prescriber. The following Elixirs of the National Formulary have been carefully selected, and embrace the most effective combinations of adjuvants and aromatics for disguising the different drugs for which they are recommended : Elixir— Anisi ; a combination of Anethol, Fennel, and Bitter Almond. Curassao (Curacao Cordial); a combination of Curacao, Orris, and a little Citric Acid. Adjuvant Elixirs.—The following are intended as vehicles for Quinine and similar bitter substances, and as adjuvants for Tinctures and Fluid Extracts of bitter and resinous drugs, such as Cinchona, Cascara Sagrada, etc. They all contain Glycyrrhiza, which, in the form directed in the N. F. (Russian Licorice Root, peeled), is most effective in masking the bitter taste of Quinine, when it is directed to be simply suspended in the mixture without the use of acid for effecting solution. Acids precipitate the glycyrrhizin and destroy its power of masking the bitter taste : Elixir— Adjuvans ; a combination of Orange, Wild Cherry, Glycyr- rhiza, Coriander, and Caraway. Except for the exhibition of Quinine this is the most effective of the adju- vant Elixirs. 6^ A TEXT-BOOK OF MATERIA MEDIC, Elixir— _ . Eriodictyi Aromaticum (Arom. Elixir Verba Santa; Elixir Corrigens).—A solution of Verba Santa in Comp. Elixir of Taraxacum, intended as a vehicle for Quinine and other bitter remedies. Glycyrrhiz.e (Elixir of Licorice); a solution of Licorice in Aromatic Elixir, the most effective vehicle for Quinine. Glycyrrhiza: Aromaticum ; Elixir of Licorice, with the addi- tion of strong aromatics. Taraxaci Compositum ; an improved form of this well-known compound, useful as a mild adjuvant. Medicinal Elixirs.—These comprise the Elixirs mostly in use; also, a number of preparations in which the prescriber will find satisfactory substitutes, designated by scientific titles and of definite strength and uniform composition, intended to replace various nostrums. Active Drug in i Fluidrachm. 4 Cc. Elixir- £raim- Gm- Acidi Salicylici............. 5 °-3 Ammonii Bromidi............ 5 °-3 Ammonii Valerianate.......... 2 °-12 The odor and taste of the salt being well covered by the addition of vanilla and a little chloroform. Ammonii Valerianate et Quinines.—The above, with Quinine Hydrochlorate .... \ 0.015 Aph Graveolentis (Celery Compound).—Con- taining Celery, Coca, Kola, and Viburnum, each................. 4 °-25 Bismuthi.—Bismuth and Ammonium Citrate . 2 0.12 Buchu................. 7i o-5 Buchu Compositum.—Buchu, Cubeb, Juniper, and Uva Ursi, combined........15 1. Buchu et Potassii Acetatis.—Elixir Buchu, with Potassium Acetate......... 5 0.3 Caffeinve.—Caffeine (in solution in Hydro- bromic Acid).............. 1 0.06 Calcii Bromidi............. 5 0.3 Calcii Hypophosphitis.......... 2 .12 PHARMACEUTICAL PREPARATIONS. 69 Active Drug in 1 Fluidrachfn. 4 Cc. Elixir— Grains. Gm. Calcii Lactophosphatis.—Calcium Lactate (in Phosphoric Acid)............ 1 0.06 Catharticum Compositum.—Each fluidrachm (4 Cc.) contains Senna j\ grains (0.5); Podo- phyllum 4 grains (0.25); Leptandra and Jalap, each 3 grains (0.2); Rochelle Salts j\ grains (0.5); and Sodium Bicarbonate 1 grain (0.06). The mixture should be shaken. Chloroformi Compositum.—A mixture of equal parts of Chloroform, Tincture of Opium, Spirit of Camphor, Aromatic Spirit of Ammonia, and Alcohol, flavored with Cin- namon. The old title, " Chloroform Pare- goric," is recommended to be abandoned for the above. Each fluidrachm (4 Cc.) contains 1 grain (0.06) of Opium and 11 minims (0.7) of Chloroform. Cinchon.e (P^lixir Calisaya).—This preparation is from the best Calisaya Bark, representing about 2 grains (0.12) in each fluidrachm (4 Cc). It is preferable to preparations made from Quinine and the cheaper alkaloids in being a more agreeable and effective anti- periodic tonic. Cinchon.e et Ferri (Calisaya and Iron; Fer- rated Elixir of Calisaya).—Phosphate of Iron . 2 0.12 Cinchon.e et Hypophosphitum.—Calcium and Sodium Hypophosphites, each...... I O.06 Cinchona, Ferri, Bismuthi et Strychnine. —Phosphate of Iron......... 2 0.12 Bismuth and Ammonium Citrate..... I 0.06 Strychnine Sulphate...........yoj 0.0007 Cinchon.e, Ferri et Bismuthi.—Phosphate of Iron................ 2 0.12 Bismuth and Ammonium Citrate..... 1 0.06 Cinchon/E, Ferri et Calcii Lactophosphatis. —Phosphate of Iron......... if 0.1 Calcium Lactophosphate......about 1 0.06 70 A TEXT-BOOK OF MA TERIA MEDICA. Active Drug in i Fluidrachm. 4 Cc. Elixir— Grains. Gm. Cinchona, Ferri et Pepsinl—Phosphate of Iron................ 1} 0.1 Pepsin................ 1 0.06 Cinchone, Ferri et Strychnine.—Phosphate of Iron............... 2 0.12 Sulphate of Strychnine.........y^ 0.0007 Cinchona, Pepsint et Strychnine.—Contain- ing smaller quantities of the Cinchona Alka- loids, Pepsin 1 grain (0.06), and Sulphate of Strychnine............Y^- 0.0007 Coce (Coca).—Leaves, Erythroxylon Coca . . 7! 0.5 Coce et Guarane.—Coca and Guarana, of each y\ 0.5 Corydalis Compositum.—Containing of Cory- dalis, Stillingia, Iris, and Xanthoxylum, combined..............15 1. Potassium Iodide............ 3 0.2 Digestivum Compositum.—Containing about 5 grains (0.3) of Pulvis Digestivus in each fluidrachm (4 Cc). Eucalypti.—Eucalyptus Globulus..... 7^-0.5 Euonymi (Wahoo).—Euonymus Atropurpureus 10 0.6 Ferri Hypophosphitis. — Hypophosphite of Iron (ferric)............. I 00.6 Ferri Lactatis............. 1 0.06 Ferri Phosphatis.—Phosphate of Iron (U.S. P.) 2 0.12 Ferri Phosphatis, Cinchonidine et Strych- nine.—Phosphate of Iron....... 2 0.12 Cinchonidine.............. 1 0.03 Sulphate of Strychnine.........^-i 0.0007 Ferri Phosphatis, Quinine et Strychnine. —Phosphate of Iron, 1 grain (0.06); Qui- nine ................ I. 0.03 Sulphate of Strychnine.........JL o.OOi Ferri Pyrophosphatis.......... 2 0.12 Ferri, Quinine et Strychnine.—Ferric Chlo- ride, 1 grain (0.06); Quinine Hydrochlorate \ 0.03 Sulphate of Strychnine........._L_. 0.OOO7 Frangule (Buckthorn).—Rhamnus Frangula . 15 1. PHARMACEUTICAL PREPARATIONS. ?i Active Drug in 1 Fluidrachm. 4 Cc. Elixir— Grains. Gm. Gentiane................ 2 O.I2 Gentiane cum Tinctura Ferri Chloride— Tincture Citro-chloride of Iron..... 5 0.3 Gentiane et Ferri Phosphatis (ferrophos- phated).—Phosphate of Iron...... 1 0.06 Grindelee.—Grindelia Robusta...... 4 0.25 Guarane.—Paullinia Cupana........12 0.75 Humuli................. 7i Q-5 Hypophosphitum.—Calcium Hypophosphite . 3 0.2 Sodium and Potassium Hypophosphites, each 1 0.06 Hypophosphitum cum Ferro.—Calcium and Sodium Hypophosphite, each...... I 0.06 Potassium and Iron Hypophosphites, each . \ 0.03 Lithii Bromidi............. 5 0.3 Lithii Citratis............. 5 0.3 Lithii Salicylate............ 5 0.3 Malti et Perri.—Phosphate of Iron .... 1 0.06 Malt PLxtract..............15 1. Paraldehyde—Paraldehyde........15 1. Pepsini.—Pepsin.........• . . . 1 0.06 Pepsint, Bismuthi et Strychnine.—Elixir Pep- sin and Bismuth, and Strychnine .... y^j- 0.0007 Pepsint et Bismuthi.—Pepsin....... 1 0.06 Bismuth and Ammonium Citrate...... 2 0.12 Pepsint et Ferri.—Elixir of Pepsin and Tinc- ture Citro-chloride of Iron....... 5. 0.3 Phosphori et Nucis Vomice.—Elixir Phos- phorus, with Tincture Nux Vomica ... 2 0.12 Picis Compositum.—A combination of Prunus Virginiana.Tolu, Methylic Alcohol, and Sul- phate of Morphine..........-fa 0.0015 Pilocarpi (Jaborandi).—Pilocarpus Selloanus . 4 0.25 Potassii Acetatis............ 5 0.3 Potassii Acetatis et Juniperi.—Elixir Potass. Acet. with Juniper.......... j\ 0.5 Potassii Bromide—Potassium Bromide, effect- ually masked in Adjuvant Elixir . . . . IO 0.6 An Elixir half this strength has also been used. A TEXT-BOOK OF MATERIA MEDICA. Active Drug in I Fluidrachm. 4 Cc. Elixir— Grains. Gm. Quinine Compositum (Red).—Sulphates of Quinine, \ grain (0.008), Cinchonidine and Cinchonine, each............-fa 0.004 Chiefly intended as a substitue for Elixir Cinchona when the administration of other constituents of the bark may be deemed ob- jectionable. Quinine et Phosphatum Compositum.—Qui- nine Sulphate............ \ 0.015 Phosphate of Iron........... 1 0.06 Calcium Lactophosphate......... f 0.05 Quinine Valerianate et Strychnine.—Va- lerianate of Quinine.......... 1 0.06 Sulphate of Strychnine..........y-^ 0.0007 Rhamnt Purshiane (Cascara Sagrada).—Rham- nus Purshiana, its bitterness effectually masked with Elixirs of Glycyrrhiza and Taraxacum Compound ..............15 1. Rhamnt Purshiane Compositum (Laxative Elixir; Elixir Purgans).—Cascara Sagrada . j\ 0.5 Senna and Juglans, each......... 5 0.3 Associated with aromatics and correctives ; a most effective laxative in doses of from 1 to 2 fluidrachms (4-8 Cc). Rhei.—Sweet Tincture of Rhubarb, represent- ing Rhubarb.............. 2\ 0.15 Rhei et Magnesie Acetate.—Magnesium Acetate, 4 grains (0.25); Rhubarb..... y| 0.5 Rubi Compositum (Blackberry Compound).— Blackberry Root, Galls, and Cinnamon (Sai- gon), in equal proportions, combined .... 10 0.6 with smaller quantities of Cloves, Mace, and Ginger, in Blackberry Juice and Syrup. Sodii Bromide—Sodium Bromide, in Adjuvant Elixir.................IO 0.6 Sodii Hypophosphitum.......... 2 0.12 Sodii Salicylate (to be freshly prepared when required for use)............ c 0.3 PHARMACEUTICAL PREPARATIONS. 73 Active Drug in i Fluidrachm. 4 Cc. Elixir— Grains. Gm. Stillingie Compositum. — Compound Fluid Extract of Stillingia, N. F.........15 1. Strychnine Valerianate......... * 0.0007 Turnere (Damiana).—Turnera Aphrodisiaca . 10 0.6 Viburnt Opuli Compositum.—Viburnum Opu- lus, Aletris Farinosa, each....... 5 0.3 Trillium (Beth Root)..........10 0.6 Viburnt Prunifolii (Black Haw)...... 71 0.5 Zinci Valerianate.—Zinc Valerianate ... 1 0.06 Cordiale Rubi Fructus (Blackberry Cordial).—An aromatic Syrup of Blackberry Juice, used as a mild astringent in bowel complaints. Succus Limonis cum Pepsino (Lime Juice and Pepsin).—Each fluidrachm (4 Cc.) represents 2 grains (0.12) of Pepsin. GLYCERITA—GLYCERITES. The Glycerites, or " Glyceroles," are solutions of substances in Glycerin. They are made either by direct solution, by heat, or by extrac- tion of a drug, as in Hydrastis ; one is made by chemical reaction —/. e. Boroglycerin. There are six official, comprising those used externally either alone or as additions to washes, gargles, injections, etc.: Percentage Glyceritum— by weight. Acidi Carbolici...........acid, carbolic 20. Acidi Tannici.............acid, tannic 20. Boroglycerini............boroglyceride 50. Hydrastis.........representing hydrastis 100. The following are used chiefly as pharmacal agents ; the Gly- cerite of Starch as an excipient for Pill-masses; and the Glycerite of Egg-yolk as an emulsifying agent: Glyceritum— Amyli..............water 10, starch 10. Vitelli...............fresh egg-yolk 45. The Glycerite of Starch is sometimes used externally, and is 74 A TEXT-BOOK OF MATERIA MEDICA known as Glycerin Ointment, also as "plasma." The Glycerite of Egg-yolk, also known as " glyconin," has been used as an applica- tion to sore nipples. Unofficial Glyeeritcs of the National Formulary. Glyceritum — Pepsini (Glycerole of Pepsin).—Each 4 Cc. (fluidrachm) repre- sents 0.3 (5 grains) of Pepsin. Picis Liquide (Tar).—Containing about 0.3(5 grains) of Tar. Tragacanth.e.—Containing about 12 per cent, of tragacanth. MUCILAGINES—MUCILAGES. The Mucilages are prepared by extracting a mucilaginous drug with Water or dissolving a Gum in Water. The following four are official: Gm. in ioo Cc, Mucilago— or percentage. Acaciae................gum arabic 34. Sassafras Medullas..........sassafras pith 2. Tragacanthae........glycerin 18; tragacanth 6. Ulmi..............slippery-elm bark 6. The Mucilages are chiefly employed as vehicles in Mixtures to aid in suspending insoluble substances ; as excipients in Pills and Troches; and as emulsifying agents. They are sometimes used for their demulcent effect. THE LIQUID MIXTURES—INTERNAL. MISTUR.-E—MIXTURES. The official Mixtures are liquid preparations, for internal use, of medicinal substances dissolved or suspended in Water containing sugar, gum, or glycerin. They should be prepared extemporane- ously. The term Mixture is also applied to any combination of substances that cannot be otherwise classified. There are four official mixtures : Mistura— Gms. in ioo Cc. Cretae (Chalk Mixture) .... comp. chalk powcler 20. cinnamon water 40; water, to 100. Ferri Comp. (Griffith's Mixt.) . . . myrrh, sugar, each 1.8 potass, carb. 0.8 triturate with gradual addition of rose water 70. ferrous sulphate, 0.6; spir. lavend., 6 ; rose water, to 100. THE LIQUID MIXTURES-INTERNAL. 75 Mistura— Gms. in 100 Cc. Glycyrrhizae Comp.....pure extract glycyrrhiza 3 (Brown Mixture) Spirit ether nitrous 3 wine antimony 6 tinct. opium, camph. 12 syrup 5 ; mucilage acacia 10; water, to 100 Rhei et Sodae.........sodium bicarbonate 3 fl. exts. ipecac 0.3, rhubarb 1 spirit peppermint 3.5 ; glycerin 35.; water, to 100 Unofficial Mixtures of the National Formulary. Mistura— Acacie—(Mistura Gummosa, Ph. Ger.).—Acacia, pulv., Sugar, in Water. Should be freshly made when wanted for use. Adstringens et P^scharotica (Villate's Solution).—Solu- tion of Lead Subacet. 1^ fluidounces (45.); Sulphates of Copper, Zinc, each, 1 troy ounce (30.); Acetic Acid 13 fluid- ounces (360 Cc). Ammonii Chloridi (Mistura Solvens Simplex).—Ammonium Chloride, Purif. Ext. Glycyrrhiza, each 180 grains (12.), in Water 16 fluidounces (450 Cc). Mistura (or Mixturd) Solvens Stibiata is prepared by dis- solving 0.3 Antimony and Potassium Tartrate in 1000 Cc. of Mistura Ammonii Chloridi. Camphor.e Acida (Mistura Antidysenterica; Hope's Mix- ture).—Nitric Acid 120 mins. (8 Cc.); Tinct. Opium 80 mins. (5 Cc.); in Camphor Water 16 fluidounces (450 Cc). Camphore Aromatica (Parrish's Camphor Mixture).—Tinct. Lavender Comp. 4 fluidounces (120 Cc.); Sugar 240 grains (15.); in Camphor Water 16 fluidounces (450 Cc). Carmenativ.\ (Dalby's Carminative).—Magnes. Carb. 1 troy ounce (30.); Potass. Carb. 20 grains (1.3); Tinct. Opium 180 mins. (12 Cc); Oils of Caraway, Fennel, Peppermint, each* 4 drops (0.1); Syrup 2\ fluidounces (75 Cc.); in 16 fluidounces (450 Cc). Each fluidounce (30 Cc.) represents about 1 grain of Opium (0.06). Chlorale et Potassii Bromidi Composita (Mixture of Chloral and Bromide).—Each fluidrachm (4 Cc.) contains 15 grains (1.), each, of Chloral and Potassium Bromide, 5 5 76 .-/ TEXT-BOOK OF MATERIA MEDICA Mistura— and \ grain (0.008), each, of Exts. Indian Cannabis and Hyoscyamus. Chloroformi et Cannabis Indice Composita {Chloroform Anodyne).—-Each fluidrachm (4 Cc.) represents 7 J minims (0.5 Cc), each, of Chloroform and Tinct. Indian Cannabis; 3| minims (0.25 Cc) Tinct. Capsicum; and about j grain (0.01) of Morphine Sulph. Contra Diarrhceam (Cholera Mixture).—Tinctures of Opium, Capsicum, Rhubarb, and Spirits of Camphor and Pepper- mint, each, equal volumes. The above formula appears to be that in most general use, also known under the name of " Sun Mixture." Of other similar preparations in more or less general use, the following may be mentioned here: 2. Loomis" Diarrhea Mixture.—Tincture Opium, \ fluid- ounce (15 Cc) ; Tincture Rhubarb, h fluidounce (15 Cc); Tincture Catechu Comp., 1 fluidounce (30 Cc.); Oil of Sas- safras, 20 minims (1.3 Cc.); Tincture Lavender Comp., to make 4 fluidounces (120 Cc). 3. Sguibb's Diarrhea Mixture.—Tincture Opium, 1 fluid- ounce (30 Cc); Tincture Capsicum, 1 fluidounce (30 Cc); Spirit of Camphor, 1 fluidounce (30 Cc.); Purif. Chloroform, 180 minims (12 Cc); Alcohol, enough to make 5 fluidounces (150 Cc). 4. Thielemann's Mixture (Mixt. Thielemanni, Ph. Suec).— Wine Opium, 1 fluidounce (30 Cc.); Tinct. Valerian, \\ fluidounces (45 Cc.); Ether, \ fluidounce (15 Cc.); Oil Peppermint, 60 minims (4 Cc.); Fl. Ex. Ipecac, 15 minims (1 Cc.); Alcohol, to make 4 fluidounces (120 Cc). 5. Velpcaiis Diarrhea Mixture.—Tincture Opium, Tinc- ture Catechu Comp., Spirit Camphor, of each, equal volumes. Copaibe Composita— 1. Lafayette Mixture.—Copaiba, 2 fluidounces (60 Cc); Tinct. Lavender Comp., 2 fluidounces (60 Cc.); Solution Potassa, \ fluidounce (15 Cc.); Spirit Xitr. Ether, 2 fluid- ounces (60 Cc.); Syrup, 5 fluidounces (150 Cc.); Mucilage Dextrin, to make 16 fluidounces (450 Cc). This mixture should be well agitated when used. Each fluidrachm con- tains y\ minims of Copaiba. 2. Chapman's Mixture.—Copaiba, 4 fluidounces (125 Cc); THE LIQUID MIXTURES—INTERNAL. 77 Mistura— Tinct. Lav. Comp., 240 minims (15.5 Cc); Tincture Opium, 240 minims (15.5 Cc); Spirit Nitro. Ether, 4 fluidounces (125 Cc.); Mucilage Acacia, ih fluidounces (45 Cc); Water, to make 16 fluidounces (450 Cc). Expectorans, Stokes (Stokes' Expectorant).—Ammonium Carb., 120 grains (8.); Fl. Ext. Senega, | fluidounce (15 Cc); Fl. Ext. Squill, % fluidounce (15 Cc); Tinct. Opium, Camph., 2\ fluidounces (80 Cc); Water, \\ fluidounces (45 Cc.); Syrup Tolu, to make 16 fluidounces (450 Cc). Guaiaci (Guaiac Mixture, Ph. Br.).—Resin Guaiac, Sugar, each, 190 grains (12.5); Acacia Powder, 100 grains (7.); Cinna- mon Water, 16 fluidounces (450 Cc). To be well agitated when used. Magnesie et Asafcetide (U. S. P. 1880.).—Dewees' Carmina- tive.—Magnesium Carbonate, 90 grains (6.0); Tinct. Asa- fcetida, 2 fluidrachms (8 Cc.); Tinct. Opium, 20 minims (1.2 Cc); Sugar, 180 grains (12.0); Water, to make 4 fluid- ounces (120 Cc). Olei Baesamica (Balsamum Vitae Hoffmanni, Ph. Ger.).— A solution of Oils of Lavender, Thyme, Lemon, Mace, Orange-flowers, Cloves, Cinnamon, and Balsam Peru in Alcohol. Olei Picis (Tar Mixture).—A mixture of Oil of Tar, \ fluid- ounce (15 Cc.); Chloroform, 75 minims (5 Cc.); Oil of Pep- permint, 20 minims (1.3 Cc), in Elixir, to make 16 fluid- ounces (450 Cc). Rhei Composita (Squibb's Rhubarb Mixture).—Fl. Ext. Rhubarb, 120 minims (6. Cc.); Fl. Ext. Ipecac, 16 minims (1. Cc.); Sodium Bicarb., 330 grains (11.); Glycerin, 6 fluid- ounces (240.), in Peppermint Water, 16 fluidounces (450 Cc). Sassafras et Opii (Mist. Opii Alkalina ; Godfrey's Cordial).— A mixture of Oil of Sassafras, Tincture of Opium, and Potass. Carb. in Molasses, Alcohol, and Water. Each fluidrachm (4 Cc.) contains 2 minims (0.12) Tinct. Opium, correspond- ing to \ grain (0.01) Opium. Sode et Menthe (Soda Mint).—Sodium Bicarb., 320 grains (20.); Spirit Ammonia Arom., 4 Cc. (60 minims); Spear- mint Water, 16 fluidounces (450 Cc). Splenetica (Spleen Mixture; Gadberry's Mixture).—Iron Sulphate, Quinine Sulphate, Nitric Acid, each, 100 grains /8 A TEXT-BOOK OF MA TERIA MEDICA. Mistura— (J.); Potassium Nitrate, 300 grains (20.). in Water, 16 fluid- ounces (450 Cc). Sulphurica Acida (Haller's Acid Elixir, Ph. Ger.).—Sul- phuric Acid, 1 part; Alcohol, to make 4 parts, by weight. KMULSA—EMULSIONS. Emulsions are liquid preparations consisting of oily, fatty, resin- ous, or otherwise insoluble substances suspended in watery liquids by the intervention of gum, mucilage, or other viscid matter. For the internal administration of Oils it is often necessary to exhibit them in a palatable form, so that they may be borne by the stomach and their assimilation favored. This is usually effected by suspending the oil in a wateiy liquid or mixture by means of an emulsifying agent, such as acacia, etc. Many natural substances are intimate mixtures of oils or fats with water, in the form of an emulsion. Of animal products, Milk is a most perfect emulsion; so is Egg-yolk. From the Milk-juice of some plants the water evaporates and the dried milk-juice col- lects in the seeds, as in almonds and other nuts, or exudes from other portions of the plant when the parts are wounded; in this way the gum-resins of asafcetida, etc. are produced. From these substances Emulsions may be obtained by restoring the water lost by evaporation—that is, by rubbing them with water in a mortar. In this way the so-called natural Emulsions are made. Artificial Emulsions. These are made by mixing the Oil with a certain proportion of the emulsifying agent, adding Water, and triturating the mixture in a mortar or agitating it in a flask. There are various methods, but these are general rules: The emulsification of the oil should be complete before the mixture is made up to the required measure. When alcoholic liquids are to be added, they should first be diluted as much as possible. Salts should be dissolved before being added. No heat should be employed, as the oil separates when an emulsion is heated. Emulsions should be freshly prepared and be preserved in a cold place. The most common emulsifying agent is Powdered Gum Acacia (Acacia pulv.). The Oil is thoroughly mixed by trituration in a mortar with one-fourth its weight of powdered Acacia. To this one and a half times as much water as of gum is added at once, and the mixture is rapidly triturated with a rotary motion of the pestle THE LIQUID MIXTURES—INTERNAL. 79 until it becomes stiff and assumes a milk-white color. This so- called " mother-emulsion" may now be diluted to the required measure, and other substances, flavors, etc. be added. Powdered Tragacanth may be used in the same way or in the form of mucilage, but it does not produce so permanent emulsions as does gum acacia. Mucilage of Acacia or of Irish Moss is not so satisfactory as powdered gum: while it produces a good emulsion, the division of the oil-globules is not so thorough as in the preceding: emulsifica- tion being incomplete, the mixture more rapidly separates into a heavier, watery liquid and a lighter, thick, gelatinous emulsion, which requires thorough mixing before use. Extract of malt is an excellent emulsifying agent when its use is admissible. The Oil should be added to the Malt Extract contained in a capacious mortar, and incorporated in small quantities at a time. A good article will emulsify an equal volume of cod- liver oil. Condensed Milk and Egg-yolk produce the most perfect emulsions, and also the most palatable, but they rapidly ferment and spoil. Glycerin and sugar added to emulsions for the purpose of preservation and palata- bility induce separation, and their use is not advisable. Emulsification " by intervention " is the best and only reliable method to be employed with P^thereal Oils and all substances of themselves not emulsifiable. The process is illustrated in the official Chloroform Pmiulsion. Oil of Turpentine, for example, is emulsified by dissolving the Turpentine Oil in twice its volume of a bland fixed oil (Almond Oil), incorporating an equal weight of powdered Acacia, adding Water, and proceeding as with an ordinary emulsion. Pancicatin emulsionizes fats in preparing them for digestion, but it does not produce a permanent emulsion when used artificially. While, therefore, not a reliable emulsifying agent, it aids the assimilation of oils, and its^ddition to emulsions is sometimes therapeu- tically desirable. As it is only active in alkaline media, the Emulsion should be prepared with a little Sodium Bicarbonate. The addition of Alkalies to emulsions should be avoided. Soaps are not Emulsions, nor is the use of Soap-bark to be recommended. Of the four official Emulsions three are natural emulsions; one is artificial: Gm. in 100 Cc, Emulsum— or percentage by vol. Ammoniaci..............ammoniac 4. Amygdalae............sweet almond 6. sugar 3 ; acacia 1. Asafcetidae........asafoetida, in select tears 6. Chloroformi .... tragacanth powd. 1.5 ; chloroform 4. expressed oil almond 6; water, to 100. 80 A TEXT-BOO A' OF MATERIA .MEDICA. Shake the Chloroform and Tragacanth together in a dry bottle, incorporate 25 Cc. Water, then the Almond Oil in small quantities, and finally in the same way add the remainder of the Water. Unofficial Emulsions of the National Formulary. Emulsions should, of all pharmaceuticals, be prepared within a reasonable period previous to the time of dispensing. A true emulsion should contain the oil simply suspended in the form of a mechanical mixture, which, from its very character, cannot with- stand the effects of variation in temperature any better than a natural emulsion, such as milk or emulsions of almonds, gum- resins, etc., and consequently quickly degenerates or spoils. An emulsion may be perfect—that is, the oil-globules entirely extinguished—yet a separation similar to that occurring in milk will take place, which, though in its first stage not so objection- able, will eventually impair the medicinal value of the preparation. These reasons are, it is believed, sufficient to condemn the various " ready-made " or patent emulsions, and to justify the physician in prescribing such as are kept on hand by the pharmacist, in smaller quantities, prepared according to these formulas. A typical formula for emulsions, with Acacia, is— I$s. Olei Morrhuae.......120 Cc, 3iv; Acacias pulv........30 Gm., ,lj; Aquae.......q. s. ad 240 Cc, 3viij. Emulsify by trituration in a mortar, and add the flavoring. The following are flavors employed: (1) Gaultheria, (2) gaul- theria and sassafras, (3) aromatic spirit, (4) gaultheria, bitter almond, and coriander, (5) gaultheria, sassafras, and bitter almond, (6) gaul- theria and bitter almond, (7) oil of neroli, bitter almond, and cloves. Unless otherwise specified, that designated as No. 5 may be em- ployed in these Emulsions. The following formulas may be useful as indicating the form of prescription for any combination desired. Hypophosphite Salts or any medication desired may usually be dissolved in the water directed in the formula, should a preparation be indicated different from any of the following emulsions of the N. F.: Emulsio— Olei Morrhue cum Calcii et Sodii Phosphatibus.—Cal- cium Phosphate, Sodium Phosphate, of each, 1 grain in I fluidrachm (0.06 in 4 Cc). EXTRACTIVE PREPARATIONS. 8l Olei Morrhue cum Calcii Lactophosphate. — Calcium Lactophosphate, 3 grains in 1 fluidrachm (0.2 in 4 Cc). Olei Morrhue cum Calcii Phosphate.—Calcium Phos- phate, 2 grains in 1 fluidrachm (0.12 in 4 Cc). Olei Morrhue cum Extracto Malti.—Contains 40 per cent. Extract of Malt. Olei Morrhue cum Hypophosphite.—The Hypophosphite Salt or any combination of the following: Calcium, Po- tassium, Sodium, or Iron, to be directed by the prescriber, 8 grains to the fluidounce (0.5 in 30 Cc). Olei Morrhue cum Pruno Virgintana.—Wild Cherry (Fluid Ext.), \ fluidrachm to 1 fluidounce (2 Cc. in 30 Cc). Olei Ricini.— 1 fluidounce (30 Cc.) contains 2\ fluidrachms (10 Cc.) Castor Oil, disguised by the addition of Vanilla. Olei Terebinth ine.—Contains 1 fluidrachm (4 Cc.) Oil of Turpentine 1 fluidounce (in 30 Cc), prepared according to the following formula: I$s. Olei Terebinthinae......3iv, Acaciae pulv.......gr. xxx, Vitelli Ovi (Egg-yolk); Elixir Aromatici .... ana 3iv, Aquae Cinnamomi . . q. s. ad siv, Make an emulsion by trituration in a mortar. Phosphatica (Phosphatic Emulsion).—Prepared with Glycerite of Egg-yolk, and contains in 1 fluidounce (30 Cc.) Cod Liver Oil, 2 fluidrachms (8 Cc.); Dilute Phosphoric Acid, 22-L minims (1.5 Cc.); Jamaica Rum, flavored with Bitter Almond and Orange Flower Water. EXTRACTIVE PREPARATIONS. The active medicinal constituents, or principles, of crude drugs are obtained by extraction. Extraction is effected either by macera- tion, expression, and filtration or straining, or by maceration with heat, when it is called digestion, or by percolation. The liquid employed, termed menstruum (pi. menstrua), may be Water or Al- cohol, or Alcohol and Water in various proportions, sometimes with Glycerin. A few drugs require alkaline menstrua, some acid menstrua, while the oleoresins are made with Ether. 12.5 Cc; 2.0 15 Cc.; 00 Cc. 82 A TEXT-BOOK OF MATERIA MEDICA The Infusions and Decoctions are the simplest preparations made by extraction, and represent most nearly all the soluble constitu- ents of the drugs. But not all drugs are adapted to this method of extraction nor to this exceedingly effective, though not espe- cially elegant, form of exhibition. The most generally convenient and effective class of extractive preparations are the Tinctures. They are the simplest form of alco- holic preparations, and the other more concentrated preparations are usually first obtained as tinctures and then concentrated by evaporation, so as to yield the fluid extract, extract, or resin respectively. The only accurate method for determining the doses of extrac- tive preparations is to compare their drug-strength. Thus, the doses of the respective preparations of Nux Vomica, based upon their relative drug-strength, would be as follows: Average Dose of Drug. of Preparation. ,------A------n ,----------A---------^ Tincture . . .20%, 1 in 5, 3 grains (0.2) = 15 minims (1. Cc). Fluid Extract 100%, 1 in 1, 3 grains (0.2)= 3 minims (0.2 Cc). Extract . . . 1000 c/r, 10 in 1,3 grains (0.2) =fa grain (0.02 Gm.). In the same way the doses of the preparations of Opium may be presented: Average Dose of Drug. of Preparation. t---------*---------N ,---------------*---------------v Tincture of Opium . 10%, 1 grain (0.06) = 10 minims (0.6 Cc). " deod. iof/o, 1 grain (0.06) = 10 minims (0.6 Cc). Vinegar of Opium . 10^, 1 grain (0.06) = 10 minims (0.6 Cc). Wine of Opium . . 10%, I grain (0.06) = 10 minims (0.6 Cc). Extract of Opium . 150%, 1 grain (0.06) = % grain (0.04). While the preparations of these two drugs are standardized according to their alkaloid percentage strength in the U. S. P., such strength is not as available for computing or estimating doses as is the drug-strength. The determination of alkaloidal percentage in preparations is a check upon their preparation, but is not of so much importance to the physician as it is that the preparations be made by a skilful and conscientious pharmacist, from the very best quality of material, in a thorough manner. EXTRACTIVE PREPARATIONS. 83 INFUS A—INFUSIONS. Unless otherwise directed, Infusions are prepared by the general official process: Of the Drug, coarsely comminuted...... 5 Gm. Boiling Water...............100 Cc Pour the boiling Water on the Drug in a suitable vessel, provided with a cover, and let it stand for half an hour; strain, and add enough Water through the strainer to make ico Cc. Caution.—The strength of Infusions of powerful drugs—e. g. Ipecac—should be especially prescribed. The following Infusions are official, being prepared of different strengths and by other processes than directed in the general formula: Gm. in 100 Cc. Infusum Digitalis . alcohol, 10; cinnamon water, 15; digitalis 1.5 Infusum Sennae Comp. (Black Draught) . . fennel 2 ; senna 6. manna, magnesium sulph., of each 12. Drugs whose active principles are volatile or changed by heat are prepared by percolation without heat, or cold Infusion : Gm. in 100 Cc Infusum Cinchonas .... acid arom. sulph. 1 ; cinchona 6. Infusum Pruni Virginianae........wild cherry 4. Unofficial Infusions of the National Formulary. Infusum— Bravere (U. S. P. 1880).—Brayera (Cusso), 6 ; Boiling Water, 100 Cc. To be dispensed without straining the mixture. Gentiane Compositum Fortius.—For preparing Infusum Gentianae Compositum by mixing 1 volume with 3 volumes of water. Ros.e Compositum (Compound Infusion of Rose, Ph. Br.).— • An infusion of Red Rose in diluted Sulphuric Acid, Sugar, and Water. The Species (Teas) are mixtures of drugs contused or bruised for the preparation of Cataplasms ; or Infusions and Decoctions, sometimes designated as Haustus (Draught). The following are in the National P'ormulary: Species— Emollientes (Emollient Cataplasm, Ph. Ger.).—A mixture of Althaea Leaves, Mallow Leaves, Melilot Tops, Matricaria, and Flaxseed, equal parts of each. 84 A TEXT-BOOK OF MATERIA MEDICA. Species— Lax antes (St. Germain Tea, Ph. Ger.).—A mixture of Senna, Elder-flowers, Fennel, Anise, and Potassium Bitartrate. Pectorales (Breast Tea, Ph. Ger.).—A mixture of Althaea, Coltsfoot, Glycyrrhiza, Anise, Mullein Flowers, and Orris Root. Infusum Pectoralc (Pectoral Infusion, or Infusion of Pec- toral Species) is made by infusing I troy ounce (30 Gm.) of the above in the usual manner, so as to obtain 10 fluid- ounces (300 Cc.) of strained product. DECOCTA—DECOCTIONS. Unless otherwise directed, Decoctions are prepared according to the following general process: Of the Drug, coarsely comminuted...... 5 Gm. Boiling water, to make...........100 Cc. Pour the boiling Water on the Drug, contained in a suitable vessel provided with a cover, bring it to a boil, and let it boil for fifteen minutes; let it cool to 400 C. (1040 F.), express, strain, and add cold Water through the strainer to make 100 Cc. Caution as with Infusions. The following Decoctions are official, as being made of strengths and methods other than those directed in the general process: Gm. in 100 Cc. Decoctum Cetrariae ........Iceland moss 5. Decoctum Sarsaparillae Comp. mezereum 1 ; sarsaparilla 10. glycyrrhiza, sassafras, guaiac wood, of each 2. Decoctum Aloes Compositum, N. F., is a mixture of Ext. Aloes, Myrrh, Saffron, Potass. Carb., Ext. Glycyrrh, Tinct. Cardamom Comp., and Water.—Extempore. ACET A—VINEGARS. The Vinegars are made by extraction with Dilute Acetic Acid. Bv maceration : Gm. in 100 Cc. Acetum Opii (Black Drop) . sugar 20; nutmeg 3; opium 10. Scillae................squill 10. The Vinegars of Lobelia and Sanguinaria (U. S. P. 1880) were of the same strength. VINA—WINES. The Wines are made by solution, by maceration, or by macera- tion and percolation. The Menstruum is White Wine, to which from EXTRACTIVE PREPARATIONS. 85 10 to 15 per cent, of Alcohol is added to aid in the extraction and the preservation. There are ten Wines official. The Natural Wines: Vinum Album and Vinum Rubrum are treated under Alcohol. Vinum— Gm. in 100 Cc Antimonii . . . antimony, potass, tart. (sol. water) 0.4 Colchici Radicis........colchicum root 40. Colchici Seminis......; . colchicum seed 15. Ergotae................ergot 15. Ferri Amarum . . soluble iron and quinine citrate 5. (Bitter Wine of Iron) tinct. orange peel 15 ; syrup 30. Ferri Citratis .... iron and ammonium citrate 4. syrup 10; tinct. orange peel 15. Ipecacuanhas.....alcohol 10; fl. ext. ipecac 10. Opii......cinnamon, cloves, each, 1 ; opium 10. The Dose of the Vinegar and Wine of Opium is the same, 10 minims (0.6) representing 1 grain (0.06) opii pulveris. The dose of the Wine of Colchicum Root is 10 minims (0.6), it being nearly three times the strength of the Wine of Colchicum Seed, of which the dose is 30 minims (2 Cc). Unofficial Wines of the National Formulary. The Wines, with a few exceptions, are prepared with White Wine {Vinum album, U. S.), usually with the addition of 10 per cent, of Alcohol, in order better to preserve the preparation. Vinum— Aloes (U. S. P. 1880).—Representing 6 per cent, of Aloes with Aromatics. Aurantii.—Sherry Wine flavored with Orange. Aurantii Compositum (Elixir Aurantiorum Compositum).—A combination of Bitter Orange Peel, Absinthium, Menyanthes, Cascarilla, Cinnamon, and Gentian, in Sherry Wine. Useful as a stomachic tonic in doses of 1 fluidrachm (4 Cc). Carnis (Beef and Wine).—Each fluidrachm (4 Cc) represents 2 grains (0.12) of Extract of Beef. The Extract of Beef in this and similar preparations is that which is pre- pared by Liebig's method. Carnts et Ferri (Beef, Wine, and Iron).—Each fluidrachm (4 Cc.) represents 2 grains (0.12) of Extract of Beef and 2 minims (0.12) Tincture of Citro-chloride ("Tasteless" Tincture) of Iron. 86 A TEXT-BOOK OF MATERIA MEDICA. Vinum— Carnts, Ferri et Cinchon.e (Beef, Wine, Iron, and Cinchona). —Each fluidrachm (4 Cc.) represents 2 grains (0.12) Extract of Beef, 2 minims (0.2) Tincture Citro-chloride of Iron, and small quantities of Cinchona alkaloids, in Angelica Wine. Coce (Erythroxyli).—Each fluidounce (30 Cc.) represents 30 grains (2 Gm.) of Coca in Claret Wine. Coce Aromaticum.—Each fluidounce (30 Cc.) represents 30 grains (2 Gm.) of Coca with Aromatics. Fraxini Americane (White Ash).—Each fluidrachm (4 Cc.) represents 30 grains (2 Gm.) of Fraxinus (bark). Pepsint (Pepsin).—Each fluidrachm (4 Cc.) represents 1 grain (0.06) of Pepsin. Picis (Tar).—A saturated solution of Tar, in Sherry Wine. Pruni Virgintane (Wild Cherry).—Each fluidrachm (4 Cc.) represents 15 grains (1 Gm.) of Wild Cherry, in Angelica Wine. Pruni Virginiane Ferratum (Wild Cherry, Ferrated).—Each fluidrachm (4 Cc.) represents 5 minims (0.3 Cc.) of Tincture of Citro-chloride of Iron and 13! grains (0.9 Gm.) of Wild Cherry, in Angelica Wine. Rhei (U. S. P. 1880).—Representing 10 per cent, of Rhubarb and 1 per cent, of Calamus. TINCTURE—TINCTURES. Tinctures are liquid preparations made by the extraction of Drugs with menstrua of Alcohol and Water in various propor- tions. They are prepared by maceration and filtration; also by percolation: By maceration and filtration, those containing resins and oleo- resins, Musk, and tinctures of fresh herbs; in a few instances with heat, the Tincture of Quillaja and Tincture of Strophanthus. By percolation, when prepared from dried vegetable drugs—i. e. barks, leaves, roots, etc., usually after brief maceration. By solution, mixing a solution (chloride of iron) or dissolving a solid in Alcohol (Iodine, Ext. Nux Vomica). Assayed Tinctures.—Two of the most important Tinctures are required to be of certain specified alkaloidal strengths, and their classification according to their respective drug-strengths is there- fore only approximately correct. Tinctura Opii is made so as to represent from 1.3 to 1.5 per EXTRACTIVE PREPARATIONS. 87 cent, of crystallized morphine, the proportion obtained from 10 per cent, of Opii Pulvis, U. S. Tinctura Nucis Vomicce is made by solution of 2 per cent, of the official Extract, representing about ten times its weight of the drug; the Tincture therefore represents 20 per cent, of the drug, and con- tains 0.3 per cent, total alkaloids. Tincturae Herbaram Recentium.—Tinctures of Fresh Herbs, or " Green Tinctures," similar to the Homoeopathic or so-called " German Tinctures," also to the specific tinctures of the Eclectics, when not otherwise directed are to be prepared by the following general formula: Take of the fresh herb, bruised or crushed, 50 Gm.; macerate for fourteen days in Alcohol 100 Cc.; express the liquid and filter. Tinctures of the U. S. P. Name. Tinctura— Aconiti Aloes Aloes et Myrrhse . Arnicse Florum . Arnicse Radicis . Asafoetidae . . . Aurantii Amaroe . Aurantii Dulcis . Belladonnas Foliorum Benzoini..... Benzoini Composita (Turlington's Bal- sam). Drug. . Root .... / Aloes . . , I Licorice . , (Aloes......10 Myrrh.....10 Licorice.....10 . Flowers.....20 . Root......10 . Gum resin ... 20 . Bitter Orange peel 20 . Sweet.....20 . Leaves.....15 . Balsam ..... 20 ... 121 Gm. Average Dose. Menstrua. in Alcohol, Drug. Rep. Tinct. 30 Cc. per cent. Grains. Gm. Cc. Min. 35 70 I O.06 0.2 3 10) 50 6 0.4 4. 60 Bryoniae .... Calendulse . . . Calumbae .... Cannabis Indicse . Cantharidis . . . Capsici..... Cardamomi . . . Cardamomi Composita }• Benzoin . . Storax..... 8 Tolu...... 4 Aloes...... 2.. . Root......10 . Florets.....20 . Root .••... 10 . Flower tops ... 15 . Insect ..... 5 . Fruit...... 5 . Fruit......10 ' Cardamom .... 2 ^ Cassia Cinnam. . . 2 Caraway .... 1 Cochineal .... 0.5 Glycerin.....5 , 75 5° 65 100 60 IOO 50 IOO IOO IOO 60 IOO IOO 95 5° 50 0.8 0.2 0.2 0.4 0.4 0.4 0.1 0.4 0.5 0.2 0.4 0.4 °-3 1. 2. 2. 2. 2. 0.6 2. 0.015 °-3 0.1 2. 0.4 4. 60 15 30 30 3° 30 10 30 30 3° 30 60 30 5 30 60 60 88 A TEXT-BOOK OF MATERIA MEDICA. Name. Drug. Tinctura— Catechu Composita . Bitter Orange peel Serpentaria Glycerin . I Catechu I Cinnamon Chiratae.......Herb . . Cimicifugae.....Rhizome Cinchonae......Bark . . . ' Red Cinchona Cinchonae Composita (Huxham's Tinc- ture). Cinnamomi.....Ceylon Colchici Seminis . . . Seed Croci.......Saffron . Cubebae......Fruit . Digitalis......Leaves . Ferri Chloridi .... Solution Gallrc.......Nutgall Gelsemii......Root (Gentian Bitter Orange Cardamom Guaiaci....... Resin . . Guaiaci Ammoniata. . Resin . . Humuli......Hops . . Hydrastis......Rhizome . Hyoscyami.....Herb . . Iodi........Iodine . . r Ipecac . . Ipecacuanhae et Opii j 0pium deod Kino........Insp. juice Krameriae......Rhatany . Lactucarii......Insp. juice Oil Lavender Oil Rosemary I Cinnamon . Lavandulae Composita -j p, (For flavoring.) Nutmeg . Red Saunders Lobelias......Herb . . . Matico.......Leaves . . . Moschi.......Musk . . . Myrrhae......Gum resin . Nucis Vomicae .... Extract . . Opii........Pulv. Opium r Opium pulv. I Acid Benzoic { Camphor . . Oil Anise L Glycerin . . Opii Camphorata (Paregoric.) Ave ■age Dose. Cm Menstrua Alcohol, in Drug. Rep. Tinct. IOO Cc per cent. Grains Gm. Cc. Min. IO } *> \2 0.8 4- 60 IO IO 65 6 0.4 4- 60 20 IOO 12 0.8 4 60 20 67 12 0.8 4- 60 IO] 2 7-5 J 85 0.8 60 IO 75 6 0.4 4- 60 15 60 5 °-3 2. 3° IO 5° 6 0.4 4- 60 20 IOO 12 0.8 4- 60 15 5o 2* 0.15 1. '5 25 Cc 75 4 0.25 1. •5 20 90 12 0.8 4- 60 15 65 2i 0.15 I. '5 101 :1 60 12 0.8 4- 60 20 IOO 12 0.8 4- 60 20 6 0.4 2. 3° 20 50 12 0.8 4- 60 20 50 12 0.8 4- 60 15 50 5 °-3 2. 30 7 IOO Only externally. IO J IO J 20 1 0.06 0.6 10 IO 65 6 0.4 4- 60 20 50 12 0.8 4- 60 50 50 For syrup. 0.8 -1 0.2 2. 0-5 - 75 4- 3° I. I. -1 20 5° 6 0.4 2. 30 IO 5° 3 0.2 2. 30 5 5o ij O.I 2. 30 20 IOO 6 0.4 2. 30 2 75 1 3 0.02 I. '5 10 5o 1 0.06 0.6 10 0.4-0.4 Opium 0.4 r 5o 1 0.015 4- 60 0.4 4- - EXTRACTIVE PREPARATIONS. 89 Gm. Drug. in Menstrua Alcohol, Average Dose. Name. Drug. Rep. Tinct. Tinctura— IOO Cc . per cent. Grains . Gm. Cc. Min. Opii Deodorata . . Opium..... 10 20 I O.06 0.6 10 Physostigmatis . . . Calabar Bean 15 IOO I O.06 0.4 7 Pellitory . . 20 IOO Externally. Wood . . 10 35 3 0.2 2. 30 Soap Bark 20 35 6 0.4 2. 3° R, . f Rhubarb . 1 Cardamom "} * 8 05 4- 60 - Rhubarb . 20 Cinnamon 4 Rhei Aromatica . . - Cloves . . 4 ► 50 15 I. 4- 60 (For syrup.) Nutmeg . - Glycerin . 2 f Rhubarb . . Glycyrrhiza Anise . . IO Rhei Dulcis (Sweet } Tincture of Rhu- r 4 4 50 8. 120 barb.) ' Cardamom 1 Glycerin . 1 IOJ Sangiiinariae .... Blood-root 15 15 IO 60 5 2\ 0-3 O.15 0.4 2. 3° 15 60 Squill . , 75 65 1. Rhizome . 3 6 4- Stramonii Seminis . Seed . . 15 50 H 0.15 1. 15 Seed . . 5 65 1 O.OI5 0.3 5 Musk-root 10 65 3 0.2 2. 30 Tolu . . IO IOO 3 0.2 2. 30 Root . . 20 75 12 0.8 4- 60 Valerianae Ammoniatae Root . . 20 6 0.4 2. 3° Fruit . . . IO 65 3 0.2 2. 30 Veratri Viridi . . . Rhizome . 40 IOO 2 0.12 0.3 5 Zingiberis...... Ginger. . 20 IOO 6 0.4 2. 3° Unofficial Tinctures of the National Formulary. Tinctura— Amara (Bitter Tincture, Ph. Ger.).—Containing Gentian, Cen- taury, Bitter Orange Peel, Orange Berries, and Zedoary. Antacrida (Dysmenorrhoea Mixture; Fenner's Guaiac Mix- ture).—A mixture of Guaiac, Canada Turpentine, Oil of Sas- safras, and \ grain (0.02) Corrosive Mercuric Chloride in each fluidrachm (4 Cc). Dose, from 10 to 20 minims (0.6 to 1.3 Cc). Antiperiodica (Warburg's Tincture).— With Aloes: Rhubarb, Angelica Seed, of each, grains 56 (4.); Elecampane, Saf- fron, Fennel, of each, grains 28 (2.); Aloes (aq. ext), Gen- tian, Zedoary, Cubeb, Myrrh, White Agaric, Camphor, of each, grains 14 (1.); Quinine Sulphate, grains 160 (10.); Diluted Alcohol, enough to make fluidounces 16 (473 Cc). 90 A TEXT-BOOK OF MATER JA MEDICA. Tinctura— Antiperiodica (Warburg's).—The preceding without Aloes. Each fluidounce (30 Cc.) of either tincture contains 10 grains (0.6) of Quinine Sulphate. Aromatica (Stomachic, Ph. Ger.).—A combination of Cinna- mon, Ginger, Galangal, Cloves, and Cardamom. Capsici et Myrrh.e (Hot Drops).—The preparation popularly known as " Number Six." Cinchone Detannate.—For admixture with preparations containing Iron. Conti (U. S. P. 1880).—Representing 15 per cent, of Conium. Coto.—This preparation contains j\ grains (0.5) true Bolivian Bark in each fluidrachm (4 Cc). The Para Coto, frequently employed, differs considerably from the above. Ferri Chloridi /Etherea (Bestucheff's Tincture; Lamott's Drops, Ph. Ger.).—Each fluidrachm (4 Cc) represents about \ grain (0.3) Metallic Iron. Ferri Citro-chloridi (Tasteless Tincture of Iron).—Practi- cally identical in the strength of Iron, but not in Alcohol, with the official Tincture of Chloride of Iron, containing an amount of Iron equivalent to y\ grains (0.5) of Dry Chloride of Iron in each fluidrachm (4 Cc). A convenient form of Iron for admixture with Tinctures of vegetable astringent drugs, such as Gentian and Cinchona, preparations of which it does not, unlike other iron com- pounds, discolor. Ferri Pomata (Ferrated Extract of Apples ; Malate of Iron, Ph. Ger.).—Each fluidrachm (4 Cc.) represents about f grain (0.025) of Metallic Iron. Guaiaci Composita (Dewees' Tincture of Guaiac).—Each fluidrachm (4 Cc.) represents 7} grains (0.5) Guaiac. Ignatie (U. S. P. 1880).—Representing 10 per cent, of Ignatia. Iodi (Churchill's).—A solution of 10 grains (0.6) Iodine in each fluidrachm (4 Cc), with Potassium Iodide in Alcohol. Not to be confounded with Churchill's Iodine Caustic (Liquor Iodi Causticus). Iodi Decolorata (Colorless Tincture of Iodine).—Contain- ing about 1 per cent, of Ammonium Iodide, with some other Iodine compounds, in alcoholic solution; for external use. EXTRACTIVE PREPARATIONS. 91 Tinctura— Jalape (U. S. P. 1870).—Each fluidrachm (4 Cc.) represents about 10 grains (0.6) Jalap. Jalap.e Composita.—Each fluidrachm (4 Cc) represents 7J grains (0.5) Jalap and about 2 grains (0.12) Scammony. Kino Composita— Tinctures of Kino, Opium, each . . minims 180 12. Cc. Spirit of Camphor....... 130 8.5 " Oil of Cloves......... " 2\ 0.15 " Aromatic Spirit of Ammonia . . " 15 1. " Cochineal...........grains 16 1. Diluted Alcohol to make fluidounces 4 .... 120. " Each fluidrachm (4 Cc.) represents \ grain (0.03), each, of Kino and Opium. Papaveris (Poppy).—Each fluidrachm (4 Cc.) represents 30 grains (2.) of Poppy (Capsule). Pectoralis (Bateman's Pectoral Drops).—A popular mixture of Opium, Catechu, Camphor, and Oil of Anise, containing 2\ minims (0.15) Tincture of Opium (-£- grain Pulv. Opium) in each fluidrachm (4 Cc). Persionis (Cudbear).—Intended as a coloring agent when a bright-red tint or color is to be produced, particularly in acid liquids. Persionis Composita.—A mixture of Cudbear and Caramel, intended as a coloring agent when a brownish-red tint or color is to be reproduced. Pimpinelle (Pimpinella, Ph. Ger.).—Each fluidrachm (4 Cc), represents about 10 grains (0.6) Pimpinella Root. Rhei Aquosa (Rhubarb, Aqueous, Ph. Ger.).—Each fluid- drachm (4 Cc.) represents about 5§ grains (0.4) of Rhu- barb, with alkalies, flavored with Cinnamon. Rhei et Gentiane.—Each fluidrachm (4 Cc.) represents 5 grains (0.3) of Rhubarb and I grain (0.06) of Gentian. Rhei Vinosa (Rhubarb, Vinous, Ph. Ger.).—Each fluidrachm (4 Cc.) represents about 5 grains (0.3) Rhubarb, with Bitter Orange and Cardamom, in Sweet Sherry Wine. Saponis Viridis Composita.—A solution of about 15 per cent, of Green Soap and 2 per cent, of Oil of Cade. Tincture ^theret. (Ethereal Tinctures).—The drug, prop- erly comminuted, troy ounces 2 (60 Gm.); Stronger Ether, 1 volume; Alcohol, 2 volumes; enough to make fluid- 92 A TEXT-BOOK OF MATREIA MEDICA Tinctura— ounces 16 (473 Cc). A general formula for the prepara- tion of Ethereal Tinctures of Belladonna, Castor, Digitalis, Lobelia, Valerian, and other drugs. Official in several European pharmacopoeias, and sometimes prescribed by foreign physicians. Tolutana Solubilis (Tolu, Soluble).—A so-called soluble essence of Tolu, for flavoring. Vantllint Composita.—A solution of Vanillin and Coumarin, intended for flavoring. Zedoarie Amara (Zedoary Comp.).—Similar to, but not identical with, the Tinctura Carminativa, Wedelii, etc., for- merly official in some Continental pharmacopoeias. Each fluidrachm (4 Cc.) represents 15 grains (1 Gm.) of Zedoary, y\ grains (0.5) of Aloes, and 3§ grains (0.25), each, of Rhubarb, Gentian, White Agaric, and Saffron. EXTRACTA FLUIDA—FLUID EXTRACTS. Fluid Extracts may be defined as a class of concentrated tinctures of such strength as to represent the drug, volume for weight. The fluid extracts of the U. S. P. previous to 1880 represented 1 grain of drug in 1 minim, or 1 troy ounce in 1 fluidounce. In the U. S. P. of 1880 the standard adopted was 1 Gm. in 1 Cc, and this strength has been retained as the standard of the U. S. P. 1890. Fluid extracts are made by percolation, maceration, or digestion. Except on a large scale or by fractional percolation, they cannot be prepared by simple percolation without evaporation to concen- trate the percolate to the required measure. Fractional percolation or repercolation, or simultaneous frac- tional percolation, by employment of which the use of heat for concentrating the percolate is avoided, may be used to advantage when the quantity operated upon is sufficiently large to warrant the greater time and attention required. The following is the process chiefly employed: In proceeding to percolate 100 Gm. of the drug, according to directions, the first 80 to 90 Cc. are reserved, and percolation con- tinued until the exhaustion is completed. The weak percolate is evaporated to a soft extract (the alcohol being recovered) and dis- solved in the reserved percolate. Sufficient menstruum is then added to make the product measure 100 Cc EXTRACTIVE PREPARATIONS. 93 Average Dose. Official Name of Drug. Part. Cc. Minims. Extractum Fluidum— Aconiti......Aconitum Napellus.......Tuber . . . 0.06 1 Apocyni.....Apocynum Cannabinum.....Root . . . . 1. 15 Arnicx- Radicis . . Arnica montana........Root .... 0.5 8 Aromaticum .... Pulvis Aromaticus.............0.5 8 Asclepiadis .... Asclepias tuberosa.......Root .... 2. 30 Aspidospermatis . . Aspidosperma Quebracho-bianco . Bark ... 2. 30 Aurantii Amari . . Citrus vulgaris .......Rind. . . . 1. 15 Belladonnae Radicis . Atropa Belladonna.......Root .... 0.2 3 Buchu......Barosma betulina.......Leaves ... 2. 30 Calami......Acorus Calamus........Rhizome . . 2. 30 Calumbae.....Jateorrhiza palmata......Root .... 2. 30 Cannabis Indicae . . Cannabis sativa........Fl. Tops . . 0.6 10 Capsici......Capsicum fastigiatum .....Fruit .... 0.2 3 Castaneae.....Castanea dentata........Leaves ... 4. 60 Chimaphilae .... Chimaphilaumbellata......Leaves ... 2. 30 Chiratn.'.....Swertia Chirata........Plant.... 2. 30 Cimicifugae .... Cimicifuga racemosa......Rhizome . . 2. 30 Cinchonae.....Cinchona Calisaya.......Bark .... 2. 30 Cocae.......Krythroxylon Coca.......Leaves ... 2. 30 Colchici Radicis . . Colchicum autumnale .....Corm . . . 0.3 5 Colchici Seminis . . Colchicum autumnale ..... Seed .... 0.3 5 Conii.......Conium maculatum......Fruit.... 0.25 4 Convallariae .... Convallaria majalis.......Rhizome . . 0.6 10 Cubebae.....Piper Cubeba.........Fruit .... 2. 30 Cusso......Hagenia Abyssinica......Inflor. ... 4. 60 Cypripedii .... Cypiipedium pubescens.....Rhizome . . 1. 15 Digitalis.....Digitalis purpurea.......Leaves ... 0.12 2 Dulcamarae .... Solanum Dulcamara......Branches . . 2. 30 l'TL;otae......Claviceps Purpurea.......Sclerotium . 2. 30 Eriodictyi.....Eriodictyon glutinosum.....Leaves ... 2. 30 Eucalypti.....Eucalyptus globulus......Leaves . . . 1. 15 Eupatorii.....Eupatorium perfoliatum.....Herb. ... 2. 30 Frangulae.....Rhamnus Frangula.......Bark .... 4. 60 Gelsemii.....Gelsemium sempervirens .... Rhizome . . 0.2 3 Ocntianae.....Gentiana lutea.........Root .... 1.3 20 Geranii......Geranium maculatum......Rhizome . . 2. 30 Glycvrrhizae .... Glycyrrhiza glabra.....• . Root .... 4. 60 Gossypii Radicis . . Gossypium herbaceum.....Root Bark . 2. 30 Grindeliae.....Grindelia robust.i.......Leaves ... 2. 30 Guaranre.....Paullinia Cupana........Seeds ... 4. 60 Hamamelidis . . . Hamamelis Virginiana.....Leaves ... 2. 30 HvchnMis.....Hydrastis Canadensis......Rhizome . . 2. 30 Hyoscyami .... Hyoscyamus niger.......Herb . . . 0.3 5 Ipecacuanha? . . . Cephaelis Ipecacuanha.....Root .... 0.06-2. 1-30 Iridis .....Iris versicolor.........Rhizome . . 1. 15 Krameriae.....Krameria triandra.......Root .... 2. 30 Lappre......Arctium Lappa........Root .... 2. 30 Leptandrae .... Veronica Virginica.......Rhizome . . 2. 30 94 A TEXT-BOOK OF MATERIA MEDICA. Average Dot* t A---------** Official Name Drug. ?*'* Cc- Mi"™*. Extractum Fluidum— Lobeliae.....Lobelia inflata .... ..... Herb .... 0.6 10 Lupulina?.....Humulus Lupulus.......Powder. . .0.6 10 Matico......Piper Angustifolium......Leaves ... 4. 60 Menispermi .... Menispermum Canadense .... Rhizome . . 2. 30 Mezerii......Daphne Mezereum.......Bark .... 0.3 5 Nucis Vomicae . . . Strychnos Nux-vomica.....Seed .... 0.2 3 Pareirae......Chondodendrum tomentosum . . . Root .... 2. 30 Phytolacca? Radicis . Phytolacca decandra......Root .... 0.5 8 Pilocarpi.....Pilocarpus Selloanus (Jaborandi) . Leaves ... 2. 30 Podophylli .... Podophyllum peltatum.....Rhizome . . 0.6 10 Pruni Virginianae . Prunus serolina........Bark .... 2. 30 Quassiae.....Picraena excelsa........Wood ... 0.5 8 Rhamni Purshianae . (Cascara sagrada).......Bark .... 2. 30 Rhei .<..... Rheum officinale.......Root . . . . 1. 15 Rhois Glabrae . . . Rhus glabra.........Leaves ... 2. 30 Rosae......Rosa Gallica.........Petals ... 2. 30 Rubi.......Rubus villosus . . .....Root Bark . 2. 30 Rumicis.....Rumex crispus........Root .... 4. 60 Sabinae......Juniperus Sabina........Tops .... 0.5 8 Sanguinariae .... Sanguinaria Canadensis.....Rhizome . . 0.3 5 Sarsaparillae .... Smilax officinalis, etc......Root .... 4. 60 ' Sarsaparilla, 75 Glycyrrhiza, 12 Sassafras, 10 Mezereum, 3 Scillae......Urginea maritima.......Bulb .... 0.3 5 Scoparii.....Cytisus Scoparius.......Tops .... I. 15 Scutellariae .... Scutellaria lateriflora......Herb ... 2. 30 Senegae......Polygala Senega........Root .... 0.3 5 Sennas......Cassia acutifolia and Angust. . . Leaves ... 4. 60 Serpentariae .... Aristolochia Serpentaria.....Rhizome . . 1. 15 Spigelian.....Spigelia Marilandica......Rhizome . . 2. 30 Stillingiae.....Stillingia sylvatica.......Root .... 2. 30 Stramonii Seminis . Datura Stramonium......Seed .... 0.2 3 Taraxaci.....Taraxacum officinale......Root .... 4. 60 Tritici......Agropyrum repens.......Rhizome . . 4. 60 Uvae Ursi.....Arctostaphylos Uva Ursi .... Leaves ... 2. 30 Valerianae.....Valeriana officinalis.......Rhizome . . 2. 30 Veratri Viridis . . . Veratrum viride........Rhizome . . O.I2 2 Viburni Opuli . . . (Cramp bark).........Bark .... 2. 30 Viburni Prunifolii . (Black haw).........Bark .... 2. 30 Xanthoxyli .... Xanthoxylum Americanum . . . Bark . . . . 1. 15 Sarsaparillae Com- positum Zingiberis.....Zingiber officinale.......Rhizome . 0.6 3° 10 Unofficial Fluid Extracts of the National Formulary. Unless otherwise indicated, the dose of the following Fluid Ex- tracts is from \ to 1 fluidrachm (2 to 4 Cc): EXTRACTIVE PREPARATIONS. 95 Extractum Fluidum— Adonidis.—Root of Adonis vernalis L. (Bird's Eye). Aletridis.—Rhizome of Aletris farinosa L. (Stargrass). Angelice Radicis.—Root of Archangelica L. (Angelica). Apii Graveolentis.—Seed of Apium graveolens L. (Celery). Aralie Race.mo.s.i;.—Root of Aralia racemosa L. (American Spikenard). Arntce Florum.—Flower heads of Arnica montana L. (Ar- nica). Berberidis Vulgaris.—Bark of the root of Berberis vulgaris L. (Barberry). Boldi.—Leaves of Peumus Boldus Molina (Boldo). Buchu Compositum.—A combination of Buchu, 10; Cubeb, 2 ; Juniper, 2 ; Uva Ursi, 2 parts. Calendule.—Flowering herb of Calendula officinalis L. (Marigold). Camellli;.—Leaves of Camellia Thea Link (Tea). The best quality of commercial black tea, " Formosa Oolong," to be employed for this preparation. Caulophylli.—Rhizome and rootlets of Caulophyllum thalic- troides Mich. (Blue Cohosh). Coffee Viridis.—Unroasted seeds of Coffea Arabica L. Coffee To.st.e.—Roasted seeds of Coffea Arabica L. The N. F. recommends equal portions of Java and Mocha to be employed in preparing the Fluid Extracts of Coffee. Convallarie Florum.—Flowers of Convallaria majalis L. (Lily of the Valley). Coptis.—Rhizome of Coptis trifolia Salisb. (Goldthread). Cornus Circinate.—Bark of Cornus circinata L'Her. (Green Osier.) Cornus Floride (U. S. P. 1880).—Dogwood Bark. Corydalis.—Tubers of Dicentra Canadensis De C. (Turkey Corn). Coto.—Coto bark, undetermined tree. Dose, from 5 to 15 minims (0.3 to I Cc). Feci.—Thalus of Fucus vesiculosus L. (Bladder-wrack). Helianthem 1.—Herb of Helianthemum Canadense Mich. (Frost-wort). Humuli.—Strobiles of Humulus lupulus L. (Hops). Hydrange.e.—Root of Hydrangea arborescens L. (Seven Barks). 96 A TEXT-BOOK OF MATERIA MEDICA. Extractum Fluidum— Jalape.—Tuber of Exogonium purga Benth. (Jalap). Dose, from 15 to 20 minims (1 to 1.3 Cc). Juglandis.—Bark of the root of Juglans cinerea L. (Butternut). Juniperi.—Fruit of Juniperus communis L. Kava.—Root of Piper methysticum Forster (Kava; Kava- Kava). Lactucarii (U. S. P. 1880).—Insp. juice of Lactuca virosa L. Malti.—(Fluid Extract of Malt). Menvanthis.—Leaves of Menyanthes trifoliata L. (Buckbean; Trifolium fibrinum, Ph. G.). Mezerei (U. S. P. 1880).—Bark of Daphne mezereum L. Dose, from 5 to 10 minims (0.3-0.6 Cc). Petroselint Radicis.—Root of Petroselinum sativum Hoff- man (Parsley). Quillaje.—Bark of Quillaja Saponaria Molina (Soap Bark). Rhamnt Purshiane Aromaticum.—Cascara Sagrada de- prived of its bitter taste. Rhei Aromaticum.—A combination of Rhubarb, Cinnamon, Cloves, and Nutmeg. Senn.e Deodoratum (Aqueous Fluid Extract of Senna).— This preparation is free from the objectionable " griping" qualities of the ordinary fluid extract. Sterculie.—Seeds of Sterculia acuminata R. Brown (Cola or Kola). Stilllingie Compositum (Stillingia Comp.).—Stillingia, Cory- dalis, each, 4 parts ; Iris, Sambucus, Chimaphila, each, 2 parts; Coriander, Xanthoxylum Berries, each, 1 part. Trillii.—Rhizome of Trillium erectum L. (Bethroot). Turnere.—Leaves of Turnera microphylla De C. (Damiana). Urtice.—Root of Urtica dioica L. (Nettle). Verbasci.—Leaves (and flowers) of Verbascum Thapsus L. Verbene.—Root of Verbena hastata L. (Vervain). Zee.—Stigmatum Maydis ; Corn Silk ; Stigmata of Zea Mays L. (Indian Corn). As a rule, a Fluid Extract is made of every vegetable drug which is a part of a plant. There are altogether about 500 Fluid Extracts. Relatively, the Fluid Extracts are not as strong as the Tinctures, but they have the great advantage over the latter in that they are more concentrated and of uniform drug-streno-th—the strength of the drug. EXTRACTIVE PREPARATIONS. 97 EXTRACTA—EXTRACTS. Extracts—or " solid " extracts as they are termed, to distinguish them from fluid extracts—are the soluble active principles of vege- table drugs, concentrated by evaporation to a soft solid or a plastic mass of pilular consistence. The strength of an extract depends upon the amount of the crude drug it represents. Hence, the smaller the percentage of extract obtained from a drug, the greater the relative strength of the extract, provided that the drug be exhausted with menstrua adapted to secure all the active principles in this form. The yield of extract is influenced by the character of the men- struum employed : with a few drugs like Rhubarb the quality of the drug sometimes governs the yield, the least percentage being obtained from the poorest quality. As a general rule, the more aqueous the menstrua, the greater the yield of extract; conversely, the more alcoholic the menstrua, the smaller the yield of extract. To obtain the extracts, therefore, of official strength it is necessary to use official menstrua in the extraction. Thus the extracts of different drugs are as many times stronger than the drug as the quotient obtained by dividing the drug at IOO by the percentage yield. For example : Podophyllum yields 10 per cent, of extract; then 100 -*- 10 = 10 ; that is, the extract is ten times as strong as the drug and the fluid extract, or 0.1 of the extract represents I Gm. of the drug or 1 Cc. of the fluid extract. The drug-strengths of the official Extracts, calculated by this method, as well as their relative doses based upon the amounts of drug they represent, are exhibited in the table given on page 96. The 33 official Extracts are made by extraction with alcoholic menstrua or with water, sometimes by the addition of acid or alkali. There are four extracts made by the addition of powders to the extracts, including the Extract of Colocynth, the Compound Extract of Colocynth, and the assayed extracts, made by the addi- tion of Sugar of Milk to represent a certain alkaloidal strength in the powdered extract. Extractum Nucis Vomicae contains 15 per cent, of total alka- loids ; 1 Gm. represents about 10 Gm. of drug. Extractum Opii contains 18 per cent, of crystallized morphine; 1 Gm. represents 2 Gm. of normal moist opium, about 1.4 Opii pulvis (14 per cent, morphine). 7 98 / TEXT-BOOK OF MATERIA MEDICA. Table showing the Drug-strength and the Average Doses of the Official Extracts. Extractum. Part Aconiti..........Root . Aloes (aqueous)......... Arnica;..........Root . Belladonnae Fol. Alcoholic. . Leaves Cannabis Indicae ...... Herb . Cimicifugae........Rhizome Cinchonae [Calisaya) .... Bark Colchici (acetic)......Conn Colocynthidis (powder) . . . Fruit I Ext. Colocvntl Colocynthidis Com- positum (powder) 16; Cardamom, 6; Aloes, 50; Soap,Scammony, each, 14. Fruit . Leaves Sclerot. Bark . Root , Root . Conii (acetic) . . . Digitalis..... Ergotae...... Euonymi .... Gentianae (aqueous) Glycyrrhiza? (stick) . Glycyrrhizas Purum (ammon.) Root Haematoxyli (aqueous) Hyoscyami..... Iridis....... Jalapae....... Juglandis ... Kramerias (aqueous) . Leptandrae . ... Nucis Vomicae (powder' Opii (powder) .... Physostigmatis .... Podophylli..... Quassiae (aqueous) . . Rhei........ Stramonii...... Taraxaci (aqueous) . . Uvae Ursi...... Logwood Herb Rhizome Tuber Bark Root Root Seed Calabar bean Rhizome Wood Root . Seed . Root . Leaves of Drug 1 Dose of DruK- Do,e of' 1 part of Lxtract. Grains. Gm. Grains. Gm 5 5 10 10 6 3 6 1 10 10 3 10 10 3° 5 3 .06 ■65 •65 2 ■65 .65 4 4 ■25 4 2 .12 5 3° 2. 5 30 2. 4 20 i-3 3 3° 2. 3 60 4- 4 10 •6S 6 6 •4 7 7 ■S 6 15 1. 6 15 1. 5 15 1. 5* 15 1. 10 3 .2 H 1 .06 20 1 .06 10 10 •65 25 5 •3 3 3° 2. 10 3 .2 3 3o 2. 3 3° 2. .012 •32 .12 •03 .06 .06 .12 03 I .06 1 •03 b •4 6 ■4 5 ■3 10 ■05 20 i-3 2.1, •IS 1 .06 1 .06 3 .2 3 .2 3 .2 3 .2 1 .02 T .04 J .01 I .06 I .06 IO .65 1 •IS IO •6S 10 .65 ABSTRACTA—ABSTRACTS. A class of powdered extracts, prepared from the extracts by the addition of sufficient Milk Sugar to make the product represent one-half its weight of the crude drug, was official in the U. S. P. VI. (1880) under the title of Abstracts. The Abstracts have a uniform relation to the drug—viz. / grain represents 2 grains of the drug, just as the fluid extracts have the uniform relation of representing the drug measure for weight. In preparing an abstract the drug is exhausted, the extract obtained incorporated with its weight of Milk Sugar, the mixture EX TRA CTIVE PRE PAR A TIONS. 99 powdered, and enough Milk Sugar added to bring the product to one-half the weight of the drug employed. Abstracts must be pre- served in small, perfectly dry, and well-corked vials in a dry and cool place. Their uniformity alone should have favored the employment of Abstracts in preference to the Extracts, since they do not share the variability in strength of the extracts, the dose of the Abstract beuig exactly one-half that of the crude drug or Fluid Extract. This advantage was offset by the disadvantage that Abstracts are more bulky, and caused their deletion in the U. S. P. 1890. The Ab- stracts are therefore unofficial. The official Extracts of Jalap and of Nux Vomica have su- perceded the abstracts of these respective drugs in a more con- centrated and equally convenient form. Of the remaining nine Abstracts formerly official, Aconite, Belladonna, Conium, Digitalis, Hyoscyamus (Ignatia, superceded by Nux Vomica), Podophyllum, Senega, and Valerian, the five first mentioned, commonly but erroneously called the " narcotic extracts," may be prepared, in the powdered form, of such strength as to represent the same drug-strength as their respective official " solid extracts." Extractum Ferri Pomatum, N. F.—Ferri Malas Crudus (Fer- rated Plxtract of Apples, Ph. Ger.). Extractum Glycyrrhize Depuratum, N. F.—Succus Liqui- ritiai, Ph. Ger. (Purified PCxtract of Liquorice). OLEORESINE—OI.EORESINS. To natural Oleoresins, derived as plant-exudations, belong the Turpentines and the Pitches. From similar exudations are ob- tained the Gum Resins, mixtures of Gum and Resins and sometimes Volatile Oils ; also the Balsams, which are Resins or Oleoresins associated with Benzoic or Cinnamic Acid. These are treated under their respective Drugs. The pharmaceutical Oleoresins are semi-liquid extracts, obtained by exhausting oleoresinous drugs with Ether. Ether extracts fixed and volatile oils from drugs, as well as resin; these principles constitute therefore the oleoresins, which some- times also contain other active matter in solution or suspension. The menstruum (Ether), being easily volatilized, is recovered by distillation ; it is sometimes superseded by Alcohol, which yields an extract very similar to that obtained with ether. IOO A TEXT-BOOK OF MA TERIA MEDICA. The six following are official: DfSf. Oleoresina— ,------------—*------------- Aspidii; separates in two layers, to be mixed when used ... 1-2 drachms. 4.-8. Capsici; separates fat, used only as corrective.........yW Srain- O.OI-O.OO5 Cubebae; separates wax .... 1-2 grains. 0.06-0.1 Lupulinae..........2-3 grains. 0.1-0.2 Piperis; separates piperine, to be rejected..........1-2 grains. 0.08-0.1 Zingiberis..........\-\ grain. 0.02-0.01 RESINE—RESINS. The official Resins may be divided into the (1) Natural Resins, (2) Resins obtained from Oleoresins by separating the Volatile Oil by distillation, and (3) the Pharmaceutical Resins, prepared by pre- cipitation. When a concentrated tincture of a resinous drug is poured into a large quantity of cold water, the resinous matter becomes insoluble and is precipitated; this, after being washed, dried, and sometimes powdered, is termed a resin. Resins are usually soluble in alkalies and insoluble in acids (dilute); for this reason the water used for precipitation is some- times rendered slightly acid to favor the separation. The three following are official: Per cevt. yield from Drug. Dose. Rep. Drug. Resina— ,------*------, ,-------'-------« Jalapae........15 3 grains 0.2 20 grains 1.3. Podophylli......5 \ grain 0.03 10 grains 0.6. Scammonii......65 3 grains 0.2 5 grains 0.3. Resina and Resina Copaibae are obtained as residue in the dis- tillation of the respective Oleoresins, Turpentine and Copaiba. The natural Resins are obtained as exudates—e. g. R. Guaiaci. The terms resin, resinoid, and concentration are also applied to a class of preparations used by eclectic physicians, prepared by this general process with some modifications. (See U. S. and Am. Disp.) They are named after their respective Drugs with the ending in, as in Glucosides, and must not be confused with the latter. While the Glucosides are usually the active medicinal constituents repre- senting the drug, the resinoids, with the exception of those made SOLID MIXTURES FOR INTERNAL USE. IOI from drugs whose active principles are resins, such as Cimicifuga and Podophyllum, are more or less inert, unreliable mixtures, too indefinite in their composition and strength for medicinal use. SOLID MIXTURES FOR INTERNAL USE. Mixtures of Solids for internal use embrace the following classes of preparations : Powders, Effervescent Salts, Confections, Troches, Masses, and Pills. Powders are substances reduced to a fine pulverulent condition to favor their administration and solution or absorption. A powder may be simple, such as a powdered drug, Pulvis opii, or a pow- dered salt—/. c. Qiunince sulphas ; or it may be compound, a mix- ture of several substances. Sparingly soluble substances, when finely powdered (impalpable) and thoroughly mixed by trituration in a mortar with some inert powder (diluent) such as Milk Sugar, are rendered more soluble, since a greater surface is exposed to the solvent action of the liquids of the body, and prompter and fuller effects are obtained. The potency of calomel, of the resins, and of alkaloids is in this way considerably increased within certain limits, but not to the unreasonable extent advocated by Homoeopathic pharmacy, in which this process is carried to a reductio ad absurdum. It is an excellent and convenient method for dispensing and administering the more potent agents, such as arsenous acid, mercury com- pounds, and the alkaloids. Substances triturated in this way have been called Triturations, for whose preparation the U. S. P. gives a general formula: Take of the substance, for example, Elaterin . . . I Gm. Milk Sugar, in fine powder..........9 Gm. First thoroughly triturate the medicinal substance (Elaterin) with an equal weight of Milk Sugar, then add the remainder of the Milk Sugar, and mix thoroughly by trituration (for about ten minutes). Unless otherwise specified, triturations should be of the official strength—/. c. 10 per cent, of the drug. By the addition of about an equal weight of Alcohol to the triturate it becomes a soft mass, which, after being moulded into 102 A TEXT-BOOK OF MATERIA MEDICA. disks of about I grain (0.06) each, after the evaporation of the Alcohol, furnishes the so-called Tablet Triturates. These afford a convenient method of medication for such substances as are adapted to trituration, which is, however, confined, as indicated, to a comparatively limited number of agents. To represent in the form of these tablets every kind of medicinal agent of volatile cha- racter, or drugs otherwise susceptible to change through the inevi- table exposure to the atmosphere to which every such mixture is liable, is simply to invite error in practice. These tablets, more- over, with certain chemical substances, undergo chemical changes which render them entirely insoluble, and thus practically inert. In order to be effective and otherwise reliable, the)' should be pre- pared extemporaneously by the pharmacist, in order to ensure their solubility. They should always be dissolved in a little water before they are administered. When it is desired to obtain a mild and prolonged local effect of a medicinal agent in the mouth or throat, the substance is made into a soft mass {confection) with a diluent and excipient, Sugar and Mucilage, and flavor, and formed into round or oval-shaped disks, weighing from 8 to 30 grains (Ito 2 Gm.), called variously Lozenges, Troches, Tablets, and Pastils. Troches.—When these are allowed to dissolve slowly in the mouth the diluent serves as a vehicle for the medicinal agent, and a gradual prolonged effect is obtained upon the mucous surfaces. This form of medication is adapted only to astringents, antacids, expectorants, and stomachics consisting of substances not especi- ally disagreeable to the palate. Tablets, or Lozenges, are not intended to be swallowed, nor adapted to exceedingly volatile, caustic, irritant, or otherwise un- palatable substances. For ingestion, medicinal agents should be made into a Mass {massa) with an excipient, and formed into small spheres, or balls, as a rule not over 5 grains (0.3) in weight, to be swallowed and slowly dissolved in the stomach or intestines. Such preparations are the so-called Pills {Pilules, from pila, ball). PULVERES—POWDERS. The nine official Powders are impalpable mixtures of one or more active drugs, usually with some nearly inert substance, such as Sugar, as a diluent, and Aromatics. They are made by trituration. SOLID MIXTURES FOR INTERNAL USE. 103 Pulvis— Gm. in wo. Antimonialis (James') . calc. phos. 67; antimon. oxide 33. Aromaticus .... cinnamon (Ceylon), ginger, each 35. cardamom (seed), nutmeg, each 15. Cretae Compositus . acacia p. 20; sugar 50; prep, chalk 30. Glycyrrhizae Compositus . . . senna 18; glycyrrhiza 24. fennel oil 0.4; sulphur, washed, 8; sugar 50. Ipecacuanhas et Opii . . . ipecac, opium pulv., each 10. (Dover's Powder) sugar of milk 80. Jalapae Compositus .... potass, bitartrate 65 ; jalap 35. Rhei Compositus . magnesia 65 ; ginger 10; rhubarb 25. In bo grains. Pulv. Morphinae Compositus . . camphor 10; morphine (Tulley's Powder) sulph. 1. calcium carb., precip.; glycyrrhiza p., each 20. For 12 pow . ; in each, grains. Effervescens Compositus . (Seidlitz Powder) potassium and sodium tartrate 93 Gm. 120 sodium bicarbonate 31 Gm. 40 acid tartaric. 27 Gm. 35 Many methods are in use for the purpose of disguising the taste of disagreeable remedies in the powder form. Of these the most elegant and effective method is that of enclosing the powder in a cachet or wafer. Originally wafers were made of starch-paste in thin sheets ; a piece about 0.5 dcm. (2 inches) square, immersed in water for a minute, being placed in a spoon, the powder poured into it, and then enwrapped by folding up the edges and swallowed with a little water. The cachets or " konseals " are wafer-disks consisting of two concentric halves, one of which is filled with the powder, and the other half attached by moistening the edge and pressing the edges together by means of various devices. These cachets are of three sizes, the largest holding 5 grains (0.3) Quinine Sulphate. After one minute's immersion in water they can be swallowed without any effort. Unofficial Pozuders of the N. F. Pulvis— Acacie Composites (Pulvis Gummosus, Ph. Ger.). Acetanilidi Compositus.—Containing 50 per cent. Acetan- 104 A TEXT-BOOK OF MATERIA MEDICA. Pulvis— ilid, 2 per cent. Caffeine, with Tartaric Acid and Sodium Bicarbonate. Aloes et Caxell.e (Hiera Picra). Amygdale Compositus (Almonds Comp.)—A mixture of Sweet Almond, Sugar, and Acacia, in fine powder; 180 grains (10 Gm.), triturated with Water, yield about 4 fluid- ounces (119 Cc.) of Emulsum Amygdahe. Anticatarrhalis (Catarrh Snuff.)—Hydrochlorate of Mor- phine, 1 part; Acacia, 60 parts ; Subnitrate of Bismuth, 180 parts, in fine powder. Catechu Compositus (Compound Powder of Catechu, Ph. Br.). —Catechu, 4 parts ; Kino, 2 parts ; Krameria, 2 parts; Cinnamon, 1 part; Nutmeg, 1 part. Crete Aromaticus.—A mixture of Cinnamon, Saffron, Nut- meg, Cloves, Cardamon, prepared Chalk, and Sugar. Crete Aromaticus cum Opio.—Aromatic Powder of Chalk, with 1 grain (0.06) of powdered Opium, in 40 grains (1.5) of the mixture. Official in the Ph. Br. Hydrargyri Chloridi Mitis et Jalape (Calomel and Jalap).—A mixture of Mild Chloride of Mercury, 10 grains (0.6), and Jalap, 20 grains (1.3). When " Calomel and Jalap " is prescribed for an adult, without any speciri cation of quantities, the N. F. recommends that the above mixture be dispensed as one dose. Iodoformi Compositus (Iodoform and Naphthalin).—A mixture of Iodoform, 2 parts ; Boric Acid, 3 parts ; Naphthalin, 5 parts ; with Oil of Bergamot, in fine powder. This powder is used in many cases where a diluted preparation of Iodo- form, for external purposes, is desired. The odor is masked both by the Oil of Bergamot and by the Naphthalin. Kino Compositus.—A mixture of Kino and Cinnamon, with 1 grain (0.06) of Powdered Opium in each 20 grains (1.3). Myrice Compositus (Composition Powder).—A mixture of Bayberry, Ginger, Capsicum, and Cloves. Pancreaticus Compositus (Peptonizing Powder).—A mixture of 20 parts Pancreatin and 80 parts Sodium Bicarbonate; 25 grains will peptonize 1 pint of milk. Pepsint Compositus (Pulvis Digestivus).—A mixture of Pep- sin, Pancreatin, Diastase, Lactic and Hydrochloric Acids, with Milk Sugar to represent the gastric juice. SOLID MIXTURES FOR INTERNAL USE. 105 Pulvis— Rhei et Magxesie Antsatus (Compound Anise Powder.)— A mixture of Rhubarb, Heavy Magnesia, and Oil of Anise. Talci Salicylicus (Salicylated Powder of Talcum).—A mix- ture of Talcum with 3 per cent. Salicylic Acid and 10 per cent. Boric Acid, in fine powder. Powders are usually directed to be divided into papers {char- tulce); thus, for example, a formula for a prescription would be— ty, Hydrargyri Chloridi Mitis . . 1. Sacchari Lactis......9. Misce cum trituratione et in chartulis No. x. divide. Encapsuling powders by filling them in gelatin capsules is a very convenient and elegant form of administration. No mixture which is desired to be given in the form of pozvder, howrever, should be made into a mass for facilitating the encapsuling process— a custom too frequently adopted. Many substances, especially Bismuth Subnitrate and Calomel, become exceedingly hard and quite insoluble when made into a mass. No dispenser should assume the prerogative of changing the form of medication pre- scribed. sales effervescentes—effervescent salts. These are granulated mixtures of Salts with Sugar and Sodium Bicarbonate and Tartaric Acid, which decompose when the Salt is dissolved in Water and furnish agreeable aerated draughts. The following are official, the strength indicated being that con- tained in 90 grains (6 Gm.), a heaped teaspoonful being the ordinary dose, dissolved in about 6 fluidounces (180 Cc.) of water: Caffeina Citrata Effervescens......caffeine 0.06 Lithii Citras Effervescens .... lithium citrate 0.06 Magnesii Citras I^ffervescens . magnesium citrate 1.0 Potassii Citras Effervescens . . . potassium citrate 3.0 Effervescent Salts {Granular), N. F. The strength given for these is the quantity contained in 90 grains (6 Gm.), which represents about the quantity of these Salts contained in a heaped teaspoonful of ordinary size, the average dose. 106 A TEXT-BOOK OF MATERIA MEDICA. Ferri et Quinine Citras Effervescens, i grain (0.06) Citrate of Iron and Quinine. Ferri Phosphas Effervescens, 2 grains (0.12) Phosphate of Iron. Potassii Bromidlm Effervescens, 20 grains (1.3) Potassium Bro- mide. Potassii Bromidum cum Caffeina, 10 grains (0.6) Potassium Bro- mide and 1 grain (0.06) Caffeine. Sal Carolines Factitius Effervescens (Effervescent Carlsbad Salt, artificial).—A solution of about 87 grains (5.5) in 6 fluid- ounces (178 Cc.) of Water represents an equal volume of Carlsbad Water (Sprudel). Sal Kissingensis Factitius Effervescens (Effervescent Kissingen Salt, artificial).—A solution of about 80 grains (5 Gm.) in 6 fluid- ounces (178 Cc.) represents an equal volume of Kissingen Water (Rakoczy). Sal Vichyanus F'actitius Effervescens (Effervescent Vichy Salt, artificial).—A solution of about 57 grains (4 Gm.) in 6 fluidounces (178 Cc.) of Water represents an equal volume of Vichy Water (Grand Grille). Salts {Non-effervescent). Sal Carolines Factitius. — In two forms, Dry (Ph. Ger.) and Crystalline. A solution of about 16 grains (1 Gm.) of the Dry (27 grains (1.8) of the Crystalline) in 6 fluidounces (178 Cc.) of Water represents an equal volume of Carlsbad Water (Sprudel). Sal Kissingensis Factitius.—A solution of about 24 grains (1.5) in 6 fluidounces (178 Cc.) of Water represents an equal volume of Kissingen Water (Rakoczy). Sal Vichyanus Factitius.—A solution of about 14 grains (1 Gm.) in 7 fluidounces (207 Cc.) of Water represents an equal volume of Vichy Water (Grand Grille). CONFECTIONES—CONFECTIONS. Confections may be defined as flavored masses wherein the adhesive substance is Sugar in large proportions, serving as a vehicle for masking the taste of the drug. Confections, when made by beating a fresh drug, first reduced to pulp with sugar until of the proper consistence, are termed conserves. When made from powders or extracts they are called electuaries. SOLID MIXTURES FOR INTERNAL USE. 10/ Only one representative of each class is official: Gm. in ioo Cc. Confectio Rosae......rose water 16, red rose 8. (Conserve of Rose) sugar 64, honey 12. ( oil coriander 0.5, senna 10. Confectio Sennas . < cassia fistula 16, fig 12, tamarind 10. {Electuar. Scniue) I prune 7, sugar 55, water to 100. The Confection of Senna is a very agreeable laxative, especially adapted for constipation in women and children. It is exceedingly agreeable to the taste. TROCHISCI—TROCHES. Troches, or lozenges, are confections made into various forms and then dried. The vehicle or excipient consists of Powdered Gum Tragacanth or Sugar with flavoring—in some cases orange flower water, in others tolu, nutmeg, vanilla, etc. The active ingredients are mixed with the diluent or vehicle and made into a plastic mass with the particular excipient, Water or Syrup. The mass is rolled out to the requisite thickness, and the disks formed by cutting through it with a punch or troche-cutter. The troches are then dried by exposure. The size and weight of the troche are regulated by the thickness of the mass and the diameter of the cutter. The 15 official Troches vary in weight from Gm. 0.5 to 1.5. Active Drug. Gm. in Gm. in Grains in 100 each each Trochisci— Troches. Troche. Troche. Acidi Tannici...... 6. 0.06 1 Orange flor. Ammonii Chloridi .... 10. 0.1 1^ Tolu. extract glycyrrhiza 25. 0.25 4 Catechu........ 6. 0.06 1 Orange flor. Cretan.........25. O.25 4 Nutmeg. Cubebae .... oleoresin 4. 0.04 -§ extract glycyrrhiza 25. 0.25 4 sassafras oil 1. O.OI - Perri . . . ferric hydrate 30. 0.3 5 Vanilla. Glycyrrhizae et Opii ext. glycyrrhiza 15. 0.15 21 Anise. powd. opium 0.5 mg.j. ^ I OS A TEXT-BOOK OF MATERIA MEDICA. Active Drcg. Gm. in ioo Trochisci— Troches Ipecacuanhas...... 2. Kramerias .... extract 6 Menthae Piperita? ... oil 1. Morphinas. morphine sulph. et Ipecac, powd. ipecac Potassii Chloratis .... 30. Santonini........ 3. Sodii Bicarbonatis .... 20. Zingiberis . . tinct. ginger 20. Gm. in Grains in each Troche. 0.02 O.06 O.O I 0.16 mg. 16 0.50 " 5. 0.3 0-3 0.2 0.2 each Troche. \ Orange. 1 " flor. Peppermint. Gaultheria. 1 1 3"TJ _1_ l 2 5 Lemon. Orange flor. Nutmeg. Gineer. Lozenges of Peppermint, Lemon, Musk, Vanilla, and Gaultheria may readily be prepared by saturating sugar lozenges with the respective essences or tinctures and permitting the alcohol to volatilize. MASSE—MASSES. Masses are plastic mixtures of pilular consistence. They are made by incorporating the drug with adhesive substances, by chem- ical reaction, and sometimes by both processes. The Masses are intended to be formed into pills whenever they are to be dispensed. They are therefore often called Pil., Pilulce, instead of Massa. There are only three official: Massa Copaibas .... water 1, magnesia 6, copaiba 94. The Copaivic Acid combines with the magnesia, forming mag- nesium copaivate of pilular consistence. This is also known as " solidified copaiba." Massa Ferri Carbonatis f sodium carb., ferrous sulph., each 100. (Vallet's Mass) \ honey 38, sugar 25, syrup to 100. By double decomposition between the Ferrous Sulphate and Sodium Carbonate ferrous carbonate is formed, which is incorpo- rated with Honey and Sugar to prevent oxidation and to render the mixture a plastic mass. The Pill of Ferrous Carbonate (Pil Blaudii) is preferable to this mass, as in the pill the ferrous car- bonate is better protected against oxidation. Massa Hydrargyri . glycyrrhiza 5, althaea 25, mercury 33. (Blue Mass) glycerin 3, honey of rose 34 SOLID MIXTURES FOR INTERNAL USE. 109 The mercury is extinguished by trituration with the rose honey and glycerin and the powdered glycyrrhiza; the other ingredients are then incorporated. The usual dose is from 5 to 10 grains (0.3-0.6). PILULE—PILLS. Pills are spherical, more or less soluble masses of medicinal substances rendered cohesive, plastic, and firm in consistence by the addition of some substance (usually inert) termed an excipient. The kind of excipient employed varies with the nature of the medicinal substance. As a general rule, such substances are chosen as give to the mass, with the smallest proportion, the greatest plas- ticity, and also best preserve the spherical shape of the pills. The excipient must also, unless the contrary be directed for especial purposes, be indifferent in character, to avoid change in the medic- inal agents. Soluble substances are rendered adhesive by the action of sol- vents, and require, according to their solubilities, the addition of some liquid such as Water, Alcohol, Glycerin, etc. Others require the addition of adhesive substances, such as Syrup, Mucilage, Glu- cose, Glycerite of Starch or Tragacanth, etc. Drugs adapted for dispensing in the form of pills maybe divided as follows: (1) The official Masses, Extracts, and Scaled Salts. Masses and extracts, being of pilular consistence, require no addition except when hard or dry; Water should then be incor- porated to restore them to their original form. Abstracts and powdered extracts are best made into a mass with Water. (2) Vegetable Powders in which the dose does not exceed five grains. With, these adlicsivc excipients are indicated, such as Syrup, Mu- cilage, Glycerite of Tragacanth, and Glucose. The last mentioned answers the requirements better than most other substances. Con- fection of Rose and Extracts of Gentian, Glycyrrhiza, and Taraxa- cum are also used when their color is not objectionable. (3) Salts not too deliquescent, and Alkaloids. Excipients for these must combine adhesive and absorbent quali- ties. They are first triturated with a dry powder—c. g. Althaea, Glycyrrhiza, or Milk Sugar—and then mixed with the adhesive substance—viz. Glucose or Glycerite of Starch or Tragacanth. No excipient must be used that will give to the mass a color different from that of the medicinal ingredients (the base). 110 A TEXT-BOOK OF MATERIA MEDICA. (4) Volatile Oils and Oleoresins. The quantity of these when dispensed in pills being compara- tively large, it is necessary to add some light absorbent substance, such as Magnesia or Starch, to which is added the adhesive material. The practice of adding wax or resin to oils is not to be recommended except as a last resort, since they tend to render the pill insoluble. (5) Resins and Gum Resins. These form an adhesive mass by the addition of a little Alcohol, with which more bulky excipients, such as Soap, ma)' be incorpo- rated to preserve the shape of the pill. (6) Salts of the Cinchona Alkaloids, Quinine and Cinchonidine Sulphates, etc. These are often prescribed in pill form in large doses, and it is therefore desirable to reduce their bulk. For this purpose dilute Sulphuric Acid or Tartaric Acid is added in small quantity, which acts as a solvent upon the salt, thereby converting it into a mass. This mass is incorporated with a little Glycerite of Starch, other- wise it soon loses its plasticity; it must therefore be rolled into pills as soon as formed. (7) Substances easily decomposed by organic matter. Potassium Permanganate and Silver Nitrate are quickly " re- duced " when incorporated with the excipients usually employed. These should be mixed with an inorganic diluent not affected by them, such as Kaolin, Pipe Clay, or Fullers' Earth, and made into a mass with Water, Petrolatum, Resin Cerate, etc. In order to disguise the bitter or otherwise disagreeable taste of pills, they are usually coated with sugar or gelatin. These coated pills are often objectionable on account of the coating, or the pill itself, becoming quite insoluble. When a coated pill is desired, it should be freshly made and enclosed in a gelatin capsule of the smallest size. Pills may also be coated extemporaneously by rolling them on a piece of filter-paper saturated with Mucilage of Acacia, and then in powdered Milk Sugar. Keratin-coated pills are designed for solution in the duodenum, the pills being dipped in a solution of Keratin prepared from horn shavings treated with pepsin and hydrochloric acid. Concentric pills are made up of concentric layers of different ingredients, intended to dissolve and become active at various stages in their passage through the intestinal tract. The following 15 Pills are official: SOLID MIXTURES FOR INTERNAL USE. PILUL.E. Gm. for ioo. Aloes.........aloes purif., soap, each Aloes et Asafoetidae . aloes, asafoetida, soap, eacli Aloes et Ferri . . aloes, iron sulph., arom. powder Aloes et Mastiches (Dinner Pill) .... aloes mastic red rose Aloes et Myrrhae............aloes myrrh arom. powder Antimonii Comp......antimony, sulphurated (Plummer's Pills) mild mercurous chlor. guaiac Asafcetidas.............asafoetida^ Catharticce Comp......ext. colocynth comp. mild mercurous chloride extract of jalap gamboge Catharticse Vegetabiles . . . ext. colocynth comp. exts. hyoscyam., jalap, each ext. leptandra, res. podophyll. oil peppermint Ferri Carbonatis........ferrous sulphate (Ferruginous, Chalybeate, Blaud's) potass, carb. sugar 4 ; tragac, althaea, each Ferri Iodidix..........reduced iron iodine glycyrrh., sugar, each ext. glycyrrh., acacia, each Opii...........soap 2; opium pulv. Phosphori 2............phosphorus althaea, acacia, each Rhei............soap 6; rhubarb Rhei Comp..............rhubarb aloes myrrh oil peppermint! 13 9 7 '3 4 3 13 6 4 4 4 8 20 8 6 3 i-5 6 3 i-5 o.8 16 4 5 4 I 6-5 0.06 6 20 13 io 6 o-5 eg. *3 9 7 13 4 3 13 6 4 4 4 6 3 i-5 i-5 o.8 6 6-5 0.06 20 '3 io 6 - Excipient. Glyc. water. Conf. rose. Water. Syrup. Castor oil. Soap. Water. Water. Glyc. water. Water. Glyc. water. Water. Unofficial Pills of the National Formulary. When a large number of pills are to be prepared in accordance with the given proportions, and the quantities of the ingredients are to be determined by multiplying with the number of pills re- quired, it is recommended that the nearest whole number, or near- est convenient fraction, in each case, be chosen. Pilulae— Ad Prandium (Dinner Pills).—When " Dinner Pills," under this or some other equivalent name, are prescribed without further specification, the National Formulary recommends that the Pilulae Aloes et Mastiches of the U. S. P., also called " Lad\- Webster's Dinner Pills," be dispensed. 1 Coated with ethereal solution of Balsam Tolu. 2 Phosphorus dissolved in Chloroform. H2 A TEXT-BOOK OF MATERIA MEDICA. Pilulae— Of other combinations bearing similar names or used for similar purposes, the following appear to be those most commonly in use: Chapman's Dinner Pill.—Aloes, Mastic, each, grains \\ (o.i); Ipecac, grain I (0.06); Oil of Fennel, grain \ (0.015). Cole's Dinner Pill.—Aloes, Mass of Mercury, and Jalap, each, grains i£ (0.075); ^nt- anc^ Potas. Tartrate, grain fa (0.0013). Hall's Dinner Pill.—Aloes, Ext. of Glycyrrhiza, Soap, and Molasses, each, grain 1 (0.06). Aloes et Podophylli Composit.k (Janeway's Pills).—Aloes, grain 1 (0.06); Resin Podophyllum, grain \ (0.03); Ext. Bellad. Ale, Ext. Nux Vomica, each, grain \ (0.015). Aloini Composite.—Aloin, grain \ (0.03); Resin Podophyl- lum, grain \ (0.01); Ext. Belladonna, grain \ (0.015). Aloini, Strychnin.*: et Belladonnae.—Aloin, grain \ (0.01 Gm.); Strychnine, alkaloid, grain y1^ (0.0005 Gm.); Alco- holic Extract of Belladonna, grain \ (0.008 Gm.). Aloini, Strychnin.e et Belladonn/k Composit/e.—Aloin, grain \ (0.012); Ext. Bellad. Ale, grain \ (0.008 Gm.); Strychnine, alkaloid, grain -^fa (0.0005); Ext. Rham. Pursh., grain \ (0.03). ANTiDYSPEPTiCiE.—Strychnine, alkaloid, grain fa (0.0014); Ipecac, Ext. Bellad. Ale, each, grain fa (0.006); Mass of Mercury, Ext. Colocynth. Comp., each, grains 2 (0.13). Antineuralgic^:.— 1. Gross' Antineuralgic Pills: Quinine Sulphate, grains 2 (0.13); Morphine Sulphate, grain fa (0.003) 5 Strychnine, alkaloid, grain -fa (0.002); Arsenous Acid, grain fa (0.003); Ex. Aconite Leaves (U. S. P. 1870), grain h (0.03). When " Antineuralgic Pills," or " Neuralgia Pills," with- out other specifications, are prescribed, it is recommended that the above preparation be dispensed. Sometimes the Morphine is directed to be omitted. 2. Brown-Seauard's Antineuralgic {or Neuralgia) Pills: Extracts of Hyoscyamus and Conium, each, grain -| (0.04); Extracts of Ignatia and Opium, each, grain \ (0.03); Ext. Aconite Leaves, grain \ (0.02); Ext. Stramonium, grain \ (0.01); Ext. Indian Cannabis, grain \ (0.015); Ext. Bellad. Ale, grain \ (0.01). SOLID MIXTURES FOR INTERNAL USE. 113 Pilulae— Antiperiodic.k (Warburg's Pills).—1. With Aloes: Aqueous Extract of Aloes, grain 1 (0.06); Rhubarb, grain \ (0.03); Elecampane, Saffron, Fennel, each, grain \ (0.015); Zedo- ary, Cubebs, Myrrh, White Agaric, Camphor, each, grain \ (0.008); Quinine Sulphate, grains if (0.085); Extract of Gentian, a sufficient quantity. 2. Without Aloes: The same formula as above, with omis- sion of the Aqueous Extract of Aloes. These pills have been introduced for the purpose of facilitating the adminis- tration of Warburg's Tincture in a solid form. When " Warburg's Pills " or " Pills of Warburg's Tincture " are prescribed, without further specification, those containing Aloes are recommended to be dispensed—those without Aloes only when they are expressly demanded. Each Warburg's Pill represents about I fluidrachm (4 Cc.) of Warburg's Tincture. (See Tinctura Antiperiodicai) Colocynthidis Composit.k (Pilulas Cochia).—Extract of Colo- cynth, grain ! (001); Aloes, Resin of Scammony, of each, grains 2 (0.13); Oil of Cloves, min. \ (0.015). Colocynthidis et PIvoscvami.—Extract of Colocynth, grain fa (0.006); Aloes, Resin of Scammony, Ext. Hyoscyamus, each, grains I1 (o.l); Oil of Cloves, min. 1 (o.Ol). Colocynthidis et Podophylli.—Compound Extract of Colo- cynth, grains 11 (0.16); Resin of Podophyllum, grain \ (0.015). Ferri Composit.k (U. S. P. 1880).—Myrrh, I1 grains (0.1); Ferrous Sulphate, Sodium Carbonate, each, f grains (0.048). Galbani Composit.k (U. S. P. 1880).—Galbanum, Myrrh, each, 1^ grains (o. 1); Asafcetida, -1 grain (0.03). Gloxoini (Nitroglycerin).—Spirit of Glonoin (1 per cent.), Athasa, each, grains 200 (13.0); Confection of Rose, a suf- ficient quantity. Make a mass and divide it into two hun- dred (200) pills. Each pill contains fa-^ grain (0.0007) of Glonoin (Nitro-glycerin). Laxativ.f: Post-partum (Barker's).—Ext. Colocynth. Comp., grains i-|(o.i); Aloes, grain {j-(0.05); Res. Podoph., Ipecac, each, fa grain (0.005); Ext. Nux Vomica, fa grain (0.03); Ext. Hyoscyamus, iT grains (0.8). This is the formula generally employed by Dr. Fordyce Barker, except where special circumstances render modi- s H4 A TEXT-BOOK OF MATERIA MEDICA. Pilulae— fications necessary. The formula usually quoted in manu- facturers' lists and some formularies is not correct. Mktallorum (Metallorum Amara) — Reduced Iron and Quinine Sulphate, each, grain I (0.06); Strychnine and Ar- senous Acid, of each, grain fa (0.003). Aitken's Tonic Pill is a similar combination : Reduced Iron, grain f (0.04); Quinine Sulphate, grain 1 (0.06); Strychnine, Arsenous Acid, each, grain J0- (0.0012). Opii et Camphor.i:.—Powdered Opium, 1 grain (0.06); Cam- phor, grains 2 (0.13). Opii et Plumbi.—Powdered Opium and Acetate of Lead, each, grain 1 (0.06). Podophylli, Belladonna: et Capsici (Squibb's Podophyllum Pills).—Resin Podophyllum, grain \ (0.015); Capsicum, grain \ (0.03); Ext. Bellad. Ale, grain \ (0.008); Sugar of Milk, grain 1 (0.06); Acacia, Glycerin, and Syrup, each, a sufficient quantity. Quadruplices (Ferri et Quininae Compositae).—Ferrous Sul- phate, Quinine Sulphate, Aloes, each, grain 1 (0.06); Ext. Nux Vomica, grain \ (0.015); Ext. Gentian, sufficient. Triplices (Triplex).—Aloes, grains 2 (0.13); Resin Podo- phyllum, grain \ (0.015); Mass of Mercury, grain 1 (0.06). When Pilula Triplex, under this name or some equiva- lent, is prescribed without further specification, the N. F. recommends that the above preparation be dispensed. A formula devised by John W. Francis is also in use: 2. Francis's Triplex Pill.—Aloes, Scammony, Mass of Mercury, of each, grain £ (0.05); Croton Oil, fa min. (0.003); Oil of Caraway, grain \ (0.015); Tincture of Aloes and Myrrh, a sufficient quantity. UNOFFICIAL FORMS OF MIXTURES OF SOLIDS FOR INTERNAL USE. Granules are small pills, less than 1 grain (0.06) in weight, usually sugar-coated and containing alkaloids and other active drugs. Parvulcs are identical with granules. They are usually colored red or pink. Globules {OrbiculcE) are sugar pellets to be saturated with alco- holic solutions of medicinal agents, chiefly in Homoeopathy. PREPARATIONS FOR EXTERNAL USE. 115 Compressed Pills are made by compressing powders into disks not exceeding 5 grains (0.3) in weight, without any excipient. Friable Pills are made by aggregation, spreading the powdered mixture upon nuclei or sugar granules in a revolving pan until the pills are formed. Bolus is the name given to pills exceeding 5-10 grains (0.3-0.6) in weight, used in veterinary practice. A sugar-coated bolus is called a Dragee. Rotuloj are disk-shaped forms of sugar about iL grains (0.1) in weight, which may be flavored with alcoholic solution (spirits). Bacilli are cylindrical sticks, a form of lozenge (Licorice). Lamella?, thin squares of gelatin in which the active agent has been incorporated, intended for solution in the eye. PREPARATIONS FOR EXTERNAL USE. To this group belong the liquid preparations: Liniments, Oleates and Collodions, and the mixtures of solids: Ointments, Cerates, Suppositories, Plasters, and Papers. The Vehicle, some- times incorrectly called the " base," consists chiefly of fatty sub- stances which serve as protectives or facilitate absorption. The Collodions are, however, an exception. The solid mixtures may be classified according to their fusi- bility, or melting-points, because their therapeutic uses, as well as their pharmaceutical forms, are through this quality respectively determined. Ointments fuse at the body-temperature, and therefore produce an emollient effect, or induce absorption of the medicinal substance by the system. They are applied by rubbing or inunction. Cerates have a higher fusing-point, due to Wax they contain; the medicinal agent is not so readily absorbed, and they are there- fore used to produce local effects, being spread on cloth and applied as dressings. Suppositories have the same fusibility as cerates, and ma)- be said to be cerates intended for application to the orifices of the body, both for absorption and local effect. Plasters have a still higher fusibility; they do not melt, but become adhesive by the body-temperature, and are intended to produce local effects and afford mechanical support to the parts affected. Il6 A TEXT-BOOK OF MATERIA MEDICA. The fusibilities of these various preparations are likewise gov- erned by the respective vehicles employed. LINIMEXTA—LINIMENTS. The Liniments are liquid preparations for external use, consist- ing of solutions of oily or resinous constituents in Alcohol or Oils, or mixtures of liquid Soaps. The nine official Liniments are prepared by simple admixture or solution. Linimentum— Ammonias . . cotton seed oil 60 Cc.; ammonia water 35 Cc.; alcohol 5 Cc. Belladonnae . . . fl. ext. belladonna 95 Cc.; camphor 5 Gm. Calcis (Carron Oil) . . linseed oil 50 Cc; lime solution 50 Cc. Camphorae .... cotton seed oil 80 Gm.; camphor 20 Gm. Chloroformi .... soap liniment 70 Cc.; chloroform 30 Cc. Saponis..............camphor 4.5, soap 7, rosemary oil I ; alcohol 75 ; water, to 100 Cc. Saponis Mollis,alcohol 35 Cc; lavender oil 2; soft soap 65 Gm. Sinapis Comp. . . . fl. ext. mezereum 20; mustard oil, vol. 3, camphor 6; castor oil 15 ; alcohol, to 100 Cc. Terebinthinae . . resin cerate 65 Gm.; turpentine oil 35 Gm. Unofficial Liniments of the National Formulary. Linimentum— Aconiti et Chloroformi.—Tincture of Aconite, Chloroform, each, 2 fluidounces (60 Cc.); Soap Liniment, 12 fluidounces (355 Cc). Ammonii Iodidi.—Iodine, 30 grains (2.); Oil of Rosemary, Oil of Lavender, each, no minims (7 Cc.); Camphor, 220 grains (15.); Water of Ammonia, if fluidounces (50 Cc); Alcohol, enough to make 16 fluidounces (473.17 Cc). On standing, it becomes colorless. Cantharidis (U. S. P. 1880).—Oil of Turpentine containing 15 per cent, of Cantharides. Iodi (similar to Ph. Br.).—Iodine, 900 grains (60.); Potassium Iodide, 360 grains (24.); Glycerin, \ fluidounce (15 Cc); Water, 1 fluidounce (30 Cc.); Alcohol, enough to make 16 fluidounces (473.17 Cc). Opii Compositum (Canada Liniment).—Tincture of Opium, I1 fluidounces (45 Cc.); Camphor, 120 grains (8.) ; Alcohol, 4 fluidounces (118 Cc.); Oil of Peppermint, 180 minims PREPARATIONS FOR EXTERNAL USE. 117 Linimentum — (12 Cc.); Water of Ammonia, 6 fluidounces (180 Cc.); Oil of Turpentine, enough to make 16 fluidounces (473.17 Cc). Plumbi Subacetatis (U. S. P. 1880).—Solution of Lead Sub- acetate, 35 parts; Cotton Seed Oil, 65 parts. Saponato-camphoratum (Opodeldoc; Solid Opodeldoc).— White Castile Soap, \\ ounces (45.); Camphor, \ ounce (15.); Alcohol, 20 fluidounces (592 Cc.); Oil of Thyme, 30 minims (2 Cc.); Oil of Rosemary, 60 minims (4 Cc.); Water of Ammonia, Fort., 1 fluidounce (30 Cc). Terebinthin.k Aceticum (Linimentum Album., Stokes' Lini- ment ; St. John Long's Liniment).—Oil of Turpentine, 3 fluidounces (89 Cc.); Fresh Egg, 1 ; Oil of Lemon, 60 minims (4 Cc.); Acetic Acid, 300 minims (20 Cc.); Rose Water, 2\ fluidounces (75 Cc). Tiglii (Linimentum Crotonis, Ph. Br.).—Croton Oil, 2 fluid- drachms (8 Cc.); Oil of Cajuput, 7 fluidrachms (27.5 Cc). Tiglii Compositum.—Croton Oil, 1 fluidounce (30 Cc.); Oil of Sassafras, 1 fluidounce (30 Cc.); Oil of Turpentine, I fluidounce (30 Cc.); Oil of Olive, 2 fluidounces (60 Cc). LOTIONES—WASHES. Lotio— Adstringens (Warren's Styptic).—A mixture of Sulphuric Acid, Oil of Turpentine, and Alcohol. Flava (Yellow Wash, Aqua Phagedaenica Flava, Ph. Ger.). —Corrosive Mercuric Chloride, 24 grains (1.5), in Lime Water, 16 fluidounces (473 Cc). Nigra (Black Wash; Aqua Phagedaenica Nigra, Ph. Ger.). —Mild Mercurous Chloride, 64 grains (4.), in Lime Water, 16 fluidounces (473 Cc). Plumbi et Opii (Lead-and-Opium Wash).—Lead Acetate, 120 grains (8.); Tincture of Opium, \ fluidounce (15 Cc.); in Water, 16 fluidounces (473 Cc). To be shaken when dispensed. The following are unofficial solutions and mixtures for external use: Injectio, -ones.—Aqueous solutions for introduction by means of a syringe in the orifices of the body. Il8 A TEXT-BOOK OF MATERIA MEDICA. Injcctio Hypodermica.—Solution for hypodermic or subcu- taneous injection. Enema, -atis ; Clyster.—A warm solution of Soap or a muci- laginous mixture for injection in the rectum to produce evacuation, or for nutrition. Gargarisma, -atis ; Gargle.—A wash or lotion for the throat. Collyrium, -i; "Eye-zoash."—A weak solution for instillation in the eyes. Nebula, -cc ; Spray.—A liquid intended for application by means of an atomizer. Vapor, -oris; Inhalation.—Volatile agents to be added to boiling water and inhaled, to affect the air-passages. Balneum, -ei ; Bath.—Mixture to be added to water for bath- ing purposes. OLEATA—OLEATES. The official Oleates are solutions of oleates in Oleic Acid. They are distinct from the solid oleates, which are made by double decomposition of salts of the metals and alkaline earths and sodium oleate, or Soap. (See Soap?) The liquid Oleates are intended for endermic medication. They are applied by inunction, when the Oleic Acid favors the absorp- tion of the medicinal agent, the oleate in solution. When it is not desirable to administer remedies by the mouth, the Oleates afford an effective form of medication. The solid Oleates are either dry powders, well adapted for pro- tectives as dusting powders, or soft, pliable masses to be applied in the form of ointments or plasters. Three are official—two liquid, and one, Zinc Oleate, semi-solid. They are made by incorporating the solid with the Oleic Acid, contained in a warm mortar, and effecting solution with a gentle heat: Percentage by weight. Oleatum Hydrargyri .... yellow mercuric oxide 20. Oleatum Veratrinae...........veratrine 2. Oleatum Zinci Oxidi.........zinc oxide 5. Unofficial Oleates of the National Formulary. The following are simply solutions of the alkaloids in Oleic Acid: PREPARATIONS FOR EXTERNAL USE. 119 Oleatum— AconitiN/K.—Contains 2 per cent, of crystallized Aconitine (Duquesnel's). Quinin.k.—Contains 25 per cent, of Quinine (Alkaloid). Of the solid Oleates introduced by Dr. J. V. Shoemaker, the following have been recognized, but others may also be prepared as desired: Oleatum Plumbi.—Contains about 28 per cent, of Lead Oxide. It is of the consistence and general character of Lead Plaster, and suggests similar use. Oleatum Zinci.—In the form of a soft white powder, useful as a " dusting powder," or converted into a plaster or ointment by mixing it with such proportion of Oleic Acid as may be required. OLE A INFUSA—INFUSED OILS. These preparations are obtained by infusing a dry herb, usually from the so-called narcotic plants, in five times its weight of a mixture of equal parts of Cotton Seed Oil and Lard Oil. Oleum Hyoscyami Infusum is the most familiar example. Oleum— Carbolatum.—A mixture of Cotton Seed Oil with 5 per cent. of Carbolic Acid. Hyoscyami Compositum (Balsamum Tranquillans).—Infused Oil of Hyoscyamus, with a small proportion of each of the Ethereal Oils of Absinth, Lavender, Rose, Sage, and Thyme. C( )LLODIA—COLLODK )NS. The Collodions are solutions in Ether-Alcohol of Pyroxylin or Soluble Gun Cotton. Upon evaporation of the solvent the remain- ing film excludes the air, thus protecting abraded surfaces. Col- lodion is also used as a vehicle when a prolonged local effect is desired. The following forms are official: Collodium . . solution in ether 75 ; alco. 25 ; pyroxylin 3 Collodium Flexile . . . castor oil 3 ; Canada turpentine 5 Collodium Acidi Tannici . . alco. 5 ; ether 25 ; acid tan. 20 Collodium Cantharidatum (Blistering Collodion) . (flex. collo.) cantharides 60 120 A TEXT-BOOK OF MATERIA MEDICA. Unofficial Collodions. Collodium— Iodatlm (Iodized Collodion).—Contains 5 per cent. Iodine in Flexible Collodion. Iodoformatum (Iodoform Collodion).—Contains 5 per cent. Iodoform in Flexible Collodion. Salicylatum Compositum (Corn Collodion).—Contains 11 per cent. Salicylic Acid and 2 per cent. p:xt. Cannabis Indica in Flexible Collodion. Tiglii (Croton Oil Collodion).—Contains 10 per cent. Croton Oil in Flexible Collodion. UNGUENTA—Ol NTM ENTS. Ointments are mixtures of a fatty vehicle with which medicinal agents are incorporated, readily fusing at the body-temperature, 350 t.0400 C. (950 to 1040 F.). The vehicles used are : Benzoated Lard, Ointment (simple), Lard, and Wax or Spermaceti in different proportions, Lard Oil, Olive Oil, and Suet. Petrolatum and Wool-fat {Adcps Lanoz Hydrosns. U. S. P.) are employed in unofficial ointments. The medicinal ingredients must be minutely distributed through the vehicle in order that the ointment may not prove irritating, and that the greatest possible surface be presented to the epidermis with a view to quick and uniform absorption. For this reason the highest quality of an ointment (next to its proper melting-point) is smoothness. In the preparation of ointments care must therefore be taken that the method employed be such as to yield smooth products. The melting-point is governed by the fusibility of the vehicle used, which is either officially directed, as in official preparations, or in extemporaneous preparations prescribed by the physician. The twenty-three official Ointments are prepared (1) by me- chanical admixture, (2) by fusion, or (3) by chemical reaction. Mixing the medicinal substances with the fatty body in a mor- tar or on a slab is the process usually employed for solid sub- stances, especially when insoluble in the fat. Powdered drugs, acids, alkaloids, extracts, and salts (not attended by chemical union) are examples adapted to this process. The following points must be observed: Solids must be in a fine powder before being incorporated with the vehicle ; sometimes it is an advantage to triturate the solid with PREPARATIONS FOR EXTERNAL USE. 121 a small quantity of a bland fixed oil, as Almond Oil or Olive Oil, into a smooth cream before it is mixed with the vehicle proper— Lard, etc. Extracts should be reduced to a semi-liquid condition by tritura- tion with a little dilute Alcohol or Water. Substances soluble in fats, such as Carbolic Acid, Iodine, and Camphor, may be dis- solved directly in the fat by the aid of a gentle heat. The following are the official Ointments, with their drug- strengths, their respective vehicles being given in parentheses : Percentage Unguentum— of Drugs. Acidi Carbolici............(ointment) 5 Acidi Tannici.............(benz. lard) 20 Aquae Rosae (Cold Cream) . . spermaceti 12.5 ; white wax, 12; expressed oil of almond 60 then incorporate borax 0.5 ; rose water 19 Belladonnae (dil. alcohol 5) extract . . . (benz. lard) 10 Chrysarobini (chrysophanic acid)..... " 5 Diachylon (Hebra's).........lead plaster 50 oil lavender 1 ; olive oil 49 Gallae................(benz. lard) 20 Hydrargyri (Blue Ointment).......mercury 50 mercuric oleate 2 ; suet 23 ; lard 25 Hydrargyri Ammoniati........(benz. lard) 10 Hydrargyri Oxidi Flavi.........(ointment) 10 Hydrargyri Oxidi Rubri (castor oil 5) . . . 10 Iodi (potass, iod. I, water 2 parts) .... (benz. lard) 4 Iodoformi............... IO Picis Liquidae . . . yellow wax 12.5; lard 37.5; tar 50 Plumbi Carbonatis..........(benz. lard) 10 Plumbi Iodidi............. " 10 Potassii Iodidi (sod. hypo, sulph. 1; water 10) 12 Stramonii (dil. ale. 5) Extract...... 10 Sulphuris (washed)........... 30 Veratrinae (olive oil 6)......... 4 Zinci Oxidi.............. 20 Unofficial Ointments of the National Formulary. Unguentum Acidi Gallici (U. S. P. 1880).—Contains 10 per cent. Gallic Acid. 122 A TEXT-BOOK OF MATERIA MEDICA. Unguentum Calamin.k (Unguentum Zinci Carbonatis Im- puri; Turner's Cerate).—Contains 17 per cent. Zinc Car- bonate (Imp.). Uxguentum Camphor.e (Unguentum Camphoratum).—Con- tains 20 per cent. Camphor. Unguentum Fuscum (Unguentum Matris; Mother's Salve). —Contains 50 per cent, of Camphorated Brown Plaster (N. F.). Unguentum Mezerii (U. S. P. 1880).—Represents 25 per cent. Mezereum. Unguentum Picis Compositum (Tar, Comp.).—Contains Oil of Tar, 4 per cent.; Tincture of Benzoin, 2 per cent.; and Oxide of Zinc, 3 per cent. Unguentum Sulphuris Alkalinum (U. S. P. 1880).—Contains 20 per cent. Sulphur and 10 per cent. Potassium Carbonate. Unguentum Sulphuris Compositum (Wilkinson's Ointment; Hebra's Itch Ointment).—Precipitated Calcium Carbonate, 10; Sublimed Sulphur, Oil of Cade, of eachr, 15; Soft Soap and Lard, of each, 30 parts. The Lard is mixed with the Soft Soap and Oil of Cade; the Sublimated Sulphur and Precipitated Calcium Carbonate are then grad- ually incorporated. CERATA—CERATES. Cerates are mixtures of fats similar to the ointments, but of firmer consistence, because they contain Wax or Resin (having a higher melting-point than Lard) in greater proportion than do oint- ments. In the preparation of Cerates the same rules are to be observed as noted under Ointments. The six official Cerates are prepared by fusion or simple admix- ture, and one by extraction and digestion (Ceratum Cantharidis): Percentage of Drugs. Ceratum (Simple).........lard 70; white wax 30 Camphorae . camphor liniment 10; lard 60; white wax 30 Cantharidis (Blistering Cerate) . . .oil of turpentine 15 lard, 22; cantharides 32 yellow wax, resin, each 18 previously fused, and evaporate to IOO Cetacei . . . olive oil 55 ; white wax 35 ; spermaceti 10 PREPA ~ZA TIONS FOR EXTERNAL USE. 123 Percentage of Drugs. Plumbi Subacetatis (Goulard's Cerate), camphor cerate 80 solution lead subacetate 20 Resinae (Basilicon) . . yellow wax 15 lard 50; resin 35 in cold weather yellow wax 12; lard 53; resin 35 In the " Blistering Cerate" the maceration in Turpentine Oil and subsequent digestion dissolve the vesicating principle of the Cantharides, and the preparation is therefore more active. Ceratum Camphors Compositum, N. F. (Camphor Ice).— Moulded into small cakes suitable for popular use as an applica- tion to excoriated surfaces. It contains very small quantities of Benzoic and Carbolic Acids. Ceratum Extracti Cantharidis (U. S. P. 1880).—Repre- sents 30 per cent. Cantharides. Ceratum Sabin^e (U. S. P. 1880).—Represents 25 per cent Sabine. suppositoria—suppositories. Suppositories may be defined as variously shaped masses of medicated fat, possessing a consistence ensuring their quick fusion when introduced in the orifices of the body. The U. S. P. defines Suppositories with reference to their weights and shapes, corresponding to their several uses—i. e. for introduction in the respective orifices of the body—as follows: Rectal, cone-shaped, should weigh 15 grains (1 Gm.). Urethral, pencil-shaped, should weigh 15 grains (1 Gm.). Vaginal, globular, should weigh about 45 grains (3 Gm.). The vehicle is Cacao Butter {Oleum Theobromatis), which pos- sesses the property of melting at the temperature of the human body, 350 C. (95° F.), and yet remaining firm at ordinary tempera- tures. An addition of 10 per cent, of spermaceti has been recom- mended to raise the melting-point and thus give more stability to suppositories during the heated seasons of the year. The U. S. P. gives a general formula for preparing supposi- tories ; only one Suppository is official, and this is not made from Cacao Butter. The methods of preparing suppositories are quite numerous: any process may be employed by which the product is obtained uniform in size and shape and with the medicinal ingredients thor- 124 A TEXT-BOOK OF MATERIA /EDICA. oughly incorporated. Moulds are usually employed ; the medici- nal ingredients, if solid, are first reduced to powder in a mortar, and mixed with a small quantity of the grated Fat ; the remainder of the Fat, previously melted and cooled to 35 ° C, is then gradually incorporated with this mixture, thoroughly mixed, and, if possible, without further heating, poured into the moulds, previously chilled. Another process consists in rolling the mass on a slab, cutting it as in making pills, and forming the cones with the fingers. By cold compression in a screw-press " machine," suppositories may be formed from the prepared mass. Urethral Suppositories are commonly called Bougies, or, more properly, Medicated Bougies. They are usually made with the addition of Wax, or from Glyco-gelatin mass. Suppositoria Glyccrini.—Made by reaction of Sodium Carbonate 5 grains (0.3), in Glycerin \\ grains. (6 Gm.), with Stearic Acid 8 grains (0.5), and heating until a solution of sodium stcaratc or soap is formed, which is poured into a mould. Upon cooling, the mixture gelatinizes and the suppository is wrapped in tin-foil. Uses.—Upon introduction into the rectum the mass melts, and the Glycerin, acting upon the feces, produces evacuation. Rectal suppositories are usually made twice the official size, or 30 grains (2 Gm.). A formula for suppositories would be: Extracti Belladonnae Fol., ale, o. 1 ; Acidi Tannici, 1.0; Olei Theobromatis, q. s. (20 Gm.). Fiant suppositoriae No. x. (2 Gm.). Each suppository would contain \ grain (0.01) Ext. Belladonna and \\ grains (0.1) Tannic Acid. EM PLASTR A—PLASTERS. Plasters are mixtures of various fatty or resinous solids of such high melting-point as to be friable when cold, but rendered adhesive by the warmth of the body. The vehicles of plasters are : Lead plaster ; resinous substances, made adhesive by admixture with the medicinal ingredients; and simple plasters, such as isinglass. The making of plasters does not differ materially from the pro- cess employed for ointments and cerates, since they are all prepared by melting the various substances and incorporating the medicinal PREPARATIONS FOR EXTERNAL USE. 125 substances last. The spreading of plasters, though usually done on a large scale, may be easily effected by the pharmacist with the use of a plaster iron. The thirteen official Plasters may be divided into—(1) Lead Plasters; (2) Pitch and Gum-Resin Plasters, and (3) Isinglass Plaster. (1) The most important plasters are made from Lead Plaster, or Lead Plaster mixed with Resin, the official Resin Plaster. Percentage or Emplastrum— parts in 100. Plumbi (Diachylon) .... olive oil 60; lead oxide 32 mix, and add to water 10 Boil the mixture until the reaction has ceased and the plaster is of the right consistence, replacing water lost by evaporation from time to time. Resinae (Adhesive)......yellow wax 6 ; resin 14 lead plaster 80 Saponis..........lead plaster 90; soap 10 From these the following are prepared: Emplastrum— Arnicas.....resin plaster 67; extract arnica root 33 Belladonnae........ext. belladonna leaves 20 resin plaster, soap plaster, each 40 Capsici . . . resin plaster, oleoresin capsicum q. s. Hydrargyri, lead plaster 70; mercury oleate 1.2; mercury 30 Containing lead plaster and pitch : Emplastrum— Ferri (Strengthening) . . . olive oil, 5 ; ferric hydrate 9 Burgundy pitch 14; lead plaster 72 Opii . Burgundy pitch 18; lead plaster 76; ext. opium 6 Picis Cantharidatum (Warming) . . . Burgundy pitch 92 cerate cantharides 8 (2) Pitch and Gum Resin Plasters: Emplastrum— Ammoniacicum Hydrargyro . . . . oleate mercury 0.8 mercury 18 ammoniac 72; dil. acetic acid, lead plaster, to IOO Picis Burgundicae.....olive oil 5 ; yellow wax 15 Burgundy pitch 80 126 A TEXT-BOOK OF MATERIA MEDICA. (3) Isinglass plaster (Emplastrum Ichthyocollae; Court-plaster). —A solution of 10 Gm. Isinglass is dissolved in hot Water 120 Gm.; one-half of the solution is spread upon silk (taffeta) in suc- cessive layers, and when dry the other half of the solution is spread on in a similar manner, after first having been mixed with Alcohol 40 Gm., Glycerin 1 Gm. The taffeta is then coated on the reversed side with Tincture of Benzoin to make it waterproof and antiseptic. Unofficial Plasters of the National Formulary. Emplastrum— Ammoniaci (U. S. P. 1880).—Gum-resin Ammoniac with Acetic Acid. Aromaticum (Spice Plaster).—Consisting of Cloves, Cinna- mon, and Ginger, each, 10 per cent.; Capsicum and Cam- phor, each, 5 per cent. Asafcetid.k (U. S. P. 1880).—Asafcetida 35 p.; Galbanum 15 p.; with Lead Plaster. Fuscum Camphoratum (Matris Camphoratum, Ph. Ger.).— Camphorated Mother's Plaster. A plaster similar to lead plaster, and containing camphor, 1 per cent. Galbani (U. S. P. 1880).—Galbanum Plaster. Picis Canadensis (U. S. P. 1880).—Canada Pitch Plaster. Picis Liquids Comp.—A mixture of Resin and Tar, with Podo- phyllum, Phytolacca, and Sanguinaria, of each, 10 per cent. CHARTS—PAPERS. There are two Papers official. One is made by saturating strips of white unsized paper in a 20 per cent, solution of Potassium Nitrate and drying; the other is paper coated with Mustard, used similarly to the Plasters : Charta Potassii Nitratis .... potass, nitrate 20; water 80. Vapors from incineration as inhalant. Charta Sinapis . . oil-free black mustard, 4 Gm. in 60 sq. cm. The Mustard is freed from the fixed oil by extraction with Ben- zin, and mixed with a solution of India Rubber in equal volumes of Benzin and Carbon Disulphide, and spread upon Paper. This is the well-known Mustard Plaster or Mustard Paper. When applied, the paper should be immersed in lukewarm water for a few minutes, in order to render the vesicating principle active. Charta Cantharidis, U. S. P. 1880.—Cantharidis Paper (Blis- tering Paper). PREPARATIONS FOR EXTERNAL USE. 127 Poultice or Cataplasm (Lat. Cataplasma, -atis).—A coarsely ground substance or mixture of substances, such as flaxseed or elm-bark, made into a mass with hot water or some other liquid, spread upon cloth or filled into porous bags, and applied to the body while hot. Fomentations (Lat. Fomcntum, -i).—Porous woollen cloths sat- urated with hot infusion or decoction of herbs, or other hot liquids or lotions, and applied hot. Spongiopiline.—A thick cloth covered with layers of sponge for the saturation and retention of medicinal agents intended for absorption, the exterior being composed of waterproof material, such as rubber. Plaster-Mull.—A thin cloth made impervious with rubber or gutta-percha tissue, upon which is spread or painted medicinal agents in the liquid form, intended for local application. Caustics or Escharotics (Gr. Escharotikos).—Substances used to destroy tissue by chemical action or by heat, either semi- solid mixtures made into a paste with starch or other diluent, or chemicals fused and moulded into sticks called pencils or " crayons " (Lat. stilus, -i), to be applied directly to the skin. Jlloxa is the name given to small cones of combustible substances which upon incineration do not inflame, but give off an intense heat, used for cauterization when heat is desired. Bandages; Antiseptic Dressings.—The material used for bandages is cellulose in various modifications, such as cotton, linen, jute, and other fibrous substances. Aside from the me- chanical support afforded, bandages also serve to keep wounds clean by absorbing and withdrawing secretions (pus) which would otherwise prove irritating, and by protecting them against extrane- ous matter serve to promote the healing process. These various substances may be used either plain or medi- cated, when they are called antiseptic. Gossypium Purificatum, U. S. P.; Absorbent Cotton.—The hairs of Gossypium hcrbaceum L., freed from oil and resinous substances by treatment with alkalies and bleaching agents. These hairs rep- resent microscopic ducts in which liquids are absorbed through capillarity. The freer from oily constituents, the more readily will water)- liquids be taken up and retained ; hence the absorbability of cotton depends upon its purity. This is equally true with all other bandage material. Linen in the form of thin sheets, known as Muslin or Muslin- 128 A TEXT-BOOK OF MATERIA MEDICA. gauze, or purified similarly to cotton, when it is called Lint, is made from the bast-fibres of the Li mini usitatissimum L, Flax. Hemp and Jute are the bast-fibres of their respective plants. Medicated Dressings.—These are made by saturating the ma- terial or vehicle in a solution of certain strength of the medicinal agent, or incorporating the latter in powdered form. In the appli- cation of a dressing which has been rendered aseptic or antiseptic by impregnating it with Phenol (Carbolic Acid), Salicylic Acid, Mercuric Chloride, or similar agent, it is desired to bring in con- tact with the wound a solution of certain strength—for example, a 5 or io per cent, solution of Phenol, a fa or ^ of I per cent. solution of Mercuric Chloride, etc. The quantity of material which conveys the agent is of no consequence, as the fabric simply serves as a vehicle for the medicinal or antiseptic agent. The strengths of such dressings should therefore be designated by the percentage- strength of the solutions by which they are saturated, rather than by the percentage by weight of the medicinal agent the finished dress- ing may contain. In dressings of antiseptic agents that are usually applied in sub- stance, such as Boric Acid and Iodoform, the percentage-amount actually contained by weight in the finished dressing should be stated. Here the use of a vehicle is only a matter of convenience, and it is desirable to know just how much of the medicinal agent is contained in a certain quantity by weight or by area of the dressing. Medicated Cottons.—Purified cotton is saturated in a solution in Water, or Glycerin and Water, of the strength desired of the medicinal agent, and thoroughly expressed. The following are the usual strengths : Percentage. Gossypium Boratum...........acid boric 5 or 10 Carbolatum..............phenol 5 or 10 Iodoformatum...........iodoform 10 to 20 Salicylatum...........acid salicylic 10 to 20 Stypticum.........Monsel's solution Sublimatum........mercuric chloride fa to fa Iodoform, being insoluble in Water, should be dissolved in Ether or, preferably, in a mixture of Alcohol and Glycerin. Medicated Gauzes ; Carbasa.—The material used for making Medicated Gauzes is a muslin gauze free from sizing or other ex- traneous matter. The gauze is thoroughly impregnated with the PREPARATIONS FOR EXTERNAL USE. 129 solution of the particular strength required, then forcibly expressed, after which it is ready for use ; or, if desired for future use, it should be tightly rolled, wrapped in parchment paper, and kept in closely covered boxes in a cool, dry place. The following are the most commonly used Gauzes and their strengths: Percentage. Carbasus Boratum.............acid boric 5-10 Carbolatum...............phenol 5-10 Iodoformatum.............iodoform 10-20 Salicylatum............acid salicylic 10-20 Sublimatum..........mercuric chloride fa fa The Iodoform Gauze is made in the same way as the Cotton, by saturation with a solution of Iodoform in Alcohol and Glycerin. All the others, except the Mercurial Gauze, contain Glycerin. Mercuric Chloride is dissolved in Water with a little Acid Tartaric [ 5 parts for 1 of Mercuric Chloride), the presence of which in the Gauze prevents the formation of insoluble albuminate of mercury when it is brought in contact with the albuminous discharges from wounds. Plaster-of-Paris bandages are made by thoroughly incorpo- rating Calcium Sulphate (gypsum) into linen bandages. When applied, the bandage, after being dipped in water, sets hard and firm in a few minutes. 9 CLASS I-DISEASE MEDICINES. DIVISION I.—RESTORATIVES. GROUP I.—DIGESTANTS. [In the present work care has been taken to designate the proper pronunciation (Foster) of the names of drugs and their preparations common to Materia Medica and Therapeutics. The simplest and most efficient method appears to be that herein fol- lowed—namely, to indicate accent and quantity by a single sign; for example, Pep- slnum (nom.)—Pepslni (gen.), in which the i is long and the accent upon the second syllable; C6cculus—Cdcculi, in which the o is short and the accent upon the first syllable. In nearly all cases the genitive, as used in prescription-writing, and the English equivalent, are given. When the accusative, not genitive, is adopted, the usage is marked by "(ace.)"; as Pilulae, Pllulas (ace), etc.] PepsTnum—Pepslni—Pepsin. U. S. P. Origin.—A proteolytic ferment or enzyme obtained from the glandular layer of fresh stomachs from healthy pigs, and capable of digesting not less than 3000 times its own weight of freshly coagulated and disintegrated egg albumen when tested by the process given in the United States Pharmacopoeia. Description and Properties.—A fine white, or yellowish-white, amorphous powder, or thin, pale yellow, or yellowish, transparent or translucent grains or scales, free from offensive odor, and having a mildly acidulous or slightly saline taste, usually followed by a suggestion of bitterness. It slowly attracts moisture when exposed to the air. Soluble, or for the most part soluble, in about 100 parts of water, with more or less opalescence ; more soluble in water acid- ulated with hydrochloric acid; insoluble in alcohol, ether, or chlo- roform. Pepsin usually has a slightly acid reaction. It may be neutral, but should never be alkaline. Dose.—5-60 gr. (0.3-4.0 Gm.). 131 132 A TEXT-BOOK OF MATERIA MEDICA. Official Preparations. Pepsinum Saccharatum—Pepslni Saccharati—Saccharated Pepsin. Formula: Pepsin io, Sugar of Milk 90 parts. Dose, 30 gr-4 dr. (2.0-16.0 Gm.). Antagonists and Incompatibles.—Tannic and gallic acids are incompatibles. Mineral salts, alcohol, and alkalies precipitate pep- sin from solution, the two latter impairing its digestive property. The " Wine of Pepsin " is therefore unreliable. Synergists.—Diluted hydrochloric acid, in not over ^j- of 1 per cent., increases its digestive action. Physiological Action.—Its only influence seems to be upon the digestive system. Pepsin is a typical restorative, being a normal constituent of the gastric juice, and in the presence of hydrochloric acid digesting the nitrogenous elements of the food, converting them into albumoses, and finally into peptones. Therapeutics.—Externally and Locally.—Its digestive action is utilized to dissolve or digest the false membrane in diphtheria and croup. A solution of pepsin has also been injected into the blad- der to digest blood-clots. It has been further recommended as an application to cancer of the cervix uteri. Internally.—As a restorative, where there is a lessened secre- tion of gastric juice, atonic dyspepsia, apcpsia of infants, cancer of the stomach, and gastric ulcer, pepsin has proved serviceable. It is also employed to favor digestion in convalescence from acute and long illness. It is frequently necessary to give pepsin, or " pepton- ized milk," in acute dyspeptic diarrhea of infants. Administration.—Pepsin should be given in powder or dis- solved in glycerin (Glycerol of Pepsin), or in water acidulated with hydrochloric acid, directly after meals. The drug should not be given continuously for too long a period, lest the function of the stomach become impaired from disuse, the artificial digestion having replaced the natural, normal process. Unless there be some direct indication for its use, rather than give pepsin it is better to stimulate the gastric glands to secrete a larger amount of their normal juice, that they may not lie idle, and their function be consequently impaired by disuse. Hydro- chloric acid administered with pepsin probably slightly promotes glandular activity. Often, however, pepsin must be given, and in certain cases the stomach is in such a condition that nutrient en- emata must be administered. Yet, since the rectum possesses very DIGESTANTS. 133 feeble powers of digestion, food should always be predigested. Sup- positories of peptonized meat are frequently used for this purpose. PancreatTnum—Pancreatlni—Pancreatin. I. S. P. Origin.—A mixture of the enzymes naturally existing in the pancreas of warm-blooded animals, usually obtained from the fresh pancreas of the hog. Description and Properties.—A yellowish, yellowish-white, or grayish amorphous powder, odorless, or having a faint, peculiar, not unpleasant odor, and a somewhat meat-like taste. Slowly and almost completely soluble in water, insoluble in alcohol. Pancreatin digests albuminoids and all proteid substances, and converts starch into sugar. Prolonged contact with mineral acids renders it inert. Dose.—10-20 gr. (0.6-1.2 Gm.). Antagonists and Incompatibles.—Strong mineral acids. Synergists.—Weak alkalies. Physiological Action.—The four ferments which it contains render it capable, in either weak alkaline or acid media, of digest- ing nitrogenous substances; emulsifying fats and oils, and re- solving them into fatty acids and glycerin; converting starch into sugar; and curdling milk. Therapeutics.—Like pepsin, it is used as an artificial agent in certain disorders of digestion. Administration.—It may be given dry, in powder, capsules, or compressed pills, or in solution. It should be administered in combination with an alkali, as the activity of pancreatin is de- stroyed by acids, and should be given ordinarily from two to four hours after meals, when the chyme has entered the intestine. It may also be administered immediately after eating or with the food, since there is an interval of from fifteen minutes to half an hour after the ingestion of food before the stomach-contents are ren- dered sufficiently acid by the gastric juice to interfere with the activity of the pancreatin. For rectal nourishment pancreatin is preferable to pepsin, be- cause of its superior action in predigesting food. Papain, Papoid, or Papayotin. Origin.—The inspissated juice of the unripe fruit of Carica Papaya. Description and Properties.—A whitish, slightly astringent powder, soluble in water. 134 A TEXT-BOOK OF MATERIA MEDICA. Dose.—1-8 gr. (0.06-0.5 Gm.). Antagonists and Incompatibles.—Tannic and gallic acids. Lead salts and alcohol are incompatible with papain. Synergists.—The digestive ferments. Physiological Action.—In this it resembles pepsin, though dif- fering from the latter, as well as from pancreatin, in that it is equally active in neutral, alkaline, or acid media. It converts pro- teids into soluble peptones, and acts as a stimulant to the gastric glands. It converts starch into maltose, and upon false membranes acts more energetically than pepsin. It dissolves intestinal worms. Therapeutics.—Externally.—The uses of papain are more mani- fold than those of the digestive ferments previously mentioned. Like pepsin, it has been successfully employed to dissolve false membrane in diphtheria and croup. The juice of pineapple, which possesses a ferment (bromelin) similar to that of papain, is a val- uable domestic remedy in these diseases. Papain has been used with some benefit in indurated eczema and in syphilitic ulcerations of the tongue. It has been highly recommended by Johnston as a solvent of cerumen: 15 drops (1.0 Cc.) of a solution of 20 grains to 1 oz. (1.2 Gm—30 Cc.) of distilled water are dropped into the outer meatus, and the parts syringed an hour afterward with a solution of boric acid. Internally, papain may be used for the same purposes as pepsin and pancreatin ; yet, while theoretically superior, it is practically inferior to them, fortunately not having supplanted them in actual practice. Administration.—When used to aid digestion, papain should be given after meals, either in powders, capsules, compressed tablets, or aqueous solution freshly prepared. GROUP II.—FATS AND OILS. Oleum Morrhuae—Olei Morrhuae—Cod Liver Oil. r. s. p. Origin.—A fixed oil obtained from the fresh livers of Gadus Morrhua L. and other species of Gadus. Description and Properties.—A pale-yellow, thin, oily liquid, having a peculiar, slightly fishy, but not rancid odor, and a bland, slightly fishy taste. Specific gravity 0.920 to 0.925 at 150 C. (590 F.). Scarcely soluble in alcohol, but readily soluble in ether, FATS AND OILS. 135 chloroform, or carbon disulphide, also in 2.5 parts of acetic ether. It contains several glycerides, the principal one being olein, traces of iodine, bromine, chlorine, biliary salts, phosphoric and sulphuric acids, a peculiar principle (gaduin), and several alkaloids. Morrhuol, a name given by Chapoteaut to a mixture of the various alkaloids and important principles of cod liver oil, occurs as an amber-brown, bitter, aromatic liquid. Dose.—1-4 fluidrachms (3.8-15 Cc). Physiological Action.—Externally and Locally.—It possesses emollient properties, and may be applied to the skin and mucous membranes without causing irritation. It slightly reduces tempera- ture in fever when applied to the body. Internally.—Fat is a normal and necessary constituent of the body. It is the fuel used to supply force, and those tissues and organs which are the most energetic require the most fat. Conse- quently, nerves, muscles, and glands are more abundantly fur- nished with fat than cartilage, and in cases of starvation those structures demanding the greater supply must have it, at the ex- pense of the less highly organized and active tissues—as is seen in the great emaciation preceding the decline of mental powers. The blood contains about one-half of 1 per cent, of fat; the muscles, 3 per cent.; the brain, 8 per cent.; and the nerves 22 per cent. In order, therefore, that the various cells of the body may possess sufficient vitality to withstand by physiological resistance the en- croachments of disease and the invasion of pathogenic micro-or- ganisms, this equilibrium must be maintained. Yet this necessary food, fat, is more frequently deficient than any other, from the difficulty either of obtaining a supply or of digesting and assimi- lating it. Dr. Hughes Bennett was near.the truth in observing that " the main causes of tuberculosis are the dearness of butter and the abundance of pastry-cooks," intimating that the poor and underfed are unable to obtain sufficient fat, while the digestion of the wealthy class is deranged by pastries, so that they are unable to assimilate a proper amount of fat. Dr. Brunton cites the case of a barrister who before pleading a case invariably took a full dose of cod liver oil, believing that it rendered his mind more active. Before oils or fats can enter the various cells and act as food, and consequently a source of power, they must be digested and assimilated by the system. The value of an oil is based upon—(1) I3rj A TEXT-BOOK OF MATERIA MEDICA Its rate of absorption; (2) its rate of oxidation ; (3) its agreeable taste. Cod liver oil, while to many persons repugnant in taste, is more readily absorbed and oxidized than any other fat. It has already been prepared by the liver, and therefore partly elaborated, and, owing to the biliary salts which it contains, it passes more readily through animal membranes. Moreover, Naumann has shown that cod liver oil is more easily oxidized than any other oil, rendering this substance almost an ideal ready-made food. Its actions upon the several systems are here considered. Digestive System.—Large doses disturb the stomach and may even occasion vomiting, but in medicinal doses alone, or in the form of an emulsion, it may be taken usually without discomfort, in some cases even increasing the appetite. In the stomach cod- liver oil is unaffected, but in the intestines it meets the pancreatic juice, which resolves a portion of it into glycerin and fatty acids, the latter combining with the alkalies of the bile and the intes- tinal juice to form soaps, while the remaining, and larger, por- tion is emulsionized by the alkaline secretions of the intestines. Circulatory System.—The number of red corpuscles is increased and the quality of the blood is greatly improved. Nervous System.—This shares with the other tissues of the body the general amelioration, the drug being a food and tonic to the brain and nerves. Respiratory System.—No special action is noticeable other than the natural improvement in the respiratory power incidental to better blood and an increased functional activity of the nerves and muscles. Absorption and Elimination.—Cod liver oil can be absorbed only after it enters the intestines. The glycerin and fatty acids formed by the pancreatic juice are readily absorbed by the mucous mem- brane, together with the soaps produced by the action of the bile and the intestinal juice. The oil remaining, as has been stated, is emulsionized—that is, it is subdivided into minute globules each enclosed in an envelope composed of alkaline albuminate and soap, which has a great affinity for the mucous membrane and carries the oil through the columnar epithelium of the intestinal villi into the lymph-spaces. The osmosis inward of the oil-emulsion is rendered still easier by the action of the bile with which the mucous membrane is bathed. FATS AND OILS. 137 Oils and fats which are absorbed and not needed for cell-food are deposited beneath the skin as subcutaneous fat, serving as a protection against external cold as well as a reserve supply in case the economy needs more fat than can be taken into the system and assimilated. The weight, therefore, is usually greatly increased under the administration of cod liver oil. It will be seen that much of the oil taken into the system is oxidized, being subsequently excreted as carbonic acid and water. Temperature.—When taken internally the temperature is unaf- fected, but, as has been observed, when applied to the epidermis the bodily heat is reduced. Untozvard Action.—In addition to disturbances of digestion sometimes occasioned by moderate doses, cod liver oil at times produces a vesicular eczema which may spread over the entire body. This eruption is probably caused by the volatile fatty acids which the oil contains. Poisoning.—Cod liver oil possesses no poisonous action. Therapeutics.—Externally and Locally.—Cod liver oil is much used by dermatologists in diseases of the skin, being especially ser- viceable in softening the crusts of eczema. It has been applied to the skin to allay irritation and for the reduction of temperature in the exanthemata. In cases of marasmus and rachitis, and in wasting diseases generally, it is a valuable remedy to sustain the vital energy and improve nutrition, the oil being given in the form of baths. Daily inunctions are beneficial in chronic scaly skin diseases, while a local application to the chest has seemed at times to influ- ence favorably the course of pertussis. Local applications have also been adopted empirically, and with satisfactory results, in chronic rheumatism and rheumatoid arthritis. Internally.—For two or three centuries cod liver oil has been used both externally and internally for chronic rheumatism, but it is only since 1841 that it has been employed in the treatment of tuberculosis. While to-day it does not receive the enthusiastic support which attended its introduction in the latter disease, it is nevertheless a standard and highly efficacious remedy in the various forms of the disorder. It is equally valuable in scrofulous affections, and even more potent in rachitis. Chronic bronchitis is perhaps more frequently relieved by its use than by any other internal remedy. Diseases resulting in anemia are usually more benefited by cod liver oil than by other remedial agents. Chronic arthritis, 138 A TEXT-BOOK OF MATERIA MEDICI. fistula, and abscess in the neighborhood of the joints have been greatly improved by its use. Atheroma of the arteries and many cutaneous diseases, particularly the strumous variety, and syphilo- dermata yield to its alterative and nutrient properties. Probably no single drug is employed in nervous diseases with effects so markedly beneficial as those of cod liver oil. While possessing no specific action, it increases the strength and vitality of the patient, enabling him to resist morbid tendencies more suc- cessfully, and, by augmenting the force-producing material and improving the condition of the nerves, lessens the liability to nervous derangement. Diabetes mcllitus and Bright's disease, with anemia yet unat- tended by marked digestive disturbance, are decidedly improved by the administration of cod liver oil. Should no gastric disorder supervene, this remedy should invari- ably be given in the last-named diseases. It certainly serves to maintain the general health, and is singularly efficacious in pro- longing the lives of the afflicted patients, enabling them to profit by hygienic measures, upon which great reliance should be placed. The tonic and nutritive properties of the drug have been strikingly shown in the rapid improvement of patients convalescing from acute diseases. In catarrhal conditions, especially in ozena and otitis following measles and scarlet fever, it is of marked benefit. Without entering upon specific considerations other than the above, it will be seen that cod liver oil is indicated whenever there is defective activity, whether inherited or acquired. Contraindications.—It is to be remembered that cod liver oil is a food and not a medicine: it is therefore contraindicated in all diseases where it proves detrimental to the appetite, causing eruc- tation, heartburn, diarrhea, etc. It is usually contraindicated in fevers, owing to the suspension of the secretions and impairment of digestion characteristic of acute febrile disorders. Administration.—In the early use of cod liver oil it is advis- able to prescribe small doses, that its toleration by the stomach may be gradually acquired. To many patients, however, it is ex- tremely distasteful, and the repugnance is increased rather than lessened by continued use. In such cases it is better, if possible, to disguise the taste and smell in some manner rather than to abandon so valuable a remedy when clearly indicated. Various means have been employed for this purpose. An emulsion may be made which obviates its disagreeable qualities. There are in MINERAL ACIDS. 139 the market soft capsules containing this oil that serve an excellent purpose, being easily swallowed and disguising completely the taste and odor of the drug. Administration should occur ordi- narily some time after meals, that the oil may reach the intestines as soon as possible. GROUP IIP—MINERAL ACIDS. Mineral Acids are classed here as Restorative Medicines, be- cause some of them appear in the normal secretion from certain glands, as, for instance, the gastric glands and in the perspira- tion and urine. Sulphuric and nitric acids are not normal constituents of the body, and are by some authors classed as escharotics, although the action and medical uses of these inor- ganic acids will here be considered. There are, however, certain characteristics common to all mineral acids which claim primary attention: 1. Concentrated mineral acids are caustic to a greater or less degree. 2. They combine with alkalies and alkaline earths to form salts, and unite with vegetable acids, setting them free from their com- bination with bases. 3. When in contact with the tissues of the body they combine with the protoplasm, neutralizing the alkalies which the latter con- tains and forming mineral salts. They also combine with the albu- min, forming acid albumin. 4. Upon the blood they precipitate the albuminous constituents and decompose the hemoglobin. 5. Acids are said to stimulate the secretion from alkaline glands. On the other hand, they depress the secretion from acid glands. 6. They diminish the functional activity of the muscular and nervous systems. Applied locally in a concentrated form, or taken internally in poisonous doses, they tend to produce rigidity of the muscles by coagulating the myosin (Brunton). 7. The alkalinity of the blood is lessened and the acidity of the urine increased by the internal administration of all mineral acids. 14° A TEXT-BOOK OF MATERIA MEDICA. Acidum Hydrochloricum—Acidi Hydrochlonci— Hydrochloric Acid. r. s. 1*. (Muriatic Acid.; Origin.—A liquid composed of 31.9 per cent, by weight of Abso- lute Hydrochloric Acid (HCL = 36.3/) and 68.1 per cent, of Water. Description and Properties.—A colorless, fuming liquid, of a pungent odor and an intensely acid taste. Fumes and odor disap- pear on diluting the acid with 2 volumes of water. Specific grav- ity about 1.163 at 150 C. (590 F.). Miscible in all proportions with water and alcohol. Hydrochloric acid should be kept in dark, amber-colored, glass-stoppered bottles. Dose.—2-5 minims (0.12-0.3 Cc), well diluted. Official Preparations. Acidum Hydrochloricum Dilutum—Acidi Hydrochlorici Diluti—Diluted Hydrochloric Acid (Diluted Muriatic Acid).—Dose, 10-20 minins (0.6-1.2 Cc). Formula: Hydrochloric Acid, 100; Distilled Water, 219. Sp. gr. about 1.050. Acidum Nitrohydrochloricum—Acidi Nitrohydrochlorici—Nitrohydro- chloric Acid.—Dose, 2-5 minims (0.12-0.3 Cc), well diluted. (Described under Nitric Acid.) Acidum Nitrohydrochloricum Dilutum—Acidi Nitrohydrochlorici Diluti —Diluted Nitrohydrochloric Acid.—Dose, 5-20 minims (0.3-1.2 Cc). (Described under Nitric Acid.) Acidum Phosphoricum—Acidi Phosphorici— Phosphoric Acid. U. S. I*. Origin.—A liquid composed of not less than 85 per cent, by weight of Absolute Orthophosphoric Acid (H3P04 = 97.8) and not more than 15 per cent, of Water. Description and Properties.—A colorless liquid, without odor, but having a strongly acid taste. Specific gravity not below 1.710 at 150 C. (590 F.). Miscible in all proportions with water or alco- hol. Phosphoric acid should be kept in glass-stoppered bottles. Dose.—The diluted acid only is given internally. Official Preparation. Acidum PhosphSricum Dilutum—Acidi Phosph6rici Diluti (Diluted Phos- phoric Acid).—Dose, 5-25 minims (0.3-1.5 Cc). Diluted phosphoric acid contains 10 per cent, by weight of absolute orthophosphoric acid. Acidum Sulphuricum—Acidi Sulphurici—Sulphuric Acid. r. S. J\ Origin.—A liquid composed of not less than 92.5 per cent, by MINERAL ACIDS. IAl weight of Absolute Sulphuric Acid (H2S04 = 97.82) and not more than 7.5 per cent, of Water. Description and Properties.—A colorless liquid of oily con- sistence, inodorous, and very caustic and corrosive. Specific gravity not below 1.835 at 150 C. (590 F.). Miscible in all proportions with water and alcohol, with evolution of so much heat that the mixing requires great caution. Sulphuric acid should be kept in glass-stoppered bottles. Dose.—2-5 minims (0.12-0.3 Cc), well diluted. Official Preparations. Acidum Sulphuricum Aromaticum—Acidi Sulphurici AromStici—Aro- matic Sulphuric Acid.—Dose, 5-20 minims (0.3-1.2 Cc). Formula: Sulphuric Acid, 100; Tincture of Ginger, 50; Oil of Cinnamon, 1; Alcohol, to make 1000 parts. Acidum Sulphuricum Dilutum—Acidi Sulphurici Diluti—Diluted Sul- phuric Acid.—Dose, 5-20 minims (0.3-1.2 Cc). Diluted sulphuric acid contains 10 per cent, by weight of absolute sulphuric acid. Acidum Nitricum—Acidi NItrici—Nitric Acid. U. S. P. Origin.—A liquid composed of 68 per cent, by weight of Abso- lute Nitric Acid (HNOs = 62.89) and 32 per cent, of Wrater. Description and Properties.—A colorless, fuming liquid, very caustic and corrosive, and having a peculiar, somewhat suffocating odor. Specific gravity about 1.414 at 150 C. (590 F.). Nitric acid should be kept in dark, amber-colored, glass-stoppered bottles. Dose.—2-5 minims (0.12-0.3 Cc), well diluted. Official Preparations. Acidum Nitricum Dilutum—Acidi NItrici Diluti—Diluted Nitric Acid.— Dose, 5-20 minims (0.3-1.2 Cc). Diluted nitric acid contains 10 per cent, by weight of absolute nitric acid. Acidum Nitrohydrochloricum — Acidi Nitrohydrochlorici — Nitrohydro- chloric Acid.—Formula: Nitric Acid, 180; Hydrochloric Acid, 820 parts. Description and Properties:— A golden yellow, fuming, and very corrosive liquid, having a strong odor of chlorine. Completely volatilized by heat. It readily dissolves gold-leaf, and a drop of it added to potassium iodide T. S. liberates iodine. Dose.—1-3 minims (0.06-0.18 Cc). Acidum Nitrohydrochloricum Dilutum—Acidi Nitrohydrochlorici Diluti— Diluted Nitrohydrochloric Acid.—Dose, 5-20 minims (0.3-1.2 Cc). Formula: Nitric Acid, 40; Hydrochloric Acid, 180; Distilled Water, 780 parts. Antagonists and Incompatibles.—Hydrochloric acid and its preparations are incompatible (forming explosive compounds) with M2 A TEXT-BOOK OF MATERIA MEDICA. oxidizable substances—phosphorus, sulphur and the sulphides, alcohols, ethers, carbohydrates, etc. All the mineral acids are in- compatible with the alkalies and their carbonates, salts of lime, lead, and silver, and decompose glucosides. Synergists.—The action of hydrochloric acid upon the diges- tive system is aided by the digestive ferments and the vegetable bitters. Physiological Action.—The general action of mineral acids upon the various systems is herewith given in detail: Externally and Locally.—Applied in a concentrated form to the skin or to any tissue of the body, acids abstract the water from the tissues and destroy the protoplasm, acting as escharotics. Weaker solutions vesicate, merely inflaming the parts to which they are applied, without destroying the tissue, while extremely diluted or weak solutions are irritant and astringent. Internally.—Digestive System.—Diluted acids only should be administered internally. Save with reference to the poisonous effects of concentrated acids, therefore, the physiological action of diluted acids only will be here considered. The salivary glands are stimulated, resulting in an increased flow of saliva, moistening the mouth and allaying thirst. The appetite and digestion are improved, and the secretions from the liver and the duodenal glands are increased. Long-continued use of the mineral acids impairs digestion by lessening the normal secretion of the gastric glands, while protracted use may produce salivation. Mineral acids tend to constipate the bowels. Circulatory System.—Diluted acids in medicinal doses cause a rise in blood-pressure, and increased action of the heart, prob- ably due to their stimulating action on the vaso-motor mechanism. Concentrated acids relax the muscular tissue of both the heart and blood-vessels. Mineral acids combine with the albumin or the alkaline bases of the blood, lessening the alkalinity of that fluid. Nervous System.—Medicinal doses, so far as observed, produce no special action upon the nervous system other than to occasion a slight stimulation of the brain, due probably to a gentle arterial excitement. Respiratory System.—No important action under medicinal doses has been observed. Absorption and Elimination.—Mineral acids, above all hydro- chloric acid, are readily absorbed. They are quickly converted MINERAL ACIDS. 143 into neutral salts in the intestines, and are absorbed as such. The excess of the acid which does not enter into combination in the stomach and intestines is rapidly absorbed into the blood, com- bining with its alkaline bases, and in this form is excreted, princi- pally by the kidneys, as acid salts. Temperature.—Medicinal doses have no influence upon temper- ature. Untoward Action.—Mineral acids under too prolonged admin- istration impair the appetite and disturb digestion, occasioning toothache and gastric oppression, and at times salivation and diar- rhea. The prolonged use of nitric acid may produce erosion of the gums and tongue, with loosening of the teeth. Poisoning.—The mineral acids when taken in a concentrated form and in toxic doses act like corrosive poisons, causing intense burning in the stomach and intestines and active gastric inflamma- tion. Violent vomiting occurs, the ejected matter containing blood, and, in the case of hydrochloric acid, a white cloud of ammonium chloride is discerned if the ejecta be placed near the vapor of ammonia. The respiration is greatly depressed, and there is a strong, persistent acid taste in the mouth, the mucous membrane of which is discolored, while the tongue is swollen and inflamed. There is great thirst, and the pulse becomes rapid and tense. The temperature, at first elevated, soon falls below normal, pro- found prostration supervening, and death resulting either from shock or from secondary inflammation. A post-mortem examination shows the results of corrosive poi- soning : ulceration or evidences of intense inflammation of the mucous membrane of the mouth, esophagus, stomach, and intes- tines. Occasionally the walls of the latter are perforated. Should death be delayed for some time, there is found fatty degeneration of the kidneys and other internal organs. Treatment of Poisoning.—This should be prompt. The cautious administration of alkalies is indicated to neutralize the acid, though the evolution of carbonic-acid gas resulting therefrom may rupture the stomach. The stomach should be washed out, and this treat- ment followed by demulcent drinks and oil, milk, and eggs. Opium may be necessary for the relief of pain, and brandy or whiskey subcutaneously in case of collapse. Therapeutics.—Externally and Locally.—Hvdrochloric acid is employed as a caustic in noma and putrid sore throat. Mixed 144 A TEXT-BOOK OF MATERIA MEDICA. with two or three parts of honey, it is an efficient application to the throat in diphtheria. Andrews and Morris have recommended diluted hydrochloric acid for the remcrval of sequestra, and Chas- saignac has utilized the acid in removing necrosed bone in osteitis and caries. Nitric acid is a much more powerful caustic, and as such is used more extensively than any other mineral acid, because of its limited action and the ease with which it is controlled. It is an excellent caustic in cases of cancer of the cervix, venereal zvarts, hospital gangrene, phagedenic ulceration, hemorrhoids, and prolapse of the rectum, especially in the case of children. In cases also of fungoid granulation and excessive hemorrhage from the uterus it has been highly recommended. In certain diseases of the throat, nose, and car this acid has been used for the destruction of growths, as well as for its escharotic action in ulcerated conditions. Dermatologists find nitric acid to be an efficient application for the removal and destruction of epithelioma, moles, ncvi, chloasma, etc., caution being exercised in the latter case merely to produce an exfoliation of the skin, not sufficient destruction of tissue to result in a cicatrix. Liveing recommends a very weak solution of nitric acid with tincture of opium in pruritus. Phosphoric acid, in the strength of 50 grains (3.2) to the ounce (30.0 Cc.) of distilled water, has been suggested by Grossich in the treatment of scrofulous ulcers, and an injection of this solution into tuberculous glands of the neck is highly recommended by the same authority. Sulphuric acid is perhaps the most persistent, irritating, and destructive caustic known. Its affinity for water, and its consequent extensive action, render it when used alone unfit for caustic pur- poses. Mixed with powdered charcoal, however, it forms a paste which is an efficient caustic application to chancres, cancers, etc. Frazer considers the strong sulphuric acid the best caustic in the bites of rabid animals. Diluted solution, in the proportion of 6 parts of the strong acid to 4 parts of diluted alcohol, has been recommended for epistaxis. Internally.—Hydrochloric acid, being a normal constituent of the stomach, is indicated in certain forms of gastric dyspepsia, par- ticularly in the atonic variety. In these latter cases there is usually decomposition and fermentation of food, which condition is greatly MINERAL ACIDS. x45 relieved by the administration of pepsin or hydrochloric acid after meals, or the same with bitters before meals. In intestinal indigestion hydrochloric acid is an admirable rem- edy, given one or two hours after meals. The diluted hydrochloric acid is a valuable internal remedy in the treatment of diphtheria, and during the course of fevers, par- ticularly typhoid. As a routine treatment in the latter disease the author almost invariably gives hydrochloric acid in connection with pepsin, finding that it not only allays thirst and moistens the tongue, but exerts an antiseptic influence in the bowels, thereby lessening the danger of auto-infection and relapse. Alkiewicz recommends weak solutions of hydrochloric acid as efficacious in nausea and vomiting accompanying certain infectious diseases. In certain affections of the skin dependent upon deranged diges- tion hydrochloric acid often proves a potent remedy. Nitric acid has been used for the same purposes as hydro- chloric acid, although for digestive disorders it is inferior to the latter drug. In intermittent and periodical fevers, however, nitric acid is an efficient remedy. In hepatic disorders the diluted nitrohydrochloric acid deservedly holds a high place as a remedial agent, and the same remedy is frequently employed with success in chronic syphilis. In the conditions known as oxaluria and lithemia nitric and nitrohydrochloric acids serve an excellent purpose. The invaluable preparation introduced by Dr. Hope in 1826, known as " Hope's camphor mixture "—a combination of nitrous acid, camphor-water, and tincture of opium—has never been sur- passed as a remedy in serous diarrhea. The aphonia of singers and public speakers is often relieved by the diluted nitric acid, certain cases of bronchitis being also bene- fited by the same remedy. Melancholia and the hypochondriasis of dipsomaniacs are some- times relieved by diluted nitrohydrochloric acid. Phosphoric acid has acquired some reputation as a remedy in anemia and as a tonic in zvasting diseases and neurasthenia. Its value, however, is based more upon theory than upon the results of clinical observation. The experience of the author warrants the assumption that phosphoric is inferior to hydrochloric acid in these conditions, its action being entirely due to increasing diges- tion and thereby improving nutrition. Probably phosphoric acid is superior to the other mineral acids 10 146 A TEXT-BOOK OF MATERIA MEDICA. only in its action in diabetes, in which disease it certainly possesses a remarkable influence in diminishing thirst and lessening the secretion of urine. Sulphuric acid, in the author's opinion, is inferior to nitric or nitrous acid in serous diarrhea. It is nevertheless an invaluable, as well as an old and tried, remedy in cholera, the statistics furnished by the Insane Department of the Philadelphia Almshouse during an epidemic of this disease appearing to prove its efficacy. This remedy also deserves favorable consideration in the treat- ment of acute lead-poisoning. Moreover, in chronic lead-poisoning water acidulated with sulphuric acid makes an efficient prophylactic, and the remedy has also been suggested as a preventive of Asiatic cholera. Owing to its astringent and antiseptic properties this acid, par- ticularly the aromatic sulphuric acid, proves a good remedy in cer- tain cases of diarrhea. It is especially valuable in checking the sweating in phthisis. The same preparation has been found bene- ficial in hcmatcmcsis, as well as in intestinal and uterine hemorrhage. Where there is a tendency to dissolution of the blood, as in scurvy and purpura, sulphuric acid has proved valuable, and it has been recommended as an internal remedy in lichen, prurigo, and many itching diseases of the skin. Contraindications.—Acute inflammation of the stomach, rheu- matism, gout, and where the urine is excessively acid and of high specific gravity. Administration.—Only the diluted acids should be given in- ternally, and even these should be further diluted, and taken, if possible, through a glass tube, to prevent injury to the enamel of the teeth. They should not be administered for too long a period, and the first indication of untoward action, such as griping, diar- rhea, etc., is to be taken as a warning that the drug must be with- drawn. Acidum Lacticum—Acidi Lactici—Lactic Acid. U. S. P. Origin.—An organic acid usually obtained by subjecting milk sugar or grape sugar to lactic fermentation. It is composed of 75 per cent, by weight of Absolute Lactic Acid (CHC3H503 = 89.79) and 25 per cent, of Water. Description and Properties.—A colorless, syrupy liquid, odorless, of a purely acid taste, and absorbing moisture on ex- MINERAL ACIDS. 747 posure to damp air. Specific gravity about 1.213 at 150 C. (590 F.). Freely miscible with water, alcohol, or ether; insoluble in chloroform, benzin, or carbon disulphide. Dose.—20-30 minims (1.2-1.8 Cc), diluted and sweetened. Official Preparation. Syrupus C31cii Lactophosphatis—Syrupi Calcii Lactophosphatis—Syrup of Calcium Lactophosphate.—Dose, 1-2 fluidrachms (3.7-7.3 C). Formula: Precipitated Calcium Carbonate, 25; Lactic Acid, 60; Phosphoric Acid, 36; Orange Flower Water, 25; Sugar, 700; Water, q. s. ad 1000. Antagonists and Incompatibles.—Alkalies and the salts ot the mineral acids are incompatible with lactic acid. Synergists.—Pepsin, vegetable acids, hydrochloric acid, and sodium chloride. Physiological Action.—Externally and Locally.—Lactic Acid is a caustic to highly organized tissues, resembling the mineral acids in its local action. It dissolves false membrane to which it is applied. Internally.—Digestive System.—It is generally present in the stomach during the first forty-five minutes of stomachic digestion, but cannot be considered a normal constituent of the gastric juice. Circulatory System.—Being absorbed from the stomach, it com- bines with bases in the blood, forming lactates which are rapidly converted into carbonates. In certain morbid conditions of the system, such as acute rheumatism, it is found free in the blood. Richardson has produced endocarditis in dogs by injecting lactic acid into the peritoneal cavity. Large doses decrease the normal alkalinity of the blood. Nervous System.—Large doses greatly depress the nervous sys- tem, frequently producing neuralgia and myalgia. Absorption and Elimination.—It is absorbed from the stomach, undergoes a change in the blood, and is eliminated by the kidneys, although, according to Lehmann, when large doses have been taken it is found in the urine unchanged; and we have Benzelius and Scherer as authorities that lactic acid can be detected in the spleen and the muscular fluid and has been found in the exudates of puerperal fever. Untozvard Action, Poisoning, and Treatment of Poisoning are similar to those of the mineral acids. Therapeutics.—Externally and Locally.—It has been used I48 A TEXT-BOOK OF MATERIA MEDICA. locally for the same purposes as the mineral acids, but it is thought by many clinicans to be superior to the latter in tubercu- lous ulceration. In the Hamburg General Hospital, Dr. Zippel has employed it with excellent success in the treatment of tubercu- lous fistulae. He inserted into the fistula rods made of lactic acid, gelatin, and menthol, enveloped with a thin layer of collodion. As a solvent of false membranes lactic acid is unquestionably superior to the mineral acids, being highly recommended for this purpose in diphtheria and croup by such authorities as Morell Mackenzie, Lennox Browne, Weber, Dureau, etc. Internally.—Digestive System.—It is used in the digestive dis- orders, such as atonic and irritative dyspepsia, and in all those derangements of digestion which are benefited by hydrochloric acid. In oxaluria, lithemia, chronic cystitis with ammoniacal urine, chronic dysentery, and dyspeptic and tuberculous diarrhea it has proved an efficient remedy. It has been recommended by Dr. Foucaut as a prophylactic in gout. Since this drug was suggested by Cantani as a remedy in dia- betes mcllitus it has been used with varying success. Balfour and Foster, as well as Cantani himself, have reported many cases which have greatly improved under the administraton of lactic acid accompanied by an appropriate dietetic regimen. In the continued use of this drug for diabetes, however, it is well to remember that acute rheumatism and rheumatic endocarditis may be induced, endangering the life of the patient even more than the disease for which the drug was prescribed. Lactic acid has been recommended by Preyer, Mendel, and Maragliano as a hypnotic. Yet the authority appears to rest rather upon theoretical deduction than the result of clinical observation. Contraindications.—The same as for mineral acids. Administration.—Lactic acid should be given well diluted. GROUP IV.—VEGETABLE ACIDS. Acidum Aceticum—Acidi Acetici—Acetic Acid. 77. S. P. Origin.—A liquid composed of 36 per cent, by weight of Ab- solute Acetic Acid (HC2H302= 59.86) and 64 per cent, of Water. Description and Properties.—A clear, colorless liquid, having VEGETABLE ACIDS. 149 a strong, vinegar-like odor, a purely acid taste, and a strongly acid reaction. Miscible with water or alcohol in all proportions. Dose.—The diluted acid only is given internally. Official Preparation. Acidum Aceticum Dilutum—Acidi Acetici Diluti—Diluted Acetic Acid.__ Dose, 1-2 fluidrachms (3.7-7.4 Cc). Acidum Cltricum— Acidi Citrici—Citric Acid. U. S. P. Origin.—An organic acid usually prepared from lemon-juice. Description and Properties.—Colorless, translucent, right- rhombic prisms; odorless, having an agreeable, purely acid taste; efflorescent in warm air and deliquescent when exposed to moist air. Soluble in 0.63 part Water, in 1.61 parts of alcohol, in about 0.4 part of boiling water, and in 1.43 parts of boiling alcohol. Dose.—5-20 grains (0.3-1.25 Gm.). Official Preparation. Syrupus Acidi Citrici—Syrupi Acidi Citrici—Syrup of Citric Acid.—Dose, 2-8 fluidrachms (7.4-30. Cc.) (10 per cent.). Acidum Tartaricum—Acidi Tartarici—Tartaric Acid. U.S. P. Origin.—An organic acid usually prepared from argols. Description and Properties.—Colorless, translucent, mono- clinic prisms, or crystalline crusts, or a white powder; odorless, having a purely acid taste, and permanent in air. Soluble in about 0.8 part of water and in 2.5 parts of alcohol; also in about 0.5 part of boiling water and in 0.2 part of boiling alcohol. DOSe.—10-30 grains (0.6-2.0 Gm.). Antagonists and Incompatibles.—Alkalies are chemically in- compatible with the vegetable acids. With the alkaline, earthy, and metallic bases vegetable acids unite to form salts, the acetates of which are all soluble. Synergists.—Alkalies, and, under certain circumstances, mineral acids and the digestive ferments. Physiological Action.—Externally and Locally.—The vege- table acids have about the same action externally and locally as the diluted mineral acids, not caustic but irritant, acetic acid being the most powerful and citric acid the weakest. 15° A TEXT-BOOK OF MATERIA MEDICA. Internally.—Digestive System— Their action on the salivary and gastric glands is similar to that of the mineral acids. Their influ- ence upon the stomach is not so marked as that of hydrochloric acid, though the secretions from the intestinal glands are more augmented by vegetable than by mineral acids. Too large or prolonged doses of the vegetable acids produce flatulence and abdominal pain, and may even occasion diarrhea or enteritis. Circulatory System.—Large doses retard and weaken the pulse. As with mineral acids, their tendency is to lessen the alkalinity of the blood. They unite with alkalies in the stomach to form salts, and as such enter the blood, where they are oxidized, the product being carbonic acid, which lessens the alkalinity of the blood and increases the acidity of the urine. Absorption and Elimination.—As stated, vegetable acids unite with the alkalies to form salts, as such entering the circulation. They are eliminated chiefly by the kidneys, increasing the excre- tion of both water and solids. Elimination also takes place to a considerable extent by the intestinal canal. Untozvard Action.—Under prolonged dosage there is great ema- ciation, deterioration of the blood, and a scorbutic condition. Poisoning.—Their toxic effects are almost identical with those of the mineral acids, the Treatment of Poisoning being the same as with the latter. Therapeutics.—Externally and Locally.—All the above-named vegetable acids are irritant, more or less antiseptic, and hemo- static, acetic acid being the most powerful antiseptic of the three. Englemann regards acetic acid as superior to mercuric chloride as a disinfectant in obstetrical practice, employing a solution of from 3 to 5 per cent, for this purpose. A diluted solution is a valuable injection in gonorrhea of the female. The glacial acetic acid is a powerful caustic, and is much used to dissolve horny growths, warts, corns, etc. The most important use of acetic acid is in the treatment of certain parasitic skin diseases, probably no remedy excelling it in cases of ringzuorm and pityriasis. Diluted acetic acid, or vinegar, is an efficient gargle in simple sore throat and the last stage of angince of exanthemata, as well as a valuable hemostatic, espe- cially in epistaxis. Citric acid is but little used locally, although solutions have been employed with some success to relieve the itching and sting- ing of " prickly heat" and urticaria. A sponge-bath of vinegar ALKALIES. x5i and water is a grateful and efficient means of reducing temperature and checking excessive sweating in disease. Tartaric acid has been used by Potter as an application to the throat in diphtheria, the effect being to convert the membrane into a gelatinous mass which is more easily expelled. Internally.—Acetic acid is little used internally. Citric acid, however, in the form of a lemonade, is a refreshing refrigerant drink in fevers, while a similar hot lemonade taken at bedtime is a valuable and agreeable means of aborting a " cold." Lemon- or lime-juice is an infallible prophylactic against scurvy, being unques- tionably the most efficient remedy for the disease. It is well known by the laity that eating lemons increases the functional activity of the liver. Lemons and citric acid, there- fore, are efficient remedies in relieving attacks of biliousness and catarrhal jaundice, and they even appear to counteract the effects of malaria. Lemon-juice is an old and esteemed remedy in acute rheumatism. Vegetable acids are used for the same disorders of the digestive tract as mineral acids, although not so efficient as the latter, espe- cially the hydrochloric. Much of the benefit derived from sour table-wines is due to the fruit-acids they contain. Contraindications.—Ordinarily the same as for mineral acids. It is a matter of observation that nursing mothers may produce a troublesome diarrhea in the infant by partaking too freely of vine- gar or acid fruits. Administration.—A solution of citric acid may be made of about the acidity of lemon-juice by dissolving 570 grains (36.93 Gm.) in 1 pint (473.17 Cc.) of distilled water. Vegetable acids when taken internally should be mixed with, or dissolved in, water and diluted and sweetened, that they may be pleasant to the taste and acceptable to the stomach. GROUP V.—ALKALIES. Alkalies are classed as Restoratives because the blood and many secretions of the body are normally alkaline in reaction. The fol- lowing drugs are numbered among alkalies or antacids: Liquor pot;issae, potassii acetas, potassii bicarbonas, potassii bitartras, potassii carbonas, potassii citras, potassii tartras, liquor sodae, sodii 152 A TEXT-BOOK OF MA TERIA MEDICA. acetas, sodii bicarbonas, sodii carbonas, sodii carbonas exsiccatus, calcii carbonas praecipitatus, creta preparata, liquor calcis, mistura cretae, syrupus calcis, lithii benzoas, lithii carbonas, lithii citras, lithii citras effervescens, lithii salicylas, magnesii carbonas, ammonii carbonas, spiritus ammoniae aromaticus. Liquor Potassae—Liquoris Potassae—Solution of Potash. U.S. P. Origin.—An aqueous solution of Potassium Hydrate containing about 5 per cent, of the Hydrate. Description and Properties.—A clear, colorless liquid, odor- less, having a very acrid and caustic taste and a strongly alkaline reaction. It should conform to the same reaction and tests as an aqueous solution of potassa. (See Potassa.) Dose.—5-20 minims (0.3-1.2 Cc), well diluted. Potassii Acetas—Potassii Acetatis—Potassium Acetate. 77. S. P. Origin.—Prepared by the action of Acetic Acid upon Potassium Carbonate. Description and Properties.—A white powder or crystalline masses, of a satiny lustre, odorless, and having a warm, saline taste; very deliquescent on exposure to the air. Soluble in 0.36 part of water and in 1.9 parts of alcohol; with increasing tempera- ture it becomes much more soluble in both liquids. Potassium acetate should be kept in well-stoppered bottles. Dose.—15-60 grains (1.0-4.0 Gm.). Potassii Bicarbonas—Potassii Bicarbonatis—Po- tassium Bicarbonate. 77. S. P. Origin.—Prepared by the action of Carbon Dioxide upon a solution of the Carbonate. Description and Properties.—Colorless, transparent, mono- clinic prisms, odorless, and having a saline and slightly alkaline taste. Permanent in the air, soluble in 3.2 parts of water at 150 C. (590 F.) and in 1.9 parts at 500 C. (1220 F.). At a higher temper- ature the solution rapidly loses carbon dioxide, and, after boiling, contains only potassium carbonate. It is almost insoluble in alcohol. The drug should be kept in well-stoppered bottles. Dose.—10-40 grains (0.6-2.5 Gm.). ALKALIES. 153 Potassii Bitartras—Potassii Bitartratis— Potassium Bitartrate. V. S. P. (Cream of Tartar.) Origin.—Prepared by purifying and crystallizing Argol or Crude Tartar, a residuum of grape-juice after fermentation. Description and Properties.—Colorless or slightly opaque, rhombic crystals, or a white, somewhat gritty powder, odorless, and having a pleasant, acidulous taste ; permanent in the air. Sol- uble in about 200 parts of water and in about 16.7 parts of boiling water; very slightly soluble in alcohol. Dose.—10 grains—\ ounce (0.6-16.0 Gm.). Official Preparation. Pulvis Jalapae CompOsitus—Pulveris Jalapae Conipttsiti—Compound Pow- der of Jalap.—Dose, 10-30 grains (0.6-2.0 Gm.); used as a hydragogue cathartic. Potassii Carbonas—Potassii Carbonatis—Potas- sium Carbonate. U.S. P. Origin.—Prepared from the ash obtained from the residue of the beet-sugar manufacture. It may also be obtained from wood-ashes. Description and Properties.—A white, granular powder, odor- less, and having a strongly alkaline taste ; very deliquescent; solu- ble in 1.1 parts of water at 150 C. (590 F.) and in about 0.65 part of boiling water; insoluble in alcohol. Its aqueous solution (1 in 20) has a strongly alkaline reaction upon litmus-paper, and effer- vesces with acids. Potassium carbonate should be kept in well- stoppered bottles. Dose.—5-30 grains (0.3-2.01 Gm.). Potassii Citras—Potassii Citratis—Potassium Citrate. U.S. P. Origin.—Prepared by the action of Citric Acid upon a solution of Potassium Carbonate. Description and Properties.—Transparent, prismatic crystals, or a white, granular powder, odorless, and having a cooling, saline taste; deliquescent on exposure to the air. Soluble in 0.6 part of water at 150 C. (590 F.), and very soluble in boiling water; feebly soluble in alcohol. Potassium citrate should be kept in well-stop- pered bottles. Dose.—15-60 grains (1.0-4.0 Gm.). 154 A TEXT-BOOK OF MATERL l MEDICA. Potassii Tartras—Potassii Tart rat is—Potassium Tartrate. (Unofficial.) Origin.—Prepared by the action of Acid Potassium Tartrate upon Potassium Carbonate. Description and Properties.—It occurs usually in the form of a granular or fine white powder, inodorous, and of a saline, bitter- ish taste. Soluble in 0.75 part of water at 2° C. (35.60 P\), and in 0.47 part of water at 640 C. (147.20 P\). Dose.—30 grains—\ ounce (2.0-16.0 Gm.). preparations of sodium. Liquor Sodae—Liquoris Sodae—Solution of Soda. U. &. P. (Solution of Sodium Hydrate.) Origin.—An aqueous solution of Sodium Hydrate (NAOH = 39.96), containing about 5 per cent, of the Hydrate. Description and Properties.—A clear, colorless liquid, odor- less, having a very acrid and caustic taste and a strongly alkaline reaction. Dose.—5-20 minims (0.3-1.8 Cc). Sodii Acetas—Sodii Acetatis—Sodium Acetate. U. S. P. Origin.—It may be obtained by neutralizing Acetic Acid with Sodium Carbonate. The usual article, however, is manufactured on a large scale in the United States in the process of purifying acetic acid from wood vinegar. Description and Properties.—Colorless, transparent, mono- clinic prisms, or a granular, crystalline powder, odorless, and having a cooling, saline taste; efflorescent in warm, dry air. Soluble in 1.4 parts of water and in 30 parts of alcohol; also in 0.5 part of boiling water and in 2 parts of boiling alcohol. Sodium acetate should be kept in well-stoppered bottles. Dose.—15-60 grains (1.0-4.0 Gm.). Sodii Bicarbonas—Sodii Bicarbonatis—Sodium Bicarbonate. U. S. P. Origin.—Prepared by saturating a mixture of 2 parts of Crys- tallized and 3 parts of Dried Sodium Carbonate with Carbon Diox- ALKALIES. 155 ide, generated by the action of hydrochloric acid upon marble. The damp Salt formed is shaken with half its weight of Distilled Water, the undissolved portion being dried by exposure to the air. Description and Properties.—A white, opaque powder, odor- less, and having a cooling, mildly alkaline taste; permanent in dry, but slowly decomposed in moist, air. Soluble in 11.3 parts of water at 150 C. (590 F.); above that temperature the solution loses carbon dioxide, and at a boiling heat the salt is entirely converted into normal carbonate. Insoluble in alcohol and ether. The drug should be kept in well-closed vessels, in a cool place. Dose.—10-30 grains (0.6-2.0 Gm.). Official Preparations. Mistura Rhei et Sodae—Misturse Rhei et Sodae—Mixture of Rhubarb and Soda.—Dose, \-2 fluidounces (7.4-59 Cc). Trochisci Sodii Bicarbonatis—Trochiscos (ace) Sodii Bicarbonatis— Troches of Sodium Bicarbonate.—Dose, 1 to 6 troches. Sodii Carbonas—Sodii Carbonatis—Sodium Carbonate. 77. S. P. Origin.—Obtained from Sodium Sulphate and Sodium Chloride, but chiefly by a complicated process, known as Lcblancs, from Sodium Sulphate, which is mixed with Chalk and Coal, the mixture ignited, and the resultant mass exhausted with Water and concen- trated, the carbonate separating from the hot liquid being purified. Description and Properties.—Colorless, monoclinic crystals, having a strongly alkaline taste. In dry air the salt effloresces, and if left exposed soon loses about half its water of crystallization (3146 per cent, of its weight), becoming a white powder. Soluble in 1.6 parts of water at 150 C. (590 F.), in 0.09 part at 380 C. (100.40 F.), in 0.2 part of boiling water, and in 1.02 parts of glycerin; insoluble in alcohol and ether. The aqueous solution gives an alkaline reaction with litmus-paper, and effervesces strongly with acids. The drug should be kept in well-closed vessels. Dose.—10-30 grains (.06-2.0 Gm.). Official Preparation. Sodii Carbonas Exsiccatus—Sodii Carbonatis Exsiccati—Dried Sodium Carbonate.—Description and Properties.—A loose white powder, conforming to the reactions and tests for sodii carbonas. Dose.—3-10 grains (0.2-0.6 Gm.). 156 A TEXT-BOOK OF MATERIA MEDICA. PREPARATIONS OF CALCIUM. Calcii Carbonas Praecipitatus—Calcii Carbonatis Praecipitati—Precipitated Calcium Carbonate. 77. S. P. Origin.—Prepared by mixing aqueous solutions of Calcium Chloride and Sodium Carbonate, the resulting precipitate of Cal- cium Carbonate being purified. Description and Properties.—A fine white powder, without odor or taste, permanent in the air. Nearly insoluble in water, its solubility being increased by the presence of ammonium salts, and especially by carbonic acid, and diminished by alkali hydrates. Insoluble in alcohol, but in diluted acetic, hydrochloric, or nitric acid completely soluble, with effervescence. Dose.—15-30 grains (1.0-2.0 Gm.). Creta Praeparata—Cretae Praeparatae— Prepared Chalk. U. S. P. Origin.—Native, friable Calcium Carbonate freed from most im- purities by elutriation. Description and Properties.—A white, amorphous powder, often moulded into conical drops, odorless and tasteless, permanent in the air. Almost insoluble in water ; insoluble in alcohol; soluble in diluted acetic, hydrochloric, or nitric acid, with copious efferves- cence, but without leaving more than a trifling residue. Dose.—5-60 grains (0.3-4.0 Gm.). Official Preparations. Hydrargyrum cum CretS—Hydrfirgyri cum Creta—Mercury with Chalk.— Dose, 2-10 grains (0.12-0.6 Gm.). (Described under Hydrargyrum.) Pulvis Cretae CompSsitus—Ptllveris Cretae Comp6siti -Compound Chalk Powder.—Dose, 20-60 grains (1.30-4.0 Gm.). Trochisci Cretae—Trochiscos (ace) Cretae—Troches of Chalk.—Dose, ad libitum. Unofficial Preparations. Ptilvis Cretae AromSticus—Ptilveris Cretae AromStici—Aromatic Powder of Chalk.—Dose, 30-60 grains (2.0-4.0 Gm.). A mixture of Aromatics with Chalk. Pulvis Cretae Aromatticus cum Opio—Ptilveris Cretae AromStici cum Opio —Aromatic Powder of Chalk and Opium.—Dose, 10-20 grains (0.6-1.30 Gm.). I grain (.06 Gm.) of Opium in every 40 grains (2.5 Gm.) of the previous mixture. ALKALIES. x57 Liquor Calcis—Liquoris Calcis—Solution of Lime. U. S. P. (Solution of Calcium Hydrate; Lime Water.) Origin.—A saturated, aqueous solution of Calcium Hydrate. Description and Properties.—A clear, colorless liquid, without odor, and having a saline and feebly caustic taste. It absorbs carbon dioxide from the air, so that a pellicle of calcium carbonate forms on the surface of the liquid. On being heated it becomes turbid through separation of calcium hydrate, which redissolves when the liquid is cooled. It gives a strong alkaline reaction with litmus paper. Dose.—^-4 ounces (15.0-118.3 Cc). Official Preparations. LinimSntum CSlcis—LinimSnti Calcis—Lime Liniment (Carron Oil).— For external use. Mistura Cretae—Mistiirae Cretae—Chalk Mixture.—Dose, 1-4 fluidrachms (4.0-15. Cc). Compound Chalk Powder, Cinnamon Water, and \\ater. Syrupus CSlcis—Syrupi CSlcis—Syrup of Lime.—Dose, \-2 fluidrachms (I.8-7.4 Cc). PREPARATIONS OF LITHIUM. Lithii Carbonas—Lithii Carbonatis—Lithium Carbonate. U. S. P. Origin.—Lithium is found in many mineral waters, the carbon- ate being prepared from lepidolite. Description and Properties.—A light white powder, odorless, and having an alkaline taste; permanent in the air. Soluble in 80 parts of water and 140 parts of boiling water; much more soluble in water saturated with carbon dioxide; insoluble in alcohol, but soluble in diluted acids, with active effervescence. Dose.—2-10 grains (o. 12-0.6 Gm.). Lithii Citras—Lithii Citratis—Lithium Citrate. U. S. P. Origin.—Prepared by adding Lithium Carbonate to a solution of Citric Acid. Description and Properties.—A white powder, odorless, and having a cooling, faintly alkaline taste; deliquescent on exposure to the air. Soluble in 2 parts of water and in 0.5 part of boiling 158 A TEXT-BOOK OF MATERIA MEDICA. water ; almost insoluble in alcohol or ether. Lithium citrate should be kept in well-stoppered bottles. Dose.—2-10 grains (0.12-0.6 Gm.). Official Preparation. Lithii Citras Effervescens—Lithii Citratis Effervescentis—Effervescent Lithium Citrate.—Dose, 1-2 drachms (4.0-8.0 Gm.). PREPARATIONS OF MAGNESIUM. Magnesia—Magnesiae—Magnesia. 77 S. P. (Light Magnesia; Calcined Magnesia.) Origin.—Prepared by subjecting Magnesium Carbonate to a low red heat in a Cornish or Hessian crucible closed loosely by a lid. Description and Properties.—A white, very light, and very fine powder, without odor, and having an earthy, but not a saline, taste. On exposure to the air it slowly absorbs moisture and car- bon dioxide. Almost insoluble in water and insoluble in alcohol, but soluble in diluted acids. Magnesia should be kept in well- closed vessels. Dose.—As an antacid, 10-15 grains (0.6-1.0 Gm.). Official Preparation. Pulvis Rhei Compfisitus—Ptilveris Rhei Comp6siti—Compound Powder of Rhubarb.—Dose, as a laxative, 20-60 grains (1.30-4.0 Gm.). Formula: Rhubarb, 25 ; Magnesia, 65 ; Ginger, 10 parts. Magnesii Carbonas— Magnesii Carbonatis— Magnesium Carbonate. 77. S. P. Origin.—Prepared by evaporating to dryness the mixed solu- tions of Magnesium Sulphate and Sodium Carbonate, and purifying and drying the residue. Description and Properties.—Light, white, friable masses, or a light, white powder, without odor, and having a slightly earthy taste; permanent in the air. Almost insoluble in water, to which, however, it imparts a slightly alkaline reaction; insoluble in alco- hol, but soluble in diluted acids, with active effervescence. Dose.—As an antacid, 5-20 grains (0.3-1.3 Gm.). PREPARATIONS OF AMMONIUM. Ammonii Carbonas—Ammonii Carbonatis— Ammonium Carbonate. 77. S. P. Origin.—Prepared by a complicated process by heating in an iron or earthen retort a mixture of Sal Ammoniac and Chalk. ALKALIES. r59 Description and Properties.—White, hard, translucent, striated masses, having a strongly ammoniacal odor without empyreuma, and a sharp, saline taste. On exposure to the air the salt loses both ammonia and carbonic acid, becoming opaque, and is finally converted into friable porous lumps or a white powder. Slowly but completely soluble in about 5 parts of water at 150 C. (590 F.) and decomposed by hot water, with the evolution of carbonic acid and ammonia. By prolonged boiling with water the salt is com- pletely dissipated. The aqueous solution possesses a strongly alkaline reaction and effervesces with acids. Dose.—3-10 grains (0.18-0.6 Gm.). Official Preparation. Spiritus Ammoniae Aromaticus—Spiritus Ammoniae Arom3tici—Aromatic Spirit of Ammonia.—Composition: Ammonium Carbonate, Ammonia Water, Aro- matic Oils, Alcohol, and Water. Description and Properties.—A nearly colorless liquid when freshly prepared, but gradually acquiring a somewhat darker tint. It has a pungent, ammoniacal odor and taste. Dose.—\-\ fluidrachm (1.8-3.7 Cc). Antagonists and Incompatibles.—The alkalies and their car- bonates are incompatible with acids and with metallic salts. The ammonium carbonate is incompatible with the acidulous salts and with lime water. Synergists.—Agents promoting waste, such as vegetable acids, mercury, iodine, etc., increase the therapeutic activity of the alkalies. Physiological Action.—The alkalies mentioned in this group may be divided into direct antacids, or those which neutralize or lessen the acidity of the stomach, and indirect antacids, or those which, being oxidized in the blood, are excreted as carbonates, diminishing the acidity of the urine and increasing the alkalinity of the blood, although not influencing the acidity in the stomach. The direct antacids are lime water, prepared chalk, and magnesia. The indirect antacids are potassium acetate, bitartrate, citrate, and tartrate, sodium acetate, and lithium citrate. The following alkalies are both direct and indirect antacids: solution of potassa, solution of soda, carbonates and bicarbonates of potassium, sodium, lithium, magnesium, and ammonium. The physiological action of the various alkalies will now be considered in detail. 160 A TEXT-BOOK OF MATERIA MEDICA. Externally and Locally.—The hydrates of potassium and sodium are caustic and rubefacient. The solutions of soda and potassa, when applied undiluted, irritate the surface of the skin and soften and dissolve the epidermis and horny tissues, uniting with the albumin of the various structures to form a soluble alkali-albu- minate. The carbonates and bicarbonates exert a similar, though much weaker, action, while the acetates, bitartrates, citrates, and tartrates have no local influence. The ammonium salts do not affect the epidermis in the manner of those previously mentioned, penetrating without dissolving it, irritating the underlying structures, and inducing an effusion of lymph, thus acting as vesicants. Should a strong solution of ammonia be applied to the skin and evaporation be prevented, suppuration and sloughing may ensue. Internally.—Digestive System.—Potassium salts in small doses promote the secretion of gastric juice, thus obeying the law by which alkalies augment acid secretions. Large doses neutralize free acid in the stomach, and, by rendering the chyme neutral or alkaline, interfere with the secretion from the pancreas, liver, and intestines, thereby deranging digestion. Circulatory System.—The salts of potassium, by lessening the acidity of the gastric juice and entering the circulation, increase the alkalinity of the blood. The bicarbonates, however, taken in large doses upon an empty stomach, enter the circulation unchanged, where, by decomposing the neutral phosphate of sodium present, they form the acid phosphate of sodium, reducing the alkalinity of the blood and increasing the acidity of the urine. Far different are the effects of these alkalies when taken after meals, the salts being then decomposed in the stomach by the acid gastric juice, the alkaline base increasing the alkalinity of the blood. The acetates, citrates, and bitartrates enter the blood unchanged. The acid radical being destroyed, and the base combining with the carbon dioxide formed, the salts are converted into the alkaline car- bonates, increasing the alkalinity of the blood and urine. It is believed that the amount of hemoglobin is increased by the potas- sium salts when the blood is deficient in this substance, though large doses interfere with the ozonizing function of the red blood- corpuscles. Should the caustic alkalies be injected directly into the blood, death quickly ensues from coagulation of that fluid, arising from ALKALIES. 161 excessive formation of alkali-albuminate. Under very large or poisonous doses the heart-muscle is weakened, decreasing the force of its contractions, arrest taking place in diastole. Even medicinal doses, if long continued, may occasion cardiac depression, diminish- ing the force of the circulation. Small doses may increase blood- pressure, though the pulse-rate be diminished. Brunton and Cash have demonstrated that minute amounts of potassium salts applied to muscle increase its contractile power, while large doses diminish or paralyze this force. Nervous System.—When potassium salts are administered in medicinal doses and for a reasonable length of time, no important action upon the nervous system is produced ; but if excessive doses be taken, the nerve-centers and motor nerves are paralyzed, after a period of temporary excitement. Owing, however, to the fact that potassium is a protoplasmic poison, affecting alike the muscles and nerve-tissues, its salts should not be given in full doses for too long a period without counteracting their depressing influence by the use of muscle- and nerve-tonics. Respiratory System.—The only action of importance upon the respiratory system is the increased amount and diminished viscidity of the secretion from the bronchial tubes. Absorption and Elimination.—The potassium salts possess very high diffusive power. They are easily and quickly absorbed and rapidly excreted, the salts with vegetable acids being eliminated as alkaline carbonates, rendering the urine alkaline. Salts of potas- sium are chiefly eliminated by the kidneys, though the process takes place to some extent through the bronchial mucous mem- brane and other secretions. They are active diuretics, increasing the amount of water and, by stimulating the renal epithelium, augmenting the excretion of solids. The uric acid is greatly dimin- ished, being converted into urea, and as such eliminated, showing that the alkalies increase oxidation and promote waste. Temperature.—Medicinal doses have no effect upon temperature. Untozvard Action.—Under prolonged dosage the digestion be- comes impaired. There is present paralysis of the muscular fibers of the intestines, accompanied by diarrhea or constipation and tym- panites. There may be also present emaciation, muscular weakness, nervous prostration, and anemia. Poisoning.—The caustic preparations of potassium produce all the symptoms of a corrosive mineral poison, somewhat resembling the poisonous action of the mineral acids already described. Death 11 162 a TEXT-BOOK OF MATERIA MEDICA. is occasionally preceded by convulsions, the heart's action being arrested before respiratory failure. The carbonates and bicarbonates and the salts of vegetable acids are not considered poisonous, nor do they produce the corrosive effects of caustic potash or its solution. Treatment of Poisoning.—Vegetable acids are chemically incom- patible, and should be given freely, together with oils and demul- cent drinks as protectives, and opium, if necessary, to relieve pain. Cardiac stimulants—digitalis, brandy, caffeine, etc.—may be required to sustain the heart, to be given hypodermically. The Comparative Action of the Alkalies.—Sodium salts in their action are analogous to potassium, although less irritating to the gastro-intestinal tract. They are also less depressing to the circulatory, muscular, and nervous systems. They differ from the potassium salts in that they lengthen, instead of shortening, the muscular curve. They are neither absorbed nor eliminated so rapidly, and are consequently less active as diuretics. They are not nearly so powerful solvents of uric acid, and are therefore inferior to the potassium salts in gout. Indeed, the nodules, known as " chalk-stones," frequently found upon the joints of gouty pa- tients are composed of urate of sodium. Lithium salts closely resemble in their effects those of potas- sium, their action upon the nerves and muscles, however, being less powerful. The contractile force of muscle is invariably di- minished by lithium and increased by potassium. As a solvent of uric acid, lithium is the most powerful of all the alkalies, the urates, formed under the administration of the carbonate or citrate, being extremely soluble, rendering the alkaline salts of lithium superior to the other alkalies in gout and in the uric-acid diathesis. Calcium salts are more sedative and astringent in their action upon the gastro-intestinal tract than the other alkalies, and are direct antacids. They tend to produce constipation. The nervous and muscular systems are less affected by these salts than by the remaining alkalies, the contractile muscular force, however, being increased by calcium. They are less readily absorbed and excreted than the foregoing alkalies, and less active in increasing the alka- linity of the urine. Magnesium Salts.—Magnesia and the magnesium carbonates are direct antacids and sedative to the stomach, acting upon the intestinal canal as saline cathartics. In their influence upon the circulatory system they are feebler than, but similar to, the potas- sium salts, slightly increasing the alkalinity of the blood. They ALKALIES. 163 are not so readily absorbed, nor so rapidly excreted, as the salts of potassium and sodium, while increasing the amount of water and solids excreted and acting as solvents of uric acid. Ammonium Salts.—These preparations are used rather as car- diac stimulants, their physiological action being more extensively considered under that group. As antacids their action may be briefly compared with that of the other alkalies. Their effect upon the gastric juice and its secretion is similar to that of the car- bonates and bicarbonates above mentioned. They dilate the blood- vessels of the stomach, augmenting the blood-supply and pro- ducing a sensation of warmth in the epigastrium. Lethal doses act as emetics. They increase the glycogenic function of the liver and stimulate the circulatory system, elevating the pulse-rate and rais- ing arterial tension. In medicinal doses they stimulate the spinal cord, motor nerves, and muscles, while toxic doses paralyze these structures. They prevent the coagulation of the blood and lessen the oxygen-carrying power of the red corpuscles. By them also the respirations are increased in frequency. The salts of ammonium are quickly absorbed and undergo oxi- dation in the body, augmenting the amount of uric acid and urea in the urine, thereby increasing its acidity to some extent. As regards the poisonous activity of the alkalies mentioned, ammonium ranks next to potassium, the most toxic of all. Therapeutics.—Externally and Locally.—Norton has recom- mended liquor potasS/E in ingrozving toe-nail, the solution being applied to the nail, which is soon rendered so soft that it can be easily scraped without causing pain. The same remedy is used in many diseases of the skin to allay itching and soften the horny epithelium. It is also employed extensively in diseases of the car and throat, and in the proportion of 1 part to 10 of water it is very effective in softening impacted cerumen. The potassium carbonate in solution is frequently used in various pruriginous diseases of the skin, being a highly efficient antipruritic. The detergent and sialagogue properties of potassium citrate and tartrate are rendered serviceable in certain diseases of 'the mouth. Sodium bicarbonate is a deservedly popular dressing for burns, and pain and swelling of the joints in acute articular rheumatism are sometimes greatly relieved by enveloping the articulations in a hot solution rendered alkaline with this salt. T. Michailoff highly recommends sodium bicarbonate in granular tonsillitis and pharyn- gitis, the powdered salt being applied every two or three hours. 164 A TEXT-BOOK OF MATERIA MEDICA. In diseases of the ear it is used for the same purposes as the potas- sium preparations above mentioned. It is one of the ingredients of " Dobell's Solution," which is an effective antiseptic wash in nasal catarrh, and the solution of sodium bicarbonate has been sug- gested by Forchheimer as a valuable remedy in thrush or aphtha. Sodium carbonate may be used for the same purposes as the bicarbonate, though probably inferior to it in all cases save infantile eczema capitis, in which condition it is a most valuable remedy for softening the eczematous crusts. Prepared chalk is an ingredient of many ointments used in the treatment of erysipelas and subacute eczema. Lime water, mixed with equal parts of linseed or olive oil, is highly prized as a dress- ing for bums, and the efficiency of the " black " and " yellow" washes in the treatment of venereal sores is too well known to require further testimony in their favor. These latter preparations also make excellent applications in acute eczema. Lime water may sometimes be used with advantage in leucorrhea and z'agimtis. Lithii carbonas, in the proportion of 5 grains (0.3 Gm.) to 1 ounce (30.0 Cc.) of water, is highly recommended by Garrod for the removal of gouty deposits, the solution being kept con- stantly applied to the parts by means of lint or absorbent cotton. Magnesium carbonate makes an efficient dusting powder in der- matitis and irritable conditions of the skin. Ammonium carbonate mixed with lanolin readily dissolves the epidermic scales of psori- asis, and the aromatic spirit of ammonia is a grateful application to the scalp in pityriasis. Internally.—Digestive System.—The carbonates and bicarbon- ates, when given before meals, serve to increase the flow of gastric juice. They act as sedatives to the stomach, particularly in painful conditions arising from a deficient secretion of gastric juice. As antacids, when given after meals, they are very useful in counter- acting excessive acidity of the stomach. The acidity due to the formation of fatty acids, the result of defective digestion, is not relieved by the administration of these salts after meals, but if taken before meals they are valuable in correcting the deficiency of gastric secretion to which the disordered digestion is due. In atonic dyspepsia these preparations administered with vegetable bitters serve a useful purpose. The bicarbonates and the salts of the vegetable acids, by increas- ing the alkalinity of the blood, are of great value in gout, the lithia salts being the most efficient in this condition. They are also of ALKALIES. 165 great benefit in the treatment of acute rheumatism. The extensive experience of the author in connection with the latter disease justifies the statement that in the treatment of them alkalies are far superior to any other drugs, salicylic acid not excepted. It is necessary to saturate the system with some bland alkali, preferably a sodium salt, that the pernicious effects of the increased amount of uric acid formed may be rendered nugatory until convalescence shall have become assured. Thorough alkalinization should be produced and maintained, so that the sweat, saliva, and urine, which are acid in acute rheumatism, shall give no acid reaction to blue litmus-paper. While it is admitted that the treatment of acute rheumatism by alkalies alone will not shorten the course of the disease so readily as the employment of salicylates, there is certainly less danger of heart-complications, the period of convalescence is reduced, and the tendency to relapse lessened by the use of alkaline remedies. Even in chronic rheumatism where no serious renal derange- merits exist the mild alkalies, which are well borne by the stomach, are undoubtedly indicated, since it is well known that in chronically rheumatic subjects there is a decidedly lessened alkalinity of the blood. It is, perhaps, unnecessary to add that in the treatment of these cases proper hygiene, food, and cholagogues are important adjuncts to successful management. The author is disposed to go still further and urgently recommend complete alkalinization of the system, in connection with other therapeutic measures, in dealing with rheumatoid arthritis. The acetates, bitartrates, and citrates are efficient diuretics, cathartics, and diaphoretics, the first-named salts being superior diuretics, the potassium bitartrate a reliable cathartic, and the citrates active diaphoretics. In lithcmia these salts serve a valuable purpose by rendering the urine persistently alkaline, retarding the formation of uric-acid calculi, and even dissolving small calculi of this variety. In chronic Bright's disease the acetates and citrates are fre- quently indicated for their diuretic action, while potassium bi- tartrate is one of the most effective cathartics and diuretics in acute nephritis and cardiac dropsy. Lime water is a useful remedy for vomiting—whether due to irritability, gastric ulcer, or cancer—and is also valuable in check- ing this symptom in pulmonary tuberculosis. It is an important adjunct to milk, in preventing the formation of curds and relieving infantile vomiting. 166 A TEXT-BOOK OF MATERIA MEDICA In the acute mycotic diarrhea of children, characterized by acid gastro-intestinal fermentation, the above combination is extremely useful. The symptoms also of chronic diarrhea and dysentery arc often mitigated by this simple remedy. In rachitis and osteomalacia it has in certain cases appeared to be beneficial. Lime water is without doubt a very efficient remedy in diabetes insipidus, and may also exert a favorable influence in chronic bron- chitis by checking and otherwise modifying the mucous secretion. It should be remembered that this preparation is a valuable anti- dote in arsenical poisoning. The syrup of lime is a very inferior remedy, the sugar which it contains neutralizing the beneficial action which the lime alone might exert. Prepared chalk, or chalk mixture, is useful in relieving the premonitory diarrhea of cholera, and simple diarrheas of children, with greenish acid stools and flatulent distention of the abdo- men, are greatly benefited by this preparation. It is very neces- sary, however, that the chalk mixture be freshly prepared, the cinnamon water it contains being liable with age to fungoid con- tamination, and the propagation of microorganisms, which would seriously aggravate the condition for which the remedy is given, occasioning vomiting, etc. Magnesia is an invaluable antacid in gastric disorders, and especially in aphthce attending infantile diarrhea. As above stated, the lithium preparations are unquestionably superior to the other alkalies in the gouty and uric-acid diatheses. The ammonium preparations are useful antacids, being particu- larly efficacious in the dyspepsia of drunkards to allay nausea and vomiting, render the mucus less viscid, and act as stimulants to the circulation. Their excitant qualities, together with their prop- erty of modifying the mucous secretion, render them also of value in appropriate cases of subacute and chronic bronchitis. The re- maining important uses of the ammonium preparations will be considered under " Cardiac Stimulants." In conclusion, it may be well to mention the value of alkalies in aiding the digestion of fats, and as efficient remedies in the dys- pepsia and indigestion from which obese, gouty, and rheumatic subjects frequently suffer. The virtue and uses of mineral waters will be fully discussed in the following group devoted to the subject. Contraindications.—Alkalies are contraindicated in the phos- phatic diathesis, since there is danger of the formation of phosphatic MINERAL WATERS. 167 calculi. The calcium preparations should not be given to patients suffering from oxaluria. Administration.—The alkalies should invariably be adminis- tered largely diluted, thus favoring absorption and preventing their irritant action upon the gastro-intestinal mucous membrane. The time of administration—whether before or after meals—will depend entirely upon the effect desired, a thorough knowledge of their action as above given being necessary to an intelligent and proper use of the various preparations. GROUP VI.—MINERAL WATERS. The line of demarcation between mineral and ordinary waters cannot be definitely drawn. Although in the former there is usu- ally present an excess of mineral constituents or of temperature, some drinking waters contain more mineral ingredients than others, while many very pure waters, both cold and warm, have been re- garded for ages as mineral springs. As Pliny observed, waters are such as the soil through which they flow, it being a matter of observation that chalk or limestone formations, for instance, natu- rally impregnate with their normal constituents the springs originat- ing in them. Still, it is impossible to determine with certainty the depth from which these waters flow, or to ascertain the various dis- tances from the surface at which they assimilate foreign ingredients. Nor are the geographical distribution and altitude of mineral springs less remarkable than the diversity of their constituents. Although especially abundant in volcanic regions, mineral springs are by no means confined to them. They have been found on alpine heights—even at the snow-line in the Himalayas—and they rise from the bottom of the sea, as at Baiae and Ischia. The foreign ingredients of mineral waters, as shown by analysis, are very numerous, some of them occurring in exceedingly minute, others in large, quantities. Among them are soda, magnesium, calcium, potash, alumina, iron, boron, iodine, bromine, arsenic, lithium, cesium, rubidium, fluorine, barium, copper, zinc, manga- nese, strontium, silica, phosphorus, besides extractive substances and various organic deposits known under various names. The constituent gases include carbonic and hydrosulphuric acids, nitro- gen, oxygen, hydrogen, and ammonia. Of all these, by far the 168 A TEXT-BOOK OF MATERIA MEDICA. most important from a therapeutic point of view are sodium, mag- nesium, iron, carbonic acid, sulphur, and perhaps hytlrosulphuric acid. The various substances detected separately by chemists are in their analyses combined by them into various salts—if not with absolute certainty, undoubtedly with a close approximation to it. These combinations are very numerous, some waters containing from io to 20 per cent, of them ; yet there are always certain pre- dominating constituents which mark the character of the spring, while many substances, such as cesium, rubidium, or fluorine, occur in mere traces and must be regarded as unimportant. Mineral waters may be considered, therefore, as weaker or stronger solutions of salts and gases of higher or lower tempera- ture, although the quantity of saline ingredients commonly bears but a very small proportion to that of the fluids containing them. For purposes of therapy they are used either externally in the form of baths or internally as beverages. With regard to the former use—or, to speak technically, balneotherapy—the scope of the present work precludes treatment in extcnso. Enough to say that in certain conditions the system is undoubtedly benefited by resort to baths of various characters, especially when accompanied by the accessory aid of well-considered diet and regimen. The literature connected with the subject of potable waters is voluminous, yet the deductions drawn by various observers touch- ing their efficacy and in relation to the comparative value of natural springs are too frequently colored by individual bias, or based upon too hasty analysis to furnish infallible data or warrant the definite statement possible in ordinary therapeutics. That certain waters charged with foreign ingredients when ingested react upon the system favorably in the case of certain disorders it were futile to deny. Yet even here there are subsidiary considerations not to be ignored; and it is an open question how far the patient may be relieved by the potency of the remedy per se, or whether the col- lateral aids of environment, climate, altitude, temperature, etc. may not have an important bearing upon beneficial results. It has been well observed that in the case of water taken in situ the curative atmosphere of the surroundings, the favorable season of the year, the reflex influence of social amenities, and freedom from customary cares, aided by studied regimen under constant medical supervision, play no unimportant part in the alleviation of positive or imaginary disorders. The maxim, "Amuse the patient and let nature work the cure," seems not wholly inapplicable to MINERAL WATERS. 169 many fashionable resorts where a constant round of gayety acts as a practical, though imperceptible, tonic or stimulant upon subjects of certain nervous susceptibilities. These considerations are no less forcible in the case of American " watering-places " than in those of the more famous resorts of Europe. Various attempts have been made to range mineral waters according to their therapeutic action, their external and internal effects physiologically, and, most frequently, according to their chemical composition. Yet their influence is so dependent upon idiosyncrasy and their constituents so varied that it is wellnigh impossible to select a definite system free from objections, although a scientific classification, uniformly adopted, would undoubtedly promote their rational employment. Many sulphur waters are practically earthy or saline ones, yet the presence of minute quan- tities of hydrosulphuric acid, an ingredient so palpable as always to attract attention, has determined a classification obviously at variance with natural fact. The general rule has been to class waters under the head of their predominating elements, the desid- eratum being comparative simplicity untrammelled by theoretical considerations. In this view perhaps the most convenient arrange- ment of native mineral springs is that subjoined, adopted by Dr. A. N. Bell and widely accepted by writers on therapeutics: Alkaline.—These waters owe their chief therapeutic value to the alkaline salts they contain. They are rich in alkaline car- bonates, especially the sodium carbonate. Other substances are included among their ingredients,, many of them strongly charged with carbonic-acid gas, which may possibly contribute to their physiological activity. Saline.—These either contain (1) chloride of sodium as the principal ingredient, or (2) are largely impregnated with the sul- phates of sodium and magnesium. Several other ingredients enter into their composition, yet their efficacy chiefly depends upon their predominating elements : the second class includes the bitter or purgative waters highly prized both in this country and abroad. Sulphuretted.—The sulphuretted hydrogen present in these waters lends to them their chief therapeutic value. They contain also various sulphides—of potassium, sodium, calcium, and mag- nesium—together with earth}' and other sulphates, which doubtless contribute in a measure to their potency as physiological agents, although their action upon the system is still a matter of con- jecture. 17° A TEXT-BOOK OF MA 1ERIA MEDICA. Chalybeate. — Many mineral springs contain iron, yet in amounts so insignificant as to be of little value to therapy. There are, however, chalybeate waters highly charged with iron salts in the form of the carbonate or sulphate which have acquired a repu- tation for efficacy in the treatment of certain diseases. Acidulous.—The valuable property of these springs lies in the superabundance of carbonic-acid gas they contain, to which the solid constituents are subordinate, the carbon dioxide being the important therapeutic ingredient. Calcareous.—Calcium, in the form of the carbonate, is the valuable constituent of calcareous waters. Besides this substance they contain magnesium carbonate in varying quantities. Their utility as mineral waters has been questioned, many authorities refusing them recognition as therapeutic agents. The following enumeration of able list compiled by Dr. A. N. B Alkaline: Adams, California. Albury, Vermont. Alum, Virginia. Borax, California. Blount, Alabama. Berkshire, Vermont. Canon City, Colorado. Carlisle, Colorado. Congress, California. Elgin, Vermont. Fry's Soda, California. Highland, California. Highgate, Vermont. Lower Soda, California. Milford, New Hampshire. Manitou, Colorado. Middletown, Vermont. Napa Soda, California. Newbury, Vermont. Perry, Illinois. Rocky Mountain, Colorado. Ravenden, Arkansas. South Park, Colorado. native springs is from the admir- al: Summit Soda, California. Seltzer, California. Sheldon, Vermont. Vichy, California. Wilholt Soda, California. Calcic : Bethesda, Wisconsin. Butterworth, Michigan. Birch-Dale, Vermont. Clarendon, Vermont. Eaton Rapid, Michigan. Gettysburg, Pennsylvania. Hubbardstown, Michigan. Silurian, Wisconsin. Chalybeate: Abbeville, South Carolina. Bedford, Pennsylvania. Blossburg, Pennsylvania. Cooper's Well, Mississippi. Esbitt, Kentucky. Fayette, Pennsylvania. Gordon's, Georgia. MINERAL WA TERS. 171 Greencastle, Indiana. Kittrell's, North Carolina. Madison, Georgia. Manley, North Carolina. Milford, New Hampshire. Montvale, Tennessee. Owasso, Michigan. Rowland's, Georgia. Schooley's Mountain, New Jersey. Schuyler County, Illinois. Sparta, Wisconsin. Versailles, Indiana. Purgative Saline : Blue Lick, Kentucky. Crab Orchard, Kentucky. Elgin, Vermont. Esculapian, Kentucky. Harrodsburg, Kentucky. Midland, Michigan. Pagosa, Colorado. Saline : Fruit-Port Well, Michigan. Grand Haven, Michigan. Louisville Artesian, Kentucky. Michigan Congress, Michigan. Mt. Clemens, Michigan. Ocean, Alabama. Salt, Virginia. Spring Lake Well, Michigan. St. Louis, Missouri. Sulphurous : Alpena, Michigan. Balston, New York. Bladon, Florida. Blue Lick, Kentucky. Carlisle, Pennsylvania. De Soto, Louisiana. Dremion, Kentucky. French Lick, Indiana. Glenn's, South Carolina. Highgate, Vermont. Indian, Georgia. Indian, Indiana. Lodi Artesian, Indiana. Manley, North Carolina. Minnequa, Pennsylvania. Montesano, Missouri. Olympian, Kentucky. Portea Springs, Colorado. Salt Sulphur, Virginia. Saratoga, New York. Sharon, New York. Sheldon, Vermont. Shocco, North Carolina. St. Helena White Sulphur, California. St. Louis, Michigan. Sweet, Missouri. Valhemosa, Alabama. West Baden, Indiana. White Sulphur, Louisiana. White Sulphur, Montana. White Sulphur, Virginia. Unclassified : Alum, Virginia. Birch-Dale, New Hampshire. Borax, California. Climax, Missouri. Eureka, Arkansas. Fairview, Texas. Greeneleone, Florida. Geysers, the American, Wyo- ming. Geyser Spa, California. Iodide and Bromide, Missouri. Piedmont, Texas. Stafford, Connecticut. 172 A TEXT-BOOK OF MA TERIA MEDICA. Summit, Maine. Sheldon, Vermont. Thermal Springs: Agua Caliente, New Mexico. Arrow-Head, California. Buncombe County, North Carolina. Calistoga, California. Chalk Creek Hot, Colorado. Charleston Artesian, South Carolina. Des Cahutes Hot, Oregon. Harbines, California. Hot Springs, Arkansas. Idaho Hot, Colorado. Merriweather, Georgia. Middle Park Hot, Colorado. Ojo Caliente, New Mexico. Paraiso, California. Passo Robles, California. Salt Lake, Utah. Seigler, California. Skaggs, California. Volcano, Nebraska. Warm and Hot, West Virginia. GROUP VII.—BITTERS. SIMPLE BITTERS. Quassia—Quassiae—Quassia. U. S. P. Origin.—The wood of Picrcena excelsa Swz., a tree resembling the common ash, attaining a height of from 60 to 80 feet (18-24 M.), indigenous in Jamaica. Description and Properties.—In the shops it is usually met with in the form of chips or raspings of a yellowish-white color. Quassia contains two bitter principles—quassin and picrasmin. It contains no tannin. Dose.—10-30 grains (0.6-2.0 Gm.). Official Preparations. Extractum Quassiae—ExtrScti Qu3ssiae—Extract of Quassia.—Dose, 1-3 grains (0.065-0.2 Gm.). Extr3ctum Quassiae Fluidum—ExtrScti Qu3ssiae Fluidi—Fluid Extract of Quassia.—Dose, 10-30 minims (0.6-2.0 Cc). Tinctura Quassiae—Tincturae Quassiae—Tincture of Quassia.—Dose, \-2 fluidrachms (2.0-7.3 Cc). Gentiana—Gentiana^—Gentian. U. S. P. Origin.—The root of Gentiana lutea L., a plant from 2 to 3 feet high, indigenous in the mountainous portions of Central Europe. Description and Properties.—It appears in nearly cylindrical pieces or longitudinal slices about 1 inch (25 Mm.) thick, the upper portion closely annulate, the lower longitudinally wrinkled; exter- nally deep yellowish-brown ; internally lighter; somewhat flexible BITTERS. T», and rather thick, separated from the subspongiose meditullium by a black cambium line. Odor peculiar, faint, stronger when moist- ened ; taste sweetish and persistently bitter. Gentian contains a bitter principle, geutiopicrm, and also geutisic acid, to which its yellow color is due. It contains about 15 per cent, of glucose but no starch or tannin. Dose.—5-30 grains (0.3-2.0 Gm.). Official Preparations. Extractum Gentianae-Extracti Gentianae-Extract of Gentian.—Zfcw 2- ic grains (0.12-0.6 Cm.). Extractum Gentianae Fluidum-Extracti Gentianae Fluidi-Fluid Extract of Gentian.—Dose, 5-30 minims (0.3-2.0 Cc). Tinctura Gentianae CompSsita—Tincturae Gentians Comp&sitae-Com- pound Tincture of Gentian.-/?**,, 1-2 fluidrachms (4.0-8.0 Cc). 10 per cent. with Orange Peel and Cardamom. Calumba-Calumbae-Calumba. 1. s. p. (COLCMHO.) Origin.—The root of Jateorhiza palmata, Lam., a plant native to the forests of Eastern Africa and Madagascar, and cultivated in the East Indies. Description and Properties.—Nearly circular disks 1 to 2 inches (25-50 Mm.) in diameter and }toi inch (6-12 Mm.) thick. Externally greenish-brown and wrinkled; internally yellowish or grayish-yellow ; depressed in the center, with a few interrupted cir- cles of projecting wood-bundles ; distinctly radiate in the outer por- tion; fracture short, mealy; odor slight; taste mucilaginous, slightly aromatic, very bitter. It contains a bitter crystalline principle, ca- lumbin, calumbic acid, bcrbcrinc, and starch. No tannin is present. Dose.—10-60 grains (0.6-4.0 Gm.). Official Preparations. Extr3ctum Calumbae Fliiidum—Extr3cti Calumbae Fluidi—Fluid Extract of Calumba.—Dose, 10-60 minims (0.6-4.0 Cc). Tinctura Calumbae—Tincturae Calumbae—Tincture of Calumba.—Dose, 1- 4 fluidrachms (4.0-15. Cc). Calendula—Calendula—Calendula. U. s. P. 1 Marigold.) Origin.—The florets of Calendula officinalis L., an annual plant, a native of the Levant and Europe, frequently cultivated as a garden ornament. 1/4 A TEXT-BOOK OF MATERIA MEDICA. Description and Properties.—Florets about \ inch (12 Mm.) long, linear and strap-shaped, delicately veined longitudinally, yellow or orange-colored, three-toothed at the apex, the short, hairy tube enclosing the remnants of a filiform style elongately cleft. Odor slight and somewhat heavy; taste rather bitter and faintly saline. It contains a peculiar gummy principle, calcndulin, 1 bitter constituent, and a trace of volatile oil. Dose.—5-30 grains (0.3-2.0 Gm.). Official Preparation. Tinctura CalSndulae—Tincturae Calgndulae—Tincture of Calendula.—Dose, 15-60 minims (1.0-4.0 Cc). Unofficial Preparation. Extr3ctum CalSndulae Fliiidurn—Extr3cti CalSndulae Fluidi—Fluid Ex- tract of Calendula.—Dose, S~3° minims (0.3-2.0 Cc). Chi rata—Chi ratae—Chi rata. U. S. P. Origin.—The entire plant, Szvertia chirata Hamilton, an annual, native to Northern India. Description and Properties.—Chirata as found in the shops consists of short sections of the stem and branches pressed and split, brown or dark-purple in color, and mixed with a few leaves and flowers. It contains a very bitter yellow principle, a hygro- scopic powder, chiratin, a bitter syrupy liquid, ophelic acid, a resin, coloring matter, etc. Dose.—5-20 grains (0.3-1.3 Gm.). Official Preparations. Extractum Chiratae Fluidum—Extr3cti Chiratae Fluidi—Fluid Extract of Chirata.—Dose, 5-20 minims (0.3-1.3 Cc). Tinctura Chiratae—Tincturae Chiratae—Tincture of Chirata.—Dose, y2-\ fluidrachm (2.0-4.0 Cc). AROMATIC BITTERS. Anthemis-Anthemidis—Anthemis. U. S. P. (Chamomile.) Origin.—The flower-heads of Anthemis nobilis L., a low peren- nial plant indigenous in Southern and Western Europe. Description and Properties.—Heads subglobular, about \ inch (2 Cm.) broad, consisting of an imbricated involucre and numerous white, strap-shaped, three-toothed florets, and a few, if any, yellow BITTERS. J75 tubular disk-florets, inserted upon a chaffy, conical, solid receptacle ; of a strong, agreeable odor and an aromatic, bitter taste. Anthemis contains a bitter principle, a pale-blue or yellowish-brown volatile oil, and a trace of tannin, together with other unimportant con- stituents. Dose.—15-60 grains (1.0-4.0 Gm.), in infusion or fluid extract. Cascarilla—Cascarlllae—Cascarilla. U. S. P. Origin.—The bark of Croton clutcria, Bennett, a small shrub indigenous in the Bahama Islands. Description and Properties.—Quills or curved pieces about -^ inch (2 Mm.) thick, having a grayish, somewhat fissured, easily detached, corky layer, more or less coated with a white lichen, the uncoated surface being dull brown, the inner surface being smooth. The bark breaks with a short fracture, having a resinous and radially striate appearance. When burned it emits a strong, aro- matic, somewhat musk-like odor; taste warm and very bitter. It contains a volatile oil, a bitter, crystalline principle, cascarillin, tannin, resin, etc. Dose.—10-30 grains (0.6-2.0 Gm.), or 10-30 minims (0.6-2.0 Cc.) of the fluid extract. Prunus Virginiana—Pruni Virginianse—Wild Cherry. U. S. P. Origin.__The bark, collected in autumn, of Prunus serotina Ehr, a large forest tree indigenous in North America. Description and Properties.—It is met with in curved pieces or irregular fragments -^ inch (2 Mm.) or more thick; outer surface greenish-brown or yellowish-brown, smooth and somewhat glossy, marked with transverse scars. If the bark is collected from the old wood and deprived of the corky layer, the outer surface is nut-brown and uneven ; inner surface somewhat striate or fissured. Upon maceration in water it develops a distinct bitter-almond odor. Taste astringent, aromatic, and bitter. It contains a volatile oil, hydrocyanic acid, tannin, a bitter glucoside, resin, etc. Dose.—^-1 drachm (2.0-4.0 Gm.). Official Preparations. Extractum Pruni Virginian* Fliiidum-Extracti Pruni Virginianae Fluidi —Fluid Extract of Wild Cherry.—Dose, 30-60 minims (2.0-4.0 Cc). i;6 .•/ TEXT-BOOK OF MATERIA MEDICA. Infusum Pruni Virginianae—Infusi Pruni Virginianae - Infusion of WilJ Cherry.—Dose, 1-2 fluidounces (30.0-60.0 Cc). Syrupus Pruni Virginianae—Syrupi Pruni Virginianae—Syrup of Wild Cherry.—Dose, 2-4 fluidrachms (S.o-15. Cc). Serpentaria—Serpentariae—Serpentaria. U.S. />. (Virginia Snake-root. ) Origin.—The rhizome and roots of Aristolochia serpentaria L, and of Aristolochia reticulata Nutt., perennial herbs indigenous in the United States. Description and Properties.—The rhizome is about I inch (25 Aim.) long, thin, curved; on the upper side with approximate, short stem-bases ; on the lower side with numerous thin, branching roots about 4 inches (10 Cm.) long; dull yellowish-brown, inter- nally whitish ; the wood-rays of the rhizome are longest on the lower side ; odor aromatic, camphoraceous; taste warm, bitterish, and camphoraceous. It contains \ per cent, of volatile oil, a bitterish principle, aristolochine, tannin, resin, starch, etc. The roots of Aristolochia reticulata are coarser, longer, and less interlaced than those of Aristolochia serpentaria. Dose.—10-30 grains (0.6-2.0 Gm.). Official Preparations. Extractum Serpentariae Fluidum — Extr3cti Serpentariae Fluidi—Fluid Extract of Serpentaria.—Dose, 10-30 minims (0.6-2.0 Cc). Tinctura Cinchonae Composita—Tincturae Cinchonas Comp6sitae—Com- pound Tincture of Cinchona.—Dose, 1-4 fluidrachms (4.0-15. Cc.) (2 per cent. of serpentaria.) Tinctura Serpentariae—Tincturae Serpentariae—Tincture of Serpentaria.— Dose, \-2 fluidrachms (2.0-8.0 Cc). Antagonists and Incompatibles.—The salts of iron, lead, and silver are incompatible with gentian and the aromatic bitters, though preparations of iron can be given with quassia and calumba. Boil- ing water impairs the virtues of wild cherry. Synergists.—The digestants, mineral acids, and, under certain conditions, alkalies, and the restorative agents generally, aid the action of vegetable bitters. Physiological Action.—Because of their action in augmenting the secretions from the salivary and gastric glands, aiding diges- tion and improving nutrition, Vegetable Bitters are classed among Restoratives. By increasing the activity of the various glands they BITTERS. i/7 aid digestion, and by their effect upon the nerves they stimulate the appetite. Pure bitters act immediately upon contact; that is, their efficiency is due to their local action upon the mucous membrane of the gastro-intestinal tract, with which they are brought into direct contact. There are certain drugs, however—such as cin- chona, nux vomica, etc.—which act also upon the blood or remote parts of the system. When used as bitters we are concerned only with the local action of these agents. I. Bitters increase the secretion from the salivary glands. This effect is produced by stimulating the ends of the nerves of taste distributed in the mucous membrane of the mouth, from which nerves the im- pression is conveyed to the center in the medulla, and from there transmitted to the vaso-motor and secretory nerves sup- plying the salivary glands, increasing their blood-supply and activity, and at once promoting the secretion of saliva. Were salivary secretion stimulated by the drug entering the circulation, and through the blood exciting the medulla and the glands, a much longer time would elapse before an increased flow of saliva would be pro- duced. It is therefore certain that the rapid reflex excitation of the glands, and consequent immediate increase in the sal- ivary secretion, are due to direct contact with the nerve-endings in the mucous membrane of the mouth. The accompanying diagram (Fig. i) will serve to elucidate the action named. II. Bitters increase the secretion from the gastric glands. The primary action is an augmented flow of gastric juice, caused by reflex stimulation from the mouth. It is well known that there is an intimate relationship between the stomach and the senses of taste and smell—the taste of victuals or the odor of a tempting dinner, or the familiar instance of a dog looking wistfully at a meat- stand, exciting the appetite and, reflexly, the flow of gastric juice. Bitters act in a similar manner. The nerves of taste are stimu- lated ; the impression is conveyed to the medulla, and from it trans- mitted not only to the salivary glands, but through the fibers of 12 Fig. i.—Diagram illustrating the action of bitters on the salivary glands: i, nerve conveying the impression from the mucous mem- brane of the mouth (C) to the me- dulla (A); 2, secretory nerve trans- mitting the impression from the medulla (A) to the salivary gland (B); 3, duct of the salivary gland. A TEXT-BOOK OF MA TERIA MEDICA. the vagus, increasing the blood-supply to the gastric glands and thereby promoting their functional activity. When the bitters have been swallowed, an increased secretion ensues, occasioned by direct stimulation of the mucous mem- brane of the stomach. Through the sen- sory fibers of the vagus the impression is conveyed to the center in the medulla, returning by the vaso-motor and secretory fibers, and increasing the functional activity of the glands. This action is well shown in the diagram (Fig. 2). When too large a dose of bitters has been taken, or under prolonged medicinal dosage—when contraindicated by an irri- table stomach—the effects are a diminished secretion of gastric juice and a corre- sponding increase in the secretion of mucus. This effect of over-stimulation or irritation is well illustrated in persons addicted to the excessive use of alcohol, a moderate amount promoting the secretion of gastric juice and improving the appetite, while excess occa- sions nausea and the vomiting of glairy mucus. The theory governing the above action is that a medicinal dose of bitters is just sufficient to stimulate the functional activity of the gastric glands, but that immoderate or continuous dosage tends to convey the impression farther up in the medulla, causing stimulation of the vaso-constrictor fibers, con- tracting the blood-vessels, and lessening the blood-supply and the secretion from the glands. At the same time the secretory fibers supplying the mucous cells are stimulated, causing an increased secretion of mucus. Should the dose be sufficiently large to pro- duce vomiting, the action is due to the fact that the impression is conveyed still higher in the medulla, and from there transmitted to the nerves supplying the abdominal walls and diaphragm, the effect being to produce emesis. The diagram (Fig. 3) graphically illustrates this action. III. Bitters stimulate the peristaltic movements of the stomach by reflex action. The sensory nerves in the mucous membrane are Fig. 2.—Diagram illustrating the action of bitters on the gas- tric secretion: A, medulla ; B, stomach; C, gland; D,D, blood- vessels supplying the gland; E, nerves of taste ; i, vaso-motor fibers ; 2, secretory fibers ; 3, sen- sory fibers. BITTERS. 1/9 irritated, and an impression is conveyed by them to Auerbach's plexus between the muscles in the walls of the stomach, from which plexus, or ganglion, the influence is transmitted to the mus- cles themselves, causing increased activity or peristalsis. Another method by which peristalsis is stimulated occurs when the impression is conveyed by the sensory nerves directly to the center in the medulla, and from there through the motor fibers of the vagus to Auerbach's plexus, affecting the muscles in the man- ner above described. The cut (Fig. 4) will serve to illustrate the modus operandi. Fig 3— Diagram illustrating the supposed nervous connections of the stomach. A gentle stimulus applied to the walls of the stomach is transmitted by the afferent nerves (A) to a nerve-center (B), and thence along the vaso-dilating nerves (C) and the secreting nerves {£>) to the vessels of the mucous membrane and the cells of the gastric follicles. A stronger stimulus is transmitted up to the nerve- center (E), and thence along the vaso-constricting fibers (F) and the secreting fibers (G) of the mu- cous follicles. A still stronger stimulus is transmitted to H, and thence along the motor nerves to the abdominal walls (A", K), causing them to contract and produce retching or vomiting. IV. Bitters augment absorption by increasing the blood-supply to the mucous membrane of the stomach. It is a physiological fact that the larger the blood-supply passing through the blood- vessels, and the greater the amount of lymph conveyed through the lymph-channels, the more rapid the absorption. V. Bitters are more or less antiseptic and arrest fermentation, both physiological and pathological. The peptonization of food is 180 A TEXT-BOOK OF MATERIA MEDICA. a physiological fermentative process, forming a contraindication to the administration of bitters during active digestion. Therapeutics.—Externally and Locally.—Calendula, in the form of a poultice, is an efficient and grateful application as a dress- ing to cancer of the breast. The tincture of calendula is recommended by many phy- sicians as an external application for contu- sions, sprains, etc., although not so efficient as tincture of arnica. The drug has been used topically in chronic pharyngitis and suppurative inflammation of the ear. Internally.—The simple bitters are pecu- liarly useful in atonic and fermentative dys- pepsia, chronic gastric catarrh, and as a tonic in convalescence from acute disease, in mala- rial fever, and in the anorexia following it. Infusion of quassia is a most efficacious injection to destroy seat-zvorms [Oxyuris ver- micularis), the infusion being injected into the rectum, which has been previously washed out with soap and water. The aromatic bitters are used to stimu- late the appetite and improve the condition of the digestive apparatus. The simple bit- ters are similarly used, but the former pos- sess more stimulating and tonic properties, owing to their volatile and astringent con- stituents. Chamomile, in addition to its action as a stimulant to the digestion, has been employed with benefit in delirium tremens and as an emmenagoguc; while in the form of hot poultices chamomile flowers serve as an efficient appli- cation for local pains of almost any description. Wild cherry might not inaptly be called a sedative tonic, its peculiarly bitter yet not unpleasant taste causing it to be well toler- ated by the stomach, and rendering it one of the best stomachic tonics, especially during convalescence, when its sedative action upon the heart allays febrile and cardiac excitement. The syrup of wild cherry is a common ingredient of " cough syrups." It is thought to quiet the cough and allay the irritability of the nervous system in bronchitis and phthisis. Serpentaria is considered an efficient expectorant in pneumonia Fig. 4.—Diagram illustrating the action of bitters upon peri- stalsis : A, medulla; B, stom- ach ; C, Auerbach's plexus; D, mucous membrane; E, muscles ; i, motor fibers ; 2, sensory fibers. HEM A TICS. 181 and capillary bronchitis. Next to its use as a stomachic its chief value seems to be as a stimulant in typhus and typhoid fevers, the compound tincture of cinchona being a most excellent remedy in the low forms of typhoid. The fluid extract of serpentaria is con- sidered somewhat of a sexual stimulant. It is a valuable applica- tion for poisoning by Rhus toxicodendron. Contraindications.— i. Bitters should not be given when the secretion of gastric juice is diminished as the result of organic disease. 2. They are contraindicated as stomachics during the course of acute disease, as in fevers. 3. When, after a reasonable time, they fail to improve the appetite, they should be discontinued. 4. In convalescence from acute disease, when the appetite is vora- cious, they are contraindicated. 5. In catarrhal conditions of the mu- cous membrane of the stomach—as in chronic gastritis and " drunk- ards' catarrh of the stomach "—alcoholic preparations of bitters, tinctures, etc. should not be administered, aqueous preparations only, like infusions, being permissible. 6. Should the digestion be impaired and the appetite good, it is an indication that the indiges- tion is intestinal, and therefore beyond the influence of bitters. Administration.—To improve the appetite bitters should be given from one-half to one hour before meals. When necessary to use them for a long time, one bitter should be substituted for another in the course of every week or two; otherwise the stomach may rebel at the monotony. Bitters may be given in the form of a powder or a solid extract. Ordinarily, however, it is preferable to administer a liquid preparation—fluid extract, tincture, or infusion. A pleasant method of giving the latter preparation in the case of quassia is to allow water to stand over-night or for a few hours in a quassia-cup—purchasable at almost any drug-store—when the water will become impregnated with the bitter principle of the quassia. GROUP VIII.—HEMATICS. preparations of iron. Ferrum Reductum—Ferri Reducti—Reduced Iron. U. S. P. (Iron by Hydrogen; Queyenne's Iron.) Origin.—Obtained by passing Hydrogen through a hot closed tube containing freshly prepared and thoroughly washed Ferric Oxide. 182 A TEXT-BOOK OF MATERIA MEDICA. Description and Properties.—A very fine, grayish-black, lustre- less powder, odorless and tasteless; permanent in dry air; insolu- ble in water or alcohol. Dose.—1-5 grains (0.5-0.3 Gm.). Ferri Carbonas Saccharatus — Ferri Carbonatis Saccharati — Saccharated Ferrous Carbonate. U. S. P. Origin.—Prepared from Ferrous Sulphate, Sodium Bicarbonate, Sugar, and Distilled Water, by solution and filtration. Description and Properties.—A greenish-brown powder grad- ually becoming oxidized by contact with air; without odor, and having at first a sweetish, afterward a slightly ferruginous, taste. Only partly soluble in water, but completely soluble in hydro- chloric acid, with copious evolution of carbonic-acid gas, forming a clear, greenish-yellow liquid. The product should be kept in small, well-stoppered bottles. Dose.—2-10 grains (0.12-0.6 Gm.). Massa Ferri Carbonatis—Massae Ferri Carbonatis —Mass of Ferrous Carbonate. U. S. P. (Vallet's Mass.) Origin.—Prepared by solution, filtration, and evaporation from Ferrous Sulphate, Sodium Carbonate, Clarified Honey, Sugar, Syrup, and Distilled Water. Description and Properties.—When recently prepared the mass is of a greenish-gray color, but on exposure it becomes greenish-black. Dose.—3-5 grains (0.15-0.3 Gm.). Mistura Ferri Composita—Misturae Ferri Com- positae—Compound Iron Mixture. U.S.P. (Griffith's Mixture.) Origin.—Prepared by mixing Ferrous Sulphate, Myrrh, Sugar, Potassium Carbonate, Spirit of Lavender, and Rose Water. Description and Properties.—When newly prepared it is of a dirty greenish color, but slowly oxidizes on exposure to the air, and should therefore be freshly prepared when needed. Dose.—\-\\ ounces (15.-45 Cc). HEM A TICS. 183 Ferri Iodidum Saccharatum—Ferri Iodidi Saccha- rati—Saccharated Ferrous Iodide. U. s. P. Origin.—Prepared by solution, filtration, evaporation, and tritu- ration from Iron Wire, Reduced Iron, Iodine, Distilled Water, and Sugar of Milk. Description and Properties.—A yellowish-white or grayish, hygroscopic, odorless powder, having a sweetish, ferruginous taste' Soluble in 7 parts of water, but only partially soluble in alcohol. It should be kept in a cool, dark place, in small, perfectly dry, securely-stoppered bottles. Dose.—5-10 grains (0.3-0.6 Gm.). Pilulae Ferri Iodidi—Pilulas (ace.) Ferri Iodidi—Pills of Ferrous Iodide. U.S.P. Origin.—Pills made of Reduced Iron, Iodine, Glycyrrhiza, Sugar, Extract of Glycyrrhiza, Acacia, Balsam of Tolu, Water, and Ether, evaporated to pilular consistence. Description and Properties.—These preparations are very un- stable, and should be kept from the light as much as possible. Dose.—One to two pills, each pill containing nearly 1 grain (0.061 Gm.) of ferrous iodide. Syrupus Ferri Iodidi—Syrupi Ferri Iodidi—Syrup of Ferrous Iodide. U. S. P. Origin.—A syrup containing 10 per cent, of Ferrous Iodide. Description and Properties.—A transparent, pale-green liquid, having a sweet, strongly ferruginous taste and a neutral reaction. Dose.—5-30 minims (0.3-2.0 Cc). Ferri Chloridum—Ferri Chloridi—Ferric Chloride. Origin.—Prepared by the action of Hydrochloric Acid and Distilled Water upon Iron Wire, subsequent filtration, addition of Nitric Acid, and crystallization. Description and Properties.—Orange-yellow, crystalline pieces, odorless or having a faint odor of hydrochloric acid, and a strongly styptic taste ; very deliquescent in moist air; freely and completely soluble in water or alcohol, also in a mixture of 1 part of ether and 3 parts of alcohol. Ferric chloride should be kept in glass- stoppered bottles protected from light. Dose.—It is chiefly used topically, as an astringent and hemo- static. 184 A TEXT-BOOK OF MA TERIA MEDICA. Liquor Ferri Chloridi—Liquoris Ferri Chloridi— Solution of Ferric Chloride. U. s. I*. Origin.—An aqueous solution of Ferric Chloride (FeXl,-, 323.98), containing about 37.8 per cent, of the anhydrous salt, corresponding to 62.9 per cent, of the crystallized salt, or about 13 per cent, of metallic iron. Description and Properties.—A reddish-brown liquid, having a faint odor of hydrochloric acid, an acid, strongly styptic taste, and an acid reaction. Dose.—2-10 minims (0.12-0.6 Cc), largely diluted. Tinctura Ferri Chloridi—Tincturae Ferri Chloridi— Tincture of Ferric Chloride. U. S. P. Origin.—A hydro-alcoholic solution of Ferric Chloride, con- taining about 13.6 per cent, of the anhydrous salt, corresponding to about 4.7 per cent, of metallic iron. Description and Properties.—A bright, brownish liquid having a slightly ethereal odor, a very astringent, styptic taste, and an acid reaction. Dose.—5-30 minims (0.3-2.0 Cc). Liquor Ferri Acetatis—Liquoris Ferri Acetatis— Solution of Ferric Acetate. U. S. P. Origin.—An aqueous solution of Ferric Acetate, containing about 31 per cent, of the anhydrous salt, corresponding to about 7.5 per cent, of metallic iron. Description and Properties.—A dark, reddish-brown, clear liquid, of an acetous odor, a sweetish, acidulous, somewhat styptic taste, and a slightly acid reaction. Dose.—1-8 minims (0.06-0.5 Cc). Liquor Ferri et Ammonii Acetatis—Liquoris Ferri et Ammonii Acetatis—Solution of Iron and Ammonium Acetate. U. S. P. (Basham's Mixture.) Formula.—Prepared with Tincture of Ferric Chloride, 20 parts; Diluted Acetic Acid, 30; Solution of Ammonium Acetate, 200; Aromatic Elixir, 100; Glycerin, 120; Water, to 1000. Dose.—1-4 fluidrachms (4.0-15.0 Cc). Ferri Citras—Ferri Citratis—Ferric Citrate. U. S. P. Origin.—Prepared by evaporating solution of Ferric Citrate on a water-bath at a temperature not exceeding 6o° C. (1400 F.). HEM A TICS. I85 Description and Properties.—Thin, transparent, garnet-red scales, without odor and having a slightly ferruginous taste. Slowly but completely soluble in cold water, and readily soluble in hot water, but diminishing in solubility with age. Insoluble in alcohol. Ferric citrate should be kept in well-stoppered bottles, protected from light. Dose.—5-20 grains (0.3-1.20 Gm.), in solution. Liquor Ferri Citratis—Liquoris Ferri Citratis— Solution of Ferric Citrate. U. S. P. Origin.—Prepared by precipitating a solution of Ferric Sulphate in Water with Ammonia Water, adding Citric Acid, filtering, and evaporating the filtrate to the proper amount. Description and Properties.—A dark-brown liquid, odorless, of an acid reaction, and possessing a slightly ferruginous taste. Dose.—5-15 minims (0.3-1.0 Cc). Vinum Ferri Citratis—VIni Ferri Citratis—Wine of Ferric Citrate. U. s. P. Composition.—Iron and Ammonium Citrate, Tincture of Sweet Orange Peel, Syrup, and Water. Dose.—\-\ fluidrachm (2.0-4.0 Cc). Ferri et Ammonii Citras—Ferri et Ammonii Citratis —Iron and Ammonium Citrate. U. s. p. Origin.—Prepared by evaporating a solution of Ferric Citrate and Ammonia Water. Description and Properties.—Thin, transparent, garnet-red scales, odorless, and having a saline, mildly ferruginous taste; deliquescent in moist air. Completely soluble in water, but insoluble in alcohol. Dose.—5-10 grains (0.3-0.6 Gm.). Ferri et Quininae Citras—Ferri et QuinTnae Citratis —Iron and Quinine Citrate. U. s. P. Origin.—Solution of Ferric Citrate in Distilled Water and solution of Quinine and Citric Acid in Distilled Water are mixed, evaporated on a water-bath to the consistence of syrup, and dried <>n plates of glass. Description and Properties.—Thin, transparent scales, of a 186 a TEXTBOOK OF MA TERIA MEDICA. reddish-brown color, without odor, and having a bitter, mildly ferruginous taste ; slowly deliquescent in damp air. Gradually but completely soluble in cold water, more readily soluble in hot water, and but partially soluble in alcohol, its solubility diminishing with age. It should be kept in well-stoppered bottles, protected from light. Dose.—2-10 grains (0.12-0.6 Gm.). Ferri et QuinTnae Citras Solubilis—Ferri et QuinTnae Citratis Solubilis—Soluble Iron and Quinine Citrate. U. S. P. Origin.—Prepared in the same manner as the above salt, but with the addition of Ammonia Water. Description and Properties.—Thin, transparent scales, of a greenish, golden-yellow color, odorless, and having a bitter, mildly ferruginous taste; deliquescent in damp air. Rapidly and com- pletely soluble in cold water, but only partially soluble in alcohol. It should be kept in well-stoppered bottles, protected from light. Dose.—2-10 grains (0.12-0.6 Gm.). Ferri et Strychninae Citras—Ferri et Strychnines Citratis—Iron and Strychnine Citrate. U.S. P. Origin.—Solution of Iron and Ammonium Citrate in Distilled Water and solution of Strychnine and Citric Acid in Distilled Water are mixed, evaporated to the consistence of syrup by means of a water-bath, and dried on plates of glass. Description and Properties.—Thin, transparent scales, varying in color from garnet-red to yellowish-brown, without odor, and having a bitter, slightly ferruginous taste; deliquescent in damp air. Readily and completely soluble in water, but only partly sol- uble in alcohol. It should be kept in well-stoppered bottles, pro- tected from light. Dose.—1-3 grains (0.06-0.18 Gm.). Vinum Ferri Amarum—Vlni Ferri Amari—Bitter Wine of Iron. U. S. P. ■ Composition.—Soluble Iron and Quinine Citrate, Tincture of Sweet Orange Peel, Syrup, White Wine. Dose.—1-2 fluidrachms (4.0-8.0 Cc). HE MA TICS. 187 Syrupus Ferri, QuinTnae, et StrychnTnae Phospha- tum—Syrupi Ferri, QuinTnae, et StrychnTnae Phosphatum—Syrup of the Phosphates of Iron, Quinine, and Strychnine. U.S. P. Dose.—1-2 fluidrachms (4.0-8.0 Cc). Ferri Lactas—Ferri Lactatis—Ferrous Lactate. U. S. P. Description and Properties.—Pale, greenish-white crusts, con- sisting of small, needle-shaped crystals, having a slight, peculiar odor, and a mild, sweetish, ferruginous taste. Slowly but com- pletely soluble in 40 parts of water and in 12 parts of boiling water; almost insoluble in alcohol. Ferrous lactate should be kept in well-stoppered bottles. Dose.—1-3 grains (0.06-0.2 Gm.). Syrupus Hypophosphitum cum Ferro—Syrupi Hy- pophosphitum cum Ferro—Syrup of Hypophos- phites with Iron. U. S. P. Ferrous Lactate and Potassium Citrate dissolved in Syrup of Hypophosphites. Dose.—\-1 fluidrachm (2.0-4.0 Cc). Ferri Oxidum Hydratum—Ferri Oxidi Hydrati— Fe rri c H y d rate. I. S. P. (Ferric Hydroxide—Hydrated Oxide of Iron.) Origin.—To a solution of Ammonia Water in Water is added a solution of Ferric Sulphate in Water, and the precipitate collected. Description and Properties.—A brownish-red magma, wholly soluble in hydrochloric acid, without effervescence. Dose.—4 drachms (16 Gm.), or ad libitum in case of arsenical poisoning. Ferri Oxidum Hydratum cum Magnesia —Ferri Oxidi Hydrati cum Magnesia—Ferric Hydrate with Magnesia. U. S. P. Solution of Ferric Sulphate, Magnesia, and Water. Dose.—Amounts as necessary ad libitum. 188 A TEXT-BOOK OF MATERIA MEDICA. Ferri et Ammonii Sulphas—Ferri et Ammonii Sul- phatis—Ferric Ammonium Sulphate. U. s. I*. (Amm on io-ferric Sulphate—Ammonio-ferric Alum.) Origin.—The crystals formed by adding Ammonium Sulphate to a boiling-hot solution of Ferric Sulphate. Description and Properties.—Pale violet, octahedral crystals, odorless, and having an acid, styptic taste; efflorescent on exposure to the air. Soluble in 3 parts of water and in 0.8 part of boiling water; insoluble in alcohol. The product should be kept in well- stoppered bottles. Dose.—5-15 grains (0.5-1.0 Gm.). Ferri et Ammonii Tartras—Ferri et Ammonii Tar- tratis— Iron and Ammonium Tartrate. U. s. P. (Ammonio-ferric Tartrate.) Description and Properties.—Thin, transparent scales, varying in color from garnet-red to reddish-brown, without odor, and having a sweetish, slightly ferruginous taste; slightly deliquescent in the air. Very soluble in water; insoluble in alcohol. Iron and ammonium tartrate should be kept in well-stoppered bottles, pro- tected from light. Dose.—10-30 grains (0.6-2.0 Gm.). Ferri et Potassii Tartras—Ferri et Potassii Tar- trates—Iron and Potassium Tartrate. U. S. J*. (Potassio-ferric Tartrate.) Description and Properties.—Thin, transparent scales, vary- ing in color from garnet-red to reddish-brown, without odor, and having a sweetish, slightly ferruginous taste; slightly deliquescent in the air. Very soluble in water; insoluble in alcohol. It should be kept in well-stoppered bottles, protected from light. Dose.—5-20 grains (0.3-1.2 Gm.). Ferri Phosphas Solubilis—Ferri Phosphatis Solu- bilis—Soluble Ferric Phosphate. U. s. P. Description and Properties.—Thin, bright-green, transparent scales, odorless, and having an acidulous, slightly saline taste. The salt is permanent in dry air when excluded from light, becoming dark and discolored when exposed to it. Freely and completely HEM A TICS. 189 soluble in water, but insoluble in alcohol. It should be kept in dark amber-colored, well-stoppered bottles. Dose.—5-10 grains (0.3-0.6 Gm.). Ferri Pyrophosphas Solubilis-Ferri Pyrophospha- tis Solubilis—Soluble Ferric Pyrophosphate. U S. P. Description and Properties.—Thin apple-green, transparent scales, without odor, and having an acidulous, slightly saline taste; permanent in dry air if protected from light, and if exposed to it becoming dark and discolored. Freely and completely soluble in water, but insoluble in alcohol. It should be kept in dark amber- colored, well-stoppered bottles. Dose.—2-5 grains (0.1-0.3 Gm.). Ferri Hypophosphis—Ferri Hypophosphitis—Ferric Hypophosphite. U. S. J*. Origin.—The precipitate formed by mixing solutions of Sodium Hypophosphites and Ferric Chloride or Ferric Sulphate. Description and Properties.—A white or grayish-white pow- der, odorless and nearly tasteless, permanent in the air. Only slightly soluble in water. It should be kept in well-stoppered bottles. Dose.—5-10 grains (0.3-0.6 Gm.). Ferri Valerianas—Ferri Valerianates—Ferric Valerianate, r. s. V. Origin.—The precipitate obtained by adding to a cold solution of Ferric Sulphate or Ferric Chloride a cold solution of Sodium Valerianate. Description and Properties.—A dark, brick-red, amorphous powder, of somewhat varying chemical composition, having the odor of valerianic acid and a mildly styptic taste; permanent in dry air. Insoluble in cold water, but readily soluble in alcohol. Boiling water decomposes it, setting free the valerianic acid and leaving ferric hydrate. It should be kept in small, well-stoppered bottles, in a cool, dark place. Dose.—1-3 grains (0.06-0.18 Gm.). 19° A TEXT-BOOK OF MATERIA MEDICA. Ferri Sulphas—Ferri Sulphatis—Ferrous Sulphate. U S. P. Origin.—Obtained by the action of Sulphuric Acid and Water upon Iron Wire. Description and Properties.—Large, pale bluish-green mono- clinic prisms, without odor, and having a saline, styptic taste; efflorescent in dry air; on exposure to moist air the crystals rap- idly absorb oxygen, becoming coated with a brownish-yellow, basic ferric sulphate. Soluble in 1.8 parts of water and in 0.3 part of boiling water ; insoluble in alcohol. Dose.—1-3 grains (0.06-0.18 Gm.). Ferri Sulphas Exsiccatus—Ferri Sulphatis Exsic- cati—Dried Ferrous Sulphate. U. S. P. Description and Properties.—A grayish-white powder, slowly but completely soluble in water. Dose.—|—2 grains (0.03-0.12 Gm.). Ferri Sulphas Granulatus—Ferri Sulphatis Granu- lati—Granulated Ferrous Sulphate. U. S. P. Description and Properties.—A pale bluish-green, crystallized powder, which should conform in every respect to the reactions and tests given under Ferri Sulphas in the U. S. P. Dose.—^-3 grains (0.03-0.18 Gm.). Liquor Ferri Subsulphatis—Liquoris Ferri Subsul- phatis—Solution of Ferric Subsulphate. U. S. P. (Solution of Basic Ferric Sulphate—Monsel's Solution.) Origin.—An aqueous solution of basic Ferric Sulphate—of varying chemical composition—corresponding to about 13.6 per cent, of metallic iron. Description and Properties.—A dark, reddish-brown liquid, odorless or nearly so, of an acid, strongly styptic taste, and an acid reaction. Miscible with water and alcohol in all proportions, without decomposition. Dose.—1-10 minims (0.06-0.6 Cc), largely diluted—chiefly used, however, as a local styptic HEMATICS. I9I Liquor Ferri Tersulphatis—Liquoris Ferri Tersul- phatis—Solution of Ferric Sulphate. U. S. P. Origin.—An aqueous solution of normal Ferric Sulphate, con- taining about 28.7 per cent, of the salt, and corresponding to about 8 per cent, of metallic iron. Description and Properties.—A dark, reddish-brown liquid, almost odorless, having an acid, strongly styptic taste, and an acid reaction. Miscible with water and alcohol in all proportions, with- out decomposition. Dose.—1-10 minims (0.06-0.6 Cc), given in the same manner and for the same purposes as the preceding preparation. Pilulae Aloes et Ferri—Pilulas (ace.) Aloes et Ferri— Pills of Aloes and Iron. U. S. P. Described under Aloes. Dose.—5-10 grains (0.3-0.6 Gm.), or two or three pills. Emplastrum Ferri—Emplastri Ferri—Iron Plaster. U. S. P. (Strengthening Plaster.) Formula : Ferric Hydrate, 90; Olive Oil, 50; Burgundy Pitch, 140; Lead Plaster, 720. For external use. Trochisci Ferri—TrochTscos (ace) Ferri—Troches of Iron. U. s. P. Composition.—Ferric Hydrate; Vanilla; Sugar; Mucilage of Tragacanth. Dose.—One to two troches, each troche containing 5 grains (0.3 Gm.) of ferric hydroxide. Liquor Ferri Nitratis—Liquoris Ferri Nitratis— Solution of Ferric Nitrate. U. S. P. Origin.—An aqueous solution of Ferric Nitrate, containing about 6.2 per cent, of the anhydrous salt, corresponding to about 1.4 per cent, of metallic iron. Description and Properties.—A clear, amber-colored or red- dish liquid, odorless, having an acid, styptic taste, and an acid reaction. Dose.—5-10 minims (0.3-0.6 Cc). 192 A TEXT-BOOK OF MATERIA MEDICA. Pilulae Ferri Carbonatis—Pilulas (ace) Ferri Car- bonatis—Pills of Ferrous Carbonate. U. s. r. (Ferruginous Pills—Chalybeate Pills—Blauo's Pills.) Dose.—2 to 5 pills, each pill containing I grain (0.064 Gm.) of ferrous carbonate. Unofficial Preparations. Tinctura F&rri Acetatis—Tincturae FSrri Acetatis—Tincture of Ferric Ace- tate, U. S. P.—Composition: Solution of Ferric Acetate; Alcohol; Acetic Ktlicr. Description and Properties.—A clear, dark, reddish-brown liquid, transparent in thin layers, having the odor of acetic ether, an acidulous and astringent taste, and a slightly acid reaction. Miscible in all proportions with water, without becoming turbid. The tincture should be kept in the dark and in a cool place. Dose.—5-30 minims (0.2-2.0 Cc.). Ffirri Arsenas—Fferri Arsenatis—Iron Arsenate.—Description and Proper- ties.—A green or blue-green, amorphous powder, insoluble in water and in alcohol. Dose.—^-\ grain (0.003-0.03 Gm.). Ffirri Albiiminas—Ffirri Albuminatis—Albuminate of Iron.—Description and Properties.—Golden yellow, transparent scales, containing 3.34 per cent, of iron. Dose.—5-30 grains (0.3-2.0 Gm.). A liquor and a syrup of albuminate of iron are used. FSrrum Dialysatum—FSrri Dialysati—Dialyzed Iron (Liquor Ferri Dia- lysatus—Liquor Ferri Oxychlorati).—Description and Properties.—Perfectly transparent, thin layers, of a deep brown-red color, inodorous, and almost destitute of styptic taste. Miscible with alcohol, glycerin, syrup, and distilled water, but not with spring-water or other, even dilute, saline solutions. Dose.—10-30 minims (0.6-2.0 Cc). Liquor Ferri Peptonati—Liquoris F6rri Peptonati—Solution of Peptonate of Iron.—Dose, |—2 fluidrachms (2.0-8.0 Cc). Liquor Mangano-FSrri Peptonatus—Liquoris M3ngano-F8rri Peptonati (Gude)—Solution of Peptonate of Iron and Manganese.—A proprietary prepa- ration from the formula of Dr. Gude. Dose.—2-4 fluidrachms (8.0-15.0 Cc). Allied Compounds. Haemogallol.— Origin.—Prepared by the action of Pyrogallol on the coloring matter of the blood. Description and Properties.—A reddish-brown, tasteless powder. Dose.—1-8 grains (0.06-0.5 Gm.). Haemol.— Origin.—Prepared by the action of Zinc Dust on the coloring matter of the blood. Description and Properties.—A blackish-brown powder having a slight taste. Dose.—1-8 grains (0.06-0.5 Gm.). Ferratin.— Origin.—A compound of Iron first obtained by Professor Schmiedeberg from hog's liver. Description and Properties.—A fine, reddish-brown powder containing about 7 per cent, of iron. One variety is insoluble, though the sodium ferratin is freely soluble in water. HEM A TICS. *93 Dose.— Io-20 grains (0.16-1.2 Gm.). Haemalbumin.—A preparation said to contain two albuminoids and salts of the blood. Description and Properties.—A permanent powder, soluble in water and in alcohol. Dose.—5-15 grains (0.3-1.0 Gm.). Haemoglobin.—Said to be the coloring principle of the solid elements of the blood. Dose.—1-3 grains (0.06-0.18 Gm.). Haemoferrum.—Claimed to be a natural proteid compound of Iron obtained from bullock's blood. Dose.—1-3 grains (0.06-0.18 Gm.). Iron Quinine Chloride.—A yellowish-red powder, soluble in water, alcohol, and glycerin. Dose.—1-3 grains (0.06-0.18 Gm.). Used externally as a hemostatic Antagonists and Incompatibles.—The ferric salts are incom- patible with tannic and gallic acids and vegetable astringents, and gelatinize mucilage of acacia. The carbonates are also incompatible with tannic and mineral acids and acidulous salts. The salts of the vegetable acids and the iodides are incompatible with mineral acids, tannic acid, and with alkalies and their carbon- ates. The tincture of the chloride of iron is also incompatible with tannic acid, vegetable astringents, alkalies and their carbon- ates, lime water, and the carbonates of calcium and magnesium. Synergists.—All the restorative medicines are synergistic. Physiological Action.—Iron is a typical restorative, being an essential element of the blood, there being 1 part of iron to 230 of red globules. It has also been found in the gastric juice, bile, lymph, chyle, milk, urine, pigment of the eye, etc. This omni- presence is readily accounted for when it is remembered that the food of man contains iron in variable quantities. Indeed, this use- ful metal may well be called a respiratory nutrient because of its property of increasing the oxygen-carrying power of the red blood- corpuscles—muscular force and functional activity generally being dependent upon the supply of oxygen, or proper respiration, as the motive power. When the system is in a normal, healthy condition, sufficient iron is furnished by the mixed diet to answer all physiological requirements. In many diseased conditions, however, there is a deficiency of iron, and it is necessary to restore this element in one way or another. The chief actions of iron are—1. To increase the oxygen- carrying powers of the blood; 2. To convert the oxygen present in the tissues into ozone; 3. To serve both as a local and general astringent. 13 194 A TEXT-BOOK OF MATERIA MEDICA. The physiological effects upon the various systems, locally and internally, now to be considered, are due directly or indirectly to the principal actions above mentioned. Externally and Locally.—Neither the ferric nor the ferrous salts exert any action upon the unbroken skin. When applied, however, to mucous membranes or denuded surfaces, they are astringent and hemostatic, the ferric salts being the more powerful, coagulating albuminous fluids. When applied to bleeding surfaces the hemo- static action is due rather to the coagulation of the blood, forming a natural barrier to its escape, than to any direct action upon the walls of the vessels. The vegetable salts—scale preparations— possess so feeble astringent properties that they are rarely, if ever, used as local applications. The acid and astringent preparations of iron act upon the teeth. The ferric oxides are disinfectant, owing to their property of con- verting oxygen into ozone. Internally.—Digestive System.—The teeth and tongue are black- ened by the preparations of iron. In the stomach, when not con- traindicated and in small doses, its slightly irritant and astringent properties render iron quite a valuable stomachic tonic. Under excessive doses or prolonged administration the acid preparations especially are apt to cause gastric derangement—anorexia, nausea, and serious indigestion. The ferric chloride is particularly valu- able in that its ingestion does not, like that of other preparations of iron, diminish the supply of hydrochloric acid in the gastric juice. The scale salts, though disturbing the digestion less than the acid preparations, are ordinarily inferior to the latter. All the preparations of iron are probably converted into the chloride in the stomach. When entering the intestines they are converted into the ferric oxide, ferrous chloride, the alkaline albu- minate, and the insoluble sulphide and tannate. Most of the iron preparations are constipating, the phosphate and pyrophosphate being exceptions. They tend to diminish the bile and the secre- tions from the gastro-intestinal tract. Circulatory System.—The action of iron upon the blood is of great importance, since, the metal being a normal constituent of that fluid, its administration has a nutrient as well as a medicinal influence. A primary effect is to supply a deficiency of red cor- puscles and bring the hemoglobin up to the normal standard. Iron enables the red corpuscles to convey more oxygen to the tissues, converting that element into ozone and thereby rendering it HEMATICS. I95 more active in promoting oxidation. The muscular power of the heart is increased, the arterioles slightly contracted, and arterial tension somewhat raised. Nervous System.—The general effect is tonic, the influence of iron and its salts being highly beneficial in strengthening the action of the nerves in cases of physical debility. With subjects inclined to plethora, however, certain untoward symptoms may result from administration of the stronger preparations, including a feeling of congestion in the cerebrum. Respiratory System.—No immediate action is perceptible under normal conditions, but in anemic states, by supplying the nerve- centers, muscles, and lungs with better blood, the respiratory power is increased. Absorption and Elimination.—Opinions differ regarding the form in which iron is absorbed. Probably much of it is converted into the soluble chloride and absorbed as such, while a portion, passing into the intestines, may there be converted into the soluble alka- line albuminate capable of absorption. The larger portion of iron taken into the system, however, is changed into the insoluble sul- phide and tannate, and excreted as such, giving to the feces a black color. Such part of the iron as enters the circulation com- bines with the red corpuscles. The salts of the organic acids are absorbed directly into the blood. Such careful pharmacologists as Bunge, Schmiedeberg, and Hamburger claim that inorganic preparations of iron are neither absorbed nor assimilated, maintaining that the blood and hemo- globin are influenced only by the organic compounds. Yet, not- withstanding these statements, clinical experience has fully demon- strated the value of such preparations as reduced iron, tincture of the chloride, carbonate, etc.; and it is still perhaps a mooted ques- tion whether appreciable amounts of them are actually absorbed, or whether, according to Bunge, the inorganic prevent the decom- position of the organic salts of iron in the food by fixing the decomposing agents in the intestines. At all events, the beneficial results in anemia and chlorosis of large doses of the inorganic preparations are too manifest to justify abandonment of these agents because of our ignorance touching their modus operandi. Bunge's hypothesis would at least seem plausible when it is remembered that only traces of iron can be found in the urine vvhen the drug is given by the stomach, while if injected into the circulation large quantities are eliminated by the kidneys. It is 196 A TEXT-BOOK OF MATERIA MEDICA. quite possible that the improvement in the red corpuscles, and the promotion of oxidation independent of them, take place in the portal circulation,.and that when the iron reaches the liver it is there intercepted and, together with the bile, turned back into the intestines. The amount of urea is increased and micturition rendered more frequent by preparations of this metal. Elimination takes place chiefly by the feces, to which a blackish color is imparted by the formation of ferrous sulphide. The bile, urine, and even the skin, as well as the mucous and serous mem- branes, share in the excretory process. Temperature.—The administration of iron tends to raise bodily heat. This, however, may be due only to the normal influence of the metal, the ozonizing power of which, affecting the promo- tion of tissue-waste, naturally causes an elevation of temperature. Untoward Action.—The continued use of ferruginous prepara- tions has a tendency to impair the normal digestive powers, occa- sioning even gastric oppression, nausea, and vomiting. Reduced iron, the phosphate, and the pyrophosphate produce less untoward action than other preparations, and the ferrous are better tolerated than the ferric salts. Not infrequently acne of the face, breast, and back is occasioned, while the prolonged administration of the drug may in rare cases be accompanied by hemorrhages from the mucous membranes and symptoms of plethora and vascular excitement. Large doses of the ferrous sulphate may occasion obstruction of the bowels. Poisoning.—The ferric preparations in a concentrated form pro- duce all the symptoms of an irritant poison—gastric pain, vomit- ing, etc Treatment of Poisoning.—The stomach should be emptied by an emetic or carefully cleansed, the treatment being followed by the administration of alkali solutions, tannic acid, and demulcent drinks, the procedure being similar to that employed in poisoning from mineral acids. Therapeutics.—Externally and Locally.—The astringent and styptic properties of chlorides and sulphates of iron have rendered them serviceable in controlling hemorrhage and as local astrin- gents in relaxed conditions of the pharynx and larynx and mucous membranes generally. The tincture of the chloride has been highly recommended as a local application to the throat in diph- theria, and chronic and indolent ulcers may often be benefited by HEMATICS. 197 a wash containing from 2 to 5 grains (0.12-0.3 Gm.) of the sulphate to 1 ounce (30.0 Cc) of water. Internally.—The most important use of iron is to restore the number of red corpuscles. In nearly every form of anemia, there- fore, iron is indicated. In chlorosis, especially, it is of great value; but in order that its effects may be most beneficial, cathartics, such as rhubarb and aloes, which do not weaken the intestines should accompany its use. Even the anemia due to hemorrhage calls for iron; yet if the assimilative functions are not impaired, the drug should be reinforced by plenty of nutritious food, from which the constituents of the blood are normally elaborated. The anemia of scrofula and syphilis is benefited by some form of iron, care being taken in these cases to select the proper salts. In glandular scrofula, for instance, the iodide is to be preferred, and, theoretically, this salt is preferable also in syphilis, yet in the latter disease the efficacy of the salt depends less upon its particular radical than upon its restorative properties and its power of counter- acting the depressing and mischievous effects so often produced by excessive use of the specific. In the desquamative forms of Bright's disease iron is of signal benefit. In this condition the blood-disks are rapidly destroyed by the urea; moreover, certain preparations of iron possess quite a local action upon the kidney. Iron is also useful in jaundice where there is more or less cholemia, with destruction of the red corpuscles. Many ncrzwus disorders dependent upon anemia are relieved by iron. Even in chorea and various neuralgias—especially those of an intermittent nature arising from an impoverished state of the blood—iron is of decided value. In many chronic nervous diseases, however, good judgment in the use of the drug is necessary, lest it prove more prejudicial than advantageous. In anemia of certain cardiac diseases iron is of unquestioned value, though the fact is well known to observant practitioners that in these cases iron alone is but a single element in the successful treatment of them. While iron is of great service in lessening the muco-purulent expectoration of chronic bronchitis, its influence in pulmonary tuber- culosis is less favorable. At times, it is true, the drug appears to improve the condition of phthisical patients, yet more frequently it induces hemoptysis and hastens the progress of the disease. In certain disorders of the geuito-urinary tract—prolapsus uteri, incon- 198 A TEXT-BOOK OF MATERIA MEDICA. tine nee of urine, seminal emissions, prostatorrhca, etc.—iron is an appropriate remedy. It is an important agent in the treatment of diabetes, though care should be taken to guard against its tendency to constipate the bowels. As observed later on, iron is contraindicated in febrile diseases, yet it is a matter of clinical experience that the drug acts favorably in modifying the course of idiopathic erysipelas, pyemia, septicemia and diphtheria. The astringent action of iron is available in the treatment of vaginal leucorrhea, hematemesis, and passive hemorrhages from the uterus, bladder, kidneys, etc. It has also proved highly beneficial in certain forms of chronic diarrhea and dysentery. In amenorrhea and menorrhagia, when due to a deficiency of normal blood, iron is an extremely valuable remedy. Contraindications.—Iron is usually contraindicated in fever and acute inflammatory conditions, in anemia of malignant disease, such as cancer, in Addison's disease, and in the hemorrhagic diath- esis. Should the use of iron derange digestion or aggravate hemorrhoidal conditions, the drug should be discontinued or care- fully administered, being associated with stomachics or laxatives to mitigate its untoward effects. Administration.—If the appetite be poor, iron should be ad- ministered in small doses (invariably after meals) or preceded by vegetable bitters. The tincture of the chloride and the stronger preparations should be freely diluted with water. The citrate of iron is a mild preparation well adapted for children and persons of delicate stomach. Probably the salt richest in iron, yet of all the ferruginous preparations the most agreeable and least irritating, is the iron and potassium tartrate. The soluble ferric pyrophosphate is also a mild and pleasant preparation. The compound iron mixture pos- sesses special advantages in the treatment of chlorosis and chronic diseases of the skin, while the solution of iron and ammonium acetate (Basham's mixture) is the best preparation in albuminuria— particularly that accompanying tubular nephritis—it being agree- able and well tolerated. The best styptic is the ferric subsulphate or its solution. Dialyzed iron, being agreeable to the taste, was formerly a pop- ular remedy. Some of the allied compounds above mentioned are very useful. The ferratin especially is a most valuable compound of iron, while HEM A TICS. I99 the liquor mangano-ferri peptonatus is an agreeable and efficient remedy, having no deleterious effect upon digestion, but, on the contrary, actually improving the appetite. Manganum-Mangani—Manganese. This metal is a normal constituent of the body, existing in ap- preciable though minute quantities in the blood, bile, etc. From the fact of its presence in the blood, and because of the similarity of its chemical affinities to those of iron, theorists, rather than careful and practical observers, have advocated its use as a worthy and efficient substitute for the latter agent. Its therapeutic uses as a restorative, or as an alternative or synergist to iron, are based more upon abstract deductions than upon clinical observation. Still, as its chemical character resem- bles that of iron—though the metal in its operation is often antagonistic to the latter—its salts are of sufficient therapeutic importance to merit brief mention here. Mangani Dioxidum—Mangani Dioxidi—Manganese Dioxide. U. S. P. (Black Oxide of Manganese.) Origin.—Native, crude manganese dioxide, containing at least 66 per cent, of the pure dioxide. Description and Properties.—A heavy, grayish-black, more or less gritty powder, without odor or taste; permanent in the air; insoluble in water or alcohol. Dose.—5-40 grains (0.3-3.0 Gm.). Mangani Sulphas—Mangani Sulphatis—Manganese Sulphate. U. s. P. Origin.—Obtained by heating Manganese Dioxide with suf- ficiently strong Sulphuric Acid, evaporation, and crystallization. Description and Properties.—Colorless or pale rose-colored, transparent, tetragonal prisms, odorless, and having a slightly bitter and astringent taste; slightly efflorescent in dry air. Soluble in 0.8 part of water and in 1 part of boiling water; insoluble in alco- hol. Manganese sulphate should be kept in well-stoppered bottles. Dose.—2-5 grains (0.1-0.3 Gm.). (For Potassium Permanganate see section on Antiseptics.) Antagonists and Incompatibles.—The salts of lead, silver, and mercury are incompatible with manganese. 200 A TEXT-BOOK OF MATERIA MEDICA. Synergists.—Iron is theoretically synergistic, and the salts of zinc, copper, and silver are similar in their action on the nervous system. Physiological Action.—Externally and Locally.—The two salts above mentioned have no important local action. Internally.—In large doses these salts, especially the sulphate, irritate the gastro-intestinal tract, while excessive doses may even occasion gastro-enteritis. The sulphate acts as an emeto-cathartic and possesses cholagogue properties. As is the case with many other drugs of this character, small doses may even promote the appetite and improve the digestive function. Large doses, or the continued administration of these preparations, affects the system more like zinc than iron, pro- ducing great depression, muscular weakness and waste, diminishing the pulse-beat, weakening the heart, and lowering arterial tension. There is, moreover, a tendency to fatty degeneration of the muscles and liver. Therapeutics.—The manganese dioxide has been used in the treatment of gastralgia, pyrosis, and simple ulcer of the stomach. Its action probably resembles that of bismuth, though it is a much less efficient remedy than the latter drug. The sulphate is used occasionally as a cholagogue purgative in malarial jaundice, although why it should be preferred to many other and superior cholagogues it is difficult to understand. Gouty dyspepsia appears to have been much improved by the use of manganese. The association of iron and manganese makes a valuable combination in the treatment of chlorosis and many variations of anemia. Phosphorus—Phosphori—Phosphorus. U. S. P. Origin.—It exists, chiefly as phosphates, in many minerals and in all plants and animals. It is prepared by treating Calcined Bones with Sulphuric Acid, evaporation, and distillation. Description and Properties.—A translucent, nearly colorless solid, of a waxy luster, having at ordinary temperatures about the consistence of beeswax. When kept for some time the surface becomes red and occasionally black. Phosphorus has a distinctive and disagreeable odor and taste {tasting being allowable only in the form of extreme dilution). When exposed to the air it emits white fumes, visible in the dark, and having an odor somewhat resembling HEM A TICS. 201 that of garlic. Upon prolonged exposure to air it takes fire spon- taneously. Phosphorus is insoluble, or nearly so, in water, to which, how- ever, it imparts its characteristic disagreeable odor and taste. It is soluble in 350 parts of absolute alcohol, in 80 parts of absolute ether, and in about 50 parts of any fatty oil. It is very soluble in chloroform or in carbon disulphide, the latter yielding a solution to be handled with the greatest care to prevent accident from combus- tion. The drug should be carefully kept under water, in strong, well-closed vessels, in a secure and moderately cool place protected from light. Dose.—T^0 3^ grain (0.0006-0.002 Gm.). Official Preparations. Oleum Phosphoratum—Olei Phosphorati—Phosphorated Oil.—Dose, 1-5 minims (0.06-0.3 Cc). A clear, yellowish liquid, having the odor of phosphorus and of ether, but not phosphorescent in the dark. It should be perfectly free from particles of undissolved phosphorus. Pilulae Phfisphori—Pllulas (ace.) Ph6sphori—Pills of Phosphorus.—Dose, one to two pills. Each pill contains T^5 grain (0.0006 Gm.) of phosphorus. Spiritus Ph6sphori—Spiritus Ph6sphori—Spirit of Phosphorus (Tincture of Phosphorus).—Dose, 5-30 minims (0.3-2.0 Cc). Elixir Phttsphori—Elixir Ph6sphori—Elixir of Phosphorus.—Dose, \-2 fluid- drachms (2.0-8.0 Cc). Antagonists and Incompatibles.—The principal chemical anti- dotes are hydrated magnesia, lime water, powdered charcoal, cop- per sulphate, and old acid turpentine. Synergists.—Cod liver oil and the Restoratives generally aid the action of phosphorus. It is claimed that arsenic and sulphur are also synergistic. Physiological Action.—Externally and Locally.—Applied to the skin, phosphorus causes local inflammation, ulceration, and possibly gangrene. The fumes may produce the most serious results—even maxillary necrosis where dental caries is present, as well as great irritation of the conjunctivae and the respiratory mucous membrane. The graver systemic symptoms are confined to the conditions induced by toxic doses of the drug. Internally.—Digestive System.—Taken into the stomach, no special effect is apparent as a result of small doses, save that the drug acts as a functional stimulant. Larger amounts have been held to impede digestion by impairing the action of the gastric juice upon albuminoid materials. Immoderate doses occasion 202 A TEXT-BOOK OF MATERIA MEDICA. great irritation of the stomach and intestines, accompanied by abdominal distress, vomiting, and purging. Jaundice is a not infrequent result of ingestion, due to obstruction of the biliary ducts. Minute quantities stimulate the nutrition of the tissues, especially that of the osseous system. Circulatory System.—The primary action is stimulating, the pulse rising and acquiring additional force, though not firmness The facial capillaries are expanded, often congested ; the cutaneous circulation becomes more rapid; and diaphoresis is produced. Under toxic doses the action of the heart is strongly depressed. Nervous System.—In repairing the waste of tissue phosphorus acts upon the nervous system as a tonic, improving the nutrition of debilitated parts and restoring to normal conditions the func- tional activity of organs and tissues. Small or moderate doses act as stimulants to the entire nervous system, intellectual activity being promoted and the sexual appetite increased. Toxic effects include coma, and occasionally vertigo, with delirium, convulsions, insensibility, and collapse. Respiratory System.—The deleterious action of the fumes of phosphorus is exemplified in their irritating effect upon the broncho- pulmonary mucous membrane. Toxic symptoms are often accom- panied by serious disturbances, respiratory failure being among the immediate causes of death. Absorption and Elimination.—The modus operandi of absorption is a matter of some dispute. Probably a portion of the drug undergoes oxidation in the stomach, and the phosphoric acid formed, combining with the alkalies, enters the blood as phos- phates. A part of the phosphorus is dissolved in the fats and oils present in the stomach, probably entering the circulation as ele- mentary phosphorus. The drug, having undergone oxidation in the system, is elim- inated as phosphoric acid, chiefly by the urine, increasing the excretion of urinary phosphates. The liver shares in the excretory process. Temperature.—Owing to capillary expansion, the superficial temperature is at first slightly raised, being subsequently dimin- ished. Evaporation and radiation, arising from profuse diaphoresis, contribute to thermal reduction. Eye.—In chronic poisoning from phosphorus hemorrhages and patches of degeneration in the retina are sometimes visible, the ophthalmoscopic picture resembling the retinitis of albuminuria. HE MA TICS. 203 Under medicinal doses no special effects upon the eye are reported, although, as has been stated, the vapor of phosphorus is highly irritant to the conjunctivae. Uterus.—The action of phosphorus tends to increase the men- strual flow. Untoward Action.—Small doses produce in some individuals severe gastric disturbance, and in rare cases diarrhea, tenesmus, and jaundice. The fatty degeneration of the retinal capillaries mentioned above—such as results from chronic intoxication affect- ing workers in match-factories—is an untoward manifestation to be guarded against by every available means. Poisoning.—The effects of a fatal dose of phosphorus are not immediate. After a lapse of several hours great weakness occurs, accompanied in a large majority of cases by vomiting. Abdominal pains follow, the symptoms becoming more acute, mucus and bile being present in the ejecta, which for a while retain the odor and luminosity of phosphorus. With the cessation of vomiting pain is abated, although it may extend over the entire abdominal region and even be attended with paroxysms. The foregoing symptoms are accompanied by pronounced anorexia, thirst and fever, a thickly-coated or whitish tongue, burning in the throat, and often signs of collapse. The temper- ature at first reaches nearly the maximum possible without proving fatal, subsequently sinking below the normal. After a few days jaundice sets in. The urine is diminished, becoming charged with albumin and urates, and even bloody, containing among other ingredients biliary acids and coloring matter. In fatal cases urea is almost wholly wanting. The stools may be normal, but the general condition is usually marked by diarrhea or constipation and flatulence. Hemorrhage often occurs, wounds bleeding pro- fusely, and as the severity of the symptoms increases delirium ensues, or coma terminating in convulsions. Serious nervous manifestations are frequently preceded by restlessness, insomnia, headache, and vertigo. In some delirious conditions wild, erotic states of the mind are the precursors of convulsive or comatose symptoms. Somnolence is not uncommon, with partial spasms and contraction or paresis of the voluntary muscles. Post-mortem examinations show that the liver, heart, kidneys, muscles, capillaries, and arterioles are implicated in the general effects of the poisoning, undergoing fatty degeneration. Sometimes the preponderating influence of the poison affects 204 A TEXT-BOO A' OF MA TERIA MEDICA. the bronchial and gastro-intestinal mucous membranes, or it may visit the nervous system or be manifested in the circulatory sys- tem. In cases of acute poisoning the duration of the malady varies greatly, death occurring at times within a few days, or, again, being deferred for a few weeks. As a rule, recovery is retarded, the elimination of the drug requiring time. The symptoms of chronic poisoning are in some respects espe- cially marked, inhalation of phosphorus-fumes frequently resulting in pronounced conditions of necrosis, particularly of the lower max- illary, although it has been maintained that this feature of the poi- soning is contingent upon denuded surfaces of bone, disintegration or softening of tissues, caries of the teeth, or communicating wounds. Very rarely the palate and frontal bones are similarly attacked. Treatment of Poisoning.—Emetics and purgatives are of the first necessity. Copper sulphate is the most efficient emetic as well as the best chemical antidote. Hydrated magnesia, charcoal, and lime water have been suggested, yet their action is tardy, and a more efficient antidote is desirable. Several chemical and physio- logical agents have been employed to counteract the effects of the drug, among them old acid (oxygenated) oil of turpentine and potassium permanganate in a } per cent, solution, opium being used as a stimulant to the heart and the circulatory system. As prophylactic measures for the protection of workmen against phosphor-necrosis masks covering mouth and nose have been found serviceable, as well as inhalation of the vapor of turpentine obtained by suspending a small bottle of the fluid about the neck. The teeth should be kept constantly in good condition, since caries favors the tendency to necrosis. Therapeutics.—Phosphorus is not used externally, but inter- nally it is a food, especially of the nervous and osseous systems, stimulating protoplasmic activity, although, according to Gubler, " phosphorus is a rapid stimulant, but it acts by causing waste, and not by increasing power; it impoverishes, and does not enrich; it momentarily galvanizes, as it were, the torpid functions, but is incapable of renewing a dilapidated constitution or even a nervous system exhausted by chronic disease." Clinical experience has certainly demonstrated its utility as a nutrient tonic to the nervous and osseous tissues. In neurasthenia and chronic nervous exhaustion it is highly efficacious. Paraplegia, particularly when resulting from excessive venery, is usually bene- fited by this drug, while the cases of locomotor ataxia improved by HEM A TICS. 205 phosphorus are numerous enough to deserve special consideration. Neuralgia, particularly of the fifth nerve and accompanied by great debility, is relieved by full doses administered every four hours. It is claimed by competent observers that certain cases of angina pectoris have been completely relieved by phosphorus. It has even been recommended in epilepsy, but its value here becomes more than doubtful when no mention of it is made by the best authorities on this disease. In paralysis resulting from cerebral hemorrhage it has been found beneficial. It has proved of great value in osteomalacia and rachitis, and the drug is credited with the cure of pernicious anemia, though it is singular, if the drug possesses any real value in this disease, that the fact has been recognized by so few observers. Such able men as Fox and Broadbent praise its efficacy in lytnphadenoma. The insomnia of the aged and the zvakefulness of cerebral anemia and exhaustion usually yield to this remedy. As to its aphrodisiac effects there is great difference of opinion, some physicians believing it to be a most powerful agent in reliev- ing functional impotence, while others—among them so enthusiastic an advocate of phosphorus as Thompson—conclude that the drug is inefficient for this purpose unless given in larger doses than safety prescribes. The enthusiastic praise of its eulogists, however, as a remedy in impotence of a functional character is of so con- vincing a nature as to certainly justify an extended trial in this condition. Scarcely less is the testimony regarding its efficacy in chronic psoriasis, lepra, lupus, and acne indurata. Administration.—Since many persons have a peculiar suscepti- bility to phosphorus, its administration should begin with small doses, and, should it be thought necessary to prolong the adminis- tration for an indefinite period, the tendency of the drug to produce general steatosis should not be forgotten. The phosphorus pill is undoubtedly the best form in which to administer the drug, though it possesses the disadvantages of being insoluble in the intestinal fluids and of producing more or less irritation of the gastro-intestinal mucous membrane, though the latter effect is usually unnoticed under ordinary medicinal dosage on a full stomach. The liquid preparations of phosphorus are more unstable, tending to become rapidly inert by oxidation. The spirit of phosphorus is sometimes given in cod liver oil or the elixir of calisaya. 206 A TEXT-BOOK OF MATERIA MEDICA Calcii Hypophosphis—Calcii Hypophosphitis—Cal- cium Hypophosphite. U. s. p. Origin.—Obtained by heating Phosphorus with Milk of Lime and exposing the mixture to the air. Description and Properties.—Colorless, transparent, mono- clinic prisms, or small, lustrous scales, or a white, crystalline powder; odorless, having a nauseous, bitter taste, and permanent in the air. Soluble in 6.S parts of water and in 6 parts of boiling water; insoluble in alcohol. Dose.—5-6 grains (0.3-0.4 Gm.). Calcii Phosphas Praecipitatus—Calcii Phosphatis Praecipitati—Precipitated Calcium Phosphate. U. S. P. Origin.—Prepared by the action of Hydrochloric Acid and Water upon Bone-ash, the addition of Solution of Ammonia to render the mixture of an alkaline reaction, and washing and drying the precipitate. Description and Properties.—A light, white, amorphous pow- der, odorless and tasteless, permanent in the air. Almost insoluble in cold water; partly decomposed by boiling water, which dissolves out an acid salt; almost insoluble in acetic acid, except when freshly precipitated; easily soluble in hydrochloric or nitric acid; insoluble in alcohol. Dose.—10-30 grains (0.6-2.0 Gm.). Sodii Hypophosphis—Sodii Hypophosphitis— Sodium Hypophosphite. U. S. P. Origin.—Prepared by adding Sodium Carbonate to a solution of Calcium Hypophosphite and evaporating the filtrate. Description and Properties.—Small, colorless, transparent, rec- tangular plates of a pearly lustre, or a white, granular powder, odorless, and having a bitterish-sweet, saline taste. Very deliques- cent on exposure to moist air. Soluble in 1 part of water and in 30 parts of alcohol, also in 0.12 part of boiling water and in I part of boiling alcohol; slightly soluble in absolute alcohol; insoluble in ether. Sodium hypophosphite should be kept in well-stoppered bottles. Dose.—5-10 grains (0.3-0.6 Gm.). HE MA TICS. 207 Potassii Hypophosphis—Potassii Hypophosphitis— Potassium Hypophosphite. U.S. P. Origin.—Prepared in a similar manner to Calcium Hypophos- phite, or by double decomposition of Calcium Hypophosphite and Potassium Carbonate. Description and Properties.—White, opaque, hexagonal plates, or crystalline masses, or a granular powder, odorless, and having a pungent, saline taste; very deliquescent. Soluble in 0.6 part of water and in 7.3 parts of alcohol. Potassium hypophosphite should be kept in well-stoppered bottles. Dose.—5-30 grains (0.3-2.0 Gm.). Acidum Hypophosphorosum Dilutum—Acidi Hypo- phosphorosi Diluti—Diluted Hypophosphorous Acid. U.S. P. Origin.—Prepared by decomposing Potassium Hypophosphite by Sulphuric Acid, filtering, and evaporating to a syrupy consist- ence. It contains 10 per cent, by weight of absolute hypophos- phorous acid. Description and Properties.—A colorless liquid, without odor, and having an acid taste. Specific gravity about 1.046. Miscible in all proportions with water. Dose.—It is never used as a therapeutic agent by itself, but in the syrup of the hypophosphites. Syrupus Hypophosphitum—Syrupi Hypophosphi- tum—Syrup of Hypophosphites. Formula: Calcium Hypophosphite, 45 ; Sodium Hypophos- phite, 15; Potassium Hypophosphite, 15; Diluted Hypophos- phorous Acid, 2; Spirit of Lemon, 5; Sugar, 500; sufficient Water to make IOOO. Dose.—1-2 fluidrachms (4.0-8.0 Cc). Syrupus Hypophosphitum cum Ferro—Syrupi Hy- pophosphitum cum Ferro—Syrup of Hypophos- phites with Iron. Formula: Ferrous Lactate, 10; Potassium Citrate, 10; Syrup of the Hypophosphites, to 1000. Dose.—1-2 fluidrachms (4.0-8.0 Cc). 208 A TEXT-BOOK OF MATERIA MEDICA. Zinci Phosphidum—Zinci Phosphidi—Zinc Phosphide. U. s. p. Origin.—Prepared from Vapor of Phosphorus in a current of Dry Hydrogen over heated Zinc, after all atmospheric air has been expelled. Description and Properties.—A gritty powder of a dark-gray color, or crystalline fragments of a dark, metallic luster, and having a faint odor and taste of phosphorus. In contact with air it slowly emits phosphorous vapor. Insoluble in water or alcohol. Zinc phosphide should be kept in small glass-stoppered bottles. Dose.—A^ \ grain (0.004-0.02 Gm.). Antagonists and Incompatibles.—The sodium and potassium hypophosphites are incompatible with the soluble salts of mercury and silver, and the soluble phosphates and carbonates are incom- patible with calcium hypophosphite. Zinc phosphide is decom- posed by mineral acids. Synergists.—Phosphorus, cod liver oil, and the Restoratives generally. Physiological Action.—Although not possessing the active and poisonous properties of phosphorus, the hypophosphites are similar in their effect to small doses of phosphorus—i. e. in stimu- lating and regenerating the nervous system and those tissues which contain phosphorus and lime. The calcium phosphate possesses no action superior to that of the hypophosphite, and its virtues are chiefly those of the hypo- phosphite. The phosphate is soluble to a slight extent in lactic and hydro- chloric acids, so that when taken by the stomach a portion diffuses into the blood. The zinc phosphide is more active, and resembles more closely the action of phosphorus, and in too large doses it irritates the stomach in the same manner as uncombined phosphorus. Therapeutics.—Externally and Locally.—The calcium phos- phate, combined with a little free phosphoric acid, has been recommended by Doubenski in the treatment of tuberculous ulcera- tions. "Cold abscesses and fistulous tracts were treated by packing with gauze soaked with a solution of 5 parts to 100." Internally.—The hypophosphites may be employed for the same conditions as those in which phosphorus is used. In chlorosis, anemia, scrofula, and tuberculosis they have been highly recom- mended. In the author's opinion, in the cachexiae mentioned the HEM A TICS. 209 benefit derived from their use is slight compared with that of cod liver oil and the hygienic influences rendered serviceable in these conditions. The praise bestowed upon calcium phosphate consists largely of assertions rather than evidence: if it possesses any therapeutic value, it is chiefly that of the hypophosphite. The zinc phosphide has medicinal virtues greatly superior to those of the preparations above mentioned. In nervous disorders dependent upon defective nutrition it is equal, if not superior, to phosphorus, and it may be employed for any condition in which the latter drug is useful. Administration.—The zinc phosphide is best given in pill form. The hypophosphites and calcium phosphate may be given in cap- sules, though the syrup of the hypophosphites is usually preferred. It is a question whether the sugar which the syrup contains may not tend to induce or aggravate the gastric fermentation so often present in cases requiring the use of a reconstituent. Cinchona—Cinchonae—Cinchona. U. S.P. Origin.—The bark of Cinchona Calisaya Weddell, Cinchona officinalis L., and of their hybrids and those of other species of Cinchona, yielding, when assayed by the process given in the U. S. Pharmacopoeia, " not less than 5 per cent, of total alkaloids and at least 2.5 per cent, of quinine." The genus Cinchona as at present constituted consists of from thirty-one to thirty-six species, all of which are native to South America. The habitat of the tree follows the eastern slope of the Andes, beginning in Bolivia and extending through Peru. From about 2° south lati- tude in Ecuador it occupies also the eastern slope of the Western Cordilleras, until by two narrow belts it enters the highlands of New Granada, whence it spreads northeast and northward into Venezuela, reaching the vicinity of Caracas and the Caribbean Sea. The climate in which the most valuable species are found is, according to Karster (1858), characterized by a rainy season lasting for nine months, heavy rains falling principally during the night, alternating with sunshine and fog during the day. During the remaining three months of the year the nightly temperature fre- quently sinks below freezing-point, in the day-time, however, reaching 25° C. {77° F.), producing dense fogs. The Cinchonas are evergreen trees or shrubs, the most valuable u 210 A TEXT-BOOK OF MATERIA MEDICA. species attaining a height of from 40 to 80 feet (12 to 24 M.). They are not met with in the valleys, but are found at altitudes varying from 330 feet (100 M.) to 11,500 feet (3500 M.). Accord- ing to Weddell, the most valuable species grow at an altitude of 5300 to 7900 feet (1600 to 2400 M.). All the species are found in the primeval forests, either singly or in collections of a few specimens. The tree is cultivated in British Sikkin, Ceylon, Java, and Jamaica. Description and Properties.—In quills or in curved pieces, varying in length, and usually TV or i inch (2 or 3 Mm.), or some- times \ inch (5 Mm.), thick; the outer surface covered with a gray or brownish-gray cork, usually slightly wrinkled, marked with transverse and also intersecting longitudinal fissures (C. Calisaya), and sometimes with scattered warts and slight longitudinal ridges; inner surface light cinnamon-brown, very highly striate; fracture of the outer layer short and granular, finely fibrous in the inner layer; powder light- or yellowish-brown ; odor slight, somewhat aromatic; taste bitter and somewhat astringent. Cinchona Rubra—Cinchonae Rubrae—Red Cin- chona. U. S. P. Origin.—The bark of Cinchona succirubra Pavor, containing not less than 5 per cent, of its peculiar alkaloids. Description and Properties.—In quills or in curved pieces, varying in length, and from yV to i or i mcn (2 to 4 or 5 Mm.) thick; the outer surface covered with a grayish-brown cork, more or less rough from warts and longitudinal warty ridges, and few, mostly short, transverse fissures; inner surface more or less deep reddish-brown and distinctly striate; fracture short-fibrous in the inner layer; powder reddish brown ; odor slight; taste bitter and astringent. Among the various alkaloids found in cinchona the following are the most important: Quinine, quinidine, cinchonine, and cin- chonidine, the medicinal value of the bark depending almost exclu- sively upon the alkaloid quinine. Other less important ingredients are kinic and kinovic acids, kinovin, cinchotannic acid, cinchona-red, and a minute quantity of a butyraceous, volatile oil. The ash amounts to between 1 and 2 per cent., consisting chiefly of the carbonates of calcium and potas- sium. Dose of powdered cinchona, 15-60 grains (1.0-4.0 Gm.). HEM A TICS. 211 Official Preparations of Cinchona. Extractum Cinchonae—Extracti Cinchonae—Extract of Cinchona.—Dose, 5- 30 grains (0.3-2.0 Gm.). Extractum Cinchonae Fluidum—Extracti Cinchonae Fluidi—Fluid Extract of Cinchona.—Dose, 10-60 minims (0.6-4.0 Cc). Infusum Cinchonae—Infusi Cinchonae—Infusion of Cinchona (6 per cent.).— Dose, 1-4 fluidrachms (4.0-15.0 Cc). Tinctura Cinchonae—Tincturae Cinchonae—Tincture of Cinchona (20 per cent).—Dose, 1-2 fluidrachms (4.0-8.0 Cc). Official Preparation of Cinchona Rubra. Tinctura Cinchonae CompOsita—Tincturae Cinchonae Compositae—Com- pound Tincture of Cinchona (10 per cent., with Bitter Orange Peel 8 per cent., and Serpentaria 2 per cent.).—Dose, 1-4 fluidrachms (4.0-15.0 Cc). Official Alkaloids and Salts. Cinchonidinae Sulphas—Cinchonidinae Sulphatis—Cinchonidine Sulphate. —Description and Properties.—White, silky, acicular crystals, without odor and having a very bitter taste; slightly efflorescent on exposure to air. Soluble in 70 parts of water and in 66 parts of alcohol. Dose.—10-30 grains (0.6-2.0 Gm.). Cinchonina—Cinchoninae—Cinchonine.—Description and Properties.—White lustrous prisms or needles, without odor, at first almost tasteless, but soon developing a bitter after-taste; permanent in the air; soluble in 3760 parts of water and in 116 parts of alcohol. Dose.—5-30 grains (0.3-2.0 Gm.). Cinchoninae Sulphas—Cinchoninae Sulphatis—Cinchonine Sulphate.— Description and Properties.—Hard, white, lustrous, prismatic crystals, without odor and of a very bitter taste; permanent in the air; soluble in 66 parts of water and in 10 parts of alcohol. Dose. — 5-30 grains (0.3-2.0 Gm.). Quinidinae Sulphas—Quinidlnae Sulphatis—Quinidine Sulphate.—Descrip- tion and Properties.—White silky needles, odorless, and of a very bitter taste; per- manent in the air; soluble in 100 parts of water and in 8 parts of alcohol. It should be kept in well-stoppered bottles, in a dark place. Dose.—5-30 grains (0.3-2.0 Gm.). Quinlna—Quininae—Quinine.—Description and Properties.—A white, flaky, amorphous or crystalline powder, odorless, and having a very bitter taste; permanent in the air; soluble in 1670 parts of water and in 6 parts of alcohol. Quinine should be kept in well-stoppered bottles, in a dark place. Dose.—1-60 grains (0.06-4.0 Gm.). Quininae Bisulphas—Quininae Bisulphatis—Quinine Bisulphate.—Descrip- tion and Properties.—Colorless, transparent, or whitish orthorhombic crystals or small needles; odorless and having a very bitter taste; efflorescent on exposure to the air. Soluble in 10 parts of water and in 32 parts of alcohol. It should be kept in well- stoppered bottles, in a dark place. Dose.— 1 —15 grains (0.06-1.0 Gm.). Quininae Hydrobromas—Quininae Hydrobromatis—Quinine Hydrobro- mate.—Description and Properties.—White, light, silky needles; odorless and of a very 212 A TEXT-BOOK OF MATERIA MEDICA. bitter taste. The salt is liable to lose water on exposure to warm or dry air. Soluble in 54 parts of water and in 0.6 part of alcohol. It should be kept in well stoppered bottles, in a dark place. Dose.—1-20 grains (0.06-1.3 Gm.). Quininae Hydrochloras—Quininae Hydrochloratis—Quinine Hydrochlorate. —Description and Properties.—White, silky, light, and fine needle-shaped crystals, odorless, and having a very bitter taste. The salt is liable to lose water on exposure to warm air. Soluble in 34 parts of water and in 3 parts of alcohol. Quinine hydro- chlorate should be kept in well-stoppered bottles, in a dark place. Dose.—1—15 grains (0.06-1.0 Gm.). Quininae Sulphas—Quininae Sulphatis—Quinine Sulphate.—Description and Properties.—White, silky, light, and fine needle-shaped crystals, fragile and somewhat flexible, making a very light and easily compressible mass, lusterless from superficial efflorescence after being for some time exposed to the air; odorless and having a per- sistent, very bitter taste. The salt is liable to lose water on exposure to warm air, to absorb moisture in damp air, and to become colored by exposure to light. Soluble in 740 parts of water and in 65 parts of alcohol, also in 40 parts of glycerin and in about 680 parts of chloroform, and freely soluble in dilute acids. It should be kept in well- stoppered bottles, in a dark place. Dose.—1-60 grains (0.06-4.0 Gm.). Quininae Valerianas — Quininae Valerianatis — Quinine Valerianate.— Description and Properties.—White or nearly white, pearly, lustrous, triclinic crystals, having a slight odor of valerianic acid, and a bitter taste; permanent in the air; soluble in 100 parts of water and in 5 parts of alcohol. It should be kept in well-stoppered bottles, in a cool place. Dose.—1-20 grains (0.06-1.3 Gm.). Unofficial Alkaloids and Salts. Chinoidinum—Chinoidini—Chinoidine.— Origin.—Obtained from the mother- liquor in the preparation of quinine sulphate, cinchonine, and the other alkaloids of cinchona. Description and Properties.—Cylindrical rolls or masses, of a more or less deep- brown or black color and a resin-like appearance. It has but a slight taste, being faintly bitter on mastication. Almost insoluble in water; freely soluble in alcohol. Dose.—3-30 grains (0.2-2.0 Gm.). Cinchonidinae Sallcylas—Cinchonidinae Salicylatis—Cinchonidine Salicy- late.—Dose, 2-10 grains (0.12-0.6 Gm.). Cinchonina Iodosulphas—Cinchoninae Iodosulphatis—Cinchonine Iodosul- phate (Antiseptol) (50 per cent, of iodine).—Description and Properties.—A light powder of a reddish-brown color; insoluble in water, but soluble in alcohol. Used principally as a substitute for iodoform. Chinolin—Chinolin—Chinolin (Qutnolin).—Origin.—Prepared from Cincho- nine or Quinine by distillation, or obtained synthetically. Description and Properties.—A colorless liquid, with an aromatic, pungent odor; slightly soluble in water, freely soluble in alcohol. Dose.—3-10 minims (0.18-0.6 Cc). Chlnolin T3rtras—Chinolin Tartratis—Chinolin Tartrate.—Soluble in 70 or 80 parts of water. Dose, 5-15 grains (0.3-1.0 Gm.). Quinetum—Quineti—Quinetum.—A mixture of the alkaloids precipitated by an alkali. Dose, 1-60 grains (0.06-4.0 Gm.). HEM A TICS. 213 Quininae Hydrochloras Carbamidata—Quininae Hydrochloratis Carbami- datae.—Double salt of Quinine and Urea. Soluble in water. Dose, 1-10 grains (0.06- 0.6 Gm.). Usually employed hypodermically. Antagonists and Incompatibles.—Agents promoting waste— such as the salts of mercury, iodine, copper, zinc, and lead—are therapeutically antagonistic to cinchona. The cerebral effects of quinine are antagonized by morphine, while atropine opposes its action upon the nervous and circulatory systems, as well as its antipyretic powers. The incompatibles are free tannic acid, alkalies and alkaline earths, and iodine. Fowler's solution is incompatible with infusion and decoction of cinchona. Synergists.—The Restoratives and all agents promoting con- structive metamorphosis. The antipyretic action of quinine is enhanced by the antipyretics, salicylic acid, and some of the anti- septics. Its antiperiodic action is aided by arsenic, eucalyptus, carbolic acid, and creasote. The name Cinchona given to Peruvian bark was accorded in honor of the countess of Chinchon, cured of tertian fever by the use of the drug, as early as the seventeenth century, the Spanish conquerors of the country having discerned the curative properties of the plant which scientific investigation has rendered invaluable as a therapeutic agent. The native Indians had long been ac- quainted with its medicinal virtue, and but for the inquisitorial bigotry of the age the beneficiary of its potency, upon her return to Spain, would have introduced it into Europe. Such, however, was the antagonism aroused among an over-zealous clergy, and so great the force of professional rivalry, that every- where the new discovery encountered opposition, one religious body formally spurning it as the invention of unenlightened sav- ages, although the countess was not deterred from employing it among the peasantry dwelling upon her estates (Markham). About the middle of the seventeenth century a large quantity of the bark received from America reawakened discussion, and finally a council of Jesuits held at Rome approved a distribution of the drug—called therefrom " Jesuits' bark." It quickly found its way to other parts of the Continent and to England; yet still the opposition to its use was pronounced, and it was only when an English quack doctor succeeded in effecting cures among persons 214 A TEXT-BOOK OF MATERIA MEDICA of rank by an employment of the drug that its services became general in malarial and typhoid fevers, as well as in various other diseases. The discovery of the active principles of cinchona, crudely es- tablished by Duncan in 1803, was perfected by Pelletier and Cav- entou in 1820 by the preparations of quinine and cinchonine. In 1833 quinidine became partially known, being completely isolated as an active principle in 1852, quinine and cinchonine having been employed since 1820-21. Until the researches of Marchiafava, Celli, Laveran, Golgi, and others had disclosed the true etiology of malaria, quinine was used empirically in malarial diseases, its precise action being unknown. Its efficacy is now ascertained to be due to its power of destroying the plasmodia of malaria. In addition to this action, which ren- ders the drug of the greatest value in malarial diseases, quinine possesses many other important properties, which are here con- sidered. Physiological Action.—Externally and Locally.—The drug is a potent antiseptic, preventing putrefaction and fermentation by its destructive influence upon fungi and infusoria, a solution of 1 :250 being sufficient for this purpose, while 1 : 500 is fatal to certain micro-organisms, and even so weak a solution as 1 : 1000 suffices to destroy some infusoria. Upon the unbroken skin it has little effect, other than to pro- duce occasionally a slight roughening of the surface. To raw surfaces, however, and to mucous membranes it is irritant. Internally.—Digestive System.—Its action resembles that of vegetable bitters, augmenting the secretions from the salivary and gastro-intestinal glands, stimulating peristalsis, and increasing the blood-supply to the stomach. Under moderate doses, therefore, the appetite and digestion are improved. Large dosage disturbs digestion, occasioning nausea, with, possibly, vomiting and diarrhea. The acidity of the stomach is said to be increased by quinine sul- phate. Circulatory System.—Small doses increase the force and fre- quency of the heart's action, excessive doses slowing and weaken- ing it, and, frequently in children, causing an intermittent pulse. Toxic doses paralyze the heart, arresting it in diastole. It is uncertain whether or not these effects are due to an action on the cardiac muscle or on the ganglia. It is evident, though, that small doses elevate and large doses depress arterial tension. HEM A TICS. 215 Quinine in a remarkable manner affects the constituents of the blood. The ameboid movements of the white blood-corpuscles are arrested, preventing their migration through the capillary walls in inflammation, while their number is diminished by full doses of the drug both in health and in inflammatory conditions. The red corpuscles are relatively increased in number, at least in propor- tion to the white corpuscles, the size of the former being dimin- ished in febrile conditions. Quinine retards or impairs all the oxidizing powers of the body, and materially lessens the oxygen-carrying capacity of the red corpuscles. This is shown in the diminished metabolism of the body. Nervous System.—Small doses stimulate the cerebrum. Large doses occasion cerebral congestion, with a sensation of dizziness, fulness in the head, and other symptoms described at length under " Cinchonism." The reflex function of the spinal cord is reduced, and under toxic doses ultimately abolished, owing to stimulation of Setsche- now's inhibitory center, and later to direct depression of the spinal cord and nerves. In frogs the sensory nerves are first excited and subsequently paralyzed, through the influence of the drug upon the peripheral endings. The muscles are uninfluenced, though when applied directly to muscular fiber the drug acts as an irritant, producing muscular contractions. Respiratory System.—Quinine exerts but little influence upon the respiration, small doses slightly increasing and large doses depressing the respiratory movements. Absorption and Elimination.—The drug is quite rapidly absorbed from the alimentary canal. While its presence may be detected in the urine within fifteen minutes after the ingestion of a full dose, many hours, or even days, may elapse before the drug is finally excreted. Much of the drug undergoes a change in the system, especially in the liver, yet it may be detected in the urine as quinine and various isomeric modifications of it. While chiefly eliminated by the kidneys, it may escape from the system by other channels, having been found in the milk, sweat, saliva, tears, bile, and in dropsical effusions. The excretion of uric acid, urea, and other nitrogenous material is considerably diminished under the use of quinine. Temperature.—In health the temperature is unaffected by qui- 2l6 A TEXTBOOK OF MATERIA MEDICA. nine, but in febrile conditions, particularly in malarial fever, the drug acts as a powerful antipyretic. Yet the drug cannot be classed as a true antipyretic, since it has not been shown that it has any action on the heat-center. It is a matter of clinical observa- tion that intermittent, typhoid, and one form of puerperal fever are the only diseases which readily yield to the antipyretic influence of quinine, the temperature in such maladies as erysipelas, pneu- monia, pleurisy, etc. being comparatively unaffected even by large dosage, seeming to" prove that the drug is an antipyretic only when it destroys or renders inert the infective agent producing the fever. Eye.—There have been recorded several cases of quinine amau- rosis, with transitory blindness, color-blindness, wide dilatation of pupils—irresponsive to light, but responding to accommodation effort—pallor of the optic disks, with extreme diminution of both retinal veins and arteries and contraction of the visual field. Quinine amaurosis, however, is probably very rare, but a lim- ited number of cases being recorded, although Rogers believes that " incomplete ocular cinchonism " is of quite frequent occur- rence. Uterus.—After the inception of labor quinine seems frequently to stimulate the uterine contractions. It also increases a scanty menstrual flow. There appears to be no authoritative evidence that quinine is an abortifacient. Untoward Action.—Besides the symptoms of cinchonism from which some persons suffer after the ingestion of a small dose, there are often occasioned various eruptions of the skin, often accom- panied by marked pruritus, the eruption produced by the drug at times strongly resembling scarlatina. Peculiar disturbances of vision and impaired hearing not infre- quently attend the administration of quinine. There have been recorded cases of renal and vesical irritation, varying in intensity, following the use of the drug. The administration of the salts of quinine in pill form is often followed by gastro-intestinal catarrh. The drug has also been known to occasion epistaxis and hem- optysis. Poisoning.—Excessive doses of quinine produce a series of symptoms collectively termed cinchonism. They are—a feeling of fulness in the head, ringing or buzzing in the ears, varying degrees of deafness, headache, with possibly delirium, disturbances of vision, vertigo, and muscular weakness. Should the dose be lethal, there may be marked cardiac and respiratory failure, and collapse. HE MA TICS. 217 Treatment of Poisoning.—Potassium bromide and hydrobromic acid are the best agents to relieve the symptoms of cinchonism, full doses of the latter given with quinine being said to prevent untoward results. Should the dose be sufficient to depress the heart and respira- tion in a marked degree, cardiac and respiratory stimulants would be indicated. Therapeutics.—Externally and Locally.—Powdered cinchona bark is an ingredient of many tooth-powders. Quinine also enters into the composition of many " hair tonics," and is highly recom- mended by some physicians in the treatment of alopecia. The drug has been employed with varying success in many diseases of the nose and throat, such as hay fever, zvhooping cough, ozena, tonsillitis, etc. Ledetsch has highly recommended quinine bisulphate, I part to 100 parts of water and glycerin, as an injection in gonorrhea. The drug has been used with tincture of ferric chloride as a paint to prevent the spread of erysipelas. A 2 per cent, solution has proved an efficient remedy in cystitis, effectually preventing the decomposi- tion of the urine. Internally.—Undoubtedly the principal use of quinine is in the treatment of malarial diseases. When we realize that quinine in 1 part to 20,000 is destructive of the plasmodium malarias, it is readily understood why the drug should be so efficient as an antimalarial remedy. Quinine is one of the most powerful antiperiodics, being of more or less value in many diseased conditions characterized by periodical exacerbations. All forms of malarial fever usually yield to the proper use of quinine. It seems to be equally efficient as a prophylactic. Many periodical affections due occasionally to malarial organ- isms are peculiarly amenable to this drug, among these disorders being various neuralgias, headache, asthma, hay fever, chorea, jaun- dice, diarrhea, dysentery, etc. Quinine is a potent antiphlogistic, being very efficient in check- ing inflammation and suppuration. It is particularly beneficial in cases of prolonged suppuration, such as pulmotiary phthisis, fistu- lous discharges, septicemia, pyemia, puerperal fever, etc. It favor- ably influences the formative stages of acute inflammations, as in the beginning of endocarditis, pneumonia, pleurisy, etc. As a tonic or restorative during the course of febrile diseases, 218 A TEXT-BOOK OF MATERIA MEDICA. as well as in convalescence, quinine is highly efficient. Its action upon the gastro-intestinal tract renders it valuable in many forms of dyspepsia, especially the atonic variety. In these cases, where anemia is present, the drug may be advantageously combined with iron and nux vomica. Quinine is but little used now as a pure antipyretic, being of value in this respect, as previously stated, only when it destroys the infective cause of the fever. Its antipyretic influence is conse- quently more marked in intermittent fever. It is of value also in typlwid, although now seldom employed in this disease. The remedy has proved efficient in some cases of chorea and zvhoopiug cough. It is of decided value in the yeasty vomiting pro- duced by the sarcina ventriculi, and equally beneficial in impetigo ; while acne and ecthyma, when occasioned by reduced vitality and impaired nutrition, are greatly benefited by its internal use. Quinine is serviceable in stimulating the uterine contractions during labor and increasing the menstrual discharge in amenorrhea. Contraindications.—The drug is contraindicated in acute in- flammations of the genito-urinary and gastro-intestinal tracts, in acute or subacute inflammations of the middle ear, and in menin- gitis and cerebritis. It should not be given to infants suffering from eczema, nor to persons having a marked idiosyncrasy against the drug. Administration.—Because of its intensely bitter and disagree- able taste quinine should not be given in solution. It may be sus- pended in syrup of yerba santa or in the aromatic elixir of liquorice, which disguises the taste quite effectually, and for children is pref- erable, as a method of administration, to capsules or pills. In the case of adults the drug should be given in gelatin capsules or in the form of gelatin- or sugar-coated pills. The tannate of quinine is comparatively tasteless, and may be incorporated with chocolate in the form of lozenges, thus being readily taken by children. The drug may be also administered in a suppository by the rectum or incorporated in lard and rubbed into the skin, preferably in the axillae and the inner side of the thighs or over the abdomen. It has been employed to some extent hypodermically, the quinine hydrobromate and hydrochlorate being the salts preferred for this purpose. Injections should be made in the buttocks, and very slowly administered, since this method of administration depresses the heart to a considerable degree. ANIMAL EXTRACTS. 219 Occasionally in the treatment of malaria Warburg's tincture, containing numerous aromatics, is more efficient than quinine. In obstinate malarial affections aromatics and spices greatly enhance the effect of quinine, capsicum making one of the best adjuvants. The portal circulation is stimulated, rendering the absorption of the drug more rapid and its effects more lasting. As to the time and method of administration in malarial dis- eases, the student is referred to any standard work on the Practice of Medicine. The various tinctures and elixirs of cinchona are used exten- sively ; when employed as stomachics they should be given before meals. Quinine is best given on an empty stomach or after the active process of digestion is completed. ANIMAL EXTRACTS (ORGANOTHERAPY). The striking fact that various excretions and tissues of the living organism, when administered under certain conditions, possess a peculiar therapeutic value is now well established. The theory has long been the subject of studious attention, yet the practical application of organotherapy has in recent years acquired unprece- dented importance. Extracts derived from almost every portion of the human system, together with many animal secretions, have been prepared, one of the most original being the hypodermic injection of an extract from the recent testicles of mammals adopted by Brown-Sequard in 1889 in the treatment of senile debility. As a nutrient restorative spermini hydrochloras was found to be an efficacious remedy, abundant evidence showing that the functional activity of deteriorating organs of the animal economy was per- ceptibly improved, the nervous system responding favorably to the influence of the new agent. Cancer and chorea are said to have also been benefited by spermine. Subsequently neurasthenia, locomotor ataxia, and declining nervous force due to old age were successfully treated with a glycerin extract from the gray matter of a sheep's brain, the pro- cedure, as suggested by Paul, consisting of a nervous transfusion by hypodermic injection. The most rational and successful application of organotherapy, however, was that of Murray in 1891, who proposed the subcu- 220 A TEXT-BOOK OF MATERIA MEDICA. taneous injection of a thyroid extract in the treatment of myxedema, many cases of which have ameliorated, while others have been definitely cured, by the adoption of the remedy. The preparations in this case have included the ingestion of the dry powder, the injection of a glycerin extract, and the raw or partially cooked gland administered as food. The general testimony of writers amply attests the efficacy of the remedy, which now receives almost universal acceptance. Baumann has recently isolated from the thyroid glands of sheep an organic compound which he believes to be the essential prin- ciple of the gland and the efficient agent in the treatment of various forms of myxedema. Clinical observations by Ewald, Ross, and Treufel seem to prove the correctness of Baumann's opinion. In exophthalmic goiter the employment of thyroid gland has been held to be favorable, although authorities are not wanting who claim that its use tends to aggravate the symptoms. Especially interesting are the results of thyroid treatment in cretinism of infants—infantile myxedema—authentic reports offer- ing highly encouraging details of its successful application in this disease, eliciting from Sinkler the declaration: " It is too short a time since the introduction of the thyroid-feeding in cretinism to form any opinion as to the final results; but since in all the cases reported remarkable changes have taken place, we have reason to rejoice in possessing a remedy which can accomplish so much as has already been done in these once worse than hopeless cases." It is to be observed that both the endemic and sporadic forms of the above malady have proved amenable to the thyroid treatment. Jackson concludes that " in myxedema and cretinism it is worth while to run a risk as to life in the hope of removing symptoms that make life hardly worth living. In dermatoses, on the con- trary, life is generally little endangered, and we are not justified in resorting to too heroic measures." The remedy has been applied in insanity, with the effect of im- proving depressed, but intensifying maniacal, conditions, care being requisite in the presence of certain contraindications, such as tuberculosis, valvular disease of the heart, etc. Bramwell reports a case of tetanus resulting from thyroid extir- pation cured by doses of the gland; another of idiopathic tetany yielding to the same treatment. With regard to thyroid treatment in skin diseases, Abraham asserts that there is no constant effect in psoriasis and many other ANIMAL EXTRACTS. 221 cutaneous affections, and that in a large number of cases the results are negative, and that untoward effects are alarmingly frequent. Improvement has been noted in several cases of malignant syphilis, Menzies considering that thyroid acts as a powerful skin- tonic and a useful adjuvant to mercury and potassium iodide in the treatment of this disease. With regard to thyroid, however, it must be admitted that, save in myxedema, simple goiter, and obesity, the remedy is of com- paratively slight value, and even in these affections only by con- tinued treatment have favorable results been obtained. The favorable results often attending the partial employment of animal agents in diseases of corresponding organs, and especially the noteworthy benefits derived from the application of the thyroid treatment in myxedema, have suggested the preparation of many extracts of varying efficacy. Among these are— Nuclein.—In 1894, Professor V. Vaughan, of the University of Michigan, read a paper before the Illinois State Medical Associa- tion, giving the results of numerous experiments made by himself and Dr. McClintock with nuclein. Nuclein is a complex proteid body, characterized by its large percentage of phosphorus. It is that constituent of a cell by vir- tue of which the histologic unit grows, develops, and reproduces itself; it is the function of the nuclein to utilize the pabulum within its reach ; it is by the action of their nuclein that cells of various organs and organisms possess and manifest their individual charac- teristics. It is sometimes called chromatin on account of the readi- ness with which it absorbs and holds coloring-agents. The chro- matic difference in the nucleins of various cells is an aid to their identification under the microscope. The phosphorus exists in the form of nucleinic acid; so far as is known, this acid is the same in all cells, yet the basic part differs in various nucleins. Most of the experiments of Vaughan and McClintock, as well as those of nearly all others, have been made with the yeast nuclein ; that cell is particularly rich in nucleinic acid, easily obtained free from contamination. When administered hypodermatically or orally, nuclein increases the number of leukocytes in about three hours. The amount of increase varies with the subject; it may be slight or it may be three- fold ; it occurs principally in the polynuclear cells. Metschnikoff has shown that these cells are the most active of the phagocytes. Hans Buchner has demonstrated that the blood-serum, freed from 222 A TEXT-BOOK OF MATERIA MEDICA. corpuscular elements, is bactericidal. This bactericidal potency is due to nuclein, found free in the blood and probabl}' secreted by the leukocytes. Hahn of Munich has made experiments with se- rum upon the staphylococcus pyogenes aureus and the bacillus coli communis, showing that the administration of yeast nuclein increased this germicidal power several fold. The effects of nu- clein pass away in about forty-eight hours. Nuclein is of great value in conditions of infection where the symptoms are due to general invasion of the bacteria. Favorable results are obtained in simple anemias. It is found on the market in a 5 per cent, solution, dose I to 2 drachms. It should be given on an empty stomach. Vaughan reports that in tuberculosis the effect of moderate injections has been to lower the temperature, without untoward manifestations. Indolent ulcer has yielded com- pletely to a similar treatment. It is also stated upon high authority that the remedy is useful in " all forms of anemia, in chronic and recurrent malaria, in diges- tive disorders, and in acute and chronic pulmonary affections" (Aulde), the nuclein adopted being obtained from the thyroid and thymus glands. The latter author suggests the use of nuclein in the treatment of typhoid, in which disease the activity of leucocy- tosis is defective. Bone-marrow has proved efficacious in anemia (Dickson, Frazer), and has also been employed by Filleau in tuberculosis. Brain-extract, besides its utility in locomotor ataxia and senile debility, has been reported as beneficial in certain organic and func- tional diseases of the nervous system—in epilepsy, hysteria, mi- graine, hebephrenia, etc., as well as in bulbar palsy and general paralysis of the insane. Heart-extract has been recommended in cases of nervous prostration, it being claimed that its action tends to raise the blood-pressure and increase the number of red corpuscles; muscle-extract has served a useful purpose in affections of the corresponding tissues ; extract of pancreas, though with small success, has been employed in diabetes mcllitus; and among other preparations used with doubtful or auspicious results are medullin, from the cord; renin, from the kidneys; gastrin, from the stom- ach ; and ovarin, from the ovaries. The subject is fraught with interest to the clinician, and, as in serum-therapy, the rapid progress of therapeutic knowledge bids fair to extend its value in the rational treatment of human disease. DIVISION II.—SPECIFICS. These drugs are unnatural to the system, though acting spe- cifically, and in some unknown way, against certain diseases or morbid conditions. They are given with a view to influencing the course of the disease itself, not for their effect upon the symptoms alone. If administered for any length of time, there is danger of causing an artificial disease, because of the characteristic action of these medicines, which differs essentially from their remedial influence. When used as specifics they do not produce or relieve symp- toms, except by renewal of health or by removing either the pathological condition or the disease Whenever, therefore, these drugs produce symptoms when used specifically, it is a sign that they are contraindicated, or have been given for too long a time, or in too large doses. As they are unnatural, and consequently more or less poisonous to the system, their administration should be accompanied by restoratives to lessen their tendency to unto- ward manifestations and systemic depression. Mercury, being perhaps the most typical specific, will be first considered. Hydrargyrum—Hydrargyri—Mercury. U. S. P. (Quicksilver.) Origin.—The knowledge of this drug antedates the Christian era. It is found in Spain, Austria, Peru, and China, but is obtained principally from New Almaden, California. It occurs to some ex- tent in the metallic state in the form of minute or large globules; also in combination with oxygen, chlorine, selenium, etc.; but the principal ore from which it is extracted is cinnabar. Description and Properties.—A shining, silver-white metal, without odor or taste. It is liquid at the ordinary temperature, and easily divisible into spherical globules; but when cooled to —39.380 C. (—38.88° F.), it forms a ductile, malleable mass. Specific gravity, 13.5584 at 150 C. (590 F.). Insoluble in the ordinary solvents, also in concentrated hydro- chloric acid, and, at common temperatures, in sulphuric acid, but dissolving in the latter when boiled with it, and readily and com- pletely soluble in nitric acid. Mercury should be kept in strong, well-stoppered bottles. 223 224 A TEXT-BOOK OF MATERIA MEDICA. Dose.—Mercury is seldom given internally except in the modi- fied form of blue pill. Hydrargyrum Ammoniatum—Hydrargyri Ammo- niati—Ammoniated Mercury. U. s. P. Origin.—Prepared by mixing solutions of Ammonia and Cor- rosive Mercuric Chloride. Filter and wash the precipitated am- moniated mercury. Description and Properties.—White, pulverulent pieces, or white, amorphous powder, without odor, and having an earthy, and afterward styptic and metallic taste. Permanent in the air. Almost insoluble in water or in alcohol. It should be kept in well- stoppered bottles, protected from the light. Used externally. Official Preparation. Ungufcntum Hydrargyri Ammoniati—UnguSnti Hydrargyri Ammoniati— Ointment of Ammoniated Mercury.—Formula: Ammoniated Mercury, 10; Ben- zoinated Lard, 90 parts. For external use. Hydrargyrum cum Creta—Hydrargyri cum Creta— Mercury with Chalk. U. S. P. Origin.—Obtained by trituration of Mercury, Prepared Chalk, Clarified Honey, and Water. Description and Properties.—A light gray, rather damp pow- der, free from grittiness, without odor, and having a slightly sweet- ish taste. It contains 38 per cent, of mercury. This preparation should be kept in well-stoppered bottles, protected from light. Dose.—3-10 grains (0.18-0.6 Gm.). Massa Hydrargyri—Massae Hydrargyri—Mass of Mercury. U. S. P. (Pilula Hydrargyri—Blue Mass—Blue Pill.) Composed of Mercury, Glycyrrhiza, Althaea, Glycerin, and Honey of Rose. Dose.—|-io grains (0.03-0.6 Gm.). Unguentum Hydrargyri —Unguenti Hydrargyri — Mercurial Ointment. U. S. P. (Blue Ointment.) Composition: Mercury, Lard, Suet, and Oleate of Mercury. Used externally. SPECIFICS. 225 Emplastrum AmmonTaci cum Hydrargyro —Em- plastrum (ace.) AmmonTaci cum Hydrargyro- Ammoniac Plaster with Mercury. U. S. P. Composition : Ammoniac, Mercury, Oleate of Mercury, Diluted Acetic Acid, and Lead Plaster. Used externally. Emplastrum Hydrargyri—Emplastri Hydrargyri— Mercurial Plaster. U. S. P. Composition: Mercury, Oleate of Mercury, and Lead Plaster. Used externally. Hydrargyri Chloridum CorrosTvum — Hydrargyri Chloridi Corroslvi—Corrosive Mercuric Chloride. U. S. P. (Corrosive Chloride of Mercury—Corrosive Sublimate.) Origin.—Prepared by heating a mixture of Mercuric Sulphate, Sodium Chlorate, and Manganese Dioxide. The corrosive chloride sublimes and is condensed. Description and Properties.—Heavy, colorless, rhombic crys- tals or crystalline masses; odorless and having an acrid and per- sistent metallic taste. Permanent in the air. Soluble in 16 parts of water, in 3 parts of alcohol, in 2 parts of boiling water, in 1.2 parts of boiling alcohol, in 4 parts of ether, and in about 14 parts of glycerin. It should be kept in well-stoppered bottles. Dose.—jj4—s grain (0.001-0.008 Gm.). Hydrargyri Chloridum Mite— Hydrargyri Chloridi Mitis—Mild Mercurous Chloride. U. S. P. (Calomel—Mild Chloride of Mercury.) Origin.—Obtained by triturating Mercuric Sulphate, Mercury, Sodium Chloride, and boiling Distilled Water. Sublime, and wash the sublimed calomel with boiling distilled water. Description and Properties.—A white, impalpable powder, be- coming yellowish-white on being triturated with strong pressure. It is odorless and tasteless, and permanent in the air. Insoluble in water, alcohol, or ether, and also in cold, diluted acids. When strongly heated it is wholly volatilized, without melting. Calomel should be kept in dark, amber-colored bottles. Dose.—J-j-10 grains (0.002-0.6 Gm.). Calomel enters into the following 15 226 A TEXT-BOOK OF MA TERIA MEDICA. Official Preparations. Pilulae Antimonii Comp6sitae—Pllulas (ace.) Antimonii Comp&sitas— Com- pound Pills of Antimony.—Dose, i or 2 pills. Pilulae Catharticae Comp6sitae—Pllulas (ace.) Catharticas Compdsitas— Compound Cathartic Pills.—Dose, 1 to 3 pills. Hydrargyri Cyanidum—Hydrargyri Cyanidi—Mer- curic Cyanide. U. s. P. Origin.—It may be obtained by boiling pure Ferrocyanide of Iron with Mercuric Oxide; the mercuric cyanide, entering into solution, is separated by filtration, evaporization, and crystallization from diluted alcohol. Description and Properties.—Colorless or white prismatic crystals; odorless, and having a bitter, metallic taste {the salt is exceedingly poisonous), becoming dark-colored on exposure to light. Soluble in 12.8 parts of water and in 15 parts of alcohol. Dose.—Ti) o-iV gram (0.0006-0.004 Gm.). Hydrargyri Iodidum Flavum—Hydrargyri Iodidi Flavi—Yellow Mercurous Iodide. U. S. P. (Hydrargyri Iodidum Viride—Protiodide of Mercury—Yellow (or Green) Iodide of Mercury.) Origin.—Prepared by mixing solutions of Potassium Iodide and Mercurous Nitrate with Nitric Acid and Distilled Water. The precipitate is washed and dried. Description and Properties.—A bright yellow amorphous powder, odorless and tasteless. By exposure to light it becomes darker in proportion as it undergoes decomposition into metallic mercury and mercuric iodide. Almost insoluble in water, and wholly insoluble in alcohol or ether. It should be kept in dark, amber-colored vials, with the least possible exposure to light. Dose.—-|—\ grain (0.01-0.03 Gm.). Hydrargyri Iodidum Rubrum — Hydrargyri Iodidi Rubri—Red Mercuric Iodide. U. S. P. (Biniodide of Mercury—Red Iodide of Mercury.) Origin.—Prepared by mixing solutions of Corrosive Mercuric Chloride and Potassium Iodide; filter, and dry the precipitated red iodide. Description and Properties.—A scarlet-red, amorphous pow- der, odorless and tasteless ; permanent in the air. Almost insoluble SPECIFICS. 227 in water, but soluble in 130 parts of alcohol well-stoppered bottles, protected from light. Dose.—jV~~tV gram (0.002-0.004 Gm.). This drug enters into the Official Preparation. Liquor Arseni et Hydrargyri Iodidi—Liquoris Arseni et Hydrargyri Iodidi —Solution of Arsenic and Mercuric Iodide.—(Described under Arsenic.)—Dose, 5 minims (0.3 Cc), gradually increased. Hydrargyri Oxidum Flavum— Hydrargyri Oxidi Flavi—Yellow Mercuric Oxide. U. S. P. Origin.—Prepared by precipitating a solution of Corrosive Mercuric Chloride with Soda. Description and Properties.—A light orange-yellow, amor- phous, heavy, impalpable powder; odorless, and having a some- what metallic taste. Permanent in the air, but turning darker on exposure to light. Almost insoluble in water or in alcohol. It should be kept in well-stoppered bottles, protected from light. Not used internally. Official Preparation. Ungufintum Hydrargyri Oxidi Flavi—UnguSnti Hydrargyri Oxidi Flavi— Ointment of Yellow Mercuric Oxide.—Formula: Yellow Mercuric Oxide, 10; Ointment, 90 parts. Used externally. Hydrargyri Oxidum Rubrum—Hydrargyri Oxidi Rubri—Red Mercuric Oxide. U. S. P. (Red Precipitate.) Origin.—Prepared by dissolving Mercury in Diluted Nitric Acid. Evaporate to dryness. Triturate the mercuric nitrate thus formed with mercury and heat. Description and Properties.—Heavy, orange-red crystalline scales, or a crystalline powder, becoming yellower the finer it is divided; odorless, and having a somewhat metallic taste; perma- nent in the air. Almost insoluble in water and in alcohol. It should be kept in well-stoppered bottles, protected from light. Dose.—^4—tV gram (0.001-0.006 Gm.). Official Preparation. UnguSntum Hydrargyri Oxidi Rubri—Ungufinti Hydrargyri Oxidi Rubri —Ointment of Red Mercuric Oxide.—Formula: Red Mercuric Oxide, 10; Castor Oil, 5; Ointment, 85 parts. Used externally. It should be kept in 228 a TEXT-BOOK OF MATERIA MEDICA. Hydrargyri Subsulphas Flavus—Hydrargyri Sub- sulphatis Flavi—Yellow Mercuric Subsulphate. U. S. P. (Basic Mercuric Sulphate—Turpeth Mineral.) Origin.—Obtained by dissolving Mercury in Sulphuric and Nitric Acids. Add a sufficient quantit}- of Water. Decant and dry the residue. Description and Properties.—A heavy, lemon-yellow powder, odorless and almost tasteless ; permanent in the air. Soluble in about 2000 parts of water. Insoluble in alcohol. It should be kept in well-stoppered bottles, protected from the light. Dose.—^-3 grains (0.015-0.18 Gm.). Liquor Hydrargyri Nitratis—Liquoris Hydrargyri Nitratis—Solution of Mercuric Nitrate. U. S.P. A liquid containing about 60 per cent, of Mercuric Nitrate, together with about 11 per cent, of free Nitric Acid. Description and Properties.—A clear, nearly colorless, heavy liquid, having a faint odor of nitric acid and a strongly acid reac- tion. The product should be kept in glass-stoppered bottles. Used externally as a caustic. Unguentum Hydrargyri Nitratis — Unguenti Hy- drargyri Nitratis—Ointment of Mercuric Nitrate. U. S. P. (Citrine Ointment.) Formula: Mercury, 70; Nitric Acid, 157; Lard Oil, 760 parts. Used externally. Unofficial Preparations. Hydrargyri Sallcylas—Hydrargyri Salicylatis—Mercurous Salicylate.— Dose of Mercurous Salicylate, \-\ grain (0.008-0.015 Gm.).—Dose of Mercuric Salicy- late, -^—\ grain (0.004-0.008 Gm.). Hydrargyri Formamidatum—Hydrargyri Formamidati—Formamidate of Mercury.—Dose for hypodermic use, TV-i grain (0.005-0.01 Gm.). Hydrargyri T3nnas—Hydrargyri Tannatis—Mercurous Tannate.—Dose, \-\ grain (0.03-0.06 Gm.). Lotio Flava—Lotionis Flavae — Yellow Wash.—Corrosive Sublimate, 25 grains (1.5 Gm.), in Lime Water, 16 ounces (473.17 Cc.V For external use. Lotio Nigra—Lotionis Nigrae—Black Wash.—Calomel, 64 grains (4.15 Gm.), in Lime Water, 16 ounces (473-17 Cc). For external use. Asparagin Hydrargyrate.—Dose, \ grain (0.01 Gm.), hypodermically. SPECIFICS. 229 Antagonists and Incompatibles.—Mercury with chalk is in- compatible with acids and acidulous salts. Calomel is incompatible with alkalies, alkaline earths, alkaline carbonates, iron, lead, copper, iodine, bromides, soaps, sulphydrates, and nitrohydrochloric acid, as well as hydrochloric acid, potassium, ammonium, and sodium chloride. Corrosive sublimate is incompatible with alkalies and their car- bonates, soap, lime water, tartar emetic, the iodides of potassium and sodium, acetate of lead, silver nitrate, the sulphides, albuminous liquids (as milk, etc.), many vegetable infusions, and compound syrup of sarsaparilla. In general, metallic preparations of mercury are incompatible with iodine and the chlorides. Synergists.—Potassium iodide enhances the antisyphilitic action of mercury. Depressants—such as antimony and alkalies—increase the physiological activity of mercury and its preparations. Tonic and resin-bearing purgatives—such as aloes, rhubarb, and podophyllum—aid the cathartic action of some of the mercurial preparations. Physiological Action.—Externally and Locally.—Liquid metal- lic mercury is inert. Most of the preparations applied to the skin are antiparasitic and antiseptic, corrosive mercuric chloride being one of the most important antiseptics and universal germicides known. Some of the mercurials are powerful irritants, the nitrate being an active caustic. The mercurous salts, even, possess slightly stimulating properties. Metallic mercury and its salts are readily absorbed with the aid of friction, at times producing a slight irritation resulting from their stimulating properties. Absorption may also take place from local application in the form of a fine vapor. The introduction of the drug into the system through the medium of the skin is attended with all the symptoms of mercurial poisoning. The local actions of the various preparations differ somewhat, yet they agree in certain physiological effects produced after absorption of the drug. A common feature of mercurial application is a slight, peculiar fetor in the mouth, accompanied by soreness of the teeth, swelling of the gums, and an increase of saliva, ptyalism being a marked symptom of mercurial disturbance. A disagreeable metallic taste is seldom absent. These symptoms assume a serious phase if the 230 A TEXT-BOOK OF MATERIA MEDICA. application be continued, stomatitis and other graver conditions ensuing. Internally.—Digestive System.—Small doses have little untoward effect; they may even prove tonic. Large doses act unfavorably upon the gastro-intestinal mucous membrane, causing diarrhea and possibly more serious derangement. As purgatives the mercurial preparations act by augmenting the secretions of the intestinal glands; at the same time the pancreatic secretions are increased and there is marked activity of the absorbent system. The prin- cipal action is on the duodenum, hastening evacuation of the bile and preventing its reabsorption. While promoting excretion of bile, they act the reverse as to its secretion. This is particularly true of calomel, which actually diminishes that secretion, though it is alleged that the corrosive mercuric chloride is a direct chola- gogue, stimulating to some extent the hepatic secretory apparatus. Circulatory System.—Corrosive sublimate exerts a decided in- fluence upon the heart, its toxic effect tending to diminish cardiac action. The remaining preparations of mercury appear to be less active in this respect. The physical action of the drug upon the corpuscular constituents of the blood has been well ascertained, anemia, reduced cohesion, and final dissolution having been ob- served. It is to be noted that under prolonged or over-dosage the blood becomes impoverished, its ozonizing function is impaired, and the fibrin loses its coagulability. But when administered in minute doses the mercuric corrosive chloride acts as a tonic to the blood, increasing the number of red corpuscles and the body- weight. Should " tonic doses " be continued for too long a period, there would be increased weight, owing to too great stimulation of the lymphatic system. Nervous System.—The full effects of mercury and its prepara- tions upon the nervous system are best seen when toxic doses are given. The effects are considered in extenso under the head of " Poisoning." Respiratory System.—The general tendency of mercury, in those who have been subject to prolonged dosage, is to depress the cir- culation, rendering the breathing labored and debilitated, a sense of respiratory constriction being present. Absorption and Elimination.—When a preparation of mercury is taken internally it is converted in the stomach into a double chloride of sodium and mercury. This substance, uniting with the SPECIFICS. 231 albuminous juices, is soluble in an excess of albumin and sodium chloride, and, readily diffusing into the blood, is converted into, and exists in that fluid as, the oxyalbuminate of mercury. The absorption of this drug is gradual, yet, notwithstanding every secretion of the body contributes to its general expulsion from the system, its cumulative action is a well-established fact. Elimination occurs chiefly by the urine, the saliva, bile, sweat, milk, and feces. Even the semen shares in the process. Single doses may be eliminated in twenty-four hours, but the drug has been detected in the liver a year after the discontinuance of prolonged treatment. Mercury has been found in serum and in pus from ulcers. Calomel possesses marked diuretic action, greatly increasing the amount of urine. Temperature.—Save in a secondary manner, temperature is sel- dom affected. From over-stimulation or irritation the drug may produce local inflammatory conditions or even febrile symptoms. Eye.—Himly mentions that amaurosis mcrcurialis occurs in workers in mercury, while Galezowski reports an example of optic atrophy, and Square cites a case of optic neuritis, due to the toxic action of mercurial salts. Untozvard Action.—Many affections of the skin manifest them- selves after the exhibition of mercury, erythema and eczema (eczema mercuriale) frequently occurring after either the ingestion or the external application of mercurial preparations. The author recalls one patient in whom \ grain (0.016 Gm.) of calomel excited an exanthematous eruption over the entire body, some edema of the face, together with fever and angina of the fauces. At another time similar symptoms were produced in this patient by immersing the hands in a I : 2000 solution of corrosive sublimate. In certain persons having an idiosyncrasy regarding this drug extreme salivation and stomatitis may be induced by the internal use or the external application of mercurial preparations in medici- nal quantities. Medicinal doses may produce, in susceptible persons, marked disturbances of nutrition, sensation, and motion to such a degree as to suggest poisoning. Poisoning.—Although mercury in a metallic state is compara- tively innocuous, its vapor is capable of producing violent and dangerous symptoms. All the salts are active poisons, especially 232 A TEXT-BOOK OF MATERIA MEDICA. that known as corrosive sublimate. The symptoms following toxic doses of this preparation resemble those occasioned by arsenic. The salt, however, being more readily soluble, produces propor- tionately more speedy and pronounced effects. They are, briefly, a strong, metallic taste in the mouth, frequent and bloody evacua- tions, tenesmus, severe abdominal pains, vomiting, and labored res- piration. There may be suppression of urine, syncope, and perhaps insensibility and convulsions. One of the most obstinate features of mercurial poisoning is ptyalism or salivation. This condition is first manifested by tender- ness of the gums and teeth. The gums are inflamed and covered by a white, sticky substance, and bleed at the slightest provocation. The breath is very offensive. The teeth become loose, and may drop out. Necrosis of the maxillary bones may appear, and ex- tensive ulcerations of the gums and cheeks frequently occur. Accompanying these manifestations is an enormous increase in the amount of saliva secreted, which in some instances literally runs from the mouth night and day, often depriving the patient of sleep. Not infrequently a swelling of the lymphatic glands is also ob- served. Articulation and deglutition are interfered with from swell- ing of the tongue and ulceration of the gums, cheeks, palate, and tonsils. These symptoms, together with the fever, anorexia, mus- cular weakness, and headache which are constant accompaniments of ptyalism, render the condition of the patient very serious and tormenting. Chronic mercurial poisoning, or mercurial cachexia, is the effect produced by prolonged exposure to the fumes of mercury. The blood becomes thin and poor, with degeneration of the corpuscles. The person becomes emaciated, the heart is weak, and the whole muscular system impaired. Respiration is rapid and shallow, and the mental faculties are affected. Loss of memory, irritability of temper, melancholia, and, in rare cases, mania, may ensue. All the special senses are affected. Deafness, dimness of vision, impaired taste and sensation, as well as intestinal derangement, edema, articular pains, and generally disordered secretions, manifest them- selves. Mercurial cachexia frequently produces muscular tremors, usu- ally beginning in the upper extremities with gradual extension. Even paralysis of groups of muscles is often the result of chronic mercurial poisoning. Treatment of Poisoning.—In acute poisoning from corrosive sub- SPECIFICS. 233 limate or other active salt of mercury it is necessary to evacuate the stomach as quickly as possible, and give white of eggs freely. The after-treatment is similar to that of other corrosive poisons— the use of demulcents and opiates. For salivation, potassium chlorate probably occupies the first place as a prophylactic and curative agent. It is employed as a gargle and mouth-wash in a 2 to 3 per cent, solution. An astrin- gent wash is frequently necessary. Such drugs as tannin, myrrh, krameria, etc. may be used for this purpose. Where there is ex- tensive ulceration of the mouth disinfectant and antiseptic solutions will be found desirable. In cases of chronic mercurial poisoning it is of primary import- ance to remove all traces of the drug from the system by means of iodides, the dosage being limited in quantity, but continued for some time. Elimination of the poison from the tissues may be accomplished in various ways—the potassium iodide administered alternately with magnesium sulphate, laxatives, sulphur baths, and sulphur given internally. A change of air, liberal and nutritious diet, and tonics are also necessary. Therapeutics.—Externally and Locally.—As a germicide, anti- septic, and antiparasitic the preparations of mercury are extremely valuable, the corrosive chloride of mercury being extensively em- ployed as an antiseptic in general surgery in strengths of from 1: 1000 to 1 : 10,000. In diseases of the skin due to animal or vegetable parasites there are no drugs so valuable as certain preparations of mercury, the ointment of ammoniated mercury being highly prized. Calomel in the form of an ointment, 5 to 20 grains (0.3-1.25 Gm.) to 1 ounce (32.0 Gm.) is an efficient remedy in eczema. Indolent venereal ulcers are much improved by dusting them with calomel, while the early inflammatory conditions of these sores may be greatly benefited by the use of black wash. Many diseases of the eye, ear, nose, and throat yield to various preparations of mercury. The ointment of the yellow oxide of mercury is particularly adapted to phlyctenular ophthalmia, pannus, keratitis, chronic blepharitis marginalis, etc. Inunction with mercurial ointment or with oleate of mer- cury is excellent for the constitutional treatment of syphilis. These two preparations are of great value in subacute synovitis, pelvic cellulitis, and syphilitic orchitis and epididymitis. 234 A TEXT-BOOK OF MATERIA MEDICA The ointment of the red iodide of mercury has a reputation as an efficient remedy in goiter and enlargement of the spleen, as well as in pachymeningitis. The solution of nitrate of mercury is an active and reli- able caustic in the treatment of phagedenic ulcerations and venereal ulcerations, of the os uteri. The use of mercurials is usually attended with excellent results in promoting resolution of fibrous induration resulting from chronic inflammation. Internally.—The principal use of mercury is undoubtedly as an antisyphilitic. Mercury is an antidote against constitutional syphilis, being particularly efficient in the secondary stage. Many methods of mercurializing a patient have been adopted, mention of which will be made under " Administration." It is perhaps un- necessary to caution the therapeutist to make an accurate and positive diagnosis of syphilis before instituting the mercurial treat- ment, as otherwise the consequences may be disastrous. Mercury has been used in all stages of the disease, though, possibly from ignorance of its proper use, its employment has met with less favorable results in the primary than in the secondary form, while a careful study of syphilology leads one to believe that in tertiary syphilis it is inferior to the iodides, if not, indeed, actually contraindicated. The medical uses of mercurial preparations in disorders of the alimentary tract are very numerous. Chronic dysentery will frequently yield to y-^ to -^ grain (0.0006-0.0001 Gm.) of corrosive chloride of mercury and diarrheas of children—particularly those characterized by pale, offensive stools—together with iteo-colitis of infants, are greatly benefited by small doses of calomel or gray powder, which will also allay obstinate vomiting. As a purgative in bilious attacks, hepatic congestion, and cirrhosis calomel is an extremely valuable drug. Its action as a purgative will be more fully described under " Cathartics." This drug is also a remarkably efficient diuretic. The internal use of mercury is of great value in all nonsuppu- rative inflammations, as cirrhotic conditions in the glandular struc- tures, or in scleroses in the nervous system, such as hepatic cirrhosis, chronic interstitial nephritis, locomotor ataxia, chronic e?idarteritis, chronic affections of the lungs and pleura, etc. Many acute febrile and inflammatory conditions, such as menin- SPECIFICS. 235 gitis, pericarditis, and hepatitis, are sometimes benefited by the in- ternal administration of calomel, though in acute inflammations the chief value of the drug, whether specific or non-specific, is manifest in iritis and in acute bronchitis which shows a tendency to persist. Calomel given in from 10- to 20-grain (0.6-1. Gm.) doses in cases of pneumonia is esteemed very highly by some authorities. Calomel and opium have been used and recommended by some physicians in the treatment of Asiatic cholera. The internal use of bichloride of mercury is unquestionably of much value in the treatment of diphtheria, and the subsulphate of mercury is an old and very effective emetic in membranous laryngitis. The author has often successfully treated marasmus of infants with bichloride of mercury administered three times a day in doses of from jfa to yLg- grain (0.0005-0.0006 Gm.). Contraindications.—Mercury is usually contraindicated in tuberculosis and in persons of strumous diathesis; and, while it is of value when judiciously employed in chronic interstitial nephritis, it must nevertheless be given cautiously, and if the excretion of urine is diminished by its use, the drug should be immediately discontinued. Children, though not easily salivated, are very susceptible to other poisonous actions of calomel. Ordinarily, acute asthenic diarrhea and dysentery in adults would contraindicate the use of mercurials. Administration.—Mercuiy is introduced into the system by— 1. Inunction.—The portion of the body upon which the prepa- ration is to be applied should first be thoroughly washed with soap and warm water, and the ointment well rubbed in with the palm of the hand. The best localities for application are the inner sides of the thighs, the sides of the chest, the axillae, abdomen, and back. An excellent way to mercurialize a child is to put the ointment on the abdomen beneath a flannel binder. An efficient means also of favoring absorption is to apply the ointment to the soles of the feet, when it will be rubbed in by walking. Mercurial ointment is ordinarily used for this purpose, 15 to 30 grains (1.O-2.O Gm.) being required for each inunction. Oleate of mercury when applied externally should not be rubbed in, the simple application to the skin being sufficient. 2. Fumigation.—The iodide, mercuric sulphide, and calomel are used in this manner. The latter preparation, being preferable, is the 236 A TEXT-BOOK OF MA TERIA MEDICA. one ordinarily used. From 5 to 20 grains (0.3-1.2 Gm.) of calomel are put in a plate or a porcelain dish over a lighted spirit-lamp. These are placed under a cane-bottomed chair, in which the patient sits, nude, enveloped in a blanket reaching to the floor and fastened loosely about the neck. The calomel is volatilized by the heat, deposited in minute particles over the surface of the body, and read- ily absorbed. The fumigation should last fifteen to twenty minutes. 3. Endermically.—Mercurials may be absorbed by dusting calo- mel and certain other preparations on ulcers, open wounds, etc. 4. By the Rectum.—Mercury may be administered in the form of a suppository containing 5 to 10 grains (0.3-0.6 Gm.) of mer- curial ointment. 5. Hypodermically.—From yV to i gram (0.005-0.01 Gm.) of the bichloride of mercury, dissolved in 5 to 10 minims (0.3-0.6 Cc.) of distilled water, is injected deeply into the muscles of the gluteal region or in the subcutaneous areolar tissue of the back. The solution of peptonate of mercury has been used for this pur- pose, though the preparation which is the least objectionable is the solution of the formamidate of mercury, 16 minims (1.0 Cc), cor- responding to \ grain (0.1 Gm.) of mercuric chloride. A 1 per cent, solution of asparagin hydrargyrate has been highly recommended by Neumann for hypodermic use, the dose being about 15 minims (1.0 Cc), equivalent to \ grain (0.01 Gm.). Numerous other preparations have been recommended, but probably possess no advantage over those mentioned. 6. Internally.—In the treatment of syphilis nearly every prepara- tion of mercury has been employed, authorities differing in their choice. Bumstead prefers the bichloride, the mercurous iodide, and the mercurial pill; Berkeley Hill, the red mercuric iodide; Fox, the cyanide; Hutchinson, the gray powder, etc. It matters little which of these preparations is used. That which agrees best with the patient is advisable. Calomel, gray powder, blue pill, and corrosive sublimate are ordinarily used in disorders of the ali- mentary tract. As a rule, the first two are preferable. ARSENIC. Acidum Arsenosum — Acidi Arsenosi — Arsenous Acid. U.S. P. (Arsenic Trioxide—White Arsenic.) Origin.—Arsenic has been found in minute proportions in many mineral waters. It is obtained in large quantities by roasting SPECIFICS. 237 arsenical ores—cobalt, nickel, tin, and particularly arsenical iron pyrites—and purifying by resublimation. Description and Properties.—It is a heavy solid, occurring either as an opaque white powder or in irregular masses, of two varieties—the one, amorphous, transparent, and colorless, like glass; the other, crystalline, opaque, or white, resembling porce- lain. Frequently the glassy variety is found enclosed in an opaque, white crust. Contact with moist air changes the glassy into the white, opaque variety. Both are odorless and tasteless. Both varieties dissolve very slowly in cold water, the glassy variety requiring about 30, the porcelain-like about 80, parts of water at 150 C. (590 F.). Both are slowly but completely soluble in 15 parts of boiling water. Arsenous acid is but slightly soluble in alcohol, but is soluble in about 5 parts of glycerin. Oil of tur- pentine dissolves the glassy variety only. Both varieties are freely soluble in hydrochloric acid and in solutions of alkali hydrates and carbonates. Dose.— Ay A^ grain (0.001-0.003 Gm.). Official Preparations. Liquor Acidi Arsenosi—Liquoris Acidi Arsenosi—Solution of Arsenous Acid. — Strength, 1 per cent, of arsenous acid. Description and Properties.—A clear, colorless liquid, odorless, having an acidu- lous taste and an acid reaction. Dose.—2-10 minims (0.12-0.6 Cc). Liquor Potassii Arsenitis—Liquoris Potassii Arsenitis—Solution of Potas- sium Arsenite (Fowler's Solution).—Strength, 1 per cent, of arsenous acid. Dose.—2-10 minims (0.12-0.6 Cc). Arseni Iodidum—Arseni Iodidi—Arsenic Iodide. U. S. P. Origin.—Prepared by triturating in a mortar finely-powdered metallic Arsenic and Iodine until they are thoroughly mixed ; or by mixing solutions of Arsenous and Hydriodic Acids, and evapo- rating. Description and Properties.—Glossy, orange-red, crystalline masses, or shining, orange-red, crystalline scales, having an iodine- like odor and taste ; gradually losing iodine on exposure to air and light. Soluble in 7 parts of water and in about 30 parts of alcohol. Arsenic iodide should be kept in glass-stoppered vials, in a cool place, protected from light. Dose.—3V/—£ grain (0.002-0.008 Gm.). 238 A TEXT-BOOK OF MA TERIA MEDICA. Official Preparation. Liquor Arseni et Hydrargyri Iodidi—Liquoris Arseni et Hydrargyri Iodidi —Solution of Arsenic and Mercuric Iodide—(Donovan's Solution).—Strength: 1 per cent., each, arsenic iodide and mercuric iodide. Description and Properties.—A clear, pale-yellowish liquid, without odor, and having a disagreeable metallic taste. Dose.—1-10 minims (0.06-0.6 Cc). Sodii Arsenas—Sodii Arsenatis—Sodium Arsenate. U. S. P. Origin.—Prepared by heating to redness Arsenous Acid, Sodium Nitrate, and Sodium Carbonate. Dissolve the fused mass in water, and crystallize. Dissolve crystals in water, and recrystallize. Description and Properties.—Colorless, transparent, mono- clinic prisms, odorless, and having a mild, alkaline taste (the salt is very poisonous). Efflorescent in dry air, and somewhat deliques- cent in moist air. Soluble in 4 parts of water, very soluble in boiling water, and slightly soluble in cold water. Soluble in 60 parts of boiling alcohol. Sodium arsenate should be kept in well- stoppered bottles. Dose.—^jj—tV gram (0.001-0.006 Gm.). Official Preparation. Liquor Sodii Arsenatis—Liquoris Sodii Arsenatis—Solution of Sodium Arsenate—(Pearson's Solution).—Strength: 1 per cent, of sodium arsenate. Dose.—1-10 minims (0.06-0.6 Cc). Unofficial Preparations. Cupri Arsenis—Cupri Arsenitis—Cupric Arsenite—(Scheele's Green, Min- eral Green, Paris Green, etc.).—Dose, y^ grain (0.0006 Gm.), daily, in divided doses. Liquor Arseni Bromidi—Liquoris Arseni Bromidi—Solution of Arsenic Bromide—(Clemens' Solution).—Strength: the equivalent of 1 per cent, of arsenous acid. Dose.—1-5 minims (0.06-0.3 Cc). Liquor Arseni et Atiri Bromidi—Liquoris Arseni et Aiiri Bromidi—Solu- tion of Arsenic and Gold Bromide.—Originated with, and recommended by, Dr. Barclay, and sold under the trade name " Arsenauro." Strength : 10 minims (0.6 Cc.) contain -^ grain (0.002 Gm.) of each salt. Dose.—5-15 minims (0.3-1.0 Cc). Antagonists and Incompatibles.—Arsenic is incompatible with the salts of iron, silver, magnesia, lime, copper, ammonium, and with vegetable astringents. SPECIFICS. 239 Synergists.—The Restoratives and nux vomica are synergistic to arsenic. Physiological Action.—Externally and Locally.—Applied to the skin, arsenic acts as a caustic, exciting violent inflammation. Its escharotic influence results in destruction of vitality in the affected parts, accompanied with sloughing. Internally.—Digestive System.—Except in very small doses arsenic acts as a severe gastro-intestinal irritant. Minute and medicinal doses stimulate the flow of gastric and intestinal juices, and augment peristalsis, improving the digestive and nutritive func- tions. When too long continued, the drug produces nausea, diar- rhea, and increased micturition, with a sensation of heat and dry- ness of the throat and stomach. Toxic doses are followed by violent gastro-enteritis. Indeed, in whatever manner introduced into the system, arsenic appears to have a marked selective action upon the gastro-intestinal tract. Circulatory System.—Cardiac action may be slightly stimulated by small doses, the experience of arsenic-eaters proving that the drug, so far from being necessarily deleterious, actually tends to invigorate the system. Large doses render the heart irritable and feeble and decrease the number of red corpuscles, rendering the blood less coagulable. Medicinal doses, while not increasing the number of red corpuscles, prevent their destruction in such dis- eases as pernicious anemia. Toxic doses induce, among other severe results, the characteristic arsenical symptom—fatty degen- eration of the cardiac muscle. Nervous System.—The general effect of arsenic upon the brain and nervous system is that of a tonic—a property which is sup- posed to explain its antiperiodic nature, in which respect quinine alone is its superior. The cerebral functions are stimulated, even to the point of exhilaration. Experiments have shown that the sensory nervous apparatus is strongly and untowardly affected. The action finally involves the motor system, complete paralysis supervening. Medicinal amounts act as a nervous excitant, stimu- lating the trophic apparatus (Hare). Large doses produce dis- orders of motility and sensibility, tremors, and other serious symptoms. It has been noted that the continued use of arsenic produces tingling and a sensation of numbness in the tips of the fingers. Under prolonged use arsenic tends to accumulate to a greater extent in nervous than in other tissues. Thus, according to 240 A TEXT-BOOK OF MATERIA MEDICA. Scolosuboff, if i part is found in fresh muscle, the proportion in the liver is 10.8 ; in the brain, 36.5 ; in the spinal cord, 37.3. Respiratory System.—Ordinary amounts effect no special change in respiration other than increased power and stimulation of the respiratory center. It has been held, with authority, that small doses stimulate the peripheral endings of the pulmonary vagi. In toxic doses arsenic acts as a powerful respiratory depressant. Absorption and Elimination.—Arsenic is readily absorbed by the blood. Its presence has also been detected in the viscera, bile, urine, sweat, the bronchial and intestinal mucous membranes, and even in the parenchymatous tissues. It is eliminated slowly from the system by the intestines, and rapidly by the urine; possibly, also, by the bile and the skin. The saliva, milk, and even the tears, are said to share in the process of elimination. Medicinal doses prevent tissue-change, while large doses in- crease nitrogenous metamorphosis. The therapeutic action is cer- tainly to modify and improve nutrition. Temperature.—The temperature is unaffected by medicinal doses. Toxic doses are accompanied by a considerable rise in bodily heat, though the extremities are often cold. Eye.—Large doses of arsenic are followed by injection of the conjunctivae, eczema, inflammation, and edema of the lids. Zehn- der asserts that the prolonged administration of arsenic has caused retrobulbar neuritis, and Hutchinson believes vitreous opacities may result from such a course. Untozvard Action.—Differing from the characteristic symptoms of poisoning occasionally produced by medicinal doses in very susceptible persons, there are induced, not infrequently, restless- ness, headache, alopecia areata, bronchitis, hoarseness, disturbances of digestion, thirst, coryza, and, in rare cases, epistaxis, anaphro- disia, icterus, lacrymation, photophobia, amblyopia, dermatitis, and various cutaneous eruptions, frequently followed by desqua- mation. An eruption resembling that of measles, produced by 3 drops (0.18 Cc.) of Fowler's solution, is reported by Macnal {Medical Times and Gazette, 1868). Falck reports a case in which arsenic produced a discolored sanguinolent eruption with erysipelatous swelling. Papules and erythematous pustules have also been observed. The variety of these eruptions is well, yet somewhat homeo- pathically, described by Imbert-Gourbeyre (quoted from Lewin): SPECIFICS. 241 " Eruptions petechiales ou ecchymoses, eruptions papuleuses, ortiees, vesiculeuses, erysipelateuses, pustuleuses, . . . telles sont les formes principals de l'arsenic, exanthematogene dans ses mani- festations a la peau." Poisoning.—Large doses of arsenic produce symptoms of acute poisoning, the drug almost immediately manifesting its character- istic effects upon the gastro-intestinal canal (to which it is a marked irritant), exciting active inflammation in its delicate membrane. Other symptoms are colicky pains in the stomach, looseness of the bowels, great pain in the esophagus, and edema of the face indicated by puffiness under the eyelids. The passages are at length similar to the " rice-water " discharges of cholera, although different from the latter in the presence of blood or serum. The purging becomes obstinate and exhausting. In certain cases other choleraic symptoms are especially manifested, as increasing cold- ness of the body and cramps. Among the more prominent symp- toms is violent vomiting, which, however, aids in eliminating the poison from the stomach. The effects of arsenic are somewhat variable, intestinal inflam- mation, as autopsies show, not always being present. The quan- tity requisite to produce poisoning is often dependent upon idio- syncrasy, minute doses having proved fatal, and large amounts followed by surprising recoveries. Frequently, in place of the usual symptoms, profound coma occurs from which the patient is, perhaps, never roused. Convulsions and localized paralysis have also been observed. It is well established, too, that absorption of arsenic from a wound or from injection into the blood causes stomachic and intestinal effects often as severe as those attend- ing its ingestion. Various cutaneous symptoms are recorded, and in some cases the effects of arsenical poisoning strongly resemble those of acute yellow atrophy of the liver. Chronic Poisoning.—This malady is frequently due to the fumes or powder of arsenic inhaled in certain processes connected with the arts and manufactures or from manufactured products, such as wall-paper, certain dyes, textile fabrics, etc. The symptoms are similar to those accompanying full doses of the drug, save that the\- appear occasionally in a more aggravated form. Ordinarily, loss of appetite occurs, with nausea, abdominal pains, vomiting, mild diarrhea, and headache. The conjunctiva.' are injected, the eyes and nose watery. In severer cases peripheral neuritis may be 16 242 A TEXT-BOOK OF MA TERIA MEDICA. induced, as well as herpes zoster and paralysis of the muscles of the limbs, particularly the extensors of the hands and feet. Ataxic gait and darting pains, with rapid loss of muscular power, are not infrequent. Death from arsenical poisoning, however, is commonly the result of gastro-enteritis or collapse. The post-mortem changes are usually characteristic of corrosive poisoning—ecchymoses, erosions, and softening of the mucous membrane. The lungs and bronchial membrane are frequently congested. There is also present marked fatty degeneration of the heart, kidneys, liver, and spleen. Treatment of Poisoning.—It is necessary that treatment be ex- peditious, and the agents and methods adopted carefully chosen. Vomiting often renders the use of the stomach-pump unnecessary, yet emetics are frequently serviceable, the cleansing of the stomach being of primary importance. Various antidotes have been suc- cessfully used, the best, chemically, being freshly prepared hydrated sesquioxide of iron, administered in water, 2 or 3 tablespoonfuls every fifteen or twenty minutes. Magnesia, chalk, and lime-water also serve as efficient antidotes. The temperature of the patient should be maintained, and demulcents (oil, milk, etc.) freely given. The after-treatment should include mucilaginous drinks, opiates if indicated, cathartics, and, in case of necessity, stimulants. Therapeutics.—Externally and Locally.—The chief use of arsenic locally is as an escharotic. For this purpose it is employed to destroy malignant growths, such as cancer, sarcoma of the skin, and multiple sarcomatous degeneration of the lymphatic glands. In the latter affection the parenchymatous injection of 5 minims (0.3 Cc.) of Fowler's solution, diluted with twice the amount of distilled water, is used. Many of the pastes and " quack " cancer remedies owe what- ever efficiency they possess to arsenic. Manec's paste contains arsenous acid, 15 grains (1.0 Gm.); black sulphide of mercury, 75 grains (5.0 Gm.); burnt sponge, 35 grains (2.3 Gm.). The noted poudre caustique de Frere Cbsmc ou du Rousselot is a similar preparation, containing about the same quantity of arsenic. The solution of arsenous acid is an excellent local application to warts and corns. If these growths are very firm and horny, their removal may be facilitated by the previous application of solution of potassa. When used over large surfaces arsenic should be applied in good strength and heroically, so that active inflam- mation may be excited and the danger of absorption lessened. SPECIFICS. 243 Internally.—Arsenic is a peculiarly efficient remedy in chronic scaly skin diseases. Like all other specifics, it influences diseases of a chronic nature more favorably than acute disorders, invariably aggravating acute skin diseases. This drug, therefore, is one of the most valued remedies in psoriasis, lepra, and chronic squamous eczema. While arsenic cannot, perhaps, be classed as a specific in the above-mentioned diseases, it undoubtedly yields uniformly better results than any other single drug. The solution of potassa is a valuable synergist to arsenic in these conditions, especially in eczematous cases. Pemphigus, prurigo, acne, and lichen ruber have also been fa- vorably influenced by the continued administration of Fowler's solution. In the successful management of these chronic skin diseases it is necessary that the preparation of arsenic employed be given in as large doses as can be tolerated by the patient, and the treatment continued unremittingly for a long period. Lymphoma, whether superficial or occupying the great cavities, is frequently benefited greatly by similar treatment. Asthma and bronchitis, whether acute or chronic, accompanying or succeeding scaly skin diseases, are singularly amenable to this medicine when the dose is carried to the full physiological limit. Another condition, dysmenorrhea, frequently noticed in women with a tendency to asthma or subject to chronic diseases of the skin, is often cured or greatly benefited by arsenic. The obstinate and often incurable disease known as pernicious anemia yields better to arsenic than to any other known remedy. The effect of the drug in this disease is not due to its increasing the number and quality of the red blood-corpuscles, but rather to its preventing or delaying their destruction in the portal circulation. It should be given continuously and in gradually increasing doses until symptoms of arsenical poisoning appear, when the increase should cease and the same dose be maintained for some time. By carefully watching the indications and by the timely use of lax- atives the dosage may be easily adjusted so that the full benefit may be derived from this invaluable drug. The statements in the preceding paragraph are applicable also to leukemia, whether splenic, myelogenic, or lymphatic, and to Hodg- kiiis disease. Arsenic ranks next to quinine in the treatment of malaria. 244 A TEXT-BOOK' OF MATERIA MEDICI. Chronic cases in which quinine has lost its power are generally benefited in a marked manner by arsenic. It is a peculiar fact that relapses are fewer after the arsenic treatment than after the use of quinine. Moreover, arsenic can be administered in intermittent fever, frequently with as favorable results as quinine would give Arsenic can be employed in cases of malaria at all times with- out regard to the presence or absence of fever or chills. The neuralgias, anemia, and headache of malarial origin are singularly amenable to this medicine. In the treatment of malaria with arsenic it must be remembered that the paroxysms of ague are not relieved at once, as is the case when quinine is the medicament used; but they recur with less severity, and are of shorter duration, gradually declining until they disappear altogether. Fowler first reported the remarkable efficacy of arsenic in neuralgia of the intercostal and fifth pair of nerves. It is equally valuable in these cases whether the disease be due to malaria or to general debility. The author wishes to recommend urgently the use of arsenic in pulmonary phthisis. In certain forms of this disease he regards it equal, if not superior, to any other remedy. It is useful, however, only in those conditions which are characterized by excessive expectoration and a slow degenerative process. The good results of the arsenic treatment in these cases is shown in a conspicuous manner by a marked improvement in the general condition of the patient, there being a lessened pulmonary secretion, a reduction in temperature, improvement of the appetite, and consequent increase of the body-weight. Arsenic is contraindicated in phthisis when the cough is harsh and paroxysmal, with but scanty expectoration and a tendency to pulmonary hemorrhage. If this drug is specific in any one disease, it is so in chorea, very rarely failing to effect a cure when judiciously administered. It should be given in full doses, and increased as tolerance is established. This medicine seems to act equally well in gastralgia. It is also an efficient remedy in gastritis or the vomiting of gastritis, espe- cially in that occasioned by the excessive use of alcohol. Many irritative conditions of the stomach are relieved by minute doses of Fowler's solution. Excessive peristalsis, resulting in diarrhea, coming on immediately after taking food, is usually cured com- pletely by very small doses of Fowler's solution, alone or com- SPECIFICS. 245 bined with an equal quantity of tincture of opium. Arsenic has also been recommended in gastric ulcer and cancer. It has proved of great service in hay fever, spasmodic asthma, and acute coryza. It is often very serviceable in catarrhal pneu- monia and in chronic bronchitis. Bromide of arsenic is highly recommended in diabetes mellitus. Rheumatoid arthritis is more favorably influenced by the use of arsenic than by any other medi- cine. It should be employed in the treatment of chronic rheuma- tism. Even in secondary syphilis a combination of mercury and arsenic has produced better results, in some cases, than mercury alone. Anstie has recommended arsenic in angina pectoris, alleging that it mitigates the severity of the attacks. Chronic diarrhea, when induced by intestinal fermentation or chronic malarial infec- tion, is sometimes greatly benefited by this drug. Constipation, also, if due to deficient intestinal secretion, may frequently be relieved by the administration of small doses of arsenic. Albuminuria dependent upon imperfect digestion of albuminous substances is almost invariably relieved by Fowler's solution taken with meals. Certain nervous diseases of the aged, not due to malaria, such as melancholia and hypochondria, are often relieved by small doses of this drug. Finally, arsenic is a valuable adjunct to iron in the treatment of simple anemia and chlorosis. It is thought by some clinicians to retard the progress of epithelioma, and particularly gastric and uterine caiiccr. Contraindications.—In acute skin diseases and pulmonary tuberculosis with a tendency to hemoptysis. Administration.—Arsenic should be given ordinarily after meals. There are certain conditions, however, requiring its admin- istration in small doses before meals. When it is desired to give arsenic in pill form, the arsenous acid should be used; and for solutions the liquor potassii arsenitis is usually preferred. In syphilitic disorders Donovan's solution is an excellent prepa- ration to use. Children are much less susceptible to the drug than adults, often being able to take adult doses with impunity. During a course of arsenic the patient should be instructed to watch carefully for the first untoward manifestations, such as puf- finess about the eyes, itching of the conjunctivae, nausea, diarrhea, or numbness of the fingers. Any one of these symptoms is an 246 A TEXT-BOOK OF MATERIA MEDICA. indication that the dose should not be increased; and it may be necessary to lessen the dose, or even to discontinue the remedy altogether, for a while. There are two methods of getting a patient thoroughly under the influence of the drug: 1. Begin with a full dose of Fowler's solution, and decrease 1 minim (0.06 Cc.) a day until a minim (0.06 Cc.) dose is reached; then repeat the method. 2. Begin with a small dose of Fowler's solution, and increase 1 minim (0.06 Cc.) a day until untoward symptoms appear or the dose has reached 10 or 15 minims (0.6-1.0 Cc.); then either re- peat the method or decrease the amount 1 minim (0.06 Cc.) a day. Enormous doses of arsenic can be given hypodermically, and it is then much less toxic than when given by the mouth. Equiva- lents of 20 (1.2 Cc), 50 (3.2 Cc), and indeed 100, minims (6.5 Cc.) of Fowler's solution have been given in this manner at a single dose without toxic symptoms. Arsenic often acts more efficiently when given in this manner than when given by the mouth. The liver has a strong elective affinity for arsenic, but it is absorbed through the alimentary canal with considerable diffi- culty. The toxic action expends itself almost wholly upon the stomach and upper portion of the intestine. The hypodermic use of arsenic distributes the drug through the system just as mercury is distributed by inunction, carrying it immediately to all parts of the system by the circulation. The arsenite of sodium is free from any objection for hypodermic use : it never causes the least sign of irritation. Fowler's solution is objectionable : it invariably causes much irritation, and frequently forms an abscess. Careful study of the effects of the drug in each case will make it possible to guard its administration so that tolerance can be established—a result much to be desired in order to secure the maximum benefit. Considering the enormous doses to which the arsenocophagi become habituated, failure in the medicinal administration of arsenic argues the want of ability to employ it scientifically. lodum—Iodi—Iodine. U. S. P. Origin.—It is found in the ashes of sea-weeds and is prepared from the mother-liquor obtained in the purification of Chili salt- petre. SPECIFICS. 247 Description and Properties.—Heavy, bluish-black, dry and friable rhombic plates, having a metallic luster, a distinctive odor, and a sharp and acrid taste. It imparts a deep-brown, slowly evanescing stain to the skin, and gradually destroys vegetable colors. Iodine is soluble in about 5000 parts of water and in 10 parts of alcohol, with a brown color; also freely soluble in ether and in a solution of potassium iodide, with a brown color, and in chloroform or carbon disulphide, with a violet color. It should be kept in glass-stoppered bottles, in a cool place. Dose.—About £ grain (0.016 Gm.), although seldom given in substance. Official Preparations. Liquor Iodi Comp6situs—Liquoris Iodi Comp5siti—Compound Solution of Iodine (Lugol's Solution).—Iodine, 5; Potassium Iodide, 10; Distilled Water, to make ioo parts. Strength, 5 per cent. Dose, 1-10 minims (0.06-0.6 Cc). Tinctura Iodi—Tincturae Iodi—Tincture of Iodine.—Iodine, 70; Alcohol, to 1000. Strength, 7 per cent. Dose, 1-5 minims (0.06-0.3 Cc). Unguentum Iodi—Unguenti Iodi—Iodine Ointment.—Iodine, 4; Potassium Iodide, 1; Water, 2; Benzoinated Lard, 93. Strength, 4 per cent. For external use. Syrupus Acidi Hydriodidi-Sympi Acidi Hydriodidi —Syrup of Hydriodic Acid. U. S. P. A syrupy liquid containing about I per cent, by weight of hydriodic acid. Description and Properties.—A transparent, colorless, or only pale straw-colored liquid, odorless, and having a sweet and acidu- lous taste. Dose.—h-2 fluidrachms (2.0-8.0 Cc). Ammonii Iodidum—Ammonii Iodidi—Ammonium Iodide. U. S. P. Origin.—It is prepared by dissolving Potassium Iodide and Ammonium Sulphate in boiling Water, adding Alcohol, filtering, washing the filtrate, and evaporating it to dryness. Description and Properties.—Minute, colorless, cubical crys- tals, or a white, granular powder, without odor when colorless, but emitting a slight odor when colored, and having a sharp, saline taste. The salt is hygroscopic, and soon becomes yellow, or yellowish-brown, on exposure to the air and light, owing to the loss of ammonia and the elimination of iodine. Soluble in 1 part 248 A TEXT-BOOK OF MATERIA MEDICA. of water and in 9 parts of alcohol. Ammonium iodide should be kept in small, well-stoppered vials, protected from light. Dose.—3-20 grains (0.18-1.2 Gm.). Potassii Iodidum—Potassii Iodidi—Potassium Iodide. U. S. P. Origin.—Iodine is dissolved in a solution of Potassa in hot dis- tilled Water. The solution is evaporated, and the residue heated with charcoal. Dissolve in boiling Water, filter, wash the filtrate, and crystallize. Description and Properties.—Colorless, transparent or trans- lucent, cubical crystals, or a white, granular powder, having a pecu- liar, faint, iodine-like odor, and a pungent, saline, and afterward bitter taste. Permanent in dry air and but slightly deliquescent in moist air. Soluble in 0.75 part of water and in 18 parts of alcohol; also soluble in 2.5 parts of glycerin. Potassium iodide should be kept in well-stoppered bottles. Dose.—2-30 grains (0.12-2.0 Gm.). Official Preparation. UnguSntum Pot3ssii Iodidi—UnguSnti Potassii Iodidi—Ointment of Po- tassium Iodide.—Potassium Iodide, 12; Sodium Hyposulphite, I; Water, io; Ben- zoinated Lard, 77. For external use. Sodii Iodidum—Sodii Iodidi—Sodium Iodide. U. S. P. Origin.—Prepared from a solution of Soda in a manner similar to the preparation of potassium iodide. Description and Properties.—Colorless, cubical crystals, or a white, crystalline powder, odorless, and having a saline and slightly bitter taste. In moist air it deliquesces and becomes partially de- composed into sodium carbonate and free iodine, assuming thereby a reddish color. Soluble in 0.6 part of water and in about 3 parts of alcohol. It should be kept in well-stoppered bottles. Dose.—2-30 grains (0.12-2.0 Gm.). Strontii Iodidum—Strontii Iodidi—Strontium Iodide. U. S. P. Origin.—Prepared by neutralizing freshly prepared solution of Hydriodic Acid with Strontium Carbonate, concentrating the filtrate, and crystallizing. Description and Properties.—Colorless, transparent, hex- SPECIFICS. 249 agonal plates, odorless, and having a bitterish, saline taste; deli- quescent and colored yellow by exposure to air and light. Soluble in 0.6 part of water, also soluble in alcohol, and slightly in ether. It should be kept in dark, amber-colored, glass-stop- pered vials. Dose.—2-30 grains (o. 12-2.0 Gm.). Zinci Iodidum—Zinci Iodidi—Zinc Iodide. U. s. P. Origin.—Obtained by dissolving Zinc Oxide or Carbonate in Hydriodic Acid, or digesting Granulated Zinc in 10 parts of Iodine and 20 parts of Water, and evaporating to dryness. Description and Properties.—A white, granular powder, odor- less, and having a sharp, saline, and metallic taste. Very deliques- cent, and liable to absorb oxygen from the air and to become brown from liberated iodine. Readily soluble in water, alcohol, or ether. Zinc iodide should be kept in small, glass-stoppered bot- tles. Dose.—1-3 grains (0.06-0.18 Gm.). Sulphuris Iodidum—Sulphuris Iodidi—Sulphur Iodide. U. s. P. Origin.—Prepared by heating Washed Sulphur and Iodine in a flask until the ingredients combine. Description and Properties.—Brittle masses, of a crystalline fracture and a grayish-black, metallic luster, having the odor of iodine and a somewhat acrid taste. Almost insoluble in water; soluble in about 60 parts of glycerin ; very soluble in carbon di- sulphide. Alcohol and ether dissolve out the iodine, leaving the sulphur. Sulphur iodide should be kept in glass-stoppered bottles, in a cool place. Dose.—1-5 grains (0.06-0.3 Gm.). Unofficial Prcparatio?i. Unguentum Sulphuris Iodidi—UnguSnti Sulphuris Iodidi—Ointment of Sulphur Iodide.—Sulphur Iodide, 30 grains (2.0 Gm.); Lard, 1 ounce (30.0 Gm.). For external use. Plumbi Iodidum—Plumbi Iodidi—Lead Iodide. U. S. P. Origin.—Mix solutions of Lead Nitrate and Potassium Iodide, filter, wash the precipitate with Distilled Water, and dry it at a gentle heat. 250 A TEXT-BOOK OF MATERIA MEDICA. Description and Properties.—A heavy, bright-yellow powder, without odor or taste. Permanent in the air. Soluble in 2000 parts of water; veiy slightly soluble in alcohol, but soluble, with- out color, in solutions of the fixed alkalies, in concentrated solu- tions of the acetates of the alkalies, of potassium iodide, and of sodium hyposulphites, and in a hot solution of ammonium chloride. Lead iodide should be kept in well-stoppered bottles, protected from light. Dose.—A grain (0.013 Gm.), although, as a rule, this drug is employed externally. Argenti Iodidum—Argenti Iodidi—Silver Iodide. U. S. P. Origin.—Aqueous solutions of Silver Nitrate and of Potassium Iodide are poured together; the precipitate is then collected upon a filter and washed with Distilled Water and dried upon bibulous paper. Description and Properties.—A heavy, amorphous, light-yel- lowish powder, unaffected by light if pure, but generally becom- ing somewhat greenish-yellow, and having neither odor nor taste. Insoluble in water and alcohol. Dose.—\-2 grains (0.008-0.13 Gm.). Allied Compounds. Iodi Bromidum—Iodi Bromidi—Bromide of Iodine.— Origin.—Obtained by heating together Iodine and Bromine. Description and Properties.—A dark, reddish-brown liquid, resembling bromine in appearance and sensible properties, but yielding a perfectly transparent, brown-red solu- tion with less than 6 parts of water. For external use. Iodi Chloridum—Iodi Chloridi—Iodine Chloride (Iodine Trichloride).— Origin.—Prepared by passing dry Chlorine Gas over dry Iodine. Description and Properties.—Orange-yellow needles, gradually changing to large, transparent, rhombic plates. It has a penetrating, pungent odor, resembling bromine. Soluble in 5 parts of water, and also in alcohol and ether. Dose.—\ grain (0.01 Gm.), and externally in ■^r-\ per cent, aqueous solution. Antagonists and Incompatibles.—Iodine and the iodides are antagonized by most of the Restoratives. Iodine is incompatible with the alkaloids and most of the mineral salts and acids, and with ammonia. The iodides are incompatible with mineral acids and acid salts, bismuth subnitrate, alkaloids, silver nitrate, soluble lead salts, spirit of nitrous ether, potassium chlorate, liquorice, and SPECIFICS. 251 preparations containing starch. The tincture of iodine is incom- patible with water and aqueous preparations. Synergists.—The specifics, alkalies, and remedies increasing waste. Physiological Action.—Externally and Locally.—Iodine is a powerful disinfectant and rubefacient, as well as vesicant, caustic, parasiticide, and antiseptic. When applied to the skin or mucous membrane it produces a yellow, brown, or black stain, and is irri- tant or caustic according to the strength and frequency of the application. The discoloration, however, can be easily removed by sodium hyposulphite or ammonia. It combines with the albumin of the tissues and prevents putre- factive changes. When tincture of iodine is frequently applied or large amounts are used, desquamation of the skin is produced, and sometimes rapid vesication, or perhaps sloughing. The blood- vessels of the organs subjacent to the area to which it is applied are reflexly dilated, rendering this drug an efficient counter-irritant. The vapor of iodine when inhaled produces considerable irrita- tion of the respiratory passages, exciting cough, sneezing, increased secretion of mucus, dyspnea, and more or less pain in the chest, although when inhaled in moderate amounts its antiseptic proper- ties exert a beneficial influence upon the bronchial tissues, prevent- ing decomposition of the secretions. The iodides have no local action. hiternally.—Digestive System.—Taken internally in small doses, iodine acts as a gastric tonic, minute doses acting as a sedative, allaying nausea. In other cases a single moderate dose may occa- sion gastric uneasiness, larger amounts intensifying the discomfort and causing violent vomiting, increased salivary flow, abdominal pains, and purging. The iodides in moderate doses produce a sense of warmth in the stomach, larger amounts acting like iodine, though less irri- tating to the gastro-intestinal tract than the latter drug. Owing to their rapid diffusibility, the iodides can be tasted in a few minutes after their ingestion, considerably increasing the flow of saliva. Circulatory System.—The effects of iodine and its salts have been variously reported, it being claimed that their tendency is to contract the vessels and cause increased cardiac action. Intro- duced into the veins, a slight increase, followed by decrease of pressure, has been observed. The rapidity of elimination from the 252 A TEXT-BOOK' OF MATERIA MEDICA. blood is doubtless an impediment to any marked action on the circulation. Trasbot claims that potassium iodide dilates the blood-vessels, thereby increasing glandular secretion. The iodides are all supposed to be converted into the sodium iodide in the blood, without modifying the composition of that fluid. Nervous System.—No special action is recorded, although the potassium iodide is known to occasion unpleasant symptoms, in- cluding distress of mind and depression of spirits, accompanied now and then by lassitude and muscular debility—symptoms due rather to the influence of potassium upon the spinal cord. Respiratory System.—Little or no effect from medicinal doses has been noted. Absorption and Elimination.—Iodine and the iodides are rapidly absorbed by the mucous membranes generally, being found in the blood, mainly in combination with sodium. Elimination takes place by various channels—the urine, saliva, milk, intestinal and nasal mucous membranes. Salivary elimina- tion appears to be even more active than the urinary process, although the drug escapes largely through the kidneys, increasing the amount of water, urea, uric acid, and phosphoric and sul- phuric acids excreted. At the points of elimination the iodine escapes in its nascent state, occasioning more or less irrita- tion. Temperature.—No effects have been noted, the temperature appearing to remain stationary even in the presence of decidedly untoward symptoms. Eye.—Beyond a local congestion of the minute vessels of the sclerotic coat under certain conditions little effect has been ob- served. The symptoms of ocular iodism at times present are described under " Poisoning." Uterus.—Small doses may increase or hasten the menstrual flow and act as aphrodisiacs ; larger doses have a marked anaphro- disiac effect; while prolonged administration may result in atrophy of the ovaries. It has been maintained with authority that the catamenia are liable to increase, and that during pregnancy the drug may cause abortion. Untozvard Action.—The untoward manifestations, in susceptible patients, are identical with those of iodism. Poisoning.—Taken in excessive doses, iodine acts as a poison, and has even produced death, though rarely. The symptoms of SPECIFICS. 253 acute poisoning are those of severe gastro-enteritis, characterized by distressing stomachic and abdominal pains, accompanied by painful irritation of the esophagus, followed by violent purging and vomiting. An early symptom is a strong metallic taste in the mouth, to- gether with increased salivation. Suppression of urine, hiccough, and dysenteric pain have been reported in a fatal case resulting from external application (Biddle, p. 460). Very immoderate doses are attended with rapid and feeble pulse, deathly pallor, severe renal irritation affecting urinary secretion, and final loss of vital power followed by respiratory failure. The condition induced by prolonged or excessive use of iodine or its salts is known as Iodism. Together with a metallic taste there are present tenderness of the teeth and gums, nausea and coryza or symptoms of gastric irritation, acneiform eruptions— even a vesicular and purpuric variety not infrequently occurs— while under continued dosage the coryza becomes more pro- nounced, accompanied by edema of the eyelids, lacrymation, and ocular pains. Moreover, muscular twitchings, edema of the glottis, neuralgic pains, and atrophy of mammae, testicles, and other tis- sues occasionally supervene. Anemia and even cachexia are often manifest. Treatment of Poisoning.—The use of large amounts of starch, in the form of arrowroot or starch-water, has been successfully adopted as an antidote. Hypodermic injections of ammonia, strychnine, digitalis, alcohol, and atropine have been employed with excellent results, as tending to restore the circulation and assist respiratory movements. More recently bicarbonate of so- dium has proved an efficient antidote. The use of the stomach-pump and the application of heat to the body and extremities are naturally of the first importance. Therapeutics.—Externally and Locally.—The tincture, com- pound solution, and ointment are extensively employed as coun- ter-irritants and as aids to the absorption of fluid. The tincture is an efficient application to joints in chronic rheumatism, gout, and synovitis, and in pleurisy, both for the purpose of aborting an attack and to aid the absorption of fluid when effusion has taken place. In neuritis, onychia, periostitis, venereal bubo, glandular szvcllings, etc the tincture, applied externally, will often be of service. This same preparation is of marked benefit when hypodermi- 254 A TEXT-BOOK OF MATERIA MEDICA. cally injected in goiter, particularly of the soft or cystic variety, hydrocele, empyema, extensive serous arthritic effusion unaccompanied by inflammation, spinal meningocele, and anal fistula. The tincture is also a very efficient application in chronic metritis and chronic endometritis. In many diseases of the skin iodine serves a useful purpose as a discutient and parasiticide, lentigo, lupus, chloasma, tinea tonsurans, etc. especially indicating its use. Many chronic splenic and hepatic disorders are favorably influ- enced by an external application of the iodine ointment. The tincture of iodine has been recommended as an efficient application in recession of the gums attendant upon pyorrhea alveolar is. The vapor of iodine is frequently employed in subacute ca- tarrhal deafness and in acute coryza. A mixture of tincture of iodine \ fluidrachm (2.0 Cc), carbolic acid 10 minims (0.6 Cc), glycerin and water, each, \\ ounces (45.0 Cc), has been highly recommended by Samuel Johnston in the treatment of chronic pharyngitis. As an inhalant in chronic laryngitis and phthisis iodine in some form is highly esteemed by many physicians. Internally.—One of the principal and most important uses of iodine and the iodides is in the treatment of secondary and tertiary syphilis. All the manifestations of this disease, such as syphilitic periostitis, meningitis, endarteritis, gummata, paralysis, etc., are re- lieved by large doses of the iodides to saturation of the system. The more chronic the disease, the larger the dose required; and the more acute the attack, the smaller the dose. Iodine is peculiarly useful in combining with and eliminating mercury from the system of patients suffering from mercurial cachexia, paralysis, etc. Other metals, lead, etc., are readily elim- inated by a course of potassium iodide. Potassium iodide is of marked utility in arresting the various manifestations of scrofula, such as inflammation and ulceration of cartilaginous structures and mucous catarrhs, and hastening the reso- lution of adenitis and enlargement of lymphatics. With regard to the use of iodine in the treatment of aneurysm of the aorta Walshe says : " Not only has relief of neuralgic pains and of the general distress followed its administration, but the local pressure-symptoms have been mitigated, and firm thrombosis has taken place within the sac, while the area of pulsation and of per- SPECIFICS. 255 cussion-dulness has exhibited sensible reduction." Other authori- ties have reported favorably of its use in this condition. As a cardiac tonic iodine is of undoubted value, being especially serviceable in fatty degeneration of the heart, and in usually miti- gating the symptoms of chronic valvular diseases of the heart, especially those of the aortic orifice. It is a particularly useful remedy in chronic asthma and bronchitis, and to hasten the removal of inflammatory products of pneumonia, pleurisy, and pericarditis. The spasmodic asthma of adults and the bronchitis of children, both of which alternate with eczematous attacks, are greatly relieved by the potassium iodide. Even hereditary asthma occurs at less frequent intervals and in a milder form when the patient is kept constantly under the influ- ence of moderate doses of this drug. And if there is any remedy which has a beneficial influence in acute tubercular meningitis, it is potassium iodide. In the early stages of cirrhosis, whether of the liver or kidneys, as well as in sclerosis of the cord, it is an efficient remedy. The dropsy of splenic or hepatic induration is relieved by iodine, while in the various forms of muscular rheumatism it is one of the most potent medicaments. It has been advocated as a successful remedy in sciatica and chronic gout. It unquestionably retards the changes in chronic interstitial nephritis, though the tincture of iodine in these cases is considered superior to the potassium iodide. Ammonium iodide is highly recommended as an efficient rem- edy in acute catarrJial pneumonia and capillary bronchitis. It is especially useful in catarrhal jaundice, and has, moreover, been suggested as a good remedy in hay fever and in malarial fevers. The syrup of hydriodic acid has been commended by Craig as a valuable agent in acute rheumatism. Contraindications.—The drug should be discontinued at once when symptoms of iodism appear. It is contraindicated also in pulmonary tuberculosis when there is rapid change taking place in the lung. The iodides should not be given immediately before or after the administration of quinine. Administration.—The sodium iodide is less active and toxic than the potassium salt. The strontium iodide may be used for the same purposes as the other iodides, and possesses the advantage of disturbing the stomach less, besides being less likely to produce iodism. 256 A TEXT-BOOK OF MATERIA MEDICA. The iodides should be given in a large quantity of liquid. Their unpleasant taste may be concealed to a considerable extent by dissolving them in carbonic-acid water or Vichy water. Milk, com- pound syrup of sarsaparilla, and currant and raspberry syrups have all been used for this purpose. It is said that tincture of belladonna or sodium bicarbonate prevents the coryza caused by the iodides. The syrup of hydriodic acid is quite pleasant to the taste, and has but little tendency to produce iodism or untoward effects. This preparation should always be administered upon an empty stomach. Colchicum—Colchici—Colchicum. U. S. P. (Meadow Saffron.) Origin.—A plant indigenous in Europe, in the southern and central portions of which it is frequently found in pastures and meadows, flowering in September or October, and ripening its seeds in June following. The root and seeds are official. Description and Properties.— The root is about I inch (25 Mm.) long, ovoid, flattish, with a groove on one side; externally brownish and wrinkled, internally white and solid ; often in trans- verse slices reniform in shape, and breaking with a short, mealy fracture ; inodorous ; taste sweetish, bitter, and somewhat acrid. Dose.—2-8 grains (0.12-0.5 Gm.) in powder. Official Preparations of the Root. Extractum C51chici Radicis—ExtrScti C61chici Radicis—Extract of Col- chicum Root.—Dose, \-2 grains (0.03-0.12 Gm.). Extractum C61chici Radicis Fluidum—Extr3cti C61chici Radicis Fluidi— Fluid Extract of Colchicum Root.—Dose, 2-8 minims (0.12-0.5 Cc). Vinum C&lchici Radicis—Vini Colchici Radicis—Wine of Colchicum Root.—Dose, 5-20 minims (0.3-1.2 Cc). Colchicum seeds are subglobular, about yV inch (2 Mm.) thick, very slightly pointed at the hilum; reddish-brown, finely pitted, internally whitish; very hard and tough; inodorous; taste bitter and somewhat acrid. Both the root and seeds contain an active principle, colchicine, which is present in greater proportion in the root. Dose of the Powdered Seeds.—1-5 grains (0.06-0.3 Gm.). Dose of Colchicine.—x \ 0 JQ grain (0.0012-0.001 Gm.). SPECIFICS. 257 Official Preparations of the Seed. Extractum C61chici SSminis Fluidum—Extracti Colchici SSminis Fluidi— Fluid Extract of Colchicum Seed.—Dose, 1-5 minims (0.06-0.3 Cc). Tinctura C61chici SSminis—Tincturae CSlchici SSminis—Tincture of Col- chicum Seed.—Dose, 10-30 minims (0.6-2.0 Cc). Vinum C61chici Sfeminis—Vini C&lchici SSminis—Wine of Colchicum Seed.—Dose, 10-30 minims (0.6-2.0 Cc). Antagonists and Incompatibles.—Alcohol and opium antago- nize the cardiac depression produced by colchicum. Tannic acid and vegetable infusions containing it are incompatible, forming an insoluble tannate with the alkaloid. Synergists.—Diuretics, purgatives, emetics, and alkalies pro- mote the therapeutic activity of colchicum. Physiological Action.—Externally and Locally.—Colchicum is a decided local irritant, and when applied to the skin acts as a rubefacient. The dust when inhaled excites sneezing. Internally.—Digestive System.—In small medicinal doses colchi- cum slightly stimulates the salivary, gastric, biliary, and intestinal secretions. If these doses are repeated for several days, a sensa- tion of heat is experienced in the epigastrium, accompanied by loss of appetite and frequently by nausea. Full medicinal doses may produce purging and colic. Larger doses occasion profuse watery and choleriform or bloody evacuations from the bowels, severe abdominal pain and tenderness, excessive vomiting—in fact, all the symptoms produced by a violent gastro-intestinal irritant. Circulatory System.—Full medicinal or larger doses produce great depression of the circulation, with a small, rapid, and thready pulse. The marked cardiac depression and collapse which occur when poisonous doses of colchicum have been taken are more the result of the severe gastro-enteritis than of any direct action upon the heart. Nervous System.—The nervous system is unaffected by medici- nal doses. Even when poisonous doses have been taken the intellect usually remains unimpaired, though Toulmouche has seen the drug induce marked cerebral excitement. Discordant state- ments have been made regarding the action of colchicum upon the nervous system. The drug evidently affects different persons dif- ferently. Thus numbness or prickling, muscular pains or spasms, and occasionally convulsions, have been noticed; yet the recent investigations of Laborde and Houde upon the action of colchicine show that it has no influence upon the centers of intelligence and 17 258 A TEXT-BOOK OF MATERIA MEDICA. volition, and does not induce paralysis of central origin, either motor or sensory, though the sensory nerves are considerably depressed. Respiratory System.—Large or poisonous doses of colchicum render the respiratory movements slow and shallow. This action is not due to any direct effect upon the respiratory center, but reflexly to the depression occasioned by the violent action of the drug upon the gastro-intestinal tract. Absorption and Elimination.—Colchicum is quite rapidly ab- sorbed, and is eliminated chiefly by the bowels and kidneys, the skin sharing to some extent in the excretory process. Some ob- servers allege that colchicum does not increase the amount of urine or the excretion of urea and uric acid, while others claim that these substances are increased. The author's experiments are sufficient to satisfy him that the excretion of all these sub- stances is considerably heightened under medicinal doses of col- chicum. Temperature.—Under moderate medicinal doses the temperature is unaffected, though doses large enough to produce emeto-cathar- sis are followed by a reduction of temperature. Untozvard Action.—Many symptoms described under " Poison- ing " have been produced by very small doses. It is a matter of speculation whether these untoward manifestations were due to a decided idiosyncrasy on the part of the patient, or to the fact that the preparation employed might have contained an unusually large percentage of the alkaloid. Poisoning.—The symptoms of poisoning by colchicum are vio- lent vomiting and purging, griping and intense pain in the abdomen, and at times excessive salivation or possibly convulsions. While death is for a time delayed under a poisonous dose, a fatal termina- tion is almost inevitable. Meanwhile the patient suffers excruci- atingly, being little relieved by treatment. Treatment of Poisoning.—All that can be done is to combat symptoms, giving opium for pain, oil and demulcent drinks for the irritation, and stimulants to counteract respiratory and cardiac depression. Washing out the stomach or the use of emetics may be required. Tannic acid serves as a partial antidote, precipitating the colchicine. Therapeutics.—Externally and Locally.—Colchicum has no local therapeutic action. Internally.—Colchicum is the typical vegetable specific. Its SPECIFICS. 259 effects are in many ways analogous to those of mercury and iodine, even resulting in fatty degeneration of the liver, loss of hair, nails, teeth, etc. The drug is as valuable and certain a specific for gout as is mer- cury for syphilis. Gout in all its varied manifestations is relieved by this invaluable remedy. Diarrhea, dysentery, dyspepsia, bron- chitis, asthma, neuralgia, and eczema dependent upon a gouty condi- tion are singularly benefited by colchicum. This medicine, while quite efficacious in chronic rheumatism, and occasionally of some benefit in rheumatoid arthritis, is of no value in acute articular rheumatism. Its value is more apparent in acute than in chronic gout, and in the first attacks than in succeeding ones. Chronic gout, as well as chronic rheumatism, yields better to a combination of colchicum and potassium iodide than to colchicum alone. Some physicians recommend hypodermic injections of colchi- cine into the sheath of the nerve in sciatica. The author's quite limited use of this method has resulted in so much local irritation that he is prompted to caution the reader against the hypodermic employment of this drug. In combination with certain other agents colchicum serves an excellent purpose as a cholagogue, full doses being frequently very effective in relieving ascites due to obstructive diseases of the liver. Colchicum is sometimes employed as a drastic purgative in cerebral and portal congestion, although when given in doses suf- ficient for this purpose it occasions considerable nausea and abdom- inal distress. Colchicum has also been recommended in the treatment of gonorrhea and chordec. In doses of -fa grain (0.001 Gm.) colchicine has been suggested by Darier in certain inflammatory diseases of the eye. Hypochon- driasis resulting from renal insufficiency is frequently benefited by colchicum. Contraindications.—The drug would be contraindicated in acute inflammatory conditions of the gastro-intestinal tract. It should be cautiously administered to old people. Administration.—The liquid preparations are to be preferred, and, in order to secure the full curative effects of the drug, it is unnecessary to give it in doses sufficiently large to excite vomiting or purging. The initial dose, therefore, should be small, that it may occasion no gastric disturbance. 260 A TEXT-BOOK OF MATERIA MEDICA. The beneficial effects of colchicum may be enhanced by first emptying the intestinal canal by means of a saline cathartic. The preparations of colchicum vary greatly in strength. The crude drug contains different percentages of the alkaloid, accord- ing to the season of the year in which the plant is gathered, the colchicum root collected in July and August containing the largest percentage of colchicine. Owing to this variation in strength the assayed tincture or the alkaloid is recommended as the best prepa- ration to use, though, because of its activity and poisonous prop- erties, the alkaloid should be given in very small doses at first— not to exceed Tfg- of a grain (0.0005 Gm.) two or three times a day. Guaiaci Lignum—Guaiaci LIgrni—Guaiacum Wood. U. S. P. (Lignum Vitve.) Origin.—The heart-wood of Guaiacum officinale L. and of Guai- acum sanctum L., trees indigenous in the West Indies and on the northern coast of South America. The former is about 40 feet (12 M.) high, having evergreen pinnate leaves. Description and Properties.—The wood is heavier than water, hard, brown or greenish-brown, resinous, marked with irregular concentric circles surrounded by a yellowish alburnum; splitting unevenly, when heated emitting a balsamic odor; taste slightly acrid. It contains from 20 to 25 per cent, of resin, its most important constituent. Dose.—\-\ drachm (1.0-4.0 Gm.). Official Preparation. Guaiacum wood is contained in Decoctum Sarsaparillae Compositum, for which see Sarsaparilla. Guaiaci Resina—Guaiaci ResTnse—Guaiac. U. S. P. Origin.—The resin of the wood of Guaiacum officinale. Description and Properties.—Irregular masses or subglobular pieces, externally greenish-brown, internally of a glassy luster, and in recent guaiac usually reddish-brown, transparent in thin splinters, fusible, feebly aromatic, the odor becoming stronger upon heating; taste somewhat acrid; powder grayish, turning green on exposure to air. Soluble in potassium or sodium hydrate T. S. and in alco- SPECIFICS. 261 hoi, the alcoholic solution being colored blue by the addition of tincture of ferric chloride. The principal constituents of guaiac are—guaiaconic acid, guai- acic acid, guaiaretic acid, and a small amount of gum. These substances are insoluble in water, but soluble in alkalies. Dose.—5-30 grains (0.3-2.0 Gm.). Official Preparations. Pilulae Antimonii Comp6sitae—Pllulas (ace) Antimonii Compbsitas—Com- pound Pills of Antimony (Plummer's Pills).—Dose, 1 or 2 pills. Tinctura Guaiaci—Tincturae Guaiaci—Tincture of Guaiac.—Dose, 30-60 minims (2.0-4.0 Cc). Tinctura Guaiaci Ammoniata—Tincturae Guaiaci Ammoniatae—Ammoni- ated Tincture of Guaiac.—Dose, 30-60 minims (2.0-4.0 Cc). Unofficial Preparation. Emtilsum Guaiaci—Emtilsi Guaiaci—Guaiac Emulsion.—Dose, \-2 fluid- drachms (2.0-8.0 Cc). Antagonists and Incompatibles.—Spirit of nitrous ether and the mineral acids are incompatible with guaiac. Wrater is pharma- ceutically incompatible with the tinctures, precipitating the resin. Synergists.—Many of the diaphoretics and diuretics aid the action of guaiac. Colchicum, sarsaparilla, mezereum, stillingia, sassafras, sanguinaria, and xanthoxylum are also synergistic. Physiological Action.—Externally and Locally.—Guaiac is antiseptic, and possesses mildly astringent properties, being used locally as a gargle. Internally.—Digestive System.—It increases the flow of saliva and gastric juice, producing a sensation of warmth in the epigas- trium. It also augments the secretions from the intestinal canal, excessive doses even causing vomiting and purging. Circulatory System.—Guaiac increases the force and rapidity of the heart's action and dilates the cutaneous blood-vessels. Nervous System.—No special action has been observed. Respiratory System.—The drug is an expectorant, increasing the production and excretion of bronchial mucus. Absorption and Elimination.—Though a colloidal substance, it is absorbed into the blood with considerable facility, being excreted chiefly by the skin, exciting free diaphoresis. The bowels, kidneys, and bronchial mucous membrane assist in the excretory process. Temperature.—Under doses sufficient to cause free diaphoresis 262 A TEXT-BOOK OF MATERIA MEDICA. the temperature may be reduced. Guaiac has, however, no direct influence upon the heat-center. Uterus.—Large doses of guaiac induce contraction of the womb, the drug thus acting as an ecbolic Untoward Action.—No special symptoms are manifest other than the gastro-intestinal disturbance mentioned, and occasionally headache and giddiness. Poisoning.—Guaiac cannot be classed as a poisonous substance. Excessive doses act as a gastro-intestinal irritant, although no case of death is recorded resulting directly from this drug. Treatment of Poisoning.—This should be symptomatic, and similar to the treatment of poisoning from colchicum. Therapeutics.—Externally and Locally.—Guaiac in some form is an excellent application in follicular tonsillitis, rheumatic pharyn- gitis, and quinsy. For these cases the emulsion of guaiac serves as an efficient gargle, or the troches of guaiac may be used. Internally.—From the sixteenth to the eighteenth century guaiac was renowned as a cure for syphilis, having been introduced into Europe from San Domingo. The heroic manner, however, in which the drug was employed rendered the results more injurious than beneficial, so that the guaiac treatment was condemned, one of its most vigorous opponents being Paracelsus, to whom the reintroduction of mercury for the treatment of syphilis is largely due. Since we have learned to use mercury and iodine and its preparations intelligently the guaiac treatment of this disease pos- sesses only a historic interest. Nevertheless, the drug possesses properties which render it exceedingly valuable in chronic muscular rheumatism, neuralgic dysmenorrhea, and atonic amenorrhea. Guaiac is considered to be an efficient remedy in lumbago and chronic gout. Its most important service, however, in therapeutics is in the treatment of quinsy. It is doubtful whether there is any drug which will modify the course of this disease or abort an attack of tonsillitis so readily as this medicine. The tincture of guaiac is the preparation usually employed for this purpose, \ fluidrachm (2.0 Cc.) being given in the form of an emulsion every three or four hours. Contraindications.—There are no marked contraindications to its use. Administration.—The tinctures are very acrid and disagreeable to the taste, and should be given in the form of an emulsion. The emulsion of guaiac, a formula for which is given in the Dispensa- SPECIFICS. 263 tories, is not unpleasant, and is altogether the best liquid prepara- tion to give. The lozenges of guaiac, allowed to dissolve slowly in the mouth, serve as an agreeable and efficient method of medicating the throat with this drug. Sarsaparilla—Sarsaparillae—Sarsaparilla. U. S. P. Origin.—The root of Smilax officinalis Kunth and other species of Smilax growing in swampy forests in Mexico and as far south as the northern portion of Brazil. They are woody climbers, often attaining a great height. Description and Properties.—About l to l inch (3.17-6.35 Mm.) thick, very long, cylindrical, longitudinally wrinkled, exter- nally grayish- or orange-brown; internally showing a whitish and mealy or somewhat horny cortical layer surrounding a circular wood-zone enclosing a broad pith; nearly inodorous; taste muci- laginous, bitterish, and acrid. The thick, woody, knotty rhizome, if present, should be removed. Sarsaparilla contains an active principle, parillin, an acrid gluco- side which froths with water and otherwise closely resembles sapo- nin in its action. Dose.—30-60 grains (2.0-4.0 Gm.). Official Preparations. Decdctum Sarsaparillae Comp6situm—Dec6cti Sarsaparillae Comp&siti— Compound Decoction of Sarsaparilla.—Dose, 4-6 fluidounces (118.-178. Cc). 10 per cent., with Sassafras, Guaiac-wood, Glycyrrhiza, and Mezereum. Extractum Sarsaparillae Fluidum—Extracti Sarsaparillae Fluidi—Fluid Extract of Sarsaparilla.—Dose, \-2 fluidrachms (2.0-8.0 Cc). Extr3ctum Sarsaparillae Fluidum Comp6situm—Extracti Sarsaparillae Fluidi Comp6siti—Compound Fluid Extract of Sarsaparilla.—Dose, \-z fluid- ilrachms (2.0-S.0 Cc). Syrupus Sarsaparillae Comp6situs—Syrupi Sarsaparillae Comp6siti—Com- pound Syrup of Sarsaparilla.—Dose, 2-4 fluidrachms (8.0-16.0 Cc). A Fluid Extract, 20 per cent., with the Fluid Extracts of Glycyrrhiza and Senna, and the Oils of Sassafras, Anise, and Gaultheria. Antagonists and Incompatibles.—Alkalies and free iodine are incompatible with the official preparations of sarsaparilla. Corro- sive sublimate is said to be changed into calomel by the compound syrup of sarsaparilla. Synergists.—The specifics, diaphoretics, and diuretics. Physiological Action.—Sarsaparilla has no local influence. 264 A TEXT-BOOK OF MATERIA MEDICA. Internally its action is similar to that of guaiac, though not so energetic and irritant in large doses. Therapeutics.—As with guaiac, the history of sarsaparilla is full of interest. Introduced into Europe in the sixteenth century by the Spaniards, who had learned of its alleged virtues in consti- tutional syphilis in Peru, San Domingo, and Brazil, it retained its reputation as a specific in this disease for a century or more, when it was abandoned, only to be revived at the close of the eighteenth century. Since that time it has retained its place in medicine more through the wonderful virtues ascribed to it by nostrum-venders than to any real medicinal properties which it possesses. The consensus of competent opinion seems to be that sarsa- parilla can claim no special medicinal virtues other than its diuretic and diaphoretic properties. The compound decoction of sarsaparilla is probably the most useful official preparation, and appears to have been of some bene- fit in scrofula and strumous cutaneous affections. Indeed, some cases of constitutional syphilis have improved more rapidly under the administration of this preparation than when mercury or potas- sium iodide has been given alone. Contraindications.—There are none. Administration.—No special directions can be given for the administration of the various preparations. The compound syrup of sarsaparilla is quite pleasant to the taste, and is used extensively as a vehicle, particularly for potassium iodide. Stillingria—Stilling-iae—Stillingia. U. 8. P. (Queen's Root.) Origin.—The root of Stillingia sylvatica L., a perennial herb growing in dry and sandy soil in the Southern United States as far north as Eastern Virginia. Description and Properties.—About I foot (30 Cm.) long and nearly 2 inches (5 Cm.) thick, subcylindrical, slightly branched, compact, wrinkled, tough, grayish-brown, breaking with a fibrous fracture, showing a thick bark and porous wood, inner bark and medullary rays having numerous yellowish-brown resin-cells. The odor is peculiar and unpleasant; the taste bitter, acrid, and pungent. The fresh root probably contains an active principle not yet determined. (Old roots are nearly inert.) It contains an acrid SPECIFICS. 265 resin, sylvacrol, a volatile and a fixed oil, resin, starch, gum, and tannin. Dose.—15-30 grains (1.0-2.0 Gm.). Official Preparation. Extractum Stilllngiae Fluidum—Extracti Stilllngiae Fluidi—Fluid Extract of Stillingia.—Dose, \-i fluidrachm (1.0-4.0 Cc). Unofficial Preparations. DecOctum Stilllngiae—Dec6cti Stilllngiae—Decoction of Stillingia—Dose, 1-2 fluidounces (30-60 Cc). Extractum Stilllngiae Fluidum Compftsitum-Extracti Stilllngiae Fluidi Compdsiti—Compound Fluid Extract of Stillingia.— Dose, 1-2 fluidrachms (4.0- 8.0 Cc). Stillingia, 130; Corydalis, 130; Chimaphila, 60; Iris, 60; Sambucus, 60; Xanthoxylum Berries, 30; and Coriander, 30; to make 500 parts Fluid Extract with Dilute Alcohol. Syrupus Stilllngiae Comp6situs—Synipi Stilllngiae Comp6siti—Compound Syrup of Stillingia.—Dose, 1 fluidrachm to 1 ounce (4.0-30 Cc). Compound Fluid Extract, I, to Simple Syrup, 3 parts. Tinctura Stilllngiae—Tincturae Stilllngiae—Tincture of Stillingia.—Dose, \-\ fluidrachm (2.0 4.0 Cc). Antagonists and Incompatibles.—There are none affecting Stillingia. Synergists.—The same as for sarsaparilla. Physiological Action.—The action of stillingia resembles that of sarsaparilla, the drug increasing the various secretions and stim- ulating the heart and circulation. Therapeutics.—The medical uses are the same as those of sarsaparilla. Sanguinaria—Sanguinariae—Sangruinaria. U. S. P. ( Blood-root.) Origin.—The rhizome of Sanguinaria Canadensis L., a low perennial, a native of Canada and the United States, where it grows in open woods in a rich soil. The rhizome should be collected in autumn. Description and Properties.— Of horizontal growth, about 2 inches (5 Cm.) long and § inch (1 Cm.) thick, cylindrical, some- what branched, slightly annulate, wrinkled, reddish-brown; frac- ture short, somewhat wax}-, whitish, with numerous small red resin-cells, or of a nearly uniform, brownish-red color; bark thin; odor slight; taste persistently bitter and acrid. It contains a color- 266 A TEXT-BOOK OF MATERIA MEDICI. less alkaloid, sanguinarine, yielding red salts ; chelerythinc, yield- ing lemon-yellow salts ; homochelidonine ; and protopine. Dose.—2-20 grains (o.i 2-1.2 Gm.). Official Preparations. Extractum Sanguinariae Fluidum—Extracti Sanguinariae Fluidi—Fluid Extract of Sanguinaria.—Dose, 5-15 minims (0.3-1.0 Cc). Tinctura Sanguinariae (15 percent.)—Tincturae Sanguinariae—Tincture of Sanguinaria.—Dose, 10-60 minims (0.6-4.0 Cc). Unofficial Preparations. Acetum Sanguinariae—Aceti Sanguinariae—Vinegar of Sanguinaria.—Dose. 15-40 minims (1.0-2.5 C'c); as an emetic, 1-4 fluidrachms (4.0-16.0 Cc). Sanguinarine Nitrate.—Dose, T'2-| grain (0.005-0.008 Gm.). Antagonists and Incompatibles.—The irritation and circu- latory depression occasioned by blood-root are antagonized by opium, atropine, etc, while the incompatibles are tannic and gallic acids, alkalies, and metallic salts. Synergists.—The Specifics and the mineral and vegetable emetics aid the action of sanguinaria. Physiological Action.—Externally and Locally.—Sanguinaria is an irritant and a feeble escharotic. When the powder of blood- root is inhaled it produces great irritation of the respiratory pas- sages, with excessive secretion and violent sneezing. Internally.—Digestive System.—Medicinal doses occasion a sense of constriction in the throat and heat in the epigastrium, increasing the secretions from the stomach, liver, and intestines. Excessive doses are followed by marked salivation, nausea, and vomiting, the drug acting as a systemic emetic. Very large doses cause great irritation of the intestines, producing hypercatharsis. Circulatory System.—At first the heart's action is increased and arterial tension raised, but these effects are followed by cardiac and circulatory depression. Poisonous doses sometimes result in car- diac paralysis. Nervous System.—Large doses diminish reflex excitability by paralysis of the spinal centers, occasionally producing convulsions of spinal origin. Respiratory System.—Medicinal doses of sanguinaria have no apparent effect upon the respiration ; poisonous doses, however, render the breathing slow and shallow, death resulting from as- phyxia due to paralysis of the respiratory center. The final col- SPECIFICS. 267 lapse is often preceded by convulsions arising from the accumulation of carbon dioxide in the blood from failure of respiration. Blood-root is a stimulant expectorant, increasing the secretion from the broncho-pulmonary mucous membrane. Absorption and Elimination.—The drug is quite rapidly ab- sorbed, and is eliminated by the intestines, stomach, skin, kidneys, and bronchial mucous membrane. Temperature.—Medicinal doses have no effect upon, but exces- sive doses lower, the temperature. Eye.—Poisonous doses produce dilatation of the pupils. Uterus.—Sanguinaria possesses emmenagogue properties. Untozvard Action.—This does not differ from the poisonous action which follows. Poisoning.—Blood-root is an acro-narcotic poison, exciting sali- vation, violent vomiting, profuse watery evacuations from the bowels, and producing all the symptoms of gastro-enteritis. The muscular system is greatly relaxed, the pulse is slow, weak, and irregular, the skin covered with cold sweat, and finally collapse of the vital powers supervenes. Convulsions may precede a fatal termination, which is due to paralysis of the respiratory or cardiac center. Treatment of Poisoning.—The stomach should be washed out and diffusible stimulants freely given. Strychnine may be admin- istered hypodermically, and digitalis and amyl nitrite given if necessary. The pain and nausea may be relieved by morphine and atropine. The normal temperature of the body should be main- tained by external warmth. Therapeutics.—Externally and Locally.—The nitrate of san- guinarine—\ grain (0.015 Gm.) to 1 ounce (30 Cc.) of glycerin— has been recommended by Keyser in conjunctivitis granulosa. The powdered blood-root has been employed as a sternutatory, and when mixed with two or three times the amount of powdered acacia or starch it has proved beneficial, in the hands of some physicians, in the dry form of atrophic rhinitis. The pure powder is said to be an efficient escharotic to nasal polypi and fungoid con- ditions of the mucous membrane. Some authorities claim it to be an effective remedy for cancer, and consider it a valuable stimulant for indolent ulcers. The decoction of sanguinaria has been employed as a gargle in scarlatinal angina. This drug is now seldom used locally, the irritation caused by 268 A TEXT-BOOK' OF MATERIA MEDICA. it being so great that patients can only with great difficult}- be per- suaded to submit to the treatment. Internally.—While possessing alterative properties and classed among the Specifics, one of the principal uses of sanguinaria is in acute bronchitis, when the spasmodic element predominates and after the subsidence of the more acute symptoms. In atonic conditions of the stomach and bozvels, with increased secretion of mucus, small doses of tincture of sanguinaria prove beneficial. The tincture is of equal value in duodenal catarrh with jaundice. As an emmenagogue and aphrodisiac blood-root has been suc- cessfully employed in functional amenorrhea and dysmenorrhea, as well as in functional impotence with relaxation of the genital organs and daily seminal losses. Sanguinarine has been recommended in hysteria, either alone or associated with podophyllum. Protracted muscular rheumatism has apparently been benefited by this drug. Tincture of sanguinaria has served as an emetic in spasmodic laryngitis, though its depressing and irritating action renders san- guinaria much less desirable than certain other emetics. The drug is considered to possess marked alterative proper- ties, and is still frequently employed in the treatment of syphilitic and strumous affections of a chronic nature. It certainly appears to be a mild stimulant to the vegetative sys- tem of nerves, improving the circulation, nutrition, and secretion. Contraindications.—No special contraindication exists, unless it be an acute inflammatory condition of the stomach and bowels. Administration.—The nitrate of sanguinarine is the best prepa- ration to use in diseases of the respiratory tract. As a gargle the vinegar of sanguinaria is to be preferred, while, if the drug is to be employed as an emetic, the infusion, given in tablespoonful doses at short intervals, serves the best purpose. For other purposes the tincture is the most desirable preparation. The sanguinarine nitrate is best administered in pill form; the liquid preparations should be given well diluted with water. Mezereum—Mezerei—Mezereon.—r. S. P. Origin.—The bark of Daphne Mezereum L. and other species of Daphne, small shrubs about 2-4 feet (0.6-1.2 M.) high, indige- SPECIFICS. 269 nous in hilly and mountainous regions of Europe, extending to the Arctic Circle and eastward to Siberia. Description and Properties.—Long, thin bands, usually folded or rolled into disks, the outer surface yellowish or brownish-yellow, with transverse scars and minute blackish dots, underneath of a light greenish color; inner surface whitish, silky. Bast in trans- verse layers, very tough ; inodorous; taste very acrid. The im- portant constituent is an acrid resin, mczerin; it also contains a crystalline glucoside, daphnin. Dose.—1-5 grains (0.06-0.3 Gm.). Official Preparation. Extractum Mezerei Fluidum—Extracti Mezerei Fluidi—Fluid Extract of Mezereon.—Dose, 1-5 minims (0.06-0.3 <-c)- Mezereon is also one of the ingredi- ents in Decoctum Sarsaparillae Compositum, Extractum Sarsaparillae Fluidum Composi- tum, and Linimentum Sinapis Compositum. Antagonists and Incompatibles.—The glucoside is precipi- tated by tannic and free acids, and the resin by water, in which it is insoluble. Synergists.—All the vegetable specifics, with the exception of colchicum. Physiological Action.—Its action, both locally and internally, is quite similar to that of sanguinaria, but when applied to the skin it is more of a vesicant than an escharotic, and taken inter- nally it is more of a diuretic than sanguinaria, in poisonous doses causing severe urinary irritation and other symptoms produced by a violent gastro-intestinal irritant. The treatment of poisoning would be the same as that prescribed under poisoning by sanguin- aria. Therapeutics.—It is employed as a masticatory in paralysis of the tongue and the muscles of deglutition, and as a counter-irritant in the form of an ointment. Internally it is now seldom if ever used alone, but in combination with other vegetable specifics it is pre- scibed in chronic rheumatism and in chronic syphilitic and non- syphilitic cutaneous diseases. Contraindications.—Acute inflammation of the stomach, bow- els, and kidneys. Administration.—As it is never given internally alone, no spe- cial instructions for its administration are necessary. The fluid extract freely diluted with water would, however, be the only preparation to use. 270 A TEXT-BOOK OF MATERIA MEDICA. Xanthoxylum—Xanthoxyli—Xanthoxylum. U. s. p. (Prickly Ash.) Origin.—The bark of Xanthoxylum Amcricanum Miller and of Xanthoxylum Clava-Herculis L. Both species are native to North America, the first being shrubby and attaining a height of 10 or 12 feet (3-3.6 M.), while the second species is a small tree some- times 30 or 40 feet (9-12 M.) high. Description and Properties. — Xanthoxylum Amcricanum (Northern Prickly Ash) occurs in curved or quilled fragments about 2V inch (1 Mm.) thick; outer surface brownish-gray, with whitish patches and minute black dots, slightly furrowed, with some brown, glossy, straight, two-edged spines, linear at the base and about \ inch (6 Mm.) long; inner surface whitish, smooth; fracture short, non-fibrous, green in the outer and yellowish in the inner layer; inodorous; taste bitterish, very pungent. Xanthoxy- lum Clava-Herculis (Southern Prickly Ash) resembles the preced- ing, but is about y1^- inch (2 Mm.) thick, and is marked by many conical, corky projections, sometimes |- inch (2 Cm.) high, and by stout brown spines rising from a corky base. Xanthoxylum should not be confounded with the bark of Aralia spinosa L., which is nearly smooth externally, and beset with slender prickles in transverse rows. Prickly ash contains an acrid green oil, a colorless, crystalline resin, a bitter principle, sugar, ash, and tannic acid. Dose.—10-30 grains (0.6-2.0 Gm.). Official Preparation. Extractum Xanth6xyli Fluidum—Extr3cti Xanthftxyli Fluidi—Fluid Ex- tract of Xanthoxylum.—Dose, 10-30 minims (0.6-2.0 Cc). Physiological Action.—The action of xanthoxylum is quite similar to that of sanguinaria, though it is more of a stomachic tonic, sialagogue, diuretic, and diaphoretic, and not so much of a local irritant. It increases the heart's action and raises arterial tension. Therapeutics.—It is used locally as a masticatory for the same purposes as mezereon, and the decoction has been highly recom- mended as a gargle in chronic pharyngitis. Internally its medical uses are the same as those of stillingia, mezereon, etc., although of more value in atonic dyspepsia. SPECIFICS. 271 Contraindications and Administration are the same as for sanguinaria. Serum-therapy. Among the marvels of scientific research which have distin- guished our century no achievements are more remarkable, nor of greater moment to the welfare of mankind, than those pertain- ing to the field of biological, pathological, and therapeutic inves- tigation. Yet, brilliant as have hitherto been the triumphs of speculative thought and the deductions drawn from tireless ex- perimentation and practically applied to the curative art, the highest generalizations and most signal exhibitions of genius are perhaps related to the special phenomena revealed by the study of zymotic diseases. The limits of the present work preclude a detailed treat- ment of so extensive and complicated a subject; yet a brief sum- mary, elucidating the theory and development of serum-therapy as exemplified in contemporaneous research, should be of interest as well as benefit to the student of modern therapeutics. A glance at the history of therapeutic procedure in the prophy- lactic treatment of infectious diseases shows that the general prin- ciple underlying all later discoveries was, however crudely, divined at a much earlier period than we are wont to suppose. In view of actual attainment it is natural that the mind should revert to the transcendent services rendered to mankind by Jenner; yet it is known that the ancient Hindus and Persians, as well as the nomad tribes and caravans of Farther Asia, practised inoculation of equine virus, or horse-pox—the mammary pustule developed during early lactation in the horse, camel, and cow, and even in woman. The inoculation of human virus is of immemorial origin, proba- bly coeval with the importation of variola from Asia into Africa by the Saracens. Certain it is that as early as the tenth century the Arabs and Chinese adopted the custom of variolization, the inoc- ulation of small-pox, although the skeptical physicians of the age consigned the practice as a monopoly to women. In 1717, Lady Montague, wife of the British ambassador at Constantinople, saw an old Thessalian woman whose immunity so impressed her that she practised the operation upon her own child. Writing from Adrianople, she says: " They take the small-pox here for diversion ; I have tried it on my dear little son ; I am going to bring this useful invention into fashion in England." In 272 A TEXT-BOOK OF MATERIA MEDICA. 1718 her desire was realized, King George II. adopting the practice in the royal family. Three years later the custom was introduced in France, being accepted by Chirac and Helvetius, although the decrees of the Sorbonne and the Faculty of Medicine condemned the innovation as " illicite et contraire a la loi de Dieu ;" notwith- standing which official malediction the practice of inoculation con- tinued to spread until supplanted by vaccination proper in 1800. The French peasants knew in the last century that the act of milk- ing cows infected with mammary pustule, where there was any lesion of the epidermis on the hands, conferred immunity against small-pox; and the mountaineers have long been accustomed to collect the crusts resulting from vaccine disease, macerating them in water, and inoculating their children with the solution. The success attending these rude experiments in France was communicated by a Frenchman, Rabault, in 1768, to Dr. Pew, an English physician, who reported the matter to his friend Jenner, who at once perceived the momentous import of the discovery. Meanwhile, in 1771, a Holstein schoolmaster vaccinated three pupils; and in 1774 an English farmer, having observed the pro- tection existing among his dairymaids, and having implicit con- fidence in the efficacy derived from inoculation of bovine virus, vaccinated his wife. It was reserved for Jenner, however, in 1776, to commence the systematic and exhaustive study of the subject destined to prove inestimably beneficial to mankind. It was, in truth, the year celebrated for his declaration of scientific independence, which, after long contumely and scurrilous ridicule, was to wrest from his humiliated adversaries every weapon of derision and reproach. His early experiments were but a repetition of the empirical yet prophetic test of the English farmer; yet with his gifted insight and indomitable courage the field of discovery was greatly ampli- fied, the results being in accordance with scientific methods inspired by Jenner's originality and force. He found in the northern counties of England a certain form of ulcer upon the hands of those employed in dairies and immune against small-pox; observed that the malady resembled the pus- tules affecting the udder of the cow, having apparently been occa- sioned by contact; vaccinated an individual supposed to be un- protected against the disease, and subsequently exposed him to infection with triumphant impunity. A long interval of laborious investigation had led to this- final test, and it was not until 1798 SPECIFICS. 273 that Jenner published his first paper upon the subject, vaccination being transported to America in the following year. Such is the brief yet eloquent record of an achievement which experience has proved to be of incalculable benefit to man. To- day there is no question among the more enlightened members of the profession that the operation, properly performed, is an absolute safeguard against the infection of small-pox. Strange indeed is it that a century of comparative quiescence should have elapsed since Jenner pointed the way to the startling accomplishment of the present epoch. Yet not until Pasteur, in 1880, announced to the world the issue of his labors touching the protective inoculation of animals was the broken thread of patho- genic research taken up anew, and the task of solving its mysteries resumed—be it said with profounder acumen and far more com- plete appliances than ever before. It is a matter of record how the French savant demonstrated that cultures of the bacilli of chicken-cholera, when thoroughly dried and long exposed to the air, lost their virulence, and that fowls inoculated with the attenuated virus were rendered insensible to the attacks of more energetic micro-organisms. It was, mutatis mutandis, a modification or development of the Jennerian principle : " L'histoire de la vaccine constitue la premiere etape d'une longue serie de travaux, qu'ont inspires les admirables decouvertes revelees par le genie de Pasteur. Le principe en est toujours le meme: attenuer un virus, et l'injecter a l'animal qu'on veut immuniser" (Bernheim). Yet in the far-reaching possibilities suggested by Pasteur's experiments the present was immeasurably in advance of previous attainment. The further application of this discovery to other animal infec- tions confirmed by indisputable evidence the validity of the savant's theories and the efficacy of their practical illustration. A new- light was shed upon pathogenic study; all Europe felt the impulse given to scientific thought in its relation to therapeutic progress, and in the sanctum of the laboratory many a fervent recluse sought to amplify the knowledge already attained. A striking departure from Pasteur's method by Salmon and Smith, in 1886-87, led indirectly to the latest evolution of inocula- tive therapy. They showed conclusively that animals may be ren- dered immune against certain infectious diseases by inoculating them with filtered cultures containing the toxic products of patho- genic micro-organisms entirely free from the living bacteria to is 274 A TEXT-BOOK OF MATERIA MEDICA. which they owe their origin. By this process immunity against the bacillus of hog-cholera was attained in pigeons, the disease being almost invariably fatal to these birds. A little later (1888) Roux, employing similar sterilized cultures, succeeded in protect- ing susceptible animals against the anthrax bacillus; and more recently (1890) Behring and Kitasato have proved that immunity against the action of the tetanus bacillus may be conferred by the use of toxic products in solution freed from the presence of active germs—in a word, that purely chemical agents sufficed to attain the object hitherto deemed wholly dependent upon the influence of living bacteria. The significance of this discovery could hardly be over-estimated. By it the entire theory of causal phenomena—the protective force in which the immunizing property was supposed to reside—became modified. If not a living organism, but a chemi- cal substance, proved to be the immunizing agent, then resistance to toxic influences must proceed from some source other than bac- terial metabolism, some organic force inherent in the inoculated system. To ascertain the nature and operation of this bactericidal power and determine the rationale of acquired immunity now engaged the earnest attention of savants throughout the world. It was soon found that the lymph and blood of a normally healthy organism possessed in a degree this mysterious property of neutralizing the toxic effects of bacterial action, and gradually the truth which had thus far eluded the most searching investiga- tion was revealed. Finally, by a series of experiments involving the rarest skill and discrimination, the resistant energy developed by the infected organism was traced to certain albuminoids pertain- ing- to or dissolved in the blood-serum, the acute and comprehen- sive insight of Behring, especially, sustaining the new hypothesis, which speedily passed from the realm of conjecture to the assurance of experimental proof, culminating in the establishment of serum- therapy as a legitimate and auspicious field of therapeutic science. It should be observed that the remarkable discoveries of Koch in his chosen domain of bacteriology had exercised no little influence in guiding and confirming the wider researches of his successors. Before entering upon a consideration of practical details it should be stated that the theory and practice of serum-therapy are based upon the condition of the system, whether in man or the lower animals, which renders it inhibitive of bacterial development by opposing an effective barrier to the propagation of pathogenic germs. This self-protective antagonism pertaining to the indi- SPECIFICS. 275 vidual organism is termed immunity, and may be either natural or acquired. By natural immunity is understood the absence of all personal predisposition toward certain infections or diseases, even under the most favorable exposure. A familiar example of this inherent, congenital unsusceptibility is found in poisoning by Rhus {R. toxico- dendron, R. venenata), some persons handling the plants and even chewing the leaves with impunity, while upon others the mere proximity of the poison has a toxic effect. Acquired immunity may be either accidental or artificial. In the former case protection is secured by a previous access of the disease—as, for instance, a child recovered from scarlet fever, who is rarely prone to a second attack. In the latter case the suscept- ibility is obviated by protective inoculation, it being known, to illus- trate, that an animal inoculated by injections of anthrax-poison is, after recovery from transient symptoms of disease, rendered arti- ficially immune—a fact demonstrated by the thoroughly scientific experiments of Pasteur. An eminent authority, Schleich, has declared that natural or spontaneous immunity does not exist, but that the protective qual- ity is created by the animal kingdom—either through a previous malady or, as more frequently happens, through transmission from progenitors to offspring. Syphilis or tuberculosis in parents, he maintains, confers upon children immunity from these diseases; and the author cites in support of his theory that certain infections, such as plague and leprosy, have wholly disappeared from various countries because of the inoculation of succeeding generations and the consequent attenuation of the virus—exhaustion of the soil, as it were. Bernheim asserts that no animal is endowed with absolute immunity, but that, however strong may be the resistance of the particular organism, it must succumb to an excessive invasion of microbes or of toxic products. The doctrine of immunity has, not inaptly, been styled the theorem of which serum-therapy is the logical corollary; yet it is only within a few years that the mystery which shrouded the entire subject has been dispelled. To-day, thanks to untiring researches in the fields of physiology, biology, and chemistry, we are ac- quainted, if not with its precise nature and origin, at least with many details intimately associated with its causation. Formerly supposed to be absolute in its relation to species and individuals, we now recognize that immunity is but relative, considerations of 276 A TEXT-BOOK OF MATERIA MEDICA. climate, race, receptivity, character of pathogenic germs, and con- ditions of infection all entering as modifying factors into the devel- opment and exercise of this potent yet complex force. Chauveau has shown that Algerian sheep, relatively immune against anthrax, contract the disease under enormous hypodermic injections of culture ; on the other hand, a slight puncture of the aural epidermis is fatal to sheep in France, which, transported to Algeria, succumb to natural infection. Watson-Cheyne states that a single virulent bacillus may cause the death of a guinea-pig or induce septicemia in the mouse, provided these animals be pecu- liarly susceptible. Yet the guinea-pig is not affected by the injec- tion of a few bacilli from a septicemic mouse, while several thou- sands occasion only an abscess, although death ensues with higher dosage. Again, young white mice are quickly killed by the anthrax bacillus, while the same injection produces in the old only a local lesion. Cattle, though more amenable to infectious disease than sheep, are but slightly affected by hypodermic injections. Hogs are but slightly sensitive to anthrax, while the immunity of car- nivora is proverbial. Meat infected with anthrax is innocuous to the dog, the cat, and the fox. Again, anthrax has but little influence upon birds or fowls, especially chickens, yet it has proved fatal to sparrows and pigeons; and Pasteur overcame the immunity of chickens by plunging their feet in water, heat and cold, according to M. Roger, predisposing animals to infection, less by moderating bodily temperature than by disturbing the general economy and diminishing the power of resistance. As with anthrax, so in the case of glanders, peculiar to horses —the varying susceptibility to infectious diseases is apparent, bo- vine animals being wholly immune, and the hog, dog, singing- birds, and pigeons but slightly affected. In tuberculosis experimental injection of the same culture is followed by results widely diverse, certain animals being seized with acute phthisis, while others show marked resistance to the poison, although under excessive doses none is completely immune. In this connection it may be noted that clinical experience demon- strates the same pathological diversity in human beings. The goat, dog, ass, and sheep are rarely affected by tuberculous disease, yet all are susceptible to pathogenic inoculation. The monkey, seldom contracting the disease in his native haunts, becomes upon transportation remarkably prone to phthisical affections. With the SPECIFICS. 277 exception of the dog, most of the carnivora are easily influenced by tuberculous contagion. On the other hand, cold-blooded ani- mals are singularly immune, inoculation of toxic germs producing no development of the disease, though fatal results may occur from systemic intoxication. These examples, which might be multiplied indefinitely, suffice to show the relative character of natural immunity. It may be added that the caprice of toxic infection becomes even more appa- rent in studying the physiological and pathological conditions of the same organism when subject to the modifying influences of climate, altitude, seasons, heat, cold, traumatism, diet, ventilation, etc., and the subjective considerations of age, sex, race, fatigue, splenetic influence, nervous lesions, alcoholism, auto-intoxication, and acquired or hereditary diathesis. Indeed, the pathological records of disease abound in curious, often inexplicable, data touching individual and racial immunity. The subject is important in its bearing upon serum-therapy, and furnishes a theme of profit- able study in its relation to the practical treatment of infectious disease. With regard to the rationale of immunity, the theories advanced in explanation of this occult yet indubitable force are many, and often greatly at variance. Eliminating those which may be re- garded as too fantastic for serious consideration, the more plausible conjectures refer the phenomena in question to cellular, humoral, hunwro-ccllular, and vaso-motor agencies. Prominent among competent opinions is the doctrine of phago- cytosis proposed by Metschnikoff In 1883 Metschnikoff established the existence of an intracellular digestion, showing that nomad cells were capable of absorbing vege- table filaments; that mesodermic protoplasm possessed the same power over bacteria ; and that in the higher animals this phagocytic function had its analogue in the digestive property of leucocytes, or white blood-corpuscles. Gliige observed that in hemorrhage of the nervous centers these corpuscles digest the disintegrated myelin, and in a fresh-water crustacean, daphne, they have been seen to gather about the spores of algae, penetrating the meso- derm. Metschnikoff multiplied these examples of cellular defence among invertebrates, distinguishing two sorts of leucocytes: the stationary (macrophages) and the mobile (microphages), the latter including the white globules of lymph, and especially of blood, of 278 A TEXT-BOOK OF MATERIA MEDICA. which, together, they constitute about 20 per cent. It may be said that all organs contain elements of defence—macrophages. The experiments of Gabritschevsky, who has studied phagocy- tosis in diphtheria, are highly instructive. Injecting a pure culture of Loeffler's bacillus into the anterior chamber of a rabbit's eve, he saw the devastation wrought among the leucocytes, which appeared powerless to contend against the deadly germs. But after immu- nizing the rabbit with attenuated cultures previous to the injection of toxic bacilli, a battle-royal ensued, the phagocytic action of the leucocytes resulting in the signal triumph of the latter, so that at the end of eight hours not a single free bacillus was found in the chamber, all having been absorbed within the opposing globules. Yet, notwithstanding the plausibility of Metschnikoff's hypothe- sis and the striking significance of his experiments—embracing in epitome the whole theory of preventive inoculation—certain argu- ments of Behring and Kitasato, based upon experimental research, go far to disprove the validity of the doctrine he so zealously maintained. Still, although the substances which form the defen- sive property of phagocytes, and are so fatal to the pathogenic action of microbes, remain unknown to us, the fact of phagocyto- sis cannot be denied. It was natural in the light of new developments that investiga- tion should inquire whether the leucocytes constituted the only protective force within the organism. Then followed the theory that the humors in general possess microbicidal power—either through the presence of destructive elements and the secretion of soluble toxins or through the humoral capacity of withdrawing oxygen from the invading micro-organisms. To Buchner is chiefly due the early elucidation of the humoral theory, and of first recog- nizing in serum bactericidal properties, he being followed by Behring, to whom is to be credited the more important labor of extending experimentation and proving that animals naturally immune against a certain disease may furnish serum endued with neutralizing power. Behring found that the blood and blood-serum of the rat, which is naturally immune against anthrax, possesses strong bactericidal properties, while those of mice, cattle, etc., very susceptible to anthrax infection, have none. Further research resulted in Behring's all-important law, es- tablished by searching experiment, that "the blood and blood- serum of an individual which has been rendered artificially immune against a certain infectious disease may be transferred into another SPECIFICS. 2yg individual, with the effect of rendering the latter also immune, no matter how susceptible this animal is to the disease in question." This formulated doctrine became the fundamental motive in all future investigations, the culminating achievement of inoculative therapy being the announcement of Behring and Kitasato in 1890 concerning the artificial immunity against tetanus and diphtheria conferred by blood-serum, including the first emphatic declaration that the power of rabbits and mice when rendered immune to re- sist tetanus-poisoning " is based upon the ability of blood-serum to neutralize the toxins produced by the tetanus bacilli." As Krieger well observes: " These toxins are the poisonous products of bac- terial metabolism, and are the causes of acute disease when circu- lating in the organism. Their effect is an intoxication of the system, while after the introduction of virulent germs the cause of the dis- ease is an infection!' The moment had now arrived for applying the therapeutic test of serum to man. In every instance the validity of Behring's law was sustained, and, moreover, the invaluable discovery was made that the serum of individuals naturally immune against a certain disease possesses no immunizing properties for other individuals. This militated partly against previous theories, and proved conclu- sively that the protective agent is not a substance produced by nature in naturally immune animals, but the result of " an organic chemism " called into activity only by introduction of the corre- sponding poison or toxin. In diphtheria and similar infectious diseases, as in tetanus, the bacillus produces toxins, the effects of which can be neutralized only by the properly prepared antitoxin. It was even shown by Ehrlich.that the law applied to intoxication by certain purely chemical poisons, such as ricin and abrin, injections of gradually increased doses of serum affording complete immunity. A third theory in regard to the causes of immunity, the humoro- cellular, seeks to combine phagocytic and humoral agencies, on the ground that neither separately suffices to account for the phenom- ena observed. Such is the theory of alexins of Buchner—certain albuminoid substances in the blood which release the leucocytes at the point of infection, the bactericidal property being active rather than passive, as previously supposed. Although defended by able advocates, Hankin and others, the fallacy of certain prem- ises, as shown by Metchnikoff, served to invalidate the doctrine, while several eminent authorities have disproved the facts upon 280 A TEXT-BOOK OF MATERIA MEDICA. which the original hypothesis was founded. Nevertheless, so high an authority as Bernheim may be cited in its favor. Lastly, the vaso-motor theory of Bouchard and others asserts the claims of physiology in determining the causes of immunity. Admitting the fact of phagocytosis, they contend that the emigration of leucocytes from the vessels occurs only through the action of the vaso-motor centers, whether by exciting the dilator or paralyz- ing the constrictor muscles. From these varying opinions it is as yet difficult to form a rational conclusion entirely in accord with physiological phenom- ena. In this connection the remarks of Bernheim may be cited as those of a highly competent authority. He says, while inclining to the humoro-cellular hypothesis, " Be it as it may, we can safely aver that relative immunity exists among the majority of animals. Against certain diseases this immunity may even be absolute. Thus rats, mice, and dogs are naturally immune against the mini- mum mortal dose of the Loeffler bacillus; yet the serum from these animals when injected into other individuals is powerless to prevent infection—a point having an important bearing upon serum-therapy. Moreover, we know that man is frequently ex- posed to contagion without contracting a taint of infectious dis- ease. I myself, under the most unfavorable conditions occasioned by fatigue, have passed through epidemics of typhoid fever, cholera, and malignant influenza {la grippe) without the slightest contamination, and other practitioners have had a similar ex- perience. Meanwhile, it were folly to imitate those courageous experimenters who, wishing to prove their immunity against cer- tain diseases, have absorbed their pathogenic germs, not infre- quently with fatal results.....As many conditions tend to diminish the power of resistance in the human organism, so others fortify the system against the inroads of infection. Obedience to sound hygienic principles, a regulated and nutritious diet, and a healthy parentage render the individual capable of withstanding microbic influences which constantly assail him, his natural immu- nity being greatly reinforced by these favorable circumstances." Obscure as is the precise nature of the immunizing property possessed by serum, there is no question as to its marvellous potency. Behring and Kitasato showed that it was sufficient to mingle very small quantities of serum from an immunized subject with virulent toxins to inoculate with impunity animals sensible to infinitesimal amounts of pure toxins. In experiments made by SPECIFICS. 281 MM. Roux and Vaillard the resistant force of antitoxin passes imagination. During their researches concerning tetanus bacilli they employed cultures which, when filtered, killed guinea-pigs in doses of 0.005 c-cm-; yet one cubic centimeter of equine serum served to neutralize thirty times its volume of toxin, so that by the addition of o.OOOi ccm. of serum it was possible to neutralize completely the action of a mortal dose. In order to render a mouse immune the requisite quantity of antitoxin is so infinitesimal as scarely to be computed. In fact, serum is obtainable possessing an activity of one-millionth, the immunizing unit being the quan- tity necessary to protect one gram of a mouse's weight; that is, one cubic centimeter of serum suffices to confer immunity against fatal dosage in 1000 kilograms of mice, or 70,000 of these ani- mals, each weighing about 15 grams. It will readily be understood that the discovery of so protective a force soon awakened therapeutic hopes which, if not completely realized in tetanus—largely by reason of the difficulties attending any treatment of so fatal a disease—have, on the other hand, in the case of diphtheria, been even more happily fulfilled than was anticipated. It is to be regretted, en passant, that in the use of the term antitoxin needless ambiguity should have arisen in the public mind, a fancied identity between the antitoxic and prophylactic power of serum being widely diffused. The association of the term with the preventive property of the immunizing agent—antitetanic, antidiphtheritic—has contributed not a little to this confusion of characteristic properties. In reality, nothing could be more erro- neous than to suppose coequal activities in the two forces, the pre- ventive property of serum being far more general than its antitoxin influence—as yet scarcely proven save in tetanus and diphtheria. In hog-cholera, typhoid fever, pneumonia, aviaiy septicemia, and cholera careful researches abundantly demonstrate that the serum of animals rendered immune against these diseases, while protect- ing the alien organism from microbic infection, has no power over bacterial products, or toxins. That the immunity is conferred apart from this latter agency is evidence that the protection is due to causes other than direct bactericidal action. It is because the present terminology is defective—antitoxin failing to denote the salient property of serum—that the more descriptive expression stimulinc has been suggested on high author- ity as a substitute. It may be observed, moreover, that a still fur- 282 A TEXT-BOOK OF MATERIA MEDICA. ther confusion prevails in giving the name antitoxin to the substance injected as well as to the defensive proteids formed by its action upon the organism—an ambiguity which the use of the term " stimuline " would obviate. In considering the prophylactic effect of antitoxin, so intimately allied to serum-therapy, it may be well to emphasize the distinction between vaccination as founded by Jenner and the new method. It was formerly sought to create immunity by inoculating the individual with the pathogenic micro-organism itself—the virulent germs of disease. To-day protection is found in the injection of soluble products secreted by the micro-organism, administered in progressive doses, or, as by the latest process, in the inoculation of serum taken from an animal previously rendered immune. Herein lies the essential difference between vaccination and immu- nization—a distinction too often ignored. Vaccination can at most but prevent infection ; immunization is curative. The vaccinal sub- stance possesses no power over the actual microbes and their products: the immunizing agent is endowed with the remarkable property of neutralizing the influence of pathogenic germs or of determining their destruction. Vaccination produces in the indi- vidual inoculated deterrent forces which serve to arrest bacterial development: in immunization the obstructive agents injected are prepared, as in the laboratory, by a separate organism. In this latter medium we have a true therapeutic remedy. If we seek to draw the line of demarcation between the two methods more closely, we recognize that the modern doctrine of immunity rests upon wholly new and original researches quite distinct from those formerly pursued. Doubtless the immunizing property of serum was divined by those who adopted free vene- section in cachectic patients, abstracting the vitiated blood and replacing it with venous injection of that supplied by a healthy organism. A certain antagonism had also been observed between infectious maladies mutually opposed in their development, one of which was prone to exert a curative action upon the other. Fehleisen in 1880 cited the phenomenal case of a woman afflicted with cancer of the breast, which after three successive operations still redeveloped rapidly. Finally erysipelas affected the cicatricial wound of the amputated breast, the new malady proving beneficial to the patient, since carcinoma was not renewed. From this and similar data Emmerich inferred that it sufficed to inject the serum of animals immunized with the streptococcus of Fehleisen to treat SPECIFICS. 283 and cure (?) cancerous subjects, the toxins of streptococcus erysipe- latis preventing carcinomatous development. Having purposely dwelt at some length upon the evolution and general properties of serum-therapy, let us turn to the actual achievement of the method in its therapeutic relations to infectious disease. In view of well-authenticated and obvious records attest- ing the efficacy of the new treatment, the charge "not proven" cannot properly be sustained. Yet the observation of Achalme, that it is well to accept new theories salis cum grano, is not inap- plicable ; and the wise admonition of Bacon in regard to books, that we should read " not to accept nor refute, but to weigh and consider," is equally apposite in estimating the value of scientific discoveries, however distinguished may be their claim to recog- nition. Tetanus.—The first proof that tetanus is an infectious disease, of bacillary origin, was furnished by Carle and Rattone, who in 1884 reproduced the symptoms in a rabbit by inoculation of pus taken from a human tetanus wound. The bacilli were found in the adjacent soil, but it was not until 1889 that Kitasato succeeded in isolating pure cultures, proving conclusively the microbic nature of the disease. The earliest case treated with antitoxin was reported in 1891 by a Bolognese physician, Dr. Gagliardi, the result being highly satisfactory. In the light of subsequent experiments it is of ab- sorbing interest. The patient, a man forty-five years of age, accidentally received a wound of the left foot while crossing a rice-field. Next day (May 12, 1891), the foot having swollen considerably, he consulted Dr. Gagliardi, who made an incision and applied antiseptics. May 19th the wound was healed, but four days later symptoms of trismus appeared, becoming acute May 24th. Injections of 5 per cent, carbolic acid in the vicinity of the wound produced no effect, and on June 3d opisthotonos and aggravated symptoms were manifested. The doctor now injected 0.25 ccm. of Tizzoni's antitoxin, obtained from a strongly immunized dog, the treatment being followed by some im- provement. June 7th, relapse and tetanic spasms having super- vened, two more injections were administered, and the following day the patient gradually convalesced, being discharged as cured Jul}- 5th. The quantity of antitoxin sufficient to neutralize the tetanus-poison was less than 1 ccm. In 1891-92 four other cases were treated with like favorable results, injections of 0.25 ccm. 284 A TEXT-BOOK OF MATERIA MEDICA. twice a day, from two to six doses in all, being attended with com- plete recovery. When it is taken into consideration that the most authentic statistics of tetanus show a mortalit}- of about 88 per cent, and that by the above procedure it was reduced to 20 per cent., it is small wonder that the issue in these cases should be regarded as simply marvellous. And yet we have, after devious wanderings, reached but the threshold of the new science. In December, 1890, Behring and Kitasato demonstrated that the serum of animals rendered immune against tetanus by the injection of iodine trichloride in the blood was capable of neutral- izing tetanic poison, whether in the laboratory or in other animals, the property not being possessed by organisms not inoculated. Not only did they succeed in preventing infection, but they recog- nized in the serum a curative power, as shown in the inoculation and cure of mice. At the same time it was observed by Vaillard that the immunity conferred by the serum was of short duration, lasting only fifteen days. Kitasato's preventive injection—a mixture of living culture and gradually decreasing doses of iodine trichloride—was perfected by -Behring, who successfully applied it to the mouse, rabbit, sheep, and horse. Various results of experimental research ensued, elicit- ing among other interesting phenomena the fact that removal of the spleen renders immunization impossible. In 1891, Vaillard showed that the serum of animals naturally immune is not anti- toxic, becoming so only after a powerful dose of tetanic poison, and that the spleen and the fluids of immunized subjects are devoid of antitoxic properties. One point in the doctrine advanced by Behring and Kitasato awakened the liveliest discussion: whether it was possible to cure disease by the serum of inoculated individuals. Tizzoni and Cat- tani had failed to attain this result, and had, moreover, recognized that the condition of immunity was transient. On the other hand, Behring had claimed the cure of tetanus in the sheep and horse, and Kitasato had obtained results equally positive in the case of mice. All doubt on this head was dissipated by Ehrlich in 1891, who proved by experiments with ricin and abrin that the antitoxic and immunizing property of serum varies greatly with the degree of immunity conferred. In seeking a favorable issue it was evident that in cases of failure the inoculation had fallen short of the degree requisite to render the serum curative. SPECIFICS. 285 It should be added that in subsequent treatment Tizzoni, Cat- tani, and Vaillard met with perfect success in effecting cures. Thus far, the employment of serum as a curative agent had been confined to experiments upon animals. The results obtained urged its application to human tetanus. The first attempt was made by Kitasato in 1891, the serum being taken from a rabbit. It was unsuccessful, the dose of serum employed being too feeble to cope with the gravity of the conditions presented. In 1892, Tizzoni and Cattani and others reported 8 cures with serum from immunized dogs. It was contended, however, that a comparatively mild form of the disease was treated. In France the results of similar treatment in 1892 were wholly unfavorable, but in 1893 the cure of a peculiarly aggravated case was authentically announced, amelioration of symptoms having occurred in three, and complete restoration in twenty, days. The injection was subcutaneous in the abdominal region, 300 ccm. of equine serum from an immun- ized animal being given. The injections are said to be in them- selves harmless. Finally, MM. Roux and Vaillard formulated the mode of prep- aration of antitetanic serum, together with an analysis of its prop- erties and its curative application in man and the lower animals. It may reasonably be expected that future experiments with the antitoxin of tetanus, made with greater precision and untiring patience, will produce more favorable results. It is of primary importance to consider, first, whether sufficient amounts of immunizing serum are injected to combat the condi- tions of this most difficult disease, and, second, whether the doses are renewed often enough to arrest its progress or ensure immunity. These desiderata are sufficiently obvious, especially in view of the certainty that the antitoxin is wholly innocuous. Diphtheria.—It is in the treatment of this universal and terrible disease that serum-therapy has achieved its most signal triumphs, the marvels wrought by its influence attracting more and more the attention both of the medical profession and of the laity. The micro-organism of the malady was described by Klebs in 1883, his investigations being quickly followed by those of Loeffler, who confirmed Klebs' discovery and announced that it was possible not only to isolate, but also to produce, cultures of the microbe. Roux and Yersin, as well as other savants, have established the fact that the germ is found only in the false membrane—especially its surface—and in the saliva or contiguous mucous membrane, 286 A TEXT-BOOK OF MATERIA MEDICA. never developing in the circulating fluid either of the lymph or any other portion of the organism. The bacillus frequenting the false membrane is rarely unaccom- panied, but is found associated with other micro-organisms which exert great influence upon the progress of the disease. It propa- gates rapidly upon solidified serum, bouillon, and gelatin, though not on potato, preserving its virulence for several months. In direct contact with light and air it perishes within a few weeks. The false membrane is artificially formed by painting with pure culture the buccal ulcers of the mucous membrane in rabbits, dogs, guinea-pigs, and chickens, the symptoms produced being those of human diphtheria, and frequently fatal. The researches of Loeffler indicate that no direct action is attributable to the bacillus, the sys- temic effects of the poison being rather those of a general intoxi- cation of unknown nature—an opinion sustained by the researches of Roux and Yersin. The microbe may be ejected by the mouth together with the false membrane, but oftener it remains in an iso- lated state ensconced in buccal and nasal cavities, perhaps for sev- eral days or even weeks. Although the discovery of the pathogenic micro-organism of diphtheria is of quite recent date, no time has been lost in seeking to determine the means of conferring immunity against the disease. To Behring (1889) is due the credit of having first indicated the method of immunization in the disease, as well as in tetanus, his investigations leading him to affirm that the process of conferring immunity by the soluble products of Loeffler's bacillus derived from immunized animals, combined with a solution of iodine tri- chloride, is positively innocuous and curative in diphtheria. Little progress was made by the experiments of earlier investi- gators, but, in 1891, Aronson succeeded in immunizing rabbits against diphtheria by inoculation with cultures attenuated by the vapor of formaldehyde. The serum obtained possessed great im- munizing power, a single cubic centimeter sufficing to inoculate 4 kilograms of animal weight against the minimum mortal dose of virulent cultures. Subsequently, Aronson applied this therapeutic method to numerous children affected with diphtheria, and affirmed with Behr- ing that serum-therapy was inoffensive and a sovereign remedy in a large number of cases. He obtained the serum from dogs and sheep, but declared that large animals were preferable, especially the horse. SPECIFICS. 287 In order to formulate the dosage, Behring established a techni- cal scale in which one cubic centimeter of prepared serum is consid- ered a unit, the antitoxin supplied being of the strength of 60, 150, or 500 units according to the degree of immunity of the animal from which it is derived. The value of serum depends, he affirms, upon the difference between the original condition of, and the re- fractory state attained by, the animal under immunization. Notwithstanding the significance attaching to experiments hith- erto recorded, the thereapeutic application of serum-therapy to diphtheria may be said to date from the communication of Roux to the Congress of Buda-Pesth (September, 1894). From this moment clinical observations multiplied and statistics were reported from all parts of the world. In this memorable address the author ably reviewed the entire subject of serum-therapy, stating the relations of serum to the general economy and offering advanced and cogent suggestions concerning the employment of antitoxins to arrest the ravages of infectious disease. The early failures to cure tetanus were explained by the fact that the symptoms of the disease are frequently not manifested until it is too late to stay its progress. On the other hand, in diphtheria the evident appearance of the characteristic false membrane rendered it possible to treat the malady from its inception. The most approved, though complicated, methods of preparing the toxin were minutely described—either through the medium of bouillon as a host in contact with dry air, or a similar process in a current of moist air—and explicit instructions given regarding the attenuation of the poison by means of iodine, and the modus operandi of administration in gradually intensified doses. " With regard to diphtheria associated with certain microbes," said M. Roux, " especially streptococcus, the results of sero- therapy have been far from satisfactory. I have often saved rab- bits treated six or eight hours after tracheal infection, although repeated injections of therapeutic serum were necessary: when treatment has been deferred twelve hours, the animals have inva- riably succumbed. " The efficacy of antidiphtheritic serum having been established experimentally, its application to the human malady was a natural consequence. All my experience occurred at the Hospital for Sick Children in conjunction with MM. Martin and Chaillou. From the 1st of February to the 24th of July, 1894, 448 children were ad- mitted to the diphtheritic ward, of whom 109 died—a mortality of 288 A TEXT-BOOK OF MA TERIA MEDICA. 24.33 Per cent- ^o\v, the average mortality from 1890 to 1895 was 51.71 per cent, in a total of 3971 children. The advantage of serum-therapy, all conditions being equal, is 27.28 per cent, greater than under the former treatment. " Such are the gross statistics. It is necessary, however, to deduct from the foregoing 448 patients treated with serum 12S who, as the bacterial examination showed, were not affected with true diphtheria of the Klebs-Loeffler bacillus type, besides 20 desperate cases amenable to no possible treatment. The net statement, therefore, is 300 cases with 78 deaths—a mortality of 26 per cent., whereas a previous report, similarly computed, recorded a mortality of 50 per cent." M. Roux is quoted at length because his views are authoritative, embodying the most careful researches connected with serum- therapy in its application to diphtheria. With regard to the relative proportion of deaths, it is instructive to compare with his figures those of more recent investigators and medical practitioners. At an international Congress held in Munich in April, 1895, the merits of serum-therapy in diphtheria formed the subject of an interesting debate, eliciting reports from the most competent Continental authorities in which the efficacy of the new treatment was strikingly demonstrated. Dr. O. Heubner of the University of Berlin, comparing the statistics of the Berlin hospitals during 1894, stated that the mor- tality since the introduction of serum-therapy had been reduced to one-half of that recorded prior to that date, about 1500 cases being included in each period. Allowing for the condition of medium virulence which marked the disease, Prof. Heubner believed that this factor alone could not account for the great difference in the mortality. Up to the present time, he said, reliable information of over 3000 cases had been obtained from all parts of the world in which the disease was treated with antitoxin serum. The average of cures was 80 per cent. Referring to clinical analysis of 300 cases of diphtheria coming under his own supervision, he declared that the disease could be diagnosed only by identification of the diphtheria bacilli. Of 207 cases so diagnosed and treated in the Berlin Charite, the mortality in simple attacks was 10 per cent., and in more complicated ones 13 per cent. From personal expe- rience the speaker regarded, as the specific results of serum-treat- ment, the improvement in the febrile symptoms and the quickened cleansing of the air-passages—facts first noted since the introduc- SPECIFICS. 289 tion of serum-therapy, and confirmed wherever the method was adopted. Prof. A. Baginsky of Berlin said that prior to the introduction of the treatment with serum the more difficult and sorrowful por- tion of his life had been spent in combating the disease, against which he felt absolutely helpless, the mortality for the past four years, in spite of every effort, having been 50, 33, 36, and 42 per cent, respectively. The deaths occurring under treatment of 525 cases with Dr. Aronson's preparation had been 15 per cent. Prof, von Widerhofer of Vienna stated that in 300 cases of diphtheria coming under his cognizance the average mortality was 23.7 per cent. Excluding those that died within twenty-four hours, the disease having reached a very advanced stage previous to treatment, the mortality falls to 14.3 per cent. Prof, von Ranke of Munich reported that of 124 cases treated in the six months previous, 26 children, or 22.4 per cent., died, 102 cases presenting features of uncomplicated diphtheria. Compared with the mortality during the preceding eight years, the reduction was enormous, being less than half the minimum record for any year during that period. Prof, von Mehring reported on 74 cases, all treated with serum on the first or second day, of which only 4 died, giving a mortality of 5 per cent. During the preceding five years 30 per cent, of his diphtheria patients had died. Prof, von Noorden gave the results of his experience in 81 cases treated at the Frankfort Hospital. Most of them, unfortunately, were admitted at a late stage of the disease, generally on the third or fourth day, the severest symptoms being developed. Notwith- standing this obstacle, in place of the previous mortality of 45 per cent., only 23 per cent, was recorded. Dr. G. Seiz of Constance stated that of 27 cases treated with serum he lost only 1, or 3.3 per cent. Prof. Sigel, in charge of the Olga Hospital at Stuttgart, reported that the general mortality for the five years previous to 1894 was 40.1 per cent., and 60 per cent, among those upon whom trache- otomy was performed in the first nine months of 1894—in fact, up to the da}' on which the antitoxin treatment was commenced—the mortality rising to 50.3 and 70 per cent, respectively. During the three months of serum treatment in 1894 there was an astonishing decrease in the number of deaths, the mortality falling to 12 per cent, in general and 20.3 per cent, in tracheotomy cases. 19 290 A TEXT-BOOK OF MA TERIA MEDICA. The reports, emanating from authorities of the highest standing, were of themselves conclusive testimony in favor of serum-therapy in diphtheria as immensely superior to former methods of treatment. An interesting resume of statistics, compiled from the library of the Royal College of Surgeons, England, by Dr. G. C. Crandall of St. Louis, Mo., emphasizes in comprehensive figures the explicit advance made within a few years in the scientific control of the dis- ease. The following table embodies the results of Dr. Crandall's timely study of the subject: Authorities. Locality. Vieronit...........Heidelberg Gano-hofner.........i Prague . Viederhofer......... Kossel.......... Baginsky (quoted by Virchow) . Sonnenburg ......... Aronson.....,..... Ranke............ Soltmann.......... Risel............ Roux, Martin, and Chaillou . . . Lebreton........... Moizard........... Washbourn, Goodall, Card, and others........... White............New York . Withington..........I Boston ■ . . Total number of cases........... Average mortality, per cent......... Previous average mortality, per cent...... Collective report of other observers in different countries................ Vienna Berlin . Berlin . Berlin . Berlin . Munich Leipsic Halle . Paris . Paris . Paris London Cases treated with serum. 55 no ioo 35o 303 107 [90 85 122 114 300 258 231 Mortality in percent. 195 32 80 2632 14.6 I2.7 25'3 it).7 13-2 20.6 14.0 18.8 18.0 8.0 26.0 12.0 14.7 18.6 25.0 16.0 Previous mortality in per cent. 58.0 50.O 42.8 34-7 47.8 27.6 37-o 48.5 5i-7 50.0 3ii 42.7 _45j£_ 42.0 4022 17.1 The official report from the Imperial German Health Depart- ment up to June 20, 1895, records 2228 cases, with a percentage of mortality of 17.3; and further German statistics (August 10, 1895) include 10,240 cases in hospitals and private practice, 5790 of which were treated with antitoxin serum, the number of deaths being 552—a mortality of 9.5 per cent. Prof. Eulenburg, the author of this report, reiterated the import- ance of early recourse to antitoxin, stating that when used within the first forty-eight hours the mortality was only 4.2 per cent.: delayed beyond this period, the percentage was increased to 16.8. In America the merits of serum-therapy have been amply attested by reports from various sections of the country, one of SPECIFICS. 291 the most recent and instructive being that of the resident physi- cian of the South Department of the Boston City Hospital, as follows: "In the Boston City Hospital, from Feb. 1, 1894, to Jan. 31, 1895, before antitoxin was used, 698 cases of diphtheria were treated, with 266 deaths—a mortality of 38.1 per cent. Since the opening of the South Department, from Sept. 1 to Nov. 30, 1895, inclusive, when antitoxin was used in every case, 332 cases were treated, with 41 deaths—a percentage of 12.3. Of these 41 deaths, 23 occurred within twenty-four hours of entrance. Eliminating these, there were 309 cases with 18 deaths—a mortality of 5.8 per cent." Finally, the statement of Prof. Welch of Johns Hopkins Uni- versity, published in July and August, 1895, contains statistics of 7166 cases of diphtheria treated with antitoxin, in which the mor- tality was 17.0 per cent., and 2276 cases treated otherwise with a death-rate of 42 per cent. The foregoing figures, selected from a mass of corroborative testimony, must certainly be regarded as an eloquent tribute to the virtues of serum-therapy. They are at least a striking illustration of what Virchow has called the " brute force " of the numerical argument. Touching the method of administration and collateral manifes- tations, Roux, in the communication previously cited, says : " The serum I have employed, derived from immunized horses, had an active strength of 50,000 to 100,000. To all diphtheritic patients entering the hospital 20 cubic centimeters of this serum, in a single dose, are systematically administered, the injection being in the subcutaneous tissue, and not renewed should bacteriological examination prove that the disease was other than diphtheria. Should the existence of the disease be fully established, I have never observed the slightest discomfort resulting from the dose. " The injection is painless, and if made antiseptically should be attended with no accident. Twenty-four hours after the first injec- tion a second is made of 10 or 20 cubic centimeters, these two inoculations sufficing, as a rule, to ensure recovery. " Should the temperature continue high, a third injection of 10 or 20 cubic centimeters is given. The average weight of chil- dren being 14 kilograms, the total dose constitutes one-thou- sandth, or in exceptional cases one-hundredth, part of their weight. Untoward sequelae are less frequent under the use of serum, A TEXT-BOOK OF MATERIA MEDICA. although I have observed symptoms of paralysis. Eruptions, also, allied to urticaria may be occasioned by the antitoxin. " The physiological effect of the serum is apparent in its action upon the false membrane, which ceases to develop within twenty- four hours after the first injection, being detached after twenty-six, forty-eight, or, at most, sixty hours. In 7 cases only have I known it to persist longer. Let me add, in conclusion, that in treatment with serum I have studiously avoided the use of local applications, simply irrigating the throat with boiled water, to which was added perhaps 50 grams (per liter) of Labarraque's solution." In commenting upon the address of M. Roux, Dr. Behring added that " the specific action of antidiphtheritic serum is the surer and more rapid in proportion to the heroic nature of the dose. Since the injection is positively harmless, it may be adopted with impunity even in simply suspected cases of the disease." The prophylactic property of equine serum is well attested by Aronson, who employed antidiphtheritic injections to immunize children in families where the disease was established. One cubic centimeter of prepared serum sufficed for his purpose, of 130 chil- dren thus treated preventively only 2 being affected with a very mild form of the disease. It is impossible, says Bernheim, to assign a definite duration to the antitoxic property of serum. It may last several weeks, or even months, according to the strength of the injection and the species of animal under treatment. But, he adds, when definite immunity has been attained the protective power of serum may be prolonged by the injection of a small quantity of toxin every fourteen days. Concerning the various untoward complications arising from the use of serum and authentically reported, it is fair to say that the same phenomena are observed in diphtheritic patients treated by other methods than serum-therapy. Notwithstanding the eminent success of the method herein con- sidered, it should be said, in conclusion, that several important features are as yet but imperfectly formulated or even understood.1 1 In a paper upon the subject "Antitoxin," Prof. A. C. Cotton, M. D., of Rush Medical College, Chicago, puts the case thus strongly: " What we do not know is how much antitoxin exactly is necessary to neutralize a given quantity of toxin at somewhat lengthened periods precedent. What we do not know, and what we most particularly desire to know, inasmuch as it is about the only phase of the entire subject that has any practical bearing upon our profession as life- savers, is what number of antitoxin units is necessary to neutralize an indefinite amount SPECIFICS. 293 It is of paramount interest to ascertain, for example, the precise prophylactic power of the immunizing serum. Behring has already directed his attention to this problem, advising the injection of 5 cubic centimeters of serum in children under ten years of age, and IO cubic centimeters in older patients. Crouzon, who has prac- tised these preventive injections in 230 cases, reports but two light attacks of the disease. A similar experience is that of Baginsky in Berlin. Bernheim asserts that he has personally injected serum in 28 subjects exposed to diphtheritic infection without noting a single case of the malady. The dose employed was somewhat in excess of that proposed by Behring, being from 10 to 20 cubic centimeters, as recommended by Hilbert, the injection being twice repeated at intervals of twenty days. From a careful consideration of the subject in its relations to diphtheria, we may safely conclude— 1st. That immunized serum forms a remedy which experience proves to be wholly innocuous and eminently adapted for use in human infection. 2d. That antidiphtheritic serum has in every respect corre- sponded with the most sanguine hopes of its advocates, its employ- ment being attended with astonishing success wherever properly used and in sufficient quantities. 3d. Finally, that it is incontrovertibly established that by means of injecting serum temporary immunity from infection may be readily conferred, permanent protection being contingent merely upon a renewal of treatment. In view of the extraordinary rapidity with which recent discov- eries have been made, it is unwise to presume that we have by any means exhausted the possibilities of serum in its dominion over this dread disease. Resources of science undreamed of in the past are now concentrated upon the momentous problem of infection. What new light future investigation may shed can be regarded only as a theme for hopeful conjecture. Tuberculosis.—It may be stated, in general terms, that the microbic nature of tuberculosis was admitted by nearly all writers upon the subject before the discovery of the pathogenic micro- organism. Villemin in 1866 had established by experiment the of diphtheria toxin of unknown virulence that has invaded at a prior indefinite time, and is presumably hourly continuing to invade, in unknown strength and quantity, from a patch of recurrent and extending culture of Klebs-Loeffler bacillus on an unknown extent of mucous surface of a human being of unknown susceptibility."—The Corpuscle, Dec, 1S95. 294 A TEXT-BOOK OF MA TERIA MEDICA. infectious character of the malady; but in France the idea seemed almost revolutionary, creating no enthusiasm, it being reserved for Germany, through the indefatigable labors of Robert Koch, to develop and elucidate the theory conceived by Villemin. Koch discovered the bacillus of tuberculosis, and even succeeded in iso- lating and cultivating it, the pure cultures obtained by him always producing tuberculosis in every form. His original communication, addressed to the Physiological Society of Berlin, bore date of April io, 1882, and at once stimulated experimental research in others, who fully confirmed his discovery. The tubercle bacillus is aerobic, its existence depending wholly upon the supply of oxygen—a fact readily explaining its predilec- tion for the pulmonary tissue. The bacillus may affect all warm- blooded animals, although in different degrees, the microbe being somewhat differentiated in the lesions of birds and those of man and the mammalia in general. Spontaneous tuberculosis is extremely frequent in man, it being estimated that one-fifth of all fatalities are due to phthisis in its various forms. It is equally common among cattle, in which the progress of the disease and its lesions are precisely similar to those observed in human beings—a fact demonstrated by the admirable studies of Koch respecting pulmonary lesions and their character- istic pathogenic micro-organisms. Like other microbes, the bacillus tuberculosis secretes a large amount of soluble products. These toxins, which of late years have been subjected to careful experiment, are derived from cul- tures of human bacilli, modified or not by aviary germs and the tuberculous products produced in the organism itself. Koch's tuberculin, now known throughout the world, is simply a soluble product, prepared by a special process, consisting of a glycerized extract drawn from pure cultures of tubercle bacillus, its activity depending upon the virulence of the germs, those derived from man being more dangerous than aviary cultures. Various methods of inoculation have been adopted in tubercu- losis: 1, inoculating the patient with another disease; 2, inocula- tion with attenuated tuberculosis or that proceeding from a different species, as from birds ; 3, inoculation of, the soluble bacillar prod- ucts—tuberculin; 4, injection of blood taken from animals often immune against tuberculosis; 5, injection of serum drawn from inoculated animals; 6, finally, injection of serum taken from immunized animals. With the last two of these methods we are SPECIFICS. 295 properly concerned. The fifth has been scientifically adopted by Babes, Richard, and Hericourt, who have treated a large number of cases in which various cures have been effected. The main obstacle of the procedure lies in the difficulty of successful inocu- lation, the greater part of the animals employed dying of infectious nephritis. By the sixth method, as employed by Bernheim, this fatality is largely obviated, a careful procedure with the serum of immunized animals proving the most efficacious hitherto devised. The pro- cess of immunizing consists in injecting the toxic products nor- mally secreted by Koch's bacillus, and is, in effect, that adopted by Behring in preparing the antitoxin of diphtheria. In experiment- ing upon a large number of animals, suffice it to say that the results obtained by Bernheim were eminently satisfactory, every case indicating improvement and the actual cures being about 40 per cent. So convinced was he of the sovereign value of his method that he emphatically declared it to be the only rational procedure possible in tuberculosis : " Je puis meme affirmer que l'avenir de la therapeutique antituberculeuse reside tout entier dans cette maniere d'immuniser les animaux et d'utiliser leur serum." Applied to tuberculosis in man, there are as yet few signs of encouragement in the inoculation with the product of specific germs. The tuberculin of Koch has not responded to the hopes of its ad- vocates, the danger from untoward symptoms and relapse attending its use offsetting effectually any temporary benefit. Yet it is quite possible that the discovery of so powerful an agent may lead to others of more established efficacy. Pneumonia.—All the pulmonary symptoms which characterize this disease are produced by a single microbe, suspected by Klebs, described by Koch and others, and discovered by Pasteur in the bucco-pharyngeal cavity, its habitual haunt, whence it carries in- fection to the lungs. The pneumococcus does not confine its attacks to man, the rabbit and guinea-pig being especially sensitive to its influence. It has been observed that the microbe is a fre- quent prey to leucocytosis. It thrives in a total absence of oxygen, its vitality and virulence, so far from diminishing, being sensibly increased by anaerobic conditions. Pure cultures are easily obtain- able. Repeated inoculations of attenuated virus readily confer immunity, reduction of virulent germs being attained by the use of desiccated pneumonic viscera. The saliva of a patient, collected after defer- 296 A TEXT-BOOK OF MATERIA MEDICA. vescence, ensures protection to the mouse, the same being true of blood-serum. Immunization of animals was inaugurated by Em- merich and Fovitsky in 1891, subsequent investigators confirming their experiments under varying conditions, Foa and Scabia finally employing human serum in the inoculation of rabbits with marked success. It had been supposed that the spleen was the seat of an im- munizing product possessing greater activit}', but a glycerized extract of human spleen injected into the veins of refractory rabbits failed to arrest death. The general deduction drawn from a care- ful scrutiny of the subject tends to prove that the production of the neutralizing force in the system—the antipneumotoxin—is shared by all the elements of the organism, including the spleen. The therapeutic interest of the subject centers in the application of inoculation to man. The early experiments of Foa and Scabia were without result, neither reaction nor amelioration attending their treatment; but in 1892, Klemperer reported favorably con- cerning immunization in 40 cases of human pneumonia. In January, 1893, Lava communicated to the Academy of Med- icine in Turin the application of serum-therapy with auspicious results. He inoculated 10 subjects—5 with from 4 to 9 cubic cen- timeters of rabbit's blood-serum; 4 with a like dose of glycerized extract of the viscera of immunized rabbits ; and I with from 4 to 5 cubic centimeters of canine serum. There is no reaction at the point of inoculation, no general disturbance of the system, nor any influence upon temperature or respiration. On the contrary, the pulse is favorably influenced, as is also the general progress, as shown by Lava's experiments. Moreover, the injection hastens the crisis of the disease, conducing rapidly to complete restoration. Rozzolo also reported 5 cases treated with serum, 4 of which were cured. No influence upon the pulse, heart, or kidneys was noted. The effect of animal serum is fugacious ; that of the human product lasts several days. In all cases the serum of immunized subjects possesses a therapeutic but not an antitoxic power. It does not diminish the virulence of pneumococci, which, injected in an inoculated organism, retain their pathogenic activit}' about eighteen hours, after which, indeed, their vitality is manifested by the production of toxins producing positive chemotaxis in the phagocytes. Among other curative methods in pneumonia may be cited the SPECIFICS. 297 hypodermic injection of blood taken from convalescents and the infusion of blood from similar patients. The former resulted fav- orably (Audeoud), and the latter (Hughes of Philadelphia), an intravenous operation, was no less successful. Audeoud explains the natural crisis in pneumonia by the theory of Klemperer—that the antipneumotoxin formed in the blood of an inoculated subject by neutralizing the pneumotoxin cures the infection. Cholera.—The microbe of this terrible disease had been sought since 1848, yet the subject had never been profoundly studied until Koch succeeded in isolating the germ. Being associated with other micro-organisms, the bacillus had remained undetected, being distinguishable, in fact, only in fulminant attacks of the disease, as was noted by Strauss and Roux. Stagnant water is particularly favorable to the propagation of germs. In distilled water the bacillus survives but twelve hours ; in drinking-water, seven days (Babes); while in river or well-water it may live for seven months (Wolfhugel). As a rule, the acids are injurious to the bacilli, bichloride of mercury, sulphate of copper, and quinine being very powerful antiseptics in presence of the germs. Cholera has been observed in man alone, although Koch easily imparted the disease to guinea-pigs, to which it was fatal. Inocu- lation of choleraic virus has never produced the malady in man. The pathogenic power of the bacillus is well demonstrated by the fact that in one of the Berlin hospitals, of 207 patients attacked by cholera nostras (cholerine) in which no germ was manifest, but one case proved fatal; and, notwithstanding vigorous oppo- sition, Koch's original thesis appears to be sustained by observation. A singular fact in connection with cholera germs is that they ma}r be ingested at times, if not with impunity, at least without in- ducing the disease. Pettenkofer, having taken large doses of alkali, absorbed a considerable quantity of the poison with only the effect of a diarrhea during five days, there being no disturbance of the general system or of the kidneys. Emmerich, ingesting the tenth part of Pettenkofer's dose, was seized with diarrhea twenty-four hours afterward, and became seriously ill. Purging lasted four days, and on the eleventh day the bacilli disappeared from the stools. It were beside the purpose of the present work to relate in detail the many interesting experiments upon animals undertaken 298 A TEXT-BOOK OF MATERIA MEDICA. with a view to the application of serum-therapy in the treatment of human cholera. Although the experimental investigations of recent years foreshadow the possibility of immunization in man, it must be confessed that, as in the case of tuberculosis, they have been thus far barren of definite results. It is announced that Behr- ing has discovered a practical method of combating the disease: until the results of his later researches are known the therapeutic problem must apparently remain unsolved. The result of Haff- kin's investigation in India will be awaited with interest. Septicemia.—The streptococcus of Fehleisen (erysipelatis), which causes erysipelas, was discovered by Nepveu in France and Hiiter in Germany (1868-80), and has been the subject of careful study by Klemperer and others in the hope of determining its availability as an immunizing agent. Employing the serum of immunized rabbits, it has been found possible by intravenous injec- tion to cure the disease in mice, the serum proving efficacious only against the disease with which the animal supplying it was inocu- lated. Subsequent experiments have been attended with varying results, Marmoret in February, 1895, having succeeded in obtain- ing a germ of streptococcus so virulent that the hypodermic injec- tion of 1 q ^ 0 6 of a cubic centimeter was fatal to the rabbit in thirty hours. Inoculation with this microbe or its toxins conferred im- munity upon rabbits, which furnished a preventive and curative serum. Encouraged by previous experimentation, Charrin and Roget now sought to apply the method of serum-therapy in the treat- ment of puerperal fever. Having satisfied themselves of the cura- tive property of the serum of a mule inoculated with the microbe of erysipelas, collected fifteen days after the eighth inoculation, they injected subcutaneously 8 cubic centimeters of serum in a woman affected with the fever. The report is as follows: " The next day no improvement. A second injection of 8 cubic centi- meters. Next day condition slightly improved, but still serious. Third injection of 25 cubic centimeters. Result on the following day rapid improvement; decline of fever; general good health; and early establishment of convalescence." Syphilis.—The pathogenic source of syphilis is still unknown. The disease being contagious, attempts have long been made to discover its specific microbe, yet the highest authorities agree that as yet all researches have proved abortive. No lower animal is known to be susceptible to the malady, and, although various experiments SPECIFICS. 299 have seemed to prove the contrary, it is now determined that the lesions primarily indicating contraction of syphilis were the result of septicemia induced by some agent infected with the syphilitic virus. The sero-therapeutic methods employed in the treatment of the disease consist of inoculation with the blood of naturally immune or of syphilitic subjects. Of all animals, the horse is perhaps the only one capable of syphilization. Tommasoli in 1892-93 essayed inoculation of public women, affected with acute secondary syphilis, with lamb's serum, the results being, according to his report, highly favorable—even to the cure of syphilitic infection. Many untoward symptoms, how- ever, have attended the inoculations thus made. Mozza (1893) instituted a series of experiments, employing blood from the carotid artery of a lamb or dog, and another series in which injections were made of serum drawn from sheep inoculated with serum from syphilitic subjects in whom the disease was latent. His records indicate no very satisfactory results, yet he demonstrated that aseptic precautions allow the application of serum-therapy without local or general reaction. Finally, Hericourt and Richet attempted, with dubious success, the experimental injection of syphilitic serum, the results, in their therapeutic importance, being inconsequential. Typhoid Fever.—The bacillus of this disease was first detected in the kidneys by Bouchard in 1879. The name was given by Eberth, who studied the germ in 1880-81. Old cultures contain an exceedingly toxic ptomaine, besides a soluble substance capable of inoculating animals. The vigor of the bacillus of Eberth is re- markable, Grancher and Deschamps having shown that it sur- vives five and a half months at a depth of 50 centimeters in damp soil. Infection may occur through the medium of the pulmonary tract, and the microbe is transmissible from the mother to the fetus. All animals yet submitted to experiment are naturally immune, the first effort to inoculate them dating from 1862 (Murchison); the attempt proved futile. Other experiments in this direction were attended with like failure until Vidal and Chantemesse suc- ceeded in inoculating with very virulent cultures 30 white mice, 17 of which succumbed within twenty-four hours. Later experiments have proved the extreme virulence of serum derived from a typhoid human subject, fatality speedily resulting 300 A TEXT-BOOK OF MATERIA MEDICI from its injection, caused not by the microbe itself, since none are found after death, but by its toxic products. Among the phenomena observed in varied experimentation the inexplicable fact was revealed that the serum of certain persons never having contracted typhoid fever conferred immunity upon guinea-pigs. Casual experiments followed without favorable progress, other than the reduction of temperature. In January, 1895, however, M. Legrain, turning his attention to typhus—so closely allied to true typhoid fever—met with encouraging success. Injecting suc- cessively increased doses of serum from typhus convalescents, besides the reduction of temperature within three hours after the operation it was noted that stupor, coma, and even hemiplegia of a toxic nature, disappeared after an injection of 10 cubic centimeters. In a case of grave typhus the injection of 14 cubic centimeters on the fourth day of the infection resulted in lowering the temperature and inaugurating recovery within two days. In other serious cases, where the injection was delayed until the sixth or eighth da}' of the infection's course, the disease, though not arrested, was marked by mitigated symptoms. The serum of convalescents was taken after one week's remission of febrile manifestations. Relying upon the fact that an attack of typhus confers immunity against a second access of the disease, Stern sought to ascertain whether the serum of individuals cured was endowed with immu- nizing properties. The results were partially successful, eliciting the curious fact that the protective power of the serum appeared most active in those who finally succumbed to the disease. It also seemed problematical, to judge from these and other instances, whether immunized serum employed in this disease possesses either bactericidal or antitoxic properties. Influenza.—Although the disease has occurred at intervals since the serious epidemic of 1830-33, the earliest microbiological studies of influenza date from the epidemic of 1889-90. Investigation at that time revealed no microbes in the sputum and viscera, save those which habitually frequent the bucco-pharyngeal cavity— streptococcus, pneumococcus, pneumo-bacillus, and staphylococcus —which diversity of germs might induce the belief that "la grippe" is not due to any single micro-organism, but to several. Notwithstanding this and similar suppositions, the majority of microbiologists maintain that these bacteria are but the result of a secondary infection, and that the true germ of influenza is still SPECIFICS. 301 unknown, although many investigators have thought they had iso- lated the specific microbe. One deduction is constant as the result of their studies: the great importance of secondary infections in the course of the disease. Failure to discover the germ was in reality due to a deficiency of technique—inadequate methods of staining. Pfeiffer devised a new method, by which he detected it, and Kitasato (1892) suc- ceeded in isolating and cultivating the identical microbe. Animals do not contract the disease spontaneously, although the saliva of cats and dogs contains a bacillus having a pathogenic influence upon rabbits, the character of which closely resembles that of the Pfeiffer bacillus. Monkeys and rabbits contract the malady when inoculated with the pure culture of this germ. In man the port of entry, so to speak, of this microbe is the pulmonary tract, where it often produces lesions of suppurating broncho-pneumonia. The general phenomena observed in the disease are held by Pfeiffer to be the result of intoxication, the microbes being localized; Cauch, on the contrary, considers them due to the presence of the microbe in all the organs, even the blood. The latest investigations confirm the opinion of Pfeiffer. Brischettini has demonstrated that the propagation of the Pfeiffer bacillus is not checked by the action of serum from immunized animals, being limited to diminishing the toxicity of its soluble products. The immunity caused by the injection of these products is augmented by the injection of the culture. The injection of serum of an immunized animal neutralizes in vitro the toxins secreted by the bacillus, and in a healthy organ- ism establishes immunity, whether against infection or intoxication. It is therefore assured that in future use the serum may be em- ployed at once as an inoculative and curative agent. Reptile Poisons.—It has long been known that certain animals (reptiles) possess natural immunity against their own venom. The poison of the toad having been detected in his blood, the reptile's immunity was at first thought to be due to tolerance, the same condition existing in the salamander and viper. The relation between the blood and the venomous glands demon- strates the internal secretion of these glands. The idea of an anal- ogy between microbic virus and reptilian venom was deduced from the existence of soluble microbic toxins, as elucidated by Chauveau. The attenuating power of heat upon the venom of serpents has 302 A TEXT-BOOK OF MATERIA MEDICA. also its analogue in the similar susceptibility of micro-organisms. A mortal dose of venom subjected for five minutes to a heat of ioo0 C. may be injected with impunity into a guinea-pig weighing 500 grammes. The reaction of the organism engenders an antitoxin which, in- jected into a healthy animal, is preventive of fatal inoculation. The precise nature of this antitoxin is undetermined, yet its protective power is evident. Certain it is that the serum of a rabbit inocu- lated against viperous venom, when injected an hour and a half before the poison, completely neutralizes the latter. Curiously enough, this preventive serum of rabbits inoculated against the poison of vipers also confers immunity against cobra-venom. So far as affects man, Calmetti announces that he has employed serum with success in the treatment of snake-bites, even to the extent of curing them. Carbuncle (Anthrax).—The bacterium of anthrax, of the genus bacillus, has proved a subject of elaborate and interesting experi- ment, many features of which are of absorbing interest alike to the bacteriologist and the clinician. The animals subjected to inocula- tion have been chosen with great care, and those supplying the immunizing serum include many species. The general results of protective inoculation have been treated briefly early in the discus- sion of serum-therapy. Rabies.—In January, 1881, Galtier announced that intravenous inoculation of rabid saliva confers immunity upon sheep, confirm- ing his experiments later in the year by injecting the fluid into nine sheep and one goat. Pasteur, Chamberland, Roux, and Thuiller pursued experiments in a similar line, with somewhat negative results. By passing the virus successively from dogs to monkeys Pasteur was able to attenuate its virulence, and finally, by transferring the poison from monkeys to rabbits, a serviceable immunizing agent was obtained, still further experiments perfecting the method in view. Satisfied with his success, Pasteur now turned his attention to the inoculation of man against hydrophobia. The first operation (in 1885) was attended with auspicious results, and from that moment the savant's laboratory was invaded by affected individuals demanding cure. Institutes were founded in various parts of the world, that in Paris being the center of bacteriological study in France. In America the subject has received wide attention, but SPECIFICS. 303 in many instances the benefits derived from Pasteur's inoculative procedure have been of doubtful importance among intelligent observers. With regard to the administration of serum, several precautions are of great importance. The absolute cleanliness of the syringe, for example, should be an object of especial care. To this end a glass barrel is preferable, in order that impurities may be readily detected and removed. For packing purposes rubber or asbestos should be employed, and the instrument should be so constructed as to permit cleansing and sterilizing of every part before and after use. The mode of injection and the amount of dosage (measured in antitoxin units) vary somewhat according to the nature of the dis- ease and the age and susceptibility of the patient. Care should be taken to use only the most reliable preparations. It has been impossible to present within a necessarily limited space the entire field covered by this profoundly interesting subject. For a multitude of details, embodying a wide range of experimen- tation, and for many expressions of individual opinion awakened by a consideration of so absorbing a theme, the student is referred to the extensive bibliography relating to ever}- phase of serum- therapy. It may be readily imagined what would have been the discus- sion of Jenner's vaccination had our bacteriological and chemical knowledge and delicate appliances for investigation existed in his day. It is scarcely surprising, therefore, that the renewal of similar studies, after an interval of unprecedented scientific progress, should elicit from all parts of the world a zeal and enthusiasm impossible in any previous epoch, together with a mass of concurrent or dis- senting testimony touching new discoveries proportionate to the greatly increased number of competent investigators. Whatever be the limitations of serum-therapy, the consensus of opinion among thoughtful observers is that its importance to mankind and its pur- pose are deeply rooted in the eternal laws of matter and the methods of great Nature. Its rationale, its mysterious power, and startling phenomena awaken new and greater problems of bacterio- logical science ; yet, though the entire subject, embracing as it does so ample and momentous a field of inquiry, remains sub judice, the character of modern scientific investigation must surely reveal its truth or falsity. DIVISION III.—ANTISEPTICS. Acidum Carbolicum—Acidi Carbolici—Carbolic Acid. U.S. P. Origin.—A constituent of Coal-tar, obtained by fractional distil- lation and subsequently purified. Description and Properties.—Colorless, interlaced, or sepa- rate, needle-shaped crystals, or a white, crystalline mass, some- times acquiring a reddish tint, having a characteristic, somewhat aromatic odor, and, when copiously diluted with water, a sweetish taste, with a slightly burning after-taste. Deliquescent on exposure to damp air. Soluble in about 15 parts of water, the solubility varying accord- ing to the degree of hydration of the acid ; very soluble in alcohol, ether, chloroform, benzol, carbon disulphide, glycerin, and fixed and volatile oils. It is liquefied by the addition of about 8 per cent. of water. The vapor of the acid is highly inflammable. Carbolic acid is faintly acid to litmus-paper. It should be kept in dark amber-colored, well-stoppered bottles. Dose.—1—2 grains (0.03-0.12 Gm.). If liquefied, 1-2 minims (0.03-0.12 Cc). Official Preparations. Glyceritum Acidi CarbSlici—Glyceriti Acidi Carb61ici—Glycerite of Car- bolic Acid (25 per cent.).—For external use. Ungu&ntum Acidi Carbdlici—UnguSnti Acidi Carbftlici—Ointment of Car- bolic Acid (10 per cent.).—For external use. Unofficial Preparations. Aqua Acidi Carb&lici—Aquae Acidi CarbSlici—Carbolic Acid Water.— Strength, 2 drachms in 1 pint (8.0--473.17 Cc). Dose, 1-2 fluidrachms (4.0-8.0 Cc). Oleum Acidi Carbdlici—Olei Acidi CarbSlici—Carbolated Oil.—1 in 20 of Olive or Cotton Seed Oil. For external use. Calrbasus Acidi Carbblici—CSrbasi Acidi Carb61ici—Carbolic Acid Gauze. —Gauze containing Carbolic Acid, 1 ; Resin, 5; Paraffin, 7 parts. Used as a surgical dressing. 304 ANTISEPTICS. 305 Emplastrum Acidi CarbClici—Emplastrum (ace.) Acidi CarbSlici—Car- bolic Acid Plaster.—Composed of Carbolic Acid, 25; Shellac, 75 ; coated with Gutta- percha dissolved in Carbon Disulphide. For external use. Camphora Carbolisata—Camphorae Carbolisatae—Camphorated Carbolic Acid (Phenol-camphor).—Camphor, 2; Carbolic Acid, 1; allow to liquefy. A color- less, oily liquid, having the odor of camphor, soluble in fixed oils, alcohol, and ether, nearly insoluble in water and glycerin. Used as a local anesthetic, chiefly for toothache! Liquor Sodii Carbolatus—Liquoris Sodii Carbolati—Phenol-Sodique.— Composed of Carbolic Acid, 188 grains (12.5 Gm.); Caustic Soda, 31 grains (2.06 Gm.) Distilled Water, 4 ounces (118.29 Cc). For external use. Liquor Sodii Boratis CompSsitus—Liquoris Sodii Boratis Comp&siti— Dobell's Solution.—Composed of Borax and Sodium Bicarbonate, of each, 2 drachms (15.0 Gm.); Carbolic Acid, 24 grains (1.8 Gm.); in Water, 1 pint (473.17 Cc). Used externally in spray. Acidum Carb61icum Iodatum (N. F.)—Acidi Carbolici Iodati—Iodized Carbolic Acid (Phenol I odatim).—Composed of Iodine, 20 parts; Carbolic Acid, 76 parts; Glycerin, 4 parts. The iodine, the acid which has been previously melted, and the glycerin are put in a flask, digested at a gentle heat, and frequently agitated until the iodine is dissolved. It should be kept in glass-stoppered bottles in a dark place. Used locally, especially in gynecological practice. Allied Compounds. Creasols.—Obtained by distilling Coal-tar between 2000 and 2io°C; also obtained by fusing Toluene Sulphonic Acid with Potash. The familiar compounds of creasols are Crealin, Lysol, Solutol, Saprol, etc. They are powerful disinfectants and germi- cides, and less poisonous than carbolic acid. Aseptol, or orthophenol-sulphonic acid, is a commercial article, a straw-colored, slightly caustic liquid. It is a powerful antiseptic. Antagonists and Incompatibles.—Bromine, metallic salts, antipyrine, collodion, alkalies, saccharate of lime or lime, and soluble sulphates like Epsom or Glauber salts, are incompatibles. Atropine is a physiological antagonist. Synergists.—All members of the carbolic-acid group, antisep- tics, and motor depressants. Physiological Action.—Externally.—Carbolic acid is a local anesthetic, and, applied in full strength to animal tissues, acts as a caustic, but does not produce vesication. In weaker solutions it produces a burning and reddening of the skin. It acts more severely upon mucous membranes. It coagulates albumin, and therefore its caustic action is limited. The eschar is first whitish, subsequently becoming brownish. It is readily absorbed through the skin or through raw surfaces, and toxic effects have been thus produced. Wreak solutions are anti- pruritic and gratefully cooling and anodyne. It is a disinfectant, a deodorant, and a parasiticide. 20 306 A TEXT-BOOK OF MATERIA MEDICA. Internally.—Digestive System.—In small doses it is cooling and sedative to the stomach. In large or poisonous doses it is a pow- erful gastro-intestinal irritant. Ordinary medicinal doses are con- verted by the gastric contents into the sulphocarbolates. Circulatory System.—Medicinal doses have no apparent effect on the circulation. Large doses first depress and later accelerate the heart. Poisonous doses powerfully depress the heart, stopping it in diastole. The arterial tension is lowered by lethal doses, from paralysis of the vaso-motor center in the medulla. Nervous System.—Medicinal doses have no special effect upon the nervous system. Large or poisonous doses depress the cere- brum. Vertigo may first be noticed, which is soon followed by stupor. Owing to stimulation of the anterior cornua of the spinal cord, there may be muscular trembling or convulsions. The cornua are ultimately depressed, causing abolition of reflexes and paralysis. Respiratory System.—Small doses do not affect the respiration. Large doses first accelerate the respiratory movements, rendering them full, but shallow respirations soon follow. This action is due to stimulation of the vagi, both at the periphery and at the center. If the dose has been a poisonous one, there is great depression, and ultimately paralysis of respiration, due to depression of the centers. Absorption and Elimination.—It is absorbed from the stomach, and diffuses into the blood with great facility, circulating in that tissue probably as an alkaline carbolate. It is eliminated by all the secretions—chiefly by the kidneys and lungs—and appears in the urine as salts of sulphocarbolic and glycuronic acids, and the oxidated products hydrochinon and pyrocatechin. To the last substance is mainly due the peculiar smoky or olive-green color imparted to the urine after large or continued doses have been taken. (There is also, probably, some other factor causing this change, for pyrocatechin can exist only in alkaline urine.) When a very large amount of carbolic acid has been taken, some of it can be found in the urine unchanged. Temperature.—It is not specially affected by small doses. Full medicinal doses tend to lower bodily temperature in fever, while poisonous doses lower the temperature several degrees. The re- duction of temperature is due to its diminishing heat-production and increasing heat-dissipation. ANTISEPTICS. 307 Eye.—Poisonous doses almost invariably cause the pupil to be minutely contracted, due, probably to paralysis of the radiating fibers, the circular fibers being unaffected. Untoward Action.—Headache, either in the frontal or the occip- ital region, heaviness and a sensation of fulness in the head, dizzi- ness, and the appearance of rings before the eyes, muscular weak- ness, especially of the legs, profuse sweating, formication. Where there is an idiosyncrasy on the part of the individual against this drug, small doses even may produce the symptoms of poisoning. Poisoning.—Carbolic acid is one of the most deadly poisons, often equalling hydrocyanic acid in its rapidity of action. The patient is rendered rapidly unconscious or may drop dead within a very few moments from paralysis of respiration. Should the dose be insufficient to produce so sudden a death, the patient suffers from all the symptoms of gastro-enteritis—intense pain, with violent vomiting and purging. Fibrillary trembling maybe present. Stertorous breathing appears, with cold, clammy skin, pinched face, anxious expression, abolition of reflexes, weak, thready, and often imperceptible pulse, feeble respiration, and frequently dyspnea, and death finally occurs from failure of respiration. As toxic symptoms may be produced by the external applica- tion of solutions of carbolic acid, as in surgical dressings or vaginal or intra-uterine douches, the toxicity of this drug should be appre- ciated, and patients carefully watched for the first untoward mani- festations, such as pain in the lumbar region, smoky urine, nervous- ness, and cerebral disturbance, when the drug should be immedi- ately withdrawn. Treatment of Poisoning.—The immediate administration of mag- nesium sulphate (Epsom salts) and warm demulcent drinks should be resorted to. The application of external heat. Atropine and strychnine hypodermically. Digitalis and coffee may also be re- quired. Opium, or some preparation of it, for the relief of pain. If the patient is seen soon after the drug has been taken, the stom- ach should be washed out, after which the above treatment should be followed. Therapeutics.—Externally and Locally.—For some time after it was so prominently brought forward by Lister carbolic acid was thought to be indispensable in antiseptic surgery. It is now known that the solutions which are safe to use are inefficient, ordinarily, beyond the mere mechanical effect of washing. 308 A TEXT-BOOK OF MATERIA MEDICA. The benumbing influence produced on the hands of the sur- geon, and the discoloration of bright instruments and rapid impair- ment of their cutting surfaces, render strong solutions for disinfect- ing instruments impracticable, and indeed of less value for this purpose than the prolonged boiling in distilled water rendered slightly alkaline with sodium bicarbonate. The pain of superficial bums is relieved by applying strong solutions of carbolic acid, care being taken to prevent absorption. It is an extremely valuable drug as an antipruritic, and is hence of great utility in the treatment of certain diseases of the shin— pruritus, chronic eczema. In chilblains, tinea tonsurans, t. capitis, t. circinata, favus, etc. it is of great value. Chronic laryngitis, cha- racterized by diminished secretion, is greatly benefited by the direct application to the parts of a solution of \ drachm to i ounce of glycerin (2.0-30.0 Cc). A spray containing from 2 to 5 grains (0.12-0.36 Gm.) to 1 ounce (30.0 Cc.) of water is an efficient appli- cation in the treatment of acute and chronic inflammation of the throat and nose. Camphorated carbolic acid (campho-phenique) is a useful appli- cation in toothache due to an exposed and inflamed pulp. As a deodorant it is valuable to correct the fetor arising from syphilitic ulcerations, carcinoma, gangrene of the lungs, bronchorrhea, pneumothorax, etc. It reduces the discharge and relieves the pain in acute otitis media: a 10 per cent, solution in glycerin should be used. It is also of value in the treatment of otorrhea and in acute perforations of the tympanic membrane, but should be used in much weaker solutions—1 or 2 per cent. A lotion, 8 to 15 grains (0.5-1.0 Gm.) to 1 ounce (30.0 Cc), is an efficient antiseptic in foul and indolent ulcers. The pure acid is used as a cauterant in chancroids, lupus, gan- grene, bites of rabid animals, etc. The iodized carbolic acid is a valued local remedy in endometri- tis, chronic endocervicitis, and ulcers of the cervix. Hiiter in 1878 advocated the use of hypodermic injections of a 3 per cent, solution of carbolic acid for erysipelas, the punctures to be made at intervals upon the edge of the inflammation. Great improvement has taken place in goitre after the treatment by hypodermic injections into the tumor of a 5 per cent, solution of carbolic acid. Internally.—While inferior to salicylic acid to check fermentation, ANTISEPTICS. 309 it is nevertheless used for that purpose in dilatation of the stomach and so-called fermentative or flatulent dyspepsia. In nervous and irritative vomiting it may be given in doses of from 1 to 2 minims (0.06-0.12 Cc), well diluted and repeated at intervals of from one to four hours according to the symptoms of the case. It has been used in acute and chronic dysentery, and as an anthel- mintic against ascarides and tcenia solium. It has also been advocated as a remedy for typhoid fever and in malarial cachexia, but purely upon theoretical grounds, no clinical results having thus far justified its use in these disorders. Administration.—It may be given internally in pills or capsules, mixed with powdered liquorice-root as an excipient, or dissolved in glycerin and well diluted with sweetened water. For external use various strengths are used (from 1 :10 to 1 :500), and the various preparations mentioned may be used according to the case and indications. Sodii Sulphocarbolas—Sodii Sulphocarbolatis— Sodium Sulphocarbolate. U. s. P. Description and Properties.—Colorless, transparent, rhombic prisms, odorless, having a cooling, saline, slightly bitter taste. Somewhat efflorescent in dry air. Soluble in 4.8 parts of water, 132 parts of alcohol, 0.7 part of boiling water, and in 10 parts of boiling alcohol. The aqueous solution is neutral to litmus-paper. Dose.—10-30 grains (0.60-2 Gm.). Allied Compounds. Potassii Sulphocarbolas—Potassii Sulphocarbolatis—Potassium Sulpho- carbolate. Calcii Sulphocarbolas—Calcii Sulphocarbolatis—Calcium Sulphocarbolate. Magnesii Sulphocarbolas—Magnesii Sulphocarbolatis—Magnesium Sul- phocarbolate. Zinci Sulphocarbolas—Zincii Sulphocarbolatis—Zinc Sulphocarbolate. All of the above have been employed, but the zinc sulphocarbolate is believed to be preferable to check diarrhea and render the stools less foul. It is best given in pills, in doses of 2-3 grains (0.1-0.15 Gm.). Physiological Action.—In medicinal doses sodium sulphocar- bolate occasions no special symptoms, and in three or four times the medicinal dose it causes only slight lightness of the head. It is changed in the system into carbolic acid and sodium sul- 310 A TEXT-BOOK OF MATERIA MEDICA. phate, the latter being eliminated with the urine. The carbolic acid set free exerts its characteristic action and influence. Therapeutics.—Externally and Locally.—In the strength of \ drachm (2.0 Gm.) to 8 ounces (237.0 Cc.) of water it forms a valuable gargle in relaxed conditions of the throat. Solutions of different strengths have been used in diphtheria, acute tonsillitis, aphtha? of children, and nasal catarrh. 30 grains (2.0 Gm.) in 2 ounces (60.0 Cc.) each, of water, and hydrogen peroxide make an efficient injection in gonorrhea. Internally.—It is a mild intestinal antiseptic, and may be used internally for the same purposes as carbolic acid in such disorders as diarrhea, fermentative dyspepsia, etc. It arrests the growth of thrush, and is considered by some physicians to exert a favorable action in anginose scarlatina, diphtheria, and typhoid fever. The zinc sulphocarbolate is one of the best intestinal antiseptics to use in cases of dyspeptic diarrhea of children. Administration.—Sodium sulphocarbolate is best given in solution. Creosotum—Creosoti—Creosote. U. S. P. Origin.—A mixture of phenols, chiefly Guaiacol and Creosol, obtained during the distillation of wood-tar, preferably that of beech. Description and Properties.—An almost colorless, yellowish or pinkish, highly refractive, oily liquid, having a penetrating smoky odor, and a burning, caustic taste ; usually becoming darker in tint on exposure to light. Soluble in about 150 parts of water, but without forming a perfectly clear solution. With 120 parts of hot water it forms a clear liquid which on cooling becomes turbid, from the separation of minute oily drops. Soluble in all propor- tions in absolute alcohol, in ether, chloroform, benzin, carbon disul- phide, acetic acid, and in fixed and volatile oils. Creosote is in- flammable, burning with a luminous, smoky flame. It is neutral, or only faintly acid, to litmus-paper. Tests.—Carbolic acid is often substituted for creosote, and the following tests for the detection of carbolic acid are important: 1. If the suspended liquid is mixed with collodion, a coagulum will form if carbolic acid be present. 2. Carbolic acid produces a violet color with ferric chloride and ammonium hydrate, creosote producing a green color passing to brown. Dose.—1-5 minims (0.06-0.3 Cc). ANTISEPTICS. 3" Official Preparation. Aqua Creosoti—Aquae Creosoti—Creosote Water.—Dose, 1-4 fluidrachms (4.0-15.0 Cc). Incompatibles.—Strong sulphuric and nitric acid. It reduces silver salts, and explodes when combined with oxide of silver. Synergists.—The same as for carbolic acid. Physiological Action.—Externally.—It has the same action as carbolic acid. Internally.—Its action upon the digestive, circulatory, nervous, and respiratory systems is practically the same as that of carbolic acid. It does not stimulate the spinal cord so much as carbolic acid, and differs also from the latter drug in increasing the coagulability of the blood. Poisonous doses act like those of carbolic acid, but with more marked nervous symptoms. Absorption and Elimination.—It is eliminated by the bronchial mucous membrane, and by the kidneys as guaiacol sulphate and creosol sulphate of potassium. It is a stimulant expectorant. It has the peculiar property when applied to meat of preserving it, whence its name {crcas, flesh, sohzotc, preserve). Poisoning.—The symptoms and treatment of poisoning from creosote are the same as described under Carbolic Acid. Therapeutics.—Externally and Locally.—Creosote is superior to carbolic acid as an antipruritic, although not so generally used as the latter, on account of its acrid and penetrating odor. It can be used externally for the same purposes as carbolic acid. It is a valuable hemostatic, and the creosote water may be used for this purpose. Inhalations of creosote are recommended in phthisis, chronic bronchitis, and chronic congestion of the larynx and trachea. It is a powerful local anesthetic, and is largely used by dentists and the laity for aching teeth. It is used to preserve dead animal matter for dissection, etc. Internally—-Creosote can be used internally for the same pur- poses as carbolic acid, having the advantage over the latter drug in being one of the most efficient remedies in pulmonary tuberculosis. Probably no one remedy exerts so favorable an action upon the night-sweats, cough, and expectoration as creosote, or guaiacol, which is preferred by many physicians. It is of less value in cases 312 A TEXT-BOOK OF MATERIA MEDICA accompanied by high temperature and hemoptysis, and often aggravates these symptoms. It must be remembered that many of the cases alleged to have been cured by creosote have been treated with cod liver oil, tonics, and hygienic methods as well. Contraindications.—The same as for carbolic acid. Administration.—Pure beech-wood creosote alone should be used. It may be given in the form of creosote water, emulsion, or pills, or in capsules mixed with cod liver oil. Capsules are the least offensive way of administration. Some persons prefer to take the drug in milk. In the treatment of phthisis large doses are necessary. A tol- erance can usually be established by gradually increasing doses. If the patient manifest any untoward symptoms, the drug must be reduced in quantity or discontinued altogether. Guaiacolum—Guaiacoli—Guaiacol. Origin.—As before stated, creosote consists chiefly of Guaiacol, Creosols, and Cresols, and of these guaiacol is present to the extent of from 60 to 90 per cent. Guaiacol is obtained by fractional distillation of beechwood-tar Creosote, treated with Ammonia to remove acid compounds, and again fractionated. Guaiacol is rarely met with absolutely pure. Description and Properties.—A colorless, slightly refractive liquid, of strongly aromatic odor. Specific gravity at 150 C. (590 F.) is 1.117. Sparingly soluble in water, but readily soluble in alcohol and ether. It is soluble in solutions of sodium and potassium hydroxides, forming unstable compounds known as sodium- and potassium-guaiacol. Tests.—Pure guaiacol will separate rapidly if shaken with twice its weight of benzene, whereas the impure article forms a clear solution. " If a trace of ferric chloride is added to an alcoholic solution of guaiacol, a blue color is developed, which changes to emerald- green upon the addition of more ferric chloride." Dose.—2-10 minims (0.12-0.6 Cc). The following derivatives have been introduced: Guaiacoli BSnzoas—Guaiacoli Benzoatis—Guaiacol Benzoate (Benzosol). — Origin, by heating on a water-bath Potassium Guaiacol with Benzosol-chloride: the impure benzosol-guaiacol formed is purified by recrystallization from Alcohol. ANTISEPTICS. 313 Description and Properties.— Colorless, tasteless, and odorless crystalline powder, almost insoluble in water, but readily soluble in ether, chloroform, and hot alcohol! Dose.—10-150 grains (0.60-10 Gm.) daily. Guaiacoli Carbonas—Guaiacoli Carbonatis—Guaiacol Carbonate.— Origin, this substance is prepared by passing Phosgene Gas (carbonyl chloride) into Guaiacol previously dissolved in soda solution. The guaiacol carbonate is formed and is purified and crystallized from Alcohol. Description and Properties.—White, neutral, crystalline powder, nearly void of odor and taste, insoluble in water, slightly soluble in cold and readily soluble in hot alcohol, also in ether, chloroform, and benzene, and sparingly soluble in glycerin and fixed oils. Dose.—3-60 grains (0.2-4 Gm.) daily, gradually increased. Guaiacoli Di-iodidum—Guaiacoli Di-iodidi—Guaiacol Diodide.—Origin, by adding a solution of Iodine in potassium iodide to an aqueous solution of Sodium- guaiacol as long as precipitation continues. Description and Properties.—Reddish-brown salt, having the odor of iodine, soluble in alcohol and fixed oils, and readily decomposed. Dose.—2-15 grains (o. 10-1 Gm.). Guaiacoli Sallcylas—Guaiacoli Salicylatis—Guaiacol Salicylate (Guaiacol- salol).— Origin, by the action of Phosphorous Oxychloride on a mixture of Sodium- guaiacol and Salicylate. It is analogous to salol. Description and Properties.—White, crystalline, odorless, and tasteless powder, in- soluble in water, but soluble in alcohol, ether, and chloroform. Dose.—10-150 grains (0.60-10 Gm.) daily. Physiological Action of Guaiacol and its Derivatives.— Guaiacol produces an action very similar to that of creosote. It is not caustic when applied in full strength. It possesses marked antipyretic properties. It is readily absorbed through the unbroken skin, and rapidly reduces febrile temperature when applied in this manner. The reduction of temperature lasts from four to six hours. It is a diaphoretic and diuretic. It is excreted by the sweat, saliva, and urine, but is only slightly thrown out by the expired air, though small amounts of the drug have been found in the lung-tissue. As it is eliminated as a salt of ethyl-sulphuric acid, it must combine with albuminous bodies in the blood, and chiefly through the sulphur present in the albumin molecules. It can be found in the urine within fifteen minutes after administration or external application in the form of a substance giving the reaction of phenol. It is more agreeable to the stomach than creosote, and fre- quently improves the appetite, though to some patients it is very disagreeable and acts as an irritant. The guaiacol carbonate is usually much better borne by the stomach, and is therefore a useful and efficient substitute. 314 A TEXT-BOOK OF MATERIA MEDICA. Benzosol, guaiacol benzoate, contains 54 per cent, of guaia- col. It is usually well borne by the patient, and seldom occasions any digestive disturbance. In the intestinal canal it resolves into guaiacol and benzoic acid, and is excreted by the urine as combi- nations of these substances. Therapeutics.—Guaiacol is used for the same purposes as creosote—less likely to irritate the intestinal canal and kidneys. Guaiacol causes a marked reduction of the temperature in cases of tubercular disease when applied locally, nor is the antipyretic action when thus employed confined to tuberculous cases. It has given satisfactory results in other pyrexias. It is a very active antipyretic in erysipelas. The temperature begins to fall within fifteen or twenty minutes after the application of the drug. As with all antipyretics, the depressing action of guaiacol must be borne in mind. Raymond first suggested the local application of guaiacol in tonsillitis. It undoubtedly exerts a favorable action on the disease. Guaiacol, or some one of its derivatives, has been substituted for creosote in the treatment of phthisis and other wasting forms of tuberculosis. Guaiacol itself has no advantage over creosote. The benzosol and guaiacol carbonate possess the only advan- tage of being tasteless. Piatkowski of Vienna recommends benzosol in diabetes mellitus. There have been conflicting reports regarding its efficacy, yet suf- ficient is known in its favor to justify a further trial of this drug in diabetes. Contraindications.—The same as for creosote. Administration.—The application of guaiacol for the reduction of temperature may be made upon any portion of the skin—the back, breast, arms, thighs, or abdomen—without causing any appre- ciable difference. From 1 to 1 drachm (2.0-4.0 Cc.) is applied with a brush, and the part covered with cotton or gutta-percha tissue. The application may be repeated as often as necessary for the reduction of the fever. Other than a decided taste of guaiacol and free diaphoresis, the patient usually complains of no untoward symptoms, although in some cases quite marked nervous disturbances and other unfavor- able manifestations have been observed. It may be inhaled from hot water for certain conditions in doses of from 5-10 minims (0.3-0.6 Cc). ANTISEPTICS. 315 The solid derivatives of guaiacol may be given in powders or capsules. Guaiacol itself may be given in the same manner as creosote—preferably, mixed with cod liver oil or enclosed in cap- sules. Acidum Salicylicum—Acidi Salicylici—Salicylic Acid. U.S. P. Origin.—An organic acid, existing naturally in combination in various plants like Spircea ulmaria (meadow-sweet), Gaultheria procumbcns (wintergreen), etc., but chiefly prepared synthetically by combining the elements of pure Carbolic Acid with dry Car- bonic Acid and purifying. Description and Properties.—Light, fine, white prismatic needles, or a light white crystalline powder, odorless, having a sweetish, afterward acrid taste ; permanent in the air. It is soluble in about 450 parts of water, in 2.4 parts of alcohol, and in 14 parts of boiling water. The addition of 2 parts of sodium sulphite or 1 part of ammonium phosphate renders it much more soluble in water. Test.—The addition of ferric chloride to a saturated solution produces a fine bluish-violet color. Dose.—3-60 grains (0.25-4.0 Gm.). Lithii Salicylas—LTthii Salicylates— Lithium Salicy- late, u. S. P. Origin.—Obtained by heating Salicylic Acid, Lithium Carbonate, and Water until effervescence ceases, filtering, and evaporating. Description and Properties.—A white or grayish-white pow- der, odorless, having a sweetish taste, deliquescent on exposure to air, very soluble in water and alcohol. Dose.—5-60 grains (0.3-4.0 Gm.). Sodii Salicylas—Sodii Salicylatis—Sodium Salicy- late. U. S. P. Origin.—Prepared by acting on Sodium Carbonate with Salicylic Acid, straining, and heating the solution. Description and Properties.—A white amorphous powder, odor- less, sweetish, saline taste, permanent in air, soluble in 0.9 part of water, in 6 parts of alcohol, and in glycerin. Dose.—5-60 grains (0.3-4.0 Gm.). 316 A TEXT-BOOK OF MA TERL I MEDICA. Antagonists and Incompatibles.—The arterial and cerebral stimulants are antagonistic to salicylic acid and the salicylates. The incompatibles are the mineral acids, alkalies, metallic salts, particularly the ferric salts. Synergists.—The carbolic-acid derivatives, anesthetics, cardiac depressants, and cerebral sedatives. Physiological Action.—Externally and Locally.—Salicylic acid is antiseptic, parasiticide, irritant to mucous membranes; possesses the power to soften the epidermis ; checks perspiration when local 1}' applied (anhydrotic). Internally.—Digestive System.—Small doses stimulate the stom- ach ; larger doses act as an irritant. It is an antiferment. Circulatory System.—Small doses of salicylic acid have no very appreciable effect upon the circulation. Full medicinal doses first cause the heart to beat faster and stronger, increasing arterial tension ; later the arterial pressure is lowered, and excessive or toxic doses cause the pulse to become slow and labored. Its tend- ency ultimately, even in medicinal doses, is to depress rather than stimulate the heart. Its effect upon the blood is to restrain the migration of the white corpuscles. Nervous System.—In toxic doses, and in some susceptible per- sons in full medicinal doses, salicylic acid causes cerebral conges- tion, indicated by a feeling of tension in the cerebrum, headache, confusion of thought, tinnitus aurium, vertigo, and sometimes delirium. Toxic doses may occasionally produce cerebral con- vulsions. It lessens the reflexes, but does not affect the peripheral nerves, either motor or sensory. Respiratory System.—Small doses stimulate the respiratory cen- ter and the pulmonary vagi, making the respiration quicker and deeper. Toxic doses paralyze the center and vagi, causing slow and labored respiration and death from asphyxia. Absorption and Elimination.—Salicylic acid is converted by the gastro-intestinal secretions into the sodium salicylate, in which form it enters into the circulation. It increases the urinary flow. It appears in the urine as sali- cyluric acid. The color of the urine is changed to a dark olive- green after large doses have been taken. This change is due to the presence of indican and pyrocatechin, produced by the action of the pancreatic juice upon the salicylic acid in the intestine. ANTISEPTICS. 317 It is a powerful diaphoretic, large doses often causing exhaust- ing sweating. It also increases the secretion of milk and the amount of sugar in that secretion. Elimination takes place slowly by all the emunctories, but chiefly through the kidneys and skin. Temperature.—Febrile temperature is markedly reduced by large doses of salicylic acid. The reduction takes place usually within half an hour after a dose has been taken, and lasts several hours. The antipyretic action varies in degree according to the cause of the pyrexia and the individual susceptibility of the patient. The reduction of temperature is produced by lessening heat-production and increasing heat-dissipation. Untozvard Action.—Erythema, urticaria, or petechiae, accom- panied by intense itching, occasionally edema of the eyelids and lower extremities, mental depression, muscular weakness, motor disturbances, sweating, and buzzing in the ears, as mentioned under Poisoning, but to a less degree. Poisoning.—There are roaring in the ears, deafness, intense headache, vertigo, and possibly delirium, profuse and exhausting sweating, subnormal temperature, very weak, compressible pulse, feeble and shallow respirations, dimness of vision, ptosis, and often strabismus. The blood is disorganized, and the corpuscles rapidly break down. The urine and feces pass involuntarily. Death usually results from respiratory failure. Treatment of Poisoning.—Diffusible stimulants, atropine, strych- nine—the same treatment as in poisoning by acetanilid. Therapeutics.—Externally and Locally.—Salicvlic acid has been satisfactorily employed, in the strength of \ to I drachm in I ounce (2.0 to 4.0 in 32.0 Gm.) of cosmoline, in the treatment of erysipelas. In the treatment of chancroid salicylic acid has been extensively employed. The powdered acid should be thoroughly dusted over the surface. The peculiar action of salicylic acid in softening and loosening thickened masses of epidermis and favoring the normal prolifera- tion of epithelium renders the drug especially useful in the treat- ment of indurated eczema, particularly of the palm and sole, ver- ruca, tylosis, callositas, corns, zvarts, etc. It is one of the most useful drugs in the different varieties of eczema, impetigo contagiosa, psoriasis, lupus, parasitic affections, and in non-parasitic sycosis it has been employed by Heitzmann with 318 A TEXT-BOOK OF MATERIA MEDICA. marked success. It has been used successfully in the treatment of acne, comedones, and pruritus. A 3 per cent, solution has been recommended in aspcrgillus of the outer auditory meatus. A wash, 3 grains to 1 ounce (0.2 to 30.0 Cc.) is efficient in otorrhea. Solutions of various strengths are frequently useful in acute coryza, diphtheria, inflammation of fauces, catarrhal stomatitis, and to cor- rect offensive expectoration, especially in phthisis and gangrene of the lung. Internally.—There is no better example of empiricism in thera- peutics than the employment of salicylic acid in acute articular rheumatism. Used at first in this disease to reduce temperature, it was found that while it exerted marked antipyretic action, it also lessened the pain and swelling, and in the majority of cases short- ened the duration of the disease. It cannot be classed as a " specific " in any sense of the word, but merely relieves certain symptoms—fever, pain, and swelling. Other symptoms—or com- plications, according to some authors—such as heart affections, are uninfluenced by this medicine. Indeed, when so-called cardiac complications exist salicylic acid is certainly contraindicated. It has no power to prevent either affections of the heart or relapses. In the author's opinion, it is doubtful if salicylic acid alone is equal to the alkaline treatment or greatly superior to acetanilid or anti- pyrine. Rheumatic tetanus, irido-choroiditis, and sclerotitis are alleged to have been cured by this drug. It is useless in gout, according to the best English authorities, and is of no value in chronic or gonorrheal rheumatism, rheumatic arthritis, or rheumatic hyper- pyrexia. It is credited with being quite efficient in chorea of rheumatic origin, and in relieving the pains of herpes zoster and neuralgic headache. It is a drug to be tried in many diseases of rheumatic origin, unless some distinct contraindication to its use exists. It surpasses any drug, with the possible exception of guaiac, in the treatment of quinsy, and particularly rheumatic tonsillitis. The medicine is highly regarded by competent advocates as a remedy in diphtheria. Lumbago often yields to its influence, and it has also been recom- mended in sciatica, although in Cook County Hospital the author has seen a great number of cases of the latter treated with salicylic acid without any apparent improvement. He also regards it as valueless in typhoid and intermittent fevers. ANTISEPTICS. 3J9 It is a useful antizymotic to prevent putrefactive fermentation and flatulence, and lessen thereby the tendency to crapulous diar- rhea. Owing to the similarity of its action to that of quinine, it has been used, and with some success, in periodical neuralgias which have not responded to the latter drug. It has been found of use in influenza, and is an efficient anti- septic remedy in chronic gastric catarrh, diarrhea, cholera, and eutero-colitis. By some eminent clinicians it is considered to be one of the most effectual remedies in pleurisy with effusion. It has been recommended as an effectual anthelmintic, both for tape- and rouud-zvorms. Contraindications.—Salicylic acid should not be given in large doses to persons who have a weak heart or are otherwise greatly debilitated, at least not without counteracting its toxical tendencies with nutrients and diffusible stimulants. Administration.—Owing to its irritant action upon the mucous membranes, it is best given in a solution of glycerin and some aro- matic water, after meals. So concentrated a form as a pill or cap- sule is not recommended. Many of the untoward cerebral effects may be relieved by giving 20 grains (1.3 Gm.) of sodium or potassium bromide. Many of the toxical effects have been attributed to an impurity in the manufactured acid. If any benefit is to be derived from salicylic acid in acute artic- ular rheumatism, it must be used early in the disease and in heroic doses at comparatively frequent intervals—not less than 20 grains (1.3 Gm.) every two, three, or four hours for an adult. If too serious gastric and cerebral symptoms manifest themselves, the drug may be decreased in amount or discontinued until the unpleasant action subsides. It is better, except in acute articular rheumatism, to give a small dose, repeated frequently, than to administer a full dose at once. The physiological action and therapeutics of lithium salic- ylate are practically the same as those of salicylic acid or sodium salicylate. It is, however, richer in salicylic acid than the sodium salt, and in gout and chronic rheumatism has been found to be of more value than salicylic acid. It should be given in solution. Sodium salicylate is identical in physiological action and 320 A TEXT-BOOK OF MATERIA MEDICA. uses with salicylic acid, with the exception that it is less irritating to the stomach, and is therefore ordinarily to be preferred to the acid. It may be prescribed in aromatic water, in syrup, or in powder, pills, or capsules. Salol-Salol-Salol. U. s. P. (Phenyl Salicylate.) Origin.—The Salicylic Ether of Phenol, prepared by heating Salicylic Acid with Phenol in the presence of Phosphorus Penta- chloride. Description and Properties.—A white, crystalline powder, odorless, or having a faintly aromatic odor, and almost tasteless. Permanent in the air. Almost insoluble in water; soluble in io parts of alcohol; also in 0.3 part of ether, and readily in chloro- form and in fixed or volatile oils. Dose.—3-15 grains (o. 19-1.0 Gm.). Physiological Action.—Externally and Locally.—It is a more powerful antiseptic than either of its constituents. Nencki claims that it is not a germicide, as it will not destroy bacteria when present, although it prevents their formation. It is not, like sali- cylic acid, irritating to the mucous membranes. Internally.—The action of salol is essentially like that of salicylic acid, but it is a more powerful antipyretic, analgesic, and cerebro- spinal sedative. It reduces temperature much more promptly, the antipyretic action occurring within fifteen minutes after a full medi- cinal dose has been taken. The effect, however, is not prolonged, repeated doses being required to maintain the reduction of tem- perature. The circulation is, perhaps, not so much depressed as by sali- cylic acid. The respirations are at first quite rapidly increased, and are rendered very shallow, requiring some time to resume their normal condition. It is converted by the pancreatic and intestinal juices into its original constituents—salicylic acid and carbolic acid. It is usu- ally absorbed and eliminated very rapidly, having been detected in the urine in the form of salicyluric acid and phenol-ether-sul- phuric acid within thirty minutes after its ingestion by the stomach. To the latter acid is due the dark, smoky color of the urine which sometimes exists under large or continued doses of salol. Therapeutics.—Externally and Locally.—Salol is especially ANTISEPTICS. 321 recommended as an antiseptic dressing for wounds, burns, venereal ulcers, and buboes. Powdered salol or an ointment— 1 part to 150 parts of petrolatum—has been used in cases of tubercular laryngitis and ozena. Like salicylic acid, it is also of value in eczema and sycosis simplex. Internally.—It is an efficient remedy in all diseases benefited by the internal administration of salicylic acid. In addition to these services it is a valuable remedy in acute and chronic cystitis, gonor- rhea, intestinal catarrh, especially duodenal catarrh and catarrhal jaundice, and to relieve the pains of neuritis and myalgia. Salol is much more useful than salicylic acid in diarrhea, cholera morbus, and cholera, the latter disease yielding better, perhaps, to this remedy than to any other. Administration.—It may be given in pills, capsules, powders, emulsion, or suspended in milk. The compressed tablets of this drug so extensively used at present are not recommended, owing to their slow and difficult solution. Saliclnum—Saliclni—Salicin. U. S. P, Origin.—A Glucosid obtained from several species of Salix (willow) and Populus (poplar). Description and Properties.—Colorless or white, silky, shining, crystalline needles, or a crystalline powder, odorless and having a very bitter taste. Permanent in the air. Soluble in 28 parts of water, 30 parts of alcohol, 0.7 part of boiling water, and in 2 parts of boiling alcohol. Dose.—10 grains-2 drachms (0.6-8.0 Gm.). Physiological Action.—Its physiological effect is analogous to that of salicylic acid, but is much less active than the latter. It does not disturb digestion, but in moderate doses promotes appe- tite and acts like other bitters. It is more rapidly absorbed than salicylic acid, is partly decomposed, and is found in the urine, as salicin and salicylic acid, in from fifteen to thirty minutes after the ingestion of a single dose. Therapeutics.—While inferior to salicylic acid in most respects, salicin is frequently used for the same purposes. It is superior to, and safer than, salicylic acid in acute rheumatism characterized by a weak heart and depressed vaso-motor system. It is an excellent stomachic tonic, and may be used like other bitters in the treatment of atonic dyspepsia and other conditions benefited by this class of drugs. 21 322 A TEXT-BOOK OF MATERIA MEDICA. Contraindications.—In acute inflammatory affections of the brain and ear. Administration.—Salicin may be administered in powders, cap- sules, or solution. Owing, however, to its bulk and intensely bitter taste, it is perhaps best given in suspension in the aromatic elixir of liquorice or in syrup of yerba santa. Naphtallnum—Naphtalini—Naphtalin. U. s. P. Origin.—A hydrocarbon obtained from coal-tar. Description and Properties.—Colorless, shining, transparent laminae, having a strong, characteristic odor resembling that of coal-tar, and a burning, aromatic taste; slowly volatilized on expo- sure to air. Insoluble in water, but when boiled in it imparting a faint odor and taste. Soluble in 15 parts of alcohol, and very soluble in boiling alcohol; also very soluble in ether, chloroform, carbon disulphide, and in fixed or volatile oils. Naphtalin vola- tilizes slowly at ordinary temperatures, but rapidly when heated. Its vapor is inflammable, burning with a luminous and smoky flame. It should be kept in well-stoppered bottles. Dose.—2-10 grains (0.12-0.6 Gm.). Naphtol—Naphtol—Naphtol. U. S. P. (Beta-naphtol.) Origin.—A phenol occurring in coal-tar, but usually prepared artificially from naphtalin. Description and Properties.—Colorless or pale buff-colored, shining, crystalline laminae, or a white or yellowish-white crystal- line powder, having a faint, phenol-like odor, and a sharp, pungent, but not persistent taste. Permanent in the air. Soluble in about 1000 parts of water, in 0.75 part of alcohol, in about 75 parts of boiling water, and very soluble in boiling alcohol, ether, chloro- form, and solutions of caustic alkalies. It should be kept in dark amber-colored, well-stoppered bottles. Dose.—2-10 grains (0.12-0.6 Gm.). Allied Compounds. Alumnol.—An almost colorless, non-hygroscopic powder; readily soluble in cold water or glycerin, less soluble in alcohol, and insoluble in ether. It is employed as a local remedy in solutions varying in strength from I to 50 per cent. Used externally. Asaprol.—A colorless, neutral crystalline powder, soluble in l\ parts of water and in 3 parts of alcohol.—Dose, 15-60 grains (1.0-4.0 Gm.). Benzonaphtol.—Obtained by the action of Benzoic Chloride on Beta-naphtol in a ANTISEPTICS. 323 sand-bath. It is an odorless, tasteless, white, crystalline powder, or occurs in the form of long needles. Insoluble in cold water. Dose, 4-8 grains (0.18-0.5 Gm.). Betol (Naphtosaiol—Salinaphtol).—A substance analogous to salol, and pre- pared in the same manner, except that sodium-naphtol is used instead of sodium-phenol. It occurs as a colorless, odorless, tasteless, lustrous crystalline powder. Insoluble in water or glycerin, and with difficulty soluble in cold alcohol. Dose, 2-5 grains (0.12- 0.3 Gm.). Camphorated Naphtol.—Obtained by mixing 1 part of Beta-naphtol with 2 parts of Camphor. It is a brownish, transparent, syrupy liquid. Hydronaphtol.—A derivative of beta-naphtol, obtained by the action of reducing agents. It occurs in scale-like crystals, of a silvery white or grayish hue, of slightly aromatic odor and taste. Soluble in 1100 parts of water, and freely soluble in alcohol, ether, glycerin, benzene, chloroform, and fixed oils. Dose, 2-3 grains (0.12-0.18 Gm.). Antagonists and Incompatibles.—Physiological antagonists of naphtalin are the same as for other members of this group. Naphtol is incompatible with subacetate of lead. Synergists.—Carbolic acid and its derivatives. Physiological Action.—Naphtalin is antiseptic, antifermenta- tive, disinfectant, and deodorant. Its action is quite similar to salol, it being insoluble in the gastric juices but to some extent soluble in the intestines, where it acts as an antiseptic by local contact, deodorizing the stools and often imparting to them its ovvn odor. It is absorbed to some extent, and is eliminated by the lungs and kidneys, but escapes principally in the feces. It is broken up into naphtol or phenol, and acts as a local antiseptic and disinfec- tant at points of elimination, but does not occasion any local irri- tation unless quite large doses have been taken: "15 grains (i.O Gm.) daily have occasioned frequent micturition, with burning pain, vesical tenesmus, and redness of the urethral orifice." Purdy states that in certain cases of genito-urinary disease he has known a dose of 5 grains (0.32 Gm.) to cause severe suffering along the whole urinary tract. It is a stimulant expectorant, and differs from other members of the group in that it possesses no antipyretic action. Naphtol is quickly absorbed when applied locally. It produces considerable irritation when used in solution, but has no irritating effect when applied in the form of ointment. Toxic effects may result from its absorption by the skin, their character resembling the action of carbolic acid. Alumnol.—An astringent antiseptic. Asaprol.—An antipyretic, analgesic, and antiseptic. It is considered superior to the salicylates in these respects, having the advantage of neither exciting vomiting nor disturbing the brain or the auditory apparatus. Benzonaphtol.—Antiseptic, diuretic, and but slightly poisonous. 324 A TEXT-BOOK OF MATERIA MEDICA. Betol.—Action almost identical with that of salol. Hydronaphtol.—A powerful non-irritating, non-corrosive, and non-poisonous anti- septic, said by Dr. Fowler to possess "antiseptic properties fifteen times greater than carbolic acid.''' Dr. Levis claims that it is thirty times as antiseptic as salicylic acid, and that this property exceeds that of boric acid sixty times, of alcohol six hundred times, and that in this respect it ranks next to mercuric chloride. Therapeutics.—Externally and Locally.—N aphtali n in alcoholic solution is advised by Henri Laserre in the treatment of chronic abscesses and adenitis. It is also recommended in the treatment of scabies and other parasitic skin diseases. Internally.—It is used in typhoid fever and in the gastro-intestinal and genito-urinary disorders for which salol and carbolic acid are administered, such as chronic diarrhea and dysentery, acute or chronic cystitis, etc. The internal uses of naphtol are the same as those of naphtalin, while externally it may be employed, like carbolic acid or creasote, as a general antiseptic in cutaneous disorders, whether organic or parasitic, Aliimnol.—An efficient remedy in many acute and chronic injlammatory diseases op the skin, and in gonorrhea, chancres, syphilitic ulcers, balanitis, etc. A I per cent. solution may be injected in gonorrhea, while stronger solutions (10-50 per cent.), or alumnol plaster, are recommended in chronic diseases of the skin. Asaprol.—Given for the same purposes as salicylic acid and the salicylates, although it is not so uniformly successful in acute articular rheumatism, while having the advan- tage of causing less heart-depression. Betol.—Used chiefly in the bowel complaints of children. It may be administered either by the mouth or through the rectum, associated with bismuth or antacids. It has been used also in acute articular rheumatism and bladder affections. Camphorated naphtol is considered by some practitioners to be superior to all other remedies to prevent suppuration in acute tonsillitis. Fernet has employed it successfully in tubercular ulcerations of the tongue, while Reboul of Marseilles and others have adopted it with good effect hypodermically in tuberculous adenitis and tuberculosis of the testis. It has also been used in tuberculosis of the bladder, joints, etc. Ruault claims it to be an efficient local application to the turbinated bones in ozena. Hydronaphtol.—Considered by many physicians to be superior to carbolic acid, since it is without disagreeable odor and can be used without exciting irritation or danger of toxic impression. Dockrell employs it in the form of a plaster for destroying the trichophyton fungus of tinea tonsurans, and believes it to be superior to mercuric chloride as a germicide. It has been used as a preventive of dental caries, and in the treatment of gingivitis, pyorrhea alveolaris, diphtheria, etc. Internally it has been recommended in dysentery, diarrhea, pulmonary tuberculosis, and typhoid fever. 1 New York Med. Journ., Oct. 3, 1885. ANTISEPTICS. 325 Contraindications.—These preparations should not be given internally when the functional activity of the kidneys is defective. Administration.—Naphtalin is best given internally in the form of pills or in capsules. When it is necessary to use it topi- cally, the offensive odor of the drug may be disguised, it is said, by triturating it with a small quantity of the oil of bergamot. Naphtol should be given in capsules, in the dose recommended, three times a day or oftener if necessary. Asaprol, betol, and hvdronaphtol are best given in capsules, although betol, which is tasteless and insoluble in water, may be administered in the form of powders. ResorcTnum—ResorcTni—Resorcin. U. S. P. Origin.—Prepared by melting Galbanum, Ammoniac, or Guai- acum Resin with Potassa. It is also prepared in a similar mariner from Asafetida, Sagapenum, Ascaroid Resin, and from Phenol- sulphonic Acid and other derivatives of Phenol. Description and Properties.—Colorless or faintly reddish, needle- shaped crystals, or rhombic plates, having a faint, peculiar odor, and a disagreeable sweetish and afterward pungent taste. Resorcin acquires a reddish or brownish tint by exposure to light and air, and should be kept in dark amber-colored vials. It is soluble in 0.6 part of water, 0.5 part of alcohol, very soluble in boiling water and in boiling alcohol, readily soluble in ether and in glycerin, and very slightly soluble in chloroform. The aqueous solution is neutral or only faintly acid to litmus-paper. Dose.—3-8 grains (0.2-0.5 Gm.). Allied and Derivative Compounds. Hydroquinol—Hydroquinone—HydrochTnone—Paradioxybenzene.—Color- less, odorless, dimorphous crystals, having a sweetish taste. Soluble in 17 parts of water, and very soluble in hot water, alcohol, and ether. Dose, 1^-5 grains (0.03-0.30 Gm.), Catechol—Pyrocatechin—Orthodioxybenzene.—Acicular crystals, readily solu- ble in water, alcohol, and ether. Other allied compounds are—Thioresorcin, Resopyrine, and Fluorescein. Antagonists.—Cerebral excitants, cardiac and respiratory stim- ulants. Synergists.—Salicylic acid, quinine, carbolic acid. Physiological Action.—Externally and Locally.—Resorcin is an antiferment, antiseptic, deodorant, a feeble analgesic, and a parasiti- cide. Applied to the unbroken skin, it is non-irritating, is not ab- 326 A TEXT-BOOK OF MATERIA MEDICA. sorbed by it, and when injected into the subcutaneous tissues produces but little irritation, with no suppuration. Applied to the moistened mucous membrane, its action is similar to that of car- bolic acid, producing vesication, etc Internally.—The physiological properties of resorcin are allied to those of carbolic acid. It possesses more marked antipyretic and diaphoretic actions than carbolic acid, but when used to pro- duce these effects it greatly depresses the heart. Its chief action is on the nervous system, which it first power- fully stimulates and then depresses. It is mainly and rapidly eliminated by the urine, which it colors an olive-green or bluish-violet hue. Poisoning.—Poisonous doses produce vertigo, ringing in the ears, deafness, disturbance of vision, weak, rapid, and irregular pulse, respiration at first convulsive and jerking, afterward accelerated, shallow, and weak, death resulting finally from respiratory failure. There are great mental anxiety, epileptiform convulsions, collapse, and unconsciousness. Just before death there is a rise in temper- ature, doubtless due to excessive muscular action, although the temperature may fall below normal if there is quiet narcosis, as there may be in some instances. Treatment of Poisoning.—Hypodermic injections of atropine. The administration of diffusible stimulants. Artificial respiration. Therapeutics.—Externally and Locally.—Resorcin is especially useful in certain subacute or chronic skin affections, and may be used like salicylic acid in indurated eczema. It is of great value in psoriasis, seborrhcea sicca, pityriasis capitis, sycosis, acne rosacea, etc. A 5 to i o per cent, solution is an efficient application in pharyn- gitis, diphtheria, and ulcerative laryngitis. An ointment of resorcin is an excellent application to foul ulcers, sloughing wounds, and syphilitic ulcers. Condylomata have been cured by dusting upon them powdered resorcin. A mixture of powdered resorcin and boric acid (i : 20 or 1 : 10) has been used with brilliant results in suppuration of the middle ear. A 2 per cent, solution has been found useful in the form of a spray in whooping cough, while stronger solutions of 10 or 20 per cent, have been used with some success in hay fever. Solutions of resorcin have been used in gonorrhea and cystitis. Internally.—Resorcin is preferable to carbolic acid for internal administration, especially in digestive disorders such as gastralgia, ANTISEPTICS. 327 chronic gastritis, ulcer of the stomach, and fermentative dyspepsia, so called. Owing to its sedative and antifermentative properties, it is of value in acute diarrhea of children. It has been used with some success in intermittent fever, but not with good results sufficiently uniform to justify the exclusion of quinine. As an antipyretic it may be used when a drug of that character is indicated, but it is not equal to antipyrine or acetanilid, and in doses sufficient to produce the desired reduction of temper- ature it is too depressant to the heart. Its chief therapeutic value is for external or local use, and internally for the digestive disorders above mentioned. Administration.—It should be given in pills or capsules. Ichthyolum—Ichthyoli—Ichthyol. (Unofficial.) Origin.—It is obtained by the destructive distillation of bitumin- ous rock found near Seefeld in the Tyrolese Alps, which contains enormous quantities of semi-fossilized fishes and marine animals. Description and Properties.—It occurs in the form of a brown- ish-yellow, transparent, oily liquid, containing about 10 per cent, of sulphur. Upon being treated with concentrated sulphuric acid ichthyol is converted into ichthyol-sulphonic acid, which readily combines with ammonia and other alkalies, as well as with lithium, zinc, mercury, etc., forming the ammonium ichthyol, sodium ichthyol, zinc ichthyol, etc. Ammonium ichthyol occurs as a clear reddish-brown, syrupy liquid with a bituminous odor and taste. Soluble in water and in a mixture of equal volumes of ether and alcohol. Dose.—2-10 minims (0.12-0.6 Cc). The other salts of ichthyol-sulphonic acid occur as brownish or black tar-like masses, the sodium salt being the most important, as it is the one most employed when ichthyol is desirable in pill form. Dose.—Sodium ichthyol, 2-4 grains (0.1-0.25 Gm.). Allied Drugs. Thiolum—Thioli—Thiol.— Origin.—This substance is prepared by heating brown-colored paraffin or gas oils with Sulphur, and extracting the sulphurated, unsatu- rated hydrocarbons with Alcohol. Description and Properties.—It occurs as a neutral, solid body, non-hygroscopic and soluble in water, and of a dark-brown color, or in the form of a dark reddish- brown, syrupy liquid, containing about 40 per cent, of thiol. 328 A TEXT-BOOK OF MATERIA MEDICA. Dose.—£-1 grain (0.03-0.06 Gm.). Tumenolum—Tumenoli—Tumenol.—Origin.—It is obtained from purified mineral oils by the direct action of concentrated sulphuric acid, without previous sul- phuration, being a mixture of sulphones and sulphonic acids. Description and Properties.—A dark-brown or blackish-brown liquid of a syrupy consistency. Dose.—It is used only externally, in strengths of from 5 to 10 per cent. Antagonists and Incompatibles.—Ichthyol possesses marked reducing properties, and should not therefore be combined with substances, like potassium permanganate, which part readily with oxygen. Synergists.—Most members of this group, particularly the tars, carbolic acid, creasote, etc., aid its action. Physiological Action.—Externally and Locally.—Ichthyol is ischemic, sedative, parasiticide, and possesses antiseptic and prob- ably disinfectant properties. When applied to the skin in full strength it produces some irri- tation. It is readily absorbed, having the power to penetrate the skin, affecting the deeper tissues beneath. Internally.—Digestive System.—Very large doses produce con- siderable gastro-intestinal irritation. Circulatory System.—It has the power in medicinal doses of contracting the caliber of the arteries, and in large doses it increases the migration of the white blood-corpuscles. The physiological action has not been fully studied, and it is not yet positively known what action it has upon the nervous and respiratory systems and upon temperature. Therapeutics.—Externally and Locally.—Ichthyol was intro- duced by Unna as a valuable remedy in certain diseases of the skin. It is particularly useful in erythematous eczema, erysipelas, lupus erythematosus, irritable acne, and certain forms of acne rosacea. Agnew has employed it with advantage in lymphatic enlarge- metits. It has also been found useful in synovial inflammations, in- flammatory conditions of the female genital organs, and in certain diseases of the ear and nose. Thiol, although inferior, is similar to ichthyol in its therapeutic action. It has been found to be valuable in the treatment oi herpes zoster, dermatitis herpetiformis, and erythema multiforme. Administration.—Ichthyol, when given internally, should be dispensed in capsules, while thiol may be given in capsules, pills, or wine. Externally, ichthyol may be employed in solution, dissolved in ANTISEPTICS. 329 chloroform or in a mixture of alcohol and ether, and applied with a brush ; or in the form of an ointment mixed with soft petrolatum or lanolin in from 1-4 to 8 drachms (4.0-15.0 Cc. to 32.0 Gm.). It is used also in the form of a soap in from 5 to 20 per cent, strength. Thiol is used locally in powder form, or as an ointment of 5 to 10 per cent, of the liquid, or in collodion containing 5 per cent, of the powder, or in solutions of glycerin and aqueous solutions con- taining from 5 to 50 per cent, of the powder. Iodoformum—Iodoformi—Iodoform. U. S. P. Origin.—It is obtained by the action of Iodine, in the presence of fixed alkalies or alkali carbonates, upon Alcohol or Acetic and other easily-saponifiable Ethers. Description and Properties.—Small, lemon-yellow, lustrous crystals, of the hexagonal system, having a peculiar, very pene- trating, and persistent odor, somewhat resembling that of saffron and iodine, and an unpleasant, slightly sweetish, and iodine-like taste. It is very slightly soluble in water, to which, however, it imparts its odor and taste; soluble in about 52 parts of alcohol, in about 12 parts of boiling alcohol, or in 5.2 parts of ether, and very soluble in chloroform, benzin, and fixed and volatile oils. Iodoform is slightly volatile, even at ordinary temperatures, and in boiling water distils slowly over with its vapor. It should be kept in well-stoppered bottles, in a cool and dark place. Iodoform contains 96.69 per cent, of its weight as iodine. Dose.—1-3 grains (0.06-0.2 Gm.). Official Preparation. UnguSntum Iodof6rmi—UnguSnti Iodofftrmi—Ointment of Iodoform.—10 per cent. Used externally, Allied Compounds. Antis&ptol—Cinchonine Iodosulphate.— Origin.—It is prepared by mixing an aqueous solution of Cinchonine Sulphate with an aqueous solution of Iodine and Potas- sium Iodide, and washing and drying the resulting precipitate. Description and Properties.—It occurs as a light reddish-brown powder, insoluble in water, but soluble in alcohol and chloroform. It contains about 50 per cent, of iodine. Dose.—1-3 grains (0.06-0.2 Gm.). Arlstol—Dithymol Di-iodide.— Origin.—It is obtained by adding a solution of iodated Iodide of Potassium to an aqueous solution of Hydrate of Sodium containing thymol. The resulting precipitate is washed and subsequently dried at ordinary tem- perature. Description and Properties.—A dark, brownish-red, amorphous, almost tasteless powder, of a slight, peculiar, iodine-like odor, insoluble in water and glycerin, sparingly 330 A TEXT-BOOK OF MATERIA MEDICA. soluble in alcohol, but readily soluble in ether, collodion, and chloroform. It is also taken up by fixed oils, petrolatum, etc. Aristol is decomposed by heat and light, and it should be kept in dark amber- colored, well-stoppered bottles. It contains 45.8 per cent, of iodine. Dose.—It is not given internally. Eiirophen.—Prepared in a manner analogous to that of preparing aristol, except that isobutylorthocresol is used in place of thymol. Description and Properties.—An amorphous, yellow powder, having an odor resem- bling saffron; soluble in ether, chloroform, and fixed oils; insoluble in water and glycerin. It is permanent in dry air, but when moistened with water resolves into iodine, forming a new soluble iodine compound. When heated to 1100 C. (2300 F.) it melts, forming a clear brown liquid. It contains 27.6 per cent, of iodine. Dose.—\-\\ grains (0.016-0.09 Gm.). It is used hypodermically in olive oil, and externally in the form of an ointment, in strengths varying from 3 to 10 per cent. Antagonists and Incompatibles.—It is incompatible with the preparations of mercury and zinc, with metallic oxides, and with starch. Iodol.— Origin.— Obtained by the interaction of Iodine and Pyrrol (a constituent of mineral oil) in Alcoholic Solution for twenty-four hours, the iodol being precipitated upon the addition of Water; or it may be prepared after the manner of preparing aristol, except that Pyrrol is used instead of Thymol. Description and Properties.—It is a pale-yellow or grayish-brown, more or less crystalline, bulky, tasteless, and odorless powder. It is insoluble in water, and but slightly soluble in diluted alcohol. It is soluble in alcohol and ether. The alcoholic solution is miscible with glycerin, but when mixed with water a milky precipitate is formed. Iodol contains 88.97 Per cent, of iodine. Dose.—I£-2 grains (0.03-0.12 Gm.). Ldsophene.— Origin.—Prepared by slowly adding an aqueous solution of Iodine and Iodide of Potassium to an aqueous solution of Ortho-oxyparatoluic Acid and Sodium Bicar- bonate. The precipitate formed is washed with Water and recrystallized from Alcohol. Description and Propei'ties.—It occurs as colorless, odorless, needle-shaped crystals. Insoluble in water and alcohol, but readily soluble in ether, benzene, chloroform, and fixed oils. It contains 78.39 per cent, of iodine. Dose.—It is used externally. Sozolodol.—Origin.—A combination of Iodine 54 per cent., Carbolic Acid 20 per cent., and Sulphur 7 per cent. Description and Properties.—The sodium, potassium, ammonium, mercury, lead, and zinc salts of this acid are the preparations used, the sodium salt being the one most commonly employed. The sodium sozoiodolate occurs in bright, prismatic, needle-shaped crystals. Soluble in water, alcohol, and glycerin. Dose.—For external use, in strengths varying from 3 to 20 per cent. Sulphaminol.— Origin.—It is formed by the action of Sulphur on the salts of Meta- oxydiphenylamine. Description and Properties.—It is a yellow powder, insoluble in water, readily solu- ble in alkalies, alcohol, and glacial acetic acid. Dose.—1-4 grains (0.006-0.25 Gm.). Antagonists and Incompatibles.—Iodoform is incompatible with mercuric chloride. Physiological Action.—Externally and Locally.—Iodoform or- dinarily possesses no irritating action when applied to the skin or ANTISEPTICS. 331 mucous membranes, or to ulcers and wounds. On the contrary, it possesses analgesic properties. It has a tendency to check serous oozing when applied to wounds. Internally.—Digestive System.—Small doses, if they have any effect, slightly increase the appetite, and tend to increase the sali- vary, biliary, and intestinal secretions. Large doses disturb the stomach, and may occasion nausea, vomiting, and diarrhea. Circulatory System.—Small doses retard and strengthen the pulse, and, for a brief period only, increase arterial tension. Full medicinal doses lessen arterial tension and render the pulse slower and weaker. Lethal doses rapidly accelerate the pulse, causing it to become irregular; later, the action of the heart is slowed, and finally arrested in diastole, from paralysis of the cardiac muscle. Nervous System.—Large doses are apt to produce headache, restlessness, delirium, or stupor. The reflexes ma}- be depressed, or in some cases choreic movements may appear. Muscular con- tractility and the excitability of the nerve-centers to external stimu- lation are lessened. Respiratory System.—Very large doses produce convulsive res- piratory movements. Absorption and Elimination.—Iodoform is absorbed from the stomach, or from mucous membranes or wounds to which it is applied. It is slowly absorbed from the alimentary canal, but readily absorbed from wounds. In the tissues it combines with the proteid molecules, and is retained in the system as potassium iodide and other iodides. It is eliminated in all the secretions, and has been detected in the urine and saliva within one hour after its administra- tion, traces of it being perceptible in the secretions for three days. Iodine is liberated at the points of elimination, either as an iodate or as some organic compound of iodine, or both. The drug is also detected in the breath, though it is chiefly eliminated in the urine as alkaline sodium iodate, coloring the urine yellow. It should be remembered that iodoform is absorbed much more rapidly than it is eliminated. Temperature.—Large doses cause a rise of temperature, while poisonous doses may, at the last, produce a decided reduction of animal heat. Untozvard Action.—Sometimes iodoform excites an eczematous eruption, which may be papular or erythematous, and symptoms of vertigo. Muscular weakness and double vision have also been observed; sleepiness, alternating with excitement; incoherence of speech; headache; mental confusion ; and amblyopia. 332 A TEXT-BOOK OF MATERIA MEDICA Poisoning.—Three forms of poisoning by iodoform are described by Duret—the eruptive, the cerebral, and the syncopal. In the first of these there may be a severe and extensive ery- thema or eczematous eruption. The cerebral variety is character- ized by rapid increase of temperature and accelerated pulse—as high as 150 or 175 per minute; great irritation of the gastro-intes- tinal tract; widely dilated, or motionless and contracted, pupils; intense headache over the entire circumference of the head; mel- ancholia ; great depression of spirits; hallucinations and active delirium or suicidal mania. In the syncopal variety the patient complains of dizziness and mental confusion ; is languid and weak ; the heart's action becomes very rapid and feeble, the patient passing at length into a lethargic or comatose condition, with paralysis of the sphincters, and finally dying, perhaps quite suddenly. The symptoms of poisoning may appear soon after the applica- tion of the drug, or they may be deferred for days and even weeks. In the latter case, which may properly be termed chronic poison- ing, the patient is more apt to be melancholy, weak, and apathetic, with slight fever and accelerated pulse. Old people are the more susceptible to its toxic influence. Treatment of Poisoning.—Every particle of the drug should be immediately removed from the body or its internal administration be discontinued at once. Stimulants, diaphoretics, and diuretics should be given, with frequent bathing of the body in warm water, to hasten elimination. Opium and large doses of potassium bicar- bonate have been recommended. Therapeutics.—Externally and Locally.—Iodoform acts as an alterative, analgesic, protectant, antiseptic, and germicide to at least some forms of bacilli. It is therefore one of the best applications to wounds, ulcers, etc. It is especially valuable in the treatment of tubercular affections, such as tubercular joints, when it is used in the form of an injection—10 to 20 per cent.—in sterilized olive oil. In tubercular parenchymatous synovitis the mixture is injected di- rectly into the joint-cavity. Rinonapoli recommends a 10 per cent, ethereal solution in malignant pustule, injected hypodermically into the base of the tumor; while Terrier and Mosetig von Moorhof have both used it successfully in parenchymatous goiter. Iodoform is an exceedingly valuable application to syphilitic ulcers, chancres, chancroids, suppurating buboes, ulcerations of the uterus, uterine cancer, and indolent and irritable ulcerations of the leg. ANTISEPTICS. 333 Incorporated in a suppository, it is very efficacious in painful hemorrhoids, fistula, and fissure of the anus. It is a valuable application in many diseases of the ear, nose, throat, eye, and skin where a drug of this character is indicated. Internally.—Iodoform is used but very little internally, although it has been employed in phthisis, hemoptysis, syphilis, catarrhal jaundice, hepatic cirrhosis, gastric catarrh, diabetes, and as an intes- tinal antiseptic. The allied compounds mentioned above are used locally as sub- stitutes for iodoform. Most of them possess the great advantage of being odorless, and some of them seem to be in all respects quite as efficient as iodoform. Aristol is undoubtedly superior to it in the treatment of indolent ulcers and in many diseases of the skin, car, nose, and throat. Europhen and iodol should certainly replace iodoform in many cases. Administration.—Internally, iodoform should be given in pills or capsules. Externally, it may be used in the form of a powder, alone or mixed with powdered borax or boric acid. It is also used in the form of an ointment or collodion. It is given hypodermi- cally, mixed with olive oil and glycerin, or dissolved in ether, in strengths varying from io to 30 per cent. Its disagreeable odor may be modified or disguised by mixing it with tar, liquid styrax, balsam of Peru, thymol, coumarin, menthol, ground coffee, oil of lavender, bergamot, bitter almond, coriander, musk, vanilla, or some similar aromatic and pleasantly odorous substance. BenzoTnum— Benzoini—Benzoin. U. S. P. Origin.—A balsamic resin obtained from Styrax Benzoin Dry- ander, a large tree indigenous in Sumatra and Java, and probably also in Cochin China and Siam. Description and Properties.—Benzoin exudes from incisions in the bark, and upon exposure to the air hardens into lumps con- sisting of agglutinated, yellowish-brown tears, which are internally milk-white, or in the form of a reddish-brown mass, more or less mottled from whitish tears imbedded in it. It is almost wholly soluble in 5 parts of moderately warm alcohol and in solutions of the fixed alkalies. When heated it gives off fumes of benzoic acid. It has an agreeable balsamic odor and a slight aromatic taste. Benzoin is of the nature of a balsam, containing from 20 to 24 per cent, of benzoic acid, resin, and volatile oil. Some varieties 334 A TEXT-BOOK OF MATERIA MEDICA. contain cinnamic acid, which is undesirable, while the benzoin from Siam contains vanillin and possesses the odor of vanilla. Dose.—Benzoin is never administered in substance. Official Preparations. Adeps Benzoinatus—Adipis Benzoinati—Benzoinated Lard (2 per cent.).— For external use. Tinctura Benzoini—Tincturae Benzoini—Tincture of Benzoin.—Dose, 30 minims to I fluidrachm (2.0-4.0 Cc). Tinctura Benzoini Comp6sita—Tincturae Benzoini Compdsitae—Com- pound Tincture of Benzoin.—Benzoin, 2; Aloes, 2; Storax, 8; Tolu, 4; Alcohol, 74 parts. Dose, \-2 fluidrachms (2.0-8.0 Cc). Antagonists and Incompatibles.—The tincture and compound tincture are incompatible with aqueous preparations, the benzoins and other resins and balsams being precipitated from their alcoholic solutions by water. Physiological Action.—The action of benzoin is due to the benzoic acid which it contains, and will therefore be considered under Benzoic Acid. Acidum Benzoicum—Acidi Benzoici—Benzoic Acid. U. S. P. Origin.—An organic acid usually obtained from Benzoin by sublimation, or prepared artificially, chiefly from Toluol. Description and Properties.—White or yellowish-white lus- trous scales or friable scales, having a slight characteristic odor resembling that of benzoin, and of a warm, acid taste; somewhat volatile at a moderately warm temperature, and rendered darker by exposure to light. Soluble when pure in about 500 parts of water, in 2 parts of alcohol at about 150 C. (590 F.), in 15 parts of boiling water, and in 1 part of boiling alcohol. It is also soluble in 3 parts of ether, 7 parts of chloroform, and readily soluble in carbon disulphide, in benzol, and in fixed and volatile oils. Sparingly soluble in benzin. Benzoic acid has an acid reaction and is inflammable. It should be kept in dark amber-colored, well-stoppered bottles and in a cool place. Dose.—5-15 grains (0.3-1.0 Gm.). Ammonii Benzoas—Ammonii Benzoatis—Ammo- nium Benzoate. U.S. P. Origin.—Dissolve Benzoic Acid in Water of Ammonia and Dis- tilled Water, evaporate, and crystallize. ANTISEPTICS. 335 Description and Properties.—Thin, white, four-sided laminar crystals ; odorless, or having a slight odor of benzoic acid; a sa- line, bitter, afterward slightly acrid taste, and gradually losing am- monia on exposure to air. Soluble, at 150 C. (590 F.), in 5 parts of water, in 28 parts of alcohol, in 1.2 parts of boiling water, and in 7.6 parts of boiling alcohol. The salt is neutral or has a very slight reaction upon litmus-paper. It should be kept in well- stoppered bottles. Dose.—10-20 grains (0.6-1.2 Gm.). Lithii Benzoas—Lithii Benzoatis—Lithium Benzoate. U. S. P. Origin.—Prepared by decomposing Lithium Carbonate with Benzoic Acid. Description and Properties.—A light white powder, or small, shining, crystalline scales ; odorless or of a faint, benzoin-like odor, and of a cooling, sweetish taste; permanent in the air. Soluble in 4 parts of water, in 12 parts of alcohol, in 2.5 parts of boiling water, and in 10 parts of boiling alcohol. The presence of sodium ben- zoate increases the solubility in water and lessens it in alcohol. The aqueous solution (1 in 20) of lithium benzoate has a faintly acid reaction upon litmus. Dose.—5-20 grains (0.3-1.2 Gm.). Sodii Benzoas—Sodii Benzoatis—Sodium Benzoate. U.S. P. Origin.—Prepared by decomposing Sodium Carbonate with Benzoic Acid. Description and Properties.—A white amorphous powder, odorless or having a faint odor of benzoin and a sweetish, astrin- gent taste. Soluble in 1.8 parts of water, in 45 parts of alcohol, in 1.3 parts of boiling water, and in 20 parts of boiling alcohol. The aqueous solution is neutral to litmus-paper. It is efflorescent, and should be kept in well-stoppered bottles. Dose.—5-30 grains (0.3-2.0 Gm.). Allied and Unofficial Preparations. Bismuthi BSnzoas—Bismuthi Benzoatis—Benzoate of Bismuth. MSnthol B&nzoas—MSnthol Benzoatis—Benzoate of Menthol.—For exter- nal use. Antagonists and Incompatibles.—Benzoic acid is incompatible 336 A TEXT-BOOK OF MATERIA MEDICA. with the alkaline salts, as those of sodium, etc., and ammonium benzoate is incompatible with the ferric salts. Physiological Action.—Externally.—When applied in a con- centrated form to the skin or mucous membrane benzoic acid is an irritant, and produces a catarrhal condition of the bronchial mucous membrane when its vapors are inhaled. It is a powerful antiseptic and germicide, preventing the growth of putrefactive bacteria in a solution of I : iooo. Internally.—Digestive System.—In full medicinal doses benzoic acid irritates the throat and produces a sense of heat in the epi- gastrium. Very large doses may occasion gastric inflammation, with nausea and vomiting. The functional activity of the liver is stimulated by sodium benzoate. Circulatory System.—In large doses benzoic acid increases the pulse-rate to a marked extent, and is a stimulant to the entire circulatory apparatus. Respiratory System.—It is a powerful stimulant in moderate medicinal doses, increasing the respiratory movements and promot- ing the bronchial secretion. Absorption and Elimination.—It is eliminated chiefly by the kidneys, but also by the skin, salivary glands, and broncho-pul- monary mucous membrane. The important action of benzoic acid is the change it undergoes in the kidneys, being converted into hippuric acid, in combination with glycocoll. This change takes place only in the kidneys, and the hippuric acid formed renders alkaline urine acid, besides in- creasing the urinary flow and disinfecting and stimulating the genito-urinary tract. Temperature.—Like other members of this group, the acid, as well as its salts, possesses antipyretic properties, many observers holding it to be equal, if not superior, to salicylic acid in this respect. It is not yet known in what manner it reduces temper- ature. Untoward Action.—Benzoic acid sometimes produces urticaria or an erythematous condition of the skin. Therapeutics.—Externally and Locally.—The compound tinc- ture of benzoin is an admirable preparation for many conditions requiring antiseptic, astringent, and stimulating dressing. It is fre- quently applied to cutaneous zvounds, the alcohol evaporating and leaving upon the injured parts a protective film of balsams. A piece of lint or absorbent cotton saturated with the compound ANTISEPTICS. 337 tincture has been used to close the punctures in the skin after tenotomy. Stille recommends a combination of the compound tincture of benzoin and glycerin for the treatment of chapped hands and lips, frost-bite, and fissured and chapped nipples. R. W. Taylor treats " ringworm of the thighs " by painting the affected part with a mixture of bichloride of mercury and com- pound tincture of benzoin, 2-5 grains to 1 ounce (0.12-03 to 300 Cc). The compound tincture, diluted with water in various propor- tions, makes an efficient application in catarrhal affections of the pharynx and larynx, either in the beginning of an inflammation or during the relaxed condition which so often accompanies the ter- mination of an acute attack. The hoarseness of vocalists and public speakers, the result of excessive strain upon the vocal cords, is frequently relieved by this remedy. Inhalations of benzoin are a popular and frequently effective method of treating acute catarrhal inflammation of the upper respiratory passages. The cough and expectoration of chronic bronchitis and chronic phthisis are eased and lessened by inhaling night and morning a drachm (4 Gm.) of benzoic acid, added to boiling water. A preparation like the following is an efficient and agreeable lotion for irritative forms of chronic nasal catarrh : R. Sodii boratis, da. ~ij (60.0 Gm.) ; Acidi benzoici, gr. x (0.6 Gm.).—M. Fiat pulvis No. 1. Sig. To half a tumblerful of water add hall a teaspoonful each of the powder and glycerin. Use freely as a lotion. The simple tincture of benzoin is an excellent application to spongy gums. There is much evidence of the efficiency of bismuth benzoate as a dressing for chronic or sloughing ulcers. Specific sores, chancroids and chancres especially, are well treated by dust- ing the parts with the benzoate after thoroughly bathing the surface with a weak solution of bichloride of mercury. Probably the most important therapeutic action of benzoic acid is shown in the treatment of cystitis and pyelitis accompanied by decomposing and alkaline urine. The uric-acid diathesis is modified by this drug and its prepara- tions, particularly by the lithium benzoate. Phosphatic calculi 22 33& A TEXT-BOOK OF MATERIA MEDICA may be dissolved by the prolonged administration of ammonium benzoate, which is preferable to benzoic acid for this purpose. In- continence of urine, if due simply to the alkalinity of the urine, is relieved by the same remedy. Liegeois has employed sodium benzoate as a cholagogue with excellent results. He associates it with rhubarb. He also states that benzoate of sodium favorably modifies the pain of pharyngitis. Sodium benzoate is an excellent substitute for sodium salicylate, being especially useful in the septic diseases. It is equally power- ful as an antiseptic and antipyretic, though slower in its action than sodium salicylate. Its effects, however, are more permanent, and innocuous. Administration.—Benzoic acid is best administered in pill form or in capsules, with balsam of fir or Castile soap as an excipient. The soluble benzoates may be given in solution in some aromatic water or in compressed pills. The solution, however, is preferable, and the unpleasant taste may be well disguised by a little spirit of chloroform. When any of these preparations are given for their action upon the urinary tract, it may sometimes be advantageous to combine them with a urinary sedative, such as tincture of bella- donna or hyoscyamus. Myrrha— Myrrhae—Myrrh. U. S. P. Origin.—A gum-resin obtained from Commiphora Myrrha (Nees) Engler, a shrub or small tree " forming the chief underwood of the Arabian and African forests along the shores of the Red Sea." Description and Properties.—Roundish, irregular tears or masses, dusty brownish-yellow or reddish-brown; fracture waxy, somewhat splintery, translucent on the edges, sometimes marked with whitish veins ; odor balsamic ; taste aromatic, bitter, and acrid. It contains 60 per cent, of gum, 35 per cent, of resin, and 3 or 4 per cent, of a volatile oil (myrrhol). Dose.—5-30 grains (0.3-2.0 Gm.), in pills or emulsion. Official Preparations. Mistura Fgrri CompSsita—Misturae F6rri Compfisitae—Compound Iron Mixture.—Dose, \-z fluidounces (15-60 Cc). Pilulae Aloes et Myrrhae—Pilulas (ace) Aloes et Myrrhae—Pills of Aloes and Myrrh.—Dose, 2 to 5 pills. Tinctura Aloes et Myrrhae—Tincturae Aloes et Myrrhae—Tincture of Aloes and Myrrh (10 per cent.).—Dose, \-2 fluidrachms (2-8 Cc). ANTISEPTICS. 339 Tinctura Myrrhae—Tincturae Myrrhae—Tincture of Myrrh (20 per cent.).— Dose, 15-60 minims (1-4 Cc). Physiological Action.—Myrrh is astringent, disinfectant, slightly antiseptic, and stimulant. Its action resembles that of the aro- matics, stimulating the appetite and acting as a carminative, exces- sive doses causing nausea and vomiting. It increases the number of white blood-corpuscles, and is a stimulant to the circulation. The drug is eliminated by the mucous membranes generally, aug- menting and disinfecting their secretions. It possesses emmena- gogue properties. Therapeutics.—As a stimulant and astringent myrrh is service- able as a mouth-wash in ptyalism and spongy gums and in ozena. It is useful as a gargle in pharyngitis, relaxed throat, etc., and as an injection in leucorrhea, the latter disease, as well as cystitis, being favorably influenced by the internal administration of the drug. It has been used internally, with considerable success, as a stimulant expectorant in bronchorrhea and chronic bronchitis, and as a stom- achic in atonic dyspepsia. Administration.—Myrrh may be given internally in the form of an emulsion or pills. The tincture, either in full strength or diluted, is chiefly employed externally. Balsamum Peruvianum—Balsami Peruviani—Bal- sam of Peru. U. s. P. Origin.—A balsam obtained from Toluifera Pareinc (Royle) Baillon, a tree growing in Brazil and near the west coast of South America. Description and Properties.—A liquid having a syrupy con- sistence, free from stringency or stickiness, of a brownish-black color in bulk, reddish-brown and transparent in thin layers, of an agreeable, vanilla-like, somewhat smoky odor, and a bitter taste, leaving a persistent after-taste. On exposure to air it does not become hard. It is completely soluble in 5 parts of alcohol. The drug contains, among other substances, benzoic and cin- namic acids, cinnamein about 60 per cent, and resin 32 per cent. Dose.—8-30 minims (0.5-1.84 Cc). Physiological Action.—Its properties are similar to those of myrrh, its action being almost analogous. Therapeutics.—In various cutaneous disorders balsam of Peru is very efficient, being employed in pruritus vulva, eczema, scabies, ringzvorm, etc. It is remarkably efficacious as an application to 340 A TEXT-BOOK OF MATERIA MEDICA. cracked nipples, cracked lips, indolent sores, bed-sores, etc., and is also serviceable in certain diseased conditions of the nose and throat, such as atrophic rhinitis and tonsillar diphtheria. As a stimulant expectorant the drug is efficient in chronic bron- chitis, being regarded by some physicians as of great service in phthisis pulmonalis. Like myrrh, balsam of Peru has been used to some extent as a stomachic carminative and tonic. Administration.—It is best given in an emulsion or in glycerin. Eucalyptus—Eucalypti—Eucalyptus. U. s. P. Origin.—The leaves of Eucalyptus globulus Labillardiere, col- lected from the older part of the tree. The blue-gum tree is a rapid grower, attaining a height of 200 to 300 feet (60-90 M.). It is native to Australia, but is cultivated in various portions of Europe, Africa, and the United States with the view of rendering malarial districts habitable by its antiseptic exhalations. Description and Properties.—Petiolate, lanceolate, scythe- shaped, from 6 to 12 inches (15-30 Cm.) long, rounded below, tapering above, entire, leathery, grayish-green, glandular, feather- veined between the midrib and marginal veins; odor strongly cam- phoraceous ; taste pungently aromatic and somewhat cooling, bitter, and astringent. The most important constituent is a volatile oil, of which the leaves yield about 6 per cent. Dose.—\-2 drachms (2.0-8.0 Gm.). Official Preparation. Extractum Eucalypti Fluidum—Extracti Eucalypti Fluidi —Fluid Extract of Eucalyptus.—Dose, 5-60 minims (0.3-4.0 Cc). Oleum Eucalypti—Olei Eucalypti—Oil of Eucalyp- tus. U. S. P. Origin.—A volatile oil distilled from the fresh leaves of Euca- lyptus globulus Labillardiere, E. oleosa F. v. Miiller, and some other species of the genus. Description and Properties.—A colorless or faintly yellowish liquid, having a characteristic, aromatic, somewhat camphoraceous odor, and a pungent, spicy, and cooling taste. Soluble in all proportions in alcohol. This oil consists of two hydrocarbons (cymene and eucalyptene), terpene, and a substance upon which its medicinal value depends—eucalyptol. Oil of eucalyptus should be ANTISEPTICS. 341 kept in well-stoppered bottles, in a cool place, protected from light. Dose.—5-15 minims (0.3-1.0 Cc). Eucalyptol—Eucalyptol—Eucalyptol. U. S. P. Origin.—A neutral body obtained from the volatile oil of Eucalyptus globulus. Description and Properties.—A colorless liquid, having a cha- racteristic, aromatic, and distinctly camphoraceous odor, and a pun- gent, spicy, and cooling taste. Soluble in all proportions in alcohol. Dose.—5-10 minims (0.3-0.6 Cc). Unofficial Preparations. Aqua Eucalypti—Aquae Eucalypti—Eucalyptus Water.—Dose, 2-4 fluid- drachms (7.39-15.0 Cc). Tinctura EucaPypti—Tincturae Eucalypti—Tincture of Eucalyptus.—Dose, 1-4 fluidrachms (3.7-15.0 Cc). Antagonists and Incompatibles.—Agents promoting waste an- tagonize the therapeutic action of eucalyptus. The chemical incom- patibles are the mineral acids, mineral salts, and alkalies. Synergists.—The vegetable bitters, aromatics, antispasmodics, turpentine, cubebs, and copaiba. Physiological Action.—Externally and Locally.—Locally ap- plied, the oil of eucalyptus and eucalyptol are more or less irritant, though perhaps less active than many volatile oils. In contact with mucous membranes or injected hypodermically, they cause pain, and, when swallowed, produce a burning sensation in the throat, stomach, and intestines. If the vapor of eucalyptus be confined by preventing evapora- tion, vesication and pustulation result, the drug also acting as a rubefacient. Inhalation affects the bronchial mucous membrane unfavorably, the beneficial effects of the remedy residing in its properties as a powerful antiseptic and disinfectant. It is also slightly detergent and astringent. Internally.—Digestive System.—Small doses, by stimulating the salivar}' and peptic glands, improve the appetite and digestion, while peristalsis is increased, the drug acting as a mild laxative. The ingestion of large amounts may occasion anorexia, nausea, vomiting, and perhaps diarrhea, although the drug cannot be con- sidered an active emetic nor does it possess marked purgative properties. 342 A TEXT-BOOK OF MA TERIA MEDICA. Circulatory System.—Like quinine, eucalyptus arrests the ame- boid movements of the white blood-corpuscles. It resembles that drug also in its reputed property of contracting the enlarged spleen. Medicinal doses of eucalyptol stimulate the heart, increasing the blood-pressure—probably the effect of reflex action from the stom- ach. The arterial tension, however, though at first raised, is sub- sequently reduced, the pulse, which under moderate amounts of the drug shows an increase in force and frequency, being lowered by immoderate dosage. Nervous System.—Small doses stimulate mental activity. Fre- quent accompaniments of large doses are insomnia in the healthy and somnolence in debilitated subjects, and under certain condi- tions cerebral congestion, owing to the increased quantity of blood sent to the brain. Large or toxic doses are powerfully depressant to the brain, medulla, and spinal cord, abolishing the reflexes and at times occasioning loss of sensation in the lower limbs. " In large doses, after absorption, it seems to act chiefly on the nerve- centers, producing paralysis and death" (Hare). Respiratory System.—The drug tends to accelerate the respira- tory movements under small or moderate dosage; poisonous doses retard the breathing, finally arresting it, and causing death by paralysis of respiration. Absorption and Elimination.—The drug acting as a marked diu- retic, it is natural that elimination should take place largely by the kidneys. The skin, bowels, and bronchial mucous membrane share in the excretory process, the drug acting as a stimulant to the structures by which elimination takes place. A characteristic odor —resembling that of violets—is imparted to the urine, breath, and discharges from the bowels. Renal congestion, with pain in the region of the kidneys, is occasionally produced by very large doses of the drug. Temperature.—Excessive doses result in a fall of temperature. According to Schlager, a thermal rise succeeds the hypodermic injection of the drug, due probably to local irritation. Poisoning.—While fatal results from the ingestion of large doses are recorded, the toxic effects of eucalyptus are practically confined to the lower forms of animal and vegetable life—infusoria, crypto- gamia, etc. In Gimbert's experiments upon animals it was noted that the heart continued to beat for some time after respiration had ceased; from which it may be concluded that, since the motor nerves and muscles retained their functional activity after death, ANTISEPTICS. 343 failure of mobility and reflex power is due to central action, the drug in toxic doses being a paralyzant to the spinal cord and the medulla. Drowsiness, shallow breathing, cardiac weakness, and reduced arterial pressure are common results of poisonous doses of euca- lyptus. Treatment of Poisoning.—The stomach should be emptied, and the treatment should include the administration of alkalies or some preparation of iron, eliminants, strychnine, coffee, and diffusive stimulants. Therapeutics.—The author is indebted to Prof. G. Frank Lyds- ton, M. D., for the following communication in regard to the thera- peutics of this drug. Dr. Lydston's experience with the remedy, having been very extensive, lends to his statements authoritative weight; he is therefore quoted verbatim : " Eucalyptus is, in my experience, a most valuable remedy in chronic inflammation of mucous membranes. In nasopharyngeal catarrh it is of especial value. It may be used either in the form of spray or a thin ointment. If used as a spray, it should be com- bined with albolene or liquid vaseline in the proportion of 15 to 20 drops (0.92-1.23 Cc.) of the oil of eucalyptus to the ounce (30 Cc.) of menstruum. The strength may be considerably in- creased as tolerance is established. The most eligible preparation in the form of ointment is a combination of oil of eucalyptus with lanoline, sufficient albolene being added to liquefy the ointment. The eucalyptus may be used in this manner in a strength of 30 to 60 minims (1.84-3.7 Cc.) to the ounce (32.0 Gm.). The action of the eucalyptus is mildly stimulant and astringent and decidedly anti- septic " Eucalyptus has proven of value in my hands as a local applica- tion in acute and chronic skin diseases. In simple dermatitis a mild ointment of eucalyptus is quite efficacious. In chronic affections, such as some forms of eczema and psoriasis, a strong ointment of eucah'ptus, or even the pure oil itself, may in some cases be applied with great benefit. " Eucalyptus is also valuable in the treatment of sluggishly granulating wounds and ulcers. In gastro-intestinal diseases euca- lyptus is of great value. It is a gastro-intestinal antiseptic of great merit, and one which should be more generally used. In certain forms of diarrhea due to the development of toxines in the gastro-intestinal tract the drug is a most valuable remedy. It has 344 A TEXT-BOOK OF MA TERIA MEDICA. the merit of marked antiseptic action without sufficient astringent effect to interfere with the normal method of elimination by the bowel. In typhoid fever eucalyptus is in my opinion more strongly indicated than any other drug. Inasmuch as salol has such an enviable reputation as an intestinal antiseptic, it might be well to suggest that the oil of eucalyptus may be with propriety combined with that drug. I have used the eucalyptus alone and combined with salol, and am satisfied that either way is better than the use of the salol alone. " It has been my fortune to have a moderately extensive expe- rience in the use of eucalyptus in malarial affections. Diseases of malarial origin are infrequently met with in Chicago and its im- mediate environs, but in the New York hospitals at the time I was serving as interne typical malarial affections were abundant. I ex- perimented at that time quite extensively with eucalyptus, and found that the drug was not to be relied upon in distinct attacks of acute ague, but that it was of considerable value in the chronic forms and in the peculiar lassitude and depression with which patients who were not affected with typical malarial exacerbations often suffered. " After some years' experimentation with eucalyptus I have become convinced that its most valuable property is that of a urinary antiseptic. I take the opportunity of repeating here what I have repeatedly said elsewhere, that eucalyptus is the most reliable urinary antiseptic at our command. Careful experimenta- tion and clinical observation have shown me that in eucalyptus we have a remedy which greatly lessens the dangers of genito-urinary surgery by lessening or entirely removing the septic property of the urine, that bete noire of the andrologist. Boric acid and salol have in my experience been disappointing, while eucalyptus has exceeded my anticipations. My method of administration is by capsule, io minims (0.6 Cc.) of the oil being given four times daily, beginning several days before the operation. The only disadvan- tage attending the use of eucalyptus is gastric intolerance on the part of a few patients. As a rule, the remedy is taken without complaint, but occasionally disagreeable eructations or even vomit- ing occurs. By preceding the remedy with a large draught of milk this objection may usually be done away with. In some cases sus- pension of the remedy for a few hours will enable the stomach to acquire the desired toleration. " In the administration of eucalyptus much depends upon the ANTISEPTICS. 345 preparation used. Without the slightest desire to advocate unduly any special preparation, but simply as a matter of information to the profession, I will state that in my experience the preparations known as Tyndale's are the most reliable and elegant upon the market. These preparations comprise an aqueous solution, an ointment, and an oil, the latter of which is in daily use in my practice." The foregoing quotation expresses so clearly the uses of euca- lyptus that further details appear unnecessary. The antiseptic properties of the drug are not sufficiently realized by many physi- cians. Schultz claims that eucalyptus as an antiseptic is three times as powerful as carbolic acid, and that as an agent to arrest suppuration it is perhaps fully equal to quinine. As a stimulant expectorant eucalyptus is of great value, equal- ling, if not being superior to, any other remedy in bronchorrhea, pulmonary gangrene, and fetid bronchitis, associated or not with phthisis. Chronic or catarrhal conditions of the lungs and bronchi only are benefited by eucalyptus, acute affections of the broncho- pulmonary mucous membrane contraindicating its use. A solution of oil of eucalyptus is used as an antiseptic inhalation in diphtheria. Administration.—The fresh leaves may be employed as poul- tices. Any of the preparations may be used, but for internal pur- poses the oil, or eucalyptol, is preferable, although a good fluid extract is an agreeable form of the medicine. The oil, or euca- lyptol, may be given in an emulsion or in capsules, for topical use being diluted with alcohol or oil or incorporated in suppositories or ointments. Sodii Boras—Sodii Boratis—Sodium Borate. u. s. P. (Borax.) Origin.—Prepared by boiling together solutions of Boric Acid and Sodium Carbonate, the borax crystallizing out. It is also found in a native state on the shores of certain lakes and as a crystalline deposit in the Borax Lake of California. Description and Properties.—Colorless, transparent, mono- clinic prisms, or a white powder, inodorous, and of a sweetish, alkaline taste ; slightly efflorescent in warm, dry air; soluble in 16 parts of water and in I part of glycerin; insoluble in alcohol. Dose.—5-30 grains (0.32-2.0 Gm.). 346 A TEXT-BOOK OF MATERIA MEDICA. Acidum Boricum— Acidi Borici—Boric Acid. U. s. P. (Boracic Acid.) Origin.—Found native in Northern Tuscany. It may be pre- pared by the action of Hydrochloric Acid on Borax, filtration, and recrystallization. Description and Properties.—Transparent, colorless scales, of a somewhat pearly luster, or, when in perfect crystals, six-sided, triclinic plates, slightly unctuous to the touch, odorless, of a faintly bitterish taste, permanent in the air. Soluble in 25.6 parts of water, 15 parts of alcohol, and 10 parts of glycerin. The addition of hydrochloric acid increases its solubility in water. Dose.—5-15 grains (0.32-1.0 Gm.). Official Preparation. Glyceritum Boroglycerini—Glyceriti Boroglycerini—Glycerite of Boro- glycerin (Glycerite of Glyceryl Borate—Solution of Boroglyceride).— Boric Acid, 310; Glycerin, to 1000. For external use. Antagonists and Incompatibles.—The incompatibles of borax are the acids and metallic salts. Morphine and cocaine are pre- cipitated from solution by borax. Boric acid is also incompatible with the carbonates and bicarbonates, and with the alkaline, earthy, and metallic bases. Synergists.—The action of borax is enhanced by alkalies and substances promoting waste; that of boric acid, by the anti- septics. Physiological Action.—Externally and Locally.—Borax is ab- sorbent, protectant, sedative, and antiseptic. Applied to the un- broken skin, it acts upon the epidermis as a soap. By removing the stimulus to secretion and lessening irritation borax checks the secretion of the salivary glands. Boric acid possesses properties similar to those of borax, although more of an antiseptic and antipruritic. It has also an exsiccant and detergent influence. Internally.—In a general way the action of borax is analogous to that of the alkalies. It is refrigerant and diuretic, and by its immediate action upon the womb serves as an emmenagogue, large doses contracting the uterine muscles and acting as an ecbolic. Excessive doses of either of these drugs act as gastro-intestinal irritants. Boric acid, though stronger, resembles borax in its action. Both ANTISEPTICS. 347 substances, especially boric acid, retard the action of saliva upon starch, increasing that of the pancreatic juice upon albuminous substances, and increase gastric digestion. Immoderate doses of boric acid check gastric digestion. The drug is a moderate antipyretic, and when injected in large amounts into the circulation may occasion paralysis of the motor nerves and muscles. Absorption and Elimination.—It is eliminated by the saliva, per- spiration, feces, and urine, the latter being increased in quantity. The amount of nitrogen and solid matter excreted with the feces is also increased, as well as the elimination of urea in the urine. Untoward Action.—Boric acid has occasioned the following untoward symptoms : frequent desire to micturate ; nausea, vom- iting, and other gastric disturbances ; small, weak pulse; derange- ment of the nervous system; hiccough; and various cutaneous eruptions. Poisoning.—The symptoms of poisoning are analogus to those described above. Treatment of Poisoning.—The treatment of poisoning should be symptomatic, stimulants, morphine, etc. being employed. Therapeutics.—Externally and Locally.—Both of the above drugs are exceedingly valuable as local remedies in the treatment of many disorders of the ear, nose, and throat, such as acute and chronic nasal catarrh, pharyngitis, gingivitis, and acute hoarseness. An efficient domestic remedy in aphtha? affecting the mouths of nursing children is a mixture of borax and honey. An invaluable aseptic application in acute conjunctivitis is a sat- urated solution of boric acid. Leucorrhea, gonorrhea, and chronic cystitis are greatly benefited by solutions, in various strengths, of either or both of these drugs. Sir James Simpson recommends a solution of borax, 5-10 grains (0.32-0.6 Gm.) to 1 ounce (30.0 Cc.) of hot water, for the eruption occurring on the mucous membrane of the vulva in young girls. Since the introduction of boric acid as an antiseptic by Lister in 1872 it has steadily grown in favor in this respect, being univer- sally employed to-day, both in solution and in the powdered form, for the numerous conditions requiring an agent of this character. It is invaluable as a bland, unirritating antiseptic in general surgery, and in diseases of the eye, ear, nose, throat, and skin. It is perhaps unnecessary to enumerate the multifarious and efficient uses of this drug, the practising physician readily recog- 348 A TEXT-BOOK OF MATERIA MEDICA. nizing the conditions in which this potent remedy may be advan- tageously employed. Internally.—Borax is used internally more than boric acid. While in epilepsy inferior to the bromides, there are cases uninflu- enced by the latter remedies which respond favorably to borax. The drug has been employed in typhoid fever, though with little benefit. Dr. Sacaze of Montpelier claims to have greatly improved a case of paralysis agitans with 4- to 8-grain (0.25-0.51 Gm.) doses, given three times a day. The author has favorably influenced tl]e character of the urine in chronic cystitis by 5-grain (0.3 Gm.) doses of boric acid three times a day. These drugs have been used internally in the summer diarrhea of children. Administration.—The remedies may be given in capsules or solution. The taste of borax may be disguised by coffee, syrup of orange, or aromatic elixir of liquorice, the drug not being admin- istered with glycerin, lest an acid reaction occur. Potassii Permangranas—Potassii Permanganatis— Potassium Permanganate. U. S. P. Origin.—Obtained by heating together Caustic Potash, Potas- sium Chlorate, and Manganese Dioxide. The potassium manga- nate formed is converted into the permanganate by boiling it in water. Description and Properties.—Slender, monoclinic prisms, of a dark-purple color, almost opaque by transmitted light, and of a blue, metallic luster by reflected light; odorless, with at first a sweet and afterward a disagreeable and astringent taste ; permanent in the air; soluble in 16 parts of water. In contact with alcohol it is decomposed. Potassium permanganate should be kept in glass-stoppered bot- tles, protected from light, and should not be brought in contact with organic or readily oxidizable substances. Dose.—\-2 grains (0.03-0.12 Gm.), as a pill. Antagonists and Incompatibles.—Organic matter easily deox- idizes it, causing an explosion. Synergists.—Theoretically, the antiseptics would enhance its antiseptic action. Physiological Action.—Potassium permanganate is employed as an antiseptic and oxidizing agent in certain diseases, both the ANTISEPTICS. 349 internal and external use of the drug having proved beneficial. The peculiar property of the remedy is its readiness to part with oxygen, and its consequent availability as an agent in the destruc- tion of deleterious organisms. Brunton asserts that " when mixed with cobra-poison it completely destroys the deadly power of the latter, and the mixture may be injected subcutaneously without any bad effect," though he adds that as an antidote it is unservice- able, since it does not come in contact with the venom in the tissues. In rare instances, it is asserted, potassium permanganate has occasioned a vesicular eruption not unlike eczema. It is at times decidedly caustic Therapeutics.—Externally and Locally.—In concentrated solu- tions or in substance it is a mild escharotic. Its readiness to part with ogygen renders it of great value as a deodorant, and in dilute solutions, i to 5 grains (0.06 to 0.32 Gm.) to 1 ounce (30 Cc.) of water, it is a useful application to foul ulcers, cancer of the uterus, vagina, etc. A solution of this drug is employed for various pur- poses as an antiseptic, germicide, and deodorant, in the treatment of gonorrhea, leucorrhea, diphtheria, putrid sore throat, ozena, naso- pharyngeal catarrh, cancer of the tongue, and syphiltic ulcers. A weak solution of potassium permanganate is an efficient ap- plication in bromidrosis, and a 1 : 2000 or 1 : 5000 solution is recom- mended by Dr. Terson in purulent ophthalmia. Potassium per- manganate should not be used as an antiseptic in the peritoneal cavity, on account of its irritating properties. It is employed extensively in surgical practice for washing the hands and utensils. Internally.—Like iron, potassium permanganate has been em- ployed in anemia, although far inferior to the former drug. Favor- able reports are given regarding its value in gastric fermentation and lithiasis. Dr. Moor of New York recently advocated its use as an anti- dote to morphine-poisoning. It seems to form a chemical substance with morphine which is circulating in the blood, rendering the lat- ter inert. The drug has, therefore, been considered by some author- ities a true physiological antagonist in morphine-poisoning, whether administered hypodermically or by the mouth. Other authorities claim that it is but a chemical antagonist for morphine, being active only when brought in actual contact with the poison. Dr. Moor claims, however, that potassium permanganate does not possess the same antidotal power over certain other alkaloids, such as strychnine, atropine, cocaine, aconitine, etc. Antal, on the 350 A TEXT-BOOK OF MATERIA MEDICA. ether hand, maintains that the drug is equally serviceable in mor- phine- and strychnine-, as well as muscarine-, poisoning, and in that resulting from toxic doses oi colchicum and oxalic acid. Dr. Koosa believes it to be also efficient in poisoning from hydrocyanic acid, and Dr. Hognos reports very favorably as to its antidotal power in poisoning from phosphorus, having treated two cases successfully with this remedy. Recently, Dr. Fr. Lanz reports interesting statistics of Prof von Jaksch's clinic in which phosphorus-poisoning was treated with douches of potassium permanganate, the death-rate, however —36.66 per cent.—not speaking very favorably for the antidotal power of the drug in connection with phosphorus. Administration.—For internal use potassium permanganate should always be given in pill form, kaolin being used as an excipient, lest an explosion occur. Potassii Bichromas—Potassii Bichromatis— Potas- sium Bichromate. l.S.P. Origin.—Prepared by roasting in a reverberatory furnace Potas- sium Carbonate and Chrome-iron Ore, with the addition of Lime or Chalk to prevent fusion. The potassium bichromate formed is separated by crystallization from its solution in water acidulated with sulphuric acid. Description and Properties.—Large orange-red, transparent triclinic prisms or four-sided tables, odorless, and having a bitter, metallic taste. Permanent in the air; soluble in 10 parts of water; insoluble in alcohol. Dose.—j-L— 1 grain (0.0006-0.06 Gm.). Antagonists and Incompatibles.—Potassium bichromate is in- compatible with soluble salts of silver, mercury, and lead, and with liquor potassae, liquor sodae, and ammonia water. Synergists.—Agents promoting waste, antiseptics, and caustics. Physiological Action.—Externally and Locally.—In substance potassium bichromate is an irritant caustic, and, according to Miquel, an antiseptic in the proportion of 1 to 909. Internally.—Its action is nearly identical with that of potassium chlorate, with the additional properties of an expectorant, emetic, and mild alterative. Poisoning and treatment of poisoning do not differ essentially from those of potassium chlorate. Therapeutics.—Externally and Locally.—Potassium bichromate ANTISEPTICS. 351 is used as a caustic for warts, corns, chancres, chancroids, mucous patches, etc., and is also of considerable value as a gargle in pharyngitis. Internally.—Frazer has recently recommended this drug in the treatment of dyspepsia and gastric ulcer, claiming that the pain, nausea, vomiting, and tenderness may be readily allayed by doses of it to \ Srain (0.005-0.01 Gm.), taken upon an empty stomach three times a day. In acute gastric ulcer he has perceived no benefit so far as its effect upon the hemorrhage is concerned, the most desirable action of the drug in the latter condition being derived from its antiseptic and analgesic influence. The author desires to recommend favorably potassium bi- chromate, in doses of -^-§ grain (0.0006 Gm.) every hour or two, in aphonia and hoarseness due to excessive action of the vocal cords or resulting from an acute cold. He has found this method of treatment peculiarly and speedily efficacious. Potassii Chloras—Potassii Chloratis—Potassium Chlorate. U. S. P. Origin.—Prepared by passing Chlorine into a mixture of Potas- sium Carbonate and Slaked Lime. By subsequent boiling in water the chlorate separates by crystallization. Description and Properties.—Colorless, lustrous, monoclinic prisms or plates, or a white powder, odorless, and having a cool- ing, saline taste; permanent in the air; soluble in 16.7 parts of water; insoluble in absolute alcohol. Potassium chlorate should be kept in glass-stoppered bottles. Great caution should be observed in handling the salt, since dangerous explosions are liable to occur when it is mixed with organic matters—cork, tannic acid, sugar, etc.—or with sulphur, antimony sulphide, phosphorus, or other easily oxidizable substance, or upon being either heated directly or subjected to trituration or concussion. Dose.—3-20 grains (0.2-1.3 Gm.). Official Preparation. Trochisci Potassii Chloratis — Trochlscos (ace.) Potassii Chloratis — Troches of Potassium Chlorate.—Each troche contains 5 grains (0.32 Gm). Dose, 1 to 4 troches. Antagonists and Incompatibles.—In addition to those sub- stances mentioned above with which potassium chlorate forms 352 A TEXT-BOOK OF MA TERIA MEDICA. explosive compounds, mixture with glycerin and the hypophos- phites is liable to produce similar dangerous results. Synergists.—Agents promoting waste increase the activit}- of the drug. . Physiological Action.—Externally and Locally.—-It is slightly detergent and stimulant, antiseptic and astringent, being irritant when*applied in concentrated solution to ulcerated surfaces. Internally.—Digestive System.—Medicinal doses have no effect; poisonous doses excite violent gastro-intestinal irritation, nausea, bloody vomiting, diarrhea, and jaundice. Circulatory System.—Small doses of potassium chlorate tend to depress and subsequently raise arterial tension, accelerating the pulse; large doses lower arterial pressure alarmingly; toxic doses convert the hemoglobin of the blood into methemoglobin, the dis- organized fluid appearing in the urine. Post-mortem lesions are- enlargement of the liver, spleen, and kidneys, with evidences of marked inflammation over the whole intestinal tract. Nervous System.—Medicinal doses are inert. Toxic doses may produce delirium and death, preceded by coma or convulsions. Respiratory System.—Large doses act as a depressant to the respiratory apparatus. Absorption and Elimination.—The drug is absorbed with con- siderable rapidity, being chiefly eliminated by the salivary glands unchanged. The drug does not increase the urinary flow, large doses, on the contrary, tending to suppress it. Temperature.—Unaffected by medicinal doses, but lowered by toxic amounts. Untoward Action.—Small doses of potassium chlorate seldom produce untoward symptoms, although in rare instances eruptions of an erythematous, papular, or vesicular nature have followed the use of the drug. Digestive disturbances occasionally ensue, with pain in the region of the kidneys and albuminuria. Poisoning.—In the few recorded cases of poisoning there were observed a continuous sensation of choking, excessive thirst, per- sistent vomiting, pain in the abdomen and renal tract, and violent hiccough. Accompanying symptoms were—a small and rapid pulse and faintness, while the urine was albuminous and diminished in quantity; epistaxis was present; the eyes and lips were cyanotic, and the skin slightly jaundiced and markedly anemic; the liver and spleen were slightly enlarged; and there were alternating sensations of cold and heat, with drowsiness ending in coma and death. ANTISEPTICS. 353 Treatment of Poisoning.—The stomach should be emptied as quickly as possible and demulcents administered. The patient should be treated symptomatically, and it may be advisable to practice venesection, followed by transfusion of blood, as suggested by Landerer. Therapeutics.—Externally and Locally.—A solution of this drug has been applied with some success in foul ulcers and moist eczema. Like the potassium permanganate, it has been employed in various diseases of the nose and throat, and is especially service- able in ptyalism and aphthous ulceration. As a remedy for syphilitic mucous patches and herpes of the buccal cavity it is of considerable value. It is more efficient in acute than in chronic pharyngitis. It possesses marked cicatrizing power, advantage of which property has been taken in the treatment of phagedenic sores, the powdered drug being used for this purpose. It is thought that ene- mas of potassium chlorate solution favor the healing of rectal ulcers. Internally.—As a remedial agent this drug has not met with the success prophesied by many physicians. Dr. Coghill of England is one of its most enthusiastic champions, the drug having proved in his hands highly efficient in improving the quality of the blood in such cases as simple anemia, chlorosis, etc, as well as in "pul- monary insufficiency" and "deficient oxygenation of the blood." Other physicians have recommended it as a valuable galactagogue, tonic, and alterative, and as beneficial in certain chronic diseases of the skin, scrofula, etc. It has found some advocates as a genito- urinary antiseptic and as a remedy in typhoid fever. Yet, notwithstanding the extravagant, though isolated, reports concerning the great value of the drug, its utility has not been universally recognized ; indeed, so good an authority as Marchand declares that " chlorate of potassium should be entirely rejected in practice, and particularly in the treatment of children." Administration.—It may be given in the form of troches, powder, tablets, or a solution, an agreeable means of administra- tion being in aerated water. Owing to its tendency to decomposi- tion when combined with other substances, the drug should be prescribed alone. Aqua Hydrogrenii Dioxidi—Aquae Hydrogenii Diox- idi—Solution of Hydrogen Dioxide. U. S. P. Origin.__A slightlv acid, aqueous solution of hydrogen diox- ide, containing, when freshly prepared, about 3 per cent, by weight 2:1 354 A TEXT-BOOK OF MA TERIA MEDICA. of the pure dioxide, corresponding to about io volumes of avail- able oxygen. Description and Properties.—A colorless liquid, without odor, slightly acidulous to the taste, and producing a peculiar sensation and a soapy froth in the mouth; liable to deteriorate with age or by exposure to heat or protracted agitation. Dose.—1-4 fluidrachms (3.7-15.0 Cc), well diluted with water. Physiological Action.—Externally and Locally.—The principal action of this preparation seems to be its property of imparting oxygen to all oxidizable substances, it being one of the most pow- erful oxidizing agents in Materia Medica, and therefore an exceed- ingly active non-toxic antiseptic. When applied to a suppurating surface, or when mixed with mucus, cerumen, or blood, active effervescence is produced. Hy- drogen dioxide is a useful detergent and bleaching agent, being employed largely for the purpose of bleaching hair and delicate fabrics. Internally.—It is asserted that hydrogen dioxide yields oxygen to the blood, slightly stimulates the nervous system, and acts as a diuretic. Therapeutics.—Externally and Locally.—Hydrogen dioxide is extensively employed to cleanse diseased surfaces, such as ulcers, buboes, fistulous tracts, etc. It has been highly recommended as an antiseptic in abdominal surgery. As an antiseptic wash in empyema, cystitis, joint-cavities, venereal sores, puerperal septic endometritis, etc. hydrogen dioxide is an exceedingly valuable agent. Hydrogen dioxide appears to be an efficient injection in gonor- rhea, and is much used as an antiseptic in many diseases of the eye, ear, nose, and throat. It has been highly recommended as a solvent for diphtheritic membrane, although when frequently applied to the throat it causes an unpleasant sensation of dryness, and it seems to prevent the exfoliation of the membrane when the patient is treated with antitoxine. Hydrogen dioxide serves a useful purpose in disinfecting drink- ing-water when suspected of pollution, 1 part sufficing for 1000 parts of water, in which amount the taste or other potable quali- ties of the water are in no way impaired. Internally.—While hydrogen dioxide has been recommended in epilepsy, diabetes, angina pectoris, pneumonia, asthma, and dyspnea due to deficient circulation of blood through the heart and lungs, the results following the internal administration in these diseases ANTISEPTICS. 355 have not warranted classing the drug among important internal medicines. Administration.—For external and local use the drug may be gargled, sprayed, or applied with a syringe or a swab, either in full strength or diluted with water. Whether for external or internal use, the solution should be freshly prepared; when given internally it should be taken from a porcelain or china, not a metal, cup or spoon. Acidum Sulphurosum—Acidi Sulphurosi—Sulphur- ous Acid. U. S. P. Origin.—A liquid composed of not less than 6.4 per cent, by weight of Sulphurous Acid Gas (Sulphur Dioxide) and not more than 93.6 per cent, of Water. Description and Properties.—A colorless liquid, of the cha- racteristic odor of burning sulphur, and of a very acrid, sulphur- ous taste. It should be kept in dark-colored, glass-stoppered bottles, in a cool place, and protected from light. Dose.—1-2 fluidrachms (1.8-7.39 Cc). Physiological Action.—Externally and Locally.—Sulphurous acid is a powerful deoxidizing agent, the fumes of burning sulphur having been employed centuries ago to disinfect temples, dwellings, etc. It easily abstracts oxygen from organic bodies, the acid, in short, being a powerful disinfectant, antiseptic, deodorant, and parasiticide. Internally.—The disinfecting properties of sulphurous acid are less apparent when the drug is ingested than when it is used externally. Therapeutics.—Externally and Locally.—As an antiseptic, dis- infectant, and deodorant sulphurous acid may be employed in the treatment of various parasitic skin diseases, and a solution of sul- phurous acid affords an efficient application to the throat in pharyn- gitis, particularly the gangrenous form, diphtheria, etc According to Dujardin-Beaumetz, Sollaud, and Balbaud, non- febrile pulmonary phthisis is often favorably influenced by the daily inhalation for a short time of sulphurous-acid vapor. This dis- agreeable, not to say dangerous, method of treatment has neither been generally adopted nor proved to be of established efficacy. The acid is a useful antiseptic to apply to recent wounds, and may be employed to disinfect the dejections of the sick, the fumes 356 A TEXT-BOOK OF MATERIA MEDICA. from burning sulphur also being serviceable to disinfect rooms and bedding tainted with infectious disease. Internally.—Sulphurous acid is seldom used internally, though, owing to its powerful antifermentative properties, it has been em- ployed in so-called fermentative dyspepsia, intestinal fermentation, and urticaria. While it checks fermentation in the laboratory, its effect is less certain in the body; nor can the internal administra- tion of the drug be regarded as satisfactory. Administration.—Sulphurous acid should be given well diluted with water. Sodii Sulphis—Sodii Sulphltis—Sodium Sulphite. U. S. P. Origin.—Prepared by saturating a solution of Sodium Carbon- ate or Caustic Soda with Sulphur-dioxide Gas. Description and Properties.—Colorless, transparent, mono- clinic prisms ; odorless, and having a cooling, saline, sulphurous taste. In the air the salt effloresces and is slowly oxidized to sul- phate. Soluble in 4 parts of water; sparingly soluble in alcohol. It should be kept in well-stoppered bottles, in a cool place. Dose.—5-60 grains (0.3-4.0 Gm.). Sodii Bisulphis—Sodii Bisulphltis—Sodium Bisul- phite. U. S. P. Origin.—Prepared from Sodium Carbonate or Bicarbonate and Sulphur Dioxide. Description and Properties.—Opaque, prismatic crystals, or a granular powder, exhaling an odor of sulphur dioxide, and having a disagreeable, sulphurous taste. Exposed to the air, the salt loses sulphur dioxide and is gradually oxidized to sulphate. Soluble in 4 parts of water and in 72 parts of alcohol. The drug should be kept in a cool place, in small, well-stoppered bottles filled as full as possible. Dose,— 5-30 grains (0.3-2.0 Gm.). Sodii Hyposulphis—Sodii Hyposulphrtis—Sodium Hyposulphite. U. S. P. Origin.—Prepared by passing Sulphurous Anhydride into a solution of Sodium Carbonate with Salts. Description and Properties.—Colorless, transparent, mono- clinic prisms; odorless, and of a cooling, afterward bitter, taste. ANTISEPTICS. 357 Soluble in 0.65 part of water; insoluble in alcohol. It should be kept in well-stoppered bottles. Dose.—5-20 grains (0.3-1.3 Gm.). Physiological Action and Therapeutics of Sodium Sulphite, Bisulphite, and Hyposulphite.—These substances are feeble ger- micides and antiseptics, checking putrefaction and other forms of fermentation. It is supposed that they are decomposed in the stomach, liberating sulphurous anhydride; on which assumption they have been given to arrest gastric fermentation and as reme- dies in typhoid and yellow fevers, diphtheria, erysipelas, etc. The hypothesis, however, upon which they have been thus hopefully employed has not been confirmed by clinical experience. These drugs have nevertheless proved efficacious in the treat- ment oi scabies, sycosis, impetigo, favus, etc. Atomized solutions of sodium hyposulphite inhaled are beneficial in gangrene of the lungs, fetid bronchitis, etc. Administration.—The foregoing preparations of sulphur may be given in solution or in this form applied topically. The sodium hyposulphite may also be applied in the form of an ointment. Aqua Chlori—Aquae Chlori—Chlorine Water. I. S. P. Origin.—An aqueous solution of Chlorine, containing at least 0.4 per cent, of the gas. Description and Properties.—A clear, greenish-yellow liquid, having the suffocating odor and disagreeable taste of chlorine, and leaving no residue on evaporation. Chlorine water, even when kept from light and air, is apt to deteriorate; when it is required of full strength, it should be freshly prepared. Dose.—1-4 fluidrachms (3.7-15.0 Cc). Antagonists and Incompatibles.—The salts of lead and silver are incompatible. Synergists. — The antiseptics are theoretically synergistic, though practically the drug is almost always used alone. Physiological Action. — Externally and Locally. — Chlorine water is a powerful antiseptic, germicide, and deodorant. When applied to the skin it acts as a rubefacient and vesicant, while the vapor is quite irritating to the respiratory passages. Internally.—Chlorine water is more or less irritating to the mucous membrane of the stomach, and possesses an astringent taste. 358 A TEXT-BOOK OF MATERIA MEDICA. Therapeutics.—Externally and Locally.—Chlorine water is still occasionally used as an antiseptic and deodorant in gangrenous or sloughing wounds and for disinfecting foul discharges, etc. It has proved beneficial as a local application in aphthous stomatitis, diph- theria, and parasitic skin diseases. Internally.—Chlorine water is so seldom employed internally that its use in this respect scarcely requires comment. Administration.—When given internally the drug should be well diluted. Should poisoning ensue from the ingestion of exces- sive amounts, albumen is the best antidote; for the irritation occa- sioned by the inhalation of chlorine gas steam-inhalations are indicated. Calx Chlorata—Calcis Chloratae—Chlorinated Lime. U. S. P. ("Chloride of Lime.") Origin.—A compound resulting from the action of Chlorine upon Calcium Hydrate, and containing not less than 35 per cent. of available Chlorine. Description and Properties.—A white or grayish-white, granu- lar powder, exhaling the odor of hypochlorous acid ; of a repulsive saline taste, and becoming moist and gradually decomposing on exposure to air. It is but partially soluble in water or alcohol. The drug should be kept in well-closed vessels, in a cool and dry place. Used externally. Physiological Action and Therapeutics.—Chlorinated lime is a powerful disinfectant, yielding, when exposed to air, hypochlorous acid, which is resolved into chlorine and chloric acid, the last in turn yielding chlorine. The effects of the drug are therefore analogous to those of chlorine, yet almost the only use which chlorinated lime serves is in disinfecting cesspools and utensils employed for the dejections of invalids. Liquor Sodae Chloratae—Liquoris Sodae Chloratae— Solution of Chlorinated Lime. U. S. P. (Labarraque's Solution.) Origin.—An aqueous solution of several chlorine compounds of Sodium, containing at least 2.6 per cent, by weight of available chlorine. AROMA TICS. 359 Description and Properties.—A clear, pale-greenish liquid, having a faint odor of chlorine and a disagreeable alkaline taste. It should be kept in well-stoppered bottles, protected from light. Used externally. Physiological Action.—The action of the drug resembles that of aqua chlori, although it is feebler than the latter. Therapeutics.—Solution of chlorinated soda is used as a disin- fectant for fetid ulcers, gangrenous sores, and ozena, and as a disin- fectant wash in diseases of the uterus, vagina, and auditory canal. Administration.—There are no special directions to be ob- served in the application of this solution. AROMATICS. The following-named drugs, classed by some authors as aro- matics, are not only active antiseptics and antispasmodics, but possess properties very similar to those of the more typical anti- septics, antipyretics, and anesthetics. These antiseptic properties of aromatic drugs are well known to modern science, and, what is of unique interest and significance, were perfectly familiar to the ancients, who could not possibly divine the scientific value of the virtues familiarized only by the crudest empiricism. In the custom of the Egyptians of embalming the dead we have a remarkable example of their divination of antisepsis in the perfumes and spices in which their dead were buried; and in the Christian Gospel we read of Nicodemus that he " brought a mixture of myrrh and aloes," and that they " took the body of Jesus, and wound it in linen cloths with the spices, as the manner of the Jews is to bury" (John xix. 39,40). Apart, however, from the remarkable testimony of the fore- going examples, these peculiar properties of aromatic herbs appear to have been established in all succeeding ages. Especially among the Greeks were the medicinal virtues of certain aromas recognized, recipes for celebrated healing essences being inscribed on marble tablets in their temples. Among the Romans, too, the custom pre- vailed of mingling sacred aromatic ingredients with the ashes of the departed—a usage not wholly to be regarded as a religious ceremony, but rather as a recognition of the properties ascribed to these agents by their Athenian neighbors. Indeed, the history of perfumes teems with illustrations of the 360 A TEXT-BOOK OF MATERIA MEDICA. common faith in their healing power, though from the derivation of the word—per, through, and fnmum, smoke—the offering of incense, by burning aromatic woods, spices, and gums, seems to have been the original use suggested by them. This conception of the sacred and purifying influence of aromas is seen to-day in the censer of the ritualistic churches, as it may be traced from earliest recorded times through the centuries that intervene. The more secular regard for aromatic herbs, however, rests rather upon a rational, though unscientific, observation of facts than upon hierarchical assumption. It is recorded, for instance, that while cholera raged in Paris and London the gentle office in which they were engaged secured to the perfumers immunity from the plague, and that when the Dutch on the island of Ternate destroyed the clove tree the colony suffered from epidemics and disorders unknown before. The property of absorbing malaria generally ascribed to the leaves of Eucalyptus globulus is a further illustration of the medicinal uses of aromatic plants, this tree being considered a potent febrifuge. Witness also the beneficial results of planting this tree in the Roman Campagna. Even the refined taste and delicacy of sense which have per- petuated the "perfumes of Araby" to "sweeten," not the murder- ous hand of a Lady Macbeth, but milady's dainty finger-tips, have their rationale in a basis of sanitary law. A writer on this subject observes that " the toilet vinegars had their origin in the presump- tion of keeping those who carried them from the effects of infec- tious disease, doubtless springing out of the story of the four thieves' vinegar—reputed freebooters supposed to have plundered the sick and dying, protected by the spell of an enchanted prophy- lactic composed of rosemary, mint, lavender, calamus, cinnamon, cloves, nutmeg, etc. macerated in vinegar." Yet the vinaigrette of a lady's boudoir of to-day has its ana- logue in the beautiful scent-bottles unearthed among the ruins of Pompeii; for the cultivated tastes which still prompt the utility, as well as beauty, of flowers are fortified by the tradition of loyal centuries, and are, after all, but a tacit tribute to the truth not in- aptly stated that " poison and malaria enter the system by neglect- ing the warning given it by the nose, that outpost of the animal citadel." Aromatics owe their virtues chiefly to the volatile oils they con- tain, which usually possess the characteristic odor and taste of the AROMA TICS. 36i plants from which they are derived. Locally, they are stimulant and irritant. Internally, they stimulate, when taken in moderate quantities, the digestive organs in the same manner as vegetable bitters, and increase the activity of the circulation reflexly by stim- ulating the sensory ends of the vagus distributed to the mucous membrane of the stomach. The impression is conveyed to the center in the medulla, and from there transmitted to the accelerator nerves of the heart. Very large doses depress the heart's action, arresting it in diastole. The poisonous action of aromatics is simi- lar to that of irritant narcotic poisons. Many of them are quite powerful local anesthetics. They first stimulate and then depress and exhaust the nervous system. In diseased conditions they are used to increase peristalsis, to impart tone to the stomach, and to act as antiseptics ; to arrest gastric and intestinal fermentation ; to relieve pain wherever they are applied; and, by increasing the circulation in the brain and improving the condition of the gastro- intestinal tract, to relieve many of the phenomena of hysteria. The chief contraindication for the internal use of these drugs is in inflammation of the stomach and bowels. The volatile oils and the various preparations of the aromatics should be given diluted in some proper vehicle. AnTsum—AnTsi—Anise. U. S. P. Origin.—The fruit of Pimpinella Anisum L., a plant indigenous in Western Asia and Egypt, and extensively cultivated in Europe. Description and Properties.—About i-i inch (3-6 Mm.) long, ovate compressed laterally, grayish, finely pubescent, consisting of two mericarps, each with a flat face, and five light-brownish filiform ridges, and about fifteen thin oil-tubes, perceptible in transverse sec- tion by the aid of the microscope. Anise has an agreeable, aro- matic odor, and a sweet, spicy taste. It contains from \\ to 3 per cent, of a volatile oil. It resembles the fruit of the Conium, differ- ing from it usually in being longer and more ovate, and having another odor and taste. The fruit of the Conium has, moreover, but a single smooth mericarp without oil-tubes. Dose.—8-30 grains (0.5-2.0 Gm.). Oleum AnTsi—Olei AnTsi—Oil of Anise. U. S. P. Origin.—A volatile oil distilled from Anise. Description and Properties.—A colorless or pale-yellow, thin and strongly refractive liquid, having the characteristic odor of 362 A TEXT-BOOK OF MA TERIA MEDICA. anise, and a sweetish, mildly aromatic taste; neutral in reaction. It contains a substance known as ancthol. Oil of anise should be kept in well-stoppered bottles, protected from light, and if it has separated into a liquid and a solid portion, it should be completely liquefied by warming before being dis- pensed. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. Aqua Anisi—Aquae Anisi—Anise Water.—Dose, %-i fluidounce (8.0-30.0 Cc). Spiritus Anisi—Spiritus Anisi—Spirit of Anise.—Dose, 12 fluidrachms (4.0-8.0 Cc). Oil of anise is contained in the following preparations: Spiritus Aurantii Compfisitus ; Syrupus Sarsaparillae Comp6situs ; Tinc- tura Opii Camphorata ; Trochisci Glycyrrhizae et Opii. Physiological Action.—Anise is slightly antiseptic, stimulant, and carminative ; Oil of Anise is irritant if applied in full strength to mucous membranes, stimulating both the digestive and circulatory apparatus, improving the appetite, and slightly strengthening and accelerating the heart's action. In very large doses it possesses mildly narcotic properties. It is excreted in the urine, sweat, and by the bronchial mucous membrane, the secretion from which it liquefies. Therapeutics.—Anise is employed to relieve flatulence in children, as a sedative expectorant, and as a vehicle to flavor medicines. Cinnamomum—Cinnamomi—Cinnamon. U. S. P. Origin.—There are three official varieties of cinnamon : 1, the inner bark of the shoots of Cinnamomum Zeylanicum Breyne, a tree about 30 feet high (9 M.), found in the forests of Ceylon (Ceylon Cinnamon); 2, the bark of the shoots of one or more undetermined species of Cinnamomum grown in China (Chinese Cinnamon, Cassia Cinnamon); 3, the bark of an undetermined species of Cinnamomum known as Cinnamomum Saigonicum (Saigon Cinnamon, Saigon Cassia), from Saigon, the capital of French Cochin-China, where it is collected and exported. Description and Properties.—Most of the article brought to the United States is the Cassia cinnamon. The varieties differ some- AROMA TICS. 363 what in appearance, and are found in the shops as quills of varying lengths, about -fa inch (1 Mm.) or more in thickness, yellowish- brown in color, externally rough (Cassia), of fragrant odor, a sweet, aromatic taste, but less delicate than that of Ceylon cinna- mon, which appears in large, closely-rolled quills, composed of eight or more layers of bark of the thickness of paper; pale, yellowish-brown, the outer surface smooth, marked with wavy lines of bast-bundles; of a very sweet, fragrant odor, and a warm, aromatic, delicate taste. The Saigon cinnamon is found in the shops as large quills or broken pieces, M to 1 inch (2 to 3 Mm.) thick ; the outer surface gray or light grayish-brown, with whitish patches, more or less rough and warty, transversely ridged and longitudinally wrinkled ; the inner surface cinnamon or dark brown, granular and slightly striate, with short and granular fracture. It has a fragrant odor, and a sweet, warmly aromatic, and somewhat astringent taste. Constituents.—All the varieties contain volatile oil, tannin, mucilage, sugar, starch, a coloring principle, and a peculiar acid. The official Oil of Cinnamon is distilled from Cassia Cinnamon. Dose.—5-30 grains (0.3-2.0 Gm.). Official Preparations (Cassia Cinnamon). Tinctura Cardamomi Comptisita—Tincturae Cardamomi Compbsitae— Compound Tincture of Cardamom.—Cardamom, 20; Cassia Cinnamon, 20; Car- away, 10; Cochineal, 5; Glycerin, 50; Diluted Alcohol, q. s. ad 1000 parts. Dose, 1-2 fluidrachms (4.0-8.0 Cc). Tinctura Catechu Comp6sita—Tincturae Catechu CompOsitae—Compound Tincture of Catechu.—Catechu, 100; Cassia Cinnamon, 50; Diluted Alcohol, q. s. ad 1000 parts. Dose, \-2 fluidrachms (2.0-8.0 Cc). Tinctura Lavandulae CompSsita—Tincturae Lavandulae Compdsitae—Com- pound Tincture of Lavender.—Dose, y2-\ fluidrachm (2.0-4.0 Cc). (Formula given under Lavender.} Official Preparations {Ceylon Cinnamon). Tinctura Cinnamomi (10 per cent.)—Tincturae Cinnamomi—Tincture of Cinnamon.—Dose, ^-2 fluidrachms (2.0-8.0 Cc). Pulvis Aromaticus—Ptilveris AromStici—Aromatic Powder.—Dose, 10-30 grains (0.6-2 Gm.). (Formula given under Cardamomuw.) Oleum Cinnamomi—Olei Cinnamomi—Oil of Cinnamon. U S. P. Origin.—A volatile oil distilled from Cassia Cinnamon. Description and Properties.—A yellowish or brownish liquid, 364 A TEXT-BOOK OF MATERIA MEDICA. becoming darker and thicker with age and exposure to the air, having the characteristic odor of cinnamon, and a sweetish, spicy, burning taste. Specific gravity, 1.055 to L065. Soluble in an equal volume of alcohol, the solution being slightly acid to litmus- paper ; also soluble in an equal volume of glacial acetic acid. It should be kept in well-stoppered bottles, in a cool place, protected from light. Constituents.—Oil of cinnamon contains variable quantities of hydrocarbon, but consists chiefly of cinnamic aldehyde, and when old or exposed to the air for a considerable time cinnamic acid and resin are formed. Cinnamic acid crystallizes in shining, colorless, odorless prisms, freely soluble in alcohol, ether, and boiling water. Chlorinated lime and hot dilute nitric acid oxidize it into oil of bitter almond and benzoic acid. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. Aqua Cinnamomi (0.2 per cent.)—Aquae Cinnamomi—Cinnamon Water.— Dose, \-\ fluidounce (15-30 Cc). Spiritus Cinnamomi (10 per cent.)—Spiritus Cinnamomi—Spirit of Cinna- mon.—Dose, 5-20 minims (0.3-1.2 Cc). Physiological Action.—Cinnamon is an agreeable aromatic stimulant, carminative, stomachic, astringent, hemostatic, and anti- septic. The oil possesses germicidal properties. Therapeutics.—The same as for other aromatics. It is much used to impart an agreeable flavor to medicinal compounds and as an adjuvant to other members of this group. Preparations of cin- namon are supposed to stimulate the uterus and check uterine hem- orrhage, and are often employed alone or in combinations with more powerful medicines for this purpose. Coriandrum—Coriandri—Coriander. U. S. P. Origin.—The fruit of Coriandrum sativum L., an annual herb about 2 feet (60.0 Cm.) high, indigenous in China and on the north-eastern shore of the Mediterranean. Cultivated in Asia, Europe, and America. Description and Properties.—Globular, about \ inch (3 Mm.) in diameter, slightly pointed at the apex and crowned with the calyx-teeth at the base. The two concave mericarps cohere, en- closing a lenticular cavity, each furnished on the face with two oil- tubes ; odor and taste agreeably fragrant and aromatic. AROMA TICS. 365 Constituents.—Coriander contains nearly h of 1 per cent, of volatile oil, 13 per cent, of fatty matter, mucilage, and traces of tannin. Dose.—8-30 grains (0.5-2.0 Gm.). Oleum Coriandri—Olei Coriandri—Oil of Coriander U. S. P. Origin.—A volatile oil distilled from Coriander. Description and Properties.—A colorless or slightly yellow- ish liquid, having the characteristic aromatic odor of coriander, and a warm, spicy taste. It is one of the most stable of the volatile oils. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. Confgctio Sfinnae (5 per cent.)—Confectionis Sfennae—Confection of Senna. —Dose, 1-2 drachms (4.0-S.0 Gm.). (Formula given under Senna.) Spiritus Juniperi CompSsitus—Spiritus Juniperi CompSsiti—Compound Spirit of Juniper.—Dose, 2-4 fluidrachms (8.0-15.0 Cc). (Formula given under Carum.) Physiological Action and Therapeutics.—The same as those of the other volatile oils. Frequently used as a corrective to pur- gative medicines. Fcenlculum—Fceniculi—Fennel. U. S. P. Origin.—The fruit of Fa:niculum capillaceum Gilibert, an herba- ceous annual or perennial indigenous in Southern Europe and cul- tivated in Germany, France, and the United States. Description and Properties.—Oblong, nearly cylindrical, slightly curved, from \ to \ inch (4-12 Mm.) long, brownish or greenish-brown, readily separable into the two prominent meri- carps, each with five light-brown, obtuse ribs, with four oil-tubes on the back and two or four upon the flat face; odor and taste aro- matic, anise-like. Constituents.—Fennel contains from 2 to 4 per cent, of volatile oil, which is almost identical chemically with that of anise, 12.5 per cent, of fixed oil, and sugar. Dose.—8-30 grains (0.5-2.0 Gm.). Official Preparation. Infusum Sfinnae Comptisitum—Infusi S6nnae Comp6siti—Compound In- fusion of Senna.—Dose, 1-2 fluidounces (30.0-60.0 Cc). (Formula given under Senna.) 366 ./ TEXT-BOOK OF MATERIA MEDICA. Oleum Fceniculi—Olei Fceniculi—Oil of Fennel. U. S. P. Origin.—A volatile oil distilled from Fennel. Description and Properties.—A colorless or pale-yellowish liquid, having the characteristic aromatic odor of fennel, and a sweetish, mild, and spicy taste. Soluble in an equal volume of alcohol. It should be kept in well-stoppered bottles, in a cool place, and if it has partly or wholly solidified, it should be com- pletely liquefied by warming before being dispensed. Constituents.—It has the same constituents as the oil of anise. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. Aqua Fcenlculi (2 per cent.)—Aquae Fcenlculi—Fennel Water.—Dose, \-\ fluidounce (8.0—30.0 Cc). Pulvis Glycyrrhizae CompSsitus—Ptilveris Glycyrrhizae Compdsiti—Com- pound Liquorice Powder.—Dose, \-2 drachms (2.0-8.0 Gm.). (Formula given under Senna.) Spiritus Juniperi Compdsitus (0.5 per cent.)—Spiritus Juniperi Comp&siti— Compound Spirit of Juniper.—Dose, 2-4 fluidrachms (8.0-15.0 Cc). (Formula given under Carum.) Physiological Action and Therapeutics are the same as those of anise. Capsicum—Capsici—Capsicum. U. S. P. (Cayenne Pepper.) Origin.—The fruit of Capsicum fastigiatum Blume, a small crooked-branched shrub, 1 to 2 feet (30—60 Cm.) high, indigenous in tropical America and Asia, and cultivated in gardens. The fruit is an oblong-conical pod from \ to f- inch (8-19 Mm.) long, of a crimson or yellow color. It encloses two or three cells con- taining flat, reniform, yellowish seeds, attached to a thick, central placenta. These pods when dried and ground form capsicum, which has a peculiar odor and an intensely hot, aromatic taste. This ground product is of a bright-red color, fading upon long exposure to the light. Capsicum of the market usually consists of several species ground together, and is often adulterated with sawdust and sometimes with red lead. Constituents.—Capsicum contains capsaicin, an acrid principle found in the greatest amount in the African product; also a vola- tile alkaloid, fixed and volatile oil, and fat acids. Dose.—3-5 grains (0.2-0.3 Gm.). AROMA TICS. 3^7 Official Preparations. Extractum Capsici Fluidum—Extracti Capsici Fluidi—Fluid Extract of Capsicum.—Dose, J-to 2 minims (0.03-0.12 Cc). Emplastrum Capsici—Emplastrum (ace) Capsici—Capsicum Plaster. For external use. Oleoresina Capsici—Oleoresinae Capsici—Oleoresin of Capsicum.—Dose, \-i minim (0.015-0.06 Cc). Tinctura Capsici—Tincturae Capsici—Tincture of Capsicum.—Dose, 5-20 minims (0.3-1.2 Cc). Physiological Action.—Externally and Locally.—Capsicum is an irritant and rubefacient, producing vesication if kept in contact with the skin for a long time. It so irritates the mucous membrane of the mouth and nose as to induce sneezing. Internally.—Digestive System.—Capsicum is a powerful gastro- intestinal stimulant, increasing the flow from the salivary, gastric, and intestinal glands. It increases the blood-supply to, and stimu- lates the walls of, the stomach, occasioning a sense of heat. It is a powerful carminative. Large doses produce great irritation in the stomach and bowels. Circulatory System.—It is a powerful stimulant to the heart, greatly increasing the strength and rapidity of its action. Absorption and Elimination.—It is chiefly eliminated by the kid- neys, increasing the flow of urine. Large doses may produce vesical tenesmus, and aphrodisiac effects have sometimes been pro- duced. Therapeutics.—Externally and Locally.—Owing to its counter- irritant action, capsicum is employed to relieve lumbago, torticollis, neuralgia, rheumatic pains, and acute inflammations of the skin or mucous membrane. An infusion or the diluted tincture is an excellent gargle in relaxed uvula, pharyngitis, and the angina of scarlet fever. The tinctures of capsicum and cantharides have been used to stimulate the scalp in the various forms of alopecia. The tincture is frequently used as a domestic remedy for the benefit of chilblains and toothache. Internally.—Capsicum is a most valuable stomachic in an atonic condition of the digestive organs, and a very efficient remedy in the irritable and catarrhal conditwis of the stomach due to the ex- cessive use of alcohol. The tincture of capsicum or the powdered drug, added to hot water or to hot water and whiskey, makes a valuable and rapid car- diac and vascular stimulant. 368 A TEXT-BOOK OF MA TERIA MEDICA. Contraindications.—Capsicum and its preparations should not be given in acute inflammatory affections of the gastro-intestinal and genito-urinary tracts. Administration.—The oleoresin and the powder should be given in pills or capsules. The fluid extract and the tincture should be administered well diluted with water. Piper—Piperis— Pepper. U. s. P. (Black Pepper.) Origin.—The unripe fruit oi Piper nigrum L., a knotted, pointed- branched, aromatic, climbing shrub, indigenous in India, and culti- vated in many of the East Indian and Philippine and some of the West Indian islands. Constituents.—Its important constituents are a volatile oil (i to 2 per cent.); a neutral principle, piperin (6 to 8 per cent.); and a pungent, soft, dark-green resin, to which the acrid taste and medici- nal properties of pepper are due. Dose.—5-20 grains (0.3-1.2 Gm.) Official Preparations. Oleoresina Piperis—Oleoresinae Piperis—Oleoresin of Pepper.—Dose, \-\ grain (0.015-0.06 Gm.). Piperinum—Piperini—Piperin.—Origin.—A neutral principle obtained from Pepper, as well as from other plants of the natural order Piperacea. Description and Properties.—Colorless, or pale-yellowish, shining, prismatic crystals, odorless, and almost tasteless when first taken into the mouth, but after a while pro- ducing a sharp, biting sensation. Permanent in the air; almost insoluble in water, but soluble in 30 parts of alcohol and in 1 part of boiling alcohol. It is isomeric with mor- phine, and can be decomposed into piperic acid and a liquid alkaloid, piperidine. Dose.—i-io grains (0.03-0.6 Gm.). Derivative Compound. Piperonal—Heliotropin.—Obtained from Piperic Acid by oxidation. It occurs in small white crystals, soluble in about 600 parts of cold water, and very readily soluble in alcohol and ether. The dose is 10-15 grains (0.6-1.0 Gm.). It has been used as an antiseptic and antipyretic. Physiological Action and Therapeutics of pepper and its preparations are almost identical with those of capsicum. Pepper, particularly piperin, possesses antiperiodic and anti- septic properties to a greater extent than capsicum. Myristica—Myrlsticae— Nutmeg. U.S. P. Macis— Macidis—Mace. U. S. P. Origin.—The seed (Myristica) and the membrane, " arillode,'* AROMA TICS. 369 investing the kernel (Mace) of Myristica fragrans Houttuyn, a tree about 30 feet (9 M.) high, found in the Molucca Islands and cul- tivated in the East Indies. Oleum Myrlsticae—Olei Myrlsticae—Oil of Nutmeg. U. S. P. Origin.—A volatile oil distilled from Nutmeg. Description and Properties.—A thin, colorless or pale-yel- lowish liquid, having the characteristic odor of nutmeg and a warm, spicy taste. It becomes darker and thicker by age and ex- posure to the air. Soluble in an equal volume of alcohol. It should be kept in well-stoppered bottles, in a cool place, protected from light. Dose.—1-3 minims (0.06-0.18 Cc). Official Preparation. Spiritus Myrlsticae (5 per cent.)—Spiritus Myrlsticae—Spirit, or Essence, of Nutmeg.—Dose, 15-60 minims (1.0-4.0 Cc). Physiological Action and Therapeutics are the same as those of anise. Caryophyllus—Caryophylli—Cloves. U. s. P. Origin.—The unexpanded flowers of Eugenia aromatica (L.) O. Kuntze, a hard-wood, shrubby evergreen. It was originally found in the Molucca Islands, whence it was introduced and cultivated among the East Indian Islands. Description and Properties.—The buds are about f inch (15 Mm.) long, dark-brown, consisting of a subcylindrical, solid and glandular calyx-tube, terminated by four teeth and surmounted by a globular head, formed by four petals covering numerous curved stamens, and one style. A clove resembles a nail (L. davits; Fr. clou). Cloves have a strong aromatic odor and a pungent, spicy taste, and when pressed or scratched emit oil. Constituents.—Cloves contain about 18 per cent, of a highly pungent volatile oil, 17 per cent, of tannin, and small quantities of fixed oil, gum, resin, etc. Two crystalline principles have been separated : caryophyllin, a white, resinous substance—a stearopten —odorless and tasteless ; and cugenin, a substance soluble in boil- 24 37° A TEXT-BOOK OF MATERIA MEDICA. ing alcohol and isomeric with eugenol, a constituent of the volatile oil. Dose.—5-10 grains (0.3-0.6 Gm.). Official Preparation. Tinctura Lavandulae CompSsita—Tincturae Lavandulae Compfisitae—Tinc- ture of Lavender.—Dose, \-\ fluidrachm (2.0-4.0 Cc). (Formula given under Lavender.) Oleum Caryophylli—Olei Caryophylli—Oil of Cloves. U. S. P. Origin.—A volatile oil distilled from Cloves. Description and Properties.—A pale-yellow, thin liquid, be- coming darker and thicker by age and exposure to the air, having a strongly aromatic odor of cloves and a pungent, spicy taste. Its specific gravity is 1.060-1.067. Soluble in an equal volume of alcohol, the solution being slightly acid to litmus-paper. Constituents.—Oil of cloves consists of a light and a heavy oil, the former a hydrocarbon, supposed to be inactive; the latter a phenol-like liquid termed eugenol, a colorless oil, with the odor of cloves, a specific gravity of 1.076 to 1.0785, yielding with bases crystalline salts. Schenck has demonstrated the presence of sali- cylic acid in oil of cloves. Dose.—1-10 minims (0.06-0.6 Cc). Allied Compounds and Derivatives. Bfenzoyl-eugenol.— Origin.—From Eugenol. Description and Properties.—It occurs in neutral, odorless, colorless, acicular crys- tals, having a feebly bitter taste; soluble in hot alcohol, ether, and chloroform, and insoluble in water. Dose.—Not yet determined. Cinnamyl-eugenol.— Origin.—A derivative of Eugenol. Description and Properties.—Colorless, odorless, tasteless, lustrous needles, soluble in hot alcohol, ether, and chloroform, and insoluble in water. Eugenyl-acStamide.— Origin. — Obtained from Eugenol-acetic-ethyl-ether by treating with solution of Ammonia. It occurs as a crystalline powder. Physiological Action.—Externally and Locally.—Oil of cloves is a counter-irritant, local anesthetic, and germicide. Internally.—Its action is essentially the same as that of anise, it being a powerful carminative and stimulant. Therapeutics.—Externally and Locally.—Oil of cloves is em- ployed as a local anesthetic in toothache, earache, and neuralgia, and as a synergist to other counter-irritants, rubefacients, and anti- AROMATICS. 371 septics. The eugenol-acetamide is a powerful local anesthetic, being analogous to cocaine in its action. Internally.—The therapeutics are similar to those of anise. The bexzoyl-eugexol has been highly recommended by some prac- titioners as a valuable remedy in tuberculosis. The author has suc- cessfully employed the following combination as an antiseptic and antifermentative in gastric fermentation, to be administered either in soft capsules, with olive oil as a vehicle, or in the form of an emul- sion : &. Olei Caryophylli, Olei Cinnamomi, Olei Menthae Piperitae, Creosoti, ad. try. M. Sig.—Take at one dose. The better way to administer it is in the form of soft capsules, each capsule containing the above dose in about 6 minims (0.37 Cc.) of olive oil. One or two capsules should be given three times a day, after meals. Pimenta—Pimentae—Pimenta. I. S.P. (Allspice.) Origin.—The nearly ripe fruit of Pimenta officinalis Lindley, an evergreen tree about 30 feet (9 M.) high, indigenous in the West Indies, Central America, and the northern part of South America. Constituents.—The most important constituent is the volatile oil, of which the fruit yields from 3 to 4 per cent. Oleum Pimentae—Olei Pimentae—Oil of Allspice. U. S. P. Origin.—A volatile oil distilled from Pimenta. Description and Properties.—A colorless or pale-yellow liquid, having a strong, aromatic, clove-like odor, and a pungent, spicy taste. It becomes darker and thicker with age and exposure. With an equal volume of alcohol it forms a clear solution. Dose.—1-5 minims (0.06-0.3 Cc). Physiological Action and Therapeutics are similar to those of cloves. Oleum Cajuputi—Olei Cajuputi—Oil of Cajuput. U. S. P. Origin.—A volatile oil distilled from the leaves of Melaleuca 372 A TEXT-BOOK OF MATERIA MEDICA. leucadendron L., a tree with crooked stem and scattered branches, resembling the weeping willow, indigenous in the East Indies. Description and Properties.—A light, thin, bluish-green, or, after rectification, colorless liquid, having a peculiar, agreeable and distinctly camphoraceous odor, and an aromatic, bitterish taste. Specific gravity, 0.922. With an equal volume of alcohol it affords a clear solution, which either has a slightly acid reaction or, in the case of the rectified oil, is neutral to litmus-paper. Constituents.—The chief constituent is cajuputol, the hydrate of the hydrocarbon cajuputene. Cajuputol is identical with euca- lyptol. Dose.—1-5 minims (0.06-0.3 Cc). Physiological Action and Therapeutics are identical with those of the oil of cloves. Cardamomum—Cardam5mi—Cardamom. U. s. P. Origin.—The fruit of Elettaria repens (Sonnerat) Baillon, a per- ennial plant 6 to 10 feet (1.8-3 M-) high- Cardamom is indigenous in Hindustan, in the mountainous regions of Malabar. The same plant furnishes three varieties of cardamoms, known in commerce as the shorts, short-longs, and long-longs. Description and Properties.—Ovoid or oblong, from f to £ inch (12 Mm.-2 Cm.) long, obtusely triangular, rounded at the base, beaked, longitudinally striate; of a pale-buff coior, three- celled, with a thin, leathery, nearly tasteless pericarp and a central placenta. The seeds are about \ inch (5 Mm.) long and \ inch (3 Mm.) broad, reddish-brown, angular, rugose, depressed at the hilum, surrounded by a thin membranous arillus. They have an agreeable odor and a pungent, aromatic taste. The seeds contain 10 per cent, of fixed oil and 4.6 per cent, of a volatile oil, besides albuminous matter, gum, starch, etc. The volatile oil possesses the odor and taste of the seeds, is colorless or yellowish, dextrogyre, contains oxygen, and has a specific gravity of 0.93 to 0.94. Dose.—5-15 grains (0.3-1 Gm.). Official Preparations. Tinctura Cardamomi (10 per cent.)—Tincturae Cardamomi—Tincture of Cardamom.—Dose, 1-2 fluidrachms (4.0-8.0 Cc). Tinctura Cardamomi Compbsita—Tincturae Cardamomi Comp6sitae— AROMA TICS. 373 Compound Tincture of Cardamom.—Cardamom, 20; Cinnamon, 20; Caraway, 10; Cochineal, 5; Glycerin, 50; Dilute Alcohol, q. s. ad 1000 parts. Dose, 1-2 fluid- drachms (4.0-8.0 Cc). Pulvis Aromaticus—Ptilveris Aromatici—Aromatic Powder.—Ceylon Cinna- mon, 35 5 Ginger, 35; Cardamon, 15; Nutmeg, 15. Dose, 10-30 grains (0.6- 2.0 Gm.). There is also a fluid extract made from this powder. Dose, 10-30 minims (0.6- 2.0 Cc). Antagonists and Incompatibles.—Free acids are incompatible with the compound tincture of cardamom, separating insoluble car- minic acid in it. Physiological Action.—In this respect Cardamom conforms to the general character of the Aromatic Group. Therapeutics.—Essentially the same as for other members of this group. Cardamom is used principally as an adjuvant to other aromatics, stimulants, stomachics, and carminatives. Zingiber—Zinglberis—Ginger. U. S. P. Origin.—The rhizome of Zingiber officinale Roscoe, a perennial herb indigenous in tropical Asia and now cultivated in most tropi- cal countries. Description and Properties.—A thick, flattish rhizome from 1 to 4 inches (25 to 100 Mm.) long, with club-shaped lobes on one side; deprived of the corky layer, pale, buff-colored, striate, breaking with a mealy, rather fibrous fracture, showing numerous small, scattered resin-cells and fibro-vascular bundles, the latter enclosed by a nucleus sheath. Agreeably aromatic, and of a warm, pungent taste. Ginger contains from f to 2 per cent, of a pale-yellow, volatile oil, to which the ginger owes its aromatic properties; also a soft resin, giving to the drug its hot, pungent taste. The proportion of resin present varies with the different varieties of ginger, that from the East Indies yielding about 8 per cent., while the Jamaica product yields only about 5 per cent. Dose.—8-30 grains (0.5-2.0 Gm.). Official Preparations. Extractum Zinglberis Fluidum—Extracti Zinglberis Fluidi—Fluid Ex- tract of Ginger.—Dose, 10-30 minims (0.6-2.0 Cc). Oleoresina Zinglberis—Oleoresinae Zinglberis—Oleoresin of Ginger.— Dose, 1-3 grains (0.06-0.iS Gm.). Pulvis Aromalticus—Pulveris Aromatici—Aromatic Powder.—Dose, 10-30 grains (0.6-2.0 Gm.). (Formula given under Cardamomum.) 374 A TEXT-BOOK OF MATERIA MEDICA. Pulvis Rhei Compdsitus—Pulveris Rhei Comp6siti—Compound Powder of Rhubarb.—Rhubarb, 25 ; Magnesia, 65 ; Gm^cr, 10 parts. Dose, l/2-l drachm (2.0-4.0 Gm.). Syrupus Zinglberis—Syrupi Zinglberis—Syrup of Ginger.—Dose, l/2-2 drachms (2.0-8.0 Cc). Tinctura Zinglberis—Tincturae Zinglberis—Tincture of Ginger.—Dose, 1-2 fluidrachms (4.0-8.0 Cc). Trochisci Zinglberis—Trochlscos (ace) Zinglberis—Troches of Ginger.— Dose, use freely as required. Physiological Action and Therapeutics are almost identical with those of other aromatics. Ginger is especially valuable as a stomachic and carminative, to stimulate the stomach, improve the appetite, and relieve flatulency and colic. It is a safe and efficient domestic remedy for the relief of simple diarrhea. It is also much used as a corrective to modify the taste and action of other medicines. Calamus—Calami—Calamus. U.S. P. (Sweet Flag.) Origin.—The rhizome of Acorus Calamus L., a plant indige- nous in North America, Europe, and Western Asia, growing in swamps and along the shores of streams and ponds. Description and Properties.—Calamus is found in subcylin- drical sections of various lengths, about 1 inch (2 Cm.) broad, externally reddish-brown, internally whitish, of a spongy texture, breaking with a short, corky fracture, showing numerous oil-cells and scattered wood-bundles. It has a strong aromatic, fragrant odor, and a warm, peculiar, bitterish taste. Calamus contains from 1 to 2 per cent, of volatile oil possessing the odor and taste of cal- amus, a glucosid (acorin) in the form of a bitter, yellow syrupy liquid, besides calamine, choline, resin, starch, and mucilage. Dose.—15-60 grains (1.0-4.0 Gm.). Official Preparation. ExtrSctum Calami Fluidum—Extracti Calami Fluidi—Fluid Extract of Calamus.—Dose, 15-60 minims (1.0-4.0 Cc). Physiological Action and Therapeutics.—The action of cala- mus is similar to that of anise, but it.is more tonic than the latter. Large doses of the volatile oil produce tetanic convulsions. It is used for the same purposes as anise, but probably possesses more stomachic and carminative properties. AROMA TICS. 2>75 Oleum Gaultheriae—Olei Gaultheriae—Oil of Winter- green. U. S. P. Origin.—A volatile oil distilled from the leaves of Gaultheria procumbens L., a small evergreen plant indigenous in the northern hemisphere and bearing a scarlet, fleshy, berry-like fruit. Description and Properties.—The volatile oil is a colorless or yellow, or occasionally reddish, liquid, having a characteristic, strongly aromatic odor, and a sweetish, warm, and aromatic taste. Specific gravity, 1.175 to 1.185. It consists almost entirely of methyl salicylate. It should be kept in well-stoppered bottles, protected from light. Dose.—2-10 minims (0.12-0.6 Cc). Official Preparation. Spiritus Gaultheriae—Spiritus Gaultheriae—Spirit of Gaultheria (Essence of Wintergreen).—Dose, 1-2 fluidrachms (4.0-8.0 Cc). Physiological Action.—Externally and Locally.—Oil of winter- green is a stimulant and a powerful antiseptic. Internally.—Its action is identical with that of salicylic acid and its salts, but it does not depress the heart like the latter drugs. Therapeutics.—Externally and Locally.—Used for the same purposes as oil of cloves and other aromatic oils. Internally.—Used for the same purposes as salicylic acid. Oleum Lavandulae Florum—Olei Lavandulae Florum — Oil of Lavender Flowers. U. S. P. Origin.—A volatile oil distilled from fresh flowers of Lavandula officinalis Chaix. Lavender is native to Southern Europe and cultivated in gardens. Description and Properties.—A colorless or yellowish liquid, having the fragrant odor of lavender flowers and a pungent and bitterish taste. Soluble in all proportions of alcohol. It should be kept in well-stoppered bottles, in a cool place, protected from light. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. Spiritus Lavandulae (5 per cent.)—Spiritus Lavandulae—Spirit of Lavender. —Dose, *4-l fluidrachm (2.0-4.0 Cc). Tinctura Lavandulae Comp6sita—Tincturae Lavandulae Comp5sitae—Com- 376 A TEXT-BOOK OF MATERIA MEDICA. pound Tincture of Lavender.—Oil of Lavender, 8; Oil of Rosemary, 2; Cassia Cinnamon, 20; Cloves, 5; Nutmeg, 10; Red Saunders, 10; Alcohol, 0.7; Water, 250; Diluted Alcohol, q. s. ad 1000 parts. Dose, '2-i fluidrachm (2.0-4.0 Cc). Com- pound Tincture of Lavender is an ingredient of Liquor Potassii Arsenitis. Physiological Action and Therapeutics are the same as those of other volatile oils mentioned in this group. Mentha Piperita—Menthae Piperitae—Peppermint. U. S. P. Origin.—The leaves and tops of Mentha piperita Smith, a perennial plant found in damp places in England and other Euro- pean countries and in North America. Peppermint contains about 1 per cent, of a volatile oil—its, most important constituent. Official Preparation. Spiritus Menthae Piperitae (10 per cent.)—Spiritus MSnthae Piperitae—Spirit, or Essence, of Peppermint.—Dose, 5-60 minims (0.3-0.4 Cc). Spirit of Peppermint is an ingredient of Mistura Rhei et Sodae. Oleum Menthae Piperitae—Olei Menthae Piperitae— Oil of Peppermint. U. S. P. Origin.—A volatile oil distilled from Peppermint. Description and Properties.—A colorless or yellowish or greenish-yellow liquid, becoming darker and thicker by age and exposure to the air, having the characteristic strong odor of pep- permint, and a strongly aromatic, pungent taste, followed by a sensation of cold upon inhalation. It forms a clear solution with an equal volume of alcohol, becoming turbid when further diluted, and is soluble in all proportions in carbon disulphide and in glacial acetic acid. When exposed to a freezing temperature the oil becomes thick and cloudy, and separates crystals of menthol, to which it owes its peculiar odor. Dose.—1-5 minims (0.06-0.3 Cc). Official Preparations. Aqua MSnthae Piperitae (0.2 per cent.)—Aquae MSnthae Piperitae—Pepper- mint Water.—Dose, y2-\ fluidounce (15.0-30.0 Cc). Trochisci MSnthae Piperitae (.01 Cc. in each)—Trochlscos (ace) MSnthae Piperitae—Troches of Peppermint.—Dose, freely as desired. AROMATICS. 377 Menthol—Menthol—Menthol. U. S. P. Origin.—A stearopten obtained from the official Oil of Pepper- mint or from Japanese or Chinese Oil of Peppermint. Description and Properties.—Colorless, acicular or prismatic crystals, having a strong and pure odor of peppermint, and a warm, aromatic taste, followed by a sensation of cold when air is inhaled. Menthol is but slightly soluble in water, but imparts to the latter its odor and taste. It is freely soluble in alcohol, ether, chloroform, carbon disulphide, and glacial acetic acid. Dose.—\-2 grains (0.03-0.12 Gm.). Allied Compounds. Benzoate of Menthol; Chloral Menthol.—These combinations are quite active local anesthetics and analgesics. Physiological Action and Therapeutics.—Externally and Lo- cally.—Menthol is an antiseptic, antipruritic, analgesic, and anes- thetic, as well as a germicide. It is used for the same purposes as oil of cloves. It is used extensively in headache, being rubbed on the forehead. Owing to its analgesic properties, it is used in the form of an ointment in various strengths for painful hemor- rhoids, burns, boils, and superficial inflammations. The oil of peppermint, or menthol, is an ingredient of many sprays and lotions for the treatment of diseases of the ear, nose, and throat. As an antipruritic menthol is a valuable remedy to relieve the itching of eczema, pruritus, urticaria, etc. It should be dissolved in oil for this purpose—in severe cases 50 grains to 1 ounce (3.2 Gm. to 30.0 Cc). Internally.—The uses of oil of peppermint are similar to those of other aromatic oils, it being a valuable carminative, stimu- lant, antifermentative, and antispasmodic. In small doses menthol has been given to allay nausea and vomiting and to relieve the pain of gastralgia. Mentha Viridis—Menthae Viridis—Spearmint. U. S. P. This is one of the mints, found in the same localities as peppermint, and containing, like the latter drug, a volatile oil forming its active constituent. It possesses milder properties than peppermint, although similar to it in its action and uses. To some 37§ A TEXT-BOOK OF MATERIA MEDICA. people it has a more agreeable taste than peppermint, and in infantile cases it is usually preferred. Official Preparations. Aqua MSnthae Viridis—Aquae MSnthae Viridis—Spearmint Water. Spiritus MSnthae Viridis—Spiritus MSnthae Viridis—Spirit, or Essence, of Spearmint. The dose of the oil of spearmint and of the above preparations is the same as for the corresponding oil and preparations of peppermint. Thymol—Thymol-Thymol. U. S. P. Origin.—A phenol or stearopten occurring in, and obtained by, freezing or distilling the volatile oils of Thymus vulgaris, Thymus monarda, and Carum ajowan. Description and Properties.—Large, colorless, translucent crystals of the hexagonal system, having an aromatic, thyme-like odor, and a pungent aromatic taste, with a very slight caustic effect upon the lips. Its specific gravity as a solid is 1.069, but when liquefied by fusion it is lighter than water. It is soluble in about 1200 parts of water and in less than its own weight of alcohol, ether, or chloroform; also readily soluble in carbon disulphide, glacial acetic acid, and in fixed or volatile oils. When triturated with about equal quantities of camphor, menthol, or chloral, it liquefies. Dose.—1-5 grains (0.06-0.3 Gm.). Allied and Derivative Compound. Thymacetin, a derivative of thymol, prepared after the manner of phenacetin, and holding the same relation to thymol as phenacetin does to phenol (carbolic acid). It is a white, crystalline powder, sparingly soluble in water. Dose, 3-10 grains (0.2-0.6 Gm.). Physiological Action and Therapeutics are similar to those of phenacetin, thymace- tin possessing marked analgesic and hypnotic properties. Physiological Action.—Thymol is a powerful antiseptic, being ten times less poisonous than carbolic acid, yet as an antiseptic far superior to it. While stimulant, it is not irritant or corrosive. It is also a deodorant, disinfectant, parasiticide, and local anesthetic, as well as an antipruritic, antipyretic, and antifermentative. Absorption and Elimination.—It is eliminated chiefly by the lungs and kidneys, producing some irritation at the points of elimination. The urine is increased in quantity, often assuming a dark greenish hue. AROMA TICS. 379 Untoward Action.—The following symptoms have been pro- duced by the administration of large doses: burning sensation in the mouth and stomach, persisting in some instances for days, accompanied by pain and tenderness under pressure. According to Balz, " perspiration is sometimes observed, and occasionally a transient buzzing in the ears and deafness." Poisoning.—In addition to untoward manifestations, there may be nausea and vomiting, profuse sweating, great reduction of tem- perature, dizziness, violent delirium, and collapse. Therapeutics.—Externally and Locally .—The applications of thymol in surgery are identical with those of carbolic acid. Among surgeons who recommend and use it is Mr. Spencer Wells, who employs it in a solution of i : iooo for spray, irrigation, sponges, instruments, and all other antiseptic purposes. Crocker in 1878 introduced it as an efficient remedy in certain skin diseases. It probably owes its value in these cases to its anti- pruritic and antiparasitic properties. It is also extensively used in diseases of the nose, throat, and ear, and in certain disorders of the gcnito-urinary tract. Thymol is also administered by inhalation in certain broncho-pulmonary disorders. Internally.—Thymol is used for the same purposes as other antiseptics, such as carbolic acid, resorcin, beta-naphtol, etc Martini highly recommends it as an intestinal antiseptic in the treatment of diarrhea, dysentery, and typhoid fever. Bulfalini has employed it with some success in limiting fermen- tation during a proteid diet in the treatment of diabetes. It has also been favorably recommended in phthisis, vesical catarrh, sto- matitis, and diphtheria. Administration.—It may be applied externally in solution (1 : 1000), as an ointment (1-10 per cent), or in the form of thymol gauze as a surgical dressing (1 per cent, of thymol). For internal use it should be given in pills or capsules. Carum—Cari—Caraway. U. S. P. Origin.—The fruit of Carum Carvi L., a biennial plant native to Central and Western Asia. It is cultivated in Europe and in the United States. Description and Properties.—Oblong, laterally compressed, about \ to \ inch (4-5 Mm.) in length, tapering somewhat at the 380 A TEXT-BOOK OF MA TERIA MEDICA. ends, brown, with five yellowish, filiform ribs, and six oil-tubes. Caraway has an agreeable odor and a sweetish, spicy taste. Constituents.—It contains from 5 to 7 per cent, of a volatile oil. Dose.—15-30 grains (1.0-2.0 Gm.). Official Preparation. Tinctura Cardamomi Comp6sita (10 per cent.)—Tincturae Cardamomi Compflsitae—Compound Tincture of Cardamom.—Dose, 1-2 fluidrachms (4.0- 8.0 Cc). (Formula given under Catiamomum.) Oleum Cari—Olei Cari—Oil of Caraway. U. S. P. Origin.—A volatile oil distilled from Caraway. Description and Properties.—A colorless or pale-yellow, thin liquid, having the characteristic aromatic odor of caraway and a mild, spicy taste. Soluble in an equal volume of alcohol, this solution being neutral to litmus-paper. By fractional distillation the oil may be separated into two portions: a light hydrocarbon with but little odor and taste, carvene, and a heavy oil having an agreeable caraway odor, carvol, and isomeric with menthol, myristicol, and thymol. Dose.—1-10 minims (0.6-0.66 Cc). Official Preparation. Spiritus Juniperi Compftsitus (0.05 per cent.)—Spiritus Juniperi Compftsiti— Compound Spirit of Juniper.—Oil of Juniper, 4; Oil of Caraway, \; Oil of Fennel, Yz ; Alcohol, 0.7; Water, q. s. ad iooo parts. Dose, 2-4 fluidrachms (8.0-15.0 Cc). Physiological Action and Therapeutics.—The same as those of the other aromatic oils. CLASS II.-SYMPTOM MEDICINES. GROUP I.—ANTISPASMODICS. Antispasmodics are remedies used to allay spasm and quiet nervous excitement or improve unfavorable conditions of the mind, as in cases of convulsions, hysteria, melancholia, hypo- chondriasis, etc. They act as stimulants to the brain and higher nervous centers, and as depressants of the lower centers, diminish- ing muscular activity and, partly through their action upon the higher nervous centers, increasing the co-ordinating power. They are to a considerable degree cardiac stimulants, diaphoretics, ex- pectorants, and antiseptics. Asafcetida—Asafcetidae—Asafetida. U. S. P. Origin.—A gum resin obtained from the root of Ferula fcctida (Bunge) Regel, a large perennial herb found in Turkestan, Western Thibet, and Western Afghanistan. Description and Properties.—Irregular masses composed of whitish tears imbedded in a yellowish- or brownish-gray, sticky mass. The tears when hard break with a conchoidal fracture, showing a milk-white color, which changes, on exposure, to pink, and finally to brown. The drug has a persistent alliaceous odor and a bitter, alliaceous, acrid taste. When triturated with water it yields a milk-white emulsion, which becomes yellow upon the addi- tion of ammonia water. It is partly soluble in ether, and at least 60 per cent, of it should dissolve in alcohol. Dose.—5-8 grains (0.3-0.5 Gm.). Official Preparations. Emiilsum Asafcetidae—Emiilsi Asafcetidae—Emulsion of Asafetida. —Dose, 2-4 fluidrachms (7.39-15 Cc). Pilulae Aloes et Asafcetidae—Pllulas (ace) Aloes et Asafcetidae.—Pills of Aloes and Asafetida.—Dose, 2 to 5 pills. Pilulae Asafcetidae—Pllulas (ace.) Asafcetidae—Pills of Asafetida.—Dose, 2 to 5 pills. Tinctura Asafcetidae—Tincturae Asafcetidae—Tincture of Asafetida (20 per cent.).—Dose, 10-40 minims (0.6-2.5 Cc). 381 382 A TEXT-BOOK OF MATERIA MEDICA. Ammonlacum—Ammonlaci—Ammoniac. U. S. P. Origin.—A gum resin obtained from Dorema Ammoniacum Don, a plant 6 or 7 feet (2 M.) high, found in the deserts and barren regions of Persia and Tartary. Description and Properties.—Roundish tears, y^--^ inch (1.5- 12 Mm.) in diameter; externally pale yellowish-brown, internally milk-white; brittle when cold, and breaking with a flat, conchoidal, and waxy fracture; or the tears are superficially united into irreg- ular masses without any intervening dark-colored substance. It has a peculiar odor and a bitter, acrid, and nauseous taste. When triturated with water it readily yields a milk-white emulsion. It contains from 1.8 to 4 per cent, of volatile oil, 70 to 72 per cent. of resin, and 18 to 22 per cent, of gum. Dose.—2-10 grains (0.12-0.6 Gm.). Official Preparations. Emplastrum Ammonlaci cum Hydrargyro—Empiastra Ammonlaci cum Hydrargyro—Ammoniac Plaster with Mercury.—For external use. Emtilsum Ammonlaci—Emiilsi Ammonlaci—Emulsion of Ammoniac (4 per cent.).—Dose, }i-i fluidounce (15 to 30 Cc). Camphora—Camphorae—Camphor. U. S. P. Origin.—A stearopten (of the nature of a ketone) obtained from Cinnamomum camphora L., and purified by sublimation. The camphor laurel is a handsome tree 25 to 30 feet (7.5-9 M.) high, indigenous in Eastern and Southeastern Asia, and cultivated in Italy as an ornamental tree. Description and Properties.—White, translucent masses, of a tough consistence and crystalline structure, readily pulverizable in the presence of a little alcohol, ether, or chloroform; having a penetrating, characteristic odor and a pungently aromatic taste. Very sparingly soluble in water, but readily soluble in alcohol, ether, chloroform, carbon disulphide, benzin, and in fixed and vola- tile oils. When camphor is triturated in about molecular proportions with menthol, thymol, phenol, or chloral hydrate, liquefaction ensues. It melts at 1750 C. (3470 F.), boils at 2040 C. (399.20 F.), and is inflammable, burning with a luminous, smoky flame. On exposure to the air it evaporates more or less rapidly at ordinary temperatures, and when moderately heated it sublimes without leaving a residue. ANTISPASMODICS. 383 From camphor may be obtained a number of interesting com- pounds, such as camphoric acid, cymol, etc. The drug should be kept in well-closed vessels, in a cool place. Dose.—2-10 grains (0.12-0.6 Gm.). Official Preparations. Aqua Camphorae—Aquae Camphorae—Camphor Water (0.8 per cent.).__ Dose, \-2 fluidounces (15-30 Cc.). LinimSntum Camphorae—LinimSnti Camphorae—Camphor Liniment.__ Camphor, 20; Cotton Seed Oil, 80 parts. For external use. LinimSntum Saponis—LinimSnti Saponis—Soap Liniment (4.5 percent.).__ For external use. Spiritus Camphorae—Spiritus Camphorae—Spirit of Camphor (10 per cent.). —Dose, 5-40 minims (0.3-2.6 Cc). Tinctura Opii Camphorata—Tincturae Dpii Camphoratae—Camphorated Tincture of Opium (0.4 per cent.).—Dose, 1-4 fluidrachms (4-15 Cc). Camphora Monobromata—Camphorae Monobro- matae—Monobromated Camphor. U. S. P. Origin.—Prepared by heating Camphor and Bromine, dissolving in Benzin, and crystallizing from hot Alcohol. Description and Properties.—Colorless, prismatic needles or scales, of a mild, camphoraceous odor and taste, permanent in the air, unaffected by light, and neutral to litmus-paper. Almost in- soluble in water; freely soluble in alcohol, ether, chloroform, hot benzin, and fixed and volatile oils; slightly soluble in glycerin. Dose.—2-5 grains (0.12-0.3 Gm.). Acidum Camph6ricum—Acidi Camphdrici—Camphoric Acid.— Origin.— Obtained by the oxidation of Camphor through the action of Nitric Acid. Description and Properties.—White, acicular crystals, odorless, and of a weak, acid, and slightly astringent taste. Soluble in hot water, alcohol, ether, and fatty oils; almost insoluble in cold water. Dose.—10-30 grains (0.6-2.0 Gm.). Valeriana—Valerianae—Valerian. U. S. P. Origin.—The rhizome and roots of Valeriana officinalis L., an herbaceous perennial 2 to 4 feet (0.6-1.2 M.) high, a native of Europe, and cultivated to some extent in New England and New York. Description and Properties.—The rhizome varies in length be- tween \ and 1 \ inches (1-3 Cm.), and has nearly an equal diameter, thick, upright, subglobular or obconical, truncate at both ends, brown or yellowish-brown, internally whitish or pale-brownish, 384 A TEXT-BOOK OF MATERIA MEDICA. with a narrow circle of white wood under the thin bark. Roots numerous, slender, brittle, brown, with a thick bark and slender, ligneous cord. Odor peculiar, becoming stronger and unpleasant on keeping; taste camphoraceous and somewhat bitter. Valerian contains valerianic and other acids and a volatile oil Dose.—15-60 grains (1.0-4.0 Gm.). Official Preparatio7is. Extr3ctum Valerianae Fluidum—Extracti Valerianae Fluidi—Fluid Ex- tract of Valerian.—Dose, 15-60 minims (1.0-4.0 Cc). Tinctura Valerianae—Tincturae Valerianae—Tincture of Valerian (20 per cent.).—Dose, 1-2 fluidrachms (4-8 Cc). Tinctura Valerianae Ammoniata—Tincturae Valerianae Ammoniatae—Am- moniated Tincture of Valerian (20 per cent.).—Dose, 30-60 minims (2.0-4.0 Cc,). Ammonii Valerianas—Ammonii Valerianates—Am- monium Valerianate. U. S. P. Origin.—Obtained by saturating Valerianic Acid with Gaseous Ammonia and crystallizing. Description and Properties.—Colorless or white quadrangular plates, emitting the odor of valerianic acid; of a sharp and sweet- ish taste ; deliquescent in moist air. Very soluble in water and in alcohol. Ammonium valerianate should be kept in well-stoppered bottles. Dose.—2-10 grains (0.12-0.6 Gm.). Ferri Valerianas—Ferri Valerianatis—Ferric Valerianate. U. S. P. Origin.—Prepared by mixing solutions of Ferric Sulphate and Sodium Valerianate and washing the precipitate formed. Description and Properties.—A dark brick-red amorphous powder of somewhat varying chemical composition, having the odor of valerianic acid and a mildly styptic taste; permanent in dry air. Insoluble in cold water, but readily soluble in alcohol. Ferric valerianate should be kept in small, well-stoppered bottles, in a cool and dark place. Dose.—1-3 grains (0.6-0.2 Gm.). Zinci Valerianas—Zinci Valerianatis—Zinc Vale- rianate. U. S. P. Origin.—Obtained by evaporating hot solutions of Zinc Sul- ANTISPASMODICS. 385 phate and Sodium Valerianate, the zinc valerianate crystallizing out. Description and Properties.—White, pearly scales, having the odor of valerianic acid and a sweetish, astringent, and metallic taste. On exposure to air it slowly loses valerianic acid. Soluble in about 100 parts of water and in 40 parts of alcohol. It should be kept in small, well-stoppered bottles. Dose.—J-3 grains (0.03-0.2 Gm.). Antagonists and Incompatibles.—The actions of asafetida, ammoniac, and camphor are opposed by arterial sedatives, acids, and neutral salts, while quinine, digitalis, and ergot antagonize the action of valerian. Water and aqueous solutions precipitate camphor from its alco- holic solution. Synergists.—The antispasmodics are synergistic to each other. They are also aided in their action by the aromatics and many of the gum resins and balsams, alcohol, ether, etc. These remedies are so nearly alike in their action that their physiological effects will here be considered as a whole, mention being made of any marked difference in their individual action should it exist. Physiological Action.—Externally and Locally.—The only member of this group having any special local action is camphor. This drug has an anesthetic effect upon the unbroken skin, but in a concentrated state is very irritating to mucous membranes, and may even produce inflammation and sloughing. Camphor is also a powerful parasiticide. Digestive System.—In medicinal doses antispasmodics stimulate the digestion and augment the secretions from the gastro-intestinal tract. They also stimulate peristalsis, and are active carminatives and calmatives to the digestive tract. Asafetida is the most laxa- tive of all. Large doses of any antispasmodic cause nausea, vomiting, and purging, camphor being the most irritant, and in toxic doses acting as an irritant poison. Circulator}1 System.—In medicinal doses the antispasmodics in- crease the force of the heart and elevate arterial tension. Asafetida exerts the greatest influence on menstruation, while camphor has the most marked effect upon the general circulation. Nervous System.—It is probably upon the nervous system that 25 386 A TEXT-BOOK OF MATERIA MEDICA. these drugs exert their most potent action. They are all stimu- lants to some portion of the cerebrum. Their precise influence upon the brain is, however, unknown, and in order to form a better conception of the action of these drugs some explanation of the function of the brain is necessary. The cerebrum consists of a complex mechanism, each localized area having a definite physiological function, the relations of the several areas differing one from another, some being equal and others subordinate. These areas probably are—I. Perception areas —five ; 2. Judgment areas ; 3. Emotion areas ; 4. Motor areas ; 5. Inhibitory areas. These areas are all connected by commissural fibers. The emotion and motor areas are controlled by the functional influence of the areas of inhibition. Sometimes disturbing influ- ences modify this adjustment, so that the lower areas act inde- pendently. The perturbation may be due either to deficient power of inhibition, to unusual activity of the lower areas, or to lack of co-ordination in the connecting fibers by which the unimpeded areas are held in subjection. Even a slight loss of command occasions in the subject an irritability readily aroused, together with annoy- ance from trivial causes which under normal conditions would be inconsequential. The mental derangement accompanying these phenomena we call nervousness, and when the symptoms become still further aggravated the mental disturbance known as hysteria results. Again, the emotion and cerebral motor areas may become so far freed from restraint that even violent hysterical symptoms ensue, including convulsions or coma. Obviously, therefore, the only remedy for the malady is to restore the equilibrium between the inhibitory and lower areas. This may be effected either by stimulation of the debilitated areas of inhibition, by depression of the over-active lower areas, or by supplying a possible deficiency in the conductive force of the fibers. The first of these desiderata may be attained by improving the circulation and affording stronger nutriment. By dilating the arterioles small doses of alcohol and ether accomplish this object, and may act favorably in an attack of hysteria. Alcohol, however, in large doses exerts a deleterious influence by causing exceeding depression of the central nervous system, resulting in incoherence. Arsenic, quinine, cod-liver oil, and iron by their tonic effects may, under continued dosage, abort access of hysteria. ANTISPASMODICS. 387 Other remedial agents which tend to act directly upon the cell- ular structure of the inhibitory areas, and thereby invigorate them, are the drugs under consideration—the antispasmodics. By stim- ulation of the inhibitory centers they may allay the spasms of hysteria. The morbid activity of the lower areas may be ameliorated by depressant remedies, among which morphine and the bromides may prove particularly beneficial. The antispasmodics, it will be seen, appear to exert a calmative influence upon certain nerve-centers, allaying nervous excitement and muscular spasm. They produce a gentle, exhilarating effect upon the brain, and diffuse a feeling of warmth in the system. It is claimed that they also possess mildly aphrodisiac properties. Excessive doses, on the other hand, may occasion delirium, even merging in maniacal excitement, this being particularly true of camphor, toxic doses of which drug, in the monobromated form, cause muscular weakness, passing into paralysis, followed by stupor and collapse. Valerian may occasion formication of the hands and feet and a condition of melancholia. Respiratory System.—The antispasmodics are all respiratory stimulants and stimulant expectorants. Large doses of mono- bromated camphor depress respiration. Absorption and Elimination.—These drugs are readily absorbed from the stomach or rectum, and are eliminated by the intestinal tract, kidneys, lungs, skin, and mucous membranes generally, stim- ulating the glands in these structures, and, in the case of asafetida and valerian, imparting the characteristic odor of these drugs to the excretions. Temperature.—Unaffected except by monobromated camphor, which in large doses acts as a depressant. Uterus.—The menstrual flow and sexual appetite are increased at first; continued dosage, however, has a depressing effect upon the generative functions, camphor perhaps being the most active in large doses. It is said that the sexual passion of cats is extraordinarily excited by valerian, probably because of its odor. Untoward Action.—Camphor may occasion mental confusion, headache, vertigo, dryness of the mouth and thirst, flushing of the face, clammy perspiration, disturbances of digestion, and strangury. Musk produces similar untoward manifestations, with a sense of pressure in the eye-sockets and marked sexual excitement. The 388 A TEXT-BOOK OF MATERIA MEDICA. symptoms caused by valerian are very much the same, although, as in the untoward action of asafetida, there is more disturbance of the gastro-intestinal tract, such as nausea, borborygmi, diarrhea, and colicky pains. Barbier noted visual hallucinations in a person treated with valerian. Poisoning.—The symptoms of poisoning resemble the untoward action, save that the effects may be more marked, with greater irritation of the intestinal tract and more pronounced cerebral disturbance. Treatment of Poisoning.—Coffee and the arterial sedatives an- tagonize the action of camphor. The patient should be treated symptomatically; emetics or the stomach-pump should be employed, and measures taken to favor elimination. Excessive nervous mani- festations may be controlled by opium or the bromides. Therapeutics.—Externally and Locally.—The only member of the present group used locally is camphor, its anesthetic and anti- pruritic properties rendering it of great value in the treatment of diseases of the skin. "Anderson's powder," composed of pulver- ized camphor, starch, and zinc oxide, is a very soothing and efficient dusting powder in erythema, erythematous eczema, and urti- caria. "Camphor-ice" and ointments of camphor, alone or com- bined with salicylic acid, are used for " chapped hands," ulcers, etc. Various inhalants and powders containing camphor have been successfully employed in the treatment of ozena, acute coryza, and laryngitis. Suppositories of camphor afford great relief in cases of chordee, while the camphor liniment is a household remedy for sprains, bruises, chilblains, etc. Camphor chloral makes an efficient local application in neur- algia, and the campho-phenique is an excellent antiseptic, when mixed with oil being an efficient dressing for wounds. Internally.—The disagreeable odor and taste of many of the antispasmodics—notably asafetida, valerian, and musk—greatly limit their use. Asafetida is an exceedingly valuable stomachic tonic, and singularly beneficial in the atonic dyspepsia and constipa- tion of nervous and anemic women. It stimulates the appetite and digestion, acts as a laxative, and allays much of the nervousness and melancholia from which these patients so frequently suffer. Asafetida is a peculiarly potent remedy in relieving parox- ysms of hysteria, and there is probably no more effective agent for the alleviation of flatulent colic of infants and various infantile convulsions. ANTISPASMODICS. 389 Chronic bronchitis and bronchorrhea, especially when attended with spasmodic dyspnea, are very favorably influenced by this rem- edy. Its antispasmodic action renders asafetida of considerable value in zohooping cough and the sympathetic cough of mothers. The drug has been highly recommended in chorea occurring in young girls about the age of puberty, who are weak, anemic, and suffering from menstrual irregularities. The emulsion of asafetida, used as an enema, often affords prompt and complete relief in the tympanitis of typhoid fever. Ammoniacum is chiefly employed as a stimulant expectorant in chronic bronchitis. Camphor is a remarkably efficient anodyne, an- tispasmodic, and carminative in flatulent colic, diarrhea of infants, and the diarrhea of the aged produced by relaxation of the bowels. For many years camphor has been considered a valuable remedy in the diarrhea ushering in an attack of Asiatic cholera. The various spasmodic and hysterical disorders for which asa- fetida is recommended are also greatly benefited by camphor. It is, moreover, a serviceable stimulant expectorant and a potent remedy, especially monobromated camphor, to allay sexual excite- ment and for the relief of chordce. It has likewise proved effica- cious in spermatorrhea. Mania, especially the puerperal form, delirium tremens, and melancholia have readily yielded to full doses of camphor. The internal use of the drug has appeared to prove beneficial in senile gangrene. Dysmenorrhea and the after-pains of labor are greatly relieved by camphor, either alone or combined with morphine. The drug has been used extensively as a cardiac stimulant and to allay the delirium and restlessness oi typhoid, typhus, and exanthematous fevers. Camphoric acid is an efficient remedy in checking the night- sweats of phthisis and excessive perspiration in acute rheumatism. It is recommended by Wood in enuresis and spermatorrhea. While not so efficient as camphor or monobromated camphor in spas- modic and hysterical disorders, it has proved of some benefit in these conditions. Camphoric acid in from 1 to 2 per cent, solution is useful in the treatment oi acute pharyngitis and acute coryza, being employed in the form of a gargle or spray. Camphoric acid has been used internally to acidify ammoniacal urine in cystitis. Valerian has been employed for the same class of disorders as 39° A TEXT-BOOK OF MA TERIA MEDICA. those treated with asafetida, but seems to be superior to the latter in mitigating the hysterical manifestations and vaso-motor disturb- ances occurring at the menopause. The hypochondriasis of feeble and morbidly sensitive girls and women is usually soon relieved by this remedy. Nervous headache and vertigo due to cerebral anemia and the irregular distribution of blood are, in the majority of cases, promptly relieved by valerian or the ammonium valerianate. Valerian has been favorably recommended in both diabetes insipidus and mellitus. Contraindications.—There are no special contraindications to the use of antispasmodics other than in acute inflammations of the gastro-intestinal tract, when camphor should not be employed. Administration.—Any of the preparations of the various mem- bers of this group may be used. Asafetida and camphor in sub- stance should always be given in the form of pills or capsules. Camphoric acid is best administered in capsules. GROUP II.—ANTIPYRETICS. Acetanilidum1—Acetanilldi—Acetanilid. Origin.—An acetyl derivation of Aniline. Description and Properties.—White, shining, micaceous, crys- talline laminae, or a crystalline powder, odorless, faintly burning taste, permanent in air, neutral to litmus-paper. It is soluble, at 15° C. (590 F.), in 194 parts of water, 5 parts of alcohol, 18 parts of boiling water, and in 0.4 part of boiling alcohol; also in 18 parts of ether, and easily soluble in chloroform. Dose.—2-10 grains (0.1-0.65 Gm.). Physiological Action.—Externally and Locally.—Antiseptic, slightly sedative. 1 Antipebrin is a copyrighted name for Acetanilid, or Phenyl-acetamide, as it is sometimes called. The copyrighted word Antipebrin should never be used. The pro- prietary preparations like Antikamnia, Antinervin, Phenolyd, Exodyne, etc. are said, by different chemists who have analyzed them, to be mechanical mixtures of Acetanilid and one or more such substances as Sodium Bicarbonate, Caffeine, Ammonium Bromide, Salicylic Acid, Sodium Salicylate, etc. Such secret preparations should not be counte- nanced by medical men. Should a combination containing some of the aforesaid drugs be desired, a prescription for the same should be written, specifying the proportions wanted in each particular case, rather than prescribe a proprietary article costing a dollar or more an ounce, the same mixture being put up by any pharmacist for ten cents an ounce. ANTIPYRETICS. 391 Internally.—Digestive System.—Non-irritating, sedative; medic- inal doses sometimes allay nausea. Circulatory System.—In therapeutic doses acetanilid appears to have no action upon the blood. The corpuscles are unaffected under the influence of small doses, but toxic doses disorganize the corpuscles. When large doses are taken, or even small doses by one who has an idiosyncrasy against the drug, the arterial blood becomes venous in character, the normal alkalinity of the blood is decreased, and much of the hemoglobin is reduced to methemoglobin. Heart and Blood-vessels.—In medicinal doses the arterial ten- sion is slightly raised, while the heart is slowed. Toxic doses directly depress the heart and vaso-motor mechanism, causing an immediate fall of arterial pressure and great cardiac depression. Nervous System.—In medicinal doses acetanilid is a sedative to the sensory nerves and spinal cord. Small doses are mildly stim- ulant to the brain, and under certain conditions the drug is a hypnotic. Toxic doses result in general anesthesia and abolition of reflexes, with paralysis of motor and sensory nerves. Respiratory System.—Medicinal doses produce no special effect. When toxic doses are given there is a rapid and labored respiration. Death is produced by respiratory failure, due to direct action of the drug upon the respiratory center, and indirectly by greatly de- creasing the oxygen-carrying power of the blood and by paralyz- ing the peripheral motor nerves. Absorption and Elimination.—Acetanilid is an active diuretic, in- creasing the excretion of urea, and to some extent the excretion of uric acid. After toxic doses have been taken the urine becomes dark or brownish in color, from the presence of disorganized corpuscular elements of the blood. It is diaphoretic. Acetanilid is chiefly elim- inated by the kidneys in the form of sulphate of para-amido-phenol. Temperature.—Acetanilid has little or no effect on the normal body temperature; but if the latter is above normal, the drug has a marked antipyretic action, often reducing the temperature to below normal. This peculiar effect of acetanilid. and of the anti- pyretic group in general, is due primarily to the action of the drug on the heat-center in the medulla. When the body is in a state of hyperpyrexia the heat-center is in a depressed condition, owing to certain poisons circulating in the blood, and will not respond to the normal limit (98.60) of body temperature. Acetani- lid increases the irritability of the heat-center, causing it to respond to a lower temperature, and, through its action on the vasomotor 392 A TEXT-BOOK OF MATERIA MEDICA. center, stimulates the vasodilators, thereby augmenting the periph- eral circulation, with consequent increase of heat-dissipation. Eye.—Medicinal doses have no apparent influence on the eye. Toxic doses have produced contracted and motionless pupils. Untozvard Action.—Under prolonged use of acetanilid conges- tion of the liver, kidneys, and spleen occurs. Paroxysms of sneezing have apparently been induced by a medicinal dose, and, under the same, redness of the skin, chilliness, and cyanosis have sometimes ensued. Poisoning.—The skin is cyanosed, the face is livid and anxious, and the body is covered with cold sweat. There may be vomiting; the pulse is soft, slow, and weak, accompanied by profound pros- tration. The respirations are first rapid and labored, and later slow and very shallow, death resulting usually from respiratory paraly- sis. After death the heart, liver, and kidneys are found in a state of acute fatty degeneration. Treatment of Poisoning.—Diffusible stimulants, like alcohol, in small doses, ammonia, and sulphuric ether. Coffee, atropine, and strychnine hypodermically as circulatory and respiratory stimu- lants. External heat and, if necessary, oxygen inhalations to over- come cyanosis. Therapeutics.—Externally and Locally.—Acetanilid has been locally applied for the treatment oi chancre and chancroid, but there are other antiseptics which are generally considered to be more satisfactory. It is quite an active hemostatic, and may be used in epistaxis and hemoptysis. Internally.—The use of acetanilid in fevers has been practically abandoned by the great majority of clinicians. If an antipyretic of this character is indicated at all, it is in sthenic fevers, and then to be used only with great care. Its tendency to cause cardiac depression, profuse sweating, and collapse renders its use harmful, if not unsafe, in low conditions like typhoid fever and advanced phthisis. It may often be administered with good effect in the first stage of pneumonia. The headache, fever, and other unpleasant symptoms in the exanthemata are greatly modified by its use, although when this drug is given to children they must be very carefully watched to avoid untoward effects. There is considerable difference of opinion in regard to the utility of acetanilid in rheumatism. Some authorities believe that it exer- cises a most favorable influence in the acute articular variety, being less apt to disturb the brain than salicylic acid or its salts. The ANTIPYRETICS. 393 drug certainly mitigates, and often entirely relieves, the pain and swelling, while it reduces the fever. Like salicylic acid, it has no power to prevent heart-complications, but, on the contrary, it should be used with great care, if at all, when such complications exist. It has no tendency to prevent relapses. The dose of acetanilid in acute rheumatism should not exceed 6 grains (0.5 Gm.) three times a day. Acetanilid is a very efficient analgesic, and the introduction of this drug, antipyrine, and other remedies of this character has enabled us to relieve the pains of certain spinal diseases more efficiently than was possible before. The crises of locomotor ataxia are quite promptly relieved by acetanilid. Neuralgias of every kind indicate its use. The pains of neuritis, lumbago, gastralgia, dysmenorrhea, sciatica, tabes dor- salis, and nearly every kind of headache usually yield to its anal- gesic influence. In many cases of chorea and epilepsy (especially the diurnal variety), and in those cases characterized by full habit and high arterial tension, the drug has often been employed successfully. Pains which are paroxysmal in character yield best to acetanilid. It quiets the excitement in mama a potu, and in exceptional cases lessens the paroxysms of whooping cough. In doses of 3-5 grains (0.2-0.32 Cc), thrice daily, acetanilid has proved efficient as a relief for seasickness. It has also been found serviceable in traumatic tetanus. The author has found it to be of great value in influenza, or " la grippe," combined or given alternately with salol or sodium salicy- late. It is also highly praised in acute bronchitis. Contraindications.—In low fevers, at any rate not in repeated doses ; in fatty or dilated heart, blood disorders, advanced tuber- cular disease, and exhaustion from hemorrhages. Administration.—It may be prescribed in powders, pills, com- pressed tablets, capsules, or alcoholic solution. A speedier effect is produced if it is taken dissolved in a small quantity of alcohol or wine diluted with water. The average dose as an antipyretic usually should not exceed 5 grains (0.3 Gm.); as an anodyne, 2-5 grains (0.1-O.3 Gm.). It may be repeated at intervals of about four hours or less, according to its effects. Its action in neuralgias, according to Hare, may be assisted by associating it with small doses of monobromated camphor. 394 A TEXT-BOOK OF MATERIA MEDICA. Antipyrina—Antipyrina^—Antipyrine. Origin.—A Coal-tar derivative. Description and Properties.—A white, crystalline powder, odorless, of a slightly bitter taste, freely soluble in water, alcohol, and chloroform. Dose.—3-20 grains (o. 19-13 Gm.). Antagonists and Incompatibles.—Antipyrine is incompatible with spirit of nitrous ether and nitrous compounds, the chlorides of mercury, the iodides of arsenic and mercury, the ferric salts in solution, tincture of iodine, most of the vegetable astringents, car- bolic acid, chloral, beta-naphtol, sodium bicarbonate, sodium salicy- late, and the salts of quinine and caffeine. Synergists.—The same as for other members of this group. Physiological Action.—Digestive System.—Antipyrine differs from acetanilid in that it often produces vomiting. Respiratory System.—In medicinal doses it increases the number of respiratory movements. In every other respect it has the same action upon the respiration as acetanild. Absorption and Elimination.—Kidneys.—Antipyrine lessens the amount of urine, urea, and uric acid excreted, but increases the amount of sulphuric acid in the urine. Like acetanilid, toxic doses cause the urine to assume a dark or brownish color. It is more rap- idly eliminated than acetanilid, being detected in the urine within three hours after being taken. Eye.—Toxic doses have produced amblyopia and hallucinations of vision. Therapeutics.—The remarks on the therapeutics of acetanilid are applicable to this drug, although antipyrine is a more powerful antiseptic, analgesic, and local anesthetic. As an analgesic it prob- ably ranks next to opium. The anesthesia produced by antipyrine often lasts for several hours or even days. In acute coryza and inflammation of the pharynx great relief is obtained by spraying the parts with a 2 or 4 per cent, solution, after applying a solution of cocaine to prevent the primary smarting and irritation which the antipyrine produces. A 20 per cent, solution has been used in otitis, and a 4 per cent. solution has been found very efficient in cystitis. Antipyrine has been used with some success in diabetes melhtus and malarial diseases, particularly in intermittent fever. It does not, however, possess the antiperiodic and specific action of quinine in malarial poisoning. AN TIP YRE TICS. 395 Administration.—The drug is best given in water or some aromatic water or syrup. It may also be given hypodermically. In hemorrhage the powdered drug may be applied locally, or a 40 per cent, solution, which causes less irritation. From i-2 grains (0.03-O.12 Gm.), once or twice a day, is sufficient for children. Ordinarily a dose of 5 grains (0.3 Gm.) is sufficient for an adult. Phenacetin. Origin.—A Coal-tar derivative. Description and Properties.—A colorless, odorless, tasteless powder, or glistening, scaly crystals, sparingly soluble in cold water, more or less soluble in boiling water, and freely soluble in 16 parts of rectified spirits. Dose.—1-10 grains (0.06-0.6 Gm.). Physiological Action.—Phenacetin differs from acetanilid only in the following respects : Circulatory System.—Small doses increase the force of the heart, accelerate the pulse, and raise arterial tension. Large doses affect the blood and the circulatory system like acetanilid. Kidneys.—It is a diuretic, but not so active as acetanilid. W7hen large doses have been taken the urine is dark-yellow in color and gives the reaction for sugar. As an antipyretic phenacetin is said to be slower in its action than acetanilid, nor is it so powerful as an analgesic and hypnotic. By many physicians the drug is considered one of the safest of the synthetical antipyretics, though in very large doses, accord- ing to Hare, it is more apt to disintegrate the blood than either antipyrine or acetanilid. It certainly has an advantage over many other antipyretics in being tasteless, seldom exciting nausea, exces- sive diuresis, diaphoresis, or diarrhea. The author's experience leads him to consider it as possessing a briefer antithermic action and a greater tendency to produce cyanosis and rigors than ace- tanilid or antipyrine. Therapeutics.—Phenacetin is given in the same class of diseases as acetanilid. Contraindications.—The same as for acetanilid. Administration.—The drug maybe dispensed in powders, pills, capsules, tablets, or suspended in mucilaginous drinks.1 1 Phenacetin mav be adulterated with phenacetidin, a by-product in manufacture and a poisonous substance, which in small doses induces kidney trouble. Many of the toxic 396 A TEXT-BOOK OF MA TERIA MEDICA. Phenocoll. Origin.—A combination of Para-amido Phenocoll and Glycocoll. The phenocoll hydrochloride is the salt used in medicine. Description and Properties.—A white crystalline powder, sol- uble in 16 parts of water, and freely soluble in hot alcohol, forming a neutral solution. Dose.—3-15 grains (0.2-1.0 Gm.). Incompatibles.—All the alkalies. Physiological Action.—Phenocoll differs from acetanilid in no essential particulars other than the following: Circulatory System.—Its effect upon the heart and pulse is sim- ilar to that of acetanilid, but it has no influence upon the blood itself. Kidneys.—The excretion of nitrogen in the urine is increased. Temperature.—In febrile conditions it produces a decided fall of temperature within one hour after its administration by the stomach, caused by an enormous diminution of heat-production without any marked alteration of heat-dissipation. Therapeutics—Experience with phenocoll hydrochloride is yet too limited for us to draw any trustworthy conclusions as to its safety compared with the antipyretics previously mentioned or re- garding its real place in medicine. The results, thus far, have shown it to be comparatively safe—probably the safest of all antipyretics— and of value internally for all conditions benefited by the previously named antipyretics. It is not so valuable an antipyretic and anal- gesic in rheumatism as acetanilid or antipyrine, nor is it so efficient an analgesic in myelitis, sciatica, or neuralgia; but, on the other hand, it far surpasses these drugs in the treatment of intermittent fever, ranking next to quinine in malarial disorders. Pelletini, indeed, regards it as superior to all antimalarial reme- dies, and Bonetti considers it a real substitute for quinine. symptoms of acetan'Ud so closely resemble aniline-poisoning as to suggest the production of that substance in the blood. There is a close relationship between the two bodies, and there is some ground to suspect the occasional presence of aniline in samples. The important question of adulteration and impurity should not be lost sight of in consider- ing the ill effects of any drug. In the experience of the author, better results, in every particular, have been obtained from antipyrine than from either of the other antipyretics mentioned, so that he almost invariably uses it, both for adults and children, believing it the safest drug of its class, as well as the most certain and uniform in its action. These drugs are unquestionably given in too large doses by the majority of physi- cians, and persons suffering from high temperature are more susceptible to their untoward influences—like cyanosis, collapse, etc.—than those whose temperature is normal. ANTIPYRETICS. 397 Phenocoll possesses the advantage of not producing the un- pleasant effects of quinine. It is a powerful antiseptic, and may be applied locally where a drug of that character is indicated. Contraindications.—Probably the same as for acetanilid. Administration.—Locally, the drug may be employed in solu- tion or in the form of an ointment in strengths varying from 5 to 20 per cent. Internally it may be administered, in the doses recom- mended, from three to five times a day, in powders, aqueous solu- tion, or in capsules. Exalgine (Methylacetanilide). Origin.—As the chemical name indicates, this substance is a derivative of Acetanilid. Description and Properties.—Exalgine occurs in colorless needles or prisms, inodorous and tasteless. It is neutral to test- paper, and is freely soluble in alcohol, chloroform, carbon disul- phide, and boiling water. It requires about 60 parts of cold water or 10 parts of ether for solution. Dose.—2-4 grains (0.1-0.2 Gm.). Antagonists and Incompatibles.—Exalgine is incompatible with the iodides, salicylic acid, and solution of potassa. Synergists.—All members of this group, as well as opium, cocaine, belladonna, and hyoscyamus. Physiological Action.—Exalgine is almost identical in its action with acetanilid, with the exception that it possesses less antipyretic power. In medicinal doses the drug increases arterial tension, and in full doses profoundly affects the cerebro-spinal axis. It is more uncertain than, and not so safe as, either of the drugs previously mentioned. Therapeutics.—Exalgine should never be employed as an anti- pyretic, but as an analgesic it may be given for the same purposes as acetanilid and antipyrine. Good results have been reported in the treatment of chorea by this drug. Contraindications.—The same as for other agents of this group, and, in addition, fever, it is said, contraindicates its use. Administration.—Exalgine may be administered either in pow- ders or capsules, but the doses should not be given at frequent intervals, from six to seven hours elapsing between them, and only in exceptional cases should more than 10 grains (0.16 Gm.) be given in twenty-four hours. 398 A TEXTBOOK OF MATERIA MEDICA. GROUP III.—ANESTHETICS. As heretofore defined, these are substances having the property of destroying sensation, or producing anesthesia, either general or local. To Dr. Oliver Wendell Holmes is due the credit of proposing the term " anesthetic." This group naturally occupies the place between the preceding one and the next—Hypnotics. As before stated, there exists a close chemical relationship between antiseptics, antipyretics, anesthetics, hypnotics, and analgesics. The first two of these possess marked anesthetic and analgesic properties. The drugs included in the present group should properly be classed as general anesthetics, possessing more nearly the characteristics of typical anesthetics. An ideal agent of this description should be a substance capable of rapidly and safely producing profound anesthesia, and susceptible of speedy elimination, so that consciousness may be restored soon after the withdrawal of the anesthetic, with no discomfort to the patient. The typical anesthetic should also be convenient and safe— a stable, non-irritating, pleasantly odorous, homogeneous liquid, with a boiling-point neither too high nor too low. Unfortunately, there is no substance which fully meets these requirements, ether and chloroform approaching nearest to the ideal agent. The general anesthetics, with the exception of nitrous oxide, all belong to the class of alcohols and ethers. Indeed, alcohol, although in this work not classed among anesthetics, possesses marked anesthetic properties, as well as others—antiseptic, anti- pyretic, etc.—characteristic of these drugs. It has been stated by Dr. Richardson that the first recorded case of the use of an anesthetic in surgery was that of Dr. Collier in 1839, who anesthetized his patient by causing him to inhale the fumes of alcohol. It has been well known for centuries that alcohol, when taken in large quantities, possesses the power to lessen pain and sensa- tion. The anesthesia produced by this drug, however, is too tardy and prolonged to render it practically serviceable. General anesthetics abolish sensation throughout the whole body by destroying the sensibility of the nerve-centers—directly, by affecting the nervous tissue, or indirectly, by influencing the cir- culation, or the blood, in such a manner as to interfere with the functional activity of the nerve-cells. A NFS THE TICS. 399 The detailed action and uses of anesthetics are fully described under " yEther " and " Chloroformum." Local anesthetics are used to deaden the sensation or abolish the sensibility of the peripheral nerves of a localized, particular area. The most important are—cocaine, carbolic acid, iodoforin eugenol-acetamide, and antipyrine. Some aromatics are also quite powerful anesthetics. The physiological action of local anesthetics is given under the respective agents. Either—Athens—Ether. U. S. P. Origin.—A liquid composed of about 96 per cent, by weight of Ether or Ethyl Oxide, and about 4 per cent, of Alcohol con- taining a little Water. Ether is known as sulphuric ether, and was called Aither For- tior by the Pharmacopoeia of 1880. Description and Properties.—A transparent, colorless, mobile liquid, having a characteristic odor and a burning, sweetish taste. Specific gravity, 0.725-0.728. Soluble in about ten times its vol- ume of water, with slight contraction of bulk. Miscible, in all pro- portions, with alcohol, chloroform, benzin, benzol, and fixed and volatile oils. Ether is highly volatile and inflammable, its vapor, when mixed with air and ignited, exploding violently. It should be kept in well-stoppered containers, preferably in tin cans, in a cool place, remote from lights or fire. Dose.—15-40 minims (1.0-4.0 Cc). Official Preparations. Spiritus Athens—Spiritus Athens—Spirit of Ether.—Dose, \-\ fluidrachm (1.0-4.0 Cc). Spiritus Athens CompSsitus—Spiritus Athens Comp6siti—Compound Spirit of Ether (Hoffmann's Anodyne).—Ether, 325; Alcohol, 650; Ethereal Oil, 25 parts. Dose, 5-60 minims (0.3-4.0 Cc). Antagonists and Incompatibles.—The stimulant and anodyne action of ether is antagonized by the arterial sedatives, the tetaniz- ing alkaloids, strychnine, picrotoxin, etc. Synergists.—The arterial and cerebral stimulants, chloroform and other anesthetics, and alcohol. Physiological Action.—Externally and Locally.—Ether when applied to the skin produces intense cold by its rapid evaporation. If it is confined and its evaporation prevented, great irritation is 400 A TEXT-BOOK OF MATERIA MEDICA excited. By spraying a part with ether it becomes quickly frozen, marked local anesthesia being produced thereby. Applied to mucous membranes, it creates considerable irritation, especially of the fauces and respiratory tract when inhaled. Internally.—Digestive System.—It is a carminative, increasing peristalsis and the secretions from the pancreas and the salivary and gastric glands, at the same time dilating the vessels of the stomach. Circulatory System.—When taken into the stomach ether re- flexly stimulates the heart in a manner similar to that of alcohol, raising arterial tension by increasing the force and frequency of the heart's action. Ether stimulates the heart and increases the blood-pressure when inhaled. It is a diffusible, rapid, and reliable cardiac stimulant. In very large or poisonous amounts it exhausts the heart by over- stimulation, acting as a cardiac depressant. Nervous System.—Ether first occasions a considerable degree of excitement, due to the direct action of the ethyl upon the cere- bral cortex. Its action in this respect is analogous to that of alcohol, and, like the latter drug, it affects the nervous system in a certain order, primarily stimulating and afterward depressing, first, the cerebral hemispheres; second, the sensory areas of the spinal cord; third, the motor areas of the spinal cord ; fourth,the sensoiy centers of the medulla oblongata; and, finally, the motor areas of the medulla. The motor nerves and muscles are unaffected. Respiratory System.—Medicinal doses stimulate and poisonous doses paralyze the respiratory center. Respiration is frequently arrested at the beginning of ether- inhalation, owing to reflex spasm arising from irritation of the peripheral ends of the vagi and trigemini. As the inhalation is continued the breathing becomes deeper and faster from stimula- tion of the respiratory center. This part of the nervous system may, in fact, become exhausted from over-stimulation, when the respirations are slow and shallow. In fatal cases of ether-narcosis the respiration is usually arrested before the cessation of the heart's action. Absorption and Elimination.—Ether is rapidly eliminated, chiefly by the lungs, but also by the kidneys, which are often considerably irritated by the process. Temperature.—The prolonged administration of ether produces a great reduction of temperature—doubtless due to the depression ANESTHETICS. 401 of the circulation and respiration and the rapid evaporation of the drug chilling the body and lungs, rather than to any direct action upon the nervous mechanism presiding over the heat-centers. In brief, the action of ether when inhaled is as follows : At first a sensation of choking and irritability of the respiratory mucous membrane is experienced. A greatly increased activity of the sali- vary glands follows, accompanied by a sensation of pricking or tingling of the hands and feet. The conjunctiva is injected, the face is flushed, the veins of the neck are distended, and there is experienced a peculiar feeling of lightness, together with a perver- sion of all the senses, due to emotional excitement. The patient may yell, laugh, cry, curse or pray, struggle or become pugilistic, while the breathing may be spasmodic or stertorous, the pulse becoming rapid and strong. As the inhalation is continued the respiration is quickened, the skin becomes moist and warm, and relaxation of the muscles en- sues, with abolition of reflexes, contracted pupils, and complete suspension of sensation. Finally, as perfect unconsciousness super- venes, the pupils are dilated; the respiration is slow and deep, and later very weak ; and the skin is cool and moist. If the inhalation be discontinued before a toxic quantity of ether has been administered, consciousness gradually returns—in some cases almost at once, although some loss of sensation and muscular weakness remain for a while. The return of consciousness is usually accompanied by retching and vomiting—often by severe rigors, unless care has been taken to keep the patient warm. Great excitement not infrequently attends this stage of etherization. Treatment of Untozvard Manifestations.—Withdraw the ether if there be danger of respiratory or cardiac failure, lowering the head if there be indications of the latter, and if respiratory failure be threatened, as indicated by cyanosis, avoiding a prostrate position. Meanwhile, other measures for the relief of cardiac or respiratory failure may be resorted to: artificial respiration, friction, or the electric current to excite respiratory action, one electrode being placed upon the larynx and the other upon the epigastrium. Hy- podermic injections may be resorted to—of strychnine, digitalis, or atropine, or, in desperate cases, of ammonia. When asphyxia is produced by the lodgement of mucus in the respiratory passages, the hypodermic injection of ether itself is per- missible, if necessary, to excite more vigorous respirations. 402 A TEXT-BOOK OF MATERIA MEDICA. Should nausea become too persistent, a hypodermic injection of morphine will usually suffice to quiet it. Ice-water or a little ether poured over the epigastrium will establish regular respirations when suspended, as is often the case, during the first stage of anesthesia. Therapeutics.—Externally and Locally.—The hypodermic in- jection of 15 minims (1.0 Gm.) of ether in close proximity to the affected nerve has been found valuable in neuralgia and sciatica. The hypodermic method of administration has been also prac- tised in the treatment of shock and in the threatened collapse fol- lowing post-part'urn hemorrhage, as well as for the cure oi sebaceous cysts. The local anesthetic properties of ether render it valuable in many diseases of the skin, such as pruritus, urticaria, etc. For treatment of these disorders it is usually combined with some aromatic. A wet compress saturated with ether has been successfully applied to the forehead for the relief of epistaxis. Internally.—Ether is used as an antispasmodic in order to facili- tate certain examinations, the reduction of dislocations, and to relieve pain in the general practice of surgery, obstetrics, and den- tistry. It has been used as an anthelmintic against tape-worms. The compound spirit of ether is a stimulant, antispasmodic, and anodyne. It is an efficient remedy for gastralgia and flatulent colic, and is used to allay many of the symptoms of hysteria, as well as restlessness and insomnia unaccompanied by fever. Palpitation of the heart and nausea due to the excessive use of tobacco are also greatly benefited by this preparation. In angina pectoris and hic- cough it is an efficient remedy. Contraindications.—Acute or chronic disease of the kidneys. Dilatation or fatty degeneration of the heart. Disease of the lungs. Tumors of the brain or about the neck. Atheromatous condition of the arteries. Enlarged tonsils, chronic alcoholism, or aneurysm. It is necessary at times to give an anesthetic in the foregoing cases, and the surgeon is justified in the use of ether, but the administration should be extremely careful and conducted under skilful supervision whenever the above contraindications exist— particularly in conditions of dilated or fatty heart or chronic alcoholism. ANESTHETICS. 403 Administration.—In administering anesthetics the following precautions should be taken: The stomach of the patient should contain no undigested food. The clothing should be loose about the neck, thorax, and ab- domen, allowing perfect freedom of respiration. Artificial teeth should be removed. It should be remembered that ether is inflammable, and, when its vapor is mixed with air, explosive: it should, therefore, not be used near a flame or an actual cautery, from which it may ignite. The parent should be kept covered, in order that there may not be too great a reduction in temperature. He should, moreover, be watched for several hours after the administration, since there is always more or less danger until the effects of the ether have entirely disappeared. Under proper methods the administration of ether occasions little inconvenience. In addition to the recommendations above given, it may be added that smearing the mouth and nose with oil prevents the excoriation frequently occasioned by contact with the anesthetic There are various means of administration, the simplest and in many cases the most efficient being a towel shaped into a funnel or hollow cone, with a piece of stiff paper laid between the outer folds to preserve the shape. Among many mechanical contrivances the inhaler of Dr. O. H. Allis of Philadelphia is perhaps the best. At the Massachusetts General Hospital a cone-shaped sponge is employed. In using the towel-cone the inner surface is saturated with about half an ounce of ether, the inhaler at first not being placed close to the mouth and nose, thus allowing the vapor to be suf- ficiently diluted with air. The effect of this method is to accustom the air-passages to the primary irritation of the anesthetic and graduate its effects. After this the towel may be pressed close to the mouth and nose and the concentrated ether freely adminis- tered. In this manner a person may become completely etherized without nausea or resistance. The insensibility of the conjunctiva and complete relaxation of the muscles, accompanied by semi- stertorous breathing, indicate that the stage of desirable anesthesia is attained. The quantity of ether administered should now be reduced, further supplies being limited to the amount requisite to maintain complete anesthesia. The symptoms incident to the primary effects of etherization— 404 A TEXT-BOOK OF MATERIA MEDICA. cerebral excitement, muscular activity, etc.—should not induce withdrawal of the anesthetic, but rather its continuance. Should vomiting occur at this stage, etherization should be suspended and the mouth thoroughly cleansed by means of a sponge or a towel. Complete loss of consciousness marks the following stage of anesthesia, when total relaxation supervenes, accompanied by gentle, regular breathing. Should stertorous respiration attend further etherization, it is a warning of paresis, and the drug should be withdrawn. Congestion of the facial muscles during anesthesia is quite normal, pallor, as a rule, indicating cardiac or respiratory debility. The practice of closely covering the face is thus to be discouraged, since it conceals important symptoms of the patient's physiological condition. The danger from asphyxia in complete etherization is shown by the entire muscular relaxation of the tongue, which is prone to drop backward, and the closing of the glottis, suspending respiration. In such an occurrence the jaw should be pressed for- ward, the head being well extended, and, if necessary, the tongue brought forward with the forceps. Under favorable conditions from five to twelve minutes are re- quired to etherize the patient completely. The effects of anesthesia upon recovery vary with the temperament and character of the individual and the conditions under which the drug is administered. Great excitability may attend awakening from etherization, or the patient may return to consciousness as from a tranquil slumber. Nausea and vomiting frequently accompany rallying from the narcosis—not, however, such as may require especial treatment. Should somnolence be manifested, it is best not to rouse the patient, that the awakening may be easy and natural. In etherizing a female patient the presence of a woman is always desirable, in order that her testimony may assuage certain abnor- mal impressions to which women during anesthesia are prone, the hallucinations being more readily dispelled by one of their own sex. To the operator and attendants her presence is also of importance. Great care should be taken to see that the patient is well cov- ered and not exposed to drafts, in its relaxed condition the body being peculiarly susceptible to pneumonia or pleurisy. The anes- thetic should be carefully examined before administration, and the character of the drug thoroughly known. A NES THE TICS. 405 Chloroformum-Chloroformi—Chloroform. U. S. P. Origin.—A liquid consisting of from 99 to 99.4 per cent., by weight, of Absolute Chloroform, and from 1 to 0.6 per cent, of Alcohol. Description and Properties.—A heavy, clear, colorless, mobile, and diffusible liquid, of a characteristic ethereal odor and a burning O taste. Specific gravity, not below 1.490. Soluble in about 200 times its volume of cold water, and in all proportions in alcohol, ether, benzol, benzin, and fixed and volatile oils. Chloroform is volatile, even at a low temperature, and boils at 6o° to 6i° C. (i40°-i4i.8° F.). It is not inflammable, but its heated vapor burns, emitting a green flame. It should be kept in dark, amber-colored, glass-stoppered bottles, in a cool and dark place. (See tests for chloroform in U. S. Pharmacopoeia, p. 88.) Dose.—2-15 minims (0.12-1.0 Cc). Official Preparations. Aqua Chlorofftrmi—Aquae Chloroformi—Chloroform Water.—Dose, 1-4 fluidrachms (4.0-16.0 Cc). Emtilsum Chlorofdrmi—Emiilsi ChlorofSrmi—Chloroform Emulsion.— Dose, 1-4 fluidrachms (4.0-16.0 Cc). LinimSntum Chloroformi—LinimSnti Chloroformi—Chloroform Liniment. —For external use. Chloroform, 30; Soap Liniment, 70 parts. Spiritus ChlorofOrmi—Spiritus Chloroformi—Spirit of Chloroform.—Dose, 10 minims-i fluidrachm (0.6-4.0 Cc). Unofficial Preparations. Chlorodyne.—This preparation was first introduced by Dr. Collis Browne of Lon- don. Numerous formulae for chlorodyne have been published, the British Pharmacopoeia containing an official preparation, Tinctura Chloropormi et Morphines, intended as a substitute for chlorodyne, and composed of chloroform, ether, alcohol, morphine hydrochlorate, dilute hydrocyanic acid, oil of peppermint, fluid extract of liquorice, treacle, and syrup. Dose, 10 minims (0.6 Cc). Parke, Davis & Co. of Detroit, Mich., prepare a similar and excellent compound known as Chlor-Anodyne. The different preparations of chlorodyne and its substitutes vary greatly in the dose, from 5 minims to 1 fluidrachm (0.3-4.0 Cc.); in prescribing, therefore, the strength of the n^ent should be ascertained. Remedies of this character possess powerful narcotic, anodyne, and antispasmodic properties, and should be administered cautiously and only under the direction of a physician. In addition to the above, there is an efficient carminative and antispasmodic known as Tinctura Chloropormi Composita (B. P.)—dose, 20 minims-1 fluidrachm (1.2-4.0 Cc.)—containing chloroform and compound tincture of cardamom and various anesthetic mixtures; and chloroform ointments of different strengths. 406 A TEXT-BOOK OF MATERIA MEDICA. Antagonists and Incompatibles.—Chloroform will not mix with weak spirits or glycerin. Circulatory and respiratory stimu- lants and galvanism antagonize to some extent its poisonous action. There is no chemical antidote. Synergists.—Anesthetics, alcohol, morphine, chloral, and many of the hypnotics. Physiological Action.—Externally and Locally.—Its action is similar to that of ether, though when confined on the skin it pro- duces vesication. It is more of an irritant to mucous membranes than ether, yet when inhaled it is less irritating to the respiratory tract. Internally.—Digestive System.—Its action upon the digestive tract is nearly identical with that of ether, except that when taken in a concentrated form it occasions marked irritation of the stom- ach and intestines, often resulting in violent gastro-enteritis. Circulatory System.—Chloroform depresses the heart and cir- culation, the former by weakening the cardiac muscle, and the latter by lowering arterial pressure by depressing the vaso-motor center. It frequently produces an intermittent pulse by stimulating the inhibitory ganglia of the heart. Nervous System.—It affects the brain and spinal cord in the same manner and order as ether, like it producing death, usually by respiratory failure, though sometimes the heart first succumbs to the influence of the drug. When locally applied the sensory and motor nerves are affected in the same manner as by ether. Small amounts of chloroform stimulate, and large quantities depress, the nervous system. Respiratory System.—Its action closely resembles that of ether, though its operation is more rapid and powerful. Absorption and Elimination.—Chloroform affects the kidneys by irritation, certain investigators claiming that acute nephritis ensues, blood and albumin being often present. Temperature.—It depresses the temperature, although probably by a different action from that of ether, reducing bodily tempera- ture by lessening heat-production and increasing heat-dissipation. Untoward Action.—If there be any marked idiosyncrasy against chloroform, death usually occurs suddenly after a few inhalations of the drug. When applied externally there is produced not infrequently an urticaria-like eruption or an eczematous condition of the skin; vesicles may result. If applied to sensitive portions of the skin, such as the scrotum, severe and persistent pain is sometimes occa- ANES THE TICS. 407 sioned. Frequently, when applied to wounds and mucous mem- branes, it causes intense irritation, so much so that the mucous membrane may be shed in pieces. The symptomatic manifestations of chloroform-anesthesia, the methods of administration, and the treatment of chloroform acci- dents are here given in detail. The phenomena attending the administration of chloroform in- dicate three separate stages of narcosis. The first of these is allied to intoxication induced by alcoholic stimulants. In this stage, although sensation is dulled, consciousness is retained, and, al- though the period is brief as a rule, in some patients, such as those of intemperate habits, it may last for some time and be accom- panied by violent excitement. In such cases the administration of chloroform is attended with no little danger. The second stage, available for surgical operations, is one of complete anesthesia. The patient is perfectly passive, conscious- ness and sensation being for the time wholly obliterated. The third stage is the most delicate to deal with, profound un- consciousness, with stertorous breathing and total muscular relaxa- tion, as well as temporary annihilation of reflexes, indicating the danger-line of anesthesia. Only under extreme necessity should the administration be carried thus far, It is well to guard against taking the pulse as an infallible guide to the patient's condition. In each successive stage the cardiac movements are variable, although, generally speaking, certain pulsations accompany the above-named degrees of narcosis. As has been suggested in the case of ether, a few precautions in the administration of chloroform are obvious—that there be no undigested food in the stomach ; that the clothing be loose about the neck, chest, and abdomen ; and that artificial teeth be removed. The appliances used in producing anesthesia by the aid of chloroform are various, the simplest, as in the administration of ether, being a cone formed of a napkin or a towel enclosing a sponge or not, a sponge alone, or a handkerchief, upon which a small quantity of chloroform—not exceeding from a half to one fluid- drachm (2.0—4.0 Cc.) at a time—is poured. The utmost vigilance is requisite in the administration, the respiration, pulse, and facial indications being constantly observed; a supply of air being allowed to mingle with the anesthetic to obviate the dangerous effect of its concentrated vapor; and the drug being instantly withdrawn upon the slightest indication of untoward symptoms, 408 A TEXT-BOOK OF MATERIA MEDICA. such as lividity of the face, debility of heart-pulsations, and ster- torous or spasmodic respiration, and an ominous dilatation of the pupils. Should respiration cease, the tongue should immediately be brought forward or the lower maxillary manipulated as in the case of ether. Should these resources be unavailing, artificial respira- tion or the galvanic current should be tried. To restore cardiac action nitrite of amyl may be used, or hypodermic injections of ammonia or digitalis as a cardiac stimulant. A mixture of ether and chloroform has been suggested by com- petent authorities as the safest and most efficient anesthetic. Yet its utility in many cases has proved doubtful, experience in opera- tive surgery rather inclining to the use of a single agent. Although the symptomatic features of chloroform-narcosis, especially those which accompany collapse and death, have been studiously examined, the conditions causing disaster are still but imperfectly understood. Nevertheless, premonitory indications are seldom wanting which mark clearly enough the limit of safety in administration. Of these, extreme mydriasis and failure to pro- duce reflex action in the conjunctiva are alone symptoms to be regarded with the gravest apprehension. The statistics of deaths from chloroform present a melancholy yet instructive spectacle to the thoughtful physician, and the deduc- tions drawn from them go far to show the value of exceeding cau- tion in the use of so subtle and powerful an anesthetic. The pathological considerations of any given case fail to throw light upon the immediate cause of the patient's collapse, the cessation of respiration or stoppage of the pulse resulting in syncope or asphyxia varying in their mutual order and coincidences. It is not to be inferred that chloroform is of itself necessarily dangerous, its noxious effects depending upon its administration rather than upon the drug. An instance of its harmless use is found in the method of producing partial and temporary anesthesia adopted by some physicians in cases of childbirth, neuralgia, etc., by which the patient is permitted to administer the anesthetic. This method consists in saturating with chloroform a small sponge placed in a cup or tumbler, and allowing the patient to inhale the fumes at will. Before the system can absorb a lethal quantity of the drug muscular relaxation intervenes and the hand involuntarily drops, the semi-conscious state meanwhile dulling sensation and causing the patient to forget pain. Upon the return of conscious- A NES THE TICS. 409 ness the administration may be repeated, with little danger of un- toward results from the small amount of chloroform inhaled. The bottle, it is hardly necessary to say, should never be entrusted to the patient. Additional Anesthetics, and their Comparative Value. Ethyl Bromide.—A colorless, inflammable liquid, with a burn- ing taste and an odor like that of chloroform. It is readily decom- posed, with evolution of bromine. Its action is uncertain, causing great irritation of the respiratory passages, and usually producing death by paralysis of respiration. Ethyl Chloride.—A volatile, colorless, and inflammable liquid having a pleasant odor. It is a very fugacious anesthetic, greatly depressing the heart and respiration, and is mainly used, in the form of a spray, to produce local anesthesia. Ethyl Iodide.—A liquid anesthetic, similar in its physiological action to chloroform. Anesthesia produced by it, however, is more tardy, although more permanent. It is considered a comparatively safe and efficient anesthetic to relieve spasm of the respiratory passages, as in asthma and laryngitis. Ethylene Bichloride.—More rapid and powerful in its action than chloroform, though not so safe, affecting the respiratory center invariably before influencing the heart. While speedier in its action than ether, it is probably more dangerous. Ethylene Bromide.—A weak yet dangerous anesthetic, greatly depressing the respiratory center, and tending to cause paralysis of the extremities and stoppage of the heart. Ethylidene Chloride.—A non-inflammable liquid resembling chloroform in its physical appearance, and in its physiological action as well, although much less depressant to the heart. It causes more irritation to the respiratory passages, with vomiting and great languor and discomfort as its sequelae. Ethylene Iodide.—A crystalline substance, its fumes when heated producing anesthesia, with great irritation of the respiratory passages, and death by asphyxia. Methyl Chloride.—A colorless, inflammable gas, with a taste and odor resembling those of ether and chloroform. Cold lique- fies it. It is used locally to produce anesthesia and to relieve pain in neuralgia. Methylene Bichloride.—A colorless liquid, its odor being like that of chloroform. Exposure to the light decomposes it. Anes- 410 A TEXT-BOOK OF MATERIA MEDICA. thesia produced by this agent is accompanied with comparatively little irritation of the respiratory tract, but it occasions a primary stage of excitement like that induced by ether, and, as in the case of chloroform administration, vomiting is likely to ensue. Death takes place from paralysis of the heart. The numerous fatalities which have occurred under this anesthetic indicate the danger of its use, and its volatility renders its employment difficult in a hot atmosphere. Carbon Tetrachloride—Tetrachlormethane.—A transparent, colorless liquid, of an agreeable aromatic flavor, analogous in its action to chloroform, but less irritating, although far more danger- ous to the heart. Formic Ether.—A thin, colorless, inflammable liquid, of strong, agreeable odor and pungent taste. It acts like chloroform, though the signs of asphyxia are less marked. Its effects last for several hours. Methylic Ether.—A colorless, inflammable gas, heavier than air, of an ethereal odor and aromatic taste. Richardson considers it a safe anesthetic, though objectionable because of its odor—less agreeable than those of ether and chloroform—and the rapidity with which it volatilizes from its solution. Methylal—Methylen—Dimethyl Ether.—A highly volatile, colorless, limpid liquid, of penetrating ethereal odor. It is used chiefly as a local anesthetic and as an efficient hypnotic in insanity and delirium tremens. Acetic Ether (U. S. P.).—A colorless, limpid, volatile liquid having an agreeable, refreshing, ethereal, and somewhat acetous odor and taste. It has the advantage over sulphuric ether of being less inflammable and less volatile. Owing to its pungent and agreeable odor, too, it is superior to the latter drug in stimulating the nasal passages in cases of syncope and nervous agitation. Pental.—A colorless, volatile, inflammable liquid, insoluble in water, but miscible in all proportions with alcohol, ether, and chlo- roform. It has a mustard-like odor, and is comparatively free from danger. When poisonous amounts are administered the pulse is quickened, the respiration embarrassed, and death ensues from paralysis of the heart. It resembles chloroform rather than ether, but is less irritating and seldom accompanied by unpleasant after- effects. It requires but about 5 drachms (20.0 Cc.) to produce anesthesia, which occurs in from two to three minutes. There is a difference of opinion as to the safety of pental, some A NES THE TICS. 411 physicians considering it less dangerous than chloroform, and others regarding it as less efficient and not so safe. Nitrous Oxide ("Laughing Gas").—A colorless gas, of a very slight, agreeable odor and sweetish taste. It is not inflammable, but supports combustion of ignited bodies. Pressure and cold condense it into either a thin, colorless, very mobile liquid or colorless crystals. It is a rapid anesthetic, unconsciousness being produced in from one-half a minute to three minutes. The pulse is strong and quick, the respirations frequent and shallow, while, as the inhalation continues, the breathing becomes stertorous and the face is cyanotic. If the inhalation be interrupted or the gas mixed with air, symptoms of intoxication are manifested, accompanied by a high degree of mental excitement. It is a very safe anesthetic, but the anesthesia is of quite short duration, rendering it valuable mainly for the extraction of teeth and in minor surgery. The comparative value of ether and chloroform may be sum- marized as follows: 1. If an anesthetic be required, ether is preferable in the case of a patient suffering from a weak cardiac action or an organic disease of the heart. 2. For operations about the face or of the stomach, as there is less danger of reflex inhibition of the heart, ether is preferable to chloroform. 3. Ether is preferable as an anesthetic in the extraction of teeth, chloroform being more apt to cause cardiac paralysis, reflexly by way of the dental nerve to the root of the vagus, and through the vagus to the inhibitory ganglia of the heart-muscle. 4. Ordinarily, ether is superior to, and safer than, chloroform as an anesthetic for adults, unless some special contraindication exist, there being less danger in ether of cardiac failure, to which adults are more liable. Chloroform is much superior to ether in— 1. Obstetrics, since the use of it is attended with less depression and irritation of the respiration and respiratory tract. Moreover, chloroform produces less nausea and vomiting, and may be admin- istered by the patient herself under proper directions. 2. It is preferable in anesthetizing children, being more rapid in its action and less potent as a respiratory depressant, the respiratory center of the child being more susceptible than that of the adult, and in children the danger of cardiac paralysis being slight. 412 A TEXT-BOOK OF MATERIA MEDICA. 3. Should the patient be suffering from nephritis, chloroform is preferable as an anesthetic, since it is less irritating to the kidneys. 4. Should an anesthetic be required for patients afflicted with pulmonary tuberculosis, empyema, or other disease of the lungs, chloroform should be used, since its effect upon the respiratory system is less depressing. GROUP IV.—HYPNOTICS. Chioral—Chloralis—Chloral. F. ,v. P. Origin.—A crystalline solid composed of Trichloraldehyde or Chloral (an unstable, oily, and colorless fluid), with 1 molecule of Water, forming the Hydrate of Chloral, the official preparation, and the only one used in medicine. Chloral itself is prepared by the action of Chlorine upon Alcohol, whence the name chlor-al. Description and Properties.—Chloral hydrate occurs as sepa- rate, rhomboidal, colorless, transparent crystals, having an aromatic, penetrating, and slightly acrid odor, and a bitterish, caustic taste. It is slightly volatilized when exposed to the air, and is freely solu- ble in water, alcohol, and ether, being also soluble in chloroform, benzol, benzin, carbon disulphide, and fixed and volatile oils. It liquefies when triturated with an equal quantity of camphor, menthol, thymol, or carbolic acid. Dose.—5-20 grains (0.3-1.2 Gm.). Unofficial Preparations. The proprietary preparation known as Bromidia contains to each drachm (4.0 Cc.) 15 grains (i.o Gm.), each, of Chloral and Potassium Bromide, together with a small quantity of Extract of Hyoscyamus and Extract of Cannabis Indica. Camphorated Chloral.—Equal parts of Chloral and Camphor. A colorless liquid, of syrupy consistence, soluble in alcohol, ether, chloroform, glycerin, and fixed oils, and also in aqueous solutions of chloral. It is decomposed by water, chloral hydrate being dissolved and camphor precipitated. Chloral-glycerite is prepared by dissolving I drachm (4.0 Gm.) of Chloral in 4 drachms (15.0 Cc) of Glycerin, being used as a solvent for powerful alkaloids. Chloral-ph5nol.—Prepared by triturating equal parts of Chloral and Carbolic Acid. It occurs as a colorless, viscid liquid, with a sweet caustic taste. Used externally. Allied Compounds. Amylene Hydrate.—A tertiary alcohol, the chemical name being dimethylethyl- carbinol. Description and Properties.—It occurs as a limpid, colorless, neutral fluid, of a HYPNOTICS. 413 peculiar odor and burning taste. It is soluble in 8 parts of water, and miscible in all proportions with alcohol, chloroform, benzin, glycerin, and fixed oils. Dose.—1-2 fluidrachms (4.0-8.0 Cc). Chloral-ammonium.—Obtained by passing a rapid current of dry Ammonia through a solution of Anhydrous Chloral and Chloroform as long as it is absorbed. Its chemical name is trichloramidethylic alcohol. It occurs as small, white acicular crys- tals, and is soluble in alcohol and slightly soluble in water, although the aqueous solution is unstable. Dose.—15-30 grains (1.0-2.0 Gm.). Chloralose.—Prepared by heating equal quantities of Anhydrous Chloral and dry Glucose; hence the name, chloral-ose. Description and Properties.—-It occurs in the form of fine needles, completely vola- tilizing without decomposition. It has an acrid, nauseous taste, and is soluble in hot water and in alcohol. Dose.—2-10 grains (0.12-0.6 Gm.). Hypnal.—A compound of Chloral and Antipyrine, known as monochlorantipyrine. A similar preparation containing more chloral is called dichloralantipyrine. Description and Properties.—It occurs in the form of transparent, rhombic crystals, odorless and tasteless, soluble in from 5 to 6 parts of water. Dose.—5-20 grains (0.35-1.3 Gm.). Hypnone.—A term given by Dujardin-Beaumetz to a member of the ketones, known as acetophcnonc or phenybnethylketone, phenomethvl-acetone. Description and Properties.— A colorless, mobile, refrangent liquid, of a pungent taste and a persistent odor resembling that of bitter almond and orange. It is not inflammable, though intensifying the combustion of substances impregnated with it. It is freely soluble in alcohol, ether, chloroform, benzin, and fixed oils, sparingly soluble in glycerin, and insoluble in water. Dose.—5-10 minims (0.3-0.6 Cc). Unofficial Preparations.—A Syrup and an Elixir of Hypnone are in use. Ural—Chloral-urethane—Uralium.—A compound of the following drug, Ure- thane, and Chloral Hydrate. Description and Properties.—A crystalline body, soluble in alcohol and ether, in- soluble in cold water, and decomposed by boiling water. Dose.—10-30 grains (0.6-2.0 Gm.). Urethane—Ethyl Carbamate—Ethyl Urethane.—This substance is obtained by the action of Ammonia on Ethyl Carbonate, or by that of Urea or Carbamide on Ethyl Alcohol at a high temperature. Desc?-iption and Properties.—It occurs as colorless, odorless, columnar or tabular crystals, having a pleasant, cooling, and saline taste, somewhat resembling that of salt- petre. It is soluble in about 1 part of water, and in like proportion in ether and chlo- roform, in 0.6 part of alcohol, 0.8 part of liquefied carbolic acid, 3 parts of glycerin, 15 parts of castor oil, and 20 parts of olive oil. Z>at.t;jat;-= •: . ... Strychnine-poisoning. MOTOR EXCITANTS. 471 Temperature.—Under therapeutic doses the temperature is slightly raised, owing to increased oxidation, as shown by the increase of urea and carbcin dioxide eliminated and of oxygen taken in. During the tetanic convulsions the body temperature is markedly raised, though it is generally greatly reduced during the stage of exhaustion immediately preceding death. Eye.—The general nervous stimulation produced by strychnine affects the mechanism of the eye, vision, as has been remarked, being rendered more acute. Uterus.—Strychnine exerts some influence upon the muscular uterine tissues and assists the catamenia. Untoward Action.—Certain peculiar manifestations, having but slight resemblance, or none whatever, to the characteristic symp- toms of poisoning, have followed the ingestion of small doses of strychnine. Some observers have noted the presence of a scarla- tiniform eruption; cramps followed by perspiration, resembling in some respects the tertian type of intermittent fever; redness of the eyes; formication ; a peculiar heaviness and stiffness of the limbs ; persistent and painful priapism; and gastric uneasiness. Children are exceedingly susceptible to the untoward effects of strychnine, its administration requiring extreme caution. The author, however, is familiar with a case resulting beneficially in the practice of Dr. Alfred C. Cotton of Chicago, when -^ grain (0.036 Gm.) of strychnine sulphate was given hypodermically every three hours to a child three years of age seriously ill with pneu- monia. Such heroic dosage is nevertheless seldom advisable. Poisoning.—As is the case with other active poisons, strychnine in lethal doses produces varying effects dependent upon tempera- ment, idiosyncrasy, and physiological conditions. Generally speak- ing, the absorption of large doses is followed by rigidity of the lower maxillary, dilatation of the pupils, increased action of the reflexes, and spasmodic and distressing muscular contraction, affect- ing the extensors particularly. Finally, the respiratory, muscles are affected with tetanic rigidity, death resulting from asphyxia. In many cases the earliest symptoms of poisoning are restlessness and anxiety, twitching of the muscles, and stiffness of the neck. Spinal convulsions are manifested, the patient assuming the position of opisthotonos, so that he rests upon his head and his heels. The slightest external irritation at this stage, even a movement of the bed-clothes, is sufficient to cause a recurrence of convulsions. Notwithstanding these grave symptoms, the mind remains unaf- 472 A TEXT-BOOK OF MA TERIA MEDICA. fected until carbonic-acid poisoning sets in, and the stomach is usually retentive. Accompanying the usual symptoms in cases of acute poisoning is the distortion of the features, which assume a ghastly grin {risus sardonicus). The action upon the genito- urinary tract is quite marked, involuntary ejaculations of semen frequently taking place, together with incontinence of urine. The earlier paroxysms attendant upon the effects of the drug are seldom fatal, but in the intervals of repose the patient's mind is oppressed with a sense of impending dissolution, intensified by each renewed access of spasm and increasing severity of pain. Treatment of Poisoning.—Emetics and cleansing of the stomach are naturally of the first importance. Animal charcoal and tannic acid should be freely administered, while copious anal injections containing potassium bromide and chloral are often efficacious in relieving the spasms. Amyl-nitrite inhalations may prove serviceable as an aid to restore failing respiration when artificial means are required. The chemical antidote to strychnine is tannin, which should be given immediately in the form of an aqueous solution, the stomach being subsequently well cleansed. Catheterism should be per- formed frequently to favor elimination, care being taken not to create a recurrence of spasm and consequent convulsions, which may often be obviated by the inhalation of chloroform or ether in sufficient quantities to produce complete anesthesia. The bowels should be evacuated, croton oil per rectum being an efficient agent. As has been stated, potassium bromide, chloral, and physostig- mine are serviceable physiological antidotes. Opium and conium may also be used to counteract the effects of the drug. Paralde- hyde has been preferred to chloral, and tobacco and alcohol have been suggested, even in heroic doses, should the malady refuse to yield to other remedial agents. Therapeutics.—Externally and Locally.—M. Mackenzie has rec- ommended strychnine in 2*4 A^ grain (0.0027-0.004 Gm.) doses in some harmless and inert medium as an insufflation in anosmia, and lint saturated with the tincture of nux vomica and applied to the perineum has been advised in incontinence of urine. Internally.—There is no more efficient remedy in atonic dys- pepsia than nux vomica or strychnine. Both possess all the prop- erties of the simple bitters, besides stimulating the nerve-centers, rendering the co-ordination of the digestive process more perfect MOTOR EXCITANTS. 473 and enabling the stomach to respond more readily when the stim- ulus of food is applied to it. The gastric catarrh of inebriates is especially benefited by this drug, which also serves a useful purpose in the vomiting of preg- nancy and of phthisis. Its tonic action upon the intestinal muscles renders it an invalu- able remedy in habitual constipation, atonic diarrhea, and prolapsus of the rectum, the latter condition being frequently observed in children and aged persons, especially the latter, who are often men- tally depressed by this infirmity, and who are relieved by strych- nine, either given internally or injected as a solution into the sub- cutaneous tissue of the rectum, toning up the muscles and at the same time stimulating the cerebrum, relieving the melancholia and inspiring the patient with hope. Strychnine is a most valuable cardiac tonic, having a marked action on the cardiac nervous system and also upon the heart muscle. In pneumonia, typhoid fever, and other diseases accom- panied by dyspnea and feeble heart-action, no more valuable drug can be employed. It differs from alcohol and other cardiac stimu- lants in that its use is not followed by depression. The hypoder- mic injection of full doses of strychnine ordinarily renders the pulse full and strong, even when it is scarcely perceptible and death appears imminent. Many clinicians have undoubtedly tided pneumonic patients over the critical period by the heroic use of strychnine, when, but for the drug, they would have died. The functional irregularity of the heart's action accompany mg hysteria, hypochondriasis, and pregnancy is greatly relieved by moderate doses of tincture of nux vomica. As a tonic in chlorosis and anemia strychnine is an esteemed rem- edy, being, in the author's opinion, the best we possess in general efficiency. It improves the appetite, prevents putrefactive changes, and aids digestion, thereby enabling the patient to partake of and assimilate more nutriment. It also increases the force of the heart, quickens the circulation, and raises arterial tension, nourishing all parts of the body and rendering the condition more favorable for oxidation in the tissues and for the removal of waste products. The amount of urine is increased, constipation is relieved, and thus elimination of these products facilitated. Oxidation is further enhanced by the increased respiratory movements, rendering the blood richer in oxygen and increasing the number of the red corpuscles. 474 A TEXT-BOOK OF MA TERIA MEDICA. The potent action of strychnine upon the nervous system stimu- lates the spinal cord, giving the patient greater strength, and, by invigorating the brain, animating him with cheerfulness and con- fidence and a disposal to exercise. Strychnine, then, is at once a gastric, vascular, nervous, mus- cular, and respiratory tonic, being an invaluable remedy in debility from any cause. In bronchial and neurotic asthma, as well as in many forms of neuralgia, particularly the visceral variety, the drug is an efficient remedy. In bronchitis also, and to relieve the coughs of neurotic origin, it is of great value. Paralysis of spinal origin—paraplegia, etc.—and hemiplegia pre- vious to degeneration, with complete relaxation of the muscles, are benefited by strychnine, although in the latter affection it is of little if any value in recent cases or when the muscles do not respond to the electric current. The sphincters of the body, although belonging to the unstriped muscles, are more or less under the control of the will; still, when there is an atonic condition of these structures, as in incontinence of urine, due to weakness of the sphincter, strychnine is a very powerful remedy. For the same remedial properties it is equally valuable in retention of urine when the detrusor muscle is too weak to empty the bladder. Probably no other drug equals strychnine in diphtheritic paraly- sis, the form of the disease most benefited by the remedy. It is of use, however, in all varieties oi functional paralysis, such as those resulting from hysteria, mental emotion, alcoholism, venereal ex- cesses, the abuse of opium, lead-poisoning, gout, rheumatism, concussion of the spinal marrow, etc. Jewell claims that strychnine has caused an improvement in myelitis after the failure of other remedies. The weak and semi-paralyitic condition sometimes induced by bromides is improved by strychnine. The drug has found a few supporters in the treatment of tetanus, epilepsy, tic douloureux, and chorea, though it has not been gener- ally adopted as a remedy in these diseases. Strychnine is exceedingly efficacious in amaurosis due to exces- sive use of alcohol or tobacco, being also valuable in paresis of the ocular muscles. Night-blindness is also greatly benefited by this drug. It is of undoubted merit in delirium tremens, as well as in pre- MOTOR EXCITANTS. 475 venting the usual effects of alcoholic intoxication ; in fact, the drug is one of the best remedies in the treatment of alcoholism, the strychnine nitrate being usually employed, hypodermically. Ac- cording to the best authorities on dipsomania, strychnine seems to be a true antagonist to the untoward action of alcohol, and it is probably the important constituent of the numerous " cures " for the alcohol habit. No less valuable is strychnine in the treatment of acute poisoning by chloral, morphine, and physostigmine. As an aphrodisiac it is of unquestioned value in functional sper- matorrhea, and it is thought to produce contractions of the gravid uterus and cause abortion or premature delivery. When a predis- position to post-partum hemorrhage exists, the administration of strychnine may prove of great service. Finally, strychnine has been highly recommended in the flight- sweats of phthisis and in diabetes mellitus. Contraindications.—Strychnine is contraindicated or of no value in true voluntary muscular paralysis, where the region is directly under the control of the cerebrum. It is also contraindi- cated in acute inflammatory conditions of the spinal cord and excessive reflex irritability. Administration.—The extract of nux vomica, the tincture, the fluid extract, or the alkaloid strychnine may be given and gradually increased, a tolerance by the system being rapidly established. The salts of strychnine are preferable to other preparations, the crude drug and its preparations varying greatly in strength, io minims (0.6 Cc.) of one tincture sometimes containing as large a percent- age of strychnine as 20 minims (1.2 Cc) of another. The drug should be cautiously administered to children, the initial dose for a child five or six years of age not exceeding Tuir gram (0.0006 Gm.). In using strychnine hypodermically the soluble hypodermic tablets should be freshly dissolved in distilled water. The solutions of strychnine and of the other alkaloids should not be kept in stock, as they become contaminated with microscopic plants. Cocculus—Cocculi—Cocculus Indicus. (Fish Berry.) Origin.—The dried fruit of Auamirta Cocculus Wright and Arnott, a climbing shrub in Eastern India, native to the Malabar coast. 476 A TEXT-BOOK OF MATERIA MEDICA. Description and Properties.—A globular, kidney-shaped, one- celled berry, about \ inch (6 Mm.) in diameter and I inch (io Mm.) in length, blackish-brown and wrinkled. The seed is very bitter, but the pericarp is tasteless. The chief constituent is picroloxiu, the poisonous principle contained in the kernel and first isolated by Boullay in 1819. The crude drug is not used internally. Unofficial Preparations. Tinctura C&cculi— Tincturae Cdcculi—Tincture of Cocculus.—Dose, 2-20 minims (o. 12-1.2 Cc). Extractum C6cculi Fluidum—Extracti Cftcculi Fluidi—Fluid Extract of Cocculus.—Dose, 1-3 minims (0.06-0.2 Cc). Picrotoxinum—Picrotoxini—Picrotoxin. U. S. P. Origin.—A neutral principle obtained from the seed of Aua- mirta paniculata Colebrooke. Description and Properties.—Colorless, flexible, shining, pris- matic crystals, or a micro-crystalline powder, odorless and having a very bitter taste; permanent in the air. Soluble in 240 parts of water and in 9 parts of alcohol. Dose.—^j—3V gram (0.OOI-O.OO2 Gm.). Antagonists and Incompatibles.—Chloral, the motor depres- sants, acetic acid, and the anesthetics antagonize the effects of picrotoxin. Synergists.—All the motor excitants. Physiological Action.—Externally and Locally.—It is a power- ful parasiticide, being very destructive to lower forms of animal life. Internally.—Digestive System.—In small medicinal doses its action is similar to that of strychnine. Circulatory System.—Its general effects do not differ essentially from those of strychnine. Nervous System.—Picrotoxin differs somewhat from strychnine in its action upon the nervous system, poisonous doses producing epileptiform convulsions and spasms of the flexor muscles, alter- nating from tonic to clonic, whereas the spasms induced by strychnine affect principally the extensor muscles and are tetanic in character. The brain also is differently affected—toxic doses resulting in stupor, delirium, coma, and complete insensibility. Respiratory System.—Picrotoxin tends to stimulate the respira- tory center, its general influence being analogous to that of strych- nine. MOTOR EXCITANTS. 477 Absorption and Elimination.—The drug is rapidly absorbed, and, as in the case of strychnine, is eliminated chiefly by the kidneys, the sweat being also a channel of excretion, since cocculus, even more than strychnine, acts as a powerful diaphoretic. Temperature.—No special action has been noted, though the temperature may be raised slightly during the convulsive period. Eye.—The pupils are dilated during the tonic and contracted during the clonic spasms. An ophthalmoscopic examination shows a marked hyperemia of the ocular fundus. Poisoning.—The drug produces muscular twitchings, incoordi- nation, great restlessness, tonic convulsions, with opisthotonos or emprosthotonos, alternating with clonic spasms and succeeded by paralysis, delirium, and coma. The respiratory apparatus is affected as in strychnine-poisoning. The symptoms are very similar to those of an epileptic seizure, and the post-mortem lesions are analogous to those of epilepsy. Treatment of Poisoning.—This is identical with that prescribed in cases of poisoning by strychnine. Therapeutics.—Externally and Locally.—The most important use of cocculus locally is in the treatment oi parasitic and skin dis- eases, an ointment of picrotoxin—io grains to i ounce (0.6-32.0 Gm.)—being employed for this purpose. Caution should be used in applying it to abraded surfaces lest poisoning result. The decoction or tincture of cocculus Indicus is very effective in destroying parasitic vermin infesting the head and body. Internally.—Picrotoxin has been used, although less success- fully, for many diseases treated with strychnine, especially paralysis of the extremities and of the sphincters. Planat has highly recommended the use of cocculus in epilepsy; the best results in this disease, however, are obtained in the treat- ment of the nocturnal variety. The same authority advised the employment of the drug in chorea, infantile eclampsia, and chronic spasm of the limbs. Bartholow suggested that the drug, like strychnine, would prove valuable in intestinal torpor. Bokai has advocated its use in opium-poisoning. Unquestionably, its most valuable action is in controlling the night-szveats of phthisis. Mirrell, who first used it for this purpose, reported but one failure in twenty. Gubler has succeeded in greatly benefiting glosso-labio-laryngeal paralysis by the hypo- dermic injection of -^ grain (0.001 Gm.) of picrotoxin. 478 A TEXT-BOOK OF MATERIA MEDICA. Dysmenorrhea and migraine occurring at the menstrual period are said to be greatly relieved by this drug. Even sero-purulent leucorrhea, it is claimed, has derived benefit from the administration of some preparation of cocculus. Contraindications.—Similar to those for strychnine. Administration.—The picrotoxin is far preferable to other preparations of cocculus, both for external and internal use. It should be very cautiously administered, however. Ergota—Ergotae—Ergot. U. S. P. (Ergot of Rye.) Origin.—The sclerotinum of Claviceps purpurea (Fries) Tulasne (Fungi), replacing the grain of rye, Sccale cercalc L. Most of the commercial article comes from Spain and Russia. Description and Properties.—Somewhat fusiform, obtusely triangular, usually curved, about f to i^ inches (2-3 Cm.) long and \ inch (3 Mm.) thick ; three-furrowed, obtuse at both ends, purplish- black, internally whitish, with some purplish striae, breaking with a short fracture; odor peculiar, heavy, increased by trituration with potassium or sodium hydrate T. S.; taste oily and disagreeable. Old ergot, which breaks with a sharp snap, is almost or entirely devoid of a pinkish tinge in the fracture, is hard and brittle between the teeth, and comparatively odorless and tasteless—should be rejected. Ergot should be but moderately dried and preserved in a close vessel, with a few drops of chloroform added from time to time to prevent the development of insects. When more than one year old it is unfit for use. The active constituents of ergot are not definitely ascertained. It contains, however, an acid soluble in water and variously termed sclerotinic, crgotinic, and ergotic acid, and another, soluble in alka- lies, known as sphacelic acid. Both of these acids possess ecbolic properties. Ergot also contains a principle known as cornutin, and 30 per cent, of a yellow non-drying saponifiable fixed oil, besides proteids, sugar, tannin, and ash. The commercial ergotin is merely a purified aqueous extract of ergot. Dose.—5-60 grains (0.30-4.0 Gm.). Official Preparations. Extractum Ergotae—Extracti Ergotae—Extract of Ergot.—Dose, 2-10 grain. (0.12-0.06 Gm.). MOTOR EXCITANTS. 479 Extractum Ergotae Fluidum—Extracti Ergotae Fluidi—Fluid Extract of Ergot.—Dose, 15-60 minims (1.0-4.0 Cc). Vinum Ergotae—Vini Ergotae—Wine of Ergot.—Dose, 1-3 fluidrachms (4.0- 12.0 Cc). Unofficial Preparations. Tinctura Ergotae—Tincturae Ergotae—Tincture of Ergot.—Dose, \-2 fluid- drachms (2.0-8.0 Cc). Ergotin (Bonjean's).—Dose, 2-8 grains (0.012-0.5 Gm.). Antagonists and Incompatibles.—The cardiac and motor depressants antagonize the action of ergot. Caustic alkalies and metallic salts are chemically incompatible. Synergists.—Its action upon the circulation is aided by digitalis and belladonna; upon the nervous system by strychnine; while ustilago, hydrastine, gossypium, and the emmenagogues enhance its influence upon the uterus. Physiological Action.—Externally and Locally.—Ergot has no distinctive action upon the skin, but upon mucous membranes its influence is that of an astringent, possessing hemostatic properties. Internally.—Digestive System.—In large doses it is a gastro- intestinal irritant, occasioning considerable heat and dryness of the throat, accompanied by thirst and succeeded by pain in the stom- ach and bowels, vomiting, and occasionally purging, with violent peristalsis, although constipation is the commoner sequence. Circulatory System.—Repeated medicinal doses increase the blood-pressure, although rendering the pulse slower and smaller— the result primarily of stimulation of the vaso-motor center, fol- lowed by peripheral action, causing a tonic contraction of the small unstriped muscle fibers. A poisonous dose lowers arterial tension, causing the pulse to beat faster and softer—an effect due to exhaustion from over- stimulation or to direct depressant action upon the heart-muscle. It is claimed by competent authority that there is no active and actual contraction of the arteries, the result of stimulation of the vaso-motor system, but that the arteries contract because of the fulness of the veins, there not being sufficient blood to fill both systems, marked arterial anemia consequently resulting. It must be admitted that the true physiological action upon the circulatory system is not yet generally understood, being still sub judicc, since equally competent pharmacologists maintain that the arterial pres- sure is increased as explained above. It is an undisputed fact, however, that the cardiac muscle is 480 A TEXT-BOOK OF MATERIA MEDICA. actually contracted by ergot. Indeed, Willebrand claims that " the normal or hypertrophied heart so contracts under the action of ergot that the difference in size is appreciable by percussion" (Bartholow). If any changes are produced by this drug in the composition of the blood, they have not been ascertained. Nervous System.—Medicinal doses have no especial action, though excessive doses sometimes depress the sensory mechanism, producing general cutaneous anesthesia. The action of toxic doses on the nervous system will be described under " Poisoning." Respiratory System.—Medicinal doses produce no particular effect. Large doses depress the respiratory center, rendering the breathing shallow. This action is manifest from the first, there being no primary stimulation of the respiration. Death from an overdose of ergot usually results from paralysis of the respiratory center. Absorption and Elimination.—The active constituents of ergot are rapidly absorbed into the blood, and are eliminated principally by the kidneys, increasing the urinary flow. Temperature.—No special action has been observed. Eye.—The caliber of the retinal and nutrient opticus blood- vessels is reduced, resulting in marked pallor of the disk, transitory amblyopia, and papillary anemia. Uterus.—Probably the most important action of ergot is upon this organ. It produces in full doses tetanic, tonic contraction of the uterine muscle, the uterus becoming hard and pale, and forcing the blood out of the uterine arterioles. The organ is more sensi- tive to the action of the drug during pregnancy. The precise manner in which ergot affects the uterus is still a matter of discussion. It is fairly demonstrated, however, that the drug acts both centrally and peripherally, owing to its different constituents, cornutin acting centrally and sclerotinic acid periph- erally. The drug causes a contraction of involuntary muscles throughout the body. It is doubtful if any drug in our Materia Medica has been more carefully studied than ergot, and, if opinions differ widely as to its modus operandi, it is because we have to deal with a very complex substance, the nature, and even the number, of whose constituents are as yet inadequately known. Many principles of the drug are unstable and variable in their action, certain preparations differing MOTOR EXCITANTS. 481 decidedly from others in their influence, as, for instance, Tanret's ergotinine, which has no effect upon the uterus. Bonjean's ergotin is a powerful ecbolic, and has a marked action, moreover, upon the vascular system, whereas Wigger's ergotin is inert. Untoward Action.—In addition to the gastro-intestinal disturb- ances already described, there are occasionally produced headache, mental confusion, dizziness, a feeling of chilliness, muscular weak- ness, dilatation of pupils, and glimmering before the eyes. Poisoning.—There are two varieties of ergot-poisoning, acute and chronic. Under the administration of immoderate doses pecu- liar symptoms appear, known collectively as acute ergotism. Rest- lessness, mental worry, headache, tinnitus aurium, dilatation of the pupils, pallor and coldness of the skin, and other effects are present. At times cutaneous anesthesia is manifest or general formication. Epileptiform spasms, great reduction of respiration and temperature, may occur, while obstruction of cardiac movements, with sudden nausea and violent vomiting, and other alarming manifestations, attest the untoward properties of the drug. Chronic ergotism is confined chiefly to Europe, where ergotized rye is used in bread-making. The disease is marked by convulsive or gangrenous conditions. The first variety, the convulsive, is characterized by paroxysmal spasms of the flexor muscles, which later become continuous, re- sulting in opisthotonos or emprosthotonos. There is dimness of vision, while an increasing intensity of symptoms develops affection of other special senses, those of hearing and smell being either impaired or temporarily lost. Violent abdominal cramps also occur, together with painful dyspnea, death resulting from asphyxia or coma. The second (gangrenous) form is signalized by severity of local phenomena, profound dyscrasia, formication or cutaneous anes- thesia, impairment of special senses, and numbness of the muscles or extremities, followed by sloughing or atrophy of the diseased parts and mummification or dry or moist gangrene. Fatal results of chronic ergotism are usually traceable to the convulsions, although moist or dry gangrene may in certain cases produce death. Treatment of Poisoning.—Symptoms of acute poisoning may be alleviated by hot baths and the administration of tannic acid and cardiac stimulants. For the treatment of chronic ergotism hygienic measures and symptomatic remedies are indicated. 31 482 A TEXT-BOOK OF MATERIA MEDICA. Therapeutics.—Externally and Locally.—Ergot, in an impalpa- ble powder, has been recommended as an external application in the treatment of carbuncle and epithelioma. In the form of lozenges or diluted fluid extract the drug has been employed in acute pharyngitis. The hypodermic injections, of ergotin are valua- ble in nasal hypertrophies, prolapsus of the rectum, hemorrhoids, enlargement of the prostate gland, aneurysm, varicocele, and vari- cose veins. Internally.—The most important medical use of ergot is to promote uterine contractions in labor. The preponderance of testimony among the most experienced obstetricians is in favor of its use only after the expulsion of the uterine contents. This is a rule, however, which cannot be invariably followed. While the employment of the drug is contraindicated in the first stage of labor, it may be safely employed during the second stage, when there is uterine inertia, provided all the parts be in a normal condition and there exists no mechanical impediment to the rapid delivery of the child. Ergot is of service also when the placenta is retained owing to inefficient and feeble uterine contractions. With these exceptions it is customary—and the author concurs in the procedure—to delay the administration of the drug until the expulsion of the placenta, when a full dose of the fluid extract is given, or ergotin hypodermically. When ergot is administered during the second stage of labor, it should be given in small doses, so as to promote intermittent rather than continuous contractions of the uterus. No drug possesses so energetic and prompt an action as ergot in post-partum and uterine hemorrhage. It is an exceedingly efficacious remedy also in subinvolution and in uterine fibroids and polypi. The accompanying diagrams will illustrate the control of hemor- rhage through the contraction of the uterine muscle and arterioles, and the influence of ergot upon submucous fibroid tumors by mechanical compression and consequent diminution of their blood- supply. It is obvious that the location of a subperitoneal tumor is such that the drug cannot influence its growth as it can a sub- mucous fibroid. This remedy is also extremely useful in the treatment of ple- thoric amenorrhea, congestive dysmenorrhea, menorrhagia, chronic metritis, etc. Dilatation of the cardiac cavities without valvular lesion is much improved by the administration of ergot; the remedy has MOTOR EXCITANTS. 483 also been employed with considerable success in chronic diarrhea and dysentery. Incontinence of urine—depending either upon enlarged prostate, irritability, or a paretic or paralytic condition of the bladder—is Fig. 6.—Diagram showing how ergot reduces Fig. 7.—Diagram showing how ergot reduces uterine hemorrhage: A, uterine muscle; B, B, the size of a submucous fibroid, but has no effect arteries. upon a subperitoneal fibroid : A, uterine muscle ; B, subperitoneal fibroid ; C, submucous fibroid ; D, D, arteries. greatly relieved by this remedy. The atonic form of spermatorrhea is palliated or cured by ergot. The drug is of value also in cerebral hyperemia and consequent mania, as well as in cerebrospinal meningitis, congestion of the spine, myelitis, and congestive headaches. Ergot has been highly recommended, notably by Dr. J. M. Da Costa, in diabetes insipidus, and by such authorities as Heltzmann and D'Enslow in prurigo, erythema, itrticaria, and acne rosacea. Owing to the peculiar action of ergot upon unstriped muscular fiber it is a valuable drug in various forms of hemorrhage. The diseases mentioned as being favorably influenced by the local application yield as readily perhaps to the internal administra- tion of ergot. Finally, this remedy has met with some success in the treatment oi leucorrhea, galactorrhea, hypostatic congestion of the lungs, whoop- ing cough, the different varieties of purpura, colliquative szveats, splenic enlargements, and exophthalmic goiter. Contraindications.—During the first stage of labor and in cerebral or spinal anemia. Administration.—For its action upon the uterus a valuable 484 .•/ TENT-BOOK OF MATERIA MEDICA. fluid extract is the best preparation as an internal remedy; for hypodermic use the aqueous extract (ergotin) or some of the non-alcoholic fluid preparations manufactured by certain reliable pharmacists for this particular purpose, should be employed. Ergotin may be incorporated in suppositories when for any reason it is desirable to administer the drug per rectum. Gossypii Radicis Cortex—Gossypii Radicis Corticis— Cotton Root Bark. U. S. P. Origin.—The bark of the root of Gossypium herbaceum L. and of other species of the genus, indigenous in the tropical and sub- tropical regions of Asia and Africa. The plant has been cultivated in the United States and other countries from a very early period, many characteristic varieties having been produced. Description and Properties.—It occurs in thin, flexible bands or quilled pieces, the outer surface brownish-yellow, with slight longitudinal ridges or meshes, small, black circular dots, or short, transverse lines, and dull, brownish-orange patches, from the abra- sion of the thin cork; inner surface whitish, of a silky lustre, finely striate; bast-fibers long, tough, and separable into papery layers; inodorous; taste very slightly acrid and faintly astringent. It contains a fixed oil, a small quantity of tannin, sugar, and starch, a yellow resin, and, in the fresh bark, a pale-yellow chromo- gene, soluble in alcohol, which on exposure to air becomes red and resinous. Dose.—15-60 grains (1.04-4.0 Gm.). Official Preparation. Extractum Gossypii Radicis Fluidum—Extracti Gossypii Radicis Fluidi— Fluid Extract of Cotton Root Bark.—Dose, \-\ fluidrachm (1.8-3.7 Cc). Antagonists and Incompatibles.—The same as for ergot. Synergists.—Ergot and its synergists. Physiological Action.—Identical with that of ergot, but infe- rior in certainty of action. Therapeutics.—Cotton root bark is employed only for its action upon the uterine system, in which respect it is identical with ergot. An exception may possibly be in its use in the treatment of subin- volution and tumors of the uterus, in which cases it is less efficient than ergot. Contraindications.—The same as for ergot. Administration.—The fluid extract only should be employed. MOTOR EXCITANTS. 485 Hydrastis—Hydrastis—Hydrastis. U. S. P. (Golden Seal.) Origin.—The rhizome and roots of Hydrastis Canadensis L., a perennial native to Canada and the United States east of the Mis- sissippi, growing in rich woodlands and in the Southern States, confined to mountainous districts. Description and Properties.—The rhizome is from 1 to 2 inches (2-5 Cm.) long and about \ inch (6 Mm.) thick, oblique, with short branches, somewhat annulate and longitudinally wrinkled; externally brownish-gray; fracture short, waxy, red- dish-yellow, with a thickish bark, about ten narrow wood-wedges, broad medullary rays, and large pith. Roots thin, brittle, with a thick yellow bark and subquadrangular woody centre. Odor slight, taste bitter. The principal constituents are hydrastine (colorless and slightly acrid) and berberine (yellow and intensely bitter), the latter alkaloid be;ng also found in berberis, Colombo, menispermum, coptis, etc. There is a yellow resinoid (hydrastin) on the market which should not be confounded with the active alkaloid hydrastine. Dose.—The crude drug is not given internally. Official Preparations. Extractum Hydrastis Fluidum—Extracti Hydrastis Fluidi—Fluid Extract of Hydrastis.—Dose, 10-30 minims (0.6-2.0 Cc). Glyceritum Hydrastis—Glycerlti Hydrastis—Glycerite of Hydrastis.—Used externally. Tinctura Hydrastis—Tincturae Hydrastis—Tincture of Hydrastis.—Dose, 30-60 minims (2.0-4.0 Cc). Hydrastina—Hydrastinae—Hydrastine (unofficial).—An alkaloid obtained from Hydrastis. Origin, Description, and Properties.—Colorless, very brilliant, glassy crystals ; taste slightly acrid; fully soluble in ether and chloroform, but freely soluble in water. Dose.—-^-\ grain (0.002-0.03 Gm.). Hydrastininae Hydrochloras— Hydrastininae Hydrochloratis—Hydrastinine Hydrochlorate. U. S. P.—Origin.—The hydrochlorate of an artificial alkaloid • - rived from Hydrastine. Description and Properties.—Light-yellow, amorphous granules, or a pale-yellow crystalline powder, odorless, and having a bitter, saline taste; deliquescent on exposure to damp air. Soluble in 0.3 part of water and in 3 parts of alcohol. The product should be kept in well-stoppered vials. Dose.—jJj-I grain (0.005-0.03 Gm.). Antagonists and Incompatibles.—The alkalies, mineral acids, and tannic and other vegetable acids are incompatible with prepara- tions of hydrastis. The physiological antagonists are chloral, potassium bromide, and the motor depressants. 486 A TEXT-BOOK OF MA TERIA MEDICA. Synergists.—Quinine and the vegetable bitters aid its action upon the digestive tract, ergot upon the uterus, and strychnine upon the spinal cord. Physiological Action.—Externally and Locally.—Hydrastine possesses considerable anesthetic action when applied locally, and upon the eye its effect is to contract and afterward dilate the pupil. Internally.—Digestive System.—Its action resembles that of strychnine, though excessive doses produce greater gastric dis- turbance, almost invariably occasioning vomiting. Circulatory System.—Its influence is similar to that of strych- nine, but not so powerful. In its effect upon the white blood-cor- puscles it resembles quinine, arresting their movements. Nerz'ous System.—Here also the action of hydrastis is analogous to that of strychnine, although it is much less powerful, while more persistent. It differs from its congener, however, in its effect upon the sensory nerve-fibers, very large doses impairing their func- tional activity, and, when locally applied, producing anesthesia. Respiratory System.—In its action upon the respiratory system it resembles strychnine, differing in no essential particular. Absorption and Elimination.—It is slowly absorbed, tending to accumulate in the system. It is eliminated chiefly by the kidneys, increasing slightly the urinary flow. Temperature.—Medicinal doses have no effect; poisonous doses decrease bodily heat. Eye.—It has no particular action upon the eye, other than to first contract and then dilate the pupil when directly applied. Uterus.—Hydrastine is a feeble oxytocic, affecting the womb in a manner similar to, though much less powerful than, ergot. Untoward Action.—The untoward manifestations are essentially those of poisoning. Poisoning.—The symptoms are almost identical with those of strychnine. Treatment of Poisoning.—The same as that of poisoning by strychnine. Therapeutics.—Externally and Locally.—Hydrastin (the yellow resinoid)—in the proportion of 5 grains (0.3 Gm.) to 1 ounce (30.0 Cc.) of water, or the fluid extract of hydrastis, 15 to 20 minims (1.0-1.2 Cc.) to 4 ounces (118 Cc.) of water—makes an efficient injection in gonorrhea. Hydrastine (the alkaloid), or, preferably, hydrastine hydro- MOTOR EXCITANTS. 487 chlorate—3 grains (1.2 Gm.) to 1 ounce (30.0 Cc.) of glycerin— affords great relief in certain forms of chronic conjunctivitis. Hydrastis is a valuable remedy in catarrh of the upper respira- tory tract. The tincture—1 fluidrachm (3.7 Cc.) to 1 ounce (30.0 Cc.) of water—is a valuable mouth-wash in all indolent and offensive ulcera- tions of the mouth and throat, such as syphilitic and mercurial affec- tions, follicular pharyngitis, etc. The fluid extract serves a useful purpose in the local treatment of anal fissure and of rectal ulcer, vaginal and uterine ulcerations, and leucorrhea. Indolent ulcers anywhere, and chancres and chan- croids, are stimulated to a healthier condition by the application of this preparation. An ointment of hydrastine hydrochlorate, in strength vary- ing from 5-30 grains (0.3-2.0 Gm.) to 1 ounce (32.0 Gm.) of simple ointment, affords an efficient local application in acne and seborrhea sicca, and the same preparation makes a serviceable dressing for ulcerated carcinoma and bromidrosis. The distilled extract of witch-hazel with hydrastine hydro- chlorate is recommended in hyperidrosis. Palmer has successfully employed inhalations of a solution of 1 part of the extract to 3 parts of salt water in tubercular and simple bronchitis.. The topical action of hydrastis and its preparations is that of an antiseptic and tonic, strengthening the circulation and nutrition, rendering the drug peculiarly valuable in diseases of mucous sur- faces. Internally.—As a remedy for diseased conditions of the stomach and bowels it is of much the same value as the vegetable bitters, and may be used for the same purposes. Hydrastine possesses considerable antiperiodic power, having been employed in intermittent fever and chronic malaria, though much inferior to quinine, and probably also to arsenic. Its bene- ficial action in these conditions is undoubtedly due to its power to increase the functional activity of the liver, this influence also ren- dering it valuable in chronic constipation induced by hepatic inac- tivity—catarrhal jaundice, too, being frequently relieved by the remedy. Hydrastine, more especially hydrastine hydrochlorate, acts upon the uterus very much like ergot, and has been highly recom- mended by well-known authorities in uterine hemorrhage and other 488 A TEXT-BOOK OF MATERIA MEDICA. uterine disorders for which ergot is used. By careful observers, of experience with the drug, it is considered superior to ergot in the hemorrhage of puberty and the menopause, as well as in congestive dysmenorrhea. Bossi, who has employed hydrastis Canadensis extensively in obstetrical practice, regards it as a valuable hemostatic, believing it to be much safer than ergot in the hands of ignorant individuals and mid wives. Koniger has treated hemoptysis successfully with the fluid extract in 20- or 30-minim (1.2-2.0 Cc.) doses, repeated several times a day. The drug has proved equally beneficial in arresting the night-szveats of phthisis, and is an efficient substitute for alco- holic stimulants when their use is abandoned. Hydrastine hydrochlorate has recently been favorably men- tioned as a remedy for epilepsy, strychnine-poisoning, and hydro- phobia. Contraindications.—The same as for vegetable bitters, strych- nine, and ergot. Administration.—When taken for its action upon the stomach and bowels it should be given before meals; for its effect on the uterus it is best administered in divided doses or the hydrastine hydrochlorate hypodermically. Rhus Toxicodendron—Rhois Toxicodendri—Rhus Toxicodendron. U. S. P. (Poison Ivy.) Origin.—The fresh leaves oi Rhus radicans L., a climbing shrub indigenous in Canada and the greater part of the United States westward to the Rocky Mountains. Description and Properties.—Long-petiolate, trifoliate, the lat- eral leaflets sessile or nearly so, about 4 inches (10 Cm.) long, obliquely ovate, pointed; the terminal leaflets stalked, ovate or oval, pointed, with a wedge-shaped or rounded base; the leaflets entire and glabrous or variously notched, coarsely toothed, or lobed, more or less downy ; when dry papery and brittle; inodorous ; taste somewhat astringent and acrid. The fresh leaves abound in an acrid juice which darkens on exposure to air, and when applied to the skin produces inflammation and swelling. The leaves should therefore not be touched with the bare hands. The fresh leaves contain a volatile acid (toxicodendric), which MOTOR EXCITANTS. 489 is almost entirely absent in the dried leaves. In addition to this active constituent the leaves contain tannin. Dose.—1-5 grains (0.06-0.3 Gm.). Unofficial Preparation. Tinctura Rhois Toxicodfendri—Tincturae Rhois ToxicodSndri—Tincture of Toxicodendron.—Dose, J^-2 minims (0.006-0.12 Cc). Prepared from fresh plants —1 part of fresh leaves to 2 parts of alcohol. Physiological Action.—Externally and Locally.—The fresh leaves of this common plant are extremely irritant to the skin, generally acting as a marked vesicant and establishing severe local inflammation, manifested by acute dermatitis, excessive edema, and hyperemia. In many cases these effects are much less pronounced, while in certain individuals they are never occasioned by contact with or even chewing the leaves. As with poison sumach—Rhus venenata—the toxic influence of the plant derived from local appli- cation is apparently more virulent during the period of florescence. The inflammation somewhat resembles erysipelas, being rapidly diffused and accompanied by a general systemic disturbance, in- cluding abdominal pains, nausea, and vomiting, with perhaps diar- rhea, diuresis, and serous passages. Profuse diaphoresis and lum- bar and articular pains may also result. These symptoms cease after about ten days or a fortnight without other sequel than desquamation of the affected surface. Internally.—The effects of the drug administered internally are to cause gastro-intestinal inflammation, with drowsiness and stupor, and occasionally delirium and convulsions. Vertigo, nausea, chilli- ness, thirst, weak and irregular cardiac movements, diaphoresis, muscular debility, and diuresis are also reported. Dilatation of the pupils is also a result of ingestion or internal absorption, and an illustration of the virulence of the drug is seen in the fact that even air impregnated with exhalations from the leaves may cause epi- dermic eruption, while the berries have produced serious symptoms in the spinal and cerebral systems, and in an authentic case the root has proved notably fatal. Treatment of Poisoning.—Many remedies have been used, with varying efficacy, to allay the toxic effects of the drug. Dermal poisoning has been relieved by glycerite of carbolic acid or alkaline lotions. In the earlier stage of external irritation warm soapsuds and sodium bicarbonate have been successfully applied. Alum- curd, ammonia in weak solution, solution of chlorinated soda, and A TEXT-BOOK OF MATERIA MEDICA. many other agents have been employed to meet the requirements of certain stages of the affection. A solution of cocaine, 4 to 8 per cent., quickly relieves the cutaneous irritation ; a liquid prepara- tion of grindelia robusta makes a grateful application ; while opium, coffee, and laxatives would be indicated. Therapeutics.—Externally and Locally.—The diluted tincture— 8 minims (0.5 Cc.) to 4 ounces (118 Cc.) of water—has met with some favor, as has been stated, in the treatment of sprains, burns, etc. In weak solution with alcohol the remedy has been used as a stimulating application in cases of sprains, chilblains, burns, insect-stings, etc. Internally.—It has been recommended in rheumatic affections of fibrous tissues, paralysis, erysipelas, herpes zoster, pemphigus, eczema, and erythema. Dr. Rothrock believes it to be a valuable cerebro-spinal stimu- lant. It has been supported as a strong palliative or cure in inconti- nence of urine depending upon atony of the bladder. It is evident that the drug needs to be much more thoroughly investigated, there being widely diverse opinions regarding its thera- peutic value. There is, however, sufficient testimony in its favor from competent authorities to justify further examination and use of this extremely active remedy. Contraindications.—The meager knowledge we possess re- specting its true action in disease renders it impossible to mention any special contraindication to its employment. Administration.—The tincture is the only preparation used, and should be cautiously administered. Coca—Cocae—Coca. U. S. P. Origin.—The leaves of Erythroxylon Coca Lam., a shrub about 6 feet (1.8 M.) high, with numerous spreading purplish-brown branches, bearing bright green leaves varying in size according to the nature of the plant or of the soil in which it grows. The flowers, found either alone or in clusters, are small, regular, her- maphrodite, white or greenish-yellow, being succeeded by small scarlet berries. Coca is indigenous in the mountains of Peru and Boliva, and on the eastern slopes of the Andes is cultivated in damp, warm valleys from 3000 to 6000 feet (914.5-1829 M.) above the sea- MOTOR EXCITANTS. 49i level, being also grown in some parts of Colombia, Brazil, the Argentine Republic, and the island of Java. The province of La Paz in Bolivia produces the largest crops, the article being more highly esteemed than the Peruvian variety. Cocaine, how- ever, is obtained from leaves of the Javanese plant. Description and Properties.—In size and shape the leaves resemble those of tea, ovate, lanceolate, or obovate-oblong, from | to 2 or 2\ inches (2-5 or 7 Cm.) long and 1 to i| inches (25- 37 Mm.) broad; short-petiolate, entire, rather obtuse or emarginate at the apex, slightly reticulate on both sides, with a prominent midrib, and on each side of it a curved line running from base to apex ; odor slight and tea-like, taste somewhat aromatic and bitter, when chewed temporarily benumbing the lips and tongue. The active constituent is the alkaloid cocaine. The plant also contains two other alkaloids—ecgonine and hygrinc, and a peculiar tannin, coca-tauuic-acid, having a green reaction upon salts of iron. Dose.—J-4 drachms (2.0-16.0 Gm.). Official Preparation. Extractum Cocae Fluidum—Extracti Cocae Fluidi—Fluid Extract of Coca. —Dose, 20 minins-i fluidrachm (1.2-4.0 Cc). Cocaina—Cocainae—Cocaine (unofficial).—Description and Properties.—Color- less, prismatic crystals, of a strongly alkaline reaction. The taste is bitterish and pro- duces a transient numbness of the tongue. Soluble in 704 parts of water, in much less alcohol and ether, and in fixed oil. Dose.—£-1 grain (0.03-0.06 Gm.). Cocainae Hydrochloras—Cocainaa Hydrochloratis— Cocaine Hydrochlorate. U. S. P. This is the only official salt of cocaine, and the one almost invariably used in medicine. Description and Properties.—Colorless, transparent crystals or a white, crystalline powder, odorless, of a saline, slightly bitter taste, and producing upon the tongue a tingling sensation followed by numbness of some minutes' duration. Permanent in air, soluble in 0.48 part of water and 3.5 parts of alcohol; very soluble in boiling water and in boiling alcohol. Dose.—-L-2 grains (0.008-0.12 Gm.). Cocainae Phenas—Cocainae Phenatis—Cocaine Phenate (unofficial).—This salt contains about 75 per cent, of the alkaloid. Description and Properties.—It occurs as a yellow, viscid mass. Soluble in alcohol, insoluble in water. Dose.—fV-£ grain (0.005-0.01 Gm.). 492 A TEXT-BOOK OF MATERIA MEDICA. Antagonists and Incompatibles.—Morphine, chloral, amyl- nitrite, alcohol, chloroform, and ether are physiological antagonists. The most direct opponents are chloral and morphine. Cocaine is incompatible with caustic alkalies and the alkaline carbonates and bicarbonates, as well as with bichloride of mercury, iodine and the iodides, ammonia, zinc chloride, and borax. Synergists.—Medicinally, its cerebral effects may be enhanced by the cerebral stimulants, such as alcohol, cannabis Indica, and belladonna, while its analgesic and anesthetic action may be aided by carbolic acid, atropine, opium, and conium. When used as a mydriatic atropine serves as a valuable synergist. Physiological Action.—For our first knowledge of the physio- logical properties of coca we are indebted to its empirical use among the natives of Peru. The history of the drug is replete with interest and romance. It was regarded as the living repre- sentation of the Deity, the ground whereon it grew being held sacred. During the reign of the Incas its use was a royal privi- lege, the people being compelled to obtain permission from the governor to avail themselves of its benefits. Later it was adopted indiscriminately. The native coqucros (coca-chewers) have learned from experi- ence that they can climb the Andes, work laboriously in the mines, and endure fatigue and hunger more hardily when chewing the leaves of the plant, and from time immemorial the drug has been recognized by observers as possessing powerful nutritive, stimulant, and restorative properties. In describing the action of the crude drug the author can add little to the words of Linnaeus, who long ago wrote that coca possessed "the penetrating aroma of vegetable stimulants, the astricting and fortifying virtues of an astringent, the antispasmodic qualities of bitters, and the mucilaginous, nutritive properties of analeptics or of alimentary plants." "This leaf," he adds, "ex- hibits with energy its action on all parts of the animal economy. Olido in ncrvos, sapido in fibras, utroque in fluido." Since the isolation of the alkaloid cocaine, to which the drug owes its physiological and medical properties, by Gaedeke in 1855, and the subsequent study of it by eminent pharmacologists and therapeutists, we have learned more of the physiological action of coca. Its effect upon different systems are here described in detail. Externally and Locally.—Cocaine is analgesic, anesthetic, and MOTOR EXCITANTS. 493 ischemic. Upon the unbroken skin it has no action, but upon mucous membranes or the subcutaneous tissue it produces com- plete local anesthesia. The surface to which it is applied becomes paler than normal, owing to contraction of the blood-vessels, but afterward reddens and appears turgescent through secondary dila- tation of the vessels. The absorption of the drug by mucous membranes varies with the locality to which it is applied—with difficulty from the conjunctiva, yet with great readiness from the Schneiderian membrane, producing its characteristic constitutional effects. Applied to the conjunctiva, or even taken internally, cocaine causes a transitory contraction of the pupil, soon followed by dila- tation. The accommodation is impaired, but not completely de- stroyed, the ocular tension being lowered. The anesthetic action of cocaine applied locally is due to the depression of the ends of the sensory nerves. It dilates the pupil by stimulating the ends of the sympathetic nerve, which innervates the radiating fibers of the iris. In addition to its local analgesic action the drug possesses the power of destroying the functions of the nerves of special sense, so that taste and smell, as well as the tactile sense, are abolished. When applied locally or taken internally it primarily checks many of the secretions, though those from the pancreas and liver seem to be uninfluenced by its internal use. The secondary impression of cocaine, however, when the blood-vessels become dilated, is accompanied by increased secretion. Francois-Franck, who has made an exhaustive study of the local action of cocaine, contends that it is " a powerful paralyzing poison, acting alike on sensory and motor nerve-endings, on all kinds of peripheral nerves, on nerve-centers, muscles, glands, epithelium, leucocytes, vegetable protoplasm, micro-organisms, etc." Internally.—Digestive System.—On account of its stimulant action upon the constrictor fibers of the great sympathetic nerve, under the influence of moderate doses peristalsis is largely increased in the stomach and intestines, very large or poisonous doses, on the contrary, causing great sluggishness of the bowels. Although it has been shown by experiments upon animals that cocaine is incapable of sustaining life, it diminishes in man the sen- sation of hunger, owing to its local anesthetic action upon the mucous membrane of the stomach, so that the coqueros are able to 494 ./ TENT-BOOK OF MATERIA MEDICA. abstain from food for days, thirst also being allayed. This diminu- tion of hunger does not seem to impair appetite and digestion, since food is subsequently relished and digested as well as, if not better than, if coca had not been used. Circulatory System.—Medicinal doses of cocaine increase the force and frequency of the cardiac contractions, and also arterial pressure. Large or poisonous doses render the pulse slow, soft, and weak, and lower arterial tension. The exact modus operandi is not fully determined, such eminent authorities as Mosso, Yon Aurep, Vulpian, Ott, Nikolsky, and others differing as to its action upon the circulatory apparatus. It is quite probable that its action is similar to that of atropine in this respect. Nervous System.—When given internally its first action is upon the brain, moderate doses greatly stimulating the intellectual facul- ties and producing a feeling of ecstasy and well-being, in many respects akin to the sensations experienced under the action of cannabis Indica. In the course of a few hours the stage of cere- bral excitement is succeeded by mental, moral, and muscular depression. Toxic doses result in incoherent speech and wild delirium, accompanied by swaying of the head, followed by epileptiform con- vulsions and narcosis. The convulsions are of cerebral origin, the effect of cocaine upon the spinal cord being yet but imperfectly understood. The sensory nerves are depressed by small and paralyzed by lethal doses. The motor nerves are also depressed by large doses, this action, however, being subordinate to that exerted upon the sensory nerves. The muscles are stimulated by medicinal doses through impression upon the motor tracts, although large doses greatly depress muscular activity. The chewing of coca, as prac- tised by the natives of Peru and Bolivia, undoubtedly appears to augment muscular strength and powers of endurance. Mosso claims that small doses of cocaine serve as a power- ful muscular stimulant in cases of exhaustion from hunger or fatigue. Laffont states that cocaine possesses an " excito-functional action on the great sympathetic constrictor nerve, consequently an exalta- tion of the functional action of all the non-striated muscles or muscles of organic life which are subordinated to it." Respiratory System.—Medicinal doses powerfully stimulate the respiratory center, increasing the rapidity and depth of the respira- MOTOR EXCITANTS. 495 tions. Poisonous doses paralyze the center, the result being dys- pnea, feeble breathing, and death from respiratory failure. Absorption and Elimination.—Cocaine is quickly absorbed, being eliminated principally by the kidneys in a form differing from its original nature. Much of it undergoes oxidation in the body. The amount of urine is increased, though the nitrogenous ele- ments are diminished. The habitual use of the drug lessens urinary secretion. Cocaine possesses no cumulative action, although its effects become more marked under repeated dosage, due probably to some special dynamic action upon the nervous system. Temperature.—Medicinal doses have no influence on bodily heat, but poisonous doses usually raise the temperature, owing, according to Reichert, to an increase of heat-production. Eye.—Cocaine produces a noticeable dilatation of the pupil, as already explained under " Local Action," the maximum change being reached in about an hour, and the normal state regained in from twelve to twenty-four hours. Cocaine-poisoning.—Among the more prominent physiological symptoms resulting from the ingestion of excessive doses of coca- ine or repeated and continued injections are a tendency to coma or collapse; a feeble, thready pulse, often running extremely high; great emaciation ; anorexia and impairment of the digestive powers; and increased frequency, and again alarming depression, of respira- tion. There are other symptoms, scarcely less serious, which, as the majority of observations show, render cocaine one of the most generally deleterious of drugs, opium not excepted. Dropsy, ma- rasmus, numbness, syncope, profound malaise, muscular twitchings with mild convulsions, insomnia, amblyopia, mydriasis, visual hal- lucinations, headache, vertigo, dangerously elevated temperature, dental decay, and fetid breath,—even this admonitory catalogue of ills fails to complete the recorded phenomena attending poisoning from cocaine. Yet, grave as are the foregoing physical changes incident to an immoderate use of the drug, the mental and, above all, the moral effects of cocaine-poisoning are far more deplorable. It is a melan- choly but indubitable fact that to one fully committed to the so-called " cocaine habit " there appears at times no principle of honor or deco- rum to which the vitiated sensibilities are amenable. The enfeeble- ment of the intellectual faculties, the loss of memory, inability to coordinate or control ideas, a consciousness occasionally merged 496 A TEXT-BOOK OF MATERIA MEDICA. in pronounced mania, possibly with homicidal inclination, and an intense selfishness of thought and purpose, in which apathy, neg- lect of domestic obligations, and complete debasement of nobler qualities are developed,—these lamentable accompaniments mani- fest too clearly the degenerating influences exerted by a constant resort to the use of this ill-fated, if not fatal, drug. An instance coming under the author's personal observation will serve to illustrate the entire lapse of the subject's morale. The case is that of a well-known, successful, and highly esteemed practitioner, who, becoming addicted to the employment of cocaine as an alleviation for bodily and mental depression, reached at last a stage of moral degradation in which he neither shrank from lying and stealing nor considered any means of gratifying his dis- eased appetite too abject—the persuasions of friends, the considera- tions of professional duty and social position, and the distracted appeals of his own family being alike unavailing to arrest the passion to which he had succumbed. It is grateful to record that from his moral turpitude the subject at length emerged triumphantly, to-day occupying a proud position reflecting honor upon himself and his profession. A still more distressing case, in that it was attended with fatal results, is that of a physician personally known to the author who, contracting the cocaine habit, in blind folly administered the drug to his wife and child, all dying within the period of a few months. The desperation to which the cocaine habitue may be driven in his temporary madness is shown in the case of a young man scarcely twenty years of age, son of an eminent surgeon, who, the author is authentically informed, during a journey by rail in which he was deprived of the customary facilities for hypodermic injection, ripped open his arm with a pocket-knife and poured the drug into the wound. In such cases the salient features of the malady may be prop- erly regarded as allied to those of acute mania, the treatment being exceedingly difficult—the more so because of the absence of deter- rent motives prompted by conscience, which in the course of the indulgence becomes torpid or perverted. There is, moreover, with cocaine-poisoning always danger of deliberate or involuntary relapse. It frequently happens that cocainism arises from a desire to relieve effects produced by the immoderate use of opium. Yet the latter drug, being taken to offset the influence of cocaine, in reality MOTOR EXCITANTS. 497 but aggravates the evil, the two agents interacting and still further lessening the chances of recovery. Treatment of Poisoning.—Several antidotes have been favorably adopted—amyl nitrite, caffeine, atropine, and inhalations of ammonia. Chloroform, ether, subcutaneously injected, and strychnine have also proved more or less efficient remedies. With regard to the withdrawal of cocaine, equally competent authorities appear to differ, the immediate cessation of the drug being advocated, and again this course condemned as liable to produce collapse. The author is of the opinion that, as in other respects, the procedure followed in the treatment of the opium habit is the wisest and safest. The disease, however, at least during its more serious manifes- tations, is essentially allied to insanity, and permanent cure must look to the rationale of the conditions, with the paramount object of restoring to its normal activity the moral tone of the patient's. thought and desire. That complete regeneration of mind and body may be reasonably contemplated is amply attested by the case above cited; nor should discouragement deter the physician from his task, nor measures of untimely severity be suffered to exas- perate and confirm an untoward mental state possibly susceptible of intelligent control. Therapeutics.—Externally and Locally.—The indications for the local anesthetic action of cocaine are very numerous. The general surgeon will find many opportunities to employ the drug advantageously; indeed, in many instances it has replaced all other anesthetics. In many operations on the genito-urinary tract, rectum, nose, throat, ear, and eye it serves a most valuable pur- pose. The urethra can be rendered perfectly insensible to pain by the application of a 2 to 4 per cent, solution, repeated two or three times at intervals of five or ten minutes. Even the sensibility of the bladder itself can be benumbed to a great extent by the local application of a cocaine solution, so that sounding for stone may be painlessly accomplished. A case of lithotrity is reported in which, without suffering, an operation was performed in fifteen minutes, the only anesthetic used being a solution of cocaine applied to the parts. Urethral caruncles may be removed successfully and without inconvenience to the patient by the injection of a 4 per cent, solu- tion at the lines of attachment. An injection of a small amount of the same solution into the cellular tissue of the prepuce pre- 32 498 A TEXT-BOOK OF MATERIA MEDICA. vents pain in circumcision and in the operation for phimosis. In the treatment of fistula in ano, hemorrhoids, both internal and external, and other diseases of the rectum, cocaine is of signal value. An ointment of cocaine, 4 per cent, strength, affords a grateful anodyne dressing for burns, it being borne in mind that in all cases where ointments of this drug are used the alkaloid cocaine, and not its salts, is to be employed. Cocaine is an important anesthetic in many minor operations, such as opening oi felons, abscesses, etc.; it is also highly service- able in dentistry and for the removal of small neoplasms. Prob- ably its most extensive use in this respect is in operations upon the eye, nose, and throat, its widest field of usefulness being in operative ophthalmic surgery. The following prescription makes an efficient application for the relief of many of the distressing symptoms of acute coryza and hay fever : K. Cocainae hydrochloratis, gr. x (0.6 Gm.); Menthol, gr. xij (O.72 Gm.); Pulveris camphorae, gr. iij (0.2 Gm.); Pulveris magnesiae, Sacchari lactis, da. 3ij (8.0 Gm.). M.—Sig. Use a small portion as a snuff twice a day. A small quantity of morphine sulphate is sometimes an excellent addition to the above. The peculiar qualities of cocaine render it one of the safest, as well as most convenient and serviceable, mydriatics. It quickly dilates the pupil, which regains its normal condition in from ten to twenty hours. The dilatation, too, is easily overcome by the application of eserine, a solution of \ grain (0.03 Gm.) to 1 ounce (30.0 Cc.) of the latter drug being strong enough to neutralize the effects of a 4 per cent, solution of cocaine. It should be remembered that local applications to the conjunc- tivae, nares, and fauces may produce in susceptible persons systemic effects. Cocaine combined with atropine forms a mydriatic which for many purposes is superior to either drug separately, the mydriasis being of longer duration than that produced by cocaine, while the paralysis of the accommodative apparatus is briefer than that occasioned by atropine. The phenate of cocaine is less toxic than the hydrochlorate, MOTOR EXCITANTS. 499 owing to its power of coagulating albumin, and thereby being less readily absorbed. It is also more agreeable to the taste. While it does not produce anesthesia so readily as the hydrochlorate, its effect is more permanent, and, in addition, it possesses powerful antiseptic properties. By many physicians it is preferred in laryn- gological work. Internally.—Coca has been successfully used in gastralgia and to improve the digestion. Cocaine is frequently an efficient remedy in seasickness and to allay excessive vomiting. Bartholow has highly recommended the drug in chorea, asthma, paralysis agitans, and alcoholic and senile tremor. It has also been suggested as a cure for the opium, alcohol, and tobacco habits. The wine of coca is an excellent tonic during convalescence from acute disease and in debilitated conditions generally. It has been extensively employed in melancholia. Cocaine combined with atropine is said to make an efficient hypnotic. Contraindications.—No special or distinct contraindication to its use exists. In diseases of the kidneys with diminished urinary flow it should be cautiously administered, lest cumulative effects ensue. With subjects suffering from weak or diseased heart similar caution is to be used. Administration.—For hypodermic use solutions of from 2 to 5 per cent, are generally employed. It should be noted that children and females require smaller doses of the drug. It is altogether probable that many of the coca wines on the market contain varying quantities of cocaine. The reckless and indiscriminate prescription of these preparations, therefore, is liable to induce the cocaine habit. It is questionable, indeed, whether the administration of cocaine with a view to curing the intemperate use of opium, alcohol, or tobacco is wise. It frequently happens that patients thus treated lose their craving for the latter drugs only to acquire an inordinate appetite for cocaine, which, as has been shown, is possibly more dangerous than either of them in its physical and moral effects. 500 A TEXT-BOOK OF MATERIA MEDICA. GROUP VII.—MOTOR DEPRESSANTS. Conium—Conii—Conium. U.S. P. (H KM LOCK.) Origin.—The full-grown fruit of Conium maculatum L., gath- ered while yet green. Spotted hemlock is a biennial indigenous in the temperate regions of Asia, Europe, and Northern Africa, and naturalized in some portions of New England, New York, and South America. It grows in waste places and along streams. Description and Properties.—About \ inch (3 Mm.) long, broadly ovate, laterally compressed, grayish-green, often divided into two mericarps, each with five crenate ribs, without oil-tubes, and containing a seed grooved on the face; odor and taste slight. When triturated with solution of potassium or sodium hydrate conium gives off a strong, disagreeable, mouse-like odor. The most important constituent is a volatile liquid alkaloid, coniine. It also contains methyl-coniine, conhydrine, and its isomer pseudo-conine. Dose.—1-5 grains (0.06-0.3 Gm.). Official Preparations. Extractum Conii—Extracti Conii—Extract of Conium.—Dose, \-\ grain (0.03-0.06 Gm.). Extractum Conii Fluidum—Extracti Conii Fluidi—Fluid Extract of Co- nium.—Dose, 1-5 minims (0.06-0.3 Cc). Unofficial Preparations. Tinctura Conii—Tincturae Conii—Tincture of Conium (15 per cent.).—Dose, 10-30 minims (0.6-1.8 Cc). Siccus Conii—SQccus Conii—Conium Juice.—Dose, \-z fluidrachms (1.8-7.4 Cc). The juice expressed from fresh leaves, and \ volume of alcohol added to pre- serve it. Coniina—Coniinae—Coniine.—Description and Properties.—A colorless, inflam- mable, oily liquid, having a strong alkaline reaction and a penetrating, suffocating odor. It is soluble in all proportions in alcohol, ether, chloroform, benzene, benzin, and fixed oils. It requires 100 parts of cold water for solution, the liquid becoming turbid on warming. Dose.—Jjj-i minim (0.006-0.06 Cc). Coniinae Hydrobromas—Coniinae Hydrobromatis—Coniine Hydrobro- mate.—Description and Properties.—It occurs in colorless, transparent prisms ; soluble in water and alcohol in the proportion of 1 to 2 parts; very slightly soluble in ether. Dose.—Jjy-i grain (0.002-0.06 Gm.). Antagonists and Incompatibles.—Nux vomica and its alka- MOTOR DEPRESSANTS. 501 loids, cocculus and picrotoxin, are antagonistic to conium. Tannic acid and the alkalies are chemically incompatible. Synergists.—The motor depressants and morphine. Physiological Action.—Externally and Locally.—Coniine, the active principle of conium, has no effect upon the unbroken skin. Applied to bruised surfaces, it has been thought to possess anes- thetic or analgesic properties. The specific behavior of the drug, however, renders the above action problematical, according to some authorities. Internally.—Digestive System.—Conium increases the salivary secretion, and when taken into the stomach exerts no special action upon the digestive system, other than an occasional disturbance of the gastro-intestinal tract, possibly resulting in vomiting and diar- rhea under full dosage. Circulatory System.—Although when ingested coniine is rapidly absorbed by the blood; circulating in the system unchanged, its action is not clearly defined, though it has been held that the cir- culation is first accelerated and then retarded, with a lowering of arterial pressure preceded by a decided increase. From its capacity to paralyze the terminal vagi it is natural to suppose that it increases the rapidity of the cardiac movements, yet a characteristic feature of the absorption of coniine is the appar- ent absence of cardiac derangement, the heart, as well as the mind, remaining unaffected in the presence of alarming symptoms. Nervous System.—The brain is unaffected, consciousness being preserved to the last; muscular irritability is uninfluenced; and even under large doses there is little impression made upon the nerves beyond a slight impairment of their conductivity due tc paralysis of certain ganglia located along the motor nerves, thus checking the transmission of motor impulses. This latter influence is first manifested in the peripheries, gradually ascending until the spinal cord is involved, the reverse process marking the effects of methyl-coniine. Respiratory System.—Large or poisonous doses act as depres- sants upon the respiratory center in the medulla, and, although the breathing may at first be normal, paralysis and asphyxia may finally result from immoderate ingestion. Absorption and Elimination.—The drug is readily absorbed, elimination taking place by various channels, but chiefly through the kidneys and by expiration. Coniine has been detected in con- siderable quantities in the liver, lungs, and spleen. 5°2 A TEXT-BOOK OF MA TERIA MEDICA. Temperature.—It has been held that bodily temperature is per- ceptibly lowered by conium, proportionately with the extent of the paralysis occasioned. High authorities, however, assert an increase of temperature under both therapeutic and toxic doses. Eye.—Heaviness of the eyelids, dilated pupils, accompanied by double or confused vision and occasionally entire loss of sight, have been noted among the symptoms incident to the administra- tion of active dosage. The effects thus recorded have been ascribed to paralysis of the third nerve rather than to stimulation of the sympathetic. Poisoning.—A frequent symptom of conium-poisoning is ptosis, arising from paralysis of the oculo-motor nerves. Staggering gait, general muscular relaxation, impairment of vision, nausea, and ver- tigo are also not infrequent. The severer symptoms are marked by muscular paralysis of the extremities, derangement of vocal organs resulting in difficulty of speech, and dilatation of the pupils. The brain meanwhile remains unaffected until overcome by the accumulation of carbonic-acid gas in the blood, when delirium and coma may ensue, and finally cerebral convulsions and fatal collapse through respiratory failure. With regard to the effect of toxic doses upon the heart conflict- ing statements are recorded, experiment having proved that in warm-blooded animals the cardiac movements speedily cease, it being authoritatively stated, on the other hand, that the drug exerts no influence upon the heart. Treatment of Poisoning.—The stomach should be evacuated by means of emetics or lavage, after which tannic acid and the phys- iological antidotes may be administered—tetanizing agents, such as strychnine and picrotoxin, with alcoholic stimuli if necessary. Coffee and also hypodermic injections of atropine have been highly recommended. Muscular exercise has been known to delay the action of the poison, and free counter-irritation by mustard may be serviceable. Therapeutics.—Externally and Locally.—In many respects the medicinal operation of conium bears no relation to its physio- logical action. Experimentation shows that it exerts but a feeble action upon the sensory nerves, yet clinical experience establishes its value in mitigating the pain of cancer when locally applied. In ulcerating cancer of the breast especially, poultices composed of conium leaves afford wonderful relief from pain and greatly improve the condition. A similar application has proved beneficial MOTOR DEPRESSANTS. 503 in scrofulous glandular sores. Dewees has recommended an injec- tion composed of the extract 3 parts to water 16 parts in uterine cancer. Ovarian menorrhagia is well treated by inserting in the vagina once or twice daily a suppository containing 1 or 2 grains (0.06- 0.12 Gm.) of conium. Acute laryngitis may be greatly relieved by the inhalation of a solution containing 2 fluidrachms (7.4 Cc.) of succus conii to 16 or 20 ounces (473~59I-5 Cc) of water and 20 grains (1.2 Gm.) of sodium carbonate. The vapor of coniine inhaled is an efficient palliative of the cough of phthisis and acute bronchitis. The peculiar mouse-like odor renders the use of conium in dis- eases of the respiratory tract objectionable to many persons. Internally.—Its action upon the motor mechanism gives value to the drug in diseases characterized by excessive motor activity. Conium is therefore an efficient remedy in allaying the motor excitement of acute mania. Advantage has been taken of its action in the treatment of asthma, and in chorea and paralysis agitans it certainly serves a useful purpose. It has been claimed that zvhooping cough yields to its influence. It has proved beneficial in other spasmodic affections, such as tetanus and blepharospasm accompanying many acute inflamma- tions of the eye. Coniine has even been suggested as a remedy in hydrophobia and strychnine-poisoning. Coniine iivdrobromate has been proposed by Wolfenden as an efficient remedy in epilepsy. Conium has also been suggested in puerperal convulsions, while in infantile convulsions the drug has been employed with great benefit, being well tolerated by children. Coniine has been used hypodermically and with marked success to relax the muscles in dislocations of the joints, as well as in pneu- monia and pleurisy. In the latter diseases the drug so depresses the ends of the motor nerves that the impulse exciting the respira- tory muscles is interfered with and the cough greatly relieved, a reduction of the pulse-rate and temperature usually accompanying the cessation of coughing. Contraindications.—Conium should not be given to persons suffering from great exhaustion and debility or from diseases inter- fering with the rhythm of the heart. Administration.—The preparations of conium are very unreli- 5°4 A TEXT-BOOK OF MATERIA MEDICA. able, the fluid extract being perhaps the one to be depended upon most uniformly. Owing to the uncertainty of their strength, the administration should begin with small doses gradually augmented until interference with involuntary motion is observed, when further increase should be stopped. The effects of the drug are weakened by repeated doses, rendering an increase in the dose necessary from time to time. Coniine and morphine greatly aid each other, and this combination is a particularly efficient one in the treatment of painful muscular spasms and acute mania with excessive motor activity. Dr. Squibbs has stated that there is danger in diluting the fluid extract, a precipitate being formed containing the active principle. Gelsemium—Gelsemii—Gelsemium. U. s. P. (Yellow Jasmine.) Origin.—The rhizome and roots of Gelsemium sempervircns (L.) Pers., a plant indigenous in the southern United States, growing in moist woods. Description and Properties.—Cylindrical, long or cut in sec- tions about I inch (25 Mm.) in length, externally light yellowish- brown, with purplish-brown longitudinal lines; tough, fracture splintery; bark thin, with silky bast-fibers closely adhering to the pale-yellowish, porous wood, which has five medullary rays, and in the rhizome a thin pith; odor aromatic, heavy; taste bitter. It contains an alkaloid, gelsemiue, which forms its active princi- ple, gelseminine, gelseminic acid, volatile oil, resins, gallic acid, etc. Dose.—2-10 grains (0.13-0.6 Gm.). Official Preparations. Extractum Gelsemii Fluidum—Extracti Gelsemii Fluidi—Fluid Extract of Gelsemium.—Dose, 2-10 minims (0.12-0.6 Cc). Gelsemina (unofficial)—Gelseminae—Gelsemine.—Description and Proper- ties.—A brittle solid, transparent, crystallizable mass, converted into a colorless liquid at 45° C. (1130 F.). Insoluble in cold water, but soluble to a slight extent in hot water, as well as in alcohol; taste bitter. Dose.—^^-.fV grain (0.0003-0.001 Gm.). Antagonists and Incompatibles.—The cardiac and diffusible stimulants are antagonistic; tannic acid and caustic alkalies are incompatible, precipitating the alkaloid. Synergists.—The motor depressants. Physiological Action.—Externally and Locally.—It is a mild sedative and astringent, the alkaloid being a mydriatic. MOTOR DEPRESSANTS. 505 Internally.—Digestive System.—No special action has been noted, though when excessive doses have been taken nausea and vomiting may ensue. Circulatory System.—Medicinal doses of gelsemium produce no marked effect, but toxic doses reduce the heart's action, rendering the pulse slower and weaker and lowering arterial tension. Nervous System.—The drug has no effect upon higher cerebral centers, the mind remaining clear to the last. In large doses it paralyzes the roots of the motor cerebral nerves and the motor areas of the spinal cord, with consequent paralysis of all the mus- cles of the body. This condition is succeeded by cutaneous anes- thesia, due to depression of the receiving center and the sensory tract in the spinal cord. The motor nerves and muscles are unaf- fected. Convulsions rarely result in man from a poisonous dose, but occur in animals, with backward movements. The exact cause of this action is undetermined. Respiratory System.—The breathing is rendered slower and shallower, being frequently irregular. Death results from asphyxia, caused by depression and ultimate paralysis of the respiratory center. Absorption and Elimination.—Gelsemium is speedily absorbed and readily excreted, chiefly by means of the kidneys. Untoward symptoms produced by immoderate amounts of the drug prac- tically subside within three hours after ingestion. Fig. 8.—Diagram showing how gelsemium produces convergent strabismus : A,A, superior rectus ; B,B, external rectus—too weak; C,C, internal rectus; D,D, third nerve; E,E, sixth nerve; F,F, optic nerve; G,G, lesser wing. Temperature.—Poisonous doses cause a reduction in temper- ature. Eye.—Under full dosage the pupil is widely dilated and diplopia and marked ptosis ensue. The mydriasis and ptosis are caused by S06 A TEXT-BOOK OF MATERIA MEDICA. paralysis of the third nerve. The sixth, which innervates the ex- ternal rectus muscle, is often depressed more than the third nerve, supplying the internal rectus, producing convergent strabismus, as shown in Figure 8. The diplopia is caused by the squint and incoordination of the ocular movements. In strabismus the eyes are not directed exactly to the object, and the image does not fall on corresponding part- of the retinas ; consequently, two perceptions are received in the visual center and two objects apparently seen. Uterus.—No important action has been observed. Untoward Action.—This does not essentially differ from that observed in poisoning, though the symptoms may be of a milder form. Poisoning.—In toxic doses gelsemium is quickly fatal. The early symptoms include drooping of the eyelids, wide dilatation and immobility of the pupils, extreme muscular weakness, affecting first the muscles of the upper extremities, and incoordination of movements. Diplopia and dimness of vision may ensue, accom- panied by difficulty of speech, coldness of the body surface, and general cutaneous anesthesia, with decidedly lower temperature. Meanwhile, there is marked diminution in the force and frequency of the pulse and respiration. While the patient may be drowsy, the mind is unaffected until carbonic-acid narcosis supervenes. Death is usually the result of respiratory failure, due to paralysis of the muscles of respiration. (See Plate I.) Treatment of Poisoning.—The evacuation of the stomach is of the first importance, either by the stomach-pump or by the use of emetics. Washing out with a solution of tannic acid is probably the best method to pursue. External heat should be applied and diffusible stimulants administered, followed by digitalis and strych- nine. The hypodermic injection of morphine and atropine is highly recommended in gelsemium-poisoning. Therapeutics.—Externally and Locally.—The drug is seldom used externally, although it has been employed by ophthalmolo- gists as a mydriatic. Internally.—Clinically, gelsemium is now considered less valu- able than formerly. It has been favorably mentioned by certain authors in the treatment of tetanus, mania with motor excitement, and paralysis agitans. Theoretically, it would seem to be of value in certain convulsive disorders, like chorea, pertussis, etc., yet its PLATE II. Gelsemium-poisoning, MOTOR DEPRESSANTS. 507 use has not met with the success which its action upon the mus- cular system would indicate. The drug appears to be more serviceable in trifacial neuralgia, and it seems to be even more efficient in neuralgia with involve- ment of the inferior dental nerve. In these disorders, as in ovarian neuralgia, dysmenorrhea, etc., for which it has been employed with some success, the drug should be pushed to its physiological limit. Bartholow praised the action of gelsemium in cerebrospinal meningitis and " acute inflammations of the lungs and pleura." Bulkley is responsible for its use in pruritus and eczema, the itching of which it certainly appears to alleviate. The therapeutics of gelsemium would perhaps be incomplete without mentioning hemoptysis, remittent fever, acute coryza, mi- graine, Meniere's disease, and spermatorrhea, in all of which the drug has been used and recommended. Contraindications.—Diseases accompanied by exhaustion and great muscular weakness. Administration.—Any of the preparations may be given, the initial dose being small, and the amount increased gradually until dilatation of the pupil or drooping of the eyelids is manifest. Grindelia—Grindeliae—Grindelia. U. S. P. Origin.—The leaves and flowering tops of Grindelia robusta Xutt, and of Grindelia squarrosa Dunal, herbaceous or suffruticose perennials indigenous in the western part of North America and Mexico. Description and Properties.—Leaves about 2 inches (5 Cm.) long, varying from broadly spatulate or oblong to lanceolate, sessile or clasping, obtuse, more or less sharply serrate, often spinous- toothed or even laciniate-pinnatifid, pale-green, smooth, finely dotted, thickish, brittle; heads many-flowered, subglobular or somewhat conical, the involucre hemispherical, about f inch (10 Mm.) broad, composed of numerous imbricated, squarrose- tipped, or spreading scales; ray-florets yellow, liqulate, pistillate; disk-florets yellow, tubular, perfect; pappus consisting of two or three awns of the length of the disk-florets; odor balsamic; taste pungently aromatic and bitter. The principal constituent is probably a resinous substance. It also contains an alkaloid principle, grindeline, and a volatile and a fixed oil. Dose.—10-60 grains (0.6-4.0 Gm.). 508 A TEXT-BOOK OF MATERIA MEDICA. Official Preparation. ExtrSctum Grindeliae Fluidum—Extracti Grindeliae Fluidi—Fluid Extract of Grindelia.—Dose, 10-60 minims (0.6-3.7 Cc). Antagonists and Incompatibles.—The motor excitants and cerebral stimulants are antagonistic. Aqueous preparations, the caustic alkalies, and mineral salts are incompatible. Synergists.—The motor depressants. Physiological Action.—Externally and Locally.—The drug is sedative and mildly astringent. Internally.—Digestive System.—When ingested it excites a sense of warmth in the epigastrium, and in moderate doses increases the secretion of the gastric juice, stimulating the appetite and improv- ing digestion. Circulatory System.—It differs somewhat from conium in that the heart is slowed by medicinal doses through stimulation of the inhibitory center. The blood-pressure, however, is raised and maintained by stimulation of the vaso-motor center. Nervous System.—Grindelia possesses considerable hypnotic power. Its effect upon the motor mechanism is similar to that of conium, the muscular weakness affecting first the lower extremi- ties. The sensory nerves are first depressed, there being quite marked cutaneous anesthesia. The drug depresses the reflex mechanism in the spinal cord, so that the reflex movements are greatly lessened: it is said that it also depresses the phrenic nerve. Respiratory System.—Small doses have little effect upon the respiratory movements ; large doses retard the breathing; while toxic doses may produce death through paralysis of the respiratory muscles. The drug slightly increases the secretion from the pulmonary mucous membrane, and relaxes the circular fibers of the bronchial muscles through depression of the ends of the motor fibers of the vagus distributed to these muscles and of the reflex center in the medulla. The ends of the sensory nerves distributed to the pul- monary mucous membrane are also depressed. Absorption and Elimination.—Grindelia is readily absorbed, and is eliminated chiefly by the kidneys, increasing the urinary flow, the lungs sharing in the excretory process. Temperature is unaffected. Eye.—Large doses cause dilatation of the pupil. Uterus.—No effect has been noticed. Untozvard Action.—Excepting drowsiness, reduction of cutane- MOTOR DEPRESSANTS. 509 ous sensibility, slight gastric disturbance, and a feeling of weakness no symptoms have been recorded. Poisoning.—The drug is feebly toxic; excessive doses, how- ever, act as a gastro-intestinal irritant. The patient is sleepy and complains of muscular weakness ; there is a numb or anesthetic condition of the skin, while the pupils are dilated and the pulse and respiratory movements slow and feeble. Should death occur, it will be from paralysis of the muscles of respiration. Treatment of Poisoning.—The same as in poisoning from conium—diffusible stimulants, strychnine, etc. Therapeutics.—Externally and Lo- cally.—Grindelia is a very efficient ap- plication to the skin in rhus-poisoning. Indeed, it serves as a soothing lotion in many acute inflammations of the skin, such as eczema, etc. The fluid extract used should be well diluted and applied on cloths. Indolent ulcers are well treated by a diluted solution of the drug. It also serves as an efficient injection in gonor- rhea, leucorrhea, and vaginitis. Internally.—Grindelia has acquired an enviable reputation as a remedy for spasmodic asthma, its action upon the bronchial muscles rendering it singu- larly beneficial in this disorder. It acts upon every possible point to relax the spasm of the bronchial muscles, as is shown in Fig- ure 9. The drug has no influence, however, in preventing a recur- rence of the paroxysms. The drug has been highly recommended in acute and chronic bronchitis, hay fever, zvhooping cough, and in spasmodic cough of whatever nature. It has even been suggested as a palliative remedy in pneumonia and cardiac and pulmonary dyspnea. There are no special Contraindications or directions for Ad- ministration, save that the fluid extract is pharmaceutically incom- patible with aqueous preparations. Fig. 9.—Diagram showing how grin- delia relaxes spasm of the bronchial muscles in asthma. The sensory nerves (B) in the mucous membrane of the bronchial tubes are depressed, so that there is less irritation transmitted to the medulla, to be returned by the motor fibers supplying the bronchial muscles, thus exciting bronchial spasm. The respiratory center (A) is depressed, together with the ends of the motor nerves (C), limiting the amount of irri- tation in the bronchial muscles (E). The diaphragm (F) is relaxed through depression of the phrenic nerve (Z>). 5io A TEXT-BOOK OF MATERIA MEDICA Physostlgrma—Physostigmatis— Physostigma. U. S. P. (Calabar Bkan.) Origin.—The seed of Physostigma venenosum Balfour, a lofty, half-shrubby, climbing plant (somewhat resembling the scarlet- runner or Spanish bean of our gardens) growing near the mouths of the Niger and Old Calabar River in Western Africa, and attain- ing a height of 40 or 50 feet (12-15 M-)- Description and Properties.—The seeds are about I to 1^ inches (25-30 Mm.) long, f to f inch (15-20 Mm.) broad, and \ to finch (10-15 Mm.) thick; oblong and somewhat reniform; testa granular, chocolate-brown, with a broad black groove extending the entire length of the convex edge; embryo with a short, curved radicle and two large, white concavo-convex cotyledons ; inodor- ous ; taste bean-like. The drug contains an alkaloid, physostigminc (also known as escrine), which is the principal constituent; calabarine, to which the drug owes its tetanizing properties ; and cseridine (a laxative and motor excitant); besides a neutral principle, physosterin, related to cholesterin. Dose.—1-4 grains (0.065-0.25 Gm.). Official Preparations. Extractum Physostigmatis—Extracti Physostlgmatis—Extract of Physo- stigma.—Dose, T*g—^ grain (0.004-0.01 Gm.). Tinctura Physostigmatis—Tincturae Physostlgmatis—Tincture of Physo- stigma.—Dose, 5-10 minims (0.3-0.6 Cc). The alkaloid, Physostigmine, is not official. It occurs in colorless or slightly pink- ish crystals ; sparingly soluble in water; readily soluble in alcohol.—Dose, y^-^ grain (0.0006-0.003 Gm.). The salicylate and sulphate of physostigmine are official. Physostigminae Salicylas—Physostigminae Salicylatis—Physostigmine Salicylate (Eserine Salicylate). U. S. P. Description and Properties.—Colorless or faintly yellowish, shining, acicular, or short, columnar crystals, odorless, and of a bitter taste; acquiring a reddish tint when exposed to light and air; soluble in 150 parts of water and 12 parts of alcohol. The salicylate should be kept in small, dark amber-colored, and well-stoppered vials. Dose.—yIjj-Jj grain (0.0005-0.002 Gm.). Physostigminae Sulphas—Physostigminae Sulphatis—Physostigmine Sul- phate (Eserine Sulphate). U. S. P. Description and Properties.—A. white, or yellowish-white, micro-crystalline pow- der, odorless, and of a bitter taste. It is veiy deliquescent when exposed to moist air, gradually turning reddish in air and light. Very soluble in water and alcohol; still more so at the boiling-point of these liquids. It should be kept in small, dark amber- colored, and well-stoppered vials. Dose.—y^o-sV S™11 (0.0005-0.002 Gm.). MOTOR DEPRESSANTS. 5H Unofficial Preparation. Physostigminae Hydrobromas—Physostigminae Hydrobromatis—Physo- stigmine Hydrobromate.—Dose, Thriis g™111 (0.0005-0.002 Gm.). Antagonists and Incompatibles.—The action of physostigma upon the heart, respiration, and pupils is antagonized by atropine; that on the spinal cord by chloral; while, in a general way, the motor excitants, particularly the tetanizing agents, are therapeuti- cally antagonistic. The caustic alkalies and tannic acid are chemically incompatible. Synergists.—The motor depressants. Physiological Action.—Externally and Locally.—No external Fig. io.—Diagram illustrating the mechanism of secretion. An impression is transmitted over the afferent nerve (B) to the medulla (A), and thence over the secretory nerve (C) to the secretory cells (A", K) of the gland (F). At the same time the vaso-motor nerves (E) are stimulated, causing a con- traction of the arterioles (/) supplying the gland ; hence, as soon as the lymph in the lymph-spaces (H) is consumed, the secretion from the gland is diminished for lack of material necessary to the secretory cells in elaborating their normal secretions. action of physostigma and its preparations is noted, unless it be its effect upon the pupil, which outward application contracts, and the slight abolition of functional activity in the motor and sensory 5J2 A TEXT-BOOK OF MA TERIA MEDICA nerves, occasioned, it is said, by a strong solution of physostig- mine. Internally.—Digestive System.—The administration of the drug tends to stimulate the salivary, gastric, and intestinal secretions, followed by lessened secretion (see Figure io), and, by acting upon the muscular coats of the stomach and intestines, to increase peristalsis. Nausea, retching, vomiting, and purging may result. The rationale of its action is doubtless direct stimulation of the unstriped muscle-fibers. Circulatory System.—No influence on the blood has been de- tected. Small doses increase arterial tension, the heart's action becoming slower and stronger. Although the effect upon the heart is somewhat obscure, it appears that under poisonous doses the cardiac pulsations are greatly reduced, being slow and feeble, and finally ceasing alto- gether. It is reasonably supposed that this action is due to pri- mary stimulation of the peripheral vagi, influencing the cardiac ganglia, and also to the effect upon the vaso-motor centers. The subsequent exhaustion and relaxation of the arteries are doubtless the result of a similar influence. There is marked elevation of blood-pressure under moderate doses, although there may occur a brief period of depression. Toxic doses are accompanied by a notable decrease of arterial ten- sion, the cardiac ganglia being seized with paralysis and the heart finally arrested in diastole. Nervous System.—As with conium, the mind is comparatively unaffected by physostigma, remaining lucid even to the verge of final collapse. The spinal cord, however, appears to bear the prin- cipal shock, the total abolition of reflex activity indicating a selective action of the drug. To the effect on the motor nerves, occasioning a diminution of power, must be attributed the muscular debility and paralytic symptoms manifest under the administration of toxic doses. Respiratory System.—No interference with respiration is caused by moderate doses of the drug. Larger amounts primarily de- press the respiratory centers, stimulate the peripheries of the pul- monary vagi, and contract the caliber of the bronchial tubes, even to the extent of serious constriction, death usually resulting from asphyxia. The breathing is first quickened and then retarded, the effect of the drug upon the respiration being more powerful than its circu- PRACTICAL POINTS IN NURS- ING* For Nurses in Private Practice. By Emily A. M. Stoney, Graduate of the Training; - School STONEY'S NURSING for Nurses, Lawrence, Mass.; Late Superintendent of the Training-School for Nurses, Carney Hospital, South Boston, Mass. 456 pages, handsomely illustrated. Cloth, $J.75 net. J> J> SECOND EDITION, REVISED. The author explains, in popular language, the entire range of private nursing as distinguished from hospital nursing, and the nurse is instructed how to meet the various emergencies that arise. A valuable feature of the work will be found in the directions for improvising everything ordi- " There are few books intended for non-profes- sional readers which can be so cordially endorsed by a medical journal as can this one."—Thera- peutic Gazette. 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GARRIGUES' DISEASES OF WOMEN MOTOR DEPRESSANTS. 513 later)' influence, the heart continuing to beat for some time after pulmonary action has ceased. Absorption and Elimination.—The active principles of physo- stigma and its alkaloids are rapidly diffused in the blood. They are largely excreted by the kidneys, the bile and saliva contributing to the process of elimination, and have been detected in the gastric juices after intravenous injection. Temperature.—A slight depression has been noted. Eye.—Applied locally to the conjunctiva or introduced into the circulation, whether by ingestion or injection, physostigmine causes myosis or contraction of the pupil by stimulating the peripheral endings of the oculo-motor nerves, possibly by a depression of the sympathetic fibers. Other prominent symptoms present are spasm of accommoda- tion and decreased intraocular tension and myopia. Irritation of the third nerve is the principal cause of these phenomena: they have also been attributed to the stimulating action of the drug upon the muscular fibers of the iris rather than to any paralyzing influence upon the sympathetic, pupillar dilatation being manifest under excitation of the latter nerve. The intraocular pressure is lowered (1) by lessening the blood- supply to the eye through contraction of the blood-vessels; (2) by diminishing the secretion of the aqueous humor from the glands on the surface of the ciliary body; (3) by contracting the iris, so that the aqueous humor can more readily pass through the canal of Schlemm. Uterus.—The full influence of the drug tends to produce uterine contraction. Untoward Action.—When eserine is applied to the eye it occa- sionally produces a nervous contractile pain in the entire eyeball, which extends in a manner similar to ciliary neurosis along the course of the supraorbital nerve, resembling migraine. Small doses have in some individuals produced nausea and general uneasiness, and occasionally intense pain in the epigas- trium. Poisoning.—Taken in poisonous doses, physostigma causes nausea, giddiness, and muscular tremors and weakness, followed by complete muscular relaxation. Cardiac action is diminished; the reflexes are in abeyance; the respiration is retarded; and myosis and motor paralysis are manifest. The pupils visibly con- tract, and purging and vomiting may ensue. Fatal results are 33 514 A TEXT-BOOK OF MATERIA MEDICA. possible through paralysis of the respiratory center and consequent asphyxia. The more rapid collapse succeeding the administration of lethal doses is due to cardiac syncope. Treatment of Poisoning.—The stomach should be evacuated, the process being followed by the hypodermic injection of a solution of atropine, which may prove an efficient physiological antidote. Tannic acid may be used as a chemical antagonist. Diffusible stimulants, such as ether or ammonia, may serve to arrest cardiac and respiratory failure. Digitalis and alcohol have also been suc- cessfully employed. Temperature should be maintained by the application of external heat. Therapeutics.—Externally and Locally.—Physostigmine and eserixe sulphate are the preparations usually employed, their only action of importance being in diseases of the eye. They are of value in breaking up adhesions of the iris to the cornea or lens, strengthening the muscle of accommodation, reducing intraocular pressure, and removing the effects of atropine, although Jessup claims that complete ciliary paralysis by atropine and the mydriasis induced by hyoscine are unaffected by eserine. In certain cases of ulcer of the cornea uncomplicated with iritis and sloughing keratitis, where there is little inflammation or ciliary irritation, eserine sometimes produces prompt improvement when atropine has failed. Paralytic mydriasis and paralysis of accommodation are tempo- rarily relieved by this drug, and weak solutions have been employed with varying success in accommodative asthenopia without refrac- tive errors. The remedy is of unquestioned value in the early stages of glaucoma, but only at the commencement of an acute attack and contraindicated in the hemorrhagic form. Should the drug fail to contract the pupil when used for glaucoma, it may induce irritating spasm of the ciliary muscles by increasing the blood-supply to the iris. Physostigmine is sometimes employed to prevent prolapsus of the iris, following peripheral perforation of the cornea or cataract extraction, particularly without iridectomy. The remedy serves a useful purpose also in coal-miners' nys- tagmus, one drop of a collyrium containing \ grain (0.096 Gm.) of physostigmine sulphate in 1 ounce (30.0 Cc.) of distilled water being dropped into the eye three times a day. Eserine is also em- ployed in neuralgia of the eyeball and photophobia. MOTOR DEPRESSANTS. 5*5 Internally.—Physostigma has proved efficacious in constipation due to an atonic condition of the intestines with deficient secretion. The state of the muscular intestinal layer frequently allows gas to accumulate in the bowels, with consequent troublesome flatulence. The drug, by imparting tone to the muscles and increasing peri- stalsis, greatly relieves this unpleasant condition. Gastric and intestinal dilatation have been successfully treated by Hare with this remedy. It is valuable in chronic bronchitis with dilatation of the bronchial tubes, and is said to relieve broiichial asthma and emphysema. Progressive paralysis of the insane is sometimes relieved by physostigma, while its good reputation in tetanus is well estab- lished. It has been used, but with less favorable results, in chorea, epilepsy, infantile convulsions, and other spasms. Some authorities have recommended it in the treatment of paraplegia due to myeli- tis, renal hemorrhage, night-szveats of phthisis, and locomotor ataxia. Contraindications.—The same as for conium. Administration.—The extract or the tincture is usually pre- ferred for internal administration, although the alkaloid fully repre- sents the drug and ma)' be given either by the mouth or hypo- dermically. For application to the eye the salts of the alkaloid are used. A convenient form of eserine in ophthalmic practice is the medicated gelatin disks. Curare—Curare—Curare. (WOORARI.) Origin.—An extract of uncertain composition prepared by the natives of South America as an arrow-poison. Dr. Jobert reported to the French Academy in 1878 that the poison was prepared chiefly from Strychnos Castclno?aua and other species of Strychnos, and Cocculus toxiferus, containing also variable quantities of other poisonous plants, such as Didclphys caucriz'ora, etc. It is alto- gether probable that its ingredients include the poison of venomous reptiles. Description and Properties.—The extract is a blackish-brown, friable solid, brittle or hygroscopic, of a very bitter taste; almost completely soluble in dilute alcohol. Cold water dissolves about 75 per cent., which portion contains the poisonous alkaloids and is insoluble in ether and but sparingly soluble in absolute alcohol. Two alkaloids have been obtained from this substance—curarine and citrine. 5J6 A TENT-BOOK OF MATERIA MEDICA. Dose.—Aj-i grain (0.003-0.03 Gm.), hypodermically given. Dose of Curarine.—-joo~ioo gram (0.0003-0.0006 Gm.), hypo- dermically. Antagonists and Incompatibles.—The excito-motors are an- tagonistic. Tannic acid and the caustic alkalies are chemically incompatible. Synergists.—The depresso-motors. Physiological Action.—When applied to the denuded skin it is a powerful irritant; introduced into the circulation hypodermically, it exerts a very decided and characteristic action. Circulatory System.—Medicinal doses render the pulse fuller and exceedingly rapid; there is marked dilatation of the blood- vessels of the skin and the various glands ; while the blood-pres- sure, though little affected by small doses, is decidedly lowered by large ones. The action on the circulation is due to diminished inhibition on the heart, owing to paralysis of the ends of the vagi, while the accelerator nerves are stimulated. Nervous System.—Immoderate doses cause great muscular weakness and paralysis of all the voluntary muscles. The ends of the motor and sensory nerves are paralyzed, the former being soonest affected. Beyond a slightly diminished contractility the voluntary muscles are but little influenced. The spinal cord may be paralyzed under toxic doses, although the brain-centers remain unaffected until carbonic-acid narcosis sets in. Respiratory System.—Curare is a powerful respiratory depress- ant, paralyzing the ends of the motor nerves distributed to the respiratory muscles. When lethal doses have been given the paralysis becomes central, finally producing death by its action on the respiratory muscles. Absorption and Elimination.—When ingested the process of absorption is exceedingly slow, but when injected into the circula- tion the drug is rapidly absorbed. It is quickly eliminated by the kidneys, causing sugar to appear in the urine. A portion of the poison is also excreted with the feces. The sweat, saliva, nasal mucus, and tears, although their secretion is greatly increased by the drug, do not seem to share in the process of elimination. Temperature.—The temperature is elevated. Eye.—Under poisonous doses there is marked ptosis, disordered vision, protrusion of the eyeballs, and, as a late ocular symptom, myosis. MOTOR DEPRESSANTS. 517 Poisoning.—Curare is a rapid and active poison. The move- ments of the heart are greatly accelerated; the pulse is weak and dicrotic; the temperature is elevated, and the respiration corre- spondingly depressed; extreme muscular weakness ensues, with incoordination of movements; the urine becomes saccharine. Finally, paralysis of the extremities and the respiratory muscles supervenes, death occurring from respiratory paralysis. Treatment of Poisoning.—The same as in the treatment of poi- soning from conium, with catheterization of the bladder to favor elimination, and artificial respiration. Therapeutics.—While of great scientific interest and of value for experimental purposes in ascertaining the effect of certain drugs upon animals, the therapeutic uses of curare are quite limited, being confined to certain spasmodic diseases, particularly hydrophobia. The remedy has also been used with varying success in chorea, tetanus, and epilepsy, but when the convulsions are due to excessive activity of the cerebral motor areas the bromides are superior to curare. Contraindications.—The same as for conium. Administration.—The crude drug or the alkaloid curare should be given hypodermically. Aspidosperma—Aspidospermatis—Aspidosperma. U. S. P. Origin.—The bark oi Aspidosperma Quebracho-bianco Schlech- tendal, a large evergreen tree, of exceedingly hard wood (Sp. qucbrar, to break, and hacha, an axe), indigenous in the Argentine Republic. Description and Properties.—Occurring in nearly flat pieces about \ to \\ inches (12.O-30.O Mm.) thick ; the outer surface yel- lowish-gray or brownish, deeply fissured, inner surface yellowish- brown or reddish-brown, distinctly striate; fracture displaying two sharply-defined strata of about equal thickness, both marked with numerous whitish dots and striae arranged in tangential lines; the fracture of the outer lighter-colored layer rather coarsely granu- lar, and that of the darker-colored inner layer short-splintery; inodorous; taste very bitter and slightly aromatic. Six alkaloids have thus far been isolated from aspidosperma, the most important being aspidospermine and quebrachine, the former occurring in colorless prismatic crystals insoluble in water and soluble in 48 parts of alcohol. Dose.—5-30 grains (0.3-2.0 Gm.). 518 A TEXT-BOOK OF MATERIA MEDICA. Official Preparations. Extractum Aspidospfermatis Fluidum—Extracti Aspidosp&rmatis Fluidi— Fluid Extract of Aspidosperma.—Dose, 5-30 minims (0.3-1.8 Cc). Aspidospermine (unofficial).—Dose, \-\ grain (0.016-0.03 Gm.). Quebrachine (unofficial).—Dose, 1-2 grains (0.06-0.12 Gm.). Physiological Action.—Externally and Locally.—No important action has been noted. Internally.—Digestive System.—It is a stomachic, having an action analogous to the vegetable bitters. Circulatory System.—Aspidosperma depresses the heart, render- ing its action slower, with reduction of arterial tension. Nervous System.—In its action it resembles conium. It de- presses the motor mechanism by its influence on the motor centers, and lessens the reflexes through its influence on the spinal cord. Excessive doses cause vertigo and headache, together with paraly- sis of the extremities, the lower being first affected. Respiratory System.—Medicinal amounts of aspidosperma retard the breathing, but deepen the inspirations; aspidospermine, on the contrary, increases the respiratory movements. Toxic doses para- lyze the respiratory center, death resulting apparently from asphyxia and convulsions. Absorption and Elimination.—It readily passes into the blood, and is excreted chiefly by the urine, the saliva and sweat sharing in the process of elimination. Temperature.—It is antipyretic, febrile temperature being re- duced by full doses of the drug. Poisoning.—Aspidospermine is an active respiratory poison, the toxic symptoms being vertigo, headache, free diaphoresis and sali- vation, great muscular weakness, with paralysis of the lower extremities, slow and weak heart, reduction of temperature, marked depression of the respiration, and death from respiratory failure. Treatment of Poisoning.—The same procedure is advisable as in cases of poisoning from the other motor depressants. Therapeutics.—Aspidosperma is not employed locally, its chief value being in the treatment of dyspnea of whatever variety, though it is fair to state that Pluzoldt considers it contraindicated in cardiac dyspnea. The drug is equal, if not superior, to grindelia in the treatment of spasmodic disorders of the respiratory apparatus. By some clinicians it is claimed to be an efficient remedy in pneumonia, being especially useful in relieving cyanosis. MOTOR DEPRESSANTS. 519 Aspidospermine has been highly recommended as an anti- periodic in malaria, and has appeared to modify the symptoms of acute articular rheumatism. Administration.—Both the fluid extract and the alkaloid may be given internally, although a favorite and efficient method of administering the alkaloids is by hypodermic injection. Sumbul—Sumbul—Sumbul. U. S. P. Origin.—The root of Ferula sumbul (Kauffmann) Hooker fil, a perennial about 8 feet (2.4 M.) high, indigenous in regions north and east of British India. Description and Properties.—It occurs in transverse segments, varying in diameter from 1 to 3 inches (2-7 Cm.), and in length from 6 to 12 inches (14-30 Cm.); light spongy, annulate or longi- tudinally wrinkled; bark thin, brown, more or less bristly fibrous; the interior whitish, with numerous brownish-yellow resin-dots and irregular, easily separated fibers; odor strong, musk-like; taste bitter and balsamic. It contains sumbulic and valerianic acids, a small quantity of volatile oil, and two balsamic resins to which its odor is due. Dose.—15-30 grains (1.0-2.0 Gm.). Official Preparation. Tinctura Sumbul—Tincturae Sumbul—Tincture of Sumbul.—Dose, 15-60 minims (1.0-3.7 Cc). The drug has not yet been carefully studied. It is unknown just what substances are incompatible with it, though the motor excitants are probably antagonistic. The exact physiological action is not definitely understood, yet so far as it has been investigated it seems to possess some of the properties of both the motor de- pressants and antispasmodics, having a sedative action upon the brain and spinal cord. Therapeutics.—The drug is valuable in the various manifesta- tions of hysteria, and has been employed with some success in ovarian neuralgia and dysmenorrhea. It is similar to, though not so efficient as, grindelia in spasmodic coughs. Indeed, most of the disorders benefited by the antispas- modics yield to the influence of sumbul. In neurasthenia with anemia the extract of sumbul, combined with iron and arsenic, serves a very useful purpose. 520 A TEXT-BOOK OF MATERIA MEDICA. Administration.—It may be given in the form of the tincture, or the extract may be administered in pill form. Viburnum Prunifolium—Viburni Prunifolii—Black Haw. r. ,s. P. Origin.—The bark of Viburnum prunifolium L., a tall shrub or small tree IO to 20 feet (3-6 M.) high, growing in thickets through- out the greater portion of the United States east of the Mississippi. Description and Properties.—Thin pieces or quills, glassy purplish-brown, with scattered warts and minute black dots; when collected from old wood, grayish-brown, the thin corky layer easily removed from the green layer; inner surface whitish, smooth; frac- ture short; inodorous ; somewhat astringent and bitter. It contains a bitter principle (viburnin), a bitter resin, valerianic acid, besides tannic, oxalic, citric, and malic acids. Dose.—30-60 grains (2.0-4.0 Gm.). Official Preparation. Extractum VibGrni Prunifolii Fluidum—Extracti Viburni Prunifolii Fluidi —Fluid Extract of Black Haw.*—Dose, l/2-l fluidrachm (1.8-3.7 Cc). Antagonists and Incompatibles.—It is chemically incompatible with iron and other substances affected by tannic acid. Synergists.—Antispasmodics and uterine sedatives. Physiological Action and Therapeutics.—The action of black haw is not thoroughly understood. It appears to have a sedative action upon the spinal centers, similar in many respects to that of conium. It acts as an antispasmodic, diuretic, nervine, and tonic, being especially useful in various uterine disorders, such as spas- modic and membranous dysmenorrhea. The various vaso-motor disturbances and the menorrhagia inci- dent to the menopause are frequently relieved by this remedy. It is also of some value in the prevention of abortion. Its sedative properties render it serviceable in relieving the severity of after- pains. Liquor Sedans (P., D. & Co.) is superior to the fluid extract of black haw for the disorders mentioned. Contraindications and Administration require no special com- ment or suggestion. 1 Parke, Davis & Co. of Detroit manufacture a preparation called Liquor Sedan-. intended as a substitute for certain secret preparations. The formula is given on the label of each bottle, and the remedy is composed of black haw, golden seal, and Jamaica dogwood, combined with aromatics, in the form of an elixir. MOTOR DEPRESSANTS. 521 Viburnum Opulus—Viburni Opuli—Cramp Bark. I. S. P. Origin.—The bark of Viburnum Opulus L., a small tree 10 to 15 feet (3-4.5 M.) high, indigenous in Canada, the Northern United States, Europe, and Northern Asia. Description and Properties.—Flattish or curved bands, or occasionally quills, sometimes 12 inches (30 Cm.) long and from ■fc to TV inch (1-1.5 Mm.) thick; outer surface ash-gray, marked with somewhat transversely scattered, elongated warts of a brown- ish color, due to abrasion, and marked more or less with blackish dots, with black, irregular lines or thin ridges, arranged chiefly in a longitudinal direction; underneath the easily-removed corky layer of a pale-brownish or reddish-brown color; the inner surface dingy white or brownish; fracture tough, the tissue separating in layers; inodorous; taste somewhat astringent and bitter. Dose.—1-2 drachms (4.0-8.0 Gm.). Official Preparation. Extractum VibQrni Opuli Fluidum—Extracti Viburni Opuli Fluidi—Fluid Extract of Cramp Bark.—Dose, 1-2 fluidrachms (3.7—7.3 Cc). The general observations upon Viburnum prunifolium are appli- cable to this drug. Acidum Hydrocyanicum Dilutum—Acidi Hydrocy- anici Diluti—Diluted Hydrocyanic Acid. U.S. P. (Prussic Acid.) Origin.—A liquid composed of 2 per cent, by weight of abso- lute Hydrocyanic Acid and 98 per cent, of Water, prepared by distilling a mixture of Potassium Ferrocyanide, Sulphuric Acid, and Water into Distilled Water. Description and Properties.—A colorless liquid, of a charac- teristic odor and taste, resembling those of bitter almonds. As it is very poisonous, great care should be taken in tasting it. It should be kept in small, dark-amber colored, cork-stoppered bottles, in a cool place. Dose.—1-5 minims (0.06-0.3 Cc). Antagonists and Incompatibles.—Atropine is a physiological antagonist, the diffusible stimulants also counteracting the effects of the drug. The metallic salts, particularly cobalt nitrate, are chemically incompatible. 522 A TEXT-BOOK OF MATERIA MEDICA. Synergists.—The cardiac and motor depressants. Physiological Action.—Externally and Locally.—Applied lo- cally to the unbroken skin, its first effect is slightly irritating, but soon after sedative and anesthetic, because of its influence in causing paralysis of the sensory nerve-endings. It is very rapidly absorbed from raw surfaces, even toxic effects resulting from its application. Internally.—Digestive System.—Being quickly absorbed by the mucous membranes, hydrocyanic acid acts as an anesthetic and sedative upon the stomach, moderate doses having little influ- ence upon a healthy organism. Toxic doses may be followed by vomiting and the terribly lethal action of the drug, the peculiarly sudden and violent activity of which renders it the most fatal poison known. Circulatory System.—Prussic acid passes very readily into the blood, upon which it acts with physical effects variously reported, it having been observed that the blood is at first changed to a bright red or arterial tint, soon changing to a dark venous color. Upon the heart its influence, though in small doses sedative through stimulation of the vagus center, in toxic doses is particu- larly active, suspending its movements and arresting it in diastole. A temporary, yet doubtful, increase, followed by a decline, of arterial pressure has been noted. In lethal doses the decrease of tension is unquestionable. Observations upon the physiological effects of prussic acid have been attended with considerable dif- ficulty : a slow and frequently irregular pulse, however, is among the authenticated phenomena. By its action on the respiratory functions of the red blood-corpuscles the supply of oxygen to the circulation is impeded. Nervous System.—Medicinal doses have no appreciable effect save to occasion a depression of the sensory fibers of the vagus. The cerebral effects of large doses are giddiness and stupor, often accompanied by total insensibility or coma. Toxic doses produce marked cutaneous anesthesia, beginning in the lower extremities, caused by paralysis of the sensory ends and sensory tracts. The motor mechanism shares in the general influence, which causes excessive muscular weakness, resulting from depression of the spinal motor areas, the ends of the motor nerves, and the mus- cles respectively. Respiratory System.—Very small doses of hydrocyanic acid have no effect upon respiration. Full or large doses have been observed MOTOR DEPRESSANTS. 523 to render the breathing labored and irregular. Under toxic doses the respiration becomes enfeebled, finally ceasing altogether, death ensuing from asphyxia due to paralysis of the respiratory move- ments by direct action upon the center. It has been noted that lethal doses are so quickly fatal that the respirations cannot be counted. Absorption and Elimination.—As has been remarked, absorption takes place with great rapidity, elimination being probably through the kidneys, salivary glands, and lungs, the process being accel- erated by means of the drug's exceeding volatility. In case of poisoning, should death be averted for half an hour there is chance of recovery. Temperature.—No special influence has been observed. Eye.—The pupils are, as a rule, visibly dilated under serious dosage, a temporary hemianopia having been also observed in a case of poisoning with recovery. Untoward Action.—There are no untoward manifestations save those described under " Poisoning." Poisoning.—The celerity of action characteristic of prussic acid is evidenced by the fact that death may be instantaneous, the sub- ject falling with a gasp and momentary convulsion, followed by immediate collapse. In such cases the countenance is cyanotic, the teeth firmly set, the eyes wide open, and the lips covered with bloody froth. In less violent cases the symptoms may take the form of reduced respiration, impairment of cardiac movements, and cerebral disturbance. A third stage is marked by wide dilatation of the pupils, loss of consciousness, delirious cries, accompanied by strong convulsions, vomiting, incontinence of urine, involuntary defecation, and even erections of the penis and ejaculations of semen (Hare). In still another stage asphyxia, collapse, and death occur in rapid succession. Treatment of Poisoning.—Owing to the physical action of prussic acid upon the blood, artificial respiration is generally pow- erless to avert fatal results (Ringer). Efficient antidotes are ammonia and its carbonate, to be administered whenever prac- ticable. Alcoholic stimuli may prove of service, yet the fearful rapidity of the drug's action renders poisoning by prussic acid rarely amenable to systematic treatment. A vigorous recourse to alternately warm and cold affusions, together with inhalations of ammonia, has been recommended as of primal)- importance. Secondary means of allaying toxic effects 524 A TEXT-BOOK OF MA TERIA MEDICA. may be found in the internal administration of chlorine water or of potassium carbonate, followed by the sulphates of iron. More recently the subcutaneous injection of atropine has been suo-o-ested as the true physiological antidote (Farquharson), while Dr. Antal considers cobalt nitrate the best chemical antagonist. So lono- as the faintest pulsation is discernible no efforts at recovery should be remitted. Therapeutics.—Externally and Locally.—Hydrocyanic acid is a valuable antipruritic, being frequently employed to relieve the itching of various diseases of the skin, such as eczema, erythema, urticaria, pruritus vulvce, etc. It is commonly applied in strengths of \ fluidrachm (1.8 Cc.) to I ounce (30.0 Cc.) of water. Inhalations of a solution containing 3 minims (0.18 Cc.) of diluted hydrocyanic acid to 8 ounces (236.6 Cc.) of water at a temperature of 1200 F. have been recommended by Mackenzie and others in asthma and the irritative cough of phthisis. Internally.—Its sedative properties render the drug an efficient remedy in obstinate vomiting and gastric pain from whatever cause. It is also valuable to relieve coughs of a dry, hacking nature, zvhooping cough, and various neuroses of the respiratory organs. Macdonald reports a case of night cough of a child that yielded promptly to hydrocyanic acid after every other treatment had been tried in vain. The drug has also been employed in neuralgia and acute mania and melancholia. In irritable conditions of the heart it serves as a useful palliative, and it is also of some value in relieving the distress of irritative dyspepsia. Contraindications.—Extreme muscular weakness and the last stages of valvular heart disease. Administration.—Owing to the exceedingly rapid elimination of prussic acid the dose should be frequently repeated—every hour or two. In the early administration the minimum dose should be first prescribed, the amount being gradually increased to the maximum or until the patient complains of constriction about the throat or other untoward manifestation, when the dosage should be discontinued. Whenever a fresh supply is prescribed it is best to begin with the minimum dose, owing to the variations in strength in the different samples. Hydrocyanic acid may be given in syrup, water, or glycerin, or in some effervescent draught. MOTOR DEPRESSANTS. 525 Potassii Cyanidum—Potassii Cyanidi—Potassium Cyanide. U.S. P. Origin.—Prepared by heating in an iron crucible a mixture of exsiccated Potassium Ferrocyanide 8 parts and Potassium Carbon- ate 3 parts until effervescence ceases. Description and Properties.—White, opaque, amorphous pieces, or a white, granular powder, odorless when perfectly dry, but in moist air exhaling the odor of hydrocyanic acid. The taste is sharp and somewhat alkaline, but should be ascertained with great care, as the salt is very poisonous. In moist air it deliquesces; soluble in about 2 parts of water and sparingly soluble in alcohol. Potassium cyanide should be kept in well-stoppered bottles. Dose.—^-1 grain (0.004-0.008 Gm.). Cyanide of potassium differs from hydrocyanic acid, with which it generally assimilates, in being less rapid in its action, producing dermatitis or eczematous eruption by local application to the epi- dermis, and in its possibly fatal results from free contact with abraded surfaces. The therapeutic uses are practically those of hydrocyanic acid. Amyl NItris—Amyl Nitrltis—Amyl Nitrite. U.S. P. Origin.—Obtained by the action of Nitric Acid upon Amylic Alcohol—a liquid containing about 80 per cent, of amyl (princi- pally iso-amyl) nitrite, together with variable quantities of unde- termined compounds. Description and Properties.—A clear yellow or pale-yellow liquid, of a peculiar, ethereal, fruity odor and a pungent, aromatic taste. Almost insoluble in water; miscible in all proportions with alcohol or ether. In alcoholic solution it gradually decomposes, with formation of ethyl nitrite and amylic alcohol. It should be kept in small, dark-colored, glass-stoppered bottles, in a cool and dark place, remote from lights and fire. Dose.—l-i minim (0.03-0.06 Cc.) internally ; for inhalation 1-5 minims (0.06-0.3 Cc). Antagonists and Incompatibles.—The motor excitants antago- nize the action of amyl nitrite. Synergists.—The motor depressants. Physiological Action.—Externally and Locally.—Its action is that of a mild irritant when applied to the skin. Internally.—The following actions apply to ingestion or inhala- tion of the drug. 526 .-/ TEXT-BOOK OF MATERIA MEDICA. Digestive System.—No important action has been observed. Circulatory System.—Almost immediately after inhalation of amyl nitrite there is a marked flushing of the skin, first perceptible in the face, doubtless occasioned by dilatation of the capillaries. The heart's action is increased and somewhat weakened, and the pulse is soft and compressible. The blood-pressure falls very markedly, the condition being caused by a paralyzing action upon the muscle-fibers found in the walls of the small arterioles, causing marked dilatation. The same cause accounts for the change in the action of the heart, due to diminution of peripheral resistance Amyl nitrite has no central action. The inhalation of large amounts renders the heart very weak, toxic doses arresting that organ in diastole. The functional activ- ity of the hemoglobin is checked, giving to the arterial and venous blood a dark chocolate color. Nervous System.—Among the effects are cerebral oppression, flushing of the head and face, vertigo, headache, and confusion of ideas, with diminished reflex excitability, muscular weakness, and unsteadiness of gait, both the voluntary and involuntary muscles being relaxed. These actions are due to the depressing influence of the drug upon the motor areas of the brain and spinal cord. Respiratory System.—Small doses quicken the respiration by- lowering arterial pressure and possibly by moderate stimulation of the center, due to accumulation of carbon dioxide. Immoderate or toxic amounts render the breathing slow and labored from depression of the respiratory center and arrest of the corpuscular action of the blood. Absorption and Elimination.—Amyl nitrite is rapidly absorbed, being eliminated chiefly by the kidneys, increasing the amount of urine, uric acid, and urea excreted. Sugar may frequently be de- tected in the urine, probably resulting from the action of the drug in dilating the hepatic vessels and increasing the circulation in the liver. Temperature.—Bodily heat is reduced both in health and in fever, due to dilatation of the peripheral blood-vessels and a reduc- tion of the oxygen-carrying power of the red blood-corpuscles. Eye.—There is marked dilatation of the retinal vessels and hyperemia of the papilla, producing chromatopsia of the parti- colored variety and hallucinations of vision. These effects are usually transitory, and disappear with the elimination of the drug. Uterus.—The uterine muscle is relaxed. MOTOR DEPRESSANTS. 527 Untozvard Action.—In addition to the symptoms described under <( Poisoning," there have been noted gastric disturbance, nausea and vomiting, dryness of the mouth and trembling of the lips, irritation of the throat, defective vision, and subjective sensations of color, usually yellow vision. Poisoning.—The toxic effects of amyl nitrite include an exceed- ingly rapid and weak heart, final retardation of the pulse, cyanosis of the face, slow and shallow respiration, cold extremities, subnor- mal temperature, great muscular weakness, abolished reflexes, vertigo, intense headache, and disordered vision. Death results from cardiac or respiratory failure. Treatment of Poisoning.—Strychnine and digitalis are required to sustain the heart; ergotin or atropine may be administered sub- cutaneously, together with cold applications to the head, diffusible stimulants, and artificial respiration if necessary. Sodii NItris—Sodii Nitrltis—Sodium Nitrite. U. s. P. Origin.—Obtained by heating Sodium Nitrate with Lead, the oxygen from the nitrate being abstracted by the lead oxide formed. Description and Properties.—White, opaque, fused masses, usually in the form of pencils, or colorless, transparent, hexagonal crystals; odorless, and of a mild, saline taste. When exposed to the air the salt deliquesces and is gradually oxidized to sodium nitrate. Soluble in about 1.5 parts of water; slightly soluble in alcohol. It should be kept in well-stoppered bottles. Dose.—2-5 grains (0.12-0.3 Gm.). Spiritus GlonoTni—Spiritus Glonolni—Spirit of Glo- noin. U.S. P. (Spirit of Nitroglycerin.) An alcoholic solution of 1 per cent, of nitroglycerin. Origin.—Nitroglycerin is obtained by gradually adding Dehy- drated Glycerin to a mixture of Nitric and strong Sulphuric Acid, the nitroglycerin formed being washed with water and dilute soda solution to remove all acid. Description and Properties.—Nitroglycerin occurs as a clear, colorless liquid possessing the odor and taste of alcohol. It should be tasted and handled with great caution, since it is apt to produce violent headache, whether ingested or applied to the skin. It explodes with great force, and should be kept in a cool place, -remote from lights or fire. 528 .-/ TENT-BOOK OF MATERIA MEDICA. Dose.—1-3 minims (0.06-0.18 Cc.) of the spirit. The actions of sodium nitrite and nitroglycerin are very similar to those of amyl nitrite, although the)' are less prompt, while more persistent. Nitroglycerin produces a frontal headache of much greater intensity than that caused by amyl nitrite. This is also true of sodium nitrite, though the headache it occasions is less severe than that resulting from nitroglycerin. Both the sodium nitrite and nitroglycerin are preferable to the amyl nitrite for internal administration. Therapeutics.—Externally and Locally.—The nitrites are not used for external purposes. Internally.—The property of amyl nitrite in suddenly lowering arterial pressure and dilating the arterioles renders it of inestima- ble value as a relief for the terrible precordial pain in angina pectoris. Epileptic seizures may often be aborted by the instant inhalation of amyl nitrite upon the first indication of the aura epileptica. The drug has also been successfully employed for the relief of asthma, particularly the uremic form, as well as for cardiac dyspnea and puerperal eclampsia. Like many other motor depressants, it has been used in the treatment of tetanus and strychnine-poisoning. It has proved an efficient preventive for the chill occurring in virulent malarial fiver, and has served as a valuable antidote in poisoning from chloroform. The drug is indicated in all conditions of high arterial tension, as in chronic nephritis, etc. It is also beneficial in congestive dys- menorrhea. The sodium nitrite is used for the same purposes as the amyl nitrite, though superior to it for internal administration, as in cases of abnormally high arterial tension. Nitroglycerin is specially adapted for the treatment of cardi- opathies occurring after middle life. The tendency to increase of peripheral resistance in the vessels after adult life is attained renders possible the favorable administration of doses of nitroglycerin intol- erable in early life. The drug is often of marked benefit in the arrhythmia of slightly enlarged and degenerated hearts with arteriosclerosis. It is also of considerable value in relieving the pseudo-anginas which are frequently a feature of vascular disease. It should be given in doses of giro to tut grain (0.00032-0.0006 Gm.) twice or four times daily. MOTOR DEPRESSANTS. 529 Osier recommends the prolonged administration of nitroglycerin in locomotor ataxia, affirming that it lessens the frequency of the crises and relieves the neuralgic pains. The drug is of use in sciatica, and frequently relieves obstinate hiccough. It has been recommended for the same diseases for which amyl nitrite is used. BROMIDES. Potassii Bromidum—Potassii Bromidi—Potassium Bromide. U. S. P. Origin.—Prepared by adding Bromine to a solution of Potassa, evaporating to dryness, mixing with Charcoal, heating to redness, dissolving in Water, and crystallizing. Description and Properties.—Colorless or white, cubical crys- tals or granules, odorless, with a pungent, saline taste; permanent in air; soluble in about 1.6 parts of water and in 200 parts of alcohol. Dose.—5-60 grains (0.3-4.0 Gm.). Sodii Bromidum—Sodii Bromidi—Sodium Bromide. U. S. P. Origin.—Obtained from a solution of Soda in the same manner as Potassium Bromide. Description and Properties.—Colorless or white, cubical crys- tals, or a white, granular powder, odorless, and with a saline, slightly bitter taste. From air the salt abstracts moisture without deliquescing. Soluble in 1.2 parts of water and in 13 parts of alcohol. It should be kept in well-stoppered bottles. Dose.—10-60 grains (0.6-4.0 Gm.). Ammonii Bromidum—Ammonii Bromidi—Ammo- nium Bromide. U. S. P. Origin.—Obtained by neutralizing Hydrobromic Acid with Ammonia or Ammonium Carbonate, evaporating, and crystallizing. Description and Properties.—Colorless, transparent, prismatic crystals, or a white, crystalline powder, odorless, and of a pungent, saline taste; permanent in the air. Soluble in 1.5 parts of water and in 30 parts of alcohol. Dose.—5-30 grains (0.3-2.0 Gm.). 34 53° A TEXT-BOOK OF MATERIA MEDICA Lithii Bromidum—Lithii Bromidi—Lithium Bromide. U. S. P. Origin.—Prepared by a solution of Ferrous Bromide and Lithium Carbonate, the cool liquid being evaporated and crystallized. Description and Properties.—A white, granular salt, odorless, and having a sharp, slightly bitter taste ; very deliquescent. Solu- ble in 0.6 part of water and very soluble in alcohol. It should be kept in well-stoppered bottles. Dose.—5-20 grains (0.3-1.2 Gm.). Calcii Bromidum—Calcii Bromidi—Calcium Bro- mide. U. S. P. Origin.—Prepared by dissolving pure Calcium Carbonate in Hydrobromic Acid and evaporating. Description and Properties.—A white, granular salt, odorless, of a sharp, saline taste and very deliquescent. Soluble in 0.7 part of water and in I part of alcohol. It should be kept in well- stoppered bottles. Dose.—10-30 grains (0.6-2.0 Gm.). Zinci Bromidum—Zinci Bromidi—Zinc Bromide. U. S. P. Origin.—Prepared by digesting Granulated Zinc in Hydrobromic Acid, concentrating the solution, acidulating with Hydrobromic Acid, and drying upon a water-bath. Description and Properties.—A white, granular powder, odor- less, and having a sharp, saline, and metallic taste. Very deliques- cent. Readily soluble in water and alcohol. Dose.—1-5 grains (0.06-0.3 Gm.). Strontii Bromidum—Strontii Bromidi—Strontium Bromide. U. S. P. Origin.—Obtained by neutralizing Hydrobromic Acid with Strontium Carbonate, filtration, and evaporation. Description and Properties.—Colorless, transparent, hexagonal crystals, odorless, and having a bitter, saline taste. Very deliques- cent. Soluble in 1.05 parts of water and readily soluble in alcohol. Dose.— 5-30 grains (0.3-2.0 Gm.). MOTOR DEPRESSANTS. 531 Acidum Hydrobromicum Dilutum—Acidi Hydro- bromici Diluti — Diluted Hydrobromic Acid. U. S. P. Origin.—A liquid composed of 10 per cent, by weight of Abso- lute Hydrobromic Acid and 90 per cent, of Water. Description and Properties.—A clear, colorless liquid, odor- less, and having a strongly acid taste. Miscible in all proportions with water and alcohol. It should be kept in glass-stoppered bottles, protected from light. Dose.—20 minims-2 fluidrachms (1.23-7.39 Cc). Bromoformum—Bromoformi—Bromoform (Unofficial). Origin.—Obtained by the action of Bromine upon equal parts of Methylic Alcohol and Caustic Potash. Description and Properties.—A colorless, limpid liquid with an agreeable odor and sweet taste. Insoluble in water, but soluble in alcohol and ether. It should be kept in well-stoppered, dark, amber-colored bottles. Dose.—1-5 minims (0.06-0.3 Cc). Antagonists and Incompatibles.—The bromides are antago- nized by the motor excitants and cardiac stimulants. The incom- patibles are acids, acidulous and metallic salts. Spirit of nitrous ether is incompatible with the ammonium bromide. Synergists.—Their action upon the brain is enhanced by opium and the hypnotics, while the cardiac depressants increase their effect upon the circulatory system. Physiological Action.—The action of potassium bromide is here given, that being the type of the group: later the comparative actions of the various members will be considered. Externally and Locally.—Potassium bromide is slightly seda- tive to mucous membranes when applied locally, lessening the reflex irritability, particularly of the pharynx. Internally.—Digestive System.—No effect is produced by mod- erate amounts. Excessive doses have occasioned a sense of cold- ness in the epigastrium, with nausea and looseness of the bowels. Circulatory System.—The bromides depress the circulation, causing the pulse to become slower, softer, and weaker, and short- ening the systole while prolonging the diastole of the heart. The caliber of the vessels is diminished, although arterial pressure is 532 1 TEXT-BOOK OF MATERIA MEDICA. lowered. Arterial anemia of the brain is present, owing to the contraction of the blood-vessels and diminished arterial pressure. Toxic doses of potassium bromide cause dilatation of the heart and paralysis in diastole. The exact points where the bromides act to cause this circula- tory depression are undetermined. Nervous System.—When given for a long time or under large dosage the bromides depress the cerebral cells, producing somno- lence, reducing the excitability of the brain, and, if long continued, impairing the memory and intellect. Under their influence there is marked depression of the motor mechanism, resulting in muscular weakness. Every possible point of the apparatus is depressed—the cerebral and spinal motor areas, the spinal motor tracts, the ends of the motor nerves, and even the muscles themselves. Bromides also lessen greatly the reflex excitability of the spinal cord. As in their action upon the motor mechanism, they depress every part of the reflex apparatus—the ends of the afferent and efferent nerves and the reflex center wherever it may be. The sensory mechanism is therefore impaired, causing dimin- ished sensibility of the skin and mucous membranes. The functional activity of the sexual organs is considerably less- ened by these drugs. Respiratory System.—Under full doses the respirations are slower and shallower, owing to depression of the respiratory center, paralysis of which usually causes death, although fatal paralysis may affect the heart because of the poisonous influence of the potassium upon the cardiac muscle. Absorption and Elimination.—The bromides are very rapidly absorbed, having been found in the urine ten minutes after their ingestion (Dujardin-Beaumetz), and are quickly eliminated, chiefly by the kidneys, increasing the flow of urine, and also by the skin, saliva, intestinal and mammary glands, and the bronchial mucous membrane. The sulphur and nitrogen in the urine are increased and the amount of phosphorus decreased. Notwithstanding the rapid elimination of the bromides, under prolonged administration they tend to accumulate in the system, being found abundantly in the nerve-centers. Temperature.—Immoderate doses cause a reduction of temper- ature, due to depression of the circulation and lessening of tissue- change. MOTOR DEPRESSANTS. 533 Eye.—There may occur dilatation of the pupil, conjunctival catarrh, diplopia, amblyopia, dimness of vision, and dilatation of the retinal blood-vessels. Uterus.—A diminution of the catamenia may sometimes be present. Untozvard Action.—The susceptibility of individuals to the un- toward action of the bromides is extremely variable. The symp- toms observed are—gastric uneasiness with eructation, nausea and vomiting, analgesia of the epiglottis and pharynx, bronchial catarrh, hoarseness and cough, acute coryza and conjunctivitis, offensive breath, dysuria, diminished sensibility of the genito-urinary mucous membrane, and a variety of cutaneous eruptions. Poisoning.—Bromism, as, the symptoms of poisoning are termed, may be divided into acute and chronic. Acute bromism, resulting from a single toxic dose, is manifested by violent frontal headache, great muscular weakness, incoordi- nation of movements, abolition of reflexes, somnolence, slow and shallow breathing, subnormal temperature, lustreless eyes, and very slow and weak pulse, death resulting from either respiratory or cardiac failure. Chronic bromism, caused by prolonged use of the bromides, is characterized by mental apathy, constant drowsiness, hallucination or melancholia, considerable cutaneous anesthesia, muscular weak- ness, poor circulation, cold extremities, marked anemia, impairment of the sexual function, deranged digestion, and cutaneous eruptions of various forms collectively designated as " bromine acne." Treatment of Poisoning. — The drug should be immediately withdrawn and methods adopted to hasten elimination, such as the administration of diuretics, cathartics, etc. Tonics, such as strych- nine, iron, and the cardiac stimulants, should be given, while exer- cise and change of scene may counteract the psychical symptoms. It is claimed that the daily administration of Fowler's solution causes a rapid disappearance of the bromine eruption. Comparative Action of the Bromides.—Potassium bromide contains 66 per cent, of bromine. It is the least hypnotic and most toxic to the heart and muscular system. Sodium bromide, yS per cent, of bromine, is more hypnotic, but much less toxic, than the potassium salt. Its effect upon the cir- culation is the most pronounced of all the bromides. Ammonium bromide is less toxic and more stimulating than potassium bromide, though resembling it in other respects. 534 A TEXT-BOOK OF MA TERIA MEDICA. Lithium bromide is the richest in bromine, containing 92 per cent., and is probably the most hypnotic of all. Its action more nearly resembles that of the sodium salt. Calcium bromide, while resembling them in its action, is less energetic than the other bromides. Zinc bromide is the most irritant, and is supposed to possess both tonic and sedative properties. Strontium bromide is the mildest of all, being less prone to cause bromism. Diluted hydrobromic acid in its action resembles the bro- mides, though much less depressant than the potassium salt, and less likely to occasion symptoms of chronic poisoning. Therapeutics.—Externally and Locally.—Pharyngitis is relieved by a gargle containing potassium bromide and potassium chlorate. A solution of potassium bromide diminishes the sensibility of the throat, so that examinations are more easily made. A solution of 4 parts of potassium bromide in 20 parts of glycerin affords a soothing lotion in painful hemorrhoids. It is asserted that the powdered salt has been dusted over indolent ulcers with benefit. Internally.—The bromides are especially useful in allaying excessive brain activity, the insomnia (particularly the sleeplessness de- pendent upon nervous excitement, exhaus- tion, and irritability) and headache of cerebral congestion yielding readily to these remedies. They are undoubtedly the most efficient medicinal agents for the relief of epilepsy, being given either alone or in combination with some vegetable bitter. Fere combines with them an intestinal antiseptic, asserting that the union lessens the tendency to bro- mism. Bechterew highly recommends a com- bination of the bromides with Adonis vernalis. Being such marked depressants of the reflex centers, they are of decided benefit in nervous spasmodic disorders, and particu- larly valuable in infantile convulsions. During dentition children suffer from various disturbances due to irritation of the dental nerve—convulsions, cough, indigestion, diarrhea, strabismus, etc.—in all of which the bromides, being Fig. 11. — Diagram showing how irritation of the dental nerve in teething, by stimulating the sensitive reflex mechanism of the infant, may produce strabismus (B), cough (D, K), indigestion (L), diarrhea (M), and convul- sions (N). MOTOR DEPRESSANTS. 535 powerful depressants of the reflex mechanism, prove of great value. (See Diagram 11.) Whenever there is increased reflex excitability the bromides are indicated. They are therefore valuable in the reflex disturbances of the menopause, spasmodic asthma, laryngismus stridulus, whooping cough, and other coughs of reflex origin. They have also been used in tetanus and strychnine-poisoning. Excessive nervous irritability is quickly relieved by these reme- dies, either singly or in combination with some of the antispas- modics, such as asafetida, valerian, etc. Because they depress the sexual mechanism they are of decided benefit in spermatorrhea of the plethoric or in the condition arising from irritation of the deep urethra. Menorrhagia resulting from excessive ovarian excitement is frequently relieved by these agents, while nymphomania and delirium tremens are often greatly benefited by full doses of the bromides. The ammonium bromide has been employed with benefit, it is said, in diabetes of nervous origin. Cerebral vomiting and the vomiting of pregnancy axe sometimes singularly amenable to the influence of the bromides. The author is quite partial to a combination of sodium bromide, spirit of nitrous ether, and tincture of aconite, in anise water, as a remedy in acute febrile attacks of children with delirium. Small doses are given at frequent intervals until there is a decided im- provement in the symptoms. The bromides are claimed to be of value in acute and muscular rheumatism. The lithium salt is undoubtedly of service in these cases and in the uric-acid diathesis' The sedative action upon the circulatory apparatus exerted by the bromides renders them valuable in cardiac irritability when not due to anemia. They are particularly useful in quieting the heart's action in exophthalmic goiter. Augagneur advises the use of the bromides together with the iodides in the treatment of syphilis, believing that their administra- tion prevents such untoward manifestations as dysphonia, aphonia, or dyspnea in laryngeal syphilis. The strontium bromide is highly recommended \r\fermentative dyspepsia due to decomposition of food. Bromoform ranks to-day superior to all other remedies in the treatment of zvhooping cough, an overwhelming amount of authori- tative evidence tending to prove that the drug not only greatly 536 A TEXT-BOOK' OF MA TERIA MEDICA. curtails the duration of the disease, but mitigates the severity of the paroxysms and renders them less frequent. Bromoform has also been highly recommended in acute mania and delirium tremens. Diluted hydrobromic acid is used for the same purposes as the bromides, some clinicians preferring it to the latter to quiet the delirium of simple continued fevers. It is employed extensively to relieve the symptoms of cinchonism. Contraindications.—The bromides are contraindicated in con- ditions of great debility, anemia, or fatty or weak heart with low arterial pressure. Administration.—The bromides should be given in solution, and when long continued, as in the treatment of epilepsy, they should be accompanied by restorative agents. Carbonated waters, milk, and aromatic elixir serve as efficient vehicles to disguise the taste of these salts. Children acquire a remarkable tolerance for the bromides, so that large doses may be given them with but little danger. Bromoform may be dropped into a spoonful of water and ad- ministered in this simple manner, or it may be dissolved in gly- cerin. P. W. Bedford has originated a formula which makes an exceedingly palatable and perfect solution : Bromoformi, Hlxvj (i.o Cc); Alcoholis, Tincturae Cardamomi Compositae, da. f 3ij (7.39 Cc.); Glycerini, q. s. ad. sij (60.0 Cc). Each fluidrachm contains 1 minim (0.06 Cc.) of bromoform. The diluted hydrobromic acid should be given in water or syrup. GROUP VIII.—CARDIAC STIMULANTS.1 Cardiac remedies may be divided into Cardiac Tonics, Cardiac Stimulants, and Cardiac Sedatives or Depressants. The grouping is a rational one, both from a clinical and a physiological point of view, although the Cardiac Sedatives are at present much more 1 The author is indebted to Joseph M. Patton, M. D., Professor of Medicine in the Chicago Policlinic, for valuable assistance in preparing the present group, his observa- tions on therapeutics being occasionally cited verbatim. CARDIAC STIMULANTS. 537 limited in their clinical application than they were a few years ago, being used principally in sthenic fevers with excessive cardiac action. Cardiac Tonics.—By these are implied those drugs which add tone to the cardiac muscle and the nervous mechanism of the heart, increasing the nutrition of that muscle, and consequently augment- ing its capacity for work. The cardiac tonics have little or no effect upon the dynamic force exerted through the contraction of the heart-muscle, herein lying their essential distinction from cardiac stimulants, which affect per sc the muscular contractile force. The proper period for the employment of cardiac tonics antici- pates that where the exhibition of cardiac stimulants becomes neces- sary. They are, moreover, prophylactic against the latter contin- gency, preventing the development of a hyposystolic condition of the heart. They are also indicated subsequent to the temporal)' use of cardiac stimulants to improve the nutrition of the heart and maintain the beneficial results of stimulation. Cardiac tonics should be given in small doses and the adminis- tration prolonged. The principal members of the group are—strychnine, the iodidks, arsenic, and iron, to which should be added mercury in small doses. The most useful are strychnine and the iodides, and they are well adapted for combined administration. Since most cases requiring the exhibition of this class of remedies occur after middle life, they are especially benefited by the action of strychnine on the cardiac nervous system and the increased nutrition to the heart-muscle through the effect of the iodides on the smaller vessels. The progressive tendency of after- lifetime toward loss of elasticity and a contraction of the smaller arteries is opposed by the action of the iodides in dilating these vessels. The advantage of prolonged administration of mercury in small doses in chronic cardiopathies during or after middle life is probably due to the stimulating effect of the drug on the func- tions of elimination. Mercury is adapted to nearly all senile cardiopathies, particu- larly in conditions of general vascular sclerosis, the most desirable form being the bichloride or red iodide in doses of A~ grain (0.001 Gm.) three times daily. Arsenic may be used in the form of the arsenic iodide or as 538 .-/ TENT-BOOK OF MA TERIA MEDICA. Fowler's solution. It is of special value in anemic conditions associated with cardiopathies in young persons. The most eligible form of iron for cardiac patients, especially after middle life, when elimination is an important consideration, is the liq. ferri et ammonii acetatis (Basham's mixture), or the so-called tasteless tincture of iron, with which the tincture of nux vomica may be well combined. The physiological action and further medical uses of these cardiac tonics are more fully described under their respective heads. Cardiac Stimulants.—As cardiac stimulants are designated those drugs endued with the specific property of lengthening and invigorating the contraction of the cardiac muscle. This effect would necessarily be more or less temporary, and, while some permanent benefit may be derived from improved nutrition result- ing from a better blood-supply afforded by these agents, they are adapted only for passing administration and are not true cardiac tonics. The general indication for the employment of this class of remedies rests in the presence of dynamic insufficiency of the muscle, which may be either actual or relative, as is the case of increased peripheral resistance to the blood-current. In the latter instance it is evident that the extracardiac obstruction must be removed before the salutary effects of cardiac stimulants can be obtained. It is in actual failure of the contractile force of the cardiac muscle that these stimulants display their most beneficial influence. This failure is due to a greater quantity of blood in the cavity than the muscle is able to cope with. The amount of dynamic force required at each contraction to expel this quantity is so great that the muscle is unable to withstand the pressure without stretching, and consequently dilatation is developed. Here the favorable action of cardiac stimulants is manifest, since by stimulating the muscle to more vigorous contraction the equilibrium of the circu- lation is maintained until compensatory increase in muscular power has had time to develop. The principal cardiac stimulants are—Digitalis, Strophan- tus, Caffeine, Alcohol, Ammonia, Spartein, Cactus grandi- flora, Adonis vernalis, and Convallaria, all fully described under their respective heads. In addition to these, strychnine, opium, and nitroglycerin are CARDIAC STIMULANTS. 539 sometimes used as cardiac stimulants. They are fully described under their respective heads. Digitalis is the typical medicament of the group, after many years still retaining its place as the most trustworthy and generally useful cardiac stimulant. Digitalis—Digitalis—Digitalis. U. S. P. ( FOX-GLOVE.) Origin.—The leaves of Digitalis purpurea L., collected from plants of the second year's growth. The plant is a biennial, 2-5 feet (0.6-1.5 M.) high, indigenous in Southern and Central Europe, and growing wild as far north as Norway. It is also found in Madeira and the Azores, and is well known everywhere as an ornamental garden plant. Description and Properties.—From 4 to 12 inches (10-30 Cm.) long, ovate or ovate-oblong, narrowed, with a petiole, crenate, dull green, densely and finely pubescent, wrinkled above, paler and reticulate beneath, midrib broad near the base; odor slight, some- what tea-like; taste bitter, nauseous. The leaves of mullein, Inula coryza and Inula hclcnium, are sometimes mixed with those of fox-glove. It is yet undecided what the chief constituents are. Five prin- ciples, however, have been isolated, neither of which represents the crude drug. They are—digitalin (soluble in alcohol, insoluble in water); digitalcin (soluble in water and alcohol); digitonin, the most active diuretic principle (soluble in water, insoluble in alcohol); digitin, an inert substance; and digitoxiu, the most active con- stituent (insoluble in water and sparingly soluble in alcohol). All save digitoxin are glucosids. Dose.—J-2 grains (0.03-0.12 Gm.). Official Preparations. Extractum Digitalis—Extracti Digitalis—Extract of Digitalis.—Dose, \-\ grain (0.01-0.03 Gm.). Extractum Digitalis Fluidum—Extracti Digitalis Fluidi—Fluid Extract of Digitalis.—Dose, )->-2 minims (0.03-0.12 Cc). Infusum Digitalis—Infusi Digitalis—Infusion of Digitalis [\]/2 per cent.).— Dose, 1-4 fluidrachms (3.7—15 Cc). Tinctura Digitalis—Tincturae Digitalis—Tincture of Digitalis (15 per cent.). —Dose, 5-20 minims (0.3-1.2 Cc). Unofficial Preparations. Digitalinum—Digitallni—Digitalin.—Description and Properties.—An amor- phous, yellowish-white, crystalline powder or scales, or light, white crystalline tufts of 540 A TEXT-BOOR- OF MATERIA MEDICA. needle-, odorless and of an intensely bitter taste. Insoluble in water, soluble in alcohol. /;(,.,Y._T£Tr_Ji5. grain (0.0006-0.002 Gm.). DigitSxin—Digit6xin—Digitoxin.—Description and Properties.—A white, crys- talline body, of a bitter taste ; insoluble in water, soluble in chloroform. Dose.—^-jl-g grain (0.0003-0.0006 Gm.). Antagonists and Incompatibles.—The most complete antag- onist is saponine, the active constituent of Saponaria officinalis. The cardiac depressants antagonize the action of digitalis upon the heart, morphine and the emetics possessing a similar property, though in less degree. The incompatibles are the ferric chloride and sulphate, prepara- tions of cinchona, tannic acid and preparations containing it, and the subacetate and acetate of lead. Synergists.—The cardiac action of digitalis is aided by other members of the group (cardiac stimulants), and also by belladonna and ergot. Physiological Action.—Externally and Locally.—Digitalis pos- sesses mild sedative properties when locally applied, and is readily absorbed by the skin. Internally.—Digestive System.—Small doses ordinarily produce no effect upon the stomach. Large doses act as a gastro-intestinal irritant, exciting nausea, vomiting, and diarrhea. These effects may follow the prolonged administration even of small doses. Circulatory System.—The principal effects of digitalis are upon the circulatory apparatus, the action of the drug varying according to the size of the dose. Medicinal doses cause the pulse to beat stronger, firmer, and slower, the strength of the beat being due to stimulation of the cardiac ganglia and the muscular fibers them- selves. Arterial pressure is raised through stimulation of the vaso- motor center in the medulla and the ganglia situated in the mus- cular coats of the blood-vessels, causing a contraction both of the arteries and arterioles. This increase of arterial tension gives firmness to the pulse-beat: its slowness is due to lessened frequency in the heart-beat, caused by stimulation of both the roots and ends of the cardiac vagus, and consequent lengthening of the diastolic period. Large doses may cause the pulse to beat faster and still increase arterial pressure. The rapid cardiac action is due to over-stimula- tion of the pneumogastric nerve and consequent exhaustion. The inhibition being removed and the heart acting under the influence CARD I A C S TIM PLANTS. 541 of the sympathetic nerves, its beats are more frequent. The arterial tension is still high, because the mechanism presiding over the caliber of the arterioles is not so easily over-stimulated as the vagus, and contracts still more, which, with the increased action of the heart, tends to increase arterial tension. Toxic doses render the pulse very rapid, irregular, soft, and weak. The irregular action of the heart is due to exhaustion of the motor ganglia in the heart-muscle from over-stimulation, one of the functions of these ganglia being to induce regular cardiac contraction. The pulse is soft because of lowered arterial pressure, the arterioles under these doses being dilated from exhaustion of the vaso-motor mechanism. The weak pulse is due to exhaustion of the muscular power of the heart from over-stimulation. Death usually occurs with stoppage of the heart in diastole. Nervous System.—No effect is produced by medicinal doses. Immoderate doses, however, occasion headache and vertigo, to- gether with lessened reflex activity—by stimulating Setchenow's inhibitory center and depressing the motor nerves. The muscles themselves may be paralyzed, the sensory nerves being unaffected. Respiratory System.—Medicinal doses have no effect upon the system; toxic doses slow the respiration. Absorption and Elimination.—Digitalis is rapidly absorbed and slowly eliminated, probably by the kidneys, under certain conditions increasing the urinary flow, and many authorities claim the amount of solids excreted is augmented, except urea and uric acid, which are diminished. Its diuretic action is due to the increase of blood-pressure in the glomeruli of the kidneys, being therefore more pronounced in conditions of low arterial pressure. Very large doses, instead of increasing the amount of urine, may diminish or even wholly suppress it. The action of digitalis upon the kidneys is elucidated by the diagram (Fig. 12). It is claimed that two constituents of digitalis, digitoxin and digitalein, dilate the renal arteries, while digitalin has no effect; upon the renal blood-vessels, but contracts those of the general system. The true action of digitalis, however, is as yet undetermined. It is an extremely complex drug, and its various constituents pos- 542 A TEXT-BOOK OF MATERIA MEDICA. sess different properties when therapeutically employed. It is obvious, therefore, that the action upon the heart and kidneys will depend largely upon the particular preparation administered. Temperature.—Medicinal amounts have no appreciable effect Fig. 12.—A, heart; B, veins; C, efferent vessels; D, artery; E, capillary system; F, afferent vessels ; G, kidney ; H, glomerules of the kidney. upon the temperature; large doses cause a reduction of bodily heat in febrile conditions, while toxic doses reduce temperature even in health. The action of digitalis upon the circulatory system is retarded by high temperature. Eye.—Medicinal amounts have no effect. Large or poisonous doses may cause dimness of vision, amblyopia, diplopia, or mydri- asis. In a case of poisoning by digitalis recorded by Jeanton there was xanthopsia for two days. Uterus.—Large doses stimulate contraction in the uterine muscles. Untoward Action.—Erysipelatous and papular eruptions have been produced by the drug, there having been also observed nausea and a feeling of weakness in the stomach, dimness of vision, headache, heaviness of the head, sleeplessness, and debility. Poisoning.—Toxic symptoms may occur either from the inges- tion of a single poisonous dose or the accumulation of the drug under prolonged administration. There are marked disturbances of the gastro-intestinal tract, abdominal pains, vomiting and purging, a rapid, irregular, and compressible pulse—often imper- ceptible at the wrist—and syncope, more frequently occurring when the patient is raised up. Other symptoms are—feeble respiration, dilated pupils and occasionally double vision, headache, delirium and stupor, and CARDIAC STIMULANTS. 543 possibly convulsions just before death, which occurs from cardiac failure. Digitalis is not a rapid poison, the fatal collapse being usually deferred from ten to forty-eight hours. Treatment of Poisoning.—Lavage of the stomach should be immediate, emetics being too depressing if the heart is already affected by the poison. A solution of tannic acid should be intro- duced into the stomach as the best chemical antidote. Diffusible stimulants may be required, the horizontal position should be maintained, and external heat applied, particularly to the abdomen. Saponin, aconite, and opium are physiological antidotes, and one or more of them should be employed. Therapeutics.—Externally and Locally.—Poultices made of digitalis leaves have been employed with some success in acute inflammation of the joints, and when applied over the loins act as an efficient sedative and diuretic in congestion of the kidneys. Internally.—Digitalis is one of the most important drugs known to medicine. The remedy is indicated in deranged conditions of the circulatory system itself, and, moreover, where, although the cir- culatory mechanism be normal, an abnormal state of other organs may be improved by changing the circulation in them. Digitalis is indicated in any case where there is actual failure in the dynamic power of the heart-muscle, irrespective of the nature of any primary valvular lesion inducing the hyposystolic condition. Of course the rational use of the drug presupposes the absence of extensive fatty degeneration or interstitial myocarditis, since, should these conditions be advanced, there is danger of producing permanent asystole. It is difficult to estimate the integrity of the heart-muscle, and many cases presumably intolerant of the drug bear digitalis well. There has been considerable objection to the use of digitalis in cardiac ataxia resulting from aortic regurgitation, on the ground that the latter action is more forcible and extensive under its influence. This argument is generally advanced by those who believe that the dilatation of the left ventricle in aortic regurgitation is due mainly to the effect of the counter-current upon the relaxed ventricle while in diastole. The regurgitant stream has probably little or no influence in producing the dilatation, since the cubic area of the ventricular cavity covered by the stream is so much greater than that of its inlet that it is difficult to see how great pressure could be exerted in this way. The phenomenon is, rather, A TEXT-BOOK OF MATERIA MEDICA. mainly due to the greater pressure necessary to empty the ventricle of its superfluous blood. That there is any marked increase in the amount of regurgi- tated blood through reduced action of the heart is not sustained by the clinical results of the administration of digitalis in cases of aortic regurgitation. Indeed, they respond to the use of the drug as promptly as any other lesion, save that it is at times necessary to o-ive larger doses, often twice the quantity administered in other valvular lesions. As to the cumulative effect of digitalis, so much feared by the older writers on its action, the evil may be ascribed to improperly selected cases or faulty administration. Under proper conditions the drug may be given for months without ill effect. It is asserted that the action of digitalis may be manifested for some time upon discontinuance of a brief dosage. With regard to the specific effect of the drug upon the heart- muscle this is not true, since the influence of the drug lasts but a icw days, indirectly, through the additional muscle-power devel- oped during a iew weeks' administration. During or after middle life, if the vascular tension be increased, and especially if there be any sclerosis of the vessels, the administration of digitalis should be combined with that of vaso-dilators, to prevent contraction of the vessels and consequent increase of peripheral resistance. Of these adjuncts, opium is generally the most useful, from 2 to 5 drops (0.1-0.3 Cc.) of the deodorized tincture or-gV to-jL-grain (0.003-0.005 Gm.) of morphine sulphate being given (Patton). In mitral regurgitation digitalis is an exceedingly efficient rem- edy. As shown in the diagram (Fig. 13), there is a deficiency of blood in the systemic arteries, and consequently an over-accumula- tion in the pulmonary vessels and systemic veins. Owing to this venous hyperemia, there is congestion of the lungs, stomach, liver, and the entire digestive tract, together with the attendant symp- toms—dyspnea, bronchitis, deranged digestion, constipation, edema, etc. Digitalis by improving the pumping power of the heart equalizes the circulation, fills the systemic arteries, and relieves the venous congestion with its accompanying symptoms. Digitalis is valueless in the presence of compensator)- hyper- trophy, but after dilatation occurs is wonderfully effective, the size of the heart being often perceptibly diminished by a proper admin- istration of the drug. CARDIAC STIMULANTS. 545 Digitalis may act indirectly as a tonic by improving the nutri- tion of the heart through the prolonged diastole and contraction of the cardiac muscle it occasions. The longer the period of dia- stole, the more time is allowed for the coronary arteries to fill and nourish the heart by the better blood-supply. The increased arte- rial tension produced by the drug causes the blood to be sent into the coronary arteries with greater force during the cardiac diastole. The forcible contraction of the heart occasioned by this drug expels the blood from the veins of the cardiac mus- cle, improved nutrition of the muscle resulting from this me- chanical action. The prolonged diastole pro- duced by digitalis allows the heart to rest, conserving its energy and rendering the drug of great value in many acute 5 diseases accompanied by ex- Fig. *3—Diagram showing how digitalis relieves the symptoms of mitral disease: i, right heart; 2 CCSSlVe Cardiac action. left heart; 3, lungs; 4, systemic arteries; 5, capil- In many valvular diseases Iar;es: r systemic veins; 7l liver; 8' intestin«: J 9, lymphatics. of the heart there is marked irregularity, an irritability in its action being often more serious than the mere leakage of blood. Digitalis by stimulating the vagus and motor ganglia reduces the irritative influence, causing the heart to beat more regularly. The drug is therefore of great service in exophthalmic goiter. In any condition of low arterial tension, whether resulting from hemorrhage, general debility, or whatever cause, digitalis by increas- ing the force of the heart and raising arterial pressure serves a useful purpose. In collapse from shock, poisoning, or cholera, where the great veins are dilated, it has proved an efficient agent. The functional activity of the various organs in anemia and other deranged conditions of the system may be improved by the administration of this remedy. The circulation being improved, there is increased absorption 35 546 A TEXT-BOOK OF MATERIA MEDICA of fluid from the tissues, as well as greater circulation of fresh intercellular fluid, favoring combustion and functional activity, while the waste products are more readily removed. This action renders digitalis valuable as a tonic. In the second stage of pneumonia it is of the greatest importance, being of use here to stimulate the contractile force of the cardiac muscle when the intraventricular pressure becomes stronger than the unaided muscle can resist, and dilatation is imminent if not already begun. The main indication for the drug is the increase in intensity of the second pulmonic sound. In congestion of the lungs during the course oi exhausting fevers, such as typhoid, and in the first stage of meningitis, bronchitis, cellu- litis, etc. before transudation takes place, it is considered by many physicians to be a valuable remedy in relieving the venous stasis. Digitalis is singularly beneficial in scarlet fever to slow the heart and by its action upon the kidneys prevent renal com- plications. Mr. Jones was among the first to recommend large doses of digitalis in delirium tremens. The author has found it to be won- derfully effective in this condition, particularly where there is low arterial pressure, at the same time having observed that smaller or stimulant doses are more beneficial than the larger ones suggested by Jones. The drug is undoubtedly less serviceable in delirium tremens characterized by high arterial tension. Digitalis has been successfully employed in acute mania and epilepsy, Gowers recommending it in the latter disease as an adju- vant to the bromides, associated with belladonna. It is fair to state that in maniacal conditions the preponderance of testimony is in favor of large doses—\ to 4 fluidrachms (1.8-15. Cc.) of the tincture. Through its action in contracting the caliber of the arterioles digitalis serves as a valuable hemostatic in hemoptysis, epistaxis, menorrhagia, etc. The drug is thought to enhance the influence of ergot in post- partum hemorrhage, and when associated with iron it is of value in purpura hcemorrhagica. According to Harold Henry, digitalis and strychnine have proved beneficial in the diarrhea complicating remittent fever. The drug, combined with ergot or potassium bromide according to the indications, has been successfully employed in spermatorrhea and nocturnal emissions. CARDIAC STIMULANTS. ^47 It is said that absorption of pleuritic effusion is hastened by the continued administration of digitalis. Clifford Allbutt recommends it in sufficient doses to reduce the pulse to 45 or 50 in aneurysm. This method of treatment, how- ever, has not been widely adopted. Digitalis is one of the best antidotes to aconite- and muscariue- poisoning. The remedy is invaluable as a diuretic to relieve cardiac or renal dropsy, its efficiency being more apparent in the former variety, although acute renal dropsy usually yields to its influence. Should the renal structure be impaired, the drug is less serviceable, al- though, when combined with other appropriate remedies, it is decidedly beneficial in chronic Bright's disease with cardiac dilata- tion. In the early stages of the malady, accompanied by cardiac hypertrophy and high arterial tension, it is doubtful whether digitalis is indicated, either alone or in combination. In conclusion, it should be stated that digitalis is recommended by all authors in every valvular disease of the heart, with the pos- sible exception of aortic regurgitation, some writers supposing it to be harmful in this condition because of the prolonged diastole it occasions. The author's experience leads him to differ with those who con- sider aortic insufficiency a contraindication to the use of this important drug. The excellent and logical reasons advanced by Professor Patton for the use of the remedy in aortic regurgitation coincide entirely with the author's views. Contraindications.—Digitalis should not be given when there is marked degeneration of the heart-muscle or of the arterial walls. In simple hypertrophy, apoplexy, high arterial pressure, or vascular excitement the use of the drug is inadvisable. Many physicians regard aneurysm as a contraindication to the use of digitalis. Administration.—Any of the official preparations may be given, or the powdered leaves in pills or capsules—not at too frequent intervals, however, from four to eight hours elapsing between the doses, lest the drug accumulate in the system, producing poisonous symptoms. When digitalis has been administered for some time to a patient suffering from ascites, and the fluid is removed by paracentesis, poisoning may ensue. It is well, therefore, to discontinue the remedy for two or three days before tapping the patient. 548 A TEXT-BOOK OF MA TERIA MEDICA. The rapidity of the drug's action upon the heart depends upon the presence or absence of a febrile state. The stimulant action upon the heart is usually observable in from twenty-four to thirtv- six hours. The effects of the drug commonly continue from three to seven days after its discontinuance. The powdered digitalis, though the most irritant to the stom- ach, fully represents the drug, which is true of none of the prepa- rations. Of the active constituents, digitalin is usually preferred, notwith- standing its uncertain action. The infusion of digitalis, being an aqueous preparation and con- taining, therefore, a larger proportion of digatonin, is superior for diuretic purposes ; while the alcoholic preparations, like the fluid extract and tincture, being richer in digitalin and digitalein, are preferable when an action upon the heart is desired. Ordinarily, therefore, digitalis should be given in solution, the tincture and infusion being the most reliable preparations; care being taken in the selection of the crude drug upon the character of which the strength of the preparation depends. In uncomplicated cases of cardiac failure, the result of valvular lesion, the tincture is most eligible. In cardiac failure associated with, or resulting from, kidney lesions the infusion, combined with some other diuretic, should be used. Strophanthus—Strophanthi—Strophanthus. U. S. P. Origin.—The seed of Strophanthus hispidus D. C, deprived of its long awn. The plant is a woody climber, ascending to the tops of high trees, from which it hangs in festoons. It is found in tropical Africa, where it is used to prepare an arrow-poison termed kombi. Description and Properties.—The seeds are about £ inch (15 Mm.) long and \ to \ inch (4-5 Mm.) broad, oblong-lanceolate, flattened and obtusely-edged, grayish-green, covered with appressed silky hairs, one side extending into the attenuated, pointed end; kernel white and oily, consisting of a straight embryo having two cotyledons, and surrounded by a thin layer of perisperm; nearly inodorous ; taste very bitter. Strophanthus contains a glucosid, strophanthin, upon which its medicinal properties depend. It also contains kombic acid. Another CARDIAC STIMULANTS. 549 active principle, ouabain, is obtained from a similar species of Strophanthus. Official Preparations. Tinctura Strophanthi—Tincturae Strophanthi—Tincture of Strophanthus (5 per cent.).—Dose, 2-10 minims (0.12-0.6 Cc). Unofficial Preparations. Strophanthin—Strophanthin—Strophanthin. Origin.—A glucosid obtained from the seeds of several species of Strophanthus, chiefly from Strophanthus hispidus. Description and Properties.—A. white, amorphous or crystalline powder, of an acid- ulous, intensely bitter taste; soluble in water and in alcohol. Dose.—r^ to ^ grain (0.0006-o.coi Gm.). Ouabain—Ouabain—Ouabain.— Origin.—A glucosid obtained from Acocan- thera ouabalo and Strophanthus glabrtis. Description and Properties.—A white, transparent, crystalline powder, inodorous and of a slightly bitter taste. Soluble in hot water, sparingly soluble in cold water, insoluble in alcohol. Dose.—^rire to 3^ grain (0.000032-0.00012 Gm.). Antagonists and Incompatibles.—Probably the same as for digitalis. Synergists.—Digitalis, spartein, adonidin, etc. Physiological Action.—Externally and Locally.—The tincture of strophanthus has no local action of importance. Strophanthin and ouabain, however, possess marked sedative properties, the latter being much the stronger. They paralyze the ends of the sensory nerves and are powerful local anesthetics, in this respect surpassing even cocaine in their influence upon the cornea, the anesthesia produced by the glucosids being of much longer dura- tion than that caused by cocaine. When poisonous amounts of ouabain are applied locally the motor nerves are paralyzed. These substances apparently have no action upon the central nervous system. Externally.—Digestive System.—Strophanthus is similar in its action to digitalis, though less apt to disturb digestion in small doses; on the contrary, its bitter taste tends to improve the appetite. Ouabain increases peristalsis and acts as an emetic by centric influence. Circulatory System.—Upon the heart its action is identical with 550 A TEXTBOOK OF MATERIA MEDICA. that of digitalis, though differing from the latter drug in its effect upon arterial tension and the arterioles. Strophanthus does not contract the arterioles and the arterial pressure is but slightly raised, the elevation being due to the increased force of the heart, toxic doses paralyzing it in systole. The glucosidal principle, ouabain, on the other hand, increases arterial tension and contracts the principal vessels in the same manner as digitalis Nervous System.—Strophanthus affects the nervous system even less than digitalis. Poisonous doses, while not influencing the motor nerves so much as digitalis, act as a direct muscle- poison. Ouabain paralyzes both the sensory and motor nerves and abolishes reflex action, being a direct poison to the striated muscles. Respiratory System.—It has no important action. Ouabain primarily increases and secondarily diminishes respiration through its action upon the center. Absorption and Elimination.—Strophanthus is rapidly absorbed, and more readily eliminated than digitalis, possessing no cumulative action. It is principally excreted by the kidneys, increasing the amount of urine by the strengthened heart's action. Unlike digi- talis, the drug has no influence upon the caliber of the renal vessels. Temperature.—Very large doses of strophanthus cause a slight reduction of temperature, not, however, to the extent of digitalis. Eye.—Excessive doses contract the pupil and increase intra- ocular tension. Uterus.—It resembles digitalis, though more feeble in its action upon the uterus. The symptoms and treatment of Poisoning are similar to those described under Digitalis, although strophanthus is more apt to occasion diarrhea. Therapeutics.—Externally and Locally.—Strophanthin has been occasionally employed as a local anesthetic, but the testimony in its favor is hardly sufficient to encourage its use. Internally.—Strophanthus is a cardiac remedy, being indicated in the same varieties of heart disease as digitalis. It is of particular value in stenosis of the mitral orifice, having a happy influence in controlling the irregular rhythm, nervous dyspnea, and intermittent pains distinctive of this lesion. The drug is also well adapted in CARDIAC STIMULANTS. 551 subduing functional irregularities of rhythm in cases of irritable or tobacco heart. Theoretically, strophanthus is superior to digitalis in certain stages of Brights disease and heart failure of elderly people with slightly degenerated arteries. Shoemaker advocates the use of strophanthus in the treatment of psoriasis, combining it with the fluid extract of hoang-nan. While in the majority of cardiac diseases digitalis should be first tried, where it fails strophanthus is the proper recourse. It is a peculiarly efficient drug in the cardiac diseases of children, accord- ing to the majority of observers being safer than digitalis for young patients. Strophanthin has been used hypodermically with some success for the relief of chills due to malaria, shock, or nervousness. Dr. Gemmell and other observers claim that ouabain in doses of from ^^ to ^fo grain (0.00006-0.00003 Gm.) greatly reduces the number and severity of the paroxysms in whooping cough. Contraindications.—The same as for digitalis. Administration.—Of the preparations of strophanthus, the tincture is preferable, both for convenience and safety. Should strophanthin or ouabain be desirable, a solution is to be pre- ferred. Scoparius—Scoparii—Scoparius. U. S. P. (Broom.) Origin.—The tops of Cytisus scoparius L., a shrub 3 to 6 feet (.9-1.8 M.) high, found in Western Siberia and the greater part of Europe. It is sometimes cultivated, and is occasionally met with wild in some of the Middle and Southern States. Description and Properties. — Occurring in thin, flexible, branched twigs, pentangular, winged, dark green, nearly smooth, tough, usually free from leaves; odor peculiar when bruised; taste disagreeably bitter. The constituents of scoparius are an oily, bitter substance, spar- teine, a cardiac stimulant, and a neutral, crystalline principle, scopa- rin, to which the diuretic action of the drug is due. Dose.—-1—1 drachm (2.0-4.0 Cc), in infusion. Official Preparations. Extractum Scoparii Fluidum—Extracti Scoparii Fluidi—Fluid Extract of Scoparius.—Dose, J< —I fluidrachm (2.0-4.0 Cc). 552 A TEXT-BOOK OF MATERIA MEDICA. Sparteinae SQlphas—Sparteinae Sulphatis—Sparteine Sulphate.—The neu- tral sulphate obtained from the alkaloid sparteine. Description and Properties.—Colorless, white, prismatic crystals, or a granular powder, odorless, and having a slightly saline and somewhat bitter taste; liable to attract moisture when exposed to damp air; very soluble in water and alcohol. Dose.—^5-2 grains (0.003-0.1 Gm.). Unofficial Preparation. Scoparine—Scoparine—Scoparine.—Description and Properties.—Amorphous or in small crystals, of a pale-yellow color, inodorous and tasteless. Dose.—1-15 grains (0.06-1.0 Gm.), as a diuretic. Antagonists and Incompatibles.—The antagonists are the same as for digitalis, and tannic acid and potassium iodide are incompatibles. Synergists.—Digitalis, strophanthus, adonidin, etc. Physiological Action.—Externally and Locally.—No action observed. Internally.—Digestive System.—Sparteine sulphate acts like bit- ters in improving the appetite and digestion. Large doses, as with digitalis, produce vomiting and purging. Circulatory System.—It has been claimed that the action of sparteine upon the heart and blood-vessels is similar to that of digitalis; but numerous experiments upon animals show that the drug has no action upon these organs. (Cushing and Matthews, Archives of Experimental Pharmacology and Pathology, 1895.) Notwithstanding the results of the pharmacological experiments above referred to, the author has observed that, clinically, the drug is similar in its action to that of digitalis, save that it is not so powerful, but more rapid, though the arterioles are not contracted as is the case with digitalis. Nervous System.—Sparteine resembles coniine rather than digi- talis in its action upon the nervous system, depressing the brain and spinal cord, and lowering reflex action through paralysis of the motor tracts. Under toxic doses there is also extreme mus- cular weakness, often complete paralysis. Respiratory System.—Medicinal doses produce no effect. Toxic doses slow and weaken the respiration, death being possible from paralysis of the respiratory center. Absorption and Elimination.—It is rapidly absorbed and as read- ily eliminated, and, unlike digitalis, has no cumulative action. In disease it is an active diuretic, particularly the infusion or fluid CARDIAC STIMULANTS. 553 extract or the alkaloid scoparin. Sparteine, on the other hand, is not an active diuretic. Scoparius therefore increases the flow of urine and the excre- tion of urea, The drug has no direct action upon the renal struc- ture, diuresis being produced by increased blood-pressure. It also possesses diaphoretic properties. Poisoning.—The following symptoms occur: Small, rapid, and irregular pulse, dyspnea, great muscular weakness, incoordination of movement, and muscular tremors, followed possibly by clonic and tonic convulsions, which are replaced by marked depression of the nervous and muscular systems, and collapse, death usually resulting from paralysis of the respiratory center. Treatment of Poisoning.—The respiration should be stimulated by hypodermic injections of strychnine and atropine. It may even be necessary to apply electricity over the vagi or practise artificial respiration. Potassium iodide or solutions of tannic acid should be given, and the free use of diuretics or diluents to favor elim- ination. Therapeutics.—Externally and Locally.—No influence is ex- erted. Internally.—Scoparius is used for the same purposes as digi- talis. It is particularly serviceable in some cases of nephritis with weak, irregular heart-action, and in chronic Bright's disease with cardiac hypertrophy and high arterial tension. It is also useful in the nervous, irregular heart of opium habitues. Sparteine sulphate has been recommended in paralysis agi- tans and asthma. Like strophanthus, it is of more value in mitral than in other valvular diseases. For some reason scoparius is generally less esteemed than digitalis, although, while competent clinicians consider it of minor importance as a cardiac remedy, the drug is not without enthusi- astic advocates among those of authority. Contraindications.—Practically the same as for digitalis, though less definite. Administration.—The fluid extract of scoparius may be given, or the decoction, " made by adding h an ounce (16.0 Gm.) of the broom-tops to 1 pint {}, liter) of water and boiling them down to I pint (250 Cc). Of this 1 ounce (32.0 Cc.) should be taken ever)- three hours. This decoction is one of the most efficient diuretics in cardiac dropsy" (Hare). The sparteine sulphate is usually employed when an action on 554 A TEXT-BOOK OF MATERIA MEDICI. the heart is desired : it may be administered either hypodermically, in pill, capsule, or aqueous solution. Cactus—Cacti—Cactus. (Night-blooming Cereus.) Origin.—The stems and flowers of Cactus grandiflorus L, a plant indigenous in tropical America and frequently cultivated for ornament. Preparations. Extractum C3cti Fluidum—Extracti C3cti Fluidi—Fluid Extract of Cac- tus.—Dose, 5-10 minims (0.3-0.6 Cc). Tinctura C3cti—Tincturae Cacti—Tincture of Cactus.—Dose, 15-20 minims (1.-1.2 Cc). Physiological Action and Therapeutics.—Cactus differs from digitalis in its less disturbing influence upon the digestive appa- ratus. Its action upon the circulation is to elevate arterial pressure and increase the strength and rapidity of the heart's action when given in medicinal doses. Toxic doses, on the contrary, diminish both the blood-pressure and the pulse-rate, rendering the heart irregular in its action and arresting it in systole. Moreover, the reflexes are increased by poisonous doses, death being preceded by clonic and tetanic convulsions of spinal origin. Therapeutically, cactus probably possesses no advantages over digitalis. It has, however, been highly recommended by certain physicians in myocarditis, aortic regurgitation, functional disorders of the heart, severe arrhythmia, angina pectoris, and cardiac weak- ness following typhoid fever. Dr. Wilcox considers mitral stenosis a contraindication to its use. It is asserted that it produces no cumulative effects or untoward symptoms. Adonis Vernalis—Adonidis Vernalis—False Helle- bore. (Pheasant's Eye.) Origin.—A perennial herb attaining a height of about 10 inches (25 Cm.), indigenous in Europe. Description and Properties.—It has but little odor and a some- what acrid and bitter taste. The plant contains a glucosid, adoni- CARDIAC STIMULANTS. 555 din, to which it owes its medicinal properties. This constituent is a light-colored, crystalline powder, of a bitter taste and soluble in water and alcohol. Dose of Adonidin.—M-\ grain (0.003-0.01 Gm.). Antagonists, Incompatibles, and Synergists.—The same as for digitalis. Physiological Action and Therapeutics.—The action of adoni- din is similar to that of digitalis, although more nearly resembling that of digitalin, save that it is not cumulative. It is used for the same purposes as digitalis, being peculiarly valuable in relieving the pains of heart disease, and is by some physicians preferred to digitalis in the treatment of aortic and mitral insufficiency, cardiac asthma, and functional irregularity of the heart. Convallaria—Convallariae—Convallaria. U. S. P. (Lii.y of the Valley.) Origin.—The rhizome and roots of Convallaria majalis L., a stemless perennial indigenous in Europe, Northern Asia, and North America. Description and Properties.—Of horizontal growth and some- what branched, about \ inch (3 Mm.) thick, cylindrical, wrinkled, whitish, marked with a few circular scars ; at the annulate joint with about eight or ten thin roots; fracture somewhat fibrous, white; odor peculiar, pleasant; taste sweetish, bitter, and somewhat acrid. Convallaria contains two glucosids : convallamarin, the cardiac- acting principle; and convallarin, an emeto-cathartic principle. Official Preparations. Extractum Convallariae Fluidum—Extracti Convallariae Fluidi—Fluid Ex- tract of Convallaria.—Dose, 15-30 minims (1-2 Cc). Unofficial Preparations. Extractum Convallariae—Extr3cti Convallariae—Extract of Convallaria.— Dose, 5-15 grains (0.3-1.0 Cc). Infusum Convallariae—Infusi Convallariae—Infusion of Convallaria.—Dose, 0-2 ounces (15-60 Cc.) (25 parts in 75 parts of water). Convallamarinum — Convallamarlni — Convallamarin. — Description and Properties.— A whitish-brown, amorphous powder, soluble in water and alcohol. Dose.—^-2 grains (0.016-0.12 Gm.). Convallarinum—Convallarlni—Convallarin.—Description and Properties.—A crystalline body insoluble in water, soluble in alcohol. Dose.—2-4 grains (0.12-0.24 Gm.). 556 A TEXT-BOOK' OF MATE RE! MEDICA. Antagonists and Incompatibles.—The antagonists are the same as for digitalis ; tannic acid precipitates the convallamarin. Synergists.—The cardiac stimulants enhance its cardiac action ; emetics and cathartics aid its emeto-cathartic effects. Physiological Action.—Almost identical with that of digitalis, but less powerful and possessing no cumulative action. Prepara- tions free from convallarin do not disturb the stomach nor affect the cerebro-spinal functions. It is asserted that convallaria has stronger diuretic properties than digitalis. Convallamarin in some cases has produced, among other un- toward symptoms, hemoptysis and dyspnea. Convallarin is a drastic purgative, and in full doses occasions nausea and gastric pain. Therapeutics.—Convallaria is used for the same purposes ex- actly as digitalis. The only advantage it possesses over the latter drug is that it has no cumulative action. By some physicians it is considered superior to digitalis as a diuretic and cardiac stimulant after failure of compensation, the diuresis it occasions persisting for some time after the withdrawal of the drug. It has been employed with some benefit in various forms of neuralgia, and has even been recommended to calm the restlessness and relieve the insomnia of fever. Contraindications.—The same as for digitalis. Administration.—The fluid extract is the best preparation to use, although the infusion is highly recommended by many physi- cians. Caffeina—Caffeinae—Caffeine. U. S. P. Origin.—A feebly basic, proximate principle obtained from the dried leaves of Thea Sinensis (tea) L., or from the dried seeds of Coffea Arabica (coffee) L., and found also in other plants. It may also be prepared synthetically from theobromine by the introduction of a third methyl group. Description and Properties.—Fleecy masses of long, flexible, white crystals, having a silky luster, without odor and of a bitter taste; permanent in the air; soluble in 80 parts of water and 33 parts of alcohol. Dose.—2-5 grains (0.12-0.3 Gm.). Official Preparations. Caffeina Citrata — Caffeinae Citratae — Caffeine Citrate.—Description and Properties.—A white powder, odorless, having a purely acid taste and an acid PATHOLOGICAL TECHNIQUE: A Practical Manual for Laboratory Work in Path- ology, Bacteri- ology, andMor- bid Anatomy, with Chapters MALLORY AND WRIGHT'S PATHOLOGICAL TECHNIQUE on Post-Mortem Technique and the Performance of Autopsies. By Frank B. Mallory, A.M., M.D., Assistant Professor of Pathology, Harvard Uni- versity Medical School; Assistant Pathologist to the Boston City Hospi- tal ; Pathologist to the Children's Hos- '* I have been looking forward to the publica- tion of this book, and I am glad to say that I find it to be a most useful laboratory and post-mortem guide, full of practical information, and well up to date."—William H. Welch, Professor of Pathology, Johns Hopkins University, Baltimore, Md. pital; and James H. Wright, A.M., M.D., Director of the Laboratory of the Massachusetts General Hospital; Instructor in Pathology, Harvard Uni- versity Medical School. Octavo. 397 pages, with J 05 illustrations. Cloth, $2.50 net. j*j*j*«^«^«^«^«^ For sale by all Booksellers, or sent post-paid on receipt of price. "W. B. SAUNDERS, Publisher, 925 Walnut St., Philadelphia. A Text-Book of DISEASES of WOMEN. By Charles B. Penrose, M.D., Ph.D., Professor of Gyne- cology in the Uni- versity of Pennsyl- vania; Surgeon to the Gynecean Hospital, Philadelphia. Octavo. 529 pages, handsomely illus- trated. Cloth, $3.50 net. A- A- .* In this work, -which has been -written for both the student of gynecology and the general prac- titioner, the author presents the best teaching " I shall value very highly the copy of Penrose's ' Diseases of Women ' received. I have already recommended it to my class as THE BEST book."—Howard A. Kelly, Professor of Gyne- cology and obstetrics, Johns Hopkins University, Baltimore, MJ. of modern gynecology untrammelled by anti- quated theories or methods of treatment. In most instances but one plan of treatment is "The copy of ' A Text-Book of Diseases of Women ' by Penrose, received to-day. ] have looked over it and admire it very much. have no doubt it will have a large sale, as it justly merits.' —E. E. Montgomkry, Professor of Clin- teal Gynecology, Jefferson Medical College, Phila- delphta. recommended, to avoid confusing the student or the physician who consults the book for prac- tical guidance. J* j* <£ -j* a* jt & jA For sale by all iiookseliers, or sent post-paid on receipt of price. W. B. SAUNDERS, Publisher, 925 Walnut St., Philadelphia. PENROSE'S DISEASES OF WOMEN CARDIAC STIMULANTS. 557 reaction. I part of citrated caffeine forms a clear, syrupy solution with about 3 parts of water. Dose.—2-5 grains (0.12-0.3 Gm.). Caffeina Citrata Efferv6scens—Caffeinae Citratae EffervescSntis—Efferves- cent Citrated Caffeine.—Dose, 1-4 drachms (4.0-16.0 Gm.). Allied Compounds. Guaranine.—The alkaloid obtained from the seeds of Paullinia cupana. Theine.—An alkaloid obtained from tea. Theobromine.—An alkaloid obtained from cacao seeds. Sodio-theobromine Salicylate (Diuretin).—An active diuretic described under the group " Diuretics." Guaranine, theine, and theobromine, while chemically almost identical with caffe- ine, differ from it somewhat in their physiological action. Guaranine depresses first the sensory and afterward the motor nerves, affecting [hem from the center toward the periphery. Its primary effect in toxic doses is to pro- duce general hyperesthesia, succeeded by convulsions of spinal origin. Theine in its action very closely resembles guaranine, save that when injected it causes local anesthesia. It lowers the temperature, while caffeine tends to raise bodily heat. Theobromine differs in no essential from caffeine. Antagonists and Incompatibles.—Cerebral and cardiac de- pressants antagonize the action of caffeine. Synergists.—Members of this group and the Cerebral and Motor Excitants. The action of caffeine upon the digestive tract may be enhanced by the vegetable bitters. Physiological Action.—Externally and Locally.—Caffeine pos- sesses no very important local action, though freshly roasted coffee is slightly analgesic and deodorant, as well as antiseptic—a prop- erty due to the empyreumatic oils developed by roasting rather than to the caffeine which it contains. Internally.—Digestive System.—In moderate amounts caffeine, like tea and coffee, stimulates the appetite, improving the digestion, and relieving the sense of plenitude in the stomach. All of them increase peristalsis and (particularly coffee) act as mild laxatives and slightly stimulate the secretion of bile. Immoderate and continued dosage of caffeine or the excessive use of tea and coffee profoundly disturbs the digestive function, resulting in gastric catarrh, indigestion, hepatic congestion, consti- pation, and hemorrhoids. Circulatory System.—Medicinal doses of caffeine strengthen and quicken the heart's action. The rapidity of the heart's action is increased, shortening the diastolic period, the drug in this respect differing from digitalis; at the same time the arterial pressure is elevated. 558 A TEXT-BOOK OF MATERIA MEDICA. The precise modus operandi of caffeine in its action upon the circulatory system is still a disputed question, some investigators claiming that its whole and only influence proceeds from a direct stimulation of the heart-muscle, while others consider its action to be upon the nervous system. So far as relates to arterial pressure, the preponderance of testimony seems to prove that the tension is raised independently of any action on the vaso-motor centers. Kxcessive doses depress the heart, causing an irregular, slow, and weak pulse. Nervous System.—The drug is a decided cerebral excitant, stim- ulating the mental function, occasioning wakefulness, and under large doses producing hallucinations and delirium. There is a marked difference between the effects upon the brain caused by caffeine and those occasioned by opium. The former renders the reasoning and imaginative powers more acute, enabling the person to perform increased and prolonged mental work. Moreover, the cerebral excitation caused by caffeine is not suc- ceeded by mental depression and sleep; while opium occasions an incoordination of mental activity, the brain being incapable of performing active practical and physiological work, and the reason- ing powers rendered subservient to the imaginative. The opium habitue thus becomes a visionary, his mental powers inclining more to revery than to action. The primary excitation induced by the drug, however, is soon succeeded by lethargy and sleep. The moderate use of tea or coffee increases muscular endu- rance; large doses, on the other hand, occasion muscular trem- bling and marked weakness. Excessive doses lessen the activity of the spinal reflex centers. In moderate amounts coffee possesses some aphrodisiac action. Respiratory System.—Medicinal doses slightly stimulate, while toxic doses depress, the respiration. Absorption and Elimination.—Caffeine is freely absorbed, and is chiefly eliminated by the kidneys, a portion being oxidized in the body. The primary effect of the drug upon the kidneys is to diminish the blood-supply to the kidneys, thereby lessening the amount of urine. At the same time the drug has a direct stimu- lating action upon the secreting structure of the kidney, and if its effect upon the vaso-motor center is not too marked its general action is that of a diuretic. Ordinarily, caffeine lessens tissue-waste; the elimination of urea, CARDIAC STIMULANTS. 559 however, is not uniform, being in some cases increased and in others diminished. Temperature.—Under large doses of the drug the temperature is slightly elevated, the result of combined increase of heat-pro- duction and heat-dissipation. Toxic doses first raise and then depress temperature. Eye.—Strong solutions of caffeine applied to the cornea act as a mild mydriatic and anesthetic. Hutchinson records a case of amblyopia produced by the drug. Untozvard Action.—Caffeine occasionally causes marked cere- bral congestion, insomnia, and embarrassment of respiration, while the untoward effects of an immoderate use of coffee are described by Guilliot {Nat. Disp., p. 363) as follows: " The skin is pale or dusky, the expression is dull, and the features have the look of premature old age, and sometimes are slightly swollen. The flesh wastes, the eyes have a glassy look, the pupils are dilated, the lips and tongue are tremulous; the appetite is lost; there is insomnia or else disturbed sleep; dyspep- sia accompanies constipation or diarrhea; neuralgia affects the stomach and other parts ; headache and vertigo are common, and spasms or general convulsions may occur." According to the same writer, " habitual excess of coffee induces in men sexual apathy and impotence, and in women leucorrhea. Sometimes it produces pruritus aui aut vulva:!' Poisoning.—A case has been reported by Liell where 18 grains {1.16 Gm.) of citrated caffeine taken by a woman were in an hour and a half accompanied by the following symptoms : " Delirium, semi-consciousness, absence of headache, pulse 55 and irregular, cold extremities and general clammy perspiration, normal temperature (?), anesthesia, slight paresis of hands, feet, and tongue, and a reeling gait. Convulsions followed of a teta- noid character; the pupils were normal, the vision dim; some vomiting took place ; there was abdominal colic, but no opening of the bowels; and urination was frequent and copious." Treatment of Poisoning.—This should include the use of emetics and eliminants, together with diffusible stimulants and the applica- tion of external heat. Therapeutics.—Externally and Locally.—Burning coffee in a room deodorizes the air, and micro-organisms can be destroyed by allowing a bowl of coffee to stand in it. Powdered coffee is used to disguise the offensive odor of iodoform, and is frequently asso- 560 A TEXT-BOO A' OF MATERIA MEDICA. ciated with it in the form of an ointment in the treatment of aural eczema. Equal portions of pulverized coffee and boric acid have been recommended by Guerder as an insufflation in zvhooping cough. Internally.—The chief value of caffeine is as a diuretic and cardiac stimulant, being peculiarly useful in cases of senile cardi- opathies associated with nephritis, in which, from degeneration of the heart-muscle, digitalis is not well tolerated. In some instances the primary effect of caffeine is to increase the pulse-rate; usually, however, if the remedy be adapted to the case, there is a secondary slowing of the heart's action. The drug is considered by some physicians to be superior to digitalis as a cardiac stimulant in valvular disease accompanied by fatty heart. It is an efficient remedy to counteract the cardiac depression in lozo fevers, and is a comparatively safe drug in myocarditis. It is a remarkably efficacious remedy in cardiac and renal dropsy and to remove pleuritic effusion, etc. Its action upon the digestive system renders caffeine of great value as a stomachic tonic. Migraine, due either to gastric catarrh or nervousness, frequently yields to this drug. Its value in the treatment of headaches may be enhanced by administering it together with antipyrine or sodium bromide. Choleraic diarrhea, the result of nervous depression, is often markedly benefited by citrated caffeine. It has also been used with some success in the diarrhea of phthisis. The pains of locomotor ataxia have been greatly relieved by the hypodermic injection of from |- to ^ grain (0.OI-O.03 Gm.) of THEINE. Sodio-henzoate of caffeine in doses of 5 to 1 o grains (0.32- 0.64 Gm.) is considered by Misrachi to be superior to ergot in post-partum hemorrhage. Caffeine possesses a considerable repu- tation as a remedy for asthma. It is a matter of frequent observation that strong coffee cer- tainly modifies the effects of alcoholic intoxication. Hiccough is often relieved by coffee. Caffeine or strong coffee has unquestionably proved valuable in the reduction of strangulated hernias after taxis has failed. The medical uses of caffeine would be incomplete without mention of its extreme value in opium-poisoning. Here a salt of caffeine may be used hypodermically or a strong infusion of coffee given by the mouth or rectum. CARDIAC STIMULANTS. 561 In conclusion, it may not be out of place, in comparing this drug with digitalis, to quote again from the National Dispensatory, 5th ed., p. 365 : " Unlike digitalis, which affects only certain invol- untary muscles, caffeine, like alcohol, stimulates the entire muscu- lar and vascular systems. It has been repeatedly said that caffeine and digitalis cannot be therapeutically substituted for one another —that the former acts where the latter ceases to act; and the ex- planation of this fact resides in their very dissimilar modes of action. When digitalis fails, it is because the heart is either posi- tively or relatively incompetent to propel the blood, and the medi- cine has no power of strengthening except by tonically contracting it; but coffee or caffeine stimulates the nervous centers which are the source of the heart's power, and temporarily restores the regu- larity and efficiency of its function, and so permits the removal of the dropsies, etc. which immediately threaten the extinction of life." Contraindications.—Ordinarily, caffeine is contraindicated in acute inflammations, particularly of the kidneys. Administration.—The alkaloid may be given by the stomach, but when hypodermic medication is desired caffeine is unavailable, a fresh salt for hypodermic use being properly employed, made by combining caffeine with salicylic acid, cinnamic acid, or sodium benzoate. The latter salt—sodio-benzoate of caffeine—is probably the most eligible and contains 45 per cent, of caffeine. The citrated caffeine should be given in pills, capsules, or tablets ; the effervescent citrate, in water. A valerianate of caffeine is prepared which has been employed with success, it is asserted, in hysterical vomiting and zvhooping cough in doses of from \ to 2 grains (0.03-0.12 Gm.). Strong coffee serves as a most excellent substitute for the alka- loid, and may be given by the mouth or as an enema. Alcohol—Alcoholis—Alcohol. U. S. P. Origin.—A liquid composed of about 91 per cent, by weight or 94 per cent, by volume of Ethyl Alcohol, and about 9 per cent, by weight of Water. Description and Properties.—A transparent, colorless, mobile, and volatile liquid, of a characteristic, rather agreeable odor, and a burning taste. Miscible with water, ether, or chloroform in all pro- portions. It is inflammable, and readily volatilized even at low temperatures. Alcohol should be kept in well-closed vessels, in a cool place, remote from lights or fire. 36 562 A TEXT-BOOK OF MATERIA MEDICA. Official Preparation. Alcohol Dilutum—Alcoholis Diluti—Diluted Alcohol.—A liquid composed of about 41 per cent, by weight, or about 48.6 per cent, by volume, of absolute Ethyl Alcohol, and about 59 per cent, by weight of Water. It should be kept in well-closed vessels, in a cool place, remote from lights or fire. Alcohol Absolutum—Alcoholis Absoluti—Absolute Alcohol. U.S. P. Origin.—Ethyl Alcohol, containing not more than 1 per cent. by weight of Water. Description and Properties.—A transparent, colorless, mobile, and volatile liquid, of a characteristic, rather agreeable odor, and a burning taste. Very hygroscopic. It should be kept in well- stoppered bottles or tin cans, in a cool place, remote from lights or fire. Alcohol Deodoratum—Alcoholis Deodorati—De- odorized Alcohol. U. S. P. Origin.—A liquid composed of about 92.5 per cent, by weight, or 95.1 per cent, by volume, of Ethyl Alcohol, and about 7.5 per cent, by weight of Water. Description and Properties.—As given and described under Absolute Alcohol. Spiritus VIni Gallici—Spiritus Vini Gallici—Brandy. U. S. P. Origin.—An alcoholic liquid obtained by the distillation of the fermented, unmodified juice of fresh grapes, and at least four years old. Description and Properties.—A pale amber-colored liquid, having a distinctive odor and taste and a slightly acid reaction. Its specific gravity should not be more than 0.941, nor less than 0.925, corresponding, approximately, to an alcoholic strength of 39 to 47 per cent, by weight or 46 to 55 per cent, by volume. Spiritus Frumenti—Spiritus Frumenti—Whiskey. U. S. P. Origin.—An alcoholic liquid obtained by the distillation of the mash of fermented grain—usually mixtures of Corn, Wheat, and Rye—and at least two years old. CARDIAC STIMULANTS. 563 Description and Properties.—An amber-colored liquid, having a distinctive odor and taste, and a slightly acid reaction. Its specific gravity should not be more than 0.930 nor less than 0.917, corresponding, approximately, to an alcoholic strength of 44 to 50 per cent, by weight or 50 to 58 per cent, by volume. Vinum Album—VIni Albi— White Wine. U. S. P. Origin.—An alcoholic liquid made by fermenting the juice of fresh grapes, the fruit of Vitis vinifera (nat. ord. Vitacece), freed from seeds, stems, and skins. Description and Properties.—A pale amber-colored or straw- colored liquid, having a pleasant odor, free from yeastiness, and a fruity, agreeable, slightly spirituous taste, without excessive sweet- ness or acidity. It should contain not less than 10 nor more than 14 per cent, by weight—equivalent to 12.4 to 17.3 per cent, by volume—of absolute alcohol. Vinum Rubrum—VIni Rubri—Red Wine. U. S. P. Origin.—An alcoholic liquid made by fermenting the juice of fresh, colored grapes, together with their skins. Description and Properties.—A deep red liquid, having a pleasant odor, free from yeastiness, and a fruity, moderately astrin- gent, pleasant, and slightly acidulous taste, without excessive sweet- ness or acidity. It should contain not less than 10 nor more than 14 per cent, by weight—equivalent to 12.4 to 17.3 per cent, by volume—of absolute alcohol. Unofficial Alcoholic Preparations. Spiritus Rectificatus—Spiritus Rectificati—Rectified Spirit contains 85 per cent, by weight of absolute alcohol. Proof Spirit contains 49 per cent, by weight of absolute alcohol, together with a peculiar volatile oil and other foreign material. Gin is usually distilled in Holland from rye or barley, and flavored with juniper ber- ries and hops. It contains about 42 per cent, by weight of absolute alcohol, and is probably more diuretic than other liquors because of the oil of juniper it contains. Rum is obtained by distilling fermented molasses, having about the same alcoholic strength as gin. Port Wine is prepared by adding spirit during the process of manufacture, bring- ing the alcoholic strength up to 30 or 40 per cent. Sherry Wine is a dry wine, having from 20 to 35 per cent, of alcohol. Sparkling Wines contain from 8 to 10 per cent, of alcohol. They are more or less sweet wines, and are charged with carbonic acid, being bottled before fermentation is completed, the grape-sugar, in consequence, not undergoing conversion into alcohol, The sparkling wines are Champagne, Hock, and Sparkling Catawba. 564 A TENT-BOOK OF MATERIA MEDICA. Sweet Wines are those in which the sugar has not all been converted into alcohol, the alcoholic strength being therefore relatively low—from 6 to 7 per cent. Among the sweet wines may be classed Angelica, Madeira, Malaga, Muscatel, Tokay, etc. Dry Acid Wines are those in which the fermentation is complete, the alcoholic strength varying from 5 to 7 per cent. They are such as California I lock, Ohio and Kelly Island Catawba, Rhine and Moselle wines, Hochheimer, Diirkheimer, Deides- heimer, etc. Light Red Wines contain 5 to 7 per cent, of alcohol, and are astringent, contain- ing tannic acid and the coloring matter of the grape. They are Claret, Red Rhine, Concord, Hungarian, etc. Beer, Ale, and Porter are prepared by fermenting malted grain with hops and adding other bitters. Beer contains from 2 to 3 per cent, of alcohol; ale and porter, from 4 to 6 per cent., besides carbonic and lactic acids, malt extract, various aromatics, and potassium and sodium salts. Antagonists and Incompatibles.—The motor, cerebral, and cardiac depressants are antagonistic to moderate amounts of alcohol. Synergists.—The motor excitants, atropine, ether, and the dif- fusible stimulants. Physiological Action.—Few drugs have occasioned such di- versity of opinion regarding their physiological action and uses as alcohol. With those who—as Nathaniel asked, " Can any good thing come out of Nazareth ?"—question whether any benefit can accrue from alcohol, being honestly convinced that the drug pos- sesses no value in medicine, the author begs leave to take respect- ful yet decided issue. Indeed, extensive reading, experimentation, and clinical experience have alike proved to him conclusively that we have in alcohol a drug endued with peculiar and invaluable properties, rendering its efficacy inferior to that of no remedy in the range of materia medica. Like opium and other powerful agents, the drug may prove noxious or beneficial according to the manner and judgment with which it is employed. The physiological action as here given agrees with the best authorities on the subject. Externally and Locally.—Alcohol is a powerful antiseptic and disinfectant. It possesses also rubefacient, astringent, and anhi- drotic properties. When applied in full strength to the skin it pro- duces a sensation of coldness, due to rapid evaporation. Should the drug be diluted, the sensation of cold is greatly diminished. If evaporation be prevented, the effect is that of heat or burning, owing to the penetration of the drug through the epidermis and its chemical influence upon the tissues beneath. Its effect upon mucous membranes is similar to that upon the CARDIAC STIMULANTS. 565 skin, save that the former are more readily affected. The mucous membrane becomes whitened and corrugated, because of the coagu- lation of albumin and the abstraction of water. The white film, which is the precipitated albumin, later disappears as the albu- min is redissolved in liquids present, although the prolonged action of alcohol upon mucous membranes produces a permanent co- agulation. When the drug is applied to the skin the secretion of sweat is lessened and the cutaneous blood-vessels contracted. Internally.—Digestive System.—The local action upon the mu- cous membrane of the mouth is as above described. There is a burning sensation, and marked increase of saliva due entirely to reflex action. When ingested a sense of warmth is experienced in the stomach, the blood-vessels of which are dilated, with accom- panying increase in the secretion of gastric juice, as well as stimu- lation of peristaltic action. As a consequence, moderate amounts of the drug, when taken before meals, improve the appetite and favor digestion : if taken during the active period of digestion, the process is retarded. It will be observed that the action of alcohol upon the digestive system is quite similar to that of vegetable bitters, immoderate amounts checking the flow of gastric juice and increasing the secre- tion of mucus, producing a catarrhal condition ; while excessive doses or the daily and intemperate use of the drug frequently occasions nausea and vomiting. Upon the intestines alcohol acts as an astringent, brandy being an efficient agent in checking diarrhea. Small amounts of the drug act as an hepatic stimulant, while large quantities change the character of the bile, at the same time lessening its amount. Circulatory System.—Taken into the stomach, alcohol reflexly and rapidly stimulates the heart before absorption can take place, the effect upon the circulation persisting after the drug is absorbed. Cardiac action is rendered more rapid and forcible, probably by stimulation of the heart-muscle, as well as of the accelerator center in the medulla. Arterial tension is raised, although the blood-vessels are dilated, especially those of the skin, owing to the depression of the vaso-motor center located in the ves- sel-walls. Toxic doses depress the heart and still further dilate the arterioles, greatly lowering the blood-pressure. This action of alcohol, in causing the heart to beat stronger and faster, at the same time dilating the blood-vessels—particularly those of 566 A TEXT-BOOK OF MATERIA MEDICA. the peripheries—renders the drug one of the m<»st valuable dif- fusible stimulants. Excessive doses of alcohol greatly depress or paralyze the heart, while an enormous amount, when taken upon an empty stomach, by reflex action occasioning cardiac paralysis, may pro- duce instantaneous collapse. The ameboid movements of the white blood-corpuscles are tem- porarily increased, though subsequently diminished. The function of the red corpuscles is impaired, preventing the oxyhemoglobin from parting with its oxygen, consequently retarding oxidation in the tissues. It is a matter of observation that persons addicted to the habitual use of alcohol are frequently obese, on account of the imperfect combustion of fat and its consequent accumulation in the tissues. Experiments have conclusively shown that moderate amounts of alcohol are oxidized during their circulation in the body. Alco- hol must, then, serve as a food to a certain extent. Indeed, experi- ments have irrefutably proved that the body-weight of an animal may be maintained for a considerable period upon alcohol alone. This peculiar and apparently paradoxical property, of lessening and at the same time undergoing oxidation, renders the drug of eminent value in certain conditions. Nervous System.—Moderate amounts of alcohol stimulate the nervous system, particularly the brain, chiefly through the increased supply of blood to the parts, although the drug probably exerts some influence also upon the nerve-cells. The highest nerve- centers are first affected, so that a person who has taken alcohol displays a keener intelligence, a brighter wit, and possesses a sense of general mental and physical power. Should the dose have been large, depression is wont to succeed the feeling of exaltation, the functions in general sharing in the change, which passes from the highest to the lowest centers in regular succession, the order of functional disturbance being that of the cerebrum, cerebellum, spinal cord, and, lastly, the medulla oblongata. It will be observed that in this descending scale of functional derangement the mental faculties, being the highest, are earliest affected, resulting in failure of coordination in reasoning power and loss of control in the logical sequence of ideas, although the imagination, the emotions, and the faculty of speech may still re- tain their normal energy and exercise. Soon, however, the will- power succumbs ; the emotions, while yet stimulated, are no longer CARDIAC STIMULANTS. 567 subject to mental command ; the imagination becomes disordered ; and the patient laughs and weeps hysterically, and, as a final result accompanying this stage of intoxication, the power of speech is merged in spasmodic, incoherent, or almost inaudible utterances or perhaps total dumbness. The muscular system, being less highly organized, may still retain its activity; yet it at last yields to the influence of the poi- son, the movements becoming wholly incoordinate, until the patient sinks into a condition of drowsy, helpless stupor, in which he is incapable of the slightest effort dependent upon muscular energy. Consequent to this stage is the influence upon the spinal cord, the reflex centers in which are abolished, the patient micturating and defecating involuntarily. Meanwhile the respiratory center, hitherto unaffected, shares the general influence of the drug. The breathing is difficult, or even paralyzed, and the face livid. At length the cardiac movements are involved, and, the paralysis affecting its functions—at first stimulated—fatal collapse ensues. A frequent phenomenon incident to the depression of the reflex centers is found in the fact that injuries which under normal condi- tions might prove fatal to the subject have little or no effect upon the system saturated with alcohol, the heart and respiratory appa- ratus being for the time immune against reflex action. Respiratory System.—Medicinal amounts deepen and accelerate respiration ; large doses render the breathing slow and shallow,— these effects being due to stimulation or depression of the respira- tory center. Death from a toxic dose of alcohol usually results from paralysis of respiration. It may be noted that under toxic dosage of the drug the amount of carbonic acid exhaled is dimin- ished. Absorption and Elimination.—Alcohol is very rapidly absorbed, and " eliminated unchanged in small proportion to the quantity in- gested," owing to the fact that the greater proportion of it is oxi- dized in the body. The kidneys, lungs, skin, and liver share in the excretory process. The quantity of urine is greatly increased, principally on account of increased arterial pressure, although the amount of urea, sodium chloride, and uric, phosphoric, and sulphuric acids in the urine is diminished by alcohol. When taken internally the amount of sweat is slightly increased, due partly to a direct stimulation of the sweat-glands, and partly to the dilatation of the cutaneous blood-vessels. 568 A TEXT-BOOK OF MATERIA MEDICA. Temperature.—Alcohol is an antipyretic of considerable power. This action is owing (i) to lessening of tissue-oxidation ; (2) to the cooling of the blood through dilatation of the cutaneous blood- vessels, subjecting the warm blood from the interior of the body to the cooling influence of the atmosphere; (3) to the cooling of the surface of the body from the evaporation of sweat. The power to resist cold is diminished by the habitual use of alcohol. The drug would be useful in stimulating warmth in a person who had been long exposed to cold, but only in a warm room. Then, by rapidly dilating the blood-vessels of the skin and allowing the blood to flow to the surface, the subject is favorably affected by the external heat, while there is less danger of congestion in some internal organ. Eye.—The excessive use of alcohol may produce amblyopia, watery eyes, and congested conjunctivae. Untozvard Action is fully described under " Poisoning." Poisoning.—The untoward or poisonous action of alcohol may be divided into what are known as Acute and Chronic Alcoholism. The former has been described in detail under the effect of alcohol upon the Nervous System, and doubtless most readers are too familiar, from observation, with the effects of alcoholic intoxi- cation to require further enlightenment as to its general phe- nomena. A serious and altogether too frequent accompaniment of acute alcoholism is delirium tremens, the symptoms of which are as fol- lows : The malady is usually announced by marked anorexia, insomnia, and restlessness; tremor, especially of the tongue; dis- orders of vision and hearing; great mental depression; a soft and weak pulse; and cold extremities. These manifestations are succeeded in a day or two by active delirium, even passing into wild mania and horrible hallucinations, in which the distorted imagination conjures up the most loathsome images of reptiles, the vivid spectacle of which preys upon the mind with pitiable terror and dismay. Even the tenderest offices in behalf of the sufferer are perverted by the disordered reason, which becomes possessed only with the sentiment of abject, agonizing fear. The muscles are in a constant tremor, and the patient talks in- cessantly and incoherently. The pulse is usually rapid, feeble, and dicrotic, and insomnia is continuous. The patient may even pass into a state of coma-vigil, which is generally the precursor of death, or fatal collapse may occur suddenly and unexpectedl)-. In other CARDIAC STIMULANTS. 569 cases the sufferer may relapse into a sound sleep, when the delirium subsides and convalescence is established. It should be observed that alcoholic coma may be confounded with uremic coma, apoplexy, opium-narcosis, sunstroke, epileptic coma, or asphyxia. Diabetic or hysterical coma may also be confounded with alco- holic coma. So far as the odor of the breath is concerned, it is not pathognomonic, since a person in a comatose condition from other causes may have previously taken sufficient alcohol to impart to the breath a distinct odor of the drug. It is often, in fact, extremely difficult to make a positive diagno- sis of true alcoholic coma. It may sometimes happen that the patient is suffering from the combined action of alcohol and opium or noxious gases, or that he has been seized with cerebral hemor- rhage or sunstroke. Chronic alcoholism is generally the result of the continuous and excessive use of alcohol. The symptoms vary according to the individual case. There maybe (1) the moderate, daily drinker; (2) the periodical inebriate, usually the highly gifted, sensitive, and sympathetic, who drinks to excess at certain distinct intervals with a deliberation and moral perversity expressed by the declaration of a noted British general: " By the blessing of God, I intend to get gloriously drunk next Saturday night;" (3) the immoderate, im- pulsive, maniacal inebriate, who, during his usually brief existence after the establishment of the disease, is subject to constant and excessive indulgence, incapacitating him from the simplest duties of a rational life. The habitual drinker sooner or later suffers from disturbed digestion, gastric catarrh, and irregularity of the bowels; his face is usually puffed and bloated, while the capillaries, especially of the cheeks and nose, become permanently dilated, marked acne rosacea not infrequently developing in the latter organ. The excessive use of alcohol predisposes the subject to cirrhosis of the liver, other conditions being arterio-sclerosis, fatty degenera- tion of the heart and liver, paralysis, peripheral neuritis, Bright's disease, amaurosis, ataxia, epilepsy, insanity, etc. Treatment of Acute Alcoholic Poisoning.—The stomach should be emptied of all unabsorbed alcohol; cautious inhalations of am- monia should be given, accompanied by the internal administration of the aromatic spirit of ammonia and black coffee. Capsicum and vinegar also have the power to stimulate the patient and counteract 570 A TEXT-BOOK OF MA TERIA MEDICA. the ill effects of alcohol, while it is said that ammonium chloride, in a dose of 30 grains (2.0 Gm.) given in 8 ounces (236.59 Cc.) >A water, is an exceedingly efficient antagonist. Should there be great depression of respiration, faradism of the muscles of respiration may be necessary, with warm applications to the extremities and cold to the head. Hot milk and other forms of nutritious liquid food form an essential element in the restoration of the patient. Treatment of Delirium Tremens.—The management of this phase of alcoholism requires great skill and judgment, the student being referred for details to any standard work on the Practice of Medi- cine. The indications are to quiet the patient and sustain his physical strength. This has been accomplished by the adminis- tration of chloral and potassium bromide or opium, these drugs, together with digitalis, strychnine, and other cardiac stimulants, having proved highly efficient remedies. Gastric sedatives may be required, such as bismuth, carbolic acid, hydrocyanic acid, etc. Nutritious and easily digested food should be given, and, in case of gastric intolerance, enemata should be adopted. Treatment of Chronic Alcoholism.—A thoughtful and extended experience with inebriates has convinced the author that the great majority of dipsomaniacs suffer from a disease possessing usually a distinct and traceable etiology and resulting from either inher- ited or acquired neurosis. In many cases the malady is charac- terized by uniform development, progress, symptomatology, and termination. The author makes this statement with the full knowledge that he will be regarded as a " sentimentalist" by many professedly " practical" men. Yet a careful scrutiny of numerous cases and a consideration of the means adopted in the treatment of them will, he believes, convince the thoughtful physician that he has to deal with a thoroughly diseased organism rather than with the victim of a " vicious drug habit " readily overcome by a moderate exercise of the will. The medicinal agents most serviceable in the treatment of chronic alcoholism are strychnine, atropine, small doses of the alteratives, arsenic, potassium iodide, and mercury, while phos- phorus and other restoratives and tonics will frequently be found useful. The hygienic surroundings should be of the best, and the treat- ment should include a nutritious, non-stimulating diet taken with CARDIAC STIMULANTS. 571 regularity, and the free use of fruits and vegetables. Close atten- tion should be paid to the condition of the bowels and skin, and, among other remedial influences, should be mentioned laxatives when necessary, frequent Turkish baths, and, above all, change of scene and engaging mental occupation. From time to time various drugs have been heralded as specifics in the treatment of alcoholism, certain " cures " (sic) acquiring an influence among the ignorant and unscientific wholly at variance with the therapeutic value of these vaunted remedies. It is super- fluous to say that to a skilled and enlightened professional judg- ment the rationale of intemperance and the agents serving to miti- gate the malady present a problem far too complicated to be grasped by the empirical understanding, operating even under the most ingenuous motives. Therapeutics.—Externally and Locally.—Alcohol is an efficient application for contusions, sprains, and indolent ulcers, and is also serviceable in hardening the skin and preventing the formation of bed-sores. It is a useful hemostatic to check capillary oozing, and, being a powerful antiseptic, is available in all wounds. Uterine hemorrhage is controlled by inserting in the cavity of the uterus a tampon saturated with the drug. Its local anesthetic properties render alcohol valuable in relieving irritation of the skin in urticaria, frost-bite, etc.; it also serves as an efficient gargle in diphtheria and acute pharyngitis. Alcohol, or rrandy, has been successfully employed to harden nipples and prevent their cracking. A very efficient means of reducing temperature in fever is to bathe the skin with alcohol, the method being also useful to check exa ssiz 'c szi 'eating. The absorption of inflammatory exudates may be aided and the pain of muscular rheumatism relieved by rubbing the affected area with tincture of camphor or soap linimext, both of which con- tain alcohol. Internally.—Alcohol, in the form of wine, beer, or ale, taken before or during meals, is an efficient stomachic. Atonic dyspepsia and the zoeakened digestion attendant upon convalescence from acute diseases are greatly benefited by some form of alcohol. When digestion becomes impaired as the result of physical or mental exhaustion the drug serves a useful purpose as a tonic. The wisdom of using the drug, however, in the above condi- tions may be questioned, because of the danger of establishing the 572 A TEXT-BOOK OF MATERIA MEDICA. desire or habit, particular!}- in the case of neurotic women and those whose debilitated energies call for renewed and increasing quantities of the drug. Frequently the physical or mental depression, the peculiar, irre- sistible craving for stimulants, the insomnia and fitful appetite and disposition which urge recourse to alcoholic indulgence, are but the early manifestations of a brain-and-nerve degeneration, the impulse to drink being only the physical demand for relief. There is less danger attending the administration of alcohol in conditions of lowered vitality and weakened digestion in old people than in the young and middle-aged. The drug is decidedly contra- indicated in persons of average health and fair digestion, although beneficial in the aged, whose powers are failing from natural decline. The anesthetic and sedative properties of alcohol, especially in the form of champagne, which contains carbon-dioxide gas, may frequently control obstinate vomiting. Gastralgia and the pain arising from flatulence are often readily relieved by brandy, and the same remedy may be used efficiently in checking simple diarrhea. As a pure cardiac stimulant, alcohol is remarkably serviceable in syncope, asphyxia, exhausting hemorrhages, diphtheria, and col- lapse where death seems imminent. In counteracting the effects of narcotic poisons it is almost indispensable; it is, moreover, un- doubtedly the most efficient antidote to the poison of venomous reptiles. It is a common practice with some surgeons to precede the inhalation of chloroform with the administration of I or 2 ounces (30.O-60.O Cc.) of whiskey or brandy, for the twofold purpose of sustaining the heart and prolonging the anesthesia. In certain stages of various acute diseases, such as typhoid, typhus, small-pox, pneumonia, cerebrospinal meningitis, capillary bronchitis, etc., alcohol is one of the most potent and valuable rem- edies. It should be employed in these cases only when there is marked depression of the circulatory apparatus, characterized by a weak, rapid, soft, and irregular pulse, with a feeble sound of the heart and threatened syncope or delirium. Alcohol is beneficial in such cases as the foregoing when by its use the tongue is moistened, the pulse and respiration is slowed, the restlessness and delirium quieted, and the skin becomes less parched. CARDIAC STIMULANTS. 573 Should the drug increase the pulse and intensify the nervous manifestations, it is an indication that the dosage is excessive, in which event it may be well to discontinue the administration alto- gether. Even where the action of the drug is favorable, it is doubtful whether it should ever be given in fevers throughout the twenty-four hours, administration being advisable rather when the muffled or absent first sound of the heart indicates impending cardiac failure. This usually occurs during the interval between midnight and 7 a.m. Stimulation should therefore begin before midnight, and full doses—say I fluidounce (30 Cc.)—be given every three hours, full doses being of more service than repeated smaller amounts. It should be remembered that alcohol generates no new energy, but simply enables a person to utilize in a short period all his available reserve force. The utmost discrimination and judgment are requisite to the proper administration of the drug. In pyemia, septicemia, erysipelas, and diphtheria alcohol is fre- quently one of our most efficient remedies, while clinical experi- ence has fully demonstrated its value in retarding the progress of phthisis. Tubercular patients acquire a marked tolerance for the drug, being often able to assimilate enormous quantities without deleterious results. Small quantities of alcohol appear to exert a favorable action in functional impotence. Its sedative action, or possibly its property of increasing intra- cranial blood-pressure, renders alcohol valuable as a hypnotic in neurasthenia. A veiy common remedy for anemia and chlorosis is red wine. Acute coryza or a cold may often be wholly aborted by taking a good quantity of hot whiskey or hot " gin sling " upon retiring. The statement made by so prominent a physician as Mr. Law- son Tait, " I am fully persuaded, after thirty years of life as hard in work and as full of responsibility as well could be, that the mod- erate use of alcohol is a necessity in our modern life," is, in the author's opinion, too strong. Physicians, of all men, should realize the ill effects of over-work, as well as those of alcohol. Is it not wiser to limit the amount of labor than to attempt undue exertion under the stimulus of so seductive and dangerous a drug? Sta- tistics show that of those addicted to the excessive use of alcohol and other pernicious drugs, by far the largest percentage is among 574 A TEXT-BOOK OF MATERIA MEDICA. physicians—a sad commentary on their wisdom and professional knowledge. Contraindications.—Alcohol should not be given when the urine is of high specific gravity. It is ordinarily contraindicated in nephritis and diseases of the liver, gout, gleet, gonorrhea, and urethritis. The malt liquors and sweet wines should not be given in diabetes nor to persons suffering from eczema. Alcohol is also dangerous in hypertrophy of the heart and excessive cardiac action. Administration.—When possible, alcohol should always be taken with food. Brandy is the best astringent, and brandy and champagne are the best preparations to allay nausea. Whiskey is the least constipating, and gin the most diuretic. As regards their sedative action, there is no preference, whichever is most agreeable to the patient and least affects the head being advisable. As stomachics either claret, beer, or ale is most efficacious in im- proving the appetite. In cases of fermentative dyspepsia sweet wines and malted liquors are more injurious than beneficial, whiskey or brandy being preferable. When desired as diffusible stimulants in cases of cardiac failure brandy or whiskey only should be employed, which preparations may be given hypodermically. PREPARATIONS OF AMMONIUM. Aqua Ammoniae Fortior—Aquae Ammoniae Fortioris —Stronger Ammonia Water. U. S. P. Origin.—An aqueous solution of ammonia (NH, = 17.01), con- taining 28 per cent, by weight of the gas. Description and Properties.—A colorless, transparent liquid, having an excessively pungent odor and a very acrid and alkaline reaction. It should be kept in strong, glass-stoppered bottles. Dose.—3-6 minims (0.18-0.3 Cc). Official Preparation. Spiritus Ammoniae—Spiritus Ammoniae—Spirit of Ammonia.—Origin.— An alcoholic solution of ammonia, containing 10 per cent, by weight of the gas. Description and Properties.—A colorless liquid, having a strong odor of ammonia and a specific gravity of about 0.810 at 150 C. (590 F.). It should be kept in glass- stoppered bottles, in a cool place. Dose.—10-60 minims (0.6-3.7 Cc). CARDIAC STIMULANTS. 575 Aqua Ammoniae—Aquae Ammoniae—Ammonia Water. U. S. P. Origin.—An aqueous solution of ammonia, containing 10 per cent, by weight of the gas. Description and Properties.—A colorless, transparent liquid, having a pungent odor, an acrid, alkaline taste, and a strongly alkaline reaction. It should be kept in glass-stoppered bottles, in a cool place. Dose.—10-20 minims (0.6-1.2 Cc.) well diluted. Official Preparations. LinimSntum Ammoniae—Linimfinti Ammoniae—Ammonia Liniment (Am- monia Water, 350; Alcohol, 50; Cotton-seed Oil, 600).—For external use. Spiritus Ammoniae Aromaticus—Spiritus Ammoniae Aromatici. See Am. monium Carbonate. Ammonii Carbonas—Ammonii Carbonatis— Ammonium Carbonate. U. s. p. Origin.— Prepared by subjecting to sublimation and resublima- tion a mixture of Ammonium Sulphate or Chloride and Calcium Carbonate. Description and Properties.—Wrhite, hard, translucent, striated masses, having a strongly ammoniacal odor without empyreuma, and a sharp, saline taste. On exposure to air the salt loses both ammonia and carbonic acid, becoming opaque, and is finally con- verted into friable, porous lumps or a white powder. Slowly but completely soluble in about 5 parts of water; decomposed by hot water, with the elimination of carbonic acid and ammonia. Ammonium carbonate should be kept in well-stoppered bottles, in a cool place. Dose.—2-15 grains (0.12-1.0 Gm.). Official Preparation. Spiritus Ammoniae Aromaticus—Spiritus Ammonias Aromatici—Aromatic Spirit of Ammonia (Ammonium Carbonate, 34; Ammonia Water, 90; Oil of Nut- meg, i; Oil of Lemon, 10; Alcohol, 700; Oil of Lavender Flowers, 1; Water, to make 1000).—Description and Properties.—A nearly colorless liquid when freshly pre- pared, but gradually acquiring a somewhat darker tint. It has a pungent, ammoniacal odor and taste. It should be kept in glass-stoppered bottles, in a cool place. Dose.—1/2-2 fluidrachms (1.8-7.3 Cc.). Antagonists and Incompatibles.—The cardiac sedatives are 576 A TEXT-BOOK OF MA TERIA MEDICA. antagonistic. The incompatibles are the vegetable and mineral acids, the earthy salts, lime water, and solutions of acidulous salts. Synergists.—Cardiac and diffusible stimulants, antispasmodics, and capsicum internally. The local action of ammonium prepara- tions is enhanced by cantharides and counter-irritants. Physiological Action.—Externally and Locally.—When solu- tions of ammonia are applied to the skin or mucous membranes they act as irritants, rubefacients, or vesicants according to the strength of the solution and the freedom or confinement of the vapor. When inhaled the vapor occasions great irritation of the respi- ratory passages, together with a sense of suffocation and spasmodic closure of the glottis. There are also produced marked irritation of the conjunctivae, lacrymation, and a watery secretion from the nose. Internally.—Digestive System.—Small doses act like alkalies upon the gastro-intestinal tract, augmenting the flow of gastric juice when given before meals and neutralizing it when given after meals. Excessive doses occasion violent and destructive inflammation of the mouth, esophagus, and stomach, possibly resulting in stric- ture of the esophagus and stenosis of the pyloric orifice. Circulatory System.—These preparations, whether ingested or injected into the" system, cause a temporary fall of arterial pressure, quickly followed by a decided increase and acceleration of the pulse, owing to stimulation of the accelerator nerves of the heart. Their precise action upon the blood is not known, though they certainly lessen the oxygen-carrying powei of the red corpuscles and dimin- ish the tendency to coagulation of the blood. Nervous System.—Other than their action upon the sensory nerves when locally applied, these preparations affect the nervous system only in stimulating the motor centers of the spinal cord, excessive doses causing convulsions. Respiratory System.—They stimulate the respiratory center, greatly increasing the number of respirations. Absorption and Elimination.—The preparations of ammonium are rapidly absorbed, being oxidized in the system and eliminated chiefly by the kidneys, increasing the acidity of the urine and aug- menting its amount, as well as increasing the proportion of nitric acid, uric acid, and urea excreted. The continued use of ammo- nium preparations therefore promotes tissue-waste. CARDIAC STIMULANTS. 577 Temperature is unaffected by medicinal amounts. Poisoning.—In toxic doses these preparations are powerful cor- rosive poisons, exciting violent inflammation of the gastro-intestinal tract, labored respiration, great cardiac depression, muscular weak- ness, and possibly convulsions. Treatment of Poisoning.—Similar to that of poisoning by the corrosive alkalies—evacuation of the stomach, the internal admin- istration of vinegar or other vegetable acids, followed by oil and demulcent drinks, opium being indicated for the relief of pain. Therapeutics.—Aqua ammonle is a valuable ingredient of " hair tonics " in premature alopecia. The ammonia liniment is a favorite remedy for chilblains. The aromatic spirit of ammonia is of value in many diseases of the scalp, such as pityriasis, etc., and, when well diluted with water, has been recommended in acute pharyngitis. The ammonium carbonate possesses an action similar to that of salicylic acid in its property of dissolving epidermic scales, rendering it of value in preparing the skin for the subsequent local treatment of psoriasis^ As a counter-irritant ammonia water—or, preferably, the am- monium liniment—is efficient in chronic rheumatism and joint affections. Ammonia water relieves the irritation caused by bites of insects ; its vapor inhaled acts as a rapid restorative in cases oi fainting. Internally.—The ammonium preparations here mentioned are serviceable in lessening excessive acidity of the stomach. The aromatic spirit of ammonia is frequently beneficial in allaying the distress of nervous headache, and is also an efficient remedy to counteract the effects of an immoderate use of alcoholic stimulants, having proved in many cases valuable in the treatment of delirium tremens. The most important uses of these preparations are, perhaps, as powerful diffusible stimulants to the circulatory, respiratory, and spinal systems. They are of undoubted value in sudden cardiac failure arising from any cause, such as poisoning from chloroform, noxious gases, hydrocyanic acid, etc. Taken internally or by intra- venous injection, they counteract the poisonous effects resulting from the bites of venonions reptiles. The carbonate is an excellent stimulant to sustain the heart and respiration during the course of pneumonia, eruptive and con- tinued fevers, etc. In all dynamic conditions of the heart this preparation should be given in small doses, frequently repeated. 37 578 A TEXT-BOOK OF MATERIA MEDICA. The carbonate is also a valuable stimulant expectorant in chronic bronchitis and broncho-pneumonia. The preparations of ammonia have been recommended in threatened thrombosis. The condition being established, however, the only effective method of treatment is by intravenous injection, when the thrombi may be redissolved through direct contact with the remedy. Contraindications.—Acute gastritis and conditions of excessive acidity of the urine. Conditions of anemia and great emaciation would contraindicate the prolonged use of these preparations. Administration.—The liquid preparations should always be well diluted, and the carbonate should invariably be given in solu- tion. The fluid extract of glycyrrhiza disguises the taste very well. Owing to the rapid elimination of these drugs, the dosage should be frequently repeated. GROUP IX.—CARDIAC SEDATIVES. AconTtum—Aconiti—Aconite. U. S. P. Origin.—The tuber of Aconitum Napellus L., a plant about 40 inches (1 M.) high, met with throughout the greater portion of Asia and Europe, mostly in mountainous regions. Description and Properties.—From §- to |- inch (10-20 Mm.) thick at the crown, and from 2 to 3 inches (50-75 Mm.) long, with scars or fragments of radicles; dark brown externally, whitish in- ternally ; with a rather thick bark, the central axis about seven- rayed ; without odor, taste at first sweetish, soon becoming acrid, and producing a sensation of tingling and numbness lasting for some time. It contains an acrid alkaloid, aconitine. Dose.—\-2 grains (0.03-0.12 Gm.). Official Preparations. Extr3ctum Aconiti—Extr3cti Aconiti—Extract of Aconite.—Dose, -e\-\ grain (0.006-0.01 Gm.). Extractum Aconiti Fluidum—Extracti Aconiti Fluidi—Fluid Extract of Aconite.—Dose, ^o~2 minims (0.006-0.12 Cc). Tinctura Aconiti—Tincturae Aconiti—Tincture of Aconite.—Dose, £-5 min- ims (0.008-0.3 Cc). CARDIAC SEDATIVES. 579 Unofficial Preparation. Fleming's Tincture of Aconite is nearly twice as strong as the official tincture, the dose being correspondingly smaller. Aconitlna—Aconitlnae—Aconitine. (Unofficial.) Origin.—An alkaloid principle extracted from Aconite. Description and Properties.—The alkaloid exists in two forms, crystalline and amorphous ; white or yellowish-white, odorless, with a strong acrid taste characteristic of aconite. The crystalline form is soluble in alcohol, ether, and chloroform, and partially so in water. The alkaloid is one of the most powerful of poisons, rivalling in virulence hydrocyanic acid. The various aconitines are of different strengths, so that only the minimum dose of a new sample should at first be employed. Dose.—t^Vu—2T0~ gram (0.00006-0.00025 Gm.). Oleatum Aconitlnae—Oleati Aconitlnae—Oleate of Aconite.—A 2 per cent. solution of Aconitine in Oleic Acid. For external use. Antagonists and Incompatibles.—Digitalis and other cardiac stimulants, including atropine and ether, antagonize the action of aconite. Synergists.—All members of this group and cold enhance the action of the drug. Physiological Action.—Externally and Locally.—Applied to mucous membranes or to the skin for any length of time, aconite first stimulates and then depresses the ends of the sensory nerves, producing respectively tingling, numbness, and local anesthesia. Internally.—Digestive System.—Except when given in very di- lute solutions, aconite produces tingling and numbness of the lips and mouth, with increased secretion from the salivary glands. Large doses cause great irritation, together with a sense of con- striction in the fauces. Under normal conditions of the stomach aconite may act upon that organ as a sedative, augmenting its secretions. Large doses may occasion pain, nausea, and vomiting. Circulatory System.—Aconite causes a marked slowing of the heart's action, due to stimulation of the vagus center in the me- dulla. Following the slowing of the heart, due to vagus action, aconite has a direct action on the heart-muscle, increasing its irri- 580 A TENT-BOOK OF MATERIA MEDICA. tability, causing it to become very rapid and weak, eventually occa- sioning delirium cordis through over-stimulation. Death usually occurs from cardiac paralysis, the heart being arrested in diastole. The arterioles are contracted, owing to stimulation of the vaso- motor center in the medulla; but because of this action, occasion- ing a marked slowing of the heart, there is a great decrease of blood-pressure. Moreover, the contractive action of the vaso- motor center is somewhat counteracted by its primary stimulation of the cutaneous nerves, resulting in dilatation of the peripheral vessels and consequent flushing of the skin. Nervous System.—Excessive doses of aconite cause a slight stimulation of the sensory nerve-endings, finally followed by depression, the muscles passing into a state of paralysis, probably occasioned by direct action upon the muscle-tissue. Respiratory System.—The respiration is slowed by moderate doses; under large doses it is rendered both shallow and slow. The breathing is retarded, -because the peripheral endings of the vagi distributed to the lungs are depressed. Under large doses there is depression of the respiratory center, paralysis of which may be occasioned by lethal amounts. Absorption and Elimination.—Aconite is rapidly absorbed, but its channels of elimination are not definitely known, although it is probably excreted by the kidneys, and to some extent by the skin, the drug acting as a mild diaphoretic. Temperature.—Aconite is alleged to be a decided antipyretic, the reduction of temperature being due to various causes : (1) the slow- ing of the circulation, diminishing the metabolism ; (2) the peripheral action of aconite, causing dilatation of the cutaneous blood-vessels; (3) the depressing action of the drug upon all muscle-tissue. Eye.—Toxic amounts of the drug have produced mydriasis, misty vision, and diplopia. Untoward Action.—Besides the symptoms described under " Poisoning," there have been observed pustular and erythematous eruptions, vertigo, and dimness of vision. Poisoning.—The first effect of toxic doses is to cause marked tingling of the tongue and lips, which sensation soon extends to the fingers and may even affect the entire cutaneous surface. There is extreme muscular weakness, particularly noticeable in the lower extremities. The pulse, at first slow and weak, soon becomes rapid and almost imperceptible. The respirations are quite feeble and shallow, and there may be marked dyspnea. CARDIAC SEDATIVES. 581 The countenance is anxious and the skin pallid, cold, and cov- ered with sweat, with great reduction of temperature. These symp- toms are accompanied by dimness of vision, the pupils usually being widely dilated. Rarely there are present epileptiform convulsions. Death may be postponed for some time, or it may rapidly follow a lethal dose. Treatment of Poisoning.—The patient should be placed in a horizontal position, better with the feet raised slightly. The stomach should be thoroughly evacuated; bodily heat should be maintained by external warmth ; diffusible stimulants, such as ether, alcohol, and spirits of ammonia should be given hypodermically, the treatment being followed by administration of digitalis. Atro- pine and strychnine hypodermically are indicated to stimulate the respiration and assist in stimulating the heart. Therapeutics.—Whether locally applied or given internally aconite is an excellent remedy in neuralgia?, particularly in tic douloureux. The tincture, aconite liniment, or an ointment of Aconitine may be applied to the course of the affected nerve. The tincture of aconite frequently proves beneficial in herpes zoster, chilblain, pruritus, etc., and its extended application has even been recommended to allay the pain of chronic rheumatism. Internally.—Aconite is an exceedingly efficacious remedy in many febrile diseases, particularly the sthenic fevers of children and those fevers resulting from inflammation, such as tonsillitis, laryn- gitis, pharyngitis, quinsy, etc. The drug seems to exert a pecu- liarly beneficial influence on mucous membranes, all acute inflam- matory conditions of the throat, bronchial tubes, or intestinal canal —characterized by fever, a small, wiry pulse, and rapid cardiac action—being greatly improved by the remedy. As previously indicated, aconite is one of the most efficient sedatives in the irritative fevers of children. It is equally valuable in the first stage of pneumonia and in pleurisy, and is an invaluable adjunct to opium in the treatment oi peritonitis. Pericarditis is often favorably influenced by this drug, while it is also of great service in allaying nervous palpitation of the heart or that due to cxccssiz'c cardiac hypertrophy. The injection into the rectum of 8 or 10 minims (0.5-0.6 Cc.) of the tincture of aconite, while perhaps producing a slight pro- lapsus of the rectum, quickly affects an irritable stricture of the urethra, so that a catheter may be passed with little difficult}-, al- though the operation may have been previously found impossible. 582 A TEXT-BOOK OF MATERIA MEDICA. Probably there is no better combination to "break up a cold" than aconite and Dover's powder, the tincture of aconite, given at frequent intervals for a few hours, being followed, preferably at bed- time, with 8 or 10 grains (0.5-0.6 Gm.) of Dover's powder. Aconite has been favorably recommended in the acute stages of cerebrospinal meningitis and as a cardiac sedative in aneurysm. Contraindications.—Aconite is always contraindicated in sub- acute or chronic conditions or when the heart's action is weak. It is also intolerable in catarrhal conditions of the stomach. Administration.—A good, reliable tincture is the best prepara- tion for internal use. Moreover, better results are obtained by giving the drug in fraction of minim doses—from -^ to \ minim (0.006-0.03 Cc.) in a teaspoonful of water every fifteen minutes— than by larger dosage. The most desirable influence of the drug appears to be realized by this method. Veratrum Viride—Veratri Viridis—Veratrum Viride. U. S. P. (American Hellebore.) Origin.—The rhizome and roots of Veratrum viride Solander, a plant growing in swampy places and damp thickets in Canada, and in the United States as far south as Georgia. The plant closely resembles V. album of Europe, and is also allied to a species found in Eastern Siberia. Description and Properties.—Rhizome upright, obconical, simple or divided, from 2 to 3 inches (50 to 75 Mm.) long; exter- nally blackish-gray, internally grayish-white, showing numerous short, irregular wood-bundles. Many shrivelled, light yellowish- brown roots issue from all parts of the rhizome. The drug is inodorous, but strongly sternutatory when pow- dered, the taste being bitterish and very acrid. Veratrum viride contains the following alkaloids : jcrvinc, pseu- dojervine, rubijervine, and cervadinc. The first named is the cardiac depressant principle of the drug, and the remaining three are ster- nutatory. Veratrina (U. S. P.) is not found in this drug, as formerly sup- posed, Sabadilla being its principal source. Veratroidine, once supposed to be a distinct alkaloid, is probably only a mixture of rubijervine and a toxic resin. Dose.—1-5 grains (0.01-0.3 Gm.). CARDIAC SEDATIVES. 5«3 Official Preparations. Extractum Veratri Viridis Fluidum—Extr3cti Veratri Viridis Fluidi— Fluid Extract of Veratrum Viride.—Dose, i-5 minims (0.01-0.3 Cc). Tinctura Veratri Viridis—Tincturae Veratri Viridis—Tincture of Veratrum Viride (40 per cent.).—Dose, £-5 minims (0.01-0.3 Cc), Allied Drugs. Veratrum Album—Veratri Albi—White or European Hellebore. Sebadllla—Sebadlllae—Cevadilla. The seeds of this plant yield the following official alkaloid, known as Veratrine: Veratrlna—Veratrlnae—Veratrine. U. S. P. Description and Properties.—A white or grayish-white, amor- phous or semi-crystalline powder; odorless, but causing intense irritation and sneezing whenever even a minute quantity reaches the mucous membrane; of an acrid taste, and leaving a sensation of tingling and numbness on the tongue; permanent in the air; very slightly soluble in hot or cold water, soluble in 3 parts of alcohol. Dose.—M-\ grain (0.0016-0.016 Gm.). Official Preparations. Oleatum Veratrlnae—Oleati Veratrlnae—Oleate of Veratrine (2 percent.). For external use. UnguSntum Veratrlnae—UnguSnti Veratrlnae—Veratrine Ointment (4 per cent.). For external use. Antagonists and Incompatibles and Synergists are the same as for Aconite. Physiological Action.—The following remarks refer only to the crude drug, the actions of Jcrvinc, the mixture Veratroidine, and Veratrine being given separately. Externally and Locally.—Veratrum is more of an irritant than aconite, exciting some inflammation of the skin when applied locally, and when in contact with the nasal mucous membrane producing violent sneezing. Internally.—Its effects are in every respect analogous to those of aconite, with the following exceptions, in the several systems: Digestive System.—Veratrum is more apt to occasion nausea and vomiting. Circulatory System.—The drug is a more powerful depressant to the circulation, small doses, while not materially affecting the 584 A TEXT-BOOK OF MATERIA MEDICA. pulse-rate, greatly reducing its force, large doses rendering the pulse very weak, almost indistinguishable, and very rapid. Nervous System.—It does not, as does aconite, affect the sen- sory nerves, but in large doses paralyzes the motor system cen- trally, impairing the reflexes. Under moderate doses there is extreme muscular weakness. Respiratory System.—Veratrum depresses the respiration less than aconite. Absorption and Elimination.—The drug is absorbed with great facility, and is eliminated chiefly by the bowels. It possesses much feebler diuretic and diaphoretic properties than aconite. Temperature.—In medicinal doses it is not so powerful an anti- pyretic as aconite. Untoward Action.—Veratrum occasionally produces an erythem- atous or pustular eruption. Poisoning.—Except that the drug causes no cutaneous anesthe- sia or diminution of sensation, the symptoms of poisoning are almost identical with those occasioned by aconite. Treatment of Poisoning.—The same as prescribed for aconite. The Physiological Actions of jervine, veratroidine, and vera- trine are as follows: Externally and Locally.—Jervine is a mild irritant when applied to the skin or mucous membranes. Veratroidine is less irritating when similarly applied. Veratrine is a powerful irritant when applied by inunction, producing a tingling or prickling sensation, followed by pain and finally by numbness. Internally.—Digestive System.—Jervine has no noticeable effect upon the stomach and bowels, but produces marked salivation. Veratroidine in full doses occasions vomiting and purging. Vera- trine excites great irritation of the gastro-intestinal tract, causing profuse salivation, with vomiting and purging and severe epigas- tric pain. Circulatory System.—Jervine renders the pulse slower, softer, and fuller, with marked reduction of arterial pressure. This action is due to direct depression of the cardiac muscle or of the motor ganglia, the dilatation of the arterioles being the result of a de- pressant effect upon the vaso-motor center. Veratroidine retards the heart's action by stimulating the pneu- mogastrics. The arterial pressure is lowered by weakening of the heart. The vaso-motor center is not depressed, nor are the arte- rioles dilated. CARD I A C SEDA TII ES. 585 Veratrine markedly retards cardiac action, lengthening the diastolic period. The blood-pressure is decreased. Nervous System.—Jervine causes great muscular weakness, with abolition of reflexes, owing to its depressing action upon the motor areas of the spinal cord. Upon the cerebral motor areas, however, its influence is that of a stimulant, so that poisonous doses of this alkaloid produce convulsions of cerebral origin. The muscles themselves and the motor nerves are unaffected, though in the later stage of poisoning numbness is present, showing that some portion of the sensory mechanism is depressed. Veratroidine manifests the same action as jervine. Veratrine.—This alkaloid affects neither the brain nor the spinal cord. The motor and sensory nerves, on the other hand, betray its influence, being first stimulated and then paralyzed. The pain primarily produced by the local application of vera- trine is due to excessive stimulation of the peripheral endings of the sensory nerves. Respiratory System.—Jervine is a powerful depressant to the respiration, death occurring from asphyxia when lethal doses are taken. Veratroidine affects the system in like manner with jervine. Veratrine.—Small doses accelerate the respiratory movements. Large doses retard and finally arrest respiration—the former amounts acting as stimulants, and the latter causing paralysis of the respiratory center. Temperature.—Moderate amounts of jervine and veratro- idine have no marked effect upon, while poisonous doses depress, temperature. Veratrine in large doses is more of an antipyretic than either jervine or veratroidine. Poisoning.—The symptoms of poisoning from either one of the above alkaloids would be a combination of the effects produced by lethal amounts, as stated, separately. Treatment of Poisoning.—The same as prescribed under Vera- trum Viride. Therapeutics.—Externally and Locally.—Veratrum viride is seldom, if ever, used locally. Veratrine, though in rare cases given internally, is wellnigh restricted to external or local appli- cation. The oleate or ointment of veratrine when applied over the affected nerve is exceedingly efficacious in neuralgia, particularly 586 A TEXT-BOOK OF MATERIA MEDICA. in tic douloureux and orbital neuralgia. In the latter affection great care should be taken in administration, lest some portion of the drug enter the eye, in which case violent and persistent conjuncti- vitis would ensue. Internally.—Veratrum viride may be employed for the same conditions for which aconite is recommended, although it is doubt- ful whether it possesses any advantages over the latter drug; in- deed, by man)' competent physicians it is considered inferior to, and more dangerous than, aconite. Moreover, the nausea and vomiting which in many patients are likely to follow the ingestion of this drug render its use objectionable. Contraindications.—The same as for aconite. Administration.—The tincture of veratrum viride only should be given, beginning with small doses, as recommended for aconite, and cautiously increasing the amount. Veratrine may be applied in the form of an ointment, oleate, or in solution together with alcohol and glycerin. Phytolaccae Fructus—Phytolaccae Fructus—Phyto- lacca Fruit. U. S. P. Origin.—The fruit of Phytolacca decandra L., a perennial herb indigenous in North America, growing in waste places. Description and Properties.—A depressed-globular, dark- purple compound berry, about \ inch (8 Mm.) in diameter, com- posed of ten carpels, each containing one lenticular black seed; juice purplish-red, inodorous; taste sweet, slightly acrid. The fruit contains phytolaccin, phytolaccic acid, tannin, gum, sugar, and a coloring matter. Dose.—5-30 grains (0.3-2.0 Gm.). Phytolaccae Radix—Phytolaccae Radicis—Phyto- lacca Root. U. S. P. (Poke-root.) Origin.—The root of Phytolacca decandra L. Description and Properties.—Large, conical, branched, and fleshy; mostly in transverse or longitudinal slices, wrinkled, gray- ish, hard; fracture fibrous, the wood-bundles in several distinct concentric circles; inodorous; taste sweetish and acrid. It con- tains resin, gum, fixed oil, tannin, starch, sugar, and a glucosid. Dose.—5-30 grains (0.3-2.0 Gm.). CARDIAC SEDATIVES. 587 Official Preparation. Extractum Phytolaccae Radicis Fluidum—Extracti Phytolaccae Radicis Fluidi—Fluid Extract of Phytolacca Root.—Dose, 5-30 minims (0.3-2.0 Cc). Antagonists and Incompatibles.—The cardiac stimulants, opium, and ether oppose the action of phytolacca. Synergists.—All the members of this group; the motor- depressants and emetics also enhance the action of the drug. Physiological Action.—Externally and Locally.—The pow- dered root is extremely irritating to mucous membranes, in certain subjects occasioning an erythematous eruption and excoriations. Internally.—Digestive System.—Phytolacca possesses emeto- cathartic properties. It occasions much nausea, with great de- pression, persisting for some time before vomiting occurs. The drug augments the secretion of bile and acts as a laxative. Circulatory System.—Like aconite, it reduces the force and fre- quency of the heart's action and lowers arterial tension. Nervous System.—Poke-root is a powerful motor depressant, acting as a direct paralyzant to the spinal cord and medulla, although the muscles and motor nerves are unaffected. Respiratory System.—Phytolacca is a respiratory depressant, rendering the breathing slow and shallow. Toxic doses produce death by paralysis of the respiratory center, preceded by tetanic convulsions. Absorption and Elimination.—The drug is readily absorbed, and is eliminated chiefly by the kidneys. Temperature.—Medicinal doses have no effect on temperature. Poisoning.—The symptoms of poisoning are quite similar to those produced by veratrum, though the nausea and vomiting are postponed longer after the ingestion of phytolacca. Treatment of Poisoning.—The same as recommended under Aconite and Veratrum. Therapeutics.—Externally and Locally.—Preparations of phyto- lacca have been successfully used to allay inflammation, as in cases of follicular pharyngitis, tonsillitis, mastitis, ulcers, buboes, burns, abscesses. The drug is also useful in chronic eczema, sycosis, favus, etc. The fluid extract may be applied, or the powdered root incorporated in ointment either singly or associated with other medicinal agents. Internally.—The drug has proved an efficient remedy in chronic rheumatism, its alterative properties rendering it also of some service in the treatment of scrofula, syphilis, and chronic diseases of the skin. 588 A TEXT-BOOK OF MATERIA MEDICA. In mastitis, follicular pharyngitis, tonsillitis, etc. the internal use of the drug is indicated, mastitis especially often yielding readily to the internal use of the fluid extract, combined with the local application of an ointment containing phytolacca. It has been recommended in obesity, possessing undoubted efficacy in this respect. It is claimed that the proprietary prep- aration known as "Anti-fat" is a resinoid preparation of the berries. Contraindications.—The same as for veratrum viride. Administration.—No special directions are necessary. The powder, tincture, or fluid extract may be given internally; for topical use an ointment may be prepared. Pulsatilla—Pulsatlllae—Pulsatilla. U. S. P. Origin.—The herb of Anemone Pulsatilla and Anemone pra- tensis L., collected soon after flowering. Description and Properties.—Leaves radical, petiolate, silky- villous, twice or thrice deeply three-parted or pinnately cleft, with linear, acute lobes, appearing after the large purple flowers; in- odorous, very acrid. It contains a peculiar, acrid, crystallizable principle known as ancmonin. Dose.—1-5 grains (0.06-0.3 Gm.). Unofficial Preparations. Extractum Pulsatlllae—Extracti Pulsatlllae—Extract of Pulsatilla.—Dose, £-3 grains (0.03-0.2 Gm.). Tinctura Pulsatlllae—Tincturae Pulsatlllae—Tincture of Pulsatilla.—Dose, 10-20 minims (0.6-1.2 Cc). Anemonin.—Occurring in crystalline, colorless needles, soluble in warm alcohol, insoluble in water.—Dose, \-\ grain (0.05-0.01 Gm.). Antagonists and. Incompatibles and Synergists the same as for Aconite. Physiological Action.—Externally and Locally.—Pulsatilla is a decided irritant to the skin, the bruised plant when rubbed upon it even producing vesication. In the mouth it produces a sensation of burning, succeeded by numbness. Internally.—The action of the drug is identical with that of aconite, though pulsatilla possesses greater emetic properties. Therapeutics.—The drug may be employed for the same pur- poses as aconite, though as a cardiac sedative it is less efficient. It has been recommended as a useful emmenagogue. CARDIAC SEDATIVES. 589 Arnicae Flores—Arnicae Florum—Arnica Flowers. U. S. P. Origin.—The flower-heads of Arnica montana L., a plant in- digenous in the mountainous regions of Europe and Northern Asia, and also found in the northwestern part of America. Description and Properties.—Heads about I to 2 inches (25-50 Mm.) in diameter, depressed-roundish, consisting of a scaly in- volucre in two rows, and a small, nearly flat, hairy receptacle, bearing about sixteen yellow, strap-shaped, ten-nerved ray-florets and numerous yellow, five-toothed, tubular disk-florets, with slen- der, spindle-shaped akenes crowned by a hairy pappus. Odor feeble and aromatic ; taste bitter and acrid. Arnica flowers contain a glucosid (?), arnicin, a volatile oil, capronic and caprylic acids, resins, tannin, etc. Dose.—5-30 grains (0.3-2.0 Gm.). Official Preparation. Tinctura Arnicae Florum—Tincturae Arnicae Florum—Tincture of Arnica Flowers (20 per cent.).—Dose, 10-30 minims (0.6-2.0 Cc). Chiefly, however, used externally as a vulnerary. Arnica Radix—Arnicae Radicis—Arnica Root. U.S. P. Origin.—The rhizome and roots oi Arnica montana L. Description and Properties.—The rhizome is horizontal, some- what contorted, 2 to 3 inches (5-7 Cm.) long, and \ or \ (3 or 4 Mm.) or less in diameter, externally brown, rough from leaf-scars, internally whitish, with a rather thick bark containing a circle of resin-cells surrounding the short, yellowish wood-wedges, and a large, spongy pith. The roots are numerous, thin, fragile, grayish- brown, with a thick bark containing a circle of resin-cells. Odor somewhat aromatic; taste pungently aromatic and bitter; the con- stituents the same as those of the flowers. Dose.—5-30 grains (0.3-2 Gm.). Official Preparations. ExtrSctum Arnicae Radicis Fluidum—Extr3cti Arnicae Radicis Fluidi— Fluid Extract of Arnica Root.—Dose, 5-30 minims (0.3-2.0 Cc). Extractum Arnicae Radicis—Extracti Arnicae Radicis—Extract of Arnica Root.—/W, 2-5 grains (0.13-0.3 Gm.). Emplastrum Arnicae—Empiastra Arnicae—Arnica Plaster (^3 Per cent- °f extract). For external use. 590 A TEXT-BOOK OF MA TERIA MEDICA. Tinctura Arnicae Radicis—Tincturae Arnicae Radicis—Tincture of Arnica Root (io per cent.).—Dose, 20-30 minims (1.3-2.0 Cc). Antagonists and Incompatibles and Synergists are the same as for Aconite. Physiological Action.—Externally and Locally.—The local action of both the root and flowers is irritant, that of the latter being the more powerful. Occasionally tincture of arnica flowers produces marked inflammation of the skin, resembling erysipelas. Internally.—The internal effects of arnica are as yet imperfectly understood, it being difficult to assign the drug to its proper group. Digestive System.—Small doses slightly stimulate the digestive apparatus. Large amounts produce nausea, vomiting, and diarrhea of a choleraic character. Circulatory System.—Small doses stimulate the heart and in- crease arterial pressure; full or large doses retard the pulse and depress the circulation. Nervous System.—Large amounts cause headache, with great depression of the nerve-centers. Toxic amounts occasion motor and sensory paralysis, coma, at times convulsions, collapse, and death. Respiratory System.—The respiration is slowed, although under small doses there may be temporary acceleration. Absorption and Elimination.—The active principle of arnica dif- fuses readily into the blood, the drug being eliminated chiefly by the kidneys, though the skin shares in the excretory process. Temperature.—Large doses cause a reduction of temperature. Untoward Action.—The topical application of arnica may cause in susceptible persons violent cutaneous inflammation and the pro- duction of pustules, or even distinct bullae, attended with marked constitutional symptoms. When taken internally the drug occa- sions a sensation of burning in the mouth and throat, violent pain in the stomach, tenesmus, and choleraic diarrhea, intense headache, and dizziness. Poisoning.—In addition to the above-named symptoms there are great cardiac depression, decided muscular weakness, slow and shallow respiration, paralysis of the nervous system, and death resulting from collapse. Treatment of Poisoning.—The treatment should be much the same as that prescribed under Aconite. Atropine is probably the best physiological antidote. Therapeutics.—Externally and Locally.—Arnica enjoys a well- CARDIAC SEDATIVES. 591 deserved reputation as an efficient remedy for the relief of bruises, sprains, and external inflammations generally. It has been recom- mended also as a topical application in myalgic rheumatism. The local application of the tincture causes the rapid disappearance of ecchymoses. Equal parts of the tincture of arnica and glycerin, diluted with water, have been recommended as a stimulant in inflammation of the mucous membrane of the mouth. Internally.—Arnica is not a very popular remedy for internal administration. It has, however, been used with varying success in idiopathic mania, delirium tremens, and rheumatic gout. It has also been beneficially employed in exhausting diarrhea, chronic dys- entery, epistaxis, hemoptysis, and paralysis of the bladder. Contraindications.—Externally when there exists any acute skin disease; internally in cases of inflammation of the gastro-in- testinal tract, fatty or valvular disease of the heart, and in all asthmatic conditions. Administration.—The tincture of arnica is the form generally preferred for external and internal use. In applying any prepara- tion externally the susceptibility to the irritating properties of the drug peculiar to certain persons should be remembered. Potassii Nitras—Potassii Nitratis—Potassium Nitrate. U. S. P. (Nitre; Saltpetre.) Origin.—Purified from native Saltpetre. Description and Properties.—Colorless, six-sided, rhombic prisms, or a crystalline powder; odorless, and having a cooling, saline, and pungent taste. Permanent in the air. Soluble in 3.8 parts of water, very sparingly soluble in alcohol. Dose.—5-30 grains (0.3-2.0 Gm.). Official Preparations. Argfenti Nitras Dilutus—ArgSnti Nitratis Diluti—Diluted Silver Nitrate. —Used externally. Ch3rta Potassii Nitratis—Chartas (ace) Potassii Nitratis—Potassium Nitrate Paper.—Intended for burning, the fumes to be inhaled. Antagonists and Incompatibles.—Cardiac and diffusible stim- ulants antagonize the action of potassium nitrate upon the heart. Mineral acids and metallic salts are incompatible. Synergists.—The cardiac depressants, diuretics, and agents increasing waste aid the action of potassium nitrate. 592 A TEXT-BOOK OF MATERIA MEDICA. Physiological Action.—Externally and Locally.—The drug has no important local action. Internally.—Digestive System.—Large doses occasion nausea and vomiting; poisonous doses produce violent gastro-intestinal inflammation and diarrhea, blood sometimes being vomited and passed with the stools. Circulatory System.—Small doses have no marked influence on the circulatory system ; full doses act as a cardiac depressant, slow- ing and weakening the pulse; poisonous doses produce great weak- ness, syncope, and death from cardiac failure. Nervous System.—No special action is noticeable, although poi- sonous doses produce tremulousness, insensibility, and convulsions. Respiratory System.—Large doses retard respiration. Absorption and Elimination.—Potassium nitrate passes rapidly into the blood unchanged, and is eliminated by the kidneys un- changed. Small doses are actively diuretic, stimulating the renal cells. Large amounts, from too free stimulation, are apt to irri- tate and inflame the kidneys, even so far as to produce hematuria. The drug is also eliminated to some extent by the skin, being therefore a mild diaphoretic. Temperature.—Unaffected by medicinal amounts, but lowered by poisonous doses. Poisoning.—There is violent gastro-intestinal inflammation, with vomiting and purging, blood being present in the ejecta and feces. Other symptoms are—subnormal temperature, coldness of the ex- tremities, a weak and thready pulse, slow and shallow respiration, tremulousness and great muscular weakness, dimness of vision or total blindness, deafness, insensibility, and possibly convulsions. The urine is diminished or suppressed. Should the patient recover from an immoderate dose of the drug, he suffers for some time from dysuria, irritability of the stomach, colic, muscular weakness, and a sensation of chilliness in the back and limbs. Treatment of Poisoning.—There is no special antidote for nitre; cases of poisoning, therefore, are to be treated symptomatically, measures for relief including evacuation of the stomach, de- mulcents, opiates for pain, and cardiac and respiratory stim- ulants. Therapeutics.—Externally and Locally.—Solutions of this drug have been found serviceable as applications to bruises and abrasions. The last stage of pharyngitis is greatly relieved by a gargle of a CARDIAC SEDATIVES. 593 solution of potassium nitrate, in the proportion of 1 drachm (4.0 Gm.) to 1 pint (473 Cc.) of water. It is claimed that a paste of powdered nitre and water applied to the face night and morning is an effective method of removing freckles. The difficulty of breathing in cases of spasmodic asthma may be greatly relieved by the inhalation of the fumes of burning NITRE-PAPER. Internally.—The drug was formerly much used in acute artic- ular rheumatism and as a refrigerant and sedative in inflammations, pneumonia, and various fevers. It is employed to a considerable extent as a diuretic and diaphoretic, although greatly inferior to the acetates and citrates. Administration.—It should be given in solution, though the powder is sometimes used in combination with calomel, tartar emetic, or Dover's powder. The potassium-nitrate paper, as has been stated, should be burned and the fumes arising therefrom inhaled. Sodii Nitras—Sodii Nitratis—Sodium Nitrate. U. S. P. Origin.—It is found in great quantities imbedded in clay and sand in certain districts of Chili and Peru. Description and Properties.—Colorless, transparent, rhombo- hedral crystals, odorless, having a cooling, saline, and slightly bit- ter taste; deliquescent in moist air. Soluble in 1.3 parts of water and in about 100 parts of alcohol. Sodium nitrate should be kept in well-stoppered bottles. Dose.—\-\ ounce(15.5-31.0 Gm.). Physiological Action.—The action of the salt resembles closely that of potassium nitrate, though it is much feebler than the latter drug, while possessing greater purgative properties. Therapeutics.—Externally and Locally.—A solution of the salt possesses some power as a solvent of false membranes, and has been used in the form of a spray to diminish fibrinous exudations in the pharynx and larynx. Internally.—It may be employed for the same purposes as the potassium nitrate, and has been advantageously adopted as a laxa- tive in diarrhea and dysentery. Administration.—Sodium nitrate is best given dissolved in a large quantity of water. 594 A TEXT-BOOK OF MATERIA MEDICA GROUP X.—DIAPHORETICS. Diaphoretics—or sudoriflcs, as they are also called—are medi- cines which promote diaphoresis or sweating. Their action in stimulating transpiration by the skin may be enhanced by exer- cise, external warmth, nauseants, and drugs which dilate the vessels, determining more blood to the cutaneous blood-vessels. Diaphoretics are employed principally for their evacuant, revul- sive, and alterative effects, and to promote absorption. Pilocarpus—Pilocarpi—Pilocarpus. U. S. P. (Jaborandi.) Origin.—The leaflets of Pilocarpus selloauus Engler (Rio Janeiro Jaborandi) and oi Pilocarpus jaborandi Holmes (Pernambuco Jabo- randi). Description and Properties.—About 4 to 6 inches (10-15 Cm.) long and h to 2\ inches (4-6 Cm.) broad, short-stalked, oval or ovate-oblong, entire and slightly revolute at the margin, obtuse and slightly emarginate, unequal at the base; dull-green, coriace- ous, pellucid punctate, mostly smooth; when bruised, slightly aromatic; taste somewhat bitter and pungent. Pilocarpus contains a volatile oil and two alkaloids, pilocarpine and jaborine, the latter being chemically isomeric with the former, although directly antagonistic in physiological action. Dose.—5-60 grains (0.3-4.0 Gm.). Official Preparation. Extractum Pilocarpi Fluidum—Extr3cti Pilocarpi Fluidi—Fluid Extract of Pilocarpus.—Dose, 5-60 minims (0.3-4.0 Cc). Unofficial Preparation. Infusum Pilocarpi—Infusi Pilocarpi—Infusion of Pilocarpus.— Dose, 2 fluici- drachms-4 fluidounces (8.0-118.3 Cc). Pilocarplnae Hydrochloras—Pilocarpine Hydro- chloratis—Pilocarpine Hydrochlorate. U.S.P. Origin.—The hydrochlorate of an alkaloid obtained from Pilo- carpus. Description and Properties.—Small, white crystals, odorless and of a faintly bitter taste; deliquescent on exposure to damp air. DIAPHORETICS. 595 Very soluble in water and in alcohol. It should be kept in small, well-stoppered bottles. Dose.—-$x-\ grain (0.OOI-O.03 Gm.). Jaborine is a yellow, amorphous alkaloid, isomeric with pilocarpine and closely resembling atropine in its physiological action. The varying effects which occasionally follow the use of the commercial pilocarpine are due to the presence of jaborine, which antagonizes the action of pilocarpine in almost every particular. It is highly important, therefore, when administering pilocarpine or any of its pren- arations to obtain the drugs free from jaborine, which is not used medicinally. Antagonists and Incompatibles.—Atropine is a perfect physi- ological antagonist to pilocarpine, being directly opposite in its action throughout its entire range, T\^ grain (0.0006 Gm.) being sufficient to counteract \ grain (0.01 Gm.) of pilocarpine. Morphine relieves the nausea. The incompatibles are tannic acid, caustic alkalies, and the ferric and metallic salts. Synergists.—The cardiac depressants, particularly aconite and veratrum viride, gelsemium, sarsaparilla, spirit of nitrous ether, and drugs which paralyze the vaso-motor system, enhance the activity of pilocarpus. Physiological Action.—Externally and Locally.—There is no action of importance. Internally.—Digestive System.—The action of pilocarpine is here given, since the alkaloid fully represents the drug. When pilocarpine is taken into the mouth, the ends of the chorda tympani and secretory nerves are stimulated, causing an increased secretion of saliva. Should large doses be taken, there is a feeling of tenderness in the mouth and severe salivation is produced. The gastric glands are stimulated by the drug, their normal secretion being augmented. By stimulating the unstriped muscle- fibers pilocarpine increases peristalsis, both of the stomach and the intestines, in large doses acting as a cathartic. Immoderate amounts may also induce vomiting. The bile and pancreatic juice are not affected by moderate amounts of the drug. Circulatory System.—At first the vaso-motor nervous system is depressed, resulting in an acceleration of the cardiac movements, with dilatation of the blood-vessels. The heart, however, is soon slowed and the arterial pressure lowered, so that pilocarpine is in reality a cardiac depressant rather than a cardiac stimulant. Pilocarpine acts directly upon the heart, either by stimulating 596 A TEXT-BOOK' OF MA TERIA MEDICA. the terminations of the vagus or by depressing the motor centers in the heart-muscle or the muscle itself. Nervous System.—In medicinal amounts pilocarpine has no per- ceptible action on the central nervous system, although stimulating the nerve-terminations of involuntary muscles—/'. e. those of the stomach, intestines, heart, spleen, bladder, uterus, etc. Poisonous doses have produced (in the frog) tetanic convulsions, followed by paralysis, the result of depression of the muscles and spinal centers, the nerves apparently being unaffected. Respiratory System.—The respiratory movements are unaffected by medicinal amounts, but the bronchial secretion is augmented. Absorption and Elimination.—Pilocarpine is rapidly absorbed, and is eliminated principally by the skin, occasioning free, and under large doses excessive, diaphoresis. The sweat is at first acid, then neutral, and finally alkaline in reaction. The diaphoresis produced by pilocarpine is due to stimu- lation of the secretory nerves supplying the glands. The kidneys, under small doses, are stimulated, there being a slight increase in the urine, while in disease the amount of urea is considerably augmented. The drug is also eliminated by the salivary glands, there being frequently an enormous increase in the salivary secretion. Under the influence of pilocarpine there is an increase in the gastric, bronchial, and lacrymal secretions, even the secretion of milk being notably augmented. Temperature.—Succeeding a very brief and slight elevation of temperature there is a decided diminution of bodily heat, resulting from the dilatation of cutaneous blood-vessels and the evaporation of the perspiration. Eye.—Whether applied locally to the eye or taken internally, pilocarpine produces marked contraction of the pupil by stimulating the peripheral endings of the iridal nerves. The drug also pro- duces an increased tension of the eyeball. Uterus.—There is authority for the statement that pilocarpine stimulates the gravid uterus, inducing uterine contractions or in- creasing the energy of those already established. The effect of the drug upon the uterus, however, is more pro- nounced and apparent in cases of eclampsia, seeming to prove the fallacy of the statement that pilocarpine is a true ecbolic. Untozuard Action.—Nausea and vomiting are of quite frequent occurrence, the vomiting being preceded by long and distressing DIAPHORETICS. 597 nausea. Occasionally the patient complains of severe pain in the urethra and in the lumbar region, with frequent desire to micturate. There have often been present headache, vertigo, hiccough, dimness of vision, gastric and abdominal pains, stupor, and chilli- ness. There may occur even collapse. Poisoning.—The symptoms produced by poisonous doses of pilocarpine are exaggerations of those described above, together with diarrhea, exhausting and excessive sweating and salivation, marked cardiac and respiratory depression, and collapse. Treatment of Poisoning.—If the drug has been ingested, the stom- ach should be immediately cleansed with a solution of tannic acid. To counteract the untoward effects of pilocarpine, whether the drug has been ingested or given by subcutaneous injection, atro- pine is undoubtedly the most complete physiological antagonist, and should be given hypodermically. Morphine is indicated to control the nausea and vomiting, while some of the cardiac stimu- lants may be required to counteract cardiac depression. Therapeutics.—Externally and Locally.—Pilocarpine, or the fluid extract of jaborandi, has been highly recommended for alopecia. By the use of pilocarpine the hair becomes darker. The fluid extract of pilocarpus has been employed as a local appli- cation in erysipelas and eczema. Lozenges containing -£§ grain (o.ooi Gm.) of pilocarpine are efficient in relieving dryness of the throat. As a myotic pilocarpine is used in many diseases of the eye. Internally.—The principal internal use of pilocarpine is as a diaphoretic in Brighfs disease. In cardiac dropsy it is not a safe remedy, because of its depressing influence upon the heart. The drug is very efficient in removing pleuritic effusion, while in uremic poisoning it is unquestionably the most valuable remedy we possess. The hypodermic injection of small doses of pilocarpine has been highly recommended as an efficient remedy in erysipelas, particularly during the first stages of the disease. The drug has been successfully used to abort malarial paroxysm, and has proved beneficial in tobacco and alcoholic amblyopia. Pilocarpine has been found useful in humid asthma, bronchor- rhea, and hiccough, and, in small doses, in arresting the szveating of phthisis and for the relief of ptyalism. The drug is an efficient galactogoguc, and has been used with success in mumps, chronic en- largement of the cervical glands, and adenitis of the inguinal glands. 598 A TEXT-BOOK OF MATERIA MEDICI. Pilocarpine materially lessens the flow of urine in diabetes in- sipidus, and in main- diseases of the eye and ear the internal use <>f the drug serves a useful purpose. The property possessed by pilocarpine of stimulating the glands of the skin renders this remedy of great service in man)- chronic diseases of the skin characterized by a dry, scah' condition. It is a peculiarly valuable agent in phthiriasis, psoriasis, certain forms of eczema, pruritus senilis, etc. Pilocarpine or fluid extract of jaborandi may be useful in breaking up a cold. Finally, pilocarpine has been highly recommended in catarrhal jaundice, and is one of the most efficient antidotes to belladonna- poisoning. Contraindications.—The drug should never be employed when the heart is weak from thinning and atrophy of its walls or from fatty degeneration, nor where there is a tendency to pulmonary conges- tion and edema. The drug is also contraindicated in asthenic fevers, such as typhoid fever, etc. Administration.—Pilocarpine is superior to the crude drug, being far more reliable in its action and less liable to produce nausea and vomiting. Pilocarpine is usually given hypodermically, although it is frequently administered by the mouth, in solution, or in trOches. Of all the preparations of the crude drug, the fluid extract and infusion are commonly employed, the latter being less apt to cause profuse salivation. An elixir of pilocarpus is prescribed consider- ably. Should preparations of jaborandi be given upon an empty stomach, they are less apt to occasion nausea. This inconvenience may be also avoided by giving an infusion by enema. Liquor Ammonii Acetatis—Liquoris Ammonii Ace- tatis—Solution of Ammonium Acetate. U. s. P. (Spirit of Mindererus. i Origin.—An aqueous solution of Ammonium Acetate, contain- ing about 7 per cent, of the salt, together with small amounts of Acetic and Carbonic Acids. Description and Properties.—A clear, colorless liquid free from empyreuma, of a mildly saline, acidulous taste and an acid reaction. This preparation when required should be freshly made. Dose.—h-i fluidounce (15.0-30.0 Cc), in sweetened water. DIAPHORETICS. 599 Official Preparation. Liquor F6rri et Ammonii Acetatis—Liquoris Fern et Ammonii Acetatis— Solution of Iron and Ammonium Acetate (Basham's Mixture).—Described under " Preparations of Iron.'' Antagonists and Incompatibles.—The metallic sulphates, the salts of lead and silver, lime water, the carbonates of potassium and sodium, and acids are incompatible Synergists.—Spirit of nitrous ether, potassium citrate, and many of the refrigerants and diaphoretics. Physiological Action and Therapeutics.—Solution of am- monium acetate is both a mild diaphoretic and diuretic, according as the action is governed by other more powerful agents. For instance, if the skin is warm and the cutaneous blood-vessels dilated, the preparation acts as a diaphoretic, while if the condition of the skin is the reverse, the action of the drug is directed to the kidneys. Should the preparation be given with aconite or spirit of nitrous ether, its action would be that of a diaphoretic, but if the drug were associated with digitalis or squill, it would act as a diuretic. In any case the action of the drug is due to a stimulation of the secretory cells or nerves. The principal medical use of solution of ammonium acetate is as a diaphoretic in febrile conditions, such as acute coryza, influenza, acute pharyngitis, etc. It is a very efficient remedy in muscular rheumatism, and in the eruptive fevers when the eruption is re- tarded. It is frequently associated with other remedies in the treatment of scarlatinous dropsy. Owing to its property of stimulating the heart and circulation, the remedy has been recommended in low forms of fever, in the belief that it helps to sustain the powers of life, in lowering the pulse and temperature, moistening the tongue, and quieting the delirium. In migraine and in alcoholic intoxication few remedies are so successful, the drug frequently dissipating the effects of acute alcoholism at once. The remedy has been found efficacious in dysmenorrhea and menorrhagia, and has been employed externally and locally as a discutient in mammary engorgements, glandular swellings, contu- sions, incipient abscesses, etc. Administration.—The preparation, as has been said, should be freshly made when wanted, and should be administered well diluted with sweetened water. 600 A TEXT-BOOK OF MATERIA MEDICA. Spiritus /Etheris Nitrosi—Spiritus /Etheris Nitrosi -Spirit of Nitrous Ether. U. s. #\ (Swket Spirit of Xitrk.1 Origin.—An alcoholic solution of Kthyl Nitrite, yielding, when freshly prepared and tested in a nitrometer, not less than eleven times its own volume of nitrogen dioxide. Description and Properties.—A clear, mobile, volatile, and inflammable liquid, of a pale-yellowish or faintly greenish-yellow tint, having a fragrant, ethereal, and pungent odor free from acridity, and a sharp, burning taste. It should be kept in dark amber-col- ored, well-stoppered bottles, remote from lights and fire. Dose.—1-2 fluidrachms (2.0-8.0 Cc). Antagonists and Incompatibles.—The incompatibles are po- tassium iodide, ferric sulphate, antipyrine, mucilage of acacia, tinc- ture of guaiacum, and gallic and tannic acids. Synergists.—Diaphoretics, diuretics, antispasmodics, tincture of aconite, potassium citrate, etc Physiological Action and Therapeutics.—When applied to the skin and allowed to evaporate spirit of nitrous ether produces a slight anesthetic effect. Internally, its action is very similar to that of the ammonium acetate. It dilates the blood-vessels more than the latter preparation, besides being more of a diffusible stim- ulant, stomachic, and carminative. Like the solution of ammonium acetate, spirit of nitrous ether acts either as a diaphoretic or diuretic, the effect depending upon the manner in which it is administered. For its diuretic action it should be given in ice-water and the patient kept cool; to produce diaphoresis its administration should be accompanied by warm drinks and the patient be well covered. Spirit of nitrous ether is used for about the same purposes as the solution of ammonium acetate, being particularly serviceable in febrile affections to promote critical sweating, employed either alone or in combination with tincture of aconite. It is frequently given as a diuretic in Bright's disease, congestion of the kidneys, and pain- ful affections of the urinary apparatus. It is a serviceable remedy to relieve flatulent distention of the stomach, to allay nausea, and to quiet nervous agitation. As an antispasmodic the remedy is frequently employed to relieve the pain of dysmenorrhea, and it may be inhaled for the relief of cough- ing. It enters into many expectorant mixtures, and is a soothing application to the forehead in neuralgic headache. EMETICS. 601 Administration.—The dose and manner of administering spirit of nitrous ether depend upon the action desired. As an anti- pyretic in febrile affections it should be given in doses of 20-30 minims (1.30-2.0 Cc), in sweetened water, every half hour. To produce diuresis the drug should be associated with some other diuretic and given in larger doses, \-\ fluidrachm (2.0-4.0 Cc), every three or four hours. If the remedy is desired for its diapho- retic action, it should be given in hot water, in doses of 20 or 30 minims (1.30-2.0 Cc), repeated every half hour, the patient being well covered. Should the drug be given as a nervous stimulant, the dose should not be less than 1 fluidrachm (4.0 Cc). Care should be exercised in the selection of spirit of nitrous ether that it be reliable and of full strength. If the preparation has been kept in large bottles exposed to light and air, the drug will be more or less inert and should not be prescribed. GROUP XL—EMFTICS. Kmetics are agents which produce vomiting or emesis. Vomiting is the result of the following actions: 1. The relaxa- tion of the cardia; 2. The contraction of the pylorus; 3. The con- traction of the gastric muscles; 4. The contraction of the dia- phragm; 5. The contraction of the abdominal muscles. The effect of these coordinate acts is to compress the stomach, expelling its contents through the relaxed cardia. The nervous mechanism involved in the act of vomiting is under the control of the medulla. The vomiting center may be stimulated in various ways—reflexly, through the sense of sight or taste, the stomach, peritoneum, biliary passages, kidneys, heart, or lungs, or by irritation of the pharynx or esophagus. The dia- gram (Fig. 14) serves to explain the mechanism of emesis. This is the nervous mechanism directly involved in the act of vomiting, regardless of the cause of the emesis. The vomiting center and a portion of the respiratory center intimately connected with it act simultaneously, either by way of the stomach or reflexly through other parts of the body—as is illustrated in certain injuries or diseases—or by direct stimulation of the center by some sub- stance carried to it in the blood. 602 A TEXT-BOOK OF MATERIA MEDICA. Fig. 14.—A,A, abdominal walls ; B, respiratory muscle : 1, respiratory center ; 2, vomiting center; 3, stomach; 4, afferent nerve passing from mucous membrane in stomach to vomiting center in me- dulla ; 5, efferent nerve passing from vomiting center to muscular fiber of cardia, relaxing it; 6, efferent nerve passing from medulla to pylorus, contracting it; 7, efferent nerve, influencing gastric muscles to contract; 8, efferent nerve, causing contraction of diaphragm; 9, efferent nerve, causing abdominal muscles to contract. The Local or Gastric Emetics1 are— * Alum ; * Yellow Mercuric Sulphate ; * Copper Sulphate ; * Sodium Chloride ; * Zinc Sulphate ; * Ammonium Carbonate ; * Mustard. (The drugs marked with an asterisk (*) are considered elsewhere in the present work.) The Direct or Systemic Emetics are— Apomorphine Hydrochlorate ; Antimony and Potassium Tartrate ; Ipecacuanha; Lobelia. Local or gastric emetics are the more rapid in their action, producing emesis in from two to five minutes. The systemic emetics must be absorbed and pass to the medulla before they produce vomiting, consequently requiring more time to exert their 1 Some authors reverse the nomenclature, considering those drugs which act only on the stomach " direct," and those affecting the medulla " indirect." EME TICS. 603 influence. Moreover, the action of the latter class of emetics is of much longer duration and followed by greater depression of the muscular and circulatory systems, together with greater consti- tutional disturbance. Some emetics act both locally and centrally. Tartar emetic and ipecacuanha affect the stomach locally, but, since their action is chiefly upon the vomiting center through the circulation, they are classed as systemic emetics. Zinc sulphate and copper sul- phate, on the other hand, while to a slight extent acting on the medulla, are classed as local emetics, because their principal action is upon the mucous membrane of the stomach. Within a few minutes after an emetic has been ingested there is a feeling of nausea and distress, with decided muscular relaxation. The circulator}- system is depressed; the pulse is small and irregu- lar, and a sensation of faintness ensues. The flow of saliva is increased, and vomiting soon follows. During emesis the arterial tension is raised, the face is flushed, and there is an increase in bodily heat. When vomiting has subsided there is a reduction of temperature, with cardiac and muscular weakness, the skin being bathed in perspiration. Occasionally fatal syncope has followed the use of emetics. Antagonists.—Drugs known as Anti-emetics are used to allay nausea and check vomiting. Like emetics, these agents are divided into Local Anti-emetics or Gastric Sedatives and Direct or Sys- temic Anti-emetics, according to their action. Among the most important Anti-emetics are the following: Local Atiti-emetics or Gastric Sedatives. (All save Ice are treated elsewhere in the present work.) Alcohol (especially champagne); Ether; Arsenic (small doses) ; Ipecac (small doses); Belladonna; Ice; Bismuth subnitrate and subcar- Opium ; bonate ; Hydrocyanic acid; Carbolic acid ; Menthol; Cerium oxalate; Potassium nitrate; Chloroform; Silver nitrate; Cocaine; Sulphocarbolates; Creasote ; Tincture of iodine (small doses). Calomel (small doses); 604 A TEXT-BOOK' OF MATERIA MEDICA. Direct or Systemic Anti-emetics or Gastric Sedatives. Alcohol; Chloral; Ammonium ; Hydrocyanic acid ; Amyl nitrite ; Nitroglycerin ; Bromides; Opium. It will be observed that some drugs are both local and direct Anti-emetics. There are certain measures which may be adopted to allay nausea and relieve vomiting, such as a recumbent posture and injection of large quantities of aerated water into the rectum. Synergists.—The emetics are of course mutually synergistic. Emetics are adjuncts to antiperiodics and expectorants, although the latter do not particularly enhance the action of the former. Emetics are used— i. To empty the stomach in cases where the presence of undi- gested food occasions pain, headache, etc., or to expel some poi- sonous substance from the stomach. For this purpose the local emetics are preferable. In cases of poisoning the local emetics are the more reliable. 2. To remove foreign bodies from the esophagus. For this pur- pose the direct or systemic emetics should be used. 3. To remove foreign bodies from the larynx, as in cases of membranous croup, laryngeal diphtheria, etc., the effort of vomit- ing being sometimes sufficient to dislodge and remove the mem- brane or other foreign substance. 4. To remove the bronchial secretion in cases of bronchitis and catarrhal pneumonia. In these cases the direct emetics should be employed, preferably ipecacuanha or apomorphine, because they possess more expectorant properties. 5. To empty the gall-bladder in cases of biliousness or malaria, or where small gall-stones are present in the gall-duct, the com- pression of the liver between the diaphragm and the abdominal muscles expelling the bile from the liver into the duodenum and forcing the gall-stones through the duct. 6. To relax spasm of the pharyngeal muscles in cases of spas- modic laryngitis. For this purpose the systemic emetics are pref- erable. Contraindications.—Emetics should not be given to persons suffering from aneurysm, hernia, peritonitis, prolapse of the uterus or rectum, atheroma, or where there is very high arterial tension, a EMETICS. 605 tendency to hemorrhage from the lungs or uterus, or a tendency to abortion. The emetic drugs which have not been elsewhere discussed in the present work are here given in detail: Apomorphlnae Hydrochloras—ApomorphTnse Hy- drochloratis — Apomorphine Hydrochlorate. U. S. P. Origin.—The hydrochlorate of an artificial alkaloid prepared from Morphine or Codeine. Description and Properties.—Minute, grayish-white, shining, acicular crystals, without odor, having a faintly bitter taste, and acquiring a greenish tint upon exposure to light and air. Soluble in about 45 parts of water and about 45 parts of alcohol. It should be kept in small, dark, amber-colored vials. If the prepa- ration imparts to 100 parts of water when slightly shaken an emerald-green color, the drug should be rejected. Dose.—^V~TO" gram (0.003-0.006 Gm.) by the mouth; -^-\ grain (0.0025—0.01 Gm.) hypodermically. Physiological Action.—Externally and Locally.—None. Internally.—Digestive System.—From five to twenty minutes after ingestion—according to the dose and the manner of adminis- tration—vomiting ensues, being repeated three or four times at intervals of about fifteen minutes. The emesis is preceded and attended by a slight nausea, with but moderate depression. Apo- morphine is a typical direct or systemic emetic, its entire action being exerted upon the vomiting center in the medulla. It is per- haps the most powerful and certain emetic we possess. Circulatory System.—Small doses have no perceptible effect upon the circulation. Full doses increase the rapidity and force of the heart's action and raise arterial pressure, owing to stimulation of the accelerator nerves and vaso-motor center. Large or toxic amounts depress the circulatory system or paralyze the cardiac muscle. Nervous System.—Full doses stimulate the brain and may even occasion delirium. Poisonous amounts produce convulsions, prob- ably of spinal origin, succeeded by paralysis of the motor and sen- sory nerves, and consequently of the muscles. Respiratory System.—Small amounts do not affect the respira- tory movements, although the secretion from the bronchial mucous membrane is increased. Full doses accelerate and deepen respira- tion, while toxic amounts cause depression. 606 A TENT-BOOK OF MATERIA MEDICA. Absorption and Elimination.—Apomorphine is readily absorbed, and is excreted through the gastro-intestinal tract, as well as by the broncho-pulmonary mucous membrane, the kidneys, and the skin. Temperature is unaffected by small doses, but may be lowered by large amounts. Poisoning.—The symptoms would be violent vomiting, delirium or convulsions, and marked cardiac and respirator}- depression, death resulting from asphyxia. Treatment of Poisoning.—The systemic gastric sedatives and cardiac stimulants. Therapeutics.—Apomorphine is the most reliable emetic to use when prompt emesis is necessary or in cases where swallowing is difficult or impossible. It is extremely useful as an emetic in cases of poisoning, though it frequently happens in narcotic poisoning that the vagus center is so blunted by the poison that apomorphine fails to act. Should it be necessary to provoke emesis when the stomach is in a state of acute inflammation, apomorphine is preferable to any other emetic. Given by the mouth in small doses—from fa grain (o.OOi Gm.) to fa grain (0.003 Gm.) every three or four hours—this drug is an exceedingly efficient remedy in acute bronchitis. It is equally beneficial in relieving the dry, hacking cough of chronic bronchitis, chronic catarrhal pneumonia, and tuberculosis. Contraindications.—The same as for emetics generally. Administration.—Apomorphine when given as an emetic should invariably be administered hypodermically, and the solu- tion be always freshly prepared. When the drug is used as an expectorant it should be given by the mouth. Great care should be taken in administering the drug to children, as they bear the remedy very badly. Antimonii et Potassii Tartras—Antimonii et Potas- sii Tartrates—Antimony and Potassium Tartrate. U. S. P. (Tartar Emetic; Tartrated Antimony.) Origin.—Antimony Trioxide is mixed with Acid Potassium Tartrate and Water to the consistence of a paste, allowed to stand for twenty-four hours, boiled in water, and crystallized. Description and Properties.—Colorless, transparent crystals of the rhombic system, becoming opaque and white on exposure EMETICS. 607 to air, or a white, granular powder, without odor and having a sweet, afterward disagreeable, metallic taste. Soluble in 17 parts of water and in 3 parts of boiling water, but insoluble in alcohol, which precipitates it from its aqueous solution in the form of a crystalline powder. Dose.—As an emetic, 1-2 grains (0.06-0.12 Gm.); as a cardiac depressant, \-\ grain (0.03-0.06 Gm.); as a diaphoretic and expectorant, -go-! grain (0.003-0.01 Gm.). Official Preparations. Syrupus Scillae Compositus—Syrupi Scillae CompSsiti—Compound Syrup of Squills (Hive Syrup).—Formula: Fluid Extract of Squill, 80; Fluid Extract of Senega, 80; Antimony and Potassium Tartrate, 2; Sugar, 750; Precipitated Calcium Phosphate, 10; Water, to 1000. Dose.—5-60 minims (0.3-4.0 Cc). Vinum Antimonii—VIni Antimonii—Wine of Antimony.—Formula: Anti- mony and Potassium Tartrate, 4; Boiling Distilled Water, 65; Alcohol, 150; White Wine, to 1000. Dose.—5-60 minims (0.3-4.0 Cc). Antagonists and Incompatibles.—Opium, alcohol, and the cardiac stimulants and antispasmodics generally are antagonistic Tannic and gallic acids and the lead salts are incompatible. Synergists.—Emetics, cathartics, and cardiac depressants pro- mote the action of tartar emetic Physiological Action.—Externally and Locally.—Tartar emetic is a powerful irritant when applied to the skin, producing a fol- licular inflammation followed by a papular eruption, becoming vesicular, and later forming pustules with a central umbilication, desiccation finally occurring, the pustules closely resembling those of small-pox. Internally.—Digestive System.—Upon the mucous membrane of the gastro-intestinal tract, as upon the skin, antimony and potas- sium tartrate acts as a powerful irritant. Small doses, occasioning only a sensation of warmth in the stomach, soon produce an in- creased secretion of saliva and gastric juice, as well as of secretions from the intestines, liver, and pancreas, more or less nausea fre- quently accompanying these symptoms. A little larger dosage excites vomiting, due at first to the irri- tating action of the drug upon the mucous membrane and nerves of the stomach, and, as soon as the drug is absorbed, affecting directly the vomiting center in the medulla. Full or large doses irritate the intestines, producing diarrhea, the discharges, if the dose 608 A TEXT-BOOK OF MATERIA MEDICA. has been excessive, strikingly resembling those of cholera. Ac- companying the foregoing symptoms are severe cramps and epigastric pain. Circulatory System.—Tartar emetic is a powerful cardiac de- pressant, even in small doses slowing and weakening the heart's action, and simultaneously lowering arterial pressure by direct de- pression of the heart-muscle and of the vaso-motor mechanism in the walls of the blood-vessels. Poisonous doses of the drug profoundly depress the heart, which is finally arrested in diastole. Nervous System.—Antimony and potassium tartrate in small doses and under certain conditions exerts a sedative influence upon the brain. Indeed, its action is that of a depressant to the entire nervous system, particularly the spinal cord, small doses depressing the sensory side, while poisonous doses paralyze both the motor and sensory centers of the cord. Under the administration of antimony, therefore, reflex excita- bility is diminished and the muscular system is depressed, the drug acting as an antispasmodic, probably by its influence both upon the muscles and the nervous system. Respiratory System.—Very small doses have no effect upon the respiratory movements, but increase the secretions from the bronchial mucous membrane. Full doses depress the respiratory movements, shortening the inspiration, but prolonging expiration. Toxic doses render the breathing extremely irregular and greatly lengthen the pause between inspiration and expiration, while there is an enormous increase in the bronchial secretion. The action of tartar emetic upon the respiratory system is very complex. The explanation as given by Hare is : " Primarily the respiratory center in the medulla is depressed, and the governing nerves of breathing, the pneumogastrics, are also rendered inactive; secondarily, the cardiac failure readily causes pulmonary conges- tion ; and, thirdly, the drug causes such an outpouring of liquid and mucus into the bronchial tubes that the patient is drowned in his own secretion, which he is too weak to expel." Absorption and Elimination.—Tartar emetic rapidly enters the blood, and is eliminated by many channels, principally by the bowels, but also by the bile, milk, sweat, and urine. The drug is an active diaphoretic, expectorant, and cholagogue. Temperature.—Small doses do not affect temperature percep- tibly ; large doses lower bodily heat, chiefly by depressing the EMETICS. 609 circulation, although the drug may possibly influence the heat- center to some extent, lessening heat-production. Untoward Action.—The untoward manifestations produced by medicinal amounts of tartar emetic in individuals having a marked susceptibility to the drug do not differ essentially from the symp- toms of poisoning next described. Poisoning.—Tartar emetic produces all the symptoms of an irritant poison—severe burning sensation in the esophagus and stomach and violent and repeated vomiting, the ejecta, in addition to undigested food, containing mucus, bile, and frequently blood. These symptoms are attended with severe colicky pains in the abdomen and serous purging, the discharges resembling those of cholera, the analogy with the latter disease being rendered the more striking by the presence of cramps in the extremities—a cha- racteristic feature of poisoning by tartar emetic Together with these gastro-intestinal symptoms there is extreme prostration, accompanied by an irregular, weak, almost impercep- tible pulse, great muscular relaxation, depressed respiration, pinched and livid countenance, cold, clammy skin, reduction of tempera- ture, and scanty and bloody urine. Death may be preceded by stupor, wild delirium, or convulsions. Treatment of Poisoning.—If the poison has not been entirely ejected in the act of vomiting, the stomach should be immediately washed out with a solution of tannic acid, after which strong coffee should be administered, together with demulcent drinks, anodynes, and respiratory and cardiac stimulants should they be necessary. Therapeutics.—Externally and Locally.—Tartar emetic was formerly used as a rubefacient, being still so employed to some extent. The tendency of the drug, however, to produce extensive papular eruption and destruction of tissue renders its external use unsafe. Hebra considers that the external use of tartar emetic is a " useless, injurious procedure, and occasionally even dangerous to life." S. Hartwell Chapman has recommended the use of a lozenge containing fa^ grain (0.0003 Gm.) of tartar emetic and fa grain (0.001 Gm.) of codeine in acute inflammation of the throat when accompanied with fever. Internally.—The medical uses of tartar emetic are constantly becoming more restricted. Because of its slow and depressing action the employment of the drug as an emetic has been prac- tically abandoned. It is still used as a sedative antiphlogistic in 39 6lO A TEXT-BOOK OF MATERIA MEDICA. various acute inflammations. It is beneficial in the earl}- stages of acute laryngitis and bronchitis, but its administration should be dis- continued after a free secretion of bronchial mucus is established. The remedy is occasionally given for its diaphoretic influence in various fevers, and has even been recommended as a cholagogue. The compound svrup of squills is a useful expectorant, being a popular and efficient remedy for croup. Administration.—As an emetic the action of the drug is facili- tated and enhanced by associating it with ipecacuanha, the reme- dies together being given in powdered form. As a diaphoretic and expectorant small doses of the wine of antimony are preferable, repeated every two or three hours. Ipecacuanha—Ipecacuanhae—Ipecac. U. s. p. Origin.—The root of Ccphaelis Ipecacuanha (Brotero) A. Rich- ard, a plant indigenous in the damp forests of Brazil, New Granada, and the northeastern portion of Bolivia. It is cultivated to some extent in India and Sikkim. According to the National Dispensatory, " The drug first be- came known in Europe in 1672, and a few years after was success- fully employed by Helvetius, a Dutch physician living in Paris, from whom (1688) Louis XIV. purchased the secret for 1000 louis d'or and made it public." Description and Properties.—The older roots are in pieces of 2 to 6 inches (5-15 Cm.) in length and about \ inch (4 Mm.) thick, mostly simple, contorted, dull grayish-brown or blackish, finely wrinkled, closely and irregularly annulated and often transversely fissured; bark thick, brittle, brownish, easily separated from the thin, whitish, tough, ligneous portion; odor slight, peculiar, nau- seous ; taste bitterish, acrid, nauseating. When ipecac is sound and free from mouldiness its quality is proportionate to the thick- ness of the bark and the thinness of the ligneous portion. The active principle of ipecac is emetine, of which there is present 1 to 2 per cent. The drug also contains ipecacuanhic or cephaelic acid, starch, resin, etc. Dose.—As an emetic, 15-30 grains (1.0-2.0 Gm.); as an expec- torant, \-2 grains (0.03-0.12 Gm.). Official Preparations. ExtrSctum Ipecacuanhae Fluidum—Extr3cti Ipecacuanhae Fluidi—Fluid Extract of Ipecacuanha.—Dose, as an emetic, 15-30 minims (0.2-0.5 Cc); as an expectorant, \-z minims (0.03-0.12 Cc). EMETICS. 611 Pulvis Ipecacuanhae et Opii—Pulveris Ipecacuanha et Opii—Powder of Ipecac and Opium. (See Opium, p. 428.) Syrupus Ipecacuanhae—Syrupi Ipecacuanhae—Syrup of Ipecac—Formula: Fluid Extract of Ipecac, 75; Acetic Acid, 10; Glycerin, 100; Sugar, 700; Water, to 1000.—Dose, as an emetic, 2-6 fluidrachms (7.39-22.50 Cc.); as an expectorant, 5-30 minims (0.3-2.0 Cc). Tinctura Ipecacuanhae et Opii—Tincturae Ipecacuanhae et Opii—Tincture of Ipecac and Opium. (See Opium, p. 428.) Trochisci Ipecacuanhae—Trochlscos (ace) Ipecacuanhae—Troches of Ipe- cac—Composition : Each troche contains about \ grain (0.02 Gm.) of Ipecac, together with Tragacanth, Sugar, and Oil of Orange. Dose.— 1 to 6 troches. Trochisci Morphinae et Ipecacuanhae—Trochlscos (ace) Morphinae et Ipe- cacuanhae. (See Morphine, p. 429.) Vinum Ipecacuanhae—VIni Ipecacuanhae—Wine of Ipecac (10 per cent.).__ Dose, 1-60 minims (0.06-4.0 Cc). Antagonists and Incompatibles.—The gastric sedatives and narcotics generally hinder the emetic properties of ipecac. The in- compatibles are tannic acid and vegetable infusions containing it, metallic salts, and caustic alkalies. Synergists.—The emetics, sedative expectorants, warm drinks, are synergistic, and opium aids the diaphoretic properties of the drug. Physiological Action.—Externally and Locally.—Ipecac is a powerful irritant to the mucous membranes of the respiratory tract when the powdered drug is inhaled. The prolonged application of ipecac to the skin occasions much irritation, even producing vesication, pustulation, and ulceration. Ipecac also possesses some antiseptic properties. Internally.—Digestive System.—In small doses ipecac acts as a stimulant to the stomach. The salivary and gastric glands are stimulated, the action of very small doses of the drug resembling that of vegetable bitters. Large doses are powerfully irritant and emetic, the emesis being the result of both a local irritation upon the stomach and a direct action upon the vomiting center in the medulla. The vomiting is preceded by and attended with but little if any nausea, although there is usually a marked increase in the secretion of bile and intes- tinal mucus, full doses of the drug acting not only as an emetic, but as a purgative and cholagogue. Circulatory System.—Except in occasioning the ordinary depres- sion incident to the act of vomiting, ipecac in moderate amounts has no influence upon the heart. Enormous doses, however, par- 6i2 A TEXT-BOOK OF MATERIA MEDICA. ticularly if injected into the jugular vein, have destroyed the life of dogs by cardiac paralysis. Nervous System.—Save in stimulating that portion of the me- dulla oblongata which presides over the act of vomiting, and a slight diminution of the reflex activity of the spinal cord, ipecac has no important action upon the nervous system. Respiratory System.—So far as the respirator}- movements are concerned, they are unaffected by moderate doses of ipecac. The bronchial mucous membrane is stimulated, augmenting the se- cretion of bronchial mucus, and therefore reflexly stimulating coughing. Absorption and Elimination.—The active principle of ipecac is rapidly absorbed, being eliminated chiefly by the gastro-intestinal mucous membrane, although the other secretions share in the excretory process, the skin being especially affected by this drug, which acts as a mild diaphoretic Temperature.—Under medicinal doses the temperature is un- changed. Poisonous doses reduce temperature. Untozvard Action.—Rarely, in persons peculiarly susceptible to the drug, intense cutaneous irritation and conjunctival inflammation, accompanied by neuralgia of the face and scalp, have been produced. Even soiling the hand with a few drops of the tincture of ipecac has occasioned unfavorable results. The general untoward symptoms are those of poisoning. Poisoning.—There is violent vomiting and purging, the ejecta containing bile and frequently blood. Among the graver symp- toms are abdominal pain, marked cardiac depression, muscular weakness, and greatly diminished reflex irritability. The skin is cold and bathed in perspiration. Treatment of Poisoning.—Tannic acid should be given as the chemical antidote. Opium, belladonna, and cardiac stimulants may be necessary. Therapeutics.—Externally and Locally.—Troches of ipecac and spray inhalations of wine of ipecac are used to allay the cough and expectoration in acute bronchitis and obstinate " winter cough." Powdered ipecac has been successfully employed as a dressing in anthrax, the drug being capable of destroying the anthrax bacilli, although having no effect on the spores. Internally.—Ipecac in proper doses is a very efficient emetic, and is frequently employed as such, particularly when it is desir- able through the act of vomiting to empty the air-passages, as in EMETICS. 613 croup, bronchitis, tracheitis, and the early stages of diphtheria. The action of the drug is so tardy, however, that it is not the most de- sirable emetic to use when it is necessary to empty the stomach quickly, as in cases of poisoning. When the stomach contains a quantity of undigested food, causing pain, headache, etc., ipecac is a valuable emetic to empty the stomach, since the drug occasions no marked nausea or de- pression. Paradoxical as it may seem, minute doses of ipecac, such as I to 4 minims (0.06-0.2 Cc.) of the wine or fa to \ grain (0.006-0.01 Gm.) of the powdered drug, act as an efficient gastric sedative and stomachic, frequently arresting vomiting when other drugs have failed. The statement, however, that minim doses of the wine of ipecac allay the nausea and vomiting of pregnancy is probably apocryphal. Ipecac in small doses is an excellent adjuvant to other chola- gogues to relieve the distress of hepatic dyspepsia. The drug is equally advantageous in atonic dyspepsia, attended with flatulence, depression of spirits, etc. The notoriety and pecuniary profit which Helvetius secured in connection with ipecac—or Radix antidyseuterica, as it was origi- nally named by its propagator—were due to its apparent specific action in dysentery. The drug is peculiarly efficient in dysentery of a bilious type, acute dysentery other than bilious yielding less readily to the rem- edy. It is true that in these last-named cases ipecac and opium have been advantageously employed, though it is probable that the opium had the larger influence in modifying the course of the dis- ease. Whatever the form of dysenteric attack may be, ipecac is the more efficient the earlier it is administered. The drug, in order to exert any beneficial influence in bilious dysentery, must be given in large doses—60 to 90 grains (3.88— 5.83 Gm.) in a single dose or 20 grains (1.29 Gm.) eveiy four hours. These doses of course will at first produce emesis, but the repeti- tion of them tends to establish a tolerance of the remedy, an early attainment of which is most desirable. Various methods have been employed to aid the stomach in retaining the drug, such as the administration of opium or other gastric sedative, a sinapism placed upon the epigastrium, etc. Ipecac has been highly recommended in infantile diarrhea. It has been successfully employed in hematemesis and uterine hemor- 614 A TEXT-BOOK OF MA TERIA MEDICA. rhage, it being customary in the former complaint to give at first an emetic dose, succeeded by smaller and nauseating amounts. Like other emetics, ipecac has proved efficient in expediting labor by relieving rigidity of the os uteri. The drug has been found beneficial in relieving hemoptysis, and it is of unquestioned value in many affections of the lungs and bronchial tubes. In pneumonia, particularly in the congestive and declining stages of the disease, it has proved serviceable. In bronchitis and phthisis, especially when the secretion is scanty, and in chronic bronchitis with much cough and but a moderate amount of expectoration, ipecac is a valuable remedy. It has been found valuable in spasmodic asthma. Ipecac is an important adjuvant to quinine in the treatment of remittent and intermittent fevers, the latter disease having been cured, it is claimed, by ipecac alone in doses of I or 2 grains (0.06-0.12 Gm.), given every three or four hours. Contraindications.—Ipecac is not permissible for patients suf- fering from aneurysm, hernia, prolapse of uterus or rectum, etc. Administration.—The drug is notoriously uncertain in its action, probably because of the variation in the percentage of eme- tine, the freshly powdered root being ordinarily more reliable. For purposes of emesis the freshly powdered root is preferable, to be taken with plenty of warm water. An infusion or decoction is frequently employed to produce emesis. As a diaphoretic the powder is also preferable, though in any case the fluid extract may be substituted for the powdered form. As an expectorant the syrup and wine are the preparations usually employed. Children are very tolerant of ipecac, the syrup being the prepa- ration usually given to them. Emetine, though not official, is an important remedy, and may be administered as an emetic in doses of fa to \ grain (0.005-0.01 Gm.), and in correspondingly small doses when a diaphoretic or expectorant action is desired. Lobelia—Lobeliae—Lobelia. U. S. P. (Indian Tobacco.) Origin.—The leaves and tops of Lobelia inflata L., collected after a portion of the capsules have become inflated. The plant is indigenous in the United States. Description and Properties.—As it appears in the market EME TICS. 6l5 lobelia consists of fragments of green leaves, stems, rather elon- gated dried flowers, and portions of the membranous capsules. The odor is very irritating, and the taste pungent and persistently acrid. The plant contains a yellowish acrid liquid alkaloid, lobeline, besides lobclic acid, lobelacrin, resin, fixed oil, gum, etc. Dose.—1-10 grains (0.065-0.6 Gm.). Official Preparations. Extractum Lobeliae Fluidum—Extr3cti Lobeliae Fluidi—Fluid Extract of Lobelia.—Dose, 1-10 minims (0.06-0.6 Cc). Tinctura Lobeliae—Tincturae Lobeliae—Tincture of Lobelia (20 per cent). —Dose, 8-15 minims (0.5-1.0 Cc). Antagonists and Incompatibles.—The effects of lobelia on the circulatory system are antagonized by the cardiac stimulants; its influence on the nervous system is counteracted by strychnine and other motor excitants. The incompatibles are all caustic alkalies. Synergists.—The motor depressants and emetics enhance the effects of lobelia. Physiological Action.—Externally and Locally.—Although the drug is readily absorbed through the skin, there is no action of importance. Internally.—Digestive System.—Lobelia produces symptoms similar to those of ipecac, save that lobelia is more powerful, occa- sioning more distressing nausea and intense prostration. Circulatory System.—Lobelia is a powerful cardiac depressant, its action being due both to direct depression of the heart and paralysis of the vaso-motor centers. Under poisonous doses the heart stops in diastole. Nervous System.—Full doses depress the motor nerve-ganglia. Poisonous doses are necessary to affect the higher cerebral centers, when coma and convulsions are produced. The muscles and nerves themselves are unaffected by lobelia. Respiratory System.—The muscular coats of the bronchi are relaxed by the drug. The respiration is slowed even by small doses. Large or toxic doses profoundly depress the respiratory center, death resulting from respiratory failure. Absorption and Elimination.—The active principle of lobelia is readily absorbed, and is excreted chiefly by the kidneys and skin, the drug acting as a diuretic and diaphoretic. Under emetic doses much of the drug is eliminated by way of the stomach and intestines. 616 A TEXT-BOOK OF MATERIA MEDICA. Temperature.—Full doses lower the temperature. Untoward Action.—Does not differ essentially from the effects of poisoning. Poisoning.—The symptoms include—violent vomiting and purging, a very weak and irregular pulse, an anxious, livid coun- tenance, skin cold and bathed in perspiration, respiration slow and very feeble, contracted pupils, and possibly coma or convulsions preceding death, which occurs from respiratory failure. Treatment of Poisoning.—The symptoms should be counter- acted by cardiac and respiratory stimulants, employing such drugs as atropine, strychnine, alcohol, ammonia, etc, hypodermically. Therapeutics.—Externally and Locally.—None. Internally.—While formerly lobelia was used extensively as an emetic, at the present day, owing to the intense nausea and great depression occasioned by the drug, it has been practically sup- planted by other less dangerous emetics. Its principal use nowadays is as a remedy in spasmodic asthma and as an expectorant in certain cases of bronchitis. Contraindications.—The same as for emetics in general. Administration.—The powder, fluid extract, or tincture may be used. The taste of the fluid preparations may be agreeably disguised by aromatic elixir or aromatic elixir of liquorice. GROUP XII.—EXPECTORANTS. Expectorants are drugs which stimulate, depress, or modify the secretion from the bronchial or laryngeal membrane and pro- mote its expulsion. There are many drugs not classed as expectorants which, under certain conditions, may be used to serve one of these purposes. Thus, opium and chloral, by the depressing influence which they exert upon the respiratory center and the reflex mechanism, may relieve reflex and purposeless cough, or, as is the case with the former drug, check excessive secretion or render it more viscid. Demulcents, such as gum acacia, flaxseed, elm, etc, and other drugs like potassium chlorate, sodium chloride, etc., either lessen or excite the tracheal and bronchial cilia, retarding or promot- ing expectoration of bronchial mucus. The classification usually adopted seems to be the most reasonable—viz. that of dividing expectorants into two classes: i. Nauseant or Sedative. 2. Stim- ulating. EXPECTORANTS. 617 Among the more important Nauseant or Sedative Expectorants are— * Alkalies ; * Ipecacuanha; * Antimony and Potassium Tar- * Lobelia; trate (Tartar Emetic); * Pilocarpus ; * Apomorphine ; * Potassium Iodide ; * Grindelia; * Quebracho ; all of which are considered in detail elsewhere. The important Stimulating Expectorants are— * Acids ; Oil of Scotch Fir (Oleum Pini * Ammonium Carbonate; Sylvestris); Ammonium Chloride ; Oleum Pini Pumilionis ; * Balsam of Peru ; Onion ; Balsam of Tolu ; Saccharine Substances ; * Benzoin and Benzoic Acid; Senega (Saponin); * Copaiba; * Sulphur; * Cubeb; * Squill; Garlic; Tar; Liquorice; Terebene; * Nux Vomica Terpin Hydrate ; (Strychnine); * Turpentine. (Those marked with an asterisk (*) are elsewhere given in detail.) As a rule, Sedative Expectorants are permissible only in acute stages of bronchitis, when, as is the case in the beginning of all in- flammations, there is complete or partial suspension of function, absence of secretion, and much irritation in the bronchi, with dis- tressing, harsh, and dry cough. In these conditions of the respiratory passages the nauseating sedative expectorants serve a useful purpose in lowering arterial tension, lessening the blood-supply to the inflamed parts, and increasing the secretion of mucus. In sufficiently large doses to produce emesis the same expecto- rants are frequently employed to expel an accumulation of mucus mechanically by the act of vomiting. Stimulating expectorants are more serviceable in chronic and relaxed conditions of the mucous membrane. They are usually employed to diminish or disinfect an abnormally increased secre- tion. These remedies generally increase blood-pressure and facili- tate expectoration, being eliminated to a great extent by the mucous membranes which they stimulate. 618 A TEXT-BOOK OF MATERIA MEDICA. The alkalies are especially useful in lessening the viscidity of mucus, rendering it more fluid, less tenacious, and therefore more easily expelled. It requires considerable skill to combine expectorants so as to best suit the various conditions found in practice. The diseases of the respiratory passages gradually merge, so that in the' treatment of them it is often difficult to decide which remedy will be of more service, a sedative or a stimulant expectorant. The physician should carefully examine each individual case and decide whether he wishes to diminish or increase the blood-supply to the respira- tory tract; to stimulate or depress the respirations; to overcome spasm of the bronchial muscles; to diminish, increase, or disinfect the bronchial secretion. A thorough knowledge of the patient's condition and of the physiological action of the various remedies at command will enable the observant practitioner to combine expectorants in such manner as to yield ordinarily highly satisfactory results. Ammonii Chloridum—Ammonii Chloridi—Ammo- nium Chloride. U. S. P, Origin.—Ammonium sulphate is first formed by neutralizing Gas Liquor with Sulphuric Acid. After crystallization sublime with Sodium Chloride. Description and Properties.—A white, crystalline powder, without odor, having a cooling, saline taste, and permanent in the air. Soluble in 3 parts of water; almost insoluble in alcohol. Dose.—1-30 grains (0.06-2.0 Gm.). Official Preparation. Trochisci Ammonii Chloridi—Trochlscos (ace) Ammonii Chloridi— Troches of Ammonium Chloride.—Each troche contains 2 grains (0.12 Gm.).— Dose, I to 6 troches. Antagonists and Incompatibles.—Therapeutically, ammonium chloride is antagonized by the cardiac depressants. The incom- patibles are—alkalies, alkaline earths and their carbonates, tartaric acid, mineral acids, and the soluble lead and silver salts. Synergists.—The expectorants, emetics, and diaphoretics en- hance the action of the drug. Physiological Action.—Externally and Locally.—Ammonium chloride is irritant and resolvent. EXPECTORANTS. 619 Internally.—In medicinal doses the drug increases the secretions from the gastro-intestinal glands, acting as a cholagogue. The solid constituents of the blood are diminished. The drug appears to have a special action upon the mucous membranes, augmenting their normal secretions and promoting nutritive changes and epithelial exfoliation. Ammonium chloride is readily absorbed, and is eliminated by the kidneys, skin, bronchi, and mucous membranes generally, the drug being a feeble diuretic, diaphoretic, and expectorant. Save uric acid, which is slightly diminished, all the solids of the urine are increased under the use of ammonium chloride. The drug is not considered poisonous. Therapeutics.—Externally and Locally.—Ammonium chloride possesses a wide range of therapeutic applications. Solutions of various strengths have proved markedly efficient as local applica- tions in indolent buboes, epididymitis, orchitis, bruises, inflammatory szvellings, suppurative mastitis, etc. Senile gangrene is much bene- fited by immersing the foot in a bath containing 8 ounces (249.0 Gm.) of the drug. A solution of 3 drachms (12.0 Gm.) of ammonium chloride to I pint (473.17 Cc.) of water is an efficient remedy in vaginitis. The lotion may be used as an injection or a tampon saturated with the fluid and applied to the parts. Lozenges, solutions, or the nascent fumes of the drug have been found serviceable in many diseases of the nose, throat, and ear, such as coryza, chronic laryngitis send pharyngitis, chronic aural catarrh, etc. Internally.—Few remedies are more efficient than ammonium chloride in bronchitis that has passed its inflammatory stage. In chronic bronchitis, particularly that form occurring in old people and persons of a feeble habit of body, the drug is very valuable, either given alone or associated with stimulant expectorants. The remedy has appeared to be somewhat beneficial in zvhooping cough. Ammonium chloride has been employed in intermittentfever'and to promote the eruption in the exanthematous fevers. It is certainly of great utility in goiter, and has proved beneficial in amenorrhea and dysmenorrhea. The drug is considered an efficient remedy in glandular enlargements, as in those of the prostate, liver, etc. It assuredly stimulates the functional activity of the liver and is fre- quently given as a cholagogue. Ammonium chloride usually exerts a prompt and salutary 620 A TENT-BOOK OF MATERIA MEDICA action in neuralgias, particularK' the neuralgia affecting the fifth pair, the intercostal nerves, and the sciatic nerve. The remedy has been also advantageously employed in myalgia and chronic mus- cular rheumatism. Contraindications.—Inflammation of the stomach, aggravated dyspepsia, marked emaciation, and anemia contraindicate the drug. Administration.—Ammonium chloride is best given in solution, its disagreeable taste being well disguised by the addition of some preparation of liquorice, such as the syrup, fluid extract, or the aromatic elixir of liquorice. In bronchial diseases the virtues of the drug are enhanced by this association. Balsamum Tolutanum—Balsami Tolutani—Balsam of Tolu. U.S. P. Origin.—A balsam obtained from Toluifcra Balsamum L., an evergreen tree from 60 to 80 feet (18-24 M.) high, growing in the high, rolling country of Venezuela and New Granada. Description and Properties.—A yellowish-brown, semi-fluid, or nearly solid mass, becoming more brittle when exposed to cold; transparent in thin layers, having an agreeable odor, recalling that of vanilla, but distinct from it, and a mild, aromatic taste; readily and completely soluble in alcohol, chloroform, and solutions of the fixed alkalies; almost wholly soluble in ether, but nearly insoluble in water or carbon disulphide. The drug contains a volatile oil (chiefly toluene), cinnamic and benzoic acids, and a resin. Dose.—8-30 minims (0.5-2.0 Cc). Official Preparations. Syrupus Tolutanus—Syrupi Tolutani—Syrup of Tolu (1 per cent.).—Dose, 2-6 fluidrachms (8-24 Cc). Tinctura Tolutana—Tincturae Tolutanae—Tincture of Tolu (10 per cent.). —Dose, j'2-2 fluidrachms (2-8 Cc). Tinctura Benzoini CompSsita—Tincturae Benzoini CompSsitae —Compound Tincture of Benzoin (4 per cent.).—Described under Benzoin. Antagonists and Incompatibles.—Aqueous preparations are pharmaceutical^ incompatible with the tincture of tolu. Synergists.—The balsams, aromatic drugs, volatile oils, and stimulant expectorants. Physiological Action.—Balsam of tolu is antiseptic, disinfec- tant, and stimulant when applied to the skin and to raw surfaces. It is a pleasant carminative and stomachic. EXPECTORANTS. 621 The drug is excreted principally by the mucous membranes, the secretions from which it stimulates and disinfects. The skin and kidneys also share in the excretory process. Therapeutics.—Inhalations of the vapor of tolu have been suc- cessfully employed in the treatment of chronic pharyngitis, and a pigment composed of 1 part of tolu to 5 parts of ether or alcohol has been beneficially applied to diphtheritic deposits on the tonsils and pharynx. Its agreeable flavor, together with its stimulating and expector- ant properties, renders tolu an efficient and eligible ingredient of cough mixtures, lozenges, vapors, etc. employed to modify the course of subacute and chronic bronchitis. Administration.—Tolu is usually administered in the form of syrup, although the tincture may be given in emulsion. Inhala- tions of tolu vapor are employed and lozenges containing tolu are frequently used. Allium—Allii-Garlic. U. S. P. Origin.—The bulb of Allium sativum L., a bulbous plant indig- enous in Central Asia and the basin of the Mediterranean, and cultivated for culinary purposes in Europe and North America. Description and Properties.—Bulb rubglobular, compound, consisting of about eight compressed, wedge-shaped bulblets, arranged in a circle about the base of the stem and covered by several dry, membranaceous scales. Odor pungent and disagree- able ; taste warm and acrid. Garlic should be used without having been dried. The drug contains about \ per cent, of a volatile oil, to which its odor and taste are due. Dose, of bruised or chopped garlic or of the expressed juice, about 30 grains (2.0 Gm.). Official Preparation. Syrupus Allii—Syrupi Allii—Syrup of Garlic—Dose, 1-2 fluidrachms (4.0- 8.0 Cc). Allied Species. Allium Cepa I..—Allii Cepae—Onion. Physiological Action.—Both garlic and onion are stimulants to the part to which they are directly applied, garlic being the stronger of the two. 622 A TEXT-BOOK OF MATERIA MEDICA. Internally they are carminative and stomachic, and are used as condiments and as foods. Like all substances which stimulate the digestive apparatus, in excessive amounts they may occasion nausea, vomiting, colic, and diarrhea. The active constituents of these drugs are eliminated by the mucous membranes, skin, kidneys, and respirator}' tract. The taste and odor of the drugs are imparted to the milk of nursing women. Both garlic and onion are rapidly absorbed and about as quickly eliminated. Therapeutics.—An onion poultice is a valuable domestic rem- edy for chronic or acute bronchitis in children, abscesses, and to relieve strangury when applied to the perineum, in which case it proves to be singularly efficient. The core of a roasted onion is said to quickly relieve earache when inserted in the auditory canal. Syrup of garlic or onion is an invaluable expectorant in chronic catarrhs of the respiratory passages in children and infants, and is quite an efficient remedy in the decline of whooping cough. A synthetical substance known as Allyl Tribromide (Tribrom- hydrin), closely allied to oil of garlic, has been highly recommended in spasmodic asthma, infantile convulsions, hysteria, angina pectoris, and other spasmodic disorders. It should be administered in cap- sules in doses of from i to 5 minims (0.06-0.3 Cc). Administration.—When garlic or onion is used for poultices, it should be boiled. Internally, the expressed juice made into a syrup with sugar or the official syrup of garlic is the form in which these drugs are usually given. Glycyrrhiza—Glycyrrhizae—Glycyrrhiza. U. S. P. (Liquorice Root.) Origin.—The root of Glycyrrhiza glabra L. and of the variety glandulifcra (Waldstein et Killaibel) Regel et Herder, a perennial plant indigenous in the countries lying on the northern and south- ern shores of the Mediterranean and farther east through the Cau- casus, Northern Persia, Afghanistan, and Southern Siberia to China, and cultivated to some extent in England, France, Germany, and the United States. Description and Properties.—In long, cylindrical pieces from \ to 1 inch (6-25 Mm.) thick, longitudinally wrinkled, externally grayish-brown, warty; internally tawny yellow, pliable, tough; EXPECTORANTS. 623 fracture coarsely fibrous; bark rather thick; wood porous, but dense in the narrow wedges; medullary rays linear; taste sweet, somewhat acrid. The underground stem, which is often present, has the same appearance, but contains a thin pith. The drug derived from the variety glandulifera (so-called Rus- sian liquorice) consists usually of roots or root-branches 1 to 4 inches (2-10 Cm.) thick and 8 to 12 inches (15-30 Cm.) long, fre- quently deprived of the corky layer, the wood rather soft' and usually more or less cleft. Liquorice contains a glucoside, glycyrrhizin, besides asparagin, glycyramarin, an acrid resin, starch, etc. Dose.—15-60 grains (1-4 Gm.). Official Preparations. Extractum Glycyrrhizae Fluidum—Extracti Glycyrrhizae Fluidi—Fluid Extract of Glycyrrhiza.—/Aw, 15-60 minims (1.0-4.0 Cc). Extractum Glycyrrhizae—Extracti Glycyrrhizae—Extract of Glycyrrhiza.— Dose, freely. (Extract of Glycyrrhiza is contained in Trochisci Ammonii Chloridi and Trochisci Glycyrrhizae et Opii.) Extractum Glycyrrhizae Purum—Extr3cti Glycyrrhizae Puri—Pure Extract of Glycyrrhiza.—Dose, freely. Glycyrrhizinum Ammoniatum—Glycyrrhizini Ammoniati—Ammoniated Glycyrrhizin.—Description and Properties.—Dark-brown or brownish-red scales, with- out odor and having a very sweet taste; readily soluble in water and in alcohol. Dose.—5-15 grains (0.3-1.0 Gm.). Mistura Glycyrrhizae Composita— Misturae Glycyrrhizae Compositae—Com- pound Mixture of Glycyrrhiza (Brown Mixture).—Formula: Pure Extract of Glycyrrhiza, 30; Sugar, 50; Mucilage of Acacia, 100; Camphorated Tincture of Opium, 120; Wine of Antimony, 60; Spirit of Nitrous Ether, 30; Water, to 1000. Dose.—1-4 fluidrachms (4.0-15.0 Cc). Pulvis Glycyrrhizae Compdsitus—Pulveris Glycyrrhizae Compdsiti—Com- pound Powder of Glycyrrhiza. (See Senna, p. 681.) Besides the foregoing compounds, glycyrrhiza forms a more or less important ingredient of eleven other official preparations. Physiological Action and Therapeutics.—The drug when chewed increases the flow of saliva. It is demulcent and laxative, and possesses slight stimulating properties when locally applied. It favors the secretions of the congested mucous membrane of the respiratory passages. Liquorice is used chiefly for its demulcent properties in sore throat, hoarseness, pharyngeal cough, acute bronchitis, etc. An in- fusion of the root is an agreeable and useful drink in febrile catarrhal affections and in irritative disorders of the bozvels and urinary organs attended with fever and great thirst. 624 A TEXT-BOOK OF MA IE RE I MEDICA. The various preparations of liquorice are serviceable in conceal- ing the taste of nauseous and bitter medicines and as an excipient for pills. Administration.—There are no special directions to be given— any of the preparations may be used. Oleum Pini SylvSstris—Olei Pini Sylv6stris—Oil of Scotch Fir (unofficial). — Origin, Description, and Properties.—A volatile oil distilled from the leaves of Pinus Sylvestris, colorless, fragrant. Used by inhalation or locally. The drug is used in various sprays and inhalations in nasal catarrh, acute coryza, and many diseases of the respiratory passages. Oleum Templlnum—Olei Templini—Oil of Pine (unofficial).— Origin, Descrip- tion, and Properties.—A volatile oil distilled from the shoots of Pinus Pumilio. A col- orless or yellowish-green oil, of an agreeable, somewhat terebinthinate odor. Oleum Templinum is used in the same manner and for the same purposes as Oil of Scotch Fir. Pix Liquida—PTcis Llquidae—Tar. U.S.P. Origin.—An empyreumatic oleoresin obtained by the destructive distillation of the wood of Pinus palustris Miller, and other species of Pinus. Description and Properties.—Thick, viscid, semi-fluid, black- ish-brown, heavier than water, transparent in thin layers, becoming granular and opaque with age ; odor empyreumatic, terebinthinate; taste sharp, empyreumatic. Tar is slightly soluble in water; solu- ble in alcohol, fixed and volatile oils, and solution of potassium or sodium hydrate. The drug contains many substances, chief among which are an empyreumatic, volatile oil, pyrocatechin, acetone, xylol, toluol, cresols (creasote), guaiacol, phenol, etc. Dose.—15-60 grains (1-4 Gm.). Official Preparations. Syrupus Picis Llquidae—Syrupi Picis Llquidae—Syrup of Tar (7.5 percent.). —Dose, 1-4 fluidrachms (4.0-15.0 Cc). Ungu6ntum Picis Llquidae—UnguSnti Picis Llquidae—Tar Ointment (50 per cent.).—Used externally. Oleum Picis Llquidae—Olei Picis Llquidae—Oil of Tar. U. S. P.— Origin. —A volatile oil distilled from tar. Description and Properties.—An almost colorless liquid when freshly distilled, but soon acquiring a dark reddish-brown color and having a strong tarry odor and taste. It is readily soluble in alcohol.—Dose, 1-5 minims (0.065-0.3 Cc). Unofficial Preparations. Aqua Picis Llquidae—Aquae Picis Llquidae—Tar Vizier.—Dose, 1 pint (473.17 Cc.) in the course of a day. EXPECTORANTS. 625 Glyceritum Picis Llquidae—Glyceriti Picis Llquidae—Glycerite of Tar.— Dose, \-2 fluidrachms (2.0-8.0 Cc). Vinum Picis (N. F.)—VIni Picis—Wine of Tar (a saturated solution in sherry wine).—Dose, 1-4 fluidrachms (4.0-15.0 Cc). Derivatives and Allied Drugs. Lysol.—Prepared by the action of alkalies on tar-oils and fats. A brownish, oily liquid with a feeble, aromatic creasote-like odor, containing 50 per cent, of cresols and readily miscible with water. Used as a disinfects nt and antiseptic. Pixol.—A compound of tar soap and caustic potash or soda. Used as a disinfec- tant and antiseptic. Pix BStulae — Picis BStulae—Birch Tar (Oleum Rusci).—Origin.—Prepared in Russia from the wood and bark of Betula alba L. Description and Properties.—Resembling wood-tar in appearance, but remaining liquid, and having the peculiar, penetrating odor of Russia leather, in the manufacture of which it is used. For the most part employed externally. Oleum Cadinum—Olei Cadini—Oil of Cade. U. S. P.— Origin.—A product of the dry distillation of the wood of yuniperus oxyccdrus L. Description and Properties.—An empyreumatic, brownish or dark-brown, clear, thick liquid, possessing a tarry odor and an empyreumatic, burning, somewhat bitter taste. Almost insoluble in water; partially soluble in alcohol. Dose.—2-6 minims (0.12-0.3 Cc). Chiefly used externally. Antagonists and Incompatibles.—There are none of special importance. Synergists.—The aromatics, carbolic acid, creasote, and many of the antiseptics, turpentine, and the stimulant expectorants. Physiological Action.—Externally and Locally.—Tar is a stim- ulant, astringent, antipruritic, antiseptic, and parasiticide. It is readily absorbed from the skin, and when applied too freely may produce a papular eruption. Internally.—The action of tar closely resembles that of turpen- tine, although creasote is perhaps a more perfect analogue. Small doses stimulate the circulation and increase secretions generally. Immoderate dosage or the prolonged administration of tar impairs the appetite, deranges digestion, and depresses the circulatory and nervous systems. While the drug is not considered poisonous, the ingestion of excessive quantities of oil of tar has been attended with a few fatal results. The symptoms following imprudent dosage are nausea, vomiting, severe abdominal pain, diarrhea, headache, and dizziness. The urine is colored blackish-brown, and may contain blood or albumin and emit the peculiar odor of tar. There may be present erythema, or the skin ma}' be covered with papules or vesicles attended with intense itching. Therapeutics.—Externally and Locally.—With the possible 40 626 A TEXT-BOOK OF MATERIA MEDICA. exception of sulphur and mercury, tar is the most universally employed remedy for cutaneous diseases, the drug having for cen- turies held an important place among the efficient topical agents in the treatment of diseases of the skin, unhealthy ulcers, fissured nipples, boils, excoriations, etc. In chronic eczema the drug is peculiarly serviceable, and it has proved beneficial in chronic psoriasis and scabies. The oil of cade and oil of birch are used for the same pur- poses as tar, being usually preferred by expert dermatologists. The tarry preparations are valuable antipruritics, and of service in pruritus and various itching diseases of the skin, although their tendency to produce irritative and inflammatory effects when con- tinuously and injudiciously applied should not be overlooked. The benign and emollient effects of tar are best obtained when the drug is mixed with some soothing or astringent powder, such as chalk. The valuable properties of tar in the treatment of cutaneous diseases are often nullified by the ignorance of the physician and lack of proper administration of the drug. Prof. James Nevins Hyde has truthfully observed that " the skill of a physician en- trusted with the management of a disease of the skin might also be measured by his success in the use of tar." Lozenges containing tar, the vapor of oil of tar, and sprays containing tar are extensively employed in the treatment of various diseases of the nose and throat. Internally.—Tar has long possessed an enviable reputation as a remedy for chronic pulmonary complaints, being very efficient in the treatment of chronic bronchitis and the advanced stages of obstinate acute bronchitis, lessening the expectoration, allaying the oppression and distress in the chest, and soothing the cough. These symptoms, which attend many cases of pulmonary phthisis, are frequently relieved by some preparation of tar. Not only is this remedy of value in catarrhal conditions of the respiratory passages : it is equally efficient in similar conditions of mucous membranes elsewhere. Thus tar water has been employed with great benefit in gleet, leucorrhea, vesical catarrh, etc., being given both by the mouth and in the form of an injection. Administration.—Tar may be given in milk or beer or in pill form, although the most palatable forms are the syrup, glycerite, wine, and tar water, the last of which may be given to the extent of i or 2 pints (473.17 or 946.35 Cc.) daily. EXPECTORANTS. 627 Senega—Senegae—Senega. V. S. P. Origin.—The root of Polygala Senega L., a plant indigenous in North America, from Canada southward to South Carolina and westward to Wisconsin. Description and Properties.—About 4 inches (10 Cm.) long, with a knotty crown and spreading, tortuous branches, keeled when dry, fleshy and round after having been soaked in water; externally yellowish-gray or brownish-yellow; bark thick, white within, enclosing an irregular, porous, yellowish wood; odor slight, unpleasant; taste sweetish, afterward acrid. Senega contains sene- gin, also known as saponin, and polygalic acid, an acrid principle to which the medicinal property of the drug is due, besides a fixed and a volatile oil. Dose.—10-30 grains (0.6-2.0 Gm.). Official Preparations. Extractum Sfcnegae Fluidum—Extracti Sfinegae Fluidi—Fluid Extract of Senega.—Dose, 10-30 minims (0.6-2.0 Cc). Syrupus SSnegae—Syrupi Sfinegae—Syrup of Senega (20 per cent, of fluid extract).—Dose, 30-60 minims (2.0-4.0 Cc). Syrupus Scillae Compdsitus—Syrupi Scillae CompSsiti—Compound Syrup of Squill (contains 8 per cent, of Senega). (Described under Scilla, p. 635.) Physiological Action.—Externally and Locally.—The active principle of senega is a decided irritant to the skin and mucous membranes, causing violent sneezing and cough, with marked hydremia and increased secretion from the bronchial and nasal mucous membranes when the powder is inhaled. Internally.—Digestive System.—Small doses stimulate the mu- cous membranes of the mouth and stomach, augmenting the sali- vary and gastric secretions, although frequently occasioning indi- gestion. Large doses irritate the alimentary canal, producing vomiting, diarrhea, and abdominal pain. Circulatory System.—The active principle of senega circulates in the blood unchanged, affecting the heart and blood-vessels after the manner of digitalis, though with less power and certainty. Nervous System.—Under medicinal doses no important action has been noted. Very large doses depress the nervous system. Respiratory System.—It is here that senega appears to exert its most important influence. The excretion of the drug through the bronchial mucous membrane irritates the respiratory passages, oc- casioning hyperemia, increased secretion, and, reflexly, cough. Absorption and Elimination.—The active principle of senega is 628 A TEXT-BOOK OF MATERIA MEDICA. absorbed with difficulty, being excreted through the bronchial mucous membrane and the kidneys, irritating these structures during the process, and consequently acting as a stimulant, expec- torant, and diuretic. The drug also possesses some diaphoretic virtue, being partially excreted by the skin. Temperature.—The body-heat is uninfluenced. Uterus.—It is believed that senega possesses emmenagogue properties. Untozoard Action.—Immoderate, and in certain susceptible sub- jects small, doses of senega have produced irritation and burning in the throat, salivation, impaired appetite, a sense of oppression in the stomach, nausea, vomiting, colicky pains, and profuse diarrhea. Poisoning.—Senega is not regarded as a poisonous drug, exces- sive doses producing symptoms analogous to those of " Untoward Action," save that they are intensified. Treatment of Poisoning.—Elimination is to be favored, and the symptoms treated as they appear, gastric sedatives, anodynes, and cardiac stimulants being employed. Therapeutics.—Externally and Locally.—No action has been observed. Internally.—The principal use of senega is that of a stimulating expectorant. The reputation of the drug originated with its efficacy in typhoid pneumonia, and it is still considered a valuable remedy in asthenic pulmonary diseases. It is highly beneficial in subacute bronchitis when the power to cough is feeble. In like manner senega is useful in bronchorrhea and chronic bronchitis with profuse expectoration, though less valu- able when the mucus is tough and scanty. The simple catarrhal laryngitis following croup is greatly relieved by the administration of senega. The drug is an appropriate remedy in amenorrhea the result of passive uterine congestion, and senegin has been recommended as a remedy for uterine hemorrhage. According to some authorities, the drug has proved beneficial in chronic rheumatism. Contraindications.—Senega is inadmissible in acute bronchitis and indigestion, or when there is marked irritation and inflamma- tion of the gastro-intestinal tract. Administration.—The syrup of senega is the preparation usually employed as an expectorant. Senegin may be given in doses of 2 grains (0.13 Gm.) in capsules. EXPECTORANTS. 629 Terebenum— Terebeni—Terebene. U. S. P. Origin.—A liquid consisting chiefly of Pinene, and containing only very small proportions of Terpinene and Dipentene ; obtained by the action of Sulphuric Acid upon Turpentine, and distillation. Description and Properties.—A colorless or slightly yellow- ish, thin liquid having rather an agreeable thyme-like odor and an aromatic, somewhat terebinthinate taste. Only slightly soluble in water, but soluble in an equal volume of alcohol. Terebene should be kept in well-stoppered bottles, in a cool place protected from light. Dose.—5-15 minims (0.3-1.0 Cc). Physiological Action.—When applied externally terebene acts as a stimulant, germicide, antiseptic, and astringent. Internally, small doses act as a stimulant to the gastro-intestinal tract, large amounts being irritant and producing effects similar to those of turpentine. The drug is eliminated by the kidneys, bronchial mucous mem- branes, skin, bowels, etc, acting as a mild astringent and antiseptic at the points of elimination. Therapeutics.—Externally and Locally.—The inhalation of terebene—20 minims (1.23 Cc.) daily—allays the cough oi laryngeal phthisis and has proved beneficial in irritative bronchial cough, while a spray of terebene mixed with oil of eucalyptus and alcohol has been advised in zvhooping cough. Equal parts of terebene and olive oil have been recommended by Vaucher and Bertin in the treatment of uterine cancer. Tere- bene has been successfully employed as a general antiseptic dress- ing of zcouuds, ulcers, burns, etc Internally.—Whether inhaled or taken into the stomach, terebene is a powerful stimulant, antiseptic expectorant in chronic bronchitis. The drug is of service in affections of either the upper or lower respiratory passages. In zvintcr cough, bronchorrhea, emphysema, and even in phthisis, it is an efficient remedy. Not only in bronchial affections is the drug valuable, but it has been used with striking success as a substitute for copaiba and oil of sandalwood in geuito-uri?iary diseases. It has even been claimed to influence favorably the course oi puerperal fever and to relieve the symptoms oi flatulent dyspepsia. Administration.—Terebene may be given in emulsion or in mixtures associated with other expectorants and enclosed in cap- sules or dropped upon sugar. 630 A TEXT-BOOK OF MATERIA MEDICA. Terplni Hydras—TerpJni Hydratis—Terpin Hydrate. U. S. P. Origin.—The hydrate of the diatomic alcohol Terpin, prepared by mixing rectified Oil of Turpentine, Alcohol, and Nitric Acid, allow- ing the mixture to stand for three or four days in shallow porcelain dishes, collecting the crystals which have formed, drying on ab- sorbent paper, and recrystallizing in a cold solution of alcohol. Description and Properties.—Colorless, lustrous, rhombic prisms, nearly odorless, and having a slightly aromatic and some- what bitter taste. Permanent in the air. Soluble in about 250 parts of water and in 10 parts of alcohol. Terpin hydrate should be kept in well-stoppered bottles. Dose.—2-30 grains (0.12-2.0 Gm.). Physiological Action.—Terpin hydrate is a powerful antiseptic, its action resembling that of turpentine, though inferior in strength. Therapeutics.—Externally and Locally.—The drug is used in the form of lozenges and as an inhalant in chronic tracheitis and chronic bronchitis. Internally.—Terpin hydrate may be used for the same purposes as terebene, being considered by some physicians superior to the latter drug in bronchial affections. It has been recommended as an efficient remedy in asthma, hay fever, nephritis, and neuralgia. Administration.—Terpin hydrate may be given in lozenges, emulsion, or aromatic elixir, although the most judicious method of administration perhaps is in capsules. Terpinol is obtained by boiling terpin hydrate with dilute mineral acids. It occurs as an oily body with a hyacinthine odor. Insoluble in water, but readily soluble in alcohol and in ether. Terpinol is a valuable bronchial stimulant, and may be used for the same diseases of the respiratory passages for which terpin hydrate is recommended. It is best given in capsules, in doses of about 2 grains (0.12 Gm.) each, repeated from four to six times a day. GROUP XIII.—DIURETICS AND SUBSTANCES ACTING ON THE KIDNEYS AND THE URINARY SYSTEM. Diuretics are drugs which increase the flow of urine. Con- sidered in a broader sense, however, these agents augment the secretion and modify the character of the urine— 1. By increasing the amount. DIURETICS. 631 2. By rendering the urine acid. 3. By rendering the urine alkaline. 4. By removing waste products or increasing the solid con- stituents of the urine. 5. By preventing the decomposition of the urine. The last-named action is peculiar to benzoic * and salicylic * acids, cubeb, copaiba, uva-ursi, oil of sandalwood, volatile oils,* saccharin, and salol.1 The following medicines affecting the urinary system are called Lithontriptics, because of their power to prevent the formation of concretions in the urinary passages or to dissolve them when formed: Piperazin, potassium salts * lithium salts,* ammonium benzoate * benzoic acid,* dilute nitric acid.* Among the principal drugs which render the urine acid are— benzoic * and salicylic * acids and many of their salts, immoderate amounts of the vegetable acids,* and sour wines.* The alkalies,* particularly the potassium and lithium salts, when taken internally, render the urine alkaline in reaction. Diuretics may be either Direct or Indirect—/'. c. they may act on the kidneys themselves or upon certain structures outside the kidneys. The structures in the kidneys which have to do with the elimination of water, solids, etc. are—1. The Malpighian tufts, which eliminate principally water, but also mineral salts and certain pathological and foreign substances which may be present. 2. The glandular epithelium lining the convoluted tubules, which excretes waste-products, such as urea, etc. 3. The constricted portion of the tubules, serving to prevent (according to the Cohnheim-Bauman theory) the too rapid escape of water, thus allowing time for its absorption in cases where it is desirable that the water be retained in the system. The functional activity of these various structures is regulated by the nervous mechanism through its influence upon the blood-supply. For example, the supply of blood to the glomeruli is influenced largely by the size of the blood-vessels, regulated by the vaso-con- strictor and vaso-dilator nerves ; but it has not been proven that the secretory cells are in any way affected by the nervous mechanism. Diuretics act— 1. By increasing the general blood-pressure. 2. By causing local dilatation of the renal arterioles. 1 The drugs marked with an asterisk are described elsewhere in the present work. 632 A TEXT-BOOK OF MATERIA MEDICA. 3. By directly stimulating the glandular secreting renal structures. 4. By simple mechanical force. The following table, modified from Brunton's work on Pharma- cology, Therapeutics, and Materia Medica, serves to elucidate the methods by which the various diuretic agents probably exert their influence: ' Increased cardiac f Digitalis,* action. Raise arterial pressure. Generally Locally on kidneys. Contract effer- ent vessels. General vascular contraction. Act on the vaso- motor centers. I Alcohol.* Digitalis* Strophanthus,* Squill, Scoparius,* Convallaria,* Strychnine,* Caffeine,* Erythrophleum (cold to the skin). Same as above ? Scoparius,* Buchu, Uva Ursi, Locally on kidney, "j Juniper, Turpentine, Copaiba, [ Cantharides.* Dilate efferent vessels. Act either on vaso- motor centers or locally on renal vessels. Act on secreting nerves and renal cells. Increase water excreted Increase water and solids excreted . - By simple mechanical action Nitrites,* Alcohol.* Urea, Caffeine,* Diuretin, Calomel.* Colchicum,* Liquor Potassae,* Potassium Acetate,* Potassium Citrate,* Potassium Nitrate,* Sodium Citrate * and other salines. Water, local bleeding, dry cupping, warm fomentations. The secretion of urine is considerably influenced by the activity of the skin and bowels; for instance, when the cutaneous glands are stimulated and there is free perspiration, a diminished urinary secretion ensues. The functional activity of the skin and sudo- DIURETICS. 633 riparous glands depends greatly upon the amount of blood sup- plied to them. Whatever augments the flow of blood to these structures increases the secretion of the sweat-glands. Conse- quently, external warmth dilates the cutaneous blood-vessels and promotes diaphoresis, while cold contracts the cutaneous vessels, diverting the flow of blood to the internal organs, thereby increas- ing the secretion from the kidneys and lessening that from the skin. It will be seen, therefore, that the functions of the skin and kidneys are compensatory, the compensation being also partially observable in the mutual relations between the bowels and kidneys. It is well known that when there is active purgation, with frequent watery movements from the bowels, the amount of urine secreted is proportionally diminished. Any drug which increases the general blood-pressure and forces a larger blood-supply into the kidneys augments the pressure in the glomeruli, distending the capsule and enlarging the area of the osmotic membrane, which action, combined with an increase in the circulation, promotes and facilitates filtration, thereby augmenting the amount of urine. The membrane lining the inner capsule of the glomerulus is covered with a single layer of cubical epithe- lium possessing a secretory function, rendered more active in accordance with the physiological fact that the greater the blood-supply to a gland or secreting structure, the greater its functional activity. The blood-pressure in the glom- eruli, as has been said, may be in- creased by additional pressure in the general circulation. It may be raised also locally through dilatation of the afferent blood-vessel supply- ing the Malpighian corpuscle, or con- traction of the efferent vessels, allowing a smaller quantity of blood to escape from the glomei ules. Fig. 15.—A, glomerules of capillary blood-vessels; B, cubical or secreting cells covering the membrane surrounding the capillary plexus; C, space between the two layers opening into a convoluted tu- bule ; D, the external layer covered by flattened epithelial cells; E, convoluted tubule lined with a single layer of nucle- ated polyhedral epithelium; F, afferent ar- tery entering the Malpighian corpuscle, dividing in the interior into a dense, con- voluted capillary plexus, which finally leads out of the corpuscle by G, a small, efferent vessel comparable to a vein, at a point op- posite to that where the afferent vessel enters the Malpighian corpuscle. 634 A TEXT-BOOR' OF MATERIA MEDICA. By referring to the foregoing tabular view we may ascertain the drugs acting upon the general and those affecting the local circulation. The preceding diagram (Fig. 15) will serve to elucidate the action taking place in the glomeruli. The secreting structures of the convoluted tubules are stimu- lated by the influence of certain drugs which are carried in the blood, acting as excitants upon the secreting cells. This neces- sarily requires an extra supply of blood to the part furnishing material for the extra secretion. By reference to the table on page 632 it will be seen what diuretics act upon these struct- ures. The subjoined diagram (Fig. 16) shows the structures concerned with the functional activity of the kidney. Fig. 16.—i, Malpighian corpuscle; 2, convoluted tubule with capillary plexus from efferent vessel; 3, constricted portion of the tubule; 4, unstriped muscle-fibers surrounding the constricted portion; 5, afferent blood-vessel leading into the Malpighian body ; 6, efferent vessel leading out of the Mal- pighian corpuscle; 7, the collecting tube. The imbibition of large amounts of water, while increasing the blood-pressure to some extent, mechanically increases the amount of water eliminated by the kidney. This is commonly known as the " flushing action," and renders the urine more dilute. In congested conditions of the kidneys certain remedial meas- ures—such as local venesection, dry cupping, warm fomentations, etc.—promote renal secretion. Therapeutics.— i. To remove excessive accumulation of fluid in DIURETICS. 635 the tissues and serous cavities of the body when the blood-pressure is low. For this purpose the most efficient service is derived from the use of drugs which act by increasing the systemic blood-pressure, and stimulating the secreting cells of the kidneys. Ordinarily, the agents most beneficial in cardiac dropsy or drop- sies due to venous congestion are digitalis, calomel, scoparius, squill, diuretin, etc. 2. To remove excess of fluid from the body when the blood-pressure is about normal, as in cases of hepatic cirrhosis with dropsy. The remedies found to be most efficient in these conditions are diuretin, copaiba, and calomel, although frequently saline pur- gatives, by ridding the peritoneal cavity of excess of water and preventing the accumulation of fluid by lowering the abnormally high blood-pressure in the portal circulation, prove more beneficial than diuretics. 3. To remove water from the blood when the arterial pressure is abnormally high. For this purpose diuretics are indicated in the early stages of many acute diseases, such as the eruptive fevers, tonsillitis, bron- chitis, etc. In these cases agents which dilate the cutaneous blood- vessels, such as spirit of nitrous ether, etc., should be employed. Diaphoretics and cathartics are likewise beneficial. 4. To remove from the blood injurious zuaste products and poi- sonous substances. For this purpose drugs which stimulate the convoluted tubules and increase oxidation should be given, such as potassium nitrate and bitartrate, the lithium salts, turpentine, juniper, diuretin, and the remedies mentioned under " Lithontriptics." The foregoing remedies will be found useful in diseases asso- ciated with rheumatic, gouty, and uric-acid diatheses, as well as in many acute diseases where there is rapid accumulation of deleteri- ous, retrograde material. 5. To lessen the acidity of the urine. The alkalies and the alkaline salts of the organic acids are the most useful agents for this purpose, being serviceable in such con- ditions as gonorrhea and acute inflammatory states of the genito- urinary tract. In debilitated conditions there is quite often an ex- cessive acidity of the urine, irritating the mucous membrane and causing frequent micturition. In such cases the alkaline diuretics or alkaline mineral waters are of service. 636 A TEXT-BOOK OF MATERIA MEDICI 6. To increase the acidity of the urine. This is necessary when, from any cause, there is ammoniacal decomposition of the urine, as in cystitis. In such cases benzoic acid is probably the most beneficial remedy, though the salicylates, salol, and the volatile oils, etc. may also prove useful. 7. To prevent the formation of urinary concretions or to dissolve them when formed, as in cases of renal calculi, etc. For these purposes the drugs included under " Lithontriptics " are the most efficient. 8. To dilute the urine. This process is necessary to prevent the deposit of urinary solids from farming calculi in the kidneys or bladder. For this purpose water or the alkaline mineral waters, taken in large quantities, will prove most useful. Administration.—Diuretics are often very uncertain in their action, in health many of them apparently exerting no influence upon the kidneys, and in diseased conditions not infrequently proving inert. They are more certain in their action when em- ployed in combination—that is, a union of drugs which act both generally upon the systemic circulation and locally upon the various secreting structures of the kidneys. Diaphoretics, being diverse in their action, should not be given with diuretics. When administered, diuretics should be freely diluted with water. The patient's skin should be kept cool and the bowels prevented from acting too freely, in order that the full benefit of this class of remedies may be obtained. The diuretic drugs not described elsewhere in the present work are herewith considered in detail. Scilla-Sclllae—Squill. U. S. P. Origin.—The bulb of Urginea maritima (L.) Baker, a plant in- digenous in the basin of the Mediterranean from Syria westward to the coast of the Atlantic. The bulb is deprived of its dry, mem- branaceous outer scales and cut into thin slices, the central por- tions being rejected. Description and Properties.—Occurring in narrow segments about 2 inches (5 Cm.) long, slightly translucent, yellowish-white or reddish, brittle and pulverizable when dry, tough and flexible after exposure to damp air; inodorous ; taste mucilaginous, bitter, and acrid. The drug contains three active principles—scillipicnn, DIURETICS. 637 scillitoxin (both acting upon the heart), and scillin (an emetic prin- ciple)—together with various unimportant substances, such as mu- cilage, sugar, etc. Dose.—1-4 grains (0.06-0.25 Gm.). Official Preparations. Acetum Sclllae-Aceti Scillae—Vinegar of Squill (10 per cent.).—Dose, 10-30 minims (0.6-2.0 Cc). Extractum Scillae Fluidum—Extr3cti Scillae Fluidi—Fluid Extract of Squill.—Dose, 1-4 minims (0.065-0.25 Cc). Syrupus Scillae—Syrupi Scillae—Syrup of Squill (45 per cent, of the Acetum). —Dose, 30—60 minims (2.0-4.0 Cc). Syrupus Scillae Compftsitus—Syrupi Scillae Compositi—Compound Syrup of Squill.—Dose, 15 minims-2 fluidrachms (1.0-8.0 Cc). Fluid Extract 8 per cent., with Fluid Extract of Senega 8 per cent, and Tartar Emetic 2 per cent., or \ grain (.008 Gm.) to 1 fluidrachm (4.0 Cc). Tinctura Scillae—Tincturae Scillae—Tincture of Squill (15 per cent.).—Dose, 5-20 minims (0.3-1.3 Cc). Antagonists and Incompatibles.—The action of squill upon the circulatory system is antagonized by the cardiac depressants. Tannic acid is incompatible. Synergists.—The diuretic action of squill is enhanced by the diuretics and many of the cardiac stimulants. As an expectorant the drug is aided by senega and tartar emetic Physiological Action.—Externally and Locally.—There is no action of special importance. Applied to mucous membranes, however, squill acts as an irritant. Internally.—Digestive System.—Large doses of the drug excite nausea, vomiting, and purging. Excessive amounts may produce gastro-enteritis. Circulatory System.—The action of squill upon the heart and blood-vessels resembles that of digitalis, although as a cardiac stimulant digitalis is the more powerful. Nervous System.—Poisonous doses produce marked cerebral symptoms, and in warm-blooded animals may occasion paralysis and convulsions. Respiratory System.—The bronchial mucus is increased and expectoration facilitated by small doses of squill. Toxic doses render the respiration rapid and shallow. Absorption and Elimination.—The active principles of squill are quickly diffused through the blood, being eliminated chiefly by the kidneys and bronchial mucous membrane. In the passage of squill through the kidneys the latter are 638 A TEXT-BOOK OF MA TERIA MEDICA. stimulated by the drug, which influence, together with the drug's action upon the systemic circulation, renders squill an active and valuable diuretic, increasing not only the amount of urine, but also the quantity of inorganic solids. Very large doses irritate and inflame the kidneys, resulting in strangury and hematuria, with occasionally entire suppression of urinary flow. Untoward Action.—This does not differ essentially from the symptoms of " Poisoning." Poisoning.—In toxic doses squill acts as an acro-narcotic poison. The symptoms produced by excessive doses are—nausea, violent vomiting, serous and bloody diarrhea, severe griping, a sensation of burning in the throat, vesical tenesmus accompanied by pain, bloody urine, and perhaps entire suppression of the urinary flow. The pulse is feeble and slow or sometimes rapid, the symptoms terminating in collapse and death, occasionally preceded by convul- sions. Treatment of Poisoning.—The stomach should be evacuated and demulcent drinks freely given. Opium may be necessary to relieve pain, while diffusible stimulants serve to counteract cardiac and respiratory depression. Therapeutics.—Squill is not used externally and locally. It has been employed internally as a diuretic in dropsy. When asso- ciated with digitalis and calomel it is an exceedingly active diuretic in cases of cardiac dropsy, chronic pleurisy, and pericarditis with effusion. Squill is an efficient expectorant, the vinegar, svrup, and com- pound syrup of squill being useful preparations in subacute and chronic forms of bronchitis, particularly when the sputum is tena- cious and with difficulty expelled. Contraindications.—Squill should not be employed in cases of acute diseases of the kidneys. It is also inadmissible in acute bronchitis and in phthisis. Administration.—Any of the preparations of the drug may be given, to be prescribed well diluted with syrup or glycerin. Inasmuch as the diuretic action of squill ceases after a while, the doses should be repeated and gradually enlarged until some untoward action supervenes, when further increase should be sus- pended. Because of its too irritating properties the drug is seldom given alone when desired for its diuretic action. DIURETICS. 639 Owing to the free acetic acid which it contains, syrup of squill is incompatible with ammonium carbonate and other alkalies. Erythrophleum—Erythrophlei—Erythrophleum. (Casca Bark.) Origin.—A glucosid obtained from the bark of Erythrophlceum Guincnsc Don, known under the names of Casca bark, Sassy bark, and Ordeal bark. The tree is a native of West Africa, the plant being used by the natives as an ordeal in witchcraft. Description and Properties.—Erythrophlein hydrochloride, the salt usually employed, occurs in the form of whitish crystals, soluble in water. Dose.—fa-fa grain (.001-005 Gm.). Physiological Action and Therapeutics.—The powdered bark when inhaled causes violent sneezing. The tincture of the bark, or the glucosid, when taken in poisonous doses occasions nausea, vomiting, purging, intense headache, intoxication, convulsions, and death. In medicinal doses the drug affects the circulatory system after the manner of digitalis, and acts upon the kidneys as an active diuretic. It was at one time supposed to be a powerful local anes- thetic; further examination, however, has proved the claim to be unfounded. Casca bark or its glucosid has been employed in intermittent fever, diarrhea, dysentery, and dyspepsia. Its chief medical uses are in valvular diseases of the heart and as a diuretic in cardiac and renal dropsies. Administration.—A tincture of the bark (10 per cent, strength) may be given internally, diluted with water, in doses of 5-10 min- ims (0.3-0.6 Cc). Erythrophlein hydrochlorate is usually given hypodermically. Buchu—Buchu—Buchu. U.S. P. Origin.—The leaves of Barosma betulina (Thunberg) Bartling et Wendland, and Barosma crenulata (L.) Hooker, plants or shrubs attaining a height of several feet, indigenous in the southern por- tion of Africa, particularly in various parts of Cape Colony. Description and Properties.—The leaves are \ to f inch (12 to 19 Mm.) long, roundish-obovate, with a rather wedge-shaped base, or varying between oval and obovate, crenate or serrate, with a gland at the base of each tooth, dull yellowish-green, thickish, 640 A TEXT-BOOK OF MATERIA MEDICA. pellucid-punctate; odor and taste strongly aromatic, somewhat mint-like, pungent, and bitterish. Buchu contains from 1 to 1.56 per cent, of a volatile oil, which, on exposure to a low temperature, releases barosma camphor or diosphenol, a stearopten. The bitter principle of buchu is rutin ; resin is also present. Dose.—15-30 grains (1.-2. Gm.). Official Preparation. Extractum Buchu Fluidum—Extracti Buchu Fluidi—Fluid Extract of Buchu.—Dose, 15-30 minims (i.-2.Cc). Physiological Action and Therapeutics.—Externally and locally buchu has no action of importance. When ingested it acts as a carminative, in small doses occasioning a feeling of warmth, but in excessive doses acting as an irritant. Upon the circulation the influence of the drug is that of a mild stimulant. Its active constituents are rapidly diffused through the blood, and are eliminated principally by the kidneys, the bronchial mucous membrane sharing in the excretory process. Buchu increases the fluid and solid constituents of the urine, imparting to it a peculiar aromatic odor. The drug acts as a tonic astringent and disinfectant to the mucous membranes, from which it is eliminated, diminishing the secretions. If taken for too long a period, irritation and inflammation of the kidneys are apt to ensue because of excessive stimulation. The drug is chiefly employed as a stimulant diuretic and expecto- rant in catarrhal conditions of the genito-urinary organs and bron- chial tubes. Buchu is therefore of service in urethritis, gonorrhea, gleet, chronic cystitis, incontinence of urine due to want of muscular tone, pyelitis, etc. The drug has also proved beneficial in certain cases of chronic bronchitis, and has even been recommended in chronic rheumatism and lithemia. Contraindications.—Buchu is contraindicated in acute inflam- mation of the kidneys. Administration.—The fluid extract and the infusion are the only preparations employed. They should be given freely diluted with water. Uva Ursi—Uvae Ursi—Uva Ursi. U S. P. (Bearberry.) Origin.—The leaves of Arctostaphylos Uva Ursi (L.) Sprengel., a trailing evergreen plant distributed throughout the northern por- DIURETICS. 641 tion of North America, extending as far south as New Jersey and westward to Colorado. The plant is also found in most parts of Europe and in Northern Asia. Description and Properties.—Leaves very short-stalked, obovate or oblong-spatulate, coriaceous, about |- inch (2 Cm.) long and \ to \ inch (6 to 8 Mm.) wide, obtuse, with slightly revolute edges, upper surface with depressed veins, lower surface distinctly reticulate ; odor faint, hay-like ; taste strongly astringent and some- what bitter. Uva ursi contains two bitter glucosids, arbutin and ericolin, and a tasteless principle, urzonc, besides tannic and gallic acids. Dose.—15-60 grains (1.-4. Gm.). Official Preparations. Extractum Uvae Ursi—Extracti Uvae Ursi—Extract of Uva Ursi.—Dose, 5-15 grains (0.3-1.0 Gm.). Extractum Uvae Ursi Fluidum—Extracti Uvae Ursi Fluidi—Fluid Extract of Uva Ursi.—Dose, 15-60 minims (1-4 Cc). The Physiological Action and Therapeutics of uva ursi are analogous to those of buchu. Juniperus—Juniperi—Juniper. (Juniper Berries.) Origin.—The fruit of Juniperus communis (L.), an evergreen tree indigenous in the northern hemisphere and found in the United States and Canada and in Europe. Description and Properties.—Berries globular, about the size of a large pea, externally of a glossy, purplish-black color, covered with a grayish bloom. They have an aromatic, balsamic odor, and a sweet terebinthinate, bitterish, and slightly acrid taste. Juniper contains a volatile oil; also juniperin, sugar, wax, fat, etc. Dose.—15-60 grains (1.-4. Gm.). Oleum Juniperi—Qlei Juniperi—Oil of Juniper. U. S. P. Origin.—A volatile oil distilled from the fruit of Juniperus communis. Description and Properties.—A colorless or faintly greenish- yellow liquid, becoming darker and thicker through age and exposure to air, having the characteristic odor of juniper and 41 642 A TEXT-BOOK OF MATERIA MEDICA. a warm, aromatic, somewhat terebinthinate and bitterish taste. Sol- uble in about four times its volume of alcohol, forming a more or less turbid liquid, which is neutral or slightly acid to litmus-paper. Dose.—5-15 minims (0.3-1.0 Cc). Official Preparations. Spiritus Juniperi—Spiritus Juniperi—Spirit of Juniper.—Dose, 1-8 fluidrachms (4.0-30.0 Cc). Formula: Oil of Juniper, 5; Alcohol, 95 parts. Spiritus Juniperi Comp6situs—Spiritus Juniperi Compdsiti—Compound Spirit of Juniper.—Formula: Oil of Juniper, 8; Oil of Caraway, 1; Oil of Fennel, 1; Alcohol, 1400; Water sufficient to make 2000 parts.—Dose, 2-4 fluidrachms (8.0-15.0 Cc). Unofficial Preparations. Extractum Juniperi Frtictus Fluidum—Extracti Juniperi Fructus Fluidi— Fluid Extract of Juniper Berries.—Dose, 15-60 minims (1.0-4.0 Cc). Infusum Juniperi—Infiisi Juniperi—Infusion of Juniper.—1 ounce (31. Gm.) of Juniper to 1 pint (473. Cc.) of Water.—Dose, 2-4 fluidounces (60.-118. Cc). Physiological Action and Therapeutics.—Juniper in its action resembles buchu, being a stimulant diuretic. Under certain condi- tions it acts as a diaphoretic. It is a tonic to the stomach and a mild aphrodisiac. The volatile oil, which is the active constituent of juniper, diffuses through the blood with great facility, stimulating the heart, and, in dropsical conditions, increasing the flow of urine. In health, however, the amount of urine is diminished, while that of urea is augmented. Juniper is used for the same purposes as buchu—being superior to the latter drug perhaps—especially in various dropsies and passive congestion of the kidneys. Contraindications.—The same as for buchu. Administration.—Any of the preparations may be given, gin being a popular diuretic Oleum Terebinthinse—Olei Terebinthinae—Oil of Turpentine. U. S. P. Origin.—A volatile oil distilled from turpentine—a concrete oleoresin obtained from Pinus palustris Miller and other species of Pinus. Description and Properties.—A thin, colorless liquid, of a characteristic odor and taste, both of which become stronger and less agreeable with age and exposure to air. Soluble in three DIURETICS. 643 times its volume of alcohol. Oil of turpentine should be kept in well-stoppered bottles, protected from light. Dose.—5-15 minims (0.3-1.0 Cc), in emulsion. Official Preparations. Linirn6ntum Terebinthinae—LinimSnti Terebinthinae—Turpentine Lini- ment (35 per cent, with resin cerate). For external use. Oleum Terebinthinae Rectificatum—Olei Terebinthinae Rectificati—Rec- tified Oil of Turpentine.—ZW, 5-15 minims (0.3-1.0 Cc.). Antagonists and Incompatibles.—The motor depressants and agents increasing waste therapeutically antagonize the action of turpentine. Bromine, iodine, and nitric and sulphuric acids are incompatible, explosion occurring with the first two, and combus- tion taking place by mixture with the acids named. Synergists.—The therapeutic actions of turpentine are enhanced by buchu, cubeb, copaiba, oil of sandalwood, and the diffusible and alcoholic stimulants. Physiological Action.— Externally and Locally.—Oil of turpen- tine is antiseptic, hemostatic, irritant, counter-irritant, rubefacient, vesicant, and a parasiticide. Its action resembles closely that of the volatile oils as described under " Aromatics." When applied to the epidermis the drug dilates the cutaneous blood-vessels, occasioning a sensation of heat and producing red- ness of the skin, and, if the oil be applied with inunction for any length of time, vesication ensues, with, occasionally, intractable ulcerations. The fumes of oil of turpentine when inhaled cause great irritation of the eyes and the respiratory passages. The drug is readily absorbed from the unbroken skin. Internally.—Digestive System.—When taken into the mouth turpentine produces a burning, pungent taste and an immediate and augmented salivary secretion. Swallowed in immoderate amounts, the drug occasions a sensation of heat in the epigastrium, with in- creased peristaltic action and secretion. The intestines are simi- larly affected, the intestinal peristalsis being greatly augmented, the drug acting as an efficient carminative. Large doses of turpentine produce severe, burning pain in the stomach and bowels, accompanied by nausea, vomiting, and purg- ing, the feces often containing blood. The drug is an efficient anthelmintic for tape-worm. Circulatory System.—Turpentine is a cardiac stimulant, increasing the force and rapidity of the heart's action and raising arterial ten- 644 A TEXT-BOOK OF MATERIA MEDICA. sion by direct cardiac influence. The blood-vessels are contracted by the drug, which may account for its hemostatic properties. Very large doses slow the heart by stimulating the vagus inhibitory center. Nervous System.—Small doses increase and large doses dimin- ish reflex excitability. Large doses produce giddiness, mental exhilaration, and incoherence of ideas, followed by dulness and occasionally coma. There is incoordination of movements, resulting in unsteady gait, great muscular weakness, and diminished sensation, usually preceding the impairment of voluntary motion. Respiratory System.—The effect of inhaled oil of turpentine on the respiratory passages has been described. When ingested the druo; increases and disinfects the bronchial secretion. Small doses increase and large doses diminish the respiratory movements. Absorption and Elimination.—Oil of turpentine is rapidly diffused in the blood, in moderate doses stimulating the kidneys and in- creasing the flow of urine, to which it imparts the odor of violets. Large doses irritate the kidneys, lessening the amount of urine, rendering it highly colored, and in some cases producing albu- minuria, hematuria, and even total suppression. There are present priapism and a frequent desire to micturate. Turpentine is rapidly eliminated from the system, not only by the kidneys, but by the skin, and bronchial and intestinal mucous membranes as well. Temperature.—The drug is a mild antipyretic. Uutozoard Action.—Erythema and eczematous eruptions are produced by both the ingestion and the local application of turpen- tine. In susceptible individuals small doses may occasion serious disturbances of the genito-urinary and gastro-intestinal tracts, such as strangury, painful erections, salivation, and stomatitis. The administration of repeated doses of oil of turpentine may produce peculiar nervous manifestations, such as headache, drowsi- ness, dizziness, and a sense of mental vacuity. Poisoning.—Few cases are recorded of death resulting from the ingestion of excessive amounts of turpentine, owing to the fact that the greater amount of the drug passes away through the bowels. The symptoms produced by very large doses are—great mus- cular weakness, abolition of reflexes, and violent vomiting and purging, with bloody evacuations from the bowels. There is great DIURETICS. 645 irritation of the genito-urinary tract, with constant efforts to mic- turate, hematuria or entire suppression of urine, painful priapism, and violent strangury. The skin is moist, and the face flushed or cyanosed, while dila- tation of the pupils, slow, labored, and stertorous breathing, and occasionally paroxysms of convulsive coughing, may be attendant symptoms. Either great mental excitement or profound insensibility may be present. The heart and circulatory system are greatly depressed, death, when occurring, being usually the result of cardiac failure. Treatment of Poisoning.—The stomach should be at once evacu- ated, and elimination favored by every possible means. The free administration of demulcent drinks is advisable, while to relieve pain opium may be given. Other symptoms should be treated according to their indications. Therapeutics.—Externally and Locally.—Oil of turpentine is an efficient counter-irritant, being employed as such in lumbago, my- algia, neuralgia, rheumatic pains, bronchitis, pleurisy, and various forms of chronic inflammation. A turpentine stupe is perhaps the most effective method in the local application of the drug. It is applied as follows: (1) A flannel is wrung out of hot water, sprinkled well with the oil and allowed to remain in contact with the affected part from five to twenty minutes, as indicated by the sensibility of the skin. Care must be taken in the preparation of the flannel lest the patient be chilled or scalded. (2) A vessel containing the oil is placed in hot water and a flannel wrung from the oil applied as desired. A turpentine stupe is perhaps the most grateful and efficient local application in peritonitis. Owing to its antiseptic and hemostatic properties the oil of turpentine is frequently and beneficially employed as a dressing for lacerated wounds. The drug is an active parasiticide, and has been used success- fully in the treatment of tinea tonsurans, etc. It has also been favorably recommended, when diluted with some bland oil, as a remedy for alopecia areata and psoriasis. Turpentine serves a useful purpose in many diseases of the ear and throat. Cecchini uses turpentine in the treatment of caries of the tem- poral bone. J. Solis Cohen recommends the vapor of turpentine as an 646 A TEXT-BOOK OF MA TERIA MEDICA. efficient means of allaying the cough and irritation occasioned by acute laryngeal catarrh. Erichsen employs the drug as a hemostatic to check bleeding after excision of the tonsils. The inhalation of the oil of turpentine lessens pulmonary hyperemia and excessive bronchial secretion. The drug has been recommended as a local application in diphtheria after the removal of the membranes. Internally.—Turpentine is a valuable remedy for gastric or intestinal flatulence, particularly when the condition arises from an atonic state of the muscles of the stomach or intestines. The drug is frequently employed in typhoid fever, not only for the relief of tympanitis, but also to check intestinal hemorrhage. In chronic intestinal catarrh, as well as in a catarrhal condi- tion of any mucous membrane, turpentine is a valuable remedial agent. The drug is an effectual hemostatic when given internally, having been successfully employed in hemoptysis, hematemesis, hematuria, menorrhagia, purpura hcemorrhagica, etc. Turpentine is a very powerful anthelmintic against tape-worm. When given for this purpose it should be administered in a single large dose, from 4-8 fluidrachms (15.-30. Cc), together with a large dose of some purgative like castor-oil to ensure the prompt elimination of the turpentine from the bowels. As a cardiac stimulant turpentine is often employed in low and depressed conditions of the circulatory system, such as typhoid, yellozv, and puerperal fevers, pneumonia, capillary bronchitis, trau- matic erysipelas, etc. As has been suggested, the drug has a decided and beneficial influence upon relaxed and chronic catarrhal conditions of mucous membranes, rendering this remedy of great value in bronchorrhea, chronic bronchitis, emphysema with marked bronchial catarrh, etc. This action upon the mucous membranes, together with the diu- retic properties of the drug, renders turpentine an exceedingly valuable remedy in the treatment of gleet, subacute gonorrhea, chronic cystitis, spermatorrhea, prostatorrhea, pyonephrosis, etc. Old ozonized oil of turpentine is one of the best antidotes and prophylactics in cases of phosphorus-poisoning. So-called atonic incontinence of urine is frequently benefited by the drug; and Durand has highly recommended oil of turpen- tine as a solvent of biliary calculi. DIURETICS. 647 Contraindications.—Oil of turpentine should never be given to patients suffering from Bright's disease or acute inflammation of the gastro-intestinal and genito-urinary tracts. The drug should be withheld in cases of active hemorrhage in plethoric subjects ; and, while some authorities recommend turpen- tine in hematuria, others class this condition as a contraindication. If given in the latter condition, the dose should be small and cautiously repeated. Administration.—Small doses of turpentine may be given on lumps of cut sugar, but usually preference is given to administra- tion in the form of a capsule or an emulsion, 1 fluidrachm (4. Cc.) of mucilage of acacia, if properly manipulated, emulsifying \ fluid- drachm (2. Cc.) of oil of turpentine with 1 fluidounce (30. Cc.) of water. Flavoring substances can be incorporated in the emulsion, rendering the preparation not unpleasant to the taste. In giving turpentine its tendency to produce untoward manifes- tations, particularly of the genito-urinary tract, should be remem- bered, care being invariably exercised in the administration of the drug. For external use the drug may be used in full strength, diluted with some bland oil or ointment, or applied in the form of stupes. Turpentine is sometimes employed as an enema, in which case it should, of course, be mixed with some bland oil and mucilage of acacia in the form of an emulsion. Copaiba—Copalbae—Copaiba. U. S. P. (Balsam of Copaiba.) Origin.—The oleoresin of Copaiba Langsdorffii (Desfontaines) 0. Kuntze, and other species of Copaiba, lofty forest trees, natives of Central America. Description and Properties.—A transparent or translucent, more or less viscid liquid of a pale-yellow to brownish-yellow color, having a peculiar aromatic odor and a bitter acrid taste. Insoluble in water; readily soluble in absolute alcohol, ether, chlo- roform, carbon disulphide, benzin, and fixed and volatile oils. Copaiba contains a volatile oil, tzvo resins, copaibic acid (soluble in absolute alcohol and in ammonia), and a bitter principle. The term " balsam " is a misnomer, since the drug contains neither benzoic nor cinnamic acid. Dose.—5-30 minims (0.3-2.0 Cc), in emulsion or in capsule. 648 A TEXT-BOOK' OF MA TERIA MEDICA. Official Preparation. Massa Copaibae—Massae Copaibae—Mass of Copaiba.—Formula: Copaiba, 94; Magnesia, 6; Water, a sufficient quantity.—Dose, 5-30 grains (0.3-2.0 Cm.). Oleum Copaibae—Olei Copaibae—Oil of Copaiba. U. S. P. Origin.—A volatile oil distilled from Copaiba. Description and Properties.—A colorless or pale-yellowish liquid, having the characteristic odor of copaiba and an aromatic, bitterish, and pungent taste. Soluble in about ten times its volume of alcohol, forming a slightly turbid liquid, which is neutral to litmus-paper. The drug should be kept in well-stoppered bottles, in a cool place. Dose.—5-15 minims (0.3-1 Cc). Resina Copaibae—Reslnae Copaibae—Resin of Copaiba. U.S. P. Origin.—The residue left after distilling off the volatile oil from Copaiba. Description and Properties.—A yellowish or brownish-yellow, brittle resin, having a slight odor and taste of copaiba. Soluble in alcohol, ether, chloroform, carbon disulphide, benzol, and amylic alcohol. Dose.—5-15 grains (0.3-1.0 Gm.). Antagonists and Incompatibles.—Copaiba is antagonized by the same drugs which antagonize turpentine. It is pharmaceuti- cally incompatible with aqueous preparations. Synergists.—The same as for turpentine. Physiological Action.—Externally and Locally.—Copaiba has no influence of importance, being but slightly stimulant to the skin. Internally.—Digestive System.—Its action is analogous to that of turpentine and the volatile oils. The ingestion of the drug, even in small doses, is almost always succeeded by eructations tasting of copaiba. Copaiba exerts no special influence upon the circulatory, ner- vous, and respiratory systems. Absorption and Elimination.—The drug enters the circulation with facility, and is slowly eliminated by the skin and mucous membranes generally, although chiefly by the kidneys. The resin which the drug contains is a powerful stimulant of the genito- DIURETICS. 649 urinary structures, increasing the quantity, and to some extent the solid constituents, of the urine. Large doses irritate the kidneys, occasionally producing strangury, bloody urine, pain in the blad- der, etc. Under the use of copaiba albumin is sometimes found in the urine. Frequently the nitric-acid test with urine may give a reac- tion as if for albumin, the conclusions being then erroneous, since the resin of copaiba eliminated in the urine is by the action of nitric acid precipitated as a milky cloud, readily differentiated from albumin by heating the urine or mixing it with alcohol, by both of which means the resinous precipitate is dissolved. Copaiba acts as a stimulant and disinfectant at the points of elimination, in medicinal amounts increasing secretion and impart- ing to the secretion from the kidneys, bronchial mucous membrane, and skin a peculiar, fragrant odor. Untoward Action.—It often happens that after a few days' ad- ministration of copaiba there is produced in certain individuals an eruption, usually resembling roseola, which later may be trans- formed into true papules. Or the eruption may be scarlatiniform in character or a true eczema ensue. These eruptions are first noticeable on the upper and lower extremities, backs of the hands and knees, malleoli, etc., and are attended with intense itching. Under the prolonged use of the drug there may occur serious disturbances of the digestive and genito-urinary tracts. Poisoning.—In addition to the untoward manifestations already mentioned, very large doses of copaiba produce symptoms similar to those described under Turpentine. Cases have been recorded in which excessive amounts occasioned paralysis and tetanoid attacks. Treatment of Poisoning.—This should be the same as prescribed under Turpentine. Therapeutics.—Externally and Locally.—The use of copaiba has recently been revived by Dr. Beach of Boston as a protectant antiseptic and antiphlogistic dressing for the treatment of chronic and indolent ulcers. It has been advocated as an excellent application in many chronic diseases of the skin, such as psoriasis, lupus, etc. The drug has proved valuable in frost-bites, while Shoemaker mentions it as a useful remedy to apply to " thickened and irritable conditions of the tongue, month, rectum, vagina, uterus, and urethra!' The same authority affirms that the drug sometimes completely re- 650 A TEXT-BOOK OF MATERIA MEDICA. moves the discharge of gleet when applied directly to the ure- thra. Internally.—The principal use of copaiba is as a stimulant and disinfectant of the genito-urinary tract in cases of gleet, subacute gonorrhea, vaginitis, cystitis, pyelitis, etc In ascites and dropsical conditions, particularly those due to hepatic and cardiac disease, the resin of copaiba proves a very efficient and reliable diuretic. Under prolonged use, however, a tolerance appears to be established. Copaiba is a valuable remedy in chronic bronchitis and bronchor- rhca with offensive expectoration. The drug has been at times given internally with good results in psoriasis, urticaria, etc., although the internal use of copaiba in these disorders is less common than formerly. The drug has found enthusiastic advocates as a remedy in chronic diarrhea and dysentery, and has also been recommended in chronic proctitis and chronic intestinal catarrh. Contraindications.—The same as for turpentine. Administration.—The methods of administration recommended for turpentine are applicable to this drug. It is claimed that many of the untoward manifestations produced by copaiba may be pre- vented by giving the drug with an alkali. With this object in view copaiba was associated with magnesia in the " Massa Copaibae." Yet, while this preparation is perhaps less likely to produce unto- ward results, it is undoubtedly less active therapeutically than the single drug. Oleum Santali—Olei Santali—Oil of Santal. U. S. P. (Oil of Sandalwood.) Origin.—A volatile oil distilled from the wood of Santalum album L., a small tree indigenous in Southern India and portions of the East Indies. Description and Properties.—A pale-yellowish or yellow, somewhat thickish liquid, having a peculiar, strongly aromatic odor and a pungent, spicy taste ; readily soluble in alcohol. It is frequently adulterated with oil of cedar. Dose.—5-20 minims (0.3-1.2 Cc). Physiological Action and Therapeutics.—The action of oil of sandalwood resembles closely that of copaiba, and it may be given for the same purposes as the latter drug, although oil of sandal- DIURETICS. 65i wood is more popular, and ordinarily a more efficient remedy, for gonorrhea, particularly in the early stages. Administration.—The same as in the case of copaiba. Cubeba—Cubebae—Cubeb. U. S. P. Origin.—The unripe fruit of Piper Cubeba Linn, fil., a climbing diecious shrub about 20 feet (6 M.) high, indigenous in Java. Description and Properties.—Globular, about \ or \ inch (4 or 5 Mm.) in diameter, contracted at the base into a rounded stipe about \ or f inch (6 or 10 Mm.) long, reticulately wrinkled, blackish-gray, internally whitish and hollow; odor strong, spicy; taste aromatic and pungent. It contains from 5 to 15 per cent. of a volatile oil, an odorous principle, cubebin, and a diuretic prin- ciple, cubebic acid, besides resin, fat, wax, and starch. Dose.—5-60 grains (0.32-4.0 Gm.). Official Preparations. Extractum Cubebae Fluidum—Extracti Cubebae Fluidi—Fluid Extract of Cubeb.—Dose, 5-60 minims (0.32-4.0 Cc). Oleoresina Cubebae—Oleoresinae Cubebae—Oleoresin of Cubeb.—Dose, 15^ 30 minims (0.32-2.0 Cc). Tinctura Cubebae—Tincturae Cubebae—Tincture of Cubeb (20 per cent.). —Dose, Yz-i fluidrachms (2.0-8.0 Cc). Trochisci Cubebae—Trochlscos (ace.) Cubebae—Troches of Cubeb. (Each troche contains % minim (.043 Cc.) of the oleoresin.)—Dose, 1 to 6 troches. Oleum Cubebae—Olei Cubebae—Oil of Cubeb. U.S. P. Origin.—A volatile oil distilled from Cubeb. Description and Properties.—A colorless, pale-greenish, or yellowish liquid, having the characteristic odor of cubeb and a warm, camphoraceous, aromatic taste. Soluble in an equal volume of alcohol. It should be kept in well-stoppered bottles, in a cool place, protected from light. Dose.—5-15 minims (0.3-1.0 Cc). Antagonists and Incompatibles-—The motor depressants an- tagonize the action of cubeb. Synergists.—Buchu, copaiba, oil of santal, black pepper, and many of the aromatics and volatile oils. Physiological Action.—Externally and Locally.—Like the aromatics and drugs containing a volatile oil, cubeb is irritant and rubefacient when applied by inunction. 652 A TEXT-BOOK OF MATERIA MEDICA. Internally.—Digestive System.—In medicinal amounts cubeb is an aromatic stomachic, increasing the appetite and improving digestion. As is the case with other drugs of this class, large dos- age or the too prolonged use of small amounts irritates the stomach and deranges digestion, cubeb acting as a laxative and occasioning a sensation of heat and discomfort about the rectum. Circulatory System.—Like other members of the Pepper family, cubeb enters the blood with facility, and increases the force and frequency of the heart's action. Nervous System.—No important action has been noted. Respiratory System.—There is no perceptible effect when the drug is given in medicinal doses. Absorption and Elimination.—Cubeb is absorbed and eliminated with considerable rapidity. It escapes from the system chiefly by the urine, though the skin and bronchial mucous membrane share in the excretory process. The drug acts as an active stimulant and disinfectant to the structures by which it is excreted, and is consequently a diuretic expectorant and mild diaphoretic. The urine and the amount of uric acid are increased by cubeb, the drug appearing in the urine as a salt of cubebic acid, which may be precipitated by nitric acid, the precipitate resembling that of albumin. Untoward Action.—Cubeb occasionally produces great disturb- ance in the gastro-intestinal tract, colicky pains, and diarrhea. The most frequent untoward manifestations, however, are various cutaneous eruptions, appearing in the form of papules, and often- times as a diffuse erythema. No febrile symptoms attend these eruptions, which usually disappear shortly after the suspension of the drug. Poisoning.—Although cubeb is not regarded as a poison, very large doses may be followed by all the symptoms of severe gastro- intestinal irritation. Treatment of Poisoning.—The indications are to empty the stomach, favor elimination, and treat the patient symptomatically by the use of demulcents, anodynes, stimulants, etc., as necessary. Therapeutics.—Externally and Locally.—The drug is a de- servedly popular remedy in many diseases of the nose and throat. The insufflation of an impalpable powder of cubeb or the inhala- tion of smoke from the burning drug is an efficient palliative to the sense of oppression arising from turgescence of the nasal mucous membrane. DIURETICS. 653 The troches of cubeb are extensively used for coughs, hoarse- ness, etc. The oil of cubeb is used as an inhalant and as a local application in many diseases of the throat and respiratory passages. Internally.—Cubeb is used internally for about the same pur- poses as copaiba, although by many physicians considered to be inferior to the latter drug in genito-urinary disorders. The drug has been recommended in certain nervous disorders, such as headache, impaired memory, vertigo, and fainting, and has even been thought to prove beneficial in certain cases of paralysis. Contraindications.—The same as for copaiba. Administration.—Any of the preparations may be given. The oleoresin is best administered in capsules or emulsion. Diuretin—Diuretin—Diuretin. (SODIO-SALICYLATE OF THEOBROMINE.) Origin.—The name indicates the origin, the drug being a chemi- cal combination of Theobromine (49.7 per cent.) and Salicylic Acid (38.1 per cent.). It is, in reality, a mixture of Theobromine and Sodium Salicylate. Description and Properties.—A white powder, soluble in less than half its weight of hot water, the solution remaining perfect on cooling. Sparingly soluble in cold water; soluble in warm alco- hol ; insoluble in chloroform or ether. The drug has a disagree- able, soap-like taste, and undergoes decomposition when exposed to the air. Dose.—15 grains (1.0 Gm.); 45 to 105 grains (2.9-7.0 Gm.) may be given in divided portions in twenty-four hours. Antagonists and Incompatibles.—The properties of diuretin being as yet imperfectly known, it is impossible to enumerate all the antagonists, incompatibles, and synergists. The action of the drug would certainly be retarded by the cardiac and motor de- pressants. Acids, both mineral and vegetable, are incompatible. Synergists.—The therapeutic influence of the drug would theoretically be enhanced by caffeine, digitalis, and many of the cardiac stimulants and diuretics. Physiological Action.—Externally and Locally.—There is none. Internally.—Digestive System.—Diuretin has no important ac- tion, though in many cases it may cause disturbance of digestion, impair the appetite, and even occasion nausea, vomiting, and diarrhea. 654 A TEXT-BOOK OF MATERIA MEDICA. Circulatory System.—The drug has a very beneficial action upon the svstem in failing compensation and edema, its favorable influence being due to its effect upon the kidneys. Theobromine, like caffeine, exercises a direct, stimulating action upon the renal epithelium and also a stimulating effect upon the vaso-motor center in the medulla. While we should expect a marked diuretic action from the drug, such is not always the case, because of its vaso-motor influence in contracting the vessels of the kidney. The vaso-motor action, however, is remedied by the presence of the salicylate, leaving the blood-supply to the kidney increased, through the functional activity of the cells. Nervous System.—Large and continued doses frequently occa- sion headache, somnolence or insomnia, with buzzing in the ears, and symptoms resembling those produced by the salicylates. Respiratory System.—Diuretin exerts no direct influence upon the respiratory system. Yet dyspnea, bronchitis, etc., the result of a dropsical condition, are relieved by the administration of the drug. Absorption and Elimination.—Diuretin is somewhat rapidly ab- sorbed, being eliminated mainly by the kidneys, the process greatly stimulating the renal epithelium. It is proper to state, however, that some authors attribute the diuretic power of the drug to its action upon the circulation, rather than to any effect upon the secreting structures of the kidney. The author's experience leads him to incline to the opinion that the principal action of the drug is upon the kidneys. In cases where diuretin is indicated the amount of urine is increased from three- to sixfold in twenty-four hours, under its administration the diuretic action of the drug gradually reaching its maximum between the second and third days. In the case of healthy persons diuretin has little influence upon the amount of urine excreted. Untozoard Action.—In certain individuals the drug causes great disturbance of the gastro-intestinal tract, such as nausea, vomiting, diarrhea, palpitation of the heart, headache, and slight fever; occa- sionally cutaneous eruptions may be present. Poisoning.—No cases of poisoning are recorded. Therapeutics.—The drug is used exclusively as a diuretic in cases of dropsy, ascites, pleuritic effusion, etc Diuretin is worthy of a thorough trial for the removal of drop- sical fluids, irrespective of the cause. DIURETICS. 655 Dr. Herrick of Chicago, who has not only devoted much study to the literature of the subject, but has also had a wide experience with the remedy, in a recent paper on " Diuretin " sums up the medical uses of the drug, as follows: " Diuretin is a diuretic acting by direct stimulation of the renal epithelium, and best suited to cases in which there is general drop- sical effusion. It is the best medicinal remedy for removing drop- sical fluid due to valvular disease of the heart after digitalis and pure cardiac tonics have failed. Diuretin has oftentimes a bene- ficial effect in other circulatory diseases with dropsy, as myocarditis, pericarditis, aneurysm, arteriosclerosis. Its action is here more uncertain than in valvular disease. In the dropsy of nephritis it can be used without danger of irritating the kidney, the effects in acute nephritis being more certain than in chronic nephritis. Where the renal epithelium has undergone too extensive degeneration the drug may fail to act. In the dropsy of portal obstruction, and especially of cirrhosis of the liver, it usually fails to give good results." Contraindications.—There are no special contraindications to the use of diuretin, unless it be in cases of marked gastric irritation, when the drug would undoubtedly aggravate the symptoms. Administration.—Diuretin may be given in capsules or dis- solved in some aromatic water or in milk. It should never be dispensed in powders, since it absorbs carbonic acid from the air and undergoes decomposition. It is preferable to give the drug in solution; and it can be easily associated with digitalis and similar remedies, but when used with the cardiac remedies the doses of diuretin should be smaller. When giving this drug in cases of marked ascites, or for the removal of large quantities of dropsical fluid, the first doses should be small and gradually increased to the maximum amount or until the desired effect be produced, lest by a too sudden removal of the fluid alarming collapse ensue. As acids are incompatible with the drug, diuretin should not be given immediately after meals, but its administration postponed for about three hours, to avoid unpleasant symptoms arising from the action of the gastric juice upon the remedy. The practice of adding fruit syrups or juices to a solution of diuretin for the purpose of rendering it more palatable should be strictly avoided, since the theobromine is precipitated by the vege- table acids as a thick white sediment. 656 A TEXT-BOOK OF MA TERIA MEDICA. The maximum daily amount which can be safely administered is 150 grains (9.72 Gm.). The average daily amount is 45 to 105 grains (2.9-7.O Gm.), given in divided doses of about 15 grains (1.0 Gm.) each. If diuresis is not increased in six days, the use of the drug should be suspended and recourse to other treatment adopted. Piperazlnum—PiperazTni—Piperazin. (PlPERAZIDINE; ETHYLENEIMINE; DlETHYLENEDIAMINE; DlSl'I.K.MIN!■:. ] Origin.—Obtained by the action of Ammonia on Bromide or Chloride of Ethylene. Description and Properties.—It occurs as a crystalline solid, exceedingly soluble in water, the solution being practically taste- less. When exposed to the air the drug is very deliquescent, becoming completely liquefied on long exposure. Dose.—5-15 grains (0.3-1.o Gm.). Antagonists and Incompatibles.—The incompatibles are alka- loids, tannic acid, preparations of cinchona, salts of iron, alum, Donovan's solution, acetanilid, phenacetine, and sodium salicylate. Synergists.—Lithium and its salts and the lithontriptics enhance the therapeutic action of piperazin. Physiological Action and Therapeutics.—The drug apparently has no effect whatever upon either the Digestive, Circulatory, or Respiratory Systems. Excessive doses, however, have affected the Nervous System, producing certain untoward manifestations, such as muscular tremors, hallucinations, and clonic spasms. The drug is non-irritating when applied to mucous membranes. Piperazin is rapidly absorbed from the stomach, circulates in the blood unchanged, and reaches the concretions of urates and gouty deposits, neutralizing and dissolving them, thus hastening their removal from the body. Piperazin may be detected in the urine two hours after ingestion. The only important action of piperazin is its property of dis- solving uric acid, with which it forms a neutral and exceedingly soluble salt, piperazin urate, said to be seven times more soluble in water than lithium urate. The superiority of piperazin over lithium carbonate as a uric- acid solvent has been indubitably established. Under the administration of piperazin there is an enormous in- crease in the amount of urea, with a corresponding decrease in the elimination of uric acid, indicating that there is active oxidation. DIURETICS. 657 While greatly increasing the amount of urea eliminated, neither the volume of urine nor the acid reaction of that fluid is ordinarily influenced. Moreover, while in certain cases diuresis is consider- ably augmented, the specific gravity of the urine is lowered, al- though the urine never becomes alkaline or even neutral. Therapeutics.—Externally and Locally.—A solution of pipera- zin (1 to 2 per cent.) in a mixture of water and alcohol (1 to 4, re- spectively) has been applied locally to gouty joints and swellings with beneficial results. A similar solution is equally effective in relieving the pain, allaying the inflammation, and hastening the healing of gouty sores. Solutions of piperazin may be injected into the bladder in order to dissolve vesical calculi. The drug has been recommended for local hypodermic injection in gout, although Wittsock, who used it in this manner consider- ably, claims that the subcutaneous administration of piperazin is painful and dangerous, causing inflammation with tendency to abscess. Internally.—Piperazin is one of the most useful remedies in gout. Its efficacy in this disease is said to be enhanced by combining with it phenocoll hydrochloride or phenacetin. Renal and vesical calculi of the uric-acid variety are dissolved by the free administration of piperazin. It has even proved bene- ficial in chronic cystitis and chronic rheumatic arthritis. Gruber has advocated the use of the drug in diabetes mellitus, and it has proved to be of service in renal colic and hematuria. It is in the uric-acid diathesis, however, that the drug is par- ticularly useful. The pruritus of this condition and other manifes- tations so frequently resulting from imperfect elimination of nitrog- enous material are promptly relieved by the internal administra- tion of this remedy. Contraindications.—None of importance can be named. Administration.—Piperazin is best given in aerated water, al- though it may be acceptably administered in distilled water and syrup, orange flower water, or other agreeable vehicle. Saccharin um—Saccharlni—Saccharin. (Anhydro-ortho-sulphamin-benzoic Acid; Benzoyl-sulphonic-imide; Gluside; Glucusimide.) Origin.—A derivative of the aromatic series, prepared by a complicated process from Toluene. 4? 658 A TEXT-BOOK OF MATERIA MEDICA. Description and Properties.—A white, crystalline powder, of an acid reaction, a faint, amygdaloid odor, and an intensely sweet taste. One part of saccharin in 70,000 parts of water will impart to the solution a decidedly saccharine flavor, the drug being nearly 300 times sweeter than cane-sugar. Saccharin is slightly soluble in water, 1 : 400; soluble in 30 parts of alcohol; and freely soluble in glycerin. The commercial article is usually very impure. Dose.—\-2 grains (0.03-0.12 Gm.). Physiological Action.—In a neutral or alkaline medium sac- charin acts as an antiseptic. Internally it exerts no notable influ- ence. It is said that when mixed with food it interferes with the action of saliva upon starch, and it is thought to retard the action of the other digestive ferments. The drug is not decomposed in the body, and is eliminated by the kidneys unchanged, increasing the amount of chlorides excreted in the urine, which fluid is so influenced by the drug that it does not so readily undergo fer- mentation. Therapeutics.—Externally and Locally.—Saccharin is used as a mouth-wash, being especially beneficial in aphtha7. Felici of Rome highly recommends the application of a solution of saccharin in ozena. Internally.—The principal use of the drug is as a substitute for sugar in cases of diabetes. Dr. James Little recommends saccharin in chronic cystitis with ammoniacal urine. The drug is extensively used in various elixirs, syrups, etc. to overcome the bitterness of quinine and other bitter alkaloids. Administration.—Saccharin should be given in solution. CATHARTICS. 659 GROUP XIV.—CATHARTICS. Cathartics or Purgatives are substances which cause hurried evacuation of the bowels either by direct local irritation of the intestinal mucous membrane or by setting up an osmotic current from the tissues toward the lumen of the intestines, causing an accumulation of fluid in the bowels—in both cases causing in- creased peristalsis and watery or semisolid evacuations. Mechanism of Purgation.—It should be remembered that the epithelial surfaces through which the substances needful to the body enter it, and the waste-products leave it, are physiologically outside the body. The mucous membrane of the alimentary canal is in a sense as much external as the skin covering the surface of the body and is subject to the same irritating influences. The muscular mechanism of the intestines is somewhat peculiar in that it possesses the power to rhythmically contract and relax in a wave-like manner (peristalsis), the peristaltic waves travelling down- ward. These rhythmical movements of the intestines carry their contents along their lumen from the cardia to the rectum, and are to a large extent independent of the central nervous system, although in a way controlled by a nervous mechanism. The nor- mal contents of the small intestine are fluid, and are passed into the large intestine as such. In their passage along the large bowel the fluid part is largely absorbed and the semisolid part remaining is passed on into the rectum as feces. In order that any substance may act as a purgative it must change the normal contents of the bowels in such a way as to cause fluid or semisolid evacuations. When a substance locally irritates the intestinal mucous membrane the intestines respond by increased peristalsis, which hurries the fluid contents of the small intestine through the large bowel so rapidly that absorption does not take place and the feces are evacuated in a fluid form. While increased peristalsis may be caused by action on the nervous mechanism of the intestines the exact modus operandi is imperfectly understood, and until the action of drugs on such mechanism is more thoroughly investigated we must as- sume that the action of purgatives is due chiefly to their local influence. Cathartics may be classified according to their various actions, the following table serving to show how and where the various drugs exert their several influences: 660 A TEXT-BOOK OF MA TERIA MEDICA. i. Classification according to their Mode of Action. Laxatives. Simple purgatives. Aloes. Calomel.* Cascara sagrada (full doses). Castor oil (full doses). Ox-gall. Rhubarb. Euonymus. Iris. Juglans. Leptandra. Senna. Hydragogue purgatives. Croton oil (small doses). Elaterin. Gamboge. Salines. Magnesium citrate. Magnesium sulphate. Potassium bitartrate.* Potassium sulphate. Potassium tartrate.* Potassium and sodium tartrate. Sodium phosphate. Sodium sulphate. Drastic purgatives. Cathartic acid (hy- podermically). Colocynth. Croton oil. Elaterin. Gamboge. Jalap. Scammony. Podophyllin Cassia. Castor oil. Cascara sagrada. * Glycerin. * Magnesia. * Magnesium carbonate. Manna. Sulphur. Taraxacum. There are certain drugs which are not classed as cathartics, which are some- times prescribed by physi- cians as laxatives, such as— Belladonna.* Ergot.* Hyoscyamus.* Nux vomica.* Physostigma.* Stramonium.* Certain articles of diet are laxative, such as bran bis- cuit, brown bread, ginger- bread, oatmeal, figs, honey, molasses, prunes, raspber- ries, strawberries, tama- rinds, olive oil, etc. 2. Classification according to their Manner of reaching the Intestinal Mechanism. By first contact. Nearly all the drugs used as cathartics. By circulation contact. Morphine.* Muscarine.* Physostigma.* Pilocarpine.* Strychnine.* By excretion contact. Aloes. Castor oil. Croton oil. Colocynth. Elaterium. Podophyllin. Rhubarb. Senna. j. Conditions of the Intestines affecting the Action of Drugs. Drugs requiring the presence of Drugs requiring the presence Drugs not requiring the presence an alkali or bile to act. of an acid to act. of either alkali, bile, or acid. an alkali or bile to act. Aloes. Elaterium. Gamboge. Jalap. of an acid to act. Magnesium carbonate.* Magnesia.* of either alkali, bile, or acid. Castor oil. Colocynth. Croton oil. Euonymin. (Drugs marked with an asterisk (*) are here given in detail; others are described elsewhere.) CATHARTICS. 661 Drugs requiring the presence of an alkali or bile to act. Scammony. Sulphur. Drugs not requiring the presence of either alkali, bile, or acid. Iris. Leptandra. Magnesium citrate. Magnesium sulphate. Podophyllin. Potassium and sodium tar- trate. Rhubarb. Senna. Sodium phosphate. f Classification according to the Anatomical Portion of the Intestinal Canal on which they Act. Small intestine. Colon. Calomel.* Colocynth. Castor oil. Elaterium. Jalap. Gamboge. Leptandra. Magnesium citrate. Podophyllin. Magnesium sulphate. Rhubarb. Potassium bitartrate.* Scammony. Potassium sulphate. Senna. Potassium tartrate* Potassium and sodium tartrate. Sodium sulphate. Descending colon and rectum. Aloes. 5. Classification of Cathartics according to Other Actions. Stomachics. Hepatic stimulants and cholagogues Galactagogues. Rendering the milk purgative. Increasing menstrual flow. Aloes. Aloes. Castor oil. Aloes. Aloes. Cascara sagrada. Colocynth. Castor oil. Euonymin. Colchicin. Rhubarb. Leptandrin. Euonymin. Senna. Iridin. Iridin. There are Rhubarb. Leptandrin. Podopliyllin. Sodium phosphate. Sodium sulphate. Cholagogues. probably some other cathartics that affect the milk. Aloes. Mercury with chalk.* Cal< 3mel.* Pil. hydrargyri.* Col. jcynth. Podophyllin. Euonymin. Rhubarb. Irid in. (Drugs marked with an asterisk (*) are here given in detail; others are described elsewhere.) 662 A TEXT-BOOK OF MATERIA MEDICA. Intestinal peristalsis is increased probably by the stimulation of— [. The intestinal muscles (moderate stimulation); 2. The afferent nerves connecting the intestinal mucous mem- brane with Auerbach's ganglia; 3. Auerbach's ganglia; 4. The ends of the efferent nerves passing from Auerbach's ganglia to the intestinal muscles; 5. The ends of the afferent nerves passing from the intestinal mucous membrane to the brain ; 6. The motor centers in the brain; 7. The ends of the motor nerves terminating in Auerbach's ganglia. Depression of— 8. The inhibitory motor center; 9. The ends of the inhibitory motor nerves terminating in Auerbach's ganglia; 10. The inhibitory motor center in the suprarenal plexus. It will be seen that any substance which stimulates the motor apparatus or depresses the inhibitory motor mechanism will increase peristalsis. Intestinal secretion may doubtless be promoted by any sub- stance which serves to stimulate the secretory or the vaso-dilator apparatus, or to depress the inhibitory secretory or vaso-constrictor mechanism. The methods by which absorption is diminished are not thor- oughly understood, but it is known that— 1. By increasing peristalsis and hastening the removal of fluid from the bowels absorption takes place less rapidly; 2. By giving drugs—e. g. magnesium sulphate—having high osmotic equivalents, with a great affinity for water, the absorption of fluid is prevented; 3. Substances which in some manner affect the columnar epithelium of the intestinal glands retard absorption; 4. Drugs which diminish the circulation in the intestinal mucous membranes act as deterrents to the absorptive process. It is apparent that certain drugs produce various effects, and that their mode of action varies according to the size of the dose and occasionally with the idiosyncrasy of the patient. Nearly ail cathartic drugs act by some local influence upon the CATHARTICS. 663 intestinal mucous membranes previous to absorption ; others, again, affect the bowels after they have entered the circulation—strych- nine, for example, physostigmine, pilocarpine, etc, acting in this manner. Certain other drugs, such as podophyllin, colocynth, etc., if in- jected into the circulation are excreted by the mucous membrane of the intestines, and by their irritation produce catharsis. The condition of the intestinal canal has much to do with the activity of certain drugs. Thus certain medicines produce cathar- sis regardless of the reaction of intestinal fluids ; others are inert without the presence of bile or other alkaline fluids or salts; and still a third class occasion catharsis only when after ingestion they come in contact with an acid. Of the last mentioned, magnesium carbonate is an excellent example, the drug being inert unless it be acted upon by an acid in the stomach or bowels. It is a remarkable fact that, as is shown in the tables, different cathartics act more energetically upon different portions of the in- testines. The action of calomel, for instance, is almost entirely confined to the duodenum, while aloes acts only upon the descend- ing colon and the rectum. In selecting a cathartic, therefore, a knowledge of the part of the intestinal canal to be acted upon and the locality in which the drug operates is necessary in order to secure the most satisfactory results. Many cathartics contain principles which render them tonic to the stomach ; others greatly stimulate the secretion of bile (hepatic stimulants); while the cholagogues merely hasten the expulsion of bile from the intestinal canal, preventing its absorption. Certain drugs, being excreted in the milk, which it renders purgative, are well adapted for administration to the nursing mother in order to produce catharsis in the infant. Castor oil, greatly augmenting the secretion of milk, is an excellent medium as a laxative in such cases. Aloes increases the menstrual flow; other drugs promote the secretion of urine, etc. Therapeutics.—Cathartics are employed— 1. To remove feces and produce a simple evacuation of the bowels. The Laxatives are best adapted for this purpose. 2. For the relief of chronic constipation. For this purpose great judgment is requisite in the selection of a drug or combination of agents, it being important to determine whether there is diminished peristalsis or secretion ; whether there exists an atonic condition of 664 A TEXT-BOOK OF MATERIA MEDICA. the intestinal muscles; or whether the disorder is located in the small intestine, the colon, or the rectum. 3. To remove from the bowels noxious substances or pathogenic matter. For this purpose the mercurial preparations, calomel or gray powder, are best, since they are not only active cathartics, but bactericides as well. 4. To stimulate the torpid liver. For this purpose the hepatic stimulants would naturally be employed. 5. To lessen the activity of the liver, as in bilious conditions. In such cases the cholagogue cathartics should be used. 6. To deplete the gastro-duodenal mucous membrane, where the congested and swollen mucous membrane obstructs the outflow of bile, resulting in jaundice. In this condition the salines, especially the sodium salts, are the most efficient cathartics. 7. To promote absorption and remove dropsical effusions in cer- tain diseases of the heart, liver, and kidneys. Here active cathar- sis is necessary, the hydragogue cathartics being indicated. 8. To remove urea, etc., from the blood. Occasionally in certain renal diseases the functional activity of the kidneys is so defective that waste matter, urea, etc., rapidly accumulates in the system, occasioning uremic convulsions, coma, or other serious symptoms. In such cases it may be necessary to give a drastic purgative, such as croton oil, which acts rapidly, causing profuse watery stools. 9. To lower the blood-pressure where high arterial tension aggra- vates a malady, as at the onset of many acute diseases, and in cerebral hemorrhage, meningitis, etc. In these conditions it is necessary to employ such drugs as, by dilating the intestinal blood- vessels, drain the blood away from other organs and cause abun- dant watery discharges from the bowels. Hydragogue or drastic purgatives answer the required purpose. 10. For the relief of hemorrhoids, in which cases the mild laxa- tives, such as sulphur, senna, etc., are serviceable. 11. To aid the restoration of the catamenia. For this purpose aloes is usually employed, particularly if it be necessary to deter- mine more blood to the pelvic organs. If depletion be required, the selection should be made from the hydragogue cathartics. 12. To purge the nursing infant through the mother s milk. For this purpose such drugs as rhubarb, senna, and castor oil may be administered to the mother. 13. To lozver the temperature in fever, in which cases the saline cathartics may be advantageously employed. CATHARTICS. 665 Contraindications.—Active catharsis by the more powerful hydragogue or drastic purgatives would be contraindicated in ap- pendicitis, peritonitis, typhlitis, intussusception, pregnancy, and typhoid fever, or where there is inflammation of the mucous mem- brane of the gastro-intestinal tract. Administration.—Probably no group of medicines demands greater judgment in administration than Cathartics. Ordinarily, the efficiency of these agents is increased and their operation rendered less irritant by associating drugs acting upon different portions of the alimentary canal. Their action, too, is more prompt and certain when the remedies are given upon an empty stomach and the efficiency of their operation is enhanced by exercise and diminished by sleep. The action of cathartics is promoted by the addition of small doses of emetics, mydriatics, quinine, and bitters, quinine especially strengthening the action of magnesium sulphate. Mild diluent beverages also promote the activity of cathartics. Cold applied to the abdomen, enemata, massage of the abdominal walls, and electricity, all act as adjuvant measures in the employment of purgative medicines. As has been previously suggested, a knowledge of the portion of the intestinal canal upon which the various cathartics act is of primary importance. Thus, if it be necessary to influence only the duodenum, calomel or podophyllin should be used; if the small intestine, senna or jalap; if the descending colon or rectum, aloes,—the drugs acting upon these organs alone. Moreover, due consideration should be given to the proper time for the administration of the different cathartics, the resinoid pur- gatives acting best when taken at night or before dinner, and the salines when taken in the morning before breakfast. The mode of administration is also of great importance, in order to obtain from these agents the fullest benefit. The salines, for instance, act best when given in solution in either very cold or very hot water, their activity being enhanced by association with bitters, iron, or sulphuric acid. On the other hand, the resinoid drugs should be administered in the form of pills, and if, for any reason, it is desirable that the drug should enter the intestine with- out coming in contact with the mucous membrane of the stomach, the drug may be given in the form of pills coated with keratin, which is unaffected by the gastric juice, but readily dissolved in the alkaline intestinal juices. 666 A TEXT-BOOK OF MA TERIA MEDICA. In the following detailed description cathartic drugs are grouped according to their modus operandi, the mildest drugs or laxatives being first considered. LAXATIVES. Certain substances never produce active purgation, but simply unload the bowels by slightly increasing both peristalsis and secre- tion, expelling the feces in a softened though solid and formed condition, without irritation and without perceptibly affecting the general system. These agents are especially useful where we wish to evacuate the bowels with the least possible local derangement, as in simple constipation from dyspepsia, in children, pregnant women, con- valescents from acute disease, or patients affected with hemorrhoids, hernia, affections of the rectum or womb, typhoid fever, early simple diarrhea, or in inflammation or surgical operations about the abdomen and pelvis. Besides the laxative drugs mentioned below there are many articles of diet which by purely mechanical action produce catharsis, such as oatmeal, brown bread, whole flour, molasses, prunes, figs, etc. Cassia Fistula—Cassise Fistulae—Cassia Fistula. U. S. P. (Purging Cassia.) Origin.—The fruit of Cassia Fistula L., a tree 30 to 50 feet (9-15 M.) high, indigenous in the East Indies. Description and Properties.—Cylindrical, ij to 2 feet (45-60 Cm.) long, nearly 1 inch (25 Mm.) in diameter, blackish-brown, somewhat veined, the sutures smooth, forming two longitudinal bands; indehiscent, internally divided transversely into numerous cells, each containing a reddish-brown, glossy, flattish-ovate seed imbedded in a blackish-brown sweet pulp; odor resembling that of prunes. Dose.—1-2 drachms (4.0-8.0 Gm.). Official Preparation. Confectio S6nnae—Confectionis Sfennse—Confection of Senna.—Described under Senna, p. 681. Physiological Action and Therapeutics.—Cassia is a mild and pleasant laxative. It is seldom given alone, however, but forms an ingredient in the confection of senna. CATHARTICS. 667 Oleum Riclni—Olei Riclni—Castor Oil. U. s. P. Origin.—A fixed oil expressed from the seed of Ricinus com- munis L., a plant indigenous in Southern Asia and cultivated in temperate countries for ornament and other purposes, remaining a large annual. Description and Properties.—A pale-yellowish or almost color- less, transparent, viscid liquid, having a faint, mild odor and a bland, afterward slightly acrid and generally offensive taste. Solu- ble in an equal volume of alcohol and in all proportions in abso- lute alcohol. Castor oil should be kept in well-stoppered bottles. Dose.—\-2 fluidounces (8.0-60. Cc.) Physiological Action.—Externally and Locally.—Castor oil— like other bland fixed oils, such as almond oil, olive oil, etc.—is sedative and protective when applied to the skin or mucous membranes. Internally.—The only important action is upon the intestinal tract, on which the oil acts as a mild irritant, causing purgation. Chemically castor oil is a combination of glycerin, fatty acids, and ricinoleic acid. This combination passes the stomach unchanged, but in the presence of the bile and pancreatic juice it is broken up into glycerin and ricinoleic acid; the ricinoleic acid combines with sodium and forms sodium ricinoleate, which has marked irritating properties. The ricinoleate of sodium is absorbed and excreted in ' various ways, appearing in the mother's milk and imparting to it purgative properties. Castor oil requires from four to six hours to operate, its action being usually attended with little pain. Indeed, the author is inclined to attribute anodyne properties to the drug, since it has frequently occurred to him in practice that a dose of castor oil given to a child suffering with colicky pains, while producing no movement of the bowels, served to allay the distress and cause the patient to sink into a quiet sleep. The poisonous principle, ricine,found in castor beans is an albu- minous substance belonging to the globulin group, and is generally termed a toxglobulin. Ricineis one of the most powerful poisons known, but being insoluble in oil and soluble in water it is not present in expressed castor oil. The symptoms of poisoning from castor beans are violent abdominal pain, vomiting, purging, and collapse. Post-mortem examinations have revealed evidences of , severe inflammation in the stomach and intestines. 668 A TEXT-BOOK OF MATERIA MEDICA. Castor oil should not be used as an habitual laxative, its con- tinual employment being liable to occasion constipation with all its attendant evils. Therapeutics.—Castor oil is used alone or associated with bal- sam of Peru as a sedative protectant dressing for superficial ulcera- tions. The drug is also serviceable in various diseases of the skin and mouth. It is probably superior to all other laxatives, and is applicable to all conditions for which laxatives are employed. In large doses it is one of the best purgatives to give in conjunction with an anthelmintic. Administration.—The unpleasant taste of castor oil is the only objection to its use. Yet it can be rendered quite palatable by mixing it with an equal quantity of glycerin, to which may be added a few drops of oil of cinnamon or oil of wintergreen. Various other devices for disguising the taste have been adopted, such as enveloping the oil in the froth of beer, ale, or porter, or washing out the mouth with brandy or whiskey previous to admin- istration, and allowing the patient to swallow the oil quickly, when it will not adhere to the mouth and fauces, especially if followed by a drink of some alcoholic liquid. In the form of an emulsion the taste of the oil is well disguised. There are also soft capsules of castor oil which are of course taste- less, yet they are too bulky to be popular. Castor-oil emulsion may be used as an enema when a mild injection is required. Rhamnus Purshiana—Rhamni Purshianae-Cas- cara Sagrada. U. S. P. Origin.—The bark of Rhamnus Purshiana D. C, a shrub or small tree 15 to 20 feet (4.5-6 M.) high, indigenous on the Pacific coast of North America from the British possessions southward to Northern California. Description and Properties.—Quills or curved pieces about \ to 4 inches (3-10 Cm.) long and about fa inch (2 Mm.) thick; outer surface brownish-gray and whitish, the young bark with numerous, rather broad, pale-colored warts ; inner surface yellow- ish to light brownish, becoming dark brown with age; smooth or finely striate, fracture short, yellowish, in the inner layer of thick bark somewhat fibrous ; inodorous ; taste bitter. The bark contains red, yellow, and brown resins, tannic, malic, CATHARTICS. 669 and oxalic acids, a volatile oil, and a neutral, crystalline sub- stance. Dose.—30-60 grains (2.0-4.0 Gm.). Official Preparation. ExtrSctum Rhamni Purshianae Fluidum—ExtrScti Rhamni Purshianse Fluidi—Fluid Extract of Rhamnus Purshiana.—Dose, %-\ fluidrachm (10-40 Cc). Unofficial Preparations. Certain pharmaceutical chemists, in order to overcome the bitter taste of cascara have devised various preparations, such as— Cascara Cordial. Aromatic Fluid Extract of Cascara. Elixir of Cascara, etc. Messrs. Parke, Davis & Co. of Detroit offer a concentrated preparation of the drug, known as Cascarin, which is almost tasteless and soluble in water. Dose, '/~K grain (0.01-0.03 Gm.). Physiological Action.—Cascara sagrada is a peculiarly efficient laxative, although in certain individuals it appears to be inert unless associated with other purgatives. The bitter principle it contains gives to the drug stomachic properties, and it is also said to stimu- late slightly the functional activity of the liver. The action of cascara is seldom attended with irritation or un- pleasant symptoms, the drug requiring from six to ten hours to operate. Therapeutics.—Cascara is a very valuable laxative, being em- ployed chiefly to overcome habitual constipation due to simple tor- por of the colon without associated disease. The drug is not adapted for rapid evacuation of the bowels, but rather for regulating their action. Administration.—The fluid and solid extracts are usually em- ployed, although the cascara cordial and the aromatic fluid extract, while requiring larger doses, are so palatable that they have become deservedly popular. Whatever be the preparation used in cases of habitual consti- pation, it should be given in small but repeated doses, gradually diminished until a natural action of the bowels shall have been established. The drug should be administered upon an empty stomach and in as diluted a condition as possible. Magnesia—Magnesiae—Magnesia. U. S. P. (Light Magnesia; Calcined Magnesia.) Origin, description, and properties given under " Alkalies," p. 156. Dose.—5-60 grains (0.32-4.0 Gm.). 670 A TEXT-BOOK OF MATERIA MEDICA. Magnesii Carbonas—Magnesii Carbonatis—Mag- nesium Carbonate. U. s. P. Origin, description, and properties given under " Alkalies," p. 156. Dose.—1—2 drachms (1.0-8.0 Gm.). Physiological Action.—Both magnesia and magnesium car- bonate are mild antacid laxatives, requiring the presence of an acid in the stomach and bowels to render them active. Occasion- ally, when there is marked acidity of the stomach, magnesium carbonate occasions flatulence. When taken in large amounts or for a long time magnesia tends to accumulate in the intestines. This untoward effect may be pre- vented by administering with the drug lemonade, the acid of which increases the solubility of the magnesia. Therapeutics.—Magnesium carbonate as a protective powder is an effective agent in the treatment of dermatitis of the external auditory passage. The drug is a valuable antidote to counteract the effects of phosphorus-poisoning in the throat. Both magnesia and magnesium carbonate are mild alkalies, and may be used for the same purposes as the alkalies. They are serviceable antidotes to poisoning from mineral and oxalic acids and many mineral salts. They are pleasant laxatives, being ex- tensively employed for children. Manna—Mannae— Manna. U. S. P. Origin.—The concrete, saccharine exudation of Fraxinus Ornus L, a slender tree indigenous on the northern shore of the Mediter- ranean from Asia Minor west to Spain. Description and Properties.—Flattish, somewhat three-edged pieces, about 8 inches (20 Cm.) long and 2 inches (5 Cm.) broad (usually smaller), friable, externally yellowish-white, internally white, porous, and crystalline; or fragments of different sizes, brownish-white and somewhat glutinous on the surface, internally white and crystalline ; odor honey-like ; taste sweet, slightly bitter, and faintly acrid. Manna contains a resin, the purgative principle, besides mannite, fraxin, and sugar. Dose.—I~i ounce (16.0-32.0 Gm.), dissolved in hot water. Official Preparation. Infusum S6nnae Compftsitum—Infusi Sgnnae Compdsiti—Compound Infu- sion of Senna.—See Senna, p. 681. CATHARTICS. 671 Physiological Action and Therapeutics.—Manna is a laxative, cholagogue, and nutrient. Its mild laxative action renders the drug peculiarly efficient in constipated conditions of pregnant women, and children and persons suffering from piles or irritation of the genito-urinary tract. The drug is slow in its action, tending to confine the bowels after the primary laxative effect. Sulphur Sublimatum—Sulphuris Sublimati—Sub- limed Sulphur. U. S. P. Origin.—Obtained from Crude Sulphur by sublimation. Description and Properties.—A fine yellow powder, having a slight characteristic odor and a faintly acid taste. Insoluble in water; slightly soluble in absolute alcohol; more readily soluble in benzin, benzol, oil of turpentine and many other oils, as well as in ether, chloroform, and boiling aqueous solutions of alkaline hydrates. Dose.—15-60 grains (1.0-4.0 Gm.). Official Preparations. Sulphur Lotum—Sulphuris Loti—Washed Sulphur.— Origin.—Sublimed Sul- phur, 100; Water, ioo; Ammonia Water, io; digested, filtered, drained, and dried. Description and Properties.—A fine yellow powder without odor or taste. Insoluble in water, but soluble in the substances which dissolve sulphur. Dose.—15-60 grains (1.0-4.0 Gm.). Unguentum Sulphuris—Ungufenti Sulphuris—Sulphur Ointment.—Washed Sulphur, 300; Benzoin.ited Lard, 700. For external use. Washed sulphur is an ingredient of compound liquorice powder. Sulphur Praecipitatum—Sulphuris Praecipitati— Precipitated Sulphur. U. S. P. (Milk of Sulphur; Lac Sulphur.) Origin.—Sublimed Sulphur is boiled with Slaked Lime and Water. To the solution is added Hydrochloric Acid, which throws down Sulphur as a fine precipitate, the powder being washed and dried. Description and Properties.—A fine amorphous powder of a pale-yellow color, without odor or taste. Insoluble in water. Dose.—15-60 grains (1.0-4.0 Gm.). Physiological Action.—Externally and Locally.—Sulphur is an active parasiticide, antiseptic, and keratoplastic agent. Upon the skin the drug of itself has no influence; a portion of it, however, 672 A TEXT-BOOK OF MATERIA MEDICA. is converted into hydrogen sulphide, which acts as a mild cutane- ous irritant. Internally.—As observed, sulphur proper has no action either externally or locally, although it is a normal constituent of nearly all the solids and fluids of the body. When ingested some of it is converted into hydrogen sulphide and other sulphides, which increase the intestinal secretions and promote peristalsis. The drug is chiefly excreted with the stools, which are rendered soft and semi-liquid. A portion of the hydrogen sulphide formed is eliminated through the kidneys, lungs, skin, and milk-glands. The drug is usually found in the urine as sulphate. There is imparted to the breath the offensive odor of hydrogen sulphide, and the minute portion eliminated through the skin is suf- ficient to discolor silver ornaments in contact with the body-surface. While hydrogen sulphide is a powerful poison, decomposing the blood and paralyzing the nervous and muscular systems, the amount formed and absorbed under the administration of sulphur is too small to produce marked toxic symptoms, even when large amounts of sulphur have been ingested, there is produced only violent vomiting and purging, a slight elevation of temperature, and a distinct odor of hydrogen sulphide in the breath. When sulphur is used in full doses for a long time, it tends to impair the quality of the blood and produce muscular weakness. Occasionally untoward manifestations, such as miliary eruption and eczema, accompany either the external application or the ingestion of the drug. As a laxative sulphur is slow and mild, although it occasionally causes considerable flatus, in some cases rendering the drug objec- tionable as a purgative. Therapeutics.—Externally and Locally.—While classed among laxative drugs, sulphur is a most efficient remedy in many diseases of the skin, nose, throat, etc., the external uses of sulphur being very numerous. The drug is perhaps the most serviceable parasiticide we possess in scabies, sulphur ointment well rubbed into the skin being usually sufficient to destroy the parasite. Even diseases induced by vegetable parasites, such as tinea versicolor, etc., are cured by inunctions of sulphur ointment. The drug is successfully employed in the treatment of infil- trated eczema, impetigo, sycosis, ecthyma, acne, comedo, and psoriasis. The flowers of sulphur is an old domestic remedy, and quite CATHARTICS. 673 an efficient one, in diphtheria and pharyngitis. Finally, Coroden and Duchane have both reported the successful treatment of sciatica by enveloping the affected limb in precipitated sulphur, the profuse sweating induced being followed by a decided allevi- ation of pain. When sulphur is burned sulphur dioxide is formed, a powerful germicide. By the fumes rooms and clothing may be disinfected, fumigation by sulphur being a common procedure to destroy the germs of typhoid fever, tuberculosis, cholera, diphtheria, small- pox, etc. Internally.—The principal internal use of sulphur is as a mild laxative, the drug being especially indicated for persons afflicted with hemorrhoids or anal fissure. Lozenges are prepared containing sulphur and cream of tartar, which, if taken daily for some time, will overcome habitual consti- pation, being especially serviceable in constipation due to disease of the liver. Sulphur has been used internally, and occasionally with con- siderable success, in bronchitis, chronic rheumatism, and eczema attended with much itching. Administration.—Sulphur may be given in the form of loz- enges or mixed with molasses—either alone or associated with cream of tartar, which is said to enhance the action of sulphur. Milk and syrup have been used as vehicles in the administration of the drug. Sulphurous baths, both natural and artificial, have been em- ployed in the treatment of rheumatism, gout, and some cutaneous affections. Not only for these purposes, but for their laxative influence as well, sulphurous waters are held in great repute. Taraxacum—Taraxaci—Taraxacum. U. S. P. (Dandelion.) Origin.—The root of Taraxacum officinale Weber, a perennial, acaulescent herb found in most countries of the northern hemi- sphere. Description and Properties.—Slightly conical, about 12 inches (30 Cm.) long and \ to 1 inch (12-25 Mm.) thick above, crowned with several short, thickish heads, somewhat branched, dark brown, longitudinally wrinkled; when dry breaking with a short fracture, showing a yellowish, porous central axis surrounded by a thick, 13 674 A TEXT-BOOK OF MATERIA MEDICA. white bark containing numerous milk-vessels arranged in con- centric circles ; inodorous ; bitter. The drug contains a bitter principle, taraxacin, besides inulin, resin, sugar, and mucilaginous substances. Dose.—1-4 drachms (4.0-15.0 Gm.). Official Preparations. Extractum Taraxaci—Extracti Taraxaci—Extract of Taraxacum.—Dose, 5-60 grains (0.3-4.0 Gm.). Extractum Taraxaci Fluidum—Extracti Taraxaci Fluidi—Fluid Extract of Taraxacum.—Dose, 1-4 fluidrachms (4.0-15.0 Cc). Physiological Action and Therapeutics.—Taraxacum is a stomachic tonic, diuretic, laxative, cholagogue, and feeble hepatic stimulant. It has been a popular remedy for constipation associated with hepatic congestion and atonic dyspepsia, yet the drug is now less employed than formerly, in actual practice being usually united with other laxatives. The extract or fluid extract may be given, the latter and the expressed juice being the more active. SIMPLE PURGATIVES. These differ from laxatives only in degree, the former being more active, exciting greater peristaltic action and causing a larger secretion from the intestinal glands. Simple purgatives usually oc- casion one or more copious and somewhat liquid stools, frequently accompanied by considerable irritation and griping. Aloe—Aloes—Aloes. U. S. P. Origin.—The inspissated juice of the leaves of Aloe {A. vera (L.) Webb; A. Perryi Baker), a plant resembling the so-called century plant {Agave Americana), indigenous in India and North- eastern Africa, and naturalized along the shores of the Mediter- ranean and in the West Indies. Official Varieties. Aloe BarbadSnsis— Aloes BarbadSnsis— Barbadoes Aloes (CuRACOA Aloes).— Origin.—Prepared from Aloe vera. Habitat.—Island of Barbadoes. Description and Properties.—Hard masses, orange-brown, opaque, translucent on the edges; fracture waxy or resinous, somewhat conchoidal; odor saffron-like; taste strongly bitter. CATHARTICS. 6/5 Dose.—\-\o grains (0.03-0.6 Gm.). Aloe Socotrina—Aloes Socotrinae—Socotrine Aloes.— Origin.—Obtained from Aloe Perryi. Habitat.—Island of Socotra in the Strait of Bab-el-Mandeb. Description and Properties.—Hard masses, occasionally soft in the interior, opaque, yellowish-brown, orange-brown, or dark ruby-red, not greenish, translucent on the edges; fracture resinous, somewhat conchoidal. When breathed upon it emits a fragrant, saf- fron-like odor. Taste peculiar, strongly bitter. Almost entirely soluble in alcohol and in 4 parts of boiling water. The aqueous solution becomes turbid on cooling and yields a deposit. Examined under the microscope, Socotrine aloes exhibits numerous crystals. The active principle of the various Aloes is aloin, a neutral prin- ciple, varying in chemical composition and physical properties according to the species from which it is derived; thus the sub- stance from Barbadoes aloes (barbaloin) is soluble in 60 parts of water, 20 parts of alcohol, and 470 parts of ether; that from Soco- trine aloes (socalo'in) is soluble in 60 parts of water, 30 parts of absolute alcohol, and 380 parts of ether. Nataloin, obtained from the unofficial Cape aloes, may be distinguished from the official alo'in by heating the former with a drop or two of sulphuric acid and exposing it to the vapor of nitric acid, when nataloin changes to a blue color; barbaloin and soca- loin are unaffected by this test. Nitric acid applied to barbaloin gives a crimson color, which rapidly fades; the crimson color imparted to nataloin is permanent, while no color is produced when nitric acid is applied to socaloin. Dose.—|-io grains (0.03-0.6 Gm.). Official Preparations. Extractum Aloes—Extracti Aloes—Extract of Aloes.—Dose, \-t> grains {0.03-0.4 Gm.). Aloe Purificata—Aloes Purificatae—Purified Aloes.—Dose, \-\o grains (0.03- 0.6 Gm.). Extractum Colocynthidis Compftsitum—Extracti Colocynthidis Compbsiti —Compound Extract of Colocynth.—Dose, 5-25 grains (0.3-1.6 Gm.). The following official preparations are prepared from purified aloes: Pilulae Aloes—Pllulas (ace.) Aloes—Pills ofAloes.—Dose, 1 to 4 pills. Pilulae Aloes et Asafcetidae—Pllulas (ace.) Aloes et Asafcetidae—Pills of Aloes and Asafetida.—Each pill contains about \\ grains (0.085 Gm.) of each.— Dose, I to 5 pills. Pilulae Aloes et Ferri—Pllulas (ace.) Aloes et Ferri—Pills of Aloes and Iron.—Each pill contains about 1 grain (0.06 Gm.), each, of Aloes, dried Ferrous Sul- phate, and Aromatic Powder.—Dose, 1 to 4 pills. Pilulae Aloes et Mastiches—Pllulas (ace.) Aloes et Mastiches—Pills of Aloes and Mastich.—Each pill contains about 2 grains (0.12 Gm.), together with Mastich and Red Rose.—Dose, 1 to 3 pills. Pilulae Aloes et Myrrhae—Pllulas (ace.) Aloes et Myrrhae—Pills of Aloes and Myrrh.—Each pill contains 2 grains (0.12 Gm.), together with Myrrh and Aromatic Powder.—Dose, 1 to 3 pills. 676 A TEXT-BOOK OF MATERIA MEDICA. Pilulae Rhei Compfisitae—Pllulas (ace.) Rhei Compositas—Compound Pills of Rhubarb.—Each pill contains i grain (0.06 Gm.) of Aloes.—Dose, I to 3 pills. Tinctura Aloes—Tincturae Aloe?—Tincture of Aloes (10 per cent.).—Dose, £-1 fluidrachm (2.0-4.0 Cc). Tinctura Aloes et Myrrhae—Tincturae Aloes et Myrrhae—Tincture of Aloes and Myrrh (10 per cent, ^f each, with Glycerin 10 percent.).—Dose, 1-2.I fluidrachms (2.0-10.0 Cc). Tinctura Benzoini Compdsita—Tincturae Benzoini Compftsitae—Compound Tincture of Benzoin (2 per cent, of Aloes).—Dose, 10-40 minims (0.6-2.6 Cc). Aloinum—Aloini—Aloin. U. S. P.— Origin.—A neutral principle obtained from several varieties of Aloes. Description and Properties.—Minute, acicular crystals, or a micro-crystalline pow- der, varying in color from yellow to yellowish-brown; odorless or possessing a slight odor of aloes, of a characteristic, bitter taste, and permanent in the air. The solubilities of barbaloin and socaloin are given above. Dose.—\-i grains (0.03-0.12 Gm.). Physiological Action.—Aloes has no local action, although the drug is readily absorbed from ulcers or abraded surfaces. Internally, it is stomachic, increasing the secretions from the gastro-intestinal tract. It probably increases the secretion of bile. Its principal action appears to be upon the colon, the muscular coat of which it stimulates, besides augmenting the secretion from the large intestine. In from ten to fifteen hours after the ingestion of the drug it causes soft, dark-colored evacuations, its action being usually attended with more or less griping pain. The blood-supply to the lower bowel and pelvic viscera is increased by aloes; and the drug, if used. habitually, may bring on or aggravate hemorrhoids. The menstrual function is stimu- lated, the drug being quite a decided emmenagogue. Aloes is readily absorbed; it is thrown off through the bowels and kidneys, and is found also in the milk. Therapeutics.—The principal use of aloes is as a purgative in habitual constipation due to a torpid condition of the large intestine. Jaundice resulting from hepatic congestion is well treated with aloes and blue pill. Pills of aloes and iron are useful adjuvants to other remedies in the treatment of chlorosis. Amenorrhea, which is such a common condition in chlorosis, is relieved by aloes. Pills of aloes and iron are equally valuable in menorrhagia arising from debility. Contraindications.—Aloes is ordinarily contraindicated in hem- orrhoids, although those cases attended with a mucous discharge are frequently benefited by it. The drug is considered objection- CATHARTICS. 677 able in pregnancy, in persons of plethoric, bilious, or hemorrhagic constitution, and in menorrhagia of the strong and full-blooded. Administration.—When desired as a purgative, aloes in pill form is preferable to the liquid preparations, and the drug may be given alone or associated with other purgatives, tonics, or antispasmodics. Aloin is perhaps to be preferred to aloes, as it gripes less and may be given in smaller doses. As a purgative aloes ranks between rhubarb and senna. Fel Bovis—Fellis Bovis—Oxgall. U. S. P. (Fel Tauri.) Origin.—The fresh bile of Bos Taurus L. Description and Properties.—A brownish-green or dark-green, somewhat viscid liquid, having a peculiar, unpleasant odor and a disagreeable, bitter taste. Dose.—5-15 grains (0.3-1.0 Gm.). Official Preparation. F61 Bovis Purificatum—F611is Bovis Purificati—Purified Oxgall.—Descrip- tion and Properties.—A yellowish-green, soft solid, having a peculiar odor and a partly sweet and partly bitter taste. Very soluble in water and in alcohol. Dose.—5-15 grains (0.3-1.0 Gm.). Physiological Action and Therapeutics.—Like bile, oxgall augments the duodenal secretions, emulsionizes fats, and increases intestinal peristalsis. The drug liquefies the bile, and acts as a cholagogue and purgative. It is a useful cathartic when the stools are very offensive and of a light clay color, indicating a deficient biliary secretion. The drug is serviceable in jaundice due to obstruction of the common duct by inspissated bile or mucus. Impacted feces are readily removed by an enema containing 15 or 20 grains (1.0-1.3 Gm.) of oxgall. The drug is an efficient intes- tinal antiseptic, and may be beneficially employed for that purpose in typhoid fever and intestinal fermentation. Oxgall is usually given in pill form. Rheum—Rhei—Rhubarb. U. S. P. Origin.—The root of Rheum officinale Baillon, a plant indigen- ous in the western and northwestern portions of China. Description and Properties.—In cylindrical, conical, or flattish 678 A TEXT-BOOK OF MATERIA MEDICI segments, deprived of the dark-brown, corky layer, smoothish or somewhat wrinkled, externally covered with a bright yellowish- brown powder, marked with white, elongated meshes, containing a white, rather spongy tissue, and a number of short, reddish- brown or brownish-yellow striae ; compact, hard ; fracture uneven ; internally white, with numerous red, irregularly-curved, and inter- rupted medullary rays, which are radially parallel only near the cambium line ; odor somewhat peculiar, aromatic ; taste bitter, some- what astringent. When chewed, rhubarb feels gritty between the teeth and imparts a yellow color to the saliva. Rhubarb which is very porous, or has a prominently mucilaginous taste, or is of a dark-brown color internally, should be rejected. The drug contains the following constituents: chrysophan (and chrysophanic acid), emodin, aparetin, phaeoretin, erythroretin, rheumic acid, and rheotannic acid, besides starch, calcium oxalate, etc. Dose.—5-30 grains (0.32-1.94 Gm.). Official Preparations. Extractum Rhei—Extracti Rhei—Extract of Rhubarb.—Dose, 3-15 grains (0.19-1.0 Gm.). Extractum Rhei Fluidum—Extracti Rhei Fluidi—Fluid Extract of Rhubarb (this preparation is used in Mistura Rhei et Sodae and in Syrupus Rhei).—Dose, 5-30 minims (0.3-2.0 Cc). Pilulae Rhei—Pllulas (ace) Rhei—Pills of Rhubarb.—Each pill contains 3 grains (0.19 Gm.). Dose, I to 5 pills. Pilulae Rhei Comp6sitae—Pllulas (ace) Rhei CompOsitas—Compound Rhubarb Pills.—Each pill contains about 2 grains (0.12 Gm.) of Rhubarb, with puri- fied Aloes \% grains (0.09 Gm.), Myrrh, and Oil of Peppermint. Dose, 1 to 3 pills. Pulvis Rhei Comp6situs—Pulveris Rhei CompSsiti—Compound Rhubarb Powder (Gregory's Powder)—(25 per cent., with Magnesia and Ginger).—Dose, */2- 1 drachm (2.0-4.0 Gm.). Tinctura Rhei—Tincturae Rhei—Tincture of Rhubarb (10 per cent., with Cardamom).—Dose, y2-\ fluidrachms (2.0-15.0 Cc). Tinctura Rhei Aromatica—Tincturae Rhei Aromaticae—Aromatic Tincture of Rhubarb (20 per cent., with Cassia, Cinnamon, Cloves, and Nutmeg).—Dose, 1-3 fluidrachms (4.0-12.0 Cc). This preparation is used to make Syrupus Rhei Aromaticus. Tinctura Rhei Dtilcis—Tincturae Rhei Dulcis—Sweet Tincture of Rhubarb (10 per cent., with Glycyrrhiza, Anise, and Cardamom).—Dose, ^-4 fluidrachms (2.0- 15.0 Cc). Mistura Rhei et Sodae—Misturae Rhei et Sodae—Mixture of Rhubarb and Soda.—Formula: Sodium Bicarbonate, 35; Fluid Extract of Rhubarb, 15; Fluid Extract of Ipecac, 3; Glycerin, 350; Spirit of Peppermint, 35; Water, to 1000.—Dose, %-2 fluidounces (8.0-60.0 Cc). Syrupus Rhei—Syrupi Rhei—Syrup of Rhubarb.—Formula: Fluid Extract CATHARTICS. 679 of Rhubarb, ioo; Potassium Carbonate, 10; Spirit of Cinnamon, 4; Glycerin, 50; Water and Syrup, to 1000.—Dose, 1-4 fluidrachms (4.0-15.0 Cc). Syrupus Rhei Aromaticus—Syrupi Rhei Aromatici—Aromatic Syrup of Rhubarb.—Formula: Aromatic Tincture of Rhubarb, 150; Syrup, 850.—Dose, ^-2 fluidrachms (2.0-8.0 Cc). Physiological Action and Therapeutics.—Rhubarb in mod- erate doses is a stomachic, acting similarly to the aromatic bitters, increasing secretion, peristalsis, vascularity, and absorption, thereby aiding digestion and serving as a tonic. In larger doses it is a mild cathartic, producing in from four to eight hours a soft yellow- ish-brown evacuation, not watery, which is not infrequently accom- panied by griping. It undoubtedly slightly increases the secretion of bile, though it is by no means an active hepatic stimulant. After full doses of rhubarb have been taken the purgative action is succeeded by quiescence of the bowels, the constipation being the result of the action of the astringent constituents of the rhu- barb. Small doses, however, taken daily, serve a useful purpose in relieving habitual constipation, without in the least impairing digestion. The drug is excreted with the feces, urine, perspiration, and milk; the urine is slightly increased in amount, and together with the perspiration and milk, is colored yellow. The milk acquires a bitter taste and purgative properties. Rhubarb is one of the best purgatives for children suffering from diarrhea caused by irritating ingesta in the bowels or to cold; it is also of value in some cases of dysentery. Summer diarrhea of children is often cured by some preparation of rhubarb alone, the diarrhea ceasing after a free purge by the drug. As a simple laxative for children it is a valuable remedy, owing to its secondary tonic and astringent effects, and is recommended as a laxative to expel thread-zvorms. When hemorrhoids are connected with constipation, much relief may be obtained by the gentle action of rhubarb. Administration.—Rhubarb is seldom given alone, because of the griping it occasions. For children the syrups are excellent preparations, and the mixture of rhubarb and soda is an appropri- ate remedy when the secretions of the stomach and bowels are unduly acid. In habitual constipation of adults the simple rhubarb pill is an efficient preparation. 680 A TEXT-BOOK OF MATERIA MEDICA. The choice of the preparation will depend largely upon the individual case. Euonymus—Euonymi—Euonymus. U. s. P. (Wahoo.) Origin.—The bark of the root of Euonymus atropurpureus Jacquin, a shrub 6 to io or 14 feet (1.8 to 3 or 4.2 M.) high, found growing in shady woods of the northern and middle section of the United States east of the Mississippi. Description and Properties.—In quilled or curved pieces fa to £ inch (2 to 5 Mm.) thick; outer surface ash-gray, with blackish patches, detached in thin and small scales; inner surface whitish or slightly tawny, smooth; fracture smooth, whitish, the inner layers of a laminated appearance; nearly inodorous; taste sweet- ish, somewhat bitter and acrid. The chief constituent of the drug is a resin, euonymin. Dose.—1-2 drachms (4.0-8.0 Gm.). Official Preparation. Extractum EuOnymi—Extracti Euftnymi—Extract of Euonymus.—Dose, 1-5 grains (0.06-0.3 Gm.). Eubnymin (unofficial).— Origin.—A resin from the root and stem-bark of Euonymus atropurpureus Jacquin. Description and Properties.—A brown or greenish-brown hygroscopic powder with a feebly bitter taste, soluble in water, almost insoluble in alcohol and ether. Dose.—X~3 grams (0.01-0.19 Gm.). Physiological Action and Therapeutics.—Euonymus resem- bles rhubarb in its action, but is milder, small doses being stimu- lant to the stomach. The drug is an active hepatic stimulant, increasing the secretion of bile and facilitating its excretion into the intestine. It is excreted by the kidneys and broncho-pulmonary mucous membrane, being a mild diuretic and expectorant. Euony- mus is an excellent cathartic, particularly in cases of constipation attended with impaired functional activity of the liver. Euonymin is the preparation usually employed, although the official extract of euonymus is a reliable preparation. Tris—Tridis—Iris. U. S. P. (Blue Flag.) Origin.—The rhizome and roots of Iris versicolor L., found growing in wet and swampy meadows from Canada southward to Florida and westward to Minnesota and Arkansas. CATHARTICS. 68l Description and Properties.—Rhizome of horizontal growth, consisting of joints 2 to 4 inches (5 to 10 Cm.) long, cylindrical in the lower half, flattish near the upper extremity, and terminated by a circular scar, annulated from the leaf-sheaths, grayish-brown; roots long, simple, crowded near the broad end; odor slight; taste acrid and nauseous. The drug contains an acrid resin, iridin, fixed oil, starch, gum, tannin, sugar, and indications of an alkaloid. Dose.—10-30 grains (0.6-2.0 Gm.). Ojficial Preparations. Extractum Iridis—Extracti Iridis—Extract of Iris.—Dose, 1-3 grains (0.06- 0.2 Gm.). Extractum Iridis Fluidum—Extracti Iridis Fluidi—Fluid Extract of Iris. —Dose, 10-30 minims (0.6-2.0 Cc). Iridin (unofficial).—Dose, 1-3 grains (0.06-0.2 Gm.). Physiological Action and Therapeutics.—Iris is similar in its action to euonymus, although it is more apt to disturb the stomach and occasion nausea. It is actively purgative and possesses diu- retic properties. Like euonymus, it is a hepatic stimulant, and may be used for the same purposes as the former drug. It may be used in dropsy, and has been found to be an efficient cathartic in malarial and catarrhal jaundice and bilious remittent fever. It exerts a specific influence in enlargement of the thyroid gland. The dried drug is inert, the fluid extract and iridin being the most reliable preparations to use. Jugrlans—Jutland is—Juglans. U. S. P. (Butternut.) Origin.—The bark of the root of Juglans cincrca L., a tree 30 to 40 feet (9-12 M.) high, growing in forest and bottom-lands in Canada, and the greater portion of the United States westward to Missouri and Arkansas. Description and Properties.—In flat or curved pieces, from \ to l inch (3 to 6 Mm.) thick; the outer surface dark gray and nearly smooth or deprived of the soft cork, and deep brown ; the inner surface smooth and striate; transverse fracture short, deli- cately checkered, whitish and brown ; odor feeble; taste bitter and somewhat acrid. The drug contains a bitter, oily extractive, juglandic acid, two other acids, and various salts. Dose.—1-2 drachms (4.0-8.0 Gm.). 682 A TEXT-BOOK OF MA TERIA MEDICA. Official Preparation. Extractum Juglandis—Extracti Juglandis —Extract of Juglans.—Dose, 5-30 grains (0.3-2.0 Gm.). Physiological Action and Therapeutics.—The action and medical uses of this drug are analogous to those of euonymus. Leptandra—Leptandrae—Leptandra. U. s. P. (Culver's Root.) Origin.—The rhizome and roots of Veronica virginica L, a plant indigenous in Canada, and in the United States as far west as the Mississippi Valley. Description and Properties.—Of horizontal growth, from 4 to 6 inches (10 to 15 Cm.) long and about \ inch (6 Mm.) thick, some- what flattened, bent and branched, deep blackish-brown, with cup- shaped scars on the upper side, hard, of a woody fracture, with a thin, blackish bark, a hard, yellowish wood, and a large, purplish- brown, about six-rayed pith; roots thin, wrinkled, very fragile; inodorous; taste bitter and feebly acrid. Leptandra contains a crystalline glucosid, leptandrin, besides tannin, gum, and a small quantity of volatile oil. Dose.—15-60 grains (1.0-4.0 Gm.). Official Preparations. Extractum Leptandrae—Extracti Leptandrae—Extract of Leptandra.—Dose, 1-5 grains (0.06-0.3 Gm.). Extractum Leptandrae Fluidum—Extracti Leptandrae Fluidi—Fluid Ex- tract of Leptandra.—Dose, 15-60 minims (1.0-4.0 Cc). The Pilulae Catharticae Vegetabiles contain }£. grain (0.01 Gm.) of Extract of Leptandra to each pill. Leptandrin (unofficial).—Dose, 1-3 grains (0.06-0.2 Gm.). Physiological Action and Therapeutics.—The action of lep- tandra is similar to the actions of euonymus, iris, and juglans, the green root, however, being more of an irritant to the gastro-intes- tinal tract, possessing marked emeto-cathartic properties. It is an active hepatic stimulant, and may be advantageously employed for the same purposes as euonymus, iris, etc. Senna—Sennae—Senna. U. S. P. Origin.—The leaflets of Cassia acutifolia Delile (Alexandria senna) and of Cassia angustifolia Vahl (India senna), small shrubs CATHARTICS. 683 found in Upper Egypt and southward to Nubia, Sennaar, and Kor- dofan, and farther westward in tropical Africa {Cassia acutifolid), and in Southwestern Arabia, along the Somali coast of Africa, and east- ward in Northern India {Cassia angustifolia). Description and Properties.—Alexandria senna consists of leaflets about 1 inch (25 Mm.) long and f inch (10 Mm.) broad, lanceolate or lance-oval, subcoriaceous, brittle, rather pointed, un- equally oblique at the base, entire, grayish-green, somewhat pubes- cent ; of a peculiar odor and a nauseous, bitter taste. India senna consists of leaflets 1 to 2 inches (2.5-5 Cm.) long and § to f inch (10-15 Mm.) broad, lanceolate, acute, unequally oblique at the base, entire, thin, yellowish-green or dull green, nearly smooth ; odor peculiar, somewhat tea-like ; taste mucilagi- nous, bitter, and nauseous. Senna contains a sulphuretted glucosid, cathartic acid, to which the purgative properties of the drug are due. Senna also contains chrysophan, besides sennacrol and sennapicrin (two bitter princi- ples), catharto-mannite, mucilage, etc. Dose.—10 grains-3 drachms (0.6-12.0 Gm.). Official Preparations. Conffictio S6nnae—Confectionis Sfinnae—Confection of Senna.—10 per cent., with Cassia Fistula, Tamarind, Prune, Fig, Sugar, and Oil of Coriander. Dose, 1-3 drachms (4.0-12.0 Gm.). Extractum Sfennae Fluidum—Extracti Senna Fluidi—Fluid Extract of Senna.—Dose, 10 minims-3 fluidrachms (0.6-11.09 Cc). Infusum Sennae Comp6situm—Infusi Sennae Compositi—Compound Infu- sion of Senna.—6 per cent., with Manna and Magnesium Sulphate, each, 12 per cent., and Fennel 2 per cent. Dose, 1-2^ fluidounces (30.0-75.0 Cc). Pulvis Glycyrrhizae Compositus—Pulveris Glycyrrhizae Compdsiti—Com- pound Powder of Glycyrrhiza.—Formula: Senna, 180; Glycyrrhiza, 236; Oil of Fennel, 4; Washed Sulphur, 80; Sugar, 500. Dose, ^-2 drachms (2.0-8.0 Gm.). Syrupus Sennae—Syrupi Sennae—Syrup of Senna (25 per cent.).—Dose, )<-\ fluidounce (8.0-3.0 Cc). Cathartic Acid, Cathartinic Acid (unofficial).— Origin.—An active principle obtained from the leaves of various species of Cassia. Description and Properties.—It occurs as brown, hygroscopic scales, freely soluble in water and in alcohol. Dose.—2-6 grains (0.12-0.38 Gm.). Physiological Action and Therapeutics.—Senna is an active purgative, acting upon nearly the entire intestinal tract, increasing both peristalsis and intestinal secretion, although having but little effect upon the biliary secretion. It is apt to occasion much flatu- lence and griping unless it is associated with aromatics. Full doses 684 A TEXT-BOOK OF MATERIA MEDICA. open the bowels in from four to eight hours, producing one or more copious liquid, yellow stools, but never occasioning hyper- catharsis, and the purgation is not followed by constipation. An infusion of senna, if injected into the veins, excites both vomiting and purging. Some persons are so susceptible to the influence of senna as to be purged even by its odor. The drug, or some constituent of it, is eliminated by the urine, to which it imparts a red color, and by the milk, rendering it pur- gative. The various preparations of senna are very efficient purgatives in cases of simple constipation or in cases oi fecal accumulation in the colon. Infusion of senna is an admirable purgative with which to suc- ceed the administration of blue pill. In cases of biliousness there is probably no better treatment than calomel or blue pill at night and infusion of senna in the morning. Habitual constipation and the constipation of pregnancy are safely and agreeably treated by compound liquorice powder. Administration.—Senna is seldom given alone, but is generally associated with some corrective to prevent griping. The infusion, compound liquorice powder, syrup, and confection of senna are employed. The compound liquorice powder and the confection being the mildest and pleasantest, the latter preparation, when coated with chocolate, is readily taken by children, and in this form is the well- known laxative " Tamar IndienP HYDRAGOGUE PURGATIVES. These drugs are more active than the preceding class, pro- ducing an abundant secretion from the intestinal mucous mem- brane, removing a large quantity of water from the blood-vessels, and producing several copious, watery stools. Oleum Tig-lii—Olei Tiglii—Croton Oil. U. S. P. Origin.—A fixed oil expressed from the seed of Croton Tiglium L., indigenous in Hindostan and some of the East Indian and Philippine islands. Description and Properties.—A pale-yellow or brownish-yel- low, somewhat viscid, and slightly fluorescent liquid, having a slight, fatty odor, and a mild, oily, afterward acrid and burning, taste CATHARTICS. 685 {great caution is necessary in tasting). Croton oil should be kept in small, well-stoppered bottles, and should be handled with caution, for when applied to the skin it produces rubefaction or a pustular eruption. When fresh, croton oil is soluble in about 60 parts of alcohol, the solubility increasing by age. The drug contains several volatile acids, of which tiglinic acid is the characteristic one; besides this, it contains lauric, myristic, palmitic, stearic, formic, acetic, isobutyric, and isovalerianic acids. Dose.—\-2 minims (0.01-0.12 Cc.) on a lump of sugar or mixed with some bland oil. Physiological Action.—Externally and Locally.—Croton oil is a powerful irritant when applied to the skin, exciting inflammation and quickly producing vesication, which rapidly merges into pus- tules closely resembling those of variola, and perhaps lasting several days. In many cases permanent cicatrices mark the sites of these pustules. If the drug be rubbed over the abdomen, it may produce pur- gation. The irritating action is wholly due to the free croton- oleic acid which the oil contains. Internally.—When a drop or two of croton oil is taken into the stomach it occasions a sense of heat in the epigastrium, which is soon succeeded by griping and abdominal pain, and in from half an hour to two hours after the ingestion of the drug there are pro- duced profuse watery stools, with considerable burning and irrita- tion about the anus. The drug greatly increases the vascularity of, and the secretion from, the gastro-intestinal tract, without specially influencing the biliary secretion. Large doses produce violent gastro-enteritis, hypercatharsis, with great prostration and collapse resembling that of cholera. In case of poisoning the stomach should be immediately evacu- ated, and demulcent drinks freely given. Opium and stimulants may be necessary. Therapeutics.—Externally and Locally.—The external use of croton oil is comparatively limited. It is occasionally painted over the seat of pain in intercostal neuralgia, while a liniment of croton oil applied to the chest is said to be beneficial in phthisis and chronic bronchitis. The same prep- aration is recommended as a local application in congestive dysmen- orrhea and chronic congestion of the uterus. 686 A TEXT-BOOK OF MATERIA MEDICA Croton oil has been put to many other uses, but the results ob- tained are so unsatisfactory that it is needless to enumerate them. Internally.—The drug is used as a purgative, as a rule only in cases of emergency, and then a single dose is usually sufficient. It is employed in such cases as intestinal obstruction from accumu- lated feces produced by torpor of the bowels, diseases of the neroous system, lead-poisoning, etc. In lead colic it is probably superior to all other purgatives. Croton oil is sometimes employed for its revulsive action in apoplexy. As a purgative it is frequently given to lunatics, because, on account of the smallness of the dose, it may be easily placed on the back of the tongue, where it is quickly swallowed reflexly. Contraindications.—The drug should never be given to preg- nant women, to children, nor to patients suffering from hemor- rhoids, peritonitis, gastritis, or enteritis. Administration.—Croton oil may be given in emulsion, or mixed with some bland oil, or dropped on a piece of loaf sugar, or in pill form. The best excipient for pills of croton oil is breadcrumb. Elaterlnum—Elaterlni—Elaterin. U. S. P. Origin.—A neutral principle obtained from Elaterium, a sub- stance deposited by the juice of the fruit of Ecballium elaterium L., commonly known as " squirting cucumber," a vine growing in the Mediterranean regions of Europe, Africa, and Asia. Description and Properties.—Minute, white, hexagonal scales or prismatic crystals, without odor, and having a slightly acrid, bitter taste; permanent in the air; soluble in 4250 parts of water and 337 parts of alcohol. Dose.—fa—fa grain (0.002-0.005 Gm.). Official Preparation. Trituratio Elaterlni—Triturationis Elaterlni—Trituration of Elaterin.— Dose, about \ grain (0.05 Gm.). Physiological Action and Therapeutics.—Elaterin is the most powerful hydragogue purgative known. The drug greatly increases the salivary, gastric, and intestinal secretions, as well as those from the liver and pancreas. It is a violent purgative, whether given internally or injected CATHARTICS. 687 subcutaneously, producing abundant watery evacuations attended with much griping pain and great prostration. Elaterin is indicated where profuse serous discharges are de- sired, as in cases of congestion of the brain and lungs, ascites, and chronic nephritis. Contraindications.—The drug is not permissible in inflamma- tory conditions of the gastro-intestinal tract, nor in pregnancy, and it should be administered with much care, if at all, in heart disease. Administration.—The drug may be given in pill form, in alco- holic solution, or in the form of the trituration. Elaterin varies greatly in strength, which suggests caution in its use. Cambogia—Cambogiae—Gamboge. U. S. P. Origin.—A gum-resin obtained from Garcinia Hanburii Hooker filius, a medium-sized tree, indigenous in Siam, Cambodia, and Cochin China. Description and Properties.—In cylindrical pieces, sometimes hollow in the center, 1 to 2 inches (2 to 5 Cm.) in diameter, longi- tudinally striate on the surface; fracture flattish-conchoidal, of a waxy luster, orange-red; in powder bright yellow; inodorous; taste very acrid; the powder sternutatory. Gamboge is partly soluble in alcohol and in ether. Dose.—1-5 grains (0.06-0.32 Gm.). Official Preparation. Pilulae Catharticae Compositae—Pllulas (ace) Catharticas Compbsitas— Compound Cathartic Pills.—Dose, 1-3 pills. Physiological Action and Therapeutics.—Gamboge is a vio- lent hydragogue purgative, exciting active peristalsis and greatly augmenting the secretion from the intestinal glands, although not increasing the secretion of bile. Small and repeated doses are slightly diuretic, coloring the urine yellow. Gamboge is seldom given alone, being usually associated with other purgatives. It is used in combination when a hydragogue action by the kidneys as well as the bowels is desired. It is thought to be of use in hepatic congestion arising from malarial causes. The drug is an efficient anthelmintic, and is occasionally prescribed with vermicide medicines. A TEXT-BOOK OF MA TERIA MEDICA. SALINES. Magnesii Citras Effervescens—Magnesii Citratis Effervescentis—Effervescent Magnesium Ci- trate, u. S. P. Formula: Magnesium Carbonate, io ; Citric Acid, 46 ; Sodium Bicarbonate, 34; Sugar, 8; Alcohol and Distilled Water, a suf- ficient quantity. Description and Properties.—A white, coarsely granular salt, without odor, and having a mildly acidulous, refreshing taste. Deliquescent on exposure to the air. Soluble, with copious effer- vescence, in 2 parts of water; almost insoluble in alcohol. The product should be kept in well-closed vessels. Dose.—^-1 ounce (8.O-32.O Gm.). Liquor Magnesii Citratis—Liquoris Magnesii Citratis —Solution of Magnesium Citrate. U. s. P. Formula: Dissolve Magnesium Carbonate, 15, in a solution of Citric Acid, 30; add Syrup of Citric Acid, 60; then Crystals of Potassium Bicarbonate, 25. Cork the bottle and wire immediately. The product effervesces when uncorked. Dose.—2-8 fluidounces (60.0-237.0 Cc). Magnesii Sulphas—Magnesii Sulphatis—Magne- sium Sulphate. U. S. P. (Epsom Salt.) Origin.—Obtained by the action of Sulphuric Acid upon native Magnesium Carbonate, treated with Water, filtered, and the filtrate evaporated to crystallization. Description and Properties.—Small, colorless, rhombic prisms or acicular crystals, without odor, and having a cooling, saline, and bitter taste; slowly efflorescent in dry air. Soluble in 1.5 parts of water; insoluble in alcohol. Dose.—i-i ounce (8.0-32.0 Gm.). Antagonists and Incompatibles.—Magnesium sulphate is in- compatible with alkaline carbonates, phosphoric acid, phosphates, lead acetate, silver nitrate, and lime water. Synergists.—Saline purgatives. Potassii Sulphas—Potassii Sulphatis—Potassium Sulphate. U.S. P. Origin.—Prepared by adding Potassium Carbonate to Acid Potassium Sulphate. CATHARTICS. 689 Description and Properties.—Hard, colorless, transparent, six- sided, rhombic prisms terminated by pyramids, or in white powder; odorless, and having a somewhat bitter, saline taste. Permanent in the air. Soluble in about 9.5 parts of water, insoluble in alcohol. Dose.—1-4. drachms (2.0-16.0 Gm.). Potassii et Sodii Tartras-Potassii et Sodii Tartratis —Potassium and Sodium Tartrate. U. S. P. (Rochelle Salt.) Origin.—Prepared by adding Acid Potassium Tartrate to a hot solution of Sodium Carbonate. Description and Properties.—Colorless, transparent rhombic prisms, or a white powder, odorless, and having a cooling, saline taste. The crystals slightly effloresce in dry air. Soluble in 1.4 parts of water, almost insoluble in alcohol. Dose.—30 grains-i ounce (2.0-32.0 Gm.). Official Preparation. Piilvis Effervfescens Comp6situs—Pulveris EffervescSntis Compdsiti— Compound Effervescing Powder (Seidlitz Powder).—Each powder has of Ro- chelle Salt, 120 grains (8.0 Gm.); of Sodium Bicarbonate, 40 grains (3.0 Gm.), mixed in a blue paper; and of Tartaric Acid, 35 grains (2.26 Gm.), in a white paper. Dose.—One or two of each dissolved separately in separate quantities of water, the solutions poured together and drunk while effervescing. Sodii Phosphas—Sodii Phosphatis—Sodium Phos- phate. U.S. P. (Sodium Orthophosphate.) Origin.—Prepared by digesting Bone Ash with Sulphuric Acid. The solution is filtered, and to it is added Sodium Carbonate, and the filtrate evaporated to crystallization. Description and Properties.—Large, colorless, monoclinic prisms, odorless, and having a cooling, saline taste. The crys- tals effloresce in the air, and gradually lose 5 molecules of water of crystallization. Soluble in 5.8 parts of water; insoluble in alcohol. Sodium phosphate should be kept in well-stoppered bottles, in a cool place. Dose.—5 grains-i ounce (0.32-32.0 Gm.). 44 690 A TEXT-BOOK OF MATERIA MEDICA. Sodii Sulphas—Sodii Sulphatis—Sodium Sulphate. u. s. p. (Glauber's Salt.) Origin.—The residue left in the manufacture of Hydrochloric Acid from Salt is neutralized with Sodium Carbonate. Description and Properties.—Large, colorless, transparent, monoclinic prisms or granular crystals; odorless, and having a bitter, saline taste. The salt effloresces rapidly in the air, and finally loses all its water of crystallization. Soluble in 2.8 parts of water and in glycerin; insoluble in alcohol. Dose.—1-8 drachms (4.0-32.0 Gm.). Physiological Action and Therapeutics of the Salines.—These preparations greatly augment the amount of fluid in the intestinal canal. This increase of fluid is not a secretion, but a result of the high osmotic equivalent of the salts which tends to draw the body- fluids into the intestines, while hindering to a certain extent absorp- tion of fluid from the intestines. The purgative influence is really due to the mechanical action of the fluid in the intestines. Save the sulphate and phosphate of sodium, which are mild he- patic stimulants, the salines have no effect upon the biliary secretions. The sodium salts are more efficient than the potassium salts as purgatives, owing to their higher osmotic equivalents. Purgation by the salines is painless, and occurs usually in from two to three hours after administration, there being ordinarily two or three watery evacuations. In cases of habitual constipation, particularly that associated with the gouty diathesis, there are no better purgatives than the salts of sodium or mineral waters containing them, such as Carlsbad, Marienbad, Hunyadi Janos, etc. For children there is no better purgative than sodium phos- phate, especially where the stools show a deficiency of bile. In duodenal catarrh excellent results are obtained by this drug; also in chronic rheumatism, and to retard the formation of biliary calculi. Concentrated saline purgatives are efficient remedies for the removal of dropsical and pleuritic effusions. Magnesium sulphate, combined with dilute sulphuric acid, is the most efficient treatment in cases of chronic lead-poisoning. Rochelle salt and Seidlitz powder are pleasant and useful purgatives in cases of biliousness, migraine, etc. Solution of mag- CATHARTICS. 691 nesium citrate is used for the same purpose, but, while very palatable and acceptable to the stomach, is not always reliable, besides being apt to occasion slight griping. Administration.—The salines should be taken dissolved in as concentrated a solution as possible, and ordinarily should be administered in the morning, when the stomach is empty. DRASTIC PURGATIVES. These drugs are even harsher in their action than hydragogue purgatives, exciting violent peristalsis, and in large doses producing gastro-enteritis and all the symptoms occasioned by an irritant poison. The evacuations produced by these drugs are numerous, copious, and watery, attended with much griping pain, tenesmus, and borborygmi. Colocynthis—Colocynthidis-Colocynth. U. S. P. Origin.—The fruit of Citrullus Colocynthis Schroder, deprived of its rind. The colocynth plant is indigenous in Japan and is cultivated and naturalized in Spain. Description and Properties.—From 2 to 4 inches (5-10 Gm.) in diameter; globular; white or yellowish-white, light, spongy; readily breaking into three wedge-shaped pieces, each containing, near the rounded surface, many flat, ovate, brown seeds ; inodor- ous ; taste intensely bitter. The active constituent of colocynth is colocynthin, a glucosid, of which there is present about 2 per cent. Colocynth also con- tains resin, gum, and an amyloid principle. Dose.—5-10 grains (0.3-0.6 Gm.). Official Preparations. Extractum Colocynthidis—Extracti Colocynthidis—Extract of Colocynth. Dose, \-2 grains (0.03-0.13 Gm.). Extractum Colocynthidis CompOsitum—Extracti Colocynthidis CompSsiti —Compound Extract of Colocynth.—Extract of Colocynth 16 per cent., with Aloes Scammony, Cardamom, and Soap. Dose.—5-25 grains f0.3-1.6 Gm.). Compound Extract of Colocynth enters into the following pills : Pilulae Catharticae Comp6sitae (8 per cent.). Pilulae Catharticae Vegetables (6 per cent.). Physiological Action and Therapeutics.—The action of colo- cynth is very similar to that of elaterin. In small doses, however, 692 A TEXT-BOOK OF MATERIA MEDICA. it rather acts as a stomachic, improving the appetite and augment- ing the secretions of the whole gastro-intestinal tract. Colocynth is quite a decided hepatic stimulant and cholagogue. Pills containing colocynth are useful to produce abundant watery evacuations, as is necessary sometimes in the treatment of hepatic and renal diseases where there is constipation and ascites. The drug should be employed only when there is some marked indication for its use, as colocynth, like the other drastics, is too irritant for habitual use. Gastro-intestinal inflammation, pregnancy, etc., would contra- indicate its use. Jalapa—Jalapae—Jalap. U.S. P. Origin.—The tuberous root of Ipomoea Jalapa Nuttall, a twin- ing herbaceous perennial growing in damp and shady woods on the eastern slope of the Mexican Andes. It has been introduced into India and Jamaica. Description and Properties.—Napiform, pyriform, or oblong, varying in size, the large roots incised, more or less wrinkled, dark brown, with lighter-colored spots and short, transverse ridges; hard, compact, internally pale grayish-brown, with numerous con- centric circles composed of small resin-cells; fracture resinous, not fibrous; odor slight, but peculiar, smoky, and sweetish; taste sweetish and acrid. Jalap contains two resins, one hard, the other soft, the former, termed jalapin or convolvulin, being the active principle of the drug. According to the U. S. Pharmacopoeia, there must be not less than 12 per cent, of resin, of which not less than 10 per cent. must be soluble in ether. Dose.—5-30 grains (0.32-2.0 Gm.). Official Preparations. Extractum Jalapae—Extracti Jalapae—Extract of Jalap.—Dose, 2-5 grains (0.13-0.3 Gm.). Pulvis Jalapae CompSsitus—Pulveris Jalapae Comp6siti—Compound Jalap Powder (35 per cent., with Potassium Bitartrate).— Dose, 15-60 grains (1.0-4.0 Gm.). Resina Jalapae—Resmae Jalapae—Resin of Jalap.—Description and Proper- ties.—Yellowish-brown or brown masses or fragments, breaking with a resinous, glossy fracture, translucent at the edges, or a yellowish-gray or yellowish-brown powder, having a slight, peculiar odor, and a somewhat acrid taste. Permanent in the air. Soluble in alcohol in all proportions. Dose.—2-5 grains (0.13-0.3 Gm.). Extract of Jalap is one of the ingredients of Pilulae Catharticae Comp6sita and Pilulae Catharticae Vegetables. CATHARTICS. 693 Physiological Action and Therapeutics. — The purgative action oi jalap is developed in the duodenum, where it comes in contact with the bile. The secretion from the intestinal glands is greatly augmented, as well as the vascularity and peristalsis of the intestines. The biliary flow is but little affected. Purgation is produced by jalap in three or four hours, the evacuations being profuse and watery and attended with griping pain. Jalap—or, preferably, the compound jalap powder—is a reliable hydragogue cathartic for the removal of dropsical effusiotis, being especially appropriate for nephritic patients. Small doses of jalap are serviceable in constipation due to de- ficient intestinal secretion. The drug is frequently associated with anthelmintic medicines as a vermifuge. Scammonium—Scammonii—Scammony. U. s. P. Origin.—A resinous exudation from the living root of Convol- vulus Scammonia L., a herbaceous, twining perennial, growing in Syria, Asia Minor, and Greece. Description and Properties.—Occurring in irregular angular pieces or circular cakes, greenish-gray or blackish, internally por- ous, and breaking with an angular fracture, of a resinous luster; odor peculiar, somewhat cheese-like ; taste slightly acrid ; powder gray or greenish-gray. It contains a resin, jalapin, which is the active principle, besides gum, starch, etc. Dose.— 1-15 grains (0.06-1.0 Gm.). Official Preparation. Resina Scammonii—Resinae Scammonii—Resin of Scammony.—Descrip- tion and Properties.—Yellowish-brown or brownish-yellow masses or fragments, break- ing with a glossy, resinous fracture, translucent at the edges, or a yellowish-white or grayish-white powder, having a faint, peculiar odor, and a slight, peculiar taste. Soluble in alcohol in all proportions. Dose.—1-8 grains (0.06-0.5 Gm.). Physiological Action and Therapeutics.—The action of scam- mony is identical with that of jalap, save that it stimulates the muscular coat of the intestines more, producing more irritation and griping than jalap, though not increasing secretion so much as the latter drug. 694 A TEXT-BOOK OF MA TERIA MEDICA. The therapeutics are the same as for jalap. The drug may be given in powder, emulsion, or in milk, but is inactive in pilular form. Podophyllum—Podophylli—Podophyllum. U. S. P. (May Apple.) Origin.—The rhizome and roots of Podophyllum pcltatum L., an herbaceous perennial growing in rich woodlands in Canada and the United States. Description and Properties.—Of horizontal growth, consisting of joints about 2 inches (5 Cm.) long, flattish cylindrical, about \ inch (6 Mm.) thick, but somewhat enlarged at the end, which has a circular scar on the upper side, a tuft of about ten nearly simple, fragile roots on the lower side, and is sometimes branched laterally; smooth or somewhat wrinkled, orange-brown, internally white and mealy, with a circle of small wood-bundles ; pith large; nearly inodorous ; taste sweetish, somewhat bitter and acrid. Podophyllum contains a resin, podophyllin, composed princi- pally of podophyllotoxin, which is probably a mixture of picropodo- phyllin, the purgative principle, and podophyllinic acid, an inactive resin acid. Among other constituents of the drug are several minor resins and a coloring principle. Dose.—5-20 grains (0.32-1.29 Gm.). Official Preparations. Extractum Podophylli—Extracti Podophylli—Extract of Podophyllum.— Dose, 1-3 grains (0.06-0.2 Gm.) Extractum Podophylli Fluidum—Extracti Podophylli Fluidi—Fluid Ex- tract of Podophyllum.—Dose, 5-20 minims (0.32-1.29 Cc). Resina Podophylli—Resinae Podophylli—Resin of Podophyllum.—Descrip- tion and Properties.—An amorphous powder, varying in color from grayish-white to pale greenish-yellow or yellowish-green, turning darker when exposed to heat; having a slight peculiar odor and a peculiar, faintly bitter taste; permanent in the air; soluble in alcohol in all proportions. Dose.—l-i grain (0.008-0.06 Gm.). PodophyllotOxin (unofficial).—ZW, y^-^ grain (0.0006-0.006 Gm.). Physiological Action and Therapeutics.—The powdered root is an irritant to the skin, and when inhaled occasions a decided irritation of the eyes and respiratory passages. It is absorbed when applied to ulcers and raw surfaces, producing its character- istic purgative effects. The drug is a gastro-intestinal irritant, being ANTHELMINTICS. 695 apt to excite nausea, in full doses producing salivation and greatly augmenting the intestinal secretions, and especially the bile. Under full doses of podophyllum there is marked peristalsis, attended with severe griping pains, and in the course of ten or twelve hours there is produced a complete evacuation of the bowels, the feces being liquid and deeply stained with bile. The drug being one of the most active hepatic stimulants and cholagogues in the Pharmacopoeia, it is a peculiarly appropriate remedy in that condition known as torpor of the liver. The con- stipation attending hepatic cirrhosis and cancer, as well as that from any hepatic disorder, is well treated by podophyllum. The slowness and completeness of its action, together with its property of stimulating the functional activity of the liver, renders the drug extremely serviceable in the treatment of habitual consti- pation from any cause. It should, however, be associated with antispasmodics, such as hyoscyamus or belladonna, to overcome its griping. When asso- ciated with other purgatives care should be exercised to select those only which, like itself, are tardy in their action. Owing to the susceptibility of certain persons to the drug, the dosage should be small at first and gradually increased as necessary. GROUP XV.—ANTHELMINTICS. Anthelmintics are remedies which kill or expel intestinal worms. Those drugs which kill the parasites are called vermi- cides, and those which simply promote their expulsion are called vermifuges} The vermicides are— Aspidium, Kamala, Chenopodium, Oleum Terebinthinae,* Cusso, Pepo, Granatum, Santonica. The vermifuges are— Calomel* Spigelia. Hydragogue Purgatives,* Anthelmintics are here divided according to the kind of intesti- nal parasite against which they are employed. The Oxyuris vcrmicularis is the small worm, often called seat- 1 Drugs marked with an asterisk (*) are considered elsewhere. 696 A TEXT-BOOK OF MATERIA MEDICA. worm or thread-worm, that infests the large intestine and rectum. The Ascaris litmbricoides is the common round-worm, found chiefly in the small intestine. The Tamice are the tape-worms. Remedies employed against the Oxyuris vermicularis: A weak solution of Carbolic Acid,* Lime Water,* Infusion of Quassia,* Calomel,* Decoction of Aloes,* Oleum Terebinthinae.* Remedies employed against the Ascaris litmbricoides : Chenopodium, Calomel,* Santonica, Hydragogue Purgatives,* Spigelia, Oleum Terebinthinae.* Remedies employed against the Tenia Solium and other varieties of Taenia: Aspidium, Kamala, Cusso, Pepo, Granatum, Oleum Terebinthinae.* Chenopodium—Chenopodii—Chenopodium. U. s. P. (American Wormseed.) Origin.—The fruit of Chenopodium ambrosioides L., and the variety anthelminticum Gray, plants indigenous in the West Indies, and Central and South America, and naturalized in the United States. Description and Properties.—Nearly fa inch (2 Mm.) in diam- eter, depressed globular, dull greenish or brownish, the integu- ments friable, and containing a lenticular, obtusely-edged, glossy, black seed. It has a peculiar, somewhat terebinthinate odor, and a bitterish, pungent taste. It contains a volatile oil, to which its medical properties are due. Dose.—15-30 grains (1.0-2.0 Gm.). Oleum Chenopodii—Olei Chenopodii-Oleum Che- nopodii. U.S. P. (Oil of American Wormseed.) Origin.—A volatile oil distilled from Chenopodium. Description and Properties.—A thin, colorless or yellowish liquid, having a peculiar penetrating, somewhat camphoraceous odor, and a pungent and bitterish -taste. Dose.—2-10 minims (0.12-0.6 Cc). ANTHELMINTICS. 697 Physiological Action and Therapeutics.—Both the powdered seed and the oil are efficient anthelmintics, particularly useful to expel round-worms {Ascarides lumbricoides) from children. The drug should invariably be followed by a brisk cathartic. The powder may be given suspended in molasses, or the oil may be given dropped upon loaf-sugar, or in the form of an emulsion, or enclosed in capsules. Santonica—Santonicae—Santonica. U. S. P. (Levant Wormseed.) Origin.—The unexpanded flower-heads of Artemisia paucifiora Weber, a plant growing in Asia and exclusively collected in North- ern Turkestan. Description and Properties.—From fa to \ inch (2 to 3 Mm.) long, oblong-ovoid, obtuse, smooth, somewhat glossy, grayish- green, after exposure to light brownish-green, consisting of an in- volucre of about twelve to eighteen closely imbricated, glandular scales with a broad midrib, enclosing four or five rudimentary florets; odor strong, peculiar, somewhat camphoraceous; taste aromatic and bitter. The drug contains about 2 per cent, of a neutral principle, santonin, to which its anthelmintic properties are due. It also contains about 1 per cent, of an unimportant volatile oil. Dose.—10-60 grains (0.6-4.0 Gm.). SantonTnum—Santonini—Santonin. U. S. P. Origin.—A neutral principle obtained from Santonica. Description and Properties.—Colorless, shining, flattened, pris- matic crystals, odorless, and nearly tasteless when first put into the mouth, but afterward developing a bitter taste; not altered by ex- posure to air, but turning yellow on exposure to light. Nearly insoluble in cold water; soluble in 40 parts of alcohol. Santonin should be kept in dark, amber-colored vials, and should not be exposed to light. Dose.—\-\ grain (0.016-0.06 Gm.) for a child; 1-5 grains (0.06-0.32 Gm.) for an adult. Official Preparation. Trochisci Santonini—Trochlscos (ace.) Santonini—Troches of Santonin.— Each troche contains \ grain (0.03 Gm.).—Dose, 2 (child) to 10 troches (adult). 698 A TEXT-BOOK OF MATERIA MEDICA. Physiological Action and Therapeutics.—In full or large doses santonin may excite nausea or vomiting, with abdominal pain, diarrhea, eructations, borborygmi, and great thirst. It readily enters the blood, where it exists as sodium santoninate. Large doses may cause giddiness, headache, hallucinations of smell and taste, tremors, and a species of depression, the combination of symptoms forming what is called santonin intoxication. The drug is chiefly eliminated through the kidneys, small amounts of santonin even imparting to the urine a distinct yellow color if the urine is acid, and a decided purplish or even red color if the urine is alkaline. Under certain circumstances when the urine is decidedly alkaline, as in cases of cystitis, the administra- tion of santonin may produce so marked a discoloration of the urine as to suggest hematuria. Probably the most remarkable phenomenon attending the inges- tion of medicinal doses of santonin is that of xanthopsia or yellow vision, which may continue for several hours. According to Rose, " there occasionally appears before the peculiar yellow sight, after large doses of santonin, a violet color of the field of vision: the intensity of this color is in proportion to the darkness of the objects looked at. All light objects, such as windows, paper, etc., appear actually yellow. Red and blue appear often in their complementary colors, orange and green, so that carmine-red appears pale, madder- red a bronze color, and the sky and blue objects green. This> however, is not always the case, and it has been noticed after the employment of santonin that red appears violet or light, and dark objects appear orange to one person, and to another green." (Quoted from Lewin.) This peculiar effect of santonin is due, according to Rose, to a nervous change in the retina or in the brain. Affections of the skin—e. g. urticaria—have occasionally fol- lowed the administration of santonin. Decidedly poisonous effects have sometimes been produced by comparatively small amounts of the drug. The symptoms of a fatal case from over-dose of santonin were convulsions accompanied by unconsciousness, twitching of the eyeballs, dilated pupils, cold sweat, weak pulse, feeble respiration, and, after some hours, sudden death. In case of poisoning by santonin the remedial measures are in- ternal and external stimulants, eliminants, and artificial respiration. Santonin is certainly a most efficient remedy against the ascaris, and to a less extent it is of use against the oxyuris. It has no effect on the tcenia. A N THE L MIN TICS. 699 The drug should be given on an empty stomach, preferably at night, either alone or associated with calomel, and followed in two or three hours by castor oil or other brisk cathartic. It may be administered in the form of a powder mixed with sugar or jelly, or in pills or capsules. Troches of santonin b..e much used and are very efficient. Spigelia—Spigeliae—Spigelia. U. S. P. (Pinkroot.) Origin.—The rhizome and roots of Spigelia marilandica L., a plant growing in rich shady woods, chiefly in the southern part of the United States, but found as far northward as Pennsylvania and Wisconsin. Description and Properties.—Of horizontal growth, about 2 inches (5 Cm.) or more long, about \ inch (3 Mm.) thick, dark purplish-brown, bent, somewhat branched on the upper side, with cup-shaped scars; on the lower side with numerous thin, brittle, light-colored roots about 4 inches (10 Cm.) long; the rhizome internally with a whitish wood and a pith which is usually dark colored or decayed; odor somewhat aromatic; taste sweetish, bitter, and pungent. It contains a volatile alkaloid, spigclinc, which is the active principle. Dose.—1-2 drachms (1.0-8.0 Gm.). Official Preparation. Extractum Spigeliae Fltiidum—Extracti Spigelian Flflidi—Fluid Extract of Spigelia.— Dose, \-2 fluidrachms (1.0-8.0 Cc). Physiological Action and Therapeutics.—Spigelia is a pow- erful anthelmintic, being a decided vermifuge against the Ascaris litmbricoides. When given alone and in full doses it may produce symptoms of narcotic poisoning. This may be obviated by asso- ciating it with cathartics and aromatics. The drug may be administered in the form of a tea, associated with senna, fennel, or other aromatics. The fluid extract is a reli- able preparation. Remedies employed against the different varieties of Taenia : Aspldium—Aspidii—Aspidium. U. S. P. (Male Fern.) Origin.—The rhizome of Dryopteris Filix mas Schott and of Dryopteris marginalis Gray, plants indigenous in North America, ;oo A TEXT-BOOK OF MATERIA MEDICA. a portion of South America, Asia, Europe, and some parts of Africa. Description and Properties.—From 3 to 6 inches (7 to 15 Cm.) long, \ to 1 inch (12 to 25 Mm.) thick, and, together with the closely imbricated, dark-brown, roundish, and slightly curved stipe-remnants, 2 to 3 inches (50 to 75 Mm.) in diameter; densely covered with brown, glossy, transparent, and soft, chaffy scales; internally pale green, rather spongy; vascular bundles about ten {Dryopteris Filix mas) or six {Dryopteris marginalis) in number, arranged in an interrupted circle; odor slight, but disagreeable; taste sweetish, acrid, somewhat bitter, astringent, and nauseous. Aspidium contains filicic acid, tannaspidic acid, pteritannic acid, filicin (filicic acid anhydride), fixed oil, a trace of volatile oil, and chlorophyl. Dose.—J-2 drachms (2.0-8.0 Gm.). Official Preparation. Oleoresina Aspidii—Oleoresinae Aspidii—Oleoresin of Aspidium.—Dose, l-i fluidrachm (1.0-4.0 Cc). Note.—Oleoresin of aspidium usually deposits, on standing, a granular crystalline substance. This should be thoroughly mixed with the liquid portion before use. The oleoresin should be kept in well-stoppered bottles. Physiological Action and Therapeutics.—Aspidium is the most reliable tceniacide known to materia medica. Though it is employed against both the armed and unarmed varieties of tape- worm, it is nevertheless against the latter that it is specially effec- tive. In the cases of armed taeniae special precautions must be taken to ensure success. The drug possesses tonic and astringent properties, and if taken in very large doses may occasion nausea, vomiting, diarrhea, and gastric and abdominal pains. Several fatal cases of poisoning have occurred, and it is believed that the fatalities were due not so much to excessive dose as to increased absorption of the drug through the influence of the castor oil that had been administered with it. When given for the expulsion of tape-worm the bowels should first be emptied by a castor-oil purge, and then the oleoresin be administered in gelatin capsules or in emulsion. Previous to the exhibition of the anthelmintic the patient should for at least twenty-four hours live on exceedingly spare diet, and the medicine then be given in the morning fasting. A few hours ANTHELMIN TICS. 701 later an active purge of about 1 ounce (30.0 Cc.) of castor oil or calomel and jalap should be given to expel the dead worm, which should be carefully examined for the head. If the head did not pass, the treatment should be repeated the following day or soon after. Cusso—Cusso—Kousso. U. S. P. (Brayera.) Origin.—The female inflorescence of Hagenia Abyssinica (Bruce) Gmelin, a handsome tree 40 to 50 feet (12 to 18 M.) high, in- digenous on the table-land and in the mountainous districts of Abyssinia. Description and Properties.—In bundles, rolls, or compressed clusters consisting of panicles about 10 inches (25.0 Cm.) long, with a sheathing bract at the base of each branch; the two round- ish bracts at the base of each flower and the four or five obovate outer sepals are of a reddish color, membranous and veiny; calyx top-shaped, hairy, enclosing two carpels or nutlets ; odor slight, fragrant, and tea-like; taste bitter, acrid, and nauseous. It contains a neutral active principle, kosin, a tasteless and an acid resin, and about 24 per cent, of tannin. Dose.— 1-4 drachms (4.0-16.0 Gm.). Official Preparation. Extractum Cusso Fluidum—Extracti Cusso Fluidi—Fluid Extract of Cusso.—Dose, 1-4 fluidrachms (4.0-15.0 Cc). Kosin—Koussein (unofficial).— Origin.—The active principle from the flowers and unripe fruits of Hagenia Abyssinica (Bruce) Gmelin. Description and Properties.—An amorphous yellowish crystalline powder having a pungent bitter taste. Insoluble in water, but readily soluble in alcohol and in ether. Dose, 15-30 grains (1.0-2.0 Gm.), to be divided into four doses and taken at inter- vals of half an hour. Physiological Action and Therapeutics.—The action of kousso upon the digestive tract, under large doses, is similar to the action of aspidium. It is a reliable anthelmintic for all species of tape- worm. The fluid extract should be given in the form of an emul- sion, the patient having previously fasted, and the exhibition of the drug followed in a few hours by a large dose of castor oil. Granatum—Granati—Pomegranate. U. S. P. Origin.—The bark of the stem and root of Punica Granatum L, a shrub or small tree about 20 feet (6 M.) high, indigenous in Southwestern Asia from Northern India to Palestine. 702 A TEXT-BOOK OF MATERIA MEDICA. Description and Properties.—In thin quills or fragments from 2 to 4 inches (5 to 10 Cm.) long and from fa to -1- inch (1. to 3. Mm.) thick; outer surface yellowish-gray, somewhat warty or longitudinally and reticulately ridged; the stem-bark often partly covered with blackish lichens; the thicker pieces of the root-bark more or less scaly externally; inner surface smooth, finely striate, grayish-yellow; fracture short, granular, greenish-yellow, indis- tinctly radiate; inodorous ; taste astringent, very slightly bitter. It contains as its active constituent a liquid alkaloid, pelletierine, with its three allied alkaloids, methyl-pelletierine, pseudo-pclletierine, and iso-pelleticrinc, besides mannite and punico-tannic acid. Dose.—\-\\ drachms (2.0-6.0 Gm.). Unofficial Preparations. Pelletierine.— Origin.—An alkaloid derived from the root-bark of Punica grana- tum L. Description and Properties.—A colorless liquid. Soluble in 20 parts of water and miscible in all proportions with alcohol. It forms crystalline salts with acids, the prin- cipal one being the tannate. There are also the sulphate, hydrobromate and hydrochlorate. Pelletierinae Tannas—Pelletierinae Tannatis—Pelletierine Tannate.—De- scription and Properties.—A yellowish, hygroscopic, odorless powder, with a pungent astringent taste. Soluble in 700 parts of water and in 80 parts of alcohol. Dose.—1-5 grains (0.06—0.32 Gm.). Physiological Action and Therapeutics.—Locally pomegran- ate is astringent. In large doses it excites vomiting, acts as a purgative, paralyzes the motor nerves, but does not affect sensa- tion, and dilates the capillaries. Pomegranate and its alkaloid, pelletierine, are efficient anthel- mintics for tape-worm. Like other anthelmintics, the drug should be given on an empty stomach, and if the bowels are not freely moved by the remedy, an active cathartic should follow its administration. A decoction of the bark may be used, but, owing to the diffi- culty in obtaining the fresh drug, which alone possesses anthel- mintic properties, the tannate of pelletierine, which is always reliable, is usually administered. Kamala—Kamalae— Kamala. U. S. P. (Rottlera.) Origin.—The glands and hairs from the capsules of Mallotus Philippinensis (Lamarck) Mueller, Arg., a large shrub or small tree ANTHELMINTICS. 703 growing wild in Australia, Eastern China, India, Southern Arabia, and Abyssinia. Description and Properties.—A granular, mobile, brick-red or brownish-red powder, inodorous and nearly tasteless, imparting a deep-red color to alkaline liquids, alcohol, ether, or chloroform, and a pale yellow tinge to boiling water. Under the microscope it is seen to consist of stellately arranged, colorless hairs, mixed with depressed-globular glands, containing numerous red, club-shaped vesicles. It contains a resinous coloring matter, rottlerin, and several resins. Dose.—1-2 drachms (4.0-8.0 Gm.). Physiological Action and Therapeutics.—Kamala is a gastro- intestinal irritant and purgative, and an efficient anthelmintic against the Tcenia solium, as well as the Oxyuris vcrmicularis and the Ascaris lumbricoidcs. The drug should be taken suspended in syrup, and followed by a full dose of castor oil. Pepo—Peponis—Pumpkin Seed. U. S. P. Origin.—The seed of Cucurbita Pepo L., the common pumpkin, indigenous in tropical Asia and America, and cultivated through- out the temperate zones. Description and Properties.—About f inch (2 Cm.) long, broadly-ovate, flat, white or whitish, nearly smooth, with a shallow groove parallel to the edge; containing a short, conical radicle and two flat cotyledons ; inodorous ; taste bland and oily. It contains an acrid resin, supposed to be the active principle, and from 30 to 35 per cent, of a thick red fixed oil. Dose.—1-3 ounces (32.0-94.0 Gm.). Physiological Action and Therapeutics.—Pumpkin seed ranks next to aspidium as a remedy for the destruction of tapc-zvorm, and has the advantage of being free from any disagreeable taste or unpleasant action. For administration the fresh pumpkin seeds should be beaten into a paste with powdered sugar and diluted with milk or water to about 1 pint (473.17 Cc). Previous to its administration the patient should fast for twenty-four hours, when the bowels should be flushed out with a large saline purgative. A portion of the emulsion of pumpkin seed is then to be taken, preferablv in the morning, and the balance taken in two doses at intervals of about two hours, the patient meanwhile remaining in bed to prevent, as far as possible, disturbance of the stomach. 704 A TEXT-BOOK OF'MATERIA MEDICA. Three or four hours after the last dose of the emulsion has been taken the patient should be given a full dose of castor oil. GROUP XVI.—EMMENAGOGUES AND ECBOLICS. Emmenagogues are remedies which restore or increase the men- strual flow. They are divided, according to their action, into two classes. Those which act upon the uterine muscle or mucous membrane are said to be direct; those which influence the uterus by affecting the general health of the body, or by altering the blood-supply of the parts, or by influencing the nervous system, are said to be indirect. The principal Direct Emmenagogues are— Ergot, Borax, Digitalis, Rue, Savine, Hydrastis, Quinine, Caulophyllum, Asafetida, Tansy, Myrrh, Apiol, Guaiac, Hedeoma. Cantharides, The Indirect Emmenagogues are— Iron and the Hematics, Cinnamon, Cod Liver Oil, Aloes. Strychnine, ( Hot foot-bath. Baths Hot hip-bath. I Mustard bath. Leeches J To genitals. I To thighs. ( Baths. Mustards Poultices to thighs. I Stupes. Ecbolics or Oxytocics are remedies which act directly upon the uterine muscular fibers, inducing uterine contraction, and are chiefly used during or immediately after parturition to produce or increase uterine action. They are therefore contraindicated before parturi- tion, lest they induce abortion, although they are often used crimi- nally for this purpose. The exact manner in which ecbolics act is unknown, but it is EMMENAGOGUES AND ECBOLICS. 705 supposed that they act directly by stimulating the uterine center in the cord or reflexly through uterine congestion. In small doses many of the ecbolics are emmenagogue, while many of the direct emmenagogues are ecbolic. The only justifiable uses for ecbolics are in parturition, with uterine inertia and unobstructed and well-dilated maternal parts, when it is desired to hasten the delivery of the child, or, second, to induce firm contraction of the uterus, and thus prevent or check uterine hemorrhage after the birth of the child. The principal Ecbolics are— Ergot, Oil of Rue, Ustilago, Borax, Hydrastis, Pilocarpine, Savine, Potassium Permanganate, Quinine, Strong Purgatives. Cotton Root Bark, Drugs which have not been considered elsewhere in the present work will now be described. Sablna—Sabinae—Savine. U. S. P. Origin.—The tops of Juniperus Sabina L., a small ever- green procumbent or erect shrub, distributed throughout the greater portion of Europe, Siberia, Canada, and the Northern United States. Description and Properties.—Short, thin, subquadrangular branchlets; leaves rather dark green, in four rows, opposite, scale- like, ovate-lanceolate, more or less acute, appressed, imbricated, on the back with a shallow groove containing an oblong or round- ish gland; odor peculiar, terebinthinate; taste nauseous, resinous, and bitter. It contains 2 per cent, of a volatile oil, tannin, resin, gum, etc. Dose.—5-15 grains (0.3-1.0 Gm.). Official Preparatio7t. Extractum Sabinae Fluidum—Extracti Sabinae Fluidi—Fluid Extract of Savine.—Dose, 5-15 minims (0.3-1.0 Cc). Oleum Sabinae—Olei Sabinae—Oil of Savine. U. S. P. Origin.—A volatile oil distilled from Savine. Description and Properties.—A colorless or yellowish liquid 45 706 A TEXT-BOOK OF MA TERIA MEDICA. having a peculiar terebinthinate odor and a pungent, bitterish, and camphoraceous taste. It becomes darker and thicker by age and exposure to the air. Soluble in an equal volume of alcohol. Dose.—1-5 minims (0.06-0.3 Cc). Physiological Action and Therapeutics.—The action of savine depends on the presence of the volatile oil, and this oil differs in its local external effect from the oil of turpentine merely in that the oil of savine is more active. It occasions much irritation, vesi- cation, and even pustulation when applied to the skin. Taken internally in small doses, it produces a sensation of heat in the epigastrium, with flatulence and frequently nausea. Toxic doses excite violent gastro-enteritis. The drug stimulates the circulation, and later, under full me- dicinal doses, depresses it. It is rapidly absorbed, and is excreted by various channels, increasing the urinary and bronchial excre- tions. These excretions, as well as the sweat and breath, smell strongly of the drug. Savine is a decided irritant to the uterus and ovaries, inducing marked hyperemia of those organs, and promoting contractions of the pregnant uterus. Toxic doses produce symptoms similar to those occasioned by oil of turpentine—violent gastro-enteritis, suppressed or bloody urine, great depression, etc. The treatment in poisoning by oil of savine would be full doses of Epsom salt, demulcents, anodynes, and stimulants if necessary. Savine in the form of an ointment is used as a stimulant appli- cation to keep up the discharge from blisters. An alcoholic solu- tion of oil of savine, 5-30 minims (0.3-1.8 Cc.) to 1 ounce (30.0 Cc), is used in alopecia pityroides. Oil of savine is a very efficient remedy in amenorrhea, and is also of benefit in certain cases of monorrhagia due to an enlarged and passively congested uterus. The hemorrhage following abor- tion is usually well controlled by this remedy. The powder or fluid extract may be given, but the oil is the most effective preparation, and may be prescribed in capsules, pills, or emulsion. It should be given cautiously. Ruta—Rutae—Rue. (Unofficial.) Origin.—The leaves of Ruta gravcolens L., an herbaceous or suffruticose perennial 2 or 3 feet (60 or 90 Cm.) high, indigenous in Southern Europe. EMMENAGOGUES AND ECBOLICS 707 Description and Properties.—The leaves are ternate, the leaf- lets being obovate-oblong, yellowish-green, thickly dotted with minute, transparent oil-vesicles. They have a peculiar, strongly balsamic odor, and possess an aromatic, bitter, and acrid taste. The principal constituent of rue is a volatile oil. Dose.—5-20 grains (0.3-1.3 Gm.). Oleum Rutae—Olei Rutae—Oil of Rue. (Unofficial.) Origin.—A volatile oil distilled from Ruta graveolens L. Description and Properties.—A colorless or greenish-yellow liquid with the peculiar odor of the plant, and a pungent, some- what acrid, bitterish taste. Soluble in an equal weight of alcohol. Dose.—2-5 minims (0.13-0.3 Cc). Physiological Action and Therapeutics.—The action of oil of rue is analogous to that of oil of savine, though less powerful. It is used for the same purposes also, and has occasionally been employed in hysteria. The oil should be administered in capsules. Caulophyllum—Caulophylli—Caulophyllum. U. S. P. (Blue Cohosh.) Origin.—The rhizome and roots of Caulophyllum Thalictroidcs (L.) Michaux, a smooth and glaucous perennial, found in rich woodlands from Canada south to Carolina and Kentucky. Description and Properties.—Rhizome of horizontal growth, about 4 inches (10 Cm.) long and about \ to J- inch (6 to 10 Mm.) thick, bent; on the upper side with broad, concave stem-scars and short, knotty branches ; externally grayish-brown, internally whitish, tough, and woody. Roots numerous, matted, about 4 inches (10 Cm.) long and fa inch (1 Mm.) thick, rather tough; nearly inodorous; taste sweetish, slightly bitter, and somewhat acrid. Caulophyllum contains an odorless, colorless, and tasteless alka- loid, caulophyllin, besides resins, tannin, starch, gum, etc. Dose.—5-30 grains (0.3-2.0 Gm.). Physiological Action and Therapeutics.—Blue cohosh is em- menagogue, antispasmodic, diuretic, and demulcent. It is quite an efficient remedy to increase the force of uterine contractions, and is of service in the treatment of spasmodic dysmenorrhea. It is usually given in the form of a decoction. 708 A TEXT-BOOK OF MATERIA MEDICA. Tanacetum—Tanaceti— Tansy. U. s. P. Origin.—The leaves and tops of Tanacetum vulgare L., a perennial herb indigenous in Europe and Central Asia, and nat- uralized in many parts of North America. Description and Properties.—Leaves about 6 inches (15.24 Cm.) long, bipinnatifid, the segments oblong, obtuse, serrate, or incised, smooth, dark green, and glandular; flower-heads corym- bose, with an imbricated involucre, a convex, naked receptacle, and numerous yellow tubular florets; odor strongly aromatic; taste pungent and bitter. It contains a volatile oil and a bitter principle, tanacetin, besides tannin, resin, etc. Dose.—15-60 grains (1.0-4.0 Gm.), in infusion. Physiological Action and Therapeutics.—In moderate doses tansy acts as an aromatic bitter. Excessive amounts produce all the symptoms of an irritant narcotic—vomiting, purging, severe abdominal pain, loss of consciousness, convulsions, and great car- diac and respiratory weakness, death usually resulting from paral- ysis of respiration. The drug is regarded as an efficient remedy in amenorrhea, and is extensively employed in domestic practice in hysteria and colic, and topically for bruises, sprains, muscular rheumatism, etc It is used in the rural districts to promote or restore menstrua- tion, and occasionally is employed with criminal intent as an abor- tifacient, but usually with negative results. The drug may be given in the form of an infusion, 1 ounce to 1 pint (32.0 Gm.-473.17 Cc), of which 1 or 2 ounces (30.0 or 60.0 Cc.) may be taken at a dose. The oil of tansy is occasionally prescribed in doses of 1-5 minims (0.06-0.3 Cc). Petrosellnum—PetroselTni—Parsley. Origin.—The root of Petroselinum sativum (Hoffmann), Apium Petrosellnum L., a plant indigenous in Southern Europe, and much cultivated for culinary purposes. Description and Properties.—The root is tapering, from 4 to 8 inches (10-20 Cm.) long, about l inch (12 Mm.) thick; exter- nally yellowish or light brown ; odor aromatic ; taste sweetish and aromatic. It contains a volatile oil and apiol, the chief constituent. Dose.—30-60 grains (2.0-4.0 Gm.). EMMENAGOGUES AND ECBOLICS. 709 Apiolum—Apioli—Apiol (Unofficial).— Origin.—A camphor obtained from the fruit of Petroselinum sativum Hoffmann. Description and Properties.—White needles, of a feeble, parsley odor. Insoluble in water, but freely soluble in alcohol and in ether. Dose.—10-15 grains (0.6-1.0 Gm.). Physiological Action and Therapeutics.—The root is carmin- ative, laxative, and diuretic. Apiol is an active emmenagogue. Given in excessive doses, it occasions severe frontal headache, dizziness, and ringing in the ears. It causes a rapid rise of blood- pressure, due to increased cardiac action and stimulation of the vaso-motor centers. Apiol, or Chapoteaut's apioline, is usually prescribed, and is an efficient remedy in amenorrhea, dysmenorrhea, and as an anti- periodic in malarial affections. As an emmenagogue in cases of scanty or deficient menstruation apioline is very effective. The drug is best given in capsules, as prepared by Chapoteaut,1 one or two capsules being taken after meals three times a day. Hedeoma—Hedeomae—Hedeoma. U. S. P. (Pennyroyal.) Origin.—The leaves and tops of Hedeoma pulcgioidcs (L.) Per- soon, an annual herb indigenous in North America. Description and Properties.—Leaves opposite, short-petioled, about \ inch (12 Mm.) long, oblong-ovate, obscurely serrate, glan- dular beneath ; branches roundish-quadrangular, hairy; flowers in small, axillary cymules, with a tubular-ovoid, bilabiate, and five- toothed calyx, and a pale-blue, spotted, bilabiate corolla, containing two sterile and two fertile exserted stamens ; odor strong, mint-like; taste warm and pungent. Its virtues depend upon a volatile oil. Dose.—15-60 grains (1.0-4.0 Gm.) in infusion. Oleum Hedeomae—Olei Hedeomae—Oil of Hede- oma. U. s. P. (Oil of Pennyroyal.) Origin.—A volatile oil distilled from Hedeoma. Description and Properties.—A pale-yellowish, limpid liquid, having a characteristic, pungent, mint-like odor and taste. It should 1 M. Chapoteaut has prepared from the alcoholic solution of a petrol-ethereal extract a thick reddish liquid, to which he has given the name Apioline. This substance he claims to be the true active principle, and it is dispensed in capsules containing 3 minims (0.18 Cc.) each. 7IO ./ TEXT-BOOK OF MATERIA MEDICA. be kept in well-stoppered bottles, in a cool place, protected from light. Dose.—2-10 minims (0.1-0.6 Cc). Physiological Action and Therapeutics.—Hedeoma is aro- matic, stimulant, carminative, and emmenagogue, while the oil is rubefacient if rubbed into the skin. The herb is given in the form of a hot infusion to bring on retarded or suspended menstruation and for the relief oi flatulent colic, pharyngitis, bronchitis, etc., as well as to dissipate congestions of various parts. The oil of hedeoma is an active emmenagogue, and is used to increase the rubefacient effect of various embrocations. GROUP XVII.—ASTRINGENTS. Astringents are medicines which cause the contraction of living tissues, diminishing the amount of blood or other fluid in them, and reducing hemorrhage, or, through their constipating action, limiting the intestinal secretions as well as those from mucous membranes generally. They act chemically upon the tissues, and, when taken inter- nally, their influence is similar to that of tonics, invigorating the various structures of the body, their principal use being, in cases of relaxed conditions of the muscles and fibers or of the mucous membranes characterized by excessive secretion. Astringents are more or less irritating, and should therefore not be employed, as a rule, in acute inflammatory conditions. There are, however, four exceptions—lead acetate or subacetate, bismuth subnitrate or subcarbonate, cerium oxalate, and silver nitrate— which are sedative astringents and would be indicated in acute inflammatory states. Astringents vary in the intensity of their action, their strength being directly proportionate to the condensation of tissue. Herein lies the chief difference between astringents and caustics. If the heavy metals be arranged according to their astringent properties, the feeblest at one extreme and the strongest at the other, it will be observed that the least astringent is the most caustic, and the most astringent the least caustic, the order being as follows : lead {astringent), iron, zinc, copper, silver, tin, mercury {caustic), lead being the most astringent and least caustic, and mercury the most caustic and least astringent. ASTRINGENTS. 711 The explanation of these diverse properties is that the astrin- gents expel the fluid from the protoplasm, contracting or constring- ing the tissue and causing it to occupy less space; whereas the caustics relax the eschar, reducing the space it occupies. The caustic action of a mineral salt depends both upon the nature of the base and the acid radical. In other words, the salt and the products of its action must both be somewhat soluble in water, otherwise the eschar will be firm, and the drug will therefore act as an astringent. The chlorides of the heavy metals are usually soluble, and are generally the more caustic, as, for instance, zinc chloride, mercuric chloride (corrosive sublimate), etc. Should a chloride be insoluble in water, it will not act as a caustic—as, for example, the insoluble, and consequently inert, silver chloride. Certain drugs which in a concentrated state are caustic are, if sufficiently diluted, astringent, as is the case with sulphuric acid. An astringent drug employed to check hemorrhage is called a styptic, the subsulphate of iron being extensively used as such. Astringents differ in some respects from other groups of medi- cines, in that they do not, as a rule, assist one another by combi- nation. They are divisible into—(1) Vegetable astringents; (2) mineral astringents. The vegetable astringents mentioned in this group, beginning with the type, are— Tannic Acid, Kino, Rhus Glabra, Gallic Acid, Krameria, Rosa Gallica, Galla, Hematoxylon, Rubus. Quercus Alba, Hamamelis, Catechu, Geranium, Cinnamon also possesses considerable astringent properties, but is classed among the Aromatics. The mineral astringents, beginning with the type, are— Lead, Silver, Bismuth, Zinc, Alum, Cerium Oxalate. Copper, Certain salts of iron are powerfully astringent, although classed with iron under the Restoratives. Diluted sulphuric and nitric acids also possess marked astringent properties. (See Mineral Acids.) Antagonists and Incompatibles.—The vegetable astringents are incompatible with the salts of iron (ferric and ferrous), and also with the salts of lead, silver, antimony, and copper; with the alka- 712 A TEXT-BOOK OF MATERIA MEDICA. loids, the glucosids, and gelatin ; and with the alkalies and mineral acids and emulsions. Spirit of nitrous ether is incompatible with gallic acid. Synergists.—Tonics and bitters, and also agents increasing waste, favor the action of vegetable astringents. VEGETABLE ASTRINGENTS. Acidum Tannicum—Acidi Tannici—Tannic Acid. U. S. P. Origin.—An organic acid obtained from Nutgall. Description and Properties.—A light-yellowish, amorphous powder, usually cohering in the form of glistening scales or spongy masses; odorless or with a faint characteristic odor and a strongly astringent taste ; gradually turning darker when exposed to air and light. Soluble in about i part of water and in 0.6 part of alcohol; very soluble in boiling water and in boiling alcohol; also soluble in about 1 part of glycerin with the assistance of a moderate heat; freely soluble in diluted alcohol and sparingly in absolute alcohol; almost insoluble in absolute ether, chloroform, benzol, or benzin. Dose.—1-20 grains (0.06-1.2 Gm.). Official Preparations. Collodium Stypticum—Collodii St^ptici—Styptic Collodion.—Used exter- nally and locally. (Tannic Acid, 20; Alcohol, 5; Ether, 25; Collodion, to 100.) Glyceritum Acidi Tannici—Glyceriti Acidi Tannici—Glycerite of Tannic Acid.—Used externally and locally. (Tannic Acid, 20; Glycerin, 80.) Trochisci Acidi T3nnici—Trochlscos (ace.) Acidi Tannici—Troches of Tannic Acid.—Dose, 1 to 3 troches. Unguentum Acidi Tannici—Ungugnti Acidi Tannici—Ointment of Tannic Acid. —Used externally and locally. (Tannic Acid, 20; Benzoated Lard, 80.) Physiological Action.—Externally.—Tannic acid has little if any effect upon the unbroken skin. Upon raw surfaces, however, it acts as a powerful astringent, contracting the tissues and coagu- lating the albumin. Urticaria and erythema sometimes follow its use. Internally.—Digestive System.—By coagulating the albumins tannic acid imparts a dryness to the mouth, accompanied by a sen- sation of puckering. It partially paralyzes the sensory nerve- endings, thus blunting the sense of taste. Large doses produce vomiting by an irritant action, while diarrhea, followed by consti- pation, may be present. ASTRINGENTS. 7*3 By its action on the stomach pepsin is precipitated, albumin co- agulated, and the secretion of gastric juice diminished, all of which actions tend to impair the digestive function. There is a partial conversion of the tannic acid into gallic and pyrogallic acids. To facilitate absorption there must be a preliminary conversion of tannic into gallic acid, and this reaction takes place in the intestine. A diminution of peristalsis is followed by constipation. Circulatory System.—Its astringent property makes tannic acid a valuable hemostatic. It arrests hemorrhage by contracting the blood-vessels. The blood absorbs it as gallic acid, and is not affected by it. Nervous System.—No special effect has been observed. Respiratory System.—Save in arresting hemorrhage of the lungs, no influence is known. Absorption and Elimination.—Being absorbed as gallic acid, the kidneys eliminate it in that form. A doubtful action ascribed to it by some authorities is that of diminishing albuminuria. Uterus.—No special influence other than arresting hemorrhage has been noted. Untoward Action.—A dose of 3 grains (0.2 Gm.) may cause pain in the stomach and intestines. Following such a dose, there may be coating of the tongue, thirst, eructation of gas, and tenes- mus. A tendency to hemorrhoidal congestion is enhanced. Therapeutics.—Externally and Locally.—Tannic acid is a val- uable application for bed-sores and ulcers. Its astringent property is of use in cases of intertrigo, impetigo, sycosis, sore nipples, and eczema of the chronic, desquamating variety. It is beneficial in hyperidrosis of the hands and feet, of the axillce and genitals. A solution of the acid has been found of advantage in erysipelas and lymphangitis. The glycerite of tannin, applied locally in cases of otorrhea and ozena as sequelae of scarlet fever or measles, is of great benefit. The same preparation or a powder may be used in stomatitis, ton- sillitis, and pharyngitis, as well as in cases of spongy or ulcerous gums. The lozenges are beneficial in whooping cough. Sup- positories of tannic acid are employed for hemorrhoids, fissure, prolapse, and rectal ulcers. An aqueous solution of tannic acid is very useful in leucor- rhea. The glycerite and iodoform tannin are excellent agents in inflammation of the cervix uteri. Tannic acid also dispels the odor and allays the discharges in carcinoma uteri, being applied as a 7^4 A TEXT-BOOK OF MATERIA MEDICA. vaginal douche. It is useful as a lotion in herpes and alopecia cir- cumscripta. Injection of the acid or insufflation of the powder into the urethra is of some value in gonorrhea. In hemoptysis an aque- ous solution (5-10 grains to the ounce of water) may be used as a spray. In acute dysentery much benefit may be derived from an enema of 10 grains of tannin added to a 4 per cent, solution of boric acid. It lessens pain and tenesmus and controls hemorrhage. Internally.—For other than local action gallic is preferable to tannic acid, the latter not being absorbable. Tannic acid is styptic in hematemesis and intestinal hemorrhage and checks diarrhea. It forms tannates when given as an antidote for poisoning by alkaloids and tartar emetic. Since these tannates are more or less soluble, however, some drug should be given as a purgative. Contraindications.—From comparative absorbability of tannic and gallic acids the former is preferable for local, the latter for systemic, effects. Administration.—For hematemesis powders of 10-20 grains are given. For effect upon the intestines it should be administered in pills, 3-5 grains, or it may be dissolved in the stomach. Locally it may be applied as a solution, glycerite, powder, suppository, or an ointment. Styptic collodion is a protection to lacerated or incised wounds. Acidum Gallicum—Acidi Gallici—Gallic Acid. U. S. P. Origin.—An organic acid usually prepared from Tannic Acid. Description and Properties.—White or pale fawn-colored, silky, interlaced needles or triclinic prisms; odorless, having an astringent or slightly acidulous taste; permanent in the air. Sol- uble in 100 parts of water and in 5 parts of alcohol. Dose.—5-20 grains (0.3-1.2 Gm.). Physiological Action.—Gallic acid resembles tannic acid in its action, but does not coagulate albumin, and therefore does not possess the local influence of the latter. It is eliminated by the kidneys as gallic acid. Therapeutics.—Externally and Locally.—Gallic acid is seldom used externally. Locally, tannic acid is preferable, but gallic acid is effectual applied as a glycerite, 1 drachm-i ounce (4.0-32.0 Gm.), in cases of tonsillitis and pharyngitis. Gallic acid and stramonium ointment in equal parts form an unguent for hemorrhoids. In alcoholic solution it is applied to the membrane of diphtheria. ASTRINGENTS. 715 Internally.—Gallic acid is chiefly serviceable in hemorrhage from the stomach, intestines, lungs, and kidneys, It is employed in men- orrhagia, but ergot is better. It reduces albumin in some forms of Bright's disease, and is useful in checking excessive sweating and bronchorrhca. In chronic phthisis it relieves the night-sweats and reduces profuse expectoration. Cystitis, dysentery, and chronic diar- rhea are benefited by its use. It checks suppuration and stays the progress of pyelitis and pyelo-nephritis. Used in conjunction with opium, it has been found beneficial in diabetes insipidus. Pvrogallic acid is of use in acne, but produces a discoloration of the skin. Pyrogallol, 2 grains (.12 Gm.), is used in internal hemorrhage. As an ointment, I drachm-1 ounce (4.0-32.0 Gm.), it is palliative in psoriasis, and it is also beneficial in lupus and epithelioma. Gallanol, the analid of gallic acid, is a bactericide, and is use- ful in psoriasis in the form of a powder or in an ointment (1 to 30). It is also used in alcoholic solutions of 10 per cent, strength. It relieves the pruritus of chronic eczema. In favus and tricophytosis a mixture is used consisting of gallanol 10 parts, ammonia 1 part, and alcohol 50 parts. Gallicine, methyl ether of gallic acid, applied in finely divided form with a brush, is of benefit in keratitis and conjunctivitis, as well as in eczema of the eyelids. Administration.—Gallic acid is not to be combined with iron. It is administered in powder or pill form. The glycerite and the ointment are used locally. Galla-Gallae-Nutgrall. U. s. P. Origin.—An excrescence on Quercus Lusitanica Lamarck,caused by the punctures and deposited ova of Cynips gallon tinctorial Olivier. Quercus Lusitanica is a small tree, or oftener a shrub, 4 to 6 feet (1.2-1.8 M.) high, indigenous in the basin of the Mediter- ranean. Description and Properties.—Nutgalls are subglobular, about 1 inch (25 Mm.) in diameter, more or less tuberculated above, otherwise smooth, heavy, hard ; often with a circular hole near the middle communicating with the central cavity containing either the partly developed insect or pulverulent remains of it; inodor- ous ; taste strongly astringent. Galla in substance is seldom given internally. 716 A TEXT-BOOK OF MATERIA MEDICA. Official Preparations. Tinctura Gailae—Tincturae G311ae—Tincture of Nutgall.—Dose, i to 2 fluid- drachms (4.0-8.0 Gm.). UnguSntum Galla—Ungufinti Gillae—Ointment of Nutgall.—Used exter- nally. Physiological Action.—Its action is that of tannic acid, which is derived from galls. Therapeutics.—Externally and Locally.—Galla, in combination with stramonium liniment or 1 drachm (4.0 Gm.) of powdered opium to each ounce (32.0 Gm.) of nutgall ointment, is an excellent application for external hemorrhoids. For eczema of the scalp, herpes, fissured nipples, indolent ulcers, and chilblains nutgall oint- ment has proved beneficial, as well as for alopecia circumscripta and rectal prolapse. One part of powdered galls to seven or eight of vaseline is a most excellent application for lessening the cica- tricial contraction following extensive bums. Galla is used little locally, but is recommended as a gargle and wash, being applied to the relaxed mucous membranes of the mouth, vagina, and rectum. Internally.—Tannic and gallic acids are preferable in severe diarrhea and dysentery, an infusion or decoction being used as an enema. Administration.—Galls are used mostly in the form of an infusion or ointment. The tincture is seldom employed. QueYcus Alba—Quercus Albae—White Oak. U. S. P. Origin.—The bark of Quercus alba L. The oaks are shrubs or trees growing chiefly in the temperate zone, often forming exten- sive forests. The white oak is a stately tree, 60 to 80 feet (18-24 M.) high, found from Canada to Florida and west to Wisconsin and Eastern Texas. Description and Properties.;—In nearly flat pieces deprived of the corky layer, about \ inch (5 Mm.), pale brown ; inner surface with short, sharp, longitudinal ridges; tough and of a coarse, fibrous fracture, a faint, tan-like odor, and a strongly astringent taste. As found in the shops, it is usually an irregularly coarse fibrous powder, which does not tinge the saliva yellow. Dose.—Seldom given in substance. A decoction is sometimes given internally, but the chief use of the drug is for external or local application. ASTRINGENTS. jzy Physiological Action.—The general action is that of tannic acid. Therapeutics.—Externally and Locally.—-It is used for chapped nipples, gangrene, ulcers, and dermatitis venenata. It is of value as an ointment in hemorrhoids, prolapsus ant, anal fissure, and leu- corrhea. The drug is also serviceable in relaxed uvula and as a tooth-powder. It stains the linen, however, which somewhat limits its use. Pessaries made of the bark have been used to check uterine hemorrhage. For hernia the concentrated fluid extract is injected into the tissues for the purpose of exciting inflammation and consequent contraction of the hernial ring. Internally.—It reduces bronchial discharge, hemoptysis, serous diarrhea, and dysentery. Administration.—Externally it is used as a poultice—chiefly in the form of the powdered bark. The decoction is employed almost exclusively as an injection and for internal administration. The laity were formerly wont to roast the acorns and chew them, or grate them and mix the gratings with cocoa or chocolate, believing them to be a cure for diarrhea as well as for flatulent dyspepsia and scrofula. Catechu—Catechu—Catechu. IT. S. P. Origin.—An extract prepared from the wood of Acacia catechu (Linn, fil.) Willd., a tree 30 to 40 feet (9-12 M.) high, indigenous in the East Indies and Ceylon. Description and Properties.—Occurring in irregular masses, containing fragments of leaves; dark-brown, brittle, somewrhat porous and glossy when freshly broken. It is nearly inodorous and has a strongly astringent and sweetish taste. Dose.—10-30 grains (0.6-2.0 Gm.). Official Preparations. Tinctura CStechu Compftsita—Tincturae Catechu Compositae—Compound Tincture of Catechu.—Dose, \-2 fluidrachms (2.0-8.0 Cc). (Catechu, 100; Cassia Cinnamon, 50; by maceration and percolation with Diluted Alcohol to 1000.) Trochisci Catechu—Trochlscos (ace.) CStechu—Troches of Catechu.— Dose, 1 to 6 troches. (Each troche contains 1 grain (0.06 Gm.) of catechu.) Physiological Action.—Catechu does not differ in its action from tannic acid. It is to be preferred to kino, however, since its operation is more energetic. Therapeutics.—Externally and Locally.—Though used but little externally, it is a very efficient remedy for ulcerated nipples 718 A TEXT-BOOK OF MATERIA MEDICA. and chrotiic ulcers, the form employed being that of a lotion, used either alone or in combination with copper sulphate or alum. Catechu is of service in constringing relaxed tissues, and is used as a mouth-wash in spongy gums, ptyalism, and relaxation of the uvula. It is also of use as a gargle in pharyngitis and chronic sore throat of public speakers and users of tobacco. In gonorrhea and leucorrhea an injection of 2-3 drachms (8.0-12.0 Gm.) of the tincture in 5-6 ounces (160.0-192.0 Gm.) of water is beneficial. Catechu has been used by persons suffering from pyrosis. It is claimed that chewing a small pellet of the drug diminishes the coating of mucus on the mucous membrane of the stomach. It is applied to aphtha? in stomatitis. Internally.—Its prevailing use is in chronic serous diarrheas, but the administration must be preceded by a saline purge in order to secure the fullest effect. Catechu checks uterine hemor- rhage and the secretions in bronchitis and chronic phthisis. Administration.—The troche is best used in chronic pharyn- gitis and relaxed buccal mucous membranes, or a piece of the drug may be chewed with beneficial results. For diarrhea the compound tincture, with a little morphia or the official chalk mixture, is the best form for use. Kino—Kino—Kino. U. S. P. Origin.—The inspissated juice of Pterocarpus marsupianum Roxburgh, a tree (called buja in Bengal) 60 to 80 feet (18-24 M.) high, indigenous in India and Ceylon. Description and Properties.—Small, angular, dark brownish- red and transparent; inodorous, very astringent and sweetish, coloring the saliva deep red. Soluble in alcohol, nearly insoluble in ether, and only slightly soluble in cold water. Dose.—10-20 grains (0.6-1.2 Gm.). Official Preparation. Tinctura Kino—Tincturae Kino—Tincture of Kino.—Dose, \-2 fluidrachms (1.0-8.0 Cc). Physiological Action.—Its action is similar to that of tannic acid. It colors the saliva red. Therapeutics.—Externally and Locally.—Kino is an efficient dressing for flabby, indolent ulcers, acting as a stimulant. Vet the other astringents deserve precedence. As a gargle in pharyngitis and relaxed uvula kino is valuable, but, owing to its disagreeable ASTRINGENTS. 719 taste, krameria is to be preferred. Owing to its speedy action, it checks the hemorrhage in epistaxis where other astringents fail. In leucorrhea and gofiorrhea an infusion or injection is serviceable. Internally.—In the polyuria of diabetes, in menorrhagia, the sweating of phthisis, and pyrosis it has been used to some advan- tage ; also in dysentery and chronic diarrheas with profuse serous discharges. It is less irritating than the other astringents. Administration.—The powder is used as an insufflation in epistaxis, and is dusted on ulcers. In diarrhea it is best to use kino in combination with opium or chalk mixture. The tincture is used internally. Krameria— Krameriae—Krameria. U. S. P. (Rhatany.j Origin.—The root of Krameria triandra Ruiz et Pavon, and of Krameria ixina L., a low shrub with spreading branches, native to Bolivia and Peru, growing in sandy localities in the mountains at an altitude of 3000 to 8000 feet (900-2440 M.). Description and Properties.—From 1 to i{ inches (25-38 Mm.) thick, knotty and several-headed above, branched below, the branches long; bark smooth, or in the thinner pieces scaly, deep rust-brown, fa—fa inch (1-2 Mm.) thick, very astringent, inodor- ous ; wood pale, brownish-red, tough, with fine medullary rays, nearly tasteless. The root of Krameria ixina (Savanilla rhatany) is less knotty and slenderer, and has a dark purplish-brown bark about \ inch (3 Mm.) thick. Dose.—8-30 grains (0.5-2.0 Gm.). Official Pirparations. ExtrSctum Krameriae—Extracti Krameriae—Extract of Krameria.—Dose, 5-10 grains (0.3-0.6 Gm.). ExtrSctum Krameriae Fluidum—Extracti Krameriae Fluidi—Fluid Extract of Krameria.—Dose, 5-30 minims (0.3-2.0 Cc). Tinctura Krameriae—Tincturae Krameriae—Tincture of Krameria.—Dose, \-2 drachms (2.0-8.0 Cc). Trochisci Krameriae—Trochlscos (ace.) Krameriae—Troches of Krameria. —Dose, 1 to 5 troches. (Each troche contains 1 grain (0.06 Gm.), Syrupus Krameriae—Syrupi Krameriae—Syrup of Krameria.—Dose, A-4 fluidrachms (2.0-16.0 Cc). Physiological Action.—The action of krameria is identical with that of tannic acid. Therapeutics.—Externally and Locally.—Its value as a topical application is of little consequence, but it has served satisfactorily 720 A TEXT-BOOK OF MA TERIA MEDICA. as an ointment for hemorrhoids. It is used as an infusion or injec- tion of the diluted tincture or fluid extract in leucorrhea, gleet, and especially in anal fissure, for which it has been highly recom- mended, since it checks the accumulation of feces in the rectum by constricting its walls, rendering defecation less painful and prevent- ing the formation of ulcers. The powder is used in epistaxis and rectal bleeding, also in prolapsus ani and ozena of a non-specific nature. It is used extensively in the preparation of tooth-powders, being especially beneficial where the gums display a tendency to bleed readily. A mouth-wash and gargle are used "in ptyalism, spongy gums, pharyngitis, and relaxation of the uvula. Internally.—Krameria has gained a wide reputation for allaying habitual, but not profuse, uterine hemorrhage. It may be used to check intestinal hemorrhages, hematuria, hematemesis, and hemopty- sis, but the other astringents are preferable. It is a good tonic for debilitated patients. It is also used in chronic diarrhea and dysen- tery and in incontinence of urine. Administration.—The powder is used in the nose and rectum either by insufflation or by means of a pledget of cotton. As an injection and enema the fluid extract is used. In fissure of the anus the rectum must be emptied first by an enema; then a solu- tion of the extract, I drachm (4.0 Gm.) to 1 ounce (30.0 Cc.) of water, is emptied into the bowel and allowed to run out, repeating the process several times. This procedure is very painful at first, but as the fissure gradually heals the operation will cause the patient little if any pain. Keep the bowels open with a mild saline laxative. The success attending the operation warrants any discomfort which the patient may experience. The nasal douche is best in ozena, followed by an insufflation of the powder. Haematoxylon—Haematoxyli—Haematoxylon. U S. P. (Logwood.) Origin.—The heart-wood of Hoematoxylon Campechianum L., a tree 30 to 40 feet (9-12 M.) high, indigenous on the shores of the Gulf of Campeachy and in certain parts of South America. Description and Properties.—Heavy, hard, externally pur- plish-black, internally brownish-red, marked with concentric cir- cles, splitting irregularly; odor faint, agreeable, taste sweetish, astringent. When chewed it colors the saliva dark pink. Only the preparations of Haematoxylon are used internally. ASTRINGENTS. 721 Official Preparation. Extractum Haematoxyli—Extracti HaematSxyli—Extract of Hsematoxy- lon.—Dose, 5-15 grains (0.3-1.0 Gm.). Physiological Action.—Its astringent properties are due to the tannin which haematoxylon contains. Therapeutics.—Externally and Locally.—It is a valuable anti- septic, as well as a healing application in gangrene and foul- smelling sores. It is also beneficial as an injection in leucorrhea. Internally.—Haematoxylon has a very agreeable, sweetish taste ; hence it is well taken by children. It is of marked benefit in in- fantile diarrhea, but has the disadvantage of coloring the dis- charges and diaper blood-red, causing much alarm to the mother. The urine is also colored. It arrests internal hemorrhage and sweating, and is also used in dysentery, tuberculous diarrhea, and atonic dyspepsia. Some authorities claim that haematoxylon causes phlebites. Administration.—In diarrhea a decoction with a little aromatic sulphuric acid is the best preparation. To it may be added a little syrup of ginger and camphorated tincture of opium. The decoc- tion is, in fact, the best preparation to use. Hamamelis—Hamamelidis—Hamamelis. U. S. P. (Witch-hazel.) Origin.—The leaves of Hamamelis Virginica L., a shrub 6 to 10 feet (1.8-3.0 M.) high, growing in damp woods and thickets in Canada and the United States. Description and Properties.—Short-petiolate, about 4 inches (10 Cm.) long, obovate or oval, slightly heart-shaped and oblique at the base, sinuate-toothed, thickish, nearly smooth, inodorous; taste astringent and bitter. Official Preparation. Extractum Hamamfelidis Fluidum—Extracti HamamSlidis Fluidi—Fluid Extract of Hamamelis.—Dose, yi-2 fluidrachms (2.0-8.0 Cc). Physiological Action.—The action of tannic acid is also that of hamamelis, save that the latter has a somewhat different influ- ence upon the circulation. Circulatory System.—Hamamelis acts on the muscular fibers of the veins, the modus operandi, however, not being satisfactorily determined. Large doses produce severe throbbing headache. 46 722 A TEXT-BOOK OF MATERIA MEDICA Therapeutics.—Externally and Locally.—For sprains and bruises hamamelis is a favorite application, although some authorities re- gard it merely as a placebo. Locally, the fluid extract, with the addition of one-third its volume of glycerin, has been used in urticaria, rhus-poisoning, and phlegmasia dolcns. Owing to its marked sedative properties, hamamelis ointment is extremely beneficial in varicose ulcers, eczema, herpes, seborrhea, and acne rosacea, as well as in checking excessive secretions. It is also efficient in carbuncle, freckles, hyperidrosis, lupus erythematosus, burns, and frost-bites. The local action of the drug is important. The distilled extract, diluted with alcohol or water, is applied to inflamed gums, the nasal mucous membrane after removal oi polypi, and in pharyn- gitis as a spray. As a suppository or applied by means of a piece of cotton or wool soaked with the fluid extract, hamamelis affords a most grateful relief in bleeding piles, especially the internal vari- ety. In cystitis and hemorrhage from the bladder an injection of the diluted fluid extract or distilled extract is very valuable, besides being a most reliable topical application in capillary hemor- rhage from wounds, epistaxis, and bleeding after extraction of teeth. The ointment is used in rectal fissures and ulcers, and the lotion has been employed to some extent in chronic rheumatism, since it relieves the pain and stiffness in the muscles and joints. The decoction, with a little boric acid and a I per cent, solution of creasote, has been recommended as a gonorrheal injection. Internally.—Given internally, hamamelis enhances the results obtained by the local application in bleeding piles, leucorrhea, and gonorrhea, and, owing to its peculiar action upon the veins, in varicose veins. It lessens the pain of dysmenorrhea, while by its use in menorrhagia the flow is remarkably diminished. It is highly beneficial in internal hemorrhages, hemoptysis, hematuria, hemateme- sis, and especially in uterine hemorrhages. It reduces suppuration in pyelitis and the excessive morbid discharge in chronic bronchitis. It is a valuable remedy in purpura hemorrhagica, chronic enteritis, diarrhea, dyse?itery, and varicocele. Hamamelis also prevents abortion. Administration.—The best preparation, both for internal and external use, is the distilled extract, although it is not official. The ointment and lotion are used externally, and the fluid extract internally. The preparations of hamamelis to be found in drug- stores are unreliable unless they be perfectly fresh. Some of the ASTRINGENTS. 723 proprietary preparations are concocted with extreme care and accuracy, and are often much more efficient than the official articles which have been standing in the shops for a long while, possibly exposed to the air. Geranium—Geranii—Geranium. U. S. P. (Cranesbill.) Origin.—The rhizome of Geranium maculatum L., a perennial herb with a stem 2 to 3 feet (30-60 Cm.) high, very'common in Canada and the United States westward as far as Kansas. Description and Properties.—Growth horizontal, cylindrical, 2 to 3 inches (5-7 Cm.) long and about \ inch (1 Cm.) thick- rather sharply tuberculated, longitudinally wrinkled, dark brown; bark thin ; wood-wedges yellowish, small, forming a circle near the cambium line; medullary rays broad, central pith large; roots thin, fragile, inodorous; taste strongly astringent. Dose.—20-40 grains (1.2-2.40 Gm.). Official Preparation. Extractum Geranii Fluidum—Extracti Geranii Fluidi—Fluid Extract of Geranium.—Dose, 20-40 minims (1.2-2.40 Cc). Physiological Action.—The action of geranium corresponds with that of tannic acid. Therapeutics.—Externally and Locally.—Geranium is not used externally. Its local action is varied. It is serviceable as an astringent gargle in sore throat; as a mouth-wash in aphthous stomatitis; in relaxed conditions of the rectum, vagina, and throat; in buccal ulcer, metrorrhagia, and anal fissure ; in prolapsus ani and epistaxis. It has also proved valuable as an injection in leucorrhea, gonorrhea, and gleet. Internally.—Owing to its agreeable taste, it is useful in infantile diarrhea and for persons having weak stomachs. In the early stages of phthisis it is very beneficial, as it reduces the fever and pulse-rate, at the same time checking the night-sweats, cough, expectoration, and hemoptysis. Under it the patient's appetite im- proves and he gains in weight. The fluid extract, in combination with an aromatic, gives perceptible temporary relief in rapid acute phthisis attended with severe, distressing cough and debilitating night-sweats. It has also been used to advantage in internal hemorrhages. 724 A TEXT-BOOK OF MA TERIA MEDICA. Administration.—Locally, the powdered root and fluid extracts are used, but the fluid extract diluted with water is preferable. For an injection a decoction, I ounce (32.0 Gm.) to 1-2 pints (512.0-1024.0 Gm.) of water, is used, and the decoction in milk is of service in infantile diarrhea. Prof. Johnson claims that gera- nium contains mucilaginous material which, acting as a demulcent, makes the decoction a much more desirable preparation than a simple solution of tannin. Rhus Glabra—Rhois Glabrae—Rhus Glabra. U. s. P. (Sumach.) Origin.—The fruit of Rhus glabra L., a shrub or suffruticose plant about 12 feet (3.6 M.) high, growing in rocky or barren soil in North America. Description and Properties.—Subglobular, about \ inch (3 Mm.) in diameter, drupaceous, crimson, densely hairy, containing a roundish-oblong, smooth putamen; inodorous; taste acidulous. Dose.—The preparations only are used internally. Official Preparation. Extractum Rhois Glabrae Fluidum—Extr3cti Rhois Glabrae Fluidi—Fluid Extract of Rhus Glabra.—Dose, \-i fluidrachm (1.0-4.0 Cc). Allied Species. Rhus Aromatica—Rhois Aromaticae—Sweet Sumach. Unofficial Preparation. Extractum Rhois Aromaticae Fluidum—Extracti Rhois Aromaticae Fluidi ^Fluid Extract of Rhus Aromatica.—Dose, 5 minims-i fluidrachm (0.3-4.0 Cc). Physiological Action.—The action of Rhus glabra resembles that of tannic acid. Therapeutics.—Externally and Locally.—An infusion or the ; fluid extract is used as a topical application for ulcers and in- flamed wounds. The infusion is an excellent mouth-wash in spongy gums, ptyalism, pharyngitis, aphthous stomatitis, and tonsil- litis. It can be used alone, but is much more efficient when com- bined with potassium chlorate and glycerin, adding a little menthol, j 2_3 grains (.12-20 Gm.), to make the mixture more agreeable. It is also of service as an injection in leucorrhea. Internally.—Rhus glabra acts well in staying incontinence of ) urine and hematuria. A dose of 10-30 drops of the fluid extract, ASTRINGENTS. 725 taken two or three times daily, has produced complete temporary suspension of nocturnal eneurcsis of children, as well as senile eneurcsis. Administration.—The fluid extract is used exclusively. Rosa Gallica—Rosae Gallicae—Red Rose. U. S. P. Origin.—The petals of Rosa gallica L., collected before ex- panding. Description and Properties.—Usually occurring in small cones consisting of numerous imbricated, roundish, retuse, deep purple- colored, yellow-clawed petals, having a roseate odor and a bitterish, slightly acidulous, and distinctly astringent taste. Official Preparations. Confectio Rosae—Confectionis Rosae—Confection of Rose.—Used as an excipient in pill masses. Extractum Rosae Fluidum—Extracti Rosae Fluidi—Fluid Extract of Rose. —Used chiefly as a vehicle. Physiological Action.—It acts like tannic acid. Therapeutics.—Externally and Locally.—The ointment is used for chapped lips and hands, and also for superficial burns and in erythema. The fluid extract is used as an application to inflamed eyes, buccal, aural, and anal ulcers, and in aphthous stomatitis. It has been employed in conjunction with sodium salicylate to prevent the pitting of small-pox. Its chief use, however, is as a vehicle and flavoring extract. Internally.—It is practically of but little value as an internal agent, although it exerts some action in checking profuse szveats and in uterine hemorrhages. Administration.—The fluid extract is mainly used, an infusion of which is given internally. The fresh leaves, crushed, are ser- viceable as a poultice. Rubus—Rubi—Blackberry. U. S. P. Origin.—The root-bark of Rubus villosus Ait., Rubus Canaden- sis L., and Rubus triznalis Mx., common shrubby North American plants. Description and Properties.—Thin, tough, flexible bands, outer surface blackish or blackish-gray, inner surface pale-brownish, some- 726 A TEXT-BOOK OF MA TERIA MEDICA. times with strips of whitish, tasteless wood adhering; inodorous; taste strongly astringent, somewhat bitter. Official Preparation. Extractum Rubi Fluidum—Extracti Rubi Fluidi—Fluid Extract of Rubus. —Dose, 0-2 fluidrachms (2.0-8.0 Cc). Physiological Action.—Identical with that of tannic acid. Therapeutics.—Internally.—The fluid extract is used in the summer diarrhea of children—practically its only employment. An infusion of the leaves is claimed by Popoff to be an excellent remedy for debility of the bladder. Administration.—The fluid extract and the infusion are used as medicinal agents. The syrupus rubi idaei is used only as a vehicle. Blackberry cordial and blackberry brandy are favorite modes of administration. It is commonly believed by the laity that the various blackberry and raspberry preserves are efficacious as remedies ; on the contrary, they are highly irritating, because of the seeds present in them. MINERAL ASTRINGENTS. Plumbum—Plumbi—Lead. The salts of lead only are used in medicine. Plumbi Acetas—Plumbi Acetatis—Lead Acetate. U. S. P. (Sugar of Lead.) Origin.—Metallic Lead is dissolved, in the presence of air, in Acetic Acid, or Lead Oxide is dissolved by the aid of a gentle heat in Acetic Acid and Water, the solution being filtered, evaporated, and crystallized. Description and Properties.—Colorless, shining, transparent, monoclinic prisms or plates, or heavy, white, crystalline masses, or granular crystals, having a faintly acetous odor and a sweetish, astringent, and afterward metallic taste. On exposure to the air efflorescent and absorbing carbon dioxide. Soluble in 203 parts of water and in 21 parts of alcohol, in 0.5 part of boiling water, and in 1 part of boiling alcohol. Lead acetate should be kept in well-stoppered bottles. Dose.—^-5 grains (0.03-0.3 Gm.). ASTRINGENTS. 727 Official Preparations. Liquor Plumbi Subacetatis—Liquoris Plumbi Subacetatis—Solution of Lead Subacetate (Goulard's Extract).—Used externally and locally. (The solu- tion contains about 25 per cent, of Lead Subacetate.) Liquor Plumbi Subacetatis Diliitus—Liquoris Plumbi Subacetatis Diluti —Diluted Solution of Lead Subacetate (Lead Water).—Used externally and locally. (It contains 3 per cent, of Lead Subacetate.) Ceratum Plumbi Subacetatis—Cerati Plumbi Subacetatis—Cerate of Lead Subacetate (Goulard's Cerate).—Used externally and locally. (Goulard's Extract, 20; Camphor Cerate, 80 parts.) Unofficial Preparation. LinimSntum Plumbi Subacetatis—LinimSnti Plumbi Subacetatis—Lini- ment of Lead Subacetate.—Used externally and locally. (40 parts of Lead Sub- acetate to 60 parts of Cotton Seed Oil.) Plumbi Carbonas—Plumbi Carbonatis—Lead Car- bonate, u. S. P. (White Lead.) Origin.—Obtained by passing Carbon-dioxide Gas through a solution of Lead Acetate, or by adding an Alkali Carbonate to a solution of a Neutral Lead Salt. Description and Properties.—A heavy, white, opaque powder or a pulverulent mass, without odor or taste. Permanent in the air. Insoluble in water or alcohol, but soluble in acetic or diluted acetic acid, with effervescence. Lead carbonate should be kept in well-stoppered bottles. Used externally and locally. Official Preparation. Unguentum Plumbi Carbonatis—UnguSnti Plumbi Carbonatis—Ointment of Lead Carbonate (10 per cent.).—Used externally and locally. Plumbi Iodidum—Plumbi Iodidi—Lead Iodide. U. S. P. Origin.—Obtained by mixing a solution of Lead Nitrate and Potassium Iodide, and drying the precipitate. Description and Properties.—A heavy, bright-yellow powder without odor or taste. Permanent in the air. Soluble in about 2000 parts of water and in about 200 parts of boiling water, sep- arating from the latter solution in brilliant golden-yellow spangles I or crystalline laminae. Very slightly soluble in alcohol, but sol- uble, without color, in solutions of the fixed alkalies, in concen- 728 A TEXT-BOOK OF MATERIA MEDICA. trated solutions of the acetates, of the alkalies, potassium iodide, and sodium hyposulphite, and in a hot solution of ammonium chloride. Lead iodide should be kept in well-stoppered bottles. Dose.—\ grain (0.13 Gm.). Official Preparation. UnguSntum Plumbi Iodidi— UnguSnti Plumbi Iodidi—Ointment of Lead Iodide (10 per cent.).—Used externally and locally. Plumbi Nitras—Plumbi Nitratis—Lead Nitrate. U. S. P. Origin.—Prepared by dissolving Lead in Diluted Nitric Acid. Description and Properties.—Colorless, transparent, octahedral crystals, or white, nearly opaque crystals, without odor and having a sweetish, astringent, and afterward metallic taste. Permanent in the air. Soluble in 2 parts of water; almost insoluble in alcohol. Used externally and locally. Plumbi Oxidum—Plumbi Oxidi—Lead Oxide. U.S. P. (Litharge.) Origin.—Obtained by roasting Lead in air. Description and Properties.—A heavy, yellowish or reddish- yellow powder or minute scales, without odor or taste. On expo- sure to the air it slowly absorbs moisture and carbon dioxide. Almost insoluble in water and insoluble in alcohol. Soluble in acetic or diluted nitric acid and in warm solutions of the fixed alkalies. Lead oxide should be kept in well-closed vessels. Used externally and locally. Official Preparations. Emplastrum Plumbi—Empiastra Plumbi—Lead Plaster (Diachylon Plas- ter).—Used externally and locally. (Lead Oxide or Lead Plaster is contained in Emplastrum Ammoniaci cum Hydrar- gyro and in Emplastra Ferri, Hydrargyri, Opii, Resinae, and Saponis.) Unguentum Diachylon—UnguSnti Diachylon—Diachylon Ointment.— (Lead Plaster, 500; Olive Oil, 490; Oil of Lavender Flowers, 10.) Used externally and locally. Physiological Action.—Lead per se is practically inert; some of its salts, however, particularly the acetate, possess valuable therapeutic properties. ASTRINGENTS. 729 Externally and Locally.—Applied to the unbroken skin, lead salts have little if any effect, yet they act readily upon denuded surfaces, blanching the tissue of the parts by contraction of the small blood-vessels. In sores and ulcers they coagulate the albumin of the discharge and the protoplasm of the neighboring superficial cells, thus forming a protective coating for the healthier structure beneath. These salts have likewise a sedative action because of the decreased local circulation and the presumably depressant effect upon the nerve endings. Moreover, by virtue of their astringency they furnish valuable hemostatic and antiphlogistic remedies. In some cases the skin is discolored by their use. Internally.—Digestive System.—Lead acts immediately in the mouth, causing a sweet, styptic taste and coagulating the mucus. It contracts the cells and vessels of the entire alimentary canal, inducing dryness by diminished secretion. Consequent to the dis- turbed physiological functions of the digestive tract, the peristaltic movements diminish, and constipation necessarily ensues. Circulatory System.—The heart's action is slowed through the branches of the vagus by irritation of the cardiac inhibitory center. The pulse is lessened in volume and frequency, and lacks regularity. The blood takes up the lead as an albuminate, which soon passes into the tissues. While yet in the vascular system it inter- feres with the nutritive function of the corpuscles, producing by their destruction a watery condition of the blood. This explains the anemia usually present in cases of plumbism or lead-poisoning. Nervous System.—Both sensory and motor functions become deranged, especially the latter. This central irritation causes a dis- turbance, and finally paralysis, of various muscles. The involun- tary muscles appear to be most affected, and of these primarily the intestinal; hence, with the assistant local effect, arise distressing abdominal pains and spasms. The cardiac center and vagal branches to the heart are influenced, as already stated. Respiratory System.—The irritation produced in the respiratory centre has an inhibitory action through the vagus upon the respira- tion. Absorption and Elimination.—The preparations of lead are con- verted in the stomach into an albuminate, and thence taken up by the blood, very little absorption taking place in the intestine, where the lead is converted into an insoluble sulphide. It is absorbed by the abraded skin, and enters directly into combination with the 730 A TEXT-BOOK OF MATERIA MEDICA. albumin of the tissues. A portion of the lead albuminate is elimi- nated by the liver with the bile into the intestine, where, being con- verted into a sulphide, it is excreted in that form with the feces. The skin, kidneys, and mammary glands assist in its elimination. Lead is not easily removed from the whole system, owing to its retention by the ubiquitous albumin ; consequently some alterative, such as potassium iodide, should be administered. Uterus.—Under the influence of lead, abortion is liable to occur or the child be still-born. This is probably due to a disturbance of the quality and quantity of the blood-supply to the affected parts. Untoward Action.—Undesirable results have followed the ad- ministration of medicinal doses of lead acetate, evidently arising from insufficient elimination. Baker observed loss of appetite, gas- tralgia, constipation, and paralysis of three weeks' duration. This last symptom occurred in the hand of a man who had taken I grain (.06 Gm.) of lead acetate twice daily for four days to relieve hema- turia. In another case attacks of colic, lasting several months, fol- lowed the exhibition of 4 grains (.25 Gm.) of the same salt for three days. Tanquere des Planches suggests caution in too free an administration of lead preparations, as being prone to occasion disagreeable symptoms. The external application of lead solutions and ointments some- times produces unpleasant effects, such as discoloration of the skin. In the mucous membrane lead rarely excites symptoms of poison- ing, a single case being reported where lead water compresses were applied to the eye. Gastric pains have occurred after re- peated applications of such compresses to a contused shoulder, the pains ceasing with their withdrawal and reappearing with a renewal of the treatment. Colic and paralysis of the member have fol- lowed washing of a large ulcer of the leg with lead water, these symptoms disappearing upon a withdrawal of the drug. In still another case a sweetish, styptic taste in the mouth and stiffness of the neck resulted from the external use of the solution. Poisoning.—Cases of acute poisoning are in therapeutics for- tunately rare, the acetate—the form generally given—producing emesis, thus preventing toxic effects of the drug. The first symptom of poisoning is a sweetish, metallic taste, soon followed by nausea and vomiting of a white, milky fluid con- taining curdy material—the result of a combination of the exces- sive lead with the hydrochloric acid of the. gastric juice, and the ASTRINGENTS. 731 formation of lead chloride. Constipation and subsequent diarrhea usually occur, with black passages, the discoloration being caused by the sulphide of lead formed in the intestinal canal. There is severe, persistent pain in the abdominal muscles, which are rigid and contracted, while a retraction of the abdominal walls is clearly perceptible. There are great thirst, and possibly cramps in the calves of the legs, neuralgic pains, muscular twitchings, vertigo, stupor, anesthesia, and paralysis. Tenesmus is present, and the face is pale and the lips livid. A blue line, due to a deposit of the sulphide, is usually found on the gums near the incisor teeth. As a rule, the liver is retracted and often diminished in size. The pulse is rapid and tense at first, becoming weak, compressible, and slow. Treatment of Poisoning.—Evacuation of the stomach is impera- tive, the process being more or less assisted by the emetic property of the drug. Some sulphate should be administered in order to form an insoluble lead compound. Epsom and Glauber's salts are the best antidotes, since they are readily soluble and easily ob- tained ; acting, moreover, as a purge, they empty the intestinal canal. Opium will serve to relieve pain and irritation, while to maintain bodily temperature hot applications can be used on the feet and abdomen. Chronic Poisoning.—The acute form of poisoning just considered is always produced by a soluble lead salt; chronic plumbism, on the contrary, is invariably caused by an insoluble salt. The symp- toms are numerous and manifold, there being no physiological dis- turbance of the acute which is not present in the chronic condition. The train of untoward symptoms is occasioned by long-continued medicinal use of lead preparations. Very frequent sources of poisoning are: drinking water conveyed in lead pipes, and foods colored with chrome yellow and those contained in cans soldered with lead. It is especially liable to occur among painters (colica pictonum), manufacturers of lead salts, color-grinders, and type- setters and founders. Wrist-drop, bilateral, resulting from paralysis of the extensor muscles of the forearm, is one of the most prominent symptoms, although not a constant occurrence. The supinator longus, being also a flexor, usually escapes this influence. Colic, sharp abdom- inal pains, chiefly in the umbilical region, retraction of the abdom- inal muscles and cramps, and paralysis of the calves of the legs may be present in plumbism—or " saturnism," as it is sometimes termed, a word transmitted to us from medieval alchemy. Obsti- 732 A TEXT-BOOK OF MATERIA MEDICA. nate constipation, with the passage of clay-colored stools, as has been stated, necessarily occurs; and anorexia, gastralgia, and arthralgia are seldom absent. The liver, the most important me- dium in the elimination of the poison, in severe cases becomes overtaxed and reduced in size. The tongue is white and coated, and the skin, lips, and mucous membranes are discolored. A blue line on the anterior gums is pathognomonic, although it may be absent in those who take special care of the teeth. Headache, delirium, and epileptiform convulsions, constituting encephalopathia saturnina, may occur, being usually due to uremia induced by insufficient elimination of the poison. Albuminuria, cirrhosis, and contraction of the kidneys, with diminished excretion of uric acid, are present, and amblyopia and amaurosis may be in- cluded among the symptoms. The heart and the entire vascular system are, as has been said, considerably deranged. Multiple neuritis, anterior poliomyelitis, and atrophy of the nerve-trunks, with resultant muscular wasting and loss of power, gradually mani- fest themselves. Gout sometimes occurs, and, as noted in acute poisoning, miscarriage is liable to take place. Treatment of Poisoning.—The sulphates are given for their chemical and purgative effects, yet in chronic plumbism the hepatic purgatives—calomel, gamboge, jalap, etc.—are preferable. Opium and morphine relieve pain and spasms, being claimed by some authorities as specifics in lead-poisoning. Sulphuric-acid lemonade and plenty of milk have been found beneficial. Potassium iodide in ten-grain doses, three times daily, has an eliminative effect. The cerebral symptoms may be alleviated by a diaphoretic, such as pilocarpin or an alcohol sweat. In progressive paralysis strychnine is widely employed. Fara- dization of the muscles, if they respond, or otherwise galvanization, should be used to increase muscular force and prevent atrophy. Plumbi Acetatis.—This being the typical lead salt, its action will be first considered. Therapeutics.—Externally and Locally.—It acts as a sedative as well as an astringent in acute inflammations, such as eczema (not chronic), impetigo, lichen, and erythema ; but it must not be used stronger than io grains (0.64 Gm.) to 1 ounce (30.0 Cc.) of water. It is of service as an injection in gonorrhea, leucorrhea, gleet, and otorrhea. In combination with opium it makes a good topical application for hemorrhoids. As a gargle it is of some value, and is also serviceable in orchitis, synovitis, and paronychia. ASTRINGENTS. J33 Internally.—Its most important use is in checking hemorrhages, in which it is associated with opium, although it is chemically in- compatible with that drug. It is of service in hemorrhage in typhoid fever, yellow fever, hemoptysis, and gastric ulcer. It lowers the heart's action, constringing the arterioles, in this respect resembling digitalis, combined with which drug it is beneficial in hypertrophy of the heart. Morbid discharges, such as the night-szveats and diarrhea of phthi- sis and the diarrhea of typhoid, dysentery, cholera infantum, secretions in bronchorrhca, and serous diarrhea, are effectually checked by the acetate of lead and opium, which diminishes the pain, griping, and tenesmus attending the respective affections. By far its most fre- quent use, however, is in serous diarrheas, the drug acting very quickly and efficiently, and being both sedative and astringent. Given in chronic gastritis zvith pain, lead acetate affords marked relief. It was at one time advocated in internal aneurysm, but is of little if any value in this respect. Liquor Plumbi Subacetatis.—This preparation is used exten- sively for bruises, sprains, acute eczema, and as a cooling application in ecthyma, erysipelas, and all kinds of inflammations; it should be well diluted. It also relieves the itching of urticaria, pruritus pudendi, and eczema. A felon may be aborted by saturating bread-crumbs with Goulard's solution, making a poultice, and placing it over the finger. Plumbi Iodidi.—Used very little. It acts beneficially when employed as an ointment applied to enlarged lymphatic glands and spleen ; also for psoriasis and chronic eczema. It is given in 1-2 grain- (0.06-0.12 Gm.) doses to reduce malarial spleen. Carbonate of lead is used only externally, in the form of an ointment, for burns, scalds, erysipelas, and intertrigo. It should never be applied to abraded surfaces, as it is rapidly absorbed. It should be mixed with linseed oil. Plumbi Oxidum.—Hebryre commends an application of equal parts of lead plaster and linseed oil for sweating of the feet. It is chiefly used in the preparation of diachylon or lead-plaster, emplas- trum saponis and emplastrum resinae being also prepared with the oxide. Plumbi Nitras.—Used with good results in onychia and also in the manufacture of Ledoyne's disinfectant. It is an excellent remedy for fissured nipples, care being taken to wash the nipple 734 A TEXT-BOOK OF MATERIA MEDICA. before suckling. Should the fissures be deep, it is well to wash the nipple with morphine sulphate or a little cocaine, as the lead application is exceedingly painful. It destroys the fetid odor arising from gangrenous sores and offensive discharges from the ears, nostrils, rectum, and vagina. It has also proved serviceable in epithelioma. Chloride of lead and tannate of lead have been used ex- ternally as ointments—the chloride to allay pain and arrest morbid grozoths, and the tannate in threatening bed-sores. Administration.—Locally a watery solution of lead acetate, io grains (0.64 Gm.) to 1 ounce (30.0 Cc), is used. Powdered opium can be added, 1 drachm to the pint of water. Applied to mucous membranes or used as an injection, 2 grains (0.12 Gm.) to 1 ounce (30.0 Cc.) of water, or 5 grains (0.32 Gm.) of the acetate and 5 (0.32 Gm.) of zinc sulphate in I ounce (30.0 Cc.) of water—rose-water, for instance—proves a most efficient application. Suppositories for hemorrhoids may contain 1 grain (0.06 Gm.) of opium to 3-5 grains (0.19-0.32 Gm.) of the acetate. The pilulae plumbi cum opio—lead acetate 3 grains (0.19 Gm.), opium 1 grain (0.06 Gm.)—is mostly used internally, one pill being taken every three hours. In dysentery and cholera infantum an enema containing 5 grains (0.32 Gm.) of lead acetate to I grain (0.06 Gm.) of opium, or \ grain (0.03 Gm.) of morphine to 1 ounce (30.0 Cc.) of water, gives excellent results. Should there be any abrasion of the skin, lead subacetate must not be used, as it prevents healing by constringing the edges of the wound. It is not used internally. Solution of subacetate of lead is most frequently used in union with opium, forming the well-known L. and L., or lead-water-and- laudanum, solution. It is also used in conjunction with glycerin, 1 ounce of each, or as Goulard's cerate, consisting of 20 parts Goulard's extract to 80 parts camphor cerate. For ulcers, fissured nipples, and epithelioma lead nitrate is used, chiefly in the powdered form. In the nose, ears, vagina, and rectum a douche (2-5 grains (0.13-0.32 Gm.) to 1 ounce (30.0 Cc.) of water) is used. A solution of 10 grains (0.64 Gm.) to 1 ounce (30.0 Cc.) of glycerin or brandy is a very good application for sore nipples. Zincum—Zinci—Zinc. U. S. P. Origin.—Obtained by roasting the native Zinc Sulphide or Car- bonate, and reducing the resulting oxide with charcoal. ASTRINGENTS. 735 Description and Properties.—A bluish-white metal, showing a crystalline fracture and having a specific gravity ranging from 6.9 when it is cast to 7.2 after it is rolled. Soluble in diluted sulphuric or hydrochloric acid, with evolution of hydrogen gas. Metallic zinc occurs in the form of thin sheets or in irregular, granulated pieces, or moulded into thin pencils, or in a state of fine powder. The following salts of zinc are official: Zinci Acetas—Zinci Acetatis—Zinc Acetate.— Origin.—Obtained by dissolv- ing Zinc Acetate in Acetic Acid and Water and boiling: zinc acetate crystallizes out. Description and Properties.—Soft, white, six-sided, monoclinic plates, of a pearly luster, having a faintly acetous odor and an astringent metallic taste. Exposed to the air, the salt gradually effloresces and loses some of its acid. Soluble in 2.7 parts of water and 36 parts of alcohol. Zinc acetate should be kept in well-stoppered bottles. Dose.—As a tonic, )/2-2 grains (0.03-0.12 Gm.); as an emetic, 10-30 grains (0.6-2.0 Gm.); but principally used externally and locally. Zinci Carbonas Praecipitatus—Zinci Carbonatis Praecipitati— Precipitated Zinc Carbonate.— Origin.—Prepared by pouring together solutions of Zinc Sulphate and Sodium Carbonate, and drying the precipitated zinc salt. Description and Properties.—An impalpable white powder, of somewhat variable chemical composition, without odor or taste ; permanent in the air. Insoluble in water or alcohol. Dose.—2-3 grains (0.12-0.18 Gm.). Chiefly used externally. Zinci Iodidum—Zinci Iodidi—Zinc Iodide.— Origin.—Prepared by dissolving Zinc Oxide or Carbonate in Hydriodic Acid. Description and Properties.—A white, granular powder, odorless, having a sharp, saline, and metallic taste. Very deliquescent, and liable to absorb oxygen from the air, becoming brown from liberated iodine. Readily soluble in water, alcohol, or ether. Zinc iodide should be kept in small glass-stoppered bottles. Dose.—j^-2 grains (0.03-0.12 Gm.). Also used externally. Zinci SQlphas—Zinci Sulphatis—Zinc Sulphate.— Origin.—Prepared by dis- solving Granulated Zinc in Sulphuric Acid, certain precautions being taken to remove Impurities. Description and Properties.—Colorless, transparent, rhombic crystals, without odor, and having an astringent, metallic taste. Efflorescent in dry air. Soluble in 0.6 part of water and in 3 parts of glycerin; insoluble in alcohol. Zinc sulphate should be kept in well-stoppered bottles. Dose.—1-3 grains (0.06-0.18 Gm.); as an emetic, 10-60 grains (0.6-4.0 Gm.). Zinci Oxidum—Zinci Oxidi—Zinc Oxide.—Origin.—Prepared by heating Zinc Carbonate to redness in a crucible. Description and Properties.—An amorphous white powder, without odor or taste. Insoluble in water or alcohol. It should be kept in well-stoppered bottles. Dose.—34f—5 grains (0.015-0.3 Gm.). Official Preparations of Zinc Oxide. Ungufentum Zinci Oxidi—UnguSnti Zinci Oxidi—Ointment of Zinc Oxide (20 per cent.).—Used externally and locally. Antagonists and Incompatibles.—The salts of zinc are incom- 736 A TEXT-BOOK OF MATERIA MEDICA. patible with the vegetable astringents, alkalies and their carbonates, lime water, the sulphides, silver nitrate, lead acetate, and milk. Synergists.—The same as for lead. The metallic form is not used in medicine. Physiological Action.—Externally and Locally.—The zinc salts resemble the lead salts in their action, but they are less powerful astringents. They are also to a slight extent hemostatic. The chloride is exceedingly caustic. Internally.—Digestive System.—The sulphate of zinc and, in a slight degree, the carbonate are specific emetics, causing rapid emesis, with but little nausea or depression. Their modus operandi is not definitely known, but it is believed that their effects are partly due to local action on the stomach, and partly to stimulation of the vomiting center in the medulla. Vomiting is also produced by injecting a solution of the salt into the circulation ; but this is doubtless owing to the fact that the salt is excreted by the stomach, and that it also exerts an influence on the medullary center. The salts of zinc also act as astringents upon the gastro-intes- tinal mucous membrane. Circulatory System.—Practically nothing is known of the action of zinc salts on the heart, blood, and vessels. They exist in the blood as albuminates, in close relation with the red corpuscles. Nervous System.—Zinc valerianate acts as a sedative, but this action is wholly dependent upon the valerian. The salts are also astringents and possess some tonic properties. They may cause transverse myelitis. Absorption and Elimination.—The zinc salts are absorbed from the stomach or enter directly into the circulation when injected. They are eliminated by the liver and kidneys, but mainly by the intestinal glands. Zinc salts do not accumulate so rapidly as mer- cury, lead, and copper. Untozvard Action.—3-5 grains (o. 19-0.32 Gm.) have produced nausea and gastric oppression, while if the zinc salt reaches the intes- tines diarrhea results. When taken on a full stomach the salts form an insoluble albuminate which undergoes the regular digestive process. Repeated small doses, 3 grains (0.19 Gm.), have produced gastric oppression, eructations, slight confusion of thought, dizziness, bodily exhaustion, thirst, gastralgia, vomiting, and diarrhea. Zinc dyscra- sia may follow, characterized by obstinate constipation, emaciation, and anemia. ASTRINGENTS. 737 Poisoning.—Continued use or excessive doses of zinc will pro- duce poisoning, with symptoms resembling those of lead-poisoning. Chronic zinc-poisoning is rare. Treatment of Poisoning.—Chemical antidotes are the bicarbon- ates of soda and potassium. Flour and water, soapsuds, and milk are also beneficial. Morphine given hypodenmically relieves the vomiting. Laxatives and potassium iodide may serve later to assist in eliminating the zinc. Therapeutics.—Zinc Oxide.—Externally and Locally.—The ointment or powder is used in chronic eczema, intertrigo, burns, fis- sured nipples, anal fissure, ulcers, and skin diseases. In combination with linseed oil the oxide has also been used in erysipelas. The drug has proved useful as an injection in leucorrhea. Internally.—Associated with bismuth, sodium bicarbonate, or belladonna, it is very effective in diarrhea—particularly the summer diarrhea of children—and dysentery. It is a most excellent remedy for colliquative szveating and the sweating of phthisis, and also serves to check the profuse secretion of bronchorrhea, although its use may occasion disordered diges- tion, since zinc is but sparingly soluble. It has been used extensively in the treatment of hysteria, spas- modic asthma, chorea, and epilepsy ; yet, even though it is claimed to be a specific, its action as such is exceedingly doubtful. Zinc oxide has proved highly beneficial in zvhooping cough, de- lirium tremens, and chronic alcoholism—especially the two latter, which are attended with considerable nervousness. The oxide is also valuable in gastralgia. Zinc Acetate.—It is used only externally and as an injection in gonorrhea and leucorrhea. In conjunctivitis it is useful as a collyrium. Zinc Sulphate.—Externally and Locally.—The external use is chiefly in zveeping eczema, pruritus, and ulcers. Locally it is of ser- vice as a wash in ophthalmia and conjunctivitis, and as an injection in gonorrhea, leucorrhea, vulvitis, and otitis. It is also used in gan- grenous stomatitis, cancrum oris, and as a gargle in enlarged tonsils and relaxed sore throat. In nasal polypi the powder is insufflated, the solution being applied to the stump after removal of the poly- pus. It dries up soft tumors near the vagina, anus, and female urethra. It is also used in lupus exedens and cancer of the breast, but does not act upon parts covered by epithelium. Its application is very painful, but the eschar does not tend to spread, and sepa- rates much more readily than those of many other caustics. 738 A TEXT-BOOK OF MATERIA MEDICA. Internally.—Its chief use is that of an emetic after ingestion or poison, irritating foods, and especially narcotics, as well as where the air-passages are obstructed, as in croup and diphtheria. It acts as an astringent in chronic diarrhea and dysentery when associated with opium and ipecac. It is serviceable in typhoid fiver, flatulent dyspepsia, coursing oxularia, spasmodic asthma, and zvhoop- ing cough. Like the other zinc salts, it has also been used in hysteria, chorea, epilepsy, and angina pectoris. Zinc Carbonate.—This preparation is used only externally, for blisters, zuecping eczema, and intertrigo. It is employed in the form of a powder, but generally as an ointment—cardamine ointment. Zinc Iodide.—This salt is but little used, but is of some value as a gonorrheal injection, as an application to enlarged and indu- rated tonsils, and in scrofulous glands. Zinc phosphide and zinc valerianate are used only for the benefit derived from the phosphorus and valerianic acid, and may properly be omitted here. Administration.—Externally the powder or ointment of zinc oxide is used, or the drug may be mixed with powdered starch, lycopodium, or acacia. Before applying these preparations it is well to wash the parts with a weak solution of carbolic acid. Internally, \ grain (o.oi Gm.) zinc oxide and 3 grains (0.19 Gm.) sodium bicarbonate are given in diarrhea, or, if preferable, bismuth subnitrate 10 grains (0.64 Gm.), pepsin (Sheffer's) 3 grains (0.19 Gm.), and zinc oxide \-\ grain (0.03-0.06 Gm.), with a little opium added. As an injection a combination of 10 grains (0.64 Gm.) each of zinc sulphate and lead acetate is used, the two salts interacting and pro- ducing lead sulphate—which is precipitated and insoluble—and zinc acetate. Locally and externally the dry powder of zinc sulphate is used, or a mixture of zinc sulphate 10 grains (0.64 Gm.), aqua rosae 4 ounces (118.29 Cc), and glycerin 1 drachm (4.0 Cc), as a lotion. As an injection it is associated with lead acetate, forming the zinc acetate and lead sulphate. In ophthalmia neonatorum zinc sulphate 5 grains (0.32 Gm.), morphine sulphate 3 grains (0.19 Gm.), and aqua rosae 1 ounce (30 Cc), perhaps with atropine added, form an excellent mixture. Internally, in dyspepsia 1-2 grains (0.06-0.12 Gm.) may be given, and for intestinal affections 1 grain (0.06 Gm.) each of the sulphate, powdered opium, and ipecac three times daily. To produce emesis 5 grains (0.32 Gm.) are sufficient. ANOMALIES AND CURIOSITIES OF MEDICINE. By George M. Gould, A.M.,M.D., and Walter L.Pyle, A.M., M.D. Im- perial octavo* 968 pages, handsomely GOULD AND PYLE'S CURIOSITIES OF MEDICINE illustrated. Cloth, $6.00 net; Half Morocco, $7.00 net. £• J> <£ J> J- An encyclopedic collection of rare and extra- ordinary cases, and of the most striking instances of abnormality in all branches of medicine and surgery, derived from an exhaustive research of medical literature from its origin to the present day, abstracted, annotated, classified, and in- dexed. As a complete and authoritative Book "A most remarkable and interesting volume. It stands alone among medical literature, an anomaly on anomalies. It is a book full of reve- lations from its first to its last page, and cannot but interest and sometimes almost horrify its readers."—American Medico-Stngical Bulletin. "One of the most valuable contributions ever made to medical literature. Every page is as fascinating as a novel."— Brooklyn Medical Jour- nal. of Reference it will be of value not only to members of the medical profession, but to all persons interested in general scientific, sociologic, and medicolegal topics; in fact, the absence of any complete work upon the subject makes this volume one of the most important literary inno- vations of the day. <£ £• <£ <£ <£ <£ <£ Sent post-paid on receipt of price. W. B. SAUNDERS, Publisher, 925 Walnut St., Philadelphia. A Clinical Text-Book of SURGICAL DIAGNOSIS AND TREATMENT. By J. W. Mac- donald, M.D. Edin., L.R.C.S. Edin., Professor of the Practice of Surgery and of Clinical Surgery in Hamline Uni- versity, Minneapolis, Minn. Octavo. 800 pages, handsomely illustrated. Cloth, $5.00 net; Half Morocco, $6.00 net. e^* «£* «J" fc?* «£" e^* *3* e^"* «^" This work aims in a comprehensive manner to furnish a guide in matters of surgical diagnosis. It sets forth in a systematic way the necessities of examinations and the proper methods of making them. The various portions of the body are then taken up in order and the diseases " The work is brimful of just the kind of prac- tical information that is useful alike to students and practitioners."—Cincinnati Lancet-Clinic. and injuries thereof succinctly considered and the treatment briefly indicated. Practically all the modern and approved operations are de- scribed with thoroughness and clearness. The work concludes with a chapter on the use of the Rbntgen rays in surgery. «£* «£* <£ And pleasantly. or Diluent J The hackneyed rule of Asclepiades that medicines should always be so combined as to cure quickly, safely, and pleasantly (curare, cito, tuto, et jucunde) has resulted in the adoption of the above form of inscription. The theoretical prescriber writes by rule, religiously avoids incompatibles, and would be shocked by, and have little respect for, a physician who should deliberately include in the same pre- scription the names of substances directly antagonistic to each other physiologically. The subject will be further discussed here- after. As a general rule, we prescribe only one drug to provoke emesis, and a combination of several if we wish a diuretic. A purgative is usually multiple, but if the selection be castor oil or croton oil, it will be single. After we have selected the Basis, or chief ingredient, of our prescription, the next point to determine is whether we can add anything which will in any manner be of real assistance to that Basis. This ingredient, or Adjuvant, as it is called—has usually a physiological action similar to that produced by combining two cathartics or two diuretics acting upon different portions of the intestines or kidneys. Sometimes, however, an Adjuvant may differ in its effects—as sulphuric acid serves as an Adjuvant to quinine, by favoring its absorption and thereby hastening and increasing its action, as mercury assists the action of squills upon the kidneys, or iron acts as an Adjuvant to a cardiac stimulant. The Adjuvant, as a rule, should not be directly opposed in its action to that of the Basis, as chloral is to strychnine, a diuretic to a diaphoretic, or a typical cardiac stimulant to a cardiac depressant. Having chosen the Adjuvant, the next point to consider is whether the action of the drugs selected may not be rendered more kindly through the addition of some other substance as a PRESCRIPTIONS. 787 corrective. A substance may be added which will correct some disagreeable effect of the active agents by producing a medicinal impression upon the patient. Extract of belladonna or hyoscya- mus relieves the griping occasioned by some of the more violent cathartics, like podophyllin, and other well-known instances of this kind are those of the aromatic spirit of ammonia, which mitigates the unpleasant symptoms of iodism, and hydrobromic acid, which lessens the untoward action of quinine. Again, a corrective may act by producing some chemical effect upon the Basis—as salicylic acid is rendered more soluble and less irritating by combining it with sodium carbonate or bicarbonate, forming the sodium salicylate. Great care and thought should be given not only to the Basis, Adjuvant, and Corrective, but also to the Vehicle, which claims equal attention. A prescription is often rendered more kindly, and no less efficient, through the medium of some substance producing a more agreeable taste. It is a mistaken idea that medicines, in order to be effective, should be repulsive to the patient. The homeopath's success is largely due to the very agreeable taste of his remedies. The mere caprice of the patient, however, should not be considered in the choice of a remedy when, in the best judgment of the physician, it is indicated. Still, it is well to study carefully the art of prescribing agreeable doses, so far as may be compatible with fidelity to science. It is to be noted that pleasant- ness of taste is far more important in the case of fluids than in that of solids. Aromatic elixirs, syrups, aromatic waters, etc. are in frequent use as Vehicles, yet it must be remembered that oftentimes a sen- sitive patient repudiates sweets and syrupy mixtures. In many cases simple syrup or pure water serves, after all, as the best vehi- cle, although the physician's choice must be governed mainly by experience. It will be observed that in the body of the present work, in the majority of cases, the method of administration is fully explained. It may here be noted that liquids are much more readily absorbed than solids, yet adults usually prefer to take medicines in the solid form, such as pills, capsules, powders, and tablets. In illness the patient's condition is often such that the gastric and intestinal secre- tions are greatly reduced, and there may not be sufficient fluid to dissolve the solid, so as to render it in a condition to be absorbed. It frequently happens, for instance, that pills are voided with the 788 A TEXT-BOOK OF MA TERIA MEDICA. stools unchanged, and, on the other hand, solid substances, such as pills or capsules, may remain in the intestinal canal until the secre- tions are restored, when the accumulated medicine will all be acted on at once, and, passing into solution, be absorbed in excessive doses. Such is the frequent cause of the cumulative effect which sometimes occurs, not without serious consequences. Even alkaloidal salts, which are readily soluble, are, perhaps, in many instances, best given in solution. Infants require liquid medicines, water or syrup being the best vehicle. Bitter medicines, like quinine, may be given in aromatic elixir of liquorice or syrup of yerba santa. As a general rule the metals and their compounds should be administered in the form of pills or in a small quantity of fluid. The purgative salts, potas- sium iodide, and the diuretics, are best given in large quantities of fluid. Prof. H. C. Wood, M. D., has written so clearly upon the art of combining, or, more correctly speaking, associating, medicines that we cannot do better than quote his observations verbatim: " The art of combining medicines is not a difficult one, but in practice certain principles should not be lost sight of. Chief of these are, to prescribe as few remedies as possible, and to use no powerful drug without a very distinct idea of what it is intended to do. Whenever it is desired to give a powerful remedy in increasing doses until its physiological effect is produced, it should always be given by itself. Thus, it may be necessary to give arsenic so as to impress the system, at the same time that iron is indicated ; but the two remedies should be given separately, so that the dose of either can be increased or diminished independently of the other." The principles of combination formulated below were long ago enunciated by Dr. Paris, but are to-day as imperative as ever. Medicines are combined— 11 First. To augment, correct, or modify the action of a medicine. Thus, purgatives act much more kindly when a number of them are united together. The chief reason of this probably is that, as different remedies affect different portions of the gut, the whole in- testine is best reached by a union of the diverse substances. It may take an intense irritation of the mucous membrane to purge as actively as does a mild irritation of both the mucous membrane and the muscular coat. " There are powerful medicines which act similarly upon some parts of the organism, but dissimilarly upon other parts. By com- PRESCRIPTIONS. 789 bining such remedies powerful effects can be obtained at the points where the two lines of action cross each other, without influencing to a great extent other portions of the system. Thus, chloral pro- duces sleep by its action upon the brain, and also has a distinct influence upon the heart, but none upon the intestinal tract. Mor- phine acts upon the brain, and does not influence the heart, but has a powerful effect upon the intestinal tract. By combining chloral and morphine we get an overwhelming conjoined influence upon the brain in producing sleep, with the least possible disturbance of the heart and of the intestinal tract. " Second. To obtain the joint action of two or more diverse remedies. Thus, in a cough-mixture morphine may be included to quiet the cough, whilst ipecacuanha and squill (in accordance with the first principle) are added to affect the mucous membrane. The application of this principle requires caution, or the practitioner will be led into that chief abomination—polypharmacy. It is worse than futile to attempt to prescribe for every symptom. It is the underlying cause of the disorder, or the under-stratum of bodily condition, which must be sought out and prescribed for simply. " Third. To obtain a special combination which is really a new remedy, or which experience has shown acts almost as a new remedy. Thus, when to potassium iodide in solution corrosive sublimate is added a new chemical compound (potassio-mercuric iodide) is formed, which experience has shown to be of great value in syphilitic diseases. Griffith's antihectic mixture (mistura ferri comp.) is another instance of the use of chemical changes, the protocarbonate of iron (ferrous carbonate) being formed out of the sulphate of the metal and the potassium carbonate. In the famous Dover's powder no chemical change occurs, but the ordi- nary action of opium upon the skin is so enhanced by the ipecac that the combination may be looked upon almost as a new remedy. "Fourth. To afford a suitable form. Thus, acacia is added to make an emulsion, or confection of rose to make a pill. In the choice of excipients care should be exercised to select a substance free from medicinal properties, having no chemical incompatibility with the medicinal agent and of suitable physical character. Bread- crumb often makes a good excipient for pills, but with silver nitrate it is chemically incompatible, on account of the sodium chloride it contains. " When writing a prescription the utmost care should be taken to use such excipients that the combination should not only be 79° A TEXT-BOOK' OF MATERIA MEDICA. attractive to the eye, but also as little repulsive to the palate as may be. Whenever possible the pill form should be employed with bitter or disagreeable medicines. The pill may be readily coated with silver-foil; tonic pills may be coated with iron by shaking or rolling them in ferri pulvis while soft and sticky. Sugar-coated pills and ' compressed pills' are apt to get so hard and insoluble that their use requires caution. In regard to mixtures, flavoring oils should be freely used, and the power of glycerin to conceal the disagreeable taste of many substances should be remembered." l As vehicles for liquid mixtures for internal use the following classes of official preparations are best adapted—The aromatic waters : rose, anise, fennel, and the mints when flavor alone is desired, the most delightful flavor of all being orange flower water. The aromatic syrups: orange, orange flower, and tolu when it is desired to disguise the taste and to suspend resinous or otherwise sparingly soluble substances in the mixture. The elixirs when in addition to agreeable flavor it is desirable to employ a vehicle as a solvent for certain salts not readily soluble in water or syrups. The elixirs containing about 25 per cent, of alcohol, they are useful vehicles for tinctures and fluid extracts of resinous drugs such as cubeb, buchu, uva ursi, valerian, viburnum, etc. When flavor alone is desired the elixir aromaticum, U. S. Ph., a delightful combination of orange and other aromatics, should be used. To disguise the taste of bitter drugs, as in the last men- tioned, elixirs of licorice, or of eriodictyon (yerba santa) are mostly employed. Incompatibility. Due regard is to be paid to the mutual chemical, pharmaceutical, and therapeutical relations of the drugs combined in a prescription. When different substances, whether liquid or solid, are com- bined or associated and undergo a more or less complete change, they are said to be incompatible, the incompatibility consisting of three kinds : chemical, pharmaceutical, and therapeutical, although the last division is not scientifically correct, since one substance cannot be therapeutically incompatible with another, although it may be a physiological antagonist. The incompatibles and antagonists of the different substances are fully mentioned under the respective drugs. The principles governing incompatibility, however, may well be considered here. 1 Therapeutics, 7th edition, pp. 108 et seq. PRESCRIPTIONS. 791 Chemical incompatibility is of the most importance. The commonest forms of chemical incompatibility occur under the following conditions: 1. When a new and insoluble salt is formed, resulting from a mixture of solutions of soluble salts. Example (1): mixing solutions of lead acetate and zinc sulphate, both soluble salts, but producing by chemical decomposition a new and insoluble salt, the sulphate of lead, which is precipitated. 2. By the addition of a strong acid to solutions of salts of weak or volatile acids, such as carbonates and bicarbonates, with resulting decomposition. Example (2): ammonium carbonate, the salt of a weak acid radical, added to syrup of squills, containing acetic acid, causes decomposition to take place, with effervescence and the liberation of carbonic acid gas. 3. Salts of a feeble or volatile base are decomposed by the addition of a strong alkali. Example (3) : the evolution of ammonia when a strong alkali is added to ammonia alum, and when chloral hydrate is decomposed by alkalies, such as aromatic spirit of ammonia, lime solution, etc. 4. Alkaloids, or their salts, are thrown out of solution or pre- cipitated from their solutions by the addition of alkalies or alkaline salts. Example (4): sulphate of strychnine in solution is precipitated as the insoluble bromide of strychnine by the addition of a larger proportion of potassium bromide. Quinine sulphate is precipitated as insoluble quinine acetate when mixed with a solution of potas- sium acetate. 5. Tannic and gallic acids and preparations containing them, as well as many other vegetable acids, produce discoloration or precipitation of iron and many of its compounds. Example (5): ink is the best illustration of this incompatibility. Writing fluids are usually combinations of tannic or gallic acid with some preparation of iron. Add the tincture of ferric chloride to tincture of cinchona, and notice the discoloration. There are certain preparations of iron, like the compounds with ammonium or sodium citrate (see tinct. ferri citro-chloride, N. F., tasteless tincture of iron) which produce little discoloration with vegetable astringents, and none at all with vegetable preparations containing no tannic or gallic acid. Pharmaceutical incompatibility is the production of fewer or more insoluble substances in mixtures or preparations of vegetable druo-s associated or not with any chemical compounds. Pharma- 792 1 TEXT-BOOK OF MATERIA MEDICI. ceutical incompatibility may occur in liquids or solids, although much more frequent in liquid mixtures, causing a separation of either inert or active ingredients. Examples : vegetable tinctures of resinous drugs with water, such as tincture of guaiac and water; copaiba and oils with aqueous preparations; spirit of nitrous ether with mucilage of acacia, etc. The separation or precipitation may frequently be prevented by the intervention of some viscid sub- stance, such as syrup, glucose, glycerin, mucilage of acacia, etc. Incompatibility ma}- be both chemical and pharmaceutical. In the following list the substances which cannot be classed as incom- patible under any of the above divisions are given for reference: Substance. Acacia .... Acids in general Acid. Arsenous. Salicylic . . Tannic . . . Incompatible with f Alcohol, alcoholic and ethereal tinctures; * borax; ferric t chloride; lead salts. ) Alkalies, alkaline solutions; metallic oxides. •j Ferric hydrate; magnesia; lime water. [ Iron compounds; potassium iodide; * lime water. / Alkalies, carbonates and bicarbonates; lime water; chlorine I water; albumin; gelatin. < Calomel;* sulphur; tannin. r Alkalies, carbonates ; * ammonium and mercury compounds; I potassium bromide and alcohol. * ,. f Ammonia;* alkalies, carbonates; chloral; metallic salts; I starch.* Acacia; acid hydrochlor.; acid sulphuric and sulphates; ammon. chloride; carbonates; lime water, iodine; potas- sium iodide; tannin. Bismuth. Subnitrate Chloral. Hydrate . Lead. Acetate Mercury. Bichloride . Mild chloride (Calomel) Potassium. Chlorate . . Permanganate Sodium. Bicarbonate . Bromide . . Silver. Nitrate . . . -| Potassium iodide ;* salts, carbonates; tannin; borax. . . i Acids, acid salts; alkalies, carbonates; ammon. chloride; . . \ iodine; potassium iodide ; ferric chloride, iodide; sulphur. J Acids, mineral; calomel; organic substances; sulphur. Iodide f Acids, acid salts ; alkaloids; iron ; lead and mercury salts; \ potassium chlorate; silver nitrate ; chlorine water. j Ammonia, salts; alcohol; glycerin; ethereal oils; organic / substances. I Acids, acid salts; acid, tannic; alkaloids; metallic salts. \ Acids, mineral; chlorine water; mercury compounds. 1 Acids, acetic, hydrochloric, hydrocyanic, sulphuric, tartaric, and their salts; alkalies, carbonates; iodine; potass, iodide, bromide; sulphur. Those marked with an * are sometimes directed to be compounded for the purpose of effecting some special change or producing new compounds. PRESCRIPTIONS. 793 Among the above, potassium permanganate forms an explosive mixture with glycerin ; so does chromic acid. Chlorates of potas- sium, etc. explode when triturated with sulphur. The strong acids, nitric and sulphuric acids, and especially mixtures of these, react so strongly with volatile oils (hydrocarbons) as to cause explosion. Iodine affects these oils in the same way—fulminates. It not infrequently happens that the physician intentionally writes a chemically incompatible prescription. " Black wash " and " yellow wash " are examples. Other instances are such pharma- copceial preparations as liquor ammonii acetatis, mistura ferri com- posita, and liquor magnesii citratis. Physiological antagonists are often given together, as atropine and morphine, or aconite and digitalis in certain cases of cardiac arrhythmia. No general rule can be laid down for the avoidance of so-called therapeutical incompatibility. Some of our most valuable drugs contain active principles which are physiologically opposed to each other in their action ; instance : jaborandi, which contains two abso- lutely antagonistic alkaloids, pilocarpine and jaborine, the latter in small quantit}', yet sufficient to control the action of the former. Digitalis contains several distinct principles, one of which, digi- tonin, is the direct antagonist of the others. Opium is a conspicuous example of a complex remedy, con- taining, besides gum, sugar, etc, eighteen different alkaloids, two neutral principles, and two peculiar acids ; so that a prescriber of this drug, while he may, perhaps, flatter himself that he is con- forming strictly to the present notions of pharmaceutical simplicity, is in effect a polypharmacist of most pronounced type. Moreover, not only are the constituents of opium very numerous, but, like others mentioned, the drug affords in its thebaine and morphine a further illustration of direct physiological antagonism. The author cannot too strongly recommend that physicians ignorant of the physiological action of drugs in large and small doses, if they prescribe at all, should avoid including many reme- dies in one prescription. Such practitioners had best adhere to a single remedy or adopt homeopathy. But, given a competent and thorough knowledge of the action of drugs and the exact condi- tion of the patient, the physician is justified in giving one or twenty drugs in the same prescription, since he is perfectly familiar with the several agents of relief, and can foretell with nicety the effect to be produced by their combination ; and in all cases a physician 794 A TEXT-BOOK OF MATERIA MEDICA. should be as certain of the action, strength, and reliability of the drugs he administers as the surgeon of the aseptic condition of his hands and instruments. Estimation of Amounts in a Prescription. Having decided upon the various ingredients which are to enter into the prescription, the next consideration is the amount of each desirable. In the first place, do not prescribe more than the prognosis seems to call for. If in your judgment the patient will not require medicine more than five or six days, and not oftener than three times a day, a two-ounce mixture should be prescribed if a liquid, or the required number of pills, powder, capsules, etc. if a solid, is desired. In prescribing liquid medicines note must be taken of the several sizes of medicine-vials, their capacities being in this coun- try i, 2, and 4 fluidrachms, and I, 2, 3, 4, 6, 8, 12, and 16 fluid- ounces. In the larger cities vials may also be had of metric capacities—30, 60, 90, 120, 240, and 500 Cc. While it is not essential, it is in much better taste to have a prescribed mixture aggregate just a bottleful of one of the above sizes. Where two different mixtures for the same person are prescribed, or differ- ent mixtures for different persons in the same house or family, it is well to order them put up in vials of different sizes to avoid confusing the medicine. This is especially desirable when both internal and external remedies are prescribed for the same person. The amounts of the ingredients requisite for any given prescrip- tion are determined in various ways. The amount of the active ingredients will of course be the product of two factors, the quan- tity of dose and the number of doses required ; and the quantities must be such as can be expressed in the system of weights and measures adopted, and indicated by round numbers such as best conform to the relation between the denominations of the particular system followed in the prescription. There is no difficulty in computing the amounts in a solid mix- ture, powders, pills, or suppositories, especially if ten or its multiple is prescribed, nor in external preparations, where the strength is expressed by percentage, and are therefore most conveniently and accurately prescribed according to the metric system ; but many additional considerations occur in estimating amounts in fluid mixtures. PR ES CRIP TIONS. 795 Frequently solids like salts, etc. are prescribed in solution, but their bulk may be safely disregarded in the estimation of amounts of the liquid measure ; for a solid in the quantity usually prescribed increases the whole volume of the solution but very little. Ordi- narily a fluidrachm (4.0 Cc), or a teaspoonful, should not contain over 5 grains (0.32 Gm.), nor a tablespoonful, or 4 fluidrachms (15.0 Cc), over 20 grains (1.29 Gm.), of a solid in solution, unless the substance be very bland, when twice these quantities are permissible. The following is a very simple rule for estimating amounts in Apothecaries' Measure: In an eight-ounce mixture, the dose being a drachm, take as many drachms of the medicine as there are wanted minims or grains to the dose. It will be observed that in this case the basis is an eight-ounce mixture, yet it typifies the rule, which, when thoroughly understood, may easily be applied to a four-ounce or a two-ounce mixture, one-half or one-fourth as many drachms; while if the dose is to be a dessertspoonful, or two drachms, it is only necessary to take one-half as many drachms to an eight-ounce mixture, reducing for smaller mixtures in accordance with the rule. If the dose be a tablespoonful, or four drachms, one-fourth as many drachms must be taken to an eight-ounce mixture as there are minims or grains to the dose. This rule, while not fractionally exact, is sufficiently accurate for all practical purposes. Examples: We desire to give an eight-ounce mixture, with a drachm for a dose, each dose to contain 12 grains of potassium bromide and 10 grains of chloral, the vehicle to be syrup of orange and water. We have here, then, 64 doses of a drachm each : to be exact, therefore, we should have 768 grains of potassium bromide, or 12 drachms and 48 grains; but, following the rule, we put in the mixture 12 drachms, since we desire 12 grains to the dose. Of chloral we would require exactly 640 grains, or 10 drachms and 40 grains, but we use the round number, 10 drachms, in the mixture. We see that in each case there is but the fraction of a grain short in the dose. The prescription would consequently be written as follows: IL Potassii bromidi, 3xij; Chloralis, ox; Syrupi aurantii, Siv; Aquae, q. s. ad sviij. M. et ft. sol. Sig. Teaspoonful for a dose. 796 A TEXT-BOOK OF MA TERIA MEDICA. This is more of each ingredient than should be prescribed in a fluidrachm. It were better, then, that the dose should be a dessert- spoonful, or two drachms; and in order that the two teaspoonfuls should contain only 12 grains of potassium bromide and 10 grains of chloral, the whole amount of the medicament must be divided by 2—/. e. the prescription should read: I$4. Potassii bromidi, 3yj ; Chloralis, 7>x; Syrupi aurantii, 3iv; Aquae, q. s. ad sviij. M. et ft. sol. Sig. A dessertspoonful for a dose. In case the prescription be for a four-ounce mixture, with a dessertspoonful for a dose, the amounts of the solid substances would, of course, be one-half, and if for a tzvo-ounce mixture, one- fourth of the above. When writing a prescription put down first all the ingredients which are to enter into the combination, and after the last one, which is usually the vehicle, write the whole amount; i. e. if it is to be a four-ounce mixture, write after the name of the vehicle " q. s. ad f^iv." Then begin with the Basis, the first ingredient, and write the amount required in the whole mixture. In other words, decide upon the doses to be given after the medicines have been selected. It is important to adopt as a golden rule to carefully and delib- erately read over the entire prescription before it is handed to the patient, and more especially to scrutinize each item and the quanti- ties to guard against transposition of the latter, which otherwise may result in a fatal error. The next thing to be determined is the manner in which the medicine should be measured out to the patient for internal use. A graduated medicine-glass is always preferable to a domestic measure, and should be ordered in all cases.. Teaspoons, as well as dessertspoons and tablespoons, vary considerably, besides, owing to adhesion, may, according to the manner in which they are filled, show a variation of nearly 50 per cent, in their capacity. A teaspoonful, considered to be equivalent to one fluidrachm, may contain from one-half to two fluidrachms; a dessertspoonful, which should be equivalent to two fluidrachms, and a tablespoonful, equal to one-half fluidounce, vary almost as much in capacity. It is necessary to be exact in the administration of medicines, it PRESCRIPTIONS. - o 0 o 0 o - r- O 0 o O 0 0 0 0 0 o O OOi oj to K) >- N- o o o n o o n n R n Oj OOj o o o n a 3 tO o-noj C"> to o Oi Ol oc c^ Oi Oi O-eeeoo.,.. r : e e e e s o orq e e e e e ,- rv n ■'-- iutOj M k) h _m P^^ """■N,ONt0i-ii-iOO Ul OJ m N ff-lz. Oi Ol Oj be b> Oi Oi lnO^Wi*t>J to i-i w K:"'HI_ ki»Hpppppppppooooopp do b^oi iiiiowbbbbbbb'ob'o Oi oj OnOj t0t0-«OOOOO Ol tO Ol Ut/1 tg ^ M H ______________ _ ___ Ol MOj w m « » p p p p 6 p p p p p p p b o o" On vi uiMHobbbbbbbb Oi vi OlOJOJtOOOOOO vi V OJ Oj N lu p\*> ui m « « p p p p p" p p p pop O O ' in ms o\j> ij»bb'obbbbb Oi vi on*. >-i O O O o Oi Lnsi ^oi J> ________________________________________Ot_________ O pNOl OJt0t0«« 00000 0 00000 oi m oj onoj HMNobbbbb Oi to C\Oo OMJ h ^ o o _____________________________________________Or Oi U) 00 pNf* ta M m m p O O O O O O O O O O oi On dj ooj> to !i m b b b b b b Ul OJ 00OJ »—i •—i >—■ oi tj 00 0 vb Oi O O p p WNN-Mobbb Ol Ol OJ to »* i-h VI Ol to po _mp yi > w to m m p p p p p p p p p p .fc. oi oMw bo io onoj MOHobbbb Ul M |J* M M M N ________________________00 Ol Ol OCOl to (0 « _ OUl O OnOi J> to [0 w O O O O O O O O O O oi oj onoj ij ii h b b b b b OltOOl Oo Ol to tO I- »« ________________________________________Ol VI Oj (0 — — ^Ifl MS OiJkW MNOOpppppppp On ' >0 00 ' Ol b\ O0J> lijMMObbbb Ol O CTsOJ to (0 i-i ____________J>___On Ui to « 0 O Oi kO vi CJ\W i^iHi->ppppppppp oi ' vi oi j> u> to b b b b b (jn vi J> OJ tO to ________Ol______Ol OJ 10 M -• C^oj 00 O ^O vi J> oj to ii O O O p O O p O 0 j> bo ' to vi O j> -" b>oi co to O O O O 0 Ol OOl vO J> J> OJ 10 Ol______Ol ^ U 10 M M C oi O to O OOOi J>toi-OOpOOpppp Oi oj Onoi j> to ■-■ O O O 0 Ol Ol Ol J> oj to oi C> J> OJ to""" -> oo ii j> -4> to vp pooi u> -- p O p p O p O p C 10 ' Oi J> Oj oi to VO <7\J> W M N H M O ON to 00\© J> ^O to O Ooj — i-i-iOOOO Jo « b Ol "H Os tO y o o o >:4- o^oioj to to - - _ _ ^ ~ « ^ oi p p oi p oj O p\oo ~~~?ppppp Ol 10 OMJo ON to >- h 00 c? oi oi oj oi oi to « - 80J O ONOl J> 10 M - « « ^ « « oooopospoj p^u> ^^tPPPPP j> tO b>' OJ Ol tO N ~ ~ 798 A TEXT-BOOK OF MATERIA MEDICA. being well known that the action of drugs varies greatly with the size of the dose, small doses in their action being often directly opposite to large doses. Ordinarily, it is unwise to prescribe medicines to be drojiped out, since a drop varies greatly in dimension according to the vis- cosity and specific gravity of the fluid, the shape, size, and charac- ter of the neck and lip of the bottle, as well as its degree of fulness, and the steadiness of the hand in dropping. In computing doses of powerful medicines, therefore, always estimate for minims instead of drops. Direct the use of a " dropper " or minim pipette for the admin- istration of liquids by drop doses, such as Fowler's solution, collyria, etc. There are exactly sixty minims of any fluid to one fluidrachm, while sixty drops may be fewer or more than one drachm, as the following list shows: Drops in f 3j Weight of f 3j. (60 M.). Gr. Gm. Acidum Carbolicum..........m 59 3.82 Acidum Sulphuricum Aromaticum .... 146 53 3.43 /Ether Fortior............176 39 2.52 Chloroformum Purificatum.......250 80 5.18 Creosotum..............122 56^ 3.66 Ext. Belladonnae Fluidum.......156 57 3.69 Ext. Colchici Radicis Fluidum.....160 55 3.56 Ext. Digitalis Fluidum........134 62 4.01 Liq. Iodi Compositus......... 63 59 3.82 Liq. Potassii Arsenitis......... 57 cc 3.56 Oleum Caryophylli..........^o 57 3.69 Oleum Tiglii.............I04 50 3.24 Spiritus Ammoniae Aromaticus.....142 48 3.11 Syrupus Ferri Iodidi......... 65 77 4.98 Syrupus Scillae Compositus.......102 70 4.53 Tinctura Aconiti...........I46 46 2.98 Tinctura Belladonnae.........137 c? ,,, Tinctura Cantharidis.........131 ri ? 11 Tinctura Ferri Chloridi........150 53 3.43 Tinctura Nucis Vomicae........140 44 2.85 Tinctura Opii............I3o $3 ^ ^ Tinctura Veratri Viridis.......I4c 46 2.98 Vinum Colchici Seminis........Hi c4 1 4q Language and Grammatical Construction of Prescriptions. A prescription is written partly in Latin, partly in English. The name of the patient and the date should be in English; the super- scription in Latin abbreviations; the inscription in Latin; the sub- PRESCRIPTIONS. 799 scription in Latin or Latin abbreviations; and the signature, or directions to the patient, in English. A prescription properly and unmistakably written is a cardinal requisite to the successful administration of medicine, no less than to its correct preparation by the druggist. Every practitioner and pharmacist should possess some knowledge of Latin grammar, yet by the observance of a few simple rules one wholly ignorant of the language may acquire a proper use of the forms generally adopted; and a little study, aided by constant practice, will soon fix in the memory the peculiarities of gender, case, and number, together with the agreement of adjectives, to be met with in all prescriptions. It is to be observed that the Latin tongue has been chosen as the medium of medical and pharmaceutical instructions because of its conciseness, stability, and universal acceptance by the scien- tific world. Moreover, the Latin name is specific, while the English name may refer to several drugs of entirely different properties: for instance, " Snake root," applied by residents of this or that locality to Cimicifuga racemosa, Aristolochia serpentaria, Asarum Canadcnse, Eupatorium aromaticum, Polygala Senega, etc. To begin with, then, the prescription-writer must endeavor to lay aside English and familiarize himself with various Latin verbs (most of them in the imperative, or commanding, mood); a long list of drugs and medicines, to be correctly written and pronounced; a limited number of adjectives, agreeing in gender, case, and number with the nouns they qualify; a few prepositions governing certain fixed cases; and a small number of terms and phrases of general importance. Let us consider them seriatim. Verbs. The first item of a prescription is a verb: recipe, " take," the sign being ly,. One need not know the conjugation of the Latin rcclpcre to understand the import of this order. Such imperatives simply signify the instructions of the physician. A very few verbs are used in the subjunctive mood, having the force of the imperative, such as fiat, pi. flant, " let it, or them, be made (into, in pllulas); or " let----be made," as in the ex- pression/W mistura, "let a mixture be made"; sufficiat, " may suffice," as in the common instruction, abbreviated " q. s.," quantum sufficiat, "as much as may be required "; ne repctatur, " do not let it be repeated," or " do not repeat"; bulliat, " let it boil." 8oo A TEXT-BOOK OF MA TERIA MEDICA A future passive participle is also frequently used: dividtndus, like an adjective agreeing with the noun in gender, case, and num- ber, and signifying " to be divided (into)," as in the order in tro- chlscos dividenda (massa), " to be divided into troches," though the imperative divide, " divide into," is often used. Nouns. These form by far the largest vocabulary, including all official and nearly all unofficial drugs and medicines, together with their compounds. A considerable number, ending in a, are of the first declension, all feminine.1 Example : Singular. Nominative. — Oliva — Olive (subject). Genitive. — Ollvae — of Olive. Accusative. — Ollvam — Olive (object). Ablative. — Oliva — with Olive. Plural. Nom. — Ollvae — Olives (subject). Gen. — Olivarum — of Olives. Ace — Olivas — Olives (object). Abl. — Olivis — with Olives. [The Latin dative and vocative cases are never used, and the plural number rarely.] An extensive list of medical agents ends in us (generally masculine) or urn, on (neuter), and are of the second declension. (Piinos, masc, is exceptional.) Example: Singular. Nom. — Oleum — Oil (subject). Gen. — Olei — of Oil. Ace — Oleum — Oil (object). Abl. — Oleo — with Oil. Plural. Nom. — Olea — Oils (subject). Gen. — Oleorum, Oleum — of Oils. Ace — Olea — Oils (object). Abl. — Oleis — with Oils. 1 The genders of nouns are given as a guide to the agreement of adjectives. PRESCRIPTIONS. 8oi It may be noted, in passing, that the genitive singular is almost exclusively used in prescription-writing. We are now prepared to analyze a simple prescription and understand its elements. Referring to the foregoing examples, suppose we wish the drug- gist to supply three drachms of olive oil. We prescribe as follows : fy Olei Ollvae 3iij. Recipe, Take of oil of olives three drachms. It must be borne in mind that the direct object of the imperative recipe in this example, as well as in all similar cases, is not the medicine oleum, but the amount of it prescribed, as indicated by the Roman numerals and the symbol of Apothecaries' weight, which, written in full, would be trcs drachmas (ace). In this class of prescriptions, therefore, including nearly all in use, we need con- sider only the genitive, the accusative or grammatical object of the verb being expressed in the quantity symbolically indicated. It will be noted, moreover, that the construction, or order, of the Latin words is the reverse of English usage. Yet it is evi- dent that a grocer's clerk, for instance, might well, and frequently does, employ the same mode of expression: (of) Granulated Sugar lbs 10— a construction precisely analogous to that of the above prescrip- tion, which simple form may be taken as a type for all, subject to such modifications as the nature of the drug and the treatment may require. Nouns of the second declension ending in on, all neuter, are of Greek derivation, and are declined like oleum. Example: Singular. Nom. — Toxicodendron. Gen. — Toxicodendri. Ace — Toxicodendron. Abl. — Toxicodendro, etc. Prlnos, also of Greek origin, is declined: Nom. — Prlnos. Gen. — Prini. Ace — Prlnon. Abl. — Prlno, etc. 51 802 A TEXT-BOOK OF MA TERIA MEDICA. The remaining nouns of the second declension all end in us (with four exceptions, masculine), and are declined like the follow- ing example: Nom. — Juniperus. Gen. — Juniperi. Ace — Junlperum. Abl. — Junipero, etc. 3d fern. 4th fern. 4th masc. Indeed, all prescription nouns ending in us are of the second declension, save seven: Nom. Gen. Rhus, Rhois, Cornus, Cornus, Quercus, Quercus, Fructus, Fructus, Haustus, Haustus, Potus, Potus, Spiritus, Spiritus, The four exceptions to the masculine gender mentioned are: Juniperus, ^ Prunus, ,, r _' > all lem. Sambucus, I Ulmus, J With these—to be committed to memory—the second declen- sion ends, so far as it concerns the prescription-writer. While touching upon the fourth declension it may be well to complete the study of it, there being but six nouns, ending in us, of this declension (Rhus is of the third). They are, as already enumerated: Cornus, Quercus, Fructus, Haustus, Potus, Spiritus, and are thus declined Singular. Nom. — Spiritus. Gen. — Spiritus. Ace — Spiritum. Abl. — Spiritu. PRESCRIPTIONS. 803 Plural. Nom. — Spiritus. Gen. — Splritum. Ace — Spiritus. Abl. — Spiritibus. We now come to the third declension, to which belong all nouns not included in the foregoing first, second, and fourth, the fifth Latin declension, like the dative and vocative cases, not being used in prescriptions. All nouns, with seventeen exceptions, having terminations other than a (except four), us, um, and on, are of the third declension. Here the changes from nominative to genitive and other cases are quite variable, and may be best remembered by arranging the nouns in groups according to their nominative endings, with ex- amples of their several declensions. Group I.—Thirty-three nouns ending in as make the genitive in atis. All are masculine save Asclepias (Gen. Asclepiadis), which is feminine, and all are names of salts. Example: Singular. Nom. — Nitras. Gen. — Nitratis. Ace — Nitratem. Abl. — Nitrate, etc Group II.— Nouns ending in is: (a) Genitive unchanged ; all feminine. Ex. Nom. Cannabis; Gen. Cannabis. (b) Genitive changing into itis, all masculine. Ex. Nom. Arsenis ; Gen. Arsenitis. (c) Genitive changing into idis, all feminine. Ex. Nom. Hamamelis; Gen. Hamamelidis. (d) Genitive changing into oris, one only, masculine. Ex. Nom. Pulvis ; Gen. Pulveris. Group III.— Nouns ending in o, all feminine except Carbo, Pepo, and Sapo, which are masculine: (a) Genitive ending in onis. Ex. Nom. Lotio; Gen. Lotionis. (b) Genitive ending in litis. Ex. Nom. Mucilago; Gen. Muciiaginis. 804 A TEXT-BOOK OF MA TERIA MEDICA. Group IV.— Nouns ending in x, masculine or feminine : (a) Genitive ending in els. Ex. Nom. Borax; Gen. Boracis. (b) Genitive ending in els, and the last vowel of the nomina- tive (e) changed to /. Ex. Nom. Ruma; Gen. Rum/cis. Group V.— Nouns ending in r, masculine or neuter : Genitive simply adds Is. Ex. Nom. Liquor; Gen. Liquoris. Group VI.— Nouns ending in a, all neuter: Genitive ends in atis. Ex. Nom. Enema; Gen. Enematis. Group VII.— Nouns ending in s, masculine or feminine: Genitive ends in is. Ex. Nom. Adeps ; Gen. Adipis. Group VIII.— Nouns ending in /, all neuter : (a) Genitive simply adds is. Ex. Nom. Chloral; Gen. Chloralis. (b) Genitive doubles / and adds is. Ex. Nom. Mel; Gen. Mellis. Group IX.— Nouns ending in u, all neuter: (a) Genitive ending in onis (nominative in dn). Ex. Nom. Limon ; Gen. Limonis. (b) Genitive ending in luis (nominative in en). Ex. Nom. Semen ; Gen. Seminis. [Erigeron has the genitive Erigerontis.] Group X.— One noun ending in c, neuter: Genitive simply adds is. Ex. Nom. Lac; Gen. Lactis. In conclusion, there are a number of indeclinable nouns, such being all neuter, of various endings and derivations. PRESCRIPTIONS. 805 Adjectives. These are many, and, as has been said, their agreement in gender, case, and number with the nouns they qualify is of para- mount importance in correct prescription-writing. They are de- clined like nouns of different declensions, having the same cases and numbers, and may be divided into two classes. Class I. includes all but fourteen of the adjectives used in pre- scriptions. The nominative has three distinct endings : us, mascu- line, declined like the second declension of nouns; a, feminine, declined like the first declension; and um, neuter, declined like the second declension. Example: Singular. (2d decl.) (istdecl.) (added.) Masc. Fern. Neut. Nom. Fluidus, Fluida, Fluidum. Gen. Fluidi, Fluidae, Fluidi. Ace Fluidum, Fluidam,' Fluidum. Abl. Fluido, Fluida, Fluido. Plural. Nom. Fluidi, Fluidae, Fluida. Gen. Fluidorum, Fluidarum, Fluidorum. Ace Fluidos, Fluidas, Fluida. Abl. Fluidis, Fluidis, Fluidis. Class II. includes the remaining fourteen adjectives in use. These, with few exceptions, have two, instead of three endings: one in is for both masculine and feminine genders, and another in e for the neuter. Adjectives of this class are declined like nouns of the third declension. Example : Singular. Masc. and Fern. Kent. Nom. Dulcis, Dulce. Gen. Dulcis, Dulcis, Ace Dulcem, Dulce. Abl. Dfilci, Dulci. (The form Dulce is sometimes wrongly used for the ablative.) 806 A TEXT-BOOK OF MATERIA MEDICA. Plural. Nom. Dukes, Dulcia. Gen. Diilcium, Dulcium. Ace Dulces, Diilcia. Abl. Dulcibus, Dulcibus, The exceptions in nominative endings are- Singular. Masc. and Fern. (i) Nom. Effervescens, Gen. Ace Abl. Xeut. Effervescens. Effervescentis, Effervescentis. Effervescentem, Effervescens. Effervescente, or -i, Effervescente, or i. Plural. Nom. Effervescentes, EffervescCntia. Gen. Effervescentium, Effervescentium. Ace Effervescentes, Effervescentia. Abl. Effervescentibus, Effervescentibus. Singular. (2) Nom. Tricolor, Gen. Tricoloris, Ace Tricolorem, Abl. Tricolore, or -i, Tricolor. Tricoloris. Tricolor. Tricolore, or -i. Plural. Nom. Tricolores, Gen. Tricolorum, Ace Tricolores, Abl. Tricoloribus, Tricolora. Tricolorum. Tricolora. Tricoloribus. Singular. Masc. and Fern. Xeut. (3) Nom. Fortior, Fortius. Gen. Fortioris, Fortioris. Ace Fortiorem, Fortius. Abl. Fortiore, or -i, Fortiore, or -i. PRESCRIPTIONS. Plural. Nom . Fortiores, Fortiora. Gen. Fortiorum, Forti orum. Ace Fortiores, Fortiora. Abl. Fortioribus, Fortioribus. Numerals as far ruinations: as quatuor are declined like adjectives of three Singular. Masc. Fern. Xeut. (i) Nom. Unus, Una, Unum. Gen. Unlus, Unlus, Unlus. Ace Unum, Unam, Unum. Abl. Uno, Una, Plural. Uno. (2) Nom. Duo, Duae, Duo. Gen. Duorum , Duarum, Duorum. Ace Duos, Duas, Duo. Abl. Duobus, Duabus, Plural. Duobus. Masc. Ft m. Xeut. (3) Nom. Tres, Tres, Tria. Gen. Trlum, Trlum, Trlum. Ace Tres, Tres, Tria. Abl. Tribus, Tribus, Tribus. [The ordinal numbers, primus, secundus, tertius, etc., are not used in prescription-writing.] Conjunctions—Adverbs. Conjunctions are rare, except et, and. Adverbs are very seldom employed. Prepositions. Three prepositions govern the accusative case: ad, to, up to; in, into; and supra, upon. Others are rarely used. Two prepositions, oftenest used, govern the ablative case: cum, with, and pro, for. 808 A TEXT-BOOX OF MATERIA MEDICA. Words and Phrases. [In the following list accepted usage rather than rigid adherence to Latin quantity has in a few instances appeared advisable. One would hardly insist upon semel, tere, bene, (semmei, terry, benny) in place of the customary long vowel sounds, though the former are obviously in accordance with Latin prosody.] Ad libitum, at pleasure. Ad saturaudum, to saturation. Ana, aa, of each. Bene, well, Bis, twice. Bis indies, twice a day. Clbus, food. Cochleare medium, a dessertspoon(ful). Cochleare magnum, a tablespoon(ful). Cochleare parvum, a teaspoon(ful). Collutorium, a mouth-wash. Dcin, afterward. Dimidius, half. Dosus, a dose. Et, and. Extcude supra, spread upon. Gradatim, gradually. Gutta, a drop. Guttatim, drop by drop. Hora, an hour. In dies, daily. Lagena, a bottle. Libra, a pound. Llnteum, lint. Mane, in the morning. Mane primo, early in the morning. Mica panis, a breadcrumb. Non, not. Node, at night. Numerus, a number. Numero, in number. Octarius, a pint. Partes ozquales, in equal parts. Pro re natd, as required. Quantum sufficiat, q. s., as much as is necessary. Quaqua hora, every hour. Saturatus, saturated. PRESCRIPTIONS 809 Sccitula, a box. Scmel, once. Semissis, ss., a half. Scmuirachma, half a drachm. Slmul, together. Sine, without. Statim, immediately. Tales, such. Tales doses, such doses. Tore slmul, rub together. Tcr in die, three times a day. These complete the list of Latin parts of speech, conjugations, declensions, etc., with which the prescription-writer is likely to be concerned. There are niceties of Latin construction which, to one acquainted with that idiom, will readily occur in scanning the order of words in certain medicinal compounds. Having the sanction of professional usage, the departure from the classic arrangement is of slight importance, and it is certainly in accordance with the clearer, more direct English form. Instance the construction in what are known as " Galenical Preparations " (an objectionable adjective, by the way, being at variance with the rules of etymology, since the c of the derivative is wanting in the parent word Galen). In writing these the nominative—Unguentum, Mistura, Tinctura, etc.—is placed first, as, Unguentum Zinci Oxidi, etc. Oleum Morrhuae is also an example, and others are not uncommon, apart from the Galenical order. The practical difficulties in writing prescriptions correctly are largely eliminated by the almost exclusive use of the genitive. Vet it is necessary to understand clearly the use of the accusative in all cases where the medicine is prepared from the mass according to certain established formulae, and moulded in certain forms, if not already prepared, as in the condition of pills, troches, etc., which are the immediate object of the imperative recipe, and cannot be placed in the genitive. Example: R. Pllulas (not Pilularum) Ferri Iodidi (a number). \\ nere the mass is mentioned or implied in the prescription, the general rule of the genitive is followed, as: R. Unguenti Bella- 810 A TEXT-BOOK OF MATERIA MEDICA. donna? (a portion); and where the terms fiat, fiant are expressed, the nominative is naturally used, as, for example, R. Massae hydrargyri, gr xxx ; Fiant pilulae No. x. Sig. Take one at bed-time. Were pllula \s the subject of the Latin irregular verb signifying "to be made," no case save the nominative being admissible. It has been presumed in the foregoing pages that all prescrip- tions are to be written in full—a practice which, could it meet with universal acceptance, would not infrequently be of vital importance alike to patient and practitioner. Custom, however—and in certain cases advantageously—has authorized the extensive use oi abbrevia- tions, although the dangers of carelessness or ignorance in their employment will be apparent if we consider that, for example, Ammon. may mean either Ammonia or Ammoniacum; Odor., Chlorum, Chloral, Chloroformum, Chloras, or Chloridum ; Hyd. Chlor., Hydrate of Chloral or Hydrargyri Chloridum Corrosivum or Mite; Sulph., Sulphur, Sulphas, Sulphidum, or Sulphis; Zinc. Phos., Zinci Phosphas or Zinci Phosphidum. These are but few of the many instances of ambiguity occa- sioned by inadvertence or want of familiarity with the full Latin form, or at least its recognized and unmistakable abbreviation. In conclusion, let the writer of prescriptions be warned against too great haste and a chirography which none but its author can decipher—a deficiency for which he alone is responsible, though the onus may fall upon the luckless druggist or his bewildered clerk. With regard to form, it has been our object to show that there is really little difficulty in writing good prescription Latin, and where the slightest chance of error exists the ampler expression, as we have strongly urged, should be used. A clear, business-like method, deliberately chosen and consistently pursued, will render this important item of the physician's labor simple, agreeable, and efficient. It is necessary not only that the directions to the patient should be written in perfectly legible English and in full, but that they should contain the exact dose, time for, and method of taking, and, in short, every detail which it may be advisable for the patient and nurse to know, clearly and intelligibly expressed. A physician is PRE SCR IP TIONS. 811 seldom justified in writing merely " As directed," the full directions being the only clue to the safety of the medicine. Moreover, verbal instructions to the patient or attendant may be partially or even wholly forgotten, or confounded with directions relating to other matters connected with the case, and thus the welfare of the patient be endangered. All preparations intended for external or local application or for injections should be marked accordingly, " For External Use," etc.; and if the agent be a poisonous mixture, a " Not-to-be-taken " label should be attached to the bottle. If a mixture is ordered contain- ing an insoluble substance, a " Shake-well " label should be used. Should it be necessary to prescribe an extraordinary dose of some powerful drug, the name of the remedy should be under- scored or attention called to it by a x, referring to the bottom of the prescription, where should be written : " Large dose intended," or " Dose of above correct," or something to indicate to the phar- macist that the writer is fully aware of the unusual amount, and thus save delay in consulting with the physician—which a careful and competent druggist would otherwise do. Should it, in the opinion of the physician, be undesirable to repeat the prescription, he should write at the bottom, " Do not repeat," or the customary Latin, " Ne repetatur." Every prescriber should be supplied with suitable prescription- blanks arranged in the form of pads conveniently carried in the pocket, a suitable size being four by five inches. The paper should be of linen, of good quality; otherwise it is liable to become detached from the druggist's files and lost. It is certainly advisable for the physician to write his prescrip- tions invariably in ink, since pencil is easily erased, and a pre- scription thus perishable would be of little use in medico-legal emergencies. Besides, an unscrupulous druggist who had been careless in compounding the remedy might easily change the pencil instructions to conform to his mistake. Finally, the pencil-writing is always liable to be erased or partially obliterated when carried for some time or subjected to frequent handling. The prescription-blank should have printed neatly upon one margin or the back the physician's residence and office, together withhours for consultation, and telephone number if he has one. This advertises the physician to some extent in a legitimate way, besides enabling the patient or druggist to communicate with him readily if necessary. 8l2 A TENT-BOOR' OF MATERIA MEDICA It is a matter of personal taste whether the druggist's name should appear upon the blank. Considerations of courtesy and the possible event of loss or of legal contingencies may weigh with some practitioners, though others are of the opinion that it is un- desirable to print anything on the blank save the physician's name, office, hours, and telephone number. The prescription should always be signed by the writer in full, that professional responsibility and identity may be assured, the academic " M. D." being preferable as a title to " Dr.," which is applicable to various professions—often of questionable repute and authenticity. In concluding these practical hints, the author cannot too strongly impress upon the student the importance of always writing as clear, legible, complete, and classical a prescription as possible. In a new community the reputation of the recent graduate is often dependent upon the character of the prescription he writes. The druggist invariably scans his instructions from the new doctor criti- cally, and the laity and the profession will soon learn the young aspirant's proficiency or ignorance by his public committal in a pre- scription. No matter how able a diagnostician, pathologist, or bac- teriologist he may be, if his first effort in prescription-zvriting be illegible, poor Latin or for a hopelessly incompatible mixture, the druggist will label, classify, and measure him with the keenness of professional insight; the judgment will go forth quietly ; and years of successful practice may not serve to eradicate that first unfavor- able impression. CLINICAL INDEX. Abrasions— Isinglass, 783 Potassium nitrate, 592 Protectives, 774 Abscess— Calcium phosphate, 208 Cocaine, 498 Cod liver oil, 138 Naphthalin, 324 Onion poultice, 622 1'hvtolacca, 587 Solution of ammonium acetate, 599 Acidity of Stomach— Alkalies, 164 Ammonium preparations, 577 Acne— Kowler's solution, 243 Hydrastine ointment, 487 Ichthyol, 328 Phosphorus, 205 Pyrogallic acid, 715 Quinine, 218 Salicylic acid, 318 Sulphur, 672 Acne Rosacea— Bismuth subnitrate, 753 Ergot, 483 Hamamelis, 722 Ichthyol, 328 Resorcin, 326 Aconite-poisoning— Atropine, 462 Digitalis, 547 Adenitis— Camphorated naphtol, 324 Naphtalin, 324 Pilocarpine, 597 Potassium iodide, 254 After-pains— Black haw, 520 Camphor, 389 Albuminuria— Arsenic, 245 Alcoholic Tremor— Cocaine, 499 Alcoholism— Aromatic spirit of ammonia, 577 Cocaine, 499 Coffee, 560 Solution of ammonium acetate, 599 Strychnine. 475 Alcoholism— Tincture of lupulin, 447 Zinc oxide, 737 Alopecia — Aqua ammoniae, 577 Capsicum, 367 Nutgall ointment, 716 Pilocarpine, 597 Quinine, 217 Savine, 706 Tannic acid, 714 Tincture of cantharides, 767 Turpentine, 645 Amaurosis— Strychnine, 474 Amblyopia— Pilocarpine, 597 Amenorrhea— Aloes, 676 Ammonium chloride, 619 Apioline, 709 Ergot, 482 Guaiac, 262 Iron, 198 Quinine, 218 Sanguinaria, 268 Savine, 706 Senega, 628 Tansy, 708 Tincture of cantharides, 767 Anal Fissure— Belladonna ointment, 461 Bismuth subnitrate, 753 Chloral, 419 Cocaine, 498 Fluid extract of hydrastis, 487 Geranium, 723 Glycerin, 776 Iodoform, ^jj Krameria, 720 Red rose, 725 Sulphur, 673 Tannic acid, 713 Tincture of iodine, 254 White oak, 717 Zinc oxide, 737 Anemia— Arsenic, 244 Bone marrow, 221 Cod liver oil, 137 Copper, 741 813 8i4 CLINICAL INDEX Anemia— Digitalis, 545 Hypophosphites, 20S Iron, 197 Manganese, 200 Nuclein, 221 Phosphoric acid, 145 Potassium chlorate, 353 Potassium permanganate, 349 Red wine, 573 Strychnine, 473 Aneurysm— Digitalis, 547 Diuretin, 655 Ergot, 482 Iodides, 254 Lead acetate, 733 Angina Pectoris— Allyl tribromide, 622 Amyl nitrite, 527 Arsenic, 245 Cactus, 554 Chloral, 420 Compound spirit of ether, 402 Hydrogen dioxide, 354 Phosphorus, 205 Zinc sulphate, 738 Anginose Scarlatina— Sodium sulphocarbolate, 310 Anorexa— Simple bitters, 180 Anosmia— Strychnine, 472 Anthrax— Serum-therapy, 302 Aortic Regurgitation— Adonidin, 555 Cactus, 554 Digitalis, 543 Apepsia— Pepsin, 132 Aphonia— Alum, 750 Blisters, 763 Bromides, 535 Nitric acid, 145 Potassium bichromate, 351 Aphthae— Borax, 347 Catechu, 718 Magnesia, 166 Red rose, 725 Rhus glabra, 724 Saccharine, 658 Sodium bicarbonate, 164 Sodium sulphocarbolate, 310 Apoplexy— Croton oil, 686 Arrhythmia— Cactus, 554 Nitroglycerin, 528 Arsenical Poisoning— Hydrated sesquioxide of iron, 242 Lime water, 166 Arsenical Poisoning— Magnesia, 240 Arterio-sclerosis — Diuretin, 655 Nitroglycerin, 52S Arthritis, Chronic — Cod liver oil, 137 Ascarides— Carbolic acid, 309 Ascites— Colchicum, 259 Colocynth, 692 Copaiba, 650 Diuretin, 654 Elaterin, 687 Aspergillus— Salicylic acid, 318 Asphyxia— Alcohol, 572 Mustard, 770 Asthenopia— Physostigmine, 514 Asthma— Adonidin, 555 Allyl tribromide, 622 Amyl nitrite, 528 Arsenic, 243 Belladonna, 461 Bromides, 535 Caffeine, 560 Chloral, 420 Cocaine, 499 Colchicum, 259 Conium, 503 Grindelia, 509 Hydrogen dioxide, 354 Hyoscyamus, 464 Iodides, 255 Ipecac, 614 Lobelia, 616 Nitre-paper, 593 Opium, 440 Physostigma, 515 Pilocarpine, 597 Quinine, 217 Spartein sulphate, 513 Stramonium, 463 Strychnine, 474 Terpin hydrate, 630 Zinc oxide, 737 Zinc sulphate, 738 Atheroma— Cod liver oil, 138 Aural Catarrh— Ammonium chloride, 619 Belanitis— Alumnol, 324 Silver nitrate, 546 Bed-sores— Alcohol, 571 Emollients, 774 Glycerin, 776 Lead tannate, 734 CLINICAL INDEX. 815 Bed-sores— Protectives, 774 Silver nitrate, 745 Tannic acid, 713 Belladonna-poisoning__ Pilocarpine, 598 Biliary Calculi— Sodium phosphate, 690 Turpentine, 646 Biliousness— Calomel, 234 Citric acid, 151 Seidhtz powder, 690 Senna, 684 Bites of Insects— Ammonia water, 577 Olive oil, 77S Rhus toxicodendron, 490 Bites of Rabid Animals- Carbolic acid, 308 Solution of chloride of antimony, 758 Sulphuric acid, 144 Bites of Venomous Reptiles- Solution of chloride of antimony, 758 Bladder, Chronic Catarrh of__ Tincture of cantharides, 767 Bladder, Debility of— Fluid extract of blackberry, 726 Tincture of cantharides, 767 Bladder, Paralysis of— Arnica, 591 Bladder, Spasm of— Cannabis, 452 Blepharitis Marginalis— Yellow-oxideof-mercury ointment, 233 Blepharospasm— Conium, 503 Boils- Belladonna ointment, 460 Cantharidal blister, 766 Olycerin, 776 Menthol, 377 Silver nitrate, 745 Tar, 626 Brain, Congestion of— Elaterin, 6S7 Bright's Disease— Alkalies, 165 Cod liver oil, 138 Digitalis, 547 Gallic acid, 715 Iron, 197 Pilocarpine, 597 Scoparius, 553 Spirit of nitrous ether, 600 Strophanthus, 551 Bromidrosis— Chloral, 419 Hydrastine ointment, 487 Potassium permanganate, 349 Bronchitis— Acetanilid, 393 Alum, 750 Ammoniacum, 389 Bronchitis— Ammonium carbonate, 578 Ammonium chloride, 619 Ammonium preparations, 166 Apomorphine, 606 Arsenic, 243 Asafetida, 389 Balsam of tolu, 621 Benzoic acid, 337 Buchu, 640 Burgundy-pitch plaster, 772 Calomel, 235 Cannabis, 452 Catechu, 718 Codeine, 445 Cod liver oil, 137 Colchicum, 259 Copaiba, 650 Creosote, 311 Croton oil, 685 Demulcents, 774 Digitalis, 546 Eucalyptus, 345 Grindelia, 509 Hamamelis, 722 Hedeoma, 710 Hydrastis, 487 Hyposulphites, 357 Iodides, 255 Iron, 197 Lime water, 166 Liquorice, 623 Lobelia, 616 Myrrh, 339 Nitric acid, 145 Onion poultice, 622 Opium, 440 Physostigma, 515 Sanguinaria, 268 Senega, 628 Squill, 638 Strychnine, 474 Sulphur, 673 Syrup of garlic, 622 Tar, 626 Tartar emetic, 610 Terebene, 629 Terpin hydrate, 630 Turpentine, 646 Wild cherry, 180 Wine of ipecac, 612 Bronchorrhea— Alum, 750 Asafetida, 389 Carbolic acid, 308 Copaiba, 650 Eucalyptus, 345 Gallic acid, 715 Lead acetate, 733 Myrrh, 339 Pilocarpine, 597 Senega, 628 Terebene, 629 Turpentine, 040 8i6 CLINICAL INDEX. Bronchorrhea— Zinc oxide, 737 Bruises— Ammonium chloride, 619 Arnica, 591 Camphor liniment, 388 Hamamelis, 722 Olive oil, 778 Potassium nitrate, 592 Solution of lead subacetate, 733 Tansy, 708 Buboes- Ammonium chloride, 619 Hydrogen dioxide, 354 Iodoform, 332 Phytolacca, 587 Salol, 321 Tincture of iodine, 253 Buccal Ulcer— Geranium, 723 Red rose, 725 Burns— Acacia, 780 Bismuth subgallate, 754 Bismuth subnitrate, 753 Carbolic acid, 308 Cocaine ointment, 498 Hamamelis, 722 Lead carbonate, 734 Lime water, 164 Linseed oil, 779 Menthol, 377 Nutgall ointment, 716 Ointment of rose, 725 Olive oil, 778 Phytolacca, 587 Protectives, 774 Rhus toxicodendron, 490 Salol, 321 Sodium bicarbonate, 163 Terebene, 629 Zinc oxide, 737 Calculi- Ammonium benzoate, 338 Callositas— Salicylic acid, 317 Cancer— Arsenic, 242 Bromine, 762 Calendula, 180 Carbolic acid, 308 Conium, 502 Hydrastine ointment, 487 Nitrate of sanguinarine, 267 Podophyllum, 695 Spermine, 219 Sulphuric acid, 144 Zinc chloride, 762 Zinc sulphate, 738 Cancer of Cervix— Nitric acid, 144 Cancer of Stomach— Arsenic, 245 Cancer of Stomach— Pepsin, 132 Cancer of Tongue— Potassium permanganate, 349 Cancer of Uterus— Arsenic, 245 Chloral, 418 Pepsin, 132 Potassium permanganate, 349 Tannic acid, 713 Cancer of Vagina— Potassium permanganate, 349 Cancrum Oris— Bismuth subnitrate, 753 Zinc sulphate, 737 Capillary Bronchitis— Alcohol, 572 Ammonium iodide, 255 Serpentaria, 181 Turpentine, 646 Carbuncle— Belladonna ointment, 460 Cantharidal blister, 766 Ergot, 482 Glycerin, 776 Hamamelis, 722 Serum-therapy, 302 Cardiac Depression— Caffeine, 560 Cardiac Irritability— Bromides, 535 Cardiac Pain— Belladonna, 462 Caries of the Temporal Bone- Turpentine, 645 Catarrh— Benzoic acid, 337 Borax, 347 Boric acid, 347 Dobell's solution, 164 Eucalyptus, 343 Hydrastis, 487 Potassium permanganate, 349 Sodium sulphocarbolate, 310 Catarrh of Stomach — Capsicum, 367 Cellulitis— Digitalis, 546 Cerebral Anemia— Phosphorus, 205 Cerebral Hemorrhage— Phosphorus, 205 Cerebral Hyperemia— Belladonna, 462 Colchicum, 259 Ergot, 483 Cerebro-spinal Meningitis— Aconite, 582 Alcohol, 572 Blisters, 763 Ergot, 483 Gelsemium, 507 Cerumen, Impacted — Glycerin, 776 CLINICAL INDEX. Cerumen, Impacted— Liquor potassa-, 163 Papain, 134 Cervix, Erosion of— Glycerin, 776 Chafing of the Skin— Lycopodium, 783 Chancre— Acetanilid, 392 Alumnol, 324 Bismuth benzoate, 337 Bismuth subnitrate, 753 Fluid extract of hydrastis, 487 Iodoform, 332 Solution of chloride of antimony, 758 Sulphuric acid, 144 Chancroid— Acetanilid, 392 Bismuth benzoate, 337 Carbolic acid, 308 Fluid extract of hydrastis, 487 Iodoform, 332 Potassium bichromate, 351 Salicylic acid, 317 Silver nitrate, 745 Chapping— Bismuth subnitrate, 753 Camphor ice, 388 Compound tincture of benzoin, 337 Glycerin, 776 Ointment of rose, 725 Tragacanth, 782 Chilblain- Aconite, 581 Alum, 750 Ammonia liniment, 577 Camphor liniment, 388 Capsicum, 367 Carbolic acid, 308 Nutgall ointment, 716 Rhus toxicodendron, 490 Chills— Strophanthus, 551 Chloasma— Nitric acid, 144 Tincture of iodine, 254 Chloroform-poisoning— Ammonia, 577 Amyl nitrite, 528 Atropine, 402 Strychnine, 475 Chlorosis— Aloes, 676 Arsenic, 245 Hypophosphites, 208 Iron, 197 Manganese, 200 Potassium chlorate, 353 Red wine, 573 Strychnine, 473 Cholera— Bismuth subnitrate, 754 Calomel and opium, 235 Camphor, 389 52 Cholera— Chloral, 420 Opium, 440 Salicylic acid, 319 Salol, 321 Serum-therapy, 297 Sulphur, 673 Sulphuric acid, 146 Cholera Infantum— Bismuth subnitrate, 754 Lead acetate, 733 Cholera Morbus— Chloral, 420 Opium, 440 Salol, 321 Chordee— Camphor, 388 Cannabis, 452 Colchicum, 259 Hop poultice, 447 Monobromated camphor, 389 Chorea— Acetanilid, 393 Arsenic, 244 Asafetida, 389 Cerium oxalate, 755 Chloral, 419 Cocaine, 499 Conium, 503 Copper sulphate, 741 Curare, 517 Exalgine, 397 Gelsemium, 506 Hyoscine, 466 Iron, 107 Opium, 440 Physostigma, 515 Picrotoxin, 477 Quinine, 217 Salicylic acid, 318 Silver nitrate, 746 Spermine, 219 Strychnine, 474 Zinc oxide, 737 Zinc sulphate, 738 Cinchonism— Diluted hydrobromic acid, 536 Cirrhosis of Kidneys— Potassium iodide, 255 Cirrhosis of Liver— Calomel, 234 Iodoform, j;^3 Potassium iodide, 255 Colchicum-poisoning— Potassium permanganate, 350 Colds- Aconite, 581 Citric acid, 151 Fluid extract of pilocarpus, 598 Mustard bath, 770 Colic- Belladonna, 462 Chloral, 419 Ginger, 374 8i8 CLINICAL INDEX. Colic— Hedeoma, 710 Hyoscyamus, 466 Tansy, 708 Collapse— Alcohol, 572 Digitalis, 545 Coma— Mustard, 770 Comedo — Salicylic acid, 318 Sulphur, 672 Condylomata— Chromic acid, 758 Copper sulphate, 740 Resorcin, 326 Solution of chloride of antimony, 758 Congestion of Lungs— Ergot, 4S3 Congestive Chill- Opium, 440 Conjunctivitis— Alum, 750 Bismuth subnitrate, 753 Boric acid, 347 Copper sulphate, 740 Gallicine, 715 Hydrastine hydrochlorate, 487 Morphine sulphate, 440 Nitrate of sanguinarine, 267 Silver nitrate, 745 Zinc acetate, 737 Zinc sulphate, 737 Constipation— Aloes, 676 Arsenic, 245 Asafetida, 388 Belladonna, 461 Cascara sagrada, 669 Cassia fistula, 666 Castor oil, 668 Colocynth, 692 Euonymus, 680 Glycerin, 777 Hydrastine, 487 Jalap, 693 Magnesia, 670 Magnesium carbonate, 670 Manna, 671 Oxgall, 677 Physostigma, 515 Podophyllum, 695 Rhubarb, 679 Senna, 684 Sodium salts, 690 Strychnine, 473 Sulphur, 673 Taraxacum, 674 Contusions— Alcohol, 571 Calendula, 180 Solution of ammonium acetate, 599 Convalescence— Alcohol, 571 Convalescence— ( od liver oil, 13S Simple bitters, 180 Wine of coca, 499 Convulsions— Chloral, 419 Corneal Ulcer— Physostigmine, 514 Corns- Acetic acid, 150 Arsenic, 242 Glacial acetic acid, 761 Potassium bichromate, 351 Salicylic acid, 317 Corrosive Poisoning— Olive oil, 778 Coryza— Ammonium chloride, 619 Antipyrine, 394 Arsenic, 245 Camphor, 388 Camphoric acid, 389 Cocaine, 498 Dover's powder, 441 Gelsemium, 507 Glycerin, 776 Iodine, vapor of, 254 Oil of Scotch fir, 624 Salicylic acid, 318 Solution of ammonium acetate, 599 Whiskey, 573 Cough— Apomorphine, 606 Benzoic acid, 337 Bromides, 534 Cannabis, 452 Cerium oxalate, 755 Coniine, 503 Cubeb, 653 Geranium, 723 Grindelia, 509 Hydrocyanic acid, 524 Ipecac, 612 Lactucarium, 448 Linseed tea, 779 Liquorice, 623 Spirit of nitrous ether, 600 Strychnine, 474 Sumbul, 519 Terebene, 629 Turpentine, 646 Cracked Nipples— Bismuth subnitrate, 753 Brandy, 571 Chloral, 419 Compound tincture of benzoin, 337 White oak, 717 Cretinism— Thyroid extract, 220 Croup— Alum, 750 Ipecac, 613 Lactic acid, 148 Papain, 134 CLINICAL INDEX. Croup— Pepsin, 132 Senega, 628 Silver nitrate, 745 Tartar emetic, 610 Zinc sulphate, 738 Crusts, Removal of— Olive oil, 778 Cuts — Isinglass, 783 Cystitis— Antipyrine, 394 Belladonna, 462 Benzoic acid, 337 Boric acid, 347 Buchu, 640 Camphoric acid, 389 Copaiba, 650 I (emulcents, 774 Elm, 781 Gallic acid, 715 Hamamelis, 722 Hydrogen dioxide, 354 Hyoscyamus, 466 Lactic acid, 148 Myrrh, 339 Piperazin, 657 Quinine, 217 Resorcin, 326 Saccharin, 658 Salol, 321 Turpentine, 646 Deafness— Iodine, vapor of, 254 Deglutition, Painful— Olive oil, 77S Delirium of Fevers— Diluted hydrobromic acid, 536 Delirium Tremens— Arnica, 591 Aromatic spirit of ammonia, 577 Bromides, 535 Bromoform, 536 Camphor, 389 Chamomile, 180 Digitalis, 546 Hyoscine, 466 Strychnine, 474 Tincture of lupulin, 447 Zinc oxide, 737 Dementia— Eucalyptus, 343 Hyoscine, 466 Dermatitis— Ichthyol, 328 Magnesium carbonate, 164 White oak, 717 Diabetes Insipidus— Ergot, 483 Gallic acid, 715 Lime water, 166 Pilocarpine, 598 Tincture of cantharides, 767 Diabetes Insipidus— Valerian, 390 Diabetes Mellitus— Alum, 750 Ammonium bromide, 535 Antipyrine, 394 Arsenic, 245 Cod liver oil, 138 Extract of pancreas, 222 Glycerin, 777 Guaiacol, 314 Hydrogen dioxide, 354 Iodoform, ~x>33 Iron, 198 Lactic acid, 148 Phosphoric acid, 146 Piperazin, 657 Saccharin, 658 Strychnine, 475 Thymol, 379 Valerian, 390 Diarrhea— Alum, 750 Arnica, 591 Arsenic, 244 Bismuth phosphate, 754 Bismuth subgallate, 754 Bismuth subnitrate, 754 Bismuth tannate, 754 Borax, 348 Boric acid, 348 Brandy, 572 Bromides, 534 Caffeine, 560 Camphor, 389 Catechu, 718 Cerium oxalate, 755 Chalk mixture, 166 Colchicum, 259 Copaiba, 650 Copper sulphate, 741 Demulcents, 774 Digitalis, 546 Elm, 781 Ergot, 483 Erythrophleum, 639 Eucalyptus, 343 Fluid extract of blackberry, 726 Gallic acid, 715 Ginger, 374 Hamamelis, 722 Hematoxylon, 721 Hope's camphor mixture, 145 Hydronaphtol, 324 Infusion of nutgall, 716 Ipecac, 613 Iron, 198 Kino, 719 Krameria, 720 Lactic acid, 148 Lead acetate, 733 Lime water, 166 Pepsin, 132 Prepared chalk, 166 820 CLINICAL INDEX. Diarrhea. Quinine, 217 Resorcin, 327 Rhubarb, 679 Salicylic acid, 319 Salol', 321 Sodium nitrate, 593 Sodium sulphocarbolate, 310 Strychnine, 473 Sulphuric acid, 146 Tannic acid, 714 Thymol, 379 White oak, 717 Zinc oxide, 737 Zinc sulphate, 738 Zinc sulphocarbolate, 310 Digestive Disorders— Nuclein, 221 Digestive Organs, Inflamed Condi- tions of— Althaea, 781 Dilatation of Heart— Digitalis, 544 Ergot, 482 Dilatation of Stomach— Carbolic acid, 309 Physostigma, 515 Diphtheria— Alcohol, 572 Alum, 750 Balsam of tolu, 621 Bichloride of mercury, 235 Chloral, 419 Chlorine water, 358 Eucalyptus, 343 Gallic acid, 714 Hydrochloric acid, 144 Hydronaphtol, 324 Hyposulphites, 357 Ipecac, 613 Iron, tincture of chloride of, 196 Lactic acid, 148 Papain, 134 Pepsin, 132 Potassium permanganate, 349 Resorcin, 326 Salicylic acid, 318 Serum-therapy, 285 Sodium sulphocarbolate, 310 Sulphur, 673 Sulphurous acid, 355 Tartaric acid, 151 Thymol, 379 Turpentine, 646 Zinc sulphate, 738 Diphtheritic Paralysis— Strychnine, 474 Dropsy— Caffeine, 560 Copaiba, 650 Digitalis, 547 Diuretin, 654 Iris, 681 Jalap, 693 Dropsy— Juniper, 642 Potassium bitartrate, 165 Potassium iodide, 2^5 Salines, 690 Solution of ammonium acetate, 599 Squill, 638 Dryness of Mouth— Glycerin, 776 Duodenal Catarrh— Salol, 321 Sanguinaria, 268 Sodium phosphate, 690 Dysentery- Acacia, 780 Alum, 750 Arnica, 591 Bismuth phosphate, 754 Bismuth subgallate, 754 Bismuth subnitrate, 754 Carbolic acid, 309 Colchicum, 259 Copaiba, 650 Copper sulphate, 741 Corrosive chloride of mercury, 234 Demulcents, 774 Elm, 781 Ergot, 483 Erythrophleum, 639 Gallic acid, 715 Geranium, 723 Hamamelis, 722 Hematoxylon, 721 Hydronaphtol, 324. Infusion of nutgall, 716 Ipecac, 613 Iron, 198 Kino, 719 Krameria, 720 Lactic acid, 148 Lead acetate, 733 Lime water, 166 Olive oil, 778 Opium, 217 Quinine, 217 Rhubarb, 679 Silver nitrate, 746 Sodium nitrate, 593 Tannic acid, 714 Thymol, 379 White oak, 717 Zinc oxide, 737 Zinc sulphate, 738 Dysmenorrhea— Acetanilid, 393 Ammonium chloride, 619 Amyl nitrate, 528 Apioline, 709 Arsenic, 243 Black haw, 520 Camphor, 389 Cannabis, 452 Caulophyllum, 707 Croton oil, 685 CLINICAL INDEX. 821 Dysmenorrhea— Ergot, 482 Gelsemium, 507 Guaiac, 262 Hamamelis, 722 Hydrastine, 488 Picrotoxin, 478 Sanguinaria, 268 Solution of ammonium acetate, 599 Spirit of nitrous ether, 600 Sumbul, 519 Dyspepsia— Alcohol, 571 Alkalies, 164 Ammonium preparations, 166 Asafetida, 388 Bismuth phosphate, 754 Carbolic acid, 309 Cerium oxalate, 755 Colchicum, 259 Erythrophleum, 639 Hematoxylon, 721 Hops, 447 Hydrochloric acid, 144 Hydrocyanic acid, 524 Ipecac, 613 Lactic acid, 148 Manganese sulphate, 200 Myrrh, 339 Pepsin, 132 Potassium bichromate, 351 Quinine, 218 Resorcin, 327 Simple bitters, 180 Sodium sulphocarbolate, 310 Strontium bromide, 535 Strychnine, 472 Sulphurous acid, 356 Taraxacum, 674 Terebene, 629 Xanthoxylum, 271 Zinc sulphate, 738 Dysphonia— Bromides, 535 Dyspnea— Amyl nitrite, 528 Aspidosperma, 518 Bromides, 535 Grindelia, 509 Hydrogen dioxide, 354 Ear, Diseases of— Aristol, 333 Calendula, 180 Ichthyol, 328 Iodoform, 333 Liquor potassce, 163 Nitric acid, 144 Sodium bicarbonate, 164 Earache— Hops, 447 Oil of cloves, 370 Onion, 622 Ecchymoses— Arnica, 591 Eclampsia, Infantile— Picrotoxin, 477 Ecthyma— Quinine, 218 Solution of lead subacetate, 733 Sulphur, 672 Eczema— Anderson's powder, 388 Arsenic, 243 Belladonna, 461 Bismuth subgallate, 754 Black wash, 164 Calomel, 233 Carbolic acid, 308 Cod liver oil, 137 Coffee, 560 Colchicum, 259 Eucalyptus, 343 Fluid extract of pilocarpus, 597 Galla, 716 Gallicine, 715 Gelsemium, 507 Glycerite of starch, 756 Grindelia, 509 Hamamelis, 722 Hydrocyanic acid, 524 Ichthyol, 328 Lead acetate, 732 Lead iodide, 734 Lycopodium, 783 Menthol, 377 Papain, 134 Phytolacca, 587 Potassium chlorate, 353 Prepared chalk, 164 Resorcin, 326 Rhus toxicodendron, 490 Salicylic acid, 317 Salol, 321 Sodium carbonate, 164 Solution of lead subacetate, 733 Sulphur, 672* Tannic acid, 713 Tar, 626 Yellow wash, 164 Zinc carbonate, 738 Zinc oxide, 737 Zinc sulphate, 738 Edema of the Prepuce- Glycerin, 776 Emphysema— Physostigma, 515 Terebene, 629 Turpentine, 646 Empyema— Hydrogen dioxide, 354 Tincture of iodine, 254 Endarteritis— Iodides, 254 Mercury, 234 822 CLINICAL INDEX. Endocarditis— Blisters, 763 Carbolic acid, 308 Quinine, 217 Endometritis— Carbolic acid, 308 Glycerite of tannic acid, 776 Hydrogen dioxide, 354 Solution of zinc chloride, 762 Tincture of iodine, 254 Enlarged Tonsils— Chromic acid, 758 Zinc sulphate, 737 Enteralgia— Belladonna, 461 Hyoscyamus, 466 Enteritis— Demulcents, 774 Hamamelis, 722 Enterocolitis— Salicylic acid, 319 Enuresis— Camphoric acid, 389 Rhus glabra, 725 Epididymitis— Ammonium chloride, 619 Mercurial ointment, 233 Silver nitrate, 745 Epilepsy— Acetanilid, 393 Amyl nitrite, 528 Borax, 348 , Brain-extract, 221 Bromides, 534 Chloral, 420 Coniine hydrobromate, 503 Copper sulphate, 741 Curare, 517 Digitalis, 546 Hydrastine hydrochlorate, 488 Hydrogen dioxide, 354 Phosphorus, 205 Physostigma, 515 Picrotoxin, 477 • Silver nitrate, 746 Strychnine, 474 Zinc oxide, 737 Zinc sulphate, 738 Epistaxis— Acetanilid, 392 Acetic acid, 150 Alum, 749 Arnica, 591 Digitalis, 546 Ether, 402 Geranium, 723 Hamamelis, 722 Kino, 719 Krameria, 720 Sulphuric acid, 144 Epithelioma— Arsenic, 245 Bismuth subnitrate, 753 Ergot, 482 Epithelioma— Lead nitrate, 734 Nitric acid, 144 Pyrogallol, 715 Zinc chloride, 762 Erysipelas— Alcohol, 573 Belladonna, 462 Bismuth subnitrate, 753 Carbolic acid, 308 Fluid extract of pilocarpus, 597 Glycerin, 777 Guaiacol, 314 Hyposulphites, 357 Ichthyol, 328 Iron, 198 Lead carbonate, 734 Lycopodium, 783 Pilocarpine, 597 Prepared chalk, 164 Quinine, 217 Rhus toxicodendron, 490 Salicylic acid, 317 Solution of lead subacetate, 733 Tannic acid, 713 Turpentine, 646 Zinc oxide, 737 Erythema — Anderson's powder, 388 Bismuth subnitrate, 753 Ergot, 483 Hamamelis, 722 Hydrocyanic acid, 524 Ichthyol, 328 Lead acetate, 732 Rhus toxicodendron, 490 Exanthemata— Acetanilid, 392 Acetic acid, 150 Ammonium carbonate, 577 Ammonium chloride, 619 Camphor, 389 Cod-liver oil, 137 Opium, 442 Solution of ammonium acetate, 597 Excoriations— Acacia, 780 Glycerin, 776 Olive oil, 778 Protectives, 774 Tar, 626 Exophthalmic Goiter— Belladonna, 462 Bromides, 535 Digitalis, 545 . Ergot, 483 Thyroid extract, 220 Eye, Diseases of— Fluid extract of red rose, 725 Iodoform, 333 Physostigmine, 514 Fainting— Ammonia water, 577 CLINICAL INDEX. Fainting— Cubeb, 653 Fatty Heart— Caffeine, 560 Fauces, Inflammation of— Salicylic acid, 318 Favus— Carbolic acid, 308 Gallanol, 715 Hyposulphites, 357 Phytolacca, 587 Febrile Affections— Acacia, 780 Acetanilid, 392 Aconite, 581 Ammonium carbonate, 577 Citric acid, 151 Demulcents, 774 Hydrochloric acid, 145 Opium, 441 Potassium nitrate, 593 Sodium bromide, 535 Spirit of nitrous ether, 600 Tartar emetic, 610 Felons— Chloral, 419 Cocaine, 498 Silver nitrate, 745 Solution of lead subacetate, 733 Fermentation— Salicylic acid, 319 Fissured Nipples— Galla, 716 Glycerin, 776 Lead nitrate, 734 Tar, 626 Zinc oxide, 737 Fistula- Calcium phosphate, 208 Cantharidal blister, 766 Cod liver oil, 138 Hydrogen dioxide, 354 Iodoform, t,^ Fistulous Discharges— Quinine, 217 Fistulous Openings, to Dilate— Elm, 781 Flatulence— Anise, 362 Asafetida, 388 Brandy, 572 Camphor, 389 Compound spirit of ether, 402 Ginger, 374 Glycerin, 777 Hops, 447 Physostigma, 515 Salicylic acid, 319 Spirit of nitrous ether, 600 Turpentine, 646 Freckles— Hamamelis, 722 Potassium nitrate, 593 Frost-bite— Alcohol, 571 Compound tincture of benzoin, 337 Hamamelis, 722 Galactorrhea— Ergot, 483 Gall-stones— Olive oil, 778 Gangrene— Ammonium chloride, 619 Bromine, 762 Carbolic acid, 308 Hematoxylon, 721 Lead nitrate, 734 Nitric acid, 144 White oak, 717 Gangrene of Lungs— Carbolic acid, 308 Eucalyptus, 345 Hyposulphites, 357 Salicylic acid, 318 Gangrene of Pharynx— Alum, 749 Copper sulphate, 740 Gangrenous Sores— Solution of chlorinated soda, 359 Gastralgia— Acetanilid, 393 Arsenic, 244 Belladonna, 461 Bismuth phosphate, 754 Brandy, 572 Coca, 499 Compound spirit of ether, 402 Manganese dioxide, 200 Menthol, 377 Resorcin, 326 Silver nitrate, 746 Silver oxide, 746 Zinc oxide, 737 Gastric Acidity— Glycerin, 777 Gastric Catarrh— Iodoform, 333 Salicylic acid, 319 Simple bitters, 180 Strychnine, 473 Gastric Fermentation— Hyposulphites, 357 Potassium permanganate, 349 Gastric Pain— Cantharidal blister, 767 Hydrocyanic acid, 524 Gastric Ulcer— Arsenic, 245 Bismuth subnitrate, 754 Lead acetate, 733 Manganese dioxide, 200 Potassium bichromate, 351 Silver nitrate, 746 Silver oxide, 746 Gastritis— Acacia, 780 824 CLINICAL INDEX. Gastritis— Arsenic, 244 Bismuth subnitrate, 754 Demulcents, 774 Lead acetate, 733 Resorcin, 327 Silver nitrate, 746 Gastrodynia— Codeine, 445 General Debility— Digitalis, 545 Gingivitis— Borax, 347 Boric acid, 347 Hydronaphtol, 324 Glandular Enlargements— Ammonium chloride, 619 Solution of ammonium acetate, 599 Gleet- Alum, 750 Buchu, 640 Copaiba, 650 Copper sulphate, 740 Geranium, 723 Krameria, 720 Lead acetate, 732 Tar water, 626 Tincture of cantharides, 767 Turpentine, 646 Glossitis— Chromic acid, 759 Goiter— Ammonium chloride, 619 Carbolic acid, 308 Red-iodide-of-mercury ointment, 234 Tincture of iodine, 254 Gonorrhea— Acetic acid, 150 Alum, 750 Alumnol, 324 Argonin, 746 Bismuth subnitrate, 753 Bismuth tannate, 754 Boric acid, 347 Buchu, 640 Cannabis, 452 Catechu, 718 Chloral, 418 Chromic acid, 759 Colchicum, 259 Copaiba, 650 Copper sulphate, 740 Geranium, 723 Glycerin, 776 Grindelia, 509 Hamamelis, 722 Hydrastin, 486 Hydrogen dioxide, 354 Kino, 719 Lead acetate, 732 Oil of santal, 650 Potassium permanganate, 349 Quinine bisulphate, 217 Resorcin, 326 Gonorrhea— Salol, 321 Silver nitrate, 745 Sodium sulphocarbolate, 310 Solution of zinc chloride, 762 Tannic acid, 713 Turpentine, 646 Zinc acetate, 737 Zinc sulphate, 737 Gout- Alkalies, 164 Arnica, 591 Colchicum, 259 Guaiac, 262 Lactic acid, 148 Lithium carbonate, 164 Piperazin, 657 Potassium iodide, 255 Salicylic acid, 318 Tincture of iodine, 253 Gouty Diathesis— Lithium preparations, 166 Sodium salts, 690 Gouty Sores— Piperazin, 657 Granular Lids— Bismuth subnitrate, 753 Granulations— Alum, 749 Nitric acid, 144 Gummata— Iodides, 254 Hay Fever— Ammonium iodide, 255 Arsenic, 245 Cannabis, 452 Cocaine, 498 Grindelia, 509 Quinine, 217 Resorcin, 326 Terpin hydrate, 630 Headache— Acetanilid, 393 Aromatic spirit of ammonia, 577 Arsenic, 244 Bromides, 534 Butyl-chloral hydrate, 424 Caffeine, 560 Cannabis, 452 Cubeb, 653 Ergot, 483 Menthol, 377 Quinine, 217 Salicylic acid, 318 Spirit of nitrous ether, 600 Valerian, 390 Heart, Fatty Degeneration of— Iodine, 255 Heart, Functional Disorders of— Cactus, 554 Heart, Functional Irregularity of— Adonidin, 555 Strychnine, 473 CLINICAL INDEX. Heart, Valvular Diseases of— Iodine, 255 Hebephrenia— Brain extract, 222 Hematemesis— Alum, 750 Gallic acid, 714 Hamamelis, 722 Ipecac, 613 Iron, 198 Krameria, 720 Sulphuric acid, 146 Tannic acid, 714 Turpentine, 646 Hematuria— Alum, 750 Hamamelis, 722 Krameria, 720 Piperazin, 657 Rhus glabra, 724 Turpentine, 646 Hemiplegia— Strychnine, 474 Hemoptysis— Acetanilid, 392 Arnica, 591 Digitalis, 546 Fluid extract of hydrastis, 488 Gallic acid, 714 Gelsemium, 507 Geranium, 723 Hamamelis, 722 Iodoform, ^33 Ipecac, 014 Krameria, 720 Lead acetate, 733 Tannic acid, 714 Turpentine, 646 White oak, 717 Hemorrhage— Alcohol, 572 Alum, 749 Digitalis, 545 Ergot, 483 Geranium, 723 Hamamelis, 722 Iron, 198 Lead acetate, 733 Opium, 441 Pyrogallol, 715 Turpentine, 646 Hemorrhage, Intestinal— Gallic acid, 714 Sulphuric acid, 146 Hemorrhage, Renal— Gallic acid, 714 Hemorrhage Uterine— Nitric acid, 144 Sulphuric acid, 146 Hemorrhoids— Belladonna ointment, 461 Chromic acid, 759 Cocaine, 498 Ergot, 4S2 Hemorrhoids— Galla, 716 Gallic acid, 714 Hamamelis, 722 Iodoform, 333 Krameria, 720 Lead acetate, 732 Manna, 671 Menthol, 377 Nitric acid, 144 Potassium bromide, 534 Rhubarb, 679 Stramonium ointment, 464 Sulphur, 673 Tannic acid, 713 White oak, 717 Hepatic Cirrhosis— Podophyllum, 695 Hepatic Congestion— Calomel, 234 Gamboge, 687 Taraxacum, 674 Hepatic Disorders— Nitric acid, 145 Hepatitis— Calomel, 235 Hernia— Caffeine, 560 Fluid extract of white oak, 717 Herpes— Aconite, 581 Bismuth subgallate, 754 Galla, 716 Hamamelis, 722 Ichthyol, 328 Lycopodium, 783 Rhus toxicodendron, 490 Salicylic acid, 318 Tannic acid, 714 Herpes of Buccal Cavity— Potassium chlorate, 353 Hiccough— Chloral, 420 Coffee, 560 Compound spirit of ether, 402 Infusion of mustard, 770 Nitroglycerin, 529 Pilocarpine, 597 Hoarseness— Borax, 347 Boric acid, 347 Compound tincture of benzoin, 3 Cubeb, 653 Licorice, 623 Potassium bichromate, 351 Hodgkin's Disease— Arsenic, 243 Hydrocele— Chloral, 418 Tincture of iodine, 254 Hydrocyanic-Acid-poisoning— Ammonia, 577 Potassium permanganate, 350 826 CLINICAL INDEX. Hydrophobia— Coniine, 503 Curare, 517 Hydrastine hydrochlorate, 488 Opium, 440 Hydrothorax— Cantharidal blisters, 766 Hyperidrosis— Chloral, 419 Chromic acid, 759 Hamamelis, 722 Hydrastine ointment, 487 Tannic acid, 713 Hyperpyrexia, Rheumatic— Salicylic acid, 318 Hypertrophy of Heart— Aconite, 581 Lead acetate, 733 Hypochondria— Arsenic, 245 Colchicum, 259 Diluted nitrohydrochloric acid, 145 Valerian, 390 Hysteria— Allyl tribromide, 622 Asafetida, 388 Belladonna, 461 Brain-extract, 221 Compound spirit of ether, 402 Copper sulphate, 741 Oil of rue, 707 Sanguinaria, 268 Sumbul, 519 Tansy, 708 Valerian, 390 Zinc oxide, 737 Zinc sulphate, 738 Hysterical Convulsions— Hyoscine, 466 Hysterical Paralysis— Blisters, 763 Ileo-colitis— Calomel, 234 Gray powder, 234 Impetigo— Hyposulphites, 357 Lead acetate, 732 Quinine, 218 Salicylic acid, 317 Sulphur, 672 Tannic acid, 713 Impotence — Alcohol, 573 Cannabis, 453 Phosphorus, 205 Sanguinaria, 268 Tincture of cantharides, 767 Incontinence of Urine— Ammonium benzoate, 338 Belladonna, 461 Buchu, 640 Ergot, 483 Hyoscyamus, 466 Incontinence of Urine— Iron, 198 Krameria, 720 Rhus glabra, 724 Rhus toxicodendron, 490 Tincture of cantharides, 767 Tincture of nux vomica, 472 Turpentine, 646 Indigestion— Bromides, 534 Hydrochloric acid, 145 Infantile Convulsions— Allyl tribromide, 622 Asafetida, 388 Bromides, 534 Chloral, 419 Conium, 503 Physostigma, 515 Inflamed Gums— Hamamelis, 724 Inflammation of Nose— Carbolic acid, 308 . Inflammation of Throat— Carbolic acid, 308 Inflammations— Hop poultice, 447 Linseed poultice, 779 Mercury, 234 Inflammatory Exudates, to Hasten Absorption of— Rubefacients, 771 Influenza— Acetanilid, 393 Salicylic acid, 319 Serum-therapy, 300 Solution of ammonium acetate, 599. Ingrowing Toe-nail— Alum, 750 Liquor potassae, 163 Insanity— Hyoscine, 466 Sulphonal, 427 Thyroid extract, 220 Insomnia— Bromides, 534 Chloral, 419 Chloral formamide, 423 Convallaria, 556 Hyoscine, 466 Opium, 440 Paraldehyde, 428 Phosphorus, 205 Intermittent Fever— Ammonium chloride, 619 Antipyrine, 394 Arsenic, 244 Erythrophleum, 639 Hydrastine, 487 Ipecac, 614 Nitric acid, 145 Phenocoll, 396 Quinine, 218 Resorcin, 327 Salicylic acid, 318 CLINICAL INDEX. Intertrigo — Bismuth subnitrate, 753 Lead carbonate, 734 Lycopodium, 783 Tannic acid, 713 Zinc carbonate, 738 Zinc oxide, 737 Intestinal Catarrh— Copaiba, 650 Salol, 321 Turpentine, 646 Intestinal Dilatation— Physostigma, 515 Intestinal Fermentation— Oxgall, 677 Sulphurous acid, 356 Intestinal Hemorrhage— Alum, 750 Hemaloxylon, 721 Krameria, 720 Tannic acid, 714 Intestinal Obstruction— Croton oil, 686 Intestinal Torpor— Picrotoxin, 477 Intestinal Ulcerations— Silver nitrate, 746 Irido-choroiditis— Salicylic acid, 318 Iritis— Calomel, 235 Irritable Conditions of the Heart— Hydrocyanic acid, 524 Strophanthus, 551 Irritation, Relief of— Cod-liver oil, 137 Jaborandi-poisoning— Atropine, 462 Jaundice- Aloes, 676 Citric acid, 151 Hydrastine, 487 Iodoform, 333 Iris, 681 Iron, 197 Manganese sulphate, 200 Oxgall, 677 Pilocarpine, 598 Quinine, 217 Salol. 321 Joints, Inflammation of— Digitalis, 543 Rubefacients, 771 Keratitis— Gallicine, 715 Yellow-oxide-of-mercury ointment, 233 Kidneys, Congestion of— Digitalis, 543 Juniper, 642 Spirit of nitrous ether, 600 Laryngeal Catarrh— Compound tincture of benzoin, 337 Turpentine, 646 Laryngeal Papillomata— Chromic acid, 759 Laryngismus Stridulus— Bromides, 535 Chloral, 419 Laryngitis— Acacia, 780 Aconite, 581 Alum, 750 Ammonium chloride, 619 Camphor, 388 Carbolic acid, 308 Chromic acid, 758 Glycerin, 776 Iodine, 254 Resorcin, 326 Salol, 321 Sanguinaria, 268 Senega, 628 Subsulphate of mercury, 235 Succus conii, 503 Tartar emetic, 610 Larynx, Chronic Ulceration of— Silver nitrate, 745 Larynx, Congestion of— Creasote, 311 Lead-poisoning— Alum, 750 Croton oil, 686 Magnesium sulphate, 690 Sulphuric acid, 146 Lentigo— Tincture of iodine, 254 Lepra— Arsenic, 243 Phosphorus, 205 Leucorrhea— Alum, 750 Bismuth subnitrate, 753 Bismuth tannate, 754 Boric acid, 347 Catechu, 718 Chromic acid, 759 Cocculus, 478 Ergot, 483 Fluid extract of hydrastis, 487 Geranium, 723 Glycerite of tannic acid, 776 Grindelia, 509 Hamamelis, 722 Hematoxylon, 721 Iron, 198 Kino, 719 Krameria, J20 i Lead acetate, 732 Lime water, 164 Myrrh, 339 Potassium permanganate, 349 Rhus glabra, 724 Silver nitrate, 745 828 CLINICAL INDEX. Leucorrhea — Solution of zinc chloride, 762 Tannic acid, 713 Tar water, 626 White oak, 717 Zinc acetate, 737 Zinc oxide, 737 Zinc sulphate, 737 Leukemia— Arsenic, 243 Lichen— Fowler's solution, 243 Lead acetate, 732 Sulphuric acid, 146 Lithemia— Alkalies, 105 Buchu, 640 Lactic acid, 148 Nitric acid, 145 Lithiasis— Potassium permanganate, 349 Liver, Torpor of— Podophyllum, 695 Locomotor Ataxia— Acetanilid, 393 Brain-extract, 221 Caffeine, 560 Mercury, 234 Nitroglycerin, 529 Phosphorus, 204 Physostigma, 515 Silver nitrate, 746 Lumbago— Acetanilid, 393 Burgundy-pitch plaster, 772 Capsicum, 367 Guaiac, 262 Salicylic acid, 318 Turpentine, 645 Lungs, Chronic Affections of— Mercury, 234 Lungs, Congestion of— Digitalis, 546 Elaterin, 687 Lungs, Inflammation of— Gelsemium, 507 Lupus— Carbolic acid, 308 Chloride of zinc, 762 Copaiba, 649 Hamamelis, 722 Ichthyol, 328 Phosphorus, 205 Pyrogallol, 715 Salicylic acid, 317 Tincture of iodine, 254 Zinc sulphate, 738 Lymphadenoma— Phosphorus, 205 Lymphangitis— Tannic acid, 713 Lymphatic Enlargements— Ichthyol, 328 Lead iodide, 734 Lymphoma— Arsenic, 243 Malaria— Antipyrine, 394 Apioline, 709 Arsenic, 243 Carbolic acid, 309 Citric acid, 151 Eucalyptus, 344 Hydrastine, 4S7 Nuclein, 221 Pilocarpine, 597 Quinine. 217 Malarial Fever— Ammonium iodide, 255 Amyl nitrite, 528 Quinine, 217 Simple bitters, 180 Malignant Pustule— Iodoform, 332 Solution of chloride of antimony, 758 Mammary Glands, Enlarged and Painful- Olive oil, 778 Solution of ammonium acetate, 599 Mania— Acetanilid, 393 Arnica, 591 Bromoform, 536 Camphor, 389 Cannabis, 452 Conium, 503 Digitalis, 546 Ergot, 483 Gelsemium, 506 Hydrocyanic acid, 524 Hyoscine, 466 Marasmus— Bichloride of mercury. 235 Cod liver oil, 137 Mastitis— Ammonium chloride, 619 Phytolacca, 587 Measles— Mustard bath, 770 Melancholia— Arsenic, 245 Camphor, 389 Cannabis, 452 Diluted nitrohydrochloric acid, 145 Hydrocyanic acid, 524 Wine of coca, 499 Meniere's Disease— Gelsemium, 507 Meningitis— Calomel, 234 Digitalis, 546 Iodides, 254 Menopause, Disturbances of— Bromides, 535 Menorrhagia— Aloes, 676 Alum, 750 CLINICAL INDEX. Menorrhagia— Belladonna, 462 Black haw, 520 Bromides, 535 Cannabis, 452 Conium, 503 Digitalis, 546 Ergot, 482 Gallic acid, 714 Hamamelis, 722 Iron, 198 Kino, 719 Savine, 7°6 Solution of ammonium acetate, 599 Tincture of cantharides, 767 Turpentine, 646 Menses, to Restore or Increase— Emmenagogues and ecbolics, 704 Hedeoma, 710 Mustard sitz-bath, 770 Mercurial Sore Mouth— Silver nitrate, 745 Metritis, Chronic— Cannabis, 452 Ergot, 482 Tincture of iodine, 254 Metrorrhagia— Geranium, 723 Migraine— Butyl-chloral hydrate, 424 Caffeine, 560 Cannabis, 452 Gelsemium, 507 Picrotoxin, 478 Seidlitz powder, 690 Solution of ammonium acetate, 599 Mitral Regurgitation— Adonidin, 555 Digitalis, 544 Mitral Stenosis— Strophanthus, 540 Moles— Nitric acid, 244 Morbid Growths— Zinc chloride, 762 Morphine-poisoning— Potassium permanganate, 349 Strychnine, 475 Mouth, Diseases of— Potassium citrate, 163 Potassium tartrate, 163 Mouth, Ulcerations of— Chromic acid, 759 Mucous Membranes, Inflamed ( ditions of— Demulcents, 774 Mucous Patches— Potassium chlorate, 353 Mumps— Pilocarpine. 597 Muscarine-poisoning— Digitalis, 547 Potassium permanganate, 350 Myalgia— Ammonium chloride, 620 Salol, 321 Turpentine, 645 Myelitis— Ergot, 483 Phenocoll, 396 Strychnine, 474 Myocarditis— Cactus, 554 Caffeine, 560 Diuretin, 655 Myxedema— Thyroid extract, 220 Narcotic Poisoning— Alcohol, 572 Mustard, 770 Rubefacients, 771 Nasal Catarrh— Bismuth oxide, 754 Bismuth subnitrate, 753 Glycerin, 776 Oil of Scotch fir, 624 Nasal Polypi— Chromic acid, 758 Nitrate of sanguinarine, 267 Zinc sulphate, 738 Nausea— Compound spirit of ether, 402 Hydrochloric acid, 145 Menthol, 377 Spirit of nitrous ether, 600 Neoplasms— Cocaine, 498 Nephritis — Amyl nitrate, 528 Elaterin, 687 Mercury, 234 Potassium bitartrate, 165 Potassium iodide, 255 Scoparius, 553 Terpin hydrate, 630 Tincture of cantharides, 767 Nervous Debility — Rubefacients, 771 Nervous Diseases— Cod liver oil, 13S Iron, 197 Nervous Excitement— Rubefacients, 771 Nervous Irritability— Bromides, 535 - Nervousness— Lactucarium, 448 Neuralgia— Acetanilid, 393 Aconite, 581 Ammonium chloride, 620 Arsenic, 244 I Belladonna plaster, 461 Blisters, 763 Butyl-chloral hydrate, 424 830 CLINICAL INDEX Neuralgia— Camphor-chloral, 388 Camphorated chloral, 419 Cannabis, 452 Cantharidal blister, 766 Capsicum, 367 Chloral, 420 Colchicum, 259 Convallaria, 556 Croton oil, 685 Ether, 402 Gelsemium, 507 Hydrocyanic acid, 524 Hyoscyamus, 466 Iron, 197 Oil of cloves, 370 Phenocoll, 396 Phosphorus, 205 Quinine, 217 Rubefacients, 771 Salicylic acid, 319 Strychnine, 474 Terpin hydrate, 630 Turpentine, 645 Veratrine ointment, 586 Neurasthenia— Alcohol, 573 Brain-extract, 219 Phosphoric acid, 145 Phosphorus, 204 Sumbul, 519 Neuritis— Acetanilid, 393 Salol, 321 Tincture of iodine, 253 Nevi— Chloride of zinc, 762 Nitric acid, 144 Night-blindness— Strychnine, 474 Night-sweats— Camphoric acid, 389 Fluid extract of hydrastis, 488 Gallic acid, 715 Geranium, 723 Lead acetate, 733 Physostigma, 515 Picrotoxin, 477 Strychnine, 475 Zinc oxide. 737 Nocturnal Emissions— Digitalis, 546 Noma— Hydrochloric acid, 143 Nose, Diseases of— Aristol, 333 Ichthyol, 328 Iodoform, 333 Nitric acid, 144 Nymphomania— Bromides, 535 Nystagmus— Physostigmine sulphate, 514 Obesity— Phytolacca, 5.SS Thyroid extract, 221 Offensive Discharges— Lead nitrate, 734 Onychia— Lead nitrate, 734 Tincture of iodine, 253 Ophthalmia— Alum, 750 Bismuth tannate, 754 Potassium permanganate, 349 Silver nitrate, 745 Zinc sulphate. 737, 738 Opium Habit— Cocaine, 499 Opium-poisoning— Caffeine, 560 Picrotoxin, 477 Orchitis— Ammonium chloride, 619 Belladonna ointment, 461 Hop poultice, 447 Lead acetate, 732 Mercurial ointment, 233 Silver nitrate, 735 Os Uteri, Rigidity of— Ipecac, 614 Osteitis— Hydrochloric acid, 144 Osteomalacia— Lime water, 166 Phosphorus, 205 Otitis— Antipyrine, 394 Bismuth subgallate, 754 Cantharidal blister, 767 Carbolic acid, 308 Cod-liver oil, 138 Zinc sulphate, 737 Otorrhea— Carbolic acid, 308 Lead acetate, 732 Salicylic acid, 318 Silver nitrate, 746 Tannic acid, 713 Ovarian Neuralgia— Sumbul, 519 Ovaritis— Cantharidal blister, 767 Oxalic-acid-poisoning— Potassium permanganate, 350 Oxaluria— Lactic acid, 148 Nitric acid, 145 Zinc sulphate, 738 Ozena— Bismuth oxide, 754 Bismuth subnitrate, 753 Camphor, 388 Camphorated naphtol, 324 Chromic acid, 759 Cod-liver oil, 138 CLINICAL INDEX. 831 Ozena — Krameria, 720 Myrrh, 339 Potassium permanganate, 349 Quinine, 217 Saccharin, 658 Salol, 321 Solution of chlorinated soda, 359 Tannic acid, 713 Pachymeningitis — Red-iodide-of-mercury ointment, 234 Pain— Ether, 402 Opium, 440 Palpitation of Heart— Aconite, 581 Compound spirit of ether, 402 Palsy — Brain-extract, 222 Pannus— Yellow-oxide-of-mercury ointment, 233 Paralysis — Brain-extract, 222 Cocculus, 477 Cubeb, 653 Iodides, 254 Mezereum, 269 Phosphorus, 205 Rhus toxicodendron, 490 Strychnine, 474 Paralysis Agitans— Borax, 348 Cocaine, 499 Conium, 503 Gelsemium, 506 Hyoscine, 466 Sparteine sulphate, 553 Paralytic Mydriasis— Physostigmine, 514 Paraplegia— Phosphorus, 204 Physostigma, 515 Strychnine, 474 Parasitic Skin Diseases— Chlorine water, 358 Cocculus, 477 Salicylic acid, 317 Sulphurous acid, 355 Paronychia— Lead acetate, 732 Pelvic Cellulitis— Mercurial ointment, 233 Pemphigus— Fowler's solution, 243 Rhus toxicodendron, 490 Pericarditis— Blisters, 763 Calomel, 235 Cantharidal blister, 766 Diuretin, 655 Iodides, 255 Squill, 638 Periodical Fevers— Nitric acid, 145 Periostitis— Cantharidal blister, 767 Iodides, 254 Tincture of iodine, 253 Peritonitis— Aconite, 581 Opium, 441 Turpentine, 645 Pernicious Anemia— Arsenic, 243 Phosphorus, 205 Phagedenic Sores— Potassium chlorate, 353 Solution of nitrate of mercury, 234 Pharyngitis— Acacia, 780 Aconite, 581 Alcohol, 571 Ammonium chloride, 619 Aromatic spirit of ammonia, 577 Balsam of tolu, 621 Borax, 347 Boric acid, 347 Calendula, 180 Camphoric acid, 389 Capsicum, 367 Catechu, 718 Ergot, 482 Gallic acid, 714 Glycerin, 776 Guaiac, 262 Hamamelis, 722 Hedeoma, 710 Kino, 71S Krameria, 720 Myrrh, 339 Phytolacca, 587 Potassium bichromate, 351 Potassium bromide, 534 Potassium chlorate, 353 Potassium nitrate, 592 Resorcin, 326 Rhus glabra. 724 Sodium benzoate, 338 Sodium bicarbonate, 163 Solution of ammonium acetate, 599 Sulphur, 673 Sulphurous acid, 355 Tannic acid, 713 Tincture of hydrastis, 487 Tincture of iodine, 254 Xanthoxylum, 271 Pharynx, Catarrhal Affections of— Compound tincture of benzoin, 337 Phimosis— Cocaine, 498 Phlegmasia Dolens— Hamamelis, 722 Phlyctenular Ophthalmia— Yellow-oxide-of-mercury ointment, 233 832 CLINICAL INDEX. Phosphorus-poisoning— Magnesium carbonate, 670 Ozonized oil of turpentine, 646 Potassium permanganate, 350 Photophobia— Physostigmine, 514 Phthiriasis— Pilocarpine, 598 Phthisis— Acetanilid, 392 Alcohol, 573 Arsenic, 244 Benzoic acid, 337 Catechu, 718 Codeine, 445 Creasote, 311 Croton oil, 682 Gallic acid, 715 Geranium, 723 Guaiacol, 314 Iodine, 254 Iodoform, 333 Quinine, 217 Salicylic acid, 318 Sulphurous acid, 355 Tar, 626 Terebene, 629 Thymol, 379 Wild cherry, 180 Physostigmine-poisoning— Atropine, 462 Strychnine, 475 Pityriasis— Acetic acid, 150 Aromatic spirit of ammonia, 164 Resorcin, 326 Pleura, Chronic Affections of— Mercury, 234 Pleurisy— Aconite, 581 Blisters, 763 Burgundy pitch plaster, 772 Cantharidal blister, 766 Coniine, 503 Gelsemium, 507 Iodides, 255 Opium, 441 Quinine, 217 Salicvlic acid, 319 Squill, 638 Tincture of iodine, 253 Turpentine, 645 Pleuritic Effusion— Caffeine, 560 Digitalis, 547 Diuretin, 654 Pilocarpine, 597 Salines, 690 Pneumonia— Acetanilid. 392 Aconite, 5S1 Alcohol, 572 Ammonium carbonate, 577 Ammonium iodide, 255 Pneumonia — Apomorphine, 606 Arsenic, 245 Aspidosperma, 5'8 Calomel, 235 Cantharidal blister, 766 Coniine, 503 Digitalis, 546 Grindelia, 509 Hydrogen dioxide, 354 Iodides, 255 Ipecac, 614 Potassium nitrate, 593 Quinine, 217 Senega, 628 Serpentaria, 180 Serum-therapy, 295 Strychnine, 473 Turpentine, 646 Pneumothorax— Carbolic acid, 308 Poisoning— Apomorphine, 606 Poisoning from Noxious Gases— Ammonia, 577 Poisoning from Venomous Reptiles- Alcohol, 572 Ammonia, 577 Polypi— I lamamelis, 722 Zinc chloride, 762 Polyuria— Alum, 750 Kino, 719 Portal Congestion— Colchicum, 259 Post-partum Hemorrhage— Digitalis, 546 Ergot, 482 Ether, 402 Sodio-benzoate of caffeine, 560 Strychnine, 475 Priapism— Lupulin, 447 Prickly Heat— Citric acid, 150 Proctitis— Copaiba, 650 Progressive Paralysis of the Insane- Physostigma, 515 Prolapsus Ani— Bismuth subnitrate, 753 Ergot, 482 Geranium, 723 Krameria, 720 Nitric acid, 144 Strychnine, 473 Tannic acid, 713 White oak, 717 Prolapsus of Iris— Physostigmine, 514 Prolapsus Uteri- Iron, 197 CLINICAL INDEX. Prostate Gland, Enlargement of— Ergot, 482 Prostatitis— Belladonna, 462 Hyoscyamus, 466 Prostatorrhea— Iron, 198 Tincture of cantharides, 767 Turpentine, 646 Prurigo— Ergot, 483 Fowler's solution, 243 Sulphuric acid, 146 Pruritus— Aconite, 581 Alum, 750 Camphorated chloral, 419 Cannabis, 452 Carbolic acid, 308 Ether, 402 Gallanol, 715 Gelsemium, 507 Hydrocyanic acid, 524 Menthol, 377 Nitric acid, 144 Pilocarpine, 598 Piperazin, 657 Salicylic acid, 318 Solution of lead subacetate, 733 Tar, 626 Zinc sulphate, 737 Pruritus Ani— Silver nitrate, 745 Pruritus Vulvae— Silver nitrate, 745 Psoriasis— Ammonium carbonate, 577 Arsenic, 243 Copaiba, 649 Eucalyptus, 343 Gallanol, 715 Lead iodide, 734 Phosphorus, 205 Pilocarpine, 598 Pyrogallol, 715 Resorcin, 326 Salicylic acid, 317 Strophanthus, 551 Sulphur, 672 Thyroid extract, 221 Turpentine, 045 Ptyalism — Alum, 749 Bismuth subnitrate, 753 Catechu, 718 Copper sulphate, 740 Krameria, 720 Myrrh, 339 Pilocarpine, 597 Potassium chlorate, 353 Rhus glabra, 724 Puerperal Eclampsia— Amyl nitrite, 528 Conium, 5°3 Puerperal Fever— Opium, 441 Quinine, 217 Terebene, 629 Turpentine, 646 Pulmonary Affections, Chronic— Cetraria, 780 Nuclein, 221 Turpentine, 646 Purpura— Digitalis, 546 Ergot, 483 Hamamelis, 722 Sulphuric acid, 146 Turpentine, 646 Putrid Sore Throat— Potassium permanganate, 349 Pyelitis— Benzoic acid, 337 Buchu, 640 Copaiba, 650 Gallic acid, 715 Hamamelis, 722 Tincture of cantharides, 767 Pyelo-nephritis— Gallic acid, 715 Pyemia— Alcohol, 573 Iron, 198 Quinine, 217 Pyonephrosis— Turpentine, 646 Pyorrhea Alveolaris— Hydronaphtol, 324 Tincture of iodine, 254 Pyros's— Bismuth subnitrate, 754 Catechu, 718 Glycerin, 777 Kino, 719 Manganese dioxide, 200 Rabies— Serum-therapy, 302 Rachitis— Cod liver oil, 137 Lime water, 166 Phosphorus, 205 Rectal Bleeding— Krameria, 720 Rectal Fissure— Hamamelis, 722 Rectal Prolapse— Nutgall ointment, 716 Rectal Ulcer— Fluid extract of hydrastis, 487 Hamamelis, 722 Potassium chlorate, 353 Silver nitrate, 746 Tannic acid, 713 Relaxed Uvula— Capsicum, 367 White oak, 717 53 834 CLINICAL INDEX. Remittent Fever— Gelsemium, 507 Ipecac, 614 Iris, 681 Renal Calculi— Piperazin, 657 Renal Colic— Piperazin, 657 Renal Hemorrhage— Physostigma, 515 Respiratory Organs, Inflamed Condi- tions of— Althaea, 781 Restlessness of Fever— Convallaria, 556 Retention of Urine— Strychnine, 474 Rheumatic Affections— Rhus toxicodendron, 490 Rheumatic Arthritis— Piperazin, 657 Salicylic acid, 318 Rheumatic Pains— Capsicum, 367 Turpentine, 645 Rheumatism— Acetanilid, 392 Aconite, 581 Alkalies, 165 Ammonium liniment, 577 Ammonium chloride, 620 Arnica, 591 Arsenic, 245 Asaprol, 324 Aspidospermine, 519 Belladonna plaster, 461 Betol, 324 Bromides, 535 Buchu, 640 Burgundy-pitch plaster, 772 Camphoric acid, 389 Citric acid, 151 Cod liver oil, 137 Colchicum, 259 Guaiac, 262 Hamamelis, 722 Mezereon, 269 Phenocoll, 396 Phytolacca, 587 Potassium iodide, 255 Potassium nitrate, 593 Salicylic acid, 318 Sanguinaria, 26S Senega, 628 Sodium bicarbonate, 163 Sodium phosphate, 690 Solution of ammonium acetate, 599 Sulphur, 673 Tansy, 708 Tincture of camphor, 571 Tincture of iodine, 253 Rheumatoid Arthritis— Alkalies, 165 Arsenic, 245 Rheumatoid Arthritis— Cod liver oil, 137 Colchicum, 259 Rhinitis— Nitrate of sanguinarine, 267 Rhus-poisoning— Grindelia, 509 Hamamelis, 722 Serpentaria, 181 Ringworm— Acetic acid, 150 Compound tincture of benzoin, 337 Copper sulphate, 740 Salicylic acid, 319 Salivary Fistula— Arsenic, 242 Chromic acid, 759 Scabies— Copper sulphate, 740 Hyposulphites, 357 Sulphur ointment, 672 Scales, Removal of — Olive oil, 778 Scarlatina— Belladonna, 461 Scarlatinal Angina— Sanguinaria, 267 Scarlet Fever— Digitalis, 546 Mustard bath, 770 Sciatica— Acetanilid, 393 Blisters, 763 Cantharidal blisters, 766 Colchicine, 259 Ether, 402 Nitroglycerin, 529 Phenocoll, 396 Potassium iodide, 255 Salicylic acid, 318 Sulphur, 673 Sclerosis— Mercury, 234 Potassium iodide, 254 Sclerotitis— Salicylic acid, 318 Scrofula— Cod liver oil, 137 Hypophosphites, 208 Iron iodide, 197 Phytolacca, 587 Potassium iodide, 254 Sarsaparilla, 264 Scrofulous Glands — Zinc chloride, 762 Scrofulous Sores— Conium, 503 Phosphoric acid, 144 Scurvy— Citric acid, 151 Sulphuric acid, 146 Sea-sickness— Acetanilid, 393 CLINICAL INDEX. 835 Sea-sickness— lielladonna, 462 Chloral, 420 Chloral formamide, 424 Cocaine, 499 Seat-worms— Quassia, 1N0 Sebaceous Cysts— Kther, 402 Seborrhea— Hamamelis, 722 Hydrastine ointment, 487 Resorcin, 326 Seminal Emissions— Iron, iqS Senile Debility — Brain-extract, 221 Spermine, 219 Senile Gangrene— Camphor, 389 Septicemia— Alcohol, 573 Iron, 198 Quinine, 217 Serum-therapy, 298 Sequestra- Hydrochloric acid, 144 Sexual Excitement— Monobromated camphor, 389 Shock- Digitalis, 545 Ether, 402 Opium, 441 Skin, Diseases of— Acetic acid, 150 Aristol, 333 Cod liver oil, 137 Eucalyptus, 343 Hydrochloric acid, 145 Iodoform, ^^^ Liquor potassae, 163 Potassium carbonate, 163 Sulphuric acid, 146 Skin, Irritable and Inflamed Condi- tions of— Althaja, 7S1 Sleeplessness— Lactucarium, 448 Small-pox— Alcohol, 572 Sulphur, 673 Sore Nipples— Silver nitrate, 745 Tannic acid, 713 Sore Throat- Acetic acid, 150 Alum, 749 Hydrochloric acid, 143 Liquorice, 623 Sores, Foul-smelling— Hematoxylon, 721 Spasmodic Rigidity of Os Uteri- Belladonna ointment, 461 Spasmodic Rigidity of Os Uteri— Chloral, 420 Spermatorrhea— Belladonna, 462 Bromides, 535 Camphoric acid, 389 Digitalis, 546 Ergot, 483 Gelsemium, 507 Lupulin, 447 Strychnine, 475 Tincture of cantharides, 767 Turpentine, 646 Spinal Congestion— Belladonna, 462 Ergot, 483 Spinal Diseases— Acetanilid, 393 Spinal Meningitis— Blisters, 763 Splenic Enlargements— Ergot, 483 Lead iodide, 734 Red-iodide-of-mercury ointment, 234 Spongy Gums— Catechu, 718 Krameria, 720 Myrrh, 339 Rhus glabra, 724 Tannic acid, 713 Tincture of benzoin, 337 Sprains— Alcohol, 571 Arnica, 591 Calendula, 180 Camphor liniment, 388 Hamamelis, 722 Olive oil, 778 Rhus toxicodendron, 490 Solution of lead subacetate, 733 Tansy, 708 Sthenic Fevers— Chloral, 421 Stomatitis- Alum, 749 Bismuth subnitrate, 753 Chlorine water, 358 Copper sulphate, 740 Geranium, 723 Salicylic acid, 318 Tannic acid, 713 Thymol, 379 Zinc sulphate, 737 Strabismus— Bromides, 534 Strangury— Demulcents, 774 Onion poultice, 622 Stricture— Aconite, 581 Olive oil, 77S Strumous Affections— Sanguinaria, 268 836 CLINICAL INDEX. Strychnine-poisoning— Amyl nitrite, 528 Bromides, 534 Chloral, 420 Coniine, 503 Hydrastine hydrochlorate, 488 Potassium permanganate, 350 Subinvolution— Cannabis, 452 Ergot, 484 Glycerite of tannic acid, 776 Sweating— Alcohol, 571 Alum, 750 Belladonna, 461 Bismuth subnitrate, 753 Camphoric acid, 389 Ergot, 483 Gallic acid, 715 Hematoxylon, 721 Kino, 719 Lead oxide, 734 Pilocarpine, 597 Red rose, 725 Silver oxide, 746 Sulphuric acid, 146 Zinc oxide, 737 Swellings, Glandular— Tincture of iodine, 253 Swellings, Inflammatory— Ammonium chloride, 619 Hyposulphites, 357 Sycosis— Phytolacca, 587 Resorcin, 326 Salicylic acid, 317 Salol, 321 Sulphur, 672 Tannic acid, 713 Sympathetic Cough— Asafetida, 389 Syncope— Alcohol, 572 Mustard, 770 Synovitis— Belladonna ointment, 460 Cantharidal blister, 767 Ichthyol, 328 Iodoform, 332 Lead acetate, 732 Mercurial ointment, 233 Tincture of iodine, 253 Vesicants, 763 Syphilis— Arsenic, 245 Bromides, 535 Chloride of zinc, 762 Chromic acid, 758 Cod-liver oil, 138 Guaiac, 262 Iodides, 254 Iodoform, 333 Iron, iodide, 197 Mercurial preparations, 233 Syphilis — Me/ereon, 269 Nitric acid, 145 Papain, 134 Phytolacca, 587 Sanguinaria, 268 Sarsaparilla, 264 Serum-therapy, 298 Silver iodide, 746 Thyroid extract, 221 Tabes Dorsalis— Acetanilid, 393 Tape-worms— Carbolic acid, 309 Ether, 402 Kousso, 701 Male fern, 700 Pomegranate, 702 Pumpkin seed, 703 Salicylic acid, 319 Tetanus— Acetanilid, 393 Amyl nitrite, 528 Bromides, 535 Chloral, 420 Conium, 503 Curare, 517 Gelsemium, 506 Opium, 440 Physostigma, 515 Salicylic acid, 318 Serum-therapy, 283 Strychnine, 474 Thyroid extract, 221 Tetany— Thyroid extract, 220 Thirst, to Quench— Demulcents, 774 Thread-worms— Rhubarb, 679 Throat, Acute Inflammation of— Tartar emetic, 609 Throat, Diseases of— Aristol, 333 Iodoform, 333 Liquor potassae, 163 Nitric acid, 144 Pilocarpine, 597 Throat, Relaxed— Myrrh, 339 Thrombosis— Ammonia, 578 Thrush- Sodium bicarbonate, 164 Sodium sulphocarbolate, 310 Thyroid Gland, Enlargement of— Iris, 681 Tic Douloureux— Aconite, 581 Butyl-chloral hydrate, 424 Strychnine, 474 j Veratrine ointment, 586 CLINICAL INDEX. 837 Tinea Capitis— Carbolic acid, 308 Tinea Circinata— Cantharidal blister, 767 Carbolic acid, 308 Tinea Sycosis— Copper sulphate, 740 Tinea Tarsi— Copper sulphate, 740 Tinea Tonsurans— Cantharidal blister, 767 Carbolic acid, 308 Hydronaphthol, 324 Tincture of iodine, 254 Turpentine, 645 Tinea Versicolor— Sulphur ointment, 672 Toadstool-poisoning— Atropine, 462 Tobacco Habit— Cocaine, 499 Strophanthus, 551 Tongue, Fissure of— Glycerin, 776 Tongue, Tuberculosis of— Chromic acid, 759 Tonsillitis— Aconite, 581 Alum, 749 Camphorated naphtol, 324 Gallic acid, 714 Guaiac, 262 Guaiacol, 314 Phytolacca, 587 Quinine, 217 Rhus glabra, 724 Salicylic acid, 318 Silver nitrate, 745 Sodium bicarbonate, 163 Sodium sulphocarbolate, 310 Tannic acid, 713 Tonsils, Enlarged— Zinc iodide, 738 Zinc sulphate, 738 Toothache— Campho-phenique, 308 Camphorated chloral, 419 Capsicum, 367 Creosote, 309 Oil of cloves, 370 Torticollis— Capsicum, 367 Trachea, Congestion of— Creosote, 311 Tracheitis— Ipecac, 613 Silver nitrate, 745 Terpin hydrate, 630 Trachoma— Alum, 750 Bismuth subnitrate, 753 Trichophytosis— Gallonal, 715 Tubercular Joints— Iodoform, 332 Tuberculosis— Benzoyl-eugenol, 371 Bone-marrow, 221 Camphorated naphtol, 324 Cantharidin, 767 Cod liver oil, 137 Creosote, 311 Guaiacol, 314 Hydronaphtol, 324 Hypophosphites, 208 Iron, 197 Nuclein, 221 Phosphoric acid, 144 Serum-therapy, 293 Sulphur, 673 Tuberculous Ulceration— Calcium phosphate, 208 Lactic acid, 148 Turgescence of Nasal Mucous Mem- brane— Cubeb, 652 Tylosis— Salicylic acid, 317 Tympanites— Asafetida, 389 Turpentine, 646 Typhoid Fever— Acacia, 780 Alcohol, 572 Bismuth salicylate, 754 Borax, 348 Camphor, 389 Carbolic acid, 309 Digitalis, 546 Eucalyptus, 344 Hydrochloric acid, 145 Hydronaphtol, 324 Hyposulphites 357 Nuclein, 221 Oxgall, 677 Potassium chlorate, 353 Quinine, 218 Salicylic acid, 318 Serpentaria, 181 Serum-therapy, 299 Sodium sulphocarbolate, 310 Strychnine, 473 Sulphur, 673 Thymol, 379 Turpentine, 646 Zinc sulphate, 738 Typhus Fever— Alcohol, 572 Camphor, 389 Serpentaria, 1S1 Ulcerated Nipples— Catechu, 717 Ulceration, Phagedenic— Nitric acid, 144 Ulcerations, Superficial— Castor oil, 668 838 CLINICAL INDEX. Ulcer of Cervix— Carbolic acid, 308 Ulcer of Stomach— Pepsin, 132 Resorcin, 327 Ulcerous Gums— Tannic acid, 713 Ulcers— Alcohol, 571 Alum, 750 Alumnol, 324 Aristol, 3^ Bismuth benzoate, 337 Bismuth subgallate, 754 Bismuth subiodide, 754 Bismuth subnitrate, 753 Camphor ointment, 388 Cantharidal blister, 766 Carbolic acid, 308 Catechu, 717 Chloral, 418 Chloride of zinc, 762 Chromic acid, 759 Copaiba, 649 Copper sulphate, 740 Fluid extract of hydrastis, 487 Galla, 716 Grindelia, 509 Hydrogen dioxide, 354 Iodoform, 332 Iron sulphate, 196 Kino, 718 Lycopodium, 783 Nitrate of sanguinarine, 267 Nuclein, 221 Phytolacca, 587 Potassium bromide, 534 Potassium chlorate, 353 Potassium permanganate, 349 Resorcin, 326 Rhus glabra, 724 Silver nitrate, 745 Solution of chlorinated soda, 359 Tannic acid, 713 Tar, 626 Terebene, 629 Vesicants, 763 White oak, 717 Zinc oxide, 737 Zinc sulphate, 738 Ulcers of Mouth and Throat— Tincture of hydrastis, 487 Ulcers, Syphilitic— Carbolic acid, 308 Resorcin, 326 Ulcers, Venereal— Calomel, 233 Uremia— Opium, 440 Pilocarpine, 597 Uremic Convulsions— Chloral, 420 Urethral Caruncles— Cocaine, 497 Urethritis— Buchu,640 Elm, 781 Uric-acid Diathesis— Lithium bromide, 535 Lithium preparations, 166 Urinary Organs, Inflamed Conditions of— Altluea, 781 Urticaria— Alcohol, 571 Anderson's powder, 388 Citric acid, 150 Copaiba, 650 Ergot, 483 Ether, 402 Hamamelis, 722 Hydrocyanic acid, 524 Menthol, 377 Solution of lead subacetate, 733 Uterine Cancer— Conium, 503 Iodoform, 332 Terebene, 629 Uterine Contraction, to Stimulate— Quinine, 218 Uterine Fibroids— Ergot, 482 Uterine Hemorrhage— Alcohol, 571 Catechu, 718 Cinnamon, 364 Ergot, 482 Hamamelis, 722 Hydrastine, 487 Ipecac, 613 Krameria, 720 Red rose, 725 Senegin, 628 White oak, 717 Uterine Polypi— Ergot, 482 Uterine Tumors— Ergot, 484 Uterine Ulcerations— Fluid extract of hydrastis, 487 Iodoform, 332 Uterus, Congestion of— Croton oil, 685 Glycerite of tannic acid, 776 Uterus, to Dilate Neck of— Elm, 781 Uvula, Relaxation of Alum, 749 Catechu, 718 Kino, 718 Krameria, 720 Vaginal Ulcerations— Fluid extract of hydrastis, 487 Vaginitis— Ammonium chloride, 619 Copaiba, 650 CLINICAL INDEX. 839 Vaginitis— Grindelia, 509 Lime water, 164 Valvular Diseases of Heart— Convallaria, 556 Digitalis, 543 Sparteine sulphate, 553 Strophanthus, 550 Varicocele— Ergot, 482 Hamamelis, 722 Varicose Ulcers— Hamamelis, 722 Varicose Veins— Ergot, 482 Hamamelis, 722 Variola— Glycerite of starch, 776 Venereal Sores— Black wash, 164 Hydrogen dioxide, 354 Salol, 321 Solution of nitrate of mercury, 234 Yellow wash, 164 Venereal Warts— Nitric acid, 144 Verruca— Alum, 749 Salicylic acid, 317 Vertigo— Cubeb, 653 Valerian, 390 Vesical Calculi— Piperazin, 657 Vesical Catarrh— Silver nitrate, 746 Tar water, 626 Thymol, 379 Vesical Tenesmus— Hyoscyamus, 466 Vomiting— Ammonium bromide, 535 Bismuth subnitrate, 753 Caffeine, 561 Calomel, 234 Cantharidal blister, 767 Champagne, 572 Cocaine, 499 Gray powder, 234 Hydrochloric acid, 145 Hydrocyanic acid, 524 Ipecac, 613 Lime water, 164 Menthol, 377 Quinine, 218 Vomiting of Pregnancy— Ammonium bromide, 535 Cerium oxalate, 755 Chloral, 420 Strychnine, 473 Vomiting of Uterine Disease- Cerium oxalate, 755 Vulvitis— Zinc sulphate, 737 Warts— Acetic acid, 150 Arsenic, 242 Glacial acetic acid, 760 Potassium bichromate, 351 Salicylic acid, 317 Wasting Diseases— Cod liver oil, 137 Phosphoric acid, 145 Whooping Cough— Acetanilid, 393 Alum, 750 Ammonium chloride, 619 Asafetida, 389 Belladonna, 461 Bromides, 535 Bromoform, 535 Caffeine, 561 Chloral, 419 Cod liver oil, 137 Coffee, 560 Conium, 503 Ergot, 483 Gelsemium, 506 Grindelia, 509 Hydrocyanic acid, 524 Hyoscyamus, 466 Ouabain, 551 Quinine, 218 Resorcin, 326 Silver nitrate, 745 Syrup of garlic, 622 Tannic acid, 713 Terebene, 629 Zinc oxide, 737 Zinc sulphate, 738 Worms— Anthelmintics, 695 Chenopodium, 697 Kamala, 703 Olive oil, 778 Santonin, 698 Spigelia, 699 Wounds— Alcohol, 571 Bismuth subgallate, 754 Bismuth subnitrate, 753 Campho-phenique, 388 Chlorine water, 358 Compound tincture of benzoin, 336 Glycerin, 776 Iodoform, 332 Olive oil, 778 Resorcin, 326 Rhus glabra, 724 Salol, 321 Silver nitrate, 745 Sulphurous acid, 355 Terebene, 629 Turpentine, 645 Yellow Fever— Hyposulphites, 357 Turpentine, 646 GENERAL INDEX. Note.—The bold-face figures indicate the pages on which the drags are treated in extenso. Absolute alcohol, 562 Abstracta, 98 Abstracts, 98 Acacia, 773, 779 Aceta, 84 Acetanilid, 390 Acetanilidum, 390 Acetic acid, 148 glacial, 763 ether, 410 Acetum opii, 430 sanguinariae, 266 scilla, 637 Acid phosphates, 55 Acidum aceticum, 148 dilutum, 149 glaciale, 760 arsenosum, 236 benzoicum, 334 boricum, 346 camphoricum, 383 carbolicum, 304 iodatum, 305 chromicum, 758 citricum, 149 gallicum, 714 hydrobromicum dilutum, 531 hydrochloricum, 140 dilutum, 138 hydrocyanicum dilutum, 521, 742 hypophosphorosum dilutum, 207 lacticum, 146 nitricum, 141 dilutum, 141 nitrohydrochloricum, 140, 14-1 dilutum, 140, 141 phosphoricum, 140 salicylicum, 315 sulphuricum, 140 aromaticum, 141 dilutum, 141 sulphurosum, 355 tannicum, 712 tartaricum, 149 Aconite, 578 Aconitine, 579 Aconitum, 578 Adeps benzoinatus, 334 Adhesive plaster, 125 Adonis vernalis, 554 Either, 399 Albuminate of iron, 192 Alcohol, 561, 604, 771 absolutum, 562 deodoratum, 562 Alcoholic extract of belladonna leaves, 454 eye-wash, 60 Ale, 564 Alkali solutions, 55 Alkalies, 151, 617 Alkaline salt solutions, 54 Allium, 621 cepa, 621 Allspice, 371 Almond, 773 oil, 773 Almonds, comp., 104 Aloe, 674 barbadensis, 674 purificata, 675 socotrina, 675 Aloes, 674, 7°4 Aloin, 676 Aloinum, 676 Althaea, 781 Alum, 711, 747 (burnt), 757 Alumen, 747 exsiccatum, 747 Alumini hydras, 748 sulphas, 748 Aluminis glyceritum, 747 Aluminum aceto-tartrate, 747 boroformate, 748 hydrate, 748 sulphate, 74S Alumnol, 322, 324, 747 American hellebore, 582 wormseed, 696 Ammonia, 771 (confined vapor), 763 liniment, 575 water, 575 Ammoniac, 382 plaster with mercury, 225, 382 Ammoniacum, 382 Ammoniated glycyrrhizin, 623 mercury, 224 tincture of guaiac, 261 of valerian, 384 Ammonii benzoas, 334 bromidum, 529 $41 842 GENERAL INDEX. Ammonii carbonas, 158, 5 75 chloridum, 618 valerianas, 3S4 Ammonio-ferric alum, 188 sulphate, 188 tartrate, 188 Ammonium, 604 benzoate, 334 bromide, 529 carbonate, 158, 575 chlorate, 016, 618 iodide, 247 iodidum, 247 valerianate, 3S4 Amyl nitris, 525 nitrate, 525, 604 Amylene hydrate, 412 Anemonin, 58S Anesthetics, 398 Anhydro-ortho-sulphanin-benzoic acid, ( Animal charcoal, 774 extracts, 219 Ani^e, 361 water, 362 Anisum, 361 Anthelmintics, 695 Anthemis, 174 Antimonii et potassii tartras, 606 Antimony chloride, 757 and potassium tartrate, 602, 606, 617 Antipyrine, 394 Antiseptol, 329 Antispasmodics, 381 Apiol, 704, 709 Apiolum, 709 Apomorphine, 617 hydrochlorate, 602 Aqua acidi carbolici, 304 ammonia fortior, 574 ammoniae, 575 anisi, 362 camphorae, 383 chlori, 357 chloroformi, 405 cinnamomi, 364 creosoti, 311 eucalypti, 341 fceniculi, 366 hydrogenii dioxidi, 353 menthae piperitae, 376 viridis, 378 picis liquidae, 624 Aquae medicatae, 53 Aqueous fluid extract of senna, 96 Argenti cyanidum, 741 iodidum, 250, 742 nitras, 742 dilutus, 591, 742 fusus, 742 oxidum, 743 Argonin, 746 Aristol, 329 Arnica, 771 flores, 589 Arnica flowers, 589 plaster, 589 radix, 589 root, 589 Aromatic bitters, 1 74 powder, 363, 373 of chalk, 156 and opium, 156 spirit of ammonia, 575 sulphuric acid, 141 syrup of rhubarb, 679 tincture of rhubarb, 678 waters—official, 53 Aromatics, 359 Arseni iodidum, 237 Arsenic iodide, 237 solutions, 54 trioxide, 236 Arsenious acid, 757 Arsenous acid, 236 Asafetida, 3*1, 704 Asaprol, 322-324 Asparagin hydrargyrate, 228 Aspidium, 695, 697, 699 Aspidosperma, 5X7 Aspidospermine, 5'8 Astringents, 710 Atropa mandragora, 455 Atropina, 454 Atropinae sulphas, 455 Atropine, 454 compared with morphine, 459 sulphate, 455 Bacilli, 115 Balsam of copaiba, 647 of Peru, 339 of tolu, 617, 620 Balsamum Peruvianum, 339 tolutanum, 620 tranquillans, 119 Bandages—antiseptic dressings, 127 Barbadoes aloes, 674 Barker's pills, 113 Barley, 773 Basham's mixture, 54 Basic mercuric sulphate, 228 Basilicon, 123 Bateman's pectoral drops, 91 Baths, 704 Battery-fluid, 56 Bay rum, 59 Bearberry, 640 Beef and wine, 85 wine, and iron, 85 wine, iron, and cinchona, 86 Beer, 564 Belladonna, 661 leaves, 453 liniment, 454 ointment, 454 plaster, 454 root, 454 Belladonnae folia, 453 GENERAL INDEX. Belladonnae radix, 454 Ben/.oate of bismuth, 335 of menthol, 335, 377 Benzoated lard, 334 Benzoic acid, 334 Benzoin, 333 Benzoinum, 333 Benzonaphtol, 322, 323 Benzosol, 312 Benzoyl-eugenol, 370 Benzoyl-sulphonic-imide, 657 Bestucheff's tincture, 90 Beta-naphtol, 322 Betol, 323, 324 Biniodide of mercury, 226 Birch tar, 625 Bismuth, 711 and ammonium citrate, 751 chrysophenate, 752 citrate, 751 naphtholate, 752 salicylate, 752 subcarbonate, 751 subgallate, 752 subiodide, 752 subnitrate, 752 tribromphenate, 752 Bismuthi et ammonii citras, 751 benzoas, 335 citras, 751 salicylas, 752 subcarbonas, 751 subiodidum, 752 subnitras, 752 Bitter wine of iron, 186 Bitters, 172 Black cohosh, 63 draught, 83 drop, S4 haw, 73, 520 mustard, 70S oxide of manganese, 199 pepper, 368 wash, 228 Blackberry, 725 aromatic, 66 cordial, 73 Bland oils, 77 3 Blaud's pills, in, 192 Blistering cerate, 122 collodion, 119, 764 paper, 126 Blood-root, 265 Blue cohosh, 707 flag, 680 mass, 108, 224 ointment, 121, 224 pill, 224 Bolus, 115 Bone-marrow, 222 Boracic acid, 346 Borax, 345, 7°4, 7°5 Bougies, 124 Boulton's solution, 56 Brain-extract, 222 Bran, 773 Brandy, 59, 562 Bray era, 701 Bread, 773 Bromide of iodine, 250 Bromides, 529, 604 Bromine, 75S, 762 Bromoform, 531 Bromum, 762 Broom, 551 Brown mixture, 75, 623 Brown-Sequard's antineuralgic pills, Buchu, 632, 639 Buckthorn, 70 berries, 66 Burgundy pitch, 772 -pitch plaster, 772 Burnt alum, 747 Butter of antimony, 757 Butternut, 681 Butyl-chloral hydrate, 424 Cacao butter, 773 Cactus, 554 Caffeina, 55^ citrata, 556 effervescens, 557 Caffeine, 556 citrate, 556 Calabar bean, 510 Calamus, 374 Calcii bromidum, 530 carbonas praecipitatus, 156 hypophosphis, 206 phosphas praecipitatus, 206 sulphocarbolas, 309 Calcined magnesia, 158, 669 Calcium bromide, 530 hypophosphite, 206 sulphocarbolate, 309 Calendula, 173 Calomel, 225, 661 and jalap powder, 104 Calumba, 173 Calx, 761 chlorata, 35S Cambogia, 6S7 Camphor, 3S2, 77' ice, 123 liniment, 383 water, 383 Camphora, 382 carbolisata, 305 monobromata, 383 Camphorated carbolic acid, 305 chloral, 412 naphtol, 323, 324 tincture of opium, 383, 430 Camphoric acid, 383 Canada liniment, 116 -pitch plaster, 126 snake-root, 63 Cannabin tannate, 413 844 GENERAL. INDEX. Cannabine tannate, 448 Cannabinone, 448 Cannabis Indica, 448 Cantharidal collodion, 764 pitch plaster, 772 Cantharides, 704, 763, 764 cerate, 764 Cantharidis paper, 126 Cantharis, 764 Capsicum, 366, 771 plaster, 367 Caraway, 379 Carbasus acidi carbolici, 304 Carbolated oil, 304 Carbolic acid, 304, 757 Carbolic-acid gauze, 304 plaster, 305 water, 304 Carbon tetrachloride, 410 Cardamom, 372 Cardamomum, 372 Cardiac stimulants, 536 Carron oil, 116 Carum, 379 Caryophyllus, 369 Casca bark, 639 Cascara sagrada, 72, 668 Cascarilla, 175 Cassia cinnamon, 363 fistula, 666 Castor oil, 667 Catarrh snuff, 104 Catechol, 325 Catechu, 711, 717 Cathartic acid, 683 Cathartics, 658 Cathartinic acid, 683 Caulophyllum, 704, 707 Caustic potash, 757, 759 soda, 757, 759 Caustics (escharotics), 127, 756 Cayenne pepper, 366 Celery compound, 68 Cerata, 122, 123 Cerate of lead subacetate, 727 Cerates, 122 Ceratum cantharidis, 764 plumbi subacetatis, 727 Cerii oxalas, 755 Cerium oxalate, 711, 755 Cerous oxalate, 755 Cetraria, 773, 780 Cevadilla, 583 Ceylon cinnamon, 363 Chalk mixture, 74 Chalybeate pills, in, 192 Chamomile, 174 Channing's solution, 56 Chapman's dinner pill, 112 mixture, 76 Charcoal, 774 Charta potassii nitratis, 591 sinapis, 769 Chemical food, 65 Chemical waters, official, 53 Chenopodium, 6q5, (>96 Chinconidinae sulpha.-, 211 Chinoidine, 212 Chinoidinum, 212 Chinolin, 212 tartras, 212 tartrate, 212 Chirata, 174 Chloral, 412, 604 Chloral ammonium, 413 butylicum, 424 formamide, 422 formidatum, 422 glycerite, 412 menthol, 377 phenol, 412 urethane, 413, 422 Chloralamide, 422 Chloralose, 413, 422 Chlor-ammonium, 422 Chloride of lime, 358 Chlorinated lime, 358 Chlorine water, 357 Chlorodyne, 405 Chloroform, 405, 771 anodyne, 76 emulsion, 405 liniment, 405 water, 405 Chloroformum, 405 Chlorohydrophosphate of lime, 63 Cholera mixture, 76 Chromic acid, 757, 758 anhydride, 758 trioxide, 758 Churchill's iodine caustic, 57 tincture of iodine, 90 Cimicifuga, 63 Cinchona, 209 rubra, 210 Cinchonidinae salicylas, 212 Cinchonidine salicylate, 212 sulphate, 211 Cinchonina, 211 Cinchoninae iodosulphas, 212 sulphas, 211 Cinchonine, 211 iodosulphate, 329 sulphate, 211 Cinnamomum, 362 Cinnamon, 362, 704 water, 364 Cinnamyl-eugenol, 370 Citric acid, 149 Citrine ointment, 228 Clemens' solution, 57 Cloves, 369 Coca, 70, 490 Cocaina, 491 Cocainae hydrochloras, 491 phenas, 491 Cocaine, 491 hydrochlorate, 491 GENERAL INDEX. Cocaine phenate, 491 Cocculus, 475 Indicus, 475 Codeina, 431 Codeine, 431 C.d liver oil, 134, 704 Coffee, 64 Colchicum, 256 Cold cream, 121 Cole's dinner pill, 112 Collodia, official, 119 Collodion, 774 Collodium stypticum, 712 cantharidatum, 764 Colocynth, 691 Colocynthis, 691 Colorless tincture of iodine, 90 Columbo, 173 Comparative action of alkalies, 162 Composition powder, 104 Compound anise powder, 105 cathartic pills, 687 chalk powder, 156 decoction of sarsaparilla, 263 effervescing powder, 689 extract of colocynth, 675, 691 fluid extract of sarsaparilla, 263 of stillingia, 265 infusion of senna, 365, 670, 683 iron mixture, 1N2, 338 jalap powder, 692 liniment of mustard, 769 liquorice powder, 366 mixture of glycyrrhiza, 623 pills of antimony, 261 of rhubarb, 676 powder of glycyrrhiza 623, 683 of jalap, 153 of moqmine, 431 of rhubarb, 374 rhubarb pills, 678 powder, 678 solution of iodine, 247 spirit of aether, 399 of juniper, 365, 366, 380, 642 syrup of sarsaparilla, 263 of squill, 607, 627, 637 of stillingia, 265 tincture of benzoin, 334, 620, 676 of cardamom, 363, 372, 380 of catechu, ^3 of cinchona, i7<>, 211 of gentian, 173 of lavender, 363, 375 Compressed pills, 115 Confectio rosae, 725 sennae, 365 Confection of rose, 725 of senna, 365, 6S3 Confectiones, 106, 107 Confections, 106 Coniina, 500 Conii nx- hydrobromas, 500 Coniine, 500 Coniine hydrobromate, 496 Conium, 500 juice, 500 Conserve of rose, 107 Convallamarin, 555 Convallamarinum, 555 Convallaria, 555 Convallarin, 555 Copaiba, 632, 647 Copper, 711 ^ sulphate, 739, 757 Coriander, 364 Coriandrum, 364 Corn collodion, 120 Corrosive chloride of mercury, 225 mercuric chloride, 225 sublimate, 225 Cotton root bark, 4*4. 7°5 Court plaster, 774, 782 Coxe's hive syrup, 62 Cramp bark, 521 Cranesbill, 723 Cream of tartar, 153 Creasols, 305 Creasote, 310 Creosote water, 310 Creosotum, 310 Creta praeparata, 156 Croton chloral, 424 collodion, 120 oil, 684, 763 Cubeb, 651 Cubeba, 650 Culver's root, 682 Cupri arsenis, 238 sulphas, 739 Cupric arsenite, 238 Curacoa aloes, 674 cordial, 67 Curare, 515 Cusso, 695, 696, 701 Dalby's carminative, 75 Damiana, 73 Dandelion, 671 Decocta, 84 Decoction of cetraria, 780 of stillingia, 265 Decoctions, 84 Decoctum cetrariae, 780 sarsaparillae compositum, 263 stilllngiae 265 Demulcents, 773 Denarcotized opium, 430 Deodorant solution, 58 Deodorized alcohol, 562 opium, 430 Dermatol, 752 Dermol, 752 Dewees' carminative, 77 tincture of guaiac, 90 Diachylon, 125 ointment, 728 plaster, 728 846 GENERAL INDEX. Dialyzed iron, 192 Diaphoretics, 504 Diethylendiamine, 656 Diethyl-sulphon-diethyl-methane, 425 Diethyl-sulphon-methyl-ethyl-methane, 425 Digestants, 131 Digitalin, 539 Digitalinum. 530. Digitalis, 539, 704 Digitoxin, 540 Diluted acetic acid, 149 hydrobromic acid, 531 hydrochloric acid, 140 hydrocyanic acid, 521, 742 hypophosphorous acid, 207 nitric acid, 141 nitrohydrochloric acid, 140, 141 phosphoric acid, 140 silver nitrate, 591, 742 solution of lead subacetate, 727 sulphuric acid, 141 Dimethyl ether, 410 Dinner pill, 111 Disease medicines, 131 Dispensatory, 26 Dispermin, 656 Dithymol di-iodide, 329 Diuretin, 557, 632, 653 Dobell's solution, 58, 305 Donovan's solution, 54, '238 Dover's powder, 103, 430 Drastic purgatives, 691 Dried alum, 747 ferrous sulphate, 190 sodium carbonate, 155 Drugs, untoward effects of, 34 Dry acid wines, 564 Dysmenorrhea mixture, 89 Ecbolics, 704 Effervescent Carlsbad salt, 106 citrated caffeine, 557 Kissingen salt, 106 magnesium citrate, 688 salts, 105 Vichy salt, 106 Effervescing saline water, 58 Elaterin, 686 Elaterinum, 686 Electuar. sennae, 107 Elixir aurantiorum compositum, 85 calisaya, 69 of paraldehyde, 428 of phosphorus, 201 paraldehydi, 428 phosphori, 201 purgans, 72 Elixiria, 66-73 Elixirs, 66 adjuvant, 67 medicinal, 68 Elm, 780 Emetics, 601 Emmenagogues, 704 Emollients, 773 Emplastra, 124-126 Emplastrum acidi carbolici, 305 aramoniaci cum hydrargyro, 225, 382 arnicae, 589 belladonnae, 454 capsici, 367 ferri, 191, 772 hydrargyi i, 225 ichthyocolla', 774, 7S2 opii, 430, 772 picis Burgundicae, 772 cantharidatum, 764, 772 plumbi, 728 Emulsion of ammoniac, 382 of asafetida, 381 Emulsiones, 78-81 Emulsions, 78 Emulsum ammoniaci, 382 asafcetidae, 381 chloroformi, 405 guaiaci, 261 Epispastics, 763 Epsom salt. 688 Ergot, 47S, 661, 704, 705 of rye, 473 Ergota, 478 Ergotin, 479 Erythrophleum, 632, 639 Escharotics, 756 Eserine salicylate, 510 sulphate, 510 Essence of ginger, 59 of nutmeg, 369 of peppermint, 376 of spearmint, 378 of wintergreen, 375 Ether, 771 Ethereal tinctures, 91 Ethyl bromide, 409 carbamate, 413 chloride, 409 iodide, 409 urethane, 413 Ethylene bichloride, 409 bromide, 409 chloride, 409 iodide, 409 Ethylenimine, 656 Ethylidene chloride, 409 Eucalyptol, 341 Eucalyptus, 340 water, 341 Eugenol-acetamide, 370 Euonymin, 680 Euonymus, 680 European hellebore, 583 Europhen, 330 Exalgine, 397 Expectorants, 616 Expressed oil of almond, 778 Extract of aconite, 578 of aloes, 675 of arnica root, 589 GENERAL INDEX Extract of cinchona, 211 of colchicum root, 256 of colocynth, 691 of conium, 500 of convallaria, 555 of digitalis, 539 of ergot, 478 of euonymus, 680 of gentian, 173 of glycyrrhiza, 623 of hematoxylon, 721 of hyoscyamus, 464 of iris, 681 of jalap, 692 of juglans, 682 of krameria, 719 of leptandra, 682 of nux vomica, 467 of opium, 430 of pancreas, 222 of physostigma, 510 of podophyllin, 694 of pulsatilla, 588 of quassia, 172 of rhubarb, 678 of taraxacum, 674 of uva ursi, 641 Extracta, 97 fluida, 92-96 Extractive preparations, 81 Extracts, 97 official, table of average doses, 98 Extractum aconiti, 578 fluidum, 578 aloes, 675 arnicae radicis, 589 fluidum, 589 aspidospermatis fluidum, 518 belladonnae foliorum alcohol icum, 454 radicis fluidum, 454 cacti fluidum, 554 calami fluidum, 374 calendulae fluidum, 174 calumbae fluidum, 173 cannabis indicae, 448 fluidum, 448 capsici fluidum, 367 chiratae fluidum, 174 cinchonae, 211 fluidum, 211 cocae fluidum, 491 cocculi fluidum, 476 colchici radicis, 256 fluidum, 256 seminis fluidum, 257 colocynthidis, 691 compositum, 675, 691 conii, 500 fluidum, 500 convallariae fluidum, 555 cubeba- fluidum, 651 cusso fluidum, 701 digitalis, 539 fluidum, 539 Extractum ergotae, 478 fluidum, 479 eucalypti fluidum, 340 euonymi, 680 gelsemii fluidum, 504 gentianae, 173 fluidum, 173 geranii fluidum, 723 glycyrrhizae, 623 fluidum, 623 purum, 623 gossypii radicis fluidum, 484 grindeliae fluidum, 508 hematoxyli, 721 hamameiidis fluidum, 721 hydrastis fluidum, 485 hyoscyami, 464 fluidum, 464 ipecacuanhae fluidum, 610 iridis, 681 fluidum, 681 jalapae, 692 juglandis, 682 juniperi fructus fluidum, 642 krameriae, 719 fluidum, 719 leptandrae, 682 fluidum, 682 lobeliae fluidum, 615 lupulini fluidum, 446 mezerei fluidum, 269 nucis vomicae, 467 fluidum, 467 opii, 430 physostigmatis, 510 phytolaccae radicis fluidum, 587 pilocarpi fluidum, 594 podophylli, 694 fluidum, 694 pulsatillae, 588 quassiae, 172 fluidum, 172 rhei, 678 fluidum, 678 rhois aromaticae fluidum, 724 glabrae fluidum, 724 rosae fluidum, 725 rubi fluidum, 726 sabinae fluidum, 705 sanguinariae fluidum, 266 sarsaparillae fluidum, 263 compositum, 263 scillae fluidum, 637 scoparii fluidum, 551 senegae fluidum, 627 sennae fluidum, 683 serpentariae fluidum, 176 spigeliae fluidum, 699 stillingiae fluidum, 265 compositum, 265 stramonii seminis, 463 fluidum, 463 taraxaci, 674 fluidum, 674 848 GENERAL INDEX Extractum uvae ursi, 641 fluidum, 641 Valerianae fluidum, 3S4 veratri viridis fluidum, 583 viburni opuli fluidum, 521 prunifolii fluidum, 520 xanthoxyli fluidum, 270 zingiberis fluidum, 373 False hellebore, 554 Fats and oils, 134 Fehling's solution, 56 Fel bovis, 677' purificatum, 677 tauri, 677 Fennel, 365 water, 366 Fenner's guaiac mixture, 89 Ferrated extract of apples, 90 Ferratin, 192 Ferri albuminas, 192 arsenas, 192 carbonas saccharatus, 182 chloridum, 183 citras, 184 et ammonii citras, 185 sulphas, 188 tartras, 188 et potassii tartras, 188 et quininae citras, 185 solubilis, 186 et strychninae citras, 186, 468 hypophosphis, 189 iodidum saccharatum, 183 lactas, 187 oxidum hydratum, 187 cum magnesia;, 187 phosphas solubilis, 188 pyrophosphas solubilis, 189 sulphas, 190 exsiccatus, 190 granulatus, 190 valerianas, 189, 384 Ferric ammonium sulphate, 188 chloride, 183 citrate, 184 hydrate, 187 with magnesia, 187 hydroxide, 187 hypophosphite, 189 valerianate, 189, 384 Ferrous chloride, 64 lactate, 187 sulphate, 190 Ferruginous pills, in, 192 Ferrum dialysatum, 192 reductum, 181 Figs, 773 Fish berry, 475 Flaxseed, 773 Flour, 773 Fluid extract of aconite, 578 of arnica root, 589 of aspidosperma, 518 Fluid extract of belladonna root, 454 of black haw, 520 of cactus, 554 of calamus, 374 of calendula, 174 of calumba, 173 of capsicum, 367 of chirata, 174 of cinchona, 211 of coca, 491 of cocculus, 476 of colchicum root, 256 seed, 257 of conium, 500 of cotton-root bark, 484 of cramp bark, 521 of cubeb, 651 of cusso, 701 of digitalis, 539 of ergot, 479 of eucalyptus, 340 of gelsemium, 504 of gentian, 173 of geranium, 723 of ginger, 373 of glycyrrhiza, 623 of grindelia, 508 of hamamelis, 721 of hydrastis, 485 of hvoscyamus, 464 of Indian cannabis, 448 of ipecacuanha, 610 of iris, 681 of juniper berries, 642 of krameria, 719 of leptandra, 682 of lobelia, 615 of lupulin, 446 of mezereon, 269 of nux vomica, 467 of phytolacca root, 587 of pilocarpus, 594 of podophyllum, 694 of quassia, 172 of rhubarb, 678 of rhus aromatica, 724 glabra, 724 of rose, 725 of rubus, 726 of sanguinaria, 266 of sarsaparilla, 263 of savine, 705 of scoparius, 551 of senega, 627 of senna, 683 of serpentaria, 176 of spigelia, 699 of squill, 637 of stillingia, 265 of stramonium seed, 463 of taraxacum, 674 of uva ursi, 641 of valerian, 384 of veratrum viride, 583 GENERAL INDEX. Fluid extract of xanthoxylum, 270 Fluid extracts, 92 Fluorescein, 325 Fceniculum, 305 Fomentations, 127 1'ormamidate of mercury, 228 Formic ether, 410 Fowler's solution, 54, 237 Foxglove, 539 Francis's triplex pill, 114 " French mixture," 56 Friable pills, 115 Gadberry's mixture, 77 Galbanum plaster, 126 Galla, 711, 715 Gallic acid, 711, 714 (.ambnge, (187 Girlie,'017, 021 Gastric sedatives, 603 Gastrin, 222 Gelatin, 773 Gelsemina, 504 Gelsemium, 504 Gentian, 172 Gentiana, 172 Geranium, 711, 723 Gin, 59, 563 Ginger, 373 Glacial acetic acid, 757, 760 (ilauber's salt, 690 Globules. 114 Glucusimide, 657 Gluside, 657 Glycerine, 661, 773, 774 Glycerinum, 774 Glycerita, 73, 74 Glycerite of alum, 747 of boroglycerin, 346 of carbolic acid, 304 of glyceryl borate, 346 of hydrastis, 485 of starch, 775 of tannic acid, 712 of tar, 625 of yolk of egg, 775 Glyceritum acidi carbolici, 304, 775 tannici. 712, 7 75 amyli, 775 boroglycerini. 346, 775 hydrastis, 4S5, 775 picis liquidae, 625 vitelli, 775 Glycerole of pepsin, 74 Glyconin, 775 Glycyrrhiza, 622 Glycyrrhizinum ammoniatum, 623 Godfrey's cordial, 77 Golden seal, 485 Gossypii radicis cortex, 4S4 Goulard's cerate, 123. 727 extract, 727 Granatum, 695, 696. 701 Granulated ferrous sulphate, 190 Granules, 114 Green iodide of mercury, 226 Griffith's mixture, 74, ls2 Grindelia, 507, 617 Gross' antineuralgic pills, 112 Guaiac, 260, 704 emulsion, 2bi Guaiaci lignum, 260 resina, 260 Guaiacol, 312 benzoate, 312 carbonate, 313 di-iodide, 313 salicylate, 313 Guaiacoli benzoas, 312 carbonas, 313 di-iodidum, 313 salicylas, 313 Guaiacolum, 312 Guaiacum wood, 260 Guaramine, 557 Gum Arabic, 779 H^malbumin, 193 Haemoferrum, 193 Haemogallol, 192 Haemoglobin, 193 , Haemol, 192 Hall's dinner pill, 112 solution of strychnine, 58 Hamamelis, 711, 721 Heart-extract, 222 Hebra's ointment, 121 Hedeoma, 704, 709 Heliotropin, 368 Hematics, 181, 704 Hematoxylon, 711, 720 Hemlock, 500 Henbane, 464 Hiera picra, 104 Hive syrup, 607 Hoffmann's anodyne, 60, 399 Homatropina, 455 Honey, 773 Hope's mixture, 75 Hops, 445 Hot drops, 90 Humulus, 445 Huxham's tincture, 88 Hydragogue purgatives, 684 Hydrargyri chloridum mite, 225 corrosivum, 225 cyanidum, 226 formamidatum, 228 iodidum flavum, 226 rubrum, 226 viride, 226 oxidum flavum, 227 rubrum, 227 salicylas, 228 subsulphas flavus, 228 tannas, 228 Hydrargyrum, 223 ammoniatum, 224 54 85o GENERAL INDEX. Hydrargyrum cum creta, 156, 224 Hydrastina, 485 Hydrastinae hydrochloras, 4S5 Hydrastine, 485 hydrochlorate, 485 Hydrastis, 4*5, 704, 705 Hydrated oxide of iron, 187 Hydrochloric acid, 140 Hydrocyanic acid, 604 Hydrogen peroxide, 53 Hydronaphtol, 323, 324 Hydroquinol, 325 Hydroquinone, 325 Hyoscinae hydrobromas, 464 Hyoscine hydrobromate, 413, 464 Hyoscyami sulphas, 465 Hyoscyaminae hydrobromas, 465 Hyoscyamine hydrobromate, 465 sulphate, 465 Ihoseyamus. 404, 661 Hvpnal.413, 4^ Hypophusphiie of iron, 64 of lime, 63 and soda, 63 Ice, 603 Iceland moss, 780 Ichthyocolla, 782 Ichthyol, 327 Ichthyolum, 327 Indian tobacco, 614 Infusa, 83, 84 Infused oils, 119 Infusion of cinchona, 211 of convallaria, 555 of digitalis, 539 of hops, 446 of juniper, 642 of pilocarpus, 594 of wild cherry, 176 Infusions, 83 Infusum cinchonae, 211 convallariae, 555 digitalis, 539 humuli, 446 juniperi, 642 pilocarpi, 595 pruni Virginianae, 176 sennae compositum, 365, 670, 683 Iodi bromidum, 250 chloridum, 250 Iodide of calcium, 63 of iron and manganese, 64 Iodine, 246, 763, 771 caustic, 57 chloride, 250 ointment, 247 trichloride, 250 Iodized collodion, 120 carbolic acid, 305 Iodoform, 329 collodion, 120 and naphtalin powder, 104 Iodoformum, 329 Iodol, 330 Iodum, 24' 1 Ipecac, 010, 763 Ipecacuanha, 602, 610, 017 Iridin, 681 Iris, 080 Irish moss, 64 Iron, 704 and ammonium tartrate, 188 citrate, 185 and potassium tartrate, 188 and quinine citrate, 185 and strychnine citrate, 186 arsenate, 192 by hydrogen, 181 plaster, 191 quinine chloride, 193 solutions, 54 Isinglass, 773, 7S2 plaster, 782 Jaborandi, 71, 594 Taborine, 595 Jackson's pectoral syrup, 65 Jalap, 692 Jalapa, 692 James's powder, 103 Jamestown weed, 462 Janeway's pills, 112 Javelle water, 57 Jimson weed, 462 Juglans, 681 Juniper, 632, 641 berries, 641 Juniperus, 641 Kamala, 605, 696, 702 Kino, 711, 7IN Kosin, 701 Koussein, 701 [ Kousso, 701 Krameria, 711. 719 Labarraque's solution, 55, 35s Lac sulphur, 671 Lactic acid, 146 Lactophosphate of lime with iron, 64 of iron, 64 Lactucarium, 447 Lady Webster's dinner pills, III Lafayette mixture, 76 Lamellae, 115 Lard, 773 Laudanum, 430 Laughing gas, 411 Laxative elixir, 72 Laxatives, 666 Lead, 711, 720 acetate, 726 carbonate, 727 iodide, 249, 727 nitrate, 728 oxide, 728 plaster, 728 GENERAL INDEX. 851 1 t ad water, 55, 727 Leeches, 704 Leptandra, 682 Leptandrin, 682 Levant wormseed, 697 Light magnesia, 15S, 669 red wines, 504 lignum vitae, 260 Lily of the valley, 555 Lime, 757, 701 juice and pepsin, 73 liniment, 157 water, 55, 157 Liniment of lead subacetate, 727 Linimenta, 116, 117 Liniments, 116 Linimentum album, 117 ammoniae, 575 belladonnae, 454 calcis, 157 camphorae, 383 chloroformi, 405 plumbi subacetatis, 727 saponis, 383 sinapis compositum, 769 Linseed meal, 773 oil, 773- <79 Liquid mixtures—internal, 74 rennet, 58 Liquor acidi arsenosi, 237 ammonii acetatis, 598 antimonii chloridi, 757 arseni bromidi, 238 arsenii bromidi, 57 et auri bromidi, 238 et hydrargyri iodidi, 227, 238 calcis, 157 ferri acetatis, 184 chloridi, 184 citratis, 185 dialysatus, 192 et ammonii acetatis, 184. 599 nitratis, 19I oxychlorati, 192 peptonati, 192 subsulphatis, 190 tersulphatis, 191 hydrargyri nitratis, 228 iodi compositus, 247 magnesii citratis, 688 mangano-ferri peptonatus, 192 plumbi subacetatis, 727 dilutus, 727 potassae, 152 arsenitis, 237 sedans, 520 sodae, 154 chloratae, 358 sodii arsenatis, 238 boratis compositus, 305 carbolatus, 305 Liquores, 53 unofficial, 55—59 Liquorice, 65, 617. 022, 773 I Liquorice root, 622 Litharge, 728 Lithii bromidum, 530 benzoas, 335 carbonas, 157 citras, 157 I effervescens, 158 salicylas, 315 Lithium benzoate, 335 bromide, 530 carbonate, 157 citrate, 1^7 salicylate, 315 Lobelia, 602, 607, 614 Local anti-emetics, 603 Logwood, 720 Loomis's diarrhea mixture, 76 Losophene, 330 Lotio flava, 228 nigra, 228 Lotiones, 117, 118 Lugol's solution, 55 Lunar caustic, 742 Lupulin, 445 Lupulinum, 445 Lycopodium, 774, 783 Lysol, 625 Mace, 368 Macis, 368 Magendie's solution of morphine, 57 Magnesia, 661, 669 Magnesii carbonas, 158, 670 sulphas, 688 effervescens, 688 sulphocarbolas, 309 Magnesium carbonate, 158, 661, 670 sulphate, 688 sulphocarbolate, 309 Male fern, 699 Mandrake, 455 Manganese, 199 I dioxide, 199 sulphate, 199 Mangani dioxidum, 199 sulphas, 199 Manganum, 199 Manna, 670 Marigold, 173 Marshmallow, 773, 781 Mass of copaiba, 648 of ferrous carbonate, 182 of mercury, 224 Massa ferri carbonatis, 182 j copaibae. 648 hydrargyri, 224. 775 Massae, 108 Masses, 108 May apple, 694 I Meadow-saffron, 256 Medicated cottons, 128 dressings, 1 28 gauzes—carbasa, 128 ! waters, 53 852 GENERAL INDEX. Medicines, administration of, 29 classification of, 24 disease, 26 dosage, 31 symptom, 26 Medullin, 222 Mentha piperita, 376 viridis, 377 Menthol, 377, 771 benzoas, 335 Mercurial ointment, 224 plaster, 225 Mercuric chloride, 757 cyanide, 226 nitrate, 757 oxide, 757 Mercurous salicylate, 228 tannate, 228 Mercury, 223 with'chalk, 156, 224, 662 Metallorum amarae, 114 Methyl chloride, 409 Methylacetanilide, 397 Methylal, 410 Methylen, 410 Methylene bichloride, 409 Methylic ether, 410 Metric system, 44 Mezereon, 26S, 763, 771 Mezereum, 268 Mild chloride of mercury, 225 mercurous chloride, 225 Milk of sulphur, 671 Mineral acids, 139, 757 astringents, 711, 720 waters, 167 Mistura antidysenterica, 75 ferri composita, 1S2, 338 glycyrrhizae composita, 623 opii alkalina, 77 rhei et sodae, 155, 678 solvens simplex, 75 Misturae, 74-78 Mitigated caustic, 742 Mixture of chloral and bromide, 75 of rhubarb, and soda, 155, 678 Monobromated camphor, 383 Monsel's solution, 54, 190 Morphina, 431 Morphinae acetas, 431 hydrochloras, 431 sulphas, 431 Morphine, 661 acetate, 431 hydrochlorate, 431 sulphate, 431 Mother's salve, 122 Motor excitants, 466 Moulded silver nitrate, 742 Mucilage of acacia, 779 of elm, 781 of sassafras pith, 782 of tragacanth, 782 Mucilages, 74 Mucilagines, 74 Mucilago acaciae, 77') sassafras medulla;, 782 tragacanthae, 775. 7*2 ulmi, 781 Muriatic acid, 140 Muscarine, 661 Muscle-extract, 222 Mustard, 704, 70S, 771 paper, 769 volatile oil, 763 Myristica, 368 Myrrh, 33S, 704 Myrrha, 338 Naphtalin, 322, 324 ; Naphtalinum, 322, 324 Naphtol, 322, 324 Xaphtosalol, 323 Native mineral springs, list of, 170 Xeutral mixture, 54 Nitre, 591 Nitric acid, 141 ! Nitroglycerin, 525, 604 pills, 113 Nitrohydrochloric acid, 140, 141 Nitrous oxide, 411 Nuclein, 221 Nutgall, 715 Nutmeg, 368 Nux vomica, 467, 661 Oatmeal, 773 Official—officinal, 23 Oil of allspice, 371 of American wormseed, 696 of anise, 361 of cade, 625 of cajuput, 371, 771 of caraway, 380 of chenopodium, 696 of cinnamon, 363 of cloves, 370 of copaiba, 648 of coriander, 365 of cubeb, 651 of eucalyptus, 340 of fennel, 366 of flaxseed, 779 of hedeoma, 709 of juniper, 641 of lavender flowers, 375 of nutmeg, 369 of pennyroyal, 709 of peppermint, 376 of pine, 624 of rue, 705, 707 of sandalwood, 650 of savine, 705 of Scotch fir, 617, 624 of tar, 624 of turpentine, 771 of wintergreen, 375 I Ointment of ammoniated mercury, 224 GENERAL INDEX. Ointment of carbolic acid, 304 of iodoform, 329 of lead carbonate, 727 iodide, 728 of mercuric nitrate, 228 of pota-sium iodide, 248 of red mercuric oxide, 227 of sulphur iodide, 249 of tannic acid, 712 of yellow mercuric oxide, 227 of zinc oxide, 735 Oleata, official, 118 unofficial, 119 Oleate of aconite, 579 of sodium, 58 of veratrine, 583 Oleates, 118, 119 Oleatum aconitinae, 579 veratrinae, 583 Oleoresin of aspidium, 699 of capsicum, 367 of cubeb, 651 of ginger, yjT, of lupulin, 446 of pepper, 368 Oleoresina aspidii, 699 capsici, 367 cubebae, 651 lupulini, 446 piperis, 308 zingiberis, 373 'Oleoresinae, 99 Oleoresins, 99 'Oleum acidi carbolici, 304 amvgdakv expressum, 778 anisi, }(>i cadinum, 625 cajuputi, 371 cari, 380 caryophylli, 370 chenopodii, 696 cinnamomi, 363 copaibae, 648 coriandri, 365 cubebae, 651 eucalypti, 340 fceniculi, 366 gaultheriae, 375 hedeoma, 709 juniperi, 641 lavandulae florum, 375 lini, 779 menthae piperitae, 376 morrhua\ 134 myristica', 369 olivae, 777 phosphoratum, 201 picis liquidae, 624 pimentae, 371 pini syhestris, 617, 624 ricini, 667 rusci, 625 ruta-, 707 sabinae, 785 Oleum santali, 650 sinapis volatile, 769 templinum, 624 tiglii, 684 Olive oil, 773. 777 Onion, 617, 021 Opii pulvis, 430 Opium, 431, 004 compared with its alkaloids, deodoratum, 430 plaster, 430 Opodeldoc, 117 Organotherapy, 219 (hthodioxybenzene, 325 Ouabain, 549 Ovarin, 222 Oxgall, 677 Ow sulphate of iron, 56 Oxytocics, 704 Pancreatic solution, 57 Pancreatin, 133 Pancreatinum, 133 Papain, 133 Papers, 126 Paradioxybenzene, 325 Paraffin, 773 Paraldehyde, 427 Paraldehydum, 427 Paregoric, 88, 430 Parrisli's camphor mixture, 75 Parsley, 708 Parvules, 114 Pearson's solution, 238 Pelletierinae tannas, 702 Pelletierine, 702 tannate, 702 Pennyroyal, 709 Pental, 410 Pepo, 695, 696, 703 Pepper, 368 Peppermint, 376 Pepsin, 131 Pepsinum, 131 saccharatum, 132 Peptonizing powder, 104 Petrolatum, 773 Petroleum, 773 ' Petroselinum, 708 Pharmaceutical preparations, 51 Pharmacology, 21 Pharmacopoeia, 23 Pheasant's eye, 554 Phenacetin, 395 Phenocoll, 396 Phenol-camphor, 305 iodatum, 305 -sodique, 58, 305 Phenyl salicylate, 320 Phosphatic emulsion, 81 Phosphorated oil, 201 | Phosphoric acid, 140 Phosphorus, 200 Physostigma, 510, 661 854 GENERAL INDEX. Physostigminae hydrobromas, 511 salicylas, 510 sulphas, 510 Physostigmine hydrobromate, 511 salicylate, 510 sulphate, 510 Phytolacca fruit, 586 root, 586 Phytolaccae fructus, 586 radix, 586 Picrotoxin, 476 Picrotoxinum, 476 Pills, 109 of aloes, 675 and asafetida, 381, 675 and iron, 191, 675 and mastich, 675 and myrrh, 338, 675 of asafetida, 381 of ferrous carbonate, 192 iodide, 183 of opium, 430 of phosphorus, 201 of rhubarb, 678 Pilocarpinae hydrochloras, 594 Pilocarpine, 594, 661, 705 hydrochlorate, 594 Pilocarpus, 594, 617 Pilulae, 109-114 aloes, 675 et asafoetidae, 381, 675 et ferri, 191, 675 et mastiches, 675 et myrrhae, 338, 675 antimonii compositae, 261 asafcetidae, 381 catharticae compositae, 687, 691, 692 vegetabiles, 682, 691, 692 Cochia, 113 ferri carbonatis, 192 et quininae compositae, 114 iodidi, 183 hydrargyri, 224, 662 official, III opii, 430 phosphori, 201, 775 rhei, 678 compositae, 676, 67S unofficial, m-114 Pimenta, 371 Pinkroot, 699 Piper, 368 Piperazidine, 656 Piperazinum, 656 Piperin, 368 Piperinum, 368 Piperonal, 368 Pitch, 771 Pix betulae, 625 Burgundica, 772 liquida, 624 Fixol, 625 Plaster-mull, 127 Plaster-of-Paris bandages, 129 Plasters, 124 Plumbi acetas, 726 carbonas, 727 iodidum, 249, 727 nitras, 728 oxidum, 728 Plumbum, 726 Plummers pills, in, 261 Podophyllotoxin, 694 Podophyllum, 694 Poison ivy, 488 Poke root, 586 Pomegranate, 701 Port wine, 563 Porter, 564 Potassa, 759 and lime, 757 with lime, 759 Potassii acetas, 152 bicarbonas, 152 bichromas, 350 bitartras, 153 bromidum, 529 carbonas, 153 chloras, 351 citras, 153 cyanidum, 525 et sodii tartras, 689 hypophosphis, 207 iodidum, 248 nitras, 591 permanganas, 348 sulphas, 688 sulphocarbolas, 309 tartras, 154 Potassio-ferric tartrate, 188 Potassium acetate, 152 and sodium tartrate, 689 bicarbonate, 152 bichromate, 3^0 bitartrate, 153, 661 bromide, 529 carbonate, 153 chlorate, 351 citrate, 153 cum calcii, 759 cyanide, 525 hydrate, 759 hydroxide, 759 bypophn-phite, 207 iodide, 248, 617 nitrate, 591 paper, 591 permanganate, 348, 705 sulphate, 688 sulphocarbolate, 309 tartrate, 154, 661 Poultice (cataplasm), 127 Powder of ipecac and opium, 430, 611 Powdered opium, 430 Powders, 102 unofficial, 103 Precipitated calcium carbonate, 156 phosphate, 206 GENERAL INDEX. Precipitated sulphur, 671 zinc carbonate, 735 Preparations for external use, 115 of ammonium, 158 of calcium, 156 of iron, 181 of lithium, 157 of magnesium, 158 of sodium, 154 Prepared chalk, 156 Prescription-writing, 798 Prescriptions, 784 Prickly ash, 270 Proof spirit, 563 Protective agents, 773 Protoxide of mercury, 226 Prunus Virginiana, 175 Prussic acid, 521, 742 Pulsatilla, 588 Pulveres, 102-105 Pulvis aromaticus, 363, 373 cretae aromaticus, 156 cum opio, 156 compositus, 156 digestivus, 104 effervescens compositus, 689 glycyrrhizae compositus, 366, 623, 0S3 ipecacuanhae et opii, 430, 611 jalapae compositus, 153, 692 morphinae compositus, 431 rhei compositus, 374, 678 Pumpkin seed, 702 Purging cassia, 666 Purified aloes, 675 cotton, 774 oxgall, 677 Pyrocatechin, 325 Quassia, 172 Quebrachine, 518 Quebracho, 617 Queen's root, 264 Quercus alba, 711, 716 Quevenne's iron, 181 Quicksilver, 223 Quinetum, 212 Quinidinae sulphas, 211 Quinidine sulphate, 211, 212 Quininae bisulphas, 211 hydrobromas, 211 hydrochloras, 212 carbamidata, 213 sulphas, 212 valerianas, 212 Quinine, 211, 7°4, 7°5 bisulphate, 211 hydrobromate, 211 hydrochlorate, 212 valerianate, 212 Quinolin, 212 Rectifii-d spirit, 563 Red cinchona, 210 iodide of mercury, 226 1 Red mercuric iodide, 226, 227 precipitate, 227 rose, 725 wine, 563 Reduced iron, 181 Remedies, 21 Renin, 222 Resin of copaiba, 648 of jalap, 692 of podophyllum, 694 of scammony, 693 Resina copaibae, 648 jalapa\ 692 podophylli, 694 scammonii, 693 Resinae, 100 Resins, 100 Resopyrine, 325 Resorcin, 325 Resorcinum, 325 Restoratives, 131 Rhamnus Purshiana, 668 Rhatany, 719 Rheum, 677 Rhubarb, 677 Rhus aromatica, 724 glabra, 711, 724 toxicodendron, 488, 763 Rochelle salt, 689 Rosa gallica, 711, 725 Rottlera, 702 Rotulae, 115 Rubefacients, 771 Rubi compositum, 72 Rubus, 711. 725 Rue, 704, 706 Rum, 563 Ruta, 706 !Sabina, 705 | Saccharated ferrous iodide, 183 carbonate, 182 Saccharin, 657 Saccharine substances, 617 Saccharinum, 657 Sales effervescentes, 103 Salicin, 321 ! Salicinum, 321 j Salicvlated powder of talcum, 105 Salinaphtol, 323 Salol, 320 Saltpetre, 591 Sanguinaria, 265 Sanguinarine nitrate, 266 Santonica, 695, 697 Santonin, 697 Santoninum, 697 Saponin, 6l7 Sarsaparilla, 263 Sassafras medulla, 782 pith, 773, 7*2 Savine, 704, 705 Scammonium, 693 I Scammony, 693 856 GENERAL INDEX. Scilla, 636 Scoparine, 552 Scoparius, 551 Scopola carniolica, 455 japonica, 455 Sebadilla, 583 Seidlitz powder, 103, 0*9 Senega, 617, 627 Senna, 682 aromatic, 66 compound, 66 Serpentaria, 176 Serum-therapy, 271 Sherry wine, 563 Silver, 711 cyanide, 741 iodide, 250. 742 nitrate, 742, 757, 7^3 oxide, 743 Simple bitters, 172 cerate, 122 purgatives, 074 Sinapis alba, 708 nigra, 768 Slippery elm, 773, 7*0 Smith's solution of bromine, 55 Soap liniment, 3*3, 773 Socotrine aloes, 675 Soda, 759 mint, 77 Sodii acetas, 154 arsenas, 238 benzoas, 335 bicarbonas, 154 bisulphis, 356 boras, 345 bromidum, 529 carbonas, 155 exsiccatus, 155 hypophosphis, 206 hyposulphis, 356 iodidum, 248 nitras, 593 nitris, 527 phosphas, 689 salicylas, 315 sulphas, 690 sulphis, 356 sulphocarbolas, 309 Sodio-salicylate of theobromine, 653 Sodio-theobromine salicylate, 557 Sodium acetate, 154 arsenate, 238 benzoate, 335 bicarbonate, 154 bisulphite, 356 borate, 345 bromide, 529 carbonate, 155 hydrate, 759 hydroxide, 759 hypophosphite, 206 hyposulphite, 356 iodide, 248 Sodium nitrate, 593 nitrite, 527 orthophosphate, 689 phosphate, 089 salicylate, 315 sulphate, 690 sulphite, 356 sulphocarbolate, 309 Solid mixtures, internal use, 101 opodeldoc, 117 Soluble ferric phosphate, 188 pyrophosphate, 189 iron and quinine citrate, 186 saccharated iron, 65 Solution of ammonium acetate, 598 of antimony chloride, 757 of arsenic and gold bromide, 238 and mercuric iodide, 227, 238 bromide, 237 of arsenous acid, 237 of basic ferric sulphate, 190 of boroglyceride, 346 of calcium hydrate, 157 of chlorinated lime, 358 potassa, 57 of ferric acetate, 184 chloride. 184 citrate, 185 nitrate, 191 subsulphate, 190 sulphate, 191 of ferrous chloride, 56 of gutta percha, 774 of hydrogen dioxide, 353 of iodide of mercury and potassium, c6 of iron and ammonium acetate, 1*4, 599 of lead subacetate, 727 of lime, 157 of magnesium citrate, 688 of mercuric nitrate, 22S of oxysulphuret of calcium, 56 of peptonate of iron, 192 and manganese, ig2 of potash, 152 of potassium arsenite, 237 of saccharin, 57 of soda, 154 of sodium arsenate, 238 hydrate, 154 silicate, 774 Solutions, 53 of metallic compounds, 55 Sozal, 748 Sozoiodol, 330 Spanish flies, 764 Sparkling wines, 563 Sparteinae sulphas, 552 Sparteine sulphate, 552 Spearmint, 377 water, 378 Spermaceti, 773 Spice plaster, 126 Spigelia, 695, 696, 699 GEN ERA i Spirit of ammonia, 574 of anise, 362 of camphor, 383 of chloroform, 405 of cinnamon, 364 of ether, 399 of gaultheria, 375 of glonoin, 527 of juniper, 642 of lavender, 375 of nitroglycerin, 527 of nitrous ether, 000 of nutmeg, 369 of peppermint, 376 of phosphorus, 201 of soap, 60 of spearmint, 378 Spirits, 59, 60 Spiritus aetheris, 399 compositus, 399 nitrosi, 600 ammoniae, 574 aromaticus, 159, 575 anisi, 362 aurantii compositus, 363 camphorae, 383 chloroformi, 405 cinnamomi, 364 frumenti, 562 gaultheria-, 375 glonoini, 527 juniperi, 642 compositus, 365, 366, 380, 642 lavandulae, 375 menthae piperitae, 376 viridis, 378 Mindererus, 54 myristicae, 369 phosphori, 201 rectificatus, 563 vini gallici, 562 Spleen-mixture, 77 Spongiopiline, 127 Squibb's diarrhea mixture, 76 podophyllum pills, 114 rhubarb mixture, 77 Squill, 632, 636 Starch, 773 Stillingia, 264 comp., 96 St. John Long's liniment, 117 Stokes's expectorant, 77 liniment, 117 Stramonii folia, 462 semen, 463 Stramonium, 661 leaves, 462 seed, 463 Strengthening plaster, 125, 191 Stronger ammonia water, 574 Strontii bromidum, 530 iodidi, 248 Strontium bromide, 530 iodide, 248 I INDEX. 857 Strophanthin, 549 Strophanthus, 548 Strychnine, 407, 661, 704 Styptic collodion, 712 Sublimed sulphur, 671 Succus conii, 500 Sugar of lead, 726 Sulphaminol, 330 Sulphonal, 425 Sulphur iodide, 249 lotum, 671 ointment, 671 praecipitatum, 671 sublimatum, 671 Sulphuric acid, 140 Sulphuris iodidum, 249 Sulphurous acid, 355 Sumach, 724 Sumbul, 519 Sun mixture, 76 Suppositoria, 123, 124 glycerini, 775 Suppositories, 123 of glycerin, 775 Sweet flag, 374 spirit of nitre, 60, 600 sumach, 724 tincture of rhubarb, 89, 67* wines, 564 Syrup of acacia, 780 of althaa, 781 of calcium lactophosphate, 147 of citric acid, 149 of Dover's powder, 65 of ferrous iodide, 183 of garlic, 621 of ginger, 374 of hydriodic acid, 247 of hypophosphites, 207 with iron, 1S7, 207 of ipecac, 611 of lactucarium, 447 of morphine, 65 of phosphates of iron, quinine, and strychnine, 187 of rhubarb, 678 of senega, 627 of senna, 683 of squill, 637 of tar, 624 of tolu, 620 of wild cherry, 176 Syrups, 60 Svrupus acaciae, 780 acidi citrici, 149 hydriodici, 247 allii, 621 althaea, 781 calcii lactophosphatis, 147 corrigens, 64 ferri iodidi, 183 quininae, et strychninae phosphatum, 1*7, 4<>S hypophosphitum, 207 858 GEXERAL INDEX. Syrupus hypophosphitum cum ferro, 1*7, 207 ipecacuanhae, 611 krameria, 719 lactucarii, 447 picis liquidae, 624 pruni Virginianae, 176 rhei, 678 aromaticus, 679 sarsaparillae compositus, 263, 362 scillae, 637 compositus, 607, 627, 637 senegae, 627 sennae, 683 stillingiae compositus, 265 tolutanus, 620 zingiberis, 374 Systemic anti-emetics, 604 Tanacetum, 70S Tannic acid, 711, 712 Tansy, 704, 708 Tar, 74, 6 I 7 alkaline, 57 compound ointment, 122 mixture, 77 ointment, 624 water, 624 Taraxacum, 671 Tartar emetic, 606, 763 Tartaric acid, 149 Tartrated antimony, 606 Tasteless syrup of iodide of iron, 64 tincture of iron, 90 Terebene, 617, 029 Terebenum, 629 Terpene hydrate, 617 Terpin hydrate, 630 Terpini hydras, 630 Terpinol, 630 Tetrochlormethane, 410 Tetronal, 425 Theine, 557 Theobromine, 557 Therapeutics, 22 Thielmann's mixture, 76 Thioform, 752 Thiol, 327 Thiolum, 327 Thioresorcin, 325 Thompson's solution of phosphorus, 57 Thorn apple, 462 Thymacetin, 378 Thymol, 378 Tinctura aconiti, 578 aloes, 676 and myrrhae, 338, 676 arnicae florum, 689 radicis, 590 asafcetidae, 381 belladonnae foliorum, 454 benzoini, 334 composita, 334, 620, 676 cacti, 554 Tinctura calendulae, 174 calumba-, 173 cannabis indicae, 448 cantharidis, 764 capsici, 367 cardamomi, 372 composita, 363, 372, 380 catechu composita, 363, 717 chirata, 174 cinchonae, 211 composita, 176, 211 cinnamomi, 363 cocculi, 476 colchici seminis, 257 conii, 500 cubeba1, 651 digitalis, 539 ergotae, 479 eucalypti, 341 ferri acetatis, 192 chloridi, 184 gallae, 715 gentianae composita, 173 guaiaci, 261 ammoniata, 261 humuli, 446 hydrastis, 485 hyoscyami, 464 iodi, 247 ipecacuanhae et opii, 430, 611 kino, 718 krameriae, 719 lactucarii, 447 lavandula- composita, 363, 375 lobeliae, 615 nucis vomicae, 467 opii, 430 camphorata, 362, 383, 430 deodorati, 430 physostigmatis, 510 pulsatillae, 588 quassiae, 172 rhei, 678 aromatica, 678 dulcis, 678 rhois toxicodendri, 489 sanguinariae, 266 scillae, 637 serpentariae, 176 stillingiae, 265 stramonii seminis, 463 strophanthi, 549 sumbul, 519 tolutana, 620 Valerianae, 384 ammoniata, 384 veratri viridis, 583 zingiberis, 374 Tincture of aconite, 578 of aloes, 676 and myrrh, 338, 676 of arnica flowers, 589 root, 590 of asafetida, 381 GENERAL INDEX. 859 Tincture of belladonna leaves, 454 of benzoin, 334 of cactus, 554 of calendula, 174 of calumba, 173 of cantharides, 764 of capsicum, 367 of cardamom, 372 of chirata, 174 of cinchona, 211 of cinnamon, 363 of cocculus, 476 of colchicum seed, 257 of conium, 500 of cubeb, 651 of cudbear, 91 of deodorized opium, 430 of digitalis, 539 of Dover's powder, 430 of ergot, 479 of eucalyptus, 341 of ferric acetate, 192 chloride, 184 of ginger, 374 of guaiac, 261 of hops, 446 of hydrastis, 485 of hyoscyamus, 464 of Indian cannabis, 448 of iodine, 247 of ipecac and opium, 430, 6ll of kino, 718 of krameria, 719 of lactucarium, 447 of lobelia, 615 of lupulin, 446 of nutgall, 715 of opium, 430 of phosphorus, 201 of physostigma, 510 of poppy, 91 of pulsatilla, 58S of quassia, 172 of rhubarb, 678 of rhus toxicodendron, 489 of serpentaria, 176 of squill, 637 of stillingia, 265 of stramonium seed, 463 of strophanthus, 549 of sumbul, 519 of tolu, 620 of valerian, 3S4 of veratrum viride, 583 Tinctures, 86 Tolu, soluble, 92 Topical remedies. 75^ Tragacanth, 773. 7*1 Tragacantha, 781 Trional, 425 Triplex pills, 114 Trituratio elaterini, 686 Trituration of elaterin, 686 Troches, 107 Troches of ammonium chloride, 618 of catechu, 717 of chalk, 156 of cubeb, 651 of ginger, 374 of ipecac, 611 of iron, 191 of krameria, 719 of liquorice and opium, 430 of morphine and ipecac, 431, 611 of peppermint, 376 of potassium chlorate, 351 of santonin, 697 of sodium bicarbonate, 155 of tannic acid, 712 Trochisci acidi tannici, 712 ammonii chloridi, 618 catechu, 717 cretae, 156 ferri, 191 glycyrrhizae et opii, 362, 430 ipecacuanhae, 611 krameriae, 719 menthae piperitae, 376 morphinae et ipecacuanhae, 431, 611 potassii chloratis, 351 santonini, 697 sodii bicarbonatis, 155 zingiberis, 374 Tulley's powder, 103 Tumenol, 328 Tumenolum, 328 Turlington's balsam, 87 Turner's cerate, 122 Turpentine, 632 Turpeth mineral, 228 Ulmus, 780 Unguenta, 120-122 Unguentum acidi carbolici, 304 tannici, 712 belladonnae, 454 camphoratum, 122 diachylon, 728 hydrargyri, 224 ammoniati, 224 nitratis, 228 oxidi flavi, 227 rubri, 227 iodi, 247 iodoformi, 329 matris, 122 picis liquidae, 624 plumbi carbonatis, 727 iodidi, 728 potassii iodidi, 248 stramonii, 463 sulphuris, 671 iodidi, 240 veratrinae, 583 zinci carbonatis impuri, 122 oxidi, 735 Ural, 413, 422 Uralium, 413 S6o GENERAL INDEX. Urea, 632 Urethane, 413, 420 Ustilago, 705 Uva ursi, 632, 640 Valerian, 383 Valeriana, 383 Vallet's mass, 108, ls2 Vaseline 773 Vegetable acids, 148 astringents, 7 11 Velpeau's diarrhea mixture, 76 Veratrina, 583 Veratrine, 583 ointment, 583 Veratrum album, 583 viride, 582 Vermicides, 695 Vermifuges, 695 Vesicants, 763 Viburnum opulus, 521 prunifolium, 520 Vienna caustic, 759 paste, 759 Villate's solution, 75 Vina, 84-86 Vinegar of opium, 430 of sanguinaria, 266 of squill, 637 Vinegars, 84 Vinum album, 563 antimonii, 607 ferri amarum, 186 citratis, 185 colchici radicis, 256 seminis, 257 ergotae, 479 ipacacuanhae, 611 opii, 430 picis, 625 rubrum, 563 Virginia snake root, 176 Vleminck's solution or lotion, 56 Volatile oil of mustard, 769 oils, 771 Wahoo, 70, 680 Warburg's pills, 113 tincture, 89, 90 Warming plaster, 125, 7 72 Washed sulphur, 671 Washes, 117 Weights and measures, 42 Whiskey, 59, 562 White arsenic, 236 While ash, 86 hellebore, 583 lead, 727 mustard, 768 oak, 716 of of vienna- Edit*d by J. 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AN AMERICAN TEXT=BOOK OF DISEASES OF THE EYE, EAR, NOSE, AND THROAT. By 58 Prominent Specialists. Edited by G. E. de Schweinitz, M.D., Professor of Ophthalmology in the Jefferson Medical College, Phila- delphia ; and B. Alexander Randall, M.D., Professor of Diseases of the Ear in the University of Pennsylvania and in the Philadelphia Polyclinic. Ready soon. Illustrated Catalogue of the "American Text-Books" sent free upon application. 4 Medical Publications of W. B. Saunders. AN AMERICAN TEXT=BOOK OF GENITO-URINARY AND SKIN DISEASES. By 47 Eminent Specialists and Teachers. Edited by L. Bolton Bangs, M.D., Late Professor of Genito-Urinary and Venereal Diseases, New York Post-Graduate Medical School and Hospital; and W. A. Hardaway, M.D., Professor of Diseases of the Skin, Missouri Medical College. Imperial octavo volume of 1229 pages, with 300 en- gravings and 20 full-page colored plates. Cloth, $7.00 net; Sheep or Half Morocco, 58.00 net. Sold by Subscription. 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Its descriptions of conditions, its recommen- dations for treatment, and above all the necessary technique of different operations, are clearly and admirably presented. . . . It is well up to the most advanced views of the day, and embodies all the essential points of advanced American gynecology. It is destined to make and hold a place in gynecological literature which will be peculiarly its own."— Medical Record, New York. AN AMERICAN TEXT=BOOK OF LEGAL MEDICINE AND TOXI- COLOGY. Edited by Frederick Peterson, M.D., Clinical Professor of Mental Diseases in the Woman's Medical College, New York; Chief of Clinic, Nervous Department, College of Physicians and Surgeons, New York; and Walter S. Haines, M.D., Professor of Chemistry, Pharmacy, and Toxicology in Rush Medical College, Chicago. In Preparation. AN AMERICAN TEXT=BOOK OF OBSTETRICS. By 15 Eminent American Obstetricians. Edited by Richard C. Nor- ris, M.D.; Art Editor, Robert L. Dickinson, M.D. One handsome imperial octavo volume of over 1000 pages, with nearly 900 beautiful colored and half-tone illustrations. Cloth, $7.00 net; Sheep or Half Morocco, $8.00 net. Sold by Subscription. " Permit me to say that your American Text-Book of Obstetrics is the most magnificent medical work that I have ever seen. I congratulate you and thank you for this superb work, which alone is sufficient to place you first in the ranks of medical publishers. "—Alexander J. C. SKENE, Professor of Gynecology in the Long Island College Hospital, Brooklyn, N. Y. " This is the most sumptuously illustrated work on midwifery that has yet appeared. In the number, the excellence, and the beauty of production of the illustrations it far surpasses every other book upon the subject. This feature alone makes it a work which no medical library should omit to purchase."—British Medical Journal. " As an authority, as a book of reference, as a ' working book' for the student or prac- titi°?-er*, «e commend h because we believe there is no better."—American lournal of the Medical Sciences. J J Illustrated Catalogue of the "American Text-Books " sent free upon application. Medical Publications of W. B. Saunders. 5 AN AMERICAN TEXT=BOOK OF PATHOLOGY. Edited by John Guiteras, M.D., Professor of General Pathology and of Morbid Anatomy in the University of Pennsylvania; and David Riesman, M.D., Demonstrator of Pathological Histology in the University of Pennsylvania. In Preparation. AN AMERICAN TEXT-BOOK OF PHYSIOLOGY. By io of the Leading Physiologists of America. Edited by William H. Howell, Ph.D., M.D., Professor of Physiology in the Johns Hop- kins University, Baltimore, Md. One handsome imperial octavo volume of 1052 pages. Illustrated. Cloth, $6.00 net; Sheep or Half Morocco, $7.00 net. Sold by Subscription. " We can commend it most heartily, not only to all students of physiology, but to every physician and pathologist, as a valuable and comprehensive work of reference, written by men who are of eminent authority in their own special subjects."—London Lancet. " To the practitioner of medicine and to the advanced student this volume constitutes, we believe, the best exposition of the present status of the science of physiology in the English language."—American Journal of the Medical Sciences. AN AMERICAN TEXT-BOOK OF SURGERY. Second Edition. By 13 Eminent Professors of Surgery. Edited by William W. Keen, M.D., LL.D., and J. William White, M.D., Ph.D. Handsome imperial octavo volume of 1250 pages, with 500 wood-cuts in the text, and 39 colored and half-tone plates. Thoroughly revised and enlarged, with a section devoted to " The Use of the Rontgen Rays in Surgery." Cloth, $7.00 net; Sheep or Half Morocco, $8.00 net. Sold by Sub- scription. " Personally, I should not mind it being called THE Text-Book (instead of A Text- Book) , for I know of no single volume which contains so readable and complete an account of the science and art of Surgery as this does."—Edmund Owen, F.R.C.S., Member of the Board of Examiners of the Royal College of Surgeons, England. " If this text-book is a fair reflex of the present position of American surgery, we must admit it is of a very high order of merit, and that English surgeons will have to look very carefully to their laurels if they are to preserve a position in the van of surgical practice."— London Lancet. AN AMERICAN TEXT-BOOK OF THE THEORY AND PRACTICE OF MEDICINE. By 12 Distinguished American Practitioners. Edited by William Pepper, M.D., LL.D., Professor of the Theory and Practice of Medi- cine and of Clinical Medicine in the University of Pennsylvania. Two handsome imperial octavo volumes of about 1000 pages each. Illus- trated. Prices per volume : Cloth, $5.00 net; Sheep or Half Morocco, $6.00 net. Sold by Subscription. " I am quite sure it will commend itself both to practitioners and students of medicine, and become one of our most popular text-books."-Alfred Loomis M;D., LL,.D., Pro- fessor of Pathology and Practice of Medicine, University of the City of New York. " We reviewed the first volume of this work, and said : * It is undoubtedly one of the best text-books on the practice of medicine which we possess.' A consideration of the second and last volume leads us to modify that verdict and to say that the completed work is in our opinion the best of its kind it has ever been our fortune to see. — New York Medical Journal._______.________ Illustrated Catalogue of the "American Text-Books" sent free upon application. 6 Medical Publications of W. B. Saunders. AN AMERICAN YEAR-BOOK OF MEDICINE AND SURGERY. A Yearly Digest of Scientific Progress and Authoritative Opinion in all branches of Medicine and Surgery, drawn from journals, monographs, and text-books of the leading American and Foreign authors and investigators. Collected and arranged, with critical editorial com- ments, by eminent American specialists and teachers, under the general editorial charge of George M. Gould, M.D. One handsome imperial octavo volume of about 1200 pages. Uniform in style, size, and general make-up with the "American Text-Book" Series. Cloth, $6.50 net; Half Morocco, $7.50 net. Sold by Subscription. " It is difficult to know which to admire most—the research and industry of the distin- guished band of experts whom Dr. Gould has enlisted in the service of the Year-Book, or the wealth and abundance of the contributions to every department of science that have been deemed worthy of analysis. . . . It is much more than a mere compilation of abstracts, for, as each section is entrusted to experienced and able contributors, the reader has the advantage of certain critical commentaries and expositions . . . proceeding from writers fully qualified to perform these tasks. . . . It is emphatically a book which should find a place in every medical library, and is in several respects more useful than the famous 'Jahrbucher' of Germany."—London Lancet. ANDERS' PRACTICE OF MEDICINE. Second Edition. A Text-Book of the Practice of Medicine. By James M. Anders, M.D., Ph.D., LL.D., Professor of the Practice of Medicine and of Clinical Medicine, Medico-Chirurgical College, Philadelphia. In one handsome octavo volume of 1287 pages, fully illustrated. Cloth, $5.50 net; Sheep or Half Morocco, $6.50 net. " It is an excellent book,—concise, comprehensive, thorough, and up to date. It is a credit to you ; but, more than that, it is a credit to the profession of Philadelphia—to us." James C. Wilson, Professor of the Practice of Medicine and Clinical Medicine, Jefferson Medical College, Philadelphia. " I consider Dr. Anders' book not only the best late work on Medical Practice, but by far the best that has ever been published. It is concise, systematic, thorough, and fully up to date in everything. I consider it a great credit to both the author and the publisher."— A. C. Cowperthwaite, President of the Illinois Homeopathic Medical Association. ASHTON'S OBSTETRICS. Fourth Edition, Revised. Essentials of Obstetrics. By W. Easterly Ashton, M.D., Pro- fessor of Gynecology in the Medico-Chirurgical College, Philadelphia. Crown octavo, 252 pages ; 75 illustrations. Cloth, $1.00; interleaved for notes, $1.25. [See Saunders"1 Question- Compends, page 21.] " Embodies the whole subject in a nut-shell. We cordially recommend it to our read ers."—Chicago Medical Times. BALLS BACTERIOLOGY. Third Edition, Revised. Essentials of Bacteriology ; a Concise and Systematic Introduction to the Study of Micro-organisms. By M. V. Ball, M.D., Bacteriol- ogist to St. Agnes' Hospital, Philadelphia, etc. Crown octavo, 218 pages; 82 illustrations, some in colors, and 5 plates. Cloth, $1.00; interleaved for notes, $1.25. [See Saunders' Question-Compends, page 21.] " The student or practitioner can readily obtain a knowledge of the subject from a perusal of this book. The illustrations are clear and satisfactory."—Medical Record, New York. Medical Publications of W. B. Saunders. 7 BASTIN'S BOTANY. Laboratory Exercises in Botany. By Edson S. Bastin, M.A., late Professor of Materia Medica and Botany, Philadelphia College of Pharmacy. Octavo volume of 536 pages, with 87 plates. Cloth, $2.50. " It is unquestionably the best text-book on the subject that has yet appeared. The work is eminently a practical one. We regard the issuance of this book as an important event in the history of pharmaceutical teaching in this country, and predict for it an unquali- fied success."—Alumni Report to the Philadelphia College of Pharmacy. "There is no work like it in the pharmaceutical or botanical literature of this country, and we predict for it a wide circulation."—American Journal of Pharmacy. BECK'S SURGICAL ASEPSIS. A Manual of Surgical Asepsis. By Carl Beck, M.D., Surgeon to St. Mark's Hospital and the New York German Poliklinik, etc. 306 pages; 65 text-illustrations, and 12 full-page plates. Cloth, $1.25 net. " An excellent exposition of the ' very latest' in the treatment of wounds as practised by leading German and American surgeons."—Birminghatn (Eng.) Medical Review. "This little volume can be recommended to any who are desirous of learning the details of asepsis in surgery, for it will serve as a trustworthy guide."—London Lancet. BOISLINIERE'S OBSTETRIC ACCIDENTS, EMERGENCIES, AND OPERATIONS. Obstetric Accidents, Emergencies, and Operations. By L. Ch. Boisliniere, M.D., late Emeritus Professor of Obstetrics, St. Louis Medical College. 381 pages, handsomely illustrated. Cloth, $2.00 net. " It is clearly and concisely written, and is evidently the work of a teacher and practi- tioner of large experience."—British Medical Journal. " A manual so useful to the student or the general practitioner has not been brought to our notice in a long time. The field embraced in the title is covered in a terse, interesting way."—Yale Medical Journal. BROCKWAY'S MEDICAL PHYSICS. Second Edition, Revised. Essentials of Medical Physics. By Fred J. Brockwav, M.D., Assistant Demonstrator of Anatomy in the College of Physicians and Surgeons, New York. Crown octavo, 330 pages; 155 fine illustrations. Cloth, $1.00 net; interleaved for notes, $1.25 net. [See Saunders1 Question-Compends, page 21.] " The student who is well versed in these pages will certainly prove qualified to com- prehend with ease and pleasure the great majority of questions involving physical principles likely to be met with in his medical studies."—American Practitioner and News. "We know of no manual that affords the medical student a better or more concise exposition of physics, and the book may be commended as a most satisfactory presentation of those essentials that are requisite in a course in medicine."—Xew York Medical Journal. " It contains all that one need know on the subject, is well written, and is copiously illustrated."—Medical Record, Xew York. BURR ON NERVOUS DISEASES. A Manual of Nervous Diseases. By Charles W. Burr, M.D., Clinical Professor of Nervous Diseases, Medico-Chirurgical College, Philadelphia; Pathologist to the Orthopedic Hospital and Infirmary for Nervous Diseases; Visiting Physician to St. Joseph's Hospital, etc. In Preparation. 8 Medical Publications of W. B. Saunders. BUTLER'S MATERIA MEDICA, THERAPEUTICS, AND PHAR- MACOLOGY. Second Edition, Revised. A Text=Book of Materia Medica, Therapeutics, and Pharma- cology. By George F. Butler, Ph.G., M.D., Professor of Materia Medica and of Clinical Medicine in the College of Physicians and Surgeons, Chicago; Professor of Materia Medica and Therapeutics, Northwestern University, Woman's Medical School, etc. Octavo, 860 pages, illustrated. Cloth, 34.00 net; Sheep, 35.00 net. " Taken as a whole, the book may fairly be considered as one of the most satisfactory of any single-volume works on materia medica in the market,"—Journal of the American Medical Association. "The work is executed in a clear, concise, and practical manner, and should meet with a hearty endorsement from the students of our up-to-date colleges. The book will be found a valuable work of reference for the practitioner."—American Medico-Surgical Bulletin. CASSELBERRY ON THE NOSE AND THROAT. Diseases of the Nose and Throat. By W. E. Casselberrv, Pro- fessor of Laryngology and Rhinology in the Northwestern University Medical School, Chicago. In Preparation. CERNA ON THE NEWER REMEDIES. Second Edition, Revised. Notes on the Newer Remedies, their Therapeutic Applications and Modes of Administration. By David Cerna, M.D., Ph.D., formerly Demonstrator of and Lecturer on Experimental Therapeutics in the University of Pennsylvania; Demonstrator of Physiology in the Medical Department of the University of Texas. Rewritten and greatly enlarged. Post-octavo, 253 pages. Cloth, $1.25. " The appearance of this new edition of Dr. Cerna's very valuable work shows that it is properly appreciated. The book ought to be in the possession of every practising physi- cian."—Xew York Medical Journal. CHAPIN ON INSANITY. A Compendium of Insanity. By John B. Chapin, M.D., LL.D., Physician-in-Chief, Pennsylvania Hospital for the Insane ; late Physi- cian-Superintendent of the Willard State Hospital, New York; Hon- orary Member of the Medico-Psychological Society of Great Britain) of the Society of Mental Medicine of Belgium. i2mo, 234 pages, illustrated. Cloth, $1.25 net. The author has given, in a condensed and concise form, a compendium of Diseases of the Mind, for the convenient use and aid of physicians and students. The work will also prove valuable to members of the legal profession and to those who, in their relations to the insane and to those supposed to be insane, often desire to acquire some practical knowledge of insanity presented in a form that may be understood by the non-professional reader. CHAPMAN'S MEDICAL JURISPRUDENCE AND TOXICOLOGY. Second Edition, Revised. Medical Jurisprudence and Toxicology. By Henry C. Chapman, M.D., Professor of Institutes of Medicine and Medical Jurisprudence in the Jefferson Medical College of Philadelphia. 254 pages, with 55 illustrations and 3 full-page plates in colors. Cloth, Si.50 net. "The best book of its class for the undergraduate that we know of."—New York Medical Times. Medical Publications of W. B. Saunders. 9 CHURCH AND PETERSON'S NERVOUS AND MENTAL DISEASES. Nervous and Mental Diseases. By Archibald Church, M.D., Professor of Mental Diseases and Medical Jurisprudence in the North- western University Medical School, Chicago; and Frederick Peter- son, M.D., Clinical Professor of Mental Diseases in the Woman's Medical College, New York; Chief of Clinic, Nervous Department, College of Physicians and Surgeons, New York. In Preparation. CLARKSON'S HISTOLOGY. A Text-Book of Histology, Descriptive and Practical. By Arthur Clarkson, M.B., CM. Edin., formerly Demonstrator of Physiology in the Owen's College, Manchester; late Demonstrator of Physiology in Yorkshire College, Leeds. Large octavo, 554 pages; 22 engravings in the text, and 174 beautifully colored original illustra- tions. Cloth, strongly bound, 36.00 net. " The work must be considered a valuable addition to the list of available text-books, and is to be highly recommended."—New York Medical Journal. "This is one of the best works for students we have ever noticed. We predict that the book will attain a well-deserved popularity among our students."—Chicago Medical Recorder. "The volume is a most valuable addition to the armamentarium of the teacher."— Brooklyn Medical Journal. CLIMATOLOGY. Transactions of the Eighth Annual Meeting of the American Climatological Association, held in Washington, September 22-25, 1891. Forming a handsome octavo volume of 276 pages, uniform with remainder of series. (A limited quantity only.) Cloth, $1.50. COHEN AND ESHNER'S DIAGNOSIS. Essentials of Diagnosis. By Solomon Solis-Cohen, M.D., Pro- fessor of Clinical Medicine and Applied Therapeutics in the Philadel- phia Polyclinic ; and Augustus A. Eshner, M.D., Professor of Clinical Medicine in the Philadelphia Polyclinic. Post-octavo, 382 pages; 55 illustrations. Cloth, $1.50 net. [See Saunders' Question-Compends, page 21.] " We can heartily commend the book to all those who contemplate purchasing a 'com- pend.' It is modern and complete, and will give more satisfaction than many other works which are perhaps too prolix as well as behind the times."—Medical Review, St. Louis. CORWIN'S PHYSICAL DIAGNOSIS. Essentials of Physical Diagnosis of the Thorax. By Arthur M. Corwin, A.M., M.D., Demonstrator of Physical Diagnosis in Rush Medical College, Chicago; Attending Physician to Central Free Dis- pensary, Department of Rhinology, Laryngology, and Diseases of the Chest, Chicago. 200 pages, illustrated. Cloth, flexible covers, $1.25 net. " It is excellent The student who shall use it as his guide to the careful study of physical exploration upon normal -and abnormal subjects can scarcely fail to acquire a good working knowledge of the subject."—Philadelphia Polyclinic. " \ most excellent little work. It brightens the memory of the differential diagnostic siens and it arranges orderly and in sequence the various objective phenomena to logical solution of a careful diagnosis. "—Journal of Nei-vous and Mental Diseases. 10 Medical Publications of W. B. Saunders. CRAGIN'S GYNAECOLOGY. Fourth Edition, Revised. Essentials of Gynaecology. By Edwin B. Cragin, M.D., Attend- ing Gynaecologist, Roosevelt Hospital, Out-Patients' Department, New York, etc. Crown octavo, 200 pages; 62 fine illustrations. Cloth, $1.00; interleaved for notes, $1.25. [See Saunders1 Question- Compends, page 21.] " A handy volume, and a distinct improvement on students' compends in general. No author who was not himself a practical gynecologist could have consulted the student's needs so thoroughly as Dr. Cragin has done."—Medical Record, New York. CROOKSHANK'S BACTERIOLOGY. Fourth Edition, Revised. A Text=Book of Bacteriology. By Edgar M. Crookshank, M.B., Professor of Comparative Pathology and Bacteriology, King's College, London. Octavo volume of 700 pages, with 273 engravings and 22 original colored plates. Cloth, $6.50 net; Half Morocco, $7.50 net. " To the student who wishes to obtain a good rhume of what has been done in bacteri- ology, or who wishes an accurate account of the various methods of research, the book may be recommended with confidence that he will find there what he requires."—London Lancet. Da COSTA'S SURGERY. Second Ed., Revised and Greatly Enlarged. Modern Surgery, General and Operative. By John Chalmers DaCosta, M.D., Clinical Professor of Surgery, Jefferson Medical College, Philadelphia; Surgeon to the Philadelphia Hospital, etc. Handsome octavo volume of 900 pages, profusely illustrated. Cloth, $4.00 net; Half Morocco, $5.00 net. " We know of no small work on surgery in the English language which so well fulfils the requirements of the modern student."—Medico-Chirurgical Jourtial, Bristol, England. DE SCHWEINITZ ON DISEASES OF THE EYE. Third Edition, Revised. Diseases of the Eye. A Handbook of Ophthalmic Practice. By G. E. de Schweinitz, M.D., Professor of Ophthalmology in the Jefferson Medical College, Philadelphia, etc. Handsome royal octavo volume of 700 pages, with 256 fine illustrations and 2 chromo-litho- graphic plates. Cloth, $4.00 net; Sheep or Half Morocco, $5.00 net. " A clearly written, comprehensive manual. One which we can commend to students as a reliable text-book, written with an evident knowledge of the wants of those entering upon the study of this special branch of medical science."—British Medical Journal. " A work that will meet the requirements not only of the specialist, but of the general practitioner in a rare degree. I am satisfied that unusual success awaits it."—William Pepper, M.D., Professor of the Theory and Practice of Medicine and Clinical Medicine, University of Pennsylvania. DORLAND'S OBSTETRICS. A Manual of Obstetrics. By W. A. Newman Dorland, M.D., Assistant Demonstrator of Obstetrics, University of Pennsylvania; Instructor in Gynecology in the Philadelphia Polyclinic. 760 pages; 163 illustrations in the text, and 6 full-page plates. Cloth, 32.50 net. " By far the best book on this subject that has ever come to our notice."—American Medical Review. " It has rarely been our duty to review a book which has given us more pleasure in its perusal and more satisfaction in its criticism. It is a veritable encyclopedia of knowledge, a gold mine of practical, concise thoughts."—American Medico-Surgical Bulletin. Medical Publications of W. B. Saunders. 11 FROTHINGHAM'S GUIDE FOR THE BACTERIOLOGIST. Laboratory Guide for the Bacteriologist. By Langdon Froth- ingham, M.D.V., Assistant in Bacteriology and Veterinary Science, Sheffield Scientific School, Yale University. Illustrated. Cloth, 75 cts. " It is a convenient and useful little work, and will more than repay the outlay neces- sary for its purchase in the saving of time which would otherwise be consumed in looking up the various points of technique so clearly and concisely laid down in its pages." — Ameri- can Medico-Surgical Bulletin. QARRIGUES' DISEASES OF WOMEN. Second Edition, Revised. Diseases of Women. By Henry J. Garrigues, A.M., M.D., Pro- fessor of Gynecology in the New York School of Clinical Medicine; Gynecologist to St. Mark's Hospital and to the German Dispensary, New York City, etc. Handsome octavo volume of 728 pages, illus- trated by 335 engravings and colored plates. Cloth, $4.00 net; Sheep or Half Morocco, $5.00 net. " One of the best text-books for students and practitioners which has been published in the English language ; it is condensed, clear, and comprehensive. The profound learning and great clinical experience of the distinguished author find expression in this book in a most attractive and instructive form. Young practitioners to whom experienced consultants may not be available will find in this book invaluable counsel and help."—Thad. A. R.EAMY, M.D., LL.D., Professor of Clinical Gynecology, Medical College of Ohio. GLEASON'S DISEASES OF THE EAR. Second Edition, Revised. Essentials of Diseases of the Ear. By E. B. Gleason, S.B., M.D., Clinical Professor of Otology, Medico-Chirurgical College, Philadelphia ; Surgeon-in-Charge of the Nose, Throat, and Ear Depart- ment of the Northern Dispensary, Philadelphia. 208 pages, with 114 illustrations. Cloth, 31.00; interleaved for notes, $1.25. [See Saunders1 Question-Compends, page 21.] " It is just the book to put into the hands of a student, and cannot fail to give him a useful introduction to ear-affections ; while the style of question and answer which is adopted throughout the book is, we believe, the best method of impressing facts permanently on the mind."—Liverpool Medico- Chirurgical Journal. GOULD AND PYLE'S CURIOSITIES OF MEDICINE. Anomalies and Curiosities of Medicine. By George M. Gould, M.D., and Walter L. Pyle, M.D. An encyclopedic collection of rare and extraordinary cases and of the most striking instances of abnormality in all branches of Medicine and Surgery, derived from an exhaustive research of medical literature from its origin to the present day, abstracted, classified, annotated, and indexed. Handsome im- perial octavo volume of 968 pages, with 295 engravings in the text, and 12 full-page plates. Cloth, 36.00 net; Half Morocco, 37.00 net. Sold by Subscription. " One of the most valuable contributions ever made to medical literature. It is, so far as we know, absolutely unique, and every page is as fascinating as a novel. Not alone for the medical profession has this volume value: it will serve as a book of reference for all who are interested in general scientific, sociologic, or medico-legal topics. —Brooklyn Medical fournal. "This is certainly a most remarkable and interesting volume. It stands alone among medical literature, an anomaly on anomalies, in that there is nothing like it elsewhere in medical'literature. It is a book full of revelations from its first to its last page, and cannot but interest and sometimes almost horrify its readers."— American Medico-Surgical Bulletin. 12 Medical Publications of TV. B. Saunders. GRIFFIN'S MATERIA MEDICA AND THERAPEUTICS. Manual of Materia Medica and Therapeutics. By Hknkv A. Griffin, A.B., M.D., Assistant Physician to the Roosevelt Hospital, Out-Patient Department, New York City. In Preparation. GRIFFITH ON THE BABY. Second Edition, Revised. The Care of the Baby. By J. P. Crozer Griffith, M.D., Clini- cal Professor of Diseases of Children, University of Pennsylvania; Physician to the Children's Hospital, Philadelphia, etc. 121110, 404 pages, with 67 illustrations in the text, and 5 plates. Cloth, 31.50. " The best book for the use of the young mother with which we are acquainted. . . . There are very few general practitioners who could not read the book through with advan- tage. ''—Archives of Pediatrics. "The whole book is characterized by rare good sense, and is evidently written by a master hand. It can be read with benefit not only by mothers but by medical students and by any practitioners who have not had large opportunities for observing children."—Ameri- can Journal of Obstetrics. GRIFFITH'S WEIGHT CHART. Infant's Weight Chart. Designed by J. P. Crozer Griffith, M.D., Clinical Professor of Diseases of Children in the University of Penn- sylvania, etc. 25 charts in each pad. Per pad, 50 cents net. A convenient blank for keeping a record of the child's weight during the first two years of life. Printed on each chart is a curve representing the average weight of a healthy infant, so that any deviation from the normal can readily be detected. GROSS, SAMUEL D., AUTOBIOGRAPHY OF. Autobiography of Samuel D. Gross, M.D., Emeritus Professor of Surgery in the Jefferson Medical College, Philadelphia, with Remi- niscences of His Times and Contemporaries. Edited by his Sons, Samuel W. Gross, M.D., LL.D., late Professor of Principles of Sur- gery and of Clinical Surgery in the Jefferson Medical College, and A. Haller Gross, A.M., of the Philadelphia Bar. Preceded by a Memoir of Dr. Gross, by the late Austin Flint, M.D., LL.D. In two handsome volumes, each containing over 400 pages, demy octavo, extra cloth, gilt tops, with fine Frontispiece engraved on steel. Price per volume, 32.50 net. " Dr. Gross was perhaps the most eminent exponent of medical science that America has yet produced. His Autobiography, related as it is with a fulness and completeness seldom to be found in such works, is an interesting and valuable book. He comments on many things, especially, of course, on medical men and medical practice, in a very interest- ing way."—The Spectator, London, England. HAMPTON'S NURSING. Nursing: Its Principles and Practice. By Isabel Adams Hamp- ton, Graduate of the New York Training School for Nurses attached to Bellevue Hospital; Superintendent of Nurses, and Principal of the Training School for Nurses, Johns Hopkins Hospital, Baltimore, Md. i2mo, 484 pages, profusely illustrated. Cloth, 32.00 net. " Seldom have we perused a book upon the subject that has given us so much pleasure as the one before us. We would strongly urge upon the members of our own profession the need of a book like this, for it will enable each of us to become a training school in him- self. ''— Ontario Medical Journal. Medical Publications of W. B. Saunders. 13 HARE'S PHYSIOLOGY. Third Edition, Revised. Essentials of Physiology. By H. A. Hare, M.D., Professor of Therapeutics and Materia Medica in the Jefferson Medical College of Philadelphia; Physician to the Jefferson Medical College Hospital. Containing a series of handsome illustrations from the celebrated "Icones Nervorum Capitis" of Arnold. Crown octavo, 239 pages. Cloth, 31.00 net; interleaved for notes, 31.25 net. [See Saunders1 Question-Compends, page 21.] "The best condensation of physiological knowledge we have yet seen."—Medical Record, New York. HART'S DIET IN SICKNESS AND IN HEALTH. Diet in Sickness and in Health. By Mrs. Ernest Hart, formerly Student of the Faculty of Medicine of Paris and of the London School of Medicine for Women ; with an Introduction by Sir Henry Thompson, F. R. C. S., M. D., London. 2 20 pages; illustrated. Cloth, $1.50. " We recommend it cordially to the attention of all practitioners; both to them and to their patients it may be of the greatest service."—New York Medical Journal. HAYNES' ANATOMY. A Manual of Anatomy. By Irving S. Haynes, M.D., Adjunct Professor of Anatomy and Demonstrator of Anatomy, Medical Depart- ment of the New York University, etc. 680 pages, illustrated with 42 diagrams in the text, and 134 full-page half-tone illustrations from original photographs of the author's dissections. Cloth, 32.50 net. " This book is the work of a practical instructor—one who knows by experience the requirements of the average student, and is able to meet these requirements in a very satis- factory way. The book is one that can be commended."—Medical Record, New York. HEISLER'S EMBRYOLOGY. A Text=Book of Embryology. By John C. Heisler, M.D., Pro- fessor of Anatomy in the Medico-Chirurgical College, Philadelphia. In Preparation. HIRST'S OBSTETRICS. A Text-Book of Obstetrics. By Barton Cooke Hirst, M.D., Professor of Obstetrics in the University of Pennsylvania. In Prepa- ration. HYDE AND MONTGOMERY ON SYPHILIS AND THE VENEREAL DISEASES. Syphilis and the Venereal Diseases. By James Nevins Hyde, M.D., Professor of Skin and Venereal Diseases, and Frank H. Mont- gomery. M.D., Lecturer on Dermatology and Genito-Urinary Diseases in Rush Medical College, Chicago, 111. 618 pages, profusely illustrated. Cloth, S3.50 net. " We can commend this manual to the student as a help to him in his study of venereal diseases. "—Liverpool Medico-Chirurgical Journal. "The best student's manual which has appeared on the subject."—St. Louis Medical and Surgical Journal. 14 Medical Publications of W. B. Saunders. JACKSON AND GLEASON'S DISEASES OF THE EVE, NOSE, AND THROAT. Second Edition, Revised. Essentials of Refraction and Diseases of the Eye. By Edward Jackson, A.M., M.D., Professor of Diseases of the Eye in the Phila- delphia Polyclinic and College for Graduates in Medicine ; and— Essentials of Diseases of the Nose and Throat. By E. Bald- win Gleason, M.D., Surgeon-in-Charge of the Nose, Throat, and Ear Department of the Northern Dispensary of Philadelphia. Two volumes in one. Crown octavo, 290 pages; 124 illustrations. Cloth, $1.00; interleaved for notes, 31.25. [See Saunders' Question-Compends, page 21.] " Of great value to the beginner in these branches. The authors are both capable men, and know what a student most needs."—Medical Record, New York. KEATING'S DICTIONARY. Second Edition, Revised. A New Pronouncing Dictionary of Medicine, with Phonetic Pronunciation, Accentuation, Etymology, etc. By John M. Keating, M.D., LL.D., Fellow of the College of Physicians of Phila- delphia; Vice-President of the American Paediatric Society; Editor "Cyclopaedia of the Diseases of Children," etc.; and Henry Hamilton, Author of "A New Translation of Virgil's ^Eneid into English Rhyme," etc.; with the collaboration of J. Chalmers Da- Costa, M.D., and Frederick A. Packard, M.D. With an Appendix containing Tables of Bacilli, Micrococci, Leucomaines, Ptomaines; Drugs and Materials used in Antiseptic Surgery; Poisons and their Antidotes; Weights and Measures; Thermometric Scales; New Official and Unofficial Drugs, etc. One volume of over 800 pages. Prices, with Denison's Patent Ready-Reference Index: Cloth, 35.00 net; Sheep or Half Morocco, 36.00 net; Half Russia, 36.50 net. Without Patent Index: Cloth, 34.00 net; Sheep or Half Morocco, $5.00 net. "lam much pleased with Keating's Dictionary, and shall take pleasure in recommend- ing it to my classes."—Henry M. Lyman, M.D., Professor of the Principles and Practice of Medicine, Rush Medical College, Chicago, III. " I am convinced that it will be a very valuable adjunct to my study-table, convenient in size and sufficiently full for ordinary use."—C. A. LlNDSLEY, M.D., Professor of the Theory and Practice of Medicine, Medical Dept. Yale University. KEATING'S LIFE INSURANCE. How to Examine for Life Insurance. By John M. Keating, M.D., Fellow of the College of Physicians of Philadelphia; Vice- President of the American Psediatric Society; Ex-President of the Association of Life Insurance Medical Directors. Royal octavo, 211 pages; with two large half-tone illustrations, and a plate prepared by Dr. McClellan from special dissections; also, numerous other illustra- tions. Cloth, $2.00 net. " This is by far the most useful book which has yet appeared on insurance examination, a subject of growing interest and importance. Not the least valuable portion of the volume is Part II, which consists of instructions issued to their examining physicians by twenty-four representative companies of this country. If for these alone, the book should be at the right hand of every physician interested in this special branch of medical science."—The Medical News. Medical Publications of W. B. Saunders. KEEN ON THE SURGERY OF TYPHOID FEVER. The Surgical Complications and Sequels of Typhoid Fever. By Wm. AY. Keen, M.D., LL.D., Professor of the Principles of Sur- gery and of Clinical Surgery, Jefferson Medical College, Philadelphia; Corresponding Member of the Societe de Chirurgie, Paris; Honorary Member of the Societe Beige de Chirurgie, etc. Octavo volume of 386 pages, illustrated. Cloth, $3.00 net. This monograph is the only one in any language covering the entire subject of the Surgical Complications and Sequels of Typhoid Fever. It will prove to be of importance and interest not only to the general surgeon and physician, but also to many specialists—laryn- gologists, gynecologists, pathologists, and bacteriologists. KEEN'S OPERATION BLANK. Second Edition, Revised Form. An Operation Blank, with Lists of Instruments, etc. Required in Various Operations. Prepared by W. W. Keen, M.D., LL.D., Professor of the Principles of Surgery in Jefferson Medical College, Philadelphia. Price per pad, containing blanks for fifty operations, 50 cents net. KYLE ON THE NOSE AND THROAT. Diseases of the Nose and Throat. By D. Braden Kyle, M.D.. Clinical Professor of Laryngology and Rhinology, Jefferson Medical College, Philadelphia; Consulting Laryngologist, Rhinologist, and Otologist, St. Agnes' Hospital; Bacteriologist to the Philadelphia Orthopedic Hospital. In Preparation. LAINE'S TEMPERATURE CHART. Temperature Chart. Prepared by D. T. Laine, M.D. Size 8x13^ inches. A conveniently arranged Chart for recording Temperature, with columns for daily amounts of Urinary and Fecal Excretions, Food, Remarks, etc. On the back of each chart is given in full the method of Brand in the treatment of Typhoid Fever. Price, per pad of 25 charts, 50 cents net. " To the busy practitioner this chart will be found of great value in fever cases, and especially for cases of typhoid."—Indian Lancet, Calcutta. LOCKWOOD'S PRACTICE OF MEDICINE. A Manual of the Practice of Medicine. By George Roe Lock- wood, M.D., Professor of Practice in the Woman's Medical College of the New York Infirmary, etc. 935 pages, with 75 illustrations in the text, and 22 full-page plates. Cloth, #2.50 net. " Gives in a most concise manner the points essential to treatment usually enumerated in the most elaborate works."—Massachusetts Medical Journal. LONG'S SYLLABUS OF GYNECOLOGY. A Syllabus of Gynecology, arranged in Conformity with " An American Text=Book of Gynecology." By J. W. Long M.D., Professor of Diseases of Women and Children, Medical College ot Virginia, etc. Cloth, interleaved, $1.00 net. « The book is certainly an admirable resume of what every gynecological student and nractitioner should know, and will prove of value not only to those who have the American Text Book of Gynecology,' but to others as *e\U<-Brooklyn Medical Journal. 16 Medical Publications of W. B. Saunders. MACDONALD'S SURGICAL DIAGNOSIS \ND TREATMENT. Surgical Diagnosis and Treatment. By J. W. Macdonald, M.D. Edin., L.R.C.S., Edin., Professor of the Practice of Surgery and of Clinical Surgery in Hamline University; Visiting Surgeon to St. Barnabas' Hospital, Minneapolis, etc. Handsome octavo volume of 800 pages, profusely illustrated. Cloth, S5.00 net; Half Morocco, $6.00 net. " A thorough and complete work on surgical diagnosis and treatment, free from pad- ding, full of valuable material, and in accord with the surgical teaching of the day."—The Medical A'ercs, ATew York. " The work is brimful of just the kind of practical information that is useful alike to students and practitioners. It is a pleasure to commend the book because of its intrinsic value to the medical practitioner."—Cincinnati Lancet-Clinic. MALLORY AND WRIGHT'S PATHOLOGICAL TECHNIQUE. Pathological Technique. A Practical Manual for Laboratory Work in Pathology, Bacteriology, and Morbid Anatomy, with chapters on Post-Mortem Technique and the Performance of Autopsies. By Frank B. Mallory, A.M., M.D., Assistant Professor of Pathology, Harvard University Medical School, Boston; and James H. Wright, A.M., M.D., Instructor in Pathology, Harvard University Medical School, Boston. Octavo volume of 396 pages, handsomely illustrated. Cloth, $2.50 net. "I have been looking forward to the publication of this book, and I am glad to say that I find it to be a most useful laboratory and post-mortem guide, full of practical information and well up to date."—William H. Welch, Professor of Pathology, Johns Hopkins Uni- versity, Baltimore, Md. MARTIN'S MINOR SURGERY, BANDAGING, AND VENEREAL DISEASES. Second Edition, Revised. Essentials of Minor Surgery, Bandaging, and Venereal Diseases. By Edward Martin, A.M., M.D., Clinical Professor of Genito-Urinary Diseases, University of Pennsylvania, etc. Crown octavo, 166 pages, with 78 illustrations. Cloth, $1.00 ; interleaved for notes, $1. 25. [See Saunders1 Question-Compends, page 21.] "A very practical and systematic study of the subjects, and shows the author's famil- iarity with the needs of students."—Therapeutic Gazette. MARTIN'S SURGERY. Sixth Edition, Revised. Essentials of Surgery. Containing also Venereal Diseases, Surgi- cal Landmarks, Minor and Operative Surgery, and a complete de- scription, with illustrations, of the Handkerchief and Roller Bandages. By Edward Martin, A.M., M.D., Clinical Professor of Genito- Urinary Diseases, University of Pennsylvania, etc. Crown octavo, 338 pages, illustrated. With an Appendix containing full directions for the preparation of the materials used in Antiseptic Surgery, etc. Cloth, $1.00; interleaved for notes, $1.25. [See Saunders1 Question-Compends, page 21.] " Contains all necessary essentials of modern surgery in a comparatively small space. Its style is interesting, and its illustrations are admirable."—Medical and Surgical Reporter. Medical Publications of W. B. Saunders. 17 McFARLAND'S PATHOGENIC BACTERIA. Second Edition, Re- vised and Greatly Enlarged. Text-Book upon the Pathogenic Bacteria. By Joseph McFar- i.and, M. D., Professor of Pathology and Bacteriology in the Medico- Chirurgical College of Philadelphia, etc. Octavo volume of 497 pages, finely illustrated. Cloth, $2.50 net. '■ Dr. McFarland has treated the subject in a systematic manner, and has succeeded in presenting in a concise and readable form the essentials of bacteriology up to date. Alto- gether, the book is a satisfactory one, and I shall take pleasure in recommending it to the students of Trinity College."—H. B. Anderson, M.D., Professor of Pathology and Bac- teriology, Trinity Medical College, Toronto. MEIGS ON FEEDING IN INFANCY. Feeding in Early Infancy. By Arthur V. Meigs, M.D. Bound in limp cloth, flush edges, 25 cents net. "This pamphlet is worth many times over its price to the physician. The author's experiments and conclusions are original, and have been the means of doing much good."— Medical Bulletin. MOORE'S ORTHOPEDIC SURGERY. A Manual of Orthopedic Surgery. By James E. Moore, M.D., Professor of Orthopedics and Adjunct Professor of Clinical Surgery, University of Minnesota, College of Medicine and Surgery. Octavo volume of 356 pages, handsomely illustrated. Cloth, $2.50 net. A practical book based upon the author's experience, in which special stress is laid upon early diagnosis, and treatment such as can be carried out by the general practitioner. The teachings of the author are in accordance with his belief that true conservatism is to be found in the middle course between the surgeon who operates too frequently and the orthopedist who seldom operates. MORRIS'S MATERIA MEDICA AND THERAPEUTICS. Fifth Edition, Revised. Essentials of Materia Medica, Therapeutics, and Prescription- Writing. By Henry Morris, M.D., late Demonstrator of Thera- peutics, Jefferson Medical College, Philadelphia; Fellow of the College of Physicians, Philadelphia, etc. Crown octavo, 288 pages. Cloth, $1.00; interleaved for notes, $1.25. [See Saunders1 Question-Compends, page 21.] " This work, already excellent in the old edition, has been largely improved by revi sion."—American Practitioner and News. MORRIS, WOLFF, AND POWELL'S PRACTICE OF MEDICINE. Third Edition, Revised. Essentials of the Practice of Medicine. By Henry Morris, M. D., late Demonstrator of Therapeutics, Jefferson Medical College, Phila- delphia ; with an Appendix on the Clinical and Microscopic Examina- tion of Urine, by Lawrence Wolff, M.D., Demonstrator of Chemistry, Jefferson Medical College, Philadelphia. Enlarged by some 300 essen- tial formulas collected and arranged by William M. Powell, M.D. Post-octavo, 488 pages. Cloth, $2.00. [See Saunders1 Question-Compends, page 21.] " The teaching is sound, the presentation graphic ; matter full as can be desired, and style attractive."—American Practitioner and News. 2 18 Medical Publications of W. B. Saunders. MORTEN'S NURSE'S DICTIONARY. Nurse's Dictionary of Medical Terms and Nursing Treat- ment. Containing Definitions of the Principal Medical and Nursing Terms and Abbreviations; of the Instruments, Drugs, Diseases, Acci- dents, Treatments, Operations, Foods, Appliances, etc. encountered in the ward or in the sick-room. By Honnok Morten, author of " How to Become a Nurse," etc. i6mo, 140 pages. Cloth, $1.00. " A handy, compact little volume, containing a large amount of general information, all of which is arranged in dictionary or encyclopedic form, thus facilitating quick reference. It is certainly of value to those for whose use it is published."—Chicago Clinical Review. NANCREDE'S ANATOMY. Fifth Edition. Essentials of Anatomy, including the Anatomy of the Viscera. By Charles B. Nancrede, M.D., Professor of Surgery and of Clini- cal Surgery'in the University of Michigan, Ann Arbor. Crown octavo, 388 pages; 180 illustrations. With an Appendix containing over 60 illustrations of the osteology of the human body. Based upon Gray's Anatomy. Cloth, $1.00; interleaved for notes, $1.25. [See Saunders1 Question-Compends, page 21.] " For self-quizzing and keeping fresh in mind the knowledge of anatomy gained at school, it would not be easy to speak of it in terms too favorable."—American Practitioner. NANCREDE'S ANATOMY AND DISSECTION. Fourth Edition. Essentials of Anatomy and Manual of Practical Dissection. By Charles B. Nancrede, M.D., Professor of Surgery and of Clinical Surgery, University of Michigan, Ann Arbor. Post-octavo; 500 pages, with full-page lithographic plates in colors, and nearly 200 illustrations. Extra Cloth (or Oilcloth for the dissection-room), $2.00 net. " It may in many respects be considered an epitome of Gray's popular work on general anatomy, at the same time having some distinguishing characteristics of its own to commend it. The plates are of more than ordinary excellence, and are of especial value to students in their work in the dissecting room."—Journal of the American Medical Association. NORRIS'S SYLLABUS OF OBSTETRICS. Third Edition, Revised. Syllabus of Obstetrical Lectures in the Medical Department of the University of Pennsylvania. By Richard C. Norris, A.M., M.D., Demonstrator of Obstetrics, University of Pennsylvania. Crown octavo, 222 pages. Cloth, interleaved for notes, $2.00 net. "This work is so far superior to others on the same subject that we take pleasure in calling attention briefly to its excellent features. It covers the subject thoroughly, and will prove invaluable both to the student and the practitioner."—Medical Record, New York. PENROSE'S DISEASES OF WOMEN. Second Edition, Revised. A Text=Book of Diseases of Women. By Charles B. Penrose, M.D., Ph.D., Professor of Gynecology in the University of Pennsyl- vania ; Surgeon to the Gynecean Hospital, Philadelphia. Octavo volume of 529 pages, handsomely illustrated. Cloth, $3.50 net. "I shall value very highly the copy of Penrose's 'Diseases of Women' received. I have already recommended it to my class as THE BEST book."—Howard A. KELLY, Professor of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Aid. " The book is to be commended without reserve, not only to the student but to the general practitioner who wishes to have the latest and best modes of treatment explained with absolute clearness."—Therapeutic Gazette. Medical Publications of W. B. Saunders. 19 POWELL'S DISEASES OF CHILDREN. Second Edition. Essentials of Diseases of Children. By William M. Powell, M.D., Attending Physician to the Mercer House for Invalid Women at Atlantic City, N. j. ; late Physician to the Clinic for the Diseases of Children in the Hospital of the University of Pennsylvania. Crown octavo, 222 pages. Cloth, $1.00; interleaved for notes, $1.25. [See Saunders1 Question-Compends, page 21.] "Contains the gist of all the best works in the department to which it relates."— American Practitioner and News. PRINGLE'S SKIN DISEASES AND SYPHILITIC AFFECTIONS. Pictorial Atlas of Skin Diseases and Syphilitic Affections (American Edition). Translation from the French. Edited by j. J. Pringle, M.B., F.R.C.P., Assistant Physician to the Middlesex Hospital, London. Photo-lithochromes from the famous models in the Museum of the Saint-Louis Hospital, Paris, with explanatory wood- cuts and text. In 12 Parts. Price per Part, $3.00. Complete in one volume, Half Morocco binding, $40.00 net. " I strongly recommend this Atlas. The plates are exceedingly well executed, and will be of great value to all studying dermatology."—Stephen Mackenzie, M.D. "The introduction of explanatory wood-cuts in the text is a novel and most important feature which greatly furthers the easier understanding of the excellent plates, than which nothing, we venture to say, has been seen better in point of correctness, beauty, and general merit."—New York Medical Journal. PYE'S BANDAGING. Elementary Bandaging and Surgical Dressing. With Direc- tions concerning the Immediate Treatment of Cases of Emergency. For the use of Dressers and Nurses. By Walter Pye, F.R.C.S., late Surgeon to St. Mary's Hospital, London. Small i2mo, with over 80 illustrations. Cloth, flexible covers, 75 cents net. " The directions are clear and the illustrations are good."—London Lancet. " The author writes well, the diagrams are clear, and the book itself is small and port- able, although the paper and type are good."—British Medical Journal. RAYMOND'S PHYSIOLOGY. A Manual of Physiology. By Joseph H. Raymond, A.M., M.D., Professor of Physiology and Hygiene and Lecturer on Gynecology in the Long Island College Hospital; Director of Physiology in the Hoagland Laboratory, etc. 382 pages, with 102 illustrations in the text, and 4 full-page colored plates. Cloth, $1.25 net. " Extremelv well gotten up, and the illustrations have been selected with care. The text is fully abreast with modern physiology."—British Medical Journal. RONTGEN RAYS. Archives of the Rontgen Ray (Formerly Archives of Clinical Skiagraphy). Edited by Sydney Rowland, M.A., M.R.C.S., and W. S. Hedley. M.D., M.R.C.S. A series of collotype illustrations, with descriptive text, illustrating the applications of the new photo- graphv to Medicine and Surgerv. Price per Part, $1.00. Now ready: Vol. I., Parts I. to IV.; Vol. II., Parts I.. II. Saunders' Question Compends Arranged in Question and Answer Form, HTHE MOST COMPLETE AND BEST ILLUSTRATED SERIES OF COMPENDS EVER ISSUED. Now the Standard Authorities in Medical Literature .... with Students and Practitioners in every City of the United States and Canada. o- OVER 165,000 COPIES SOLD. ^ -<* THE REASON WHY. They are the advance guard of "Student's Helps"—that do help. They are the leaders in their special line, well and authoritatively written by able men, who, as teachers in the large colleges, know exactly what is wanted by a student preparing for his examinations. The judgment exercised in the selection of authors is fully demonstrated by their professional standing. Chosen from the ranks of Demonstrators, Quiz-masters, and Assistants, most of them have become Professors and Lecturers in their respective colleges. Each book is of convenient size (5x7 inches), containing on an average 250 pages, profusely illustrated, and elegantly printed in clear, readable type, on fine paper. The entire series, numbering twenty-three volumes, has been kept thoroughly revised and enlarged when necessary, many of the books being in their fifth and sixth editions. TO SUM UP, Although there are numerous other Quizzes, Manuals, Aids, etc. in the market, none of them approach the "Blue Series of Question Compends;" and the claim is made for the following points of excellence : I. Professional distinction and reputation of authors. 2. Conciseness, clearness, and soundness of treatment. 3. Quality of illustrations, paper, printing, and binding. Any of these Compends will be mailed on receipt of price see next page for List). baunders' Question-Compend Series* Price, Cloth, $J.OO per copy, except when otherwise noted. "Where the work of preparing students' manuals is to end we cannot say, but the baunders Series, in our opinion, bears off the palm at present."— New York Medical Record. 1. ESSENTIALS OF PHYSIOLOGY. By H. A. Hare, M.D. Third edition, revised and enlarged. ($1.00 net.) 2. ESSENTIALS OF SURGERY. By Edward Martin, M.D. Sixth edition, revised, with an Appendix on Antiseptic Surgery. 3. ESSENTIALS OF ANATOMY. By Charles B. Nancrede, M.D. Fifth edition, with an Appendix. 4. ESSENTIALS OF MEDICAL CHEMISTRY, ORGANIC AND INORGANIC. By Lawrence Wolff, M.D. Fourth edition, revised, with an Appendix. 5. ESSENTIALS OF OBSTETRICS. By W. Easterly Ashton, M.D. Fourth edition, revised and enlarged. 6. ESSENTIALS OF PATHOLOGY AND MORBID ANATOMY. By C. E. Armand Semple, M.D. 7. ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS, AND PRE- SCRIPTION=WRITING. By Henry Morris, M.D. Fifth edition, revised. 8, 9. ESSENTIALS OF PRACTICE OF MEDICINE. By Henry Morris, M.D. An Appendix on Urine Examination. By Lawrence Wolff, M.D. Third edition, enlarged by some 300 Essential Formulae, selected from eminent authorities, by Wm. M. Powell, M.D. (Double number, $2.00.) 10. ESSENTIALS OF GYN/ECOLOGY. By Edwin B. Cragin, M.D. Fourth edition, revised. 11. ESSENTIALS OF DISEASES OF THE SKIN. By Henry W. Stelwagon, M.D. Third edition, revised and enlarged. ($1.00 net.) 12. ESSENTIALS OF MINOR SURGERY, BANDAGING, AND VENEREAL DISEASES. By Edward Martin, M.D. Second ed., revised and enlarged. 13. ESSENTIALS OF LEGAL MEDICINE, TOXICOLOGY, AND HYGIENE. By C. E. Armand Semple, M.D. 14. ESSENTIALS OF DISEASES OF THE EYE, NOSE, AND THROAT. By Edward Jackson, M.D., and E. B. Gleason, M.D. Second ed., revised. 15. ESSENTIALS OF DISEASES OF CHILDREN. By William M. Powell, M.D. Second edition. 16. ESSENTIALS OF EXAMINATION OF URINE. By Lawrence Wolff, M.D. Colored " Vogel Scale." (75 cents.) 17. ESSENTIALS OF DIAGNOSIS. By S. Solis Cohen, M.D., and A. A. Eshner, M.D. ($1.50 net.) 13. ESSENTIALS OF PRACTICE OF PHARMACY. By Lucius E. Sayre. Second edition, revised and enlarged. 20. ESSENTIALS OF BACTERIOLOGY. By M. V. Ball, M.D. Third edition, revised. 21. ESSENTIALS OF NERVOUS DISEASES AND INSANITY. By John C. SHAW, M.D. Third edition, revised. 22. ESSENTIALS OF MEDICAL PHYSICS. By Fred J. Brockway, M.D. Second edition, revised. (Si.00 net.) 23. ESSENTIALS OF MEDICAL ELECTRICITY. By David D. Stewart, MD., and Edward S. Lawrance, M.D. 24. ESSENTIALS OF DISEASES OF THE EAR. By E. B. Gleason, M.D. Second edition, revised and greatly enlarged. Pamphlet containing specimen pages, etc sent free upon application. Saunders' ( ~+ , . tor otudents New Series and of Manuals Practitioners> 'T'HAT there exists a need for thoroughly reliable hand-books on the leading branches of Medicine and Surgery is a fact amply demonstrated by the favor with which the SAUNDERS NEW SERIES OF MANUALS have been received by medical students and practitioners and by the Medical Press. These manuals are not merely condensations from present literature, but are ably written by well-known authors and practitioners, most of them being teachers in representative American colleges. Each volume is concisely and authoritatively written and exhaustive in detail, without being encumbered with the introduction of "cases," which so largely expand the ordinary text-book. These manuals will therefore form an admirable collection of advanced lectures, useful alike to the medical student and the practitioner: to the latter, too busy to search through page after page of elaborate treatises for what he wants to know, they will prove of inestimable value; to the former they will afford safe guides to the essential points of study. The SAUNDERS NEW SERIES OF MANUALS are conceded to be superior to any similar books now on the market. No other manuals afford so much infor- mation in such a concise and available form. A liberal expenditure has enabled the publisher to render the mechanical portion of the work worthy of the high literary standard attained by these books. Any of these Manuals will be mailed on receipt of price (see next page for List). oaunders' New Series of Manuals* VOLUMES PUBLISHED. PHYSIOLOGY. By Joseph Howard Raymond, A.M., M.D., Professor of Physiology and Hygiene and Lecturer on Gynecology in the Long Island College Hospital; Director of Physiology in the Hoagland Laboratory, etc. Illustrated. Cloth, $1.25 net. SURGERY, General and Operative. By John Chalmers DaCosta, M.D., Clini- cal Professor of Surgery, Jefferson Medical College, Philadelphia; Surgeon to the Philadelphia Hospital, etc. Second edition, thoroughly revised and greatly enlarged. Octavo, 900 pages, profusely illustrated. Cloth, S4.00 net; Half Morocco, $5.00 net. DOSE-BOOK AND MANUAL OF PRESCRIPTION=WRITING. By E. Q. Thornton, M.D., Demonstrator of Therapeutics, Jefferson Medical College, Phila- delphia. Illustrated. Cloth, $1.25 net. SURGICAL ASEPSIS. By Carl Beck, M.D., Surgeon to St. Mark's Hospital and to the New York German Polildinik, etc. Illustrated. Cloth, 51-25 net. MEDICAL JURISPRUDENCE. By Henry C. Chapman, M.D. Professor of Insti- tutes of Medicine and Medical Jurisprudence in the Jefferson Medical College of Phila- delphia. Illustrated. Cloth, $1.50 net. SYPHILIS AND THE VENEREAL DISEASES. By James Nevins Hyde, M.D., Professor of Skin and Venereal Diseases, and Frank H. Montgomery, M.D., Lecturer on Dermatology and Genito-Urinary Diseases in Rush Medical College, Chicago. Profusely illustrated. (Double number.) Cloth, #2.50 net. PRACTICE OF MEDICINE. By George Roe Lockwood, M.D., Professor of Practice in the Woman's Medical College of the New York Infirmary; Instructor in Physical Diagnosis in the Medical Department of Columbia College, etc. Illustrated. (Double number.) Cloth, $2.50 net. MANUAL OF ANATOMY. By Irving S. Haynes, M.D., Adjunct Professor of Anatomy and Demonstrator of Anatomy, Medical Department of the New York University, etc. Beautifully illustrated. (Double Number.) Cloth, #2.50 net. MANUAL OF OBSTETRICS. By W. A. Newman Dorland, M.D., Assistant Demonstrator of Obstetrics, University of Pennsylvania; Chief of Gynecological Dis- pensary, Pennsylvania Hospital, etc. Profusely illustrated. (Double number.) Cloth, $2.50 net. DISEASES OF WOMEN. By J. Bland Sutton, F.R.C.S., Assistant Surgeon to Middlesex Hospital and Surgeon to Chelsea Hospital, London; and Arthur E. Giles, M.D., B.Sc. Lond., F.R.C.S. Edin., Assistant Surgeon to Chelsea Hospital, London. Handsomely illustrated. (Double number.) Cloth, $2.50 net. VOLUMES IN PREPARATION. NOSE AND THROAT. By D. Bradf.x Kyle, M.D., Clinical Professor of Laryn- eologv and Rhinology, Jefferson Medical College, Philadelphia ; Consulting Laryngolo- gist Rhinologist, and Otologist, St. Agnes' Hospital; Bacteriologist to the Philadel- phia Orthopedic Hospital and Infirmary for Nervous Diseases, etc. NFRVOUS DISEASES By Charles W. Burr, M.D., Clinical Professor of Nervous Diseases, Medico-Chirurgical College. Philadelphia; Pathologist to the Orthopaedic Hospital and Infirmary for Nervous Diseases; \ isiting Physician to the St. Joseph Hospital, etc. %* There will be published in the same series, at short intervals, carefully-prepared works on various subjects by prominent specialists. Pamphlet containing specimen pages, etc. sent free upon application. 24 Medical Publications of W. B. Saunders. SAUNDBY'S RENAL AND URINARY DISEASES. Lectures on Renal and Urinary Diseases. By Robert Sauxdby, M.D. Edin., Fellow of the Royal College of Physicians, London, and of the Royal Medico-Chirurgical Society; Physician to the General Hospital; Consulting Physician to the Eye Hospital and to the Hos- pital for Diseases of Women; Professor of Medicine in Mason College, Birmingham, etc. Octavo volume of 434 pages, with numerous illus- trations and 4 colored plates. Cloth, $2.50 net. " The volume makes a favorable impression at once. The style is clear and succinct. We cannot find any part of the subject in which the views expressed are not carefully thought out and fortified by evidence drawn from the most recent sources. The book may be cordially recommended."—British Medical Journal. SAUNDERS' POCKET MEDICAL FORMULARY. Fifth Edition, Revised. By William M. Powell, M.D., Attending Physician to the Mercer House for Invalid Women at Atlantic City, N. J. Containing 1800 formulae selected from the best-known authorities. With an Appen- dix containing Posological Table, Formulas and Doses for Hypo- dermic Medication, Poisons and their Antidotes, Diameters of the Female Pelvis and Fcetal Head, Obstetrical Table, Diet List for Various Diseases, Materials and Drugs used in Antiseptic Surgery, Treatment of Asphyxia from Drowning, Surgical Remembrancer, Tables of Incompatibles, Eruptive Fevers, Weights and Measures, etc. Hand- somely bound in flexible morocco, with side index, wallet, and flap. #1.75 net. " This little book, that can be conveniently carried in the pocket, contains an immense amount of material. It is very useful, and, as the name of the author of each prescription is given, is unusually reliable."—Medical Record, New York. SAUNDERS' POCKET MEDICAL LEXICON. Fourth Edition, Revised. A Dictionary of Terms and Words used in Medicine and Surgery. By John M. Keating, M.D., Fellow of the College of Physicians of Philadelphia; Editor of the " Cyclopaedia of Diseases of Children," etc.; Author of the "New Pronouncing Dictionary of Medicine;" and Henry Hamilton, Author of "A New Translation of Virgil's ^Eneid into English Verse;" Co-Author of the "New Pronouncing Dictionary of Medicine." 321110, 280 pages. Cloth, 75 cents; Leather Tucks, $1.00. "Remarkably accurate in terminology, accentuation, and definition."—Journal of the American Medical Association. SAYRE'S PHARMACY. Second Edition, Revised. Essentials of the Practice of Pharmacy. By Lucius E. Sayre, M.D., Professor of Pharmacy and Materia Medica in the University of Kansas. Crown octavo, 200 pages. Cloth, $1.00; interleaved for notes, $1.25. [See Saunders1 Question-Compends, page 21.] " The topics are treated in a simple, practical manner, and the work forms a very useful student's manual."—Boston Medical and Surgical Journal. Medical Publications of W. B. Saunders. 25 SEMPLE'S LEGAL MEDICINE, TOXICOLOGY, AND HYGIENE. Essentials of Legal Medicine, Toxicology, and Hygiene. By C. E. Armand Semple, B. A., M. B. Cantab., M. R. C. P. Lond., Physician to the Northeastern Hospital for Children, Hackney, etc. Crown octavo, 212 pages; 130 illustrations. Cloth, $1.00; interleaved for notes, $1.25. [See Saunders1 Question-Compends, page 21.] " No general practitioner or student can afford to be without this valuable work. The subjects are dealt with by a masterly hand."—London Hospital Gazette. SEMPLE'S PATHOLOGY AND MORBID ANATOMY. Essentials of Pathology and Morbid Anatomy. By C. E. Armand Semple, B.A., M.B. Cantab., M.R.C.P. Lond., Physician to the Northeastern Hospital for Children, Hackney, etc. Crown octavo, 174 pages; illustrated. Cloth, $1.00; interleaved for notes, $1.25. [See Saunders1 Question-Compends, page 21.] " Should take its place among the standard volumes on the bookshelf of both student and practitioner."—London Hospital Gazette. SENN'S GENITO-URINARY TUBERCULOSIS. Tuberculosis of the Genito-Urinary Organs, Male and Female. By Nicholas Senn, M.D., Ph.D., LL.D., Professor of the Practice of Surgery and of Clinical Surgery, Rush Medical College, Chicago. Handsome octavo volume of 320 pages, illustrated. Cloth, $3.00 net. " An important book upon an important subject, and written by a man of mature judg- ment and wide experience. The author has given us an instructive book upon one of the most important subjects of the day."—Clinical Reporter. " A work which adds another to the many obligations the profession owes the talented author.''—Chicago Medical Recorder. SENN'S SYLLABUS OF SURGERY. A Syllabus of Lectures on the Practice of Surgery, arranged in conformity with " An American Text=Book of Surgery." By Nicholas Senn, M.D., Ph.D., Professor of the Practice of Surgery and of Clinical Surgery in Rush Medical College, Chicago. Cloth, $2.00. " This syllabus will be found of service by the teacher as well as the student, the work being superbly done. There is no praise too high for it. No surgeon should be without it."—New York Medical Times. SENN'S TUMORS. Pathology and Surgical Treatment of Tumors. By N. Senn, M D PhD, LL.D., Professor of Surgery and of Clinical Surgery, Rush'Medical College; Professor of Surgery, Chicago Polyclinic; Attending Surgeon to Presbyterian Hospital; Surgeon-in-Chief, St. Joseph's Hospital, Chicago. Octavo volume of 710 pages, with 515 engravings, including full-page colored plates. Cloth, $6.00 net; Half Morocco, S7.00 net. - The most exhaustive of any recent book in English on this subject. It is well illus- trated and will doubtless remain as the principal monograph on the subject in our language or some vears. The book is handsomely illustrated and printed, and the author has given a JSabE andTasting contribution to surgery. "-Journal of the American Medical Association. 26 Medical Publications of W. B. Saunders. SHAW'S NERVOUS DISEASES AND INSANITY. Third Edition, Revised. Essentials of Nervous Diseases and Insanity. By John C. Shaw, M.D., Clinical Professor of Diseases of the Mind and Nervous System, Long Island College Hospital Medical School; Consulting Neurologist to St. Catherine's Hospital and to the Long Island College Hospital. Crown octavo, 186 pages; 48 original illustrations. Cloth, $1.00 ; interleaved for notes, $1.25. [See Saunders1 Question-Compends, page 21.] "Clearly and intelligently written."'—Boston Medical and Surgical Journal. "There is a mass of valuable material crowded into this small compasi."—American Medico-Surgical Bulletin. STARR'S DIETS FOR INFANTS AND CHILDREN. Diets for Infants and Children in Health and in Disease. By Louis Starr, M.D., Editor of "An American Text-Book of the Diseases of Children." 230 blanks (pocket-book size), perforated and neatly bound in flexible morocco. $1.25 net. The first series of blanks are prepared for the first seven months of infant life; each blank indicates the ingredients, but not the quantities, of the food, the latter directions being left for the physician. After the seventh month, modifications being less necessary, the diet lists are printed in full. Formulae for the preparation of diluents and foods are appended. STELWAGON'S DISEASES OF THE SKIN. Third Edition, Revised. Essentials of Diseases of the Skin. By Henry W. Stelwagon, M.D., Clinical Professor of Dermatology in the Jefferson Medical College, Philadelphia; Dermatologist to the Philadelphia Hospital; Physician to the Skin Department of the Howard Hospital, etc. Crown octavo, 270 pages; 86 illustrations. Cloth, $1.00 net; inter- leaved for notes, $1.25 net. [See Saunders1 Question-Compends, page 21.] "The best student's manual on skin diseases we have yet seen."—Times and Register. STENGEL'S PATHOLOGY. A Manual of Pathology. By Alfred Stengel, M.D., Physician to the Philadelphia Hospital; Professor of Clinical Medicine in the Woman's Medical College; Physician to the Children's Hospital; late Pathologist to the German Hospital, Philadelphia, etc. In Preparation. STEVENS' MATERIA MEDICA AND THERAPEUTICS. Second Edition, Revised. A Manual of Materia Medica and Therapeutics. By A. A. Stevens, A.M., M.D., Lecturer on Terminology and Instructor in Physical Diagnosis in the University of Pennsylvania; Demonstrator of Pathology in the Woman's Medical College of Philadelphia. Post- octavo, 445 pages. Cloth, $2.25. " The author has faithfully presented modern therapeutics in a comprehensive work, and, while intended particularly for the use of students, it will be found a reliable guide and sufficiently comprehensive for the physician in practice."—University Medical Magazine. Medical Publications of W. B. Saunders. 27 STEVENS' PRACTICE OF MEDICINE. Fifth Edition, Revised. A Manual of the Practice of Medicine. By A. A. Stevens, A.M., M.D., Lecturer on Terminology and Instructor in Physical Diagnosis in the University of Pennsylvania; Demonstrator of Pathology in the Woman's Medical College of Philadelphia. Specially intended for students preparing for graduation and hospital examinations. Post- octavo, 511 pages; illustrated. Flexible leather, $2.50. "The frequency with which new editions of this manual are demanded bespeaks its popularity. It is an excellent condensation of the essentials of medical practice for the student, and maybe found also an excellent reminder for the busy physician."—Buffalo Aledical Journal. STEWART'S PHYSIOLOGY. A Manual of Physiology, with Practical Exercises. For Students and Practitioners. By G. N. Stewart, M.A., M.D., D.Sc, lately Examiner in Physiology, University of Aberdeen, and of the New Museums, Cambridge University; Professor of Physiology in the Western Reserve University, Cleveland, Ohio. Octavo volume of 800 pages; 278 illustrations in the text, and 5 colored plates. Cloth, $3.50 net. " It will make its way by sheer force of merit, and amply deserves to do so. It is one of the very best English text-books on the subject."—London Lancet. "Of the many text-books of physiology published, we do not know of one that so nearly comes up to the ideal as does Prof. Stewart's volume."—British Medical Journal. STEWART AND LAWRANCE'S MEDICAL ELECTRICITY. Essentials of Medical Electricity. By D. D. Stewart, M.D., Demonstrator of Diseases of the Nervous System and Chief of the Neurological Clinic in the Jefferson Medical College; and E. S. Lawrance, M.D., Chief of the Electrical Clinic and Assistant Demon- strator of Diseases of the Nervous System in the Jefferson Medical College, etc. Crown octavo, 158 pages; 65 illustrations. Cloth, $1.00 ; interleaved for notes, $1.25. [See Saunders1 Question-Compends, page 21.] " Throughout the whole brief space at their command the authors show a discriminating knowledge of their subject."—Medical News. STONEY'S NURSING. Second Edition, Revised. Practical Points in Nursing. For Nurses in Private Practice. By Emily A. M. Stoney, Graduate of the Training-School for Nurses, Lawrence, Mass.; late Superintendent of the Training-School for Nurses, Carney Hospital, South Boston, Mass. 456 pages, illustrated with 73 engravings in the text, and 8 colored and half-tone plates. Cloth, $1.75 net. " There are few books intended for non-professional readers which can be so cordially endorsed by a medical journal as can this one."—Therapeutic Gazette. " This is a well-written, eminently practical volume, which covers the entire range of private nursing as distinguished from hospital nursing, and instructs the nurse how best to meet the various emergencies which may arise, and how to prepare everything ordinarily needed in the illness of her patient."—American Journal of Obstetrics and Diseases of Women and Children. " It is a work that the physician can place in the hands of his private nurses with the assurance of benefit."— Ohio Medical Journal. 28 Medical Publications of W. B. Saunders. SUTTON AND GILES' DISEASES OF WOMEN. Diseases of Women. By J. Bland Sutton, F.R.C.S., Assistant Surgeon to Middlesex Hospital, and Surgeon to Chelsea Hospital, London; and Arthur E. Giles, M.D., B.Sc. Lond., F.R.C.S. Edin., Assistant Surgeon to Chelsea Hospital, London. 436 pages, hand- somely illustrated. Cloth, 52.50 net. '' The book is very well prepared, and is certain to be well received by the medical public.''—British Medical Journal. "The text has been carefully prepared. Nothing essential has been omitted, and its teachings are those recommended by the leading authorities of the day."—Journal of tht American Medical Association. THOMAS'S DIET LISTS AND SICK-ROOM DIETARY. Diet Lists and Sick=Room Dietary. By Jerome B. Thomas, M.D., Visiting Physician to the Home for Friendless Women and Children and to the Newsboys' Home ; Assistant Visiting Physician to the Kings County Hospital. Cloth, $1.50. Send for sample sheet. " The idea is good, and the lists are copious."—London Lancet. "Its practical usefulness places it among the requirements of every practitioner."— Chicago Medical Recorder. THORNTON'S DOSE=BOOK AND PRESCRIPTION-WRITING. Dose-Book and Manual of Prescription-Writing. By E. Q. Thornton, M.D., Demonstrator of Therapeutics, Jefferson Medical College, Philadelphia. 334 pages, illustrated. Cloth, $1.25 net. "Full of practical suggestions; will take its place in the front rank of works of this sort."—Medical Record, New York. VAN VALZAH AND NISBET'S DISEASES OF THE STOMACH. Diseases of the Stomach. By William W. Van Valzah, M.D., Professor of General Medicine and Diseases of the Digestive System and the Blood, New York Polyclinic; and J. Douglas Nisbet, M.D., Adjunct Professor of General Medicine and Diseases of the Digestive System and the Blood, New York Polyclinic. Octavo volume of 674 pages, illustrated. Cloth, $3.50 net. VIERORDT'S MEDICAL DIAGNOSIS. Fourth Edition, Revised. Medical Diagnosis. By Dr. Oswald Vierordt, Professor of Medi- cine at the University of Heidelberg. Translated, with additions, from the fifth enlarged German edition, with the author's permission, by Francis H. Stuart, A. M., M. D. Handsome royal octavo volume of 600 pages; 194 fine wood-cuts in text, many of them in colors. Cloth, $4.00 net; Sheep or Half Morocco, $5.00 net; Half Russia, $5.50 net. " A treasury of practical information which will be found of daily use to every busy practitioner who will consult it."—C. A. Lindsley, M.D., Professor of the Theory and Practice of Medicine, Yale University. " Rarely is a book published with which a reviewer can find so little fault as with the volume before us. Each particular item in the consideration of an organ or apparatus, which is necessary to determine a diagnosis of any disease of that organ, is mentioned; nothing seems forgotten. The chapters on diseases of the circulatory and digestive apparatus and nervous system are especially full and valuable. The reviewer would repeat that the book is one of the best—probably the best—which has fallen into his hands."—University Medical Magazine. Medical Publications of W. B. Saunders. 29 WARREN'S SURGICAL PATHOLOGY AND THERAPEUTICS. Surgical Pathology and Therapeutics. By John Collins Warren, M.D., LL.D., Professor of Surgery, Medical Department Harvard University; Surgeon to the Massachusetts General Hospital, etc. Handsome octavo volume of 832 pages; 136 relief and lithographic illustrations, 33 of which are printed in colors, and all of which were drawn by William J. Kaula from original specimens. Cloth, $6.00 net; Half Morocco, $7.00 net. "There is the work of Dr. Warren, which I think is the most creditable book on Surgical Pathology, and the most beautiful medical illustration of the bookmaker's art, that has ever been issued from the American press."—Dr. Roswell Park, in the Harvard Graduate Magazine. " The handsomest specimen of bookmaking that has ever been issued from the American medical press."—American Journal of the Medical Sciences. " A most striking and very excellent feature of this book is its illustrations. Without exception, from the point of accuracy and artistic merit, they are the best ever seen in a work of this kind. Many of those representing microscopic pictures are so perfect in their coloring and detail as almost to give the beholder the impression that he is looking down the barrel of a microscope at a well-mounted section."—Annals of Surgery. WEST'S NURSING. An American Text-Book of Nursing. By American Teachers. Edited by Roberta M. West, late Superintendent of Nurses in the Hospital of the University of Pennsylvania. In Preparation. WOLFF ON EXAMINATION OF URINE. Essentials of Examination of Urine. By Lawrence Wolff, M.D., Demonstrator of Chemistry, Jefferson Medical College, Philadelphia, etc. Colored (Vogel) urine scale and numerous illustrations. Crown octavo. Cloth, 75 cents. [See Saunders1 Question-Compends, page 21.] " A very good work of its kind—very well suited to its purpose."—Times and Register. WOLFF'S MEDICAL CHEMISTRY. Fourth Edition, Revised. Essentials of Medical Chemistry. Organic and Inorganic. Containing also Questions on Medical Physics, Chemical Physiology, Analytical Processes, Urinalysis, and Toxicology. By Lawrence Wolff, M.D., Demonstrator of Chemistry, Jefferson Medical College, Philadelphia, etc. Crown octavo, 218 pages. Cloth, $1.00; inter- leaved for notes, $1.25. [See Saunders1 Question-Compends, page 21.] "The scope of this work is certainly equal to that of the best course of lectures on Medical Chemistry."— Pharmaceutical Era. CLASSIFIED LIST OF THE Medical Publications OF W. B. SAUNDERS, 925 Walnut Street, Philadelphia. ANATOMY, EMBRYOLOGY, HISTOLOGY. Clarkson—A Text-Book of Histology, 9 Haynes—A Manual of Anatomy, . . . 13 Heisler—A Text-Book of Embryology, 13 Nancrede—Essentials of Anatomy, . . 18 Nancrede—Essentials of Anatomy and Manual of Practical Dissection, ... 18 Semple—Essentials of Pathology and Morbid Anatomy,.........25 BACTERIOLOGY. Ball—Essentials of Bacteriology, ... 6 Crookshank—A Text-Book of Bacteri- ology, ..............10 Frothingham —Laboratory Guide, . . 11 Mallory and Wright — Pathological Technique,...........16 McFarland—Pathogenic Bacteria, . . 17 CHARTS, DIET-LISTS, ETC. Griffith—Infant's Weight Chart, ... 12 Hart—Diet in Sickness and in Health, . 13 Keen—Operation Blank, .....15 Laine—Temperature Chart, ... . 15 Meigs—Feeding in Early Infancy, . . 17 Starr—Diets for Infants and Children, . 26 Thomas—Diet-Lists and Sick-Room Dietary.............. 28 CHEMISTRY AND PHYSICS. Brockway—Essentials of Medical Phys- ics,..............7 Wolff—Essentials of Medical Chemistry, 29 CHILDREN. An American Text-Book of Diseases of Children, . . .......3 Griffith—Care of the Baby,.....12 Griffith—Infant's Weight Chart, ... 12 Meigs—Feeding in Early Infancy, . . 17 Powell—Essentials of Dis. of Children, 19 Starr—Diets for Infants and Children, . 26 DIAGNOSIS. Cohen and Eshner—Essentials of Di- agnosis, ............9 Corwin—Physical Diagnosis, .... 9 Macdonald—Surgical Diagnosis and Treatment, ...........16 Vierordt—Medical Diagnosis, .... 28 DICTIONARIES. Keating—Pronouncing Dictionary, . . 14 Morten—Nurse's Dictionary, .... 18 Saunders' Pocket Medical Lexicon, . 24 EYE, EAR, NOSE, AND THROAT, An American Text-Book of Diseases of the Eye, Ear, Nose, and Throat, . 3 Casselberry—Dis. of Nose and Throat, 8 De Schweinitz—Diseases of the Eye,. 10 Gleason—Essentials of Dis. of the Ear, 11 Jackson and Gleason—Essentials of Diseases of the Eye, Nose, and Throat, 14 Kyle—Diseases of the Nose and Throat, 15 GENITO=URINARY. An American Text-Book of Genito- Urinary and Skin Diseases,.....4 Hyde and Montgomery—Syphilis and the Venereal Diseases,......13 Martin—Essentials of Minor Surgery, Bandaging, and Venereal Diseases, . 16 Saundby—Renal and Urinary Diseases, 24 Senn—Genito-Urinary Tuberculosis, . 25 GYNECOLOGY. American Text-Book of Gynecology, 4 Cragin—Essentials of Gynecology, . . 10 Garrigues—Diseases of Women, ... 11 Long—Syllabus of Gynecology, ... 15 Penrose—Diseases of Women, .... 18 Sutton and Giles—Diseases of Women, 28 MATERIA MEDICA, PHARMACOL- OGY, AND THERAPEUTICS. An American Text-Book of Applied Therapeutics...........3 Butler—Text-Book of Materia Medica, Therapeutics and Pharmacology, ... 8 Cerna—Notes on the Newer Remedies, 8 Griffin—Materia Med. and Therapeutics, 12 Morris—Essentials of Materia Medica and Therapeutics, . . .....17 Saunders' Pocket Medical Formulary, 24 Sayre—Essentials of Pharmacy, ... 24 Stevens—Essentials of Materia Medica and Therapeutics,.........26 Thornton—Dose-Book and Manual of Prescription-Writing........28 Warren—Surgical Pathology and Ther- apeutics, ...........29 MEDICAL JURISPRUDENCE AND TOXICOLOGY. An American Text-Book of Legal Medicine and Toxicology,.....4 Chapman—Medical Jurisprudence and Toxicology,..........8 Semple—Essentials of Legal Medicine. Toxicology, and Hygiene,.....25 Medical Publications of W. B. Saunders. 31 NERVOUS AND MENTAL DISEASES, ETC. Burr—Nervous Diseases,...... 7 Chapin—Compendium of Insanity, . . 8 Church and Peterson—Nervous and Mental Diseases,.........9 Shaw—Essentials of Nervous Diseases and Insanity............26 NURSING. An American Text-Book of Nursing, 29 Griffith—The Care of the Baby, ... 12 Hampton—Nursing,.......12 Hart—Diet in Sickness and in Health, 13 Meigs—Feeding in Early Infancy, . . 17 Morten—Nurse's Dictionary.....18 Stoney—Practical Points in Nursing, . 27 OBSTETRICS. An American Text-Book of Obstetrics, 4 Ashton—Essentials of Obstetrics, . . 6 Boisliniere—Obstetric Accidents, Emer- gencies, and Operations,...... 7 Dorland —Manual of Obstetrics, . . . Io Hirst—Text-Book of Obstetrics, ... 13 Norris—Syllabus of Obstetrics, .... 18 PATHOLOGY. An American Text-Book of Pathology, 5 Mallory and Wright — Pathological Technique,..........J6 Semple—Essentials of Pathology and Morbid Anatomy,.........25 Senn—Pathology and Surgical Treat- ment of Tumors, ......25 Stengel—Manual of Pathology, ... 26 Warren—Surgical Pathology and Thera- peutics, .............29 PHYSIOLOGY. An American Text-Book of Physi- ology, ..............5 Hare—Essentials of Physiology, ... 13 Raymond—Manual of Physiology, . . 19 Stewart—Manual of Physiology, ... 27 PRACTICE OF MEDICINE. An American Text-Book of the The- ory and Practice of Medicine, .... 5 An American Year-Book of Medicine and Surgery, • . ■ • Anders—Text-Book of the Practice of Medicine,....... • Lockwood—Manual of the Practice of Medicine, . . • .• • ' *5 Morris—Essentials of the Practice ot Medicine, . . ■ '',.'' r Rowland and Hedley — Archives of the Roentgen Ray, . ■ • • . • • • l9 Stevens—Manual of the Practice of Medicine,............2> SKIN AND VENEREAL. An American Text-Book of Genito- Urinary and Skin Diseases,.....3 Hyde and Montgomery—Syphilis and the Venereal Diseases.........13 Martin—Essentials of Minor Surgery, Bandaging, and Venereal Diseases, . 16 Pringle—Pictorial Atlas of Skin Dis- eases and Syphilitic Affections, . . . 19 Stelwagon—Essentials of Diseases of the Skin,............26 SURGERY. An American Text-Book of Surgery, 5 An American Year-Book of Medicine and Surgery............ 6 Beck—Manual of Surgical Asepsis, . . 7 DaCosta—Manual of Surgery, .... 10 Keen —Operation Blank,.....15 Keen—The Surgical Complications and Sequels of Typhoid Fever......15 Macdonald—Surgical Diagnosis and Treatment, ....... 16 Martin—Essentials of Minor Surgery, Bandaging, and Venereal Diseases, . 16 Martin—Essentials of Surgery, . . . . 16 Moore—Orthopedic Surgery......17 Pye—Elementary Bandaging and Surgi- cal Dressing,..........19 Rowland and Hedley —Archives of the Roentgen Ray,........19 Senn—Genito-Urinary Tuberculosis, . 25 Senn — Syllabus of Surgery, . . . . 25 Senn—Pathology and Surgical Treat- ment of Tumors,.......25 Warren—Surgical Pathology and Ther- apeutics, ............29 URINE AND URINARY DISEASES. Saundby—Renal and Urinary Diseases, 24 Wolff—Essentials of Examination of Urine,.............29 MISCELLANEOUS. Bastin—Laboratory Exercises in Bot- any, .............7 Gould and Pyle—Anomalies and Curi- osities of Medicine,....... 11 Keating—How to Examine for Life Insurance, ...........l4 Keen—Surgical Complications and Se- quels of Typhoid Fever, .....15 Rowland and Hedley—Archives of the Roentgen Ray,........19 Saunders' Medical Hand-Atlases, . . 2 Saunders' New Series of Manuals, 22, 23 Saunders' Pocket Medical Formulary, 24 Saunders' Question-Compends, . . 20, 21 Senn—Pathology and Surgical Treat- ment of Tumors, ... . -25 Stewart and Lawrance—Essentials of Medical Electricity,...... 27 Thornton—Dose-Book and Manual of Prescription-Writing,......28 Van Valzah and Nisbet—Diseases of the Stomach,...........2^ In Preparation for Early Publication. AN AMERICAN TEXT-BOOK OF DISEASES OF THE EYE, EAR, NOSE, AND THROAT. Edited by G. E. de Schweinitz, M.D., Professor of Ophthalmology in the Jeffer- son Medical College, Philadelphia; and B. Alexander Randall, M.D., Professor of Diseases of the Ear in the University of Pennsylvania and in the Philadelphia Polyclinic. AN AMERICAN TEXT-BOOK OF PATHOLOGY. Edited by John Guiteras, M.D., Professor of General Pathology and of Morbid Anatomy in the University of Pennsylvania; and David Riesman, M.D., Demon- strator of Pathological Histology in the University of Pennsylvania. AN AMERICAN TEXT-BOOK OF LEGAL MEDICINE AND TOXICOLOGY. Edited by Frederick Peterson, M.D., Clinical Professor of Mental Diseases in the Woman's Medical College, New Vork; Chief of Clinic, Nervous Department, College of Physicians and Surgeons, New York; and Walter S. Haines, M.D., Professor of Chemistry, Pharmacy, and Toxicology in Rush Medical College, Chicago, Illinois. STENGEL'S PATHOLOGY. A Manual of Pathology. By Alfred Stengel, M. D., Physician to the Philadelphia Hospital; Professor of Clinical Medicine in the Woman's Medical College; Physician to the Children's Hospital; late Pathologist to the German Hospital, Philadelphia, etc. CHURCH AND PETERSON'S NERVOUS AND MENTAL DISEASES. Nervous and Mental Diseases. By Archibald Church, M.D., Professor of Mental Diseases and Medical Jurisprudence in the Northwestern University Medical School, Chicago; and Frederick Peterson, M.D., Clinical Professor of Mental Diseases in the Woman's Medical College, New York ; Chief of Clinic, Nervous Department, College of Physicians and Surgeons, New York. HEISLER'S EMBRYOLOGY. A Text-Book of Embryology. By John C. Heisler, M.D., Professor of Anatomy in the Medico-Chirurgical College, Philadelphia. KYLE ON THE NOSE AND THROAT. Diseases of the Nose and Throat. By D. Braden Kyle, M. D., Clinical Pro- fessor of Laryngology and Rhinology, Jefferson Medical College, Philadelphia; Con- sulting Laryngologist, Rhinologist, and Otologist, St. Agnes' Hospital; Bacteriologist to the Philadelphia Orthopedic Hospital and Infirmary for Nervous Diseases, etc. HIRST'S OBSTETRICS. A Text-Book of Obstetrics. By Barton Cooke Hirst, M.D., Professor of Obstetrics in the University of Pennsylvania. WEST'S NURSING. An American Text-Book of Nursing. By American Teachers. Edited by Roberta M. West, Late Superintendent of Nurses in the Hospital of the University of Pennsylvania. \LDICINE NATIONAL LIBRARY O ivsouvn 3Noia3w jo Aavaan ivnoiivn snoiqsw jo Aavaan ivnoiivn 3noio3^ 1RARY or MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LI / J? 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